The Views of Family Members about Nursing Care of Psychiatric Patients Admitted at a Mental Hospital in Malawi

Family members of a mentally ill person play a crucial role in the recovery of their sick relative. They care for their sick relatives at home and in hospital. Some views of family members indicate that they get satisfaction from participating in nursing care of their sick relative. The aim of this study was to describe the views of family members about nursing care of psychiatric patients admitted at a mental hospital in Malawi. A qualitative study design was used and data were collected from ten participants through in-depth interviews. Ethical approval was granted by relevant authorities. Data were analysed using Colaizzi method. The findings fell into the following four themes that emerged: family participation in nursing care;nurses’ skills and experience in caring;respect for psychiatric patients and interactions and information sharing. This study offers valuable information about the views of families regarding nursing care of psychiatric patients. They are involved in the care of their sick relatives although there is lack of effective cooperation between them and nurses. The lack of collaboration made families receive inadequate information about their sick relative. Therefore, it is imperative that nurses are competent in implementing family involvement in nursing care.

Mental Health Problems Affecting People Who Have HIV and AIDS in Malawi: A Review

Malawi is located in the southern part of Africa with a population of more than 16 million people. The country is ravaged with HIV and AIDS epidemic of which the prevalence rate is at 14%. The people who have HIV/AIDS are also affected by mental and psychological disorders. Nevertheless, very little is known about mental health care of people who have HIV and AIDS in Malawi. We did literature search using AJOL, Proquest, PsychINFO, Google Scholar and HINARI search engines and the search yielded scanty (12) research studies on the mental health of people with HIV and AIDS that were conducted in Malawi between 2006-2014. Twelve (12) studies that were reviewed focused on prevalence of mental disorders among people who have HIV and AIDS;nurses’ knowledge and skills for providing mental health care to people living with HIV and AIDS (PLWHA);perceived risk of HIV infection among people who have mental health problems;substance abuse and HIV/AIDS issues and awareness of interaction between HIV/AIDS and Mental health. In conclusion, the review shows that people with HIV infection are also affected by mental health problems such as depression and substance abuse. They receive some mental health care in general settings at ART clinics because mental health care is integrated into general health care delivery system. Therefore, it is necessary that health professionals who are generalists should be equipped with adequate knowledge and skills for providing mental health care to care to people with HIV and AIDS.

School health promotion:A cross-sectional study on Clean and Healthy Living Program Behavior(CHLB)among Islamic Boarding Schools in Indonesia

Objective:This study aims to identify the knowledge,attitude,and behavior of students using eight indicators of Clean and Healthy Living Behavior(CHLB)in relation to the health education and grade levels in Islamic Boarding Schools(IBS)in Jember regency,East Java Province,Indonesia.Methods:A cross-sectional school-based survey design was used.About 114 students(mean age of 13.17 years old)selected through a multi-stage random sampling completed a selfadministered questionnaire to measure the eight indicators of CHLB,such as washing hands with running water and soap,eating healthy snacks,using clean and healthy latrines,exercising regularly and measurably,eradicating mosquito larvae,not smoking at school,weighing and height measurement every 6 months,and disposing garbage properly.The data analyses included descriptive and comparative analyses of the difference in knowledge,attitude,and behavior toward CHLB by health education and grade level.Results:About 66.7% students received health education.Significant knowledge in CHLB in relation to health education and grade was observed(P<.05),including in-depth knowledge of exercises,measurable weight and height,smoking,and healthy latrines.Meanwhile,no significant difference was observed between the attitude toward CHLB and health education in different grade levels.Furthermore,CHLB was associated with health education,including habitual exercise and using of clean and healthy latrines.

Prevalence and associated factors of health problems among Indonesian farmers

Objective： This study examined the prevalence of health problems and their associated factors among Indonesian farmers.Methods： A cross-sectional study was conducted among 179 farmers who completed a self-administered questionnaire and physical examination. The data were analyzed using descriptive, comparative, and multinomial logistic regression analyses.Results： The prevalence of varying health problems was 28.5% underweight, 10.6% overweight, 62.6% anemia, and 50.3% joint and bone pain. These results showed that being older and drinking coffee increased the likelihood of being underweight, while having less than 30 min of recess per working period and working for more than 5 days per week decreased the likelihood of being overweight.Meanwhile, being a younger male and working for less than 5 days per week decreased the risk of anemia. Furthermore, older age and less than 30 min of recess per working period were associated with increased joint and bone pain.Conclusions： We recommend the provision of screening programs and health education programs,including dietary programs and physical and exercise programs, by the occupational health nursing（OHN） program, to prevent and reduce health problems in the agricultural sector.

Lebanese Student’s Experience of Benefits of High Fidelity Simulation in Nursing Education: A Qualitative Approach

Background: Simulation is perceived as an important part to the nursing clinical educational experience since it can offer a safe learning environment for the students’ clinical practice. Objective: The purpose of this study was to explore the Lebanese student’s experience of benefits of high fidelity simulation in nursing education. Design: A qualitative study using open-ended questionnaire. Setting: This study was implemented at private university in Lebanon between January and April 2015. Participants: A purposive sample was sought from those who have a simulated experience. Methods: Qualitative data were collected via interviews and analysed using a thematic approach. Findings: Four major themes were identified: “Bridging Theory to Clinical Practice”, “Developing Critical Thinking and Decision-making”, “Practicing Safely Leads to Enhancing Confidence”, “Teamwork Spirit and students’ motivation to earn and practice more”. Conclusion: Simulation was found to be an acceptable learning strategy for novice nursing students. The use of simulations is a useful and effective learning strategy. Students with a higher positive attitude towards the simulation experience displayed better learning outcomes. Thus, the integration of simulation into the learning experience of nursing students will bridge the gap between theory and practice;enhance their critical thinking and motivation aptitudes along with traditional clinical practice by sparing them a safe milieu.

Psychiatric electronic health records privacy in Jordan: A policy brief

Psychiatric health records are highly sensitive data which requires special policy to maintain its privacy,without affecting data accessibility.The current authors reviewed social,ethical and legal underpinnings for psychiatric electronic health records(EHR),and suggests a policy to maintain privacy and confidentiality of the psychiatric data,without affecting data accessibility.The purpose of this policy brief is to discuss and provide alternatives regarding psychiatric electronic health records privacy and information access.The current policy applied in Jordan still immature to ensure high levels of reliability,as the psychiatric data is openly accessed to the non-specialized personnel.Sensitive personal data policy is recommended in this paper with developing overriding mechanisms to counteract obstacles to data accessibility.

Nursing students’experiences of horizontal violence and occupational belonging during clinical placements

Background:Horizontal violence has negatively affected the students’active learning,interpersonal relationship,and occupational belonging.However,little attention has been paid to the relationship between horizontal violence and occupational belonging among nursing students.Objective:The objective of this study was to explore the frequency,types,perpetrators,effects,and responses of horizontal violence experienced by nursing students and the relationship between occupational belonging and horizontal violence.Materials and Methods:The present study used a descriptive,cross-sectional survey design.The data were collected from the 277 undergraduate nursing students selected by convenience sampling method using personal characteristics form,horizontal violence survey,and occupational belonging subscale at nursing faculty in Istanbul.Results:The first three horizontal violence behaviors experienced by nursing students were found,respectively:being forced to do trivial and unimportant work which are not the students’responsibility(84.1%),being exposed to sarcastic remarks by nurses(80.9%)and unwillingness of the nurse to help and lack of support(80.9%)and being ignored by nurses(77.3%).Nearly half of the students(48.4%)considered leaving nursing profession as a result of horizontal violence.There was a negative relation between horizontal violence and occupational belonging(P<0.05).As horizontal violence scores increased,occupational belonging scores decreased.Conclusions:Findings from this study shown that horizontal violence decreasing occupational belonging,and so nursing students consider leaving nursing profession or education.Further studies are needed to better demonstrate addressing the horizontal violence bilaterally and the effective preventive interventions.

埃及护士专业共享治理与职业动机现状的调查研究

目的旨在调查埃及护士专业共享治理及职业动机的现状,并探讨其相关性。方法采用横断面调查法,于2022年5—8月选取埃及亚历山大大学附属医院内科、外科和ICU工作的724名护士为研究对象。采用专业护理治理指数(Index of Professional Nursing Governance,IPNG)和职业动机量表进行调查。结果本组护士IPNG总分为(109.18±22.76)分(量表得分范围50~250分,50个条目),表明护士感知专业治理水平较低。其中获取信息维度的均分最高,为(2.81±0.76)分;其次是设定目标和解决冲突的能力维度,为(2.75±0.53)分;参与委员会组织维度均分最低为(1.65±0.37)分。职业动机的总分为(69.82±9.70)分(量表得分范围25~105分),表明护士职业动机处于中等水平,其中职业洞察力维度均分最高为(3.56±0.34)分,职业适应力维度均分最低为(3.07±0.49)分。男性、年龄在30岁以下、本科学历、在ICU工作的护士IPNG和职业动机量表总分较高(P<0.001)。相关分析结果显示,护士专业共享治理得分与职业动机得分呈正相关(r=0.239,P=0.003)。结论研究结果可以为护理管理者提供理论依据,重新规划管理模式,并制订相应策略,从而为护士提供更好的职业规划。

The role of nurses in the prevention of cervical cancer: Cervical screening, an unkept promise by the majority of women in Nigeria

Cervical cancer remains a major public health problem accounting for continuous female death in developing countries.Cervical cancer is the second most common cancer in women globally with an estimated number of 500,000 new cases of cervical cancer and 273,000 mortalities annually.Cervical screening is the best cancer screening test in the history of medicine and most cost-effective of all medical screening tests.The study review aimed to highlight methods of cervical cancer prevention,identify the uptake of cervical screening among women,and explain the role of nurses in uptake of cervical screening.Cervical cancer is preventable and easily treatable if it is detected at early stages,but poor information on prevention and access to screening and treatment contributes to 90%of deaths.In the developing countries such as Nigeria,a large proportion of cervical cancers are diagnosed in advanced stages,with poor rates of survival.The three main methods for preventing cervical cancer are through primary prevention(human papillomavirus vaccination and health education),secondary prevention(cervical screening,early detection of precancerous lesions,and treatment),and tertiary prevention(measures to slow the progression or recurrence,surgical removal,radiotherapy,and chemotherapy).Nurses can help improve the acceptability of this neglected promise by focusing on health education on cervical screening and vaccination in prenatal clinics and infant welfare clinics where there are more women.Inclusion of cyberspace could also serve as a successful and popular platform for this health teaching.All nurses/midwives must preach and fervently work toward the WHO 90–70–90 plan for eradicating cervical cancer.

Relationship between Respiratory Muscle Strength and Static Balance in Older People Requiring Support and Care

Purpose: This study aimed to clarify the relationship between respiratory muscle strength and balance in older people requiring support or nursing care. Methods: Thirty-seven older subjects aged 65 years or older who were certified as requiring nursing care or support were included in the study. Maximal inspiratory pressure (PIMAX), maximal expiratory pressure (PEMAX), and one-leg standing time were measured. Additionally, the Functional Reach Test (FRT) was performed. Pearson correlation coefficient and multiple regression analyses were performed. Results: One-leg standing time was positively correlated with PEMAX, and was particularly correlated with PIMAX, while FRT score was not correlated with respiratory muscle strength. Multiple regression analysis with one-leg standing time as the dependent variable and PIMAX and PEMAX as independent variables showed that only PIMAX was significantly correlated with one-leg standing time. Conclusion: Focusing on expiratory and inspiratory muscle strength is important for improving one-leg standing ability and thus preventing falls in older people.

Possibilities of Assessing Respiratory Muscle Strength and Trunk Muscle Mass in the Prevention of Sarcopenia in Older People Living in the Community

Objective: The purpose of this study was to clarify the relationship between respiratory muscle strength and skeletal muscle mass (trunk, upper limbs, and lower limbs) in older people who were certified as requiring nursing or supportive care. Methods: Thirty-five older people (65 years or older) who were certified as requiring nursing care or support were included in the study. The subjects were divided into a non-sarcopenic group (n = 12) and a sarcopenic group (n = 23) according to the sarcopenia diagnostic criteria proposed by the Asian Working Group for Sarcopenia. Maximum inspiratory pressure, maximum expiratory pressure, skeletal muscle mass (trunk, upper and lower limbs), and hand grip strength were measured. Pearson’s correlation coefficient and multiple regression analysis were used for statistical processing. Results: In the non-sarcopenic group, both expiratory muscle strength and hand grip strength were correlated with skeletal muscle mass. In the sarcopenia group, expiratory muscle strength was not correlated with skeletal muscle mass, and only hand grip strength was correlated with upper limb muscle mass. Multiple regression analysis revealed that, in the non-sarcopenic group, trunk muscle mass was the primary factor in expiratory muscle strength and upper limb muscle mass was the primary factor in hand grip strength. In the sarcopenia group, upper limb muscle mass was found to be the main factor in hand grip strength. Conclusion: Our results highlight the importance of assessing expiratory muscle strength and trunk muscle mass before sarcopenia develops in older people who require support and nursing care.

Nurse-led group cognitive behavioral therapy for major depressive disorder among adults in Japan: A preliminary single-group study

Objectives:The prevalence and burden of disease of depression necessitates effective and accessible treatment options worldwide.Since April 2016,Japanese national health insurance has covered nurseadministered cognitive behavioral therapy(CBT)for mood disorders.However,empirical support for nurse-led CBT for depression in Asian countries,especially in Japan,is still lacking.This preliminary study aimed to examine the feasibility and acceptability of nurse-led group CBT for Japanese patients with depression.Methods:In this single-arm study,we evaluated the effects of a 6-week group CBT,led by trained nurses,on patients with major depression.The primary outcome was the Beck Depression Inventory-Ⅱ(BDI-Ⅱ).Assessments were conducted at the beginning and end of the intervention.Results:Of 25 participants screened,23 were eligible for the study(of these,three dropped out during the trial but were included in the analysis).Nurse-led group CBT led to significant improvements in the severity of depression(BDI-Ⅱ,P<0.001).The mean total BDI-Ⅱscore improved from 23.1(SD=7.56)to 12.4(SD=8.57),and the pre-to post-effect size was large(Cohen's d=1.33).After CBT,45%of the participants were judged to be treatment responders,and 34%met the remission criteria.Conclusions:Our preliminary findings indicate that 6 weeks of nurse-led group CBT produced a favorable treatment outcome for individuals with major depression in a Japanese clinical setting.The results of this study might encourage more Asian nurses to provide CBT as a part of their nursing practice.Further controlled trials that address the limitations of this study are required.

约旦冠心病患者心理韧性的调查研究

目的调查约旦冠心病患者心理韧性现状及相关因素。方法采用横断面调查研究,便利选取在约旦安曼市2所公立医院心内科门诊就诊的134例患者,并采用心理韧性量表(The Connor-Davidson Resilience Scale,CD-RISC)对其进行面对面调查。采用Mann-Whitney U检验、Kruskal Wallis检验对数据进行分析。结果冠心病患者心理韧性得分为68.00(60.75,74.00),属于中等水平。没有心脏病手术史的患者心理韧性总得分[69.50(63.25,75.00)比65.50(58.00,72.00)]和“个人能力、高标准、坚韧维度”得分[22.00(18.50,26.00)比21.00(15.75,23.00)]均高于有心脏病手术史患者(P<0.05)。在职的患者“积极接受改变并确保关系维度”得分高于已经退休的患者[15.00(14.00,16.00)比14.00(12.00,15.00),P<0.05]。其他不同人口学资料患者的心理韧性及维度得分比较,差异均无统计学意义。结论应将冠心病患者的心理韧性水平及其相关因素纳入综合护理计划,以提高患者的生活质量,加强有效的应对策略,改善身心健康,并进一步预防并发症的发生。

工作环境效能问卷阿拉伯语版的信效度检验

目的确定工作环境效能问卷-Ⅱ(the Condition for Workplace Effectiveness Questionnaire-Ⅱ,CWEQ-Ⅱ)阿拉伯语版的心理测量学特征,此问卷用于测量护士结构性赋权的现状。为了提高问卷在阿拉伯语国家研究人员中的可用性和可信性,有必要提供有效及可靠的阿拉伯语版本问卷。方法采用横断面调查方法。2018年12月至2019年6月,选取约旦4所医院的275名护士为调查对象。采用内部一致性系数、折半系数验证问卷的信度,采用验证性因子分析评价问卷的因子结构。结果CWEQ-Ⅱ阿拉伯语版心理测量学特征支持6因子模型,包括机会、信息、资源、支持、正式权利及非正式权利。结果显示,问卷的拟合指数符合预定标准:CFI=0.96,RMSEA=0.06,Х^(2)/df=2.08。问卷的Cronbach’s α系数为0.95,各个维度的Cronbach’s α系数为0.83~0.89;总问卷折半系数为0.91,各维度折半系数为0.83~0.87。结论研究结果显示CWEQ-Ⅱ阿拉伯语版在测量护士结构性赋权应用中具有良好的信度和效度。

护士工作经验、结构性赋权及计算机使用态度的相关性研究

目的本研究旨在探讨护士工作经验、结构性赋权与计算机使用态度的关系。方法本研究属于横断面调查研究。采用人口统计学问卷、工作环境效能问卷-Ⅱ(the Conditions for Work Effectiveness Questionnaire-II,CWEQ-Ⅱ)和医疗实践工作中使用计算机的态度预测量表(the Pretest for Attitudes toward Computers in Healthcare,PATCH)对约旦4所医院的184名注册护士进行调查。结果护士的工作年限范围为1~26年,中位数为5.0年。护士PATCH得分为(61.90±11.38)分,其中45.1%护士对使用计算机的态度属于“在使用用户友好型计算机时感觉舒适”的类别。CWEQ-II平均得分为(12.40±2.43)分,其中机会为(3.57±0.87)分,资源为(2.83±0.85)分,信息为(3.06±0.79)分,支持为(2.95±0.86)分。127名(69.0%)护士具有中等水平的结构性赋权。护士的工作经验、结构性赋权分别与使用计算机的态度存在弱负相关(r=-0.17,P<0.05)及弱正相关(r=0.20,P<0.05)。结论结果显示,工作年限长的护士较不愿意使用计算机。加强护士的结构性赋权,改善工作环境可以改变护士对计算机使用的态度。

Social Support and Adolescents’ Alcohol Use: An Integrative Literature Review

The trajectories at treatment of alcohol use and abuse among adolescents have become a major health concern. The purpose of this paper was to discuss alcohol use and abuse among adolescents and its relationship to social support. Integrative review has been utilized to address the issue. There is a presentation of findings from research examining social support concepts and their relationship to adolescents’ alcohol use and abuse. Treatment requires awareness of underlying causes in order to establish effective treatment approaches. Determining these underlying causes requires adequate knowledge of family, peers, and societal influences on adolescents’ alcohol use and abuse. Health professionals across disciplines have an important role in implementing multidisciplinary interventions. The purpose of this paper was to discuss alcohol use and abuse among adolescents and its relationship to social support. Results, controversies and concerns raised by the reported results are addressed. Implications for future research are delineated.

纤维肌痛综合征的治疗

背景：目前尚未明确纤维肌痛综合征（fibromyalgia syndrome，FMS）的最佳疗法，相关的综合性循证指导原则也未见报道。 目的：为FMS的最佳治疗提供最新的循证指导原则。 资料来源、选择与提取：检索Cochrane Collaboration Reviews（1993年至2004年）、MEDLINE（1966年至2004年）、CINAHL（1982年至2004年）、EMBASE（1988年至2004年）、PubMed（1966年至2004年）、Heahhstar（1975年至2000年）、Current Contents（2000年至2004年）、Web of Science（1980年至2004年）、Psychlnfo（1887年至2004年）和Sciece Citation Indexes（1996年至2004年）上有关FMS的所有人群试验（随机对照试验及其汇总分析）。由美国疼痛协会（American Pain Society，APS）挑选出13位不同领域的疼痛治疗专家组成多学科小组，负责对文献进行评审。由APS的工作人员和犹他药品信息服务机构（Utah Drug Information Service）对部分文献进行评审，作为补充。共对505篇文章进行了审核。 数据综合：有关FMS的文献存在着重大缺陷，许多治疗性试验观测时间比较短，而且未经过盲法处理。目前，还没有哪种疗法被美国食品与药物管理局（US Food and Drug Administration）特批用于治疗FMS。但是，目前的证据表明，服用小剂量三环类抗抑郁药、开展心血管适应性锻炼、实施认知行为疗法、对患者进行教育都是有效的。其他几种常用疗法（如触发点注射）尚未经充分评价。 结论：尽管FMS是一种复杂的慢性疾病，但现有的药物干预及非药物干预仍能取得临床疗效。依据目前的证据，我们建议逐一实施患者教育、特定药物治疗、锻炼及认知疗法，必要时四管齐下。

The Interaction and Life Experiences between the Patient and the Nurse Caring for the Patient with COVID-19 in Turkey: A Qualitative Dyadic Approach

Previous research and observations have shown that COVID-19 affected both patients’and nurses’mental health.Even in the best times,one of the best ways to improve patients’experiences is to improve the health workers’experience.Therefore,it is important to be aware of the patterns of interaction between patients diagnosed with COVID-19 and the nurses caring for them and to help them recognize the strengths of their relationship.In this study,we aimed that purposed to discover the interaction and life experiences between the COVID-19 patients and the nurses who provided care for them in Turkey.With the dyadic approach,a qualitatively descriptive design has been used.The research examples consisted of 12 patients diagnosed with COVID-19 selected by purposeful exemplification and 12 nurses who provided care to them.Semi-structured individual in-depth interviews were conducted with individuals.The study adheres to the COREQ guidelines.As a result of the content analysis,four main themes came forward:life change,pandemic journey,getting strong together,new horizons.Institutions should focus on appropriate psychological interventions in order to fortify the relations and mental health of dyad members.Institutions should focus on appropriate psychological interventions in order to fortify the relations and mental health of dyad members.In our research,it is expected to guide related public institutions and non-governmental organizations on formulating policies related to protecting and maintaining the mental health of nurses and patients,extending the scope of existing information,providing patient-health worker security,to assess the problems on thefield through the eyes of patients-health workers and to take necessary precautions.This study,which deals with the interaction and life experiences of patients with COVID-19 and nurses who care for them,will shed light on patients,families,communities,organizations,health policies and systems.

Factors Associated with Substance Use Disorder among Adolescents Age Group: An Integrative Review

Aim: Reviewing the existed literature that addresses the factors influencing adolescent’s substance use disorder. Background: Substance use disorder among adolescents considered a major problem worldwide that affects adolescents wellbeing and destroys their functionality socially, physically and psychologically. Data Sources: A review of relevant literature uses electronic databases including EBSCO, MEDLINE, CINAHL, and PubMed. Methods: Using an integrative method, peer-reviewed research and discussion papers published between 2011 and 2019 and listed in the CINAHL, SCOPUS, Science Direct, PubMed and Google Scholar databases were reviewed. Findings: A final review of 9 studies that used quantitative and qualitative research methods to study many factors was related to the substance use disorder. Themes were: Influence of psychological factors on adolescents. Influence of socio-cultural factors on adolescents, the influence of biological factors on adolescents and the influence of environmental factors on adolescents. Conclusions: Reviewed articles revealed that many psychological, biological, socio-cultural, and environmental factors that increase adolescents risk having substance use disorder. For example, stressful life events during adolescents like loss of someone increase the risk to take illicit substances in order to forget painful memory;personal tendency like curiosity and experimentation, increase the risk to have risk health behaviors like substance use disorder. Furthermore, adolescence is a critical period that youth need more supervision and health education to protect them from Substance use disorder.

Correlation between Occupational Stress, Lifestyle, and Hyperglycemia among Obese and Non-Obese Middle-Aged Japanese Male Workers

The aim of this study was to identify the correlation between stress, lifestyle, and hyperglycemia among middle-aged Japanese male workers. We also analyzed the obese (OB) and non-obese (non- OB) groups pertaining to the risk of hyperglycemia. A total of 353 male employees aged between 50 and 59 years taking health checkup sat a company in Japan were examined. The data were collected using validated scales of occupational stress and medical examination. Of the 353 employees, 335 (effective response rate 95%) were analyzed. “Support from colleagues” and “reward from work” reported by the OB group were lower than the non-OB group. The items “eating until satiety” and “having greasy meal often” were significantly more common in the OB group than in the non-OB group. There was a significant correlation between less sleep time and hyperglycemia in the OB group than in the non-OB group. The non-OB group reported more overtime hours than the OB group. Hyperglycemia in the non-OB group was positively correlated with long working hours, “workload,” and “mental workload.” The results indicated that the OB group would benefit from lifestyle interventions, for example, improvement in sleep time and eating habits may prevent hyperglycemia and eventually in obesity. Furthermore, it was suggested that stress in response to “workload” and “mental workload” owing to long working hours leads to hyperglycemia in the non-OB group. Therefore, the improvement of the workplace environment, reducing the number of hours at work, and stress management are required to prevent hyperglycemia in the non-OB group.