Walking behaviour and glycemic control in type 2 diabetes: seasonal and gender differences-Study design and methods

BACKGROUND: The high glucose levels typically occurring among adults with type 2 diabetes contribute to blood vessel injury and complications such as blindness, kidney failure, heart disease, and stroke. Higher physical activity levels are associated with improved glycemic control, as measured by hemoglobin A1C. A 1% absolute increase in A1C is associated with an 18% increased risk for heart disease or stroke. Among Canadians with type 2 diabetes, we postulate that declines in walking associated with colder temperatures and inclement weather may contribute to annual post-winter increases in A1C levels. METHODS: During this prospective cohort study being conducted in Montreal, Quebec, Canada, 100 men and 100 women with type 2 diabetes will undergo four assessments (once per season) over a one-year period of observation. These assessments include (1) use of a pedometer with a concealed viewing window for a two-week period to measure walking (2) a study centre visit during which venous blood is sampled for A1C, anthropometrics are assessed, and questionnaires are completed for measurement of other factors that may influence walking and/or A1C (e.g. food frequency, depressive symptomology, medications). The relationship between spring-fall A1C difference and winter-summer difference in steps/day will be examined through multivariate linear regression models adjusted for possible confounding. Interpretation of findings by researchers in conjunction with potential knowledge "users" (e.g. health professionals, patient groups) will guide knowledge translation efforts. DISCUSSION: Although we cannot alter weather patterns to favour active lifestyles, we can design treatment strategies that take seasonal and weather-related variations into account. For example, demonstration of seasonal variation of A1C levels among Canadian men and women with T2D and greater understanding of its determinants could lead to (1) targeting physical activity levels to remain at or exceed peak values achieved during more favourable weather conditions. Strategies may include shifting to indoor activities or adapting to less favourable conditions (e.g. appropriate outdoor garments, more frequent but shorter duration periods of activity) (2) increasing dose/number of glucose-lowering medications during the winter and reducing these during the summer, in anticipation of seasonal variations (3) examining the impact of bright light therapy on activity and A1C among T2D patients with an increase in depressive symptomology when sunlight hours decline

Authentic leadership and psychological well-being at work of nurses: The mediating role of work climate at the individual level of analysis

Authentic leadership has been purported to influence psychological well-being through its impact on work climate. Using a sample of 406 nurses, a time-lagged study design was employed to determine the mediational role of work climate in explaining the impact of authentic leadership. Two self-reported questionnaires were completed to ascertain: (1) authentic leadership; and (2) work climate at baseline. In addition, nurses completed a measure to determine their level of psychological well-being at work at the 6 month time period. A mediation analysis with the use of a bootstrapping technique reveals that work climate mediates the relationship between authentic leadership and psychological well-being at work. These findings indicate that authentic leadership impacts the work climate in a positive manner; thereby, increasing levels of psychological well-being at work. We discuss theoretical and practical implications of the findings for future research as well as outline some limitations

Participants’ Perceptions of a Group Based Program Incorporating Hands-On Meal Preparation and Pedometer-Based Self-Monitoring in Type 2 Diabetes

Nutrition education (portion sizes, balanced meals) is a cornerstone of diabetes management; however, moving from information to behavior change is challenging. Through a single arm intervention study, we recently demonstrated that combining education with group-based meal preparation training has measureable effects on weight, eating behaviour, and glycemic control in adults with type 2 diabetes. In the present study, we conducted an in-depth examination of participants’ perceptions of this strategy, through focus group discussion, to delineate effective elements of the strategy from participants’ perspectives.Participants who had completed the nutrition education/meal preparation training program were invited to attend one of four focus group discussions. These were led by experienced facilitators and guided by questions addressing experiences during the intervention and their perceived impact. Audiotapes were transcribed and qualitative content analysis of transcripts was performed. We report herein themes that achieved saturation across the four discussions.Twenty-nine (80.6%, 29/36) attended a focus group discussion. The program elements perceived as effective by participants included the hands-on interactive learning approach to meal preparation, the grocery store tour, pedometer-based self-monitoring, experiencing the link between food consumption/physical activity and glucose changes during the program, and peer support. Discussants reported changes in eating and walking behaviour, greater confidence in ability to self-manage diabetes, reductions in glucose levels and/or need for glucose-lowering medications, and, in some cases, weight loss. Family members and friends were facilitators for some and barriers for others in terms of achieving health behavior changes.Among adults with type 2 diabetes, a group based program that included hands-on meal preparation and pedometer-based self-monitoring was perceived as effective in conveying information, developing skills, building confidence, and changing health behaviors

Evaluating Health-Related Quality-of-Life Studies in Paediatric Populations: Some Conceptual, Methodological and Developmental Considerations and Recent Applications

Although numerous paediatric-based health-related quality-of-life (HR-QOL) instruments are currently in use, there still remain conceptual, methodological and developmental issues to address. This paper provides an up-to-date critical review of the HR-QOL literature in paediatric medicine. Our analysis indicates that there is no consensus on how HR-QOL and overall QOL should be defined and measured in children. It is recommended that future studies focus on operationalising and distinguishing these constructs from each other and from traditional health-status measures. A clear empirical basis for generating instrument items and for prioritising specific domains must be described. Researchers should consider using the data gathered during their first interviews as a springboard from which to test their ideas of HR-QOL and QOL, reformulate concepts and subsequently retest their notions before developing instruments. Related to methodological challenges, consistency and agreement are still used interchangeably when comparing child and parent reports of children's HR-QOL. The Pearson correlation is a measure of co-variation in scores, and not a measure of agreement. We recommend that researchers focus on determining agreement as opposed to consistency. Few, if any, attempts have been made to account for the possibility that a response shift may have occurred in the evaluation of HR-QOL. Most studies have compared HR-QOL scores of children with illness with their healthy peers. As such, there is a dearth of knowledge regarding the normative process of adaptation within the context of illness. It is recommended that researchers focus on gathering data using a relative standard of comparison. We further recommend that researchers interpret HR-QOL data in line with their intended purpose. Regarding developmental consideration, particular attention ought to be paid to developing instruments that consider children's emerging sense of self, cognitive capacity and emotional awareness. Instruments that include items that are age appropriate are more likely to maximise reliability and validity of reports. The results of many HR-QOL instruments are applied in pharmacotherapeutic and pharmacoeconomic assessments. However, there has been relative infrequent application of economically valid HR-QOL tools (utility scales) and the use of HR-QOL scales as outcome measures in paediatric drug trials. As such, few cost-utility analyses have been performed to inform paediatric decision making. In addition, many of the concerns in the development of HR-QOL instruments should also be applied to the utility scales such that they reflect adequately children's preferences for health states.Children, Quality-of-life-rating-scales

Further Study of “Care Partnerships”: The Rheumatology Perspective

Abstract: Objective: We have previously described rheumatology ‘care partnerships ’ from the perspective of Quebec family doctors. Our current objective was to describe the perceptions of rheumatologists regarding rheumatology ‘care partnerships’. Methods: Practicing Quebec adult rheumatologists (N=100) were mailed a questionnaire, asking them to rate, on a 5-point scale, factors of importance regarding their relationship with family physicians. A factor was considered to be ranked as high importance to the rheumatologist, if the factor was scored as>4. Results: Of the 100 rheumatologists contacted, 56 completed the survey. All but one of the respondents (n=55) ranked communication and information exchange, as being of high importance. Clear and appropriate balance of responsibilities was also considered very important by most respondents (n=47, 84%) as was appropriateness of referrals from the family physicians (n=42, 75%). Personal knowledge of the family physician (n=19, 34%) and physical proximity to the family physician (n=7, 13%) were less frequently ranked as important to rheumatologists. Conclusion: Along with our previous work, these results confirm that rheumatologists and family doctors share similar values when it comes to rheumatology “care partnerships”. Further study of how to optimize relationships between family physicians and specialists would be of interest

Focus Group Interview Questions.

<p>Focus Group Interview Questions.</p

Schematic summary of focus group themes and their possible inter-relationships.

<p>The program tested included group-based hands-on meal preparation training under the supervision of a dietitian and chef, a grocery store tour, and pedometer-based self-monitoring. Focus group analyses indicate that the program led to a perception of peer and professional support, greater skills in meal preparation, more knowledge of healthy food choices and combinations, and greater awareness of step counts through pedometer-based self-monitoring. These stimulated changes in eating and physical activity behaviours and witnessing of impact on glucose levels. This enhanced self-efficacy in terms of diabetes management. In many cases, program participation stimulated health-related discussion at home; family interest and engagement enhanced the program’s effects. Lack of such engagement from family or friends, however, posed a barrier to improvement for some.</p