Factor analysis of self-treatment in diabetes mellitus: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Self-treatment is a treatment of oneself without professional help, which may cause health-related consequences. This investigation examined the self-treatment behaviors in patients with diabetes mellitus in Iran/kashan.</p> <p>Methods</p> <p>The patients who referred to the clinic of diabetes and those who were admitted to the General hospital in the city of Kashan due to diabetes mellitus were asked to participate in this cross-sectional study. For data collection, The 25 item questionnaire of Likert scale type with four scales was used. Factor analysis was performed to define the patterns of self-treatment.</p> <p>Results</p> <p>398 patients participated in the study. The mean age of the study population was 54.9 ± 12.9 years. The majority (97%) had type 2 diabetes. 50% of patients reported self- treatment. The self-treatment score was 45.8 ± 8.8 (25-100). Female gender, lower education and co-morbid illnesses of hypertension, hyperlipidemia and cardiac disease had significant relationship with self-treatment. The factor analysis procedure revealed seven factors that explained the 43% of variation in the self-treatment. These seven factors were categorized as knowledge, deficiencies of formal treatments, available self-treatment methods, physician related factors, the tendency to use herbal remedies, underlying factors such as gender and factors related to diabetes.</p> <p>Conclusions</p> <p>There is a medium tendency for self-treatment in diabetic patients. The assessment of self-treatment practices must be an essential part of patients' management in diabetes care.</p

Patterns of Retinal Damage Facilitate Differential Diagnosis between Susac Syndrome and MS

Susac syndrome, a rare but probably underdiagnosed combination of encephalopathy, hearing loss, and visual deficits due to branch retinal artery occlusion of unknown aetiology has to be considered as differential diagnosis in various conditions. Particularly, differentiation from multiple sclerosis is often challenging since both clinical presentation and diagnostic findings may overlap. Optical coherence tomography is a powerful and easy to perform diagnostic tool to analyse the morphological integrity of retinal structures and is increasingly established to depict characteristic patterns of retinal pathology in multiple sclerosis. Against this background we hypothesised that differential patterns of retinal pathology facilitate a reliable differentiation between Susac syndrome and multiple sclerosis. In this multicenter cross-sectional observational study optical coherence tomography was performed in nine patients with a definite diagnosis of Susac syndrome. Data were compared with age-, sex-, and disease duration-matched relapsing remitting multiple sclerosis patients with and without a history of optic neuritis, and with healthy controls. Using generalised estimating equation models, Susac patients showed a significant reduction in either or both retinal nerve fibre layer thickness and total macular volume in comparison to both healthy controls and relapsing remitting multiple sclerosis patients. However, in contrast to the multiple sclerosis patients this reduction was not distributed over the entire scanning area but showed a distinct sectorial loss especially in the macular measurements. We therefore conclude that patients with Susac syndrome show distinct abnormalities in optical coherence tomography in comparison to multiple sclerosis patients. These findings recommend optical coherence tomography as a promising tool for differentiating Susac syndrome from MS

Validation of the questionnaire on beliefs about medication with type 2 diabetic patients

O presente trabalho teve como objectivo validar o Questionário Crenças sobre a Medicação, que avalia Crenças Gerais e Crenças Específicas, estudando suas propriedades psicométricas em uma amostra de 387 pacientes diabéticos tipo 2. O estudo de validade para as Crenças Gerais revelou uma solução de um factor, com um alfa de 0,76, e para as Crenças Específicas, dois factores – Necessidades e Preocupações –, com um alfa de 0,77 e 0,69 respectivamente. Quanto à validade de constructo, verificou-se uma relação entre as Crenças Gerais e a subescala Necessidades das Crenças Específicas com Adesão à Medicação, avaliada pela Escala de Avaliação de Aderência Médica. O instrumento apresenta boas qualidades psicométricas para ser utilizado em pacientes diabéticos tipo 2.The present paper focused on the validation of the Questionnaire on Beliefs about Medication, which assesses both General Beliefs and Specific Beliefs. The psychometric properties of the instrument were analyzed on a sample of 387 type 2 diabetic patients. The validity study for General Beliefs found a unifactorial solution, with an alpha of .76, and for Specific Beliefs, a two-factor solution – Necessities and Concern –, with an alpha of .77 and .69, respectively. In terms of construct validity, a relationship between General Beliefs, subscale Necessities from Specific Beliefs, and adherence to medication, as evaluated by Medical Adherence Rating Scale, was found. The instrument presents good psychometric qualities to be used in type 2 diabetic patients.Fundação para a Ciência e Tecnologia (FCT

Macular thickness measurements in healthy Norwegian volunteers: an optical coherence tomography study

<p>Abstract</p> <p>Background</p> <p>Ethnic, intersubject, interoperator and intermachine differences in measured macular thickness seem to exist. Our purpose was to collect normative macular thickness data in Norwegians and to evaluate the association between macular thickness and age, gender, parity, and contraception status.</p> <p>Methods</p> <p>Retinal thickness was measured by Stratus Optical Coherence Tomography in healthy subjects. Mean macular thickness (MMT) was analyzed by repeated measures ANOVA with three dependent regional MMT-variables for interaction with age, gender, parity and oral contraception use. Exploratory correlation with age by the Pearson correlation test, both before and after stratification by gender was performed. Differences in MMT between older and younger subjects, between oral contraception users and non-users, as well as parous and nulliparous women were studied by post-hoc Student's t-tests.</p> <p>Results</p> <p>Central MMT in Norwegians was similar to values earlier reported in whites. MMT in central areas of 1 and 2.25 mm in diameter were higher in males than in females. In younger subjects (≤43 years) differences in MMT between genders were larger than in the mixed age group, whereas in older subjects (>43 years) the small differences did not reach the set significance level. No differences were found in minimal foveolar thickness (MMFT) between the genders in any age group.</p> <p>Mean foveal thickness (1 mm in diameter) was positively associated with age in females (r = 0.28, p = 0.03). MMFT was positively associated with age in all groups and reached significance both in females and in mixed gender group (r = 0.20, p = 0.041 and r = 0.26, p = 0.044 respectively).</p> <p>Mean foveal thickness and MMFT were significantly higher in parous than in nulliparous women, and age-adjusted ANOVA for MMFT revealed a borderline effect of parity.</p> <p>Conclusions</p> <p>Age and gender should be taken into consideration when establishing normal ranges for MMT in younger subjects. The gender difference in retinal thickness in young, but not older adults suggests a gonadal hormonal influence. The possible association between parity and retinal structure and its clinical relevance, should be studied further.</p

Care Management: Adherence to Therapies Among Patients at Bu-Alicina Clinic, Qazvin, Iran

Background: Non-adherence to treatment is a problem of increasing concern for all stakeholders. This study was designed to determine the prevalence of non-adherence among the clients consulting internists or cardiologists at Bu-Alicina Clinic in Qazvin.&#13; Methods: A total number of 400 clients came to Bu-Alicina Clinic (center for internal medicine and cardiology) were randomly interviewed through a questionnaire during a two month period in 2003. Self-administered methods were used if the clients applied. The data were interpreted using statistical methods.&#13; Results: The clients were between 14 and 78 years old (33.7+8.5) and 57.5% of them were women and 42.5% were men. Of total number, 30.7% were consulting for continuation of their therapies and of these clients, 41.5% had pooradherence to their current therapies. The more educated clients were 1.6 times (OR=1.62; 95% CI=0.71, 3.74) likely to be more adherent to the therapies.There was no significant difference between the internal diseases patients and cardiology patients in this regard (41.7%vs 40%). Of the total number of 400 clients, 79.5% had history of consulting to medical clinics during the last three months and 37.4% of them had non-adherence to their past therapies. The more frequent factors were: forgetfulness (13.3%), not to be able to afford to pay for treatment costs (10.3%), disbelieve to the doctor and consulting another ones (8.4%), long distance (8.4%), feeling that it is not important to take medications (7.4%), side effects (7.4%), disbelieve to the diagnosis (7.1%), religious considerations (6.5%), and misunderstanding or lack of information about the prescription (5.8%). No significant difference was found between men and women on this aspect.&#13; Conclusion: Patients need advice, supported information from professionals about their health and therapies. Certain studies must be done to determine the pitfalls and effective interventions address that barriers can be developed.&#13; Keywords: adherence, non-adherence, non communicable diseas

Responding to demand for inpatient care in the process of health development

During recent decades, many changes are happening in health sector and countries are trying to respond to the increasing health demands of people. Although hospitals have important role in health delivery system of any country, numerous factors have to be taken into account before establishing a new hospital in certain area. During recent decades, in many developing countries, new hospitals are built and equipped with sophisticated plant, without any scientific investigation. This means wastage of scarce resources. This paper aims to introduce need assessment methodology to establish hospitals and discuss the criteria to be met prior to their construction in the process of health care development

Surveying the principle of diagnosis recording in patients' medical records of Kashan hospitals in 1381

Background: With respect to the importance of recording diagnosis in patients' medical data for educational, research and legal and statistic aspects, we designed a study on patients' medical records that were hospitalized in Kashan's hospitals in 1381. Material and methods : This study was performed on medical files of 51 specialists working in Kashan University of Medical Sciences. Totally, 1071 medical records which were selected randomly, averagely 21 records for each physician, were included. We used the list of standard principle of International Classification of Disease (ICD-10). Data extracted and separated according to each hospital and clinical field. Results: Data were recorded correctly in diagnosis, orders, and external events, 87, 77, and 65, respectively. The rate of diagnosis records were in its high level in Matini hospital (92), and were in lowest range in Naqavi hospital. The rate of order records were 95 in Shahid Beheshti and in lowest range in Naqavi hospital (72.9). The rate of principle of external events records were in highest range in Shahid Beheshti hospital (77.8) and in lowest range in Matini hospital (50). Conclusion: We found the rate of recording level was good. It is correlated with attention of specialist and supervisor of medical data committee of university

Risk Management Status of Waste Anesthetic Gases Using ECRI Institute Standards

Background: The aim of this study was assessment the risk management status of waste anesthetic gases in academicals hospitals in Iran to prevent from harmful effects of these gases on employees' health.Methods: A descriptive-analytic study was designed in 2011. Standard structured checklist developed by ECRI institute (Emergency Care Research Institute) was applied. Checklists were filled onsite through direct observation and interviews with anesthesia personnel in 46 operating rooms at 4 hospitals from all of the hospitals under affiliation of Isfahan University of Medical Sciences. These hospitals were selected based on the number of surgical beds.Results: Total means score of WAGs risk management status was 1.72 from the scale of 3. In the studied operating rooms, only 28% complied with predetermined standards, 16% needed improvement and 56% had no compliance. Total mean scores of compliance in planning, training and evaluation and monitoring of waste anesthetic gases were weak and equipment and work activity was at medium level.Conclusion: The risk management status of waste anesthetic gases in the hospitals to be weak, therefore operating room personnel are exposed to medium to high level of these gases. The hospital mangers should prepare and apply scavenging equipment, development of control program, quality improvement, risk management and maintenance of anesthesia equipment. Finally, ongoing monitoring and evaluation, education to personnel and modification of policy and procedures and improvement of work activities should be considered

Assessment of consideration on the importance of Medical Records Department standards of Kashan Hospitals, 2004

Background: Development of efficient and effective systems is one of the aims of Medical centers.Standards are criteria for evaluation of affairs and without them ,evaluation is impossible.this study was carried out to determine the extent of application of standard to Medical records department . Materials and Methods: This is a descriptive study.and all of Kashan Hospitals are enrolled to it. Data were collected by direct observation and completion of a questionnaire about procedures and practices, equipments , environment and personels of medical recording departments of the Hospitals.Collected data were analysed with scaling. Results: Findings showed that scale of paying attention to standards was 61. Procedures and practices had a scale with 55/8. Statistic unit had least scale with 53/5 and coding unit had the highest scale with 65/2. Conclusion: Totally ,paying attention to medical records department standards was in middle level.Lack of procedural standards was the most important defect