Overall Level Of Control Research Articles

Control of Hypertension in Pregnant Women in Secondary Health Facilities in Nigeria: A Cross-Sectional Study

Hypertension is among the non-communicable diseases that complicate pregnancies in women. Diagnosis and control of this condition are important in reducing the risk of maternal and foetal mortality. This study was aimed at determining the prevalence and control of hypertension among pregnant women visiting secondary health care facilities in four Local Government Areas in Lagos (2) and Abuja (Federal Capital Territory) (2), Nigeria. Our findings showed that there was a high prevalence of hypertension in these facilities (50%). Our finding also revealed that the overall level of control was 30.45%, which decreased with time in the course of the management. The control was highest in the first quarter and lowest in the third (last) quarter. The consistent and appropriate use of antihypertensives is important to prevent the complications associated with non-communicable diseases like hypertension during pregnancy. Healthcare providers should therefore advocate early diagnosis and management of hypertension during pregnancy. Keywords: Control, Hypertension, Non-communicable diseases, Pregnancy, Secondary healthcare.

A retrospective cohort study examining secondary prevention post stroke in primary care in an Asian setting

BackgroundStroke is one of the top contributors to burden of disability-adjusted life-years worldwide. Family physicians have key role in optimising secondary prevention following stroke by managing clinical risk factors and promoting overall control in accordance with clinical practice guidelines.MethodsOur objectives were: (i) to examine level of overall risk factor control together with control of singular risk factors one-year after an index-stroke event in individuals attending primary care facility and (ii) to describe factors associated with satisfactory risk factors control in individuals following stroke.Study Design: Retrospective cohort study.We conducted a study looking retrospectively at records from our electronic chronic disease database. Our study included individuals following stroke who visited primary care setting in Singapore between January 2012 to December 2016.ResultsThere were 24,240 individuals in our study. Overall control was better in individuals without diabetes following stroke (49.2%) as compared to those with diabetes (28.1%).Among individuals without diabetes following stroke, factors significantly associated with overall control were sex (male) [OR (reference: female): 1.23, 95% CI: 1.10, 1.39], ethnicity (Malay) [OR (reference: Chinese): 0.72, 95% CI: 0.58, 0.90], BMI (high risk) [OR (reference: low risk): 0.72, 95% CI: 0.62, 0.84) and atrial fibrillation [OR: 1.47, 95% CI: 1.21, 1.78].Among individuals with diabetes following stroke, factors significantly associated with overall control were sex (male) [OR (reference: female): 1.28, 95% CI: 1.12, 1.46], ethnicity (Malay) [OR (reference: Chinese): 0.81, 95% CI: 0.65, 0.99], ethnicity (Indian) [OR (reference: Chinese): 0.70, 95% CI: 0.55, 0.88], BMI (high risk) [OR (reference: low risk): 0.71, 95% CI: 0.59, 0.84), BMI (moderate risk) [OR (reference: low risk): 0.84, 95% CI: 0.72, 0.98), atrial fibrillation [OR: 1.24; 95% CI: 1.02, 1.51], chronic kidney disease [OR: 0.63, 95% CI: 0.54, 0.72] and smoking status [OR: 0.68, 95% CI: 0.54, 0.88].ConclusionWe reported sub-optimal level of overall control. Among individuals following stroke, those with diabetes had higher proportion of sub-optimal control as compared to those without diabetes. Irrespective of diabetic status, being female, having high BMI, and of Malay ethnicity as compared to Chinese ethnicity were associated with poorer overall risk factor control.

The Active Sensing of Control Difference.

SummaryIn everyday life, people control objects in the world around them to varying degrees. The processes people actively use to establish their control, while interacting with an environment containing large ambiguity, remain unknown. This study examines how people explore their control over the environment and how they detect small differences in control among objects. In the experimental task, participants moved three dots on a screen and identified one dot over which the level of control is different from that of the other two. The results support a two-step behavior mechanism underlying the sensing of control difference: People first explore their overall control in the environment, and then the results of the initial exploration are used to selectively tune the direction (i.e., either more or less) of the detected control difference, ensuring efficient and rapid detection of the type of control difference that is potentially important for further action selections.

Patient Preferred and Perceived Control in Dental Care Decision Making.

Shared decision making is increasingly considered the most desirable model for making decisions in medical and dental settings. It supports patients by empowering them to play an active role in the decision-making process. However, dental patients' involvement needs and perceptions have not yet been sufficiently assessed. The aim of this study was to assess patients' preferred roles in decision making for a range of dental treatments and whether patients' preferences are being met. Based on a cross-sectional study design, dental patients' autonomy preferences and actual perceived roles were surveyed in the context of existing dental appointments in a consecutive sample of 101 adult dental patients (aged 20 to 79 y). The questionnaire for the assessment of patient preferred and perceived roles in dental decision making consisted of 14 items, each representing a decision in the broad spectrum of preventive and restorative dental treatment planning, and was administered before the dental appointment and immediately afterward. Responses for each item were indicated on an ordinal 5-point scale, which was adapted from the Control Preference Scale. Differences in overall levels of control and responses for each decision were tested for statistical significance per the Wilcoxon matched-pairs signed-rank test. Furthermore, a multilevel mixed effects linear regression model was computed. Patients rated their preferred role in decision making more active and involved than their perceived role. This effect was observed and statistically significant ( P < 0.05) for 11 of 14 treatment decisions. Perceived roles (follow-up) matched the preferred roles (baseline) for less than half of patients. None of the sociodemographic characteristics had a substantial statistical effect on whether perceived roles matched the preferred roles. Dental patients' perceived roles in decision making do not meet their preferences. Dentists should allow and encourage their patients to be more active in decision making. Since dental patients' perceived roles in decision making do not meet their preferences, clinicians should encourage and enable their dental patients to fulfill the role in decision making that they prefer. This may help in the future to not only fulfill the right of patients to be informed but also empower them to play an active role in the decision-making process and reduce the risk of decisional conflicts.

Reducing the impact of insulin sensitivity variability on glycaemic outcomes using separate stochastic models within the STAR glycaemic protocol.

BackgroundThe metabolism of critically ill patients evolves dynamically over time. Post critical insult, levels of counter-regulatory hormones are significantly elevated, but decrease rapidly over the first 12–48 hours in the intensive care unit (ICU). These hormones have a direct physiological impact on insulin sensitivity (SI). Understanding the variability of SI is important for safely managing glycaemic levels and understanding the evolution of patient condition. The objective of this study is to assess the evolution of SI over the first two days of ICU stay, and using this data, propose a separate stochastic model to reduce the impact of SI variability during glycaemic control using the STAR glycaemic control protocol.MethodsThe value of SI was identified hourly for each patient using a validated physiological model. Variability of SI was then calculated as the hour-to-hour percentage change in SI. SI was examined using 6 hour blocks of SI to display trends while mitigating the effects of noise. To reduce the impact of SI variability on achieving glycaemic control a new stochastic model for the most variable period, 0–18 hours, was generated. Virtual simulations were conducted using an existing glycaemic control protocol (STAR) to investigate the clinical impact of using this separate stochastic model during this period of increased metabolic variability.ResultsFor the first 18 hours, over 80% of all SI values were less than 0.5 × 10-3 L/mU.min, compared to 65% for >18 hours. Using the new stochastic model for the first 18 hours of ICU stay reduced the number of hypoglycaemic measurements during virtual trials. For time spent below 4.4, 4.0, and 3.0 mmol/L absolute reductions of 1.1%, 0.8% and 0.1% were achieved, respectively. No severe hypoglycaemic events (BG < 2.2 mmol/L) occurred for either case.ConclusionsSI levels increase significantly, while variability decreases during the first 18 hours of a patients stay in ICU. Virtual trials, using a separate stochastic model for this period, demonstrated a reduction in variability and hypoglycaemia during the first 18 hours without adversely affecting the overall level of control. Thus, use of multiple models can reduce the impact of SI variability during model-based glycaemic control.

Control of Seedling Sericea Lespedeza (Lespedeza cuneata) with Herbicides

AbstractTwo field experiments were conducted at the Agronomy Research Station near Stillwater, OK in 2004 and 2005 to identify and evaluate herbicides applied preplant incorporated, preemergence, early postemergence, or late postemergence for the control of seedling sericea lespedeza. Trifluralin, applied preplant incorporated, controlled seedlings 77 (15 wk after emergence [WAE]) and 63% (16 WAE) in 2004 and 2005, respectively. Flumioxazin, imazapic, fluometuron, diuron, sulfentrazone, atrazine, metribuzin, and metolachlor applied preemergence all provided greater than 86% seedling control at 15 and 16 WAE in both years. Diclosulam, applied preemergent, controlled seedlings 47% at 15 WAE in 2004 and 91% control at 16 WAE in 2005. In 2004, triclopyr, metsulfuron-methyl, glyphosate, picloram, dicamba, and 2,4-D amine plus picloram (tank-mix) applied early postemergence controlled 90 to 100% of the sericea lespedeza seedlings at 15 WAE. However, in 2005, only triclopyr, metsulfuron-methyl, glyphosate, and 2,4-D amine plus picloram (tank-mix) showed greater than 80% control at 16 WAE. Triclopyr, applied late postemergence, controlled seedlings 100% at 15 and 16 WAE, in both years. In 2004, dicamba plus 2,4-D (premix) and glyphosate were the only other herbicides which provided greater than 75% control at 15 WAE. These data suggest that there were preemergence-applied herbicides that were effective for the control of seedling sericea lespedeza. These data also suggest that triclopyr was the most effective postemergence-applied herbicide for the control of seedling sericea lespedeza. The data also showed that the overall level of control of seedling sericea lespedeza decreased as the season progressed and the plant matured.

Organisational control in programme teams: An empirical study in change programme context

The objective of this paper is to identify control mechanisms and control modes in change programme teams. We focused on the control relationships within a programme team consisting of project managers and a programme manager. We investigated four case programmes aiming at an organisational change and including a significant IT component, and identified 23 control mechanisms. The control mechanisms seemed to be complementary rather than substitutes, and the overall level of control in the case programmes varied significantly.

Glucose Control, Self-Care Behaviors, and the Presence of the Chronic Care Model in Primary Care Clinics

The purpose of this study was to examine the relationship between A1C and the extent to which care delivered to patients with type 2 diabetes in primary care clinics is consistent with the chronic care model (CCM), after controlling for self-care behaviors. This was a cross-sectional, observational study of care provided to 618 patients with type 2 diabetes across 20 small, autonomous primary care clinics in South Texas. Subjects completed an exit survey. The medical record was abstracted for A1C values. Clinicians completed the Assessment of Chronic Illness Care (ACIC) survey, a validated measure of the extent to which care delivered is consistent with the CCM. There was a significant relationship between ACIC score and A1C, but this relationship varied according to self-care behavior for exercise and was strongest for those who did not adhere to exercise recommendations: for every 1-point increase in ACIC score, A1C was 0.144% lower (P < 0.001). The relationship between ACIC score and A1C for those who adhered to their diet was similar to that for those who did not, after adjusting for exercise, but the overall level of control was better for those who adhered to their diet. Characteristics of the primary care clinic where one receives care are an important predictor of glucose control. If resources for implementing the CCM are limited, one might want to focus on clinics with low ACIC scores that serve a population of patients who are sedentary because this population may be likely to realize the most benefit from improved glucose control.

Child feeding practices and perceptions of childhood overweight and childhood obesity risk among mothers of preschool children

AbstractAim: The present study assessed the relationship between maternal attitudes, beliefs and child feeding practices. It was hypothesised that: (i) maternal control over feeding would increase when mothers perceived their children as over‐ or underweight and were concerned about the weight status of their children; and (ii) mothers would express more concern about their daughters' weight, and report higher levels of control over feeding as a result.Methods: Participants included 112 mothers and their children aged 2–6 years who were attending swim lessons at a Central Coast swim school. Mothers completed the Child Feeding Questionnaire to assess maternal attitudes, beliefs and control over child feeding. Child and maternal body mass indexes were measured. Correlational analyses, t‐tests and multiple regression analyses were performed.Results: Mothers reported a high overall level of control in child feeding, and a low level of concern for child weight. Child overweight and obesity were marginally lower than reported in previous studies. Mothers reported more concern for their daughters' weight, but did not report increased control over feeding based on child gender. Pressure to eat was negatively associated with maternal education, suggesting a link between socioeconomic status and child feeding practices. Mothers displayed higher levels of parental control over obese than normal‐weight children, suggesting that they accurately assessed the weight status at the obese level.Conclusion: Mothers may be able to detect obesity in their children, but not overweight. Mothers may also be unconcerned about their sons' weight, and this discrepancy should be investigated in clinical and educational settings. Nutrition education and child obesity prevention and treatment programs should take maternal attitudes, perceptions and child feeding practices into account when planning interventions.

Effect of entomopathogenic nematode ( Steinernema carpocapsae Weiser) application technique on the efficacy and distribution of infection of the large pine weevil ( Hylobius abietis L.) in stumps of Sitka spruce ( Picea sitchensis Carr.) created at different times

The large pine weevil ( Hylobius abietis) is a major pest of young conifer and broadleaf transplants on restock sites in the UK. The objectives of this study were two-fold. The first was to test the effectiveness of two methods of application of the entomopathogenic nematode Steinernema carpocapsae in infecting the various life stages of the weevil in Sitka spruce ( Picea sitchensis) stumps. The second objective was to investigate the importance of distribution and development of each of the weevil life stages in order to improve our understanding of factors influencing infection by S. carpocapsae. The method of nematode application on 24 July 1997, as well as the distribution and life stage of H. abietis within the stump and root system of Sitka spruce, were all shown to affect nematode efficacy as a field-based biological control agent. In contrast, the time of felling of the trees from July to September 1995 to create these stumps did not result in different rates of nematode infection of H. abietis in the stumps 2 years post-felling, but did influence development of the pest. H. abietis larvae were more widely distributed throughout the stump and root system than pupae, callow adults and pre-emergent adults that tended to be in the upper regions of the soil and close to the stump bole. Callow adults were highly susceptible to nematode infection, but larvae and older adults were not. Pupae had similar infection to larvae possibly due to late nematode application, as laboratory studies showed similar infection rates to callow adults. The results showed that S. carpocapsae tended to remain near the point of application, with the incidence of H. abietis infection declining with increasing distance from the stump and with increasing soil depth. The distribution of the most susceptible stages was, therefore, optimal for maximum nematode infection. At the time of the trial, susceptible H. abietis life stages comprised only 14–20% of the H. abietis population and the low level of control achieved (5.2–18.3%) reflects the differential susceptibility of these stages. The short duration of the callow adult and pupal stages, combined with the variation in development rates, indicated a fairly narrow application window in which to maximise infection rates. Timing of nematode treatment to proceed or better coincide with the susceptible stages of the lifecycle, multiple applications and/or increased dose rates of nematodes would probably have increased the overall level of control. Of the two application techniques used the subsurface drench was more efficient than the surface spray application, the former targeting a greater proportion of the susceptible life stages of H. abietis.

The Behavior of Anxious Parents: Examining Mechanisms of Transmission of Anxiety From Parent to Child

Examined the behavior of anxious parents in interactions with their children (ages 6 to 12 years) to test hypotheses about possible psychosocial mechanisms of transmission of anxiety from parent to child. Fifty-one parent-child dyads completed the study. Parents and children were assessed with structured interviews and participated in 2 tasks that were videotaped and coded. Twenty-five dyads had an anxious parent. Primary diagnoses of the anxious group were mostly panic disorder (PD), with or without agoraphobia (AG), social phobia (SP), and generalized anxiety disorder. Anxious participants were excluded if they presented a secondary diagnosis other than another anxiety disorder. Control parents had no present or past diagnosis. Observational data revealed that anxious parents were significantly less productively engaged and more withdrawn and disengaged during the interactions but did not differ from nonanxious parents in terms of overall levels of control. Sequential analyses indicated that there was a trend for both parent group and child sex to effect efforts to control the interaction in response to child expression of negative affect. Implications of these results for a mediational role of parental behavior in the development and maintenance of child anxiety are discussed.

The Behavior of Anxious Parents: Examining Mechanisms of Transmission of Anxiety From Parent to Child

Examined the behavior of anxious parents in interactions with their children (ages 6 to 12 years) to test hypotheses about possible psychosocial mechanisms of transmission of anxiety from parent to child. Fifty-one parent-child dyads completed the study. Parents and children were assessed with structured interviews and participated in 2 tasks that were videotaped and coded. Twenty-five dyads had an anxious parent. Primary diagnoses of the anxious group were mostly panic disorder (PD), with or without agoraphobia (AG), social phobia (SP), and generalized anxiety disorder. Anxious participants were excluded if they presented a secondary diagnosis other than another anxiety disorder. Control parents had no present or past diagnosis. Observational data revealed that anxious parents were significantly less productively engaged and more withdrawn and disengaged during the interactions but did not differ from nonanxious parents in terms of overall levels of control. Sequential analyses indicated that there was a trend for both parent group and child sex to effect efforts to control the interaction in response to child expression of negative affect. Implications of these results for a mediational role of parental behavior in the development and maintenance of child anxiety are discussed.

Using clinical measures of disease control to reduce the burden of asthma.

Clinical treatment guidelines encourage physicians to select asthma treatment in order to achieve established clinical treatment goals. Treatment selected on this basis may have profound effects upon other outcomes, some of which, such as improvements in well-being and lifestyle, are of direct benefit to the patient, and others, such as utilisation of healthcare resources and productivity, are of benefit to society. There is, however, evidence that a large proportion of patients do not achieve the goals of asthma management, such as those appearing in the international guide produced by the Global Initiative on Asthma (GINA). Furthermore, evaluation of the individual guideline goals provides little indication of the level of overall control achieved in individual patients, in spite of the fact that overall or comprehensive control is likely to be of greater value to the patient than control of only limited aspects of the disease. To give an indication of overall asthma control, and assess whether it is possible to reach this target, the GINA goals of asthma management have been amalgamated into a composite measure of overall asthma control. This approach has been used to assess recent clinical trials with the fluticasone propionate plus salmeterol combination given through a single inhaler compared with alternative treatment approaches. The studies showed that overall asthma control can be achieved, but at the fixed treatment doses used in clinical trials by only about half of the patients. Once such measures of control are included in management guidelines, healthcare professionals may need help to ensure implementation, using methods such as educational programmes and computerised disease management programmes. Improving asthma control in this way is likely to be associated with significant economic benefits.

Long‐term glycaemic control achieved in young insulin‐dependent diabetics

AbstractThe long‐term glycaemic control, assessed by the mean of three successive levels of glycosylated haemoglobin (HbA1c) achieved in a special clinic for insulindependent diabetics aged 12–40, was audited in 1984 and 1987. Clinic policy involved a twice‐daily insulin regimen with infrequent blood glucose monitoring and little emphasis on dietary compliance or formal education. Overall levels of diabetic control were identical in 1984 and 1987; 34% of patients had HbA levels within three standard deviations of the mean and 60% within five standard deviations. There was no correlation between control and age or duration of diabetes. Diabetic control deteriorated in 24% of patients and improved in 20% between 1984 and 1987. There was no significant difference in the overall levels of control compared with other centres. It is concluded that frequent blood glucose monitoring, strict dietary compliance and formal education are not important factors in glycaemic control in insulin‐dependent diabetes.

Ultralow-volume mists of chlorpyrifos from a tractor-mounted blower for area control of the lone star tick (Acari: Ixodidae).

A conventional tractor-mounted mist blower was modified for ultralow-volume (ULV) application of nonaqueous formulations of chlorpyrifos for area control of the lone star tick, Amblyomma americanum (L.), in wooded plots (0.20–0.36 hal and high-use recreational areas (0.98–5.10 ha) in Oklahoma during 1981 to 1983. The construction of the mist blower for ULV application is described. Mist deposits of a red fluorescent dye indicated that uniformity of coverage over 15-m swaths with the prototype ULV mist blower was equal to that obtained with another mist blower used for low-volume (LV) application of aqueous formulations. Field assays with a dose of 0.28 kg chlorpyrifos/ha showed that ULV mists (volumes of 0.39–1.17 liters/ha) were equal to LV mists (47 liters/hal in effectiveness against ticks. The overall levels of control of ticks with ULV mists were 85% (larvae), 94% (nymphs), 90% (adult males), and 86% (adult females) for posttreatment intervals of 1 to 6 weeks (nymphs and adults) and one day to 3 weeks (larvae). Relative densities of ticks were determined by a dry ice method (nymphs and adults) and a cloth drag method (larvae).

Adolescent Reactions to Attempted Parental Control and Influence Techniques

Surprisingly, previous research has not found that patterns of children's behavior are clearly and consistently related to the overall levels of control attempted by parents or to the element of power in parental influence techniques. As a step toward clarity, some conceptual distinctions relevant to parental behaviors and to offspring reactions are drawn and examined in data from 224 mothers and 180 fathers of sixth-, eighth-, and tenth-grade students. The results indicate the importance of distinguishing between the amount of control attempted by a parent and the control techniques used, between imperative command and coercive control techniques, between offspring's behavioral compliance with and emotional acceptance of parental influence attempts, and between maternal and paternal behavior.