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Status psicologico, autoefficacia e controllo glicemico nel diabete tipo 2: studio trasversale e studio randomizzato controllato per valutare l’efficacia di un intervento psicologico nel migliorare il controllo glicemico
Full text linkPROGETTO I – STUDIO TRASVERSALE
Distress psicologico, autoefficacia e controllo glicemico in soggetti con diabete tipo 2
Premesse e scopo dello studio: Depressione e bassa percezione di autoefficacia sono associati con scarso controllo glicemico in soggetti con diabete. Una scarsa aderenza al programma terapeutico potrebbe determinare un abbassamento del senso di efficacia incrementando la probabilità di sintomi depressivi.
E’ stato condotto uno studio allo scopo di indagare la relazione tra distress psicologico, compenso metabolico e senso di autoefficacia in soggetti con diabete tipo 2 (DM2).
Soggetti e Metodi: Sono stati analizzati 172 soggetti (104 M; 68 F) affetti da DM2 afferenti presso il Servizio di Diabetologia dell’AOUI di Verona.
A tutti i soggetti sono stati somministrati 4 questionari: la Beck Depression Inventory (BDI-II) per la rilevazione del tono dell’umore, la Beck Anxiety Inventory (BAI) per la rilevazione dei livelli di ansia, la Binge Eating Scale (BES) per la rilevazione della severità dei comportamenti Binge e il Multidimensional Diabetes Questionnaire che valuta, attraverso 3 sottoscale, lo stress legato al diabete, il supporto relazionale e l’autoefficacia percepita.
Risultati: I soggetti arruolati avevano un’età media (±SD) di 62.6±7.5 anni, durata di diabete pari a 10.9±8.4 anni, body mass index (BMI) 31.4±4.0 Kg/m2, emoglobina glicosilata (HbA1c) % 7.5±1.2. Nel complesso, il 14.5% e il 18.6% dei soggetti analizzati presentava, rispettivamente, sintomi di ansia e depressione clinicamente rilevante.
In analisi univariata la percezione di autoefficacia mostrava una correlazione negativa con il distress psicologico espresso in termini di depressione (r=-0.37, p<0.001), ansia (r=-0.28, p<0.001) e comportamenti binge (r=-0.48, p<0.001) e con gli indici di compenso metabolico, HbA1c (r=-0.21, p=0.005) e BMI (r=-0.25, p=0.001). All'aumentare di HbA1c aumentava la percezione di compromissione (r=0.33, p<0.001) e di gravità (r=0.24, p=0.001) associata al diabete. Non è stata invece rilevata un'associazione tra HbA1c e distress psicologico (depressione: r= 0.019, p=0.80; ansia: r=0.10, p=0.15; comportamenti binge: r=0.14, p=0.07).
Conclusioni: In un ampio campione di pazienti italiani affetti da DM2 si è riscontrata una elevata prevalenza di distress psicologico, ma questo non si associava significativamente con il controllo glicemico.
Un peggiore compenso glicemico, maggiore adiposità e una più elevata prevalenza di sintomi depressivi e ansiosi erano significativamente associati ad uno scarso senso di autoefficacia nei confronti della gestione del DM2. Questi risultati sottolineano il ruolo chiave della autoefficacia nella gestione del DM2 e suggeriscono che interventi mirati psicologici focalizzati su questo costrutto possano favorire un miglioramento degli outcome clinici e psicologici associati al diabete.
PROGETTO II – STUDIO CLINICO RANDOMIZZATO CONTROLLATO
Efficacia di un intervento psicologico nel migliorare il controllo glicemico e ridurre il distress psicologico in soggetti con diabete tipo 2
Premesse e scopo dello studio: Disturbi psicopatologici e disagio psicologico sono fattori individuali che giocano un ruolo importante nell'insorgenza e nel peggioramento del diabete.
E’ stato dimostrato che soggetti con DM hanno una probabilità doppia di incorrere in un episodio depressivo nel corso della loro vita rispetto a soggetti non diabetici. Inoltre, in soggetti con diabete la depressione tende ad associarsi con scarsa aderenza al regime terapeutico, più complicanze e più alti tassi di ospedalizzazione. Ad oggi è poco chiaro il meccanismo sottostante la relazione tra distress psicologico e peggioramento degli outcome clinici associati al diabete. Il principale scopo di questa ricerca è stato valutare l'efficacia di un intervento psicologico in soggetti con diabete tipo 2 in non ottimale compenso glicemico
Materiali e Metodi: 55 soggetti, 25 donne e 30 maschi di età compresa tra 36 e 73 anni sono stati randomizzati a gruppo di controllo (cure standard) o a gruppo d'intervento (cure standard+intervento convenzionale). A tutti i soggetti che hanno accettato di partecipare allo studio sono stati somministrati una serie di test e questionari alla fine dell'intervento (T26) e a 12 settimane di Follow-up (T38).
Risultati: Nei soggetti che hanno finora completato lo studio (N=44), si è osservato un significativo miglioramento del compenso glicemico (p=0.02) e una significativa riduzione del valore di BMI (p=0.005) dei soggetti del gruppo di intervento rispetto ai soggetti del gruppo di controllo. Analogamente, il gruppo di intervento presentava rispetto al gruppo di controllo una netta riduzione dello stato ansioso (p=0.027) e depressivo (p<0.001) e della severità dei comportamenti binge (p=0.006). Infine, si è anche osservato un significativo aumento della percezione di autoefficacia nel gestire la malattia nel gruppo intervento (p<0.001) rispetto al gruppo di controllo. Nei soggetti che avevano completato il follow-up (N=38) si è osservato che gruppo intervento e gruppo di controllo non mostravano variazioni statisticamente significative relativamente al compenso glicemico (p=0.84) e al valore di BMI (p=0.47) durante l'arco temporale complessivo dello studio da T0 a T38. Per quanto riguarda la variabili psicologiche, al follow-up si confermava un significativa riduzione dello stato ansioso (p=0.019) e della sintomatologia depressiva (p=0.035). Non si è confermata invece la riduzione della gravità dei comportamenti binge (p=0.12), mentre si manteneva significativamente aumentata la percezione dell' autoefficacia (p<0.001).
Conclusioni: Il presente studio mostra l'efficacia di un intervento psicologico nel ridurre il distress psicologico e nel migliorare il controllo glicemico. Il maggior cambiamento si è rilevato nel corso del trattamento e tende a rimanere stabile al follow-up per le variabili psicologiche ma non per quelle metaboliche.PROJECT I – CROSS-SECTIONAL STUDY
Psychological distress, self-efficacy and glycemic control in type 2 diabetes.
Background: Psychological distress and poorer glycemic control are strongly associated together in people affected by diabetes mellitus. Higher diabetes-related self-efficacy is associated with both better glycemic control and increased engagement in self-care behaviors. Poor behavioral adherence to diabetic regimen (diet and physical activity) may lower self-efficacy, which would lead, in turn, to a higher likelihood of depressive symptoms. This study aimed to investigate the association among psychological distress, glycemic control and self-efficacy in type 2 diabetes (T2D).
Subjects and Methods: One-hundred seventy-two subjects with T2D were consecutively recruited from the Verona Diabetes Center. Standard biochemical parameters and the following survey batteries were assessed in all study participants: the Beck Depression Inventory (BDI-II) to assess the severity of depression; the Beck Anxiety Inventory (BAI) to assess the level of anxiety; the Binge Eting Scale (BES) to assess the severity of binge eating; the Multidimensional Diabetes Questionanire to assess the psychosocial adjustment of patients to diabetes.
Results: Age, body-mass index (BMI) and glucose control (HbA1c) were (mean±SD) 62.6±7.5 years, 31.4±4.0 Kg/m2, 7.5±1.2% respectively. Prevalence of clinically detectable anxiety and depression was 14.5% and 18.6%, respectively. Self-efficacy was inversely correlated with HbA1c (r=-0.21, p=0.005), BMI (r=-0.25, p=0.001) and with psychological distress, a composite endpoint comprised of depression (r=-0.37, p<0.001), anxiety (r=-0.28, p<0.001) and binge eating (r=-0.48, p<0.001). HbA1c was positively correlated with perceived interference (r=0.33, p<0.001) and perceived severity of diabetes (r=-0.14, p=0.001). No correlation was found between HbA1c and psychological distress (depression: r=0.019, p=0.80; anxiety: r=0.10 p=0.15; binge eating: r=0.14, p=0.07).
Conclusions: Psychological distress was highly prevalent in a sample of T2D Italian patients. Despite psychological distress and glycemic control were not related to each other, we found that a lower sense of self-efficacy was significantly related to a poorer glycemic control, increased adiposity and a higher prevalence of depression and anxiety. Our data highlight the key role of self-efficacy in the management of T2D and suggest that interventions focused on improvement of self-efficacy may favorably impact both clinical and psychological diabetes outcomes.
Project II – Randomized Clinical Trial
Effects of psychological intervention on glycemic control and psychological distress in type 2 diabetic patients
Background: Increasing evidence suggests that psychological disorders play an important role in the development and worsening of type 2 diabetes (T2D). Among the spectrum of psychological disorders, there is a wide literature about the association between depression and T2D and current data show an approximately two-fold prevalence of depression in adults affected by diabetes compared to un-affected subjects. Moreover, depression in diabetic patients is associated with higher blood glucose levels, poorer adherence to therapeutic regimens (whether pharmacological or therapeutic lifestyle changes), more medical complications, and higher hospitalization rates. Nevertheless, at the best of our knowledge, the mechanism underlying the association between depression and adverse diabetes-related outcomes is currently unresolved.
Aim of this project is to assess the efficacy of a psychological treatment for diabetic patients with suboptimal level of Hemoglobin A1c.
Subjects and Methods: 55 subjects, 25 females and 30 males were randomized to two treatment arms standard diabetes care or 24 individual sessions of psychological intervention.
Those who agreed to take part in the study completed survey batteries at the end of the study (T26) and at 12-week follow-up (T38).
Results: Among those who completed the 24-week study evaluation the intervention group showed lower HbA1c (p=0.02) and BMI (p=0.005)), markedly reduced anxiety e depression and higher perceived self-efficacy ) (p<0.001) compared to the control group at the end of the study.
Among those subjects who completed the follow-up evaluation (N=38) there were not significant differences on measures of glycemic control (p=0.84) and BMI (p=0.47) from baseline (T0) to follow-up (T38). About psychological measures, at follow-up it was confirmed a significant decrease of anxiety (p=0.019) and depression (p=0.035) but not of binge eating (p=0.12), while it was confirmed a significant increase of diabetes self-efficacy (p<0.001).
Conclusion: The data showed a significant decrease of psychological distress among type 2 diabetic patients after 24 weeks of psychological intervention added to standard medical care
Depressive symptoms and glycaemic control in adults with type 1 diabetes: an exploratory study on the role of family functioning
No full textPsychological distress and family functioning have a considerable impact on diabetes self-management and glycaemic control in individuals with type 1 diabetes (T1D). However, the influence of both individual and family factors on glycaemic control has not been adequately investigated yet. This study aimed at examining the relationship between perceived family functioning and depressive symptoms with the frequency of capillary self-monitoring of blood glucose (SMBG) and glycaemic control (HbA1c) in a large sample of adults with T1D
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Psychological distress, Self-Efficacy and Glycemic Control in Type 2 Diabetes
No full textAim – To investigate the association of glycemic control with depression, anxiety, self-efficacy and other diabetes-specific psychological measures in a cohort of adult patients with type 2 diabetes (T2D) free of severe chronic diabetes-related complications. Methods – In 172 T2D outpatients consecutively recruited at the Diabetes Center of Verona City Hospital, we performed a standard medical assessment and completed the Beck Depression Inventory-II (BDI-II), the Beck Anxiety Inventory (BAI) and the Multidimensional Diabetes Questionnaire (MDQ). Results – Age, body mass index (BMI) and glycosylated hemoglobin (HbA1c) were (median [IQR]): 64.0 [58.0-69.0] years, 31.0 [28.0-34.4] kg/m2, and 7.3 [6.7-8.0] %, respectively. The overall prevalence of anxiety and depression was 14.5% and 18.6%, respectively. Higher levels of HbA1c were significantly (p<0.001) associated with a number of MDQ dimensions, such as higher perceived interference with daily activities (Spearman’s rho coefficient=0.33), higher perceived diabetes severity (rho=0.28) and lower self-efficacy (rho=-0.27), but not with depression or anxiety. These three variables were also independent predictors of higher HbA1c levels, when entered in a multivariable stepwise-forward regression model that also included age, BMI, diabetes duration and diabetes-specific social support as covariates. Conclusion – Lower self-efficacy and higher diabetes distress were closely associated with poorer glycemic control. No direct association between HbA1c and clinical psychological symptoms was detected. These results highlight that a number of diabetes-specific psychological variables may play a role amidst psychological distress and glycemic control. Further studies are needed to elucidate the relevance of diabetes distress and self-efficacy to the achievement of individual glycemic targets
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
koamabayili/VECTRON-author-checklist: VECTRON author checklist
No full textWe have done our best to complete the author checklist relating to the use of animals in the hut study. Note that the objective for the hut study was to evaluate the IRS treatment applications for residual efficacy against Anopheles mosquitoes, including the local An. coluzzii mosquito population. Cows were only used to attract mosquitoes into the huts and no tests were carried out directly on the cows. The author checklist is intended for use with studies where experiments are carried out on animals, which is why we have had such difficulty in completing this for the hut study, as many of the questions do not relate to how the cows were used
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