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This chapter follows the work of Mary Simkhovitch, a key figure in settlement houses in New York, but also a major proponent of the notion of municipalisation, a concept developed in Germany that advocated the transferal to city ownership of previously private, corporate assets. Simkhovitch was part of a group of Americans who were strongly influenced by ideas regarding social welfare that developed in Germany at the end of the 19th Century. She sought to implement these ideas in New York by establishing the Greenwich House settlement and then serving as its headworker for 44 years. During this period, she engaged in efforts to regulate industries through the National Consumers League, spearheaded tenement reform and the creation of public housing in New York, and played a key role in efforts to expand green spaces and recreational opportunities for children, adolescents, and adults in the city.

Objective: Euglycemic diabetic ketoacidosis (DKA) is a known potential complication from sodium-glucose cotransporter 2 (SGLT2) inhibitor use. We present a unique case presentation of a 44-year-old, male patient on an SGLT2 inhibitor who developed euglycemic DKA while following a carbohydrate-restricted diet, the Atkins diet.Methods: The patient was on sitagliptin and metformin after a hemoglobin A1c result of 9.3% (78 mmol/mol). Motivated to obtain better glycemic control and weight loss, he started on the Atkins diet, but stayed in the carbohydrate-restricted first phase of the diet. Canagliflozin was added to his regimen 1 month later. Three to four days after starting on the medication, he developed severe abdominal pain.Results: The patient was found to have anion gap metabolic acidosis with an elevated beta-hydroxybutyrate level of 75.50 mg/dL (the reference range is 0.20 to 2.80 mg/dL) and a blood glucose value of 180 mg/dL.Conclusion: The low-carbohydrate diet likely predisposed our patient to a ketogenic metabolic state and the addition of canagliflozin likely precipitated the worsening of his ketosis and subsequent DKA. For patients taking SGLT2 inhibitors, carbohydrate-restricted diet plans may increase the risk of developing euglycemic DKA.Abbreviations: DKA diabetic ketoacidosis SGLT2 sodium-glucose cotransporter 2

Both interpretive and positivist research were a daily part of early work by social workers in settlement houses of the US Social Workers from 1902 to 1922 at Greenwich House, a settlement house (neighborhood center) founded on the west side of Greenwich Village, New York City in 1902, involved themselves in diverse investigative methods. As this analysis reveals, Greenwich House workers pursued case studies of families, residential blocks, neighborhoods, and workplaces; ethnographic depictions of an alley and a garment workers’ strike; participant-observation of tenement households, small businesses, street life, and urban factories; and social surveys on the sanitary conditions and degree of housing congestion in the neighborhoods surrounding Greenwich House.

Introduction Given the increasing prevalence of diabetes mellitus, trainees should have a strong foundation in the management of diabetes. Published literature on the knowledge base and comfort level of medical trainees in diabetes care describes varying levels of exposure to diabetes management in both inpatient and outpatient settings. Methods This eight-module curriculum provides a foundation in the diagnosis, evaluation, and management of diabetes mellitus in the adult patient, as well as pharmacological treatment, patient education, and complications. Specifically, the modules consist of an introduction to diabetes, diagnosis and glycemic goals, patient education, basic nutrition, noninsulin therapies, insulin therapies, complications of diabetes, and financial considerations and cost. Each is a stand-alone presentation that may be viewed nonsequentially. We estimate each module taking 15 to 30 minutes to read. Students received a postsurvey. Results We received responses from 23 (18%) of the total eligible residents over the course of 3 years. Approximately 50% of respondents completed an endocrinology elective as either a medical student or first-year resident. Overall, the majority of respondents felt that the modules had the correct amount of content, the online format was adequate, their understanding of diabetes was enhanced, and the curriculum led to altering their care. Discussion This resource is unique to MedEdPORTAL as it includes basic information on diabetes education and medical-nutritional therapy. We have required completion of these modules by our internal medicine residents since the class that enrolled in 2013. The curriculum is directed towards incoming first-year internal medicine residents but may also be used by trainees in other primary care fields.

AIM To examine the epidemic of diabetes mellitus (DM) and its impact on mortality from all-cause and cardiovascular disease (CVD), and to test the effect of antidiabetic therapy on the mortality in United States adults. METHODS The analysis included a randomized population sample of 272149 subjects ages ≥ 18 years who participated in the National Health Interview Surveys (NHIS) in 2000-2009. Chronic conditions (hypertension, DM and CVD) were classified by participants’ self-reports of physician diagnosis. NHIS-Mortality Linked Files, and NHIS-Medical Expenditure Panel Survey Linkage Files on prescribed medicines for patients with DM were used to test the research questions. χ2, Poisson and Cox’s regression models were applied in data analysis. RESULTS Of all participants, 22305 (8.2%) had DM. The prevalence of DM significantly increased from 2000 to 2009 in all age groups (P < 0.001). Within an average 7.39 (SD = 3) years of follow-up, male DM patients had 1.56 times higher risk of death from all-cause (HR = 1.56, 95%CI: 1.49-1.64), 1.72 times higher from heart disease [1.72 (1.53-1.93)], 1.48 times higher from cerebrovascular disease [1.48 (1.18-1.85)], and 1.67 times higher from CVD [1.67 (1.51-1.86)] than subjects without DM, respectively. Similar results were observed in females. In males, 10% of DM patients did not use any antidiabetic medications, 38.1% used antidiabetic monotherapy, and 51.9% used ≥ 2 antidiabetic medications. These corresponding values were 10.3%, 40.4% and 49.4% in females. A significant protective effect of metformin monotherapy or combination therapy (except for insulin) on all-cause mortality and a protective but non-significant effect on CVD mortality were observed. CONCLUSION This is the first study using data from multiple linkage files to confirm a significant increased prevalence of DM in the last decade in the United States. Patients with DM have significantly higher risk of death from all-cause and CVD than those without DM. Antidiabetic mediations, specifically for metformin use, show a protective effect against all-cause and CVD mortalities.

Objective: We assessed the hypothesis that metformin use significantly decreases risk of all-cause and heart disease (HD) mortality in patients with diabetes mellitus (DM). Methods: Subjects with DM aged ≥30 (n=3612) participating in 1999 -2010 National Health and Nutrition Examination Surveys, who had anti-DM drug therapy information, and were followed up by December 2011 were analyzed. Baseline DM, coronary heart disease (CHD) and heart failure (HF) were defined as a physician-diagnosis of the disease(s). Death from HD was classified using ICD10:I20-I25). Results: Mean (SD) age of 3612 participants was 63.1 (13.02), 83.4% (3056/3612) were under anti-DM therapies, and 20.3% was in metformin monotherapy, 4.9% in metformin combination (MCO), 24.8% in insulin, 45.4% in thiazolidinedione, sulfonylurea, and combinations, and 4.7% in any other antidiabetic drugs therapies. Baseline CHD and HF rates were 11.38% and 9.13%. At the end of follow-up, 1024 died from all-cause (21.86%), and 222 died from HD. Multivariate Cox’s proportional hazard regression analysis indicated that diabetic patients with comorbid HD (CHD and/or HF) had significant higher all-cause mortality than those without. However, these excess mortalities were significantly reduced in patients with metformin therapies than their counterparts without metformin. The hazard ratios (HR, 95%CI) of metformin use versus those without for all-cause mortality was 0.53 (0.38-0.76, p=0.001). Diabetic patients with CHD and with metformin therapies had a significantly lower 10-year all-cause mortality than those without metformin (33% vs. 64%, p In conclusion , metformin significantly increased survival rates from all-cause mortality in diabetic patients with comorbid CHD and/or HF. The mortality risk reduction may be partially explained by an effect of metformin on a reduction of dyslipidemia and insulin resistance.

Objective: We describe a young patient who had hyperglycemia as a sign of pheochromocytoma. He had been diagnosed with type 1 diabetes, but insulin was ultimately discontinued. We also examine the impact of metyrosine on glucose levels during the perioperative period of adrenalectomy.Methods: We present a case report with clinical, imaging, and laboratory findings and provide a brief review of the literature.Results: A 31-year-old man presented with uncontrolled hypertension. His urinary metanephrine levels were very high (metanephrine 51,460 μg/24 hours; normetanephrine 17,666 μg/24 hours). Magnetic resonance imaging revealed bilateral enlarged adrenal glands (left 6.5 × 6.0 × 5.7 cm; right 8.3 × 8.4 × 7.9 cm) and he was diagnosed with pheochromocytoma. In preparation for bilateral adrenalectomy, his blood pressure was controlled with phenoxybenzamine and metyrosine. Glucose levels and exogenous insulin declined with metyrosine therapy. The patient was determined to have multiple endocrine neoplasia type 2A syndrome. He had been misdiagnosed with type 1 diabetes mellitus with negative anti–glutamic acid decarboxylase 65.Conclusion: Excess catecholamine production can lead to hyperglycemia, which may be reduced with use of metyrosine. During the pre-operative preparation, glucose and insulin requirements should be carefully monitored to reduce the risk of hypoglycemia before and after pheochromocytoma resection.Abbreviation: MEN2A = multiple endocrine neoplasia type 2A

Management of patients with diabetes mellitus and chronic kidney disease (CKD) is a challenging task because multiple factors in each condition may impact the other. Glycemic control offers significant benefits in the prevention of diabetic kidney disease (DKD), but other associated morbidities are also important to address. Patients with diabetes with insufficient glycemic and blood pressure control are at a high risk for developing both cardiovascular disease and progression of nephropathy. This article discusses proper screening, identification, and management in the different stages of DKD, with special considerations for dialysis and transplant patients. We also review information on altered metabolism of medications and the appropriate use of diabetic agents, including recommendations for management of glucose control in CKD.

Summary Objective: To evaluate and compare glucose variability, hypoglycaemic events and daily glycaemic control in well-controlled (HbA1c ≤ 7%), type 1 diabetic patients treated with either continuous subcutaneous insulin infusion (CSII) using lispro or multiple daily insulin injection (MDI) using glargine once daily and lispro with meals. Research design and methods: A total of 16 patients with type 1 diabetes receiving treatment with either CSII (eight patients) or MDI (eight patients), all with HbA1c levels

Manual methods of blood glucose monitoring are labor-intensive, costly, prone to error, and expose the caregiver to blood. The VIA(R) blood chemistry monitor for glucose can automatically measure plasma glucose (PG) every 5 minutes for 72 hours using blood sampled from a peripheral vein/artery or a central vein.VIA performance was evaluated in eight normal and five type 1 diabetic (T1DM) subjects in 15 separate experiments. The VIA device was connected to a peripheral vein and reported a PG value every 5 minutes during each 510-minute experiment. Blood samples were collected manually every 10 minutes and assayed using a HemoCue(R) beta-glucose analyzer (HC). Whole blood HC measurements were corrected to PG values. Paired HC/VIA measurements (n = 717) were analyzed.Mean PG was 90 +/- 14 and 96 +/- 12 mg/dl in normal subjects and 194 +/- 64 and 173 +/- 48 mg/dl in T1DM subject as measured by the HC and VIA, respectively. Clark error grid analysis revealed 86% points in zone A, 11% points in zone B, and 2% points in zone D. Linear regression analysis yielded the following equation: VIA = 0.732 x HC + 30.5 (r(2) = 0.954). Residual analysis revealed a glucose-dependent bias between the HC and the VIA. VIA data were transformed using the linear regression equation to correct for bias. After the correction, the mean absolute relative difference between the VIA and the HC was less than 10%, and 99.6% of data were in zones A and B. The VIA was able to sample blood automatically every 5 minutes for more than 8 hours in the laboratory setting. On average, the VIA reported glucose values for 94% of the samples it attempted to obtain.This study demonstrated that the VIA blood chemistry monitor for glucose can reliably sample blood frequently for a prolonged period of time safely and effectively in diabetic and nondiabetic volunteers. Agreement between the two devices was the closest at normal glucose concentrations. After correcting for a glucose-dependent bias between the devices, the MARD was consistently less than 10% for all glucose ranges.

There has been substantial growth in the variety of available antidiabetic agents during the last decade and a half. The role of these newer agents in patients with diabetes and end-stage renal disease (ESRD) population, and their relative benefits and risks in this population compared to patients without ESRD are not yet clear. This stems from the altered state of glucose homeostasis in ESRD, which places patients at high risk for hypoglycemia and, in certain situations, hyperglycemia. In addition, there is a dearth of evidence to support a benefit of tight glycemic control on either micro- or macrovascular outcomes in ESRD patients; furthermore, the metrics by which glycemic control is conventionally measured are less valid in ESRD. In this review, we will discuss noninsulin and insulin-based therapies as well as unique challenges, contraindications, advantages, and disadvantages to their use in ESRD. We will also review issues pertinent to both hemodialysis (HD) and peritoneal dialysis (PD) patients.

This study's primary objective was to evaluate the implementation of a domestic violence questionnaire introduced as a component of child maltreatment investigations. Interviews were conducted with a sample of 15 caseworkers. Case record data provided additional data. The questionnaire resulted in a 100% increase in the number of battered women identified during investigations. The interview data revealed that although there was resistance to the implementation of the questionnaire, there was a willingness to comply and complete the questionnaire. Workers conveyed a sense of responsibility to provide services to combat domestic violence. Most respondents believed their mandate was to protect the child and questioned the role of identifying domestic violence in protecting children. The questions of how child protective workers should assess and intervene with domestic violence are complex and lead to an examination of the mission of child protective service agencies.

This essay is a case study of a New York City philanthropy's effort from 1927 through 1953 to preserve the health of white women working in clerical, sales, and professional jobs for low wages. In creating a subsidized health clinic for this targeted population of women workers, the urban charity succeeded in relieving the suffering and worry of one part of the working-poor population while simultaneously reinforcing racial and social class divisions of the period.

Point/Counterpoint is a regular feature of the Journal of Social Work Education. Its purpose is to provide a vehicle for the expression of contrasting views on controversial topics in social work education. Our goal is to illuminate important debates and explore the diverse perspectives that are shaping social work education. In each issue of the Journal two social work educators are invited to comment on a topic about which they have differing viewpoints. Each commentator is given an opportunity to make a brief rebuttal. In this issue, Barbara Simon (Associate Professor, Columbia University) and Bruce Thyer (Professor, University of Georgia, Athens) address the question: Are theories for practice necessary?

U.S. policy towards immigrants since 1798 serves as a clear window through which to view both change and continuity in official resistance to the growth of a multicultural nation. Traditions of nativism, racism, and xenophobia are clearly documented in the history of immigration policy. So also are efforts to supplant these virulent traditions with greater receptivity to demographic diversity. Two centuries of federal policies on immigration, together with case records of social work agencies that served immigrants, constitute excellent texts from which to teach social work students about the historical ambivalence of the people of the United States and their government towards welcoming "others."

Shift work introduces multiple strains into the lives of working women and men. Nonstandard working hours affect sleeping and eating regimes, dating opportunities, long-term relationships, child-raising patterns, sexual life, and stress levels. This article focuses upon helping human service workers to assess the psychosocial and physiological impact of shift work and to assist clients with the development of coping strategies.

Though social work educators at the graduate and undergraduate level require their students to write much and often, the quality of writing of many recent graduates appears to be inadequate for meeting the contemporary demands of everyday practice in social work settings or interdicsiplinary arenas. In order to prepare more fully social work students for addressing contemporary social issues and for serving their clients, social work educators in the 1990s could draw upon the expertise of those composition teachers who have devised approaches to the teaching of writing that take into account the special demands of a given profession or discipline. The authors reflect on their application of such an approach in three social work programs - two at the graduate level and one at the undergraduate level.

This article investigates the structures that lock women into jobs that offer low pay and minimal security. The argument advanced assumes that the marked inequality of women in the work place serves the perceived interests of powerful groups. To endure, that inequality must be organized and institutionalized. The authors suggest a framework of analysis that faces the nature of the relationships among the sources of power, institutions, and processes that keep women in this unequal position in the work force.

Despite the activism of many individual social workers in the first decade of the second wave of the U.S. women's movement, 1963-73, the National Association of Social Workers (NASW), the largest and most visible organization representing professional social workers, was slow to respond to the challenge put forth by liberal, radical, and socialist feminists. However, this delay in response was replaced, from 1973 onward, with an explosion of activity on feminist topics in NASW and in the profession's publications, agencies, and schools. Fifteen years later, feminist activity by social work organizations has become institutionalized and widespread in the face of the assault by the Reagan administration.

A study of fifty never-married women, aged 66-101, from metropolitan areas in the northeastern United States, revealed that most (84 percent) had been the primary caregivers for their aged and dying parents. Most of the women derived satisfaction and legitimacy from their role of nurturer. However, many also paid a high price for providing this care; they became emotionally and physically exhausted, financially depleted, and socially isolated.