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Low Risk (low + risk)
Kinds of Low Risk Terms modified by Low Risk Selected AbstractsHigh Risk Groups Often Have Higher Levels of Alcohol Response Than Low Risk: The Other Side of the CoinALCOHOLISM, Issue 2 2010David B. Newlin First page of article [source] Despite Profile Suggesting Low Risk, Indian-Born U.S. Mothers Have High Levels of Some Poor Birth OutcomesPERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH, Issue 6 2003S. London No abstract is available for this article. [source] A Safe and Cost-Effective Short Hospital Stay Protocol to Identify Patients at Low Risk for the Development of Significant Hypocalcemia After Total ThyroidectomyTHE LARYNGOSCOPE, Issue 6 2006Zayna S. Nahas BS Abstract Objective: The objective of this retrospective chart review was to determine if serial postoperative serum calcium levels early after total thyroidectomy can be used to develop an algorithm that identifies patients who are unlikely to develop significant hypocalcemia and can be safely discharged within 24 hours after surgery. Methods: Records of 135 consecutive patients who underwent total/completion thyroidectomy and were operated on by the senior author from 2001 to 2005 have been reviewed. For the entire study group, reports of the early postoperative serum calcium levels (6 hours and 12 hours postoperatively), final thyroid pathology, preoperative examination, inpatient course, and postoperative follow up were reviewed. An endocrine medicine consultation was obtained for all patients while in the hospital after surgery. For patients who developed significant hypocalcemia, reports of their management and the need for readmission or permanent medications for hypoparathyroidism were reviewed. According to the change in serum calcium levels between 6 hours and 12 hours postoperatively, patients were divided into two groups: 1) positive slope (increasing) and 2) nonpositive (nonchanging/decreasing). Results: All patients with a positive slope (50/50) did not develop significant hypocalcemia in contrast to only 59 of 85 patients (69.4%) with a nonpositive slope (P < .001, positive predictive value of positive slope in predicting freedom from significant hypocalcemia = 100%, 95% confidence interval = 92.9,100). In the nonpositive slope group, 61 patients had a serum calcium level ,8 mg/dL at 12 hours postoperatively (,0.5 mg/dL below the low end of normal), and 53 (87%) of these patients remained free of significant hypocalcemia in contrast to only 6 (25%) of 24 patients with serum calcium level <8 mg/dL at 12 hours postoperatively (sensitivity = 90%, positive predictive value = 87%). In addition, of the eight patients who developed significant hypocalcemia in the nonpositive slope group with a serum calcium level ,8 mg/dL at 12 hours postoperatively, 7 (88%) patients developed the signs and symptoms during the first 24 hours after total thyroidectomy. Readmission and permanent need for calcium supplementation happened in two patients, respectively, all with serum calcium levels <8 mg/dL at 12 hours after total thyroidectomy. The compressive and/or symptomatic large multinodular goiter as an indication for thyroidectomy was associated with developing significant hypocalcemia (P < .05). There was no statistically significant correlation between the development of significant hypocalcemia and gender, age, thyroid pathology other than goiter, or neck dissection. Conclusion: Patients with a positive serum calcium slope (t = 6 and 12 hours) after total thyroidectomy are safe to discharge within 24 hours after surgery with patient education with or without calcium supplementation. In addition, patients with a nonpositive slope and a serum calcium level ,8 mg/dL at 12 hours postoperatively (,0.5 mg/dL below the low end of normal) are unlikely to develop significant hypocalcemia, especially beyond 24 hours postoperatively, and therefore can be safely discharged within 24 hours after total thyroidectomy with patient education and oral calcium supplementation. Our management algorithm identifies those patients at low risk of developing significant hypocalcemia early in the postoperative course after total thyroidectomy to allow for a short hospital stay and safe discharge. [source] Factors Associated with the Choice of Delivery without Epidural Analgesia in Women at Low Risk in FranceBIRTH, Issue 3 2008Camille Le Ray MD ABSTRACT: Background: Regional anesthesia is used for three-fourths of the deliveries in France. Epidural analgesia during labor is supposed to be available to all women at low risk. The purpose of our study was to examine how the choice of delivery without an epidural varied in this context according to women's characteristics, prenatal care, and type of maternity unit. Methods: The 2003 National Perinatal Survey in France collected data about a representative sample of births. We selected 8,233 women who were at low risk and therefore should have been able to choose whether or not to deliver without epidural analgesia. Women were interviewed in the maternity unit after delivery. The factors associated with women's choice to deliver without epidural analgesia were studied with multivariable analyses. Results: Of the 2,720 women who gave birth without epidural analgesia, 37 percent reported that they had not wanted one; other reasons were labor occurring too quickly (43.9%), medical contraindication (3.3%), and unavailability of an anesthesiologist (2.8%). The reported decision to deliver without epidural analgesia was closely associated with high parity. It was also more frequent among women in an unfavorable social situation (not cohabiting, no or low-qualified job) and among women who gave birth in nonuniversity public hospitals, in small- or medium-sized maternity units, and in maternity units without an anesthesiologist always on site. Conclusions: Unfavorable social situation and organizational factors are associated with the reported choice to give birth without epidural analgesia. This finding suggests that women are not always in a position to make a real choice. It would be useful to improve the understanding of how pregnant women define their preferences and to know how these preferences change during pregnancy and labor. (BIRTH 35:3 September 2008) [source] Low risk of contrast-medium-induced nephropathy with modern angiographic techniqueJOURNAL OF INTERNAL MEDICINE, Issue 5 2001G. Sterner Abstract.,Sterner G, Nyman U, Valdes T (Malmö University Hospital, Malmö, Sweden). Low risk of contrast-medium-induced nephropathy with modern angiographic technique. J Intern Med 2001; 250: 429,434. Objective and design.,A retrospective study of the incidence of contrast-medium-induced nephropathy (CMN) in patients with renal insufficiency. Subjects.,All angiographies with and without endovascular therapeutic procedures (n=2400) performed at the hospital during 1 year were evaluated. A total of 139 patients were found to have a preangiographic serum-creatinine (s-Cr) of 150 ,mol L,1 or above. Postprocedural serial s-Cr values were present in 118 patients and these were included in the study. Results.,Amongst patients receiving only iodinated contrast media (CM) 8% demonstrated a 25% rise in s-Cr. The corresponding figure was 11 and 12.5% amongst patients who were given either iodinated CM together with carbon dioxide (CO2) or CO2 as sole contrast medium. After exclusion of other explanations of impaired renal function all together only seven of 114 patients (6%) were considered to have developed CMN. Four of the seven patients restituted renal function completely, whilst it remained decreased in three. No patient required dialysis. The percentage of diabetic patients were not found to be different in patients with and without signs of CMN. Conclusions.,The present retrospective study indicate that the risk of CMN in connection with angiography is low when modern low-osmolality CM and contrast saving angiographic technique including CO2 is used combined with proper hydration. Patients with diabetes mellitus were not found more frequently in the groups with CMN. [source] Low risk of overt nephropathy after 24 yr of childhood-onset type 1 diabetes mellitus (T1DM) in NorwayPEDIATRIC DIABETES, Issue 5 2006Torild Skrivarhaug Aim:, To estimate the risk of diabetic nephropathy and associated risk factors in a nationwide cohort of childhood-onset type 1 diabetes mellitus (T1DM) and 19,30 yr of diabetes duration. Methods:, Patients diagnosed with childhood-onset T1DM (<15 yr) from 1973 through 1982, who previously (1989,1990) participated in a clinical examination to assess diabetic complications, were invited for a new examination in 2002,2003. Of 355 eligible patients, 299 participated (84.2%), and complete urine samples for evaluation of albuminuria were obtained from 295 patients, with a mean age of 33 yr (range 20.9,44.0) and mean diabetes duration of 24 yr (range 19.3,29.9). Persistent microalbuminuria and overt nephropathy [albumin excretion rate (AER) 15,200 ,g/min and AER > 200 ,g/min, respectively] in at least two out of three consecutive overnight urine samples were defined as diabetic nephropathy. Results:, Overt nephropathy was found in 7.8% [95% confidence interval (CI) 4.7,10.9] and persistent microalbuminuria in 14.9% (95% CI 10.8,19.0) of the subjects. Hemoglobin A1c (HbA1c) (p = 0.001), systolic blood pressure (BP) (p = 0.002), total cholesterol (p = 0.019), and C-reactive protein (CRP) (p = 0.019) were associated with diabetic nephropathy. Significant predictors in 1989,1990 for the development of diabetic nephropathy in 2002,2003 were HbA1c (p < 0.001), AER (p = 0.007), and cholesterol (p = 0.022). Conclusions:, In a subgroup of patients diagnosed with childhood-onset T1DM in 1973,1982, 7.8% had overt nephropathy after 19,30 yr of diabetes duration, which is low compared with studies from other countries. HbA1c, systolic BP, total cholesterol, and CRP were each independently associated with diabetic nephropathy. [source] Comparison of a Long-Pulse Nd:YAG Laser and a Combined 585/1,064-nm Laser for the Treatment of Acne Scars: A Randomized Split-Face Clinical StudyDERMATOLOGIC SURGERY, Issue 11 2009SEONG UK MIN MD BACKGROUND Nonablative laser is gaining popularity because of the low risk of complications, especially in patients with darker skin. OBJECTIVE To compare the efficacy and safety of a long-pulse neodymium-doped yttrium aluminium garnet (Nd:YAG) laser and a combined 585/1,064-nm laser for the treatment of acne scars. MATERIALS AND METHODS Nineteen patients with mild to moderate atrophic acne scars received four long-pulse Nd:YAG laser or combined 585/1,064-nm laser treatment sessions at fortnightly intervals. Treatments were administered randomly in a split-face manner. RESULTS Acne scars showed mild to moderate improvement, with significant Echelle d'évaluation clinique des cicatrices d'acné (ECCA) score reductions, after both treatments. Although intermodality differences were not significant, combined 585/1,064-nm laser was more effective for deep boxcar scars. In patients with combined 585/1,064-nm laser-treated sides that improved more than long-pulse Nd:YAG laser-treated sides, ECCA scores were significantly lower for combined 585/1,064-nm laser treatment. Histologic evaluations revealed significantly greater collagen deposition, although there was no significant difference between the two modalities. Patient satisfaction scores concurred with physicians' evaluations. CONCLUSION Both lasers ameliorated acne scarring with minimal downtime. In light of this finding, optimal outcomes might be achieved when laser treatment types are chosen after considering individual scar type and response. [source] A Review of the Biologic Effects, Clinical Efficacy, and Safety of Silicone Elastomer Sheeting for Hypertrophic and Keloid Scar Treatment and ManagementDERMATOLOGIC SURGERY, Issue 11 2007BRIAN BERMAN MD Silicone elastomer sheeting is a medical device used to prevent the development of and improve the appearance and feel of hypertrophic and keloid scars. The precise mechanism of action of silicone elastomer sheeting has not been defined, but clinical trials report that this device is safe and effective for the treatment and prevention of hypertrophic and keloid scars if worn over the scar for 12 to 24 hours per day for at least 2 to 3 months. Some of the silicone elastomer sheeting products currently on the market are durable and adhere well to the skin. These products are an attractive treatment option because of their ease of use and low risk of adverse effects compared to other treatments, such as surgical excision, intralesional corticosteroid injections, pressure therapy, radiation, laser treatment, and cryotherapy. Additional controlled clinical trials with large patient populations may provide further evidence for the efficacy of silicone elastomer sheeting in the treatment and prevention of hypertrophic and keloid scars. The purpose of this article is to review the literature on silicone elastomer sheeting products and to discuss their clinical application in the treatment and prevention of hypertrophic and keloid scars. [source] Treatment of Recurrent Ingrown Great Toenail Associated with Granulation Tissue by Partial Nail Avulsion Followed by Matricectomy with Sharpulse Carbon Dioxide LaserDERMATOLOGIC SURGERY, Issue 5 2002Kuo-chia Yang MD background. The effectiveness of partial nail avulsion followed by matricectomy with carbon dioxide (CO2) laser for the treatment of ingrown great toenails remains unclear. objective. This study sought to determine the effectiveness of partial nail avulsion followed by matricectomy with sharpulse CO2 laser in the treatment of recurrent ingrown great toenails associated with granulation tissue. materials and methods. Fourteen patients with a total of 18 recurrent ingrown great toenails were randomly selected for participation in this study. Partial nail avulsions followed by matricectomy with sharpulse CO2 laser were performed on the involved nails. After at least 6 months, we evaluated the recurrence of ingrown toenails, regrowth of the nail spike, duration of post-treatment pain and post-treatment infection. results. Partial nail avulsion followed by matricectomy with sharpulse CO2 laser in the treatment of ingrown toenails resulted in a high cure rate, short postoperative pain duration and low risk of postoperative infection. conclusion. This method we advocate is convenient and effective for the treatment of recurrent ingrown great toenail associated with granulation tissue. [source] Prediction of mortality at age 40 in Danish males at high and low risk for alcoholismACTA PSYCHIATRICA SCANDINAVICA, Issue 6 2004J. Knop Objective:, This prospective high-risk study examined the influence of father's alcoholism and other archival-generated measures on premature death. Method:, Sons of alcoholic fathers (n = 223) and sons of non-alcoholic fathers (n = 106) have been studied from birth to age 40. Archival predictors of premature death included father's alcoholism, childhood developmental data, and diagnostic information obtained from the Psychiatric Register and alcoholism clinics. Results:, By age 40, 21 of the 329 subjects had died (6.4%), a rate that is more than two times greater than expected. Sons of alcoholic fathers were not more likely to die by age 40. Premature death was associated with physical immaturity at 1-year of age and psychiatric/alcoholism treatment. No significant interactions were found between risk and archival measures. Conclusion:, Genetic vulnerability did not independently predict death at age 40. Death was associated with developmental immaturities and treatment for a psychiatric and/or substance abuse problem. [source] Vildagliptin plus metformin combination therapy provides superior glycaemic control to individual monotherapy in treatment-naive patients with type 2 diabetes mellitusDIABETES OBESITY & METABOLISM, Issue 5 2009E. Bosi Aim:, To compare the efficacy and safety of vildagliptin and metformin initial combination therapy with individual monotherapies in treatment-naive patients with type 2 diabetes mellitus (T2DM). Methods:, This was a 24-week, randomized, double-blind, active-controlled study. Treatment-naive patients with T2DM who had a glycated haemoglobin (HbA1c) of 7.5,11% (N = 1179) were randomized equally to receive vildagliptin plus high-dose metformin combination therapy (50 mg + 1000 mg twice daily), vildagliptin plus low-dose metformin combination therapy (50 mg + 500 mg twice daily), vildagliptin monotherapy (50 mg twice daily) or high-dose metformin monotherapy (1000 mg twice daily). The primary objective was to demonstrate that HbA1c reduction from baseline with either combination therapy is superior to both monotherapies at the week 24 endpoint. Patients who failed glycaemic-screening criteria [HbA1c >11% or fasting plasma glucose (FPG) >15 mmol/l (270 mg/dl)] could enter a 24-week, single-arm substudy. These patients (N = 94) received open-label vildagliptin plus high-dose metformin combination therapy (100 mg + 1000 mg twice daily). Results:, From comparable baseline values (8.6,8.7%), HbA1c decreased in all four treatment groups, to the greatest extent with vildagliptin plus high-dose metformin combination therapy. Mean (SE) HbA1c change from baseline was ,1.8% (0.06%), ,1.6% (0.06%), ,1.1% (0.06%) and ,1.4% (0.06%) with vildagliptin plus high-dose metformin combination therapy, vildagliptin plus low-dose metformin combination therapy, and vildagliptin and metformin monotherapies respectively. The between-group difference was superior with vildagliptin plus high-dose metformin combination therapy (p < 0.001 vs. both monotherapies) and vildagliptin plus low-dose metformin combination therapy (p < 0.001 and p = 0.004, vs. vildagliptin and metformin monotherapies, respectively). Higher baseline HbA1c values were linked to greater HbA1c reductions, with changes of ,3.2% (0.22%), ,2.7% (0.22%), ,1.5% (0.24%) and ,2.6% (0.26%) respectively, occurring in patients with baseline HbA1c,10%. Reductions in FPG were superior with vildagliptin plus high-dose metformin combination therapy [change from baseline ,2.63 (0.13) mmol/l] compared with both monotherapies [,1.26 (0.13) mmol/l and ,1.92 (0.13) mmol/l, respectively; p < 0.001]. There was no incidence of hypoglycaemia or severe hypoglycaemia with either combination therapy, and neither was associated with weight gain. All treatments were well tolerated and displayed a comparable incidence of adverse events overall. Despite superior HbA1c lowering, the vildagliptin plus low-dose metformin combination therapy group demonstrated a favourable gastrointestinal (GI) tolerability profile compared with metformin monotherapy. Conclusions:, In treatment-naive patients, combinations of vildagliptin and both high-dose and low-dose metformin provide superior efficacy to monotherapy treatments with a comparable overall tolerability profile and low risk of hypoglycaemia. The potential dose-sparing effect of adding vildagliptin to low-dose metformin in preference to the up-titration of metformin may allow patients to achieve equivalent or superior HbA1c lowering without the GI tolerability issues associated with higher doses of metformin. [source] Reflecting on Type 2 Diabetes Prevention: More Questions than Answers!DIABETES OBESITY & METABOLISM, Issue 2007J. Rosenstock Given the enormous public health and economic burden posed by the global epidemic of type 2 diabetes mellitus (T2DM), intervention in the prediabetes stage of disease to prevent progression to T2DM and its vascular complications seems the most sensible approach. Precisely how best to intervene remains the subject of much debate. Prudent lifestyle changes have been shown to significantly reduce the risk of progression in individuals with impaired fasting glucose (IFG) and impaired glucose tolerance (IGT). Although lifestyle modifications are notoriously difficult to maintain, there is evidence that intensive intervention results in continued preventive benefit after the stopping of structured counselling. A number of drug therapies, including metformin, acarbose, orlistat and rosiglitazone, have also been proven effective in preventing progression from IFG/IGT, but unresolved issues still remain. Specifically, whether large numbers of individuals with glucose dysregulation who may never progress to T2DM should be exposed to the risk of pharmacological adverse effects is a topic of discussion and debate. Furthermore, there are limited data on the effectiveness of implementing interventions during the prediabetic state to prevent cardiovascular complications that may be hyperglycaemia related. A recent American Diabetes Association (ADA) consensus statement on IFG/IGT recommends lifestyle modification for individuals with IFG or IGT. Of note, the ADA consensus statement introduces the option of adding metformin treatment to lifestyle changes in those individuals who have combined IFG/IGT plus an additional risk factor for progression and who also have some features that increase the likelihood of benefiting from metformin treatment. The dipeptidyl peptidase-4 inhibitors are a new class of oral antidiabetic agents that, in addition to being effective in improving glycaemic control, may exert beneficial effects in preserving ,-cell function. These characteristics, combined with a low risk of hypoglycaemia, weight neutrality and what appears , so far , to be a relatively benign tolerability profile, make these agents intriguing candidates for preventive treatment. [source] Combination therapy using metformin or thiazolidinediones and insulin in the treatment of diabetes mellitusDIABETES OBESITY & METABOLISM, Issue 6 2005Suzanne M. Strowig The biguanide, metformin, sensitizes the liver to the effect of insulin, suppressing hepatic glucose output. Thiazolidinediones such as rosiglitazone and pioglitazone enhance insulin-mediated glucose disposal, leading to reduced plasma insulin concentrations. These classes of drugs may also have varying beneficial effects on features of insulin resistance such as lipid levels, blood pressure and body weight. Metformin in combination with insulin has been shown to significantly improve blood glucose levels while lowering total daily insulin dose and body weight. The thiazolidinediones in combination with insulin have also been effective in lowering blood glucose levels and total daily insulin dose. Triple combination therapy using insulin, metformin and a thiazolidinedione improves glycaemic control to a greater degree than dual therapy using insulin and metformin or insulin and a thiazolidinedione. There is insufficient evidence to recommend the use of metformin or thiazolidinediones in type 1 diabetic patients. Although these agents are largely well tolerated, some subjects experience significant gastrointestinal problems while using metformin. Metformin is associated with a low risk of lactic acidosis, but should not be used in patients with elevated serum creatinine or those being treated for congestive heart failure. The thiazolidinediones are associated with an increase in body weight, although this can be avoided with careful lifestyle management. Thiazolidinediones may also lead to oedema and are associated with a low incidence of hepatocellular injury. Thiazolidinediones are contraindicated in patients with underlying heart disease who are at risk of congestive heart failure and in patients who have abnormal hepatic function. The desired blood glucose-lowering effect and adverse event profiles of these agents should be considered when recommending these agents to diabetic patients. The potential for metformin or the thiazolidinediones to impact long-term cardiovascular outcomes remains under investigation. [source] Twice daily biphasic insulin aspart improves postprandial glycaemic control more effectively than twice daily NPH insulin, with low risk of hypoglycaemia, in patients with type 2 diabetesDIABETES OBESITY & METABOLISM, Issue 6 2003J. S. Christiansen Objective:, Biphasic insulin aspart 30 (BIAsp30) is a dual release formulation, containing 30% soluble and 70% protamine-crystallized insulin aspart. This study compared the glycaemic control and safety profiles achieved with either twice daily BIAsp30 or NPH insulin in patients with type 2 diabetes not optimally controlled by oral hypoglycaemic agents (OHAs), NPH insulin or a combination of both. Methods:, In this 16-week multinational, parallel-group, double-blind trial, 403 such patients were randomized to receive either BIAsp30 or NPH insulin immediately before breakfast and evening meals. OHAs were discontinued at randomization. Efficacy was assessed by glycosylated haemoglobin (HbA1c) and self-recorded daily 8-point blood glucose (BG) profiles. Hypoglycaemic and other adverse events were the chosen safety parameters. Results:, HbA1c concentration decreased by >0.6% (p < 0.0001 vs. baseline) in both groups, with metabolic control continuing to improve throughout the trial without reaching a stable level. Patients who switched from once or twice daily NPH monotherapy to twice daily BIAsp30 achieved a significantly greater reduction in HbA1c (0.78%) than those randomized to twice daily NPH insulin (0.58%; p = 0.03). BIAsp30 decreased mean daily postprandial glycaemic exposure to a greater extent than NPH insulin (mean difference = 0.69 mmol/l; p < 0.0001), reflecting greater decreases in the postbreakfast and postdinner increments (of 1.26 and 1.33 mmol/l, respectively), although postlunch increment was relatively increased (by 0.56 mmol/l). Despite the greater reduction in overall postprandial glycaemic exposure in the BIAsp30 group, the overall safety profile of BIAsp30 was equivalent to that of NPH insulin with <2% of patients experiencing major hypoglycaemia, and approximately 33% reporting minor hypoglycaemic episodes, in both groups. Conclusion:, Twice daily BIAsp30 reduced postprandial glucose exposure to a significantly greater extent than NPH insulin and was at least as effective at reducing HbA1c in patients with type 2 diabetes. Both insulins were well tolerated. In patients poorly controlled on OHAs or NPH alone, glycaemic control can be improved by switching to twice daily BIAsp30, without increasing hypoglycaemic risk. [source] Comparing risk profiles of individuals diagnosed with diabetes by OGTT and HbA1cThe Danish Inter99 studyDIABETIC MEDICINE, Issue 8 2010R. Borg Diabet. Med. 27, 906,910 (2010) Abstract Aims, Glycated haemoglobin (HbA1c) has been proposed as an alternative to the oral glucose tolerance test for diagnosing diabetes. We compared the cardiovascular risk profile of individuals identified by these two alternative methods. Methods, We assessed the prevalence of cardiovascular risk factors in individuals with undiagnosed diabetes according to the World Health Organization classification or by the newly proposed HbA1c level , 6.5% among 6258 participants of the Danish Inter99 study. Receiver operating curve analysis assessed the ability of fasting: 2-h plasma glucose and HbA1c to distinguish between individuals at high and low risk of ischemic heart disease, predicted by the PRECARD program. Results, Prevalence of undiagnosed diabetes was 4.1% [95% confidence interval (CI) 3.7,4.7%] by the current oral glucose tolerance test definition, whereas 6.6% (95% CI 6.0,7.2%) had diabetes by HbA1c levels. HbA1c -defined individuals were relatively older with higher proportions of men, smokers, lipid abnormalities and macro-albuminuria, but they were leaner and had lower blood pressure. HbA1c was better than fasting- and 2-h plasma glucose at distinguishing between individuals of high and low predicted risk of ischaemic heart disease; however, the difference between HbA1c and fasting- and 2-h plasma glucose was not statistically significant. Conclusions, Compared with the current oral glucose tolerance test definition, more individuals were classified as having diabetes based on the HbA1c criteria. This group had as unfavourable a risk profile as those identified by the oral glucose tolerance test. [source] Hypoglycaemia in Type 2 diabetesDIABETIC MEDICINE, Issue 3 2008S. A. Amiel Abstract The primary cause of hypoglycaemia in Type 2 diabetes is diabetes medication,in particular, those which raise insulin levels independently of blood glucose, such as sulphonylureas (SUs) and exogenous insulin. The risk of hypoglycaemia is increased in older patients, those with longer diabetes duration, lesser insulin reserve and perhaps in the drive for strict glycaemic control. Differing definitions, data collection methods, drug type/regimen and patient populations make comparing rates of hypoglycaemia difficult. It is clear that patients taking insulin have the highest rates of self-reported severe hypoglycaemia (25% in patients who have been taking insulin for > 5 years). SUs are associated with significantly lower rates of severe hypoglycaemia. However, large numbers of patients take SUs in the UK, and it is estimated that each year > 5000 patients will experience a severe event caused by their SU therapy which will require emergency intervention. Hypoglycaemia has substantial clinical impact, in terms of mortality, morbidity and quality of life. The cost implications of severe episodes,both direct hospital costs and indirect costs,are considerable: it is estimated that each hospital admission for severe hypoglycaemia costs around £1000. Hypoglycaemia and fear of hypoglycaemia limit the ability of current diabetes medications to achieve and maintain optimal levels of glycaemic control. Newer therapies, which focus on the incretin axis, may carry a lower risk of hypoglycaemia. Their use, and more prudent use of older therapies with low risk of hypoglycaemia, may help patients achieve improved glucose control for longer, and reduce the risk of diabetic complications. [source] Long-term effects of leisure time physical activity on risk of insulin resistance and impaired glucose tolerance, allowing for body weight history, in Danish menDIABETIC MEDICINE, Issue 1 2007T. Berentzen Abstract Aims To determine if the level of leisure time physical activity (LTPA) in young adulthood in obese and non-obese men reduces the risk of insulin resistance (IR) and impaired glucose tolerance (IGT) in middle age, and if such an effect is explained by the current level of LTPA, or by the body mass index (BMI) history preceding and subsequent to the assessment of LTPA. Methods Longitudinal study of groups of obese and randomly selected non-obese men identified at around age 19, and re-examined at mean ages of 32, 44 and 51. BMI was measured at all four examinations. LTPA was assessed by self-administrated questionnaires at the last three examinations. IR and the presence of IGT was determined by an oral glucose tolerance test at the last examination. Results LTPA in young adulthood reduced the risk of IR and IGT in middle age throughout the range of BMI. Adjustment for the BMI history preceding and subsequent to the assessment of LTPA attenuated the association with IR and IGT, but active men remained at low risk of IR and IGT. Adjustment for subsequent and current levels of LTPA, smoking habits, alcohol intake, educational level and family history of diabetes had no notable influence on the results. Conclusion LTPA appears to reduce the risk of IR and IGT, an effect which is not explained by the current level of physical activity, and only partially explained by the BMI history preceding and subsequent to the assessment of LTPA. [source] Process evaluation of an out-patient detoxification serviceDRUG AND ALCOHOL REVIEW, Issue 6 2005Dr CLAUDIA SANNIBALE Abstract This paper describes the process evaluation of an out-patient detoxification service (ODS) established by Drug Health Services (DHS) to increase the supervised withdrawal options for substance users in a Sydney metropolitan Area Health Service. The ODS aimed to provide a safe and effective supervised withdrawal to substance users who were at low risk of severe withdrawal, engage those with severe dependence in further treatment and increase the involvement of general practitioners (GPs) in the medical care of ODS clients. During its first 10 months of operation, the ODS received 199 inquiries, assessed 82 individuals and admitted 76 clients for detoxification. Withdrawal treatment proceeded without complications and within the expected time frames. Fifty-four clients completed withdrawal, 10 ceased treatment, 10 remained in treatment without completing withdrawal and two were transferred elsewhere. Clients who injected substances (mainly heroin) daily at admission, compared to others, were less likely to complete withdrawal and more likely to use a range of non-prescribed substances during withdrawal. One-fifth of clients went on to further treatment with DHS, attending at least once. Overall, the ODS met its goals, providing a safe and effective supervised withdrawal to local residents, especially women, young people and those withdrawing from benzodiazepines who had significant substance dependence, impairment and previous alcohol and other drug (AOD) treatment. Non-injecting substance users benefited most from the ODS in terms of withdrawal completion and ongoing treatment. The level of GP involvement in the conjoint care of ODS clients remained constant over time. The development and expansion of the ODS are discussed. [source] Telemetry Monitoring during Transport of Low-risk Chest Pain Patients from the Emergency Department: Is It Necessary?ACADEMIC EMERGENCY MEDICINE, Issue 10 2005Adam J. Singer MD Abstract Background: Low-risk emergency department (ED) patients with chest pain (CP) are often transported by nurses to monitored beds on telemetry monitoring, diverting valuable resources from the ED and delaying transport. Objectives: To test the hypothesis that transporting low-risk CP patients off telemetry monitoring is safe. Methods: This was a secondary analysis of a prospective, observational cohort of ED patients with low-risk chest pain (no active chest pain, normal or nondiagnostic electrocardiogram, normal initial troponin I) admitted to a non,intensive care unit monitored bed who were transported off telemetry monitor by nonclinical personnel. A protocol allowing transportation of low-risk CP patients off telemetry monitoring to a monitored bed was developed, and an ongoing daily log of patients transported off telemetry was maintained for the occurrence of any adverse events en route to the floor. Adverse events requiring treatment included dysrhythmias, hypotension, syncope, and cardiac arrest. The study population included patients who presented during September,October 2004, whose data were abstracted from the medical records using standardized methodology. A subset of 10% of the medical records were reviewed by a second investigator for interrater reliability. Death, syncope, resuscitation, and dysrhythmias during transport or immediately on arrival to the floor were the outcomes measured. Descriptive statistics and confidence intervals (CIs) were used in data analysis. Results: During the study period, 425 patients had CP of potentially ischemic origin, of whom 322 (75.8%) were low risk and met the inclusion criteria and were transported off monitors. Their mean (±standard deviation) age was 58.3 (±16.0) years; 48.1% were female. During transport from the ED, there was no patient with any adverse events requiring treatment and there was no death (95% CI = 0% to 0.93%). Conclusions: Transportation of low-risk ED chest pain patients off telemetry monitoring by nonclinical personnel to the floor appears safe. This may reduce diversion of ED nurses from the ED, helping to alleviate nursing shortages. [source] Landscape composition and vole outbreaks: evidence from an eight year study of Arvicola terrestrisECOGRAPHY, Issue 6 2000E. Fichet-Calvet This study investigates the relationships between landscape composition and the population dynamics of the fossorial water vole Arvicola terrestris. Land use patterns were studied based on agricultural and forestry data from the French Ministry of Agriculture collected in 1955 and 1988. In the Massif Central, France, water vole populations were monitored from 1985 to 1993 by using index methods. Outbreaks of water vole populations occurred in many dispersed epicentres and spread suddenly and widely over > 7500 km2. At a regional scale, the fluctuation lasts six years on average with an outbreak period lasting from two to three years. Density variation patterns are positively correlated with the proportion of permanent grassland to agricultural land. A high risk of outbreak is linked to a high proportion of permanent grassland (over 90%), whereas a low risk of outbreak is linked to a proportion of < 80%, Conversely, density variation patterns are negatively correlated with the proportion of temporary grassland to agricultural land and with the proportion of forest to total land in the western (major) part of the study area. Temporary grassland thus appears to be a marginal habitat for water voles and extensive forests could act as a brake on outbreaks. The increase in the area of permanent grassland from 1955 to 1988 was apparently the major cause of chronic high densities of water voles. Therefore, land use and landscape management could be one way to control water vole outbreaks. [source] Association of type of sport and performance level with anatomical site of orthopaedic injury diagnosisEQUINE VETERINARY JOURNAL, Issue S36 2006R. C. MURRAY Summary Reason for performing study: Although anecdotal reports of increased orthopaedic injury risk in equine sports exist, there is little scientific evidence to support this. Objectives: To test whether horses undertaking a single competitive sport have increased risk of specific injuries compared to those used for general purpose riding (GP); and whether injury type varies with sport category and performance level. Methods: Data from 1069 records of horses undergoing orthopaedic evaluation (1998,2003) and meeting inclusion criteria were reviewed. Sport category (GP, showjumping, dressage, eventing, racing), level (nonelite or elite) and diagnosis were recorded. Effects of sport category and level on probability of a specific diagnosis were assessed using chisquared tests. Logistic regression was used to determine which competitive sports and levels increased risk of injury compared with GP. Results: Overall there was a significant effect of sport category and level on diagnosis (P<0.0001). There was significant difference between anatomical site injured and sport category (P<0.0001); a high risk of forelimb superficial digital flexor tendon injury in elite eventing (P<0.0001) and elite showjumping (P=0.02); distal deep digital flexor tendon (DDFT) injury in elite showjumping (P=0.002); and hindlimb suspensory ligament injury in elite (P<0.0001) and nonelite (P=0.001) dressage. There was a low risk of tarsal injury in elite eventing (P=0.01) and proximal DDFT injury in dressage (P = 0.01). Conclusions: Horses competing in different sports are predisposed to specific injuries; particular sports may increase the risk of injury at certain anatomical sites; and the type and site of injury may reflect the type and level of performance. Potential relevance: These findings could guide clinicians in the diagnosis of sport related injuries. [source] Liability Risk for Outside Directors: a Cross-Border AnalysisEUROPEAN FINANCIAL MANAGEMENT, Issue 2 2005Bernard Black G34; G38 Abstract Much has been said recently about the risky legal environment in which outside directors of public companies operate, especially in the USA, but increasingly elsewhere as well. Our research on outside director liability suggests, however, that directors' fears are largely unjustified. We examine the law and lawsuit outcomes in four common law countries (Australia, Canada, Britain, and the USA) and three civil law countries (France, Germany, and Japan). The legal terrain and the risk of ,nominal liability'(a court finds liability or the defendants agree to a settlement) differ greatly depending on the jurisdiction. But nominal liability rarely turns into ,out-of-pocket liability,' in which the directors pay personally damages or legal fees. Instead, damages and legal fees are paid by the company, directors' and officers'(D&O) insurance, or both. The bottom line: outside directors of public companies face a very low risk of out-of-pocket liability. We sketch the political and market forces that produce functional convergence in outcomes across countries, despite large differences in law, and suggest reasons to think that this outcome might reflect sensible policy. [source] CLINICAL STUDY: Abnormalities in cortical and transcallosal inhibitory mechanisms in subjects at high risk for alcohol dependence: a TMS studyADDICTION BIOLOGY, Issue 3-4 2008Kesavan Muralidharan ABSTRACT Central nervous system (CNS) hyperexcitability and a resulting state of behavioral undercontrol are thought to underlie the vulnerability to early-onset alcohol dependence (AD). The aim of this study was to explore the differences in the functioning of cortical inhibitory systems, utilizing transcranial magnetic stimulation (TMS), in subjects at high risk (HR) and low risk (LR) for AD and to examine the relationship between CNS inhibition and behavioral undercontrol. Right-handed HR (n = 15) and LR (n = 15) subjects, matched for age, gender, height, weight and education, were assessed for psychopathology and family history of alcoholism using the Semi-Structured Assessment for the Genetics of Alcoholism and the Family Interview for Genetic Studies. Following single-pulse TMS, an electromyogram recorded from the right opponens pollicis muscle was used to measure the silent periods at different stimulus intensities. HR subjects had significantly shorter contralateral and ipsilateral (iSP) silent periods and a relatively higher prevalence of ,absent' iSP. They had significantly higher mean externalizing symptoms scores (ESS) than LR subjects, and there was a significant negative correlation between iSP duration and ESS. These preliminary findings suggest that HR subjects have relative impairments in corticocortical and transcallosal inhibitory mechanisms. The consequent state of CNS hyperexcitability may be etiologically linked to the excess of externalizing behaviors observed in this population, which is thought to be a predisposition to a higher risk of developing early-onset alcoholism. [source] Clinical Characteristics as Predictors of Recurrent Alcohol-related SeizuresACADEMIC EMERGENCY MEDICINE, Issue 8 2000Niels K. Rathlev MD Abstract. Objective: To determine whether clinical data available in the emergency department can accurately predict a subset of patients at low risk of developing recurrent seizures following one or more initial alcohol-related seizures in the out-of-hospital arena. Methods: This was a retrospective secondary analysis of data obtained from the placebo arms of two prospective, randomized trials of drug treatments for the prevention of recurrent alcohol-related seizures. Subjects with and without one or more recurrent alcohol-related seizures during the study period were compared according to the following characteristics: 1) age, 2) gender, 3) daily ethanol consumption, 4) years of ethanol abuse, 5) previous alcohol-related seizure, 6) previous seizure of other etiology, 7) temperature, 8) heart rate, 9) systolic blood pressure, 10) diastolic blood pressure, 11) respiratory rate, and 12) ethanol level. Data were analyzed with t-tests and chi-square where appropriate. Results: One hundred five placebo-treated patients were analyzed and 31 (30%) developed recurrent alcohol-related seizures. None of the listed characteristics were statistically different between the two groups except for the initial ethanol level. Subjects with an ethanol level higher than 100 mg/dL were less likely (0%) to develop recurrent seizures than patients with a level equal to or below 100 mg/dL (36%) (p < 0.01). Conclusions: An initial ethanol level higher than 100 mg/dL was significantly associated with a low risk for recurrent alcohol-related seizures during the observation period. No other low-risk clinical characteristics could be identified. [source] Multiple predator-avoidance behaviours of the freshwater snail Physella heterostropha pomila: responses vary with riskFRESHWATER BIOLOGY, Issue 3 2000Thomas M. McCarthy Summary 1We examined the predator-avoidance behaviour, exhibited in response to chemical cues, of two populations of the snail Physella heterostropha pomila. Snails were subjected to four treatments simulating different degrees of predation risk: control water (low risk), or water from tanks containing nonforaging crayfish (intermediate risk), crushed conspecifics (high risk) or crayfish consuming conspecifics (high risk). Data were analysed using three-way ANOVA models (population × predator chemicals × injured conspecific chemicals). 2Physella increased its avoidance behaviour as risk increased. Crayfish cue elicited a significantly greater response than from controls. Cues from injured conspecifics elicited the strongest response. 3Physella exhibited several types of avoidance behaviour, including burial into the substratum, moving to the water surface, and crawling out of the water. The type of cue present influenced response type. Cues from crayfish reduced burial and increased movement to the water surface or out of the water. Cues from injured-conspecifics significantly increased crawling completely out of the water. 4The two populations differed in the type and degree of response exhibited. One population exhibited significantly greater ,reactivity' (i.e. any avoidance behaviour) in response to foraging crayfish, and more burial and crawl-out behaviours were exhibited in high-risk treatments. [source] Relevance of the genes for bone mass variation to susceptibility to osteoporotic fractures and its implications to gene search for complex human diseasesGENETIC EPIDEMIOLOGY, Issue 1 2002Hong-Wen Deng Abstract We investigate the relevance of the genetic determination of bone mineral density (BMD) variation to that of differential risk to osteoporotic fractures (OF). The high heritability (h2) of BMD and the significant phenotypic correlations between high BMD and low risk to OF are well known. Little is reported on h2 for OF. Extensive molecular genetic studies aimed at uncovering genes for differential risks to OF have focussed on BMD as a surrogate phenotype. However, the relevance of the genetic determination of BMD to that of OF is unknown. This relevance can be characterized by genetic correlation between BMD and OF. For 50 Caucasian pedigrees, we estimated that h2 at the hip is 0.65 (P < 0.0001) for BMD and 0.53 (P < 0.05) for OF; however, the genetic correlation between BMD and OF is nonsignificant (P > 0.45) and less than 1% of additive genetic variance is shared between them. Hence, most genes found important for BMD may not be relevant to OF at the hip. The phenotypic correlation between high BMD and low risk to OF at the hip (approximately ,0.30) is largely due to an environmental correlation (,E = ,0.73, P < 0.0001). The search for genes for OF should start with a significant h2 for OF and should include risk factors (besides BMD) that are genetically correlated with OF. All genes found important for various risk factors must be tested for their relevance to OF. Ideally, employing OF per se as a direct phenotype for gene hunting and testing can ensure the importance and direct relevance of the genes found for the risk of OF. This study may have significant implications for the common practice of gene search for complex diseases through underlying risk factors (usually quantitative traits). Genet. Epidemiol. 22:12,25, 2002. © 2002 Wiley-Liss, Inc. [source] Glomus jugulare tumor: Tumor control and complications after stereotactic radiosurgeryHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 4 2002Robert L. Foote MD Abstract Background We evaluated toxicity and long-term efficacy of stereotactic radiosurgery in patients with symptomatic or progressive glomus jugulare tumors. Methods Twenty-five consecutive patients (age, 30,88 years; 17 women, 8 men) who underwent stereotactic radiosurgery with the Leksell Gamma Knife (dose, 12,18 Gy) were prospectively followed. MRI and clinical examinations were performed at 6 months and 1, 2, and 3 years, and then every 2 years. Results None of the tumors increased in size, 17 were stable, and 8 decreased (median imaging follow-up, 35 months; range, 10,113 months). Symptoms subsided in 15 patients (60%); vertigo occurred in 1, but balance improved with vestibular training (median clinical follow-up, 37 months; range, 11,118 months). No other new or progressive neuropathy of cranial nerves V,XII developed. Conclusions Stereotactic radiosurgery can achieve excellent tumor control with low risk of morbidity in the treatment of glomus jugulare tumors. The lower cranial nerves can safely tolerate a radiosurgical dose of 12 to 18 Gy. © 2002 Wiley Periodicals, Inc. Head Neck 24: 332,339, 2002; DOI 10.1002/hed.10005 [source] Cardiovascular Risk Assessment and TriptansHEADACHE, Issue 2004Vasilios Papademetriou MD Identifying the patient for whom triptans are contraindicated because of recognized, diagnosed cardiovascular disease is relatively straightforward. Determining whether a patient with potential unrecognized cardiovascular disease is an appropriate candidate for triptan therapy, however, constitutes a difficult challenge, especially in the absence of a framework for workup of patients. This article discusses the pathophysiology of coronary heart disease and issues involved in assessing cardiovascular risk, and it attempts to provide a framework for cardiovascular risk assessment that can be applied to decisions for prescribing triptans. Current guidelines for cardiovascular risk assessment allow stratification of patients to low, intermediate, or high risk of coronary heart disease events. This framework for risk assessment can be applied to decisions for prescribing triptans. Cardiovascular risk-assessment algorithms discussed elsewhere in this supplement suggest that patients at low risk (1 or no risk factors) of coronary heart disease can be prescribed triptans without the need for a more intensive cardiovascular evaluation. Conversely, patients with established coronary heart disease or coronary heart disease risk equivalents should not be prescribed triptans according to the current prescribing recommendations. Patients at intermediate risk (2 or more risk factors) of coronary heart disease require cardiovascular evaluation before triptans can be prescribed. Current understanding suggests that the risk of future acute coronary events is a function of the absolute number of vulnerable plaques present, a variable that cannot be accurately determined using available technology or risk-prediction models. Cardiovascular risk-assessment guidelines should be evaluated in the context of this limitation. [source] Age at Acquisition of Helicobacter pylori Infection: Comparison of Two Areas with Contrasting Risk of Gastric CancerHELICOBACTER, Issue 3 2004M. Constanza Camargo ABSTRACT Background.,Helicobacter pylori infection is usually acquired during childhood and is a known risk factor for the development of gastric malignancies in adulthood. It has been reported that early age at first infection may determine a neoplastic outcome in adults. The purpose of this study was to determine the prevalence of Helicobacter pylori infection in children residing in areas with high (Pasto) and low risk (Tumaco) of gastric cancer in Colombia to evaluate whether differences in the age of acquisition of H. pylori infection were present in the two populations. Materials and Methods., The study sample was based on a census taken in 1999. Using the 13C-urea breath test, we compared the prevalence of H. pylori infection among children aged 1,6 years. Results., Among 345 children in Pasto, 206 (59.7%) were H. pylori -positive, compared with 188 (58.6%) among 321 children in Tumaco. The two populations share a common pattern of very early age at infection and marked increase in prevalence during the first 4 years of life. No differences in any one year were observed when comparing the two groups. Conclusions., The prevalence of infection was similarly high and increased with age in both populations. In these populations the age of acquisition of H. pylori after 1 year of age does not appear to be a primary factor responsible for the differences in the rates of gastric cancer incidence in adults. Previous findings in adults showed lower prevalence of the most virulent genotypes in Tumaco compared to Pasto, and bacterial virulence may play a key role in determining cancer outcome. [source] Analysis of risk factors predicting thrombotic and/or haemorrhagic complications in 306 patients with Essential ThrombocythemiaHEMATOLOGICAL ONCOLOGY, Issue 3 2007Franca Radaelli Abstract Thrombotic and haemorrhagic complications are the main causes of morbidity in Essential Thrombocythemia (ET). We investigated the clinical and laboratory characteristics associated with the occurrence of these events with the aim of identifying subgroups of patients who might benefit from anti-aggregant and/or cytoreductive therapy. The study involved 306 consecutive ET patients (median age 58 years and median follow-up 96 months); the investigated variables were age, gender, platelet count, previous history of thrombotic or haemorrhagic events, disease duration and cardiovascular risk factors. Forty-six patients (15%) experienced thrombotic complications during the follow-up: 26/64 patients with a previous history of thrombosis (40.6%) and 20/242 patients without (8.3%; p,<,0.0001). Thirty-one patients (10%) experienced major haemorrhagic complications, mainly gastrointestinal tract bleeding: 3 with and 28 without a history of haemorrhagic events (p,=,0.052). When the patients with a negative history of thrombosis were stratified on the basis of the number of cardiovascular risk factors (none vs. one vs. more than one), there was a significant correlation with the occurrence of thrombotic events (p,<,0.05). ET patients with a positive history of thrombosis are at high risk of thrombotic complications, and should receive cytoreductive and anti-aggregant treatment. Asymptomatic patients with a negative thrombotic history and no cardiovascular risk factors are at low risk, and should not be treated. Patients with a negative thrombotic history and one or more cardiovascular risk factors are at intermediate risk, and should be treated with anti-aggregant and/or cytoreductive therapy. The need for treatment should be periodically re-evaluated. Age and platelet count, generally accepted as very important risk factors for thrombosis, did not seem in our series associated with an increased risk for thrombosis. Copyright © 2007 John Wiley & Sons, Ltd. [source] | ||||||||||||||||||||||||||||||||||||||||||||||