A brief psychological intervention to improve adherence in type 2 diabetes.

OBJECTIVE: Diabetes perceptions, acceptance and treatment motivation are changeable factors of adherence. This study aimed to test the effects of brief psychological interventions based on diabetes threat and mastery perceptions in terms of adherence, acceptance and motivation. Physicians may find such interventions useful during a 15-minute consultation with diabetes patients. RESEARCH DESIGN AND METHODS: This randomized controlled study included 80 patients with type 2 diabetes, recruited from the hospital diabetes department, who were randomly assigned to four intervention groups based on autobiographical recall. Those in the two intervention groups were asked to recall diabetic events based on mastery and threat perceptions, respectively, whereas those in the two control groups recalled non-diabetic events based on positive and negative emotions, respectively. Following this, all participants completed validated self-questionnaires assessing diabetes perceptions, acceptance, treatment motivation and adherence. RESULTS: Patients in the threat group reported less adherence (P<0.01) and less avoidance (P<0.05), and perceived diabetes as less threatening (P<0.05) than those in the mastery group. Similar results were obtained when the threat group was compared with its matched negative-emotion control group (P<0.05, P<0.05 and P=0.087, respectively). Patients in the mastery group reported feeling a stronger sense of mastery (P<0.05) than those in their positive-emotion control group and greater treatment acceptance than those in the threat group (P<0.01). CONCLUSION: Contrary to conventional medical belief, discussing threatening personal events with patients can yield positive results. Health professionals should take threat and mastery perceptions of diabetes into account during regular consultations with a view to improving treatment acceptance and adherence. With this brief intervention of type 2 diabetes patients, it was also more effective to alleviate their emotional difficulties than to enhance their perception of mastery.

Spontaneous rupture of Achilles tendon and Cushing's disease. Case report.

Spontaneous rupture of Achilles tendon is observed in patients with tumors, metabolic disorders, infections and systemic diseases. Fluoroquinolones may cause tendinopathies. In addition, spontaneous rupture uncommonly occurs in Cushing's syndrome. We report a case of Cushing's disease revealed by recurrent rupture of Achilles tendon. Tendon tears are described in patients receiving long-term steroid treatment, probably via a mechanism similar to that one occurring in Cushing's syndrome. Although exceptional, this diagnosis should be discussed in patients with spontaneous rupture of Achilles tendon.

Mending the Med.

PIP: In 1975, the Barcelona Convention to Protect the Sea was signed with an action plan to deal with marine pollution and halting land-based contributions to water pollution. Specifically, the Blue Plan aimed to attack the interaction between population, natural resources, environmental degradation, and economic development for the entire Mediterranean region. Scenarios were constructed to depict demographic, international economic, and national development prospects. Population was expected to grow from 357 million in 1985 to 575 million in 2025. Population concentration was expected to decline from 66% in the north to 22% in 2025. The populations in the south and east would grow to 5 times the 1950 figures. Fertility rates are expected to fall in the south, as educational levels of women rise. The decline in population in the north will mean an aging population in the north and a young population in the south with employment imbalances. Rapid urbanization will be a problem throughout the region, and particularly in the coastal areas. The demand for water, waste disposal, and conflicting pressures on use of sea and land will be the consequences. Tourism will aggravate general population conditions. The coastal regions currently receive about 100 million international and domestic tourists annually. Under poor economic conditions, scenarios would project tourism increases to 170 million by 2025. Under sustainable development scenarios, the numbers would increase even higher to 340 million tourists, mostly domestic. The environmental impact of tourism centers on the pressure on water resources, space use, and solid and liquid waste, during the summer when the water supply is low and the forests are dry. Most countries rely heavily on tourism for balance of payments and as a source of hard currency for food imports. The expectation is that the coastal areas, though fragile, are the primary asset for Mediterranean countries. Coast management thus far has contributed to erosion, deforestation, and erratic concrete surfacing of shore areas. Delays in sustainable development will only contribute to further pollution. The entire Mediterranean region could face social and ecological disruption in the future if population development needs are not met. Environmental and development issues threaten long-term peace and stability.^ieng