Overcoming barriers to diabetes control in geriatrics

Modulating peroxisome proliferator-activated receptors for therapeutic benefit? Biology, clinical experience, and future prospects

Clinical trials of cardiovascular disease (CVD) prevention in patients with type 2 diabetes mellitus primarily have been directed at the modification of a single major risk factor; however, in trials that enroll patients with and without diabetes, the absolute risk in CVD events remains higher in patients with diabetes. Efforts to reduce the macrovascular and microvascular residual risk have been directed toward a multifactorial CVD risk-factor modification; nonetheless, long-term complications remain high. Dual-peroxisome proliferator-activated receptor (PPAR) α/γ agonists may offer opportunities to lower macrovascular and microvascular complications of type 2 diabetes mellitus beyond the reductions achieved with conventional risk-factor modification. The information presented elucidates the differentiation of compound-specific vs class-effect properties of PPARs as the basis for future development of a new candidate molecule. Prior experience with thiazolidinediones, an approved class of PPARγ agonists, and glitazars, investigational class of dual-PPARα/γ agonists, also provides important lessons about the risks and benefits of targeting a nuclear receptor while revealing some of the future challenges for regulatory approval.

Control in childbirth: a concept analysis and synthesis

AIM

To report a concept analysis of control in childbirth.

BACKGROUND

Control has a variety of definitions from a wide range of disciplines. In childbirth, however, the concept is more tenuous and depends on the context. It can be viewed in relationship to a woman's body and labour progression, pain, environment and the ability to request her method of birth.

DATA SOURCES

Medline, CINAHL and PsycINFO databases were searched between 1970-2011 using the keywords, 'control', 'childbirth', 'labour' and 'delivery'.

REVIEW METHODS

Walker and Avant's method of concept analysis was used for this review. In addition, cases were placed before defining attributes as recommended by Risjord.

RESULTS

Four attributes of control were identified: decision-making, access to information, personal security and physical functioning. Antecedents include pregnancy and expectations of the birth. Consequences include childbirth satisfaction, childbirth experience, emotional well-being, fulfilment and the transition into motherhood. A model case, contrary case and borderline case are described.

CONCLUSION

Clarifying the definition of control in childbirth and defining its attributes can help inform women and maternity providers throughout the world. This analysis provides clarity to a previously tenuous concept and allows practitioners to better understand the critical relationship between control in childbirth and satisfaction with the childbirth experience. It also has the potential to affect perinatal outcomes and subsequently healthcare costs.