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J T Saunders

Publications and source records attributed to J T Saunders.

14 recordsLinked to original sources
PubMed2000

A national diabetes care and education programme: the Ghana model.

An account is given of how a national diabetes care and education programme was developed in Ghana, a developing country, through international collaboration of medical schools, industry and government health care institutions. The approach is by way of trained diabetes teams consisting of physicians, dietitians and nurse educators at two tertiary institutional levels (teaching hospitals) who in turn trained teams consisting of physicians, dietitians or diettherapy nurses, nurse educators and pharmacists at regional and district/sub-regional levels to offer care and education to patients and the community. In three years all regional and about 63% of sub-regional/district health facilities had trained diabetes health care teams, run diabetes services and had diabetes registers at these institutions. Additionally a set of guidelines for diabetes care and education was produced. All programme objectives with the exception of one (deployment of diabetes kits) were met. Distances to be travelled by persons with diabetes to receive diabetes care had been reduced considerably. The success of the project has given an impetus to the collaborators to extend the programme to the primary health care level. The continuing prohibitive prices of diabetes medications and supplies however, could be addressed by removing taxes on such supplies. The Ghana diabetes care model, a 'top-down' approach, initially involving two diabetes centres is recommended to other developing countries, which intend to incorporate diabetes care and education into their health care system.

Delivery of Health Care↗
PubMed2000

PICCOLO: a tool for combinatorial library design via multicriterion optimization.

Combinatorial library design is by nature a multicriterion problem. These criteria often include reagent diversity, product similarity to lead compounds and product novelty with respect to a corporate compound bank. More recently, developability and druglikeness have also attracted much attention in library design practices. To address this multicriterion design problem, we have developed a computer program (PICCOLO) that simultaneously optimizes all the factors under consideration using a weighted sum optimization technique. In this paper, we describe the overall design of this program and the formulation of individual penalty functions that characterize the underlying design criteria. We also give an example to illustrate the process and the result of a library design using this program.

Algorithms↗
PubMed2000

Genetic targeting of green fluorescent protein to gonadotropin-releasing hormone neurons: characterization of whole-cell electrophysiological properties and morphology.

GnRH neurons form the final common pathway for central control of reproduction, with regulation achieved by changing the pattern of GnRH pulses. To help elucidate the neurobiological mechanisms underlying pulsatile GnRH release, we generated transgenic mice in which the green fluorescent protein (GFP) reporter was genetically targeted to GnRH neurons. The expression of GFP allowed identification of 84-94% of immunofluorescently-detected GnRH neurons. Conversely, over 99.5% of GFP-expressing neurons contained immunologically detectable GnRH peptide. In hypothalamic slices, GnRH neurons could be visualized with fluorescence, allowing for identification of individual GnRH neurons for patch-clamp recording and subsequent morphological analysis. Whole-cell current-clamp recordings revealed that all GnRH neurons studied (n = 23) fire spontaneous action potentials. Both spontaneous firing (n = 9) and action potentials induced by injection of depolarizing current (n = 17) were eliminated by tetrodotoxin, indicating that voltage-dependent sodium channels are involved in generating action potentials in these cells. Direct intracellular morphological assessment of GnRH dendritic morphology revealed GnRH neurons have slightly more extensive dendrites than previously reported. GnRH-GFP transgenic mice represent a new model for the study of GnRH neuron structure and function, and their use should greatly increase our understanding of this important neuroendocrine system.

Action Potentials↗
PubMed2000

Is "sugar" the same as diabetes? A community-based study among rural African-Americans.

OBJECTIVE: To determine if differing beliefs about high blood glucose exist and are associated with blood glucose control among rural African-Americans. RESEARCH DESIGN AND METHODS: A community-based sample of rural African-Americans completed a survey, and a subsample underwent a subsequent screening that included glucose and GHb measurement. Participants were asked if they thought they had diabetes or sugar-diabetes on the survey; "sugar" was added to the screening along with specific questions about this condition. RESULTS: A total of 1,031 people completed the survey, and 403 the screening exam. The total prevalence of diabetes was 13.6% for men and 15.5% for women. Among those who reported having one of the three conditions, 64% said they had diabetes, 7% sugar-diabetes, and 29% sugar. There was a discrepancy between the survey and screening in that 31% of subjects who answered "yes" to whether they had sugar at the screening had answered "no" to the survey question about diabetes. Subjects who believed they had sugar felt their condition was less serious and had higher glucose levels than those who said they had diabetes. CONCLUSIONS: Diabetes was very common in this population. Over one-fourth of those with diabetes believed they had the condition "sugar." Efforts are needed to improve control of diabetes in this population and should consider these disparate health beliefs.

Adult↗
PubMed1998

Facilities and resources for diabetes care at regional health facilities in southern Ghana.

In the fall of 1995, each of the five provincial hospitals in southern Ghana was visited and facilities and resources for diabetes care assessed. In addition, health facilities and standards of care questionnaires were completed. Only Korle Bu Teaching Hospital run a diabetes clinic and had diabetologists. Only two facilities had an eye specialist or trained dietician. None of the five facilities had a trained diabetes educator or chiropodist. Except for sphygmomanometers, basic equipment for clinical care were lacking. Basic biochemistry tests were available at all facilities. Creatinine clearance and 24-h urine protein, glycated haemoglobin, fasting triglyceride, total cholesterol and HDL cholesterol were available at only one centre. None of the facilities measured C-peptide, islet cell antibody and urine microalbumin. None of the facilities had chronic haemodialysis service. Insulin supply was erratic at two institutions. Three regions had active diabetes associations. The facilities and system of diabetes care in southern Ghana revealed in this study are far from satisfactory. Training of health care personnel in diabetes management and education may enhance diabetes care despite the existing constraints. Furthermore, the development of international and regional guidelines for facilities and resources may facilitate implementation of international resolutions and clinical practice guidelines.

Diabetes Mellitus↗
PubMed1997

Prevalence of coronary heart disease risk factors among rural blacks: a community-based study.

BACKGROUND: Coronary heart disease (CHD) remains the most common cause of death among blacks, and the difference in CHD mortality between blacks and whites is growing. This trend may be due in part to higher rates of CHD risk factors among blacks. This study was done to determine the prevalence of CHD risk factors among a population-based sample of 403 rural blacks in Virginia. METHODS: Community-based screening evaluations included the determination of exercise and smoking habits, blood pressure, height, weight, total and high-density lipoprotein (HDL) cholesterol, and glycosylated hemoglobin. RESULTS: The prevalences of smoking (32.5% of men, 20.0% of women), high cholesterol (16.6% of men, 18.9% of women) and sedentary lifestyle (37.5% of men, 66.7% of women) were similar to prevalences reported for other black populations. However, the prevalences of diabetes (13.6% of men, 15.6% of women), hypertension (30.9% of men, 43.1% of women), and obesity (38.7% of men, 64.7% of women) were higher than those reported elsewhere. Increased body mass index was significantly associated with higher prevalences of hypertension, diabetes, and low HDL cholesterol. CONCLUSIONS: Innovative methods are needed to decrease the high risk factor prevalences among this population.

Adult↗
PubMed1994

Thermal biofeedback in the treatment of intermittent claudication in diabetes: a case study.

The objective of the present case study was to examine the therapeutic effects of thermal biofeedback-assisted autogenic training on a patient with non-insulin-dependent diabetes mellitus (NIDDM), vascular disease, and symptoms of intermittent claudication. The patient received thermal biofeedback from the hand for five sessions, then from the foot for 16 sessions, while hand and foot skin temperature were monitored simultaneously. In addition, the patient was instructed in autogenic training and practiced daily at home. Follow-up measurements were taken at 12 and 48 months. Within-session foot temperature rose specifically in response to foot temperature biofeedback and starting foot temperature rose between sessions. Posttreatment blood pressure was reduced to a normal level. Attacks of intermittent claudication were reduced to zero after 12 sessions and walking distance increased by about a mile per day over the course of treatment. It would appear that thermal biofeedback and autogenic training are potentially promising therapies for persons with diabetes and peripheral vascular disease.

Biofeedback, Psychology↗
PubMed1992

Combination of very-low-calorie diet and behavior modification in the treatment of obesity.

Very-low-calorie diets (VLCDs) cause rapid weight loss. However, weight regain is rapid upon discontinuing the VLCD unless lifestyle is altered. The addition of a behavioral-modification (BMOD) program improves the long-term outcome. The major components of a BMOD program to alter lifestyle are education about nutrition and eating habits with alteration of amount and patterns of eating, institution of an aerobic activity program designed to increase energy expenditure, training in self-awareness and assertiveness, and training in coping techniques for long-term alteration of lifestyle. By retrospective chart review, we evaluated two VLCD programs at the same institution. One program gave 12 wk of BMOD before a 12-wk course of VLCD (Program 1), then scheduled individual visits regularly thereafter. The other program used simultaneous VLCD and BMOD in a 26-wk treatment course (Program 2), consisting of 2 wk of stabilization on 5020 kJ/d (1200 kcal/d), 12 wk of VLCD, and 12 wk of transition to a low-calorie solid food diet. Follow-up was obtained at 1 y in both groups. Maximum weight loss was similar, but subjects in Program 2 regained about one-third of the lost weight versus approximately 10% in Program 2. A third program of preceding BMOD followed by a low-calorie diet (Program 3) gave similar weight maintenance at 1 y as Program 1. Prospective studies are needed to determine if BMOD simultaneously with or preceding VLCD promotes better long-term weight maintenance. These data confirm the benefits of long-term follow-up for maintaining weight loss.

Adult↗
PubMed1990

Validation of scale measuring environmental barriers to diabetes-regimen adherence.

This study reports on the validation of a diabetes-specific measure of environmental barriers to regimen adherence. The reliability and validity of the environmental barriers to adherence scale (EBAS) were determined for a sample of 214 insulin-dependent and non-insulin-dependent diabetic patients. The scale was shown to be a valid measure of barriers to adherence as assessed by its relationship to the barriers to adherence questionnaire and the barriers to adherence portion of the diabetes-care profile. The medication, testing, exercise, and diet subscales of the EBAS were correlated with four corresponding and three noncorresponding measures of self-care behavior from the diabetes self-care behaviors scale. Each subscale correlated well with its corresponding self-care behavior. The internal consistency of the scale and the test-retest reliability were found to be good. The results suggest that the EBAS scale is a valid, reliable measure of barriers to diabetes-regimen adherence.

Diabetes Mellitus↗
PubMed1975

Job design variables as change measures in a correctional facility.

The importance of working conditions is stressed as a neglected area of concern in human service organizations. The present investigation attempts to demonstrate the utility of the concept of job design dimensions as evaluative measures of change in a correctional facility for delinquent youth. Staff were administered a modified version of the Hackman/Lawler Job Design Inventory at two time periods separated by an interval of 14 months. Staff who were participants in an innovative institutional change program at both times were compared with staff who were not participants at Time I but were at Time II. The results provide support for the notion that examination of the perceptions of working conditions by employees may be an important method for assessing institutional change.

Adolescent↗