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Women With Gestational Diabetes During Pregnancy Have A Substantial And Persistently Elevated Risk Of Type 2 Diabetes Post-Birth
Women who develop gestational diabetes (GD) during pregnancy have a seven-and-a-half times increased risk of developing type 2 diabetes post-birth, which lasts throughout their lifetime. However, there is no agreed policy on the long-term follow up of these women and many do not return for the currently recommended 6-week post-birth diabetes check. An Article in this week"s diabetes special issue of The Lancet says that the strength of the association suggests that both disorders have an overlapping cause-and this should act as an incentive for women to attend the recommended post-birth check. This attendance could be an opportunity to provide advice on diet and exercise, and treatments to delay or prevent onset of diabetes-as well as alerting these women to symptoms of future diabetes, and to alert general practitioners responsible for their long-term care.
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'Past Time' To Denounce Tiller Murder, Violence Perpetrated By Some Antiabortion Advocates, Opinion Piece Says
In the wake of the shooting death of Kansas abortion provider George Tiller, columnist Ellen Goodman writes in the Boston Globe that she "can"t help wondering whether rhetoric can justify a crime in the mind of a fanatic." She continues, "Can"t words provide the sort of perverse moral platform that jihadists stand on and the alternate universe in which a "lone nut" can find a home?" Goodman writes that she does not blame Tiller"s death on "everyone who checks a pro-life box on the pollster"s chart," but it is "well past time for the antiabortion movement to denounce those who are in the profession of inflaming passions."Tiller "was a doctor of last resort for many women, especially those women for whom the sonogram did not bring joy but tragic tidings," Goodman writes, adding, "He refused to be cowed. At the very least, he should be buried with truth." In his recent commencement address at the University of Notre Dame, President Obama asked, "As citizens of a vibrant and varied democracy, how do we engage in vigorous debate? How does each of us remain firm in our principles, and fight for what we consider right, without demonizing those with just as strongly held convictions on the other side?" Goodman writes, "One way is for those who truly "denounce the murder" to take on the chorus, the back-up singers, who still provide the doo-wop for the next deranged soloist." She concludes, "You see, this suspect was not such a lone gunman. And no, I am afraid, this was not an isolated incident" (Goodman, Boston Globe, 6/5).
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Many U.S. Hospitals Fail To Report Physician Disciplinary Cases To National Databank
Many U.S. hospitals do not take sufficient disciplinary action against physicians for poor conduct or medical incompetence and fail to report such cases to the National Practitioner Data Bank, according to a report released Wednesday by Public Citizen, the Contra Costa Times reports. Congress established the databank in 1990 as a central repository for information about physicians whose hospital privileges had been withdrawn or limited for more than 30 days. The bank is closed to the public (Kleffman, Contra Costa Times, 5/27).For the report, Public Citizen"s Health Research Group analyzed studies by the HHS Office of Inspector General and the Citizen Advocacy Center, as well as medical journal articles and recommendations made during an October 1996 meeting on under-reporting by hospitals (Stark/Hallihan, ABCNews.com, 5/27). According to the report, nearly half of U.S. hospitals did not submit one physician"s name in 17 years to the databank. One purpose of the databank is to provide hospitals with background information about physicians they were considering hiring at their facilities. Under the initial expectations of the databank, federal officials estimated that at least 5,000 disciplinary cases would be reported annually. However, on average, about 650 reports have been made annually since the databank was created, the report found (Contra Costa Times, 5/27). The group on Wednesday sent a letter to HHS Secretary Kathleen Sebelius that included recommendations to improve the efficacy of the databank. The letter said that the reporting numbers are "unreasonably low, compared with what would be expected if hospitals pursued disciplinary actions aggressively and reported all such actions." The letter urged Sebelius to ensure that hospitals are conducting necessary peer reviews and oversight of physicians, taking proper disciplinary actions and reporting them to the databank so that physicians" track records are available to all hospital administrators. Penalties also should be established for hospitals that fail to comply with the reporting requirements, the group said.Al Levine, the author of the report, said some hospitals had found ways to avoid their physician reporting responsibilities, such as by limiting restrictions on hospital privileges to fewer than 30 days or giving physicians a "leave of absence" in place of suspending their privileges. Levine said, "Even in states with high levels of reporting," it "seems to be concentrated in a few facilities" (Contra Costa Times, 5/27).In a statement responding to the report, the American Hospital Association said, "The premise that the number of reports received by the National Practitioner Data Bank correlates to jeopardized patient care is inaccurate," adding, "Hospitals are actively involved in a wide variety of efforts to continuously improve care and talk publicly about the care we provide" (ABCNews.com, 5/27).
Endocrinology

Salmonella's Sweet Tooth Predicts Its Downfall

For the first time UK scientists have shown what the food poisoning bug Salmonella feeds on to survive as it causes infection: glucose. Their discovery of Salmonella"s weakness for sugar could provide a new way to vaccinate against it. The discovery could also lead to vaccine strains to protect against other disease-causing bacteria, including superbugs. "This is the first time that anyone has identified the nutrients that sustain Salmonella while it is infecting a host"s body," says Dr Arthur Thompson from the Institute of Food Research. The nutrition of bacteria during infection is an emerging science. This is one of the first major breakthroughs, achieved in collaboration with Dr. Gary Rowley at the University of East Anglia. Salmonella food poisoning causes infection in around 20 million people worldwide each year and is responsible for about 200,000 human deaths. It also infects farm animals and attaches to salad vegetables. During infection, Salmonella bacteria are engulfed by immune cells designed to kill them. But instead the bacteria multiply. Salmonella must acquire nutrients to replicate. The scientists focused on glycolysis, the process by which sugars are broken down to create chemical energy. They constructed Salmonella mutants unable to transport glucose into the immune cells they occupy and unable to use glucose as food. These mutant strains lost their ability to replicate within immune cells, rendering them harmless "Our experiments showed that glucose is the major sugar used by Salmonella during infection," said Dr Thompson. The mutant strains still stimulate the immune system, and the scientists have filed patents on them which could be used to develop vaccines to protect people and animals against poisoning by fully virulent Salmonella. Glycolysis occurs in most organisms including other bacteria that occupy host cells. Disrupting how the bacteria metabolise glucose could therefore be used to create vaccine strains for other pathogenic bacteria, including superbugs. The harmless strains could also be used as vaccine vectors. For example, the flu gene could be expressed within the harmless Salmonella strain and safely delivered to the immune system. The next stage of the research will be to test whether the mutants elicit a protective immune response in mice. In Germany the nutrition of bacteria is the subject of a six-year priority programme of research to investigate why bacteria are able to multiply inside a host"s body to cause disease. The IFR is an institute of the Biotechnology and Biological Sciences Research Council (BBSRC). This research was funded by a Core Strategic Grant from BBSRC. Andrew Chapple Norwich BioScience Institutes


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