Medical advice and diabetes self-management reported by Mexican-American, Black- and White-non-Hispanic adults across the United States

Background Diabetes has reached epidemic proportions in the United States, particularly among minorities, and if improperly managed can lead to medical complications and death. Healthcare providers play vital roles in communicating standards of care, which include guidance on diabetes self-management. The background of the client may play a role in the patient-provider communication process. The aim of this study was to determine the association between medical advice and diabetes self care management behaviors for a nationally representative sample of adults with diabetes. Moreover, we sought to establish whether or not race/ethnicity was a modifier for reported medical advice received and diabetes self-management behaviors. Methods We analyzed data from 654 adults aged 21 years and over with diagnosed diabetes [130 Mexican-Americans; 224 Black non-Hispanics; and, 300 White non-Hispanics] and an additional 161 with 'undiagnosed diabetes' [N = 815(171 MA, 281 BNH and 364 WNH)] who participated in the National Health and Nutrition Examination Survey (NHANES) 2007-2008. Logistic regression models were used to evaluate whether medical advice to engage in particular self-management behaviors (reduce fat or calories, increase physical activity or exercise, and control or lose weight) predicted actually engaging in the particular behavior and whether the impact of medical advice on engaging in the behavior differed by race/ethnicity. Additional analyses examined whether these relationships were maintained when other factors potentially related to engaging in diabetes self management such as participants' diabetes education, sociodemographics and physical characteristics were controlled. Sample weights were used to account for the complex sample design. Results Although medical advice to the patient is considered a standard of care for diabetes, approximately one-third of the sample reported not receiving dietary, weight management, or physical activity self-management advice. Participants who reported being given medical advice for each specific diabetes self-management behaviors were 4-8 times more likely to report performing the corresponding behaviors, independent of race. These results supported the ecological model with certain caveats. Conclusions Providing standard medical advice appears to lead to diabetes self-management behaviors as reported by adults across the United States. Moreover, it does not appear that race/ethnicity influenced reporting performance of the standard diabetes self-management behavior. Longitudinal studies evaluating patient-provider communication, medical advice and diabetes self-management behaviors are needed to clarify our findings.

Developing The Ladder To Professionalism

Developing The Ladder To Professionalism by Tom Baum, Manager, Curricula Development Unit and Patricia Reid, Training Advisor, Curricula Development Unit at the Council for Education, Recruitment and Training, State Agency for Hotels, Catering and Tourism in Dublin, Ireland: “Developments are currently in hand to promote increased professionalism in management within the hotel and catering industry in Ireland. The authors discuss the particular responsibility of educational agencies. Recent initiatives to provide a comprehensive and flexible career ladder encompassing craft training, in-service and “second-chance” education, as well as more conventional college-based initial management are reviewed, as are attempts by various industry associations to enhance the professionalism of members.” In this discussion, the authors have primarily devoted their attention to degree gaps in professionalism in the hospitality industry, and the measures that can be taken to mitigate these circumstances. “The hotel, catering, and tourism industry, in common with others involved in the service function, has been relatively slow to adopt modern approaches to management and technology at all levels,” Baum and Reid want you to know. The authors hail from Ireland and point to steps that the industry, in Ireland, is taking to address service problems. “Developments are taking place in Ireland toward professionalism in management in the context of the Irish hotel and catering industry; education and educationally related institutions have taken a role in contributing to the professionalization of work in this area,” say the authors. Baum and Reid point to CERT’s - The State Training Agency for Hotels, Catering and Tourism - involvement in promoting professionalism in the Irish hospitality industry, and provide a comprehensive graph to illustrate CERT’s paths to successful management. Worthy of note is, proprietor management is more common on that side of the Atlantic’, with most properties tending to be smaller than U.S. chain operations. That fact, by no means suggests that management style is indeed complete in the U.K, but it can be said that maybe such style is more congenial. “However, finding the balance between operationalism and the management and development functions seems to underpin perhaps the cardinal problems of professionalism in hotel and catering management in Ireland,” say the authors. “The dichotomy, clearly represented in the management of the industry, is equally evident within the educational and training system and also in the limited influence of associations…” Baum and Reid expand on that issue. The authors do concede that it is difficult to quantify what exactly constitutes good professionalism in the hospitality industry; it is, after all, a fairly subjective concept. They continue by describing some of the degree and sub-degree programs being offered in Ireland.

Medical Advice and Diabetes Self-Management Reported by Mexican-American, Black- and White-Non-Hispanic Adults Across the United States

Background: Diabetes has reached epidemic proportions in the United States, particularly among minorities, and if improperly managed can lead to medical complications and death. Healthcare providers play vital roles in communicating standards of care, which include guidance on diabetes self-management. The background of the client may play a role in the patient-provider communication process. The aim of this study was to determine the association between medical advice and diabetes self care management behaviors for a nationally representative sample of adults with diabetes. Moreover, we sought to establish whether or not race/ethnicity was a modifier for reported medical advice received and diabetes self-management behaviors. Methods: We analyzed data from 654 adults aged 21 years and over with diagnosed diabetes [130 MexicanAmericans; 224 Black non-Hispanics; and, 300 White non-Hispanics] and an additional 161 with ‘undiagnosed diabetes’ [N = 815(171 MA, 281 BNH and 364 WNH)] who participated in the National Health and Nutrition Examination Survey (NHANES) 2007-2008. Logistic regression models were used to evaluate whether medical advice to engage in particular self-management behaviors (reduce fat or calories, increase physical activity or exercise, and control or lose weight) predicted actually engaging in the particular behavior and whether the impact of medical advice on engaging in the behavior differed by race/ethnicity. Additional analyses examined whether these relationships were maintained when other factors potentially related to engaging in diabetes self management such as participants’ diabetes education, sociodemographics and physical characteristics were controlled. Sample weights were used to account for the complex sample design. Results: Although medical advice to the patient is considered a standard of care for diabetes, approximately onethird of the sample reported not receiving dietary, weight management, or physical activity self-management advice. Participants who reported being given medical advice for each specific diabetes self-management behaviors were 4-8 times more likely to report performing the corresponding behaviors, independent of race. These results supported the ecological model with certain caveats. Conclusions: Providing standard medical advice appears to lead to diabetes self-management behaviors as reported by adults across the United States. Moreover, it does not appear that race/ethnicity influenced reporting performance of the standard diabetes self-management behavior. Longitudinal studies evaluating patient-provider communication, medical advice and diabetes self-management behaviors are needed to clarify our findings.