Effect of lifestyle intervention holistic approach on blood glucose levels, health-related quality of life and medical treatment cost in type 2 diabetes mellitus patients

Type 2 Diabetes Mellitus (T2DM) is a costly, lifestyle-related disorder, its management is very critical and challenging hence lifestyle intervention may a cornerstone in the reversal and management of T2DM. This study designed to assess the impact of lifestyle intervention holistic (LIH) Model on blood glucose levels (BGL), Health-Related Quality of Life (HRQOL), and medical treatment cost in T2DM patients. This prospective, quasi-experimental study was conducted among 224 T2DM patients in Delhi Diabetes Research Center (DDRC), New Delhi. The study participants were allocated into two groups-Lifestyle Intervention Counseling (LIC) group received lifestyle-based counseling through the LIH model while the Usual-care group received only standard treatment. Study outcomes were assessed at baseline, 3rd, 6th, and 12th month and data were analyzed through SPSS. Study results revealed that LIC participants had decreased in fasting blood glucose 0.26 mg dL-1(-4.37 to 4.89), blood glucose postprandial -70.16 mg dL-1(-85.15 to -55.16), HbA1C -2.82% (-5.26 to -0.37), medicine cost (p < 0.004), hospitalization cost (p < 0.011), and cost of surgery (p < 0.0005). A significant improvement also observed in HRQOL and adherence towards a holistic model in LIC group. The study concludes that lifestyle-based counseling and its adherence was cost-effective and significantly improves BGL, HRQoL, and medical treatment in T2DM patients.

The occupational stress in International Business Travellers of a multinational of the automotive sector / O stress ocupacional em Viajantes de Negócios Internacionais de uma multinacional do setor automóvel / El estrés ocupacional en Viajeros de Negocios Internacionales en una multinacional del sector automotriz

International business travelers constitute an emerging type of international mobility, and there is a gap in terms of studies that address well-being. Based on the Holistic Model of Stress, we intend to explore the occupational stress associated with business travel through a qualitative case study using document analysis and semi-structured interviews. We verified a predominance of distress sources in the trip stage and the adoption of coping strategies focused on the problem. Personal and professional factors are assumed to be the main moderators of the stress experienced. We conclude that travel brings mostly negative personal consequences that are accentuated during the traveler's career, and confirm that the trips are a source of stress with impact on the personal and professional life of the traveler. The paper includes a discussion on the theoretical and practical implications of the findings for both the company and the travelers.

Os Viajantes de Negócios Internacionais constituem uma modalidade de mobilidade internacional emergente, existindo uma lacuna ao nível de estudos que abordem o seu bem-estar. Com base no Modelo Holístico de Stress pretendemos explorar o stress ocupacional associado às viagens de negócios através de um estudo de caso qualitativo com recurso à análise documental e à entrevista semiestruturada. Foram predominantes as fontes de distress na fase da viagem e da adoção de estratégias de coping focadas no problema. Fatores pessoais e profissionais assumem-se como principais moderadores do stress percecionado. Concluímos que a viagem tem maioritariamente consequências pessoais e negativas que se acentuam ao longo da carreira do viajante e confirmamos que as viagens são uma fonte de stress com impacto na sua vida pessoal e profissional do viajante. O artigo incluí a discussão acerca das implicações teóricas e práticas dos resultados para a organização e para os viajantes.

Los Viajeros de Negocios Internacionales constituyen una modalidad de movilidad internacional emergente, existiendo una laguna en el nivel de estudios que abordan su bienestar. Con base en el Modelo Holístico de Estrés pretendemos explorar el estrés ocupacional asociado a los viajes de negocios a través de un estudio de caso cualitativo, utilizando el análisis documental y la entrevista semiestructurada. Se verificó un predominio de fuentes de distress y la adopción de estrategias de coping enfocadas en el problema. Los factores personales y profesionales se asumen como principales moderadores del estrés percibido. Concluimos que el viaje tiene mayormente consecuencias personales y negativas, que se acentúan al través de la carrera de viajero. Confirmamos así que los viajes son una fuente de estrés con impacto en la vida personal y profesional. El artículo incluye la discusión sobre las implicaciones teóricas y prácticas de los resultados para la organización y para los viajeros.

O modelo holístico do ensino da medicina / The teaching of Medicine based on a holistic model

A tônica deste artigo é o inconformismo do autor com a persistência de problemas, identificados há mais de quarenta anos pelo Ministério da Educação e pela Associação Brasileira de Escolas Médicas, que vêm prejudicando a formação dos médicos. Entre eles, a ausência de critérios para criação de escolas, de mecanismo de fiscalização de seu funcionamento; falta de articulação entre o ciclo básico e clínico; quase inexistência de integração ensino-serviço; falta de participação em atividades comunitárias; desapreço pelo ensino de graduação; número excessivo e desarticulado das disciplinas; fragmentação do ensino do internato; falta de incentivo à cultura da avaliação educacional; inadequação dos critérios para seleção e promoção dos professores; insuficiente preparo pedagógico dos docentes; despreparo dos docentes para atividades administrativas; despreocupação com o ensino da Ética. As falhas consideradas mais graves são: falta de importância dada ao ensino da relação médico-paciente e a despreocupação com o aprendizado de situações relacionadas às esferas mental e social, grandes responsáveis pela gênese de doenças e o consequente despreparo do médico. Infelizmente, a escola médica está desatenta ao humanismo, aqui entendido como ideal de comportamento e, por isso mesmo, deveria implantar um sistema de valores em que seriam ressaltadas a bondade, a sensibilidade, a paciência, o respeito pelo outro e a preocupação em tranquilizar o doente.

The tone of this article is one of nonconformity due to the persistent problems that are jeopardizing medical education. These problems were identified by the Ministry of Education and the Brazilian Association of Medical Schools more than 40 years ago. Among them, we can highlight the lack of criteria for the creation of schools; lack of a monitoring mechanismto regulate their operation; lack of interaction between the basic and clinical cycles; near nonexistence of teaching-service integration; lack of participation in community activities; feeling of contempt for undergraduate teaching; excessive and unarticulated number of courses; fragmentationof medical residency teaching programs; lack of incentives to the culture of educational assessment; inadequate criteria for the selection and promotionof teachers; teachers? insufficient pedagogical knowledge and skills; teachers? inability to perform administrative duties, and disregard for the teaching of Ethics. The most serious weaknesses are lack of importance given to the doctor-patient relationship and lack of concern for the learning of experiences associated with the mental and social spheres, whichare highly responsible for the genesis of diseases and the consequent lack of qualification and ability of doctors. Unfortunately, medical schools are overlooking humanism, which is hereby considered ideal behavior. Therefore, they should implement a system of values in which kindness, sensitivity, patience, mutual respect and the desire to put patients at ease would be emphasized.

Experiencia de la consulta homeopática de un programa docente en Costa Rica, 2003-2007. Un enfoque de atención holística / Experience of a Homeopathy Consultation at a Teaching Program in Costa Rica, from 2003 to 2007

Objetivos: Describir la experiencia de la consulta homeopática, su metodología y caracterizar a los pacientes. Material y métodos: Estudio descriptivo de 83 expedientes; se analizaron variables cualitativas (sexo, estado conyugal, ocupación, escolaridad, residencia, credo, modo de acceso a la consulta, motivo de consulta, motivos de consulta físicos y psíquicos, dolor, síntomas psíquicos y físicos, diagnóstico o problemas) y cuantitativas (edad, duración de la primera consulta, número de motivos de consulta, número de diagnósticos /problemas principales, comparación del número de motivos de consulta con los diagnósticos /problemas, número total de consultas, número y costo de los medicamentos y resultado de la aplicación de la Glasgow Homoeopathic Hospital Outcome Scale. La información se recolectó del expediente clínico. Los datos se almacenaron y analizaron en el programa SPPS versión 12.0; se obtuvieron medidas de tendencia central, frecuencias y proporciones. Resultados: Se atendieron 83 personas, con un intervalo de edad entre 5 meses y 83 años, promedio 38 años. 79% adultos, predominó el sexo femenino. 57% accedió por demanda libre; 28% por referencia de médicos y enfermeros. 81% consultó por problemas físicos de salud; una vez realizado el diagnóstico, la proporción de estos disminuyó casi a la mitad y los físico-psíquicos se incrementaron ocho veces. El promedio de duración de la primera consulta fue de 66 minutos, del número de consultas fue de dos y el de medicamentos, de tres. El costo promedio de las prescripciones fue de ¢1.946ºº por paciente. Conclusiones: En el distrito de Pavas existe demanda por la consulta homeopática, que debe investigarse. Este enfoque terapéutico holístico identificó trastornos de salud no reportados por los pacientes como motivos de consulta iniciales. Los resultados obtenidos coinciden, en algunos aspectos, con otras investigaciones internacionales en el campo de la práctica clínica homeopática.

Objectives: To describe the experience, clinical methods and patients characteristics seen during homeopathic consultation. Methods: The present is a descriptive study of 83 total clinical records. The following qualitative variables were analyzed (sex, marriage status, occupation, education, residence, religion, referral manner, physical an psychic consultation reasons, diagnosis or problems). Quantitative variables were: age, duration of first consultation, number of complaints at consultation, comparison between number of complaints for consultation with diagnosis / problems, total number of consultations, number and cost of homeopathic medications and results of the application of the Glasgow Homoeopathic Hospital Outcome Scale. Data was obtained from the clinical records, and then analyzed with the SPPS software 12.0 version. Central tendency measures, frequencies and proportions were obtained. Results: 83 patients were seen, during the study period, ranging from 5 months to 83 years of age, average 38 years. There was female sex majority, and 79% were adult. Fifty seven percent attended on their own will, 28% were referred by physicians or nurses. Eighty one percent consulted because of physical problems, however after establishing a medical diagnosis, those diminished around 50% but psycho-physical health problems increased 8 times. The average of the first consultation was 66 minutes; the number of consultations was 2 and 3 the medications per person. The average cost of the prescriptions was ¢ 1 946.00 (aprox. 3 US dollars) per patient. Conclusions: There is a demand for homeopathic consultation in Pavas district that should be investigated. The holistic therapeutic approach identified health problems in patients, that they did not report at the initial consultation. The results obtained coincidence in some aspects, with other international investigations in the field of clinical homeopathic practice.

Development of health Promotion Program for Individuals With Arthritis: Application of holistic Model / 간호학회지

In this study, domains, contents, and effects of pre-existed intervention programs for individuals with arthritis were meta-analyzed to develop arthritis health promotion program based on Holistic Model. The developed program includes strategies of cognition, environment, and behavior, and also generates positive changes in the physical, psychological, and social demensions. Then needs assessment on conveniently selected 153 women who visited a university hospital in Seoul or in Inchon are conducted to identify the objective domains of arthritis health promotion program. According to the study results, target health problems of the arthritis health promotion program were shown as pain, disability, depression, and role impediment in social domain. These objectives could be achieved by including the strategies of changing cognition, the strategies of changing behavior through learning the skill related to the health promoting behavior, and the strategies of changing environment in the health promotion program. That is, it is analyzed that the contents of program are not exclusive one another in physical, psychological, and social demensions, and also are not exclusive one another in aspect of cognition, behavior, and environment. The necessary methods to achieve the desired objectives for the developed arthritis health promotion program and evaluation subjects are as follows : (1) In the arthritis health promotion program, knowledge on management of arthritis, efficacy related to arthritis management, skill for pain management, skill for exercise, establishment of positive self-concept, enhancement of positive thinking, stress management, skill for problem solving, skill for setting goals, skill for requesting help, and skill for communication are all included. Through the improvement of all those strategies, intermediate objectives, such as "joint protection, and maintenance of pain management behavior", "maintenance of regular exercise", and "promotion of coping skill in psychosocial dimension" are achieved. (2) These intermediate objectives are also the methods for achieving objectives in next stage. It implies that through the intermediate objectives, the final objectives such as "minimization of physical symptoms and signs", "maximization of psychological function", and "maximization of role performance in social domain" could be achieved. Each of these final objectives reflects the different dimension of quality of life, respectively. When these objectives are achieved, the quality of life that client perceives is improved. Therefore, through evaluation of these final objectives, the level of achieving final outcome of arthritis health promotion such as quality of life is determined.

Correlation between skin thermal pain and noxious stimuli / 西安交通大学学报(医学版)

Objective The aim of this paper is to develop a holistic mathematical model to quantify the correlation between skin thermal sensation and noxious stimuli,since skin thermal pain is one of the most common problems in everyday life and the understanding of the underlying physical mechanisms is still not clear.Methods The model is developed by considering the biothermomechanical behaviour of skin tissue and by incorporating the current understanding of biophysical and neurophysiological mechanisms of pain sensation.Results The proposed model consisted of three interconnected sub-models: peripheral modulation of noxious stimuli,which converts the energy from a noxious thermal stimulus into electrical energy via nerve impulses;transmission,which transports these neural signals from the site of transduction in the skin to the spinal cord and brain;and modulation and perception in the spinal cord and brain.The model predictions agree well with existing experimental data.Conclusion With this model,a direct relationship has been built between the level of thermal pain sensation and the character of noxious stimuli.