Natural history of pancreatic islet B-cell function in type 2 diabetes mellitus studied over six years by homeostasis model assessment.

Islet B-cell function and insulin sensitivity were estimated with the aid of a mathematical model from repeated fasting plasma glucose and insulin measurements over a 6 year period in 131 patients with type 2 diabetes mellitus who could be managed satisfactorily on dietary therapy alone. They presented between the ages of 40 and 69 years, and were studied before and after one year of treatment, and then at regular intervals from 12 until 72 months later. A method of averaging the individual trends by means of a linear model regression technique was used to assess the progression of their diabetes. Dietary management over the first 12 months resulted in weight loss from 118% to 106% average body weight, and improved insulin sensitivity from 26% to 40% of normal (p less than 0.001). From 12 to 72 months, the fasting plasma glucose rose at a mean rate of 0.23 mmol/l per year (p less than 0.001) despite a rate of weight loss of 0.2% average body weight per year (p less than 0.01). The estimated islet B-cell function, expressed as a percentage of normal, decreased significantly (p less than 0.05) at a rate of 1.5% per year, with no statistically significant change in insulin sensitivity. Extrapolation suggests the reduction in B-cell function predated the departure of fasting plasma glucose from the normal range.

Availability and acceptance of health education among socially 'at risk' pregnant women attending health centres in Belfast.

This study highlights the large number of pregnant women in Belfast who fall into the 'at risk' category based on socioeconomic factors and suggests a need for greater emphasis on health education by professionals in both the fields of health and education in order to improve the knowledge and change the attitudes and behaviour of pregnant women; this could play an important part in reducing infant mortality and handicap in our society. The study showed that neither patients nor health care teams see health education as an integral part of antenatal and postnatal care and that little impact has been made in encouraging patients to plan their pregnancies, stop smoking and eat a more balanced diet.

Psychotropic drug use in Northern Ireland 1966-80: prescribing trends, inter- and intra-regional comparisons and relationship to demographic and socioeconomic variables.

A study of psychotropic drug prescribing, derived from the computerized pricing data in Northern Ireland from 1966, showed that the use of these drugs reached a peak in 1975, when about 12.5% of the adult population were estimated to have been receiving them, and declined in the following 5 years. Benzodioazepines accounted for three-quarters of all psychotropic drugs prescribed in 1980. Benzodiazepine tranquillizer prescribing was consistently 20-30% higher than in the rest of the United Kingdom, in contrast to hypnotic and antidepressant prescribing which has been consistently lower. The rate of increase in benzodiazepine tranquillizer prescribing was greater than in other European countries, but the level remains lower than in Iceland and Denmark. The influence of a number of demographic and socioeconomic variables was studied in an intra-regional analysis of the 1978 data for the 17 health districts in the province, using multivariate and multiple regression statistics. The prescribing of benzodiazepine hypnotics was almost entirely accounted for by the proportion of elderly (over 65 years) and women aged 45-59 years: neuroleptic prescribing was largely a function of factors associated with rural areas (overcrowding and unemployment) and the proportion of elderly; but neither tranquillizer, antidepressant, barbiturate hypnotic nor psychostimulant prescribing were satisfactorily explained by these variables.

Influence of social class on the risk of recurrence of anencephalus and spina bifida.

This study suggests that social class has an effect on the incidence of anencephalus and spina bifida, the malformations being more frequent in the lower socio-economic groups. A family study of 226 patients with a CNS malformation suggests that social class also may be important in determining the recurrence risk of such malformations: there are higher risks in social classes III, IV and V than in social classes I and II.