The association of self-reported diabetes with impaired social functioning in low-, middle- and high-income countries: findings from the World Health Survey.

AIM: Epidemiological studies from high-income countries show that diabetes is associated with impaired social functioning. As healthcare systems in middle- and low-income countries offer fewer resources to curtail the potential social impact of diabetes, we performed a comparative study on the diabetes-social impairment link in low-, middle- and high-income countries. METHODS: We use data from the cross-sectional World Health Survey (n = 235 428 from 10 low-income, 29 middle-income and 9 high-income countries). Diabetes was defined by self-reports of a diagnosis. Impaired social functioning was considered present if participants reported severe or extreme difficulties with personal relationships or participation in the community. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) in the overall sample and by income regions. ORs were corrected for demographics and health-related lifestyles, and then additionally adjusted for impairments that may explain any observed association (i.e. impaired vision, mood, cognition and mobility). RESULTS: In the overall sample, we confirmed an association between self-reported diabetes and impaired social functioning (OR = 1.47, 95% CI = 1.18-1.83). The strength of that relationship increased with decreasing country income (e.g. OR in low-income countries = 2.23, 95% CI = 1.14-4.37). Associations were substantially attenuated by further correction for impairments, in particular mood problems, in the overall sample (OR = 0.92, 95% CI = 0.72-1.16) and all income regions. CONCLUSIONS: Self-reported diabetes is associated with impaired social functioning in high- and middle-income countries, and this relationship is even stronger in low-income countries. Associations are largely explained by physical and mental impairments, which may be due to diabetes.

[Differences in the Provision of Lifestyle Counseling for Cardiovascular Disease Prevention Between Urban and Rural Regions in Germany. Findings from a National Survey of Primary Care Physicians]. / Stadt-Land-Unterschiede im Angebot von Lebensstilberatung zur Prävention kardiovaskulärer Erkrankungen in der Hausarztpraxis. Ergebnisse einer bundesweiten Hausärztebefragung.

AIMS: In Germany, shortages in primary care physicians (PCPs) were reported in some rural regions. In this paper, we explored if regional differences in the distribution of PCPs are associated with the provision of lifestyle counseling in primary care. METHODS: In a nationwide study, a total of 4,074 randomly selected PCPs were asked about provision of lifestyle counseling to their patients, their attitudes, and perceived barriers. RESULTS: PCPs from rural regions provided less frequently lifestyle advice for cardiovascular disease prevention. Compared to their colleagues in urban areas, more PCPs from rural regions believed that were inadequately qualified for the lifestyle counseling and that they had been less successful in helping patients to modify their lifestyles. Physicians from rural practices named more often than PCPs from urban practices a lack of adherence by the patients (65 vs. 57%), insufficient opportunities to collaborate with providers of preventive services (62 vs. 55%), and lack of time (66 vs. 52%; all p<0.001) as barriers in providing patients with lifestyle counseling. CONCLUSION: Taking into account the expected increased shortages in PCPs in rural regions, the results show the need for targeted interventions for improving lifestyle counseling in rural practices.

Co-stimulation with an olfactory stimulus increases arousal responses to trigeminal stimulation.

UNLABELLED: An interaction of the intranasal chemical trigeminal and the olfactory system has previously been described. Intranasal chemical trigeminal stimulation during sleep leads to a dose-dependent increase in arousal reactions while pure olfactory stimuli are not able to trigger arousals or awakenings during sleep, regardless of the concentration used. The aim of the study was to assess whether co-stimulation with an olfactory substance increases arousal responses to intranasal chemical trigeminal stimulation. EXPERIMENTAL PROCEDURES: Five young healthy, normosmic volunteers of both sexes participated in the trial and 20 nights of testing were performed. For intranasal chemical trigeminal stimulation, CO(2) was administered at 40% v/v and at 0% as a control stimulus. For olfactory co-stimulation, H(2)S was used at a concentration of 8 ppm. To compare the specific nasal chemical trigeminal/olfactory interaction with an interaction between an olfactory stimulus and peripheral somatosensory stimulation, an electrical stimulation protocol at the forearm was used with and without olfactory co-stimulation. RESULTS: Chemical trigeminal stimulation with 40% CO(2) led to an increase in arousal frequency compared to the control stimulus, which was most pronounced in light sleep. Co-stimulation with H(2)S was associated with higher arousal frequencies and shorter arousal latencies compared to isolated chemical trigeminal stimulation. The differences between the three study conditions were statistically significant for light sleep. Increasing electric stimulus concentration was associated with an increase in arousal frequency, again most pronounced in light sleep. Co-simulation with the olfactory stimulus did not lead to a systemic effect with regard to arousal reactions. CONCLUSIONS: The present results confirm the close interaction of the olfactory and chemical trigeminal system and support the idea that this interaction takes place at an early stage of processing.