Diabetes control and the influence of family functioning

Background: The link between glycaemic control of type 1 diabetes and family functioning is complex, with the existing literature largely focussing upon the association between clear patterns of disturbances in family functioning and suboptimal diabetic control. The more subtle changes to family function that might influence the degree of successful management of a child's diabetes have been less well studied. Methods: This study sought to explore whether suboptimal glycaemic control was associated with variations in family functioning that might not in themselves prompt concern in routine clinic review. The project focussed on families attending for routine follow-up in specialist paediatric diabetes clinics in the North East of England. Mother and child participants provided demographic information and completed the Family Adaptation and Cohesion Evaluation Scale (FACES IV), and the quality of their glycaemic control was assessed using the mean HbA1c value for each child over the last year. Families with clear emotional or family difficulties, or where the level of control was causing clear concern were excluded (as were families where there was major physical or a member with significant learning disabilities). The sample was divided into two groups; families whose children were in optimal glycaemic control of their diabetes, and families where the glycaemic control was suboptimal. Results: Whatever the degree of control, nearly all the mothers and index children reported functioning within the balanced range. The mothers of children with optimal glycaemic control reported their family to be more cohesive and expressed greater satisfaction with family life than mothers whose child's glycaemic control was suboptimal. The children with suboptimal diabetic control also tended to view their family life as more chaotic. Discussion: Despite the challenges most families cope reasonably well with the issues that managing type 1 diabetes in a child bring. However suboptimal control tends to be associated with some unhelpful family issues, and the implications for intervention are discussed. Conclusions: Suboptimal control, when it is present, prompts exploration of a wide range of factors. Assessment of family functioning should be part of this process, even if there is no evidence of major family difficulties because subtle distortions in functioning can significantly influence glycaemic control, especially in early adolescence

The Relationship of Mental Health & Family Functioning with Maintaining Optimal Glycaemic Control in Type 1 Diabetes

The association between glycaemic control of type 1 diabetes and mental health issues within the family is well recognised, but the degree of difficulty that is associated with modest sub-optimal control is not. 66 families agreed to take part in the study, and they were divided into two groups according to the quality of metabolic control (good or sub-optimal). Of the 37 boys, 19 had suboptimal metabolic control, and of the 27 girls, 15 did not have a good control. Mother and child participants provided demographic information, and mothers completed the 28-item General Health Questionnaire (GHQ), the revised version of the Swanson, Nolan and Pelham Questionnaire (SNAP IV), elements of the Ontario Child Health Scale, and the Family Adaptation and Cohesion Evaluation Scale (FACES IV). The results from these scales were compared to the quality of the children’s glycaemic control. Sub-optimal control was associated with the increased emotional symptoms and behavioural difficulties in the young person (p < 0.0001), and increased mental health difficulties in their mothers (p < 0.001). These elements had an adverse impact on the level of satisfaction with family life. Having sub-optimal glycaemic control is associated with an increased risk of having mental health symptoms, and a possible mechanism for this association is explored. Even modest deterioration in a family’s mental health can have an adverse effect upon glycaemic control, and should be assessed as a routine in review clinics

Nimbin Mardi Grass Festival: managing the impacts

The Mardi Grass Festival is an annual political rally against the illegality of cannabis (Help End Marijuana Prohibition) as well as a celebration and demonstration of alternative lifestyle choices. Held at the time of the cannabis harvest, the festival runs for three days over the long weekend in May. A survey of those attending the festival was conducted in 1997 and again in 1999 to examine certain aspects of managing the festival. The surveys collected information on demographics and expenditure as well as both visitor and resident perceptions. Also, interviews with event organisers and other information collected from business, media and other sources provided considerable insight into the impacts of the festival on the local and regional community. A comparison is made of the economic benefits realised in the local Nimbin economy from the two festivals, by event organisers and participants, and local and regional retailers and suppliers. Issues such as leakage of festival benefits out of Nimbin are considered as a result of the study. From social and cultural perspectives, Mardi Grass generates substantial interest. The festival is an avenue for developing non traditional creative and artistic expression. Values and beliefs that underpin alternative lifestyle approaches are reinforced. Similarly, it generates interest and even greater awareness of the political issues that motivate the event. The controversial substance of the celebration attracts the inquisitive who may be only seeking non committal entertainment value. Further, it reminds of the tensions created within communities by a desire to protest against particular freedoms. The role of management in minimising negative impacts on a range of environments was central to this study. This includes the impact of festival visitors on other local infrastructure. Similarly, marketing and management opportunities and recommendations are made as a result of the findings

Stakeholders, industry knowledge and adaptive management in the Australian whale-watching industry

Whale watching has become an economically valuable tourism sector. The whale-watching industry is complex, involves multiple stakeholders and can involve multilevel governance. This paper uses the concept of adaptive management to underpin an investigation of industry knowledge and information exchange between two key stakeholder groups in whale watching in Australia – whale-watching operators and environmental resource managers. Twenty commercial operators and nine environmental resource managers were interviewed using both quantitative and open-ended questions. Findings showed key differences between stakeholders involved, and inconsistent perspectives across the industry. Resource managers found biological issues, species health and numbers and interpretation important; operators sought clear and consistent knowledge on compliance, legislation and rules. Only half of the operators had direct access to research and researchers. Managers found the industry to be relatively unprofessionally qualified, especially small and non-specialised operators. Whale-watching operators did not specify that any information (about new knowledge, regulations or policy) was obtained from environmental resource managers through information exchanges. There was inconsistent contact between stakeholders, limiting information exchange and the knowledge-building potential of the industry. Improved dialogue between these groups may not only address existing uncertainties, but also lead to more sustainable outcomes across the industry

Young people who cut themselves: a growing challenge for educational settings

There has been an increasing pattern of young people seeking to cope with the stresses of modern life by acts of self-harm. The frequency of this has been estimated by one review as between one in 12 and one in 15 across the UK. In this article, Margaret Dimmock, family therapist, Sue Grieves, community psychiatric nurse, both of whom work for the Child and Adolescent Mental Health Service in Hartlepool, and Maurice Place, Professor of Child and Family Psychiatry at Northumbria University, report the results of a survey carried out in a large comprehensive secondary school in the North of England, where the rate of self-destructive behaviour was found to be at least 9.8%. The reasons for this behaviour are explored when the authors look at the differences in coping behaviour that these young people show compared with their peers. The results from this project indicate that, within this sample of young people, there is a tendency to worry far more; to feel rather remote from peers; and to feel less able to cope with setbacks. Drawing on these findings, Margaret Dimmock, Sue Grieves and Maurice Place discuss some approaches that might help young people to avoid self-harming behaviour in future

Manajemen Personalia

330 hal.;21 C

The intellectual culture of the English country house, 1500-1700

This is a ground-breaking collection of essays by leading and emerging scholars, which uncovers the vibrant intellectual life of early modern provincial England. The essays in the volume explore architectural planning, libraries and book collecting, landscape gardening, interior design, the history of science and scientific experimentation, and the collection of portraits and paintings