A National Survey of the Provision of Sexual Health Clinical Services by Public Health in Canada: First Insights

Objectives: Data documenting the scope of sexual health clinical services offered as public health in Canada are unavailable. This article provides first insights into the scope of STI and clinical sexual health services available nationally. Methods: Data were gathered using an online survey of 113 Canadian public health units. Results: Almost half of the clinics were not providing expedited partner therapy, one third were not providing point of care testing for HIV and one third were not using syndromic management of sexually transmitted infections (STIs). Low rates of physician support were evident. Conclusion: Given the ever-higher rates of STIs, findings from this study identify important challenges to providing comprehensive services.     

糖化血红蛋白、糖化白蛋白及空腹血糖在糖尿病诊断中的价值

目的：评估糖化血红蛋白（HbA1c）、血清糖化白蛋白（Glycated Albumin,GA）及空腹血糖（Fasting Plasma Glucose, FPG）在糖尿病（ Diabetes Mellitus,DM）患者早期诊断中的价值。方法收集2010～2013年浙江省台州医院同时检测HbA1c、GA及FPG的人群的相关数据,分为糖尿病组和非糖尿病组,进行受试者工作特征曲线（ Receiver Operator Character-istic curve,ROC曲线）分析以得出3种指标诊断DM的cut-off值、曲线下面积（ Area Under the Curve,AUC）其灵敏度、特异性,再进一步计算3种指标联合诊断DM的灵敏度及特异性。结果①DM组的HbA1c、GA及FPG均高于非DM 组（ HbA1c：9．14％vs．5．84％, P ＝0．000;GA：24．8mmol/Lvs．13．8mmol/L, P ＝0．000;FPG：9．65mmol/L vs．5．77mmol/L, P ＝0．000）。②HbA1c诊断DM的cut-off值为6．85％,AUC为0．911,灵敏度为84．2％,特异性为96．2％;GA诊断DM的cut-off值为17．5,AUC为0．881,灵敏度为71．6％,特异性为93．6％;FPG诊断DM的cut-off值为7．52mmol/L,AUC为0．836,灵敏度为70．2％,特异性为82．1％。③HbA1c、GA及FPG联合诊断DM的灵敏度及特异性分别为91．1％,76．3％。结论HbA1c、GA及FPG对DM皆有诊断价值,其中HbA1c的诊断DM效能最大。 HbA1c、GA及FPG联合诊断可提高DM诊断的灵敏度,在DM筛查中具有重要价值。     

大鼠胰岛细胞的分离、纯化和培养研究

目的研究Wistar大鼠胰岛细胞分离、纯化和培养的改良方法和条件,为进行细胞电生理实验提供胞膜完整、活性良好的胰岛细胞。方法水合氯醛腹腔麻醉,采用胶原酶ⅴ逆行灌注、原位消化及Ficoll-400梯度离心的方法分离、纯化大鼠胰岛,并分离、培养胰岛单细胞。结果采用该方法分离、纯化胰岛的获得率稳定;急性分离、培养的胰岛细胞12h～24h贴壁,（4～5）d胰岛细胞生长状态最佳,胞膜完整,折光性好。结论逆行灌注、原位消化及Ficoll-400梯度离心为一种有效的分离、纯化胰岛细胞的方法,培养的胰岛细胞（4～5）d达到最佳状态,适合进一步研究的要求。     

Utilizing health ambassadors to improve type 2 diabetes and cardiovascular disease outcomes in Gadsden County,Florida

Minority racial and ethnic groups are at higher risk for developing type 2 diabetes. These groups also experience more severe complications from diabetes and have higher mortality rates as a result of the disease, such as cardiovascular disease, amputation and kidney failure. Underserved rural ethnically disparate populations benefit from health education outreach efforts that are conveyed and translated by specially-trained community health ambassadors. Project H.I.G.H. (Helping Individuals Get Healthy) was developed to target the priority areas of type 2 diabetes and cardiovascular disease. Utilizing trained community health ambassadors, CDC's The Road to Health Toolkit as well as New Beginnings: A Discussion Guide for Living Well with Diabetes was used as a model for a community-based educational program. The overall goal of Project H.I.G.H was to implement and evaluate: (1) a coordinated, behavior-focused, family-centered, community-based educational program and; (2) a client service coordination effort resulting in improved health outcomes (BMI, Glucose Levels, BP) for individuals with type 2 diabetes and cardiovascular disease in Gadsden County, Florida. Overall, Project H.I.G.H. was very successful in its first year at motivating participants to delay or prevent diabetes and/or cardiovascular disease or at the very least to start taking better care of their health.     

Statistical frameworks for setting cutoff points of metabolic syndrome criteria

We propose three statistical frameworks for determining the cutoff points of metabolic syndrome (MetS) criteria, consisting of six components that are the same as in widely used MetS definitions, e.g., the 2004 updated NCEP-ATPIII criteria. Several international organizations have proposed MetS definitions; no literature indicates that any of these definitions is based on statistical frameworks. For all the three frameworks, the cutoff points are set to maximize the observed prevalence rate of stroke and DM. The three frameworks differ in assumptions on the joint distribution of the six components. Using the cohort data from a regional hospital in Taiwan, we illustrate applications of the three frameworks and compare them with the updated NCEP-ATPIII definition and the 2009 consensus definition of IDF and AHA/NHLBI. The performance measure is the odds ratio, the odds of getting stroke or DM within subjects with MetS divided by the analogous odds for subjects without MetS. Our numerical results show that the odds ratios of the three frameworks are higher than those of the updated-NCEP and consensus definitions, showing that the proposed frameworks seem to provide a better association of MetS with stroke and DM.     

Diabetes mellitus in Native Americans: The problem and its implications

Since World War II, diabetes has become one of the most common serious diseases among Native Americans. Rates of diabetes and its complications, which include premature death, renal failure, and limb amputation, are substantially higher among Native Americans than among the US general population, and the frequency of diabetes among Native Americans is increasing. Several potentially modifiable factors, including obesity, dietary composition, and physical inactivity, are thought to be contributing to these high rates. The potential benefit from prevention of diabetes is considerable, and a population-based approach may be the most effective way of achieving sustainable lifestyle changes among Native Americans. Estimation of the social and economic costs of diabetes and assessment of the marginal costs and benefits of various diabetes control measures can support resource allocation decisions aimed at improving the health of Native American people.     

村卫生室公共卫生服务功能弱化的表征及原因——基于南通市H镇的考察

村卫生室是农村三级医疗卫生服务网的最基层组织,在农村医疗卫生工作中承担着重要功能。南通市H镇村卫生室功能的实现情况表明,村卫生室在预防、保健、健康检查、健康教育等方面存在敷衍塞责、流于形式的现象,公共卫生服务功能呈弱化趋势。     

小鼠脂肪细胞糖尿病药物筛选模型的优化及应用

糖尿病已经成为世界范围内危害人类健康的主要疾病之一,对糖尿病的研究和治疗具有重要意义,本文首先建立并优化小鼠脂肪细胞糖尿病药物筛选模型,然后使用临床抗糖尿病药物对该模型进行考察,并对海糖平(H)和杉糖平(S)两种降糖新药进行了筛选。通过Western-blot法检测GLUT4(葡萄糖转运蛋白4)以确定药物的药效。结果表明,用临床抗糖尿病药物考察模型能客观反映该药物药效。在此模型上,对杉糖平和海糖平的各个馏分进行初步筛选,发现两种药物的一些有效成分。     

Diabetes, aging and physical activity

Diabetes mellitus (DM) is a metabolic disease affecting the regulation of insulin and glucose causing a disruption in the normal control of counterregulatory hormones and macronutrients, resulting in blood glucose accumulation. Metabolic deregulation leads to the production of noxious substances that have a particular propensity for damaging vascular and nervous structures. Physiological changes observed with aging are correlated with a concomitant increase in DM and its associated complications. Long-term complications, including peripheral and central neuropathies, micro- and macrovascular damage, retinopathy, and nephropathy are the major causes of mortality in diabetics [cardiovascular disease (CVD) being the primary complication causing death in this population]. All-cause mortality is three to four times greater in the DM population; hence, management of DM is of timely importance, particularly with a projected prevalence increase of 134% within the next 25 years among individuals over the age of 65 years. Exercise modalities, including endurance and resistance training, were employed to improve glycemic/metabolic control and to ameliorate the progression of DM-related complications. Several risk factors, including glucose levels, blood pressure, lipid/cholesterol profile, and BMI, are reportedly improved with these modes of exercise. However, not all studies demonstrate an improvement in risk factors, but consistently note improvement in complications and a reduction of DM incidence. There is convincing evidence that exercise, with or without specific improvements to traditional DM-related risk factors, is an effective therapy for the management of DM.The Canadian Centre for Activity and Aging is affiliated with St. Joseph’s Health Care and The University of Western Ontario, London, Ontario, Canada.     

The Efficacy of Involuntary Treatment in the Community

SUMMARY

Since the passing of the Mental Health Act (1986), Victoria, Australia, has implemented Community Treatment Orders (CTOs) as an alternative to involuntary inpatient admission for patients who are assessed as unable to be treated less restrictively but in an effort to avoid frequent hospital admissions. It is estimated that currently 3,000 people are annually placed on CTOs in this Australian state. The following article will review existing international and national literature on the subject of forms of involuntary treatment in the community before reporting on the findings of a research project that focused on gaining both consumer and service provider perspectives on the efficacy of CTOs. The research method was largely qualitative, involving three focus groups attended by 30 consumers, as well as 18 individual interviews with service providers. The aim of the project was to offer a voice to both consumers and service providers about their experiences and views of current practice and policy implementation in an area that can have a profound effect on the rights of consumers. Findings suggest that CTOs involve complex decision-making that tests professionals' ability to make judgements about legal and clinical processes. Consumers were generally dissatisfied with many aspects of the use of CTOs and both groups tended to view CTOs as stigmatising and disempowering. There were a variety of views expressed about the process of admission, discharge, and community supports. The article concludes by discussing the findings in the context of existing national and international literature and makes a number of recommendations about law reform, and service provision.