Kathleen Moltz

Psychometric Properties of the Revised Parental Monitoring of Diabetes Care Questionnaire in Adolescents With Type 1 Diabetes

PURPOSE We evaluated the psychometric properties of a revised version of the Parental Monitoring of Diabetes Care questionnaire (PMDC-R) designed to evaluate parental supervision and monitoring of adolescent diabetes care behaviors. The revised measure was intended to capture a broad range of ways used by parents to gather information about youth adherence to diabetes care. METHODS Two hundred sixty-seven caregivers of 12-18-year-old adolescents with type 1 diabetes completed the PMDC-R. Measures of parental knowledge of youth illness management, illness management behavior, and metabolic control were also obtained. RESULTS The PMDC-R demonstrated good internal consistency (alpha coefficient = .91) and test-retest reliability (r = .79, p < .001). Supporting the instruments construct validity, a bifactor model with one primary factor and three secondary factors had an acceptable fit to the data (comparative fit index = .92, root mean square error of approximation = .06). Concurrent validity was also supported. In structural equation models, parental monitoring, as assessed by the PMDC-R, had a significant direct effect on parental knowledge of adolescent diabetes management and, through knowledge, an indirect effect on adolescent diabetes management and metabolic control. CONCLUSIONS The PMDC-R displayed strong psychometric properties and represents an important next step in refining the measurement of parental monitoring for youth with chronic illnesses.

Improving screening for diabetes in cystic fibrosis

PURPOSE Annual screening for cystic fibrosis-related-diabetes (CFRD) using oral glucose tolerance test (OGTT) is recommended, but national testing rates are low. The purpose of this paper is to implement the quality improvement (QI) initiative to improve cystic fibrosis (CF) annual screening rates among patients at one CF center. DESIGN/METHODOLOGY/APPROACH To improve screening for CFRD at the CF Center, the authors used the Dartmouth Microsystem Improvement Ramp method and formed a collaborative working group. A process map was created to outline the steps and a fishbone analysis was performed to identify barriers and to utilize resources for implementing new interventions. FINDINGS Prior to these interventions, 21 percent of eligible patients had completed annual screening and after the intervention, it rose to 72 percent. The initial completion rate with the first prescription was only 50 percent, but it improved steadily to 54/75 (72 percent) in response to reminder letters sent six weeks after the initial script was given. PRACTICAL IMPLICATIONS Close tracking and reminder letters can improve adherence with annual OGTT screening for CFRD among CF patients, with special emphasis on high-risk patients. ORIGINALITY/VALUE There should be a special emphasis on screening for CFRD in high-risk CF patients (those with low BMI or higher age). This QI initiative brought about several operational changes in the annual OGTT screening process that have now become the standard operating procedure at the center.

Risk factors and management of deep venous thrombosis in children following post‐surgical hypopituitarism in craniopharyngioma

Post‐operative hypopituitarism following craniopharyngioma (CP) surgery is treated by replacement of various hormones. The risk of deep venous thrombosis (DVT) following CP surgery and initiation of hormones has not been well studied and recognized. We present three patients with DVT who had family history of DVT and procoagulant risk factors such as inherited thrombophilia and elevated Von Willebrand factor levels due to treatment with desmopressin. We discuss the individualized management of anticoagulation and the dilemma of starting estrogen and progesterone replacement therapy in them. Pediatr Blood Cancer 2011;57:175–177.

Enhancing Parental Motivation to Monitor African American Adolescents’ Diabetes Care: Development and Beta Test of a Brief Computer-Delivered Intervention

Background African American youth are at increased risk for poor diabetes management. Parenting behaviors such as parental monitoring are significant predictors of youth diabetes management and metabolic control, but no intervention has targeted parental monitoring of daily diabetes care. Objective The purpose of the present study was to develop and pilot test a three-session computer-delivered intervention to enhance parental motivation to monitor African American pre-adolescents’ diabetes management. Methods The 3 Ms (Medication, Meter, and Meals) intervention was based on the Information-Motivation-Behavioral Skills (IMB) model of health behavior change and Motivational Interviewing approaches. Five caregivers of African American youth aged 10-13 years diagnosed with type 1 diabetes for a minimum of one year (ie, the target population) reviewed the intervention and provided feedback via semi-structured interviews. Interviews were transcribed and analyzed using thematic analysis. Results Caregivers’ responses to interview questions suggest that The 3 Ms was helpful (minimum rating was 8 out of 10) and they would recommend the program to another parent of a child with diabetes (minimum rating was 9 out of 10). Three of five reported that The 3 Ms program increased the likelihood that they would talk to their child about diabetes. Thematic analysis suggested two primary themes: caregivers found the intervention to be a useful reminder of the importance of supervising their child’s diabetes care and that it evoked a feeling of shared experience with other parents. Conclusions The 3 Ms computer-delivered intervention for increasing parental monitoring of African-American youth with type 1 diabetes was well-received and highly rated by a small sample of representative caregivers. Trial Registration ClinicalTrials.gov NCT01515930; http://clinicaltrials.gov/ct2/show/NCT01515930 (Archived by WebCite at http://www.webcitation.org/6Rm0vq9pn).

Computerized intervention to increase motivation for diabetes self-management in adolescents with type 1 diabetes

Purpose: The purpose of this study was to assess the feasibility of a three-session computer intervention to improve diabetes management among African-American youth with type 1 diabetes. Methods: The 3 Ms (Medication, Meter, and Meals) intervention was based on the Information-Motivation-Behavioral Skills model of health behavior change and Motivational Interviewing approaches. Feasibility was assessed based on rates of intervention participation and intervention satisfaction using a mixed-methods approach. Participants included 23 youths aged 10–13. Results: Mean satisfaction rates from questionnaires were high across ratings for both general satisfaction and helpfulness of the intervention for improving diabetes care. Intervention participation rates were also high, with 87% completing all three sessions. Thematic analyses suggests that adolescents found the intervention helpful for changing their diabetes management behaviors, their thoughts about the importance of diabetes care, reminding them to complete care, feeling empowered about diabetes management feeling supported by family. Conclusion: Adolescents found The 3 Ms computer-delivered intervention to be helpful in improving diabetes care and completed a high percentage of sessions. The delivery of motivation-building interventions that do not require a highly trained human interventionist during routine diabetes clinic visits has the potential to improve adolescent health at reduced costs-savings.

Adaptation of an Evidence-Based Diabetes Management Intervention for Delivery in Community Settings: Findings From a Pilot Randomized Effectiveness Trial

Objective To adapt an evidence-based intervention targeting diabetes management in adolescents with poorly controlled type 1 diabetes for use in a community setting by community health workers (CHWs) and to conduct pilot testing of the new intervention, REACH for Control (RFC). The study was conducted as a collaboration between university researchers and a federally qualified health center. Methods In a pilot effectiveness trial, feasibility and acceptability of RFC were evaluated based on participant enrollment, treatment dose, and consumer satisfaction. RFC effects on adolescent adherence, health outcomes, and quality of life were also assessed. The trial used a parallel group design. Families were randomized to 6 months of RFC plus standard medical care (n = 26) or standard care (SC) only (n = 24). Data were collected at baseline and 7-month posttest. A mixed-methods approach was used to analyze data. Results Qualitative analyses suggested that caregivers viewed RFC and delivery of a home-based intervention by CHWs positively. Furthermore, adolescents who received RFC had statistically significant (p = .05) and clinically meaningful improvements in hemoglobin A1c (HbA1c) (0.7%) and reported significant improvements in quality of life from baseline to follow-up (p = .001). No significant changes were found for adolescents in standard medical care. However, while dose of primary intervention session delivered was acceptable, dose of follow-up sessions used for skills practice was low. Conclusions Results provide preliminary support for RFCs acceptability and effectiveness to improve health status and quality of life when used in community settings serving high-risk, low-income families. Additional testing in a full-scale effectiveness trial appears warranted.

Use of Gonadotropin-Releasing Hormone for Intractable Seizures in a Girl with Precocious Puberty without Hypothalamic Hamartoma.

The use of gonadotropin-releasing hormone analogs has been reported in the treatment of gelastic seizures and precocious puberty associated with hypothalamic hamartomas, but not in other seizure types without hypothalamic hamartoma. We describe a 7.5 year-old girl whose seizures subsided after gonadotropin-releasing hormone analog implant, administered for precocious puberty.