Poorly controlled diabetes is common among the majority of youth with type 1 diabetes and can lead to adverse health outcomes at an early age. There is a need to change this to minimise the risk of negative long-term consequences. The onset of complications from diabetes can be prevented or delayed with good management as demonstrated by blood glucose being kept close to or within the normal range. Diabetes control is challenging for young people due to a combination of physiological and psychological factors. Diabetes control needs to be monitored both at an individual level and also at a population level, in order to optimise health outcomes and provide important information for health service provision. There are gaps in knowledge relating to the current level of diabetes control at a population level and of the epidemiological characteristics of youth with type 1 diabetes in the Canterbury region in New Zealand. There has been no research of this nature in the Canterbury region since 2003. There are also gaps in knowledge and a lack of national and international research that investigates psychosocial characteristics of youth with type 1 diabetes and the impact these may have on diabetes control. There is a potentially promising intervention, namely, Motivational Interviewing (MI), that although previous research investigating it with diabetes has shown some promise, methodological problems have limited the conclusions that can be drawn. This thesis, within the New Zealand context, addresses some of these gaps and adds to the body of knowledge of research concerning diabetes control and youth with type 1 diabetes, and investigates MI intervention for youth with poorly controlled diabetes. The thesis encompasses three studies. The first study is an audit that provides up-to-date information on epidemiological characteristics and clinical outcomes for the youth population with type 1 diabetes residing in the Canterbury region. The second study is a cross-sectional study that investigates the relationship between glycaemic control and key psychosocial characteristics: illness beliefs, self-efficacy, and quality of life in youth with type 1 diabetes in Canterbury. The third study is a longitudinal study that investigates the efficacy of MI as an intervention for youth with poorly controlled type 1 diabetes, and explores its impact on diabetes outcomes using statistical and clinical analyses. The first study showed that from 2003 to 2010 the prevalence of adolescents and young adults with type 1 diabetes in Canterbury has increased; there is therefore an increased demand on health resources. In addition, in 2010 glycaemic control at a population level was in the poorly controlled diabetes range and this had remained unchanged since 2003. This suggests the need for more intensive interventions. The second study found that poor diabetes control in youth with type 1 diabetes is influenced by a number of factors, including negative views on diabetes, lower perceived personal control, higher diabetes-related concerns, and lower levels of worry about complications. These findings provide a new understanding of the importance of balancing worries about diabetes complications and the perception of diabetes as a threatening condition. The third study showed that the MI intervention was generally successful in improving diabetes outcomes – clinical, psychosocial, and behavioural changes were observed. Statistically and clinically significant positive changes were found across multiple variables: glycated haemoglobin (HbA1c), glycaemic variability, adherence, and psychosocial functioning. Taken together, the findings of the three studies indicate that majority of youth with type 1 diabetes in the Canterbury region had poor glycaemic control, which suggests that additional interventions may be required to improve management of their condition, especially interventions targeting psychosocial functioning (e.g., illness perceptions) and diabetes self-management. Motivational Interviewing may be a viable option, and therefore further research into this approach is recommended.

No description available.

The purpose of the present study was to investigate whether a self-evaluation procedure paired with a token economy would be effective in reducing the off-task and talk-out behavior of behaviorally disordered and learning disabled high school students in a resource classroom. The study also examined the effects of the seIf-evaluation procedures when monitored by regular education peers on target students' behavior in their regular education English class. In addition to improving classroom behavior, another purpose of the study was to examine the effective ness of the self-evaluation procedures when paired with an academic goal-setting component on academic variables in both the resource and regular education classrooms. The results revealed that student behavior generally improved after self-evaluation procedures were taught in the resource room and that improved behavior generalized to the regular class once peers implemented the matching component of the self-management procedures. As a group, students' average rate of off-task behavior decreased 17% in the resource room and 35% in the regular class. Averages rates of talk-outs for the group were reduced by 6% in the resource room and 24% in the regular class. Gains in academic performance were observed in both the special and regular classrooms. An increase in the number of assignments completed was observed following the implementation of the self-management procedures across all subjects in the special education class, as was an increase in the overall percentage of those assignments that were correct. Similarly, the percent complete on assignments in the regular class increased on the average 20% while the percent correct increased 24% following the implementation of the matching procedures.

Bakgrund: Diabetes typ 2 är en kronisk sjukdom som behöver bemötas dagligen. En av hörnstenarna i behandlingen är egenvård som personen själv utför vilket är nödvändigt för att bromsa eller förhindra komplikationer. För att personer med diabetes skall kunna utföra egenvården behövs kunskap om sjukdomen. Hur det är att leva med diabetes är en subjektiv upplevelse och behöver bemötas utifrån det. Människor kan uppleva det mödosamt att bryta vanor och beteenden, det är lätt att falla tillbaka till gamla vanor. Vården har ett ansvar att främja patienters hälsa och välmående och att ge verktyg för att sköta om sin diabetes. Syfte: Syftet med litteraturstudien är att belysa hur sjukvården kan stötta personer med diabetes typ 2 för bättre kontroll av diabetessjukdomen. Metod: Metoden för denna studie har varit litteraturöversikt. Ett utbrett sökande av vetenskapliga artiklar och efterföljande analys samt sammanställning har gjorts. De elva artiklarna som valts ut har varit av både kvalitativ och kvantitativ karaktär. Resultat: Författarna har kommit fram till tre teman. Det första temat är Utbildning och har tre subteman; Egenvårdsutbildning, Personcentrerad utbildning, och Utbildning i grupp. Det andra temat är; Motiverande samtal. Det tredje temat är; Skapa relationer och har tre subteman; Avsätta tid och lyssna, Personligt bemötande och Engagemang. Diskussion: Litteraturöversikten visar på att egenvårdsutbildningar ger viktiga kunskaper så att personer med diabetes tar riktiga beslut och utför egenvård korrekt. Vidare är relationen mellan sjuksköterskan och patienten viktig vilket även styrks av Dorothea Orems egenvårdsteori. Närstående kan också ha en positiv inverkan på egenvården om de är engagerade i den.

Urinary Incontinence is a common health problem that can cause both severe medical and social problems, resulting in negative impact on different aspects of Quality of Life. In 2000, the Swedish Council on Health Technology Assessment (SBU) published a systematic review, “Treatment of Urinary Incontinence” where multiple knowledge gaps in the field of UI, all of considerable clinical importance, were pointed out.Several of these knowledge gaps have been the starting points for the projects in this thesis. The overall aim has been to study the impact of different interventions for urinary incontinence in women on the population level but also on the patient group level, for assessessing the significance of UI on general living conditions and to validate instruments to measure quality of life to be used as part of the evaluation of treatment effectiveness. Paper I: A population-based study where UI amongst women was found to be commonly associated with different psychosocial problems and an expressed feeling of vulnerability. Paper II: A population-based study where informative material on UI to the general public in order to increase knowledge and encourage self management was found promising for meeting increasing demands and optimizing healthcare resources. Paper III: A randomized controlled trial where both electrical stimulation and drug therapy reduced the number of micturitions and improved QoL in women with urge or urge incontinence, but electrical stimulation was not found to be superior to drug therapy. Paper IV: A prospective cohort study where the international questionnaires UDI-6 and IIQ-7 after translation and validation, showed good responsiveness and were easy to administer and to fill out. The UDI-6 scale did not accomplish the same solid result in the psychometrical analysis as the IIQ-7 scale but both scales showed good responsiveness and can thereby be recommended for clinical use.

Background Type 2 diabetes demands self-management over time, to maintain health and reduce the risk for diabetes complications. However, despite efforts, many persons with type 2 diabetes are not reaching the treatment targets. In diabetes, person-centred care and group education are recommended. Diabetes specialist nurses (DSNs) working in primary healthcare have an important role in supporting patients with type 2 diabetes in their self-management to adapt to the demands of the disease in everyday life. Therefore, it is important to explore the DSNs’ professional role and their experiences of practising person-centred care. The overall aim of the thesis was to explore the professional role of DSNs in primary healthcare, and to describe their experiences of person-centred diabetes care. Methods The thesis includes three studies with qualitative, and one with a quantitative, approach. Data collection consisted of focus group interviews, individual interviews, observations, and questionnaires. Qualitative content analysis and statistics were used in the analysis. In studies I and II, 29 and 31 DSNs participated, respectively. In study III, 10 DSNs and 44 persons with type 2 diabetes participated. Lastly, in study IV, 10 DSNs participated. Results The results in the thesis showed that DSNs have a complex and multifaceted professional role that entails striving to be an expert, a fosterer, a leader, an executive, and a role model, which they found challenging. The DSNs perceived high job demands, such as decision-making and learning. The thesis also showed that the interaction between DSNs and persons with type 2 diabetes shifted from empowerment to authority struggles during group support sessions based on person-centred care. The experience of person-centred care was described as enriching, but DSNs also expressed ambivalence, related to an altered professional role. Conclusion There is a desire by DSNs to be close to persons with type 2 diabetes, although they have several challenges to fulfil, which makes it difficult to uphold a relation with proximity; thus, distance is also present. Even though person-centred care is recommended in healthcare, and despite DSNs’ efforts to practise PCC, the result of this thesis shows that it also implies an altered professional role for DSNs that has to be addressed. / Diabetes intervention in Västerbotten, DIVA 2

Implementing self-management for enterprise systems is difficult. First, the scale and complexity of such systems makes it hard to understand and interpret system behavior or worse, the root causes of certain behaviors. Second, it is not clear how the goals specified at a system-level translate to component-level actions that drive the system. Third, the dynamic environments in which such systems operate requires self-management techniques that not only adapt the system but also adapt their own decision making processes. Finally, to build a self-management solution that is acceptable to administrators, it should have the properties of tractability and trust, which allow an administrator to both understand and fine-tune self-management actions. This dissertation work introduces, implements, and evaluates iManage, a novel system state-space based framework for enabling self-management of enterprise-scale systems. The system state-space, in iManage, is defined to be a collection of monitored system parameters and metrics (termed system variables). In addition, from amongst the system variables, it identifies the variables of interest, which determine the operational status of a system, and the controllable variables, which are the ones that can be deterministically modified to affect the operational status of a system. Using this formal representation, we have developed and integrated into iManage techniques that establish a probabilistic model relating the variables of interest and the controllable variables under the prevailing operational conditions. Such models are then used by iManage to determine corrective actions in case of SLA violations and/or to determine per-component ranges for controllable variables, which if independently adhered to by each component, lead to SLA compliance. To address the issue of scale in determining system models, iManage makes use of a novel state-space partitioning scheme that partitions the state-space into smaller sub-spaces thereby allowing us to more precisely model the critical system aspects. Our chosen modeling techniques are such that the generated models can be easily understood and modified by the administrator. Furthermore, iManage associates each proposed self-management action with a confidence-attribute that determines whether the action in question merits autonomic enforcement or not.

This dissertation presents a new model of how children self-manage asthma with their parents. Traditional models of children's asthma self-management (CASM) rely on notions of adherence to medical regimens and consider parents to have primary responsibility for their children's health. However, children have primary control over the key CASM strategy: the self administered inhaler. This study investigated how children self-manage asthma, the tools they use and how they undertake shared responsibility for CASM with their parents. Employing sociological theories of children and childhood, a grounded theoretical, mixed method research design was employed to analyse data from multiple sources: primary qualitative data from interviews conducted with eight children (n = 8, age 7 -12 years) and their parents; interviews with two parents of infants; and secondary quantitative data from the 2001 NSW Child Health Survey (CHS01). Clear delineation was found between child and parent responsibilities. Responsibilities are responsive and adaptable according to the nature of the asthma event. There is consensus between children and parents as to what their responsibilities should be. Asthma is familiar, recognisable and usually easy to manage, particularly as children’s own actions are central to CASM. Thus, children considered asthma a predominantly 'ordinary' experience. 'Ordinary' tools include inhalers and non asthma-specific activities, such as resting. Parental responsibility focused on monitoring and reminding children of 'ordinary' CASM tasks. During frightening asthma events - such as night-time episodes and hospitalisation - children abdicated primary responsibility for CASM to their parents. 'Extraordinary' tools include nebulisers, oral medications and hospital. During 'extraordinary' asthma, the parental role is primary and includes responsibility for action and decision-making. While not considered 'ordinary', children nonetheless described frightening events in a way that accommodates asthma within schema for everyday life. Parents also described the '(extra) ordinariness' of asthma, but expressed greater anxiety for their children's future. This, plus the vigilance necessary for parents to monitor their child's condition, appeared to problematise asthma more for parents than for children. This was supported by results from parent-reported CHS01 analyses. This new model of CASM is discussed with respect to its implications for public health self management programs, guidelines and future research.

Thesis (Ph.D.)--University of Adelaide, Dept. of Psychology, and, Centre for Automotive safety Research , 2004? / Includes bibliographical references (p. 396-420). Also available online.

Thesis (M.I.T.)--The Evergreen State College, 2010. / Title from title screen (viewed 7/7/2010). Includes bibliographical references (leaves [116]-120).