A gender-specific approach to improving substance abuse treatment for women: The Healthy Steps to Freedom program

Given that women increasingly report using drugs to lose weight, substance abuse treatment programs must include body image, weight, eating pathology, and health knowledge as core intervention targets. This study tested the efficacy of a supplemental health and body image curriculum designed for women in substance abuse treatment who report weight concerns called Healthy Steps to Freedom (HSF). Data from 124 adult women recruited from substance abuse treatment facilities in southern Nevada completed measures of drug use, body dissatisfaction, eating pathology, thin-ideal internalization, and health knowledge/behaviors before and after participation in the 12-week HSF program. Results revealed that thin-ideal internalization, body dissatisfaction, and eating disorder symptoms significantly decreased after HSF program participation, whereas health-related behaviors (e.g., increased healthy food consumption) and knowledge (e.g., understanding of basic nutrition, exercise) increased. These results suggest that the inclusion of the HSF program in substance abuse treatment improves weight-related issues in substance-abusing women.     

History of recurrent urinary tract infection is not predictive of abnormality on voiding cystourethrogram

Purpose

The American Academy of Pediatrics recently recommended against routine voiding cystourethrograms (VCUGs) in children 2 to 24 months with initial febrile UTI, raising concern for delayed diagnosis and increased risk of UTI-related renal damage from vesicoureteral reflux (VUR). We assessed factors potentially associated with higher likelihood of abnormal VCUG, including UTI recurrence, which could allow for more judicious test utilization.

Methods

We retrospectively reviewed all initial VCUGs performed at Children’s Hospital of Michigan between January and June, 2010. History of recurrent UTI was ascertained by evidence of two or more prior positive cultures or history of “recurrent UTI” on VCUG requisition. Outcomes assessed included rates of VUR or any urologic abnormality on VCUG.

Results

Two hundred and sixty-two patients met inclusion criteria. VUR was detected in 21.3 %, urologic abnormality including VUR in 27.4 %. Degree of bladder distension, department of referring physician, study indication, positive documented urine culture, and history of recurrent UTI or UTI and other abnormality were all not associated with increased likelihood of VUR or any urologic abnormality on VCUG.

Conclusion

VUR and VCUG abnormality are no more likely when performed after recurrent UTI or for UTI plus other abnormality. This reasons against postponing VCUG until after UTI recurrence, as positive findings are no more likely in this setting.     

Cepheid Xpert MRSA cycle threshold in discordant colonization results and as a quantitative measure of nasal colonization burden

We analyzed the cycle threshold (C(T)) of PCR surveillance MRSA swabs obtained from veterans. Lower C(T) on admission was associated with a positive culture from nasal swabs at discharge. Compared to PCR, direct plating of nasal swabs performed poorly, especially for patients with an elevated C(T). The C(T) is strongly correlated with quantitative nasal cultures. Clinical and infection control applications of the C(T) have yet to be defined and warrant further evaluation.     

Psychometric Findings for a Spanish Translation of the Diabetes Self-Management Profile (DSMP-Parent-Sp)

OBJECTIVE

Few validated measures exist to evaluate self-management of diabetes in families with limited English proficiency. The present study evaluated the psychometric properties and the factorial equivalence of a Spanish translation of the parent report version of the Diabetes Self-Management Profile (DSMP-Parent-Sp).

RESEARCH DESIGN AND METHODS

Hispanic families of youth (mean 13.7 years old) with type 1 diabetes were recruited from three clinics in South Florida and represented a wide range of nationalities and acculturation levels. A total of 127 parents reported on their child''s self-management behaviors using either the original DSMP-Parent (59.8%) or the DSMP-Parent-Sp (40.2%). In addition, youth reported their self-management using the original DSMP in English, and physicians rated their perceptions of the youth''s self-management. Glycemic control was indexed by A1C in the past 3 months and collected from medical chart review.

RESULTS

Item analysis confirmed that the DSMP-Parent-Sp items related to the overall composite score in expected ways, and internal consistency estimates were adequate. Paired correlations demonstrated strong parent-child concordance and a significant relationship with physician perceptions of self-management. Evidence of concurrent and convergent validity, as well as “strict factorial invariance,” was demonstrated.

CONCLUSIONS

These preliminary findings indicate that the DSMP-Parent-Sp is a reliable and valid parent report measure of the diabetes self-management behaviors of Hispanic youths. In addition, there is preliminary evidence that the translated measure may be considered equivalent to the original English measure when used to measure self-management in Hispanic youth with diabetes.Hispanics make up the nation''s largest minority group at ∼15% of the total U.S. population (1). In addition, they are the fastest growing and youngest minority group in the U.S., with projections indicating that 133 million Hispanics will reside in the U.S. by the year 2050. There is corresponding evidence of an increase in the rate of type 1 diabetes among Hispanic youth in some U.S. cities (2), and diabetes is diagnosed in 13.8 of every 100,000 U.S. Hispanic children between 10 and 19 years of age (3). Despite their increasing numbers, Hispanic youth have been underrepresented in pediatric research (4) and, more specifically, in the type 1 diabetes literature. The dearth of data regarding this growing population exists in part because of a lack of validated measures available for families with limited English proficiency. The present study provides psychometric data on a Spanish translation of a parent report diabetes self-management measure that has significant potential to affect the literature in this area.The existing diabetes literature points to the important role that parents play in diabetes care (5–7), and recent work suggests that Hispanic parents have a significant impact on youth''s self-management (8). However, non–English-speaking individuals, especially parents, are often excluded from research in health care settings (9). Although there is evidence that Hispanic youth in the U.S. often develop English language skills rapidly, parents of Hispanic youth may have limited English proficiency (10). In addition to language barriers, Hispanic caregivers face multiple risk factors that may have an impact on their children''s diabetes outcomes, including socioeconomic status and health literacy limitations (11). Therefore, it is important for pediatric diabetes researchers to overcome language barriers and find ways to incorporate Hispanic parents with limited English proficiency in their research and intervention initiatives.It is especially important to include Hispanic families of youth with type 1 diabetes, given recent epidemiological data from the SEARCH for Youth with Diabetes Study Group (3), which illustrates the disproportionate health burden and poor glycemic control seen in U.S. Hispanic youth with type 1 diabetes. In addition, studies comparing Hispanic youth and adults with type 1 diabetes with their white, non-Hispanic counterparts have demonstrated significant disparities in both glycemic control and risk for long-term complications associated with diabetes (3,12,13). Given the disparities, researchers have called for further investigation targeting the underlying processes that lead to poorer outcomes in Hispanic youth (14). To date, only one published study has examined adherence in Hispanic youth with type 1 diabetes (12). In addition, no validated Spanish measures of diabetes self-management for parents have been described in the literature.To address the current absence of Spanish diabetes self-management measures, we have developed a Spanish translation of the Diabetes Self-Management Profile for parent (DSMP-Parent) report, the DSMP-Parent-Sp. The DSMP was originally developed and validated in a predominantly non-Hispanic, white sample (15). The most recent version of the measure includes both Conventional Regimen and Flexible Regimen Forms (16). The Flexible Regimen Form is a revision of the earlier Conventional Regimen Form developed for specific use with youth who are given regimens that include carbohydrate counting. In the present psychometric evaluation of the translation, we present preliminary findings on the psychometric properties of the DSMP-Parent-Sp and its equivalence to the original English DSMP-Parent. First, we examined the internal consistency of the measure. Second, to support the validity of the measure, we examined its relationship to other reports of youth self-management (i.e., child and physician report), as well as its relationship to youth''s age and glycemic control. Based on previous findings, it was expected that parents'' ratings of their child''s self-management on the DSMP-Parent-Sp would be inversely associated with age, with older youth being reported to have poorer self-management. Parent ratings indicating better youth self-management were also expected to correspond with lower A1C levels in youth, reflecting better glycemic control. Finally, given the diversity that exists in the English proficiency of Hispanic families, it is important that the new measure can be used alongside the original English version. Therefore, we examined the equivalence of concepts in the DSMP-Parent-Sp and the original English measure through tests of factorial invariance.