Low carbohydrate meals or a small dose of insulin normalises one-hour blood glucose in a woman with normal glucose tolerance and elevated one-hour postload glucose: A case report

Diabetes is diagnosed by 2-hour BGL ≥ 11.1 mmol/L on OGTT, fasting BGL ≥ 7.0 mmol/L or HbA1C ≥ 6.5%. IFG and IGT are similarly diagnosed by elevated fasting and 2-hour BGLs. Although-hour BGL is routinely measured, results are classified as NGT if fasting and 2-hour levels are normal, irrespective of elevation at 1 hour. It has, however, been shown that 1-hour postload BGL is a strong predictor of future risk for type 2 diabetes and vascular disease, even in those with NGT. Additionally Meisinger et al. identified 1-hour postload glycaemia as a long-term predictor for all-cause mortality in men without diabetes. There is no normal range for 1-hour glucose, but ≥ 8.6 mmol/L has been identified as a cut-off marking increased cardiovascular and diabetes risk. It has been suggested that recognition and management of those with NGT and 1-hour glucose ≥ 8.6mmol/L may reduce incidence of diabetes and vascular events

Misinterpreting P-Values in Research

The overuse of p-values to dichotomize the results of research studies as either being either significant or non-significant has taken some investigators away from the main task of determining the size of the difference between groups and the precision with which it is measured. Presenting the results of research as statements such as “p 0.05”, “NS” or as precise p-values has the effect of oversimplifying study findings. Further information regarding the size of the difference between groups is required. Presenting confidence intervals for the difference in effect, of say two treatments, in addition to p-values, has the distinct advantage of presenting imprecision on the scale of the original measurement. A statistically significant test also does not imply that the observed difference is clinically important or meaningful

Omitting follow-up food after initial hypoglycaemic treatment does not increase the likelihood of repeat hypoglycaemia

Introduction: Guidelines for self-treatment of hypoglycaemia specify initial treatment with quick-acting carbohydrate until blood glucose levels normalize and then follow-up with longer-acting carbohydrate. The few studies investigating follow-up show 29–57% omission or undertreatment with follow-up carbohydrate but do not investigate the association of this with repeat hypoglycaemia. This study aimed to develop, validate and administer a questionnaire to delineate this association. The timeframe targeted was 2 h post primary hypoglycaemic event (PPHE), the time influenced by long-acting carbohydrate. Methods: A questionnaire was generated, test–retest reliability assessed, and it was piloted on convenience samples from the target population. The final version was administered to all insulin-treated individuals attending an outpatient diabetes clinic over 4 weeks (169).Results: Questionnaire development: readability (69.6—standard/easy), test–retest reliability (Cohen’s kappa 0.57–0.91) and return rate (72.2%) were all acceptable. Questionnaire data: questionnaires were returned by 122 participants (63 males/59 females). Method of insulin administration was subcutaneous insulin injections (91%) and continuous subcutaneous insulin infusion (CSII) (9%). Repeat hypoglycaemia within 2 h PPHE was reported by 8.2% of respondents. There was no significant difference for age, gender and diabetes duration between those reporting repeat hypoglycaemia and those without. Consumption of follow-up longer-acting carbohydrate was reported by 58.2% of responders with 48% of these using long-acting and 52% medium-acting carbohydrate foods. Method of insulin administration and consumption of follow-up food were significantly associated with repeat hypoglycaemia (P = 0.015, 0.039) but presence or absence of symptoms and duration of action of carbohydrate were not significantly associated (P = 0.103, 0.629). Hierarchical logistic regression analysis showed omission of follow-up food PPHE was not a significant predictor of increased likelihood of repeat hypoglycaemia within 2 h PPHE, irrespective of method of insulin administration (P = 0.085). Conclusion: This study supports guidelines that recommend judicious, rather than routine use of follow-up longer-acting carbohydrate PPHE

Tailored, iterative, printed dietary feedback is as effective as group education in improving dietary behaviours: results from a randomised control trial in middle-aged adults with cardiovascular risk factors

<p>Abstract</p> <p>Background</p> <p>Tailored nutrition interventions have been shown to be more effective than non-tailored materials in changing dietary behaviours, particularly fat intake and fruit and vegetable intake. But further research examining efficacy of tailored nutrition education in comparison to other nutrition education methods and across a wider range of dietary behaviours is needed. The Stages to Healthy Eating Patterns Study (STEPs) was an intervention study, in middle-aged adults with cardiovascular risk factors, to examine the effectiveness of printed, tailored, iterative dietary feedback delivered by mail in improving short-term dietary behaviour in the areas of saturated fat, fruit, vegetable and grain and cereal intake.</p> <p>Methods</p> <p>STEPs was a 3-month randomised controlled trial with a pre and post-test design. There were three experimental conditions: 1) tailored, iterative, printed dietary feedback (TF) with three instalments mail-delivered over a 3-month period that were re-tailored to most recent assessment of dietary intake, intention to change and assessment of self-adequacy of dietary intake. Tailoring for dietary intake was performed on data from a validated 63-item combination FFQ designed for the purpose 2) small group nutrition education sessions (GE): consisting of two 90-minute dietitian-led small group nutrition education sessions and 3) and a wait-listed control (C) group who completed the dietary measures and socio-demographic questionnaires at baseline and 3-months later. Dietary outcome measures in the areas of saturated fat intake (g), and the intake of fruit (serves), vegetables (serves), grain and cereals as total and wholegrain (serves) were collected using 7-day estimated dietary records. Descriptive statistics, paired t-tests and general linear models adjusted for baseline dietary intake, age and gender were used to examine the effectiveness of different nutrition interventions.</p> <p>Results</p> <p>The TF group reported a significantly greater increase in fruit intake (0.3 serves/d P = 0.031) in comparison to GE and the C group. All three intervention groups showed a reduction in total saturated fat intake. GE also had a within-group increase in mean vegetable intake after 3 months, but this increase was not different from changes in the other groups.</p> <p>Conclusions</p> <p>In this study, printed, tailored, iterative dietary feedback was more effective than small group nutrition education in improving the short-term fruit intake behaviour, and as effective in improving saturated fat intake of middle-aged adults with cardiovascular risk factors. This showed that a low-level dietary intervention could achieve modest dietary behaviour changes that are of public health significance.</p

Vision Self-Mmanagement For Older Adults: a Randomised Controlled Trial

Background/aims Ageing of the population will result in unprecedented numbers of older adults living with age-related vision loss (ARVL). Self-management models improve health outcomes and reduce healthcare costs; however, the principles have rarely been applied in low vision services. Methods A two-armed randomised controlled trial of older adults (n=77) with ARVL compared ‘usual care’ provided by a not-for-profit community agency with an extended model of care (usual care+self-management group intervention). The primary outcome variable (participation in life situations) was measured using the Activity Card Sort. Secondary outcome measures examined general health and vision-specific domains. Results The intention-to-treat analysis demonstrated that the extended model produced significantly better participation in life situations at post-test when compared with the usual care only group. Gains were made regardless of whether participants were, or were not, depressed at baseline. The addition of the self-management group was also successful in significantly reducing depression, increasing physical and mental health, generalised and domain-specific self-efficacy, and adjustment to ARVL. With the exception of adjustment and mental health, differences were still apparent at 12 weeks\u27 follow-up. Conclusion Addition of self-management significantly improved general health and vision-specific rehabilitation outcomes for older adults with ARVL

Amyloid-β colocalizes with apolipoprotein B in absorptive cells of the small intestine

Background: Amyloid-β is recognized as the major constituent of senile plaque found in subjects with Alzheimer's disease. However, there is increasing evidence that in a physiological context amyloid-β may serve as regulating apolipoprotein, primarily of the triglyceride enriched lipoproteins. To consider this hypothesis further, this study utilized an in vivo immunological approach to explore in lipogenic tissue whether amyloid-β colocalizes with nascent triglyceride-rich lipoproteins. Results: In murine absorptive epithelial cells of the small intestine, amyloid-β had remarkable colocalization with chylomicrons (Manders overlap coefficient = 0.73 ± 0.03 (SEM)), the latter identified as immunoreactive apolipoprotein B. A diet enriched in saturated fats doubled the abundance of both amyloid-β and apo B and increased the overlap coefficient of the two proteins (0.87 ± 0.02). However, there was no evidence that abundance of the two proteins was interdependent within the enterocytes (Pearson's Coefficient < 0.02 ± 0.03), or in plasma (Pearson's Coefficient < 0.01). Conclusion: The findings of this study are consistent with the possibility that amyloid-β is secreted by enterocytes as an apolipoprotein component of chylomicrons. However, secretion of amyloid-β appears to be independent of chylomicron biogenesis

Synergistic effects of high fat feeding and apolipoprotein E deletion on enterocytic amyloid-beta abundance

Background: Amyloid-β (Aβ), a key protein found in amyloid plaques of subjects with Alzheimer's disease is expressed in the absorptive epithelial cells of the small intestine. Ingestion of saturated fat significantly enhances enterocytic Aβ abundance whereas fasting abolishes expression. Apolipoprotein (apo) E has been shown to directly modulate Aβ biogenesis in liver and neuronal cells but it's effect in enterocytes is not known. In addition, apo E modulates villi length, which may indirectly modulate Aβ as a consequence of differences in lipid absorption. This study compared Aβ abundance and villi length in wild-type (WT) and apo E knockout (KO) mice maintained on either a low-fat or high-fat diet. Wild-type C57BL/6J and apo E KO mice were randomised for six-months to a diet containing either 4% (w/w) unsaturated fats, or chow comprising 16% saturated fats and 1% cholesterol. Quantitative immunohistochemistry was used to assess Aβ abundance in small intestinal enterocytes. Apo E KO mice given the low-fat diet had similar enterocytic Aβ abundance compared to WT controls. Results: The saturated fat diet substantially increased enterocytic Aβ in WT and in apo E KO mice, however the effect was greater in the latter. Villi height was significantly greater in apo E KO mice than for WT controls when given the low-fat diet. However, WT mice had comparable villi length to apo E KO when fed the saturated fat and cholesterol enriched diet. There was no effect of the high-fat diet on villi length in apo E KO mice. Conclusion: The findings of this study are consistent with the notion that lipid substrate availability modulates enterocytic Aβ. Apo E may influence enterocytic lipid availability by modulating absorptive capacity

Assessing employees perception on health and safety management in public hospitals

This article examined the perception of employees regarding the management of Occupational Health and Safety (OHS) in public hospital in Malaysia.418 employees from three state hospitals in the northern region of Malaysia participated in this study and that gave a response rate of 43.15%. Data was collected using a set of questionnaires which consists of variables including safety satisfaction and feedback, safety communication, role of supervisor, work pressure, training and competence, management commitment, safety involvement, safety objectives, safety reporting, and leadership style.Data analysis was done using descriptive statistics, t-test, one-way ANOVA, Pearson correlation and multiple regressions.Findings showed that employees perceived safety reporting as the most important dimension and work pressure as the least important component in the OHS practices in their workplaces.Empirical evidence indicated that there was no significant difference in safety satisfaction and feedback between male and female workers but there was a significant difference among these employees in safety involvement.In addition, results also showed that there was a significant difference in safety satisfaction faced by job position like nurse but there was no significant difference between employees with job tenure comprise of less than 1 year, 2 to 15 years, and 16 years and above.Findings suggested that there was a significant positive correlation between safety satisfaction and feedback and safety communication, safety involvement, training and competence, safety reporting, work pressure, safety objectives, management commitment, role of supervisors, and leadership style.Regression analysis revealed approximately 54.5% (R2 = 0.545) of variance in safety satisfaction and feedback, that was simultaneously explained by five independent variables including safety involvement, safety reporting, work pressure, management commitment, and safety objectives

Occupational safety and health management in Malaysia: An overview

In today’s economy, globalization has shown tremendous impact on companies. Global competition increases safety and health risks and companies incurred additional cost on safety. To meet the challenges posed by these changes, revamping safety and health practices through strategies to improve performance is critical so as to motivate workforce in creating a safe and healthy environment that lead to decrease work-related accidents and ill-health in the workplace. Although work-related accidents and ill-health are preventable, there is a need for collaboration at the international, regional, national and enterprise levels to accomplish this mission with a positive commitment amongst all concerned. Due to that fact, companies need to focus on continual improvement of their performance in order to survive in the marketplace. One of the mean to encourage employers to achieve a higher standard of safety and health in the workplace is through effective occupational safety and health management

Validity and reliability of the safety climate measurement in Malaysia

Organizations started giving attention to organizational and management impact on safety performance particularly the function of safety climate.Inconsistency concerning the appropriate elements that should be in safety climate scale has called for an assessment of the safety climate construct.The purpose of this study was to develop a measure of attitudes and perceptions of safety that are related to safety climate in the workplace.The Safety Climate Assessment Scale(SCAS) was administered to 372 employees ranging from physician to support staff.Analysis of data was done using statistical analysis from the SPSS version twelve. Safety experts reviewed the content validity of the safety climate measurement. Construct validity was analyzed by the exploratory factor analysis, and concurrent validity was examined by correlations.Cronbach’s alpha was used to measure internal consistency reliability.The results revealed acceptable internal consistency reliability, content validity, construct validity and concurrent validity for the SCAS. The SCAS scores had acceptable overall internal consistency reliability (r = .950). The correlation analysis indicated that scores on the 10 dimension scales of safety climate were moderately dependable