The document summarizes key findings from the DAWN2 study on the psychosocial impact of diabetes. It finds that:
- Living with diabetes negatively impacts quality of life and emotional well-being. Nearly half of people with diabetes experience significant diabetes-related distress.
- Family members of people with diabetes also experience burden and worry. Many family members want to help but do not know how.
- Participation in diabetes education is associated with better psychosocial outcomes for people with diabetes. However, over half have never participated in education programs.
- There are gaps in psychosocial support from healthcare systems and many providers want more training to better support patients. Discrimination due to diabetes is also common.
Cardiometabolic Disease Pathophysiology & Novel Therapies for Atherosclerosis...InsideScientific
In this webinar, Dr. Michael Sturek reviews features of macrovascular atherosclerosis and microvascular dysfunction that underlie ischemic events and the need for appropriate animal models for optimal translation.
The unabated increase in cardiometabolic disease is a main reason why coronary heart disease remains the leading cause of death worldwide. Despite the effectiveness of lipid lowering therapy in treatment of coronary atherosclerosis, calcification remains a challenging clinical problem.
Lipid lowering therapy is highly effective in treating atherosclerosis, but statins and exercise have been shown to increase coronary artery calcification. Dr. Sturek will review data showing a predominance of intracellular calcium (Ca2+) release in coronary smooth muscle cells that decreases remarkably in cells from metabolic syndrome swine and humans. The early event in coronary artery calcification, i.e. the extracellular deposit of Ca2+ crystals as hydroxyapatite, may be triggered by impaired lysosomal Ca2+ signaling. Selective, novel modulation of lysosomal Ca2+ stores may alter autophagy and matrix vesicle release to treat coronary atherosclerosis and calcification.
Cardiometabolic Disease Pathophysiology & Novel Therapies for Atherosclerosis...InsideScientific
In this webinar, Dr. Michael Sturek reviews features of macrovascular atherosclerosis and microvascular dysfunction that underlie ischemic events and the need for appropriate animal models for optimal translation.
The unabated increase in cardiometabolic disease is a main reason why coronary heart disease remains the leading cause of death worldwide. Despite the effectiveness of lipid lowering therapy in treatment of coronary atherosclerosis, calcification remains a challenging clinical problem.
Lipid lowering therapy is highly effective in treating atherosclerosis, but statins and exercise have been shown to increase coronary artery calcification. Dr. Sturek will review data showing a predominance of intracellular calcium (Ca2+) release in coronary smooth muscle cells that decreases remarkably in cells from metabolic syndrome swine and humans. The early event in coronary artery calcification, i.e. the extracellular deposit of Ca2+ crystals as hydroxyapatite, may be triggered by impaired lysosomal Ca2+ signaling. Selective, novel modulation of lysosomal Ca2+ stores may alter autophagy and matrix vesicle release to treat coronary atherosclerosis and calcification.
Outpatient Diabetes Education - Haiti presented at Hôpital Sacré Coeur in Milot, Haiti.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
there is a link between emotional problems and incidence, response, prognosis of heart diseases especially ischemia. management of this co morbidity is very important.
Prediabetes means that your blood sugar level is higher than normal but not yet high enough to be classified as type 2 diabetes. Without intervention, prediabetes is likely to become type 2 diabetes in 10 years or less.
this is a brief study on prediabetes , in present scenario many of them are prediabetic ......
please comment
thank you
ADA EASD Management of hyperglycemia in type 2Mgfamiliar Net
Management of Hyperglycemia in Type 2 Diabetes:
A Patient-Centered Approach: Position Statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD).
Inzucchi SE, Bergenstal RM, Buse JB, et al.
Diabetes Care. 2012 Apr 19.
Mental health stigma can be divided into two distinct types: social stigma is characterized by prejudicial attitudes and discriminating behaviour directed towards individuals with mental health problems as a result of the psychiatric label they have been given. In contrast, perceived stigma or self-stigma is the internalizing by the mental health sufferer of their perceptions of discrimination (Link, Cullen, Struening & Shrout, 1989), and perceived stigma can significantly affect feelings of shame and lead to poorer treatment outcomes (Perlick, Rosenheck, Clarkin, Sirey et al., 2001).
Outpatient Diabetes Education - Haiti presented at Hôpital Sacré Coeur in Milot, Haiti.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
there is a link between emotional problems and incidence, response, prognosis of heart diseases especially ischemia. management of this co morbidity is very important.
Prediabetes means that your blood sugar level is higher than normal but not yet high enough to be classified as type 2 diabetes. Without intervention, prediabetes is likely to become type 2 diabetes in 10 years or less.
this is a brief study on prediabetes , in present scenario many of them are prediabetic ......
please comment
thank you
ADA EASD Management of hyperglycemia in type 2Mgfamiliar Net
Management of Hyperglycemia in Type 2 Diabetes:
A Patient-Centered Approach: Position Statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD).
Inzucchi SE, Bergenstal RM, Buse JB, et al.
Diabetes Care. 2012 Apr 19.
Mental health stigma can be divided into two distinct types: social stigma is characterized by prejudicial attitudes and discriminating behaviour directed towards individuals with mental health problems as a result of the psychiatric label they have been given. In contrast, perceived stigma or self-stigma is the internalizing by the mental health sufferer of their perceptions of discrimination (Link, Cullen, Struening & Shrout, 1989), and perceived stigma can significantly affect feelings of shame and lead to poorer treatment outcomes (Perlick, Rosenheck, Clarkin, Sirey et al., 2001).
Our aim is to alleviate human suffering related to diabetes and its complications among those least able to withstand the burden of the disease. From 2002 to March 2017, the World Diabetes Foundation provided USD 130 million in funding to 511 projects in 115 countries. For every dollar spent, the Foundation raises approximately 2 dollars in cash or as in-kind donations from other sources. The total value of the WDF project portfolio reached USD 377 million, excluding WDF’s own advocacy and strategic platforms.
Slides on Diabetes in the South Focus on Prevention.2018hivlifeinfo
Learn how to overcome common barriers to diabetes prevention with this downloadable slideset.
Richard E. Pratley, MD
Format: Microsoft PowerPoint (.ppt)
File Size: 3.16 MB
Released: October 23, 2018
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
Abstract—Diabetes is a disease which is on continuous increase specialy in country like India. It involve is a multisystem so intend to affect quality of life of patients. So this study was conducted on 250 Diabetes Mellitus patients to observe their quality of life on various domains viz Physical, Mental, Social and environmental through WHOQOL-Bref questionnaire. It was found that 54.4% were unable to level their quality of life, they say neither good nor bad. But 23.2% were feeling bad and 22.4 % were feeling good about their quality of life. Whereas regarding patient's satisfaction about their health 39.2% were unable to level their quality of life and 35.6% were dissatisfied and 25.2 % were satisfied with their health. Significantly more cases were unable to understand about their quality of life than their satisfaction to their health. It was also found that Physical quality of life was affected most followed by environmental, psychological and social dimension of quality of life.
A correlation study to determine the effect of diabetes self management on di...Kurt Naugles M.D., M.P.H.
Self-Management in this presentation refers to those activities people undertake in an effort to promote health, prevent disease, limit illness, and restore well being. Several investigators contend that self-management be made a major component of many patient health-care strategy (Glasgow, et al., 2001; Wagner, et al., 2001). Currently, nearly 125 million Americans suffer from chronic debilitating illnesses (Anderson, 2000). These national figures clearly underscore the need to develop a multidimensional approach in regards to disease management. Accordingly, measures that incorporate the patient’s perspective in managing his or her health should be explored.
Diabetes mellitus is among those conditions suspected to be highly influenced by self-management activities (Sprangers, et. al., 2000). If benefits do indeed exist, they need to be fully evidenced. The investigation presented here sought to examine the role self management plays in the health outcomes of individuals living with diabetes.
PREVALENCE OF DEPRESSION AND ITS ASSOCIATED FACTORS IN ADULTS WITH DIABETES M...pijans
The prevalence of Diabetes Mellitus has been rising steadily owing to several factors such as sedentary
lifestyle, obesity and an aging population. The prevalence of diabetes is predicted to double globally from
171 million in 2000 to 366 million in 2030 with a maximum increase in India with up to 79.4 million
individuals in India. Depression occurs frequently with diabetes but there are not many studies in India to
estimate its prevalence and associated factors. This study was done with the aim of estimating the
prevalence of depression among diabetes patients using the validated Patient Health Questionnaire-9 and
also its associated factors.
Improving the Health of Adults with Limited Literacy: What's the Evidence?Health Evidence™
Health Evidence, in partnership with the National Collaborating Centre for Determinants of Health (NCCDH), hosted a 60 minute webinar, funded by the Canadian Institutes of Health Research (KTB-112487), on interventions to improve the health of adults with limited literacy, presenting key messages, and implications for practice on Wednesday October 31, 2012 at 1:00 pm EST. Maureen Dobbins, Scientific Director of Health Evidence, lead the webinar, which included interactive discussion with Karen Fish, Knowledge Translation Specialist, and Connie Clement, Scientific Director, both from the NCCDH.
This webinar focused on interpreting the evidence in the following review:
Clement, S., Ibrahim, S., Crichton, N., Wolf, M., Rowlands, G. (2009). Complex interventions to improve the health of people with limited literacy: A systematic review. Patient Education & Counseling, 75(3): 340-351.
Health Awareness as a Predictor of Chronic Non-Communicable Diseases in St. V...Jodean Campbell
Objective:
To evaluate the effect of health awareness on health values such as dietary structure and choices. To evaluate the effect of health awareness levels on the presence of Chronic Noncommunicable Diseases in St. Vincent and the Grenadines.
Results:
Participants with high awareness levels have higher educational levels and lower incidences of non-communicable diseases than individuals with low awareness levels. Chi square test gave a p value less than 0.00001 for the association between awareness level and disease. The relationship between awareness level and education, yielded a p value of 0.000088.
A study on awareness of diabetic complications among type 2 diabetes patientsiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Abstract Quality improvement methods are vital in treati.docxrobert345678
Abstract
Quality improvement methods are vital in treating biopsychosocial conditions. Diabetes is a chronic disease that requires follow-
up care to prevent comorbidities. With an increased population suffering from diabetes, mainly type 2 diabetes, traditional
treatments are ineffective, and a new treatment approach should be adopted. While this is deemed a plausible solution to curb the
increase of diabetes, research indicates that 70% of quality improvement initiatives fail within twelve months of implementation
(O'Donoghue et al., 2021). Therefore, stakeholders must follow proposed improvements methods closely to achieve meaningful
and sustainable change. To combat widespread chronic diseases such as diabetes, strategies such as self-management support,
intensified treatment, encouraged physical activity, and patient education plays a crucial role in managing a patient's condition.
The disease heavily relies on one self-management abilities. The proposed strategies aim to achieve patient adherence to prevent
other health effects that can be otherwise be contained and ensure that mental distress often experienced by diabetes patients is
adequately dealt with.
This study source was downloaded by 100000855641916 from CourseHero.com on 01-03-2023 03:05:19 GMT -06:00
https://www.coursehero.com/file/137101090/NURS-FPX6021-Assessment-3-Yudelca-Collado-Quality-Improvement-Presentation-Poster-1-2pptx/
https://www.coursehero.com/file/137101090/NURS-FPX6021-Assessment-3-Yudelca-Collado-Quality-Improvement-Presentation-Poster-1-2pptx/
Quality Improvement Presentation Poster
Yudelca Collado
Capella University
Biopsychosocial Concepts for Advanced Nursing Practice I
Quality Improvement Presentation Poster
1/27/2022
Quality Improvement Methods
• The word "quality improvement" refers to the practice of enhancing
the intended outputs of an existing process. Typically, this would need
previous knowledge of the process and the areas that may be
improved.
• Once a problem has been identified, it is critical to develop a plan of
action to improve the outcomes in that area. Recent studies have
indicated the sufficient evidence-to-clinical practice gap in diabetes
care (Mukerji et al., 2019). Upon discovering this, several plans of
action are required to improve the gaps in care delivery towards
diabetes patients.
• While most providers concentrate on the physical aspect of the
patient's health, research indicates that diabetes patients are often
affected by depression and diabetes distress ( Gary et al., 2019). This
results in underdiagnosis and undertreatment of diabetes patients,
which impedes patients' chances of managing their health condition.
• With the identification of this, challenges within primary care must be
addressed to ensure that there is sufficient screening for both
depression and diabetes distress.
• Several strategies must be applied to sufficiently monitor the patient:
self-management support, intensi.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Pharma Pcd Franchise in Jharkhand - Yodley Lifesciences
Psychosocial impact of diabetes
1. Psychosocial impact of diabetes:
DAWN 2
multi-national results
Ingrid Willaing
Steno Diabetes Center, Denmark
on behalf of the DAWN2 study group
2. WONCA 2015
Duality of Interest Declaration
Ingrid Willaing
I report the following potential
duality/dualities of interest in the field
covered by my lecture:
Advisory board member for Novo Nordisk A/S
Employed by Steno Diabetes Center A/S,
a research hospital working in the Danish
National Health Service and owned by Novo
Nordisk A/S
3. Background
Living with diabetes is demanding and many experience
psychosocial challenges1
Effective psychosocial support can help reduce stress,
improve psychological functioning and improve
outcomes2,3
Healthcare professionals feel ill-equipped to provide
required psychosocial support4
1. Rubin RR, et al. Diabetes Care 1992;11:1640–57
2. Alloway SC, et al. Can J Diet Pract Res 2001;62:188–92
3. Jacobson AM. N Eng J Med. 1996;334:1249–53
4. Peyrot M, et al. Diabet Med 2005;22:1379–85
5. Diabetes has a negative impact on a
wide range of life domains
Nicolucci A, et al. Diabet Med 2013;30:767–77
100
80
60
40
20
0
Relationships
with family/
friends/peers
Work and
studies
Leisure
activities
FinancesReduced
emotional
well-being
Reduced
physical
health
21
35
38
4446
62
Proportionofpeoplewith
diabetes(%)
People with diabetes reported a negative impact on the
following aspects of living:
6. Almost half of people with diabetes
have diabetes-related emotional
distress (PAID-5 ≥ 40)
Proportion of people with diabetes who had significant
emotional distress related to diabetes80
0
Proportionofpeoplewithdiabetes
(%,95%CI)
10
20
30
40
70
60
50
Nicolucci A et al. Diabet Med 2013;30:767–77
*Global score
Country-specific data and the mean (dotted line) are adjusted for clustering, and weighted on age,
gender, region, and education to allow generalization from the sample to larger populations.
These data differ from the unadjusted global score and country score (range).
CI, confidence interval; PAID-5, Problem Areas in Diabetes Short Form – 5 items.
7. 14% of people with diabetes report
likely depression (WHO-5 ≤28)
Nicolucci A et al. Diabet Med 2013;30:767–77
Holt RIG et al. IDF Melbourne 2013;P-1726
Proportion of people with diabetes with likely depression30
0
Proportionofpeoplewithdiabetes
(%,95%CI)
5
10
15
20
25
*Global score
Country-specific data and the mean (dotted line) are adjusted for clustering, and weighted on age,
gender, region, and education to allow generalization from the sample to larger populations.
These data differ from the unadjusted global score and country score (range).
CI, confidence interval; WHO-5, World Health Organization Well-Being Index-5.
8. Women with diabetes report worse
psychosocial outcomes than men
Nicolucci A, et al. IDF Melbourne 2013;P-1653
Indicators Men
N=4523
Women
N=4073
p
WHO-5: Psychological well-being 59±23 55±24 <0.0001
PAID-5: Diabetes distress 32±25 37±26 <0.0001
EQ-5D VAS: Health perception 68±19 66±20 <0.0001
DIDP: diabetes impact
(% reporting a slightly negative
to very negative impact):
Physical health
Financial situation
Relationship with family, friends and peers
Leisure activities
Work or studies
Emotional well-being
61
38
20
38
32
43
62
45
21
36
33
48
0.22
<0.0001
0.71
0.23
0.64
<0.0001
I am very worried about the risk
of hypoglycemic events
(% who mainly or fully agree)
51 57 <0.0001
9. Discrimination is common and
associated with worse outcomes
19% of people with diabetes experienced discrimination
from their community1
Experiencing discrimination due to diabetes is
associated with increased diabetes-related emotional
distress2
1. Nicolucci A, et al. Diabet Med 2013;30:767–77
2. Wens J, et al. EASD, Barcelona 2013; PS 095-P1142
10. Discrimination varies across countries
Country-specific data and the mean (dotted line) are adjusted for clustering,
and weighted on age, gender, region, and education to allow generalization
from the sample to larger populations. These data differ from the
unadjusted global score and country score (range). Wens J, et al. EASD, Barcelona 2013; PS 095-P1142
Proportionofpeoplewithdiabetes
(%,95%CI)
0
10
20
30
50
40
Proportion of people with diabetes who feel discriminated
against because of their diabetes
11. Higher levels of empowerment are
associated with a less negative impact
on different aspects of life
Percentage of respondents reporting a negative impact by tertiles (from empowerment scale)
0 10 20 30 40 50 60
Leisure activities
Work or studies
Emotional well-being
Percentage
Lower
Middle
Higher
Tertile
13. Background
Family support and social support are essential for
living well with diabetes1
Limited evidence is available about adult family
members’ burden of diabetes2
Only a few, small studies have evaluated the
burden of diabetes on adult family members of
people with diabetes
The DAWN2 study provides an opportunity to
review this globally
1. Peyrot M, et al. Diabet Med 2005;22:1379–85
2. Torenholt R, et al. Diabet Med 2013]
14. Total participants globally n=15,438
People with diabetes1
n=8596
Type 1
n=1368
Type 2 (n= 7228)
-Insulin Med (n=2591)
-Non-Insulin Med (n=2937)
-Non-Med (n=1700)
Family members2
n=2057
Healthcare professionals3
n=4785
PCPs/GPs
n=2066
Diabetes specialists
n=1350
Nurses
n=827
Dietitians
n=542
Family members in DAWN2
1. Nicolucci A, et al. Diabet Med 2013;30:767–77; 2. Kovacs Burns K, et al. Diabet Med 2013;30:778–88
3. Holt R, et al. Diabet Med 2013;30:789–98
15. Diabetes has a negative impact on a
wide range of life domains of family members
Kovacs Burns K, et al. Diabet Med 2013;30:778–88
Negativeimpact
(%)
Work and
studies
Reduced
physical
health
Leisure
activities
FinancesReduced
emotional
well-being
Relationships
with family/
friends/peers
Family members of people with diabetes reported
a negative impact on the following aspects of living:
16. Diabetes results in burden, worry
and distress for adult family members
of people with diabetes
Kovacs Burns K, et al. Diabet Med 2013;30:778–88
Kovacs Burns K, et al. IDF Melbourne 2013;PD-0924
40% 35%
expressed high
levels of
distress related
to concerns
about their
relative with
diabetes
reported a
‘moderate’ to
‘very large’
burden from
caring for a
relative with
diabetes
17. 61% of family members are very
worried about hypoglycemia
Kovacs Burns K, et al. Diabet Med 2013;30:778–88
Proportionoffamilymembers
(%,95%CI)
100
0
10
20
30
40
60
80
90
70
50
Global score
Country-specific data and the mean (dotted line) are adjusted for clustering,
and weighted on age, gender, region, and education to allow generalization
from the sample to larger populations. These data differ from the unadjusted
global score and country score (range).
18. Many family members want to help,
but do not know how to
Kovacs Burns K, et al. Diabet Med 2013;30:778–88
...want to be
more involved in
helping with
diabetes care
… do not know
how best to help
46%
39% 37%
% of family members who…
…would like to be more
involved in helping their
relative with diabetes deal
with feelings about the
condition
19. The majority of family members have
not participated in diabetes education
71% 77%
Type 1 diabetes Type 2 diabetes
of family
members did
not participate
in any diabetes
educational
activity
Willaing I, et al. Diabetes 2013;62(suppl 1):A79
of family
members did
not participate
in any diabetes
educational
activity
20. Family member participation in
diabetes education varied by country
Country-specific data and the mean (dotted line) are adjusted for
clustering, and weighted on age, gender, region, and education to allow
generalization from the sample to larger populations. These data differ
from the unadjusted global score and country score (range). Family
member participation in education 463/2057=23% Kovacs Burns K, et al. Diabet Med 2013;30:778–88
60
50
40
30
20
10
0
Proportionoffamilymembers
(%,95%confidenceinterval)
22. Background
Active self-management is essential to achieving good
health and quality of life in diabetes1,2
Strategies are available today that can increase
involvement of people with diabetes in their disease
management3,4
The DAWN2 study allows us to review the current
situation in terms of involvement and education of
people with diabetes
1. Peyrot M, et al. Diabet Med 2005;22:1379–85
2. Funnell MM, et al. Clinical Diabetes 2004;22:123–7
3. Coulter A, et al. BMJ 2007;335:24–7
4. Haas L, et al. Diabetes Care 2012;35:2393–401
23. Gaps in care for psychosocial and
behavioral assessment
*Percentages given are weighted and do not reflect crude
rates of respondents for each indicator; thus crude numbers
and percentages do not coincide Nicolucci A et al. Diabet Med 2013;30:767–77
In the past 12 months, did anyone from
your healthcare team (% reporting ‘yes’):
Global score,
%*
Country score,
median (range)
Measure your long-term blood sugar
control level?
72 75.3 (61.6–92.8)
Examine your feet? 45 53.6 (14.8–81.8)
Ask if you have been anxious or depressed? 32 32.5 (14.6–57.3)
Ask about the types of foods you have
been getting?
49 45.4 (26.6–63.8)
24. Differences in perceptions about
communication across countries
0
20
40
60
80
100 Proportion of people with diabetes who said their healthcare
team asked them how diabetes affects their lives
Proportionofpeoplewithdiabetes
Proportion of healthcare professionals who said they asked their
patients how diabetes affects their lives
25. Perceptions of communication differ
between people with diabetes and
healthcare professionals
People with diabetes
were listened to
regarding how they
would like to do things
29
37 38
56
77
72
0
20
40
60
80
100
Individuals(%)
People with diabetes
being asked by their
healthcare professional
for ideas when making
their diabetes
care plan
People with diabetes
felt that their
healthcare professional
conveyed confidence
in their ability to
make changes
People with diabetes Healthcare professionals
27. Base: All Qualified HCPs (PCPs/GPs: n=2,066; Specialists: n=1,350;
Nurses: n=827, Dietitians n=542)
Q1050 Have you ever attended post-graduate training in any of
the following areas?
Post-graduate training (HCPs)
Base: All Qualified HCPs (PCPs/GPs: n=2,066; Specialists:
n=1,350; Nurses: n=827, Dietitians n=542)
Q1055 In which of the following areas would you like to
receive more training or support on an ongoing basis in order
to provide better care for your patients with diabetes?
Training Attended Training Desired
AD
AB
A
AD
CD
AB
A
BD
ACD
AC
A
A
AD
BD
BCD
A
D
ABC
A
ABD
B
A
AB
AB
AB
A
28. Beliefs about diabetes management
(HCPs)
Base: All Qualified HCPs (PCPs/GPs: n=2,066; Specialists: n=1,350; Nurses: n=827, Dietitians: n=542)
Q950 Please think about your personal beliefs around diabetes management and indicate the extent to which you agree or
disagree with each of the following statements.
53%
16%
52%
58%
26%
60%
57%
16%
51%
43%
17%
37%
0% 100%
It is important for me to advocate on behalf of
people with diabetes and be involved in health
policy issues for improvement of care of diabetes
HCPs have a very limited influence on how well
people take care of their diabetes
My success in caring for people with diabetes
depends largely on my ability to understand and
manage the emotional issues my patients face
PCPs/GPs (A) Specialists (B) Nurses (C) Dietitians (D)
Ratings of ‘5’ or ‘6’ on a 6-Point Agreement Scale
(‘1’ = Fully Disagree and ‘6’= Fully Agree)
A
A
A
ABD
A
ABD
A
29. Participation in diabetes education is
associated with better psychological outcomes
Participation in diabetes education was
associated with:
− better quality of life (p=0.0002)
− higher diabetes empowerment (p<0.0001)
− fewer psychological problems (p=0.001)
− better wellbeing (p=0.005)
Willaing I et al. EASD 2013, Barcelona; PS 094-P1136
30. Diabetes is associated with significant psychosocial
challenges
Family members are burdened by diabetes – but they
represent an untapped potential for support
Active engagement and participation of people with
diabetes is lacking – and there are significant
communication gaps
Half of all people with diabetes never participated in a
diabetes education program, but those who did, found it
very helpful
Training and support for healthcare professionals is
limited - but much wanted
Discrimination due to diabetes is prevalent and is linked to
worse treatment outcomes
DAWN2: Key global findings
31. For further information,
please see:
− www.dawnstudy.com
Thank you for your attention!
Thank you
Editor's Notes
Thank you for the introduction and
thank you for the opportunity to present at this conference
I come from Steno Diabetes Center, DK and I am presenting this on behalf of the DAWN2 study group
These are my conflicts of interest
Living with diabetes is demanding and many people experience psychosocial challenges due to their diabetes
We know from previous research that effective psychosocial support can help reduce stress, can improve psychological functioning and improve outcomes such as glycaemic control and quality of life
The first DAWN study showed that healthcare professionals at that time felt ill-equipped to provide the required psychosocial support for people with diabetes
The DAWN2 study explores the current status for psychosocial health in people with diabetes as well as the status for self-reported qualifications of health care professionals to provide the support that is needed
I will present a number of the overwhelming amount of results from the study.
First we will look at the impact of diabetes on quality of life and well-being in people with diabetes.
Many of these results have been published in Diabetic Medicine, and a number of country results have been published in more local journals.
Many more papers are coming up on global as well as local results of the DAWN2 study.
DAWN2™ shows that altogether diabetes has a negative impact on a wide range of life domains.
62% of PWD report about reduced physical health
46% report about reduced emotional well-being
44% report a negative impact on finances
38% report a negative impact on leisure activities
35% report a negative impact on work and studies
And 21% report impaired relationships with family, friends and peers
These numbers underpin the challenges that people with diabetes face in their daily life. They also indicate a substantial need for improved support.
This slide shows the prevalence of diabetes related emotional distress in the 17 countries, measured by the PAID scale.
The countries are grouped by geographical region with America to the left, then Western Europe, Eastern Europe and Russia, Eastern and Asian countries to the right.
The horizontal dotted orange line shows the cluster adjusted average of 41% from all countries.
The country range varied from about 20% - more than 60%, shown here as squares with confidence intervals. Some countries are somewhat above the average of 41%, and some are somewhat under - with the largest emotional burden in south and east Europe and Asia
When we look at the prevalence of people with diabetes with likely depression, using the WHO-5 scale, we see a slightly different pattern across countries with a mean of about 15% reporting likely depression with slightly higher proportions in eastern European countries.
Some subgroups of people with diabetes seem to have worse psychological outcomes than others. Women report worse outcomes than men as shown in this table:
Women report
Lower psychological well being, more diabetes distress and lower health perception (measured by WHO-5 and EQ 5D)
A higher percentage of women report negative impact on finances and on emotional well-being
And there is a higher degree of serious worries about hypoglycaemia
Unfortunately discrimination due to diabetes happens with a mean of 19% experiencing this across the 17 countries.
Experiencing discrimination due to diabetes is associated with increased diabetes-related emotional distress.
This slide shows the distrubution of experiencing discrimination across the 17 countries.
We see that there is variation across countries – but we see discrimination in all countries.
Countries like Algeria, Turkey, India and Poland have more problems than the other countries.
There are some positive findings, or some hope:
This slide shows that higher levels of empowerment, measured by the Diabetes Empowerment Scale, were associated with less negative impact of diabetes on different aspects of life such as emotional well-being, work or studies and leisure activities.
The dark blue bars illustrate lower level of empowerment, the lighter blue bars illustrate middle level of empowerment and the grey bars higher level of empowerment
The y-axis shows different aspects of life: emotional well-being, work or studies and leisure activities.
The x-axis shows the percentage of respondents by tertiles reporting a negative impact of diabetes on these different aspects of life.
A rather under researched area is the family burden of diabetes.
In the following I will show you some of the results from the DAWN2 study on experiences, attitudes, wishes and needs of family members of people with diabetes
Previous research on diabetes and family shows that diabetes affects the entire family. Family is generally a primary source of support for PWD and plays a key role in instrumental care and in providing emotional and moral support. Family support and social support are essential for living well with diabetes.
Previous studies have also shown that family influences the ability of the person with diabetes to self-manage and cope with having diabetes. But we have limited evidence about the burden of diabetes on adult family members of people with diabetes.
In the DAWN2 study this burden is evaluated.
In the following slides I will focus on the reports from the 2057 family members of people with diabetes who participated in the DAWN2 study
This slide shows the wider social and psychological impact diabetes has on adult family members living with people with diabetes.
Almost half of family members report reduced emotional well-being and more than a third of family members report that diabetes impacts on their financial situation.
But also leisure activities, physical health, work and family relationships are negatively affected by diabetes.
In more detail this slide shows that 40% of family members expressed high levels of distress related to concerns about their relative with diabetes
and 35% of family members reported a moderate to very large burden from caring for a relative with diabetes.
As for worries about hypoglycaemia as many as in average 61% of family members are very worried about hypoglycaemia with some variation across countries.
Algeria represents the highest percentage (80%) and DK and the Netherlands the lowest (30%).
Many family members want to help, but do not know how to help.
These results highlight a willingness from up to 46% of family members to increase their support, and be more involved in helping with diabetes care
but also highlight an unmet need to understand how to support as 37% do not know how to help.
This slide shows that the majority of family members have NOT participated in diabetes education. Approximately 75% of family members of people with diabetes have never participated in any educational activity to support them in supporting their family member with diabetes. Almost the same number for type 1 and type 2 diabetes.
And this slide shows the rates of family member participation in diabetes education in the 17 countries. Again the countries are grouped by geographical region with America to the left, then Western Europe, Eastern Europe and Russia, Eastern and Asian countries to the right.
The horizontal dotted orange line shows the cluster adjusted average of 23% participation rate from all countries.
The country range varied from about 10-40%, again shown as squares with confidence intervals. Some countries are somewhat above the average of 23%, and some are considerably under.
The following slides show results about active involvement of people with diabetes
and support for self-management
Previous studies have shown that active involvement of people with diabetes is essential to achieving good health outcomes and good quality of life
Previous studies have also shown that strategies are available today that can increase involvement of people with diabetes in their disease management
This slide shows shows indications of critical gaps in diabetes care as regards psychosocial and behavioral assessment in diabetes care.
The slide shows a rate of 72% having had long term blood sugar measured and about half of people with diabetes having had foot examinations and assessment of food choices.
But we see a low rate of PWD being questioned about psychosocial health, as less than a third have been asked about that.
There is one crucial question which should probably be asked regularly if you believe in a psychosocial impact of diabetes. That is how diabetes affects the life of the person with diabetes.
Here we see the proportion of people with diabetes who said their healthcare team asked them how diabetes affects their lives
And now wee see the proportion of healthcare professionals who said they asked their patients how diabetes affects their lives
These spectacular differences in perceptions about communication vary in size across countries – but the differences are found in all countries
This slide also shows how perceptions of communication about involvement differ between people with diabetes and healthcare professionals
The dark blue bar shows the percentage of people with diabetes who report having been asked by their healthcare professional for ideas when making their diabetes care plan. The lighter blue bar shows the percentage of health care professionals who report having asked the patients about ideas.
Similarly you see the differences regarding listening to how people with diabetes would like to do things
and third: whether health care professionals conveyed confidence in patients’ ability to make changes
These differences in perceptions may be significantly contributing to poor self-management of diabetes
The last results are about education and training
Let us take a look at health care professionals and their post graduate training in this busy and somewhat complicated slide.
The bars show the different groups of health care professionals:
PCPs/GPs are light blue, Diabetes specialists are darker blue, Nurses are medium blue/light purple and Dieticians are grey.
The red ABCDs identify significant differences between the professional groups.
Let us focus on PCPs/GPs and the left side of the slide. Looking at training attended we see that in general this group has received lees training than diabetes specialists, not only in medical management of diabetes, but also in dietary management, communication and motivation, self-management education and psychological aspects of diabetes. Looking at the right side of the slide: apart from medical and dietary management of diabetes, PCPs/GPs are less interested in receiving more training than the other professional groups. However, HCPs seem altogether very motivated for more training regarding psychosocial aspects of diabetes
Here we see that PCPs/GPs differ significantly from the other professional groups as regards beliefs about the impact of the professional on self-management by the person with diabetes.
PCPs/GPs to a significantly lesser degree believe that their success in caring for people with diabetes largely depends on their ability to understand and manage emotional issues their patients face.
And 17% believe that HCPs have a very limited influence on how well people take care of their diabetes.
There may be many explanations for these results.
As in many other studies we found that participation in diabetes education for people with diabetes is significantly associated with better psychological outcomes such as:
better quality of life
higher diabetes empowerment
fewer psychological problems
better wellbeing
We also found that those who did participate in diabetes education found it helpful
In summary the DAWN2 study shows that:
Diabetes is associated with significant psychosocial challenges
Family members are burdened by diabetes and they represent un untapped potential for support
Active engagement of people with diabetes is lacking
Half of people with diabetes and less than 25% of family members ever participated in diabetes education – but those who did found it very helpful
Discrimination due to diabetes is prevalent and is linked to worse treatment outcomes
Training and support for healthcare professionals is limited – but desired by health care professionals
For further information about the DAWN2 study you can look at this website.
Thank you for your attention!