The "sugar dilemma".

Type 2 diabetes mellitus is characterized by insulin resistance and elevated blood glucose levels. Treatment protocols generally include dietary restriction of sugar, as well as drugs aiming at a reduction of blood glucose, mainly by activating the insulin system or supplementing insulin. This established approach does not take into account the outstanding physiological role of glucose as a key molecule in metabolism. Glucose is crucial to meet the high energy demand of the brain, which depends on it as an exclusive nutrient. Insulin independent glucose transporters GLUT1 import glucose into the brain. Reduction of blood glucose, as in current treatment concepts, may lead to energy deficiency in the brain and consecutively to worsening of - possibly already impaired - neurocognitive function. Reduced cell membrane fluidity of the vascular endothelium of the bloodbrain-barrier (BBB) - due to malnutrition and/or aging - is considered a major factor in pathogenesis of the cerebral metabolic syndrome, which is a key step in neurodegeneration. Under this aspect we suggest a novel approach to prophylaxis and treatment focusing on a sufficient supply of glucose to the brain.

Pneumococcal vaccination: perceptions of primary care physicians.

BACKGROUND: Little is known about barriers to pneumococcal vaccination in the primary care setting. METHODS: Mail survey to 405 randomly selected Massachusetts primary care physicians (response rate 68%). RESULTS: Seventy-nine percent considered themselves knowledgeable about current vaccination guidelines, and 75% said vaccination is an important clinical priority. Respondents answered a mean of five of six knowledge questions about vaccination "correctly," that is, consistent with current scientific evidence or expert opinion. Physicians reported high immunization rates: 51% thought over half their eligible patients were vaccinated; however, only 27% thought their colleagues immunized a similar number of patients. Physician attitude was the strongest independent predictor of high reported immunization rates (odds ratio of 4.7, P = 0.0001). Twenty-four percent of respondents thought physician oversight due to the need to attend to other active medical problems greatly reduces the number of patients they immunize. None of eight other financial, administrative, and clinical barriers were felt to be important by more than 7% of physicians. Sixty-six percent of physicians favored a standing order policy to immunize their eligible patients. CONCLUSIONS: Oversight and overestimation of immunization rates appear to be important barriers to pneumococcal vaccination. The literature suggests that reminder and performance feedback systems directed toward eliminating these barriers have had some success; interventions such as standing order policies may yield further improvements and appear to be acceptable to most physicians.

Healthy aging: guidelines for cancer screening and immunizations.

With increasing life expectancy over the past 50 years, screening for treatable illness and active measures to prevent disease and promote a healthy lifestyle have become increasingly important for older patients. In general, the benefits of such efforts have become more apparent, but depend also upon general health and life expectancy of the individual. Tests for malignancies of the breast, cervix, prostate, colon, skin, and oral cavity are considered to meet screening criteria. Immunization guidelines have been recently updated, and good evidence supports the benefit of protecting older patients from influenza and pneumococcal pneumonia. Counseling on prevention of falls and injuries in the home and on the highways can help reduce the risk of accidents.