Glycaemic and insulin index of four common German breads.

BACKGROUND/OBJECTIVES: German-style breads are recommended as a lower glycaemic index (GI) alternative, yet little data is available. Our aim was to test the GI and insulin index (II) of four breads and rolls commonly consumed in Germany. SUBJECTS/METHODS: Four German bread products were tested for their GI and II in 12 healthy subjects according to the International Standard Organization guidelines. RESULTS: Only the wholemeal rye bread with visible intact grains and sunflower seeds was identified as low GI (GI=55). Both the wholemeal spelt wheat (GI=63) and the rye wheat sourdough bread (GI=62) were classified as medium GI, whereas soft pretzel was high GI (GI=80, P<0.05 compared with other products). The II of soft pretzels (II=102) was also highest and differed significantly from wholemeal rye (II=70) and rye sourdough bread (II=72) but not from wholemeal spelt wheat (II=77). CONCLUSIONS: Contrary to popular belief, these German-style breads are medium to high GI, with the exception of the rye bread with intact grains and seeds. The results highlight the need to test, rather than 'guestimate', the GI of local products, and develop a broader range of low-GI breads.

Effects of human milk and formula on postprandial glycaemia and insulinaemia.

BACKGROUND/OBJECTIVES: Consumption of formula in place of human milk may produce differences in postprandial glycaemia and insulinaemia that contribute to metabolic programming in the first year of life. The objective of the current study was to determine glycaemic and insulinaemic responses to human milk compared with a typical commercial formula, and then compare 11 other formulas. SUBJECTS/METHODS: On separate mornings in random order, 10 healthy breastfeeding mothers consumed 25 g available carbohydrate portions of their own milk, a formula and reference food (25 g glucose on two occasions). In the second study, 10 different healthy subjects consumed 25 g available carbohydrate portions of 11 different commercial formulas and three reference foods (25 g glucose on three occasions). Fingerpick blood samples were taken at regular intervals over 2 h, and the glycaemic index (GI) and insulin index determined according to a standardised protocol. RESULTS: There were no significant differences in postprandial glycaemia or insulinaemia after human milk vs a typical formula (P = 0.3). Both produced a low GI (mean ± s.e.m.: 38 ± 7 vs 34 ± 7, respectively) and high insulin index (87 ± 14 vs 94 ± 16). The GI and insulin indices of the other formulas ranged from 18 ± 3 to 67 ± 6 and 53 ± 9 to 209 ± 33, respectively. CONCLUSIONS: Human milk and a typical formula elicit similar postprandial glycaemic and insulinaemic responses, but there is a wide range of responses to other formulas.

'Be Clear on Cancer': the impact of the UK National Bowel Cancer Awareness Campaign.

AIM: The National Bowel Cancer Awareness Campaign ('Be Clear on Cancer') was launched by the UK government in January 2012, encouraging people with bowel symptoms to present to primary care. Our aim was to evaluate the impact of the campaign on colorectal services in secondary care. METHOD: Suspected cancer 2-week-wait (2WW) patients 3 months before and 3 months after the launch of the campaign were included. Demographics, reason for referral, investigations performed, cost analysis and eventual diagnoses were collected. RESULTS: Three hundred and forty-three patients [median age 70 (36-100) years, 194 (57%) women] were seen and investigated in the 3 months prior to the launch of the campaign at an average cost of £575 per patient. Twenty-seven (8%) were diagnosed with lower gastrointestinal cancer and 29 (8%) with polyps. In the 3 months following the launch, 544 patients [median age 68 (30-92) years, 290 (53%) women] were reviewed (59% increase; P = 0.004). The 'did not attend' rate fell from 10% to 1%. Thirty-two (6%) patients were diagnosed with a lower gastrointestinal cancer and 20 (4%) with colorectal polyps. The cost per colorectal cancer detected rose from £7585.58 before the campaign to £9662.72 after launch (P = 0.04). CONCLUSION: The 'Be Clear on Cancer' campaign has substantially increased the number of referrals under the 2WW rule, but mainly in the worried well. This has increased demands on both resources (59% more tests) and finance. Cost per cancer detected rose by 27% with no increase in funding to support the increased activity.

Effects of PGX, a novel functional fibre, on acute and delayed postprandial glycaemia.

BACKGROUND: Viscous fibre in food has established health benefits, but few functional fibre preparations are both effective and palatable. Our objective was to determine the most effective dose, formulation and timing of consumption of a novel fibre supplement (PolyGlycopleX (PGX)) in reducing postprandial glycaemia. SUBJECTS/METHODS: Three trials were undertaken, each with 10 subjects (8M and 8F; age 24.4 ± 2.6 years). Granular supplement was tested at four doses (0, 2.5, 5.0 and 7.5 g) with breakfast (study 1). Granular and capsule forms of the supplement were given in a single dose (5 g for granules and 4.5 g in capsules) at -60, -45, -30, -15 and 0 before, and +15 min after a bread meal (study 2). Capsules at increasing doses (1.5, 3, 4.5 and 6 g) were consumed with the evening meal to determine effects on glucose tolerance at breakfast (study 3). Incremental area under the blood glucose curve was determined. RESULTS: Granular PGX at breakfast time at doses of 2.5, 5 and 7.5 g reduced the incremental area under the curve by up to 50% in a linear dose-response fashion (P<0.001). The granular form of PGX (5 g), but not the capsules, reduced glycaemia by up to 28% when consumed from -45 to +15 min (P<0.001). Capsules containing 3, 4.5 and 6 g PGX consumed with the evening meal reduced glycaemia at breakfast by up to 28% (P<0.001). CONCLUSIONS: PGX has biologically important, dose-related effects on acute and delayed (second meal) postprandial glycaemia.

Effect of the glycemic index of carbohydrates on day-long (10 h) profiles of plasma glucose, insulin, cholecystokinin and ghrelin.

BACKGROUND: Low glycemic index (GI) carbohydrates have been linked to increased satiety. The drive to eat may be mediated by postprandial changes in glucose, insulin and gut peptides. OBJECTIVE: To investigate the effect of a low and a high GI diet on day-long (10 h) blood concentrations of glucose, insulin, cholecystokinin (CCK) and ghrelin (GHR). DESIGN: Subjects (n=12) consumed a high and a low GI diet in a randomized, crossover design, consisting of four meals that were matched for macronutrients and fibre, and differed only in carbohydrate quality (GI). Blood was sampled every 30-60 min and assayed for glucose, insulin, CCK and GHR. RESULTS: The high GI diet resulted in significantly higher glucose and insulin mean incremental areas under the curve (IAUC, P=0.027 and P=0.001 respectively). CCK concentration was 59% higher during the first 7 h of the low GI diet (394+/-95 pmol/l min) vs the high GI diet (163+/-38 pmol/l min, P=0.046), but there was no difference over 10 h (P=0.224). GHR concentration was inversely correlated with insulin concentration (Pearson correlation -0.48, P=0.007), but did not differ significantly between the low and high GI diets. CONCLUSIONS: Mixed meals of lower GI are associated with lower day-long concentrations of glucose and insulin, and higher CCK after breakfast, morning tea and lunch. This metabolic profile could mediate differences in satiety and hunger seen in some, but not all, studies.

Hospital and hospice resource use of HIV-positive patients in Edinburgh.

A prospective study of health service and hospice resource utilization (average length of stay or ALOS, discharge rate, bed day use, outpatient consultation) analysed with reference to gender, risk activity, immunological and clinical staging (1987 definition of AIDS) for the financial year 1992-93 was undertaken at the Regional Infectious Disease Unit (RIDU), City Hospital, Edinburgh, Scotland where 72% of 513 patients were infected via injection drug use. Not surprising therefore overall, drug users were the heaviest users of the inpatient facilities (74% of the discharges and 65% of the bed days) although homosexuals had the highest discharge rate (114 per 100 person years) and rate of bed day use (1654 days per 100 person years). Immunodeficiency (CD4 count < 200 cells/ul) and a clinical diagnosis of AIDS were both associated with greater inpatient and outpatient resource use compared to those without immunodeficiency (CD4 count > or = 200 CD4 cells/ul) or AIDS. Gender effects were complex; the ALOS for women was increased for all risk groups whatever the CD4 count whilst there was no consistent trend of more resource use for women by risk group. Drug users were the heaviest overall users of the local hospice (84% of all admissions, 83% of the bed days and a discharge rate of 76.4 per 100 person years), more than double the rates experienced by the other risk groups. Thus both clinical and immunological staging (AIDS or a CD4 count < 200 cells/ul) were associated with increased resource use in HIV infection and estimates of resource use for AIDS need to be increased by around one-third to take into account hospice use. Despite the preponderance of drug users in Edinburgh, comparisons with other centres did not reveal increased resource use.

The cost of health care for HIV-positive patients.

Utilizing a prospective study of health service activity for HIV/AIDS, 2 estimates of hospital costs of care analysed with reference to gender, risk activity, immunological and clinical staging (1987 definition of AIDS) were undertaken. Utilizing combined costs per life year (based on hospital and hospice activity but not primary and community care) the ratio of costs for CD4 < 200 and CD4 > 200 was for most risk groups between 2-5:1 whilst for AIDS: pre-AIDS it was between 3.6-8.3:1 except for homosexuals where it was 12.6:1. A comparison of the standard hospital costs for infectious diseases with the published accounts for clinical AIDS care in Lothian suggests a 3-4-fold underestimate in the costs of providing a comprehensive health care service.

An evaluation of community nursing services for HIV/AIDS patients in Lothian, Scotland.

This paper reports on a postal questionnaire survey of district nurses' work with HIV positive patients. Each nurse was asked to provide information about their contact with HIV positive patients and the level of training they had received in HIV/AIDS care. The nature of nursing activities carried out for these patients was established along with levels of confidence the nurses had in being able to provide a high standard of care. Where the nurses indicated less than full confidence they were asked to indicate what factors predisposed their response. Questionnaires were completed by 101 district nurses. On average, each nurse made 1.25 visits to HIV-infected patients in the two weeks preceding the study. The nursing activities most commonly carried out for these patients were providing advice/counselling, carer support, general nursing care and specialist treatments. The activities least commonly carried out were technical procedures, tests and assessments. Nurses were most confident in providing a high standard in relation to general nursing care and least confident that high standards were being achieved in providing specialist treatments. The most frequently encountered explanations offered by the district nurses for their lack of confidence in achieving a high standard were a lack of specialist training and a lack of experience with HIV-infected patients.

Experiences of informal carers providing nursing support for disabled dependants.

This paper provides an account of the experience of a group of informal carers who provided nursing support for their physically disabled dependants. The project was designed to establish the extent to which carers are equipped to fulfil their role in terms of equipment, facilities, skills, levels of personal health and the extent of support available to them from agencies outside the home. The carers were found to be providing the majority of nursing support required by their dependants. This mainly involved carrying out tasks of personal care although, for some, more technical procedures were involved. The findings indicate there is scope for professional nurses to make a greater contribution to the support of informal carers, particularly by regular review of the nature and level of assistance which carers provide and by giving training in the skills which carers require.

Differential classification in school refusal.

It has been argued that school refusal may not be a unitary syndrome, but a common presenting symptom founded on differing underlying dynamics. The paper explores this hypothesis empirically. The clinical files of 100 refusers were scored for several variables which could potentially differentiate between school refusal subtypes, and for several commonly accepted beliefs about school refusal. The data were subjected to a variety of analyses, culminating in cluster analysis. Cluster (C) 1 consisted of children who feared separation from dependent, overprotective mothers. C2 youngsters were perfectionistic and depressed. They dominated mothers who had been deprived in childhood. C3 consisted of extensively disturbed children from multiproblem families, who had suffered early separation or loss, and who were fearful and depressed.

Designing simulations and games: a workshop for health care professionals.

This article describes the important elements of a five-day workshop for teaching health care professionals to design and use simulation/gaming activities. Suggested guielines are identified for planning and conducting a workshop. The importance of early planning is emphasized by identifying the specific objectives of the workshop and preparing the staff to facilitate the attainment of each objective. The selection of staff and participants is discussed. A day-to-day description of a typical workshop is presented. Also included is a description of several content presentations which teach the workshop participants the required skills and knowledge in design, selection, research, and evaluation of simulation/gaming activities.