INTRODUCTIONThe Diabetes Health Profile-18 (DHP-18) measures diabetes-related psychological well-being in patients with type 2 diabetes mellitus (T2DM). It includes 3 subscales: psychological distress (PD), barriers to activity and disinhibited eating. The psychometric properties of the DHP have not been evaluated in Asia. The aim of this study was to determine the psychometric properties of the DHP in multiethnic Singapore.

MATERIALS AND METHODSPatients between the ages of 18 to 65 diagnosed with diabetes (either type 1 or type 2) for at least 1 year were recruited from a diabetes outpatient clinic in a tertiary hospital. They completed a set of self-administered questionnaires including sociodemographic information and the DHP. Validity of the DHP was evaluated using confirmatory factor analysis (CFA) and exploratory factor analysis (EFA). Reliability was assessed with internal consistency and sensitivity was determined by effect size, associated with detecting a statistically significant and clinically important difference between various patient subgroups.

RESULTSA total of 204 patients with mean age 45.4 (11.9) years, comprising 64% males and 50% Chinese, 27% Indian and 12% Malay were studied. In CFA, model fit was poor. Forced 3-factor EFA supported the original 3-factor structure of the DHP. Convergent and discriminant validity was demonstrated (100% scaling success). DHP was sensitive across majority of social demographic, clinical and social-functioning determinants (i.e., effect size >0.3). Cronbach's alpha exceeded 0.70 for all subscales. Ceiling effects were negligible but large floor effects were seen for the PD subscale (23%).

CONCLUSIONThe DHP is valid, reliable and sensitive for measuring well-being in Asian patients with T2DM.

Adolescent ; Adult ; Aged ; Diabetes Mellitus, Type 1 ; psychology ; Diabetes Mellitus, Type 2 ; psychology ; Emotional Adjustment ; Ethnic Groups ; psychology ; statistics & numerical data ; Factor Analysis, Statistical ; Feeding Behavior ; psychology ; Female ; Humans ; Male ; Middle Aged ; Psychological Tests ; Psychometrics ; Reproducibility of Results ; Sensitivity and Specificity ; Singapore ; Stress, Psychological ; diagnosis ; etiology ; psychology ; Surveys and Questionnaires ; Young Adult

OBJECTIVES: Previous observations propose that risk-taking behaviors such as cigarette smoking are prevailing among young people with chronic conditions including diabetes. The purpose of this study was to examine whether cigarette smoking is more prevalent among diabetics than non-diabetics and whether it differs by age at the time of diagnosis with diabetes from young adulthood (YAH) to adulthood (AH). METHODS: We used US panel data from the National Longitudinal Study of Adolescent Health (Add Health Study) during the years 2001 to 2002 (Wave III, YAH) and 2007 to 2008 (Wave IV, AH). Multivariate logistic regression models were applied to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of cigarette use behaviors according to age at the time of diagnosis with diabetes, after adjusting for demographic and selected behavioral factors. RESULTS: Of 12 175 study participants, 2.6% reported having been diagnosed with diabetes up to AH. Early-onset diabetics (age at diagnosis <13 years) were more likely than non-diabetics to report frequent cigarette smoking (smoking on > or =20 days during the previous 30 days) in YAH (OR, 3.34; 95% CI, 1.27 to 8.79). On the other hand, late-onset diabetics (age at diagnosis > or =13 years) were more likely than non-diabetics to report heavy cigarette smoking (smoking > or =10 cigarettes per day during the previous 30 days) in AH (OR, 1.54; 95% CI, 1.03 to 2.30). CONCLUSIONS: The current study indicated that diabetics are more likely than non-diabetics to smoke cigarettes frequently and heavily in YAH and AH. Effective smoking prevention and cessation programs uniquely focused on diabetics need to be designed and implemented.
Adolescent ; Adult ; Age Factors ; Demography ; Diabetes Mellitus/diagnosis/*psychology ; Female ; Humans ; Logistic Models ; Longitudinal Studies ; Male ; National Longitudinal Study of Adolescent Health ; Odds Ratio ; Sex Factors ; Smoking/*psychology/trends ; Young Adult

PURPOSE: Transplant patients under immunosuppression are susceptible to mycobacterium tuberculosis infection. We analyzed renal transplant recipients, to evaluate the risk factors, clinical characteristics, and long-term outcomes of post- transplant tuberculosis (TB). METHODS: This study is based on the records of renal allograft recipients from October 1991 to June 2006 in two transplant centers in Korea. The demographic data, clinical manifestations, and long-term outcomes of this cohort of patients were retrospectively analyzed. RESULTS: Total 617 patients were enrolled in this study. Eighteen cases of TB (2.92%) occurred with a mean interval from transplant to diagnosis of TB of 33.1 (range: 1~121) months. Most of post-transplant TB were pulmonary TB (including pleural) (13/18), and extrapulmonary TB occurred in 5/18. There was no difference in the prevalence of diabetes mellitus, hepatitis B or C, and immunosuppressive agents between the patients who had developed post- transplant TB and who had not. However, there was higher incidence of acute rejection in post-transplant TB group (0.9+/-1.1 vs. 0.4+/-0.6, P=0.043), and post-transplant TB group had a tendency toward more past history of TB infection (P=0.096). Thirteen patients were successfully treated, 2 patients have been under treatment and 3 patients died. The patient survival was significantly reduced by post- transplant TB in multivariate analysis (relative risk=3.355, P=0.038). CONCLUSION: Post-transplant TB is a serious problem, which is associated with poor outcomes in renal transplant patients. Therefore, high index of suspicion is warranted to ensure early diagnosis and prompt initiation of treatment.
Cohort Studies ; Diabetes Mellitus ; Dietary Sucrose ; Early Diagnosis ; Hepatitis B ; Humans ; Immunosuppression ; Immunosuppressive Agents ; Incidence ; Kidney Transplantation ; Korea ; Multivariate Analysis ; Mycobacterium ; Mycobacterium tuberculosis ; Prevalence ; Prognosis ; Rejection (Psychology) ; Retrospective Studies ; Risk Factors ; Transplantation, Homologous ; Transplants ; Tuberculosis

PURPOSE: The purpose of this study was to explore the levels of depression experienced by clients (N=152) with Type 2 Diabetes Mellitus(DM), and to compare the levels of self care activity, metabolic control and cardiovascular risk factors between depressed and non-depressed clients. METHOD: Participants aged 50 and above were conveniently recruited in B city. The levels of depression, self-care activity, metabolic control of glucose and lipids, and cardiovascular risk factors of the participants were measured by using questionnaires and blood tests from November, 2003 to June, 2004. Data was analyzed with descriptive statistics, Pearson correlation, Spearman rho and t-test using the SPSS WIN 10.0 program. RESULT: The prevalence of depression(CES-D=16) among the participants was 44.1%. The levels of self-care activities(p=.012), glucose(p=.019), total cholesterol(p=.022), LDL(.007) and cardiovascular risk factors(p=.012) were significantly higher in the depressed group than those in the non-depressed group. CONCLUSION: Based on the findings, we concluded that many DM patients experience depression and the depression of type 2 DM clients is significantly related with self care activities, diabetic control, and cardiovascular complications. However, this study did not address causality among these variables. Therefore, further research, such as a longitudinal cohort study, is needed to identify causality among these variables.
*Self Care ; Risk Factors ; Middle Aged ; Male ; Humans ; Female ; Diabetes Mellitus, Type 2/blood/complications/*psychology ; Depression/*complications/diagnosis ; Cholesterol/blood ; Cardiovascular Diseases/blood/*complications ; Blood Glucose/*analysis ; Aged