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Hara Y.,Kurume University | Iwashita S.,Chidoribashibyouin Sue Clinic | Okada A.,Okada Clinic | Tajiri Y.,Kurume University | And 6 more authors.
BioPsychoSocial Medicine

Background: Patient empowerment has recently been proposed as an important concept in self-management for effective glycemic control. A concise self-completed questionnaire for patients with type 2 diabetes mellitus was created to comprehensively evaluate their empowerment on the basis of self-managed dietary/exercise behaviors, psychological impact, and family support. The reliability and validity of this short questionnaire were tested and factors relating to patient empowerment were analyzed.Methods: The self-completed empowerment questionnaire was based on questionnaires for self-managed dietary and exercise behaviors, the Appraisal of Diabetes Scale, and the Diabetes Family Behavior Checklist. The questionnaire was trialed on 338 male and female patients with type 2 diabetes mellitus who lived with family. The validity and reliability of the questionnaire were investigated and stepwise multiple linear regression analysis was used to identify factors that affect patient empowerment.Results: The self-completed patient empowerment questionnaire included 13 questions on background data (e.g., age, gender, and HbA1c) and 18 questions within five scales to assess self-managed dietary behaviors, self-managed exercise behaviors, and psychological impact of diabetes, as well as positive and negative feedback in patient-family communication. The questionnaire showed sufficient internal consistency, construct validity, reproducibility, factorial construct validity, and concurrent validity. The results were generally satisfactory, and the questionnaire reflected the particular characteristics of treatment methods. Multiple linear regression analysis showed that patient empowerment was strongly affected by the number of disease-related symptoms, age, and gender.Conclusions: The results suggest that the concise self-completed empowerment questionnaire developed here is useful for measuring the empowerment of individual patients and evaluating the impact of symptoms and therapies on empowerment. © 2014 Hara et al.; licensee BioMed Central Ltd. Source

Yamada S.,Osaka City University | Inaba M.,Osaka City University | Okada S.,Okada Clinic | Imanishi Y.,Osaka City University | And 4 more authors.
Metabolism: Clinical and Experimental

Sustained high glucose impairs bone metabolism in patients with type 2 diabetes mellitus (T2DM). In this study, the relationship between glycemic control and bone metabolism was examined in male hemodialysis (HD) patients with T2DM. To avoid the effect of menstruation and the menstrual cycle, obesity, and glycosuria-induced hypercalciuria on bone metabolism, male anuric nonobese HD patients with T2DM (n = 42) were enrolled. Calcaneus stiffness index (SI) was determined using ultrasound after HD session. Casual plasma glucose (PG), glycated hemoglobin (HbA 1c), and glycated albumin (GA) were measured before the HD session. In simple regression analysis, log PG (r = -0.333, P < .05) and log GA (r = -0.350, P < .05), but not log HbA 1c (r = -0.134, P = .3985), exhibited significant and negative correlations with calcaneus SI. In multiple regression analysis including log BMI, log cCa × Pi product, and log PG, log PG was associated significantly in a negative manner with calcaneus SI, in addition to log cCa × Pi product. When log PG was replaced with log GA or log HbA 1c, log GA, but not log HbA 1c, emerged as a significant factor associated. The mechanism as to why HbA 1c failed to associate could be explained by its false reduction by erythropoietin injection. The present study supported the notion of GA as an appropriate indicator for glycemic control in HD patients with T2DM. Furthermore, it is suggested that poor glycemic control might be a significant factor toward decreasing calcaneus SI in T2DM HD patients. © 2010 Elsevier Inc. All rights reserved. Source

Hara Y.,Kurume University | Iwashita S.,Chidoribashibyouin Sue Clinic | Inada C.,Inada Medical Clinic | Okada A.,Okada Clinic | And 12 more authors.
Diabetes Research and Clinical Practice

Aims: An appropriate questionnaire for assessing family support of self-management behavior of Japanese Type 2 diabetes patients has yet to be developed. We produced a Japanese version of the Diabetes Family Behavior Checklist (DFBC) and tested its reliability and validity. Methods: The study enrolled Japanese patients with Type 2 diabetes mellitus who were living with their families: 158 patients in the Insulin Group and 169 in the Oral Hypoglycemic Agents Group. The external validity of the DFBC was tested with questionnaires of self-managed dietary and exercise behaviors, the Appraisal of Diabetes Scale (ADS), and HbA1c. Results: The DFBC comprised two components: " Negative" and " Positive" feedbacks. Cronbach's alpha in the subcategories was ≥0.93, and the test-retest showed an intraclass correlation coefficient of 0.89. " Positive" and " Negative" scores correlated with self-managed dietary and/or exercise behaviors, the ADS scores in the both Groups. For patients having HbA1c levels of ≤6.8% there was a correlation between their " Positive" and " Negative" scores and the scores of their families in both Groups. Conclusion: The DFBC showed evidence of validity and reliability and may be a useful tool for quick assessment of self-managed treatment behavior of Japanese Type 2 diabetes patients and support received from their family. © 2012 Elsevier Ireland Ltd. Source

Okamoto M.,Tottori Prefectural Central Hospital | Kakehi E.,Tottori Prefectural Central Hospital | Maeda K.,Tottori Prefectural Central Hospital | Yanagitani A.,Tottori Prefectural Central Hospital | And 4 more authors.
Gastroenterological Endoscopy

We describe a patient who had a hamartomatous inverted polyp (HIP) of the stomach. A 59-year-old woman was admitted to our hospital for further examination of a protruding lesion of the stomach. A tumor in the anterior wall of the upper body of the stomach was incidentally revealed during an upper gastrointestinal X-ray series at a mass screening. Gastrointestinal endoscopy disclosed a pedunculated submucosal tumor (SMT). The tumor was resected endoscopically. Histological examination revealed submucosal proliferation of gastric glands and the adjacent cystic structure. The surface of the tumor was covered with normal mucosa. A definite diagnosis of HIP was made. Some complications such as bleeding, obstruction and coexisting gastric cancer have been reported. Though it is difficult to make a definite diagnosis before resection, we should consider an HIP in the differential diagnosis of gastric SMT. Source

Nimmannitya K.,Osaka City University | Tateishi C.,Osaka City University | Mizukami Y.,Osaka City University | Hamamoto K.,Osaka City University | And 4 more authors.
Journal of Dermatology

Psoriasis is a common chronic inflammatory skin disease but psoriasis patients with renal impairment undergoing dialysis are not frequently seen. Furthermore, the published work contains little information on the treatment with biologic drugs of patients with end-stage renal disease. We describe a 57-year-old man with refractory plaque-type psoriasis and end-stage renal disease due to polycystic kidney disease undergoing hemodialysis. He had tried topical medications and ultraviolet therapy for many years and was then treated with ustekinumab (an interleukin-12 and interleukin-23 blocker), which resulted in good clinical response along with stable renal function. After a few years of therapy, no side-effects have been observed. Our experience with this patient expands the spectrum of ustekinumab to include psoriasis patients with renal failure undergoing hemodialysis. © 2015 Japanese Dermatological Association. Source

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