published_or_final_version / Medicine / Doctoral / Doctor of Philosophy

published_or_final_version / Nursing Studies / Master / Master of Philosophy

Background: African American (AA) women have a disproportionately higher prevalence of Type 2 Diabetes Mellitus (T2DM) and its related complications than Hispanics and non-Hispanic white women. Cultural practices, stigmatization, discrimination, socio-economic status, historical experiences and geographical locations have all been proposed as factors that influence the prevalence of T2DM in AA women. However, no study has explored how AA women with T2DM perceive their risk of developing diabetes complications, and how their risk perceptions impact their diabetes self -management. Purpose: The purpose of this study was to describe the perceptions that AA women diagnosed with T2DM have of their risks of developing DM complications, how their perceived risk of diabetes complications influences their DM self-management, and how the socio-cultural and economic contexts in which DM management occurs influences AA women's DM self-management behaviors. Method: A qualitative descriptive study was used to provide a comprehensive description of the perception of risk for developing diabetes complications among AA women with T2DM. A purposive sample of 10 AA women with T2DM was selected for the study. Findings: Findings revealed that the risk perception for developing DM complications influenced DM self-management among AA women with T2DM. Sociocultural and economic factors were also found to influence DM self-management among AA women with T2DM. Conclusion: This study revealed numerous factors that were associated with development of diabetes complications among AA with T2DM. However, risk perception stood out to be associated with all the factors.

Background. Diabetes seems to be associated with an increased risk of fractures in the general population. We aimed to determine whether pre-transplant diabetes increases the risk of fractures among patients receiving solid organ transplantation. / Methods. We conducted a nested case-control study in a cohort of subjects 18 years and older who received a first solid organ transplantation in Quebec between January 1st 1986 and July 31st 2005, and who were covered by the RAMQ drug plan at least 1 year before the transplantation and 3 months after the date of discharge from the transplantation hospitalization. Cases were subjects from the cohort who had sustained a fracture between the date of discharge from the hospitalization for transplantation and the end of the study period or the patient's death. The fracture date was the case index date. All incidental fractures were included except fractures of the skull, phalanges of the hand and foot, multiple fractures and pathological fractures, and were identified by medical service claims. Controls were matched to cases on the type of organ transplanted and on the date of the transplantation (+/- 3 months). Crude and adjusted odds ratios (OR) were obtained with univariate and multivariate conditional logistic regression models. / Results. The study included 238 cases and 873 controls. Pre-transplant diabetes was present in 30% of the cases and 22% of the controls (crude OR: 2.16, 95% CI: 1.7--2.8). After adjusting for potential confounders, pre-transplantation diabetes remained a significant risk factor for fractures (adjusted OR: 1.94, 95% CI: 1.5--2.6). / Conclusion. Pre-transplant diabetes appeared to significantly increase post-transplant fractures among adults receiving solid organ transplantation.

The aim of this study was to determine management regimens and level of knowledge of diabetes and its‟ ocular complications among private patients in a sample of the population of the Western Cape region of South Africa. A population-based cross-sectional study design, using purposive accidental random sampling, was used. Questionnaires completed by diabetic patients who fund their condition privately outside of the South African Public Health sector were used. One hundred and twenty-two subjects participated in the research, 66 (54%) males and 56 (46%) females. There were 73 rural and 49 urban participants. The overall sample mean BMI was 30.7, average fasting plasma glucose (FPG) 8.1 mmol/l and the majority of respondents did not perform a daily FPG test or know the significance of the HbA1c test. The majority of participants were unaware of the serious ocular consequences of prolonged hyperglycaemia. Sixty-seven percent of respondents considered that they knew enough about diabetes to manage their own condition. From the data it is apparent that private patients‟ knowledge of the systemic and ocular complications of diabetes is sub-optimal. Whilst the majority considered annual eye examinations as important, less than one-third of respondents actually undertook them. Optometrists should be offered programmes to enhance their skills and co-manage and educate diabetic patients with other health care practitioners on a formal basis. Health insurance institutions should take cognisance of the value of patient education and preventative diabetic management and incentivize patients and health care providers in this regard. / Thesis (M.Optom.)-University of KwaZulu-Natal, Westville, 2011.

The purpose of this study was to determine if there was a difference in physical selfconcept due to level of physical activity or the subject's frame of reference. Participants included female students in two HSC-160 courses and members of the Ball State University women's softball, field hockey, and basketball teams in the fall of 2000. The study was conducted using a demographic questionnaire, the Physical Self-Description Questionnaire (PSDQ), and a physical activity log. Subjects received instructions to complete the PSDQ comparing themselves to either someone more physically fit or less physically fit. Subjects chose one of three physical activity levels, nonparticipant, exercisers, or athlete, based on definitions given on the demographic questionnaire. Results of the study indicated that as the level of physical activity increased, so did physical self-concept scores. Results did not find a significant difference in frame of reference and level of physical activity. / School of Nursing

People with diabetes are at a greater risk of burn injuries than those without diabetes. This stems from the epidemiological profiles of the conditions and the effects of morbidities associated with diabetes. Both conditions share some similarities in terms of metabolic alterations and suboptimal immune functions which may result in poor outcomes for patients. For that reason, it is reasonable to deduce that patients with diabetes are a challenging group to manage in burns units. However, this deduction should be taken cautiously because of lack of supporting evidence. Accordingly and after consulting with clinical experts, the research in this portfolio investigated the association between diabetes and burn injuries. In particular, two different aspects of this association were investigated in two individual quantitative and descriptive inquiries. The first was a case note review of patients hospitalised with a principal diagnosis of a foot burn injury in a large tertiary hospital in South Australia from 1999 to 2004. The second study investigated management of diabetes in burns units treating adults. This study is an e-mail survey of clinical leaders of burns units in Australia, New Zealand, Hong Kong and the United Kingdom. The clinical leaders were approached indirectly through key liaison persons in each identified unit. In the first study, outcomes for twelve subjects with and fifty-two without diabetes were described using descriptive and non-parametric statistics. In the second study, descriptive frequencies and content analysis were adopted to analyse twenty-nine responses from seventeen out of thirty burns units which participated in the study. Supporting findings in the literature, the first study showed that burn injuries among subjects with diabetes were mainly resulted from household devices. There were no statistically significant differences between subjects with and without diabetes in terms of size and depth of burn injuries and treatment received. In spite of this, there was a statistically significant association between diabetes and the experience of local post-burn complications and longer duration of hospitalisation. The second study indicated that more than twenty-five percent of the respondents believed that multidisciplinary centres should only occasionally be involved in the process of care. Participants reported that the individual profile of each patient plays a major role in determining the management of diabetes. Additionally, it was found that the insulin sliding scale was commonly used in the management of diabetes in burns units. The association between diabetes and a burn injury is a serious issue in terms of health and cost. This association need be addressed firstly and most importantly at the prevention level; secondly through proper management of both diabetes and burns. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1285462 / Thesis (D.Nurs.)--Population Health and Clinical Practice, 2007.

Master of Public Health / OBJECTIVES: In Australia, diabetes causes significant morbidity and mortality. Whilst the need to prevent diabetes and its complications has been widely recognised, the capacity of health care systems - which organise diabetes care - to facilitate prevention has not been fully established. METHODS: A series of seven population-based case-control studies were used to examine the effectiveness of the Australian health care system and its capacity to manage diabetes. Six of the studies compared the patterns of care of patients who had developed advanced diabetes complications in 2000 (cases), to similar patients who remained free of the condition (controls) across Australia and for various risk groups. A secondary study investigated the role of treating GPs in the development of the outcome. RESULTS: A strong relationship between the patterns of care and the development of advanced diabetes complications was found and is described in Chapter 4. In Chapter 5, this same relationship was investigated for each Australian state and territory, and similar findings were made. The study in Chapter 6 investigated whether late diagnosis or the patterns of care was the stronger risk factor for advanced diabetes complications, finding that the greatest risk was associated with the latter. In Chapter 7 the influence of medical care during the pre-diagnosis period was explored, and a strong relationship between care obtained in this period and the development of advanced complications was found. In Chapter 8, which investigated the role of socio-economic status in the development of advanced complications, found that the risk of advanced diabetes complications was higher in low socio-economic groups. Chapter 9 investigated geographic isolation and the development of advanced diabetes complications and found that the risk of advanced complications was higher in geographically isolated populations. Finally, Chapter 10, which utilised a provider database, found that some GP characteristics were associated with the development of advanced diabetes complications in patients. CONCLUSION: A number of major risk factors for the development of advanced complications in Australia was found. These related to poorer diabetes management, later diagnosis, low socioeconomic status and geographic isolation. Strategies must be devised to promote effective diabetes management and the early diagnosis of diabetes across the Australian population.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A prioridade no tratamento do diabetes à garantir ao paciente seu equilÃbrio metabÃlico e mantÃlo assim, propiciando um estado o mais prÃximo possÃvel da fisiologia normal do organismo. Entretanto, um dos problemas que os profissionais de saÃde encontram à a dificuldade dos pacientes seguirem o tratamento de forma regular e sistemÃtica, pois estes frequentemente sÃo portadores de outras condiÃÃes mÃrbidas, fazendo uso de vÃrias medicaÃÃes alÃm das especÃficas para o diabetes. Este fato dificulta a adesÃo e o uso correto dos esquemas propostos. O objetivo deste estudo foi investigar as caracterÃsticas de adesÃo terapÃutica de portadores de Diabetes mellitus atendidos na rede pÃblica de saÃde no municÃpio de Fortaleza, Cearà e seus fatores relacionados. Foi realizado um estudo transversal, onde foram incluÃdos 140 pacientes atendidos do AmbulatÃrio de Diabetes do Hospital UniversitÃrio Walter CantÃdio (HUWC) e 116 pacientes do Centro de SaÃde AnastÃcio MagalhÃes (CSAM) no ano de 2010, selecionados de forma sequenciada. Para mensurar a prevalÃncia da nÃo adesÃo ao tratamento foi empregado o mÃtodo do autorrelato e considerado adesÃo quando o paciente fazia uso de pelo menos 90% do tratamento proposto. Na anÃlise dos dados foram utilizados o teste de Kalmogorov-Smirnov, teste t de Student, kendall tau b e o coeficiente de contingÃncia, com nÃvel de significÃncia estatÃstica de 5% (p<0,05), utilizando-se o software SPSS (Z14.0). Dos 256 pacientes, houve predomÃnio do sexo feminino (66,8%), casados (53,5%), aposentados (39,1%), com ensino fundamental incompleto (32,4%) e renda familiar mÃdia de 1 salÃrio mÃnimo (39,8%). Quanto à doenÃa, 93,7% possuÃam diabetes tipo 2, com uma mÃdia de 10 anos de diagnÃstico, 75,4% tambÃm eram hipertensos e a principal complicaÃÃo crÃnica encontrada foi a retinopatia (35,9%). As associaÃÃes medicamentosas foram prevalentes entre os pacientes (50,4%) e as drogas de escolha foram sulfonilureia (36,3%) e metformina (66%). A atividade fÃsica foi referida por 43,8% dos pacientes e a dieta por 57%. A adesÃo ao tratamento medicamentoso foi de 74% no CSAM e 77% no HUWC. Fatores relacionados à relaÃÃo profissional-paciente, como a qualidade e frequÃncia das orientaÃÃes, mostraram-se fortemente associados à adesÃo ao tratamento (p<0,001), assim como, os fatores relacionados à doenÃa, onde pacientes com controle bom ou aceitÃvel do diabetes (p<0,007) e que nÃo possuÃam internaÃÃes obtiveram melhor adesÃo (p<0,018). Quanto à influÃncia do sistema de saÃde, pessoas mais satisfeitas e que melhor qualificaram o serviÃo apresentaram melhor adesÃo (p<0,045). Na anÃlise clÃnica houve predomÃnio do sobrepeso (39,5%) e obesidade (32%). As medidas alteradas de circunferÃncia abdominal (65,6%), cervical (68,8%) e relaÃÃo cintura-quadril (78,1%) estiveram presentes em grande parte dos pacientes do CSAM e HUWC. Os valores antropomÃtricos alterados nÃo apresentaram diferenÃa na anÃlise da adesÃo. Quanto aos exames laboratoriais, em ambos os locais, a maioria dos pacientes que apresentaram adesÃo estava com glicemia de jejum (65,1%), pÃs-prandial (61,7%) e hemoglobina glicada (68,1%) acima dos valores recomendados. Identificou-se um elevado nÃmero de fatores que podem influenciar na adesÃo ao tratamento, sendo um problema frequente na prÃtica clÃnica. As taxas nÃo satisfatÃrias de adesÃo à terapÃutica farmacolÃgica podem justificar possivelmente o mau controle metabÃlico entre os pacientes. Traduzem a necessidade de se ampliar o foco na atenÃÃo integral a estas pessoas.

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