The needs, concerns and characteristics of younger Australian adults with Type 2 diabetes

Aims : The mean age of onset of Type 2 diabetes mellitus is decreasing in Australia and internationally. We conducted an internet-based survey to improve our understanding of the emotional well-being and unmet needs of younger adults with Type 2 diabetes, and to inform service provision for this group.

Methods : A random sample of National Diabetes Services Scheme registrants (n = 1,417) with Type 2 diabetes, aged 18–39 years, living in the Australian state of Victoria received an invitation to complete the online survey. The study was also advertised state-wide. The survey included validated scales (PAID-5: diabetes-related distress; WHO-5: general emotional well-being) and study-specific items. A total of 149 eligible respondents participated.

Results : Almost two-thirds (63%) of respondents reported severe-diabetes related distress; more than a quarter (27%) had impaired general emotional well-being. Most (82%) were overweight or obese (BMI ≥ 25); most (77%) had at least one other co-morbidity. Lack of motivation, feeling burned out, and being time-poor were identified as top barriers to self-management. More than half (59%) of respondents had not participated in structured diabetes education. Respondents perceived that younger adults with Type 2 diabetes had different health-care needs than their older counterparts (68%), and that most Type 2 diabetes information/services were aimed at older adults (62%). Of a range of potential new services, respondents indicated greatest interest in an online forum specifically for younger adults with Type 2 diabetes.

Conclusions : Younger adults with Type 2 diabetes have impaired emotional well-being and physical health. Population-based research is needed to confirm the current findings, to further inform service delivery and optimise outcomes for this group.

Information needs of young adults with type 2 diabetes : a literature review

Background Type 2 diabetes (T2DM) is increasingly prevalent in young adults but there is very little information about what information they need to undertake diabetes self-management.

Aim To undertake a structured literature review to identify what information people with type 2 diabetes aged 25 to 45 years need to manage their diabetes and how they would like to receive it.

Methods A structured literature search was conducted. The MEDLINE, CINAHL, AMI, APAIS-Health databases were searched for articles published between 1980 and 2011. The reference list of journals and relevant websites were searched. Inclusion criteria were: literature about T2DM in young adults and literature about education and information needs of young adults with T2DM.

Results Only one article specifically focussed on the information needs of young people with T2DM and two reports included some information about T2DM and young adults. The limited data available suggested young adults with T2DM have specific information needs that are not sufficiently addressed in current resources, and have some needs different from young people with type 1 diabetes. Young people with T2DM want clear, consistent information from credible sources, delivered in a range of formats. They also want psychological support and counselling, age-specific education groups, after hours access to health professionals and education provided to family members and the community about T2DM in young people and about how to support people with T2DM.

Conclusion With the prevalence of T2DM in young adults continuing to increase, the need to address the specific information needs and learning styles of people with T2DM aged 25 to 45 is increasingly important.

Self-management needs during life transitions among younger people with type 2 diabetes : an Australian and Danish cohort comparison

The primary aim of this pilot study is to provide cross-cultural and detailed insights into how psychological and social factors impact on younger people with type 2 diabetes (T2DM) and self-management skille (20-40 years). The specific objectives are to: identify self-management strategies used by younger people with T2DM during life transitions in the period from 20-40 years of age; investigate participants' perception of self-management to identify the specific needs of younger people with T2DM. This research will provide health professionals with insights to the specific needs for young adults with T2DM and will add ground breaking innovative information by investigating cultural comparison between Australia and Denmark.

Legitimising lethal male violence : why defensive homicide needs to be abolished

This articles examine the unintended operation defensive homicide in Victoria since its introduction in November 2005. In doing so, its makes an argument for the abolition of this alternative offence to murder. 

Diabetes care provision: barriers, enablers and service needs of young adults with Type 1 diabetes from a region of social disadvantage

AIMS:
To determine the barriers to and enablers of engaging with specialist diabetes care and the service requirements of young adults with Type 1 diabetes mellitus from a low socio-economic, multicultural region.

METHODS:
A cross-sectional survey targeted 357 young adults with Type 1 diabetes, aged 18-30 years. Participants completed questions about barriers/enablers to accessing diabetes care and service preferences, self-reported HbA(1c), plus measures of diabetes-related distress (Problem Areas in Diabetes), depression/anxiety (Hospital Anxiety and Depression Scale), and illness perceptions (Brief Illness Perceptions Questionnaire).

RESULTS:
Eighty-six (24%) responses were received [55 (64%) female; mean ± sd age 24 ± 4 years; diabetes duration 12 ± 7 years; HbA(1c) 68 ± 16 mmol/mol (8.4 ± 1.5%)]. Logistical barriers to attending diabetes care were reported; for example, time constraints (30%), transportation (26%) and cost (21%). However, 'a previous unsatisfactory diabetes health experience' was cited as a barrier by 27%. Enablers were largely matched to overcoming these barriers. Over 90% preferred a multidisciplinary team environment, close to home, with after-hours appointment times. Forty per cent reported severe diabetes-related distress, 19% reported moderate-to-severe depressive symptoms and 50% reported moderate-to-severe anxiety.

CONCLUSIONS:
Among these young adults with Type 1 diabetes, glycaemic control was suboptimal and emotional distress common. They had identifiable logistical barriers to accessing and maintaining contact with diabetes care services, which can be addressed with flexible service provision. A substantial minority were discouraged by previous unsatisfactory experiences, suggesting health providers need to improve their interactions with young adults. This research will inform the design of life-stage-appropriate diabetes services targeting optimal engagement, access, attendance and ultimately improved healthcare outcomes in this vulnerable population.

Polyandry in a marine turtle : females make the best of a bad job

The female perspective on reproductive strategies remains one of the most active areas of debate in biology. Even though a single mating is often sufficient to satisfy the fertilization needs of most females and the act of further mating incurs costs, multiple paternity within broods or clutches is a common observation in nature. Direct or indirect advantage to females is the most popular explanation. However, the ubiquity of this explanation is being challenged by an increasing number of cases for which benefits are not evident. For the first time, we test possible fitness correlates of multiple paternity in a marine turtle, an organism that has long attracted attention in this area of research. Contrary to the wide-spread assumption that multiple mating by female marine turtles confers fitness benefits, none were apparent. In this study, the environment played a far stronger role in determining the success of clutches than whether paternity had been single or multiple. A more likely explanation for observations of multiply sired clutches in marine turtles is that these are successful outcomes of male coercion, where females have conceded to superfluous matings as a compromise. Thus, multiple matings by female marine turtles may be a form of damage control as females attempt to make the best of a bad job in response to male harassment.

Project-oriented design-based learning: aligning students’ views with industry needs

This paper focuses on the alignment of students' views on project-oriented design-based learning (PODBL) with today's industrial needs. A Collaborative relationship between academic institutions and industrial expectations is a significant process towards analytical thinking (linking the theory and practice). Improving students' knowledge as well as the students' transition into industry, requires efficient joint ventures by both learning institutions and industry partners. Project-based learning (PBL) is well developed and implemented in most engineering schools and departments around the world. What requires closer attention is the focus on design within this project-based learning framework. Today design projects have been used to motivate and teach science in elementary, middle, and high school classrooms. They are also used to assist students with possible science and engineering careers. For these reasons, design-based learning (DBL) is intended to be an effective approach to learning that is centered on a design problem-solving structure adopted for a problem-oriented project-based education. Based on an industry design forum, which the authors conducted in Melbourne, Australia in 2012, a research study was performed to investigate the industry and academic requirements for students focusing on achieving design skills. To transform the present situation in the academic teaching and learning environment and to fulfill industry needs, this research study also investigated the students' views on design skills.