Thesis (M.A.)--York University, 2004. Graduate Programme in Psychology. / Typescript. Includes bibliographical references (leaves 82-102). Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://gateway.proquest.com/openurl?url%5Fver=Z39.88-2004&res%5Fdat=xri:pqdiss &rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&rft_dat=xri:pqdiss:MR11882

Background: Adherence to diabetes care is an issue of concern at Bishop Lavis Community Health Centre (BLCHC) as it results in so many diabetes patients ending up with complications that could have been avoided. Aim: To explore the reasons for people with diabetes in the Bishop Lavis area being non-adherent to diabetes care. Method: A qualitative study was undertaken. Three focus groups were held and seven in-depth interviews were conducted. The framework method was used to analyze the data. Findings: The main findings in this study was consistent with many of previous studies done on adherence, i.e. patient barriers, disease and drug regime barriers and doctor-patient relationship barriers.11 However, in this poverty-stricken area these participants also face other constraints that influence their compliance behaviour. These include 1.over-burdened public healthcare facilities, 2.insufficient education, 3.poor support structures, 4.infrastructure which is not wheelchair-friendly, 5.unsafe communities, 6.low income and unemployment. Conclusion: Non-adherence is a topic that has been widely researched over the last couple of years and it appears that the reasons are mostly consistent. However, in poverty-stricken areas it seems as if over-burdened public health services and social problems are the main reasons that need to be addressed. It is thus with great anticipation that we await the NHI plan of the government that will be rolled out as from 2012 to see whether it will better the health care services to the poor.

Submitted by Isaac Francisco de Souza Dias (isaac.souzadias@ufpe.br) on 2016-06-30T18:44:30Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) TESE-Diego Barbosa de Queiroz.pdf: 1764113 bytes, checksum: ad28a3c18ea75e679f2fcf57f7db57f7 (MD5) / Made available in DSpace on 2016-06-30T18:44:30Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) TESE-Diego Barbosa de Queiroz.pdf: 1764113 bytes, checksum: ad28a3c18ea75e679f2fcf57f7db57f7 (MD5) Previous issue date: 2014-09-30 / CAPES / O conceito da “programação fetal” sugere que um individuo pode ser “programado” durante as fases intra-uterina e perinatal para desenvolver doenças na vida adulta. A literatura mostra que o diabetes materno produz importantes alterações metabólicas na prole adulta, predispondo-os ao surgimento de doenças cardiovasculares. Este estudo analisou se a hipertensão arterial e disfunção vascular observada em ratos adultos submetidos ao diabetes materno estariam mediadas pelas ações da angiotensina II via ativação do receptor AT1 e com as alterações na inervação perivascular em preparações de artéria mesentérica. O diabetes materno foi induzido por estreptozotocina em ratas Wistar. Alterações na homeostasia da glicose, como intolerância a glicose e resistência à insulina foram observados nos ratos adultos com 12 meses de idade provenientes de mães diabéticas (O-DR) e revertidos quando tratados com losartan. Através da medida direta da PA, a PAM dos ratos (O-DR Losartan) apresentaram níveis normotensos quando comparado aos ratos (O-DR). No grupo (O-DR losartan) foi observado um aumento no relaxamento dependente do endotélio e redução na contração à fenilefrina quando comparado aos ratos (O-DR). Para avaliar o envolvimento dos metabolitos derivados do acido araquidônico, foram utilizados inibidores da COX-1 e 2 (indometacina) ou da COX-2 (NS-398), onde ambos não alteraram o relaxamento e contratilidade, significativamente no grupo O-DR tratado com losartan. Ao analisar a inervação perivascular em artéria mesentérica superior, os ratos O-DR de 6 meses de idade apresentaram aumento da inervação adrenérgica com participação da NA e ATP e elevação da inervação nitrergica com aumento da liberação de NO neuronal. Esses resultados sugerem que o Diabetes mellitus durante a fase intrauterina e perinatal causa modificações metabólicas, cardiovasculares e na inervação perivascular em ratos adultos e que estas alterações podem ser explicadas pela participação da ANGII e maior ativação da inervação adrenérgica e nitrérgica nestes distúrbios. / The concept of "fetal programming" suggests that an individual can be "programmed" during intrauterine and perinatal stages to develop diseases in adulthood. The literature shows that maternal diabetes cause important metabolic changes in adult offspring, predisposing them to the emergence of cardiovascular diseases. This study examined whether hypertension and vascular dysfunction observed in adult rats subjected to maternal diabetes would be mediated by the actions of angiotensin II via AT1 receptor activation and changes in perivascular innervation in mesenteric artery preparations. Maternal diabetes induced by streptozotocin in Wistar rats. Changes in glucose homeostasis, such as glucose intolerance and insulin resistance was observed in offspring diabetic rats (O-DR) and reversed when treated with losartan. Through direct measurement of BP, MAP of rats (O-DR Losartan) showed normotensive levels compared to offspring diabetic rats (O-DR). In group (O-DR losartan) we observed an increase in the endothelium-dependent relaxation and a reduction in the contraction to phenylephrine compared to the rats (O-DR). To assess the involvement of arachidonic acid derived metabolites, COX-1 and 2 (indomethacin) or COX-2 (NS-398), both did not alter the relaxation and contractility significantly in the group O-DR Losartan. By analyzing the perivascular innervation in the superior mesenteric artery, O-DR-6 months of age showed increased adrenergic innervation with participation of NA and ATP and increased nitrergic innervation with increased release of neuronal NO. These results suggest that diabetes mellitus during intrauterine and perinatal phase causes metabolic, cardiovascular and perivascular innervations changes in offspring diabetic rats and that these alterations can be explained by the participation of ANG II and increased activation of adrenergic and nitrergic innervation in these disorders.

Levels of diabetic care in primary health care settings in South Africa have been found to be sub-optimal. Knowledge deficits and inadequate practices have been implicated in the poor quality of local diabetes care. Type 2 diabetes and hypertension are commonly associated chronic conditions hence to optimise diabetic care, tight control of blood pressure is essential. Although guidelines for the overall management of diabetes in a primary health care setting have been published (Working Group of the National Diabetes Advisory Board, 1997; Society for Endocrinology, Metabolism and Diabetes of South Africa, 2002a), adherence to these guidelines has not yet been optimised in the primary health care setting. The objectives of the study were: to design and implement an educational intervention aimed at nursing staff, based on the South African guidelines for type 2 diabetes and hypertension, at a public sector primary health care clinic; to determine the impact of the educational intervention on the level of knowledge and attitudes of the nursing staff, and on the level of diabetic and blood pressure control achieved in the patient population, and to determine the impact of the educational intervention on pharmacological management of patients. A questionnaire was used to quantitatively assess the nursing staffs’ knowledge of the management of type 2 diabetes and hypertension at a primary health care level. A qualitative evaluation of the nursing staff attitudes was obtained using focus group interviews. The educational intervention, in the form of lectures and based on national diabetes and hypertension guidelines (Working Group of the National Diabetes Advisory Board, 1997; Society for Endocrinology, Metabolism and Diabetes of South Africa, 2002a; Milne et al., 2003), was then implemented and directed at the nursing staff at a primary health care clinic. A post-intervention evaluation was performed after four months by repeating the questionnaire and focus group interviews. Comparisons between the pre- and post-intervention questionnaire and focus group interviews evaluated the impact of the educational intervention on the knowledge and attitudes of nursing staff towards the management of type 2 diabetes. Pre- and post-intervention patient data was collected from patient medical files and compared to determine if the management of diabetes and hypertension improved in the patient population after the implementation of the educational intervention. The patient population consisted of 103 patients. The educational intervention resulted in an extremely significant improvement in the level of knowledge of the nursing staff [93 correct responses (28.3 percent; n = 329 (pre-intervention)) vs 223 correct responses (67.8 percent; n = 329 (post-intervention)); p < 0.0001, Fisher’s Exact test]. The educational intervention resulted in improved attitudes of nursing staff towards the management of diabetes. Ideal random blood glucose concentrations improved significantly [16 percent; n = 100 (pre-intervention) vs 22 percent; n = 100 (post-intervention); p = 0.0003; Student t test]. The number of patients with a compromised HbA1c level (> 8 percent) decreased by 2 [51; 49.5 percent, n = 103 (pre-intervention) vs 49, 47.5 percent, n = 103 (post-intervention)] which was not a significant improvement. Ideal blood pressure control improved by one from 38 patients [36.9 percent; n = 103 (pre-intervention)] to 39 patients [37.9 percent; n = 103 (post-intervention)] which was not significant. Optimal change of pharmacological management following the referral of an uncontrolled diabetic patient was only noted for 18 patients (20.2 percent, n = 89) referred in the post-intervention phase. Clinical inertia was identified as a major limitation to the optimisation of diabetes care. Implementation of an educational intervention based on the South African diabetes and hypertension guidelines at a public sector primary health care clinic was successful in improving the knowledge levels and attitudes of nursing staff

The purpose of this study was to answer the question, 'Will diabetic patients taught by means of a "Diabetic Teaching Tool" demonstrate a higher level of learning about self-care, than patients taught in the institution's usual manner?' The answer to the question was sought by comparing the self-care knowledge and skills of two groups of diabetic patients admitted to a suburban general hospital which, prior to the study, offered no planned programme of diabetic patient education. All diabetic patients admitted to this hospital over a six month period were screened for eligibility to participate in the study according to criteria stated by the researcher. Eligible patients admitted in the first three months were designated as control subjects; those in the last three months as experimental subjects. The twenty subjects in the control group were taught in an unplanned manner, based upon whether and/or what instructions were deemed pertinent by their nurses. A "Diabetic Teaching Tool"-- designed by the researcher and administered by each patient's own nurse(s)-- was used to instruct the twenty experimental subjects. After discharge, each of the forty subjects was visited by the researcher, at which time a profile sheet was completed and a test of diabetic learning administered. Demographic and diabetic characteristics of the subjects-obtained from the patient profile sheets-- were analyzed and described in terms of distributions, medians and/or means. The test results were subjected to t-test analyses on several dimensions. And a number of demographic and diabetic traits were compared with their respective test scores by means of the Pearson Product Moment Correlation Coefficient. The data supported the following conclusions: 1. Diabetic patients taught by means of the "Diabetic Teaching Tool" demonstrated a significantly higher level of learning about self-care than did patients taught in the unplanned manner. 2. Statistically significant differences were found between test scores of patients taught with the "Diabetic Teaching Tool" and those receiving unplanned instruction regardless of the duration of their diabetes. Thus 'old' diabetics were able to derive as much benefit from the teaching tool as were 'new' diabetics. 3. The level of learning demonstrated by patients taught with the "Diabetic Teaching Tool" appeared to be independent of the following factors: age at time of teaching and testing, previous education, and age at onset of diabetes; each of these factors was significantly related to the level of learning of patients receiving unplanned instruction. 4. Diabetic patients taught by means of the "Diabetic Teaching Tool" cited the nurse as a valuable source of information regarding diabetic management more than five times as frequently as did patients receiving unplanned instruction. Based upon these findings, several implications for nursing practice and recommendations for further research were suggested. / Applied Science, Faculty of / Nursing, School of / Graduate

The aim of this thesis was to describe and evaluate visual acuity, macular edema and patientreported outcomes (PRO) following anti-VEGF treatment of diabetic macular edema (DME) patients in a real-world setting. Using a longitudinal study design, a cohort of DME patients was followed from baseline to 1 year after treatment start. Data were collected from two eye clinics at two county hospitals. Social background characteristics, medical data and PRO were measured before treatment initiation, at four month and after 1 year. A total of 57 patients completed the study. Mean age was 69 years and the sample was equally distributed regarding sex. At baseline, the patients described their general health as low. One year after treatment initiation, 30 patients had improved visual acuity and 27 patients had no improvement in visual acuity. The patients whose visual acuity improved reported an improvement in several subscales in patient-reported outcome measures (PROM), which was in contrast to the group that experienced a decline in visual acuity, where there was no improvement in PROM. Outcomes from the study can be useful for developing and providing relevant information and support to patients undergoing this treatment.

<p>2022-03-21</p>

No description available.

<p>2022-03-22</p>

<p>2022-03-23</p>