Long-term non-pharmacological weight loss interventions for adults with type 2 diabetes mellitus

ABSTRACT: BACKGROUND: Most persons with type 2 diabetes are overweight and obesity worsens the metabolic and physiologic abnormalities associated with diabetes. OBJECTIVE: The objective of this review is to assess the effectiveness of lifestyle and behavioral weight loss and weight control interventions for adults with type 2 diabetes. METHODS: Search methods: Studies were obtained from computerized searches of multiple electronic bibliographic databases, supplemented with hand searches of selected journals and consultation with experts in obesity research. Selection criteria: Studies were included if they were published or unpublished randomized controlled trials in any language, and examined weight loss or weight control strategies using one or more dietary, physical activity, or behavioral interventions, with a follow-up interval of at least 12 months. Data collection and analysis: Effects were combined using a random effects model. MAIN RESULTS: The 22 studies of weight loss interventions identified had a 4,659 participants and follow-up of 1 to 5 years. The pooled weight loss for any intervention in comparison to usual care among 585 subjects was 1.7 kg (95 % confidence interval [CI] 0.3 to 3.2), or 3.1% of baseline body weight among 517 subjects. Other main comparisons demonstrated non significant results: among 126 persons receiving a physical activity and behavioral intervention, those who also received a very low calorie diet lost 3.0 kg (95% CI -0.5 to 6.4), or 1.6% of baseline body weight, more than persons receiving a low-calorie diet. Among 53 persons receiving identical dietary and behavioral interventions, those receiving more intense physical activity interventions lost 3.9 kg (95% CI -1.9 to 9.7), or 3.6% of baseline body weight, more than those receiving a less intense or no physical activity intervention. Comparison groups often achieved significant weight loss (up to 10.0 kg), minimizing between-group differences. Changes in glycated hemoglobin generally corresponded to changes in weight and were not significant when between-group differences were examined. No data were identified on quality of life and mortality. AUTHORS CONCLUSIONS: Weight loss strategies using dietary, physical activity, or behavioral interventions produced small between-group improvements in weight. These results were minimized by weight loss in the comparison group, however, and examination of individual study arms revealed that multicomponent interventions including very low calorie diets or low calorie diets may hold promise for achieving weight loss in adults with type 2 diabetes.

Microbial contamination of central supply systems for medical air

Existem vários padrões e recomendações para a qualidade do ar respirável relacionado aos equipamentos de proteção respiratória, mas pouco tem sido feito em relação a uma possível contaminação microbiana do ar medicinal. O presente trabalho demonstra quantitativa e qualitativamente que as linhas de ar estão relacionadas à contaminação microbiológica do ar comprimido e ar sintético para uso medicinal. Amostras de ar foram coletadas por um equipamento especialmente resistente a pressão, e o conteúdo bacteriano e fúngico foi identificado após crescimento em placa. A flora bacteriana isolada tanto dos sistema periféricos de ar foi virtualmente a mesma encontrada nas instalações centralizadas, sendo uma mistura de patógenos e bactérias normais da pele. Vários fatores contribuintes para a contaminação microbiana do ar medicinal e medidas preventivas são discutidas.

Microbial contamination of central supply systems for medical air

There are many standards and recommendations for breathing air quality associated with respiratory protection equipment, but little has been done regarding the possible microbial contamination of medical air. The present study demonstrates quantitatively and qualitatively that pipelines might be incriminated as source of microbial contamination of compressed and synthetic air for medical use. Air samples were drawn into an especially pressure-resistant device and the bacterial and fungi contents were identified after growth on agar plates. The bacterial flora isolated from peripheral air outlets was virtually the same as that found in the central air-generating installations, consisting of a mixture of pathogens and normal skin bacteria. Several factors contributing to microbial contamination of medical air are mentioned and preventive measures are discussed.

Existem vários padrões e recomendações para a qualidade do ar respirável relacionado aos equipamentos de proteção respiratória, mas pouco tem sido feito em relação a uma possível contaminação microbiana do ar medicinal. O presente trabalho demonstra quantitativa e qualitativamente que as linhas de ar estão relacionadas à contaminação microbiológica do ar comprimido e ar sintético para uso medicinal. Amostras de ar foram coletadas por um equipamento especialmente resistente a pressão, e o conteúdo bacteriano e fúngico foi identificado após crescimento em placa. A flora bacteriana isolada tanto dos sistema periféricos de ar foi virtualmente a mesma encontrada nas instalações centralizadas, sendo uma mistura de patógenos e bactérias normais da pele. Vários fatores contribuintes para a contaminação microbiana do ar medicinal e medidas preventivas são discutidas.

Microbial contamination of central supply systems for medical air

There are many standards and recommendations for breathing air quality associated with respiratory protection equipment, but little has been done regarding the possible microbial contamination of medical air. The present study demonstrates quantitatively and qualitatively that pipelines might be incriminated as source of microbial contamination of compressed and synthetic air for medical use. Air samples were drawn into an especially pressure-resistant device and the bacterial and fungi contents were identified after growth on agar plates. The bacterial flora isolated from peripheral air outlets was virtually the same as that found in the central air-generating installations, consisting of a mixture of pathogens and normal skin bacteria. Several factors contributing to microbial contamination of medical air are mentioned and preventive measures are discussed.

Existem vários padrões e recomendações para a qualidade do ar respirável relacionado aos equipamentos de proteção respiratória, mas pouco tem sido feito em relação a uma possível contaminação microbiana do ar medicinal. O presente trabalho demonstra quantitativa e qualitativamente que as linhas de ar estão relacionadas à contaminação microbiológica do ar comprimido e ar sintético para uso medicinal. Amostras de ar foram coletadas por um equipamento especialmente resistente a pressão, e o conteúdo bacteriano e fúngico foi identificado após crescimento em placa. A flora bacteriana isolada tanto dos sistema periféricos de ar foi virtualmente a mesma encontrada nas instalações centralizadas, sendo uma mistura de patógenos e bactérias normais da pele. Vários fatores contribuintes para a contaminação microbiana do ar medicinal e medidas preventivas são discutidas.