Numeracy skills are vital for a child with diabetes as they need to be able to manage their diabetes effectively, in order to protect one from the complications that come with diabetes. There have been numerous studies that illustrate the poor numeracy skills in children with diabetes. A numeracy intervention specifically related to diabetes was put into place to illustrate whether or not such an intervention is effective in improving a child’s diabetic numeracy ability, which will lead to the improvement of diabetes self-management in the future. A Quantitative quasi-experimental pre-test - post-test non equivalent control group design was conducted to explore the efficacy of an applied numeracy intervention in a South Africa type 1 diabetic child population. The study group comprised of 58 children with type 1 diabetes, each group consisted of 29 participants, and each participant in the experimental group was closely matched according to their level of formal education, grade, age and sex to a research participant in the control group. Both groups were measured before and after the intervention. The children were between the ages of 8 and 13. All participants were in formal education between Grades 3 and Grade 8. Results revealed that participants in both groups had lower ‘functional’ grades as compared to their ‘actual grade’ level which suggests that they performed below their expected grade level. Participants performed better in areas assessing basic mathematical skills than areas which assessed applied diabetes mathematical skills. The intervention was shown to be effective as analyses revealed that there was a highly significant difference (p<0.001) between the Pre and Post Test (applied mathematical sections) of the experimental group which took part in the intervention. This research is only the starting point for the assessment of the effectiveness of a numeracy component in diabetes related education in South Africa, and through this one would hope that more research in South Africa will be done in this area.

Aims: The thesis aimed to contribute to the current understanding of how to improve comprehensive health outcomes for children and adolescents with type 1 diabetes. Methods: A systematic review was undertaken to identify existing interventions designed to improve health-related quality of life in a paediatric diabetes population. The quality of identified studies was assessed and the effectiveness of the interventions was evaluated. Parent-adolescent dyads were also recruited via paediatric diabetes teams to participate in an empirical study. Participants were asked to complete questionnaires measuring psychological flexibility, mindfulness, perception of parental care and control, adherence to treatment and quality of life. Relationships were explored using correlation and regression analysis. Results: Twenty seven articles were identified in the systematic review. More than half were rated as “acceptable” or “high quality”. Quality of life was a primary treatment target in only three studies. Eight studies reported significant beneficial effects on health-related quality of life. In the empirical study, regression analysis found that both parent and adolescent diabetes-specific psychological flexibility predicted treatment adherence while adolescent mindfulness and insulin administration predicted quality of life. Conclusion: There is some evidence for the effectiveness of intensive structured education and coping skills training in improving health-related quality. However consideration should be given to developing theoretically informed interventions to target quality of life alongside other treatment related outcomes. The empirical study suggested psychological flexibility and mindfulness are useful constructs for understanding health outcomes in adolescents with type 1 diabetes. Acceptance and commitment, and mindfulness-based therapies may prove beneficial for improving outcomes in this population.

[Truncated abstract] Type 1 Diabetes is emerging as a significant public health problem faced by nearly every country in the world. It has major economic and social implications with considerable burden of illness. Approximately 140,000 Australians have been diagnosed with T1DM with an annual increase in incidence rate of 3% per year, comparable to the overall global increase. The management of T1DM requires insulin therapy which places considerable burden on the patient and their carers. Coping with daily insulin injections, dietary changes, modification of physical activity and vigilant monitoring of blood glucose levels, will impact on patient?s quality of life. The optimum goal for the treatment of type 1 diabetes is to safely achieve near-normal glycaemia and failure to maintain this goal accelerates the progression of the devastating long term complications of diabetes. Unfortunately attempts to achieve near normal glycaemia are limited by the risk of excessive lowering of blood glucose levels and hypoglycaemia remains a major barrier to strict glucose control of diabetes. In general this thesis focuses on two fundamental issues related to the epidemiology of severe hypoglycaemia. Namely, methodological consideration when analysing prospective observational data and application of the most robust methodology. A prospective open cohort study of the Princess Margaret Hospital diabetes clinic established in 1992, with 99% case ascertainment was used. This hospital is the only paediatric referral centre for type 1 diabetes and every child diagnosed in the state of Western Australia is treated at this centre. ... The results of this study showed that severe hypoglycaemia remains a major problem and recent approaches to therapy may be allowing a degree of improved control without the expected increased risk of severe hypoglycaemia. The study in chapter 7 investigates genetic risk factors related to severe hypoglycaemia. A significant relationship where the presence of the iv deletion (D) allele of the angiotensin-converting enzyme (ACE) increases risk of severe hypoglycaemia has been reported. This study concludes that the presence of D allele of the ACE gene does not predict a significantly higher risk of severe hypoglycaemia. In an attempt to optimize glycemic control, patients may suffer multiple episodes of severe hypoglycaemia which can adversely affect quality of life as well as educational and intellectual disadvantage. The study in chapter 8 investigates the factors related to recurrent severe hypoglycaemia. A rigorous and informative time-to-event approach is used to account for within child correlation, staggered enrolment and timevarying covariates. This allows important risk factors to change over time. Preschool children have an increased risk of experiencing recurrent severe hypoglycaemia. The findings of this thesis highlights the importance of selecting appropriate analytical methodology to identify risk factors associated with severe hypoglycaemia and also to dismiss factors that had previously been thought to be important. This will help in formulating management plans in order to limit the impact of severe hypoglycaemia.

Problem--The development of diabetes produces a state of shock for the child and his or her family. The single most important factor in coping with both the physical and emotional impact of diabetes is education. Only when there is a clear understanding on the part of the child and the family of what diabetes is, how it can be managed, how to prevent emergencies, and how to cope with complications should they arise, will these feelings begin to be resolved.There are very limited educational materials available to help the pre-school to elementary age children with diabetes understand their disease.Main Procedure--A support group for families who have children with diabetes was developed. The objectives were formulated in relationship to the needs of the support group. The following materials were created to help the children understand about their disease:1. A flannelboard explanation of diabetes was used to help the children understand diabetes.2. A green puppet to sing and talk to the children about the problems of being different and how to say no without calling attention to oneself was created.3. A homemade robot was made that could turn a negative message into a positive one. A discussion of what's good about today and the importance of having a positive attitude followed.4. A game called Diabetes Challenge was created. The game called for the recognition of foods and their exchange areas and also asked challenging questions about diabetes.5. Containers from three fast-food restaurants were used with food exchanges marked on them so children could select wisest choices for their meal plan.6. Marionettes and stick puppets were created to perform the puppet show "The Boy Who Cried Wolf" and then the sequel "The Girl 'Who Cried Reaction". The sequel was written by the researcher in an attempt to illustrate the importance of being believed.7. A school booklet was developed for families to inform their schools about diabetes.8. A video tape was created to be used by parents to inform their school about diabetes.Understanding diabetes and learning to care for it well is an ongoing task. Diabetes in a child is a way of life. It involves the whole family and all those outside the family that are caring for the child.It is the writer's hope that this project will be utilized as a resource for presenting important information to children who have diabetes. These materials are available upon request by contacting Julie Alexander, R.R. 1 Box 29, Eaton, IN 47338, Phone:(317) 396-9222. / Department of Elementary Education

Autoimmune diabetes is a disorder in which the (3-cells in the pancreatic islets of Langerhans are specifically destroyed resulting in absolute insulin deficiency; typically this is a childhood-onset disease, Type 1 Diabetes (T1D). Type 2 Diabetes (T2D) is a metabolic disorder usually developing in adults resulting from defects in insulin secretion and action. Latent Autoimmune Diabetes in Adults (LADA) is a form of diabetes that shares autoimmune disease pathology with T1D but a clinical presentation similar to T2D; LADA patients develop diabetes as adults (>25 years) and do not immediately require insulin treatment for survival. They are therefore often misdiagnosed with T2D. The aims of this work were to characterise immunological and genetic aspects of LADA using a large cohort collected from various patient repositories the United Kingdom to determine if it is a separate disease entity or an age-related extension of T1D. Both T1D and LADA are characterised by autoantibodies to the islet cell protein glutamic acid decarboxylase 65 (GADA) at diagnosis. The persistence and titre of GADA post-diagnosis in LADA was examined at 0.5, 3 and 6 years. GADA persisted in 93% of patients for 6 years; GADA litres decreased between 0.5 and 3 years post-diagnosis and either stabilised or increased again between 3 and 6 years. GADA titre was not associated with age at diagnosis, glycaemic control, β-cell function or other clinical features. GADA titre at 0.5 years was associated with a greater likelihood of requiring more intensive antihyperglycaemic therapy but did not predict therapy or insulin requirement at 3 and 6 years. Autoantibodies against IA-2 plus GADA compared to GADA alone at diagnosis predicted increased therapy requirement by 3 and 6 years and insulin requirement by 3 years postdiagnosis. Variants of the Human Leukocyte Antigen (HLA) genes DRB1 and DQB1, are associated with susceptibility for T1 D. An analysis of these variants in LADA (n = 378) revealed that the predisposing and protective variants in LADA are similar to those reported in T1D; DR3 (in linkage disequilibrium, LD with DQ2) and DR4 (in LD with DQ8) were the main predisposing variants whereas DR2 (in LD with DQ6) was most the protective against LADA. 85% of LADA patients possessed the DR3 and DR4 specificities, compared with 95% seen in T1D, suggesting a reduced predisposition in LADA compared with T1D. Synergistic effects of the DR3 and DR4 specificities occurred in LADA and the DRB1*0401 allele within the DR4 specificity was predisposing to disease, as seen in T1D. No other predisposing variants were identified in LADA. As reported for T1D, DR11, DR13, DQ5, DQ7 and DQ9 were protective against LADA; DQ6 was positively correlated with age at diagnosis. Association analysis of the insulin gene region in LADA (n = 400) showed that the variable number of tandem repeats (VNTR) locus primarily confers susceptibility to disease. Overall, the short Class I alleles predisposed to disease whereas longer Class III alleles conferred dominant protection, as reported in T1D. Fine-structure analysis showed that the Class I haplotypes 'IC+/ID+' and 'ID-' both conferred susceptibility for LADA - unlike in T1D, where the ID- haplotype has been reported to have protective effects. The Class III 'Protective' and Very Protective' haplotypes, conferred equal protection in LADA, as reported forTID. In conclusion; GADA persist post-diagnosis but are not markers for disease progression of LADA. Patterns of susceptibility at the HLA and insulin gene regions in LADA are similar to that reported for T1 D. LADA is likely to represent an age-related extension of T1D rather than a separate disease entity.

Thesis (M.A.)--Northern Kentucky University, 2008. / Made available through ProQuest. Publication number: AAT 1454503. ProQuest document ID: 1580779081. Includes bibliographical references (p. 33-34)

Thesis (M.D.S.)--University of Hong Kong, 2000. / Includes bibliographical references. Also available in print.

Thesis (M.S.)--University of Michigan, 1979.

Thesis (M.Sc.)--Memorial University of Newfoundland, 2004. / Includes bibliographical references.

Thesis (M.A.)--York University, 2004. Graduate Programme in Psychology. / Typescript. Includes bibliographical references (leaves 56-62). Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://wwwlib.umi.com/cr/yorku/fullcit?pMQ99301