Sex-specific-differences in cardiovascular risk in type-1-diabetes : a cross sectional study

Background: Little is known about the impact of sex-specific differences in the management of type 1 diabetes (T1DM). Thus, we evaluated the influence of gender on risk factors, complications, clinical care and adherence in patients with T1DM. Methods: In a cross-sectional study, sex-specific disparities in glycaemic control, cardiovascular risk factors, diabetic complications, concomitant medication use and adherence to treatment recommendations were evaluated in 225 consecutive patients (45.3% women) who were comparable with respect to age, diabetes duration, and body mass index. Results: Although women with T1DM had a higher total cholesterol than men, triglycerides were higher in obese men and males with HbA1c>7% than in their female counterparts. No sex differences were observed in glycaemic control and in micro- or macrovascular complications. However, the subgroup analysis showed that nephropathy was more common in obese men, hyperlipidaemic women and all hypertensive patients, whereas peripheral neuropathy was more common in hyperlipidaemic women. Retinopathy was found more frequently in women with HbA1c>7%, obese men and in both sexes with a long duration of diabetes. The multivariate analysis revealed that microvascular complications were associated with the duration of disease and BMI in both sexes and with hyperlipidaemia in males. The overall adherence to interventions according to the guidelines was higher in men than in women. This adherence was concerned particularly with co-medication in patients diagnosed with hypertension, aspirin prescription in elderly patients and the achievement of target lipid levels following the prescription of statins. Conclusions: Our data showed sex differences in lipids and overweight in patients with T1DM. Although glycaemic control and the frequency of diabetic complications were comparable between the sexes, the overall adherence to guidelines, particularly with respect to the prescription of statins and aspirin, was lower in women than in men

Accuracy, User Acceptability, and Safety Evaluation for the FreeStyle Libre Flash Glucose Monitoring System When Used by Pregnant Women with Diabetes.

Accuracy of the FreeStyle Libre™ Flash Glucose Monitoring System has not been evaluated in pregnant women with diabetes. The aim of this study was to determine accuracy (compared to self-monitoring of blood glucose [SMBG]), clinical safety, and acceptability of the FreeStyle Libre System when used at home by this population.Seventy-four participants, with type 1 (T1D, n = 24), type 2 (T2D, n = 11), or gestational (n = 39) diabetes, were enrolled across 13 sites (9 in United Kingdom, 4 in Austria). Average gestation was 26.6 ± 6.8 weeks (mean ± standard deviation), age was 30.5 ± 5.1 years, diabetes duration was 13.1 ± 7.3 years for T1D and 3.2 ± 2.5 years for T2D, and 49/74 (66.2%) used insulin to manage their diabetes. Sensors were worn for up to 14 days. Sensor glucose values (masked) were compared with capillary SMBG values (made at least 4 times/day).Clinical accuracy of sensor results versus SMBG results was demonstrated, with 88.1% and 99.8% of results within Zone A and Zones A and B of the Consensus Error Grid, respectively. Overall mean absolute relative difference was 11.8%. Sensor accuracy was unaffected by the type of diabetes, the stage of pregnancy, whether insulin was used, age or body mass index. User questionnaires indicated high levels of satisfaction with sensor wear, system use, and comparison to SMBG. There were no unanticipated device-related adverse events.Good agreement was demonstrated between the FreeStyle Libre System and SMBG. Accuracy of the system was unaffected by patient characteristics, indicating that the system is safe and accurate to use by pregnant women with diabetes

Gesatztes Unrecht

Diese Diplomarbeit behandelt die Rekonstruktion der Reform des Wiener Bettelei-Gesetzes aus politikwissenschaftlicher Sicht: ausgehend von einem kurzen geschichtlichen Überblick und grundsätzlichen Begriffs-Definitionen zum Thema Betteln werden verschiedene soziale Phänomene in Bezug sowohl auf die Existenz, als auch auf die Tätigkeit der BettlerInnen beschrieben. Im Speziellen geht es darum, wie und warum die BettlerInnen in der EU-Gesellschaft mehrheitlich abgelehnt werden: darunter fallen die Zugehörigkeit der BettlerInnen-Problematik zur (EU-) Bildpolitik, die Inklusion/Exklusion bzw. Marginalisierung der BettlerInnen in Bezug auf die EU-Gesellschaft - sowohl in ihren Heimatländern als auch in Wien bzw. West-EUropa – u.a. aus wirtschaftlichen Gründen und/oder aus Gründen der körperlichen Dysfunktionalität, die Feindbildkonstruktion im Allgemeinen und die Anwendbarkeit des Feindstrafrechts in Zusammenhang mit gesetzlichen Bettelverboten, die Zugehörigkeit der BettlerInnen zur Gruppe der ‚Überflüssigen’ und die historische Behandlung der BettlerInnen - insbesondere im Nationalsozialismus – und deren Parallelen zu den aktuellen Bettelverboten. Im zweiten Teil der Arbeit wird mittels Policy-Analyse erforscht, wie und warum das Wiener Bettelei-Gesetz zustandegekommen ist – vom Anlaß über das Agendasetting und die öffentliche Diskussion bis hin zum Gesetzesbeschluß im Wiener Landtag: mittels der ‚Advocacy-Koalitions-Theorie’ von Paul A. Sabatier werden die verschiedenen Faktoren, die zum Gesetzwerdungsprozeß des Wiener Bettel-Verbots beigetragen haben, also insbesondere politische und nicht-politische Akteure, die öffentliche Meinung und (veränderte) rechtliche Rahmenbedingungen, analysiert und hinsichtlich deren politischer Bedeutung eingeordnet. Zusammenfassend sollen also die Gründe für sowie die Art und Weise des Zustandekommens des Wiener Bettelei-Gesetzes analysiert werden und einigen gesellschaftspolitischen Phänomenen, die sich in Bezug auf die Bettelei ergeben, gegenübergestellt werden.From a political science perspective this thesis deals with the reconstruction of the reform of the Vienna begging-law: beginning with a short historical overview and basic definitions, various social phenomena caused by the existence and the activities of beggars shall be described. An important topic is about how and why beggars are rejected by the majority in the EU society: this includes membership of the policy-problem to (EU) visual-politics, the inclusion/exclusion or marginalization of the beggars in relation to the EU society - both in their home countries and in Vienna and Western Europe – for example caused by economic reasons and/or reasons of physical dysfunction, the enemy construction in general and the applicability of enemy-criminal-law in connection with begging-laws, the affiliation of the beggars to the superfluous-group, and the historical treatment of the beggars - especially in National Socialism - and their parallels to the current begging-laws. The second part of the thesis deals with a policy-analysis: how and why the Vienna begging-law has been developed - from the cause of the agenda setting and public debate to the enactment in the Vienna Landtag: using the ‘advocacy-coalition-theory' by Paul A. Sabatier the various factors that have contributed to the Vienna begging-law, especially political and non-political actors, the public opinion and the (transformed) legal framework will be analyzed and categorized depending on their political importance. In summary the reasons for and the nature and manner of the development of the Vienna begging-law are analyzed and compared with some socio-political phenomena caused by begging

An examination of the resources and relationships available to impoverished rural households to adapt and cope in response to HIV/AIDS: a survey of villages in the Sekhukhuneland region of South Africa's Limpopo Province.

This study utilises secondary analysis of data derived from the IMAGE study to examine the resources and relationships available to impoverished rural households in South Africa to adapt and cope with idiosyncratic and covariant crises. Set in the Sekhukhuneland region of Limpopo Province, the study encompasses eight villages and 9,500 households. HIV/AIDS is used as a proxy for chronic illness in the study, providing a unique context of vulnerability in which to frame the analysis of household means of adaptation and coping. The study employs the capital asset model of the sustainable livelihoods framework to provide a conceptual basis for detailing the diversity of resources and relationships available to households, both in isolation and in the broader context of the social network within which they exist. The study aims to augment the limited existing contextual research on the resources and coping mechanisms available to the rural poor of South and Southern Africa, specifically in the context of the HIV/AIDS epidemic. A significant proportion of the study population is reliant on debt for basic consumption, a majority of households lack access to banking or credit facilities and four-fifths of households have limited or no capacity to acquire even R50 to cover emergency expenses. Financial capital, the most readily convertible of asset types, thus, constitutes a reliable resource for only a few households and is inaccessible to the majority of the population. Natural capital is similarly unavailable to most households as three-quarters of the population do not own their land. Lacking ownership and control, most households are, unable to alter land-use or sell land and property as a coping strategy in times of crisis. The population is also characterised by low levels of physical capital ownership across all modern and livestock asset types. The scarcity of cash-convertible or readily-exchangeable physical assets, thus, further limits the coping strategies available to most households. Given the magnitude and severity of financial, physical and natural asset scarcity at the household level, the instrumental value of social capital is significantly diminished. Regardless of the strength of social cohesion and the willingness of individuals in a population to assist others in times of crisis, a lack of necessary financial, physical or natural capital within the network undermines and effectively nullifies the value of relational resources as a means of responding and adapting to crises. Beyond the scarcity of available capital within the social network, there is significant interhousehold variation in perceived ability to access social capital, and a marked disparity between the perceived availability of assistance and the willingness of households to assist others, with two-thirds of households believing they would be able to access financial and in-kind assistance in a time of crisis, but only one-third of households in the population acknowledging their own willingness to assist others. Social capital is, thus, not a significant or available means of adaptation and coping for the majority of households. In theory, affected households have a diversity of available coping strategies to respond and adapt to crises. However, given the severity of physical, natural and financial resource scarcity among the low-income rural population, the nature of relational resources and available social capital, as well as the high prevalence of HIV/AIDS and the clustered incidence of the epidemic in South Africa, most low-income rural households have few available options beyond reducing consumption and dispersing household members

Incretin Effect in Women with Former Gestational Diabetes within a Short Period after Delivery

Background and Aims. Women with former gestational diabetes (fGDM) are characterized by impaired beta-cell function (BC). Incretin hormones contribute to insulin secretion after oral administration of glucose. We aimed to assess the possible role of incretins on altered insulin release in fGDM. Materials and Methods. We studied 104 fGDM women within 6 months after delivery and 35 healthy women after normal pregnancy (CNT) with a 75 g oral (OGTT) and a 0.33 g/kg intravenous (IVGTT) glucose test, both lasting 3 h. The ratio of suprabasal areas under the concentration curves for glucose (dAUCGL) and C-peptide (dAUCCP) evaluated BC during OGTT (BCOG) and IVGTT (BCIV). Incretin effect was computed in all fGDM and in fGDM with normal tolerance (fGDMNGT) and with impaired glucose regulation (fGDMIGR). Results. dAUCGL of fGDM was higher (P < 0.0001) than CNT for both tests; while dAUCCP were not different. BCOG and BCIV were lower in fGDM versus CNT (1.42 ± 0.17nmolCP/mmolGLUC versus 2.53 ± 0.61, P = 0.015 and 0.41 ± 0.03 versus 0.68 ± 0.10, P = 0.0006, respectively). IE in CNT (66 ± 4 %) was not different from that of all fGDM (59 ± 3) and fGDMNGT (60 ± 3), but higher than that of fGDMIGR (52 ± 6; P = 0.03). IE normalized to BMI was 2.77 ± 0.19 % m2/kg in CNT, higher than that of fGDMIGR (1.75 ± 0.21; P = 0.02) and also of fGDMNGT  (2.33 ± 0.11; P = 0.038). Conclusion. Compromised IE characterizes fGDMIGR. In both fGDM categories, regardless their glucose tolerance, IE normalized to BMI was reduced, signifying an intrinsic characteristic of fGDM. Therefore, the diminished IE of fGDM seems to reflect an early abnormality of the general beta-cell dysfunction in the progression toward type 2 diabetes

Does Motor Skill Level Affect Physical Activity-Related Self-Efficacy and Enjoyment in Third Grade Students?

Childhood obesity has nearly tripled in the past three decades. Because of these alarming numbers, government health officials are highly concerned with causes of this trend. It has been shown that poor diet, certain behaviors such as television viewing, and a lack of physical activity are some of the causes of this increase. The purpose of this study was to examine the relationship between self-efficacy and enjoyment and a child\u27s motor skill level. The study participants included 80 third grade students (43 girls and 37 boys). The sample was split into an intervention group (n=43) and a control group (n=37). The intervention group received 4 weeks of the NutriActive experience before and after school. This experience included lessons on healthy eating, disease prevention, and motor skills. The control group participated in their normal physical education classes as usual. Self-efficacy and enjoyment of three motor skills including jump roping, kicking for accuracy, and throwing for accuracy were assessed using short questionnaires. The intervention group filled out the self-efficacy and enjoyment questionnaires at baseline and post-test. The control group filled out the self-efficacy questionnaire at both time points, but only completed the enjoyment questionnaire during the post-test. Motor skill was measured in both groups at both time points by assessing how many times a student completed each skill successfully. The jump rope, kick, and throw increased for the intervention group throughout the 4 weeks (p\u3c.05). The control group experienced a 40.5% increase in jump rope through the 4 weeks (p\u3c.05). At post-test, the intervention group was significantly better than the control group at all motor skills except for kicking. There was no significant difference between the groups or within each group in self-efficacy scores or enjoyment scores, even though the intervention group had significant increases in all motor skills except for kicking. Gender was a significant predictor of most self-efficacy and one enjoyment scores, whereas skill level emerged as a significant predictor of post-test self-efficacy in the jump rope, post-test enjoyment in the jump rope, and post-test enjoyment in the throw. Boys were better than girls at throwing, although the difference was not statistically significant. Compared with boys, girls had a higher mean jump rope enjoyment score (p\u3c.001), as well as the mean jump rope skill score (p=.089). The results of regression analysis suggest that the higher the skill level of a child, the higher that child\u27s self-efficacy of that skill. The results also indicate that children may have to reach a certain level of motor skill before it is reflected in their self-efficacy and enjoyment level

Do women with diabetes need more intensive action for cardiovascular reduction than men with diabetes?

Purpose of Review: This narrative review makes the case for greater efforts to reduce cardiovascular disease (CVD) risk in women with diabetes. Recent Findings: In a recent meta-analysis including five CVOTs of diabetes medications with 46,606 subjects, women (vs men) with type 2 diabetes had a higher relative risk for stroke (RR 1.28; 95% CI 1.09, 1.50) and heart failure (1.30; 1.21, 1.40). Prior studies found higher “within-gender” RR for CVD mortality in women with diabetes although men have an absolute higher risk. Women with prior gestational diabetes mellitus (GDM) have a 2-fold higher CVD risk than the background population. Worse CVD and CVD risk factor management in women, as well as lower female therapy adherence, contribute further to these disparities. Summary: The mechanism behind this excess risk includes biological, hormonal, socioeconomic, clinical, and behavioral factors that still require further investigation. The need for more intensive CVD reduction in women now includes more attention to screening for both incident diabetes and CVD risk factors among high-risk women