Change in cardio-protective medication and health-related quality of life after diagnosis of screen-detected diabetes: Results from the ADDITION-Cambridge cohort.

AIMS: Establishing a balance between the benefits and harms of treatment is important among individuals with screen-detected diabetes, for whom the burden of treatment might be higher than the burden of the disease. We described the association between cardio-protective medication and health-related quality of life (HRQoL) among individuals with screen-detected diabetes. METHODS: 867 participants with screen-detected diabetes underwent clinical measurements at diagnosis, one and five years. General HRQoL (EQ5D) was measured at baseline, one- and five-years, and diabetes-specific HRQoL (ADDQoL-AWI) and health status (SF-36) at one and five years. Multivariable linear regression was used to quantify the association between change in HRQoL and change in cardio-protective medication. RESULTS: The median (IQR) number of prescribed cardio-protective agents was 2 (1 to 3) at diagnosis, 3 (2 to 4) at one year and 4 (3 to 5) at five years. Change in cardio-protective medication was not associated with change in HRQoL from diagnosis to one year. From one year to five years, change in cardio-protective agents was not associated with change in the SF-36 mental health score. One additional agent was associated with an increase in the SF-36 physical health score (2.1; 95%CI 0.4, 3.8) and an increase in the EQ-5D (0.05; 95%CI 0.02, 0.08). Conversely, one additional agent was associated with a decrease in the ADDQoL-AWI (-0.32; 95%CI -0.51, -0.13), compared to no change. CONCLUSIONS: We found little evidence that increases in the number of cardio-protective medications impacted negatively on HRQoL among individuals with screen-detected diabetes over five years.

The impact of intensive multifactorial treatment on perceptions of chronic care among individuals with screen-detected diabetes: results from the ADDITION-Denmark trial.

OBJECTIVES: To describe perceptions of chronic care among diabetes patients 6 years after diagnosis by screening and to examine the impact of intensive treatment on patients' perceptions of chronic care. METHODS: The ADDITION-Denmark (2001-2006) trial compared the effects of intensive multifactorial therapy (IT) with routine care (RC) among individuals with screen-detected diabetes. Perceptions of chronic care were assessed using the Patient Assessment of Chronic Illness Care (PACIC) measure after 6-year follow-up (n = 937). Analysis was by intention-to-treat, accounting for clustering by general practice. RESULTS: The mean (SD) summary PACIC score was 2.4 (0.79) in the RC and 2.4 (0.82) in the IT group. The highest mean (SD) PACIC subscale score was for Delivery System Design/Decision Support [RC: 3.2 (0.95), IT: 3.3 (0.91)] and the lowest was for Follow-up/Coordination [RC: 2.1 (0.84), IT: 2.1 (0.87)]. Perceptions of chronic care did not differ between trial groups. CONCLUSIONS: Compared to RC, an intensive multifactorial intervention was not associated with differences in perceptions of chronic care among patients with screen-detected diabetes after 6 years. Intensive treatment does not adversely affect perceptions of chronic care early in the course of the disease. However, there is potentially room for improvement in some aspects of chronic care.

Are changes in glycaemic control associated with diabetes-specific quality of life and health status in screen-detected type 2 diabetes patients? Four-year follow up of the ADDITION-Cambridge cohort.

BACKGROUND: Interventions that improve HbA1c levels do not necessarily improve health-related quality of life (QoL). This issue may be particularly relevant in asymptomatic diabetes patients detected earlier in the course of the disease. METHODS: HbA1c , diabetes-specific QoL (ADDQoL) and health status were measured in 510 screen-detected diabetes patients from the ADDITION-Cambridge trial at 1 and 5 years post diagnosis. Multivariable logistic/linear regression was used to quantify the longitudinal association between change in HbA1c from 1 to 5 years and ADDQoL and health status at 5 years, adjusting for age, sex, education and trial group; alcohol consumption, smoking, physical activity, plasma vitamin C, HbA1c , ADDQoL or health status at 1 year, and glucose-lowering medication at 5 years. RESULTS: From 1 to 5 years, median HbA1c interquartile range increased from 6.3% (5.9-6.8) to 6.8% (6.4-7.4); the median ADDQoL score and mean health status physical health summary score decreased from -0.4 (-1 to -0.08) to -0.5 (-1.08 to -0.09) (suggesting an adverse impact of diabetes on QoL) and by -0.79 (8.94) points, respectively. Increases in HbA1c were independently associated with reporting a negative impact of diabetes on QoL (OR = 1.38, 95% CI: 1.03 to 1.85) but not with the health status summary scores. CONCLUSIONS: Increases in HbA1c from 1 to 5 years post-diagnosis were independently associated with increased odds of reporting a negative impact of diabetes on QoL. While our results suggest that efforts to reduce HbA1c do not adversely affect health-related QoL, large numbers of participants still report a negative impact of diabetes on their QoL 5 years post-diagnosis.

Effects of multiwalled carbon nanotubes received orally during 6 days on the gastrointestinal tract.

The effects of multiwalled carbon nanotubes on epitheliocytes of different compartments of the gastrointestinal tract and urothelium of different compartments of the renal nephron were studied in CBA mice. The nanotubes affected mouse gastrointestinal mucosa and renal urothelium. The cell reaction in the macula densa of the renal distal tubules and the immune system reaction to oral nanotubes were detected. A possible effect of nanotubes administered orally on the renal filtration function was hypothesized.

Knowledge of sexually transmitted HPV infection, genitoanal warts, cancer and their prevention among young females after vaccine introduction in Germany.

BACKGROUND: Sexually transmitted human papillomavirus (HPV) high-risk types cause carcinoma and low-risk types lead to warts of genitoanal area. Since the HPV vaccine has been introduced, awareness of HPV infection, prevention and health-related behaviour have not been studied in a large sample of young women in Germany. OBJECTIVES: Assessment of awareness and health-related behaviour regarding HPV infection and prevention among young German females. METHODS: In 2010, a postal cross-sectional survey was conducted with a random representative sample size (n = 2000) of females aged 19-35 attending Germany's largest (comprehensive) university, which was designed to obtain data about socio-demographics, the awareness of sexually transmitted HPV, genitoanal neoplasms and their prevention, HPV vaccine, immunisation and cervical cancer screening. RESULTS: Of the 547 (27.3%) participants, 69.1% had heard of HPV, 62.5% were aware of the vaccine, 14.4% were vaccinated and 6.9% reported a history of sexually transmitted infection, including HPV (2.7%). The HPV-related knowledge among those who had heard of it was high (75.1-99.7%), except of that HPV affects men (52.9%) and HPV's causative role in genital (54.2%) and anal (35.6%) warts, and smoking (11.3%) as an HPV risk factor. The lower HPV knowledge score (

[Regional concentration of social disadvantage and of risks for lung cancer and colon cancer: systematic review and recommendations for research]. / Regionale Konzentration von sozialer Benachteiligung und von Risiken für Lungen- und Darmkrebs: Systematischer Review und Ableitung von Empfehlungen.

OBJECTIVES: Individual health status is influenced by individual social characteristics (age, gender, income usw.) and by the social characteristics of the regional environment in which the person lives. This is true also for lung cancer and colon cancer, two of the most common cancer sites in Germany. No systematic review about the social and regional distribution of lung cancer and colon cancer has been published in German-speaking countries yet. However, it could allow us to deepen the discussion regarding explanations of cancer risks and potential interventions. METHODS: Lung cancer and colon cancer have been selected because they are the two most common gender-independent cancer sites in Germany. A systematic literature search has been conducted via the Medline database using PubMed. 2 groups of regional differences have been distinguished, first by socio-economic characteristics (e. g., average household income) and second by urban vs. rural characteristics. The publications have then been analysed in a systematic way. RESULTS: 17 publications could be found, just 2 of them are from a German-speaking country (one each from Germany and Switzerland). The results concerning incidence and mortality can be summarised in the following way: The risks for lung cancer increase with decreasing socio-economic status of the region, but no clear association could be found for colon cancer. Some studies include information on urban-rural differences. They show that the risks for lung cancer are higher in urban as compared to rural areas; for colon cancer, again, no clear associations could be found. CONCLUSION: The review shows that some studies have already looked at social and regional differences in lung cancer and colon cancer, and that these associations have hardly been discussed in German-speaking countries as yet. We still do not know why lung cancer risks are especially high in low status regions, even if individual smoking is accounted for. The answer could probably be provided by risks such as air pollution. Therefore, a balanced strategy for reducing health inequalities should not just focus on improving individual health behaviour, but also on reducing the regional risks factors.

[Gerontological aspects of age-dependent mortality from malignant neoplasms of the population in the Russian Federation].

The demographic analysis of population-age mortality from malignant neoplasms of the population of RF in the years 1980-2008 enables to see the real presentation of the positive impact of medicine and the negative impact of the environment, but also to reveal fundamental biological processes that determine the health and life expectancy of Russian men and women. The authors allocate the leading role in the origin and development of malignant tumors for the aging process.

[Kinetic analysis of the age-specific mortality of the population of the Russian Federation: total mortality].

In this work kinetic analysis of the age-specific death rate of the population of the Russian Federation was made. We performed the verifying of the hypotheses about growth of the aging rate of the population of the Russian Federation. The verification displayed that at the time period under review the aging rate of the population of the Russian Federation had not changed, and the growth of the death rate in 90th years of the XX century associates with worsening of the living conditions.

Scaling invariance of the homoclinic tangle.

The structure of the homoclinic tangle of 11 / 2 degrees of freedom Hamiltonian systems in the neighborhood of the saddle point is invariant under discrete rescaling of the system's parameters. The rescaling constant is derived from the separatrix map and the Melnikov formula. Invariant manifolds for the periodically modulated Duffing oscillator are computed numerically to confirm this property. The scaling is related to the recently found invariance of the separatrix map under a discrete renormalization group. A possibility to extend the scaling invariance to different systems is demonstrated. The equivalency conditions under which two systems have the similarity of their chaotic layer structure near the saddle are derived. A numerical example shows a Duffing oscillator and a pendulum (acted on by different periodic perturbations) with the same structure of the tangle.

Chaotic advection near a three-vortex collapse.

Dynamical and statistical properties of tracer advection are studied in a family of flows produced by three point-vortices of different signs. Tracer dynamics is analyzed by numerical construction of Poincaré sections, and is found to be strongly chaotic: advection pattern in the region around the center of vorticity is dominated by a well developed stochastic sea, which grows as the vortex system's initial conditions are set closer to those leading to the collapse of the vortices; at the same time, the islands of regular motion around vortices, known as vortex cores, shrink. An estimation of the core's radii from the minimum distance of vortex approach to each other is obtained. Tracer transport was found to be anomalous: for all of the three numerically investigated cases, the variance of the tracer distribution grows faster than a linear function of time, corresponding to a superdiffusive regime. The transport exponent varies with time decades, implying the presence of multi-fractal transport features. Yet, its value is never too far from 3/2, indicating some kind of universality. Statistics of Poincaré recurrences is non-Poissonian: distributions have long power-law tails. The anomalous properties of tracer statistics are the result of the complex structure of the advection phase space, in particular, of strong stickiness on the boundaries between the regions of chaotic and regular motion. The role of the different phase space structures involved in this phenomenon is analyzed. Based on this analysis, a kinetic description is constructed, which takes into account different time and space scalings by using a fractional equation.

Passive particle transport in three-vortex flow

We study transport of tracer particles in a two-dimensional incompressible inviscid flow produced by three point vortices of equal strength. Time dependence of the flow caused by vortex motion gives rise to chaotic tracer trajectories, which fill parts of the flow plane referred to as mixing regions. For general vortex positions, a large connected mixing region (chaotic sea) is formed around vortices. It comprises a number of coherent fluid patches (islands), which do not mix with the rest of the chaotic sea, inside them particle motion is predominantly regular; three near-circular islands surrounding vortices are distinguished by their robust nature. Tracers in the chaotic sea rotate around the center of vorticity in an irregular way. Their trajectories are intermittent, long flights of almost regular motion are caused by trappings in the boundary regions of regular islands. The statistics of tracer rotation exhibits anomalous features, such as faster than linear growth of tracer ensemble variance and asymmetric probability distribution with long power tails. Exponent of the variance growth power law is different for different time ranges. Central part of the tracer distribution and its low (noninteger) moments evolve in a self-similar way, characterized by an exponent, which is different from that of the variance, and contrary to the latter is constant in time. Algebraic tails of the tracer distribution, controlling the behavior of the variance, are responsible for this effect. Long correlations in tracer motion lead to non-Poissonian distribution of Poincare recurrences in the mixing region. Analysis of long recurrences proves, that they are caused by tracer trappings inside boundary layers of islands of regular motion, which always exist inside the mixing region. Statistics of Poincare recurrences and trapping times exhibit power-law decay, indicating absence of a characteristic relaxation time. Values of the decay exponent for recurrences and for escape from the analyzed traps are very close to each other; long correlations are not dominated by a single trap, but are a cumulative effect of all of them, relative importance of a trap is determined by its size, and by its rotation frequency with respect to the background.

[The nature and mechanogenesis of pelvic bone fractures in children from exposure to the impact from blunt solid objects in a diagonal direction from the front and the side]. / Kharakter i mekhanogenez perelomov kostei taza u detei pri udarnom vozdeistvii tupymi tverdymi predmetami v diagonal'nom napravlenii speredi sboku.

Fifty cases of pelvic injuries in children are analyzed. The injuries were inflicted by blunt objects in the diagonal direction from the front from the side. Twenty-five of these (135 fractures) were expert cases, 25 (120 fractures) experimental observations. Both experimental and expert observations were divided into 3 groups depending on the angle between the direction of traumatic force action and the plane of the pelvic ring: those in the pelvic ring plane, and at angles of 45 and 90 degrees to it. In all the three groups strikes to the upper branch of the pubic bone with blunt objects from the front from the side in the diagonal direction led to development of various strained deformed states of the pelvis, each of which was characterized by specific mechanogenesis, localization, and morphology of fractures.

Pelvic polyfractures in children. Radiographic diagnosis and treatment.

Results of clinical and radiographic examinations of 43 patients, 4 to 15 years old, with pelvic polyfractures during acute- and long-term periods of trauma, and postmortem and experimental data were presented. A high rate of diagnostic mistakes and treatment failures in patients with pelvic polyfractures are defined. Depending on the location and pattern of pelvis injuries, the main reasons for complications are determined. A technique of external fixation with the application of a pivot device for managing pelvic polyfractures in children is described. The efficacy of the proposed curative tactics is shown by treatment results of 12 patients with pelvic polyfractures.

[The possibilities for detecting pelvic injuries in children (comparative x-ray, computed tomographic and morphological studies)]. / Vozmozhnosti vyiavleniia povrezhdenii taza u detei (sravnitel'noe rentgenologicheskoe, komp'iuterno-tomograficheskoe i morfologicheskoe issledovanie).

The authors analyze the possibility of detecting pelvic injuries in children on an inpatient basis by x-ray examination and computer-aided tomography and by morphological methods during forensic medical autopsy. A total of 146 cases are analyzed. X-Ray examination helped diagnose only 47.37% of all injuries in children with pelvic traumas. The informative value of the x-ray method may be improved if such factors as the presence of residual deformation with manifest asymmetry of the small pelvis entry are taken into consideration. If pelvic injuries are suspected in children, plane computer-aided tomography is advisable, for it permits the diagnosis of 76.32% injuries.

[The diagnosis of retroperitoneal hematomas]. / Diagnostika zabriushinnykh gematom.

The authors developed a method for assessment of the volume of retroperitoneal hematomas in children, based on measurements and mathematical processing of two parameters (body length or mass and the level of hematoma in relation to the lumbar spine). This method may be useful both in forensic and clinical medicine.

[X-ray diagnosis of injuries to the posterior part of the pelvic ring in children]. / Rentgenodiagnoska povrezhdenii zadnego otdela tazovogo kol'tsa u detei.

Proceeding from morphoroentgenological investigation of 48 isolated pelvic specimens from dead children, a new method for radiodiagnosis of fractures of lateral sacral masses (LSM) and rupture of sacroiliac joints (SIJ), based on quantitative assessment of pelvic ring deformity has been developed. Limitations of the method were established. The introduction of this roentgenometric method into clinical practice for diagnosis of injury of the posterior pelvic semiring permitted an increase in x-ray detection of LSM fractures 10-fold and SIJ ruptures 2.5-fold.

[Microbiologic characteristics of a trisectional horizontal biogas tank running on cow manure]. / Mikrobiologicheskaia kharakteristika trekhsektsionnoi gorizontal'noi biogazovoi ustanovki, rabotaiushchei na otkhodakh krupnogo rogatogo skota.

The methanogenic activity of manure destructors was investigated at different stages of cattle manure utilization at 35 degrees in a three-section horizontal methane tank manufactured by "Enbom" company (Finland). The association of microorganisms was found to have the highest activity at the last stage of the process, while the least activity was observed in case of fresh manure. A considerable increase of the methanogenic activity in the methane tank was proved by the radioisotopic method and by calculation of the population size of microorganisms from different groups by the series dilution method. Acetic and propionic acids were absent in samples from the third section of the methane tank, while the maximum concentration of the acids was found in the manure storage and in the first section of the methane tank. A significant part of active methanogenic microorganisms was removed with the effluent. Therefore, partial recirculation of the biomass should be used to increase the efficiency of the methane tank.