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  • 1
    ISSN: 1432-1041
    Keywords: Key words Drug utilization ; Aspirin ; Paracetamol ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Abstract Objective: Antipyretic/analgesic drugs (AADs) are among the most commonly used drugs in children. Their efficacy and adverse effects have often been debated and new AADs have been introduced over the past few years. The aim of this study was to assess the characteristics of the use of AADs in children in France, and their trends. Methods: Two surveys on household health care consumption were undertaken in France, in 1981 and in 1992. They included 5060 and 4841 children, respectively. The AADs studied were aspirin, paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs). Results: The proportion of children exposed to AADs increased significantly between 1981 and 1992 (+28% in 11 years). Among them, the percentage of subjects treated with aspirin decreased (−27%). In contrast, the percentage increased for paracetamol (+19%) and for NSAIDs (+179%). Aspirin was the AAD most used in 1981 (57.4%) and it was replaced by paracetamol in 1992 (71.6%). Nasopharyngitis was the main reason for AAD prescription under the age of 11 years; for older children it was influenza-like syndrome, irrespective of the study year. A change in AAD choice occurred in nasopharyngitis, acute bronchitis and influenza-like syndrome irrespective of the age group, and in otitis/sinusitis between 4 and 10 years. In all these cases aspirin prescription decreased, in contrast with paracetamol and NSAIDs. Self-medication of AAD was uncommon (8.3% for aspirin and 10.3% for paracetamol in 1992) and decreased (−29% and −33%). It was used principally for nasopharyngitis, influenza-like syndrome and pain. Conclusion: The consumption of AADs in children is high and is increasing. Paracetamol and NSAIDs tend to replace aspirin prescription in children and physicians have played the main role in this change.
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  • 2
    ISSN: 1432-0428
    Keywords: Impaired glucose tolerance ; natural history ; plasma glucose concentration ; Nauru
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A longitudinal study of 266 randomly selected non-diabetic Nauruans (215 normal subjects, 51 with impaired glucose tolerance) has permitted the natural history of impaired glucose tolerance to be studied in this Micronesian population. Nauruans are known to suffer from a very high prevalence of abnormal glucose tolerance. The subjects were first examined in 1975–1976, and a follow-up examination was performed in 1982. Of the subjects with impaired glucose tolerance, 26% developed diabetes during the study period (4% per annum) compared with 7% of normal subjects (1% per annum). After controlling for the effects of both age and obesity, the risk of subsequent diabetes for subjects with impaired glucose tolerance remained significantly higher than for normal subjects (odds ratio 3.6, 95% confidence interval 1.4–9.1). Of those with impaired glucose tolerance on initial examination, 39% were normoglycaemic at follow-up. In subjects with impaired glucose tolerance, of nine factors examined only plasma glucose concentration at the time of the initial examination was consistent in predicting progression to diabetes, when the data were examined by both univariate and multivariate methods. Both 2-h and fasting plasma glucose values were useful predictors. Thus, Nauruans with impaired glucose tolerance have a higher risk of subsequent diabetes than their normoglycaemic counterparts, after controlling for age and obesity. Nevertheless, the prognosis of impaired glucose tolerance is unpredictable as a substantial proportion of such subjects return to normality. Plasma glucose concentration is the most important predictor of subsequent diabetes. These results accord with recent findings from longitudinal studies of impaired glucose tolerance in other populations.
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  • 3
    ISSN: 1432-0428
    Keywords: Keywords Non-insulin-dependent diabetes mellitus ; impaired glucose tolerance ; non-esterified fatty acids ; insulin resistance ; insulin secretion ; epidemiology.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Although an increased plasma non-esterified fatty acid (NEFA) concentration has been shown to increase insulin resistance (Randle cycle), decrease insulin secretion and increase hepatic gluconeogenesis, the effect of NEFA on the deterioration of glucose tolerance has not been studied prospectively in Caucasian subjects. Therefore, we investigated whether plasma NEFA may be regarded as predictors of deterioration of glucose tolerance in subjects with normal (NGT, n = 3671) or impaired (IGT, n = 418) glucose tolerance who were participants in the Paris Prospective study. The subjects were first examined between 1967 and 1972 and underwent two 75-g oral glucose tolerance tests 2 years apart with measurements of plasma glucose, insulin and NEFA concentrations. Glucose tolerance deteriorated from NGT to IGT or non-insulin-dependent diabetes (NIDDM) in 177 subjects and from IGT to NIDDM in 32 subjects. In multivariate analysis, high fasting plasma NEFA in NGT subjects and high 2-h plasma NEFA and low 2-h plasma insulin concentrations in IGT subjects were significant independent predictors of deterioration along with older age, high fasting and 2-h plasma glucose concentrations and high iliac to thigh ratio. When subjects were divided by tertiles of plasma NEFA concentration at baseline, there was an increase in 2-h glucose concentration with increasing NEFA in the subjects who did not deteriorate, but no effect of plasma NEFA in those who deteriorated. In subjects with IGT who deteriorated compared with those who did not 2-h plasma insulin concentration was lower but there was no evidence that this resulted from an effect of plasma NEFA. Our data suggest that a high plasma NEFA concentration is a risk marker for deterioration of glucose tolerance independent of the insulin resistance or the insulin secretion defect that characterize subjects at risk for NIDDM. [Diabetologia (1997) 40: 1101–1106]
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  • 4
    ISSN: 1432-0428
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 5
    ISSN: 1432-0428
    Keywords: Keywords Diabetes mellitus ; impaired glucose tolerance ; prevalence ; 75-g oral glucose tolerance test ; Cameroon ; Africans ; rural ; urban.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The adoption of Western lifestyles is known to lead to increasing prevalence of non-insulin-dependent diabetes mellitus in Africa, yet epidemiological studies using standardised methods are rare. The prevalence of diabetes and impaired glucose tolerance was determined in a rural and an urban community in Cameroon using the 75-g oral glucose tolerance test and the World Health Organization diagnostic criteria in 719 rural (292 men, 427 women) and 1048 urban (458 men, 590 women) subjects aged 24–74 years. The response rate was 95 and 91 % for the rural and urban population, respectively. The age-standardized prevalence of diabetes in the rural and urban population was respectively 0.9 % (95 % confidence interval (0.2–2.7)) and 0.8 % (0.2–1.8) for men and 0.5 % (0.1–1.6) and 1.6 % (0.7–3.1) for women, and that of impaired glucose tolerance was 5.8 % (3.3–9.4) and 1.8 % (0.9–3.2) for men, and for women, 2.2 % (1.0–4.0) and 2.0 % (0.6–4.5). Although for both men and women the body mass index was higher at all ages in the urban than in the rural area, the 2-h plasma glucose, even after adjustment for age and body mass index, was significantly higher in the rural than in the urban area (p 〈 0.005, p 〈 0.002 for men and women, respectively). There was a female excess of diabetes in the urban area and an equal sex distribution in the rural area. In the rural area 67 % (4 of 6) of diabetic subjects were unknown before the survey, compared with 57 % (8 of 14) in the urban area. These data indicate a low prevalence of diabetes in Cameroon; however, the prevalence of impaired glucose tolerance suggests an early stage of a diabetes epidemic. [Diabetologia (1997) 40: 824–829]
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  • 6
    ISSN: 1432-0428
    Keywords: Keywords Revision ; diagnostic criteria ; diabetes ; screening ; fasting glucose ; 2-h oral glucose tolerance test.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Aims/hypothesis. The American Diabetes Association recommended that only a single fasting plasma glucose of greater than or equal to 7.0 mmol/l should be used for diagnosing diabetes in epidemiological studies and did not recommend using a 2-h oral glucose tolerance test. We evaluated the effect of diagnostic changes on the prevalence of diabetes and on the choice of subjects diagnosed with diabetes. Methods. Existing epidemiological data collected from Asian people between 30 and 89 years of age, was re-analysed separately in 11 population-based studies (n = 17 666), 6 pre-selected hyperglycaemic cohorts (n = 12 221) and one suspected diabetic cohort (n = 8 382). Results. Among the 11 population-based studies, the new fasting glucose criteria resulted in an overall reduction of 1.8 % in the prevalence of diabetes, which ranged from a reduction of 4.8 % to an increase of 1.7 % in the different studies. Of 1215 subjects diagnosed with diabetes by either criteria, only 449 met both criteria, a concordance of 37 %. More than half of the diabetic subjects had isolated post-challenge hyperglycaemia and three quarters of the subjects with impaired glucose tolerance, according to the 2-h glucose criteria, were normal according to the fasting glucose criteria. Subjects diagnosed as diabetic based only on the 2-h glucose criteria were, on average, older than those with diabetes according to the fasting criteria. Conclusion/interpretation. The fasting and the 2-h glucose criteria diagnose different groups of subjects. It would therefore be inappropriate to use the fasting glucose criteria alone for screening diabetes in Asian populations. [Diabetologia (2000) 43: 1470–1475]
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  • 7
    ISSN: 1432-0428
    Keywords: Alcohol drinking ; cardiovascular diseases ; cirrhosis ; Type 2 (non-insulin-dependent) diabetes mellitus ; glucose tolerance test ; insulin resistance ; mortality
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The aim of this study was to compare the causes of death and parameters related to alcohol consumption, between subjects diagnosed as diabetic, clinically by their general practitioner, or glucose intolerant and in particular as diabetic, using the epidemiological criteria of an abnormal glucose level following an oral glucose tolerance test. The subjects in this study were 7035 working men, aged between 44 and 55 years, who attended the first follow-up examination of the Paris Prospective Study, between 1968 and 1973. They were classified as ‘clinically diagnosed diabetic’ or, following an oral glucose tolerance test and the World Health Organisation criteria, as having ‘oral glucose tolerance test diagnosed diabetes’, impaired glucose tolerance or normoglycaemia. The relative risk of death by cirrhosis, in comparison with the normoglycaemic group, was 21 (95 % confidence interval: 9.1–49) in the group diagnosed diabetic by the oral glucose tolerance test, significantly different (p 〈 0.02) from the group diagnosed diabetic clinically 3.1 (0.41–24); factors indicative of excessive alcohol consumption at baseline differed accordingly. In contrast, the relative risks for death by coronary heart disease were similar, 2.1 (1.0–4.1) and 2.7 (1.4–5.4) respectively; all of the factors defining the insulin resistance ‘Syndrome X’ (hyperglycaemia, hyperinsulinaemia, hypertension, hyperlipidaemia and also central obesity) and predictive of coronary heart disease were elevated in both groups of diabetic subjects. ‘Diabetes’, as diagnosed by the oral glucose tolerance test, might be the consequence of excessive alcohol consumption which could lead to insulin resistance, then to coronary heart disease, as well as to alcohol-related diseases.
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