Development of a preliminary diabetes dietary satisfaction and outcomes measure for patients with type 2 diabetes.

Adopting dietary lifestyle changes for diabetes management is often difficult for patients; yet the health-related quality of life (HRQOL) outcomes of dietary management for the patient are not extensively developed in the HRQOL assessments now widely used in diabetes research. This study developed a preliminary instrument, the diabetes dietary satisfaction and outcomes measure, to assess outcomes of individuals' experiences in following a meal plan for the treatment of type 2 diabetes. A theoretical framework and preliminary focus group data guided the design of a 47-item questionnaire, administered to 239 patients with type 2 diabetes. Medical file data was obtained on 180 of these patients. Fifty-four percent of respondents were women, with mean age of 64 +/- 12 years and diabetes duration of 10 +/- 8 years. Scores for the satisfaction and other outcome measures discriminated between patient groups by age, gender, medication use, depression diagnosis, meal plan status, and employment status. Significant correlations also occurred with diet adherence, number of co-morbidities, and glycemic control as measured by glycolated hemoglobin (HbA1c). Future research with additional patient samples is needed to refine the measure for use in diabetes education programs.

A systems-in-transition paradigm for healthy communities.

WHO is generating a new approach to public health in many nations. In Canada the new public health has stimulated important innovations such as the Health Promotion Framework in Achieving Health For All and the Canadian Healthy Communities Project. There is a need, however, for a political theory of social organization and change to facilitate social and political analysis of communities. This article proposes a paradigm which organizes community using a structural-functional approach linked with process components addressing community change through development, stress and conflict. A new definition of a healthy community is proffered using the language of the model. The emerging political role of community health practitioners in the new public health is described.

Correlation of immunological studies and disease progression in chronic progressive multiple sclerosis.

Thirty untreated patients with clinically definite chronic progressive multiple sclerosis were matched with 10 patients with clinically stable definite multiple sclerosis and 16 patients with other neurological diseases. A group of 12 normal control (NC) volunteers was matched to these groups. All patients with chronic progressive multiple sclerosis and normal control subjects were analyzed for the concanavalin A suppressor assay, mitogen stimulation, and phenotyping of peripheral blood mononuclear cells. In addition, serum was analyzed for interleukin-2 levels. Results of mitogen stimulation studies did not distinguish the groups. Concanavalin A-induced suppression was significantly decreased in the patients with chronic progressive multiple sclerosis (p less than 0.01). Phenotyping of fresh cells showed an elevated CD4: CD8 ratio in the patients with chronic progressive multiple sclerosis. Neither phenotyping nor concanavalin A-induced suppression correlated with or predicted the degree of disability, but the serum levels of interleukin-2 correlated inversely with disability (p less than 0.01) and directly with a poor prognosis after 18 months of observation (p less than 0.05). Serum levels of interleukin-2 decreased as the disease progressed.

Primary cutaneous amyloidosis of the auricular concha.

Several patterns of primary cutaneous amyloidosis are recognized; in this report of four cases, we define a new pattern in which the lesions are composed of small papules grouped on the concha of the ear. The lesions typically are not pruritic but slightly friable. They may be present on both ears. The patients do not have lesions of amyloidosis on other parts of the body and no known insult precedes the appearance of lesions. This entity appears to have been described previously as collagenous papules of the ear. Histochemical and electron microscopic methods allow us to confirm the amyloid nature of the substance. We believe this condition to be a variant of primary cutaneous amyloidosis, particularly because monoclonal antikeratin antibody EKH4, which has been positive in lichenoid, macular, and skin epithelial tumor-associated amyloidoses, was positive in our cases.

Quantitation of glaucomatous visual field defects with the Mark II Friedmann analyzer.

To evaluate the ability of the Friedmann visual field analyzer to determine visual threshold and the depth of visual field defects, we correlated the visual threshold determined kinetically (Goldmann perimeter) with the static threshold (Friedmann analyzer) in various parts of the central field. We found the following: the Friedmann working threshold correlated linearly with the height of the hill of vision represented by the position of the kinetic isopters of the Goldmann perimeter; the static visual threshold (Friedmann) at a particular location, whether normal or abnormal, was linearly related to the kinetic visual threshold (Goldmann) at that location; and the depth of all visual field defects was essentially the same with both instruments. Thus, the Friedmann analyzer accurately quantitated the central visual field in both the normal and abnormal regions, and may be advantageous for following the progress of early glaucomatous defects. For other patients, however, its usefulness may be limited, because defects outside 25 degrees cannot be documented, the visual field examination may be lengthy and inefficient when quantitating large defects of irregular depth, and the maximal quantitation of depth with the Friedmann analyzer is 2.0 log units less than with the Goldmann perimeter near fixation (but there is progressively less difference for defects further from fixation).

Integration of clinical and academic nursing at the hospital clinical unit level.

In a successful attempt to solve problems in Pediatric Nursing at the Medical University of South Carolina, a Department Chairman was named Director-Chairman of Pediatric Nursing and given operational authority over both clinical and academic nursing in Pediatrics. The results were more efficient administration, a higher quality of patient care and an enriched environment for student learning.