Perspectives on colorectal cancer screening: a focus group study

Objective To assess attitudes and acceptability of Ontario consumers and doctors towards colorectal screening with faecal occult blood testing (FOBT) and colonoscopy. Design, setting and participants Focus groups with gender‐specific samples of the population, high‐risk gastroenterology patients and family doctors. Method Semi‐structured interview guides used by facilitator to lead groups through knowledge of risk factors and prevention of colorectal cancer, the screening modalities, requirements for implementing screening programmes, barriers to screening and preferences towards screening. Main findings There were low levels of knowledge about colorectal cancer and its prevention in the general population. FOBT was an acceptable screening modality, but considerable education about its use and benefits would be necessary to implement a screening programme. Colonoscopy was not perceived to be a good choice for a primary screen in the general population. The high‐risk group supported use of FOBT in the general population and emphasized the need for education. The doctors were more reluctant about screening, requesting clear guidelines. They also identified the time and resources that would be required if a screening programme were initiated. Conclusion While colorectal screening is acceptable in this sample, information and decision aids are required to enable consumers and providers to make effective decisions. Implementation of colorectal screening programmes requires substantial educational efforts for both consumers and doctors.     

Screening for type 2 diabetes with random finger‐prick glucose and bedside HbA1c in an Australian emergency department

Objective: To determine if screening for undiagnosed type 2 diabetes mellitus (T2DM) and pre‐diabetes is feasible in an Australian ED; to estimate the prevalence of T2DM and pre‐diabetes in the Australian ED population. Methods: Prospective cross‐sectional prevalence survey in the ED of St Vincent's Hospital, Melbourne, an adult, tertiary referral centre seeing approximately 40 000 patients annually. A convenience sample of adult patients was screened with finger‐prick random blood glucose and glycosylated haemoglobin (HbA1c); those over 6.0 mmol/L and 6.0% were referred for oral glucose tolerance test (OGTT). Diagnoses of T2DM and pre‐diabetes were made according to World Health Organization definitions. Those not attending for OGTT were contacted by phone, and interviewed about their reasons. Results: Seven hundred and twenty‐five patients were recruited; 135 (18.6%; 95% confidence intervals [CI] 15.9–21.6%) had known T2DM, leaving 590 screened, of whom 210 screened positive. Of the 192 referred for OGTT, 147 (77%) did not attend despite several telephone reminders. Of the 45 (23%) completing OGTT, pre‐diabetes was present in eight (17.8%; 95% CI 9.0–31.6%) and T2DM in six (13.3%; 95% CI 5.9–26.6%). Many people interviewed (18/86, 21%) did not attend for OGTT on the advice of their doctors. Conclusions: This inner city tertiary ED has a high prevalence of T2DM, diagnosed and undiagnosed, with as much as half our population possibly affected. Although ED screening might have a high yield, opportunistic screening is not feasible, with difficulties in staff engagement and patient follow up for diagnostic testing. Future studies might consider finger‐prick fasting blood glucose through a patient's general practitioner for diagnosis.     

Neurite branching on deformable substrates

The mechanical properties of substrates underlying cells can have profound effects on cell structure and function. To examine the effect of substrate deformability on neuronal cell growth, protein-laminated polyacrylamide gels were prepared with differing amounts of bisacrylamide to generate substrates of varying deformability with elastic moduli ranging from 500 to 5500 dyne/cm. Mouse spinal cord primary neuronal cells were plated on the gels and allowed to grow and extend neurites for several weeks in culture. While neurons grew well on the gels, glia, which are normally co-cultured with the neurons, did not survive on these deformable substrates even though the chemical environment was permissive for their growth. Substrate flexibility also had a significant effect on neurite branching. Neurons grown on softer substrates formed more than three times as many branches as those grown on stiffer gels. These results show that mechanical properties of the substrate specifically direct the formation of neurite branches, which are critical for appropriate synaptic connections during development and regeneration.     

Mitochondriopathie bei einem Kind mit Shwachman-Syndrom und Zöliakie Fallbericht

Background. The Shwachman syndrome represents one of the causes of exocrine pancreatic insufficiency, surpassed in incidence only by cystic fibrosis. It is a heriditary multi-organ disease with effects on pancreatic function, hematopoesis and growth of cartilage and bone. Case report. In our case, who presented with a rare combination of celiac disease and diabetes mellitus, we want to emphasise the large variability of clinical signs and symptoms. The pathogenesis of Shwachman syndrome is not delineated. The case presented here showed a respiratory-chain-defect in complex II, IV and V in fibroblast culture. Conclusions. We propose patients with Shwachman syndrome to investigate for respiratory-chain defect. This could help for better classification and diagnosis of this syndrome.     

Mitochondriopathie bei einem Kind mit Shwachman-Syndrom und Z?liakie Fallbericht Fallbericht

Hintergrund. Das Shwachman-Syndrom ist nach der Zystischen Fibrose die zweith?ufigste Ursache einer angeborenen exokrinen Pankreasinsuffizienz. Es handelt sich dabei um eine heredit?re Multiorgankrankheit mit Auswirkungen auf die Pankreasfunktion, die H?matopoese und das Knorpel-Knochen-Wachstum.