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El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / Carta al Editor / Revisión por pares

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78 leaves : / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (M.D.)--University of Adelaide, Dept. of Child Health, 1971

Thesis (M. D.)--University of Hong Kong, 2006. / Title proper from title frame. Also available in printed format.

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Diabetes Mellitus (DM) is a complex, chronic disease, associated with potentially devastating complications. The DM-complication rate may be increased among people with schizophrenia. This study evaluated the relationship between schizophrenia and risk of preventable, acute DM-complications. Using administrative data, a retrospective study assessed acute DM complications (emergency department visits or hospitalization for hypo- or hyperglycemia, and hospital admissions for infections) among Ontario residents ages 18-50 with schizophrenia and newly diagnosed DM between 1995 and 2005, comparing people with and without pre-existing schizophrenia. People with schizophrenia had a 74% greater risk of requiring a hospital visit for hypo- or hyperglycemia (HR =1.74, 95% CI 1.42-2.12) compared to those without. The risk was similar when the outcome included infection (HR=1.62, 95% CI 1.39-1.89). Outcomes remained significant after adjustment for baseline characteristics. Understanding this relationship will direct future studies assessing barriers to care, and implementation of individualized approaches to care for this population.

Diabetes Mellitus (DM) is a complex, chronic disease, associated with potentially devastating complications. The DM-complication rate may be increased among people with schizophrenia. This study evaluated the relationship between schizophrenia and risk of preventable, acute DM-complications. Using administrative data, a retrospective study assessed acute DM complications (emergency department visits or hospitalization for hypo- or hyperglycemia, and hospital admissions for infections) among Ontario residents ages 18-50 with schizophrenia and newly diagnosed DM between 1995 and 2005, comparing people with and without pre-existing schizophrenia. People with schizophrenia had a 74% greater risk of requiring a hospital visit for hypo- or hyperglycemia (HR =1.74, 95% CI 1.42-2.12) compared to those without. The risk was similar when the outcome included infection (HR=1.62, 95% CI 1.39-1.89). Outcomes remained significant after adjustment for baseline characteristics. Understanding this relationship will direct future studies assessing barriers to care, and implementation of individualized approaches to care for this population.

In this study, patient-physician interaction, patient socio-demographic factors, health literacy, sources of care, and use of diabetes-related health services, were examined to assess the relationships to patients’ satisfaction with the quality of health care they received in the past 2 years. By examining the relationship among patient, physician and environmental systems’ factors, research findings will be used to develop interventions that will inform patient education and physician training and foster patient and physician behavior change that ultimately leads to improved health outcomes for adults with diabetes. To answer the research questions, univariate and multivariate logistic regression analyses were conducted to assess the predictability of the 5 groups of dependent variables: 1) socio-demographic factors, 2) sources of care “factors”, 3) health literacy “factors”, 4) patient-physician interaction “factors”, and 5) use of diabetes-related services “factors”. Individually these groups comprised thirty-two dependent variables. Three dependent variables, specifically confidence and trust in doctor; doctor spend as much time as wanted; and had a hemoglobin A1c in the last 6 months, were statistically significantly predictive of a relationship with patient satisfaction with quality of health care. This study provides insight regarding the specific aspects of patient-physician interaction and use of diabetes-related services that impact patient health outcomes. By knowing that a statistically significant relationship exists among confidence and trust in a doctor, being able to spend as much as time as wanted with a doctor, having a hemoglobin A1c in the last 6 months, and satisfaction with quality of health care, future investigators know which influences are perhaps most influential and deserve further exploration to predict satisfaction with quality of health care.