Self-efficacy, stress levels and daily style of living among older patients with type 2 diabetes in a rural primary care setting: a cross-sectional study.

Aims: To identify to what extent stress and self-efficacy may be associated with specific features in the elderly with type 2 diabetes, such as lifestyle habits, multi-morbidity, sleep quality and duration, and treatment regimen. Methods: A cross-sectional study of 92 out of 103 recruited patients ≥65 year old with a diagnosis of type 2 diabetes was conducted at a rural primary care unit in Northern Greece. The General Self-Efficacy Scale (GSES), the Short Anxiety Screening Test (SAST) and an original questionnaire to assess health habits and disease monitoring information were completed after structured personal interviews. Results: In the multiple linear regression analysis, patients with higher education, with more night sleeping hours and physical exercise weekly had a higher GSES score than their counterparts (p<0.05). Stress levels assessed with SAST were shown mostly associated with poor sleep quality, fewer days of meat and legumes consumption, increased body mass index and multi-morbidity (p<0.05), as emerged from the multiple linear regression analysis. Glycemic control in the elderly does not have a significant correlation with stress levels or general self-efficacy. Conclusions: Self-efficacy and stress levels are not predictors for glycemic control, but can indirectly be seen as co-determinants, contributing to the overall daily life quality among patients with diabetes. Mental health well-being, expressed by higher self-efficacy and less stress scale rating, showed positive interferences with eating, sleep and daily life attitudes among elderly with diabetes.

Comparing spoken language treatments for minimally verbal preschoolers with autism spectrum disorders.

Preschoolers with severe autism and minimal speech were assigned either a discrete trial or a naturalistic language treatment, and parents of all participants also received parent responsiveness training. After 12 weeks, both groups showed comparable improvement in number of spoken words produced, on average. Approximately half the children in each group achieved benchmarks for the first stage of functional spoken language development, as defined by Tager-Flusberg et al. (J Speech Lang Hear Res, 52: 643-652, 2009). Analyses of moderators of treatment suggest that joint attention moderates response to both treatments, and children with better receptive language pre-treatment do better with the naturalistic method, while those with lower receptive language show better response to the discrete trial treatment. The implications of these findings are discussed.

Enhancing the application and evaluation of a discrete trial intervention package for eliciting first words in preverbal preschoolers with ASD.

This study evaluates the effectiveness of an intervention package including a discrete trial program (Rapid Motor Imitation Antecedent Training (Tsiouri and Greer, J Behav Educat 12:185-206, 2003) combined with parent education for eliciting first words in children with ASD who had little or no spoken language. Evaluation of the approach includes specific intervention targets and functional spoken language outcomes (Tager-Flusberg et al., J Speech Lang Hear Res 52:643-652, 2009). Results suggest that RMIA, with parent training, catalyzes development of verbal imitation and production for some children. Three of five participants acquired word production within the DTT framework and achieved milestones of early functional spoken language use (Tager-Flusberg et al., J Speech Lang Hear Res 52:643-652, 2009). The implications of these findings for understanding the role of discrete trial approaches to language intervention are discussed.

Multidisciplinary lymphedema treatment program.

Lymphedema is an underrecognized and undertreated condition that requires a multidisciplinary approach in an individualized program that will address the special needs of each patient. In an ideal setting of an outpatient management program the team should be composed of a vascular surgeon, a dermatologist, a physiotherapist, a dietician, a psychologist, a social worker, and an office employee, working together in the assessment and management of all aspects of lymphedema. All treatment strategies and actions taken should ultimately focus on the improvement of the quality of life of patients suffering from lymphedema and on the prevention of lymphedema in high-risk patients.