[ Diabetes Type 2 ]

BMC Public Health

It was last September when doctors realized how bad China’s diabetes epidemic really was. People with diabetes in China report 3 to 4 times more in-patient care, out-patient visits, and emergency room visits than people without diabetes of the same age and sex. It is a disease that comes with rising prosperity. China, ahead of India now, has become the country with the largest number of people with diabetes in the world (). We aim to investigate the association between MetS and microalbuminuria and identify the major contributing components of MetS that result in microalbuminuria in the Chinese aged population. The risk conferred by MTHFR C677T polymorphism is higher in North China than in South China. From 2008 to 2009, he served as a civilian adviser on a Provincial Reconstruction Team in Karbala, Iraq.

The question is whether another document proposing guidelines for type 2 diabetes is really needed. The logistic regression analysis adjusted by gender and age showed a nominally significant association for rs2241766 GG+GT genotype (P = 0.065, OR = 1.55) and rs1501299 GG genotype in recessive model (OR = 1.54, P = 0.066). Despite the program’s intention to monitor the spread of diabetes, insufficient data has been collected. However, previous Myocardial Infarction (MI) history was found to be significant only in the IFG/IGT group, and previous stroke was found to be significant in the T2D group [19]. The International Diabetes Federation has estimated that there are 371 million people worldwide with the disease, including  98. Currently, lifestyle interventions focused on physical activity, diet, and other health behaviors are often adopted as the main method of MS intervention, using a web-based platform or cooperating with home-care providers or general practitioners [6–11]. Chinese Journal of New Drugs and Clinical Remedies.

Ca2+ is mainly reabsorbed in the proximal tubule. Experts in diabetes prevention and rehabilitation, researchers, medical and health professionals (physicians, pharmacists, nurses, dietitians, physical therapists, psychologists, health managers and diabetes educators, among others), technology professionals and representatives from companies and organizations involved in diabetes prevention and treatment are invited to exchange ideas at the event. This phenomenon is the same as that previously reported for the frequency of obesity in IFG/IGT subjects [13]. Such a high prevalence of IFG portends an increased diabetes incidence in the coming years because many with IFG could progress to diabetes should the levels of modifiable risk factors remain as they age. Second, because the present analyses are based on cross-sectional data, the increasing prevalence of MetS in the younger age groups could be due, in some degree, to a cohort effect. The lower prevalence of MetS in IFG/IGT subjects of greater than 61 years of age might also be due to a survivor effect, for example, if people who had MetS were more likely to die before that age and were not available for study [13]. [10], for example, reported a positive association between elevated BP, reduced HDL-C, elevated TG, and microalbuminuria in a cross-sectional study of US adults (aged ≥20 years).

In addition, the SNPs of KCNQ1 such as rs2074196, rs2237892, and rs2237895, were demonstrated to be associated with the risk of gestational diabetes mellitus in Koreans [13], and rs2283228 might contribute to the susceptibility of East Asians (Japanese and Singaporeans) to diabetic nephropathy [14]. This finding suggests that comprehensive intervention for MetS should occur as early as 30 or before 30 years of age. Gender differences were found in our study. To examine cardiometabolic health of athletes at the heavy-weight-class, we conducted a cross-sectional survey among current professional athletes of strength sports in China. Our data are different from a previous report in China that showed that prevalence of MetS was higher in women than in men (17.8% vs. 9.8%) according to 2001 ATPIII criteria [12, 13]. Although most investigations in Caucasians have not found gender differences [23, 24], many other reports have had results similar to our own [9, 25].

We believe that different diagnostic criteria affect the prevalence of MetS in different genders. The IDF criteria use central obesity as its central diagnostic criterion. Based on our data and data from other studies [13], females in China have a higher prevalence of central obesity than males. The IDF criteria and the modified NCEP-ATPIII criteria have already changed the diagnostic criteria for central obesity and HDL-Ch according to different ethnic populations. Previous reports have shown that after changing the diagnostic criteria, which were modified for ethnic differences, the prevalence of MetS increased approximately 10% in Chinese males but decreased 2% in Chinese females [13]. Also, we are working with school cafeterias and local chefs to reframe their recipes, so that whatever the kids learn in class they see on a plate at lunch. One study has found that higher testosterone and sex hormone binding globulin (SHBG) levels in aging males are associated with higher insulin sensitivity and a reduced risk for MetS independently of insulin levels and body composition measurements [26].

Another study has found that low testosterone and SHBG levels are strongly associated not only with components of MetS but also with MetS itself independent of BMI. We are caring for a huge population with diagnosed diabetes; we are also concerned about the number of people with undiagnosed diabetes. The protocol was approved by the ethics committee of the West China Hospital, Sichuan University. We used the following search terms: “type 2 diabetes”, “type 2 diabetes mellitus”, “epidemiology”, “prevalence”, “morbidity”, “China” and “Chinese”. This suggested in male, some of the MetS components worsen as early as in IFG/IGT group. In the final stage, cluster random sampling was used to identify individuals aged 18 to 79 years old from each of the villages selected for the study. Most of the subjects lived in urban areas, and the T2D subjects were mostly from clinics and hospitals.

This study was only a cross-sectional study, which cannot predict the risk of CVD directly. By learning to eat differently, they can tackle both threats at the same time—and have fun doing so. Thus, further longitude follow up study with a even big sample size of IFG and IGT subjects should be carried out. Some inflammatory cytokines such as hs-CRP, which has been proved closely related to MetS and CVD could be measured as well.

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[ Diabetes Type 1 ]

BMC Public Health

Metabolic syndrome (MeS) has received increased attention in the past few years. (2) To determine the sociodemographic factors associated with MS. The STOP Diabetes project was created by investigators at the Jean Hailes Foundation for Women’s Health to address the alarming increase in lifestyle related metabolic diseases including type 2 diabetes, and gestational diabetes (GDM). Our results were similar to the only Brazilian study [15] that has assessed these parameters, albeit with a different population (middle-aged Brazilians of Japanese descent) and different methods for assessing the presence of MS and levels of physical activity. MetS, as defined by the Harmonized criteria, was assessed over a 20 year follow-up period. The metabolic syndrome was present in 33.8% (794). Industrialization and urbanization are contributing to a global epidemic of cardiovascular disease (CVD).

Lean African women seem to be at higher risk for MS than Caucasians. However, many problems in defining the optimal diagnostic criteria remain unresolved. Sex-stratified prevalence rates of the other components of IDF-defined metabolic syndrome in relation to central obesity were estimated. Methods and Results We conducted a retrospective cohort study of ACHD patients at our center to quantify the prevalence of metabolic syndrome in an ACHD population. Blood pressure was measured on the right arm with an automated sphygmomanometer (Omron automatic blood pressure monitor with IntelliSense®, Bannockburn, Illinois, USA) after fifteen minute of rest with the subject in the sitting position. The suggested WC cut-off points to define the MS result from experts’ consensus, thus call for validation by additional clinical and epidemiological prospective studies. Paulo – SP.

More than 40 million adult Americans are affected by metabolic syndrome4, and an increasing trend has been observed in Asian countries5,6. What on earth is a Europid? In our study, this proportion was even higher (14.75% in men and 7.99% in women). Only studies where age and sex were similar between the two patient groups were included in the meta-analysis. Thus, MetS according to IDF criteria has lower prevalence. Under such condition, IDF definition will have less power, which may explain why IDF definition was less well correlated with cardiovascular risk factors in our study and previous work. One of the limitations of our study is that it was cross-sectional and examined cardiovascular risk factors among MetS definitions.

Therefore, modification of the Japanese criteria for MetS might be necessary in the future. Instead of including the NCEP definition, Can’s work examined the American College of Endocrinology (ACE) definition. Waist circumference measurement was made at minimal inspiration to the nearest 0.1 cm, midway between the lowest rib and the superior border of the iliac crest. Although our study only provided cross-sectional relationships between MetS and cardiovascular risk factors, no cross-sectional study has compared five published definitions in relation to hs-CRP, arteriosclerosis, and PVD. Another limitation of our study is that insulin sensitivity was determined by HOMA-IR, and not the insulin sensitivity index derived from the hyperinsulinemic euglycemic clamp. Previous studies indicated that there existed a moderate to strong relationship between the HOMA-IR value and the insulin sensitivity index [51, 52]. However, the insulin sensitivity index is not feasible for epidemiologic studies involving large numbers of participants.

In addition, we did not perform oral glucose tolerance testing, so we may not provide valid estimate for the prevalence of MetS for the EGIR and WHO definitions by included some patients with T2DM or excluding some hyperglycemic cases that could be detected by glucose tolerance testing.

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[ Diabetes Solutions ]

BMC Public Health

In 1993, the prevalence of diabetes among those > or = 67 years of age was 145 cases per 1,000 individuals. We analyzed their data to determine the means and correlation coefficient for Physical Inactivity and Diabetes in two groups of counties of Alabama – the ten most populous (predominantly “urban”) and the ten least populated (predominantly “rural”). We determined the optimal criterion for identifying diabetes and used it in estimating diabetes prevalence in the VA. Hemoglobin A1c levels were ordered at all ICU admissions from March 1, 2011 to September 30, 2013. Clinical data, FPG, CV risk factors and dietary habits collected. It was higher in women than men (p = 0.008). Results differed markedly between men and women.

These certificates rarely mention diabetes as the primary cause for admission or death, even though it is the underlying cause of illness for many admissions and deaths. Su, R.; Cai, L.; Cui, W.; He, J.; You, D.; Golden, A. Introduce national programme to delay and perhaps prevent type 2 diabetes. c Persons without a fasting plasma sample (n = 10) or were excluded. Between 2001 and 2003, all persons in the sample were approached for face-to-face, structured interviews by trained interviewers who had been matched by sex and presumed ethnicity. The interview included questions on self-identified ethnicity, migration history, demographic variables, lifestyle, and health status. The rates for diabetes and IGT increased with age, being 1.7 and 4.5%, respectively, for the age-group of 30-39 years, 3.9 and 8.5% for the age-group of 40-49 years, 13.6 and 13% for the age-group of 50-59 years, and 17.3 and 15.3% for the age-group of 60-69 years (P < 0.01). The prevalence of T2D was related to urbanization in Tunisia. Participation rates were higher among women than among men. In addition, participants in the interview were more likely to be married and living with a partner and/or children, and to live in a less urban area (address density of 1500–2500 addresses/km2 vs. We found 28 individuals with undiagnosed diabetes and 14 with impaired fasting glucose, which constitutes a prevalence of 5.1% (95% CI 3.2–6.9) and 2.5% (95% CI 1.2–3.9), respectively. However, the absolute and relative differences between participants and non-participants for these characteristics were small and reported trends were similar across ethnic groups (data not shown). Participants of Hindustani Surinamese, African Surinamese or Dutch origin were also invited for a physical examination at a local health care centre. Again, this difference was not statistically significant. Waist circumference midway between the lower rib margin and the iliac crest and hip circumference at the maximum point over the greater trochanters were determined to the nearest 0.01 meter by tape measure. After the subjects had emptied their bladder and had been seated for at least 5 minutes, blood pressure and resting heart rate measurements were obtained from each subject's arm at heart level using an OMRON-M4 semi-automatic sphygmomanometer with an appropriate-sized cuff. All anthropometric measurements were obtained twice and the means (rounded off to the nearest integer) were used for analysis. Overall, the survey was carried out in 540 centers across the country. DM was defined as fasting glucose ≥ 7.0 mmol/l and/or self-reported DM, excluding the self-reported diagnoses of gestational diabetes. The SUNSET-study was approved by the Institutional Review Board of the Academic Medical Centre of the University of Amsterdam, and carried out in compliance with the Helsinki Declaration. All participants provided a written informed consent.

In the present analysis, we included participants who had participated in both the interview and the physical examination. Of all participants in the interview, 71 were excluded due to missing information on self-identified ethnicity, 182 persons were excluded because they had not undergone the physical exam and 10 persons because fasting glucose measurements were not available (non-response for blood sample). As compared to those who were left in the study, those excluded were similar with regard to gender, self-reported DM and self-rated health (data not shown). In total, 1434 participants remained in the study, divided into 339 Hindustani Surinamese, 605 African Surinamese, and 490 Dutch (figure 1). Of the Hindustani participants 98.8% were born in Surinam, 99.4 had two parents who were born in Surinam and 92.1% had two parents who were of Hindustani origin. There was no difference between rural and urban areas and regions the accessibility of health facilities explain the higher level of diabetes diagnosis and treatment. Moreover, 79.3% of the African Surinamese had two parents who were of African origin.

Characteristics of the ethnic groups were described using means or proportions. In addition, the prevalence of determinants of DM was calculated, directly standardised to the age distribution of the total population. The association of determinants with DM was studied using univariate logistic regression analysis. All variables showing an association of p ≤ 0.25 for the Wald test were selected for the multivariate analyses. Stepwise multiple logistic regression was then performed to construct the optimal risk score for the occurrence of DM among Hindustani Surinamese, African Surinamese and Dutch. Criteria for entry into and exclusion from the model were a p-value for the likelihood ratio test of 0.05 and 0.10, respectively. A new risk score was developed to determine the probability of having DM with a logistic regression model using data that would be routinely available in general practice.

Variables considered were ethnicity, biomedical parameters and disease history, e.g. age, BMI, waist circumference, resting heart rate, first-degree relative with DM, hypertension, history of CVD. The risk score is based on the sum of the score of the variables included in the full model (see additional file 1: Risk score for DM SUNSET.pdf). Subsequently, we evaluated the performance of the risk score and compared it to the sets of screening criteria derived from current guidelines by calculating the area under the Receiver-Operator Characteristic curve (AUC) as a measure of diagnostic accuracy. Before analyzing the data, it was decided to consider an AUC of less than 0.60 to be poor, 0.60–0.75 to be moderate, and higher than 0.75 to be good. The cut-off for the risk scores at which fasting plasma glucose screening was indicated, was chosen such that the sensitivity was approximately 80%, but not over. Additionally, we determined the specificity, the total population selected for screening, the prevalence in the screened population (the positive predictive value), and the number needed to screen to detect a case of DM (NNS).

Finally, we estimated the diagnostic accuracy of the risk scores for the detection of a new case of DM, to simulate a situation where persons with known DM are excluded from screening. This was done because, ideally, only previously unknown cases would have been used in the derivation of the risk score for screening for unknown DM. However, given issues of power to enable statistical modelling, it was decided to base the score on all cases and to then also estimate the diagnostic accuracy of the risk scores for newly detected DM. We assessed the ability of a simplified version of our risk score, with points corresponding to the calculated odds ratio, to detect new cases of DM by calculating the number needed to screen to identify a new case of newly detected DM (NNSnew). To assess the validity of the risk scores, we used bootstrapping techniques to estimate a ‘confidence interval’ (bCI) around the estimated AUC of all risk scores in our population. We took 1000 random samples, with replacement, from the study population. At each step the parameters in the predictive models were calculated.

We subsequently estimated the AUC for each of the models and calculated the 2.5 and 97.5th percentile to indicate the ‘confidence interval'[20].

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[ Herbal Remedies ]

BMC Public Health

– Linhares RDS, et al. Asians have a lower frequency of obesity than Caucasians, but have an increasing tendency toward metabolic syndrome. In this intermingling of the biological and social, scientists can transform the social into the biological and back again. MS was defined according to the criteria formulated by the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) and the International Diabetes Federation (IDF). Several studies have demonstrated that inflammatory processes are involved in the pathogenesis of the MetS and there is evidence that suggests that components of CV risk increase the inflammatory burden in rheumatoid arthritis (RA). Results. The population- attributable fractions of the metabolic syndrome based on NCEP-ATPIII criteria were 26–27% for ischemic heart disease and ischemic stroke and 20% for total cardiovascular disease.

Overall, agreement between two definitions was moderate (men κ 0.41–0.45, women κ 0.44–0.55). Among the MetS subjects who fulfilled the modified ATP III criteria, more clustering of risk was observed in elderly than in middle-aged subjects, especially in women. Paradoxically, although the overall MS prevalence rate was significantly higher in men than in women, the prevalence of abdominal obesity was markedly higher in women, by using both high and low WC thresholds. The first stage systemic sampling was conducted in each stratum: three districts from the large cities, three districts from the small to medium cities, four counties from the class 1 rural areas and three counties from the class 2 rural counties were randomly selected based on the population size. Tous les sujets étaient résidents de la commune de Lieto en Finlande et âgés de 64 ans ou plus en 1998–1999 (n = 1529). The suggested WC cut-off points to define the MS result from experts’ consensus, thus call for validation by additional clinical and epidemiological prospective studies. While the WHO identified that a substantially high risk occurs at WC thresholds of (102/88)[26], the IDF and EGIR groups suggested lower values (94/80)[14], [27].

These criteria include 6 individual components of MetS (WC, TG, HDL-C, SBP, DBP, and FPG), which can be divided into 3 categories: WC, TG, and HDL-C for type I; SBP and DBP for type II; and FPG for type III. Within the context of the MS, the use of lower cutoff points is beneficial, as it raises the risk level for cardiometabolic disease among those identified as having the MS[29] and then indicates the need for early cardiovascular risk reduction. Stratification was conducted based on the country’s 29 areas, including 11 metropolitan cities and provinces, the administrative unit, and the dwelling type. Our findings are important, not only to help decision-making with respect to the cardiovascular risk level intervention, but also to argument the future research work on the MS as a cardiometabolic outcome. Individuals with MS have a 30–40% probability of developing diabetes and/or CVD within 20 years, depending on the number of components present [3]. There is no specific treatment but the individual components should be appropriately treated according to evidence-based recommendations such as lifestyle intervention followed by drug therapy if lifestyle intervention is unsuccessful in reaching specific goals set for the individual. Nevertheless, the established continuous relationship between WC and clinical outcomes makes the gender-specific values questionable, especially in women at menopause with an increase deposition of visceral fat [17].

Regardless of the thresholds applied, the consistent gender difference of 14 cm is discriminating, in the sense that a WC of 80 cm classifies women in a rather severe category, especially at the age of menopause where the women girth becomes physiologically larger. The ORISCAV-LUX findings demonstrated that more than 75% of women after the age of 50 years were classified as centrally obese by applying the 80 cm threshold. We found MetS to be associated with stroke in the general population, but the association disappeared after correcting for the individual MetS components. By comparing the three last definitions, the prevalence of JIS-94/80 MS was higher than IDF and R-ATPIII MS. Mean BMI of study population was low i.e. Regardless of the definition used, the prevalence of the MS increased across age groups. Concerning the agreement between definitions, although the IDF placed more emphasis on central obesity in the causation of the MS, remarkable levels of agreement were found with the JIS (κ = 0.93) and good ones with the R-ATPIII (κ = 0.84), indicating that the requirement of abdominal obesity did not induce important discrepancies in the prevalence or the classification of the MS, but rather the WC cut-off points.

study [9], cardiovascular disease (CVD) prevalence was increased in the presence of MetS irrespective of the definition used, but this increase was more pronounced when NHLBI/AHA criteria were applied in comparison with IDF definition. The use of different definitions has an impact on the estimated prevalence and confuses the interpretation of epidemiological studies[31], [33], [34]. A marked gender and American-European population’s difference was observed[35]. In an attempt to harmonize the MS definition by comparing the R-ATPIII and the IDF criteria in American and German populations, Assmann et al. presumed that the observed prevalence discrepancy and particularly the gender-specific disagreement, by using the 2 different criteria, depend on the population characteristics, since a greater portion of German cohort population had lower WC measurements and were generally leaner than Americans[35]. Despite the intensive efforts of scientific societies to harmonize the criteria to define the MS, a key consideration remains controversial for WC cutoff points in the Europid population. Given the “almost perfect” level of agreement between the JIS- and R-ATPIII-defined MS (κ = 0.91), our results indicate that the two suggested cut-off points do not affect the prevalence estimates of the MS.

In addition, the 10-year predicted CHD risk by FRS was similar for both thresholds-based definitions. Interestingly, we could not find any thresholds associated with significantly elevated HRs for cardiovascular events in either male or female subjects (data not shown). This high degree of concordance and significant identification of a large number of participants as having the MS were not surprising, considering the fact that the three definitions use the same 5 components and that 4 out of five are defined identically [36]. In addition, despite the differences in their constructs, the concordance between the studied definitions was optimal in women as compared to men. pp. In the most recent JIS definition, the IDF agreed to consider abdominal obesity as one of the 5 criteria and not deemed as a prerequisite element to diagnose the MS [16]. This harmonization is a step forward for a universal harmonization and allows a relevant international comparison.

The cross-sectional design of the ORISCAV-LUX study limits the possibility to determine which criteria better predicts adverse cardiovascular outcomes, such as the incidence of coronary events and thus precludes causal inferences. However, several strong points characterize the study. First, it is based on recent nationwide, population-based, representative sample of Luxembourg adult residents, from whom extensive direct measurements were obtained. A detailed study of non participants showed that the demographic and clinical characteristics of the ORISCAV-LUX participants were comparable with those of the non-participants[21]. The second proposal of definition is very similar to the previous one, but the cut offs were inferior regarding abdominal circumference and lipid profile. In line with the 2009 JIS recommendation, a novel aspect of this study was to assess the MS according to the most recent definition together with the lower and higher criteria for Europids. Furthermore, the predominantly white homogenous nature of the sample (94.2% Europid) ensured the control over ethnicity factor, hence allowed generalizing the results.

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[ Nutrition ]

BMC Public Health

Inpatient admissions to all English hospitals between April 2010 and March 2012 were extracted from Hospital Episode Statistics. Among more than 18,000 type 1 diabetics in Sweden followed over time, those with an insulin pump were about half as likely to die of heart-related causes, and 25 percent less likely to die of any cause, compared to those who injected themselves with insulin many times a day. They genotyped all subjects for 5 candidate single nucleotide polymorphisms (rs672888, rs1447295, rs9642880, rs16901979, and rs6983267) that were identified in previous genome-wide scans. INTERVENTIONS OR EXPOSURES: Application of Norwood and Ludwig ALA classifications to study population. The findings were published online Tuesday in Diabetes Care. Adjusting for related cardiovascular conditions, which may provide more accurate estimates of attributable risks for people with diabetes, increased these estimates to 51.4, 57.1, and 56.8%, respectively. Mortality is inversely associated with socioeconomic gradients in the general population.(1–4) Disadvantaged individuals have higher rates of mortality, and data suggest this inequality is becoming more apparent over time.(5) However, only a few studies have examined the relationship between socioeconomic status (SES) and mortality in diabetes, specifically type 1 diabetes, and study designs and definitions of SES measures have varied widely.

This revision process, and the impact on specific causes are described at http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/3303.0Technical Note12012. The study included 217,364 diabetic patients in Sweden who were younger than age 70 (mean age 58.3±9.3) when enrolled in the Sweden National Diabetes Register from 2003 through 2010. BMI is calculated by dividing weight in kilograms by height in metres squared. The coordinating registry undertakes the coordination and management of the designated activity. After the introduction of insulin therapy in 1922, this annual mortality fell by more than 80 %, to 61.4 per 1000 during the period 1922–1926. By 1939–1947, following major improvements in availability of insulin and the advent of clinical use of penicillin, mortality declined further, now by more than 90 %, to 3.3 deaths per 1000. And by the period 1950–1961, mortality had declined still further, to 1.0 per 1000 [34].

During the years 1922 to 1929, 14.5 % of deaths were caused by diabetic coma, whereas by 1956–1962 this proportion had decreased to 1.0 % [34]. 1991-1999, 2000-2009). In June, the city’s medical examiner ruled the death a homicide. One patient drowned, 1 died suddenly in the middle of the night, and 1 died of ketoacidosis. The expansion of the SUS over the past two decades provided access to an ample range of health care services for the first time to millions of Brazilians with chronic diseases. Currently, an estimated 74 % of the population depends on this public system for their care [35]. The creation of the Community Health Workers Program in 1991 and its expansion into the Family Health Program in 1994 initiated a large primary care network, today called the Family Health Strategy.


From that point to the year 2010, over 30000 multidisciplinary teams, consisting of a physician, a nurse, a nurse’s aide and paid community health workers, were organized to provide health care, each covering about 1000 families in a pre-defined territory. Study implementation details have been published previously.8 Briefly, participants attended a baseline screening visit, during which they completed self-administered questionnaires that collected information on demographics, reproductive, medical and family history, and various lifestyle factors such as physical activity. An additional fraction, especially in large metropolitan areas, receives free, public ambulatory care in various specialty clinics. Prior to 1990, access free of charge to insulin was quite limited. In the early 1990s the Ministry of Health produced a National Diabetes Plan, which proposed an equation to calculate the amount of insulin needed per year in Brazil for universal coverage and amplified public purchase of the drug. Throughout the 1990s the restructuring of care for chronic conditions such as hypertension and diabetes at the primary care level progressed, with increasing free public distribution of low cost anti-diabetic medications. In 2001, a major program emphasizing the universal treatment of these conditions at the primary care level, the Plan to Reorganize Care of Hypertension and Diabetes Mellitus [36], was launched.

The National Program of Pharmaceutical Provision for Hypertension and Diabetes, created in 2002, and subsequent laws and regulations, have allowed a progressively larger distribution, free of charge, of medicines and medical supplies to the entire population with diabetes in Brazil [37]. Over this period, the SUS also organized the treatment of emergencies, equipping emergency care facilities, providing ambulances, and organizing hotline call systems [38, 39]. In addition to further facilitating access to free medications, more recent efforts have focused on promoting a restructuring of the healthcare system in Brazil, shifting its focus toward the care of chronic conditions [9]. The Student’s t test (normally distributed) or the Mann-Whitney U test (non-normally distributed) was used to compare continuous variables by SES group. In the early 1990s, when mortality was highest, inadequate access to insulin was likely the major determinant of deaths. Subsequent greater availability of insulin through the SUS during the 1990s may be the main explanation for the sharp reductions in deaths observed. Over time, with the structuring of distribution systems and purchasing processes, and a clearer allocation of responsibilities among different administrative levels of the system, the magnitude of the problem of availability of insulin, other diabetes medications, and supplies diminished greatly.

Thus additional, more complex actions, such as the reorganization of care focusing more on the needs of people with chronic conditions, have likely assumed a greater importance in reductions in mortality in more recent years. Of note, despite this progress, mortality from acute complications of diabetes in Brazil in 2010 was still unacceptably high, 3.3 times greater than what recently reported for the U.S. levels [11]. For those under 40, Brazil’s 2004 mortality level, approximately 0.39 deaths per 100000 population, was similar to that observed between 1968 and 1979 in the state of Washington [40]. Thus, much room exists for additional improvements: strengthening the links which create networks between the relevant parts of the health care system – primary care, emergency care, hospital care, and pharmaceutical delivery, among others; enhancing coordination of care; increasing access to health services, including telephone advice for hyper and hypoglycemia crises [39]; and improving education for physicians and for patients on the identification and management of the acute complications of diabetes [39, 41]. When implemented, these actions need to be tailored so as to take into account remaining regional health inequities as well as the social adversities within which many who have diabetes live. Brazil is a country of great inequalities, and its national health system has established the goal to diminish those seen in health.

This conversion may have resulted in character translation or format errors in the HTML version. Traditionally residents of this region have had less access to health care. This is reflected in the higher mortality rates seen, in 1991 for this region. As declines, both in terms of relative and perhaps more importantly absolute terms, were greater in the Northeast than overall suggests that progress has been made in reducing health inequalities related to diabetes. The higher mortality from acute complications of diabetes we found in women has been previously reported by others [42]. A previous Brazilian study also found higher mortality due to all complications of diabetes in women [43]. This differential may merely reflect greater diagnosis of the disease among women [7], which would favor the mention of diabetes on their death certificates.

The decrease in the female:male ratio of mortality over time that we found could thus be explained by the decreasing female:male ratio of known diabetes over time. Given the current stage of both diabetes care and mortality information systems in many low and middle income countries, monitoring of deaths from acute complications of diabetes is a logical indicator to evaluate the quality of medical care offered to those with diabetes in these countries [10]. Use of this mortality statistic has several advantages: comprehensive coverage of the population in countries with compulsory registration of deaths; ability to capture the results of a wide range of actions at all levels of care; simplicity; easy access to data [17]; and the possibility of international standardization of results allowing comparison between countries and over time [44]. Further, our data show that this indicator offers important discriminatory power in settings of greater recent attention to diabetes [44]. Limitations to our analyses deserve mention. Relatively large fractions of deaths were not registered or had ill-defined causes over much of the period studied, particularly during the early years. Although these problems limit the accuracy of our estimates, especially in the initial years studied [25], we believe that the corrective algorithms we implemented have minimized their impact.

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[ Diabetes Type 1 ]

BMC Public Health

Methods: Clinical history and relevant laboratory investigations were performed on all study participants. To find better predictors of type 2 diabetes, we evaluated two different definitions of the metabolic syndrome because insulin resistance, which is commonly associated with this clustering of metabolic factors, frequently precedes the onset of type 2 diabetes. All subjects of the municipality of Lieto in Finland aged ≥64 in 1998-1999 with no type 2 diabetes mellitus at baseline (n=1117) were included. Fasting plasma ghrelin concentrations of the population‐based cohort of 1037 middle‐aged men and women were analysed using a commercial radioimmunoassay kit (Phoenix Peptide). Also, central obesity (defined by waist circumference with ethnic modification in its thresholds) has become a mandatory component in the new definition. The two definitions similarly classified ∼83% of patients as being MS positive or MS negative. A total of 472 (67.4%) women and 228 (32.6%) men were studied.


The concept of this syndrome with the central pathogenesis of insulin resistance gained ground to identify individuals who were at risk of developing diabetes and cardiovascular diseases (CVD) in the future. Subjects had to be 18 years or older and were not taking medication influencing coagulation or lipid/blood pressure lowering medication. Among postmenopausal women with angiographic CAD, the metabolic syndrome is very prevalent. Thus, it was no surprise that confusion existed over how to diagnose metabolic syndrome. Multivariate logistics regression analysis (ATP III and IDF) showed that age and BMI were significant contributors for metabolic syndrome. CONCLUSIONS—In a racially/ethnically diverse sample of U.S. We also try to place the results into clinical context by comparing metabolic syndrome assessment with other, potentially simpler methods of assessing risk of incident diabetes.

The later the development of overweight or obesity, fewer are the years of life lost [3]. There are no published data on the prevalence of the metabolic syndrome among youth in Jamaica or other countries of the English-speaking Caribbean. In one study from Trinidad and Tobago 32% of first year medical students 18-23 years old had at least one metabolic syndrome component but the overall metabolic syndrome prevalence was not reported [21]. The role of socioeconomic status in cardiovascular disease epidemiology has been well established [22]. In developed countries most studies report an inverse relationship between socioeconomic status and cardiovascular disease; however the relationship is less clear in low and middle income countries, with some studies showing a positive relationship and others a non-linear association [23, 24]. Height was measured to the nearest 0.1 cm on a Seriter stadiometer (850–2060 mm; Holtain Ltd., Crymych, UK) with the subject standing barefoot. There appears to be an inverse relationship between socioeconomic status and prevalence of the metabolic syndrome with a stronger association for women compared to men [25, 26, 28–30].

The lower cut point levels (≥94 for men and ≥80 for women) were incorporated as diagnostic criteria for the metabolic syndrome by the European Group for the Study of Insulin Resistance (EGIR) [8] whilst the National Cholesterol Education Program (NCEP) used the higher cut points in their definition of the metabolic syndrome [9]. This paper will report on the prevalence of the metabolic syndrome, and evaluate its association with markers of socioeconomic status in a sample of young adults 18-20 years old, in Jamaica, a middle income, developing country with a predominantly black population.

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[ Herbal Remedies ]

BMC Public Health

On average, people with diabetes die younger than other people. In the present study, it showed an increased trends in diabetes related mortality with growing proportions of CVD prevalence and mortality in a Chinese population. RESULTS: In Taiwan, diabetes mortality according to MCOD increased persistently from 1987 to 2007, but no prominent changes were found according to UCOD in men. To analyze excess risks for specific diagnoses, case subjects were compared with five nondiabetic control subjects, matched by age, sex, and year of death. In addition, the usefulness of statins for cardiovascular diseases that arise from type 2 diabetes has been highly debated. Longer duration of diabetes was significantly related to mortality, an association that was stronger in women than in men. The higher mortality rate of those with diabetes was not due to an acute complication of the procedure itself, and may be related to the less complete revascularization of the coronary arteries with angioplasty compared to CABG.

Insulin is a hormone that allows the body to use blood sugar. References to non-CDC sites on the Internet are provided as a service to MMWR readers and do not constitute or imply endorsement of these organizations or their programs by CDC or the U.S. Future study should focus on designing rigorous separate analyses for this population. Death rates were higher for diabetic than for nondiabetic subjects in all age, sex, and race groups. There was a strong negative relationship between household income and the AADMR for the entire city (−0.63) and for the predominantly black community areas (−0.52). between 10-15%). Thus, in terms of racial classification ascertainment, mortality analyses restricted to CHSDA counties may be most appropriate for examining AI/AN disparities in diabetes mortality.


This further validates the high mortality rate. In accordance with mortality studies from The United Kingdom [1, 6, 7], Italy [2], Germany [3], The Netherlands [4], The United States [14], Brazil [9] and Australia [5] we found that type 2 diabetic patients in comparison with the general population had a 1.5-2.5 fold higher risk of mortality depending on the age of the patients. An excess risk of death has previously been found even for newly diagnosed diabetic patients in population-based studies [3, 25]. The survival curve for diabetic men aged 40-79 years separates from the corresponding curve for the Danish population immediately after diabetes diagnosis whereas this happens after approximately 6 years for women of the same age showing that both female and male diabetic patients have increased mortality risk compared with the general population (Fig. 2 and 3). Our study, however, indicates that in most age groups diabetic men have higher excess risks than diabetic women (Table 3). This is in accordance with results from Poland [26] and Japan [27].

The initiative focuses on two main goals: empowering Americans to make healthy choices and improving care for people, focusing on aspirin for people at risk, blood pressure control, cholesterol management and smoking cessation. When looking at the race/ethnicity rates by sex, male rates are higher than female rates in the Hispanic and White populations. Health systems factors may partially account for these differences [31]. The American Indian rate was two times higher than the Hispanic rate and the Black/African American rate. Among females, the American Indian/Alaska Native rate was almost five times higher than the White rate, and two times higher than the Hispanic rate. As this study has demonstrated, markers are simply not a valid way to determine effectiveness of a treatment. Case subjects with a minor amputation were younger than those with a major amputation (minor LEA 67.1 years [13.2], major LEA 75.7 years [10.3]; P < 0.001), and we controlled for this age difference by presenting age-adjusted mortality rates. This is in accordance with most previous studies [1–3, 6, 8, 9] including a Danish diabetes register based study [21] recognising this study included both type 1 and type 2 diabetic patients and probably did not encompass all newly diagnosed patients in Denmark. Even though our cohort of patients were recruited in 1989-92, and the mortality gap between diabetic patients and the general population may have lessened in recent years it does not seem to have disappeared [13, 21]. As can be seen in figure 1, mortality rates are relatively constant over time for men and women in the three age groups. Therefore, we think that the finding of a lower relative risk of dying among the higher age groups compared to patients in the lower age groups is not due to a survivor effect, i.e. For example, these challenges stem from people with diabetes most frequently dying of cardiovascular diseases or renal failure, and the physicians who record and determine the causes of death may miss and underestimate the contributions of diabetes on death [11–19, 32]. The excess mortality extends even to the old patients up to 80 years of age (Table 3, Fig. 2 and 3). Metformin was associated with the lowest mortality rate, followed by sulfonylureas, and then insulin. These studies may reflect survival bias as pointed out earlier or too little power to show a real effect of age on mortality. The coordinates will be: C-Band: Galaxy 3/Transponder 7/Audio 6.2 & 6.8.

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[ Herbal Remedies ]

BMC Public Health

Digital and print ads bombard us with claims promising success and messages that sound too good to be true, leaving some doctors scratching their heads. You know the ones to which I’m referring; Coke, Pepsi, and any of the other brands of soft drinks in that category. Our weight management physicians and specialists create personalized plans with reasonable, attainable lifestyle goals. The Medifast diet philosophy in particular, is centered on the premise that smaller, healthier meals throughout the day will ignite and improve the body’s metabolic rate, versus the traditional three large meals. Gain practical and innovative tools and individual coaching from a dietitian/health educator. Do a self-check on what and when you eat. The study, presented as a late-breaking abstract Sunday at the American Diabetes Association’s 72nd Scientific Sessions, strongly counters the popular view that people generally cannot maintain long-term the weight loss achieved during lifestyle intervention programs.

You will receive dietary recommendations based on the latest guidelines and tailored to your other medical conditions, cultural food preferences and personal circumstances. We pledge to work closely with you in a partnership to achieve and maintain your weight management goals. This is because some people have more muscle and bone mass for a given height than others. Both interventions also achieved greater net improvements in waist circumference and fasting plasma glucose level. In October 2010, Piper made a decision. N Engl J Med 2001;344:1390-2. Yes, weight loss is often accompanied by lower glucose numbers.

In the intervention arm, about a third of participants (37.7%) lost at least 10% of their initial weight at 1 year, and about 40% of these individuals maintained this weight loss at 8 years. Many different technologies have been used in weight loss interventions including PDAs [15, 16], cell phone text messages [17, 18] and wearable physical activity monitors [19, 20]. However, Internet-based interventions have received the most empirical attention to date [21]. The sessions included private weigh-ins and supplemented topics covered in the online intervention. Programs that are solely internet-based however, do not allow for the same level of interactivity, social support, and feedback that occurs during in-person interventions. New generation handheld technologies have the potential to overcome many of the limitations of internet-based health behavior change interventions [25]. Mobile phones are becoming ubiquitous: 46% of Americans own a smartphone, with rates even higher among minority groups [26].


Smartphones provide an unprecedented opportunity for frequent and interactive feedback, tailored email or text reminders, and immediate access to social support from peers and coaches. Interactive smartphone applications can be used as a decision support tool to provide timely information on health behavior decisions occurring in real-time. These technological advances afford a promising opportunity to preserve the key components of intensive in-person treatment approaches (i.e., regular social support, accountability, and frequent feedback) while requiring fewer in-person sessions, thus, lowering the cost and broadening the accessibility of treatment. To test the feasibility and efficacy of this mobile technology-supported strategy, we have developed the E-Networks Guiding Adherence to Goals in Exercise and Diet (ENGAGED) study, a randomized controlled trial (RCT) that uses a theory-guided, technology-supported weight loss program. The conceptual basis for the ENGAGED study is Carver and Scheier’s control systems theory (CST) of self-regulation [27]. CST posits that self-regulation can be understood in terms of feedback loops, wherein people: (1) set a goal, (2) self-monitor their current status to identify discrepancy from a goal, and then (3) modify their behavior to reduce perceived discrepancy. We know that each individual comes to us with specific weight loss and health goals, and we have designed several programs to help our guests focus on those goals during their time with us.

According to CST, the core challenge in weight loss is aligning diet and activity with goals. Most weight loss efforts lose because traditional paper and pencil self-monitoring of diet and activity fails to provide salient, timely decision support and accurate feedback. Using CST as a guiding framework, ENGAGED will develop a persuasive, interactive smartphone application designed improve the saliency, timeliness, and accuracy with which participants receive feedback on their daily dietary and activity goals. Participants will monitor dietary intake and wear a Bluetooth-enabled accelerometer to receive real-time feedback on objectively measured physical activity. Persuasively designed goal thermometers on the application will display current behavior and goals to highlight behavior-goal discrepancies. We posit based on CST that the experience of receiving consistent and immediate feedback from the ENGAGED technology should reinforce adherence to self-monitoring and healthy behavior change, both during and after in-person treatment ends. Research on social networks and weight has elicited promising results.

Christakis and Fowler [28] reported that obesity can spread virally through social networks. Relatedly, other findings suggest that including friends and family as co-participants in weight loss treatment improves outcomes [29]. What’s your track record? Thus, additional strategies to provide peer support need to be identified. Social networking tools have gained popularity on many online commercial weight management programs, and preliminary evidence indicates that technology-supported social networking can be beneficial. Krukowski et al. [30] found that use of social networking features in an online weight management program was positively associated with weight loss maintenance.

The ENGAGED study will utilize technology that enhances social networking capabilities on a smartphone application to promote the development and maintenance of a positive social network. The application will allow teammates who have been incentivized to help each other via a group weight loss competition to view each others’ adherence to daily self-monitoring goals. Additionally, the application allows team members to communicate with each other via private message board or peer-to-peer messaging. By capitalizing on team-based performance incentives and enabling team building through the ENGAGED social networking technology, we aim to extend support, encouragement, and accountability for behavioral change, between and after in-person group sessions. You will probably have to stay on approximately this diet for many years, but you’ll easily become accustomed to it. Specifically, the primary aim of the ENGAGED study is to conduct a three-group randomized controlled trial testing the efficacy of the ENGAGED technology-supported behavioral weight loss program, as compared to the same program delivered using standard paper and pencil self-monitoring, and self-guided behavioral weight loss supported by participants receiving DVD’s depicting DPP treatment. Primary outcomes include: (1) weight loss and (2) behavioral adherence, which is operationalized by (a) self-monitoring of diet and activity and (b) attainment of diet and activity goals.

As a secondary outcome, the time spent administering the intervention by lifestyle coaches will also be examined to assess intervention costs. The second aim of the ENGAGED study is to test whether the weight loss in the technology-supported condition is mediated by behavioral adherence to self-monitoring and achievement of diet and activity goals. We hypothesize that using a theory-guided, technology-supported weight loss treatment will result in clinically significant weight loss with fewer in-person sessions by preserving regular social support, accountability, and feedback via mobile technology. Further, we hypothesize that technology-supported weight loss treatment will result in greater weight loss compared to the traditional paper self-monitoring approach.

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[ Diabetes Solutions ]

BMC Public Health


Co-authored by Jay S. Whichever medication you are prescribed, it will only work and help control your diabetes if you take it properly and regularly. These symptoms are due to the body’s inability to transport glucose into the cells through the loss of insulin production. Secondary end points were the change from baseline in mixed-meal stimulated C-peptide secretion and in fasting C-peptide and achieving target HbA1c ≤7% (≤53 mmol/mol). Metabolic syndrome prevalence ranged from 8% (IDF) to 21% (WHO). Type 1 diabetes is characterised by β cell destruction, an autoimmune pathological process, and absolute insulin requirement.2 Over the past 30 years it has been recognised that not all diabetes in childhood is type 1. Glucagon prods the liver to convert more of its stored glycogen into glucose, which it secretes into the bloodstream, raising blood sugar levels.

Cox regression analysis showed that diabetes risk was significantly associated with the presence of ICAs in both subjects with low titer and high titer GAD65 and IA-2 AAs. The ethics committee form the Pedro Ernesto University Hospital that belongs to the State University of Rio de Janeiro approved the study as did all the local ethics committees of each center (Appendix 1). Although no treatments exist yet, Skyler and Sosenko note that a number of clinical trials, including TrialNet, which is supported by the NIH’s National Institute of Diabetes and Digestive and Kidney Diseases, and the Immune Tolerance Network sponsored by the National Institute of Allergy and Infectious Diseases, are devoted to developing safe and effective therapies to halt the progression to type 1 diabetes from the development of autoantibodies. Islet cell transplants are now available through the NHS for people who satisfy the criteria given below. This process does NOT occur in all patients and it sometimes takes several weeks to a month to start noting the production of the body’s own insulin (endogenous insulin). Intensive insulin therapy reduces, but does not eliminate, the risks of complications from type 1 diabetes (3,4) and normal glycemic control is difficult to achieve long term (5). Hospitalization for diabetes ketoacidosis, hyperglycemia without DKA and hypoglycemia in the previous year were also investigated.

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[ Nutrition ]

BMC Public Health

We have recently shown that permanent neonatal diabetes can be caused by activating mutations in KCNJ11 that encode the Kir6.2 subunit of the β-cell ATP-sensitive K+ channel. The extent to which the in vitro characteristics of the mutation can predict a successful transfer is not known. pmiCME is approved as a provider of nursing contact hours by the AANP (provider renewal in 2018). Those trials comprise “external” or “independent” validations. Increased expression of glucocorticoid receptor and 11beta-HSD1 in the liver of db/db mice was correlated with elevated circulating levels of corticosterone, insulin, and blood glu-cose. Okay, you already know that now. Methodology.

Gender differences were also seen in Canada where PCBs were inversely associated with T3 but not T4 in women, and PCBs were inversely associated with T4 but not T3 in men [40]. The incidence rates (per 1000 patient-years) for the primary CV endpoint were 5.3 for linagliptin versus 16.8 for total comparators. Studies from Spain, Canada, Denmark, Portugal, and South Australia [34–38] have shown that the prevalence of obesity has increased between the mid-1990s and the beginning of the 2000s. In Finland, national FINRISK studies have shown that the increase in BMI has slowed down in men, and has been quite stable in women between 1997 and 2002, whereas a remarkable shift towards higher waist circumference has been observed [32]. Reversion to NGT was associated with modest improvements, whereas conversion to T2DM was associated with significant worsening of the cardiometabolic risk profile. Among US adults the increases in the prevalence of obesity previously observed does not appear to be continuing at the same rate during the past 10 years, particularly for women [3]. Studies show proper exercise and diet is beneficial to both types of diabetes.

The large US study with African-American women11 and the French study9, also looked at the association for decaffeinated coffee. In addition to the changes seen in the FIN-D2D area, most changes in body weight and the prevalence of obesity were similar in the control area, especially among men. Although the five hospital districts of FIN-D2D formed a pilot area, the information of the importance of healthy lifestyles in the prevention of diabetes had also spread outside the FIN-D2D area, which was the aim of population strategy, as well. High levels of glucose can cause an accumulation of toxic acids in the blood, dry mouth, weakness and even comas. Therefore, the control area can be considered better as a mini-intervention area rather than a pure control area. Our data suggest that the effect shown in these studies may largely be due to regression to the mean rather than to the effect of the DMP. However, the use of alcohol was still high [42], and this could be a reason why the waist circumference was increasing [32], and why the beneficial trend in blood pressure had now levelled off [4].

There were also substantial differences among the studied areas on how they succeeded in the project, which can largely be explained by their different ways of action in the prevention of chronic diseases, and also their different population structures. It should also be noted that the prevalence of diabetes in the FIN-D2D area has already for a long time been higher than the mean prevalence of diabetes in Finland [25]. The areas were thus establishing this project from different starting points, but they also reached the goals differently. The FIN-D2D was a national health promoting programme, and not an actual scientific study. However, from the very beginning it was decided to analyse its influence by comparing changes in adiposity markers in the FIN-D2D area and the preselected control area. Pancreatic auto-antibodies are present in 85–90% of type 1 diabetic patients at diagnosis (4). Usually women are more likely to participate in lifestyle change programmes than men [43].

In FIN-D2D there were several projects focusing on men especially, which may have encouraged men to join these projects, and to also succeed in them. The threshold for men to participate is usually higher than that for women, but their commitment nevertheless is usually better [43–45]. Also, the interventions aimed at women may indirectly affect also men due to the fact that men usually eat meals prepared by women [46]. I take the rest of my dose with breakfast usually an hour later. A very limited number of high-quality studies were found addressing CV risk reduction in children with conditions predisposing them to accelerated atherosclerosis, including diabetes mellitus, which is insufficient for development of evidence-based recommendations. The lack of association with insulin resistance as defined by HOMA IR in those without diagnosed disease, as well as the lack of association when persons with glucose ≥110 mg/dL are included in the exposed group, is consistent with our previous report from women in the same cohort [18] and suggest effects on β-cell function [66]. Similar changes in the prevalence of morbid obesity were observed in all sub-regions, i.e.

the prevalence of morbid obesity increased in all sub-regions of the control area, and remained unchanged, in all FIN-D2D hospital districts. The prevalence of severe (BMI ≥35 kg/m2) and morbid (BMI ≥40 kg/m2) obesity has increased in Finland 2.7-fold and 5.6-fold, respectively, during 1978-2001 [47]. Although the number of massively obese individuals is still rather low in Finland, it would be of importance to restrain their number from increasing further. In USA the prevalence of morbid obesity is 5.4% in the age group of 40 or older [3], which is nearly three times the prevalence in Finland (1.9% with FIN-D2D and FINRISK studies combined). Although rather rare, this extreme group of people incur huge expenses along with increasing surgical treatment of obesity. The present results indicate that the obesity epidemic might be stabilizing or even decreasing in Finland. If this trend is sustainable, also the incidence of type 2 diabetes might follow the obesity trends, and ease off during the years to come.

To achieve this goal, we must now be able to maintain and to continue the progression already made regarding body weight. Furthermore, it would also be very important to be able to spread healthier lifestyles into the younger age groups, since obesity appears to reduce life expectancy markedly, especially among younger adults [48].

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[ Diabetes Type 1 ]

BMC Public Health

Most previous studies of hyperilpidemia in diabetics are based on patients in specialty clinics or reflect an era when diabetics consumed a high-fat, low-carbohydrate diet. He developed and leads unique specialist lipid and diabetes services including lipid clinics in adults and family lipids (joint with paediatrics), new diabetes therapies, liaison-psychiatry-diabetes, and diabetic hypertension. Both groups were compared with pregnant women with normal carbohydrate metabolism (NM). The levels of GlHb and FPG were significantly lower in the patients treated with diet alone than in the other groups. However, beyond its capacity for fat storage, white adipose tissue is now well recognised as an endocrine tissue producing multiple hormones whose plasma levels are altered in obese, insulin-resistant, and diabetic subjects. Exudative maculopathy is similarly not always responsive to laser and noticeably problematic are the larger lipid deposits (especially plaques) that form in the central macula. Intra-abdominal fat area was determined by computerized tomography analysis at the umbilical level.

Patients with LDL-C/HDL-C ratio ≥ 3 were slightly younger, less frequently used lipid-lowering drugs and had not so often a history of coronary heart disease or stroke. When compared to metformin, SUs could increase TC and LDL-C; compared to glinides, SUs increased TC and lowered HDL-C; compared to thiazolidinediones, SUs reduced TC, LDL-C, HDL-C, and increase TG. The rationale for therapy is based on the complications of severe hypertriglyceridemia and the risk of occlusive atherosclerosis. The risks and benefits of postmenopausal hormone replacement need to be carefully weighed in diabetic women. Your doctor may add another cholesterol-lowering agent (colesevelam, which blocks the intestinal absorption of bile acids, or ezetimibe, which blocks the absorption of cholesterol from the intestine). Numerous studies have demonstrated that participation in a preconception care program can reduce the incidence of malformations in women with diabetes to the background rate. An excellent example is cell-based therapy to treat diabetes.


The modified low-fat diet with walnuts group consumed higher levels of PUFAs and ALA. Two visits were foreseen (baseline and 4-month follow up). At entry, physicians recorded patient characteristics (weight, height), demographic data (year of birth, gender), inclusion in the DMPs for CHD or DM (if applicable), and the inclusion diagnosis (CHD, DM). Further, they documented cardiac risk factors (CHD with details on type of manifestation or intervention, e.g. myocardial infarction, atrial fibrillation or symptomatic arrhythmias, heart failure, positive cardiac family history for CHD), cerebrovascular disease (transient ischaemic attack, prolonged ischaemic neurological deficit, and stroke), renal insufficiency, other risk factors (hypercholesterolaemia, arterial hypertension, smoking, microalbuminuria). Though muscle pain and myositis is an issue in statin/fibrate treatment, adverse interaction appears to occur to a significantly greater extent when gemfibrozil is administered. The authors emphasise that, based on these findings, current outcomes for people with type 1 diabetes should be much improved in comparison to cohorts who had onset of type 1 diabetes in the 1950s to 1970s.

Lipid-lowering drugs were recorded, with particular focus on statins (simvastatin, lovastatin, fluvastatin, pravastatin, atorvastatin) with the respective dosages (10, 20, 40, 80 mg/d). Walk-in clinic rates can cost anywhere from $50 to $100. The results of the current treatment were noted for hyperlipidaemia (laboratory values for total cholesterol, LDL-C, high density lipoprotein cholesterol (HDL-C), and triglycerides), for hypertension (systolic and diastolic blood pressure), and long-term glycaemia status (HbA1c). Physicians commented on whether, according to their judgement, LDL-C target levels were attained (“individual targets”). At about 4 months, drug therapy and results were recorded in an analogous manner as at entry. Apart from these data, no further information about efficacy and safety was collected. If an adverse drug reaction occurred, physicians were requested to notify the manufacturer of the drug associated with the event.

Data were stored with the database system Microsoft Access 2003, and analysed with the statistical program SAS release 8.2. That said, the construction of allele scores is a challenging and imperfect science, and the authors present a strong and well-reasoned case for their approach. For quality assurance, plausibility checks using minimum and maximum values for the individual parameters were applied. Descriptive statistics were calculated and distribution of parameters was presented as means with standard deviation. Data are presented by indication (DM vs. CHD) and by DMP versus non-DMP groups, respectively. Statistical comparisons were performed between patients in the DMP vs.

non-DMP groups within the two indications (statistical significance was set at the 0.05 level). For this descriptive analysis, corrections for multiple comparisons were not performed.

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[ Diabetes Type 1 ]

BMC Public Health

In 2014, The Florida Department of Health (DOH) and the Florida Health Care Coalition (FLHCC) partnered together to develop, implement, and evaluate a project to increase inclusion of the Centers for Disease Control and Prevention’s (CDC) Diabetes Prevention Lifestyle Change Program as a covered benefit for employees in the State of Florida. “The Diabetes Prevention Program will provide Veterans with another tool to help them lead healthier, fuller lives, reducing their risk for diabetes,” said Secretary of Veterans Affairs Eric K. The announcement was made by MedNetOne CEO, Ewa Matuszewski. The faculty members of the non-profit University of Pittsburgh Diabetes Prevention Support Center (DPSC) have assigned all individual rights to receive income from the copyrighted Diabetes Prevention Program/Group Lifestyle Balance Program™ (GLB) and its derivatives to the University of Pittsburgh. While a prediabetes diagnosis indicates a high risk of developing type 2 diabetes, not all pre-diabetics progress to diabetes. This 16 week program provides group sessions and individual support with a Lifestyle Coach, Certified Personal Trainer, Registered Dietician and Licensed Therapist. Results: All three populations agreed the DPP aided in implementing lifestyle changes and preventing the onset of type 2 diabetes and the classes provided a positive experience for support, in-depth discussion, and opportunities for learning how to make lifestyle changes.

An AMA PRA Category 1 CreditTM online enduring materials format CME was chosen as the most effective and convenient activity to target primary care physicians. Yet, merely 10 percent are aware of this diagnosis. This can be done with some scheduling flexibility during months 4-6 of the program. For a list of scheduled classes, click here. If your “yes” answers score 9 or higher, then you may be at risk for pre-diabetes or diabetes, and may qualify for the program. During a bridge period between the end of DPP and the beginning of DPPOS, all participants were instructed in the lifestyle intervention. All publications, presentations, reports, or developments resulting from or relative to use of GLB materials, which have been modified (all or in part), shall be acknowledged as follows: “We would like to acknowledge the Diabetes Prevention Support Center (DPSC) of the University of Pittsburgh for training and support in the Group Lifestyle Balance program; the current program is a derivative of this material”.

It is therefore more cost effective to deliver [17, 18]. A recent meta-analysis of all published GLB studies (N = 28) found an average weight loss of 4% body weight at 12 months [19]. While clinically important, this is less than the average weight loss achieved in the original DPP trial (7%) [10]. Recruitment for the study began in April 2005 in 11 urban medically underserved neighborhoods near Pittsburgh, Pennsylvania. Further, one might also expect that participants regain weight at perhaps even larger rates than in the original DPP after program completion because the GLB is shorter and less intense. Thus, it is pertinent to increase the short- and long-term effectiveness of the GLB through means that compensate for the efficacy lost due to the group-based intervention delivery, lower contact intensity, and shorter duration. In summary, the DPP is costly, which limits widespread dissemination.

The group-delivered version (i.e., the GLB), on the other hand, is cheaper and can thus be disseminated more widely, but it is less effective. Weight regain occurs after both programs. Lifestyle Poor eating habits Engaging in a little or no physical activity Having low HDL cholesterol, high triglycerides or high blood pressure Race and ethnicity Type 2 diabetes is most common among certain racial and ethnic groups including: African Americans, Hispanics, American Indians and Alaska Natives, Asian Americans, Native Hawaiians and other Pacific Islanders. The techniques we propose to integrate into the GLB will facilitate the formation and maintenance of new habits. Ouellette and Wood [21] define habits as “[behavioral] tendencies to repeat responses given a stable supporting context” (p. 55). According to Ouellette and Wood, these cue-behavior chains have to be practiced in order to become automatic.

Automaticity of the adopted behavior is the core aspect of habits [22]. Based on the literature of habit change, we have identified if-then plans and their mental practice as the two strategies for which strongest empirical evidence exists to suggest that they lead to lasting behavior change, i.e. Today’s announcement creates the pathway for Medicare to cover National DPP certified programs, thereby opening access to millions of Americans at risk for type 2 diabetes. We have therefore integrated these habit formation techniques into the GLB. This paper describes the protocol of a randomized controlled trial that compares the enriched version of the GLB with its original version. Two decades of research have provided strong evidence that if-then planning (implementation intentions) and mental practice are crucial techniques for creating strong and lasting habits [23–27]. If-then plans are concrete action plans that specify, in an if-then format, when, where, and how one will act in order to achieve a specific goal (“If situation Y occurs, then I will initiate goal-directed behavior X!” [26–29]).

Forming if-then plans has been found to be much more effective than relying solely on motivation and willpower, as expressed in mere goal intentions (“I will do X”). In fact, a large meta-analysis reported medium-to-large effects of if-then plans on goal achievement across many behavior domains (94 studies, d = .65) [28, 29]. In a subsequent meta-analysis reviewing physical activity studies, a medium average effect size difference was found [30]. Most importantly, longitudinal studies show that the formed habits are strong and more durable when using if-then planning [31–36]. In the study with the so far longest follow-up interval (48 months), it was found that adolescents in the if-then planning group showed a 34.5% reduction in smoking uptake [32]. Evidence suggests that if-then planning leads to lasting behavior change because the plans render behavioral responses automatic [37]. Specifically, automaticity is achieved because (1) specifying the exact cues in the ‘if’ component prompts the behavioral response that the person committed him/herself to when forming the if-then plan [37]; and (2) the if-then contingency format establishes a strong mental link of causality between the critical cues (‘if’ component) and the chosen behavioral response (‘then’ component) [38].

By explicitly making the causal connection between the critical cues and the goal-directed response through the if-then format, these plans effectively move people from planning to automatically carrying out the behaviours [38, 39]. Once automatic, the behavioral response requires little mental effort, contemplative decision-making, self-regulation capacity, or external reinforcement to be carried out [40]. For instance, Milne et al. [36] found that of the people who made if-then plans about when, where, and how to exercise, 100% exercised at the place that they had specified in their if-then plan, 97% exercised at the time that they had specified, and 88% exercised on the day that they had specified. Creating new habits for complex behaviors such as healthy eating or exercising requires frequent repetition of the same behavior over an extended period of time for it to become habitual. If-then plans can help people to repeat the same behavior over and over again and thereby form habits faster and more enduringly. Mental practice independently has also been shown to improve goal attainment (e.g., [41]).

Mental practice (or mental rehearsal) is defined as ‘the cognitive rehearsal of a task in the absence of overt physical movement’ (p 481 [42]). To be effective, mental practice involves the use of multiple sensory modalities, such as imagining the motor movements, objects, situations, emotions through vision, smell, hearing etc. [43–45]. In our own research, we have shown that including mental practice into if-then planning significantly enhances the effectiveness of the if-then plans [23–25]. Combining if-then planning and mental practice is more effective than either if-then planning or mental practice alone [23]. For instance, average daily fruit consumption over a 7-day period more than doubled from pre- to post-intervention in a sample of undergraduate students (from 1.79 to 3.85 portions of fruit/day) after participants were trained to mentally practice their implementation intentions to eat more fruit. There was no increase in the control group [24].

To determine the effectiveness of the enriched GLB on weight loss at 3, 12, and 24 months (primary outcomes) and other weight relevant risk outcomes (secondary outcomes) at 3, 12, and 24 months following implementation compared with the standard GLB. To determine whether habits are formed faster (3 months), are stronger at program completion (12 months), and are maintained for a longer period of time after program completion (24 months) in the enriched versus the standard GLB.

Tags: , ,
[ Diabetes Solutions ]

BMC Public Health

According to the fetal insulin hypothesis, shared genetic factors lead to suboptimal prenatal growth and to insulin resistance in the parent’s later life.1 If this is true, we expect non-insulin dependent diabetes in parents to be associated with lower birth weight among their offspring. Studies with either quantitative or qualitative estimates of the association between birth weight and type 2 diabetes were included. Men with birth weights between 2 and 3 standard deviation score (SDS) had a 1.9-fold increased risk (HR 1.91, 95% confidence interval [CI] 1.25–2.90) of type 2 diabetes, whereas those with birth weights above 3 SDS had a 5.4-fold increased risk (HR 5.44, 95% CI 2.70–10.96) compared to men with birth weights between −2 and 2 SDS. Women diagnosed as suffering from GDM (n=162) were included in the study if their own birth weight data were available. Maternal and foetal infections, such as cytomegalovirus, chicken pox and rubella, or medical problems in expectant mothers, such as diabetes and high blood pressure, uterine and cervix abnormalities, can also explain low birth weight deliveries. All subjects were enrolled in the Newborn Follow-Up Program. The high-risk HLA-DQ2/8, DQ8/0604 and DQ8/X genotypes were associated with HrBW (odds ratio [OR] [95% CI]=1.20 [1.08-1.33], p=0.0006).

We could not verify the association between birth rank and birth weight in our cohort, because participants were largely unable to answer questions on their birth weight, probably because it had never been measured. While the association between birthweight and risk of type 2 diabetes is mediated via combined effects on beta cell function and insulin sensitivity, prematurity seems to influence risk of type 2 diabetes via attenuated insulin sensitivity only and independently of fetal growth rates. The effect of birth rank on birth weight may be reduced by older brothers [41]. Maternal diabetes was associated with higher birthweight (59 g increase; 95% CI: 50, 68; P = 3 × 10(-37)). It is also possible that birth rank may be an instrumental variable for infant growth, as well as or instead of birth weight, because infants with lower birth order often grow rapidly in the immediate post-natal period. Rapid post-natal growth is associated with cardiovascular disease risk factors [42]. We do not have infant growth rates for this cohort.


However rapid infant growth is usually associated with several aspects of cardiovascular risk [42], not just blood pressure. As regards, the assumption concerning a lack of association between birth rank and potential confounders, this was more apparent among men than women. Moreover, childhood socio-economic position has little association with CVD risk among men in this population [37]. As such, birth rank may be a more suitable instrumental variable for men than women. However, the associations were similar in both sexes. We also had to use a separate sample instrumental variable approach, so we could not adjust for covariates in the prediction equation for birth weight nor could we test the strength of our instrument. We did carry out sensitivity analyses using prediction equations based on other studies and results were similar (Additional Files 2, 3).

Cholesterol was determined by a standard enzymatic-cholesterol oxidase-based method; HDL cholesterol (HDL-C) was determined after precipitation of non-HDL lipoproteins with magnesium/dextran precipitating reagent; triglycerides were determined using a standard glycerol blanked, enzymatic, triglyceride method. It would be valuable, if birth rank were used an instrumental variable for birth weight in a single sample including birth rank, birth weight and cardiovascular risk factors, however we are not aware of any such analysis. In addition, giving birth to a macrosomic infant (10 pounds or more) could suggest an increased risk of future maternal T2DM in the absence of GDM or could result from undiagnosed GDM. Parents could also pay greater attention to children of lower birth rank, however to what extent that might be relevant in a culture where children are traditionally cared for by their grandparents is difficult to assess. It is possible that some or all of these loci could also influence the processes leading to type 2 diabetes independently of intrauterine growth. Abdominal circumference measurements were transferred into categories (percentiles) according to gestational age (10); abdominal circumference >90th percentile was defined as fetal overweight. However, we did find some of the expected associations between birth weight and cardiovascular risk, just not all of them.

Blood cord adiponectin levels are positively related with birth weight and BMI in newborns [7], although this statement has been challenged [9]. Perhaps the relevant exposure(s) did not vary or foetal exposures impact blood pressure but other mechanisms, of which birth weight is a non-causal marker, underlie the commonly observed inverse association between birth weight and diabetes, such as genetic influences as in the ‘foetal insulin hypothesis’ [43]. Alternatively, more recent socio-biological conceptualisations of the changes in disease patterns with economic development [44] suggest that the commonly observed associations for diabetes could simply be an historical coincidence, generated by two unrelated secular trends that occur with economic development. Height increases over many generations of economic development [45], perhaps as epigenetic constraints on fetal, infant and childhood linear growth “wear off” [46, 47]. Although trends in birth weight are less well documented, height determines birth weight [48]. Birth weight has certainly increased in southern Chinese over the last 60 years [25, 30]. Our criteria were consistent with previous reports except for the use of C-peptide, which provides a more objective measure of residual insulin secretion than lack of insulin treatment for 6–12 months after diagnosis, which is often used [11].

However, increasingly levels of sex-steroids over generations would also reduce vulnerability to diabetes because of the anabolic effects of sex-steroids on muscle mass [55], providing greater capacity for glucose disposal. The historical coincidence of these two separate secular trends would generate an apparent negative association between birth weight and diabetes, particularly in populations with a long history of economic development and hence heterogeneity in intra-population experience over generations. Conversely, in populations with a much more recent history of economic development and hence homogeneity of experience over generations there would be less association, as seen here and the cohorts from more recently developed populations [18–20].

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[ Herbal Remedies ]

BMC Public Health

Liraglutide causes dose-dependent and treatment-duration-dependent thyroid C-cell tumors at clinically relevant exposures in both genders of rats and mice. ARISTADA is not approved for the treatment of patients with dementia-related psychosis. This group will receive a daily video reminders and tips for the first 6 months of the study. Clinical Medicine We upload videos on Clinical Medicine every week! Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. As with all insulin preparations, the time course of action of NovoLog® may vary in different individuals or at different times in the same individual and is dependent on many conditions, including injection site, local blood supply, temperature, and level of physical activity. It is unknown whether Saxenda® causes thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans, as the human relevance of liraglutide-induced rodent thyroid C-cell tumors has not been determined.

The clinical phase was fibrinopurulent (StageII) . Victoza® is not a substitute for insulin and should not be used in patients with type 1 diabetes mellitus or diabetic ketoacidosis. Active participatory communication behaviors includes four essential elements: providing a history, asking question, expressing concerns, and making requests. STRIVERDI RESPIMAT can produce a clinically significant cardiovascular effect in some patients, as measured by increases in pulse rate, systolic or diastolic blood pressure, or symptoms, and should be used with caution in patients with cardiovascular disorders, especially coronary insufficiency, cardiac arrhythmias, hypertrophic obstructive cardiomyopathy, and hypertension. The study is limited to the Caucasian population in the U.K., and the researchers noted that a “great majority of patients had modest weight gain prior to diagnosis.” They suggested that health care providers should focus on small weight reductions for the larger populations than focusing mostly on weight loss for those at high-risk for type II diabetes. If there is stress during this time the stress hormones leave behind an epigenetic imprint, which accompanies the child for the rest of his or her life into adulthood and old age. Researchers at the Harvard John A.


Vimeo does not allow videos promoting or advertising any of the following commercial activities: Escort servicesErotic massagesFetish fulfillmentFinancial dominationPornographic magazines or websitesPenis enlargement or enhancement productsStrip clubs or other erotic entertainment venuesSeduction coaching or pick-up artist (PUA) systemsVideos promoting adult pleasure devices are sometimes allowed for PRO and Business users, provided that these videos aren’t sexually explicit. In the present study, people with diabetes received daily, asynchronous one-way videos of diabetes-related tips and reminders delivered via cell phones. It has a handle and blade, which is similar to a Macintosh laryngoscope blade in shape, and a small camera and light source at the tip of the blade. Counsellor initiated private messages and real time counselling sessions have been found to result in greater weight loss compared to web-based interventions providing information on weight loss only [24–27]. Other methods of delivering social support in web-based interventions with lower time and cost restraints include online peer discussions and provision of an available online coach (“Ask the expert” button). Neither method has been found to be successful at improving behavioural outcomes of the intervention, as few participants have shown to use these features [28]. Although the effectiveness of online coaching is well established, the high time and cost investment in comparison to computer-tailored advice means that they are rarely included in web-based health behaviour interventions aiming to reach a wide audience [29, 30].

In contrast, the McGRATH video laryngoscope does not require this manipulation. Computer-tailored advice is automatically produced using a computer-based expert system that delivers feedback based on participant’s responses to a questionnaire [18]. Computer-tailored physical activity advice is read, printed, discussed and remembered more than generic advice [31]. Furthermore, it is also more appreciated by participants, processed more intently and leads to greater attention compared to generic advice [32]. Now the body does need some glucose to function properly, usually in the morning when you wake up. Despite the well-established effects of computer-tailoring, it is unknown if computer-tailored interventions would be more effective with an element of human support. It appears no web-based physical activity interventions have provided both computer-tailored advice and online coaching simultaneously.

It is therefore unknown whether this combined approach improves intervention outcomes. Fibrin glue (Bolheal®, Kaketsuken, Kumamoto, Japan) was applied to the covered surface, and VATS debridement and decortication was then performed. In addition the computer-tailored advice may reduce reliance on the knowledge and expertise of the coach. Sixteen (32%) cases were prepubertal and 34 (68%) were postpubertal. Furthermore, advances in internet technology and broadband capacity allow the coaching sessions to be delivered via free online video-calling programs (e.g. Skype) which, unlike online instant messaging or forums, enables the participant to view the coach whilst engaging in a verbal discussion. A pedestrian spoke to him soon after the crash, but he was unresponsive.

Video-coaching facilitates higher engagement, feelings of accountability and social support, and reduces the risk of misunderstandings compared to emails and instant messaging [36, 37]. The current study will examine the feasibility, engagement, retention and effectiveness of a computer-tailored web-based physical activity intervention, with and without brief online video-coaching sessions. The findings will guide health promotion professionals in delivering future large-scale web-based physical activity interventions that are effective at engaging participants and producing long-term behaviour changes. More specifically this study will assess the between group differences in physical activity outcomes as a result of receiving computer-tailored advice inclusive of video-counselling sessions, compared to computer-tailored advice alone and a wait-list control group. The secondary analyses will assess between group differences in website engagement (website user statistics and fidelity), retention, participant satisfaction, quality of life, and correlates of physical activity (mediators and moderators). Quality-of-life will be measures using 2 validated instruments at 0, 26 and 52 weeks – the Problem Areas in Diabetes (PAID), which is a diabetes-related quality of life questionnaire and the SF-8, which is a general quality of life questionnaire for people with chronic disease.

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[ Diabetes Type 2 ]

BMC Public Health

This literature review has presented the available evidence on the household financial burden related to NCDs in LMICs. Over 50% of the youth reported that they had had an HIV test with females more likely to test than males.3 This is timely because work in Lesotho has shown that health workers attribute HIV/AIDS to changing lifestyles and demographic profiles.4 In fact family dynamics in adherence to HAART has been studied by Nigerian workers.5 Most of the respondents were adherent and attributed this to care and support they received from their families. tuberculosis and HIV) and chronic NCDs [2], based on emerging country-level evidence [3]. With greater energy expenditure, CHD incidence further declined in a curvilinear fashion. Greater attention to policymaking in sectors beyond health that have a bearing on NCDs, such as trade and marketing of unhealthy or harmful products. The declaration highlights NCDs as a major challenge for development in the 21st century, emphasising that NCDs undermine social and economic development, and threaten the achievement of global development and poverty-eradication goals. NCDs represent a serious threat for the Pacific, accounting for up to 75 per cent of recorded deaths.

The Resolution, adopted by governments at the UN, determines the length, outcomes and other key details of the UN Summit, and strongly influences whether the Summit will be a turning point for diabetes and NCDs. To address the growing threat of NCDs, India has recently developed specific targets and indicators to reduce its NCD burden by 25% by 2025, in line with the World Health Organization’s 25 x 25 initiative. This is a world in which more than 40 million pre-school children are obese or overweight. [24]. These are: genetic factors determining growth patterns may be associated with hypertension [30]; coronary artery vessel diameter increases with height and vessel with smaller diameters may result in clinical disease outcome with relatively smaller amounts of atherosclerosis. Coordinate and link with ministries of health (MoH), WHO, and other main organizations, stakeholders, academics and associations at global, regional and national levels. A key achievement has been the development of a pilot project integrating NCD prevention, early detection and management services to the primary health care level, including strengthening relevant referral systems.

Some of the most cost-effective strategies to combat tobacco use and harmful use of alcohol include raising taxes and enforcing bans on advertising especially targeted to adolescents. Anthropometric variables are collected by using direct measurement rather than self-reporting. Low- and middle-income countries are disproportionally affected: more than 80% of CVD deaths take place in low- and middle-income countries and occur almost equally in men and women. The response rates of this study are high. A NCD target was also included in the Sustainable Development Goals agenda to reduce premature deaths from NCDs by 30% by 2030. We will establish a research capacity building network with collaborating institutions. In our It suggests that shorter individuals may be at higher risk of metabolic disturbance [31].

Novartis Access has recently partnered with the ICRC, what shape is this partnership going to take and in what ways can it improve the response to challenges identified in the treatment of people with NCDs? study, we only consider individuals of age 35 years or more since in 2011 BDHS study, men and women of age 35 or older were only considered to provide the biomarker information. Therefore, results of this study may not be extended to the other age groups. Though the variables on life styles such as diet, physical exercise, and smoking are the potential confounders for the diabetes and hypertension, these were not included in the analysis since these are not available in the 2011 BDHS data. At least 50% of eligible people receive drug therapy and counseling (including glycaemic control) to prevent heart attacks and strokes. That is, the shorter height is associated with a higher occurrence of diabetes as well as hypertension. The height may be controlled by genetic and non-genetic (early-life and childhood) factors [32–34].

Naturally, if most of the members of a family are of short stature, the next generation is likely to have short stature. But, genetic factors are entirely beyond the control of human. The non-genetic factors which may affect the height include: maternal smoking during pregnancy, prenatal and postnatal, ill health during childhood and adolescence, birth weight, mental condition during childhood and adolescence. Non-genetic factors can be controlled to some extent by following a healthy life style from the childhood. Establishment of methods and tools for monitoring trends of NCD morbidity, mortality, and risk factors. To conclude with, considering the ever increasing burden of cardiovascular diseases in India the Government of India has taken certain initiatives at national level that is really commendable.

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[ Diabetes Solutions ]

BMC Public Health

The Internet has emerged as a potentially effective medium for information exchange. This article describes the reporting of sex effects by SRs on interventions for depression, type 2 diabetes mellitus, and chronic pain conditions (chronic low back pain, knee osteoarthritis, and fibromyalgia). The review includes articles that met the following criteria: (a) empirical study reporting the impact of an intervention on such outcomes as knowledge, behavior, self-care, and metabolic control; (b) children with type 1 diabetes and/or their families as primary subjects; (c) publication between 1980 and January 1, 1999; and (d) publication in English. Only randomized controlled trials, controlled clinical trials, or cohort studies with a control group were eligible for inclusion. Over the four-year observational analysis, which included more than 4,000 adults with type 2 diabetes, participants who received intensive lifestyle interventions lost significantly more weight than those in the control group and measured greater fitness improvements. Pharmacist care was not associated with a significant change in HDL cholesterol (6 studies with 826 patients; 0.2 mg/dL [-1.9 to 2.4]). It is possible to state tentatively that certain interventions have been used for specific problems with some indication that they can be effective.

Using the 2006 health checkup data obtained from each cluster, lifestyle support centers sent a program kit to the candidates who met the eligibility criteria and invited them to participate in the study. The kit included an explanation about the study’s aims and protocol, a consent form, and a questionnaire regarding lifestyle and health status. The model incorporates a systematic and sequential process that includes preliminary planning; audience, channel, and market analyses; materials development and pretesting; implementation; and evaluation. Secondary outcome measures were overall mortality, disease-specific mortality, quality adjusted life years (QALY), and clinical parameters; body mass index (BMI), weight change, blood pressure, blood parameter, smoking, alcohol consumption. Data will be collected at more than one time point in order to allow for testing of responsiveness. The progression to diabetes will be monitored by an annual health checkup and questionnaire over three years. All data for the study are collected at the lifestyle support centers and sent to the data management center in a de-identified form.

By advertising on the internet or by direct contact, we invited health care divisions at communities and companies to participate in the study. Overall, a beneficial effect on BMI was also described in the intervention group in 12 out of 14 studies. Health care divisions, in which study team members are directly involved as industrial physicians, were excluded. After the seminal report from the first Bypass Angioplasty Revascularization Investigation (BARI), which described a 3-fold higher mortality rate 5 years after percutaneous transluminal coronary angioplasty than after CABG (20.6% versus 5.8%; P=0.0003),3 several observational studies and randomized clinical trials (RCTs) have reported outcomes in diabetic subgroups. Among them 14 health care divisions belonged to companies, 2 to municipalities, and 1 was a mixture of small-sized companies and municipalities. They were all approved by the steering committee. A large health care division, covering many distant areas, was divided into groups.

This process was done by the health care division itself mainly based on the area and number of examinees. A total of 43 groups were thus formed from 17 health care divisions. The number of groups formed in each health care division ranged from 1 to 10. There was a lower incidence of diabetes in intervention groups (3% to 46%) compared with control groups (9.3% to 67.7%). Some groups that were small were pooled with others. Using the results of health checkups in 2006, candidates who met inclusion criteria (described later) were identified in each group. Prediabetes substantially raises the risk for developing type 2 diabetes.

Randomization was performed 3 times according to 3 recruitment periods (March to April, May to June, and July to August in 2007). When two or more groups were made from one health care division, they were allocated to each of the arms within the health care division. Nevertheless, authors acknowledged the limitations of this study and state that this review’s conclusion should be used with caution. Allocation was carried out using stratified randomization with seven strata of companies or communities in the first period, five strata in the second period, and three strata in the third period. A randomization list was prepared by an independent statistician using the SAS PLAN procedure with seed = 4989. This procedure was conducted using SAS version 9.1 (SAS Inc., Cary, NC, USA). Simple randomization was performed with 2 levels of treatment.

The groups were notified of their allocation status before study subjects were recruited. The subjects were notified of their allocation status when they were recruited. Guidelines for health check implementation were announced in 2004 based on the Health Promotion Law. In 2006 mandatory items to be checked included 1) anamnesis of past history including history of medication and smoking, 2) subjective and objective symptoms, 3) body height and weight, 4) Body Mass Index (BMI), calculated as body weight (kg) divided by square of body height (m2), 5) blood pressure, 6) serum alanine aminotransferase, asparate aminotransferase and gamma glutamyltranspeptidase, 7) serum triglycerides, HDL cholesterol and LDL cholesterol, 8) fasting plasma glucose, and 9) urinalysis. At health checkup sites anthropometric measurements were done by public health nurses or industrial nurses. Height was measured in the standing position by public health nurses or industrial nurses. Weight was measured without shoes or heavy clothes to the nearest 0.1 kg using standard calibrated scales.

Systolic and diastolic blood pressure values were measured in the sitting position [21]. Blood was withdrawn after 8 hours of fasting and analyzed with standard methods in clinical laboratories under the nationally certified laboratory management system. If blood was withdrawn from people who had not fasted, plasma glucose data was treated as casual plasma glucose and triglycerides values were omitted from the analysis. We did not perform any additional tests for this study. Using the 2006 year health checkups data, candidates who met the inclusion criteria were identified in each cluster. Inclusion criteria included an age of 20-65 years and impaired fasting glucose (IFG) defined as a fasting plasma glucose concentration (FPG) of 100-125 mg/dL (5.6-6.9 mmol/L). In the 2006 year health checkups, however, blood sampling was not always done in the fasting state.

In those individuals where the FPG was not available, plasma glucose concentrations (casual plasma glucose, CPG) of 118-143 mg/dL (6.6-7.9 mmol/L) [22, 23] were considered eligible. A CPG ≥11.1 mmol/l (200 mg/dl) indicates diabetic type of glucose tolerance according to the report of the committee on the classification and diagnostic criteria of diabetes mellitus [24, 25]. A CPG is also used as the risk assessment for cardiovascular disease in Japan [26]. Exclusion criteria included diagnosed diabetes, a previous history of diabetes taking anti-diabetic agents, a HbA1c of ≥ 6.5% [27]. Women with a history of gestational diabetes could be enrolled. Physical or medical conditions that do not allow exercise, pregnancy or possible pregnancy, evidence for of type 1 diabetes mellitus, liver cirrhosis or chronic viral hepatitis (type B or type C), and use of a cardiac pacemaker were also included as exclusion criteria. We also excluded those who had already participated in other lifestyle modification programs and those who could not obtain the approval from their doctors.

We outsourced some parts of the study works to three existing private companies (Tokio Marine & Nichido Medical Service Co., Ltd., National Education Association, INC. VISIT HEALTH Co., Ltd., and Meiji Yasuda System Technology Co., Ltd., Japan). They were all practicing healthcare services. They participate in this study as a lifestyle support center, which managed the recruitment and enrollment of study subjects and the lifestyle intervention. The lifestyle support center sent a program kit by mail to the eligible subjects in each cluster, inviting them to participate in the study. The kit included an explanation about the study’s aims and protocol, a consent form, and a questionnaire regarding lifestyle and health status. Those who consented to participate and completed the questionnaire were enrolled as study participants at the lifestyle support center, after their eligibility was checked based on their self-reported present and past health conditions and, when available, based on information from physicians in the health care divisions.

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[ Diabetes Solutions ]

BMC Public Health

Twenty‐one studies assessing interventions to improve adherence to treatment recommendations, not to diet or exercise, in people with type 2 diabetes in different settings (outpatients, community, hospitals, primary care) were included. According to a 2010 report from the Pew Internet and American Life Project, half of teens send 50 or more text messages a day, or 1,500 texts a month, and one in three send more than 100 texts a day, or more than 3,000 texts a month. Data were analyzed using a general linear model on log (HbA1c). Results: A total of 1099 people were studied: 574 (52%) males and 525 (48%) females, mean ± SD age 62 ± 12 years, diabetes duration 10 ± 7 years. Overall, we find that increasing diabetic drug adherence from 50% to 100% reduces the hospitalization rate by 23.3% from 15% to 11.5%. A cross-sectional and exploratory study was carried out, involving 417 type 2 diabetes mellitus patients, selected through a stratified random sample, in the Southeast of Brazil. The proportions of females/males with type 2 DM was found to be 69% and 31% respectively.

The older brother subsequently discontinued insulin therapy and both have remained off all pharmacological therapy with good glycaemic control (HbA(1c) < 53 mmol/mol, < 7%) and no adverse complications. Prospective analyses showed that neither marital quality measure at T1 was a prospective predictor of aspects of adherence to self-care at T2.Conclusions: Future efforts to improve self-care should explore the value of interventions that target the spouse and/or the couple’s relationship. Simplifying dosage regimen, selecting treatments with lower side effects along with an emphasis on diabetes complications should be taken into account in future interventions designed to improve health outcomes for patients with type 2 diabetes. These questionnaires were completed by a convenience sample of 30 diabetic patients. 19%, p=0.065). Based on their feedback, some of the questions were reworded to eliminate ambiguous phrasing. Probably the same culture and lifestyle are responsible for this. We carried out a principal component analysis followed by a varimax rotation, to explore if the attitudes questionnaire domains were valid. Blackburn, et al. For example, if pharmacists are staffing anti-coagulation clinics, spending time dispensing medications, or completing other such tasks, then they will not have the ability to engage in activities such as medication education and counseling which have been shown to positively impact medication adherence for patients with diabetes. HbA1c measurements were obtained in 85.7 and 62.1% (P = 0.04), albumin-to-creatinine determinations in 89.3 and 35.7% (P = 0.0001), FLP assessment in 92.9 and 65.5% (P = 0.021), and foot examination 82.1 and 6.9% (P = 0.0001) of patients in PMC compared with physician-managed group, respectively. Further, a Cronbach's alpha was used to examine the internal consistency of the attitude questionnaire, which was acceptable (alpha = 0.74). Each question of attitudes scale was rated on a five-point (1–5) Likert scale of agreement, ranging from "strongly disagree" to "strongly agree". Questionnaires' English version [see Additional file 2] is a translation from the authors, and had not been adapted to this language; the originals Spanish questionnaires are available from the first author.
The situation is more critical for those needing insulin. Type-2 diabetes accounts for over 90% of the cases. All four items were answered on a five-point scale, ranging from 1 (never) to 5 (very often). Inclusion criteria for all participants were: patients ≥40 years of age, who had been diagnosed with DM2 at least one year earlier, who received oral hypoglycemic medication (glibenclamide and/or metformin), and who did not use insulin or suffer from chronic complications. Diabetes Care 2008;31(8):1516–1520. Due to some diabetic patients having monotherapy or polytherapy prescription, the number of medications in our study is larger than the number of patients. Further, we took into account the prevalence of adherence reported by Donnan et al.

[14] in patients with polytherapy (35%). With this prevalence being low, it is expected that the questionnaires are able to detect most of the patients who do not adhere [15]. As a result, the sample size calculation was done to identify a specificity of 80% to detect nonadherence (95% confidence level) and a precision of 5%. It is a research-driven entity with a worldwide reach that collaborates with external healthcare experts from across academia and the public and private sectors to objectively apply IMS Health’s proprietary global information and analytical assets. EPIDAT 3.1 [16] was used to calculate the size and power of the sample, which uses the proposed formulae by Obuchowsky N [17] for studies of test accuracy. Two health professionals were trained to carry out home visits and patient interviews. In the PHCC, the interviewers invited the patients to participate and explained the details of their participation in the research by means of an informed consent form.

In the first home visit, interviewers recorded the number of pills that patients had received, and also completed the questionnaires about personal characteristics, medical prescription knowledge, and attitudes to treatment adherence. Over three months and each month, interviewers visited the patients again to register the pills that patients received in their consultation; at the last visit, they registered the pill count. The true level of treatment adherence was identified by means of the pill count. As a result, this method gave the percentage of adherence which was calculated by dividing the difference in the number of pills in the first home visit, and the pills remaining at the last home visit by the number of pills prescribed for the time interval, and multiplying the result by 100. Pill count percentages were converted to a categorical scale, as proposed by Mason [6]. As such, a patient who took between 90 and 105% of the medication prescribed was classified as having good adherence, and a patient that took < 90% or > 105% was classified as having poor adherence. To classify attitudes, answers to the questionnaire were added and divided by the number of items.

A result of 4 or 5 was classified as a positive attitude and a result of 1–3 was classified as a negative attitude. A patient was classified as having strong knowledge when the answer to the three questions matched the physician’s prescription. When at least one answer did not match with physician’s prescription the patient was classified as having weak knowledge about the medical prescription. The questionnaires of attitudes and knowledge were combined for a serial analysis [18]. Since the study was conducted at a clinic setting, a social desirability bias might have creeped in. Descriptive statistics were calculated for the sociodemographic and clinical characteristics of Type-2 diabetic patients and for treatment adherence, knowledge, attitudes, and serial analysis. Continuous data with normal distribution were described using mean and its standard deviation, or median and quartiles for variables without normal distribution.

These data analyses were conducted using SPSS 11.0 [19]. Principal component analysis and the internal consistency of the attitudes questionnaire were evaluated using SPSS [19]. The Medcalc statistical software, v10.0.1 [20] was used to calculate the sensitivity, specificity, predictive values, likelihood ratios, and post-test probabilities for each questionnaire in independent analysis, and for a serial analysis. This study was approved by the IMSS Research Committee in Aguascalientes.

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