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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Self-report questionnaires completed by young adults with Type I diabetes were examined to determine if individuals differing in recent metabolic control (Poor, Moderate or Very Good) or disease duration (Long, Short) also vary in either occurrence or type of life events during the past year or occurrence of recent emotional distress. Subjects in Poor control reported more positive and neutral life events during the past year, suggesting even those life changes individuals view benignly may be associated with metabolic control difficulties. Individuals in Poor control also reported more recent symptoms of depression, anxiety and hostility than did individuals in Moderate or Very Good control--symptomatology which may further impair their ability to adhere to a complex self-care regimen. Individuals with Long disease duration reported more positive and negative recent life experiences than did subjects with Short disease duration, but did not evidence concomitant disruptions in metabolic control. The role experience with a chronic disease may play in this finding was unclear, however. Although more research is required to clarify the exact relation of psychosocial variables and diabetic control, these findings suggest that clinically relevant subgroup parameters, subjects' perceptions of life change, and demographic variables may be important factors to assess.
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PMID:Psychosocial aspects of disease duration and control in young adults with type I diabetes. 336 73

In addition to benefiting from public health programs for all Americans, American Indians and Alaska Natives are eligible for health services from the Indian Health Service (IHS), U.S. Public Health Service. Indian Health Service provides comprehensive health services, including nutrition and dietetics, to American Indians and Alaska Natives living on or near federal Indian reservations or in traditional Indian territory, such as Oklahoma and Alaska. Dramatic improvements have occurred in the health of native Americans since IHS was transferred to the Public Health Service in 1955. Infant mortality rate, maternal deaths, and deaths related to infectious diseases have all decreased. Chronic diseases are now major causes of death. Nutritional factors contribute to at least 4 of the 10 leading causes of American Indian and Alaska Native deaths--heart disease, cancer, cirrhosis, and diabetes--and to the prevalence of overweight, obesity, hypertension, and dental caries. There is still incomplete information on nutritional status and present dietary patterns, nutritive values of native foods, and nutrition education knowledge of the population. Priority nutrition objectives have been developed to address those issues.
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PMID:Nutrition in American Indian health: past, present, and future. 353 63

Case report forms from a multicenter, randomized trial comparing ceftazidime (50 patients) with tobramycin plus ticarcillin (control group, 44 patients) in the treatment of skin and soft-tissue infections were reviewed. Two subsets of patients were identified. The target patient population (group I) comprised older patients with predisposing chronic disease (eg, diabetes mellitus) and an average of 1.8 bacterial pathogens per patient. Necrotizing soft-tissue and postoperative wound infections predominated. Group II comprised younger patients with acute onset of monomicrobial cellulitis or staphylococcal or streptococcal abscess. Clinical cure or improvement was achieved in 93% of ceftazidime-treated and 94% of control group I patients. Bacteriological eradication of the initial pathogens without superinfection was obtained in 85% and 82%, respectively, of the two treatment groups. In group II, each of the nine ceftazidime-treated patients was cured or improved and bacteria were eradicated; in the control group, nine of ten patients were clinically and bacteriologically cured. Among all patients, Staphylococcus aureus was eradicated in 18 of 19 treated with ceftazidime and in 14 of 15 treated with the control agents. The results of the study demonstrate the efficacy of ceftazidime as initial monotherapy for soft-tissue infections in patients with compromised vascularity.
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PMID:Ceftazidime versus tobramycin plus ticarcillin in the treatment of soft-tissue infections. 354 76

Health practitioners should not discourage mothers from breast feeding if they acquire an acute self limited illness. Depending on the treatment for a chronic disease, its severity, and its stage, mothers with some chronic diseases may breast feed. If a pregnant diabetic women has good prenatal care, continued good medical care for diabetes, and takes the needed increased insulin, the mammary gland should be able to produce ample milk for a health infant. Further, lactation induces a remission from diabetes. If pregnant women with severe asthma do not take medication, they are likely to experience severe asthma attacks which require large doses of medication to control them. 1 such medication, theophylline, passes to breast milk in a milk to plasma ratio of .6-.73. Mothers who have normal or mildly decreased renal function can breast feed successfully. In those women who experience moderate renal insufficiency, breast feeding can take place in only those cases where the infant is stable and can feed soon after delivery and the mother's condition is sound or improved after delivery. If indeed a woman with severe renal insufficiency can conceive, which is unlikely, she should not breast feed since the stress of pregnancy and delivery alone may have comprised her health. The limited research on breast feeding after a kidney transplant shows that an immunosuppressed women can produce immunocompetent milk with very little azathioprine present. Hypertensive mothers can breast feed their infants, especially if the internist treating her considers the lactation process. Diuretics may diminish milk production, but an active infant who stimulates milk production can counteract this effect. Methyldopa may suppress milk production.
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PMID:Maternal disease as a consideration in lactation management. 354 16

To examine the effects of intensive patient and/or physician diabetes education on patient health outcomes, a controlled trial was conducted in which internal medicine residents and their 532 diabetic patients were randomly assigned to: routine care; patient education; physician education; or both patient and physician education. Patient outcome data were analyzed either by analysis of covariance on post intervention values (2-hour post-prandial plasma glucose [PPG]; body weight [BW]; blood pressure [BP]; or analysis of variance conducted on change values (fasting plasma glucose [FPG] and glycosylated hemoglobin [A1Hgb]). After patient education, significant improvements were observed in FPG, A1Hgb, BW, and systolic and diastolic BP. Physician education resulted in significant decreases in FPG, A1Hgb and BW. The combination of patient plus physician education resulted in the greatest improvements in patients' health outcomes including FPG, A1Hgb, PPG, BW and diastolic BP. Adjusted systolic BPs were not significantly different in the two groups. While these physiologic improvements were statistically and probably clinically significant, hyperglycemia and obesity still persisted. Thus, achieving optimal patient outcomes for a chronic disease like diabetes mellitus may require a greater or more effective use of resources than currently estimated.
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PMID:DIABEDS: a randomized trial of the effects of physician and/or patient education on diabetes patient outcomes. 354 57

Taking over a chronic disease like diabetes in a hospital clinic raises multiple problems. Large numbers of diabetic patients and prolonged follow-up periods result in a mass of data that only computers can control. MELLITEE is a computerized system developed to facilitate the longterm management of patients and to help in maintaining a high standard of care. It includes a structured and standardized medical record. Physicians of three Parisian hospital clinics agreed on the minimum content of the record. MELLITEE is operated at the Saint-Louis Hospital on a 68,000 based mini-micro computer (Fortune/Thomson Micromega-32), running under the Unix operating system and with the Lied data base management system. Data are keyed directly into the computer by physicians, nurses and dietitians from throughout the department. On-line registration of information allows the suppression of the corresponding part of the usual paper record. The clinical data base obtained from administrative and medical information can be used to facilitate more effective patient follow-up and clinic management. The system is to be set up in the other collaborating centres in the near future, allowing pooling of data. It will also provide long-term information which can be used for evaluation of care and epidemiological research.
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PMID:[A computerized file for the surveillance of diabetic patients: the MELLITEE system]. 359 68

Accurate assessment of health status and forecasting of risk for poor outcomes in chronic disease require a broad representation of health measures. To support this conclusion, the health of patients with diabetes (N = 73) and hypertension (N = 105) was assessed using measures of physical and role functioning, perceived health, and disease severity (blood sugar or diastolic blood pressure, respectively, for diabetes and hypertension). Health questionnaires measuring functional limitations, overall health rating, level of health concern, perceived susceptibility to illness, and number of health problems were administered at study enrollment. Laboratory tests for blood sugar (hemoglobin A1) and diastolic blood pressures were performed at enrollment and were repeated at a subsequent clinic visit, from 3 to 6 months later. Functional limitations correlated significantly with elevated blood sugar (r = 0.57) and blood pressure (r = 0.49) at study enrollment. Perceived poor health was not substantially related to either physiologic measure at enrollment. Using ordinary least squares regression, the best predictor of both blood sugar and blood pressure at follow-up was baseline blood sugar and blood pressure, respectively. However, both functional limitations and perceived poor health made significant and independent contributions to the prediction of blood sugar and blood pressure at follow-up. The results underscore the value of both health survey measures and clinical measures in studies of chronic disease.
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PMID:Patient reports of health status as predictors of physiologic health measures in chronic disease. 359 96

In an attempt to study the incidence of hand infections in dental personnel, a standardized survey was submitted to 715 dental professionals and hygienists throughout the state of Nebraska. Of those surveyed, 508 responded (71 percent). Ninety-eight of the 508 respondents reported an infection (19.29 percent). The rate of infection was found to correlate positively with the number of patients seen per week. The rate of infection was increased in respondents with chronic disease (e.g., diabetes mellitus) versus those without chronic disease (33.33 vs. 18.59 percent). In the dental professionals surveyed, it was found that the rate of infection in those who did not routinely wear surgical gloves was significantly greater than in those who did (28.6 vs. 17.6 percent). The morbidity of infections acquired in dental practice can be substantial. A percentage of individuals must leave their practice for surgical treatment. A number have acquired hepatitis B (although none in this study), and exposure to the HTLV-III is possible. We conclude that some protection from infection can be achieved with the routine use of surgical gloves, and this practice should be considered by all, particularly those with chronic disease.
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PMID:Hand infections in dental personnel. 362 71

The Australian Region 8 (Victoria) Diabetes Education and Control Program (DECP) is a community-based program which seeks to integrate ambulatory diabetes education programs into primary health care centres. The overall goal of the DECP is to reduce the human and economic costs of diabetes in a health region which covers 25% of the population of Victoria. Several implementation models are being tested and a rigorous evaluation has been built into the program. Diabetes education activities are targeted at 3 levels--the community, persons with diabetes, and health professionals. The DECP may provide of useful model for establishing diabetes and other chronic disease education and control programs, within community settings, in other parts of Australia and other countries.
Diabetes Res Clin Pract 1986 May
PMID:A community approach to diabetes education in Australia--The Region 8 (Victoria) Diabetes Education and Control Program. 372 May

Correlations of 0.3 and 0.4 in psychological studies in chronic illness (e.g. diabetes) have been criticized as having little clinical importance. The present article suggests that correlation coefficients be interpreted as binomial effect size displays (BESD) as a means of gleaning the clinical importance of a given correlation coefficient. The BESD is easily understood, computed, and applied to research in chronic disease. An illustration is provided in which a r of 0.2 is shown to correspond to a BESD in which the success rate is improved from 40 to 60%. Using BESD to interpret the meaningfulness of relationships, correlations as low as 0.2 may have clinical importance.
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PMID:Interpreting behavioral, biomedical, and psychological relationships in chronic disease from 2 x 2 tables using correlation. 373 17


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