The Evolving Practice of Hospital at Home in the United States.

Hospital at Home (HaH) provides hospital-level services in the home to eligible patients who would otherwise require facility-based hospitalization. In the last two decades, studies have shown that HaH can improve patient outcomes and satisfaction and reduce hospital readmissions. Improved technology and greater experience with the model have led to expansion in the scope of patients served and services provided by the model, but dissemination in the United States has been hampered by lack of insurance coverage until recently. HaH is likely at the tipping point for wide adoption in the United States. To realize its full benefits, HaH will need to continue volume expansion to achieve culture change in clinical practice as facilitated by increased insurance coverage, technological advancements, and improved workforce expertise. It is also essential that HaH programs maintain high-quality acute hospital care, ensure that their benefits can be accessed by hard-to-reach rural populations, and continue to advance health equity.

Fruit and Vegetable Intake of Females Before, During, and After Introduction of 3 Bundled Food System Interventions in Urban Vietnam and Nigeria.

Background: Low fruit and vegetable (FV) intake in low- and middle-income countries, which is associated with noncommunicable diseases and micronutrient deficiencies, requires food system interventions addressing FV accessibility, affordability, and acceptability. Periodic FV intake monitoring during interventions informs progress toward achieving increased intakes and contributes to understanding the effectiveness of these interventions. Objectives: This study evaluates the trend in FV intake before, during, and after implementation of a set of nutrition-sensitive food system interventions addressing accessibility, affordability, and acceptability to increase FV consumption over a 1-y period in Vietnamese and Nigerian low-income urban and periurban females. Methods: We used the Diet Quality Questionnaire to assess FV food group consumption among 600 Vietnamese (Hanoi) and 610 Nigerian (Ibadan) females before, during, and after the interventions (Vietnam: July 2020-September 2021; Nigeria: November 2020-December 2021). A FV score was compared between exposure groups with (mixed) count modeling. The trend in consumption of individual FV groups was analyzed with mixed logistic regression. Results: The FV score was stable over time, and a small increase was observed after the intervention period especially in Nigeria and in urban Vietnam. A decrease in the total score was observed in periurban Vietnam. Fluctuations were detected in the probability of consumption of individual FV groups over time especially within the fruit groups, probably due to seasonal availability. The degree of exposure could not explain differences in FV intake. Conclusions: We found a marginal increase in the proportion of females consuming FV during the interventions in both countries. The FV score appeared to be a simple, quick, and easy-to-use indicator for monitoring diversity, variety, and consumption.

Qualitative Assessment of Implementation of a Discharge Prediction Tool Using RE-AIM Framework.

The implementation process in the routine clinical care of a new predictive tool based on machine learning algorithms has been investigated using the RE-AIM framework. Semi-structured qualitative interviews have been conducted with a broad range of clinicians to elucidate potential barriers and facilitators of the implementation process across five major domains: Reach, Efficacy, Adoption, Implementation, and Maintenance. The analysis of 23 clinician interviews demonstrated a limited reach and adoption of the new tool and identified areas for improvement in implementation and maintenance. Future implementation efforts of machine learning tools should support the proactive engagement of a wide range of clinical users since the very initiation of the predictive analytics project, provide higher transparency of the underlying algorithms, employ broader onboarding of all potential users on a periodic basis, and collect feedback from clinicians on an ongoing basis.

Racial Disparities in Documented Chief Complaints and Diagnoses in Sepsis Patients.

BACKGROUND: Using History and Physical Examination (H&P) notes, we investigated potential racial differences in documented chief complaints and problems among sepsis patients admitted to the intensive care unit. METHODS: Patient records from Medical Information Mart for Intensive Care (MIMIC-III) dataset indicating a diagnosis of sepsis were included. First recorded clinical notes for each hospital admission were assessed; free text information was specifically extracted on (1) chief complaints, and (2) problems recorded in the Assessment & Plan (A&P) section. The top 10 for each were compared between Black and White patients. RESULTS: In initial H&P notes of 17 434 sepsis patients (n = 1229 Black and n = 9806 White), the top 10 most common chief complaints were somewhat similar between Black and White patients. However, relative differences existed in terms of ranking, specifically for altered mental status which was more commonly reported in Black versus White patients (11.7% vs 7.8% P < .001). Among text in the A&P, sepsis was documented significantly less frequently among Black versus White patients: 11.8% versus 14.3%, P = .001. Racial differences were not detected in vital signs and laboratory values. CONCLUSIONS: This analysis supports the hypothesis that there may be racial differences in early sepsis presentation and possible provider interpretation of these complaints.

Review of recommended energy and nutrient intake values in Southeast Asian countries

@#This review summarises the officially published recommended energy and nutrient intake values in five Southeast Asia (SEA) countries namely Indonesia, Malaysia, Philippines, Thailand and Vietnam. The background information, general approaches and references used for setting up recommendations and the recommended intakes levels for energy, protein, fat and carbohydrate, dietary fibre, sugars,14 vitamins and 15 minerals of these countries were tabulated and compared. The recommended intake values show remarkable similarities in terms of approaches and principles taken, as well as references used as the basis for the recommendations development and the application of the recommendations in respective country. There are nevertheless some differences in age groupings, reference height and weight used, as well as the final recommendations of the intake levels for some nutrients, after adjustment to suit local situations. All five countries had provided recommendations in terms of recommended nutrient intakes (RNI) or recommended dietary allowance (RDA) for almost all the nutrients. Due to the limited availability of local data and resources, countries in the region have referred to several references, including those from Food and Agriculture Organization/World Health Organization (FAO/WHO) consultation report and recommendations from research organisations in United States and Europe and adapted the values for local uses. Opportunities should be created to enable closer dialogue and collaboration regarding future developments in nutrient recommendations for populations in the region. These could include consideration of establishing more appropriate nutrient recommendations and the call for setting up harmonised approaches to establishing recommended nutrient intake values for the region.

Oral Antineoplastics in Acute Myeloid Leukemia: A Comprehensive Review.

AML is a biologically and clinically heterogeneous disease that is associated with poor overall long-term survival. The expanding knowledge of genomic landscape in AML as well as advancements in molecular and chemical biology over the pathway in AML. After 40 years of stagnancy, the recent approval of numerous novel oral anti-leukemic agents for the treatment of AML has changed both the armamentarium of medications and treatment paradigms. These agents have unique clinical considerations in terms of administration, adverse effects, and monitoring parameters which may differ from clinician's historical expectations. Understanding the data, indication and clinical considerations for such novel oral anti-leukemic agents is paramount for clinicians caring patients with AML.

Impact of Infectious Disease after Lactococcus lactis Strain Plasma Intake in Vietnamese Schoolchildren: A Randomized, Placebo-Controlled, Double-Blind Study.

Lactococcus lactis strain Plasma (LC-Plasma) is reported to have anti-viral effects via direct activation of plasmacytoid dendritic cells, which upregulate the production of type I and III interferons. A randomized, placebo-controlled, double-blind, parallel group study was designed for elementary schoolchildren, grades 1 to 3, in Vietnam. LC-Plasma or a control were administered to schoolchildren as a beverage (1.0 × 1011 count LC-Plasma/day/person). The primary endpoint was to determine the efficacy of LC-Plasma in reducing the cumulative days absent from school due to upper respiratory disease (URID) and gastrointestinal disease (GID), and the secondary endpoint was to evaluate the potency of LC-Plasma on URID/GID symptoms and general well-being scores. LC-Plasma intake significantly reduced the cumulative days absent from school due to URID/GID (Odds ratio (OR) = 0.57, p = 0.004) and URID alone (OR = 0.56, p = 0.005); LC-Plasma also significantly reduced the number of cumulative fever positive days during the first 4 weeks of intervention (OR = 0.58, p = 0.001) and cumulative days with diarrhea during the last 4 weeks of the intervention period (OR = 0.78, p = 0.01). The number of positive general wellbeing days was significantly improved in the LC-Plasma group compared with the control throughout the intervention period (OR = 0.93, 0.93, p = 0.03, 0.04 in the first and last 4 weeks of the intervention, respectively). These data suggest that LC-Plasma seems to improve the health condition of elementary schoolchildren and reduces school absenteeism due to infectious disease, especially URID.

Efficacy of probiotics on digestive disorders and acute respiratory infections: a controlled clinical trial in young Vietnamese children.

OBJECTIVES: To evaluate the efficacy of fermented milk containing Lactobacillus casei strain Shirota (LcS) on the incidence of constipation, diarrhea, acute respiratory infections (ARI), and nutritional status of young Vietnamese children. METHODS: A controlled field trial was conducted with 1003 children (3-5 years old) in Thanh Hoa province in Vietnam. The probiotic group (n = 510) consumed fermented milk 65 mL/day containing 108 CFU/mL of LcS for the 12-week intervention period, whereas the control group (n = 493) was not given any. The incidence of constipation, diarrhea, ARI, and anthropometry in children was determined at baseline, after 4, 8, and 12-week intervention, and after the 4-week follow-up period. RESULTS: Probiotic drink decreased the incidence of constipation after the 12-week intervention period (12.0% vs. 32.0%, OR = 0.28 (95% CI: 0.21-0.40), p < 0.001), tended to decrease the incidence of diarrhea (4.9% vs. 7.9%, OR = 0.60 (95% CI: 0.35-1.01), p = 0.068), and prevented the occurrence of ARI (15.9% vs. 24.5%, OR = 0.58 (95% CI: 0.42-0.79), p < 0.001), when compared with the control group. In contrast, no probiotic effects were observed for the duration of diarrhea or ARI. Weight gain was higher in the probiotic group than in the control group after 4, 8, and 12-week intervention and after the 4-week follow-up period (p < 0.05). CONCLUSIONS: Daily intake of fermented milk containing LcS strongly prevented the incidence of constipation and ARI in Vietnamese children. This study also revealed the potential effects of the use of a probiotic drink on diarrhea prevention as well as nutritional status improvement.

Effectiveness of germinated brown rice on metabolic syndrome: A randomized control trial in Vietnam.

To treating Metabolic Syndrome (MetS) in the human body by using cooked pre-germinated brown rice (PGBR), a randomized control trial was done in Vietnam. 80 subjects (65.1 ± 3.81 years old) separated into two groups in pairs were assigned a daily intake of 200 g PGBR, and the subjects in the placebo group were kept in normal living ways (consuming white rice). Before baseline and after 3 months of the intervention, anthropometric measurements, blood chemical examinations, a nutrition survey, and physical activity measurements were conducted. The main finding showed that the percentages of patients with MetS in the PGBR group were reduced significantly compared to the placebo group (p < 0.05). Serum HDL cholesterol concentrations were significantly increased from 1.11 (mmol/l) to 1.44 (mmol/l) compared to the placebo group (p < 0.05). The findings suggest that PGBR may affect HDL cholesterol, PGBR might be considered in reducing the risk of MetS in Vietnam.

The cost of implementing Vietnam's national plan of action for nutrition for 2017-2020.

BACKGROUND: There is an urgent need to carry out a costing exercise of the National Plan of Action for Nutrition (NPAN) 2017-2020 since the costing of nutrition-sensitive interventions was not entirely integrated and proved difficult to track the different sectors' contributions to the nutrition program. OBJECTIVE: To estimate the required budget for the activities of the NPAN in 2017-2020. METHODS: A standard ingredients approach activity-based costing was employed from the provider perspective. RESULTS: The budget amount required for the NPAN activities in 2017, 2018, 2019 and 2020 would be US$ million 269.0; 310.5; 350.2 and 378.1, respectively. State budgets (especially from Ministry of Health) would be the main funding source for the NPAN. The budget required for implementing nutrition-sensitive interventions would be the largest share (more than 90%) while less than 10% are required for nutrition-specific interventions. The four interventions requiring the largest budget proportion (in 2020) included 1) Micronutrient supplementation (28.3%); 2) Breastfeeding & complementary feeding (21.9%); 3) Treatment of severe acute malnutrition (15.6%); and 4) Disease prevention and management (13.4%). CONCLUSIONS: Based on the data from Vietnam National Health account and the data on GDP of Vietnam, the total required budget for the Vietnam NPAN 2017 (USD millions 5,082) as shares of the State budget for health, total State (Government) budget, and GDP would be 5.29%, 0.49% and 0.14%, respectively. From the estimation, Vietnam represents the nutrition strategy which prioritized on nutrition-sensitive actions, similar to most of the SUN Movement member countries.

Child stunting is associated with child, maternal, and environmental factors in Vietnam.

Child stunting in Vietnam has reduced substantially since the turn of the century but has remained relatively high for several years. We analysed data on children 6-59 months (n = 85,932) from the Vietnam Nutritional Surveillance System, a nationally representative cross-sectional survey. Multivariable Poisson regression models were used to estimate relative risk (RR) of stunting, stratified by child age and ecological region. Covariates at the child, maternal, household, and environmental levels were included based on available data and the World Health Organization conceptual framework on child stunting. Among children 6-23 months, the strongest associations with child stunting were child age in years (RR: 2.49; 95% CI [2.26, 2.73]), maternal height < 145 cm compared with ≥150 cm (RR: 2.04; 95% CI [1.85, 2.26]), living in the Northeast compared with the Southeast (RR: 2.01; 95% CI [1.69, 2.39]), no maternal education compared with a graduate education (RR: 1.77; 95% CI, [1.44, 2.16]), and birthweight < 2,500 g (RR: 1.75; 95% CI [1.55, 1.98]). For children 24-59 months, the strongest associations with child stunting were no maternal education compared with a graduate education (RR: 2.07; 95% CI [1.79, 2.40]), living in the Northeast compared with the Southeast (RR: 1.94; 95% CI [1.74, 2.16]), and maternal height < 145 cm compared with ≥150 cm (RR: 1.81; 95% CI [1.69, 1.94]). Targeted approaches that address the strongest stunting determinants among vulnerable populations are needed and discussed. Multifaceted approaches outside the health sector are also needed to reduce inequalities in socioeconomic status.

Adherence to fluid resuscitation guidelines and outcomes in patients with septic shock: Reassessing the "one-size-fits-all" approach.

OBJECTIVE: The Surviving Sepsis Campaign and Centers for Medicare and Medicaid Services (CMS) Severe Sepsis and Septic Shock Management Bundle (SEP-1) recommend rapid crystalloid infusion (≥30 mL/kg) for patients with sepsis-induced hypoperfusion or septic shock. We aimed to assess compliance with this recommendation, factors associated with non-compliance, and how compliance relates to mortality. DESIGN: Retrospective, observational study. SETTING: 1136-bed academic and 235-bed community hospital (January 2015-June 2016). PATIENTS: Patients with septic shock. INTERVENTIONS: Crystalloid infusion (≥30 mL/kg) within 6 h of identification of septic shock as required by CMS. MEASUREMENTS: Associations with compliance and how compliance associates with mortality; odds ratios (OR) and 95% confidence intervals (CI) reported. MAIN RESULTS: Overall, 1027 septic shock patients were included. Of these, 486 (47.3%) met the 6-hour 30 ml/kg fluid requirement. Compliance was lower in patients with congestive heart failure (CHF) (40.9%), chronic kidney disease (CKD) (42.3%) or chronic liver disease (38.5%) and among those that were identified in the inpatient setting (35.4%) rather than in the emergency department (51.7%). When adjusting for relevant covariates, compliance (compared to non-compliance) was not associated with in-hospital mortality: OR 1.03 CI 0.76-1.41. CONCLUSIONS: These findings question a "one-size-fits-all" approach to fluid administration and performance measures for patients with sepsis.

Contemporary Remotely Sensed Data Products Refine Invasive Plants Risk Mapping in Data Poor Regions.

Invasive weeds are a serious problem worldwide, threatening biodiversity and damaging economies. Modeling potential distributions of invasive weeds can prioritize locations for monitoring and control efforts, increasing management efficiency. Forecasts of invasion risk at regional to continental scales are enabled by readily available downscaled climate surfaces together with an increasing number of digitized and georeferenced species occurrence records and species distribution modeling techniques. However, predictions at a finer scale and in landscapes with less topographic variation may require predictors that capture biotic processes and local abiotic conditions. Contemporary remote sensing (RS) data can enhance predictions by providing a range of spatial environmental data products at fine scale beyond climatic variables only. In this study, we used the Global Biodiversity Information Facility (GBIF) and empirical maximum entropy (MaxEnt) models to model the potential distributions of 14 invasive plant species across Southeast Asia (SEA), selected from regional and Vietnam's lists of priority weeds. Spatial environmental variables used to map invasion risk included bioclimatic layers and recent representations of global land cover, vegetation productivity (GPP), and soil properties developed from Earth observation data. Results showed that combining climate and RS data reduced predicted areas of suitable habitat compared with models using climate or RS data only, with no loss in model accuracy. However, contributions of RS variables were relatively limited, in part due to uncertainties in the land cover data. We strongly encourage greater adoption of quantitative remotely sensed estimates of ecosystem structure and function for habitat suitability modeling. Through comprehensive maps of overall predicted area and diversity of invasive species, we found that among lifeforms (herb, shrub, and vine), shrub species have higher potential invasion risk in SEA. Native invasive species, which are often overlooked in weed risk assessment, may be as serious a problem as non-native invasive species. Awareness of invasive weeds and their environmental impacts is still nascent in SEA and information is scarce. Freely available global spatial datasets, not least those provided by Earth observation programs, and the results of studies such as this one provide critical information that enables strategic management of environmental threats such as invasive species.

Recovery of Lactobacillus casei strain Shirota (LcS) from the intestine of healthy Vietnamese adults after intake of fermented milk.

To demonstrate the gastrointestinal survival of Lactobacillus casei strain Shirota (LcS) in healthy Vietnamese adults, a fermented milk drink containing LcS was administered daily for 14 days. Twenty-six healthy Vietnamese adults took part in the study. Each participant consumed 65 mL of a fermented milk drink containing LcS daily for 14 days. The drink contained a dose of 10 8 CFU/mL LcS. Fecal samples were collected before, during and after consuming the fermented milk drink. LcS was confirmed by culture and ELISA. After 7 and 14 days of ingesting fermented milk drink, LcS was recovered from fecal samples at average of 5.0×10 7 CFU/g feces (n=26) and 5.4×10 7 CFU/g feces (n=26), respectively. LcS persisted in 8 voluteers until day 42 (after 14 days stopping fermented milk drink) at 0.0033×10 7 CFU/g feces (n=8). We confirmed survival of LcS after passage through the gastrointestinal tract of Vietnamese adults.

Cognitive impairment in older adults with heart failure: prevalence, documentation, and impact on outcomes.

BACKGROUND: Despite the fact that 80% of patients with heart failure are aged more than 65 years, recognition of cognitive impairment by physicians in this population has received relatively little attention. The current study evaluated physician documentation (as a measure of recognition) of cognitive impairment at the time of discharge in a cohort of older adults hospitalized for heart failure. METHODS: We performed a prospective cohort study of older adults hospitalized with a primary diagnosis of heart failure. Cognitive status was evaluated with the Folstein Mini-Mental State Examination at the time of hospitalization. A score of 21 to 24 was used to indicate mild cognitive impairment, and a score of ≤20 was used to indicate moderate to severe impairment. To evaluate physician documentation of cognitive impairment, we used a standardized form with a targeted keyword strategy to review hospital discharge summaries. We calculated the proportion of patients with cognitive impairment documented as such by physicians and compared characteristics between groups with and without documented cognitive impairment. We then analyzed the association of cognitive impairment and documentation of cognitive impairment with 6-month mortality or readmission using Cox proportional hazards regression. RESULTS: A total of 282 patients completed the cognitive assessment. Their mean age was 80 years of age, 18.8% were nonwhite, and 53.2% were female. Cognitive impairment was present in 132 of 282 patients (46.8% overall; 25.2% mild, 21.6% moderate-severe). Among those with cognitive impairment, 30 of 132 (22.7%) were documented as such by physicians. Compared with patients whose cognitive impairment was documented by physicians, those whose impairment was not documented were younger (81.3 vs 85.2 years, P<.05) and had less severe impairment (median Mini-Mental State Examination score 22.0 vs 18.0, P<.01). After multivariable adjustment, patients whose cognitive impairment was not documented were significantly more likely to experience 6-month mortality or hospital readmission than patients without cognitive impairment. CONCLUSIONS: Cognitive impairment is common in older adults hospitalized for heart failure, yet it is frequently not documented by physicians. Implementation of strategies to improve recognition and documentation of cognitive impairment may improve the care of these patients, particularly at the time of hospital discharge.

Antioxidant/anti-inflammatory activities and total phenolic content of extracts obtained from plants grown in Vietnam.

BACKGROUND: Medicinal plants have been used to treat various diseases since ancient times. Their specific activities, such as antioxidant, anti-inflammatory and anti-cancer, have been studied intensively. In particular, plants grown in Vietnam have attracted considerable attention among food chemists as ideal sources of natural medicinal chemicals. RESULTS: The methanol extracts from three edible Vietnamese-grown plants, Tram, Voi and Gac, tested with the DPPH assay showed antioxidant activities of 91.7 ± 0.4, 63.4 ± 0.7 and 3.7 ± 0.1% respectively. The malonaldehyde/gas chromatography assay also revealed strong antioxidant activity in Tram and Voi at a level of 25 µg mL(-1) (95.5 ± 0.3 and 78.5 ± 1.4% respectively). These results were confirmed by the thiobarbituric acid assay. The antioxidant activities correlated positively with the level of total phenolics in all plants. Tram exhibited dose response-related lipoxygenase-inhibitory activity, with values of 74.2 ± 3.1% at 5 µg mL(-1) , 62.0 ± 0% at 0.5 µg mL(-1) and 3.0 ± 1.5% at 0.05 µg mL(-1) . Conversely, Voi and Gac showed negative anti-lipoxygenase activity. CONCLUSION: The antioxidant/anti-inflammatory activities and total phenolic contents of the three edible plants grown in Vietnam revealed that they are good sources of supplements for human health.

Protective and anticataract effects of the aqueous extract of Cleistocalyx operculatus flower buds on beta-cells of streptozotocin-diabetic rats.

The aim of the present study was to examine whether an aqueous extract of Cleistocalyx operculatus flower buds (COB) had protective and anticataract effects on beta-cells in experimental streptozotocin (STZ)-induced diabetes in rats. After 9 weeks of COB supplementation (500 mg/kg bw), the COB group had a significantly more stable insulin level as compared with the control diabetic group. Increased staining of insulin and preservation of islet cells were apparent in the COB-treated diabetic rats, whereas islet cell degeneration and weak insulin immunohistochemical staining were observed in the control diabetic rats. In addition, COB significantly delayed diabetic cataract formation and caused significant reductions in the glucose, sorbitol, and fructose levels in diabetic rat lenses. Furthermore, as compared to the control diabetic group, the COB group also showed antihyperglycemic effects (reductions in plasma glucose and HbA1c levels).

Alpha-glucosidase inhibitory and antioxidant activities of Vietnamese edible plants and their relationships with polyphenol contents.

The prevention and treatment of non-communicable diseases by using the beneficial biological effects of polyphenolic plants have attracted increasing interest from nutritional scientists. The a-glucosidase inhibitory and antioxidant activities of aqueous and methanolic extracts from 28 common Vietnamese edible plants, comprising 4 groups (plants used for making drinks, edible wild vegetables, herbs, and dark green vegetables), were investigated in vitro. The polyphenol contents of these extracts were determined by the Folin-Ciocalteu method and calculated as catechin equivalents. The extracts from plants used for making drinks showed the highest activities for both a-glucosidase inhibition and as antioxidants, followed by edible wild vegetables, herbs, and dark green vegetables. Positive relationships among alpha-glucosidase inhibitory activities, antioxidant activities and polyphenol contents of these 28 edible plants were found in both aqueous and methanolic extracts. Four new promising materials that are similar to or better than guava leaf extract, including Syzygium zeylanicum, Cleistocalyx operculatus, Horsfieldia amygdalina and Careya arborea demonstrated high alpha-glucosidase inhibitory activity (93, 76, 68 and 67%, respectively) at the final concentration of 0.8 mg lyophilized material/mL solution and antioxidant activity (85, 87, 78 and 80%, respectively) at the final concentration of 30 pg lyophilized material/mL solution. These four edible plants contained significantly high polyphenol contents (equivalent to 251.7, 146.6, 136.6 and 168.6 mg of catechin/g dry weight, respectively). Thus, these four materials might be possible new sources of a-glucosidase inhibition and antioxidants suitable for use as functional foods in the future.

Anti-hyperglycemic activity of an aqueous extract from flower buds of Cleistocalyx operculatus (Roxb.) Merr and Perry.

A screening of 5 plants used for making drinks in Vietnam revealed a Cleistocalyx operculatus (Roxb.) Merr and Perry flower bud extract to have the highest inhibitory activity against the alpha-glucosidase enzyme. The anti-hyperglycemic effects of an aqueous extract from flower buds of Cleistocalyx operculatus (CO), a commonly used material for drink preparation in Vietnam, were therefore investigated in vitro and in vivo. In vitro, the CO extract inhibited the rat-intestinal maltase and sucrase activities, with IC50 values of 0.70 and 0.47 mg/ml, respectively. These values are lower than those for a guava leaf extract (GE; IC50 0.97 and 1.28 mg/ml, respectively). Postprandial blood glucose testing of normal mice and STZ-induced diabetic rats by maltose loading (2 g/kg body weight (bw)) showed that the blood glucose reduction with CO (500 mg/kg bw) was slightly less than that with acarbose (25 mg/kg bw) but was more potent than that with GE (500 mg/kg bw). In an 8-week experiment, the blood glucose level of STZ diabetic rats treated with 500 mg of CO/kg bw/day was markedly decreased in comparison with that of non-treated diabetic rats. Consequently, CO is considered to be a promising material for preventing and treating diabetes.