Search

Vanuatu is a South Pacific island nation with limited resources and dispersed communities. Healthcare provision and population health data is lacking; and women have been an historically undervalued, underserved group. This needs assessment was completed by mothers in the area surrounding a health clinic in Vanuatu to better inform the clinic’s service expansion. In a period of six weeks, 60 parous women, between 17 and 66 years old, were interviewed in their native language (Bislama). Participants provided verbal responses to 29 questions targeting family health needs and pregnancy experiences. The questionnaire was constructed from WHO and UNICEF surveys. Descriptive statistics were calculated. Primary care complaints were the most common health concerns reported by participants. Few women (43.3%, 26/60) knew what a sexually transmitted infection was, and 38.3% (23/60) knew a place offering HIV testing. Thirty percent (18/60) never had a pelvic exam. During their last pregnancies, 98.3% (59/60) received prenatal care with a median of five visits and variable health education. Injectable (65.2%, 15/23) and oral contraception (21.7%, 5/23) were the most utilized family planning methods; one person used condoms (4.3%, 1/23). Eighty-seven percent (52/60) felt unsafe walking through their neighborhoods at night. General knowledge and utilization of women’s health resources were limited in this group. The community-based primary care setting could be an important site for future provision of women’s health services. Future studies and interventions in family planning, sexual health, and prenatal care could aid this community.

The determinants of type 2 diabetes (T2D) remission and/or relapse after gastric bypass (RYGB) remain fully unknown. This study characterized β- and α-cell function, in cretin hormone release and insulin sensitivity in individuals with (remitters) or without (non-remitters) diabetes remission after RYGB.This is a cross-sectional study of two distinct cohorts of individuals with or without diabetes remission at least 2 years after RYGB. Each individual underwent-either an oral glucose (remitters) or a mixed meal (non-remitters) test; glucose, proinsulin, insulin, C-peptide, glucagon, incretins and leptin were measured.Compared to remitters (n = 23), non-remitters (n = 31) were older (mean [±SD] age 56.1 ± 8.2 vs. 46.0 ± 8.9 years, P 0.001), had longer diabetes duration (13.1 ± 10.1 vs. 2.2 ± 2.4 years, P 0.001), were further out from the surgery (5.6 ± 3.3 vs. 3.5 ± 1.7 years, P 0.01), were more insulin resistant (HOMA-IR 4.01 ± 3.65 vs. 2.08 ± 1.22, P 0.001), but did not differ for body weight. As predicted, remitters had higher β-cell glucose sensitivity (1.95 ± 1.23 vs. 0.86 ± 0.55 pmol/kg/min/mmol, P 0.001) and disposition index (1.55 ± 1.75 vs 0.33 ± 0.27, P = 0.003), compared to non-remitters, who showed non-suppressibility of glucagon during the oral challenge (time × group P = 0.001). Higher proinsulin (16.55 ± 10.45 vs. 6.62 ± 3.50 PM, P 0.0001), and proinsulin: C-peptide (40.83 ± 29.43 vs. 17.13 ± 7.16, P 0.001) were strongly associated with non-remission status, while differences in incretins between remitters and non-remitters were minimal.Individual without diabetes remission after gastric bypass have poorer β-cell response and lesser suppression of glucagon to an oral challenge; body weight and incretins differ minimally according to remission status.背景: 目前尚未完全明确2型糖尿病(T2D)患者接受胃旁路术(RYGB)后病情缓解或复发的决定因素。这项研究描述了RYGB术后糖尿病缓解或未缓解个体的β-与α-细胞功能、肠促胰岛素激素释放及胰岛素敏感性。 方法: 这是一项横断面研究, 对RYGB术后至少2年后糖尿病缓解或未缓解的不同队列个体进行了研究。每个个体均进行口服葡萄糖(缓解者)或者混合餐(非缓解者)耐量试验；测量血糖、胰岛素原、胰岛素、C肽、胰高血糖素、肠促胰岛素以及瘦素水平。 结果: 与缓解者(n=23)相比, 未缓解者(n=31)年龄更大(平均[±SD]年龄56.1±8.2 vs. 46.0±8.9岁, P0.001)、糖尿病病程更长(13.1±10.1 vs. 2.2±2.4年, P0.001)、距离手术时间更长(5.6±3.3 vs. 3.5±1.7年, P0.01)、胰岛素抵抗更严重(HOMA-IR为4.01±3.65 vs. 2.08±1.22, P0.001), 但体重无差异。正如预期, 与未缓解者相比, 缓解者具有较高的β细胞葡萄糖敏感性(1.95±1.23 vs. 0.86±0.55 pmol/kg/min/mmol, P0.001)以及处置指数(1.55±1.75 vs. 0.33±0.27, P=0.003), 后者在口服耐量试验期间的胰高血糖素水平并未受到抑制(时间×分组, P=0.001)。较高水平的胰岛素原(16.55±10.45 vs. 6.62±3.50PM, P0.0001)以及胰岛素原:C肽比值(40.83±29.43与17.13±7.16, P0.001)与未缓解状态密切相关, 但是缓解者与未缓解者之间的肠促胰岛素差异非常小。 结论: 胃旁路术后糖尿病无缓解的个体对口服耐量试验中β细胞的应答较差, 对胰高血糖素的抑制也较小；根据糖尿病缓解状态进行分组, 发现体重与肠促胰岛素的差异非常小。.

Vanuatu is a South Pacific island nation with limited resources and dispersed communities. Healthcare provision and population health data is lacking; and women have been an historically undervalued, underserved group. This needs assessment was completed by mothers in the area surrounding a health clinic in Vanuatu to better inform the clinic's service expansion.In a period of six weeks, 60 parous women, between 17 and 66 years old, were interviewed in their native language (Bislama). Participants provided verbal responses to 29 questions targeting family health needs and pregnancy experiences. The questionnaire was constructed from WHO and UNICEF surveys. Descriptive statistics were calculated.Primary care complaints were the most common health concerns reported by participants. Few women (43.3%, 26/60) knew what a sexually transmitted infection was, and 38.3% (23/60) knew a place offering HIV testing. Thirty percent (18/60) never had a pelvic exam. During their last pregnancies, 98.3% (59/60) received prenatal care with a median of five visits and variable health education. Injectable (65.2%, 15/23) and oral contraception (21.7%, 5/23) were the most utilized family planning methods; one person used condoms (4.3%, 1/23). Eighty-seven percent (52/60) felt unsafe walking through their neighborhoods at night.General knowledge and utilization of women's health resources were limited in this group. The community-based primary care setting could be an important site for future provision of women's health services. Future studies and interventions in family planning, sexual health, and prenatal care could aid this community.