Reducing obstacles to the provision of quality diabetic care

Abstract

High quality diabetic care is seen as influenced by the organisation of care, health care workers' involvement in diabetes-specific areas, co-operation among staff members, the availability of resources, and the competence of medical staff (including both physicians and nurses). In a prospective study we have tested a programme for improvements of the quality of diabetes services which combined organisational development and continuing medical education (CME) measures. The study involved 34 primary health care centres over an 18 month period and was based on the responses to questionnaires answered by 123 general practitioners and 247 registered nurses at the 34 PHCCs.

The combined programme had a considerable influence on inter-group co-operation, staff members' perceptions of resources available, and nurses' involvement in diabetic care (54 versus 30% seeing diabetic patients for regular check-ups).

The results show that, in order to diminish obstacles to high quality care, organisation of care as well as care workers' theoretical knowledge has to be focused.     

Hemodynamic responses to speech and music in preverbal infants

Numerous studies have provided clues about the ontogeny of lateralization of auditory processing in humans, but most have employed specific subtypes of stimuli and/or have assessed responses in discrete temporal windows. The present study used near-infrared spectroscopy (NIRS) to establish changes in hemodynamic activity in the neocortex of preverbal infants (aged 4–11 months) while they were exposed to two distinct types of complex auditory stimuli (full sentences and musical phrases). Measurements were taken from bilateral temporal regions, including both anterior and posterior superior temporal gyri. When the infant sample was treated as a homogenous group, no significant effects emerged for stimulus type. However, when infants’ hemodynamic responses were categorized according to their overall changes in volume, two very clear neurophysiological patterns emerged. A high-responder group showed a pattern of early and increasing activation, primarily in the left hemisphere, similar to that observed in comparable studies with adults. In contrast, a low-responder group showed a pattern of gradual decreases in activation over time. Although age did track with responder type, no significant differences between these groups emerged for stimulus type, suggesting that the high- versus low-responder characterization generalizes across classes of auditory stimuli. These results highlight a new way to conceptualize the variable cortical blood flow patterns that are frequently observed across infants and stimuli, with hemodynamic response volumes potentially serving as an early indicator of developmental changes in auditory-processing sensitivity.     

Assessing Effort During Neuropsychological Evaluation with the TOMM in Children and Adolescents with Epilepsy

Effort assessment is of particular importance in pediatric epilepsy where neuropsychological findings may influence treatment decisions, especially if surgical interventions are being considered. The present investigation examines the Test of Memory Malingering (TOMM) in 60 children and adolescents with epilepsy. The overall pass rate for the sample was 90%. TOMM scores were unrelated to age, though there was a significant correlation between TOMM Trial 2 scores and intelligence estimates. Overall, the TOMM appears to be a valid measure of effort in young epilepsy patients, though caution should be used when interpreting scores for those with very low IQ, especially if behavioral problems are also evident. Caution should also be exercised in interpreting scores in children with ongoing interictal epileptiform activity that may disrupt attention.     

Children's memory for complex autobiographical events: Does spacing of repeated instances matter?

Often, when children testify in court they do so as victims of a repeated offence and must report details of an instance of the offence. One factor that may influence children's ability to succeed in this task concerns the temporal distance between presentations of the repeated event. Indeed, there is a substantial amount of literature on the “spacing effect” that suggests this may be the case. In the current research, we examined the effect of temporal spacing on memory reports for complex autobiographical events. Children participated in one or four play sessions presented at different intervals. Later, children were suggestively questioned, and then participated in a memory test. Superior recall of distributed events (a spacing effect) was found when the delay to test was 1?day (Experiment 1) but there was little evidence for a spacing effect when the delay was 1 week (Experiment 2). Implications for understanding children's recall of repeated autobiographical events are discussed.     

The impact of Zen meditation on security and satisfaction in monogamous relationships

The objective of this study was to evaluate the impact of Zen meditation on security and satisfaction in monogamous relationships. Levels of security and satisfaction as described by interpersonal theorist Harry Stack Sullivan, as well as meditation experience, were analysed via survey data. Data were collected via the Internet from 405 men and women who were 18 years of age or older and had been in a monogamous relationship for one year or more. Results indicated that compared to meditators, nonmeditators appeared slightly more secure and satisfied in their relationships. This may reflect the fact that different forms of meditation share philosophical beliefs that encourage mindfulness, acceptance, and moderation.     

Income and support during transition from a military to civilian career

This study examined experienced military members (N= 136, average age 51 years) transitioning to a 2nd occupation, specifically K–12 teaching, and revealed correlations between the length of their transition to both perceived support and income. Perceived support from family and friends had a small, positive correlation with transition time (r= .31), while income had a small, negative correlation with transition time (r=?.28). The Career Transitions Inventory ( Heppner, 1991 ), the Satisfaction with Life Scale ( Diener, Emmons, Larsen, & Griffin, 1985 ), demographic questions, and open‐ended questions were used. Implications for career counselors working with transitioning military members are discussed, along with future implications for research and practice.     

A Note on the Relationship Between Task Requirements and the Contextual Interference Effect

Typically, tasks used in past contextual interference experiments had movement, spatial pattern, or timing requirements. The possibility exists that the blocked/random manipulation of only one of these task characteristics contributes to the contextual interference effect. The purpose of the experiment reported here was to test the impact of separate movement and timing tasks on the superior learning of random trained groups. The task for all subjects in the movement condition was to release a start button and knock over a wooden barrier. There were three movement time goals to be learned. Half of the subjects in this condition practiced the three movements in a blocked schedule and half practiced them in a random schedule. The subjects in the no-movement condition estimated the same three times by holding down the start button for the appropriate duration. Similarly, these subjects were divided into random and blocked practice groups. All subjects then performed a retention test. Results showed that for the movement condition, the blocked group performed with less error than the random group during acquisition. In retention, however, the random group performed with less error than the blocked group. Conversely, for the no-movement condition, there were no differences between the two practice schedule groups during acquisition or during retention for any of the dependent measures. These results indicate that experimental tasks must have some type of movement requirement in order to facilitate learning through the use of random practice schedules.     

Loneliness and the Effects of Life Changes

In this study, factor analysis was used to examine whether men and women experience loneliness differently and how marital status affects the experience of loneliness (especially if the marriage is terminated). The experiences of chronic and situational or event-related loneliness are also compared. Finally, the study is also an investigation of the social stigma that causes people to refuse to admit their loneliness. As a result of this stigma, when questioned for research purposes, individuals usually report a recall of past loneliness rather than a current or ongoing experience. In the present study, the difference between loneliness recalled and loneliness experienced at the time of questioning is investigated.