To re-evaluate the relationship between glycemia and diabetic retinopathy.
We conducted a data-pooling analysis of nine studies from five countries with 44,623 participants aged 20-79 years with ...gradable retinal photographs. The relationship between diabetes-specific retinopathy (defined as moderate or more severe retinopathy) and three glycemic measures (fasting plasma glucose FPG; n = 41,411, 2-h post oral glucose load plasma glucose 2-h PG; n = 21,334, and A1C n = 28,010) was examined.
When diabetes-specific retinopathy was plotted against continuous glycemic measures, a curvilinear relationship was observed for FPG and A1C. Diabetes-specific retinopathy prevalence was low for FPG <6.0 mmol/l and A1C <6.0% but increased above these levels. Based on vigintile (20 groups with equal numbers) distributions, glycemic thresholds for diabetes-specific retinopathy were observed over the range of 6.4-6.8 mmol/l for FPG, 9.8-10.6 mmol/l for 2-h PG, and 6.3-6.7% for A1C. Thresholds for diabetes-specific retinopathy from receiver-operating characteristic curve analyses were 6.6 mmol/l for FPG, 13.0 mmol/l for 2-h PG, and 6.4% for A1C.
This study broadens the evidence based on diabetes diagnostic criteria. A narrow threshold range for diabetes-specific retinopathy was identified for FPG and A1C but not for 2-h PG. The combined analyses suggest that the current diabetes diagnostic level for FPG could be lowered to 6.5 mmol/l and that an A1C of 6.5% is a suitable alternative diagnostic criterion.
To determine sex and age differences in the use of medications for diabetes and cardiovascular risk factors in people with diabetes in Australia. Pharmaceutical claims data of participants in the 45 ...and Up Study who self-reported having diabetes before 2013, were alive on 1.sup.st January 2013 and had at least one medication dispensing record between 1.sup.st January 2013 and 31.sup.st December 2019 were analysed. Annual sex and age-specific percentages of participants supplied specific medications were estimated for years 2013 to 2019. Percentages were reported for any glucose lowering medications and by drug class, any lipid modifying agents, and any blood pressure lowering medications. Altogether 25,733 participants (45.2% women) with diabetes were included. The percentage of participants who were supplied with glucose lowering medications was consistently lower in women compared to men. In both sexes, the percentage of participants who were supplied with glucose lowering medications was lowest among those aged greater than or equal to75 years and this decreased over time. Similar findings were observed for lipid modifying agents and blood pressure lowering medications. The use of sodium glucose co-transporter 2 inhibitors increased substantially in participants aged <75 years since it became available in 2013. However, no sex differences were observed in its use among people with hospital-recorded history of cardiovascular disease. Practitioners should be aware of possible sex disparities in the pharmacological treatment of diabetes and cardiovascular risk factors in people with diabetes in Australia. There is a possible time lag between reporting of research findings and uptake of sodium glucose co-transporter 2 inhibitors prescribing in individuals with diabetes and high cardiovascular risk in clinical practice, nevertheless, the result observed was consistent with the management guidelines at the time of the study.
Full text
Available for:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Objective: To assess and compare health care costs for normal‐weight, overweight and obese Australians.
Design, setting and participants: Analysis of 5‐year follow‐up data from the Australian ...Diabetes, Obesity and Lifestyle study, collected in 2004–2005. Data were available for 6140 participants aged ≥ 25 years at baseline.
Main outcome measures: Direct health care cost, direct non‐health care cost and government subsidies associated with overweight and obesity, defined by both body mass index (BMI) and waist circumference (WC).
Results: The annual total direct cost (health care and non‐health care) per person increased from $1472 (95% CI, $1204–$1740) for those of normal weight to $2788 (95% CI, $2542–$3035) for the obese, however defined (by BMI, WC or both). In 2005, the total direct cost for Australians aged ≥ 30 years was $6.5 billion (95% CI, $5.8–$7.3 billion) for overweight and $14.5 billion (95% CI, $13.2–$15.7 billion) for obesity. The total excess annual direct cost due to overweight and obesity (above the cost for normal‐weight individuals) was $10.7 billion. Overweight and obese individuals also received $35.6 billion (95% CI, $33.4–$38.0 billion) in government subsidies. Comparing costs by weight change since 1999–2000, those who remained obese in 2004–2005 had the highest annual total direct cost. Cost was lower in overweight or obese people who lost weight or reduced WC compared with those who progressed to becoming, or remained, obese.
Conclusion: The total annual direct cost of overweight and obesity in Australia in 2005 was $21 billion, substantially higher than previous estimates. There is financial incentive at both individual and societal levels for overweight and obese people to lose weight and/or reduce WC.
Full text
Available for:
FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
In the developing embryo and fetus, endogenous or xenobiotic-enhanced formation of reactive oxygen species (ROS) like hydroxyl radicals may adversely alter development by oxidatively damaging ...cellular lipids, proteins and DNA, and/or by altering signal transduction. The postnatal consequences may include an array of birth defects (teratogenesis), postnatal functional deficits, and diseases. In animal models, the adverse developmental consequences of in utero exposure to agents like thalidomide, methamphetamine, phenytoin, benzoapyrene, and ionizing radiation can be modulated by altering pathways that control the embryonic ROS balance, including enzymes that bioactivate endogenous substrates and xenobiotics to free radical intermediates, antioxidative enzymes that detoxify ROS, and enzymes that repair oxidative DNA damage. ROS-mediated signaling via Ras, nuclear factor kappa B and related transducers also may contribute to altered development. Embryopathies can be reduced by free radical spin trapping agents and antioxidants, and enhanced by glutathione depletion. Further modulatory approaches to evaluate such mechanisms in vivo and/or in embryo culture have included the use of knockout mice, transgenic knock-ins and mutant deficient mice with altered enzyme activities, as well as antisense oligonucleotides, protein therapy with antioxidative enzymes, dietary depletion of essential cofactors and chemical enzyme inhibitors. In a few cases, measures anticipated to be protective have conversely enhanced the risk of adverse developmental outcomes, indicating the complexity of development and need for caution in testing therapeutic strategies in humans. A better understanding of the developmental effects of ROS may provide insights for risk assessment and the reduction of adverse postnatal consequences.
We aimed to assess whether remission of type 2 diabetes (T2D) could be achieved with a low-energy total diet replacement (TDR) in an Australian primary care setting.
Individuals aged 20-65 years with ...T2D duration up to 6 years, BMI >27.0 kg/m2, and not treated with insulin were prescribed a 13-week low-energy TDR (Optifast; Nestlé Health Science) followed by 8-week structured food reintroduction and 31-week supported weight maintenance. The primary outcome was T2D remission at 12 months.
A total of 155 participants comprised the intention-to-treat population. At 12 months, T2D remission was achieved in 86 (56%) participants, with a mean adjusted weight loss of 8.1% (95% CI 7.2-9.1). Two serious adverse events requiring hospitalization related to the study intervention were reported.
At 12 months T2D remission was achieved for one in two Australian adults in a primary care setting.
It is unclear which Early Warning System (EWS) score best predicts in-hospital deterioration of patients when applied in the Emergency Department (ED) or prehospital setting.
This systematic review ...(SR) and meta-analysis assessed the predictive abilities of five commonly used EWS scores (National Early Warning Score (NEWS) and its updated version NEWS2, Modified Early Warning Score (MEWS), Rapid Acute Physiological Score (RAPS), and Cardiac Arrest Risk Triage (CART)). Outcomes of interest included admission to intensive care unit (ICU), and 3-to-30-day mortality following hospital admission. Using DerSimonian and Laird random-effects models, pooled estimates were calculated according to the EWS score cut-off points, outcomes, and study setting. Risk of bias was evaluated using the Newcastle-Ottawa scale. Meta-regressions investigated between-study heterogeneity. Funnel plots tested for publication bias. The SR is registered in PROSPERO (CRD42020191254).
Overall, 11,565 articles were identified, of which 20 were included. In the ED setting, MEWS, and NEWS at cut-off points of 3, 4, or 6 had similar pooled diagnostic odds ratios (DOR) to predict 30-day mortality, ranging from 4.05 (95% Confidence Interval (CI) 2.35-6.99) to 6.48 (95% CI 1.83-22.89), p = 0.757. MEWS at a cut-off point ≥3 had a similar DOR when predicting ICU admission (5.54 (95% CI 2.02-15.21)). MEWS ≥5 and NEWS ≥7 had DORs of 3.05 (95% CI 2.00-4.65) and 4.74 (95% CI 4.08-5.50), respectively, when predicting 30-day mortality in patients presenting with sepsis in the ED. In the prehospital setting, the EWS scores significantly predicted 3-day mortality but failed to predict 30-day mortality.
EWS scores' predictability of clinical deterioration is improved when the score is applied to patients treated in the hospital setting. However, the high thresholds used and the failure of the scores to predict 30-day mortality make them less suited for use in the prehospital setting.
Full text
Available for:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The endoplasmic reticulum (ER) is a continuous endomembrane system comprising the nuclear envelope, ribosome-studded sheets, dense peripheral matrices, and an extensive polygonal network of ...interconnected tubules. In addition to performing numerous critical cellular functions, the ER makes extensive contacts with other organelles, including endosomes and lysosomes. The molecular and functional characterization of these contacts has advanced significantly over the past several years. These contacts participate in key functions such as cholesterol transfer, endosome tubule fission, and Ca2+ exchange. Disruption of key proteins at these sites can result in often severe diseases, particularly those affecting the nervous system.
Full text
Available for:
GEOZS, IJS, KILJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Abstract
We investigated experiences of mothers of school‐age children in Central New York during a time of remote education due to COVID‐19. We extend the concept of intensive mothering, ...characterized by the expectation that mothers are constantly available to meet their children's needs, and examine mothers’ intersectional identities related to their experience of remote education. Mothers working from home often went back and forth between work and school in what we refer to as a
simultaneous shift
. Essential workers were engaged in a
sequential shift
, engaging with children's schoolwork after work and trading off with partners. Mothers took on multiple roles during the pandemic which led to role strain. In extreme cases, multiple roles could be impossible to fill, leading to a situation of role conflict where the demands of one role made it impossible to meet the needs of another role. Mothers of children of color experienced more negative interactions with schools than White mothers. Mothers of children with disabilities spent extended time on remote schooling. A limitation of our study is that we only interviewed people in Central New York and cannot generalize the results of our research to a larger population. Another limitation to our approach was that we have little information on how fathers experienced work and overseeing children's schoolwork. Future research should examine how mothering may have changed after children returned to school.
Full text
Available for:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
This article describes a three-year qualitative study on how youth of color in one community-based organization, Durham Community Youth, used the mentor text, Dr. Martin Luther King Jr.’s “What’s ...your life’s blueprint?” speech, as a reflective tool to transform themselves and their community. Using a critical literacy framework, the authors situate the study within the rich history of the Black community in Durham, North Carolina and examine how students’ writing advocated for their communities by speaking out against oppressive forces. The article offers implications on how educators can reimagine the implementation and intentionality of mentor texts for youth.
Full text
Available for:
NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
Purpose
Artificially intelligent (AI) assistant-enabled smart speaker not only can provide assistance by navigating the massive amount of product and brand information on the internet but also can ...facilitate two-way conversations with individuals, thus resembling a human interaction. Although smart speakers have substantial implications for practitioners, the knowledge of the underlying psychological factors that drive continuance usage remains limited. Drawing on social response theory and the technology acceptance model, this study aims to elucidate the adoption process of smart speakers.
Design/methodology/approach
A field survey of 391 smart speaker users were obtained. Partial least squares structural equation modeling was used to analyze the data.
Findings
Media richness (social cues) and parasocial interactions (social role) are key determinants affecting the establishment of trust, perceived usefulness and perceived ease of use, which, in turn, affect attitude, continuance usage intentions and online purchase intentions through AI assistants.
Originality/value
AI assistant-enabled smart speakers are revolutionizing how people interact with smart products. Studies of smart speakers have mainly focused on functional or technical perspectives. This study is the first to propose a comprehensive model from both functional and social perspectives of continuance usage intention of the smart speaker and online purchase intentions through AI assistants.
PDF
