Prevalence of type 2 diabetes mellitus among persons with hepatitis C virus infection in the United States

BACKGROUND: Hepatitis C virus (HCV) infection may contribute to the development of diabetes mellitus. This relationship has not been investigated at the population level, and its biological mechanism remains unknown. OBJECTIVE: To examine the prevalence of type 2 diabetes among persons with HCV infection in a representative sample of the general adult population of the United States. DESIGN: Cross-sectional national survey. SETTING: The Third National Health and Nutrition Examination Survey, 1988-1994. PARTICIPANTS: 9841 persons older than 20 years of age for whom data on HCV infection and diabetes were complete. MEASUREMENTS: The presence of diabetes was ascertained by using American Diabetes Association guidelines based on fasting plasma glucose measurement and medication history. Presence of HCV infection was assessed by testing for serum HCV-specific antibodies (anti-HCV). RESULTS: Of the 9841 persons evaluated, 8.4% had type 2 diabetes and 2.1% were anti-HCV positive. Type 2 diabetes occurred more often in persons who were older, were nonwhite, had a high body mass index, and had low socioeconomic status. Type 2 diabetes was less common in persons who acknowledged previous illicit drug use. After adjustment for these factors, persons 40 years of age or older with HCV infection were more than three times more likely than those without HCV infection to have type 2 diabetes (adjusted odds ratio, 3.77 [95% CI, 1.80 to 7.87]). None of the 19 persons with type 1 diabetes were anti-HCV positive. CONCLUSION: In the United States, type 2 diabetes occurs more often in persons with HCV infection who are older than 40 years of age.     

Epidemiology of obesity in the United States

The challenges of the epidemic are not limited to concerns about bulk and weight. The disabilities caused by obesity are physiologic and psychosocial. The increased waist to hip girth is associated with increased risk of cardiovascular disease, hyperlipidemia, hypertension, and diabetes. Obesity also has been related directly to increased risk of sleep apnea, cancer, gallbladder disease, musculoskeletal disorders, severe pancreatitis, bacterial panniculitis, diverticulitis, infertility, urinary incontinence, and idiopathic intracranial hypertension. The psychosocial factors and quality of life in the obese population also have been documented. Although there is some debate, the obese have been found to be twice as likely to suffer from anxiety, impaired social interaction,and depression when compared with the nonobese population. Although advances in obesity surgery have resulted in long-term, lasting treatment of this disease and some of its comorbidities (ie, diabetes, hypertension, sleep apnea), There is a pressing need to develop a comprehensive medical and nutrition plan to reduce the prevalence of this newly identified disease state. Some draw parallels to tobacco and the morbidity and mortality associated with its use. Perhaps there are similarities in these two epidemics. Both start with education of the population as to the morbidities and mortality associated with the disease. As with tobacco, this education is especially important for youth. Without a plan of education to promote nutrition and increased physical activity, and continued research into the causes of obesity, the prevalence of obesity will continue to rise in the United States.     

社区居住的老年糖尿病患者的营养状态评估

目的本研究拟探索社区居住的老年糖尿病患者的营养状况,并与非糖尿病老年人进行比较。方法纳入2013年至2014年在北京香河园社区居住的老年人820名为研究对象,依据是否患糖尿病分为2组:糖尿病组(n=170)和非糖尿病组(n=650)。该研究由接受过问卷调查培训并通过考核的研究助理在社区卫生服务中心或入户对老年人进行面对面访视。应用老年医学疾病累积评分量表(CIRS-G)进行慢病评分。应用微营养评估简表(MNA-SF)进行营养评估。依据体质量指数(BMI)不同,将糖尿病组患者分为5个亚组,与MNA-SF的营养评估结果进行χ~2分析。采用SPSS 20.0软件进行数据处理。结果 820名研究对象年龄65～97(75.4±6.7)岁,患病数(4.7±3.3)种,其中727名(88.7%)老年人可生活自理,其余可半自理。糖尿病组的CIRS-G评分显著高于非糖尿病组[(6.38±3.67)vs(4.28±3.09)分,P0.001]。糖尿病组和非糖尿病组营养不良(5.9%vs 6.3%)和营养不良风险(48.2%vs 45.8%)的发生率差异均无统计学意义(P0.05)。糖尿病组超重(38.2%vs 34.5%)和肥胖(19.4%vs 13.8%)的发生率均显著高于非糖尿病组(P0.05)。各糖尿病亚组患者营养状态与BMI水平差异无统计学意义(χ~2=10.394,P=0.238)。结论社区糖尿病老年人的营养不良发生率与非糖尿病的老年人无明显不同,约半数糖尿病老年人存在营养不良风险。糖尿病患者营养状态与BMI水平无明显相关性。     

Epidemiology of constipation in the United States

In the present study, the epidemiology of constipation in the United States and an assessment of its impact on national health are presented. This analysis was based on four different surveys,i.e., the National Health Interview Survey, the National Hospital Discharge Survey, the National Ambulatory Medical Care Survey, and the Vital Statistics of the United States. These surveys have estimated that over 4 million people in the United States have frequent constipation, corresponding to a prevalence of about 2 percent. Constipation was the most common digestive complaint in the United States, outnumbering all other chronic digestive conditions. Cathartics and laxatives were prescribed to 2 to 3 million patients yearly by general and family practitioners or internists. In 92,000 annual hospitalizations, constipation was listed among the discharge diagnoses. About 900 persons die annually from diseases associated with or related to constipation. Constipation was three times more common in women than men. It showed a marked increase after the age of 65 years. It appeared to affect nonwhites 1.3 times more frequently than whites. In addition, constipation was more frequent in people living in the South than elsewhere in the United States, and in people from families with low income or brief education of the head of family than in people from families with high income or a high educational level of their family head. These data suggest that there are other factors involved in the cause of constipation in addition to dietary fiber content and psychogenic infljences. The frequent occurrence of constipation and its impact on public health stress the need for further studies devoted to the epidemiology and basic pathophysiology of this condition. Supported by grant So 172/1-1 from the Deutsche Forschungsgemeinschaft.     

Epidemiology of tuberculosis in the United States

After decades of decline, an unprecedented resurgence in tuberculosis occurred in the late 1980s and early 1990s. Deterioration of tuberculosis program infrastructure, the HIV/AIDS epidemic, drug-resistant tuberculosis, and tuberculosis among foreign-born persons contributed to the resurgence. Since then, tuberculosis case numbers have declined, but the decline in 2003 was the smallest since the resurgence. Key challenges remain, and efforts must focus on identifying and targeting interventions for high-risk populations, active involvement in the global effort against tuberculosis, developing new tools, and maintaining adequate resources.     

Lean versus obese diabetes mellitus patients in the United States minority population

ObjectiveTo identify special characteristics in large group of lean diabetes minority patients in comparison to obese type 2 diabetes.Methods1784 lean (BMI < 25) diabetes patients were identified and compared with 8630 obese (BMI ≥ 30) patients. Patients with Type 1 Diabetes (N = 523) were excluded. Patient data, including demographics, psychosocial factors, insulin use, and complications was analyzed.ResultsIn lean compared to obese, there was male predominance (62% vs 48%, p < 0.001), higher prevalence of insulin use (49% vs 44%, p = 0.001), lower TG/HDL (2.28 vs 3.4, p < 0.001), and higher prevalence of alcoholism (5.7% vs 2.4%, p < 0.001) and pancreatitis (3.6% vs 0.9%, p < 0.001). In both groups, African Americans and Latinos were the prevalent ethnicities (38%, 34% vs. 53%,31%).When comparing patients within the lean group who were on insulin (49%) to those on oral medications, there were more males (65% vs. 59%, p < 0.001), earlier age of onset (40 ± 14 vs. 47 ± 12, p < 0.001), lower BMI (22.1 ± 2 vs.22.6 ± 1.7, p < 0.001) and lower TG/HDL (2.18 vs. 2.42, p = 0.021).ConclusionsA subset of diabetes patients in the United States minority population are lean and may have rapid beta cell failure. The etiology is not clear and acquired factors, genetics, and autoimmunity may be contributory.     

Epidemiology of rob beta-lactamase among ampicillin-resistant Haemophilus influenzae isolates in the United States

We surveyed 161 clinical isolates of ampicillin-resistant, beta-lactamase-producing isolates of Haemophilus influenzae obtained between 1975 and 1985 to determine whether they produced TEM-1 or Rob beta-lactamase. Plasmid DNA was obtained from a Rob-producing isolate, F990, and a plasmid (pBR322) known to encode TEM-1. Both plasmids were labeled with 32P and hybridized to whole cell DNA obtained from the clinical isolates. All 161 isolates hybridized with one of the plasmid probes and could be classified as TEM-1- or Rob-producing isolates. Analysis of the distinctive pH profiles of the two beta-lactamases was used to confirm the findings of the DNA hybridization assay. Overall, 13 (8%) isolates obtained from patients in California, North Carolina, Tennessee, Missouri, Louisiana, and Mississippi produced the Rob beta-lactamase. The remaining isolates elaborated the TEM-1 enzyme. We conclude that ampicillin resistance in H. influenzae may be mediated by the production of Rob beta-lactamase and that the occurrence of this enzyme is not limited to the two isolates described to date.     

Quantification of the risk of corticosteroid-induced diabetes mellitus among the elderly

We conducted a population-based cohort study using administrative databases to quantify the association between oral and inhaled corticosteroid use and onset of diabetes mellitus in the elderly. Proton pump inhibitor (PPI) users were used as a control group. Relative to PPI users (N = 53,845), oral corticosteroid users (N = 31,864) were more likely to develop diabetes (adjusted rate ratio [aRR], 2.31; 95% confidence interval [95% CI], 2.11 to 2.54); however, inhaled corticosteroid users (N = 38,441) were not (aRR, 1.03; 95% CI, 0.93 to 1.14). The estimated number needed to harm for continuous use of oral corticosteroids relative to PPIs over 1, 2, and 3 years of use were 41, 23, and 16, respectively.     

Epidemiology of hepatitis B in the United States

Hepatitis B virus (HBV) is transmitted parenterally via infected blood or body fluids, including perinatal exposures. In the United States, the incidence of new HBV infection has decreased since the 1980s, primarily because of prevention programs such as immunization in children. Nonetheless, the prevalence and burden of chronic HBV infection remain substantial, especially among the Asian/Pacific Islander racial group. Public health efforts must continue to control transmission of HBV and minimize its future impact by identifying and providing effective interventions for individuals with chronic infection.     

Oral hypoglycemic agents in the management of non-insulin-dependent diabetes mellitus among the elderly

Management of NIDDM among elderly patients is complex due to existing chronic illnesses. Patient education of the potential side effects and drug interactions with oral hypoglycemic agents, as well as good assessment skills help to prevent complications among the elderly population.     

Epidemiology of malaria among United States government personnel assigned to diplomatic posts

The epidemiology of malaria among U.S. government personnel attached to diplomatic posts has not been reported. We reviewed malaria surveillance reports on persons with onset of symptoms between January 1988 and December 2004. Among 684 slide-proven cases, the median age was 36 years. There were 565 (82.6%) cases of Plasmodium falciparum malaria and 56 (8.2%) of P. vivax malaria. A total of 89.9% were infected in Africa and 5.8% were infected in Asia; 95% of the P. falciparum cases originated in sub-Saharan Africa. One-fourth of all cases were reported in 1990-1991. The average annual incidence (per 1,000 personnel) of Plasmodium between 1995 and 1999 was highest in west Africa (8.96), followed by central Africa (8.08), and east Africa (4.27). No or irregular chemoprophylaxis was reported by 58.5%. Among those who indicated regular prophylaxis, 78% took regimens no longer considered adequate. In sub-Saharan Africa, cases were reported in every month. There were three deaths. Prevention of malaria among U.S. Government employees attached to diplomatic posts should particularly focus on those serving in sub-Saharan Africa and malarious areas of Asia.