PURPOSE this paper describes the development and psychometric properties of the Diabetes Problem-Solving Measure for Adolescents (DPSMA). METHODS The DPSMA is a structured, interview-based questionnaire that examines how adolescents with type 1 diabetes solve diabetes-related self-management problems. Seventeen diabetes-related self-management problem vignettes were derived from a survey of adolescents and their parents. The vignettes were reviewed and finalized by a multidisciplinary team of diabetes experts. A sample of 43 adolescents, 13 to 17 years old, with type 1 diabetes, was used to establish the psychometric properties of the instrument. RESULTS The scale demonstrated acceptable internal consistency and interrater reliability. Predicted relationships with scores on concurrently administered measures of adherence, diabetes quality of life, and metabolic control provided support for construct validity. CONCLUSIONS The results suggest that the DPSMA has acceptable internal consistency, interrater reliability, and construct validity. It may be a useful tool to help healthcare providers understand the diabetes-related problem-solving abilities of their adolescent patients.

OBJECTIVE: The Diabetes Prevention Program (DPP) is a 27-center randomized clinical trial designed to evaluate the safety and efficacy of interventions that may delay or prevent development of diabetes in people at increased risk for type 2 diabetes. RESEARCH DESIGN AND METHODS: Eligibility requirements were age > or = 25 years, BMI > or = 24 kg/m2 (> or = 22 kg/m2 for Asian-Americans), and impaired glucose tolerance plus a fasting plasma glucose of 5.3-6.9 mmol/l (or < or = 6.9 mmol for American Indians). Randomization of participants into the DPP over 2.7 years ended in June 1999. Baseline data for the three treatment groups--intensive lifestyle modification, standard care plus metformin, and standard care plus placebo--are presented for the 3,234 participants who have been randomized. RESULTS: Of all participants, 55% were Caucasian, 20% were African-American, 16% were Hispanic, 5% were American Indian, and 4% were Asian-American. Their average age at entry was 51 +/- 10.7 years (mean +/- SD), and 67.7% were women. Moreover, 16% were < 40 years of age, and 20% were > or = 60 years of age. Of the women, 48% were postmenopausal. Men and women had similar frequencies of history of hypercholesterolemia (37 and 33%, respectively) or hypertension (29 and 26%, respectively). On the basis of fasting lipid determinations, 54% of men and 40% of women fit National Cholesterol Education Program criteria for abnormal lipid profiles. More men than women were current or former cigarette smokers or had a history of coronary heart disease. Furthermore, 66% of men and 71% of women had a first-degree relative with diabetes. Overall, BMI averaged 34.0 +/- 6.7 kg/m2 at baseline with 57% of the men and 73% of women having a BMI > or = 30 kg/m2. Average fasting plasma glucose (6.0 +/- 0.5 mmol/l) and HbA1c (5.9 +/- 0.5%) in men were comparable with values in women (5.9 +/- 0.4 mmol/l and 5.9 +/- 0.5%, respectively). CONCLUSIONS: The DPP has successfully randomized a large cohort of participants with a wide distribution of age, obesity, and ethnic and racial backgrounds who are at high risk for developing type 2 diabetes. The study will examine the effects of interventions on the development of diabetes.

OBJECTIVES:This study assessed the quality of diabetes care in community health centers.METHODS:In 55 midwestern community health centers, we reviewed the charts of 2865 diabetic adults for American Diabetes Association measures of quality.RESULTS:On average, 70% of the patients in each community health center had measurements of glycosylated hemoglobin, 26% had dilated eye examinations, 66% had diet intervention, and 51% received foot care. The average glycosylated hemoglobin value per community health center was 8.6%. Practice guidelines were independently associated with higher quality of care.CONCLUSIONS:Rates of adherence to process measures of quality were relatively low among community health centers, compared with the targets established by the American Diabetes Association.

Medical school faculty members and house officers often feel uncomfortable giving direct, behaviorally based feedback on performance to medical students. This paper describes a structured approach to teaching faculty members to give effective feedback to medical students, using an interactive workshop format. Starting with six key principles for effective feedback, participants practise giving feedback to 'standardized students' and develop strategies for framing the feedback in terms which are useful for students.This paper also describes the development of the workshop scenarios and provides the authors'specific strategies for giving effective feedback in various situations.

The Diabetes Prevention Program is a randomized clinical trial testing strategies to prevent or delay the development of type 2 diabetes in high-risk individuals with elevated fasting plasma glucose concentrations and impaired glucose tolerance. The 27 clinical centers in the U.S. are recruiting at least 3,000 participants of both sexes, approximately 50% of whom are minority patients and 20% of whom are > or = 65 years old, to be assigned at random to one of three intervention groups: an intensive lifestyle intervention focusing on a healthy diet and exercise and two masked medication treatment groups--metformin or placebo--combined with standard diet and exercise recommendations. Participants are being recruited during a 2 2/3-year period, and all will be followed for an additional 3 1/3 to 5 years after the close of recruitment to a common closing date in 2002. The primary outcome is the development of diabetes, diagnosed by fasting or post-challenge plasma glucose concentrations meeting the 1997 American Diabetes Association criteria. The 3,000 participants will provide 90% power to detect a 33% reduction in an expected diabetes incidence rate of at least 6.5% per year in the placebo group. Secondary outcomes include cardiovascular disease and its risk factors; changes in glycemia, beta-cell function, insulin sensitivity, obesity, diet, physical activity, and health-related quality of life; and occurrence of adverse events. A fourth treatment group--troglitazone combined with standard diet and exercise recommendations--was included initially but discontinued because of the liver toxicity of the drug. This randomized clinical trial will test the possibility of preventing or delaying the onset of type 2 diabetes in individuals at high risk.

Objectives To describe the pediatric interview as it is conducted in different practice settings and with children ranging in age from infancy to adolescence, and to identify pediatric history-taking strategies that varied across age groups. Participants and Methods A self-administered survey was designed and mailed to a group of pediatricians in the Chicago metropolitan area to assess commonly used strategies in the pediatric interview across varied patient ages and settings. The pediatricians sampled varied by geographic location as well as by practice setting. Results Results of the survey indicated that pediatricians use common strategies for establishing rapport, calming the disruptive child, and obtaining information from the child within particular age groups, but vary these strategies as the child matures. Conclusions The findings substantiate the influence of the developmental stage of the child on interview strategies used by pediatricians. Implications pertaining to development of a standardized teaching curriculum for the pediatric interview are also discussed.

The purpose of this pilot study was to test the hypothesis that children can learn to become more independent in their own diabetes self-management without compromising their metabolic control. Twenty-four children (ages 8 to 12 years) with insulin-dependent diabetes mellitus (IDDM) were matched by age and race, then randomly assigned either to a 6-week, self-management education program (experimental) or to receive usual care (control). A questionnaire was administered to the parents to determine the frequency with which 35 diabetes management behaviors were performed and the degree to which children assumed responsibility for these behaviors. Glycohemoglobin levels were monitored at baseline and at posttreatment, 12 weeks after baseline. At the posttreatment, children in the experimental group were found to be assuming significantly more responsibility for their diabetes self-care than were children in the control group. No decrease in the frequency with which self-care behaviors were performed was observed, and metabolic control was maintained. The results suggest that a diabetes self-management education program for children ages 8 to 12 years can be effective in facilitating children becoming more responsible for their own diabetes management.

A goal of the Diabetes Research and Training Centers (DRTCs) is to translate advances in diabetes research into irnproved patient care by providing innovative, state-of the-art training for health care professionals. This paper is a report on a collaborative DRTC-AADE training project. A 2-day diabetes program developed by the Chicago DRTC was packaged as a Workshop Instructor's Guide with accompanying slides and materials. AADE faculty observed the workshop presented by DRTC faculty and subsequently presented the workshop themselves. The evaluation design involved coinparitig a workshop presented by the DRTC faculty with a workshop presented by faculty from AADE. Three components were included in the evaluation: the participants' evaluation, a commitment-to-change evaluation, and the faculty observations. When cottiparitig workshops, few differences were observed in participants' or faculty observers' evaluations. Moreover, participants at both workshops were equally successful at meeting goals related to improving their diabetes education practice behaviors. Dissemination of the program has been expanded and the workshop has become part of AADE's national continuing education efforts.

We developed a 50-item multiple choice test to assess knowledge of preventive pulmonary medicine. We derived the content of test items from a comprehensive preventive pulmonary curriculum, which we developed. The test was administered to 167 medical students, residents, and practicing physicians to establish its psychometric properties and to determine if the test scores discriminated between different levels of training. Using this sample, the reliability of the test was 0.86, and the test significantly differentiated between levels of training in pulmonary medicine. We are using this multiple choice test to assess changes in knowledge of second-year medical students and of fourth-year medical students completing a pulmonary medicine elective rotation.

The text of the council's report, which is an outcome of the consideration of the options mentioned by Dr. Zervanos, appears as the first article in this issue of the journal. Dr. Zervanos sent this letter to the journal while the policies presented in the report were still being formulated. Dr. Zervanos is director, Department of Family and Community Medicine, and director, the family practice residency program, Lancaster General Hospital, Lancaster, Pennsylvania. He is also clinical professor, Department of Family Practice and Community Health, Temple University School of Medicine, Philadelphia, Pennsylvania.

The prevalence of non-insulin-dependent diabetes mellitus (NIDDM) is 50% higher in black Americans than in whites ( 1. Davidson JK The effective approach and management of diabetes in blacks and other minority groups. in: 4th ed. Report of the Secretary's Task Force on Black and Minority Health. vol 7: Chemical Dependency and Diabetes. US Dept of Health and Human Services, Washington, DC1986: 297-355 Google Scholar ). Obesity, a major risk factor for diabetes, is of epidemic proportions among black women. Fully 48% of black women between the ages of 25 and 74 have been found to be overweight, compared with 26% of white women in the same age group ( 2. Kumanyika S Obesity in black women. Epidemiol Rev. 1987; 9: 31-50 Google Scholar ). Moreover, overweight black women are less likely to lose weight than are overweight white women ( 3. Kahn HS Williamson DF Stevens JA Race and weight change in US women: the roles of socioeconomic and marital status. Am J Public Health. 1991; 81: 319-323 Google Scholar , 4. Kumanyika SK Obarzanek E Stevens VJ Hebert PR Whelton PK Weight-loss experience of black and white participants in NHLBI-sponsored clinical trials. Am J Clin Nutr. 1991; 53: 1631S-1638S Google Scholar ). Weight loss among obese individuals with NIDDM can lead to significant improvement in metabolic control ( 5. Henry RR Wallace P Olefsky JM Effects of weight loss on mechanisms of hyperglycemia in obese non-insulin-dependent diabetes mellitus. Diabetes. 1986; 35: 990-998 Google Scholar ). Behavior-oriented weight loss programs have had some success in promoting weight loss among patients with diabetes ( 6. Wing RR Marcus MD Epstein LH Salata R Type II diabetic subjects lose less weight than their overweight nondiabetic spouses. Diabetes Care. 1987; 10: 563-566 Google Scholar , 7. Wing RR Epstein LH Nowalk MP Koeske R Hagg S Behavior change, weight loss, and physiological improvements in Type II diabetic patients. J Consult Clin Psychol. 1985; 53: 111-122 Google Scholar ). Few programs have specifically addressed the weight loss needs of obese inner-city black women with NIDDM. The PATHWAYS program, developed and pilot-tested in this study, is a behavior-oriented, small-group program targeted for obese inner-city black women with NIDDM ( 8. McNabb WL Davids MD Haynes J PATHWAYS: A Weight Loss Program for Women with Diabetes. University of Chicago, Diabetes Research and Training Center, Chicago, Ill1990 Google Scholar ). The goal of the program is to bring about life-style changes that will promote long-term weight loss and optimal diabetes control.

Log in or Register Subscribe to journalSubscribe Get new issue alertsGet alerts Enter your Email address: Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent. For more information, please refer to our Privacy Policy. Subscribe to eTOC Secondary Logo Journal Logo All Articles Images Videos Podcasts Blogs Advanced Search Toggle navigation Subscribe Register Login Articles & Issues Current IssuePrevious IssuesPublished Ahead-of-Print Collections Editorials of Laura Weiss Roberts, MD, MAAM Last PageCOVID-19 and Medical EducationAddressing Race and Racism in Medical EducationeBooksView All For Authors Submit a ManuscriptInformation for AuthorsLanguage Editing ServicesAuthor Permissions Journal Info About the JournalAbout the AAMCJournal MastheadSubmit a ManuscriptAdvertising InformationSubscription ServicesReprints and Back IssuesClassified AdsRights and PermissionsFor ReviewersFor MediaFor Trainees All Articles Images Videos Podcasts Blogs Advanced Search