Sex Differences in the Prevalence and Modulators of Sleep-Disordered Breathing in Outpatients with Type 2 Diabetes.

In patients with type 2 diabetes, sleep-disordered breathing is a widespread cause of deteriorated quality of life. However, robust prevalence estimates for sleep-disordered breathing in patients with type 2 diabetes are limited due to scarce data. We investigated sex differences in sleep-disordered breathing prevalence and its modulators in the DIACORE SDB substudy, a sample of outpatient type 2 diabetes. 721 participants were tested for sleep-disordered breathing using a two-channel sleep apnoea monitoring device. Patients were stratified according to the severity of sleep-disordered breathing, defined as an apnoea-hypopnoea index < 15, ≥15 to 29, and ≥30 events per hour as no/mild, moderate, and severe sleep-disordered breathing, respectively. In the 679 analysed patients (39% women, age 66 ± 9 years, body mass index 31.0 ± 5.4 kg/m2), the prevalence of sleep-disordered breathing was 34%. The prevalence of sleep-disordered breathing was higher in men than in women (41% versus 22%, p < 0.001) and increased with age (15%, 21%, and 30% in women and 35%, 40%, and 47% in men in those aged 18-59, 60-69, or ≥70, respectively; age trend p = 0.064 in women and p = 0.15 in men). In linear regression analysis, age, BMI, and waist-hip ratio were associated with apnoea-hypopnoea index. Modulators for higher apnoea-hypopnoea index seem to be similar in men and women.

Mal de debarquement.

MAIN OUTCOME MEASURE: Clinical features of mal de debarquement syndrome. RESULTS: Nearly all respondents were middle-aged women (26 of 27; mean age, 49.3 years). The duration of symptoms ranged from 6 months to 10 years (mean, 3.5 years; SD, 2.5 years). The symptoms were constant in 23 (85%) patients. Neither meclizine hydrochloride nor transdermal scopolamine was helpful. Benzodiazepines were of the most benefit. Balance rehabilitation physical therapy was undertaken by 15 patients, who on average reported a small benefit. CONCLUSIONS: More than double the number of previously reported cases of mal de debarquement syndrome were identified by this study. The syndrome usually occurs in middle-aged women following an ocean cruise. Symptoms are often refractory to vestibular suppressants as well as physical therapy.

Self-management development in children and adolescents with diabetes: the role of maternal self-efficacy and conflict.

The overall purpose of this study was to investigate maternal self-efficacy and its relationship to maternal perception of the child's self-management of diabetes. The influence of conflict between mother and child was also examined. One hundred and four mothers of children, ages 8 to 17 years, who were attending summer diabetes camp, were asked to rate their own and their child's abilities to manage the child's diabetes. Overall, the mothers expressed a high degree of self-efficacy in managing their child's diabetes and perceived their children as average or above in managing their own diabetes when compared with agemates with diabetes. Furthermore, mother's level of self-efficacy was significantly positively related to their perceptions of their child's self-management. In addition, almost one third (30%) of the mothers reported experiencing interpersonal conflict regarding how much responsibility the child should assume in managing their own diabetes. Mothers who rated their child's level of independence as low were three times more likely to report experiencing conflict. In the vast majority of cases, the child was the primary source of conflict. When hierarchical logistic regression was used to multivariately model children's independence, conflict with the child remained a significant predictor, above and beyond background, demographic, and important conceptual variables, including self-efficacy.

Extended hospitalization of medically stable children dependent on technology: a focus on mutable family factors.

This study identified three factors that influenced extended hospital stay in medically stable children dependent on medical technology. A retrospective review of 50 charts in a level II nursery was conducted. Bivariate analysis identified factors contributing to extended stay: parental factors, societal factors, health care factors, and presence of disease. Multiple regression explained 98% of the variance in extended length of stay. Family factors accounted for 19.6%, nonfamily factors accounted for 42.5%, and the two sets of factors together accounted for an additional 35.9%. Family-related issues with a high potential for change were identified. Pediatric providers should develop family intervention strategies that identify the most appropriate level of care that both advocates in the best interest of the child and family and contains the rising cost of health care.

Comparison of mother-father perceptions of their child's self-management of diabetes.

This study compared mothers' and fathers' perceptions of their children's self-management of diabetes. Participants included a subsample of 29 paired parents of children and youth with diabetes, ages 8-14, who attended a diabetes camp in the Midwest. Parents completed a self-report structured questionnaire that included content specific to self-management. Results showed high ratings for child responsibility for self-management, style of care delivery, and mother-father self-efficacy in managing specific tasks of diabetes self-management. Although overall ratings were similar, in the majority of measures mothers' ratings were higher than fathers' ratings. Areas of similarity and significant differences in perceptions are identified with implications for practice stated.

Surveillance of traumatic brain injuries in Utah.

From 1990 through 1992 we conducted surveillance of cases requiring hospital admission and of fatal cases of traumatic brain injury among residents of Utah and found an annual incidence rate of 108.8 per 100,000 population. The greatest number of injuries occurred among men and persons aged 15 to 24 years. Motor vehicles were the leading cause of injury, followed by falls and assaults. The incidence rate we found is substantially lower than previously published rates of traumatic brain injury. This may be the result of a decrease in the incidence of these injuries in the decade since earlier studies were done, as well as changing hospital admission criteria that serve to exclude less severe cases of injury. Despite the apparent decline in rates, our findings indicate the continued importance of traumatic brain injury as a public health problem and the need to develop more effective prevention strategies that will address the major causes of these injuries.