Association between fear of hypoglycemia and physical activity in youth with type 1 diabetes: The SEARCH for diabetes in youth study.

BACKGROUND: Youth with type 1 diabetes (T1D) are encouraged to participate in physical activity (PA). Studies have identified fear of hypoglycemia (FOH) as a barrier to participating in PA. OBJECTIVES: To examine (a) PA patterns in youth with T1D by age group and (b) the relationship between both parental and youth FOH and youth PA. METHODS: A cross-sectional analysis from the SEARCH cohort study visit of youth ages 10 to 17 years with T1D (n = 1129) was conducted. Linear regression models estimated the association between self-reported number of days of vigorous PA (VPA) and moderate PA (MPA) and both youth- and parent-reported FOH. Multivariable models were adjusted for age, sex, race, duration of T1D, HbA1c, use of continuous glucose monitoring (CGM), recent severe hypoglycemia, primary insulin regimen, and BMI. RESULTS: Participants were 52% female, had mean (sd) age 14.4 (4.2) years, diabetes duration 7.5 years (1.8), HbA1c 9.2% (1.7). Older youth were less likely to engage in VPA (P < .01), or sports teams (P < .01), but more likely to engage in MPA (P < .01). Higher youth FOH (behavior subscale) was associated with increased levels of VPA (ß (se) 0.30 (0.11), P = .01) but not significantly associated with MPA (P = .06). There was no statistically significant association between parental FOH and youth PA. CONCLUSIONS: In SEARCH participants with T1D, VPA, and team sports participation declined with age, while MPA increased. We observed that higher scores on the youth FOH behavioral subscale were associated with increased VPA levels, suggesting that FOH may be less of a barrier to PA than previously thought.

Objective outcome assessment of the modified Bretteville technique.

The paradigm for hypospadias repair is a straight, erect penis, with a vertical meatus at the tip of the glans that provides satisfactory urination and is cosmetically acceptable to the patient. We provide objective outcome data on 40 cases of hypospadias repaired using the modified Bretteville technique. The 'HOSE' questionnaire, flowmetry, wetted pad and spray pattern analysis in combination with other questionnaire data were obtained to evaluate the long-term results of the modified Bretteville technique. The average HOSE score was 15/16. Cosmesis is good, with average scores of 7.1/10 (patient) and 7.6/10 (doctor). HOSE assessment is good, with 85% of patients scoring 14 or over. Uroflow rates are very good for a hypospadiac population with 82.5% of the patients within normal limits for their age group. Wetted pad and spray pattern analysis showed 56% of patients sprayed more than 3g of urine compared to 11% in a junior football team acting as control, although there was little correlation between this objective assessment and the patients' perceived symptoms as assessed by the questionnaire. The modified Bretteville hypospadias repair provides a reliable epithelialized repair of consistent dimensions with good patient-reported cosmesis and excellent functional outcomes.

A five year review of basal cell carcinoma excisions.

In the Tayside plastic surgical unit where this study was carried out, regular audits of all excised basal cell carcinomas have taken place routinely every three months for over ten years. A five-year review of excised basal cell carcinomas was undertaken between 1st February 1999 and 31st January 2004. A total of 3006 primary lesions were excised and the incomplete excision rate was 3.2%. This is low compared to other published series. The regions of the body from where these were excised are reported along with the histological subtypes of incompletely excised lesions and the further treatment of patients with incompletely excised lesions. Further treatment and follow-up of patients after surgically excised basal cell carcinoma is discussed.

High resolution mapping of genetic factors affecting abdominal bristle number in Drosophila melanogaster.

Factors responsible for selection response for abdominal bristle number and correlated responses in sternopleural bristle number were mapped to the X and third chromosome of Drosophila melanogaster. Lines divergent for high and low abdominal bristle number were created by 25 generations of artificial selection from a large base population, with an intensity of 25 individuals of each sex selected from 100 individuals of each sex scored per generation. Isogenic chromosome substitution lines in which the high (H) X or third chromosome were placed in an isogenic low (L) background were derived from the selection lines and from the 93 recombinant isogenic (RI) HL X and 67 RI chromosome 3 lines constructed from them. Highly polymorphic neutral roo transposable elements were hybridized in situ to the polytene chromosomes of the RI lines to create a set of cytogenetic markers. These techniques yielded a dense map with an average spacing of 4 cM between informative markers. Factors affecting bristle number, and relative viability of the chromosome 3 RI lines, were mapped using a multiple regression interval mapping approach, conditioning on all markers > or = 10 cM from the tested interval. Two factors with large effects on abdominal bristle number were mapped on the X chromosome and five factors on the third chromosome. One factor with a large effect on sternopleural bristle number was mapped to the X and two were mapped to the third chromosome; all factors with sternopleural effects corresponded to those with effects on abdominal bristle number. Two of the chromosome 3 factors with large effects on abdominal bristle number were also associated with reduced viability. Significant sex-specific effects and epistatic interactions between mapped factors of the same order of magnitude as the additive effects were observed. All factors mapped to the approximate positions of likely candidate loci (ASC, bb, emc, h, mab, Dl and E(spl), previously characterized by mutations with large effects on bristle number.

Consider all options when third-party benefits are paid in error.

For many healthcare providers, the greatest problem with third-party payers is getting them to pay the benefits they are contractually obligated to pay. However, another problem that arises consistently--thought less frequently--is what to do when a third-party payer provides benefits that it is not contractually bound to make and then demands the payment be refunded. One answer to this problem may be to just say "no."

The effect of nutritional support on T-lymphocyte subpopulations in protein calorie malnutrition.

T-lymphocyte subpopulations were measured in the two major types of adult malnutrition, adult marasmus and kwashiorkor-like hypoalbuminemic malnutrition. The population of T-cells (T3) and the percentage of both helper (T4) and suppressor (T8) T-cells were significantly (P less than .05) decreased in patients with kwashiorkor-like hypoalbuminemic malnutrition, but did not differ from control values in patients with adult marasmus. The ratio of helper T-cell (T4), to suppressor T-cells (T8) (range 1.2-1.6) did not vary from control values in either type of malnutrition. One week of nutritional support was not associated with a significant increase in any of the T lymphocyte subpopulations in either type of malnutrition. These T-cell subpopulation changes are consistent with the greater depression of cellular immune function seen in patients with metabolic stresses associated with kwashiorkor-like hypoalbuminemic malnutrition. With the increasing frequency in which abnormalities of T-cell subpopulations are being reported in various diseases, the coexistence of kwashiorkor-like hypoalbuminemic malnutrition should be noted for its potentially confounding effect.

Diurnal intraocular pressure in juvenile open-angle glaucoma.

Outpatient diurnal intraocular pressures were obtained on 10 patients with juvenile open-angle glaucoma at approximately 6 hour intervals. There were 8 males and 2 females with an age range of 19 to 38 years. All glaucomatous medications were stopped 24 hours before recording the tensions. The peak intraocular pressure was recorded at the 6 PM interval in 6 of the 10 patients. Three patients recorded their highest pressures at the 12 AM (midnight) interval. Extraordinarily wide angles were observed in all cases and myopia was a common refractive error. Although the family history was not known in 3 patients, there was a positive family history of glaucoma in 7 of the 10 patients, which suggests an autosomal dominant mode of inheritance.