Mothers' negative affectivity during pregnancy and food choices for their infants.

OBJECTIVE: The objective of this study was to analyze whether maternal negative affectivity assessed in pregnancy is related with subsequent infant food choices. DESIGN: The study design was a cohort study. SUBJECTS: The subjects were mothers (N=37 919) and their infants participating in the Norwegian Mother and Child Cohort Study conducted by the Norwegian Institute of Public Health. MEASUREMENTS: Maternal negative affectivity assessed prepartum (Hopkins Symptom Checklist 5 (SCL-5) at weeks 17 and 30 of pregnancy), introduction of solid foods by month 3 and feeding of sweet drinks by month 6 (by the reports of the mothers) were analyzed. RESULTS: Mothers with higher negative affectivity were 64% more likely (95% confidence interval 1.5-1.8) to feed sweet drinks by month 6, and 79% more likely (95% confidence interval 1.6-2.0) to introduce solid foods by month 3. These odds decreased to 41 and 30%, respectively, after adjusting for mother's age, body mass index (BMI) and education. CONCLUSION: The maternal trait of negative affectivity is an independent predictor of infant feeding practices that may be related with childhood weight gain, overweight and obesity.

Personal models of diabetes in relation to self-care, well-being, and glycemic control. A prospective study in adolescence.

OBJECTIVE: Personal models of diabetes have been shown to be proximal determinants of self-care behavior in adults with diabetes, both cross-sectionally and prospectively. This study set out to test the predictive utility of this approach in adolescents with diabetes. RESEARCH DESIGN AND METHODS: Participants were recruited from four regional hospitals in southern England (n = 54). They completed questionnaires assessing diabetes self-care, well-being, and personal models of diabetes (perceived impact, perceived seriousness, and short- and long-term treatment effectiveness) at baseline and 1-year follow-up. GHb assays performed as part of the patients' usual diabetes care were used to assess glycemic control. RESULTS: After controlling for baseline anxiety, change in perceived impact of diabetes prospectively predicted adolescents' anxiety (beta = -0.21; t = -2.65; P < 0.01). After controlling for baseline dietary self-care, change in perceived effectiveness of the diabetes treatment regimen to control diabetes predicted dietary self-care (beta = -0.39; t = -3.28; P < 0.0005). Poorer dietary self-care and being female were predictive of poorer glycemic control (r2 = 0.29; F = 2.74; P < 0.005). CONCLUSIONS: This study provides further support for the role of personal models of illness in determining responses to illness. As adolescents take responsibility for the management of their diabetes, parents, clinicians, educators, and interventionists should consider these adolescents' beliefs about their diabetes and its treatment as key factors influencing self-care, emotional well-being. and glycemic control.

Personal-model beliefs and social-environmental barriers related to diabetes self-management.

OBJECTIVE: The specific aims of the present study were to report on the level of personal beliefs and social and environmental barriers across different regimen areas and patient subgroups and on the relationship of personal models and perceived barriers to the level of self-management. RESEARCH DESIGN AND METHODS: This study focused on several issues related to personal models (representations of illness) and perceived barriers to diabetes self-management among a large heterogeneous survey sample of 2,056 adults throughout the U.S. RESULTS: Respondents felt that diabetes was a serious disease and that their self-management activities will control their diabetes and reduce the likelihood of long-term complications. Most frequently reported barriers were related to dietary adherence, followed by exercise and glucose testing barriers. Both personal models and barriers significantly predicted level of self-management in all three regimen areas studied (diet, exercise, and glucose testing) after controlling for the influence of demographic and medical history factors. Regimen-specific models and barriers proved to be stronger predictors than more global measures. Differences on personal models and barriers were observed among different patient groups (e.g., age, health insurance, and insulin-taking status). Possible reasons for these differences and implications for intervention and future research are discussed. CONCLUSIONS: Both the personal-model and barriers scales had good internal consistency and predicted variance in each of the self-management variables after controlling for demographic and medical history factors. These brief self-report personal-model scales demonstrated good internal reliability and were as predictive of self-management as the lengthier interview-based measures in previous studies. The assessment of the treatment effectiveness component of personal models may be sufficient for most clinical purposes.

Effects of a brief office-based intervention to facilitate diabetes dietary self-management.

OBJECTIVE: There is a pressing need for brief practical interventions that address diabetes management. Using a randomized design, we evaluated a medical office-based intervention focused on behavioral issues relevant to dietary self-management. RESEARCH DESIGN AND METHODS: There were 206 adult diabetes patients randomized to usual care or brief intervention, which consisted of touchscreen computer-assisted assessment to provide immediate feedback on key barriers to dietary self-management, and goal setting and problem-solving counseling for patients. Follow-up components to the single session intervention included phone calls and interactive video or videotape instruction as needed. RESULTS: Multivariate analyses of covariance revealed that the brief intervention produced greater improvements than usual care on a number of measures of dietary behavior (e.g., fewer calories from saturated fat, fewer high-fat eating habits and behaviors) at the 3-month follow-up. There were also significant differences favoring intervention on changes in serum cholesterol levels and patient satisfaction but not on glycosylated hemoglobin. The intervention effects were relatively robust across a variety of patient characteristics, the two participating physicians, and intervention staff members. CONCLUSIONS: If the long-term results are equally positive and generalize to other setting, this intervention could provide a prototype for a feasible cost-effective way to integrate patient views and behavioral management into office-based care for diabetes.

The summary of diabetes self-care activities measure: results from 7 studies and a revised scale.

OBJECTIVE: To review reliability, validity, and normative data from 7 different studies, involving a total of 1,988 people with diabetes, and provide a revised version of the Summary of Diabetes Self-Care Activities (SDSCA) measure. RESEARCH DESIGN AND METHODS: The SDSCA measure is a brief self-report questionnaire of diabetes self-management that includes items assessing the following aspects of the diabetes regimen: general diet, specific diet, exercise, blood-glucose testing, foot care, and smoking. Normative data (means and SD), inter-item and test-retest reliability, correlations between the SDSCA subscales and a range of criterion measures, and sensitivity to change scores are presented for the 7 different studies (5 randomized interventions and 2 observational studies). RESULTS: Participants were typically older patients, having type 2 diabetes for a number of years, with a slight preponderance of women. The average inter-item correlations within scales were high (mean = 0.47), with the exception of specific diet; test-retest correlations were moderate (mean = 0.40). Correlations with other measures of diet and exercise generally supported the validity of the SDSCA subscales (mean = 0.23). CONCLUSIONS: There are numerous benefits from standardization of measures across studies. The SDSCA questionnaire is a brief yet reliable and valid self-report measure of diabetes self-management that is useful both for research and practice. The revised version and its scoring are presented, and the inclusion of this measure in studies of diabetes self-management is recommended when appropriate.

Behavioral interventions for adolescents with type 1 diabetes: how effective are they?

OBJECTIVE: To evaluate the effectiveness of behavioral interventions for adolescents with type 1 diabetes based on a systematic review of the literature. RESEARCH DESIGN AND METHODS: The literature was identified by searching 11 electronic databases, hand-searching 3 journals from their start dates, and contacting individual researchers. Only articles that reported evaluations of behavioral (including educational and psychosocial) interventions for adolescents (age range 9-21 years) with type 1 diabetes that included a control group were included in the present review. Data summarizing the key features of the interventions and their effects were extracted from each article. Where possible, effect sizes for the randomized control trials (RCTs) were calculated. RESULTS: The search process identified 64 reports of empirical studies. Of these, 35 studies included a control group, and 24 were RCTs. Effect sizes could be calculated for 18 interventions. The overall mean effect size calculated across all outcomes was 0.33 (median 0.21), indicating that these interventions have a small- to medium-sized beneficial effect on diabetes management. Interventions that were theoretically based were significantly more effective than those that were not (P<0.05, 1-tailed). CONCLUSIONS: Research to date indicates that these interventions are moderately effective. Several methodological weaknesses to be avoided in future studies are noted. It is also recommended that investigators use the reach, efficacy, adoption, implementation, and maintenance (RE-AIM) framework to guide the design of future studies, which should result in more disseminable interventions. RE-AIM assesses the intervention's reach, or percent or representativeness of patients willing to participate; efficacy across a range of outcomes; adoption, or the percent and representativeness of settings willing to implement the intervention; implementation, or the consistency of the delivery of the intervention as intended; and maintenance, or the extent to which delivery of the intervention becomes a routine part of health care in the medical setting.

Personality and overweight in 6-12-year-old children.

BACKGROUND: Personality may be an important yet understudied influence on childhood obesity. OBJECTIVE: We investigated the association between children's personality traits and weight status in a sample of 1533 6-12 year olds. METHODS: Mothers rated their child's personality using the Norwegian Hierarchical Personality Inventory for Children, and reported on their child's height and weight. RESULTS: Relative to their normal weight peers, overweight children were rated lower on energy, optimism, compliance, concentration, perseverance, and self-confidence, and higher on egocentricity, irritability, and anxiety. CONCLUSIONS: These findings suggest possible mechanisms to investigate in future research relating personality to childhood obesity.

Pharmacological profile of duodenal alkaline secretion.

Stimulation of mucosal alkaline secretion represents an opportunity for discovering novel drugs of potential benefit in maintenance therapy of duodenal ulcer disease. We screened over 200 agents representing the full spectrum of pharmacological categories in order to characterize stimulatory pathways and identify mechanistic leads. A variety of eicosanoids, phospho-diesterase inhibitors and adrenoreceptor agonists together with forskolin, 6-hydroxy-dopamine, 2-chloroadenosine, diazepam, testosterone, dipyridamole and dihydropyridazinone caused a reproducible increase in the metabolism-dependent component of alkaline secretion in bullfrog proximal duodenum. PGE2 (ED50 0.02 microgram/ml) was the most potent agent in vitro and was also the most effective stimulant of duodenal alkalinization in vivo in an anaesthetized cat preparation. Agents without effect on spontaneous alkaline secretion by amphibian duodenum included agonists and antagonists of histamine, 5-hydroxy-tryptamine, gamma-aminobutyric acid, dopamine, muscarinic and nicotinic receptors, inhibitors of amine uptake, monoamine oxidase and cholinesterase, plus various corticoids, diuretics, oestrogens, chemotherapeutic (anticancer) and antimicrobial agents. The major mechanism of stimulating alkaline secretion in the isolated duodenum is by increasing intracellular cyclic AMP levels. This may occur by either inhibiting metabolism of the nucleotide or by stimulating its formation. Additionally, many stimulants appear to act indirectly via liberation of endogenous prostaglandins as judged from the marked attenuation of responses in the presence of indomethacin to all agonists apart from exogenous PGE2, forskolin, ICI 63197 (PDE inhibitor), 2-chloroadenosine and diazepam. Whether purinergic agonists and benzodiazepines act directly on the enterocyte or by releasing other paracrine mediators is unknown.

Effects of educational and psychosocial interventions for adolescents with diabetes mellitus: a systematic review.

BACKGROUND: Insulin-dependent diabetes mellitus, also known as type 1 diabetes, is a life-threatening condition and is the third most common chronic illness among young people. As a result of minimal or non-existent insulin production, people with diabetes must take over the normally automatic task of regulation of blood glucose levels. This is achieved by a complex regimen involving multiple, daily administrations of insulin coordinated with dietary intake and energy expenditure and monitored by blood glucose testing. OBJECTIVES: To examine the effectiveness of educational and psychosocial interventions for adolescents with type 1 diabetes designed to improve their diabetes management. Specifically, it addressed the following research questions: (1) Do educational and psychosocial interventions for adolescents with type 1 diabetes have beneficial effects on biological and psychosocial outcomes? (2) Are there types or features of interventions that have been shown to be more effective than others? (3) What evidence is there of the cost-effectiveness of interventions? METHODS: A search strategy was formulated, piloted and refined. Three journals were handsearched, 11 electronic databases were searched and personal contacts, flyers, conferences and websites were used to notify the research community of the review to access further literature. This process generated 10,535 abstracts, which, after screening, resulted in 367 articles identified for retrieval. This number was augmented by hand-searching, personal contact and exploding references, and a final total of 457 articles were scrutinised. Of these, 64 reports describing 62 studies were identified as empirical papers evaluating educational or psychosocial interventions. The relevant data were extracted from the papers and summary tables for each study were prepared. Where possible, effect sizes were computed for outcomes from studies that included a randomised control group (CG) and other relevant information. RESULTS: A descriptive analysis of the 62 studies was undertaken. Most studies (67.7%) were conducted in the USA and 41% were randomised controlled trials (RCTs), none of which were UK-based. Only 48% of the reports provided an explicit theoretical rationale for the intervention. The mean number of participants was 53.8. The studies took place in various settings, evaluated a variety of interventions, involved various interventionists, addressed various components and assessed the effects by a range of outcomes, including measures of metabolic control and psychological and behavioural outcomes. Follow-up assessments were relatively rare. RESULTS - THE EFFECTIVENESS OF INTERVENTIONS: The 25 RCTs were examined in more detail and three of the most effective were described in depth. Effect sizes could be calculated for 14 studies. The mean (pooled) effect size for psychosocial outcomes was 0.37 and 0.33 for glycated haemoglobin with outliers (0.08 without outliers), indicating that these interventions have small to medium beneficial effects on diabetes management outcomes. A narrative review of the 21 pre-post studies with no CG was performed, including evaluations of interventions conducted at summer camps, interventions for poorly controlled patients and educational interventions. All studies reported beneficial effects. RESULTS - COST-EFFECTIVENESS: Few studies addressed economic considerations associated with interventions, and the lack of information on costs and the diversity of outcomes included by investigators impeded cost- effectiveness comparisons. Shorter hospitalisation at diagnosis is at least as effective in achieving control and avoiding complications in adolescence as longer stays. Home care may result in improved outcomes but may not be cheaper than hospital care at diagnosis. Targeting poorly controlled subjects may reduce adverse events and hospitalisations and may be more cost-effective than generic interventions. There is a need for rigorous cost-effectiveness studies of educational and psychosocial interventions for adolescents with type 1 diabetes that include longer-term considerations. CONCLUSIONS: The following conclusions were drawn from this review: (1) Educational and psychosocial interventions have small to medium beneficial effects on various diabetes management outcomes. (2) Well-designed trials of such interventions are needed in the UK (no completed RCTs of educational or psychosocial interventions for adolescents with type 1 diabetes conducted in the UK were found). (3) The evidence, arising primarily from studies in the USA, provides a starting point for the design of interventions in the UK. (4) Quantitative and narrative analysis of the evidence suggested that interventions are more likely to be effective if they demonstrate the inter-relatedness of the various aspects of diabetes management. (ABSTRACT TRUNCATED)

Coping with osteoarthritis by older adults.

OBJECTIVE: To extend to patients with osteoarthritis (OA) the coping model developed for patients with rheumatoid arthritis. METHODS: Relationship among appraisal, coping, and impact of OA were examined in a prospective study. Older men and women with OA (n = 82) were recruited from the community and were assessed at baseline, 1 month, and 4 months. Appraisal at baseline was measured by an interview addressing patients' beliefs about the intensity of their OA. Active, passive, and behavioral coping were assessed at 1 month, and the impact on OA pain, affective status, and mood was assessed at 4 months. RESULTS: Appraisal of OA as more intense was related to the use of more passive coping at 1 month, and was also related to more negative mood at 4 months. Active coping was predictive of less depressed affective status, whereas passive coping was predictive of subsequent worsening of negative mood. These relationships remained significant after controlling for demographic and medical history variables and functional status measures associated with dependent variables. No relation of either appraisal or coping to pain or positive mood was observed. CONCLUSIONS: The findings suggests that as patients' appraisals of the intensity of their OA decrease, less use of passive coping strategies, which are associated with poorer outcomes, should result. It is recommended that interventions to reduce OA impact should include both modification of appraisals of OA and modification of patients' coping strategies.

Self-management of osteoarthritis.

Osteoarthritis is the most prevalent activity-limiting condition among older persons. In addition to, or instead of, taking nonsteroidal anti-inflammatory drugs, people use a variety of activities to manage their osteoarthritis. This study describes the self-management methods reported by 61 participants aged 60 years or older assessed on two occasions 8 months apart. A questionnaire was developed to assess levels of use of 10 self-management methods including low-impact activity, rest, range-of-motion exercises, relaxation, heat (or cold), taking medication, joint protection, massage, splints, and any other activity. On a typical day, participants used about four of these activities to manage osteoarthritis symptoms, and significantly more on a day that their arthritis was worse than usual. Three self-management scales were formed from groups of activities suggested by factor analysis (medication taking, typical management, and worse-day passive management) that demonstrated adequate internal consistency and stability across the two assessments. The findings are discussed in terms of the importance of developing a brief measure of osteoarthritis self-management, and the substantial individual variation in subsets of methods used.

Personal models of diabetes and their relations to self-care activities.

Investigated the personal models of diabetes held by 46 female outpatients with non-insulin-dependent diabetes mellitus. The subjects' mean age was 64 years (range = 46 to 79 years), and 24 subjects were taking insulin. Their personal models were explored by using a comprehensive interview including questions on beliefs and emotions about cause, symptoms, course, treatment, and consequences of their diabetes. Two weeks after their interview, patients provided information about their levels of self-care activities, including exercise, diet, and glucose testing. The interview provided multiple indicators of the personal-model constructs from which four composites were formed assessing cause, symptoms, treatment, and seriousness (a combination of course and consequences). In hierarchical multiple-regression analyses, these dimensions significantly improved the prediction of diet level and marginally improved the prediction of exercise after accounting for the effects of age and insulin taking. The results are discussed in terms of variations in personal models across different patient groups and diseases and the role of personal models in determining self-care behaviors.

Radon and cigarette smoking: perceptions of this synergistic health risk.

Past approaches to the measurement of the perceived risk of combined hazards have failed to demonstrate awareness of synergy (S. E. Hampson et al., 1998; D. Hermand, E. Mullet, & B. Coutelle, 1995; D. Hermand, E. Mullet, & S. Lavieville, 1997). Respondents (N = 650) were provided with information about the synergistic risk of lung cancer from the combination of smoking and radon, and their risk perceptions were assessed on two occasions. At Time 1, using Likert-type scales, there was no evidence of synergistic risk perception. At Time 2, using a scale based on the appraisal of relative risk with anchors allowing for the expression of synergy, the combined hazard of radon and smoking was rated as significantly more of a health risk than the single hazards. The findings are discussed in terms of methodological issues in assessing synergistic risk.

Conscientiousness, perceived risk, and risk-reduction behaviors: a preliminary study.

Participants (N = 343) from an Oregon community completed surveys at baseline, 3 months, and 12 months to assess personality, the perceived health risk of radon in combination with smoking, and changes in smoking behavior. Conscientiousness predicted instituting a more restrictive household smoking rule (p < .01), and perceived risk predicted reduction in cigarettes smoked per day for men (p < .001). Perceived risk predicted a reduction in the proportion of cigarettes smoked in the home for those who had high (p < .05) but not low or moderate levels of Conscientiousness, a dimension in one personality model. The results demonstrate the importance of Conscientiousness in the prediction of health behavior, particularly behavior that affects others as well as oneself.

Forming impressions from incongruent traits.

The factors that affect the ease with which impressions are formed from incongruent trait pairs are investigated. In Experiments 1 and 2, trait pairs that were both descriptively and evaluatively congruent, as well as ones that were only evaluatively congruent, were found to be more imaginable and to be perceived as more frequently co-occurring than incongruent trait pairs. In Experiment 3, response latency provided a converging measure of ease of imaginability. Experiment 4 examined written descriptions of targets described by these trait pairs, and found more attempts to integrate the congruent than the incongruent pairs. These findings are discussed in terms of the relation between laypersons' impressions of personality and formal personality assessment.

The basic level in personality-trait hierarchies: studies of trait use and accessibility in different contexts.

A person's behavior and experiences can be described at different levels of abstraction. For example, a person might be described as charitable, as generous, as kind, or as good. Is there a level in such a trait hierarchy that is particularly useful in personality descriptions? The present 4 studies show that there is indeed a general preference for a particular level; the size of this preference depends on the familiarity and likability of the target people, which included various others and the self. These findings suggest that in trait hierarchies, people prefer the highest level of abstraction that is still descriptive of behavior (e.g., kind) over more descriptive subordinate levels (e.g., charitable and generous) and over an even broader level devoid of descriptive meaning (e.g., good). This level is basic in that it represents the optimal resolution of the trade-off between bandwidth and fidelity that characterizes all hierarchies.

Participation in outpatient diabetes education programs: how many patients take part and how representative are they?

Little research has been conducted on the role of participation in programs that teach diabetes self-management skills. This paper reviews recent studies on diabetes educational programs to determine what is known about participation, and then reports our experience in recruiting patients for a program that teaches diabetes self-care skills to persons age 60 and older. Few studies have reported data on participation rates in such programs, and only one study provided information on characteristics of patients who participated versus those who did not. In our study, patients over age 70, and those with whom we initiated contact by means of a letter from their health care provider, were less likely to participate than were younger patients and those who initiated contact with us. It is recommended that future research include information on the percentage and representativeness of patients who participate in diabetes education programs. Studies should also describe their target population, procedures used to recruit participants, and program characteristics that might affect participation.

Personal models of diabetes among older adults: relationship to self-management and other variables.

The purpose of this study was to test whether older patients' personal models of diabetes predict their levels of self-management activities (dietary intake, physical activity, and blood glucose testing) and glycemic control. The Personal Models of Diabetes Interview (PMDI) was administered on two occasions to 78 patients (> or = 60 years) with non-insulin-dependent diabetes mellitus. Self-management behaviors, quality of life, and affect were assessed on the second occasion and at 4 months. Glycemic control was assessed at 4 months. Three constructs of the PMDI (cause, treatment effectiveness, and seriousness) were correlated significantly with several aspects of quality of life and with negative affect. Personal models, especially beliefs regarding treatment effectiveness, were predictive of dietary intake and physical activity but not blood glucose testing. Assessing patients' personal models is valuable for individualizing education and counseling for nutrition and physical activity, and selecting strategies consistent with patients' perspectives.

Cross-talk about the menopause: enhancing provider-patient interactions about the menopause and hormone therapy.

Although many women make the menopause transition without problematic symptoms, the current tendency to prescribe hormone replacement therapy (HRT)2 as a preventive measure against potential life-threatening conditions for postmenopausal women has made menopause a medical issue for all women. Informing the millions of women due to experience menopause over the next decades of the possible long-term risks and benefits of HRT presents a major challenge to primary care. Recent research suggests that women are dissatisfied with their interactions with their health-care providers regarding menopause and the options for menopause management. We identify barriers to effective communication between providers and patients about these issues, and make recommendations for both research and practice to facilitate more effective provider-patient interactions concerning menopause and its management.

Implementing a psychological intervention to improve lifestyle self-management in patients with type 2 diabetes.

Lifestyle and behavioural factors play an important role in the development of Type 2 diabetes and management of this illness involves a combination of medication and lifestyle change. However, diabetes lifestyle programs have been found unsuccessful unless they are intensive and continued over long periods of time. The present study, which is one of the few randomised controlled trials of lifestyle interventions to be conducted outside of the US, aims to evaluate a brief psychological intervention that can be integrated into routine usual care to assist people to make the recommended lifestyle changes. Subjects are allocated to either an intervention or usual care control group. The intervention includes assessment and a personalised programme in which realistic manageable goals for lifestyle change and overcoming barriers are negotiated using brief motivational interviewing. Maintenance issues are addressed by follow-up telephone contact. Implementation of this study is described and baseline data presented on initial participants, and implications for practice are discussed.