State of the art: understanding and integration of the social context in diabetes care.

We review the past 25 years of research addressing challenges people living with diabetes experience in their daily lives related to social contexts, i.e. in their family, at work and in society at large, and identify research gaps. We found that young people with diabetes, as they develop through to adulthood, are exposed to considerable risks to their physical and mental health. Family-system interventions have had mixed outcomes. Research in this area would benefit from attention to ethnic/cultural diversity, and involving fathers and other family members. In adults with diabetes, social support relates to better diabetes outcomes. While family member involvement in care is likely to affect health and psychosocial outcomes of the person with diabetes, key elements and mediators of effective family interventions need to be identified. The challenges of diabetes management at work are under-researched; distress and intentional hyperglycaemia are common. When depression is comorbid with diabetes, there are increased work-related risks, e.g. unemployment, sickness absence and reduced income. Research to support people with diabetes at work should involve colleagues and employers to raise awareness and create supportive environments. Stigma and discrimination have been found to be more common than previously acknowledged, affecting self-care, well-being and access to health services. Guidance on stigma-reducing choice of language has been published recently. Resilience, defined as successful adaptation to adversity such as stigma and discrimination, requires studies relevant to the specific challenges of diabetes, whether at diagnosis or subsequently. The importance of the social context for living well with diabetes is now fully recognized, but understanding of many of the challenges, whether at home or work, is still limited, with much work needed to develop successful interventions.

A cross-over experiment to investigate possible mechanisms for lower BMIs in people who habitually eat breakfast.

BACKGROUND/OBJECTIVES: The body mass index (BMI) of breakfast eaters is frequently reported to be lower compared with that of breakfast skippers. This is not explained by differences in energy intakes, indicating there may be other mechanisms serving to drive this paradoxical association between breakfast and BMI. This study aimed to investigate the effect of eating breakfast versus morning fasting on measures predominantly of metabolism in lean and overweight participants who habitually eat or skip breakfast. SUBJECTS/METHODS: Participants (n=37) were recruited into four groups on the basis of BMI (lean and overweight) and breakfast habit (breakfast eater and breakfast skipper). Participants were randomly assigned to a breakfast experimental condition, breakfast eating or no breakfast, for 7 days and then completed the alternative condition. At the end of each breakfast experimental condition, measurements were made before and after a high carbohydrate breakfast of 2274 ± 777 kJ or a rest period. Resting metabolic rate, thermic effect of food (TEF), blood glucose, insulin and leptin levels were recorded. Hunger and 'morningness' were assessed and pedometers worn. RESULTS: Lean participants had lower fasting insulin levels (P=0.045) and higher insulin concentrations following breakfast (P=0.001). BMI and breakfast habit did not interact with the experimental breakfast condition, with the exception of hunger ratings; breakfast eaters were hungrier in the mornings compared with breakfast skippers in the no breakfast condition (P=0.001). CONCLUSIONS: There is little evidence from this study for a metabolic-based mechanism to explain lower BMIs in breakfast eaters.

An explanation for enhanced perceptions of attractiveness after alcohol consumption.

Acute alcohol consumption increases ratings of attractiveness to faces. This may help to explain increased frequencies of sexual encounters during periods of alcohol intoxication. At least in part, such increased attraction may be the result of alcohol consumption decreasing ability to detect bilateral asymmetry, presumably because of the reductions in the levels of visual function. We tested the hypotheses that acute alcohol consumption decreases ability to detect asymmetry in faces and reduces preference for symmetrical faces over asymmetrical faces. Twenty images of a pair of faces and then 20 images of a single face were displayed on a computer, one at a time. Participants were instructed to state which face of each of the face pairs displayed was most attractive and then whether the single face being displayed was symmetrical or not. Data were collected near campus bars at Roehampton University. Sixty-four self-selecting students who undertook the study were classified as either sober (control) or intoxicated with alcohol. For each face pair or single face displayed, participant response was recorded and details of the alcohol consumption of participants that day were also obtained. Sober participants had a greater preference for symmetrical faces and were better at detecting whether a face was symmetrical or otherwise, supporting the hypotheses. A further, unexpected finding was that males made fewer mistakes than did females when determining whether individual faces were asymmetrical. The reduced ability of inebriated people to perceive asymmetry may be an important mechanism underlying the higher ratings of facial attractiveness they give for members of the opposite sex and hence their increased frequency of mate choice.

Self help programme for anxiety in general practice: controlled trial of an anxiety management booklet.

Behavioural methods of treating anxiety have been shown to be highly effective but are not widely available in general practice where most people suffering from anxiety are treated. This study reports a development in service delivery which is simple, inexpensive and does not make great time demands on general practitioners or require them to extend their training and expertise. The study shows that for patients suffering from panic disorder or generalized anxiety disorder the use of an anxiety management booklet in addition to their usual treatment from their general practitioner produces clinically and statistically significant improvements. Of particular importance is the speed of response to the booklet. Within the first two weeks those patients who received the booklet were significantly less anxious than the controls. The booklet was acceptable to patients and recommendations are made about how to incorporate it into clinical practice.

Additional conclusions on diazepam injectable precipitate: GC-MS confirmation.

The precipitate which forms upon dilution of diazepam injection with aqueous vehicles is shown conclusively to be diazepam and not benzoates. The results are based on GC-MS analysis of the precipitate as compared with a synthetic mixture of benzoic acid-diazepam.