Identifying solutions to psychological insulin resistance: An international study.

AIMS: To identify actions of healthcare professionals (HCPs) that facilitate the transition to insulin therapy (IT) in type 2 diabetes (T2D) adults. METHODS: Included were T2Ds in seven countries (n = 594) who reported initial IT reluctance but eventually began IT. An online survey included 38 possible HCP actions: T2Ds indicated which may have occurred and their helpfulness. Also reported were delays in IT start after initial recommendation and any period of IT discontinuation. RESULTS: Exploratory factor analysis of HCP actions yielded five factors: "Explained Insulin Benefits" (EIB), "Dispelled Insulin Myths" (DIM), "Demonstrated the Injection Process" (DIP), "Collaborative Style" (CS) and "Authoritarian Style" (AS). Highest levels of helpfulness occurred for DIP, EIB and CS; lowest for AS. Participants who rated DIP as helpful were less likely to delay IT than those who rated DIP as less helpful (OR = 0.75, p = 0.01); participants who rated CS and EIB as helpful were less likely to interrupt IT than those who rated these as less helpful (OR = 0.55, p < 0.01; OR = 0.51, p = 0.01, respectively). CONCLUSIONS: Three key HCP actions to facilitate IT initiation were identified as helpful and were associated with more successful initiation and persistence. These findings may aid the development of interventions to address reluctance to initiating IT.

The imagery of madness in village Barbados

The madman stereotype held by villagers is compared to the situation of mental patients. Correspondingly, statements by mental patients are compared with the community situation, and both stereotypes are compared for mutual imagery. Fear, distrust, and unpredictability merge as the common denominators. Madness, as used here, is not and entity, but a relationship. The parameters of this relationship are most apparent in madman-other interaction, whether inside or outside the Mental Hospital. For example, the self-imposed label of 'madman' as a social 'lever' is only meaniful in its social context. The failure of the Mental Hospital to serve, or even support the patient is also understandable in view of the ramifications of hospital admission in the context of the community. Although I have pursued several other aspects of the relationship, one of its foremost elements is conflict. Thus, it has been necessary to establish the meaning of the patient's symptoms' for others as well as for him. The reformulation of the anthropological study of madness suggested and initiated by this research - and defined by Barbadian culture -insists that we attend to events like physical and verbal fights in the community, rather than 'hyperkinetic' episodes in the psychiatric ward. To find the anthropologist's task redefined by the culture under investigation is consistent with an implicit anthropological tenent that seldom gains expression. (Summary)