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Abdul-Razak Abubakari,1 Martyn C Jones,2 William Lauder,3 Alison Kirk,4 John Anderson,5 Devasenan Devendra,6 Ebrahim K Naderali11School of Health Sciences, Liverpool Hope University, Hope Park, Liverpool, 2School of Nursing and Midwifery, University of Dundee, Dundee, 3School of Nursing and Midwifery and Health, University of Stirling, Stirling, 4Department of Sport, Culture and the Arts, University of Strathclyde, Glasgow, 5Homerton University Hospital NHS Trust, Homerton Row, London, 6West Hertfordshire Hosptials NHS Trust, Watford, UKObjectives: This study investigated ethnic differences in diabetes-specific knowledge, illness perceptions, self-management, and metabolic control among black-African, black-Caribbean,and white-British populations with type 2 diabetes. The study also examined associations between demographic/disease characteristics and diabetes-specific knowledge, illness perceptions, self-management, and metabolic control in each of the three ethnic groups.Design: Cross-sectionalSetting: Diabetes/retinal screening clinics in Hackney and Brent, London.Methods: Black-African, black-Caribbean and white-British populations with type 2 diabetes were asked to participate. Questionnaires measuring demographic/disease characteristics, diabetes-specific knowledge, self-management, and illness perceptions were used for data collection. Data for glycated hemoglobin (HbA1c) and microvascular complications were obtained from medical records. Ethnic differences in diabetes-related measures were estimated using analysis of variance/covariance. Multiple regression techniques were used to determine relationships between demographic/disease characteristics and measured diabetes-related outcomes.Results: Three hundred and fifty-nine patients participated in the study. White-British participants had high diabetes-specific knowledge compared to their black-African and black-Caribbean counterparts. Black-Africans reported better adherence to self-management recommendations than the other ethnic groups. Compared to the white-British patients, black-African and black-Caribbean participants perceived diabetes as a benign condition that could be cured. Educational status and treatment category were determinants of diabetes-specific knowledge in all three ethnic groups. However, different demographic/disease characteristics predicted adherence to self-management recommendations in each ethnic group.Conclusion: Clearly, there is disease (diabetes) knowledge-perception variation between different ethnic groups in the UK which may partly influence overall disease outcome. It is plausible to recommend screening, identifying, and dispelling misconceptions about diabetes among ethnic minority patients by health care professionals as well as emphasizing the importance of self-management in managing chronic diseases such as diabetes.Keywords: black-African, black-Caribbean, white-British, diabetes, illness perceptions, self-management

We are concerned with the flexible parametric analysis of bivariate survival data. Elsewhere, we argued in favour of an adapted form of the 'power generalized Weibull' distribution as an attractive vehicle for univariate parametric survival analysis. Here, we additionally observe a frailty relationship between a power generalized Weibull distribution with one value of the parameter which controls distributional choice within the family and a power generalized Weibull distribution with a smaller value of that parameter. We exploit this relationship to propose a bivariate shared frailty model with power generalized Weibull marginal distributions linked by the BB9 or 'power variance function' copula, then change it to have adapted power generalized Weibull marginals in the obvious way. The particular choice of copula is, therefore, natural in the current context, and the corresponding bivariate adapted power generalized Weibull model a novel combination of pre-existing components. We provide a number of theoretical properties of the models. We also show the potential of the bivariate adapted power generalized Weibull model for practical work via an illustrative example involving a well-known retinopathy dataset, for which the analysis proves to be straightforward to implement and informative in its outcomes. [ABSTRACT FROM AUTHOR]

Aim. This is a report of a research protocol to assess level, determinants and consequences of stress in NHS-24 telephone helpline nurses. Background. Nurses working in traditional hospital settings report high levels of occupational stress. Many nurses now work in call centres, environments with their own inherent stressors. Stress in nurses has been linked to reduced physical and psychological health, reduced job satisfaction, increased sickness absence and turnover, and poorer job performance. In this study, we will use multiple methods, including real time data collection to assess stress in telephone helpline nurses. Design. During 2008/09, NHS-24 nurses will (a) report general stress and call-bycall stress over two working shifts, (b) complete measures of theoretical determinants of occupational stress (demand, control, effort and reward), (c) have their concentration and attention tested before and after two shifts, (d) have their heart rate monitored over two shifts, (e) report job satisfaction, absenteeism and intended turnover and (f) allow the research team to retrieve related call data and performance indicators. Relationships between the variables will be assessed using regression and multi-level modelling. Discussion. Data will be analysed to examine the relationships between reported stress, physiological aspects of stress, call type, workplace attributes, cognitive performance, job satisfaction and absenteeism. The analysis will test models of occupational stress and assess the effects of stress on multiple work outcomes. The results will inform theoretical understanding of nurse stress, its determinants and possible methods of management. The practical challenges of conducting such a comprehensive study in a clinical environment are discussed. [ABSTRACT FROM AUTHOR]

The aim of this study was to gain service user and social care staff perspectives on the barriers facing people with intellectual disabilities when accessing primary healthcare. A qualitative mixed methods semi-structured approach involved the use of focus groups and individual interviews within the service users' homes. A purposive sampling strategy identified people using primary healthcare in the last 6 months (N = 6) with support from social care staff (N = 19). Three emergent themes were common to service users and carer staff: ;accessing the surgery', ;communication issues' and ;waiting around'. Other themes were unique to each group. Social care staff identified the ;attitudes and behaviour of primary healthcare staff' as sometimes problematic, and the importance of ;knowing the service user'. Service users identified ;feelings about going to the doctor', ;health education' and ;making changes'. Gaining these views is an important first step in improving access to primary healthcare. [ABSTRACT FROM AUTHOR]

AIMS AND OBJECTIVES: To identify whether providing a new information leaflet for parents regarding the management of a febrile convulsion was more effective in comparison with standard leaflets. BACKGROUND: Although information leaflets are frequently recommended within healthcare, their quality is often poor. Furthermore, the evidence regarding the effectiveness of leaflets is inconsistent. Few studies have evaluated the effects of providing leaflets that have been developed to improve their quality. Within the specialty of paediatrics, parents are often unprepared regarding the management of febrile convulsion at home and the provision of supplementary leaflets is recommended, despite limited evidence regarding the effectiveness of this approach. There is also limited evidence regarding whether improving the quality of these leaflets leads to better outcomes, e.g. increasing parents' behavioural knowledge. DESIGN: Double-blind randomized controlled trial. METHOD: One hundred and twenty-six parents of children hospitalized due to benign febrile convulsion were recruited (May 2000-February 2002). Seventy-one parents were randomized to receive the standard care (control leaflet) and 55 parents received the intervention (new leaflet). Data were collected from parents on discharge immediately prior to receiving the intervention and 7-14 days following the intervention via telephone interview. RESULTS: Parents who received the new leaflet found this to be more reassuring and easier to understand than parents who received the control leaflet. No differences between groups were identified regarding the primary outcome, i.e. behavioural knowledge and most of the secondary outcomes, e.g. perceived confidence, state anxiety and satisfaction with the leaflet. CONCLUSION: Although this study provides modest support for the effectiveness of providing high-quality leaflets, further research is required to determine the best methods for optimizing the effectiveness of leaflets provided at hospital discharge. RELEVANCE TO CLINICAL PRACTICE: The quality of leaflets may influence some outcomes, e.g. understanding and reassurance with the written information provided; however, additional strategies to inform parents may be necessary. [ABSTRACT FROM AUTHOR]

The American Diabetes Association currently recommends an A1C goal of less than 7 percent. However, many patients are unable to achieve this goal by using oral drug combinations or diet and exercise, leaving insulin as the only treatment option. In most cases, insulin is initiated later in therapy because of its inconvenience and adverse effects (e.g., weight gain, hypoglycemia, possible role in atherogenesis). Although insulin effectively helps patients attain glucose goals, the search for new agents continues. Two injectable agents, pramlintide and exenatide, were approved in 2005 for the treatment of diabetes. Pramlintide, indicated for use in patients with type 1 and 2 diabetes, is a synthetic analogue of human amylin that acts in conjunction with insulin to delay gastric emptying and inhibit the release of glucagon. Exenatide, a glucagon-like peptide-1 mimetic, has multiple mechanisms for lowering glucose levels, including the enhancement of insulin secretion, and is indicated for use in patients with type 2 diabetes. Clinical trials have shown that both agents reduce, by a statistically significant degree, A1C levels (0.3 to 0.7 percent more than placebo), fasting plasma glucose levels, and body weight (3 to 5 lb [1.4 to 2.3 kg]). No studies have examined their effects on diabetic complications, cardiovascular disease, or overall mortality. Pramlintide and exenatide may help make glycemic goals more attainable. [ABSTRACT FROM AUTHOR]

Aims. The aims of this paper were (1) to raise awareness of the issues in questionnaire development and subsequent psychometric evaluation, and (2) to provide strategies to enable nurse researchers to design and develop their own measure and evaluate the quality of existing nursing measures. Background. The number of questionnaires developed by nurses has increased in recent years. While the rigour applied to the questionnaire development process may be improving, we know that nurses are still not generally adept at the psychometric evaluation of new measures. This paper explores the process by which a reliable and valid questionnaire can be developed. Methods. We critically evaluate the theoretical and methodological issues associated with questionnaire design and development and present a series of heuristic decision-making strategies at each stage of such development. The range of available scales is presented and we discuss strategies to enable item generation and development. The importance of stating a priori the number of factors expected in a prototypic measure is emphasized. Issues of reliability and validity are explored using item analysis and exploratory factor analysis and illustrated using examples from recent nursing research literature. Conclusion. Questionnaire design and development must be supported by a logical, systematic and structured approach. To aid this process we present a framework that supports this and suggest strategies to demonstrate the reliability and validity of the new and developing measure. Relevance to clinical practice. In developing the evidence base of nursing practice using this method of data collection, it is vital that questionnaire design incorporates preplanned methods to establish reliability and validity. Failure to develop a questionnaire sufficiently may lead to difficulty interpreting results, and this may impact upon clinical or educational practice. This paper presents a critical evaluation of the questionnaire design and development process and demonstrates good practice at each stage of this process. [ABSTRACT FROM AUTHOR]

PURPOSE: The pharmacology, pharmacokinetics, efficacy and tolerability, safety, drug interactions, dosage and administration, cost, and place in therapy of insulin detemir are reviewed. SUMMARY: Insulin detemir is a long-acting, neutral, and soluble insulin analogue with a lower within-subject variability of fasting plasma glucose levels than isophane insulin human (NPH insulin) and insulin glargine. The lower within-subject variability of insulin detemir may decrease hypoglycemic events, especially nocturnal events, and may contribute to a decreased incidence of weight gain. In vivo, insulin detemir is 98-99% bound to albumin-one of the mechanisms contributing to its long duration of action. Several open-labeled, randomized, multicenter trials have been conducted comparing the safety and efficacy of insulin detemir to NPH insulin in patients with type 1 or type 2 diabetes mellitus. In most trials, patients were randomized to receive insulin on three different dosing schedules: basal insulin twice daily before breakfast and at bedtime, basal insulin at 12-hour intervals, or basal insulin before breakfast and dinner. Mealtime insulin was given as part of the basal-bolus therapy. Glycosylated hemoglobin values were similar in patients receiving insulin detemir or NPH insulin. Insulin detemir appears to be well tolerated. The most common adverse effects reported during clinical trials were hypoglycemia, headache, dizziness, and injection-site reactions. CONCLUSION: Insulin detemir given once or twice daily as part of basal-bolus insulin therapy is at least as effective as NPH insulin in maintaining overall glycemic control in adult patients with type 1 or type 2 diabetes mellitus. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To raise middle school student awareness, attitudes, and proactive behaviors about immunization, and to increase immunization rates among middle school students through implementation of a comprehensive integrated immunization promotion curriculum (Immunization Plus!) METHODS: Evaluation used a quasi-experimental non-equivalent comparison-groups design conducted in a sample of 40 classrooms in 22 schools in California. RESULTS: Sixth-grade students exposed to the curriculum developed more positive knowledge and attitudes, and were more likely to be immunized, to intend to obtain newly required immunizations, and to tell parents about immunizations. CONCLUSION: Infectious disease control and immunizations are under-developed subject areas within school-based health promotion in the United States that can be effectively taught to middle school students. [ABSTRACT FROM AUTHOR]

This paper presents findings of an exploratory case study that was undertaken to assess Web performance evaluation in three petroleum energy firms in the Southwest. Findings indicate that firms with clearly defined Web site objectives will tend to have much more comprehensive strategies for Web site performance evaluation. Contrary to our expectations, perceptions of Web expertise was not significantly related to perceived Web site performance. However, there was a clear relationship between perceived Web development expertise and the perceived ability to improve sites. Additionally, our findings suggest a lack of senior management guidance in Web related initiatives has contributed to an inability to successfully link Web performance measures to organizational objectives. [ABSTRACT FROM AUTHOR]

Following recent evidence of continuing high levels of distress in both trained and student nurses, a critical review of the stress reduction and stress management literature targeting both trained and student nurses is presented. Using a systematic approach, some 36 studies dating from 1980 until the present day were identified adopting either pre-experimental, quasi-experimental or experimental designs. While many work-site programmes in this series were successful in terms of adaptive changes in problem-solving, self-management skills including relaxation and interpersonal skills, affective well-being, and work performance, a number of design and evaluation inadequacies were identified. The relative lack of home-work interface or organizational level programmes to reduce work-related distress, and the scarcity of interventions targeting aspects of the work environment likely to contribute to such outcomes may have contributed to continuing high levels of distress in trained and student nurses. Recommendations regarding the future design, provision and evaluation of such work-site interventions include the further clarification of the structure of perceived stressors, and development of causal models of the stress process to identify the job characteristics 'causing' work-related distress. Such an approach would inform the design and implementation of evidence-based organizational level interventions augmenting strategies to target the health behaviour, lifestyle/risk factors and self-management skills of practitioners and students with attempts to amend problematic elements of the psychosocial work environment. [ABSTRACT FROM AUTHOR]

California's Hispanic infants have lower immunization levels than non-Latino white infants, 53.7% versus 65.2%, respectively. Spanish-language radio is an effective mass media venue for imparting information to Latino populations. It has been demonstrated that lack of parental knowledge of infant immunization timing is associated with delayed immunization coverage. In an effort to improve Latino parent knowledge of immunization timing, two Spanish-language radio commercials were developed to be used in conjunction with community-based educational efforts. In order to gage the potential educational impact of the two commercials, they were pretested with a group of low-income Spanish-speaking Latino parents who represented members of the target population for whom the commercials were created. Both commercials were rated favorably by parents, and elicited immunization-specific responses. Although correct recall of the simplified, basic immunization schedule was low, the level of immunization response consistency and overall approval of both commercials appear to support their use as part of Latino infant immunization educational outreach in California. [ABSTRACT FROM AUTHOR]

Levels of affective distress, sources of stress and coping strategies reported by first-year student nurses in Tayside, Scotland, were measured using the General Health Questionnaire (30-item version), the Beck & Srivastava Stress Inventory (BSSI) and a modified 'Ways of Coping Questionnaire'. Screening showed that, around the time of an initial series of hospital placements, 50.5% of students in cohort 1 (n = 109, week 40) and 67.9% of students in cohort 2 (n = 111, week 24) suffered significant affective distress. This exceeds levels reported in published studies of degree nursing students, fourth-year medical students, and the general female population. Distressed students reported the same sources of stress as the non-distressed students, but suffered them more intensely. Many BSSI items were seen as common sources of stress; however, the frequency with which an item was reported to be stressful was not related to whether scores on that item predicted overall distress. In both cohorts, the use of direct coping was associated with lower levels of distress, and with lower total stress scores on the BSSI. The use of fantasy and hostility was associated with high levels of distress and stress, in both groups. This screens of 220 first-year student nurses suggests that there is a problem with student distress around an initial series of general/surgical and psycho-social ward placements. The possible determinants of this distress and complex, and it is unlikely that presenting information alone will be sufficient to reduce this distress. [ABSTRACT FROM AUTHOR]

Objectives: To determine the underlying genetic diagnosis of Pierre Robin sequence (PRS) in 2 cohorts of individuals, assess the accuracy of genetic evaluation in young infants with PRS, and contrast the interventions provided to children with isolated and syndromic PRS.Study Design: The study involved retrospective chart reviews at 2 children's hospitals and a systematic literature review.Results: Approximately 40% of the patients had isolated PRS, and 60% of the patients had additional syndromic features. The patients with PRS with syndromic features required more aggressive medical management. Stickler syndrome was the most common syndromic diagnosis in PRS. The difficulty of making an accurate genetic diagnosis during the neonatal period was demonstrated.Conclusion: All infants with PRS should be evaluated to check for the presence of syndromic features, and a longitudinal follow-up is warranted to monitor for the development of any syndromic features. [ABSTRACT FROM AUTHOR]