Glucose tolerance and insulin sensitivity markers in children and adolescents with excess weight.

OBJECTIVE: Type 2 diabetes mellitus (T2DM) and obesity are alarmingly increasing in children and adolescents. Hence, predictors for early metabolic abnormalities in childhood are urgently needed. We investigated glucose tolerance in children and adolescents with obesity, markers of insulin sensitivity between males and females and the potential association between the parameters measured during an OGTT (glucose, insulin, c-peptide) and prediabetes or stages of puberty. PATIENTS AND METHODS: Glucose tolerance in 89 children and adolescents with excess weight, aged 4-19 years, from Western Greece was studied. A 3-hour OGTT was performed and fasting glucose (FG), fasting insulin (FI), 1/FI, FG/FI, Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), Quantitative insulin sensitivity check index (QUICKI), ISI Matsuda index and Insulinogenic index (IGI30), were also calculated. RESULTS: No significant differences were observed in glucose values between males and females. Insulin and c-peptide concentrations were higher in the girls at several time points. FG/FI was significantly higher in the boys. Girls with obesity may be at higher risk for future insulin resistance. CONCLUSIONS: Better surveillance of pubertal girls with obesity is crucial and can be achieved using additional information provided by an OGTT, since they appear to be at a higher risk for beta-cell exhaustion. During the OGTT, not only are the baseline and 2-hour glucose and insulin measurements useful for predicting future metabolic risks and development of T2DM in children and adolescents with obesity, but additional time measurements may also be helpful.

Childhood trauma and distress experiences associate with psychotic symptoms in patients attending primary and psychiatric outpatient care. Results of the RADEP study.

GOAL: We studied the prevalence of and association between psychotic symptoms and childhood trauma experiences in primary care patients compared with psychiatric care patients. PATIENTS AND METHODS: We note 911 primary care and psychiatric care patients over 16 years of age filled in a questionnaire including a list of lifetime psychotic symptoms of the Composite International Diagnostic Interview (CIDI) and the childhood Trauma and Distress Scale (TADS). Prevalence of and correlations between psychotic symptoms and childhood trauma and stressful experiences were calculated. Association between the sum of CIDI symptoms and the TADS sum score was analysed by Anova. RESULTS: In primary care, more than half of the patients had had at least one psychotic symptom during their lifetime, and nearly 70% of patients had experienced a childhood trauma at some time or more often. In psychiatric care patients, CIDI symptoms were more prevalent and TADS scores were higher than in primary care patients. In the whole sample, CIDI symptoms correlated with TADS scores. The association remained even when the effects of age, service, and patient's functioning were taken into account. There was a dose-response between TADS scores and CIDI symptoms. CONCLUSION: Childhood trauma experiences associate with psychotic symptoms. In clinical work, it is important to acknowledge that psychotic symptoms and childhood trauma experiences are common not only in psychiatric care but also in primary care patients, and thus require adequate attention.

Human enterovirus infections in children at increased risk for type 1 diabetes: the Babydiet study.

AIMS/HYPOTHESIS: The aim of this study was to examine human enteroviruses (HEVs) and other intestinal viruses derived from children who participated in the Babydiet intervention study and to analyse the findings according to the appearance of islet autoantibodies, dietary intervention, maternal type 1 diabetes and clinical symptoms. METHODS: In the Babydiet study the influence of first gluten exposure (6 or 12 months) on the development of islet autoimmunity was investigated in 150 children with increased genetic and familial risk for type 1 diabetes. Blood and stool samples were collected at 3 monthly intervals until the age of 3 years and yearly thereafter. Infections and clinical symptoms were recorded daily for the first year. In the present study, 339 stool samples collected from 104 children during the first year of life were analysed for HEVs and a certain proportion of the samples were analysed for other intestinal viruses. RESULTS: HEV was detected in 32 (9.4%) samples from 24 (23.1%) children. Altogether 13 serotypes were identified, with HEV-A species being the most common. Children with gastrointestinal symptoms had norovirus (3/11) and sapovirus (1/11) infections in addition to HEV (1/11). Of the 104 children, 22 developed islet autoantibodies. HEV infections were detected in 18% (4/22) and 24% (20/82) of islet-autoantibody-positive and -negative children, respectively (p = 0.5). The prevalence of HEV was similar in the gluten-exposed groups and in children from mothers with type 1 diabetes or from affected fathers and/or siblings (p = 1.0 and 0.6, respectively). CONCLUSIONS/INTERPRETATION: No correlation was found between the presence of HEV in the first year of life and the development of islet autoantibodies. There was no association between HEV infections and dietary intervention, maternal diabetes or clinical symptoms.

[Advice on contraception for new mothers in Finland]. / Synnyttäneiden ehkäisyneuvonta suomessa.

The abortion rates have increased slightly. In the statistics, the proportion of women having already given birth has become greater. New mothers should be informed of contraception. It should be emphasized that nursing is an effective method of contraception only if the mother has not had her menstruation yet and if the baby is totally breast-fed. Condom, pessary and copper coil are good contraceptives during nursing. New methods are being developed constantly, such as Nesteroni.

PIP: In Finland, abortions increased slightly after years of steady decline. In 1995, the figure was 9,884; in 1996, it was 10,437; and in 1997, it was about the same. The rate of abortions increased mainly in the 20-24, 25-29, and 30-35 age groups, and in the age group under 20. 53% of women in these age groups had given birth before. During the post-delivery period, often the suddenly increased workload and lack of time results in not seeking contraceptive counseling, although a new pregnancy would impose difficulties. According to the International Planned Parenthood Federation, a study carried out in the Philippines in 1996 indicated that postpartum amenorrhea offers protection after the first delivery for 6 months, provided menstruation does not resume and as long as exclusive breast feeding is practiced. After weaning there is an increased risk of conception. Hospitals should inform women after delivery that during the first 8 weeks the contraceptive effect of breast feeding is very strong. The use of the IUD and spermicides is recommended. At the hospital of the school of midwifery it was a practice to fit IUDs 6-8 weeks after delivery. In Finland, oral contraceptives are not recommended to lactating mothers because of the reduction in maternal milk by up to 40%. However, low-dose minipills may be considered. A future contraceptive agent for breast-feeding women is Nesteron, which was developed in the course of 15 years of research. It could be administered either via an implant or via an IUD.

[Ideas concerning organizing contraceptive advice in a big city]. / Ajatuksia ehkäisyneuvonnan järjestämisestä ns. suurkaupungissa.

The writer thinks that centralization gives the most effective results. The inhabitants of different parts of a town would also be in an equal position in this kind of a system.