A randomised controlled trial of the effect of low fat diet advice on dietary response in insulin independent diabetic women

Summary Type 2 (insulin independent) diabetic women were randomly allocated to receive advice for low fat diets or low carbohydrate diets. By 24 h weighed dietary intakes before and after a mean interval of six months, patients in the low fat group had reduced their fat intake from 41% to 31% of total energy, while carbohydrate percentage of total energy intake increased from 38% to 46%. Percentage energy intake from fat and carbohydrate in the control group remained unchanged. Body weight fell in both groups, especially for patients in the low fat group who were obese (weight/height2 28 kg/m²). Mean plasma glucose, HbA₁, and triglycerides were unchanged. Mean plasma total cholesterol fell significantly in the low fat group compared with the controls (p < 0.001), but there was no significant difference in the small reduction of high density lipoprotein cholesterol observed in both groups. Thus, adherence to low fat diets occurred without deterioration of diabetes and with benefit for weight and total cholesterol.     

Asymptomatic cerebral involvement in Sjögren's syndrome: MRI findings of 15 cases

Fifteen patients with Sjögren's syndrome without clinical evidence of central nervous system disease were studied by MRI. Signal abnormalities were observed in 9 (60%). They were always visible on T2-weighted images as small punctate areas of high signal in the basal ganglia and the white matter of the cerebral hemispheres. Abnormalities were less frequently seen on T1-weighted images. Enlargement of cerebral sulci was observed in 6 cases. The specificity and significance of these abnormalities are discussed.     

Hypothyroidism in children with filter paper TSH of 30 to 50 microU/ml at initial screening. Implication of the TSH cut-off point for recalling of infants at risk

In a systematic screening of newborns in France during the period from 1979 to 1983, 959 infants with hypothyroidism were detected. In 16 cases of confirmed hypothyroidism the initial filter paper TSH (FP-TSH) was between 30 and 50 microU/ml. These cases emphasize the necessity of keeping a "security zone" for FP-TSH value between 30 and 50 microU/ml and of recalling these patients for a second test filter paper TSH.     

Causes and consequences of elderly's agitated and aggressive behavior

Agitation and aggressiveness are frequent in the elderly and often related to dementia. As a result of the ageing of the general population this is becoming a major public health concern. No or little epidemiological data, during primary health care, about symptoms, co-morbidity, nor medical and social consequences of elderlys' disruptive behavior have been gathered or published in the French literature. Thus, in order to describe these disorders, a survey in cooperation with general practitioners (GP) was conducted. A representative sample of 212 French GP's, all with preferential geriatric activity were asked to conduct a study by including retrospectively their two most recent patients older than 65, who had exhibited agitation and/or aggressiveness. From this cross sectional study, 410 patients (female: 61%, male: 39%) were included. The mean age was 81 years (sd: 7.65). The patients suffered from change in verbal behavior (80%), verbal aggressiveness (71%), physical agitation (60%), wandering (48%), and/or physical aggressiveness (31%). The average of disruptive behavior symptoms per patient was 2.9. The symptoms appeared progressively in 81% of patients, the mean duration was two years and it was the first episode in 40% of patients. Disruptive behaviors may be explained in view of organic illness in 62% of patients (cardiovascular disease: 37%, neurologic: 12%, diabetes: 7%, dehydratation: 5%), dementia (Alzheimer disease: 20%, vascular dementia: 18%, mixed dementia: 14%). In 54% of patients disruptive behavior may be explained in view of depression: 34%, and anxiety disorder: 31%. A triggering factor was observed in 57% of cases (psychosocial stress: 39%). Somatic consequences of the symptoms were frequently identified: decrease of alimentary intake: 39%, weight loss: 27%, dehydratation: 11%, falls: 32%, and irregular medication intake: 31%. Limitation of daily life activities: 85%, and family life: 97% were also noted. Acceptability of patient's symptoms by the family was good (no discomfort or transitory and mild irritability) in 61% of cases, and very bad (reactions of exhaustion, hospitalization requirement) in 13%. This study carried out during primary care, showed that the elderly's disruptive behaviors cause severe medical consequences and familial and social distress.