Family Physician Clinical Inertia in Managing Hypoglycemia

AimsClinical inertia behaviour affects family physicians managing chronic disease such as diabetes. Literature addressing clinical inertia in the management of hypoglycemia is scarce. The objectives of this study were to create a measurement for physician clinical inertia in managing hypoglycemia (ClinInert_InHypoDM), and to determine physicians’ characteristics associated with clinical inertia.MethodsThe study was a secondary analysis of data provided by family physicians from the InHypo-DM Study, applying exploratory factor analysis. Principal axis factoring with an Oblimin rotation was employed to detect underlying factors associated with physician behaviors. Multiple linear regression was used to determine association between the ClinInert_InHypoDM scores and physician characteristics.ResultsFactor analysis identified a statistically sound 12-item one-factor scale for clinical inertia behavior. No statistically significant differences in clinical inertia score for the studied independent variables were found.ConclusionsThis study provides a scale for assessing clinical inertia in the management of hypoglycemia. Further testing this scale in other family physician populations will provide deeper understanding about the characteristics and factors that influence clinical inertia. The knowledge derived from better understanding clinical inertia in primary care has potential to improve outcomes for patients with diabetes.     

Les répercussions psychiques du cancer chez l’adolescent et le jeune adulte – AJA – et la famille : revue de la littérature narrative

Adolescent and young adult cancer – AYA – enters a period of life during which a dynamic developmental process takes place, particularly with the existential issues of separation-individualization and empowerment at stake. The experience of cancer is in fact a major ordeal, a major upheaval not only for the young person but also for his entire family. This review of the narrative literature aims to take stock of current knowledge on the psychological repercussions of serious illness on the AYA and his family. After presenting results, we will propose recommendations for the clinic and avenues for future research.     

学龄前儿童气质和家庭环境对适应行为的影响

目的 研究学龄前儿童适应行为发展的特点, 探讨气质和家庭环境对适应行为的影响, 为促进儿童适应行为的发展提供参考依据。方法 于2019年10月采取随机整群抽样的方法选取西安市3所幼儿园304名4~6岁儿童家长进行问卷填写, 采用方差分析、相关分析和回归分析探讨学龄前儿童气质、家庭环境对适应行为的影响。结果 1)学龄前儿童独立因子、认知功能因子、社会/自制因子及适应能力商数(ADQ)在年龄上差异有统计学意义(F=15.49、6.31、18.17、20.91, P＜0.05), 适应行为随着年龄的增长不断发展。2)节律性、适应性、反应强度、持久性、反应域、亲密度与ADQ显著相关(r=-0.18、-0.17、0.15、-0.13、0.18、0.28, P＜0.05);节律性、适应性、亲密度、矛盾性与独立因子显著相关(r=-0.16、-0.18、0.26、-0.13, P＜0.05), 节律性、持久性、亲密度、知识性与认知功能因子显著相关(r=-0.14, -0.17、0.18、0.11, P＜0.05);反应强度、注意分散、反应域、亲密度、组织性与社会因子显著相关(r=0.19、0.13、0.21、0.21、0.13, P＜0.05)。3)家庭亲密度(β=0.28)、气质的节律性(β=-0.15)和反应阈(β=0.14)可以共同预测适应行为(F=14.75, P<0.001)。结论 学龄前儿童的适应行为的发展受年龄、气质和家庭环境的影响, 因此, 根据儿童的气质特点, 创造适宜的家庭环境, 能够促进学龄前儿童适应行为的全面发展。     

Relationship between retail food outlets near public schools and adolescent obesity in New York City

Using objectively-measured height and weight data from academic years 2009–2013 (n = 1,114,010 student-year observations), we estimated the association between the food outlet in closest proximity to schools and the likelihood of obesity among New York City public high school students. Obesity risk was higher for students with a corner store as the nearest option to schools, regardless of whether other food outlet types were located within a quarter mile or a half mile of schools (i.e., benchmarks for zoning policies). Policymakers may want to consider introducing healthier food options near schools, in conjunction with programs to support changes within corner stores.     

Family-centered Care for Sick Newborns: A Thumbnail View

Family-centered care (FCC) for sick newborns is emerging as a paradigmatic shift in the practice of facility-based newborn care. It seeks to transforming a provider-centered model into a client-centered one and thus build a new therapeutic alliance. FCC is the cornerstone of continuum of care, imparting caregiving competencies to parents/caregivers both within institutions as well as after the discharge. This has potential gains for the newborn, family members, and facility-level staff. The initial model piloted in tertiary-care settings is now undergoing translation at five sites across the country; the outcomes are keenly awaited.     

Availability and use of neighborhood resources by older people with osteoarthritis: Results from the European Project on OSteoArthritis

This study examines the availability and use of neighborhood resources in relation to clinical lower limb osteoarthritis (LLOA) in older participants from six European countries. Of the 2757 participants (65–85 years), 22.7% had LLOA. Participants with LLOA made more use of places to sit (OR=2.50; CI: 1.36–4.60 in the UK), and less use of parks and walking areas (OR=0.30; CI: 0.12–0.75 in Sweden), compared to participants without LLOA, particularly in countries with high availability of resources. The results suggest that specific features of the environment impact the use of neighborhood resources by older adults with LLOA.     

Longitudinal effects of educational involvement on parent and family functioning among mothers of children with ASD

Utilizing a cohort sequential design and multilevel modeling on a sample of 113 mothers, the effects of three forms of maternal educational involvement (school-based involvement, home-based involvement, and home-school communication) on maternal and family functioning (maternal psychological distress, parenting efficacy, and family cohesion) were assessed over a seven year period when children with ASD in the study were 7–14 years of age. Findings indicated that maternal home-based educational involvement was linked to decreased psychological distress as well as to increased parenting efficacy and family cohesion, while home-school communication was linked to decreased distress and increased parenting efficacy (school-based involvement was related to decreased maternal distress only). In addition, in two instances, home-based involvement was found to moderate the effects of child and maternal risk factors (child problem behavior and stress proliferation) on maternal and family outcomes. Study findings are discussed in light of prior research and study limitations and implications are highlighted.