Background and Purpose-Type 2 diabetes is an established risk factor for stroke, but the relations between asymptomatic hyperglycemia, hyperinsulinemia, and stroke incidence remain uncertain. We have examined the relationship between established diabetes, nonfasting serum glucose and serum insulin concentrations, and subsequent risk of stroke. Methods-We performed a prospective study of 7735 men aged 40 to 59 years drawn from general practices in 24 British towns. Men with missing serum glucose values (nϭ50) and men on insulin injection (nϭ36) were excluded, leaving 7649 men available for analysis. Baseline nonfasting serum was analyzed for insulin with a specific enzyme-linked immunosorbent assay method in 18 of the 24 towns (nϭ5663 men). Results-During the mean follow-up period of 16.8 years, there were 347 stroke cases (fatal and nonfatal) in the 7649 men.Men who developed diabetes during follow-up (nϭ320) and men with established type 2 diabetes at screening (nϭ98) both showed significantly increased risk of stroke, even after adjustment for cardiovascular risk factors, including blood pressure (adjusted relative risk [RR], 2.27; 95% CI, 1.23 to 4.20; RR, 2.07; 95% CI, 1.44 to 2.98, respectively). In men with no diagnosed diabetes at screening (nϭ7551), risk of stroke was increased significantly only in the top 2.5% of the nonfasting glucose distribution (Ն8.2 mmol/L), and this persisted even after adjustment for cardiovascular risk factors, including hypertension (RR, 1.86; 95% CI, 1.11 to 3.13). Exclusion of the 320 men who developed diabetes during follow-up attenuated this risk so that it was no longer significant (RR, 1.56; 95% CI, 0.83 to 2.91). In the 5567 men with insulin measurements and no diagnosis of diabetes at screening, a J-shaped relationship was seen between nonfasting insulin and risk of stroke. Risk was significantly raised in the first quintile and in the fourth quintile and above compared with the second quintile, with all findings of marginal significance. Part of the increased risk at higher levels of insulin was due to men who developed diabetes in the follow-up period. Conclusions-This study confirms the importance of established type 2 diabetes as an independent risk factor for stroke.The increased risk of stroke seen in hyperglycemic subjects and those with elevated serum insulin levels at screening reflected to some extent the high proportion of men who subsequently developed diabetes. (Stroke. 1999;30:1780-1786.)

Four-layer bandaging is currently the most effective method of treating venous leg ulcers in a community setting.

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BackgroundAlcohol misuse is a significant risk factor for both self-harm and suicide, and alcohol is often involved in self-harm acts and present at time of deaths by suicide. This study sought to identify factors associated with alcohol consumption in both non-fatal self-harm presentations and cases of suicide.MethodsThis study included suicides in Cork, Ireland between September 2008 and June 2012 and self-harm presentations from January 2007 to December 2013. 8145 Emergency Department presentations involving self-harm during this period were recorded by the National Registry of Deliberate Self-Harm. Alcohol involvement in self-harm presentations was ascertained from medical notes. 307 cases of suicide during this period were recorded by the Suicide Support and Information System. Alcohol involvement in suicides was ascertained from toxicology results.ResultsAlcohol consumption was evident in 21% of self-harm presentations and in 44% of suicide cases. Univariate analysis indicated that variables associated with having consumed alcohol in a self-harm presentation were: gender, age, method of self-harm, type of aftercare received and timing of the presentation. In a multivariate model, a number of variables remained significant. Self-harm patients who consumed alcohol at time of presentation were more likely to be male (OR = 1.24, 95% CI: 1.10–1.40) and least likely to present with self-cutting (OR = 0.45, 95% CI: 0.38–0.54). Presentations with alcohol involved were less likely to be admitted to a psychiatric ward (OR = 0.60, 95% CI: 0.44–0.81) and less likely to present during the daytime (OR = 0.50, 95% CI: 0.43–0.58), and at the weekend (OR = 1.23, 95% CI: 1.09–1.40). For suicide cases, univariate analyses indicated that the only variable associated with having consumed alcohol was younger age (>65 years = ref: <25 years OR = 8.61, 95% CI: 2.35–31.55; 25–44 years OR = 11.05, 95% CI: 3.16–38.73; 45–64 years OR = 4.23, 95% CI: 1.19–15.09); male gender approached statistical significance (OR = 1.80, 95% CI: 0.98–3.29). All other variables (marital status, living arrangements, suicide note, method of suicide, drugs in toxicology) had no significant association with alcohol consumption among suicides.ConclusionThis study underlines the high frequency of alcohol involvement among those engaging in fatal and non-fatal suicidal behaviour. Alcohol involvement was associated with male gender in both suicides and self-harm presentations. Public health measures to restrict access to alcohol may be used to enhance suicide prevention, given that ecological studies show reduced suicide rates following measures to restrict access to alcohol. Active consultation and collaboration between the mental health services and addiction treatment services should be arranged in the best interests of those who present with dual diagnosis.