The associations between physical activity, health-related quality of life, regimen adherence, and glycemic control in adolescents with type 1 diabetes: A cross-sectional study.

BACKGROUND: Adolescents with Type 1 Diabetes (T1D) display a greater than two-fold higher risk of developing diabetes-related complications compared with their healthy peers and the risk increases markedly as glycated hemoglobin (HbA1c) increases. The majority of the known factors associated with improved glycemic control in adolescents with T1D are geared toward Western populations. Therefore, this study examined the associations between Physical Activity (PA), Health-Related Quality of Life (HRQoL), and regimen adherence on glycemic control in a Middle Eastern population of adolescents with T1D METHODS: The study utilized a cross-sectional design of Jordanian adolescents (aged 12-18) with T1D (n = 74). Self-reported measures used were the Pediatric Quality of Life-Diabetes Module, the International Physical Activity Questionnaire, and the Summary of Diabetes Self-Care Activities. HbA1c values were obtained from the medical records. Correlation analyses were conducted using Pearson's and Spearman's correlation tests. Multiple regression analyses were conducted to determine if HRQoL, PA, and regimen adherence predict glycemic control. RESULTS: Only 14.8 % of the participants demonstrated good glycemic control (HbA1c ≤ 7.5 %). Participants with poor control had a statistically significant lower mean PA of MET-minutes/week (3531.9 ± 1356.75 vs. 1619.81 ± 1481.95, p < .001) compared to those with good control. The total sample was found to demonstrate low HRQoL (47.70 ± 10.32). Participants were within the acceptable range of PA (1885.38 ± 1601.13) MET-minutes/week. HbA1c significantly inversely correlated with PA (r = -0.328, p = .010) and regimen adherence (r = -0.299, p = .018). The regression analysis revealed that PA significantly predicted glycemic control (ß = -0.367, p < .01) as adherence (ß = -0.409, p < .01) and disease duration did (ß = 0.444, p < .01). CONCLUSION: Better glycemic control was significantly associated with higher PA and regimen adherence levels. The correlation between PA and glycemic control depends highly on the level of regimen adherence or arguably, adherence acts as a buffer in the correlation between PA and glycemic control. There was no significant association between glycemic control and HRQoL.

Changes in Breastfeeding Exclusivity and Satisfaction During the COVID-19 Pandemic.

BACKGROUND: Because of its many benefits, exclusive breastfeeding for 6 months is a common public health goal. However, only 44% of infants aged 0-6 months are exclusively breastfed worldwide and, in the United States, only 26% of infants are exclusively breastfed for 6 months. The restrictions imposed during the COVID-19 pandemic may have reduced these rates even further. RESEARCH AIM: To examine the differences in breastfeeding exclusivity and satisfaction before and during the COVID-19 pandemic. METHODS: A cross-sectional, two-group survey design was used. Parents (N = 110) of infants born April 1 to December 31, 2019 (pre-pandemic; n = 69), or April 1 to December 31, 2020 (during the pandemic; n = 41), who received lactation support services from an urban academic breastfeeding clinic were surveyed. RESULTS: Respondents who gave birth in 2020 (pandemic year) were no less likely to exclusively breastfeed for the first 6 months of their infant's life compared to respondents who gave birth in 2019 (pre-pandemic year). After multivariable logistic regression, the odds of high breastfeeding satisfaction were 73% lower in respondents with infants born in 2020 than in respondents with infants born in 2019 (OR = 0.27, 95% CI [0.08, 0.89]). The strongest contributor to high breastfeeding satisfaction was a prenatal breastfeeding visit with an International Board Certified Lactation Consultant. CONCLUSIONS: Future research is needed to identify the specific pandemic-related factors that led to the difference in breastfeeding satisfaction between the two groups and to confirm the impact of prenatal International Board Certified Lactation Consultant visits on breastfeeding satisfaction.

Interdependence of physical and psychological morbidity among patients with cancer and family caregivers: Review of the literature.

OBJECTIVE: Caregivers for patients with cancer have an integral role in maintaining patients' health. Although patients and caregivers experience the impact of cancer individually, studies suggest their health is interdependent. The objective of this review was to synthesize the literature on interdependent physical and psychological morbidity in patient-caregiver dyads published since 2016. METHODS: A search of PubMed, CINAHL, Embase, and PsycInfo databases was performed using Cooper's recommendations and the Preferred Reporting Items for Systematic Reviews And Meta-Analyses Guidelines. Studies were included if they measured individual physical or psychological morbidity in cancer patient-caregiver dyads, evaluated interdependence, and were published in a peer-reviewed journal. RESULTS: Twenty-three studies met criteria, characterized by mainly spousal dyads. Studies included a variety of cancers and methodologies. Findings were inconsistent, indicating varying interdependence. However, the studies demonstrated a stronger relationship between patients' and caregivers' psychological morbidity than between their physical morbidity. CONCLUSIONS: This review revealed a need for continued exploration of dyadic health interdependence. Future studies should consider samples of patients with a single type of cancer, testing cultural mediators/moderators, and using longitudinal designs.

A Systematic Review of Physical Activity and Exercise on Physiological and Biochemical Outcomes in Children and Adolescents With Type 1 Diabetes.

PURPOSE: In this systematic review we aimed to evaluate the effects of physical activity (PA) and exercise on biochemical and physiological outcomes in children and adolescents with type 1 diabetes (T1D). DESIGN: The review was conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. METHODS: The search of literature was performed using PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, the Cochrane Library, Scopus, Medline, PsycINFO, the Nursing Reference Center, and Google Scholar. The search was limited to include peer-reviewed articles published in English from May 2012 to May 2018 and included adolescents <19 years of age with T1D. Twenty-seven studies met the inclusion criteria: 8 interventional and 19 observational studies. FINDINGS: Both observational and interventional studies showed considerable agreement that supervised regular moderate to vigorous physical activity (MVPA) is more effective on adiposity and cardiorespiratory fitness than habitual PA. Further, it was reported that PA of different intensities improves insulin sensitivity and decreases daily insulin dosage. Results of glycemic control were equivocal. Although observational studies reported improvement in glycemic control with PA of different intensities, most of the experimental studies revealed no significant associations. A consistent agreement among the studies revealed a considerable benefit of regular habitual PA of light to moderate intensity on blood glucose regulation and lipid profile. CONCLUSIONS: The reviewed studies showed that regular MVPA was associated with several health benefits in adolescents with T1D; however, additional studies are needed to fully understand the effect of PA on health outcomes. CLINICAL RELEVANCE: Regular MVPA (at least 4 hr per week) with good glycemic control is a promising option for adolescents with T1D when risk management of hypoglycemia is appropriately taken.

Victimization and revictimization among women of Mexican descent.

OBJECTIVE: To gain an understanding of the experiences of women of Mexican descent, born in Mexico or the United States who live with intimate partner abuse. The study was part of a larger study of the process of disclosure by women of Mexican descent who are subjected to intimate partner abuse. DESIGN: Descriptive qualitative approach. SETTING: Two sites in a South Texas-Mexico border community: a woman's shelter and an outreach agency. PARTICIPANTS: Twenty-six women of Mexican descent were interviewed. METHODS: A semistructured interview guide was used to elicit participants' views of their experiences with intimate partner abuse. RESULTS: These narratives illuminate how the process of victimization and revictimization creates an environment that blinds people to abuse, promotes denial of abuse, and leads women to remain in a harmful situation. CONCLUSION: Nurses and other health care and service providers working with women must take the initiative to assess for abuse; a few simple questions might change the woman's life and her children(s).

Factors influencing disclosure of abuse by women of Mexican descent.

PURPOSE: The purpose of this study was to describe the factors that influence disclosure of abuse by women of Mexican descent. Few published studies describe the experiences of women of Mexican descent with a history of intimate partner abuse, specifically in terms of their process of disclosure of abuse. METHODS: A qualitative research design was used to conduct this study in south Texas adjacent to the United States-Mexico border. Twenty-six key informants were recruited from two different sites. An open-ended approach with a semistructured interview guide was used to collect the narrative information from the 26 participants. RESULTS: The findings illuminated that many factors hindered disclosure. Some of these factors included protecting their partners, avoidance of worrying their mothers, and fear of losing their children. CONCLUSIONS: The study may help healthcare providers to understand the complexity of disclosure by women with a history of intimate partner abuse and may help explain why women do not readily disclose their abusive situations. CLINICAL RELEVANCE: This study on the disclosure decision process of abuse by women of Mexican descent provides some understanding on the cultural or situational factors that hindered or encouraged disclosure; ultimately this knowledge can help healthcare providers and others to provide for the woman's health, welfare, and safety.