The effectiveness of adding cognitive behavioural therapy aimed at changing lifestyle to managed diabetes care for patients with type 2 diabetes: design of a randomised controlled trial

<p>Abstract</p> <p>Background</p> <p>In patients with type 2 diabetes, the risk for cardiovascular disease is substantial. To achieve a more favourable risk profile, lifestyle changes on diet, physical activity and smoking status are needed. This will involve changes in behaviour, which is difficult to achieve. Cognitive behavioural therapies focussing on self-management have been shown to be effective. We have developed an intervention combining techniques of Motivational Interviewing (MI) and Problem Solving Treatment (PST). The aim of our study is to investigate if adding a combined behavioural intervention to managed care, is effective in achieving changes in lifestyle and cardiovascular risk profile.</p> <p>Methods</p> <p>Patients with type 2 diabetes will be selected from general practices (n = 13), who are participating in a managed diabetes care system. Patients will be randomised into an intervention group receiving cognitive behaviour therapy (CBT) in addition to managed care, and a control group that will receive managed care only. The CBT consists of three to six individual sessions of 30 minutes to increase the patient's motivation, by using principles of MI, and ability to change their lifestyle, by using PST. The first session will start with a risk assessment of diabetes complications that will be used to focus the intervention.</p> <p>The primary outcome measure is the difference between intervention and control group in change in cardiovascular risk score. For this purpose blood pressure, HbA_1c, total and HDL-cholesterol and smoking status will be assessed. Secondary outcome measures are quality of life, patient satisfaction, physical activity, eating behaviour, smoking status, depression and determinants of behaviour change. Differences between changes in the two groups will be analysed according to the intention-to-treat principle, with 95% confidence intervals. The power calculation is based on the risk for cardiovascular disease and we calculated that 97 patients should be included in every group.</p> <p>Discussion</p> <p>Cognitive behavioural therapy may improve self-management and thus strengthen managed diabetes care. This should result in changes in lifestyle and cardiovascular risk profile. In addition, we also expect an improvement of quality of life and patient satisfaction.</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN12666286</p

Optimizing lifetime reproductive output: intermittent breeding as a tactic for females in a long-lived, multiparous mammal

In iteroparous species, intermittent breeding is an important life‐history tactic that can greatly affect animal population growth and viability. Despite its importance, few studies have quantified the consequences of breeding pauses on lifetime reproductive output, principally because calculating lifetime reproductive output requires knowledge of each individual's entire reproductive history. This information is extremely difficult to obtain in wild populations. We applied novel statistical approaches that account for uncertainty in state assessment and individual heterogeneity to an 18‐year capture–recapture dataset of 6,631 female southern elephant seals from Macquarie Island. We estimated survival and breeding probabilities, and investigated the consequences of intermittent breeding on lifetime reproductive output. We found consistent differences in females’ demographic performance between two heterogeneity classes. In particular, breeding imbued a high cost on survival in the females from the heterogeneity class 2, assumed to be females of lower quality. Individual quality also appeared to play a major role in a female's decision to skip reproduction with females of poorer quality more likely to skip breeding events than females of higher quality. Skipping some breeding events allowed females from both heterogeneity classes to increase lifetime reproductive output over females that bred annually. However, females of lower quality produced less offspring over their lifetime. Intermittent breeding seems to be used by female southern elephant seals as a tactic to offset reproductive costs on survival and enhance lifetime reproductive output but remains unavoidable and driven by individual‐specific constraints in some other females

Origin, Persistence, and Resolution of the Rotational Grazing Debate: Integrating Human Dimensions Into Rangeland Research

The debate regarding the benefits of rotational grazing has eluded resolution within the US rangeland profession for more than 60 yr. This forum examines the origin of the debate and the major reasons for its persistence in an attempt to identify common ground for resolution, and to search for meaningful lessons from this central chapter in the history of the US rangeland profession. Rotational grazing was a component of the institutional and scientific response to severe rangeland degradation at the turn of the 20th century, and it has since become the professional norm for grazing management. Managers have found that rotational grazing systems can work for diverse management purposes, but scientific experiments have demonstrated that they do not necessarily work for specific ecological purposes. These interpretations appear contradictory, but we contend that they can be reconciled by evaluation within the context of complex adaptive systems in which human variables such as goal setting, experiential knowledge, and decision making are given equal importance to biophysical variables. The scientific evidence refuting the ecological benefits of rotational grazing is robust, but also narrowly focused, because it derives from experiments that intentionally excluded these human variables. Consequently, the profession has attempted to answer a broad, complex question—whether or not managers should adopt rotational grazing—with necessarily narrow experimental research focused exclusively on ecological processes. The rotational grazing debate persists because the rangeland profession has not yet developed a management and research framework capable of incorporating both the social and biophysical components of complex adaptive systems. We recommend moving beyond the debate over whether or not rotational grazing works by focusing on adaptive management and the integration of experiential and experimental, as well as social and biophysical, knowledge to provide a more comprehensive framework for the management of rangeland systems.The Rangeland Ecology & Management archives are made available by the Society for Range Management and the University of Arizona Libraries. Contact [email protected] for further information.Migrated from OJS platform August 202