IMB模型在艾滋病干预行为研究中应用

目前,女性商业性服务者(female commercial sex worker,FCSW)已经成为高危人群艾滋病行为干预的重点和难点。信息、动机、行为技巧模型^〔1〕(information-motivation-behavior-al skills model,IMB)优势在于用几个关键组分概括出行为转变过程中主要影响因素,阐明各组分与行为的关联及关联强弱和方向性,并从关联中理解和预测艾滋病预防行为,探讨行为干预最佳方案^〔2〕。本研究利用IMB为济南市FCSW预防     

2型糖尿病患者健康教育和行为干预的临床效果观察

目的探讨健康教育和行为干预在2型糖尿病患者中的应用效果。方法选取上海市浦东新区合庆社区卫生服务中心收治的130例2型糖尿病患者随机分为对照组和干预组,每组各65例。对照组实施常规治疗,干预组在对照组的基础上施行健康教育和行为干预,比较两组干预效果。结果干预组2型糖尿病患者糖尿病知识知晓率显著高于对照组(P<0.05),干预组自我管理能力显著高于对照组(P<0.05);与干预前比较,干预后两组2型糖尿病患者空腹血糖、餐后2 h血糖和糖化血红蛋白水平均显著下降(P<0.05),且干预组下降更为明显(P<0.05);与干预前比较,干预后两组2型糖尿病患者胆固醇和甘油三酯水平显著下降(P<0.05),且干预组下降更为明显(P<0.05)。结论通过对2型糖尿病患者施行健康教育和行为干预,使患者提高自我管理能力,可有效降低血糖水平,调节血脂水平。     

护理干预在2型糖尿病健康教育中的应用

目的探讨糖尿病患者对糖尿病知识的认识和自我管理水平。方法应用护理干预对124例2型糖尿病患者进行糖尿病健康教育,在教育前后进行糖尿病知识、自我管理能力测试、并对教育结果进行评价。结果通过护理干预,124例患者不同程度地掌握了糖尿病的相关知识和自我监测能力。结论应用护理干预对2型糖尿病患者进行健康教育是患者学习糖尿病知识、提高自我管理能力、有效控制血糖的有效途径。     

IMB模型在苏北农村初中生结核病预防行为干预中的应用

目的开展IMB模型在结核病中的应用研究,为结核病预防行为干预提供科学依据。方法采用自编调查问卷,对苏北农村地区3000名初中生进行调查,采用结构方程模型对IMB理论模型进行统计分析。结果预防动机对预防行为的影响最大,其全体效果的标准化回归系数为0.54;行为技巧0.28,预防信息0.21,均具有统计学意义(P<0.05)。结论 IMB模型在苏北农村初中生结核病预防行为中的应用效果较好,但尚需在今后的研究中逐步完善。     

家庭治疗干预模式在2型糖尿病患者中的应用效果研究

目的探讨家庭治疗模式对2型糖尿病患者饮食行为干预的效果。方法选取广州某三甲医院2012年1-3月在门诊治疗的2型糖尿病患者100例。随机分为实验组和对照组,各50例。实验组采用家庭治疗干预模式,对照组采取传统治疗干预方法。6个月后,实验组与对照组的观察指标进行比较,且与自身干预前的各项指标进行比较。结果干预结束后,两组实验对象的观察指标进行两独立样本t检验,且对实验组干预前后各项观察指标进行配对t检验,其中体重指数、腰臀比、空腹血糖、餐后血糖、糖化血红蛋白、甘油三酯、总胆固醇、高密度脂蛋白差异均有统计学意义(P0.05)。结论采用家庭治疗模式对糖尿病患者干预能够更好的控制患者血糖及各方面生化指标。     

社区干预对2型糖尿病患者自管行为效果评价

目的了解建立社区卫生服务团队实施社区干预措施后对2型糖尿病防治工作的影响,为今后的糖尿病的康复治疗工作提高参考。方法收集2013年1~6月城东社区卫生服务中心建档的2型糖尿病人220名,每名病人和1名全科医生1名护士1名公共卫生医生组成的家庭责任医生进行签约服务,给予病人在血糖控制与监测、饮食行为生活方式干预与调整、规律运动、遵医服药与足部护理等自我管理行为方面进行健康教育和指导,并进行干预后6个月自管行为评价。结果患者自我管理行为明显改进(P﹤0.01),血糖控制满意度明显提高(P﹤0.01)。结论对2型糖尿病患者自我管理行为进行干预,提高了患者自我保健意识,建立良好的自我管理行为习惯,可有效控制血糖,降低并发症的发生,提高患者的生活质量。     

社区健康干预在2型糖尿病应用的探讨

目的研究社区健康干预在2型糖尿病中的应用。方法对社区所在的居民进行糖尿病筛查试验,将筛检阳性并确诊的糖尿病病人分为干预社区和对照组社区。对干预社区进行为期一年的社区健康干预,对照社区不进行相应社区健康干预。结果干预社区的餐后2h血糖以及空腹血糖较对照组较低,血糖控制稳定并且干预社区的对医生听从率与对照社区相比较高。结论在社区健康干预对2型糖尿病病人餐后血糖和空腹血糖有较好的控制效果,其应用效果比较理想     

综合性干预在2型糖尿病患者中的应用体会探讨

目的:探讨综合性护理干预在2型糖尿病患者中的应用效果.方法:回顾性分析蓬溪县人民医院2014年3月至2015年11月期间收治的82例2型糖尿病患者,采用数字单双号的模式分为对照组(常规护理)与观察组(综合性护理干预),每组各41例.比较两组患者FPG、2hPG、HbA1C、胰岛素日用量以及低血糖发生率.结果:观察组FPG、2hPG、HbA1C、胰岛素日用量以及低血糖发生率均优于对照组(P<0.05)差异具有统计学意义.结果:将综合性护理干预应用于2型糖尿病患者的治疗过程中能够有效改善患者临床症状,减少胰岛素剂量,降低低血糖发生率.     

IMB模型的理论框架与运用

<正>IMB模型(信息-动机-行为技巧模型,Information-Motivation-Behavioral Skills Model,简称IMB)由JD费舍尔和WA费舍尔在1992年最早提出,与以往的健康相关行为改变模式相比,将影响行为改变的各种因素分为信息、动机、行为技巧3个组分,并验证自身具有的预防疾病的信息和参与预防的动机可通过行为技巧引发预防行为的启动和维     

2型糖尿病患者社区干预效果分析

目的通过对2型糖尿病病因、合理用药、常见并发症的认识等宣教效果的分析探讨社区自我控制糖尿病的效果。方法对社区内确诊的126例糖尿病患者科学的干预,量化干预结果。定期监测空腹血糖、餐后2小时血糖、糖化血红蛋白、甘油三脂、总胆固醇。所有结果以PSSA软件进行统计学处理。结果接受6个月社区干预的2型糖尿病患者糖尿病基本知识掌握正确度明显提高(P<0.05),空腹血糖、餐后2小时血糖、糖化血红蛋白明显降低(P<0.05);甘油三脂、总胆固醇降低不明显(P>0.05),统计学显示无意义。结论①2型糖尿病患者通过科学的社区干预,糖尿病基本知识正确掌握度明显提高,空腹血糖、餐后2小时血糖、糖化血红蛋白明显降低。②由于多重原因,甘油三脂、总胆固醇降低不明显,调脂工作仍需加强。     

Lipid Management in Patients with Type 2 Diabetes

Background

Diabetes is correlated with a high risk for cardiovascular disease (CVD). The management of diabetic dyslipidemia, a well-recognized and modifiable risk factor, is a key element in the multifactorial approach to preventing CVD in patients with type 2 diabetes. Diabetic dyslipidemia is characterized by elevated triglyceride levels, decreased high-density lipoprotein cholesterol levels, and elevated low-density lipoprotein cholesterol (LDL-C) levels.

Objectives

To describe the effective approach to the management of dyslipidemia in patients with diabetes to allow providers and payers to become familiar with the treatment goals for all the components of lipoproteins, to correctly initiate appropriate lipid-lowering medications based on treatment goals and lipid-lowering capability, and to apply the data presented in lipid clinical trials to the treatment of patients with diabetes.

Summary

Diabetes is associated with a 2- to 4-fold increase in risk for CVD. The risk factors for coronary artery disease (CAD) include hypertension, dyslipidemia, obesity, and smoking. Therefore, prioritizing and managing diabetic patients with CVD risk factors is vital.

Conclusion

LDL-C appears to have the greatest role in premature and early atherosclerosis and the development of CAD and must be treated as aggressively as hyperglycemia to reduce CAD risk. Becoming familiar with lipid treatment goals and the many therapies available today can help providers and payers implement the appropriate approach to managing diabetic dyslipidemia risk factors and reduce the burden of this disease.The prevalence of diabetes has increased dramatically in recent decades. This trend highlights the importance of prevention and appropriate therapy to reduce cardiovascular events in patients with diabetes. Reaching adequate blood glucose control is important in decreasing microvascular complications associated with diabetes; however, good lipid management is vital for reducing the incidence of cardiovascular events in patients with diabetes.1–4Cardiovascular disease (CVD) has been recognized as the most frequent cause of morbidity and mortality among those with diabetes. Diabetes is associated with a 2- to 4-fold increased risk for CVD and is identified as a coronary artery disease (CAD) risk equivalent.1–4The risk factors for CAD include hypertension, dyslipidemia, obesity, and smoking.1–3 Therefore, prioritizing and managing diabetic patients with CVD risk factors is extremely important. In dyslipidemia, serum low-density lipoprotein cholesterol (LDL-C) appears to have the greatest role in premature and early atherosclerosis and CAD development and must therefore be treated as aggressively as hyperglycemia to reduce CAD risk. In fact, improved control of LDL-C can reduce cardiovascular complications by 20% to 50%.5     

Insulin Therapy in Patients with Type 2 Diabetes Mellitus

Objective: To support policy-making for patients with diabetes mellitus we compared the costs and effectiveness of initiation of insulin therapy in patients with type 2 diabetes mellitus in 2 settings in The Netherlands. Design: Retrospective cohort study. Setting: A shared-care setting and an outpatient care setting of a university hospital. Both settings are located in Amsterdam, The Netherlands. Patients: All patients with type 2 diabetes mellitus above 40 years of age who were transferred to insulin therapy in 1993 in both settings. Intervention: Initiation and monitoring of insulin therapy in patients with type 2 diabetes mellitus. Study perspective: Healthcare sector. Main outcome measures: Baseline and 12 months glycosylated hemoglobin (HbA_1c) values and fasting blood glucose levels, and direct healthcare costs of insulin therapy. Costs were expressed in 1996 Dutch guilders (NLG) [NLG1 = 0.5 US dollars ($US)]. Results: In the shared-care setting (n = 57) the per patient healthcare costs during 1 year of follow-up averaged NLG2467. In the secondary care setting (n = 45) healthcare costs averaged NLG2740. A sensitivity analysis demonstrated that healthcare costs per patient were in the same range in both settings, ranging from NLG2000 to about NLG3400 ($US1000 to $US1700). Mean HbA_1c values fell from 9.1 to 7.9% (shared-care setting; p < 0.05) and from 10.2 to 8.2% (secondary care setting; p < 0.05). The percentage of patients with poor glycemic control (HbA_1c >8.5%) decreased from 56 to 30% (shared-care setting) and from 76 to 36% (secondary care setting). The percentage of patients with good glycemic control (HbA_1c <7%) increased from 4 to 23% (shared-care setting) and from 2 to 18% (secondary care setting). Conclusions: The study shows that in the first year of insulin therapy in patients with type 2 diabetes mellitus, acceptable glycemic control (HbA_1c >8.5%) can be attained in the majority of patients in both a shared-care and a secondary care setting, at comparable low average costs per patient.     

支持向量机在建立2型糖尿病预测模型中的应用

目的应用支持向量机(SVM)构建2型糖尿病预测模型的方法。方法简述SVM的原理、特点,并以北京市某社区健康监测档案数据为例,应用matlab软件结合libsvm工具箱实现数据分析。结果通过对2型糖尿病队列数据的分析发现,归一化可以提高预测模型的准确性,不同核函数对预测模型的影响较大,多项式核函数拟合模型最差,5次交互验证准确率和回代训练样本准确率为92.7%,预测检验样本准确率为93.1%;sigmoid核函数拟合的预测模型5次交互验证准确率为93.7%,回代训练样本准确率达到94.0%,预测检验样本准确率为97.3%;径向基核函数拟合的预测模型最佳,5次交互验证准确率为94.5%,回代训练样本准确率为95.1%,预测检验样本准确率为98.7%。结论 SVM可以用于2型糖尿病的预测分析,得到准确率较高的预测模型。     

信息-动机-行为技巧模型在霉菌性阴道炎患者随访中的运用

目的探讨信息-动机-行为技巧(IMB)模型在霉菌性阴道炎患者管理中的运用效果。方法 92例确诊为霉菌性阴道炎的患者随机均为两组,常规组给予常规的健康宣教,观察组采用以IMB理念为基础的健康管理模式,比较患者在观察期内合理用药依从性、临床治疗结局及干预前后的生活质量情况。结果观察组遵医嘱用药率明显高于常规组(P<0.01),临床治疗结局也明显优于常规组(P<0.01),干预后患者的生活质量明显优于常规组(P<0.05)。结论通过综合运用IMB理念,合理进行信息、动机和行为干预,可明显提高霉菌性阴道炎患者合理用药依从性,提升临床治疗效果,从而改善生活质量。     

Nutrition Interventions in Pediatric Patients with Type 1 Diabetes: An Evidence Analysis Center Scoping Review

The objective of this scoping review was to identify and characterize studies examining the effect of nutrition management interventions and effectiveness of medical nutrition therapy to improve nutrition-related outcomes in children and adolescents with type 1 diabetes. An in-depth electronic search was conducted by a medical librarian in six databases: Medline, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, The Cumulative Index to Nursing and Allied Health Literature, and Web of Science Core Collection. The literature search resulted in 5,122 records, and five records were identified through hand search. Of these 5,127 records, 22 articles and eight systematic reviews met our inclusion criteria. An equal number of the studies were experimental (ie, randomized or nonrandomized controlled trials, or noncontrolled trials) (n = 11) and observational (cohort, case-control, and cross-sectional) (n = 11) with the remaining studies being systematic reviews/meta-analyses (n = 8). Most of these studies were conducted in United States or Europe. Based on this scoping review, the majority of studies focus on either carbohydrate counting or evaluation of dietary intake patterns with little emphasis on tailored patient education/counseling services specifically designed to meet a young child’s or his/her family's individual needs. Indeed, only four studies in this scoping review used dietary counseling and/or medical nutrition therapy. As such, there remains a significant gap in the literature as it relates to the efficacy and long-term management implications of tailored nutrition interventions in young children with type 1 diabetes.     

我国2型糖尿病人生活方式干预效果综述

目的：了解目前我国糖尿病的流行情况及生活方式干预研究现状,分析干预研究的效果及存在的问题,为更好地开展糖尿病的控制工作提供科学依据.方法在中国学术文献总库(CNKI)、中文科技期刊数据库(VIP) PubMed、Web of Science 等主要中英文数据库中,检索对我国2型糖尿病患者进行1年或1年以上生活方式干预的随机对照试验进行文献综述.结果12个随机对照试验共包括2806例2型糖尿病患者纳入综述,干预组1475例,对照组1331例.干预组空腹血糖(FDG)[WMD ＝-1．54,95％CI (-1．96,-1．12)]、饮食控制[OR ＝5．52,95％CI (2．42,13．05)]、合理运动[OR ＝2．23,95％CI (1．56,3．19)]、自我监测[OR ＝3．87,95％CI (2．23,6．69)]4项评价指标均优于对照组,差异有统计学意义(P ＜0．01).但也存在干预主要集中于城市、对患者心理健康重视不够和健康教育方案不完善等问题.结论对2型糖尿病患者进行生活方式干预可有效控制糖尿病的病情发展,提高患者的生活质量,但需要注重干预方案的完善和实施方式的改进.     

Cost of Hypoglycemia in Patients with Type 2 Diabetes in Sweden

OBJECTIVES: Hypoglycemia is a common side effect of antidiabetic therapy. In addition to reducing well-being, hypoglycemic events may lead to substantial costs of medical care and lost productivity. The cost of hypoglycemia is, however, not well identified, particularly in patients with Type 2 diabetes. The purpose of this study was to assess the cost of hypoglycemia in Type 2 diabetes in Sweden. METHODS: A cost-of-illness approach, based on an incidence methodology, was used to estimate the cost of hypoglycemia in patients with Type 2 diabetes. A hypoglycemic event was defined as an episode with symptoms of low blood glucose levels during which the patient required assistance from another person. The events were divided into mild, moderate, and severe, and the incidence and costs of the different events were estimated based on data in the literature. RESULTS: Assuming that there are 300,000 patients with Type 2 diabetes in Sweden, it was estimated that 26,942 hypoglycemic events would occur annually in these patients, corresponding to a rate of 0.09 events per patient-year. The total cost of hypoglycemia was, in base case, estimated at about Euro 4,250,000 (Euro 14 per patient with Type 2 diabetes) per year. Moderate hypoglycemia contributed the largest proportion of these costs. CONCLUSIONS: The results indicate that hypoglycemic events lead to substantial costs, but data are scarce and more studies are needed to better understand the cost and consequences of hypoglycemia.     

2型糖尿病患者血脂水平分析

糖尿病是一种以慢性血葡萄糖（简称血糖）水平增高为特征的代谢疾病群,高血糖是由于胰岛素分泌缺陷和（或）胰岛素作用缺陷而引起。除碳水化合物外,尚有蛋白质、脂肪代谢异常。而我国2型糖尿病占据本病群体大多数（95％）。2型糖尿病（2-DM）患者常伴有血脂代谢紊乱,而这会使患者发生心血管病的危险性增大,为此笔者检测2-DM患者的血脂水平来探讨患者的血脂水平的变化及意义。     

上海市某社区2型糖尿病患者饮食干预效果评价

[目的]探索在社区开展糖尿病综合防治工作中对患者进行饮食干预的效果。[方法]2005年1-5月,在上海市嘉定区慢性病综合防治试点社区对83例2型糖尿病患者进行饮食干预,观察有关指标的变化。[结果]饮食干预前与干预后比较,患者的总能量摄入减少,蛋白质摄入量增加,脂肪与碳水化合物摄入减少（P〈0.01或〈0.05）;蛋白质供能比例增加,脂肪与碳水化合物供能比例降低;早餐和午餐供能比例增加,晚餐供能比例减少;空腹血糖值明显降低（P〈0.01）。[结论]对糖尿病病人进行膳食营养干预效果明显。