Role of health care providers in educational training of patients with diabetes.

Diabetes mellitus is a high prevalence chronic disease, in which several health care providers are involved in the treatment of patients. Multifaceted professional and organizational interventions that facilitate structured and regular review of patients are effective in improving the process of care. Moreover, patient education and enhancement of role of nurses improve clinical outcomes and process of care. As diabetic management requires strict commitment of the patients, their educational therapy is mandatory. Therapeutic Patient Education (TPE) is a continous process, integrated in health care; it is a permanent care process, patient-centred, that must be adapted to the evolution of illness and to the patient's lifestyle; TPE must be structured and organized and it should receive benefits from the appropriate pedagogic means. Since the publication of DCCT data it was clear that intensive insulin therapy had been successfully applied only in centers where a diabetologist, a specialized nurse, a dietician, a psycologist and a motivated patient worked all together, i.e. where there was a "team". The team has to follow a pedagogic, multidisciplinary and patient-centred methodology of care. Well structured integration between health care providers may help to avoid the burn-out syndrome.

Assessing resting heart rate in adolescents: determinants and correlates.

The aim of this study was to evaluate the distribution of resting heart rate and its biological and environmental determinants in adolescents. The study was cross- sectional and the population consisted of 2230 children and adolescents, age range 12-18 years, enrolled randomly from state schools in Turin, Italy. In all participants the following parameters were evaluated: heart rate, blood pressure (BP), weight, height, degree of sexual development, physical activity, parental socio-cultural level. Heart rate and BP were measured after 5, 10 and 15 min in a sitting position. Furthermore, to obtain regression equations to define heart rate as a function of the other variables available, a multiple regression analysis was performed. In both sexes BP, but not heart rate, declined significantly from the first to the last determination. Heart rate was positively and significantly correlated to BP level in both sexes; heart rate was higher in girls (3 bpm) and followed a progressive decreasing trend with age in both sexes, that was opposite to BP values. Age, sexual maturation, height, physical activity and parental socio-cultural level were independent determinants of resting heart rate. In conclusion, resting heart rate in adolescents is related to several methodological, constitutional and environmental factors that have to be taken into account when assessing heart rate values and constructing tables of normal values.