Objective: To modify a validated questionnaire to prospectively identify individuals at increased risk for undiagnosed diabetes. Research Design and Methods: Each subject was asked to answer the ADA Diabetes Risk Test (ADADRT). The total score was tabulated to know if the patient was at increased risk or not for developing diabetes. All subjects submitted venous blood samples for a fasting blood sugar (FBS) determination. The ADADRT total scores were compared with the FBS values using chi square (chi2) tests and likelihood ratios (LR). The ADADRT of the study population was modified using the new Asian BMI. Scores were recomputed and compared with FBS using the same statistical measure. The ADADRT and the Modified Diabetes Risk Test (MDRT) were compared to determine if they were statistically different using Fisher's exact test and which one would have a better sensitivity, specificity and positive predictive value. The study population in the First Phase of the study included patients in a primary care clinic in a tertiary hospital, the Second Phase was the validation in a rural community and the Third Phase was the actual implementation of the validated screening tool among patients seen in a primary care clinic in a community set-up. Results: In a representative sample of USTH patients (Phase 1), the sensitivity of the ADADRT was 41 percent, the specificity was 89 percent, x2 was at 10.59 which was significant at P> 0.05; likelihood ratio for a positive test LR (+) computed was 3.72; Likelihood ratio for negative test LR (-) computed was 0.66. In the same representative sample, the sensitivity of the MDRT was 81 percent, the specificity was 92 percent, x2 was 32.2 which was significant at P>0.05; LR (+) was 10.125 and the LR (-) was 0.21. Computed Fisher's exact test was 0.387, which was significant at P>0.05. In Phase II, ADADRT sensitivity was 64 percent, specificity was 83 percent LR (+) 3.11 and LR (-) 0.19 whereas the MDRT sensitivity was 86 percent, specificity was 72 percent, LR (+) 3.73 and LR (-) 0.43 and f-test 0.0063. In Phase III, the MDRT identified 18 as high risk where only 15 had elevated FBS. Conclusion: The modified ADA Risk Test using the new Asian BMI performed significantly better than the existing ADADRT and should serve as a simple, noninvasive and potentially cost-effective add-on screening tool for detecting those at increased risk for diabetes mellitus type 2 in the local setting.
Human ; Male ; Female ; DIABETES MELLITUS, TYPE 2

OBJECTIVES: To determine the effectiveness of visual cues/prompts to promote On-the-job physical activities. DESIGN: Cross-over experimental design, using On-the-Job Physical Activity Questionnaire. SETTING: A four-storey building of a government corporation. PATIENTS: Responses of 289 randomly selected government employees who hold office in the fourth floor were deemed evaluable out of 561 (52 percent, response rate). INTERVENTIONS: The control and experimental groups baseline on-the-job physical activity were measured and compared to their post-intervention physical activity. For Phase 1, after a one-week waiting period, a "walk" sign and a "stair" sign visual prompt were placed in the corridors and elevator entrances of the employees in their building for two weeks for the intervention group whereas the control had none. A one-week wash-out period was made. Then, phase 2 commenced with the visual prompts now placed in the building of the previous control group, and the previous experimental group now had no prompts (the cross-over). MAIN OUTCOME MEASURES: Comparison of the baseline physical activity with the post-interventional activity using the Chi-square goodness of Fit Test. RESULTS: The post-intervention group showed improved walking and use of stairs in their time on-the-job spent. CONCLUSION: Visual prompts promote the use of walking and climbing stairs among government workers in their office in a corporate setting.
WALKING, ; WORKPLACE ; EXERCISE

Human ; Male ; Female ; Aged 80 and over ; Aged ; Ambulatory Care ; Caregivers ; Family ; Patient care ; quality of life

Human ; Male ; Middle Aged ; Abdominal Pain ; diagnosis ; Fibrosis ; Carcinoma, Hepatocellular

Objective: The mandible is the most common fractured craniofacial bone of all craniofacial fractures in the Philippines, with the mandibular body as the most involved segment of all mandibular fractures. To the best of our knowledge, there are no existing guidelines for the diagnosis and management of mandibular body fractures in particular. General guidelines include the American Academy of Otolaryngology – Head and Neck Surgery Foundation (AAOHNSF) Resident Manual of Trauma to the Face, Head, and Neck chapter on Mandibular Trauma, the American Association of Oral and Maxillofacial Surgeons (AAOMS) Clinical Practice Guidelines for Oral and Maxillofacial Surgery section on the Mandibular Angle, Body, and Ramus, and a 2013 Cochrane Systematic Review on interventions for the management of mandibular fractures. On the other hand, a very specific Clinical Practice Guideline on the Management of Unilateral Condylar Fracture of the Mandible was published by the Ministry of Health Malaysia in 2005. Addressing the prevalence of mandibular body fractures, and dearth of specific guidelines for its diagnosis and management, this clinical practice guideline focuses on the management of isolated mandibular body fractures in adults. Purpose: This guideline is meant for all clinicians (otolaryngologists – head and neck surgeons, as well as primary care and specialist physicians, nurses and nurse practitioners, midwives and community health workers, dentists, and emergency first-responders) who may provide care to adults aged 18 years and above that may present with an acute history and physical and/or laboratory examination findings that may lead to a diagnosis of isolated mandibular body fracture and its subsequent medical and surgical management, including health promotion and disease prevention. It is applicable in any setting (including urban and rural primary-care, community centers, treatment units, hospital emergency rooms, operating rooms) in which adults with isolated mandibular body fractures would be identified, diagnosed, or managed. Outcomes are functional resolution of isolated mandibular body fractures; achieving premorbid form; avoiding use of context-inappropriate diagnostics and therapeutics; minimizing use of ineffective interventions; avoiding co-morbid infections, conditions, complications and adverse events; minimizing cost; maximizing health-related quality of life of individuals with isolated mandibular body fracture; increasing patient satisfaction; and preventing recurrence in patients and occurrence in others. Action Statements The guideline development group made strong recommendationsfor the following key action statements: (6) pain management- clinicians should routinely evaluate pain in patients with isolated mandibular body fractures using a numerical rating scale (NRS) or visual analog scale (VAS); analgesics should be routinely offered to patients with a numerical rating pain scale score or VAS of at least 4/10 (paracetamol and a mild opioid with or without an adjuvant analgesic) until the numerical rating pain scale score or VAS is 3/10 at most; (7) antibiotics- prophylactic antibiotics should be given to adult patients with isolated mandibular body fractures with concomitant mucosal or skin opening with or without direct visualization of bone fragments; penicillin is the drug of choice while clindamycin may be used as an alternative; and (14) prevention- clinicians should advocate for compliance with road traffic safety laws (speed limit, anti-drunk driving, seatbelt and helmet use) for the prevention of motor vehicle, cycling and pedestrian accidents and maxillofacial injuries.The guideline development group made recommendations for the following key action statements: (1) history, clinical presentation, and diagnosis - clinicians should consider a presumptive diagnosis of mandibular fracture in adults presenting with a history of traumatic injury to the jaw plus a positive tongue blade test, and any of the following: malocclusion, trismus, tenderness on jaw closure and broken tooth; (2) panoramic x-ray - clinicians may request for panoramic x-ray as the initial imaging tool in evaluating patients with a presumptive clinical diagnosis; (3) radiographs - where panoramic radiography is not available, clinicians may recommend plain mandibular radiography; (4) computed tomography - if available, non-contrast facial CT Scan may be obtained; (5) immobilization - fractures should be temporarily immobilized/splinted with a figure-of-eight bandage until definitive surgical management can be performed or while initiating transport during emergency situations; (8) anesthesia - nasotracheal intubation is the preferred route of anesthesia; in the presence of contraindications, submental intubation or tracheostomy may be performed; (9) observation - with a soft diet may serve as management for favorable isolated nondisplaced and nonmobile mandibular body fractures with unchanged pre - traumatic occlusion; (10) closed reduction - with immobilization by maxillomandibular fixation for 4-6 weeks may be considered for minimally displaced favorable isolated mandibular body fractures with stable dentition, good nutrition and willingness to comply with post-procedure care that may affect oral hygiene, diet modifications, appearance, oral health and functional concerns (eating, swallowing and speech); (11) open reduction with transosseous wiring - with MMF is an option for isolated displaced unfavorable and unstable mandibular body fracture patients who cannot afford or avail of titanium plates; (12) open reduction with titanium plates - ORIF using titanium plates and screws should be performed in isolated displaced unfavorable and unstable mandibular body fracture; (13) maxillomandibular fixation - intraoperative MMF may not be routinely needed prior to reduction and internal fixation; and (15) promotion - clinicians should play a positive role in the prevention of interpersonal and collective violence as well as the settings in which violence occurs in order to avoid injuries in general and mandibular fractures in particular.
Mandibular Fractures ; Jaw Fractures ; Classification ; History ; Diagnosis ; Diagnostic Imaging ; Therapeutics ; Diet Therapy ; Drug Therapy ; Rehabilitation ; General Surgery