Role of parenting style in achieving metabolic control in adolescents with type 1 diabetes

OBJECTIVE

To examine the role of parenting style in achieving metabolic control and treatment adherence in adolescents with type 1 diabetes.

RESEARCH DESIGN AND METHODS

Parents of 100 adolescents with type 1 diabetes completed assessments of their parenting style and sense of helplessness. Parents and patients rated patient adherence to the treatment regimen. Glycemic control was evaluated by HbA_1c values.

RESULTS

An authoritative paternal parenting style predicted better glycemic control and adherence in the child; a permissive maternal parenting style predicted poor adherence. A higher sense of helplessness in both parents predicted worse glycemic control and lesser adherence to treatment. Parental sense of helplessness was a significant predictor of diabetes control after correcting for other confounders (patient age, sex, and treatment method).

CONCLUSIONS

An authoritative nonhelpless parenting style is associated with better diabetes control in adolescents. Paternal involvement is important in adolescent diabetes management. These results have implications for psychological interventions.For children and adolescents with type 1 diabetes, the style in which their parents are involved in the daily disease management may be crucial to improving their glycemic control (1–4). Previous studies showed that an authoritative parenting style (characterized by setting clear limits to the child in a noncoercive manner) is associated with fewer behavioral problems in adolescents than a permissive parenting style (few efforts by the parents to direct and limit their child’s behavior) or an authoritarian parenting style (coercive, harsh and punitive parenting) (5–7). The degree to which parents feel helpless in influencing their child’s behavior also affects their ability to maintain appropriate levels of involvement in their child’s daily routine (8). On the basis of these findings, we hypothesized that glycemic control and treatment adherence in adolescents is better when their parents are more authoritative and less helpless.     

Pragmatic Language and School Related Linguistic Abilities in Siblings of Children with Autism

Siblings of probands with autism spectrum disorders are at higher risk for developing the broad autism phenotype (BAP). We compared the linguistic abilities (i.e., pragmatic language, school achievements, and underling reading processes) of 35 school-age siblings of children with autism (SIBS-A) to those of 42 siblings of children with typical development. Results indicated lower pragmatic abilities in a subgroup of SIBS-A identified with BAP related difficulties (SIBS-A-BAP) whereas school achievements and reading processes were intact. Furthermore, among SIBS-A-BAP, significant negative correlations emerged between the severity scores on the Autism Diagnostic Observation Schedule and full and verbal IQ scores. These results are discussed in the context of the developmental trajectories of SIBS-A and in relation to the BAP.     

Like cognitive function,decision making across the life span shows profound age-related changes

It has long been known that human cognitive function improves through young adulthood and then declines across the later life span. Here we examined how decision-making function changes across the life span by measuring risk and ambiguity attitudes in the gain and loss domains, as well as choice consistency, in an urban cohort ranging in age from 12 to 90 y. We identified several important age-related patterns in decision making under uncertainty: First, we found that healthy elders between the ages of 65 and 90 were strikingly inconsistent in their choices compared with younger subjects. Just as elders show profound declines in cognitive function, they also show profound declines in choice rationality compared with their younger peers. Second, we found that the widely documented phenomenon of ambiguity aversion is specific to the gain domain and does not occur in the loss domain, except for a slight effect in older adults. Finally, extending an earlier report by our group, we found that risk attitudes across the life span show an inverted U-shaped function; both elders and adolescents are more risk-averse than their midlife counterparts. Taken together, these characterizations of decision-making function across the life span in this urban cohort strengthen the conclusions of previous reports suggesting a profound impact of aging on cognitive function in this domain.Scientists in many disciplines have observed that age is an important determinant of decision making under uncertainty. There has been, however, disagreement about how and why attitudes toward uncertainty change with age (e.g., 1–3). There has even been controversy about the basic decision-making preference structures of midlife adults. The most important result of this controversy has been the reliance, by policy makers, on a set of stylized facts about the decision making of the “representative” midlife agent. At the same time, it is now widely acknowledged that general measures of cognitive function show profound changes across the life span (e.g., 4–8). It thus seems pressing to empirically examine decision-making changes over the life span.Just as we have begun to rely on the representative midlife agent at a policy level, our society has been increasingly concerned with the decision making of both its youngest and oldest members. Mortality and morbidity rates for adolescent decision makers continue to rise (9). The population above 65 y of age continues to grow (10), and a growing literature indicates that older adults make decisions detrimental to their wealth, health, and general well-being. Elders borrow at higher interest rates, use credit balance transfers suboptimally, misestimate property value, and pay more fees to financial institutions (11). Most older adults even fail to choose health plans correctly (12). Older adults are also more likely to make errors when voting (13). At the policy, institutional, and organizational levels, these facts stress the importance of understanding and knowing how to assist elder decision makers.Some of these formally poor decisions can be attributed to unhealthy aging, cognitive impairment, and dementia. Over 13% of adults over 71 y old have some quantifiable dementia (14), and 22.2% suffer from serious cognitive decline (15). Of course, aging takes various forms, and many older adults have motor or sensory changes but are not necessarily cognitively impaired, whereas others experience healthy aging. It is far from clear that poor decision making by elders necessarily reflects some kind of cognitive impairment. It may well be that healthy older adults make “bad” decisions because their preferences or choice efficiencies are different from those of their younger peers (16–20).Here we intensively characterized the preferences and choice efficiency of a small cohort of urban decision makers of 12 to 90 y of age, selecting only those subjects who showed the cognitive hallmarks of healthy aging. We examined their decisions in an incentive-compatible manner under conditions of “risk” and under conditions of “ambiguity,” both in the domain of losses and in the domain of gains. We measured choice accuracy and consistency, as well as individual preferences. In risky situations, the likelihood of different consequences following a choice can be described by objectively known probabilities. In ambiguous situations, these probabilities are either partially or completely unknown. Oddly enough, the studies available to date that have examined age-related differences in decision making under uncertainty have either focused on risk alone or have used tasks that convolve risk and ambiguity in an inseparable manner (21). It is in part this separation of the constituent processes of decision making that allows for several of the unique conclusions presented here.     

Maxillary sinus augmentation in the presence of antral pseudocyst: a clinical approach.

OBJECTIVE: The objective of this study is to present patients with sinus augmentation in the presence of an antral pseudocyst and the surgical procedure, complications, and outcome. STUDY DESIGN: From 2002 to 2005, 109 patients were scheduled for 1- or 2-stage maxillary sinus floor augmentation (n = 129) because of inadequate alveolar bone height for implant placement. Radiographically, a significant antral pseudocyst was shown. RESULTS: In 8 (7.3%) patients, an antral pseudocyst was diagnosed, and in 2 a history of inactive sinusitis was found preoperatively. A faint dome-shaped radiopacity was found at the lower border of the maxillary sinus. Average lesion size was 5.09 cm2. All implants functioned well at follow-up (mean 20 months). CONCLUSION: A pseudocyst of the maxillary sinus is not a contraindication for sinus augmentation. The low frequency of sinus membrane perforation and postsurgery sinusitis make the operation safe. In large lesions and in cases with an unclear diagnosis, further evaluation is needed before sinus augmentation.     

Estradiol and nicotine exposure enhances A549 bronchioloalveolar carcinoma xenograft growth in mice through the stimulation of angiogenesis

Angiogenesis is required for lung cancer growth, which is mediated by various growth factors such as vascular endothelial growth factor (VEGF). Increases in VEGF and angiogenesis have been correlated with poor prognosis and survival in patients with lung cancer. In addition, recent reports show that estradiol and nicotine play important roles in lung tumor initiation and progression. In this report, we demonstrate that estradiol and nicotine exposure enhances the growth of A549 bronchioloalveolar carcinoma xenografts in mice through the stimulation of cell proliferation, VEGF secretion and angiogenesis. We detect a four-fold increase in microvascular density in tumors from mice exposed to estradiol and nicotine compared to control tumors resulting in an increase in tumor growth. Intriguingly, the effects on angiogenesis and tumor growth by the combination of agents were additive when compared to either agent alone. Furthermore, estradiol promotes VEGF secretion from various non-small cell lung carcinoma (NSCLC) cells and this effect is augmented by nicotine in a tumor xenograft model. These results indicate that aside from their roles in promoting cell proliferation, estradiol and nicotine appear to have additive effects on the induction of angiogenesis through the stimulation of VEGF secretion during NSCLC progression.