Neighborhood conditions, diabetes, and risk of lower-body functional limitations among middle-aged African Americans: A cohort study

<p>Abstract</p> <p>Background</p> <p>The relationship between presence of diabetes and adverse neighborhood and housing conditions and their effect on functional decline is unclear. We examined the association of adverse neighborhood (block face) and housing conditions with incidence of lower-body functional limitations among persons with and those without diabetes using a prospective population-based cohort study of 563 African Americans 49-65 years of age at their 2000-2001 baseline interviews.</p> <p>Methods</p> <p>Participants were randomly sampled African Americans living in the St. Louis area (response rate: 76%). Physician-diagnosed diabetes was self reported at baseline interview. Lower-body functional limitations were self reported based on the Nagi physical performance scale at baseline and the three-year follow-up interviews. The external appearance of the block the respondent lived on and five housing conditions were rated by study interviewers. All analyses were done using propensity score methods to control for confounders.</p> <p>Results</p> <p>109 (19.4%) of subjects experienced incident lower-body functional limitations at three-year follow-up. In adjusted analysis, persons with diabetes who lived on block faces rated as fair-poor on each of the five conditions had higher odds (7.79 [95% confidence interval: 1.36-37.55] to 144.6 [95% confidence interval: 4.45-775.53]) of developing lower-body functional limitations than the referent group of persons without diabetes who lived on block faces rated as good-excellent. At least 80 percent of incident lower-body functional limitations was attributable to the interaction between block face conditions and diabetes status.</p> <p>Conclusions</p> <p>Adverse neighborhood conditions appear to exacerbate the detrimental effects on lower-body functioning associated with diabetes.</p

Hyperinsulinaemia as long-term predictor of death and ischaemic heart disease in nondiabetic men: The Malmö Preventive Project.

Objectives. Prospective studies have indicated that hyperinsulinaemia/insulin resistance is a risk factor for ischaemic heart disease (IHD), the risk decreasing with time of follow-up. Few studies have so far investigated the role of hyperinsulinaemia in the prediction of long-term total mortality. Setting. Section of Preventive Medicine, Department of Medicine, University Hospital, Malmö, Sweden. Subjects. A total of 6074 nondiabetic, middle-aged, healthy Swedish males. Screening examination. We determined IHD risk factors including blood glucose and plasma insulin before and 2 h after an oral glucose tolerance test (OGTT). Total follow-up time was 19 years. Hyperinsulinaemia was defined as values above the 10th decentile of fasting or 2 h insulin concentration. Main outcome measures. Total mortality and cardiac event (CE) rate for IHD. Results. Unadjusted relative risks (RRs) for both death and CE were J-shaped with the highest relative risk (RR: 1.4-1.6) in the hyperinsulinaemic group compared with all other men. The RRs for death and CE were significant for fasting insulin but became nonsignificant after adjustment for other risk factors and also with a longer follow-up. The risk of death in hyperinsulinaemic men, defined on the basis of 2-h insulin level, increased with time of follow-up and was still significantly increased after 19 years [RR: 1.32 (95% CI: 1.05-1.65], even after adjustment for other risk factors. Conclusions. Fasting hyperinsulinaemia was a predictor of total mortality and IHD in nondiabetic men, although not more significantly after adjustment for other risk factors and with lengthening of follow-up time. The 2-h postglucose hyperinsulinaemia appeared to be a stronger and independent predictor of mortality over long-term follow-up. These findings support the view that insulin resistance with associated cluster of risk factors predicts increased long-term risk of mortality and IHD

Key signaling nodes in mammary gland development and cancer: β-catenin

β-Catenin plays important roles in mammary development and tumorigenesis through its functions in cell adhesion, signal transduction and regulation of cell-context-specific gene expression. Studies in mice have highlighted the critical role of β-catenin signaling for stem cell biology at multiple stages of mammary development. Deregulated β-catenin signaling disturbs stem and progenitor cell dynamics and induces mammary tumors in mice. Recent data showing deregulated β-catenin signaling in metaplastic and basal-type tumors suggest a similar link to reactivated developmental pathways and human breast cancer. The present review will discuss β-catenin as a central transducer of numerous signaling pathways and its role in mammary development and breast cancer

International Consensus Statement on Rhinology and Allergy: Rhinosinusitis

Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods: ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion: This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS

A roadmap to recovery: ABCD recommendations on risk stratification of adult patients with diabetes in the post COVID-19 era

A third of the over 40,000 deaths in the UK attributed to the first wave of the COVID‐19 pandemic occurred in people with diabetes. However, the focus on emergency response to COVID‐19 in the first few months has had a major knock‐on impact on the delivery of routine clinical care for diabetes. Key challenges as we enter the second wave of the pandemic include a backlog of appointments, delays in accessing care such as structured education, and initiating insulin, GLP‐1 or diabetes technology. We anticipate ongoing pressures through increased commitments to general medicine, reductions in clinic capacities due to social distancing and reorganisation of clinic spaces. Many services have already adapted by moving much of their activity to the virtual space

The efficacy of tracheostomy tube changes by speech-language pathologists: A retrospective review

Background/Aims: The number of tracheostomised patients in the acute care setting are increasing, resulting in an equal need of providers who can safely change tracheostomy tubes without complications. The objective of this retrospective study was to ascertain if trained speech-language pathologists were able to safely and efficiently perform tracheostomy tube changes in the acute care setting with minimal adverse events. Methods: Our retrospective case series spans from June 2010 to March 2015 and was completed at an academic hospital with a level 1 trauma designation. A total of 107 consecutive referrals undergoing a tracheostomy tube change, with a speech-language pathologist, were identified. Success was defined as the placement of the tracheostomy tube into the tracheal lumen with confirmation of placement. Only complications occurring at the time of the tracheostomy tube change were considered and were defined as an airway loss event: oxygen desaturation 5mL; and the inability to perform the attempted tracheostomy tube change for any other reason. Results: All of the tracheostomy tubes changes were performed at the bedside at a mean of 13 days post tracheotomy (range 3–28). A total of 106 (99%) of 107 tracheostomy tubes changes were successfully completed without complications; 83 (79%) of the tracheostomy tubes changes performed were the initial tracheostomy tubes change completed post tracheotomy. The remaining 23 (21%) were a combination of either the second or third change. One, (less than 1%), of the procedures was attempted and discontinued before the removal of the tracheostomy tubes, and referred back to the surgical services and was successfully managed with no untoward effects to the patient. Conclusions: This is the first study to audit the outcome of speech-language pathologists' ability to successfully change a tracheostomy tube. The findings suggest that specially trained speech-language pathologists, acting as part of a multi-disciplinary care team, have the potential to safely change tracheostomy tubes in an acute care setting with the availability of immediate physician and respiratory therapy support. Additional clinical benefits of the speech-language pathologist changing tracheostomy tubes may include earlier facilitation of communication, decannulation and initiation of nutrition/hydration