Low-grade Inflammatory Marker Profile May Help to Differentiate Patients With LADA, Classic Adult-Onset Type 1 Diabetes, and Type 2 Diabetes.

OBJECTIVE: To test whether differences in serum concentrations of adiposity-related low-grade inflammatory mediators could help to differentiate patients with latent autoimmune diabetes in adults (LADA), classic adult-onset type 1 diabetes, and type 2 diabetes. RESEARCH DESIGN AND METHODS: This cross-sectional study involved 75 patients with LADA, 67 with classic adult-onset type 1 diabetes, and 390 with type 2 diabetes. Serum concentrations of adiponectin, soluble tumor necrosis factor-α receptor 2 (sTNFRII), interleukin-6, hs-CRP, and total leukocyte number were measured. To evaluate the differences of these markers among diabetes types, we performed logistic regression models and evaluated area under the receiver-operating characteristic curve (AUCROC) values. RESULTS: The profile of innate immunity-related inflammatory markers correlated with metabolic syndrome components. LADA versus classic adult-onset type 1 diabetes was independently related to sTNFRII (odds ratio [OR] 1.9 [95% CI 1.01-3.97]; P = 0.047) and hs-CRP levels (OR 0.78 [95% CI 0.62-0.96]; P = 0.019), and a higher number of total leukocytes lowered the risk of LADA compared with type 2 diabetes (OR 0.98 [95% CI 0.97-0.99]; P = 0.036). The logistic regression model including explanatory biomarkers explained 35% of the variation for LADA versus classic adult-onset type 1 diabetes (AUCROC 0.83 [95% CI 0.74-0.92]; P < 0.001) and 15% of the variation for LADA versus type 2 diabetes (AUCROC 0.73 [95% CI 0.70-0.80]; P < 0.001). CONCLUSIONS: Inflammatory, adiposity, and immune-related markers could help to differentiate a LADA diagnosis from that of classic adult-onset type 1 diabetes, and also LADA from that of type 2 diabetes, along with islet autoantibody positivity.

Snoezelen: a controlled multi-sensory stimulation therapy for children recovering from severe brain injury.

OBJECTIVE: To investigate the effects of Snoezelen therapy on physiological, cognitive and behavioural changes in children recovering from severe traumatic brain injury (TBI). METHODS: An observational study was conducted to assess the physiological, cognitive and behavioural changes of children recovering from severe TBI while receiving Snoezelen therapy. Fifteen subjects completed the pre- and post-Snoezelen treatment measurements computed over 10 consecutive sessions. Physiological, cognitive and behavioural measures were administered. Data was collected prospectively on each session in the Snoezelen room and were analysed by calculating the difference between pre- and post-treatment measurements for each Snoezelen session. RESULTS: Results revealed significant changes on physiological measures. Heart rates decreased for each subject in each treatment session and were found to be significant (p = 0.032). Muscle tone was decreased in all the affected extremities (right upper extremity p = 0.009, left upper extremity p = 0.020, right lower extremity p = 0.036 and left lower extremity p = 0.018). Agitation levels decreased over time and the overall cognitive outcome measures showed significant improvement when comparing the beginning of treatment with the end. CONCLUSION: This study revealed a beneficial use of Snoezelen therapy with children recovering from severe brain injury. However, there continues to be a critical need for evidenced-based research for this patient population and others in this multi-sensory environment.

WalkSafe: a school-based pedestrian safety intervention program.

OBJECTIVE: To evaluate the effectiveness of the WalkSafe program, an elementary school-based pedestrian safety program in a single high-risk district in Miami-Dade County. METHODS: Sixteen elementary schools were identified in a single high-risk district and enrolled in a one-year study. All schools implemented the WalkSafe program on the last week of January 2003. A pre, post, and three-month post testing of pedestrian safety knowledge was conducted. An observational component was also implemented at four schools that were randomly chosen. Engineering recommendations and law enforcement initiatives were also performed. RESULTS: A total of 6467 children from K-5th grade from 16 elementary schools participated in the program. Of these 5762 tests were collected over three different testing times. A significant difference (p-value < 0.001) was found between the pre and post testing conditions across all grade levels. There was no significant difference found between the post and three-month post testing conditions across all grade levels (p-value > 0.05). The observational data collected at four schools across the different testing times demonstrated a significant difference found between pre and post testing conditions for Group A (stop at the curb and look left, right, left) and also for Group B (midstreet crossing and darting out) (p-value < 0.05). There was no difference found between comparing the pre-test or post-test condition with the three-month post-test time. There were many environmental modifications that were recommended and actually performed. CONCLUSION: The WalkSafe program implemented in a single high-risk district was shown to improve the pedestrian safety knowledge of elementary school children. The observational data demonstrated improved crossing behaviors from pre-test to post-testing conditions. Future research will focus on sustaining the program in this district and expanding the program throughout our county.

Pediatric pedestrian trauma study: a pilot project.

OBJECTIVE: To evaluate the implementation of the WalkSafe Program, a school based educational injury prevention program for children grades Kindergarten through 5. METHODS: A randomized comparative design was used for this study. The study was conducted in two high-risk urban school districts, which were chosen based on the geographic areas with the highest pedestrian injury and fatality rates. Four elementary schools (two in each district) were identified as potential study sites. Two intervention schools, one in each school district, were randomly chosen to receive the WalkSafe program; the other two schools served as controls, and received no intervention. The data was collected within the classroom setting for both the intervention and control schools. All elementary school children were administered the same pedestrian safety questionnaire as a pre-test, post-test and at three months following the intervention. RESULTS: A total of 2300 children participated in the WalkSafe program. The intervention (I) schools showed significant improvement in post-test scores then the control (C) schools (p = 0.012), and the (I) schools were able to maintain their test scores as reflected in a three-month follow-up evaluation (p = 0.47). Grades 3-5 of the (I) schools showed significant improvement in their test scores over grades K-2 (p < 0.0001). CONCLUSION: The WalkSafe program was shown to improve the pedestrian safety knowledge of elementary school children. Future research will include implementing the WalkSafe program at each elementary school within a single high-risk district.

Outcome of motorcycle riders at one year post-injury.

OBJECTIVE: There is little information about the long-term effects of injury on victims of motorcycle crashes. Following the repeal of the mandatory helmet law in Florida, we studied the impact of crashes on riders and their outcomes one year post-injury. SUBJECTS: All patients involved in a motorcycle crash over a six-month time period were assessed at one year post-injury. Demographic information, health status, motorcycle and helmet usage, and employability were surveyed. RESULTS: There were 94 patients evaluated at our center for the first six-month period following the repeal of the helmet law, where 50 (56%) were wearing a helmet at the time of injury. Of the 94, we were able to contact 45 (48%) at one-year follow up. Fourteen (31%) of those contacted were not wearing a helmet at the time of their crash. At one year post-injury, 23 (51%) reported physical deficits, while 39 (86%) were working. Only 12 (27%) were riding a motorcycle again, and 11 (92%) were wearing a helmet. CONCLUSIONS: Motorcycle riders at one year post-injury continue to experience physical deficits related to their accidents. There is a small percentage of riders that resume riding a motorcycle after injury. Being involved in a motorcycle accident has deterred the injured rider from riding a motorcycle again at one year post-injury.