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Yes / Individuals with type 2 diabetes play a pivotal role in their health. Enhancing the self-management of diabetes can improve blood glucose control, and quality of life, and reduce diabetes-related complications. We have identified factors influencing the self-management of type 2 diabetes to inform strategies that may be applied in the long-term management of blood glucose control. Methods: We conducted a systematic literature review of recent studies published between January 2010 to December 2020 to identify the available evidence on effective self-management strategies for type 2 diabetes. The databases used for the searchers were Scopus, PubMed, Science Direct, CINAHL, and Google Scholar. We assessed English language publications only. The screening of titles was duplicated by two researchers. We then conducted a thematic analysis of the key findings from eligible publications to identify reoccurring messages that may augment or abate self-management strategies. Results: We identified 49 relevant publications involving 90,857 participants. Four key themes were identified from these publications: Individual drive, social capital, Knowledge base, and Insufficient health care. High motivation and self-efficacy enabled greater self-management. The importance of family, friends, and the health care professional was salient, as were the negative effects of stigma and labelling. Enablers to good self-management were the level of support provided and its affordability. Finally, the accessibility and adequacy of the health care services emerged as fundamental to permit diabetes self-management. Conclusions: Self-management of type 2 diabetes is an essential strategy given its global presence and impact, and the current resource constraints in health care. Individuals with type 2 diabetes should be empowered and supported to self-manage. This includes awareness raising on their role in self-health, engaging broader support networks, and the pivotal role of health care professionals to inform and support. Further research is needed into the capacity assessment of healthcare systems in diabetes medicine, targeted low-cost resources for self-management, and the financial requirements that enable self-management advice to be enacted. / While this research did not receive any specific project funding, KRB is funded by a University of Otago Pacific Ph.D. Scholarship. ANR is funded as a Research Fellow by the National Heart Foundation.

Diabetes is a rapidly growing health concern in the developed world. Hypoglycaemia is a major risk factor in people with diabetes. Each year, about 7000 calls relating to hypoglycaemia are made to the Scottish Ambulance Service (SAS), including a considerable number of repeat callers. Very little is known about people’s experiences and explanations of recurrent hypoglycaemia; in particular, why some individuals manage their recurrent hypoglycaemic episodes independently, while others require more direct healthcare support. This thesis investigated participants’ experiences and individual explanations of recurrent hypoglycaemic episodes, in order to understand their health help-seeking behaviour. To do this, it compared the experiences of people who had called the emergency services within one month prior to recruitment (SAS participants), with those people who had not done so (non-SAS participants). The study employed a multiple methods longitudinal approach to prospectively capture participants’ experiences of hypoglycaemic episodes, using qualitative semi-structured interviews, hypoglycaemia and blood glucose diaries and follow-up telephone interviews over a six month period. Thirty participants were involved in the study, recruited through the Scottish Ambulance Service, Diabetes UK (Scotland), and the University of Stirling. All participants resided in the central belt of Scotland. Qualitative data was analysed using the framework method, and quantitative data was analysed using descriptive statistics. This study found that hypoglycaemic episodes had a wide ranging impact on people’s everyday life. It was not only the actual hypoglycaemic episode that affected participants’ everyday life, but also fears and worries about future hypoglycaemic episodes, the preparations that participants engaged in, and the process of recovery. Hypoglycaemia unawareness was found to be a major problem for many people living with diabetes. It appeared to be associated with the likelihood of needing external help. There were differences between participant groups with regard to management of hypoglycaemia unawareness. Non-SAS participants adopted strategies to prepare for future hypoglycaemic episodes, and appeared to be more knowledgeable about their diabetes and its management, resulting in needing less external help. SAS participants experienced more severe hypoglycaemic episodes. Consequently, they relied more on external help. Findings of this study call for a re-conceptualisation of the previously recognised ‘balancing act’ of managing diabetes and hypoglycaemic episodes. This study introduces the concept of a hypoglycaemic episode balancing continuum (HEBC) which enables a deeper understanding of the factors involved in this balancing act: it demonstrates that people balance the various risks differently, depending on whether they prioritised their fear of hypoglycaemia over fears of long-term complications. People’s position on the continuum directly affected their management strategies for hypoglycaemic episodes. Most hypoglycaemic episodes were managed by the individual without requiring any external help. However, participants’ ability to self-care differed and deficits occurred, resulting in participants being more likely to need involvement of others (family/friends). When the capacity of others to help broke down, participants’ were more likely to need SAS emergency care. In order to explain how hypoglycaemic episodes are managed, this thesis has developed a hypoglycaemic episode help-seeking network (HEHS network), which helps to identify the various agents involved in helping to manage hypoglycaemic episodes. Findings from this study have implications for clinical practice. For example, looking at hypoglycaemia unawareness, this study has shown that current understanding may fail to take account of participants’ real experiences, which show hypoglycaemia unawareness to be a fluid phenomenon that can affect people at various times. If blood glucose levels can fail to predict onset of hypoglycaemic episodes, healthcare professionals may need to broaden the range of blood glucose readings that might indicate a hypoglycaemic episode and tailor specific advice to individual patients. To reduce the use of emergency services, more attention must be paid to hypoglycaemia unawareness and better advice provided about this condition. Also, more education should be provided for family members/carers, given the crucial role they play in the management of diabetes and hypoglycaemic episodes, and being a link in the process leading to increased use of emergency services. The HEBC could be developed into a useful ‘screening tool’ to help healthcare professionals identify those at greater risk of hypoglycaemic episodes and those at greater risk of long-term complications, and to target advice more specifically to these patient groups. Further research could explore family member/carer knowledge in more detail to better understand their role in helping to manage hypoglycaemic episodes.

Traditionally, nurse anesthesia educators have utilized prior academic achievement to predict student success. However, research has indicated that prior academic achievement offers an inadequate assessment of student success in graduate healthcare programs with extensive clinical residencies. The educational literature has identified many non-cognitive factors, such as self-efficacy and locus of control, that may provide a more holistic prediction model of student success. An experimental study with pretest-posttest design and stratified random assignment was conducted to evaluate the effectiveness of an educational intervention to promote self-management, professional socialization, and academic achievement among first semester graduate nurse anesthesia students. Participants (N = 66) were demographically similar to the national graduate nurse anesthesia student body, though Hispanics and younger students were a little over-represented in the sample (56% female, 75.8% White, 15.2% Hispanic, 6% Other, 59% ≤ 30-years-old, 67% ≤ 3 years of ICU). The results showed that most graduate anesthesia students had strong self-management and professional socialization characteristics on admission. The results did not support the effectiveness of this educational intervention. Thus, ceiling effect may have accounted in part for statistically non-significant results regarding self-efficacy (p = .190, ω2 = .03), locus of control (p = .137, ω2 = .04), professional socialization (p = .819, ω2 = .001), and academic achievement (p = .689, ω2 = .003). Future researchers may need to expand the scope of the intervention, use a more powerful and sensitive instrument, and utilize a larger sample.

Previous research indicates that elderly people want to be independent and have the opportunity to stay in their own homes for as long as possible despite chronic disease. The district nurse can, by promoting the persons ability to self-management, create conditions for the elderly to be able to live at home. In this study, a conceptual analysis of self-management was done. Self-management is a term that has no clear definition and is under development. There is no matching swedish word. The purpose was to illustrate how self-management is used in relation to elderly people living with chronic disease. The study has an inductive approach. The method is based on Rodgers' evolutionary concept analysis, a valid method for developing knowledge in nursing science. The result shows that self-management in relation to elderly people with chronic disease can imply both benefits and risks. The benefits can be increased confidence in their own ability as well as increased knowledge about the disease. The risks may be loneliness and anxiety. In summary, the study shows that research should focus on how the district nurse can contribute knowledge in order for older people to adopt self-management, but also the importance of including the negative aspects that self-management can cause. / Tidigare forskning indikerar att äldre personer vill vara självständiga och ha möjlighet att bo kvar i det egna hemmet så länge som möjligt trots kronisk sjukdom. Distriktssköterskan kan genom att främja personens förmåga till self-management skapa förutsättningar för att de äldre ska kunna klara sig hemma. Studien genomfördes som en begreppsanalys av self-management. Self-management är ett begrepp som inte har någon entydig definition och som är under utveckling. Det finns inte något motsvarande svenskt ord. Syftet var att belysa hur self-management används i relation till äldre personer som lever med kronisk sjukdom. Studien har en induktiv ansats. Metoden utgår från Rodgers evolutionära begreppsanalys, en metod för att utveckla kunskap inom omvårdnadsforskningen. Resultatet visar att selfmanagement i relation till äldre personer med kronisk sjukdom kan innebära både förtjänster och risker. Förtjänsterna kan vara en ökad tilltro till den egna förmågan samt ökad kunskap om sjukdomen. Riskerna kan vara ensamhet och ångest. Sammanfattningsvis så visar studien att forskningen framöver bör fokusera på hur distriktssköterskan kan bidra med kunskap för att äldre personer ska kunna anta selfmanagement. Det är viktigt att även inkludera de negativa aspekter som selfmanagement kan medföra.

Male stereotyping together with perception of women as inferior is hindering recognition of women in senior managerial positions. Through pervious studies regarding female leadership, conducted all over the world, the theme of women being treated differently than males is fundamentally central to all the conclusions. Not many studies relating to this topic have been conducted in South Africa and yet we are in the forefront when it comes to identifying the need to develop women into positions where they can add value on various levels. Some of the issues have even been captured in legislation. However, despite government’s intervention, it is crucial that women take ownership of their own destiny. Unless women can prove that they can add value in the positions that they are appointed, they will not be seen as leaders. To be a successful leader an individual must have certain skills and traits. Some of these can be developed over time, however the individual must first admit that there is a need and identify the area in which personal growth must take place, before a plan can be implemented. Once this point has been reached, a self-management plan can be developed by the individual to align his / her objectives. There are various components to the self-management plan and such a plan cannot always be duplicated, but the focus areas can overlap. If an individual can identify a mentor and enter into a mentoring program, it can give such an individual a huge advantage. Internal and external factors play a role in the development and implementation of a self-management plan. The problem is that one does not always have much control over these elements. Some of these elements include the corporate culture of the organisation in which females functions and the manner in which a female is able to balance work-life. This study determined that males and females agree that female managers add as much value as male managers. Further to the above, it has become evident that A Botha 344-123-44 iv males have different perceptions relating to the issues of how women are experiencing the work environment and the implementation of policies that relate to employment equity. The impact of perception must not be excluded since it can have the effect that people distinguish between leadership skills and traits on different levels. Unless female leaders can make male leaders realise that they experience the work environment and the implementation of policies that relate to employment equity differently than the manner in which males perceive it, they will not be able to get males to change the situation, since males believe that there are nothing wrong with the current situation. This brings one back to the change in culture and the issue that as a result of male dominance in the work place, it is also the males that determine the current culture. It is therefore important for females to take responsibility of the situation and where necessary change the perceptions of males to ensure that as women they are not hindered from receiving the recognition that they deserve.

<p>Autonomic computing is a paradigm that aims at reducing administrative overhead by using autonomic managers to make applications self-managing. To better deal with large-scale dynamic environments; and to improve scalability, robustness, and performance; we advocate for distribution of management functions among several cooperative autonomic managers that coordinate their activities in order to achieve management objectives. Programming autonomic management in turn requires programming environment support and higher level abstractions to become feasible.</p><p>In this thesis we present an introductory part and a number of papers that summaries our work in the area of autonomic computing. We focus on enabling and achieving self-management for large scale and/or dynamic distributed applications. We start by presenting our platform, called Niche, for programming self-managing component-based distributed applications. Niche supports a network-transparent view of system architecture simplifying designing application self-* code.  Niche provides a concise and expressive API for self-* code. The implementation of the framework relies on scalability and robustness of structured overlay networks. We have also developed a distributed file storage service, called YASS, to illustrate and evaluate Niche.</p><p>After introducing Niche we proceed by presenting a methodology and design space for designing the management part of a distributed self-managing application in a distributed manner. We define design steps, that includes partitioning of management functions and orchestration of multiple autonomic managers. We illustrate the proposed design methodology by applying it to the design and development of an improved version of our distributed storage service YASS as a case study.</p><p>We continue by presenting a generic policy-based management framework which has been integrated into Niche. Policies are sets of rules that govern the system behaviors and reflect the business goals or system management objectives. The policy based management is introduced to simplify the management and reduce the overhead, by setting up policies to govern system behaviors. A prototype of the framework is presented and two generic policy languages (policy engines and corresponding APIs), namely SPL and XACML, are evaluated using our self-managing file storage application YASS as a case study.</p><p>Finally, we present a generic approach to achieve robust services that is based on finite state machine replication with dynamic reconfiguration of replica sets. We contribute a decentralized algorithm that maintains the set of resource hosting service replicas in the presence of churn. We use this approach to implement robust management elements as robust services that can operate despite of churn.</p><p> </p> / QC 20100520

New Zealand is currently in the midst of a diabetes epidemic and it has become clear that the increasing prevalence of obesity and a sedentary lifestyle are inextricably linked to this escalating health crisis. Extensive research has long made clear that people of all ages can enhance their health by incorporating moderate levels of physical activity as part of their normal daily routine and physical activity is now recognised as a major therapeutic modality for type 2 diabetes. Despite such evidence, most people in the western world do not engage in sufficient regular physical activity and there remains a paucity of evidence that elucidates effective methods of achieving the required behaviour change over time. This study set out to demonstrate meaningful correlations between the psychosocial constructs optimism, exercise self-efficacy, goal-directness, stage of change, anxiety and depression, the biochemical measures HbA1c and BMI and also the behavioural outcomes of general physical activity and physical exercise participation, all within a newly diagnosed type 2 diabetic population. Participants (n=30, newly diagnosed adults with type 2 diabetes; mean age 61.46 years; BMI 31.43 Kg/m²[range 18.8-50.95 Kg/m²]) were recruited from attendees of the Christchurch Diabetes Centre's education seminars. The recruitment strategy was designed to search out diabetic patients as near as practicable to the point in time when they first became cognisant of their disease state. A battery of instruments was assembled into a researcher-administered retrospective questionnaire and this was completed with all subjects at baseline and again at six month follow-up. Additional data comprised subject's demographics and selected bio-chemical measures (subject height, weight, and blood Haemoglobin A1c). Descriptive, correlational and qualitative statistics were evaluated. The level of physical activity reported was significantly less than is required to facilitate the biochemical and psychological changes that are generally considered necessary to support optimal health. On average, study participants did not perform their planned physical activity tasks as well as they might have, despite being relatively optimistic and goal-directed at baseline. Many participants clearly indicated an inadequate understanding of exercise modalities and the intensity, duration and frequency of physical activity required to support optimal health. Generally, participants tended to overestimate their physical activity levels. Exercise self-efficacy emerged as an especially important psychological construct, and one that appeared to be among those central to the participants' relationships with physical activity and exercise. The study group demonstrated a relatively high prevalence of low level anxiety and depression, and even at these sub-clinical levels, anxiety and depression were significantly inversely related to optimism, goal-directness, goal-attainment, exercise self-efficacy and stage of change. The study findings illuminate the wide contextual variability among patients who are suffering from the same chronic condition. Further, the implications of conducting detailed pre-assessments of patients' personal characteristics and their psychological profiles, in order to guide intervention tailoring, are also outlined and discussed. Areas for future research are highlighted. In conclusion, meso and macro-level policy implications are discussed, with reference to an array of the broader determinants of health.