Mindfulness-based group intervention for an adolescent girl at risk for type 2 diabetes: a case study

2017 Spring.Includes bibliographical references.Adolescent-onset type 2 diabetes (T2D) is a rising healthcare problem that disproportionately impacts females and historically disadvantaged racial/ethnic groups. Standard behavioral lifestyle interventions to prevent T2D by lowering body mass index (BMI) to lessen insulin resistance, a key precursor to T2D, unfortunately have had limited long-term success. Underlying psychosocial factors, particularly depressive symptoms, have been related to insulin resistance and T2D, independent of BMI. Mindfulness-based group interventions are being utilized increasingly in adults with T2D to address depression. More recently, using a prevention lens, mindfulness-based programs have shown preliminary promise for intervening with elevated depressive symptoms and insulin resistance in adolescents at risk for T2D. Yet given the newness of this area, little research exists to deepen understanding around clinical implementation and acceptability with this at-risk, adolescent population. In the current case study, we present the experience of an adolescent girl with elevated depressive symptoms, obesity, insulin resistance, and a family history of T2D, who participated in a six-week mindfulness-based group program delivered at an outpatient therapy clinic in the context of a pilot clinical research study. At baseline, immediately following the group program, and at one-year follow-up, surveys and interviews were administered to evaluate mindfulness and depression; hypothalamic-pituitary-adrenal axis activity; BMI and body fat were assessed; and insulin resistance was estimated from the homeostasis model assessment of insulin resistance (HOMA-IR). Case results indicated increased dispositional mindfulness, decreases in depressive symptoms, and lessening of insulin resistance. BMI and body fat were stable. Key therapeutic themes that emerged for the participant included increased recognition of internal experience and decreased reactivity to stress, which might help to explain the positive psychological and insulin outcomes. We discuss several implications of the case study for potentially increasing the success of implementing mindfulness-based programs in this population, including more emphasis on the promotion of social connections among group members, increasing adherence to home practice, and facilitation techniques to promote concrete understanding of abstract mindfulness concepts. The current case results suggest that teaching mindfulness skills to adolescent girls at risk for T2D with depressive symptoms possibly may offer benefits for depression and T2D risk. Adequately-powered clinical trial data are required to evaluate these results on a larger scale

Globalizing the Department to Expand Students’ Cultural and World Awareness

Advances in technology and the development of a world economy requires all academic departments to prepare their students for life in a globalized world. This session presents specific ideas on how chairs can globalize their department, curriculum, and campus

What Clinical Strategies are Applied for Botulinum Toxin Injection in the Oromandibular Region?

Botulinum neurotoxin (BoNT) inhibits the release of acetylcholine from cholinergic nerve terminals in muscles or salivary glands. With reduced activation, the muscle activity or secretion decreases. Indications for medical, non‐cosmetic use of BoNT in the orofacial area include among others oromandibular dystonia, painful masseter hypertrophy, Frey\u27s syndrome, and severe drooling. The chapter covers anamnestic characteristics of these conditions as well as clinical, electromyographic (EMG) and laboratory findings, treatment methods with guided injections, and outcome from systematic treatment controls and follow‐up examinations

Time to antibiotic therapy and outcome in bacterial meningitis:a Danish population-based cohort study

BACKGROUND: Community-acquired bacterial meningitis (CABM) is a life-threatening disease and timing of antibiotic therapy remains crucial. We aimed to analyse the impact of antibiotic timing on the outcome of CABM in a contemporary cohort. METHODS: We conducted a population-based cohort study based on chart reviews of all adult cases (>16 years of age) of CABM in North Denmark from 1998 to 2014 excluding patients given pre-hospital parenteral antibiotics. We used modified Poisson regression analyses to compute the adjusted risk ratio (adj. RR) with 95 % confidence intervals (CIs) for in-hospital mortality and unfavourable outcome at discharge by time after arrival to hospital to adequate antibiotic therapy. RESULTS: We identified 195 adults with CABM of whom 173 patients were eligible for further analyses. The median door-to-antibiotic time was 2.0 h (interquartile range (IQR) 1.0–5.5). We observed increased adjusted risk ratios for in-hospital mortality of 1.6 (95 % CI 0.8–3.2) and an unfavourable outcome at discharge of 1.5 (95 % CI 1.0–2.2, p = 0.03) when treatment delays exceeded 6 h versus treatment within 2 h of admission. These findings corresponded to adjusted risk ratios of in-hospital mortality of 1.1 per hour of delay (95 % CI 0.8–1.5) and an unfavourable outcome at discharge of 1.1 per hour of delay (95 % CI 1.0–1.3) within the first 6 h of admission. Some patients (31 %) were diagnosed after admission and had more delays in antibiotic therapy and correspondingly increased in-hospital mortality (30 vs 14 %, p = 0.01) and unfavourable outcome (62 vs 37 %, p = 0.002). CONCLUSIONS: Delay in antibiotic therapy was associated with unfavourable outcome at discharge. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12879-016-1711-z) contains supplementary material, which is available to authorized users

Plaque in superficial femoral arteries indicates generalized atherosclerosis and vulnerability to coronary death: An autopsy study

ObjectivesRisk factors for atherosclerosis have limited ability to identify persons at high risk of coronary heart disease. Assessment of subclinical atherosclerosis in peripheral arteries might improve this limitation. We studied the relationship between atherosclerotic plaques in peripheral arteries, coronary plaques, and coronary death.MethodsPredefined segments from the left anterior descending coronary artery, the right coronary artery, bilateral carotid, and superficial femoral arteries (SFA) were obtained from 100 autopsies (20-82 years, 30 females, 27 coronary deaths). Based on microscopic examination of 4756 sections, the extension of atherosclerosis (plaque burden) and the largest plaque area in each segment were quantified.ResultsPlaque burden in all arteries increased with age and was larger in coronary death (P < .05). SFA plaques occurred later than coronary and carotid plaques. When SFA plaque had developed, coronary plaque was also present. SFA plaque (odds ratio, 95% confidence interval: 7.07 [2.40-20.81]), but not carotid plaque, was significantly associated with coronary death, also after age and gender adjustment (21.25 [5.02-89.97]). The area under the receiver operating characteristic curves for the identification of coronary death individuals was 0.72 (95% confidence interval: 0.62-0.83) for coronary plaque, and 0.80 (0.72-0.89) for SFA plaque (age and gender adjusted).ConclusionsAtherosclerosis develops slower in SFA compared with coronary and carotid arteries. In persons with plaque in the SFA, plaque is always present in the coronary arteries. In younger persons, the presence of SFA plaque indicates a generalized susceptibility to atherosclerosis and vulnerability to coronary death

Case report:Evolution of pulmonary manifestations and virological markers in critical COVID-19 infection in Bruton's agammaglobulinemia

Despite several reports and small case series on the disease course of SARS-CoV-2 infection in patients with inborn errors of immunity (IEI), including X-linked agammaglobulinemia (XLA), this topic remains incompletely described. Here we present the case of a 38-year-old unvaccinated man with XLA, who acquired SARS-CoV-2 infection and experienced a protracted disease course with 47 days of SARS-CoV-2 positivity, critical COVID-19 with respiratory insufficiency necessitating intensive care and ventilatory support, and prompting repeated intensified treatments with remdesivir, dexamethasone, and monoclonal antibodies to eventually control infection. We describe the disease course and treatment and review the current literature on COVID-19 susceptibility and evidence for vaccine efficacy in patients with XLA