Self-management programs conducted within a practice setting: Who participates,who benefits and what can be learned?

Objective

To investigate the impact of generic and diabetes-specific self-management programs offered in a real world context.

Methods

A quasi-experimental design with 12-week follow-up compared Living with a Chronic Condition and Living with Diabetes. Self-report data collected included: Self-management Knowledge and Skills; Health Related Quality of Life (HRQOL); Depression; Social Isolation; Loneliness; Self-efficacy; and Health Behaviours.

Results

Participants (N = 458) in the two programs differed on almost all baseline measures. Both demonstrated statistically significant improvements in Self-management Knowledge and Skills, as well as reductions in depression. In addition to younger age, low HRQOL, high self-efficacy and Positive and Active Engagement in Life, were the clinical factors most likely to lead to improvements in HRQOL and self-efficacy. Changes in different characteristics predicted different outcomes.

Conclusion

Both generic and disease-specific programs led to improved outcomes, despite the two programs attracting significantly different participants. Referral patterns also differed but GP referral rates were low for both.

Practice implications

Positive participant outcomes can be achieved in real life clinical settings. While younger people with a positive attitude may appear to gain more, it is important to encourage people from low socio-economic status to enter these programs so that social inequalities in health are not worsened.     

Associations Between Coerced Anal Sex and Psychopathology,Marital Distress and Non-Sexual Violence

BackgroundThere is a dearth of scientific data on anal intercourse in heterosexual relationships. Likewise, anal sex within marital relationships has yet to be fully explored.ObjectivesAmong a representative sample of married women in the Iranian capital, Tehran, we aimed to determine the association of self-reported coerced anal sex with: (i) self-reported coerced vaginal sex; (ii) self-reported non-sexual violence; (iii) psychopathology; and (iv) marital attitude.MethodThe data presented here were obtained from the Family Violence Survey conducted in Tehran in 2007. A total of 230 married Iranian women were selected via a multi-cluster sampling method from four different randomized regions. The subjects' sociodemographic data, psychological distress (Symptom Check List; SCL-90-R), personality, and relationship characteristics (Personal and Relationships Profile), and marital attitude (Marital Attitude Survey) were gathered. In addition, the participants' self-reported histories of lifetime victimization through all types of violence by the husband, including coerced anal and vaginal sex as well as psychological and physical assault (Conflict Tactic Scales-Revised; CTS-2), were collected.ResultsThere were associations between self-reported victimization through coerced anal and vaginal sex (P < 0.001), psychological (P < 0.001), and physical aggression (P < 0.001). Those reporting to have been forced into anal intercourse cited higher rates of paranoid and psychotic features, jealousy, attribution of problems to one's own behavior, conflict, and male dominance, as well as lower expectations of improvement in one's marital relationship.ConclusionIn marital relationships, women are at a higher risk of coerced anal sex if subjected to other types of sexual or non-sexual violence. Higher rates of psychopathology and poorer marital relationships are also allied to self-reported anal sexual coercion. Mohammadkhani P, Khooshabi KS, Forouzan AS, Azadmehr H, Assari S, and Lankarani MM. Associations between coerced anal sex and psychopathology, marital distress and non-sexual violence. J Sex Med 2009;6:1938–1946.     

Anterior chest wall protrusion as initial presentation of chronic granulomatous disease: a case report

Chronic granulomatous disease (CGD) is a rare primary immunodeficiency disease characterized by recurrent life-threatening bacterial and fungal infections. We report a 4-month-old girl with CGD, was firstly presented with an anterior chest wall protrusion because of an aspergillosis mass.     

Severe cutaneous reactions caused by barbiturates in seven Iranian children

Background  The severe adverse cutaneous reactions of erythema multiforme (EM), Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare mucocutaneous diseases associated with significant morbidity and mortality. The most common cause is antiepileptic drugs, particularly carbamazepine and lamotrigine, as well as the barbiturates group (phenobarbital and phenytoin). In this article, we present seven children with severe adverse cutaneous reactions caused by barbiturates.
Case Reports  The age of the affected children was between 2 and 11 years and they all had a history of taking barbiturates. Their symptoms started 1–3 weeks after the initiation of barbiturates, including a prodrome characterized by 2–3 days of malaise, fever, cough and anorexia, after which the skin and mucosal lesions appeared and worsened. The skin lesions varied from rash to large bullae, plus different forms of mucous membrane involvement. The offending drugs (barbiturates) were stopped immediately and care was largely supportive.
Conclusion  As a result of the morbidity and/or mortality associated with EM, SJS and TEN, physicians should keep in mind their differential diagnosis when cutaneous reactions are observed in patients undergoing barbiturate therapy. Furthermore, although TEN and SJS are life-threatening diseases, early detection and appropriate care can lead to a decrease in the incidence of death. The strategies described here seem to be successful and safe because, despite the serious conditions, our patients responded well. All survived.     

Impact of different placement depths on the crestal bone level of immediate versus delayed placed platform-switched implants

Purpose

The preservation of peri-implant bone is one requirement for long-term success of dental implants. The purpose of this study was to evaluate the impact of subcrestal placement on the crestal bone level of immediate versus delayed placed implants after loading.

Variation in plasma leptin levels in young Iranian children with cystic fibrosis

Introduction

Poor weight gain is one of the most important mortality hazards in cystic fibrosis (CF) patients. The mechanisms that may hinder body weight regulation are not completely understood. Leptin and its role in fat mass could be related to control of weight gain in CF patients. As the previous data are conflicting, we aimed to investigate serum leptin level in Iranian CF children compared to a control group.

Material and methods

Forty-three CF patients aged from 3 to 120 months and 43 age-matched controls were enrolled. Patients were recruited from the outpatient clinic of the Children''s Medical Center Hospital. Controls were visited in the general outpatient clinic for an annual check-up. Both groups were divided into three subgroups based on age: 3 to 12 months, 13 to 48 months, and 49 to 120 months. Body mass index (BMI) was calculated for all the participants. Serum leptin levels were measured applying a solid phase enzyme-linked immunosorbent assay (ELISA).

Results

Leptin levels and BMI values were significantly different between patients and controls (p = 0.02, p < 0.001, respectively) but only patients aged 13–48 months had significantly higher levels of leptin than age-matched controls (p = 0.016). Overall male patients’ mean leptin level was significantly higher than in female patients (p = 0.032) and male controls (p < 0.001).

Conclusions

Leptin level in our patients was significantly higher than controls. It seems that leptin levels during infancy are higher than in adult patients. Further studies are required on specific genotypes, gender and age to reveal the probable correlation with BMI and leptin levels in CF patients from different ethnic groups.     

Spectrum of Bone Marrow Failures of Myeloid Series: New Report of Neutropenic Patients from a Referral Pediatric Center in Iran

Neutropenia is a reduction of the absolute neutrophil count (ANC), which could be seen in different conditions, while its association with a number of primary immunodeficiency diseases has been reported. This study was performed in all neutropenic patients who were admitted in a referral pediatric hospital during a 6-year period (2006–2011). One hundred and forty patients with ANC of below 1500/mm³ were investigated in this study. The most common causes of neutropenia were severe congenital neutropenia (41%), aplastic anemia (19%), cyclic neutropenia (11%), hyperimmunoglobulin M syndrome (9%), and fanconi anemia (7%). The patients experienced their first manifestation at a median age of 1 year, while the median diagnostic age was 21 months. Parental consanguinity was present in about half of the cases. The most common clinical manifestations of the patients were sinusitis (62 cases), periodontitis (51 cases), acute diarrhea (39 cases), pneumonia (38 cases), abscess (36 cases), skin rashes (35 cases), and otitis media (31 cases). Twenty two patients (16%) died during the study period. Considering the differential diagnosis of neutropenia, making the diagnosis and appropriate treatments are the keys in management of patients with neutropenia to avoid further complications.     

Does the Direction of Effects in the Association Between Depressive Symptoms and Health-Risk Behaviors Differ by Behavior? A Longitudinal Study Across the High School Years

PurposeAdolescence is associated with the onset of depressive symptoms as well as significant increases in health-risk behaviors. Potential explanations for the direction of effects in the association between depressive symptoms and health-risk behaviors include the self-medication/acting out hypothesis (i.e., early depressive symptoms predict increases in risk behaviors over time) and the failure hypothesis (i.e., early participation in health-risk behaviors predicts increases in depressive symptoms over time). The purpose of the present longitudinal study was to assess these competing hypotheses across the high school years, and to examine whether the direction of effects (and therefore the self-medication/acting out and failure hypotheses) may differ depending on the type of risk behavior under consideration.MethodsThe sample consisted of 4,412 adolescents (49% female) who were followed up from grade nine to 12. Adolescents reported on their depressive symptoms and six health-risk behaviors (frequency of alcohol use, amount of alcohol consumed per drinking episode, cigarette smoking, marijuana use, hard drug use, and delinquency). Analyses were conducted with dual trajectory growth curve modeling.ResultsAdolescents who had higher depressive symptoms in grade nine reported faster increases than their peers in smoking, marijuana, and hard drug use across the high school years, supporting the self-medication hypothesis. The failure hypothesis was not supported.ConclusionThe results are important because they suggest that by targeting depressive symptoms during early adolescence, treatment programs may prevent increases in the frequency of these risk behaviors later in adolescence.     

Candida albicans interface infection after deep anterior lamellar keratoplasty

The clinical features of interface Candida keratitis after deep anterior lamellar keratoplasty (DALK), may imitate rejection or crystalline keratopathy. We report here an 18-year-old woman presented with red eye, 4 months after undergoing DALK. Slit lamp examination revealed keratic precipitates (KPs) and conjunctival injection. She was prescribed corticosteroid treatment for endothelial rejection by another ophthalmologist because of misdiagnosis, but suffered a recurrence of symptoms after reduction of the corticosteroid treatment. At that time, she was referred to our office. The recurrence persisted despite antibiotic and antifungal therapies. Ten days after treatment with interface irrigation with amphotericin, the infiltration and hypopyon were resolved. Topical steroid was added after 3 months of antifungal monotherapy. Irrigant cultures confirmed the presence of Candida albicans. The corneal graft appeared semi-clear with no signs of infection at 17-month follow-up. We recommend a close follow-up and a timely intervention to prevent the need for more invasive treatment such as penetrating keratoplasty.