Satisfaction with the Health Care Provider and Regimen Adherence in Minority Youth with Type 1 Diabetes.

To assess whether satisfaction with the health-care provider is related to regimen adherence among primarily minority youth with type 1 diabetes. Youth with type 1 diabetes (n = 169; M age = 13.88; 52 % female; 70 % Hispanic) and their parents completed questionnaires that assessed their own satisfaction with the health-care provider and youths' adherence to diabetes self-care behaviors. Higher youth and parent patient-provider relationship satisfaction was associated with higher regimen adherence. Gender affected the relationship between satisfaction and regimen adherence, such that for girls, greater satisfaction was associated with better adherence; this was not the case for boys. Patient satisfaction with the health care provider is important for regimen adherence among primarily minority youth with type 1 diabetes, particularly for girls. Future research might focus on improving youths' relationships with their health care providers as a potential pathway to improve regimen adherence.

Prescribed regimen intensity in diverse youth with type 1 diabetes: role of family and provider perceptions.

Recent literature suggests that disparities in prescribed treatments may exist for youth with type 1 diabetes. There is limited research to date examining factors associated with prescribed regimen intensity in this population. In this study, we examined racial/ethnic differences in regimen intensity and predictors of regimen intensity in youth with type 1 diabetes. We expected that minority youth would have less intensive regimens and that caregiver and physician perceptions would be associated with regimen intensity. This cross-sectional study included 178 families of 10- to 17-yr-old youth at three endocrinology clinics. Caregivers reported perceived costs and benefits of intensive regimens. Physicians described the prescribed treatment and their perceptions of family/child competence and self-management. Analyses included analysis of covariance and hierarchical multiple linear regression. Findings indicate a disparity in regimen intensity for minority youth. Caregiver perceptions of costs associated with intensive regimens and physician perceptions of family competence are associated with prescribed regimen intensity. Interventions targeting disparities in prescribed regimen intensity should be considered. Further research is needed to understand the role of family perceptions of treatments and physician clinical decision making in addressing health disparities in type 1 diabetes.

Independent neural coding of reward and movement by pedunculopontine tegmental nucleus neurons in freely navigating rats.

Phasic firing of dopamine (DA) neurons in the ventral tegmental area (VTA) and substantia nigra (SN) is likely to be crucial for reward processing that guides learning. One of the key structures implicated in the regulation of this DA burst firing is the pedunculopontine tegmental nucleus (PPTg), which projects to both the VTA and SN. Different literatures suggest that the PPTg serves as a sensory-gating area for DA cells or it regulates voluntary movement. This study recorded PPTg single-unit activity as rats perform a spatial navigation task to examine the potential for both reward and movement contributions. PPTg cells showed significant changes in firing relative to reward acquisition, the velocity of movement across the maze and turning behaviors of the rats. Reward, but not movement, correlates were impacted by changes in context, and neither correlate type was affected by reward manipulations (e.g. changing the expected location of a reward). This suggests that the PPTg conjunctively codes both reward and behavioral information, and that the reward information is processed in a context-dependent manner. The distinct anatomical distribution of reward and movement cells emphasizes different models of synaptic control by PPTg of DA burst firing in the VTA and SN. Relevant to both VTA and SN learning systems, however, PPTg appears to serve as a sensory gating mechanism to facilitate reinforcement learning, while at the same time provides reinforcement-based guidance of ongoing goal-directed behaviors.

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.