Case 10 : Moving Towards an Inclusive Society: Implementing Epilepsy Awareness Education in the Ontario Elementary School Health Curriculum

This case revolves around the stigma experienced by individuals living with epilepsy. It discusses how Martha, a strategic planner at the Epilepsy Support Centre in London, Ontario, identified the negative health and social implications that confront individuals living with epilepsy. It then sets the stage in terms of problems faced by children and adolescents with epilepsy who are living in London, Ontario, and in terms of public health issues, school boards and government, and future directions. As this is a new initiative that is designed to be introduced into the school curriculum, it is crucial to have appropriate and influential stakeholders on board to actualize this epilepsy awareness program

The discriminative power of the EuroQol visual analog scale is sensitive to survey language in Singapore

<p>Abstract</p> <p>Background</p> <p>Existing evidence for validity of the visual analog scale of the EQ-5D-3L questionnaire (EQ-VAS) is weak in Chinese-speaking respondents in Singapore. We therefore investigated the validity of the Chinese (Singapore) version of EQ-VAS in patients with diabetes.</p> <p>Methods</p> <p>In a cross-sectional survey, patients with type 2 diabetes seen in a primary care facility completed an identical Chinese or English questionnaire containing the EQ-5D-3L and questions assessing other health and disease-related characteristics. Convergent and known-groups validity of the EQ-VAS was examined for Chinese- and English-speaking respondents separately.</p> <p>Results</p> <p>The EQ-VAS was correlated with the EQ-5D-3L health index and a 5-point Likert-type scale for assessing global health in both Chinese-speaking (N = 335) and English-speaking respondents (N = 298), suggesting convergent validity. The mean EQ-VAS scores differed between English-speaking patients with differing duration of diabetes (< 10 years versus ≥ 10 years), comorbidity status (absence versus presence), and complications of diabetes (absence versus presence), providing evidence for known-groups validity. However, the EQ-VAS scores for Chinese-speaking respondents known to differ in these characteristics were similar, even among subgroups of relatively younger patients or those with formal school education.</p> <p>Conclusions</p> <p>Chinese- and English-speaking Singaporeans respond differently to the EQ-VAS. The Chinese version of EQ-VAS appears less sensitive than its English version for measuring global health in patient populations in Singapore.</p

Revisiting the determinants of students' performance in an undergraduate accountancy degree programme in Singapore

Ministry of Education, Singapore under its Academic Research Funding Tier

Diagnostic accuracy of oral glucose tolerance tests, fasting plasma glucose and haemoglobin A1c for type 2 diabetes in women with polycystic ovary syndrome:A systematic review and meta-analysis

Aims: To inform international guidelines, a systematic review and meta-analysis was conducted to assess the performance of diagnostic methods for type 2 diabetes in women with polycystic ovary syndrome (PCOS). Methods: An updated systematic search was conducted on five databases from 2017 until October 2023 and combined with prior searches (from inception). Meta-analyses of diagnostic accuracy tests were conducted. Results: Nine studies comprising 2628 women with PCOS were included. Against the oral glucose tolerance test, a haemoglobin A1C (HbA1c) ≥ 6.5% had a pooled sensitivity of 50.00% (95% confidence interval (CI): 35.53–64.47), specificity of 99.86% (95%CI: 99.49–99.98), and positive and negative predictive values of 92.59% (95%CI: 75.27–98.09) and 98.27% (95%CI: 97.73–98.68), respectively, with an accuracy of 98.17% (95%CI: 97.34–98.79). Fasting plasma glucose values ≥ 7.0 mmol/L had a pooled sensitivity of 58.14% (95%CI: 42.13–72.99), specificity of 92.59% (95%CI: 75.35–98.08), positive and negative predictive values of 92.59% (95%CI: 75.35–98.08) and 99.09% (95%CI: 98.71–99.36), respectively, and an accuracy of 99.00% (95%CI: 98.46–99.39) against the oral glucose tolerance test. Conclusions: To our knowledge, this is the first systematic review assessing the performance of diagnostic methods for type 2 diabetes in women with PCOS. We demonstrate that using a cut-off for HbA1c of ≥6.5% in this population may result in misdiagnosis of half of the women with type 2 diabetes. Our results directly informed the recommendations of the 2023 International PCOS Guideline, suggesting that the oral glucose tolerance test is the optimal method for screening and diagnosing type 2 diabetes in women with PCOS and is superior to fasting plasma glucose and HbA1c.</p

Diagnostic accuracy of oral glucose tolerance tests, fasting plasma glucose and haemoglobin A1c for type 2 diabetes in women with polycystic ovary syndrome:A systematic review and meta-analysis

Aims: To inform international guidelines, a systematic review and meta-analysis was conducted to assess the performance of diagnostic methods for type 2 diabetes in women with polycystic ovary syndrome (PCOS). Methods: An updated systematic search was conducted on five databases from 2017 until October 2023 and combined with prior searches (from inception). Meta-analyses of diagnostic accuracy tests were conducted. Results: Nine studies comprising 2628 women with PCOS were included. Against the oral glucose tolerance test, a haemoglobin A1C (HbA1c) ≥ 6.5% had a pooled sensitivity of 50.00% (95% confidence interval (CI): 35.53–64.47), specificity of 99.86% (95%CI: 99.49–99.98), and positive and negative predictive values of 92.59% (95%CI: 75.27–98.09) and 98.27% (95%CI: 97.73–98.68), respectively, with an accuracy of 98.17% (95%CI: 97.34–98.79). Fasting plasma glucose values ≥ 7.0 mmol/L had a pooled sensitivity of 58.14% (95%CI: 42.13–72.99), specificity of 92.59% (95%CI: 75.35–98.08), positive and negative predictive values of 92.59% (95%CI: 75.35–98.08) and 99.09% (95%CI: 98.71–99.36), respectively, and an accuracy of 99.00% (95%CI: 98.46–99.39) against the oral glucose tolerance test. Conclusions: To our knowledge, this is the first systematic review assessing the performance of diagnostic methods for type 2 diabetes in women with PCOS. We demonstrate that using a cut-off for HbA1c of ≥6.5% in this population may result in misdiagnosis of half of the women with type 2 diabetes. Our results directly informed the recommendations of the 2023 International PCOS Guideline, suggesting that the oral glucose tolerance test is the optimal method for screening and diagnosing type 2 diabetes in women with PCOS and is superior to fasting plasma glucose and HbA1c.</p

CD28/B7-Mediated Co-stimulation Is Critical for Early Control of Murine Cytomegalovirus Infection

Abstract Control of acute murine cytomegalovirus (MCMV) infection is dependent upon both innate and adaptive immune responses, relying primarily upon natural killer (NK) and T-cell responses for control. Although CD28/B7 plays a clear role in T-cell responses in many antigen systems including some viral infections, the importance of co-stimulation during MCMV infection is unconfirmed. In addition, recent data suggest that CD28/B7 co-stimulation might also be important to Ly49H+ NK-cell expansion. We therefore hypothesized that CD28/B7 co-stimulation is critical to viral control after MCMV infection, and further that CD28/B7 co-stimulation plays a role in MCMV-specific T- and NK-cell responses. To test these hypotheses, we utilized C57BL/6 mice lacking the co-stimulatory molecules B7-1 and B7-2 or CD28. After primary infection with MCMV, viral titers are significantly elevated in mice lacking CD28 or B7 compared with wild-type mice. Impaired viral control is associated with significant defects in peripheral T-cell responses to MCMV, which appear to be dependent upon CD28/B7 co-stimulation. Abnormal hepatic T-cell responses in CD28/ mice are preceded by impaired MCMV-specific Ly49H+ NK-cell responses. Cytokine evaluations confirm that CD28/B7 co-stimulation is not required for non-specific antiviral responses. We conclude that CD28-mediated co-stimulation is critical for early viral control during acute MCMV infection.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78134/1/vim.2008.0080.pd

Ultrafiltration versus diuretics on prognostic cardiac and renal biomarkers in acute decompensated heart failure : a systematic review and meta-analysis

Peer reviewedPublisher PD