Determinants of condom use among intravenous drug users in Spain

Attitudes to and perception of health care delivery are consideredto be important factors for patient compliance in diabetes.To Investigate insulin-treated diabetic patients' use of, experienceof and attitudes to diabetes care a questionnaire was sent to561 patients, 20–50 years old, living in northern Sweden.Four hundred and eighty-eight patients (87%) participated inthe study. Data were analysed against social, medical and geographicalbackground factors. Female patients more often than men hadseen an ophthalmologist (93 versus 87%, p<0.05), a diabetesnurse specialist (74 versus 64%, p<0.05) and a chiropodist(49 versus 30%, p<0.001) at least once during the courseof their diabetes. Women also used the services of a medicalsocial worker (17 versus 10%, p-0.05) or a psychologist (14versus 8%, p<0.01) more often. More men than women were satisfiedwith the health care they had at the onset (65 versus 38%, p<0.001),but no gender difference in attitude to their present care wasfound. Diabetic patients with chronic complications comparedto those without were less satisfied both with the care theyreceived at the onset of diabetes (40 versus 61%, p<0.001)and at the time they answered the questionnaire (59 versus 72%,p<0.01). Patients in the most sparsely populated health districtwere more seldom able to be seen by the same physician (70 versus93% and 94%, p<0.001) and patient-physician continuity waspoorer over a 3 year period (48 versus 80%, p<0.001). Basedon results of this study, we conclude that use of, experienceof and attitudes to diabetes care are primarily related to genderand sickness factors. Living in sparsely populated areas probablyaffects the use and continuity of hearth care depending on themeans available. The differences demonstrated might be an argumentfor planning more individualized care for diabetic patientsin the future.     

Insulin-treated diabetic patients: Use of, experience of and attitudes to diabetes care

Attitudes to and perception of health care delivery are consideredto be important factors for patient compliance in diabetes.To Investigate insulin-treated diabetic patients' use of, experienceof and attitudes to diabetes care a questionnaire was sent to561 patients, 20–50 years old, living in northern Sweden.Four hundred and eighty-eight patients (87%) participated inthe study. Data were analysed against social, medical and geographicalbackground factors. Female patients more often than men hadseen an ophthalmologist (93 versus 87%, p<0.05), a diabetesnurse specialist (74 versus 64%, p<0.05) and a chiropodist(49 versus 30%, p<0.001) at least once during the courseof their diabetes. Women also used the services of a medicalsocial worker (17 versus 10%, p-0.05) or a psychologist (14versus 8%, p<0.01) more often. More men than women were satisfiedwith the health care they had at the onset (65 versus 38%, p<0.001),but no gender difference in attitude to their present care wasfound. Diabetic patients with chronic complications comparedto those without were less satisfied both with the care theyreceived at the onset of diabetes (40 versus 61%, p<0.001)and at the time they answered the questionnaire (59 versus 72%,p<0.01). Patients in the most sparsely populated health districtwere more seldom able to be seen by the same physician (70 versus93% and 94%, p<0.001) and patient-physician continuity waspoorer over a 3 year period (48 versus 80%, p<0.001). Basedon results of this study, we conclude that use of, experienceof and attitudes to diabetes care are primarily related to genderand sickness factors. Living in sparsely populated areas probablyaffects the use and continuity of hearth care depending on themeans available. The differences demonstrated might be an argumentfor planning more individualized care for diabetic patientsin the future.     

Self-management behavior among patients with diabetic retinopathy in the community: a structural equation model

Purpose

Diabetic retinopathy (DR) is an important, chronic complication of diabetes, requiring competent self-management that depends on adherence to behavioral regimens. This study attempted to identify factors influencing self-management behaviors and develop a model illustrating the interdependence of several factors associated with DR patients.

Methods

In June–December 2012, 368 patients with DR completed questionnaires assessing self-management behavior, diabetes knowledge, health beliefs, social support, and treatment adherence. Structural equation modeling was used to test predicted pathways linking self-management behavior to diabetes knowledge, health beliefs, social support, and treatment adherence.

Results

The results indicated that health beliefs, treatment adherence, and duration of diabetes each had a direct impact on diabetes self-management (p < 0.05). Diabetes knowledge only indirectly influenced diabetes self-management, through health beliefs. Social support had a direct impact on diabetes self-management (β = 0.35, p < 0.01), and an indirect influence on diabetes self-management, through treatment adherence (β = 0.77, p < 0.01).

Conclusion

Health beliefs, treatment adherence, and social support directly affect diabetes self-management, and diabetes knowledge indirectly affects diabetes self-management. This suggests that enhancing DR patients’ health beliefs, treatment adherence, and social support would facilitate their diabetes self-management. Meanwhile, improved health education can strengthen diabetes knowledge, which in turn, can positively affect diabetes self-management.

     

Use of condoms: intention and behaviour of adolescents living in juvenile rehabilitation centres

The aim of the present study was to identify the psychosocialfactors explaining intention and behaviour regarding condomuse among a sample of 152 adolescents (44 F; 108 M) living injuvenile rehabilitation centres. At baseline, the variablesderived from psychosocial theories were assessed by questionnaire.The self-report of condom use was obtained 3 months later. Thevariability in intention (R² = 0.76; P < 0.001) was explainedby personal principles guiding adoption of the behaviour (ß= 0.44, P < 0.001), perceived control in adopting the behaviour(ß = 0.36, P < 0.001) and habit of using condomsin the previous 3 months (ß = 0.15, P < 0.01).Prediction of condom use yielded an R² of 0.49 (P < 0.001),the interaction terms formed by intention and perceived behaviouralcontrol (P < 0.01) and habit of using condoms by perceivedbehavioural control (P < 0.001) being the significant predictors.MANOVA analyses revealed important differences between highand low intenders on each of the items of the personal principlescale and the perceived control sub-scales. The results suggestthat the promotion of condom use among adolescents experiencingsocial adaptation difficulties should focus on developing thepersonal social responsibility that each individual has regardingthe adoption of a responsible sexual behaviour, as well as developingthe personal skills and resources necessary to overcome thepsychological and physical barriers of using condoms.     

Correlation between molecular weight of plasma albumin determined with mass spectrometry and glycation indices in factory workers

Objectives To determine the difference in molecular weights of albumin in factory workers caused by non-enzymatic glycation of plasma albumin using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI TOF/MS), and examine the epidemiological validity of this method. Methods Forty-eight male workers were tested by random sampling. The difference in molecular weights (ΔM) between the subjects’ albumin and human serum albumin was determined by MALDI TOF/MS. Correlations between ΔM vs. fructosamine, fasting plasma glucose (FPG) and HbAlc were investigated. Results ΔM showed a significant correlation with all of the tested glycation indices (ΔM vs. fructosamine: r=0.487, p<0.001) (ΔM vs. FPG: r=0.482, p<0.01) (ΔM vs. HbAlc: r=0.397, p<0.01). Conclusions Since a significant correlation between ΔM and the glycation indices was found in this investigation, further study with a larger number of subjects is needed for use in clinical applications.     

Vaccination attitudes,beliefs and behaviours among primary health care workers in northern Croatia

Primary health care workers (HCWs) provide almost all vaccine services in Croatia, so they play an essential role in vaccine recommendations and uptake. The aim of this study was to determine the level of vaccine hesitancy among primary HCWs, to identify differences between nurses and physicians in attitudes, beliefs and behaviours towards vaccination, and to determine predictors of vaccine hesitancy among HCWs. We conducted a cross-sectional study from July to December in 2018 among physicians and nurses employed in the services of epidemiology, public health, school medicine, pediatrics and general practice/family medicine in Primorje-Gorski Kotar County, a primarily urban region with a population around 300 000 in the northern part of Croatia. The list of primary HCWs offices was obtained from the Croatian Health Insurance Fond website. We used a self-administered questionnaire on their attitudes, beliefs and behaviours relative to vaccination. Obtained response rate was 65.5% (324/495) of eligible primary HCWs; 64.1% (143/223) of physicians and 66.5% (181/272) of nurses. Seventeen percent of HCWs were identified as vaccine hesitant, and in univariate analysis, we observed an association between HCWs occupation and their own vaccination against flu (p = 0.001), measles (p = 0.016) and HPV (p = 0.025). Nurses and physicians differed (p < 0.001) in their general attitude, beliefs and behaviours towards vaccination, with a higher level of hesitancy among nurses. In multiple logistic regression, those more likely to be vaccine-hesitant were nurses (AOR = 5.73, 95%CI = 2.48–13.24), those who were uncertain or would never receive a vaccine against measles (AOR=11.13; 95%CI=5.37–23.10) and HPV (AOR=5.02; 95%CI=2.60–9.74), as well as those who had encountered a serious adverse event following immunization (AOR=7.55; 95%CI=3.13–19.18). As personal hesitancy may have a negative impact on vaccination education and recommendations, and therefore vaccine coverage, it is necessary to implement interventions to increase vaccination knowledge and confidence among primary health care workers, especially nurses.     

Reducing diabetes distress and improving self-management with mindfulness

ABSTRACT

Stress associated with diabetes makes managing diabetes harder. We investigated whether mindfulness-based stress reduction (MBSR) could reduce diabetes distress and improve management. We recruited 38 participants to complete an MBSR program. Surveys and lab values were completed at baseline and post-intervention. Participants showed significant improvement in diabetes-related distress (Cohen’s d –.71, p < .002), psychosocial self-efficacy (Cohen’s d .80, p < .001), and glucose control (Cohen’s d –.79, p < .001). Significant improvements in depression, anxiety, stress, coping, self-compassion, and social support were also found. These results suggest that MBSR may offer an effective method for helping people better self-manage their diabetes and improve mental health.     

Serum nutritional status of tocopherol and retinol normalized to lipids of persons living in the southern rural Terai region in Nepal

Objective  The present study examined the levels of serum α-Tocopherol (Toc), retinol (Ret), cholesterol (Chol) and triglycerides (TG), and their correlations in the sera of people in Nepal. Methods  The survey was conducted on the general populace in the agricultural Terai region in southern Nepal. The study population consisted of 93 males and 83 females aged 10–68 years. Serum Toc and Ret were measured by high-performance liquid chromatography. Results  No significant differences were observed between the genders for the average of total Chol (T-Chol) (140 and 145 mg/100 ml, respectively), HDL-C (45 and 47 mg/100 ml), LDL-C (94 and 97 mg/100 ml), and TG (106 and 110 mg/100 ml), and the ratio of LDL/HDL (2.16). The levels of mean Toc (4.32 and 4.27 μg/ml) were about the same for both genders, while the mean Ret levels were significantly higher for males (624 ng/ml) than for females (535 ng/ml) (p<0.001). A direct relationship was found between the levels of Toc and Ret (r=0.46, p<0.001 and r=0.28, p<0.05 for males and females, respectively). Serum levels of Toc and Ret were positively related to the levels of Chol (r=0.48 and r=0.58, p<0.001 for males and r=0.49, p<0.01 and r-0.28, p<0.05 for females, respectively). The ratio of Toc/TG normalized to serum TG was directly correlated to the ratio of Ret/TG (r=0.79 for males, and r=0.72 for females, p<0.001, respectively) and the ratios of Toc/TG and Ret/TG were negatively related to the LDL/HDL levels (r=−0.49 and r=−0.43, for males, and r=−0.46 and r=−0.57 for females, p<0.001, respectively). Conclusion  The levels of Toc and Ret were low in the sera of people living in the southern rural Terai region in Nepal, and it was found that lower levels of Toc and Ret normalized to TG increased the ratio of LDL/HDL. These results suggest that greater intake of foods rich in Toc and Ret should be encouraged to reduce the erisk of coronary heart disease.     

Dietary Calcium and Blood Pressure in a Native American Population

Objective: To assess the relationship between dietary calcium and blood pressure.

Methods: Cross-sectional study of 404 adult Pima Indians of Arizona. Dietary variables were assessed by the 24-hour recall. Hypertension (HTN) was defined as systolic blood pressure (SBP) ≥140 mmHg or diastolic blood pressure (DBP) ≥90 mmHg or drug treatment.

Results: Controlled for age and sex, dietary calcium intake was higher in subjects with HTN than in those without (p<0.01), and higher dietary calcium was associated with a higher prevalence of HTN (odds ratio comparing highest with lowest tertile group of calcium=2.6, 95% CI 1.4–4.8). Age-sex-adjusted mean DBP in low, middle and high tertiles of calcium was 74, 76, and 79 mmHg, respectively (p<0.001). SBP was not significantly different in the three tertiles (p=0.07). Multiple regression analyses that controlled for age, sex, body mass index, sodium, potassium and alcohol also suggested a positive association between DBP and dietary calcium (p<0.01), an association which was stronger at higher glucose concentrations (p<0.01 for the calcium-glucose interaction).

Conclusion: In Pima Indians, a population with a high incidence of diabetes, the inverse association between dietary calcium and blood pressure reported in other populations was not found.     

Serum thiocyanate concentration as an indicator of smoking in relation to deaths from cancer

All residents aged 40 years or more in Oyabe City, Toyama Prefecture, Japan were involved in an annual medical check-up between 1987 and 1988. The cohort was followed and death certificates from cancers were confirmed prospectively. During follow-up to December 31 st, 1994, 100 deaths (28 gastric, 17 lung and 55 other cancers) from cancers occurred, and these subjects were included in this study as the case group. Subjects in the control group, matched for gender and age with the cases, were selected randomly from participants whose serum samples had been stocked during annual medical check-up. The concentration of serum thiocyanate in all (79.8 μmol/l), gastric (86.7 μmol/l) and lung (90.0 μmol/l) cancer patients were significantly higher than that of relevant controls (64.3 μmol/l, 59.0 μmol/l and 61.0 μmol/l, respectively; and p<0.001, p<0.001 and p<0.05, respectively). After adjusting for BMI, blood pressure and total serum cholesterol, the results of multiple logistic regression analysis showed that the risk of all cancers (OR=3.40, 95% confidence interval (95% Cl): 1.67–6.96, p<0.01), gastric cancer (OR=7.98, 95% CI: 1.91–33.34, p<0.05) and lung cancer (OR=8.83, 95% CI: 1.19–65.65, p<0.05) were elevated significantly with logarithm transformed values of serum thiocyanate increased. The present findings suggested that in epidemiological studies confirmation of smoking status with biomarkers such as serum thiocyanate may be important, although considering the small sample size, a relatively weaker risk to interested factors rather than the strong relationship between smoking and cancer was noted.     

Serum mineral levels among Nepalese living in the southern agricultural Terai region

The physical status and serum mineral concentrations for people aged 10 to 68 years living in an agricultural southern region of Nepal were determined. Systolic (SBP) and diastolic blood pressure (DBP) for both sexes in the 10–14 year age group were low (p<0.05. vs the other age groups) and those for the over 50-year-olds tended to be higher than the other age groups. The mean values of total proteins (TP) (8.6 ± 0.5 g/dl for males and 8.7 ± 0.6 g/dl for females) were high due to an increase of globulin (3.9 ± 0.4 g/dl for males and 4.1 ± 0.5 g/dl for females). More than three-fourths of the subjects of both sexes showed calcium (Ca) levels of 9.0–11.2 mg/dl and about 65% of them showed potassium (K) levels of 4.8–5.4 mEq/1. A significant positive correlation between DBP and serum K was observed (p<0.05). Serum inorganic phosphorus (IP) correlated with age (p<0.001) and body mass index (BMI) (p<0.001). The serum Ca levels correlated with TP (r=0.31, p<0.001), albumin (Alb) (r=0.50, p<0.001), IP (r=0.31, p<0.001), K (r=0.32, p<0.001) and chlorine (Cl)(r=-0.37, p<0.001). Cl was associated with TP (r=-0.21, p<0.05), Alb (r=-0.36, p<0.001) and IP (r=-0.21, p<0.05). These results suggested that Ca intake for the subjects seemed to be insufficient although their serum Ca level was within normal.     

Association between diabetes mellitus and hypertension with anthropometric indicators in older adults: Results of the Mexican Health Survey, 2000

Objective: To determine the association between anthropometric indicators of adiposity with type 2 diabetes mellitus (T2DM) and hypertension (HTN) in older adults.Design: Cross-sectional study of participants of the Mexican Health Survey 2000 (MHS).Setting: Mexico, subjects recruited from the general community.Participants: The analytic sample included 7,322 adults who were ≥60 years of age at the time of the survey. T2DM data were available on 6,994 individuals, who represent 95.5% of the original sample; data on HTN was available on 6,268 subjects, which accounted for 86.5% of the original sample.Measurements: Type 2 diabetes mellitus and hypertension, as well as anthropometric indicators including body mass index (BMI), waist circumference (WC), and conicity index (CI).Results: The prevalence of T2DM and HTN in this age group was 34.3% and 73.9%, respectively. After adjusting for other variables, the association between high WC and T2DM (OR=1.59 95%CI=1.26-2.01, P < 0.001) was stronger than the association with overweight (OR=1.26, 95%CI= 1.01–1.58, P=0.04) and obesity (OR=1.38, 95%CI= 1.08–1.79, P< 0.01) using BMI, and slightly higher than tertile 2 of the CI (OR=1.49, 95%CI=1.20–1.88, P< 0.01), while tertile 3 showed a stronger association with T2DM (OR=1.60, 95%CI=1.22–2.08, P< 0.001). However, the association between obesity and HTN measured by BMI (OR=1.98, 95%CI=1.48–2.65, P< 0.001) was stronger than what was observed with overweight (OR=1.42, 95%CI 1.13–1.77, P< 0.01), with high WC (OR=1.62, 95%CI=1.25–2.10, P< 0.001) and tertiles 2 and 3 of the CI (OR=1.23, 95%CI=0.99–1.55, P= 0.09); (OR=1.53, 95%CI= 1.16–2.03, P< 0.01) respectively.Conclusions: BMI and abdominal obesity are significantly and independently associated with an increase in the prevalence of T2DM and HTN among older Mexican adults.     

妊娠期糖尿病孕妇和糖耐量正常孕妇妊娠压力与社会支持的相关性研究

目的 分析妊娠期糖尿病（GDM）孕妇和糖耐量正常孕妇妊娠压力与社会支持的相关性,对比该相关性在两组间是否存在差异。方法 选取495名GDM孕妇和352名糖耐量正常孕妇,采用一般情况调查表、妊娠压力量表（PPS）和社会支持评定量表（SSRS）进行问卷调查,并运用典型相关分析来研究妊娠压力和社会支持的相关性。结果 GDM组与正常组孕妇都处于轻度压力状态（0.38±0.32分vs.0.38±0.31分, t =0.061, P> 0.05）,且社会支持度均相对较高（40.68±6.88分vs.40.66±6.71分, t=0.042 , P> 0.05）,组间比较显示差异无统计学意义。GDM组和正常组孕妇妊娠压力与社会支持均存在典型相关关系（ λGDM =0.291, F=4.282 ,P<0.01; λ正常 =0.271, F=2.900 ,P<0.01）。GDM组孕妇妊娠压力主要由“确保母子健康和安全”引起,且主观支持的影响较大;而正常组孕妇妊娠压力主要来自于“认同父母角色”,且客观支持的影响较大。结论 应重视孕妇的妊娠压力状态,根据妊娠压力来源的不同可提供有针对性的社会支持,减缓孕期压力,促进母婴健康。     

ALCOHOL INTAKE CORRELATED WITH SERUM TRACE ELEMENTS

Alcohol intake and serum copper, selenium, magnesium, iron andzinc were investigated in 85 subjects, 48 males and 37 females.Alcohol intake was measured with a questionnaire probing alcoholintake during the preceding 30 days. Mean average daily intakeamong males was 119.7 g (range 0–622.3 g) and among females32 1 g (range 0–378.5 g), and the mean consumption perdrinking day among males was 208.5 g (range 0–666.7 g)and among females 63.8 g (range 0–63.8 g). Among malesalcohol intake per drinking day correlated positively with serumcopper (r = 0.50; P < 0.001) and negatively with serum selenium(r = -0.49; P < 0.001) and magnesium (r = 0.40; P < 0.01).Likewise, among females alcohol intake per drinking day correlatedpositively with serum copper (r = 0.54; P < 0.01) and negativelywith serum magnesium (r = –0.36; P < 0.05). Serum seleniumconcentration was negatively and significantly correlated withaverage daily intake (r = –0.34; P < 0.05) but notwith intake per drinking day. No significant correlations werefound between alcohol intake and serum zinc or iron levels.Only two men, both abstainers, had abnormally low serum zinclevel, and two other men (average daily alcohol intake <37g) and two women (average daily alcohol intake <15 g) hadabnormally high serum iron level. Alcohol intake was associatedwith high serum copper and low serum magnesium and seleniumlevels.     

Cachexia and Cognitive Function in the Community-Dwelling Older Adults: Mediation Effects of Oral Health

Background

Cognitive impairment and poor oral health are common problems in older adults and are associated with malnutrition. However, it is unclear how they are related to cachexia in community-dwelling older adults. The aim of this study was to examine the relationships among cachexia, cognitive function, and oral health in community-dwelling older adults.

Methods

This study is a secondary analysis of a data-set. Data were collected in the community setting on older adults who applied for government-funded long-term care services in Hong Kong in 2017. Subjects were community-dwelling and aged ≥60 years. The outcome variable was cachexia. The predictors were cognitive function and oral health. The covariates included demographics and comorbidities associated with cachexia or malnutrition. Path analysis was employed to examine the associations among cachexia, cognitive function, and oral health using the software SAS/STAT and Mplus.

Results

This analysis included 12,940 subjects. The prevalence of cachexia was 1.3%. Cognitive function was also found to have a direct effect on the oral health indicators of chewing problems (OR=1.073, p<0.001), brushing teeth problems (OR=1.349, p<0.001), and swallowing problems (coeff.=0.177, p<0.001). Oral health indicators with a direct effect on cachexia included dry mouth (OR=1.250, p<0.001), brushing teeth problems (OR = 1.185, p<0.01), and swallowing problems (OR=1.231, p<0.001). Cognitive function had no significant direct effect, but had a significant indirect effect on cachexia (OR=1.100, p<0.001) which is mediated by brushing teeth problems (OR=1.052, p<0.001) and swallowing problems (OR=1.038, p<0.001).

Conclusion

Cognitive impairment causes cachexia indirectly through poor oral health. This study recommends adding cognitive function when screening community-dwelling older adults for cachexia. Health policymakers should stress regular oral health screening and interventions, and encourage increased utilization of oral health services by community-dwelling older adults with cognitive problems.

     

Putting the diabetes prevention program into practice: A program for weight loss and cardiovascular risk reduction for patients with metabolic syndrome or type 2 diabetes mellitus

Background: The increasing incidence and prevalence of metabolic syndrome and type 2 diabetes mellitus (DM) have significant implications on health world-wide. Large clinical trials have demonstrated the effectiveness of a comprehensive lifestyle program with a goal of moderate weight loss (5–7%) and regular exercise (150 minutes/week), resulting in a significant decrease in the incidence of type 2 DM and cardiovascular risk.Methods: This study reports on the translation of the multi-center Diabetes Prevention Program (DPP) into a cardiac rehabilitation program, utilizing the expertise and experience of a cardiac rehabilitation program staff. The study adapted materials from the DPP to develop a program that fit local needs for diabetes prevention.Results: Most participants completed the program (11 months) and their moderate weight loss was maintained for 11–12 months. At 11–12 months, waist circumference was reduced by approximately 2 inches, percent body fat was reduced by 5% (11% relative decrease, p<.05), weight was decreased by 10.1 pounds (p<.05), and blood pressure was reduced 8/3 mm Hg (p<.05). Exercise, nutrition, glucose, triglycerides, LDL-cholesterol and HDLcholesterol were all were significantly improved at 11–12 months (p<.05).Conclusions: Efforts to improve lifestyle and reduce body weight are important to patients at risk of developing diabetes. This program demonstrates that an intensive effort can significantly improve lifestyle and reduce body weight in patients with DM or at risk for DM. A program that simulates cardiac rehabilitation, translated from a successful clinical trial into practice, resulted in significant reduction and improvement in metabolic outcomes and cardiovascular risk. Support for cardiac rehabilitation from insurers to develop similar programs is encouraged and deserves further study.     

Provision of oral hygiene services as a potential method for preventing periodontal disease and control hypertension and diabetes in a community health centre in Korea

This study aimed to evaluate the effects of a community‐based oral hygiene service on general and periodontal health indicators of patients with hypertension and type 2 diabetes mellitus visiting a community health centre in Korea. The study used a one‐group pretest–posttest and interrupted time‐series design. A total of 151 participants (45% male), with a mean age of 63 ± 8.4 years, were included in the study; these included patients with hypertension (62%), diabetes (12%) and both hypertension and diabetes (26%). Two dental hygienists dedicated 2 days per week to this project, providing oral hygiene services to 10–13 participants per day. Four oral hygiene service sessions were provided per patient. The objective oral hygiene status and subjective self‐reported periodontal status were compared before and after the service. The changes in blood pressure and glycosylated haemoglobin levels were also assessed. A lower frequency of subjective swelling was reported at the fourth session (37.9%) compared to the first (55.6%) session. Further, significantly fewer cases of calculus and bleeding were observed (p < .05), and significantly more patients reported having no gum problems at the fourth session (43.1% vs. 27.2%; p < .05) than at the first session. Finally, the participants maintained stable blood pressures at each of the four sessions, and their glycosylated haemoglobin levels were significantly lower at the fourth session. In conclusion, the findings of this study suggest that community oral hygiene services provided by dental hygienists can promote objective oral hygiene and subjective periodontal status in the local community, and may help in the control of hypertension and diabetes.     

Utilities and disutilities for type 2 diabetes treatment-related attributes

Introduction Although cost-utility analyses are frequently used to estimate treatment outcomes for type 2 diabetes, utilities are not available for key medication-related attributes. The purpose of this study was to identify the utility or disutility of diabetes medication-related attributes (weight change, gastrointestinal side effects, fear of hypoglycemia) that may influence patient preference. Methods Patients with type 2 diabetes in Scotland and England completed standard gamble (SG) interviews to assess utility of hypothetical health states and their own current health state. The EQ-5D, PGWB, and Appraisal of Diabetes Symptoms were administered. Construct validity and differences among health states were examined with correlations, t-tests, and ANOVAs. Results A total of 129 patients (51 Scotland; 78 England) completed interviews. Mean utility of diabetes without complications was 0.89. Greater body weight was associated with disutility, and lower body weight with added utility (e.g., 3% higher = −0.04; 3% lower = +0.02). Gastrointestinal side effects and fear of hypoglycemia were associated with significant disutility (p < 0.001). SG utility of current health (mean = 0.87) demonstrated construct validity through correlations with patient-reported outcome measures (r = 0.08–0.31). Discussion The vignette-based approach was feasible and useful for assessing added utility or disutility of medication-related attributes.     

Sick-leave and disability pensions among female assembly workers

Sick-leave in 1984–1989 was higher in 269 women with industrialwork involving repetitive movements (total 76,540 days), thanin 290 referents with varying work tasks (26,421 days). Themedians of the individual ratios of the observed number of daysof illness versus expected (according to background population)were 1.26 and 0.24 respectively. Sick-leave with diagnoses inthe musculoskeletal system dominated in the exposed group, particularlyfor neck/shoulders (5.3 versus 0.6% of observed time, p<0.001)and arms/hands (2.4 versus 0.5%, p<0.001). Women leavingfor new jobs had, during the exposed employment, a higher sick-leavethan those who stayed (‘healthy worker selection’),and afterwards lower sick-leave. The risk of disability pensioning1980–1989 (observed/expected: 2.8 versus 0.7) was alsohigher among exposed women. Repetitive, industrial work causesextensive suffering and huge costs. Preventive measures areurgently needed.     

Associations of smoking with prescribed medications, arthritis/rheumatism and back problems in the British Health and Lifestyle Survey follow-up respondents

The relationship of smoking behaviour to the prevalence of prescribedanalgesics and/or anti-inflammatory agents, reported treatedarthritis/rheumatism or back problems has been examined. The5, 352 survivors, now aged 25–99 years, of the 1984–1985nationwide Health and Lifestyle Survey of randomly selectedBritish adults were re-interviewed in 1991–1992. Therewere 2, 300 men and 3, 052 women. The response rate was 80.8%of those traced and alive. Of those interviewed 4, 483 subjects(83.8%) were also visited by a nurse. Details of prescribedmedications and the reasons for taking them were collected bythe nurses and information on treated medical conditions wasbased on the responses during the interview. Age and socioeconomicgroup were controlled for in the analyses. There were positiveassociations, for the sexes combined, of a smoking history withcurrent prescribed analgesics (p<0.02), non-steroidal anti-inflammatoryagents (NSAIDS) (p<0.05) and analgesics and NSAIDS combined(p<0.005). Arthritis/rheumatism was more often reported bycurrently smoking men under 65 years (p<0.05) and more noticeablywomen under 55 years with a smoking history (p<0.001). Thepreviously recognized association between back problems andsmoking has been confirmed with current and past smokers, inparticular women, being more likely to be sufferers (p<0.001).In subjects who reported arthritis/rheumatism, those with asmoking history were also more likely to be currently takingthe medications than non-smokers (ORs of 1.90 and 1.67 for menand women respectively).