Experimental and clinical pharmacology - Incretin mimetics and enhancers: mechanisms of action

The incretins are peptide hormones secreted from the gut in response to food. They increase the secretion of insulin. The incretin response is reduced in patients with type 2 diabetes, so drugs acting on incretins may improve glycaemic control. Incretins are metabolised by dipeptidyl peptidase, so selectively inhibiting this enzyme increases the concentration of circulating incretins. A similar effect results from giving an incretin analogue that cannot be cleaved by dipeptidyl peptidase

Sekondêre skoolleerders se belewenis van aggressie tydens kommunikasie met hul onderwysers

M.Ed.It is clear to me that the need for the teacher and the school to provide educational help and support is greater than ever before. With reference to democratic values in a multicultural society Le Roux (1997:1) is of the opinion that teachers have a lot of responsibility for both “what” and “how” learners learn. To gain better understanding in the “functioning” of the modern educational system it is of the utmost importance to investigate “how” educational goals are attained in the modern classroom. In accordance with this reasoning not only the content of the teaching and learning experience is important but also the process of educational communication (Du Plessis, 1974:5). Especially where education is viewed as help and support to the youth, the helping relationship between teachers and the learners in their care occupies a central position (Okun, 2002:21). In accordance with this view teacher and learners in this study will be seen as senders and receivers of educational verbal and non verbal messages (Goleman, 1996:116; Goleman, 2006:14; Johnson, 2006:126). If the helping relationship is of great importance to teaching and learning and if this relationship is built and maintained via teacher-learner communication, how does the experience of aggression while communicating with their teachers affect learners? What is learners’ experience of aggression while communicating with their teachers? What can be done about the experience of aggression during teacher-learner communication? This research was done in two phases. In PHASE 1 the goal was to explore and describe grade eleven learners’ experience of aggression while communicating with their teachers. In PHASE 2 the goal was the description of guidelines for communication between secondary school learners and their teachers with special reference to the handling of aggression in the communication and relationship. It is a qualitative investigation to explore and to describe learners’ experience of aggression while communicating with their teachers. The research rests on Phenomenological principles and methods (Giorgi, 2002). I followed a functional approach and the research is carried out with the view of improving my own educational practice as well as educational practice in general. The method of data collection followed is a qualitative interpretive constructivist approach to the generation of new knowledge and the specific method employed is phenomenological interviews. The research was conducted at an ex-Model C school. The sample was purposive and grade 11 learners were given an opportunity to participate in the research on a voluntary basis. Grade eleven learners were given opportunity because, in my view, in general, they have both enough experience with teachers and the vocabulary to talk about a complex phenomenon such as the experience of aggression. The methods and procedures employed made extensive use of triangulation with a view to enhancing trustworthiness. Twelve individual phenomenological interviews were conducted as well as a focus group interview. There was a total of nineteen voluntary participants of which eighteen are Afrikaans first language speakers and one is an English first language speaker. Eight boys and eleven girls participated. All of the participants are seventeen years of age. All the participants, except one boy, also wrote a naïve sketch about their experiences before the phenomenological interview or focusgroup interview was conducted. During all the interviews, as well as directly afterwards, field notes were made, by the researcher. The central question of this investigation is: “What is grade eleven learners’ experience of aggression wile communicating with their teachers?” and this question was operationalised in the individual phenomenological interviews, focus group interview, and the naïve sketches as: “How is it for you when your teachers are aggressive when they talk to you?

Objective and perceived availability of physical activity opportunities: differences in associations with physical activity behavior among urban adolescents

ABSTRACT: BACKGROUND: This study examined the associations of the perceived and objective environment with adolescent engagement in sports activities and walking and cycling in leisure time. It also explored the degree of agreement between objective and perceived availability of physical activity (PA) facilities in neighborhoods. METHODS: Cross-sectional data on physical activity, the perceived availability of physical activity opportunities (perceived physical environment) was assessed through a questionnaire and the objective availability of PA opportunities (objective physical environment) was obtained through GIS data. The final sample included 654 adolescents with a mean age of 14.1 (SD = 1.2) years. RESULTS: Perceived availability of sports facilities and parks was significantly associated with engaging in sports (OR: 1.73; 95% CI: 1.16-2.56) and with walking and cycling in leisure time (OR: 1.66; 95% CI: 1.07-2.57) respectively. Agreement between objective and perceived environment was low to moderate with Kappa values ranging from -0.005 to 0.053. CONCLUSION: The perceived environment was the stronger correlate of PA behavior among adolescents. There were substantial differences between assessments of objective and perceived physical environmen

COPD-Lower Respiratory Tract Infection Visual Analogue Score (c-LRTI-VAS) validation in stable and exacerbated patients with COPD

BACKGROUND: We developed the chronic obstructive pulmonary disease (COPD)-Lower Respiratory Tract Infection-Visual Analogue Score (c-LRTI-VAS) in order to easily quantify symptoms during exacerbations in patients with COPD. This study aimed to validate this score. METHODS: In our study, patients with stable COPD as well as those with an acute exacerbations of COPD (AECOPD) were included. The results of c-LRTI-VAS were compared with other markers of disease activity (lung function parameters, oxygen saturation and two health related quality of life questionnaires (St Georges Respiratory Questionnaire (SGRQ) and Clinical COPD Questionnaire (CCQ)) and validity, reliability and responsiveness were assessed. RESULTS: Eighty-eight patients with clinically stable COPD and 102 patients who had an AECOPD completed the c-LRTI-VAS questionnaire. When testing on two separate occasions for repeatability, no statistically significant difference between total scores was found 0.143 (SD 5.42) (p=0.826). Internal consistency was high across items (Cronbach's apha 0.755). Correlation with SGRQ and CCQ total scores was moderate to high. After treatment for hospitalised AECOPD, the mean c-LRTI-VAS total score improved 8.14 points (SD 9.13; p≤0.001). CONCLUSIONS: c-LRTI-VAS showed proper validity, responsiveness to change and moderate to high correlation with other questionnaires. It, therefore, appears a reliable tool for symptom measurement during AECOPD. TRIAL REGISTRATION NUMBER: NCT01232140

Prevalence of neurocognitive and perceived speech deficits in patients with head and neck cancer before treatment:Associations with demographic, behavioral, and disease-related factors

BACKGROUND: Neurocognition and speech, relevant domains in head and neck cancer (HNC), may be affected pretreatment. However, the prevalence of pretreatment deficits and their possible concurrent predictors are poorly understood.METHODS: Using an HNC prospective cohort (Netherlands Quality of Life and Biomedical Cohort Study, N ≥ 444) with a cross-sectional design, we investigated the estimated prevalence of pretreatment deficits and their relationship with selected demographic, behavioral, and disease-related factors.RESULTS: Using objective assessments, rates of moderate-to-severe neurocognitive deficit ranged between 4% and 8%. From patient-reported outcomes, 6.5% of patients reported high levels of cognitive failures and 46.1% reported speech deficits. Patient-reported speech functioning was worse in larynx compared to other subsites. Other nonspeech outcomes were unrelated to any variable. Patient-reported neurocognitive and speech functioning were modestly correlated, especially in the larynx group.CONCLUSIONS: These findings indicate that a subgroup of patients with HNC shows pretreatment deficits, possibly accentuated in the case of larynx tumors.</p

Insulin Intensification for People with Type 2 Diabetes

BackgroundType 2 diabetes is a progressive disorder and with time, it is appropriate for insulin therapy to be initiated in the majority of people. Insulin is commonly initiated with once-daily basal insulin. However, when glycaemic control becomes unsatisfactory despite the introduction of basal insulin, no clear guidelines exist for intensifying the insulin regimen. In this article we aim to provide a clinician’s approach to both the optimisation of the basal insulin dose, and strategies to intensify insulin therapy.MethodsAn expert consensus panel, consisting of the authors, was convened to review the current practice of insulin intensification in people with type 2 diabetes and to develop a pragmatic algorithm for clinicians. The panel reviewed the published literature on the use of insulin in clinical practice, the evidence for different intensification strategies, and the potential impact of patient-related factors on insulin choices. ResultsInsulin intensification should only be considered after the basal insulin dose has been optimised. This is achieved by taking into account basal and prandial (pre and post) blood glucose levels, individualised target HbA1c, and dietary factors. If optimal basal insulin together with oral medications is not sufficient to reach glycaemic targets, the next step is to introduce a basal plus 1 regimen or switch to twice-daily premixed insulin. Each has advantages and disadvantages and existing guidelines do not emphasise or support any particular regimen. Therefore, it is important to individualise the choice according to the individual’s needs. A practical algorithm has been developed to help clinicians choose an appropriate second-line regimen.ConclusionAs beta-cell failure progresses in people with type 2 diabetes, basal insulin regimens need to be optimised and then intensified when necessary to maintain agreed glycaemic targets

Prospective longitudinal study on fear of cancer recurrence in patients newly diagnosed with head and neck cancer:Course, trajectories, and associated factors

Background: This study assessed the course of fear of cancer recurrence (FCR) in patients newly diagnosed with head and neck cancer (HNC), identified FCR trajectories and factors associated with FCR trajectories. Methods: Six hundred and seventeen HNC patients from the NET-QUBIC cohort study completed the Cancer Worry Scale-6 at diagnosis, 3 and 6 months post-treatment. FCR trajectories were identified using Latent Class Growth Analysis. Associations were explored between FCR trajectories and baseline demographic and medical variables, coping and self-efficacy. Results: Overall, FCR decreased slightly between baseline and 3 months post-treatment and remained stable up to 6 months. Two FCR trajectories were identified: “high stable” (n = 125) and “low declining” (n = 492). Patients with high stable FCR were younger, reported more negative adjustment, passive coping, and reassuring thoughts, and less avoidance. Conclusions: The majority of HNC patients have low declining FCR after diagnosis, but one in five patients experience persistent high FCR up to 6 months post-treatment