DIABETES SELF MANAGEMENT: MEN VS WOMEN

Self-management experiences among men and women with type 2 diabetes mellitus: a qualitative analysis

Rebecca Mathew, Enza Gucciardi, Margaret De Melo and Paula Barata

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BMC Family Practice 2012, 13:122 doi:10.1186/1471-2296-13-122

Published: 19 December 2012

Abstract (provisional)

Background

The purpose of this study is to better understand differences in diabetes self-management, specifically needs, barriers and challenges among men and women living with type 2 diabetes mellitus (T2DM).

Methods

35 participants were recruited from a diabetes education center (DEC) in Toronto, Canada. Five focus groups and nine individual interviews were conducted to explore men and women's diabetes self-management experiences.

Results

The average age of participants was 57 years and just over half (51.4%) were female. Analyses revealed five themes: disclosure and identity as a person living with diabetes; self-monitoring of blood glucose (SMBG); diet struggles across varying contexts; utilization of diabetes resources; and social support. Women disclosed their diabetes more readily and integrated management into their daily lives, whereas men were more reluctant to tell friends and family about their diabetes and were less observant of self-management practices in social settings. Men focused on practical aspects of SMBG and experimented with various aspects of management to reduce reliance on medications whereas women focused on affective components of SMBG. Women restricted foods from their diets perceived as prohibited whereas many men moderated their intake of perceived unhealthy foods, except in social situations. Women used socially interactive resources, like education classes and support groups whereas men relied more on self-directed learning but also described wanting more guidance to help navigate the healthcare system. Finally, men and women reported wanting physician support for both affective and practical aspects of self-management.

Conclusions

Our findings highlight the differences in needs and challenges of diabetes self-management among men and women, which may inform gender-sensitive diabetes, care, counseling and support.

EXERCISE THERAPY FOR MUSCULOSKELETAL DISEASES

Exercise therapy for bone and muscle health: an overview of systematic reviews

Kare B Hagen, Hanne Dagfinrud, Rikke H Moe, Nina Osteras, Ingvild Kjeken, Margreth Grotle and Geir Smedslund

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BMC Medicine 2012, 10:167 doi:10.1186/1741-7015-10-167

Published: 19 December 2012

Abstract (provisional)

Background

Musculoskeletal conditions (MSCs) are widely prevalent in present-day society, with resultant high healthcare costs and substantial negative effects on patient health and quality of life. The main aim of this overview was to synthesize evidence from systematic reviews on the effects of exercise therapy (ET) on pain and physical function for patients with MSCs. In addition, the evidence for the effect of ET on disease pathogenesis, and whether particular components of exercise programs are associated with the size of the treatment effects, was also explored.

Methods

We included four common conditions: fibromyalgia (FM), low back pain (LBP), neck pain (NP), and shoulder pain (SP), and four specific musculoskeletal diseases: osteoarthritis (OA), rheumatoid arthritis (RA), ankylosing spondylitis (AS), and osteoporosis (OP). We first included Cochrane reviews with the most recent update being January 2007 or later, and then searched for non-Cochrane reviews published after this date. Pain and physical functioning were selected as primary outcomes.

Results

We identified 9 reviews, comprising a total of 224 trials and 24,059 patients. In addition, one review addressing the effect of exercise on pathogenesis was included. Overall, we found solid evidence supporting ET in the management of MSCs, but there were substantial differences in the level of research evidence between the included diagnostic groups. The standardized mean differences for knee OA, LBP, FM, and SP varied between 0.30 and 0.65 and were significantly in favor of exercise for both pain and function. For NP, hip OA, RA, and AS, the effect estimates were generally smaller and not always significant. There was little or no evidence that ET can influence disease pathogenesis. The only exception was for osteoporosis, where there was evidence that ET increases bone mineral density in postmenopausal women, but no significant effects were found for clinically relevant outcomes (fractures). For LBP and knee OA, there was evidence suggesting that the treatment effect increases with the number of exercise sessions.

Conclusions

There is empirical evidence that ET has beneficial clinical effects for most MSCs. Except for osteoporosis, there seems to be a gap in the understanding of the ways in which ET influences disease mechanisms.

CYCLING AND BONE HEALTH

cine 2012, 10:168 doi:10.1186/1741-7015-10-168

Published: 20 December 2012

Abstract (provisional)

Background

Cycling is considered to be a highly beneficial sport for significantly enhancing cardiovascular fitness in individuals, yet studies show little or no corresponding improvements in bone mass.

Methods

A scientific literature search on studies discussing bone mass and bone metabolism in cyclists was performed to collect all relevant published material up to April 2012. Descriptive, cross-sectional, longitudinal and interventional studies were all reviewed. Inclusion criteria were met by 31 studies.

Results

Heterogeneous studies in terms of gender, age, data source, group of comparison, cycling level or modality practiced among others factors showed minor but important differences in results. Despite some controversial results, it has been observed that adult road cyclists participating in regular training have low bone mineral density in key regions (for example, lumbar spine). Conversely, other types of cycling (such as mountain biking), or combination with other sports could reduce this unsafe effect. These results cannot yet be explained by differences in dietary patterns or endocrine factors.

Conclusions

From our comprehensive survey of the current available literature it can be concluded that road cycling does not appear to confer any significant osteogenic benefit. The cause of this may be related to spending long hours in a weight-supported position on the bike in combination with the necessary enforced recovery time that involves a large amount of time sitting or lying supine, especially at the competitive level. See related commentary http://www.biomedcentral.com/1741-7015/10/169.

FRAIL HEALTH OF THE ABORIGINAL CANADIANS

BMC Public Health 2012, 12:1098 doi:10.1186/1471-2458-12-1098

Published: 20 December 2012

Abstract (provisional)

The disproportionate effects of the 2009 H1N1 pandemic on many Canadian Aboriginal communities have drawn attention to the vulnerability of these communities in terms of health outcomes in the face of emerging and reemerging infectious diseases. Exploring the particular challenges facing these communities is essential to improving public health planning. In alignment with the objectives of the Pandemic Influenza Outbreak Research Modelling (Pan-InfORM) team, a Canadian public health workshop was held at the Centre for Disease Modelling (CDM) to: (i) evaluate post-pandemic research findings; (ii) identify existing gaps in knowledge that have yet to be addressed through ongoing research and collaborative activities; and (iii) build upon existing partnerships within the research community to forge new collaborative links with Aboriginal health organizations. The workshop achieved its objectives in identifying main research findings and emerging information post pandemic, and highlighting key challenges that pose significant impediments to the health protection and promotion of Canadian Aboriginal populations. The health challenges faced by Canadian indigenous populations are unique and complex, and can only be addressed through active engagement with affected communities. The academic research community will need to develop a new interdisciplinary framework, building upon concepts from 'Communities of Practice', to ensure that the research priorities are identified and targeted, and the outcomes are translated into the context of community health to improve policy and practice.

FORMULA TO LIVE LONGER..ride bicycle to work

The longevity Olympians enjoy is within the reach of everyone, experts say.

Research published on the British Medical Journal (BMJ) website suggests athletes live 2.8 years longer on average than the average lifespan.

The research indicated those who took part in non-contact sports such as cycling, rowing and tennis enjoyed the longest life of all.

But the general population could have a similar "survival advantage" by doing a little more exercise, experts said.

The conclusion by two public health professors came after they reviewed two studies of Olympic athletes published by the BMJ website.

The studies looked at the lifespan and health of 25,000 athletes who competed in Games dating back to 1896.

Those taking part in contact sports such as boxing had the least advantage, while cyclists and rowers enjoyed the best health.

But the researchers also found those who played lower intensity sports such as golf enjoyed a boost.

'Public health failure'

Possible explanations put forward for the finding included genetic and lifestyle factors and the wealth and status that comes with sporting success.

However, the findings prompted public health experts Prof Adrian Bauman, from Australia's Sydney University, and Prof Steven Blair, from South Carolina University in the US, to suggest others could live as long as Olympic athletes.

The recommended level of physical activity for adults is 150 minutes of moderate to vigorous exercise each week.

Studies suggest people who manage that amount or more live for up to several years longer than those that do not.

Writing for the BMJ website, the professors said: "Although the evidence points to a small survival effect of being an Olympian, careful reflection suggests that similar health benefits and longevity could be achieved by all of us through regular physical activity.

"We could and should all award ourselves that personal gold medal."

But they said governments were still not doing enough to promote the benefits of physical activity, calling it a "public health failure".