Reduction of depressive symptoms in an elderly Mexican-American female with type 2 diabetes mellitus: a single-subject study.

The purpose of this study was to determine if occupation-based activities improve diabetes self-management and reduce depressive symptoms in an elderly Mexican-American woman with type 2 diabetes mellitus (T2DM). There have been no known studies showing occupational therapy's role in self-care management of T2DM in people with depressive symptoms. The individual in this single-subject research was evaluated using glycosylated haemoglobin blood tests, four self-reported standardized questionnaires, participant reflective logs and clinical observations following an 8-week intervention. The participant improved on all measures, which were sustained 1 month after treatment ended. Clinical implications highlight a new role for occupational therapists providing early intervention in people with diabetes and depression for secondary prevention of complications of uncontrolled diabetes. Research suggestions include multiple single-subject studies showing occupational therapy contributions.

Effect of a group adherence intervention for Mexican-American older adults with type 2 diabetes.

OBJECTIVE: I evaluated the effect of a culturally tailored, peer-led support group intervention on improvement in adherence behaviors of Mexican-American older adults with type 2 diabetes mellitus and obtained feedback on the cultural relevance of the manual that structured the intervention. METHOD: The one-group pretest-posttest design used five self-report questionnaires and blood testing to measure change among 4 men and 12 women, ages 60-85. RESULTS: Empowerment, self-efficacy, and attitude were highly significant at 2-, 4-, and 6-mo posttests. Glycosylated hemoglobin test results were significant at p < .05 between pretest and 2-mo posttest with a stabilizing effect on the 6-mo posttest. CONCLUSION: Mexican-American older adults' adherence may improve with a culturally sensitive, structured peer-led program with indirect consultation from an occupational therapist.

Wireless photoplethysmographic device for heart rate variability signal acquisition and analysis.

The photoplethysmographic (PPG) signal has the potential to aid in the acquisition and analysis of heart rate variability (HRV) signal: a non-invasive quantitative marker of the autonomic nervous system that could be used to assess cardiac health and other physiologic conditions. A low-power wireless PPG device was custom-developed to monitor, acquire and analyze the arterial pulse in the finger. The system consisted of an optical sensor to detect arterial pulse as variations in reflected light intensity, signal conditioning circuitry to process the reflected light signal, a microcontroller to control PPG signal acquisition, digitization and wireless transmission, a receiver to collect the transmitted digital data and convert them back to their analog representations. A personal computer was used to further process the captured PPG signals and display them. A MATLAB program was then developed to capture the PPG data, detect the RR peaks, perform spectral analysis of the PPG data, and extract the HRV signal. A user-friendly graphical user interface (GUI) was developed in LabView to display the PPG data and their spectra. The performance of each module (sensing unit, signal conditioning, wireless transmission/reception units, and graphical user interface) was assessed individually and the device was then tested as a whole. Consequently, PPG data were obtained from five healthy individuals to test the utility of the wireless system. The device was able to reliably acquire the PPG signals from the volunteers. To validate the accuracy of the MATLAB codes, RR peak information from each subject was fed into Kubios software as a text file. Kubios was able to generate a report sheet with the time domain and frequency domain parameters of the acquired data. These features were then compared against those calculated by MATLAB. The preliminary results demonstrate that the prototype wireless device could be used to perform HRV signal acquisition and analysis.

A culturally sensitive diabetes peer support for older Mexican-Americans.

The purpose of this study was to determine if a peer-led diabetes support group intervention could improve adherence to recommendations for self-management in 42 Mexican-American elders with type 2 diabetes. This mixed-method pilot study occurred at a community-based diabetes education centre in Texas. The 10-week intervention programme was compared to usual care on five self-reported questionnaires and blood tests during four collection periods. Participants displayed statistically significant improvements in blood sugar, self-efficacy, transformational change and personal resources. Qualitative themes were derived from 30 focus group meetings, which were as follows: do not trust the system, choice + control = power and the social cost of diabetes. The results suggested a consultation role for occupational therapists in training peer leaders to learn to lead and manage community-based diabetes self-management programmes. Limitations were the sample size of the convenience sample, and the lack of qualitative analysis of the control group discussions. Future research should involve a study of expanded community-based social networks using experimental design.

Experience of mexican-american elders with diabetes: a phenomenological study.

ABSTRACT The purpose of this study was to gain insight about the lived experience of Mexican-American elders and the psychosocial issues that can impede or facilitate making the necessary lifestyle changes to adhere to a diabetes self-care regimen. As a phenomenological study, focus group discussions of male and female Mexican-Americans, ages 60-85, were conducted to capture their perspectives. Four themes emerged from the discussions which included (1) our social discomfort gets in the way of taking care of ourselves, (2) commonalities that bond us support us, (3) we do not have clear goals, and (4) we have lost control of our lives. Discussion how the experience of adapting to the demands of diabetes is ever changing and Mexican-American elders with diabetes may benefit at any stage of the adaptation process from supportive relationships that target psychosocial adjustment. Implications for occupational therapy practice, education, and research are discussed.

Case study of Bell's palsy applying complementary treatment within an occupational therapy model.

For 7% of people with Bell's palsy, facial impairment is permanent. The case study patient was a 48-year-old female who had no recovery from paralysis 12 weeks after onset. Goals were to restore facial sensory-motor functions, functional abilities and reduce depression. Facial paralysis was assessed by clinical observations, the Facial Disability Index and Beck Depression Index. Complementary interventions of aromatherapy, reflexology and electro-acupuncture were used with common physical agent modalities in an intensive home activity and exercise programme. The patient had 100% return of function and resolution of depression after 10 days of intervention. The limitation of this study is that it was a retrospective case study and the investigators reconstructed the case from clinical notes. Further research using a prospective approach is recommended to replicate this study.

A Web-based vital sign telemonitor and recorder for telemedicine applications.

We describe a vital sign telemonitor (VST) that acquires, records, displays, and provides readings such as: electrocardiograms (ECGs), temperature (T), and oxygen saturation (SaO2) over the Internet to any site. The design of this system consisted of three parts: sensors, analog signal processing circuits, and a user-friendly graphical user interface (GUI). The first part involved selection of appropriate sensors. For ECG, disposable Ag/AgCl electrodes; for temperature, LM35 precision temperature sensor; and for SaO2 the Nonin Oximetry Development Kit equipped with a finger clip were selected. The second part consisted of processing the analog signals obtained from these sensors. This was achieved by implementing suitable amplifiers and filters for the vital signs. The final part focused on development of a GUI to display the vital signs in the LabVIEW environment. From these measurements, important values such as heart rate (HR), beat-to-beat (RR) intervals, SaO2 percentages, and T in both degrees Celsius and Fahrenheit were calculated The GUI could be accessed through the Internet in a Web-page facilitating the possibility of real-time patient telemonitoring. The final system was completed and tested on volunteers with satisfactory results.

A PDA-based flexible telecommunication system for telemedicine applications.

Technology has been used to deliver health care at a distance for many years. Telemedicine is a rapidly growing area and recently there are studies devoted to prehospital care of patients in emergency cases. In this work we have developed a compact, reliable, and low cost PDA-based telecommunication device for telemedicine applications to transmit audio, still images, and vital signs from a remote site to a fixed station such as a clinic or a hospital in real time. This was achieved based on a client-server architecture. A Pocket PC, a miniature camera, and a hands-free microphone were used at the client site and a desktop computer running the Windows XP operating system was used as a server. The server was located at a fixed station. The system was implemented on TCP/IP and HTTP protocol. Field tests have shown that the system can reliably transmit still images, audio, and sample vital signs from a simulated remote site to a fixed station either via a wired or wireless network in real time. The Pocket PC was used at the client site because of its compact size, low cost and processing capabilities.