Factors affecting the disclosure of diabetes by ethnic minority patients: a qualitative study among Surinamese in the Netherlands

<p>Abstract</p> <p>Background</p> <p>Diabetes and related complications are common among ethnic minority groups. Community-based social support interventions are considered promising for improving diabetes self-management. To access such interventions, patients need to disclose their diabetes to others. Research on the disclosure of diabetes in ethnic minority groups is limited. The aim of our study was to explore why diabetes patients from ethnic minority populations either share or do not share their condition with people in their wider social networks.</p> <p>Methods</p> <p>We conducted a qualitative study using semi-structured interviews with 32 Surinamese patients who were being treated for type 2 diabetes by general practitioners in Amsterdam, the Netherlands.</p> <p>Results</p> <p>Most patients disclosed their diabetes only to very close family members. The main factor inhibiting disclosure to people outside this group was the Surinamese cultural custom that talking about disease is taboo, as it may lead to shame, gossip, and social disgrace for the patient and their family. Nevertheless, some patients disclosed their diabetes to people outside their close family circles. Factors motivating this decision were mostly related to a need for facilities or support for diabetes self-management.</p> <p>Conclusions</p> <p>Cultural customs inhibited Surinamese patients in disclosing their diabetes to people outside their very close family circles. This may influence their readiness to participate in community-based diabetes self-management programmes that involve other groups. What these findings highlight is that public health researchers and initiatives must identify and work with factors that influence the disclosure of diabetes if they are to develop community-based diabetes self-management interventions for ethnic minority populations.</p

The parent?infant dyad and the construction of the subjective self

Developmental psychology and psychopathology has in the past been more concerned with the quality of self-representation than with the development of the subjective agency which underpins our experience of feeling, thought and action, a key function of mentalisation. This review begins by contrasting a Cartesian view of pre-wired introspective subjectivity with a constructionist model based on the assumption of an innate contingency detector which orients the infant towards aspects of the social world that react congruently and in a specifically cued informative manner that expresses and facilitates the assimilation of cultural knowledge. Research on the neural mechanisms associated with mentalisation and social influences on its development are reviewed. It is suggested that the infant focuses on the attachment figure as a source of reliable information about the world. The construction of the sense of a subjective self is then an aspect of acquiring knowledge about the world through the caregiver's pedagogical communicative displays which in this context focuses on the child's thoughts and feelings. We argue that a number of possible mechanisms, including complementary activation of attachment and mentalisation, the disruptive effect of maltreatment on parent-child communication, the biobehavioural overlap of cues for learning and cues for attachment, may have a role in ensuring that the quality of relationship with the caregiver influences the development of the child's experience of thoughts and feelings

Plasma glucose alone does not predict neurologic dysfunction in hypoglycemic nondiabetic subjects

Study objective: To assess the value of plasma glucose concentration alone as a predictor of neurologic dysfunction in nondiabetic subjects with normal baseline neurologic examination and electroencephalographic (EEG) findings. Methods: Neurologic function and EEG results were evaluated in 17 subjects before and during insulin-induced hypoglycemia using relevant and reliable clinical tools for bedside use. Results: Hypoglycemia (mean nadir concentration, 30 mg/dL) was without effect on level of consciousness or cranial nerve, motor, sensory, vestibulocerebellar, language, or simple visuospatial functions. Attention was minimally impaired in all subjects, but memory in only 3. EEG results remained normal in 5 subjects; minimal to moderate nonspecific changes occurred in the rest. All patients manifested signs of sympathetic stimulation from hypoglycemia, including tremor, tachycardia, and diaphoresis. The manifestations of neuroglycopenia did not correlate significantly with nadir plasma glucose or duration of hypoglycemia. Conclusion: Moderately severe hypoglycemia of short duration can be neurologically occult, or subtle inattention can be its first and only clinical manifestation. Our findings are at variance with reports in the emergency medicine literature in which marked deficits are universally present at glucose concentrations equal to those attained in this study. This discrepancy suggests that the expression of neuroglycopenia is multifactorially determined and that plasma glucose concentration alone does not predict neurologic dysfunction in nondiabetic subjects with normal baseline neurologic examinations

Psychogenic movement disorders

The diagnosis of PMDs is by no means a simple task. Organic movement disorders are more often misdiagnosed as psychogenic rather than the reverse. The degree to which psychological factors underlie movement disorders may range from being the exclusive cause to being a reaction to the movement disorder. The most common psychiatric illnesses associated with PMDs are depression, conversion reactions, and anxiety disorders. Although the diagnosis of psychogenicity may seem elusive, the definitions and diagnostic criteria of PMDs outlined in this article serve as useful guidelines for obtaining a more accurate diagnosis. The emphasis on a multidisciplinary approach with a strong alliance of neurologist and psychologist or psychiatrist is essential to assure proper diagnoses and treatment

Predicting long-term outcome in individuals at risk for Alzheimer\u27s disease with the dementia rating scale

The Dementia Rating Scale, previously shown to be sensitive to dementia progression, was used to differentiate among normal control subjects, patients with Alzheimer\u27s disease (AD), and those judged to be at risk for AD on the basis of subclinical memory impairment. The memory scale of the Dementia Rating Scale predicted with 93% accuracy which at-risk individuals would develop AD at 4- to 6-year follow-up

Differentiating Alzheimer\u27s disease from Huntington\u27s disease with the Wechsler Memory Scale-Revised

The WMS-R represents a significant improvement over the original version of the WMS. Patterns of performance on the five WMS-R indices successfully differentiated patients with a \u27cortical\u27 (that is, DAT) from patients with a \u27subcortical\u27 (that is, HD) dementia. The differences between ACI and GMI also indicated that DAT patients\u27 attention and concentration were better preserved than those of equally demented HD patients. Analyses of the differences between GMI and DMI indicated that rapid forgetting was more apparent for DAT than for HD patients in the early stages of these disorders. When savings scores for the Logical Memory and Visual Reproduction tests were used to examine retention over a 30-minute period, both mildly and moderately demented DAT patients demonstrated more rapid forgetting than did HD patients with similar levels of cognitive decline. Disciminant analyses performed with these indices of forgetting showed 95 per cent accurate classification of DAT and elderly controls, and 79 per cent correct classification of DAT and HD patients. Assessment of the patients\u27 tendencies to make prior-item intrusion errors on the Visual Reproduction tests of the WMS and WMS-R yielded significant differences between patient groups and the two versions of the test. Patients with DAT made significantly more prior-figure intrusion errors than did HD patients on both versions of the VRT, but the original WMS form of this figural memory test was more likely to elicit such errors than was the revised version. Despite many improvements in the revised scale, a number of limitations still exist including standardization and a lack of norms for elderly individuals, as well as failures to include tests of verbal recognition and adequate measures of nonverbal memory

Influence of demographic variables on the dementia rating scale

Demographic characteristics influence many cognitive assessment tools. We evaluated the impact of age, education, and gender on the Dementia Rating Scale (DRS) in a sample of 212 normal people. Separate regression analyses revealed that age was the most potent demographic factor, whereas education and gender had little impact. However, the amount of variance accounted for by age was small (less than 20%). Clinical utility of age-adjusted DRS total score cut-offs was investigated in samples of Alzheimer\u27s and Parkinson\u27s disease patients. Hit rate analysis revealed greater sensitivity for a single cut-off value than age-corrected cut-off scores. Overall, these findings revealed the lack of a clinically meaningful relationship between demographic characteristics and DRS scores, suggesting that age, education, and gender can be ignored for interpretative purposes based on cut-off scores