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Purpose The purpose of this study was to explore how adults with prediabetes perceive their risk of developing diabetes and examine their preferences for evidence-based treatment options to prevent diabetes. Methods A qualitative study was conducted in 2 large Midwest primary care practices, involving in-depth semistructured interviews with 35 adult patients with prediabetes. Results This ethnically diverse (77% nonwhite) sample of middle-aged primary care patients exhibited multiple diabetes risk factors. Knowledge gaps about prediabetes and its medical management were pervasive. Most patients overestimated the risk of developing diabetes and were not familiar with evidence-based treatment options for prediabetes. They suggested that receiving brief, yet specific information about these topics during the study interview motivated them to act. The majority of participants considered both intensive lifestyle intervention and metformin acceptable treatment options. Many preferred initial treatment with intensive lifestyle intervention but would take metformin if their efforts at lifestyle change failed and their primary care physician recommended it. Some participants expressed wanting to combine both treatments. Conclusions This qualitative study highlights potential opportunities to promote patient-centered dialogue about prediabetes in primary care settings. Providing patients specific information about the risk of developing diabetes and evidence-based treatment options to prevent or delay its onset may encourage action. Physicians’ prediabetes counseling efforts should be informed by the finding that most patients consider both intensive lifestyle intervention and metformin acceptable treatment options.

Spatial skills are associated with mathematics skills, but it is unclear if spatial training transfers to mathematics skills for preschoolers, especially from underserved communities. The current study tested (a) whether spatial training benefited preschoolers’ spatial and mathematics skills, (b) if the type of feedback provided during spatial training differentially influenced children’s spatial and mathematics skills, and (c) if the spatial training’s effects varied by socioeconomic status (SES). Preschoolers (N = 187) were randomly assigned to either a ‘business-as-usual’ control or one of three spatial training groups (modeling and feedback [MF]; gesture feedback [GF]; spatial language feedback [SLF]). Three-year-olds were trained to construct puzzles to match a model composed of various geometric shapes. New models were created similar to the 2-dimensional trials of the Test of Spatial Assembly (TOSA). Training was given once per week for 5 weeks. Preschoolers were pretested and posttested on 2D and 3D TOSA trials, spatial vocabulary, shape identification, and 2 mathematics assessments. Results indicate that first, any spatial training improved preschoolers’ 2D TOSA performance, although a significant interaction with SES indicated improvement was driven by low-SES children. Furthermore, low-SES children showed greatest gains on the 2D TOSA with MF and GF. Second, MF and GF improved low-SES children’s performance on the 3D TOSA. Third, only low-SES children with MF saw improvements in far-transfer to mathematics (Woodcock-Johnson: Applied Problems, but not the Test of Early Mathematical Ability). Results indicate that, especially for low-income learners, spatial training can improve children’s early spatial and mathematics skills.

Aim: The present study investigates the role of attachment representation and mentalization as possibly protective factors in the relationship between early maltreatment and potential for violence in adolescence. Methods: For the current study, 161 adolescents, aged 14-21 years, were recruited from high schools and youth psychiatry. Early maltreatment was assessed by the Childhood Experiences of Care and Abuse Questionnaire, attachment was assessed using the Adult Attachment Projective Picture System, and mentalization was coded with the Reflective Functioning Scale from Adult Attachment Interviews. Potential for violence was operationalized using the Reactive-Proactive Aggression Questionnaire, and the presence of conduct disorder was assessed by the Structured Clinical Interview. Using structural equation modeling, reflective functioning and attachment were tested as mediators on the direct effect of early maltreatment on potential for violence. Results: There was a direct effect of early maltreatment on potential for violence. Furthermore, this direct effect was partially mediated by reflective functioning but not by attachment representations. Discussion: The results contribute to the idea that mentalization serves as a protective factor that may suspend the pathway from early maltreatment to violence in adolescence. Because of the transformation of attachment patterns into generalized cognitive models of attachment, attachment in adolescence may have a less pronounced effect on violence in this specific developmental phase. Future studies should test for further group differences in community and clinical groups, which was not possible in the present study due to the limited sample size.

Background: Low-dose computed tomography (LDCT) scan for lung cancer screening is underutilized.Studies suggest that up to one-third of providers do not know the current lung cancer screening guidelines.Thus, identifying the barriers to utilization of LDCT scan is essential. Methods: Primary care providers in three different healthcare settings in the United States were surveyed to assess provider knowledge of LDCT scan screening criteria, lung cancer screening practices, and barriers to the utilization of LDCT scan screening. Fisher's Exact, Chi-Squared, and Kruskal-Wallis tests were used to compare provider responses. Multivariable logistic regression was used to test the association between provider characteristics and the likelihood of utilizing LDCT scan for lung cancer screening. Results: The survey was sent to 614 providers, with a 15.7% response rate. Overall, 29.2% of providers report never ordering LDCT scans for eligible patients. Providers practicing at a community or academic hospital more frequently order LDCT scans than those practicing at a safety net hospital. Academic-and community-based providers received a significantly higher mean knowledge score than safety net-based providers [academic 6.84 (SD 1.33), community 6.72 (SD 1.46), safety net 5.85 (SD 1.38); P<0.01]. Overall, only 6.2% of respondents correctly identified all six Centers for Medicare and Medicaid Services eligibility criteria when challenged with three incorrect criteria. Common barriers to utilization of LDCT scan included failure of the electronic medical record (EMR) to notify providers of eligible patients (54.7%), patient refusal (37%), perceived high false-positive rate leading to unnecessary procedures (18.9%), provider time constraints (16.8%), and lack of insurance coverage (13.7%). Conclusions: Provider knowledge of lung cancer screening guidelines varies, perhaps contributing to underutilization of LDCT scan for lung cancer screening. Improved provider education at safety net hospitals and improving EMR-based best practice alerts may improve the rate of lung cancer screening.

Early spatial skills predict the development of later spatial and mathematical skills. Yet, it is unclear how comprehension of the words that capture spatial relations, words like behind and under, might be associated with children’s early spatial and mathematics skills. The current study addressed this question by conducting a moderated mediation model to test the potential moderating effects of group factors, such as socioeconomic status (SES) and gender, on the possible mediation of spatial language comprehension on the association between spatial skill and mathematics performance. In total, 192 3-year-olds were tested on a battery of assessments, including a novel Spatial Language Comprehension Task, a test of spatial skills (2- and 3-dimensional trials of the Test of Spatial Assembly [2D and 3D TOSA, respectively]), and a composite of 2 mathematical assessments. The results indicate that this novel Spatial Language Comprehension Task is a reliable measure useful for examining group differences and the early space–math link. Specifically, higher-SES preschoolers and females had higher spatial language comprehension compared with their lower-SES peers and males, respectively. These SES and gender disparities in spatial language comprehension are concerning, given the strong association between spatial language comprehension and mathematics skills. Additionally, spatial language comprehension mediated the association between spatial skill and mathematics performance for females only. Future work should examine the potential causal role that spatial language comprehension may have in concurrent and later spatial and mathematics skills.

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Geometric forms have formal definitions. While knowing shape names is considered important for school-readiness, many children do not understand the defining features of shapes until well into elementary school (Satlow & Newcombe, 1998). One reason is likely that they do not encounter enough variety in the shapes they see (citation removed). The present study observed 60 parents and their 3-year-old children during play with geometric toys, exploring how spatial language varied with the nature of the shape-toy set (canonical shapes versus a mix of canonical and unusual or less-canonical variants) and whether geometric shapes were presented as tangible, traditional toys or shown on a touchscreen tablet app. Although children in the app condition heard more shape names than the other conditions due to the language produced by the app itself, children used more overall words and more spatial language with tangible toys that included varied shapes. In addition, parents used more shape names with sons than with daughters and tended to adjust their use of spatial language more in response to varied shape sets with boys, although these findings need replication to evaluate generality. These data suggest that including non-canonical shapes in tangible shape toys may provide a low-cost, high-impact way of refining adult-child interactions that might facilitate children’s early geometric knowledge.