An automated telephone nutrition support system for Spanish-speaking patients with diabetes.

In the United States, Spanish-speaking patients with diabetes often receive inadequate dietary counseling. Providing language and culture-concordant dietary counseling on an ongoing basis is critical to diabetes self-care. To determine if automated telephone nutrition support (ATNS) counseling could help patients improve glycemic control by duplicating a successful pilot in Mexico in a Spanish-speaking population in Oakland, California. A prospective randomized open-label trial with blinded endpoint assessment (PROBE) was performed. The participants were seventy-five adult patients with diabetes receiving care at a federally qualified health center in Oakland, California. ATNS, a computerized system that dialed patients on their phones, prompted them in Spanish to enter (via keypad) portions consumed in the prior 24 hours of various cultural-specific dietary items, and then provided dietary feedback based on proportion of high versus low glycemic index foods consumed. The control group received the same ATNS phone calls 14 weeks after enrollment. The primary outcome was hemoglobin A1c % (A1c) 12 weeks following enrollment. Participants had no significant improvement in A1c (-0.3% in the control arm, -0.1% in the intervention arm, P = .41 for any difference) or any secondary parameters. In our study, an ATNS system did not improve diabetes control in a Spanish-speaking population in Oakland.

Differentiating medicinal from illicit use in positive methamphetamine results in a pain population.

In addition to illicit methamphetamine, there are prescription and over-the-counter medications that, if ingested, may yield positive methamphetamine (MAMP) results on laboratory urine drug tests. The purpose of the study is to estimate the prevalence of medicinal and illicit MAMP in the pain population using chiral analysis to determine the relative amounts of the d and l-MAMP enantiomers. This retrospective analysis included the LC-MS/MS results and prescriber provided medication histories of 485,889 de-identified urine specimens from patients treated for pain. Two groups of 100 specimens each were subjected to chiral analysis. Group 1 contained specimens that were MAMP positive and amphetamine negative. Group 2 contained randomly selected MAMP positive specimens. The overall MAMP positivity rate of the 485,889 specimens tested was 1.6%. The prevalence of MAMP medications based on reported medications and detection of l-MAMP in Group 1 and Group 2 was 44% and 6%, respectively. These data indicate that the use of both illicit and medicinal MAMP is found in this patient population, and that medicinal use is underreported in clinical histories. Therefore, clinical laboratories should provide on request chiral analysis to aid in differentiating illicit and medicinal MAMP.

Stability of pain-related medications, metabolites, and illicit substances in urine.

BACKGROUND: Effective urine drug testing requires an understanding of the stability of medications, metabolites and other substances excreted in the urine matrix. When the testing results do not fit the clinical picture, physicians frequently request repeat testing of the original specimen in order to corroborate the results. We determined the stability in urine of various medications, metabolites, and illicit substances commonly requested for testing by physicians treating patients with pain and pain-related disorders. METHODS: Quantitative analyses of urine specimens were performed using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Two replicates at a high and low concentration were analyzed at time 0, and after 2, 3 and 6 months following storage at +4 °C and -20 °C. At each time interval, the percent difference from time 0 for each analyte was calculated and averaged for each storage condition. RESULTS: For the majority of medications, the percent differences were within 20% of the original measurement for all 3 storage conditions. All were within 30% of the original measurement after 2, 3 and 6 months in all storage conditions, except for 7-amino-clonazepam, and carboxy-tetrahydrocannabinol. CONCLUSIONS: The findings from the current study confirm that the majority of medications, metabolites, and illicit substances commonly requested for testing by physicians treating patients with pain and pain-related disorders are stable within 20% of the original concentration when stored refrigerated or frozen for up to 6 months. Thus, delayed testing, repeat testing, and add-on testing of urine specimens can yield reliable results for up to 6 months following the urine collection date.

Illicit drug use correlates with negative urine drug test results for prescribed hydrocodone, oxycodone, and morphine.

BACKGROUND: A number of studies indicate that 10.8%-34% of patients with chronic pain use illicit drugs. One hypothesis for this occurrence is that some patients may be supplementing their prescription medications with illicit drugs. OBJECTIVE: The primary purpose of this retrospective data analysis was to test the hypothesis that people whose urine specimens are positive for the medications that have been listed as being prescribed to them are positive for fewer illicit substances than those whose specimens were negative for their prescribed medications. The secondary purpose of the study was to correlate the use of illicit drugs and the amount of prescribed medications excreted in urine. STUDY DESIGN: A retrospective study of the incidence of patients using illicit drugs versus their consistency with reported medications. METHODS: Using urine specimens from a cohort of nearly 400,000 patients whose identities had been redacted, and who were being treated for chronic pain with opioid therapy, this study was performed to correlate the patients' positivity with their prescribed medication to the prevalence of illicit substance use. A secondary study was conducted to correlate the amount of prescribed medication excreted in urine (measured in ng/mL) with the incidence of illicit drug use. The specific prescription medications analyzed were hydrocodone, morphine, and oxycodone. RESULTS: Specimens defined as negative for prescribed hydrocodone (27.3%), morphine (11.5%) or oxycodone (19%) were more likely to contain illicit drugs than those found to be positive for the prescribed medication. The illicit drug prevalence among the inconsistent specimens was 15.3% for hydrocodone, 23.8% for morphine, and 24.4% for oxycodone. The secondary study showed no statistically significant difference in the excretion level of prescribed medication between those patients using and not using illicit drugs. LIMITATIONS: The study is limited in that no data was obtained to determine the causal relationships of illicit drug use. CONCLUSIONS: This work supports the hypothesis that people who are positive for their prescribed medications use fewer illicit drugs than those who do not take their medications. It may be beneficial for physicians to test more thoroughly for illicit drugs when patients' drug tests are negative for their prescribed medications.

Marfan syndrome.

PURPOSE: To provide an overview of Marfan syndrome (MFS), including diagnostic criteria, genetic factors involved, emerging theories for treatment, a case study, and an overview of genetic counseling for individuals and families of those with MFS. DATA SOURCES: Selected research, review, and clinical articles. CONCLUSIONS: MFS is a connective tissue disorder with distinct physical characteristics. Recent advances in the field of genetics have traced this disease process to certain gene mutations. Affecting the optical, skeletal and cardiovascular systems, MFS can cause significant morbidity and mortality if left untreated. Close surveillance and early treatment are necessary to ensure a normal life span. IMPLICATIONS FOR PRACTICE: It is important for the advanced practice nurse (APN) to be aware of the complications in those with MFS. Attentive surveillance can decrease mortality and morbidity associated with this syndrome. A multidisciplinary approach, utilizing the expertize of the APN, is necessary for comprehensive care.

Adjuvantes: un componente esencial de las vacunas de Neisseria

Adjuvants may be classified into delivery systems and immune potentiator or modulator molecules based on their mechanism of action. Neisseria vaccines containing traditional adjuvants such as aluminium salts have existed for long time, but meningitis caused by Neisseria meningitidis serogroups, particularly serogroup B, continues to be a global health problem. Novel strategies have applied in silico and recombinant technologies to develop universal antigens (e.g. proteins, peptides and plasmid DNA) for vaccines, but these antigens have been shown to be poorly immunogenic even when alum adjuvanted, implying a need for better vaccine design. In this work we review the use of natural, detoxified, or synthetic molecules in combination with antigens to activate the innate immune system and to modulate the adaptive immune responses. In the main, antigenic and imune potentiator signals are delivered using nano-, micro-particles, alum, or emulsions. The importance of interaction between adjuvants and antigens to activate and target dendritic cells, the bridge between the innate and adaptive immune systems, will be discussed. In addition, nasal vaccine strategies based on the development of mucosal adjuvants and Neisseria derivatives to eliminate the pathogen at the site of infection provide promising adjuvants effective not only against respiratory pathogens, but also against pathogens responsible for enteric and sexually transmitted diseases(AU)

Fluid resuscitation in the trauma patient.

Trauma is responsible for 25% of all emergency department visits causing a healthcare burden of more than $400 billion a year. Timely and appropriate fluid resuscitation may mean the difference between survival and death. Controversy surrounds the best method of fluid resuscitation for optimum recovery. This article will evaluate current research regarding the various types of fluid resuscitation in the trauma population. Colloid and crystalloid fluid will be compared describing the risks and benefits of each.

Residents at high altitude show a lower glucose profile than sea-level residents throughout 12-hour blood continuous monitoring.

It is known that residents at high altitude (HA) have a lower basal glycemia than residents at sea level (SL). However, whether such a difference is maintained throughout the full day remains unknown. We compared 12-h blood glucose profiles from 10 healthy males native residents at HA (3250 m) and 8 male residents at SL. Glucose profile at HA was lower throughout the glucose monitoring than that at SL (mean profile: 50.6 +/- 3.7 and 73.4 +/- 4.0 mg/dL, respectively; p < 0.001). Basal and postprandial insulin and triacylglycerol values were similar in both groups. In conclusion, HA natives resident have a lower blood glucose profile than SL residents throughout 12-h continuous monitoring.

Monitoreo continuo de la glicemia en el poblador de los andes / Constant monitoring of the glicemia in the settler of the Andes

Es conocido que el habitante de la altura tiene una glicemia más baja en comparación con el habitante del nivel del mar. Esta diferencia ha sido establecida teniendo en cuenta los valores basales de glicemia. Sin embargo, se desconoce si esta diferencia permanece durante el día. Por lo tanto, el objetivo principal del estudio fue comparar el perfil del monitoreo continuo de glucosa durante 12 horas. El estudio incluyó 10 varones voluntarios del nivel del mar y 10 varones de la altura (3,250 m). La edad promedio fue 24,4 mas menos 1,8 años y 22,2 mas menos 3,2 años, y el índice de masa corporal, 22,8 mas menos 1,2 y 22,9 mas menos 2,6 kg/m², respectivamente. Los sujetos de la altura mostraron una menor glicemia durante las 12 horas de monitoreo en comparación con los del nivel del mar (52,4 mas menos 6,8 mg/dL y 73,0 mas menos 12,6 mg/dL, respectivamente; P menor que 0,001). Los niveles de triglicéridos fueron mayores en el grupo de altura pero no estadísticamente significativos (123 mas menos 53,9 mg/dL y 80,8 mas menos 27,9 mg/dL, respectivamente; P mayor que 0,05) No hubo diferencias en la sensibilidad a la insulina. En conclusión, los sujetos de la altura tuvieron una menor glicemia al menos durante las 12 h de monitoreo continuo.

Dietary intake of children at high risk for cardiovascular disease.

Cardiovascular disease and obesity begin in childhood, and dietary interventions to prevent them should be initiated then. We hypothesized that children who were at high risk for cardiovascular disease based on family history would have diets that were different than those of children from low-risk families. Two hundred ninety-seven children were screened for family history of early cardiovascular disease; had height, weight, and finger-stick total cholesterol measured; and filled out food frequency questionnaires. Sixty-eight (23%) children were at risk for cardiovascular disease. Cholesterol was significantly higher compared with those not at risk (4.71+/-0.93 mmol/L vs 4.35+/-0.92 mmol/L, P=.005). Intakes of energy, fat, fiber, and cholesterol were similar between groups. Children at high risk for cardiovascular disease were no more likely to meet guidelines for heart-healthy diets than were children at low risk. Families need guidance to change dietary patterns to prevent future disease.

Home and eating environments are associated with saturated fat intake in children in rural West Virginia.

OBJECTIVE: To describe sociodemographic, environmental, and knowledge factors in relation to self-reported, energy-adjusted saturated fat consumption among children in rural West Virginia. PARTICIPANTS: Three hundred twenty-five 5th graders who participated in the Coronary Artery Risk Detection in Appalachian Communities Project conducted in 3 rural counties in West Virginia in 1998-1999. METHODS: A cross-sectional survey based on self-reported information collected using a food frequency questionnaire, a nutrition knowledge questionnaire, and a family composition questionnaire. STATISTICAL ANALYSES: Descriptive statistics and multiple linear regression analysis. RESULTS: The mean percentage of energy from total fat was 31.8% +/- 4.9 and from saturated fat was 11.8% +/- 2.3. Energy-adjusted saturated fat intake was significantly higher among children with higher frequencies of breakfast and late-night snacks prepared away from home, and in households with single mothers. Variables associated with higher energy-adjusted saturated fat intake with marginal statistical significance (P=.05-.10) included attendance at schools with a higher percentage of students receiving free or reduced-price lunch, usual breakfast location other than home or school, and less knowledge about low-fat, low-sodium foods. Frequent late-night snacks prepared away from home and living with single mothers remained as significant correlates of energy-adjusted saturated fat intake independent of other hypothesized determinants. CONCLUSION: Efforts to reduce saturated fat intake among children in rural areas should focus on food prepared away from home. Nutrition-related behaviors of single mothers should be explored further.