bluuebunny/crossref_metadata_2025_split huggingface dataset:
Coping strategies of family carers for older relatives in Finland
Authors: Kuuppelomäki Merja , Sasaki Akiko , Yamada Kouko , Asakawa Noriko , Shimanouchi Setsu 
Published: August 2004

Background.  As the population continues to age, it is important that older people and their family carers get all the help and support they need with coping. This requires knowledge and understanding of the factors that foster and promote coping strategies, and on the other hand that complicate coping.Aims and objectives.  Conducted as part of a major international research project on carers’ work and coping in four countries, the purpose of this study was to explore the coping strategies of family carers looking after older relatives in their own home and to identify related factors.Design.  A survey involving 290 family carers from three towns in Finland.Methods.  The data were collected with a questionnaire including the Carers’ Assessment of Managing Index developed by Nolan et al. (1995).Results.  The most helpful coping strategy was to establish one's priorities and concentrate on them. Other strategies that over 80% of the respondents regarded as helpful were believing in oneself and one's ability to handle the situation, taking life 1 day at a time, looking for positive things in each situation and relying on one's own expertise and experience. The 10 most helpful coping methods included five problem‐solving strategies, four emotional‐cognitive strategies and one managing stress strategy. The age and gender of the family carers were found to correlate with the results.Conclusions.  Our findings lend further support to earlier results according to which there are both similarities and differences in the coping strategies of family carers in different countries.Relevance to clinical practice.  Nurses who meet family carers of ageing individuals in their work will be able to use these results in assessing how these carers are coping and whether they need support, as well as in developing services for family carers.
Perceived barriers and facilitators to implementing research findings in the Irish practice setting
Authors: Glacken Michèle , Chaney David 
Published: August 2004

Background.  Studies have consistently demonstrated that nurses are increasingly recognizing the role research has to play in their daily practice. Despite this recognition the actual application of research findings in the practice setting is still poor. To date, the barriers to implementing research findings in the Republic of Ireland's practice setting have not been explored empirically. This study sought to address this gap.Aims.  The aims of this study were to ascertain what Registered Nurses practising in the Republic of Ireland perceive as barriers to the implementation of research findings in the practice setting and to explore what they perceive would facilitate them in using research findings in their daily practice.Design.  Cross‐sectional survey.Methods.  A non‐probability strategy was employed with all Registered Nurses who commenced a nursing‐focused academic course accredited by the University of Dublin, Trinity College, between September 2001 and February 2002 invited to participate. The ethical rights of the participants in terms of anonymity, privacy and informed consent were assured through a number of mechanisms. Data were collected via the Barriers scale.Findings.  Eight of the top 10 ranked barriers were organization centred. The top barrier was a perception of insufficient authority to instigate change in the practice setting. The perceived key facilitators to implementing research findings included protected time for retrieval and evaluation of research findings, instrumental support from management, informed supportive personnel in the practice settings and accessible educational opportunities to augment critical reading skills.Relevance to clinical practice.  The Irish Government is committed to provide the people of Ireland with an evidence‐based health service. From a nursing perspective the findings of this study indicate that a number of strategies have to be introduced or enhanced in the practice settings before this commitment can be realized.
Nursing home residents’ dependence and independence
Authors: Stabell Aase , Eide Hilde , Solheim Gunnel Anita , Solberg Kari Nässelqvist , Rustøen Tone 
Published: August 2004

Background.  Entering an institution constitutes one of the most difficult developmental challenges for older people, and may lead to increased dependency because of reinforcing environmental events such as the interaction pattern of the staff.Aims and objective.  The aim of this paper was to describe the pattern of social interaction between nursing home residents and the nursing staff during mealtimes.Design and methods.  Six residents of a nursing home in a suburb of Oslo were observed. Data were collected during 120 systematic observations. Different types of behaviour relating to the residents’ level of independence when interacting with the staff were examined using a structured observational scheme developed by Baltes.Results.  Data showed that the residents’ maintenance of independent self‐care was the most predominant behaviour. Residents were rarely socially active. The behaviour of one resident varied among meals. Observations of independent self‐care maintenance during interactions between the residents and the staff were sometimes consistent and sometimes inconsistent. The response of the nursing staff to the residents’ social engagement was variable. Generally, however, they did not respond at all and seldom displayed engagement‐supportive behaviour.Conclusions.  The results represent a challenge to the nursing staff to increase social interaction during mealtimes, and also to examine their inconsistent behaviour towards the residents.Relevance to clinical practice.  Mealtime appears to be a good opportunity to foster the independence of the residents as well as to enhance social activity in the form of informal conversation. Greater consistency of staff behaviour is required, based on ethical values such as consideration of the residents’ self‐esteem and autonomy, thereby stimulating independent self‐care at mealtimes. Inconsistent behaviour, often based on values that are not clarified, may, on the contrary, lead to increased dependence of the residents.
Assertiveness and caring: are they compatible?
Authors: McCartan Patrick J , Hargie Owen DW 
Published: August 2004

Background.  Findings from numerous assertion studies suggest that nurses are generally non‐assertive. This study examines the role of caring as an important determinant of adaptive assertive behaviour.Aim and objectives.  The aim of the investigation was to explore the relationship between assertion and caring skills. Two study objectives sought to determine whether both positive and negative assertive behaviours were related to caring skills.Design.  Correlational and cross‐sectional study.Method.  The Caring Assessment Instrument (Care Q – Questionnaire Version) and the assertion inventory were used to collect self‐report data from a convenience sample of 94 subjects. Behavioural data were obtained by directly sampling 50 nurses’ responses within role‐play situations.Results.  One significant result between the various assertion measurements and caring skill scores was noted, highlighting a relationship between negative assertion and the caring ‘accessible’ subscale.Conclusion.  Overall the findings of the study suggest that positive and negative assertive behaviours are not related to caring skills.Relevance to clinical practice.  The current findings suggest that the presence of caring attributes cannot be offered as a possible reason for non‐assertion in nurses.
Statin use in Type 2 diabetes mellitus is associated with a delay in starting insulin
Authors: Yee A. , Majumdar S. R. , Simpson S. H. , McAlister F. A. , Tsuyuki R. T. , Johnson J. A. 
Published: August 2004

AbstractAims  It has been suggested that HMG Co‐A reductase inhibitors (‘statins’) may reduce the risk of developing Type 2 diabetes mellitus. This study was designed to evaluate whether use of statins would also delay progression to insulin therapy.Methods  This was a retrospective cohort study using Saskatchewan Health databases to identify subjects newly started on oral antidiabetic agents from 1991 to 1996.Subjects  < 30 years of age or with previous lipid‐lowering drug use were excluded. Medications known to influence glycaemic control, co‐morbidity, and demographic data were collected. Statin exposure was defined as at least 1 year of use. Primary outcome was starting insulin treatment. Multivariate Cox proportional hazards models were used to examine the association between statin use and starting insulin.Results  The final cohort included 10 996 new users of oral antidiabetic agents, of which 484 (4.4%) used statins. Mean age was 64 years and 55% were male. Mean duration of follow‐up was 5.1 years; 11.1% (n = 1221) eventually started insulin treatment. Statin users were no less likely than non‐users to start insulin treatment eventually (11.6% vs. 11.1%, P = 0.74). After multivariate adjustment, however, statin use was associated with a 10‐month delay before newly treated diabetic subjects needed to start insulin treatment (adjusted hazard ratio 0.74; 95% confidence interval 0.56, 0.97, P = 0.028).Conclusion  The use of statins is associated with a delay in starting insulin treatment in patients with Type 2 diabetes initially treated with oral antidiabetic agents. Whether this relationship exists for patients at high risk of developing diabetes should be examined in a randomized trial.
Effect of acute hyperglycaemia on sodium handling and excretion of nitric oxide metabolites, bradykinin, and cGMP in Type 1 diabetes mellitus
Authors: Šimková R. , Kazdová L. , Karasová L. , Simek S. , Pelikánová T. 
Published: August 2004

AbstractAims  The aim of this study was to evaluate the effect of acutely induced hyperglycaemia on renal sodium handling and to explore the role of the bradykinin‐nitric oxide‐cGMP signalling pathway.Patients and methods  We compared 20 Type 1 diabetic (DM1) patients without microalbuminuria with 15 weight‐, age‐, and sex‐matched healthy controls (C). Clearances of para‐aminohippuric acid (CPAH), inulin (Cin), lithium, sodium, and urinary nitrite/nitrate (NOx), cGMP and bradykinin excretion rates were measured in two 90‐min periods: a glycaemic clamp‐induced euglycaemia (5 mmol/l—period I) and hyperglycaemia (12 mmol/l—period II) (Study 1) and during time‐controlled euglycaemia (5 mmol/l—period I and 5 mmol/l—period II) to avoid the effects of time and volume load (Study 2).Results  Cin and CPAH were not significantly different during euglycaemia (period I of Study 1) in DM1 and controls, whereas fractional excretion of sodium was decreased in DM1 (1.84 ± 0.75 vs. 2.36 ± 0.67%; P < 0.05) due to an increase in fractional distal tubular reabsorption of sodium (94.01 ± 1.94 vs. 92.24 ± 2.47%; P < 0.05). A comparison of changes during Study 1 and Study 2 revealed acute hyperglycaemia did not change renal haemodynamics significantly, while fractional distal tubular reabsorption of sodium increased (DM1: P < 0.05; C: P < 0.01) and fractional excretion of sodium decreased (P < 0.01) in both groups. The urinary excretion rates of NOx were comparable during euglycaemia in DM1 and C. While in C, they significantly increased during Study 1 (period I: 382 ± 217 vs. period II: 515 ± 254 nmol/min; P < 0.01) and Study 2 (period I: 202.9 ± 176.8 vs. period II: 297.2 ± 267.5 nmol/min; P < 0.05) as a consequence of the water load, no changes were found in DM1. The urinary excretion of bradykinin was lower in DM1 compared with C (0.84 ± 0.68 vs. 1.20 ± 0.85 µg/min; P < 0.01) during euglycaemia; it was not affected by hyperglycaemia. There were no significant differences between DM1 and C and in cGMP urinary excretion rates following hyperglycaemia.Conclusion  This study demonstrates that DM1 without renal haemodynamic alterations is associated with impaired renal sodium handling. Moreover, we did not find a relationship between the renal excretion rates of vasoactive mediators and sodium handling due to hyperglycaemia.
A single dose of nateglinide improves post‐challenge glucose metabolism and endothelial dysfunction in Type 2 diabetic patients
Authors: Shimabukuro M. , Higa N. , Takasu N. , Tagawa T. , Ueda S. 
Published: August 2004

AbstractAims  This randomized crossover placebo‐controlled study aimed to assess the efficacy of nateglinide, a phenylalanine‐derived insulin secretagogue, on forearm endothelial function in diabetic subjects before and after an oral glucose load.Methods  Forearm blood flow (FBF) was measured using strain‐gauge plethysmography during reactive hyperaemia before and after an oral glucose load (75 g) with a prior use of placebo or nateglinide (90 mg) in 15 diet‐treated Type 2 diabetic patients or age‐matched controls with normal glucose tolerance.Results  The peak FBF response and total reactive hyperaemic flow (flow debt repayment: FDR), indices of resistance artery endothelial function, were decreased after an oral glucose load in diabetic patients, but unchanged in controls. Nateglinide administered to diabetic patients accelerated insulin secretion and reduced post‐challenge plasma glucose, and also abolished the post‐challenge impairment of endothelial function. The peak FBF and FDR were well correlated with 120‐min glucose levels and 30‐min insulinogenic index.Conclusions  A single challenge of glucose was shown to impair endothelial function in diabetic patients, and the post‐challenge endothelial dysfunction was improved by a prior use of nateglinide. Long‐term effects of nateglinide on endothelial function in Type 2 diabetic patients need to be clarified in future studies.
The number of unexpected HbA1c variants may be a greater problem in routine practice than is generally realized
Authors: Reynolds T. M. , Twomey P. J. , Harvey T. C. , Green B. N. 
Published: August 2004

AbstractBackground  The majority of variant and abnormal haemoglobins are clinically silent but may not be biochemically silent when it comes to HbA1c estimation.Case report  We describe several cases in which there were problems in the determination of HbA1c for monitoring diabetes in patients that would not normally be classified as being at risk. Four of these cases were sufficiently unusual to warrant individual publication but all came from a very restricted geographical area with a population of only approximately 500 000. The significance of this is not that variant haemoglobins affect HbA1c analysis but that the occurrence of unexpected/unusual variant haemoglobins may be more frequent than most clinicians would expect, considering that only a small proportion of the basal population are diabetic and have their HbA1c monitored. Differences will exist between different areas due to differences in both the prevalence of variants and the analytical methods employed.Conclusions  Consequently, we propose greater interaction between diabetologists and the laboratory in an attempt to identify these clinically but not biochemically silent variants to achieve a true estimation of the glycaemic control in affected patients.
Type 1 diabetes mellitus in childhood: a matched case control study in Lancashire and Cumbria, UK
Authors: Marshall A. L. , Chetwynd A. , Morris J. A. , Placzek M. , Smith C. , Olabi A. , Thistlethwaite D. 
Published: August 2004

AbstractAims  The aim of the study was to identify environmental risk factors for insulin‐dependent diabetes mellitus (Type 1 DM) in childhood.Methods  A matched case‐control study of Type 1 DM conducted in Lancashire and Cumbria, UK, using a structured interview. Cases (n = 196, participation rate 83%) were children under 16 years of age diagnosed prior to October 1998 and attending diabetic clinics. Controls (n = 381) were healthy children from the community matched by gender and by age (within a few days of birth). The data were analysed by logistic regression using the technique of Breslow and Day for matched case control studies.Results  The multivariate regression model showed that the following factors were significantly associated with the risk of developing Type 1 DM (odds ratio, 95% confidence intervals): sharing a room with a sibling (0.458, 0.290–0.721), social contact with other children when aged 6–11 months (0.439, 0.256–0.752), consumption of sugary food (0.080, 0.024–0.261), parental insulin dependent diabetes mellitus (10.651, 3.086–36.761), maternal thyroid disease (4.861, 1.681–14.058), consuming more than one pint of milk per day prior to school entry (0.498, 0.310–0.802), maternal smoking during pregnancy (0.373, 0.218–0.636), a father with no academic qualifications (0.504, 0.278–0.913), maternal age at time of birth (0.900, 0.854–0.948), maternal infections in pregnancy (2.453, 1.011–5.948), other maternal illnesses or conditions in pregnancy (2.007, 1.139–3.535), belonging to an Asian family (0.104, 0.028–0.394), and regular contact with pets and other animals (0.552, 0.309–0.987).Conclusion  Many of the results are consistent with the hygiene hypothesis which links improved living standards with decreased exposure to microorganisms and increased risk of immune mediated disease in childhood. These findings challenge the idea that improved hygiene acts exclusively through a Th2 mechanism leading to atopic disease as Type 1 DM is mediated by a Th1 reaction. The association with maternal smoking could be due to recall bias but a causal link cannot be excluded with confidence.
Metabolic, immunological and clinical characteristics in newly diagnosed Asian diabetes patients aged 12–40 years
Authors: Pan C. Y. , So W. Y. , Khalid B. A. K. , Mohan V. , Thai A. C. , Zimmet P. , Cockram C. S. , Jorgensen L. N. , Yeo J. P. ,   The ASDIAB Study Group
Published: August 2004

AbstractAim  To describe the clinical, biochemical and immunological characteristics of young‐onset diabetes in Asia.Methods  Clinical, biochemical and immunological variables were assessed in 919 newly diagnosed (duration less than 12 months) young onset Asian diabetic patients aged between 12 and 40 years. The subjects constituted 57% Chinese, 29% Indians and 14% Malays, recruited from diabetes centres in China, Hong Kong, India, Malaysia and Singapore.Results  The mean age (± sd) was 31.6 ± 7.2 years, with the majority (66%) in the 31–40 years age group. Mean body mass index (BMI) (± sd) was 25.3 ± 5.0 kg/m2 with 47% exceeding the suggested Asian cut‐off point for obesity (BMI ≥ 25). Ethnic difference in clinical characteristics included BMI, blood pressure, mode of treatment and degree of insulin resistance. Most patients had a clinical presentation of Type 2 diabetes. About 10% had a classical combination of ketotic presentation, presence of autoimmune‐markers and documented insulin deficiency indicative of Type 1 diabetes. Forty‐eight percent were receiving oral hypoglycaemic agents (OHAs) while 31% were on diet only, 18% were receiving insulin and 2% were on a combination of insulin and OHA.Conclusion  Young onset diabetes patients in Asia represent a heterogenous group in terms of their clinical and biochemical characteristics and classical Type 1 diabetes is relatively uncommon. The 5‐year follow up study will determine the progress of these patients and help to clarify the natural history.
HMG‐CoA reductase inhibitors prevent bone loss in patients with Type 2 diabetes mellitus
Authors: Nakashima A. , Nakashima R. , Ito T. , Masaki T. , Yorioka N. 
Published: August 2004

AbstractAims  It has been reported that 3‐hydroxy‐3‐methylglutaryl co‐enzyme A (HMG‐CoA) reductase inhibitors increase bone mineral density (BMD) in vivo. We investigated the effect of HMG‐CoA reductase inhibitors on BMD in patients with Type 2 diabetes mellitus.Patients and methods  We selected 122 patients with Type 2 diabetes, who were not taking active vitamin D preparations. Their mean age was 67.3 ± 9.2 years. They were divided into a control group (n = 63) without HMG‐CoA reductase inhibitor therapy and an HMG‐CoA group (n = 59) who were treated with these drugs. The BMD of the distal one‐third of the radius was measured by dual‐energy X‐ray adsorptiometry at baseline and after 2 years.Results  There were no significant differences between the control and HMG‐CoA groups at baseline with respect to age, gender, body mass index, duration of diabetes, haemoglobin A1c, fasting plasma glucose, adjusted calcium, serum phosphorus, alkaline phosphatase, albumin excretion rate and radial BMD. However, there was a significantly smaller annual decrease of the radial BMD in the HMG‐CoA group. Multiple regression analysis with a forward elimination procedure revealed a positive correlation of the radial BMD Z‐score with body mass index, while there was a negative correlation with alkaline phosphatase and albumin excretion rate. In addition, the annual rate of change of the radial BMD showed a positive correlation with HMG‐CoA reductase inhibitor therapy.Conclusions  These findings suggest that HMG‐CoA reductase inhibitors may prevent bone loss in patients with Type 2 diabetes.
The effect of diabetes on heart rate and other determinants of myocardial oxygen demand in acute coronary syndromes
Authors: Foo K. , Sekhri N. , Knight C. , Deaner A. , Cooper J. , Ranjadayalan K. , Suliman A. , Timmis A. D. 
Published: August 2004

AbstractAims  To compare major determinants of myocardial oxygen demand (heart rate, blood pressure and rate pressure product) in patients with and without diabetes admitted with acute coronary syndromes.Methods  A cross‐sectional study of the relation between diabetes and haemodynamic indices of myocardial oxygen demand in 2542 patients with acute coronary syndromes, of whom 1041 (41.0%) had acute myocardial infarction and 1501 (59.0%) unstable angina.Results  Of the 2542 patients, 701 (27.6%) had diabetes. Major haemodynamic determinants of myocardial oxygen demand were higher in patients with than without diabetes: heart rate 80.0 ± 20.4 vs. 75.2 ± 19.2 beats/minute (P < 0.0001); systolic blood pressure 147.3 ± 30.3 vs. 143.2 ± 28.5 mmHg (P = 0.002); rate‐pressure product 11533 ± 4198 vs. 10541 ± 3689 beats/minute × mmHg (P < 0.0001). Multiple regression analysis confirmed diabetes as a significant determinant of presenting heart rate [multiplicative coefficient (MC) 1.05; 95% confidence interval (CI) 1.03–1.07; P < 0.0001], rate pressure product (MC 1.09; CI 1.05–1.12; P < 0.0001) and systolic blood pressure, which was estimated to be 3.9 mmHg higher than in patients without diabetes (P = 0.003). These effects of diabetes were independent of a range of baseline variables including acute left ventricular failure and mode of presentation (unstable angina or myocardial infarction).Conclusions  In acute coronary syndromes, heart rarte and other determinants of myocardial oxygen demand are higher in patients with than without diabetes, providing a potential contributory mechanism of exaggerated regional ischaemia in this high‐risk group.
The trade union response to agency labour in Britain
Authors: Heery Edmund 
Published: August 2004

ABSTRACTThe growth of agency work in recent years has posed a challenge to trade unions, which must decide if they will accept agency workers as part of their constituency and accept employment agencies as legitimate labour‐market actors. This article analyses the reaction of British unions to agency work and identifies four main responses: exclusion, replacement, regulation and engagement. It concludes with an evaluation of union policies, which stresses the need for unions to secure broad regulation of the agency labour market either through multi‐employer bargaining or employment law.