Objectives To investigate if there is an association between dental health status and high blood pressure, to test the effectiveness of screening for high blood pressure and high blood glucose performed by the dental health care in collaboration with primary health care and to investigate the direct costs for this type of screening organisation. Study population and methods In Paper I 54 subjects with known hypertension and 141 with a high blood pressure in the dental office were compared with matched controls. In Paper II 1,149 subjects were screened for hypertension and in Paper III 1,568 subjects were screened for diabetes in dental care. Follow up was performed in co-operating primary health care centres. In paper IV the direct costs for screening and follow-up were calculated. Results There was a significant association between deep periodontal pockets and high blood pressure, even when the influence of age, sex, smoking and number of teeth was taken into account. Among those being screened for high blood pressure and high blood glucose 20.6% and 9.9% respectively were referred to primary health care, and a hypertension or a diabetes diagnosis was found in 32.1% and 5.8% of those screening positive. For every 18th subject screened a hypertension case was found (“numbers needed to screen” (NNS)), and for every 196th a diabetes case. NNS for combined hypertension and diabetes screening was 15. The total direct costs for screening and follow up per diagnosis found were 5,298 SEK for hypertension, 19,100 SEK for diabetes, and  4,116 SEK for combined blood pressure and blood glucose screening. Conclusions There was an association between dental health and hypertension. Screening for hypertension was highly efficient, while screening for diabetes was less so, because it is a less prevalent condition. Screening for both conditions appears to be the most efficient type of screening.

High dietary sodium intake is hypothesized to increase food intake (FI), fluid intake and glycemic response. Two short-term randomized repeated-measures studies measured the effects of acute sodium intake on FI, water intake (WI), subjective appetite (SA), thirst, and blood glucose (BG) in young men. Sodium additions were 740 and 1480 mg to a solid food (beans) in Experiment 1; and 500, 1000, 1500 and 2000 mg to a beverage (tomato juice) in Experiment 2. FI and WI were measured at ad libitum pizza meals 120 and 30 min later, respectively. SA, thirst and BG were measured at intervals before and after pizza. Compared with controls, treatments with added-sodium had no effect on dependent measures. In conclusion, acute intake of sodium in a solid or liquid matrix does not increase subjective ratings of appetite or thirst, ad libitum food or water intakes, or blood glucose in healthy young adults.

In order to elucidate the component(s) of yellow peas responsible for their health benefits, the effects of 10 or 20 g of isolated yellow pea protein (P10 and P20) or fibre (F10 and F20) on food intake (FI) at an ad libitum pizza meal served at 30 min (experiment 1) or 120 min (experiment 2), blood glucose (BG) and appetite in young healthy males (20-30 y) were investigated. In experiment 1, P20 suppressed FI compared to all other treatments and lowered cumulative FI (pizza meal kcal + treatment kcal) compared to F10. Protein treatments suppressed pre-meal (0-30 min) BG compared to control, whereas only P20 suppressed post-meal (50-120 min) BG. In experiment 2, there was no effect of treatment on any outcome measures. Thus, protein is the component responsible for the short-term effects of yellow peas on glycaemia and FI, but its second-meal effects diminish by 2 hours post-consumption.

High dietary sodium intake is hypothesized to increase food intake (FI), fluid intake and glycemic response. Two short-term randomized repeated-measures studies measured the effects of acute sodium intake on FI, water intake (WI), subjective appetite (SA), thirst, and blood glucose (BG) in young men. Sodium additions were 740 and 1480 mg to a solid food (beans) in Experiment 1; and 500, 1000, 1500 and 2000 mg to a beverage (tomato juice) in Experiment 2. FI and WI were measured at ad libitum pizza meals 120 and 30 min later, respectively. SA, thirst and BG were measured at intervals before and after pizza. Compared with controls, treatments with added-sodium had no effect on dependent measures. In conclusion, acute intake of sodium in a solid or liquid matrix does not increase subjective ratings of appetite or thirst, ad libitum food or water intakes, or blood glucose in healthy young adults.

In order to elucidate the component(s) of yellow peas responsible for their health benefits, the effects of 10 or 20 g of isolated yellow pea protein (P10 and P20) or fibre (F10 and F20) on food intake (FI) at an ad libitum pizza meal served at 30 min (experiment 1) or 120 min (experiment 2), blood glucose (BG) and appetite in young healthy males (20-30 y) were investigated. In experiment 1, P20 suppressed FI compared to all other treatments and lowered cumulative FI (pizza meal kcal + treatment kcal) compared to F10. Protein treatments suppressed pre-meal (0-30 min) BG compared to control, whereas only P20 suppressed post-meal (50-120 min) BG. In experiment 2, there was no effect of treatment on any outcome measures. Thus, protein is the component responsible for the short-term effects of yellow peas on glycaemia and FI, but its second-meal effects diminish by 2 hours post-consumption.

Background: Self-care is a multi-dimensional concept and has different definitions. Amongthe definitions, Orem’s definition of self-care is more consistent. Orem (1995) argues that,self-care is a personal activity to take care and maintain of own self health and illness andprevention of disease related complications. Aim: The aim of the paper was to investigate the factors that contribute to self-care behavioramong patients with Type 2 DM as argued in the literature. Method: data was collected from the following electronic databases: CINAHL, PubMed,LibHub, SweMed and Google Scholar-to find full texts. Data was analyzed through CriticalAppraisal Skill Programme. To ensure validity and reliability the author were blinded toreduce study bias and articles were selected according their quality. Result: 31 relevant studies were included in the review, among the major findings of the studywere; Age, Social support/network, high income level, high educational attainment and longType 2 DM diagnosis history had a positive predictor in Type 2 DM patients self-carecontributing factors. Conclusion: To improve a Type 2 DM patients self-care activities the present study concludedthat Demographic, Socio-Economic and Social support factors are among the positivecontributors in patients of Type 2 DM successful Self-Care activities. Key words; Blood glucose self-monitoring, self-administration, Self-care, self-medication,Type 2 Diabetes. / The aim of the paper was to investigate the factors that contribute to self-care behavior among patients with Type 2 DM as argued in the literature.

Bakgrund: Diabetes mellitus typ 2 förväntas öka drastiskt de kommande åren. För att uppnå förändring behöver personerna få insikt och förståelse för sambandet mellan delar i egenvård. Empowerment har visat sig vara av betydelse för att uppnå egenkontroll och självständighet i egenvård. Syfte: Syftet var att beskriva effekten av empowerment på egenvård hos personer med diabetes mellitus typ 2. Metod: En litteraturöversikt har genomförts baserad på vetenskapliga artiklar med kvantitativ design och analyserades enligt Fribergs trestegsmodell. Resultat: Resultatet är en sammanställning av totalt tio artiklar bestående av ett sjukdoms- specifikt- eller patientdrivet program innehållande empowermentinterventioner. Intervention- erna visar på olika förbättringar i utfallen fysisk aktivitet, kosthållning, kunskap och attityder, egenmätning av blodglukos samt tillfredsställelse och livskvalitet i det dagliga livet. Utfall i egenvård har påvisat en signifikant effekt på reducerad blodglukosnivå i samtliga artiklar. Slutsats: Genom hela litteraturöversikten har effekter av empowerment bevisats ha en bety- delse då deltagarna har erhållit en förbättrad egenvård efter interventionerna. / Background: The prevalence of diabetes mellitus type 2 is expected to rise dramatically within the upcoming years. To achieve a difference, the persons need insight and understand- ing regarding the connections of the elements in the self-care. Patient empowerment has shown to be of great importance when it comes to being able to take control of their self-care. Aim: The aim was to describe the effect of empowerment on self-care in patients with diabe- tes mellitus type 2. Method: An overview of the literature was used, including relevant articles with a quantita- tive design analyzed according to Fribergs three step model. Results: The result is a compilation of a total of ten articles consisting of either a disease- specific or a patient-driven program containing interventions of empowerment. The interven- tion shows a variation of improvements in the events of physical activity, diet, knowledge and attitudes, the self-measurement of blood glucose together with an increased life quality and satisfaction in the everyday life. The outcome in self-care has shown a significant effect con- sidering the reduction in the blood glucose level in all of the articles. Conclusion: Throughout the literature review, it’s been found that empowerment has shown to be an important and positive factor to patients health and treatment programs, as patients have improved and maintained self-care as a result of interventions.

People in low socioeconomic status groups are at increased risk for diabetes mellitus, a group of diseases associated with high levels of blood glucose. High rates of depression have been found in people with diabetes. The study examined the relationship between stress, depression, and glycemic control in low-income type 2 diabetes patients. Participants were recruited at two community health centers that provide free medical care. The following hypotheses were examined: (1) experiencing stressful life events is positively correlated with blood glucose level; (2) negative stressful events have a greater association with glucose level than positive stressful events; (3) depression mediates the relationship between negative stressful events and glucose level (mediation model); (4) the effect of experiencing both negative stressful events and depression is predictive of glucose level (additive model); (5) the interaction between negative stressful events and depression is predictive of glucose level (interactive model); and (6) perceptions of control moderates the relationship between stress and depression.Stressful life events and depression were not related to blood glucose levels in bivariate correlations. The data did not support any of the three models of the relationship between stress, depression, and glycemic control. The strongest predictor of glycemic control was Hispanic ethnicity, however, income and education appear to confound this relationship.Depression was positively correlated with the total number of stressful events and negative stressful events and negatively correlated with perceptions of control. Participants in the study with less than a high school education had the highest amount of depression. In post-hoc analyses, four variables (education, perceptions of control, stressful life events, blood glucose) predicted 58% of the variance in depression, and education and perceptions of control were the strongest predictors. Per ceptions of control was a significant partial mediator of the relationship between education and depression and also partially mediated the relationship between stress and depression.The results of the study indicate that decreasing stressful life events and increasing perceptions of control is important in reducing low-income diabetes patients' level of depression.

Background: The incidence of postoperative nausea and vomiting (PONV) can be reduced by dexamethasone. Single dose administration may cause elevated blood glucose levels in obese adults. No data are available for children. Objective: The aim was to evaluate perioperative blood glucose changes related to body weight in children who received dexamethasone. Methods: This prospective observational study included 62 children. All patients received total intravenous anesthesia and a single dose of dexamethasone (0.15mg/kg, maximum 8mg). Blood glucose levels were measured up to 6 hours. Standard deviation scores (SDS) were calculated using age- and gender-specific BMI percentiles, p<0.05. Results: 62 children (11.5±2.9years, median SDS 0.43, 29% overweight/obese) were included. Blood glucose level increased from 5.52±0.52 to 6.74±0.84mmol/l 6h after dexamethasone without correlation to the BMI-SDS. Conclusions: This study shows an increase of perioperative blood glucose (normoglycemic ranges) after single dose of dexamethasone but no BMI-dependent effect in children. Therefore, low-dose dexamethasone may be used in obese children for PONV prophylaxis.

In many African countries, including South Africa, much attention has been centred on the management of HIV/AIDS and tuberculosis epidemics. However, there is growing awareness in South Africa that life-style related non-communicable conditions, such as diabetes and obesity, represent an important health priority (Pirie, 2005:42). The general objective of this study was to evaluate the treatment of diabetic patients in clinics on primary healthcare level and to determine what contributions can be made in the prevention of diabetic complications. The research method consisted out of the selection of the study population, data collection (questionnaire) and the data analysis. There was no structural way of deciding which patients would be selected to be interviewed. As the patients arrived for their appointments the interviewer was informed. No patient was forced to participate in this study and after they agreed to the interview, they signed a consent form that releases the University of any liability that may occur and to give their permission for the interview. The questionnaire was compiled which covered all the aspects of diabetes. This included diagnostic data, life-style, well-being, compliance and monitoring. The researcher completed the questionnaires whilst interviewing the patients. The data obtained from the questionnaires were statistically analysed by using the Statistical Analysis System, SAS 9.1. Effect size, which was given by the Phi coefficient, was used as a descriptive statistic. In this particular study population, the majority of patients were classified as type 2 diabetics. This can be viewed in table 4.8 where 62.14% of the total study population was classified as group B, which means that these patients use oral glucose lowering drugs to control their disease. A further 33.98% of the population was classified as group C diabetics, which means that these patients need oral glucose lowering drugs as well as exogenous insulin to maintain a healthy life. The latter group obviously consists of patients whose diabetic status was not under control in the past, thus the need for the insulin. This clearly shows that these patients have not been informed about how they can manage the disease by dietary modification and lifestyle interventions. Lifestyle, socio-economic and education played a major role in the development of this disease in these patients. The weight status of the study population was determined and can be viewed in table 4.15. Only 20.39% of them were of normal weight with a body mass index (BMI) ranging between 18.5 - 24.9 kg/m2. 39.81% of them were overweight with their BMI ranging between 25 - 29.9 kg/m2 and the remaining 39.81% of the study population were classified as obese with their BMI's above 30 kg/m2. The majority (an estimated 80%) of the study population were above optimal weight. This may cause the development of chronic complications, such as retinopathy, neuropathy and nephropathy. The socio-economic status of the study population was relatively poor because of unemployment. Although 90.07% of them said they had no difficulty to follow their diet (table 4.56) almost half of the patients said they had some difficulty to get the correct food for their specific needs (table 4.53). The first may be because they are still eating they way they used to with no modifications and the latter may be because of their financial status. Not being able to find work has a major effect on their lives. They cannot afford to buy foods suitable for their needs. As previously stated, patient education is fundamental in the managing and controlling diabetes. When these patients were asked whether they know what diabetes is, and what the complications of the disease might hold, most of them answered that it means they have 'sugar', and cannot eat sugary foods any more. This clearly indicates that they did not have a complete knowledge of their disease. After having explained to them in uncomplicated terms what the disease implicates, many of them said it had not been not explained to them previously and that they now understood it better. It was concluded that the majority of the studied population were under a false impression of what diabetes implied. This is partly due to the lack of time the clinic staffs have to spend with each patient, educating them about the disease. One aspect that was most obvious during this study was the fact that an estimated 20% of all patients studied had their own blood glucose monitor (table 4.80). This is somewhat concerning because to have optimal control over one's blood glucose levels, one needs to has a blood glucose monitor for regular monitoring. An estimated 70% of the studied population measures their blood glucose only once a month when they attend the clinic for their monthly visit (table 4.81). This is not nearly enough to ensure optimal control. The average blood glucose levels were calculated and described in section 4.7. Even with the minimal measurement, about 50% of these patients' blood glucose levels were fairly under control with an average of 6-9mmol/L (table 4.88). But the other estimated 50% of the population were not controlled with averages of either below 5mmol/L or above 9mmol/L. This is concerning because the possibility that these uncontrolled cases may develop chronic complications, might be unavoidable unless they start taking control of their lives. And for this to happen, these patients need all the possible education from qualified health care providers and the support of their families. Certain recommendations and restrictions were formulated and discussed. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2008.