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Pathogenetic mechanisms of hereditary diabetes mellitus
141
SELECTEDABSTRACTS
From the world literature, this issue features abstracts focusing on education and alcohol use, genetic counseling, health beliefs and practices, hospital roles, patient compliance, and roles of pharmacists. It includes representation from China, Hungary, the Netherlands, South Africa, Sweden, Switzerland, the United States, and West Germany. Many of the articles are concerned with the inner beliefs and health practices of patients who are confronting a wide range of illnesses and varying degrees of health while interacting with selected healthcare providers and health-care institutions. The manner in which education and counseling interface with important aspects of patient care is also described. EDUCATION AND ALCOHOL ABUSE The role of education at each level of prevention-primary, secondary, and tertiary-is becoming recognized as a necessary component of programs and services to reduce alcohol abuse. Although much emphasis is placed on primary prevention, efforts at other levels of prevention need to continue as well. 1) Dangers of alcohol abuse: Situation in the GFR (German) CREMER, U. Bundesminist . Jugend, Fam . Gesundh . , Bonn, West Germany Drug Alcohol Depend. II(l), 121-125, 1983 In 1975 an action program on the prevention and containment of alcohol abuse was decided upon for the Federal Republic of Germany. Many items on the agenda will require long-term projects. Initial efforts, however, have largely proved successful, as the population has increasingly become aware of the dangers of alcohol abuse. The number of people drinking alcoholic beverages daily or almost daily has decreased, while the number of those drinking hardly ever or never has increased. The group of people in danger of becoming dependent on alcohol has grown smaller, and alcohol consumption per capita has remained stable. The groups still in need of special attention are children and young people-particularly girls, because of the fetal alcohol syndrome-as well as parents and teachers, who set the primary example for the young. Health education for
VOLUME5iNUMBER3
these groups is now especially important since it proved to be the key factor in this program’s success among the general population. The need, however, for developing even more effective health-education strategies and research is apparent. 2) Alcohol and drug problems and health education (German) JANZ, H.W. Wahrendorffschen Krankenanst . , Ilten/Hannover, West Germany Drug Alcohol Depend. 11(l), 67-70, 1983 ‘Ibis article emphasizes the need for effective preventive measures against internal chemical pollution (“chemische Inweltverschmutzung”) analogous to those already taken against environmental pollution (“Umweltverschmutzung”). Beyond governmental prohibitions on both forms of pollution, however, health education is seen as a key instrument in the prevention of internal pollution by fostering individual responsibility for maintaining one’s own health. GENETIC COUNSELING Key to the prevention of recurring health problems of genetic origin is effective genetic counseling. Even though this is a well-developed specialty with increasingly sophisticated research, those in any discipline concerned with counseling about health-related decision making will find the literature in this field very useful. 3) Pathogenetic mechanisms of hereditary diabetes meliitus RUDIGER, H.W., and DREYER, M. Arbeitsgr. Erb-Konstitutionskr., Med. Klin., Univ. Hamburg, D-2000 Hamburg 20, West Germany Hum. Gener. 63(2), 100-106, 1983 Novel laboratory techniques such as the determination of proinsulin, insulin, C-peptide, and insulin receptors have allowed further subclassification of diabetes mellitus today as representing a symptom rather than a disease. Numerous pathogenetic mechanisms of diabetes have been identified, many of these being genetically determined, and this may extend possibilities for genetic
142 counseling. As a geneticist’s view, the pathogenetic concept of diabetes presented here is mostly confuted to genetic mechanisms, leaving aside other influences on the development of diabetes such as hormones, viruses, nutrition, and drugs. Mendelian-inherited diabetic disorders are related to different pathogenetic principles where possible. These are speculative in some cases. 4) Genetic counseling clinical chromosome analysis in 522 cases LI, L., XIA, J., DAI, H., et al. Med. Genet. Lab., Hunan Med. Coll., Changsha, China Chin. Med. J. (Peking) 95(11), 793-804, 1982 Chromosome analysis in 522 cases at a genetic counseling clinic from April 1973 to December 1980 revealed 60 cases (11.5%) with numerical or structural abnormalities. The structural aberrations include 12 types involving chromosomes nos. 1, 2, 4, 5, 7, 9, 12, 13, X and Y. None of the karyotypes had been reported previously in China and nine types in 12 cases had not been reported in the world. These nine karyotypes include 46, XY, t(1; 4) (q43; q25); 46, XY, -13, +der (13), t(4; 13) (q25; q34); 46, XY, t(1; 17) (~36; q21’); 46, XX or XY, t(5; 7) (q22; ~13); 46, XY, or XX, inv(5) (p15.1; q33.1); 46, XX, 39, -9, +del (9), +del (9) (pteralphacen- > qll::q13> qter); 46, XX, inv(l2) (~1110; q1310); 46, XY/45, XY, t(13; 13) (~12; ~12) and 45, X/46, Xx/47, XX, +t(Y; Y) (Yqter> Ypl::Yql 1 - > Yqter). Typical cases with the new chromosome aberrations am described and the origin of chromosomal aberrations and their prevention are discussed. HEALTH
BELIEFS
AND PRACTICES
The outcome of efforts to influence patient behaviors depends ultimately upon the beliefs of the patients themselves. Research has linked selected health beliefs and practices of patients with nearly every health condition known. When health-care providers begin to “diagnose” their clients’ underlying health beliefs, they will begin to understand better the inner reasons affecting patient behaviors. 5) Beliefs and practices concerning measles in Gazankulu IJSSELMUIDEN, C.B. Elim Hosp., Gazankulu, Transvaal, South Africa S. Afr. Med. J. 63(10), 360-363, 1983 A survey was undertaken to isolate social factors that might be influencing the coverage of a measlesvaccination program which, after several years, showed no decrease in the measles admission rate at the area hospital. It was found not only that measles is still a
common disease, but also that it is considered essential for the normal development of a child. In the home treatment of measles, moreover, a variety of indigenous medications ate used, some of which ate potentially dangerous. Almost 80% of mothers will visit a clinic if their children have measles, but 64% combine this with traditional therapy. The majority, however, were in favor of a vaccination program. The content of any health-education program, therefore, must be carefully considered, to prevent adverse effects in the population. 6) Factors influencing initiation of breast-feeding EKWO, E.E., DUSDIEKER, L.B . , and BOOTH, B.M. Dept. Ped., Univ. Iowa Hosp., Iowa City, IA, U.S.A. Am. J. Dis. Child. 137(4), 375-377, 1983 The critical incidence method was used to study factors motivating 33 primigravidas and 39 multigravidas to initiate breast-feeding of their infants. The women studied chose breast-feeding because they believed it would protect the infant against infection, establish matemalinfant bonding, and provide better nutrition than cow ‘s-milk formula. They also viewed it as the natural way to feed infants and felt that it would be both convenient and emotionally satisfying. The decision to breast-feed was made well in advance of pregnancy by primigravidas and shortly before pregnancy by multigravidas. Friends who had successfully nursed infants were as influential as immediate family members in influencing our study subjects in their decision to breastfeed. Prenatal counseling, though important, may not be the optimal period for motivating women to breast-feed. HOSPITAL ROLES IN HEALTH EDUCATION/PATIENT EDUCATION The rising costs of health care have encouraged many hospitals to diversify into the broader fields of health promotion and health education. However, the new requirements of diagnostic related groups will increasingly force hospitals to examine their entire range of educational services and determine first and foremost how to provide the most effective patient education at the lowest cost. 7) Developing a strategy for reducing hospital expenditures BRINES, D.S. Vermont Hosp. Assoc., Blanchard Court, Montpelier, VT, U.S.A. Hosp. Health Serv. Adm. 27(5), 284, 1982 A number of courses of action are suggested to reduce increases in hospitals’ expenditures. They are: utilization of group-purchasing practices; reduction of staff;
PATlENT EDUCATION AND COUNSELING
SELECTEDABSTRACTS
From the world literature, this issue features abstracts focusing on education and alcohol use, genetic counseling, health beliefs and practices, hospital roles, patient compliance, and roles of pharmacists. It includes representation from China, Hungary, the Netherlands, South Africa, Sweden, Switzerland, the United States, and West Germany. Many of the articles are concerned with the inner beliefs and health practices of patients who are confronting a wide range of illnesses and varying degrees of health while interacting with selected healthcare providers and health-care institutions. The manner in which education and counseling interface with important aspects of patient care is also described. EDUCATION AND ALCOHOL ABUSE The role of education at each level of prevention-primary, secondary, and tertiary-is becoming recognized as a necessary component of programs and services to reduce alcohol abuse. Although much emphasis is placed on primary prevention, efforts at other levels of prevention need to continue as well. 1) Dangers of alcohol abuse: Situation in the GFR (German) CREMER, U. Bundesminist . Jugend, Fam . Gesundh . , Bonn, West Germany Drug Alcohol Depend. II(l), 121-125, 1983 In 1975 an action program on the prevention and containment of alcohol abuse was decided upon for the Federal Republic of Germany. Many items on the agenda will require long-term projects. Initial efforts, however, have largely proved successful, as the population has increasingly become aware of the dangers of alcohol abuse. The number of people drinking alcoholic beverages daily or almost daily has decreased, while the number of those drinking hardly ever or never has increased. The group of people in danger of becoming dependent on alcohol has grown smaller, and alcohol consumption per capita has remained stable. The groups still in need of special attention are children and young people-particularly girls, because of the fetal alcohol syndrome-as well as parents and teachers, who set the primary example for the young. Health education for
VOLUME5iNUMBER3
these groups is now especially important since it proved to be the key factor in this program’s success among the general population. The need, however, for developing even more effective health-education strategies and research is apparent. 2) Alcohol and drug problems and health education (German) JANZ, H.W. Wahrendorffschen Krankenanst . , Ilten/Hannover, West Germany Drug Alcohol Depend. 11(l), 67-70, 1983 ‘Ibis article emphasizes the need for effective preventive measures against internal chemical pollution (“chemische Inweltverschmutzung”) analogous to those already taken against environmental pollution (“Umweltverschmutzung”). Beyond governmental prohibitions on both forms of pollution, however, health education is seen as a key instrument in the prevention of internal pollution by fostering individual responsibility for maintaining one’s own health. GENETIC COUNSELING Key to the prevention of recurring health problems of genetic origin is effective genetic counseling. Even though this is a well-developed specialty with increasingly sophisticated research, those in any discipline concerned with counseling about health-related decision making will find the literature in this field very useful. 3) Pathogenetic mechanisms of hereditary diabetes meliitus RUDIGER, H.W., and DREYER, M. Arbeitsgr. Erb-Konstitutionskr., Med. Klin., Univ. Hamburg, D-2000 Hamburg 20, West Germany Hum. Gener. 63(2), 100-106, 1983 Novel laboratory techniques such as the determination of proinsulin, insulin, C-peptide, and insulin receptors have allowed further subclassification of diabetes mellitus today as representing a symptom rather than a disease. Numerous pathogenetic mechanisms of diabetes have been identified, many of these being genetically determined, and this may extend possibilities for genetic
142 counseling. As a geneticist’s view, the pathogenetic concept of diabetes presented here is mostly confuted to genetic mechanisms, leaving aside other influences on the development of diabetes such as hormones, viruses, nutrition, and drugs. Mendelian-inherited diabetic disorders are related to different pathogenetic principles where possible. These are speculative in some cases. 4) Genetic counseling clinical chromosome analysis in 522 cases LI, L., XIA, J., DAI, H., et al. Med. Genet. Lab., Hunan Med. Coll., Changsha, China Chin. Med. J. (Peking) 95(11), 793-804, 1982 Chromosome analysis in 522 cases at a genetic counseling clinic from April 1973 to December 1980 revealed 60 cases (11.5%) with numerical or structural abnormalities. The structural aberrations include 12 types involving chromosomes nos. 1, 2, 4, 5, 7, 9, 12, 13, X and Y. None of the karyotypes had been reported previously in China and nine types in 12 cases had not been reported in the world. These nine karyotypes include 46, XY, t(1; 4) (q43; q25); 46, XY, -13, +der (13), t(4; 13) (q25; q34); 46, XY, t(1; 17) (~36; q21’); 46, XX or XY, t(5; 7) (q22; ~13); 46, XY, or XX, inv(5) (p15.1; q33.1); 46, XX, 39, -9, +del (9), +del (9) (pteralphacen- > qll::q13> qter); 46, XX, inv(l2) (~1110; q1310); 46, XY/45, XY, t(13; 13) (~12; ~12) and 45, X/46, Xx/47, XX, +t(Y; Y) (Yqter> Ypl::Yql 1 - > Yqter). Typical cases with the new chromosome aberrations am described and the origin of chromosomal aberrations and their prevention are discussed. HEALTH
BELIEFS
AND PRACTICES
The outcome of efforts to influence patient behaviors depends ultimately upon the beliefs of the patients themselves. Research has linked selected health beliefs and practices of patients with nearly every health condition known. When health-care providers begin to “diagnose” their clients’ underlying health beliefs, they will begin to understand better the inner reasons affecting patient behaviors. 5) Beliefs and practices concerning measles in Gazankulu IJSSELMUIDEN, C.B. Elim Hosp., Gazankulu, Transvaal, South Africa S. Afr. Med. J. 63(10), 360-363, 1983 A survey was undertaken to isolate social factors that might be influencing the coverage of a measlesvaccination program which, after several years, showed no decrease in the measles admission rate at the area hospital. It was found not only that measles is still a
common disease, but also that it is considered essential for the normal development of a child. In the home treatment of measles, moreover, a variety of indigenous medications ate used, some of which ate potentially dangerous. Almost 80% of mothers will visit a clinic if their children have measles, but 64% combine this with traditional therapy. The majority, however, were in favor of a vaccination program. The content of any health-education program, therefore, must be carefully considered, to prevent adverse effects in the population. 6) Factors influencing initiation of breast-feeding EKWO, E.E., DUSDIEKER, L.B . , and BOOTH, B.M. Dept. Ped., Univ. Iowa Hosp., Iowa City, IA, U.S.A. Am. J. Dis. Child. 137(4), 375-377, 1983 The critical incidence method was used to study factors motivating 33 primigravidas and 39 multigravidas to initiate breast-feeding of their infants. The women studied chose breast-feeding because they believed it would protect the infant against infection, establish matemalinfant bonding, and provide better nutrition than cow ‘s-milk formula. They also viewed it as the natural way to feed infants and felt that it would be both convenient and emotionally satisfying. The decision to breast-feed was made well in advance of pregnancy by primigravidas and shortly before pregnancy by multigravidas. Friends who had successfully nursed infants were as influential as immediate family members in influencing our study subjects in their decision to breastfeed. Prenatal counseling, though important, may not be the optimal period for motivating women to breast-feed. HOSPITAL ROLES IN HEALTH EDUCATION/PATIENT EDUCATION The rising costs of health care have encouraged many hospitals to diversify into the broader fields of health promotion and health education. However, the new requirements of diagnostic related groups will increasingly force hospitals to examine their entire range of educational services and determine first and foremost how to provide the most effective patient education at the lowest cost. 7) Developing a strategy for reducing hospital expenditures BRINES, D.S. Vermont Hosp. Assoc., Blanchard Court, Montpelier, VT, U.S.A. Hosp. Health Serv. Adm. 27(5), 284, 1982 A number of courses of action are suggested to reduce increases in hospitals’ expenditures. They are: utilization of group-purchasing practices; reduction of staff;
PATlENT EDUCATION AND COUNSELING