Arab Americans have high prevalences of metabolic syndrome (MetS) and depression. Depression and external locus of control (LOC) may worsen MetS. We examined the relationship between depression and MetS with a convenience sample of 136 Arab Americans living in the Washington, DC, metropolitan area. Participants were surveyed with the Multidimensional Health Locus of Control questionnaire and the Center of Epidemiological Studies-Depression scale. Laboratory measurements were collected based on the components of MetS. A structural equation model was used to explore the relationship between MetS and depression through analysis of LOC. MetS was significantly correlated with external LOC (powerful others and chance), and depression was correlated with a weak internal LOC. Future study of the effect of LOC on health outcomes in Arab Americans may be used to mitigate MetS and depression in this population. 相似文献
A wide range of local thermal ablative therapies have been developed in the treatment of non resectable hepatocellular carcinoma(HCC) in the last decade.Laser ablation(LA) and radiofrequency ablation(RFA) are the two most widely used of these.This article provides an up to date overview of the role of laser ablation in the local treatment of HCC.General principles,technique,image guidance and patient selection are discussed.A review of published data on treatment efficacy,long term outcome and complication rates of laser ablation is included and comparison with RFA made.The role of laser ablation in combination with transcatheter arterial chemoembolisation is also discussed. 相似文献
PURPOSE: To investigate if relationships exist among macrophage infiltration, plasma matrix metalloproteinase (MMP) levels, and the number of emboli generated during endoluminal carotid interventions. METHODS: Carotid endarterectomy specimens excised as intact cylinders (n=27) were subjected to a standardized angioplasty procedure under radiological guidance in an ex vivo pulsatile flow model. Emboli collected in distal filters were counted and sized using microscopy. Preoperative plasma gelatinase activity was determined by gelatin zymography and quantified using image analysis software. Levels of tissue inhibitors of metalloproteinases (TIMP) 1 and 2 were determined by ELISA. Macrophages within postangioplasty plaques were analyzed using immunohistochemical staining for CD68 antigen and graded by a blinded examiner. Statistical analysis was performed using Spearman's rank correlation. RESULTS: The median number of emboli recorded during angioplasty was 104 (interquartile range 33.75-242.5, absolute range 13-1090). Plasma MMP-9 and MMP-2 levels correlated with emboli number (r=0.544 [p=0.003] and r=0.412, [p=0.033], respectively), while TIMP-1 and TIMP-2 levels did not. Macrophage infiltration within the plaques correlated with emboli number (r=0.722, p<0.001) and the plasma MMP-9 level (r=0.489, p=0.010). CONCLUSIONS: These data indicate that plaque macrophage infiltration may play a role in the generation of emboli during endoluminal carotid intervention, possibly via modulation of protease activity. 相似文献
Advancements in smartphone technology coupled with the proliferation of data connectivity has resulted in increased interest and unprecedented growth in mobile applications for diabetes self-management. The objective of this article is to determine, in a systematic review, whether diabetes applications have been helping patients with type 1 or type 2 diabetes self-manage their condition and to identify issues necessary for large-scale adoption of such interventions.
Methods
The review covers commercial applications available on the Apple App Store (as a representative of commercially available applications) and articles published in relevant databases covering a period from January 1995 to August 2012. The review included all applications supporting any diabetes self-management task where the patient is the primary actor.
Results
Available applications support self-management tasks such as physical exercise, insulin dosage or medication, blood glucose testing, and diet. Other support tasks considered include decision support, notification/alert, tagging of input data, and integration with social media. The review points to the potential for mobile applications to have a positive impact on diabetes self-management. Analysis indicates that application usage is associated with improved attitudes favorable to diabetes self-management. Limitations of the applications include lack of personalized feedback; usability issues, particularly the ease of data entry; and integration with patients and electronic health records.
Conclusions
Research into the adoption and use of user-centered and sociotechnical design principles is needed to improve usability, perceived usefulness, and, ultimately, adoption of the technology. Proliferation and efficacy of interventions involving mobile applications will benefit from a holistic approach that takes into account patients’ expectations and providers’ needs. 相似文献
We compared A1C and fasting plasma glucose (FPG) in predicting cardiovascular disease (CVD) in a population with widespread obesity and diabetes.
RESEARCH DESIGN AND METHODS
A total of 4,549 American Indian adults underwent the Strong Heart Study (SHS) baseline examination (1989–1991). Data from 3,850 individuals (60% women) with baseline measurements of FPG and A1C and no prevalent CVD were analyzed; 1,386 had known diabetes. CVD events were ascertained over a median of 15 years.
RESULTS
A1C ≥6.5% had a 44.3% sensitivity and 98.9% specificity to identify participants with FPG ≥126 mg/dL. Increases in A1C were associated with adverse CVD risk factor profiles; individuals with known diabetes had worse profiles. For A1C <5, 5 to <5.5, 5.5 to <6, 6–6.5, or ≥6.5% or known diabetes, the multivariate-adjusted hazard ratio (HR) [95% CI] for coronary heart disease (CHD) was significant only for individuals with known diabetes (2.76 [2.17–3.51]). Similarly, the adjusted HRs for total CVD were significant only for individuals with A1C ≥6.5% or known diabetes (1.50 [1.10–2.04] and 2.52 [2.06–3.08], respectively). Similar results were observed for FPG.
CONCLUSIONS
Individuals with known or newly diagnosed diabetes had increased risk for CVD. Although A1C is more convenient than FPG in diagnosing diabetes, neither test adds to conventional CVD risk factors in predicting CHD or total CVD.Fasting plasma glucose (FPG) has been the standard measure for diagnosing diabetes (1). Hemoglobin A1c (A1C) ≥6.5% has been offered as an alternative diagnostic criterion (2) on the basis of the relationship between A1C and microvascular complications. A1C and FPG measure differing aspects of glucose metabolism; A1C measures chronic glycemia (during the previous 2–3 months), while FPG primarily reflects hepatic glucose output at the time of sampling. As expected, A1C identifies different individuals as diabetic than does FPG (3). Additionally, it was reported (4) in a predominantly white cohort with low prevalence of obesity or diabetes that increments of A1C >5.5% predict significantly increased risk for coronary heart disease (CHD) and stroke, whereas FPG of 100–126 mg/dL does not.Many U.S. minority populations have high rates of obesity, insulin resistance, and diabetes (5,6). We recently reported that A1C alone identifies fewer diabetes cases than FPG, and neither FPG nor A1C alone can identify all diabetes cases (7). Because the Strong Heart Study (SHS) cohort had a high prevalence of obesity and type 2 diabetes >20 years ago, it serves as a model for other minority populations experiencing epidemics of these disorders (8). In this article, cardiovascular disease (CVD) incidence by A1C category will be examined, and the value of A1C and FPG in predicting CVD will be compared. 相似文献
Building knowledge on how child welfare services (CWS) should tailor services for unaccompanied refugee minors (URMs) is important. URMs and youth in foster care are high-risk groups taken care of by the CWS in Norway. Little is known on whether knowledge gained from youth in foster care can inform services for URMs, and if these groups are comparable in terms of experiences of potential traumatic events (PTEs) and post-traumatic stress disorder (PTSD) symptom load. Eighty-one URMs reported PTEs and PTSD-symptoms using an adapted version of the Child and Adolescent Trauma Screen (CATS). Responses were described and compared with a sample of 303 youth in foster care in linear regression models. We present relative risks (RR) and standardized mean differences (SMD) for the PTEs and the PTSD subscale and total score between the groups in forest plots. URMs had experienced a mean (standard deviation) of 6.4 (3.4) PTEs and 43.9% reported to have PTSD-symptoms at or above the clinical cut off. Compared to the foster youth, URMs reported more exposures of interpersonal violence outside of the family (RRs ranging from 66.4 [95%CI 18.1; 243.5) to 1.3 (1.0, 1.5)], and more PTSD-symptoms in the re-experiencing subscale [SMD = 0.3 (95% CI 0.1, 0.6)]. The frequency and types of PTEs and the PTSD-symptom load and profile among URMs and youth in foster care differed. Findings underscore the importance of qualified and targeted care for URMs, and that this care should differ to that of other high-risk groups in the CWS.