A community-targeted implementation of self-management for people with epilepsy and a history of negative health events (SMART): A research and community partnership to reduce epilepsy burden

Introduction: Evidence suggests that gender may influence many aspects of type 2 diabetes (T2DM) self-management (SM) and we posit that limited English language–proficient Latinx immigrants face additional challenges. Methods: Instruments and semi-structured interviews were used to examine gender differences on health literacy, diabetes knowledge, health-promoting behaviors, diabetes, eating and exercise self-efficacy (SE), and T2DM SM practices among a cohort of limited English language–proficient Latinx immigrants. Statistical and qualitative analysis procedures were performed comparing males and females. Results: Thirty persons participated. Males tended to be older, have higher educational achievement, and more financial security than females. Physiologic measures tended worse among female participants. Health literacy and exercise SE scores were similar, but females scored lower on Eating and Diabetes SE. Forty-seven percent ( n= 9) of the women reported a history of gestational diabetes mellitus and a majority of men ( n = 7) cited difficulty with excessive alcohol. Consumption: Males appeared to receive more SM support compared to females. Females more frequently noted how family obligations and a lack of support impeded their SM. Work environments negatively influenced SM practices. Conclusion: Men and women have unique SM challenges and as such require individualized strategies and support to improve T2DM management.

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Older Adults’ Adoption of Mobility Devices: Interplay of Predisposing Factors and Precipitating Health Events

Innovation in Aging ◽

10.1093/geroni/igaa057.1567 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 484-485

Author(s):

Farhanaz Sharmin ◽

Laura Sands

Keyword(s):

Older Adults ◽

Logistic Regression ◽

Chronic Conditions ◽

High School Education ◽

Living Alone ◽

Mobility Limitations ◽

Chi Square ◽

Health Events ◽

Mobility Devices ◽

History Of

Abstract Existing mobility limitations and chronic conditions increase likelihood of adopting mobility-related devices such as canes and walkers. Prior research has not considered how recent acute events such as falls and hospitalizations contribute to the adoption of mobility devices. We studied 4,592 older adults who responded to the 2015 and 2016 National Health and Aging Trends Study surveys, and classified adoption of mobility devices as: (i) Never users (did not use mobility devices either year) and (ii) New users (started using mobility devices in 2016). We determined through chi-square tests, that predisposing characteristics from 2015 that were significantly associated with being a New User in 2016 were: being female, aged 80+, minority race, having a high-school education or lower, living alone, being obese, and having a history of dementia, arthritis, stroke, mobility difficulties, falls, and hospitalization (all P’s<0.05). We used logistic regression to determine the contribution of recent precipitating events on the adoption of mobility devices among older adults after controlling for 2015 characteristics that were significantly associated with being a New user. Precipitating events were significantly associated with being a New user of mobility equipment. Specifically, older adults who, between the 2015 and 2016 interviews, experienced a fall (OR=1.7; 95% CI=1.1-2.9), hospitalization (OR=3.7; 95% CI=2.3-5.9) or increase in mobility difficulties (OR=3.7; 95% CI=2.3-5.9) were more likely to be New users. Study findings reveal the importance precipitating events on the adoption of mobility devices, signaling the importance of assessing for need for mobility devices after these events.

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The association between hypertension self-management and stroke event in male patients at the Badung District Hospital, Bali

Public Health and Preventive Medicine Archive ◽

10.15562/phpma.v6i2.14 ◽

2018 ◽

Vol 6 (2) ◽

pp. 82

Author(s):

Ni Kadek Sutini ◽

Ni Wayan Septarini ◽

I Made Ady Wirawan ◽

Anak Agung Sagung Sawitri

Keyword(s):

Medication Adherence ◽

Stress Management ◽

Self Management ◽

Stroke Event ◽

Adherence To Medication ◽

History Of ◽

Male Patients ◽

Main Components ◽

Self Administered Questionnaire ◽

Poor Management

Background and purpose: Hypertension is a major risk factor for stroke. Despite efforts to control hypertension with pharmacological and non-pharmacological therapies, the prevalence of and death from stroke is reported to be increasing. This study aims to determine the association of hypertension self-management with the incidence of stroke in patients with hypertension.Methods: A case-control study was conducted involving 44 patients suffering from hypertension and who had suffered a stroke as a case, as well as 44 patients with hypertension and no stroke as a control. Data on self-management of diet, physical activity, stress mitigation efforts, alcohol consumption, and medication adherence were collected using self administered questionnaire. Data on the diagnosis of hypertension, stroke and history of comorbidities were obtained from the patient's medical records. Multivariatee analysis using logistic regression was employed to assess the association between hypertension self-management with the incidence of stroke in patients with hypertension.Results: Characteristics of cases and controls did not differ in education, marital and socioeconomic status, but differed in age and employment. Multivariate analysis showed that there were three components of hypertension self-management associated with the incidence of stroke, namely poor adherence to medication (AOR=7.28; 95%CI: 2.19-24.17), poor self-management of stress (AOR=5.45; 95%CI: 1.56-18.99), and poor management of self-regulated diet (AOR=5.28; 95%CI: 1.31-21.32).Conclusions: Medication adherence, diet and stress management are the three main components of self-management that are associated with stroke events among hypertension patients. Efforts to increase medication adherence, diet and stress management should be enhanced.

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ORGANIZATION OF AMBULATORY CARE FOR TYPE 2 DIABETES MELLITUS

Vestnik ◽

10.53065/kaznmu.2021.72.26.041 ◽

2021 ◽

pp. 187-193

Author(s):

З.К. Манатбекова ◽

А. Озат ◽

А.Е. Бектур ◽

А.Р. Шаймерден ◽

Д.А. Ахат ◽

...

Keyword(s):

Type 2 Diabetes ◽

Outpatient Care ◽

Best Practice ◽

Self Management ◽

Order Sets ◽

History Of ◽

Insulin Use ◽

Quality Assurance Standards

Качественная амбулаторная помощь при диабете требует как стандартов оказания амбулаторной помощи, часто обеспечиваемой структурированными наборами заказов, так и стандартов обеспечения качества для улучшения процессов. Протоколы, обзоры и руководства «передовой практики» непоследовательно применяются в больницах. Чтобы исправить это, в больницах установлены протоколы для структурированного ухода за пациентами и структурированные наборы заказов, которые включают компьютеризированный ввод заказов врача (CPOE). В первоначальных заказах должен быть указан тип диабета (например, диабет 1 или 2 типа) или отсутствие диабета в анамнезе. Поскольку стационарное использование инсулина и приказы о выписке могут быть более эффективными, если основаны на уровне A1C при поступлении, выполните тест A1C у всех пациентов с диабетом или гипергликемией, госпитализированных в больницу, если тест не был проведен. выполнено за предыдущие 3 месяца. Целью данной работы является рассмотрение стандартов амбулаторного лечения пациентов с диабетом 2 типа, составление рекомендации по поведению и формировании навыков в отношении самоконтроля при диабете. Quality ambulatory diabetes care requires both outpatient care standards, often provided by structured ordering, and quality assurance standards to improve processes. “Best practice” protocols, reviews and guidelines are inconsistently applied in hospitals. To remedy this, hospitals have established protocols for structured patient care and structured order sets that include computerized entry of physician orders (CPOE). Initial orders must indicate the type of diabetes (such as type 1 or 2 diabetes) or no history of diabetes. Because inpatient insulin use and discharge orders may be more effective if based on admission A1C levels, perform an A1C test on all diabetic or hyperglycemic patients admitted to the hospital if the test has not been performed. completed in the previous 3 months. The aim of this work is to review the standards of outpatient treatment of patients with type 2 diabetes, to draw up recommendations on behavior and skills formation in relation to self-management in diabetes.

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Helping Teachers Promote Self-Directed Language Learning: Report of a Fulbright Scholar in Ecuador

PROFILE Issues in Teachers Professional Development ◽

10.15446/profile.v21n2.75121 ◽

2019 ◽

Vol 21 (2) ◽

pp. 145-153

Author(s):

Joan Rubin

Keyword(s):

Language Learning ◽

Goal Setting ◽

Task Analysis ◽

Self Regulation ◽

Language Teachers ◽

Self Management ◽

Learning Skills ◽

Experience Teaching ◽

Fulbright Scholar ◽

History Of

Since Ecuador has determined that it wants to be fully bilingual in ten years, this paper describes the experience of a Fulbright Scholar at a university Language Center in Quito; one helping language teachers improve the language learning skills of their students. The theoretical framework for this work comes from Learner Self-Management (LSM) or Self-Regulation. The scholar details her experience teaching LSM concepts such as SMART goal setting, Task Analysis, Cognitive and Affective Strategies. She provides descriptions of what these language teachers consider the roles of the teacher and that of the learner to be and also what their most critical teaching issues were. She also briefly elaborates the history of the development of learner strategies and the value of metacognitive strategies and knowledge.

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Thrombophilia: What's a Practitioner to Do?

Hematology ◽

10.1182/asheducation.v2001.1.322.322 ◽

2001 ◽

Vol 2001 (1) ◽

pp. 322-338

Author(s):

B. Gail Macik ◽

Jacob H. Rand ◽

Barbara A. Konkle

Keyword(s):

Hormonal Therapy ◽

Oral Anticoagulant Therapy ◽

Laboratory Finding ◽

Treatment Strategies ◽

Self Management ◽

New Approach ◽

Self Testing ◽

Abnormal Laboratory Finding ◽

History Of ◽

Management Issues

Abstract Management of thrombophilia is an ever-changing field as new disorders are described and additional clinical experience accrues. This paper addresses three common management issues in the care of patients with thrombophilia. The first two topics are updates for common but perplexing hypercoagulable states and the last topic introduces a new option for optimal management of oral anticoagulant therapy. Dr. Jacob Rand updates and organizes the approach to patients with antiphospholipid syndrome. This syndrome is a common acquired thrombophilic state, but the diagnosis and treatment of patients remains a challenge. Dr. Rand outlines his diagnostic and treatment strategies based on the current understanding of this complicated syndrome. Dr. Barbara Konkle addresses the special concerns of managing women with thrombophilia. Hematologists are often asked to advise on the risks of hormonal therapy or pregnancy in a woman with a personal or family history of thrombosis or with an abnormal laboratory finding. Dr. Konkle reviews the available data on the risks of hormonal therapy and pregnancy in women with and without known underlying thrombophilic risk factors. In Section III, Dr. Gail Macik will discuss a new approach to warfarin management. Several instruments are now available for home prothrombin time (PT) monitoring. Self-testing and self management of warfarin are slowly emerging as reliable alternatives to traditional provider-based care and Dr. Macik reviews the instruments available and the results of studies that support this new management option.

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Association between hormone replacement therapy and dementia: is it time to forget?

International Psychogeriatrics ◽

10.1017/s1041610205001559 ◽

2005 ◽

Vol 17 (2) ◽

pp. 155-164 ◽

Cited By ~ 14

Author(s):

Osvaldo P. Almeida ◽

Leon Flicker

Keyword(s):

Hormone Replacement Therapy ◽

Replacement Therapy ◽

Observational Studies ◽

Animal Studies ◽

Hormone Replacement ◽

Health Events ◽

Increased Risk ◽

Estrogen Plus Progestin ◽

History Of

The results of in vitro and animal studies provide a strong rationale for the use of hormone replacement therapy (HRT) to prevent dementia and Alzheimer's disease (AD). In humans, the results of 16 observational studies are consistent with the hypothesis that estrogen use reduces the risk of AD by 10 to 60%. However, women who are prescribed HRT are less likely to have hypertension, diabetes and history of stroke than nonusers. As all of these factors have been associated with increased risk of dementia (including AD), this “prescription bias” may have a significant impact on the results of observational studies. Randomized trials are designed with the aim of avoiding many of the potential biases and confounding (measured or unmeasured) of observational studies. The results of the Women's Health Initiative Memory Study (WHIMS) indicate that HRT (estrogen plus progestin or estrogen alone) increases the risk of dementia (hazard ratio, HR=1.8, 95% CI=1.2–2.6). Taking into account the results of the WHIMS and the adverse health events associated with the use of estrogen plus progestin or estrogen alone, we conclude that HRT cannot be recommended as a safe and effective strategy to prevent dementia.

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The Stroke Prevention Programme: a programme of research to inform optimal stroke prevention in primary care

Programme Grants for Applied Research ◽

10.3310/pgfar04030 ◽

2016 ◽

Vol 4 (3) ◽

pp. 1-290

Author(s):

Kate Fletcher ◽

Jonathan Mant ◽

Richard McManus ◽

Richard Hobbs

Keyword(s):

Primary Care ◽

Cost Effectiveness ◽

Usual Care ◽

Research Programme ◽

Cost Effective ◽

Self Management ◽

Controlled Trials ◽

National Guidelines ◽

History Of ◽

General Practices

BackgroundThe management of cardiovascular (CV) risk factors in community populations is suboptimal. The aim of this programme was to explore the role of three approaches [use of a ‘polypill’; self-management of hypertension; and more intensive targets for blood pressure (BP) lowering after stroke] to improve prevention of CV disease (CVD) in the community.Research questions(1) Is it more cost-effective to titrate treatments to target levels of cholesterol and BP or to use fixed doses of statins and BP-lowering agents (polypill strategy)? (2) Will telemonitoring and self-management improve BP control in people on treatment for hypertension or with a history of stroke/transient ischaemic attack (TIA) in primary care and are they cost-effective? (3) In people with a history of stroke/TIA, can intensive BP-lowering targets be achieved in a primary care setting and what impact will this have on health outcomes and cost-effectiveness?DesignMixed methods, comprising three randomised controlled trials (RCTs); five cost-effectiveness analyses; qualitative studies; analysis of electronic general practice data; a screening study; a systematic review; and a questionnaire study.SettingUK general practices, predominantly from the West Midlands and the east of England.ParticipantsAdults registered with participating general practices. Inclusion criteria varied from study to study.InterventionsA polypill – a fixed-dose combination pill containing three antihypertensive medicines and simvastatin – compared with current practice and with optimal implementation of national guidelines; self-monitoring of BP with self-titration of medication, compared with usual care; and an intensive target for systolic BP of < 130 mmHg or a 10 mmHg reduction if baseline BP is < 140 mmHg, compared with a target of < 140 mmHg.ResultsFor patients known to be at high risk of CVD, treatment as per guidelines was the most cost-effective strategy. For people with unknown CV risk aged ≥ 50 years, offering a polypill is cost-effective [incremental cost-effectiveness ratio (ICER) of £8115 per quality-adjusted life-year (QALY)] compared with a strategy of screening and treating according to national guidelines. Both results were sensitive to the cost of the polypill. Self-management in people with uncontrolled hypertension led to a 5.4 mmHg [95% confidence interval (CI) 2.4 to 8.5 mmHg] reduction in systolic BP at 1 year, compared with usual care. It was cost-effective for men (ICER of £1624 per QALY) and women (ICER of £4923 per QALY). In people with stroke and other high-risk groups, self-management led to a 9.2 mmHg (95% CI 5.7 to 12.7 mmHg) reduction in systolic BP at 1 year compared with usual care and dominated (lower cost and better outcome) usual care. Aiming for the more intensive BP target after stroke led to a 2.9 mmHg (95% CI 0.2 to 5.7 mmHg) greater reduction in BP and dominated the 140 mmHg target.ConclusionsPotential for a polypill needs to be further explored in RCTs. Self-management should be offered to people with poorly controlled BP. Management of BP in the post-stroke population should focus on achieving a < 140 mmHg target.Trial registrationCurrent Controlled Trials ISRCTN17585681, ISRCTN87171227 and ISRCTN29062286.FundingThe National Institute for Health Research (NIHR) Programme Grants for Applied Research programme. Additional funding was provided by the NIHR National School for Primary Care Research, the NIHR Career Development Fellowship and the Department of Health Policy Research Programme.

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The Impact of a Community Pharmacy Diabetes Self-Management Education Program on Diabetes Distress

Journal of Pharmacy Technology ◽

10.1177/8755122518805429 ◽

2018 ◽

Vol 35 (1) ◽

pp. 3-10 ◽

Cited By ~ 2

Author(s):

Morgan L. Machen ◽

Hamilton C. Borden ◽

Kenneth C. Hohmeier

Keyword(s):

Community Pharmacy ◽

Management Education ◽

Information Age ◽

Retrospective Chart Review ◽

Self Management ◽

Diabetes Distress ◽

Health History ◽

Scale Scores ◽

History Of ◽

The Impact

Background: Negative psychosocial implications stemming from the presence of diabetes, known as diabetes distress, place people with diabetes at twice the likelihood of having clinical depression than those who do not have the disease. While many community pharmacies have incorporated diabetes self-management education (DSME) programs into their practices, there are no known studies that evaluate the impact that this model may have on diabetes distress. Objective: The purpose of this study is to evaluate the impact that a community pharmacy DSME program has on diabetes distress. Methods: Retrospective chart review for pre- and post-DSME Problem Areas in Diabetes scale scores, pertinent health history (type and duration of diabetes, A1C, and medications), and demographic information (age, gender) of patients who completed Blount Discount Pharmacy’s DSME program. Data were analyzed using descriptive and inferential statistics. Results: Of the 17 charts that were reviewed, there was an overall decrease in Problem Areas in Diabetes scale scores from baseline ( P = .029). Greater reduction was observed in patients with a long-standing history of diabetes compared with those who were diagnosed with diabetes within the previous 12 months of DSME. Conclusions: The findings suggest that a community pharmacy DSME program may reduce diabetes distress and warrant future study.

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A Cross-Sectional Evaluation of Illness Perception About Asthma Among Asthma Patients at a Referral Tertiary Care Public Chest Hospital in Delhi, India

International Journal of User-Driven Healthcare ◽

10.4018/ijudh.2012070104 ◽

2012 ◽

Vol 2 (3) ◽

pp. 32-43

Author(s):

Sushil Shendge ◽

Barnali Deka ◽

Anita Kotwani

Keyword(s):

Inhaled Corticosteroids ◽

Tertiary Care ◽

Illness Perception ◽

Clinical History ◽

Self Management ◽

Cross Sectional ◽

The Public ◽

Co Morbidity ◽

Asthma Patients ◽

History Of

Adult patients visiting emergency room (March 2009-December 2009) of the public chest hospital for asthma exacerbation completed interviewer-administered questionnaires on sociodemographics, clinical history, disease beliefs, use of inhaled corticosteroids (ICS), and self-management of asthma after stabilization of their condition. Overall 87% patients believed that they had asthma when they are having symptoms, which is called as no symptoms, no asthma belief. No association was found between no symptoms, no asthma belief with gender, income, family history of asthma, and co-morbidity. Younger patients in the age group 18-29 years had four to five-fold greater odds and patients with education above 10th grade had three to four-fold greater odds of having the no symptoms, no asthma belief or the acute episodic belief. Acute episodic belief was negatively associated with beliefs about always having asthma, asthma being a serious condition, having lung inflammation, or the importance of using ICS, and was positively associated with expecting to be cured. All patients irrespective of their belief of acute or chronic nature of asthma had poor adherence to the treatment and other self-management behaviors.

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