Toree Malasanos

Exploration of food addiction in pediatric patients: A preliminary investigation

Objectives:The goals of the present study were to explore the possibility that symptoms of food addiction may exist for some children and to identify factors that may be associated with pediatric food addiction. Methods:Participants were 50 children (aged 8–19), recruited from the Pediatric Lipid Clinic at a large southeastern teaching hospital, and their parent/guardian. Participants completed questionnaires to assess food- and eating-related attitudes and behaviors, as well as symptoms of food addiction. Results:Parent- and child-reported behaviors and attitudes demonstrated similar patterns. Child body mass index ratings were significantly correlated with overeating (r = 0.42, P = 0.02) and emotional eating (r = 0.33, P = 0.04). Of note, 15.2% of children indicated that they “Often,” “Usually,” or “Always” think that they are addicted to food, and an additional 17.4% reported that they “Sometimes” feel that way. Food addiction symptoms were significantly correlated with child overeating (r = 0.64, P < 0.001), uncontrolled eating (r = 0.60, P < 0.001), emotionol eating (r = 0.62, P < 0.001), food preoccupation (r = 0.58, P < 0.001), overconcern with body size (r = 0.54, P < 0.001), and caloric awareness and control (r = −0.31, P = 0.04). Conclusions:The results of the present study suggest that “food addiction” may be a real problem for a subset of children who suffer from overweight/obesity. Identification of food addiction may improve obesity treatment efforts for this subset of patients.

Improved access to subspecialist diabetes care by telemedicine : cost savings and care measures in the first two years of the FITE diabetes project

We have used telemedicine clinics supplemented by online education to provide effective care for children with diabetes. Before the programme began, the mean interval between visits was 149 days; in year 1 of the programme it was 98 days, and in year 2 it was 89 days. Before the programme, there were on average 1 3 hospitalizations a year (47 days) and this decreased to 3.5 hospitalizations a year (5.5 days). Emergency department visits decreased from 8 to 2.5 per year. On 10 occasions after the programme started, ketosis was managed by telephone intervention alone, relying on family-initiated calls. Over 90% of patients and family members expressed satisfaction with the telemedicine service and wished to continue using it. In all, 95% felt little self-consciousness. Over 90% felt their privacy was respected. The programme saved US

Telehealth Behavior Therapy for the Management of Type 1 Diabetes in Adolescents

27,860 per year. The present study demonstrated improved access to specialized health care via telemedicine in combination with online education improved health status and reduced costs by reducing hospitalizations and emergency department visits.

Diabetes Awareness and Reasoning Test: A Preliminary Analysis of Development and Psychometrics

Background: Poor management of type 1 diabetes mellitus (T1DM) may result in serious medical complications. Psychological intervention may improve adherence to medical regimens; however, access to trained professionals is limited, particularly in rural communities. Telehealth interventions may address this by allowing families to access services at home; however, little is known about the efficacy of such services. Method: This study presents results from a pilot trial of a randomized waitlist controlled trial of Telehealth Behavioral Therapy (TBT) for youths with T1DM. Primary outcome measures were adherence to the diabetes regimen, glycemic control, and level of family discord. Thirty-two youths (23 female) with T1DM (aged 9 to 17 years) and one parent or caregiver participated. Telehealth Behavioral Therapy sessions were conducted thrice weekly for 12 weeks by phone and lasted an average of 15 min each. Results: Results indicated that youths in treatment decreased their hemoglobin A1c by 0.74 compared to 0.09 in the waitlist, though this was not statistically significant. Youths in treatment reported increased unsupportive and decreased caring parental behaviors. Conclusion: Telehealth Behavioral Therapy improves access to knowledgeable providers and results in a clinically significant improvement in glycemic control. Despite some youths experiencing an increase in unsupportive parental behaviors, TBT is a promising method of service delivery that warrants further investigation.

School nurse, family and provider connectivity in the FITE diabetes project

Diabetes-related knowledge is a crucial element of diabetes self-management. To date, diabetes knowledge questionnaires have been primarily developed and evaluated in adult populations, or have become outdated with advances in type 1 diabetes (T1D) treatments. Given this, we developed and conducted an initial evaluation of the Diabetes Awareness and Reasoning Test child and parent report versions (DART/DART-P). Participants were 139 children with T1D and 64 parents recruited from an outpatient pediatric diabetes clinic and an overnight camp for youth with diabetes. Item analyses were conducted to develop the DART/DART-P. Reliability analyses for the DART/DART-P indicated adequate internal consistencies for the Total Score and all of the subscales except the child School Factors subscale. Preliminary validity support was provided through examination of demographic moderators (e.g., age, education) and correlations with HbA1c. Implications of the DART/DART-P for clinical practice and research are highlighted.

ANALYSIS: mobile phones integrated into diabetes management: a logical progression.

The Florida Initiative in Telehealth and Education (FITE) diabetes project includes a system of remote blood glucose monitoring and online education for school personnel, families and providers. Forty-four patients with diabetes (100% of patients), six caregivers, six case managers and 18 school nurses were provided with secure email access, allowing blood glucose and other data transfer. In all, 50% of school nurses and 100% of case managers completed educational modules on the FITE Website. Over 90% of patients and all school nurses received equipment for transmitting blood glucose data to their computers. The data were discussed during clinic appointments. Inclusion of previously unavailable data from school nurses contributed to fine-tuning the diabetes management regimen. Those patients, families and school nurses who chose to transmit blood glucose data and participate in online education expressed satisfaction with the technology, the process and the improved communication.

Tanner Stage 4 Breast Development in Adults: Forensic Implications

In this issue of Journal of Diabetes Science and Technology, the intervention described by D. Katz, “Novel Interactive Cell-Phone Technology for Health Enhancement,” uses cell phones to provide the rapid communication necessary for the support of intensive management of diabetes. Mobile technology is widely accepted in todays society and can be an effective tool for this cause. There have been numerous interventions using various communication tools, including cell phones, to manage chronic disease, which all propose that improved communication and feedback to patients would improve health status. Dr. Katz has taken the next step by giving semiautomated, real-time, immediate feedback on each data point all transmitted by cell phone.

Home-based behavioral health intervention: Use of a telehealth model to address poor adherence to type-1 diabetes medical regimens.

BACKGROUND AND OBJECTIVE: Forensic testimony in alleged child pornography cases commonly asserts that Tanner stage (TS) 4 breast development, characterized by secondary mounding of the areola that is obliterated in TS 5, is evidence of age <18 years. Clinical experience does not support this notion, but there are no relevant studies. We sought to estimate how frequently TS 4 might be interpreted from nonclinical images by individual forensic experts. METHOD: Published images of 547 adult women were independently examined by the authors and classified as having TS 4 or TS 5 breast development. RESULTS: There was concordance among all 4 of the examiners for 17 of the images, agreement of 3 of the examiners on another 36 images, of 2 examiners on 39 images, and 53 images were designated TS 4 by only 1 examiner, for a total of 153 (26.5%) images that could have been considered by a single forensic expert to represent TS 4. CONCLUSIONS: A substantial number of adults have persistent TS 4 breast development. This observation, and the frequent difficulty distinguishing TS 4 from TS 5, even by adolescent development specialists, especially in nonclinical images, renders testimony based on this distinction invalid. Without clinical relevance for distinguishing these advanced stages of breast development, they should both be considered indicative of full maturation. Testimony based on this inappropriate test of maturity should no longer be allowed.