Renal denervation in a patient with Alport syndrome and rejected renal allograft

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Narayana Raju

2015-12-01

Full Text Available Renal denervation is a new intervention to treat resistant hypertension. By applying radiofrequency (RF to renal arteries, sympathetic nerves in adventitia layer of vascular wall can be denervated. Sympathetic hyperactivity is an important contributory factor in hypertension of hemodialysis patients. Hyperactive sympathetic nervous system aggravates hypertension and it can cause complications like left ventricular hypertrophy, heart failure, arrhythmias and atherogenesis. Our report illustrates the use of renal denervation using conventional RF catheter for uncontrolled hypertension in a patient with Alport syndrome and rejected renal allograft. Progressive and sustained reduction of blood pressure was obtained post-procedure and at 24 months follow-up with antihypertensives decreased from 6 to 2 per day, thereby demonstrating the safety, feasibility, and efficacy of the procedure. There are some reports available on the usefulness of this technique in hemodialysis patients; however, there are no studies of renal denervation in patients with Alport syndrome and failed allograft situation.

Renal denervation in a patient with Alport syndrome and rejected renal allograft.

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Raju, Narayana; Lloyd, Vincent; Yalagudri, Sachin; Das, Bharati; Ravikishore, A G

2015-12-01

Renal denervation is a new intervention to treat resistant hypertension. By applying radiofrequency (RF) to renal arteries, sympathetic nerves in adventitia layer of vascular wall can be denervated. Sympathetic hyperactivity is an important contributory factor in hypertension of hemodialysis patients. Hyperactive sympathetic nervous system aggravates hypertension and it can cause complications like left ventricular hypertrophy, heart failure, arrhythmias and atherogenesis. Our report illustrates the use of renal denervation using conventional RF catheter for uncontrolled hypertension in a patient with Alport syndrome and rejected renal allograft. Progressive and sustained reduction of blood pressure was obtained post-procedure and at 24 months follow-up with antihypertensives decreased from 6 to 2 per day, thereby demonstrating the safety, feasibility, and efficacy of the procedure. There are some reports available on the usefulness of this technique in hemodialysis patients; however, there are no studies of renal denervation in patients with Alport syndrome and failed allograft situation. Copyright © 2015 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

Quaternary epitopes of α345(IV) collagen initiate Alport post-transplant anti-GBM nephritis

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Olaru, Florina; Luo, Wentian; Wang, Xu-Ping

2013-01-01

Alport post-transplant nephritis (APTN) is an aggressive form of anti-glomerular basement membrane disease that targets the allograft in transplanted patients with X-linked Alport syndrome. Alloantibodies develop against the NC1 domain of α5(IV) collagen, which occurs in normal kidneys, including...... of alloantibodies against allogeneic collagen IV. Some alloantibodies targeted alloepitopes within α5NC1 monomers, shared by α345NC1 and α1256NC1 hexamers. Other alloantibodies specifically targeted alloepitopes that depended on the quaternary structure of α345NC1 hexamers. In Col4a5-null mice, immunization...... with native forms of allogeneic collagen IV exclusively elicited antibodies to quaternary α345NC1 alloepitopes, whereas alloimmunogens lacking native quaternary structure elicited antibodies to shared α5NC1 alloepitopes. These results imply that quaternary epitopes within α345NC1 hexamers may initiate...

Detection of mutations in the COL4A5 gene by SSCP in X-linked Alport syndrome

DEFF Research Database (Denmark)

Hertz, Jens Michael; Juncker, I; Persson, U

2001-01-01

, three in-frame deletions, four nonsense mutations, and six splice site mutations. Twenty-two of the mutations have not previously been reported. Furthermore, we found one non-pathogenic amino acid substitution, one rare variant in a non-coding region, and one polymorphism with a heterozygosity of 28...... of type IV-collagen. We performed mutation analysis of the COL4A5 gene by PCR-SSCP analysis of each of the 51 exons with flanking intronic sequences in 81 patients suspected of X-linked Alport syndrome including 29 clear X-linked cases, 37 cases from families with a pedigree compatible with X...

Integration-free induced pluripotent stem cells derived from a patient with autosomal recessive Alport syndrome (ARAS).

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Kuebler, Bernd; Aran, Begoña; Miquel-Serra, Laia; Muñoz, Yolanda; Ars, Elisabet; Bullich, Gemma; Furlano, Monica; Torra, Roser; Marti, Merce; Veiga, Anna; Raya, Angel

2017-12-01

A skin biopsy was obtained from a 25-year-old female patient with autosomal recessive Alport syndrome (ARAS) with the homozygous COL4A3 mutation c.345delG, p.(P166Lfs*37). Dermal fibroblasts were derived and reprogrammed by nucleofection with episomal plasmids carrying OCT3/4, SOX2, KLF4 LIN28, L-MYC and p53shRNA. The generated induced Pluripotent Stem Cell (iPSC) clone AS FiPS1 Ep6F-2 was free of genomically integrated reprogramming genes, had the specific homozygous mutation, a stable karyotype, expressed pluripotency markers and generated embryoid bodies which were differentiated towards the three germ layers in vitro. This iPSC line offers a useful resource to study Alport syndrome pathomechanisms and drug testing. Copyright © 2017 The Author(s). Published by Elsevier B.V. All rights reserved.

Mutation in the alpha 5(IV) collagen chain in juvenile-onset Alport syndrome without hearing loss or ocular lesions

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Zhou, J; Hertz, Jens Michael; Tryggvason, K

1992-01-01

A single base mutation was identified in the type IV collagen alpha 5 chain gene (COL4A5) of a Danish kindred with Alport syndrome. The 27-year-old male proband developed hematuria in childhood and terminal renal failure at the age of 25 years. He has no hearing loss or ocular lesions. Electron...... microscopy demonstrated splitting of the lamina densa of the glomerular basement membrane. The proband's mother has had persistent microscopic hematuria since the age of 40 years, but no other manifestations. Southern analysis of MspI-digested genomic DNA from the proband showed the absence of 1.3-kb and 0...

Complete amino acid sequence of the human alpha 5 (IV) collagen chain and identification of a single-base mutation in exon 23 converting glycine 521 in the collagenous domain to cysteine in an Alport syndrome patient

DEFF Research Database (Denmark)

Zhou, J; Hertz, Jens Michael; Leinonen, A

1992-01-01

We have generated and characterized cDNA clones providing the complete amino acid sequence of the human type IV collagen chain whose gene has been shown to be mutated in X chromosome-linked Alport syndrome. The entire translation product has 1,685 amino acid residues. There is a 26-residue signal...

Generation of integration-free induced pluripotent stem cell lines derived from two patients with X-linked Alport syndrome (XLAS).

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Kuebler, Bernd; Aran, Begoña; Miquel-Serra, Laia; Muñoz, Yolanda; Ars, Elisabet; Bullich, Gemma; Furlano, Monica; Torra, Roser; Marti, Merce; Veiga, Anna; Raya, Angel

2017-12-01

Skin biopsies were obtained from two male patients with X-linked Alport syndrome (XLAS) with hemizygous COL4A5 mutations in exon 41 or exon 46. Dermal fibroblasts were extracted and reprogrammed by nucleofection with episomal plasmids carrying OCT3/4, SOX2, KLF4 LIN28, L-MYC and p53 shRNA. The generated induced Pluripotent Stem Cell (iPSC) lines AS-FiPS2-Ep6F-28 and AS-FiPS3-Ep6F-9 were free of genomically integrated reprogramming genes, had the specific mutations, a stable karyotype, expressed pluripotency markers and generated embryoid bodies which were differentiated towards the three germ layers in vitro. These iPSC lines offer a useful resource to study Alport syndrome pathomechanisms and drug testing. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Ultrastructural Characterization of the Glomerulopathy in Alport Mice by Helium Ion Scanning Microscopy (HIM).

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Tsuji, Kenji; Suleiman, Hani; Miner, Jeffrey H; Daley, James M; Capen, Diane E; Păunescu, Teodor G; Lu, Hua A Jenny

2017-09-15

The glomerulus exercises its filtration barrier function by establishing a complex filtration apparatus consisting of podocyte foot processes, glomerular basement membrane and endothelial cells. Disruption of any component of the glomerular filtration barrier leads to glomerular dysfunction, frequently manifested as proteinuria. Ultrastructural studies of the glomerulus by transmission electron microscopy (TEM) and conventional scanning electron microscopy (SEM) have been routinely used to identify and classify various glomerular diseases. Here we report the application of newly developed helium ion scanning microscopy (HIM) to examine the glomerulopathy in a Col4a3 mutant/Alport syndrome mouse model. Our study revealed unprecedented details of glomerular abnormalities in Col4a3 mutants including distorted podocyte cell bodies and disorganized primary processes. Strikingly, we observed abundant filamentous microprojections arising from podocyte cell bodies and processes, and presence of unique bridging processes that connect the primary processes and foot processes in Alport mice. Furthermore, we detected an altered glomerular endothelium with disrupted sub-endothelial integrity. More importantly, we were able to clearly visualize the complex, three-dimensional podocyte and endothelial interface by HIM. Our study demonstrates that HIM provides nanometer resolution to uncover and rediscover critical ultrastructural characteristics of the glomerulopathy in Col4a3 mutant mice.

Loss of the BMP antagonist USAG-1 ameliorates disease in a mouse model of the progressive hereditary kidney disease Alport syndrome.

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Tanaka, Mari; Asada, Misako; Higashi, Atsuko Y; Nakamura, Jin; Oguchi, Akiko; Tomita, Mayumi; Yamada, Sachiko; Asada, Nariaki; Takase, Masayuki; Okuda, Tomohiko; Kawachi, Hiroshi; Economides, Aris N; Robertson, Elizabeth; Takahashi, Satoru; Sakurai, Takeshi; Goldschmeding, Roel; Muso, Eri; Fukatsu, Atsushi; Kita, Toru; Yanagita, Motoko

2010-03-01

The glomerular basement membrane (GBM) is a key component of the filtering unit in the kidney. Mutations involving any of the collagen IV genes (COL4A3, COL4A4, and COL4A5) affect GBM assembly and cause Alport syndrome, a progressive hereditary kidney disease with no definitive therapy. Previously, we have demonstrated that the bone morphogenetic protein (BMP) antagonist uterine sensitization-associated gene-1 (USAG-1) negatively regulates the renoprotective action of BMP-7 in a mouse model of tubular injury during acute renal failure. Here, we investigated the role of USAG-1 in renal function in Col4a3-/- mice, which model Alport syndrome. Ablation of Usag1 in Col4a3-/- mice led to substantial attenuation of disease progression, normalization of GBM ultrastructure, preservation of renal function, and extension of life span. Immunohistochemical analysis revealed that USAG-1 and BMP-7 colocalized in the macula densa in the distal tubules, lying in direct contact with glomerular mesangial cells. Furthermore, in cultured mesangial cells, BMP-7 attenuated and USAG-1 enhanced the expression of MMP-12, a protease that may contribute to GBM degradation. These data suggest that the pathogenetic role of USAG-1 in Col4a3-/- mice might involve crosstalk between kidney tubules and the glomerulus and that inhibition of USAG-1 may be a promising therapeutic approach for the treatment of Alport syndrome.

Identification of a distinct type IV collagen α chain with restricted kidney distribution and assignment of its gene to the locus of X chromosome-linked Alport syndrome

International Nuclear Information System (INIS)

Hostikka, S.L.; Hoeyhtyae, M.; Tryggvason, K.; Eddy, R.L.; Byers, M.G.; Shows, T.B.

1990-01-01

The authors have identified and extensively characterized a type IV collagen α chain, referred to as α5(IV). Four overlapping cDNA clones isolated contain an open reading frame for 543 amino acid residues of the carboxyl-terminal end of a collagenous domain, a 229-residue carboxyl-terminal noncollagenous domain, and 1201 base pairs coding for a 3' untranslated region. The collagenous Gly-Xaa-Yaa repeat sequence has five imperfections that coincide with those in the corresponding region of the α1(IV) chain. The noncollagenous domain has 12 conserved cysteine residues and 83% and 63% sequence identity with the noncollagenous domains of the α1(IV) and α2(IV) chains, respectively. The α5(IV) chain has less sequence identity with the putative bovine α3(IV) and α4(IV) chains. Antiserum against an α5(IV) synthetic peptide stained a polypeptide chain of about 185 kDa by immunoblot analysis and immunolocalization of the chain in human kidney was almost completely restricted to the glomerulus. The gene was assigned to the Xq22 locus by somatic cell hybrids and in situ hybridization. This may be identical or close to the locus of the X chromosome-linked Alport syndrome that is believed to be a type IV collagen disease

A nonsense mutation in the COL4A5 collagen gene in a family with X-linked juvenile Alport syndrome

DEFF Research Database (Denmark)

Hertz, Jens Michael; Heiskari, N; Zhou, J

1995-01-01

diagnosis on chorionic villi tissue, obtained from one of the female carriers in the family, revealed a male fetus hemizygous for the mutated allele. A subsequent prenatal test in her next pregnancy revealed a normal male fetus. Prenatal diagnosis of Alport syndrome has not previously been reported....

A Case of Alport Syndrome with Posttransplant Antiglomerular Basement Membrane Disease despite Negative Antiglomerular Basement Membrane Antibodies by EIA Treated with Plasmapheresis and Intravenous Immunoglobulin

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Sumiko I. Armstead

2013-01-01

Full Text Available Posttransplant antiglomerular basement membrane (anti-GBM disease occurs in approximately 5% of Alport patients and usually ends in irreversible graft failure. Recent research has focused on characterizing the structure of the anti-GBM alloepitope. Here we present a case of a 22-year-old male with end-stage renal disease secondary to Alport syndrome, with a previously failed renal allograft, who received a second deceased-donor kidney transplant. Six days after transplantation, he developed acute kidney injury. The serum anti-GBM IgG was negative by enzyme immunoassay (EIA. On biopsy, he had crescentic glomerulonephritis with linear GBM fixation of IgG. With further analysis by western blotting, we were able to detect antibodies to an unidentified protein from the basement membrane. This patient was treated with plasmapheresis twice per week and monthly intravenous immunoglobulin (IVIG for a total of five months. At the end of treatment, these unknown antibodies were no longer detected. His renal function improved, and he has not required dialysis. We conclude that anti-GBM disease in patients with Alport Syndrome may be caused by circulating antibodies to other components of the basement membrane that are undetectable by routine anti-GBM EIA and may respond to treatment with plasmapheresis and IVIG.

A Case of Alport Syndrome with Posttransplant Antiglomerular Basement Membrane Disease despite Negative Antiglomerular Basement Membrane Antibodies by EIA Treated with Plasmapheresis and Intravenous Immunoglobulin.

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Armstead, Sumiko I; Hellmark, Thomas; Wieslander, Jorgen; Zhou, Xin J; Saxena, Ramesh; Rajora, Nilum

2013-01-01

Posttransplant antiglomerular basement membrane (anti-GBM) disease occurs in approximately 5% of Alport patients and usually ends in irreversible graft failure. Recent research has focused on characterizing the structure of the anti-GBM alloepitope. Here we present a case of a 22-year-old male with end-stage renal disease secondary to Alport syndrome, with a previously failed renal allograft, who received a second deceased-donor kidney transplant. Six days after transplantation, he developed acute kidney injury. The serum anti-GBM IgG was negative by enzyme immunoassay (EIA). On biopsy, he had crescentic glomerulonephritis with linear GBM fixation of IgG. With further analysis by western blotting, we were able to detect antibodies to an unidentified protein from the basement membrane. This patient was treated with plasmapheresis twice per week and monthly intravenous immunoglobulin (IVIG) for a total of five months. At the end of treatment, these unknown antibodies were no longer detected. His renal function improved, and he has not required dialysis. We conclude that anti-GBM disease in patients with Alport Syndrome may be caused by circulating antibodies to other components of the basement membrane that are undetectable by routine anti-GBM EIA and may respond to treatment with plasmapheresis and IVIG.

Alport's syndrome with focal segmental glomerulosclerosis lesion - Pattern to recognize.

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Alsahli, Afnan A; Alshahwan, Sara I; Alotaibi, Amal O; Alsaad, Khaled O; Aloudah, Nourah; Farooqui, Mahfooz; Al Sayyari, Abdullah A

2018-01-01

The association between Alport's syndrome (AS) and focal segmental glomerulosclerosis (FSGS) in the same patient is complex and rarely reported. We report a case of a 42-year-old male presenting with proteinuria, microscopic hematuria, elevated serum creatinine and hypertension with unremarkable physical examination apart from obesity. The renal biopsy showed well-established FSGS pattern of injury with mild interstitial fibrosis and tubular atrophy, while the electron microscopic examination demonstrated glomerular basement membranes (GBM) changes compatible with AS. AS can be complicated by segmental glomerular scarring, which can mimic primary FSGS, while familial FSGS can result from mutations in collagen IV network of the GBM. This overlap can complicate histopathological interpretation of renal biopsy, which should be accompanied by mutational analysis for accurate diagnosis and proper therapeutic intervention.

High mutation detection rate in the COL4A5 collagen gene in suspected Alport syndrome using PCR and direct DNA sequencing

DEFF Research Database (Denmark)

Martin, P; Heiskari, N; Zhou, J

1998-01-01

-amplified and sequenced from DNA of 50 randomly chosen patients with suspected Alport syndrome. Mutations were found in 41 patients, giving a mutation detection rate of 82%. Retrospective analysis of clinical data revealed that two of the cases might be autosomal. Although it could not be determined whether the remaining...

X-linked Alport syndrome associated with a synonymous p.Gly292Gly mutation alters the splicing donor site of the type IV collagen alpha chain 5 gene.

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Fu, Xue Jun; Nozu, Kandai; Eguchi, Aya; Nozu, Yoshimi; Morisada, Naoya; Shono, Akemi; Taniguchi-Ikeda, Mariko; Shima, Yuko; Nakanishi, Koichi; Vorechovsky, Igor; Iijima, Kazumoto

2016-10-01

X-linked Alport syndrome (XLAS) is a progressive hereditary nephropathy caused by mutations in the type IV collagen alpha chain 5 gene (COL4A5). Although many COL4A5 mutations have previously been identified, pathogenic synonymous mutations have not yet been described. A family with XLAS underwent mutational analyses of COL4A5 by PCR and direct sequencing, as well as transcript analysis of potential splice site mutations. In silico analysis was also conducted to predict the disruption of splicing factor binding sites. Immunohistochemistry (IHC) of kidney biopsies was used to detect α2 and α5 chain expression. We identified a hemizygous point mutation, c.876A>T, in exon 15 of COL4A5 in the proband and his brother, which is predicted to result in a synonymous amino acid change, p.(Gly292Gly). Transcript analysis showed that this mutation potentially altered splicing because it disrupted the splicing factor binding site. The kidney biopsy of the proband showed lamellation of the glomerular basement membrane (GBM), while IHC revealed negative α5(IV) staining in the GBM and Bowman's capsule, which is typical of XLAS. This is the first report of a synonymous COL4A5 substitution being responsible for XLAS. Our findings suggest that transcript analysis should be conducted for the future correct assessment of silent mutations.

The Chemical Chaperone, PBA, Reduces ER Stress and Autophagy and Increases Collagen IV α5 Expression in Cultured Fibroblasts From Men With X-Linked Alport Syndrome and Missense Mutations

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Dongmao Wang

2017-07-01

Discussion: Sodium 4-phenylbutyrate increases collagen IV α5 mRNA levels, reduces ER stress and autophagy, and possibly facilitates collagen IV α5 extracellular transport. Whether these actions delay end-stage renal failure in men with X-linked Alport syndrome and missense mutations will only be determined with clinical trials.

Alport syndrome: impact of digenic inheritance in patients management.

Science.gov (United States)

Fallerini, C; Baldassarri, M; Trevisson, E; Morbidoni, V; La Manna, A; Lazzarin, R; Pasini, A; Barbano, G; Pinciaroli, A R; Garosi, G; Frullanti, E; Pinto, A M; Mencarelli, M A; Mari, F; Renieri, A; Ariani, F

2017-07-01

Alport syndrome (ATS) is a genetically heterogeneous nephropathy with considerable phenotypic variability and different transmission patterns, including monogenic (X-linked/autosomal) and digenic inheritance (DI). Here we present a new series of families with DI and we discuss the consequences for genetic counseling and risk assessment. Out of five families harboring variants in more than one COL4 gene detected by next generation sequencing (NGS), minigene-splicing assay allowed us to identify four as true digenic. Two families showed COL4A3/A4 mutations in cis, mimicking an autosomal dominant inheritance with a more severe phenotype and one showed COL4A3/A4 mutations in trans, mimicking an autosomal recessive inheritance with a less severe phenotype. In a fourth family, a de novo mutation (COL4A5) combined with an inherited mutation (COL4A3) triggered a more severe phenotype. A fifth family, predicted digenic on the basis of silico tools, rather showed monogenic X-linked inheritance due to a hypomorphic mutation, in accordance with a milder phenotype. In conclusion, this study highlights the impact of DI in ATS and explains the associated atypical presentations. More complex inheritance should be therefore considered when reviewing prognosis and recurrence risks. On the other side, these findings emphasize the importance to accompany NGS with splicing assays in order to avoid erroneous identification of at risk members. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

A novel COL4A3 mutation causes autosomal-recessive Alport syndrome in a large Turkish family.

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Uzak, Asli Subasioglu; Tokgoz, Bulent; Dundar, Munis; Tekin, Mustafa

2013-03-01

Alport syndrome (AS) is a genetically heterogeneous disorder that is characterized by hematuria, progressive renal failure typically resulting in end-stage renal disease, sensorineural hearing loss, and variable ocular abnormalities. Only 15% of cases with AS are autosomal recessive and are caused by mutations in the COL4A3 or COL4A4 genes, encoding type IV collagen. Clinical data in a large consanguineous family with four affected members were reviewed, and genomic DNA was extracted. For mapping, 15 microsatellite markers flanking COL4A3, COL4A4, and COL4A5 in 16 family members were typed. For mutation screening, all coding exons of COL4A3 were polymerase chain reaction- amplified and Sanger-sequenced from genomic DNA. The disease locus was mapped to chromosome 2q36.3, where COL4A3 and COL4A4 reside. Sanger sequencing revealed a novel mis-sense mutation (c.2T>C; p.M1T) in exon 1 of COL4A3. The identified nucleotide change was not found in 100 healthy ethnicity-matched controls via Sanger sequencing. We present a large consanguineous Turkish family with AS that was found to have a COL4A3 mutation as the cause of the disease. Although the relationship between the various genotypes and phenotypes in AS has not been fully elucidated, detailed clinical and molecular analyses are helpful for providing data to be used in genetic counseling. It is important to identify new mutations to clarify their clinical importance, to assess the prognosis of the disease, and to avoid renal biopsy for final diagnosis.

Bromide supplementation exacerbated the renal dysfunction, injury and fibrosis in a mouse model of Alport syndrome.

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Yokota, Tsubasa; Omachi, Kohei; Suico, Mary Ann; Kojima, Haruka; Kamura, Misato; Teramoto, Keisuke; Kaseda, Shota; Kuwazuru, Jun; Shuto, Tsuyoshi; Kai, Hirofumi

2017-01-01

A seminal study recently demonstrated that bromide (Br-) has a critical function in the assembly of type IV collagen in basement membrane (BM), and suggested that Br- supplementation has therapeutic potential for BM diseases. Because salts of bromide (KBr and NaBr) have been used as antiepileptic drugs for several decades, repositioning of Br- for BM diseases is probable. However, the effects of Br- on glomerular basement membrane (GBM) disease such as Alport syndrome (AS) and its impact on the kidney are still unknown. In this study, we administered daily for 16 weeks 75 mg/kg or 250 mg/kg (within clinical dosage) NaBr or NaCl (control) via drinking water to 6-week-old AS mice (mouse model of X-linked AS). Treatment with 75 mg/kg NaBr had no effect on AS progression. Surprisingly, compared with 250 mg/kg NaCl, 250 mg/kg NaBr exacerbated the progressive proteinuria and increased the serum creatinine and blood urea nitrogen in AS mice. Histological analysis revealed that glomerular injury, renal inflammation and fibrosis were exacerbated in mice treated with 250 mg/kg NaBr compared with NaCl. The expressions of renal injury markers (Lcn2, Lysozyme), matrix metalloproteinase (Mmp-12), pro-inflammatory cytokines (Il-6, Il-8, Tnf-α, Il-1β) and pro-fibrotic genes (Tgf-β, Col1a1, α-Sma) were also exacerbated by 250 mg/kg NaBr treatment. Notably, the exacerbating effects of Br- were not observed in wild-type mice. These findings suggest that Br- supplementation needs to be carefully evaluated for real positive health benefits and for the absence of adverse side effects especially in GBM diseases such as AS.

Mutation analysis of COL4A3 and COL4A4 genes in a Chinese

Indian Academy of Sciences (India)

Autosomal dominant Alport syndrome (ADAS) accounts for 5% of all cases of Alport syndrome (AS), a primary basement membrane disorder arising from mutations in genes encoding the type IV collagen protein family.Mutationsin COL4A3 and COL4A4 genes were reported to be associated with ADAS. In this study, clinical ...

Stigma Perceived and Experienced by Adults with Type 1 Diabetes

DEFF Research Database (Denmark)

Hansen, Ulla Møller; Willaing, Ingrid; Ventura, Adriana D

2017-01-01

OBJECTIVES: We aimed to (a) culturally and linguistically adapt the Type 1 Diabetes Stigma Assessment Scale (DSAS-1) from English (for Australia) into Danish and (b) examine psychometric properties of the measure among Danish adults with type 1 diabetes. METHODS: We performed a forward......-backward translation, face validity interviews with experts and cognitive debriefing of the Danish version (DSAS-1 DK) with ten adults from the target group. The DSAS-1 DK was then completed by 1594 adults with type 1 diabetes. Electronic clinical records provided age, diabetes duration, diabetes-related complications...... to advance research into the stigma perceived and experienced by adults with type 1 diabetes in a Danish context....

Adult-type hypolactasia and regulation of lactase expression

DEFF Research Database (Denmark)

Troelsen, Jesper Thorvald

2005-01-01

, the main carbohydrate in milk. Individuals with adult-type hypolactasia lose their lactase expression before adulthood and consequently often become lactose intolerant with associated digestive problems (e.g. diarrhoea). In contrast, lactase persistent individuals have a lifelong lactase expression......A common genetically determined polymorphism in the human population leads to two distinct phenotypes in adults, lactase persistence and adult-type hypolactasia (lactase non-persistence). All healthy newborn children express high levels of lactase and are able to digest large quantities of lactose...... and are able to digest lactose as adults. Lactase persistence can be regarded as the mutant phenotype since other mammals down-regulate their lactase expression after weaning (the postweaning decline). This phenomenon does not occur in lactase persistent individuals. The regulation of lactase expression...

Suicidal ideation reported by adults with Type 1 or Type 2 diabetes

DEFF Research Database (Denmark)

Handley, T E; Ventura, A D; Browne, Jessica L

2016-01-01

factor for a suicide attempt, the findings have implications for healthcare professionals, pointing to the importance of adequate screening and action plans for appropriate follow-up of those reporting depression. Our findings are also indicative of the psychological toll of diabetes more generally......AIMS: To examine the prevalence and correlates of suicidal ideation (SI) in a community-based sample of adults with Type 1 or Type 2 diabetes. METHODS: Participants were 3338 adults aged 18-70 years with Type 1 diabetes (n = 1376) or Type 2 diabetes (non-insulin: n = 1238; insulin: n = 724) from...... a national survey administered to a random sample registered with the National Diabetes Services Scheme. Depression and SI were assessed using the Patient Health Questionnaire, and diabetes-specific distress with the Problem Areas In Diabetes scale. Separate logistic regression analyses by diabetes type...

Dados clínicos e da audição em indivíduos com Síndrome de Alport Clinical data and hearing of individuals with Alport syndrome

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Fatima Regina Abreu Alves

2008-12-01

Full Text Available A Síndrome de Alport (SA é uma desordem hereditária, caracterizada por nefropatia, muitas vezes, com perda auditiva sensorioneural e com defeitos oculares. OBJETIVO: Analisar os dados clínicos e da audição em indivíduos com SA, com ênfase na correlação entre alteração renal e perda auditiva (PA. FORMA DE ESTUDO: clínico prospectivo com coorte transversal. CASUÍSTICA E MÉTODO: 37 indivíduos realizaram avaliação otorrinolaringológica e testes audiológicos. Foram considerados para a análise estatística da PA os resultados das audiometrias de tons puros. RESULTADOS: Nos 28 indivíduos que apresentavam alterações clínicas foram encontrados 46,4% de DLX e 53,6% de AD. A PA ocorreu em 46,1% dos avaliados. 12 pacientes tinham PA no exame audiométrico 11,5%, leve e 34,6%, moderada. Comparados os familiares normais aos que tinham alteração renal, todos os que apresentavam PA mostravam comprometimento renal. Em 30,8% a configuração era descendente suave em agudos e em 11,5% era plana. CONCLUSÕES: A distribuição dos padrões de herança não coincide com o descrito na literatura. A PA é um achado extra-renal freqüente. Existe associação entre acometimento renal e PA (p= 0,009. As configurações mais freqüentes foram: descendente suave em agudos e plana. Não há associação entre a PA e a idade. Não existe correlação entre PA e sexo neste grupo.Alport Syndrome (AS is a hereditary disease, characterized by nephropathy, often times with sensorineural hearing loss and ocular defects. AIM: to analyze the clinical and hearing information from individuals with AS, more specifically the correlation between renal disorder and hearing loss (HL. STUDY DESIGN: clinical prospective with cross-sectional cohort. MATERIALS AND METHODS: 37 individuals underwent otorhinolaryngological evaluation and were submitted to audiologic tests. For HL statistical analysis we considered only the results from the pure tone audiometries

Adult type granulosa cell tumor in adult testis: report of a case and review of the literature

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Zhanyong Bing

2011-10-01

Full Text Available Granulosa cell tumors can be classified into juvenile and adult types and more commonly occur in ovaries. Adult testicular granulosa cell tumors are extremely rare and only 29 cases of adult type have previously been reported. We report here a 28-year-old Caucasian man with a left testicular adult type granulosa cell tumor. The tumor measured 2.6 x 2.6 x 2.5 cm and was mitotically active (10/10 HPF. Immunohistochemical stains showed the tumor diffusely positive for inhibin and vimentin, and negative for epithelial membrane antigen, cytokeratins, synaptophysin, HMB-45, OCT-4, placental-like alkaline phosphatase and lymphoid markers . The reported granulosa cell tumors in adult testis were briefly reviewed.

Histopathological types in adult nephrotic syndrome

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Md. Ghulam Yusuf

2016-01-01

Full Text Available In Bangladesh, there are very few studies about biopsy proven adult Nephrotic syndrome (NS with histological types and their clinical findings. To determine the histological types of glomerulonephritis (GN in adult NS and correlate them with the clinical presentations and biochemical parameters, we studied 100 biopsies in 87 patients who underwent ultrasonography- guided renal biopsy in Rangpur Medical College and Hospital from July 2010 to June 2012. The mean age of the patients was 32.8 ± 13.2 years; male was preponderance (72.4% and most of the patients (67.8% came from rural areas. Membranoproliferative GN (MPGN was the most common underlying cause that was found in 32 (36.8% patients followed by mesangial prolife- rative GN in 27 (31% patients, membranous GN in 16 (18.4% cases, minimal change disease in four (4.6% patients, diffuse proliferative GN in four (4.6% patients, focal segmental GN, and focal proliferative GN in two (2.4% patients each. High proteinuria level was found in minimal change disease, which was 7.59 ± 0.24 g/24 h (mean ± standard deviation. The most common symptoms were oliguria (92% and edema (86.2% followed by hematuria (dark urine (72.4% and hypertension (35.6%. MPGN was the most common histological type of adult NS in Rangpur.

Social Network Types and Mental Health Among LGBT Older Adults

Science.gov (United States)

Kim, Hyun-Jun; Fredriksen-Goldsen, Karen I.; Bryan, Amanda E. B.; Muraco, Anna

2017-01-01

Purpose of the Study: This study was designed to identify social network types among lesbian, gay, bisexual, and transgender (LGBT) older adults and examine the relationship between social network type and mental health. Design and Methods: We analyzed the 2014 survey data of LGBT adults aged 50 and older (N = 2,450) from Aging with Pride: National Health, Aging, and Sexuality/Gender Study. Latent profile analyses were conducted to identify clusters of social network ties based on 11 indicators. Multiple regression analysis was performed to examine the association between social network types and mental health. Results: We found five social network types. Ordered from greatest to least access to family, friend, and other non-family network ties, they were diverse, diverse/no children, immediate family-focused, friend-centered/restricted, and fully restricted. The friend-centered/restricted (33%) and diverse/no children network types (31%) were the most prevalent. Among individuals with the friend-centered/restricted type, access to social networks was limited to friends, and across both types children were not present. The least prevalent type was the fully restricted network type (6%). Social network type was significantly associated with mental health, after controlling for background characteristics and total social network size; those with the fully restricted type showed the poorest mental health. Implications: Unique social network types (diverse/no children and friend-centered/restricted) emerge among LGBT older adults. Moreover, individuals with fully restricted social networks are at particular risk due to heightened health needs and limited social resources. This study highlights the importance of understanding heterogeneous social relations and developing tailored interventions to promote social connectedness and mental health in LGBT older adults. PMID:28087798

Determinants of quality of life in adults with type 1 and type 2 diabetes

Directory of Open Access Journals (Sweden)

Imayama Ikuyo

2011-12-01

Full Text Available Abstract Background Limited evidence exists on the determinants of quality of life (QoL specific to adults with type 1 diabetes (T1D. Further, it appears no study has compared the determinants of QoL between T1D and type 2 diabetes (T2D groups. The objectives of this study were to examine: (1 determinants of QoL in adults with T1D; and, (2 differences in QoL determinants between T1D and T2D groups. Methods The Alberta Longitudinal Exercise and Diabetes Research Advancement (ALEXANDRA study, a longitudinal study of adults with diabetes in Alberta, Canada. Adults (18 years and older with T1D (N = 490 and T2D (N = 1,147 provided information on demographics (gender, marital status, education, and annual income, personality (activity trait, medical factors (diabetes duration, insulin use, number of comorbidities, and body mass index, lifestyle behaviors (smoking habits, physical activity, and diet, health-related quality of life (HRQL and life satisfaction. Multiple regression models identified determinants of HRQL and life satisfaction in adults with T1D. These determinants were compared with determinants for T2D adults reported in a previous study from this population data set. Factors significantly associated with HRQL and life satisfaction in either T1D or T2D groups were further tested for interaction with diabetes type. Results In adults with T1D, higher activity trait (personality score (β = 0.28, p -0.27, p -0.12, p -0.14, p Conclusions Health services should target medical and lifestyle factors and provide support for T1D adults to increase their QoL. Additional social support for socioeconomically disadvantaged individuals living with this disease may be warranted. Health practitioners should also be aware that age has different effects on QoL between T1D and T2D adults.

Type 2 diabetes detection and management among insured adults.

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Dall, Timothy M; Yang, Weyna; Halder, Pragna; Franz, Jerry; Byrne, Erin; Semilla, April P; Chakrabarti, Ritashree; Stuart, Bruce

2016-01-01

The Centers for Disease Control and Prevention estimates that 28.9 million adults had diabetes in 2012 in the US, though many patients are undiagnosed or not managing their condition. This study provides US national and state estimates of insured adults with type 2 diabetes who are diagnosed, receiving exams and medication, managing glycemic levels, with diabetes complications, and their health expenditures. Such information can be used for benchmarking and to identify gaps in diabetes detection and management. The study combines analysis of survey data with medical claims analysis for the commercially insured, Medicare, and Medicaid populations to estimate the number of adults with diagnosed type 2 diabetes and undiagnosed diabetes by insurance type, age, and sex. Medical claims analysis used the 2012 de-identified Normative Health Information database covering a nationally representative commercially insured population, the 2011 Medicare 5% Sample, and the 2008 Medicaid Mini-Max. Among insured adults in 2012, approximately 16.9 million had diagnosed type 2 diabetes, 1.45 million had diagnosed type 1 diabetes, and 6.9 million had undiagnosed diabetes. Of those with diagnosed type 2, approximately 13.0 million (77%) received diabetes medication-ranging from 70% in New Jersey to 82% in Utah. Suboptimal percentages had claims indicating recommended exams were performed. Of those receiving diabetes medication, 43% (5.6 million) had medical claims indicating poorly controlled diabetes-ranging from 29% with poor control in Minnesota and Iowa to 53% in Texas. Poor control was correlated with higher prevalence of neurological complications (+14%), renal complications (+14%), and peripheral vascular disease (+11%). Patients with poor control averaged $4,860 higher average annual health care expenditures-ranging from $6,680 for commercially insured patients to $4,360 for Medicaid and $3,430 for Medicare patients. This study highlights the large number of insured adults with

Pathogenesis and treatment of adult-type granulosa cell tumor of the ovary.

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Färkkilä, Anniina; Haltia, Ulla-Maija; Tapper, Johanna; McConechy, Melissa K; Huntsman, David G; Heikinheimo, Markku

2017-08-01

Adult-type granulosa cell tumor is a clinically and molecularly unique subtype of ovarian cancer. These tumors originate from the sex cord stromal cells of the ovary and represent 3-5% of all ovarian cancers. The majority of adult-type granulosa cell tumors are diagnosed at an early stage with an indolent prognosis. Surgery is the cornerstone for the treatment of both primary and relapsed tumor, while chemotherapy is applied only for advanced or non-resectable cases. Tumor stage is the only factor consistently associated with prognosis. However, every third of the patients relapse, typically in 4-7 years from diagnosis, leading to death in 50% of these patients. Anti-Müllerian Hormone and inhibin B are currently the most accurate circulating biomarkers. Adult-type granulosa cell tumors are molecularly characterized by a pathognomonic somatic missense point mutation 402C->G (C134W) in the transcription factor FOXL2. The FOXL2 402C->G mutation leads to increased proliferation and survival of granulosa cells, and promotes hormonal changes. Histological diagnosis of adult-type granulosa cell tumor is challenging, therefore testing for the FOXL2 mutation is crucial for differential diagnosis. Large international collaborations utilizing molecularly defined cohorts are essential to improve and validate new treatment strategies for patients with high-risk or relapsed adult-type granulosa cell tumor. Key Messages: Adult-type granulosa cell tumor is a unique ovarian cancer with an indolent, albeit unpredictable disease course. Adult-type granulosa cell tumors harbor a pathognomonic somatic missense mutation in transcription factor FOXL2. The key challenges in the treatment of patients with adult-type granulosa cell tumor lie in the identification and management of patients with high-risk or relapsed disease.

Social Network Types and Mental Health Among LGBT Older Adults.

Science.gov (United States)

Kim, Hyun-Jun; Fredriksen-Goldsen, Karen I; Bryan, Amanda E B; Muraco, Anna

2017-02-01

This study was designed to identify social network types among lesbian, gay, bisexual, and transgender (LGBT) older adults and examine the relationship between social network type and mental health. We analyzed the 2014 survey data of LGBT adults aged 50 and older (N = 2,450) from Aging with Pride: National Health, Aging, and Sexuality/Gender Study. Latent profile analyses were conducted to identify clusters of social network ties based on 11 indicators. Multiple regression analysis was performed to examine the association between social network types and mental health. We found five social network types. Ordered from greatest to least access to family, friend, and other non-family network ties, they were diverse, diverse/no children, immediate family-focused, friend-centered/restricted, and fully restricted. The friend-centered/restricted (33%) and diverse/no children network types (31%) were the most prevalent. Among individuals with the friend-centered/restricted type, access to social networks was limited to friends, and across both types children were not present. The least prevalent type was the fully restricted network type (6%). Social network type was significantly associated with mental health, after controlling for background characteristics and total social network size; those with the fully restricted type showed the poorest mental health. Unique social network types (diverse/no children and friend-centered/restricted) emerge among LGBT older adults. Moreover, individuals with fully restricted social networks are at particular risk due to heightened health needs and limited social resources. This study highlights the importance of understanding heterogeneous social relations and developing tailored interventions to promote social connectedness and mental health in LGBT older adults. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Long-term treatment with EGFR inhibitor erlotinib attenuates renal inflammatory cytokines but not nephropathy in Alport syndrome mouse model.

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Omachi, Kohei; Miyakita, Rui; Fukuda, Ryosuke; Kai, Yukari; Suico, Mary Ann; Yokota, Tsubasa; Kamura, Misato; Shuto, Tsuyoshi; Kai, Hirofumi

2017-12-01

Alport syndrome (AS) is a hereditary kidney disease caused by mutation of type IV collagen. Loss of collagen network induces collapse of glomerular basement membrane (GBM) structure. The previous studies showed that upregulation of some tyrosine kinase receptors signaling accompanied GBM disorder in AS mouse model. EGFR signaling is one of the well-known receptor kinase signaling that is involved in glomerular diseases. However, whether EGFR signaling is relevant to AS progression is still uninvestigated. Here, we determined the involvement of EGFR in AS and the effect of suppressing EGFR signaling by erlotinib treatment on AS progression. Phosphorylated EGFR expression was investigated by Western blotting analysis and immunostaining of kidney tissues of Col4a5 mutant mice (a mouse model of X-linked AS). To check the effect of blocking EGFR signaling in AS, we administered erlotinib to AS mice once a day (10 mg/kg/day) orally for 18 weeks. Renal function parameters (proteinuria, serum creatinine, and BUN) and renal histology were assessed, and the gene expressions of inflammatory cytokines were analyzed in renal tissues. Phosphorylated EGFR expression was upregulated in AS mice kidney tissues. Erlotinib slightly reduced the urinary protein and suppressed the expression of renal injury markers (Lcn2, Lysozyme) and inflammatory cytokines (Il-6, Il-1β and KC). Erlotinib did not improve renal pathology, such as glomerular sclerosis and fibrosis. These findings suggest that EGFR signaling is upregulated in kidney, but although inhibiting this signaling pathway suppressed renal inflammatory cytokines, it did not ameliorate renal dysfunction in AS mouse model.

Social network types among older Korean adults: Associations with subjective health.

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Sohn, Sung Yun; Joo, Won-Tak; Kim, Woo Jung; Kim, Se Joo; Youm, Yoosik; Kim, Hyeon Chang; Park, Yeong-Ran; Lee, Eun

2017-01-01

With population aging now a global phenomenon, the health of older adults is becoming an increasingly important issue. Because the Korean population is aging at an unprecedented rate, preparing for public health problems associated with old age is particularly salient in this country. As the physical and mental health of older adults is related to their social relationships, investigating the social networks of older adults and their relationship to health status is important for establishing public health policies. The aims of this study were to identify social network types among older adults in South Korea and to examine the relationship of these social network types with self-rated health and depression. Data from the Korean Social Life, Health, and Aging Project were analyzed. Model-based clustering using finite normal mixture modeling was conducted to identify the social network types based on ten criterion variables of social relationships and activities: marital status, number of children, number of close relatives, number of friends, frequency of attendance at religious services, attendance at organized group meetings, in-degree centrality, out-degree centrality, closeness centrality, and betweenness centrality. Multivariate regression analysis was conducted to examine associations between the identified social network types and self-rated health and depression. The model-based clustering analysis revealed that social networks clustered into five types: diverse, family, congregant, congregant-restricted, and restricted. Diverse or family social network types were significantly associated with more favorable subjective mental health, whereas the restricted network type was significantly associated with poorer ratings of mental and physical health. In addition, our analysis identified unique social network types related to religious activities. In summary, we developed a comprehensive social network typology for older Korean adults. Copyright © 2016

Adult-Onset Type 1 Diabetes: A Qualitative Study of Decision-Making Needs.

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Jull, Janet; Witteman, Holly O; Ferne, Judi; Yoganathan, Manosila; Stacey, Dawn

2016-04-01

Type 1 diabetes is an autoimmune disease resulting from insulin deficiency and must be carefully managed to prevent serious health complications. Diabetes education and management strategies usually focus on meeting the decision-making needs of children and their families, but little is known about the decisional needs of people with adult-onset type 1 diabetes. The aim of this study was to explore the diabetes-related decision-making needs of people diagnosed with adult-onset type 1 diabetes. An interpretive descriptive qualitative study was conducted. Participants who self-identified as having adult-onset type 1 diabetes were interviewed using a semistructured interview guide. Transcripts were coded to identify needs, supports and barriers using thematic analysis. Participating in the study were 8 adults (2 men, 6 women), ages 33 to 57, with type 1 diabetes for durations of 1 to 20 or more years. Their decision-making needs are summarized in 6 broad themes: 1) people diagnosed with type 1 diabetes are launched into a process of decision-making; 2) being diagnosed with type 1 diabetes means you will always have to make decisions; 3) knowledge is crucial; 4) personal preferences matter; 5) support is critical for decisions about self-care in type 1 diabetes; 6) living with type 1 diabetes means making very individualized decisions about daily life. The findings describe the sudden and ubiquitous nature of type 1 diabetes decision-making and the need to tailor approaches for making care decisions in type 1 diabetes. People diagnosed with adult-onset type 1 diabetes require access to reliable information, support and opportunities for participation in decision-making. Copyright © 2016 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.

Adult-Onset Type 1 Diabetes and Pregnancy: Three Case Reports

Directory of Open Access Journals (Sweden)

Barbara Bonsembiante

2013-01-01

Full Text Available From 5% to 10% of diabetic patients have type 1 diabetes. Here we describe three cases of adult-onset type 1 diabetes in pregnancy treated at our clinic between 2009 and 2012. Two patients came for specialist examination during pregnancy, the third after pregnancy. These women had no prior overt diabetes and shared certain characteristics, that is, no family diabetes history, age over 35, normal prepregnancy BMI, need for insulin therapy as of the early weeks of pregnancy, and high-titer anti-GAD antibody positivity. The patients had persistent diabetes after delivery, suggesting that they developed adult-onset type 1 diabetes during pregnancy. About 10% of GDM patients become pancreatic autoantibody positive and the risk of developing overt diabetes is higher when two or more autoantibodies are present (particularly GAD and ICA. GAD-Ab shows the highest sensitivity for type 1 diabetes prediction. We need to bear in mind that older patients might conceivably develop an adult-onset type 1 diabetes during or after pregnancy. So we suggest that women with GDM showing the described clinical features shall be preferably tested for autoimmunity. Pregnant patients at risk of type 1 diabetes should be identified to avoid the maternal and fetal complications and the acute onset of diabetes afterwards.

Cognitive function in adult offspring of women with Type 1 diabetes

DEFF Research Database (Denmark)

Clausen, Tine Dalsgaard; Mortensen, E L; Schmidt, L

2011-01-01

Maternal diabetes may affect offspring cognitive function. The objective of the study was to evaluate cognitive function and potential predictors hereof in adult offspring of women with Type 1 diabetes.......Maternal diabetes may affect offspring cognitive function. The objective of the study was to evaluate cognitive function and potential predictors hereof in adult offspring of women with Type 1 diabetes....

The Use of Mobile Applications Among Adults with Type 1 and Type 2 Diabetes

DEFF Research Database (Denmark)

Trawley, Steven; Baptista, Shaira; Browne, Jessica L

2017-01-01

BACKGROUND: While the number of diabetes-specific mobile applications (apps) continues to grow, there is a lack of knowledge about their actual use. METHODS: The second MILES (Management and Impact for Long-term Empowerment and Success)-Australia study was a national cross-sectional survey...... of the psychological, behavioral, and social aspects of diabetes for adults with type 1 diabetes (T1D) and type 2 diabetes (T2D). Associations between diabetes-specific app usage and demographic, clinical, and psychosocial variables were examined. RESULTS: Of the 1589 respondents responding to the diabetes...... respondents, the most commonly reported reason for not using apps was a belief that they could not help with diabetes self-management. CONCLUSIONS: A minority of adults with T1D and T2D use apps to support their self-management. App use among adults with T1D is associated with a more recent T1D diagnosis...

Health Care Transition in Young Adults With Type 1 Diabetes: Perspectives of Adult Endocrinologists in the U.S.

Science.gov (United States)

Garvey, Katharine C; Telo, Gabriela H; Needleman, Joseph S; Forbes, Peter; Finkelstein, Jonathan A; Laffel, Lori M

2016-02-01

Young adults with type 1 diabetes transitioning from pediatric to adult care are at risk for adverse outcomes. Our objective was to describe experiences, resources, and barriers reported by a national sample of adult endocrinologists receiving and caring for young adults with type 1 diabetes. We fielded an electronic survey to adult endocrinologists with a valid e-mail address identified through the American Medical Association Physician Masterfile. We received responses from 536 of 4,214 endocrinologists (response rate 13%); 418 surveys met the eligibility criteria. Respondents (57% male, 79% Caucasian) represented 47 states; 64% had been practicing >10 years and 42% worked at an academic center. Only 36% of respondents reported often/always reviewing pediatric records and 11% reported receiving summaries for transitioning young adults with type 1 diabetes, although >70% felt that these activities were important for patient care. While most respondents reported easy access to diabetes educators (94%) and dietitians (95%), fewer (42%) reported access to mental health professionals, especially in nonacademic settings. Controlling for practice setting and experience, endocrinologists without easy access to mental health professionals were more likely to report barriers to diabetes management for young adults with depression (odds ratio [OR] 5.3; 95% CI 3.4, 8.2), substance abuse (OR 3.5; 95% CI 2.2, 5.6), and eating disorders (OR 2.5; 95% CI 1.6, 3.8). Our findings underscore the need for enhanced information transfer between pediatric and adult providers and increased mental health referral access for young adults with diabetes post-transition. © 2016 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

Nephrocalcinosis as adult presentation of Bartter syndrome type II.

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Huang, L; Luiken, G P M; van Riemsdijk, I C; Petrij, F; Zandbergen, A A M; Dees, A

2014-02-01

Bartter syndrome consists a group of rare autosomal-recessive renal tubulopathies characterised by renal salt wasting, hypokalaemic metabolic alkalosis, hypercalciuria and hyperreninaemic hyperaldosteronism. It is classified into five types. Mutations in the KCNJ1 gene (classified as type II) usually cause the neonatal form of Bartter syndrome. We describe an adult patient with a homozygous KCNJ1 mutation resulting in a remarkably mild phenotype of neonatal type Bartter syndrome.

Differentiation of adult-type Leydig cells occurs in gonadotrophin-deficient mice

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Charlton HM

2003-02-01

Full Text Available Abstract During mammalian testis development distinct generations of fetal and adult Leydig cells arise. Luteinising hormone (LH is required for normal adult Leydig cell function and for the establishment of normal adult Leydig cell number but its role in the process of adult Leydig cell differentiation has remained uncertain. In this study we have examined adult Leydig cell differentiation in gonadotrophin-releasing hormone (GnRH-null mice which are deficient in circulating gonadotrophins. Adult Leydig cell differentiation was assessed by measuring expression of mRNA species encoding four specific markers of adult Leydig cell differentiation in the mouse. Each of these markers (3β-hydroxysteroid dehydrogenase type VI (3βHSD VI, 17β-hydroxysteroid dehydrogenase type III (17βHSD III, prostaglandin D (PGD-synthetase and oestrogen sulphotransferase (EST is expressed only in the adult Leydig cell lineage in the normal adult animal. Real-time PCR studies showed that all four markers are expressed in adult GnRH-null mice. Localisation of 3βHSD VI and PGD-synthetase expression by in situ hybridisation confirmed that these genes are expressed in the interstitial tissue of the GnRH-null mouse. Treatment of animals with human chorionic gonadotrophin increased expression of 3βHSD VI and 17βHSD III within 12 hours further indicating that differentiated, but unstimulated cells already exist in the GnRH-null mouse. Thus, while previous studies have shown that LH is required for adult Leydig cell proliferation and activity, results from the present study show that adult Leydig cell differentiation will take place in animals deficient in LH.

Self-regulation resources and physical activity participation among adults with type 2 diabetes.

Science.gov (United States)

Castonguay, Alexandre; Miquelon, Paule; Boudreau, François

2018-01-01

Physical activity plays a crucial role in the prevention and treatment of type 2 diabetes. Therefore, it is important to understand why so few adults with type 2 diabetes regularly engage in physical activity. The role of self-regulation in the context of health-related behavior adherence, especially in terms of physical activity engagement and adherence, has largely been reviewed based on the strength energy model. Building on this line of research, the aim of this theoretical work was to highlight how self-regulation and ego depletion can influence the lower rate of physical activity participation among adults with type 2 diabetes, compared to adults from the general population.

Prevalence of Disability and Disability Type Among Adults--United States, 2013.

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Courtney-Long, Elizabeth A; Carroll, Dianna D; Zhang, Qing C; Stevens, Alissa C; Griffin-Blake, Shannon; Armour, Brian S; Campbell, Vincent A

2015-07-31

Understanding the prevalence of disability is important for public health programs to be able to address the needs of persons with disabilities. Beginning in 2013, to measure disability prevalence by functional type, the Behavioral Risk Factor Surveillance System (BRFSS), added five questions to identify disability in vision, cognition, mobility, self-care, and independent living. CDC analyzed data from the 2013 BRFSS to assess overall prevalence of any disability, as well as specific types of disability among noninstitutionalized U.S. adults. Across all states, disabilities in mobility and cognition were the most frequently reported types. State-level prevalence of each disability type ranged from 2.7% to 8.1% (vision); 6.9% to 16.8% (cognition); 8.5% to 20.7% (mobility); 1.9% to 6.2% (self-care) and 4.2% to 10.8% (independent living). A higher prevalence of any disability was generally seen among adults living in states in the South and among women (24.4%) compared with men (19.8%). Prevalences of any disability and disability in mobility were higher among older age groups. These are the first data on functional disability types available in a state-based health survey. This information can help public health programs identify the prevalence of and demographic characteristics associated with different disability types among U.S. adults and better target appropriate interventions to reduce health disparities.

Multitasking in older adults with type 2 diabetes: A cross-sectional analysis.

Science.gov (United States)

Rucker, Jason L; McDowd, Joan M; Mahnken, Jonathan D; Burns, Jeffrey M; Sabus, Carla H; Britton-Carpenter, Amanda J; Utech, Nora B; Kluding, Patricia M

2017-01-01

Deficits in the ability to multitask contribute to gait abnormalities and falls in many at-risk populations. However, it is unclear whether older adults with type 2 diabetes mellitus (DM) also demonstrate impairments in multitasking. The purpose of this study was to compare multitasking performance in cognitively intact older adults with and without DM and explore its relationship to measures of gait and functional ability. We performed a cross-sectional analysis of 40 individuals aged 60 and older with type 2 DM and a matched group of 40 cognitively intact older adults without DM. Multitasking was examined via the ambulatory Walking and Remembering Test (WART) and seated Pursuit Rotor Test (PRT). Self-selected normal and fast walking speed and stride length variability were quantitatively measured, and self-reported functional ability was assessed via the Late Life Function and Disability Index (LLFDI). Participants with DM walked slower and took more steps off path when multitasking during the WART. No between-group differences in multitasking performance were observed on the PRT. Multitasking performance demonstrated little correlation with gait and functional ability in either group. Older adults with DM appear to perform poorly on an ambulatory measure of multitasking. However, we analyzed a relatively small, homogenous sample of older adults with and without type 2 DM and factors such as peripheral neuropathy and the use of multiple comparisons complicate interpretation of the data. Future research should explore the interactions between multitasking and safety, fall risk, and function in this vulnerable population. Clinicians should recognize that an array of factors may contribute to gait and physical dysfunction in older adults with type 2 diabetes, and be prepared to assess and intervene appropriately.

Multitasking in older adults with type 2 diabetes: A cross-sectional analysis.

Directory of Open Access Journals (Sweden)

Jason L Rucker

Full Text Available Deficits in the ability to multitask contribute to gait abnormalities and falls in many at-risk populations. However, it is unclear whether older adults with type 2 diabetes mellitus (DM also demonstrate impairments in multitasking. The purpose of this study was to compare multitasking performance in cognitively intact older adults with and without DM and explore its relationship to measures of gait and functional ability.We performed a cross-sectional analysis of 40 individuals aged 60 and older with type 2 DM and a matched group of 40 cognitively intact older adults without DM. Multitasking was examined via the ambulatory Walking and Remembering Test (WART and seated Pursuit Rotor Test (PRT. Self-selected normal and fast walking speed and stride length variability were quantitatively measured, and self-reported functional ability was assessed via the Late Life Function and Disability Index (LLFDI.Participants with DM walked slower and took more steps off path when multitasking during the WART. No between-group differences in multitasking performance were observed on the PRT. Multitasking performance demonstrated little correlation with gait and functional ability in either group.Older adults with DM appear to perform poorly on an ambulatory measure of multitasking. However, we analyzed a relatively small, homogenous sample of older adults with and without type 2 DM and factors such as peripheral neuropathy and the use of multiple comparisons complicate interpretation of the data. Future research should explore the interactions between multitasking and safety, fall risk, and function in this vulnerable population. Clinicians should recognize that an array of factors may contribute to gait and physical dysfunction in older adults with type 2 diabetes, and be prepared to assess and intervene appropriately.

Regulated gene expression in cultured type II cells of adult human lung.

Science.gov (United States)

Ballard, Philip L; Lee, Jae W; Fang, Xiaohui; Chapin, Cheryl; Allen, Lennell; Segal, Mark R; Fischer, Horst; Illek, Beate; Gonzales, Linda W; Kolla, Venkatadri; Matthay, Michael A

2010-07-01

Alveolar type II cells have multiple functions, including surfactant production and fluid clearance, which are critical for lung function. Differentiation of type II cells occurs in cultured fetal lung epithelial cells treated with dexamethasone plus cAMP and isobutylmethylxanthine (DCI) and involves increased expression of 388 genes. In this study, type II cells of human adult lung were isolated at approximately 95% purity, and gene expression was determined (Affymetrix) before and after culturing 5 days on collagen-coated dishes with or without DCI for the final 3 days. In freshly isolated cells, highly expressed genes included SFTPA/B/C, SCGB1A, IL8, CXCL2, and SFN in addition to ubiquitously expressed genes. Transcript abundance was correlated between fetal and adult cells (r = 0.88), with a subset of 187 genes primarily related to inflammation and immunity that were expressed >10-fold higher in adult cells. During control culture, expression increased for 8.1% of expressed genes and decreased for approximately 4% including 118 immune response and 10 surfactant-related genes. DCI treatment promoted lamellar body production and increased expression of approximately 3% of probed genes by > or =1.5-fold; 40% of these were also induced in fetal cells. Highly induced genes (> or =10-fold) included PGC, ZBTB16, DUOX1, PLUNC, CIT, and CRTAC1. Twenty-five induced genes, including six genes related to surfactant (SFTPA/B/C, PGC, CEBPD, and ADFP), also had decreased expression during control culture and thus are candidates for hormonal regulation in vivo. Our results further define the adult human type II cell molecular phenotype and demonstrate that a subset of genes remains hormone responsive in cultured adult cells.

Social functioning in adults with neurofibromatosis type 1.

Science.gov (United States)

Pride, Natalie A; Crawford, Hilda; Payne, Jonathan M; North, Kathryn N

2013-10-01

Neurofibromatosis type 1 (NF1) is a common single-gene disorder characterised by a diverse range of cutaneous, neurological and neoplastic manifestations. It is well recognised that children with NF1 have poor peer interactions and are at risk for deficits in social skills. Few studies, however, have examined social functioning in adults with NF1. We aimed to determine whether adults with NF1 are at greater risk for impairment in social skills and to identify potential risk factors for social skills deficits. We evaluated social skills in 62 adults with NF1 and 39 controls using self-report and observer-report measures of social behaviour. We demonstrate that adults with NF1 exhibit significantly less prosocial behaviour than controls. This deficit was associated with social processing abilities and was more evident in males. The frequency of antisocial behaviour was comparable between the two groups, however was significantly associated with behavioural regulation in the NF1 group. These findings suggest that poor social skills in individuals with NF1 are due to deficits in prosocial behaviour, rather than an increase in antisocial behaviour. This will aid the design of interventions aimed at improving social skills in individuals with NF1. Copyright © 2013 Elsevier Ltd. All rights reserved.

Adult care providers' perspectives on the transition to adult care for emerging adults with Type 1 diabetes: a cross-sectional survey.

Science.gov (United States)

Michaud, S; Dasgupta, K; Bell, L; Yale, J-F; Anjachak, N; Wafa, S; Nakhla, M

2018-03-25

To assess adult diabetes care providers' current transition practices, knowledge about transition care, and perceived barriers to implementation of best practices in transition care for emerging adults with Type 1 diabetes mellitus. We administered a 38-item web-based survey to adult diabetes care providers identified through the Québec Endocrinologist Medical Association and Diabetes Québec. Fifty-three physicians responded (35%). Fewer than half of all respondents (46%) were familiar with the American Diabetes Association's transition care position statement. Approximately one-third of respondents reported a gap of >6 months between paediatric and adult diabetes care. Most (83%) believed communication with the paediatric team was adequate; however, only 56% reported receiving a medical summary and 2% a psychosocial summary from the paediatric provider. Respondents believed that the paediatric team should improve emerging adults' preparation for transition care by developing their self-management skills and improve teaching about the differences between paediatric and adult-oriented care. Only 31% had a system for identifying emerging adults lost to follow-up in adult care. Perceived barriers included difficulty accessing psychosocial services, emerging adults' lack of motivation, and inadequate transition preparation. Most (87%) were interested in having additional resources, including a self-care management tool and a registry to track those lost to follow-up. Our findings highlight the need to better engage adult care providers into transition care practices. Despite adult physicians' interest in transition care, implementation of transition care recommendations and resources in clinical care remains limited. Enhanced efforts are needed to improve access to mental health services within the adult healthcare setting. © 2018 Diabetes UK.

Type 1 diabetes: addressing the transition from pediatric to adult-oriented health care

Directory of Open Access Journals (Sweden)

Monaghan M

2016-04-01

Full Text Available Maureen Monaghan,1,2 Katherine Baumann2 1Center for Translational Science, Children's National Health System, 2George Washington University School of Medicine, Washington, DC, USA Abstract: Adolescents and young adults with type 1 diabetes are at risk for poor health outcomes, including poor glycemic control, acute and chronic complications, and emergency department admissions. During this developmental period, adolescent and young adult patients also experience significant changes in living situation, education, and/or health care delivery, including transferring from pediatric to adult health care. In recent years, professional and advocacy organizations have proposed expert guidelines to improve the process of preparation for and transition to adult-oriented health care. However, challenges remain and evidence-based practices for preparing youth for adult health care are still emerging. Qualitative research suggests that adolescent and young adult patients rely on health care providers to guide them through the transition process and appreciate a gradual approach to preparing for adult-oriented health care, keeping parents in supportive roles into young adulthood. Patients also benefit from specific referrals and contact information for adult care providers. Promising models of transition care include provision of transition navigators, attendance at a young adult bridge clinic, or joint visits with pediatric and adult care providers. However, much of this research is in its early stages, and more rigorous trials need to be conducted to evaluate health outcomes during transition into adult health care. The purpose of this review is to provide an overview of the transition process, patient and health care provider perceptions of transition care, and emerging evidence of successful models of care for engagement in adult-oriented health care. Recommendations and resources for health care providers are also presented. Keywords: type 1 diabetes

Are there differential relationships between different types of childhood maltreatment and different types of adult personality pathology?

Science.gov (United States)

Cohen, Lisa Janet; Tanis, Thachell; Bhattacharjee, Reetuparna; Nesci, Christina; Halmi, Winter; Galynker, Igor

2014-01-30

While considerable data support the relationship between childhood trauma and adult personality pathology in general, there is little research investigating the specific relationships between different types of childhood maltreatment and adult personality disorders. The present study tested a model incorporating five a priori hypotheses regarding the association between distinct forms of childhood maltreatment and personality pathology in 231 psychiatric patients using multiple self-report measures (Personality Diagnostic Questionnaire-4th Edition, Child Trauma Questionnaire, Conflict in Tactics Scale Parent-Child Child-Adult, and Multidimensional Neglectful Behavior Scale). Step-wise linear regressions supported three out of five hypotheses, suggesting independent relationships between: physical abuse and antisocial personality disorder traits; emotional abuse and Cluster C personality disorder traits; and maternal neglect and Cluster A personality disorder traits after controlling for co-occurring maltreatment types and personality disorder traits. Results did not support an independent relationship between sexual abuse and borderline personality traits nor between emotional abuse and narcissistic personality disorder traits. Additionally, there were three unexpected findings: physical abuse was independently and positively associated with narcissistic and paranoid traits and negatively associated with Cluster C traits. These findings can help refine our understanding of adult personality pathology and support the future development of clinical tools for survivors of childhood maltreatment. © 2013 Published by Elsevier Ireland Ltd.

Subjective sleep impairment in adults with type 1 or type 2 diabetes: Results from Diabetes MILES-The Netherlands

NARCIS (Netherlands)

Nefs, G.; Donga, E.; van Someren, E.J.W.; Bot, M.; Speight, J.; Pouwer, F.

2015-01-01

Aims: Despite growing recognition of the impact of sleep on diabetes, a clear profile of people with diabetes regarding subjective sleep impairment has yet to be established. This study examines: (1) subjective sleep characteristics in adults with type 1 and type 2 diabetes; (2) the relationship of

Subjective sleep impairment in adults with type 1 or type 2 diabetes : Results from Diabetes MILES-The Netherlands

NARCIS (Netherlands)

Nefs, Giesje; Donga, Esther; van Someren, Eus; Bot, Mariska; Speight, Jane; Pouwer, François

AIMS: Despite growing recognition of the impact of sleep on diabetes, a clear profile of people with diabetes regarding subjective sleep impairment has yet to be established. This study examines: (1) subjective sleep characteristics in adults with type 1 and type 2 diabetes; (2) the relationship of

Motives for adult participation in physical activity: type of activity, age, and gender.

Science.gov (United States)

Molanorouzi, Keyvan; Khoo, Selina; Morris, Tony

2015-01-31

In recent years, there has been a decline in physical activity among adults. Motivation has been shown to be a crucial factor in maintaining physical activity. The purpose of this study was to examine whether motives for participation could accurately discriminate gender, age, and type of physical activity. A quantitative, cross-sectional descriptive research design was employed. The Physical Activity and Leisure Motivation Scale (PALMS) was used to assess motives for physical activity in 1,360 adults (703 males, 657 females) who had been exercising regularly for at least six months. The PALMS consists of 40 items that constitute eight sub-scales (mastery, enjoyment, psychological condition, physical condition, appearance, others' expectations, affiliation, competition/ego). Respondents were divided into two age groups (young adults aged 20 to 40 years and middle-aged adults 41 to 64 years) and five types of activity (individual racing sports plus bowls, team sports, racquet sports, martial arts, and exercise). The group discriminant function analyses revealed significant canonical functions correctly classifying the cases into gender (82%), age group (83%), team sport players 76%, individual racing sport plus bowls players 91%, racquet sport players 90%, exercisers 84%, and martial art players 91%. The competition/ego, appearance, physical condition, and mastery sub-scales contributed most to gender differences. Five sub-scales (mastery, psychological condition, others' expectations, affiliation, and enjoyment) contributed most to the discriminant function for age. For type of activity, different sub-scales were the strongest contributors to the discriminant function for each type of PA. The findings in this study suggest that strong and important motives for participation in physical activity are different across type of activity, age, and gender in adults. Understanding the motives that influence physical activity participation is critical for developing

A Type 1 Diabetes Genetic Risk Score Can Aid Discrimination Between Type 1 and Type 2 Diabetes in Young Adults.

Science.gov (United States)

Oram, Richard A; Patel, Kashyap; Hill, Anita; Shields, Beverley; McDonald, Timothy J; Jones, Angus; Hattersley, Andrew T; Weedon, Michael N

2016-03-01

With rising obesity, it is becoming increasingly difficult to distinguish between type 1 diabetes (T1D) and type 2 diabetes (T2D) in young adults. There has been substantial recent progress in identifying the contribution of common genetic variants to T1D and T2D. We aimed to determine whether a score generated from common genetic variants could be used to discriminate between T1D and T2D and also to predict severe insulin deficiency in young adults with diabetes. We developed genetic risk scores (GRSs) from published T1D- and T2D-associated variants. We first tested whether the scores could distinguish clinically defined T1D and T2D from the Wellcome Trust Case Control Consortium (WTCCC) (n = 3,887). We then assessed whether the T1D GRS correctly classified young adults (diagnosed at 20-40 years of age, the age-group with the most diagnostic difficulty in clinical practice; n = 223) who progressed to severe insulin deficiency 0.280 (>50th centile in those with T1D) is indicative of T1D (50% sensitivity, 95% specificity). A low T1D GRS (young adults with diabetes, T1D GRS alone predicted progression to insulin deficiency (AUC 0.87 [95% CI 0.82-0.92]; P young adults with diabetes who will require insulin treatment. This will be an important addition to correctly classifying individuals with diabetes when clinical features and autoimmune markers are equivocal. © 2016 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

A systematic review of interventions to improve outcomes for young adults with Type 1 diabetes.

LENUS (Irish Health Repository)

O'Hara, M C

2016-10-20

Many young adults with Type 1 diabetes experience poor outcomes. The aim of this systematic review was to synthesize the evidence regarding the effectiveness of interventions aimed at improving clinical, behavioural or psychosocial outcomes for young adults with Type 1 diabetes.

Psychological interventions for diabetes-related distress in adults with type 2 diabetes mellitus

NARCIS (Netherlands)

Chew, Boon How; Vos, Rimke C; Metzendorf, Maria-Inti; Scholten, Rob Jpm; Rutten, Guy Ehm

2017-01-01

BACKGROUND: Many adults with type 2 diabetes mellitus (T2DM) experience a psychosocial burden and mental health problems associated with the disease. Diabetes-related distress (DRD) has distinct effects on self-care behaviours and disease control. Improving DRD in adults with T2DM could enhance

Surgical correction of hallux valgus complicated with adult-type pes plano-valgus.

Science.gov (United States)

Choi, Jun Young; Yoon, Hyeong Hwa; Suh, Yu Min; Suh, Jin Soo

2017-01-01

To investigate the efficiency of simultaneous correction of moderate to severe hallux valgus deformity and adult-type pes planus. Twenty cases of moderate to severe hallux valgus complicated with adult-type pes planus in 19 consecutive patients (15 (79%) women, 4 (11%) men; mean age: 44.50 ± 17.13 years, mean follow-up duration: 31.30 ± 17.02 months) were included. Medial calcaneal sliding osteotomy was performed to correct hindfoot valgus, whereas treatments of hallux valgus were case dependent. The mean postoperative hallux valgus angle, intermetatarsal angle, hindfoot alignment angle, and hindfoot alignment ratio were 8.40 ± 5.29°, 4.20 ± 2.54°, 3.09 ± 2.92º and 0.41 ± 0.17, respectively. Although a hallux varus deformity occurred as a postoperative complication in one case (5%), there were no cases of postoperative recurrence. Simultaneous correction of hallux valgus and pes plano-valgus using medial calcaneal sliding osteotomy is an effective technique that reduces recurrence of hallux valgus and increases satisfaction in patients with moderate to severe hallux valgus deformity complicated with adult-type pes planus accompanying hindfoot valgus.

Challenges contributing to disrupted transition from paediatric to adult diabetes care in young adults with Type 1 diabetes

Science.gov (United States)

Pyatak, E. A.; Sequeira, P. A.; Whittemore, R.; Vigen, C. P.; Peters, A. L.; Weigensberg, M. J.

2014-01-01

Aim To examine challenges contributing to disruptions in care during the transition from paediatric to adult care among young adults with Type 1 diabetes who are primarily in ethnic minority groups and have low socio-economic status. Methods Participants (n = 20) were newly enrolled patients in a transition clinic for young adults with Type 1 diabetes with a history of loss to medical follow-up. Participants completed qualitative semi-structured interviews detailing their transition experiences in addition to demographic, HbA1c and psychosocial measures. Descriptive statistics were completed for quantitative data, and narrative thematic analysis of interviews was used to identify common themes. A mixed-method analysis was used to identify the associations between stressors identified in interviews and clinical and psychosocial variables. Results Three categories of challenges contributing to loss to follow-up were identified: psychosocial challenges, health provider and health system challenges and developmental challenges. Participants experienced a high degree of stressful life circumstances which were associated with higher HbA1c (r = 0.60, P = 0.005), longer duration of loss to follow-up (r = 0.51, P = 0.02), greater emergency department utilization (r = 0.45, P = 0.05), and lower life satisfaction (r = −0.62, P = 0.003). Conclusions A confluence of challenges, including stressful life circumstances, healthcare system barriers and the developmental trajectory of young adulthood, contributes to a high risk of loss to follow-up and poor health in this population of young adults with Type 1 diabetes. An integrated approach to transition addressing medical and psychosocial needs may facilitate improved follow-up and health outcomes in clinical settings. PMID:24798586

Metformin in adults with type 1 diabetes

DEFF Research Database (Denmark)

Petrie, John R; Chaturvedi, Nish; Ford, Ian

2017-01-01

AIMS: Cardiovascular (CV) disease is a major cause of reduced life expectancy in type 1 diabetes (T1D). Intensive insulin therapy prevents CV complications but is constrained by hypoglycaemia and weight gain. Adjunct metformin reduces insulin dose requirement and stabilizes weight...... but there are no data on its cardiovascular effects. We have therefore initiated an international double-blind, randomized, placebo-controlled trial (REMOVAL: REducing with MetfOrmin Vascular Adverse Lesions in type 1 diabetes) to examine whether metformin reduces progression of atherosclerosis in adults with T1D....... Individuals ≥40 years of age with T1D for ≥5 years are eligible if they have ≥3 of 10 specified CV risk factors. The enrolment target is 500 participants in 17 international centres. MATERIALS AND METHODS: After 12 weeks of single-blind placebo-controlled run-in, participants with ≥ 70% adherence...

Adult-Onset Type 1 Diabetes and Pregnancy: Three Case Reports

OpenAIRE

Bonsembiante, Barbara; Dalfrà, Maria Grazia; Masin, Michela; Gallo, Alessandra; Lapolla, Annunziata

2013-01-01

From 5% to 10% of diabetic patients have type 1 diabetes. Here we describe three cases of adult-onset type 1 diabetes in pregnancy treated at our clinic between 2009 and 2012. Two patients came for specialist examination during pregnancy, the third after pregnancy. These women had no prior overt diabetes and shared certain characteristics, that is, no family diabetes history, age over 35, normal prepregnancy BMI, need for insulin therapy as of the early weeks of pregnancy, and high-titer anti...

Na+ currents in vestibular type I and type II hair cells of the embryo and adult chicken.

Science.gov (United States)

Masetto, S; Bosica, M; Correia, M J; Ottersen, O P; Zucca, G; Perin, P; Valli, P

2003-08-01

In birds, type I and type II hair cells differentiate before birth. Here we describe that chick hair cells, from the semicircular canals, begin expressing a voltage-dependent Na current (INa) from embryonic day 14 (E14) and continue to express the current up to hatching (E21). During this period, INa was present in most (31/43) type I hair cells irrespective of their position in the crista, in most type II hair cells located far from the planum semilunatum (48/63), but only occasionally in type II hair cells close to the planum semilunatum (2/35). INa activated close to -60 mV, showed fast time- and voltage-dependent activation and inactivation, and was completely, and reversibly, blocked by submicromolar concentrations of tetrodotoxin (Kd = 17 nM). One peculiar property of INa concerns its steady-state inactivation, which is complete at -60 mV (half-inactivating voltage = -96 mV). INa was found in type I and type II hair cells from the adult chicken as well, where it had similar, although possibly not identical, properties and regional distribution. Current-clamp experiments showed that INa could contribute to the voltage response provided that the cell membrane was depolarized from holding potentials more negative than -80 mV. When recruited, INa produced a significant acceleration of the cell membrane depolarization, which occasionally elicited a large rapid depolarization followed by a rapid repolarization (action-potential-like response). Possible physiological roles for INa in the embryo and adult chicken are discussed.

Gut microbiota in human adults with type 2 diabetes differs from non-diabetic adults

DEFF Research Database (Denmark)

Larsen, Nadja; Vogensen, Finn Kvist; van der Berg, Franciscus Winfried J

2010-01-01

. Methods and Findings The study included 36 male adults with a broad range of age and body-mass indices (BMIs), among which 18 subjects were diagnosed with diabetes type 2. The fecal bacterial composition was investigated by real-time quantitative PCR (qPCR) and in a subgroup of subjects (N = 20) by tag...... = 0.04). Conclusions The results of this study indicate that type 2 diabetes in humans is associated with compositional changes in intestinal microbiota. The level of glucose tolerance should be considered when linking microbiota with metabolic diseases such as obesity and developing strategies......Background Recent evidence suggests that there is a link between metabolic diseases and bacterial populations in the gut. The aim of this study was to assess the differences between the composition of the intestinal microbiota in humans with type 2 diabetes and non-diabetic persons as control...

Acute glycaemic load breakfast manipulations do not attenuate cognitive impairments in adults with type 2 diabetes.

Science.gov (United States)

Lamport, Daniel Joseph; Dye, Louise; Mansfield, Michael W; Lawton, Clare L

2013-04-01

Research on young healthy samples suggests that low glycaemic load foods can confer benefits for cognitive performance. The aim was to examine the effects of type 2 diabetes on cognitive function, and to investigate whether consumption of low glycaemic load breakfasts affects cognitive function in adults with type 2 diabetes. Memory, psychomotor skill and executive function were examined at two morning test sessions in 24 adults with type 2 diabetes and 10 adults with normal glucose tolerance (NGT) aged 45-77 years without dementia after water, low, and high glycaemic load breakfasts were consumed in accordance with a crossover, counterbalanced design. The type 2 diabetes and NGT groups were matched for education, depression, and IQ. Type 2 diabetes was associated with impairments in verbal memory, spatial memory, psychomotor skill, and executive function compared to adults with NGT. Consumption of the three breakfast conditions did not impact on cognitive performance in the type 2 diabetes or NGT participants. Abnormalities in glucose tolerance such as type 2 diabetes can have demonstrable negative effects on a range of cognitive functions. However, there was no evidence that low GL breakfasts administered acutely could confer benefits for cognitive function (ClincalTrials.gov identifier, NCT01047813). Copyright © 2012 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Self-care behaviors of Filipino-American adults with type 2 diabetes mellitus.

Science.gov (United States)

Jordan, Deovina N; Jordan, James L

2010-01-01

To examine the diabetes self-care behaviors of Filipino-American (FA) adults with type 2 diabetes mellitus (DM). The Summary of Diabetes Self Care Activities-Revised and Expanded measure was administered to 192 (74 males and 118 females) FA adult immigrants with type 2 DM. Older FAs (> or =65 years), females, those who were older when they immigrated, and participants diagnosed with type 2 DM longer were more likely to follow recommended medication regimens. Younger FAs (healthful eating plans. Likewise, females reported eating five or more servings of fruits and/or vegetables daily. Moreover, older FAs reported evenly spacing carbohydrate intake everyday. Furthermore, older participants, those with less education, participants who were older when they immigrated, and those older when diagnosed with type 2 DM ate fewer foods high in fats. As to physical activity, FA males and participants with higher education exercised more frequently. Younger FAs were less likely to perform optimum type 2 DM self-care behaviors pertaining to diet, medication taking, and blood glucose testing compared to their older counterparts. This finding suggests an increased risk for type 2 DM comorbidities and/or complications in younger FAs, which may require more intensive treatments in later years. Copyright 2010. Published by Elsevier Inc.

Regulated gene expression in cultured type II cells of adult human lung

OpenAIRE

Ballard, Philip L.; Lee, Jae W.; Fang, Xiaohui; Chapin, Cheryl; Allen, Lennell; Segal, Mark R.; Fischer, Horst; Illek, Beate; Gonzales, Linda W.; Kolla, Venkatadri; Matthay, Michael A.

2010-01-01

Alveolar type II cells have multiple functions, including surfactant production and fluid clearance, which are critical for lung function. Differentiation of type II cells occurs in cultured fetal lung epithelial cells treated with dexamethasone plus cAMP and isobutylmethylxanthine (DCI) and involves increased expression of 388 genes. In this study, type II cells of human adult lung were isolated at ∼95% purity, and gene expression was determined (Affymetrix) before and after culturing 5 days...

Adult-onset epilepsy in focal cortical dysplasia of Taylor type

NARCIS (Netherlands)

Siegel, A. M.; Cascino, G. D.; Elger, C. E.; Devinsky, O.; Laff, R.; Najjar, S.; Sperling, M. R.; LoRusso, G.; Cossu, M.; Urbach, H.; Aronica, E.; Meyer, F. B.; Scheithauer, B. W.; Dubeau, F.; Andermann, F.

2005-01-01

Focal cortical dysplasia of Taylor type (FCDT) usually presents with seizures at an early age, whereas adult onset of epilepsy is uncommon. We reviewed the medical records of 213 patients with FCDT. In 21 patients (10%), age at seizure onset ranged from 18 to 55 years (mean 25.3). The outcome of

Height at Ages 7-13 Years in Relation to Developing Type 2 Diabetes Throughout Adult Life

DEFF Research Database (Denmark)

Bjerregaard, Lise G; Jensen, Britt W; Baker, Jennifer L

2017-01-01

measured at ages 7-13 years. Hazard ratios (HR) of type 2 diabetes (age ≥30 years) were estimated without and with adjustment for birthweight and BMI. RESULTS: In men, associations between height and type 2 diabetes changed from inverse for below-average heights at age 7 years to positive for above...... for BMI, short childhood height at all ages and greater growth during childhood are associated with an increased risk of type 2 diabetes, suggesting that this period of life warrants mechanistic investigations.......BACKGROUND: Short adults have an increased risk of type 2 diabetes. Although adult height results from childhood growth, the effects of height and growth trajectories during childhood are sparsely investigated. We investigated sex-specific associations between childhood height, growth and adult...

Social network types and functional dependency in older adults in Mexico

Directory of Open Access Journals (Sweden)

Espinosa-Alarcón Patricia

2010-02-01

Full Text Available Abstract Background Social networks play a key role in caring for older adults. A better understanding of the characteristics of different social networks types (TSNs in a given community provides useful information for designing policies to care for this age group. Therefore this study has three objectives: 1 To derive the TSNs among older adults affiliated with the Mexican Institute of Social Security; 2 To describe the main characteristics of the older adults in each TSN, including the instrumental and economic support they receive and their satisfaction with the network; 3 To determine the association between functional dependency and the type of social network. Methods Secondary data analysis of the 2006 Survey of Autonomy and Dependency (N = 3,348. The TSNs were identified using the structural approach and cluster analysis. The association between functional dependency and the TSNs was evaluated with Poisson regression with robust variance analysis in which socio-demographic characteristics, lifestyle and medical history covariates were included. Results We identified five TSNs: diverse with community participation (12.1%, diverse without community participation (44.3%; widowed (32.0%; nonfriends-restricted (7.6%; nonfamily-restricted (4.0%. Older adults belonging to widowed and restricted networks showed a higher proportion of dependency, negative self-rated health and depression. Older adults with functional dependency more likely belonged to a widowed network (adjusted prevalence ratio 1.5; 95%CI: 1.1-2.1. Conclusion The derived TSNs were similar to those described in developed countries. However, we identified the existence of a diverse network without community participation and a widowed network that have not been previously described. These TSNs and restricted networks represent a potential unmet need of social security affiliates.

Predictors of Hazardous Alcohol Consumption Among Young Adult Amphetamine-Type Stimulant Users

Directory of Open Access Journals (Sweden)

Ellen M. Leslie

2016-02-01

Full Text Available Background: Very high levels of alcohol consumption have been observed in young adult amphetamine-type stimulant (i.e., ecstasy and methamphetamine users. The reasons for this association are poorly understood. Objective: To examine predictors of hazardous alcohol consumption in a sample of young adult amphetamine-type stimulant users after 30 months of follow-up, controlling for potential confounders. Method: Analysis of longitudinal data from a population-derived sample of Australian young adult amphetamine-type stimulant users (n = 292. A prediction model of alcohol use at 30 months was developed using generalized linear latent and mixed modeling (GLLAMM. Results: Concurrently using ecstasy (Adjusted Odds Ratio [AOR] = 2.67, 95% Confidence Interval [CI] = [1.41, 5.07], frequently attending nightclubs (AOR = 2.53, 95% CI = [1.04, 6.16], high baseline alcohol use patterns (AOR = 2.06, 95% CI = [1.32, 3.20], and being male (AOR = 3.60, 95% CI = [1.48, 8.78] were associated with an increased likelihood of hazardous alcohol use at 30 months. Conclusion: Concurrent, but not baseline, ecstasy use was associated with hazardous alcohol use, suggesting that combined use of these substances may have an instrumental role in terms of the social functions of drug use (e.g., increasing capacity to drink. Integration of educational interventions concerning alcohol and stimulants is warranted.

Impact on Dose Coefficients Calculated with ICRP Adult Mesh-type Reference Computational Phantoms

Energy Technology Data Exchange (ETDEWEB)

Yeom, Yeon Soo; Nguyen, Thang Tat; Choi, Chan Soo; Lee, Han Jin; Han, Hae Gin; Han, Min Cheol; Shin, Bang Ho; Kim, Chan Hyeong [Dept. of Nuclear Engineering, Hanyang University, Seoul (Korea, Republic of)

2017-04-15

In 2016, the International Commission on Radiological Protection (ICRP) formulated a new Task Group (TG) (i.e., TG 103) within Committee 2. The ultimate aim of the TG 103 is to develop the mesh-type reference computational phantoms (MRCPs) that can address dosimetric limitations of the currently used voxel-type reference computational phantoms (VRCPs) due to their limited voxel resolutions. The objective of the present study is to investigate dosimetric impact of the adult MRCPs by comparing dose coefficients (DCs) calculated with the MRCPs for some external and internal exposure cases and the reference DCs in ICRP Publications 116 and 133 that were produced with the adult VRCPs. In the present study, the DCs calculated with the adult MRCPs for some exposure cases were compared with the values in ICRP Publications 116 and 133. This comparison shows that in general the MRCPs provide very similar DCs for uncharged particles, but for charged particles provide significantly different DCs due to the improvement of the MRCPs.

Preservation of skeletal muscle mitochondrial content in older adults: relationship between mitochondria, fibre type and high-intensity exercise training.

Science.gov (United States)

Wyckelsma, Victoria L; Levinger, Itamar; McKenna, Michael J; Formosa, Luke E; Ryan, Michael T; Petersen, Aaron C; Anderson, Mitchell J; Murphy, Robyn M

2017-06-01

Ageing is associated with an upregulation of mitochondrial dynamics proteins mitofusin 2 (Mfn2) and mitochondrial dynamics protein 49 (MiD49) in human skeletal muscle with the increased abundance of Mfn2 being exclusive to type II muscle fibres. These changes occur despite a similar content of mitochondria, as measured by COXIV, NDUFA9 and complexes in their native states (Blue Native PAGE). Following 12 weeks of high-intensity training (HIT), older adults exhibit a robust increase in mitochondria content, while there is a decline in Mfn2 in type II fibres. We propose that the upregulation of Mfn2 and MiD49 with age may be a protective mechanism to protect against mitochondrial dysfunction, in particularly in type II skeletal muscle fibres, and that exercise may have a unique protective effect negating the need for an increased turnover of mitochondria. Mitochondrial dynamics proteins are critical for mitochondrial turnover and maintenance of mitochondrial health. High-intensity interval training (HIT) is a potent training modality shown to upregulate mitochondrial content in young adults but little is known about the effects of HIT on mitochondrial dynamics proteins in older adults. This study investigated the abundance of protein markers for mitochondrial dynamics and mitochondrial content in older adults compared to young adults. It also investigated the adaptability of mitochondria to 12 weeks of HIT in older adults. Both older and younger adults showed a higher abundance of mitochondrial respiratory chain subunits COXIV and NDUFA9 in type I compared with type II fibres, with no difference between the older adults and young groups. In whole muscle homogenates, older adults had higher mitofusin-2 (Mfn2) and mitochondrial dynamics protein 49 (MiD49) contents compared to the young group. Also, older adults had higher levels of Mfn2 in type II fibres compared with young adults. Following HIT in older adults, MiD49 and Mfn2 levels were not different in whole

Volunteering among Older Spanish Adults: Does the Type of Organization Matter?

Science.gov (United States)

Celdran, Montserrat; Villar, Feliciano

2007-01-01

This study in Spain explored three aspects of older adult volunteering (motivations, satisfaction, and perceptions of benefits and drawbacks) and examines to what extent these aspects are influenced by the type of organization and other factors (sociodemographic variables and level of volunteering). The sample consisted of 88 older adults…

Disease: H00581 [KEGG MEDICUS

Lifescience Database Archive (English)

Full Text Available H00581 Alport syndrome Alport syndrome is a hereditary hematuric nephropathy with frequent hearing...rogressive nephritis and hearing impairment. Kidney disease (autosomal) COL4A3 [HSA:1285] [KO:K06237] (autos

Why do young adults with Type 1 diabetes find it difficult to manage diabetes in the workplace?

Science.gov (United States)

Balfe, Myles; Brugha, Ruairi; Smith, Diarmuid; Sreenan, Seamus; Doyle, Frank; Conroy, Ronan

2014-03-01

This article explores how and why workplace environments impact diabetes management for adults people with Type 1 diabetes, 23-30 years of age. Interviews were conducted with 35 young adults, 29 women and 6 men. The majority of these interviewees worked in sectors such as banking, technology and administration. Young adults found it difficult to manage diabetes in the workplace for two main reasons: work-related time pressures and the non-routine nature of interviewees' work and working environment. Young adults also found it difficult to get the time to exercise both inside and outside of work. Young adults with Type 1 diabetes need to be provided with the tools and technologies that they need to manage diabetes in modern flexible workplaces. Copyright © 2014 Elsevier Ltd. All rights reserved.

Surgical management of adult type 1 split cord malformation. Report of two cases with literature review.

Science.gov (United States)

Viswanathan, Vibhu K; Minnema, Amy J; Farhadi, H Francis

2018-06-01

Split cord malformation (SCM) is a rare form of spinal dysraphism wherein the spinal cord is divided longitudinally into two distinct hemicords. Surgery is usually performed in children while management in adults, who rarely manifest symptoms, remains controversial. Both expectant management and prophylactic surgery have been variously advocated. The present article describes our experience in two adult patients with predominant pain-related complaints who underwent surgical excision of type 1 SCM lesions. A comprehensive review of the literature on SCM in adults is also provided. While pain, disability, and quality of life scores improved in these two patients, further larger studies will be required to define the role of surgery in adults with type 1 SCM and a pain-dominant presentation. Copyright © 2018 Elsevier Ltd. All rights reserved.

Control of glycemia and other cardiovascular disease risk factors in older adults with type 2 diabetes mellitus: data from the Adult Diabetes Control and Management.

Science.gov (United States)

Sazlina, Shariff-Ghazali; Mastura, Ismail; Ahmad, Zaiton; Cheong, Ai-Theng; Adam, Bujang-Mohamad; Jamaiyah, Haniff; Lee, Ping-Yein; Syed-Alwi, Syed-Abdul-Rahman; Chew, Boon-How; Sriwahyu, Taher

2014-01-01

The aims of the present study were to assess the control of glycemia and other cardiovascular disease risk factors, and the association between age and these controls among older adults with type 2 diabetes in Malaysia. A cross-sectional study was carried out using cases notified to the Adult Diabetes Control and Management database between 1 January and 31 December 2009. A total of 10 363 people aged over 60 years with type 2 diabetes mellitus were included in the analyses. A standard online case report form was used to record demographic data, clinical factors (diabetes duration, comorbid condition and treatment modalities), cardiovascular disease risk factors, diabetes complications and laboratory assessments. The cardiovascular disease risk factors controls assessed included glycosylated hemoglobin (HbA(1c)) control of cardiovascular disease risk factors was suboptimal in older adults with type 2 diabetes. The oldest elderly were more likely to achieve target HbA(1c) (<7.0%) and triglycerides (<1.7 mmol/L) than older adults aged 60-69 years. © 2013 Japan Geriatrics Society.

Adult lifetime reproductive value in fish depends on size and fecundity type

DEFF Research Database (Denmark)

Tsoukali, Stavroula; Olsson, Karin H.; Visser, André W.

2016-01-01

In a stable population, the adult lifetime reproductive value must be balanced against early life survival. Although delaying maturity may increase fecundity, it also reduces survival. Larger size at maturity therefore not only allows for higher fecundity, but requires it. Using simple arguments......, the expected proportionality falls off if mortality increases to include fishing. Furthermore, we find that the fecundity type (determinate or indeterminate) affects the predicted adult reproductive value, which is significantly (10-fold) higher for an indeterminate spawner than for a determinate spawner...

Yoga for Adults with Type 2 Diabetes: A Systematic Review of Controlled Trials

Science.gov (United States)

Innes, Kim E.; Selfe, Terry Kit

2016-01-01

A growing body of evidence suggests yogic practices may benefit adults with type 2 diabetes (DM2). In this systematic review, we evaluate available evidence from prospective controlled trials regarding the effects of yoga-based programs on specific health outcomes pertinent to DM2 management. To identify qualifying studies, we searched nine databases and scanned bibliographies of relevant review papers and all identified articles. Controlled trials that did not target adults with diabetes, included only adults with type 1 diabetes, were under two-week duration, or did not include quantitative outcome data were excluded. Study quality was evaluated using the PEDro scale. Thirty-three papers reporting findings from 25 controlled trials (13 nonrandomized, 12 randomized) met our inclusion criteria (N = 2170 participants). Collectively, findings suggest that yogic practices may promote significant improvements in several indices of importance in DM2 management, including glycemic control, lipid levels, and body composition. More limited data suggest that yoga may also lower oxidative stress and blood pressure; enhance pulmonary and autonomic function, mood, sleep, and quality of life; and reduce medication use in adults with DM2. However, given the methodological limitations of existing studies, additional high-quality investigations are required to confirm and further elucidate the potential benefits of yoga programs in populations with DM2. PMID:26788520

Risk of asthma in adult twins with type 2 diabetes and increased body mass index

DEFF Research Database (Denmark)

Thomsen, S F; Duffy, D L; Kyvik, K O

2011-01-01

. RESULTS: The risk of asthma was increased in subjects with type 2 diabetes relative to nondiabetic subjects both in men (13.5%vs 7.5%), P = 0.001 and in women (16.6%vs 9.6%), P = 0.001. The result remained significant after adjustment for age, BMI, smoking, symptoms of chronic bronchitis, marital status...... asthma and type 2 diabetes, 0.20 (0.01-0.40), P = 0.047; between asthma and BMI in women, 0.15 (0.07-0.22), P type 2 diabetes, 0.40 (0.29-0.43), P type 2 diabetes and increased BMI are strongly associated in adults, particularly in women......AIM: To examine the relationship between asthma, type 2 diabetes and increased body mass index (BMI) in adult twins. METHODS: We performed record linkage between questionnaire-defined asthma and BMI, and hospital discharge diagnoses of type 2 diabetes in 34,782 Danish twins, 20-71 years of age...

The Role of Age and Excess Body Mass Index in Progression to Type 1 Diabetes in At-Risk Adults.

Science.gov (United States)

Ferrara, Christine T; Geyer, Susan M; Evans-Molina, Carmella; Libman, Ingrid M; Becker, Dorothy J; Wentworth, John M; Moran, Antoinette; Gitelman, Stephen E; Redondo, Maria J

2017-12-01

Given the global rise in both type 1 diabetes incidence and obesity, the role of body mass index (BMI) on type 1 diabetes pathophysiology has gained great interest. Sustained excess BMI in pediatric participants of the TrialNet Pathway to Prevention (PTP) cohort increased risk for progression to type 1 diabetes, but the effects of age and obesity in adults remain largely unknown. To determine the effect of age and sustained obesity on the risk for type 1 diabetes in adult participants in the TrialNet PTP cohort (i.e., nondiabetic autoantibody-positive relatives of patients with type 1 diabetes). Longitudinally accumulated BMI >25 kg/m2 was calculated to generate a cumulative excess BMI (ceBMI) for each participant, with ceBMI values ≥0 kg/m2 and ≥5 kg/m2 representing sustained overweight or obese status, respectively. Recursive partitioning analysis yielded sex- and age-specific thresholds for ceBMI that confer the greatest risk for type 1 diabetes progression. In this cohort of 665 adults (age 20 to 50 years; median follow-up, 3.9 years), 49 participants developed type 1 diabetes. Age was an independent protective factor for type 1 diabetes progression (hazard ratio, 0.95; P = 0.008), with a threshold of >35 years that reduced risk for type 1 diabetes. In men age >35 years and women age <35 years, sustained obesity (ceBMI ≥5 kg/m2) increased the risk for type 1 diabetes. Age is an important factor for type 1 diabetes progression in adults and influences the impact of elevated BMI, indicating an interplay of excess weight, age, and sex in adult type 1 diabetes pathophysiology. Copyright © 2017 Endocrine Society

Healthy lifestyle intervention for adult clinic patients with type 2 diabetes mellitus.

Science.gov (United States)

Coughlin, Steven S; Hatzigeorgiou, Christos; Anglin, Judith; Xie, Ding; Besenyi, Gina M; De Leo, Gianluca; Stewart, Jessica; Wilkins, Thad

2017-01-01

Diet and exercise therapy have been reported to be effective in improving blood glucose control and are an important part of treatment of type 2 diabetes mellitus. The goal of this study is to examine the efficacy of a healthy lifestyle intervention for adult clinic patients with type 2 diabetes mellitus, as measured by Hgb-A1c, cardiovascular indicators, physical activity, weight, and BMI. Also of interest are optimal strategies for subject recruitment, the number of intervention sessions attended, and participant use of the Fitbit watch to monitor their physical activity and track food and beverage consumption. A pre/post-test design will be used in this pilot study. Non-institutionalized adult patients (n=50) aged 18-65 years who have been seen at the Augusta Health outpatient clinics (General Internal Medicine or Family Medicine) for type 2 diabetes in the past 12 months, and who are interested in reducing their risk of disease recurrence through healthy lifestyle behaviors, will be eligible to participate. At orientation visit, eligible individuals will be asked to provide written informed consent. Consenting volunteers (n=50) will be asked to complete the baseline and 6-month follow-up questionnaire and to participate in 12 weekly group sessions of 90 min duration, involving physical activity and to meet with a dietitian (baseline, one month, 90 days) to receive individualized advice on diet and nutrition. The technology-based intervention will use wrist-worn Fitbit Blaze physical activity monitoring devices. This pilot study will provide important information about the feasibility and preliminary efficacy of a healthy lifestyle intervention for adult clinic patients with type 2 diabetes mellitus. The use of consumer-facing devices such as the Fitbit watch has the potential advantage over the use of research accelerometers, pedometers, or actigraphs in increasing the likelihood that the intervention will be sustainable after the study ends.

Education, Health, and Earnings – Type 1 Diabetes in Children and Young Adults

OpenAIRE

Lovén, Ida

2015-01-01

This thesis consists of four independent exploratory research papers contributing to the economic literature on child and adolescent health, and adult educational and labor market outcomes. Each paper considers type 1 diabetes and focuses on onset over a specific age span. An overall conclusion of this thesis is that individuals with type 1 diabetes deviate from peers without diabetes, irrespective of which outcome or the timing of onset studied. Type 1 diabetes has statistically and quantita...

Sugar Sweetened Beverage Consumption among Adults with Gout or Type 2 Diabetes.

Directory of Open Access Journals (Sweden)

Rinki Murphy

Full Text Available Current guidelines for the management of type 2 diabetes and gout recommend that people with these conditions limit their sugar sweetened beverage (SSB intake. We examined self-reported SSB intake among New Zealand adults with gout or type 2 diabetes, including those on hemodialysis.1023 adults with gout and 580 adults (including 206 receiving hemodialysis with type 2 diabetes, participated in this study of between 2009 and 2012. Participants completed an interviewer-administered SSB intake question "how many sugar sweetened drinks (including fruit juice, but not including diet drinks, do you normally drink per day?" SSB consumption was recorded as a circled number 0, 1, 2, 3, 4, 5, or >5, cans or large glasses (300 mL per day.Consuming one or more SSB per day was reported by 64% (622/1023 of subjects with gout, 49% (176/374 with type 2 diabetes without dialysis, and 47% (96/206 with diabetes on dialysis. Consuming four or more SSBs per day was reported by 18% (179/1023, 9% (31/374 and 9% (18/206, respectively. Such high consumers of SSB were characterized after multivariable analysis to be more likely to be male (adjusted odds ratio (OR 1.8; 95% confidence interval 1.1-2.9, younger in age (40 vs 65 years: 1.6; 1.1-2.3, current smoker (5.2; 2.7-10.1, obese (BMI 41 vs 26 kg/m(2: 1.4; 1-1.9, and report Māori (1.8; 1.2-2.8 or Pacific (1.6; 1.1-2.5 ancestry, compared to Caucasian. People with gout were more likely to report heavy SSB intake compared to people with diabetes (OR 2.4, 95% CI 1.5-3.9. Heavy SSB consumption reported by people with diabetes was similar if they did or did not require dialysis.A high proportion of patients with gout and type 2 diabetes, including those on haemodialysis, are not responding to health messages to abstain from SSB consumption.

Diabetes stigma is associated with negative treatment appraisals among adults with insulin-treated Type 2 diabetes

DEFF Research Database (Denmark)

Holmes-Truscott, E.; Browne, J. L.; Ventura, A. D.

2018-01-01

and psychosocial issues. Subgroup analyses were conducted on the responses of 456 adults with insulin-treated Type 2 diabetes (38% women; mean ± sd age: 61.2 ± 8.8 years; diabetes duration: 14.5 ± 7.5 years; years using insulin: 6.4 ± 5.5). Participants completed validated measures of perceived and experienced......, BMI, years using insulin, injections per day), self-efficacy, diabetes-specific distress and diabetes stigma (all P diabetes......Aim: To explore factors associated with negative insulin appraisals among adults with Type 2 diabetes, including perceived and experienced diabetes stigma. Methods: The second Diabetes MILES - Australia study (MILES-2) is a national survey of adults with diabetes, focused on behavioural...

Patient perspectives on peer support for adults with type 1 diabetes: a need for diabetes-specific social capital

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Joensen LE

2016-08-01

Full Text Available Lene E Joensen,1 Tine Filges,2 Ingrid Willaing1 1Health Promotion Research, Steno Diabetes Center, Gentofte, 2Filges Analysis, Hellerup, Denmark Aim: To explore the function of peer support from the perspective of adults with type 1 diabetes in Denmark. Methods: The study population consisted of 20 adults with type 1 diabetes. The sample was diverse in relation to educational background, age, sex, and cohabitation status. Inspired by action research, several methods and perspectives on peer support were explored and tested. Workshops and group and individual interviews were performed. Systematic text condensation was used to analyze data, supplemented with theory-based interpretive analysis. Results: Adults with type 1 diabetes found peer support highly relevant to reduce a burdensome feeling of diabetes-specific loneliness. Peer support showed potential to create diabetes-specific social capital not only by creating reciprocal social support between peers but also, more importantly, by creating space for genuine trust and a feeling of communality. There was a widespread feeling of the pervasive impact of diabetes on daily life and thus the relevance of discussing all aspects of life. However, participants perceived peer support as particularly relevant in relation to big changes in life, for example, in family life, at work, or through treatment events such as getting an insulin pump. Conclusion: Peer support programs focusing on creating and establishing diabetes-specific social capital using participatory approaches seem highly relevant among adults with type 1 diabetes. Content, methods, and effects of peer support need further exploration in collaboration with adults with type 1 diabetes. Keywords: type 1 diabetes mellitus, adult, psychosocial support systems, patient preferences, peer support, diabetes-specific social capital, diabetes-specific loneliness

The prevalence of co-morbid depression in adults with Type 1 diabetes

DEFF Research Database (Denmark)

Barnard, K. D.; Skinner, T. C.; Peveler, R.

2006-01-01

Aim: To review the literature estimating the cross-sectional prevalence of clinical depression in adults with Type 1 diabetes. Methods: Electronic databases and published references were used to identify studies published between January 2000 and June 2004, with a previous meta-analysis used to i...

Severe hypoglycaemia in 1076 adult patients with type 1 diabetes

DEFF Research Database (Denmark)

Pedersen-Bjergaard, Ulrik; Pramming, Stig; Heller, Simon R

2004-01-01

BACKGROUND: Differences between studies in rates of severe hypoglycaemia in type 1 diabetic cohorts are common and poorly understood. The purpose of this study was to assess the frequency of severe hypoglycaemia in unselected patients treated in different secondary care centres and to evaluate...... the influence of risk markers, clinical setting and selection. METHODS: Cross-sectional Danish-British multicentre survey of 1076 consecutive adult patients with clinical type 1 diabetes who completed a detailed questionnaire on hypoglycaemia and related issues. Key variable was the self-reported rate of severe......, the rate of severe hypoglycaemia was 0.35 episodes/patient-year and only retinopathy was a significant risk marker together with state of awareness. CONCLUSION: Severe hypoglycaemia remains a significant clinical problem in type 1 diabetes. The rate of severe hypoglycaemia and the influence of risk markers...

Associations of Total and Domain-Specific Sedentary Time With Type 2 Diabetes in Taiwanese Older Adults

Directory of Open Access Journals (Sweden)

Ming-Chun Hsueh

2016-07-01

Full Text Available Background: The increasing prevalence of type 2 diabetes in older adults has become a public health concern. We investigated the associations of total and domain-specific sedentary time with risk of type 2 diabetes in older adults. Methods: The sample comprised 1046 older people (aged ≥65 years. Analyses were performed using crosssectional data collected via computer-assisted telephone-based interviews in 2014. Data on six self-reported domains of sedentary time (Measure of Older Adults’ Sedentary Time, type 2 diabetes status, and sociodemographic variables were included in the study. Binary logistic regression analysis was performed to calculate the adjusted odds ratios (ORs and 95% confidence intervals (CIs for total and individual sedentary behavior components and likelihood of type 2 diabetes. Results: A total of 17.5% of the participants reported type 2 diabetes. No significant associations were found between total sitting time and risk of type 2 diabetes, after controlling for confounding factors. After total sedentary behavior was stratified into six domains, only watching television for more than 2 hours per day was associated with higher odds of type 2 diabetes (OR 1.56; 95% CI, 1.10–2.21, but no significant associations were found between other domains of sedentary behavior (computer use, reading, socializing, transport, and hobbies and risk of type 2 diabetes. Conclusions: These findings suggest that, among domain-specific sedentary behavior, excessive television viewing might increase the risk of type 2 diabetes among older adults more than other forms of sedentary behavior.

Relations of Behavioral Autonomy to Health Outcomes Among Emerging Adults With and Without Type 1 Diabetes

Science.gov (United States)

Reynolds, Kerry A.; Becker, Dorothy; Escobar, Oscar; Siminerio, Linda

2014-01-01

Objective To examine the relation of behavioral autonomy to psychological, behavioral, and physical health among emerging adults with and without type 1 diabetes. Methods High school seniors with (n = 118) and without type 1 diabetes (n = 122) completed online questionnaires for three consecutive years. Behavioral autonomy, psychological health, risk behaviors, and diabetes outcomes were assessed. Regression analyses were conducted to predict Time 2 and 3 outcomes, controlling for Time 1 outcomes. Results There were no group differences in behavioral autonomy. Behavioral autonomy predicted better psychological health but only for emerging adults without diabetes. Behavioral autonomy was related to increased risk behavior for both groups. Behavioral autonomy was unrelated to self-care but predicted better glycemic control for females. Conclusions Behavioral autonomy may be beneficial for psychological health, but is related to increased risk behavior. The implications of behavioral autonomy for emerging adults with type 1 diabetes require careful consideration. PMID:25157070

Cell-type-specific expression of NFIX in the developing and adult cerebellum.

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Fraser, James; Essebier, Alexandra; Gronostajski, Richard M; Boden, Mikael; Wainwright, Brandon J; Harvey, Tracey J; Piper, Michael

2017-07-01

Transcription factors from the nuclear factor one (NFI) family have been shown to play a central role in regulating neural progenitor cell differentiation within the embryonic and post-natal brain. NFIA and NFIB, for instance, promote the differentiation and functional maturation of granule neurons within the cerebellum. Mice lacking Nfix exhibit delays in the development of neuronal and glial lineages within the cerebellum, but the cell-type-specific expression of this transcription factor remains undefined. Here, we examined the expression of NFIX, together with various cell-type-specific markers, within the developing and adult cerebellum using both chromogenic immunohistochemistry and co-immunofluorescence labelling and confocal microscopy. In embryos, NFIX was expressed by progenitor cells within the rhombic lip and ventricular zone. After birth, progenitor cells within the external granule layer, as well as migrating and mature granule neurons, expressed NFIX. Within the adult cerebellum, NFIX displayed a broad expression profile, and was evident within granule cells, Bergmann glia, and interneurons, but not within Purkinje neurons. Furthermore, transcriptomic profiling of cerebellar granule neuron progenitor cells showed that multiple splice variants of Nfix are expressed within this germinal zone of the post-natal brain. Collectively, these data suggest that NFIX plays a role in regulating progenitor cell biology within the embryonic and post-natal cerebellum, as well as an ongoing role within multiple neuronal and glial populations within the adult cerebellum.

Efficacy of a web-based intervention with mobile phone support in treating depressive symptoms in adults with type 1 and type 2 diabetes

DEFF Research Database (Denmark)

Nobis, Stephanie; Lehr, Dirk; Ebert, David D aniel

2015-01-01

OBJECTIVE: Depression is common in diabetes and linked to adverse health outcomes. This study evaluated the efficacy of a guided web-based intervention in reducing depression in adults with type 1 and type 2 diabetes. RESEARCH DESIGN AND METHODS: A total of 260 participants with diabetes and elev...

Sex-typed personality traits and gender identity as predictors of young adults' career interests.

Science.gov (United States)

Dinella, Lisa M; Fulcher, Megan; Weisgram, Erica S

2014-04-01

Gender segregation of careers is still prominent in the U.S. workforce. The current study was designed to investigate the role of sex-typed personality traits and gender identity in predicting emerging adults' interests in sex-typed careers. Participants included 586 university students (185 males, 401 females). Participants reported their sex-typed personality traits (masculine and feminine traits), gender identities (gender typicality, contentment, felt pressure to conform, and intergroup bias), and interests in sex-typed careers. Results indicated both sex-typed personality traits and gender identity were important predictors of young adults' career interests, but in varying degrees and differentially for men and women. Men's sex-typed personality traits and gender typicality were predictive of their masculine career interests even more so when the interaction of their masculine traits and gender typicality were considered. When gender typicality and sex-typed personality traits were considered simultaneously, gender typicality was negatively related to men's feminine career interests and gender typicality was the only significant predictor of men's feminine career interests. For women, sex-typed personality traits and gender typicality were predictive of their sex-typed career interests. The level of pressure they felt to conform to their gender also positively predicted interest in feminine careers. The interaction of sex-typed personality traits and gender typicality did not predict women's career interests more than when these variables were considered as main effects. Results of the multidimensional assessment of gender identity confirmed that various dimensions of gender identity played different roles in predicting career interests and gender typicality was the strongest predictor of career interests.

Psychosocial factors impacting on life transitions among young adults with type 2 diabetes

DEFF Research Database (Denmark)

Rasmussen, B; Maindal, Helle Terkildsen; Livingston, P

2016-01-01

and Danish young adults with T2DM and to identify unmet support needs during life transitions. Method: A qualitative approach was adopted using thematic content analysis of 26 in-depth semi-structured interviews. An inductive descriptive content analysis was undertaken using a comparative coding system......Background: Type 2 diabetes (T2DM) prevalence is increasing rapidly worldwide with a significant increase in young adults. There is limited information about psychosocial and service needs of this group. Aim: To explore similarities and differences in how psychosocial factors impact on Australian...

Cerebral hemodynamics in adult ischemic-type patients with moyamoya disease compared with those of atherothrombotic middle cerebral artery occlusion

International Nuclear Information System (INIS)

Idei, Masaru; Yamane, Kanji; Nishida, Masahiro; Manabe, Kazufumi; Yokota, Akira

2005-01-01

We measured regional cerebral blood flow (rCBF) in adult ischemic-type patients with moyamoya disease and in patients with atherothrombotic middle cerebral artery occlusion (MCAO) to investigate cerebral hemodynamics in adult ischemic-type of moyamoya disease. In this study we measured rCBF and regional cerebro-vascular response (rCVR) using acetazolamide by Xe-non-enhanced CT. Our subjects consisted of 15 adult ischemic-type patients with moyamoya disease and 27 atherothrombotic stroke patients with proximal occlusion of the middle cerebral artery. The region of inter est was conducted in the anterior cerebral artery, middle cerebral artery and posterior cerebral artery territories as well as basal ganglia regions. rGBF was preserved in all regions of patients with moyamoya disease. However, rCVR severely decreased in the anterior circulation territory in patients with moyamoya disease compared with those of MCAO. These results suggest that rCBF in the anterior circulation territory of adult ischemic-type patients with moyamoya disease is preserved by vasodilation of the cerebral arteries, while cerebral hemodynamic reserve capacity is severely reduced. The results indicated that basal moyamoya vessels are dilated. These findings may be one of the reasons why stroke occurs more frequently in adult than child patients with moyamoya disease. (author)

Callosal hyperintensities and gait speed gain from two types of mobility interventions in older adults.

Science.gov (United States)

Nadkarni, Neelesh K; Perera, Subashan; Studenski, Stephanie A; Rosano, Caterina; Aizenstein, Howard J; VanSwearingen, Jessie M

2015-06-01

To assess whether the volume of callosal hyperintensities in the genu and splenium of older adults with mobility impairment is differentially associated with the degree of gain in gait speed after 2 types of gait interventions. Single-blind randomized controlled trial of 2 types of gait exercises in older adults. Research center in an academic institution. Ambulatory adults (N=44) aged ≥65 years with a slow and variable gait. Twelve-week physical therapist-guided trial of a conventional walking, endurance, balance, and strength (WEBS) intervention (n=20) versus a timing and coordination of gait (TC) intervention (n=22). Gain in gait speed after the intervention and its relation to callosal hyperintensities in the genu and splenium of the corpus callosum. Gait speed improved in both the WEBS group (mean change, 0.16m/s) and the TC group (mean change, 0.21m/s; both PMobility impaired older adults with genual hyperintensities may benefit from a rehabilitation program focused on motor skill learning rather than on strength and endurance training. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Relations of behavioral autonomy to health outcomes among emerging adults with and without type 1 diabetes.

Science.gov (United States)

Helgeson, Vicki S; Reynolds, Kerry A; Becker, Dorothy; Escobar, Oscar; Siminerio, Linda

2014-01-01

To examine the relation of behavioral autonomy to psychological, behavioral, and physical health among emerging adults with and without type 1 diabetes. High school seniors with (n = 118) and without type 1 diabetes (n = 122) completed online questionnaires for three consecutive years. Behavioral autonomy, psychological health, risk behaviors, and diabetes outcomes were assessed. Regression analyses were conducted to predict Time 2 and 3 outcomes, controlling for Time 1 outcomes. There were no group differences in behavioral autonomy. Behavioral autonomy predicted better psychological health but only for emerging adults without diabetes. Behavioral autonomy was related to increased risk behavior for both groups. Behavioral autonomy was unrelated to self-care but predicted better glycemic control for females. Behavioral autonomy may be beneficial for psychological health, but is related to increased risk behavior. The implications of behavioral autonomy for emerging adults with type 1 diabetes require careful consideration. © The Author 2014. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Speech-in-Noise Perception Deficit in Adults with Dyslexia: Effects of Background Type and Listening Configuration

Science.gov (United States)

Dole, Marjorie; Hoen, Michel; Meunier, Fanny

2012-01-01

Developmental dyslexia is associated with impaired speech-in-noise perception. The goal of the present research was to further characterize this deficit in dyslexic adults. In order to specify the mechanisms and processing strategies used by adults with dyslexia during speech-in-noise perception, we explored the influence of background type,…

Social cognitive theory correlates of moderate-intensity exercise among adults with type 2 diabetes.

Science.gov (United States)

Heiss, Valerie J; Petosa, R L

2016-01-01

The purpose of this study was to identify social cognitive theory (SCT) correlates of moderate- to vigorous-intensity exercise (MVPA) among adults with type 2 diabetes. Adults with type 2 diabetes (N = 181) participated in the study. Participants were recruited through ResearchMatch.org to complete an online survey. The survey used previously validated instruments to measure dimensions of self-efficacy, self-regulation, social support, outcome expectations, the physical environment, and minutes of MVPA per week. Spearman Rank Correlations were used to determine the relationship between SCT variables and MVPA. Classification and Regression Analysis using a decision tree model was used to determine the amount of variance in MVPA explained by SCT variables. Due to low levels of vigorous activity, only moderate-intensity exercise (MIE) was analyzed. SCT variables explained 42.4% of the variance in MIE. Self-monitoring, social support from family, social support from friends, and self-evaluative outcome expectations all contributed to the variability in MIE. Other contributing variables included self-reward, task self-efficacy, social outcome expectations, overcoming barriers, and self-efficacy for making time for exercise. SCT is a useful theory for identifying correlates of MIE among adults with type 2 diabetes. The SCT correlates can be used to refine diabetes education programs to target the adoption and maintenance of regular exercise.

Obese Japanese adults with type 2 diabetes have higher basal metabolic rates than non-diabetic adults.

Science.gov (United States)

Miyake, Rieko; Ohkawara, Kazunori; Ishikawa-Takata, Kazuko; Morita, Akemi; Watanabe, Shaw; Tanaka, Shigeho

2011-01-01

Several cross-sectional studies in Pima Indians and Caucasians have indicated that obese individuals with type 2 diabetes have a higher basal metabolic rate (BMR) than healthy, obese individuals. However, no study has investigated this comparison in Japanese subjects, who are known to be susceptible to type 2 diabetes due to genetic characteristics. Thirty obese Japanese adults with pre-type 2 diabetes (n=7) or type 2 diabetes (n=13) or without diabetes (n=10) participated in this study. BMR was measured using indirect calorimetry. The relationships between residual BMR (calculated as measured BMR minus BMR adjusted for fat-free mass, fat mass, age, and sex) and biomarkers including fasting glucose, glycosylated hemoglobin (HbA(1c)), fasting insulin, homeostasis model assessment of insulin resistance (HOMA-R), triglycerides, and free fatty acids were examined using Pearson's correlation. BMR in diabetic subjects adjusted for fat-free mass, fat mass, age, and sex was 7.1% higher than in non-diabetic subjects. BMR in diabetic subjects was also significantly (pBMR and fasting glucose (r=0.391, p=0.032). These results indicate that in the Japanese population, obese subjects with type 2 diabetes have higher BMR compared with obese non-diabetic subjects. The fasting glucose level may contribute to these differences.

Impaired Word and Face Recognition in Older Adults with Type 2 Diabetes.

Science.gov (United States)

Jones, Nicola; Riby, Leigh M; Smith, Michael A

2016-07-01

Older adults with type 2 diabetes mellitus (DM2) exhibit accelerated decline in some domains of cognition including verbal episodic memory. Few studies have investigated the influence of DM2 status in older adults on recognition memory for more complex stimuli such as faces. In the present study we sought to compare recognition memory performance for words, objects and faces under conditions of relatively low and high cognitive load. Healthy older adults with good glucoregulatory control (n = 13) and older adults with DM2 (n = 24) were administered recognition memory tasks in which stimuli (faces, objects and words) were presented under conditions of either i) low (stimulus presented without a background pattern) or ii) high (stimulus presented against a background pattern) cognitive load. In a subsequent recognition phase, the DM2 group recognized fewer faces than healthy controls. Further, the DM2 group exhibited word recognition deficits in the low cognitive load condition. The recognition memory impairment observed in patients with DM2 has clear implications for day-to-day functioning. Although these deficits were not amplified under conditions of increased cognitive load, the present study emphasizes that recognition memory impairment for both words and more complex stimuli such as face are a feature of DM2 in older adults. Copyright © 2016 IMSS. Published by Elsevier Inc. All rights reserved.

Adult onset Niemann-Pick type C disease: A clinical, neuroimaging and molecular genetic study.

Science.gov (United States)

Battisti, Carla; Tarugi, Patrizla; Dotti, Maria Teresa; De Stefano, Nicola; Vattimo, Angelo; Chierichetti, Francesea; Calandra, Sebastiano; Federico, Antonio

2003-11-01

We report on a patient with adult-onset Niemann-Pick type C (NPC) disease, carrying the mutations P1007 and I1061T in the NPC1 gene, presenting with marked psychiatric changes followed by dystonia and cognitive impairment. Filipin staining, single photon emission computed tomography perfusional, positron emission tomography metabolic, conventional magnetic resonance imaging, and magnetic resonance spectroscopy findings suggested a pathophysiological correlation with phenotype expression. This case expands the clinical and genetic spectrum of the rare adult-onset NPC disease phenotype.

Young adult type 1 diabetes care in the West of Ireland: an audit of hospital practice.

LENUS (Irish Health Repository)

Casey, R

2014-11-01

It is well recognised that management of young adults with type 1 diabetes (T1DM) poses difficult challenges for physicians and health care organisations as a whole. In Ireland and in particular the west of Ireland there has been little audit or research on young adults with T1DM and the services available to them.

[Type 3 Gaucher disease, also an adult disease?

Science.gov (United States)

Leurs, A; Chepy, A; Detonellaere, C; Pascal, L; Gallois, P; Tran, T-A-C; Caillaud, C; Hatron, P-Y; Rose, C

2018-03-30

Gaucher disease is a genetic lysosomal storage disorder due to a glucocerebrosidase deficiency. Type 3, including neurological impairment, may have a specific phenotype in the context of the D409H mutation. We report the case of a 22-year-old woman who presented with Gaucher disease. Enzyme replacement therapy by imiglucerase was followed by rapid clinical and biological improvement. However, communication difficulties, which were initially attributed to the language barrier, revealed neurological impairment. After complementary assessment, the diagnosis of type 3 Gaucher disease was suspected. Gene analysis of the glucocerebrosidase showed a homozygous D409H mutation. This mutation results in calcified heart valves, corneal opacities, alteration of oculomotricity and hydrocephalus. The mild manifestation at onset and the late neurological involvement in the medical history make the diagnosis more difficult. This particular clinical phenotype deserves to be known in adult medicine departments. Copyright © 2018 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.

Galectin-1 is expressed in early-type neural progenitor cells and down-regulates neurogenesis in the adult hippocampus

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Imaizumi Yoichi

2011-01-01

Full Text Available Abstract Background In the adult mammalian brain, neural stem cells (NSCs proliferate in the dentate gyrus (DG of the hippocampus and generate new neurons throughout life. A multimodal protein, Galectin-1, is expressed in neural progenitor cells (NPCs and implicated in the proliferation of the NPCs in the DG. However, little is known about its detailed expression profile in the NPCs and functions in adult neurogenesis in the DG. Results Our immunohistochemical and morphological analysis showed that Galectin-1 was expressed in the type 1 and 2a cells, which are putative NSCs, in the subgranular zone (SGZ of the adult mouse DG. To study Galectin-1's function in adult hippocampal neurogenesis, we made galectin-1 knock-out mice on the C57BL6 background and characterized the effects on neurogenesis. In the SGZ of the galectin-1 knock-out mice, increased numbers of type 1 cells, DCX-positive immature progenitors, and NeuN-positive newborn neurons were observed. Using triple-labeling immunohistochemistry and morphological analyses, we found that the proliferation of the type-1 cells was increased in the SGZ of the galectin-1 knock-out mice, and we propose that this proliferation is the mechanism for the net increase in the adult neurogenesis in these knock-out mice DG. Conclusions Galectin-1 is expressed in the neural stem cells and down-regulates neurogenesis in the adult hippocampus.

Development of skeletal system for mesh-type ICRP reference adult phantoms

Science.gov (United States)

Yeom, Yeon Soo; Wang, Zhao Jun; Tat Nguyen, Thang; Kim, Han Sung; Choi, Chansoo; Han, Min Cheol; Kim, Chan Hyeong; Lee, Jai Ki; Chung, Beom Sun; Zankl, Maria; Petoussi-Henss, Nina; Bolch, Wesley E.; Lee, Choonsik

2016-10-01

The reference adult computational phantoms of the international commission on radiological protection (ICRP) described in Publication 110 are voxel-type computational phantoms based on whole-body computed tomography (CT) images of adult male and female patients. The voxel resolutions of these phantoms are in the order of a few millimeters and smaller tissues such as the eye lens, the skin, and the walls of some organs cannot be properly defined in the phantoms, resulting in limitations in dose coefficient calculations for weakly penetrating radiations. In order to address the limitations of the ICRP-110 phantoms, an ICRP Task Group has been recently formulated and the voxel phantoms are now being converted to a high-quality mesh format. As a part of the conversion project, in the present study, the skeleton models, one of the most important and complex organs of the body, were constructed. The constructed skeleton models were then tested by calculating red bone marrow (RBM) and endosteum dose coefficients (DCs) for broad parallel beams of photons and electrons and comparing the calculated values with those of the original ICRP-110 phantoms. The results show that for the photon exposures, there is a generally good agreement in the DCs between the mesh-type phantoms and the original voxel-type ICRP-110 phantoms; that is, the dose discrepancies were less than 7% in all cases except for the 0.03 MeV cases, for which the maximum difference was 14%. On the other hand, for the electron exposures (⩽4 MeV), the DCs of the mesh-type phantoms deviate from those of the ICRP-110 phantoms by up to ~1600 times at 0.03 MeV, which is indeed due to the improvement of the skeletal anatomy of the developed skeleton mesh models.

Hypertension among US adults by disability status and type, National Health and Nutrition Examination Survey, 2001-2010.

Science.gov (United States)

Stevens, Alissa; Courtney-Long, Elizabeth; Gillespie, Cathleen; Armour, Brian S

2014-08-14

The prevalence of hypertension among people with disabilities is not well understood. We combined data from the 2001-2010 National Health and Nutrition Examination Survey to obtain estimates of hypertension prevalence by disability status and type (cognitive, hearing, vision, or mobility limitation) and assess the association between disability and hypertension. Overall, 34% of adults with disabilities had hypertension compared with 27% of adults without disabilities; adults with mobility limitations were more likely to have hypertension than adults without disabilities (adjusted prevalence ratio: 1.23; 95% confidence interval: 1.16-1.32). Our results suggest that adults living with disabilities are an important subpopulation to include in hypertension reporting and intervention efforts.

Frailty and type of death among older adults in China: prospective cohort study

OpenAIRE

Dupre, Matthew E; Gu, Danan; Warner, David F; Yi, Zeng

2009-01-01

Objective To examine the association between frailty and type of death among the world?s largest oldest-old population in China. Design Prospective cohort study. Setting 2002 and 2005 waves of the Chinese longitudinal healthy longevity survey carried out in 22 provinces throughout China. Participants 13?717 older adults (aged ?65). Main outcome measures Type of death, categorised as being bedridden for fewer than 30 days with or without suffering and being bedridden for 30 or more days with o...

Benzonphenone-type UV filters in urine of Chinese young adults: Concentration, source and exposure

International Nuclear Information System (INIS)

Gao, Chong-jing; Liu, Li-yan; Ma, Wan-li; Zhu, Ning-zheng; Jiang, Ling; Li, Yi-Fan; Kannan, Kurunthachalam

2015-01-01

Benzophenone (BP)-type UV filters are commonly used in our daily life. 2-hydroxy-4-methoxy benzophenone (BP-3), 4-hydroxy benzophenone (4-HBP), 2,4-dihydroxy benzophenone (BP-1), 2,2′,4,4′-tetrahydroxy benzophenone (BP-2) and 2,2′-dihydroxy-4-methoxy benzophenone (BP-8) were measured in urine samples from Chinese young adults. The results indicated that Chinese young adults were widely exposed to BP-3, BP-1, and 4-HBP, with the median concentrations of 0.55, 0.21, and 0.08 ng/mL, respectively. No significant difference was found between males and females, between urban and rural population. The correlations between urinary concentrations provided important indications for sources and metabolic pathways of target compounds. The estimated daily excretion doses of BP-3, 4-HBP, BP-1, BP-2 and BP-8 were 27.2, 2.24, 5.86, 0.76 and 0.30 ng/kg-bw/day, respectively. The ratio of exposure to excretion must be considered for the exposure assessment with chemicals based on urine measurement. This is the first nationwide study on BP-derivatives with young adults in China. - Highlights: • Five BP-derivatives in urine were analyzed for Chinese young adults over China. • No difference was found between males and females, between urban and rural groups. • Concentration correlation provide indications for sources and metabolic pathways. • Ratio of exposure to excretion must be considered for the exposure assessment. - Benzophenone (BP)-type UV filters were frequently detected in urine samples from Chinese young adults, indicating their wide applications in China

Why do young adults with Type 1 diabetes find it difficult to manage diabetes in the workplace?

OpenAIRE

Balfe, Myles; Brugha, Ruairi; Smith, Diarmuid; Sreenan, Seamus; Doyle, Frank; Conroy, Ronán

2014-01-01

This article explores how and why workplace environments impact diabetes management for adults people with Type 1 diabetes, 23-30 years of age. Interviews were conducted with 35 young adults, 29 women and 6 men. The majority of these interviewees worked in sectors such as banking, technology and administration. Young adults found it difficult to manage diabetes in the workplace for two main reasons: work-related time pressures and the non-routine nature of interviewees' work and working envir...

[An adult form of type-I. Gaucher's disease].

Science.gov (United States)

Múzes, G; Pitlik, E; Gohér, A; Somogyi, A; Tulassay, Z

2000-03-26

A young woman with no previous history of any diseases was admitted for further evaluation of a mild thrombocytopenia she has had for some months. No signs of bleeding have so far occurred. Physical examination was normal except for a moderately enlarged spleen. Routine investigations showed lower platelet count. There was no laboratory evidence of disease conditions with autoimmune/inflammatory or hematologic origin. Bone marrow aspirate indicated Gaucher's-like cells raising the suspicion of Gaucher's disease. This was further supported by electron microscopic demonstration of Gaucher's bodies (with the characteristic tubular structures) in crista biopsy specimens. However, definitive diagnosis was obtained by verifying deficient lysosomal glucosylceramide-beta-D-glucosidase activity in peripheral blood leukocytes. Upon the absence of neurologic involvement the patient was typical for the adult form or type-1 Gaucher's disease.

Efficacy of a web-based intervention with mobile phone support in treating depressive symptoms in adults with type 1 and type 2 diabetes: a randomized controlled trial

NARCIS (Netherlands)

Nobis, S.; Lehr, D.; Ebert, D.D.; Baumeister, H.; Snoek, F.J.; Riper, H.; Berking, M.

2015-01-01

OBJECTIVE: Depression is common in diabetes and linked to adverse health outcomes. This study evaluated the efficacy of a guided web-based intervention in reducing depression in adults with type 1 and type 2 diabetes.

Hypertension Among US Adults by Disability Status and Type, National Health and Nutrition Examination Survey, 2001–2010

OpenAIRE

Stevens, Alissa; Courtney-Long, Elizabeth; Gillespie, Cathleen; Armour, Brian S.

2014-01-01

The prevalence of hypertension among people with disabilities is not well understood. We combined data from the 2001–2010 National Health and Nutrition Examination Survey to obtain estimates of hypertension prevalence by disability status and type (cognitive, hearing, vision, or mobility limitation) and assess the association between disability and hypertension. Overall, 34% of adults with disabilities had hypertension compared with 27% of adults without disabilities; adults with mobility lim...

Identifying non-pharmacological risk factors for falling in older adults with type 2 diabetes mellitus: a systematic review.

Science.gov (United States)

Gravesande, Janelle; Richardson, Julie

2017-07-01

To identify the non-pharmacological risk factors for falling in older adults with type 2 diabetes mellitus (DM2). A systematic review of randomized controlled trials, prospective cohort studies, cross-sectional studies and before/after studies was conducted. Eligible studies identified non-pharmacological risk factors for falling in older adults with DM2. Medline, Embase, Pubmed and CINAHL were searched for relevant studies published through December 2015. Reference lists were also searched for relevant studies. Search terms were DM2, risk factors, falls and falling, older adults, aging, non-insulin dependent diabetes mellitus, accidental falls and trip. Publication language was restricted to English. Thirteen studies met the inclusion criteria: four cross-sectional, six prospective cohorts, two randomized controlled trials and one before/after study. These studies included a total of 13,104 participants, ≥50 years. The most common risk factors for falling were impaired balance, reduced walking velocity, peripheral neuropathy and comorbid conditions. However, lower extremity pain, being overweight and comorbid conditions had the greatest impact on fall risk. Interventions to reduce falling in older adults with type 2 diabetes mellitus should focus on reducing lower extremity pain, reducing body weight and managing comorbid conditions. Implications for Rehabilitation    Diabetes mellitus:   • Older adults with type 2 diabetes mellitus (DM2) have a higher risk for falling than older adults without.   • Older adults with DM2 are more likely to suffer serious injuries when they fall.   • Comprehensive risk factor identification is necessary for rehabilitation professionals to accurately determine whether their clients are at risk for falling.   • Rehabilitation professionals also need to tailor interventions based on the client's risk factors in order to effectively reduce falls and fall-related injuries.

Association of the hypertriglyceridemic waist phenotype and type 2 diabetes mellitus among adults in China.

Science.gov (United States)

Ren, Yongcheng; Zhang, Ming; Zhao, Jingzhi; Wang, Chongjian; Luo, Xinping; Zhang, Jiatong; Zhu, Tian; Li, Xi; Yin, Lei; Pang, Chao; Feng, Tianping; Wang, Bingyuan; Zhang, Lu; Li, Linlin; Yang, Xiangyu; Zhang, Hongyan; Hu, Dongsheng

2016-09-01

To clarify the association of the hypertriglyceridemic waist phenotype and type 2 diabetes mellitus among adults in China. In the present case-control study, we included 1,685 patients with type 2 diabetes mellitus and 7,141 normal glucose-tolerant controls from the Henan Province of China in 2011. Elevated waist circumference (GW) was defined as ≥90 cm for men and ≥80 cm for women. Hypertriglyceridemia (HT) was defined as >1.7 m mol/L triglycerides (TG) level. The association of hypertriglyceridemic waist phenotype and type 2 diabetes mellitus was investigated by sex, body mass index, physical activity, and family history of diabetes. Cases and controls differed in age, waist circumference (WC), weight, TG level, fasting glucose, body mass index, smoking status, diabetic family history, physical activity and hypertriglyceridemic waist phenotype (P type 2 diabetes mellitus (odds ratio 4.14, 2.42 and 6.23, respectively). Only HTGW was consistently associated with risk of type 2 diabetes mellitus, with or without adjustment. The strongest relationship between HTGW and type 2 diabetes mellitus was for subjects with body mass index 24.0 kg/m(2) (odds ratio 6.54, 95% confidence interval 4.22-10.14) after adjustment for cofounding variables. HTGW was stably and significantly associated with risk of type 2 diabetes mellitus in adult Chinese. © 2016 The Authors. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd.

Types of adult attention-deficit hyperactivity disorder (ADHD): baseline characteristics, initial response, and long-term response to treatment with methylphenidate.

Science.gov (United States)

Reimherr, Fred W; Marchant, Barrie K; Gift, Thomas E; Steans, Tammy A; Wender, Paul H

2015-06-01

Much recent research describes the importance of emotional symptoms in ADHD. While there is no accepted system for including emotionality in diagnosing ADHD, the Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS) provides a tool to facilitate this. It assesses a range of adult ADHD symptoms which load on two factors: inattentive and emotional dysregulation. The consistently high inattentive factor was used to define significant elevation on the more variable emotional dysregulation factor (which contains four WRAADDS domains: hyperactivity/restlessness, temper, affective lability, and emotional over-reactivity) allowing the definition of two ADHD diagnostic types. We compared these two types on a broad range of adult subject characteristics, including response to methylphenidate (MPH) treatment assessed during two clinical trials. Marked impairment in three of the four emotional domains reflected a symptom severity level equivalent to that of the inattentive factor. 59 % met this threshold, defining them as ADHD emotion dysregulation presentation, as opposed to 41 % with ADHD inattentive presentation. Cluster analysis validated these groups by generating similar clusters with 85 % agreement regarding membership. ADHD emotional dysregulation presentation subjects showed more childhood ADHD symptoms, adult symptoms of oppositional defiant disorder, and evidence of personality disorder. Both types showed similar improvement during the double-blind MPH arm of the trials and during a 6-month open-label phase. Based on the presence of symptoms of emotional dysregulation, ADHD in adults can be conceptualized as two types. Impairment and comorbidity in adults with ADHD are largely concentrated in ADHD emotional dysregulation presentation patients.

Are there any disturbances in vestibular organ of children and young adults with Type I diabetes?

Science.gov (United States)

Gawron, W; Pospiech, L; Orendorz-Fraczkowska, K; Noczynska, A

2002-05-01

The aim of the work was to evaluate the vestibular organ condition in children and young adults suffering from Type I (insulin-dependent) diabetes mellitus. The group examined consisted of 95 children and young adults aged from 6 to 28 years with Type I diabetes diagnosed. The diabetic group was divided into subgroups according to duration of the disease, compensation of the disease, and presence and character of hypoglycaemic incidents, and presence of diabetic complications. The control group consisted of 44 healthy children and young adults aged 6 to 28 years. After collecting detailed medical history in each case an electronystagmographic test was performed using the computed two-canal electronystagmographer. Within the diabetic group 6 patients complained about vertigo and balance disorders. Spontaneous nystagmus occurred in 10 cases, positional one in 21 cases. Impaired optokinesis occurred in 36 cases and impaired eye tracking test in 33 cases. In caloric tests there was partial canal paresis in 4 cases and directional preponderance in 7 cases. Metabolic disturbances present in Type I diabetes cause disturbances in different parts of vestibular organ but mostly in its central part. Comparing disturbances in the vestibular organ with clinical and biochemical parameters characterising diabetes, the range of vestibular organ impairment in diabetes mellitus type 1 seems to depend mainly on the presence and character of hypoglycaemic incidents and the duration of the disease and to some extent on the compensation of diabetes.

Socioeconomic status and type 2 diabetes complications among young adult patients in Japan.

Directory of Open Access Journals (Sweden)

Mitsuhiko Funakoshi

Full Text Available To assess the relationship between socioeconomic status (SES and complications of type 2 diabetes among young adults in Japan.A cross-sectional study.Outpatient wards of 96 member hospitals and clinics of the Japan Federation of Democratic Medical Institutions.A total of 782 outpatients with type 2 diabetes (525 males, 257 females, aged 20-40 years as of March 31, 2012. After excluding 110 participants whose retinopathy diagnosis was in question, 672 participants were analyzed.We examined the relations between SES (educational level, income, type of public healthcare insurance, and employment status and diabetes complications (retinopathy and nephropathy using a multivariate logistic regression analysis.The prevalence of type 2 diabetic retinopathy was 23.2%, while that of nephropathy was 8.9%. The odds of having retinopathy were higher among junior high school graduates (OR 1.91, 95% CI 1.09-3.34, patients receiving public assistance (OR 2.19, 95% CI 1.20-3.95, and patients with irregular (OR 1.72, 95% CI 1.03-2.86 or no employment (OR 2.23, 95% CI 1.36-3.68, compared to those with a higher SES, even after covariate adjustment (e.g., age, gender, body mass index. Similarly, the odds of having nephropathy were higher among patients with middle (OR 3.61, 95% CI 1.69-8.27 or low income levels (OR 2.53, 95% CI 1.11-6.07, even after covariate adjustment.Low SES was associated with a greater likelihood of type 2 diabetes complications in young adults. These findings suggest the necessity of health policies that mitigate socioeconomic disparity and thereby reduce the prevalence of diabetic complications.

No evidence of seasonality of birth in adult type 2 diabetes in Denmark

DEFF Research Database (Denmark)

Jensen, Camilla Bjørn; Zimmermann, Esther; Gamborg, M

2015-01-01

on the risk of type 2 diabetes was assessed using Cox regression, with month or season of birth as the predictor. The underlying time variable was age, and follow-up started in 1977 or at age 30 years. RESULTS: The study population consisted of 223,099 people, of whom 12,486 developed adult type 2 diabetes......AIMS/HYPOTHESIS: The season of birth might influence prenatal circumstances, which may influence the risk of developing type 2 diabetes. The aim of this study was to determine whether the diagnosis of type 2 diabetes in Denmark changed with the season of birth. METHODS: This study used data from....... Using January as the reference month, the risk of type 2 diabetes by month of birth was not statistically different for any of the 11 comparative birth months. Grouping month of birth into seasons (spring was the reference) gave essentially similar results, showing no difference in the risk of type 2...

Physical activity among type-2 diabetic adult Nigerians.

Science.gov (United States)

Oyewole, Olufemi O; Odusan, Olatunde; Oritogun, Kolawole S; Idowu, Akolade O

2014-01-01

Regular participation in physical activity (PA) programs is a key concept included in current public health guidelines. Therefore, this study was aimed to determine PA level among adult with type 2 diabetes. A cross-section of 122 participants selected consecutively were categorized as physically inactive or active using International Physical Activity Questionnaire. Data was assessed using descriptive and inferential statistics. About 31% of the respondents were physically inactive. Residential areas were significantly associated with PA. A high proportion of those who lived in the metropolitan area were physically inactive. Less likely to be physically inactive were married (odds ratios [OR] =0.29, confidence interval [CI] =0.09-0.93) and living in an urban area (OR = 0.19, CI = 0.40-0.87). The degree holders are least physically inactive while the primary school leavers are highest. The median energy expenditure for walking, moderate and vigorous PA was 280.5, 80 and 0 MET-min/week respectively. The sedentary behavior of the respondents was 288 min/day, behavior which increases with age. This study suggests that the prevalence of physical inactivity was high among type 2 diabetics and their sedentary behavior is over 4 h/day. This group of people should be encouraged to participate regularly in PA.

The Effects of Tai Chi on Peripheral Somatosensation, Balance, and Fitness in Hispanic Older Adults with Type 2 Diabetes: A Pilot and Feasibility Study

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Elisabeth I. Cavegn

2015-01-01

Full Text Available Peripheral neuropathy and loss of somatosensation in older adults with type 2 diabetes can increase risk of falls and disability. In nondiabetic older adult population Tai Chi has been shown to enhance balance and fitness through improvements in somatosensation and neuromuscular control, and it is unclear if Tai Chi would elicit similar benefits in older adults with diabetes. Therefore, the purpose of this study was to investigate the effects of an 8-week, three-hour-per-week Tai Chi intervention on peripheral somatosensation in older adults with type 2 diabetes. Participants were eight Hispanic older adults with type 2 diabetes who participated in the Tai Chi intervention and a convenience sample of Hispanic older adults as a referent group. Baseline and postintervention assessments included ankle proprioception, foot tactile sense, plantar pressure distribution, balance, and fitness. After intervention, older adults with type 2 diabetes showed significant improvements in ankle proprioception and fitness and decreased plantar pressure in the forefoot, with no statistical effect noted in balance or tactile sensation. Study results suggest that Tai Chi may be beneficial for older adults with diabetes as it improves ankle proprioception; however, study findings need to be confirmed in a larger sample size randomized controlled trial.

Association between dietary patterns and blood lipid profiles in Korean adults with type 2 diabetes.

Science.gov (United States)

Lim, Jeong Hyun; Lee, Yeon-Sook; Chang, Hak Chul; Moon, Min Kyong; Song, YoonJu

2011-09-01

We aimed to explore the associations of dietary patterns with blood lipid profiles and obesity in adults with type 2 diabetes. The data were obtained from the Forth Korean National Health and Nutrition Examination Survey, 2007-2008. Adults 30 yr or older, from which had both biochemical and dietary data were obtained. Among them, 680 subjects were defined as having diabetes based on criteria of fasting glucose ≥ 126 mg/dL, anti-diabetic treatment, or previously diagnosed diabetes. Dietary data from a 24-hr recall were used to derive dietary patterns by factor analysis. Four dietary patterns by factor analysis were identified: 'Bread & Meat & Alcohol', 'Noodles & Seafood', 'Rice & Vegetables', and 'Korean Healthy' patterns. Serum cholesterol levels in the highest quartile of the 'Bread & Meat & Alcohol' pattern were significantly higher compared with those in the lowest quartile. In addition, total cholesterol and triglyceride levels in the highest quartile of the 'Korean Healthy' pattern were significantly lower after adjusting for potential confounders. Dietary patterns of adults with diabetes were found to be associated with blood lipid profiles. 'Korean Healthy' pattern including whole grains, legumes, vegetables, and fruits could thus improve lipid profiles among those with type 2 diabetes.

A novel type of self-beating cardiomyocytes in adult mouse ventricles

International Nuclear Information System (INIS)

Omatsu-Kanbe, Mariko; Matsuura, Hiroshi

2009-01-01

This study was designed to investigate the presence of resident heart cells that are distinct from terminally-differentiated cardiomyocytes. Adult mouse heart was coronary perfused with collagenase, and ventricles were excised and further digested. After spinning cardiomyocyte-containing fractions down, the supernatant fraction was collected and cultured without adding any chemicals. Two to five days after plating, some of rounded cells adhered to the culture dish, gradually changed their shape and then started self-beating. These self-beating cells did not appreciably proliferate but underwent a further morphological maturation process to form highly branched shapes with many projections. These cells were mostly multinucleated, well sarcomeric-organized and expressed cardiac marker proteins, defined as atypically-shaped cardiomyocytes (ACMs). Patch-clamp experiments revealed that ACMs exhibited spontaneous action potentials arising from the preceding slow diastolic depolarization. We thus found a novel type of resident heart cells in adult cardiac ventricles that spontaneously develop into self-beating cardiomyocytes.

Cost-Effectiveness of Increasing Influenza Vaccination Coverage in Adults with Type 2 Diabetes in Turkey.

Science.gov (United States)

Akın, Levent; Macabéo, Bérengère; Caliskan, Zafer; Altinel, Serdar; Satman, Ilhan

2016-01-01

In Turkey, the prevalence of diabetes is high but the influenza vaccination coverage rate (VCR) is low (9.1% in 2014), despite vaccination being recommended and reimbursed. This study evaluated the cost-effectiveness of increasing the influenza VCR of adults with type 2 diabetes in Turkey to 20%. A decision-analytic model was adapted to Turkey using data derived from published sources. Direct medical costs and indirect costs due to productivity loss were included in the societal perspective. The time horizon was set at 1 year to reflect the seasonality of influenza. Increasing the VCR for adults with type 2 diabetes to 20% is predicted to avert an additional 19,777 influenza cases, 2376 hospitalizations, and 236 deaths. Associated influenza costs avoided were estimated at more than 8.3 million Turkish Lira (TRY), while the cost of vaccination would be more than TRY 8.4 million. The incremental cost-effectiveness ratio was estimated at TRY 64/quality-adjusted life years, which is below the per capita gross domestic product of TRY 21,511 and therefore very cost-effective according to World Health Organization guidelines. Factors most influencing the incremental cost-effectiveness ratio were the excess hospitalization rate, inpatient cost, vaccine effectiveness against hospitalization, and influenza attack rate. Increasing the VCR to >20% was also estimated to be very cost-effective. Increasing the VCR for adults with type 2 diabetes in Turkey to ≥20% would be very cost-effective.

Hypertension Among US Adults by Disability Status and Type, National Health and Nutrition Examination Survey, 2001–2010

Science.gov (United States)

Courtney-Long, Elizabeth; Gillespie, Cathleen; Armour, Brian S.

2014-01-01

The prevalence of hypertension among people with disabilities is not well understood. We combined data from the 2001–2010 National Health and Nutrition Examination Survey to obtain estimates of hypertension prevalence by disability status and type (cognitive, hearing, vision, or mobility limitation) and assess the association between disability and hypertension. Overall, 34% of adults with disabilities had hypertension compared with 27% of adults without disabilities; adults with mobility limitations were more likely to have hypertension than adults without disabilities (adjusted prevalence ratio: 1.23; 95% confidence interval: 1.16–1.32). Our results suggest that adults living with disabilities are an important subpopulation to include in hypertension reporting and intervention efforts. PMID:25121351

Manual therapy in adults with tension-type headache: A systematic review.

Science.gov (United States)

Cumplido-Trasmonte, C; Fernández-González, P; Alguacil-Diego, I M; Molina-Rueda, F

2018-03-07

Tension-type headache is the most common primary headache, with a high prevalence and a considerable socioeconomic impact. Manual physical therapy techniques are widely used in the clinical field to treat the symptoms associated with tension-type headache. This systematic review aims to determine the effectiveness of manual and non-invasive therapies in the treatment of patients with tension-type headache. We conducted a systematic review of randomised controlled trials in the following databases: Brain, PubMed, Web of Science, PEDro, Scopus, CINAHL, and Science Direct. Ten randomised controlled trials were included for analysis. According to these studies, manual therapy improves symptoms, increasing patients' well-being and improving the outcome measures analysed. Manual therapy has positive effects on pain intensity, pain frequency, disability, overall impact, quality of life, and craniocervical range of motion in adults with tension-type headache. None of the techniques was found to be superior to the others; combining different techniques seems to be the most effective approach. Copyright © 2018 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

β-cell specific T-lymphocyte response has a distinct inflammatory phenotype in children with Type 1 diabetes compared with adults.

Science.gov (United States)

Arif, S; Gibson, V B; Nguyen, V; Bingley, P J; Todd, J A; Guy, C; Dunger, D B; Dayan, C M; Powrie, J; Lorenc, A; Peakman, M

2017-03-01

To examine the hypothesis that the quality, magnitude and breadth of helper T-lymphocyte responses to β cells differ in Type 1 diabetes according to diagnosis in childhood or adulthood. We studied helper T-lymphocyte reactivity against β-cell autoantigens by measuring production of the pro-inflammatory cytokine interferon-γ and the anti-inflammatory cytokine interleukin-10, using enzyme-linked immunospot assays in 61 people with Type 1 diabetes (within 3 months of diagnosis, positive for HLA DRB1*0301 and/or *0401), of whom 33 were children/adolescents, and a further 91 were unaffected siblings. Interferon-γ responses were significantly more frequent in children with Type 1 diabetes compared with adults (85 vs 61%; P = 0.04). Insulin and proinsulin peptides were preferentially targeted in children (P = 0.0001 and P = 0.04, respectively) and the breadth of the interferon-γ response was also greater, with 70% of children having an interferon-γ response to three or more peptides compared with 14% of adults (P children and adults in terms of frequency, breadth and magnitude, with the exception of responses to glutamic acid decarboxylase 65, which were significantly less frequent in adults. At diagnosis of Type 1 diabetes, pro-inflammatory autoreactivity is significantly more prevalent, focuses on a wider range of targets, and is more focused on insulin/proinsulin in children than adults. We interpret this as indicating a more aggressive immunological response in the younger age group that is especially characterized by loss of tolerance to proinsulin. These findings highlight the existence of age-related heterogeneity in Type 1 diabetes pathogenesis that could have relevance to the development of immune-based therapies. © 2016 Diabetes UK.

Behavioral Analysis of Chinese Adult Patients with Type 1 Diabetes on Self-monitoring of Blood Glucose

Directory of Open Access Journals (Sweden)

Zhao-Yi Qin

2017-01-01

Conclusions: Adult patients with type 1 diabetes in our clinic had substantial SMBG information deficits, motivation obstacles, and skill limitations. This information provided potential-focused education targets for diabetes health-care providers.

The natural history of Charcot-Marie-Tooth type 1A in adults: a 5-year follow-up study

NARCIS (Netherlands)

Verhamme, Camiel; van Schaik, Ivo N.; Koelman, Johannes H. T. M.; de Haan, Rob J.; de Visser, Marianne

2009-01-01

Charcot-Marie-Tooth type 1A is the most prevalent hereditary demyelinating polyneuropathy. The aim of this study was to investigate the natural history of the disease in adults during a 5-year follow-up and to compare the changes over time with those found in normal ageing. In a cohort of 46 adult

Energy intake and expenditure in obese older adults with and without type 2 diabetes

NARCIS (Netherlands)

Memelink, R.G.; Verreijen, A.M.; de Vogel-van den Bosch, J.; Weijs, P.J.; Deutz, N.E.P.; Mays, J.A.; Roeske, S.C.

2017-01-01

Rationale: Obesity is a risk factor for type 2 diabetes (DM2), however not all obese people develop DM2. We explored differences in energy intake and expenditure between obese older adults with and without DM2. Methods: Baseline data from 2 lifestyle interventions with a total of 202 obese older

Liver and Skin Histopathology in Adults with Acid Sphingomyelinase Deficiency (Niemann-Pick Disease Type B)

OpenAIRE

Thurberg, Beth L.; Wasserstein, Melissa P.; Schiano, Thomas; O’Brien, Fanny; Richards, Susan; Cox, Gerald F.; McGovern, Margaret M.

2012-01-01

Acid sphingomyelinase deficiency (ASMD) is a lysosomal storage disorder characterized by the pathologic accumulation of sphingomyelin in multiple cells types, and occurs most prominently within the liver, spleen and lungs, leading to significant clinical disease. Seventeen ASMD patients underwent a liver biopsy during baseline screening for a Phase 1 trial of recombinant human acid sphingomyelinase (rhASM) in adults with Niemann-Pick disease type B. Eleven of the 17 were enrolled in the trial...

Frailty transitions and types of death in Chinese older adults: a population-based cohort study

Science.gov (United States)

Jiang, Xiao-yan; Wang, Xiao-feng; Shi, Yan; Hai, Hua

2018-01-01

Background Little is known about the adverse effects of frailty transitions. In this study, we aimed to characterize the transitions between frailty states and examine their associations with the type of death among older adults in China, a developing country with a rapidly growing aging population. Methods We used data of 11,165 older adults (aged 65–99 years) from the 2002 and 2005 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Overall, 44 health deficits were used to construct frailty index (FI; range: 0–1), which was then categorized into a three-level variable: nonfrail (FI ≤0.10), prefrail (0.100.21). Outcome was four types of death based on bedridden days and suffering state (assessed in the 2008 wave of CLHLS). Results During the 3-year period, 3,394 (30.4%) participants had transitioned between different frailty states (nonfrail, prefrail, and frail), one-third transitioned to death, and one-third remained in previous frailty states. Transitions to greater frailty (ie, “worsening”) were more common than transitions to lesser frailty (ie, “improvement”). Among four categories of frailty transitions, “worsening” and “remaining frail” had increased risks of painful death, eg, with odds ratios of 1.92 (95% confidence interval [CI] =1.41, 2.62) and 4.75 (95% CI =3.32, 6.80), respectively, for type 4 death (ie, ≥30 bedridden days with suffering before death). Conclusion This large sample of older adults in China supports that frailty is a dynamic process, characterized by frequent types of transitions. Furthermore, those who remained frail had the highest likelihood of experiencing painful death, which raises concerns about the quality of life in frail populations. PMID:29805253

Predictors of cognitive decline in older adult type 2 diabetes from the Veterans Affairs Diabetes Trial

Directory of Open Access Journals (Sweden)

Mark Zimering

2016-09-01

Full Text Available Aims: Cognitive decline disproportionately affects older adult type 2 diabetes. We tested whether randomized intensive glucose-lowering reduces the rate(s of cognitive decline in adults with advanced type 2 diabetes (mean: age, 60 years; diabetes duration, 11 years from the Veterans Affairs Diabetes Trial. Methods: A battery of neuropsychological tests (digit span, digit symbol substitution (DSym, and Trails-making Part B (TMT-B was administered at baseline in ~1700 participants and repeated at year 5. Thirty-six risk factors were evaluated as predictors of cognitive decline in multivariable regression analyses.Results: The mean age-adjusted, DSym or TMT-B declined significantly in all study participants (P < 0.001. Randomized intensive glucose-lowering did not significantly alter the rate of cognitive decline. The final model of risk factors associated with 5-year decline in age-adjusted TMT-B included as significant predictors: longer baseline diabetes duration (beta = -0.028; P = 0.0057, lower baseline diastolic blood pressure (beta = 0.028; P < 0.001, and baseline calcium channel blocker medication use (beta = -0.639; P < 0.001. Higher baseline pulse pressure was significantly associated with decline in age-adjusted TMT-B suggesting a role for both higher systolic and lower diastolic blood pressure. Baseline thiazide diuretic use (beta= -0.549; P =0.015 was an additional significant predictor of 5-year decline in age-adjusted digit symbol score. Post-baseline systolic blood pressure-lowering was significantly associated (P < 0.001 with decline in TMT-B performance. There was a significant inverse association between post-baseline plasma triglyceride- lowering (P = 0.045 and decline in digit symbol substitution task performance.Conclusions: A five-year period of randomized intensive glucose-lowering did not significantly reduce the rate of cognitive decline in older-aged adults with type 2 diabetes. Systolic and diastolic blood pressure as

Associations between N-terminal pro-B-type natriuretic peptide and cardiac function in adults with corrected tetralogy of Fallot

NARCIS (Netherlands)

J.A. Eindhoven (Jannet); M.E. Menting (Myrthe); A.E. van den Bosch (Annemien); J.A.A.E. Cuypers (Judith); T.P.E. Ruys (Titia); M. Witsenburg (Maarten); J.S. Vletter-McGhie (Jackie); H. Boersma (Eric); J.W. Roos-Hesselink (Jolien)

2014-01-01

textabstractBackground Amino-terminal B-type natriuretic peptide (NT-proBNP) may detect early cardiac dysfunction in adults with tetralogy of Fallot (ToF) late after corrective surgery. We aimed to determine the value of NT-proBNP in adults with ToF and establish its relationship with

Screening of a healthy newborn identifies three adult family members with symptomatic glutaric aciduria type I

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MCH Janssen

2014-06-01

Full Text Available We report three adult sibs (one female, two males with symptomatic glutaric acidura type I, who were diagnosed after a low carnitine level was found by newborn screening in a healthy newborn of the women. All three adults had low plasma carnitine, elevated glutaric acid levels and pronounced 3-hydroxyglutaric aciduria. The diagnosis was confirmed by undetectable glutaryl-CoA dehydrogenase activity in lymphocytes and two pathogenic heterozygous mutations in the GCDH gene (c.1060A>G, c.1154C>T. These results reinforce the notion that abnormal metabolite levels in newborns may lead to the diagnosis of adult metabolic disease in the mother and potentially other family members.

Persistent poor glycaemic control in adult Type 1 diabetes. A closer look at the problem

NARCIS (Netherlands)

DeVries, J. H.; Snoek, F. J.; Heine, R. J.

2004-01-01

Around 25% of the adult Type 1 diabetes population is in persistent poor glycaemic control and thus at increased risk of developing microvascular complications. We here discuss correlates of long-standing poor glycaemic control and review the efficacy of clinical strategies designed to overcome

Serum fetuin-A associates with type 2 diabetes and insulin resistance in Chinese adults.

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Aiyun Song

2011-04-01

Full Text Available Previous studies have demonstrated that fetuin-A is related to insulin resistance among subjects with normal glucose tolerance but not patients with type 2 diabetes. There are limited data available concerning fetuin-A and insulin resistance in Chinese. We aimed to study the association of fetuin-A with insulin resistance among participants with or without type 2 diabetes in a large sample size of adults aged 40 and older.A community-based cross-sectional study was performed among 5,227 Chinese adults. The average age of our study was 61.5±9.9 years. Serum fetuin-A concentrations were not significantly different between male and female (296.9 vs. 292.9 mg/l, p = 0.11. Compared with the lowest quartile, the highest quartile of serum fetuin-A revealed a significant higher proportion of type 2 diabetic patients (34.8% vs. 27.3%, p<0.0001. In the multinomial logit models, the risk of type 2 diabetes was associated with each one quartile increase of serum fetuin-A concentrations when referenced not only to normal glucose tolerance (OR 1.24, 95% CI 1.07-1.43, p = 0.004 but also to impaired glucose regulation (OR 1.25, 95% CI 1.08-1.44, p = 0.003, respectively, after adjustment for age, sex, community, current smoking, and current drinking. The logistic regression analysis showed that fetuin-A were associated with elevated HOMA-IR and fasting serum insulin both among the participants with or without type 2 diabetes in the full adjusted analysis. There was no significant association between elevated serum fetuin-A concentrations and impaired glucose regulation (all p≥0.12.Higher fetuin-A concentrations were associated with type 2 diabetes and insulin resistance in middle aged and elderly Chinese.

UTILITY OF PSYCHOLOGICAL SCREENING OF YOUNG ADULTS WITH TYPE 1 DIABETES TRANSITIONING TO ADULT PROVIDERS.

Science.gov (United States)

Quinn, Sheila M; Ambrosino, Jodie M; Doyle, Elizabeth A; Weyman, K; Tamborlane, William V; Jastreboff, Ania M

2016-09-01

Screening for depression, diabetes distress, and disordered eating in youth with type 1 diabetes (T1D) is recommended, as these comorbidities contribute to poor glycemic control. No consensus exists on which measures are optimal, and most previous studies have used nondisease-specific measures. We examined the utility of screening for these disorders using two disease-specific and one general measure at the time of transition from pediatric to adult care. Forty-three young adults from a T1D transition clinic completed the Patient Health Questionnaire, the Diabetes Distress Scale, and the Diabetes Eating Problem Survey-Revised. Chart review determined if clinicians noted similar symptoms during the year prior to transition. Metabolic data were also recorded. Chart review identified 5 patients with depressive symptoms and 8 patients with diabetes distress. Screening identified 2 additional patients with depressive symptoms and 1 additional patient with diabetes distress. Of those noted to have symptomatic depression or diabetes distress on chart review, several subsequently screened negative on transition. Disordered eating was not detected by chart review, but 23.5% screened positive on transition. While depression, diabetes distress, and disordered eating positively correlated with glycated hemoglobin (HbA1c) (r = 0.31, P = .05; r = 0.40, P = .009; r = 0.63, PDistress Scale DEPS-R = Diabetes Eating Problem Survey-Revised.

Transfusion reactions in pediatric compared with adult patients: a look at rate, reaction type, and associated products.

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Oakley, Fredrick D; Woods, Marcella; Arnold, Shanna; Young, Pampee P

2015-03-01

The majority of reports on transfusion reactions address adult patients. Less is known about the types, incidence, and other clinical details of transfusion reactions in pediatric populations. Furthermore, to our knowledge, there have been no previous reports directly comparing these aspects between adults and pediatric patient populations to assess if there are differences. Between the period of January 1, 2011, and February 1, 2013, all reported adult and pediatric transfusion reactions at Vanderbilt University Medical Center (VUMC) were evaluated by transfusion medicine clinical service. The information was subsequently shared with the hemovigilance database. Data provided to hemovigilance included age, sex, blood product associated with the reaction, severity of the reaction, and the type of transfusion reactions. These were collated with hospital and blood bank information system-acquired data on overall admission and product transfusion. A total of 133,671 transfusions were performed at VUMC during the study period including 20,179 platelet (PLT) transfusions, 31,605 plasma transfusions, 79,933 red blood cell (RBC) transfusions, and 2154 cryoprecipitate transfusions. Over the same period, 108 pediatric and 277 adult transfusion reactions were recorded. This corresponds to an incidence of 6.2 reactions per 1000 transfusions within the pediatric (age reactions per 1000 transfusions within the adult population. In both adult and pediatric populations, transfusion reactions were most commonly associated with PLT, followed by RBC, and then plasma transfusions. Within the pediatric population, subset analysis identified multiple differences when compared to the adult population, including an increased incidence of allergic transfusion reactions (2.7/1000 vs. 1.1/1000, p reactions (1.9/1000 vs. 0.47/1000, p reactions (0.29/1000 vs. 0.078/1000, p reaction incidence was the same between sexes in adults, in pediatric patients, reactions were more common in male

Participation in Types of Physical Activities Among US Adults--National Health and Nutrition Examination Survey 1999-2006.

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Dai, Shifan; Carroll, Dianna D; Watson, Kathleen B; Paul, Prabasaj; Carlson, Susan A; Fulton, Janet E

2015-06-01

Information on specific types of physical activities in which US adults participate is important for community and program development to promote physical activity. Prevalence of participation and average time spent for 33 leisure-time aerobic activities and 10 activity categories were calculated using self-reported data from 22,545 participants aged ≥ 18 years in the National Health and Nutrition Examination Survey 1999-2006. Overall, 38% of US adults reported no leisure-time physical activities, and 43% reported 1 or 2 activities in the past 30 days. Walking was the most frequently reported activity for both men (29%) and women (38%). Among walkers, the average time spent walking was 198 minutes/week for men and 152 minutes/week for women. The most reported activities for men after walking were bicycling and yard work, and for women were aerobics and dance. For most activity categories, participation was lower among adults aged ≥ 65 years than among younger adults, and among Mexican Americans and non-Hispanic blacks than among non-Hispanic whites. Participation in most categories increased with increasing educational attainment. Participation in physical activity differs by types of activities and demographic characteristics. Physical activity promotion programs should take these differences into account when developing intervention strategies.

Antibody titers for canine parvovirus type-2, canine distemper virus, and canine adenovirus type-1 in adult household dogs.

Science.gov (United States)

Taguchi, Masayuki; Namikawa, Kazuhiko; Maruo, Takuya; Orito, Kensuke; Lynch, Jonathan; Sahara, Hiroeki

2011-09-01

Serum antibody titers for canine parvovirus type-2 (CPV-2), canine distemper virus (CDV) and canine adenovirus type-1 (CAV-1) were investigated in 1031 healthy adult household dogs (2 to 18 years old) given an annual inoculation in the previous 11 to 13 months. The number of dogs retaining significant titers of antibodies against CPV-2, CDV, and CAV-1 were 888 (86%), 744 (72%), and 732 (71%), respectively. There were no differences between males and females in antibody titers against the 3 viruses. Antibody titer for CPV-2 was significantly higher in younger dogs than in older dogs, CDV antibody was significantly higher in older dogs than in younger dogs, and CAV titer was not associated with age.

Type of childhood maltreatment and the risk of criminal recidivism in adult probationers: a cross-sectional study.

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Kim, Eun Young; Park, Jiung; Kim, Bongseog

2016-08-19

Childhood maltreatment is strongly associated with delinquency and the repeated crime. Specific types of childhood maltreatment have been found to have differential effects on recidivism in juvenile offenders, but studies of adult probationers have not been performed. This study investigated the relationship between having a history of childhood maltreatment and mental-health problems and the independent contribution of specific types of maltreatment and mental-health problems to the criminal recidivism of adult probationers. This study included 183 adult probationers (107 males and 76 females) with a mean age of 40.1 (SD = 11.8) years. Type of childhood maltreatment was assessed using the Childhood Trauma Questionnaire, which consists of five subscales (emotional neglect and abuse, physical neglect and abuse, and sexual abuse). Additionally, we used the Mini International Neuropsychiatric Interview to assess participants for the presence of psychiatric disorders and assessed levels of emotional dysregulation and resilience. Hierarchical logistic regression analysis was performed to determine whether the types of childhood maltreatment were independently associated with repeated crime, after adjusting for demographic factors and mental-health problems. The overall prevalence of mental illness in the childhood maltreatment group was significantly higher than in the no childhood maltreatment group (56.1 % vs. 38.2 %, p = 0.017). The maltreated group had a higher rate of major depressive disorder, a higher level of emotional dysregulation, and a lower level of resilience than the group that was not maltreated. Recidivism was uniquely associated with physical neglect (Adjusted Odds Ratio [AOR], 2.862; 95 % Confidence Interval [95 % CI], 1.213-6.752) and the presence of at least one psychiatric disorder (AOR, 3.791; 95 % CI, 1.703-8.443). Childhood maltreatment deserves further attention in adult probationers because it is potentially associated with higher

Neighbourhood Walkability and Daily Steps in Adults with Type 2 Diabetes.

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Hajna, Samantha; Ross, Nancy A; Joseph, Lawrence; Harper, Sam; Dasgupta, Kaberi

2016-01-01

There is evidence that greater neighbourhood walkability (i.e., neighbourhoods with more amenities and well-connected streets) is associated with higher levels of total walking in Europe and in Asia, but it remains unclear if this association holds in the Canadian context and in chronic disease populations. We examined the relationships of different walkability measures to biosensor-assessed total walking (i.e., steps/day) in adults with type 2 diabetes living in Montreal (QC, Canada). Participants (60.5±10.4 years; 48.1% women) were recruited through McGill University-affiliated clinics (June 2006 to May 2008). Steps/day were assessed once per season for one year with pedometers. Neighbourhood walkability was evaluated through participant reports, in-field audits, Geographic Information Systems (GIS)-derived measures, and the Walk Score®. Relationships between walkability and daily steps were estimated using Bayesian longitudinal hierarchical linear regression models (n = 131). Participants who reported living in the most compared to the least walkable neighbourhoods completed 1345 more steps/day (95% Credible Interval: 718, 1976; Quartiles 4 versus 1). Those living in the most compared to the least walkable neighbourhoods (based on GIS-derived walkability) completed 606 more steps per day (95% CrI: 8, 1203). No statistically significant associations with steps were observed for audit-assessed walkability or the Walk Score®. Adults with type 2 diabetes who perceived their neighbourhoods as more walkable accumulated more daily steps. This suggests that knowledge of local neighborhood features that enhance walking is a meaningful predictor of higher levels of walking and an important component of neighbourhood walkability.

Attitudes towards mental health, mental health research and digital interventions by young adults with type 1 diabetes: A qualitative analysis.

Science.gov (United States)

Clarke, Janine; Proudfoot, Judy; Vatiliotis, Veronica; Verge, Charles; Holmes-Walker, Deborah J; Campbell, Lesley; Wilhelm, Kay; Moravac, Catherine; Indu, Pillaveetil S; Bridgett, Madeleine

2018-06-01

Young people with type 1 diabetes are at increased risk of mental disorders. Whereas treatment need is high, difficulty recruiting young people with type 1 diabetes into psychosocial studies complicates development, testing and dissemination of these interventions. Interviews with young adults with type 1 diabetes were conducted to examine attitudes towards mental health and mental health research, including barriers and motivators to participation in mental health studies and preferred sources of mental health support. The interviews were audio-taped, transcribed and evaluated via thematic analysis. Young adults with type 1 diabetes were recruited via social media channels of 3 advocacy organizations. A total of 31 young adults (26 females and 5 males) with an average age of 22 years were interviewed between October 2015 and January 2016. Participants were largely unaware of their increased vulnerability to common mental health problems and knew little about mental health research. Major barriers to participation included perceived stigma and lifestyle issues and low levels of trust in researchers. Opportunities to connect with peers and help others were described as key motivators. Psychological distress was considered normal within the context of diabetes. A need for some level of human contact in receiving psychosocial support was expressed. Findings provide valuable insights into the complex dynamics of engaging young adults with type 1 diabetes in mental health studies. Interviewees provided practical suggestions to assist investigation and delivery of psychosocial interventions for this vulnerable group. © 2018 The Authors. Health Expectations published by John Wiley & Sons Ltd.

Relationship between systemic inflammation and delayed-type hypersensitivity response to Candida antigen in older adults.

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Brandt D Pence

Full Text Available Research has shown that aging is associated with increased systemic inflammation as well as a reduction in the strength of immune responses. However, little evidence exists linking the decrease in cell-mediated immunity in older adults with other health parameters. We sought to examine the relationship between cell-mediated immunity as measured in vivo by the delayed-type hypersensitivity (DTH response to candida antigen and demographic and physiological variables in older (65-80 y.o. adults. Candida antigen response was not related to gender or obesity, or to a number of other physiological variables including fitness and body composition. However, positive responders had significantly lower serum C-reactive protein levels (CRP, p4.75 mg•L(-1. Therefore, positive responses to candida antigen in older adults appears to be related to lower levels of systemic inflammation.

Stress Exposure and Physical, Mental, and Behavioral Health among American Indian Adults with Type 2 Diabetes

OpenAIRE

Walls, Melissa L.; Sittner, Kelley J.; Aronson, Benjamin D.; Forsberg, Angie K.; Whitbeck, Les B.; al’Absi, Mustafa

2017-01-01

American Indian (AI) communities experience disproportionate exposure to stressors and health inequities including type 2 diabetes. Yet, we know little about the role of psychosocial stressors for AI diabetes-related health outcomes. We investigated associations between a range of stressors and psychological, behavioral, and physical health for AIs with diabetes. This community-based participatory research with 5 AI tribes includes 192 AI adult type 2 diabetes patients recruited from clinical...

Dental insurance and dental care among working-age adults: differences by type and complexity of disability.

Science.gov (United States)

Horner-Johnson, Willi; Dobbertin, Konrad

2016-09-01

People with disabilities experience barriers to dental care, which may vary depending on type of disability and disability complexity (e.g., impact on activities of daily living). The purpose of this study was to examine differences in dental insurance, receipt of dental checkups, and delayed and unmet needs for dental care by type and complexity of disability. We conducted cross-sectional analysis of 2002-2011 data from the Medical Expenditure Panel Survey. Multivariable logistic regression analyses compared adults ages 18-64 in five disability type groups (physical, cognitive, vision, hearing, or multiple disabilities) to those with no disabilities, and compared people with complex activity limitations to those without complex limitations. All disability types except hearing had significantly higher adjusted odds of being without dental insurance, as did people with complex activity limitations. All disability groups except those with cognitive disabilities had increased odds of receiving dental checkups less than once a year. Similarly, all disability groups were at increased risk of both delayed and unmet needs for dental care. Odds ratios were generally highest for people with multiple types of disabilities. There are significant disparities in having dental insurance and receiving dental care for adults with disabilities, especially those with multiple types of disabilities, after controlling for socioeconomic and demographic differences. Further, disparities in care were apparent even when controlling for presence of dental insurance. © 2016 American Association of Public Health Dentistry.

Missed doses of oral antihyperglycemic medications in US adults with type 2 diabetes mellitus: prevalence and self-reported reasons.

Science.gov (United States)

Vietri, Jeffrey T; Wlodarczyk, Catherine S; Lorenzo, Rose; Rajpathak, Swapnil

2016-09-01

Adherence to antihyperglycemic medication is thought to be suboptimal, but the proportion of patients missing doses, the number of doses missed, and reasons for missing are not well described. This survey was conducted to estimate the prevalence of and reasons for missed doses of oral antihyperglycemic medications among US adults with type 2 diabetes mellitus, and to explore associations between missed doses and health outcomes. The study was a cross-sectional patient survey. Respondents were contacted via a commercial survey panel and completed an on-line questionnaire via the Internet. Respondents provided information about their use of oral antihyperglycemic medications including doses missed in the prior 4 weeks, personal characteristics, and health outcomes. Weights were calculated to project the prevalence to the US adult population with type 2 diabetes mellitus. Outcomes were compared according to number of doses missed in the past 4 weeks using bivariate statistics and generalized linear models. Approximately 30% of adult patients with type 2 diabetes mellitus reported missing or reducing ≥1 dose of oral antihyperglycemic medication in the prior 4 weeks. Accidental missing was more commonly reported than purposeful skipping, with forgetting the most commonly reported reason. The timing of missed doses suggested respondents had also forgotten about doses missed, so the prevalence of missed doses is likely higher than reported. Outcomes were poorer among those who reported missing three or more doses in the prior 4 weeks. A substantial number of US adults with type 2 diabetes mellitus miss doses of their oral antihyperglycemic medications.

Adults Living with Type 2 Diabetes: Kept Personal Health Information Items as Expressions of Need

Science.gov (United States)

Whetstone, Melinda

2013-01-01

This study investigated personal information behavior and information needs that 21 adults managing life with Type 2 diabetes identify explicitly and implicitly during discussions of item acquisition and use of health information items that are kept in their homes. Research drew upon a naturalistic lens, in that semi-structured interviews were…

Adult Type Granulosa Cell Tumor: A Very Rare Case of Sex-Cord Tumor of the Testis with Review of the Literature

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Dimosthenis Miliaras

2013-01-01

Full Text Available Granulosa cell tumor (GST is a sex-cord/stromal neoplasm of the gonads, more commonly arising in the ovaries, while approximately 80 cases have been reported in the testes. Out of these, 30 cases were of the adult type, while the remainder 50 cases were of the juvenile type. The latter mostly concerned infants and followed a benign course. However, the adult type testicular GCTs may be potentially malignant as it also happens in female patients with such neoplasms. We present a case of an adult type GCT located at the left testis. The patient was subjected to total orchiectomy and received no further treatment. Histology showed typical GCT histomorphology with Call-Exner bodies in some places. The immunoprofile of the tumor was CD99 (+, calretinin (+, inhibin (+, alpha smooth muscle actin (+, vimentin (+, ER (−, PR (−, keratin AE1/AE3 (−, alpha fetoprotein (−, CD117 (−, and placental alkaline phosphatase (−. Two years after surgery, the patient is alive and well with no signs of recurrence.

Regulatory focus and adherence to self-care behaviors among adults with type 2 diabetes.

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Avraham, Rinat; Van Dijk, Dina; Simon-Tuval, Tzahit

2016-09-01

The aims of this study were, first, to test the association between regulatory focus of adults with type 2 diabetes and their adherence to two types of self-care behaviors - lifestyle change (e.g. physical activity and diet) and medical care regimens (blood-glucose monitoring, foot care and medication usage). Second, to explore whether a fit between the message framing and patients' regulatory focus would improve their intentions to adhere specifically when the type of behavior fits the patients' regulatory focus as well. A cross-sectional study was conducted among 130 adults with type 2 diabetes who were hospitalized in an academic medical center. The patients completed a set of questionnaires that included their diabetes self-care activities, regulatory focus, self-esteem and demographic, socioeconomic and clinical data. In addition, participants were exposed to either a gain-framed or a loss-framed message, and were then asked to indicate their intention to improve adherence to self-care behaviors. A multivariable linear regression model revealed that promoters reported higher adherence to lifestyle change behaviors than preventers did (B = .60, p = .028). However, no effect of regulatory focus on adherence to medical care regimens was found (B = .46, p = .114). In addition, preventers reported higher intentions to adhere to medical care behaviors when the message framing was congruent with prevention focus (B = 1.16, p = .023). However, promoters did not report higher intentions to adhere to lifestyle behaviors when the message framing was congruent with promotion focus (B = -.16, p = .765). These findings justify the need to develop tailor-made interventions that are adjusted to both patients' regulatory focus and type of health behavior.

Differential Effect of Race, Education, Gender, and Language Discrimination on Glycemic Control in Adults with Type 2 Diabetes

OpenAIRE

Brice Reynolds, D.; Walker, Rebekah J.; Campbell, Jennifer A.; Egede, Leonard E.

2015-01-01

Background: Discrimination has been linked to negative health outcomes, but little research has investigated different types of discrimination to determine if some have a greater impact on outcomes. We examined the differential effect of discrimination based on race, level of education, gender, and language on glycemic control in adults with type 2 diabetes.

Preventing Unnecessary Costs of Drug-Induced Hypoglycemia in Older Adults with Type 2 Diabetes in the United States and Canada.

Science.gov (United States)

Boulin, Mathieu; Diaby, Vakaramoko; Tannenbaum, Cara

2016-01-01

The costs of drug-induced hypoglycemia are a critical but often neglected component of value-based arguments to reduce tight glycemic control in older adults with type 2 diabetes. An economic (decision-tree) analysis compared rates, costs, quality-adjusted life-years, and incremental costs per quality-adjusted life-year gained associated with mild, moderate and severe hypoglycemic events for 6 glucose-lowering medication classes in type 2 diabetic adults aged 65-79 versus those 80 years and older. The national U.S. (Center for Medicare Services) and Canadian public health payer perspectives were adopted. Incidence rates of drug-induced hypoglycemia were the highest for basal insulin and sulfonylureas: 8.64 and 4.32 events per person-year in 65-79 year olds, and 12.06 and 6.03 events per person-year for 80 years and older. In both the U.S. and Canada, metformin dominated sulfonylureas, basal insulin and glucagon-like peptide1 receptor agonists. Relative to sulfonylureas, thiazolidinediones had the lowest incremental cost-effectiveness ratios in the U.S. and dominated sulfonylureas in Canada for adults 80 years and older. Relative to sulfonylureas, dipeptidyl peptidase4 inhibitors were cost-effective for adults 80 years and older in both countries, and for 65-79 year olds in Canada. Annual costs of hypoglycemia for older adults attaining very tight glycemic control with the use of insulin or sulfonylureas were estimated at U.S.$509,214,473 in the U.S. and CAN$65,497,849 in Canada. Optimizing drug therapy for older type 2 diabetic adults through the avoidance of drug-induced hypoglycemia will dramatically improve patient health while also generating millions of dollars by saving unnecessary medical costs.

Severe hypoglycemia, impaired awareness of hypoglycemia, and self-monitoring in adults with type 1 diabetes

DEFF Research Database (Denmark)

Hendrieckx, Crystal; Jenkins, A; Hagger, Virginia

2017-01-01

AIMS: To assess prevalence of severe hypoglycemia, awareness and symptoms of hypoglycemia, and their associations with self-monitoring of blood glucose. METHODS: Diabetes MILES-Australia Study participants completed validated questionnaires and study-specific items. RESULTS: Of 642 adults with ty...... autonomic symptoms, perceived at relatively low glucose levels. Frequent self-monitoring of blood glucose prompted early recognition and treatment of hypoglycemia, suggesting severe hypoglycemia risk can be minimized.......AIMS: To assess prevalence of severe hypoglycemia, awareness and symptoms of hypoglycemia, and their associations with self-monitoring of blood glucose. METHODS: Diabetes MILES-Australia Study participants completed validated questionnaires and study-specific items. RESULTS: Of 642 adults with type...

Gender and Age - Dependent effect of type 1 diabetes on obesity and altered body composition in young adults.

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Szadkowska, Agnieszka; Madej, Anna; Ziółkowska, Katarzyna; Szymańska, Małgorzata; Jeziorny, Krzysztof; Mianowska, Beata; Pietrzak, Iwona

2015-01-01

The aim of the study was to evaluate the influence of age and gender on the prevalence of overweight and obesity, body composition and fatty tissue distribution in young adults with type 1 diabetes. 197 patients with type 1 diabetes aged 20-40 years participated in the study. The control group consisted of 138 healthy adults. Body weight, height, waist and hip circumferences were measured. Analysis of body mass composition was performed using the bioimpedance. Study groups were stratified into cohorts aged obesity were diagnosed in 35.5% and 13.2% of diabetic patients and in 26.1% and 7.3% of the control group, respectively (p=0.016). In the whole study group, advanced age (OR=1.10; pobesity, but a trend toward excessive body mass was observed in diabetic females (OR=1.18; p=0.181). Diabetic females more often had abdominal obesity than control females (mean difference - 19.2%; p=0.020). Higher total body fat mass was found in the diabetic group (p=0.037). Diabetic females had a higher amount of absolute (pobesity in early adulthood more frequently than the general population and are characterized by higher body fat mass. Gender-related differences in body weight and composition in young type 1 diabetic adults were found.

Perspectives on care for young adults with type 1 diabetes transitioning from pediatric to adult health systems: A national survey of pediatric endocrinologists.

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Agarwal, Shivani; Garvey, Katharine C; Raymond, Jennifer K; Schutta, Mark H

2017-11-01

Healthcare transition from pediatric to adult care for young adults (YA) with type 1 diabetes (T1D) is associated with risk of adverse outcomes. Consensus recommendations exist from US professional societies on transition care for YA with T1D, but it is not known whether they have been widely adopted. We describe experiences, barriers, and provider characteristics associated with transition care in a national sample of pediatric endocrinologists. US pediatric endocrinologists identified through the American Medical Association Physician Masterfile were sent an electronic survey. Response rate was 16% (164/1020) representing 32 states. The majority of pediatric endocrinologists (age 44 ± 10; years in practice 12 ± 11) were female (67%) and worked in academic centers (75%). Main reasons for transfer were age (49%) and glycemic control (18%). Barriers to transition included ending long-therapeutic relationships with patients (74%), lack of transition protocols (46%), and perceived deficiencies in adult care (42%). The majority of pediatric endocrinologists reported lack of transition training (68%); those who received training were less likely to have difficulty ending patient relationships [odds ratio (OR) = 0.39, P = .03], more likely to perform patient record transfer to adult systems (OR=1.27, P = .006), and less likely to report patient returns to pediatric care after transfer (OR=0.49, P = .01), independent of endocrinologist gender, years in practice, or practice type. There is wide variation in transition care for YA with T1D among US pediatric endocrinologists despite consensus recommendations. Dissemination of educational programming on transition care and provision of actionable solutions to overcome local health system and perceived barriers is needed. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Variation in Older Adult Characteristics by Residence Type and Use of Home- and Community-Based Services

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Heidi H. Ewen

2017-03-01

Full Text Available Background: The majority of older adults prefer to remain in their homes, or to “age-in-place.” To accomplish this goal, many older adults will rely upon home- and community-based services (HCBS for support. However, the availability and accessibility of HCBS may differ based on whether the older adult lives in the community or in a senior housing apartment facility. Methods: This paper reports findings from the Pathways to Life Quality study of residential change and stability among seniors in upstate New York. Data were analyzed from 663 older adults living in one of three housing types: service-rich facilities, service-poor facilities, and community-dwelling in single-family homes. A multinomial logistic regression model was used to examine factors associated with residence type. A linear regression model was fitted to examine factors associated with HCBS utilization. Results: When compared to community-dwelling older adults, those residing in service-rich and service-poor facilities were more likely to be older, report more activity limitations, and provide less instrumental assistance to others. Those in service-poor facilities were more likely to have poorer mental health and lower perceived purpose in life. The three leading HCBS utilized were senior centers (20%, homemaker services (19%, and transportation services (18%. More HCBS utilization was associated with participants who resided in service-poor housing, were older, were female, and had more activity limitations. More HCBS utilization was also associated with those who received instrumental support, had higher perceived purpose in life, and poorer mental health. Conclusions: Findings suggest that older adults’ residential environment is associated with their health status and HCBS utilization. Building upon the Person–Environment Fit theories, dedicated efforts are needed to introduce and expand upon existing HCBS available to facility residents to address physical and

Variation in Older Adult Characteristics by Residence Type and Use of Home- and Community-Based Services

Science.gov (United States)

Ewen, Heidi H.; Washington, Tiffany R.; Emerson, Kerstin G.; Carswell, Andrew T.; Smith, Matthew Lee

2017-01-01

Background: The majority of older adults prefer to remain in their homes, or to “age-in-place.” To accomplish this goal, many older adults will rely upon home- and community-based services (HCBS) for support. However, the availability and accessibility of HCBS may differ based on whether the older adult lives in the community or in a senior housing apartment facility. Methods: This paper reports findings from the Pathways to Life Quality study of residential change and stability among seniors in upstate New York. Data were analyzed from 663 older adults living in one of three housing types: service-rich facilities, service-poor facilities, and community-dwelling in single-family homes. A multinomial logistic regression model was used to examine factors associated with residence type. A linear regression model was fitted to examine factors associated with HCBS utilization. Results: When compared to community-dwelling older adults, those residing in service-rich and service-poor facilities were more likely to be older, report more activity limitations, and provide less instrumental assistance to others. Those in service-poor facilities were more likely to have poorer mental health and lower perceived purpose in life. The three leading HCBS utilized were senior centers (20%), homemaker services (19%), and transportation services (18%). More HCBS utilization was associated with participants who resided in service-poor housing, were older, were female, and had more activity limitations. More HCBS utilization was also associated with those who received instrumental support, had higher perceived purpose in life, and poorer mental health. Conclusions: Findings suggest that older adults’ residential environment is associated with their health status and HCBS utilization. Building upon the Person–Environment Fit theories, dedicated efforts are needed to introduce and expand upon existing HCBS available to facility residents to address physical and mental health needs

Meal types as sources for intakes of fruits, vegetables, fish and whole grains among Norwegian adults.

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Myhre, Jannicke B; Løken, Elin B; Wandel, Margareta; Andersen, Lene F

2015-08-01

To study how different meals contribute to intakes of fruits, vegetables, fish and whole grains in a group of Norwegian adults and in subgroups of this population. Moreover, to investigate the consequences of skipping the meal contributing most to the intake of each food group (main contributing meal). Cross-sectional dietary survey in Norwegian adults. Dietary data were collected using two non-consecutive telephone-administered 24 h recalls. The recorded meal types were breakfast, lunch, dinner, supper/evening meal and snacks. Nationwide, Norway (2010-2011). Adults aged 18-70 years (n 1787). Dinner was the main contributing meal for fish and vegetables, while snacks were the main contributing meal for fruit intake. For whole grains, breakfast was the main contributing meal. The main contributing meal did not change for any of the food groups when studying subgroups of the participants according to intake of each food group, educational level or age. A substantially lower intake of the food groups in question was found on days when the main contributing meal was skipped. Intakes of fruits, vegetables, fish and whole grains largely depend on one meal type. Inclusion of these foods in other meals in addition to the main contributing meal, preferably replacing energy-dense nutrient-poor foods, should be promoted.

Health Care Transition for Young Adults With Type 1 Diabetes: Stakeholder Engagement for Defining Optimal Outcomes.

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Pierce, Jessica S; Aroian, Karen; Schifano, Elizabeth; Milkes, Amy; Schwindt, Tiani; Gannon, Anthony; Wysocki, Tim

2017-10-01

Research on the transition to adult care for young adults with type 1 diabetes (T1D) emphasizes transition readiness, with less emphasis on transition outcomes. The relatively few studies that focus on outcomes use a wide variety of measures with little reliance on stakeholder engagement for measure selection. This study engaged multiple stakeholders (i.e., young adults with T1D, parents, pediatric and adult health care providers, and experts) in qualitative interviews to identify the content domain for developing a multidimensional measure of health care transition (HCT) outcomes. The following constructs were identified for a planned measure of HCT outcomes: biomedical markers of T1D control; T1D knowledge/skills; navigation of a new health care system; integration of T1D into emerging adult roles; balance of parental involvement with autonomy; and "ownership" of T1D self-management. The results can guide creation of an initial item pool for a multidimensional profile of HCT outcomes. © The Author 2017. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Analysis of epidemiological indices of type 2 diabetes mellitus in the adult population of Moscow

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Marina Fedorovna Kalashnikova

2014-07-01

Full Text Available Diabetes mellitus is a disease that presents a global medical problem. It is necessary to implement an in-depth analysis of the epidemiological situation of type 2 diabetes mellitus for planning and organizing specialized medical help to patients with type 2 diabetes mellitus. Aim. To rate the basic epidemiological indices of type 2 diabetes mellitus in actual clinical practice using the informational database of national registry of diabetic patients. Materials and methods. Epidemiological analyses were performed in two administrative districts of Moscow. From 1999 to 2011 48978 adult patients with type 2 diabetes mellitus who were aged 18 years and older were registered. We used methods of clinical, analytical and statistical epidemiology with elements of descriptive research. Results. The prevalence rate of type 2 diabetes mellitus was 1590 per hundred thousand, most patients were in the 60?64 and 70?74 age groups, and approximately 80% of patients were older than 55 years. The morbidity rate of type 2 diabetes mellitus was 138,72 per hundred thousand and was found to be higher in women at 1,89. The mortality rate of adult patients with diabetes mellitus was 0,83, mostly in men of all ages. Cardiovascular diseases accounted for most of the registered cases of deaths (34,4%. The average life expectancy appeared to be 75,24?0,45 years, although women lived 6 years longer than men. The average duration of the disease was 10,04?0,34 years. A total of 0,4% of patients underwent hospital treatment and the average length of treatment was 17?18 days. The total number of days of disablement was an average of 307,33?30,13 days (80% of patients were older than 55 years. In the study group, a mean grade of НbА1c

Management of Type 2 Diabetes Mellitus in Older Adults

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Kyung Soo Kim

2012-10-01

Full Text Available In the near future, the majority of patients with diabetes will be adults aged 65 or older. Unlike young adults with diabetes, elderly diabetic people may be affected by a variety of comorbid conditions such as depression, cognitive impairment, muscle weakness (sarcopenia, falls and fractures, and physical frailty. These geriatric syndromes should be considered in the establishment of treatment goals in older adults with diabetes. Although there are several guidelines for the management of diabetes, only a few are specifically designed for the elderly with diabetes. In this review, we present specific conditions of elderly diabetes which should be taken into account in the management of diabetes in older adults. We also present advantages and disadvantages of various glucose-lowering agents that should be considered when choosing a proper regimen for older adults with diabetes.

Comparison of two types of Actiwatch with polysomnography in older adults with intellectual disability: a pilot study.

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van de Wouw, Ellen; Evenhuis, Heleen M; Echteld, Michael A

2013-09-01

The Actiwatch is increasingly being used to investigate sleep. The aim of this study was to investigate which sensitivity setting of the Actiwatch is most suitable to detect sleep disturbance in older adults with intellectual disability (ID). Two Actiwatch types were compared to polysomnography (PSG) in 10 older adults with mild ID, using a 1-min epoch-to-epoch comparison. Outcome measures were sleep detection percentage, wake detection percentage, and overall accuracy of both Actiwatches, and several sleep parameters. The high sensitivity setting of the Actiwatch appeared most suitable to detect sleep disturbance in older adults with ID (wake detection percentage = 54.6%, sleep detection percentage = 89.7%). Sleep parameters calculated using the high sensitivity setting corresponded well to PSG outcomes. Outcomes were similar for both Actiwatches. We recommend using the high sensitivity setting of the Actiwatch for clinical evaluation of sleep, and for epidemiological research in older adults with ID.

Sex Differences in the Association Between Birth Weight and Adult Type 2 Diabetes

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Zimmermann, Esther; Gamborg, Michael; Sørensen, Thorkild I.A.

2015-01-01

a cohort of 113,801 men and 109,298 women, born 1936-1983, from the Copenhagen School Health Records Register, Denmark. During 5.6 million person-years of follow-up, 7,750 men and 4,736 women had a diagnosis of adult type 2 diabetes (30 years of age or older) obtained from national registers. When birth...... weights between 3.251 and 3.750 kg were used as the reference group for each sex separately, women with birth weights in the categories of 2.000 to 2.750 kg and 4.751 to 5.500 kg had hazard ratios [HRs] of type 2 diabetes of 1.46 (95% CI, 1.34-1.59) and 1.56 (1.20-2.04), respectively, whereas men had HRs...

Diabetes-Related distress, depression and Distress-Depression among adults with type 2 diabetes mellitus in Malaysia

NARCIS (Netherlands)

Chew, Boon How; Vos, Rimke; Mohd-Sidik, Sherina; Rutten, Guy E H M

2016-01-01

Type 2 diabetes mellitus (T2DM) brings about an increasing psychosocial problem in adult patients. Prevalence data on and associated factors of diabetes related distress (DRD) and depression have been lacking in Asia. This study aimed to examine the prevalence of DRD and depression, and their

Use of self-monitoring tools in a clinic sample of adults with type 2 diabetes.

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Tanenbaum, Molly L; Bhatt, Harikrashna B; Thomas, Valerie A; Wing, Rena R

2017-06-01

Self-monitoring is an effective strategy for chronic disease management; many readily available mobile applications allow tracking of diabetes-related health behaviors but their use has not yet been integrated into routine clinical care. How patients engage with these applications in the real world is not well understood. The specific aim of this study is to survey adults with type 2 diabetes (T2D) regarding self-monitoring behaviors, including mobile application use. In 2015, we surveyed an adult diabetes clinic population (n = 96) regarding self-monitoring behaviors: diet, physical activity, weight, and blood glucose. Self-monitoring with any method ranged from 20-90 %. About half of the participants owned smartphones; few had mobile applications. The most common app-tracked behavior was physical activity, then weight and diet. Despite numerous available mobile health-tracking applications, few T2D adults from our sample used them, though many reported self-monitoring with other methods.

Preventing Unnecessary Costs of Drug-Induced Hypoglycemia in Older Adults with Type 2 Diabetes in the United States and Canada.

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Mathieu Boulin

Full Text Available The costs of drug-induced hypoglycemia are a critical but often neglected component of value-based arguments to reduce tight glycemic control in older adults with type 2 diabetes.An economic (decision-tree analysis compared rates, costs, quality-adjusted life-years, and incremental costs per quality-adjusted life-year gained associated with mild, moderate and severe hypoglycemic events for 6 glucose-lowering medication classes in type 2 diabetic adults aged 65-79 versus those 80 years and older. The national U.S. (Center for Medicare Services and Canadian public health payer perspectives were adopted.Incidence rates of drug-induced hypoglycemia were the highest for basal insulin and sulfonylureas: 8.64 and 4.32 events per person-year in 65-79 year olds, and 12.06 and 6.03 events per person-year for 80 years and older. In both the U.S. and Canada, metformin dominated sulfonylureas, basal insulin and glucagon-like peptide1 receptor agonists. Relative to sulfonylureas, thiazolidinediones had the lowest incremental cost-effectiveness ratios in the U.S. and dominated sulfonylureas in Canada for adults 80 years and older. Relative to sulfonylureas, dipeptidyl peptidase4 inhibitors were cost-effective for adults 80 years and older in both countries, and for 65-79 year olds in Canada. Annual costs of hypoglycemia for older adults attaining very tight glycemic control with the use of insulin or sulfonylureas were estimated at U.S.$509,214,473 in the U.S. and CAN$65,497,849 in Canada.Optimizing drug therapy for older type 2 diabetic adults through the avoidance of drug-induced hypoglycemia will dramatically improve patient health while also generating millions of dollars by saving unnecessary medical costs.

Functional expression of T-type Ca2+ channels in spinal motoneurons of the adult turtle.

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Martha Canto-Bustos

Full Text Available Voltage-gated Ca2+ (CaV channels are transmembrane proteins comprising three subfamilies named CaV1, CaV2 and CaV3. The CaV3 channel subfamily groups the low-voltage activated Ca2+ channels (LVA or T-type a significant role in regulating neuronal excitability. CaV3 channel activity may lead to the generation of complex patterns of action potential firing such as the postinhibitory rebound (PIR. In the adult spinal cord, these channels have been found in dorsal horn interneurons where they control physiological events near the resting potential and participate in determining excitability. In motoneurons, CaV3 channels have been found during development, but their functional expression has not yet been reported in adult animals. Here, we show evidence for the presence of CaV3 channel-mediated PIR in motoneurons of the adult turtle spinal cord. Our results indicate that Ni2+ and NNC55-0396, two antagonists of CaV3 channel activity, inhibited PIR in the adult turtle spinal cord. Molecular biology and biochemical assays revealed the expression of the CaV3.1 channel isotype and its localization in motoneurons. Together, these results provide evidence for the expression of CaV3.1 channels in the spinal cord of adult animals and show also that these channels may contribute to determine the excitability of motoneurons.

Overexpression of SMPX in adult skeletal muscle does not change skeletal muscle fiber type or size.

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Einar Eftestøl

Full Text Available Mechanical factors such as stretch are thought to be important in the regulation of muscle phenotype. Small muscle protein X-linked (SMPX is upregulated by stretch in skeletal muscle and has been suggested to serve both as a transcription factor and a mechanosensor, possibly giving rise to changes in both fiber size and fiber type. We have used in vivo confocal imaging to study the subcellular localization of SMPX in skeletal muscle fibers of adult rats using a SMPX-EGFP fusion protein. The fusion protein was localized predominantly in repetitive double stripes flanking the Z-disc, and was excluded from all nuclei. This localization would be consistent with SMPX being a mechanoreceptor, but not with SMPX playing a role as a transcription factor. In vivo overexpression of ectopic SMPX in skeletal muscle of adult mice gave no significant changes in fiber type distribution or cross sectional area, thus a role of SMPX in regulating muscle phenotype remains unclear.

Efficacy and safety of liraglutide for overweight adult patients with type 1 diabetes and insufficient glycaemic control (Lira-1)

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Dejgaard, Thomas Fremming; Frandsen, Christian Seerup; Hansen, Tanja Stenbæk

2016-01-01

to insulin for overweight adult patients with type 1 diabetes. Methods We did a randomised, double-blind, placebo-controlled trial at Steno Diabetes Center (Gentofte, Denmark). Patients aged 18 years or older with type 1 diabetes, insufficient glycaemic control (HbA1c >8% [64 mmol/mol]), and overweight (BMI...

Gender and Age – Dependent effect of type 1 diabetes on obesity and altered body composition in young adults

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Agnieszka Szadkowska

2015-02-01

Patients with type 1 diabetes develop overweight and obesity in early adulthood more frequently than the general population and are characterized by higher body fat mass. Gender-related differences in body weight and composition in young type 1 diabetic adults were found.

Diabetes Empowerment Council: Integrative Pilot Intervention for Transitioning Young Adults With Type 1 Diabetes.

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Weigensberg, Marc J; Vigen, Cheryl; Sequeira, Paola; Spruijt-Metz, Donna; Juarez, Magaly; Florindez, Daniella; Provisor, Joseph; Peters, Anne; Pyatak, Elizabeth A

2018-01-01

The transition of young adults with type 1 diabetes (T1D) from pediatric to adult care is challenging and frequently accompanied by worsening of diabetes-related health. To date, there are no reports which prospectively assess the effects of theory-based psycho-behavioral interventions during the transition period neither on glycemic control nor on psychosocial factors that contribute to poor glycemic control. Therefore, the overall aim of this study was to develop and pilot test an integrative group intervention based on the underlying principles of self-determination theory (SDT), in young adults with T1D. Fifty-one young adults with T1D participated in an education and case management-based transition program, of which 9 took part in the Diabetes Empowerment Council (DEC), a 12-week holistic, multimodality facilitated group intervention consisting of "council" process based on indigenous community practices, stress-reduction guided imagery, narrative medicine modalities, simple ritual, and other integrative modalities. Feasibility, acceptability, potential mechanism of effects, and bio-behavioral outcomes were determined using mixed qualitative and quantitative methods. The intervention was highly acceptable to participants, though presented significant feasibility challenges. Participants in DEC showed significant reductions in perceived stress and depression, and increases in general well-being relative to other control participants. Reduction in perceived stress, independent of intervention group, was associated with reductions in hemoglobin A1C. A theoretical model explaining the effects of the intervention included the promotion of relatedness and autonomy support, 2 important aspects of SDT. The DEC is a promising group intervention for young adults with T1D going through transition to adult care. Future investigations will be necessary to resolve feasibility issues, optimize the multimodality intervention, determine full intervention effects, and fully

Utilization of 3-Month Yoga Program for Adults at High Risk for Type 2 Diabetes: A Pilot Study

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Kyeongra Yang

2011-01-01

Full Text Available Various modes of physical activity, combined with dieting, have been widely recommended to prevent or delay type 2 diabetes. Among these, yoga holds promise for reducing risk factors for type 2 diabetes by promoting weight loss, improving glucose levels and reducing blood pressure and lipid levels. This pilot study aimed to assess the feasibility of implementing a 12-week yoga program among adults at high risk for type 2 diabetes. Twenty-three adults (19 Whites and 4 non-Whites were randomly assigned to the yoga intervention group or the educational group. The yoga group participated in a 3-month yoga intervention with sessions twice per week and the educational group received general health educational materials every 2 weeks. All participants completed questionnaires and had blood tests at baseline and at the end of 3 months. Effect sizes were reported to summarize the efficacy of the intervention. All participants assigned to the yoga intervention completed the yoga program without complication and expressed high satisfaction with the program (99.2%. Their yoga session attendance ranged from 58.3 to 100%. Compared with the education group, the yoga group experienced improvements in weight, blood pressure, insulin, triglycerides and exercise self-efficacy indicated by small to large effect sizes. This preliminary study indicates that a yoga program would be a possible risk reduction option for adults at high risk for type 2 diabetes. In addition, yoga holds promise as an approach to reducing cardiometabolic risk factors and increasing exercise self-efficacy for this group.

The association between different types of exercise and energy expenditure in young nonoverweight and overweight adults

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Drenowatz, Clemens; Hand, Gregory A.; Shook, Robin P.; Jakicic, John M.; Hebert, James R.; Burgess, Stephanie; Blair, Steven N.

2015-01-01

With decades of trends for decreasing activity during work and travel, exercise becomes an important contributor to total physical activity (PA) and energy expenditure. The purpose of this study was to examine the contribution of different types of exercise to the variability in energy expenditure and time spent at different PA intensities in young adults. Four hundred and seventeen adults (49.9% male; 46.2 overweight/obese) between 21 and 36 years of age provided valid objective PA and energy expenditure data, assessed via the SenseWear Armband (BodyMedia Inc.). Frequency and duration of participation in various exercise types was self-reported. Weight status was based on body mass index (BMI) (kg/m2) with body weight and height being measured according to standard procedures. Eighty-four percent of the participants reported regular exercise engagement with no difference in participation rate by sex or BMI category. Exercise time along with sex and ethnicity explained roughly 60% of the variability in total daily energy expenditure (TDEE) while the association between exercise and time spent in moderate to vigorous PA or being sedentary was low or nonsignificant. Engagement in endurance exercise and sports contributed predominantly to the variability in energy expenditure and PA in nonoverweight participants. In overweight/obese participants engagement in resistance exercise and swimming contributed significantly to variability in TDEE. Current exercise recommendations focus primarily on aerobic exercise, but results of the present study suggest that nonweight-bearing exercises, such as resistance exercise and swimming, contribute significantly to the variability in TDEE in overweight/obese adults, which would make these types of activities viable options for exercise interventions. PMID:25647557

In vivo autoradiographic demonstration of β-adrenergic binding sites in adult rat type II alveolar epithelial cells

International Nuclear Information System (INIS)

Smith, D.M.; Sidhu, M.K.

1984-01-01

Adult male rats were injected intravenously with the muscarinic binding probe 3 H-Quinuclidinyl benzilate (QNB) or the β-adrenergic probe 3 H-dihydroalprenolol (DHA). Other rats were pre-treated with an intraperitoneal injection of a 500-fold excess of L-isoproterenol prior to the DHA. Light microscopic autoradiography of 0.5 μm sections of lung from the QNB group demonstrated very little labelling even after 6 months of exposure. In constrast, trachealis smooth muscle from these animals contained substantial labelling. Autoradiographs of lung from rats injected with DHA demonstrated labelling which was well localized over alveolar septa and concentrated over the cytoplasm of type II cells. Quantitative analysis of labelling in the DHA groups indicated a significant reduction of labelling in animals treated with L-isoproterenol prior to DHA, in both the alveolar parenchyma in general and over type II cells. The results of this study provide morphologic evidence for the uptake and specific binding of β-adrenergic antagonists by the adult lung in vivo, while failing to demonstrate similar binding of a muscarinic probe. In addition, the results demonstrate specific β-adrenergic receptors on type II cells in vivo and substantiate the view of a direct effect of β-adrenergic agonists on alveolar type II cells

[Types of Care for Adult Patients Diagnosed With Acute and Maintenance Phase Schizophrenia].

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Bohórquez Peñaranda, Adriana; Gómez Restrepo, Carlos; Oviedo Lugo, Gabriel Fernando; de la Hoz Bradford, Ana María; Castro Díaz, Sergio Mario; García Valencia, Jenny; Jaramillo González, Luis Eduardo; Ávila-Guerra, Mauricio

2014-01-01

To assist the clinician in making decisions about the types of care available for adults with schizophrenia. To determine which are the modalities of treatment associated with better outcomes in adults with schizophrenia. A clinical practice guideline was elaborated under the parameters of the Methodological Guide of the Ministerio de Salud y Protección Social to identify, synthesize and evaluate the evidence and make recommendations about the treatment and follow-up of adult patients with schizophrenia. The evidence of NICE guide 82 was adopted and updated. The evidence was presented to the Guideline Developing Group and recommendations, employing the GRADE system, were produced. Patients who were in Assertive community treatment had a lower risk of new hospitalizations. For the intensive case management, the results favored this intervention in the outcomes: medium term readmissions, social functioning and satisfaction with services. The crisis resolution teams was associated with better outcomes on outcomes of readmissions, social functioning and service satisfaction in comparison with standard care. The use of different modalities of care leads to the need of a comprehensive approach to patients to reduce the overall disability associated with the disease. Evidence shows overall benefit for most outcomes studied without encountering hazards for health of patients. This evaluation is recommended to use the professional ways of providing health services that are community-based and have a multidisciplinary group. It is not recommended the modality "day hospital" during the acute phase of schizophrenia in adults. Copyright © 2014 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

Adult onset glycogen storage disease type II (adult onset Pompe disease): report and magnetic resonance images of two cases

International Nuclear Information System (INIS)

Del Gaizo, Andrew; Banerjee, Sima; Terk, Michael

2009-01-01

Glycogen storage disease type II (GSDII), also referred to as Pompe disease or acid maltase deficiency, is a rare inherited condition caused by a deficiency in acid alpha-glucosidase (GAA) enzyme activity. The condition is often classified by age of presentation, with infantile and late onset variants (Laforet et al. J Neurology 55:1122-8, 2000). Late onset tends to present with progressive proximal muscle weakness and respiratory insufficiency (Winkel et al. J Neurology 252:875-84, 2005). We report two cases of biopsy confirmed adult onset GSDII, along with key Magnetic Resonance (MR) images. (orig.)

[Effect of high-intensity interval training on the reduction of glycosylated hemoglobin in type-2 diabetic adult patients].

Science.gov (United States)

Aguilera Eguía, Raúl Alberto; Russell Guzmán, Javier Antonio; Soto Muñoz, Marcelo Enrique; Villegas González, Bastián Eduardo; Poblete Aro, Carlos Emilio; Ibacache Palma, Alejandro

2015-03-05

Type 2 diabetes mellitus is one of the major non-communicable chronic diseases in the world. Its prevalence in Chile is significant, and complications associated with this disease involve great costs, which is why prevention and treatment of this condition are essential. Physical exercise is an effective means for prevention and treatment of type 2 diabetes mellitus. The emergence of new forms of physical training, such as "high intensity interval training", presents novel therapeutic alternatives for patients and health care professionals. To assess the validity and applicability of the results regarding the effectiveness of high intensity interval training in reducing glycosylated hemoglobin in adult patients with type 2 diabetes mellitus and answer the following question: In subjects with type 2 diabetes, can the method of high intensity interval training compared to moderate intensity exercise decrease glycosylated hemoglobin? We performed a critical analysis of the article "Feasibility and preliminary effectiveness of high intensity interval training in type 2 diabetes". We found no significant differences in the amount of glycosylated hemoglobin between groups of high intensity interval training and moderate-intensity exercise upon completion of the study (p>0.05). In adult patients with type 2 diabetes mellitus, high intensity interval training does not significantly improve glycosylated hemoglobin levels. Despite this, the high intensity interval training method shows as much improvement in body composition and physical condition as the moderate intensity exercise program.

ABO Genotype Does Not Modify the Association between the "Blood-Type" Diet and Biomarkers of Cardiometabolic Disease in Overweight Adults.

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Wang, Jingzhou; Jamnik, Joseph; García-Bailo, Bibiana; Nielsen, Daiva E; Jenkins, David J A; El-Sohemy, Ahmed

2018-04-01

Although 7 million copies of Eat Right 4 Your Type have been sold in >60 languages, there has been a lack of evidence supporting the "blood-type" diet hypothesis. The present study aimed to examine the validity of this diet in overweight adults. A total of 973 adults [mean ± SEM age: 44.6 ± 0.4 y; mean ± SEM body mass index (BMI; kg/m2): 32.5 ± 0.2; 758 women, 215 men] were participants of the Toronto Healthy Diet Study. A 1-mo, 196-item food-frequency questionnaire was used to determine dietary intakes before and after a 6-mo dietary intervention. Diet scores were calculated to determine relative adherence to each of the 4 blood-type diets as a secondary analysis. ABO blood group was determined by genotyping rs8176719 and rs8176746. ANCOVA was used to compare cardiometabolic risk factors across tertiles of diet scores. At baseline, individuals with a higher adherence score to the type A diet had lower diastolic blood pressure (tertile 3 compared with tertile 1: 70.9 ± 1.1 compared with 73.3 ± 1.1 mm Hg; P type B (tertile 3 compared with tertile 1: 100.8 ± 1.8 compared with 105.4 ± 1.7 cm; P type AB (tertile 3 compared with tertile 1: 101.2 ± 1.8 compared with 104.8 ± 1.7 cm; P type A and type B diets had greater reductions in BMI and waist circumference, respectively (P type O diet adherence showed decreases in both BMI and waist circumference (P blood-type diets and biomarkers of cardiometabolic disease in overweight adults, suggesting that the theory behind this diet is not valid This study was based on the data of a trial that was registered at www.clinicaltrials.gov as NCT00516620.

Abnormal motor phenotype at adult stages in mice lacking type 2 deiodinase.

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Bárez-López, Soledad; Bosch-García, Daniel; Gómez-Andrés, David; Pulido-Valdeolivas, Irene; Montero-Pedrazuela, Ana; Obregon, Maria Jesus; Guadaño-Ferraz, Ana

2014-01-01

Thyroid hormones have a key role in both the developing and adult central nervous system and skeletal muscle. The thyroid gland produces mainly thyroxine (T4) but the intracellular concentrations of 3,5,3'-triiodothyronine (T3; the transcriptionally active hormone) in the central nervous system and skeletal muscle are modulated by the activity of type 2 deiodinase (D2). To date no neurological syndrome has been associated with mutations in the DIO2 gene and previous studies in young and juvenile D2-knockout mice (D2KO) did not find gross neurological alterations, possibly due to compensatory mechanisms. This study aims to analyze the motor phenotype of 3-and-6-month-old D2KO mice to evaluate the role of D2 on the motor system at adult stages in which compensatory mechanisms could have failed. Motor abilities were explored by validated tests. In the footprint test, D2KO showed an altered global gait pattern (mice walked slower, with shorter strides and with a hindlimb wider base of support than wild-type mice). No differences were detected in the balance beam test. However, a reduced latency to fall was found in the rotarod, coat-hanger and four limb hanging wire tests indicating impairment on coordination and prehensile reflex and a reduction of muscle strength. In histological analyses of cerebellum and skeletal muscle, D2KO mice did not present gross structural abnormalities. Thyroid hormones levels and deiodinases activities were also determined. In D2KO mice, despite euthyroid T3 and high T4 plasma levels, T3 levels were significantly reduced in cerebral cortex (48% reduction) and skeletal muscle (33% reduction), but not in the cerebellum where other deiodinase (type 1) is expressed. The motor alterations observed in D2KO mice indicate an important role for D2 in T3 availability to maintain motor function and muscle strength. Our results suggest a possible implication of D2 in motor disorders.

Abnormal motor phenotype at adult stages in mice lacking type 2 deiodinase.

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Soledad Bárez-López

Full Text Available BACKGROUND: Thyroid hormones have a key role in both the developing and adult central nervous system and skeletal muscle. The thyroid gland produces mainly thyroxine (T4 but the intracellular concentrations of 3,5,3'-triiodothyronine (T3; the transcriptionally active hormone in the central nervous system and skeletal muscle are modulated by the activity of type 2 deiodinase (D2. To date no neurological syndrome has been associated with mutations in the DIO2 gene and previous studies in young and juvenile D2-knockout mice (D2KO did not find gross neurological alterations, possibly due to compensatory mechanisms. AIM: This study aims to analyze the motor phenotype of 3-and-6-month-old D2KO mice to evaluate the role of D2 on the motor system at adult stages in which compensatory mechanisms could have failed. RESULTS: Motor abilities were explored by validated tests. In the footprint test, D2KO showed an altered global gait pattern (mice walked slower, with shorter strides and with a hindlimb wider base of support than wild-type mice. No differences were detected in the balance beam test. However, a reduced latency to fall was found in the rotarod, coat-hanger and four limb hanging wire tests indicating impairment on coordination and prehensile reflex and a reduction of muscle strength. In histological analyses of cerebellum and skeletal muscle, D2KO mice did not present gross structural abnormalities. Thyroid hormones levels and deiodinases activities were also determined. In D2KO mice, despite euthyroid T3 and high T4 plasma levels, T3 levels were significantly reduced in cerebral cortex (48% reduction and skeletal muscle (33% reduction, but not in the cerebellum where other deiodinase (type 1 is expressed. CONCLUSIONS: The motor alterations observed in D2KO mice indicate an important role for D2 in T3 availability to maintain motor function and muscle strength. Our results suggest a possible implication of D2 in motor disorders.

Effect of Message Type on the Visual Attention of Adults With Traumatic Brain Injury.

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Thiessen, Amber; Brown, Jessica; Beukelman, David; Hux, Karen; Myers, Angela

2017-05-17

The purpose of this investigation was to measure the effect of message type (i.e., action, naming) on the visual attention patterns of individuals with and without traumatic brain injury (TBI) when viewing grids composed of 3 types of images (i.e., icons, decontextualized photographs, and contextualized photographs). Fourteen adults with TBI and 14 without TBI-assigned either to an action or naming message condition-viewed grids composed of 3 different image types. Participants' task was to select/sustain visual fixation on the image they felt best represented a stated message (i.e., action or naming). With final fixation location serving as a proxy for selection, participants in the naming message condition selected decontextualized photographs significantly more often than the other 2 image types. Participants in the action message condition selected contextualized photographs significantly more frequently than the other 2 image types. Minimal differences were noted between participant groups. This investigation provides preliminary evidence of the relationship between image and message type. Clinicians involved in the selection of images used for message representation should consider the message being represented when designing supports for people with TBI. Further research is necessary to fully understand the relationship between images and message type.

The Potential Impact of Displacing Sedentary Time in Adults with Type 2 Diabetes

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FALCONER, CATHERINE L.; PAGE, ANGIE S.; ANDREWS, ROB C.; COOPER, ASHLEY R.

2015-01-01

ABSTRACT Purpose Sedentary time, in particular, prolonged unbroken sedentary time, is detrimental to health and displaces time spent in either light or moderate intensity physical activity. This cross-sectional study aimed to identify the potential impact of reallocating time from sedentary behaviors to more active behaviors on measures of body composition and metabolic health in people with type 2 diabetes. Methods Participants were 519 adults with newly diagnosed type 2 diabetes who had been recruited to the Early Activity in Diabetes (Early ACTID) randomized controlled trial. Waist-worn accelerometers were used to obtain objective measurement of sedentary time, light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) at baseline alongside clinical measurements and fasting blood samples to determine cholesterol, triglycerides, HOMA-IR, and glucose. Isotemporal substitution modeling was performed to determine the potential impact of reallocating 30 min of sedentary time accumulated in a single bout (long bout) with 30 min of interrupted sedentary time, LPA, or MVPA. Results Sedentary time accounted for 65% of the waking day, of which 45% was accumulated in prolonged (≥30 min) bouts. Reallocation of 30 min of long-bout sedentary time with 30 min of short-bout sedentary time was associated with lower body mass index (BMI) (adjusted β, −0.60; 95% confidence interval [CI], −1.00, −0.21) and waist circumference (WC) (adjusted β, −1.16; 95% CI, −2.08, −0.25). Stronger effects were seen for LPA and MVPA. Reallocation of 30 min of long-bout sedentary time with LPA was associated with higher HDL-cholesterol (adjusted β, 0.02; 95% CI, 0.00–0.03 mmol·L−1). Conclusions Encouraging adults with newly diagnosed type 2 diabetes to break up prolonged periods of sedentary time may be an effective strategy for improving body composition and metabolic health. PMID:26378943

Comparative analysis of the protein compositions between wild type and body color mutant of helicoverpa armigera adult

International Nuclear Information System (INIS)

He Lihua; Chen Jin'e; Liu Yan; Wang Yongqiang; Liu Peigang; Meng Zhiqi

2012-01-01

To gain an in-depth understanding of the fineness and regulation mechanism of body color mutant of Helicoverpa armigera Hbner, the protein composition differences between adult of dominant mutant, recessive mutant and wild type were studied using the SDS-PAGE combined with MALDI-TOF-TOF/MS and bioinformatics analysis. The results indicated that the protein composition of the dominant mutant and wild type had little difference. However, there were obvious differences between the recessive mutant and wild-type. Three specific stripe were chosen for mass spectrometry and bioinformatics analysis, and two types of proteins related to energy metabolism and cytoskeleton were identified. These findings suggested that the two types of proteins may be associated with occurrence and regulation of body color mutant traits of H. armigera. (authors)

Stigma Perceived and Experienced by Adults with Type 1 Diabetes: Linguistic Adaptation and Psychometric Validation of the Danish Version of the Type 1 Diabetes Stigma Assessment Scale (DSAS-1 DK).

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Hansen, Ulla Møller; Willaing, Ingrid; Ventura, Adriana D; Olesen, Kasper; Speight, Jane; Browne, Jessica L

2017-12-19

We aimed to (a) culturally and linguistically adapt the Type 1 Diabetes Stigma Assessment Scale (DSAS-1) from English (for Australia) into Danish and (b) examine psychometric properties of the measure among Danish adults with type 1 diabetes. We performed a forward-backward translation, face validity interviews with experts and cognitive debriefing of the Danish version (DSAS-1 DK) with ten adults from the target group. The DSAS-1 DK was then completed by 1594 adults with type 1 diabetes. Electronic clinical records provided age, diabetes duration, diabetes-related complications, and glycemic control [glycated hemoglobin (HbA1c)]. We examined internal consistency, construct validity and structural validity of the DSAS-1 DK using exploratory and confirmatory factor analysis in a cross-validation design. The translated measure was found acceptable by the experts and target group, with only minor adaptations required for the Danish context. The DSAS-1 DK structure was best represented by a three-factor model representing the subscales 'Treated Differently,' 'Blame and Judgement,' and 'Identity Concern' (α = 0.88-0.89). The results also provided some support for calculation of a total score (19-item scale; α = 0.75). The subscales and total scale demonstrated satisfactory convergent and discriminant validity. Good structural validity was demonstrated for the three-factor model for four out of five indices [normed χ 2  = 4.257, goodness-of-fit index (GFI) = 0.923, root mean square error of approximation (RMSEA) = 0.065, standardized root mean square residual (SRMSR) = 0.0567, comparative fit index (CFI) = 0.93]. The DSAS-1 DK has a confirmed three-factor structure, consistent with the original Australian English version. The measure is now validated and available to advance research into the stigma perceived and experienced by adults with type 1 diabetes in a Danish context.

Physical and social activities mediate the associations between social network types and ventilatory function in Chinese older adults.

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Cheng, Sheung-Tak; Leung, Edward M F; Chan, Trista Wai Sze

2014-06-01

This study examined the associations between social network types and peak expiratory flow (PEF), and whether these associations were mediated by social and physical activities and mood. Nine hundred twenty-four community-dwelling Chinese older adults, who were classified into five network types (diverse, friend-focused, family-focused, distant family, and restricted), provided data on demographics, social and physical activities, mood, smoking, chronic diseases, and instrumental activities of daily living. PEF and biological covariates, including blood lipids and glucose, blood pressure, and height and weight, were assessed. Two measures of PEF were analyzed: the raw reading in L/min and the reading expressed as percentage of predicted normal value on the basis of age, sex, and height. Diverse, friend-focused, and distant family networks were hypothesized to have better PEF values compared with restricted networks, through higher physical and/or social activities. No relative advantage was predicted for family-focused networks because such networks tend to be associated with lower physical activity. Older adults with diverse, friend-focused, and distant family networks had significantly better PEF measures than those with restricted networks. The associations between diverse network and PEF measures were partially mediated by physical exercise and socializing activity. The associations between friend-focused network and PEF measures were partially mediated by socializing activity. No significant PEF differences between family-focused and restricted networks were found. Findings suggest that social network types are associated with PEF in older adults, and that network-type differences in physical and socializing activity is partly responsible for this relationship. PsycINFO Database Record (c) 2014 APA, all rights reserved.

Evidence for immunisation failure in vaccinated adult dogs infected with canine parvovirus type 2c.

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Decaro, Nicola; Desario, Costantina; Elia, Gabriella; Martella, Vito; Mari, Viviana; Lavazza, Antonio; Nardi, Manuela; Buonavoglia, Canio

2008-01-01

An outbreak of canine parvovirus type 2c (CPV-2c) infection in vaccinated adult dogs is reported. The disease occurred in a breeding kennel in Italy and affected 11 dogs aged between 6 months and 2.5 years, that had been repeatedly administered vaccines containing a type 2 (old type) CPV strain. CPV infection was demonstrated in all diseased dogs by an immunochromatographic test. A CPV strain was isolated from the intestinal content of a 20-month-old pregnant Bernese mountain bitch that underwent a fatal outcome. The strain was characterised as CPV-2c by means of real-time PCR assays using minor groove binder probes. The present report provides further concerns about the real efficacy of type 2-based vaccines against the antigenic variants of CPV and stresses the need for developing new vaccines prepared with the variants currently circulating in the dog population.

Do Perceptions of Empowerment Affect Glycemic Control and Self-Care Among Adults with Type 2 Diabetes?

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D’Souza, Melba Sheila; Karkada, Subrahmanya Nairy; Hanrahan, Nancy P.; Venkatesaperumal, Ramesh; Amirtharaj, Anandhi

2015-01-01

Background: The Arab adult with T2DM is understudied with less known facts about the perception of empowerment and its relationship with self-care and glycemic control. Purpose: The purpose of this study was to determine the extent to which perception of empowerment by Arab adults living with Type 2 Diabetes Mellitus (T2DM) was associated with better glycemic control and self-care management. Methods: A cross-sectional descriptive study was led among 300 Arab adults living in Oman with T2DM in an outpatient diabetes clinic. The Diabetes Empowerment Scale (DES), glycosylated haemaglobin (HbA1c) and Body mass index was assessed. The DES was found to be valid and reliable for the population. ANOVA, Regression analysis, and Structural equation modeling was used for analysis. Results: The composite score and three subscales of DES were a significant and strong predictor of good glycemic control among Omani adults with T2DM (pempowerment and tailor interventions to increase empowerment for better glycemic control. Patient empowerment plays an essential role in maintaining self-care behaviours and HbA1c. PMID:26156908

Motivation for diet and exercise management among adults with type 2 diabetes.

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Oftedal, Bjørg; Bru, Edvin; Karlsen, Bjørg

2011-12-01

The aim of this study was to investigate diet and exercise management and how indicators of intrinsic motivation such as ability expectations and values are associated with diet and exercise management among adults with type 2 diabetes. Motivational problems are probably one of the main reasons for poor diabetes management. However, the mechanisms involved in the motivation for adequate self-management are still unclear. A cross-sectional design including a postal questionnaire that investigated diet and exercise management as well as intrinsic motivational factors such as ability expectations and values related to these behaviours was used to collect the data. A sample comprising 425 adults with type 2 diabetes aged between 30 and 70 completed the questionnaire. Reported diet management was more in accordance with recommendations than reported exercise management. Yet results indicated equally high ability expectations and positive values for exercise and diet management. Moreover, results demonstrated that ability expectations and values explained more variance in exercise (21.6%) than in diet management (7.6%). The modest association between intrinsic motivational factors and diet management may imply that there are important extrinsic factors that play a significant role in determining dietary behaviour. The combination of lower exercise activity than recommended and high ability expectations and values for such activity may reflect that subjective exercise norms are formed individually in accordance with what most people recognise as the appropriate level of physical activity. Finally, results may indicate that there is potential for improving exercise management by stimulating intrinsic motivation as well as by more clearly communicating recommendations for such management. © 2011 The Authors. Scandinavian Journal of Caring Sciences © 2011 Nordic College of Caring Science.

Targeted exome sequencing integrated with clinicopathological information reveals novel and rare mutations in atypical, suspected and unknown cases of Alport syndrome or proteinuria.

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Rajshekhar Chatterjee

Full Text Available We applied customized targeted next-generation exome sequencing (NGS to determine if mutations in genes associated with renal malformations, Alport syndrome (AS or nephrotic syndrome are a potential cause of renal abnormalities in patients with equivocal or atypical presentation. We first sequenced 4,041 exons representing 292 kidney disease genes in a Caucasian woman with a history of congenital vesicoureteral reflux (VUR, recurrent urinary tract infections and hydronephrosis who presented with nephrotic range proteinuria at the age of 45. Her biopsy was remarkable for focal segmental glomerulosclerosis (FSGS, a potential complication of longstanding VUR. She had no family history of renal disease. Her proteinuria improved initially, however, several years later she presented with worsening proteinuria and microhematuria. NGS analysis revealed two deleterious COL4A3 mutations, one novel and the other previously reported in AS, and a novel deleterious SALL2 mutation, a gene linked to renal malformations. Pedigree analysis confirmed that COL4A3 mutations were nonallelic and compound heterozygous. The genomic results in conjunction with subsequent abnormal electron microscopy, Collagen IV minor chain immunohistochemistry and progressive sensorineural hearing loss confirmed AS. We then modified our NGS approach to enable more efficient discovery of variants associated with AS or a subset of FSGS by multiplexing targeted exome sequencing of 19 genes associated with AS or FSGS in 14 patients. Using this approach, we found novel or known COL4A3 or COL4A5 mutations in a subset of patients with clinically diagnosed or suspected AS, APOL1 variants associated with FSGS in African Americans and novel mutations in genes associated with nephrotic syndrome. These studies demonstrate the successful application of targeted capture-based exome sequencing to simultaneously evaluate genetic variations in many genes in patients with complex renal phenotypes and

Diabetes-Related Distress, Depression and Distress-Depression among Adults with Type 2 Diabetes Mellitus in Malaysia.

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Boon-How Chew

Full Text Available Type 2 diabetes mellitus (T2DM brings about an increasing psychosocial problem in adult patients. Prevalence data on and associated factors of diabetes related distress (DRD and depression have been lacking in Asia. This study aimed to examine the prevalence of DRD and depression, and their associated factors in Asian adult T2DM patients. This study was conducted in three public health clinics measuring DRD (Diabetes Distress Scale, DDS, and depression (Patient Health Questionnaire, PHQ. Patients who were at least 30 years of age, had T2DM for more than one year, with regular follow-up and recent laboratory results ( 130/80 mmHg (OR 0.53, 95% CI 0.32 to 0.89 were less likely to experience both DRD and depression. DRD and depression were common and correlated in Asian adults with T2DM at primary care level. Socio-demographic more than clinical characteristics were related to DRD and depression.

Shared decision-making: the perspectives of young adults with type 1 diabetes mellitus

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Wiley J

2014-04-01

Full Text Available Janice Wiley,1 Mary Westbrook,1 Jerry R Greenfield,2,3 Richard O Day,4 Jeffrey Braithwaite11Centre for Clinical Governance Research in Health, Australian Institute of Health Innovation, University of New South Wales, 2Diabetes and Obesity Program, Garvan Institute of Medical Research, 3Department of Endocrinology, St Vincent's Hospital, University of New South Wales, Sydney, NSW, Australia; 4Department of Clinical Pharmacology, St Vincent's Hospital, University of New South Wales, Sydney, NSW, AustraliaBackground: Shared decision-making (SDM is at the core of patient-centered care. We examined whether young adults with type 1 diabetes perceived the clinician groups they consulted as practicing SDM.Methods: In a web-based survey, 150 Australians aged 18–35 years and with type 1 diabetes rated seven aspects of SDM in their interactions with endocrinologists, diabetes educators, dieticians, and general practitioners. Additionally, 33 participants in seven focus groups discussed these aspects of SDM.Results: Of the 150 respondents, 90% consulted endocrinologists, 60% diabetes educators, 33% dieticians, and 37% general practitioners. The majority of participants rated all professions as oriented toward all aspects of SDM, but there were professional differences. These ranged from 94.4% to 82.2% for "My clinician enquires about how I manage my diabetes"; 93.4% to 82.2% for "My clinician listens to my opinion about my diabetes management"; 89.9% to 74.1% for "My clinician is supportive of my diabetes management"; 93.2% to 66.1% for "My clinician suggests ways in which I can improve my self-management”; 96.6% to 85.7% for “The advice of my clinician can be understood”; 98.9% to 82.2% for “The advice of my clinician can be trusted”; and 86.5% to 67.9% for “The advice of my clinician is consistent with other members of the diabetes team". Diabetes educators received the highest ratings on all aspects of SDM. The mean weighted average of

The role of cognitive operations in reality monitoring: a study with healthy older adults and Alzheimer's-type dementia.

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Fairfield, Beth; Mammarella, Nicola

2009-01-01

The authors examined the role of cognitive operations in discriminations between externally and internally generated events (e.g., reality monitoring) in healthy and pathological aging. The authors used 2 reality-monitoring distinctions to manipulate the quantity and quality of necessary cognitive operations: discriminating between I performed versus I imagined performing and between I watched another perform versus I imagined another performing. Older adults had more difficulty than did younger adults when discriminating between memories in both versions of the task. In addition, older adults with Alzheimer's-type dementia showed marked difficulties when attributing a source to imagined actions. The authors interpret these findings in terms of an age difficulty or the failure to use cognitive operations as useful cues during source monitoring.

Frailty transitions and types of death in Chinese older adults: a population-based cohort study

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Liu ZY

2018-05-01

Full Text Available Zu-yun Liu,1,* Yin-zhi Wei,2,* Li-qing Wei,3,* Xiao-yan Jiang,4 Xiao-feng Wang,5 Yan Shi,6 Hua Hai7 1Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA; 2Department of Geriatrics, Huangshi Central Hospital, Edong Healthcare Group, Huangshi, China; 3Department of Medical Laboratory, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; 4Key Laboratory of Arrhythmias of the Ministry of Education of China, Tongji University School of Medicine, Shanghai, China; 5Unit of Epidemiology, Ministry of Education Key Laboratory of Contemporary Anthropology, School of Life Sciences, Fudan University, Shanghai, China; 6Department of Emergency, Huai’an Second People’s Hospital and the Affiliated Huai’an Hospital of Xuzhou Medical University, Huai’an, China; 7Department of Intensive Care Unit, Xuyi People’s Hospital, Xuyi, China *These authors contributed equally to this work Background: Little is known about the adverse effects of frailty transitions. In this study, we aimed to characterize the transitions between frailty states and examine their associations with the type of death among older adults in China, a developing country with a rapidly growing aging population. Methods: We used data of 11,165 older adults (aged 65–99 years from the 2002 and 2005 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS. Overall, 44 health deficits were used to construct frailty index (FI; range: 0–1, which was then categorized into a three-level variable: nonfrail (FI ≤0.10, prefrail (0.10< FI ≤0.21, and frail (FI >0.21. Outcome was four types of death based on bedridden days and suffering state (assessed in the 2008 wave of CLHLS. Results: During the 3-year period, 3,394 (30.4% participants had transitioned between different frailty states (nonfrail, prefrail, and frail, one-third transitioned to death, and one-third remained in previous frailty states

Barriers and facilitators associated with attendance at hospital diabetes clinics among young adults (15-30 years) with type 1 diabetes mellitus: a systematic review.

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Hynes, Lisa; Byrne, Molly; Dinneen, Sean F; McGuire, Brian E; O'Donnell, Máire; Mc Sharry, Jennifer

2016-11-01

Regular clinic attendance is recommended to facilitate self-management of diabetes. Poor attendance is common among young adults with type 1 diabetes mellitus (DM). This systematic review aimed to produce a narrative synthesis of the evidence regarding factors which promote or impede regular attendance at adult diabetes clinics among young adults (15-30 years) with type 1 DM. Studies reporting facilitators and barriers to clinic attendance were identified by searching four electronic databases, checking reference lists, and contacting diabetes research networks. A total of 12 studies (8 quantitative and 4 qualitative) met the inclusion criteria. Young adult's experiences transitioning from paediatric to adult diabetes care can influence attendance at the adult clinic positively if there is a comprehensive transition programme in place, or negatively if the two clinics do not communicate and provide adequate support. Post-transition, relationship development and perceptions of the value of attending the clinic are important for regular attendance. Controlled research is required to better understand decisions to attend or not attend outpatient services among people with chronic conditions. Service delivery must be sensitive to the developmental characteristics of young adults and tailored support may be required by young adults at greatest risk of non-attendance. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

The association between cardiovascular disease and type 2 diabetes in adults with atopic dermatitis

DEFF Research Database (Denmark)

Thyssen, J P; Halling-Overgaard, A-S; Andersen, Y M F

2017-01-01

databases. Data extraction was done by two independent reviewers. We found a total of 2,855 citations, of which 53 were considered relevant based on title and abstract. Sixteen publications were included in the qualitative analysis, of which 13 were also included in a quantitative meta-analysis of crude...... 0.83-1.56), but a positive association was observed with angina pectoris (OR 1.73; 95% CI 1.27-2.37). Meta-analysis on adjusted data gave similar results. While adults with AD in some populations have increased prevalence of cardiovascular risk factors, such as obesity and smoking, it is unlikely......Recent studies examining the association between atopic dermatitis (AD) and cardiovascular disease (CVD) and type 2 diabetes have shown inconsistent results. We compared the risk of CVD and diabetes between adult patients with and without AD by searching the Pubmed, Embase, and Web of Science...

Depression and diabetes distress in adults with type 2 diabetes: results from the Australian National Diabetes Audit (ANDA) 2016.

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Nanayakkara, Natalie; Pease, Anthony; Ranasinha, Sanjeeva; Wischer, Natalie; Andrikopoulos, Sofianos; Speight, Jane; de Courten, Barbora; Zoungas, Sophia

2018-05-18

This study explores the prevalence of, and factors associated with, likely depression and diabetes distress in adults with type 2 diabetes in a large, national sample. Australian National Diabetes Audit data were analysed from adults with type 2 diabetes attending 50 diabetes centres. The Brief Case find for Depression and Diabetes Distress Score 17 were administered to screen for likely depression and diabetes-related distress, respectively. A total of 2,552 adults with type 2 diabetes participated: (mean ± SD) age was 63 ± 13 years, diabetes duration was 12 ± 10 years, and HbA1c was 8 ± 2%. Twenty-nine percent of patients had likely depression, 7% had high diabetes distress, and 5% had both. Difficulty following dietary recommendations, smoking, forgetting medications, and diabetes distress were all associated with greater odds of depression whereas higher own health rating was associated with lower odds (all p < 0.02). Female gender, increasing HbA1c, insulin use, difficulty following dietary recommendations and depression were all associated with greater odds of diabetes distress & older age, higher own health rating and monitoring blood glucose levels as recommended were associated with lower odds (all p < 0.04). Depression was associated with sub-optimal self-care, while diabetes distress was associated with higher HbA1c and sub-optimal self-care.

Effects of body weight on antibody titers against canine parvovirus type 2, canine distemper virus, and canine adenovirus type 1 in vaccinated domestic adult dogs.

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Taguchi, Masayuki; Namikawa, Kazuhiko; Maruo, Takuya; Saito, Miyoko; Lynch, Jonathan; Sahara, Hiroeki

2012-10-01

The objective of this study was to determine whether post-vaccination antibody titers vary according to body weight in adult dogs. Antibody titers against canine parvovirus type 2 (CPV-2), canine distemper virus (CDV), and canine adenovirus type 1 (CAdV-1) were measured for 978 domestic adult dogs from 2 to 6 y of age. The dogs had been vaccinated approximately 12 mo earlier with a commercial combination vaccine. The dogs were divided into groups according to their weight. It was found that mean antibody titers in all weight groups were sufficient to prevent infection. Intergroup comparison, however, revealed that CPV-2 antibody titers were significantly higher in the Super Light ( 20 kg) groups and were also significantly higher in the Light (5 to 9.9 kg) group than in the Heavy group. Antibody titers against CDV were significantly higher in the Super Light, Light, and Medium groups than in the Heavy group. There were no significant differences among the groups for the CAdV-1 antibody titers.

Herpes simplex virus type 2 seropositivity among urban adults in Africa - Results from two cross-sectional surveys in Addis Ababa, Ethiopia

NARCIS (Netherlands)

Mihret, Wude; Rinke de Wit, Tobias F.; Petros, Beyene; Mekonnen, Yared; Tsegaye, Aster; Wolday, Dawit; Beyene, Asfaw; Aklilu, Mathias; Sanders, Eduard; Fontanet, Arnaud L.

2002-01-01

BACKGROUND: Although several surveys investigating the epidemiology of herpes simplex virus type 2 (HSV-2) infection using type-specific immunologic assays have been carried out in Africa, none has examined the risk factors for HSV-2 infection in a representative sample from an urban adult

Sources of Caffeine in Diets of US Children and Adults: Trends by Beverage Type and Purchase Location

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Drewnowski, Adam; Rehm, Colin D.

2016-01-01

New sources of caffeine, besides coffee and tea, have been introduced into the US food supply. Data on caffeine consumption age and purchase location can help guide public health policy. National Health and Nutrition Examination Surveys (NHANES) were used to estimate population-level caffeine intakes, using data from 24-h dietary recall. First, caffeine intakes by age-group and beverage type were estimated using the most recent 2011–2012 data (n = 7456). Second, fourteen years trends in caffeine consumption, overall and by beverage type, were evaluated for adults and children. Trend analyses were conducted by age groups. Last, trends in caffeine intakes by purchase location and beverage type were estimated. In 2011–2012, children aged four to eight years consumed the least caffeine (15 mg/day), and adults aged 51–70 years consumed the most (213 mg/day). The population mean (age ≥ four years) was 135 mg/day, driven largely by coffee (90 mg/day), tea (25 mg/day), and soda (21 mg/day). For the 14–19 years and 20–34 years age-groups, energy drinks contributed 6 mg/day (9.9%) and 5 mg/day (4.5%), respectively. The bulk of caffeine came from store-bought coffee and tea. Among both children and adults combined, caffeine intakes declined from 175 mg/day (1999–2000) to 142 mg/day (2011–2012), largely driven by a drop in caffeine from soda (41 mg/day to 21 mg/day). Store-bought coffee and tea remain principal drivers of caffeine intake in the US. Sodas and energy drinks make minor contributions to overall caffeine intakes. PMID:26978391

Sources of Caffeine in Diets of US Children and Adults: Trends by Beverage Type and Purchase Location.

Science.gov (United States)

Drewnowski, Adam; Rehm, Colin D

2016-03-10

New sources of caffeine, besides coffee and tea, have been introduced into the US food supply. Data on caffeine consumption age and purchase location can help guide public health policy. National Health and Nutrition Examination Surveys (NHANES) were used to estimate population-level caffeine intakes, using data from 24-h dietary recall. First, caffeine intakes by age-group and beverage type were estimated using the most recent 2011-2012 data (n = 7456). Second, fourteen years trends in caffeine consumption, overall and by beverage type, were evaluated for adults and children. Trend analyses were conducted by age groups. Last, trends in caffeine intakes by purchase location and beverage type were estimated. In 2011-2012, children aged four to eight years consumed the least caffeine (15 mg/day), and adults aged 51-70 years consumed the most (213 mg/day). The population mean (age ≥ four years) was 135 mg/day, driven largely by coffee (90 mg/day), tea (25 mg/day), and soda (21 mg/day). For the 14-19 years and 20-34 years age-groups, energy drinks contributed 6 mg/day (9.9%) and 5 mg/day (4.5%), respectively. The bulk of caffeine came from store-bought coffee and tea. Among both children and adults combined, caffeine intakes declined from 175 mg/day (1999-2000) to 142 mg/day (2011-2012), largely driven by a drop in caffeine from soda (41 mg/day to 21 mg/day). Store-bought coffee and tea remain principal drivers of caffeine intake in the US. Sodas and energy drinks make minor contributions to overall caffeine intakes.

Sources of Caffeine in Diets of US Children and Adults: Trends by Beverage Type and Purchase Location

Directory of Open Access Journals (Sweden)

Adam Drewnowski

2016-03-01

Full Text Available New sources of caffeine, besides coffee and tea, have been introduced into the US food supply. Data on caffeine consumption age and purchase location can help guide public health policy. National Health and Nutrition Examination Surveys (NHANES were used to estimate population-level caffeine intakes, using data from 24-h dietary recall. First, caffeine intakes by age-group and beverage type were estimated using the most recent 2011–2012 data (n = 7456. Second, fourteen years trends in caffeine consumption, overall and by beverage type, were evaluated for adults and children. Trend analyses were conducted by age groups. Last, trends in caffeine intakes by purchase location and beverage type were estimated. In 2011–2012, children aged four to eight years consumed the least caffeine (15 mg/day, and adults aged 51–70 years consumed the most (213 mg/day. The population mean (age ≥ four years was 135 mg/day, driven largely by coffee (90 mg/day, tea (25 mg/day, and soda (21 mg/day. For the 14–19 years and 20–34 years age-groups, energy drinks contributed 6 mg/day (9.9% and 5 mg/day (4.5%, respectively. The bulk of caffeine came from store-bought coffee and tea. Among both children and adults combined, caffeine intakes declined from 175 mg/day (1999–2000 to 142 mg/day (2011–2012, largely driven by a drop in caffeine from soda (41 mg/day to 21 mg/day. Store-bought coffee and tea remain principal drivers of caffeine intake in the US. Sodas and energy drinks make minor contributions to overall caffeine intakes.

Adherence decision making in the everyday lives of emerging adults with type 1 diabetes

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Pyatak EA

2013-07-01

Full Text Available Elizabeth A Pyatak,1 Daniella Florindez,1 Marc J Weigensberg2 1Division of Occupational Science and Occupational Therapy, University of Southern California, 2Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA Purpose: The purpose of this study was to explore motivations underlying nonadherent treatment decisions made by young adults with type 1 diabetes. Methods: Eight emerging adults each completed a series of semi-structured interviews concerning their approaches to diabetes care, relationships with clinicians, and everyday activities and routines. A narrative thematic analysis was used to develop initial themes and refine them through continued data collection and review of the research literature. Results: Five themes were identified as motivating nonadherence: (1 efforts to mislead health care providers, (2 adherence to alternative standards, (3 treatment fatigue and burnout, (4 social support problems, and (5 emotional and self-efficacy problems. Conclusion: Instances of nonadherence generally involved a combination of the five identified themes. Participants reporting nonadherence also described difficulties communicating with care providers regarding their treatment. Nonjudgmental communication between providers and emerging adults may be particularly important in promoting positive health outcomes in this population. Keywords: compliance, health behavior, nonadherence, motivations

Web-based depression treatment for type 1 and type 2 diabetic patients

DEFF Research Database (Denmark)

van Bastelaar, Kim M P; Pouwer, Francois; Cuijpers, Pim

2011-01-01

intervention on a large scale at relatively low costs. This study evaluated the effectiveness of Web-based CBT for depression treatment in adults with type 1 or type 2 diabetes, with minimal guidance. RESEARCH DESIGN AND METHODS: A randomized controlled trial was conducted in the Netherlands in 255 adult...... no beneficial effect on glycemic control (P > 0.05). CONCLUSIONS: Web-based CBT depression treatment is effective in reducing depressive symptoms in adults with type 1 and type 2 diabetes. In addition, the intervention reduces diabetes-specific emotional distress in depressed patients.......OBJECTIVE: Comorbid depression is common in patients with type 1 and type 2 diabetes, adversely affecting quality of life, diabetes outcomes, and mortality. Depression can be effectively treated with cognitive behavior therapy (CBT). The Internet is a new and attractive method for delivering CBT...

Development of a situation-specific theory for explaining health-related quality of life among older South Korean adults with type 2 diabetes.

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Chang, Sun Ju; Im, Eun-Ok

2014-01-01

The purpose of the study was to develop a situation-specific theory for explaining health-related quality of life (QOL) among older South Korean adults with type 2 diabetes. To develop a situation-specific theory, three sources were considered: (a) the conceptual model of health promotion and QOL for people with chronic and disabling conditions (an existing theory related to the QOL in patients with chronic diseases); (b) a literature review using multiple databases including Cumulative Index for Nursing and Allied Health Literature (CINAHL), PubMed, PsycINFO, and two Korean databases; and (c) findings from our structural equation modeling study on health-related QOL in older South Korean adults with type 2 diabetes. The proposed situation-specific theory is constructed with six major concepts including barriers, resources, perceptual factors, psychosocial factors, health-promoting behaviors, and health-related QOL. The theory also provides the interrelationships among concepts. Health care providers and nurses could incorporate the proposed situation-specific theory into development of diabetes education programs for improving health-related QOL in older South Korean adults with type 2 diabetes.

Differential effect of race, education, gender, and language discrimination on glycemic control in adults with type 2 diabetes.

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Reynolds, D Brice; Walker, Rebekah J; Campbell, Jennifer A; Egede, Leonard E

2015-04-01

Discrimination has been linked to negative health outcomes, but little research has investigated different types of discrimination to determine if some have a greater impact on outcomes. We examined the differential effect of discrimination based on race, level of education, gender, and language on glycemic control in adults with type 2 diabetes. Six hundred two patients with type 2 diabetes from two adult primary care clinics in the southeastern United States completed validated questionnaires. Questions included perceived discrimination because of race/ethnicity, level of education, sex/gender, or language. A multiple linear regression model assessed the differential effect of each type of perceived discrimination on glycemic control while adjusting for relevant covariates, including race, site, gender, marital status, duration of diabetes, number of years in school, number of hours worked per week, income, and health status. The mean age was 61.5 years, and the mean duration of diabetes was 12.3 years. Of the sample, 61.6% were men, and 64.9% were non-Hispanic black. In adjusted models, education discrimination remained significantly associated with glycemic control (β=0.47; 95% confidence interval, 0.03, 0.92). Race, gender and language discrimination were not significantly associated with poor glycemic control in either unadjusted or adjusted analyses. Discrimination based on education was found to be significantly associated with poor glycemic control. The findings suggest that education discrimination may be an important social determinant to consider when providing care to patients with type 2 diabetes and should be assessed separate from other types of discrimination, such as that based on race.

Techniques for Exercise Preparation and Management in Adults with Type 1 Diabetes.

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Pinsker, Jordan E; Kraus, Amy; Gianferante, Danielle; Schoenberg, Benjamen E; Singh, Satbir K; Ortiz, Hallie; Dassau, Eyal; Kerr, David

2016-12-01

People with type 1 diabetes are at risk for early- and late-onset hypoglycemia following exercise. Reducing this risk may be possible with strategic modifications in carbohydrate intake and insulin use. We examined the exercise preparations and management techniques used by individuals with type 1 diabetes before and after physical activity and sought to determine whether use of differing diabetes technologies affects these health-related behaviours. We studied 502 adults from the Type 1 Diabetes Exchange's online patient community, Glu, who had completed an online survey focused on diabetes self-management and exercise. Many respondents reported increasing carbohydrate intake before (79%) and after (66%) exercise as well as decreasing their meal boluses before (53%) and after (46%) exercise. Most reported adhering to a target glucose level before starting exercise (77%). Despite these accommodations, the majority reported low blood glucose (BG) levels after exercise (70%). The majority of users of both insulin pump therapy (CSII) and continuous glucose monitoring (CGM) (Combined) reported reducing basal insulin around exercise (55%), with fewer participants adjusting basal insulin when using other devices (SMBG only = 20%; CGM = 34%; CSII = 42%; pmanagement strategies tailored to individuals' overall diabetes management, for despite making exercise-specific adjustments for care, many people with type 1 diabetes still report significant difficulties with BG control when it comes to exercise. Copyright © 2016 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.

Caries and salivary status in young adults with type 1 diabetes.

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Edblad, E; Lundin, S A; Sjödin, B; Aman, J

2001-01-01

The aim of this study was to evaluate the salivary status, prevalence of caries and the status of primary dentition, when primary teeth were exfoliated, in 41 patients, 18-24 years of age, with type 1 diabetes since childhood in comparison with age- and sex-matched non-diabetic controls. The blood glucose and glycosylated haemoglobin concentration (HbA1c), dosage of daily insulin and retinal fundus photography was recorded for the diabetic group. According to the concentration of HbA1c, the diabetic patients were divided into well and poorly controlled groups. The study was based on three intra-oral photos, dental examination including intra-oral radiographs, flow rate and buffering capacity of the saliva and amount of Streptococcus mutans and Lactobacilli. Retrospective data regarding the primary dentition was found in the dental files of each patient, and are based on the last registration for respective tooth before exfoliation. The patients with type 1 diabetes, without any relationship to metabolic control, displayed more initial buccal caries compared to healthy controls (pflow rate, buffering capacity nor amount of Streptococcus mutans and Lactobacilli), manifest caries or the status of the primary dentition were seen. We conclude that initial, but not manifest caries seems to be overrepresented in young adults with type 1 diabetes. These patients, thus, need more intense efforts regarding dental health care to prevent the development from initial to manifest caries.

Liver and Skin Histopathology in Adults with Acid Sphingomyelinase Deficiency (Niemann-Pick Disease Type B)

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Thurberg, Beth L.; Wasserstein, Melissa P.; Schiano, Thomas; O’Brien, Fanny; Richards, Susan; Cox, Gerald F.; McGovern, Margaret M.

2012-01-01

Acid sphingomyelinase deficiency (ASMD) is a lysosomal storage disorder characterized by the pathologic accumulation of sphingomyelin in multiple cells types, and occurs most prominently within the liver, spleen and lungs, leading to significant clinical disease. Seventeen ASMD patients underwent a liver biopsy during baseline screening for a Phase 1 trial of recombinant human acid sphingomyelinase (rhASM) in adults with Niemann-Pick disease type B. Eleven of the 17 were enrolled in the trial and each received a single dose of rhASM and underwent a repeat liver biopsy on Day 14. Biopsies were evaluated for fibrosis, sphingomyelin accumulation and macrophage infiltration by light and electron microscopy. When present, fibrosis was periportal and pericellular, predominantly surrounding affected Kupffer cells. Two baseline biopsies exhibited frank cirrhosis. Sphingomyelin was localized to isolated Kupffer cells in mildly affected biopsies and was present in both Kupffer cells and hepatocytes in more severely affected cases. Morphometric quantification of sphingomyelin storage in liver biopsies ranged from 4–44% of the microscopic field. Skin biopsies were also performed at baseline and Day 14 in order to compare the sphingomyelin distribution in a peripheral tissue to that of liver. Sphingomyelin storage was present at lower levels in multiple cell types of the skin, including dermal fibroblasts, macrophages, vascular endothelial cells, vascular smooth muscle cells and Schwann cells. This Phase 1 trial of rhASM in adults with ASMD provided a unique opportunity for a prospective assessment of hepatic and skin pathology in this rare disease and their potential usage as pharmacodynamic biomarkers. PMID:22613999

Cross-sectional analysis of adult diabetes type 1 and type 2 patients with diabetic microvascular complications from a German retrospective observational study.

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Happich, M; Breitscheidel, L; Meisinger, C; Ulbig, M; Falkenstein, P; Benter, U; Watkins, J

2007-06-01

To obtain epidemiological data on the prevalence of predefined stages of diabetic microvascular complications from a representative cross-section of patients with existing microvascular complications of type 1 or type 2 diabetes in Germany. A cross-sectional, retrospective study of medical records of 705 type 1 and 1910 type 2 adult diabetic patients with a diagnosis of retinopathy and/or peripheral neuropathy and/or nephropathy before 2002 and treated in 2002 in Germany. Of 376 patients with type 1 diabetes having retinopathy, 59.3% had mild or moderate non-proliferative retinopathy without macular oedema, 27.1% had macular oedema, and 13.6% had severe retinopathy without macular oedema. In 862 patients with type 2 diabetes, the distribution of retinopathy/maculopathy classes was 56.8%, 35.5%, and 7.7%, respectively. Of 381 type 1 diabetes patients with observed peripheral neuropathy, 81.4% had sensorimotor neuropathy, 8.9% had diabetic foot conditions, and 9.7% had lower extremity amputations because of diabetes. In 1005 patients with type 2 diabetes, the distribution of neuropathy classes was 78.2%, 12.1%, and 9.7%, respectively. The proportions of patients with renal insufficiency in type 1 and type 2 diabetes groups were 15.3% versus 13.5%, respectively. The study suggests that there are considerable proportions of patients with progressive stages of microvascular complications related to type 1 and type 2 diabetes in Germany. This underlines the importance of improvement of optimal quality of care and frequent screening for preventing late diabetic microvascular complications and the necessity of effective intervention strategies to tackle this major public health problem.

Different types of additional somatosensory information do not promote immediate benefits on gait in patients with Parkinson's disease and older adults

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Ellen Lirani-Silva

2015-09-01

Full Text Available AbstractPlantar cutaneous stimulation has been shown to improve gait in Parkinson's disease (PD, but the effects of different types of insoles have not been tested. We evaluated the immediate effect of different types of insoles on gait in PD patients and healthy older adults. Nineteen PD patients and nineteen healthy older adults performed and performed a walking task at their self-selected speed in three conditions: conventional insole, insole with a raised ridge around the foot perimeter, and insole with half-spheres. Plantar sensation was evaluated before and after the walking protocol. There were no differences between groups for plantar sensation before and after the walking task. PD patients demonstrated reduced stride length and stride velocity. There were no immediate benefits offered by the insoles on gait of either group. The increased plantar cutaneous stimulation does not promote immediate benefits on gait in PD patients and healthy older adults.

Impact of a brief intervention on self-regulation, self-efficacy and physical activity in older adults with type 2 diabetes

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Olson, Erin A.; McAuley, Edward

2015-01-01

Despite evidence of the benefits of physical activity, most individuals with type 2 diabetes do not meet physical activity recommendations. The purpose of this study was to test the efficacy of a brief intervention targeting self-efficacy and self-regulation to increase physical activity in older adults with type 2 diabetes. Older adults (Mage = 61.8 ± 6.4) with type 2 diabetes or metabolic syndrome were randomized into a titrated physical activity intervention (n = 58) or an online health education course (n = 58). The intervention included walking exercise and theory-based group workshops. Self-efficacy, self-regulation and physical activity were assessed at baseline, post-intervention, and a follow-up. Results indicated a group by time effect for self-regulation [F(2,88) = 14.021, p self-efficacy [F(12,77) = 2.322, p self-efficacy and self-regulation. Future research warrants adjusting intervention strategies to increase long-term change. PMID:26162648

Self-care behaviors of adults with type 2 diabetes mellitus in Greece.

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Chourdakis, Michael; Kontogiannis, Vasileios; Malachas, Konstantinos; Pliakas, Triantafyllos; Kritis, Aristidis

2014-10-01

The purpose of this study was to examine self-care behaviors of adults with type 2 diabetes mellitus living in the Metropolitan Area of Thessaloniki in Northern Greece. The Summary of Diabetes Self-Care behaviors measurement was administered to 215 patients, out of which 177 were eligible to participate (87 males). Patients, aged 30 years or more, were recruited through a university hospital day-clinic. Older patients (>65 years), as well as those with "higher educational level" did not distribute their daily carbohydrate intake equally. Nevertheless, they were more likely to adapt to their physician's recommendations regarding medication and to regularly perform suggested blood glucose checking. Exercise patterns were more often found for higher educated, earlier diagnosed males. Younger patients were less likely to follow their healthcare professional's recommendations, regarding diet, medication intake, blood glucose checking, foot care and exercise compared to older patients. These results pose a higher risk for complications and morbidity in younger patients with type 2 diabetes mellitus, who most possibly will require intensive treatment in the future.

Self-monitoring of blood glucose experiences of adults with type 2 diabetes.

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Dlugasch, Lucie B; Ugarriza, Doris N

2014-06-01

The purpose of this study was to analyze the experiences of self-monitoring of blood glucose (SMBG) usage of adults with type 2 diabetes mellitus (T2DM) who are not using insulin. Nineteen adults were asked to describe their experiences with self-monitoring. Data were analyzed using the grounded theory method. The theory of "SMBG as a Cue in T2DM Self-Care" emerged from the data and is composed of four categories: (a) Engaging, (b) Checking, (c) Responding, and (d) Establishing a Pattern. Engaging marks the beginning. Frequent monitoring characterizes this stage. Checking involves evaluating and validating the blood glucose level. The most common item evaluated or validated was the effect of foods. Responding involves taking action or experiencing emotion. Actions taken centered on dietary changes. Emotions felt were dependent on the level and ranged from blame to happiness. Participants established a pattern and used SMBG regularly or sporadically. Frequency was based on obtaining "normal" patterns, the absence of symptoms, provider disinterest, and fingertip pain. Participants described many benefits and struggles when incorporating SMBG into their self-care. Information from this study could be used to develop effective guidelines for the use of SMBG in T2DM. ©2013 The Author(s) ©2013 American Association of Nurse Practitioners.

Effects of yoga in adults with type 2 diabetes mellitus: A meta-analysis.

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Cui, Jie; Yan, Jun-Hong; Yan, Li-Ming; Pan, Lei; Le, Jia-Jin; Guo, Yong-Zhong

2017-03-01

A meta-analysis was carried out to evaluate the efficacy of yoga in adults with type 2 diabetes mellitus. The PubMed, EMBASE and Cochrane databases were searched to obtain eligible randomized controlled trials. The primary outcome was fasting blood glucose, and the secondary outcomes included glycosylated hemoglobin A1c, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglyceride and postprandial blood glucose. Weighted mean differences and 95% confidence intervals (CIs) were calculated. The I 2 statistic represented heterogeneity. A total of 12 randomized controlled trials with a total of 864 patients met the inclusion criteria. The pooled weighted mean differences were -23.72 mg/dL (95% CI -37.78 to -9.65; P = 0.001; I 2 = 82%) for fasting blood glucose and -0.47% (95% CI -0.87 to -0.07; P = 0.02; I 2 = 82%) for hemoglobin A1c. The weighted mean differences were -17.38 mg/dL (95% CI -27.88 to -6.89; P = 0.001; I 2 = 0%) for postprandial blood glucose, -18.50 mg/dL (95% CI -29.88 to -7.11; P = 0.001; I 2 = 75%) for total cholesterol, 4.30 mg/dL (95% CI 3.25 to 5.36; P 2 = 10%) for high-density lipoprotein cholesterol, -12.95 mg/dL (95% CI -18.84 to -7.06; P 2 = 37%) for low-density lipoprotein cholesterol and -12.57 mg/dL (95% CI -29.91 to 4.76; P = 0.16; I 2 = 48%) for triglycerides. The available evidence suggests that yoga benefits adult patients with type 2 diabetes mellitus. However, considering the limited methodology and the potential heterogeneity, further studies are necessary to support our findings and investigate the long-term effects of yoga in type 2 diabetes mellitus patients. © 2016 The Authors. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd.

The relationship between generic and diabetes specific psychological factors and glycaemic control in adults with type 1 diabetes

DEFF Research Database (Denmark)

Shaban, C.; Fosbury, J. A.; Cavan, D. A.

2009-01-01

259 adults with type 1 diabetes completed measure of anxiety, depression and diabetes specific distress, HbA1c from medical records. Anxiety not depression predicted HbA1c, this association was mediated by illness specific cognitions. Targeting illness specific cognitions may be more productive...

Invasive pneumococcal disease in healthy adults: increase of empyema associated with the clonal-type Sweden(1-ST306.

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Imma Grau

Full Text Available BACKGROUND: Adult invasive pneumococcal disease (IPD occurs mainly in the elderly and patients with co-morbidities. Little is known about the clinical characteristics, serotypes and genotypes causing IPD in healthy adults. METHODS: We studied 745 culture-proven cases of IPD in adult patients aged 18-64 years (1996-2010. Patients were included in two groups: 1. adults with co-morbidities, and 2. healthy adults, who had no prior or coincident diagnosis of a chronic or immunosuppressive underlying disease. Microbiological studies included pneumococcal serotyping and genotyping. RESULTS: Of 745 IPD episodes, 525 (70% occurred in patients with co-morbidities and 220 (30% in healthy adults. The healthy adults with IPD were often smokers (56% or alcohol abusers (18%. As compared to patients with co-morbidities, the healthy adults had (P<0.05: younger age (43.5+/-13.1 vs. 48.7+/-11.3 years; higher proportions of women (45% vs. 24%, pneumonia with empyema (15% vs. 7% and infection with non-PCV7 serotypes including serotypes 1 (25% vs. 5%, 7F (13% vs. 4%, and 5 (7% vs. 2%; and lower mortality (5% vs. 20%. Empyema was more frequently caused by serotype 1. No death occurred among 79 patients with serotype 1 IPD. There was an emergence of virulent clonal-types Sweden(1-ST306 and Netherlands(7F-ST191. The vaccine serotype coverage with the PCV13 was higher in healthy adults than in patients with co-morbidities: 82% and 56%, respectively, P<0.001. CONCLUSION: In this clinical study, one-third of adults with IPD had no underlying chronic or immunosuppressive diseases (healthy adults. They were often smokers and alcohol abusers, and frequently presents with pneumonia and empyema caused by virulent clones of non-PCV7 serotypes such as the Sweden(1-ST306. Thus, implementing tobacco and alcohol abuse-cessation measures and a proper pneumococcal vaccination, such as PCV13 policy, in active smokers and alcohol abusers may diminish the burden of IPD in adults.

[The influence of metabolic disturbances present in diabetes mellitus type I on vestibulo-spinal reflexes in children and young adults].

Science.gov (United States)

Gawron, Wojciech; Pośpiech, Lucyna; Orendorz-Fraczkowska, Krystyna; Noczyńska, Anna

2002-01-01

Diabetic neuropathy encompasses various disturbances concerning somatic and autonomic nervous system and has significant impact on prognosis and course of diabetes mellitus. The aim of the work is an evaluation of vestibulo-spinal reflexes in children and young adults suffering from diabetes mellitus type 1. Material--95 children and young adults aged from 6 to 28 years with diabetes mellitus type 1 diagnosed. The control group consisted of 44 otoneurologically healthy subjects aged from 6 to 28 years. After detailed medical history collection and physical ENT examination stato-posturography was performed in each case. Posturographer PE 62 Model 04 was applied in the studies. Static posturography as well as dynamic one (one leg standing test) was performed in each case. 6 patients belonging to diabetic group complained about vertigo or dizziness. There were worse stabilograms parameters in diabetic group in comparison to control one, statistically significant in younger children. There were better stabilogram parameters in diabetic patients with longer history of the disease. The parameters analysed were significantly worse in the subgroup with not compensated diabetes. The parameters were slightly better in relation to the presence of hypoglycaemic incidents. No apparent differences in stabilograms parameters were present in relation to the presence of diabetic complications. Diabetes mellitus type 1 with slight or without complications does not have significant influence on vestibulo-spinal reflexes and posture stability of the patients. Balance organ disturbances in diabetes mellitus type 1 in children and young adults despite their presence have subclinical course. Perhaps one should consider monitoring of those disturbances in the course of the disease.

Validation of an information-motivation-behavioral skills model of self-care among Chinese adults with type 2 diabetes.

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Gao, Junling; Wang, Jingli; Zhu, Yaocheng; Yu, Jinming

2013-02-04

Self-care is a crucial component of diabetes management. But comprehensive behavior change frameworks are needed to provide guidance for the design, implementation, and evaluation of diabetes self-care programs in diverse populations. We tested the Information-Motivation-Behavioral Skills (IMB) model in a sample of Chinese adults with Type 2 diabetes. A cross-sectional study of 222 Chinese adults with type 2 diabetes was conducted in a primary care center. We collected information on demographics, provider-patient communication (knowledge), social support (motivation), self-efficacy (behavioral skills), and diabetes self-care (behavior). The values of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) were also obtained. Measured variable path analyses were used to the IMB framework. Provider-patient communication (β = 0.12, p = .037), and social support (β = 0.19, p = .007) and self-efficacy (β = 0.41, p motivation and behavioral skills to effect behavior change.

Feasibility and effects of a physical exercise programme in adults with myotonic dystrophy type 1: a randomized controlled pilot study.

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Kierkegaard, Marie; Harms-Ringdahl, Karin; Edström, Lars; Widén Holmqvist, Lotta; Tollbäck, Anna

2011-07-01

To investigate the feasibility and effects of a physical exercise programme on functioning and health-related quality of life in adults with myotonic dystrophy type 1. A randomized controlled trial. Thirty-five adults with myotonic dystrophy type 1. After stratification for level of functioning, study participants were assigned by lot to either a training group or a control group. Training-group participants attended a 60-minute comprehensive group-training programme, Friskis&Svettis® Open Doors, twice a week for 14 weeks. The six-minute walk test was the primary outcome measure and the timed-stands test, the timed up-and-go test, the Epworth sleepiness scale and the Short Form-36 health survey were secondary outcome measures. Intention-to-treat analyses revealed no significant differences in any outcome measures, except for an increased between-group difference after intervention in the Short Form-36 mental health subscale and a decrease in the vitality subscale for the control group. The programme was well tolerated and many training-group participants perceived subjective changes for the better. No negative effects were reported. The Friskis&Svettis® Open Doors programme was feasible for adults with myotonic dystrophy type 1 who had been screened for cardiac involvement, had distal or mild-to-moderate proximal muscle impairment, and no severe cognitive impairments. No beneficial or detrimental effects were evident.

Adult Education in Liberia.

Science.gov (United States)

Smith, Robert M.

Adult education in Liberia is discussed as to the types of programs offered and the purposes and goals of each type. The programs are classified as Literacy Education, Continuing Education, Vocational Education, In-Service Education, and Fundamental Education. The needs of the adult Liberian in relation to the courses offered are discussed.…

Pituitary adenylate cyclase activating polypeptide reduces A-type K+ currents and caspase activity in cultured adult mouse olfactory neurons.

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Han, P; Lucero, M T

2005-01-01

Pituitary adenylate cyclase activating polypeptide has been shown to reduce apoptosis in neonatal cerebellar and olfactory receptor neurons, however the underlying mechanisms have not been elucidated. In addition, the neuroprotective effects of pituitary adenylate cyclase activating polypeptide have not been examined in adult tissues. To study the effects of pituitary adenylate cyclase activating polypeptide on neurons in apoptosis, we measured caspase activation in adult olfactory receptor neurons in vitro. Interestingly, we found that the protective effects of pituitary adenylate cyclase activating polypeptide were related to the absence of a 4-aminopyridine (IC50=144 microM) sensitive rapidly inactivating potassium current often referred to as A-type current. In the presence of 40 nM pituitary adenylate cyclase activating polypeptide 38, both A-type current and activated caspases were significantly reduced. A-type current reduction by pituitary adenylate cyclase activating polypeptide was blocked by inhibiting the phospholipase C pathway, but not the adenylyl cyclase pathway. Our observation that 5 mM 4-aminopyridine mimicked the caspase inhibiting effects of pituitary adenylate cyclase activating polypeptide indicates that A-type current is involved in apoptosis. This work contributes to our growing understanding that potassium currents are involved with the activation of caspases to affect the balance between cell life and death.

The effect of peer support in adults with insulin pump-treated type 1 diabetes

DEFF Research Database (Denmark)

Joensen, Lene Eide; Meldgaard Andersen, Merete; Jensen, Sabrina

2017-01-01

Aim: The aim of this study was to explore the effects of a flexible and participatory peer support intervention in a clinical setting for adults with type 1 diabetes treated with an insulin pump, focusing on enhancing diabetes-specific social capital. The key questions were as follows: 1) what...... empowerment, diabetes distress, diabetes-specific social support, and diabetes loneliness. HbA1c levels were compared before and after the intervention. Results: Participants experienced enhanced diabetes-specific social capital, diabetes motivation, awareness of personal diabetes practices, and serenity...

Integrating theory and data to create an online self-management programme for adults with type 2 diabetes: HeLP-Diabetes

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Kingshuk Pal

2015-10-01

This protocol demonstrates a multi-disciplinary approach to combining evidence from multiple sources to create ’HeLP-Diabetes’: a theory and evidence based online self-management intervention for adults with type 2 diabetes.

Overweight and the metabolic syndrome in adult offspring of women with diet-treated gestational diabetes mellitus or type 1 diabetes

DEFF Research Database (Denmark)

Clausen, Tine D; Mathiesen, Elisabeth R; Hansen, Torben

2009-01-01

Overweight and the metabolic syndrome in adult offspring of women with diet-treated gestational diabetes mellitus or type 1 diabetes Context: In animal studies exposure to intrauterine hyperglycemia increases the risk of cardiovascular disease through only partly understood epigenetic mechanisms....... Human long-term follow-up studies on the same topic are few. Objective: To study the risk of overweight and the metabolic syndrome in adult offspring of women with diet-treated gestational diabetes mellitus (GDM) or type 1 diabetes, and additionally to study associations between estimates of maternal...... hyperglycemia and outcome in the offspring Design: Follow-up study of 1,066 primarily Caucasians aged 18-27 years. Setting: Center for pregnant women with diabetes, Rigshospitalet, Denmark Participants: Offspring of women with diet-treated GDM (n=168) and an un-exposed reference group (n=141). Offspring...

Depression, anxiety and self-care behaviours of young adults with Type 2 diabetes : Results from the International Diabetes Management and Impact for Long-term Empowerment and Success (MILES) Study

NARCIS (Netherlands)

Browne, J. L.; Nefs, G.; Pouwer, F.; Speight, J.

2015-01-01

Aim Young adults with Type 2 diabetes have higher physical morbidity and mortality than other diabetes sub-groups, but differences in psychosocial outcomes have not yet been investigated. We sought to compare depression and anxiety symptoms and self-care behaviours of young adults with Type 2

Type 2 diabetes in young adults in Central Auckland: demography and complications.

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Beig, Junaid; Khanolkar, Manish; Cundy, Tim

2018-01-01

Type 2 diabetes (T2D) in young adults is associated with a high risk of diabetes complications. To investigated the demography and the emergence of complications of young adults with T2D in the central Auckland region where there has been substantial immigration. In total, 310 young adults with T2D (Auckland Diabetes Centre in 2015. We documented demographic, anthropometric and metabolic variables and prevalence and the emergence of complications. Three demographic groups accounted for 243 participants (78%): 135 (44%) were migrants of Asian or Pacific Island origin, diagnosed a median 9 years after migration at a mean age of 28 ± 6 years; 88 (29%) were New Zealand-born Pāsifika descent, with a high prevalence of morbid obesity and 37 (12%) had major mental illness or intellectual disability. At diagnosis, the median HbA1c was 80 mmol/mol, and in 28%, it was ≥100 mmol/mol. A median 6 years after diagnosis, 56% had some degree of retinopathy, with the prevalence related both to the duration of diabetes and glycaemic control (P = 0.001). Forty-four percent of subjects had abnormal albuminuria at diagnosis (12% with macroalbuminuria). Increased albuminuria was strongly associated with obesity (P = 0.002). The development of CKD stages 4-5 was related both to the severity of retinopathy and degree of albuminuria at diagnosis (P = 0.0001). Major cardiovascular events were related to the severity of retinopathy at diagnosis (P = 0.0001). New migrants, New Zealand-born Pāsifika and patients with mental illness or an intellectual disability comprise the bulk of young onset T2D. The disease is aggressive, and by the age of 40, patients are already developing advanced complications. © 2017 Royal Australasian College of Physicians.

Speech-in-noise perception deficit in adults with dyslexia: effects of background type and listening configuration.

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Dole, Marjorie; Hoen, Michel; Meunier, Fanny

2012-06-01

Developmental dyslexia is associated with impaired speech-in-noise perception. The goal of the present research was to further characterize this deficit in dyslexic adults. In order to specify the mechanisms and processing strategies used by adults with dyslexia during speech-in-noise perception, we explored the influence of background type, presenting single target-words against backgrounds made of cocktail party sounds, modulated speech-derived noise or stationary noise. We also evaluated the effect of three listening configurations differing in terms of the amount of spatial processing required. In a monaural condition, signal and noise were presented to the same ear while in a dichotic situation, target and concurrent sound were presented to two different ears, finally in a spatialised configuration, target and competing signals were presented as if they originated from slightly differing positions in the auditory scene. Our results confirm the presence of a speech-in-noise perception deficit in dyslexic adults, in particular when the competing signal is also speech, and when both signals are presented to the same ear, an observation potentially relating to phonological accounts of dyslexia. However, adult dyslexics demonstrated better levels of spatial release of masking than normal reading controls when the background was speech, suggesting that they are well able to rely on denoising strategies based on spatial auditory scene analysis strategies. Copyright © 2012 Elsevier Ltd. All rights reserved.

Comparison of the corneal endothelial cell count in type II diabetic patients with healthy adults

International Nuclear Information System (INIS)

Rizvi, B.Z.; Zafar, O.

2016-01-01

To compare the mean corneal endothelial cell count in type II diabetic patients with healthy adults. Study Design: Case control. Place and Duration of Study: Out-patient Department of Armed Forces Institute of Ophthalmology, Rawalpindi from September 10, 2013 to March 25, 2014. Material and Methods: A hospital-based case-control study was carried out at out-patient department of Armed Forces Institute of Ophthalmology in which 130 eyes (65 diabetic eyes and 65 controls) were included. Non-probability consecutive sampling was adopted. Relevant detailed history including information about age, gender, duration of diabetes, any other medical illness and current medical treatment being taken by patient was recorded. Results: Data entry and analysis was done in SPSS version 10. Total 130 eyes (65 diabetic and 65 non-diabetic eyes) were included in our study according to the inclusion criteria. Mean age (years) of patient in both the groups was 59.55 +- 8.01 and 53.85 +- 10.07. Mean corneal endothelial cell count in both the groups was 2368.35 +- 389.58 and 2588.64 +- 269.84 respectively which was statistically significant (p-value=0.001) in both the groups. Conclusion: The conclusion of the study was that the mean corneal endothelial cell count in type II diabetic patients was significantly less as compared to healthy adults. (author)

Immunity status of adults and children against poliomyelitis virus type 1 strains CHAT and Sabin (LSc-2ab) in Germany.

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Eggers, Maren; Terletskaia-Ladwig, Elena; Rabenau, Holger F; Doerr, Hans W; Diedrich, Sabine; Enders, Gisela; Enders, Martin

2010-12-09

In October 2007, the working group CEN/TC 216 of the European Committee for standardisation suggested that the Sabin oral poliovirus vaccine type 1 strain (LSc-2ab) presently used for virucidal tests should be replaced by another attenuated vaccine poliovirus type 1 strain, CHAT. Both strains were historically used as oral vaccines, but the Sabin type 1 strain was acknowledged to be more attenuated. In Germany, vaccination against poliomyelitis was introduced in 1962 using the oral polio vaccine (OPV) containing Sabin strain LSc-2ab. The vaccination schedule was changed from OPV to an inactivated polio vaccine (IPV) containing wild polio virus type 1 strain Mahoney in 1998. In the present study, we assessed potential differences in neutralising antibody titres to Sabin and CHAT in persons with a history of either OPV, IPV, or OPV with IPV booster. Neutralisation poliovirus antibodies against CHAT and Sabin 1 were measured in sera of 41 adults vaccinated with OPV. Additionally, sera from 28 children less than 10 years of age and immunised with IPV only were analysed. The neutralisation assay against poliovirus was performed according to WHO guidelines. The neutralisation activity against CHAT in adults with OPV vaccination history was significantly lower than against Sabin poliovirus type 1 strains (Wilcoxon signed-rank test P Sabin 1 varied between 8 and 64. Following IPV booster, anti-CHAT antibodies increased rapidly in sera of CHAT-negative adults with OPV history. Sera from children with IPV history neutralised CHAT and Sabin 1 strains equally. The lack of neutralising antibodies against the CHAT strain in persons vaccinated with OPV might be associated with an increased risk of reinfection with the CHAT polio virus type 1, and this implies a putative risk of transmission of the virus to polio-free communities. We strongly suggest that laboratory workers who were immunised with OPV receive a booster vaccination with IPV before handling CHAT in the laboratory.

A longitudinal analysis of salivary flow in control subjects and older adults with type 2 diabetes.

Science.gov (United States)

Chávez, E M; Borrell, L N; Taylor, G W; Ship, J A

2001-02-01

Many diabetics complain of xerostomia, a condition that can affect oral health, nutritional status, and diet selection. This study's purposes were (1) to investigate the effect on salivary flow of type 2 diabetes and change in glycemic control in a group of older adults over time and (2) to compare flow rates with subjective complaints of xerostomia. A total of 39 older adults, 24 with type 2 diabetes and 15 who were nondiabetic (controls), aged 54-90 years, participated in a 1-year follow-up study. Diabetic status was determined by means of glycosylated hemoglobin (HbA1c) levels and 2-hour glucose tolerance tests. Poor glycemic control was defined as HbA1c > 9%. Unstimulated whole, unstimulated parotid, and stimulated parotid saliva flow rates were measured for all subjects by a single examiner at baseline and 1 year later. Each subject completed a standardized xerostomia questionnaire at every visit. Age, sex, and duration of diabetes did not adversely affect salivary flow rates. Subjects with poorly controlled diabetes had significantly lower stimulated parotid saliva flow rates at both visits. There were no significant changes in flow rates over time on the basis of diabetic status or glycemic control. Subjects with diabetes reported significantly more complaints of thirst but not of xerostomia at 1 year. These results suggest that older adults with poorly controlled diabetes may have impaired salivary flow in comparison with subjects with better controlled diabetes and nondiabetic subjects, yet they may not have concomitant xerostomic complaints. There were no significant changes in salivary flow rates or glycemic control over the 1-year period.

Effects of exogenous fatty acids and inhibition of de novo fatty acid synthesis on disaturated phosphatidylcholine production by fetal lung cells and adult type II cells.

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Maniscalco, W M; Finkelstein, J N; Parkhurst, A B

1989-05-01

De novo fatty acid synthesis may be an important source of saturated fatty acids for fetal lung disaturated phosphatidylcholine (DSPC) production. To investigate the roles of de novo fatty acid synthesis and exogenous fatty acids, we incubated dispersed fetal lung cells and freshly isolated adult type II cells with exogenous palmitate and oleate and measured DSPC synthesis. Unlike adult type II cells, fetal lung cells did not increase DSPC synthesis when exogenous palmitate was available; adult type II cells increased DSPC synthesis by 70% in the presence of palmitate. Exogenous oleate decreased DSPC synthesis by 48% in fetal cells but not in adult type II cells. Incubation of fetal lung cells with TOFA [2-furancarboxylate, 5-(tetradecyloxy)-sodium], a metabolic inhibitor of fatty acid synthesis, decreased fatty acid synthesis by 65%. There was a simultaneous 56% inhibition of DSPC production, but no effect on protein, DNA, or glyceride-glycerol production, measured by precursor incorporation. The inhibition of DSPC synthesis associated with TOFA was partially prevented by exogenous palmitate but not oleate. Fetal cells prepared from explants that had been cultured in dexamethasone also had TOFA-associated inhibition of DSPC synthesis that was similar to non-dexamethasone-exposed cells. These studies suggest that under baseline conditions of low fatty acid availability, such as in the fetus, de novo fatty acid synthesis in fetal cells, but not in adult type II cells, provides sufficient saturated fatty acids to support maximal DSPC production. Inhibition of de novo fatty acid synthesis resulting in decreased DSPC production in fetal lung cells in conditions of low fatty acid availability suggests that fatty acid synthesis may be central to maintain DSPC synthesis in the fetus.

TRANSFER FROM PEDIATRIC TO ADULT ENDOCRINOLOGY.

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Jones, Marybeth R; Robbins, Brett W; Augustine, Marilyn; Doyle, Jackie; Mack-Fogg, Jean; Jones, Heather; White, Patience H

2017-07-01

Adult and pediatric endocrinologists share responsibility for the transition of youth with type 1 diabetes from pediatric to adult healthcare. This study aimed to increase successful transfers to adult care in subspecialty practices by establishing a systematic health care transition (HCT) process. Providers from the adult and pediatric endocrinology divisions at the University of Rochester Medical Center met monthly to customize and integrate the Six Core Elements (6CEs) of HCT into clinical workflows. Young adult patients with type 1 diabetes having an outpatient visit during a 34-month pre-post intervention period were eligible (N = 371). Retrospective chart review was performed on patients receiving referrals to adult endocrinology (n = 75) to obtain (1) the proportion of patients explicitly tracked during transfer from the pediatric to adult endocrinology practice, (2) the providers' documentation of the use of the 6CEs, and (3) the patients' diabetes control and healthcare utilization during the transition period. The percent of eligible patients with type 1 diabetes who were explicitly tracked in their transfer more than doubled compared to baseline (11% vs. 27% of eligible patients; P<.01). Pediatric providers started to use transition readiness assessments and create medical summaries, and adult providers increased closed-loop communication with pediatric providers after a patient's first adult visit. Glycemic control and healthcare utilization remained stable. Successful implementation of the 6CEs into pediatric and adult subspecialty practices can result in improvements of planned transfers of pediatric patients with type 1 diabetes to adult subspecialty providers. 6CEs = six core elements; AYA = adolescent and young adult; DKA = diabetic ketoacidosis; ED = emergency department; HbA1c = hemoglobin A1c; HCT = health care transition.

Diabetes self-management education and support delivered by mobile health (m-health) interventions for adults with type 2 diabetes mellitus

NARCIS (Netherlands)

Boels, Anne Meike; Vos, Rimke C.; Metzendorf, Maria-Inti; Rutten, Guy E.H.M.

2017-01-01

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effects of diabetes self-management education and support delivered by mobile health interventions in adults with type 2 diabetes mellitus.

Frailty and type of death among older adults in China: prospective cohort study

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Warner, David F; Yi, Zeng

2009-01-01

Objective To examine the association between frailty and type of death among the world’s largest oldest-old population in China. Design Prospective cohort study. Setting 2002 and 2005 waves of the Chinese longitudinal healthy longevity survey carried out in 22 provinces throughout China. Participants 13 717 older adults (aged ≥65). Main outcome measures Type of death, categorised as being bedridden for fewer than 30 days with or without suffering and being bedridden for 30 or more days with or without suffering. Results Multinomial analyses showed that higher levels of frailty significantly increased the relative risk ratios of mortality for all types of death. Of those with the highest levels of frailty, men were most likely to experience 30 or more bedridden days with suffering before death (relative risk ratio 8.70, 95% confidence interval 6.31 to 12.00) and women 30 or more bedridden days with no suffering (11.53, 17.84 to 16.96). Regardless of frailty, centenarians and nonagenarians were most likely to experience fewer than 30 bedridden days with no suffering, whereas those aged 65-79 and 80-89 were more likely to experience fewer than 30 bedridden days with suffering. Adjusting for compositional differences had little impact on the link between frailty and type of death for both sexes and age groups. Conclusions The association between frailty and type of death differs by sex and age. Health scholars and clinical practitioners should consider age and sex differences in frailty to develop more effective measures to reduce preventable suffering before death. PMID:19359289

Pharmacological approaches to the management of type 2 diabetes in fasting adults during Ramadan

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Al Sifri S

2012-08-01

Full Text Available Saud Al SifriEndocrinology Department, Alhada Armed Forces Hospital, Taif, Saudi ArabiaI read with great interest the recent review article by AlMaatouq regarding the pharmacological approaches to the management of type 2 diabetes in fasting adults during Ramadan.1 This article stated that "A recent prospective study of more than 1000 patients with T2DMwho fasted during Ramadan found that the risk of hypoglycemia associated with a vildagliptin-based regimen (vildagliptin 100 mg once daily was lower than that of a sulfonylurea-based regimen (both with and without metformin."1 This statement needs to be corrected.Ramadan is the lunar month observed each year in which Muslim adults will fast. This fast includes abstinence from eating, drinking, and smoking from sunrise to sunset. Hypoglycemia during this period represents the greatest health risk for these patients. Recently introduced modulators of the incretin system are the dipeptidylpeptidase-4 inhibitors, which include sitagliptin, vildagliptin, alogliptin, saxagliptin, and linagliptin. These agents are not associated with hypoglycemia.View original paper by AlMaatouq

Attitudes and barriers to exercise in adults with a recent diagnosis of type 1 diabetes: a qualitative study of participants in the Exercise for Type 1 Diabetes (EXTOD) study

OpenAIRE

Kennedy, Amy; Narendran, Parth; Andrews, Robert C; Daley, Amanda; Greenfield, Sheila M

2018-01-01

Objectives To explore attitudes and barriers to exercise in adults with new-onset type 1 diabetes mellitus (T1DM). Design Qualitative methodology using focus group (n=1), individual face-to-face (n=4) and telephone interviews (n=8). Thematic analysis using the Framework Method. Setting Nineteen UK hospital sites. Participants Fifteen participants in the Exercise for Type 1 Diabetes study. We explored current and past levels of exercise, understanding of exercise and exercise guidelines, barri...

The outcome of clinical parameters in adults with severe Type I Gaucher disease using very low dose enzyme replacement therapy.

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Wilson, Callum; Spearing, Ruth; Teague, Lochie; Robertson, Patsy; Blacklock, Hilary

2007-01-01

Enzyme replacement therapy is now well established as the treatment of choice in Type I Gaucher disease. Historically higher dosage regimens have been used in preference to lower doses despite the little clinical evidence in the way of large controlled clinical trials to support this. Moreover, the extraordinary cost of therapy means that not all eligible patients are able to be treated at the higher dose. Twelve type I adult patients with relatively severe disease were commenced on a very low dose of 7.5U of alglucerase/imiglucerase per kg every two weeks (initially given thrice weekly and later weekly). Follow-up 5 year data reveal a good visceral and haematological response with outcomes consistent with recently published treatment guidelines. Satisfactory clinical and radiological skeletal improvement was also demonstrated in most patients. Three patients had an inadequate overall skeletal response to therapy. Biomarkers also steadily improved although perhaps not quite at the same rate as that seen in higher doses. Very low dose enzyme replacement therapy may be appropriate for adult type I Gaucher patients with mild-moderate skeletal disease.

Stages of Adult Primary Liver Cancer

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... Treatment Liver Cancer Prevention Liver Cancer Screening Research Adult Primary Liver Cancer Treatment (PDQ®)–Patient Version Treatment ... are different types of treatment for patients with adult primary liver cancer. Different types of treatments are ...

Impact of case type, length of stay, institution type, and comorbidities on Medicare diagnosis-related group reimbursement for adult spinal deformity surgery.

Science.gov (United States)

Nunley, Pierce D; Mundis, Gregory M; Fessler, Richard G; Park, Paul; Zavatsky, Joseph M; Uribe, Juan S; Eastlack, Robert K; Chou, Dean; Wang, Michael Y; Anand, Neel; Frank, Kelly A; Stone, Marcus B; Kanter, Adam S; Shaffrey, Christopher I; Mummaneni, Praveen V

2017-12-01

OBJECTIVE The aim of this study was to educate medical professionals about potential financial impacts of improper diagnosis-related group (DRG) coding in adult spinal deformity (ASD) surgery. METHODS Medicare's Inpatient Prospective Payment System PC Pricer database was used to collect 2015 reimbursement data for ASD procedures from 12 hospitals. Case type, hospital type/location, number of operative levels, proper coding, length of stay, and complications/comorbidities (CCs) were analyzed for effects on reimbursement. DRGs were used to categorize cases into 3 types: 1) anterior or posterior only fusion, 2) anterior fusion with posterior percutaneous fixation with no dorsal fusion, and 3) combined anterior and posterior fixation and fusion. RESULTS Pooling institutions, cases were reimbursed the same for single-level and multilevel ASD surgery. Longer stay, from 3 to 8 days, resulted in an additional $1400 per stay. Posterior fusion was an additional $6588, while CCs increased reimbursement by approximately $13,000. Academic institutions received higher reimbursement than private institutions, i.e., approximately $14,000 (Case Types 1 and 2) and approximately $16,000 (Case Type 3). Urban institutions received higher reimbursement than suburban institutions, i.e., approximately $3000 (Case Types 1 and 2) and approximately $3500 (Case Type 3). Longer stay, from 3 to 8 days, increased reimbursement between $208 and $494 for private institutions and between $1397 and $1879 for academic institutions per stay. CONCLUSIONS Reimbursement is based on many factors not controlled by surgeons or hospitals, but proper DRG coding can significantly impact the financial health of hospitals and availability of quality patient care.

Ultra-long pharmacokinetic properties of insulin degludec are comparable in elderly subjects and younger adults with type 1 diabetes mellitus.

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Korsatko, S; Deller, S; Mader, J K; Glettler, K; Koehler, G; Treiber, G; Urschitz, M; Wolf, M; Hastrup, H; Søndergaard, F; Haahr, H; Pieber, T R

2014-01-01

Management of diabetes in elderly subjects is complex and careful management of glucose levels is of particular importance in this population because of an increased risk of diabetes-related complications and hypoglycaemia. The aim of this study was to evaluate the pharmacokinetic and pharmacodynamic properties of insulin degludec (IDeg), a basal insulin with an ultra-long duration of action, in elderly subjects with type 1 diabetes compared with younger adults. This trial was a randomised, double-blind, two-period, crossover trial conducted in a single centre and included both inpatient and outpatient periods. Subjects were men and women aged 18-35 years inclusive (younger adult group) or ≥65 years (elderly group) with type 1 diabetes who received IDeg (0.4 U/kg) via subcutaneous injection in the thigh once-daily for six days. Following 6-day dosing, a 26-hour euglycaemic glucose clamp procedure was conducted to evaluate the steady-state pharmacodynamic effects of IDeg. Blood samples were taken for pharmacokinetic analysis up to 120 h post-dose. Pharmacokinetic endpoints included the total exposure of IDeg, ie the area under the IDeg serum concentration curve during one dosing interval at steady state (AUC(IDeg,τ,SS)) (τ = 0-24 h, equal to one dosing interval) and the maximum IDeg serum concentration at steady state (C(max,IDeg,SS)). Pharmacodynamic endpoints included the total glucose-lowering effect of IDeg, ie the area under the glucose infusion rate (GIR) curve at steady state (AUC(GIR,τ,SS)), and the maximum GIR at steady state (GIR(max,IDeg,SS)). Total exposure (AUC(IDeg,τ,SS)) and maximum concentration (C(max,IDeg,SS)) of IDeg were comparable between elderly subjects and younger adults. Estimated mean age group ratios (elderly/younger adult) for AUC(IDeg,τ,SS) and C(max,IDeg,SS) and corresponding two-sided 95 % confidence intervals (CIs) were 1.04 (95 % CI 0.73-1.47) and 1.02 (95 % CI 0.74-1.39), respectively. Mean AUC(IDeg,0-12h

The nature and meaning of insulin pump use in emerging adults with type 1 diabetes.

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Hood, Donna G; Duke, Gloria

2015-05-01

Objective. The purpose of this study is to investigate the meaning of living with an insulin pump for the management of type 1 diabetes during the period of emerging adulthood. Through a phenomenological narrative, this study contributes to the reflective understanding of the everyday life experiences of this population. Methods. A hermeneutic phenomenological design was used for this study of nine emerging adults (aged 19-24 years). Data were generated through face-to-face interviews and analyzed using the phenomenological approach of Max van Manen. Results. Four themes represent the essence of the day-to-day experiences of these emerging adults: seeking control, becoming responsible, staying connected, and accepting me. Conclusions. An in-depth understanding of the meaning of daily experiences with insulin pump technology has the potential to promote a developmentally appropriate approach to this age-group. The human understanding gained through this study is essential to the development of evidence-based practice guidelines and resources for this vulnerable population.

Association of dietary pattern with biochemical blood profiles and bodyweight among adults with Type 2 diabetes mellitus in Tehran, Iran

OpenAIRE

Darani Zad, Nasrin; Mohd Yusof, Rokiah; Esmaili, Haleh; Jamaluddin, Rosita; Mohseni, Fariba

2015-01-01

Background This study was conducted to identify dietary patterns and evaluated their association with biochemical blood profiles and body weight among adults with type 2 diabetes mellitus. Methods This was a cross sectional study conducted among 400 patients with type 2 diabetes mellitus in Tehran from March to August 2013. Biochemical blood profiles, socio-demographic, lifestyle, anthropometric measurements, and dietary data were obtained. Dietary data from food frequency questionnaire were ...

Cognition and event-related potentials in adult-onset non-demented myotonic dystrophy type 1.

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Tanaka, H; Arai, M; Harada, M; Hozumi, A; Hirata, K

2012-02-01

To clarify the cognitive and event-related potentials (ERPs) profiles of adult-onset genetically-proven non-demented myotonic dystrophy type 1 (DM1). Fourteen DM1 patients and matched 14 normal controls were enrolled. DM1 patients were compared with normal controls, using a variety of neuropsychological tests; an auditory "oddball" counting paradigm for the ERPs, and low-resolution brain electromagnetic tomography (LORETA). For patients, ERPs and neuropsychological parameters were correlated with CTG repeat size, duration of illness, grip strength, and arterial blood gas analysis. Frontal lobe dysfunction, prolonged N1 latency, and attenuated N2/P3 amplitudes were observed in DM1. Longer CTG repeat size was associated with fewer categories achieved on Wisconsin Card Sorting Test. Greater grip strength was associated with better scores on color-word "interference" of Stroop test. P3 latency was negatively correlated with PaO(2). LORETA revealed significant hypoactivities at the orbitofrontal and medial temporal lobe, cingulate, and insula. There was no correlation between ERPs and CTG expansion. Adult-onset non-demented DM1 presented frontal lobe dysfunction. Absence of correlations between CTG repeat size and objective ERP parameters suggested CTG expansion in lymphocytes does not directly contribute to cognitive dysfunction. CTG expansion in lymphocytes does not directly contribute to cognitive dysfunction of adult-onset non-demented DM1. Copyright © 2011 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

Negative appraisals of insulin therapy are common among adults with Type 2 diabetes using insulin: Results from Diabetes MILES - Australia cross-sectional survey

DEFF Research Database (Denmark)

Holmes-Truscott, E.; Holmes-Truscott, E.; Skinner, T. C.

2015-01-01

Aim: To identify insulin therapy appraisals among adults with Type 2 diabetes using insulin and how negative appraisals relate to clinical, self-care and psychosocial outcomes. Methods: Diabetes MILES - Australia 2011 was a national survey of adults with diabetes, focused on behavioural...... and psychosocial issues. Subgroup analyses were conducted on the responses of 273 adults with Type 2 diabetes using insulin (46% women; mean ± sd age: 59 ± 9 years; diabetes duration: 12 ± 7 years; years using insulin: 4 ± 4). They completed validated measures of insulin therapy appraisals (ITAS), depression (PHQ......; 51% that insulin causes weight gain; 39% that they have 'failed to manage' their diabetes. Those with the greatest and least 'ITAS negative' scores did not differ by diabetes duration or years using insulin, or by average number of insulin injections or blood glucose checks per day. Those with more...

Analysis of epidemiological indices of type 2 diabetes mellitus in the adult population of Moscow

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Marina Fedorovna Kalashnikova

2014-07-01

Full Text Available Diabetes mellitus is a disease that presents a global medical problem. It is necessary to implement an in-depth analysis of the epidemiological situation of type 2 diabetes mellitus for planning and organizing specialized medical help to patients with type 2 diabetes mellitus.AimTo rate the basic epidemiological indices of type 2 diabetes mellitus in actual clinical practice using the informational database of national registry of diabetic patients.Materials and methodsEpidemiological analyses were performed in two administrative districts of Moscow. From 1999 to 2011 48978 adult patients with type 2 diabetes mellitus who were aged 18 years and older were registered. We used methods of clinical, analytical and statistical epidemiology with elements of descriptive research.ResultsThe prevalence rate of type 2 diabetes mellitus was 1590 per hundred thousand, most patients were in the 60–64 and 70–74 age groups, and approximately 80% of patients were older than 55 years. The morbidity rate of type 2 diabetes mellitus was 138,72 per hundred thousand and was found to be higher in women at 1,89. The mortality rate of adult patients with diabetes mellitus was 0,83, mostly in men of all ages. Cardiovascular diseases accounted for most of the registered cases of deaths (34,4%. The average life expectancy appeared to be 75,24±0,45 years, although women lived 6 years longer than men. The average duration of the disease was 10,04±0,34 years. A total of 0,4% of patients underwent hospital treatment and the average length of treatment was 17–18 days. The total number of days of disablement was an average of 307,33±30,13 days (80% of patients were older than 55 years. In the study group, a mean grade of НbА1c <7% was observed in 56,6% of patients. The prevalence rate of detected chronic complications was considerably lower compared to other epidemiological studies.ConclusionsOur epidemiological analyses revealed a number of features and consistent

Cell Proliferation, Migration, and Neurogenesis in the Adult Brain of the Pulse Type Weakly Electric Fish, Gymnotus omarorum

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Valentina Olivera-Pasilio

2017-08-01

Full Text Available Adult neurogenesis, an essential mechanism of brain plasticity, enables brain development along postnatal life, constant addition of new neurons, neuronal turnover, and/or regeneration. It is amply distributed but negatively modulated during development and along evolution. Widespread cell proliferation, high neurogenic, and regenerative capacities are considered characteristics of teleost brains during adulthood. These anamniotes are promising models to depict factors that modulate cell proliferation, migration, and neurogenesis, and might be intervened to promote brain plasticity in mammals. Nevertheless, the migration path of derived cells to their final destination was not studied in various teleosts, including most weakly electric fish. In this group adult brain morphology is attributed to sensory specialization, involving the concerted evolution of peripheral electroreceptors and electric organs, encompassed by the evolution of neural networks involved in electrosensory information processing. In wave type gymnotids adult brain morphology is proposed to result from lifelong region specific cell proliferation and neurogenesis. Consistently, pulse type weakly electric gymnotids and mormyrids show widespread distribution of proliferation zones that persists in adulthood, but their neurogenic potential is still unknown. Here we studied the migration process and differentiation of newborn cells into the neuronal phenotype in the pulse type gymnotid Gymnotus omarorum. Pulse labeling of S-phase cells with 5-Chloro-2′-deoxyuridine thymidine followed by 1 to 180 day survivals evidenced long distance migration of newborn cells from the rostralmost telencephalic ventricle to the olfactory bulb, and between layers of all cerebellar divisions. Shorter migration appeared in the tectum opticum and torus semicircularis. In many brain regions, derived cells expressed early neuronal markers doublecortin (chase: 1–30 days and HuC/HuD (chase: 7–180 days

HbA1c and the Prediction of Type 2 Diabetes in Children and Adults.

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Vijayakumar, Pavithra; Nelson, Robert G; Hanson, Robert L; Knowler, William C; Sinha, Madhumita

2017-01-01

Long-term data validating glycated hemoglobin (HbA 1c ) in assessing the risk of type 2 diabetes in children are limited. HbA 1c , fasting plasma glucose (FPG), and 2-h postload plasma glucose (2hPG) concentrations were measured in a longitudinal study of American Indians to determine their utility in predicting incident diabetes, all of which is thought to be type 2 in this population. Incident diabetes (FPG ≥126 mg/dL [7.0 mmol/L], 2hPG ≥200 mg/dL [11.1 mmol/L], HbA 1c ≥6.5% [8 mmol/mol], or clinical diagnosis) was determined in 2,095 children without diabetes ages 10-19 years monitored through age 39, and in 2,005 adults ages 20-39 monitored through age 59. Areas under the receiver operating characteristic (ROC) curve for HbA 1c , FPG, and 2hPG in predicting diabetes within 10 years were compared. During long-term follow-up of children and adolescents who did not initially have diabetes, the incidence rate of subsequent diabetes was fourfold (in boys) as high and more than sevenfold (in girls) as high in those with HbA 1c ≥5.7% as in those with HbA 1c ≤5.3%-greater rate ratios than experienced by adults in the same HbA 1c categories. Analyses of ROCs revealed no significant differences between HbA 1c , FPG, and 2hPG in sensitivity and specificity for identifying children and adolescents who later developed diabetes. HbA 1c is a useful predictor of diabetes risk in children and can be used to identify prediabetes in children with other type 2 diabetes risk factors with the same predictive value as FPG and 2hPG. © 2017 by the American Diabetes Association.

Cognitive decline over time in adults with myotonic dystrophy type 1: A 9-year longitudinal study.

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Gallais, Benjamin; Gagnon, Cynthia; Mathieu, Jean; Richer, Louis

2017-01-01

Myotonic dystrophy type 1 (DM1) is an inherited neuromuscular disease with multisystemic involvement including the central nervous system. The evolution of the cognitive profile is a matter of debate, whether an eventual decline could be global or process-specific. Study aims are to describe, compare and document the clinical relevance of the progression of cognitive abilities in DM1 patients with adult and late-onset phenotypes. A total of 115 DM1 patients (90 adult; 25 late-onset) were assessed twice within a 9-year period on cognitive abilities (language, memory, visual attention, processing speed, visuoconstructive abilities and executive functions) and intellectual functioning (WAIS-R 7). A significant worsening over time was observed for verbal memory, visual attention, and processing speed. The progression in cognitive scores correlated with age and disease duration, but not with nCTG, muscular impairment nor education at baseline. Intellectual functioning remained stable. The rate of decline was higher among the late-onset phenotype than in the adult phenotype. Results showed that executive functions, language, and visual memory are impaired earlier in adult life, while verbal memory, visual attention, and processing speed decline later. Globally, results suggest an early and accelerated normal ageing process. This longitudinal study was based on the largest sample and the longest time period studied to date. These findings are highly relevant for clinical practice and genetic counselling. Copyright © 2016 Elsevier B.V. All rights reserved.

Examining the candidacy of ghrelin as a gene responsible for variation in adult stature in a United Kingdom population with type 2 diabetes.

Science.gov (United States)

Gueorguiev, Maria; Wiltshire, Steven; Garcia, Edwin A; Mein, Charles; Lecoeur, Cecile; Kristen, Brigitte; Allotey, Rebecca; Hattersley, Andrew T; Walker, Mark; O'rahilly, Stephen; Froguel, Philippe; Grossman, Ashley B; McCarthy, Mark I; Hitman, Graham A; Korbonits, Márta

2007-06-01

Recently, a quantitative trait locus for stature was reported on chromosome 3p26 in patients with type 2 diabetes. Given that ghrelin is a peptide involved in GH release and located on 3p26, we hypothesized that variation within its gene (GHRL) may be responsible for the quantitative trait locus on 3p26. The evidence for linkage around GHRL was refined with the genotyping of an additional four microsatellites (D3S4545, D3S1537, D3S1597, and D3S3611), giving a total of 27 markers, followed by multipoint variance components linkage analysis. Probands from the linkage families were typed for five common single nucleotide polymorphisms (SNPs) within GHRL and tested for association with adult stature using haplotype trend regression. The maximum multipoint evidence for linkage between adult stature and the 27 microsatellites yielded an LOD score of 2.58 (P = 0.0003) between D3S1297 and D3S1304. Five common (frequency of > or =5%) SNPs were typed in the probands [two promoter SNPs (rs27647 and rs26802), two exonic (rs696217 and rs4684677), and one intronic (rs35683)] capturing 80% of the total common variation in GHRL. No association was found between any SNP (or haplotypes thereof) and adult stature. Common genetic variation within GHRL is not responsible for variation in adult stature in this population.

Shoulder function, pain and health related quality of life in adults with joint hypermobility syndrome/Ehlers-Danlos syndrome-hypermobility type

DEFF Research Database (Denmark)

Johannessen, Elise Christine; Reiten, Helle Sundnes; Løvaas, Helene

2016-01-01

Purpose To investigate shoulder function, pain and Health-Related Quality of life (HRQoL) among adults with joint hypermobility syndrome/Ehlers-Danlos syndrome-hypermobility type (JHS/EDS-HT), compared with the general population (controls). Method In a cross-sectional study using postal survey...

In adult patients with type 1 diabetes healthy lifestyle associates with a better cardiometabolic profile.

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Leroux, C; Gingras, V; Desjardins, K; Brazeau, A-S; Ott-Braschi, S; Strychar, I; Rabasa-Lhoret, R

2015-05-01

Little is known about lifestyle habits of adults with type 1 diabetes (T1D) and their association with cardiometabolic risk (CMR) factors. The aims of the present study were to determine the prevalence of adults with T1D who adopted a healthy lifestyle and to explore the association between a healthy lifestyle and the cardiometabolic profile. This is a cross-sectional analysis of 115 adults with T1D. Participants wore a motion sensor and completed a 3-day food record. The following CMR factors were assessed: body mass index, waist circumference, body composition (iDXA), glycated hemoglobin, lipids and blood pressure. Insulin resistance was estimated (estimated glucose disposal rate). Participants were classified according to the number of healthy lifestyle habits adopted (ranging from 0 to 3): regular physical activity (physical activity level ≥1.7), good diet quality (Canadian Healthy Eating Index score >80) and none-smoking status. The proportion of participants who adopted 3, 2, 1 or 0 lifestyle habits were 11%, 30%, 37%, and 23%, respectively. As the number of healthy lifestyle habits adopted increased, participants had significantly lower body mass index, waist circumference, body fat, total cholesterol, non-HDL-cholesterol, triglycerides and systolic blood pressure (p healthy lifestyle habit, body mass index decreased by 1.9 kg/m(2), waist circumference by 4.0 cm for men and 4.8 cm for women and trunk fat by 3.6% for men and 4.1% for women. These results suggest the importance of a healthy lifestyle among adults with T1D in order to control CMR factors. Copyright © 2015 Elsevier B.V. All rights reserved.

Risk factors for cardiovascular disease and type 2 diabetes retained from childhood to adulthood predict adult outcomes: the Princeton LRC Follow-up Study

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Morrison John A

2012-04-01

Full Text Available Abstract Background Pediatric risk factors predict adult cardiovascular disease (CVD and type 2 diabetes (T2DM, but whether they predict events independently of adult risk factors is not fully known. Objective Assess whether risk factors for CVD and T2DM retained from childhood to adulthood predict CVD and T2DM in young adulthood. Study design 770 schoolchildren, ages 5–20 (mean age 12, 26-yr prospective follow-up. We categorized childhood and adult risk factors and 26-year changes (triglycerides [TG], LDL cholesterol, BMI, blood pressure [BP] and glucose ≥, and HDL cholesterol Results Children who had high TG and retained high TG as adults had increased CVD events as adults (p = .0005. Children who had normal BMI and retained normal BMI as adults had reduced CVD events as adults (p = .02. Children who had high BP or high TG and retained these as adults had increased T2DM as adults (p = .0006, p = .003. Conclusions Risk factors for CVD and T2DM retained from childhood to adulthood predict CVD and T2DM in young adulthood and support universal childhood screening.

Alport syndrome

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... itching, or redness of the eye, or blurred vision. Abnormal coloring of the retina , a condition called dot-and-fleck retinopathy. It ... macula. The macula is a part of the retina that makes central vision sharper and more detailed. A macular hole causes ...

An Adult Case of Bartter Syndrome Type III Presenting with Proteinuria

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Eun Jung Cha

2016-03-01

Full Text Available Bartter syndrome (BS I–IV is a rare autosomal recessive disorder affecting salt reabsorption in the thick ascending limb of the loop of Henle. This report highlights clinicopathological findings and genetic studies of classic BS in a 22-year-old female patient who presented with persistent mild proteinuria for 2 years. A renal biopsy demonstrated a mild to moderate increase in the mesangial cells and matrix of most glomeruli, along with marked juxtaglomerular cell hyperplasia. These findings suggested BS associated with mild IgA nephropathy. Focal tubular atrophy, interstitial fibrosis, and lymphocytic infiltration were also observed. A genetic study of the patient and her parents revealed a mutation of the CLCNKB genes. The patient was diagnosed with BS, type III. This case represents an atypical presentation of classic BS in an adult patient. Pathologic findings of renal biopsy combined with genetic analysis and clinicolaboratory findings are important in making an accurate diagnosis.

An Adult Case of Bartter Syndrome Type III Presenting with Proteinuria.

Science.gov (United States)

Cha, Eun Jung; Hwang, Won Min; Yun, Sung-Ro; Park, Moon Hyang

2016-03-01

Bartter syndrome (BS) I-IV is a rare autosomal recessive disorder affecting salt reabsorption in the thick ascending limb of the loop of Henle. This report highlights clinicopathological findings and genetic studies of classic BS in a 22-year-old female patient who presented with persistent mild proteinuria for 2 years. A renal biopsy demonstrated a mild to moderate increase in the mesangial cells and matrix of most glomeruli, along with marked juxtaglomerular cell hyperplasia. These findings suggested BS associated with mild IgA nephropathy. Focal tubular atrophy, interstitial fibrosis, and lymphocytic infiltration were also observed. A genetic study of the patient and her parents revealed a mutation of the CLCNKB genes. The patient was diagnosed with BS, type III. This case represents an atypical presentation of classic BS in an adult patient. Pathologic findings of renal biopsy combined with genetic analysis and clinicolaboratory findings are important in making an accurate diagnosis.

A pilot study of factors associated with glycaemic control in adults with Type 1 diabetes mellitus on insulin pump therapy.

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Wen, W; Frampton, R; Wright, K; Fattore, S; Shadbolt, B; Perampalam, S

2016-02-01

To identify the knowledge and management factors associated with glycaemic control among adults with Type 1 diabetes mellitus treated with insulin pump therapy. A cross-sectional study of adults with Type 1 diabetes mellitus on insulin pump therapy for at least 12 months (n = 50, 18-70 years old) was undertaken between December 2013 and May 2014. A new questionnaire was developed to evaluate participants' knowledge and management related to insulin pump therapy, and were correlated with insulin pump data, HbA1c and frequency of hypoglycaemia. Participants who changed their insulin pump settings when indicated had significantly better glycaemic control than those who did not (P = 0.04). Multivariate logistic regression analysis found that better overall insulin pump therapy management was a significant predictor of better glycaemic control (odds ratio 4.45, 95% confidence interval 1.61-12.3; P = 0.004) after adjusting for potential confounders including age, gender, duration of diabetes and insulin pump therapy. However, overall insulin pump therapy knowledge was not a significant predictor of glycaemic control (P = 0.058). There was no significant association between frequency of hypoglycaemia and insulin pump therapy knowledge or management. We identified some key knowledge and management factors associated with glycaemic control in adults with Type 1 diabetes mellitus on insulin pump therapy using a newly designed questionnaire. The pilot study assessed the clinical utility of this evaluation tool, which may facilitate provision of targeted education to insulin pump therapy users to achieve optimal glycaemic control. © 2015 The Authors. Diabetic Medicine © 2015 Diabetes UK.

Exploring the role of multiple chronic conditions in traditional Chinese medicine use and three types of traditional Chinese medicine therapy among adults in Taiwan.

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Cheng, Ting-Yi; Chou, Yiing-Jenq; Huang, Nicole; Pu, Christy; Chou, Yu-Ju; Chou, Pesus

2015-06-01

Numerous people with chronic conditions like to use traditional Chinese medicine (TCM) treatment, or integrated treatment of TCM and Western medicine (WM). Our study explored the associations between multiple chronic conditions (MCC) and TCM use and the use of specific types of TCM therapy among adults in Taiwan. In addition, we explored the TCM use of adults with seven common types of chronic conditions. In our study, a national representative sample in 2005 was used. The Chronic Condition Indicator and the Clinical Classifications System created by the U.S. Agency for Healthcare Research and Quality were used to define the number of chronic conditions of adults. Logistic regressions adjusted for demographic characteristics were used to analyze the associations. The frequency of TCM use among adults with different numbers of chronic conditions was quantified. TCM use for adults with ≥5 chronic conditions (odds ratio [OR] 1.86) was higher than TCM use for adults with 2-4 chronic conditions (OR 1.51) and TCM use for adults with one chronic condition (OR 1.48). The increase in the OR of the use of Chinese herbs and traumatology manipulative therapy according to the number of chronic conditions was not as substantial as that of acupuncture-moxibustion. The frequency of TCM use exhibited an increasing trend with the increase in the number of chronic conditions (pherbs use, traumatology manipulative therapy use, and, particularly, acupuncture-moxibustion use increased as the number of chronic conditions increased. We suggest that government policy makers emphasize administering integrated TCM and WM care to people with chronic conditions or MCC.

Low serum magnesium concentrations are associated with a high prevalence of premature ventricular complexes in obese adults with type 2 diabetes

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Del Gobbo Liana C

2012-03-01

Full Text Available Abstract Background Premature ventricular complexes (PVC predict cardiovascular mortality among several adult populations. Increased arrhythmia prevalence has been reported during controlled magnesium (Mg depletion studies in adults. We thus hypothesized that serum magnesium (sMg concentrations are inversely associated with the prevalence of PVC in adults at high cardiovascular risk. Methods Anthropometric, demographic and lifestyle characteristics were assessed in 750 Cree adults, aged > 18 yrs, who participated in an age-stratified, cross-sectional health survey in Quebec, Canada. Holter electrocardiograms recorded heart rate variability and cardiac arrhythmias for two consecutive hours. Multivariate logistic regression was used to evaluate the associations between sMg and PVC. Results PVC prevalence in adults with hypomagnesemia (sMg ≤ 0.70 mmol/L was more than twice that of adults without hypomagnesemia (50% vs. 21%, p = 0.015; results were similar when adults with cardiovascular disease history were excluded. All hypomagnesemic adults with PVC had type 2 diabetes (T2DM. Prevalence of PVC declined across the sMg concentration gradient in adults with T2DM only (p 0.70 mmol/L was 0.24 (95% CI: 0.06-0.98 p = 0.046 compared to those with sMg ≤ 0.70 mmol/L. Conclusions sMg concentrations were inversely associated with the prevalence of PVC in patients with T2DM in a dose response manner, indicating that suboptimal sMg may be a contributor to arrhythmias among patients with T2DM.

Type 1 diabetes

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Insulin-dependent diabetes; Juvenile onset diabetes; Diabetes - type 1; High blood sugar - type 1 diabetes ... Type 1 diabetes can occur at any age. It is most often diagnosed in children, adolescents, or young adults. Insulin is ...

Association between post-dinner dietary intakes and nocturnal hypoglycemic risk in adult patients with type 1 diabetes.

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Desjardins, Katherine; Brazeau, Anne-Sophie; Strychar, Irene; Leroux, Catherine; Gingras, Véronique; Rabasa-Lhoret, Rémi

2014-12-01

To describe (i) current bedtime nutritional practices and (ii) the association between post-dinner dietary intake and the occurrence of non-severe nocturnal hypoglycemia (NH) in real-life conditions among adult patients with type 1 diabetes using insulin analogs. One hundred adults (median [interquartile range]: age 46.4 [36.0-55.8] years, HbA1c 7.9 [7.3-8.6] % (63 [56-70] mmol/mol)) using multiple daily injections (n=67) or insulin pump (n=33) wore a blinded continuous glucose monitoring system and completed a food diary for 72-h. NH occurred on 28% of 282 nights analyzed. (i) Patients reported post-dinner dietary intakes on 63% of the evenings. They injected rapid-acting insulin boluses on 64 occasions (23% of 282 evenings). These insulin boluses were mostly injected with (n=37) dietary intakes. (ii) Post-dinner dietary intake was not associated with NH occurrence in univariate analyses. In multivariate analyses, the injection of rapid-acting insulin modulated the association between post-dinner dietary intake and NH: with insulin, post-dinner carbohydrate intake was positively associated with NH (odds ratio (OR): 1.16 [95% confidence interval, CI: 1.04-1.29] per 5g increase, p=0.008); without insulin, post-dinner protein intake was inversely associated with NH occurrence (OR [95% CI]: 0.88 [0.78-1.00] per 2g increase, p=0.048). NH remains frequent in adults with type 1 diabetes. There is a complex relationship between post-dinner dietary intake and NH occurrence, including the significant role of nutrient content and rapid-acting insulin injection that requires further investigation. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Patient perspectives on peer mentoring: type 1 diabetes management in adolescents and young adults.

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Lu, Yang; Pyatak, Elizabeth A; Peters, Anne L; Wood, Jamie R; Kipke, Michele; Cohen, Marisa; Sequeira, Paola A

2015-02-01

The purpose of the study was to identify attitudes and topics relevant to peer mentoring as an adherence-promoting intervention for adolescents and young adults (YAs) with type 1 diabetes (T1D). Self-administered survey data were collected in 2 diabetes clinics from a convenience sample of adolescents as prospective mentees (ages 13-18) and YAs as prospective mentors (ages 19-25) with T1D. Survey topics included demographics, disease history, glycemic control, adherence, depression, barriers to disease management, social support, and interest in peer mentoring. Descriptive statistical analyses, thematic coding, and stepwise multivariate logistic regression were performed. A majority of the 54 adolescents and 46 YAs expressed interest in a peer mentoring program. Having supportive friends and living in a large household positively predicted adolescent interest in having a peer mentor. Approximately one-third of all participants experienced social barriers to diabetes management. For adolescents, barriers included inflexible schedules, unfamiliar foods, and the embarrassment of checking blood glucose in front of others. Young adults reported barriers in tracking food consumption and remembering to check blood glucose. Various diabetes management skills were in high demand by adolescents, who especially desired to learn about managing T1D on their own and in college. Participants were open to multiple communication modes, including in-person meetings, phone, text messaging, and social media. Many adolescents and young adults with T1D are interested in peer mentoring as a way to facilitate learning and sharing essential diabetes management skills and experiences. © 2014 The Author(s).

[New insights of myositis-specific and -associated autoantibodies in juvenile and adult type myositis].

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Váncsa, Andrea; Dankó, Katalin

2016-07-01

Myositis, which means inflammation of the muscles, is a general term used for inflammatory myopathies. Myositis is a rare idiopathic autoimmune disease. It is believed that environmental factors such as virus, bacteria, parasites, direct injuries, drugs side effect can trigger the immune system of genetically susceptible individuals to act against muscle tissues. There are several types of myositis with the same systemic symptoms such as muscle weakness, fatigue, muscle pain and inflammation. These include dermatomyositis, juvenile dermatomyositis, inclusion-body myositis, polymyositis, orbital myositis and myositis ossificans. Juvenile and adult dermatomyositis are chronic, immune-mediated inflammatory myopathies characterized by progressive proximal muscle weakness and typical skin symptoms. The aim of the authors was to compare the symptoms, laboratory and serological findings and disease course in children and adult patients with idiopathic inflammatory myopathy. Early diagnosis and aggressive immunosuppressive treatment improve the mortality of these patients. Myositis-specific autoantibodies have predictive and prognostic values regarding the associated overlap disease, response to treatment and disease course. The authors intend to lighten the clinical and pathogenetic significance of the new target autoantigens. Orv. Hetil., 2016, 157(29), 1179-1184.

Usability and clinical efficacy of diabetes mobile applications for adults with type 2 diabetes: A systematic review.

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Fu, Helen; McMahon, Siobhan K; Gross, Cynthia R; Adam, Terrence J; Wyman, Jean F

2017-09-01

To assess the usability and clinical effectiveness of diabetes mobile applications (diabetes apps) developed for adults with type 2 diabetes. A systematic review of the usability and effectiveness of diabetes apps was conducted. Searches were performed using MEDLINE, EMBASE, COMPENDEX, and IEEE XPLORE for articles published from January 1, 2011, to January 17, 2017. Search terms included: diabetes, mobile apps, and mobile health (mHealth). The search yielded 723 abstracts of which seven usability studies and ten clinical effectiveness studies met the inclusion criteria from 20 publications. Usability, as measured by satisfaction ratings from experts and patients, ranged from 38% to 80%. Usability problem ratings ranged from moderate to catastrophic. Top usability problems are multi-steps task, limited functionality and interaction, and difficult system navigation. Clinical effectiveness, measured by reductions in HbA1c, ranged from 0.15% to 1.9%. Despite meager satisfaction ratings and major usability problems, there is some limited evidence supporting the effectiveness of diabetes apps to improve glycemic control for adults with type 2 diabetes. Findings strongly suggest that efforts to improve user satisfaction, incorporate established principles of health behavior change, and match apps to user characteristics will increase the therapeutic impact of diabetes apps. Copyright © 2017 Elsevier B.V. All rights reserved.

Explaining psychological insulin resistance in adults with non-insulin-treated type 2 diabetes

DEFF Research Database (Denmark)

Holmes-Truscott, Elizabeth; Skinner, Timothy Chas; Pouwer, F

2016-01-01

to the model. CONCLUSIONS: Psychological insulin resistance may reflect broader distress about diabetes and concerns about its treatment but not general beliefs about medicines, depression or anxiety. Reducing diabetes distress and current treatment concerns may improve attitudes towards insulin as a potential......AIMS: To investigate the contribution of general and diabetes-specific emotional wellbeing and beliefs about medicines in the prediction of insulin therapy appraisals in adults with non-insulin-treated type 2 diabetes. METHODS: The sample included Diabetes MILES-Australia cross-sectional survey...... diabetes medications (BMQ Specific); negative insulin therapy appraisals (ITAS); depression (PHQ-9); anxiety (GAD-7), and diabetes distress (DDS-17). Factors associated with ITAS Negative scores were examined using hierarchical multiple regressions. RESULTS: Twenty-two percent of the variance in ITAS...

Types of social supports predicting health-related quality of life among adult patients with CHD in the Institut Jantung Negara (National Heart Institute), Malaysia.

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Tye, Sue K; Kandavello, Geetha; Gan, Kah L

2017-01-01

The objectives of this study were to examine which types of social supports - emotional/informational support, tangible support, affectionate support, and positive interactions - are the predictors of health-related quality of life (HRQoL) in adult patients with CHD and to assess the influence of demographic variables and clinical factors on these variables. In total, 205 adult patients with CHD from the National Heart Institute, Malaysia, were recruited. Patients were first screened by cardiology consultants to ensure they fit the inclusion criteria before filling in questionnaires, which were medical outcome studies - social support survey and AQoL-8D. Results/conclusions All social supports and their subscales were found to have mild-to-moderate significant relationships with physical dimension, psychological dimension, and overall HRQoL; however, only positive interaction, marital status, and types of diagnosis were reported as predictors of HRQoL. Surprisingly, with regard to the physical dimension of quality of life, social supports were not significant predictors, but educational level, marital status, and types of diagnosis were significant predictors. Positive interaction, affectionate support, marital status, and types of diagnosis were again found to be predictors in the aspects of the psychological dimension of quality of life. In conclusion, positive interaction and affectionate support, which include elements of fun, relaxation, love, and care, should be included in the care of adult patients with CHD.

Effectiveness of motivational interviewing for improving physical activity self-management for adults with type 2 diabetes: A review.

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Soderlund, Patricia Davern

2018-03-01

Objectives This review examines the effectiveness of motivational interviewing for physical activity self-management for adults diagnosed with diabetes mellitus type 2. Motivational interviewing is a patient centered individually tailored counseling intervention that aims to elicit a patient's own motivation for health behavior change. Review questions include (a) How have motivational interviewing methods been applied to physical activity interventions for adults with diabetes mellitus type 2? (b) What motivational interviewing approaches are associated with successful physical activity outcomes with diabetes mellitus 2? Methods Database searches used PubMed, CINAHL, and PsycINFO for the years 2000 to 2016. Criteria for inclusion was motivational interviewing used as the principal intervention in the tradition of Miller and Rollnick, measurement of physical activity, statistical significance reported for physical activity outcomes, quantitative research, and articles written in English. Results A total of nine studies met review criteria and four included motivational interviewing interventions associated with significant physical activity outcomes. Discussion Findings suggest motivational interviewing sessions should target a minimal number of self-management behaviors, be delivered by counselors proficient in motivational interviewing, and use motivational interviewing protocols with an emphasis placed either on duration or frequency of sessions.

Assessment of the mandibular symphysis of Caucasian Brazilian adults with well-balanced faces and normal occlusion: the influence of gender and facial type

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Karine Evangelista Martins Arruda

2012-06-01

Full Text Available OBJECTIVE: This study aimed to establish cephalometric reference values for mandibular symphysis in adults. Dentoalveolar, skeletal and soft tissue variables were measured considering the influence of gender and facial type. METHODS: The sample consisted of sixty cephalometric radiographs of white Brazilian adult patients, with a mean age of 27 years and 6 months, who had not undergone orthodontic treatment and who presented well-balanced faces and normal occlusion. The sample was standardized according to gender (30 males and 30 females and facial type (20 were dolichofacial, 20 mesofacial and 20 brachyfacial. RESULTS: The results showed that male and female symphyses are similar, except for symphyseal height, which was greater in males. In terms of facial type, the dolichofacial group presented narrower symphysis in dentoalveolar and basal areas, with a more accentuated lingual dentoalveolar inclination. CONCLUSION: The brachyfacial group showed broader symphysis in the dentoalveolar and basal areas and a greater buccal dentoalveolar inclination. The projection of the chin was 6.67 mm below the subnasal vertical line and there was no significant difference between the genders or facial types.

Mash1-expressing cells could differentiate to type III cells in adult mouse taste buds.

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Takagi, Hiroki; Seta, Yuji; Kataoka, Shinji; Nakatomi, Mitsushiro; Toyono, Takashi; Kawamoto, Tatsuo

2018-03-10

The gustatory cells in taste buds have been identified as paraneuronal; they possess characteristics of both neuronal and epithelial cells. Like neurons, they form synapses, store and release transmitters, and are capable of generating an action potential. Like epithelial cells, taste cells have a limited life span and are regularly replaced throughout life. However, little is known about the molecular mechanisms that regulate taste cell genesis and differentiation. In the present study, to begin to understand these mechanisms, we investigated the role of Mash1-positive cells in regulating adult taste bud cell differentiation through the loss of Mash1-positive cells using the Cre-loxP system. We found that the cells expressing type III cell markers-aromatic L-amino acid decarboxylase (AADC), carbonic anhydrase 4 (CA4), glutamate decarboxylase 67 (GAD67), neural cell adhesion molecule (NCAM), and synaptosomal-associated protein 25 (SNAP25)-were significantly reduced in the circumvallate taste buds after the administration of tamoxifen. However, gustducin and phospholipase C beta2 (PLC beta2)-markers of type II taste bud cells-were not significantly changed in the circumvallate taste buds after the administration of tamoxifen. These results suggest that Mash1-positive cells could be differentiated to type III cells, not type II cells in the taste buds.

Antibody titers against vaccine and contemporary wild poliovirus type 1 in children immunized with IPV+OPV and young adults immunized with OPV.

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Lukashev, Alexander N; Yarmolskaya, Maria S; Shumilina, Elena Yu; Sychev, Daniil A; Kozlovskaya, Liubov I

2016-02-02

In 2010, a type 1 poliovirus outbreak in Congo with 445 lethal cases was caused by a virus that was neutralized by sera of German adults vaccinated with inactivated polio vaccine with a reduced efficiency. This seroprevalence study was done in two cohorts immunized with other vaccination schedules. Russian children aged 3-6 years immunized with a combination of inactivated and live polio vaccines were reasonably well protected against any wild type poliovirus 1, including the Congolese isolate. Adults aged 20-29 years immunized only with live vaccine were apparently protected against the vaccine strain (92% seropositive), but only 50% had detectable antibodies against the Congo-2010 isolate. Both waning immunity and serological divergence of the Congolese virus could contribute to this result. Copyright © 2015 Elsevier B.V. All rights reserved.

Comparing different types of source memory attributes in dementia of Alzheimer's type.

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Mammarella, Nicola; Fairfield, Beth; Di Domenico, Alberto

2012-04-01

Source monitoring (SM) refers to our ability to discriminate between memories from different sources. Twenty healthy high-cognitive functioning older adults, 20 healthy low-cognitive functioning older adults, and 20 older adults with dementia of Alzheimer's type (DAT) were asked to perform a series of SM tasks that varied in terms of the to-be-remembered source attribute (perceptual, spatial, temporal, semantic, social, and affective details). Results indicated that older DAT adults had greater difficulty in SM compared to the healthy control groups, especially with spatial and semantic details. Data are discussed in terms of the SM framework and suggest that poor memory for some types of source information may be considered as an important indicator of clinical memory function when assessing for the presence and severity of dementia.

Synergistic effect of sevoflurane and isoflurane on inhibition of the adult-type muscle nicotinic acetylcholine receptor by rocuronium.

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Liu, Li; Li, Wei; Wei, Ke; Cao, Jun; Luo, Jie; Wang, Bin; Min, Su

2013-06-01

Inhaled anesthetics increase the incidence of postoperative residual neuromuscular blockade, and the mechanism is still unclear. We have investigated the synergistic effect of low-concentration inhaled anesthetics and rocuronium on inhibition of the inward current of the adult-type muscle nicotinic acetylcholine receptor (ε-nAChR). Adult-type mouse muscle ε-nAChR was expressed in HEK293 cells by liposome transfection. The inward current of the ε-nAChR was activated by use of 10 μmol/L acetylcholine alone or in combination with different concentrations of sevoflurane, isoflurane, or rocuronium. The concentration-response curves of five cells were constructed, and the data yielded the 5, 25, and 50 % inhibitory concentrations (IC5, IC25, and IC50, respectively) for single-drug application. Subsequently, the functional channels were perfused by adding 0.5 IC5 of either sevoflurane or isoflurane (aqueous concentrations 140 and 100 μmol/L, respectively) to the solution, followed by addition of IC5, IC25, or IC50 rocuronium. The amount of inhibition was calculated to quantify their synergistic effect. The inhibitory effect of rocuronium was enhanced by sevoflurane or isoflurane in a concentration-dependent manner. Sevoflurane or isoflurane (0.5 IC5) with rocuronium at IC5, IC25, and IC50 synergistically inhibited the current amplitude of adult-type muscle ε-nAChR. When the IC5 of rocuronium was used, isoflurane had a stronger synergistic effect than sevoflurane (p rocuronium was applied at higher concentrations (IC25 and IC50), sevoflurane had an effect similar to that of isoflurane. For both inhaled anesthetics, the synergistic effect was more intense for rocuronium at IC5 than for rocuronium at IC25 or IC50. Residual-concentration sevoflurane or isoflurane has a strong synergistic effect with rocuronium at clinically relevant residual concentrations. A lower rocuronium concentration resulted in a stronger synergistic effect.

Subjective Wellbeing Among Adults with Diabetes

DEFF Research Database (Denmark)

Holmes-Truscott, Elizabeth; Browne, Jessica L; Pouwer, Frans

2016-01-01

duration, body mass index, number of diabetes-related complications, and depression). Furthermore, adults with type 2 diabetes using insulin to manage their condition report the lowest levels of subjective wellbeing, and are also most likely to report dissatisfaction with their current health....... These findings suggest that living with diabetes, and in particular, living with type 2 diabetes and using insulin, strongly challenges the maintenance of subjective wellbeing.......This study examines the subjective wellbeing of Australian adults with diabetes who completed the Diabetes MILES—Australia survey, investigating by diabetes type and treatment, and by comparing with the subjective wellbeing of the general Australian adult population. In addition, the extent...

Neighbourhood walkability and home neighbourhood-based physical activity: an observational study of adults with type 2 diabetes

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Samantha Hajna

2016-09-01

Full Text Available Abstract Background Converging international evidence suggests that diabetes incidence is lower among adults living in more walkable neighbourhoods. The association between walkability and physical activity (PA, the presumed mediator of this relationship, has not been carefully examined in adults with type 2 diabetes. We investigated the associations of walkability with total PA occurring within home neighbourhoods and overall PA, irrespective of location. Methods Participants (n = 97; 59.5 ± 10.5 years were recruited through clinics in Montreal (QC, Canada and wore a GPS-accelerometer device for 7 days. Total PA was expressed as the total Vector of the Dynamic Body Acceleration. PA location was determined using a Global Positioning System (GPS device (SIRF IV chip. Walkability (street connectivity, land use mix, population density was assessed using Geographical Information Systems software. The cross-sectional associations between walkability and location-based PA were estimated using robust linear regressions adjusted for age, body mass index, sex, university education, season, car access, residential self-selection, and wear-time. Results A one standard deviation (SD increment in walkability was associated with 10.4 % of a SD increment in neighbourhood-based PA (95 % confidence interval (CI 1.2, 19.7 – equivalent to 165 more steps/day (95 % 19, 312. Car access emerged as an important predictor of neighbourhood-based PA (Not having car access: 38.6 % of a SD increment in neighbourhood-based PA, 95 % CI 17.9, 59.3. Neither walkability nor car access were conclusively associated with overall PA. Conclusions Higher neighbourhood walkability is associated with higher home neighbourhood-based PA but not with higher overall PA. Other factors will need to be leveraged to facilitate meaningful increases in overall PA among adults with type 2 diabetes.

Neighbourhood walkability and home neighbourhood-based physical activity: an observational study of adults with type 2 diabetes.

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Hajna, Samantha; Kestens, Yan; Daskalopoulou, Stella S; Joseph, Lawrence; Thierry, Benoit; Sherman, Mark; Trudeau, Luc; Rabasa-Lhoret, Rémi; Meissner, Leslie; Bacon, Simon L; Gauvin, Lise; Ross, Nancy A; Dasgupta, Kaberi

2016-09-09

Converging international evidence suggests that diabetes incidence is lower among adults living in more walkable neighbourhoods. The association between walkability and physical activity (PA), the presumed mediator of this relationship, has not been carefully examined in adults with type 2 diabetes. We investigated the associations of walkability with total PA occurring within home neighbourhoods and overall PA, irrespective of location. Participants (n = 97; 59.5 ± 10.5 years) were recruited through clinics in Montreal (QC, Canada) and wore a GPS-accelerometer device for 7 days. Total PA was expressed as the total Vector of the Dynamic Body Acceleration. PA location was determined using a Global Positioning System (GPS) device (SIRF IV chip). Walkability (street connectivity, land use mix, population density) was assessed using Geographical Information Systems software. The cross-sectional associations between walkability and location-based PA were estimated using robust linear regressions adjusted for age, body mass index, sex, university education, season, car access, residential self-selection, and wear-time. A one standard deviation (SD) increment in walkability was associated with 10.4 % of a SD increment in neighbourhood-based PA (95 % confidence interval (CI) 1.2, 19.7) - equivalent to 165 more steps/day (95 % 19, 312). Car access emerged as an important predictor of neighbourhood-based PA (Not having car access: 38.6 % of a SD increment in neighbourhood-based PA, 95 % CI 17.9, 59.3). Neither walkability nor car access were conclusively associated with overall PA. Higher neighbourhood walkability is associated with higher home neighbourhood-based PA but not with higher overall PA. Other factors will need to be leveraged to facilitate meaningful increases in overall PA among adults with type 2 diabetes.

Efficacy and Safety of Transthoracic Echocardiography Alone in Transcatheter Closure of Secundum-Type Atrial Septal Defects in Adults.

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Ding, Cheng; Chang, Jia-Kan; Lin, Chang-Chyi; Wu, Yong-Jian; Hsieh, Kai-Sheng

2016-04-01

On-site transthoracic echocardiography (TTE) to guide the transcutaneous closure of secundum-type atrial septal defects (ASDs) in the catheterization laboratory remains unclear, especially in adults. Between 2005 and 2012, a total of 82 adults underwent transcutaneous closure of ASDs. The initial 15 cases underwent the procedure with both on-site transesophageal echocardiography (TEE) and TTE monitoring. Since January 2008, a total of 67 patients underwent on-site TTE alone to guide the procedure. Among the 82 adult patients who underwent a transcutaneous closure of the secundum-type ASD procedure, all had successful closure of the defects, and no periprocedural adverse complications occurred. No statistical significance was observed in the successful complete shunt closure rate between the TEE plus TTE and TTE groups during sequential follow-up (postprocedure 24 hour [87% vs. 92%],1 month [93% vs. 95%], 3 month [93% vs. 97%], and 12 month [93% vs. 97%], P > 0.05, respectively) nor was a significant difference observed between the two groups, including decreased right ventricular dimension (29.5 ± 3.3 vs. 32.0 ± 4.9 mm, 26.5 ± 3.0 vs. 28.7 ± 4.6 mm, 26.2 ± 3.1 vs. 28.2 ± 4.8 mm, and 25.6 ± 2.8 vs. 27.7 ± 4.7 mm, P > 0.05, respectively) or increased left ventricular end-diastolic dimension (41.1 ± 2.0 vs. 42.6 ± 3.0 mm, 44.3 ± 2.7 vs. 45.5 ± 3.1 mm, 44.2 ± 2.8 vs. 45.4 ± 3.1 mm, 44.9 ± 2.7 vs. 45.8 ± 2.6 mm, P > 0.05, respectively) before the procedure, and at the 3-, 6-, and 12-month follow-up evaluations. This study showed that TTE guidance alone may be considered efficacious and safe as TEE during a transcutaneous ASD occlusion procedure in select adults. © 2015, Wiley Periodicals, Inc.

Golgi-type I and Golgi-type II neurons in the ventral anterior thalamic nucleus of the adult human: morphological features and quantitative analysis.

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Al-Hussain Bani Hani, Saleh M; El-Dwairi, Qasim A; Bataineh, Ziad M; Al-Haidari, Mohammad S; Al-Alami, Jamil

2008-05-01

The morphological and quantitative features of neurons in the adult human ventral anterior thalamic nucleus were studied in Golgi preparations. Two neuronal types were found and their quantitative features were studied. Golgi-type I neurons were medium to large cells with dense dendritic trees and dendritic protrusions and short hair-like appendages. They have somatic mean diameter of 30.8 microm (+/-9.4, n = 85). They have an average 100.3 dendritic branches, 48.97 dendritic branching points, and 58.85 dendritic tips. The mean diameters of their primary, secondary, and tertiary dendrites were 3.1 microm (+/-1, n = 80), 1.85 microm (+/-0.8, n = 145), and 1.5 microm (+/-0.4, n = 160), respectively. Golgi-type II neurons were small to medium cells with few sparsely branching dendrites and dendritic stalked appendages with or without terminal swellings. They have somatic mean diameters of 22.2 microm (+/-5.8, n = 120). They have an average 33.76 dendritic branches, 16.49 dendritic branching points, and 21.97 dendritic tips. The mean diameters of their primary, secondary, and tertiary dendrites were 1.6 microm (+/-0.86, n = 70), 1.15 microm (+/-0.55, n = 118), and 1 microm (+/-0.70, n = 95), respectively. These quantitative data may form the basis for further quantitative studies involving aging or some degenerative diseases that may affect cell bodies and/or dendritic trees of the Golgi-type I and/or Golgi-type II thalamic neurons.

Impaired Fasting Glucose in Omani Adults with no Family History of Type 2 Diabetes

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Sawsan Al-Sinani

2014-05-01

Full Text Available Objectives: The aim of this study was to estimate the prevalence of impaired fasting glucose (IFG among Omani adults with no family history (FH of diabetes and to investigate the factors behind the risk of developing type 2 diabetes (T2D, while excluding a FH of diabetes. Methods: A total of 1,182 Omani adults, aged ≥40 years, visited the Family Medicine & Community Health Clinic at Sultan Qaboos University Hospital, Oman, on days other than the Diabetes Clinic days, from July 2010 to July 2011. The subjects were interviewed and asked if they had T2D or a FH of T2D. Results: Only 191 (16% reported no personal history of T2D or FH of the disease. Of these, anthropometric and biochemical data was complete in 159 subjects. Of these a total of 42 (26% had IFG according to the American Diabetes Association criteria. Body mass index, fasting insulin, haemoglobin A1C and blood pressure (BP, were significantly higher among individuals with IFG (P <0.01, P <0.05, P <0.01 and P <0.01, respectively. In addition, fasting insulin, BP and serum lipid profile were correlated with obesity indices (P <0.05. Obesity indices were strongly associated with the risk of IFG among Omanis, with waist circumference being the strongest predictor. Conclusion: Despite claiming no FH of diabetes, a large number of Omani adults in this study had a high risk of developing diabetes. This is possibly due to environmental factors and endogamy. The high prevalence of obesity combined with genetically susceptible individuals is a warning that diabetes could be a future epidemic in Oman.

Usher syndrome Type I in an adult Nepalese male: a rare case report.

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Sahu, Sabin; Singh, Sanjay Kumar

2017-07-01

Usher syndrome, also known as retinitis pigmentosa-dysacusis syndrome, is an extremely rare genetic disorder, characterized by retinitis pigmentosa (RP) and congenital sensorineural hearing loss. It has been estimated to account for 3-6% of the congenitally deaf population, upto 8-33% of individuals with RP and half of all cases with combined deafness and blindness (Vernon M,1969; Boughman JA et al,1983). The prevalence of Usher syndrome have been reported to range from 3.5 to 6.2 per 100,000 in different populations (Vernon M,1969; Boughman JA et al,1983; Yan D et al, 2010). We report a case of Usher syndrome type I in an adult Nepalese male with typical congenital profound hearing loss, and night blindness secondary to retinitis pigmentosa. © NEPjOPH.

Gender and Age – Dependent effect of type 1 diabetes on obesity and altered body composition in young adults

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Agnieszka Szadkowska

2015-02-01

Full Text Available [b]Introduction and objective[/b]. The aim of the study was to evaluate the influence of age and gender on the prevalence of overweight and obesity, body composition and fatty tissue distribution in young adults with type 1 diabetes. [b]Material and methods[/b]. 197 patients with type 1 diabetes aged 20–40 years participated in the study. The control group consisted of 138 healthy adults. Body weight, height, waist and hip circumferences were measured. Analysis of body mass composition was performed using the bioimpedance. Study groups were stratified into cohorts aged <30 and 30+ years. [b]Results[/b]. Overweight and obesity were diagnosed in 35.5% and 13.2% of diabetic patients and in 26.1% and 7.3% of the control group, respectively (p=0.016. In the whole study group, advanced age (OR=1.10; p<0.001 and diabetes mellitus (OR=2.25; p=0.001 predisposed patients to excess body weight. Women had a lower prevalence of overweight and obesity, but a trend toward excessive body mass was observed in diabetic females (OR=1.18; p=0.181. Diabetic females more often had abdominal obesity than control females (mean difference – 19.2%; p=0.020. Higher total body fat mass was found in the diabetic group (p=0.037. Diabetic females had a higher amount of absolute (p<0.001 and relative body fat mass (p=0.002, fat free mass (p=0.007, relative arm (p=0.007, leg (0<0.001 and trunk (p-=0.006 fat mass than control females. Diabetic males showed only higher relative fat mass of the lower limbs compared to control males (p=0.018. [b]Conclusions[/b]. Patients with type 1 diabetes develop overweight and obesity in early adulthood more frequently than the general population and are characterized by higher body fat mass. Gender-related differences in body weight and composition in young type 1 diabetic adults were found.

Adult atopic dermatitis and the risk of type 2 diabetes

DEFF Research Database (Denmark)

Andersen, Yuki M.F.; Egeberg, Alexander; Gislason, Gunnar H.

2017-01-01

While AD is not an independent risk factor for T2D in adjusted analysis, age, smoking, alcohol abuse and use of systemic and topical corticosteroids may increase the risk of T2D in adults with AD.......While AD is not an independent risk factor for T2D in adjusted analysis, age, smoking, alcohol abuse and use of systemic and topical corticosteroids may increase the risk of T2D in adults with AD....

Role of Two Types of Syntactic Embedding in Belief Attribution in Adults with or without Asperger Syndrome

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Morgane Clémentine Burnel

2017-05-01

Full Text Available The role of syntax in belief attribution (BA is not completely understood in healthy adults and understudied in adults with autism spectrum disorder. Embedded syntax could be useful either for the development of Theory of Mind (ToM (Emergence account or more generally over the lifespan (Reasoning account. Two hypotheses have been explored, one suggesting that embedding itself (Relatives and Complement sentences and Metarepresentation account is important for ToM and another one considering that the embedding of a false proposition into a true one (Complement sentences and Misrepresentation account is important. The goals of this study were to evaluate (1 the role of syntax in ToM (Emergence vs. Reasoning account, (2 the type of syntax implied in ToM (Metarepresentation vs. Misrepresentation account, and (3 the verbally mediated strategies which compensate for ToM deficits in adults with Asperger Syndrome (AS. Fifty NeuroTypical (NT adults and 22 adults with AS were involved in a forced-choice task including ±ToM tasks (BA and a control task, physical causation, PC under four Interference conditions (silence, syllable repetition, relative sentences repetition, and complement sentences repetition. The non-significant ±ToM × Interference interaction effect in the NT group did not support the Reasoning account and thus suggests that syntax is useful only for ToM development (i.e., Emergence account. Results also indicated that repeating complement clauses put NT participants in a dual task whereas repeating relative clauses did not, suggesting that repeating relatives is easier for NT than repeating complements. This could be an argument in favor of the Misrepresentation account. However, this result should be interpreted with caution because our results did not support the Reasoning account. Moreover, AS participants (but not NT participants were more disrupted by ±ToM tasks when asked to repeat complement sentences compared to relative clause

Metabolic control targets in Sudanese adults with type 1 diabetes: A population-based study

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Ahmed O Almobarak

2017-01-01

Full Text Available Background: Type 1 diabetes is a challenging metabolic disorder for health authorities in Sudan. The objective of this study was to assess the level of glycemic control and to determine the prevalence of dyslipidemia and complications among individuals with type 1 diabetes in Sudan. Materials and Methods: Individuals with type 1 diabetes, who were having the disease for at least 1 year, were invited to participate in this study. Data were collected from two diabetes centers, in the Capital Khartoum and Atbara City, North of Sudan. Participants were interviewed using standardized pretested questionnaire to record medical history, sociodemographic data, and life style characteristics. Blood pressure, body mass index, and waist circumference were measured. Blood samples were taken for measurement of lipid profile and glycosylated hemoglobin. Results: A total of eighty individuals with type 1 diabetes volunteered to participate in this study, 37.5% of males and 62.5% of females. Majority of the patients were aged between 40 and 70 years old. There was poor glycemic control (glycosylated hemoglobin> 7%, in 83.8%. Age and sex were significant factors associated with poor glycemic control in this cohort. High cholesterol, triglyceride, and low density lipoprotein were seen in 76.2%, 27.5%, and 48.8% of participants, respectively. Low high density lipoprotein was seen in 33.8%. Hypertension was determined in 21.3%. Peripheral neuropathy, visual impairment, diabetic foot, and myocardial infarction were seen in 50%, 48.8%, 18.8%, and 2.5% of patients, respectively. Conclusion: Sudanese adults with type 1 diabetes have poor glycemic control, high prevalence of dyslipidemia, and long-term complications.

Perceptions of Help Given to Healthy Older Mothers by Adult Daughters: Ways of Initiating Help and Types of Help Given

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Martini, Tanya S.; Grusec, Joan E.; Bernardini, Silvia Cortese

2003-01-01

Older mother-adult daughter dyads (N = 43) addressed two issues pertaining to the ways in which help is initiated (offered, requested, and imposed help) and type of help given (instrumental help, advice, and emotional support) a) mothers' reasoning about these aspects of help, and b) daughters' understanding of mothers' feelings. Both groups noted…

Barriers to and enablers of insulin self-titration in adults with Type 2 diabetes: a qualitative study.

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McBain, H; Begum, S; Rahman, S; Mulligan, K

2017-02-01

To identify the barriers to and enablers of effective insulin self-titration in people with Type 2 diabetes. A qualitative semi-structured interview approach was used. Questions were structured according to the Theoretical Domains Framework, which outlines 14 domains that can act as barriers to and enablers of changing behaviour. Interviews were audio-recorded and transcribed verbatim. The data were coded according to the 14 domains, belief statements were created within each domain, and a frequency count of the most reported barriers and enablers was then carried out. Analyses were conducted by two researchers, and discrepancies agreed with a third researcher. A total of 18 adults with Type 2 diabetes took part in an interview. The majority were of South-Asian ethnicity (n = 8) and were men (n = 12). Their mean age was 61 years old. The mean duration of diabetes was 16 years and time on insulin 9 years. Inter-rater reliability for each of the domains varied (29-100%). The most frequently reported domains were Social Influence and Beliefs about Consequences; the least frequently reported were Optimism and Reinforcement. Interviewees reported receiving support to self-titrate from a range of sources. Self-titrating was perceived to have a range of both positive and negative consequences, as was not titrating. The findings highlight that those interviewed experienced a range of barriers and enablers when attempting to self-titrate. Improved education and training when initiating insulin treatment among adults with Type 2 diabetes, and throughout their journey on insulin therapy could help identify and address these barriers in order to optimize self-titration. © 2016 Diabetes UK.

Immunity status of adults and children against poliomyelitis virus type 1 strains CHAT and Sabin (LSc-2ab in Germany

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Diedrich Sabine

2010-12-01

Full Text Available Abstract Background In October 2007, the working group CEN/TC 216 of the European Committee for standardisation suggested that the Sabin oral poliovirus vaccine type 1 strain (LSc-2ab presently used for virucidal tests should be replaced by another attenuated vaccine poliovirus type 1 strain, CHAT. Both strains were historically used as oral vaccines, but the Sabin type 1 strain was acknowledged to be more attenuated. In Germany, vaccination against poliomyelitis was introduced in 1962 using the oral polio vaccine (OPV containing Sabin strain LSc-2ab. The vaccination schedule was changed from OPV to an inactivated polio vaccine (IPV containing wild polio virus type 1 strain Mahoney in 1998. In the present study, we assessed potential differences in neutralising antibody titres to Sabin and CHAT in persons with a history of either OPV, IPV, or OPV with IPV booster. Methods Neutralisation poliovirus antibodies against CHAT and Sabin 1 were measured in sera of 41 adults vaccinated with OPV. Additionally, sera from 28 children less than 10 years of age and immunised with IPV only were analysed. The neutralisation assay against poliovirus was performed according to WHO guidelines. Results The neutralisation activity against CHAT in adults with OPV vaccination history was significantly lower than against Sabin poliovirus type 1 strains (Wilcoxon signed-rank test P Conclusion The lack of neutralising antibodies against the CHAT strain in persons vaccinated with OPV might be associated with an increased risk of reinfection with the CHAT polio virus type 1, and this implies a putative risk of transmission of the virus to polio-free communities. We strongly suggest that laboratory workers who were immunised with OPV receive a booster vaccination with IPV before handling CHAT in the laboratory.

Family PArtners in Lifestyle Support (PALS): Family-Based Weight Loss for African American Adults with Type 2 Diabetes

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Samuel-Hodge, Carmen D.; Holder-Cooper, Judith C.; Gizlice, Ziya; Davis, Gwendolyn; Steele, Sonia P.; Keyserling, Thomas C.; Kumanyika, Shiriki K.; Brantley, Phillip J.; Svetkey, Laura P.

2016-01-01

Objective To develop and test a family-centered behavioral weight loss intervention for African American adults with type 2 diabetes. Methods In this randomized trial, dyads consisting of African American adult with overweight or obesity and type 2 diabetes (index participant) paired with a family partner with overweight or obesity, but not diagnosed with diabetes, were assigned in a 2:1 ratio to a 20-week special intervention (SI) or delayed intervention (DI) control group. The primary outcome was weight loss among index participants at 20 weeks follow-up. Results One hundred-eight participants (54 dyads – 36 (SI) and 18 (DI) dyads) were enrolled: 81% females; mean age, 51 years; mean weight,103 kg; and mean BMI, 37 kg/m2. At post-intervention, 96 participants (89%) returned for follow-up measures. Among index participants, mean difference in weight loss between groups was −5.0 kg, pfamily interactions, and dietary, physical activity, and diabetes self-care behaviors. SI family partners also had significant weight loss (−3.9 kg (SI) vs. −1.0 kg (DI) p=0.02). Conclusions A family-centered, behavioral weight loss intervention led to clinically significant short-term weight loss among family dyads. PMID:27911049

The Effect of Prior Task Success on Older Adults' Memory Performance: Examining the Influence of Different Types of Task Success.

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Geraci, Lisa; Hughes, Matthew L; Miller, Tyler M; De Forrest, Ross L

2016-01-01

Negative aging stereotypes can lead older adults to perform poorly on memory tests. Yet, memory performance can be improved if older adults have a single successful experience on a cognitive test prior to participating in a memory experiment (Geraci & Miller, 2013, Psychology and Aging, 28, 340-345). The current study examined the effects of different types of prior task experience on subsequent memory performance. Before participating in a verbal free recall experiment, older adults in Experiment 1 successfully completed either a verbal or a visual cognitive task or no task. In Experiment 2, they successfully completed either a motor task or no task before participating in the free recall experiment. Results from Experiment 1 showed that relative to control (no prior task), participants who had prior success, either on a verbal or a visual task, had better subsequent recall performance. Experiment 2 showed that prior success on a motor task, however, did not lead to a later memory advantage relative to control. These findings demonstrate that older adults' memory can be improved by a successful prior task experience so long as that experience is in a cognitive domain.

Hope matters to the glycemic control of adolescents and young adults with type 1 diabetes.

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Santos, Fábio R M; Sigulem, Daniel; Areco, Kelsy C N; Gabbay, Monica A L; Dib, Sergio A; Bernardo, Viviane

2015-05-01

This study investigated the association of hope and its factors with depression and glycemic control in adolescents and young adults with type 1 diabetes. A total of 113 patients were invited to participate. Significant negative correlations were found between hope and HbA1c and also between hope and depression. Hope showed a significant association with HbA1c and depression in the stepwise regression model. Among the hope factors, "inner positive expectancy" was significantly associated with HbA1c and depression. This study supports that hope matters to glycemic control and depression. Intervention strategies focusing on hope should be further explored. © The Author(s) 2015.

Functioning and disability in adults with myotonic dystrophy type 1.

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Kierkegaard, Marie; Harms-Ringdahl, Karin; Holmqvist, Lotta Widén; Tollbäck, Anna

2011-01-01

 To provide a comprehensive description of functioning and disability with regard to stages of disease progression in adults with myotonic dystrophy type 1 (DM1). Further to explore associations of measures of manual dexterity and of walking capacity with measures of activities of daily living (ADL) and participation in social and lifestyle activities. Seventy persons with DM1 underwent examinations, tests and answered questionnaires. Stages of disease progression were based on the muscular impairment rating scale.  Overweight, cardiac dysfunctions, respiratory restrictions, fatigue and/or low physical activity levels were found in approximately 40% of those with DM1. Over 75% had muscle impairments, and activity limitations in manual dexterity and walking. Dependence in personal and instrumental ADL was found in 16% and 39%, respectively, and participation restrictions in social and lifestyle activities in 52%. The presence of concurrent body-function impairments, activity limitations and participation restrictions was high. Significant differences were found in muscle impairment, manual dexterity, mobility, ADL and social and lifestyle activities with regard to disease progression. Cut-off values in measures of manual dexterity and walking capacity associated to functioning are proposed.  This information can be used for developing clinical practise and for health promotion for persons with DM1.

Nickel exposure is associated with the prevalence of type 2 diabetes in Chinese adults.

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Liu, Gang; Sun, Liang; Pan, An; Zhu, Mingjiang; Li, Zi; ZhenzhenWang, Zhenzhen; Liu, Xin; Ye, Xingwang; Li, Huaixing; Zheng, He; Ong, Choon Nam; Yin, Huiyong; Lin, Xu; Chen, Yan

2015-02-01

Nickel exposure can induce hyperglycaemia in rodents, but little is known about its association with abnormal glucose metabolism in humans. We aimed to investigate the association of nickel exposure with the prevalence of type 2 diabetes in Chinese adults. A total of 2115 non-institutionalized men and women aged 55 to 76 years from Beijing and Shanghai were included, and urinary nickel concentration was assessed by inductively coupled plasma mass spectroscopy. The prevalence of type 2 diabetes was compared across urinary nickel quartiles. Fasting plasma glucose, insulin, lipids, C-reactive protein and glycated haemoglobin A1c, as well as urinary albumin and creatinine were measured. The median concentration of urinary nickel was 3.63 mg/l (interquartile range: 2.29–5.89 mg/l), and the prevalence of diabetes was 35.3% (747 cases/2115 persons). Elevated levels of urinary nickel were associated with higher fasting glucose, glycated haemoglobin A1c, insulin and homeostatic model assessment of insulin resistance (all Pnickel quartiles were 1.27 (0.97–1.67), 1.78 (1.36–2.32) and 1.68 (1.29–2.20), respectively (referencing to 1.00), after multivariate adjustment including lifestyle factors, body mass index and family history of diabetes (P for trend nickel concentration is associated with elevated prevalence of type 2 diabetes in humans.

Older Adults and Depression

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... find more information? Reprints Share Older Adults and Depression Download PDF Download ePub Order a free hardcopy ... depression need treatment to feel better. Types of Depression There are several types of depression. The most ...

Social comparisons in adults with type 2 diabetes: Patients' reasons for target selection.

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Arigo, Danielle; Cornell, Max; Smyth, Joshua M

2018-07-01

To examine reasons for selecting a social comparison target (i.e. a specific other for relative self-evaluation), and their influence on affect and motivation for self-care, in type 2 diabetes (T2DM). Adults with T2DM (n = 180, M A1c  = 7.6%) chose to read about one of four targets. Participants rated five reasons for their choice (strongly disagree - strongly agree), and rated affect and self-care motivation before and after reading. To boost confidence in my ability to manage diabetes was rated highest overall (ps motivation (p motivation only among those who chose better-off targets (p = 0.01). Patients' reasons for a particular comparison are associated with short-term changes in affect and self-care motivation, and warrant greater empirical and clinical attention.

Evaluation of a Mobile Phone Image-Based Dietary Assessment Method in Adults with Type 2 Diabetes

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Megan E. Rollo

2015-06-01

Full Text Available Image-based dietary records have limited evidence evaluating their performance and use among adults with a chronic disease. This study evaluated the performance of a 3-day mobile phone image-based dietary record, the Nutricam Dietary Assessment Method (NuDAM, in adults with type 2 diabetes mellitus (T2DM. Criterion validity was determined by comparing energy intake (EI with total energy expenditure (TEE measured by the doubly-labelled water technique. Relative validity was established by comparison to a weighed food record (WFR. Inter-rater reliability was assessed by comparing estimates of intake from three dietitians. Ten adults (6 males, age: 61.2 ± 6.9 years old, BMI: 31.0 ± 4.5 kg/m2 participated. Compared to TEE, mean EI (MJ/day was significantly under-reported using both methods, with a mean ratio of EI:TEE 0.76 ± 0.20 for the NuDAM and 0.76 ± 0.17 for the WFR. Correlations between the NuDAM and WFR were mostly moderate for energy (r = 0.57, carbohydrate (g/day (r = 0.63, p < 0.05, protein (g/day (r = 0.78, p < 0.01 and alcohol (g/day (rs = 0.85, p < 0.01, with a weaker relationship for fat (g/day (r = 0.24. Agreement between dietitians for nutrient intake for the 3-day NuDAM (Intra-class Correlation Coefficient (ICC = 0.77–0.99 was lower when compared with the 3-day WFR (ICC = 0.82–0.99. These findings demonstrate the performance and feasibility of the NuDAM to assess energy and macronutrient intake in a small sample. Some modifications to the NuDAM could improve efficiency and an evaluation in a larger group of adults with T2DM is required.

Diabetes Type 1

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Diabetes means your blood glucose, or blood sugar, levels are too high. With type 1 diabetes, your pancreas does not make insulin. Insulin is ... kidneys, nerves, and gums and teeth. Type 1 diabetes happens most often in children and young adults ...

Incidence and prevalence of diabetic ketoacidosis (DKA) among adults with type 1 diabetes mellitus (T1D): a systematic literature review.

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Fazeli Farsani, Soulmaz; Brodovicz, Kimberly; Soleymanlou, Nima; Marquard, Jan; Wissinger, Erika; Maiese, Brett A

2017-08-01

To summarise incidence and prevalence of diabetic ketoacidosis (DKA) in adults with type 1 diabetes (T1D) for the overall patient population and different subgroups (age, sex, geographical region, ethnicity and type of insulin administration). Systematic literature review (SLR). Medline (via PubMed) and Embase (1 January 2000 to 23 June 2016). Peer-reviewed observational studies with reported data on the incidence or prevalence of DKA in T1D adults were included. A single reviewer completed the study screening and selection process and a second reviewer performed an additional screening of approximately 20% of the publications; two reviewers independently conducted the quality assessment; the results were narratively synthesised. Out of 1082 articles, 19 met the inclusion and exclusion criteria, with two additional studies identified that did not specify the patient age range and are therefore not included in the SLR. Overall, eight studies reported incidence with a range of 0-56 per 1000 person-years (PYs), with one outlying study reporting an incidence of 263 per 1000 PYs. Eleven studies reported prevalence with a range of 0-128 per 1000 people. Prevalence of DKA decreased with increasing age. Subgroup analyses were performed using data from no more than two studies per subgroup. There was a higher prevalence of DKA reported in women, non-whites and patients treated with insulin injections compared with men, whites and patients using continuous subcutaneous insulin infusion pumps, respectively. To our knowledge, this is the first SLR on the epidemiology of DKA in T1D adults. Despite an increasing prevalence of T1D in recent years, DKA in adults has been poorly characterised. In an era when the benefit-risk profiles of new antidiabetic therapies are being evaluated, including the potential risk of DKA, there is a clear need to better elucidate the expected rate of DKA among T1D adults. © Article author(s) (or their employer(s) unless otherwise stated in the text

FGF-2 potently induces both proliferation and DSP expression in collagen type I gel cultures of adult incisor immature pulp cells

International Nuclear Information System (INIS)

Nakao, Kazuhisa; Itoh, Makoto; Tomita, Yusuke; Tomooka, Yasuhiro; Tsuji, Takashi

2004-01-01

We investigated the effects of both cytokines and extracellular matrices on the proliferation and differentiation of immature adult rat incisor dental pulp cells. These immature cells, which have a high-proliferative potency in vitro and do not express mRNAs for dentin non-collagenous proteins such as dentin sialoprotein (DSP), bone sialoprotein (BSP), and osteocalcin, exist in the root regions of adult rat incisors. Fibroblast growth factor-2 (FGF-2) stimulated the proliferation of these immature cells and the subsequent production of mineralized calcium was induced by β-glycerophosphate treatment. Additionally, FGF-2 dramatically induced the expression of DSP and BSP mRNAs, but only in collagen type I gel cultures, whereas neither plate-coated collagen type I nor fibronectin, laminin or collagen type IV cultures could produce this effect and generate sufficient physiological levels of these transcripts. Although bone morphogenetic protein-4 could not induce the proliferation of immature dental pulp cells nor upregulate DSP mRNA expression, it had a synergistic effect upon DSP transcript levels in conjunction with FGF-2. These results suggest that both the presence of FGF-2 and the three-dimensional formation of immature dental pulp cells in collagen type I gel cultures are essential for both DSP expression and odontoblast differentiation. These observations provide valuable information concerning the study of the commitment and differentiation of odontoblast lineages, and also provide a basis for the rational design of cytokine and extracellular matrix based compounds for regenerative therapies in new dental treatments

Development of a supported self-management intervention for adults with type 2 diabetes and a learning disability.

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House, Allan; Latchford, Gary; Russell, Amy M; Bryant, Louise; Wright, Judy; Graham, Elizabeth; Stansfield, Alison; Ajjan, Ramzi

2018-01-01

Although supported self-management is a well-recognised part of chronic disease management, it has not been routinely used as part of healthcare for adults with a learning disability. We developed an intervention for adults with a mild or moderate learning disability and type 2 diabetes, building on the principles of supported self-management with reasonable adjustments made for the target population. In five steps, we:Clarified the principles of supported self-management as reported in the published literatureIdentified the barriers to effective self-management of type 2 diabetes in adults with a learning disabilityReviewed existing materials that aim to support self-management of diabetes for people with a learning disabilitySynthesised the outputs from the first three phases and identified elements of supported self-management that were (a) most relevant to the needs of our target population and (b) most likely to be acceptable and useful to themImplemented and field tested the intervention. The final intervention had four standardised components: (1) establishing the participant's daily routines and lifestyle, (2) identifying supporters and their roles, (3) using this information to inform setting realistic goals and providing materials to the patient and supporter to help them be achieved and (4) monitoring progress against goals.Of 41 people randomised in a feasibility RCT, thirty five (85%) completed the intervention sessions, with over three quarters of all participants (78%) attending at least three sessions.Twenty-three out of 40 (58%) participants were deemed to be very engaged with the sessions and 12/40 (30%) with the materials; 30 (73%) participants had another person present with them during at least one of their sessions; 15/41 (37%) were reported to have a very engaged main supporter, and 18/41 (44%) had a different person who was not their main supporter but who was engaged in the intervention implementation. The intervention was feasible to

Effectiveness and safety of dipeptidyl peptidase 4 inhibitors in the management of type 2 diabetes in older adults: a systematic review and development of recommendations to reduce inappropriate prescribing.

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Schott, Gisela; Martinez, Yolanda V; Ediriweera de Silva, R Erandie; Renom-Guiteras, Anna; Vögele, Anna; Reeves, David; Kunnamo, Ilkka; Marttila-Vaara, Minna; Sönnichsen, Andreas

2017-10-16

Preventable drug-related hospital admissions can be associated with drugs used in diabetes and the benefits of strict diabetes control may not outweigh the risks, especially in older populations. The aim of this study was to look for evidence on risks and benefits of DPP-4 inhibitors in older adults and to use this evidence to develop recommendations for the electronic decision support tool of the PRIMA-eDS project. Systematic review using a staged approach which searches for systematic reviews and meta-analyses first, then individual studies only if prior searches were inconclusive. The target population were older people (≥65 years old) with type 2 diabetes. We included studies reporting on the efficacy and/or safety of DPP-4 inhibitors for the management of type 2 diabetes. Studies were included irrespective of DPP-4 inhibitors prescribed as monotherapy or in combination with any other drug for the treatment of type 2 diabetes. The target intervention was DPP-4 inhibitors compared to placebo, no treatment, other drugs to treat type 2 diabetes or a non-pharmacological intervention. Thirty studies (reported in 33 publications) were included: 1 meta-analysis, 17 intervention studies and 12 observational studies. Sixteen studies were focused on older adults and 14 studies reported subgroup analyses in participants ≥65, ≥70, or ≥75 years. Comorbidities were reported by 26 studies and frailty or functional status by one study. There were conflicting findings regarding the effectiveness of DPP-4 inhibitors in older adults. In general, DPP-4 inhibitors showed similar or better safety than placebo and other antidiabetic drugs. However, these safety data are mainly based on short-term outcomes like hypoglycaemia in studies with HbA1c control levels recommended for younger people. One recommendation was developed advising clinicians to reconsider the use of DPP-4 inhibitors for the management of type 2 diabetes in older adults with HbA1c companies and authored or

Perceived functioning and disability in adults with myotonic dystrophy type 1: a survey according to the International Classification Of Functioning, Disability and Health.

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Kierkegaard, Marie; Harms-Ringdahl, Karin; Widén Holmqvist, Lotta; Tollbäck, Anna

2009-06-01

The purpose of this study was to describe and analyse self-rated perceived functioning, disability and environmental facilitators/barriers with regard to disease severity, using the International Classification of Functioning, Disability and Health (ICF) checklist, in adults with myotonic dystrophy type 1. Cross-sectional design. Forty-one women and 29 men with myotonic dystrophy type 1. A modified ICF checklist was used for self-rating of perceived problems in 29 body-function categories, difficulties in 52 activity and participation categories, and facilitators/barriers in 23 environmental-factor categories according to the verbal anchors of the ICF qualifiers. Disease severity classification was based on the muscular impairment rating scale. Of the persons with myotonic dystrophy type 1, 80% perceived problems of excessive daytime sleepiness, 76% of muscle power, and 66% of energy and drive functions, while over 59% perceived difficulties in physically demanding mobility activities. Disabilities in mobility, self-care and domestic life were more frequently reported by persons with severe disease. Support from the immediate family, medicines and social security services were perceived as facilitators for 50-60% of the participants. Disabilities and important environmental facilitators in adults with myotonic dystrophy type 1 were identified, and this clinically-relevant information can be used for developing health services for people with this condition.

A Longitudinal Investigation of Anxiety and Depressive Symptomatology and Exercise Behaviour Among Adults With Type 2 Diabetes Mellitus.

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Ivanova, Elena; Burns, Rachel J; Deschênes, Sonya S; Knäuper, Bärbel; Schmitz, Norbert

2017-02-01

Evidence suggests that symptoms of depression and anxiety predict lower exercise behaviour and, inversely, that less exercise predicts higher symptomatology. The present longitudinal study examined this reciprocal association in adults with type 2 diabetes mellitus. We predicted that symptoms of anxiety or depression would intensify over time as a consequence of lower exercise frequency and, similarly, that exercise frequency would decrease as a consequence of greater symptoms of anxiety or depression. We studied 1691 adults with type 2 diabetes who provided baseline measures in 2011 and 2 subsequent annual assessments (Follow-up 1 and Follow-up 2). Symptoms of depression and anxiety were measured using the Patient Health Questionnaire-9 and the Generalized Anxiety Disorder-7, respectively. A single item assessed exercise frequency in the past month (in days). Separate 3-wave cross-lagged path models for symptoms of anxiety and depression tested the reciprocal associations. Contrary to our hypotheses, the reciprocal associations were not supported and, by extension, the predicted secondary associations were not tested. In sum, only depressive symptoms negatively predicted subsequent exercise frequency (Follow-up 1 and Follow-up 2). Symptoms of depression were prospectively associated with lower exercise frequency, which is consistent with evidence from population-based studies that identify depressive symptoms as a barrier to exercise participation. Copyright © 2016 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.

Effects of animal type (wild vs. domestic) and diet alfalfa level on intake and digestibility of European adult rabbits (Oryctolagus cuniculus)

NARCIS (Netherlands)

Pinheiro, Victor; Outor-Monteiro, D.; Mourão, J.L.; Cone, J.W.; Guimaraes Dias Lourenco, Ana

2018-01-01

The aim of this study was to evaluate the effect of the level of alfalfa in the diet on feed intake and digestibility of two types of rabbits, wild (Oryctolagus cuniculus algirus) vs. domestic (O. cuniculus cuniculus). Ten wild (W; mean LW = 927 g) and 10 domestic (D; mean LW = 4,645 g) adult rabbit

Disclosure during private prayer as a mediator between prayer type and mental health in an adult christian sample.

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Black, Stephanie Winkeljohn; Pössel, Patrick; Jeppsen, Benjamin D; Bjerg, Annie C; Wooldridge, Don T

2015-04-01

According to Poloma and Pendleton's (J Psychol Theol 19:71-83, 1991) prayer model, there are four prayer types (colloquial, meditative, petitionary, and ritual), all of which have varying associations with mental health. However, few studies have examined what mechanisms explain these associations. The literature demonstrates that disclosing distressing information can improve mental health. Thus, the current study examined self-disclosure as a mediating variable between Poloma and Pendleton's (J Psychol Theol 19:71-83, 1991) prayer types and mental health. It was hypothesized that self-disclosure would mediate the association between prayer types involving meaningful communication with God (colloquial and meditative prayer types) and mental health and would not mediate associations between petitionary and ritual prayer types and mental health. This cross-sectional, online study analyzed data from praying Christian adults (N = 296) to test the hypotheses. As predicted, self-disclosure mediated the positive associations between colloquial and meditative prayer types and mental health. Self-disclosure was not associated with petitionary or ritual prayer and therefore did not mediate the relationships of these prayer types with mental health, as expected. Petitionary prayer had a negative relationship to mental health, while ritual prayer had a positive relationship to mental health. The results indicate that self-disclosure is an important mediator to consider when investigating the associations between private prayer and mental health.

Family history of type 2 diabetes and prevalence of metabolic syndrome in adult Asian Indians.

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Das, Mithun; Pal, Susil; Ghosh, Arnab

2012-04-01

Our objective was to test the association between familial risk of type 2 diabetes mellitus (T2DM) and the prevalence of metabolic syndrome (MS) in adult Asian Indians. A total of 448 adult (>30 years) individuals (257 males and 191 females) participated in the study. Familial risk of T2DM was classified into three groups viz., 1=both parents affected; 2=parent and/or siblings affected and 3=none or no family history for T2DM. Anthropometric measures, blood pressures, fasting blood glucose and metabolic profiles were studied using standard techniques. MS was defined accordingly. The prevalence of MS phenotypes was estimated and compared among the three familial risk strata. Individuals with a history of both parents affected from diabetes had significantly higher (Pfamily history of T2DM. Significant difference was also noticed between individuals with and without MS according to the family history of diabetes (Pfamily history of T2DM. Family history of T2DM had significant effect on individuals with MS as compared to their counterparts (individuals having no family history of T2DM). It therefore seems reasonable to argue that family history of T2DM could be useful as a predictive tool for early diagnosis and prevention of MS in Asian Indian population.

Childhood BMI and Adult Type 2 Diabetes, Coronary Artery Diseases, Chronic Kidney Disease, and Cardiometabolic Traits: A Mendelian Randomization Analysis.

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Geng, Tingting; Smith, Caren E; Li, Changwei; Huang, Tao

2018-05-01

To test the causal effect of childhood BMI on adult cardiometabolic diseases using a Mendelian randomization analysis. We used 15 single nucleotide polymorphisms as instrumental variables for childhood BMI to test the causal effect of childhood BMI on cardiometabolic diseases using summary-level data from consortia. We found that a 1-SD increase in childhood BMI (kg/m 2 ) was associated with an 83% increase in risk of type 2 diabetes (odds ratio [OR] 1.83 [95% CI 1.46, 2.30]; P = 2.5 × 10 -7 ) and a 28% increase in risk of coronary artery disease (CAD) (OR 1.28 [95% CI 1.17, 1.39]; P = 2.1 × 10 -8 ) at the Bonferroni-adjusted level of significance ( P BMI was associated with a 0.587-SD increase in adulthood BMI (kg/m 2 ), a 0.062-SD increase in hip circumference (cm), a 0.602-SD increase in waist circumference (cm), a 0.111 pmol/L increase in log fasting insulin, a 0.068 increase in log-transformed HOMA of ß-cell function (%), a 0.126 increase in log-transformed HOMA of insulin resistance (%), and a 0.109-SD increase in triglyceride (mg/dL) but a 0.138-SD decrease in HDL (mg/dL) in adults at the Bonferroni-adjusted level of significance ( P BMI was associated with increased risk of type 2 diabetes and CAD in adult life. These results provide evidence supportive of a causal association between childhood BMI and these outcomes. © 2018 by the American Diabetes Association.

The association of household food insecurity with the risk of type 2 diabetes mellitus in adults: a systematic review and meta-analysis.

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Abdurahman, Ahmed A; Chaka, Eshetu E; Nedjat, S; Dorosty, Ahmed Reza; Majdzadeh, R

2018-05-02

The link between household food insecurity and risk of type 2 diabetes mellitus still remains controversial. Therefore, we performed a systematic review and meta-analysis to clarify the association between household food insecurity and type 2 diabetes mellitus. EMBASE, PubMed, ISI Web of Science and Scopus databases were searched up to March 2017. The selection of studies, data extraction and assessing the risk of bias in the included studies were carried out by two reviewers independently. Study-specific odds ratios (ORs) were pooled using a random effects model. A total of 18 articles including a total of 55,353,915 adult participants were included in the meta-analysis. The pooled ORs of the cross-sectional studies revealed that household food insecurity was significantly associated with the odds of T2DM (OR 1.27, 95% CI 1.11-1.42) with no evidence of publication bias (p = 0.63) but heterogeneity between studies (I 2  = 61.1%). Similarly, subgroup analyses showed that the country where the study conducted and household food insecurity assessment tool used to influence the effect of household food insecurity on the odds of T2DM. However, the pooled ORs for two case-control and one cohort studies were not significantly associated between household food insecurity and T2DM in adults. This study strengthens the hypothesis of the household food insecurity effect on the odds of T2DM among adults. Further longitudinal studies based on larger, and more representative samples are needed to identify the underlying relationships between food insecurity and type 2 diabetes mellitus.

Ostreid herpesvirus type 1 replication and host response in adult Pacific oysters, Crassostrea gigas.

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Segarra, Amélie; Baillon, Laury; Tourbiez, Delphine; Benabdelmouna, Abdellah; Faury, Nicole; Bourgougnon, Nathalie; Renault, Tristan

2014-10-08

Since 2008, massive mortality outbreaks associated with OsHV-1 detection have been reported in Crassostrea gigas spat and juveniles in several countries. Nevertheless, adult oysters do not demonstrate mortality in the field related to OsHV-1 detection and were thus assumed to be more resistant to viral infection. Determining how virus and adult oyster interact is a major goal in understanding why mortality events are not reported among adult Pacific oysters. Dual transcriptomics of virus-host interactions were explored by real-time PCR in adult oysters after a virus injection. Thirty-nine viral genes and five host genes including MyD88, IFI44, IkB2, IAP and Gly were measured at 0.5, 10, 26, 72 and 144 hours post infection (hpi). No viral RNA among the 39 genes was detected at 144 hpi suggesting the adult oysters are able to inhibit viral replication. Moreover, the IAP gene (oyster gene) shows significant up-regulation in infected adults compared to control adults. This result suggests that over-expression of IAP could be a reaction to OsHV-1 infection, which may induce the apoptotic process. Apoptosis could be a main mechanism involved in disease resistance in adults. Antiviral activity of haemolymph against herpes simplex virus (HSV-1) was not significantly different between infected adults versus control.

Types and predictors of partner reactions to HIV status disclosure among HIV-infected adult Nigerians in a tertiary hospital in the Niger Delta

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Ogoina, Dimie; Ikuabe, Peter; Ebuenyi, Ikenna; Harry, Tubonye; Inatimi, Otonyo; Chukwueke, Ogechi

BACKGROUND AND OBJECTIVE: Our aim was to describe the types and determinants of partner reactions to HIV-status disclosure among adults attending an antiretroviral therapy-(ART) clinic in the Bayelsa State, Nigeria. METHODS: A cross-sectional study was undertaken between January and March 2013 among

Determinants of medication adherence among adults with type 2 diabetes mellitus in three Malaysian public health clinics: a cross-sectional study

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Chew BH

2015-05-01

Full Text Available Boon-How Chew,1 Noor-Hasliza Hassan,2 Mohd-Sidik Sherina3 1Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 2Klinik Kesihatan Dengkil, Ministry of Health, 3Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia Abstract: Medication adherence (MA in adults with type 2 diabetes mellitus (T2D is associated with improved disease control (glycated hemoglobin, blood pressure, and lipid profile, lower rates of death and diabetes-related complications, increased quality of life, and decreased health care resource utilization. However, there is a paucity of data on the effect of diabetes-related distress, depression, and health-related quality of life on MA. This study examined factors associated with MA in adults with T2D at the primary care level. This was a cross-sectional study conducted in three Malaysian public health clinics, where adults with T2D were recruited consecutively in 2013. We used the 8-item Morisky Medication Adherence Scale (MMAS-8 to assess MA as the main dependent variable. In addition to sociodemographic data, we included diabetes-related distress, depressive symptoms, and health-related quality of life as independent variables. Independent association between the MMAS-8 score and its determinants was done using generalized linear models with a gamma distribution and log link function. The participant response rate was 93.1% (700/752. The majority were female (52.8%, Malay (52.9%, and married (79.1%. About 43% of patients were classified as showing low MA (MMAS-8 score <6. Higher income (adjusted odds ratio 0.90 and depressive symptoms (adjusted odds ratio 0.99 were significant independent determinants of medication non-adherence in young adults with T2D. Low MA in adults with T2D is a prevalent problem. Thus, primary health care providers in public health clinics should focus on MA counselling for adult T2D patients who are

Dropout From an eHealth Intervention for Adults With Type 2 Diabetes: A Qualitative Study.

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Lie, Silje Stangeland; Karlsen, Bjørg; Oord, Ellen Renate; Graue, Marit; Oftedal, Bjørg

2017-05-30

Adequate self-management is the cornerstone of type 2 diabetes treatment, as people make the majority of daily treatment measures and health decisions. The increasing prevalence of type 2 diabetes mellitus (T2DM) and the complexity of diabetes self-management demonstrate the need for innovative and effective ways to deliver self-management support. eHealth interventions are promoted worldwide and hold a great potential in future health care for people with chronic diseases such as T2DM. However, many eHealth interventions face high dropout rates. This led to our interest in the experiences of participants who dropped out of an eHealth intervention for adults with T2DM, based on the Guided Self-Determination (GSD) counseling method. In this study, we aimed to explore experiences with an eHealth intervention based on GSD in general practice from the perspective of those who dropped out and to understand their reasons for dropping out. To the best of our knowledge, no previous qualitative study has focused on participants who withdrew from an eHealth self-management support intervention for adults with T2DM. A qualitative design based on telephone interviews was used to collect data. The sample comprised 12 adults with type 2 diabetes who dropped out of an eHealth intervention. Data were collected in 2016 and subjected to qualitative content analysis. We identified one overall theme: "Losing motivation for intervention participation." This theme was illustrated by four categories related to the participants' experiences of the eHealth intervention: (1) frustrating technology, (2) perceiving the content as irrelevant and incomprehensible, (3) choosing other activities and perspectives, and (4) lacking face-to-face encounters. Our findings indicate that the eHealth intervention based on GSD without face-to-face encounters with nurses reduced participants' motivation for engagement in the intervention. To maintain motivation, our study points to the importance of

Diabetes-Specific and General Life Stress and Glycemic Outcomes in Emerging Adults With Type 1 Diabetes: Is Race/Ethnicity a Moderator?

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Butler, Ashley M; Weller, Bridget E; Yi-Frazier, Joyce P; Fegan-Bohm, Kelly; Anderson, Barbara; Pihoker, Catherine; Hilliard, Marisa E

2017-10-01

This study examines whether race/ethnicity moderates relationships of (a) diabetes stress and general life stressors with (b) diabetes outcomes of glycemic control and diabetic ketoacidosis (DKA) among emerging adults (aged 18-25 years) with type 1 diabetes (T1D). Using a T1D Exchange Registry sample of non-Hispanic White, African American, and Hispanic emerging adults (N = 3,440), multiple group analyses were used to determine whether race/ethnicity moderates the relationships between stress and diabetes outcomes. The relationships between the two stress types and glycemic control did not differ between African American and non-Hispanic Whites. However, as compared with non-Hispanic Whites, the association between higher diabetes-specific stress and poorer glycemic control was significantly stronger for Hispanics, and Hispanics had poorer glycemic control when they experienced a relatively fewer number of general life stressors than non-Hispanic Whites. The relationships between the type of stress (diabetes-specific and general stress) and DKA did not differ across racial/ethnic groups. Future research should evaluate possible mechanisms that contribute to the different relationships of stress with glycemic control among Hispanics compared with non-Hispanic Whites. © The Author 2017. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Subjective health complaints and illness perception amongst adults with Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome-HypermobilityType - a cross-sectional study.

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Hope, Lena; Juul-Kristensen, Birgit; Løvaas, Helene; Løvvik, Camilla; Maeland, Silje

2017-10-17

To investigate the prevalence and severity of subjective health complaints and describe illness perception in a population of Joint Hypermobility Syndrome or Ehlers-Danlos Syndrome-Hypermobile Type. This study was a postal survey with a questionnaire battery on demographic data, subjective health complaints inventory, and illness perception. A total of 110 individuals diagnosed with Joint Hypermobility Syndrome or Ehlers-Danlos Syndrome-Hypermobile Type from two specialized hospitals in Norway were offered participation. Further, 140 gender- and age-matched healthy controls from statistics Norway representing the general population were sent the questionnaire for reference. Overall response rate was 30.4% (n = 76), with 44.5% (n = 49) in Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome-Hypermobile Type and 19.3% (n = 27) in controls. Subjective health complaints were significantly higher in Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome-Hypermobile Type - than in the controls (32.06 vs. 11.08; p Syndrome/Ehlers-Danlos Syndrome-Hypermobile Type had low understanding of their illness and symptoms (understanding, mean: 3.93, SD 2.88), and reported to have moderate personal and treatment control over their illness. Adults with Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome-Hypermobile Type reported higher frequency and severity of subjective health complaints than the matched controls from the general adult population in Norway. Furthermore, Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome-Hypermobile Type reported low understanding of their illness and associated symptoms, and moderate belief that their illness can be kept under control through self-management or treatment. This may indicate one of the reasons why prognosis for these patients is poor. Implications for rehabilitation Awareness of the complexity of the subjective health complaints and inquiry into illness perception could contribute with valuable information about these

Accumulation of Major Life Events in Childhood and Adult Life and Risk of Type 2 Diabetes Mellitus.

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Jolene Masters Pedersen

Full Text Available The aim of the study was to estimate the effect of the accumulation of major life events (MLE in childhood and adulthood, in both the private and working domains, on risk of type 2 diabetes mellitus (T2DM. Furthermore, we aimed to test the possible interaction between childhood and adult MLE and to investigate modification of these associations by educational attainment.The study was based on 4,761 participants from the Copenhagen City Heart Study free of diabetes at baseline and followed for 10 years. MLE were categorized as 0, 1, 2, 3 or more events. Multivariate logistic regression models adjusted for age, sex, education and family history of diabetes were used to estimate the association between MLE and T2DM.In childhood, experiencing 3 or more MLE was associated with a 69% higher risk of developing T2DM (Odds Ratio (OR 1.69; 95% Confidence Interval (CI 1.60, 3.27. The accumulation of MLE in adult private (p-trend = 0.016 and work life (p-trend = 0.049 was associated with risk of T2DM in a dose response manner. There was no evidence that experiencing MLE in both childhood and adult life was more strongly associated with T2DM than experiencing events at only one time point. There was some evidence that being simultaneously exposed to childhood MLE and short education (OR 2.28; 95% C.I. 1.45, 3.59 and work MLE and short education (OR 2.86; 95% C.I. 1.62, 5.03 was associated with higher risk of T2DM, as the joint effects were greater than the sum of their individual effects.Findings from this study suggest that the accumulation of MLE in childhood, private adult life and work life, respectively, are risk factors for developing T2DM.

Working with young adults with Type 1 diabetes: views of a multidisciplinary care team and implications for service delivery.

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Brierley, S; Eiser, C; Johnson, B; Young, V; Heller, S

2012-05-01

Young adults with Type 1 diabetes experience difficulties achieving glucose targets. Clinic attendance can be poor, although health and self-care tend to be better among those who attend regularly. Our aims were to describe staff views about challenges working with this age-group (16-21 years). Semistructured interviews were conducted with 14 staff from Sheffield Teaching Hospitals diabetes care team. Interviews were audio-recorded, transcribed and analysed using thematic analysis. Three main themes emerged. Unique challenges working with young adults included staff emotional burden, the low priority given to self-care by young adults and the complexity of the diabetes regimen. Working in a multidisciplinary team was complicated by differences in consultation styles, poor team cohesion and communication. An ideal service should include psychological support for the professional team, identification of key workers, and development of individualized care plans. Staff differed in their views about how to achieve optimal management for young adults, but emphasized the need for greater patient-centred care and a range of interventions appropriate for individual levels of need. They also wanted to increase their own skills and confidence working with this age-group. While these results reflect the views of staff working in only one diabetes centre, they are likely to reflect the views of professionals delivering care to individuals of this age; replication is needed to determine their generalizability. © 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK.

Validity and Relative Ability of 4 Balance Tests to Identify Fall Status of Older Adults With Type 2 Diabetes.

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Marques, Alda; Silva, Alexandre; Oliveira, Ana; Cruz, Joana; Machado, Ana; Jácome, Cristina

The Berg Balance Scale (BBS), the Balance Evaluation Systems Test (BESTest), the Mini-BESTest, and the Brief-BESTest are useful tests to assess balance; however, their clinimetric properties have not been studied well in older adults with type 2 diabetes (T2D). This study compared the validity and relative ability of the BBS, BESTest, Mini-BESTest, and Brief-BESTest to identify fall status in older adults with T2D. This study involved a cross-sectional design. Sixty-six older adults with T2D (75 ± 7.6 years) were included and asked to report the number of falls during the previous 12 months and to complete the Activities-specific Balance Confidence scale. The BBS and the BESTest were administered, and the Mini-BESTest and Brief-BESTest scores were computed based on the BESTest performance. Receiver operating characteristics were used to assess the ability of each balance test to differentiate between participants with and without a history of falls. The 4 balance tests were able to identify fall status (areas under the curve = 0.74-0.76), with similar sensitivity (60%-67%) and specificity (71%-76%). The 4 balance tests were able to differentiate between older adults with T2D with and without a history of falls. As the BBS and the BESTest require longer application time, the Brief-BESTest may be an appropriate choice to use in clinical practice to detect fall risk.

‘I'm not a druggie, I'm just a diabetic’: a qualitative study of stigma from the perspective of adults with type 1 diabetes

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Browne, Jessica L; Ventura, Adriana; Mosely, Kylie; Speight, Jane

2014-01-01

Objectives While health-related stigma has been the subject of considerable research in other conditions (eg, HIV/AIDS, obesity), it has not received substantial attention in diabetes. Our aim was to explore perceptions and experiences of diabetes-related stigma from the perspective of adults with type 1 diabetes mellitus (T1DM). Design A qualitative study using semistructured interviews, which were audio recorded, transcribed and subject to thematic analysis. Setting All interviews were conducted in non-clinical settings in metropolitan areas of Victoria, Australia. Participants Adults aged ≥18 years with T1DM living in Victoria were eligible to take part. Participants were recruited primarily through the state consumer organisation representing people with diabetes. A total of 27 adults with T1DM took part: 15 (56%) were women; median IQR age was 42 (23) years and diabetes duration was 15 (20) years). Results Australian adults with T1DM perceive and experience T1DM-specific stigma as well as stigma-by-association with type 2 diabetes. Such stigma is characterised by blame, negative social judgement, stereotyping, exclusion, rejection and discrimination. Participants identified the media, family and friends, healthcare professionals and school teachers as sources of stigma. The negative consequences of this stigma span numerous life domains, including impact on relationships and social identity, emotional well-being and behavioural management of T1DM. This stigma also led to reluctance to disclose the condition in various environments. Adults with T1DM can be both the target and the source of diabetes-related stigma. Conclusions Stigmatisation is part of the social experience of living with T1DM for Australian adults. Strategies and interventions to address and mitigate this diabetes-related stigma need to be developed and evaluated. PMID:25056982

Exercise improves gait, reaction time and postural stability in older adults with type 2 diabetes and neuropathy.

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Morrison, Steven; Colberg, Sheri R; Parson, Henri K; Vinik, Aaron I

2014-01-01

For older adults with type 2 diabetes (T2DM), declines in balance and walking ability are risk factors for falls, and peripheral neuropathy magnifies this risk. Exercise training may improve balance, gait and reduce the risk of falling. This study investigated the effects of 12weeks of aerobic exercise training on walking, balance, reaction time and falls risk metrics in older T2DM individuals with/without peripheral neuropathy. Adults with T2DM, 21 without (DM; age 58.7±1.7years) and 16 with neuropathy (DM-PN; age 58.9±1.9years), engaged in either moderate or intense supervised exercise training thrice-weekly for 12weeks. Pre/post-training assessments included falls risk (using the physiological profile assessment), standing balance, walking ability and hand/foot simple reaction time. Pre-training, the DM-PN group had higher falls risk, slower (hand) reaction times (232 vs. 219ms), walked at a slower speed (108 vs. 113cm/s) with shorter strides compared to the DM group. Following training, improvements in hand/foot reaction times and faster walking speed were seen for both groups. While falls risk was not significantly reduced, the observed changes in gait, reaction time and balance metrics suggest that aerobic exercise of varying intensities is beneficial for improving dynamic postural control in older T2DM adults with/without neuropathy. Copyright © 2014 Elsevier Inc. All rights reserved.

Effect of Financial Incentives on Glucose Monitoring Adherence and Glycemic Control Among Adolescents and Young Adults With Type 1 Diabetes: A Randomized Clinical Trial.

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Wong, Charlene A; Miller, Victoria A; Murphy, Kathryn; Small, Dylan; Ford, Carol A; Willi, Steven M; Feingold, Jordyn; Morris, Alexander; Ha, Yoonhee P; Zhu, Jingsan; Wang, Wenli; Patel, Mitesh S

2017-12-01

Glycemic control often deteriorates during adolescence and the transition to young adulthood for patients with type 1 diabetes. The inability to manage type 1 diabetes effectively during these years is associated with poor glycemic control and complications from diabetes in adult life. To determine the effect of daily financial incentives on glucose monitoring adherence and glycemic control in adolescents and young adults with type 1 diabetes. The Behavioral Economic Incentives to Improve Glycemic Control Among Adolescents and Young Adults With Type 1 Diabetes (BE IN CONTROL) study was an investigator-blinded, 6-month, 2-arm randomized clinical trial conducted between January 22 and November 2, 2016, with 3-month intervention and follow-up periods. Ninety participants (aged 14-20) with suboptimally controlled type 1 diabetes (hemoglobin A1c [HbA1c] >8.0%) were recruited from the Diabetes Center for Children at the Children's Hospital of Philadelphia. All participants were given daily blood glucose monitoring goals of 4 or more checks per day with 1 or more level within the goal range (70-180 mg/dL) collected with a wireless glucometer. The 3-month intervention consisted of a $60 monthly incentive in a virtual account, from which $2 was subtracted for every day of nonadherence to the monitoring goals. During a 3-month follow-up period, the intervention was discontinued. The primary outcome was change in HbA1c levels at 3 months. Secondary outcomes included adherence to glucose monitoring and change in HbA1c levels at 6 months. All analyses were by intention to treat. Of the 181 participants screened, 90 (52 [57.8%] girls) were randomized to the intervention (n = 45) or control (n = 45) arms. The mean (SD) age was 16.3 (1.9) years. The intervention group had significantly greater adherence to glucose monitoring goals in the incentive period (50.0% vs 18.9%; adjusted difference, 27.2%; 95% CI, 9.5% to 45.0%; P = .003) but not in the follow-up period (15

Aging and the Socioeconomic Life of Older Adults in India

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Sanjeev Bakshi

2016-01-01

Full Text Available The study attempts to approach aging in India from three perspectives, namely, the well-being of an aging individual, the aging household, and the aging population. The aspects, namely, work, financial dependence, integration, empowerment, and elder abuse are studied and their relation to age, gender, and marital status is investigated. The data sets pertaining to the National Sample Surveys for the reference periods 1986-1987, 1995-1996, and 2004 are primarily utilized for the purpose. The data sets from Building Knowledge Base on Population Ageing in India Survey, 2011, are also utilized for information on elder abuse. The results show that the older males are more likely to participate in household activities when compared with the older females. The married older adults are also more likely to participate in household activities when compared with their widowed counterparts. In a similar way, gender and marital status are found to be associated with empowerment of older adults. The working older adults, those who possess property and/or assets are more likely to be financially independent. Furthermore, the older females and the financially dependent older adults are more likely to face abuses of different kinds. Households are classified into three different types. Type I households have no older adults, Type II households have older adults and other younger members, and Type III households have older adults only. Results show that Type III households are found to be relatively more deprived and report higher average monthly expenditure when compared with other types of households.

The association between adult-type hypolactasia and symptoms of functional dyspepsia

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André Castagna Wortmann

2018-01-01

Full Text Available Abstract Functional dyspepsia and lactose intolerance (adult-type hypolactasia, ATH are common conditions that may coexist or even be confounded. Their clinical presentation can be similar, however, lactose intolerance does not form part of the diagnostic investigation of functional dyspepsia. Studies on the association between functional dyspepsia and ATH are scarce. This study aimed to evaluate whether ATH is associated with symptoms of functional dyspepsia. Patients fulfilling the Rome III diagnostic criteria for functional dyspepsia underwent genetic testing for ATH. Dyspeptic symptoms were evaluated and scored according to a validated questionnaire. The diagnostic criteria for ATH was a CC genotype for the -13910C/T polymorphism, located upstream of the lactase gene. The mean scores for dyspeptic symptoms were compared between patients with ATH and those with lactase persistence. A total of 197 functional dyspeptic patients were included in the study. Mean age was 47.7 years and 82.7% patients were women. Eighty-eight patients (44.7% had a diagnosis of ATH. Abdominal bloating scores were higher in ATH patients compared to the lactase persistent patients (P=0.014. The remaining dyspeptic symptom scores were not significantly different between the two groups. The study results demonstrate an association between ATH and bloating in patients with functional dyspepsia.

What factors influence uptake of retinal screening among young adults with type 2 diabetes? A qualitative study informed by the theoretical domains framework.

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Lake, Amelia J; Browne, Jessica L; Rees, Gwyneth; Speight, Jane

2017-06-01

Young adults with type 2 diabetes (T2D, 18-39years) face increased risk of vision loss from diabetic retinopathy (DR). Retinal screening is essential to detect DR, yet screening rates for this group are low and little is known about the underlying factors influencing this important behavior. Using the theoretical domains framework (TDF) to guide data collection and analysis, we explored screening barriers and facilitator, contrasting them with a comparator group of older adults with T2D (40+ years). Thirty semi-structured telephone interviews (10 younger, 20 older adults) were conducted. Data were coded into TDF domains with salience identified by "frequency" of reference. Screening facilitators and barriers were systematically compared between groups. Although many screening facilitators and barriers were shared by younger and older adults, additional factors highly relevant to the former included: social comparison with others ('social influences'); concern for the impact on the family unit, unrealistic optimism and perceived invulnerability ('beliefs about consequences'); lack of time and financial resources ('environmental context and resources'), and DR misconceptions ('knowledge'). This study demonstrated that young adult retinal screening behavior was influenced by additional social cognitive factors compared to older adults, providing a first-step evidence base for clinicians and other health professionals, and potential targets for future eye health and retinal screening interventions. Copyright © 2017 Elsevier Inc. All rights reserved.

Laryngopharyngeal reflux and herpes simplex virus type 2 are possible risk factors for adult-onset recurrent respiratory papillomatosis (prospective case-control study).

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Formánek, M; Jančatová, D; Komínek, P; Matoušek, P; Zeleník, K

2017-06-01

The human papillomavirus (HPV) causes recurrent respiratory papillomatosis (RRP). Although HPV prevalence is high, the incidence of papillomatosis is low. Thus, factors other than HPV infection probably contribute to RRP. This study investigated whether patients with papillomatosis are more often infected with herpes simplex virus type 2 and chlamydia trachomatis (ChT) and whether laryngopharyngeal reflux (LPR) occurs in this group of patients more often. Prospective case-control study. Department of Otorhinolaryngology of University Hospital. The study included 20 patients with adult-onset RRP and 20 adult patients with vocal cord cyst and no pathology of laryngeal mucosa (control group). Immunohistochemical analysis of pepsin, HPV, herpes simplex virus type 2 and ChT was performed in biopsy specimens of laryngeal papillomas and of healthy laryngeal mucosa (control group) obtained from medial part of removed vocal cord cyst during microlaryngoscopy procedures. Pathologic LPR (pepsin in tissue) was diagnosed in 8/20 (40.0%) patients with papillomatosis and in 0/20 control patients (P = .003). Herpes simplex virus type 2 was present in 9/20 (45.0%) patients with papillomatosis and in 0/20 control patients (P = .001). Five specimens were positive for both pepsin and herpes simplex virus type 2. No samples were positive for ChT. There were no significant differences between groups for age, body mass index, diabetes mellitus and gastrooesophageal reflux disease. Tobacco exposure was not more frequent in RRP group either (P = .01). Results show that LPR and herpes simplex virus type 2 are significantly more often present in patients with RRP. LPR and herpes simplex virus type 2 might activate latent HPV infection and thereby be possible risk factors for RRP. © 2016 John Wiley & Sons Ltd.

Assessment of two culturally competent diabetes education methods: individual versus individual plus group education in Canadian Portuguese adults with type 2 diabetes.

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Gucciardi, Enza; Demelo, Margaret; Lee, Ruth N; Grace, Sherry L

2007-04-01

To examine the impact of two culturally competent diabetes education methods, individual counselling and individual counselling in conjunction with group education, on nutrition adherence and glycemic control in Portuguese Canadian adults with type 2 diabetes over a three-month period. The Diabetes Education Centre is located in the urban multicultural city of Toronto, Ontario, Canada. We used a three-month randomized controlled trial design. Eligible Portuguese-speaking adults with type 2 diabetes were randomly assigned to receive either diabetes education counselling only (control group) or counselling in conjunction with group education (intervention group). Of the 61 patients who completed the study, 36 were in the counselling only and 25 in the counselling with group education intervention. We used a per-protocol analysis to examine the efficacy of the two educational approaches on nutrition adherence and glycemic control; paired t-tests to compare results within groups and analysis of covariance (ACOVA) to compare outcomes between groups adjusting for baseline measures. The Theory of Planned Behaviour was used to describe the behavioural mechanisms that influenced nutrition adherence. Attitudes, subjective norms, perceived behaviour control, and intentions towards nutrition adherence, self-reported nutrition adherence and glycemic control significantly improved in both groups, over the three-month study period. Yet, those receiving individual counselling with group education showed greater improvement in all measures with the exception of glycemic control, where no significant difference was found between the two groups at three months. Our study findings provide preliminary evidence that culturally competent group education in conjunction with individual counselling may be more efficacious in shaping eating behaviours than individual counselling alone for Canadian Portuguese adults with type 2 diabetes. However, larger longitudinal studies are needed to

Incidence of diabetic ketosis and ketoacidosis in Caucasian adults with type 2 diabetes mellitus: a population-based study

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Ivan Kruljac

2017-03-01

Full Text Available Aims: We aimed to analyze incidence and characteristics of patients with diabetic ketosis (DK and diabetic ketoacidosis (DKA in Caucasian adults with type 2 diabetes mellitus (T2DM. Methods: Studied population included 261,749 adults. DK criteria included plasma glucose >13.9 mmol/L and ketonuria >2, while in DKA bicarbonate <18 mEq/L or pH<7.30 was also required. Hyperglycemic crises without these criteria were defined as non-ketotic hyperglycemia (NKH. Results: During a 5-year period, we observed 630 episodes of DK and 215 episodes of DKA. Only 8.6% of DK episodes and 34.4% of DKA were attributed to type 1 diabetes mellitus (T1DM. Patients with T1DM were younger, leaner, majority had newly diagnosed disease, and hyperglycemia was the main cause of admission. Standardized incidence ratio for DK was 48.1 (95% confidence interval [CI] 44.5-52.1 and 17.0 (95% CI 14.9-19.4 for DKA. Incidence for both DK and DKA was increasing with age. In patients younger than 50, the incidence of DK and DKA was similar. However, dramatic rise in the incidence of DK was observed in both sexes after the age of 50. When compared with patients with NKH, the patients with DK had higher serum pH and bicarbonates. Patients with T2DM had a risk of 0.8% for developing DKA and 2.9% for DK over 5-year period. Conclusions: Our study showed that DK and DKA are not uncommon in Caucasian adults and the majority of episodes were contributed to T2DM. Incidence of DK is far more higher than the incidence of DKA in patients older than 50, who predominantly have T2DM. Moreover, patients with DK have higher serum pH and bicarbonates, both of which imply that DK and DKA are distinct clinical entities in patients with T2DM. Further studies are needed to assess the impact of these clinical entities.

Alport Syndrome Foundation

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'I'm not a druggie, I'm just a diabetic': a qualitative study of stigma from the perspective of adults with type 1 diabetes.

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Browne, Jessica L; Ventura, Adriana; Mosely, Kylie; Speight, Jane

2014-07-23

While health-related stigma has been the subject of considerable research in other conditions (eg, HIV/AIDS, obesity), it has not received substantial attention in diabetes. Our aim was to explore perceptions and experiences of diabetes-related stigma from the perspective of adults with type 1 diabetes mellitus (T1DM). A qualitative study using semistructured interviews, which were audio recorded, transcribed and subject to thematic analysis. All interviews were conducted in non-clinical settings in metropolitan areas of Victoria, Australia. Adults aged ≥18 years with T1DM living in Victoria were eligible to take part. Participants were recruited primarily through the state consumer organisation representing people with diabetes. A total of 27 adults with T1DM took part: 15 (56%) were women; median IQR age was 42 (23) years and diabetes duration was 15 (20) years). Australian adults with T1DM perceive and experience T1DM-specific stigma as well as stigma-by-association with type 2 diabetes. Such stigma is characterised by blame, negative social judgement, stereotyping, exclusion, rejection and discrimination. Participants identified the media, family and friends, healthcare professionals and school teachers as sources of stigma. The negative consequences of this stigma span numerous life domains, including impact on relationships and social identity, emotional well-being and behavioural management of T1DM. This stigma also led to reluctance to disclose the condition in various environments. Adults with T1DM can be both the target and the source of diabetes-related stigma. Stigmatisation is part of the social experience of living with T1DM for Australian adults. Strategies and interventions to address and mitigate this diabetes-related stigma need to be developed and evaluated. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Frequency and significance of antibodies to liver/kidney microsome type 1 in adults with chronic active hepatitis.

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Czaja, A J; Manns, M P; Homburger, H A

1992-10-01

To assess the frequency of antibodies to liver/kidney microsome type 1 (anti-LKM1) in patients with chronic active hepatitis, 131 such patients were tested by an indirect immunofluorescence assay. Of 62 patients with type 1 autoimmune hepatitis, none were seropositive. In contrast, 3 of 11 patients with autoimmune hepatitis and antimitochondrial antibodies (27%) were seropositive for anti-LKM1. Each had responded to corticosteroid therapy, and retesting of sera confirmed that each had been misclassified as antimitochondrial antibody positive. None of the patients with chronic active hepatitis B (14 patients) or C (24 patients) had anti-LKM1. Similarly, none of the 20 patients with cryptogenic disease had these antibodies. It is concluded that anti-LKM1 is specific for type 2 autoimmune hepatitis and is infrequent in adult patients seen at a referral center in the United States for chronic active hepatitis. Anti-LKM1 reactivity may be misinterpreted as antimitochondrial antibody reactivity by indirect immunofluorescence. Chronic hepatitis B and C virus infections are not important stimuli for the production of anti-LKM1, and testing for anti-LKM 1 is unlikely to clarify the nature of cryptogenic disease.

Gender and Age Differences in Levels, Types and Locations of Physical Activity among Older Adults Living in Car-Dependent Neighborhoods.

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Li, W; Procter-Gray, E; Churchill, L; Crouter, S E; Kane, K; Tian, J; Franklin, P D; Ockene, J K; Gurwitz, J

2017-01-01

A thorough understanding of gender differences in physical activity is critical to effective promotion of active living in older adults. To examine gender and age differences in levels, types and locations of physical activity. Cross-sectional observation. Car-dependent urban and rural neighborhoods in Worcester County, Massachusetts, USA. 111 men and 103 women aged 65 years and older. From 2012 to 2014, participants were queried on type, frequency and location of physical activity. Participants wore an accelerometer for 7 consecutive days. Compared to women, men had a higher mean daily step count (mean (SD) 4385 (2122) men vs. 3671(1723) women, p=0.008). Men reported higher frequencies of any physical activity and moderate-to-vigorous physical activity, and a lower frequency of physical activity inside the home. Mean daily step counts and frequency of physical activity outside the home decreased progressively with age for both men and women. Women had a sharper decline in frequencies of self-reported physical activity. Men had a significant decrease in utilitarian walking, which women did not (p=0.07). Among participants who reported participation in any physical activity (n=190), more women indicated exercising indoors more often (59% vs. 44%, p=0.04). The three most commonly cited locations for physical activity away from home for both genders were streets or sidewalks, shopping malls, and membership-only facilities (e.g., YMCA or YWCA). The most common types of physical activity, performed at least once in a typical month, with over 40% of both genders reporting, included light housework, brisk walking, leisurely walking, and stretching. Levels, types and location preferences of physical activity differed substantially by gender. Levels of physical activity decreased progressively with age, with greater decline among women. Consideration of these gender differences is necessary to improve the effectiveness of active living promotion programs among older adults.

The association between types of eating behaviour and dispositional mindfulness in adults with diabetes. Results from Diabetes MILES. The Netherlands.

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Tak, Sanne R; Hendrieckx, Christel; Nefs, Giesje; Nyklíček, Ivan; Speight, Jane; Pouwer, François

2015-04-01

Although healthy food choices are important in the management of diabetes, making dietary adaptations is often challenging. Previous research has shown that people with type 2 diabetes are less likely to benefit from dietary advice if they tend to eat in response to emotions or external cues. Since high levels of dispositional mindfulness have been associated with greater awareness of healthy dietary practices in students and in the general population, it is relevant to study the association between dispositional mindfulness and eating behaviour in people with type 1 or 2 diabetes. We analysed data from Diabetes MILES - The Netherlands, a national observational survey in which 634 adults with type 1 or 2 diabetes completed the Dutch Eating Behaviour Questionnaire (to assess restrained, external and emotional eating behaviour) and the Five Facet Mindfulness Questionnaire-Short Form (to assess dispositional mindfulness), in addition to other psychosocial measures. After controlling for potential confounders, including demographics, clinical variables and emotional distress, hierarchical linear regression analyses showed that higher levels of dispositional mindfulness were associated with eating behaviours that were more restrained (β = 0.10) and less external (β = -0.11) and emotional (β = -0.20). The mindfulness subscale 'acting with awareness' was the strongest predictor of both external and emotional eating behaviour, whereas for emotional eating, 'describing' and 'being non-judgemental' were also predictive. These findings suggest that there is an association between dispositional mindfulness and eating behaviour in adults with type 1 or 2 diabetes. Since mindfulness interventions increase levels of dispositional mindfulness, future studies could examine if these interventions are also effective in helping people with diabetes to reduce emotional or external eating behaviour, and to improve the quality of their diet. Copyright © 2015 Elsevier Ltd

Adult Appeal.

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Stinehart, Kathleen; Kornegay, Jane G.

1997-01-01

To reach older, nontraditional students and alumni, alumni associations must offer a different type of programming Suggestions include ignoring class years of alumni, bringing current and former adult students together, emphasizing career connections, supporting networking, featuring a college speaker to satisfy lifelong learners' hunger for…

The Effects of Intensive Nutrition Education on Late Middle-Aged Adults with Type 2 Diabetes.

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Li, Ye; Xu, Meihong; Fan, Rui; Ma, Xiaotao; Gu, Jiaojiao; Cai, Xiaxia; Liu, Rui; Chen, Qihe; Ren, Jinwei; Mao, Ruixue; Bao, Lei; Zhang, Zhaofeng; Wang, Junbo; Li, Yong

2016-09-08

Many patients with type 2 diabetes find it difficult to maintain good glycemic control. Undesirable glycemic control occurs greatly due to deficiencies of nutritional knowledge and difficulty in obtaining dietary prescriptions. The late middle-aged and elder individuals are the main populations that are affected by type 2 diabetes. The main purpose of this study was to investigate whether intensive nutrition education would make benefits for late middle-aged patients with type 2 diabetes. 196 patients between 50 to 65 years old meeting type 2 diabetes criteria and eligible for the program were included in a single-blinded, 30-day centralized management of an education program in China. Participants in the program were randomly divided into a usual nutrition education group or an intensive nutrition education group. The usual nutrition education group was used as a control group and received only basic health advice and principles of diabetic diets at the beginning and the end of the study. Participants in the intensive nutrition education group were arranged to receive intensive nutritional lectures about diabetes for 30 days. The primary outcomes were the changes in weight, body mass index (BMI), fasting plasma glucose (FPG), 2-h postprandial plasma glucose (PG), glycosylated hemoglobin (HbA1c), total glycerin (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-c), and low-density lipoprotein cholesterol (LDL-c). After 30 days of intervention, FPG, PG, and HbA1c in the treatment group decreased significantly than the control group (p nutrition education group. However, there was no statistical significance between groups. Intensive nutrition education has significant effects on blood glucose control in late middle-aged adults with type 2 diabetes. Intensive education can cultivate good diet habits and increase physical activity, which are important for diabetes patients in the short and long terms. These findings may contribute to improving

The role of chiropractic care in older adults

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Dougherty Paul E

2012-02-01

Full Text Available Abstract There are a rising number of older adults; in the US alone nearly 20% of the population will be 65 or older by 2030. Chiropractic is one of the most frequently utilized types of complementary and alternative care by older adults, used by an estimated 5% of older adults in the U.S. annually. Chiropractic care involves many different types of interventions, including preventive strategies. This commentary by experts in the field of geriatrics, discusses the evidence for the use of spinal manipulative therapy, acupuncture, nutritional counseling and fall prevention strategies as delivered by doctors of chiropractic. Given the utilization of chiropractic services by the older adult, it is imperative that providers be familiar with the evidence for and the prudent use of different management strategies for older adults.

Neighborhood walkability, deprivation and incidence of type 2 diabetes: a population-based study on 512,061 Swedish adults.

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Sundquist, Kristina; Eriksson, Ulf; Mezuk, Briana; Ohlsson, Henrik

2015-01-01

Neighborhood walkability has been associated with increased physical activity, but only a few studies have explored the association between walkability and health outcomes related to physical activity, such as type 2 diabetes. The aim of this study was to investigate the association between objectively assessed neighborhood walkability and the 4-year incidence of type 2 diabetes in a sample of 512,061 Swedish adults aged 18 years and older. Neighborhoods were defined by 408 administratively defined geographical areas in the city of Stockholm. We found a negative association between walkability and type 2 diabetes (OR=1.33, 95% CI=1.13-1.55) that remained significant after adjusting for neighborhood deprivation. This association, however, no longer remained statistically significant after adjusting for individual socio-demographic factors. These results were also confirmed using a co-sibling design. Future studies are encouraged to further explore the potential effect of a broader array of the neighborhood built environment on health outcomes related to physical activity. Copyright © 2014 Elsevier Ltd. All rights reserved.

Stress Exposure and Physical, Mental, and Behavioral Health among American Indian Adults with Type 2 Diabetes

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Melissa L. Walls

2017-09-01

Full Text Available American Indian (AI communities experience disproportionate exposure to stressors and health inequities including type 2 diabetes. Yet, we know little about the role of psychosocial stressors for AI diabetes-related health outcomes. We investigated associations between a range of stressors and psychological, behavioral, and physical health for AIs with diabetes. This community-based participatory research with 5 AI tribes includes 192 AI adult type 2 diabetes patients recruited from clinical records at tribal clinics. Data are from computer-assisted interviews and medical charts. We found consistent bivariate relationships between chronic to discrete stressors and mental and behavioral health outcomes; several remained even after accounting for participant age, gender, and income. Fewer stressors were linked to physical health. We also document a dose–response relationship between stress accumulation and worse health. Findings underscore the importance of considering a broad range of stressors for comprehensive assessment of stress burden and diabetes. Policies and practices aimed at reducing stress exposure and promoting tools for stress management may be mechanisms for optimal health for AI diabetes patients.

Stress Exposure and Physical, Mental, and Behavioral Health among American Indian Adults with Type 2 Diabetes.

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Walls, Melissa L; Sittner, Kelley J; Aronson, Benjamin D; Forsberg, Angie K; Whitbeck, Les B; al'Absi, Mustafa

2017-09-16

American Indian (AI) communities experience disproportionate exposure to stressors and health inequities including type 2 diabetes. Yet, we know little about the role of psychosocial stressors for AI diabetes-related health outcomes. We investigated associations between a range of stressors and psychological, behavioral, and physical health for AIs with diabetes. This community-based participatory research with 5 AI tribes includes 192 AI adult type 2 diabetes patients recruited from clinical records at tribal clinics. Data are from computer-assisted interviews and medical charts. We found consistent bivariate relationships between chronic to discrete stressors and mental and behavioral health outcomes; several remained even after accounting for participant age, gender, and income. Fewer stressors were linked to physical health. We also document a dose-response relationship between stress accumulation and worse health. Findings underscore the importance of considering a broad range of stressors for comprehensive assessment of stress burden and diabetes. Policies and practices aimed at reducing stress exposure and promoting tools for stress management may be mechanisms for optimal health for AI diabetes patients.

Association between sports type and overuse injuries of extremities in adults: a systematic review.

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Chéron, Charlène; Le Scanff, Christine; Leboeuf-Yde, Charlotte

2017-01-01

Sports injuries are often described as overuse or traumatic. Little is known about the frequency of overuse injuries and, in particular, if they vary between different types of sporting activities. To identify any differences between sports in relation to diagnoses of overuse injuries of the extremities (OIE) and anatomical areas most likely to be injured in adults and to compare these findings with those reported in youngsters, as identified in a previous review. A search was made in May 2015 and again in April 2016 in PubMed, SportDiscus, PsycInfo, and Web of Sciences. Search terms were « overuse injuries OR cumulative trauma disorders OR musculoskeletal injuries » AND « extremity OR limb » AND « physical activity OR sport OR risk factor OR exercises ». Inclusion criteria were: 1) prospective, or cross-sectional study design; 2) at least 1/3 of the population should be ≥ 19 years; 3) articles must clearly state if reported cases were classified as traumatic or overuse injuries in relation to a particular sports type, 4) sample size >50, and 5) articles must not deal with specific occupational subpopulations nor with clinical populations. A blinded systematic review was conducted and results reported per anatomical site of injury and diagnosis for the different sports. In all, 10 of 1435 identified articles were included, studying soccer, beach-volleyball and triathlon. In general, the incidence estimates were low, never above 2.0/1000 h of practice, similar to results seen in children/adolescents. The incidence estimates and the diagnoses of OIE were given only in 4 articles on soccer, making comparisons between sports impossible. As in children/adolescents, the lower limb is more often affected than the upper but contrary to young people the injured site in adults is more often the knee and above, and there were also differences in the diagnoses for the two age groups. The literature does not permit to identify clearly the difference in the

Motivational Profiles for Physical Activity Practice in Adults with Type 2 Diabetes: A Self-Determination Theory Perspective.

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Gourlan, Mathieu; Trouilloud, David; Boiché, Julie

2016-01-01

Drawing on Self-Determination Theory, this study explored the motivational profiles toward Physical Activity (PA) among adults with type 2 diabetes and the relationships between motivational profile, perceived competence and PA. Participants were 350 men and women (Mean age 62.77 years) who were interviewed on their motivations toward PA, perceived level of competence to practice, and PA practice. Cluster analyses reveal the existence of three distinct profiles: "High Combined" (ie, high scores on motivations ranging from intrinsic to external regulation, moderate level on amotivation), "Self-Determined" (ie, high scores on intrinsic, integrated, and identified regulations; low scores on other regulations), and "Moderate" (ie, moderate scores on all regulations). Participants with "High Combined" and "Self-Determined" profiles reported higher perceived competence and longer leisure-time PA practice in comparison to those with a "Moderate" profile. This study highlights the necessity of adopting a person-centered approach to better understand motivation toward PA among type 2 diabetics.

Diagnostic approach to chronic kidney disease

African Journals Online (AJOL)

syndrome may suggest disorders such as polycystic kidney disease,. Alport syndrome, focal ... metabolic syndrome assists with the evaluation of the patient's cardiovascular risk .... found during heavy exercise, fever and stress. • Common ...

Complementary Therapies Used Among Adult Patients with Type 2 Diabetes Mellitus in Aceh, Indonesia

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Niswah Niswah

2014-04-01

Full Text Available Purpose: This study aimed to reveal Complementary Therapies (CT use among adult patients with type 2 diabetes mellitus (T2DM in Aceh, Indonesia, and to determine the reasons of using the CT.Methods: A descriptive, cross-sectional study was undertaken using a self-reported questionnaire. One hundred and fifty four adult patients with T2DM has been completed the questionnaire. Descriptive statistics was used to analyze the data.Results: Herbs as a part of biological based therapies were the most popular of CT use among subjects in this study (100% followed by mind-body intervention (94.2%, manipulation and body based methods (19.5% and alternative medical methods (3.9%. The reasons for using each CT based on the belief in effects of CT on lowering blood sugar (100%, maintaining healthy body (76.6%, and relieving symptoms of DM (35.7%. Relatives and friends (98.7% were main resources to obtain the CT information, and the family members (91.0% were main support of CT use. While, the nature (89.0% was the easiest source to access a CT product, followed by local markets (36.4%.Conclusion: This study found that herbs were believed by all subjects could reducing blood glucose, maintaining healthy body, and relieving symptoms of DM. Family members and easy to access the CT products from nature took the important role in influencing a person to use CT. More experimental studies examining effects of each CT especially herbal medicine and mind-body intervention are needed in the future.

Word-stem priming and recognition in type 2 diabetes mellitus, Alzheimer's disease patients and healthy older adults.

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Redondo, María Teresa; Beltrán-Brotóns, José Luís; Reales, José Manuel; Ballesteros, Soledad

2015-11-01

The present study investigated (a) whether the pattern of performance on implicit and explicit memory of patients with type 2 diabetes mellitus (DM2) is more similar to those of patients with Alzheimer's disease (AD) or to cognitively normal older adults and (b) whether glycosylated hemoglobin levels (a measure of glucose regulation) are related to performance on the two memory tasks, implicit word-stem completion and "old-new" recognition. The procedures of both memory tasks included encoding and memory test phases separated by a short delay. Three groups of participants (healthy older adults, DM2 patients and AD patients) completed medical and psychological assessments and performed both memory tasks on a computer. The results of the word-stem completion task showed similar implicit memory in the three groups. By contrast, explicit recognition of the three groups differed. Implicit memory was not affected by either normal or pathological aging, but explicit memory deteriorated in the two groups of patients, especially in AD patients, showing a severe impairment compared to the cognitively healthy older adults. Importantly, glycosylated hemoglobin levels were not related to performance on either implicit or explicit memory tasks. These findings revealed a clear dissociation between explicit and implicit memory tasks in normal and pathological aging. Neuropsychologists and clinicians working with TM2 patients should be aware that the decline of voluntary, long-term explicit memory could have a negative impact on their treatment management. By contrast, the intact implicit memory of the two clinical groups could be used in rehabilitation.

Innovative biomarkers for predicting type 2 diabetes mellitus: relevance to dietary management of frailty in older adults.

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Ikwuobe, John; Bellary, Srikanth; Griffiths, Helen R

2016-06-01

Type 2 diabetes mellitus (T2DM) increases in prevalence in the elderly. There is evidence for significant muscle loss and accelerated cognitive impairment in older adults with T2DM; these comorbidities are critical features of frailty. In the early stages of T2DM, insulin sensitivity can be improved by a "healthy" diet. Management of insulin resistance by diet in people over 65 years of age should be carefully re-evaluated because of the risk for falling due to hypoglycaemia. To date, an optimal dietary programme for older adults with insulin resistance and T2DM has not been described. The use of biomarkers to identify those at risk for T2DM will enable clinicians to offer early dietary advice that will delay onset of disease and of frailty. Here we have used an in silico literature search for putative novel biomarkers of T2DM risk and frailty. We suggest that plasma bilirubin, plasma, urinary DPP4-positive microparticles and plasma pigment epithelium-derived factor merit further investigation as predictive biomarkers for T2DM and frailty risk in older adults. Bilirubin is screened routinely in clinical practice. Measurement of specific microparticle frequency in urine is less invasive than a blood sample so is a good choice for biomonitoring. Future studies should investigate whether early dietary changes, such as increased intake of whey protein and micronutrients that improve muscle function and insulin sensitivity, affect biomarkers and can reduce the longer term complication of frailty in people at risk for T2DM.

The experience of Japanese adolescents and young adults after losing siblings to childhood cancer: three types of narratives.

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Kamibeppu, Kiyoko; Sato, Iori; Hoshi, Yasutaka

2015-01-01

The aim of this study was to describe Japanese adolescents' and young adults' experiences after losing siblings to childhood cancer. A conceptual framework of the transition and analysis based on narrative method were adopted from qualitative data from 6 Japanese adolescents and young adults who had lost their siblings to childhood cancer. It was revealed that the participants' psychological experience after the sibling's death was directed by their perceptions of their mothers' responses to bereavement. We also found that the psychological distance between participants and their mothers could be an important factor in enabling transition into mourning and in orienting the lost sibling in their mind. The stories obtained from these 6 participants were categorized into the following 3 types of narratives: "Mother in another world and the sibling who became a god," "Return of the loving mother and the sibling as savior," and "The poor mother and the sibling who needs my help to carry on her legacy." This typology will serve as a framework for grief care and future research. © 2014 by Association of Pediatric Hematology/Oncology Nurses.

Sibling Status Effects: Adult Expectations.

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Baskett, Linda Musun

1985-01-01

This study attempted to determine what expectations or beliefs adults might hold about a child based on his or her sibling status alone. Ratings on 50 adjective pairs for each of three sibling status types, only, oldest, and youngest child, were assessed in relation to adult expectations, birth order, and parental status of rater. (Author/DST)

Comparison of osteoporosis in US adults with type 1 and type 2 diabetes mellitus.

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DeShields, S C; Cunningham, T D

2018-01-20

We examined bone mineral density (BMD) and osteoporosis prevalence in those with type 1 compared to type 2 diabetes derived from a nationally representative sample from the civilian community in the United States. Data from the National Health and Nutrition Examination Survey (NHANES) for 2005-2006, 2007-2008, 2009-2010, and 2013-2014 were merged to obtain a large sample of diabetics at least 20 years of age with participation in the interview and medical examination. Osteoporosis status was defined by BMD at the total femur, femoral neck, or total lumbar spine. Self-reported diabetics that were prescribed insulin within the first year of diagnosis, are currently taking insulin, and reported no prescriptions for any diabetic pills were classified as type 1. Remaining self-reported diabetics were deemed as having type 2. A total of 2050 diabetics were included in which 87 (4%) were classified as type 1. Type 1 diabetics were found to have a significantly lower BMD at the total femur and femoral neck, but not at the lumbar spine in the adjusted models. Diabetics with type 1 were 4.7 times more likely to have osteoporosis than those with type 2. There was no significant relationship between diabetes type and BMD or osteoporosis prior to adjustment for confounders. Although our results show an increased likelihood of osteoporosis among those with type 1 diabetes, future studies including a larger sample from a community population are needed. It may benefit diabetics, especially those with type 1, to initiate osteoporosis screening methods including evaluation of fracture risk, bone quality, and BMD measurements at multiple sites earlier than recommended.

The effectiveness of health literacy oriented programs on physical activity behaviour in middle aged and older adults with type 2 diabetes: a systematic review

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Michael Huen Sum Lam

2016-06-01

Full Text Available Health literacy is the first step to self-management of type II diabetes mellitus, of which physical activity is the least compliant behavior. However, no reviews have summarized the effect and the process of interventions of health literacy oriented programs on physical activity behavior among middle aged and older adults with type II diabetes mellitus. This article is the first to examine the effectiveness of health literacy oriented programs on physical activity behavior among middle aged and older adults with type II diabetes mellitus. This systematic review extracted articles from nine electronic databases between 1990 and 2013. Six interventional studies were extracted and reported in accordance with the guidance of Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Findings demonstrated that health literacy oriented programs increased the frequency and duration of physical activity among patients with high health literacy. Although some studies effectively improved the health literacy of physical activity, gap in literature remains open for the indistinct and unreliable measurement of physical activity within self-management programs of type II diabetes mellitus, and the questionable cross-culture generalizability of findings. Further studies with well-knit theorybased intervention with respect to patients’ cultural background, duration of intervention and objective measurements are encouraged to elucidate the relationship between health literacy oriented programs and physical activity behavior.

Childhood Age and Associations Between Childhood Metabolic Syndrome and Adult Risk for Metabolic Syndrome, Type 2 Diabetes Mellitus and Carotid Intima Media Thickness: The International Childhood Cardiovascular Cohort Consortium.

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Koskinen, Juha; Magnussen, Costan G; Sinaiko, Alan; Woo, Jessica; Urbina, Elaine; Jacobs, David R; Steinberger, Julia; Prineas, Ronald; Sabin, Matthew A; Burns, Trudy; Berenson, Gerald; Bazzano, Lydia; Venn, Alison; Viikari, Jorma S A; Hutri-Kähönen, Nina; Raitakari, Olli; Dwyer, Terence; Juonala, Markus

2017-08-16

There is paucity of knowledge concerning the specific age in youth when the associations of metabolic syndrome (MetS) begin to be operative. Thus, we investigated the relation of age to the associations of childhood MetS with adult MetS, type 2 diabetes mellitus and high carotid intima-media thickness. Five thousand eight-hundred three participants were analyzed in 4 cohort studies (Cardiovascular Risk in Young Finns, Bogalusa Heart Study, Princeton Lipid Research Study, Insulin Study). International cutoffs and previously used 75th percentile cutoffs were used for children to define MetS and its components. Mean follow-up period was 22.3 years. Logistic regression was used to calculate risk ratios and 95% confidence intervals. Childhood MetS and overweight were associated with over 2.4-fold risk for adult MetS from the age of 5 years onward. Risk for type 2 diabetes mellitus was increased from the age of 8 (risk ratio, 2.6-4.1; 95% confidence interval, 1.35-6.76 and 1.12-7.24, respectively) onward for the 2 childhood MetS criteria based on international cut-off values and for childhood overweight. Risk for high carotid intima-media thickness was significant at ages 11 to 18 years in relation to childhood MetS or overweight (risk ratio, 2.44-4.22; 95% confidence interval, 1.55-3.55 and 2.55-5.66, respectively). Continuous childhood MetS score was associated with adult MetS from the age of 5, with type 2 diabetes mellitus from the age of 14 and with high carotid intima-media thickness from the age of 11 years onward. Adult MetS was predicted by MetS in childhood beginning at age 5. However, adult type 2 diabetes mellitus and subclinical atherosclerosis were not predicted by childhood data until after age 8. Body mass index measurement alone at the same age points provided similar findings. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Postsecondary Employment Experiences Among Young Adults With an Autism Spectrum Disorder RH: Employment in Young Adults With Autism

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Roux, Anne M.; Shattuck, Paul T.; Cooper, Benjamin P.; Anderson, Kristy A.; Wagner, Mary; Narendorf, Sarah C.

2013-01-01

Objective We examined postsecondary employment experiences of young adults with an autism spectrum disorder (ASD) and compared these outcomes with those of young adults with different disabilities. Method Data were from Wave 5 of the National Longitudinal Transition Study 2 (NLTS2), a nationally representative survey of young adults who had received special education services during high school. We examined the prevalence of ever having had—and currently having—a paid job at 21–25 years of age. We analyzed rates of full employment, wages earned, number of jobs held since high school, and job types. Results About half (53.4%) of young adults with an ASD had ever worked for pay outside the home since leaving high school, the lowest rate among disability groups. Young adults with an ASD earned an average of $8.10 per hour, significantly lower than average wages for young adults in the comparison groups, and held jobs that clustered within fewer occupational types. Odds of ever having had a paid job were higher for those who were older, from higher-income households, and with better conversational abilities or functional skills. Conclusions Findings of worse employment outcomes for young adults with an ASD suggest this population is experiencing particular difficulty in successfully transitioning into employment. Research is needed to determine strategies for improving outcomes as these young adults transition into adulthood. PMID:23972695

Drosophila type II neuroblast lineages keep Prospero levels low to generate large clones that contribute to the adult brain central complex

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Drummond Michael L

2010-10-01

Full Text Available Abstract Tissue homeostasis depends on the ability of stem cells to properly regulate self-renewal versus differentiation. Drosophila neural stem cells (neuroblasts are a model system to study self-renewal and differentiation. Recent work has identified two types of larval neuroblasts that have different self-renewal/differentiation properties. Type I neuroblasts bud off a series of small basal daughter cells (ganglion mother cells that each generate two neurons. Type II neuroblasts bud off small basal daughter cells called intermediate progenitors (INPs, with each INP generating 6 to 12 neurons. Type I neuroblasts and INPs have nuclear Asense and cytoplasmic Prospero, whereas type II neuroblasts lack both these transcription factors. Here we test whether Prospero distinguishes type I/II neuroblast identity or proliferation profile, using several newly characterized Gal4 lines. We misexpress prospero using the 19H09-Gal4 line (expressed in type II neuroblasts but no adjacent type I neuroblasts or 9D11-Gal4 line (expressed in INPs but not type II neuroblasts. We find that differential prospero expression does not distinguish type I and type II neuroblast identities, but Prospero regulates proliferation in both type I and type II neuroblast lineages. In addition, we use 9D11 lineage tracing to show that type II lineages generate both small-field and large-field neurons within the adult central complex, a brain region required for locomotion, flight, and visual pattern memory.

Effects of long-term multicomponent exercise on health-related quality of life in older adults with type 2 diabetes: evidence from a cohort study.

Science.gov (United States)

Baptista, Liliana C; Dias, Gonçalo; Souza, Nelba R; Veríssimo, Manuel T; Martins, Raul A

2017-08-01

To establish the effect of a long-term multicomponent exercise (LTMEX) intervention (24 months) on health-related quality of life (HRQoL), in older adults with type 2 diabetes (T2D). This longitudinal retrospective cohort study analyzes the effects of a supervised LTMEX program on HRQoL in older adults with T2D (n = 279). Participants underwent one of two conditions: LTMEX (n = 241) trained three times per week; and unchanged lifestyle-the control group (CO; n = 38). Participants completed baseline, and 2-year follow-up evaluations including the Short Form Health Survey 36 (SF-36), anthropometric, hemodynamic components, and cardiorespiratory fitness (VO 2 peak). LTMEX improves HRQoL, specifically physical functioning (P health (P health (MH; P older adults with T2D, and also anthropometric, hemodynamic profile, and cardiorespiratory fitness.

Predictors of Diet-Induced Weight Loss in Overweight Adults with Type 2 Diabetes.

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Kirsten A Berk

Full Text Available A very low calorie diet improves the metabolic regulation of obesity related type 2 diabetes, but not for all patients, which leads to frustration in patients and professionals alike. The aim of this study was to develop a prediction model of diet-induced weight loss in type 2 diabetes.192 patients with type 2 diabetes and BMI>27 kg/m2 from the outpatient diabetes clinic of the Erasmus Medical Center underwent an 8-week very low calorie diet. Baseline demographic, psychological and physiological parameters were measured and the C-index was calculated of the model with the largest explained variance of relative weight loss using backward linear regression analysis. The model was internally validated using bootstrapping techniques.Weight loss after the diet was 7.8±4.6 kg (95%CI 7.2-8.5; p<0.001 and was independently associated with the baseline variables fasting glucose (B = -0.33 (95%CI -0.49, -0.18, p = 0.001, anxiety (HADS; B = -0.22 (95%CI -0.34, -0.11, p = 0.001, numb feeling in extremities (B = 1.86 (95%CI 0.85, 2.87, p = 0.002, insulin dose (B = 0.01 (95%CI 0.00, 0.02, p = 0.014 and waist-to-hip ratio (B = 6.79 (95%CI 2.10, 11.78, p = 0.003. This model explained 25% of the variance in weight loss. The C-index of this model to predict successful (≥5% weight loss was 0.74 (95%CI 0.67-0.82, with a sensitivity of 0.93 (95% CI 0.89-0.97 and specificity of 0.29 (95% CI 0.16-0.42. When only the obese T2D patients (BMI≥30 kg/m2; n = 181 were considered, age also contributed to the model (B = 0.06 (95%CI 0.02, 0.11, p = 0.008, whereas waist-to-hip ratio did not.Diet-induced weight loss in overweight adults with T2D was predicted by five baseline parameters, which were predominantly diabetes related. However, failure seems difficult to predict. We propose to test this prediction model in future prospective diet intervention studies in patients with type 2 diabetes.

SDHA loss of function mutations in a subset of young adult wild-type gastrointestinal stromal tumors

International Nuclear Information System (INIS)

Italiano, Antoine; Chen, Chun-Liang; Sung, Yun-Shao; Singer, Samuel; DeMatteo, Ronald P; LaQuaglia, Michael P; Besmer, Peter; Socci, Nicholas; Antonescu, Cristina R

2012-01-01

A subset of KIT/PDGFRA wild-type gastrointestinal stromal tumors (WT GIST) have been associated with alteration of the succinate dehydrogenase (SDH) complex II function. A recent report identified four non-syndromic, KIT/PDGFRA WT GIST harboring compound heterozygous or homozygous mutations in SDHA encoding the main subunit of the SDH complex II. Next generation sequencing was applied on five pediatric and one young adult WT GIST, by whole exome capture and SOLiD 3-plus system sequencing. The putative mutations were first confirmed by Sanger sequencing and then screened on a larger panel of 11 pediatric and young adult WT GIST, including 5 in the context of Carney triad. A germline p.Arg31X nonsense SDHA mutation was identified in one of the six cases tested by SOLiD platform. An additional p.D38V missense mutation in SDHA exon 2 was identified by Sanger sequencing in the extended KIT/PDGFRA WT GIST patients cohort. Western blotting showed loss of SDHA expression in the two cases harboring SDHA mutations, while expression being retained in the other WT GIST tumors. Results were further confirmed by immunohistochemistry for both SDHA and SDHB, which showed a concurrent loss of expression of both proteins in SDHA-mutant lesions, while the remaining WT tumors showed only loss of SDHB expression. Germline and/or somatic aberrations of SDHA occur in a small subset of KIT/PDGFRA WT GISTs, outside the Carney’s triad and are associated with loss of both SDHA and SDHB protein expression. Mutations of the SDH complex II are more particularly associated with KIT/PDGFRA WT GIST occurring in young adults. Although pediatric GIST consistently display alterations of SDHB protein expression, further molecular studies are needed to identify the crucial genes involved in their tumorigenesis

Quantification of left to right shunts in adults with atrial septal defects of secundum type, using radionuclide technique

International Nuclear Information System (INIS)

Sire, S.; Rootwelt, K.; Mangschau, A.

1991-01-01

Quantification of left to right shunt was carried out in 15 adult patients with a suspected ostium secundum atrial septal defect (ASD II). Radionuclide shunt quantitation correlated well with the results of righ heart catheterization. The radionuclide technique failed in two patients for technical reasons, but revealed no false negative or false positive results when technically satisfactory. The diagnosis was confirmed at operation. It is concluded that the radionuclide technique is a useful and reliable method which can also be used at follow-up after surgery in patients with artrial septal defects of secundum type. 20 refs., 3 figs., 1 tab

Memory Monitoring and Control in Young and Intermediate-Age Adults

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Maxciel Zortea

2015-08-01

Full Text Available The way adults perceive and regulate learning (metamemory is an important indicator of how they perform on memory tasks. This study assessed memory monitoring, control and performance in young and intermediate-age adults according to item type (with or without semantic relation, type of judgment of learning (JOL - immediate or delayed, and age. Twenty-six young adults (M = 22 years old and 18 intermediate-age adults (M = 47 years old participated, who responded to an experimental paradigm to evaluate metamemory. Results showed that related word-pairs received higher magnitude for the JOLs and better cued-recall scores. JOLs’ accuracy was similar between the age groups, delayed JOLs being more accurate only for young adults. Intermediate-age adults apparently based their allocation of study time less on JOLs or cued-recall than young adults.

Healthcare Resource Utilization and Costs Associated with Ketosis Events in Pediatric and Adult Patients with Type 1 Diabetes Mellitus in the UK.

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Thalange, Nandu; Aldhouse, Natalie Valerie Jane; Kitchen, Helen; Howard, Daniel; Tutkunkardas, Deniz; Håkan-Bloch, Jonas

2017-10-01

Ketosis is a metabolic state associated with insulin deficiency. Untreated, it develops into diabetic ketoacidosis, a significant contributor to mortality and morbidity in people with type 1 diabetes mellitus (T1DM). Little is understood about how patients utilize healthcare resources during ketosis events. This study aimed to identify and quantify healthcare resource utilization and provide estimates of associated costs of ketosis events in T1DM, treated unaided or with healthcare professional (HCP) assistance in the UK. Qualitative interviews with adult patients, pediatric carers, and HCPs identified resources used by patients/carers during ketosis events. An online quantitative survey was then used to quantify patients/carers resource use during their/their child's most recent ketosis event, and HCPs estimated patient resource uptake to corroborate the findings. Associated costs estimated from UK data sources were applied to the survey results to calculate the cost of ketosis events in adults and children. Quantitative survey responses from 93 adults, 76 carers, and 52 HCPs were analyzed. Patients and carers monitored ketosis during and following the event with ketone strips and additional glucose strips, and administered treatment comprising insulin and pump set changes where appropriate. Additionally, patients/carers accessed phone services and many received follow-up medical appointments. In total, 70% (n = 65) of adult and 66% (n = 50) of pediatric ketosis events were managed at home, for which resource use costs per event were £23.87 and £38.00 respectively. Remaining events were treated in NHS facilities costing £217.57 per adult and £352.92 per child. Weighted averages identified that ketosis events cost £81.98 per adult and £142.97 per child. Indirect costs from work productivity loss increase these figures to £225.11 per adult and £256.88 per child. Healthcare resource use for ketosis events is high in adults and children with T1DM and

Adult Learning, Economy and Society

DEFF Research Database (Denmark)

Olesen, Henning Salling

2010-01-01

The article relates the different types of adult education, continuing education and training to an overall societal context of socio-economic modernization by focussing on the multiple functions of adult learning. Each of well known empirical categories is seen in its historical relation to mode...... embracing form which set a new framework for human participation in the new global society....

11beta-hydroxysteroid dehydrogenase type 2 expression in the newly formed Leydig cells after ethane dimethanesulphonate treatment of adult rats.

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Katerina Georgieva

2008-01-01

Full Text Available The enzyme 11beta-hydroxysteroid dehydrogenase (11beta-HSD catalyzes the reversible conversion of physiologically active corticosterone to the biologically inert 11beta-dehydrocorticosterone in rat testis and protect the Leydig cells (LCs against the suppressive effect of glucocorticoids. The developmental pathway of the adult LCs population is accompanied with an increase in the 11beta-HDS activity. Thus, 11beta-HDS together with its role in controlling the toxicological effect of glucocorticoids on LCs can be used as a marker for their functional maturity. Ethane 1,2-dimethanesulphonate (EDS treatment of adult rats become unique appropriate model, which enable to answer many questions related to the differentiation of adult LCs in the prepubertal rat testis. The aim of the present study was to investigate the specific changes in the 11beta-HDS type 2 immunoreactivity in tandem with the expression of androgen receptor (AR during renewal of LCs population after EDS treatment. In the present study, we observed the first appearance of immunostaining for 11beta-HSD2 in new LCs population on day 14 after EDS administration when the progenitor LCs were detected. Our immunohistochemical analysis revealed progressive increases in the 11beta-HSD2 reaction intensity on 21 days after EDS treatment and reached a maximum on day 35. AR immunoexpression was found in new LCs on day 14 and 21 after EDS injection with an increasing curve of intensity. The most prominent AR immunostaining in new population LCs was evident by 35 days after EDS and that coincided with the increased number of LCs and restoration of adult LCs population. Our results demonstrated similar pattern of immunoreactivity for 11beta-HSD2 and AR in new LCs population after EDS treatment and suggested that the changes in 11beta-HSD2 expression can be used for evaluation of adult LCs differentiation in rat testis.

The effect of three different types of walking aids on spatio-temporal gait parameters in community-dwelling older adults.

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Härdi, Irene; Bridenbaugh, Stephanie A; Gschwind, Yves J; Kressig, Reto W

2014-04-01

Gait and balance impairments lead to falls and injuries in older people. Walking aids are meant to increase gait safety and prevent falls, yet little is known about how their use alters gait parameters. This study aimed to quantify gait in older adults during walking without and with different walking aids and to compare gait parameters to matched controls. This retrospective study included 65 older (≥60 years) community dwellers who used a cane, crutch or walker and 195 independently mobile-matched controls. Spatio-temporal gait parameters were measured with an electronic walkway system during normal walking. When walking unaided or aided, walking aid users had significantly worse gait than matched controls. Significant differences between the walking aid groups were found for stride time variability (cane vs. walker) in walking unaided only. Gait performances significantly improved when assessed with vs. without the walking aid for the cane (increased stride time and length, decreased cadence and stride length variability), crutch (increased stride time and length, decreased cadence, stride length variability and double support) and walker (increased gait speed and stride length, decreased base of support and double support) users. Gait in older adults who use a walking aid is more irregular and unstable than gait in independently mobile older adults. Walking aid users have better gait when using their walking aid than when walking without it. The changes in gait were different for the different types of walking aids used. These study results may help better understand gait in older adults and differentiate between pathological gait changes and compensatory gait changes due to the use of a walking aid.

[Diabetes type 1 in young adults: The relationship between psycho-social variables, glycemic control, depression and anxiety].

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Steinsdottir, Fjola Katrin; Halldorsdottir, Hildur; Gudmundsdottir, Arna; Arnardottir, Steinunn; Smari, Jakop; Arnarson, Eirikur Orn

2008-12-01

The aim of the present study was to investigate whether psycho-social variables, for example social support and task- and emotion-oriented coping would predict psychological and physical well being among young adults with diabetes. Participants were 56 individuals in their twenties suffering from type 1 diabetes. Response rate was 78%. The participants came from the whole of Iceland, 64.3% from the Greater Reykjavík area and 33.9% from rural areas. One participant did not indicate his place of residence. Self-assessment scales were used to assess depression, anxiety, task-, avoidance- and emotion-oriented coping, social support and problems relating to diabetes. Additional information was obtained from patients' records concerning the results of blood glucose measurements (HbA1c). Good social support was related to less anxiety and depression and to less self-reported problems related to having diabetes. Emotion-oriented coping was related to not feeling well and task- oriented coping to feeling better. No relationship was found between psychosocial variables and blood glucose measurements and a limited relationship between self-reported problems related to having diabetes and these measurements. Social support and coping are strongly related to measurements of depression, anxiety and problems related to having diabetes in the present age group. The results indicate that it is very important to teach and strengthen usage, as possible, of task-oriented coping instead of emotion-oriented coping. The results also indicate that social support is highly important for young adults with diabetes type 1. It is clear that friends and family have to be more involved in the treatment and also more educated about the disease and the importance of giving the right kind of support.

Development of the pediatric quality of life inventory neurofibromatosis type 1 module items for children, adolescents and young adults: qualitative methods.

Science.gov (United States)

Nutakki, Kavitha; Varni, James W; Steinbrenner, Sheila; Draucker, Claire B; Swigonski, Nancy L

2017-03-01

Health-related quality of life (HRQOL) is arguably one of the most important measures in evaluating effectiveness of clinical treatments. At present, there is no disease-specific outcome measure to assess the HRQOL of children, adolescents and young adults with Neurofibromatosis Type 1 (NF1). This study aimed to develop the items and support the content validity for the Pediatric Quality of Life Inventory™ (PedsQL™) NF1 Module for children, adolescents and young adults. The iterative process included multiphase qualitative methods including a literature review, survey of expert opinions, semi-structured interviews, cognitive interviews and pilot testing. Fifteen domains were derived from the qualitative methods, with content saturation achieved, resulting in 115 items. The domains include skin, pain, pain impact, pain management, cognitive functioning, speech, fine motor, balance, vision, perceived physical appearance, communication, worry, treatment, medicines and gastrointestinal symptoms. This study is limited because all participants are recruited from a single-site. Qualitative methods support the content validity for the PedsQL™ NF1 Module for children, adolescents and young adults. The PedsQL™ NF1 Module is now undergoing national multisite field testing for the psychometric validation of the instrument development.

Congenital hearing loss. Is CT enough?

African Journals Online (AJOL)

Mahmoud Agha

2014-01-24

Jan 24, 2014 ... Congenital hearing loss is one of the developmental disorders that may be not clearly .... Alport syndrome, Klippel-Feil, Norrie disease and Waarden- .... Bismuth eye shield was routinely used for all patients (AttenuRad;.

Older adults abuse in three Brazilian cities

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Rosalina Aparecida Partezani Rodrigues

Full Text Available ABSTRACT Objective: To analyze the police reports filed by older adults who suffered abuse in order to identify the socio-demographic characteristics of victims and aggressors, type of violence, location, as well as to compare rates in three Brazilian cities in the period from 2009 to 2013. Method: Ecological study, in which 2,612 police reports registered in Police Stations were analyzed. An instrument was used to obtain data from the victim, the aggressor and the type of violence. Results: Psychological abuse predominated and most cases occurred in the older adults own home. In the cities of Ribeirão Preto and João Pessoa, the older adults presented similar rates for both gender. Regarding the standardized rates, in João Pessoa, there was a rise of this type of abuse in the two first years, and later there was a certain stability. In the city of Teresina, there was an increase, also observed in the city of Ribeirão Preto in the three first years, followed by a decrease. Conclusion: Older adults abuse is a cultural phenomenon difficult to be reported by them, since it occurs in the family context.

Is type-D personality trait(s or state? An examination of type-D temporal stability in older Israeli adults in the community

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Ada H. Zohar

2016-02-01

Full Text Available Background. Type D personality was suggested as a marker of poorer prognosis for patients of cardiovascular disease. It is defined by having a score of 10 or more on both sub-scales of the DS14 questionnaire, Social Inhibition (SI and Negative Affectivity (NA. As Type D was designed to predict risk, its temporal stability is of prime importance. Methods. Participants in the current study were 285 community volunteers, who completed the DS14, and other personality scales, at a mean interval of six years. Results. The prevalence of Type D did not change. The component traits of Type D showed rank order stability. Type D caseness temporal stability was improved by using the sub-scales product as a criterion. Logistic hierarchical regression predicting Type D classification from Time1 demonstrated that the best predictors were Time1 scores on NA and SI, with the character trait of Cooperation, and the alexithymia score adding some predictive power. Conclusions. The temporal stability of the component traits, and of the prevalence of Type D were excellent. Temporal stability of Type D caseness may be improved by using a product threshold, rather than the current rule. Research is required in order to formulate the optimal timing for Type D measurement for predictive purposes.

Whole-body patterns of the range of joint motion in young adults: masculine type and feminine type.

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Moromizato, Keiichi; Kimura, Ryosuke; Fukase, Hitoshi; Yamaguchi, Kyoko; Ishida, Hajime

2016-10-01

Understanding the whole-body patterns of joint flexibility and their related biological and physical factors contributes not only to clinical assessments but also to the fields of human factors and ergonomics. In this study, ranges of motion (ROMs) at limb and trunk joints of young adults were analysed to understand covariation patterns of different joint motions and to identify factors associated with the variation in ROM. Seventy-eight healthy volunteers (42 males and 36 females) living on Okinawa Island, Japan, were recruited. Passive ROM was measured at multiple joints through the whole body (31 measurements) including the left and right side limbs and trunk. Comparisons between males and females, dominant and non-dominant sides, and antagonistic motions indicated that body structures influence ROMs. In principal component analysis (PCA) on the ROM data, the first principal component (PC1) represented the sex difference and a similar covariation pattern appeared in the analysis within each sex. Multiple regression analysis showed that this component was associated with sex, age, body fat %, iliospinale height, and leg extension strength. The present study identified that there is a spectrum of "masculine" and "feminine" types in the whole-body patterns of joint flexibility. This study also suggested that body proportion and composition, muscle mass and strength, and possibly skeletal structures partly explain such patterns. These results would be important to understand individual variation in susceptibility to joint injuries and diseases and in one's suitable and effective postures and motions.

Understanding the Relationship between Type 2 Diabetes Mellitus and Falls in Older Adults: A Prospective Cohort Study

Science.gov (United States)

Roman de Mettelinge, Tine; Cambier, Dirk; Calders, Patrick; Van Den Noortgate, Nele; Delbaere, Kim

2013-01-01

Background Older adults with type 2 Diabetes Mellitus are at increased risk of falling. The current study aims to identify risk factors that mediate the relationship between diabetes and falls. Methods 199 older adults (104 with diabetes and 95 healthy controls) underwent a medical screening. Gait (GAITRite®), balance (AccuGait® force plate), grip strength (Jamar®), and cognitive status (Mini-Mental State Examination and Clock Drawing Test) were assessed. Falls were prospectively recorded during a 12-month follow-up period using monthly calendars. Results Compared to controls, diabetes participants scored worse on all physical and cognitive measures. Sixty-four participants (42 diabetes vs. 22 controls) reported at least one injurious fall or two non-injurious falls (“fallers”). Univariate logistic regression identified diabetes as a risk factor for future falls (Odds Ratio 2.25, 95%CI 1.21–4.15, p = 0.010). Stepwise multiple regressions defined diabetes and poor balance as independent risk factors for falling. Taking more medications, slower walking speed, shorter stride length and poor cognitive performance were mediators that reduced the Odds Ratio of the relationship between diabetes and faller status relationship the most followed by reduced grip strength and increased stride length variability. Conclusions Diabetes is a major risk factor for falling, even after controlling for poor balance. Taking more medications, poorer walking performance and reduced cognitive functioning were mediators of the relationship between diabetes and falls. Tailored preventive programs including systematic medication reviews, specific balance exercises and cognitive training might be beneficial in reducing fall risk in older adults suffering from diabetes. PMID:23825617

Disparities in current cigarette smoking prevalence by type of disability, 2009-2011.

Science.gov (United States)

Courtney-Long, Elizabeth; Stevens, Alissa; Caraballo, Ralph; Ramon, Ismaila; Armour, Brian S

2014-05-01

Smoking, the leading cause of disease and death in the United States, has been linked to a number of health conditions including cancer and cardiovascular disease. While people with a disability have been shown to be more likely to report smoking, little is known about the prevalence of smoking by type of disability, particularly for adults younger than 50 years of age. We used data from the 2009-2011 National Health Interview Survey to estimate the prevalence of smoking by type of disability and to examine the association of functional disability type and smoking among adults aged 18-49 years. Adults with a disability were more likely than adults without a disability to be current smokers (38.8% vs. 20.7%, p<0.001). Among adults with disabilities, the prevalence of smoking ranged from 32.4% (self-care difficulty) to 43.8% (cognitive limitation). When controlling for sociodemographic characteristics, having a disability was associated with statistically significantly higher odds of current smoking (adjusted odds ratio = 1.57, 95% confidence interval 1.40, 1.77). The prevalence of current smoking for adults was higher for every functional disability type than for adults without a disability. By understanding the association between smoking and disability type among adults younger than 50 years of age, resources for cessation services can be better targeted during the ages when increased time for health improvement can occur.

Working Memory and Speech Recognition in Noise under Ecologically Relevant Listening Conditions: Effects of Visual Cues and Noise Type among Adults with Hearing Loss

Science.gov (United States)

Miller, Christi W.; Stewart, Erin K.; Wu, Yu-Hsiang; Bishop, Christopher; Bentler, Ruth A.; Tremblay, Kelly

2017-01-01

Purpose: This study evaluated the relationship between working memory (WM) and speech recognition in noise with different noise types as well as in the presence of visual cues. Method: Seventy-six adults with bilateral, mild to moderately severe sensorineural hearing loss (mean age: 69 years) participated. Using a cross-sectional design, 2…

The effect of preference for three different types of music on magnitude estimation-scaling behavior in young adults.

Science.gov (United States)

Fucci, D; Petrosino, L; Banks, M; Zaums, K; Wilcox, C

1996-08-01

The purpose of the present study was to assess the effect of preference for three different types of music on magnitude estimation scaling behavior in young adults. Three groups of college students, 10 who liked rock music, 10 who liked big band music, and 10 who liked classical music were tested. Subjects were instructed to assign numerical values to a random series of nine suprathreshold intensity levels of 10-sec, samples of rock music, big band music, and classical music. Analysis indicated that subjects who liked rock music scaled that stimulus differently from those subjects who liked big band and classical music. Subjects who liked big band music scaled that stimulus differently from those subjects who liked rock music and classical music. All subjects scaled classical music similarly regardless of their musical preferences. Results are discussed in reference to the literature concerned with personality and preference as well as spectrographic analyses of the three different types of music used in this study.

Supervised Balance Training and Wii Fit-Based Exercises Lower Falls Risk in Older Adults With Type 2 Diabetes.

Science.gov (United States)

Morrison, Steven; Simmons, Rachel; Colberg, Sheri R; Parson, Henri K; Vinik, Aaron I

2018-02-01

This study examined the benefits of and differences between 12 weeks of thrice-weekly supervised balance training and an unsupervised at-home balance activity (using the Nintendo Wii Fit) for improving balance and reaction time and lowering falls risk in older individuals with type 2 diabetes mellitus (T2DM). Before-after trial. University research laboratory, home environment. Sixty-five older adults with type 2 diabetes were recruited for this study. Participants were randomly allocated to either supervised balance training (mean age 67.8 ± 5.2) or unsupervised training using the Nintendo Wii Fit balance board (mean age 66.1 ± 5.6). The training period for both groups lasted for 12 weeks. Individuals were required to complete three 40-minute sessions per week for a total of 36 sessions. The primary outcome measure was falls risk, which was as derived from the physiological profile assessment. In addition, measures of simple reaction time, lower limb proprioception, postural sway, knee flexion, and knee extension strength were also collected. Persons also self-reported any falls in the previous 6 months. Both training programs resulted in a significant lowering of falls risk (P general balance ability. Interestingly, the reduced falls risk occurred without significant changes in leg strength, suggesting that interventions to reduce falls risk that target intrinsic risk factors related to balance control (over muscle strength) may have positive benefits for the older adult with T2DM at risk for falls. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Determinants of medication adherence among adults with type 2 diabetes mellitus in three Malaysian public health clinics: a cross-sectional study.

Science.gov (United States)

Chew, Boon-How; Hassan, Noor-Hasliza; Sherina, Mohd-Sidik

2015-01-01

Medication adherence (MA) in adults with type 2 diabetes mellitus (T2D) is associated with improved disease control (glycated hemoglobin, blood pressure, and lipid profile), lower rates of death and diabetes-related complications, increased quality of life, and decreased health care resource utilization. However, there is a paucity of data on the effect of diabetes-related distress, depression, and health-related quality of life on MA. This study examined factors associated with MA in adults with T2D at the primary care level. This was a cross-sectional study conducted in three Malaysian public health clinics, where adults with T2D were recruited consecutively in 2013. We used the 8-item Morisky Medication Adherence Scale (MMAS-8) to assess MA as the main dependent variable. In addition to sociodemographic data, we included diabetes-related distress, depressive symptoms, and health-related quality of life as independent variables. Independent association between the MMAS-8 score and its determinants was done using generalized linear models with a gamma distribution and log link function. The participant response rate was 93.1% (700/752). The majority were female (52.8%), Malay (52.9%), and married (79.1%). About 43% of patients were classified as showing low MA (MMAS-8 score health care providers in public health clinics should focus on MA counselling for adult T2D patients who are younger, have a higher income, and symptoms of depression.

Power and Authority in Adult Education

Science.gov (United States)

Alsobaie, Mohammed Fahad

2015-01-01

This paper covers power and authority in adult education, focusing on the modern definitions of power and authority in the educational context, then moving into past precedents of the use of power and authority of classrooms. Finally, the optimal types of power and authority to apply to adult education are examined. Power defines a relationship…

Construct Validation of a Program to Increase Use of Self-Regulation for Physical Activity among Overweight and Obese Adults with Type 2 Diabetes Mellitus

Science.gov (United States)

Petosa, R. Lingyak; Silfee, Valerie

2016-01-01

Background: Studies have revealed that overweight adults with type 2 diabetes have low rates of physical activity and are resistant to change. Purpose: The purpose of this study was to use construct validation of intervention methods to examine the impact of a 4-week behavioral intervention on the use of self-regulation skills for physical…

Validity of the IPAQ among Mexican adults with type 2 diabetes

Directory of Open Access Journals (Sweden)

Nuris Yohana Caravali-Meza

2016-08-01

Full Text Available Objective: The purpose of this study was to validate the short and long version of the IPAQ in adults with diabetes in Tijuana. Methods: Direct interview of the short version (IPAQ-S and long (IPAQ-L version was applied twice over a period of five days. The participants wore an Actigraph accelerometer (AA model GT1M during seven days. Data from accelerometer was processed using Actilife v4.4.1 and Meterplus v4.0 software. The test-retest reliability and the validity of the questionnaires were assessed using the Spearman’s correlation coefficient. Results: 31 subjects with type 2 diabetes participated in the study. The mean age was 51.5 years old and BMI was 30.8 Kg/m2. The tes-retest results for the IPAQ-S were for vigorous PA 0.89(p=0.0001, for light PA 0.74(p=0.001, for the IPAQ-L were for vigorous PA 0.74 (p=0.0001, for light PA 0.70 (p=0.01, for moderate PA was 0.69 (p=0.02. The correlation coefficients between AA counts/min/d with moderate PA from IPAQ-S and IPAQ-L were 0.37 (p=0.04 and 0.39 (p=0.03 respectively. Conclusions: Although it was shown a good reproducibility there was modest significant correlations between the direct measures of PA and the questionnaires for moderate and light PA.

Understanding physical activity in adults with type 2 diabetes after completing an exercise intervention trial: A mediation model of self-efficacy and autonomous motivation.

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Sweet, Shane N; Fortier, Michelle S; Guérin, Eva; Tulloch, Heather; Sigal, Ronald J; Kenny, Glen P; Reid, Robert D

2009-08-01

This study was set out to test if autonomous motivation mediated the relationship between self-efficacy and 12-month physical activity (PA) in adults with type 2 diabetes involved in a randomized exercise trial. Participants (n = 234) completed questionnaires measuring barrier self-efficacy at 3 months, autonomous motivation at 6 months, and PA at 12 months. A mediational analysis of longitudinal data revealed that autonomous motivation mediated the relationship between barrier-self-efficacy and PA. High barrier self-efficacy can therefore help predict 12-month PA in adults with type 2 diabetes, although this effect is attenuated by autonomous motivation. Hence, participating in PA for autonomous reasons such as by choice and/or for fun further explains PA at 12 months in this population. Results of this study extend our understanding of the motivational constructs involved in PA in the maintenance phase. This study has important theoretical implications in that it helps to organize and consolidate well-known correlates of PA by proposing a temporal relationship between them that could be tailored in interventions.

Generalized Hyperalgesia in Children and Adults Diagnosed With Hypermobility Syndrome and Ehlers-Danlos Syndrome Hypermobility Type: A Discriminative Analysis.

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Scheper, M C; Pacey, V; Rombaut, L; Adams, R D; Tofts, L; Calders, P; Nicholson, L L; Engelbert, R H H

2017-03-01

Lowered pressure-pain thresholds have been demonstrated in adults with Ehlers-Danlos syndrome hypermobility type (EDS-HT), but whether these findings are also present in children is unclear. Therefore, the objectives of the study were to determine whether generalized hyperalgesia is present in children with hypermobility syndrome (HMS)/EDS-HT, explore potential differences in pressure-pain thresholds between children and adults with HMS/EDS-HT, and determine the discriminative value of generalized hyperalgesia. Patients were classified in 1 of 3 groups: HMS/EDS-HT, hypermobile (Beighton score ≥4 of 9), and healthy controls. Descriptive data of age, sex, body mass index, Beighton score, skin laxity, and medication usage were collected. Generalized hyperalgesia was quantified by the average pressure-pain thresholds collected from 12 locations. Confounders collected were pain locations/intensity, fatigue, and psychological distress. Comparisons between children with HMS/EDS-HT and normative values, between children and adults with HMS/EDS-HT, and corrected confounders were analyzed with multivariate analysis of covariance. The discriminative value of generalized hyperalgesia employed to differentiate between HMS/EDS-HT, hypermobility, and controls was quantified with logistic regression. Significantly lower pressure-pain thresholds were found in children with HMS/EDS-HT compared to normative values (range -22.0% to -59.0%; P ≤ 0.05). When applying a threshold of 30.8 N/cm 2 for males and 29.0 N/cm 2 for females, the presence of generalized hyperalgesia discriminated between individuals with HMS/EDS-HT, hypermobility, and healthy controls (odds ratio 6.0). Children and adults with HMS/EDS-HT are characterized by hypermobility, chronic pain, and generalized hyperalgesia. The presence of generalized hyperalgesia may indicate involvement of the central nervous system in the development of chronic pain. © 2016, American College of Rheumatology.

Associations between N-terminal pro-B-type natriuretic peptide and cardiac function in adults with corrected tetralogy of Fallot.

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Eindhoven, Jannet A; Menting, Myrthe E; van den Bosch, Annemien E; Cuypers, Judith A A E; Ruys, Titia P E; Witsenburg, Maarten; McGhie, Jackie S; Boersma, Eric; Roos-Hesselink, Jolien W

2014-07-01

Amino-terminal B-type natriuretic peptide (NT-proBNP) may detect early cardiac dysfunction in adults with tetralogy of Fallot (ToF) late after corrective surgery. We aimed to determine the value of NT-proBNP in adults with ToF and establish its relationship with echocardiography and exercise capacity. NT-proBNP measurement, electrocardiography and detailed 2D-echocardiography were performed on the same day in 177 consecutive adults with ToF (mean age 34.6 ± 11.8 years, 58% male, 89% NYHA I, 29.3 ± 8.5 years after surgical correction). Thirty-eight percent of the patients also underwent a cardiopulmonary-exercise test. Median NT-proBNP was 16 [IQR 6.7-33.6] pmol/L, and was elevated in 55%. NT-proBNP correlated with right ventricular (RV) dilatation (r = 0.271, p present in 69 patients (39%). Moderate or severe pulmonary regurgitation was not associated with higher NT-proBNP. Tricuspid and pulmonary regurgitation peak velocities correlated with NT-proBNP (r = 0.305, p < 0.001 and r = 0.186, p = 0.045, respectively). LV twist was measured with speckle-tracking echocardiography in 71 patients. An abnormal LV twist (20 patients, 28%) was associated with elevated NT-proBNP (p = 0.030). No relationship between NT-proBNP and exercise capacity was found. NT-proBNP levels are elevated in more than 50% of adults with corrected ToF, while they are in stable clinical condition. Higher NT-proBNP is most strongly associated with elevated pulmonary pressures, and with LV dysfunction rather than RV dysfunction. NT-proBNP has the potential to become routine examination in patients with ToF to monitor ventricular function and may be used for timely detection of clinical deterioration. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Protection motivation theory and the prediction of physical activity among adults with type 1 or type 2 diabetes in a large population sample.

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Plotnikoff, Ronald C; Lippke, Sonia; Trinh, Linda; Courneya, Kerry S; Birkett, Nick; Sigal, Ronald J

2010-09-01

To investigate the utility of the protection motivation theory (PMT) for explaining physical activity (PA) in an adult population with type 1 diabetes (T1D) and type 2 diabetes (T2D). Cross-sectional and 6-month longitudinal analysis using PMT. Two thousand three hundred and eleven individuals with T1D (N=697) and T2D (N=1,614) completed self-report PMT constructs of vulnerability, severity, response efficacy, self-efficacy, and intention, and PA behaviour at baseline and 6-month follow-up. Multi-group structural equation modelling was conducted to: (1) test the fit of the PMT structure; (2) determine the similarities and differences in the PMT structure between the two types of diabetes; and (3) examine the explained variance and compare the strength of association of the PMT constructs in predicting PA intention and behaviour. The findings provide evidence for the utility of the PMT in both diabetes samples (chi(2)/df=1.27-4.08, RMSEA=.02-.05). Self-efficacy was a stronger predictor of intention (beta=0.64-0.68) than response efficacy (beta=0.14-0.16) in individuals with T1D or T2D. Severity was significantly related to intention (beta=0.06) in T2D individuals only, whereas vulnerability was not significantly related to intention or PA behaviour. Self-efficacy (beta's=0.20-0.28) and intention (beta's=0.12-0.30) were significantly associated with PA behaviour. Promotion of PA behaviour should primarily target self-efficacy to form intentions and to change behaviour. In addition, for individuals with T2D, severity information should be incorporated into PA intervention materials in this population.

Calculation of local skin doses with ICRP adult mesh-type reference computational phantoms

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Yeom, Yeon Soo; Han, Haegin; Choi, Chansoo; Nguyen, Thang Tat; Lee, Hanjin; Shin, Bangho; Kim, Chan Hyeong; Han, Min Cheol

2018-01-01

Recently, Task Group 103 of the International Commission on Radiological Protection (ICRP) developed new mesh-type reference computational phantoms (MRCPs) for adult males and females in order to address the limitations of the current voxel-type reference phantoms described in ICRP Publication 110 due to their limited voxel resolutions and the nature of the voxel geometry. One of the substantial advantages of the MRCPs over the ICRP-110 reference phantoms is the inclusion of a 50-μm-thick radiosensitive skin basal-cell layer; however, a methodology for calculating the local skin dose (LSD), i.e., the maximum dose to the basal layer averaged over a 1-cm2 area, has yet to be developed. In the present study, a dedicated program for the LSD calculation with the MRCPs was developed based on the mean shift algorithm and the Geant4 Monte Carlo code. The developed program was used to calculate local skin dose coefficients (LSDCs) for electrons and alpha particles, which were then compared with the values given in ICRP Publication 116 that were produced with a simple tissue-equivalent cube model. The results of the present study show that the LSDCs of the MRCPs are generally in good agreement with the ICRP-116 values for alpha particles, but for electrons, significant differences are found at energies higher than 0.15 MeV. The LSDCs of the MRCPs are greater than the ICRP-116 values by as much as 2.7 times at 10 MeV, which is due mainly to the different curvature between realistic MRCPs ( i.e., curved) and the simple cube model ( i.e., flat).

Magnitude of cognitive dysfunction in adults with type 2 diabetes: a meta-analysis of six cognitive domains and the most frequently reported neuropsychological tests within domains

NARCIS (Netherlands)

Palta, P.; Schneider, A.; Biessels, G.J.; Touradji, P.; Hill-Briggs, F.

2014-01-01

The objectives were to conduct a meta-analysis in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards to determine effect sizes (Cohen’s d) for cognitive dysfunction in adults with type 2 diabetes, relative to nondiabetic controls, and to obtain

Epidemic myalgia and myositis associated with human parechovirus type 3 infections occur not only in adults but also in children: findings in Yamagata, Japan, 2014.

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Mizuta, K; Yamakawa, T; Kurokawa, K; Chikaoka, S; Shimizu, Y; Itagaki, T; Katsushima, F; Katsushima, Y; Ito, S; Aoki, Y; Matoba, Y; Tanaka, S; Yahagi, K

2016-04-01

We previously reported an association between human parechovirus type 3 (HPeV3) and epidemic myalgia with myositis in adults during summers in which an HPeV3 outbreak occurred in children. However, this disease association has not yet been reported elsewhere. We have since continued our surveillance to accumulate data on this disease association and to confirm whether myalgia occurs in children as well as adults. Between June and August 2014, we collected 380 specimens from children with infectious diseases. We also collected clinical specimens from two adult and three paediatric patients suspected of myalgia. We then performed virus isolation and reverse-transcription-PCR using the collected specimens. We detected HPeV3 in 26 children with infectious diseases, which we regarded as indicating an outbreak. We also confirmed HPeV3 infection in all patients suspected of myalgia. In particular the symptoms in two boys, complaining of myalgia and fever, closely matched the criteria for adult myalgia. Based on our findings from 2008, 2011 and 2014, we again urge that clinical consideration be given to the relationship between myalgia and HPeV3 infections during HPeV3 outbreaks in children. Furthermore, our observations from 2014 suggest that epidemic myalgia and myositis occur not only in adults but also in children.

Momentary Predictors of Insulin Restriction Among Adults With Type 1 Diabetes and Eating Disorder Symptomatology.

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Merwin, Rhonda M; Dmitrieva, Natalia O; Honeycutt, Lisa K; Moskovich, Ashley A; Lane, James D; Zucker, Nancy L; Surwit, Richard S; Feinglos, Mark; Kuo, Jennifer

2015-11-01

Individuals with type 1 diabetes who restrict insulin to control weight are at high risk for diabetes-related complications and premature death. However, little is known about this behavior or how to effectively intervene. The aim of the current study was to identify predictors of insulin restriction in the natural environment that might inform new treatment directions. Eighty-three adults with type 1 diabetes and a range of eating disorder symptomatology completed 3 days of ecological momentary assessment. Participants reported emotions, eating, and insulin dosing throughout the day using their cellular telephone. Linear mixed models were used to estimate the effects of heightened negative affect (e.g., anxiety) before eating and characteristics of the eating episode (e.g., eating a large amount of food) on the risk of insulin restriction. Individuals who reported greater-than-average negative affect (general negative affect and negative affect specifically about diabetes) during the study period were more likely to restrict insulin. Momentary increases in anxiety/nervousness and guilt/disgust with self before eating (relative to an individual's typical level) further increased the odds of restricting insulin at the upcoming meal. Insulin restriction was more likely when individuals reported that they broke a dietary rule (e.g., "no desserts"). Results suggest that insulin restriction might be decreased by helping patients with type 1 diabetes respond effectively to heightened negative affect (e.g., anxiety, guilt) and encouraging patients to take a less rigid, punitive approach to diabetes management. © 2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

Exercise but not metformin improves health-related quality of life and mood states in older adults with type 2 diabetes.

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Baptista, Liliana C; Machado-Rodrigues, Aristides M; Martins, Raul A

2017-07-01

The aim of this cohort study is to analyse the effect of three types of treatment: (i) exercise training with multicomponent exercise (E); (ii) pharmacologic treatment with oral hypoglycaemic drug - metformin (M); and (iii) a combined therapy - exercise and metformin (E + M) on health-related quality of life (HRQoL) and mood states in older adults with type 2 diabetes (T2D) with comorbidity in an early stage of the disease. Participants (n = 284) underwent 1 of the following 3 conditions: (i) E (n = 59) trained three times/week; (ii) M (n = 30) used 850 mg of metformin twice daily; and (iii) E + M (n = 195) combined exercise and metformin. Furthermore, participants completed baseline and 2-year follow-up evaluations including a Shortform Health Survey 36, Profile of Mood States - Short-form, the health history questionnaires, anthropometric, and blood biochemistry. E and E + M revealed improved mood states, with large effect size on the vigour domain, and moderate effect size in the anger and total mood disturbance (TMD) domains (P  0.05). Metformin had no significant effect on the self-referred HRQoL in T2D participants aged above 60 years, in an early stage of the disease. The E and E + M were the most effective long-term therapies to improve mood states and HRQoL in older adults with T2D.

Digital games for type 1 and type 2 diabetes: underpinning theory with three illustrative examples.

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Kamel Boulos, Maged N; Gammon, Shauna; Dixon, Mavis C; MacRury, Sandra M; Fergusson, Michael J; Miranda Rodrigues, Francisco; Mourinho Baptista, Telmo; Yang, Stephen P

2015-03-18

Digital games are an important class of eHealth interventions in diabetes, made possible by the Internet and a good range of affordable mobile devices (eg, mobile phones and tablets) available to consumers these days. Gamifying disease management can help children, adolescents, and adults with diabetes to better cope with their lifelong condition. Gamification and social in-game components are used to motivate players/patients and positively change their behavior and lifestyle. In this paper, we start by presenting the main challenges facing people with diabetes-children/adolescents and adults-from a clinical perspective, followed by three short illustrative examples of mobile and desktop game apps and platforms designed by Ayogo Health, Inc. (Vancouver, BC, Canada) for type 1 diabetes (one example) and type 2 diabetes (two examples). The games target different age groups with different needs-children with type 1 diabetes versus adults with type 2 diabetes. The paper is not meant to be an exhaustive review of all digital game offerings available for people with type 1 and type 2 diabetes, but rather to serve as a taster of a few of the game genres on offer today for both types of diabetes, with a brief discussion of (1) some of the underpinning psychological mechanisms of gamified digital interventions and platforms as self-management adherence tools, and more, in diabetes, and (2) some of the hypothesized potential benefits that might be gained from their routine use by people with diabetes. More research evidence from full-scale evaluation studies is needed and expected in the near future that will quantify, qualify, and establish the evidence base concerning this gamification potential, such as what works in each age group/patient type, what does not, and under which settings and criteria.

Ibuprofen for acute treatment of episodic tension-type headache in adults.

Science.gov (United States)

Derry, Sheena; Wiffen, Philip J; Moore, R Andrew; Bendtsen, Lars

2015-07-31

Tension-type headache (TTH) affects about one person in five worldwide. It is divided into infrequent episodic TTH (fewer than one headache per month), frequent episodic TTH (1 to 14 headaches per month), and chronic TTH (15 headaches a month or more). Ibuprofen is one of a number of analgesics suggested for acute treatment of headaches in frequent episodic TTH. To assess the efficacy and safety of oral ibuprofen for treatment of acute episodic TTH in adults. We searched CENTRAL (The Cochrane Library), MEDLINE, EMBASE, and our own in-house database to January 2015. We sought unpublished studies by asking personal contacts and searching on-line clinical trial registers and manufacturers' websites. We included randomised, placebo-controlled studies (parallel-group or cross-over) using oral ibuprofen for symptomatic relief of an acute episode of TTH. Studies had to be prospective and include at least 10 participants per treatment arm. Two review authors independently assessed studies for inclusion, and extracted data. Numbers of participants achieving each outcome were used to calculate risk ratio (RR) and number needed to treat for an additional beneficial outcome (NNT) or number needed to treat for an additional harmful outcome (NNH) of oral ibuprofen compared to placebo for a range of outcomes, predominantly those recommended by the International Headache Society (IHS). We included 12 studies, all of which enrolled adult participants with frequent episodic TTH. Nine used the IHS diagnostic criteria, but two used the older classification of the Ad Hoc Committee, and one did not describe diagnostic criteria but excluded participants with migraines. While 3094 people with TTH participated in these studies, the numbers available for any form of analysis were lower than this; placebo was taken by 733, standard ibuprofen 200 mg by 127, standard ibuprofen 400 mg by 892, and fast-acting ibuprofen 400 mg by 230. Participants had moderate or severe pain at the start of

Food insecurity is associated with high risk glycemic control and higher health care utilization among youth and young adults with type 1 diabetes.

Science.gov (United States)

Mendoza, Jason A; Haaland, Wren; D'Agostino, Ralph B; Martini, Lauren; Pihoker, Catherine; Frongillo, Edward A; Mayer-Davis, Elizabeth J; Liu, Lenna L; Dabelea, Dana; Lawrence, Jean M; Liese, Angela D

2018-04-01

Household food insecurity (FI), i.e., limited availability of nutritionally adequate foods, is associated with poor glycemic control among adults with type 2 diabetes. We evaluated the association of FI among youth and young adults (YYA) with type 1 diabetes to inform recent clinical recommendations from the American Diabetes Association for providers to screen all patients with diabetes for FI. Using data from the Washington and South Carolina SEARCH for Diabetes in Youth Study sites, we conducted an observational, cross-sectional evaluation of associations between FI and glycemic control, hospitalizations, and emergency department (ED) visits among YYA with type 1 diabetes. FI was assessed using the Household Food Security Survey Module, which queries conditions and behaviors typical of households unable to meet basic food needs. Participants' HbA 1c were measured from blood drawn at the research visit; socio-demographics and medical history were collected by survey. The prevalence of FI was 19.5%. In adjusted logistic regression analysis, YYAs from food-insecure households had 2.37 higher odds (95% CI: 1.10, 5.09) of high risk glycemic control, i.e., HbA 1c >9.0%, vs. peers from food-secure households. In adjusted binomial regression analysis for ED visits, YYAs from food-insecure households had an adjusted prevalence rate that was 2.95 times (95% CI [1.17, 7.45]) as great as those from food secure households. FI was associated with high risk glycemic control and more ED visits. Targeted efforts should be developed and tested to alleviate FI among YYA with type 1 diabetes. Copyright © 2018 Elsevier B.V. All rights reserved.

Symptoms of Eating Disorders and Depression in Emerging Adults with Early-Onset, Long-Duration Type 1 Diabetes and Their Association with Metabolic Control.

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Bächle, Christina; Lange, Karin; Stahl-Pehe, Anna; Castillo, Katty; Scheuing, Nicole; Holl, Reinhard W; Giani, Guido; Rosenbauer, Joachim

2015-01-01

This study analyzed the prevalence of and association between symptoms of eating disorders and depression in female and male emerging adults with early-onset, long-duration type 1 diabetes and investigated how these symptoms are associated with metabolic control. In a nationwide population-based survey, 211 type 1 diabetes patients aged 18-21 years completed standardized questionnaires, including the SCOFF questionnaire for eating disorder symptoms and the Patient Health Questionnaire (PHQ-9) for symptoms of depression and severity of depressive symptoms (PHQ-9 score). Multiple linear and logistic regression models were used to analyze the association between eating disorder and depressive symptoms and their associations with HbA1c. A total of 30.2% of the women and 9.5% of the men were screening positive for eating disorders. The mean PHQ-9 score (standard deviation) was 5.3 (4.4) among women and 3.9 (3.6) among men. Screening positive for an eating disorder was associated with more severe depressive symptoms among women (βwomen 3.8, peating disorder symptoms nor severity of depressive symptoms were associated with HbA1c among women, while HbA1c increased with the severity of depressive symptoms among men (βmen 0.14, p=0.006). Because of the high prevalence of eating disorder and depressive symptoms, their interrelationship, and their associations with metabolic control, particularly among men, regular mental health screening is recommended for young adults with type 1 diabetes.

Determinants of medication adherence among adults with type 2 diabetes mellitus in three Malaysian public health clinics: a cross-sectional study

OpenAIRE

Chew BH; Hassan NH; Sherina MS

2015-01-01

Boon-How Chew,1 Noor-Hasliza Hassan,2 Mohd-Sidik Sherina3 1Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 2Klinik Kesihatan Dengkil, Ministry of Health, 3Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia Abstract: Medication adherence (MA) in adults with type 2 diabetes mellitus (T2D) is associated with improved disease control (glycated hemoglobin, blood pressure, and lipid pro...

Disparities in Current Cigarette Smoking Prevalence by Type of Disability, 2009–2011

Science.gov (United States)

Stevens, Alissa; Caraballo, Ralph; Ramon, Ismaila; Armour, Brian S.

2014-01-01

Objectives Smoking, the leading cause of disease and death in the United States, has been linked to a number of health conditions including cancer and cardiovascular disease. While people with a disability have been shown to be more likely to report smoking, little is known about the prevalence of smoking by type of disability, particularly for adults younger than 50 years of age. Methods We used data from the 2009–2011 National Health Interview Survey to estimate the prevalence of smoking by type of disability and to examine the association of functional disability type and smoking among adults aged 18–49 years. Results Adults with a disability were more likely than adults without a disability to be current smokers (38.8% vs. 20.7%, pdisability was associated with statistically significantly higher odds of current smoking (adjusted odds ratio = 1.57, 95% confidence interval 1.40, 1.77). Conclusions The prevalence of current smoking for adults was higher for every functional disability type than for adults without a disability. By understanding the association between smoking and disability type among adults younger than 50 years of age, resources for cessation services can be better targeted during the ages when increased time for health improvement can occur. PMID:24791023

The Effects of Intensive Nutrition Education on Late Middle-Aged Adults with Type 2 Diabetes

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Ye Li

2016-09-01

, there was no statistical significance between groups. Conclusions: Intensive nutrition education has significant effects on blood glucose control in late middle-aged adults with type 2 diabetes. Intensive education can cultivate good diet habits and increase physical activity, which are important for diabetes patients in the short and long terms. These findings may contribute to improving education methodology and nutrition therapy in patients with type 2 diabetes.

A Systematic Review of Transitional Care for Emerging Adults with Diabetes.

Science.gov (United States)

Findley, Mary K; Cha, EunSeok; Wong, Eugene; Faulkner, Melissa Spezia

2015-01-01

The prevalence of diabetes and prediabetes in adolescents is increasing. A systematic review of 31 research articles focusing on transitional care for adolescents or emerging adults with diabetes or prediabetes was completed. Studies focused on those with type 1 diabetes, not type 2 diabetes or prediabetes, and were primarily descriptive. Major findings and conclusions include differences in pediatric versus adult care delivery and the importance of structured transitional programs using established recommendations of leading national organizations. Implications include future research on program development, implementation, and evaluation that is inclusive of adolescents and emerging adults, regardless of diabetes type, or prediabetes. Copyright © 2015 Elsevier Inc. All rights reserved.

Hunting Increases Phosphorylation of Calcium/Calmodulin-Dependent Protein Kinase Type II in Adult Barn Owls

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Grant S. Nichols

2015-01-01

Full Text Available Juvenile barn owls readily adapt to prismatic spectacles, whereas adult owls living under standard aviary conditions do not. We previously demonstrated that phosphorylation of the cyclic-AMP response element-binding protein (CREB provides a readout of the instructive signals that guide plasticity in juveniles. Here we investigated phosphorylation of calcium/calmodulin-dependent protein kinase II (pCaMKII in both juveniles and adults. In contrast to CREB, we found no differences in pCaMKII expression between prism-wearing and control juveniles within the external nucleus of the inferior colliculus (ICX, the major site of plasticity. For prism-wearing adults that hunted live mice and are capable of adaptation, expression of pCaMKII was increased relative to prism-wearing adults that fed passively on dead mice and are not capable of adaptation. This effect did not bear the hallmarks of instructive information: it was not localized to rostral ICX and did not exhibit a patchy distribution reflecting discrete bimodal stimuli. These data are consistent with a role for CaMKII as a permissive rather than an instructive factor. In addition, the paucity of pCaMKII expression in passively fed adults suggests that the permissive default setting is “off” in adults.

MR imaging in adults with Gaucher disease type I: evulation of marrow involvement and disease activity

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Hermann, G. (Dept. of Radiology, Mount Sinai Medical Center, City Univ. of New York, NY (United States)); Shaprio, R.S. (Dept. of Radiology, Mount Sinai Medical Center, City Univ. of New York, NY (United States)); Abdelwahab, I.F. (Dept. of Radiology, Mount Sinai Medical Center, City Univ. of New York, NY (United States)); Grabowski, G. (Dept. of Pediatrics, Mount Sinai Medical Center, City Univ. of New York, NY (United States))

1993-05-01

An investigation was conducted to determine the usefulness of magnetic resonance imaging (MRI) in the evaluation of bone marrow involvement in patients with Gaucher disease type I. T1- and T2-weighted images were obtained of the lower extremities of 29 adult patients. Patients were classified into one of three groups based on marrow signal patterns on T1- and T2-weighted images as well as change in signal intensity from T1- to T2-weighted images. An increase in signal intensity from T1- to T2-weighted images was the criterion for an 'active process' within the bone marrow. Classification of the 29 patients produced the following results: Group A: Normal, 4 patients; group B: Marrow infiltration, 16 patients; group C: Marrow infiltration plus active marrow process, 9 patients. Correlation with clinical findings revealed that all nine patients with evidence of an active marrow process on MRI (group C) had acute bone pain. Conversely, only one of the remaining 20 patients (groups A and B) had bone pain. There was no correlation between disease activity and findings on conventional radiographs. We conclude the MRI provides an excellent noninvasive assessment of the extent and activity of marrow involvement in type I Gaucher disease. (orig.)

MR imaging in adults with Gaucher disease type I: evulation of marrow involvement and disease activity

International Nuclear Information System (INIS)

Hermann, G.; Shaprio, R.S.; Abdelwahab, I.F.; Grabowski, G.

1993-01-01

An investigation was conducted to determine the usefulness of magnetic resonance imaging (MRI) in the evaluation of bone marrow involvement in patients with Gaucher disease type I. T1- and T2-weighted images were obtained of the lower extremities of 29 adult patients. Patients were classified into one of three groups based on marrow signal patterns on T1- and T2-weighted images as well as change in signal intensity from T1- to T2-weighted images. An increase in signal intensity from T1- to T2-weighted images was the criterion for an 'active process' within the bone marrow. Classification of the 29 patients produced the following results: Group A: Normal, 4 patients; group B: Marrow infiltration, 16 patients; group C: Marrow infiltration plus active marrow process, 9 patients. Correlation with clinical findings revealed that all nine patients with evidence of an active marrow process on MRI (group C) had acute bone pain. Conversely, only one of the remaining 20 patients (groups A and B) had bone pain. There was no correlation between disease activity and findings on conventional radiographs. We conclude the MRI provides an excellent noninvasive assessment of the extent and activity of marrow involvement in type I Gaucher disease. (orig.)

The Profiles of Creative Potential and Personality Characteristics of Adult Professionals

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Lee, Seon-Young; Min, Jiyeon

2016-01-01

Using 5 divergent thinking indices of the Torrance Tests of Creative Thinking and the Myers-Briggs Type Indicator, this study examined the creative profiles of 236 adult professionals and relationships between their creative characteristics and personality types. All these adults were in their middle or late stage of professional development in…

Development of the adult neurogenic niche in the hippocampus of mice

Directory of Open Access Journals (Sweden)

Zeina eNicola

2015-05-01

Full Text Available When does adult hippocampal neurogenesis begin? We describe the development of the neurogenic niche in the subgranular zone (SGZ of the hippocampal dentate gyrus. We did so from the perspective of the situation in the adult.Ontogeny of the dentate gyrus is complex and results in an ectopic neurogenic niche that lifelong generates new granule cells. Neurogenesis during the fetal and early postnatal periods builds the dentate gyrus and gives way to activity-dependent adult neurogenesis. We used markers most relevant to adult neurogenesis research to describe this transition: Nestin, Sox2, BLBP, GFAP, Tbr2, Doublecortin (DCX, NeuroD1 and Prox1. We found that massive changes and a local condensation of proliferating precursor cells occurs between postnatal day 7 (P7, near the peak in proliferation, and P14. Before and around P7, the spatial distribution of cells and the co-localization of markers were distinct from the situation in the adult. Unlike the adult SGZ, the marker pair Nestin/Sox2 and the radial glial marker BLBP were not overlapping during embryonic development, presumably indicating different types of radial glia-like cells. Before P7 GFAP-positive cells in the hilus lacked the radial orientation that is characteristic of the adult type-1 cells. DCX, which is concentrated in type-2b and type-3 progenitor cells and early postmitotic neurons in the adult, showed diffuse expression before P7. Intermediate progenitor cell marker Tbr2 became restricted to the SGZ but was found in the granule cell layer and hilus before. Lineage markers NeuroD1 and Prox1 confirmed this pattern.We conclude that the neurogenic niche of adult neurogenesis is in place well before true adulthood. This might indicate that consistent with the hypothesized function of adult neurogenesis in activity-dependent plasticity, the early transition from postnatal neurogenesis to adult neurogenesis coincides with the time, when the young mice start to become active themselves.

Dietary Inflammatory Index and Type 2 Diabetes Mellitus in Adults: The Diabetes Mellitus Survey of Mexico City.

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Denova-Gutiérrez, Edgar; Muñoz-Aguirre, Paloma; Shivappa, Nitin; Hébert, James R; Tolentino-Mayo, Lizbeth; Batis, Carolina; Barquera, Simón

2018-03-21

Diet and inflammation are both associated with type 2 diabetes mellitus (T2DM). In the present study, we aimed to assess the relation between the dietary inflammatory index (DII) and the presence of T2DM in Mexican adults participating in the Diabetes Mellitus Survey administered in Mexico City (DMS-MC). The study involved 1174 subjects (48.5% men) between 20-69 years of age. A validated semi-quantitative food frequency questionnaire was employed to evaluate dietary intake and to compute DII. The DII is based on scientific evidence about the association between dietary compounds and six established inflammatory biomarkers. Multivariate logistic regression models were used to estimate the odds ratios (ORs) and 95% confidence intervals (95% CIs) of DII in relation to T2DM. Our results suggest that subjects in the highest quintile of the DII had higher odds of T2DM (OR = 3.02; 95% CI: 1.39, 6.58; p = 0.005) compared to subjects in the lowest quintile of DII scores. Assessing possible effect modification, an association with T2DM was evident when comparing DII quintile 5 to quintile 1 for participants aged ≥ 55 years (OR = 9.77; 95% CI: 3.78, 25.50; p = 0.001). These results suggest that a pro-inflammatory diet is associated with significantly higher odds of T2DM among adult Mexicans.

Effectiveness of technology-assisted case management in low income adults with type 2 diabetes (TACM-DM: study protocol for a randomized controlled trial

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Strom Joni L

2011-10-01

Full Text Available Abstract Background An estimated 1 in 3 American adults will have diabetes by the year 2050. Nationally, South Carolina ranks 10th in cases of diagnosed diabetes compared to other states. In adults, type 2 diabetes (T2DM accounts for approximately 90-95% of all diagnosed cases of diabetes. Clinically, provider and health system factors account for Methods We describe a four-year prospective, randomized clinical trial, which will test the effectiveness of technology-assisted case management in low income rural adults with T2DM. Two-hundred (200 male and female participants, 18 years of age or older and with an HbA1c ≥ 8%, will be randomized into one of two groups: (1 an intervention arm employing the innovative FORA system coupled with nurse case management or (2 a usual care group. Participants will be followed for 6-months to ascertain the effect of the interventions on glycemic control. Our primary hypothesis is that among indigent, rural adult patients with T2DM treated in FQHC's, participants randomized to the technology-assisted case management intervention will have significantly greater reduction in HbA1c at 6 months of follow-up compared to usual care. Discussion Results from this study will provide important insight into the effectiveness of technology-assisted case management intervention (TACM for optimizing diabetes care in indigent, rural adult patients with T2DM treated in FQHC's. Trial Registration National Institutes of Health Clinical Trials Registry (http://ClinicalTrials.gov identifier# NCT01373489

Prevalence of obesity and metabolic syndrome components in Mexican adults without type 2 diabetes or hypertension.

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Rojas-Martínez, Rosalba; Aguilar-Salinas, Carlos A; Jiménez-Corona, Aída; Gómez-Pérez, Francisco J; Barquera, Simón; Lazcano-Ponce, Eduardo

2012-01-01

To describe the number of Mexican adults with undiagnosed diabetes and arterial hypertension and their association with obesity. The study included a sub-sample of 6 613 subjects aged 20 years or more who participated in the 2006 National Health and Nutrition Survey (ENSANUT 2006). Subjects with a previous diagnosis of diabetes or hypertension (n=1 861) were excluded. Prevalences and standard errors were estimated, taking into account the complex sample design. 6.4 million adults have obesity and undiagnosed impaired fasting glucose. Almost two million more have fasting glucose levels diagnostic for diabetes. As for arterial blood pressure, 5.4 million adults had prehypertension. Another 5.4 million adults had blood pressure levels suggestive of probable hypertension. A total of 21.4 million Mexican adults with obesity had at least one further component of the metabolic syndrome. A large proportion of adults with obesity-related metabolic comorbidities remains undiagnosed in Mexico.

Increased anxiety and fear memory in adult mice lacking type 2 deiodinase.

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Bárez-López, Soledad; Montero-Pedrazuela, Ana; Bosch-García, Daniel; Venero, César; Guadaño-Ferraz, Ana

2017-10-01

A euthyroid state in the brain is crucial for its adequate development and function. Impairments in thyroid hormones (THs; T3 or 3,5,3'-triiodothyronine and T4 or thyroxine) levels and availability in brain can lead to neurological alterations and to psychiatric disorders, particularly mood disorders. The thyroid gland synthetizes mainly T4, which is secreted to circulating blood, however, most actions of THs are mediated by T3, the transcriptionally active form. In the brain, intracellular concentrations of T3 are modulated by the activity of type 2 (D2) and type 3 (D3) deiodinases. In the present work, we evaluated learning and memory capabilities and anxiety-like behavior at adult stages in mice lacking D2 (D2KO) and we analyzed the impact of D2-deficiency on TH content and on the expression of T3-dependent genes in the amygdala and the hippocampus. We found that D2KO mice do not present impairments in spatial learning and memory, but they display emotional alterations with increased anxiety-like behavior as well as enhanced auditory-cued fear memory and spontaneous recovery of fear memory following extinction. D2KO mice also presented reduced T3 content in the hippocampus and decreased expression of the T3-dependent gene Dio3 in the amygdala suggesting a hypothyroid status in this structure. We propose that the emotional dysfunctions found in D2KO mice can arise from the reduced T3 content in their brain, which consequently leads to alterations in gene expression with functional consequences. We found a downregulation in the gene encoding for the calcium-binding protein calretinin (Calb2) in the amygdala of D2KO mice that could affect the GABAergic transmission. The current findings in D2KO mice can provide insight into emotional disorders present in humans with DIO2 polymorphisms. Copyright © 2017 Elsevier Ltd. All rights reserved.

Memory performance on the Auditory Inference Span Test is independent of background noise type for young adults with normal hearing at high speech intelligibility.

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Rönnberg, Niklas; Rudner, Mary; Lunner, Thomas; Stenfelt, Stefan

2014-01-01

Listening in noise is often perceived to be effortful. This is partly because cognitive resources are engaged in separating the target signal from background noise, leaving fewer resources for storage and processing of the content of the message in working memory. The Auditory Inference Span Test (AIST) is designed to assess listening effort by measuring the ability to maintain and process heard information. The aim of this study was to use AIST to investigate the effect of background noise types and signal-to-noise ratio (SNR) on listening effort, as a function of working memory capacity (WMC) and updating ability (UA). The AIST was administered in three types of background noise: steady-state speech-shaped noise, amplitude modulated speech-shaped noise, and unintelligible speech. Three SNRs targeting 90% speech intelligibility or better were used in each of the three noise types, giving nine different conditions. The reading span test assessed WMC, while UA was assessed with the letter memory test. Twenty young adults with normal hearing participated in the study. Results showed that AIST performance was not influenced by noise type at the same intelligibility level, but became worse with worse SNR when background noise was speech-like. Performance on AIST also decreased with increasing memory load level. Correlations between AIST performance and the cognitive measurements suggested that WMC is of more importance for listening when SNRs are worse, while UA is of more importance for listening in easier SNRs. The results indicated that in young adults with normal hearing, the effort involved in listening in noise at high intelligibility levels is independent of the noise type. However, when noise is speech-like and intelligibility decreases, listening effort increases, probably due to extra demands on cognitive resources added by the informational masking created by the speech fragments and vocal sounds in the background noise.

Memory performance on the Auditory Inference Span Test is independent of background noise type for young adults with normal hearing at high speech intelligibility

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Niklas eRönnberg

2014-12-01

Full Text Available Listening in noise is often perceived to be effortful. This is partly because cognitive resources are engaged in separating the target signal from background noise, leaving fewer resources for storage and processing of the content of the message in working memory. The Auditory Inference Span Test (AIST is designed to assess listening effort by measuring the ability to maintain and process heard information. The aim of this study was to use AIST to investigate the effect of background noise types and signal-to-noise ratio (SNR on listening effort, as a function of working memory capacity (WMC and updating ability (UA. The AIST was administered in three types of background noise: steady-state speech-shaped noise, amplitude modulated speech-shaped noise, and unintelligible speech. Three SNRs targeting 90% speech intelligibility or better were used in each of the three noise types, giving nine different conditions. The reading span test assessed WMC, while UA was assessed with the letter memory test. Twenty young adults with normal hearing participated in the study. Results showed that AIST performance was not influenced by noise type at the same intelligibility level, but became worse with worse SNR when background noise was speech-like. Performance on AIST also decreased with increasing MLL. Correlations between AIST performance and the cognitive measurements suggested that WMC is of more importance for listening when SNRs are worse, while UA is of more importance for listening in easier SNRs. The results indicated that in young adults with normal hearing, the effort involved in listening in noise at high intelligibility levels is independent of the noise type. However, when noise is speech-like and intelligibility decreases, listening effort increases, probably due to extra demands on cognitive resources added by the informational masking created by the speech-fragments and vocal sounds in the background noise.

Cognitive skills and reading in adults with Usher syndrome type 2

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Cecilia eHenricson

2015-03-01

Full Text Available Objective: To investigate working memory, phonological skills, lexical skills, and reading comprehension in adults with Usher syndrome type 2 (USH2.Design: The participants performed tests of phonological processing, lexical access, working memory and reading comprehension. The design of the test situation and tests was specifically considered for use with persons with low vision in combination with hearing impairment. The performance of the group with USH2 on the different cognitive measures was compared to that of a matched control group with normal hearing and vision (NVH.Study Sample: Thirteen participants with USH2 aged 21–60 years and a control group of ten individuals with NVH, matched on age and level of education.Results: The group with USH2 displayed significantly lower performance on tests of phonological processing, and on measures requiring both fast visual judgment and phonological processing. There was a larger variation in performance among the individuals with USH2 than in the matched control group.Conclusions: The performance of the group with USH2 indicated similar problems with phonological processing skills and phonological working memory as in individuals with long-term hearing loss. The group with USH2 also had significantly longer reaction times, indicating that processing of visual stimuli is difficult due to the visual impairment. These findings point toward the difficulties in accessing information that persons with USH2 experience, and could be part of the explanation of why individuals with USH2 report high levels of fatigue and feelings of stress (Wahlqvist et al., 2013.

Diabetes MILES--Australia (management and impact for long-term empowerment and success: methods and sample characteristics of a national survey of the psychological aspects of living with type 1 or type 2 diabetes in Australian adults

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Speight Jane

2012-02-01

Full Text Available Abstract Background Successful management of diabetes requires attention to the behavioural, psychological and social aspects of this progressive condition. The Diabetes MILES (Management and Impact for Long-term Empowerment and Success Study is an international collaborative. Diabetes MILES--Australia, the first Diabetes MILES initiative to be undertaken, was a national survey of adults living with type 1 or type 2 diabetes in Australia. The aim of this study was to gather data that will provide insights into how Australians manage their diabetes, the support they receive and the impact of diabetes on their lives, as well as to use the data to validate new diabetes outcome measures. Methods/design The survey was designed to include a core set of self-report measures, as well as modules specific to diabetes type or management regimens. Other measures or items were included in only half of the surveys. Cognitive debriefing interviews with 20 participants ensured the survey content was relevant and easily understood. In July 2011, the survey was posted to 15,000 adults (aged 18-70 years with type 1 or type 2 diabetes selected randomly from the National Diabetes Services Scheme (NDSS database. An online version of the survey was advertised nationally. A total of 3,338 eligible Australians took part; most (70.4% completed the postal survey. Respondents of both diabetes types and genders, and of all ages, were adequately represented in both the postal and online survey sub-samples. More people with type 2 diabetes than type 1 diabetes took part in Diabetes MILES--Australia (58.8% versus 41.2%. Most respondents spoke English as their main language, were married/in a de facto relationship, had at least a high school education, were occupied in paid work, had an annual household income > $AUS40,000, and lived in metropolitan areas. Discussion A potential limitation of the study is the under-representation of respondents from culturally and

Adherence in adults with type 1 diabetes mellitus correlates with treatment satisfaction but not with adverse events

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Hendrychova T

2013-09-01

Full Text Available Tereza Hendrychova,1 Magda Vytrisalova,1 Alena Smahelova,2 Jiri Vlcek,1 Ales Antonin Kubena1 1Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University in Prague, Hradec Králové, Czech Republic; 2Diabetes Center, Department of Gerontology and Metabolism, University Hospital and Faculty of Medicine in Hradec Králové, Charles University in Prague, Hradec Králové, Czech Republic Purpose: Diabetes self-care and self-monitoring adherence has a positive effect on the metabolic control of the disease. The aim of this study was to analyze the adherence to self-care recommendations and to identify its correlates in adults with type 1 diabetes mellitus. Patients and methods: One hundred and eleven patients with type 1 diabetes were enrolled in an observational cross-sectional study conducted at the Diabetes Center of the University Hospital in Hradec Králové, Czech Republic. Diabetes self-care adherence was measured by the Self Care Inventory-Revised, and treatment satisfaction by the Diabetes Treatment Satisfaction Questionnaire-status version. Additional data were collected from self-administered questionnaires and medical records. The Mann–Whitney test, Spearman correlations, and multiple linear regressions were used in the statistical analysis. Results: The mean age of patients was 42.4 years; 59.5% of them were females and 53.2% of all patients used an insulin pump. The mean glycosylated hemoglobin (HbA1c was 66.2 ± 15.3 mmol/mol and the mean insulin dosage was 0.6 ± 0.3 IU insulin/kg/day. The number of hypoglycemic episodes (including severe that patients had in the last month before taking the survey was 3.6 ± 3.2. Self-care adherence was associated with treatment satisfaction (0.495; P = 0.004 along with frequency of self-monitoring of before meal blood glucose (0.267; P = 0.003. It was not associated with the incidence of hypoglycemic events or any other insulin therapy-related problems

Aspirin for acute treatment of episodic tension-type headache in adults.

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Derry, Sheena; Wiffen, Philip J; Moore, R Andrew

2017-01-13

Tension-type headache (TTH) affects about 1 person in 5 worldwide. It is divided into infrequent episodic TTH (fewer than one headache per month), frequent episodic TTH (two to 14 headache days per month), and chronic TTH (15 headache days per month or more). Aspirin is one of a number of analgesics suggested for acute treatment of episodic TTH. To assess the efficacy and safety of aspirin for acute treatment of episodic tension-type headache (TTH) in adults compared with placebo or any active comparator. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and the Oxford Pain Relief Database from inception to September 2016, and also reference lists of relevant published studies and reviews. We sought unpublished studies by asking personal contacts and searching online clinical trial registers and manufacturers' websites. We included randomised, double-blind, placebo-controlled studies (parallel-group or cross-over) using oral aspirin for symptomatic relief of an acute episode of TTH. Studies had to be prospective, with participants aged 18 years or over, and include at least 10 participants per treatment arm. Two review authors independently assessed studies for inclusion and extracted data. For various outcomes (predominantly those recommended by the International Headache Society (IHS)), we calculated the risk ratio (RR) and number needed to treat for one additional beneficial outcome (NNT), one additional harmful outcome (NNH), or to prevent one event (NNTp) for oral aspirin compared to placebo or an active intervention.We assessed the evidence using GRADE and created a 'Summary of findings' table. We included five studies enrolling adults with frequent episodic TTH; 1812 participants took medication, of which 767 were included in comparisons of aspirin 1000 mg with placebo, and 405 in comparisons of aspirin 500 mg or 650 mg with placebo. Not all of these participants provided data for outcomes of interest in this review

Heterogeneous pattern of bone disease in adult type 1 Gaucher disease: clinical and pathological correlates.

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van Dussen, L; Lips, P; van Essen, H W; Hollak, C E M; Bravenboer, N

2014-09-01

Gaucher disease (GD) is a lysosomal storage disorder characterized by accumulation of glucosylceramide in macrophages, so-called Gaucher cells, as a result of a deficiency of the lysosomal enzyme glucocerebrosidase. Bone complications are an important cause of morbidity of GD and are thought to result from imbalance in bone remodeling. Bone manifestations among GD patients demonstrate a large variation including increased osteoclastic bone resorption, low bone formation and osteonecrosis. The purpose of the current case series is to describe the histological features observed in undecalcified bone samples, obtained from three GD patients, and evaluate the relationship with clinical features in these patients. Bone fragments were obtained from three adult type 1 GD patients with variable degrees of bone disease during orthopedic surgery. Specimens were embedded without prior decalcification in methylmethacrylate and prepared for histology according to standardized laboratory procedures. Histology revealed a heterogeneous pattern of bone involvement. High cellularity of bone marrow, abundant presence of Gaucher cells (GCs) and high turnover were observed in a patient with a history of multiple bone complications, while minimal bone turnover and few GCs were detected in the mildest affected patient in this series. An intermediate picture with relatively low bone turnover and a substantial amount of Gaucher cells was demonstrated in the third, moderately affected patient. No gross abnormalities in three biochemical markers of bone turnover (osteocalcin, N-terminal propeptide of type 1 procollagen and type 1 collagen C-terminal telopeptide) were noted. Plastic embedding and subsequent Goldner and TRAP staining offered a unique possibility to study bone histological findings in GD. Our data show that bone manifestations in GD may vary both clinically as well as histologically and bone disease in GD will likely require a personalized approach. Copyright © 2014 Elsevier

Short-term high-intensity interval and moderate-intensity continuous training reduce leukocyte TLR4 in inactive adults at elevated risk of type 2 diabetes.

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Robinson, Emily; Durrer, Cody; Simtchouk, Svetlana; Jung, Mary E; Bourne, Jessica E; Voth, Elizabeth; Little, Jonathan P

2015-09-01

Exercise can have anti-inflammatory effects in obesity, but the optimal type and intensity of exercise are not clear. This study compared short-term high-intensity interval training (HIIT) with moderate-intensity continuous training (MICT) in terms of improvement in cardiorespiratory fitness, markers of inflammation, and glucose control in previously inactive adults at elevated risk of developing type 2 diabetes. Thirty-nine inactive, overweight/obese adults (32 women) were randomly assigned to 10 sessions over 2 wk of progressive HIIT (n = 20, four to ten 1-min sessions at ∼90% peak heart rate, 1-min rest periods) or MICT (n = 19, 20-50 min at ∼65% peak heart rate). Before and 3 days after training, participants performed a peak O2 uptake test, and fasting blood samples were obtained. Both HIIT (1.8 ± 0.4 vs. 1.9 ± 0.4 l/min, pre vs. post) and MICT (1.8 ± 0.5 vs. 1.9 ± 0.5 l/min, pre vs. post) improved peak O2 uptake (P fasting plasma glucose (P fasting glucose. Copyright © 2015 the American Physiological Society.

FAT-FREE MASS, METABOLICALLY HEALTHY OBESITY, AND TYPE 2 DIABETES IN SEVERELY OBESE ASIAN ADULTS.

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Pramyothin, Pornpoj; Limpattanachart, Vichol; Dawilai, Suwitcha; Sarasak, Rungnapha; Sukaruttanawong, Chariya; Chaiyasoot, Kusuma; Keawtanom, Songsri; Yamwong, Preyanuj

2017-08-01

To determine whether fat free mass (FFM) is independently associated with the metabolically healthy obesity (MHO) phenotype, the metabolic syndrome (MS), and type 2 diabetes (T2D) in obese Asian adults. Obese patients (body mass index [BMI] ≥25 kg/m 2 ) seeking weight management at an academic medical center from 2007 to 2016 were included. FFM was measured by bioelectrical impedance. Of the 552 patients (67.0% female, median age 40.5 years, median BMI 38.3 kg/m 2 ), MHO was present in 19%, MS in 55.4%, and T2D in 32.6%. In multivariate models, higher fat-free mass index (FFMI) was independently associated with the metabolically abnormal obesity (MAO) phenotype, (odds ratio [OR] 1.22, 95% confidence interval [CI] 1.09-1.37), and increased risk of MS (OR 1.12, 95% CI 1.03-1.22) in women but not in men. Older age was independently associated with the MAO phenotype (OR 1.06, 95% CI 1.04-1.09 in women; OR 1.06, 95% CI 1.02-1.09 in men), MS (OR 1.05, 95% CI 1.03-1.06 in women; OR 1.05, 95% CI 1.02-1.07 in men), and T2D (OR 1.07, 95% CI 1.05-1.09 in women; OR 1.06, 95% CI 1.04-1.09 in men). Waist-hip ratio was independently associated with the MAO phenotype in men (OR 1.08, 95% CI 1.01-1.15), while waist circumference was associated with T2D in women (OR 1.03, 95% CI 1.01-1.05). Older age, central fat distribution, and-in contrast to previous findings-an increase in FFMI among women were independent predictors of adverse metabolic health in this cohort of middle-aged obese Asian adults. Further studies are required to elucidate underlying mechanisms and therapeutic implications of these findings. BIA = bioelectrical impedance analysis BMI = body mass index CI = confidence interval DXA = dual-energy X-ray absorptiometry FFM = fat-free mass FFMI = fat-free mass index FM = fat mass HbA1c = glycated hemoglobin A1c MAO = metabolically abnormal obesity MHO = metabolically healthy obesity MS = metabolic syndrome OR = odds ratio T2D = type 2 diabetes WC = waist circumference

A Comparison of Screening Tools for the Early Detection of Peripheral Neuropathy in Adults with and without Type 2 Diabetes

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Jennifer J. Brown

2017-01-01

Full Text Available Objective. Examine the effectiveness of the 128 Hz tuning fork, two monofilaments, and Norfolk Quality of Life Diabetic Neuropathy (QOL-DN questionnaire as tools for the early detection of diabetic peripheral neuropathy (DPN in overweight, obese, and inactive (OOI adults or those who have prediabetes (PD or type 2 diabetes (T2D. Research Design and Methods. Thirty-four adults (mean age 58.4 years ± 12.1 were divided by glycemia (10 OOI normoglycemic, 13 PD, and 11 T2D. Sural nerves were tested bilaterally with the NC-stat DPNCheck to determine sural nerve amplitude potential (SNAP and sural nerve conduction velocity (SNCV. All other testing results were compared to SNAP and SNCV. Results. Total 1 g monofilament scores significantly correlated with SNAP values and yielded the highest sensitivity and specificity combinations of tested measures. Total QOL-DN scores negatively correlated with SNAP values, as did QOL-DN symptoms. QOL-DN activities of daily living correlated with the right SNAP, and the QOL-DN small fiber subscore correlated with SNCV. Conclusions. The 1 g monofilament and total QOL-DN are effective, low-cost tools for the early detection of DPN in OOI, PD, and T2D adults. The 128 Hz tuning fork and 10 g monofilament may assist DPN screening as a tandem, but not primary, early DPN detection screening tools.

Children have type 2 diabetes too: an historical perspective.

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Dean, Heather J; Sellers, Elizabeth A C

2015-10-01

Prior to 1985, type 2 diabetes was a disease of adults. Simultaneously with the global epidemic of childhood obesity, type 2 diabetes has increased in children. Initially, the presentation of small case series of type 2 diabetes in children was met with skepticism. As the number and size of the case series grew and the first long-term outcomes of end-stage complications in young adults appeared in the literature, the international community took notice with guarded interest. Type 2 diabetes disproportionately affects the children of specific ethnic groups and from disadvantaged socioeconomic environments, especially Indigenous populations. The past decade has seen unprecedented intense global interest in the etiology, treatment, and prevention of type 2 diabetes in children.

Genital Herpes Simplex Virus Type 2 Shedding Among Adults With and Without HIV Infection in Uganda.

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Phipps, Warren; Nakku-Joloba, Edith; Krantz, Elizabeth M; Selke, Stacy; Huang, Meei-Li; Kambugu, Fred; Orem, Jackson; Casper, Corey; Corey, Lawrence; Wald, Anna

2016-02-01

Despite the high prevalence of herpes simplex virus type 2 (HSV-2) in sub-Saharan Africa, the natural history of infection among Africans is not well characterized. We evaluated the frequency of genital HSV shedding in HIV-seropositive and HIV-seronegative men and women in Uganda. Ninety-three HSV-2-seropositive Ugandan adults collected anogenital swab specimens for HSV DNA quantification by polymerase chain reaction 3 times daily for 6 weeks. HSV-2 was detected from 2484 of 11 283 swab specimens collected (22%), with a median quantity of 4.3 log10 HSV copies/mL (range, 2.2-8.9 log10 HSV copies/mL). Genital lesions were reported on 749 of 3875 days (19%), and subclinical HSV shedding was detected from 1480 of 9113 swab specimens (16%) collected on days without lesions. Men had higher rates of total HSV shedding (relative risk [RR], 2.0 [95% confidence interval {CI}, 1.3-2.9]; P genital lesions (RR, 2.1 [95% CI, 1.2-3.4]; P = .005), compared with women. No differences in shedding rates or lesion frequency were observed based on HIV serostatus. HSV-2 shedding frequency and quantity are high among HSV-2-seropositive adults in sub-Saharan Africa, including persons with and those without HIV infection. Shedding rates were particularly high among men, which may contribute to the high prevalence of HSV-2 and early acquisition among African women. © The Author 2015. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

Symptoms of Eating Disorders and Depression in Emerging Adults with Early-Onset, Long-Duration Type 1 Diabetes and Their Association with Metabolic Control.

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Christina Bächle

Full Text Available This study analyzed the prevalence of and association between symptoms of eating disorders and depression in female and male emerging adults with early-onset, long-duration type 1 diabetes and investigated how these symptoms are associated with metabolic control.In a nationwide population-based survey, 211 type 1 diabetes patients aged 18-21 years completed standardized questionnaires, including the SCOFF questionnaire for eating disorder symptoms and the Patient Health Questionnaire (PHQ-9 for symptoms of depression and severity of depressive symptoms (PHQ-9 score. Multiple linear and logistic regression models were used to analyze the association between eating disorder and depressive symptoms and their associations with HbA1c.A total of 30.2% of the women and 9.5% of the men were screening positive for eating disorders. The mean PHQ-9 score (standard deviation was 5.3 (4.4 among women and 3.9 (3.6 among men. Screening positive for an eating disorder was associated with more severe depressive symptoms among women (βwomen 3.8, p<0.001. However, neither eating disorder symptoms nor severity of depressive symptoms were associated with HbA1c among women, while HbA1c increased with the severity of depressive symptoms among men (βmen 0.14, p=0.006.Because of the high prevalence of eating disorder and depressive symptoms, their interrelationship, and their associations with metabolic control, particularly among men, regular mental health screening is recommended for young adults with type 1 diabetes.

Type I diabetes among children and young adults: the role of country of birth, socioeconomic position and sex.

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Hussen, Hozan Ismael; Yang, Dong; Cnattingius, Sven; Moradi, Tahereh

2013-03-01

To investigate associations between country of birth, parental country of birth, and education with respect to incidence rate and time trends of type 1 diabetes mellitus (T1DM) among children and young adults. We followed a nation-wide cohort of 4 469 671 males and 4 231 680 females aged 0-30 years between 1969 and 2008. Incidence rate ratios (IRRs) with 95% confidence intervals (CIs) for T1DM were calculated using Poisson regression models. We further calculated age-standardized rates (ASRs) of T1DM, using the world population as standard. During the study period, the ASR of T1DM increased among children younger than 15 years, but not among young adults (15-30 years). Compared with Swedish-born children, male and female immigrant children had 44 and 42% lower IRR of TIDM, respectively. Among offspring to immigrants, corresponding decreases in IRRs were 27 and 24%, respectively. Compared with children to parents with high education, male children to parents with low education had a 10% decreased IRR of T1DM, while no effect was observed among females. The IRR of T1DM increased with increasing age and calendar time of follow-up in both sexes (p-for trend <0.0001). In young adults, the IRR among immigrants decreased by 32% in males and 22% in females, while corresponding reductions in IRRs were less in offspring to immigrants. We found a lower IRR of T1DM among offspring to immigrants, but especially among young immigrants compared with Sweden-born individuals. The findings show that environmental factors are important in the etiology of T1DM. © 2012 John Wiley & Sons A/S.

Type 1 diabetes, quality of life, occupational status and education level

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Nielsen, Helena B.; Ovesen, Louise L.; Mortensen, Laust H.

2016-01-01

among women, as compared to men. No significant differences were found with regard to working hours. CONCLUSION: Our findings suggest that type 1 diabetes is associated with lower health-related quality of life, higher unemployment and additional sick leave. The negative association with type 1 diabetes......, occupational status (level of employment, working hours and sick leave) and education level. METHODS: 2415 adults (aged 18-98years) with type 1 diabetes were compared to 48,511 adults (aged 18-103years) from the general population. Data were obtained from two cross-sectional surveys conducted in 2010 and 2011...... is more pronounced in women and older adults....

Is the change in body mass index among children newly diagnosed with type 1 diabetes mellitus associated with obesity at transition from pediatric to adult care?

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Manyanga, Taru; Sellers, Elizabeth Ac; Wicklow, Brandy A; Doupe, Malcolm; Fransoo, Randall

2016-12-01

Insulin therapy is lifesaving treatment for individuals with type 1 diabetes (T1D). Its initiation maybe associated with significant weight gain because of change from a catabolic to an anabolic state. Excessive weight-gain increases the risk of obesity and is associated with chronic disease. To examine if change in body mass index (BMI) among children in the 6 months after diagnosis with type 1 diabetes mellitus is associated with long-term obesity. This was a population-based retrospective study of 377 children (aged 2-18 yr) with type 1 diabetes. Measured heights and weights were used to calculate BMI z-scores based on Centers for Disease Control and Prevention (CDC) cut-points. Generalized Linear Models using BMI group, and age group at diagnosis; postdiagnosis weight change; and sex were applied to assess associations between postdiagnosis weight change and BMI z-score at transition to adult care. Mean BMI z-score increased from 0.28 at diagnosis, to 0.53 at 6 months and 0.66 at transition to adult care. Change in BMI z-scores differed by initial BMI group and magnitude of postdiagnosis weight change. Younger children (11 yr) had higher (p = 0.004) BMI z-scores at diagnosis but not at last visit (p = 0.1) than older (≥11 yr) children at diagnosis. BMI z-score at diagnosis, postdiagnosis weight change, female sex, and longer duration with TID were associated with higher BMI z-score at time of transition. BMI z-score at diagnosis was the strongest predictor of BMI z-score at time of transition to adult care, however; its effect was mediated by magnitude of weight change 6 months after diagnosis, sex, and age group at diagnosis. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Latent Fairness in Adults' Relationship-Based Moral Judgments.

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Hao, Jian; Liu, Yanchun; Li, Jiafeng

2015-01-01

Can adults make fair moral judgments when individuals with whom they have different relationships are involved? The present study explored the fairness of adults' relationship-based moral judgments in two respects by performing three experiments involving 999 participants. In Experiment 1, 65 adults were asked to decide whether to harm a specific person to save five strangers in the footbridge and trolley dilemmas in a within-subject design. The lone potential victim was a relative, a best friend, a person they disliked, a criminal or a stranger. Adults' genetic relatedness to, familiarity with and affective relatedness to the lone potential victims varied. The results indicated that adults made different moral judgments involving the lone potential victims with whom they had different relationships. In Experiment 2, 306 adults responded to the footbridge and trolley dilemmas involving five types of lone potential victims in a within-subject design, and the extent to which they were familiar with and affectively related to the lone potential victim was measured. The results generally replicated those of Experiment 1. In addition, for close individuals, adults' moral judgments were less deontological relative to their familiarity with or positive affect toward these individuals. For individuals they were not close to, adults made deontological choices to a larger extent relative to their unfamiliarity with or negative affect toward these individuals. Moreover, for familiar individuals, the extent to which adults made deontological moral judgments more closely approximated the extent to which they were familiar with the individual. The adults' deontological moral judgments involving unfamiliar individuals more closely approximated their affective relatedness to the individuals. In Experiment 3, 628 adults were asked to make moral judgments with the type of lone potential victim as the between-subject variable. The results generally replicated those of the previous

Adult neuronal ceroid-lipofuscinosis.

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Goebel, H H; Braak, H

1989-01-01

Among the different clinical forms of neuronal ceroid-lipofuscinosis (NCL), the adult type is the least frequent, most sporadic and most difficult one to diagnose. Clinical symptomatology differs from the classical childhood NCL forms in that ocular symptoms are absent while changes of behavior, dementia and seizures dominate the clinical picture. Excessive accumulation of NCL-specific lipopigments has largely been explored in the nervous system, where pigmento-architectonic investigations disclose layer-specific cortical pathology similar to but less pronounced than that of juvenile and protracted juvenile NCL. Ultrastructural analysis of lipopigments in adult NCL reveals diversity of lipopigment fine structure, but less impressive than in the childhood forms of NCL. Abnormal accretion of lipopigments outside the nervous system has rarely been demonstrated and requires ampler documentation, making in vivo diagnosis of adult NCL often difficult and sometimes equivocal. Adult NCL is now frequently considered identical to "Kufs' disease". However, in the past, the latter term has comprised a heterogeneous spectrum of lipidoses the NCL-nature of which had not been unequivocally established. Thus, one may either speak of "Kufs' syndrome" or abandon this term altogether. Although patients afflicted with adult NCL may suffer from Kufs' disease, not all who have and had Kufs disease may have or have had adult NCL. The current debate on adult NCL centers around scepticism concerning many of the earlier reports, on incorporating diagnostic studies of non-CNS organs in presumptive patients and on distinguishing adult NCL from "atypical" patients or forms of NCL, as well as other disorders marked by non-specific abnormal accumulation of lipofuscin.

Adiposity Impacts Intrarenal Hemodynamic Function in Adults With Long-standing Type 1 Diabetes With and Without Diabetic Nephropathy: Results From the Canadian Study of Longevity in Type 1 Diabetes.

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Bjornstad, Petter; Lovshin, Julie A; Lytvyn, Yuliya; Boulet, Genevieve; Lovblom, Leif E; Alhuzaim, Omar N; Farooqi, Mohammed A; Lai, Vesta; Tse, Josephine; Cham, Leslie; Orszag, Andrej; Scarr, Daniel; Weisman, Alanna; Keenan, Hillary A; Brent, Michael H; Paul, Narinder; Bril, Vera; Perkins, Bruce A; Cherney, David Z I

2018-04-01

Central adiposity is considered to be an important cardiorenal risk factor in the general population and in type 1 diabetes. We sought to determine the relationship between central adiposity and intrarenal hemodynamic function in adults with long-standing type 1 diabetes with and without diabetic nephropathy (DN). Patients with type 1 diabetes ( n = 66, duration ≥50 years) and age-/sex-matched control subjects ( n = 73) were studied. The cohort was stratified into 44 DN Resistors (estimated glomerular filtration rate [eGFR] >60 mL/min/1.73 m 2 and inulin [GFR INULIN ], effective renal plasma flow for p -aminohippuric acid [ERPF PAH ]) was measured. Afferent arteriolar resistance, efferent arteriolar resistance, renal blood flow, renal vascular resistance [RVR], filtration fraction, and glomerular pressure were derived from the Gomez equations. Fat and lean mass were quantified by DXA. Whereas measures of adiposity did not associate with GFR INULIN or ERPF PAH in healthy control subjects, trunk fat mass inversely correlated with GFR INULIN ( r = -0.46, P INULIN values in DN and DN Resistors, but the relationships between central adiposity and ERPF PAH and RVR were attenuated and/or reversed in patients with DN compared with DN Resistors. The adiposity-intrarenal hemodynamic function relationship may be modified by the presence of type 1 diabetes and DN, requiring further study of the mechanisms by which adiposity influences renal hemodynamic function. © 2018 by the American Diabetes Association.

A tailored intervention to promote uptake of retinal screening among young adults with type 2 diabetes - an intervention mapping approach.

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Lake, Amelia J; Browne, Jessica L; Abraham, Charles; Tumino, Dee; Hines, Carolyn; Rees, Gwyneth; Speight, Jane

2018-05-31

Young adults (18-39 years) with type 2 diabetes are at risk of early development and rapid progression of diabetic retinopathy, a leading cause of vision loss and blindness in working-age adults. Retinal screening is key to the early detection of diabetic retinopathy, with risk of vision loss significantly reduced by timely treatment thereafter. Despite this, retinal screening rates are low among this at-risk group. The objective of this study was to develop a theoretically-grounded, evidence-based retinal screening promotion leaflet, tailored to young adults with type 2 diabetes. Utilising the six steps of Intervention Mapping, our multidisciplinary planning team conducted a mixed-methods needs assessment (Step 1); identified modifiable behavioural determinants of screening behaviour and constructed a matrix of change objectives (Step 2); designed, reviewed and debriefed leaflet content with stakeholders (Steps 3 and 4); and developed program implementation and evaluation plans (Steps 5 and 6). Step 1 included in-depth qualitative interviews (N = 10) and an online survey that recruited a nationally-representative sample (N = 227), both informed by literature review. The needs assessment highlighted the crucial roles of knowledge (about diabetic retinopathy and screening), perception of personal risk, awareness of the approval of significant others and engagement with healthcare team, on retinal screening intentions and uptake. In Step 2, we selected five modifiable behavioural determinants to be targeted: knowledge, attitudes, normative beliefs, intention, and behavioural skills. In Steps 3 and 4, the "Who is looking after your eyes?" leaflet was developed, containing persuasive messages targeting each determinant and utilising engaging, cohort-appropriate imagery. In Steps 5 and 6, we planned Statewide implementation and designed a randomised controlled trial to evaluate the leaflet. This research provides an example of a systematic, evidence

Diabetes-Related Distress, Depression and Distress-Depression among Adults with Type 2 Diabetes Mellitus in Malaysia.

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Chew, Boon-How; Vos, Rimke; Mohd-Sidik, Sherina; Rutten, Guy E H M

2016-01-01

Type 2 diabetes mellitus (T2DM) brings about an increasing psychosocial problem in adult patients. Prevalence data on and associated factors of diabetes related distress (DRD) and depression have been lacking in Asia. This study aimed to examine the prevalence of DRD and depression, and their associated factors in Asian adult T2DM patients. This study was conducted in three public health clinics measuring DRD (Diabetes Distress Scale, DDS), and depression (Patient Health Questionnaire, PHQ). Patients who were at least 30 years of age, had T2DM for more than one year, with regular follow-up and recent laboratory results (depression and the combination DRD-depression with demographic and clinical characteristics were analysed using generalized linear models. From 752 invited people, 700 participated (mean age 56.9 years, 52.8% female, 52.9% Malay, 79.1% married). Prevalence of DRD and depression were 49.2% and 41.7%, respectively. Distress and depression were correlated, spearman's r = 0.50. Patients with higher DRD were younger (OR 0.995, 95% CI 0.996 to 0.991), Chinese (OR 1.2, 95% CI 1.04 to 1.29), attending Dengkil health clinic (OR 1.1, 95% CI 1.00 to 1.22) and had higher scores on the PHQ (OR 1.1, 95% CI 1.04 to 1.06). Depression was less likely in the unmarried compared to divorced/separately living and those attending Dengkil health clinic, but more likely in patients with microvascular complications (OR 1.4, 95% CI 1.06 to 1.73) and higher DDS (OR 1.03, 95% CI 1.02 to 1.03). For the combination of DRD and depression, unemployment (OR 4.7, 95% CI 1.02 to 21.20) had positive association, whereas those under medical care at the Salak health clinics (OR 0.28, 95% CI 0.12 to 0.63), and those with a blood pressure > 130/80 mmHg (OR 0.53, 95% CI 0.32 to 0.89) were less likely to experience both DRD and depression. DRD and depression were common and correlated in Asian adults with T2DM at primary care level. Socio-demographic more than clinical characteristics were

Perceptions of the Healthfulness of Foods of New Zealand Adults Living With Prediabetes and Type 2 Diabetes: A Pilot Study.