bluuebunny/crossref_metadata_2025 huggingface dataset:
The Diabetes Education Experience of Randomly Selected Patients Under the Care of Community Physicians
Authors: Anderson Robert M. , Hiss Roland G. , Stepien Cathiej. , Fitzgerald James T. , Funnell Martha M.
Published: April 2008

The purpose of this study was to describe the diabetes education and nutritional counseling received by patients under the active care of community physicians. The study population consisted of 440 patients with diabetes from the practices of 68 primary care physicians in eight Michigan communities. Fifty-eight percent of the sample reported having received diabetes education, and the mean number of years since the most recent education was 4.15 years. Sixty-six percent reported having seen a dietitian. Patients who had received diabetes education scored higher on a basic diabetes knowledge test (70% correct vs 60%) than patients who had not received diabetes education. From 1981 to 1991, a decline was observed in the percentage of patients who reported having received diabetes education (70% to 58%). Although patient education is an integral part of comprehensive diabetes care, too few patients are receiving it. Furthermore, diabetes education often results in less-than-optimal levels of knowledge. The situation has deteriorated over the past 10 years, and patients who are not on insulin typically are the least well served.
Beliefs About Smoking and Diabetes Care
Authors: Haire-Joshu Debra , Heady Susan , Thomas Leela , Schechtman Ken , Fisher Edwin B.
Published: April 2008

The purpose of this study was to address the following questions: 1) Do smokers with diabetes believe that cigarettes have favorable outcomes associated with diabetes management? 2) Do smokers with diabetes believe that quitting smoking negatively impacts diabetes management? 3) Do smokers with diabetes perceive significant Others as being supportive ofattempts to quit smoking? and 4) What is the relationship between these factors and attitude toward quitting smoking?

Patients with insulin-dependent diabetes mellitus (IDDM) completed a measure of Attitude Toward Quitting Smoking, which assessed desire and confidence in ability to achieve cessation, and the Diabetes and Smoking Beliefs Questioltllaire, which assessed beliefs regarding cigarettes and diabetes management. Smokers whose attitudes reflected less desire to quit and less confidence in doing so reported that cigarettes had utilit y in diabetes management, that quitting has negative effects on diabetes, and perceived significant others as only moderately supportive of attempts to quit smoking. Implications of these findings for diabetes education are discussed.
A Retrospective Study of Treatment Outcome for Patients With Non-Insulin-Dependent Diabetes at an Inner-City Hospital
Authors: Nadra Wissam E. , Knight Eric L. , Lee Martha B. , Meehan Woerner P.
Published: April 2008

The medical records of 173 consecutive patients with diabetes who were newly enrolled in our facility in 1990 were analyzed for blood glucose at 1 year. A total of 81 females and 72 males with non-insulin-dependent diabetes were studied. With regard to overall compliance in keeping clinic appointments, 56 (36.6%) patients were still coming in for follow-up I year after the diagnosis of diabetes versus 97 (63.4%) patients who had stopped coming in. Overall, 70 (45.8%) patients had a plasma glucose > 180 mg/dL and had not achieved metabolic control, and 83 (54.2%) patients had a plasma glucose≤180 mg/dL and had achieved good metabolic control at their last visit. Most patients with good control (58/153, 69.9%) had stopped coming in by the end of 1 year. Only 25 patients with plasma glucose ≤180 mg/dL were still coming in for follow-up visits, representing the smallest percentage (16.3%) of the total population studied. At I year there also was a correlation between increased body weight and improved glycemic control.
Diabetes Care Needs of Hispanic Patients Treated at Inner-City Neighborhood Clinics in New York City
Authors: Engel Samuel , Shamoon Harry , Basch Charles E. , Zonszein Joel , Wylie-Rosett Judith
Published: April 2008

The charts of 254 Hispanic patients were selected from a sample of 321 patients with diabetes in four urban clinics that received federal funding to provide medical care in underserved communities. A standardized chart-audit protocol was used to assess the process of healthcare delivery and the presence of diabetes-associated comorbidities and complications in patients. Inconsistent recognition of obesity (11% identified vs 59% present), hyperlipidemia (17% identified vs 69% present), and renal dysfunction (3.5% identified vs 16% present) was evident on chart review. We also found inadequate compliance with current recommendations for diabetes care with respect to routine health screenings for diabetes-related complications, recognition of comorbid diagnoses, and referral of patients for recommended specialty consultations. Issues specific to the varied Hispanic populations may need to be considered to improve the delivery of diabetes care for the growing Hispanic population with diabetes.
Assessing the Impact of an Outpatient Education Program for Patients With Gestational Diabetes
Authors: Smits Mary W. , Paulk Tish H. , Kee Carolync.
Published: April 2008

In this descriptive study, two treatment approaches designed to help women with gestational diabetes manage their pregnancies were compared: a hospital, outpatient-based, nursing intervention and the traditional, office-based care provided by obstetricians. A research model was constructed using three variables suggested by the literature: input variables (risk factors prior to gestation), moderating variables (conditions that occur during pregnancy), and outcome variables (normal vs abnormal outcomes for mother and infant). This research model was used to contrast the two treatment approaches. The principal statistical procedure employed was logistic regression, a backward elimination method where the dependent variable is expressed as an odds ratio. Neither treatment approach significantly reduced the risk of abnormal outcomes for mother or infant. First-time mothers, patients with gestational diabetes on medications, and patients with gestational diabetes experiencing complications during pregnancy had a significantly greater risk of having an infant with one or more abnormal outcomes.
Pregnant Women With Diabetes: Antepartum and Postpartum Morbidity
Authors: York Ruth , Brown Linda P. , Miovech Susan , Armstrong Cynthia L.
Published: April 2008

Despite advances in obstetrical management, the problems that women with diabetes experience most frequently during their pregnancies and postpartum have not been clearly defined. The purpose of this study was to provide morbidity data on this patient population to assist in determining appropriate interventions.
Treating Constipation in the Patient With Diabetes
Authors: Haines Stuart T.
Published: April 2008

Patients with diabetes have a significant risk of developing severe constipation often due to dysfunction of the autonomic nervous system. Constipation is a symptom, rather than a disease, and is characterized by decreased defecation frequency, increased stool hardness, and/or difficulty passing fecal matter. Self-treatment of constipation with over-the-counter laxative products, home remedies, and foodstuffs is commonplace. Patients frequently call upon health professionals for advice regarding constipation. The diabetes educator should be familiar with the causes and rational treatment of this disorder in the person with diabetes.
Aspiration of the Subcutaneous Insulin Injection: Clinical Evaluation of Needle Size and Amount of Subcutaneous Fat
Authors: Peragallo-Dittko Virginia
Published: April 2008

Investigating the rationale for a particular technique can reveal the surprising finding that some techniques are not based on scientific research. Aspiration of the insulin syringe is an example of a technique that evolved based on assumption. In a study designed to challenge the need to aspirate during insulin administration, 204 injections that were aspirated yielded no blood return. The historical and research literature supports the finding that aspiration never was proven to be a reliable indicator of correct subcutaneous needle placement. Because inadvertent intramuscular injection of insulin has been documented, diabetes educators need a reliable method to individualize insulin administration techniques to decrease the risk of incorrect needle placement. Until a reliable method is available, the literature supports lifting a skinfoldfor all subcutaneous insulin injections.
Psychosocial Challenges for Children with Insulin-Dependent Diabetes Mellitus
Authors: Pond Jami S. , Peters Michelle L. , Pannell Dana L , Rogers Cosby S.
Published: April 2008

This article describes the particular relevance of Erik Erikson's psychosocial stages of development for children with insulin-dependent diabetes. The developmental issues for young children centering on trust, autonomy, initiative, and industry have special significance for children with diabetes. Although the issues faced in each of Erikson's psychosocial stages are present in every stage, behaviors are manifested differently at each stage. Practical suggestions are provided for families and healthcare providers living with or working with children of various ages who have diabetes.
Personal Models of Diabetes Among Older Adults: Relationship to Self-Management and Other Variables
Authors: Hampson Sarah E. , Glasgow Russell E. , Foster Lyn S.
Published: April 2008

The purpose of this study was to test whether older patients' personal models of diabetes predict their levels of self-management activities (dietary intake, physical activity, and blood glucose testing) and glycemic control. The Personal Models of Diabetes Interview (PMDI) was administered on two occasions to 78 patients (≥60 years) with non- insulin-dependent diabetes mellitus. Self-management behaviors, quality of life, and affect were assessed on the second occasion and at 4 months. Glycemic control was assessed at 4 months. Three constructs of the PMDI (cause, treatment effectiveness, and seriousness) were correlated significantly with several aspects of quality of life and with negative affect. Personal models, especially beliefs regarding treatment effectiveness, were predictive of dietary intake and physical activity but not blood glucose testing. Assessing patients' personal models is valuable for individualizing education and counseling for nutrition and physical activity, and selecting strategies consistent with patients' perspectives.
Guidelines for Facilitating a Patient Empowerment Program
Authors: Arnold Marilynn S. , Butler Patricia M. , Anderson Robert M. , Funnell Martha M. , Feste Catherine
Published: April 2008

The traditional medical treatment model often ignores the emotional, spiritual, social, and cognitive aspects of living with a chronic disease such as diabetes. Empowerment programs address these psychosocial areas by helping individuals develop skills and self-awareness in goal setting, problem solving, stress management, coping, social support, and motivation. Although many diabetes educators have been taught to use an empowerment curriculum to facilitate self-management, there is minimal research concerning the actual process of providing such programs to patients. We evaluated an empowerment curriculum (Empowerment: A Personal Path to Self-Care) with a diverse group of individuals with diabetes to determine the key elements of planning and implementing a successful diabetes patient empowerment program.
A Comparative Evaluation of Bedside Capillary Blood Glucose Monitoring Devices Designed for Hospital Use
Authors: Johnson Patricia L. , Luther Robyn J. , Hipp Shelia , Stegeman Michael , Green Andrew J.
Published: April 2008

Capillary blood glucose monitoring devices (CBGMs) that incorporate "wipeless" technology recently have been designed and marketed for hospital use. Our objective was to evaluate three such devices for accuracy and precision, comparing them to a popular device that utilizes older technology and to a reference standard. Blood glucose level was simultaneously determined on the CBGMs and a reference standard. Results were analyzed for precision by performing repeated measurements of a single sample and for accuracy across the entire range of determinations. Clinically relevant subsets of the entire range also were detemnined and arbitrarily defined as low (<60 mg/dL), normal (60 to 140 mg/dL), high (141 to 300 mg/dL), and very high (>300 mg/dL). We found that accuracy and precision of these devices varied considerably. Lack of accuracy was particularly evident upon analysis of the clinically relevant subset ranges of blood glucose levels. Consequently, routine evaluation of CBGMs should include analysis of clinically relevant subset ranges of blood glucose levels. The marked differences in accuracy and precision between CBGMs that are currently
Monitoring Behavioral Changes in Diabetes Care With the Diabetes Self-Management Record
Authors: Bielamowicz Mary K. , Miller Wayne C. , Elkins Eric , Ladewig Howard W
Published: April 2008

An evaluation instrument called the diabetes self-management record has been developed to better document the positive behavioral changes associated with diabetes education programming. This record is a simple behavior monitoring system that awards points for positive behaviors associated with exercise, glucose monitoring, and nutrition management. A group of 39 adults with diabetes monitored their behaviors with the record prior to, immediately after; and 4 to 6 weeks following a diabetes education programming course. Overall diabetes management scores were higher (mean ± SEM=56.2 ± 3.5 vs 66.3 ± 2.9) following the educational intervention, as well as specific behavioral scores for exercise, glucose monitoring, fat consumption, refined sugar/carbohydrate consumption, and eating behavior. These behaviors were maintained for at least 4 to 6 weeks postprogramming. The diabetes self-management record can be used as an adjunct to diabetes education programming, as an evaluator of the educational intervention, and/or as a behavior monitoring tool for diabetes self-management.
Diabetes Control Programs: New Directions
Authors: Anderson Lynda A. , Bruner Laney A. , Satterfield Dawn
Published: April 2008

The diabetes control programs (DCPs), which involve state and territorial health agencies working cooperatively with the Centers for Disease Control and Prevention, offer new opportunities for diabetes educators to expand their scope of practice into public health. The intervention activities of the 40 core-capacity DCPs that are proposed for the next fiscal year are summarized in this paper to provide insight into the new directions of the DCPs. These activities span a range of health-system and community-based approaches and are described by their potential impact on the audience. The interventions are aimed at a variety of intended audiences and partners, including minorities, individuals with diabetes, healthcare providers, and policymakers. As diabetes educators continue to expand their scope of practice, the DCPs offer opportunities to go beyond individual practice behaviors by participating in community development activities, disseminating practice guidelines, changing organizational practices, and advocating for health-related public policy and legislation.
Physical Activity in Adolescents With Diabetes
Authors: Loman Deborah G. , Galgani Carol A.
Published: April 2008

This study investigated the physical activity and beliefs about exercise of 30 adolescents with diabetes. The Seven-Day Physical Activity Recall was used to determine the physical activity for two different recall periods that were 2-weeks apart. Forty percent of the youths engaged in 30 minutes of moderate activity 5 times per- week while only 10% engaged in 20 minutes of vigorous activity 3 times per week. Forty-seven percent of the teens consistently achieved or surpassed the time equivalent of activity for one of the Healthy People 2000 Objectives for moderate or vigorous physical activity. This group had significantly higher scores on the Exercise Belief Instrument for Adolescents that was developed for this study. Strategies to encourage regular physical activity are discussed.
The Role of the Health Belief Model in Amputees' Self-Evaluation of Adherence to Diabetes Self-Care Behaviors
Authors: Pham Duc T. , Fortin Fabienne , Thibaudeau Marie F.
Published: April 2008

This study involving 76 amputated patients with non-insulin-dependent diabetes mellitus examined the relationship between their beliefs regarding diabetes and its treatment and their- self-evaluation of adherence to diabetes self-care behaviors. Descriptive results showed a high level of adherence to medication, foot care, and blood glucose testing, and a low level of adherence to diet and exercise. The correlative analysis revealed significant relationships between perceived social support and adherence to diet, and between perceived social support, barriers, and adherence to the practice of exercise. The regression analysis showed a significant influence of perceived social support on adherence to diet. The same relationship was observed for the influence of perceived social support and barriers on adherence to exercise. Findings support the importance of giving more attention to patients' needs regarding adherence to diet and exercise, improving social support, and removing barriers to patients' treatment. After an amputation it is important to provide patients with an appropriate diabetes teaching andfollow-up program.
Ethical Conflicts Reported by Registered Nurse/Certified Diabetes Educators
Authors: Redman Barbara K. , Fry Sara T.
Published: April 2008

The purpose of this pilot study was to identify types of ethical conflicts reported by Certified Diabetes Educators who also are Registered Nurses (RN/CDEs).

Ethical conflicts expressed by RN/CDEs in active practice in Maryland, Virginia, and the District of Columbia were described by these healthcare professionals. Each conflict was analyzed according to three themes: the practice context, the ethical principles in conflict, and how the conflict was experienced by the nurse subject.

The majority of ethical conflicts (75%) concerned disagreement with the quality of medical care the patient was receiving. The principles most often in conflict were beneficence and nonmaleficence. Most conflicts were experienced as dilemmas (two or more principles that seem to apply but support mutually inconsistent courses of action).
Theory and Practical Applications of a Wellness Perspective in Diabetes Education
Authors: Klepac Marcia J.
Published: April 2008

From a wellness perspective, health is viewed in a broad sense that encompasses interrelationships among physical, mental, social, emotional, and spiritual components. This approach to health is particularly applicable in diabetes management because diabetes affects all areas of a person's life — work, family, social, and recreational. The boundaries of diabetes education need to be expanded to address this holistic view of health. The integration of a wellness approach in an adult-centered diabetes education program is described to offer a new perspective in diabetes management and education. This outpatient, hospital-based program is provided at regular intervals for small groups of 6 to 12 participants, most of whom have type II diabetes. Support for this wellness direction in diabetes education is discussed in relation to theoretical principles of the wellness model, including similarities and differences with other concepts such as empowerment and self-efficacy. Practical applications of the wellness perspective are clarified using this specific outpatient program as a case example.
A Computerized Model for Home Glucose Monitoring Proficiency Testing: Efficacy of an Innovative Testing Program
Authors: Schrot Richard J. , Foulls Philip R. , Morrison Anthony D. , Farese Robert V.
Published: April 2008

PURPOSE

A newly instituted computerized system for proficiency testing of home glucose monitoring was evaluated comparing accuracy of patient determination of glucose with serum values measured in the laboratory.

METHODS

Patients returning for routine blood glucose testing ordered by their care provider brought their glucose monitoring equipment to the laboratory. They performed a finger-stick glucose check in the laboratory while the laboratory phlebotomist drew blood for glucose determination; both results were computer analyzed. Patients with a 25% or less variation from the laboratory were considered proficient, while those with greater than 25% variation were defined as nonproficient.

RESULTS

Over a 19-month period, 300 of the 3208 patients notified about the study completed proficiency testing at least once. Using the defined proficiency of 25% variation or less, 12% of the participants were nonproficient. Using a variation of 15% or less, 31% of patients were nonproficient.

CONCLUSIONS

An annual methodology evaluation such as the one in this study should become a standard of care to identify patients for remedial classes to correct the source of error. The goal must be to meet or exceed the American Diabetes Association standard of 15% total error in home glucose monitoring.
The Scope of Practice of Diabetes Educators in the State of Georgia
Authors: Kaufman Melissa W. , All Anita C. , Davis Harry
Published: April 2008

PURPOSE

The purpose of this study was to identify and describe the scope of practice trends of diabetes educators in the state of Georgia.

METHODS

The Diabetes Educator Responsibilities Questionnaire (DERQ) was sent to 221 members of the American Association of Diabetes Educators listed in the 1995 membership directory in Georgia. Of the 221 members, 97 returned completed questionnaires. This population of healthcare professionals comprised the sample population.

RESULTS

In assessing the primary responsibilities of the sample, more than 50% of the respondents performed six of the nine educator roles. Less than 50% of the respondents indicated that they "Always" or "Frequently" used behavior modification strategies in teaching people with diabetes.

CONCLUSIONS

The questionnaire used in this study should be expanded to elicit more detailed information regarding decisions to use or not use behavior modification techniques in diabetes education.
Developing a Computerized Diabetes Self-Management Education Module for Documenting Outcomes
Authors: Tomky Donna M.
Published: April 2008

PURPOSE

This paper describes a process used to develop a computerized diabetes self-management education record that complies with the National Standards for Diabetes Self-Management Education Programs.

METHODS

A working prototype was developed to computerize 1 of the 15 content modules outlined in the National Standards for use on the World Wide Web. During program development, three consultants reviewed the content and proposed structure. For the subsequent prototype, five diabetes educators served as users and evaluated the content, design, and flow of the system.

RESULTS

The module was found to be thorough in terms of curriculum content and proposed structure for subsequent teaching. Overall, users were satisfied with the graphic interface screens and provided important feedback for determining specific modifications for future development.

CONCLUSIONS

The World Wide Web format provides a universal platform for documenting diabetes education outcomes and allows a broad range of access and networking capabilities.
Involvement in Health Behaviors Among Youth With Diabetes
Authors: Hanna Kathleen M. , Outhrle Diana W.
Published: April 2008

PURPOSE

The purpose of this study was to examine involvement in a broad range of health behaviors among adolescents and young adults with diabetes.

METHODS

The sample consisted of 107 adolescents and young adults (12 to 24 years old) with Type 1 diabetes mellitus. Participants were asked to report involvement in health-enhancing, health-compromising, and diabetes mismanagement behaviors.

RESULTS

The participants reported low levels of health-compromising behaviors and high levels of health-enhancing behaviors. Females reported significantly higher levels of diabetes mismanagement than males. Males in late adolescence (18 to 24 years) reported significantly higher levels of health-compromising behaviors than males in early (12 to 14 years) and middle (15 to 17 years) adolescence. Females in late adolescence (1 8 to 24 years) reported significantly higher levels of health-compromising behaviors than females in early adolescence (12 to 14 years).

CONCLUSIONS

Diabetes educators who work with youth may want to assess all of these health behaviors, keeping in mind age and gender differences.
Culture Counts: Why Current Treatment Models Fail Hispanic Women With Type 2 Diabetes
Authors: Oomen Jody S. , Owen Lynda J. , Suggs L. Suzanne
Published: April 2008

PURPOSE

The purpose of this article is to evaluate whether current treatment models adequately address the cultural factors involved in treatment adherence in Hispanic females with Type 2 diabetes.

METHODS

A review of relevant professional literature was conducted.

RESULTS

Established health behavior models do not adequately address the unique needs of the female Hispanic population, especially those older women who hold traditional religious and cultural beliefs.

CONCLUSIONS

To decrease the devastating effects of Type 2 diabetes among Hispanic women, interventions must be based on a comprehensive, culturally sensitive model that works with cultural values, not against them.
Clinical Implications of Amylin and Amylin Deficiency
Authors: Kruger Davida F. , Gatcomb Patricia M. , Owen Susan K.
Published: April 2008

PURPOSE

this paper presents an overview of the physiology of glycemic control and the mechanisms of amylin deficiency in people with diabetes. Benefits of replacement therapy with both pramlintide and insulin are discussed.

METHODS

The discovery of the pancreatic p-cell hormone amylin, which is cosecreted with insulin in response to hyperglycemia, has prompted a reanalysis of the mechanisms underlying the control of glucose homeostasis. A review of the current literature on amylin and amylin deficiency provides the basis of this reanalysis, with a discussion of the clinical implications for people with diabetes.

RESULTS

Amylin appears to work with insulin to regulate plasma glucose concentrations in the bloodstream, suppressing the postprandial secretion of glucagon and restraining the rate of gastric emptying. People with diabetes have a deficiency in the secretion of amylin that parallels the deficiency in insulin secretion, resulting in an excessive inflow of glucose into the bloodstream during the postprandial period.

CONCLUSIONS

While insulin replacement therapy is a cornerstone of diabetes treatment, replacement of the function of both amylin and insulin may allow a more complete restoration of the normal physiology of glucose control.
Relationship Between Use of Food Labels and Nutrition Knowledge of People With Diabetes
Authors: Kessler Hermine , Wunderlich Shahla M.
Published: April 2008

PURPOSE

The purpose of this study was to identity how people with diabetes use food labels to manage their intake of specific nutrients, which information is used on the Nutrition Facts label, and the relationship between food label use and nutrition knowledge.

METHODS

A total of 190 individuals participated in this study. Data were collected at six different locations in New Jersey using a four-page questionnaire. Descriptive statistics were employed to assess demographic and clinical characteristics of the participants; chi-square was used to test significance of nominal and ordinal data.

RESULTS

People with diabetes read food label information more often than general consumers; checking sugar content ranked highest. Only 59% of label users referred to the total carbohydrate listings. The level of nutrition knowledge for the majority of participants was "fair" or less, with the remaining scoring "good" and above. The use of nutrition labeling has a limited effect on nutrition knowledge gain.

CONCLUSIONS

Individuals who received most of their information from healthcare providers had a "good" or better nutrition knowledge score. An education program is needed that teaches people how to apply information from the Nutrition Facts label to make healthy food choices.
Self-Awareness in Diabetes: Using Body Cues, Circumstances, and Strategies
Authors: Hernandez Cheri Ann , Bradish Grace I. , Rodger N. Wilson , Rybansky Susan I.
Published: April 2008

PURPOSE

This research was the first phase of a study designed to develop and pilot test an educational program to increase self-awareness of salient body cues in adults with Type 1 diabetes. The purpose of this study was to identify (1) the cues, sensations, and circumstances that people with diabetes and their families associate with hypoglycemia, euglycemia, and hyperglycemia; and (2) the types of strategies that people with diabetes use to tune in to body cues and sensations.

METHODS

A series of four focus group sessions were held at monthly intervals with four female participants and four family members. These sessions were audiotaped and transcribed verbatim.

RESULTS

Participants described the existence of unique as well as usual body cues for hyperglycemia and hypoglycemia and the circumstances associated with these cues. Subjective and objective strategies were identified for tuning into these body cues and sensations.

CONCLUSIONS

People with diabetes should be encouraged to identify their own body cues that signify different levels of glycemia because these personal cues may be different than classical textbook symptoms. Even people with hypoglycemia unawareness may recognize unique cues that replace the autonomic ones they have lost.
The Diabetes Time Management Questionnaire
Authors: Gafarian Celeste T. , Heiby Elaine M. , Blair Patrick , Singer Frank
Published: April 2008

PURPOSE

The purpose of this study was to test the psychometric properties of the 49-item Diabetes Time Management Questionnaire (DTMQ) in individuals with diabetes. The DTMQ was designed to assess general time management skills and those specifically relevant to compliance to a diabetes healthcare regimen.

METHODS

Participants completed the DTMQ; the Habits, Attitudes, and Knowledge Questionnaire of Diabetic Compliance (HAK); and the Diabetes Knowledge Schedule (DKS) to provide two indices of construct validity of the DTMQ. Three HAK items related to time management skills (HAK-TM) provided an index of concurrent criterion-related validity for the DTMQ.

RESULTS

Test-retest stability reliability results were significant for DTMQ total and individual item scores. Concurrent criterion-related validity of the DTMQ was supported by a significant correlation with the HAK-TM items. Construct validity of the DTMQ was partly supported by significant correlations with the DKS and two HAK items measuring diet and exercise compliance.

CONCLUSIONS

The results support the use of the DTMQ to assess the time management skills of individuals with diabetes.
Diabetes Educators' Perspectives on Barriers for Patients and Educators in Diabetes Education
Authors: Sprague Maureen A. , Shultz Jill Armstrong , Branen Laurel J. , Lambeth Suzanne , Hillers Virginia N.
Published: April 2008

PURPOSE

this study assessed diabetes educators' perspectives on barriers that potentially affect patient access to and utilization of diabetes education.

METHODS

A 40-item questionnaire was developed to collect needs assessment data on diabetes education programs. The questionnaire was mailed to a Washington State professional practice group in diabetes education (N=143).

RESULTS

Most respondents were registered nurses (61%) or registered dietitians (27%); 74% were certified diabetes educators. The educators' perceptions of the difficulty that type 1 versus type 2 patients experience in different areas of self-management after diabetes education underscored the importance of learning effective long-term skills for self-care. Some of the reasons given for type 2 patients dropping out of diabetes education programs were also cited as barriers to conducting follow-up, such as education being a low priority for the patient and the patient not being able to afford diabetes care services.

CONCLUSIONS

Educators appeared to relate many patient barriers to a lack of patient understanding of the evolving nature of diabetes and the subsequent need for educational support. The role of continuing education for all patients needs to be emphasized to the patient during the initial education, as well as to the healthcare community and the patient's support network.
Using a Focus Group to Design a Diabetes Education Program for an African American Population
Authors: Blanchard Mary A. , Rose Linda E. , Taylor Jan , McEntee Margaret A. , Latchaw Linda L.
Published: April 2008

PURPOSE

the purpose of this project was to determine what factors need to be considered in planning a diabetes education program to better meet the needs of African Americans with diabetes in a community served by a suburban community hospital.

METHODS

Two focus group sessions were conducted. The sessions were recorded, transcribed, and analyzed by members of the research team.

RESULTS

Four themes emerged that had bearing on program development: (1) a sense of personal powerlessness, (2) fear related to complications, (3) recognition of knowledge deficits accompanied by an inability to link behavior to outcomes, and (4) a clear vision of what kind of educational setting would interest and benefit the group.

CONCLUSIONS

There were significant differences between what was being offered for diabetes education at the facility and what was desired according to the focus group, including factors of cost and leadership. Recommendations for future program planning are given.
A Multiethnic Study of the Predictors of Macrosomia
Authors: Hardy Dale S.
Published: April 2008

PURPOSE

this study examined predictors of macrosomia in a multiethnic sample of 213 low-income women diagnosed with gestational diabetes mellitus (GDM) after week 24 of their pregnancy.

METHODS

Medical records were reviewed retrospectively. Variables examined were mother's height, weight history, educational level, age at diagnosis, weeks at diagnosis and delivery, type of diabetes, mean fasting blood glucose (FBG), and infant's weight, sex, and Apgar scores.

RESULTS

Fifty-one percent of babies were macrosomic. Weight gain, nonpregnant weight, weight at delivery, FBG, and Apgar scores at 1 minute were associated with macrosomia, especially in Hispanic women. Logistic regression revealed that nonpregnant weight was the strongest predictor of macrosomia.

CONCLUSIONS

Nonobese GDM mothers with optimal weight gain but with high FBG levels >90 mg/dL may be at risk for macrosomia. The major concerns with obese GDM mothers are nonpregnant weight and high blood glucose levels, in this order. Education for women with GDM should target these risk factors to decrease macrosomia.
Diabetes Patient Education Research: An Integrative Literature Review
Authors: Fain James A. , Nettles Anne , Funnell Martha M. , Prochownik Denise Charron
Published: April 2008

PURPOSE

The purpose of this study is to summarize the accumulated state of knowledge in the area of diabetes patient education research and highlight important issues that research has left unanswered.

METHODS

An integrative literature review was conducted on the topic of diabetes patient education between the years 1985 and 1998. Keywords used in the computerized search were diabetes mellitus, patient education, health education, research, and behavior change. The databases searched were MEDLINE, CINAHL, HealthSTAR, EMBASE, and CHID-HE. A total of 78 papers were reviewed.

RESULTS

Most studies lacked a theoretical framework and the majority of studies were conducted in an outpatient setting. HbA,, was the most frequently employed outcome measure, with little, if any, description of the interventions.

CONCLUSIONS

Much has been learned in terms of the effectiveness of diabetes education on improving knowledge. However, other topic areas and outcomes need further exploration.
Characteristics of the Learner: Children and Adolescents
Authors: Orey Margaret , Kanner Sheri , Lacey Kimberly O.
Published: April 2008

PURPOSE

The purposes of this paper are to (1) review the literature on educational interventions for children and adolescents; (2) determine what kinds of interventions have been studied, how effective they are, and their outcomes; and (3) develop recommendations for further research in the field.

METHODS

An integrative literature review approach was used. Articles were included in this review if they met the criteria of being an empirical study reporting results of an intervention whose primary subjects were children with type 1 diabetes and/or their families, and published between 1980 and January 1, 1999. Of the 59 articles identified, 41 met these criteria.

RESULTS

The majority of the studies focused on adolescents. Results suggested that traditional educational interventions are successful in increasing knowledge but less successful in increasing quality of life or improving metabolic control. Psychosocial and family interventions (coping skills training) have been more successful in both quality-of-life and metabolic outcomes.

CONCLUSIONS

There is much work to be done to strengthen our understanding of what works under what conditions. More studies of younger children, minority youth, and families are needed using wellcontrolled experimental designs with adequate samples.
Provider Impact in Diabetes Education
Authors: Young-Hyman Deborah
Published: April 2008

PURPOSE

Literature search from 1985 to the present was performed using Web-based search engines to identify evidence-based studies of diabetes education.

METHODS

Twelve studies were identified in which a provider characteristic was defined as a discriminate variable associated with impact or efficacy of the education intervention. Provider was defined as all those participating in diabetes care and education (eg, patient, education and care teams, funding and policy agencies). The Certified Diabetes Educator credential also was described.

RESULTS

Specialty or discipline of the provider/care team, technology when used to assist providers, and physician practice patterns have been assessed. There is a paucity of research that assesses provider impact or the specific impact of provider characteristics on diabetes outcomes in a controlled and scientifically rigorous fashion.

CONCLUSIONS

Suggestions for evaluating provider impact based on literature concerning psychotherapy and healthcare education outcomes are: identify provider characteristics/attitudes/skills and link them to outcomes, define therapeutic alliance in diabetes care/ education and assess its contribution to outcomes; and use performance measures as provider characteristics.
Theory is the Cart, Vision is the Horse: Reflections on Research in Diabetes Patient Education
Authors: Anderson Robert M. , Funnell Martha M.
Published: April 2008

PURPOSE

In this paper, we examine the nature of vision and the role it plays in helping educators identify and use theories productively. We also discuss the role of theory in diabetes education and provide criteria for selecting appropriate theories.

METHODS

The vision of diabetes education developed at the Michigan Diabetes Research and Training Center was used to illustrate how our vision has influenced our use of educational and behavioral theories.

RESULTS

Both our vision and our theoretical assumptions should be articulated, discussed, debated, and studied.

CONCLUSIONS

Diabetes patient education research can systematically contribute to the development of a sound, coherent, and progressive body of knowledge that will truly serve diabetes patient education.
Interventions to Promote Diabetes Self-Management: State of the Science
Authors: Brown Sharon A.
Published: April 2008

PURPOSE

The purpose of this paper is to review the diabetes education literature that has emerged over the past 20 years to determine what we currently know about diabetes self-management interventions and their effectiveness in producing improved health outcomes.

METHODS

Findings of studies that were reported prior to 1990 were compared with findings of studies that have been conducted since 1990 to determine what recent changes and patterns in diabetes self-management education have occurred. Future directions in diabetes self-management research and practice were projected from these findings.

RESULTS

Most studies lacked adequate descriptions of the interventions tested, which precludes replication or application of the most effective strategies to clinical practice. Trends in interventions have evolved from education only to education plus behavioral models, with more attention given to interventions specifically for minority populations. The interventions that have been designed and tested seem to be longer, with more emphasis on simple, practical approaches to diabetes self-management.

CONCLUSIONS

The literature supports the effectiveness of diabetes education and behavioral interventions in improving psychosocial and health outcomes. The question of how to best achieve these improved outcomes continues to need further exploration.
Deliberative Drift: The Emergence of Deliberation in the Policy Process
Authors: Mclaverty Peter , Halpin Darren
Published: April 2008

This article explores the issue of what we call “deliberative drift”: the emergence of deliberation in a non-deliberative setting. The literature on deliberative democracy has tended to focus upon practices taking place in specifically deliberative settings. We ask whether deliberation cannot logically occur elsewhere in the policy process, or, more specifically, can politics based on bargaining and aggregation be transformed (or drift) toward deliberative practice? In pondering this question, Habermas's argument that a communicative rationality underpins deliberation is useful, as it demarcates deliberative from other practices by a willingness of participants to cast aside fixed preferences. While procedures and institutional designs are inflexible, the orientations or rationalities of individuals may be much more malleable. We explore one empirical case in which what started as negotiating and instrumental processes drifted toward a deliberative practice. We speculate that the rationalities that participants bring to their interaction, and the ways in which those rationalities change with the development of trust between participants, are as important in determining whether deliberation occurs as is the setting within which the interaction takes place.
Banking on Democracy: The Political Economy of International Private Bank Lending in Emerging Markets
Authors: Rodríguez Javier , Santiso Javier
Published: April 2008

Clearly, a new agenda is emerging for private international banks. Political issues such as human rights seem to be a current concern. But what about democracy? What about political regimes? Are they taken into account by private banks when they decide whether to invest in a country? Put another way, do private banks have democratic political preferences? In this article, we focus on cross-border lending from international bank(er)s. The questions asked are as follows. Do bank(er)s react positively (that is by increasing their lending) when an emerging democracy appears? Do we witness increased bank lending after democratic transitions? Lastly, is there any relation between democratic consolidation and bank lending?
Critical Memories of Crafted Virtues
Authors: Hasian Marouf
Published: April 2008

This article provides a critical legal analysis of the rhetoric surrounding the “modern slavery” problems associated with the Cadbury Brothers firm during the early 20th century. The Cadbury firm sued The Standard newspaper for libel, alleging that the firm's directors' reputations had been damaged. The author argues that critical analysis of this libel trial shows how the crafting of Victorian or Edwardian virtues often involved the defense of imperial reputations, and in this case British liberals and conservatives debated each other as they critiqued Portuguese colonial practices. The author concludes that the work of Henry Nevinson and other investigators continues to influence modern interrogations of contemporary cocoa business practices.
Assessing the Influence of Gestalt-Type Characteristics on Preferences Over Lifetime Health Profiles
Authors: Oliver Adam
Published: April 2008

Introduction . In contrast to the basic tenets of economic theory, there is substantial evidence that people's remembered and predicted utility of events systematically differs from the utility that they experience. These systematic differences are caused by ``gestalt characteristics.'' The objective of this study was to test whether people maximize quality-adjusted life years (QALYs), or whether QALY maximization is compromised by their being influenced by factors that resemble the gestalt characteristics when choosing between lifetime health profiles. Methods . Time trade-off values were elicited from 50 respondents, who were also presented with a series of hypothetical questions that each depicted 2 lifetime health profiles. The respondents were asked to choose which of the 2 profiles in each question they would prefer to experience. By inputting the values that the respondents placed on the health states into the lifetime health profiles, it was possible to observe whether their answers were consistent with QALY maximization or with various hypothesized gestalt-type effects. Results . Across decisions that involve a simple trade-off between the length of life and the quality of the health state, choices consistent with QALY maximizing were relatively common, although even here approximately half of the respondents violated this rule. Consistency with QALY maximization was lower in most of the other tests and indicated that many people might, for example, prefer to trade off some lifetime health to experience a good end to life, or to avoid highly unstable lifetime health profiles. Conclusion . The respondents' answers were often consistent with the hypothesized gestalt-type effects, but it is probable that for some of the questions the characteristics themselves were not driving the respondents' answers and that factors such as complex rates of discounting might have played a role. However, whatever the driving motivation behind the respondents' answers, the important point to note from this study is that QALY maximization is often substantially and systematically violated when people are offered a choice over the lifetime health profiles that they would prefer to experience.
A Media Campaign Prevention Program for Child Sexual Abuse
Authors: Self-Brown Shannon , Rheingold Alyssa A. , Campbell Carole , de Arellano Michael A.
Published: April 2008

This study examines the face validity and feasibility of materials included in a multimedia child sexual abuse (CSA) prevention campaign. A quantitative survey method assessed participants' comfort level, knowledge gain, and likelihood of behavioral change in response to the media campaign. Furthermore, a focus group method explored participants' attitudes and opinions regarding the campaign and the unique effects of ethnic or cultural norms on participants' acceptance of the media materials. Six groups, established based on participant ethnicity (i.e., three Caucasian groups, two African American groups, one Hispanic group), met at two sites in the Charleston, South Carolina, area. Quantitative data suggest that participants reported increased CSA knowledge and low levels of discomfort or anxiety related to exposure to the materials. Focus group results suggest that study participants, regardless of ethnic background, agreed that the media campaign can have a positive impact on public knowledge of CSA. Implications and directions for future research are discussed.