Denise Charron-Prochownik

Diabetes and Pregnancy: Factors associated with seeking pre-conception care

OBJECTIVE To define sociodemographic characteristics, medical factors, knowledge, attitudes, and health-related behaviors that distinguish women with established diabetes who seek pre-conception care from those who seek care only after conception. RESEARCH DESIGN AND METHODS A multicenter, case-control study of women with established diabetes making their first pre-conception visit (n = 57) or first prenatal visit without having received pre-conception care (n = 97). RESULTS Pre-conception subjects were significantly more likely to be married (93 vs. 51%), living with their partners (93 vs. 60%), and employed (78 vs. 41%); to have higher levels of education (73% beyond high school vs. 41%) and income (86% >

A Longitudinal Study of Biomedical and Psychosocial Predictors of Multiple Hospitalizations Among Young People with Insulin-dependent Diabetes Mellitus

20,000 vs. 60%); and to have insulin-dependent diabetes mellims (IDDM) (93 vs. 81%). Pre-conception subjects with IDDM were more likely to have discussed preconception care with their health care providers (98 vs. 51%) and to have been encouraged to get it (77 vs. 43%). In the prenatal group, only 24% of pregnancies were planned. Pre-conception patients were more knowledgeable about diabetes, perceived greater benefits of pre-conception care, and received more instrumental support. CONCLUSIONS Only about one-third of women with established diabetes receive pre-conception care. Interventions must address prevention of unintended pregnancy. Providers must regard every visit with a diabetic woman as a pre-conception visit. Contraception must be explicitly discussed, and pregnancies should be planned. In counseling, the benefits of pre-conception care should be stressed and the support of families and friends should be elicited.

Impact of a Preconception Counseling Program for Teens With Type 1 Diabetes (READY-Girls) on Patient-Provider Interaction, Resource Utilization, and Cost

The aim of the present study was to estimate the cumulative probability of multiple diabetes‐related hospitalizations and identify associated risk factors in a sample of 92 school‐age children, newly diagnosed with insulin‐dependent (Type 1) diabetes mellitus, who were followed longitudinally for up to 14 years (mean: 9 years). ‘Multiple hospitalizations’ as a variable was defined as three or more admissions. Altogether 26 young patients (28%) had multiple admissions (with a total of 158 hospitalizations), yielding an estimated cumulative probability for this outcome of 0.33 by 10 years after onset of diabetes. Multivariate longitudinal analyses revealed that at any given point in time, four variables significantly increased the risk of multiple admissions: higher levels of glycosylated haemoglobin reflecting poorer metabolic control, higher levels of externalizing symptoms reflecting greater behaviour problems, younger age at diagnosis, and lower socio‐economic status. According to the results of post hoc analyses, however, the aforementioned risk factors do not appear to be specific to multiple hospitalizations, and can serve to identify groups that are generally vulnerable to readmissions.

Randomized Efficacy Trial of Early Preconception Counseling for Diabetic Teens (READY-Girls)

OBJECTIVE To evaluate the impact of a preconception counseling program tailored for teens with type 1 diabetes on cognitive, psychosocial, and behavioral outcomes and to assess its cost-effectiveness. RESEARCH DESIGN AND METHODS A total of 88 teens with type 1 diabetes from two sites were randomized into the READY-Girls (Reproductive-health Education and Awareness of Diabetes in Youth for Girls) intervention (IG) (n = 43) or standard care (SC) (n = 45) groups. During three diabetes clinic visits, IG subjects viewed a two-part CD-ROM, read a book, and met with a nurse. Program effectiveness was measured by knowledge, attitudes, intentions, and behaviors regarding diabetes, pregnancy, sexuality, and preconception counseling. Assessments occurred at baseline, before and after viewing program materials, and at 9 months. Economic analyses included an assessment of resource utilization, direct medical costs, and a break-even cost analysis. RESULTS Age range was 13.2–19.7 years (mean ± SD 16.7 ± 1.7 years); 6% (n = 5) were African American, and 24% (n = 21) were sexually active. Compared with baseline and SC subjects, IG subjects demonstrated a significant group-by-time interaction for benefit and knowledge of preconception counseling and reproductive health: increasing immediately after the first visit (P < 0.001) and being sustained for 9 months (P < 0.05 benefits; P < 0.001 knowledge). For IG subjects, preconception counseling barriers decreased over time (P < 0.001), and intention and initiation of preconception counseling and reproductive health discussions increased (P < 0.001). Costs of adverse reproductive outcomes are high. Direct medical costs of READY-Girls were low. CONCLUSIONS READY-Girls was beneficial and effects were sustained for at least 9 months. This low-cost self-instructional program can potentially empower young women with type 1 diabetes to make well-informed reproductive health choices, adding little time burden or cost to their diabetes management.

Reproductive health beliefs and behaviors in teens with diabetes: application of the Expanded Health Belief Model.

OBJECTIVE—To develop and assess the feasibility of an early preconception counseling program for adolescents called READY-Girls (Reproductive-health Education and Awareness of Diabetes in Youth for Girls). RESEARCH DESIGN AND METHODS—A total of 53 adolescent females with type 1 diabetes between 16 and 19.9 years of age were randomized into groups receiving a CD-ROM, a book, or standard care (control) and given one comprehensive session. Outcomes were assessed at baseline, immediately after, and at 3 months. RESULTS—Teens who received the CD and those who received the book demonstrated significant (P ≤ 0.05) sustained improvement (over 3 months) in knowledge, perceived benefits of both receiving preconception counseling and using effective family planning, and perceived more support with reproductive health issues. CONCLUSIONS—Clinical feasibility of the program was demonstrated. Both the CD and the book appeared to be efficacious formats for the short term. Future studies should examine repeated boosters of a CD and a book, which are not meant to replace but rather to reinforce and supplement health professional education.

Knowledge, attitudes and behaviors related to sexuality and family planning in adolescent women with and without diabetes.

Abstract: Objective: To identify significant correlates among constructs of the Expanded Health Belief Model (EHBM) with reproductive health behaviors [preventing an unplanned pregnancy and seeking preconception counseling (PC)] and metabolic control in teenaged women with type 1 diabetes.

A Quality Improvement Initiative to Increase HPV Vaccine Rates Using an Educational and Reminder Strategy With Parents of Preteen Girls

Background:  Sexually active adolescents with diabetes are at high risk for unplanned pregnancies and reproductive complications.

Outpatient Versus Inpatient Care of Children Newly Diagnosed With IDDM

INTRODUCTION A quality improvement project was undertaken to determine if an evidence-based educational brochure and reminder system can increase human papillomavirus (HPV) vaccine uptake and dose completion rates. METHOD Development of a brochure to promote HPV vaccine uptake was based on predictors of parental acceptance and Health Belief Model concepts. Electronic alerts prompted telephone reminders for dose completion. This quality improvement project utilized a quasi-experimental design with 24 parents of preteen girls from a private pediatric practice and a historical control group of 29 parents. HPV vaccine rates were compared between the groups. RESULTS A significant difference in HPV vaccine uptake (χ(2) = 11.668, P = .001; odds ratio [OR] = 9.429, 95% confidence interval [CI] = 2.686-33.101) and dose completion (χ(2) = 16.171, P < .001; OR = 22.500, 95% CI = 4.291-117.990) rates were found between the historical control and intervention groups. Parents who received the clinical protocol were 9.4 times and 22.5 times more likely to have HPV vaccine uptake and dose completion, respectively. DISCUSSION Low national HPV vaccine rates demonstrate the need for theory-based vaccine delivery programs. These results show that an evidence-based educational brochure and reminder system appeared to improve HPV vaccine uptake and dose completion rates at this private pediatric practice.

Self-Monitoring of Blood Glucose Is Associated With Problem-Solving Skills in Hyperglycemia and Hypoglycemia

As health care systems scramble to find more cost-effective ways of delivering care, the issue of outpatient versus inpatient management and education for children with newly diagnosed diabetes comes into question. Although some centers have been successfully practicing routine outpatient management for decades, the common practice of the majority of providers is to hospitalize new-onset children for metabolic stabilization and initial education. Increasingly, however, health care services are being shifted from inpatient to outpatient settings in an effort to reduce costs. Potential for substantial savings may exist for the initial treatment of IDDM. Approximately 13,171 newly diagnosed cases of IDDM in patients under age 19 years are estimated to occur every year in the U.S. (1). If we assume that the average length of stay for an inpatient admission in these cases is 3-5 days and that the average hospital expense per inpatient per day is

Biomedical and Psychosocial Predictors of Early Rehospitalization Among Children With Insulin‐dependent Diabetes Mellitus: A Longitudinal Study

931 (2), then the hospital costs for these events would amount to