Search results for: diabetes Mellitu foot care

Authors: Miriam Colleran, Barbara Sheehy-Skeffington

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Background: Patients with intellectual disabilities have specific palliative care needs, which can affect how resources and services are planned for this type of patient population. Aim: The purpose of this practice review is to assess the indications for, numbers of and outcomes of care for adults with intellectual disabilities referred to a specialist palliative care service over a two-year period. Service utilization aspects considered included the frequency of home visits by a specialist palliative care doctor or clinical nurse specialist and the number of hospice admissions that occurred for the patients. Method: A retrospective review was carried out of persons 18 years and older with intellectual disabilities referred to a specialist palliative care service. A manual review was carried out of the register using the place of residence and diagnosis in addition to the patients known to the clinicians who had intellectual disabilities. Results: 16 persons with intellectual disabilities were identified as being referred during that time. However, this may be an underestimate. 8 women and 8 men were referred with an age range of 50 to 81 years old. 4 patients referred did not have home visits from the specialist palliative care team. A range of 2 to 12 phone calls per person occurred by the specialist palliative care team regarding this cohort of patients. For some patients, the care is ongoing. Sadly, other patients died. Conclusion: Providing specialist palliative care for adults with intellectual disabilities is an important element of palliative care. Further research is necessary, and education to inform, support and empower specialist palliative care professionals in optimizing palliative and end-of-life care for persons with intellectual disabilities and to inform service development and provision.

Keywords: palliative care, intellectual disabilities, service planning, practice review

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Authors: Ram Sharan Mehta, Dina Khanal, Pushpa Parajuli, Gayanand Mandal, Bijaya Bartuala

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Background: Cardiovascular disease (CVD) is the leading cause of death worldwide. Adequate awareness of risk factors of CVD is the first step towards effective preventive strategies to combat the CVD burden in diabetes patients.This study aims to assess the awareness on risk factors of CVD among patients with diabetes mellitus attending diabetic clinic of BPKIHS and to find the association between awareness with their selected socio demographic variables. Methods and Material: A descriptive cross sectional study was conducted among 112 patients with diabetes in diabetic clinic of BPKIHS. Convenient sampling technique was used for data collection over duration of one month using interview schedule by HDFQ II tool. Data were analyzed by using descriptive and inferential statistics. (Chi square). Results: The mean age of respondents was 55.4±12.13 years. That mean HDFQ score was 14.31± 5.08. Only 33% of the respondents had adequate level of awareness whereas majority of the respondents (67%) had inadequate level of awareness. Majority of the respondent (83.9%) were aware about smoking, (78.6%) physical activity, (75%) increasing age, (75.9%) high blood pressure, (71.4%) overweight respectively. Whereas most of the respondents were not aware of high cholesterol, fatty diet, preventive strategies and association of diabetes with CVD. Awareness was statistically significant with (p=0.043) educational status, (p=0.025) monthly income, (p=0.05) residence, (p=0.006) CVD information received and (p=0.022) co morbid condition as a heart disease. Conclusion: The findings of this study concluded most of the respondents had an inadequate level of awareness on risk factors of CVD. So Effective education and appropriate preventive strategies of CVD are indeed important to reduce CVD burden in diabetes patients.

Keywords: cardiovascular disease, awareness, diabetes patients, risk

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Authors: Han Chih Feng, Yi-Cheng Hou, Jing-Huei Wu

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Diabetes is a chronic disease. Nutrition knowledge and skills enable individuals with type 2 diabetes to optimize metabolic self-management and quality of life. This research studies the effect of nutritional education on diabetes inpatients in terms of their cognition, behavior, and attitude. The participants are inpatients diagnosed with diabetes at Taipei Tzu Chi Hospital. A total of 103 participants, 58 male, and 45 females, enrolled in the research between January 2018 and July 2018. The research evaluates cognition, behavior, and attitude level before and after nutritional education conducted by dietitians. The result shows significant improvement in actual consumption (2.5 ± 1.4 vs 3.8 ± 0.7; p<.001), diet control motivation (2.7 ± 0.8 vs 3.4 ± 0.6; p<.001), correct nutrition concept (1.2± 0.4 vs 2.4 ± 0.5; p<.001), learning willingness (2.7± 0.9 vs 3.4 ± 0.6; p<.001), cognitive behaviors (1.4 ± 0.5 vs 2.9 ± 0.7; p<.001). AC sugar (278.5 ± 321.5 vs 152.2 ± 49.1; p<.001) and HbA1C (10.3 ± 2.6 vs 8.6 ± 1.9; p<.001) are significant improvement after nutritional education. After nutritional education, participants oral hypoglycemic agents increased from 16 (9.2%) to 33 (19.0%), insulin decreased from 75 (43.1%) to 68 (39.1%), and hypoglycemic drugs combined with insulin decreased from 83 (47.7%) to 73 (42.0%).Further analysis shows that female inpatients have significant improvement in diet control motivation (3.91 ± 0.85 vs 4.44 ± 0.59; p<0.000), correct nutrition concept (3.24± 0.48 vs 4.47± 0.51; p<0.000), learning willingness (3.89 ± 0.86 vs 4.44 ± 0.59; p<0.000) and cognitive behaviors (2.42 ± 0.58 vs 4.02 ± 0.69; p<0.000); male inpatients have significant improvement in actual food intake (4.41± 0.92 vs 3.97 ± 0.42; p<0.000), diet control motivation (3.62 ± 0.86 vs 4.29 ± 0.62; p<0.000), correct nutrition concept (3.26 ± 0.44 vs 4.36 ± 0.49; p<0.000), learning willingness (3.72± 0.93 vs 4.33± 0.63; p<0.000) and cognitive behaviors (2.45± 0.54 vs 4.03± 0.77; p<0.000). In conclusion, nutritional education proves effective, regardless of gender, in improving an inpatient’s cognition, behavior, and attitude toward diabetes self-management.

Keywords: diabetes, nutrition education, actual consumption, diet control motivation, nutrition concept, learning willingness, cognitive behaviors

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Authors: Samaneh Yavari, Christiane Pferrer, Elisabeth Engelke, Alexander Starke, Juergen Rehage

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Background: Three nociceptive thresholds of thermal, electrical, and mechanical thresholds commonly use to evaluate the local anesthesia in many species, for instance, cow, horse, cat, dog, rabbit, and so on. Due to the lack of investigations to evaluate and/or validate such those nociceptive thresholds, our plan was the comparison of two-foot local anesthesia methods of Intravenous Regional Anesthesia (IVRA) and our modified four-point Nerve Block Anesthesia (NBA). Materials and Methods: Eight healthy nonpregnant nondairy Holstein Frisian cows in a cross-over study design were selected for this study. All cows divided into two different groups to receive two local anesthesia techniques of IVRA and our modified four-point NBA. Three thermal, electrical, and mechanical force and pinpricks were applied to evaluate the quality of local anesthesia methods before and after local anesthesia application. Results: The statistical evaluation demonstrated that our four-point NBA has a qualification to select as a standard foot local anesthesia. However, the recorded results of our study revealed no significant difference between two groups of local anesthesia techniques of IVRA and modified four-point NBA related to quality and duration of anesthesia stimulated by electrical, mechanical and thermal nociceptive stimuli. Conclusion and discussion: All three nociceptive threshold stimuli of electrical, mechanical and heat nociceptive thresholds can be applied to measure and evaluate the efficacy of foot local anesthesia of dairy cows. However, our study revealed no superiority of those three nociceptive methods to evaluate the duration and quality of bovine foot local anesthesia methods. Veterinarians to investigate the duration and quality of their selected anesthesia method can use any of those heat, mechanical, and electrical methods.

Keywords: mechanical, thermal, electrical threshold, IVRA, NBA, hind limb, dairy cow

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Authors: Ibrahim Mohammed

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Background: Diabetes mellitus is a chronic disease that can cause devastating secondary complications, reducing the quality and length of life as well as increasing medical costs for the patient and society. The guidelines recommend both clinical and preventive strategies for diabetes management and are regularly updated. The aim of the study is to assess the level of adherence of physicians to American Diabetes Association Guidelines. Method: Observational multicenter retrospective study will be conducted among different hospitals in the central region. Patient data will be collected from the records of the last three years (2017- 2020). Records will be selected randomly after a complete randomized design. The study focuses on the management of type 2 according to ADA not changed in the last three updating; those standards; all patients should be taking Metformin 1500 to 2000 mg/day as recommended dose and should be received a high dose of statin if the high risk to ASCVD or moderate statin if not at risk, patients with hypertension and diabetes should taking ACE or ARBS. Result: The study aimed to evaluate the commitment of physicians in the central region to the ADA. Out of the 153 selected patients, only 17 % were able to control their diabetes with an average A1c below 7. ADA stated that to reach the minimum benefit of using Metformin, the daily dose should be between 1500 and 2000 mg. Results showed that 110 patients were on Metformin, where 68% of them were on the recommended dose. ADA recommended the intake of high statin for diabetic patients with ASCVD risk, while diabetic patients without ASCVD risk should be on a moderate statin. Results showed that 61.5% of patients with ASCVD risk were at high statin while only 36% of patients without ASCVD risk were at moderate statin. Results showed that 89 patients have hypertension, and 80% of them are getting ACE/ARBs as recommended by the ADA. Recommendation: It is necessary to implement periodic training courses for some physicians to enhance and update their knowledge.

Keywords: American Diabetic Association, diabetes mellitus, atherosclerotic cardiovascular disease, ACE inhibitors

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Authors: Sidra Islam, Moin Uddin, Mir A. Rouf

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A wide variety of pathological disorders owing to hyperglycemic conditions involves structural rearrangements and condensations of proteins. The implication of methylglyoxal (MG) modified immunoglobulin G (IgG) in the onset and progression of diabetes type 2 (T2DM) is studied in the present study. Using biophysical and biochemical approaches MG was found to perturb the structure of IgG, effect its microenvironment and leads to aggregate formation. Furthermore, MG-IgG was found to be highly immunogenic inducing high titre antibodies in female rabbits. Clinical studies revealed the presence of circulating anti-MG-IgG antibodies as analyzed by direct binding ELISA. The circulating auto antibodies were highly specific for MG-IgG as revealed by inhibition ELISA. Thus it can be concluded that MG is a powerful agent with a high damaging potential. To IgG. It is highly capable of generating immune response that contributes to the immunopathology associated with diabetes. Dicarbonyl adducts may emerge as potential biomarkers for T2DM.

Keywords: immunogenicity, Immunoglobulin G, methylglyoxal, Type 2 Diabetes Mellitus

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Authors: Yi-Chuan Cheng, Li-Chi Huang, Yu-Shan Chang

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Introduction: The main purpose of this study was to explore the relationship between the learning number, care knowledge, care skills and maternal confidence in preterm infant care in Taiwan. Background: Preterm infants care has been stressful for mother caring at home. Many programs have been applied for improving the infant care maternal confident. But less to know the learning behavior in mothers of preterm infant. Methods: The sample consisted of 55 mothers with preterm infants were recruited in a neonatal intermediate unit at a medical center in central Taiwan. The self-reported questionnaires including knowledge and skills of preterm infant care scales and maternal confidence scale were used to evaluation, which were conducted during hospitalization, before hospital discharge, and one month after discharge. We performed by using Pearson correlation of the collected data using SPSS 18. Results: The study showed that the learning number and knowledge in preterm infant care was a significant positive correlation (r = .40), and the skills and confidence preterm infant care was positively correlated (r = .89). Conclusions: Study results showed the mother had more learning number in preterm infant care will be stronger knowledge, and the skills and confidence in preterm infant care were also positively correlated. Thus, we found the learning behavior change significant care knowledge. And the maternal confidence change significant with skill on preterm infant’s care. But bondage still needs further study and develop the participation in hospital-based instructional programs, which could lead to greater long-term retention of learning.

Keywords: learning behavior, care knowledge, care skills, maternal confidence

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Authors: Alok Raghav, Jamal Ahmad

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Background: Serum albumin glycation and advanced glycation end products (AGE) formation correlates in diabetes and its associated complications. Extensive modified human serum albumin is used to study the biochemical, electrochemical and functional properties in hyperglycemic environment with relevance to diabetes. We evaluate Spectroscopic, side chain modifications, amino acid analysis, biochemical and functional group properties in four glucose modified samples. Methods: A series four human serum albumin samples modified with glucose was characterized in terms of amino acid analysis, spectroscopic properties and side chain modifications. The diagnostic technique employed incorporates UV Spectroscopy, Fluorescence Spectroscopy, biochemical assays for side chain modifications, amino acid estimations. Conclusion: Glucose modified human serum albumin confers AGE formation causes biochemical and functional property that depend on the reactivity of glucose and its concentration used for in-vitro glycation. A biochemical and functional characterization of modified albumin in-vitro produced AGE product that will be useful to interpret the complications and pathophysiological significance in diabetes.

Keywords: glycation, diabetes, human serum albumin, biochemical and electrochemical characterization

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Authors: Yu Chen

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Auricular-magnet therapy is the development of auricular acupuncture. It is a powerful, convenient, and quick result-achieving therapeutic method. This therapy works by using magnetic discs to be placed on acupuncture points on the ears to treat diseases and improve health. In this study, the fundamental principles, indications, and contraindications of this therapy are discussed. Five examples, including reducing blood glucose levels, healing gangrene for diabetes patients, and treating Bell's palsy, are presented. Auricular-magnet therapy is a powerful development in acupuncture.

Keywords: auricular-magnet therapy, Bell’s palsy, diabetes mellitus, food craving, insomnia, nausea, obesity

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Authors: Daniella Arieli

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As human population is ageing, globally, we are faced with the need to find solutions for the care of older people who have reached the stage of needing full-time nursing care. Basically, there are two basic alternatives: 1. moving the individual to an institutional setting, a care home, or other form of residency, and 2. Arranging care for them in their own home, what is known as “ageing in place”. As ageing in place is becoming popular in many parts of the world, there is a need to understand its’ everyday consequences for all the involved parties: the care recipient, her/his family members and the live-in care workers. This is crucial because choosing home care means that the role of the care recipient’s relatives becomes very demanding and requires a level of support and responsibility that is often beyond what families can offer. This is particularly challenging when the older person faces dementia. While most Western countries offer a range of social services, many citizens around the world find the care provided by governments and associated social support structures insufficient. Individuals and families find themselves in the position of having to take on the responsibility themselves and find a path for the care of frail members, while facing considerable personal burdens and challenging dilemmas. The aim of this work is to discuss those challenges. The study is based on an ethnographic study of home care for older people in Israel.

Keywords: aging in place, family caregivers, policy making, qualitative research

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Authors: I. V. Palamarchuk, N. V. Zaichko

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Background and Aims: Galectin-3 is a marker of subclinical cardiac injury and is elevated in individuals with type 2 diabetes mellitus; while hydrogen sulfide (H₂S), metabolite of sulfur-containing amino acids, is considered having antifibrogenic effects. This study was designed to investigate whether metformin and its combination with NaHS can influence plasma galectin-3 and cystathionine-γ-lyase/hydrogen sulfide (CSE/H₂S) system in diabetic rat’s heart. Methods: 32 healthy male rats (180-250 g) were divided into 4 groups. To induct diabetes, rats (group 2-4) were injected with streptozotocin (STZ, 40 mg/kg/i.p., 0.1 M citrate buffer (pH 4.5). Rats from 3d (STZ+Metf) and 4th (STZ+Metf+NaHS) groups were given metformin (500 mg/kg/day) orally, and rats from 4th (STZ+Metf+NaHS) group were injected sodium hydrosulfide (NaHS, 3 mg/kg/i.p.) once per day starting from 3 to 28 day after streptozotocin injection. Rats of first group (control) were administered the equivalent volumes of 0.9% NaCl. Plasma galectin-3 was measured by ELISA. Rats’ hearts were sampled for determination of H2S by reaction with N,N-Dimethyl-p-phenylenediamine. Determination of CSE gene expression was performed in real time using PCR in the presence of SYBR Green I, using DT-Light detecting amplifier ('DNA-technology', Russia). Results: Induction of streptozotocin diabetes (STZ-diabetes, group 2) was followed by low myocardial H2S concentration and CSE expression (by 35%, p < 0.05 and 60.5%, p < 0.001 respectively, than that in controls), while plasma galectin-3 in this group was significantly higher than in controls (by 3.8 times, p < 0.05). Administration of metformin (group 3) resulted in significantly higher H₂S concentration (by 28.5%, p < 0.05), whereas CSE expression was only by 6% more than that in STZ-diabetes, as well as plasma galectin-3 was only by 14.8% lower in comparison with untreated diabetic rats. The inhibition of H₂S generation and CSE activity by diabetes was greatly attenuated in STZ+Metf+NaHS group. The combination of metformin with NaHS significantly stimulated H₂S production (by 48%, p < 0.05 and 15%, p < 0.05 more than STZ-diabetes and STZ+Metf respectively) and CSE gene expression (by 64.8%, p < 0.05 compared to STZ-diabetes and by 55.4%,p < 0.05 compared to STZ+Metf). Besides, plasma galectin-3 in rats receiving metformin and NaHS was significantly lower by 42%, p < 0.05 and 32.5%, p < 0.05 compared to STZ-diabetes and STZ+Metf groups respectively. Conclusions: To summarize, dysfunction of CSE/H2S system and galectin-3 stimulation was found in streptozotocin-induced diabetic rats. Metformin and its combination with exogenous H2S effectively prevented the development of metabolic changes induced by diabetes. These findings suggest that CSE/H₂S system can be integrated into pathogenesis of diabetic complications through modulation of pro-inflammatory and pro-fibrogenic mediator galectin-3.

Keywords: cystathionine-γ-lyase, diabetic heart, galectin-3, hydrogen sulfide, metformin, sodium hydrosulfide

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Authors: Bengi Demirci

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Out-of-pocket payments have become one of the common models adopted by health care reforms all over the world, and they have serious implications for not only the financial set-up of the health care systems in question but also for the people involved in terms of their access to the health care services provided. On the one hand, out-of-pocket payments are used in raising resources for the finance of the health care system and in decreasing non-essential health care expenses by having a deterrent role on the patients. On the other hand, out-of-pocket payment model causes regressive distribution effect by putting more burdens on the lower income groups and making them refrain from using health care services. Being a relatively incipient country having adopted the out-of-pocket payment model within the context of its Health Transformation Program which has been ongoing since the early 2000s, Turkey provides a good case for re-evaluating the pros and cons of this model in order not to sacrifice equality in access to health care for raising revenue for health care finance and vice versa. Therefore this study aims at analyzing the impact of out-of-pocket payments on the health finance system itself and on the patients’ access to healthcare services in Turkey where out-of-pocket payment model has been in use for a while. In so doing, data showing the revenue obtained from out-of-pocket payments and their share in health care finance are analyzed. In addition to this, data showing the change in the amount of expenditure made by patients on health care services after the adoption of out-of-pocket payments and the change in the use of various health care services in the meanwhile are examined. It is important for the incipient countries like Turkey to be careful in striking the right balance between the objective of cost efficiency and that of equality in accessing health care services while adopting the out-of-pocket payment model.

Keywords: health care access, health care finance, health reform, out-of-pocket payments

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Authors: Emily Rowe

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Introduction: Balance assessments can be used to help evaluate a person’s risk of falls, determine causes of balance deficits and inform intervention decisions. It is widely accepted that instrumented quantitative analysis can be more reliable and specific than semi-qualitative ordinal scales or itemised scoring methods. However, the uptake of quantitative methods is hindered by expense, lack of portability, and set-up requirements. During stepping, foot placement is actively coordinated with the body centre of mass (COM) kinematics during pre-initiation. Based on this, the potential to use COM velocity just prior to foot off and foot placement error as an outcome measure of dynamic balance is currently being explored using complex 3D motion capture. Inertial sensors and pressure mats might be more practical technologies for measuring these parameters in clinical settings. Objective: The aim of this study was to test the criterion validity and test-retest reliability of a synchronised inertial sensor and pressure mat-based approach to measure foot placement error and COM velocity while stepping. Methods: Trials were held with 15 healthy participants who each attended for two sessions. The trial task was to step onto one of 4 targets (2 for each foot) multiple times in a random, unpredictable order. The stepping target was cued using an auditory prompt and electroluminescent panel illumination. Data was collected using 3D motion capture and a combined inertial sensor-pressure mat system simultaneously in both sessions. To assess the reliability of each system, ICC estimates and their 95% confident intervals were calculated based on a mean-rating (k = 2), absolute-agreement, 2-way mixed-effects model. To test the criterion validity of the combined inertial sensor-pressure mat system against the motion capture system multi-factorial two-way repeated measures ANOVAs were carried out. Results: It was found that foot placement error was not reliably measured between sessions by either system (ICC 95% CIs; motion capture: 0 to >0.87 and pressure mat: <0.53 to >0.90). This could be due to genuine within-subject variability given the nature of the stepping task and brings into question the suitability of average foot placement error as an outcome measure. Additionally, results suggest the pressure mat is not a valid measure of this parameter since it was statistically significantly different from and much less precise than the motion capture system (p=0.003). The inertial sensor was found to be a moderately reliable (ICC 95% CIs >0.46 to >0.95) but not valid measure for anteroposterior and mediolateral COM velocities (AP velocity: p=0.000, ML velocity target 1 to 4: p=0.734, 0.001, 0.000 & 0.376). However, it is thought that with further development, the COM velocity measure validity could be improved. Possible options which could be investigated include whether there is an effect of inertial sensor placement with respect to pelvic marker placement or implementing more complex methods of data processing to manage inherent accelerometer and gyroscope limitations. Conclusion: The pressure mat is not a suitable alternative for measuring foot placement errors. The inertial sensors have the potential for measuring COM velocity; however, further development work is needed.

Keywords: dynamic balance, inertial sensors, portable, pressure mat, reliability, stepping, validity, wearables

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Authors: Baloyi Gift Tlharihani

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This paper explores the relationship between pastoral care and counselling and psychology. It will critically review the variety of views and debates regarding this relationship while acknowledging the different sides of the debates on the sameness and difference of these notions, this paper argues for the inevitable interconnectedness of the two. There has always been a close relationship, between pastoral care and counselling and psychology, although these are two totally different notions. Even though pastoral care and counselling are thought of as more spiritually focused and psychology with emotional and mental challenges, the components that connect these two sciences are represented by the care of human being. Therefore, this paper is interested in the interconnectedness of these two science as they both makes a vital contribution to human caring. It indicates that whether we take the dualistic difference between the body and soul, the trichotomous difference between the body, soul and spirit, our essential nature is found in the unity of those constituent elements.

Keywords: anthropology, human care, pastoral care and counseling, psychology

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Authors: Jin Hun Choi, So Hyun Ahn, Seong Keun Wang, Ik-Seung Chee, Jung Lan Kim, Sun Woo Lee

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Objectives: The purpose of the study is to investigate the effects of day hospital care in hospitalized schizophrenic patients in terms of treatment adherence and treatment outcomes. Methods: Among schizophrenic patients hospitalized between 2011 and 2012, 23 day hospital care patient and 40 control subjects were included in the study. All candidates underwent Beck Cognitive Insight Scale, Drug Attitude Inventory, World Health Organization Quality of Life Assessment and Psychological Well-Being Scale when their symptoms were stabilized during hospitalization, and after being discharged, 23 patients received day hospital care for two months and then changed to out-patient care while 40 patients received out-patient care immediately after discharge. At the point of two months of out-patient care, the treatment adherence of the two groups was evaluated; tracking observation was performed until February, 2013, and survival rates were compared between the two groups. Results: Treatment adherence was higher in the day hospital care group than in the control group. Kaplan-Meier survival analysis showed a higher survival rate for the day hospital care group compared to the control group. Levels of cognitive insight and quality of life were higher after day hospital care than before day hospital care in the day hospital care group. Conclusions: Through the study, it was confirmed that when hospitalized schizophrenic patients received continuous day hospital care after being discharged, they received further out-patient care more faithfully. The study is considered to aid in the understanding regarding schizophrenic patients’ treatment adherence issues and improvement of treatment outcomes.

Keywords: schizophrenia, day hospital care, adherence, outcomes

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Authors: Giovana Vesentini, Fernanda Piculo, Gabriela Marini, Debora Damasceno, Angelica Barbosa, Selma Martheus, Marilza Rudge

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Problem statement: Skeletal muscle is highly adaptable, muscle fiber composition and size can respond to a variety of stimuli, such physiologic, as pregnancy, and metabolic abnormalities, as Diabetes mellitus. This study aimed to analyze the effects of pregnancy-associated diabetes on the rectus abdominis muscle (RA), and to compare this changes in rats and women. Methods: Female Wistar rats were maintained under controlled conditions and distributed in Pregnant (P) and Long-term mild pregnant diabetic (LTMd) (n=3 r/group). Diabetes in rats was induced by streptozotocin (100mg/Kg, sc) on the first day of life, for a hyperglycemic state between 120-300 mg/dL in adult life. Female rats were mated overnight, at day 21 of pregnancy were anesthetized, and killed for the harvesting of maternal RA. Pregnant women who attended the Diabetes Prenatal Care Clinic of Botucatu Medical School were distributed in Pregnant non-diabetic (Pnd) and Gestational Diabetic (GDM) (n=3 w/group). The diagnosis of GDM was established according to ADA’s criteria (2016). The harvesting of RA was during the cesarean section. Transversal cross-sections of the RA of both women and rats were analyzed by transmission electron microscopy. All procedures were approved by the Ethics Committee on Animal Experiments of the Botucatu Medical School (Protocol Number 1003/2013) and by the Botucatu Medical School Ethical Committee for Human Research in Medical Sciences (CAAE: 41570815.0.0000.5411). Results: The photomicrographs of the RA of rats revealed disorganized Z lines, thinning sarcomeres, and a usual quantity of intermyofibrillar mitochondria in the P group. The LTMd group showed swollen sarcoplasmic reticulum, dilated T tubes and areas with sarcomere disruption. The ultrastructural analysis of Pnd non-diabetic women in the RA showed well-organized myofibrils forming intact sarcomeres, organized Z lines and a normal distribution of intermyofibrillar mitochondria. The GDM group revealed increase in intermyofibrillar mitochondria, areas with sarcomere disruption and increased lipid droplets. Conclusion: Pregnancy and diabetes induce adaptations in the ultrastructure of the rectus abdominis muscle for both women and rats, changing the architectural design of these tissues. However, in rats these changes are more severe maybe because, besides the high blood glucose levels, the quadrupedal animal may suffer an excessive mechanical tension during pregnancy by gravity. Probably, these findings may suggest that these alterations are a risk factor that contributes to the development of muscle dysfunction in women with GDM and may motivate treatment strategies in these patients.

Keywords: gestational diabetes, muscle dysfunction, pregnancy, rectus abdominis

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Authors: Lundqvist M., Alwin J., Levin L-A.

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Background: Assistance dogs are dogs trained to assist persons with functional impairment or chronic diseases. The assistance dog concept includes different types: guide dogs, hearing dogs, and service dogs. The service dog can further be divided into subgroups of physical services dogs, diabetes alert dogs, and seizure alert dogs. To examine the long-term effects of health care interventions, both in terms of resource use and health outcomes, cost-effectiveness analyses can be conducted. This analysis can provide important input to decision-makers when setting priorities. Little is known when it comes to the cost-effectiveness of assistance dogs. The study aimed to assess the cost-effectiveness of certified service or hearing dogs in comparison to regular companion dogs. Methods: The main data source for the analysis was the “service and hearing dog project”. It was a longitudinal interventional study with a pre-post design that incorporated fifty-five owners and their dogs. Data on all relevant costs affected by the use of a service dog such as; municipal services, health care costs, costs of sick leave, and costs of informal care were collected. Health-related quality of life was measured with the standardized instrument EQ-5D-3L. A decision-analytic Markov model was constructed to conduct the cost-effectiveness analysis. Outcomes were estimated over a 10-year time horizon. The incremental cost-effectiveness ratio expressed as cost per gained quality-adjusted life year was the primary outcome. The analysis employed a societal perspective. Results: The result of the cost-effectiveness analysis showed that compared to a regular companion dog, a certified dog is cost-effective with both lower total costs [-32,000 USD] and more quality-adjusted life-years [0.17]. Also, we will present subgroup results analyzing the cost-effectiveness of physicals service dogs and diabetes alert dogs. Conclusions: The study shows that a certified dog is cost-effective in comparison with a regular companion dog for individuals with functional impairments or chronic diseases. Analyses of uncertainty imply that further studies are needed.

Keywords: service dogs, hearing dogs, health economics, Markov model, quality-adjusted, life years

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Authors: Eunkyo Kang, Jihye Lee, Jiyeon Choo

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Background: Pediatric palliative care has been increasing, and the number of studies has focused on the age at which pediatric patient can be notified their terminal illness, pediatric advanced care planning (ACP) and palliative care. However, there is a lack of research on health professionals’ perception. Aim: We aimed to investigate the perceptions of healthcare professionals about appropriate age disclosing terminal illness, awareness of ACP, and the relationship between ACP knowledge and the preference for palliative care for children. Methods: We administered nationwide questionnaires to 928 physicians from the 12 hospitals and the Korean Medical Association and 1,241 individuals of the general Korean population. We asked about the age at which the pediatric patients could be notified of their terminal illness, by 4 groups; 4 years old or older, 12 years old or older, 15 years old or older, or not. In addition, we surveyed the questionnaires about the knowledge of ACP of the medical staff, the preference of the pediatric hospice palliative care, aggressive treatment, and life-sustaining treatment preference. Results: In the appropriate age disclosing terminal illness, there were more respondents in the physicians than in the general population who thought that it was possible even at a younger age. Palliative care preference in pediatric patients who were expected to expire within months was higher when health care professionals had knowledge of ACPs compared to those without knowledge. The same results were obtained when deaths were expected within weeks or days. The age of the terminal status notification, the health care professionals who thought to be available at a lower age have a higher preference for palliative care and has less preference for aggressive treatment and life-sustaining treatment. Conclusion: Despite the importance of pediatric palliative care, our study confirmed that there is a difference in the preference of the health care professionals for pediatric palliative care according to the ACP knowledge of the medical staff or the appropriate age disclosing terminal illness. Future research should focus on strategies for inducing changes in perceptions of health care professionals and identifying other obstacles for the pediatric palliative care.

Keywords: pediatric palliative care, disclosing terminal illness, palliative care, advanced care planning

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Authors: V. Mathad, S. Shivprasad, P. Shivsharannappa, M. K. Patil

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Introduction: Non-communicable diseases are emerging diseases in India. Government of India launched National Programme for Prevention and Control of Cardiovascular Diseases, Cancer and Stroke (NPCDCS) during the year 2008. The aim of the programme was to reduce the burden of non communicable diseases by health promotion and prompt treatment. Objective: The present study was intended to assess the impact of National Program for prevention and control of Cardiovascular Diseases, Diabetes, Cancer and Stroke Programme on biochemical and physiological factors influencing Type 2 diabetes in Kalaburagi District. Material and Method: NCD Clinic was established at District Hospital during April 2016. All the patients attending District Hospital Kalaburagi above the age of 30 years are screened for Non Communicable Diseases under NPCDCS Programme. A total sample of 7447 patients attending NCD Clinic situated at Kalaburagi district was assessed in this study. Pre structured and pretested schedule seeking information was obtained from all the patients by the counselor working under NPCDCS programme. All the Patients attending District Hospital were screened for Diabetes using Glucometer at NCD clinic. The suspected cases were further confirmed through Biochemical investigations like Fasting Blood glucose, HBA1c, Urine Glucose, Kidney Function test. SPSS 20 version was used for analysis of data. Chi square test, P values and odds ratio was used to study the association of factors. Results: A Total of 7447 patients attended NCD clinic during the year 2017-18 were analyzed, Diabetes was seen among 3028 individuals were as comorbidities along with Hypertension was seen among 757 individuals. The mean age of the population was 50 ± 2.84. 3440(46.2%) were males whereas Female constituted 4007(53.8%) of population. The incidence and prevalence of Diabetes being 8.6 and 12.8 respectively. Diabetes was more commonly seen during the age group of 40 to 69 years. Diabetes was significantly associated with Age group 40 to 69 years, obesity and female gender (p < 0.05). The risk of developing Hypertension and comorbidity conditions of hypertension and Diabetes was 1.224 and 1.305 times higher among males, whereas the risk of diabetes was 1.127 higher among females as compared to males. Conclusion: The screening for NCD has significantly increased after launching of NPCDCS programme. NCD was significantly associated with obesity, female gender, increased age as well as comorbid conditions like hypertension and tuberculosis.

Keywords: non-communicable diseases, NPCDCS programme, type 2 Diabetes, physiological factors

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Authors: Minna K. Miller, Chantel. E. Canessa, Suzanna V. McRae, Susan Shumay, Alissa Collingridge

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Primary care provides the first point of contact and access to health care services. For the pediatric population, the goal is to help healthy children stay healthy and to help those that are sick get better. Primary care facilitates regular well baby/child visits; health promotion and disease prevention; investigation, diagnosis and management of acute and chronic illnesses; health education; both consultation and collaboration with, and referral to other health care professionals. There is a protective association between regular well-child visit care and preventable hospitalization. Further, low adherence to well-child care and poor continuity of care are independently associated with increased risk of hospitalization. With a declining number of family physicians caring for children, and only a portion of pediatricians providing primary care services, it is becoming increasingly difficult for children and their families to access primary care. Nurse practitioners are in a unique position to improve access to primary care and improve health outcomes for children. Limited literature is available on the nurse practitioner role in primary care pediatrics. The purpose of this paper is to describe the development, implementation and evaluation of a Nurse Practitioner-led pediatric primary care clinic in a tertiary care setting. Utilizing the participatory, evidence-based, patient-focused process for advanced practice nursing (PEPPA framework), this paper highlights the results of the initial needs assessment/gap analysis, the new service delivery model, populations served, and outcome measures.

Keywords: access, health outcomes, nurse practitioner, pediatric primary care, PEPPA framework

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Authors: Faiz N. K. Yusufi, Aquil Ahmed, Jamal Ahmad

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Diabetes in India is growing at an alarming rate and the complications caused by it need to be controlled. Coronary heart disease (CHD) is one of the complications that will be discussed for prediction in this study. India has the second most number of diabetes patients in the world. To the best of our knowledge, there is no CHD risk score for Indian type 2 diabetes patients. Any form of CHD has been taken as the event of interest. A sample of 750 was determined and randomly collected from the Rajiv Gandhi Centre for Diabetes and Endocrinology, J.N.M.C., A.M.U., Aligarh, India. Collected variables include patients data such as sex, age, height, weight, body mass index (BMI), blood sugar fasting (BSF), post prandial sugar (PP), glycosylated haemoglobin (HbA1c), diastolic blood pressure (DBP), systolic blood pressure (SBP), smoking, alcohol habits, total cholesterol (TC), triglycerides (TG), high density lipoprotein (HDL), low density lipoprotein (LDL), very low density lipoprotein (VLDL), physical activity, duration of diabetes, diet control, history of antihypertensive drug treatment, family history of diabetes, waist circumference, hip circumference, medications, central obesity and history of CHD. Predictive risk scores of CHD events are designed by cox proportional hazard regression. Model calibration and discrimination is assessed from Hosmer Lemeshow and area under receiver operating characteristic (ROC) curve. Overfitting and underfitting of the model is checked by applying regularization techniques and best method is selected between ridge, lasso and elastic net regression. Youden’s index is used to choose the optimal cut off point from the scores. Five year probability of CHD is predicted by both survival function and Markov chain two state model and the better technique is concluded. The risk scores for CHD developed can be calculated by doctors and patients for self-control of diabetes. Furthermore, the five-year probabilities can be implemented as well to forecast and maintain the condition of patients.

Keywords: coronary heart disease, cox proportional hazard regression, ROC curve, type 2 diabetes Mellitus

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Authors: Ayşegül Bilge, Hacer Demirkol, Merve Uğuryol

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Therapeutic touch is one of the most important methods of complementary and alternative treatments. Therapeutic touch requires the sharing of universal energy. Therapeutic touch (TT) provides the interaction between the patient and the nurse. In addition, nurses can be aware of physical and mental symptoms of patients through therapeutic touch. Therapeutic touch (TT) is short-term provides the advantage for the nurse. For this reason, nurses have to be aware of the importance of therapeutic touch and they can use it from the primary care to tertiary care in nursing practices at in health field.

Keywords: health care services, complementary treatment, nursing, therapeutic touch

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Authors: Mohammad Ansari, Satinder Mann, Ahmed Ismail

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Primary care patients in Emergency Departments (ED) have been the topic of discussion since 1998 in the United Kingdom. Numerous studies have analysed attendances in EDs retrospectively and suggest that at least one third to fifty percent patients attending ED with problems which could be managed appropriately in General Practice or minor injuries units. The pattern of ED Usage seems to be International. In Australia and many departments in the United States include walk in facilities staffed by physicians on family practice residency programme. It clearly appears in the United Kingdom that EDs have to accept that such patients with primary care problems will attend the ED and facilities will have to be provided to see and treat such patients. Urgent care centres were introduced in the United Kingdom nearly a decade ago to reduce the pressure on EDs. Most of these were situated near pre-existing EDs. Unfortunately these centres failed to have the desired effect of reducing the number of patients visiting EDs, it has been noticed that when more patients were seen in Urgent Care centres there were increased attendances in ED as well. A new model of Urgent Care centre was started in the ED of George Eliot Hospital, Nuneaton, UK. We looked at the working of the centre by looking at the number of patients seen daily against the number of total attendances in the ED. We studied the number and type of patients seen by the Urgent Care Doctor. All the medical records of the patients were seen and the time patients spent in the Urgent Care centre was recorded. The total number of patients seen during this study were 1532. 219 (14.3% ) were seen within our Urgent Care centre. None of the patients waited over four hours to be seen. It has been recognised that primary care patients in the ED are a major part of attendances of the department and unless these patients are seen in Urgent Care centres, overcrowding and long waits cannot been avoided. It has been shown that employing primary care Physicians in Urgent Care centres reduces overall cost because they do not carry out as many investigations as Junior Doctors. In our study over 14% patients were seen by Urgent Care Physicians and none of the patients waited for more than four hours and we feel that care provided to the patients by Urgent Care centre was highly effective and satisfying for the patient.

Keywords: urgent care centres, primary care physicians, overcrowding, cost

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Authors: Rajesh Kumar Suman, Ipseeta Ray Mohanty, Manjusha K. Borde, Ujjawala maheswari, Y. A. Deshmukh

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Background: Metabolic syndrome encompasses cluster of risk factors for cardiovascular disease which includes abdominal obesity, dyslipidemia, hypertension, and hyperglycemia. The incidence of metabolic syndrome is on the rise globally. Objective: The present study was designed to develop a unique animal model that will mimic the pathological features seen in a large pool of individuals with diabetes and metabolic syndrome; suitable for pharmacological screening of drugs beneficial in this condition. Material and Methods: A combination of high fat diet (HFD) and low dose of streptozotocin (STZ) at 30, 35 and 40 mg/kg was used to induce metabolic syndrome co-existing with diabetes mellitus in Wistar rats. Results: The 40 mg/kg STZ produced sustained hyperglycemia and the dose was thus selected for our study to induce diabetes mellitus. Rat fed HFD (HF-DC) group showed significant (p < 0.001) increase in body weight on 4th and 7th week as compared with NC (Normal Control) group rats. However, the increase in body weight of HF-DC group rats was not sustained at the end of 10th weeks. Various components of metabolic syndrome such as dyslipidemia {(Increased Triglyceride, total Cholesterol, LDL Cholesterol and decreased HDL Cholesterol)}, diabetes mellitus (Blood Glucose, HbA1c, Serum Insulin, C-peptide), hypertension {Systolic Blood pressure (p < 0.001)} were mimicked in the developed model of metabolic syndrome co existing with diabetes mellitus. In addition significant cardiac injury as indicated by CPK-MB levels, artherogenic index, hs-CRP. The decline in hepatic function {(p < 0.01) increase in the level of SGPT (U/L)} and renal function {(increase in creatinine levels (p < 0.01)} when compared to NC group rats. The histopathological assessment confirmed presence of edema, necrosis and inflammation in Heart, Pancreas, Liver and Kidney of HFD-DC group as compared to NC. Conclusion: The present study has developed a unique rodent model of metabolic syndrome; with diabetes as an essential component.

Keywords: diabetes, metabolic syndrome, high fat diet, streptozotocin, rats

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Authors: Parvin Farzanegi

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Background: Diabetes is a metabolic disorder associated with increased free radicals and oxidative stress. The evidence indicates that physical inactivity is a modifiable behavioral risk factor for a wide range of chronic disorders such as diabetes mellitus. We investigated the effects of eight-week aerobic exercise on some antioxidant enzyme activities in postmenopausal women with type 2 diabetes mellitus (T2DM). Methods: sixteen sedentary postmenopausal women with T2DM were randomly assigned to the control (n=8; CG) and exercise group (n=8; EG). The exercise consisted of progressive aerobic training at a moderate intensity (50-70% of the maximum heart rate), for 25-60 min/day, and 3 days/week for 8 weeks. Age, sex, and body mass index were similar in the two groups. Antioxidant status was evaluated by measuring the superoxide dismutase (SOD) and catalase (CAT) activity. Also levels of malondialdehyde (MDA) as an index of lipid peroxidation and glucose in the plasma were measured before and after the intervention. Results: Following the 8 weeks of exercise training, the plasma MDA and glucose levels were significantly reduced in EG compared to CG (P=0.001 and P=0.011 respectively). However, SOD (P=0.017) and CAT (P=0.011) activities were increased in EG compared to CG. Conclusion: The present study suggests regular aerobic exercise appears can exert protective effects against oxidative stress due to its ability to increase antioxidant defense and glucose control in postmenopausal women with T2DM.

Keywords: aerobic exercise, antioxidant, diabetes mellitus, type 2

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Authors: A. Iqbal Banauaji, Muchamad Sholikun

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Diabetes mellitus (DM) is a metabolism disorder that tends to increase its prevalence in the world, including in Indonesia. The development of DM type 2 can cause oxidative stress characterized by an imbalance between oxidants and antioxidants in the body Increased oxidative stress causes type 2 diabetes mellitus to require intake of exogenous antioxidants in large quantities to inhibit oxidative damage in the body. Bran can be defined as a functional food because it consists of 11.39% fiberand 28.7% antioxidants and the purple yam consists of anthocyanin which functions as an antioxidant. With abundant amount and low price, purple yam and bran can be used for analog rice as the effort to diversify functional food. The antioxidant’s activity of analog rice from purple yam and bran which is measured by using DPPH’s method is 12,963%. The rough fiber’s level on the analog rice from purple yam is 2.985%. The water amount of analog rice from purple yam and bran is 8.726%. Analog rice from purple yam and bran has the similar texture as the usual rice, tasted slightly sweet, light purple colored, and smelled like bran.

Keywords: antioxidant, analog rice, functional food, diabetes mellitus

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Authors: Devatha Kalyan Kumar, R. Poovarasan

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In this paper, we have taken certain important factors and health parameters of diabetes patients especially among children by birth (pediatric congenital) where using the above three metrics methods we are going to assess the importance of each attributes in the dataset and thereby determining the most highly responsible and co-related attribute causing diabetics among young patients. We use cost optimization, control chart and Spearmen methodologies for the real-time application of finding the data efficiency in this diabetes dataset. The Spearmen methodology is the correlation methodologies used in software development process to identify the complexity between the various modules of the software. Identifying the complexity is important because if the complexity is higher, then there is a higher chance of occurrence of the risk in the software. With the use of control; chart mean, variance and standard deviation of data are calculated. With the use of Cost optimization model, we find to optimize the variables. Hence we choose the Spearmen, control chart and cost optimization methods to assess the data efficiency in diabetes datasets.

Keywords: correlation, congenital diabetics, linear relationship, monotonic function, ranking samples, pediatric

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Authors: Mohsen Salesi, Seyyed Zoheir Rabei

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Exercise has been considered a cornerstone of diabetes prevention and treatment for decades, but the benefits of resistance training are less clear. The purpose of this study was to determine the impact of resistance training on blood profile and inflammatory marker (CRP) of type 2 diabetes mellitus people. Thirty diabetic male were recruited (age: 50.34±10.28 years) and randomly assigned to 8 weeks resistance exercise training (n=15) and control groups (n=15). Before and after training blood pressure, weight, lipid profile (TC, TG, LDL-c, and HDL-c) and hs-CRP were measured. The resistance exercise training group took part in supervised 50–80 minutes resistance training sessions, three days a week on non-consecutive days for 8 weeks. Each exercise session included approximately 10 min of warm-up and cool-down periods. Results showed that TG significantly decreased (pre 210.19±9.31 vs. 101.12±7.25, p=0.03) and HDL-c significantly increased (pre 42.37±3.15 vs. 47.50±2.19, p=0.01) after exercise training. However, there was no difference between groups in TC, LDL-c, BMI and weight. In addition, a decrease in fasting blood glucose levels showed significant difference between groups (pre 144.65±5.73 vs. 124.21±6.48 p=0.04). Regular resistance exercise training can improve the lipid profile and reducing the cardiovascular risk factors in T2DM patients.

Keywords: lipid profile, resistance exercise, type 2 diabetes mellitus, men

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Authors: Mohamed A. Hammad, Dzul Azri Mohamed Noor, Syed Azhar Syed Sulaiman, Abeer Kharshid, Nor Azizah Aziz, Tarek M. Elsayed

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Medication safety is always an issue. In 2015, the National Pharmaceutical Control Bureau released a statement requesting all statins manufacturers in Malaysia to include the risk of diabetes information in the drug information leaflet in response to United States Food and Drug Administration (U.S. FDA) report. However, the data regarding this warning label in Malaysia is limited, so there is still some uncertainty whether such risk can also be observed in the Malaysian population or not. The study aims to determine the effect of statins on HbA1c% in type 2 diabetic outpatients in endocrine clinics at Hospital Pulau Pinang between June 2015 and May 2016 in Malaysia. In a prospective cohort study, records of 400 type 2 diabetic patients (control group 104 patients not using statin and treatment group 296 patients using statin) were reviewed to identify demographic criteria and lab tests. The prevalence of glycemic control (Glycated hemoglobin, HbA1C ≤ 7% for patient < 65 years, and < 8% for patient ≥ 65 years) was estimated, according to American Diabetes Association guidelines 2015. The results were presented as descriptive statistics. From 296 patients with Type 2 diabetes using statins cohort with a mean age of 57.52 ± 12.2 years, only 81 (27.4%) cases had controlled glycemia, and 215 (72.6%) had uncontrolled glycemia, CI: 95% (6.3–11.1). While the control group 104 diabetic patients had a mean age 46.1 ± 18 years and distributed among 59 (56.7%) patients with controlled diabetes and 45 (43.3%) cases, had uncontrolled glycemia, CI: 95% (5.2–10.3). The relative risk (RR) of uncontrolled glycemia in diabetic patients used statins was 1.68, and the excessive relative risk (ERR) was 68%. The absolute risk (AR) was 29.3%, and the number needed to harm (NNH) was 4. Diabetic patients using statins have more risk of uncontrolled glycemia than the patients with Type 2 diabetes non-using statins.

Keywords: diabetes mellitus, HbA1c, Malaysia, outpatients, statin, type 2, uncontrolled glycemia

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Authors: Francis Sichimba

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Literature has increasingly acknowledged the important role that grandparents play in child care with evidence highlighting differences in grand-parental investment between countries and cultures. However, there are very few systematic cross cultural studies on grandparents’ participation in child care. Thus, we decided to conduct this study in Zambia and the Netherlands because the two countries differ rather drastically socially and culturally. The objective of this study was to investigate grand-parental involvement in child care in Zambia and the Netherlands. In line with the general objective, four hypotheses were formulated using nationality, family size, social economic status (SES), attachment security as independent variables. The study sample consisted of 411 undergraduate students from the University of Zambia and the University of Leiden. A questionnaire was used to measure grand-parental involvement in child care. Results indicated that grandparent involvement in child care was prevalent in both Zambia and Netherlands. However, as predicted it was found that Zambian grandparents (M = 9.69, SD=2.40) provided more care for their grandchildren compared to their Dutch counterparts (M = 7.80, SD=3.31) even after controlling for parents being alive. Using hierarchical logistic regression analysis the study revealed that nationality and attachment-related avoidance were significant predictors of grand-parental involvement in child care. It was concluded that grand-parental care is a great resource in offering complementary care in both countries.

Keywords: attachment, care, grand-parenting involvement, social economic status

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