Effects of self-management training in Type 2 diabetes: a randomized, prospective trial.

AIMS: The efficacy of three education programmes for Type 2 diabetic patients was tested in a randomized trial. A didactic-oriented training programme (treatment A) was compared with a self-management-oriented programme delivered in group sessions (treatment B). The latter programme was compared with a more individualized approach (treatment C). METHODS: One hundred and eighty-one Type 2 diabetic patients (age 55.6 +/- 6.3 years, diabetes duration 6.6 +/- 6.2 years, HbA(1c) 7.8 +/- 1.6%, female 49.7%) took part. Efficacy was assessed 3 months (t1) after baseline (t0) and at a follow-up 15 months (t2) after baseline. RESULTS: The fall in HbA(1c) in treatment B at t1 was sustained at t2 (t0 8.1 +/- 1.8%, t1 7.3 +/- 1.7%, t2 7.4 +/- 1.9%). In treatment A, HbA(1c) was unchanged throughout (t0 7.6 +/- 1.5%, t1 7.5 +/- 1.3%, t2 7.7 +/- 1.7%; treatment A vs. treatment B; P < 0.05). With the more individualized approach of treatment C, there was a fall in HbA(1c) at t1, but this was not sustained at t2 (t0 7.8 +/- 1.6%, t1 7.1 +/- 1.3%, t2 7.6 +/- 1.6%; treatment B vs. treatment C; P = 0.73). There were also significant benefits in treatment B subjects compared with treatment A in further medical (body mass index and fasting blood glucose), psychological (control, irritability and hunger dependency of eating behaviour, and trait anxiety) and behavioural (exercise) variables. There were no significant benefits of the more individualized treatment C compared with group treatment B. No significant differences were found regarding triglyceride levels, high-density lipoprotein, diabetes-related knowledge, negative well-being, urine or blood glucose levels or foot care. CONCLUSION: Self-management training had a significantly higher medium-term efficacy than didactic diabetes education. The group sessions were more effective than a more individualized approach.     

Performance measures for evaluating services for people with a first episode of psychosis

Aim: The purpose of this project was to operationalize and apply a previously identified set of performance measures designed to evaluate services for those experiencing a first episode of a schizophrenia spectrum disorder. Methods: Operational definitions were developed for previously identified measures through an iterative process of discussions between clinical experts and health‐care evaluators. Data were collected from existing sources including corporate databases, clinical databases and chart review. Results: Definitions were developed for 44 measures covering seven of eight domains recommended for service level evaluation by the Canadian Institute for Health Information domains. Forty measures could be calculated. Conclusions: The measures represent a comprehensive set of performance measures suitable for the evaluation of services for people with a first‐episode psychosis. The measures could be used by other services in order to establish standards and norms for routine clinical practice.     

Preference awareness education as stress management training for academic staff

This paper describes a response directed stress management intervention (SMI) in the form of a Jungian based preference awareness education (PAE). It uses the Insights System of personality types to increase awareness of behaviour and communication preferences of self and different others. Eighteen self‐recruited academic employees participated for 7 weeks and received feedback about work preferences and personality type. The aim was to reduce perceptions of stress and interpersonal stress and to increase feelings of job satisfaction and interpersonal satisfaction. The data were analysed using two‐tailed t‐tests. No significant findings were observed for the total sample after training, however, interesting results were found for certain sub‐sample groups. Extravert‐thinking types, reported decreased stress levels (p > 0.018), and participants suffering high stress/interpersonal stress pre‐PAE, reported decreased stress levels (p > 0.010–0.018). Participants suffering low job/interpersonal satisfaction pre‐PAE, reported increased job satisfaction (p > 0.015–0.016). These results suggest that individuals who report high levels of stress and dissatisfaction are most likely to benefit from this type of intervention. Future PAE research might: (a) use pilot studies to meet the intervention preferences of employees that are reluctant to participate in SMIs; (b) include a wait‐list control group; use: (c) a follow up education/measures; (d) and organizational level (stressor directed) SMIs at the same time as response directed initiatives. Copyright © 2005 John Wiley & Sons, Ltd.     

Dietary intake in the elderly estimated by a 24 hour recall and a food frequency questionnaire

Two hundred and thirty-five tenants living in sheltered housing in Scotland were surveyed to identify the extent of under-nutrition and the social factors which contribute to its development. A validated 24 h recall and the nutrient checklist published by NAGE were used to evaluate patterns of dietary intake. A questionnaire was developed which included scales designed to measure depression, social engagement, cognitive function, mobility and functional ability. The results show considerable evidence of a number of major nutrients in which there were low intakes. In order to express the extent of poor nutrition, a nutrient score was developed where points are awarded based on the number of nutrients falling below the Lower Reference Nutrient Intake, the Estimated Average Requirement or below half the daily Estimated Average Requirement.     

A comparison of nutritional intake, functional status and muscle strength between elderly day hospital and day centre attenders in South London

Two sample groups of elderly were compared from a population living in South London. One group attended a local day centre (a socially orientated establishment), and the other attended a local day hospital (a therapeutically orientated establishment).
The aim of the study was to compare nutritional intake, functional status and muscle strength between these two groups.
The mean nutritional intakes of the day hospital and day centre attenders were similar. Intake of macronutrients, with the exception of fibre, met Recommended Daily Allowances (RDAs) in both groups. In take of folic acid, vitamin D and zinc fell below recommendations in both groups.
Low intake of folic acid was improved by supplementation, and some individual blood levels of folate reflected this. Blood folate levels were generally within normal limits. Low intake of vitamin D was improved by supplementation, but blood levels were generally normal anyway. There was, however, a tendency for the more dependent day hospital patients to have lower vitamin D levels. This group also had less sunshine exposure.
Communal dining, whether in the setting of day hospital or day centre, may have been an essential means of bolstering nutritional intake for many 'at risk' elderly.
There were significant differences in functional status and muscle strength in favour of the day centre group and these indicate that anthropometric indices rather than nutritional or biochemical indices were the most reliable markers of disease and disability in this study.
The effect of fortifying local meals-on-wheels was also highlighted, and suggests that this may be one means of preventing nutritional deficiencies in the vulnerable, house-bound elderly.
Alcohol intake was reported as being modest. However, discrepancies were noted on review of biochemical indices known to be influenced by alcohol intake.     

九十年代中国人群的膳食与营养状况

九十年代中国人群的膳食与营养状况葛可佑，翟风英，闽怀成，程列，王青，贾凤梅（中国预防医学科学院营养与食品卫生研究所，北京１０００５０）人群的膳食营养状况在一定程度上可以反映一个国家的经济发展和社会文明程度。世界上大多数发达国家及若干发展中国家都在有计...     

Evaluation of an Australian intervention to encourage breast feeding in primiparous women

Breast feeding has nutritional, immunologic and antiallergicadvantages for the infant. Although it has been widely recommendedthat infants be exclusively breast fed until 4–6 monthsof age, only about half of all Australian babies currently receiveextended breast feeding. The present study evaluated an intensiveprogramme designed to increase the proportion ofprimi-parousmothers who breast fed for 4 months or longer. Women who registeredwith the hospital at least 20 weeks before delivery and whointended to breastfeed were eligible for the study. Two hundredand thirty-five women were allocated to receive either usualcare or an intensive breast feeding programme when they registeredwith the hospital. The intensive programme consisted of writtenmaterials, and group and individual sessions with a lactationcounsellor. It also included a visit from a breastfeeding consultantwhile in hospital after the birth and contact on return home.Women were followed up 6 weeks and 4 months after delivery.There were no significant differences in breastfeeding ratesbetween the control and intervention groups at either follow-uppoint. Breast feeding until 4 months was more likely among womenwhose baby did not receive a bottle feed while still in hospitaland who did not smoke, use the combined oral contraceptive pillor introduce solid food before 4 months. Those mothers who enjoyedand felt satisfied with breastfeeding were more likely to continueto 4 months. It seems likely that programmes designed to increasebreastfeeding will need to address underlying factors such ashospital policy rather than simply providing more health education.     

Burns during pregnancy: a gloomy outcome

The effect of burns on fetal and maternal survival is known to be detrimental. This prospective study describes the performance of pregnant burned patients who were managed and followed up for fetal and maternal outcomes at Ain Shams University's burn unit and Maternity Hospital during the period from October 1995 to September 1996. During the 12-month period, 27 pregnant burned patients were managed. Fetal and maternal mortality correlated with the total body surface area (TBSA) burned, the mortality rate being 63 per cent for both mothers and fetuses in the 25–50 per cent TBSA group. A fetal loss of 56 per cent with no maternal loss were recorded in the 15–25 per cent TBSA group. Experience in dealing with pregnant burned patients proves that early surgical excision and skin grafting, with timely termination of pregnancy are the best lines of treatment. Prevention or minimizing the effects of the burns may be achieved by proper education and guidance of the pregnant woman.     

油菜和向日葵花粉的成分分析及其蛋白质营养评价

<正> 花粉在古代就曾作为强身保健食品。美、英两国的科学家曾分析了花粉的成分,发现花粉由96种元素组成,其中有维生素、矿物质、酶、蛋白质和某些其它物质。美国明尼苏达大学曾做过花粉对动物的增重实验。当41～150日龄小猪饲料中添加2～3％的玉米花粉时,体重增长明显快于对照组,     

Belt device for simplified CT-guided puncture and biopsy: A technical note

A new radiolucent device for increased accuracy of CT-guided fine-needle punctures permits precise determination of the optimum angle, depth, and position of the fine needle, which can be preset from the data supplied on the CT monitor. Puncture and repeat scans for controlling the tip of the needle can be performed with the patient in a stationary position. The device is designed as a belt that holds a needle holder sheath and a goniometric scale, both of which can be moved to varying positions around the patient.