There is value in treating elevated levels of diabetes distress: the clinical impact of targeted interventions in adults with Type 1 diabetes.

AIM: To compare the effect of targeted interventions to reduce high diabetes distress among adults with Type 1 diabetes with a comparison sample of similar but untreated individuals, and to document the stability of untreated diabetes distress over time. METHODS: A total of 51 adults with Type 1 diabetes with elevated baseline diabetes distress (distress score ≥ 2.0) and HbA1c levels (≥ 58 mmol/mol) were identified from a longitudinal, non-intervention study, and compared with a similar sample of 51 participants in an intervention study. Both groups completed the T1-DDS diabetes distress questionnaire at baseline and 9 months. RESULTS: Large and significant reductions in diabetes distress scores were recorded in the intervention group (mean ± sd change = -0.6 ± 0.6), while minimal change was found in the non-intervention group (-0.2 ± 0.6, group effect P = 0.002; effect size d = 0.67). Additional analyses using the established minimal clinically important difference for the T1-DDS showed that diabetes distress increased significantly (minimal clinically important difference ≥ 1) or persisted at high levels for 51% of participants in the non-intervention group, compared with 23.5% in the intervention group. CONCLUSION: Our results showed that targeted interventions led to dramatic reductions in diabetes distress compared with a lack of treatment. We also conclude that elevated diabetes distress, when left unaddressed, does not resolve over time and often remains chronic. (Clinical Trials Registry no.: NCT02175732).

Motivation and attitudes toward changing health (MATCH): A new patient-reported measure to inform clinical conversations.

OBJECTIVE: To identify and assess patient motivation to initiate or maintain behavior changes. METHODS: Attitudinal statements were developed from structured patient interviews and translated into 18 survey items. Items were analyzed with exploratory factor analysis (EFA). RESULTS: An EFA with 340 type 2 diabetes patients identified three areas of patient attitudes toward changing health behaviors: (1) willingness to make changes (3 items; α = 0.69), (2) perceived ability to make or maintain changes (3 items; α = 0.74), and (3) and feeling changes are worthwhile (3 items; α = 0.61). Greater perceived ability and feelings of worthwhileness were associated with positive psychosocial and behavioral management indicators. All three areas were associated with confidence and attitudes toward making a specific behavioral change (e.g., improve diet). CONCLUSIONS: MATCH is an internally consistent and valid 9-item scale that provides a profile of factors influencing motivation that can be used in clinical and research settings.

Diabetes distress is linked with worsening diabetes management over time in adults with Type 1 diabetes.

AIM: To determine the cross-sectional and longitudinal associations between diabetes distress and diabetes management. METHODS: In a non-interventional study, 224 adults with Type 1 diabetes were assessed for diabetes distress, missed insulin boluses, hypoglycaemic episodes, and HbA1c at baseline and 9 months. RESULTS: At baseline, greater distress was associated with higher HbA1c and a greater percentage of missed insulin boluses. Longitudinally, elevated baseline distress was related to increased missed insulin boluses, and decreases in distress were associated with decreases in HbA1c . In supplementary analyses, neither depression symptoms nor a diagnosis of major depressive disorder was associated with missed insulin boluses, HbA1c or hypoglycaemic episodes in cross-sectional or longitudinal analyses. CONCLUSIONS: Significant cross-sectional and longitudinal associations were found between diabetes distress and management; in contrast, no parallel associations were found for major depressive disorder or depression symptoms. Findings suggest that elevated distress may lead to more missed insulin boluses over time, suggesting a potential intervention target. The covarying association between distress and HbA1c points to the complex and likely interactive associations between these constructs. Findings highlight the need to address distress as an integral part of diabetes management in routine care.

Patient understanding of genetic information influences reproductive decision making in retinoblastoma.

BACKGROUND: Retinoblastoma is the most common malignant tumour of the eye in childhood, with nearly all bilateral tumours and around 17% to 18% of unilateral tumours due to an oncogenic mutation in the RB1 gene in the germline. Genetic testing enables accurate risk assessment and optimal clinical management for the affected individual, siblings, and future offspring. MATERIAL AND METHODS: We carried out the first UK-wide audit of understanding of genetic testing in individuals with retinoblastoma. A total of 292 individuals aged 16 to 45 years were included. RESULTS: Patients with bilateral disease were significantly more likely to understand the implications of retinoblastoma for siblings and children. There was a significant association between not knowing the results of genetic testing or not understanding the implications and not having children, particularly in women. Surprisingly, this was also true for individuals treated for unilateral disease with a low risk of retinoblastoma for their offspring. CONCLUSION: We are concerned that individuals may be making life choices based on insufficient information regarding risks of retinoblastoma and reproductive options. We suggest that improvement in transition care is needed to enable individuals to make informed reproductive decisions and to ensure optimal care for children born at risk of retinoblastoma.

Oral health awareness and care preferences in patients with diabetes: a qualitative study.

BACKGROUND: People with type 2 diabetes have an increased risk of oral health problems; however, oral health is currently not included in structured diabetes reviews and education in the UK. AIM AND OBJECTIVES: This study explores the patient's experience related to oral health and diabetes, especially in relation to: • Awareness of the link between oral health and diabetes and oral self-care needs. • Interaction with health professionals in dental and general practice. • Preferences for receiving oral health information and education. Methods This nested qualitative study involved semi-structured telephone interviews with a purposive sample of 20 participants from a questionnaire study on oral health awareness in patients with diabetes. Interview transcripts were analysed using a thematic framework approach. RESULTS: Participants were mostly unaware of the link between oral health and diabetes. Those that had been made aware by a health professional were not given concrete self-care advice. Interactions with dental professionals were often limited to informing the dental practice of their diagnosis and current medication. Most participants were in favour of dentists screening for diabetes, but as their general practice was the hub for diabetes care, they felt GPs or nurses should provide oral health information and discuss oral health with patients. CONCLUSIONS: Written information regarding diabetes and its possible effects on oral health needs to be more readily available to people with diabetes, especially at diagnosis. There may be a place for introducing a structured oral health question in routine diabetes reviews.

What is the effect of peer support on diabetes outcomes in adults? A systematic review.

AIM: There is increasing interest in the role that peers may play to support positive health behaviours in diabetes, but there is limited evidence to inform policy and practice. The aim of this study was to systematically review evidence of the impact and effectiveness of peer support in adults living with diabetes. METHODS: We searched the Cochrane Library, MEDLINE, PubMed, EMBASE and CINHAL for the period 1966-2011, together with reference lists of articles for eligible studies. Data were synthesized in a narrative review. RESULTS: Twenty-five studies, including fourteen randomized, controlled or comparative trials, met the inclusion criteria. There was considerable heterogeneity in the design, setting, outcomes and measurement tools. Peer support was associated with statistically significant improvements in glycaemic control (three out of 14 trials), blood pressure (one out of four trials), cholesterol (one out of six trials), BMI/weight (two out of seven trials), physical activity (two out of five trials), self-efficacy (two out of three trials), depression (four out of six trials) and perceived social support (two out of two trials). No consistent pattern of effect related to any model of peer support emerged. CONCLUSIONS: Peer support appears to benefit some adults living with diabetes, but the evidence is too limited and inconsistent to support firm recommendations. There remains a need for further well-designed evaluations of its effectiveness and impact. Key questions remain over its suitability to the needs of particular individuals, populations and settings, how best to implement its specific components and the sustainability of its effects.

The medical and dental attendance pattern of patients attending general dental practices in Warwickshire and their general health risk assessment.

BACKGROUND: The dental team could have an important role to play in general health risk assessment within primary and community healthcare.Aims To describe medical and dental attendance patterns, demographics and health profiles of patients routinely attending general dental practices in Warwickshire. To identify whether a subgroup attend dental practices regularly but attend medical practices infrequently and discuss whether preventive healthcare interventions delivered in general dental practice would be appropriate. METHODS: A self-completion questionnaire was administered to patients attending 16 dental practices in Warwickshire. RESULTS: Eight hundred and eleven completed questionnaires were returned (74% response). Seven hundred and eighty-nine (98%) respondents visited their dentist every one to two years or more frequently and of these a subgroup of 121 (15.3%) visited their general medical practice surgery or health centre less often than every two years. In the subgroup 9.5% reported high blood pressure, 17.6% currently smoked, 22% drank above recommended guidelines, 32.1% were overweight and 7.3% obese. DISCUSSION: The data suggest there may be a role for dental practitioners in identifying patients at risk of having undiagnosed or future general health problems and providing appropriate general health advice, screening or signposting the patient to relevant general healthcare facilities either within or external to the dental practice.

Oral health awareness in adult patients with diabetes: a questionnaire study.

OBJECTIVE: To investigate oral health awareness, oral hygiene and attitudes towards general dental practitioners' (GDP) involvement in diabetes screening in adults with diabetes. DESIGN: Self-completion questionnaire. SETTING: General medical practices in Warwickshire. SUBJECTS AND METHODS: Adults with diabetes attending clinics run by practice or diabetes nurses in general medical practices. RESULTS: Two hundred and twenty-nine of 615 (37.2%) questionnaires were completed in 14 general medical practices. The majority of respondents (79.8%, 178/223) visited a dentist once or twice a year, but oral care varied; 67.2% (133/198) reported brushing at least twice a day, whereas only 15.3% (29/190) flossed daily. Awareness of oral health risks was limited: 69.1% (150/217) had never received any oral health advice related to their diabetes. Over half of respondents supported the idea of dentists offering screening for diabetes (121/226, 53.5%). CONCLUSIONS: Many adults with diabetes have poor awareness of oral care and health complications associated with diabetes, and are receiving limited advice from healthcare professionals. Training and advice for both healthcare professionals and patients concerning the importance of good oral health in patients with diabetes is needed. The role of dentists in diabetes screening and support requires further investigation.

Retrieval of DNA from the faces of children aged 0-5 years: a technical note.

Approximately 21% of children suffer from some form of physical abuse. It is hypothesized that when an individual hits a child some of that person's DNA will be deposited onto the child's skin. As yet, no one has reported a method of sampling DNA from the skin of this vulnerable group of individuals. We have sampled DNA from several facial areas of 30 children aged 5 years of age and under. The results show that it is possible to swab the faces of this age group without distressing them or contaminating the samples. Additionally the results indicate that the DNA obtained is almost entirely that of the subject, with little nondonor DNA being observed.

Investigation into the usefulness of DNA profiling of earprints.

DNA profiling of biological trace evidence has been used for many years. The application of this technique specifically to the DNA profiling of earprints has not to date been thoroughly investigated. This report presents the results of 60 earprints collected from three healthy adult volunteers under controlled laboratory conditions. DNA profile analysis revealed that high levels of non-donor alleles are observed when earprints are collected for DNA profiling. The source of these non-donor alleles is investigated and the impact that their presence within the profile may have on the use of this technique is discussed.

9649 forensic web watch--DNA in forensic science.

In 1923, within the Manual of Police technique, Edmond Locard published what is commonly known as the Doctrine of Exchange; a series of rules related to the exchange of trace evidence between the victim and offender. Although at the time of publication these rules principally applied to trace evidence related to print (for exchange finger print or shoeprint), fibre and blood, today one can add the very substance that defines each human being -- DNA. Since th first use of DNA evidence to help identify an offender in the Pitchfork Murders of 1986, the use of DNA within forensic science has developed from its humble days within a single experimental laboratory at the University of Leicester to a multi-million pound industry. It thus seams fitting that this forensic web watch should originate from the very University where the use of DNA in forensic science was conceived, drawing the readers attention to a number of sites which can be used as an introduction to the concept of the use of DNA in forensic science today.