Therapeutic Training Game for Children with Diabetes: A Study on Teaching Insulin Self-Injection

学校质量、个人禀赋与教育回报的城乡差距 (School Quality, Innate Ability, and the Urban-Rural Disparity in Returns to Schooling in China)

Introduction: As per the International Diabetic Federation Atlas, 2021, 3 in 4 adults with type 2 diabetes mellitus live in low and middle income countries. This represents a tremendous burden on the healthcare system of these countries. Self-care practices can mitigate the disease burden. Objectives: To assess the self-care practices among the type 2 patients using Summary of Diabetes Self-Care Activities (SDSCA). Method: A facility based cross sectional study was undertaken among adults aged 25-60 years using a modified SDSCA, validated in Indian settings to study the self-care practices in diabetic patients. The modified domains included practices on dietary modifications, regular physical activity, foot care, regular blood glucose monitoring, drug adherence and addictions. Mean scores of these domains in SDSCA were compared with HbA1c measurements. Statistical tests performed included unpaired T test and chi-square. Results: Mean age of the patients was 49.60+ 11.13 Years. There were about 117(54.4%) patients with controlled HbA1c measurements. There was a statistically significant association of dietary modifications, regular physical activity, foot care, drug adherence and addictions with controlled HbA1c measurements. (p value=0.05) Conclusion: Self-care practices can significantly alter diabetes control and prevent complications. Regular glucose monitoring was lacking in several patients and led to poor glycemic controls. These results can inform clinical practice and patient care for better management of the type 2 diabetes mellitus.

To study the epidemiological status of diabetes' risk factors among urban and suburban residents and their perceptions of their own health status and risk of diabetes. Stratified multi-stage sampling method was used to conduct the survey among 18-60 years old residents from Zhejiang, Jiangsu, Shanxi, Henan, Yunnan, and Qinghai provinces in China from March to May in 2013. The Questionnaire of Health Literacy of Diabetes Mellitus of the Public in China was used to conduct the survey, and then the data were analyzed. The main contents of the questionnaire included diabetes mellitus knowledge, diabetes mellitus risk factors and diabetes mellitus risk self-assessment. The results of the survey were standardized by the 6(th) national census data. A total of 4 416 respondents were surveyed, and 4 282 valid questionnaires were successfully collected during the survey and the response rate was 97.0%. After weighted adjustment, the overweight and obesity rate of the residents in 6 provinces was 35.3%, abdominal obesity rate was 54.7%. 77.8% of the residents without diabetes had more than one risk factor, but only 8.5% thought they might got diabetes. The residents with high risk behavior possessing rates of diabetes were in eastern areas (79.7%), urban areas (80.7%), men (84.1%), aged from 45 to 60(100.0%), below primary school education level (83.4%) and enterprise personnel (79.7%). The residents with high risk consciousness of getting diabetes were in eastern areas (11.0%), urban areas (9.7%), men (9.7%), aged from 45 to 60 (12.3%), over college education level (12.7%) and the offices (14.7%). The results of logistic regression showed that residents in the middle areas (OR = 2.148, 95% CI: 1.633-2.920), urban residents (OR = 2.100, 95% CI: 1.611-2.738), male (OR = 2.488, 95% CI: 1.962-3.154), the older (OR = 1.102, 95% CI: 1.090-1.115) had a higher risk behavior rate of diabetes mellitus. Urban residents (OR = 2.784, 95% CI: 1.497-5.175), male (OR = 1.522, 95% CI: 1.152-2.011), the older (OR = 1.022, 95% CI: 1.009-1.035), college educational level (OR = 1.685, 95% CI: 1.033-2.749), with a higher score of health awareness(OR = 1.090, 95% CI: 1.061-1.120)had a higher risk consciousness to being diabetes mellitus. The urban and suburban residents in China had a high risk behavior possessing rates of diabetes, and a low risk consciousness of being diabetes.

The primary goal of multimodal visual representation learning is to generate implicit information that effectively represents multimodal information by exploring the commonalities and characteristics between different modalities. This research report will discuss currently widely used advanced methods in the field of multimodal visual representation learning. This article will discuss these methods in the following order, culminating in multimodal visual learning: (1) pre-trained visual representation learning, (2) generative visual representation learning, (3) contrastive multimodal visual representation learning, and (4) image-text multimodal visual representation learning methods. Each element provides useful clues that ultimately lead to multimodal visual learning. Pre-trained visual representation learning refers to the application of supervised pre-training models in visual representation learning, while generative visual representation learning uses generative models to learn feature representations that can integrate multimodal information. Contrastive multimodal visual representation learning uses contrastive learning methods to compare similar and dissimilar sample pairs, learning feature representations in a self-supervised manner. Image-text multimodal visual representation learning methods, on the other hand, attempt to enhance the capabilities of visual representation learning by fusing visual information (such as images) with textual information. This review report will explain the above research background, the classification of different research methods, commonly used evaluation methods , and future development trends.

Treating Type 2 Diabetes Mellitus: A Growing Epidemic

To investigate diabetes family involvement, including supportive and nonsupportive family behaviours in China, and explore the relationships among opposite forms of family involvement, diabetes self-management and glycaemic control. A cross-sectional study. Type 2 diabetes patients were recruited from hospitals in Nanjing, Shanghai and Jinan, and communities across China, between April 2023 and August 2023. A total of 1648 patients completed questionnaires regarding diabetes family involvement, diabetes self-management, perceived glycaemic control and patient characteristics. Data analysis was conducted using SPSS 26.0 and PROCESS macro. The mean scores for supportive and nonsupportive family behaviours were 19.14 out of 40 and 12.47 out of 30, respectively, resulting in an overall family involvement score of 6.67. Overall family involvement, especially supportive family behaviours, was positively related to diabetes self-management and perceived glycaemic control, whereas nonsupportive family behaviours were not. Diabetes self-management partially mediated the relationships between both overall family involvement and supportive family behaviours with perceived glycaemic control. Diabetes family involvement was suboptimal. Overall family involvement, especially supportive family behaviours, could not only directly improve glycaemic control but also indirectly enhance it through promoting diabetes self-management. The findings highlight the importance of promoting supportive family involvement and patient self-management in diabetes management. This study endorses the necessity for healthcare professionals to integrate the family unit into diabetes management and implement interventions at the family unit level, to address the neglect of families in current interventions. It also advocates for promoting supportive family involvement rather than all family involvement in future interventions. Promoting supportive family involvement and patient self-management can better improve patients' glycaemic control and alleviate the burden on medical and social systems. This study adheres to the STROBE guideline of reporting. No Patient or Public Contribution.

TABLE OF CONTENTSPreamble 686Definition of the Problem 688Purpose of These Guidelines 688Methodology and Evidence 689General Approach to the Patient 692History 693Physical Examination and Routine Laboratory Tests 693Multivariable Indices to Predict Preoperative Cardiac Morbidity 694Clinical Assessme

To synthesize evidence about the impact of Internet and phone-based diabetes education and management on metabolic control, self-management behavior changes, and psychological effects among children and adolescents with type 1 diabetes mellitus (T1DM). Internet and mobile technologies were commonly used to improve diabetes management among children and adolescents with type 1 diabetes mellitus. The effectiveness of new technology-based diabetes education and management has previously not been synthesized. PubMed, EBSCO, Cochrane Library, Web of Science, Joanna Briggs Institute Library, and the Chinese databases CNKI and Wanfang were searched from 1989 to March 2020. Two reviewers independently selected randomized controlled trials (RCTs), in English and Chinese, which compared an intervention group of new technology-based diabetes education and management with a control group of usual care. The primary outcomes were metabolic control, such as glycated hemoglobin (HbA1c), and secondary outcomes consisted of behavior changes and psychological effects, such as self-efficacy and quality of life. A total of 23 RCTs with 1,824 participants met the inclusion criteria. The meta-analysis showed that phone calls could significantly reduce HbA1c (MD=-.17; 95% CI [-.33, -.01]; I2 =0%) in children and adolescents with T1DM. New technology-based diabetes education and management could significantly improve self-efficacy (SMD=0.37; 95% CI [.07, .67]; I2 =0%). No benefits on behavior changes and quality of life were identified. New technology-based diabetes education has potential benefits for children and adolescents with T1DM, such as improving metabolic control through phone calls and increasing their self-efficacy of diabetes management. Well-designed RCTs with larger sample sizes and longer intervention duration should be conducted, especially in developing countries.

Background: Torres Strait Islanders (TSI) have the highest prevalence of Type 2 diabetes in Australia with about a third of the adult population affected; the incidence of Type 2 diabetes and other co-morbid conditions are also extremely high at around 3%. A review in 2005 noted that newer diabetes cases were younger, more obese and had poorer glycaemic control compared to 6 years previously. Clinicians report anecdotally that many patients are prescribed insulin therapy; however, it is unknown if patients are collecting their medication from local primary health care centres. Diabetes is associated with significant depression, which can result in poorer clinical outcomes, including increased mortality. Little is known about the prevalence of depression among TSI adults with diabetes. Models of chronic disease management in the Torres Strait region remains an ongoing discussion that supports better self-management of diabetes amongst patients. Study Aims: The overall aim of this thesis is to provide epidemiological evidence to support the development of community level interventions to address the most important risk factors associated with the health of Torres Strait Islanders with Type 2 diabetes. 1. Review patient level factors on behavioural aspects of diabetes management and care including psychological insulin resistance and depression. 2. Review health service factors that impact on diabetes management and care. Methods / Design: Study 1: 29/197 adults with poorly controlled diabetes who have refused insulin treatment, were interviewed using validated instruments Insulin Treatment Appraisal Scale (ITAS) and Barriers to Insulin Treatment Questionnaire (BITQ). Study 2: A descriptive cross-sectional survey in 2013 and 2014, Interviews with 188/197 adults with diabetes in five remote Torres Strait Islands using the Patient Health Questionnaire (PHQ)-9. Study 3: A Retrospective clustered cohort study of the impact of the intervention on care processes, intermediate clinical outcomes in 285 adults with known diabetes. At baseline 197 participants from five remote Torres Strait Island communities (mostly the Eastern group of Islands) consented to be enrolled in the survey. A further 88 records from the western group of islands were audited from 2012 - 2015 and serves as a comparator group. Target population: Adults diagnosed with Type 2 diabetes located in the remote Island communities of the Torres Strait region with primary health care services provided by Queensland Health. Results: Study 1: Thirty- four percent (n=197) had poor glycaemic control. Compared to those with HbA1c 8.5% and taking insulin (n=37), the 29 insulinnaive participants were more obese, more likely to smoke and drink alcohol, have lower mean HbA1c and fewer years with diabetes. Among the insulinnaive group, those reporting higher 'barriers' (BITQ scores) were older and with lower formal education than those reporting fewer barriers. TSI participants consistently scored low on 'knowledge' items in the ITAS, especially those which would guide insulin initiation (insulin improves glucose control and prevents complications). Study 2: Ninety – five percent (n=197) completed PHQ-9 interviews. The median PHQ-9 score was 5.5 (IQR 0-7); 42% of respondents scored 0-4 (noneminimal), 46% scored 5-9 (mild) and 12% scored10+ (moderate –severe). Mean Hba1c was 8.3% (67.4 mmol). HbA1c was not related to PHQ-9 scores (β=0.20, Ρ = 0.323), however exercise in hours (β =0.34, Ρ < 0.001) and screen time in hours (β = 0.11, Ρ < 0.001) were significant predictors of depression after adjusting for other study variables. Study 3: At baseline, overall (n=285), 61% were women, 75% were aged over 50, 67% were obese (Body Mass Index (BMI), higher in the comparator group), 65% were poorly controlled (Hba1c>8.5%) and 18% were smokers (lower in comparator group). At baseline (2012) GP management plans (GPMP) and team care arrangements (TCA) were more likely to be completed in the eastern group 93% vs. 39% with 90% referred to a dietician, diabetes educator or podiatrist. However, in 2015 a decrease in the GPMP from 93% vs. 20% in the eastern group. It appeared that participants in the eastern group had better glycaemic control than those in the western group (34% had hba1c> 8.5% compared to 39% in the eastern group) and this difference persisted through to 2015. Conclusion: Improving patient level factors on behavioural characteristics of diabetes care requires better communication between service providers and clients, taking consideration of local cultural contexts and beliefs. Simple health promotion activities could improve mental health and general well-being in this population. Understanding patient behaviour can assist service providers to deliver appropriate service delivery that involves clients' input. Overall, patients with Type 2 diabetes are hesitant to commence insulin therapy, mild depression scores were evident that do not appear to have an effect on glycaemic control. However, care planning, referrals, and other clinical measures important to diabetes care, and actual numbers of consultations appeared to decline dramatically between 2012 and 2015 in all sites. This suggests that a more systematic approach to population-level diabetes care is required.

Dementia and diabetes mellitus are common long-term conditions that coexist in a large number of older people. People living with dementia and diabetes may be at increased risk of complications such as hypoglycaemic episodes because they are less able to manage their diabetes. To identify the key features or mechanisms of programmes that aim to improve the management of diabetes in people with dementia and to identify areas needing further research. Realist review, using an iterative, stakeholder-driven, four-stage approach. This involved scoping the literature and conducting stakeholder interviews to develop initial programme theories, systematic searches of the evidence to test and develop the theories, and the validation of programme theories with a purposive sample of stakeholders. Twenty-six stakeholders (user/patient representatives, dementia care providers, clinicians specialising in dementia or diabetes and researchers) took part in interviews and 24 participated in a consensus conference. The following databases were searched from 1990 to March 2016: MEDLINE (PubMed), Cumulative Index to Nursing and Allied Health Literature, Scopus, The Cochrane Library (including the Cochrane Database of Systematic Reviews), Database of Abstracts of Reviews of Effects, the Health Technology Assessment (HTA) database, NHS Economic Evaluation Database, AgeInfo (Centre for Policy on Ageing - UK), Social Care Online, the National Institute for Health Research (NIHR) portfolio database, NHS Evidence, Google (Google Inc., Mountain View, CA, USA) and Google Scholar (Google Inc., Mountain View, CA, USA). We included 89 papers. Ten papers focused directly on people living with dementia and diabetes, and the rest related to people with dementia or diabetes or other long-term conditions. We identified six context-mechanism-outcome (CMO) configurations that provide an explanatory account of how interventions might work to improve the management of diabetes in people living with dementia. This includes embedding positive attitudes towards people living with dementia, person-centred approaches to care planning, developing skills to provide tailored and flexible care, regular contact, family engagement and usability of assistive devices. A general metamechanism that emerges concerns the synergy between an intervention strategy, the dementia trajectory and social and environmental factors, especially family involvement. A flexible service model for people with dementia and diabetes would enable this synergy in a way that would lead to the improved management of diabetes in people living with dementia. There is little evidence relating to the management of diabetes in people living with dementia, although including a wider literature provided opportunities for transferable learning. The outcomes in our CMOs are largely experiential rather than clinical. This reflects the evidence available. Outcomes such as increased engagement in self-management are potential surrogates for better clinical management of diabetes, but this is not proven. This review suggests that there is a need to prioritise quality of life, independence and patient and carer priorities over a more biomedical, target-driven approach. Much current research, particularly that specific to people living with dementia and diabetes, identifies deficiencies in, and problems with, current systems. Although we have highlighted the need for personalised care, continuity and family-centred approaches, there is much evidence to suggest that this is not currently happening. Future research on the management of diabetes in older people with complex health needs, including those with dementia, needs to look at how organisational structures and workforce development can be better aligned to the needs of people living with dementia and diabetes. This study is registered as PROSPERO CRD42015020625. The NIHR HTA programme.

Recent statistics suggest that student externalizing behaviors are increasing in Western and Asian countries; however, there is a paucity of research on teachers’ perspectives of these behaviors in Middle Eastern countries. A mixed-methods research design was used to investigate Kuwaiti public elementary and middle school teachers’ perceptions of their classroom behavior management (CBM) experiences, including their (a) academic preparation; (b) use of CBM practices to support students with externalizing behaviors; (c) observations of student externalizing behaviors; and (d) perceptions on administrative support and family involvement. Participants included 2,140 general and special education teachers randomly recruited from 45 schools. Results indicated that fewer than half of the teachers surveyed had prior instruction in CBM, reported using a wide variety of CBM practices in response to student behavior problems, and perceived higher levels of administrative support than family involvement. Implications of the study’s findings and suggestions for further research were discussed

Review question/objective The objective of this review is to synthesise the best available evidence on the experience of diabetes and diabetes management among pregnant women, and how these experiences relate to their understanding of their condition and adherence to treatment regimes Inclusion Criteria Types of participants This review will consider studies that include pregnant women who have pre-existing diabetes mellitus (Type 1 or Type 2 diabetes) or gestational diabetes mellitus. Phenomena of interest This review will consider studies that explore experience among women with pre-existing or gestational diabetes in pregnancy, and their experiences of adhering (or not) to prescribed treatment regimes.

Background: The self-care management of older diabetics is inconsistent and exhibits low adherence. This incident may be influenced by the elderly's disease management capabilities and familial involvement, which may not be conducive to their health and care. This study aimed to develop a management plan for elderly diabetes mellitus that emphasizes self-efficacy and family involvement. Methods: This research employed an explanatory survey design with a cross-sectional methodology. The probability sampling method, particularly simple random sampling, was employed to choose respondents for this study from a cohort of 100 individuals with diabetes mellitus and their families. We created a thorough assessment questionnaire for diabetes mellitus management in the elderly, utilizing the functional consequence model and family-centred nursing theory as the research framework. The statistical method employed was SEM-PLS. Results: The outer model analysis revealed that all indicators of each construct were valid, with a factor loading value of &gt; 0.7. The inner model analysis revealed that the variables family structure, family function, family stressors, elderly risk factors, age-related changes, and elderly consequence functions had a significant effect with a t-value of &gt;1.96 and p-value &lt;0.05. Conclusion: The diabetic mellitus management model, which is based on self-efficacy and familial support, improves self-care management among the elderly. Nurses should adopt the diabetic mellitus management model to increase patient autonomy and educate families on how to support their loved ones, thereby improving the self-care practices of elderly adults with diabetes.

Usefulness of Mean Platelet Volume as a Biomarker for Long-Term Outcomes After Percutaneous Coronary Intervention

改革开放以来,随着中国教育规模的扩张,城乡居民的受教育水平逐年提高,但 教育不平等问题并未得到有效改善。本文使用CGSS2008数据,检验户籍、家庭社会 经济地位、父母受教育年限以及兄弟姐妹数量等因素对初中、高中和大学三个教育阶 段升学机会的影响及其作用在1978至2008年期间的变化趋势。研究发现,初中升学机 会的城乡差异没有变化,高中和大学升学机会的城乡不平等有扩大趋势;父亲职业地 位对子女升学机会的影响保持不变,表明教育获得的阶层差异自1978年以来没有发生 明显变化;父母受教育年限对子女教育获得的作用显著,而且其作用持续上升;因兄 弟姐妹数量差异导致的教育不平等也有上升趋势。要理解改革后中国教育不平等的结 构及其演变,除讨论阶层不平等外,尚需关注影响居民教育决策的微观机制。 关键词理性行动理论 文化资本 教育分层 教育政策 Despite the expansion of Chinese education and the steady rise in the educational level of urban and rural residents since reform and opening up, the problem of educational inequality has persisted. This study employs CGSS2008 data to test the effects of household registration, family socio-economic status, years of parental education, and sibship size on educational opportunity at the three stages of junior middle school, senior middle school and higher education, as well as the changes in these effects over the period 1978-2008. The results show that there is no observable rural-urban disparity in opportunities for continuation to the junior middle school stage, but there is rising inequality in opportunities for continuation to senior middle school and higher education; the influence of father’s occupational status on children’s educational opportunities remains largely the same, indicating that the stratification of educational attainment has not changed markedly since 1978; years of parental education play a marked and increasing role in children’s educational attainment; and educational inequality due to sibship size also displays a rising tendency. To understand the structure and evolution of inequality in Chinese education since reform and opening up, it is necessary to study the micro-level mechanisms affecting residents’ educational decision-making.