Effectiveness of system-based intervention in reducing incidence of type 2 diabetes and to improve the postnatal metabolic profiles in women with gestational diabetes mellitus: a randomized controlled study

AIM

The objective of this study was to determine the effectiveness of system-based intervention in reducing the incidence of diabetes and to improve the postnatal metabolic profiles among women with gestational diabetes mellitus (GDM).

MATERIALS AND METHODS

For women in the intervention arm (n = 130), they received one session of individualized health education at 36 gestational weeks, a booklet of diabetes prevention, five-session of postpartum booster educational program which were conducted including 1 session of dietary and exercise counseling by dietician and physiotherapist at 6 weeks postpartum. For women in the control group (n = 168), standard treatment whereby they had received group therapy on diet and physical activity modification by dietician and staff nurses during the antenatal period.

RESULTS

There were no significant differences in baseline characteristics between groups for most of the variables examined except for educational level which the control group had a higher education than the intervention group. The women assigned to system-based intervention have a significant difference to GDM women who were assigned to the control group for LDL and HDL but not in anthropometric measurements, blood pressure, glucose index, total cholesterol, and triglyceride. In addition, it was found that the incidence of Type 2 diabetes mellitus (T2DM) 2 years after delivery was 20% in the intervention arm compared to 17% in the control arm.

CONCLUSION

The system-based intervention was not statistically superior to the control intervention as there is no difference in terms of incidence of T2DM between the intervention and control group. We, therefore, suggested that more intensive interventions are needed to prevent GDM from developing into T2DM.

Determining the Effects of Psychosocial and Spiritual Support Among Patients With Substance Abuse: A Scoping Review

Substance use disorder (SUD) has both social and public health problems with a substantial burden to society. SUD is a type of mental illness and has been described as a chronic relapsing disease. Treatments for SUD may include among others, psychosocial rehabilitation as a provision to comprehensive treatment to address the social and behavioral issues. These psychosocial components can address the issues of morality, spirituality, and religion. Religion and spirituality are believed to support SUD clients in the reduction of drug use, other associated high-risk behaviors, and criminal issues. In promoting treatment retention, it is important to reduce the drug use, maintain abstinence, and influence the self-esteem and coping ability of SUD clients. Hence, this review was conducted to determine the effects of psychosocial and spiritual support towards clients with substance abuse problem. We had followed the framework from Arksey and O’Malley’s scoping review in identifying published studies from specific databases to be included in this review. A total of 8560 articles from various databases were screened. After removing duplicates, two authors independently screened 244 titles and abstracts. A total of eighteen articles were included in the final review. Out of eighteen studies, seventeen studies found that psychosocial support and spiritual needs have positive effect among substance abuse clients. Psychosocial and spiritual supports are beneficial among SUD clients due to various potential factors, such as religious reasons, personal beliefs or philosophical reasons, safety concerns, and a desire for improvements from substance abuse.

Factors affecting paramagnetic contrast enhancement in synovial fluid: effects of electrolytes, protein concentrations, and temperature on water proton relaxivities from Mn ions and Gd chelated contrast agents

INTRODUCTION

Protein and electrolyte concentration of synovial fluid (SF) varies with the type of underlying arthritis. These characteristics can be utilized by magnetic resonance technology to provide a potentially significant diagnostic modality through quantitative assessments of inherent water relaxation rates and their response to contrast agents.

METHODS

We evaluated the effect of a classic "in vitro" contrast agent, the Mn ion, and a common "in vivo" gadolinium based contrast agent, gadopentetate dimeglumine, on the water relaxation times of solutions with biochemical compositions simulating different types of arthritis along with similar studies of SF obtained from patients.

RESULTS

The results demonstrate how protein and electrolyte concentrations play a significant role in the response of water relaxation to the Mn ion but much less so to chelated gadolinium contrast agents used clinically.

DISCUSSION

A major challenge remains to develop paramagnetic agents with less toxicity than the Mn ion but with similar properties that can then serve as a tool to determine protein concentrations through imaging and thereby assist in the diagnosis of inflammatory arthrides and evaluation of therapeutic regimens.

Investigation of the activation of a human serum complement protein, C3, by orthopedic prosthetic particulates

Myriad molecular, cellular, and physiological processes underlie the inflammatory and osteolytic processes induced by particles of biomaterials resulting from the wear of implants such as total joint replacement prostheses. The objective this study was to investigate the role that the complement system may be playing in these phenomena. The aim was to evaluate the degree to which particles of selected orthopaedic materials--high density and ultrahigh molecular weight polyethylene, polymethylmethacrylate, and commercially pure titanium--cause the elevation of a key complement molecule, C3a, in an in vitro assay that directly measured the concentration of C3a. The results demonstrated that HDPE particles, at high concentration, are capable of causing the elevation of C3a in the in vitro assay. This finding is discussed in the context of other work and the mechanics of the complement system as it may affect the osteolytic process.

Effect of mechanical perturbation on the release of PGE(2) by macrophages in vitro

Macrophages play numerous roles in both physiologic and pathologic processes. Along with fibroblasts, they comprise the synovial tissue that forms the lining of musculoskeletal joint capsules and bursae, and they often envelop implants. During the process of phagocytosing prosthesis-related particles, macrophages in peri-implant tissue release inflammatory mediators. Little is known, however, about the response of these cells to mechanical perturbation, which often is a component of the physical environment of the cell. Mouse peritoneal macrophages were grown on a flexible membrane in vitro and a dynamic 1-Hz spatially uniform sinusoidal strain pattern imparted to the elastomeric substrate. The effect of mechanical strain on prostaglandin (PG) E(2) release was evaluated using cells that were activated by lipopolysaccharide (LPS) as well as by those that were not. The results are compared with the levels of PGE(2) stimulated by metallic particles. Strain magnitudes of 4 and 8% applied for 1 h resulted in almost a twofold increase in the release of PGE(2) from LPS-stimulated cells (p < 0.05) and nonstimulated macrophages (p < 0.07), compared with nonperturbated controls. No release was elicited by a challenge of metal particles. These findings demonstrate for the first time an effect of mechanical force on the release of an inflammatory mediator by macrophages. This response may help to explain the macrophage-mediated processes underlying the osteolysis associated with loose prostheses in bone and suggests a mechanism for the inflammation of synovial tissues by excessive mechanical strain.

Update on nerve palsy associated with total hip replacement

Nerve palsy is an uncommon but acknowledged complication of total hip replacement. The overall prevalence is approximately 1%. The sciatic nerve, or the peroneal division of the sciatic nerve, is involved in nearly 80% of cases. The risk of nerve palsy in association with total hip replacement is increased for female compared with male patients, with a diagnosis of developmental dysplasia, and with patients undergoing revision surgery. In the majority of cases, the origin of the palsy is unknown. Because peripheral nerves are sensitive to compression, unrecognized compression may play a role in these cases. The prognosis for neurologic recovery is related to the degree of nerve damage. Complete, or essentially complete, recovery occurs in approximately 41% and another 44% have only a mild deficit. Approximately 15% have a poor outcome characterized by weakness that limits ambulation and/or persistent dysesthesia. Patients with some motor function immediately after the operation and those who recover some motor function within approximately 2 weeks of surgery have a good prognosis for recovery. In general, recovery of femoral nerve palsies is more predictable than that of sciatic palsies.