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Articles by S. Thomas
Total Records ( 6 ) for S. Thomas
  H Kendig , C Browning , R Pedlow , Y Wells and S. Thomas
 

Background: strategies to enable older people to remain in their own homes require information on potential intervention areas and target groups for health promotion and healthcare services.

Objective: this study aimed to identify socioeconomic, health and lifestyle factors in entry to residential aged care facilities.

Design: a prospective cohort study was conducted from 1994 to 2005.

Setting: the information source was the Melbourne Longitudinal Studies on Healthy Ageing Program.

Subjects: one thousand Australians aged 65 years and over living in the community were used as baseline sample.

Methods: socio-medical data were gathered in face-to-face baseline interviews, and outcomes were identified in biennial follow-ups with respondents, informants and death registries over 12 years. Cox regression models identified baseline predictors of subsequent entry to residential aged care for men and women from among socio-demographic, health status and lifestyle factors.

Results: the most significant factors were older age, Instrumental Activities of Daily Living (IADL) dependence, cognitive impairment, underweight body mass index (BMI) and low social activity. For men only, the number of medical conditions and healthy nutrition score also emerged as significant. For women only, never having been married, IADL dependence and low BMI also were significant. For men, the risk of entry to residential aged care facilities was associated mainly with disease burden, whereas for women, social vulnerability and functional capacities were more important. Healthy lifestyles were important indirectly insofar as they influenced subjects' health status.

Conclusion: to facilitate older people to stay in the community, it is important to treat or ameliorate medical conditions, promote healthy lifestyles and consider gender-specific risks.

  K. Ridge , J. Treasure , A. Forbes , S. Thomas and K. Ismail
  Aims To elicit the barriers and motivators to better diabetes self care in patients with Type 1 diabetes. Methods  We obtained a purposive sample of 47 patients with Type 1 diabetes and persistent suboptimal glycaemic control from a randomized controlled trial of nurse-delivered psychological interventions. Each participant’s second session of motivational interviewing was analysed using content analysis. Results Four major themes emerged: emotions of living with Type 1 diabetes, perceived barriers to diabetes management, motivators for change and methods of coping. Increased assistance and support from family and healthcare teams, the prospect of improved emotional and physical well-being and feelings of success were described as factors that might motivate participants to practice more effective self care. Conclusions An enhanced awareness of the range of psychological concepts in diabetes may enable a better therapeutic relationship between clinicians and patients.
  J. Karalliedde , S. Vijayanathan and S. Thomas
  Background  Macro- and microvascular complications of diabetes are varied and can present with a range of clinical signs and symptoms. Diabetic muscle infarction is a rare vascular complication of diabetes that is often not recognized.

Case report  We report a case of diabetic muscle infarction, where a 65-year-old woman with Type 2 diabetes presented with acute-onset severe pain in her right leg and foot drop.

Conclusions  Her foot drop was a result of a concomitant compression nerve injury as a consequence of the muscle oedema following infarction. Our case highlights the importance of early recognition and investigation of atypical presentations of vascular complications of diabetes.

  A. Patel , E. Maissi , H.-C. Chang , I. Rodrigues , M. Smith , S. Thomas , T. Chalder , U. Schmidt , J. Treasure and K. Ismail
  Aims  To assess the cost-effectiveness of motivational enhancement therapy and cognitive behaviour therapy for poorly controlled Type 1 diabetes.

Methods  Within-trial prospective economic evaluation from (i) health and social care and (ii) societal perspectives. Three hundred and forty-four adults with Type 1 diabetes for at least 2 years and persistent, suboptimal glycaemic control were recruited to a three-arm multi-centre randomized controlled trial in London and Manchester, UK. They were randomized to (i) usual care plus four sessions of motivational enhancement therapy (ii) usual care plus four sessions of motivational enhancement therapy and eight sessions of cognitive behaviour therapy or (iii) usual care alone. Outcomes were (i) costs, (ii) Quality-Adjusted Life Year gains measured by the EuroQol 5-dimensional health state index and the 36-item Short Form and (iii) diabetes control measured by change in HbA1c level at 1 year.

Results  Both intervention groups had significantly higher mean health and social care costs (+ £535 for motivational enhancement therapy and + £790 for combined motivational enhancement and cognitive behavioural therapy ), but not societal costs compared with the usual-care group. There were no differences in Quality Adjusted Life Years. There was a significantly greater HbA1c improvement in the combined motivational enhancement and cognitive behavioural therapy group (+ 0.45%; incremental cost-effectiveness ratio = £1756), but the not in the motivational enhancement therapy group. Cost-effectiveness acceptability curves suggested that both interventions had low probabilities of cost-effectiveness based on Quality Adjusted Life Years (but high based on HbA1c improvements). Imputing missing costs and outcomes confirmed these findings.

Conclusions  Neither therapy was undisputedly cost-effective compared with usual care alone, but conclusions vary depending on the relative importance of clinical and quality-of-life outcomes.

  K. Ridge , S. Thomas , P. Jackson , S. Pender , S. Heller , J. Treasure and K. Ismail
 

Aims

To describe the development of an intervention for parents and carers of young people with Type 1 diabetes and assess the feasibility, acceptability and emerging clinical themes.

Methods

Participants were carers of young persons aged 10-18 years with a diagnosis of Type 1 diabetes of more than 12 months' duration in two inner-city South London hospitals. Carers were invited to attend six sessions of a group workshop where they received emotional support, diabetes education and were taught motivational interviewing techniques to support their child.

Results

Out of 106 eligible participants, carers of 31 young people with Type 1 diabetes were recruited, 17 of whom ‘completed’ the intervention (attending four or more sessions). Participants discussed a variety of themes in session, including the increasing difficulty of diabetes management as children grow older, parenting techniques for managing diabetes in the home and the emotional challenges of having a child with a chronic illness.

Conclusions

Engaging parents in a carer intervention for Type 1 diabetes was a challenge, but parents who participated appeared to value the programme. Future interventions for carers need to take account of carers' wishes and expectations in order to maximize user uptake.

  R. A. Maitland , P. T. Seed , A. L. Briley , M. Homsy , S. Thomas , D. Pasupathy , S. C. Robson , S. M. Nelson , N. Sattar and L. Poston
 

Aim

To examine the prediction of gestational diabetes in obese women using routine clinical measures and measurement of biomarkers related to insulin resistance in the early second trimester.

Methods

A total of 117 obese pregnant women participating in a pilot trial of a complex intervention of dietary advice and physical activity were studied. Blood samples were obtained at recruitment (15+0-17+6 weeks' gestation) and demographic, clinical history and anthropometric measures recorded. The biomarkers analysed were plasma lipids (HDL cholesterol, LDL cholesterol, triglycerides), high-sensitivity C-reactive protein, alanine transaminase, aspartate transaminase, ferritin, fructosamine, insulin, adiponectin, tissue plasminogen activator, interleukin-6, visfatin and leptin. Univariate and logistic regression analyses were performed to determine independent predictors and area under the receiver-operating curve was calculated for the model.

Results

Of the 106 participants included in the analysis, 29 (27.4%) developed gestational diabetes. Participants with gestational diabetes were older (= 0.002), more often of parity ≥ 2, had higher systolic (= 0.02) and diastolic blood pressure (= 0.02) and were more likely to be black (= 0.009). Amongst the blood biomarkers measured, plasma adiponectin alone remained independently associated with gestational diabetes in adjusted models (= 0.002). The area under the receiver-operating curve for clinical factors alone (0.760) increased significantly (area under the curve 0.834, chi-square statistic (1) = 4.00, = 0.046) with the addition of adiponectin.

Conclusions

A combination of routinely measured clinical factors and adiponectin measured in the early second trimester in obese women may provide a useful approach to the prediction of gestational diabetes. Validation in a large prospective study is required to determine the usefulness of this algorithm in clinical practice. (Clinical Trial Registry No: ISRCTN89971375)

 
 
 
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