糖尿病教育在2型糖尿病防控工作中的重要性

近年来,由于糖尿病的高患病率、高致残率和高死亡率带来沉重的社会和经济负担。预防糖尿病发生、改善糖尿病患者现况等均提示推广普及糖尿病教育具有重要意义。通过糖尿病教育可以全面改善患者临床控制指标、知识水平、自我管理水平和自我效能水平,且从卫生经济学角度分析显示其投入相对较小的成本即可达到良好的效果和效用,因而在糖尿病防控体...     

Parental and family risk factors for substance use in inner-city African-American children and adolescents

The purpose of this study was to develop and test a multidimensional model of parental and family influences on risk for substance use in inner-city African-American primary grade children and their adolescent siblings. The risk factors investigated were conceptually grouped into three broad domains of family influences and the respective indices computed: parental risk attributes, family risk attributes, and parenting styles. Parenting styles were captured as indicators of a latent construct, poor parenting. In study 1, we hypothesized that the parental and family risk variables would be mediated through parenting styles to predict intentions to use drugs, actual drug use, positive drug attitudes, and negative drug attitudes in a sample of 455 inner-city African-American families and their primary-grade children. In study 2, the substance use risk model was tested on a sample of 59 adolescent sibilings to determine whether the pattern of parental and family factors that contributed to early high-risk attitudes and behaviors in children would predict drug attitudes and behaviors in teen siblings. The results confirmed our expectations that parental and family risks were important predictors of childrens' negative drug attitudes and intentions to use drugs in the future and that positive parental and family characteristics would protect against future risk by enhancing negative drug attitudes. Also, substance use attitudes and behaviors in the teen siblings were predicted primarily by family risk characteristics. The family risk index also predicted frequency of use of hard drugs, but only when mediated through poor parenting. The implications of these results for future research are discussed.     

Amygdala upregulation of NCAM polysialylation induced by auditory fear conditioning is not required for memory formation, but plays a role in fear extinction

There is much interest to understand the mechanisms leading to the establishment, maintenance, and extinction of fear memories. The amygdala has been critically involved in the processing of fear memories and a number of molecular changes have been implicated in this brain region in relation to fear learning. Although neural cell adhesion molecules (NCAMs) have been hypothesized to play a role, information available about their contribution to fear memories is scarce. We investigate here whether polysialylated NCAM (PSA-NCAM) contributes to auditory fear conditioning in the amygdala. First, PSA-NCAM expression was evaluated in different amygdala nuclei after auditory fear conditioning at two different shock intensities. Results showed that PSA-NCAM expression was increased 24 h post-training only in animals subjected to the highest shock intensity (1mA). Second, PSA-NCAM was cleaved in the basolateral amygdaloid complex through micro-infusions of the enzyme endoneuraminidase N, and the consequences of such treatment were investigated on the acquisition, consolidation, remote memory expression, and extinction of conditioned fear memories. Intra-amygdaloid cleavage of PSA-NCAM did not affect acquisition, consolidation or expression of remote fear memories. However, intra-amygdaloid PSA-NCAM cleavage enhanced fear extinction processes. These results suggest that upregulation of PSA-NCAM is a correlate of fear conditioning that is not necessary for the establishment of fear memory in the amygdala, but participates in mechanisms precluding fear extinction. These findings point out PSA-NCAM as a potential target for the treatment of psychopathologies that involve impairment in fear extinction.     

Lack of phenotype for LTP and fear conditioning learning in calpain 1 knock-out mice

We previously proposed the hypothesis that calpain activation played an important role in long-term potentiation (LTP) of synaptic transmission in hippocampus. Two forms of calpain are predominant in brain tissues, calpain 1 (mu-calpain), activated by micromolar calcium concentration and calpain 2 (m-calpain), activated by millimolar calcium concentration in vitro. In the present study, we tested the role of calpain 1 in LTP and in learning and memory using calpain 1 knock-out mice. Changes in learning and memory were assessed using both context and tone fear conditioning. No differences in freezing responses were observed between the knock-out and the wild-type animals during the acquisition phase of the training, eliminating the possibility that the knock-out animals could be differentially affected by the foot shock. Likewise, no differences in freezing responses elicited by either the context or the tone were observed during the retention phase. No differences in short-term potentiation (STP) or LTP were observed in hippocampal slices from the knock-out and matched wild-type mice. Several interpretations might explain these negative results. First, it is conceivable that calpain 2 plays a more dominant role in neurons, and that calpain 1 makes a minor contribution as opposed to its suspected predominant role in the hematopoietic system. Alternatively, it is conceivable that some as yet unknown compensatory mechanisms take effect, and that calpain 2 or another calpain isoform substitutes for the missing calpain 1.     

Fear of Hypoglycemia in Parents of Young Children with Type 1 Diabetes Mellitus

The current study examined fear of hypoglycemia in 81 mothers and 64 fathers of young children with type 1 diabetes (T1DM) using the Hypoglycemia Fear Survey-Parents of Young Children (HFS-P-YC possible range = 26–130). Mothers and fathers completed the HFS-P-YC at enrollment and mothers completed it 2 weeks later. Families recorded daily blood glucose on a standardized meter for 2 weeks. Mothers’ mean total HFS-P-YC score was 75.0 (SD = 17.2) and fathers’ mean score was 66.5 (SD = 18.0). Mothers reported greater HFS-P-YC total and behavior subscale scores than fathers. Mothers’ HFS-P-YC scores were comparable to published HFS scores for mothers of preadolescents with T1DM and higher than adult patients with T1DM. The HFS-P-YC had good internal consistency and test–retest reliability in this sample. These findings suggest parents of young children with T1DM report a high level of fear of hypoglycemia. Additionally, the HFS-P-YC appears to be a reliable measure in this population.     

伴家族史的2型糖尿病危险因素的病例对照研究

为探讨2型糖尿病代谢特征及发病的危险因素,选取大连地区91例有家族史的T2DM患者为病例组,以44例患者的配偶（糖耐量正常）为对照组,进行流行病学问卷调查和体格检查,同时测定空腹血糖、空腹胰岛素、总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白等指标,采用稳态模型法计算两组的胰岛素抵抗指数和β细胞功能指数,并进行多因素非条件Logistic回归分析。结果显示：TG、腰臀比和Ln（HOMAIR）病例组高于对照组,而Ln（HOMAβ）则病例组低于对照组,均具有统计学意义（P〈0．05）。多因素非条件Logistic回归分析结果提示,影响T2DM发病的因素有心血管疾病史、Ln（HOMAIR）及Ln（HOMAβ）。由此可见T2DM患者存在血脂代谢异常;心血管疾病史和Ln（HOMAIR）为发病的危险因素,Ln（HOMAβ）为保护因素。     

Evidence for an encounter expectancy bias in fear of spiders

Whereas research has demonstrated that phobic or fearful individuals overestimate the likelihood of incurring aversive consequences from an encounter with feared stimuli, it has not yet been systematically investigated whether these individuals also overestimate the likelihood (i.e., the frequency) of such encounters. In the current study, spider-fearful and control participants were presented with background information that allowed them to estimate the overall likelihood that different kinds of animals (spiders, snakes, or birds) would be encountered. Spider-fearful participants systematically overestimated the likelihood of encountering a spider with respect to the likelihood of encountering a snake or a bird. No such expectancy bias was observed in control participants. The results thus strengthen our idea that there indeed exist two different types of expectancy bias in high fear and phobia that can be related to different components of the fear response. A conscientious distinction and examination of these two types of expectancy bias are of potential interest for therapeutic applications.     

The relationship of offending style to psychological and social risk factors in a sample of adolescent males

Research has indicated that life‐course persistent offenders typically vary their offending style, following a criminal career progression from co‐ to solo‐offending. Few studies have investigated the offenders who contemporaneously mix their style of offending. A sample of 1,047 male adolescent offenders from the Pathways to Desistance study was investigated over a 7‐year period. Participants were identified as solo, co or contemporaneous mixed style (CMS) offenders for each wave of data and one‐way between groups analysis of variance was conducted to examine variations between the different offending styles in terms of offending frequencies, exposure to violence, peer antisocial behaviour and influence, resistance to peer influence, impulse control and psychopathy. CMS offenders were found to consistently report significantly higher rates of offending and present significantly higher negative risk factors and lower protective risk factors than solo‐ and co‐offenders for the duration of the study. A multinomial logistic regression was used to investigate predictors of offending style with CMS as the reference category. Higher levels of exposure to violence and peer antisocial behaviour and lower levels of impulse control predicted membership of the CMS group for the first part of the study when compared with co‐offenders; and higher levels of exposure to violence and peer antisocial behaviour continued to predict CMS offending when compared to solo‐offenders until the end of the study.     

Self-reported Diabetes Prevalence and Risk factors in South Africa: Results from the World Health Survey

Using the data from the South African World Health Survey (WHS), the current study aims to assess the self-reported prevalence of diabetes and associated risk factors by socio-economic characteristics in South Africa. A population-based survey of 2314 participants (1116 men and 1236 women) was conducted in South Africa in 2003. Results indicate an overall self-reported diabetes prevalence of 9.1%, 7.1% for men and 10.8% for women. In terms of diabetes risk factors, high rates of overweight or obesity (58.4%), physical inactivity (55.2%), less than 5 servings of fruits and vegetables in a day (69.3%), and medium or high stress levels (63.3%) were found; 18.4% were smoking daily and 7.3% were risky drinkers. Univariate regression analyses found that from the six different risk factors none apart from having high stress were associated with the occurrence of diabetes. Greater age was associated with obesity and inversely associated with insufficient consumption of fruits and vegetables. Daily smoking and being physically inactive were inversely associated with risky drinking. Low socioeconomic background was associated with unhealthy diet, physical inactivity and stress.     

Individual Growth Curve Modeling of Specific Risk Factors and Memory in Youth with Type 1 Diabetes: An Accelerated Longitudinal Design

Objective: To examine if diabetes risk factors disrupt memory score trajectories in youth with T1D over three years with a powerful accelerated longitudinal method and individual growth curve modeling. Methods: Participants aged 9–17 completed memory measures at study enrollment and two years later. Results: Poorer metabolic control over the course of the study related to a significant decrease in visual memory scores. Compared to baseline, these youth scored 1.99 points lower at follow-up. Generally appropriate developmental gains were made in memory trajectories and girls' visual and verbal memory improved more than boys. No significant effects of disease duration, age of onset, or severe hypoglycemia were found on visual or verbal memory over three years time. Conclusions: Of the risk factors studied, only poorer metabolic control had a significant impact upon visual memory after three years. Verbal memory was unaffected. However, given that level of metabolic control tends to remain relatively consistent over time, the effect of continued poorer metabolic control on memory should be monitored.     

A Cognitive Behavioral Adherence Intervention for Adolescents with Type 1 Diabetes

This study examined the impact of a cognitive behavioral intervention for nonadherent adolescents with type 1 diabetes. Six youths having problems following the diabetes regimen received training in cognitive restructuring and problem solving during individual sessions. A multiple baseline design across participants was used. Treatment effectiveness was assessed through 24-hr recall adherence interviews with adolescents and frequency of testing data was downloaded from glucose meters. Data was also collected for diabetes-specific stress. Five youths displayed improvement on at least one self-care behavior. Furthermore, the results suggest that the cognitive behavioral intervention was effective in diminishing diabetes-related stress in two participants. Cognitive behavioral interventions show promise for increasing self-care behaviors among nonadherent youths with type 1 diabetes. However, individual youths varied in their response to treatment. Further research is needed in developing procedures to better meet the needs of youths, improve youth participation, and enhance treatment effectiveness.     

Pre-adoptive risk factors and behavioural problems in children adopted from Poland

Behavioural problems in adoptees have been related to adverse circumstances prior to adoption. We examined pre-adoptive risk factors and post-adoptive behavioural problems in children adopted from Poland. Dutch adoptive parents of 133 Polish adoptees (M_age = 8.7 years, range 2.8–15.2; M_ageadoption = 3.0 years, range .4–6.9) answered the Child Behaviour Checklist and questions regarding pre-adoptive risk factors, such as institutionalization, neglect and abuse. Polish adoptees in our sample were four times more likely to have clinical behavioural problems than non-adopted children. Compared with a group of children adopted from various countries, predominantly from Asia, Polish adoptees had higher levels of behavioural problems as well. Multiple pre-adoptive risk factors were present. Only a history of abuse was found to be associated with behavioural problems after adoption. Special attention and support after adoption are needed for these children and their adoptive parents, especially when a pre-adoptive history of abuse is known.     

Lifestyle changes are related to reductions in depression in persons with elevated coronary risk factors

This observational study investigates whether persons with elevated coronary risk factors (CRFs >3 and/or diabetes) and depression [i.e., ≥16 on the Center for Epidemiological Scale – Depression (CES-D)] can make changes in health behaviours over 3 months and improve depressive symptoms and other CRFs. Analyses were based on data from 310 men and 687 women enrolled in the high-risk arm of the Multisite Cardiac Lifestyle Intervention Program, targeting diet (10% fat), exercise (3 h per week) and stress management (7 h per week). As expected, at study entry, depressed persons had a more adverse medical status, consumed more dietary fat and practiced less stress management than non-depressed persons. To examine 3-month changes, participants were grouped into (1) depressed persons who became non-depressed (CES-D ≤ 16, n = 248; 73%), (2) persons who remained or became depressed (CES-D >16, n = 76) and (3) non-depressed persons who remained non-depressed (n = 597). All persons, regardless of group, met program goals. The greatest improvements (i.e., diet, exercise, perceived stress, hostility and mental health) were observed in Group 1 relative to Groups 2 and 3, which did not differ from each other. Comprehensive lifestyle changes appear to be feasible and beneficial for initially depressed persons with elevated CRFs.     

A systematic review of the evidence-based psychosocial risk factors for understanding of borderline personality disorder

Borderline personality disorder (BPD) is a serious personality disorder characterized by affective instability, impulsivity and interpersonal disturbance. Currently, intensive research is being conducted concerning the aetiology of BPD, including research on neurobiological, temperamental, psychosocial and cultural risk factors. This study focuses on psychosocial risk factors while other risk factors are taken into account in the discussion of the development of BPD. To our knowledge, no systematic review of the evidence-based medicine literature concerning this theme has been made thus far. However, understanding psychosocial risk factors of BPD is important in order to develop psychotherapeutic treatment models and methods. We provide a systematic review of the literature focusing on psychosocial risk factors for BPD. Utilizing this knowledge, we discuss how these data may be used when studying the development of borderline personality disorder and the treatment of borderline personality disorder.     

The Ethics of Type 1 Diabetes Prediction and Prevention Research

There are approximately one million cases oftype 1 diabetes in the US, and the incidenceis increasing worldwide. Given that two-thirdsof cases present in childhood, it is criticalthat prediction and prevention research involvechildren. In this article, I examine whethercurrent research methodologies conform to theethical guidelines enumerated by the NationalCommission for the Protection of Human Subjectsof Biomedical and Behavioral Research, andadopted into the federal regulations thatprotect research subjects. I then offer twopolicy recommendations to help researchersdesign studies that conform to these ethicalrequirements.     

A longitudinal study of psychosocial distress in breast cancer: Prevalence and risk factors

This longitudinal study was conducted among 102 women with non-metastasic breast cancer to identify the time evolution and prevalence of distress at specific times through diagnosis and treatment of disease: preliminary diagnosis, surgery, definitive diagnosis and chemotherapy. Additionally, the study aimed to examine the role of demographic, medical and psychosocial factors on distress. The results indicated that prevalence of distress was higher at initial diagnosis (25%) than the following time points (approximately 17%). The differences inter-individuals in the levels of distress were observed over the four assessments. No relation between distress and demographic and medical factors was found. However, psychosocial aspects were significant risk factors. Patterns of emotional suppression and specific coping responses like helplessness/hopelessness, anxious preoccupation, cognitive avoidance and fatalism were positively related to distress, whereas fighting spirit and perceived social support showed a protective role. Moreover, helplessness/hopelessness and anxious preoccupation jointly predicted 75% of cases and 98% non-cases of distress. Finally, a mediational model between emotional suppression and distress through helplessness/hopelessness was tested. Results support the necessity of routine distress screening all through the illness. Implications of data for psychosocial interventions with breast cancer patients are highlighted.     

Identification of biological and environmental risk factors for language delay: The Let's Talk STEPS study

The aim of this population-based study was to identify demographic factors for language delays at an early age. The risk analysis covered 11 biological and 8 environmental factors. The mothers’ concerns regarding language development were also examined. A total of 226 children from a Finnish cohort study were invited to participate in language assessments at 36 months. The test results for word finding and language comprehension were compared with parental questionnaires about children's vocabulary at 13 and 24 months.Regression analysis revealed that the father's social class (t = −2.79, p = 0.006) and working full time (t = −2.86, p = 0.005) significantly predicted children's language delay. In addition, language comprehension was significantly predicted by the mother's social class (t = −2.06, p = 0.041) and by gender, with an advantage to girls (t = −2.71, p = 0.008). Vocabulary at 24 months was a powerful predictor for lexical development (t = 4.58, p < 0.0001) and language comprehension (t = 4.85, p < 0.0001) at 36 months. Mothers’ concerns were correlated with children's limited lexicons as early as 24 months (r = 0.31, p < 0.0001) and poor language comprehension (r = −0.35, p < 0.0001) at 36 months. Mothers were especially concerned if the parents needed special education during school years.At the population-level, gender was the most powerful biological factor in predicting language delays. Similarly, both parents’ social status had predictive value for the child's language development. In addition, it was found that the mother's concern about her child's slow language acquisition should be taken into account when making decisions regarding special support.     

青少年抑郁情绪的发展轨迹:界定亚群组及其影响因素

本研究意在分性别考察中国青少年抑郁情绪的发展轨迹及其影响因素。785名男生和859名女生参加了3轮追踪研究,初始测量阶段的年龄跨度为10~16岁,平均年龄分别为12.99±1.84和12.96±1.87岁。采用流调中心抑郁量表(CES-D)简版测量青少年的抑郁情绪。模型拟合的结果显示男女生的抑郁情绪在10~19岁时段皆呈线性增长趋势,其中男生分为两个亚群组,人际关系解释了部分变异;女生分为4个亚群组,学业压力和人际关系均解释了部分变异。     

网络心理教育在1型糖尿病青少年患者自我管理中的作用

探讨网络心理健康教育在1型糖尿病青少年患者中的实证效果,选取1型糖尿病青少年100例,随机分成对照组和干预组各50例.干预组实施网络健康教育,通过网络视频,讲授糖尿病的相关知识,进行定期随访;对照组采用常规健康管理模式,只发放糖尿病知识宣传册由1型糖尿青少年患者和家属自己学习.干预组糖尿病青少年患者自我管理、生活质量、心理状态情况有明显改善,干预后糖化血红蛋白水平下降,对照组上述指标无明显改变.网络心理教育课程是一种新型的有效的健康教育管理模式,能够让1型糖尿病青少年患者病情稳定,同时减少并发症的发生.