Mindfulness-based intervention for depression and insulin resistance in adolescents: Protocol for BREATHE, a multisite, pilot and feasibility randomized controlled trial

BACKGROUND

Elevated depression symptoms have been associated with higher insulin resistance in adolescents, and consequently, greater risk for type 2 diabetes (T2D). Mindfulness-based intervention (MBI) may be suited for adolescents at risk for T2D given its potential to decrease depression and improve stress-related behavior/physiology underpinning insulin resistance. To prepare for a future multisite efficacy randomized controlled trial, a rigorous, multisite, pilot and feasibility study is needed to test this approach. The current paper describes the design and protocol for a multisite, pilot and feasibility randomized controlled trial of six-week MBI, cognitive-behavioral therapy (CBT), and health education (HealthEd) group interventions, to assess multisite fidelity, feasibility, and acceptability.

METHODS

Participants are N = 120 adolescents ages 12-17, with body mass index (BMI) ≥85th percentile, elevated depression symptoms (20-item Center for Epidemiologic Studies-Depression Scale total score > 20), and family history of diabetes. Enrollment occurs across four United States (US) sites, two in Colorado, one in Washington, D·C., and one in Maryland. Group interventions are delivered virtually by trained psychologists and co-facilitators. Assessments occur at baseline, six-week follow-up, and one-year follow-up.

RESULTS

Primary outcomes are intervention implementation fidelity, based upon expert ratings of audio-recorded sessions (≥80% adherence/competence), and recruitment feasibility, based upon percentage enrollment of eligible youth (≥80%). Secondary outcomes are intervention training fidelity/feasibility/acceptability, recruitment timeframe, and retention/assessment feasibility.

CONCLUSION

Findings will inform optimization of training, recruitment, intervention delivery, retention, and assessment protocols for a multisite, efficacy randomized controlled trial evaluating MBI for decreasing depression and improving insulin resistance in adolescents at risk for developing T2D.

BREATHE-T1D: Using iterative mixed methods to adapt a mindfulness-based intervention for adolescents with type 1 diabetes: Design and development

BACKGROUND

Negative affect is prevalent among adolescents with type 1 diabetes (T1D) and may impact diabetes self-management and outcomes through stress-related behaviors such as disordered eating.

METHODS

We describe the development of and design for the adaptation of a mindfulness-based intervention (MBI) for adolescents with T1D and negative affect. BREATHE-T1D is an MBI designed to target negative affect that has been tailored to address the unique lived experiences of adolescents with T1D. Qualitative interviews with stakeholders and participants were used to inform iterative adaptations to the intervention and control curricula over the course of the study. The primary aim of this paper is to describe the design, development, and protocol of the present pilot feasibility trial.

CONCLUSIONS

Iterative, qualitative methodology throughout the adaptation of an intervention is important for ensuring the resulting intervention is relevant and meaningful for the target population.

CLINICAL TRIAL REGISTRATION NUMBER

NCT05268393.

Gait Variability and Relationships With Fear, Avoidance, and Pain in Adolescents With Chronic Pain

OBJECTIVE

Some children with chronic pain struggle with fear of pain, avoidance behaviors, and associated disability; however, movement adaptations in the context of chronic pain in childhood is virtually unknown. Variability in adaptive movement responses previously observed between individuals might be largely explained by the presence of problematic psychological drivers (eg, fear, avoidance). The goals of this study were to quantify the variability of gait and examine relationships among pain, fear, avoidance, function (perceived and objective), and gait variability.

METHODS

This study used a cross-sectional design. Eligible patients were between 8 and 17 years of age and had musculoskeletal, neuropathic, or headache pain that was not due to acute trauma (eg, active sprain) or any specific or systemic disease. Participants completed the Numeric Pain Rating Scale, Fear of Pain Questionnaire (FOPQ), Functional Disability Inventory, and 6-Minute Walk Test and received kinematic gait analysis. Relationships were analyzed among these measures, and the self-report and functional measures were examined to determine whether they predicted gait variability (GaitSD).

RESULTS

The 16 participants who were evaluated (13.8 [SD = 2.2] years of age; 13 female) had high Numeric Pain Rating Scale scores (6.2 [SD = 2.1]), FOPQ-Fear scores (25.9 [SD = 12.1]), FOPQ-Avoidance scores (22.8 [SD = 10.2]), and Functional Disability Inventory scores (28.6 [SD = 9.4]) and low 6-Minute Walk Test distance (437.1 m [SD = 144.6]). Participants had greater GaitSD than age-predicted norms. Fear was related to self-selected GaitSD, and avoidance was related to both self-selected and standardized GaitSD. Avoidance predicted 43% and 47% of the variability in self-selected and standardized GaitSD, respectively.

CONCLUSION

GaitSD was significantly related to both fear of pain and avoidance behaviors, suggesting the interplay of these psychological drivers with movement. FOPQ-Avoidance was robust in accounting for GaitSD.

IMPACT

This study offers preliminary evidence in understanding movement adaptations associated with adolescents with chronic pain. They may lend to more directed interventions.

Subjective social status in adolescents with asthma: Psychosocial and physical health outcomes

OBJECTIVE

Asthma prevalence and morbidity are disproportionately higher among youth with lower socioeconomic status (SES). Examination of subjective social status (SSS) may improve understanding of associations between SES and health outcomes in pediatric asthma.

METHOD

Fifty adolescents with asthma (Mage = 13.2 years, SD = 1.23; 54% male; 55.1% African American) completed the MacArthur Scale of Subjective Social Status-Youth Version, Daily Life Stressors Scale, Children's Depression Inventory-Short Form, Adolescent Sleep-Wake Scale-short version, and Asthma Control Test during the baseline visit of a study of health behaviors. Body mass index z scores (BMIz) were calculated using height and weight obtained during the visits. Hierarchical linear regressions examined associations between SSS and psychosocial and physical health outcomes, controlling for caregiver-reported objective SES.

RESULTS

Caregiver-reported objective SES was not associated with adolescent SSS. SSS-society was associated with daily stress (b = -3.14), t(47) = -2.13, p = .033; asthma control (β = .34, p = .045); BMIz (β = .38, p = .013); and sleep quality (β = .49, p = .001). SSS-community was associated with daily stress (b = -3.76), t(46) = -3.07, p = .002, and sleep quality (β = .36, p = .010). SSS was not associated with depressive symptoms.

CONCLUSIONS

Adolescents' SSS may not always reflect caregiver's objective SES. Perceived social status may play a role in the experience of daily stress, asthma control, BMIz, and sleep quality among adolescents with asthma. SSS may offer a novel means of assessing health disparities in pediatric asthma. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

[Primary epiphyseal osteomyelitis in children]

A 4-year-old boy was hospitalized for suspected hematogenous osteomyelitis of the distal femur. Bone scan and repeated radiographs showed a rare condition, primary epiphyseal osteomyelitis. Needle biopsy and aspiration were negative. Penbritin and orbenil, 2 g of each, gave complete clinical and radiographic healing 7 weeks after initial treatment.

Early diagnosis at the CDH clinic

In 1978, 488 of 8,211 registered newborn babies in the Haifa area were referred to us for suspected congenital dislocation of the hip. The findings were as follows: normal, 53%; justifying further follow-up, 40.5%; subluxation, 4% (19 cases); and dislocation, 2.5% (12 cases). The infants with subluxation or dislocation were not older than six months. Treatment of dislocation included: open reduction, 1; closed reduction under general anesthesia, 4; and reduction and treatment by abduction splints, 7. After this treatment, all hips were stable. Abduction splints were used in the 19 subluxation cases; there was no aseptic necrosis of the femoral head. All infants with minor deviations in the hip joints, such as consistent limited abduction, delayed appearance of epiphyseal ossification center or acetabular dysplasia, were deliberately grouped under "justifying follow-up." It is possible that these minor deviations harbor the buds of early osteoarthritis.