Twice-Daily vs 4-Times-Daily Glucose Testing in Women With Gestational Diabetes Mellitus: A Pilot Study.

OBJECTIVES: In women with gestational diabetes mellitus (GDM), glycemic control is typically assessed by capillary blood glucose (BG) self-monitoring. Currently, the standard method of monitoring is by 4-times-daily self-measurements. The goal of our study was to determine whether twice-daily capillary BG testing is comparable with 4-times-daily testing in women with GDM. METHODS: Thirty-two women with GDM completed initial dietary counselling and recorded consecutive fasting and 2-h postprandial BG over a 14-day period. We randomly selected 2 of 4 BG measurements on each given day and compared mean (95% confidence interval [CI]) twice-daily vs 4-times-daily BG measurements using paired t tests and Bland-Altman plots. The proportion of 14-day BG measurements above glycemic targets was also compared between twice-daily vs 4-times-daily testing for fasting and postprandial readings. RESULTS: Comparing twice-daily vs 4-times-daily mean BG, there was a small difference for fasting BG (0.09 mmol/L; 95% CI, 0.03 to 0.14), but not for 2-h postbreakfast (-0.05 mmol/L; 95% CI, -0.17 to 0.06), 2-h postlunch (-0.03 mmol/L; 95% CI, -0.13 to 0.08) or 2-h postdinner (0.05 mmol/L; 95% CI, -0.09 to 0.19) BG. Bland-Altman plots showed general agreement and minimal bias between twice-daily vs 4-times-daily BG, whether fasting or postprandial. There was no significant difference in the proportion of 14-day BG measurements above glycemic targets comparing twice-daily vs 4-times-daily testing in the fasting or postprandial states. CONCLUSIONS: Twice-daily BG testing appears to generate 14-day average values similar to 4-times-daily BG testing. In women with GDM, whose BG is in target range, twice-daily BG monitoring may reduce inconvenience and cost.

Gemfibrozil disrupts the metabolism of circulating lipids in bobwhite quails.

The circulating lipids of birds play essential roles for egg production and as an energy source for flight and thermogenesis. How lipid-lowering pharmaceuticals geared to prevent heart disease in humans and that are routinely released in the environment affect their metabolism is unknown. This study assesses the impact of the popular drug gemfibrozil (GEM) on the plasma phospholipids (PL), neutral lipids (NL), and nonesterified fatty acids (NEFA) of bobwhite quails (Colinus virginianus). Results show that bird lipoproteins are rapidly altered by GEM, even at environmentally-relevant doses. After 4 days of exposure, pharmacological amounts cause an 83% increase in circulating PL levels, a major decrease in average lipoprotein size measured as a 56% drop in the NL/PL ratio, and important changes in the fatty acid composition of PL and NEFA (increases in fatty acid unsaturation). The levels of PL carrying all individual fatty acids except arachidonate are strongly stimulated. The large decrease in bird lipoprotein size may reflect the effects seen in humans: lowering of LDL that can cause atherosclerosis and stimulation of HDL that promote cholesterol disposal. Lower (environmental) doses of GEM cause a reduction of %palmitate in all the plasma lipid fractions of quails, but particularly in the core triacylglycerol of lipoproteins (NL). No changes in mRNA levels of bird peroxisome proliferator-activated receptor (PPAR) could be demonstrated. The disrupting effects of GEM on circulating lipids reported here suggest that the pervasive presence of this drug in the environment could jeopardize reproduction and migratory behaviours in wild birds.

Informational needs of gynecologic cancer survivors.

OBJECTIVES: In preparation for the launch of a gynecologic oncology survivorship program, this study looked at the informational needs of women with gynecologic cancers. Although studies have touched on some of these needs, no published literature has investigated the comprehensive informational needs of gynecologic oncology patients within all sites of gynecologic cancers. METHODS: A needs assessment, consisting of a self-administered questionnaire, was conducted at an ambulatory gynecologic oncology clinic from August 2010 to March 2011. This study investigated the informational needs of patients, including the importance of information, the amount desired, and the preferred mode of delivery. Informational needs were grouped into six domains: medical, practical, physical, emotional, social, and spiritual. RESULTS: 185 surveys were analyzed and the majority of the respondents were Caucasian (77%) and over the age of 50 (66%). Forty-nine percent of respondents were diagnosed with ovarian cancer, and there was an even distribution between newly diagnosed patients (38%), those in long-term follow-up (27%), and those with recurrent disease (37%). Overall, respondents placed more importance on receiving medical information (P<0.01). The three preferred education modalities were; pamphlets, one-on-one discussions with health care professionals and websites. Age, education, and disease site were associated with differing informational needs. CONCLUSIONS: This study has highlighted the most important informational needs of patients with gynecologic malignancies in our patient population. This information may guide the development of clinical survivorship programs and educational resources for patients in the future.

Virtual reality induces dissociation and lowers sense of presence in objective reality.

This study utilizes an innovative experimental paradigm to investigate the effects of virtual reality (VR) on dissociative experience and the sense of presence. A nonclinical sample of 30 people were administered measures of dissociation, sense of presence, and immersion before and after an immersion in a virtual environment. Results indicate an increase in dissociative experience (depersonalization and derealization), including a lessened sense of presence in objective reality as the result of exposure to VR. Higher preexisting levels of dissociation and a tendency to become more easily absorbed or immersed were associated with higher increases in dissociative symptoms resulting from VR immersion. Results are discussed in terms of imaginative processes underlying the dissociative experience and potential implications to the treatment of anxiety disorders with VR.

Cognitive mechanisms underlying virtual reality exposure.

Many studies have assessed virtual reality exposures efficacy, but very few examined its treatment processes. The addition of objective measures of arousal and information processing mechanisms would be a valuable contribution in order to provide a more complete and detailed picture. The goal of this study was to better document the cognitive mechanisms associated with therapeutic change after an in virtuo exposure treatment. Twenty-eight adults suffering from arachnophobia were assessed and received an exposure-based treatment using virtual reality. General outcome and specific processes measures included a battery of standardized questionnaires, a pictorial emotional Stroop task, a Behavioral Avoidance Test, and a measure of participants' cardiac response while they looked at a live tarantula. The analyses showed that changes in perceived self-efficacy and dysfunctional beliefs were the best predictors of change in general outcome and cardiac response; change in dysfunctional beliefs were the best predictor of change in behavioral avoidance. These innovative results provide a very detailed and organized picture of the complex cognitive mechanisms involved in therapeutic change following in virtuo exposure for arachnophobia.

Effectiveness of virtual reality exposure in the treatment of arachnophobia using 3D games.

Buying or creating a virtual reality (VR) software is very costly. A less expensive alternative could be to modify already existing 3D computer games. The goal of this study is to assess the effectiveness of in virtuo exposure in the treatment of arachnophobia using modified 3D games. Participants were 10 women and 1 man. Virtual worlds were created using the game editor of a 3D computer game (Half-Life), modified to offer graduals hierarchies of fearful stimuli (spiders). Analyses revealed significant improvement between pre and post results on the behavioral avoidance test, the Spider Beliefs Questionnaire, and perceived self-efficacy. These promising results suggest that therapy using virtual reality exposure via a modified computer game is useful in the treatment of arachnophobia.

Documenting the efficacy of virtual reality exposure with psychophysiological and information processing measures.

Many outcome studies have been conducted to assess the efficacy of virtual reality in the treatment of specific phobias. However, most studies used self-report data. The addition of objective measures of arousal and information processing mechanisms would be a valuable contribution in order to validate the usefulness of virtual reality in the treatment of anxiety disorders. The goal of this study was to document the impact of virtual reality exposure (VRE) on cardiac response and automatic processing of threatening stimuli. Twenty-eight adults suffering from arachnophobia were assessed and received an exposure-based treatment using virtual reality. General outcome and specific processes measures included a battery of standardized questionnaires, a pictorial emotional Stroop task, a behavioral avoidance test and a measure of participants' inter-beat intervals (IBI) while they were looking at a live tarantula. Assessment was conducted before and after treatment. Repeated measures ANOVAs revealed that therapy had a positive impact on questionnaire data, as well as on the behavioral avoidance test. Analyses made on the pictorial Stroop task showed that information processing of spider-related stimuli changed after treatment, which also indicates therapeutic success. Psychophysiological data also showed a positive change after treatment, suggesting a decrease in anxiety. In sum, VRE led to significant therapeutic improvements on objective measures as well as on self-report instruments.