Effect of Diabetes Self-Management Education on Glycaemic Control in Sudanese Adults with Type 2 Diabetes

Research Background: The high prevalence of diabetes in Sudan, estimated at 16%, highlights the importance of effective health education in diabetes management. Diabetes self-management education has been identified as a crucial tool in enhancing the knowledge, attitudes, and abilities necessary for self-management among individuals with diabetes. Aim: To assess the impact of diabetes self-management education on medication adherence and glycemic control in Sudanese adults with type 2 diabetes before and 3 months after the DSME intervention. Method: The study was conducted in Sudan between September 2022 and March 2023, it was an interventional, one-group, pre- and post-test study that aimed to assess the impact of diabetes self-management education (DSME) on medication adherence and diabetes control in Sudanese adults with type 2 diabetes. The research was conducted in primary health care centers in six cities in Sudan and involved 244 participants. The data entry and statistical analysis were conducted using the Statistical Package for Social Sciences version 27.0. A paired t test was used for analysis. Results: The study included 244 participants, 67% of whom were males. The age mean ± SD was 48.6 ± 9.3 years, and 85.3% of participants were married. Age at onset of diabetes mean ± SD was 40.60 ± 7.81 years;44.6% had diabetes for less than 5 years;and 84.1% had a positive family history of diabetes mellitus. The levels of poor, low, and partial adherence to medication decreased by 8.2%, 4%, and 20.6%, respectively, after the intervention. The levels of good and high medication regime adherence increased by 13% and 19.8%, respectively;BMI decreased by 1.1 ± 0.73 kg/m2 (p = 0.005). The fasting blood sugar decreased by 69 ± 32.9 mg/dl (p = 0.049), and the glycated hemoglobin decreased by 1.21 ± 0.28% (p = 0.001). Conclusions: The findings of this study reinforce the importance of patient education in improving glycemic control and enhancing self-management behaviors. Patient education plays a critical role in enhancing glycemic control and self-management behaviors. It is essential for healthcare providers to adopt a patient-centered approach, taking into account the individual's beliefs, attitudes, and knowledge about their illness and treatment. Overcoming these challenges necessitates a comprehensive approach, including enhancing healthcare professionals’ knowledge and communication skills, offering accessible and culturally sensitive diabetes education programs, and addressing barriers to resources and support for self-management.

The effect of goal setting in asthma self-management education:A systematic review

Background: Asthma self-management education combining with behavior therapy is considered to be more effective.Goal setting is a common behavior change technique used to help patients self-manage their symptoms.However,empirical evidence around its effectiveness on asthma management lacks clarity.Aims: To systematically integrate and appraise the evidence for effectiveness of goal setting interventions on asthma outcomes.Methods: Databases included CENTRAL,PubMed,EMBASE,CINAHL and Proquest Psychology Database were systematically searched for relevant intervention studies employing goal setting technique as a method in asthma education program for self-management.Characteristic of studies and outcomes in clinical,psychosocial and healthcare utilization outcome were extracted.Results: From a total of 2641 citations,45 full-text articles were assessed for eligibility and 9 studies met the inclusion criteria.Eight studies were randomized controlled trial and one was before-after study.None studies have a high methodological quality.Goal-setting based intervention appeared to improve symptom control,quality of life and self-efficacy in adult patients with asthma.Conclusion: This systematic review highlighted the potential of a goal setting technique in the asthma self-management education.However,due to the limitations of the quality and quantity of the included literature,more rigorous studies are needed.In the future,better effective study protocol combining with goal setting approach and other behavior technique is needed to further investigate.

Preferences of Persons with Type 2 Diabetes for Diabetes Self-Management Education Interventions: An Exploration

Objectives: Treatment preferences affect treatment engagement, adherence and outcomes. There is limited knowledge of patients’ preferences for Diabetes Self-Management Education (DSME). This study explored the preferences of Canadians with diabetes for components, mode and dose for implementing DSME interventions. Methods: A cross-sectional design was used. Adults with diabetes completed a questionnaire to assess participants’ preferences for components (i.e. content), mode (i.e. teaching strategies, delivering formats) and dose (i.e. number and length of sessions) of DSME. Descriptive statistics were used to analyze the data. Results: Participants (n = 100) were middle-aged men and women, who had diabetes for 6.1 years and previously received (95.0%) DSME. They indicated preference for DSME to include a combination of educational, behavioral and psychological components;to be delivered in individual, face-to-face sessions (4 sessions, 60 minutes each, given monthly) that allowed discussion with one diabetes educator to develop and carry out a care plan. Conclusions: Diabetes educators may consider eliciting patient’s preferences and tailoring DSME to fit patients’ preferences. Delivering interventions that are consistent with patients’ preferences increases their motivation to engage in intervention, satisfaction and adherence to treatment and achievement of desired outcomes.

Efficacy of empowerment education in self-management with Type 2 Diabetes Mellitus:A systematic review and meta-analysis

Objective:To evaluate the impact of empowerment education in self-management with Type 2 Diabetes Mellitus.Methods:A literature search was performed in PubMed,Web of Science,Cochrane Library,Embase,China National Knowledge Infrastructure(CNKI),WanFang Data,CQVIP and China Biology Medicine disc(CBMdisc)and for randomized controlled trials published before November 2018.RevMan5.3 software was used for metaanalysis.Results:A total of 11 articles were included,involving 1139 patients.The group of empowerment education included 574 participants,and the regular education groups 565 participants.Meta-analysis showed that the group of empowerment education has an advantage over the control group in the levels of self-efficacy[MD=17.55,95%CI(14.14,20.96),P<0.00001],self-management[SMD=0.85,95%CI(0.60,1.11),P<0.00001],as well as the effectiveness of short-term empowerment education(within 6 months)on reducing HbA1c(P<0.05);however failed to long-term empowerment education(beyond 12 months)(P=0.05).Conclusion:This meta-analysis indicates that empowerment education can be an acceptable and appropriated nursing intervention for type 2 diabetes mellitus patients.

Diabetes self-management education:Benefits and challenges

Diabetes mellitus has spread throughout many nations of the world and is now a serious threat.A lack of patient self‑management has been linked to this drain on global health.The consequences of diabetic patients’poor self‑management have increased a variety of complications and lengthened hospital stays.Poor information and skill acquisition have been linked to poor self‑management.Participating in a co‑operative approach known as diabetes self‑management education will help diabetes patients who want to successfully self‑manage their condition and any associated conditions.Information is one of the most important components of a diabetes management strategy.In conclusion,numerous studies have shown that patients with diabetes have poor self‑management skills and knowledge in all areas,making training in diabetes self‑management necessary to minimize the complications that may result from diabetes mellitus among the patients.This review discussed the severity of diabetes mellitus,diabetes self‑management,and the benefits and challenges of diabetes self‑management,which may aid individuals in understanding the significance of diabetes self‑management and how it relates to diabetes self‑care.

Exploring the Influences of Continuous Self-Management Education on the Self-Care Skills and Health Behavior of Patients with PICC Intubation

Objective:To analyze the effects of continuous self-management education on the selfcare ability and health behavior of patients with tumor through peripherally inserted central venous catheters(PICC).Methods:The period from August 2018 to August 2020 was used as the research time range,and the random number table method was used as the basis for grouping.80 patients with malignant tumors who regularly performed fixed catheter maintenance care in the PICC clinic of our hospital were admitted in the experimental group(given PICC specialist nursing,and implemented continuous self-management education),and 80 patients with PICC tube malignant tumors discharged from the superior hospital during this time range served as the control group(return to the original catheterization hospital from time to time or perform catheter maintenance care in the nursing clinic of our hospital).The self-care ability scores,health behavior scores,and complications during intubation between both groups were analyzed.Results:(1)There was no significant difference in self-care ability score and healthy behavior score between groups before the intervention,P>0.05;the self-care ability score and health behavior score of the research group were better than the control group after intervention,P<0.05;(2)After investigation,the incidence of complications in the research group(2.50%)was lower than that of the control group(10.00%),but there was no difference between the groups,P>0.05.Conclusion:Continuous self-management education has good effects on improving the self-care ability of tumor patients with PICC intubation.It can urge patients to maintain good health behaviors and reduce complications.It is worthy of promotion.

Impact of stage-specific limb function exercises guided by a selfmanagement education model on arteriovenous fistula maturation status

BACKGROUND The exercise of limb function is the most economical and safe method to promote the maturation of arteriovenous fistula(AVF).However,due to the lack of a uni-fied exercise standard in China,many patients have insufficient awareness of the importance of AVF,leading to poor effectiveness of limb function exercise.The self-management education model can effectively promote patients to take pro-active health-related actions.This study focuses on the characteristics of patients during the peri-AVF period and conducts a phased limb function exercise under the guidance of the self-management education model to observe changes in fac-tors such as the maturity of AVF.AIM To assess the impact of stage-specific limb function exercises,directed by a self-management education model,on the maturation status of AVFs.METHODS This study is a randomized controlled trial involving 74 patients with forearm AVFs from the Nephrology Department of a tertiary hospital in Sichuan Province,China.Patients were randomly divided into an observation group and a control group using a random number table method.The observation group underwent tailored stage-specific limb func-tion exercises,informed by a self-management education model which took into account the unique features of AVF at various stages,in conjunction with routine care.Conversely,the control group was given standard limb function exercises along with routine care.The assessment involves the maturity of AVFs post-intervention,post-operative complications,and the self-management level of the fistula in both groups patients.Analyses were conducted using SPSS version 23.0.Count data were represented by frequency and percentage and subjected to chi-square test comparisons.Measurement data adhering to a normal distribution were presented as mean±SD.The independent samples t-test was utilized for inter-group comparisons,while the paired t-test was used for intra-group comparisons.For measurement data not fitting a normal distribution,the median and interquartile range were presented and analyzed using the Wilcoxon rank sum test.RESULTS At the 8-wk postoperative mark,the observation group demonstrated significantly higher scores in AVF symptom recognition,symptom prevention,and self-management compared to the control group(P<0.05).However,the variance in symptom management scores between the observation and control groups lacked statistical signi-ficance(P>0.05).At 4 wk after the operation,the observation group displayed a superior vessel diameter and depth from the skin of the drainage vessels in comparison to the control group(P<0.05).While the observation group did manifest elevated blood flow rates in the drainage vessels relative to the control group,this distinction was not statistically significant(P>0.05).By the 8-wk postoperative interval,the observation group outperformed the control group with notable enhancements in blood flow rates,vessel diameter,and depth from the skin of drainage vessels(P<0.01).Seven days following the procedure,the observation group manifested significantly diminished limb swelling and an overall reduced complication rate in contrast to the control group(P<0.05).The evaluation of infection,thrombosis,embolism,arterial aneurysm stenosis,and incision bleeding showed no notable differences between the two groups(P>0.05).By the 4-wk postoperative juncture,complications between the observation and control groups were statistically indistinguishable(P>0.05).CONCLUSION Stage-specific limb function exercises,under the guidance of a self-management education model,amplify the capacity of AVF patients to discern and prevent symptoms.Additionally,they expedite AVF maturation and miti-gate postoperative limb edema,underscoring their efficacy as a valuable method for the care and upkeep of AVF in hemodialysis patients.

Quantitative assessment of self-management in patients with nonalcoholic fatty liver disease: An unmet clinical need

In this editorial we comment on the article titled“Establishment and validation of an adherence prediction system for lifestyle interventions in non-alcoholic fatty liver disease”by Zeng et al published in a recent issue of the World Journal of Gastroenterology.Non-alcoholic fatty liver disease(NAFLD)represents one of the current challenges in hepatology and public health,due to its continuous growing prevalence and the rising incidence of NAFLD-related fibrosis,non-alcoholic steatohepatitis and cirrhosis.The only effective therapeutic strategy for this dis-ease is represented by encouraging patients to improve their lifestyle through the modification of dietary intake and increased physical exercise,but the effective application of such modifications is often limited by various factors such as lack of information,psychological barriers or poor social support.While poor adherence to a healthy lifestyle can be decisive in determining the clinical outcome,in daily practice there is a lack of quantitative instruments aimed at identifying patients with the lowest adherence to lifestyle changes and higher risk of disease progre-ssion in the course of follow-up.In this article,Zeng et al propose a quantitative scale to assess the grade of adherence of patients with NAFLD to hea-lthy lifestyle intervention,called the Exercise and Diet Adherence Scale(EDAS).This scale,consisting of 33 items divided into 6 dimensions which relates to six subjective aspects in the self-management of NAFLD,has shown a good correlation with the identification of the sub-cohort of patients with the highest reduction in caloric intake,increase in physical exercise,probability of a reduction in liver stiffness measurement and alanine aminotransferase levels.The cor-relation among clinical outcomes and specific dimensions of this scale also highlights the pivotal role of a good and confidential doctor-patient relationship and of an effective communication.There is an urgent need for practical and effective instruments to assess the grade of self-management of NAFLD patients,together with the development of multidisciplinary teams with the aim of applying structured behavioral interventions.

Multiple mediation effects of health locusof control and hope on the relationshipbetween stroke patients’ social supportand self-management

Objective:This study aimed to identify the mediation effects of health locus of control(HLC)and hope between stroke patients’social support and self-management.Methods:A cross-sectional study was conducted.A total of 300 Chinese stroke patients were recruited by convenient sampling from the acupuncture department of two Chinese Traditional Medical Hospitals in Tianjin Province from June to September 2018.The self-report questionnaires include Social Support Assessment Scale,Herth Hope Index,Mental Health Locus of Control Scale,Stroke Self-management Behavior Scale,and personal information questionnaires.All the survey data were entered in Excel and analyzed using the SPSS 24.0 program.Mediation was tested with Bootstrapping in AMOS 23.0 program.Results:The result showed that internal health locus of control(IHLC),chance health locus of control(CHLC)and hope were the mediators between social support and self-management.The direct,indirect,and total effects of social support on self-management behavior were 0.306 (P<0.01),0.109(P<0.01),and 0.415(P<0.01),respectively.Conclusions:Social support can directly influence self-management,and it can also indirectly influence self-management through IHLC,CHLC,and hope.

Educational Synergy

In a significant stride towards fostering international collaboration in education,China has rea"rmed its commitment to supporting Rwanda’s technical and vocational education and training(TVET)sector.The partnership,marked by the signing of two letters of intent between Rwanda Polytechnic and prominent Chinese institutions,underscores the mutual dedication to enhancing skills development and fostering economic growth.

Education Hand Up

Ugandans hail Chinese oil giant CNOOC for its support in benefitting local education sector Leaders,students and parents in Uganda have hailed China National Offshore Oil Corp.(CNOOC)Uganda Ltd.for its supporting role in the country’s education sector,including building schools,paying school fees and sponsoring activities to keep students in school.

Implementing and Popularizing Health Clinics and Educational Programs in NJ School Areas for Supporting NJ Pregnant Teenagers

This proposal focuses on the prevalence of teenage pregnancy issue in NJ and illustrates the benefits of school-based health clinics and educational programs which should be implemented for teenage pregnancy and childbearing.Without the early intervention of educational programs and preventive medical services which should be implemented in school areas,teen pregnancy and childbearing can have physical and emotional health influences on teen mothers,their babies and other family members,and the worst consequence should be abortion.What’s more,teenage pregnancy and childbearing have substantial economic consequence for state.The annual estimated cost associated with teen childbearing (teens 19 and younger) in NJ to taxpayers is at least $167 million in 2004 (24% federal costs and 76% state and local costs).Studies demonstrated that a much larger amount of money is spent on the consequences of teenage pregnancy than on prevention.NJ has an opportunity to invest in prevention and reduce not only the monetary but also the societal costs to our youth burdened by the often overwhelming responsibilities of teenage pregnancy and parenting.According to the 15 years follow-up research and data analyzing,two models of success which specifically implemented in South Carolina high schools and Chicago public schools have been proved to effectively reduce incidence of repeat pregnancy and emergency room visits,reduce incidence of teen mothers smoking during pregnancy,improve emotional outcomes among teen mothers,decrease incidence of teen mothers drug impairment,arrest,conviction,or jail time and reduce use of food stamps and other public assistances,which can consequently increase the state public health costs.In order to support teen mothers’ academic,physical,emotional and social needs in a stable and consistent school environment,the plan which titled "Physical and Mental Health Promotion for NJ Teen Mothers" is effective and practical enough to arouse the attention of some relevant departments.It’s worth patron to fund the plan because supporting teenage pregnancy at early stage can subsequently benefit the national and state economy and teen mothers.

Importance of Early Intervention and Special Educational Support for High School Students with Attention-Deficit/Hyperactivity Disorder

Aim: The present study aimed to investigate problems relating to education, past situations and treatments in high school students with attention-deficit/ hyperactivity disorder (ADHD) and to discuss appropriate considerations. Methods: Participants were 6 students who were diagnosed with ADHD according to Diagnostic and Statistical Manual of Mental Disorders IV, Text Revision (DSM-IV-TR) criteria. Results: In total, 6 cases of high-school students with ADHD showed dominantly inattention features. They had notably not been diagnosed with ADHD or received appropriate special support education until they were of high-school age, although they had clearly shown characteristic features of the disorder from childhood. As a result, they had decreased motivation to study and showed indolence, and suffered from low self-esteem. Conclusion: This case report suggests that early diagnosis of ADHD and early intervention with special support education are of great importance. To support these students, better educational and medical support systems are warranted.

Inspiration from Comparative Study of Distance-education Learning Support Services of China and UK

The theory and practice of OUUK learning support service has been widely praised, from the study of composition and dominantof OUUK learning support service system, and as Jiangyin Open Studying center, Wuxi, Jiangsu example, in-depth investigation and analysis ofthe present situation of China＇s distance-education learning support services, explore the reference value of the successful experience of OUUKand inspiration to the distance education in China.

School Support Services Model for Students With Disabilities in General Education Classrooms： Using Data From the Special Needs Education Longitudinal Study in Taiwan

The purposes of this study were to establish a school support service model for students with disabilities in general classroom, and to explore the current status of school support services provided for students with disabilities in preschools, primary, and junior high schools. Therefore, this study used data from the Special Needs Education Longitudinal Study in Taiwan, collected in the 2007-2008 academic year. There were 2,924 students with disabilities selected in the study who were placed in general classrooms; 855 were in preschool, 1,079 were in primary school and 990 were in junior high school. The questionnaires in the database were answered by their teachers. The results of this study are listed, as follows： In terms of the school support service model for students with disabilities in the three stages of education, adjustment in teaching accounts for 1-15% of the explanatory power regarding the overall model, while support services account for 63-85%, which peak in junior high schools. Secondly, itinerant teachers are found to be the most important human resource in preschools. For primary and junior high schools, parents and special education teachers are the more prevalent influences. The more common school support services are tuition refunds, itinerant services, adjustments in examinations, and scholarships.

Supporting Education

THERE is good news for African countries whose development has long been restricted by poor education. New options exist for funding of educational development oroiects.

Diabetes self-management (DSM) in Omani with type-2 diabetes

Objective:The aim of this study was to assess the status of diabetes self-management(DSM)among Omanis with type-2 diabetes and its relationship with glycemic control and demographic variables.Methods:A correlational descriptive design using questionnaire was conducted with a convenience sample of 266 Omani patients with type-2 diabetes to collect the data.Results:The findings indicated that DSM among the study subject is sub-optimal.Only 1%of them were regular on SMBG;9.5%of them exercise regularly;and 18%of them maintain healthy diet practices.No significant relationship between DSM and glycemic control(p>0.05)was found.DSM was found to be associated with age,gender,level of education,and duration of diabetes.Examining the differences between two regions in Oman(Muscat&Aldhakiliyah)indicated that participants from Muscat differ only in practicing SMBG.Conclusion:Results indicated that many Omani patients with type-2 diabetes do not perform DSM consistently.Practice implications:The findings of this study set the stage to develop teaching strategies that will improve DSM and subsequently improve diabetes management in patient with type-2 diabetes in Oman.

Effectiveness of the flipped classroom on the development of self-directed learning in nursing education:a meta-analysis

Objectives: To examine the best practice evidence of the effectiveness of the flipped classroom（FC） as a burgeoning teaching model on the development of self-directed learning in nursing education.Data sources: The relevant randomized controlled trial（RCT） and non-RCT comparative studies were searched from multiple electronic databases including PubMed, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature（CINAHL）, Cochrane Central Register of Controlled Trials（CENTRAL）, Wanfang Data, China National Knowledge Infrastructure（CNKI）, and Chinese Science and Technology Periodical Database（VIP） from inception to June 2017.Review methods: The data were independently assessed and extracted for eligibility by two reviewers. The quality of included studies was assessed by another two reviewers using a standardized form and evaluated by using the Cochrane Collaboration’s risk of bias tool. The self-directed learning scores（continuous outcomes） were analyzed by using the 95% confidence intervals（Cls） with the standard deviation average（SMD） or weighted mean difference（WMD）. The heterogeneity was assessed using Cochran’s I;statistic.Results: A total of 12 studies, which encompassed 1440 nursing students（intervention group = 685, control group = 755）, were eligible for inclusion in this review. Of 12 included studies, the quality level of one included study was A and of the others was B. The pooled effect size showed that compared with traditional teaching models, the FC could improve nursing students’ selfdirected learning skill, as measured by the Self-Directed Learning Readiness Scale（SDLRS）, Self-Directed Learning Readiness Scale for Nursing Education（SDLRSNE）, Self-Regulated Learning Scale（SRL）, Autonomous Learning Competencies scale（ALC）, and Competencies of Autonomous Learning of Nursing Students（CALNS）. Overall scores and subgroup analyses with the SRL were all in favor of the FC.Conclusions: The result of this meta-analysis indicated that FCs could improve the effect of self-directed learning in nursing education.Future studies with more RCTs using the same measurement tools are needed to draw more authoritative conclusions.

Status of Understanding of the Disease and Self-Management Behavior among Patients with Hypertension

Background: Hypertension is a lifestyle-related disease that has no subjective symptoms but could lead to severe complications. The goals of treatment for hypertension are to maintain blood pressure with medications and prevent complications. Measuring blood pressure at home regularly is critical for patients with hypertension. Purpose: This study aimed to 1) clarify the status of patients’ understanding of hypertension and self-management, 2) identify nursing practices that could support patients with hypertension in making them aware of the need for understanding hypertension, monitoring blood pressure at home, and engaging in self-management. Method: A questionnaire survey on understanding of the disease and self-management behavior was conducted among patients with hypertension who regularly visited outpatient clinics. As for data analysis, descriptive statistics were computed for patients’ attributes, clinical findings, understanding of the disease, and self-management behavior. Cross-tabulation and the chi-square test were used for each item on understanding of the disease and self-management behaviors. Results: Data were obtained from 150 participants (93 males and 57 females) with a mean age of 70 years. Patients with a higher understanding of the disease and those who were aware of the target blood pressure were more likely to engage in self-management behavior, including monitoring blood pressure at home, ensuring regular outpatient visits, and consulting with nurses or physicians. In addition, the percentage of patients who recognized the need to achieve their target blood pressure was higher among those who had a spouse and lived with their family. Discussion: Regular monitoring and recording of blood pressure at home are the most important self-management behaviors. Understanding of the disease and self-management behavior and support from the family are critical for maintaining appropriate self-management. Therefore, in cooperation with physicians, nurses should provide health education to patients and their families to enable them to perform appropriate self-management. Health expenditures increase with age, especially in those aged 65 years and over. The prevalence of hypertension increases with age;patients aged 65 years and over need to engage in self-management to maintain their target blood pressure. Nurses should provide patients with hypertension aged 65 years and over with appropriate nursing care to enable them to measure and record their blood pressure at home appropriately and regularly. Appropriate nursing care may help reduce the health expenditure. This may help reduce the health expenditure.

Viewpoint of Nigerians towards sexual abuse and molestation of children:A call to proper education

Dating back to several years in Nigeria,there was a new development on the ratification of the Convention on the Rights of the Child[1].This treaty promised to be the“silver bullet”supporting children’s health,protection,and enjoyable childhood.The development is the world’s most rapid ratified human rights treaty,with 120 signatories[2].