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.

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.

Statistical detection of chromosomal homology using shared-gene density alone.

MOTIVATION: Over evolutionary time, various processes including point mutations and insertions, deletions and inversions of variable sized segments progressively degrade the homology of duplicated chromosomal regions making identification of the homologous regions correspondingly difficult. Existing algorithms that attempt to detect homology are based on shared-gene density and colinearity and possibly also strand information. RESULTS: Here, we develop a new algorithm for the statistical detection of chromosomal homology, CloseUp, which uses shared-gene density alone to fully exploit the observation that relaxing colinearity requirements in general is beneficial for homology detection and at the same time optimizes computation time. CloseUp has two components: the identification of candidate homologous regions followed by their statistical evaluation using Monte Carlo methods and data randomization. Using both artificial and real data, we compared CloseUp with two existing programs (ADHoRe and LineUp) for chromosomal homology detection and found that in general CloseUp compares favorably. AVAILABILITY: CloseUp and supplementary information are available at http://www.igb.uci.edu/servers/cgss.html CONTACT: pfbaldi@ics.uci.edu.

Comparison of patients' and healthcare professionals' beliefs about and attitudes towards Type 2 diabetes.

AIMS: To compare patients' and healthcare professionals' beliefs and attitudes towards diabetes. METHODS: One hundred and four healthcare professionals (nurses, dieticians, general practitioners) and 100 of their patients with Type 2 diabetes completed the Diabetes Attitude Scale, 3rd version (DAS-3). Healthcare professionals also answered questions about their provision of diabetes care. RESULTS: Healthcare professionals viewed Type 2 diabetes as more serious than their patients. Most of the healthcare professionals considered diabetes harder to treat than other chronic conditions and felt that they did not have adequate time and resources to treat their diabetes patients effectively. CONCLUSIONS: This study suggests that an important part of forming collaborative alliances with patients is to recognize the distinction between practitioner and patient perspectives in Type 2 diabetes.

Neuropsychological functioning in older people with type 2 diabetes: the effect of controlling for confounding factors.

AIMS AND METHODS: Neuropsychological functioning was examined in a group of 33 older (mean age 62.40 +/- 9.62 years) people with Type 2 diabetes (Group 1) and 33 non-diabetic participants matched with Group 1 on age, sex, premorbid intelligence and presence of hypertension and cardio/cerebrovascular conditions (Group 2). RESULTS: Data statistically corrected for confounding factors obtained from the diabetic group were compared with the matched control group. The results suggested small cognitive deficits in diabetic people's verbal memory and mental flexibility (Logical Memory A and SS7). No differences were seen between the two samples in simple and complex visuomotor attention, sustained complex visual attention, attention efficiency, mental double tracking, implicit memory, and self-reported memory problems. CONCLUSIONS: These findings indicate minimal cognitive impairment in relatively uncomplicated Type 2 diabetes and demonstrate the importance of control and matching for confounding factors.

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.

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)

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.

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.

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.

Using radon risk to motivate smoking reduction: evaluation of written materials and brief telephone counselling.

OBJECTIVE: Radon and cigarette smoking have synergistic effects on lung cancer, even when radon concentrations are relatively low. Working through an electric utility company, we sought to reach smoking households with low radon concentrations and motivate smoking cessation or prohibiting smoking in the home. DESIGN: Eligible homes (n = 714) were randomised to receive: (1) the Environmental Protection Agency's (EPA's) "A citizen's guide to radon"; (2) a specially developed pamphlet; or (3) that pamphlet plus brief telephone counselling. PROCEDURE: Utility company "bill stuffers" offered free radon test kits to smoking households. All households received radon test results with an explanatory cover letter. Both the specially developed pamphlet and the telephone counselling emphasised that smoking cessation or prohibiting smoking in the home were the optimal risk reduction strategies. Households were followed up at 3 and 12 months after receiving materials. RESULTS: The specially developed pamphlet and the EPA guide yielded similar outcomes. There was a non-significant trend for telephone counselling to produce greater sustained quitting than the specially developed pamphlet, and phone counselling led to significantly more new household smoking bans. CONCLUSIONS: Working through a public utility company is an efficient way to reach smoking households, and brief telephone counselling is a promising method for promoting household smoking bans and cessation in homes alerted to the risk posed by the combination of radon and smoking.

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.

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.

Social support and personal models of diabetes as predictors of self-care and well-being: a longitudinal study of adolescents with diabetes.

OBJECTIVES: To examine whether peer support and illness representation mediate the link between family support, self-management and well-being. METHOD: Fifty-two adolescents (12-18 years old) with Type I diabetes were recruited and followed over 6 months, completing assessments of self-management, well-being, and social support. RESULTS: Perceived impact of diabetes and supportive family and friends were prospectively predictive of participants' well-being measures. Although support from family and friends was predictive of better dietary self-care, this relationship was mediated by personal model beliefs. In particular, beliefs about the effectiveness of the diabetes treatment regimen to control diabetes was predictive of better dietary self-care. CONCLUSIONS: Both friends and family are important to support adolescents as they live with and manage their diabetes. Personal models of diabetes are important determinants of both dietary self-care and well-being. In addition, personal models may serve to mediate the relationship between social support and dietary behavior.

Radon-smoking synergy: A population-based behavioral risk reduction approach.

BACKGROUND: Radon and cigarette smoking have a synergistic, multiplicative effect on lung cancer rates. Smokers, and perhaps nonsmoking residents, of smoking households are at increased risk for lung cancer even when radon levels are relatively low. A behavioral risk reduction strategy emphasizing smoking cessation is proposed and data are presented from pilot studies and a short-term evaluation of a randomized intervention trial. METHODS: Pilot studies, including radon testing, interviews, questionnaires, and focus groups, led to a three-arm randomized intervention trial comparing two kinds of written materials and telephone counseling. Smoking households were recruited by offering free radon test kits through an electric utility companies billing system. Three-month follow-up data were obtained by mail and phone. RESULTS: Of an estimated 2,600 smoking households in the utility district, 1,220 requested a radon test kit, and 714 were randomized into three treatment conditions. Brief phone counseling (up to two short calls) significantly increased smoking quit rates, compared to written materials only, and was also related to other risk reduction behaviors (e.g., household ban on smoking). CONCLUSIONS: Offering free radon testing through a public utility billing system is an effective recruitment tool for reaching households at risk due to radon-smoking synergy. Brief telephone counseling is superior to written materials in reducing smoking and encouraging indoor smoking bans. Methods are needed to better inform smokers of their additional risk from exposure to even low levels of radon.

Lay understanding of synergistic risk: the case of radon and cigarette smoking.

The combination of radon and smoking produces a synergistic risk of lung cancer. Lay understanding of this risk was examined from the perspectives of mental models theory, the psychometric approach to risk perception, and optimistic bias. As assessed by interview, participants (N = 50) had more extensive mental models for the risks of smoking than for the risks of radon or the combination of radon and smoking; 32% knew little or nothing about radon. Despite reading an informational brochure, their risk-perception ratings of the three hazards showed no perception of the synergy between smoking and radon risk, although the combined hazard was rated as less familiar but more controllable than the average of the single hazards (p < .01). No evidence of optimistic bias for the health consequences of radon, or the combination of radon and smoking was observed. Participants appeared to be combining the single-hazard risks subadditively to arrive at their combined-hazard risk perceptions. Further research on the integration of perceived risks would be beneficial for designing optimal communications about synergistic risk.

Social support and personal models of diabetesin relation to self-care and well-being inadolescents with type I diabetes mellitus.

This study set out to examine whether peer support and illness representation mediates the link between family support, self-management and well-being. Seventy-four participants (12-18-years-old) with type I diabetes mellitus completed questionnaires assessing their self-management, depression, anxiety, perceived social support and personal models of diabetes. Perceived impact of diabetes, but not perceived seriousness, and peer support were significant predictors of depression. Family support was a significant predictor of all self-management measures. However, for dietary self-management this relationship was partially mediated by the perceived efficacy of treatment to control diabetes, but not efficacy of treatment to prevent complications.

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.

Long-term effects and costs of brief behavioural dietary intervention for patients with diabetes delivered from the medical office.

This study evaluated the 12-month follow-up results and costs of a personalized, medical office-based intervention focused on behavioral issues related to dietary self-management. Two hundred and six adults having diabetes attending an internal medicine outpatient clinic visit were randomized to either Usual Care or to Brief Intervention. The single session intervention involved touchscreen computer-assisted assessment that provided immediate feedback on key barriers to dietary self-management, goal setting and problem-solving counselling. Follow-up components included phone calls and videotape intervention relevant to each participant. Brief Intervention produced significantly greater improvement than Usual Care on multiple measures of change in dietary behaviour (e.g., covariate adjusted difference of 2.2% of calories from fat; p = 0.023) and on serum cholesterol levels (covariate adjusted difference of 15 mg/dl; p = 0.002) at 12-month follow-up. There were also significant differences favouring intervention on patient satisfaction (p < 0.02) but not on HbA1c levels. The costs of intervention ($137 per patient) were modest relative to many commonly used practices.

Patient-physician interactions in diabetes management: consistencies and variation in the structure and content of two consultations.

The structure and content of medical consultations concerning diabetes were examined in two, successive quarterly medical consultations between two physicians and their diabetes patients (N = 44). The consultations were audio-taped and coded for structure (e.g. question asking, information giving) using a modified version of the Roter Interactional Analysis System (inter-coder correlations typically exceeded 0.90 for the composite variables derived from the coding system). The tapes were also coded for content by monitoring the topics discussed (e.g. diet, medication, exercise). The majority of the interactions consisted primarily of information giving and positive talk on the part of both patients and providers. Nutrition-related issued, blood glucose monitoring, medication and exercise were addressed in the majority of interactions, but other regimen areas such as foot care, smoking habits, and alcohol were seldom discussed. There was little stability across the two consultations in terms of either structure (median test-retest correlation = 0.24) or content (majority of test-retest correlations were below 0.30). The importance of studying more than one patient-physician encounter when studying interaction style and content is discussed, as is the need for investigation of interactions between non-physician health care providers and patients with chronic disease.