[Diabetes and cardiovascular health literacy in childhood and adolescence - a 12-year follow-up]. / Diabetes- und kardiovaskuläre Gesundheitskompetenz im Kindes- und Jugendalter ­ ein 12-Jahres-Follow-up.

BACKGROUND: The incidence of diabetes mellitus and cardiovascular diseases is increasing worldwide and also in Germany. The aim of the study was to assess the health literacy regarding these diseases in childhood and adolescence. METHODS: Students of the 5th-12th grade (grammar school ("Gymnasium"), secondary school forms ("Realschule" and "Hauptschule")) were interviewed in 2007 (n = 4383) and 2019 (n = 572) about diabetes and secondary complications. In addition, questions about other cardiovascular risk factors were asked in 2019. RESULTS: Diabetes-related questions were answered correctly by 56 % in 2007 as well as 53 % in 2019. Among others, 70 % (2007) as well as 75 % (2019) of the students stated "ate too much sugar" as a cause for type 1 diabetes. Further, questions about major risk factors for heart attack and stroke were answered correctly by only 33 % (for diabetes) and 43 %-53 % (for smoking) of students.Across all questions, a positive association indicated between the rate of correct answers and the educational level of the school institution; however, the differences remained marginal at 5-19 % between Gymnasium and Hauptschule or Realschule at both survey time points. A difference between genders was indicated in 2007 (girls: 59 % vs. boys: 52 %) and 2019 (girls: 56 % vs. boys: 51 %). CONCLUSION: Changes in health literacy regarding diabetes and other cardiovascular risk factors among 5th-12th grade students over the past 12 years could not be observed. The assumed self-infliction of type 1 diabetes may be perceived as discrimination by those affected.

The Epidemiological Boehringer Ingelheim Employee Study (Part 3): Association of Elevated Fasting Insulin Levels but Not HOMA-IR With Increased Intima Media Thickness and Arteriosclerosis in Middle-Aged Persons.

Background: Recently published genetic studies have indicated a causal link between elevated insulin levels and cardiovascular disease (CVD) risk. We, therefore, hypothesized that increased fasting insulin levels are also associated with precursors of CVD such as endothelial lesions. Methods: Middle-aged (≥40 years, n = 1,639) employees were followed up for the occurrence of increased intima media thickness (IMT ≥ 1 mm) or plaques in abdominal or cervical arteries (arteriosclerosis). Multivariable logistic regression analyses determined the incidence of increased IMT or arteriosclerosis. Adjusted relative risk (ARR) for increased IMT and arteriosclerosis was calculated by using Mantel-Haenszel analysis. Results: Increased IMT was diagnosed in 238 participants (15 %) and 328 (20 %) developed arteriosclerosis after 5 years of follow-up. Logistic regression analysis identified fasting insulin, BMI and smoking as risk factors for both cardiovascular endpoints (all p < 0.05), whereas age and diastolic blood pressure were risk factors for increased IMT only, and male sex was associated with incident arteriosclerosis only (all p < 0.01). Additional adjustment for BMI change during follow-up did not modify these associations (including fasting insulin), but adjustment for fasting insulin change during follow-up removed BMI as risk factor for both cardiovascular endpoints. Fasting insulin change during follow-up but not BMI change associated with increased IMT and arteriosclerosis (both p < 0.001). ARR analysis indicated that high fasting insulin and BMI added to age and sex as risk factors. Homeostatic model assessment of insulin resistance (HOMA-IR) did not associate with either cardiovascular endpoint in any model and smoking did not increase the risk conferred by high fasting insulin levels. Conclusions: Higher fasting insulin levels and increases in fasting insulin over time are associated with atherogenic progression and supersede BMI as well as HOMA-IR as risk factors.

Continuous Protein Supplementation Reduces Acute Exercise-Induced Stress Markers in Athletes Performing Marathon.

The aim of this study was to determine the changes in endurance performance and metabolic, hormonal, and inflammatory markers induced by endurance stress (marathon race) in a combined strategy of training and dietary protein supplementation. The study was designed as a randomised controlled trial consisting of regular endurance training without and with a daily intake of a soy protein-based supplement over a three-month period in 2 × 15 (10 males and 5 females per group) endurance-trained adults. Body composition (body mass, BMI, and fat mass) was determined, and physical fitness was measured by treadmill ergometry at baseline and after 3 months of intervention; changes in exercise-induced stress and inflammatory markers (CK, myoglobin, interleukin-6, cortisol, and leukocytes) were also determined before and after a marathon competition; eating behaviour was documented before and after intervention by a three-day diet diary. Although no significant influence on endurance performance was observed, the protein supplementation regime reduced the exercise-induced muscle stress response. Furthermore, a protein intake of ≥20% of total energy intake led to a lower-level stress reaction after the marathon race. In conclusion, supplementary protein intake may influence exercise-induced muscle stress reactions by changing cellular metabolism and inflammatory pathways.

Metabolic Determinants of Impaired Pulmonary Function in Patients with Newly Diagnosed Type 2 Diabetes Mellitus.

AIMS: Impaired lung function associates with deterioration of glycemic control and diabetes-related oxidative stress in long-standing type 2 diabetes. We hypothesized that recent-onset type 2 diabetes patients exhibit abnormal pulmonary function when compared to glucose-tolerant controls and that the frequencies of single-nucleotide polymorphisms (SNPs), known to associate with lung dysfunction, are different between both groups. METHODS: Type 2 diabetes patients with a known disease duration<1 year (n=34) had similar age, sex distribution and BMI as overweight controls (n=26). Lung function was assessed by spirometry comprising predicted forced vital capacity (FVC%), predicted forced expiratory volume in one second (FEV1%) and the FEV1/FVC ratio. Multivariable linear regressions were performed to investigate group differences, which were adjusted for potential confounders such as age, sex, BMI, height and smoking status. SNP genotyping was conducted using real-time polymerase chain reaction-based allelic discrimination. RESULTS: Patients with type 2 diabetes had lower FEV1%, FEV1/FVC and VO2max (all p<0.05). Among patients with type 2 diabetes, FEV1% correlated positively with VO2max (r=0.40, p<0.05) and FEV1/FVC correlated negatively with HbA1c (r=-0.49, p<0.01). Regression analyses across the whole cohort indicated that the group differences in FEV1/FVC can be explained by the confounding effect of HbA1c. The frequencies of the SNPs rs1042713, rs1079572, rs11172113, rs12504628, rs1422795, rs1481345, rs2235910, rs2277027, rs2284746, rs4341, rs7068966, rs925284, rs993925 and rs3824658 did not differ between both groups. CONCLUSIONS: Recent-onset type 2 diabetes patients exhibit reductions in features of pulmonary function, which might be at least in part resulting from glucotoxicity.

The MMPI-2/MMPI-2-RF Symptom Validity Scale (FBS/FBS-r) is not a measure of 'litigation response syndrome': commentary on Nichols and Gass (2015).

OBJECTIVES: To address (1) Whether there is empirical evidence for the contention of Nichols and Gass that the MMPI-2/MMPI-2-RF FBS/FBS-r Symptom Validity Scale is a measure of Litigation Response Syndrome (LRS), representing a credible set of responses and reactions of claimants to the experience of being in litigation, rather than a measure of non-credible symptom report, as the scale is typically used; and (2) to address their stated concerns about the validity of FBS/FBS-r meta-analytic results, and the risk of false positive elevations in persons with bona-fide medical conditions. METHOD: Review of published literature on the FBS/FBS-r, focusing in particular on associations between scores on this symptom validity test and scores on performance validity tests (PVTs), and FBS/FBS-r score elevations in patients with genuine neurologic, psychiatric and medical problems. RESULTS: (1) several investigations show significant associations between FBS/FBS-r scores and PVTs measuring non-credible performance; (2) litigants who pass PVTs do not produce significant elevations on FBS/FBS-r; (3) non-litigating medical patients (bariatric surgery candidates, persons with sleep disorders, and patients with severe traumatic brain injury) who have multiple physical, emotional and cognitive symptoms do not produce significant elevations on FBS/FBS-r. Two meta-analytic studies show large effect sizes for FBS/FBS-r of similar magnitude. CONCLUSIONS: FBS/FBS-r measures non-credible symptom report rather than legitimate experience of litigation stress. Importantly, the absence of significant FBS/FBS-r elevations in litigants who pass PVTs demonstrating credible performance, directly contradicts the contention of Nichols and Gass that the scale measures LRS. These data, meta-analytic publications, and recent test use surveys support the admissibility of FBS/FBS-r under both Daubert and the older Frye criteria.

A meta-analysis of the neuropsychological effects of occupational exposure to manganese.

This article reports a meta-analysis of 25 samples in 20 peer-reviewed published neuropsychological studies of the cognitive, psychological, motor, and sensory/perceptual effects of exposure to manganese. These studies included 1,410 exposed participants and 1,322 controls, for a total N = 2,732. Studies were excluded from this analysis if they were unpublished, had uncodeable data, were based on fewer than four participants, failed to have a comparison group, or reported on manganese effects other than cognitive or sensory/motor (e.g., liver functioning). Because the independent variables defining manganese exposure varied across studies, effect sizes were calculated for exposed versus non-exposed workers. Dose-response relations were considered for measures of manganese levels in air/dust (84% of studies reported), blood (MnB; 76% reported), urine (MnU; 52% reported), and hair samples (4% reported). Level of exposure was also estimated by reported years of exposure (M = 13.1 years). Cohen's d statistic yielded a statistically significant weighted mean effect size of - .17, p < .0001 for manganese exposure. However, an effect this small is typically undetectable when evaluating individuals because it is smaller (about 1/6 SD) than the confidence intervals of most neuropsychological measures. Because the effect is so slight and the overlap so great between exposed and unexposed participants (87%), the error rate would exceed the hit rate if causal conclusions were rendered for occupational exposure to manganese as the source of an individual's cognitive, sensory, or motor impairments based on neuropsychological testing or symptom reports.

A meta-analysis of the neuropsychological effects of occupational exposure to mercury.

This paper reports a meta-analysis of 36 peer-reviewed published studies of the neuropsychological effects of occupational exposure to mercury, which yielded 43 independent samples. These studies included 2,512 exposed participants and 1,846 controls, for a total sample size of 4,358. Because the independent variables defining mercury exposure varied across studies, effect sizes were calculated for exposed versus non-exposed workers. Dose-response relations were considered for measures of mercury levels in urine (81% of studies reported), blood (42% of studies reported), and air samples (33% of studies reported). Level of exposure was also estimated by reported years of exposure (M = 11.3, SD = 5.6). Cohen's d statistic yielded a statistically significant weighted study-mean effect size of -.23, p < .0001 for occupational mercury exposure. However, an effect this small is typically undetectable when evaluating individuals because it is smaller than the typical 95% confidence interval used for most neuropsychological measures. None of the exposure variables analyzed reached statistical significance. The magnitude of self-reported symptoms (-.30) was slightly larger than that obtained from objective test scores (-.22), though the difference was not statistically significant. Also, the weighted mean effect size for psychomotor skills (-.34) was the largest in magnitude, whereas the weighted mean effect size for verbal comprehension measures had the smallest (-.06). However, an analysis of the differential effects of mercury exposure across cognitive domains found significant differences between verbal comprehension measures and all other domains. None of the other domains were significantly different from one another. The weighted study-mean effect size suggests that the prevalence of neuropsychological deficits due to occupational exposure to mercury is small and difficult to detect on an individual case-by-case basis.