Long-term effects of retinopathy of prematurity (ROP) on rod and rod-driven function.

The purpose of this study was to determine whether recovery of scotopic sensitivity occurs in human ROP, as it does in the rat models of ROP. Following a cross-sectional design, scotopic electroretinographic (ERG) responses to full-field stimuli were recorded from 85 subjects with a history of preterm birth. In 39 of these subjects, dark adapted visual threshold was also measured. Subjects were tested post-term as infants (median age 2.5 months) or at older ages (median age 10.5 years) and stratified by severity of ROP: severe, mild, or none. Rod photoreceptor sensitivity, S (ROD), was derived from the a-wave, and post-receptor sensitivity, log σ, was calculated from the b-wave stimulus-response function. Dark adapted visual threshold was measured using a forced-choice preferential procedure. For S (ROD), the deficit from normal for age varied significantly with ROP severity but not with age group. For log σ, in mild ROP, the deficit was smaller in older subjects than in infants, while in severe ROP, the deficit was quite large in both age groups. In subjects who never had ROP, S (ROD) and log σ in both age groups were similar to those in term born controls. Deficits in dark adapted threshold and log σ were correlated in mild but not in severe ROP. The data are evidence that sensitivity of the post-receptor retina improves in those with a history of mild ROP. We speculate that beneficial reorganization of the post-receptor neural circuitry occurs in mild but not in severe ROP.

Deactivation of the rod response in retinopathy of prematurity.

It is known that retinopathy of prematurity (ROP) alters the activation of rod photoreceptors, but the effect of ROP on deactivation has not been investigated. We studied deactivation using an electroretinographic (ERG) paired flash procedure in 22 subjects (12 infants and 10 older subjects) with a history of preterm birth and ROP. The amplitude of the rod-isolated a-wave response to a flash presented 2-120 s after a test flash was measured, and the time at which it reached 50% of the single flash amplitude (t(50)) was determined by linear interpolation. Deactivation results were compared to those in former preterms who never had ROP (n = 6) and term-born controls. In infants, t(50) values of ROP subjects did not differ from those in subjects who never had ROP or term-born controls. Among mature ROP subjects, eight of 12 had t(50) values longer than any control subject. Prolonged deactivation in these mature ROP subjects may indicate lack of maturation of the deactivation process (t(50)) or progressive compromise of retinal function with increasing age.

Adapting urban best management practices for resilience to long-term environmental changes.

Stormwater best management practices (BMPs) help mitigate the adverse effects of urban development on stream hydrology and water quality, and are widely specified in development requirements and watershed management plans. However, design of stormwater BMPs largely relies on experience with historic climate, which may not be a reliable guide to the future. To inform BMP design that is robust to future conditions, it is important to examine how potential changes in precipitation, temperature, and potential evapotranspiration will affect the performance of BMPs. We use continuous simulation modeling to examine BMP performance under current and potential future climatic conditions and determine the changes needed in site configuration to address future impacts. We perform modeling for five development types in five different regions of the United States and explore both conventional ("gray") and green infrastructure (GI) stormwater management approaches. If stormwater designs are adapted to address potential future climate conditions, this study suggests that the most cost-effective approaches may use both gray and green BMPs. If the magnitude of extreme weather events increases dramatically, then gray practices that provide detention storage may have better cost-effectiveness. Incorporating risk of future climate impacts into stormwater design may help communities become more resilient. PRACTITIONER POINTS: There is a risk that projected changes in meteorological forcing will negatively affect stormwater BMP performance. Under projected future climate conditions, this study suggests the most cost-effective approaches may use both gray and green BMPs. If the magnitude of extreme weather events increases dramatically, gray practices that provide detention storage may have better cost-effectiveness. Flexibility is beneficial in adaptation and resilience planning due to uncertainty in projected precipitation volume and intensity changes.

Retinal degenerative and hypoxic ischemic disease.

A broad spectrum of retinal diseases affects both the retinal vasculature and the neural retina, including photoreceptor and postreceptor layers. The accepted clinical hallmarks of acute retinopathy of prematurity (ROP) are dilation and tortuosity of the retinal vasculature. Additionally, significant early and persistent effects on photoreceptor and postreceptor neural structures and function are demonstrated in ROP. In this paper, we focus on the results of longitudinal studies of electroretinographic (ERG) and vascular features in rats with induced retinopathies that model the gamut of human ROP, mild to severe. Two potential targets for pharmaceutical interventions emerge from the observations. The first target is immature photoreceptors because the status of the photoreceptors at an early age predicts later vascular outcome; this approach is appealing as it holds promise to prevent ROP. The second target is the interplay of the neural and vascular retinal networks, which develop cooperatively. Beneficial pharmaceutical interventions may be measured in improved visual outcome as well as lessening of the vascular abnormalities.

Projected impact of implementing the results of the diabetes prevention program in the U.S. population.

OBJECTIVE: To determine the feasibility of using either fasting plasma glucose or HbA(1c) to identify individuals in the U.S. population who meet the Diabetes Prevention Program (DPP) criteria for intervention, defined as BMI >/=24 kg/m(2), fasting plasma glucose level 96-125 mg/dl, and 2-h glucose level 140-199 mg/dl in an oral glucose tolerance test (OGTT). RESEARCH DESIGN AND METHODS: Analysis of a representative sample of U.S. adults aged 40-74 years with no medical history of diabetes for whom data on height, weight, fasting plasma glucose, HbA(1c), and 2-h plasma glucose during an OGTT were obtained. Sensitivity, specificity, positive predictive value (PPV), and receiver operator characteristic (ROC) curves for fasting glucose and HbA(1c) were determined. RESULTS: Using BMI <24 kg/m(2) as an initial criterion eliminated 27.2% of U.S. adults from further testing. Of the remaining group, 41.1% did not have to be considered for an OGTT because their fasting glucose level was below or above 96-125 mg/dl. Overall, 10.6% of adults aged 40-74 years without medical history of diabetes met the DPP eligibility criteria for intervention. Among individuals with BMI >/=24 kg/m(2) and fasting glucose level 96-125 mg/dl, applying a fasting plasma glucose cutoff of >/=105 mg/dl excluded 62.5% of this group and resulted in 56.0% of those with 2-h glucose level 140-199 mg/dl in this group being identified, with a specificity of 72.0% and a PPV of 17.1%. Similar values were obtained for an HbA(1c) cutoff value of >/=5.5%. CONCLUSIONS: Using data on BMI and setting cutoff values for fasting glucose and HbA(1c) would greatly reduce the number of individuals who would need to undergo an OGTT while achieving adequate sensitivity, specificity, and PPV.

A qualitative study exploring counselling for release of information to participants of a donor-assisted conception programme.

Worldwide, donor-assisted conceptions are increasing with legislative reforms in some countries providing opportunities for participants of a donor-assisted conception programme, i.e. recipients, donors, donor-conceived adults and their genetically related siblings and half-siblings, to access information. Whilst policy and practice for accessing donor-identifying information vary, there has been no research exploring the perceptions and experiences of those who provide the service. This study aimed to explore the perceptions and experiences of Australian and New Zealand infertility counsellors who provide counselling for release of information to participants of a donor-assisted conception programme. Using a qualitative research design, in-depth interview data of six infertility counsellors were thematically analysed to identify key themes. We report the primary themes that emerged from the data which include professional perspectives on the role of counsellor in the counselling process, the professional and societal responsibility to provide counselling, and influences on professional practice. Findings from this qualitative study can be used as a platform for larger international studies on the clinical practice of donor information release and to inform clinical practice and service delivery. The implications of these results for policy and future longitudinal research are also discussed.

Family Outbreaks of Nontyphoidal Salmonellosis following a Meal of Guinea Pigs.

Salmonella outbreaks have been linked to a wide variety of foods, including recent nationwide outbreaks. Guinea pig (Cavia porcellus), also known as cuy or cobayo, has long been a popular delicacy and ceremonial food in the Andean region in South America. This case report describes three family outbreaks of nontyphoidal salmonellosis, each occurring after a meal of guinea pigs. We believe this case report is the first to describe a probable association between the consumption of guinea pig meat and human salmonellosis. Physicians should be aware of the association of Salmonella and the consumption of guinea pigs, given the increasing immigration of people from the Andean region of South America and the increasing travel to this region.

Legionella pneumophila cases in a community hospital: A 12-month retrospective review.

BACKGROUND: Legionella pneumonia has long been recognized as an important cause of community-acquired pneumonia associated with significant morbidity and mortality; however, the description of the incidence of this disease is restricted to sporadic cases in the literature. With the advent of an inexpensive and rapid urine antigen test, routine testing has become more common. We report findings of a retrospective review of 266 patients who were admitted with a clinical diagnosis of community-acquired pneumonia over a 12-month period and were tested for Legionella pneumophila serogroup 1, reporting the prevalence and determinants of Legionella infection. METHODS: Chart reviews of 266 patients admitted for community-acquired pneumonia and who underwent urine antigen testing for Legionella pneumophila during a 1-year time period were conducted, looking at demographic information as well as clinical and laboratory presentation, reporting on the prevalence and determinants of urine antigen positivity using multivariate logistic regression analysis. RESULTS: Legionella pneumophila serogroup 1 was found in 2.3% of cases of community-acquired pneumonia. We also found that altered mental status, diarrhea, history of lung disease, and alcohol intake were significantly associated with pneumonia associated with Legionella. The presence of these four factors had a low sensitivity in predicting Legionella infection (33%); however, they had a positive predictive value of 98%, with a specificity of 100. All the Legionella-infected patients in our study required admission to the intensive care unit, and one of them developed Guillain-Barré syndrome, which to our knowledge represents the only reported case of this syndrome related to Legionella infection in an adult in the English scientific literature. CONCLUSION: Legionella pneumophila serogroup 1 is a common cause of sporadic cases of community-acquired pneumonia associated with a high morbidity and protean manifestations. Clinical features have a poor sensitivity in identifying cases, and routine urine antigen testing in patients with suggestive clinical symptoms appears to be a rational approach in the evaluation of community-acquired pneumonia.

An evaluation of bioactive glass in the treatment of periodontal defects: a meta-analysis of randomized controlled clinical trials.

BACKGROUND: The regenerative surgical treatment of intrabony defects caused by periodontal disease has been examined in several systematic reviews and meta-analyses. The use of bioactive glass (BG) as a graft material to treat intrabony defects has been reported, but all data have not been synthesized and compiled. Our objective was to systematically review the literature on the use of BG for the treatment of intrabony defects and to perform a meta-analysis of its efficacy. METHODS: A search of PubMed, EMBASE, and Cochrane Database of Systematic Reviews, as well as a manual search of recently published periodontology journals, were conducted to identify randomized controlled trials of the use of BG in the treatment of intrabony and furcation defects. Criteria included publication in English, follow-up duration of ≥6 months, baseline and follow-up measures of probing depth (PD) and clinical attachment levels (CAL) with 95% confidence intervals (CIs), and an appropriate control arm. Twenty-five citations were identified, 15 of which were included in the final analysis. Data, including study methods and results, as well as CONSORT (Consolidated Standards of Reporting Trials) criteria, were extracted from eligible studies and cross-checked by at least two reviewers. RESULTS: Meta-analyses of eligible studies were performed to ascertain summary effects for changes in PD and CAL among experimental and control groups, using the mean change plus standard deviation for each study. Pooled analyses showed that BG was superior to control for both measures: the mean (95% CIs) difference from baseline to follow-up between BG and controls was 0.52 mm (0.27, 0.78, P <0.0001) in reduction for PD and 0.60 mm (0.18, 1.01, P = 0.005) in gain for CAL. Analyses of CAL revealed heterogeneity across studies (I(2) = 60.5%), although studies reporting PD measures were homogeneous (I(2) = 0.00%). CAL heterogeneity appeared secondary to active controls versus open flap debridement (OFD) alone and to defect-type modifying BG treatment success. Per subgroup analyses, the benefit of BG over control treatment was highly significant only in studies comparing BG to OFD (P <0.0001), with mean difference change in CAL being 1.18 mm (95% CI = 0.74, 1.62 mm) between the BG and OFD group. CONCLUSION: Treatment of intrabony defects with BG imparts a significant improvement in both PD and CAL compared to both active controls and OFD.

A leadership program in an undergraduate nursing course in Western Australia: building leaders in our midst.

This paper discusses a leadership program implemented in the School of Nursing at Edith Cowan University to develop leadership in fourth semester nursing students enrolled in a three year undergraduate nursing degree to prepare them for the dynamic 'changing world' environment of healthcare. Students were invited to apply to undertake the program in extracurricular time. Nineteen students applied to the program and ten were chosen to participate in the program. The numbers were limited to ten to equal selected industry leader mentors. The leadership program is based on the belief that leadership is a function of knowing oneself, having a vision that is well communicated, building trust among colleagues, and taking effective action to realize one's own potential. It is asserted that within the complexity of health care it is vital that nurses enter the clinical setting with leadership capabilities because graduate nurses must take the lead to act autonomously, make decisions at the point of service, and develop a professional vision that fits with organizational and professional goals Thus, the more practice students have with leadership skills, the more prepared they will be to enter the workforce. The program consists of three components: leadership knowledge, leadership skills and leadership-in-action. The leadership program focuses on the student-participant's ability to be self reflective on personal leadership qualities, critically appraise, and work within a team as well as to take responsibility for ensuring the achievement of team goals as leader. The program is practical and is reliant on the involvement of leader mentors who hold positions of leadership with the health industry in Western Australia. Students completed a pre and post program questionnaire related to abilities and skills in leadership. This paper discusses pre and post evaluation data against program outcomes. The findings demonstrate that participants of the program increased their ability to influence, persuade and motivate others; to effectively communicate; to team build and work collaboratively; to develop problem solving and perseverance skills to overcome obstacles; and to serve as agents for positive change.

Depressive symptoms and the risk of type 2 diabetes mellitus in a US sample.

OBJECTIVE: There is some evidence to suggest that individuals with depression are at an almost twofold increased risk of developing type 2 diabetes mellitus, but results are far from conclusive. Therefore, to determine if depressive symptoms increased the risk of type 2 diabetes, we conducted longitudinal analyses using data from the NHANES I Epidemiologic Follow-up Survey (NHEFS). RESEARCH DESIGN AND METHODS: Participants included individuals who were white or African-American, did not report previous diagnosis of diabetes, and who completed the Centers for Epidemiologic Studies Depression (CES-D) questionnaire in the 1982-1984 study (n = 8870). Participants were followed up for incident-diagnosed diabetes through 1992 (mean follow-up 9.0 years). RESULTS: There were 1444 (15.9%) participants with high depressive symptoms in the 1982-1984 study (CES-D score > or = 16). During follow-up, there were 465 incident cases of diabetes. Incidence of diabetes was 6.9/1000 person years among those with high depressive symptoms, 6.0/1000 person years among those with moderate symptoms, and 5.0/1000 person years among those with no symptoms. After adjusting for age, sex, and race, the relative hazard (RH) of diabetes among those with high depressive symptoms was 1.27 (95% CI: 0.93 to 1.73) compared to those without symptoms. Further adjustment for education and known diabetes risk factors (body mass index and physical activity) further attenuated the relationship (RH 1.11, 95% CI: 0.79 to 1.56). CONCLUSIONS: There was no increased incidence of diabetes for those with high or moderate depressive symptoms compared to those with no depressive symptoms. These results do not support the etiologic relationship of depression predisposing individuals to diabetes.

Higher fasting insulin but lower fasting C-peptide levels in African Americans in the US population.

BACKGROUND: Fasting serum insulin and fasting serum C-peptide are risk factors for developing type 2 diabetes. Because of the higher incidence of type 2 diabetes in African Americans and Hispanic Americans, it is likely that these groups may differ from non-Hispanic whites in their levels of insulin and C-peptide. METHODS: We analyzed data from a nationally representative sample of adults in the US population for whom sociodemographic, clinical, and laboratory information were obtained. The data were used to describe distributions of fasting insulin and fasting C-peptide in non-Hispanic white, non-Hispanic black, and Mexican American men and women aged >or=20 years without a medical history of diabetes. RESULTS: Among men, Mexican Americans had higher insulin values than non-Hispanic whites and blacks. Among women, both Mexican Americans and blacks had higher insulin values than whites. For C-peptide, differences by sex and race-ethnicity paralleled those seen for fasting insulin with the exception that black men had significantly lower C-peptide values than whites and Mexican Americans. After adjustment for age, fasting plasma glucose (FPG), body mass index (BMI), and waist-to-hip ratio (WHR), the higher levels for insulin in blacks and Mexican Americans remained; both black men and women had significantly lower C-peptide values than whites and Mexican Americans. The molar ratio of fasting C-peptide to fasting insulin was similar for men and women in each race-ethnic group. However, blacks had substantially lower ratios than whites and Mexican Americans. CONCLUSIONS: We found wide variations in fasting insulin and fasting C-peptide levels by race and ethnicity in US adults that were not explained by confounding factors, primarily measures of obesity. Most notably, the higher fasting insulin and lower fasting C-peptide levels in blacks implies that there is a derangement in insulin clearance and an impairment in beta-cell function in blacks compared with whites and Mexican Americans.

Epidemiology of diabetic retinopathy - abstract

Diabetes mellitus is the leading cause of blindness in adults in the United States and about 8 per cent of those who are legally blind have diabetes mellitus as the cause of their blindness. Decreasing visual acuity and increasing prevalence of blindness are strongly related to duration of diabetes mellitus. Three complications of diabtes mellitus may lead to blindness: retinopathy, cataracts, and glaucoma. After 15 years of diabetes mellitus, almost 100 per cent of IDDM, 80 per cent of insulin-treated NIDDM, and 50 per cent of NIDDM not treated with insulin have alterations in the small blood vessels of the retina characterizing diabetic retinopathy. Approximately 40 per cent of IDDM and 5-10 per cent of NIDDM have severe, vision-threatening proliferative retinopathy after 15 years of diabetes mellitus. A substantial proportion of patients with NIDDM have retinopathy at diagnosis of their diabetes mellitus leading to the conclusion that diabetes mellitus has been present in a pre-clinical undiagnosed stage for about 10 years before NIDDM is clinically recognised. There are substantial racial differences in the prevalence of retinopathy in patients with diabetes mellitus. In U.S. patients with NIDDM, retinopathy is found in 13 per cent of non-Hispanic Whites, 28 per cent of Blacks, and 35 per cent of Mexican Americans. This racial disparity remains even after stratifying by duration of NIDDM. The higher rates in Mexican Americans versus non-Hispanic Whites have also been found in community-based studies in San Antonio, Texas, and the San Luis Valley, Colorado. However, one study of Jamaican Blacks and British Whites found no differences in the frequency of retinopathy after adjustment for glycaemia and other risk factors. There seem to be few differences in the prevalence of diabetic retinopathy by sex, and there are no definitive studies documenting an influence of genetic factors. Prevalence of retinopathy increases with increasing age but it is difficult to disentangle this from the effect of longer duration of diabetes mellitus. Insulin, either exogenous or endogenous, and C-peptide appear to have no role in the development of retinopathy. Studies on the relationships between retinopathy and high blood pressure, lipids, cigarette smoking, alcohol intake, obesity, physical activity and socioeconomic status have yielded inconsistent results. However, there is a large body of basic, clinical, and epidemiological studies which demonstrate the strong relationship between hyperglycaemia and the development and progression of diabetic retinopathy. The U.S. Diabetes Control and Complications Trial definitely showed that reducation in glycaemia ia accompanied by substantial decreases in the occurrence of new retionpathy in IDDM patients without retinopathy and decreases in the progression of retinopathy in patients with retinopathy at baseline. Whether this finding also applies with NIDDM is under study (AU)

Trends in the epidemiology of diabetes mellitus - abstract

Although diabetes mellitus has been recognized clinically for centuries, it is only within the past several decades that intensive scientific study of this disease has been conducted. The publication of diagnostic criteria and classification by the U.S. Natioanl Diabetes Data Group and the World Health Organization in 1979 - 80 was a sentinel event in the impetus for understanding the scope and impact of diabetes mellitus in international populations. Subsequent to these publications, numerous research groups around the world have conducted scientific investigations of the epidemiology of diabetes mellitus. Their findings show that IDDM is increasing in certain areas of Europe but that in many other countries its incidence is stable. In contrast, NIDDM is a growing problem worldwide. In the United States, the prevalence rate has tripled in the last 30 years. In every community studied, a substantial prevalence of undiagnosed NIDDM has been found; often there is one undiagnosed case of NIDDM for every known patient with this disease. This is similar to the situation with hypertension during the 1970s, in which undiagnosed hypertension was found to be very common and major national programmes were initiated to uncover undiagnosed cases and institute treatment. Epidemiological studies have established that prevalence of NIDDM is vastly different among countries and among racial/ethnic groups. In the United States, Blacks and Mexicans have 2- to 3-fold higher prevalence of NIDDM compared to non-Hispanic whites. NIDDM is virtually absent among the Bantu of Africa, yet it is extraordinarily common among U.S. Blacks. The population with the highest prevalence in the world, the Pima Indians of Southern Arizona, have a counterpart Pima population in the mountains of Mexico in which NIDDM is uncommon. Such differences in diabetes mellitus prevalence led to epidemiological investigations of risk factors for NIDDM, and numerous risk factors have been documented and refined: total obesity, abdominal fat disposition, duration of obesity, physical inactivity, dietary fat, family history of diabetes mellitus, genetic markers, hyperinsulinaemia. The epidemiology of diabetes mellitus has now moved into an important new stage: collaboration between epidemiologists and laboratory researchers to uncover the molecular mechanisms through which these risk factors act to cause diabetes mellitus and to discover the genes that determine NIDDM. The epidemiological studies conducted during the past decade have also laid the foundation for implementing a significant event: inauguration of programmes for the prevention of NIDDM (AU)

Characteristics of the pre-clinical state in type 11 diabetes mellitus - abstract

Preclinical type II diabetes was recognized by the U.S. National Diabetes Data Group and the World Health Organization in 1979 - 80. Their recognition of this condition was based on studies of people with varying degrees of post-challenging glucose tolerance who were followed prospectively for the development of complications of diabetes mellitus, primarily retinopathy. It was found that undiagnosed diabetic subjects whose 2-hour post-challenge glucose value was o11.1 mmol/l were at high-risk of developing diabetic complications. Subsequent studies have found that undiagnosed pre-clinical type II diabetes mellitus is very common in many countries. In the US population, it is found in 10 - 20 percent of persons aged 50 years and older, with even higher rates in Blacks, Mexican Americans, and American Indians. This is a significant proportion of the American population to have a disease that conveys increased morbidity and mortality and yet is totally untreated. There is significant fasting (Mean 7.5 mm01/1) and post-challenge (mean 14.4 - 15.0mm01/1) hyperglycaemia among subjects with preclinical type II diabetes mellitus in the USA. The levels of hyperglycaemia are not benign. Indeed, if patients with known diagnosed diabetes mellitus exhibited these values, their hyperglycaemia would surely not remain untreated. Certainly, at least dietary therapy would be instituted, if not oral hypoglycaemic agents. Nevertheless, all subjects with pre-clinical type II diabetes are undiagnosed and their hyperglycaemia remains untreated. When in the natural history of diabetes mellitus is type II diabetes diagnosed? Recent data show that retinopathy begins developing at least 7 years before clinical diagnosis of type II diabetes mellitus and that onset of type II diabetes mellitus probably occurs at least 5 years before that. During this entire 12-years period, hyperglycaemia in these undiagnosed cases is totally untreated and significant retinopathy is developing, indicating that widespread structural lesions related to diabetes mellitus are occurring. Other data confirm that pre-clinical type II diabetes mellitus is not a benign condition. Significant complications are present in patients at diagnosis. For example, 21 percent of newly diagnosed patients have retinopathy in US studies and prevalence of retinopathy was 29 percent among newly diagnosed patients enrolled in the UK Prospective Study of Type II diabetes mellitus. Prevalence of macrovascular disease in undiagnosed NIDDM is about equal to that found in diagnosed diabetes mellitus, and rates of coronary heart disease in both diagnosed and undiagnosed diabetes mellitus are about twice the rate found in non-diabetics. Mortality in undiagnosed diabetes mellitus is also equal to that of diagnosed and both are significantly higher than that in non-diabetics. Risk factors for micro- and Macro-vascular complications in pre-clinical Type II diabetes mellitus are very common and are as frequent as those found in diagnosed diabetics. The prevalence of treatable risk factors for subjects with undiagnosed diabetes mellitus in the U.S.A. includes 31 percent exceeding fasting plasma glucose of 7.8 mmol/l. Obesity is present in 67 percent, including 82 percent of women and 50 percent of men. Over 60 percent have hypertension, only half of which is controlled. Total cholesterol>240mg/dl is found in 49 percent and LDL-cholesterol > 160 mg/dl is found in 42 percent. Prevalence of hypertriglyceridaemia is 28 percent and 32 percent smoke cigarettes. Dietary fat intake>30 percent of calories occurs in 79 percent of subjects with undiagnosed diabetes mellitus, saturated fat>10 percent of calories occurs in 77 percent, and subjects with pre-clinical diabetes mellitus are thus at high risk for coronary heart disease. We have methods in our therapeutic armamentarium to deal with all of these risk factors, should we choose to find and diagnose the millions of people who have undiagnosed diabetes mellitus(AU)

Factors that influence the occurrence of teenage pregnancy - abstract

OBJECTIVES: To examine the way by which the family and other socio-environmental factors may influence the occurrence of pregnancies among teenagers. DESIGN AND METHODS: A case control methodology was used. The sample size was 90 with a 1:1 ratio of cases to control. Pregnant teenagers (14-19 years) who attended the antenatal clinic at the University Hospital of the West Indies and the Department of Social and Preventive Medicine, University of the West Indies (UWI) during February and March of 1995 were selected as cases. All female teenagers who had never been pregnant, and who lived on five randomly selected streets in the nearby community, were selected as controls. RESULTS: The adolescents who became pregnant were 2.7 times more likely to have a mother who was herself a teenaged mother. They were also likely to have had no discussion with their parent or guardian about human sexuality. CONCLUSIONS: There is the need to break the intergenerational cycle of teenage pregnancy. Parenting education, including effective communication skills, is vital.(AU)