Early Postoperative Outcomes and Medication Cost Savings after Laparoscopic Sleeve Gastrectomy in Morbidly Obese Patients with Type 2 Diabetes

Background. We investigated the effect of laparoscopic sleeve gastrectomy (LSG) on morbidly obese diabetics and examined the short-term impact of LSG on diabetic medication cost. Methods. A prospective database of consecutive bariatric patients was reviewed. Morbidly obese patients with type 2 diabetes who underwent LSG were included in the study. Age, gender, body mass index (BMI), diabetic medication use, glucose, insulin, and HbA1c levels were documented preoperatively, and at 2 weeks, 2 months, 6 months, and 12 months postoperatively. Insulin resistance was estimated using the homeostatic model assessment (HOMA). Use and cost of diabetic medications were followed. Results. Of 178 patients, 22 were diabetics who underwent LSG. Diabetes remission was observed in 62% of patients within 2 months and in 75% of patients within 12 months. HOMA-IR improved after only two weeks following surgery (16.5 versus 6.6, P < 0.001). Average number of diabetic medications decreased from 2.2 to <1, within 2 weeks after surgery; corresponding to a diabetes medication cost savings of 80%, 91%, 99%, and 99.7% after 2 weeks, 2 months, 6 months, and 12 months, respectively. Conclusion. Morbidly obese patients with diabetes who undergo LSG have high rates of diabetes remission early after surgery. This translates to a significant medication cost savings

Adolescent Loneliness and Health in Early Adulthood

The health consequence of loneliness in the early life course is an understudied topic in the sociological literature. Using data from Waves 1–3 of the National Longitudinal Study of Adolescent Health, we examine pre-disease pathways in the relationship between adolescent loneliness and early adult health. Our results indicate that loneliness during adolescence is associated with diagnosed depression, poorer adult self-rated health, and metabolic risk factors related to cardiovascular disease. High depressive symptoms and parent support are important pathways through which the health consequences of loneliness are exacerbated or offset. There is also evidence that lonely youth remain at higher risk for experiencing adult depression and poor self-rated health even in the presence of equivalent levels of parental support relative to non-lonely adolescents. Furthermore, lonely adolescent females are more vulnerable to reporting poor adult self-rated health and being overweight or obese in adulthood. In sum, our study demonstrates the importance of adolescent loneliness for elevating the risk of poor health outcomes in adulthood

Adolescent Loneliness and Health in Early Adulthood

The health consequence of loneliness in the early life course is an understudied topic in the sociological literature. Using data from Waves 1–3 of the National Longitudinal Study of Adolescent Health, we examine pre-disease pathways in the relationship between adolescent loneliness and early adult health. Our results indicate that loneliness during adolescence is associated with diagnosed depression, poorer adult self-rated health, and metabolic risk factors related to cardiovascular disease. High depressive symptoms and parent support are important pathways through which the health consequences of loneliness are exacerbated or offset. There is also evidence that lonely youth remain at higher risk for experiencing adult depression and poor self-rated health even in the presence of equivalent levels of parental support relative to non-lonely adolescents. Furthermore, lonely adolescent females are more vulnerable to reporting poor adult self-rated health and being overweight or obese in adulthood. In sum, our study demonstrates the importance of adolescent loneliness for elevating the risk of poor health outcomes in adulthood

Homocysteine, MTHFR C677T gene polymorphism, folic acid and vitamin B 12 in patients with retinal vein occlusion

BACKGROUND: Many available data have suggested that hyperhomocysteinaemia, an established independent risk factor for thrombosis (arterial and venous), may be associated with an increased risk of retinal vein occlusion (RVO). AIM OF THE STUDY: To evaluate homocysteine metabolism in consecutive caucasian patients affected by RVO from Northern Italy. PATIENTS AND METHODS: 69 consecutive patients from Northern Italy (mean age 64.1 ± 14.6 yy) with recent RVO, were tested for plasma levels of homocysteine (tHcy: fasting and after loading with methionine), cyanocobalamine and folic acid levels (CMIA-Abbot) and looking for MTHFR C677T mutation (Light Cycler-Roche) and compared to 50 volunteers, enrolled as a control group. RESULTS: Fasting levels of tHcy were significantly higher in patients than in controls: mean value 14.7 ± 7.7 vs 10.2 ± 8 nmol/ml. Post load levels were also significantly higher: mean value 42.7 ± 23.7 vs 30.4 ± 13.3 nmol/ml; Total homocysteine increase was also evaluated (i.e. Δ-tHcy) after methionine load and was also significantly higher in patients compared to control subjects: mean Δ-tHcy 27.8 ± 21.5 vs 21.0 ± 16 nmol/ml (normal value < 25 nmol/ml). Furthermore, patients affected by RVO show low folic acid and/or vitamin B12 levels, although differences with control group did not reach statistical significance. Heterozygous and homozygous MTHFR mutation were respectively in study group 46% and 29% vs control group 56% and 4%. CONCLUSION: our data confirm that hyperhomocysteinaemia is a risk factor for RVO, and also that TT genotype of MTHFR C677T is more frequently associated with RVO: if the mutation per se is a risk factor for RVO remains an open question to be confirmed because another study from US did not reveal this aspect. Hyperomocysteinemia is modifiable risk factor for thrombotic diseases. Therefore, a screening for tHcy plasma levels in patients with recent retinal vein occlusion could allow to identify patients who might benefit from supplementation with vitamins and normalization of homocysteine levels, in fasting and after methionine load

Persistent effects of in utero overnutrition on offspring adiposity: the Exploring Perinatal Outcomes among Children (EPOCH) study

Aims/hypothesis: We previously showed that intrauterine exposure to gestational diabetes mellitus (GDM) increases selected markers of adiposity in pre-pubertal adolescents. In the present study, we examined these associations in adolescence, and explored whether they are strengthened as the participants transition through puberty. Methods: Data from 597 individuals (505 unexposed, 92 exposed) participating in the longitudinal Exploring Perinatal Outcomes among Children (EPOCH) study in Colorado were collected at two research visits when the participants were, on average, 10.4 and 16.7 years old. Adiposity measures included BMI, waist/height ratio, and visceral and subcutaneous adipose tissue (as determined by MRI). Separate general linear mixed models were used to assess the longitudinal relationships between exposure to maternal GDM and each adiposity outcome. We tested whether the effect changed over time by including an interaction term between exposure and age in our models, and whether the associations were explained by postnatal behaviours. Results: Compared with unexposed participants, those exposed to maternal GDM had higher BMI (β = 1.28; 95% CI 0.35, 2.21; p < 0.007), waist/height ratio (β = 0.03; 95% CI 0.01, 0.04; p = 0.0004), visceral adipose tissue (β = 4.81; 95% CI 1.08, 8.54; p = 0.01) and subcutaneous adipose tissue (β = 35.15; 95% CI 12.43, 57.87; p < 0.003). The magnitude of these differences did not change over time and the associations did not appear to be explained by postnatal behaviours. Conclusions/interpretation: Our data provide further evidence that intrauterine exposure to maternal GDM is associated with increased offspring adiposity, an effect that appears early in life and tracks throughout adolescence. Efforts to prevent childhood obesity following intrauterine exposure to maternal GDM should target the prenatal or early life periods

Association of Type 1 Diabetes vs Type 2 Diabetes Diagnosed During Childhood and Adolescence With Complications During Teenage Years and Young Adulthood

The burden and determinants of complications and comorbidities in contemporary youth-onset diabetes are unknown

WHAT YOU DON’T KNOW CAN HURT YOU: EARLY LIFE COURSE RACIAL HEALTH DISPARITIES IN UNDIAGNOSED DIABETES

This dissertation addresses several issues related to racial health disparities in undiagnosed diabetes in American young adults in a three-article format. The first chapter examines rates of diabetes severity across age-matched samples of young adults from two large nationally representative studies. Although the purpose of this study was to explore the impact of nonresponse on prevalence estimates, I find that the prevalence discrepancies have less to do with which respondents are missing blood samples and more to do with the samples coming from initial samples that are not equivalent. The second chapter uses an adaptation of the Stress Process Model to identify the effects of racial minority status, perceived discrimination, mastery, and risky coping strategies on diabetes severity in a race-stratified young adult sample. Data from the National Longitudinal Study of Adolescent Health were used to analyze diabetes risk severity using multinomial logistic regression analysis. Large disparities in diabetes risk severity were found by race, particularly for undiagnosed diabetes. Multivariate results show complex relationships between experiencing discrimination and diabetes risk severity by race, which suggest that discrimination effects diabetes risk severity differently for blacks and whites. The final study examines the impact of help seeking and diagnosis allocation with diabetes diagnosis disparities. Andersen’s Behavioral Model of Health Services Use (1995) is used to model diabetes diagnostic disparities among young adults with diabetes. Tests of Andersen’s model using data from the National Longitudinal Study of Adolescent Health reveal no difference in help seeking across race/ethnic groups. Although all race/ethnic groups were equally likely to seek care, large diagnostic disparities persist for blacks. As a result, young adult black diabetics are significantly less likely to receive a diagnosis for diabetes even when they sought care in the previous three months. Taken together, this dissertation reveals that racial health disparities in diabetes diagnoses are complex. Estimates of the prevalence, predictors, and pathways to diagnosis differ by race in meaningful and previously unexplored ways. This research serves to document this problem, provide foundational evidence of meaningful relationships, and shed light on the possible public health and policy implications associated with these disparities. Adviser: Bridget J. Goosb

Le Savon ou « l’exercice » du lecteur

À lire Francis Ponge, on n’est pas surpris d’être constamment invité à voir double : ses textes, on le sait, en même temps qu’ils décrivent un objet nous parlent d’autre chose, c’est-à-dire d’eux-mêmes, et sont en quelque sorte les fragments d’un art poétique en acte. Mais pour que ces éléments coexistent, il y faut certains ajustements, une certaine adéquation ou homologie entre l’objet et le texte. C’est ce double jeu qu’il a appelé « rhétorique de l’objet » et qu’il a mis en œuvre et en lu..

Técnicas anestésicas em molares mandibulares com pulpite irreversível Revisão sistemática integrativa

Introdução: Os dentes afetados por pulpite irreversível sintomática (PIS) têm que ser submetidos a tratamento endodôntico. O controlo eficaz da dor durante o tratamento é necessário para permitir o conforto do paciente e os operadores devem conhecer as diferentes técnicas anestésicas e a eficácia das mesmas. Objetivo: O objetivo deste trabalho é elaborar uma revisão sistemática integrativa da literatura publicada para comparar a eficácia das diferentes técnicas anestésicas (o bloqueio do nervo alveolar inferior, a anestesia infiltrativa, a intraligamentar e a intraóssea) em molares mandibulares com pulpite irreversível sintomática. Materiais e métodos: Foi realizada uma pesquisa bibliográfica na base de dados PubMed (via National Library of Medicine). Foi utilizada a estratégia PICO e foram redigidos critérios de inclusão e de exclusão para escolher os artigos úteis para o presente estudo. Resultados/discussão: No presente estudo foi evidenciado que a taxa de sucesso do bloqueio do nervo alveolar inferior, pode variar entre 14% até 73%. A anestesia infiltrativa teve uma eficácia de 29% até 84%, sendo que a intraligamentar teve um sucesso de 48% até 75% e intraóssea entre 68% e 92%. Conclusão: A anestesia de bloqueio do nervo alveolar inferior por si só não permitiu, de forma confiável, o tratamento do canal radicular sem dor para molares inferiores com PIS. Neste sentido, os profissionais devem considerar técnicas suplementares adicionais, como as anestesias infiltrativas, intraósseas ou intraligamentares, para obter anestesia pulpar quando há falha do BNAI, mas ainda não existe uma técnica estatisticamente melhor que as outras.Introduction: Teeth affected by symptomatic irreversible pulpitis (SIP) must undergo endodontic treatment. Effective pain control during treatment is necessary to allow patient comfort and operators must be familiar with the different anesthetic techniques and their effectiveness. Objective: The aim of this dissertation is to elaborate a systematic integrative review of the published literature toto compare the effectiveness of different anesthetic techniques (inferior alveolar nerve block, infiltrative, intraligamentary, intraosseous) in mandibular molars with symptomatic irreversible pulpitis. Materials and methods: An electronic bibliographic search was performed in the PubMed database (via the National Library of Medicine) using the following keywords: [pulpitis], [dental anesthesia], [inferior alveolar nerve], [anesthesia], [local anesthetics]. The PICO strategy was used and inclusion and exclusion criteria were written to choose useful articles in the present study. Results/discussion: In the present study, it was shown that the success rate of inferior alveolar nerve block, can vary from 14% to 73% Infiltrative anesthesia had an efficiency of 29% to 84%, with intraligamentary having a success of 48% to 75% and intraosseous between 68% and 92%. Conclusion: Inferior alveolar nerve block injection alone did not reliably allow pain-free root canal treatment for lower molars with PI. Therefore, practitioners should consider additional supplementary techniques, such as infiltrative, intraosseous, or intraligamentary injections, to obtain pulpal anesthesia when IANB fails, but we still do not have a technique that is statistically better than the others

What you don\u27t know can hurt you: Early life course racial health disparities in undiagnosed diabetes

This dissertation addresses several issues related to racial health disparities in undiagnosed diabetes in American young adults in a three-article format. The first chapter examines rates of diabetes severity across age-matched samples of young adults from two large nationally representative studies. Although the purpose of this study was to explore the impact of nonresponse on prevalence estimates, I find that the prevalence discrepancies have less to do with which respondents are missing blood samples and more to do with the samples coming from initial samples that are not equivalent. The second chapter uses an adaptation of the Stress Process Model to identify the effects of racial minority status, perceived discrimination, mastery, and risky coping strategies on diabetes severity in a race-stratified young adult sample. Data from the National Longitudinal Study of Adolescent Health were used to analyze diabetes risk severity using multinomial logistic regression analysis. Large disparities in diabetes risk severity were found by race, particularly for undiagnosed diabetes. Multivariate results show complex relationships between experiencing discrimination and diabetes risk severity by race, which suggest that discrimination effects diabetes risk severity differently for blacks and whites. The final study examines the impact of help seeking and diagnosis allocation with diabetes diagnosis disparities. Andersen\u27s Behavioral Model of Health Services Use (1995) is used to model diabetes diagnostic disparities among young adults with diabetes. Tests of Andersen\u27s model using data from the National Longitudinal Study of Adolescent Health reveal no difference in help seeking across race/ethnic groups. Although all race/ethnic groups were equally likely to seek care, large diagnostic disparities persist for blacks. As a result, young adult black diabetics are significantly less likely to receive a diagnosis for diabetes even when they sought care in the previous three months. Taken together, this dissertation reveals that racial health disparities in diabetes diagnoses are complex. Estimates of the prevalence, predictors, and pathways to diagnosis differ by race in meaningful and previously unexplored ways. This research serves to document this problem, provide foundational evidence of meaningful relationships, and shed light on the possible public health and policy implications associated with these disparities