OBJECTIVETo report results from YourWay, an Internet-based self-management intervention for adolescents with type 1 diabetes.RESEARCH DESIGN AND METHODSA total of 72 adolescents with type 1 diabetes, ages 13–17 years, were randomized to a usual-care-plus-Internet support or a usual-care group. The intervention was designed to enhance problem-solving barriers to self-management. A1C was obtained from medical records, and problem-solving and self-management were obtained via adolescent report.RESULTSGroup differences were not statistically significant using intent-to-treat analyses. Using as-treated analyses, adolescents in the treatment condition showed statistically significant improvement in self-management (d = 0.64; P = 0.02) and important improvements in problem-solving (d = 0.30; P = 0.23) and A1C (d = −0.28; P = 0.27). Mean A1C for the intervention group remained constant (−0.01%), while the control group increased (0.33%).CONCLUSIONSThis brief trial suggests that self-management support delivered through a secure website may improve self-management and offset typical decreases in adolescent glycemic control.

Progress in implementing evidence-based behavioral practices has been slow. A qualitative study was performed to characterize the major facilitators and barriers to evidence-based practice (EBP) perceived by behavioral professionals. Members of professional e-mail listservs were queried and 84 barriers and 48 facilitators were nominated by 37 respondents. Thematic analysis revealed seven themes to describe both barriers and facilitators: (a) training, (b) attitudes, (c) consumer demand, (d) logistical considerations, (e) institutional support, (f) policy, and (g) evidence. Most frequently cited barriers included negative attitudes about EBP and lack of training. Barriers also reflected confusion between EBP and the products of EBP (i.e., empirically supported treatments [ESTs]). Main facilitators included a growing evidence base. Results suggest that uptake of EBP may be facilitated by education and training.

Patient web portals (PWPs), defined as the integration of electronic medical records and patient health records, have been related to enhanced patient outcomes. A literature review was conducted to characterize the design and evaluation of PWPs to improve health care processes and outcomes in diabetes. A summary of 26 articles revealed the positive impact PWPs have on patient outcomes, patient-provider communication, disease management, and access to and patient satisfaction with health care. Innovative and useful approaches included the evaluation of specific components of the PWPs, assessing the impact of PWPs on mediators of health behaviors, such as patient distress, identification of barriers to use, and patient willingness to pay for access. Future research should focus on relevant processes that mediate patient and provider use, impact on health care utilization, and a patient-centered approach to the design and integration of educational opportunities afforded through PWPs.

We examined the relationship between nocturnal respiratory disturbance and learning and compared learning in children with and without nocturnal respiratory disturbance. Subjects were 149 participants in a prospective cohort study examining sleep in children ages 6-12: The Tucson Children's Assessment of Sleep Apnea study (TuCASA). Sleep was assessed via home polysomnography. Intelligence, learning and memory, and academic achievement were assessed. Parents rated attention. Group comparisons were used to test the hypothesis that the group with an apnea/hypopnea index (AHI) of 5 or more (n = 77) would have weaker performance than the group with AHI less than 5 (n = 72). The group with AHI of 5 or more had weaker learning and memory though differences between groups decreased when arousals were taken into account. There was a greater percentage of Stage 1 sleep in the AHI 5 or more group, and Stage 1 percentage was negatively related to learning and memory in the sample (n = 149). There were negative relationships between AHI and immediate recall, Full Scale IQ, Performance IQ, and math achievement. Hypoxemia was associated with lower Performance IQ. Thus, findings suggest that nocturnal respiratory disturbance is associated with decreased learning in otherwise healthy children, that sleep fragmentation adversely impacts learning and memory, and that hypoxemia adversely influences nonverbal skills.

Racial/ethnic minorities, older adults, and persons with lower health literacy or more depressive symptoms appeared to be the least engaged in a mHealth intervention. To facilitate equitable intervention impact, future research should identify and address factors interfering with mHealth engagement.

Summary We conducted a pilot trial of a new mobile and web-based intervention to improve diabetes adherence. The text messaging system was designed to motivate and remind adolescents about diabetes self-care tasks. Text messages were tailored according to individually-reported barriers to diabetes self-care. A total of 23 adolescents with type 1 diabetes used the system for a period of three months. On average, they received 10 text messages per week (range 8–12). A matched historical control group from the same clinic was used for comparison. After three months, system users rated the content, usability and experiences with the system, which were very favourable. Comparison of the intervention and control groups indicated a significant interaction between group and time. Both groups had similar HbA1c levels at baseline. After three months, the mean HbA1c level in the intervention group was unchanged (8.8%), but the mean level in the control group was significantly higher (9.9%), P = 0.006. The results demonstrate the feasibility of the messaging system, user acceptance and a promising effect on glycaemic control. Integrating this type of messaging system with online educational programming could prove to be beneficial.

Objective-This prospective study characterizes trajectories of symptoms and impairment in pediatric patients with abdominal pain not associated with identifiable organic disease. Method-TheChildren's Somatization Inventory and the Functional Disability Inventory were administered four times over 5 years to 132 patients (6-18 years old) seen in a pediatric gastroenterology clinic. Individual trajectories were empirically grouped and correlates of trajectory group membership at baseline were evaluated.Results-A model with three unique trajectories was found to adequately fit both symptom and impairment data. Two trajectories indicated relatively long-term improvement and one indicated continued high levels of symptoms and impairment. At baseline, the long-term risk group did not have the most severe pain but had significantly more anxiety, depression, lower perceived selfworth, and more negative life events.Conclusions-These results indicate that several distinct trajectories of relatively long-term outcomes may exist in children with functional abdominal pain. One trajectory indicated longterm risk for a high level of symptoms and impairment. Psychosocial correlates of long-term risk for physical symptoms and impairment, such as child-reported stress and internalizing symptoms, may be useful for treatment planning. Keywordsfunctional abdominal pain; somatic symptoms; impairment; trajectories; longitudinal; children Abdominal pain is one of the most common reasons for referral to pediatric primary care and gastroenterology clinics (Starfield et al., 1980). Recurrent episodes of pain over a period of several months or longer may affect as many as 10% to 24% of children and adolescents Hyams et al., 1996;Oster, 1972 pain in children is functional-without objective evidence of organic disease (Boyle, 1997;Walker et al., 2004). Some children with persistent abdominal pain also report a variety of additional symptoms including headaches, fatigue, dizziness, and nonspecific somatic complaints (Oster, 1972), suggesting the possibility of a somatization disorder (Ernst et al., 1984;Walker et al., 1991). Moreover, abdominal pain and associated somatic symptoms can have a considerable impact on children's daily functioning both academically and socially (Claar et al., 1999).Prospective studies have shown that many children with abdominal pain continue to complain of somatic symptoms and disability years after their initial evaluation (Apley and Hale, 1973;Christensen and Mortensen, 1975;Magni et al., 1987;Stickler and Murphy, 1979;Walker et al., 1995Walker et al., , 1998. For any patient population, however, the average longitudinal trajectory rarely describes all individuals. To date, subgroups of change have not been delineated for pediatric abdominal pain and the relationship between initial status and trajectories of change across time has not been investigated. Characterization of unique patterns of change is important because it may identify profiles of long-term risk that facilitate tailoring interventions fo...

Insulin pumps and continuous glucose monitors (CGM) are increasingly important components of managing type 1 diabetes (T1D) and have been shown to improve glycemic control, health-related quality of life, and treatment satisfaction. [1][2][3][4][5] Device users report benefits such as increased flexibility and freedom and decreased stress.6,7 However, consistent adherence to wearing these devices requires a complex set of user behaviors. Device wearers must change insulin pump and CGM sites frequently; order and maintain the proper supplies and prescriptions; calibrate the CGM through regular blood glucose checks; count carbohydrates; and administer boluses.8,9 Table 1 outlines the numerous adherence tasks required for using insulin pumps and CGM, divided by frequency of engagement in each task.Greater CGM adherence-and engagement in the tasks outlined in Table 1-has been linked to optimal diabetes outcomes. [10][11][12][13][14][15] Specifically, wearing a CGM 6 or more days a week, 15 or at least 60% of the time, 14 has been linked to greater improvements in HbA1c compared to wearing a CGM fewer than 6 days a week. More frequent blood glucose monitoring has been linked to greater CGM adherence and greater benefit from CGM.12 Furthermore, greater adherence to CGM has been linked to better treatment satisfaction; frequent users may focus more on benefits outweighing the hassles while infrequent users focus more on hassles Abstract Background: Insulin pumps and continuous glucose monitors (CGM) can improve glycemic control for individuals with type 1 diabetes (T1D). Device uptake rates continue to show room for improvement, and consistent adherence is needed to achieve better outcomes. Diabetes health care providers have important roles to play in promoting device use and adherence. Methods:We surveyed 209 clinicians who treat people with type 1 diabetes to examine perceptions of barriers to device uptake, attitudes toward diabetes technology, and resources needed for clinicians to improve device uptake. We compared findings with our survey of adults with T1D.Results: Younger clinicians treated more patients using insulin pumps (r = -.26, P < .001) and CGM (r = -.14, P = .02), and had more positive attitudes about diabetes technology (r = -.23, P = .001). The most frequently endorsed modifiable barriers were perceptions that patients dislike having the device on their body (73% pump; 63% CGM), dislike the alarms (61% CGM), and do not understand what to do with device information or features (40% pump; 46% CGM). Clinicians wanted lower cost and better insurance coverage for their patients, and they recommended counseling and education to help address barriers and improve adherence to devices. Conclusion:Clinicians perceive many barriers to their patients initiating and adhering to diabetes devices. Findings highlight opportunities for intervention to improve clinician-patient communication around device barriers to help address them.