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  • 1
    ISSN: 1573-2649
    Keywords: Ambulatory care ; diabetes ; psychological ; dysfunctioning ; reliability ; validity
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The aim of the studies was to evaluate the psychometric properties and construct validity of the Diabetes Health Profile (DHP-1). Content for the DHP-1 was derived following in-depth interviews with 25 insulin dependent and insulin requiring patients, a review of the literature and discussions with health care professionals. Initial analysis of the factor structure of the DHP-1 was carried out on the responses of 239 insulin dependent and insulin requiring patients, with a mean age of 40.85 years (SD=13.0), resulting in a 43 item three factor solution. The 43 item version of the DHP-1 was completed by 2,239 insulin dependent/requiring patients (mean age = 39.8, SD=10) years. Fifty-one per cent were men. A forced three factor Principal Factoring Analysis with varimax rotation was carried out. Eleven items were excluded with item factor cross loadings 〉0.30 or item factor loadings 〈0.30. PAF analysis of the 32 items resulted in a three factor solution accounting for 33% of the total explained variance. The three factors were interpreted as Psychological Distress, Barriers to Activity and Disnhibited Eating. Factor congruence between subsamples were: Psychological distress (0.93), Barriers to Activity (0.93) and Disinhibited Eating (0.99). Coefficients of congruence between men and women were 0.94, 0.92 and 0.99 for Psychological Distress, Barriers to Activity and Disinhibited Eating respectively. Internal consistency of the three factors (Cronbach's α) were: Psychological Distress (0.86), Barriers to Activity (0.82), and Disinhibited Eating (0.77). Construct-convergent validity was investigated on a sample of 233 insulin dependent and insulin requiring patients (mean age = 51.46 years). Psychological Distress and Barriers to Activity subscales correlated with the Hospital Depression and Anxiety Scale = 0.50 to 0.62, p〈0.01 and subscales of the SF-36 (range: r=−0.17 to -0.62, p〈0.01). These findings lend support to the construct validity and reliability of the DHP-1 and that it is suitable for further development.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1573-2649
    Keywords: DHP ; diabetes ; health-related quality of life ; NIDDM ; RAND-36 ; reliabllity ; SF-36 ; validity
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Recently, a new diabetes-specific questionnaire, the Diabetes Health Profile (DHP), has been developed to identify psychosocial dysfunctioning of insulin-requiring (NIDDM) and insulin-dependent diabetes mellitus (IDDM) patients. The DHP comprises three dimensions: psychological distress (PSY: 14 items), barriers to activity (BAR: 12 items) and disinhibited eating (EAT: five items). This study investigates the psychometric properties of the DHP in Dutch noninsulin-dependent diabetes mellitus (NIDDM) patients referred for insulin therapy. In addition, the relation-ship between patient characteristics and the DHP outcome was examined. The factor structure found was similar but not identical to former studies, but construct validity was supported by high correlations of our factor structure and the original factor outcome and Cronbach's α. The three factors explained 32% of the variance, supporting earlier findings. It was shown that Cronbach's α was satisfactory (0.72, 0.72 and 0.79). Convergent validity showed strong and significant correlations between the PSY/BAR dimensions and predicted corresponding scales of the RAND-36. However, the PSY/BAR dimensions also showed, although less strong, significant correlations with the non-corresponding RAND-36 scales. The EAT dimension showed only correlations with two of the RAND-36 dimensions, thus measuring a different trait. Regression analysis showed that older patients had less problems with items of the EAT dimension and that no difference was found between men and women, supporting earlier findings. The hyperglycaemic complaint ‘fatigue’ gave a significantly lower score (more problems) on the PSY and BAR dimensions. Younger age, the presence of hypertension and retinopathy resulted in a significantly lower score on the EAT dimension. DHP outcome was not significantly influenced by duration of diabetes, HbA1c (indicator of glycemic control), serum total cholesterol, body mass index, chronic diabetes complications and comorbidity. Overall, the psychometric properties were good considering the small and diverse sample, suggesting that the DHP is promising for use in NIDDM patients, although more study is necessary in a larger sample.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1573-2649
    Keywords: Self-completion patient outcome instrument ; diabetes ; responsiveness to change.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Self-completion instruments assessing subjective health are increasingly being used to measure patient outcome. However, there is very little evidence as yet of existing instruments' responsiveness to change. This paper describes a study to evaluate the responsiveness to change of a self-completion instrument for the measurement of clinical outcome in patients with diabetes. A prospective follow-up study of 48 patients with non-insulin-dependent diabetes commencing insulin therapy was carried out, with assessments at baseline (i.e. pre-intervention), 6 weeks and 3 months post-intervention. The outcome measures used were the changes in scores on the self-completion instrument for symptom level, physical function, energy, depression, psychological distress and barriers to activity, HbA1c, non-fasting serum cholesterol and the body mass index (BMI). There were significant improvements in HbA1c and non-fasting serum cholesterol and worsening of the BMI, as expected. The self-completion instrument detected significant improvements in patient-reported symptoms within 6 weeks of the intervention (p〈0.01) and in energy levels (p〈0.05). There is evidence from this study of the self-completion instrument's ability to respond to change and it has potential for use in evaluative studies.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Journal of comparative physiology 168 (1998), S. 526-532 
    ISSN: 1432-136X
    Keywords: Key wordsMyofilaments ; Skinned muscle ; Catfish ; pH ; Temperature
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology , Medicine
    Notes: Abstract Fish are chronically exposed to a wide range of temperatures and acidic environments. Fish hearts have to therefore adapt to these changes in order to maintain contractility. Myofibrillar responsiveness to Ca2+ is exquisitely sensitive to both temperature and pH in mammalian myocardium. To evaluate myofilament calcium-activation, we chemically skinned ventricular myocardium from catfish (Pterygoplichthys). A decrease in pH from 7.5 to 6.8, irrespective of temperature change, shifted the calcium-force curve towards higher calcium concentrations without affecting maximal Ca2+-activated force. The contractile elements are therefore sensitive to changes in pH. In intact muscle preparations the active twitch force was decreased with increasing temperature (10–22 °C). However, the sensitivity of the myofilaments to Ca2+ was independent of temperature. These data suggest a possible role of the sarcoplasmic reticulum (SR) in mediating the effects of temperature. The response of intact muscle preparations to changes in temperature is therefore not likely due to temperature-dependent changes in myofilament calcium responsiveness.
    Type of Medium: Electronic Resource
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