Detecting growth hormone misuse in athletes

Athletes have been misusing growth hormone (GH) for its anabolic and metabolic effects since the early 1980s, at least a decade before endocrinologists began to treat adults with GH deficiency. Although there is an ongoing debate about whether GH is performance enhancing, recent studies suggest that GH improves strength and sprint capacity, particularly when combined with anabolic steroids. The detection of GH misuse is challenging because it is an endogenous hormone. Two approaches have been developed to detect GH misuse; the first is based on the measurement of pituitary GH isoforms and the ratio of 22-kDa isoform to total GH. The second is based on the measurement of insulin like growth factor-I (IGF-I) and N-terminal propeptide of type III procollagen (P-III-NP) which increase in a dose-dependent manner in response to GH administration. Both methodologies have been approved by the World Anti-Doping Agency (WADA) and have led to the detection of a number of athletes misusing GH

Low uptake of postpartum screening for Type 2 diabetes in women after a diagnosis of gestational diabetes

Postpartum screening rates for Type 2 diabetes after a diagnosis of gestational diabetes are low across many high-income countries, ranging from 20 to 58% up to 1 year after delivery [1,2]. Subsequent annual follow-up rates plateau at 20% [1].We conducted an audit to assess postnatal diabetes screening rates in 233 women living in the city of Southampton with a history of gestational diabetes, diagnosed using WHO criteria. Current local practice involves giving verbal and written information regarding the risks of Type 2 diabetes after pregnancy at the initial consultation. After delivery and before discharge, all women are recommended to undergo postnatal glucose testing and are informed verbally and in writing to contact their general practitioner for annual ongoing screening. A copy of this letter is sent to the woman's general practitioner

Adherence with NICE guidance on lifestyle advice for people with schizophrenia: a survey

Background Substantial weight gain is common in people taking antipsychotics. NICE recommends these patients are offered physical health screening and intervention. The STEPWISE trial is currently evaluating a lifestyle education programme in addition to usual care. However, it is difficult to define what constitutes “usual care”. Aims To define “usual care” for lifestyle management in people with schizophrenia, schizoaffective disorder and first episode psychosis in STEPWISE study sites. Method Ten NHS Mental Health Trusts participated in a bespoke survey based on NICE guidance. Results Eight trusts reported offering lifestyle education programmes. Nine Trusts reported offering smoking cessation support. Reported recording of biomedical measures varied. Conclusions No consistent lifestyle education programme is currently offered across UK NHS Mental Health Trusts. The survey benchmarks ‘usual care’ for the STEPWISE study on which changes can be measured

Development of an acceptable and feasible self-management group for children, young people and families living with Type 1 diabetes.

AIMS: This study developed an acceptable and feasible self-management intervention that addresses the self-identified needs of children and young people with Type 1 diabetes and their parents. METHODS: Phase 1 reviewed previous interventions and interviewed the clinical team, young people and families. Phase 2 ran three age-matched focus groups with 11 families of children aged 8-16 years. Feedback was used to modify the workshop. Phase 3 evaluated feasibility of delivery, as well as the effects on metabolic control, quality of life and fear of hypoglycaemia, measured at baseline and 1-3 months post intervention. RESULTS: Eighty-nine families were invited to take part. Twenty-two (25%) participated in seven pilot groups (median age of young people 10 years, 36% girls). The intervention comprised a developmentally appropriate workshop for young people and parents addressing: (1) blood glucose control, (2) the potential impact of long-term high HbA1c , (3) the effects of 'hypos' and 'hypers', (4) self-management techniques and (5) talking confidently to people about diabetes. Participants were enthusiastic and positive about the workshop and would recommend it to others. Young people liked sharing ideas and meeting others with diabetes, while parents enjoyed listening to their children talk about their diabetes knowledge. CONCLUSIONS: Families living with Type 1 diabetes participated in developing a self-management group intervention. Although we demonstrated acceptability and feasibility, the pilot study results do not support the development of a randomized control trial to evaluate the effectiveness in improving HbA1c

Local Government's effective community responses

Speech given at the conference 'Reducing criminality: partnerships and best practice', Perth, 31 July to 1 August 2000, by Adam Graycar, Director, Australian Institute of Criminology. This speech is made available under the CC-BY-NC-ND 4.0 license: http://creativecommons.org/licenses/by-nc-nd/4.0/The challenge before us is to find the right set of interventions to prevent criminal behaviour among young people, and prevent that behaviour becoming a lifelong activity. The two main strategies are on the one hand to reduce the supply of motivated offenders, and on the other to make crime more difficult to commit. Crime is the result of complex changes in economic, social and cultural factors such as unemployment, dysfunctional families, child abuse, poor education, community breakdown, economic inequality and substance abuse. If crime prevention is to succeed it should focus on broad social outcomes, for example reducing social exclusion. Compelling evidence suggests that those who feel excluded from participation in community life are more likely to offend against that community. Addressing this sense of exclusion can reduce the risk of offending. In simple terms the criminal justice domain plays only a small part in crime prevention and preventing the supply of motivated offenders

Copenhagen Diabetes Consensus (CODIAC) 2021: user involvement in diabetes care, prevention and research

Aims User involvement is pivotal for health development, but there are significant gaps in our understanding of the concept. The Copenhagen Diabetes Consensus on User Involvement in Diabetes Care, Prevention and Research (CODIAC) was established to address these gaps, share knowledge and develop best practices. Methods A literature review of user involvement was undertaken in diabetes care, prevention and research. Moreover, a Group Concept Mapping (GCM) survey synthesized the knowledge and opinions of researchers, healthcare professionals and people with diabetes and their carers to identify gaps between what is important for user involvement and what is being done in practice. Finally, a consensus conference discussed the main gaps in knowledge and practice while developing plans to address the shortcomings. Results The literature review demonstrated that user involvement is an effective strategy for diabetes care, prevention and research, given the right support and conditions, but gaps and key challenges regarding the value and impact of user involvement approaches were found. The GCM process identified 11 major gaps, where important issues were not being sufficiently practised. The conference considered these gaps and opportunities to develop new collaborative initiatives under eight overall themes. Conclusions User involvement is effective and adds value to diabetes care, prevention and research when used under the right circumstances. CODIAC developed new learning about the way in which academic and research knowledge can be transferred to more practice-oriented knowledge and concrete collaborative initiatives. This approach may be a potential new framework for initiatives in which coherence of process can lead to coherent outputs

A new DAWN: Improving the psychosocial management of diabetes

Aims: The second Diabetes Attitudes, Wishes and Needs (DAWN-2) study assessed psychosocial issues and health-care provision of people with diabetes, their family members and health-care professionals. Materials and Methods: Participants completed an online, telephone or in-person survey designed to assess health-related quality-of-life, self-management, attitudes/beliefs, social support and priorities for improving diabetes care as well as health-care provision and the impact of diabetes on family life. Results: A total of 8596 adults with diabetes, 2057 family members of people with diabetes and 4785 health-care professionals across 17 countries completed the survey. There were significant between country differences, but no one country's outcomes were consistently better or worse than others. A high proportion of people with diabetes reported likely depression (13.8%) and poor quality-of-life (12.2%). Diabetes had a negative impact on many aspects of life, including relationships with family/friends and physical health. A third of family members did not know how to help the person with diabetes, but wanted to be more involved in their care. Many health-care professionals indicated that major improvements were needed across a range of areas including health-care organization, resources for diabetes prevention, earlier diagnosis and treatment and psychological support. Conclusions: DAWN-2 is a multinational, multidisciplinary systematic study that compared unmet needs of people with diabetes and those who care for them in 17 countries across four continents. Its findings should facilitate innovative efforts to improve self-management and psychosocial support in diabetes, with the aim of reducing the burden of disease. The implications for India are discussed

Editorial. Glyburide for gestational Diabetes: time for a pause for thought

Gestational diabetes mellitus (GDM) remains a major clinical challenge and is likely to remain so as the numbers of women with hyperglycemia in pregnancy continue to increase. The rising incidence has followed the changing demographic characteristics of pregnant women, such as older age and increasing body mass index, coupled with new stricter diagnostic criteria.1 While one may debate whether it is appropriate to medicalize the pregnancies of such a large proportion of women, a more pertinent question is how to manage their hyperglycemia to reduce fetal and maternal morbidity