Tolerance Data 2011 Greek Free Download 56
Beaulah Mozie
According to Shneidman's theory, mental pain or "psychache", which refers to an endopsychic painful experience consisted of excessively felt negative feelings, is a key component to the understanding of suicidal behaviour, as to its psychological features. Shneidman himself supported that 'suicide is caused by psychache', more precisely suicide occurs when a person can no longer tolerate this pain. Findings of previous studies have shown that mental pain is an independent predictive factor for suicidal behaviour. In the present study we evaluated the psychometric properties of the Greek version of the Mental Pain Scale (MPS) and the Tolerance for Mental Pain Scale (TMPS) ina non clinical sample consisted of 112 participants (73 female and 39 male). Moreover, we explore the relationships between mental pain, depression, and suicide risk and for the first time the effect of the tolerance for mental pain on depression and suicide risk. We hypothesized that both the level of mental pain and the degree of tolerance for mental pain would predict suicide risk, independently of the level of depression. Both MPS and TMPS appear to have satisfactory to high levels of internal consistency, test-retest reliability, and concurrent validity. Suicide risk was correlated to mental pain, tolerance for mental pain, and depression. Multiple regression analysis showed that mental pain and tolerance for mental pain have a significant contribution to suicide risk, independently of depression, confirming our hypothesis.Using an additional multivariate regression with the factors extracted from MPS and TMPS as independent variables, we found that especially 'loss of control' of mental pain and the ability to 'contain the pain' contribute uniquely to suicide risk. Our findings offer support to the hypothesis that mental pain is a clinical entity distinct from depression with a specific and important contribution to the suicide risk.Depression alone is not enough to cause suicide. The mental pain construct, although related to depression,could shed light on the comprehension of the human experience that leads to suicide. Relieving mental pain may constitute a distinct and important treatment goal, along with the remission of depression and despair, so that the person can maintain control and contain all the distressing events that comprise the painful experience. Both MPS and TMPS appear to be valid and reliable tools for the assessment of mental pain and its tolerance, respectively. They could also be employed in further investigation on the role of specific aspects of the mental pain experience in suicidal behaviours.
Objective: The conventional approach to analyzing data from oral glucose tolerance testing (OGTT) requires model identification in each individual separately (standard two stage, STS), ignoring knowledge about the population as a whole. In practice, however, the OGTT is sparsely sampled and individual estimates are often not resolvable from available data. This weakness is often encountered in large scale trials or epidemiological studies, leading to either multiple imputations or simply much less data available for analysis.
Methods: We have applied a population approach, nonlinear mixed effects modeling, to plasma glucose, insulin and C-peptide data obtained from a 120 minute OGTT undertaken by 106 subjects with varying glucose tolerance. This method provides estimates of population means, variances and covariances of model parameters and empirical Bayes estimates of individual parameter values, as well as measures of intra-individual (within-subject) and inter-individual (between-subject) variability. The recently developed oral glucose minimal model was used to evaluate insulin sensitivity, and a combined model approach was used to assess β-cell secretion.
The current practice in following TDT patients above the age of 10 years, is to screen annually for glucose disturbances with main objectives the early diagnosis and treatment of disturbances. The screening strategy for abnormalities of glucose metabolism in TDT patients varies widely as regard to the methods, the age of starting and the intervals between screening. The most commonly used methods for screening are the random plasma glucose (RPG), fasting plasma glucose (FPG), 2hours post-prandial glucose (2h- PG), and 2 hours oral glucose tolerance test (OGTT) (6). There are also wide variations for the age of starting screening as well for the rate of testing recommended by international and national committees. In an ICET-A report, a table summarizing the recommendations of the most active relative committees is included (7). However, in clinical practice this is not rare. None of the committees, recommends (even optional) glucose tolerance (GT) combined with insulin response (IRsp) during OGTT.
The study was designed to evaluate if there are advantages of combined assessment of glucose tolerance and insulin response during OGTT in screening TDT patients for early diagnosis and management of disturbances of glucose metabolism.
In all patients the glucose tolerance (GT) and insulin response (IRsp) were simultaneously assessed during OGTT. The patients received 1.75 g/kg /BW (maximum dose 75g) of 33 % concentration of glucose after an overnight fast. Venous blood samples for glucose and insulin determination were obtained right after oral glucose consumption and at intervals of 30 minutes up to 2 hours. Plasma glucose and insulin were assessed by routine laboratory methods; the glucose oxidase method for plasma glucose and radioimmunoassay commercially available kits, for plasma insulin.
The analytical data (mean + SD) of glucose tolerance during OGTT in 43 patients are summarized in table 2, and illustrated in figure 1, while the relative data on insulin response (secretion) are presented in table 3 and figure 2.
The most interesting finding in this series of young patients with thalassemia is the wide changes in the pattern of insulin secretion in the group of patients with normal glucose tolerance. Only 9 (29 %) had normal insulin secretion pattern, while 14 (45 %) had high insulin secretion (hyper- secretion) and 8 (26 %) had delayed peak insulin secretion (response) pattern. On the other hand none of the patients with impaired or diabetic glucose tolerance had normal or increased insulin secretion; the majority of patients (8/9) with impaired glucose tolerance and 2/3 with diabetic glucose tolerance had delayed peak insulin response with a peak insulin level above 30μU/ml, at 90 minutes. Only one patient from each of the last two groups had low insulin secretion with insulin peak levels below 30 μU/ml (hypoinsulinemia) (Table 3, figure 2).
In contrast, data on disturbances in insulin secretion during OGTT analyzing the patterns of insulin response in TDT patients, to our knowledge are limited. Most data reported on disturbances of insulin secretion concern studies with Intravenous Glucose Tolerance Test (IVGTT) on normal individuals.
Intravenous glucose tolerance and plasma insulin response studied in 27 children with TM less than 11 years of age and 10 health controls of comparable age showed: i) no differences in fasting plasma glucose and insulin levels between the two groups. ii) Differences were found at 10 and 20 minutes of intravenous glucose administration both in glucose levels (considerably higher) and insulin levels (considerably lower) in thalassemic children. iii) Evidence of depression of pancreatic function was found in 6 of 27 thalassemic children(14). In contrast in another study on insulin resistance and β-cell function in 36 chronically transfused children aged 8-15 years no disturbances were found (15). This may be due to mild clinical phenotypes of patients as well as to differences in transfusions rate and in the annual consumption of blood.
In an interesting study, Glucose, Insulin and C peptide levels during OGTT were assessed in 36 thalassemic patients (22 with NGT, 6 with IGT and 7 with diabetic GT) and 32 healthy controls. During OGTT, patients with IGT presented with hyperinsulenemia and delayed peak insulin. The C-peptide/insulin ratio was reduced in patients with impaired glucose tolerance compared to controls. Insulin sensitivity was significantly reduced in patients with impaired or diabetic glucose tolerance compared to healthy controls (17).
The results of our study, clearly demonstrated that in the group of 43 TDT children and young people aged 12-20 years (except of three older patients) with a moderate degree of iron over load (ferritin ranging between 1,000- 3,000 ng/ml) and BMI within normal range for age and sex, the prevalence of patients with NGT was 72 % (31/43), with IGT 21 % (9/43) and with diabetic GT 7 % (3/43). More interesting were the findings of insulin response (secretion) during OGGT and especially among the 31 patients with normal glucose tolerance. In this group only 9 (29 %) patients had normal insulin levels while in the remaining, insulin secretion was impaired; 14 patients had hyper secretion of insulin (insulin resistance), 8 had delayed peak insulin but no one had deficient insulin secretion (hypoinsulinemia). In contrast none of the patients with impaired and diabetic glucose tolerance, had normal or high insulin secretion. All patients with IGT had delayed peak insulin response (with insulin levels above 35 μU/ml) except one with deficient insulin response (hypoinsulinemia).
The data obtained from the evaluation of glucose tolerance and insulin response during OGTT are of great importance since these data, combined with our clinical experience in managing patients with thalassemia and glucose disturbances, can assist in guiding therapeutic interventions. More precisely, based on these results, we suggest that patients with delayed insulin response and especially those with high secretion of insulin and normoglycemia, would benefit from diet and exercise alone as a measure to delay the development of irregularities in glucose metabolism. On the contrary, those with impaired or diabetic GT and delayed peak insulin would benefit more from the administration of oral hypoglycemics, in addition to diet and exercise. In our experience, in these patients oral hypoglycemics postponed development of insulin dependent diabetes for many years (19).
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