- Email: [email protected]
Paediatric diabetes outreach services in rural NSW, Australia
s414
Poster Session 2
PM01 Psychological Aspects in Rehabilitation of Children and Adolescents with Diabetes ‘Qpe 1 T.V. TOLSTAYA, V.I. Ivanova, T.V. Mohort, V.A. Podolskaya, N.G. Rys, LG. Kobiskaya.
Conclusion: With the use of education & ICT we not only reached to a good metabolic control but also can able to prevent late complications of diabetes.
P1603 The purpose of conducted study was estimation of social and psychological adaptation of the children and adolescents with diabetes Type 1. On the basis of rehabilitation department in “‘Axakovshina” clinic 87 children and adolescents (50 of them in age till 14 years and 36 in age of 15-19 years) were surveyed for 3 years. To the children treatment was conducted, and also they were trained in the “Diabetes School”. Control group consisted of 72 practically healthy children of age IO-15 years. For psychological testing were used HAM test (Health state, Activity, Mood; Spilberger questionnaire enabling to evaluate a level of situational and personal anxiety. Personal differential test was applied to study of properties of the person (a level of self-respect, reliance of self, level of extroversion of the person). As a result of conducted study it was revealed, that in the group of the ill children percent of the children with reduced activity was well above than in control group (40.0% and 3,4% correspondingly). At duration of illness for more than 10 years authentic decrease of average valuations of scales “Health state” and “Mood” (HAM) is marked in comparison with the children having shorter term of disease. The children with high levels situational and personal anxiety were met more often among ill. In the group of the ill children reduced marks on all scales “personal differential” questionnaire were registered more often. Thus, children and adolescents with diabetes have changes in psychological status depending on the duration of disease, which should be taken into account at realisation of rehabilitation. The active combination of medical and psychological rehabilitation was carried out by work in common in a centre of social and psychological rehabilitation “UNESCO-Chernobyl” on the basis of the rehabilitation department of “Axakovshina” clinic. The positive factor of the social adaptation is the organisation of the groups consisting of the children with the same diseases and psychological problems. Simultaneous training of patients in “Diabetes School” gives optimum results.
Paediatric Diabetes Outreach Services in Rural NSW, Australia ANGELA C. MIDDLEHURST, Martin Silink, Neville J. Howard, Geoffrey R. Ambler, Penelope Handelsman. Endocrinology, New Childrens Hospital, Sydney, New South Wales, Australia The health system in Australia aims to provide equal access to specialist care for patients in rural and urban areas. The country’s vast size and widely dispersed population challenges realisation of this goal. In 1978 a diabetes outreach service (DOS) was set up to provide care to patients living in 2 rural centres. Aims included: reducing long distance travel to referral centres; developing expertise in childhood diabetes management in rural health professionals: extending outreach consultant services statewide. Currently clinicians from 3 tertiary paediatric diabetes centres make twice yearly visits to 533 patients in 17 centres. Travel is by Royal Plying Doctor Service or commercial aircraft. The program costs approximately A$20,000 excluding salaries and facility fees. The goals of DOS have been met: hospital admissions of rural children have been reduced: ongoing training and support of local health professionals is provided: shared care is promoted. Continuing challenges include; rising incidence rates from 14.4 - 18.6/100,000 from 1990 1996: increased consumer expectations; escalating cost; pressure to meet standards of care with decreasing resources. Further evidence that the DOS is achieving its purpose is contained in the 1999 NSW survey in which HbAlc levels of 1191 patients in 8 urban and 17 rural centres were tested. There was no significant difference in the mean HbAlcs (range 8.3 - 8.8%). We conclude that the DOS has succeeded in ensuring that rural children are not disadvantaged compared with their urban counterparts in terms of metabolic control and reduction of costly hospital admissions.
Pm4 PM02 The Effect of Use of ICT and Education on Metabolic Control of Diabetics Type 1 A. RAJAB, E Taleghani, A.A. Molaverdikhani. Diabetes Education centez Iranian Diabetes Society, Tehran, Iran (Islamic Republic Of) Introduction: On the basis of DCCT Studies, ICT & education have a good effect in metabolic control and quality of life in diabetes. In this study, we aimed to investigate the effect of ET & education on metabolic control in diabetes type 1. Methodology: 57 patients aged 5 to 18 years (average = 13) of Iranian Diabetes Society participated in this study. The tools were questionnaire and a metabolic control was HbAlc. Before research the knowledge of all patients measured by questionnaire and HbAlc checked in the beginning of study. All cases participated in three- day intensive training course were repeated every three months. After one year following- up, HbAlc measured and questionnaire completed again. Results: Frequency of average of sever hypoglycemia decreased from 0.45 to 0.08 (P
Clinical Profile and Follow-Up of Diabetes Mellitus in the Young in North India K. BALASUBRAMAN IAN, Vivek Arya, Vijayalakshmi Bhatia, Mesh Bhatia. Department of Endocrinology, Sanjay Gandhi Postgraduate Institute, Lucknow, Uttar Pradesh, India
In contrast to patients from developed countries, young patients with diabetes mellitus (DM) from developing nations may have differences in presentation and an adverse prognosis. However, there is scant information available on this topic. AIM: To study the clinical profile, prevalence of microvascular complications and mortality of patients with onset of DM5 18 years, managed at a tertiary care centre. Materials and Methods: Hundred and nine consecutive patients seen in the last 10 years were studied. Sixty patients were prospectively followed for z 1 year between Jan.1997 and Dec.1998. Results: Of the 109 patients, 92 (84%) had type 1 DM, 4 (4%) type 2 DM, 5 (5%) fibrocalculous pancreatic diabetes, 4 (4%) malnutrition modulated DM, 2 (2%) genetic syndromes and 2 (2%) due to thalassemia. The 60 patients prospectively followed-up were of age (mea&SD) 16f7 years, had age at onset I1 f4 years and duration of DM 7~t5 years. Four patients were on intensive (multiple injection) therapy, 3 on a single daily dose, while the majority were on 2 daily insulin doses. Frequency of self monitoring of blood glucose was 0-20/week (average 4.5/week). Mean HbAlc was 8.1 +2.3% (normal 4-6%). HbAlc was ~8% in 56%, between 8 and 10% in 26% and z- 10% in 18% of subjects. Frequency of severe hypoglycemia was 3.3/100 patient years and of ketoacidosis 5/100 patient years. In patients with duration of DM > 5 years, 6/31 (19%) had retinopathy (2 proliferative), 4124 (16%) had nephropathy (3 overt proteinuria, 1 microalbuminuria) and IO/34 (29%)
Poster Session 2
PM01 Psychological Aspects in Rehabilitation of Children and Adolescents with Diabetes ‘Qpe 1 T.V. TOLSTAYA, V.I. Ivanova, T.V. Mohort, V.A. Podolskaya, N.G. Rys, LG. Kobiskaya.
Conclusion: With the use of education & ICT we not only reached to a good metabolic control but also can able to prevent late complications of diabetes.
P1603 The purpose of conducted study was estimation of social and psychological adaptation of the children and adolescents with diabetes Type 1. On the basis of rehabilitation department in “‘Axakovshina” clinic 87 children and adolescents (50 of them in age till 14 years and 36 in age of 15-19 years) were surveyed for 3 years. To the children treatment was conducted, and also they were trained in the “Diabetes School”. Control group consisted of 72 practically healthy children of age IO-15 years. For psychological testing were used HAM test (Health state, Activity, Mood; Spilberger questionnaire enabling to evaluate a level of situational and personal anxiety. Personal differential test was applied to study of properties of the person (a level of self-respect, reliance of self, level of extroversion of the person). As a result of conducted study it was revealed, that in the group of the ill children percent of the children with reduced activity was well above than in control group (40.0% and 3,4% correspondingly). At duration of illness for more than 10 years authentic decrease of average valuations of scales “Health state” and “Mood” (HAM) is marked in comparison with the children having shorter term of disease. The children with high levels situational and personal anxiety were met more often among ill. In the group of the ill children reduced marks on all scales “personal differential” questionnaire were registered more often. Thus, children and adolescents with diabetes have changes in psychological status depending on the duration of disease, which should be taken into account at realisation of rehabilitation. The active combination of medical and psychological rehabilitation was carried out by work in common in a centre of social and psychological rehabilitation “UNESCO-Chernobyl” on the basis of the rehabilitation department of “Axakovshina” clinic. The positive factor of the social adaptation is the organisation of the groups consisting of the children with the same diseases and psychological problems. Simultaneous training of patients in “Diabetes School” gives optimum results.
Paediatric Diabetes Outreach Services in Rural NSW, Australia ANGELA C. MIDDLEHURST, Martin Silink, Neville J. Howard, Geoffrey R. Ambler, Penelope Handelsman. Endocrinology, New Childrens Hospital, Sydney, New South Wales, Australia The health system in Australia aims to provide equal access to specialist care for patients in rural and urban areas. The country’s vast size and widely dispersed population challenges realisation of this goal. In 1978 a diabetes outreach service (DOS) was set up to provide care to patients living in 2 rural centres. Aims included: reducing long distance travel to referral centres; developing expertise in childhood diabetes management in rural health professionals: extending outreach consultant services statewide. Currently clinicians from 3 tertiary paediatric diabetes centres make twice yearly visits to 533 patients in 17 centres. Travel is by Royal Plying Doctor Service or commercial aircraft. The program costs approximately A$20,000 excluding salaries and facility fees. The goals of DOS have been met: hospital admissions of rural children have been reduced: ongoing training and support of local health professionals is provided: shared care is promoted. Continuing challenges include; rising incidence rates from 14.4 - 18.6/100,000 from 1990 1996: increased consumer expectations; escalating cost; pressure to meet standards of care with decreasing resources. Further evidence that the DOS is achieving its purpose is contained in the 1999 NSW survey in which HbAlc levels of 1191 patients in 8 urban and 17 rural centres were tested. There was no significant difference in the mean HbAlcs (range 8.3 - 8.8%). We conclude that the DOS has succeeded in ensuring that rural children are not disadvantaged compared with their urban counterparts in terms of metabolic control and reduction of costly hospital admissions.
Pm4 PM02 The Effect of Use of ICT and Education on Metabolic Control of Diabetics Type 1 A. RAJAB, E Taleghani, A.A. Molaverdikhani. Diabetes Education centez Iranian Diabetes Society, Tehran, Iran (Islamic Republic Of) Introduction: On the basis of DCCT Studies, ICT & education have a good effect in metabolic control and quality of life in diabetes. In this study, we aimed to investigate the effect of ET & education on metabolic control in diabetes type 1. Methodology: 57 patients aged 5 to 18 years (average = 13) of Iranian Diabetes Society participated in this study. The tools were questionnaire and a metabolic control was HbAlc. Before research the knowledge of all patients measured by questionnaire and HbAlc checked in the beginning of study. All cases participated in three- day intensive training course were repeated every three months. After one year following- up, HbAlc measured and questionnaire completed again. Results: Frequency of average of sever hypoglycemia decreased from 0.45 to 0.08 (P
Clinical Profile and Follow-Up of Diabetes Mellitus in the Young in North India K. BALASUBRAMAN IAN, Vivek Arya, Vijayalakshmi Bhatia, Mesh Bhatia. Department of Endocrinology, Sanjay Gandhi Postgraduate Institute, Lucknow, Uttar Pradesh, India
In contrast to patients from developed countries, young patients with diabetes mellitus (DM) from developing nations may have differences in presentation and an adverse prognosis. However, there is scant information available on this topic. AIM: To study the clinical profile, prevalence of microvascular complications and mortality of patients with onset of DM5 18 years, managed at a tertiary care centre. Materials and Methods: Hundred and nine consecutive patients seen in the last 10 years were studied. Sixty patients were prospectively followed for z 1 year between Jan.1997 and Dec.1998. Results: Of the 109 patients, 92 (84%) had type 1 DM, 4 (4%) type 2 DM, 5 (5%) fibrocalculous pancreatic diabetes, 4 (4%) malnutrition modulated DM, 2 (2%) genetic syndromes and 2 (2%) due to thalassemia. The 60 patients prospectively followed-up were of age (mea&SD) 16f7 years, had age at onset I1 f4 years and duration of DM 7~t5 years. Four patients were on intensive (multiple injection) therapy, 3 on a single daily dose, while the majority were on 2 daily insulin doses. Frequency of self monitoring of blood glucose was 0-20/week (average 4.5/week). Mean HbAlc was 8.1 +2.3% (normal 4-6%). HbAlc was ~8% in 56%, between 8 and 10% in 26% and z- 10% in 18% of subjects. Frequency of severe hypoglycemia was 3.3/100 patient years and of ketoacidosis 5/100 patient years. In patients with duration of DM > 5 years, 6/31 (19%) had retinopathy (2 proliferative), 4124 (16%) had nephropathy (3 overt proteinuria, 1 microalbuminuria) and IO/34 (29%)