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M Peyrot

Publications and source records attributed to M Peyrot.

34 records · Page 2Linked to original sources
PubMed1992

Psychosocial problems and interventions in diabetes. A review of the literature.

This article reviews and organizes the recent literature on psychosocial problems and interventions in diabetes to see if it is possible to identify effective modes of treatment for numerous different psychosocial problems. An attempt was made to review extensively the references on psychosocial problems and to review exhaustively the references on psychosocial interventions. The review was organized under four major headings: psychological sequelae of medical crises, psychopathology in diabetes, stress and hassles in living with diabetes, and family dysfunctions. Results of the literature review were similar for all areas: although some studies suggested that these problems are especially severe for people with diabetes, the best-designed studies suggested that this was not so. Regardless of the prevalence of these problems in the diabetic population at large, individuals who suffer from these problems are at special risk for reduced physical and emotional well-being, so they need psychosocial interventions that effectively resolve their difficulties. Unfortunately, the literature on psychosocial interventions in diabetes is meager, and it lacks the systematic, quantitative evaluations necessary to identify effective modes of treatment for different psychosocial problems. It is possible to state tentatively that certain interventions have been used for specific problems with some indication that they can be effective. Issues for future research are identified. Addressing these issues might provide a foundation for making decisions about areas ripe for clinical trials, and ultimately determining which intervention is best suited for treating any given psychosocial problem.

Adult↗
PubMed1991

Differential effect of diabetes education on self-regulation and life-style behaviors.

OBJECTIVE: To examine the effect of diabetes education on self-regulation and life-style behaviors. RESEARCH DESIGN AND METHODS: Participants in an outpatient diabetes education program completed a protocol measuring several self-care behaviors and glycemic control at entry (n = 165) and 6 (n = 124) and 12 (n = 89) mo after the program. RESULTS: Improvement was noted at 6 mo for most self-care behaviors and glycemic control. At 12 mo, lower glycosylated hemoglobin levels were maintained (P less than 0.001) without increases in perceived hypoglycemia. Improvement was not maintained for those self-care behaviors that require change in life-style, i.e., diet and exercise. However, self-care behaviors that allow patients to self-regulate their glycemic control--self-monitoring of blood glucose and insulin dose self-adjustment--were improved at 12 mo over preprogram levels (P less than 0.001). Frequency of insulin self-adjustment continued to increase during the period between follow-ups. CONCLUSIONS: The findings suggest that diabetes education is effective in promoting self-regulation behaviors, although it has less effect on traditional regimen behaviors such as diet and exercise.

Activities of Daily Living↗
PubMed1990

Supplier-induced demand for pastoral care services in the general hospital: a natural experiment.

Assesses the effects the elimination of a pastoral care training program and a reduction in staff had on referral rates for pastoral care. Results showed a decrease in referrals initiated by pastoral care staff but an increase in pastoral care referrals initiated by medical staff and patients. Notes that when pastoral care staff were less available, the demand for their services became more apparent.

Chaplaincy Service, Hospital↗
PubMed1985

Narcotics anonymous: its history, structure, and approach.

Although Narcotics Anonymous (NA) is the oldest and largest self-help group for the support of drug abusers, it has received little study. This paper provides an overview of the history, structure, philosophy, and activities of the NA fellowship based on interviews with members, a survey of the NA literature, and observation at a residential therapeutic community employing the NA approach. The latter data provide a means of analyzing the relationship between NA and those implementing its program. Suggestions for research are advanced in recognition of Narcotics Anonymous as both underground social movement and major treatment modality for drug abusers.

Goals↗
PubMed1984

Anticholeraic effect of methylated casein in rat jejunum.

To explore the antisecretory effect of methylated casein (MC) cholera toxin was placed in isolated jejunal loops, and in vivo water fluxes were measured 3 h later in the presence or absence of MC. Secretion was observed in the loops filled with Ringer's solution only, but net absorption was observed in all 10 loops to which MC was added. Its actions was evident within 20 min, and was exerted directly on the luminal side of the epithelium. This response was dose-dependent and the antisecretory effect vanished after boiling MC and after ultrafiltration. In vitro, the antisecretory effect of MC consisted of reversing net Na and Cl fluxes from secretion to absorption (delta JNanet = 6.18 +/- 1.25 and delta JClnet = 5.10 +/- 1.66 microEq . h-1 . cm-2). This change was due to the enhancement of mucosal to serosal flux. Transepithelial potential difference and tissue conductance did not alter. Interestingly, MC did not interfere with intestinal function in the absence of stimulation by cholera toxin. In the presence of cholera toxin, MC and glucose both stimulated ionic absorption by different mechanisms, MC stimulating neutral NaCl absorption, and glucose stimulating electrogenic Na absorption. MC did not alter basal adenylate cyclase activity but it inhibited the cholera toxin-stimulated increase in activity. The present results indicate that methylated casein inhibits water and electrolyte secretion induced by cholera toxin in rat jejunum. Its availability, low cost, and curative effect from the luminal side constitute compelling indications for further investigation.

Adenylyl Cyclases↗
PubMed1981

Reduction of bile salt secretion in children with coeliac disease in activity and in remission.

To assess the role of intestinal absorption in bile secretion, the effects of milk perfusion into the duodenum on bile salt secretion were studied in children with active coeliac disease. Bile secretion was evaluated by measuring the bile salt concentration and output in the duodenum in response to a perfusion with a milk containing a casein hydrolysate as the protein source (4 ml/min/m2) followed by i.v. injection of 2 U/kg cholecystokinine (CCK). Bile salt output was estimated taking into account the dilution of the BSP perfused into the first part of the duodenum and collected 15 cm further on. Results found in nine children with active coeliac disease (A) were compared both to results for seven control children (C) and to those for three children with coeliac disease in remission (CDR). The values obtained show: 1. a significant drop in bile salt concentration and output in response to Nutramigen perfusion in groups A and CDR compared to group C; 2. a diminution in bile salt output perfusion is groups A and CDR; 3. smaller variations in bile salt output (expressed in mumol/min m2) after i.v. stimulation by CCK in group A (from 25 +/- 3.5 to 36 +/- 8.5) than in group C (from 46 +/- 6 to 52 +/- 9) or group CDR (from 19.5 +/- 1.4 to 52 +/- 20.6). However, there was no significant difference between the groups, because responses were heterogeneous; 4. there was no correlation between bile salt output or intestinal concentration of bile salt and fat absorption. These results indicate a reduction in bile salt secretion during the active phase of coeliac disease. The mechanism controlling this anomaly is not clear, since reduced bile salt output persisted after histological restoration of the duodenum.

Bile Acids and Salts↗
PubMedDate not supplied

Quality of life and diabetes.

Quality of life is an important health outcome in its own right, representing the ultimate goal of all health interventions. This paper reviews the published, English-language literature on self-perceived quality of life among adults with diabetes. Quality of life is measured as physical and social functioning, and perceived physical and mental well-being. People with diabetes have a worse quality of life than people with no chronic illness, but a better quality of life than people with most other serious chronic diseases. Duration and type of diabetes are not consistently associated with quality of life. Intensive treatment does not impair quality of life, and having better glycemic control is associated with better quality of life. Complications of diabetes are the most important disease-specific determinant of quality of life. Numerous demographic and psychosocial factors influence quality of life and should be controlled when comparing subgroups. Studies of clinical and educational interventions suggest that improving patients' health status and perceived ability to control their disease results in improved quality of life. Methodologically, it is important to use multidimensional assessments of quality of life, and to include both generic and disease-specific measures. Quality of life measures should be used to guide and evaluate treatment interventions.

Adult↗
PubMedDate not supplied

Psychosocial factors in diabetes control: adjustment of insulin-treated adults.

Twenty insulin-treated diabetic adults were studied to identify psychosocial factors important in diabetic (blood glucose) control. Diabetic control was assessed by glycosylated hemoglobin, a measure of long-term glucose control. Subjects were equally divided between "good" and "poor" glucose control groups with sex balanced in each group. A multifactorial biopsychosocial model was proposed and tested. This model incorporated both direct (psychophysiologic) and indirect (behavioral) components. The behavioral variables investigated included predisposing (orientational), enabling (resource/barrier), and conditioning (inhibiting and motivating) factors. The psychophysiologic variables investigated were stress-response factors (elevating and dampening). Univariate and multivariate analysis demonstrated significant relationships between glucose control and each category of variables, using measures of diabetes knowledge and attitudes, health locus of control, and coping styles. The findings support both the stress-coping-illness and health-belief/illness-behavior models of diabetic adjustment and control.

Adaptation, Psychological↗
PubMedDate not supplied

The impact of barriers and self-efficacy on self-care behaviors in type 2 diabetes.

PURPOSE: This cross-sectional, correlational study examined the relationships of diabetes-specific treatment barriers and self-efficacy with self-care behaviors. METHODS: A total of 309 people with type 2 diabetes participated in this study. All of the factors were assessed by self-report questionnaires. Self-care behaviors included exercise, diet, skipping medication, testing blood for glucose, adjusting insulin to avoid or correct hyperglycemia, and adjusting diet to avoid or correct hypoglycemia. RESULTS: Perceived barriers to carrying out self-care behaviors were associated with worse diet and exercise behavior. Greater self-efficacy predicted more frequent blood glucose testing, less frequent skipping of medication and binge eating, and closer adherence to an ideal diet. Nontraditional dimensions of self-efficacy were associated with worse self-care. Self-efficacy explained 4% to 10% of the variance in diabetes self-care behaviors beyond that accounted for by patient characteristics and health beliefs about barriers. CONCLUSIONS: The findings of this study provided support for Rosenstock's proposal that a person's self-perceived capability to carry out a behavior should be incorporated into an expanded health belief model.

Adult↗
PubMedDate not supplied

Modeling the effect of diabetes education on glycemic control.

The objective of this study was to identify the mechanisms by which diabetes education improves glycemic control. Study participants were 82 adult patients from a comprehensive outpatient diabetes education program who completed a research protocol at the outset of the program and again 6 to 12 months later. The research protocol included a glycosylated hemoglobin assay and self-reported frequency of two insulin administration events (shot skipping and dosage adjustment), self-monitoring of blood glucose (SMBG), and exercise. Those who did not improve any aspect of self-care reduced their mean glycohemoglobin from 9.7 to 9.0. Those who improved exercise or SMBG (but not both) reduced their glycohemoglobin from 10.9 to 9.6. Those who improved both exercise and SMBG and those who improved insulin administration had the largest improvement in glycemic control, from 12.5 to 9.6. These findings suggest that if diabetes education can help patients improve self-care behavior, it can bring about dramatic improvements in glycemic control. Improved insulin administration is the single most powerful way to improve glycemia, but improving other aspects of self-care also can produce substantial gains.

Blood Glucose Self-Monitoring↗
PubMedDate not supplied

Behavior change in diabetes education.

PURPOSE: The purpose of this paper is to explore how diabetes education produces change in self-care behavior. METHODS: Published research on diabetes education relevant to behavior change was examined and a framework was formulated for the study of behavior change. RESULTS: Research indicates that education improves patient self-management, which in turn improves glycemic control and health status. Yet, there is relatively little information on what types of education produce what particular benefits for which types of patients. Moreover, we do not know the benefits of various forms of education (for selected groups) relative to their costs. Empirical studies of how education produces behavior change are few, but much preliminary work has been done to identify potential behavioral determinants that can be targeted by interventions. Theoretical models of behavior change have been advanced (e.g., stages of change) but they have yet to be rigorously tested. CONCLUSIONS: Initial answers to the research questions can be generated by conducting more sophisticated analyses of the type of data already being collected. However, obtaining complete answers to some of these questions will require more extensive data collection, including large-scale studies of multiple interventions in multiple patient groups.

Attitude to Health↗
PubMedDate not supplied

Effect of diabetes education on self-care, metabolic control, and emotional well-being.

Participants (n=165) entering a week-long outpatient education program completed a protocol measuring self-care patterns, glycosylated hemoglobin levels, and emotional well-being. Emotional well-being was reassessed at the end of the program, and the entire protocol was completed again at 6 mo (n=124). At the program's end, participants improved on all measures of emotional well-being (P less than .01). Self-esteem and diabetes self-efficacy rose, whereas anxiety and depression fell. At 6 mo, improvement in emotional well-being continued, and important self-care behaviors improved from preprogram levels. Self-monitoring of blood glucose and exercise rose (both P less than .001), and bringing (P less than .01) and glycosylated hemoglobin levels (P less than .001) fell. Program effects were unrelated to demographic or disease characteristics but strongly related to initial status. Participants who entered the program with high levels of emotional well-being or good self-care patterns or glycemic control tended to change little, if at all, at later measurements. On the other hand, people who entered the program with low levels of emotional well-being or with poor self-care patterns or glycemic control improved substantially. Our findings suggest that diabetes education can promote long-term benefits in self-care, metabolic control, and emotional status if the program is specifically designed to provide these benefits. Aspects of the program that contribute to its efficacy are discussed.

Adult↗