Controlling the aggregation of sodium dodecylsulphate in aqueous poly(ethylene glycol) solutions

The role of PEG's of different molecular weights on the self-assembly of SDS and the role of added NaCl has been addressed opening new scopes for further studies.

Influence of hydrotropic coions on the shape transitions of sodium dioctylsulfosuccinate aggregates in an aqueous medium

The slope change of the CH plot is a manifestation of the shape change of the ionic micelles. However, binding of the salicylate coion to ionic micelles is an exception to this inference.

Patient explanations for non-attendance at structured diabetes education sessions for newly diagnosed Type 2 diabetes: a qualitative study

AIM

To determine the reasons for non-attendance at structured education sessions among people with a recent diagnosis of Type 2 diabetes.

METHODS

This was a qualitative study using semi-structured interviews to elicit the main themes explaining non-attendance. A thematic framework method was applied to analyse the data. People who had not attended structured education were recruited from a population cohort of newly diagnosed Type 2 diabetes from South London (the South London Diabetes cohort study), UK.

RESULTS

A sample of 30 people was interviewed. Three main themes emerged from the qualitative data explaining non-attendance at structured education: (1) lack of information/perceived benefit of the programme (e.g. not being informed about the course by their health professional); (2) unmet personal preferences (e.g. parking, timing); and (3) shame and stigma of diabetes (e.g. not wishing to tell others of diabetes diagnosis).

CONCLUSION

This is the first time that reasons for non-attendance have been explored in depth among people who have newly diagnosed Type 2 diabetes. Novel reasons identified included non-attendance because of shame and stigma of diabetes. To improve uptake at structured education we need to: consider how health professionals in primary care communicate with their patients on the subject of structured diabetes education; offer alternatives to the traditional group education format; and understand that diabetes is associated with health-related stigma, which may affect participation.

Reasons for cannabis use in first-episode psychosis: does strength of endorsement change over 12 months?

BACKGROUND

Why patients with psychosis use cannabis remains debated. The self-medication hypothesis has received some support but other evidence points towards an alleviation of dysphoria model. This study investigated the reasons for cannabis use in first-episode psychosis (FEP) and whether strength in their endorsement changed over time.

METHODS

FEP inpatients and outpatients at the South London and Maudsley, Oxleas and Sussex NHS Trusts UK, who used cannabis, rated their motives at baseline (n=69), 3 months (n=29) and 12 months (n=36). A random intercept model was used to test the change in strength of endorsement over the 12 months. Paired-sample t-tests assessed the differences in mean scores between the five subscales on the Reasons for Use Scale (enhancement, social motive, coping with unpleasant affect, conformity and acceptance and relief of positive symptoms and side effects), at each time-point.

RESULTS

Time had a significant effect on scores when controlling for reason; average scores on each subscale were higher at baseline than at 3 months and 12 months. At each time-point, patients endorsed 'enhancement' followed by 'coping with unpleasant affect' and 'social motive' more highly for their cannabis use than any other reason. 'Conformity and acceptance' followed closely. 'Relief of positive symptoms and side effects' was the least endorsed motive.

CONCLUSIONS

Patients endorsed their reasons for use at 3 months and 12 months less strongly than at baseline. Little support for the self-medication or alleviation of dysphoria models was found. Rather, patients rated 'enhancement' most highly for their cannabis use.

Provision of health promotion programmes to people with serious mental illness: a mapping exercise of four South London boroughs

BACKGROUND

People with serious mental illness (SMI) are at increased risk of developing various physical health diseases, contributing to significantly reduced life expectancies compared with the general population. In light of this, the Department of Health have set the physical health of people with mental health problems as a priority for improvement. Additionally, the UK government encourages the NHS and local authorities to develop health promotion programmes (HPPs) for people with SMI.

AIMS

To document how many and what types of HPPs were available to people with SMI across four South London boroughs, UK.

RESULTS

We found 145 HPPs were available to people with SMI across the four boroughs, but with an inequitable distribution. We also found that certain HPPs set admission criteria that were likely to act as a barrier to improving health.

CONCLUSIONS

A more integrated approach of documenting and providing information regarding the provision of HPPs for or inclusive of people with SMI is needed.

ABSTRACT

People with serious mental illness (SMI) such as schizophrenia, schizoaffective disorders and bipolar disorder are at increased risk of developing diabetes, cardiovascular disease and respiratory disease, contributing to significantly reduced life expectancies. As a result, emphasis has been placed on developing Health Promotion Programmes (HPPs) to modify the risk of poor physical health in SMI. We examined how many and what types of HPPs are available for or inclusive of people with SMI across four borough in South London, UK. A cross-sectional mapping study was carried out to identify the number of HPPs available to people with SMI. We found 145 HPPs available to people with SMI existed across the four boroughs but with an inequitable distribution, which in some boroughs we anticipate may not meet need. In some cases, HPPs set admission conditions which were likely to further impede access. We recommend that accurate and readily available information on the provision of HPPs for or inclusive of people with SMI is needed.

Diabetes-oriented learning family intervention (DOLFIN): a feasibility study evaluating an intervention for carers of young persons with Type 1 diabetes

AIMS

To describe the development of an intervention for parents and carers of young people with Type 1 diabetes and assess the feasibility, acceptability and emerging clinical themes.

METHODS

Participants were carers of young persons aged 10-18 years with a diagnosis of Type 1 diabetes of more than 12 months' duration in two inner-city South London hospitals. Carers were invited to attend six sessions of a group workshop where they received emotional support, diabetes education and were taught motivational interviewing techniques to support their child.

RESULTS

Out of 106 eligible participants, carers of 31 young people with Type 1 diabetes were recruited, 17 of whom 'completed' the intervention (attending four or more sessions). Participants discussed a variety of themes in session, including the increasing difficulty of diabetes management as children grow older, parenting techniques for managing diabetes in the home and the emotional challenges of having a child with a chronic illness.

CONCLUSIONS

Engaging parents in a carer intervention for Type 1 diabetes was a challenge, but parents who participated appeared to value the programme. Future interventions for carers need to take account of carers' wishes and expectations in order to maximize user uptake.

The clinical characteristics at diagnosis of type 2 diabetes in a multi-ethnic population: the South London Diabetes cohort (SOUL-D)

AIMS/HYPOTHESIS

This study aimed to investigate the clinical features of newly diagnosed type 2 diabetes in an urban multi-ethnic cohort.

METHODS

A population-based cross-sectional design was used. People diagnosed with type 2 diabetes in the preceding 6 months were recruited from primary care practices in three adjacent inner-city boroughs of South London, serving a population in which 20% of residents are of black African or Caribbean ethnicity. Sociodemographic and biomedical data were collected by standardised clinical assessment and from medical records. Multiple logistic regression methods were used to report associations between ethnicity and diabetes-complication status.

RESULTS

From 96 general practices, 1,506 patients were recruited. Their mean age was 55.6 (± 11.07) years, 55% were men, 60% were asymptomatic at diagnosis and 51%, 38% and 11% were of white, black and South Asian/other ethnicity, respectively. Compared with white participants, black and South Asian/other participants were: younger (mean age 58.9 [± 10.09], 52.4 [± 11.19] and 51.5 [± 10.42] years, respectively; p < 0.0001); less likely to have neuropathy (10.1%, 3.6% and 4.4%; p < 0.0001) or report coronary artery disease (12.7%, 4.8% and 7.3%; p < 0.0001). In logistic regression, compared with white participants, black participants had lower levels of macrovascular complications (OR 0.52, 95% CI 0.32, 0.84; p = 0.01). Male sex was independently associated with microvascular disease (OR 1.69, 95% CI 1.26, 2.28; p < 0.0001).

CONCLUSIONS/INTERPRETATION

The prevalence of complications at time of diagnosis was lower than expected, especially in black and South Asian/other ethnic groups. However, in multi-ethnic inner-city populations, onset of type 2 diabetes occurred almost 10 years earlier in non-white populations than in white participants, predicating a prolonged morbidity.

Aggregation behavior of sodium dioctylsulfosuccinate in aqueous ethylene glycol medium. A case of hydrogen bonding between surfactant and solvent and its manifestation in the surface tension isotherm

The dependence of critical micelle concentration (cmc) of sodium dioctylsulfosuccinate (AOT) on the amount of ethylene glycol (EG) in water + EG medium was reported to be unusual and different from that of other surfactants to the extent that the cmc of AOT in EG is lower than in water. It is yet to be understood why AOT behaves so in water + EG medium, although AOT is known to have some special properties. Hence in the present study cmc of AOT in water + EG medium in the range from 0 to 100% (by weight) EG is measured by using surface tension and fluorescence emission methods. In contrast to what was reported, this study revealed that with respect to EG amount the cmc of AOT follows the general trend and AOT has higher cmc in EG than in water. On the other hand, it was surprisingly found that a break in the surface tension isotherm occurs in the premicellar region when the amount of EG exceeds 50% rendering a bisigmoidal shape to the surface tension isotherm. UV spectral study showed that AOT and EG undergo hydrogen bonding in the premicellar region when the EG amount is ≥50% and this hydrogen bonding becomes less on adding NaCl. The density functional theory calculations also showed formation of hydrogen bonds between EG and AOT through the sulfonate group of AOT providing thereby support to the experimental findings. The calculations predicted a highly stable AOT-EG-H(2)O trimer complex with a binding energy of -37.93 kcal mol(-1). The present system is an example, which is first of its kind, of a case where hydrogen bonding with surfactant and solvent molecules results in a surface tension break.

Five-year follow-up of a cohort of people with their first diabetic foot ulcer: the persistent effect of depression on mortality

AIMS/HYPOTHESIS

Depressive disorders are associated with mortality within 18 months of presentation of diabetic foot ulcers (DFU). The main aim of this study was to determine whether depressive disorder is still associated with increased mortality in people with their first foot ulcer at 5 years.

METHODS

This is a 5-year follow-up of a cohort of 253 patients presenting with their first DFU. At baseline, the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) 2.1 was used to define those who met DSM-IV (Diagnostic and Statistical Manual 4th edition) criteria for depressive disorder. Cox regression analysis controlled for potential covariates: age, sex, marital status, socioeconomic status, smoking, mean HbA(1c), diabetes complications and ulcer severity. The main outcome was mortality at 5 years.

RESULTS

The prevalence of DSM-IV depressive disorder at baseline was 32.2% (n = 82). There were 92 (36.4%) deaths over the 5 years of follow-up. In the Cox regression (n = 246), after adjusting for covariates, baseline DSM-IV depressive disorder was significantly associated with a twofold increased risk of mortality for any depressive episode (HR 2.09, 95% CI 1.34, 3.25), minor (HR 1.93, 95% CI 1.00, 3.74) or major depressive disorders (HR 2.18, 95% CI 1.31, 3.65), compared with patients who were not depressed.

CONCLUSIONS/INTERPRETATION

Depression is associated with a persistent twofold increased risk of mortality in people with their first DFU at 5 years.

Themes elicited during motivational interviewing to improve glycaemic control in adults with Type 1 diabetes mellitus

AIMS

To elicit the barriers and motivators to better diabetes self care in patients with Type 1 diabetes.

METHODS

We obtained a purposive sample of 47 patients with Type 1 diabetes and persistent suboptimal glycaemic control from a randomized controlled trial of nurse-delivered psychological interventions. Each participant's second session of motivational interviewing was analysed using content analysis.

RESULTS

Four major themes emerged: emotions of living with Type 1 diabetes, perceived barriers to diabetes management, motivators for change and methods of coping. Increased assistance and support from family and healthcare teams, the prospect of improved emotional and physical well-being and feelings of success were described as factors that might motivate participants to practice more effective self care.

CONCLUSIONS

An enhanced awareness of the range of psychological concepts in diabetes may enable a better therapeutic relationship between clinicians and patients.

Human facial neural activities and gesture recognition for machine-interfacing applications

The authors present a new method of recognizing different human facial gestures through their neural activities and muscle movements, which can be used in machine-interfacing applications. Human-machine interface (HMI) technology utilizes human neural activities as input controllers for the machine. Recently, much work has been done on the specific application of facial electromyography (EMG)-based HMI, which have used limited and fixed numbers of facial gestures. In this work, a multipurpose interface is suggested that can support 2-11 control commands that can be applied to various HMI systems. The significance of this work is finding the most accurate facial gestures for any application with a maximum of eleven control commands. Eleven facial gesture EMGs are recorded from ten volunteers. Detected EMGs are passed through a band-pass filter and root mean square features are extracted. Various combinations of gestures with a different number of gestures in each group are made from the existing facial gestures. Finally, all combinations are trained and classified by a Fuzzy c-means classifier. In conclusion, combinations with the highest recognition accuracy in each group are chosen. An average accuracy >90% of chosen combinations proved their ability to be used as command controllers.

A US-UK comparison of health in 1990-1991 Gulf War veterans

BACKGROUND

UK and US military personnel appear to have different health profiles yet direct comparisons of health status and deployment exposures between US and UK military populations have never been performed.

AIMS

To compare US and UK military personnel deployed to the 1991 Persian Gulf War (PGW) for rates of symptom reporting, medical conditions and health status [Short Form-36 general health perception (GHP) and physical functioning (PF) subscales] and self-report military exposures.

METHODS

We analysed representative cross-sectional samples of military personnel from the Iowa Persian Gulf Study (n = 3626) and the UK Health Survey of Military Personnel (n = 5573) that included directly comparable measures and stratified by those who had been deployed to PGW and those who had not been deployed to PGW.

RESULTS

Although UK veterans had similar mean PF scores as US veterans (mean differences in PGW: 0.86, 95% CI -0.36 to 2.07 and in non-deployed -0.61, 95% CI -1.84 to 0.62), they had worse mean GHP scores (mean differences in PGW: -5.62, 95% CI -7.44 to -3.80 and in non-deployed -3.83, 95% CI -5.40 to -2.27). UK PGW veterans were more likely to report Gulf specific exposures, and this was associated with worse GHP (UK mean difference -9.05, 95% CI -11.49 to -6.61 versus US mean difference -4.30, 95% CI -6.62 to -1.98).

CONCLUSIONS

This study observed transatlantic variations in health status in military populations that may reflect cultural differences in the reporting of health.

Motivational enhancement therapy with and without cognitive behaviour therapy for Type 1 diabetes: economic evaluation from a randomized controlled trial

AIMS

  To assess the cost-effectiveness of motivational enhancement therapy and cognitive behaviour therapy for poorly controlled Type 1 diabetes.

METHODS

  Within-trial prospective economic evaluation from (i) health and social care and (ii) societal perspectives. Three hundred and forty-four adults with Type 1 diabetes for at least 2 years and persistent, suboptimal glycaemic control were recruited to a three-arm multi-centre randomized controlled trial in London and Manchester, UK. They were randomized to (i) usual care plus four sessions of motivational enhancement therapy (ii) usual care plus four sessions of motivational enhancement therapy and eight sessions of cognitive behaviour therapy or (iii) usual care alone. Outcomes were (i) costs, (ii) Quality-Adjusted Life Year gains measured by the EuroQol 5-dimensional health state index and the 36-item Short Form and (iii) diabetes control measured by change in HbA(1c) level at 1 year.

RESULTS

  Both intervention groups had significantly higher mean health and social care costs (+ £535 for motivational enhancement therapy and + £790 for combined motivational enhancement and cognitive behavioural therapy), but not societal costs compared with the usual-care group. There were no differences in Quality Adjusted Life Years. There was a significantly greater HbA(1c) improvement in the combined motivational enhancement and cognitive behavioural therapy group (+ 0.45%; incremental cost-effectiveness ratio = £1756), but the not in the motivational enhancement therapy group. Cost-effectiveness acceptability curves suggested that both interventions had low probabilities of cost-effectiveness based on Quality Adjusted Life Years (but high based on HbA(1c) improvements). Imputing missing costs and outcomes confirmed these findings.

CONCLUSIONS

  Neither therapy was undisputedly cost-effective compared with usual care alone, but conclusions vary depending on the relative importance of clinical and quality-of-life outcomes.

Type 2 diabetes mellitus as a risk factor for the onset of depression: a systematic review and meta-analysis

AIMS/HYPOTHESIS

An earlier meta-analysis showed that diabetes is a risk factor for the development and/or recurrence of depression. Yet whether this risk is different for studies using questionnaires than for those relying on diagnostic criteria for depression has not been examined. This study examined the association of diabetes and the onset of depression by reviewing the literature and conducting a meta-analysis of longitudinal studies on this topic.

METHODS

EMBASE, MEDLINE and PsycInfo were searched for articles published up to September 2009. All studies that examined the relationship between type 2 diabetes and the onset of depression were included. Pooled relative risks were calculated using fixed and random effects models.

RESULTS

Eleven studies met our inclusion criteria for this meta-analysis. Based on the pooled data, including 48,808 cases of type 2 diabetes without depression at baseline, the pooled relative risk was 1.24 (95% CI 1.09-1.40) for the random effects model. This risk was significantly higher for studies relying on diagnostic criteria of depression than for studies using questionnaires. However, this difference was no longer significant when controlled for year of publication.

CONCLUSIONS/INTERPRETATION

Compared with non-diabetic controls, people with type 2 diabetes have a 24% increased risk of developing depression. The mechanisms underlying this relationship are still unclear and warrant further research.

Micellar shape driven counterion binding. Small-angle neutron scattering study of AOT micelle

Sodium dioctylsulfosuccinate (AOT) micelle has a special counterion binding behavior in aqueous electrolyte medium, viz., the counterion binding constant (β) abruptly increases by 2-fold at about 0.015 mol dm(-3) NaCl concentration (c*), but not in sodium salicylate (NaSa) solution. Since counterions affect the structure and performance of ionic surfactants, ascertaining the cause for the sudden shift in the β value of AOT micelle is of fundamental importance. In this study the special counterion binding behavior of AOT micelle has been ascertained at 40 °C by carrying out surface tension, zeta potential, and fluorescence emission (pyrene probe) measurements. The results of the small-angle neutron scattering experiment carried out at 40 °C showed that at c* the shape of AOT micelle changes from prolate spheroid to rodlike in NaCl solution, but not in NaSa solution, thus establishing micellar shape change as responsible for the abrupt change in β value. The absence of sudden shift in β of AOT micelle in NaSa solution is attributed to the binding of salicylate coanion to AOT micelle through hydrophobic interaction.

A randomised controlled trial of cognitive behaviour therapy and motivational interviewing for people with Type 1 diabetes mellitus with persistent sub-optimal glycaemic control: a Diabetes and Psychological Therapies (ADaPT) study

OBJECTIVES

To determine whether (i) motivational enhancement therapy (MET) + cognitive behaviour therapy (CBT) compared with usual care, (ii) MET compared with usual care, (iii) or MET + CBT compared with MET was more effective in improving glycaemic control when delivered by general nurses with additional training in these techniques.

DESIGN

A three-arm parallel randomised controlled trial as the gold standard design to test the effectiveness of psychological treatments.

SETTING

The recruiting centres were diabetes clinics in seven acute trusts in south-east London and Greater Manchester.

PARTICIPANTS

Adults (18-65 years) with a confirmed diagnosis of type 1 diabetes for a minimum duration of 2 years and a current glycated (or glycosylated) haemoglobin (HbA1c) value between 8.2% and 15.0%.

INTERVENTIONS

The control arm consisted of usual diabetes care which varied between the hospitals, but constituted at least three monthly appointments to diabetes clinic. The two treatments arms consisted of usual care with MET and usual care with MET + CBT.

MAIN OUTCOME MEASURES

The primary outcome was HbA1c at 12 months from randomisation. Secondary outcome measures were 1-year costs measured by the Client Service Receipt Inventory at baseline, 6 months and 12 months; quality of life-years [quality-adjusted life-years (QALYs)] measured by the SF-36 (Short Form-36 Health Survey Questionnaire) and EQ-5D (European Quality of Life-5 Dimensions) at baseline and 12 months.

RESULTS

One thousand six hundred and fifty-nine people with type 1 diabetes were screened and 344 were randomised to MET + CBT (n = 106), MET (n = 117) and to usual care (n = 121). The 12-month follow-up rate for HbA1c was 88% (n = 305). The adjusted mean 12-month HbA1c was 0.45% lower in those treated with MET + CBT [95% confidence interval (CI) 0.16% to 0.79%, p = 0.008] than for usual care; 0.16% lower in those treated with MET (95% CI 0.20% to 0.51%, p = 0.38) than for usual care; and 0.30% lower with MET + CBT than with MET (95% CI -0.07% to 0.66%, p = 0.11). The higher the HbA1c, and the younger the participant at baseline, the greater was the reduction in HbA1c. The interventions had no effect on secondary outcomes such as depression and quality of life. The economic evaluation was inconclusive. Both interventions were associated with increased health care costs than for usual care alone. There was no significant difference in social costs. Cost effectiveness ratios, up to one year, varied considerably according to whether QALY estimates were based on EQ-5D or SF-36 and whether imputed or complete data were used in the analyses.

CONCLUSIONS

A combination of MET and CBT may be useful for patients with persistent sub-optimal diabetic control. MET alone appears less effective than usual care. Economic evaluation was inconclusive.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN77044517.

Urban-rural differences of gynaecological malignancies in Egypt (1999-2002)

OBJECTIVE

In previous studies, we have shown a three to four times higher urban incidence of breast cancer and estrogen receptor-positive breast cancers in the Gharbiah Province of Egypt. We investigated the urban-rural incidence differences of gynaecologic malignancies (uterine, ovarian and cervical cancers) to explore if they show the same trend that we found for breast cancer.

DESIGN

Cancer registry-based incidence comparison.

SETTING

Gharbiah population-based cancer registry (GPCR), Tanta, Egypt.

SAMPLE

All patients with uterine, ovarian and cervical cancer in GPCR from 1999 to 2002.

METHODS

We calculated uterine, ovarian and cervical cancer incidence from 1999 to 2002. For each of the three cancers, we calculated the overall and age-specific rates for the province as a whole, and by urban-rural status, as well as for the eight districts of the province.

RESULTS

Incidence of all three cancer sites was higher in urban than in rural areas. Uterine cancer showed the highest urban-rural incidence rate ratio (IRR = 6.07, 95% CI = 4.17, 8.85). Uterine cancer also showed the highest urban incidence in the oldest age group (70+ age category, IRR = 14.39, 95% CI = 4.24, 48.87) and in developed districts (Tanta, IRR = 4.14, 95% CI = 0.41, 42.04). Incidence rates by groups of cancer sites showed an increasing gradient of urban incidence for cancers related to hormonal aetiology, mainly of the breast and uterus (IRR = 4.96, 95% CI = 2.86, 8.61).

CONCLUSIONS

The higher urban incidence of uterine cancer, coupled with our previous findings of higher incidence of breast cancer and estrogen receptor positive breast cancer in urban areas in this region, may be suggestive of possible higher exposure to environmental estrogenic compounds, such as xenoestrogens, in urban areas.

Prioritisation of Tests for the Prediction of Preeclampsia Complications: A Delphi Survey

BACKGROUND

Preeclampsia is associated with several maternal and fetal complications. Numerous tests - including patient history, physical examination findings, and laboratory investigations - are used to predict such complications in women with preeclampsia. At present, there are no robust systematic reviews or large studies examining the accuracy of tests that could predict complications in women with preeclampsia.

OBJECTIVE

To identify the tests (which include items of history, examination, and investigations) that are clinically relevant in predicting maternal and fetal complications in women with preeclampsia.

METHODS

A two-generational Delphi method was used to prioritize the clinically relevant tests that are considered helpful in predicting the maternal and fetal complications of preeclampsia.

RESULTS

Blood pressure was rated as the best predictor of complications with mean score (+/- SD) of 4.7 (+/- 0.47), followed by proteinuria 4.6 (+/- 0.5) and liver function tests 4.5 (+/- 0.52).

CONCLUSION

The list of tests that have been identified and prioritized will form the basis for future systematic reviews of the literature in this field.

No association of depression and anxiety with the metabolic syndrome: the Norwegian HUNT study

OBJECTIVE

To examine the associations of depression and anxiety with the metabolic syndrome.

METHOD

Cross-sectional study of 9571 participants aged 20-89 years in the Nord-Trøndelag Health Study (HUNT 2). We assessed anxiety and depression with the Hospital Anxiety and Depression Scale and the metabolic syndrome with the International Diabetes Federation criteria.

RESULTS

Despite generous statistical power and use of both continuous and categorical approaches, we found no association between anxiety or depression and the metabolic syndrome in models adjusted for age, gender, educational level, smoking, physical activity and pulse rate. When adjusted for age and gender only, we found a weak positive association for depression when a continuous measure was used, but not at the case level. The findings were similar across sexes, and robust for exclusion of cardiovascular disease and antidepressants.

CONCLUSION

In this largest study to date we found no association of anxiety and depression with the metabolic syndrome.

National guidelines for psychological care in diabetes: how mindful have we been?

AIMS

To assess the availability and types of psychological services for people with diabetes in the UK, compliance with national guidelines and skills of the diabetes team in, and attitudes towards, psychological aspects of diabetes management.

METHODS

Postal questionnaires to team leads (doctor and nurse) of all UK diabetes centres (n = 464) followed by semi-structured telephone interviews of expert providers of psychological services identified by team leads.

RESULTS

Two hundred and sixty-seven centres (58%) returned postal questionnaires; 66 (25%) identified a named expert provider of psychological services, of whom 53 (80%) were interviewed by telephone. Less than one-third (n = 84) of responding centres had access to specialist psychological services and availability varied across the four UK nations (P = 0.02). Over two-thirds (n = 182) of centres had not implemented the majority of national guidelines and only 2.6% met all guidelines. Psychological input into teams was associated with improved training in psychological issues for team members (P < 0.001), perception of better skills in managing more complex psychological issues (P < or = 0.01) and increased likelihood of having psychological care pathways (P < or = 0.05). Most (81%) expert providers interviewed by telephone were under-resourced to meet the psychological needs of their population.

CONCLUSIONS

Expert psychological support is not available to the majority of diabetes centres and significant geographical variation indicates inequity of service provision. Only a minority of centres meet national guidelines. Skills and services within diabetes teams vary widely and are positively influenced by the presence of expert providers of psychological care. Lack of resources are a barrier to service provision.

Chronic fatigue syndrome and related disorders in UK veterans of the Gulf War 1990-1991: results from a two-phase cohort study

BACKGROUND

The aim was to determine the prevalence of chronic fatigue syndrome (CFS), chronic fatigue and fibromyalgia in UK military personnel after the Gulf War 1990-1991.

METHOD

A two-phase cohort study was used. Three randomly selected subsamples identified from a population-based cross-sectional postal survey of over 10,000 current and ex-service UK military personnel (Gulf veterans were those deployed to the Gulf War 1990-1991; non-Gulf veterans were Bosnia peacekeepers 1992-1997 and those on active duty during the Gulf War 1990-1991 but not deployed) were recruited. Their disability status was assessed using the Short Form 36 physical functioning scale; Gulf veterans who reported physical disability (n=111) were compared with non-Gulf (n=133) veterans who reported similar levels of physical disability. Screening for known medical and psychiatric conditions was conducted to exclude medical explanations for disability and symptomatic distress. Standardised criteria for CFS, chronic fatigue and fibromyalgia were used.

RESULTS

Disabled Gulf veterans were more likely to be overweight, have elevated gamma-glutamyl transferase levels and screen positive for hypertension. There were no other clinically significant differences in clinical markers for medically explainable conditions. Disabled Gulf veterans were more likely than similarly disabled Bosnia and Era veterans (adjusted odds ratio 7.8, 95% confidence interval 2.5-24.5) to meet the criteria for CFS. Rates for other medically unexplained conditions were not significantly increased.

CONCLUSIONS

Symptoms in keeping with CFS account for a significant part of the symptomatic distress in Gulf veterans.

First- v. second-generation antipsychotics and risk for diabetes in schizophrenia: systematic review and meta-analysis

BACKGROUND

The increased prevalence of diabetes in schizophrenia is partly attributed to antipsychotic treatment, in particular second-generation antipsychotics, but the evidence has not been systematically reviewed.

AIMS

Systematic review and meta-analysis comparing diabetes risk for different antipsychotics in people with schizophrenia.

METHOD

We searched MEDLINE, PsycINFO, EMBASE, International Pharmaceutical Abstracts, CINAHL and Web of Knowledge until September 2006. Studies were eligible for inclusion if the design was cross-sectional, case-control, cohort or a controlled trial in individuals with schizophrenia or related psychotic disorders, where second-generation antipsychotics (defined as clozapine, olanzapine, risperidone and quetiapine) were compared with first-generation antipsychotics and diabetes was an outcome. Data were pooled using random effects inverse variance weighted meta-analysis.

RESULTS

Of the studies that met the inclusion criteria (n=14), 11 had sufficient data to include in the meta-analysis. Four of these were retrospective cohort studies. The relative risk of diabetes in patients with schizophrenia prescribed one of the second-generation v. first-generation antipsychotics was 1.32 (95% CI 1.15-1.51). There were insufficient data to include aripiprazole, ziprasidone and amisulpride in this analysis.

CONCLUSIONS

There is tentative evidence that the second-generation antipsychotics included in this study are associated with a small increased risk for diabetes compared with first-generation antipsychotics in people with schizophrenia. Methodological limitations were found in most studies, leading to heterogeneity and difficulty interpreting data. Regardless of type of antipsychotic, screening for diabetes in all people with schizophrenia should be routine.

Amyloidosis of the breast mimicking recurrence in a previously treated early breast cancer

Amyloid involvement of the breast is infrequently reported and may have clinical and radiological features suspicious for a primary breast malignancy. We describe a case of amyloid of the breast in which asymptomatic mammographic findings were suspicious for locally recurrent disease in a patient with previously treated breast cancer.