Self-reported prevalence of diabetes and preventive health care practices among people with diabetes in South Carolina

As a result of the neuropathologic process of Alzheimer's disease (AD), significant changes occur in neuromotor function (e.g., paratonia and compulsive grasping). These changes become manifest in the moderately severe stage of AD, when patients begin to require ongoing assistance with activities of daily life (ADL), and they are prominent in the severe stage of AD, when patients are continuously dependent on a caregiver. Patients in these stages often display behavioral disturbances during care activities. These disturbing behaviors result not only from cognitive impairment, but also from a patient's physical inability to cooperate with the caregiver. When care management strategies take into account the characteristic physical restrictions resulting from the neuromotor changes that accompany advanced AD, the caregiving process may be significantly facilitated.     

Diminished insulin clearance during late pregnancy in patients with type I diabetes mellitus

OBJECTIVE: Published data on bone metabolism in diabetes mellitus are conflicting. We have measured pyridinium crosslinks, biochemical markers of bone resorption, in order to evaluate bone resorption in diabetes mellitus. We also wished to investigate whether, as a consequence of chronic hyperglycaemia, pyridinoline is glycosylated to a greater extent in patients with diabetes mellitus. DESIGN AND PATIENTS: This cross sectional study included 142 patients (64 males, 78 females) with insulin dependent and non-insulin dependent diabetes mellitus (IDDM and NIDDM). These patients were compared to a healthy control group of 99 individuals (39 males and 60 females). MEASUREMENTS: Pyridinium crosslinks, glycosylated, free and total pyridinoline (gPYD, fPYD, tPYD) and free and total deoxypridinoline (fDPD, tDPD) were measured in a spot urine sample by high performance liquid chromatography (HPLC). Urinary creatinine, albumin and glucose were also measured. RESULTS: In the diabetic group, values of urinary gPYD and tDYD were significantly lower than in controls. gPYD excretion was lowest in patients with severe glycosuria. Free pyridinium crosslinks, both fPYD and fDPD, were excreted to a significantly lower extent. The molar ratio of tPYD to tDPD was significantly increased in diabetes mellitus. CONCLUSIONS: Decreased excretion of tDPD suggests low bone resorption in IDDM and NIDDM. Pyridinoline is not glycosylated to a greater extent in diabetes mellitus and tends to be decreased in proportion to the degree of glycosuria. Excretion of gPYD, fPYD and fDPD is depressed in severe glycosuria. Diminshed degradation to the final products, fPYD and fDPD, might represent increased resistance to enzymatic activity or diminished enzymatic activity. The increased molar ratio tPYD/tDPD in urine suggests an increased ratio in bone collagen in diabetes mellitus.     

Client compliance with homework directives during counseling.

Investigated compliance with homework directives in counseling in 61 clients (aged 21+ yrs), with the cooperation of 18 post-master's degree counselors in a community counseling agency for adults. Compliance was examined as a function of counselor variables, client variables, and therapy variables, using rankings of counselor ability and skills, a rating of cases, and data on homework assignments. Neither counselor ability nor specific counseling skills were related to client compliance. Initial severity of client problems was related to outcome but not to compliance. Clients who remained in counseling had better compliance than those who terminated early. Whether clients presented career or personal/emotional problems was unrelated to compliance. Therapy variables that predicted compliance included assignments given early in counseling, a history of compliance, and whether counselors checked their client's attitude about homework and did not stress their own status. It is suggested that variables associated with the conduct of counseling more strongly influence compliance with homework than do either counselor or client variables. (37 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of mother-father perceptions of their child's self-management of diabetes

This study compared mothers' and fathers' perceptions of their children's self-management of diabetes. Participants included a subsample of 29 paired parents of children and youth with diabetes, ages 8-14, who attended a diabetes camp in the Midwest. Parents completed a self-report structured questionnaire that included content specific to self-management. Results showed high ratings for child responsibility for self-management, style of care delivery, and mother-father self-efficacy in managing specific tasks of diabetes self-management. Although overall ratings were similar, in the majority of measures mothers' ratings were higher than fathers' ratings. Areas of similarity and significant differences in perceptions are identified with implications for practice stated.     

Central diabetes insipidus: a complication of ventriculoperitoneal shunt malfunction during pregnancy

During pregnancy ventriculoperitoneal shunts have reported complication rates of 30% to 60%. In this case a functionally occluded shunt resulted in prolonged increased intracranial pressure, pituitary stalk damage, and permanent central diabetes insipidus. This complication of ventriculoperitoneal shunt occlusion during pregnancy has not been previously reported.     

Autoimmune thyroid disease and insulin-dependent diabetes mellitus during pregnancy and post partum

The in-vitro antimicrobial activity of HSR-903, a new fluoroquinolone, was tested against 51 clinical Neisseria gonorrhoeae isolates in comparison with ciprofloxacin, levofloxacin and sparfloxacin. The MICs of HSR-903 for 11 isolates with alterations in both GyrA and ParC, for 19 isolates with alterations only in GyrA and for 21 isolates without alterations in either GyrA or ParC ranged from 0.03 mg/L to 1.0 mg/L (MIC90 = 0.25 mg/L), from 0.03 mg/L to 0.5 mg/L (MIC90 = 0.125 mg/L) and from < or = 0.001 mg/L to 0.008 mg/L (MIC90 = 0.004 mg/L), respectively. Levofloxacin and ciprofloxacin were the least active of the four quinolones tested, particularly against the mutant strains. Sparfloxacin was more active, but HSR-903 exhibited the most potent in-vitro activity against the clinical N. gonorrhoeae isolates, including those harbouring quinolone-resistance-associated alterations in GyrA and ParC.     

Treating arousals during sleep using behavioral self-management.

Found that self-management training was associated with increased sleep efficiency, reduced number of arousals and minutes awake after sleep onset during the 1st 3rd of the night, reported improvements in the sleep quality, and less daytime sleepiness for a 58-yr-old female S. These effects were documented using laboratory and home sleep recordings and self-reports over a 5-yr period. The results suggest 2 important leads for the further development of strategies for treating the complaint of insomnia. First, multicomponent strategies to modify a variety of daytime and nighttime variables based on individual behavioral analyses may be needed. Second, maintaining improvement in sleep and daytime behavior may require that clients learn problem-solving and self-management skills, with an emphasis on experiencing a greater sense of control over factors related to good and poor sleep. (4 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The management of diabetes in pregnancy

The aim of the diabetes specialist is to provide a service to the pregnant diabetic woman so that she will present to her obstetrician with such well-controlled plasma glucose levels that her pregnancy will proceed without any diabetes-related problem, and she will be delivered of a normal baby, of normal size, at the normal full-term gestation, by the normal route. There are some problems in achieving this aim. The exact definition of hyperglycaemia in pregnancy is still a matter of dispute. Screening methods to identify the problem differ widely. Many centres have developed joint diabetes/antenatal clinics, but there are practical problems with such an approach. Pre-pregnancy counselling, and discussion of contraceptive measures is an important task for the diabetologist and requires up-to-date knowledge. Control of plasma glucose requires alteration of insulin doses as pregnancy proceeds. Mothers with retinal, renal or cardiac problems will need special care. The medical problems which develop, and the management of blood glucose during labour and delivery, mean that the diabetes team must be very adjacent to the obstetric service, and a centralised approach offers many advantages. The postpartum state, and the long-term outcome for both mother and baby, remain both an interest and a responsibility for the obstetric physician.     

Urography during pregnancy

A review of 22,971 pregnancies from 1969-74 reveals that the reasons for requesting excretory urography were renal colic of pregnancy 11, pyelonephritis 8, renal contusion 2, threatened abortion 1, and suspected degeneration of fibroid 1. The final diagnoses were similar except that two patients with torsion of ovarian cysts and a renal calculus were discovered. The only intravenous pyelographic examination that was decisive for diagnosis was in a patient with a ureteric calculus. Careful clinical correlation should reduce excretory urography during pregnancy.     

Exercise during pregnancy

Exercise has become a vital part of many women's lives. However, theoretic concerns have been raised about the safety of some forms of exercise during pregnancy. Because of the physiologic changes associated with pregnancy, as well as the hemodynamic response to exercise, some precautions should be observed. The physician should screen for any contraindications to exercise and encourage patients to avoid overly vigorous activity, especially in the third trimester, when most pregnant women have a decreased tolerance for weight-bearing exercise. Adequate hydration and appropriate ventilation are important in preventing the possible teratogenic effects of overheating. Pregnant women should avoid exercise that involves the risk of abdominal trauma, falls or excessive joint stress, as in contact sports and vigorous racquet sports. In the absence of any obstetric or medical complications, most women can maintain a regular exercise regimen during pregnancy. Some studies have found a greater sense of well-being, shorter labor and fewer obstetric interventions in physically well-conditioned women as compared with other women.     

Headache during pregnancy

A questionnaire was submitted to 430 women 3 days after delivery, asking mainly about features of headache before and during pregnancy, and their possible modification or recurrence; moreover, delivery modalities and the condition of the newborn were evaluated. One-hundred-and-twenty-six (29.3%) were found to be primary headache sufferers (IHS criteria, 1988), 81 of whom had migraine without aura (MO), 12 migraine with aura (MA), and 33 tension-type headache (TH). In all three groups, about 80% showed complete remission or a higher than 50% decrease in the number of attacks. The improvement was more evident after the end of the first trimester; this trend was common to the three primary headaches considered. In our series of primary headaches, there was only one case (MO) which began during pregnancy. In a subgroup of pluripara, headache maintained the improvement presented in the first pregnancy also during the following gravidic periods in about 50% of cases, whereas in the remaining 50% a worsening in parallel with successive pregnancies was found. Primary headaches "per se" do not seem to increase the pregnancy or delivery risks, nor the vitality of the newborn. During pregnancy, drug use was very much reduced and was restricted to a limited number of compounds.     

Listeriosis during pregnancy

Listeriosis is an uncommon infection that has a unique predilection for pregnant women and may result in pregnancy loss. Contaminated food is the usual source of infection, and increased federal surveillance of foodstuffs is the most effective strategy for prevention of disease. Although dramatic epidemics have received the most publicity, more cases of perinatal listeriosis are isolated. If Listeria chorioamnionitis is diagnosed preterm, in contrast to other types of chorioamnionitis, in utero therapy with high-dose penicillin or trimethoprim-sulfamethoxazole is possible, and preterm delivery may be avoided. The clinical characteristics of neonatal listeriosis are similar to neonatal Group B Streptococcus sepsis, with early and late onset forms of disease. The epidemiology, diagnosis, and management of Listeria infection in pregnancy are reviewed.     

Perinatal events associated with maternal smoking during pregnancy

To identify components of smoking-related increased perinatal mortality, detailed analyses of data from the Ontario Perinatal Mortality Study (50,000 births, 1,300 deaths, 1960-1961) measured the relationship of maternal smoking to birth weight, gestation, placental complications, and perinatal mortality. Cross-tabulations with other factors and multiple adjustment showed increases with amount smoked of birth weights less than 2500 gm, gestations less than 38 weeks, placenta previa, abruptio placentae, and perinatal mortality. These significant, smoking-related increases were independent of mother's height, weight, hospital status, age-parity group, birthplace, previous pregnancy history, weight gain, time of registration, and sex of child. Maternal smoking had the strongest effect on birthweight in the 8 factor regression, and birth less than 2500 gm increased directly with smoking level from 20% to 340% in 37 data subgroups. Births less than 38 weeks increased 20% and 50% and perinatal mortality increased 20% and 35% for less than 1 pack and 1 + pack smokers, respectively, adjusted for 7 other factors. Placental complications increased consistently with smoking level in all of 37 subgroups except for primiparous less than 1 pack smokers. Adjusted rates increased 25% and 92% for placenta previa, 23% and 86% for abruptions among smokers of less than 1 pack and 1 + packs, respectively. These complications carry high perinatal mortality risk, and account for one-third to one-half of the perinatal deaths attributable to maternal smoking.     

Satisfaction with medical care during pregnancy and delivery

Societal attitudes toward the medical profession are apparently undergoing a change from awe and total respect to a more critical assessing of accountability and credibility. Based on mass media reports and the increasing number of malpractice suits, it would appear that a rational, unbiased review of medical doctors, hospital personnel, and care received is in order. This review should be concerned with technical aspects of medicine as determined by highly competent professionals and the consumer's view of the medical care he receives. The latter review should logically be taken directly to the consumers of medical care to determine their satisfaction with the care they received. Because of the varied areas of specialty within the medical profession, there are different types of relationships between doctors and their patients. The obstetrician, for instance, is usually associated with pregnancy as a joyful event, in contrast to a surgeon whose diagnosis may seldom be accompanied by joy. Satisfaction with medical care could thus be expected to vary according to the area of specialty and may be related to factors over which doctors have no control, factors which initially bring the patient to the doctor for care. The degree of anxiety related to the patient's condition could also be expected to contribute to the degree of satisfaction expressed by the patient.     

Home pregnancy testing kits: prevalence of use, false-negative rates, and compliance with instructions

This study investigated the prevalence of home pregnancy kit use, incidence of false-negative results, and compliance with testing procedures. Among 144 pregnant women, identified through three health care settings, prevalence of test-kit use was 28.5 per cent. The false-negative rate was 24.3 per cent. Total compliance with instructions was reported by only 32 per cent of users. Women testing less than nine days after menstrual period was due had false-negative rates of 33 per cent contrasted with 21 per cent for those testing after the nine days.