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1.
Diabet Med ; 10(9): 847-50, 1993 Nov.
Article in English | MEDLINE | ID: mdl-8281731

ABSTRACT

Eighty-five diabetic patients who were proficient in English were studied to assess the impact of educational material of varying literacy levels on patient comprehension. Two samples of available diabetes foot care material of Grade 11 and 9 readability (measured by SMOG formula) and purposely written in-house material of Grade 6 readability were used. Patients were randomized to read information of either Grade 6 and Grade 11 or Grade 6 and Grade 9 readability. Socio-demographic data and reading habits were collected to allow for identification of literacy markers. The mean CLOZE score (a measure of comprehension) was better in patients who read the Grade 6 information than for both the Grade 11 and Grade 9 information (59.5 +/- 11.8, 46.8 +/- 22.0, 45.8 +/- 22.2 respectively, p < 0.001). When evaluated in terms of percent of patients that could independently understand the material, Grade 6 information outperformed the Grade 11 and Grade 9 information (60%, 19%, 21%, respectively, p < 0.001). For the Grade 11 and Grade 9 information, poorer comprehension was associated with a non-English speaking background, early school leaving age, infrequent reading habits, and preference for tabloids (p < 0.02). Comprehension when patients read the Grade 6 information was no longer dependent on two of the four identified literacy markers. We conclude that reducing literacy demands of health literature improves patients' comprehension. Attention to socio-demographic data and reading habits can assist educators in assessing patients' literacy status and ensuring patients are given literature of compatible readability.


Subject(s)
Diabetes Mellitus/rehabilitation , Educational Status , Patient Education as Topic , Humans , Language , Middle Aged , Reading , Socioeconomic Factors
3.
IARC Sci Publ ; (124): 349-55, 1993.
Article in English | MEDLINE | ID: mdl-8225505

ABSTRACT

Samples of clinically normal oral tissue were obtained from 17 tobacco smokers and 7 non- or ex-smokers undergoing surgery for intra-oral squamous cell carcinoma. Isolated DNA was analysed for the presence of aromatic DNA adducts using the 32P-postlabelling technique with adduct enhancement by either butanol extraction or nuclease P1 enrichment. DNA adduction detected following butanol extraction was more diverse and at a higher level than obtained with the P1 method. Adduct levels in the smokers and non- or ex-smokers were 1163 +/- 375 and 774 +/- 318 amol/micrograms, respectively. This difference is statistically significant (p < 0.05). The differential enhancement of adducts with the two protocols suggested that arylamines may be the source of at least a proportion of the DNA adduction detected. These data indicate that oral tissues are likely to be a suitable source of material for human biomonitoring and furthermore they highlight the importance of utilizing more than one enhancement procedure when examining DNA adduction induced by complex mixtures such as tobacco smoke or those encountered at industrial plants.


Subject(s)
DNA Damage , DNA/analysis , Environmental Monitoring/methods , Phosphorus Radioisotopes , Butanols , Carcinoma, Squamous Cell/chemistry , DNA, Neoplasm/analysis , Evaluation Studies as Topic , Humans , Mouth Mucosa/chemistry , Mouth Neoplasms/chemistry , Single-Strand Specific DNA and RNA Endonucleases , Smoking/adverse effects , Smoking/metabolism
4.
Diabet Med ; 10(1): 81-6, 1993.
Article in English | MEDLINE | ID: mdl-8435994

ABSTRACT

A randomized controlled trial was conducted to compare three forms of diabetes follow-up: (1) general practitioner care, (2) a system of care shared between the general practitioner (GP) and clinic and (3) conventional clinic care. Two hundred and six diabetic patients without significant diabetes-related or other medical complications were randomized to one of these follow-up systems. Metabolic control and blood pressure improved significantly and equally in all three groups (p < 0.05). The shared care group performed as well as or better than either of the other two groups in all other outcome measures. In particular, final attendance rates were 72% for shared care compared with only 35% for GP care and 53% for clinic care. Data collection rates for shared care were comparable with the clinic group for random blood glucose (88.9% vs 95.1%), weight (93.5% vs 98.3%), and blood pressure (94.8% vs 92.7%). Only in the case of glycosylated haemoglobin did shared care have poorer data collection (66.0% vs 98.4%). In all these parameters, except blood pressure, shared care out-performed the GP group. We conclude that with adequate support from and communication with hospital-based diabetes services, GPs are capable of providing care appropriate to the needs of uncomplicated diabetic patients.


Subject(s)
Diabetes Mellitus/therapy , Family Practice , Outpatient Clinics, Hospital , Blood Pressure , Body Weight , Diabetes Mellitus/blood , Diabetes Mellitus/physiopathology , Glycated Hemoglobin/analysis , Hospitals, Teaching , Humans , Middle Aged , New South Wales , Patient Education as Topic , Treatment Outcome
5.
Diabet Med ; 9(5): 475-9, 1992 Jun.
Article in English | MEDLINE | ID: mdl-1611837

ABSTRACT

Two hundred Type 2 diabetic patients newly referred to the diabetes centre at a large university teaching hospital were studied over an 8-month period. Patients completed a diabetes knowledge questionnaire, and specified their educational priorities by selecting six diabetes-related topics from a list of 14. After giving 1 h of individual education and using the same list, the educators selected six topics which they considered to be most important for that particular patient to know. Choice of educational priorities differed between the patients and the corresponding educator (p less than 0.001). In only 38% of cases did the educators' first three priorities coincide with those of the patients. The major discrepancies were in the selection of 'sick day management' and 'complications', especially favoured by patients, as against 'oral hypoglycaemic agents' and other therapy-related topics, especially favoured by educators. Diabetes knowledge was a determinant of educational priority for patients (p less than 0.001) but not educators. In contrast, only the educators' overall choices were affected by duration of diabetes (p less than 0.001). Diabetes treatment type influenced both patients' and educators' selection of priorities (p less than 0.001). We conclude that an educational strategy which relies on health professionals' perceptions to determine what diabetic patients need to know may be inadequate.


Subject(s)
Diabetes Mellitus, Type 2/rehabilitation , Patient Education as Topic , Specialties, Nursing , Blood Glucose/analysis , Diabetes Mellitus, Type 2/nursing , Female , Health Knowledge, Attitudes, Practice , Humans , Male , Middle Aged , Socioeconomic Factors , Surveys and Questionnaires
6.
Med J Aust ; 155(8): 515-8, 1991 Oct 21.
Article in English | MEDLINE | ID: mdl-1943929

ABSTRACT

OBJECTIVE: The aim of this study was to examine the sociodemographic data of diabetic patients referred to our clinic and to correlate these with characteristics of their individual general practitioners. How these factors affect the interaction between patients, general practitioners and a hospital diabetic clinic was evaluated. DESIGN: Prospective recruitment of consecutive referrals. SETTING: The diabetic clinic of a teaching hospital located in the inner city suburbs of Sydney. PATIENTS: Two hundred and forty-six patients with diabetes (10% insulin dependent), aged 20-86 years, participating in our Shared Care Project, a randomised controlled study on various methods of following up diabetic patients. INTERVENTIONS: Data for the study were gathered by interview and questionnaire during first assessment at the clinic. MAIN OUTCOME MEASURES: Clinical and sociodemographic characteristics of patients; the location of general practitioners, their diagnostic equipment and type of practice; and the level of detail recorded in referral letters from general practitioners. RESULTS: Diabetic patients of migrant background who cannot speak English are older and have less formal education. They see their doctors more often and seek out general practitioners who speak their language, even if it means travelling longer distances. Patients referred from 24 hour medical centres are younger, more educated and have less contact with their doctors both in duration and frequency of visits when compared with patients whose general practitioners operate in conventional sole or partnership practices. Many patients have more than one general practitioner, making communication with hospitals difficult. In their referral letters, general practitioners usually concentrate on hypertension, hypercholesterolaemia and metabolic aspects of diabetes, but under-emphasise diabetic complications; they make insufficient use of measurement of the glycosylated haemoglobin level to assess diabetic control while over-using glucose tolerance testing in making the diagnosis. The referral letter often does not contain enough information to help clinical decision making. CONCLUSIONS: Demography of patients and characteristics of general practitioners are important factors which can affect their interaction with public hospitals. Bearing in mind the work load of general practitioners and the diverse nature of patients, hospitals must implement systems which make it easier for general practitioners and patients to interact with them.


Subject(s)
Continuity of Patient Care/statistics & numerical data , Diabetes Mellitus, Type 1 , Outpatient Clinics, Hospital/organization & administration , Physician-Patient Relations , Physicians, Family , Referral and Consultation/organization & administration , Adult , Aged , Aged, 80 and over , Communication , Demography , Female , Humans , Interviews as Topic , Male , Middle Aged , New South Wales , Prospective Studies , Socioeconomic Factors , Surveys and Questionnaires
7.
Carcinogenesis ; 12(8): 1507-14, 1991 Aug.
Article in English | MEDLINE | ID: mdl-1860172

ABSTRACT

The genotoxicity of tobacco particulate matter (TPM) derived from a low-tar, low-nicotine cigarette has been examined by measuring micronucleus induction in a primary pulmonary cell line, both in the absence and presence of an exogenous source of metabolic activation. In an attempt to correlate the cytogenetic damage observed with DNA adduct formation, DNA extracted from TPM-treated cells has been analysed with two different modifications of the 32P-postlabelling assay. The results from the 32P-postlabelling analysis taken together with the pattern of micronucleus induction provide strong evidence that bioreactivated aromatic carcinogens, such as benzo[a]pyrene, are unlikely to be responsible for the TPM-induced cytogenetic damage observed in cultured mammalian cells.


Subject(s)
DNA/drug effects , Lung/drug effects , Smoking/adverse effects , Animals , Benzo(a)pyrene/toxicity , Cricetinae , Cricetulus , Micronucleus Tests , Phosphorus Radioisotopes
9.
Soc Sci Med ; 31(10): 1135-41, 1990.
Article in English | MEDLINE | ID: mdl-2274802

ABSTRACT

Randomized trials of formal diabetes education have proven that education in isolation from other aspects of diabetes care has limited impact on metabolic control through the simple transfer of information. Comprehensive programme evaluation requires assessment of the process by which knowledge and attitude change affect subsequent control of diabetes. This study examined the impact of a formal diabetes education programme on diabetes-specific knowledge and attitude, and the relationship between these characteristics and metabolic control of the disease over a 15-month period. Knowledge and attitude were assessed using parallel forms of the DKN and ATT39 scales presented randomly as pre-test and post-test to 309 patients attending a 2-day diabetes education programme. Mean knowledge scores increased by 25% (P less than 0.0001) and standardized ATT scores showed a small but significant positive shift after the programme (P less than 0.01) and remained stable in a subset of 177 patients at 3-month follow-up. ATT scores showed a marked convergence towards normal during the intervention (ANOVA, P less than 0.0001). Glycosylated haemoglobin (HbAlc), a medium-term measure of blood glucose control, was recorded in 209 cases for 6 months preceding the programme, and for 15 months following, at intervals of 3 months. The mean HbAlc improvement, from 11.3 to 9.0% (P less than 0.001), was predicted by stepwise regression from initial diabetes control (57% variance) and psychosocial factors (17% variance) including attitude scores and personality characteristics. Diabetes knowledge did not predict improvement in the control of diabetes.


Subject(s)
Diabetes Mellitus/metabolism , Health Knowledge, Attitudes, Practice , Patient Education as Topic , Adaptation, Psychological , Adolescent , Adult , Aged , Aged, 80 and over , Attitude to Health , Child , Diabetes Mellitus/prevention & control , Diabetes Mellitus/psychology , Female , Glycated Hemoglobin/analysis , Humans , Male , Middle Aged , Patient Compliance , Psychological Tests , Random Allocation
10.
Diabet Med ; 6(8): 698-702, 1989 Nov.
Article in English | MEDLINE | ID: mdl-2532104

ABSTRACT

It is generally accepted that people with diabetes should be encouraged to abstain from smoking but there are few data on the best strategy to implement this. In a preliminary survey of our diabetic patients, knowledge of the general and specific health effects of smoking was poor. In a prospective study of 70 diabetic smokers, only 50% agreed to participate in an anti-smoking programme, and the drop-out rate was high irrespective of whether the content of the programme was general or specific for diabetes. The enrollment rate was best 2 months after the diagnosis of diabetes and the drop-out rate was highest in patients recruited immediately following diagnosis. According to self-reported data, cigarette consumption fell after the first session of the anti-smoking programme but this could not be verified by the measurement of plasma cotinine. It is concluded that an anti-smoking counselling programme based on provision of information, within the context of a specialized diabetes centre, is not cost-effective.


Subject(s)
Diabetes Mellitus/psychology , Health Education , Smoking Prevention , Tobacco Use Disorder/rehabilitation , Cotinine/blood , Health Knowledge, Attitudes, Practice , Humans
11.
Diabetes Care ; 11(9): 719-24, 1988 Oct.
Article in English | MEDLINE | ID: mdl-3224543

ABSTRACT

The modern management of diabetes relies heavily on self-monitoring of blood glucose (SMBG), and therefore SMBG records are an important source of clinical data for management decision making. The development of a memory Glucometer has provided the opportunity to verify the validity of glucose records thus generated and observe the effects of different educational approaches on compliance with SMBG. Thirty-four patients without previous experience of SMBG were randomized into one of the following experimental groups differing in the model of diabetes care: mutual decision making, didactic, and authoritarian. Patients, unaware of the memory capacity of the glucose meter, were required to perform four glucose measurements per day over a 14-day observation period. Patient-generated blood glucose records were then compared with objective records stored in the glucose-meter memory. Patients with gestational diabetes mellitus recorded a lower proportion of correct results (63 vs. 79%, P = .049) and exhibited a tendency to invent results with lower blood glucose levels (5.3 vs. 7.5 mM, P less than .0001) than the results omitted compared with patients with non-insulin-dependent diabetes mellitus. Predictors of greater validity of records were perceived intelligence of the subject (chi 2 = 4.56, P less than .02) and private health-insurance status (chi 2 = 4.52, P less than .04), whereas the experimental group assignment was not significant. These findings reflect potential motivational and sociodemographic limitations in the validity of SMBG recordings within the management and education of patients with gestational and nongestational diabetes.


Subject(s)
Blood Glucose Self-Monitoring , Diabetes Mellitus/psychology , Patient Compliance , Blood Glucose Self-Monitoring/methods , Decision Making , Demography , Diabetes Mellitus/blood , Female , Humans , Male , Models, Psychological , Motivation
12.
Diabetes Res Clin Pract ; 3(5): 269-76, 1987.
Article in English | MEDLINE | ID: mdl-3665730

ABSTRACT

Epidemiological risk factor patterns for diabetes mellitus determined by hemoglobin A1 and fasting blood glucose criteria were compared in the biethnic (Melanesian and Indian) nation of Fiji. The 2 diagnostic criteria elicited essentially similar risk factor patterns in Indians but ranking of predictors was altered in Melanesians. By either criterion age was a dominant risk factor for diabetes in both ethnic groups with age2 a predictor in Indians of elevated hemoglobin A1 (chi 2 = 7.8, P less than 0.005) and fasting blood glucose (chi 2 = 25.3, P less than 0.0001). Age- and sex-adjusted prevalence of diabetes was higher in Indians than in Melanesians [RR = 2.5 (1.9-3.3)]. A positive family history was associated with increased risk of diabetes in both ethnic groups by the hemoglobin A1 criterion [pooled RR = 2.3 (2.0-2.6)] but was not significant in Melanesians under the fasting blood glucose criterion. A positive family history was a strong predictor of severe hyperglycemia in both ethnic groups. The relative risk for diabetes was greater in females [1.5 (1.2-9.1)], with no ethnic difference. There was no urban-rural difference in either ethnic group. The similar risk factor patterns for diabetes diagnosed by hemoglobin A1 and severe hyperglycemia suggest that elevated hemoglobin A1 may constitute a useful screening test for 'high risk' diabetic subjects.


Subject(s)
Blood Glucose/metabolism , Diabetes Mellitus, Type 2/diagnosis , Ethnicity , Glycated Hemoglobin/metabolism , Adult , Age Factors , Aged , Aged, 80 and over , Body Weight , Diabetes Mellitus, Type 2/blood , Diabetes Mellitus, Type 2/genetics , Female , Fiji , Humans , Hyperglycemia/diagnosis , Male , Middle Aged , Risk Factors , Sex Factors
13.
Diabetes Res Clin Pract ; 3(5): 257-67, 1987.
Article in English | MEDLINE | ID: mdl-3499301

ABSTRACT

Glycosylated hemoglobin was compared with fasting blood glucose as a screening test for diabetes mellitus and as an index of the severity of diabetes in biethnic (Melanesian and Indian) Fiji. Age-adjusted diabetes prevalence in the test sample was higher in Indians by either criterion. According to the hemoglobin A1 criterion, Melanesians had prevalence rates of 8.2% (males) and 15.8% (females) compared to 17.0% (males) and 24.3% (females) in Indians. In contrast, fasting blood glucose criteria (WHO) gave higher rates in each group. Hemoglobin A1 levels were higher overall in Indians and females. The predictive value of an elevated fasting blood glucose test for an elevated hemoglobin A1 was 20.0% in Melanesians and 60.7% in Indians while that of a normal fasting blood glucose test for a normal hemoglobin A1 was 89.4% in Melanesians and 89.3% in Indians. The proportion of Indians with elevated hemoglobin A1 who were severely hyperglycemic was almost 7 times higher (40.9% vs. 5.8%) than that of Melanesians. The ethnic difference in the predictive value of fasting blood glucose levels for hemoglobin A1 levels appears to be related to the greater severity of hyperglycemia of diabetic Indians compared to diabetic Melanesians. Hemoglobin A1 levels provide information on both the qualitative as well as quantitative differences in diabetes between ethnic groups.


Subject(s)
Diabetes Mellitus, Type 2/prevention & control , Ethnicity , Glycated Hemoglobin/metabolism , Mass Screening , Adult , Aged , Aged, 80 and over , Blood Glucose/metabolism , Cross-Sectional Studies , Diabetes Mellitus, Type 2/blood , Female , Fiji , Humans , Male , Middle Aged
14.
Aust Fam Physician ; 15(9): 1127-8, 1986 Sep.
Article in English | MEDLINE | ID: mdl-3767746
15.
Diabetes Care ; 7(1): 36-41, 1984.
Article in English | MEDLINE | ID: mdl-6705664

ABSTRACT

The Diabetes Knowledge Assessment (DKN) scales were developed to meet a specific need for rapid and reliable knowledge assessment in diabetic patients. Item format and item selection from an initial pool of 89 items were determined by pilot-testing over 300 diabetic subjects. Reliability analysis of the resulting 40 multiple-choice items, with a further sample of 56 subjects, gave a Cronbach's alpha coefficient of 0.92. Parallel forms DKNA, DKNB, and DKNC, each of 15 items selected from the parent set, had alpha coefficients above 0.82 and correlated 0.90 with each other. A full clinical trial, using DKNA, DKNB, and DKNC in randomized order of presentation, was conducted with 219 subjects attending a 2-day diabetes education program. Overall DKN scores improved from 7.6 (51%) to 11.3 (75%). Analysis of variance confirmed that DKNA, DKNB, and DKNC were equivalent forms at pretest. Mean posttest scores on DKNB were lower than the other scales (P less than 0.001), but variances were equivalent for all three. A specific local change in the education program format was found to account for this discrepancy in the DKNB posttest mean. In situations where comprehensive assessment of diabetes knowledge would be time-consuming and unnecessary, these results indicate that rapid and reliable assessment is possible with a scale of only 15 validated items. The development of parallel forms of the scale extends the range of retesting possibilities for diagnosis and research.


Subject(s)
Diabetes Mellitus , Patient Education as Topic/standards , Diabetes Mellitus/physiopathology , Educational Measurement/methods , Humans , Mental Recall , Random Allocation
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