The needs, concerns and characteristics of younger Australian adults with Type 2 diabetes

Aims : The mean age of onset of Type 2 diabetes mellitus is decreasing in Australia and internationally. We conducted an internet-based survey to improve our understanding of the emotional well-being and unmet needs of younger adults with Type 2 diabetes, and to inform service provision for this group.Methods : A random sample of National Diabetes Services Scheme registrants (n = 1,417) with Type 2 diabetes, aged 18&ndash;39 years, living in the Australian state of Victoria received an invitation to complete the online survey. The study was also advertised state-wide. The survey included validated scales (PAID-5: diabetes-related distress; WHO-5: general emotional well-being) and study-specific items. A total of 149 eligible respondents participated.Results : Almost two-thirds (63%) of respondents reported severe-diabetes related distress; more than a quarter (27%) had impaired general emotional well-being. Most (82%) were overweight or obese (BMI &ge; 25); most (77%) had at least one other co-morbidity. Lack of motivation, feeling burned out, and being time-poor were identified as top barriers to self-management. More than half (59%) of respondents had not participated in structured diabetes education. Respondents perceived that younger adults with Type 2 diabetes had different health-care needs than their older counterparts (68%), and that most Type 2 diabetes information/services were aimed at older adults (62%). Of a range of potential new services, respondents indicated greatest interest in an online forum specifically for younger adults with Type 2 diabetes.Conclusions : Younger adults with Type 2 diabetes have impaired emotional well-being and physical health. Population-based research is needed to confirm the current findings, to further inform service delivery and optimise outcomes for this group.<br /

Acceptability of a physiotherapeutic pain school treatment in trauma-affected populations in the Middle Eastern & Northern African region

Introduction: The aim of this study was to evaluate the acceptability of a physiotherapeutic pain treatment (Pain School), focusing on patient education, physical exercises and self-reliance, and a capacity building program developed for MENA based physiotherapists working with pain and trauma-affected populations.Method: The perceived benefits and challenges of the physiotherapy Pain School treatment were evaluated through qualitative interviews with seven physiotherapists participating in the Pain School training program. The acceptability and feasibility of the treatment manual and training program of the physiotherapists was evaluated. The preliminary results of the Pain School treatment were also analyzed with a paired-sample t-test pre- and post-treatment in 38 patients suffering from persistent pain and trauma-related stress in the MENA region. Results:&nbsp;The qualitative analysis showed good feasibility and high acceptance among the participating physiotherapists of this physiotherapeutic treatment and training program. The pre- to post-treatment evaluation of Pain School, also gave an indication of positive treatment effects. Monitoring and evaluation of treatment was found useful, but indications of mental health status were evaluated to be missing. Due to other limitations, such as author biases (authors carrying out training, interviews and analyzing qualitative results) and no control group, the results from this study do not provide a final conclusion on the training program nor treatment effects. Nevertheless, this study is an important first step to offer evidence-based standardized treatment for pain and trauma-affected populations in the MENA region

Acceptability of a physiotherapeutic pain school treatment in trauma-affected populations in the Middle Eastern & Northern African region

Introduction: The aim of this study was to evaluate the acceptability of a physiotherapeutic pain treatment (Pain School), focusing on patient education, physical exercises and self-reliance, and a capacity building program developed for MENA based physiotherapists working with pain and trauma-affected populations.Method: The perceived benefits and challenges of the physiotherapy Pain School treatment were evaluated through qualitative interviews with seven physiotherapists participating in the Pain School training program. The acceptability and feasibility of the treatment manual and training program of the physiotherapists was evaluated. The preliminary results of the Pain School treatment were also analyzed with a paired-sample t-test pre- and post-treatment in 38 patients suffering from persistent pain and trauma-related stress in the MENA region. Results:&nbsp;The qualitative analysis showed good feasibility and high acceptance among the participating physiotherapists of this physiotherapeutic treatment and training program. The pre- to post-treatment evaluation of Pain School, also gave an indication of positive treatment effects. Monitoring and evaluation of treatment was found useful, but indications of mental health status were evaluated to be missing. Due to other limitations, such as author biases (authors carrying out training, interviews and analyzing qualitative results) and no control group, the results from this study do not provide a final conclusion on the training program nor treatment effects. Nevertheless, this study is an important first step to offer evidence-based standardized treatment for pain and trauma-affected populations in the MENA region

History of Foot Ulcer Increases Mortality Among Individuals With Diabetes: Ten-year follow-up of the Nord-Trøndelag Health Study, Norway

OBJECTIVE To compare mortality rates for individuals with diabetes with and without a history of foot ulcer (HFU) and with that for the nondiabetic population. RESEARCH DESIGN AND METHODS This population-based study included 155 diabetic individuals with an HFU, 1,339 diabetic individuals without an HFU, and 63,632 nondiabetic individuals who were all followed for 10 years with mortality as the end point. RESULTS During the follow-up period, a total of 49.0% of diabetic individuals with an HFU died, compared with 35.2% of diabetic individuals without an HFU and 10.5% of those without diabetes. In Cox regression analyses adjusted for age, sex, education, current smoking, and waist circumference, having an HFU was associated with more than a twofold (2.29 [95% CI 1.82–2.88]) hazard risk for mortality compared with that of the nondiabetic group. In corresponding analyses comparing diabetic individuals with and without an HFU, an HFU was associated with 47% increased mortality (1.47 [1.14–1.89]). Significant covariates were older age, male sex, and current smoking. After inclusion of A1C, insulin use, microalbuminuria, cardiovascular disease, and depression scores in the model, each was significantly related to life expectancy. CONCLUSIONS AN HFU increased mortality risk among community-dwelling adults and elderly individuals with diabetes. The excess risk persisted after adjustment for comorbidity and depression scores, indicating that close clinical monitoring might be warranted among individuals with an HFU, who may be particularly vulnerable to adverse outcomes. Hospital-based studies have shown that mortality rates in individuals with diabetic foot ulcers are about twice those observed in individuals with diabetes without foot ulcers (1,2). A diabetic foot ulcer reflects the presence of underlying pathological conditions, and the risk of recurrent ulcers is high (3,4). It has been suggested that the elevated mortality rate among individuals with diabetic foot ulcers is related to comorbid disease such as cardiovascular disease and nephropathy (5) or to psychological factors including depression (6). Although the mortality rate in individuals with diabetes is high, no large population-based studies have examined the impact on mortality of a history of foot ulcers (HFU) among individuals with diabetes. The purpose of this study was to compare mortality rates for individuals with diabetes reporting an HFU with those for individuals without an HFU and the nondiabetic population. These issues were investigated in the Nord-Trøndelag Health Study (HUNT 2), which includes a very large population-based sample of men and women from a well-defined geographic area. Participants with self-reported diabetes were well characterized with regard to their diabetes, and information on demographics, lifestyle, and prevalent disease including depression was available

Sense of coherence and attrition during four-year follow-up in cohorts of permanent and non-permanent Finnish employees

<p>Abstract</p> <p>Background</p> <p>We studied whether health resources, measured as sense of coherence (SOC), are associated with participation in a follow-up survey among permanent and non-permanent employees who responded at baseline.</p> <p>Methods</p> <p>Of a cohort of 5,981 permanent employees, those who after four years were still in the service of the same employer were asked to participate in a follow-up survey. Another cohort consisted of 2,194 fixed-term and 682 subsidised employees; among these the follow-up survey was posted to those whose addresses were found in the population register. Non-participation was divided into loss to follow-up (i.e., failure to locate the individual, death and, among permanent employees, turnover or exit from labour market) and non-response to the follow-up survey. Logistic regression analyses were used to examine whether the respondents differed from the non-respondents with respect to SOC and other characteristics at baseline.</p> <p>Results</p> <p>Among permanent employees the follow-up survey yielded 3,998 respondents, 1,051 were lost, and 932 did not reply. Among non-permanent employees the follow-up survey yielded 1,563 respondents on initially fixed-term and 467 on subsidised contracts, the corresponding figures for those lost were 145 and 38, and for the non-respondents 486 and 177. Low SOC was associated with lower response rate among fixed-term but not among permanent or subsidised employees. No association was found between SOC and loss to follow-up.</p> <p>Conclusion</p> <p>SOC is a potential source of non-random sample attrition and should be taken into account for when estimating bias due to non-participation in occupational cohorts that include fixed-term employees.</p