Gestational diabetes: Is there a relationship between leg length and glucose tolerance?

OBJECTIVE: To assess the relationship between leg length and glucose tolerance in pregnancy. RESEARCH DESIGN AND METHODS: The leg length and leg-to-height percentage were prospectively determined on 161 glucose-tolerant women during pregnancy and 61 women with gestational diabetes mellitus (GDM). RESULTS: Women with GDM were a mean of 2.8 cm shorter than women who were glucose tolerant, due entirely to their leg lengths being a mean of 3.2 cm shorter. With respect to the 2-h result on the glucose tolerance test (GTT), there were negative correlations for height (r = -0.161, P = 0.017), leg length (r = -0.266, P < 0.0005), and the leg-to-height percentage (r = -0.294, P < 0.0005). The correlation between the leg-to-height percentage and the 2-h result on the GTT remained significant after adjustment for age (r = -0.252, P < 0.0005) and for age and BMI (r = -0.224, P = 0.001). CONCLUSIONS: Women with GDM are shorter than glucose-tolerant women and have a lower leg-to-height percentage. Consideration of short stature as a risk factor for GDM is not valid without taking into account the leg-to-height percentage.     

Care without coverage: Is there a relationship between insurance and ED care?

The Institute of Medicine (IOM) has concluded that differences in care exist for hospitalized patients on the basis of insurance; we attempted to determine if these differences begin in the emergency department (ED). We retrospectively studied high-acuity adult visits to one ED over 6 months, utilizing electronic databases. Uninsured patients were more often younger, male, and non-white (n = 3899 visits; 468 uninsured, 3431 insured). Fewer uninsured patients were admitted (9.8% vs. 27.2% insured; p < 0.001). Comparing patients by admission status, there was no evidence of difference for most measures, excepting radiographic studies (admitted patients: 78.3% uninsured vs. 90.5% insured, p = 0.007; treated-and-released patients: 62.3% uninsured vs. 69.4% insured, p = 0.004). In a subset of trauma patients for whom acuity could be evaluated with Injury Severity Scores (ISS), admission rates were similar. In this pilot study of high-acuity patients, there was limited evidence of differences in most measures of ED-based patient care on the basis of insurance status.     

Is there a relationship between wound infections and laceration closure times?

Background

Lacerations account for a large number of ED visits. Is there a ??golden period?? beyond which lacerations should not be repaired primarily? What type of relationship exists between time of repair and wound infection rates? Is it linear or exponential? Currently, the influence of laceration age on the risk of infection in simple lacerations repaired is not clearly defined. We conducted this study to determine the influence of time of primary wound closure on the infection rate.

Methods

This is a prospective observational study of patients who presented to the Emergency Department (ED) with a laceration requiring closure from April 2009 to November 2010. The wound closure time was defined as the time interval from when the patient reported laceration occurred until the time of the start of the wound repair procedure. Univariate analysis was performed to determine the factors predictive of infection. A non-parametric Wilcoxon rank-sum test was performed to compare the median differences of time of laceration repair. Chi-square (Fisher's exact) tests were performed to test for infection differences with regard to gender, race, location of laceration, mechanism of injury, co-morbidities, type of anesthesia and type of suture material used.

Results

Over the study period, 297 participants met the inclusion criteria and were followed. Of the included participants, 224 (75.4%) were male and 73 (24.6%) were female. Ten patients (3.4%) developed a wound infection. Of these infections, five occurred on hands, four on extremities (not hands) and one on the face. One of these patients was African American, seven were Hispanic and two were Caucasian (p?=?0.0005). Median wound closure time in the infection group was 867?min and in the non-infection group 330?min (p?=?0.03).

Conclusions

Without controlling various confounding factors, the median wound closure time for the lacerations in the wound infection group was statistically significantly longer than in the non-infection group.     

Is there a relationship between light touch-pressure sensation and functional hand ability?

Purpose. To investigate and compare the level of light touch-pressure sensation as tested via the Semmes Weinstein monofilament (SWM) test with the level of functional hand ability.

Methods. Twenty-seven persons with isolated sensory deficit due to leprosy and 31 healthy controls were tested in the Occupational Therapy department of a hospital for patients with Hansen's disease. Palmar light touch thresholds were determined by SMW testing. Functional hand ability was tested via the Jebsen-Taylor Hand Function Test (JTHFT) and the Functional Dexterity Test (FDT). All participants were measured by manual muscle testing (MMT) to exclude any motor impairment. Data analysis compared sensory thresholds and level of functional hand ability between the two groups and examined the relationship between the variables.

Results. In the group with sensory deficit, the sensory thresholds were significantly higher than in the control group. Significant correlations were found between the sensory thresholds measured by the SWM test and the FDT and JTHFT scores, with higher correlations found for tasks entailing manipulation of small objects.

Conclusions. The findings support the existence of a relationship between sensory light touch thresholds tested by the Semmes Weinstein monofilaments (SWMs) and hand function. However, the SWM test alone is not sufficient as an indicator of hand function and must therefore be supplemented with other hand function tests.     

Self-referral to physiotherapy: deprivation and geographical setting: Is there a relationship? Results of a national trial

Objectives

To establish the level of self-referral in urban, semi-rural and rural primary care settings, encompassing a range of deprivation, in Scotland.

Design of study

Quasi-experimental.

Setting

Twenty-nine general practices throughout Scotland.

Participants

Three thousand and ten patients (>16 years) and physiotherapists from throughout Scotland.

Method

Practices were classified in terms of their location and level of deprivation (DEPCAT scores). Historical data were used to establish national referral rates in these settings. Self-referral was introduced in each setting and the proportions of patients referring themselves or being referred by their general practitioner (GP) were collated over a full year. A further category of ‘GP-suggested’ referral was also included.

Results

There were different rates of referral according to setting (P < 0.001). A national adult referral rate of 53.5/1000 was identified. Rural areas experienced the highest rates (66/1000) of referral compared with urban (44.5/1000) and semi-rural (49/1000) settings. An overall ‘true’ self-referral rate of 22% was found. Rural areas experienced the highest levels of both self- and GP-suggested referrals (32% and 26%, respectively). An increase in total referral numbers was experienced in less than 20% of locations after introducing self-referral, all of which had a history of underprovision. Self-referrers came from all socio-economic settings, although differences were observed between the groups (P < 0.001).

Conclusions

Introducing self-referral does not appear to result in an increase in the overall referral rate when reasonable levels of service are already being provided in line with national rates according to geographical setting. Deprivation does not appear to exert a major influence on referral rates. However, the rate of self-referral in the long-term future is impossible to predict.     

Is there a causal relationship between stress and migraine? Current evidence and implications for management

BackgroundThe purpose of this narrative review is to examine the literature investigating a causal relationship between stress and migraine and evaluate its implications for managing migraine.MethodsPubMed, PsycINFO and CINAHL were searched from 1988 to August 2021, identifying 2223 records evaluating the relationship between stress and migraine. Records were systematically screened. All potentially relevant records were thematically categorized into six mechanistic groups. Within each group the most recent reports providing new insights were cited.ResultsFirst, studies have demonstrated an association of uncertain causality between high stress loads from stressful life events, daily hassles or other sources, and the incidence of new-onset migraine. Second, major stressful life events seem to precede the transformation from episodic to chronic migraine. Third, there is some evidence for changes in levels of stress as a risk factor for migraine attacks. Research also suggests there may be a reversed causality or that stress-trigger patterns are too individually heterogeneous for any generalized causality. Fourth, migraine symptom burden seems to increase in a setting of stress, partially driven by psychiatric comorbidity. Fifth, stress may induce sensitization and altered cortical excitability, partially explaining attack triggering, development of chronic migraine, and increased symptom burden including interictal symptom burden such as allodynia, photophobia or anxiety. Finally, behavioral interventions and forecasting models including stress variables seem to be useful in managing migraine.ConclusionThe exact causal relationships in which stress causes incidence, chronification, migraine attacks, or increased burden of migraine remains unclear. Several individuals benefit from stress-oriented therapies, and such therapies should be offered as an adjuvant to conventional treatment and to those with a preference. Further understanding the relationship between stress, migraine and effective therapeutic options is likely to be improved by characterizing individual patterns of stress and migraine, and may in turn improve therapeutics.     

Australian registered and enrolled nurses: Is there a difference?

There are two categories of nurse registered to practise in Australia, the degree-educated registered nurse and the certificate/diploma trained enrolled nurse (EN). While it is argued that the roles of the two categories of nurse in Australia are different, recent changes to the educational preparation and supervision requirements of ENs have narrowed these differences. This paper examines the existing literature to determine the perceived differences and similarities between registered and ENs in Australia. Differences identified included registration requirements, educational preparation, supervisory requirements and role expectation. Further research needs to be undertaken to examine the educational preparation of registered and ENs in order to obtain a greater understanding of role expectations on graduation. Supervision processes also require reviewing to demonstrate differences between indirect supervision and independent practice for ENs.     

Is there a link between dementia and phenylketonuria?

This study searches for causes of dementia by posing the hypothesis that the natural decline in the metabolic functioning associated with aging may mimic the specific "error in metabolism" present in some children at birth that leads to phenylketonuria. Although the Guthrie Test is adequate for children, perhaps a quantitative test is needed for the elderly to detect minute elevations of serum phenylalanine. If a positive relationship could be documented between elevated serum phenylalanine in the elderly and dementia, would a diet low in phenylalanine help prevent some of the manifestations seen in the elderly with dementia? By carefully following these dietary restrictions, would more of the elderly be able to "age in place" in the community and not have to be institutionalized?     

Is there a relationship between plasma phenylalanine and cholesterol in phenylketonuric patients under dietary treatment?

OBJECTIVES: To study the lipid profile in a group of treated phenylketonuric patients (PKU; n = 61) compared with a group of inborn error of intermediary metabolism patients (IEM; n = 22), a group of hyperphenylalaninemic children (HPA; n = 37), and a control group without dietary restriction (n = 41). DESIGN AND METHODS: Phenylalanine was analyzed by ion exchange chromatography and triglycerides, cholesterol and HDL were determined by standard procedures with the Cobas Integra analyzer. RESULTS: Serum total cholesterol concentrations were significantly lower in PKU patients compared with IEM patients (whose cholesterol daily intake was similar to those of PKU patients), HPA children and the control group. A negative correlation was observed between cholesterol and phenylalanine concentrations in the PKU patients. CONCLUSIONS: Our findings support the hypothesis of a relationship between high plasma phenylalanine levels and an inhibition of cholesterogenesis, although the low cholesterol intake of the special diets may also decrease serum cholesterol values.     

Is there a relationship between fatigue questionnaires and gait mechanics in persons with multiple sclerosis?

Huisinga JM, Filipi ML, Schmid KK, Stergiou N. Is there a relationship between fatigue questionnaires and gait mechanics in persons with multiple sclerosis?

Objective

To evaluate reported fatigue levels and gait deficits in patients with multiple sclerosis (MS) to determine the relationships that may exist between fatigue in patients with MS and alterations in gait mechanics.

Design

Cross-sectional.

Setting

Biomechanics laboratory.

Participants

Subjects with MS (n=32) and age- and sex-matched controls (n=30).

Interventions

None.

Main Outcome Measures

Fatigue Severity Scale (FSS), Modified Fatigue Index Scale (MFIS), and 36-Item Short Form Health Survey (SF-36) to assess fatigue and general health. Biomechanical gait analysis was performed to measure peak joint torques and powers in the sagittal plane at the ankle, knee, and hip. Correlations were performed between fatigue measures and degree of deficit within each patient with MS for each joint torque and power measure.

Results

FSS score significantly correlated with deficits in ankle power generation at late stance and walking velocity. MFIS score significantly correlated with deficits in peak knee extensor torque and knee power absorption at early stance. SF-36 subscale scores correlated with several joint torque and power variables.

Conclusions

Subjective fatigue rating scale scores alone should not be used as an indicator of motor disability or disease progression as it affects walking performance of patients with MS.