Predictors of health-related quality of life in type II diabetic patients in Greece

<p>Abstract</p> <p>Background</p> <p>Diabetes Mellitus (DM) is a major cause of morbidity and mortality affecting millions of people worldwide, while placing a noteworthy strain on public health funding. The aim of this study was to assess health-related quality of life (HRQOL) of Greek Type II DM patients and to identify significant predictors of the disease in this patient population.</p> <p>Methods</p> <p>The sample (N = 229, 52.8% female, 70.0 years mean age) lived in a rural community of Lesvos, an island in the northeast of the Aegean Archipelagos. The generic SF-36 instrument, administered by trainee physicians, was used to measure HRQOL. Scale scores were compared with non-parametric Mann-Whitney and Kruskal-Wallis tests and multivariate stepwise linear regression analyses were used to investigate the effect of sociodemographic and diabetes-related variables on HRQOL.</p> <p>Results</p> <p>The most important predictors of impaired HRQOL were female gender, diabetic complications, non-diabetic comorbidity and years with diabetes. Older age, lower education, being unmarried, obesity, hypertension and hyperlipidaemia were also associated with impaired HRQOL in at least one SF-36 subscale. Multivariate regression analyses produced models explaining significant portions of the variance in SF-36 subscales, especially physical functioning (R²= 42%), and also showed that diabetes-related indicators were more important disease predictors, compared to sociodemographic variables.</p> <p>Conclusion</p> <p>The findings could have implications for health promotion in rural medical practice in Greece. In order to preserve a good HRQOL, it is obviously important to prevent diabetes complications and properly manage concomitant chronic diseases. Furthermore, the gender difference is interesting and requires further elucidation. Modifying screening methods and medical interventions or formulating educational programs for the local population appear to be steps in the correct direction.</p

Tillit &amp; kontroll i rikets tjänst : En kvalitativ fallstudie om förvaltningsstyrning inom utrikesförvaltningen

This paper aims to highlight the Swedish foreign administration and its governance. This part of the Swedish administrative bureaucracy traces its roots to the war-ravaged 17th century and is a remarkably flexible, albeit traditional, case within the Swedish bureaucracy. The paper encompasses the governmental, departmental and agency level in relation to governance. It explores the bureaucracy’s boundedness to the dichotomous relationship of trust and control.  The paper is theory-consuming and conceptualises two logics of governance through a revisit of the antique concepts of techne and phronesis in relation to the Weberian and Hegelian interpretations of a modern bureaucracy. This is further accomplished through gathering a plethora of theoretical perspectives within the concepts of bureaucracy, governance-government and rationality. The material covers both formal tools of government as well as informal governance methods. More precisely, the material mainly consists of regulation-letters and the experiences of several ambassadors. The analysis is carried out through a hermeneutical method. The results show, somewhat unsurprisingly, that the governance encompasses logics within both the Weberian and Hegelian school of thought. Rather, it suggests that this branch of the administrative bureaucracy does not differ too much from the rest in the sense of how logics are applied to governance. However, the study finds more variation in between the different sets of agencies within the foreign bureaucracy. On the one hand, some agencies are governed through technical instructions and economic incitements. The embassies, on the other hand, are governed with a large amount of trust ensued, while also being under strict consequences if deemed necessary. Within the embassies themselves, the governance is largely based on ad-hoc and professionalism, appealing to the idea of phronesis. A further development of the Swedish foreign policy is also highlighted, where the future of its modelling seems to lean more towards a logic of traditional self-interest of the state.

DEN GAMLA VÄGEN FÖR EN NY TID : En idéanalys av konservatismen applicerat på segregationens kontemporära problem i Sverige

The purpose of the study at hand is to convey a conservative theoretical perspective on the contemporary issues of segregation in Sweden. The aim has been to forth bring answers from a presented definition of conservatism through an idea analysis, which contains the main points of the conservative formation of ideas. The execution of the study is made through the method of Badersten’s “given-that analysis”. The aforementioned ideas are based on the works of mostly prominent conservative thinkers; Edmund Burke, Michael Oakeshott, Russell Kirk, John Kekes and, last but not least, Sir Roger Scruton. These are furthermore applied to three aspects of the concept of segregation, namely ethnic, socioeconomic, and city-and-landsegregation.  In conclusion, the result contains a variety of possible solutions that are contextually bound to the situation in Sweden. These solutions, or answers, are based on typical conservative beliefsand perceptions of concepts concerning rationalism, the little platoons, historical experience, freedom, class and justice, and nationalism. The solutions that are drawn from these concepts consists of answers such as the need to increase the level of individual responsibility both in terms of the individual herself as well as in relation to the state. Another point made is that regarding the importance of a common culture with a set of norms that firmly stands as the reference point throughout society. Also, a reactive response to increase the respect and authority of the law enforcement is determined.

How to write a research proposal

A structured written research proposal is a necessary requirement when making an application for research funding or applying to an ethics committee for approval of a research project. A proposal is built up in sections of theoretical background; aim and research questions to be answered; a description and justification of the method chosen to achieve the answer; awareness of the ethical implications of the research; experience and qualifications of the team members to perform the intended study; a budget and a timetable. This paper describes the common steps taken to prepare a written proposal as attractively as possible to achieve fundin

DEN GAMLA VÄGEN FÖR EN NY TID : En idéanalys av konservatismen applicerat på segregationens kontemporära problem i Sverige

The purpose of the study at hand is to convey a conservative theoretical perspective on the contemporary issues of segregation in Sweden. The aim has been to forth bring answers from a presented definition of conservatism through an idea analysis, which contains the main points of the conservative formation of ideas. The execution of the study is made through the method of Badersten’s “given-that analysis”. The aforementioned ideas are based on the works of mostly prominent conservative thinkers; Edmund Burke, Michael Oakeshott, Russell Kirk, John Kekes and, last but not least, Sir Roger Scruton. These are furthermore applied to three aspects of the concept of segregation, namely ethnic, socioeconomic, and city-and-landsegregation.  In conclusion, the result contains a variety of possible solutions that are contextually bound to the situation in Sweden. These solutions, or answers, are based on typical conservative beliefsand perceptions of concepts concerning rationalism, the little platoons, historical experience, freedom, class and justice, and nationalism. The solutions that are drawn from these concepts consists of answers such as the need to increase the level of individual responsibility both in terms of the individual herself as well as in relation to the state. Another point made is that regarding the importance of a common culture with a set of norms that firmly stands as the reference point throughout society. Also, a reactive response to increase the respect and authority of the law enforcement is determined.

Development of an audit instrument for nursing care plans in the patient record

Objectives—To develop, validate, and test the reliability of an audit instrument that measures the extent to which patient records describe important aspects of nursing care. Material—Twenty records from each of three hospital wards were collected and audited. The auditors were registered nurses with a knowledge of nursing documentation in accordance with the VIPS model—a model designed to structure nursing documentation. (VIPS is an acronym formed from the Swedish words for wellbeing, integrity, prevention, and security.) Methods—An audit instrument was developed by determining specific criteria to be met. The audit questions were aimed at revealing the content of the patient for nursing assessment, nursing diagnosis, planned interventions, and outcome. Each of the 60 records was reviewed by the three auditors independently and the reliability of the instrument was tested by calculating the inter-rater reliability coefficient. Content validity was tested by using an expert panel and calculating the content validity ratio. The criterion related validity was estimated by the correlation between the score of the Cat-ch-Ing instrument and the score of an earlier developed and used audit instrument. The results were then tested by using Pearson's correlation coefficient. Results—The new audit instrument, named Cat-ch-Ing, consists of 17 questions designed to judge the nursing documentation. Both quantity and quality variables are judged on a rating scale from zero to three, with a maximum score of 80. The inter-rater reliability coefficients were 0.98, 0.98, and 0.92, respectively for each group of 20 records, the content validity ratio ranged between 0.20 and 1.0 and the criterion related validity showed a significant correlation of r = 0.68 (p< 0.0001, 95% CI 0.57 to 0.76) between the two audit instruments. Conclusion—The Cat-ch-Ing instrument has proved to be a valid and reliable audit instrument for nursing records when the VIPS model is used as the basis of the documentation. (Quality in Health Care 2000;9:6–13) Key Words: audit instrument; nursing care plans; quality assuranc

Alteration of the counterregulatory responses to insulin-induced hypoglycemia and of cognitive function after massive weight reduction in severely obese subjects

The autonomic nervous system (ANS) and hypothalamic-pituitary-adrenal (HPA) axis are reported as activated in excess in the morbidly obese state and, therefore, changes after weight loss can be anticipated. The aim of this study was to investigate the impact of a massive (similar to30%) weight reduction on the activation of the HPA axis and the ANS following bariatric surgery. Eight (7 women, 1 man) severely obese (125 +/- 12 kg; body mass index [BMI], 45 +/- 4 kg/m(2)) nondiabetic subjects, underwent a 3-hour hyperinsulinemic (1,034 pmol/kg/h) glucose clamp study at hypoglycemia of arterial B-glucose concentration of 3.4 mmol/L. Cognitive function was evaluated by a visuospatial computerized problem-solving test, the Perceptual Maze Test (PMT). The mean weight loss was 40 +/- 9 kg approximately 12 months postsurgery when their weight was stabilized (85 6 kg; BMI, 31 +/- 3 kg/m(2)), and insulin sensitivity improved to an average increase of 376% +/- 250% (P < .01) of initial value. Before weight reduction, all patients demonstrated brisk peak responses in glucagon, epinephrine, pancreatic polypeptide (PP), norepinephrine, and cortisol, indicative of preserved or exaggerated activation of ANS and HPA axis. In the reduced-obese state, all these responses were attenuated and most markedly so for glucagon, which was totally abolished. In contrast, the growth hormone (GH) response was increased after weight reduction. The cognitive function was clearly modified by weight reduction both during normoglycemia and hypoglycemia and was changed preferentially to a speed-preferring strategy in the reduced-obese state compared with a more accuracy preferred problem-solving process of PMT test presurgery. These results demonstrate a reduction of the glucose counterregulatory hormonal responses, increased insulin sensitivity, and perturbed cognitive function after massive weight reduction. It may be speculated on if the increased insulin sensitivity and reduced counterregulation to hypoglycemia could predispose to low plasma glucose concentrations