LARS WIBELL, MD, PHD
10OBJECTIVE -To elucidate whether family characteristics and stressful life events were associated with onset of autoimmune type 1 diabetes in young adults.RESEARCH DESIGN AND METHODS -This investigation was based on a nationwide study (Diabetes Incidence Study in Sweden) of newly diagnosed patients aged 15-34 years. Patients clinically classified as type 1 diabetic with antibodies to islet cells and/or to GAD65 were compared with age-and sex-matched control subjects via questionnaire. The questionnaire covered diabetes heredity, social environment, educational level, and life events experienced during the 12 months before diagnosis.RESULTS -The rate of response was 82% for the diabetic patients and 65% for the control subjects. Questionnaires from 349 diabetic patients and 979 control subjects were considered. Diabetes in relatives was more frequent in the patients (odds ratio [OR]2.6) who were born in Sweden and whose mothers were of Swedish origin. No major stress factors were detected in the diabetic patients; however, in comparison with the control subjects, the diabetic patients had experienced fewer conflicts with their parents and had less often broken contacts with friends.CONCLUSIONS -Young adults with recent-onset type 1 diabetes were more exposed to heredity for diabetes, but no major prediabetic stress factors were detected. Our study does not directly support the concept that psychosocial stressful life events are involved in the development of autoimmune type 1 diabetes in young adults.
Effects of a diabetes control program were evaluated in 17 primary health centers after 18 months' participation (17 nonparticipating centers served as controls). Studied were the effects of the program on the organization of diabetes care, on the process of care in terms of services delivered to patients, and on the outcomes of care as measured by improved self-care, dietary knowledge, and HbA1c values. While findings showed that patients from the intervention centers received a higher quality of service and monitored their blood glucose levels more often than did patients from the control centers, they did not demonstrate significantly better metabolic control. The reasons for this, and ways to improve the program are discussed.
Objective To identify which factors are considered important for eating habits and weight change in obese participants in a one-year weight reduction programme at a primary health care centre. Design A qualitative study of factors affecting participants' eating habits and weight change before, during and after the programme. Settiiig The primary health care centre where the programme was taking place. Method Fifteen participants were interviewed three times during the programme and once one year after the intervention programme had ended.Results Fourteen participants described how emotion and factors other than hunger, such as stress, need for affinity, depression, worry or tiredness affected their eating habits. The only participant to describe 'hunger' as the only reason for eating reached the greatest weight reduction after two years. Emotional eating continued to affect the eating habits and weight gain of all other participants. Conclusion If emotion and factors other than hunger that are associated with eating habits that lead to obesity are not addressed, the treatment needs are never met. Thus a motivational phase including an emotional evaluation of the problem behaviour and preparation for a change in lifestyle preceding the actual change of behaviour would be valuable. This at Purdue University on July 13, 2015 hej.sagepub.com Downloaded from 245 would provide an opportunity to address emotional factors and reasons other than hunger associated with excessive eating, as well as emotional factors associated with behavioural change. Furthermore, a period of supported maintenance of achieved weight loss should be included in weight reduction programmes.
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