"I'm Staring at the Screen All the Time": Technology Use and Mindfulness in Adolescents with Type 1 Diabetes.

Type 1 diabetes (T1D) is a chronic, complex medical condition associated with higher rates of anxiety in adolescents. Higher rates of anxiety are associated with poorer glycemic control. Although technological advancements have been made to improve self-management of glycemia, few technological interventions aim to mitigate anxiety symptoms. Adolescents frequently use technology every day for school and socialization in addition to management of glycemia. Technology has not yet been leveraged to provide evidence-based interventions, such as mindfulness, for anxiety symptoms and other psychosocial comorbidity in adolescents with T1D. We aimed to examine technology preferences in adolescents with type 1 diabetes, their experiences with mindfulness practices, and their perceived acceptability of a mobile health application delivering mindfulness training. Twenty participants aged 14 to 17 years old with T1D participated in this qualitative descriptive study. Interview transcripts were organized using the ATLAS.ti software version 8 and coded using an in vivo approach and thematic analysis. Descriptive statistics regarding participant demographics and hemoglobin A1c levels were analyzed using SAS statistical software version 9.2. Findings supported heavy technology use, limited experience with mindfulness, and positive receptivity regarding an app that delivered a mindfulness training program specifically for adolescents with T1D. Thus, a mobile health application may be a feasible and acceptable way to deliver an evidence-based psychosocial intervention to this vulnerable population.

Are Providers Adequately Screening for Anxiety Symptoms During Pregnancy?

OBJECTIVE: To examine the difference in prevalence of self-reported anxiety symptoms throughout pregnancy compared to clinical diagnosis of an anxiety disorder by a provider. DESIGN: Secondary data analysis of a prospective cohort study of 50 pregnant individuals. SETTING/LOCAL PROBLEM: Pregnant individuals commonly experience heightened anxiety symptoms, which are associated with adverse perinatal outcomes. However, a diagnosis of an anxiety disorder by a health care provider is less common, which may result in insufficient mental health intervention. PARTICIPANTS: Pregnant individuals were recruited at their first prenatal appointment and followed until birth. INTERVENTION/MEASUREMENTS: We examined anxiety symptoms using the Edinburgh Postnatal Depression Scale Anxiety subscale. We conducted a medical record review to examine if pregnant individuals were clinically diagnosed with an anxiety disorder. RESULTS: Based on an Edinburgh Postnatal Depression Scale Anxiety subscale cutoff score of ≥5, 40% (n = 20) of individuals experienced anxiety symptoms during pregnancy. However, only 16% (n = 8) of participants were diagnosed with an anxiety disorder by a health care provider. CONCLUSION: Anxiety symptoms are prevalent throughout pregnancy and may be underdiagnosed by health care providers. An intervention to increase clinical diagnosis of an anxiety disorder and subsequent referral to a mental health specialist may be indicated.

Application of the Adverse Childhood Experiences Framework to the NICU.

BACKGROUND: Infants and families requiring neonatal intensive care unit (NICU) care often experience significant stress and trauma during the earliest period of the infant's life, leading to increased risks for poorer infant and family outcomes. There is a need for frameworks to guide clinical care and research that account for the complex interactions of generational stress, pain, toxic stress, parental separation, and lifelong health and developmental outcomes for infants and families. PURPOSE: Apply the Adverse Childhood Experiences (ACEs) framework in the context of the NICU as a usable structure to guide clinical practice and research focused on infant neurodevelopment outcomes and parental attachment. METHODS: An overview of ACEs is provided along with a detailed discussion of risk at each level of the ACEs pyramid in the context of the NICU. Supportive and protective factors to help mitigate the risk of the ACEs in the NICU are detailed. RESULTS: NICU hospitalization may be considered the first ACE, or potentially an additional ACE, resulting in an increased risk for poorer health outcomes. The promotion of safe, stable, and nurturing relationships and implementation of trauma-informed care and individualized developmental care potentially counter the negative impacts of stress in the NICU. IMPLICATIONS FOR PRACTICE AND RESEARCH: Nurses can help balance the negative and positive stimulation of the NICU through activities such as facilitated tucking, skin-to-skin care, mother's milk, and active participation of parents in infant care. Future research can consider using the ACEs framework to explain cumulative risk for adverse health and well-being in the context of NICU care.

Social Determinants of Health Among Pregnant Hispanic Women and Associated Psychological Outcomes.

BACKGROUND: There has been a concerning surge in maternal mortality among Hispanic women in recent years. Compromised mental health is present in nearly half of all maternal deaths, and risk factors include poor social support and depression. OBJECTIVE: Among Hispanic women who were born in the USA versus those not born in the USA, we sought to describe and compare social determinants of health and maternal psychological outcomes. METHODS: Hispanic pregnant women (n = 579) were recruited from two clinics in Tampa, FL, and completed various questionnaires related to social determinants of health, depression, stress, and social support. STATISTICAL ANALYSIS: Descriptive statistics, t-tests, and chi-square analyses were used to compare relationships between maternal nativity and subsequent psychosocial outcomes. Pearson correlations were used to explore associations between variables. RESULTS: Hispanic pregnant women who were not born in the USA had lower incomes (χ2 = 5.68, p = 0.018, df = 1), were more likely to be unemployed (χ2 = 8.12, p = 0.004, df = 1), and were more likely to be married (χ2 = 4.79, p = 0.029, df = 1) when compared with those born in the USA. Those not born in the USA reported lower social support (t = 3.92, p<0.001), specifically the tangible (t = 4.18, p < 0.001) and emotional support subscales (t = 4.4, p<0.001). When compared with those born in the USA, foreign-born Hispanic women reported less stress (t = 3.23, p = 0.001) and depression (t = 3.3, p = 0.002). CONCLUSION: Pregnant Hispanic women not born in the USA are at increased risk for suboptimal social determinants of health, including less social support. US-born women were more stressed and depressed and had higher BMIs.

The Salivary Microbiome During Pregnancy: Associations With Clinical and Sociodemographic Characteristics.

PURPOSE: Poor oral health has been associated with adverse pregnancy outcomes, and the oral microbiome may play a role in these mechanisms. We aimed to examine the salivary microbiome for alterations in diversity or relative abundance throughout pregnancy and its associations with adverse pregnancy outcomes and sociodemographic characteristics. STUDY DESIGN AND METHODS: We conducted an ancillary study from a previous cohort study of 37 women during their second and third trimesters of pregnancy using preexisting, participant-collected salivary samples to examine the oral microbiome using 16S rRNA sequencing. RESULTS: The salivary microbiome demonstrated stability throughout pregnancy, as there were no significant differences in alpha or beta diversity. Individuals who were diagnosed with preeclampsia had differences in beta diversity at the genus level (F = 2.65, df = 1, P = .015). There were also differences in beta diversity at the species level in Hispanic individuals compared with non-Hispanic individuals (F = 1.7183, df = 1, P = .04). CONCLUSION: The salivary microbiome demonstrated stability throughout the second and third trimesters but may be different in Hispanics or those diagnosed with preeclampsia. As such, clinical providers need to demonstrate culturally competent care during pregnancy and continue to educate women about the importance of oral healthcare during the perinatal period. Future research is needed to examine the mechanisms associated with oral microbiome dysbiosis in Hispanic women during pregnancy and in women with preeclampsia.

A Scoping Review of the Oral Microbiome in Preterm Infants.

The purpose of this scoping review was to examine the oral microbiome composition in preterm infants, sampling and collection methods, as well as exposures associated with oral microbiome composition and health implications. We conducted a scoping review of the literature using the Arskey and O'Malley framework. We identified a total of 13 articles which met our inclusion criteria and purpose of this scoping review. Articles included in this review compared the oral microbiome in preterm infants to term infants, examined alterations to the oral microbiome over time, compared the oral microbiome to different body site microbiomes, and explored associations with clinically relevant covariates and outcomes. Exposures associated with the diversity and composition of the oral microbiome in preterm infants included delivery mode, oral feeding, oropharyngeal care, skin-to-skin care, and antibiotics. Day of life and birth weight were also associated with oral microbiome composition. The oral microbiome may be associated with the composition of the tracheal and gut microbiomes, likely due to their proximity. Alpha and beta diversity findings varied across studies as well as the relative abundance of taxa. This is likely due to the different sampling techniques and timing of collection, as well as the wide range of infant clinical characteristics. Multiple factors may influence the composition of the oral microbiome in preterm infants. However, given the heterogeneity of sampling techniques and results within this review, the evidence is not conclusive on the development as well as short- and long-term implications of the oral microbiome in preterm infants and needs to be explored in future research studies. KEY POINTS: · Day of life is a critical factor in oral microbiome development in preterm infants.. · The oral microbiome may be associated with tracheal and gut microbiome colonization.. · Future research should examine sampling methodology for examining the oral microbiome.. · Future research should explore associations with the oral microbiome and adverse health outcomes..

The Oral Microbiome Throughout Pregnancy: A Scoping Review.

INTRODUCTION: Oral health is associated with systemic health, including adverse pregnancy outcomes. Understanding the oral microbiome during pregnancy may lead to targeted interventions for prevention of adverse outcomes. The purpose of this review is to examine the literature on the oral microbiome throughout pregnancy. METHODS: We conducted a literature search with four electronic databases for original research conducted between 2012 and 2022 that examined the oral microbiome longitudinally using 16s rRNA sequencing during pregnancy. RESULTS: We identified six studies that examined the oral microbiome longitudinally throughout pregnancy, though comparisons of oral niches, oral microbiome measures, and findings between studies were not consistent. Three studies identified alterations in alpha diversity throughout pregnancy and two studies identified increased pathogenic bacteria during pregnancy. Three studies reported no changes in the oral microbiome throughout pregnancy, and one study identified differences in the composition of the microbiome based on socioeconomic status and antibiotic exposure. Two studies examined adverse pregnancy outcomes in association with the oral microbiome, one reporting no associations and one reported difference in community gene composition in those diagnosed with preeclampsia. CLINICAL IMPLICATIONS: There is limited research on the composition of the oral microbiome throughout pregnancy. There may be alterations in the oral microbiome during pregnancy such as increased relative abundance of pathogenic bacteria. Socioeconomic status, antibiotic use, and education may contribute to differences in the microbiome composition over time. Clinicians should evaluate oral health and educate on the importance of oral health care during the prenatal and perinatal time period.

Psychosocial Outcomes in Adolescents With Type 1 Diabetes: Associations With Grade Level and Disease Duration.

INTRODUCTION: The purpose of this study was to examine anxiety and depressive symptoms in adolescents with type 1 diabetes (T1D) to determine differences based on grade level and disease duration. METHOD: We conducted a secondary data analysis of adolescents with T1D, which included demographic characteristics, general anxiety symptoms, and depressive symptoms. RESULTS: Of the 147 adolescents included in the analysis, 32% (n=47) were in middle school and 68% (n=100) were in high school. Most had been diagnosed with diabetes for less than 3 years (67.3%, n=99). When controlling for covariates, middle schoolers were more likely to report clinically significant depressive symptoms compared to their high school peers (ß = 0.83, p = 0.008). DISCUSSION: Younger adolescents may be at a higher risk of a clinically significant symptom burden from depression and should be screened regularly. Future research should include tailoring psychosocial interventions specifically to an adolescent's age and disease duration.

Mindfulness in adolescents and young adults with diabetes: An integrative review.

BACKGROUND AND PURPOSE: Type 1 diabetes (T1D), type 2 diabetes, and prediabetes are increasing in incidence. Adolescents and young adults with diabetes experience psychosocial comorbidities at an increased incidence. As such, exploring interventions that can improve psychosocial and glycemic outcomes are needed. The purpose of this integrative review is to examine and synthesize the literature on mindfulness in adolescents and young adults with type 1 or type 2 diabetes or prediabetes. METHODS: Four databases were searched during May 2021. Included studies were published between 2000 and 2021, evaluated adolescents and young adults, diagnosed with type 1 or type 2 diabetes or prediabetes. Studies were excluded if they were not in English; not original research; evaluated complementary/alternative therapies as a group. To assess for risk of bias, the National Institutes of Health quality assessment tools and the Cochrane Collaboration's tool were utilized. Whittemore and Knafl's (2005) method for conducting an integrative review was utilized to synthesize results. RESULTS: We identified 137 articles in our initial search and 74 articles remained after removing for duplicates. Ten articles were included in the review, with 5 including adolescents and young adults with T1D and 5 including adolescents and young adults with prediabetes. No studies evaluated mindfulness in adolescents and young adults with type 2 diabetes. CONCLUSION: Mindfulness is an acceptable intervention in adolescents and young adults with T1D and prediabetes, resulting in positive psychosocial and glycemic outcomes. There were issues with feasibility of the intervention and mobile health technology delivery methods should be evaluated.

Scoping Review of the Relationship Between Gestational Diabetes Mellitus and the Neonatal and Infant Gut Microbiome.

OBJECTIVE: To conduct a scoping review to examine the relationship between a diagnosis of gestational diabetes mellitus (GDM) and the neonatal and infant gut microbiome from 0 to 1 year of age. DATA SOURCES: We searched PubMed, Scopus, Embase, and CINAHL for articles with key terms "microbiome" and "gestational diabetes mellitus." STUDY SELECTION: We included articles published in English in peer-reviewed journals between 2012 and 2021 that were reports of original research studies in which researchers used next-generation sequencing for analysis of the fecal microbiome and collected meconium or transitional stool from neonates and/or infants. DATA EXTRACTION: We identified nine studies with a combined sample size of 1,279 neonates and infants. We extracted data, including title, authors, sample size, study design, methods, findings, significance, and limitations. We extracted and charted confounding variables such as treatment of GDM, body mass index, gestational age at birth, antibiotic use, mode of birth, and feeding method. DATA SYNTHESIS: Gestational diabetes mellitus may alter the neonatal and infant gut microbiome because neonates and infants of women with GDM had altered composition and diversity compared to neonates and infants of women without GDM. CONCLUSION: Mechanisms by which the neonatal and infant microbiome changes in response to GDM are poorly understood and need to be evaluated in future research. Further study of how GDM plays a role in the initial seeding of the microbiome, how the maternal microbiome may affect fetal metabolic programming, and how the neonatal microbiome leads to the future development of obesity and glucose intolerance is critical. Future studies should include larger sample sizes, appropriate collection of potential confounding variables, assessment of maternal interventions for GDM, and longitudinal designs to further understand potential associations with long-term detrimental outcomes such as obesity and impaired glucose tolerance.

Cognitive Behavioral Therapy in Adolescents with Type 1 Diabetes: An Integrative Review.

PROBLEM: Type 1 Diabetes (T1D) is a complex chronic condition that impacts physiologic and psychosocial outcomes in adolescents. Adolescents with T1D experience anxiety and depressive symptoms at 2 to 3 times the rate of the general adolescent population. Anxiety and depressive symptoms negatively impact disease management. Cognitive behavioral therapy (CBT) is considered the gold standard therapeutic technique for treating anxiety and depressive symptoms. The aim of this integrative review was to examine and synthesize the extant literature exploring the effect of CBT on physiologic and psychosocial outcomes in adolescents with T1D. ELIGIBILITY CRITERIA: Electronic databases were searched with the terms "type 1 diabetes" and "cognitive behavioral therapy." Studies were included if they were published between 2000 and 2020, evaluated a pediatric population (≤18 years of age), and included individuals with diagnosed T1D. SAMPLE: 475 articles were identified in our initial search, and after removal of duplicates 353 articles remained. 339 did not meet inclusion criteria. A total of 14 papers met inclusion criteria. RESULTS: All studies included CBT, but differed in delivery methods. Several studies demonstrated evidence of the feasibility and acceptability; however, there were mixed results regarding improvement of physiologic and psychosocial outcomes. CONCLUSIONS: CBT is a feasible and acceptable intervention in adolescents with T1D. It may be a method of improving psychologic and psychosocial outcomes for this high-risk population. IMPLICATIONS: In adolescents with T1D, screening and treatment for psychosocial comorbidities should occur regularly at endocrinology visits. CBT can be operationalized to fill this gap.

Utilizing an Artificial Neural Network to Predict Self-Management in Patients With Chronic Obstructive Pulmonary Disease: An Exploratory Analysis.

PURPOSE: The main objective of this study was to utilize an artificial neural network in an exploratory fashion to predict self-management behaviors based on reported symptoms in a sample of stable patients with chronic obstructive pulmonary disease (COPD). DESIGN AND METHODS: Patient symptom data were collected over 21 consecutive days. Symptoms included distress due to cough, chest tightness, distress due to mucus, dyspnea with activity, dyspnea at rest, and fatigue. Self-management abilities were measured and recorded periodically throughout the study period and were the dependent variable for these analyses. Self-management ability scores were broken into three equal tertiles to signify low, medium, and high self-management abilities. Data were entered into a simple artificial neural network using a three-layer model. Accuracy of the neural network model was calculated in a series of three models that respectively used 7, 14, and 21 days of symptom data as input (independent variables). Symptom data were used to determine if the model could accurately classify participants into their respective self-management ability tertiles (low, medium, or high scores). Through analysis of synaptic weights, or the strength or amplitude of a connection between variables and parts of the neural network, the most important variables in classifying self-management abilities could be illuminated and served as another outcome in this study. FINDINGS: The artificial neural network was able to predict self-management ability with 93.8% accuracy if 21 days of symptom data were included. The neural network performed best when predicting the low and high self-management abilities but struggled in predicting those with medium scores. By analyzing the synaptic weights, the most important variables determining self-management abilities were gender, followed by chest tightness, age, cough, breathlessness during activity, fatigue, breathlessness at rest, and phlegm. CONCLUSIONS: The results of this study suggest that self-management abilities could potentially be predicted through understanding and reporting of patient's symptoms and use of an artificial neural network. Future research is clearly needed to expand on these findings. CLINICAL RELEVANCE: Symptom presentation in chronically ill patients directly impacts self-management behaviors. Patients with COPD experience a number of symptoms that have the potential to impact their ability to manage their chronic disease, and artificial neural networks may help clinicians identify patients at risk for poor self-management abilities.

Lues maligna in a patient with unknown HIV infection.

Lues maligna represents a rare form secondary syphilis and is also known as 'malignant syphilis' or 'ulceronodular syphilis'. This clinical entity is predominantly found in immunodeficient patients such as patients with HIV or AIDS. The patient presented here suffered from unspecific symptoms such as painful joints, headache, flu-like symptoms and a disseminated exanthema presenting with ulcerating nodules for 1 week. He further reported a 7 weeks history of painless ulcer, involving his external genitals and anus. Unsafe sexual contacts were strictly denied first, but as serological investigation could prove active syphilis and HIV infection, the patient finally stated promiscuous unprotected homosexual contacts in the past. He was treated with penicillin G intravenously three times daily. The unspecific flu-like symptoms disappeared quickly within several days, all skin lesions healed, partly with scars after 2 weeks.