Hypoglycemia in diabetes: common, often unrecognized

Hypoglycemic episodes in patients with diabetes often go unrecognized, and over time, patients may lose the ability to sense hypoglycemia, increasing their risk. Intensive diabetes control is beneficial for patients with diabetes, but it increases their risk of hypoglycemia, underscoring the complexity of diabetes management.     

Blood, AIDS, and bureaucracy: the crisis and the tragedy

The politics of health were never tested more than when AIDS surfaced at the beginning of the 1980s in the industrialized nations. In those countries, it became the most important medical crisis of the last half of the 20th century. Today, the significance of AIDS remains as not only an unrelenting disease but also as a disease that continues to affect social and political life throughout the entire world. The connection between blood transfusion and AIDS is now under control in the industrialized countries but only because of lessons that took too long to learn over the past 25 years. That process had different roots and effects depending on the various national blood programs and policies in different countries. That is illustrated by comparing events in France, Japan, Canada, and the United States that differed in donor and patient populations and on decisions made and secrets kept. Some of the problems persist to this day in parts of the world. Overall, the lessons learned from what happened with blood early in the AIDS epidemic apply to other aspects of human disease and could help in facing the new problems that are sure to appear in the future.     

International collaboration to address common problems in health care: processes, practicalities and power

This article reports on an international collaborative study into the management of chronic leg ulcers by nurses working in the community in Kronoberg, Sweden and the East Riding and Hull, UK. The management of leg ulcers like many other services provided by nurses working in the community is one that is growing out of community need, often without matching resources. This article reports on some of the processes that were involved and some of the practical considerations that were faced and addressed in formulating and conducting an international collaborative study. The article also explores the 'power' international collaboration brings to the research enterprise.     

Hypertensive disorders, diabetes mellitus, and anemia: three common medical complications of pregnancy

Hypertensive disorders, diabetes mellitus, and anemia are three common medical complications of pregnancy. In many cases, primary care physicians manage them. The understanding of these conditions and recommendations for their treatment are in constant evolution. Care for patients with these problems requires a working knowledge of current information. This article reviews the current knowledge about and treatment of these three disorders.     

Type-2 diabetes and coronary heart disease: common physiopathology,viewed from autoimmunity

Two highly prevalent diseases, Type-2 diabetes mellitus and coronary heart disease (CHD), share risk factors. Excess levels of LDL-cholesterol have been overemphasized to uniformly encompass the development of CHD, and the origin of insulin resistance underlying Type-2 diabetes has not been fully elucidated. Autoimmune response has been recognized to be responsible only of a small minority of diabetes. The increasing trend in the worldwide prevalence of diabetes and the risk factors for both diseases are reviewed, the independent mediation for CHD of (central) adiposity in both diseases and the ‘hypertriglyceridemic waist’ phenotype are outlined. Evidence is described that serum lipoprotein (Lp)(a) concentrations, not only in excess, but also in apparently ‘reduced’ levels, as a result of autoimmune response, underlie both disorders and are closely related to insulin resistance.     

The shuttle tragedy, “community grief”, and the schools

Abstract

The impact of the shuttle disaster on America's schools was the subject of much speculation almost from the moment of the tragedy itself. This article looks at reactions which have taken place since the tragedy. It includes results from a questionnaire administered to teachers and students to examine their reactions four months after the episode, as well as a protocol for dealing with grief in the schools. Both teachers and students felt that they had been totally unprepared for such a loss but they expressed positive views of the role of the media in helping them search for personal “answers” following the shuttle explosion. One point of concern for some educators and parents was the use of “humor” as a coping mechanism by students. The topics of their jokes and stories revealed a concern with bodily integrity/disintegration after the shuttle explosion which they felt that they could not speak about in any other fashion.

The protocol cited in the paper was developed at River Dell High School in New Jersey and has been adopted by a number of public schools. This protocol addresses the different approaches to individual loss and to those losses which have an impact on the entire school community.