The controversy surrounding Selenium
Filed under: Type 2, Diet, Research
I'm guessing that someone already blogged about this, but since it is no longer on this main page, I felt that it would be worth mentioning again.
Selenium. It's a naturally occurring trace mineral found in soil and food. It supposedly helps to metabolize food. So far, so good, right? Well, researchers have also discovered that selenium may also increase a person's risk of developing type 2 diabetes. That's where things become not so good.
Ironically, the study that led to this discovery was created to find out whether selenium would help PREVENT the onset of diabetes. Instead, researchers found just the opposite -- that subjects who regularly consumed selenium demonstrated an increased risk of developing diabetes.
But, the results of this study were far from conclusive. It's important to keep that in mind. Of 600 participants who took selenium, 58 developed diabetes. Of the 600 participants who took a placebo, 39 developed diabetes. Clearly, the difference of a mere 21 people does not conclusively show that selenium can increase a person's risk of diabetes. However, it certainly is enough of a disparity to raise a few eyebrows.
Sally the fabulous hypo-detecting dog
Filed under: Type 1, Research, Support, Complications, Personalities
On the 18th of July I blogged about a study that aims to explain how dogs are able to detect approaching hypoglycemic episodes in diabetic humans. Well, reader Margaret from Cumbria, in the UK, posted a comment about her dog, Sally, who is one of these amazing hypo-detecting dogs. I asked Margaret to tell us more and she obliged. Here is Sally's story:Sally is a thirteen and a half-year-old Border Collie mix who lives with human "parents" Margaret and Alan, and canine buddy Poppy, who is a Cocker Spaniel. That's Sally (right) and Poppy (left) in the picture. Margaret and Alan adopted Sally from an animal shelter when she was just a tiny pup. Little did they know that Sally came complete with a special gift: she knows when Margaret, who has type 1 diabetes, is heading dangerously low.
"She has always been a sensitive dog," writes Margaret. "She gets very upset when there is thunder in the air. She shakes uncontrollably - even if we never even hear the thunder, but she knows it is about somewhere." As for detecting oncoming hypos, Margaret says: "my husband, perhaps more than me, notices her reaction. I can be just sitting staring into space, not doing anything, and Alan comes in, sees me and sees Sally acting strangely, by which I mean slinking around, really unhappy and just looking so miserable, trying to hide in a corner and she doesn't do that for any other reason, not even for the thunder."
I asked Margaret if Sally had received any training or if they rewarded or encouraged her reaction in any way. No, replied Margaret. "We certainly don't reward her for this. I really don't want her to be so unhappy about me! But, according to my husband, it is pretty obvious when he sees Sally behaving in this way - even though it is not obvious by my actions - that I am hypo, and this has been proved to be so." She adds, "Sally is very close to me. She is with me all the time and she has done this for as long as we can remember."
Margaret has had type 1 for thirty-five years. She was nearly twenty years-old when diagnosed. She also writes that one of her three sisters was diagnosed with type 1 at age seven, but is still going strong - fifty-seven years later.
Thanks, guys, for sharing your story!
Deep belly fat not so evil after all?
Filed under: Type 2, Lifestyle, Research, Daily News
Did you hear about renowned Harvard scientist Barbara Kahn's latest published research? I blogged about it recently. Kahn and colleagues state, in a report published in Cell Metabolism (July 2007), that it's possible to use a simple blood test to detect the presence of a specific protein called RBP4. Kahn et al say the presence of RBP4 can be used to measure accumulations of deep belly fat. Underpinning this research is a belief that such accumulations of belly fat increase risk for metabolic syndrome, leading to various maladies including heart disease and diabetes.However, not everyone accepts this point of view. A Yale research team says that deep belly fat may not be so evil after all. The researchers, who are based at Yale University School of Medicine in Chevy Chase, Maryland, assert that metabolic syndrome is caused not by belly fat but by insulin resistance in skeletal muscle. This resistance, they state, makes it tough for the body to manufacture glycogen, so - in people who are insulin resistant - energy that cannot be stored as glycogen gets diverted into fatty acid production, which then contributes to metabolic syndrome.
The team compared abdominal fat levels in young and healthy individuals, some of whom were insulin sensitive and some of whom were insulin resistant. The result? "There is absolutely no difference in the volume of abdominal fat," states Yale's Gerald I. Shulman, who was lead author of the study. Abdominal fat, says Dr. Shulman, "may come later in the course of the disease [metabolic syndrome], but it's not a primary, underlying factor."
[RESEARCH] Case-control study of self reported genitourinary infections and risk of gastroschisis: findings from the national birth defects prevention study, 1997-2003
Objective To assess the association between genitourinary infections in the month before conception to the end of the first trimesterand gastroschisis.
Design Case-control study with self reported infections from a computer assisted telephone interview.
Setting National birth defects prevention study, a multisite, population based study including 10 surveillance systems for birth defects in the United States.
Participants Mothers of 505 offspring with gastroschisis and 4924 healthy liveborn infants as controls.
Main outcome measure Adjusted odds ratios for gastroschisis with 95% confidence intervals.
Results About 16% (n=81) of case mothers and 9% (n=425) of control mothers reported a genitourinary infection in the relevant time period; 4% (n=21) and 2% (n=98) reported a sexually transmitted infection and 13% (n=67) and 7% (n=338) reported a urinary tract infection, respectively. Case mothers aged <25 years reported higher rates of urinary tract infection alone and in combination with a sexually transmitted infection compared with control mothers. In women who reported both types of infection, there was a greater risk of gastroschisis in offspring (adjusted odds ratio 4.0, 95% confidence interval 1.4 to 11.6).
Conclusion There is a significant association between self reported urinary tract infection plus sexually transmitted infection just before conception and in early pregnancy and gastroschisis.
Crestor shown to reverse artery blockages in study
Filed under: Prevention, Research, Drugs
Atherosclerosis, better known as the buildup of plaque in the arteries, was thought to be an irreversible problem. The only option for actually reopening arteries was angioplasty or stents, and medication could only slow or arrest the gradual narrowing. But, doctors at the Cleveland Clinic found that by using the max dosage of the cholesterol drug Crestor, the fat clogs blocking their patients' arteries were reduced by 7 percent over 2 years.
This of course does not mean that people with clogged arteries should start downing bottles of Crestor, but it does sheds more light on the fact that lowering bad (LDL) cholesterol is the best way to prevent heart attacks. But, from this study it is possible to consider the future use of Crestor, and how it appears to actually reverse the plaque accumulation in blood vessels, something that starts as early as childhood.
Again, this is still further studies that need to be done, but this is promising information for people who thought that medication could only slow the eventual narrowing of vessels. In time, it's very possible that this method of using Crestor to clear blockages could be an alternative to surgery.
[RESEARCH] Effect of antibiotic prescribing on antibiotic resistance in individual children in primary care: prospective cohort study
Objective To assess the effect of community prescribing of an antibiotic for acute respiratory infection on the prevalence of antibiotic resistant bacteria in an individual child.
Study design Observational cohort study with follow-up at two and 12 weeks.
Setting General practices in Oxfordshire.
Participants 119 children with acute respiratory tract infection, of whom 71 received a ?lactam antibiotic.
Main outcome measures Antibiotic resistance was assessed by the geometric mean minimum inhibitory concentration (MIC) for ampicillin and presence of the ICEHin1056 resistance element in up to four isolates of Haemophilus species recovered from throat swabs at recruitment, two weeks, and 12 weeks.
Results Prescribing amoxicillin to a child in general practice more than triples the mean minimum inhibitory concentration for ampicillin (9.2 µg/ml v 2.7 µg/ml, P=0.005) and doubles the risk of isolation of Haemophilus isolates possessing homologues of ICEHin1056 (67% v 36%; relative risk 1.9, 95% confidence interval 1.2 to 2.9) two weeks later. Although this increase is transient (by 12 weeks ampicillin resistance had fallen close to baseline), it is in the context of recovery of the element from 35% of children with Haemophilus isolates at recruitment and from 83% (76% to 89%) at some point in the study.
Conclusion The short term effect of amoxicillin prescribed in primary care is transitory in the individual child but sufficient to sustain a high level of antibiotic resistance in the population.
[RESEARCH] Correlations among measures of quality in HIV care in the United States: cross sectional study
Objective To determine whether a selected set of indicators can represent a single overall quality construct.
Design Cross sectional study of data abstracted during an evaluation of an initiative to improve quality of care for people with HIV.
Setting 69 sites in 30 states.
Data sources Medical records of 9020 patients.
Main outcome measures Adjusted performance rates at site level for eight measures of quality of care specific to HIV and a site level summary performance score (the number of measures for which the site was in the top quarter of the distribution).
Results Of 28 site level correlations between measures, two were greater than 0.40, two were between 0.30 and 0.39, four were between 0.20 and 0.29, and the 20 remaining were all less than 0.20. One site was in the top quarter for seven measures, but no sites were in the top quarter for six or eight of the measures. Across the eight quality measures, sites were in the top quarter no more often than predicted by a chance (binomial) distribution.
Conclusions The quality suggested by one measured indicator cannot necessarily be generalised to unmeasured indicators, even if this might be expected for clinical or other reasons.
[RESEARCH] Low dose aspirin and cognitive function in the women's health study cognitive cohort
Objective To determine whether low dose aspirin protects women aged 65 or more against cognitive decline.
Design Cohort study within both arms of the women's health study, a randomised, double blind, placebo controlled trial of low dose aspirin for the primary prevention of cardiovascular disease and cancer, 1992-5.
Setting Women's health study, 1998-2004.
Participants 6377 women aged 65 or more.
Interventions Low dose aspirin (100 mg on alternate days) or placebo for a mean of 9.6 years.
Main outcome measures Women had three cognitive assessments at two year intervals by telephone. The battery to assess cognition included five tests measuring general cognition, verbal memory, and category fluency. The primary prespecified outcome was a global score, averaging performance across all tests. The key secondary outcome was a verbal memory score, averaging performance on four measures of verbal memory.
Results At the initial assessment (mean 5.6 years after randomisation) cognitive performance in the aspirin group was similar to that of the placebo group (mean difference in global score -0.01, 95% confidence interval -0.04 to 0.02). Mean decline in the global score from the first to the final cognitive assessment was also similar in the aspirin compared with placebo groups (mean difference 0.01, -0.02 to 0.04). The risk of substantial decline (in the worst 10th centile of decline) was also comparable between the groups (relative risk 0.92, 0.77 to 1.10). Findings were similar for verbal memory; however, a 20% lower risk was observed for decline in category fluency with aspirin (relative risk 0.80, 0.67 to 0.97).
Conclusion Long term use of low dose aspirin does not provide overall benefits for cognition among generally healthy women aged 65 or more.
[RESEARCH] Social inequalities in self reported health in early old age: follow-up of prospective cohort study
Objective To describe differences in trajectories of self reported health in an ageing cohort according to occupational grade.
Design Prospective cohort study of office based British civil servants (1985-2004).
Participants 10 308 men and women aged 35-55 at baseline, employed in 20 London civil service departments (the Whitehall II study); follow-up was an average of 18 years.
Main outcome measures Physical component and mental component scores on SR-36 measured on five occasions.
Results Physical health deteriorated more rapidly with age among men and women from the lower occupational grades. The average gap in physical component scores between a high and low grade civil servant at age 56 was 1.60 and this gap increased by 1 over 20 years. The average physical health of a 70 year old man or woman who was in a high grade position was similar to the physical health of a person from a low grade around eight years younger. In mid-life, this gap was only 4.5 years. Although mental health improved with age, the rate of improvement is slower for men and women in the lower grades.
Conclusions Social inequalities in self reported health increase in early old age. People from lower occupational grades age faster in terms of a quicker deterioration in physical health compared with people from higher grades. This widening gap suggests that health inequalities will become an increasingly important public health issue, especially as the population ages.
[RESEARCH] Survival of extremely premature babies in a geographically defined population: prospective cohort study of 1994-9 compared with 2000-5
Objective To assess changes in survival for infants born before 26 completed weeks of gestation.
Design Prospective cohort study in a geographically defined population.
Setting Former Trent health region of the United Kingdom.
Subjects All infants born at 22+0 to 25+6 weeks’ gestation to mothers living in the region. Terminations were excluded but all other births of babies alive at the onset of labour or the delivery process were included.
Main outcome measures Outcome for all infants was categorised as stillbirth, death without admission to neonatal intensivecare, death before discharge from neonatal intensivecare, and survival to discharge home in two time periods: 1994-9 and 2000-5 inclusive.
Results The proportion of infants dying in delivery rooms was similar in the two periods, but a significant improvement was seen in the number of infants surviving to discharge (P<0.001). Of 497 infants admitted to neonatal intensive care in 2000-5, 236 (47%) survived to discharge compared with 174/490 (36%) in 1994. These changes were attributable to substantial improvements in the survival of infants born at 24 and 25 weeks. During the 12 years of the study none of the 150 infants born at 22 weeks’ gestation survived. Of the infants born at 23 weeks who were admitted to intensive care, there was no significant improvement in survival to discharge in 2000-5 (12/65 (18%) in 2000-5 v 15/81 (19%) in 1994-9).
Conclusions Survival of infants born at 24 and 25 weeks of gestation has significantly increased. Although over half the cohort of infants born at 23 weeks wasadmitted to neonatalintensive care, there was no improvement in survival at this gestation. Care for infants born at 22 weeks remained unsuccessful.