Mental distress and quality of life in the hard of hearing

OBJECTIVE: This study aims to compare levels of psychological distress and the quality of life in the hard of hearing with levels reported by the signing deaf, and the hearing population. METHOD: A total of 373 members of the Hard of Hearing Association completed the brief WHO's Quality of Life, 12-item General Health Questionnaire and Brief Symptom Inventory, and provided details about their initial and current deafness. RESULTS: The hard of hearing have worse social relationships than the signing deaf, and are disadvantaged relative to the hearing in all areas measured. Quality of life is related to the level of satisfaction with the hearing achieved by hearing aids. CONCLUSION: General psychiatrists need to be aware that patients who are hard of hearing may be even more isolated than deaf people in a signing community. Hard of hearing patients with unsatisfactory hearing aids can be greatly assisted by cochlear implants.     

Granule Characterization During Fluid Bed Drying by Development of a Near Infrared Method to Determine Water Content and Median Granule Size

Purpose Water content and granule size are recognized as critical process and product quality parameters during drying. The purpose of this study was to enlighten the granule behavior during fluid bed drying by monitoring the major events i.e. changes in water content and granule size. Methods NIR spectra collected during drying and water content of sampled granules were correlated by principal component analysis (PCA) and partial least squares regression (PLSR). NIR spectra of dried granules were correlated to median granule size in a second PCA and PLSR. Results The NIR water model discriminates between various stages in fluid-bed drying. The water content can be continuously predicted with errors comparable to the reference method. The four PLS factors of the granule size model are related to primary particle size of lactose, median granule size exceeding primary particle size and amorphous content of granules. The small prediction errors enable size discrimination between fines and granules. Conclusion For product quality reasons, discrimination between drying stages and end-point monitoring is highly important. Together with the possibilities to determine median granule size and to distinguish fines this approach provides a tool to design an optimal drying process.     

Glycemic control in the metabolic syndrome and implications in preventing cardiovascular disease

The metabolic syndrome represents a cluster of cardiovascular risk factors that occur together more commonly than expected from the prevalence of their individual rates. Insulin resistance is widely believed to be the common denominator causing, in susceptible individuals, the development of various cardiovascular risk factor components of the syndrome (e.g., hyperlipidemia, hypertension, and hyperglycemia). The major cause of this insulin resistance appears to be obesity, especially the accumulation of visceral fat. This obesity is due to the combination of excessive caloric intake and inadequate physical activity rather than alterations in energy utilization. In individuals whose beta cells cannot increase their insulin secretion adequately to compensate for insulin resistance, hyperglycemia occurs.     

Evidence for a physiologic role of pancreatic glucagon in human glucose homeostasis: Studies with somatostatin

To study the role of glucagon in human glucose homeostasis, experimental glucagon deficiency was produced by infusing somatostatin (i.v. 250 μg bolus, followed by infusion of 500 μg/hr) in six normal subjects and in two hypophysectomized patients—an insulin-dependent diabetic and a nondiabetic. In normal subjects, somatostatin lowered plasma glucagon from a mean (± SE) basal level of 85 ± 15 to 33 ± 10 pg/ml, p < 0.001. Concurrently, plasma glucose fell from $\text{90 ± 2 to 73 ± 3 mg}\text{100 ml}$, p < 0.001. Serum insulin and growth hormone fell slightly during somatostatin infusion, while plasma free fatty acids rose. In both hypophysectomized patients, somatostatin lowered plasma glucagon and glucose levels. In all subjects, after stopping somatostatin infusions, plasma glucagon and glucose returned promptly to control values, while serum growth hormone did not change. In additional in vitro studies, somatostatin (1 μg/ml) had no effect on muscle glucose uptake. Since it is known that somatostatin has no direct effect on hepatic glucose production, these results suggest that the fall in plasma glucose during somatostatin infusion resulted from inhibition of glucagon secretion, thus providing evidence that this hormone plays a physiologic role in the maintenance of fasting euglycemia in man.     

Pathogenesis of hypoglycemia in insulinoma patients: suppression of hepatic glucose production by insulin

To determine the mechanism by which hyperinsulinemia causes hypoglycemia in insulinoma patients, rates of glucose production and utilization, and circulating levels of insulin, glucagon, alanine, lactate, and glycerol were measured in 6 insulinoma patients during development of fasting hypoglycemia and in 8 normal volunteers studied over an identical interval. Initially, insulinoma patients had a greater plasma insulin (42 +/- 9 versus 15 +/- 1 microunits/ml) and glucagon levels (214 +/- 31 versus 158 +/- 21 pg/ml) than normal subjects, P less than 0.05, but their plasma glucose levels (81 +/- 4 mg/dl) and rates of glucose production and utilization (1.71 +/- 0.08 and 1.74 +/- 0.08 mg/kg . min, respectively) were not significantly different from those of normal subjects (93 +/- 2 mg/dl, 1.93 +/- 0.11, and 1.92 +/- 0.13 mg/kg . min, respectively). During a subsequent 8-h fast, glucose production and glucose utilization decreased in both groups, but more markedly in insulinoma patients. Since glucose utilization exceeded glucose production to a greater extent in insulinoma patients than in normal subjects, plasma glucose decreased to 44 +/- 3 mg/dl in insulinoma patients, but only to 84 +/- 1 mg/dl in normal subjects (P less than 0.001). Glucose utilization in insulinoma patients never exceeded that of normal subjects. These results demonstrate that fasting hypoglycemia in the insulinoma patients is usually due to suppression of glucose production rather than to acceleration of glucose utilization, as is widely thought. A direct effect of insulin on the liver is probably responsible, since circulating levels of gluconeogenic precursors are normal and since plasma glucagon increases during development of hypoglycemia in insulinoma patients.     

Insulin glargine: long-acting basal insulin analog for improved metabolic control

The primary aim of insulin therapy is to replace endogenous insulin secretion in patients with type 1 or type 2 diabetes in a physiologically sound manner, mimicking normal secretion patterns to adequately regulate glucose metabolism. The currently available human insulins for basal therapy--neutral protamine Hagedorn (NPH), Lente and Ultralente--and analogs such as insulin glargine, differ in pharmacokinetic properties. Clinical trial data indicate that insulin glargine may satisfy basal insulin requirements, with an improved safety profile relative to other available insulins used for basal supplementation. This review describes the unique pharmacokinetic properties and clinical efficacy of insulin glargine.     

An innovative and reliable way of measuring health-related quality of life and mental distress in the deaf community

Abstract Background Structured assessment of quality of life and mental distress in deaf people is difficult for various reasons. This paper describes the development and reliability of an interactive computer-based assessment package for measuring quality of life and psychological distress in the deaf population. Methods The Brief version of the WHO Quality of Life (WHOQOL) Questionnaire, the 12-item General Health Questionnaire (GHQ-12) and the Brief Symptom Inventory (BSI) had been translated into sign-language and videotaped. A total of 236 members of the deaf community in Upper Austria participated by responding to a programme consisting of self-administered written and videotaped test-items presented to them on a notebook computer. The reliability of the various assessments was established on this large community sample. Results When reliability of the versions for the deaf was compared with that of written versions of the same measures in general population samples, it was found to be somewhat lower, although still in an acceptable range, for the WHO-QOL and the GHQ-12. For the BSI, the reliability was even higher than that of the general population. Conclusions For deaf individuals whose preferred communication is sign language, quality of life and mental distress can be effectively and reliably assessed with the use of carefully translated and adapted common instruments.     

Role of the kidney in hyperglycemia in type 2 diabetes

Overproduction of glucose is the major factor responsible for fasting hyperglycemia in type 2 diabetes. Formerly, this had been considered to be solely due to excessive hepatic glucose production because the human kidney was not regarded as an important source of glucose except during acidosis and after prolonged fasting. However, data accumulated over the last 60 years in animal and in vitro studies have provided considerable evidence that the kidney plays an important role in glucose homeostasis in conditions other than acidosis and prolonged fasting. This article summarizes early work in animals and humans, discusses methodologic issues in assessing renal glucose release in vivo, and provides evidence from recent human studies that the kidney substantially contributes to glucose overproduction in type 2 diabetes.