Type 2 diabetes management in nurse-led primary healthcare settings in urban and rural Cameroon

AimsTo implement a protocol-driven primary nurse-led care for type 2 diabetes in rural and urban Cameroon.MethodsWe set-up three primary healthcare clinics in Yaounde (Capital city) and two in the Bafut rural health district. Participants were 225 (17% rural) patients with known or newly diagnosed type 2 diabetes, not requiring insulin, referred either from a baseline survey (38 patients, 17%), or secondarily attracted to the clinics. Protocol-driven glucose and blood pressure control were delivered by trained nurses. The main outcomes were trajectories of fasting capillary glucose and blood pressure indices, and differences in the mean levels between baseline and final visits.ResultsThe total duration of follow-up was 1110 patient-months. During follow-up, there was a significant downward trend in fasting capillary glucose overall (p < 0.001) and in most subgroups of participants. Between baseline and final visits, mean fasting capillary glucose dropped by 1.6 mmol/L (95% CI: 0.8–2.3; p ≤ 0.001). Among those with hypertension, blood pressure also decreased significantly for systolic and marginally for diastolic blood pressure. No major significant change was noticed for body weight.ConclusionsNurses may be potential alternatives to improve access to diabetes care in settings where physicians are not available.     

Impact of Stiffer Arteries on the Response to Antihypertensive Treatment: A Longitudinal Study of the SardiNIA Cohort

ObjectivesCarotid-femoral pulse wave velocity (PWV), an index of arterial stiffness and a proxy of arterial aging, has been reported to be an independent determinant of cardiovascular health. Whether the effects of antihypertensive treatment vary in the presence of accelerated arterial aging (stiffer artery, ie, PWV >10 m/s) has not been established. We tested this hypothesis in a longitudinal study in a large community-dwelling population.DesignLongitudinal population study with repeated measures.Setting and ParticipantsStudy population consisted of a cohort of 6011 volunteers (2546 men and 3465 women, age range 14-101 years; 15,011 observations over a median follow-up of 6.8 years) participating in the SardiNIA Study.MeasuresRepeated measures of PWV, blood pressure (BP), and metabolic risk factors and the antihypertensive medication trajectories of BP and PWV over time were assessed via mixed effects models.ResultsAntihypertensive treatment significantly affected the trajectory of BP in both participants with (−0.47 ± 0.20 mmHg/y, P = .02) and participants without stiffer arteries (−0.47 ± 0.07 mmHg/y, P = .001). They also affected the trajectory of PWV in participants with stiffer artery, independent of the BP values.Conclusions and ImplicationsAntihypertensive treatment is effective in reducing both BP and PWV in older individuals with stiffer arteries.     

Safety of immunization during pregnancy: A review of the evidence of selected inactivated and live attenuated vaccines

Vaccine-preventable infectious diseases are responsible for significant maternal, neonatal, and young infant morbidity and mortality. While there is emerging scientific evidence, as well as theoretical considerations, indicating that certain vaccines are safe for pregnant women and fetuses, policy formulation is challenging because of perceived potential risks to the fetus.This report presents an overview of available evidence on pregnant women vaccination safety monitoring in pregnant women, from both published literature and ongoing surveillance programs. Safety data were reviewed for vaccines against diseases which increase morbidity in pregnant women, their fetus or infant as well as vaccines which are used in mass vaccination campaigns against diseases. They include inactivated seasonal and pandemic influenza, mono- and combined meningococcal polysaccharide and conjugated vaccines, tetanus toxoid and acellular pertussis combination vaccines, as well as monovalent or combined rubella, oral poliomyelitis virus and yellow fever vaccines. No evidence of adverse pregnancy outcomes has been identified from immunization of pregnant women with these vaccines.     

Urinary concentrations of dichlorophenol pesticides and obesity among adult participants in the U.S. National Health and Nutrition Examination Survey (NHANES) 2005–2008

Accumulating evidence from recent studies has suggested a possible link between exposure to environmental pesticides and obesity. In this study, we assessed the potential associations between exposure to dichlorophenol pesticides and obesity in adults. Study participants aged 20–85 years were selected from the 2005 to 2006 and 2007 to 2008 U.S. National Health and Nutrition Examination Survey, and were categorized as obese and non-obese based on body mass index. Creatinine-corrected urinary concentrations of dichlorophenols were determined to assess level of exposure to environmental pesticides. Multivariate logistic regression was performed using SAS 9.3 to assess the association between 2,4-dichlorophenol (2,4-DCP) and 2,5-dichlorophenol (2,5-DCP) levels in urine and obesity with adjustment for potential confounders. Significantly higher geometric means of urinary concentrations of both 2,5-DCP (p < 0.0001) and 2,4-DCP (p = 0.0170) were seen in obese adults, compared to that in non-obese adults. A dose-dependent increase in the prevalence of obesity was observed in the study participants across increasing levels of urinary 2,5-DCP (p-trend < 0.0001). Urinary concentrations of 2,5-DCP were significantly associated with obesity among the second (AOR: 1.47, 95% CI: 1.12, 1.93), third (AOR: 1.41, 95% CI: 1.07, 1.87), and fourth (AOR: 1.62, 95% CI: 1.21, 2.17) inter-quartiles after adjustment for age, gender, race, education, total fat intake, and physical activity. A statistically significant association was not seen between urinary 2,4-DCP and obesity. Our findings suggest a potential relationship between exposure to the fumigant insecticide paradichlorobenzene, measured as urinary concentrations of 2,5-DCP, and obesity in adults. Because we cannot rule out the possibility of reverse causality in our study, prospective studies measuring exposure during etiologically relevant periods are warranted.     

糖尿病及血糖状况对结核病患者治疗转归的影响

糖尿病患者是结核病的高危人群, 而结核病又是诱发、加重糖尿病急性并发症的重要原因之一。目前中国面临着严重的结核病和糖尿病双重流行, 给我国人民健康造成极大危害, 同时也给我国社会经济带来极大的负担。本文通过PubMed、Web of Science、中国知网以及万方数据知识服务平台等数据库对相关文献进行检索和阅读, 对结核病患者并发糖尿病流行病学现况、糖尿病及血糖状况对结核病患者治疗转归的影响以及糖尿病影响结核病患者治疗转归的机理研究进展进行了分析和总结, 为今后我国结核病患者的治疗与管理提供部分参考依据。     

2016–2017 Arkansas mumps outbreak in a close-knit community: Assessment of the economic impact and response strategies

On August 8, 2016, a confirmed case of mumps was reported to the Arkansas Department of Health (ADH) in an adult resident of Springdale, Arkansas. By July 2017, nearly 3,000 cases of mumps were reported to ADH from 37 of the 75 counties in Arkansas. Over 50% of cases were in the Arkansas Marshallese community, a close-knit community characterized by large, and extended families sharing the same living space and communal activities. In a statewide effort, ADH collaborated with CDC, the Republic of the Marshall Island’s (RMI) Ministry of Health, and the Arkansas Department of Education (ADE) to rapidly respond to and contain the outbreak. We assessed the economic burden to ADH of the outbreak response in terms of containment and vaccination costs, as well as response costs incurred by CDC, RMI, and ADE. The 2016–2017 Arkansas mumps outbreak was the second largest US mumps outbreak in over 30 years and was unique in size, spread, and population affected. Total public health response costs as a result of the outbreak were over $2.1 million, approximately $725 per case. The costs incurred to control this outbreak reflect the response strategies tailored to the affected populations, including consideration of social, cultural, and political factors in controlling transmission and requirements of distinctive strategies for public health outreach. Aside from the burden these outbreaks have on the affected population, we demonstrate the potential for high economic burden of these outbreaks to public health.     

膳食模式对社区管理2型糖尿病患者血糖控制影响的研究

目的 了解膳食对社区管理2型糖尿病（T2DM）患者血糖控制的影响，为实施针对糖尿病患者的防治策略和措施提供依据。方法 于2015年在常熟市和武汉市随机抽取8个社区，对进行社区管理的T2DM患者进行问卷调查、身体测量和血糖检测。研究采用因子分析获得膳食模式。并分别以FPG、餐后2 h血糖控制是否达标为因变量，进行非条件多因素logistic回归分析影响因素。结果 最终共纳入1 818名T2DM患者，患者FPG控制率为57.59%（95%CI：55.30%~59.86%），餐后2 h血糖控制率为24.90%（95%CI：22.93%~26.91%）；因子分析得到5种膳食模式：动物性食物模式、水果-水产-薯类模式、蔬菜-谷物模式、蛋-奶-豆模式和油盐模式。非条件多因素logistic回归分析显示，调整其他因素后，FPG达标概率降低与动物性食物模式（OR=0.71，95%CI：0.52~0.98）、水果-水产-薯类模式（OR=0.71，95%CI：0.51~0.97）相关，餐后2 h血糖达标概率降低与水果-水产-薯类模式（OR=0.60，95%CI：0.40~0.90）相关，FPG和餐后2 h血糖达标概率增加均与蔬菜-谷物模式（OR=1.41，95%CI：1.03~1.94；OR=1.68，95%CI：1.13~2.51）、蛋-奶-豆模式（OR=1.75，95%CI：1.25~2.46；OR=1.56，95%CI：1.00~2.42）有关。与蛋-奶-豆模式Q₄组相比，膳食模式组合（水果-水产-薯类模式Q₄组、蔬菜-谷物模式Q₂组、蛋-奶-豆模式Q₃组）FPG控制达标可能性更高（OR=6.79，95%CI：1.15~40.23，P=0.035）；与蔬菜-谷物模式Q₄组相比，膳食模式组合（水果-水产-薯类模式Q₄组、蔬菜-谷物模式Q₃组、蛋-奶-豆模式Q₂组、油盐模式Q₂组）餐后2 h血糖控制达标可能性更高（OR=12.78，95%CI：1.26~130.05，P=0.031）。结论 搭配得当的膳食模式及膳食模式组合更有利于武汉市和常熟市社区管理T2DM患者的FPG和餐后2 h血糖控制，应加强患者营养教育，提高患者食物搭配能力。