Consensus guidance for monitoring individuals with islet autoantibody-positive pre-stage 3 type 1 diabetes.

Given the proven benefits of screening to reduce diabetic ketoacidosis (DKA) likelihood at the time of stage 3 type 1 diabetes diagnosis, and emerging availability of therapy to delay disease progression, type 1 diabetes screening programmes are being increasingly emphasised. Once broadly implemented, screening initiatives will identify significant numbers of islet autoantibody-positive (IAb+) children and adults who are at risk of (confirmed single IAb+) or living with (multiple IAb+) early-stage (stage 1 and stage 2) type 1 diabetes. These individuals will need monitoring for disease progression; much of this care will happen in non-specialised settings. To inform this monitoring, JDRF in conjunction with international experts and societies developed consensus guidance. Broad advice from this guidance includes the following: (1) partnerships should be fostered between endocrinologists and primary-care providers to care for people who are IAb+; (2) when people who are IAb+ are initially identified there is a need for confirmation using a second sample; (3) single IAb+ individuals are at lower risk of progression than multiple IAb+ individuals; (4) individuals with early-stage type 1 diabetes should have periodic medical monitoring, including regular assessments of glucose levels, regular education about symptoms of diabetes and DKA, and psychosocial support; (5) interested people with stage 2 type 1 diabetes should be offered trial participation or approved therapies; and (6) all health professionals involved in monitoring and care of individuals with type 1 diabetes have a responsibility to provide education. The guidance also emphasises significant unmet needs for further research on early-stage type 1 diabetes to increase the rigour of future recommendations and inform clinical care.

Factors associated with longitudinal food record compliance in a paediatric cohort study.

OBJECTIVE: Non-compliance with food record submission can induce bias in nutritional epidemiological analysis and make it difficult to draw inference from study findings. We examined the impact of demographic, lifestyle and psychosocial factors on such non-compliance during the first 3 years of participation in a multidisciplinary prospective paediatric study. DESIGN: The Environmental Determinants of Diabetes in the Young (TEDDY) study collects a 3 d food record quarterly during the first year of life and semi-annually thereafter. High compliance with food record completion was defined as the participating families submitting one or more days of food record at every scheduled clinic visit. SETTING: Three centres in the USA (Colorado, Georgia/Florida and Washington) and three in Europe (Finland, Germany and Sweden). SUBJECTS: Families who finished the first 3 years of TEDDY participation (n 8096). RESULTS: High compliance was associated with having a single child, older maternal age, higher maternal education and father responding to study questionnaires. Families showing poor compliance were more likely to be living far from the study centres, from ethnic minority groups, living in a crowded household and not attending clinic visits regularly. Postpartum depression, maternal smoking behaviour and mother working outside the home were also independently associated with poor compliance. CONCLUSIONS: These findings identified specific groups for targeted strategies to encourage completion of food records, thereby reducing potential bias in multidisciplinary collaborative research.

Maternal anxiety about a child's diabetes risk in the TEDDY study: the potential role of life stress, postpartum depression, and risk perception.

OBJECTIVE: To understand the association between life stress, postpartum depression (PD), maternal perception of her child's risk for type 1 diabetes (T1D) and a mother's anxiety about her child's T1D risk in mothers of genetically at risk children in The Environmental Determinants of Diabetes in the Young (TEDDY) study. METHODS: A short form of the state component (SAI) of the State-Trait Anxiety Inventory, negative life events (LE), the Edinburgh Postnatal Depression Scale (EPDS), and one question about the child's risk of developing T1D risk perceptions (RP) were given to mothers at the 6-month TEDDY clinic visit. The relationship between the four measures was modeled using multiple regressions. RESULTS: Controlling for sociodemographic factors, significant country differences in SAI, LE, EPDS, and RP emerged. LE - particularly interpersonal LE - had a strong association to maternal anxiety about the baby's risk of diabetes. Both evidence of PD and accurate risk perceptions (RPs) about the child's T1D risk were associated with increased maternal anxiety about the child's T1D risk. CONCLUSION: Heightened maternal anxiety in response to the news that a child is at increased risk for T1D is common. Mothers who have experienced recent negative LE, who experience PD and who accurately understand their child's risk may be particularly vulnerable to high levels of anxiety. The findings reported here need to be confirmed in future prospective studies.

Consensus Guidance for Monitoring Individuals With Islet Autoantibody-Positive Pre-Stage 3 Type 1 Diabetes.

Given the proven benefits of screening to reduce diabetic ketoacidosis (DKA) likelihood at the time of stage 3 type 1 diabetes diagnosis, and emerging availability of therapy to delay disease progression, type 1 diabetes screening programs are being increasingly emphasized. Once broadly implemented, screening initiatives will identify significant numbers of islet autoantibody-positive (IAb+) children and adults who are at risk for (confirmed single IAb+) or living with (multiple IAb+) early-stage (stage 1 and stage 2) type 1 diabetes. These individuals will need monitoring for disease progression; much of this care will happen in nonspecialized settings. To inform this monitoring, JDRF, in conjunction with international experts and societies, developed consensus guidance. Broad advice from this guidance includes the following: 1) partnerships should be fostered between endocrinologists and primary care providers to care for people who are IAb+; 2) when people who are IAb+ are initially identified, there is a need for confirmation using a second sample; 3) single IAb+ individuals are at lower risk of progression than multiple IAb+ individuals; 4) individuals with early-stage type 1 diabetes should have periodic medical monitoring, including regular assessments of glucose levels, regular education about symptoms of diabetes and DKA, and psychosocial support; 5) interested people with stage 2 type 1 diabetes should be offered trial participation or approved therapies; and 6) all health professionals involved in monitoring and care of individuals with type 1 diabetes have a responsibility to provide education. The guidance also emphasizes significant unmet needs for further research on early-stage type 1 diabetes to increase the rigor of future recommendations and inform clinical care.

Compassion-Based Meditation in African Americans: Self-Criticism Mediates Changes in Depression.

This study examines self-criticism as a mechanism through which compassion meditation reduces depressive symptoms in low-income African American men and women (N = 59) who had recently attempted suicide. After completing several measures, including the Levels of Self-Criticism Scale and Beck Depression Inventory-II, participants were randomly assigned to receive either a six-session compassion meditation (CM) group (Grady Compassion and Meditation Program) or a six-session support group. As predicted, path analysis results showed that treatment condition led to changes in self-criticism from pre- to posttreatment, with those receiving CM showing greater reductions in levels of self-criticism than those randomized to the support group. Path analyses also revealed that changes in self-criticism fully mediated the link between condition and changes in depressive symptoms. These findings highlight the importance and value of targeting levels of self-criticism in compassion-based interventions to reduce the depressive symptoms of suicidal African Americans.

Prevalence of overweight in north Florida elementary and middle school children: effects of age, sex, ethnicity, and socioeconomic status.

BACKGROUND: The number of overweight children has been rapidly increasing, although its prevalence varies by age, sex, ethnicity, and socioeconomic (SES) status. METHODS: Height and weight assessments were used to calculate body mass index (BMI) and BMI percentile on more than 17,000 children in 1 north Florida school district's elementary and middle schools. Based on the child's BMI percentile, each child was placed into 1 of 4 groups: underweight, normal, at risk for overweight, and overweight. Logistic regression was used to test the relative contribution of sex, ethnicity, school (elementary vs middle), age, and SES (indicated by free/reduced vs full-pay lunch status) to a child's weight classification. RESULTS: Overall, 36.2% of the children were either overweight (18.9%) or at risk for overweight (17.4%). Approximately 30% of the kindergarten children were overweight (14.0%) or at risk for overweight (15.5%). African American children were most likely to begin kindergarten overweight. The prevalence of overweight increased for all ethnic groups during the elementary school years. However, African American girls and Hispanic boys were more likely to be overweight than any other ethnic group; Asian girls were least likely to be overweight. These findings could not be readily explained by the effects of SES. Higher SES appeared to be protective but only for white and Hispanic children. CONCLUSIONS: These results confirm the increasing prevalence of overweight in US school children, especially among African American girls and Hispanic boys.

Don't ask, don't tell: a systematic review of the extent to which participant characteristics are reported in social anxiety treatment studies.

BACKGROUND AND OBJECTIVES: This study examined the extent to which social anxiety treatment studies report the demographic characteristics of their participants. One hundred and 56 treatment studies published in English between 2001 and 2012 articles were collected. METHODS: Each study was evaluated on whether or not it reported information on gender, age, race, relationship status, education, socioeconomic status, sexual orientation, and disability and also the extent to which the racial composition of the sample was described. RESULTS: The majority of studies reported information on age (96.2%) and gender (94.2%), but the percentage of studies that reported anything else is much lower: race (50.0%), education (42.3%), relationship status (37.8%), socioeconomic status (5.1%), disability (2.6%), and sexual orientation (1.3%). One third (34.0%) of studies reported the race of all participants in their samples, while the remaining reported no information or information for only a subset of participants (e.g. "mostly white"). CONCLUSIONS: Participants of social anxiety disorder treatment studies generally are not described beyond their age and gender. Standards for reporting participant characteristics of treatment studies (similar to standards for reporting the methodology of treatment studies) could improve clinical researchers' and clinicians' ability to evaluate the external validity of this body of work.

Assessing daily management in childhood diabetes.

One hundred sixty-eight patients with childhood diabetes (6 to 19 years of age) and their parents participated in 24-hr recall interviews concerning daily diabetes management behavior. Each patient and parent was interviewed independently on three separate occasions. The information obtained was used to construct measures of 13 different adherence behaviors. Parent-patient agreement was good to excellent for most of the 13 behaviors. Agreement was influenced by the patient's age, with the most consistently high parent-child agreement found in the 10- to 15-year-old age group. Factor analysis of the 13 adherence behaviors resulted in a five-factor solution accounting for 70.6% of the variance. Adherence in childhood diabetes appears to be a complex construct, consisting of at least five different components unrelated to each other. Teenagers in this sample were less adherent than their younger counterparts on most of the adherence measures studied.

Stereotype confirmation concern and fear of negative evaluation among African Americans and Caucasians with social anxiety disorder.

Fear of negative evaluation is a central component of social anxiety. The current study examines the relation between fear of negative evaluation and fears of confirming stereotypes about social groups to which one belongs among people diagnosed with social anxiety disorder. Participants (N=94) with a primary diagnosis of social anxiety disorder who self-identified as either African American (n=41) or Caucasian (n=53) completed standardized self-report measures of stereotype confirmation concerns and fear of negative evaluation. Results from hierarchical logistical regression showed that stereotype confirmation concerns predicted fear of negative evaluation for both racial groups, with greater concern predicting greater fear. This association was moderated by race, B=-.24, t=-2.67, p<.01, such that stereotype confirmation concerns had a stronger association with fear of negative evaluation for Caucasians (b=.38, p<.01) than for African Americans (b=.14, p<.05). This study is the first to directly examine the relation between stereotypes and fear of negative evaluation within a socially anxious sample. Although we cannot identify the specific social group to which each participant's stereotype confirmation concerns apply, this study provides quantitative evidence that the social context within which socially anxious individuals view themselves impacts their fear of negative evaluation and highlights the need for further research in this area.

Cognitive processes as mediators of the relation between mindfulness and change in social anxiety symptoms following cognitive behavioral treatment.

The present study examined whether pretreatment mindfulness exerts an indirect effect on outcomes following cognitive-behavioral therapy (CBT). Cognitive processes of probability and cost bias (i.e., overestimations of the likelihood that negative social events will occur, and that these events will have negative consequences when they do occur) were explored as potential mediators of the relation between mindfulness and social anxiety symptom change. People with higher levels of mindfulness may be better able to benefit from treatments that reduce biases because mindfulness may aid in regulation of attention. Sixty-seven individuals with a primary diagnosis of social phobia identifying public speaking as their greatest fear received eight sessions of one of two types of exposure-based CBT delivered according to treatment manuals. Participants completed self-report measures of mindfulness, probability bias, cost bias, and social anxiety symptoms. Mediation hypotheses were assessed by a bootstrapped regression using treatment outcome data. Pretreatment mindfulness was not related to change in social anxiety symptoms from pre- to posttreatment. However, mindfulness had an indirect effect on treatment outcome via its association with probability bias, but not cost bias, at midtreatment. These findings were consistent across three metrics of social anxiety symptoms. Mindfulness may play a role in response to CBT among individuals with social phobia through its relation with probability bias--even when the treatment does not target mindfulness.