护理干预对糖尿病病人健康行为的影响

目的:减少和延缓糖尿病并发症的发生,提高生存质量;降低个体医疗费用;降低社会负担.方法:对病人进行糖尿病有关监测项目的检查.了解患病情况;收集被调查者糖尿病相关知识掌握信息;按照护理程序的方法,遵循WHO倡导的"饮食、运动、能量平衡促健康"的理念,建立对糖尿病病人健康行为的护理干预模式;以Orem"自我照顾"的理论为指导,将其应用于对糖尿病病人的健康行为指导之中,实施护理干预措施,提高病人的自护能力.结果:对94例糖尿病病人实施12个月的健康行为管理结果是:①糖化血红蛋白百分比均数由8.64下降为7.76,空腹血糖均数值(mmol/L)由8.94下降为6.68,提高了糖尿病的治疗有效率;②病人的自护能力由干预前的33.16%,提高到83.33%,自护缺陷明显改善;③病人遵医行为平均率由干预前的51.83%,提高到82.14%.使血糖平均降低了2.26mmol/L.结论:病人对饮食、运动指导、合理用药等知识有教育需求,表明医院内的健康教育对糖尿病病人是不够的,社区护理干预是护理工作的延续,对病人的支持更有针对性.接受个性化护理干预的病人对疾病防治知识认识较前提高,纠正了不良生活习惯,自我监测能力和自我护理能力提高,生理指标、并发症指标、生活质量较前改善,住院率下降,表明护理干预对病人具有支持作用,可以提醒和帮助病人遵从医嘱,达到很好控制疾病,重塑健康生活方式的目的.     

教育管理在糖尿病患者健康教育中的应用

目的:对糖尿病病患的健康教育中教育管理所起到作用及其具体效果进行分析探讨。方法:选取同期于我院进行治疗的糖尿病患者96例,将其作为研究对象。对患者教育前后的一系列控制目标如舒张压、收缩压、餐后血糖、空腹血糖、体重指数、糖尿病疾病知识了解情况以及患者的满意度等统计分析。结果:患者在糖尿病健康教育之后,餐后血糖、空腹血糖、体重指数以及收缩压较教育之前均有显著进步(P0.05),而教育前后的舒张压指标不存在显著差异(P0.05),患者的满意度及糖尿病疾病知识了解情况较教育前存在显著提升(P0.05)。结论:对糖尿病患者采取教育管理方式进行健康教育可以使病患积极配合治疗,对糖尿病疾病知识有一个基础全面的了解。在控制餐后血糖、空腹血糖、体重指数及收缩压等指标方面有着积极作用,可以有效提升患者的满意度。     

针对性健康教育对老年2型糖尿病患者糖代谢及生活质量的影响

目的：观察针对性健康教育对老年2型糖尿痛患者的干预效果及对生活质量的影响,为糖尿病的临床护理提供参考。方法：将120例老年2型糖尿病患者随机分为两组,对照组实施常规健康教育,观察组根据患者的文化水平、心理状况、遵医态度、实际需求实施针对性健康教育,护理3个月后观察患者餐后2h血糖（2hPG）、空腹血糖（FPG）、糖化血红蛋白（HbAlc）变化,并采用抑郁自评量表（SDS）、焦虑自评量表（SAS）、生活质量评定表（QOL）对患者的生活质量进行评定。结果：观察组护理后2hPG、FPG、HbAlc分别为（9．3±1．4）mmol／L、（6．9±2．1）mmol／L、（5．1±1.3）％,低于对照组的（11．3±1．8）mmol／L、（8．4±2．6）mmoUL、（6．9±1．5）％（P〈0．05）;观察组完全从医率为65．00％,高于对照组的40．00％（P〈0．01）;观察组护理后总体健康评分为（92．84＋7．19）分,高于对照组的（84．62±6．91）分（P〈0．05）。结论：针对性健康教育有利于提高老年2型糖尿病患者的从医性,提高血糖控制效率,改善患者的身心功能,提高生活质量。     

糖尿病患者重型颅脑外伤术后脑梗死发生的预防性治疗研究

目的:观察分析糖尿病患者重型颅脑外伤术后脑梗死发生情况.方法:重型颅脑外伤共112例,糖尿病患者31例,非糖尿病患者81例,糖尿病患者按术后血糖控制水平分为血糖控制良好组(＜16.0)和血糖控制不良组(＞16.0),分别为13例、18例;所有病人均采用常规去骨瓣开颅术清除血肿减压,术后早期行脱水治疗,糖尿病组患者给予胰岛素治疗,术后1天、3天、7天复查CT.结果:糖尿病组患者15例(48.4%)出现脑梗死,血糖控制良好组和血糖控制不良组分别为3例(23.1%)、12例(66.7%),非糖尿病组患者9例(13.2%)出现脑梗死.结论:通过术后早期控制血糖水平于合适状态(＜16.0),可有效降低糖尿病患者重型颅脑外伤术后脑梗死发生,明显改善患者预后.     

对糖尿病病人健康教育的体会

糖尿病是一种常见的内分泌、代谢性疾病,常可出现心、脑、肾等多种脏器的并发症,严重者可危及生命。我科收治的糖尿病患者大多数是老年病人,他们对糖尿病的认识不足,迫切需要了解如何防治糖尿病及并发症。因此,对糖尿病病人进行健康宣教,正确引导病人有效地控制血糖,防治并发症的发生至关重要。     

一项住院2型糖尿病患者血糖控制、自我管理行为及心理评估的调查

目的:目前针对中国糖尿病教育管理现状的高质量调查仍然不是很多,因此我们对一家糖尿病专科医院的住院2型糖尿患者进行了问卷调查,收集其自我管理行为、血糖控制及抑郁与心理状况,以探讨糖尿病教育管理工作的重点。方法:对2014年9月至12月间在太原糖尿病专科医院住院治疗的2型糖尿病患者,进行面对面的问卷调查。调查问卷包括一般资料问卷、Toobert行为量表简化版及WHO-5幸福感指数量表(WHO-5Well-Being Index)和中文版简化糖尿病问题量表(short-form Chinese-version PAID[SFPAID-C]scale)。结果:共调查患者330例,经双份录入和数据澄清之后剩余有效问卷315份(95.5%),男性150(47.6%)例,女性165(52.4%)例。患者年龄(60.5±9.2)岁,病程(10.0±7.1)年,BMI(25.3±3.5)kg/m~2、腰围(91.4±9.9)厘米,糖化血红蛋白(Hb A1c)(8.5±2.0)%,超重与肥胖的患者分别为71.8%和88.5%,男性和女性腹型肥胖的患病率分别为75.0%和72.7%,8.6%的患者存在亚临床或临床抑郁问题(SF-PAID-C评分≥15)。73.3%的患者接受过糖尿病教育,86.0%的患者定期监测血糖,过去一年检测过Hb A1c和血脂的患者分别为66.7%、62.9%,87.3%的患者在诊断糖尿病后改变了饮食习惯,61.9%的患者定时定量进餐,74.6%的患者规律运动,66.7%的患者每周运动时间≥150分钟。Toobert行为量表显示,患者在执行每天吃五份以上的水果和蔬菜(2.5±2.5)、把碳水化合物均匀分布到一整天(3.5±2.8)、血糖监测(3.4±2.5)以及检查脚和鞋子(3.7±2.5)方面的天数较少,执行天数为0天的患者比例分别为36.0%、25.8%、13.3%和16.5%。将患者分为接受过(231例,75.2%)和未接受过糖尿病教育(76例,24.8%)两组,接受过糖尿病教育者,年龄更大,病程更长,合并糖尿病视网膜病变、神经病变的百分比及胰岛素治疗的百分比更高,自我管理行为更好,Hb A1c水平更低,但SF-PAID-C评分和WHO-5评分没有显著性差异。将患者根据病程分为5年、6-10年、11-15年、≥16年四组,随着病程增加,接受过糖尿病教育的患者比例增加,糖尿病并发症的患病率及胰岛素治疗的百分比显著增加,WHO-5评分下降,SF-PAID-C评分上升,自我管理行为和Hb A1c差异不显著。回归分析显示,影响Hb A1c的因素包括治疗方案和自我管理行为,影响SF-PAID-C评分的因素包括运动状况及是否合并糖尿病神经病变,影响WHO-5评分的因素包括病程和自我管理行为。结论:饮食、血糖监测、足部护理、社会支持及用药依从性方面的糖尿病教育指导需要更为细致。糖尿病人在病程较长、合并有并发症及使用胰岛素治疗时,才有更大机会获得糖尿病教育,但将错过教育的最佳时机,糖尿病教育的开始时间需更早。在提升幸福指数、改善抑郁和焦虑方面,糖尿病教育没有直接作用,改善疾病控制、坚持自我管理行为、推迟并发症的发生发展,有直接作用。     

糖尿病患者整体护理中的健康教育

目的探讨对糖尿病患者实施健康教育的效果;方法将我院收治的48例糖尿病患者分为24例对照组和24例观察组,分别给予常规护理和整体护理中的健康教育,对比两组患者的对糖尿病相关知识掌握效果;结果观察组患者在接受健康教育后,按时服药、饮食控制、加强运动、血糖控制方面明显好对对照组;讨论给予糖尿病患者整体护理的健康教育能够有效提高患者掌握糖尿病相关知识,实现对血糖的控制,值得推广了应用。     

血糖检测仪在社区医疗中的应用分析

目的探讨社区医疗中血糖检测仪的应用。方法分析2010年1月～2010年10月在社区使用血糖仪的2型糖尿病患者30例,定期检测糖尿病患者的血糖控制情况,并进行健康教育。结果与同期未进行定期测量血糖的30例糖尿病患者比较,血糖控制情况差异有统计学意义。结论社区血糖检测仪应用方便,对实时检测糖尿病患者的血糖有较好的诊断价值,值得在社区广泛使用。     

80例老年糖尿病病人健康教育效果评价

老年糖尿病（DM）是指年龄在60岁以上的DM病人。DM是常见内分泌代谢疾病,随着人民生活水平提高,自身行为改变,老年糖尿病的发病率随年龄上升,患病人数在全球范围内逐年增加。因此,对老年DM病人开展健康教育,是整体医疗护理中重要组成部分。通过对2000-2004年在我院住院的80例老年2型DM病人进行有目的、有计划地进行健康教育,使病人及家属了解糖尿病知识,掌握自我保健技能,增强战胜疾病的信心。现将对80例2型DM病人实施健康教育的方法与效果报告如下。     

胰岛素治疗及血糖监测记录表的设计与应用

据世界卫生组织（WHO）的最新数据预测,到2010年全世界将有2．4亿糖尿病患者。糖尿病属终身性疾病,血糖水平是反映该病控制好坏的重要指标,良好的血糖控制是预防糖尿病并发症的主要措施。使用胰岛素治疗是对糖尿病患者最有效、副作用最小的治疗手段,如何保证病人的正确用药和血糖检测是病房管理工作中重要的一环。     

网络教育管理对糖尿病足危险因素患者干预的效果分析

目的探讨健康教育网对预防糖尿病足发生的措施。方法对85例糖尿病足高危因素患者为期1年的网络教育干预。结果糖化血红蛋白、空腹血糖、餐后2 h血糖与干预前比较有统计学意义(P<0.01)。结论应用健康教育网络形式对糖尿病足危险因素的患者进行系统、规范、全程、有计划的教育干预,可以降低糖化血红蛋白、血糖,提高踝肱指数,有效地避免糖尿病足的发生。     

猴头菌丝多糖降血糖作用研究

目的:研究猴头菌丝多糖的降血糖作用。方法:以液体发酵生产的猴头菌丝体为原料,经热水浸提、浓缩、酒精沉淀获得菌丝粗多糖;以常规降糖药物格列本脲为阳性治疗对照,通过四氧嘧啶诱发小鼠糖尿病的预防试验,比较猴头菌丝多糖各剂量与格列本脲的降血糖效果。结果:猴头菌丝多糖得率为7.14%,粗多糖再经Sevage法去除蛋白质,获得猴头菌丝精多糖(HMP),得率为10.92%;猴头多糖高、中、低三个剂量均能有效的对抗四氧嘧啶诱发的高血糖;其中,高剂量的降血糖作用与格列本脲相比,差异极显著。结论:猴头菌丝多糖对四氧嘧啶型高血糖模型小鼠有降血糖作用,作用效果优于格列本脲,对糖尿病小鼠的胰腺具有一定的保护作用。     

康复运动对冠脉支架植入术后患者相关因素的影响

目的：研究心脏康复运动对冠脉支架植入术后患者血脂、血糖、体重指数及生活质量的影响。方法：对实施冠脉支架植入术的 146例患者进行比较分析，根据随机原则分为试验组76 例及对照组70 例。对照组患者给予常规的健康教育及冠心病二级预防指 导，给予定期随访。试验组患者在此基础上给予规律的康复运动指导。经过6 个月随访，比较两组患者血脂、HbA1C、体重指数及 生活质量情况。结果：试验组患者通过为期6 个月的规律的心脏康复运动指导，其血脂、HbA1C等冠心病危险因素控制情况优于 对照组，差异有统计学意义(P<0.05)。同时，6个月后，试验组康复运动六月后sF 量表各项评分与对照组同期比较，差异均有统计 学意义(P<0.05)。结论：规范的心脏康复运动指导能够有效改善冠脉支架植入术后患者血脂、血糖情况，提高患者生活质量。     

Health checks and coronary risk: further evidence from a randomised controlled trial.

OBJECTIVE: To determine the effectiveness of a health check and assess any particular benefits resulting from feedback of plasma cholesterol concentration or coronary risk score, or both. DESIGN: Randomised controlled trial in two Glasgow work sites. SUBJECTS: 1,632 employees (89% male) aged 20 to 65 years. INTERVENTIONS: At the larger work site, (a) health education; (b) health education and feedback on cholesterol concentration; (c) health education and feedback on risk score; (d) health education with feedback on cholesterol concentration and risk score (full health check); (e) no health intervention (internal control). At the other work site there was no health intervention (external control). MAIN OUTCOME MEASURES: Changes in Dundee risk score, plasma cholesterol concentration, diastolic blood pressure, body mass index and self-reported behaviours (smoking, exercise, alcohol intake, and diet) in comparison with internal and external control groups. RESULTS: Comparisons between the full health check and the internal control groups showed a small difference (0.13 mmol/l) in the change in mean cholesterol concentration (95% confidence interval 0.02 to 0.22, P = 0.02) but no significant differences for changes in Dundee risk score (P = 0.21), diastolic blood pressure (P = 0.71), body mass index (P = 0.16), smoking (P = 1.00) or exercise (P = 0.41). Significant differences between the two groups were detected for changes in self-reported consumption of alcohol (41% in group with full health check v 17% in internal control group, P = 0.001) fruit and vegetables (24% v 12%, P < 0.001), and fat (30% v 9%, P < 0.001). Comparison of all groups showed no advantage from feedback of cholesterol concentration or risk score, or both. CONCLUSIONS: The health check only had a small effect on reversible coronary risk. It was effective in influencing self reported alcohol consumption and diet. Feedback on cholesterol concentration and on risk score did not provide additional motivation for a change in behaviour.     

针对性健康教育对老年2型糖尿病患者糖代谢及生活质量的影响*

摘要目的：观察针对性健康教育对老年2 型糖尿病患者的干预效果及对生活质量的影响,为糖尿病的临床护理提供参考。方法： 将120 例老年2 型糖尿病患者随机分为两组,对照组实施常规健康教育,观察组根据患者的文化水平、心理状况、遵医态度、实际 需求实施针对性健康教育,护理3 个月后观察患者餐后2h 血糖（2hPG）、空腹血糖（FPG）、糖化血红蛋白（HbA1c）变化,并采用抑 郁自评量表(SDS)、焦虑自评量表(SAS)、生活质量评定表(QOL)对患者的生活质量进行评定。结果：观察组护理后2hPG、FPG、 HbA1c 分别为（9.3± 1.4）mmol/L、(6.9± 2.1) mmol/L、（5.1± 1.3）%,低于对照组的（11.3± 1.8）mmol/L、(8.4± 2.6) mmol/L、（6.9± 1.5）%（P<0.05);观察组完全从医率为65.00 %,高于对照组的40.00 %（P<0.01);观察组护理后总体健康评分为（92.84± 7.19) 分, 高于对照组的（84.62± 6.91）分（P<0.05)。结论：针对性健康教育有利于提高老年2型糖尿病患者的从医性,提高血糖控制效率,改 善患者的身心功能,提高生活质量。     

High activity enables life on a high-sugar diet: blood glucose regulation in nectar-feeding bats

High blood glucose levels caused by excessive sugar consumption are detrimental to mammalian health and life expectancy. Despite consuming vast quantities of sugar-rich floral nectar, nectar-feeding bats are long-lived, provoking the question of how they regulate blood glucose. We investigated blood glucose levels in nectar-feeding bats (Glossophaga soricina) in experiments in which we varied the amount of dietary sugar or flight time. Blood glucose levels increased with the quantity of glucose ingested and exceeded 25 mmol l(-1) blood in resting bats, which is among the highest values ever recorded in mammals fed sugar quantities similar to their natural diet. During normal feeding, blood glucose values decreased with increasing flight time, but only fell to expected values when bats spent 75 per cent of their time airborne. Either nectar-feeding bats have evolved mechanisms to avoid negative health effects of hyperglycaemia, or high activity is key to balancing blood glucose levels during foraging. We suggest that the coevolutionary specialization of bats towards a nectar diet was supported by the high activity and elevated metabolic rates of these bats. High activity may have conferred benefits to the bats in terms of behavioural interactions and foraging success, and is simultaneously likely to have increased their efficiency as plant pollinators.     

Increased Prevalence of Diabetes in Argentina Is Due to Easier Health Care Access Rather than to an Actual Increase in Prevalence

Introduction

According to the Argentine National Risk Factor Survey (ANRFS), between 2005 and 2009, self-reported Diabetes increased in Argentina from 8.4% to 9.6%, accompanied by a raise in the prevalence of obesity and low physical activity. In the same period, it also increased blood sugar checks from 69.3% to 75.7%. Since surveillance data in Argentina rely on self-reports, the estimated prevalence of diabetes may be affected by an increase in the proportion of subjects with access to preventive services. We evaluated the independent effect of a recent blood sugar check, on the increase in self-reported diagnoses of diabetes between 2005 and 2009.

Materials and Methods

A secondary analysis of data from the 2005 and 2009 ANRFS was performed. Diabetes was defined as having been diagnosed Diabetes or high blood sugar by a health professional, obesity was calculated as BMI≥30 kg/m², based on self-reported height and weight and physical activity was measured using the International Physical Activity Questionnaire. We used logistic regression models to explore the relationship between prevalence of self-reported diabetes and recent blood sugar check as the main predictor.

Results

The prevalence of diabetes rose from 8.4% to 9.6%; obesity from 14.5% to 18% and low physical activity from 46.2% to 55%, between 2005 and 2009. Among those who recently checked their blood sugar no differences were found in the prevalence of diabetes: 13% in 2005 vs. 13.2% in 2009. Findings of the multivariable analysis showed that obesity and low physical activity were significantly associated with self reported diabetes in the adjusted model (OR = 1.80 for obesity, and OR = 1.12 for low physical activity but the strongest predictor was recent blood sugar check (OR = 4.75).

Discussion

An increased prevalence of self-reported diabetes between 2005 and 2009 might indicate an improvement in the access to preventive services rather than a positive increase in the prevalence of diabetes.     

Superior reproductive success on human blood without sugar is not limited to highly anthropophilic mosquito species

Anthropophilic mosquitoes such as Aedes aegypti L. (Diptera: Culicidae) have been shown to have superior reproductive success on human blood when sugar is not available. Life-table experiments were conducted with Aedes albopictus Skuse and Ae. aegypti to compare the effects of sugar availability on age-specific survivorship, lifetime and daily fecundity, and blood-feeding frequency when offered human blood daily. There were no significant interactions between the effects of sugar availability and mosquito species for these four variables, indicating similar effects of sugar availability for both species. Lifetime fecundity was not significantly affected by sugar availability, but sugar-deprived females had significantly reduced age-specific survivorship than did sugar-fed females. In absence of sugar, females took bloodmeals twice as often, resulting in a higher daily fecundity. The results indicate that superior reproductive success on human blood without sugar does not seem to be limited to highly anthropophilic mosquito species, such as Ae. aegypti. We conclude that evolution of a highly anthropophilic feeding strategy is not an inevitable result of the ability to thrive on human blood alone.     

Diel timing and frequency of sugar feeding in the mosquito Anopheles gambiae, depending on sex, gonotrophic state and resource availability

Little is known about the sugar-feeding behaviour of equatorial Africa's principal vector of malaria, Anopheles gambiae Giles (Diptera: Culicidae). It is suspected to feed on plant sugar infrequently, but possibly the timing depends on environmental circumstances, and males may differ markedly from females. These points of uncertainty were clarified in the laboratory, by monitoring both diel and longterm sugar-feeding activity in both sexes. Males fed on sugar in a nocturnal diel rhythm closely approximating non-specific flight activity. Female diel sugar-feeding patterns resembled published rhythms and cycles of host seeking. Males sugar fed nightly at an average frequency of about twice per night, sustained over 17 days. This was substantially higher than the sugar-feeding frequency of females that were allowed both blood and oviposition sites every night: they averaged about one sugar feed in every 4 nights. These females fed on sugar between gonotrophic cycles, after eggs were mature but before the next bloodmeal. They did not sugar feed during the 2 days after blood feeding, while blood was being digested and the eggs developed. A slight delay in the availability of either the oviposition site or blood led to an increase in female sugar-feeding frequency: they averaged more than once per night until the delayed resource was made available. These observations support the conclusion that sugar feeding is a normal part of the biology of both sexes of An. gambiae.