Effectiveness of lifestyle-based weight loss interventions for adults with type 2 diabetes: a systematic review and meta-analysis.

AIMS: To provide a systematic review and meta-analysis of recent evidence on the effectiveness of lifestyle-based weight loss interventions for adults with type 2 diabetes. METHODS: A search of the literature from January 2003 to July 2013 was conducted (PubMed, Embase, CINAHL and Web of Science). The studies considered eligible were randomized controlled trials evaluating weight loss interventions (diet and physical activity, with or without behavioural strategies) of ≥12 weeks duration, compared with usual care or another comparison intervention. Ten studies were included for review. Some heterogeneity was present in the sample, therefore, random-effects models were used to calculate pooled effects. RESULTS: Intervention duration ranged from 16 weeks to 9 years, with all but one delivered via individual or group face-to-face sessions. From six studies comparing lifestyle intervention with usual care the pooled effect on weight (n = 5795) was -3.33 kg [95% confidence interval (CI) -5.06, -1.60 kg], and on glycated haemoglobin (HbA1c; n = 5784) was -0.29% (95% CI -0.61, 0.03%), with both attenuated in sensitivity analyses. The pooled within-group effect on weight (n = 3063) from all 10 lifestyle intervention groups was -5.33 kg (95% CI -7.33, -3.34 kg), also attenuated in sensitivity analyses. None of the participant or intervention characteristics examined explained the heterogeneity. Only one study assessed whether intervention effects were maintained after the end of the intervention. CONCLUSIONS: Lifestyle-based weight loss intervention trials in type 2 diabetes achieve, on average, modest reductions in weight and HbA1c levels, but results were heavily influenced by one trial. Evidence-based approaches for improving the effectiveness of lifestyle-based interventions in type 2 diabetes are needed, along with future studies reporting on maintenance and cost-effectiveness.

Infection of aquatic insects with trematode metacercariae carrying Ehrlichia risticii, the cause of Potomac horse fever.

We provide evidence of Ehrlichia risticii Holland, the agent of Potomac horse fever, in trematode stages found in aquatic insects collected from a pasture stream in northern California, using nested polymerase chain reaction (PCR) amplification and sequence analyses of the 16S rRNA, 51 kDa major antigen and groEL heat shock protein genes. E. risticii was detected in metacercariae found in the immatures and adults of the following insects: caddisflies (Trichoptera), mayflies (Ephemeroptera), damselflies (Odonata, Zygoptera), dragonflies (Odonata, Anisoptera), and stoneflies (Plecoptera). The prevalence of E. risticii was 31.9% (n = 454 individuals) in aquatic insects (13 of 17 species were positive). Prevalence within orders was as follows: 43.5% (n = 207) in caddisflies, 15.2% (n = 92) in mayflies, 13.9% (n = 115) in damselflies, 10.0% (n = 10) in dragonflies, and 80.0% (n = 30) in stoneflies. This study demonstrates a broad intermediate host range for trematodes that act as vector for E. risticii. Insects are likely to play an important role in the epidemiology of this disease.

Transmission of Ehrlichia risticii, the agent of Potomac horse fever, using naturally infected aquatic insects and helminth vectors: preliminary report.

Ehrlichia risticii, the agent of Potomac horse fever (PHF), has been recently detected in trematode stages found in snail secretions and in aquatic insects. Based on these findings, horses could conceivably be exposed to E. risticii by skin penetration with infected cercariae, by ingestion of infected cercariae in water or via metacercariae in a second intermediate host, such as an aquatic insect. In order to test this hypothesis, horses were challenged with infectious snail secretions and aquatic insects collected from a PHF endemic region in northern California. Two horses stood with their front feet in water harbouring E. risticii-infected cercariae, 2 horses drank water harbouring E. risticii-infected cercariae, and 6 horses were fed pools of different aquatic insects harbouring E. risticii-infected metacercariae. In this preliminary study, only the one horse infected orally with mature caddisflies (Dicosmoecus gilvipes) developed the clinical and haematological disease syndrome of PHF. The agent was isolated from the blood of the infected horse in a continuous cell line and identified as E. risticii by characterisation of the 16S rRNA gene. Therefore, E. risticii is maintained in nature in a complex aquatic ecosystem and transmission to horses can occur through accidental ingestion of insects such as caddisflies containing infected metacercariae. At present, the small number of horses used in this study does not exclude other insects and free trematode stages as potential sources of infection.

Effects of ultra-low volume pyrethrin, malathion, and permethrin on nontarget invertebrates, sentinel mosquitoes, and mosquitofish in seasonally impounded wetlands.

Wildlife managers are concerned that insecticides used to control mosquitoes could suppress invertebrates on which wildlife feed. We assessed whether ultra-low volume (ULV) applications of pyrethrin, permethrin, and malathion for control of adult mosquitoes reduced macroinvertebrate abundance and biomass or killed mosquitofish in seasonal wetlands in California. Pyrethrin was applied over 3 seasonal wetlands on Sutter National Wildlife Refuge (NWR), and malathion or permethrin were each applied over 2 seasonal wetlands on the Colusa NWR. Three control wetlands were used per site. We measured aquatic macroinvertebrate abundance and biomass before and after insecticide application and compared the survival of mosquito larvae held in sentinel cages. At Colusa, we also used mosquitofish as sentinels, caged adult mosquitoes over the wetlands to test for pesticide efficacy and drift, and sampled night-flying insects using ultraviolet light traps. Results showed no detectable reductions in the abundance or biomass of aquatic macroinvertebrates in treated wetlands. Larval mosquitoes showed high survival in all areas. All adult mosquitoes died when caged over wetlands treated with malathion or permethrin, but all survived in controls. All mosquitofish survived. Flying insect abundance decreased after insecticide application in both treated and control wetlands but rebounded in 48 h. Results indicated that ULV applications of these insecticides to control adult mosquitoes are unlikely to have substantial effects on the aquatic insects or fish in seasonal wetlands.

Field efficacy and nontarget effects of the mosquito larvicides temephos, methoprene, and Bacillus thuringiensis var. israelensis in Florida mangrove swamps.

We compared the efficacy and nontarget effects of temephos, Bacillus thuringiensis var. israelensis (B.t.i.), and methoprene applied by helicopter to control mosquito larvae in mangrove swamps on Sanibel Island, FL, in May 1997. Three sites per treatment and 3 untreated sites were used. Temephos (Abate) was applied at 37 ml/ha (43% active ingredient [AI]), B.t.i. granules (Vectobac G) were applied at 5.606 kg/ha (200 International Toxic Units/mg), and methoprene (Altosid ALL) was applied at 213 ml/ha (5% AI). Efficacy was quantified by monitoring the survival of caged and uncaged larval Aedes taeniorhynchus. We quantified mortality of sentinel nontarget amphipods (Talitridae) at all sites, monitored the effect of temephos on flying arthropods using light traps, and collected dead insects in tarps suspended under mangroves in areas treated with either temephos or methoprene. Each pesticide showed good overall efficacy but occasional failures occurred. No detectable mortality of amphipods or flying insects attributable to pesticides was found. The inconsistent field efficacies of the pesticides indicate a need for reinspection of treated sites in this habitat.

Food web architecture and population dynamics in laboratory microcosms of protists.

In theory, food chain length and omnivory are pivotal elements of food web structure that can affect the population dynamics of species within the web. Long food chains are thought to be less stable than shorter food chains, and omnivores are thought to destabilize food webs, although populations of omnivores may be more stable than populations of nonomnivores. In three of four simple food webs assembled from bacteria and protists in laboratory microcosms, the abundance of bacterivorous protists varied more over time when the species occurred in longer versus shorter food chains. The abundance of protists attacked by omnivorous top predators was either more or less temporally variable than in webs where top predators fed only at one adjacent trophic level, depending on the particular combination of interacting species. The abundance of omnivorous top predators varied less over time than the abundance of top predators restricted to feeding only at an adjacent trophic level. Observations of increased temporal variation in prey abundance in longer food chains and low temporal variation in omnivore abundance agree broadly with several predictions of food web theory. The observation that different species in similar trophic positions can exhibit very different dynamics suggests that stability may depend on complex interactions between species-specific life-history traits and general patterns of food web architecture.

Effects of sustained-release methoprene and a combined formulation of liquid methoprene and Bacillus thuringiensis israelensis on insects in salt marshes.

Aquatic insects are an important component of the food web in salt marshes, therefore it is necessary to test whether pesticides used to control mosquitoes in salt marshes are safe for nontarget insects. We tested the nontarget effects of a combined formulation (duplex) of Bacillus thuringiensis israelensis (B.t.i.) and liquid methoprene (an insect development regulator) or sustained-release methoprene pellets (Altosid(R) pellets) by applying these materials to replicated salt marsh ponds at maximum label rates. Untreated ponds served as controls. We measured effects of the pesticides by rearing immature mosquitoes (Aedes dorsalis) and water boatmen (Trichocorixa reticulata) in predator-exclusion cages and by monitoring uncaged populations of invertebrates using replicated sweep-net samples. Both pesticides killed caged mosquitoes, and the activity of the Altosid(R) pellets continued through 99 days. There were no detectable effects of either pesticide on the survival or maturation of T. reticulata, or on abundances of uncaged invertebrates. The long-term activity of the pellets could help minimize mosquito abatement activity in salt marshes where there are breeding birds or endangered species. However, other studies suggest that this advantage needs to be balanced against the risks that sustained-release formulations could lead to development of resistance in mosquitoes or that initially undetected nontarget effects could build over time.