Social work interventions in Sweden for patients newly diagnosed with type 1 or type 2 diabetes

We evaluated psychosocial work with patients in ordinary clinical practice who were newly diagnosed with type 1 or type 2 diabetes and experienced psychosocial problems at disease onset. We examined types of psychosocial problems, causes of these problems, psychosocial interventions, extent of achievement of psychosocial treatment goals, and whether the patients felt they benefited from the treatment. Eighty-nine working-age (18–65-year-old) Swedish adults newly diagnosed with diabetes were included. Each was interviewed and responded to questionnaires at the beginning and end of the study period. Thirty-four (38%) received psychosocial treatment as needed over 2 years. A psychosocial treatment plan with a defined goal was developed for each. Interventions included counseling, problem-focused support, social information, and advice. The treatment process was documented. Eighteen patients had type 1, and 16 had type 2 diabetes. One-third had emotional problems directly caused by receiving a diagnosis. Several of them had crisis reactions. The rest had problems primarily caused by their life situations. Those with psychosocial problems caused by receiving a diagnosis achieved treatment goals more frequently than the others. Distinguishing the cause of the psychosocial problems of newly diagnosed patients may help ensure that social work resources in health care are used as effectively as possible.     

Comparison of Inulin and Lactulose as Reference Standards in the Breath Hydrogen Test Assessment of Carbohydrate Malabsorption in Patients with Chronic Pancreatic Exocrine Insufficiency

Although often used as a reference standard in the breath hydrogen test (BHT), lactulose fermentation produces more hydrogen, compared to starch, and may therefore not be ideal. This study compares inulin with lactulose as reference standard in the study of carbohydrate malabsorption. Seventeen patients with malabsorption due to chronic pancreatitis and 15 normal controls were studied. Following overnight fasts, BHTs were performed after ingesting 10 g lactulose, 10 g inulin, and 200 g (16 g highly resistant starch) maize meal. Lactulose fermentation produced significantly more hydrogen than inulin in patients with malabsorption (97± 20 vs 45± 22 ppm ⋅ hr; P < 0.05) and controls (43 ± 18 vs 21 ± 10 ppm ⋅ hr; P < 0.05). Patients produced more hydrogen than controls with both standards (lactulose, 97 ± 20 vs 43 ± 18 ppm ⋅ hr, P < 0.05; inulin 45 ± 22 vs 21 ± 10 ppm ⋅ hrs; P < 0.05), suggesting adaptation of the colonic flora. Calculated CHO malabsorption was 2.5 ± 0.8 vs 5.2 ± 3.8 g with lactulose and 5.2 ± 3.1 vs 11.2 ± 9.6 g with inulin as standards in controls and patients, respectively (P < 0.05). Lactulose produces more breath hydrogen than inulin. Calculation of CHO malabsorption using these standards is therefore not comparable.This work was supported by a grant from the South African Medical Research Council.     

Treatment of anticholinergic-induced ileus with neostigmine

A 33-year-old man with a history of recreational benztropine abuse presented to the emergency department with confusion, abdominal pain, and distention. An abdominal radiograph revealed gross fecal loading. He was initially treated with intravenous fluids and opiate analgesia. Subsequently, a diagnosis of anticholinergic poisoning was made, based on tachycardia, delirium, dry mucosa, and reduced bowel sounds. Treatment with tacrine reversed the delirium, and a history of repeated benztropine use was obtained. Persistent ileus was treated with repeated doses of neostigmine, and gastrointestinal motility returned with prompt defecation. Neostigmine appears to be useful in reversing ileus caused by anticholinergic drug overdose. Theoretically, it may be useful in reversing anticholinergic ileus resulting from acute drug overdose, allowing or enhancing decontamination, but the safety and potential efficacy of neostigmine in this scenario have not been established.     

The relationship between quality of life and adherence to treatment

Hypertension is a preventable condition, and the outcomes of clinical trials have established that its treatment reduces cardiovascular morbidity and mortality. Although awareness about the disease has improved in the past two decades, the reality is that many people remain untreated or not adequately controlled. The treatment of hypertension is usually long term, and its success will depend on the effects of the drug regimen on the patient’s quality of life. The relationship between quality of life and compliance is complex and merits careful study. Monitoring quality of life may be one of the best ways of improving adherence to treatment. Therefore, when developing an approach to the treatment of hypertension, physicians should take into consideration the impact of different antihypertensives on the patient’s overall well being, and along with the side effects and contraindications, quality-of-life issues may determine the choice of medication.