Psychosocial factors predict type 2 diabetes mastery

Background

Psychosocial aspects of chronic diseases such as Type 2 diabetes (T2D) and cardiovascular disease (CVD) are increasingly recognised as impacting effective self-management. Until now, little was known regarding the moderating effects of empowerment and depression on the relationship between diabetes-specific distress and mastery.

Purpose

To evaluate the potential mediating role of diabetes empowerment and depression on the relationship between diabetes-specific distress and mastery.

Methods

Sample comprised 131 participants diagnosed with T2D, mean [SD] age 62.3 [8.8]; 59.5% male. Mean time since diagnosis was 10.4 years. Assessments included: emotional distress (Problem Areas in Diabetes Scale; PAID); depression and anxiety (Hospital Anxiety and Depression Scale; HADS); mastery (Pearlin Mastery Scale); and empowerment (Diabetes Empowerment Scale – Short Form; DES-SF). Data were examined using SPSS: PROCESS a logistic regression-based path analytical framework for multiple mediator models.

Results

Regression coefficients for the model identified distress (b=−0.249, t(5,112)=−3.71, p<0.001), empowerment (b=0.280, t(5,112)=3.02, p<0.001) and depression (b=−0.980, t(5,112)=−5.73, p<0.001) were all statistically significant predictors of mastery. The PROCESS model assessed ΔR2 as a result of the interaction between distress and depression, which indicated a significant increase (ΔR2=0.08) in variance explained due to the inclusion of both moderators: F(2,112)=16.88, p<0.001, ΔR2=0.14. Also identified were interaction effect sizes: at low levels of empowerment, increasing depression led to increasing levels of distress predicting overall levels of mastery. This held true at moderate and high levels of empowerment; increasing levels of depression led to increasing distress predicting mastery.

Conclusions

These findings elucidate the impact of empowerment and depression on the association between distress and mastery in a diabetes cohort. The evidence suggests that the psychosocial interventions likely to have greatest impact on mastery are those that target key moderators such as empowerment and depression.

Funding Acknowledgement

Type of funding source: None

Sexually dimorphic morphology and swimming performance relationships in wild-type zebrafish Danio rerio

This study compared prolonged swimming performance (Ucrit ) between male and female Danio rerio, and characterized how body shape was associated with this performance measure in each sex. When swimming in small (n = 6) mixed-sex groups at 28 °C, males swam, on average, over 10 cm s(-1) faster than females despite being significantly smaller. Body shape was sexually dimorphic, with males and females exhibiting small, but statistically significant differences in most aspects of body shape. Body shape explained 18 and 43% of the variation in Ucrit among males and females. In general, effects of body shape on swimming performance appeared to be sex limited, whereby different aspects of body shape affected performance in each sex, although the contribution of the distance between pelvic and anal fins to swimming performance was weakly sexually antagonistic.

Comparing G: multivariate analysis of genetic variation in multiple populations

The additive genetic variance-covariance matrix (G) summarizes the multivariate genetic relationships among a set of traits. The geometry of G describes the distribution of multivariate genetic variance, and generates genetic constraints that bias the direction of evolution. Determining if and how the multivariate genetic variance evolves has been limited by a number of analytical challenges in comparing G-matrices. Current methods for the comparison of G typically share several drawbacks: metrics that lack a direct relationship to evolutionary theory, the inability to be applied in conjunction with complex experimental designs, difficulties with determining statistical confidence in inferred differences and an inherently pair-wise focus. Here, we present a cohesive and general analytical framework for the comparative analysis of G that addresses these issues, and that incorporates and extends current methods with a strong geometrical basis. We describe the application of random skewers, common subspace analysis, the 4th-order genetic covariance tensor and the decomposition of the multivariate breeders equation, all within a Bayesian framework. We illustrate these methods using data from an artificial selection experiment on eight traits in Drosophila serrata, where a multi-generational pedigree was available to estimate G in each of six populations. One method, the tensor, elegantly captures all of the variation in genetic variance among populations, and allows the identification of the trait combinations that differ most in genetic variance. The tensor approach is likely to be the most generally applicable method to the comparison of G-matrices from any sampling or experimental design.

Solar disinfection of drinking water protects against cholera in children under 6 years of age

BACKGROUND AND AIMS

We have previously reported a reduction in risk of diarrhoeal disease in children who used solar disinfected drinking water. A cholera epidemic, occurring in an area of Kenya in which a controlled trial of solar disinfection and diarrhoeal disease in children aged under 6 had recently finished, offered an opportunity to examine the protection offered by solar disinfection against cholera.

METHODS

In the original trial, all children aged under 6 in a Maasai community were randomised by household: in the solar disinfection arm, children drank water disinfected by leaving it on the roof in a clear plastic bottle, while controls drank water kept indoors. We revisited all households which had participated in the original trial.

RESULTS

There were 131 households in the trial area, of which 67 had been randomised to solar disinfection (a further 19 households had migrated as a result of severe drought). There was no significant difference in the risk of cholera in adults or in older children in households randomised to solar disinfection; however, there were only three cases of cholera in the 155 children aged under 6 years drinking solar disinfected water compared with 20 of 144 controls.

CONCLUSIONS

Results confirm the usefulness of solar disinfection in reducing risk of water borne disease in children. Point of consumption solar disinfection can be done with minimal resources, which are readily available, and may be an important first line response to cholera outbreaks. Its potential in chorine resistant cholera merits further investigation.

Lesbians' sexual history with men: implications for taking a sexual history

BACKGROUND

Health care providers may not solicit a comprehensive sexual history from lesbian patients because of provider assumptions that lesbians have not been sexually active with men. We performed this study to assess whether women who identify themselves as lesbians have a history of sexual activities with men that have implications for receipt of preventive health screening.

OBJECTIVE

To convey the importance for health care providers to know their patients' sexual history when making appropriate recommendations for preventive health care.

METHODS

A survey was printed in a national news magazine aimed at homosexual men, lesbians, and bisexual men and women. The sample included 6935 self-identified lesbians from all 50 US states. The outcomes we measured were respondents' number of lifetime male sexual partners and partners during the past year, their lifetime history of specific sexual activities (e.g., vaginal intercourse, anal intercourse), their lifetime condom use, and their lifetime history of sexually transmitted diseases.

RESULTS

Of respondents, 77.3% had 1 or more lifetime male sexual partners, 70.5% had a lifetime history of vaginal intercourse, 17.2% had a lifetime history of anal intercourse, and 17.2% had a lifetime history of a sexually transmitted disease. Exactly 5.7% reported having had a male sexual partner during the past year.

CONCLUSION

These findings reinforce the need for providers to know their patients' sexual history regardless of their reported sexual orientation, especially with regard to recommendations for Papanicolaou smears and screening for sexually transmitted diseases.

Solar disinfection of water reduces diarrhoeal disease: an update

349 Maasai children younger than 6 years old were randomised by alternate household to drink water either left in plastic bottles exposed to sunlight on the roof of the house or kept indoors (control). The trial was run in Maasai by Maasai community elders. Children drinking solar disinfected water had a significantly lower risk of severe diarrhoeal disease over 8705 two weekly follow up visits; two week period prevalence was 48.8% compared with 58.1% in controls, corresponding to an attributable fraction of 16.0%. While this reduction is modest, it was sustained over a year in free living children. It confirms solar disinfection as effective in vivo as a free, low technology, point of consumption method of improving water quality. The continuing use of solar disinfection by the community underlines the value of community participation in research.

Genetic evidence for species boundaries in frogs of the Litoria citropa species-group (Anura:Hylidae)

The Litoria citropa species-group comprises several small to medium-sized tree-frog species found from mid-eastern Queensland to eastern Victoria in a variety of habitats along streams associated with the Great Dividing Range. The smaller members of the Litoria citropa species-group, Litoria phyllochroa and L. pearsoniana, have a confused taxonomic history with the taxonomic status of several populations, some regarded as endangered, still in doubt. Multi-locus allozyme electrophoretic profiles and nucleotide sequences of a portion of the mitochondrial 16S ribosomal RNA gene were used to examine the evolutionary relationships of populations that are a geographically comprehensive and morphologically representative sample of the species-group. These data demonstrate the presence of a minimum of three species: L. nudidigitus, L. phyllochroa and a third species whose taxonomic name is yet to be resolved. This third taxon encompasses a wide range of allozyme and mitochondrial nucleotide diversity and can be divided into at least four evolutionarily significant units (ESUs) that replace each other in a linear sequence from north of the Hunter Valley in New South Wales to the Kroombit Tops in central Queensland. A possible zone of hybridisation between the southernmost pair of these ESUs was identified in northern New South Wales. The fourth ESU, a northern outlier of the range of the species-group, is confined to Kroombit Tops, central Queensland.While its phylogenetic relationship with the other three ESUs was not resolved precisely by the present analysis, it nevertheless comprises a distinct and very divergent mitochondrial lineage of considerable antiquity.Resolution of the status of a further name applied to the species-group, L. piperata, awaits a morphological analysis that includes the relevant type material.

Mitochondrial DNA diversity and historical biogeography of a wet forest-restricted frog (Litoria pearsoniana) from mid-east Australia

MtDNA sequencing was used to investigate the genetic population structure of Litoria pearsoniana, a wet forest-restricted hylid frog, endemic to southeast Queensland and northeast New South Wales, Australia. L. pearsoniana is regarded as endangered under Queensland legislation. Significant genetic divergence among populations of frogs from different rainforest isolates was identified, but the lack of reciprocal monophyly among adjacent isolates suggests this is the result of a relatively recent disruption to gene flow. A paired catchment study within a single rainforest isolate, the Conondale Range, revealed no substantial genetic structuring, indicating the occurrence of terrestrial dispersal among nearby streams either in the recent past or currently. Two major reciprocally monophyletic clades of mtDNA alleles were identified. These corresponded to two geographical regions separated by the Brisbane River valley; one consisting of the Conondale and D'Aguilar Ranges, and the other of the southern isolates in the Main, Border and Gibraltar Ranges. Sequence divergence between the two regions was more consistent with a late Miocene or Pliocene rather than late Pleistocene separation, and is similar to that found among phylogeographic divisions of rainforest reptiles and amphibians in north Queensland rainforests. The molecular evidence for long-term separation of these two regions is corroborated by the pattern of species turnover in the distributions of species of rainforest-restricted amphibians and reptiles. Bioclimatic modelling suggests that appropriate conditions for L. pearsoniana would have been restricted to isolated refugees in each phylogeographic division under cooler and drier climates, such as predicted for the last glacial maximum. Currently isolated montane areas may have been connected transiently during the past 2000 years. Identification of long-term zoogeographic divisions among southeast Queensland rainforest herpetofauna has important implications for conservation and management. Conservation management of L. pearsoniana should be applied at the scale of major rainforest isolates and the conservation status of the species should be assessed independently north and south of the historical division.

Relationships among calving season, heat load, energy balance and postpartum ovulation of dairy cows in a subtropical environment

The study was designed to examine the relationships among calving season, energy balance, temperature humidity index (THI), and postpartum ovulation in high producing cows in a subtropical environment. Holstein cows calving in a feedlot dairy in southeast Queensland during winter (n = 23) and summer (n = 21) were monitored during the first 9 weeks of lactation. Cows were weighed and blood samples collected twice weekly: plasma progesterone, plasma metabolites related to energy and mineral balance, and haematological measurements were performed. Milk production was measured, body condition score was estimated, and trans-rectal ultrasound examinations of the ovaries were each undertaken once a week. The interval between calving and first ovulation was significantly longer in cows calving in summer (22.8 vs. 17.6 days, P < 0.05). Interval from calving to the first postpartum ovulation (FOVL) was inversely related to the mean plasma glucose concentration for the first 9 weeks after calving (GLU): FOVL = 80.0-17.9GLU, (R2 = 0.25, P < 0.001). Plasma progesterone concentration during the life of the second corpus luteum after calving was negatively correlated with THI during the first 2 weeks after calving (r = 0.55, P < 0.001). Plasma glucose concentration (GLU) was negatively correlated with milk yield (MYD) and rectal temperature (RT), and positively correlated with plasma calcium concentration (Ca) according to the following regression equation. GLU = 33.1 - 0.02MYD + 0.91Ca - 0.48RT, (R2 = 0.58, P = 0.0001).

Preventing adolescent drug use: long-term results of a junior high program

OBJECTIVES

Although several studies have reported short-term gains for drug-use prevention programs targeted at young adolescents, few have assessed the long-term effects of such programs. Such information is essential for judging how long prevention benefits last. This paper reports results over a 6-year period for a multisite randomized trial that achieved reductions in drug use during the junior high school years.

METHODS

The 11-lesson curriculum, which was tested in 30 schools in eight highly diverse West Coast communities, focused on helping 7th and 8th grade students develop the motivation and skills to resist drugs. Schools were randomly assigned to treatment and control conditions. About 4000 students were assessed in grade 7 and six times thereafter through grade 12. Program effects were adjusted for pretest covariates and school effects.

RESULTS

Once the lessons stopped, the program's effects on drug use stopped. Effects on cognitive risk factors persisted for a longer time (many through grade 10), but were not sufficient to produce corresponding reductions in use.

CONCLUSIONS

It is unlikely that early prevention gains can be maintained without additional prevention efforts during high school. Future research is needed to develop and test such efforts.

Malpractice claims data as a quality improvement tool. II. Is targeting effective?

OBJECTIVE

--To evaluate the usefulness of malpractice claims data for identifying (1) physicians who are prone to negligent errors and (2) physician and hospital characteristics associated with particular kinds of errors.

DESIGN

--Retrospective review of physician malpractice claim records.

SETTING

--Large New Jersey physician malpractice insurer.

PARTICIPANTS

--Physicians practicing obstetrics and gynecology, general surgery, anesthesiology, or radiology and covered by the insurance carrier for any portion of 1977 through 1989.

MAIN OUTCOME MEASURES

--Claims were classified into 11 clinical error categories comprising three broad groups: patient management problems, technical performance problems, and staff coordination problems. Outcomes were expressed as per-physician frequency of claims due to negligence and proportion of claims associated with various types of errors.

RESULTS

--Using 5 years of claims history to predict long-term claims proneness was more accurate than chance alone by 57% in obstetrics and gynecology, 33% in general surgery, 11% in anesthesiology, and 15% in radiology. Cross-validated recursive partitioning showed that among physician characteristics, only specialty was predictive of physician error profiles. For physician claims arising in acute care hospitals, hospital size and location in addition to hospital services discriminated among different error profiles; the cross-validated accuracy of this method was 69% compared with 22% accuracy achieved by random prediction.

CONCLUSION

--Use of physicians' malpractice claims histories to target individuals for education or sanctions is problematic because of the only modest predictive power of such claims histories.

Malpractice claims data as a quality improvement tool. I. Epidemiology of error in four specialties

OBJECTIVE

--To identify potentially preventable sources of medical injury in obstetrics and gynecology, general surgery, anesthesiology, and radiology.

DESIGN

--Retrospective review of physician malpractice claim records.

SETTING

--Large New Jersey physician malpractice insurer.

PARTICIPANTS

--Physicians practicing obstetrics and gynecology, general surgery, anesthesiology, and radiology and covered by the insurance carrier during any portion of 1977 through 1989.

MAIN OUTCOME MEASURES

--Proportion of claims due to negligence associated with errors in (1) patient management, (2) technical performance, and (3) medical and nursing staff coordination and the clinical and financial consequences of such errors.

RESULTS

--Among 1371 claims ascribed to negligence, patient management errors were cited most frequently in all four specialties (48% to 75%) and, compared with performance and coordination problems, were generally associated with a higher frequency of serious injury and higher median payments. Coordination problems accounted for about 9% of claims. In obstetrics and gynecology, newborn delivery claims usually arose from management errors (57% to 68%), whereas gynecologic procedure claims were most often associated with performance errors (55% to 73%). Underperformance of cesarean section was cited more frequently than overperformance (31% vs 3%). General surgery claims were about equally divided between management and performance types regardless of procedure. Failure to perform appropriate diagnostic testing or monitoring was the main problem in 3% to 8% of claims.

CONCLUSION

--Malpractice data can be used to identify problem-prone clinical processes and suggest interventions that may reduce negligence.

Substance use among eighth-grade students who take care of themselves after school

This investigation focused on substance use among children who regularly care for themselves after school (latchkey children). The data, collected from 4932 eighth-grade students, indicated that self-care is an important risk factor for alcohol, tobacco, and marijuana use. Data collected from 2185 parents validated these findings. Eighth-grade students, who took care of themselves for 11 or more hours a week, were at twice the risk of substance use as those who did not take care of themselves at all. This relationship held at all levels of sociodemographic status, extracurricular activities, sources of social influence, and stress. Of the 186 stratified tests of the relationship, 90% were significant; even those not found to be significant were in the direction expected. Path analyses suggest that risk-taking, having friends who smoke, and being offered cigarettes may partially explain the relationship between self-care and substance use. Those eighth-grade students who select friends who smoke and place themselves in situations in which they are offered cigarettes may be manifesting a desire to display their sense of maturity and independence. The fact that the increase in substance use occurred among almost all strata tested and the fact that mediation was not complete suggest that more than one mechanism may account for the associated increase in substance use. It is also possible that more time in self-care results in more unnoticed solitary trials of substances, as well as trials motivated by peer offers or peer pressure to use substances.

Physician attitudes and experience regarding the care of patients with acquired immunodeficiency syndrome (AIDS) and related disorders (ARC)

The number of patients with acquired immunodeficiency syndrome (AIDS) continues to increase. These patients require medical care from physicians who are well trained and who are willing to provide that care. In 1985, we undertook a survey of 314 heterosexual and homosexual physicians in Los Angeles County to determine their willingness and perceived ability to care for patients with AIDS. This survey indicates that most physicians believe that special clinics staffed by physicians who have a particular expertise in caring for AIDS patients should be established. Many of the physicians surveyed indicated that concerns about the risk of contagion with AIDS is a deterrent to treating AIDS patients. Current evidence indicates this concern is unfounded. Both heterosexual and homosexual physicians indicated a lack of medical knowledge and experience regarding the opportunistic infections and cancers that are associated with AIDS, although many physicians in both groups expressed a desire to receive more training in this regard. Our survey indicates that there is a definite need for more clinically based training opportunities for physicians who would like to provide care for AIDS patients. If such training were to become available, it is likely that sufficient numbers of physicians would be willing to care for AIDS patients.

Abnormal intestinal permeability. An aetiological factor in chronic psychiatric disorders?

Abnormal intestinal absorption has been suggested as an aetiological factor in schizophrenia. A procedure for investigating intestinal permeability was carried out in a group of chronic psychiatric in-patients. A proportion of the subjects studied showed abnormal intestinal permeability which could not be attributed to established bowel disease. Patients who were receiving neuroleptic but not anticholinergic drugs were those most often showing abnormal intestinal permeability. This work is at an early stage of development but preliminary findings suggest that further investigations should be carried out to establish the circumstances in which changes in intestinal permeability may be associated with mental illness.