Effectiveness of community health workers in the care of persons with diabetes.

AIMS: The purpose of this systematic review was to examine the effectiveness of community health workers in supporting the care of persons with diabetes. METHODS: Computerized searches were conducted of multiple electronic bibliographic dababases until March 2004. We identified studies in any language and of any design that examined the effectiveness of diabetes-related interventions involving community health workers and reported outcomes in persons with diabetes. Results were synthesized narratively. RESULTS: Eighteen studies were identified, including eight randomized controlled trials. Most studies focused on minority populations in the USA. The roles and duties of community health workers in diabetes care were varied, ranging from substantial involvement in patient care to providing instrumental assistance in education sessions taught by other health professionals. Participants were generally satisfied with their contacts with community health workers and participant knowledge increased. Improvements in physiological measures were noted for some interventions and positive changes in lifestyle and self-care were noted in a number of studies. There were few data on economic outcomes, but several studies demonstrated a decrease in inappropriate health care utilization. CONCLUSIONS: Diabetes programmes include community health workers as team members in a variety of roles. There are some preliminary data demonstrating improvements in participant knowledge and behaviour. Much additional research, however, is needed to understand the incremental benefit of community health workers in multicomponent interventions and to identify appropriate settings and optimal roles for community health workers in the care of persons with diabetes.

Measurement of micronucleated erythrocytes and DNA damage during chronic ingestion of phenolphthalein in transgenic female mice heterozygous for the p53 gene.

Phenolphthalein, a common ingredient in nonprescription laxatives and a multisex, multispecies rodent carcinogen, was evaluated under chronic exposure conditions for genotoxicity in transgenic female mice heterozygous for the p53 gene (heterozygous TSG-p53 mice). Phenolphthalein was administered in the diet at 200, 375, 750, 3,000, and 12,000 ppm (corresponding to a time-weighted average of 37, 71, 146, 569, and 2,074 mg/kg/day, respectively) for 6 months (183 days). On days 39, 92, 137, and 183 of treatment, peripheral blood samples were collected and evaluated for the frequency of micronucleated polychromatic and normochromatic erythrocytes (MN-PCE and MN-NCE, respectively), the percentage of PCE (%PCE) among total erythrocytes, and the extent of DNA damage (single strand breaks, alkali labile sites, DNA crosslinking) in leukocytes. In addition, the extent of DNA damage was evaluated in liver parenchymal cells sampled from mice at the end of the 6-month treatment period. DNA damage was evaluated using the alkaline (pH > 13) Single Cell Gel (SCG) assay. In addition, using a modified SCG technique, the frequencies of leukocytes and liver parenchymal cells with extremely low molecular weight DNA (indicative of apoptosis and/or necrosis) were determined. At each sample time, phenolphthalein induced a highly significant, dose-dependent increase in the frequency of MN-PCE and MN-NCE and in %PCE. Maximal induction of MN-PCE and %PCE decreased with increasing treatment duration, most likely due to a treatment duration-dependent decrease in the relative amount of ingested phenolphthalein. A comparative analysis of the kinetochore status of MN in erythrocytes sampled from control mice and mice ingesting phenolphthalein at 12,000 ppm for 183 days indicates that the induced MN resulted predominantly but not exclusively from numerical chromosomal damage. The analysis for increased levels of DNA damage in blood leukocytes was inconclusive, with a small but statistically significant increase in DNA migration on days 39 and 137 but not on days 92 and 183. The extent of DNA migration in liver parenchymal cells sampled from mice at the end of treatment was not altered significantly. The frequencies of apoptotic and/or necrotic leukocytes and liver parenchymal cells were not increased among mice ingesting phenolphthalein. The lowest effective dose at which a significant genotoxic response (i.e., the induction of MN-NCE) was detected was 200 ppm, the lowest dose tested in this study. This dose in mice is comparable to doses (on a mg/m2 basis) experienced by humans.

Using quantitative and qualitative methods to pretest the publication. Take Charge of Your Diabetes: a Guide for Care.

Quantitative and qualitative methods used to pretest the guidebook Take Charge of Your Diabetes: A Guide for Care are presented in this paper. Questionnaires were used as the quantitative method (completed by 59 diabetes educators and 301 people with diabetes) and focus groups were used as the qualitative method (3 groups composed of 22 black men and women with diabetes) to examine the relevance, purpose, content, and presentation of the Guide. Findings from between-methods triangulation supported the relevance, clarity of messages, identification of groups that would be most likely to benefit, readability, understandability, and credibility of the Guide. Specific areas that needed modification were identified. Each evaluation method provided unique data; for example, quantifiable data on intention to change behavior was provided from one method and a recommendation that diversity be maintained was provided from the other method. The relative strengths and limitations of combining quantitative and qualitative approaches are described.

Diabetes control programs: new directions.

The diabetes control programs (DCPs), which involve state and territorial health agencies working cooperatively with the Centers for Disease Control and Prevention, offer new opportunities for diabetes educators to expand their scope of practice into public health. The intervention activities of the 40 core-capacity DCPs that are proposed for the next fiscal year are summarized in this paper to provide insight into the new directions of the DCPs. These activities span a range of health-system and community-based approaches and are described by their potential impact on the audience. The interventions are aimed at a variety of intended audiences and partners, including minorities, individuals with diabetes, healthcare providers, and policymakers. As diabetes educators continue to expand their scope of practice, the DCPs offer opportunities to go beyond individual practice behaviors by participating in community development activities, disseminating practice guidelines, changing organizational practices, and advocating for health-related public policy and legislation.

Psychosocial aspects of strabismus study.

OBJECTIVE: To assess the psychosocial implications of growing up with and living with socially noticeable strabismus. DESIGN: Self-report mailed questionnaire and the Hopkins Symptom Checklist. SETTING: Patients with strabismus who were seen at the University of California, Davis, Medical Center, Department of Ophthalmology, from 1976 to 1989. PARTICIPANTS: Forty-three female and male subjects aged 15 years or older who had a history of childhood strabismus that was uncorrected or incompletely corrected past the age of 13 years. INTERVENTION: None. MAIN OUTCOME MEASURES: Participants' responses to our survey and to the Hopkins Symptom Checklist. RESULTS: Strabismus had a negative impact on many aspects of our subjects' lives. They report difficulty with self-image, securing employment, interpersonal relationships, school, work, and sports. Furthermore, difficulties encountered did not go away after childhood, rather, the problems encountered by our subjects intensified in the teenage and adult years. Subjects demonstrated generalized higher levels of distress on the Hopkins Symptom Checklist than age- and sex-matched controls (P < .01). CONCLUSIONS: Psychosocial difficulties relating to socially noticeable strabismus are not just a problem for school-children but also for teenagers and adults. Correction of strabismus in the older teenager or adult may offer them improvement in psychosocial functioning, a benefit not previously reported in the literature.

Diabetes educators encourage safe needle practice.

Diabetes educators should lead individuals and communities in recommended needle-disposal practice, not only to promote safety but also to advocate the right of persons with diabetes to be disassociated from the fear of infectious disease prevalent in today's society.

Prevalence and variation of astigmatism in a military population.

Astigmatism is a common refractive anomaly. Observations on 1112 consecutive patients from a military optometric clinical population were taken to establish the prevalence of astigmatism and the incidence of its different variations. Astigmatism was found to exist in about 63% of the eyes. It was found that with-the-rule (WTR) and against-the-rule (ATR) astigmatism were the predominant types of astigmatism, and that approximately 70% of astigmatism found required 1.00D of correcting cylinder power or less. One objective of the study was to discover if a statistically significant difference existed between right and left eyes when comparing the mean correcting minus cylinder axes for WTR, ATR, and oblique types of astigmatism. This was shown to exist for WTR and ATR astigmatism. Further studies to determine the etiology of this difference are indicated.

Effect of vitamin E on the production of collagen, DNA and fibronectin in keratocytes in vitro.

Vitamin E (DL-alpha-tocopherol acetate) can inhibit collagen production in rabbit corneal keratocytes in vitro when incubated in the absence of serum. Cell growth is not appreciably affected but fibronectin synthesis is increased after exposure to vitamin E (DL-alpha-tocopherol and DL-alpha-tocopherol acetate) in the absence of serum. These findings may be important in understanding how vitamin E is advocated as both an inhibitor of scar formation and as an aid to healing.

Dural and carotid cavernous sinus fistulas. Diagnosis, management, and complications.

Carotid cavernous sinus fistulas (CCSFs) are a rare entity occurring as a result of head trauma and also spontaneously. The major threat from these fistulas is loss of vision. The authors reviewed 18 cases of direct and dural CCSFs seen over the last 10 years and compared our results with 553 cases treated in the literature. Seventy-one percent of our patients with direct CCSFs had successful balloon embolization. In the literature, successful closure of direct CCSFs has ranged from 58 to 100%. As experience with embolization techniques broadens, morbidity and mortality is reduced. The clinical features, diagnostic procedures, therapeutic options, and complications of treatment of CCSFs are discussed.

Modulation of rabbit keratocyte production of collagen, sulfated glycosaminoglycans and fibronectin by retinol and retinoic acid.

This study elucidates the biochemical response of rabbit corneal keratocytes (fibroblasts) to retinol and retinoic acid in their production of collagen, fibronectin, sulfated glycosaminoglycans, collagenase, and [3H]thymidine incorporation. The morphologic appearance of cultured keratocytes was not altered by retinoid treatment. Collagen production and [3H]thymidine incorporation demonstrated a parallel decline in response to retinoids. Collagen type was unaffected as was collagenase activity. Retinoids had minimal effect on cell layer-associated 35S-labeled glycosaminoglycans, however medium-soluble 35S-glycosaminoglycans were increased. The most dramatic effect was in fibronectin synthesis which was increased 2-3-fold. These data demonstrate that rabbit keratocytes alter their biosynthesis of extracellular matrices in response to retinoids. This may be significant in corneal pathology, since the delicate balance of these extracellular macromolecules is responsible for corneal integrity and stability.