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Biomedical subjects

M Peyrot

Publications and source records attributed to M Peyrot.

At least 19 recordsLinked to original sources
PubMed2006

Patient and provider perceptions of care for diabetes: results of the cross-national DAWN Study.

AIMS/HYPOTHESIS: We assessed country-level and individual-level patterns in patient and provider perceptions of diabetes care. METHODS: The study used a cross-sectional design with face-to-face or telephone interviews of diabetic patients and healthcare providers in 13 countries from Asia, Australia, Europe and North America. Participants were randomly selected adults with type 1 or type 2 diabetes (n=5,104), and randomly selected diabetes-care providers, including primary-care physicians (n=2,070), diabetes specialist physicians (n=635) and nurses (n=1,122). Multivariate analysis was used to examine the relationships between outcomes and both country and respondent characteristics, and the interaction between these two factors. RESULTS: Providers rated chronic-care systems and remuneration for chronic care as mediocre. Patients reported that ease of access to care was high, but not without financial barriers. Patients reported moderate levels of collaboration among providers, and providers indicated that several specialist disciplines were not readily available to them. Patients reported high levels of collaboration with providers in their own care. Provider endorsement of primary prevention strategies for type 2 diabetes was high. Patients with fewer socio-economic resources and more diabetes complications had lower access (and/or higher barriers) to care and lower quality of patient-provider collaboration. Countries differed significantly for all outcomes, and the relationships between respondent characteristics and outcomes varied by country. CONCLUSIONS/INTERPRETATION: There is much need for improvement in applying the chronic-care model to the treatment and prevention of diabetes in all of the countries studied. Each country must develop its own priorities for improving diabetes care and comparison with other countries can help identify strengths as well as weaknesses.

Adolescent↗
PubMed2005

Psychosocial problems and barriers to improved diabetes management: results of the Cross-National Diabetes Attitudes, Wishes and Needs (DAWN) Study.

AIMS: To examine patient- and provider-reported psychosocial problems and barriers to effective self-care and resources for dealing with those barriers. METHODS: Cross-sectional study using face-to-face or telephone interviews with diabetic patients and health-care providers in 13 countries in Asia, Australia, Europe and North America. Participants were randomly selected adults (n = 5104) with Type 1 or Type 2 diabetes, and providers (n = 3827), including primary care physicians, diabetes specialist physicians and nurses. RESULTS: Regimen adherence was poor, especially for diet and exercise; provider estimates of patient self-care were lower than patient reports for all behaviours. Diabetes-related worries were common among patients, and providers generally recognized these worries. Many patients (41%) had poor psychological well-being. Providers reported that most patients had psychological problems that affected diabetes self-care, yet providers often reported they did not have the resources to manage these problems, and few patients (10%) reported receiving psychological treatment. CONCLUSIONS: Psychosocial problems appear to be common among diabetic patients worldwide. Addressing these problems may improve diabetes outcomes, but providers often lack critical resources for doing so, particularly skill, time and adequate referral sources.

Adult↗
PubMed2001

Psychological issues and treatments for people with diabetes.

This article examines psychological issues and their treatment among people with diabetes. The paper contains two main sections, one dealing with diagnosable clinical disorders, and the other with more mundane but nevertheless important subclinical problems in living with diabetes. We review the published literature on prevalence, manifestation, consequences, and treatment of psychological disorders in persons with diabetes, primarily depression, anxiety, and eating disorders. In describing everyday problems in living with diabetes we expand our sources beyond the published literature to include our own clinical and consulting experiences as well as our unpublished qualitative research. These problems include dietary restrictions, self-monitoring of blood glucose, taking insulin injections, and lack of support from family and health care professionals. We describe methods for dealing with such problems and discuss the tension between focusing on emotional distress versus practical issues of disease management. Finally, we briefly present some potentially positive consequences of living with diabetes so that readers can be aware of the inspirational aspects of personal experience with this disease.

Activities of Daily Living↗
PubMed2000

Endogenous opioid activity is associated with obsessive-compulsive symptomology in individuals with a family history of alcoholism.

Endogenous opioid activity has been associated with the regulation of mood and inhibition of the hypothalamic-pituitary-adrenal (HPA) axis. We assessed differences in psychological symptomology and naloxone sensitivity in non-alcoholic males and females with a family history of alcoholism (FHP) and without a family history of alcoholism (FHN). This was followed by assessment of the association between naloxone sensitivity and psychological symptomology. Psychological symptomology was measured using the Revised Symptom Checklist (SCL-90-R) during enrollment. Adrenocorticotropin was measured following intravenous administration of naloxone/placebo. FHP males reported more obsessive-compulsive symptomology as well as increased sensitivity to naloxone relative to other groups. A positive association was observed between degree of obsessive-compulsive symptomology and naloxone sensitivity, and the association was strongest among FHP males. These findings suggest that the increased risk of alcoholism in FHP subjects (especially males) may be associated with altered opioid activity, which is expressed through an elevated level of obsessive compulsive symptomology.

Adolescent↗
PubMed2000

The relation of religious belief and practices, depression, and hopelessness in persons with clinical depression.

Religious belief and practices have been associated with lower levels of depression in persons dealing with stressful situations. In this study, researchers examined this relationship in 271 persons diagnosed with clinical depression. It was hypothesized that religious belief and practices would be associated with lower depression and that this relationship would be mediated by hopelessness. Religious belief, but not religious behavior, was a significant predictor of lower levels of hopelessness and depression beyond demographic variables. Through the relation of religious belief to lower levels of hopelessness, religious belief was indirectly related to less depression. There was also a small direct positive association of belief with depression, pointing to the complexity of the role belief plays for religious persons. Further study is needed for a better understanding of different ways religion affects depressed persons.

Adaptation, Psychological↗
PubMed1999

Persistence of depressive symptoms in diabetic adults.

OBJECTIVE: To determine the level and pattern of persistent depressive symptoms among adults with diabetes and identify factors associated with increased risk of being persistently depressed. RESEARCH DESIGN AND METHODS: A self-report depression symptom inventory was administered to 245 patients at two initial time points--the beginning and end of a comprehensive outpatient diabetes education program--and at 6-month follow-up. RESULTS: Only 13% of subjects were persistently depressed (i.e., exceeded the criterion for depression symptoms at all three time points). The rate of being depressed at follow-up was 10% for those negative for depression symptoms at either of the initial time points, 36% for those positive at one initial time point, and 73% for those positive at both initial time points (P < 0.0001). Those at increased risk for being persistently depressed were those who did not graduate from high school, had more than two complications of diabetes, and were not treated with insulin. CONCLUSIONS: Persistent depressive symptomatology is present in a substantial number of diabetic adults and can be effectively predicted using simple screening instruments during initial contacts. Risk factors for being persistently depressed only partly overlap those for transient depressive symptoms and represent a possible biological dimension.

Adult↗
PubMed1999

A biopsychosocial model of glycemic control in diabetes: stress, coping and regimen adherence.

This study examines stress, coping, and regimen adherence as determinants of chronic and transient metabolic control in diabetes. We also examine the interaction of biologic vulnerability and psychosocial risk factors to see if Type 1 (insulin dependent diabetes mellitus) or Type 2 (noninsulin dependent diabetes mellitus) diabetes had greater responsiveness to psychosocial risk factors. Analyses of data from insulin-treated adults with Type 1 (N = 57) and Type 2 (N = 61) diabetes supported the biopsychosocial model. For Type 1 diabetes, self-controlling persons had better glycemic control and emotional persons had worse (because of differences in stress). All of these associations were mediated by regimen compliance. For Type 2 diabetes, self-controlling persons had better glycemic control for reasons other than regimen compliance. There was an interaction between biologic and psychosocial factors, with psychosocial factors accounting for more variance in glycemic control within Type 1 patients. Stable psychosocial resources (i.e., education, being married, and positive coping styles) were associated with better chronic glycemic control, while stress and regimen nonadherence were associated with worse transient glycemic control.

Adaptation, Psychological↗
PubMed1998

Direct-to-consumer ads can influence behavior. Advertising increases consumer knowledge and prescription drug requests.

This study examines the impact of direct-to-consumer (DTC) pharmaceutical advertising on prescription drug knowledge and the requesting behavior of consumers. The authors developed and tested a conceptual model of prescription drug knowledge and requests. Consumers' belief that drug advertising can educate them was associated with a greater amount of drug knowledge, and the belief they would upset physicians by asking for specific drugs was associated with less knowledge. The belief that drug advertising reduces prices was associated with greater probability of drug requests, and the belief that physicians should be the sole source of drug information was associated with lesser probability of request. Preference for generic drugs was associated with a lesser likelihood of requesting a specific drug. Media exposure and drug advertising awareness were associated with higher drug knowledge and a greater probability of drug requesting.

Advertising↗
PubMed1997

Levels and risks of depression and anxiety symptomatology among diabetic adults.

OBJECTIVE: To determine levels of depression and anxiety symptoms among adults with diabetes and identify factors associated with increased risk. RESEARCH DESIGN AND METHODS: This study administered self-report symptom inventories to patients at the beginning (n = 634) and end (n = 578) of an outpatient diabetes education program. Subjects (n = 246) contacted by mail 6 months later completed the same instruments. RESULTS: Rates of disturbance for depression (41.3%; 95% CI: 37.4-45.2%) and anxiety (49.2%; 95% CI: 45.3-53.1%) were higher than those typical in the general population (10-20%). Probability of disturbance ranged from 5-7% for those with the lowest risk profile to 82-92% for those with the highest risk profile. Diabetes-related complications were the only disease factor associated with significantly increased risk of disturbance. Women and those with less education were at much higher risk. Only 13% of those followed for 6 months were disturbed at all three time-points. CONCLUSIONS: Diabetes is associated with increased risk of psychological disturbance, especially for those with more diabetes-related complications. Sociodemographic factors account for much of the risk differential among people with diabetes.

Adult↗
PubMed1996

Causal analysis: theory and application.

Identified opportunities to make statistical analysis more closely approximate the conceptual issues that are apparent in current research in pediatric psychology. The paper proceeds by explicating the logic of multivariate analysis and its application to causal modeling. Causal modeling techniques are discussed and the ease of employing these techniques is evaluated. Several articles from earlier issues of this journal are reviewed in terms of the application of causal analysis.

Causality↗
PubMed1995

Synthesis and characterization of supramolecular biovector (SMBV) specifically designed for the entrapment of ionic molecules.

Supramolecular biovectors (SMBV) are nanoparticular drug carriers composed of an internal crosslinked solid core externally grafted with fatty acids and surrounded with a phospholipid layer. We show in this paper that the internal core can be derivatized with anionic ligands such as phosphate in order to allow the efficient entrapment of cationic molecules through a process akin to ion exchange. Synthesis of SMBV involved first a cross linking and derivatization step of polysaccharides followed by a homogenization, a drying and a regioselective acylation step. Acylated polysaccharide cores are thus obtained which can be loaded with drugs and wrapped with a phospholipid layer. The SMBVs obtained are characterized through their size, 20 nm, and their ability to filter through 0.22 microns pore size membrane. Gel permeation chromatography experiments performed with various phospholipid/acylated cores ratios indicate that SMBVs form entities distinct from liposomes and that the optimum phospholipid/acylated cores ratio for this specific type of SMBVs is close to 100%. The supramolecular structure of SMBVs and in particular the spatial proximity between acylated cores and phospholipids is demonstrated through resonance energy transfer experiments. The drug loading capability of SMBVs is illustrated by the preparation of gentamicin and doxorubicin loaded SMBV. The therapeutic potential of SMBVs is then discussed notably in the light of a possible biomimetism with low density lipoproteins (LDL).

Doxorubicin↗
PubMed1994

The effect of child physical abuse and neglect on aggressive, withdrawn, and prosocial behavior.

This study investigated aggressive, withdrawn, and prosocial behavior in physically abused (N = 21), nonabused-neglected (N = 26), and nonabused-nonneglected (N = 21) children aged 5 to 8 years. Multiple assessment techniques were used, specifically the Human Figure and Kinetic Group Drawings, children's verbal stories, and teacher ratings on the Pittsburgh Adjustment Survey Scales. All measurement techniques were able to discriminate among the three groups. Physically abused children displayed significantly more aggressive behavior than the neglected and nonmaltreated; neglected children were significantly more withdrawn than the physically abused and nonmaltreated; nonmaltreated children exhibited significantly more prosocial behavior than the abused and neglected. No single dimension adequately discriminated each of the three groups. Full discrimination was achieved only when aggressive, withdrawn, and prosocial behavior were combined in a multivariate analysis, indicating that effects of maltreatment must be viewed as multidimensional.

Aggression↗
PubMed1994

Short-term substance abuse prevention in jail: a cognitive behavioral approach.

This article describes a cognitive-behavioral program for substance abusers which was first implemented in the Baltimore City Jail in 1987. Similar but separate programs are provided for male and female inmates, consisting of twelve to sixteen contact hours over three to four weeks. In addition to conventional drug and alcohol information (physiologic and psychological effects, treatment options), the program emphasizes cognitive and behavioral skills which can prevent substance abuse, including training in consequential thinking, and stress and anger management. Over a two-year period, 607 males and 131 females were served, of whom 429 (59%) completed the entire program. Both males and females showed statistically significant improvement from pretest to posttest in all knowledge areas. Inmates gave high ratings to the program and group leaders reported substantial change in client attitudes toward drug and alcohol use. Knowledge scores at the end of the program were highest for those who scored higher at pretest, rated their group leader higher, and were rated by their group leader as more active participants. Client participation was the strongest predictor of program outcome.

Adult↗
PubMed1994

Structure and correlates of diabetes-specific locus of control.

OBJECTIVE: To examine the structure and correlates of diabetes-specific locus of control. RESEARCH DESIGN AND METHODS: Study participants were 165 adult patients from a comprehensive outpatient diabetes education program who completed a research protocol at the outset of the program. The protocol included measures of diabetes locus of control (DLC), glycemic control, self-care behavior, and emotional well-being. RESULTS: Scales measuring internal and powerful other DLC each had two components. One component of internal DLC, autonomy, was significantly associated with positive outcomes, and the other component, self-blame, was related to negative outcomes. The two components of powerful other DLC were differently correlated with various aspects of strict regimen adherence, and chance DLC was associated with a variety of measures reflecting a pattern of dysfunction. CONCLUSIONS: The concept of DLC appears to have explanatory power in accounting for health outcomes, especially when internal DLC measures of autonomy and self-blame are differentiated. It is important to find educational interventions that work effectively with patients who believe that health outcomes are controlled by chance, because they seem to be at special risk for health-related problems.

Blood Glucose↗
PubMed1993

Biogenic, psychogenic, and sociogenic models of adjustment to chronic pain: an exploratory study.

OBJECTIVE: Based upon three models of etiology and adjustment in CLBP, predictions were made about the variables that were expected to differentiate organic and nonorganic patients, including: psychological distress (anxiety, depression, stress, alienation), pain condition and treatment, and general health. METHOD: Patients from a medical school orthopedic clinic with an organic (N = 58) or a nonorganic (N = 33) diagnosis for chronic low back pain (CLBP) were compared on medical, psychological and sociodemographic variables. RESULTS: Nonorganic patients exhibited greater emotional distress, contrary to the biogenic model, and nonorganic patients did not exhibit more somatic complaints, contrary to the psychogenic model. Both patterns were consistent with the sociogenic model; nonorganic patients were more distressed, but not because of a greater tendency to somatize. Moreover, modeling was not supported as an explanation of the pain and distress among these patients. CONCLUSIONS: Social anomie may explain why patients without a medically diagnosable cause for their pain are more psychologically distressed.

Adaptation, Psychological↗
PubMed1993

Consumer satisfaction and perceived quality of outpatient health services.

The authors examined factors related to consumer satisfaction and willingness to recommend the provider among 1,366 patients receiving examinations at a free-standing medical imaging facility. The nontechnical (nonmedical) characteristics of the service encounter were drawn from three conceptual domains--staff behavior, atmospherics, and information--and two subjective judgments regarding the medical service itself: examination comfort and perceived worth. The authors hypothesized that all of these factors are related to increased consumer satisfaction and willingness to recommend the provider. Data collection was based on a service script, and factor analysis was used to organize elements from each domain into a map of consumer perceptions. Multivariate logistic regression indicated that items from each domain were significantly related to patient satisfaction and willingness to recommend the provider.

Ambulatory Care Facilities↗