PURPOSE: Medical knowledge regarding chronic illness has increased in recent years. Critical gaps in our understanding of the educational factors necessary to change the clinical aspects of most diseases remain. The role of the general practitioner, the primary care provider, in the delivery of educational interventions has not been clearly defined. METHODS: For the first phase in the educational diagnosis of Type 2 diabetic patients treated by general practitioners in France, a stratified random sample of 8% of general practitioners was drawn; 70% agreed to be interviewed. RESULTS: Demographic characteristics of physicians were comparable with previous studies. Physicians accepted the seriousness of the disease. 75.9% devoted at least as much time to the psychological as to the somatic aspects of the disease. 74.7% reported using a co-active approach with patients, permitting the use of more innovative educational strategies. Logistic regression analysis indicated that the ages of the physicians and patients, inclusion of the family, the number of patients seen, and the perception of patients as compliant were predictive of the co-active approach. CONCLUSIONS: The overwhelming proportion of physicians who use the co-active approach was the single most important factor in the development of an educational intervention where the general practitioner serves as the primary, continuous reinforcer for long-term behavior change. This program is currently being tested in a randomized clinical trial among general practitioners in France.

Attitude of Health Personnel↗

PubMedDate not supplied

Diabetes and pancreatic carcinoma.

OBJECTIVE: To analyse the association between pancreatic cancer and non-insulin-dependent diabetes mellitus. DESIGN: Cohort study of fatal pancreatic cancer with 17 years of follow-up. SETTING: Working men in Paris. PARTICIPANTS: 6,988 men aged 44-55 years employed by a government agency. Following a 75 g oral glucose tolerance test, subjects were classed at baseline, according to the WHO criteria as normoglucose tolerant, impaired glucose tolerant or diabetic. Known diabetic patients were grouped with the latter. RESULTS: Among the 312 diabetic subjects (both known and newly diagnosed) the death rate from pancreatic cancer was 64 per 100,000 person years, and 28 and 18 per 100,000 person years among the 684 impaired glucose tolerant and 5,992 normoglycaemic subjects respectively. After the exclusion of deaths during the first five years of follow-up, a possible marker of occult cancer at baseline, the relative risk of fatal pancreatic cancer in diabetic versus normoglycaemic men was 4.9 (95% CI, 1.3 to 18 after adjustment for age and tobacco consumption).

Adult↗