High Rates Of Type Research Articles

Body mass index, waist circumference and HOMA-IR correlate with the Psoriasis Area and Severity Index in patients with psoriasis receiving phototherapy

Funding sources: This work was funded by an unrestricted research grant from Merck Serono Ltd and Abbott Laboratories Ltd and the Postgraduate Medical and Dental Board of Ireland. Conflicts of interest: none declared. Dear Editor, An increased incidence of obesity in patients with psoriasis has been documented in cross‐sectional studies of large healthcare databases and case–control studies.1 2 3 4 5 6 7 Obesity, and in particular centripetal obesity, confers a risk of developing insulin resistance and type 2 diabetes, which in turn increases the risk of cardiovascular disease. Since 1978 it has been known that patients with psoriasis have higher rates of type 2 diabetes and cardiovascular disease and it is likely that this is driven by obesity and concomitant insulin resistance. We undertook a study to establish the effect of body mass index (BMI), abdominal obesity and insulin resistance on psoriasis severity and Framingham risk. Following ethical approval, consecutive patients with psoriasis, aged ≥ 18 years, were recruited prior to commencing phototherapy or photochemotherapy (TL‐01 or psoralen plus ultraviolet A) between October 2008 and July 2011. Patients had a full physical examination and the Psoriasis Area and Severity Index (PASI) score was recorded. Height, weight and waist circumference were measured for each patient. The BMI was calculated using the formula: weight in kg/(height in m)2. Obesity was defined as a BMI > 30, overweight as BMI 25–30 and lean as a BMI < 25 according to the World Health Organization definition of obesity. Systolic blood pressure was measured using a sphygmomanometer on the left brachial artery. Fasting blood samples were taken for the measurement of insulin, glucose and serum cholesterol. Insulin resistance was measured using the homeostasis model with the formula: insulin × glucose/22·5 (HOMA‐IR, homeostatic model assessment–insulin resistance). Framingham risk was calculated using MedCalc® (MedCalc Software, Ostend, Belgium). Results were analysed using GraphPad Prism (GraphPad Software Inc., La Jolla, CA, U.S.A.), using Student's t‐test, anova and Pearson's rank correlation.

In endovascular aneurysm repair cases, when should you consider internal iliac artery embolization when extending a stent into the external iliac artery?: Table 1:

A best evidence topic was constructed according to a structured protocol. The question addressed was whether internal iliac artery (IIA) embolization is necessary for achieving the best clinical outcome in all patients when extension of the stent graft to the external iliac artery is required. Altogether more than 400 papers were found using the reported search, of which 5 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. There is a significant gap in the current literature regarding the subset of patients that may benefit from an IIA embolization during endovascular aneurysm repair (EVAR) as indications have not been clearly defined. There are several situations concerning a small number of patients, that IIA embolization might be beneficial in preventing endoleak not only to the common iliac artery but also to the aortic aneurysmal sac. For the majority of patients requiring extension of the stent graft to the external iliac artery, the current evidence, even retrospective in nature and reporting on small numbers of patients, shows that IIA embolization seems to be associated with worse clinical outcome, mostly raising the risk for new-onset buttock claudication. It seems that not all patients require embolization, as IIA coverage solely by the stent graft was not associated with a significant higher rate of type II endoleak in either study. Furthermore, coil embolization in the largest study so far was associated with higher procedure and fluoroscopy time and amount of contrast media, facts that should not be neglected. However the above-mentioned results should be taken into account with caution, as all studies were retrospective and reported on small number of patients.

Trebling in use of insulin reflects higher rates of type 2 diabetes and longer survival

Trebling in use of insulin reflects higher rates of type 2 diabetes and longer survival

Epstein–Barr virus present in T cells or B cells shows differential effects on hemophagocytic symptoms associated with outcome in T-cell lymphomas

Non-specific peripheral (PTCL-NOS) and angioimmunoblastic T-cell lymphoma (AITL) frequently show Epstein–Barr virus (EBV) expression in lymphoma or bystander B cells. However, whether EBV localization affects clinicopathologic features is unclear. We correlated EBV localization with clinicopathologic findings in PTCL-NOS (n = 63) and AITL (n = 26). PTCL-NOS showed EBV+ in 41%, with 22% in lymphoma T cells (T-EBV) and 19% in bystander B cells (B-EBV), and more EBV+ cells in T-EBV cases (39.3% vs. 11.8%, p = 0.003). Compared to B-EBV cases, T-EBV PTCL-NOS had higher rates of type II EBV latency (p = 0.003), leukopenia (p = 0.020) and hemophagocytosis (p = 0.061), which predicted a poor outcome (p < 0.001). In contrast, 88% of AITLs were EBV+, exclusively in B cells. EBV+ cases showed lower rates of hemophagocytosis (p = 0.006), but this was insignificant for prognosis. Therefore, hemophagocytic symptoms in PTCL-NOS are much more tightly associated with T-EBV and carry poor prognoses. In contrast, hemophagocytosis in AITL is correlated with EBV−, but is not significant for outcome.

AHA: Severe Obesity in US Youth Is Increasing and Difficult to Treat

Although US childhood obesity rates overall have been flat over the past several years, the prevalence of severe obesity has increased. An estimated 4% to 6% of all US youths are severely obese, and there�s evidence that they have a �much more adverse cardiometabolic risk profile� than their overweight and obese counterparts, according to an American Heart Association scientific statement. The statement defines children older than 2 years as severely obese if they have a body mass index (BMI) that is at least 20% higher than the 95th percentile for their sex and age or a BMI of 35 or higher. Severely obese children have higher rates of type 2 diabetes than children with lower BMIs, and they also demonstrate early signs of vascular dysfunction and subclinical atherosclerosis (Kelly AS et al. Circulation. doi:10.1161/CIR.0b013e3182a5cfb3 [published online September 9, 2013]).

Childhood and Adult Secondhand Smoke and Type 2 Diabetes in Women

OBJECTIVEThe objective of this study was to evaluate the relationship between childhood and adult secondhand smoke and type 2 diabetes.RESEARCH DESIGN AND METHODSWe conducted a prospective cohort study among 37,343 French women from the E3N-EPIC (Etude Epidémiologique auprès des femmes de la Mutuelle Générale de l’Education Nationale-European Prospective Investigation into Cancer and Nutrition) who never smoked and who were free of type 2 diabetes, cancer, or cardiovascular disease at baseline in 1992. Self-reported childhood secondhand smoke exposure was defined as having at least one parent who smoked. Adult secondhand smoke was defined as the sum of self-reported hours recorded at baseline of exposure to tobacco smoke from a spouse who smoked (or domestic close contact) and from outside the home.RESULTSBetween 1992 and 2007, 795 cases of incident type 2 diabetes were identified and validated through a drug reimbursement dataset and a specific questionnaire. Women with at least one parent who smoked appeared to have an 18% higher rate of type 2 diabetes than women with parents who did not smoke (age-adjusted hazard ratio 1.18 [95% CI 1.02–1.36]). Adult secondhand smoke exposure (no exposure versus ≥4 h/day) was associated with an increased rate of type 2 diabetes (1.36 [1.05–1.77], P = 0.002 for trend) after adjusting for parental history of diabetes, education, body silhouette at age 8, childhood secondhand smoke exposure, physical activity, body mass index, hypertension, hypercholesterolemia, menopausal status and hormone use, alcohol intake, and processed red meat and coffee consumption.CONCLUSIONSThis prospective analysis suggests that secondhand smoke exposure in childhood and adulthood are associated with a higher rate of type 2 diabetes.

Clinical and angiographic features associated with coronary collateralization in stable angina patients with chronic total occlusion

Coronary collateral circulation is an alternative source of blood supply to myocardium in the presence of advanced coronary artery disease. We sought to determine which clinical and angiographic variables are associated with collateral development in patients with stable angina and chronic total coronary occlusion. Demographic variables, biochemical measurements, and angiographic findings were collected from 478 patients with stable angina and chronic total coronary occlusion. The presence and extent of collaterals supplying the distal aspect of a total coronary occlusion from the contra-lateral vessel were graded from 0 to 3 according to the Rentrop scoring system. Low (Rentrop score of 0 or 1) and high (Rentrop score of 2 or 3) coronary collateralizations were detected in 186 and 292 patients, respectively. Despite similar age, cigarette smoking, and medical treatment, patients with low collateralization were female in a higher proportion and less hypertensive, and had higher rates of type 2 diabetes and dyslipidemia than those with high collateralization (for all comparisons, P<0.05). In addition, patients with low collateralization exhibited more single-vessel disease, less right coronary artery occlusion, more impaired renal function, and higher serum levels of high-sensitivity C-reactive protein (hsCRP) compared with those with high collateralization. Multivariate analysis revealed that age of ≥65 years, female gender, diabetes, no history of hypertension, dyslipidemia, moderate to severe renal dysfunction, single-vessel disease, and elevated hsCRP levels were independently associated with low coronary collateralization. Coronary collateralization was reduced in almost 40% of stable angina patients with chronic total occlusion, which was related to clinical and angiographic factors. The impact of coronary collateralization on outcomes after revascularization needs further investigation.

UK has fifth highest rate of type 1 diabetes in children, new figures show

UK has fifth highest rate of type 1 diabetes in children, new figures show

Rationale and design of South Asian Birth Cohort (START): a Canada-India collaborative study

BackgroundPeople who originate from the Indian subcontinent (South Asians) suffer among the highest rates of type 2 diabetes in the world. Prior evidence suggests that metabolic risk factors develop early in life and are influenced by maternal and paternal behaviors, the intrauterine environment, and genetic factors. The South Asian Birth Cohort Study (START) will investigate the environmental and genetic basis of adiposity among 750 South Asian offspring recruited from highly divergent environments, namely, rural and urban India and urban Canada.MethodsDetailed information on health behaviors including diet and physical activity, and blood samples for metabolic parameters and DNA are collected from pregnant women of South Asian ancestry who are free of significant chronic disease. They also undergo a provocative test to diagnose impaired glucose tolerance and gestational diabetes. At delivery, cord blood and newborn anthropometric indices (i.e. birth weight, length, head circumference and skin fold thickness) are collected. The mother and growing offspring are followed prospectively and information on the growth trajectory, adiposity and health behaviors will be collected annually up to age 3 years. Our aim is to recruit a minimum of 750 mother-infant pairs equally divided between three divergent environments: rural India, urban India, and Canada.SummaryThe START cohort will increase our understanding of the environmental and genetic determinants of adiposity and related metabolic abnormalities among South Asians living in India and Canada.

Diabetes Resolution Following Discontinuation of a Second-Generation Antipsychotic

Introduction Schizophrenia patients have higher rates of type 2 diabetes mellitus (T2DM) than population comparisons and, in conjunction with highly prevalent obesity and cardiovascular disease, this translates into a 20% reduced life expectancy (1). Unfortunately, despite arguably better outcomes in several psychiatric domains including symptoms, cognition and quality of life, the mortality gap for patients is not narrowing but may indeed be widening (2). Preferential use of second-generation antipsychotics (SGAs) as opposed to older (first-generation antipsychotics, FGAs) antipsychotics may account for the widening mortality gap (3). This is because research has confirmed a link between SGA use and development of T2DM and other metabolic complications (1). Conversely, very little evidence has accumulated that would support a connection between discontinuation of SGAs and diabetes resolution, although implications in the prevailing context would be important. Here, we describe three cases of diabetes onset with SGA treatment and confirmed resolution after switch to an FGA.

Coping with Sugar: Experiences of South Asian Diabetes Patients Living in Melbourne, Australia.

A higher rate of type 2 diabetes (T2D) among South Asian diaspora may be attributed to visceral adiposity, insulin resistance, a Westernized lifestyle including a reduction of physical activity. The Indian ethnic group in Australia had been identified as “at especially high risk” by the Victorian Government in its 2007-2010 Victorian Strategic Framework for Diabetes. And yet not much is known about the health behaviours of these groups in Australia.

Cardiometabolic Aspects of the Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder amongst women of reproductive age and is associated with various metabolic perturbations, in addition to chronic anovulation and factors related to androgen excess. In general, women live longer than men and develop cardiovascular disease at an older age. However, women with PCOS, as compared with age- and body mass index-matched women without the syndrome, appear to have a higher risk of insulin resistance, hyperinsulinemia, glucose intolerance, dyslipidemia, and an increased prothrombotic state, possibly resulting in a higher rate of type 2 diabetes mellitus, fatty liver disease, subclinical atherosclerosis, vascular dysfunction, and finally cardiovascular disease and mortality. Further alterations in PCOS include an increased prevalence of sleep apnea, as well as various changes in the secretion and/or function of adipokines, adipose tissue-derived proinflammatory factors and gut hormones, all of them with direct or indirect influences on the complex signaling network that regulates metabolism, insulin sensitivity, and energy homeostasis. Reviews on the cardiometabolic aspects of PCOS are rare, and our knowledge from recent studies is expanding rapidly. Therefore, it is the aim of the present review to discuss and to summarize the current knowledge, focusing on the alterations of cardiometabolic factors in women with PCOS. Further insight into this network of factors may facilitate finding therapeutic targets that should ameliorate not only ovarian dysfunction but also the various cardiometabolic alterations related to the syndrome.

Abstract MP084: Childhood and Adult Environmental Tobacco Smoke and Risk of Incident Type 2 Diabetes Among Never-smoking French Women

Background There is consistent evidence of a direct relation between active smoking and type 2 diabetes. However, prior studies on passive smoking (or secondhand smoke) and type 2 diabetes have often been limited by insufficiently detailed information on both childhood and adult environmental tobacco smoke exposure. Methods and Results We evaluated childhood and adult environmental tobacco exposure (ETS) in relation to incident type 2 diabetes in a prospective cohort study among 37,343 never-smoker women from the E3N-EPIC cohort, who were free of diabetes, cancer or cardiovascular disease at baseline in 1992. Self-reported childhood ETS was defined as having at least one parent who smoked (59 % of women). Adult ETS exposure was defined as the sum of self-reported hours of exposure to tobacco from a smoking spouse (or domestic close contact) and exposure to ETS outside the home, recorded at baseline. Between 1992 and 2007, 795 cases of incident diabetes were identified and validated using a drug reimbursement dataset and a specifically designed supplementary questionnaire. Adjusting for family history of diabetes, education and body silhouette at age 18 women with at least one smoking parent had an 18 % higher rate of diabetes compared to women with nonsmoking parents [HR=1.18 (95%CI 1.02-1.86)]. After additional adjustment for physical activity, BMI, parental smoking, treated hypertension and hypercholesterolemia, menopausal status and menopausal hormone use the multivariate HRs (95%CI) for adult ETS exposure relative to no exposure were 1.08 (0.92, 1.27) for &lt; 1 hours/day, 1.06 (0.77, 1.46) for 1 to 1.9 hours/day, 1.34 (1.00, 1.82) for 2 to 3.9 hours/day and 1.44 (1.11, 1.86) for ≥ 4 hours/ day with p for trend 0.003. Conclusion Childhood and adult ETS exposure may be associated to a higher rate of type 2 diabetes. These results further emphasize the health risks of past and current tobacco smoke exposure.

Perfil serológico en gestantes extranjeras frente a VIH, VHB, VHC, virus de la rubéola, Toxoplasma gondii, Treponema pallidum, y Trypanosoma cruzi

The increase in immigration is changing the prevalence of mother to child infectious diseases. Our aim is to determine the serological profile of foreign pregnant women against these infections. A retrospective cross sectional study was performed in a tertiary hospital from Madrid between August 2007 and October 2008. The seroprevalence against HIV, HBV, HCV, rubeola, T. gondii, T. pallidum and T. cruzi was determined in every pregnant immigrant, as well as in a representative group of Spanish pregnant women. A total of 2526 immigrant and 157 Spanish pregnant women were studied. None of the Spanish and 0.5% of the foreigners showed antibodies against HIV; 18.9% of them were Sub-Saharan women. Antigen HBs was detected in 2% of the immigrant women and in 1.1% of the Spanish women. Asian women had the highest rate of type B Hepatitis (10.9%). There was 0.9% of type C Hepatitis among the immigrants and 1% among the Spanish. Within the cases with RPR ≥ 1/8, 1.6% were immigrants, most of whom were Latin American. Thirty-one per cent of the immigrants showed antibodies against T. gondii (37.5% from Central America, 2.5% from the Far East). More than 95% of the Spanish women had antibodies against Rubella, this being lower in the rest of the areas (75.5% in Sub-Saharan Africa). T. cruzi infection was detected in 12.1% of the Bolivian women studied. The prevalence of mother-to-child transmitted infections depends on the origin of pregnant women. Knowledge of these differences may lead to improved control these diseases.

A World of Difference: Unraveling the Conversations African American Mothers Have with Their Adult Daughters to Negotiate Diabetes

Of the 15.7 million people with diabetes in the United States, more than half are women and minority women account for the highest rates of type II diabetes. Medical literature offers a comprehensive biomedical overview of diabetes yet communication scholars have yet to unravel this health disparity, particularly as it relates to black women. The goal of this article is to understand conversations that transpire between type II diabetic mothers and their adult daughter. The conversations held by these dyads can inform the meaning mothers give to their illness. A socio-ecological model was used as the theoretical framework to explain the multi-layered aspect of communicative health behavior. Emergent themes highlight conversations about the familial dynamics, mothers' experiences living with diabetes, and prevention for daughters. This research has extensive value for understanding the role of talk in negotiating a chronic illness and is particularly useful as a cultural snapshot for practitioners who provide information on self-care and prevention to black populations.

Challenges to the provision of diabetes care in first nations communities: results from a national survey of healthcare providers in Canada

BackgroundAboriginal peoples globally, and First Nations peoples in Canada particularly, suffer from high rates of type 2 diabetes and related complications compared with the general population. Research into the unique barriers faced by healthcare providers working in on-reserve First Nations communities is essential for developing effective quality improvement strategies.MethodsIn Phase I of this two-phased study, semi-structured interviews and focus groups were held with 24 healthcare providers in the Sioux Lookout Zone in north-western Ontario. A follow-up survey was conducted in Phase II as part of a larger project, the Canadian First Nations Diabetes Clinical Management and Epidemiologic (CIRCLE) study. The survey was completed with 244 healthcare providers in 19 First Nations communities in 7 Canadian provinces, representing three isolation levels (isolated, semi-isolated, non-isolated). Interviews, focus groups and survey questions all related to barriers to providing optimal diabetes care in First Nations communities.Resultsthe key factors emerging from interviews and focus group discussions were at the patient, provider, and systemic level. Survey results indicated that, across three isolation levels, healthcare providers' perceived patient factors as having the largest impact on diabetes care. However, physicians and nurses were more likely to rank patient factors as having a large impact on care than community health representatives (CHRs) and physicians were significantly less likely to rank patient-provider communication as having a large impact than CHRs.ConclusionsAddressing patient factors was considered the highest impact strategy for improving diabetes care. While this may reflect "patient blaming," it also suggests that self-management strategies may be well-suited for this context. Program planning should focus on training programs for CHRs, who provide a unique link between patients and clinical services. Research incorporating patient perspectives is needed to complete this picture and inform quality improvement initiatives.

Safety of antipsychotics in people with intellectual disability

Despite frequent use, little is known about the metabolic and endocrine side-effects of antipsychotics in individuals with intellectual disability. To compare indices of obesity, glucose, lipids and prolactin between antipsychotic-treated and antipsychotic-naive individuals with intellectual disability and also between participants with intellectual disability and controls from the general population. Observational study comparing 138 antipsychotic-treated and 64 antipsychotic-naive participants with intellectual disability in one National Health Service trust with general population controls. Antipsychotic treatment comprised: risperidone 48%,olanzapine 18%, thioxanthenes 10%, other 24%; monotherapy 95% of participants; mean treatment duration 8 years;median daily chlorpromazine equivalent dose 108 mg(range 16–667). Metabolic indices were the same or more favourable in the intellectual disability group than the general population control group but overweight/obesity and type 2 diabetes were more prevalent in the women in the intellectual disability group than the control group. Metabolic indices were similar, statistically or clinically, between the antipsychotic-treated and the antipsychotic-naive groups but there was a non-significant trend towards a higher rate of type 2 diabetes in the antipsychotic group. A total of 100%and 70% of participants on amisulpride/sulpiride and risperidone respectively had hyperprolactinaemia, with secondary hypogonadism in 77% and 4% of affected women and men. Antipsychotics, on average, did not increase metabolic risk,although the existence of a susceptible subgroup at risk of diabetes cannot be excluded. Some antipsychotics induced hyperprolactinaemic hypogonadism, requiring active management. However, our findings suggest that antipsychotics at the low doses routinely prescribed for people with intellectual disability are generally safe in relation to metabolic adverse effects, even if efficacy remains poorly defined.

An evaluation of the effect of recent temperature variability on the prediction of coral bleaching events

Over the past 30 years, warm thermal disturbances have become commonplace on coral reefs worldwide. These periods of anomalous sea surface temperature (SST) can lead to coral bleaching, a breakdown of the symbiosis between the host coral and symbiotic dinoflagellates which reside in coral tissue. The onset of bleaching is typically predicted to occur when the SST exceeds a local climatological maximum by 1 degrees C for a month or more. However, recent evidence suggests that the threshold at which bleaching occurs may depend on thermal history. This study uses global SST data sets (HadISST and NOAA AVHRR) and mass coral bleaching reports (from Reefbase) to examine the effect of historical SST variability on the accuracy of bleaching prediction. Two variability-based bleaching prediction methods are developed from global analysis of seasonal and interannual SST variability. The first method employs a local bleaching threshold derived from the historical variability in maximum annual SST to account for spatial variability in past thermal disturbance frequency. The second method uses a different formula to estimate the local climatological maximum to account for the low seasonality of SST in the tropics. The new prediction methods are tested against the common globally fixed threshold method using the observed bleaching reports. The results find that estimating the bleaching threshold from local historical SST variability delivers the highest predictive power, but also a higher rate of Type I errors. The second method has the lowest predictive power globally, though regional analysis suggests that it may be applicable in equatorial regions. The historical data analysis suggests that the bleaching threshold may have appeared to be constant globally because the magnitude of interannual variability in maximum SST is similar for many of the world's coral reef ecosystems. For example, the results show that a SST anomaly of 1 degrees C is equivalent to 1.73-2.94 standard deviations of the maximum monthly SST for two-thirds of the world's coral reefs. Coral reefs in the few regions that experience anomalously high interannual SST variability like the equatorial Pacific could prove critical to understanding how coral communities acclimate or adapt to frequent and/or severe thermal disturbances.

Does vitamin D deficiency contribute to increased rates of cardiovascular disease and type 2 diabetes in African Americans?

African Americans have higher rates of type 2 diabetes (T2D) and some forms of cardiovascular disease (CVD) than do European Americans. African Americans also have much higher rates of vitamin D deficiency. There is emerging evidence that vitamin D deficiency may be a risk factor for hypertension, T2D, and CVD, but the extent to which racial disparities in disease rates are explained by racial differences in vitamin D status is uncertain. Despite a large number of observational studies and a limited number of clinical trials that examined 25-hydroxyvitamin D [25(OH)D] concentrations as a potential determinant of CVD and T2D or its precursors, it remains uncertain whether improving vitamin D status would reduce risk of these conditions in the general US population or in African Americans specifically. However, if the associations reported from the observational studies are of the estimated magnitudes and causal, vitamin D supplementation could potentially have a strong preventive effect on some of these conditions and could reduce race-related disparities in their prevalence. Because of the low 25(OH)D concentrations of many, if not most, African Americans, and the low risk associated with vitamin D supplementation, it is important to obtain more definitive answers to these questions.

Identifying changes in diabetes care

AbstractMalta is a small Mediterranean island with particularly distinct population and culture. It also has one of the highest rates of type 2 diabetes in the world. As a result it provides a unique microcosm of problems in diabetes care common across Europe. This study explores the effects of culture, religion and government organisation on the management of patients with diabetes.The cultures of patients, health care professionals and the Maltese government were examined in terms of their influence on the potential to deliver culturally relevant competent care.The results of this research indicate that national culture and local practices may have a detrimental influence on the management of diabetes in Malta. The findings highlight the need for change if effective diabetes care is to be offered to the Maltese population. These changes are related to a highly complex, poorly understood health care system, and to the way in which it is structured and the way health care processes are managed in this highly specific national and ethnic culture. Copyright © 2011 John Wiley &amp; Sons.