The effect of genetic counseling for adult offspring of patients with type 2 diabetes on attitudes toward diabetes and its heredity: a randomized controlled trial.

The aim of this study is to investigate the effect of diabetes genetic counseling on attitudes toward diabetes and its heredity in relatives of type 2 diabetes patients. This study was an unmasked, randomized controlled trial at a medical check-up center in Japan. Subjects in this study are healthy adults between 30 and 60 years of age who have a family history of type 2 diabetes in their first degree relatives. Participants in the intervention group received a brief genetic counseling session for approximately 10 min. Genetic counseling was structured based on the Health Belief Model. Both intervention and control groups received a booklet for general diabetes prevention. Risk perception and recognition of diabetes, and attitude towards its prevention were measured at baseline, 1 week and 1 year after genetic counseling. Participants who received genetic counseling showed significantly higher recognition about their sense of control over diabetes onset than control group both at 1 week and 1 year after the session. On the other hand, anxiety about diabetes did not change significantly. The findings show that genetic counseling for diabetes at a medical check center helped adults with diabetes family history understand they are able to exert control over the onset of their disease through lifestyle modification.

Randomized controlled trial of the effectiveness of genetic counseling and a distance, computer-based, lifestyle intervention program for adult offspring of patients with type 2 diabetes: background, study protocol, and baseline patient characteristics.

Relatives of type 2 diabetic patients are at a high risk of developing type 2 diabetes and should be regarded as target of intervention for diabetes prevention. However, it is usually hard to motivate them to implement preventive lifestyle changes, because of lack of opportunity to take advises from medical professionals, inadequate risk perception, and low priority for preventive behavior. Prevention strategy for them therefore should be highly acceptable and suited for them. The parallel, three-group trial is now being conducted to investigate the effects of genetic counseling and/or a computerized behavioral program on the prevention of type 2 diabetes in that population. The preventive strategies used in this study could provide a novel solution to the numbers of genetically high-risk individuals, if found to be effective. The objective of this paper is to describe the background, protocol, and baseline patient characteristics of the trial.

Feasibility and efficiency of indirect lifestyle interventions in offspring of type 2 diabetic patients.

INTRODUCTION: Individuals genetically predisposed to type 2 diabetes represent an important target for preventive strategies. Genetic screening, based on information about individual genetic variants, will be possible technically, but translational research in this field is still insufficient. Family history thus represents a useful tool for detecting genetically high-risk populations in this post-genomic era. OBJECTIVES: The purpose of this pilot study was to investigate the feasibility and efficiency of indirect lifestyle interventions in offspring of type 2 diabetic patients. METHODS: Offspring were recruited from 74 diabetic (Group 1) and 39 non-diabetic (Group 2, control group) patients. A lifestyle intervention was conducted by mail, a total of 3 times, every 3 months. Lifestyle related to diet and physical activity was assessed using a self-administered questionnaire. RESULTS: Ten offspring of type 2 diabetic and 6 of non-diabetic patients participated in this study. Total energy intake decreased after 3 interventions in both of the groups (Group 1: 305 ± 228.8 kcal/day, p = 0.004; Group 2: 82 ± 65.6 kcal/day, p = 0.04); however, the effect of intervention was significantly greater in Group 1 compared to Group 2 (p = 0.021). Physical activity and other physical outcomes were stable in normal levels during the study period in both of the groups. CONCLUSIONS: The intervention program helped to reduce total energy intake in offspring of type 2 diabetic patients more than in the control group, but the acceptance rate of the intervention program was disappointingly low. Further consideration is required to access and motivate offspring to develop precautionary lifestyle principles.

Preventive behaviour in adult offspring of Type 2 diabetic patients and its relationship to parental advice.

AIMS: This study was conducted to investigate preventive behaviour of offspring at risk of Type 2 diabetes, particularly focusing on the relationship between patients' behaviour of giving advice as parents. METHODS: This cross-sectional study was based on a self-reported questionnaire survey and was conducted at the diabetes clinic of one general hospital. Subjects were 164 pairs, comprising Type 2 diabetic patients ranging in age from 50 to 75 years and non-diabetic offspring ranging in age from 20 to 50 years. RESULTS: Approximately half of patients' offspring were engaged in preventive behaviour; 51.2% to prevent weight gain and 50.6% to have a healthy diet. The proportion of offspring taking regular exercise was significantly less (40.2%) than those attempting weight control and eating a healthy diet (P = 0.0039, P = 0.0035, respectively). One hundred and six (64.6%) patients advised their offspring to change their lifestyle habits, such as with diet or exercise, for diabetes prevention. However, preventive behaviours in offspring, including preventing weight gain, having a healthy diet and taking regular exercise, were not facilitated by parental advice (P = 0.27, 0.92, 0.61, respectively). The offspring regarded medical professionals or mass media as reliable information sources, but not the family. However, they received information about diabetes most frequently from their family. CONCLUSIONS: Although more offspring practised preventive behaviour than expected, they were less likely to exercise than to change their diet or attempt to control their weight. Parental advice did not facilitate offspring preventive behaviour. Further research is needed to discover how to mediate links between parental advice and offspring preventive behaviour.

Mental adjustment to first recurrence and correlated factors in patients with breast cancer.

Previous reports have demonstrated that breast cancer patients felt that news of their recurrence was more upsetting than their initial diagnosis. However, no studies have examined the factors that are correlated with mental adjustment in breast cancer patients who experienced recurrence. The authors investigated factors that are correlated with mental adjustment styles of fighting spirit or helplessness/hopelessness in women with breast cancer with a first recurrence. Fifty-five participants were interviewed and completed the Mental Adjustment to Cancer scale. Factors that correlated significantly with fighting spirit were performance status and history of major depression, while factors that correlated significantly with helplessness/hopelessness were age, pain, and history of major depression. These findings suggest that it is necessary to provide intervention for first recurrent breast cancer patients who have such biomedical factors, as young age, poor performance status, pain, and history of major depression to help them better cope with cancer.

Quinochalcones and flavonoids from fresh florets in different cultivars of Carthamus tinctorius L.

The flavonoid constituents in fresh florets of the three distinctive cultivars of Carthamus tinctorius L. were purified and identified to investigate flavonoid biosynthesis in the petals. From the orange flower of cv. Kenba (K.), four new compounds, anhydrosafflor yellow B (1), two kaempferols, 9 and 13, and a quercetin, 17, were isolated, as well as the twelve known compounds, and their structures were determined by spectral data, chemical reactions, and molecular mechanics calculations. From the yellow flower of cv. Ogon-hanagasa (O.), two flavonols and two quinochalcones, and from the white flower of cv. Shiro-bana (S.), three flavonois were isolated. These compounds were the same as those contained in cv. K. To compare the flavonoid constituents among the three cultivars, crude extracts were analyzed by a LC/PDA/MS system. In cv. K., six quinochalcones and eleven flavonols were identified. In cv. O., three quinochalcones and nine flavonols were identified, but the red pigment, carthamin (4), and its precursor, precarthamin (3), were not detected. In cv. S., four flavonols without a 6-hydroxyl group were identified. On the basis of a comparative study on the constituents among these three cultivars, a possible biosynthetic pathway to form quinochalcones via the intermediate, pentahydroxychalcone (19), is proposed.

The relationship between fatigue, coping behavior, and inflammation in patients with rheumatoid arthritis.

Abstract This research investigated the relationships among the severity of inflammation, the extent of fatigue, and fatigue symptoms, and the relationship between fatigue and coping behavior in patients with rheumatoid arthritis (RA). Our study group consisted of 177 female patients with RA (105 women with CRP > 0.5 mg/dl and ESR > 30 mm/h (inflammatory group) and 72 women with CRP ≦ 0.5 and ESR ≦ 30 (noninflammatory group)) and 81 age-matched healthy women (control group) who were given self-assessment questionnaires. The extent of fatigue was higher in the inflammatory group than in the noninflammatory and control groups. The characteristics of fatigue symptoms in the inflammatory group were "decline in the strength to carry on the activities of daily life" and "difficulty in performing daily activity." The patients in the inflammatory group adopted a technique of "reducing the burden on the body" as a pattern of coping behavior for reducing fatigue. The extent of fatigue and fatigue symptoms perceived by RA patients is strongly related to the severity of inflammation, and these patients adopt a coping behavior in response to the extent of fatigue and subjective symptoms.

Utilization of the concentric circle model in clinical nursing: a review.

In this article, I review applications of the concentric circle model in clinical nursing. The concentric circle model is based on the cross-sectional shape of the body extremities at several points, and can be used in the areas of both kinesiology and nutritional science. This model makes it possible to calculate the cross-sectional area of muscles from measurement of the circumference of the extremities and the thickness of adipose (fatty) tissue. Then, changes in muscle strength or nutritional status can be inferred or assessed from these data. This model requires only simple and non-invasive measurements, and this is a significant and essential characteristic for its use by nurses, both in clinical and research applications.

177Lu-EDTMP: a potential therapeutic bone agent.

Lutetium-177 (177Lu) has both beta particle emissions for a therapeutic effect and gamma emissions for imaging. This study was undertaken to synthesize and evaluate 177Lu-EDTMP (ethylenediaminetetramethylene phosphonic acid) as a therapeutic radiopharmaceutical for the palliation of pain from bone metastases. Chelation of 177Lu to EDTMP was obtained by heating for 30 min in boiling water at pH 8.8, resulting in a radiochemical yield of over 99%. The compound was stable for 20 days without any appreciable dissociation. Biodistribution studies in normal rats indicated selective bone accumulation, showing faster blood clearance, higher bone uptake and higher bone-to-soft tissue ratios than 99Tcm-MDP. In conclusion, 177Lu-EDTMP has favourable biological and physical characteristics for the palliative treatment of painful bone metastases.

[A study of changes in the nutritional status of patients receiving cancer chemotherapy].

In an attempt to find a method for effective nursing support which would maintain a favorable nutritional status in patients receiving chemotherapy, the nutritional status of 15 patients with lung cancer receiving cisplatin therapy was evaluated, and the factors influencing their status were studied. (1) Nutritional status was evaluated in terms of 7 indicators: body weight, skinfold thickness, arm muscle circumference, grip strength, hemoglobin level, serum total protein and serum albumin. Among these, skinfold thickness proved to be the most sensitive indicator of the changes in nutritional status of cancer patients during chemotherapy. (2) Multiple regression analysis revealed that skinfold thickness was influenced by dietary intake, which in turn was related to nausea, vomiting, trait anxiety level estimated by STAI and maximum body temperature associated with infection. (3) It was concluded that the following nursing interventions are significant for maintenance of favorable nutritional status for cancer patients during chemotherapy. First, periodic evaluation of their nutritional status by anthropometric measurements is necessary. Secondly, efforts should be made to reduce nausea and vomiting, to reassure patients with severe anxiety so that they become mentally stable, and to motivate the patients to perform self-care for prevention of infection, thereby achieving a sufficient dietary intake.