Deviation from Developmentally Appropriate Self-Care Autonomy: Association with diabetes outcomes

Wysocki, Tim; Taylor, Alexandra; Hough, Brenda S; Linscheid, Thomas R.; Yeates, Keith Owen; Naglieri, Jack A.

doi:10.2337/diacare.19.2.119

Cited by 258 publications

(212 citation statements)

References 14 publications

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“…Conversely, patients from two-parent households have greater presumed family support, which may include a stay-at-home parent who is overly attentive to perceived changes and inclined to seek medical attention. The dynamics of a patient's household seemed to play a role in postoperative management in our study, which is consistent with existing literature examining home life, family support, and the quality of home care provided after a medical procedure [9,11,37,57]. These findings support the importance of preoperative assessment of social support and teaching pain management strategies to patients and caregivers (Table 8).…”

Section: Background and Rationalesupporting

confidence: 90%

“…Older patients also spent longer time in the apparatus and required a greater number of antibiotics. Many factors could have accounted for these findings, including medical indication for external fixation, goal(s) of treatment, knowledge of and adherence to postoperative care, and developmental stage as it impacts physical growth, cooperation, and postoperative self-care [33,41,57]. Appropriate education regarding these findings will establish reasonable expectations of treatment duration and potential challenges.…”

Section: Background and Rationalementioning

confidence: 99%

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Clinical Implications of Psychosocial Factors on Pediatric External Fixation Treatment and Recommendations

Richard

Nguyen

Birch

et al. 2015

Clin Orthop Relat Res

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Background Pediatric limb reconstruction using circular external fixation is a prolonged treatment that interrupts patients' daily function. Patient personality characteristics and expectations may interfere with planned treatment, making complicated medical procedures more challenging. The aims of this study are to identify factors impacting treatment outcome and recommendations for preoperative evaluation and planning. Questions/purposes (1) Are there group differences between patients with and without a preexisting mental health condition(s) in terms of unplanned reoperations? (2) Does the number of surgical procedures before current external fixator placement correlate with the number of unplanned readmissions, unplanned reoperations, and days spent in circular external fixation? (3) Are there group differences between single-compared with two-parent households in terms of inpatient narcotic doses, length of inpatient stay, number of unplanned readmissions, length of readmission(s), and/or unplanned outpatient clinic visits? (4) Does patient age at the time of surgery have an impact on treatment duration, postoperative complications, and treatment outcome? Methods This is a retrospective chart review of pediatric patients who underwent limb reconstruction between 2008 and 2012. Patients with limb length discrepancy [ 4 cm or severe angular deformity and who agreed to intervention were treated with circular external fixation. Sixty-seven patients were included; 16 patients were excluded. Statistical analyses included Pearson r correlation and t-test. Results Patients who reported preexisting mental health diagnosis (13%) had more unplanned reoperations than patients who did not (no mental health diagnosis; 87%) (mental health diagnosis 3.4 ± 10.3 versus no mental health diagnosis 0.2 ± 0.5 reoperation[s], p = 0.022). Number of previous surgical procedures correlated with number of unplanned reoperations (r = 0.448, p \ 0.001), number of unplanned readmissions (r = 0.375, p \ 0.001), and number of days in an apparatus (r = 0.275, p = 0.018). Compared with patients from two-parent households, patients from single-parent households received a greater number of inpatient narcotic doses (singleparent 129 ± 118 versus two-parent 73 ± 109 doses, p = 0.039), longer length of inpatient stay (single-parent 73 ± 63 versus two-parent 40 ± 65 days, p = 0.036), more unplanned readmissions (single-parent 0.4 ± 0.1 versus two-parent 0.2 ± 0.2 readmission, p = 0.024), longer hospitalization when readmitted (single-parent 5 ± 11 versus two-parent 1 ± 3 day(s), p = 0.025), and fewer unplanned outpatient visits (single-parent 0.2 ± 0.8 versus two-parent 0.9 ± 1.1 visit, p = 0.005). Apparatus applications with successful outcome had higher average age than those with poor outcome (successful outcome 16 ± 3 versus poor outcome 13 ± 4 years old, p = 0.011). Age at time of apparatus application correlated with One or more of the authors (JGB, MKS, AMC), or a member of his or her immediate family, has or may receive payments ...

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Section: Background and Rationalesupporting

confidence: 90%

Section: Background and Rationalementioning

confidence: 99%

Clinical Implications of Psychosocial Factors on Pediatric External Fixation Treatment and Recommendations

Richard

Nguyen

Birch

et al. 2015

Clin Orthop Relat Res

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“…The increasing independence of adolescents from their parents in carrying out diabetes tasks (8,10) may make monitoring by both mothers and fathers especially important (11). Ellis et al (9) found that diabetes-specific monitoring during adolescence was associated with better metabolic control via its association with better regimen adherence.…”

mentioning

confidence: 99%

“…Parental monitoring involves regular contact with adolescents regarding their daily activities and involves knowledge about and supervision of those activities (6). Although the diabetes literature has examined constructs related to parental monitoring (e.g., involvement) that are associated with positive diabetes outcomes (7,8), involvement (i.e., who is responsible for diabetes tasks) is not synonymous with monitoring (i.e., parent really knows that diabetes tasks are completed). For instance, an adolescent could manage diabetes care tasks independently (low parental involvement), while the parent monitors the success of those independent efforts (high parental monitoring).…”

mentioning

confidence: 99%

Role of Parental Monitoring in Understanding the Benefits of Parental Acceptance on Adolescent Adherence and Metabolic Control of Type 1 Diabetes

et al. 2008

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OBJECTIVE—This study examined 1) whether the benefits of mothers’ and fathers’ accepting relationships with their adolescents regarding diabetes control were due to parental monitoring and 2) how parents together may provide sufficient acceptance and monitoring for diabetes management. RESEARCH DESIGN AND METHODS—Adolescents aged 10–14 years with type 1 diabetes (n = 185) and their mothers (n = 185) and fathers (n = 145) completed assessments of parental acceptance and monitoring of diabetes tasks. Adolescents completed a modified version of the Self-Care Inventory (1) to measure adherence. A1C scores were used as a marker of glycemic control. RESULTS—Mediational analyses revealed that the benefits of adolescents’ reports of fathers’ acceptance on A1C and mothers’ and fathers’ acceptance on better adherence were partially mediated by monitoring. Both mothers’ and fathers’ monitoring and fathers’ acceptance had independent effects in predicting adherence. However, only fathers’ monitoring had an independent effect on A1C. The effect of fathers’ monitoring on A1C occurred as fathers were monitoring at a lower level than mothers. Mothers’ and fathers’ reports of their own acceptance and monitoring were not associated with A1C or adherence. CONCLUSIONS—Results reveal the importance of fathers’ acceptance and monitoring in diabetes management, a role that should be encouraged, despite the little attention it has received.

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“…13,27 In addition, there is growing consensus that youth whose parents are more engaged in diabetes management are more adherent than youth whose parents are less involved in diabetes tasks. 13,28 These associations, however, have not previously been assessed in patients initiating CGM. In this study, we found lower diabetes-specific family conflict reported by patients and parents interested in starting CGM in comparison with a general population of youth with type 1 diabetes.…”

Section: Discussionmentioning

confidence: 90%

Salient Characteristics of Youth with Type 1 Diabetes Initiating Continuous Glucose Monitoring

Teló

Volkening

Butler

et al. 2015

Diabetes Technology & Therapeutics

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Objective: Consistent continuous glucose monitoring (CGM) use is a challenge in youth with type 1 diabetes. This study aimed to investigate patient and family behavioral and clinical characteristics associated with interest in implementing CGM. Research Design and Methods: In a cross-sectional study, we compared 120 youth interested in starting CGM (the CGM group) with a general sample of 238 youth with type 1 diabetes (the Standard group). Youth and their parents completed validated surveys assessing adherence to diabetes management, diabetes-specific family conflict, parent involvement in diabetes management, and youth quality of life. Demographic and clinical data were obtained from chart review and interview. Results: Youth participants had a mean age of 13.0 -2.8 years, diabetes duration of 6.3 -3.4 years, and hemoglobin A1c (HbA1c) level of 8.2 -1.0% (66 -11 mmol/mol). Youth in the CGM group performed more frequent blood glucose monitoring, had lower HbA1c levels, and were more likely to be treated by continuous subcutaneous insulin infusion (CSII) and to be living in two-parent homes than youth in the Standard group. Compared with the Standard group, youth interested in wearing a CGM device and their parents reported greater adherence to diabetes management, less diabetes-specific family conflict, and higher youth quality of life. No differences were found between groups with respect to parent involvement in diabetes management by both youth and parent reports. Conclusions: In efforts to enhance CGM uptake, it is important to address factors such as blood glucose monitoring frequency, CSII use, adherence, and diabetes-specific family conflict when considering youth with type 1 diabetes for CGM implementation.

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Deviation from Developmentally Appropriate Self-Care Autonomy: Association with diabetes outcomes

Abstract: The findings indicate caution about encouragement of maximal self-care autonomy among youth with IDDM and suggest that families who succeed in maintaining parental involvement in diabetes management may have better outcomes.

Cited by 258 publications

References 14 publications

Clinical Implications of Psychosocial Factors on Pediatric External Fixation Treatment and Recommendations

Clinical Implications of Psychosocial Factors on Pediatric External Fixation Treatment and Recommendations

Role of Parental Monitoring in Understanding the Benefits of Parental Acceptance on Adolescent Adherence and Metabolic Control of Type 1 Diabetes

Salient Characteristics of Youth with Type 1 Diabetes Initiating Continuous Glucose Monitoring

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