Use of a mobile health van by a vulnerable population: Homeless sheltered women

Little is known about the health status of homeless women. In this study, we examined the health problems of and services provided to sheltered, homeless, Midwestern women who used a mobile health van. Our objectives were to document these women's ages, self‐reported past medical histories, self‐reported histories of addictions and hospitalizations, presenting concerns, diagnoses, and visit patterns. To this end, we performed a retrospective review of the 689 records of 408 women who had sought care during a 3‐year period. The data were divided into three groups, representing women ages 15–25 (n = 111), 26–40 (n = 211), and 41–70 (N = 86). In all three age groups, respiratory disorders were most frequently treated. Preventive health maintenance concerns were also major concerns of all age groups. Recommendations for improving the quality, continuity, and follow‐up of care are offered.     

Effective Assessment of Diabetes Control Using Personal Glucometers (CONTOURLINK,Bayer, Germany; CALLA,Wellion, Austria; LINUS,Agamatrix, USA)

Aim of this trial was to assess (1) the accuracy and precision of electrochemistry-based glucometers CONTOURLINK, CALLA, and LINUS and (2) the diabetes control using Ambulatory Glycaemic Profiles (AGP) as markers of therapeutic effectiveness. Glucometers and COBAS INTEGRA 400 Plus analyzer were used by one laboratory professional to estimate P-glucose (PG) in 112 out-patients. There were 112 sets of 12 PG estimations analyzed. In each set, means of 3 capillary PG estimations on 3 respective glucometers and on INTEGRA analyzer were calculated. The statistical program SPSS, v. 15, was applied. The mean INTEGRA PG values ranged from 2.7 to 25.3 mmol/L. There were strong correlations between mean PG on INTEGRA versus CONTOURLINK, versus CALLA, and versus LINUS; PG deviations from INTEGRA were mostly within the range ±15%. Wilcoxon Signed Rank Test revealed differences between CONTOURLINK-INTEGRA and LINUS-INTEGRA; CALLA-INTEGRA showed no difference. SD INTEGRA = 0.061 mmol/L, SD CONTOURLINK/SD CALLA/SD LINUS were 0.256/0.290/0.286 mmol/L. All patients were trained to perform defined 10-point PG profiles to adapt food, exercise, and insulin doses. The PG differences between all tested glucometers and reference values were in borderline of ISO 15197 but worthy of consideration. AGP are helpful markers of diabetes control.     

Long-term quality of life and tumour control following gamma knife radiosurgery for vestibular schwannoma

Introduction

Gamma knife radiosurgery (GKRS) has for the last decades been an established treatment option for patients with small- or medium-sized vestibular schwannomas (VS), although little data is reported on long-term outcome regarding quality of life (QOL) and tumour control in this patient category. The objective of this study was to investigate long-term QOL and tumour control in GKRS-treated VS patients at our institution.

Methods

Data was reviewed from a consecutive cohort of 128 patients, 62 men and 66 women, diagnosed with VS and treated with GKRS at Karolinska University Hospital between 1997 and 2003. Patients previously treated for VS, patients from abroad, and patients with neurofibromatosis were excluded from the study. Median age at the time of treatment was 66 years (range 23–89), with a median follow-up time of 104 months (range 11–165) and radiological median follow-up of 86 months (range 5–170). Five patients were lost to follow-up.

Results

Data on QOL (EQ-5D score) was obtained in 90 % (98/109) of all cases at the end of follow-up, showing low morbidity and a high QOL with median index of 0.91 (max. score 1.0) in these patients. Tumour control was achieved in 92 % (118/128) of patients after a single GKRS treatment. Ten patients had loss of tumour control, either radiologically seen as growth progression, or due to the need for salvage treatment. Neither pre-treatment growth of the vestibular schwannoma, or a large tumour size (Koos grade 3 & 4) was correlated with a higher degree of treatment failure (p?=?0.695 and p?=?0.647, respectively). There was no difference in tumour control in young (<60 y/o) vs. elderly (≥60 y/o) patients (p?=?0.167).

Conclusion

We report a high QOL and low morbidity at long-term follow-up after GKRS treatment in VS patients. Furthermore, a high tumour control rate was achieved independent of tumour size, patient age or pre-treatment evidence of tumour growth.     

The pyridinyl-6 position of WAY-100635 as a site for radiofluorination--effect on 5-HT1A receptor radioligand behavior in vivo.

PURPOSE: We aimed to evaluate radiofluorination at the pyridinyl-6 position of the selective 5-HT(1A) receptor antagonist, WAY-100635 [N-(2-(1-(4-(2-methoxyphenyl)piperazinyl)ethyl))-N-(2-pyridinyl)cyclohexanecarboxamide)], on 5-HT(1A) receptor radioligand behavior in vivo. PROCEDURES: The pyridinyl-6 [(18)F]fluoro derivative of WAY-100635 ([(18)F]6FPWAY) was obtained by direct nucleophilic substitution with [(18)F]fluoride ion in a bromo precursor. After intravenous injection of [(18)F]6FPWAY into Cynomolgus monkey, the uptake of radioactivity into brain regions was assessed with positron emission tomography (PET) and blood samples analyzed by high performance liquid chromatography (HPLC) for parent radioligand and radioactive metabolites. The experiment was repeated after pretreatment of the monkey with a dose of WAY-100635 that blocks brain 5-HT(1A) receptors. RESULTS: After intravenous injection of [(18)F]6FPWAY into Cynomolgus monkey, the uptake of radioactivity into whole brain reached 4.33% of injected dose at 7.5 min. Uptake was highest in 5-HT(1A) receptor-rich regions. Pretreatment with WAY-100635 reduced uptake in these regions to near the levels in receptor-devoid cerebellum. [(18)F]6FPWAY was rapidly metabolized in vivo, as evidenced by the rapid appearance of radioactive metabolites in plasma. CONCLUSION: [(18)F]6FPWAY is selective and moderately useful for imaging brain 5-HT(1A) receptors in vivo. The pyridinyl-6 position is resistant to defluorination and may be an attractive site for the (18)F-labeling of 6FPWAY analogs that resist hydrolysis.     

Continuous glucose monitoring -- a novel approach to the determination of the glycaemic index of foods (DEGIF 1) -- determination of the glycaemic index of foods by means of the CGMS.

The glycaemic index (GI) is a measure of the food power to raise plasma glucose (PG) concentration after a meal. For its determination, classical methods register the development of glucose concentration in capillary plasma or whole blood. The aim of this prospective open-label trial was to compare the GI of selected foods obtained by means of the Continuous Glucose Monitoring System (CGMS) (Minimed Medtronic, Northridge, USA) which has not been applied for this purpose until now, with the respective GI determined by a conventional method using the Glucometer Advance System (GAS) (Hypoguard, Woodbridge, United Kingdom), and to assess the advantages of each approach. METHODS: Portions of tested foods containing 50 g of carbohydrates were eaten for breakfast and for dinner after 10 and 4 h fast, respectively, by 20 healthy volunteers. Using GAS, PG-curves were constructed from 9 PG values at time 0, 15, 30, 45, 60, 75, 90, 105 and 120 min after the meal, and, using CGMS, from 25 values of interstitial fluid glucose concentration (ISFG) stored within 120 min in 5-minute intervals in CGMS memory. The GI was calculated (for GAS and CGMS separately) by dividing the incremental area under the curve for the tested food by the average area of 3 tests performed with the standard. Having excluded tests with missing glucose values, there remained 285 GAS- and 290 CGMS tests for further analysis. In each volunteer, each food was tested 3 times within one week so that 1 to 3 GI's were obtained and averaged. The GI for each tested food was calculated as the mean from the respective average GI's of 20 volunteers. The GI-variability was assessed according to the respective SD. The preference of GAS vs. CGMS in the persons tested was explored by means of a questionnaire. MS Excel and the statistical program SPSS v. 10.1 were used to analyze the data. RESULTS: The GI values (mean +/- SD) measured by GAS/CGMS were for dark chocolate 43.6 +/- 22.13 %/44.0 +/- 21.71 % (p > 0.01); for apple baby food 46.1 +/- 21.38 %/53.8 +/- 37.69 % (p > 0.01); for puffed rice squares 76.5 +/- 20.24 %/76.9 +/- 27.62 % (p > 0.01); for yogurt 43.2 +/- 20.17 %/37.7 +/- 21.55 % (p > 0.01). The GI's of dark chocolate, apple baby food and yogurt, determined by either method, were significantly lower than the GI of puffed rice squares (p < 0.01). CGMS was preferred by 12 of 20 volunteers (60 %). CONCLUSIONS: No significant difference could be seen between the GI's determined by conventional method (GAS) and by CGMS (p > 0.01). The method with CGMS is reliable and comfortable for both tested persons and investigators. Hence, it appears to become a sophisticated approach to determine the GI.