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1.
Adrian Hugh Heald Simon George Anderson Gabriela Janet Cortes Videlina Cholokova Marcos Narajos Adnan Khan Gemma Donnahey Mark Livingston 《Primary Care Diabetes》2018,12(2):133-138
Introduction
Hypoglycaemia has been recognised as a problem in the treatment for type 2 diabetes. Here we describe how levels of HbA1C and treatment with a sulphonylurea or insulin relate to risk of significant hypoglycaemia.Methods
Incident hypoglycaemia as recorded for the previous 10 years was determined from the GP records for patients with T2DM aged 75 years or more.Results
The anonymised GP records of 5974 T2DM patients (2934 men and 3040 women) aged 75 years or more were analysed.Mean age of the men was 81.0 (95% confidence interval (CI) 80.9–81.2) years and of the women was 82.2 (95% CI 82.0–82.4) years.Hypoglycaemic events of significance were recorded in 4.9% of men and 5.1% of women.The prevalence of hypoglycaemia was higher in those with a higher concurrent HbA1C. HbA1C for those people with a recorded significant hypoglycaemic attack(s) was 57.9 (95% CI 56.4–59.4) mmol/mol compared to those with no history of hypoglycaemic episodes at 51.6 (95% CI 51.3–52.0) mmol/mol (p < 0.002).Even for those on sulphonylurea and/or insulin treatment, hypoglycaemia prevalence increased with HbA1C: for patients with an HbA1C of <48 mmol/mol, age and gender adjusted hypoglycaemia prevalence was 11.1%, for HbA1C of 48–57 mmol/mol, prevalence 9.9%, for HbA1C 58–67 mmol/mol prevalence, 13.2% and for HbA1C 68 mmol/mol or more, prevalence of hypoglycaemia was 16.1%.There was a slight fall in HbA1C by age (normalised β ?0.069, p < 0.001) and no difference by level of social disadvantage.Treatment with a sulphonylurea or insulin very significantly increased the likelihood of a hypoglycaemic episode: odds ratio (OR) 8.94 (95% CI 6.45–12.42), p < 0.001, independent of age, BMI, Townsend index and gender.Conclusion
Prevalence of hypoglycaemia was greater in those individuals with higher HbA1C and in those on sulphonylurea/insulin treatment.Our findings suggest that it is variance in blood glucose rather than overall lower blood glucose levels that predisposes older people to hypoglycaemia. 相似文献2.
Rebecka Husdal Eva Thors Adolfsson Janeth Leksell Björn Eliasson Stefan Jansson Lars Jerdén Jan Stålhammar Lars Steen Thorne Wallman Ann-Marie Svensson Andreas Rosenblad 《Primary Care Diabetes》2019,13(2):176-186
Aims
To describe and analyse the associations between primary health care centres’ (PHCCs’) quality of work (QOW) and individual HbA1c levels in people with Type 2 diabetes mellitus (T2DM).Methods
This cross-sectional study invited all 1152 Swedish PHCCs to answer a questionnaire addressing QOW conditions. Clinical, socio-economic and comorbidity data for 230,958 people with T2DM were linked to data on QOW conditions for 846 (73.4%) PHCCs.Results
Of the participants, 56% had controlled (≤52 mmol/mol), 31.9% intermediate (53–69 mmol/mol), and 12.1% uncontrolled (≥70 mmol/mol) HbA1c. An explanatory factor analysis identified seven QOW features. The features having a call-recall system, having individualized treatment plans, PHCCs’ results always on the agenda, and having a follow-up strategy combined with taking responsibility of outcomes/results were associated with lower HbA1c levels in the controlled group (all p < 0.05). For people with intermediate or uncontrolled HbA1c, having individualized treatment plans was the only QOW feature that was significantly associated with a lower HbA1c level (p < 0.05).Conclusions
This nationwide study adds important knowledge regarding associations between QOW in real life clinical practice and HbA1c levels. PHCCs’ QOW may mainly only benefit people with controlled HbA1c and more effective QOW strategies are needed to support people with uncontrolled HbA1c. 相似文献3.
Xianfeng Zhou Xiaonan Ruan Lipeng Hao Yi Zhou Jianjun Gu Hua Qiu Kang Wu Siyu Yu Xinyi Rui Xiaonan Wang Xiaolin Liu Juzhong Ke Genming Zhao Qiao Sun 《Primary Care Diabetes》2018,12(3):238-244
Aims
Due to the diversity of the Chinese population, it requires considerable research to evaluate HbA1c diagnostic threshold for diagnosis of hyperglycemia.Methods
We included 7909 subjects aged ≥15 without known diabetes from the baseline of Pudong community cohort in 2013. Participants took oral glucose tolerance test (OGTT) and HbA1c assay. Receiver operating characteristic curve determined the HbA1c threshold in the diagnosis of hyperglycemia.Results
The optimal HbA1C threshold for diagnosing newly diagnosed diabetes (NDD) and pre-diabetes in this population was 6.0% (AUC = 0.798, 95%CI: 0.779–0.818) and 5.6% (AUC = 0.655, 95%CI: 0.638–0.671). When compared with elderly age group (≥70 years), HbA1c for detecting NDD performed better in youth (15–39 years: P = 0.003, 40–49 years: P < 0.001). There were 13.81% and 13.34% of participants would be newly detected as NDD and pre-diabetes via HbA1c criteria; meanwhile 3.20% and 15.52% diagnosed as NDD and pre-diabetes by OGTT criteria would be missed diagnosis.Conclusions
The optimal HbA1c thresholds for NDD and pre-diabetes were lower than ADA criteria. It is necessary to carefully consider whether choose HbA1c as a diagnostic criterion or combine two diagnostic standards. Age-specific diagnostic thresholds should be considered when HbA1c was recommended as diagnostic standard. 相似文献4.
Srujitha Marupuru Padmanav Senapati Swathi Pathadka Sonal Sekhar Miraj Mazhuvancherry Kesavan Unnikrishnan Mohan K. Manu 《The Brazilian journal of infectious diseases》2017,21(3):312-316
Background
World Health Organization estimated that people with diabetes (DM) are at 2–3 times higher risk for tuberculosis (TB). Studies have shown that DM not only increases the risk of active TB, but also puts co-affected persons at increased risk of poor outcomes.Objectives
To determine the protective effect of metformin against TB in DM patients and also, to investigate the relationship between poor glycemic control and TB.Methods
A case–control study was conducted over 8 months, where cases and controls were selected based on the inclusion and exclusion criteria of the study. The diabetics diagnosed with TB were selected as study group (SG = 152) and without TB were as control group (CG = 299). Exposure status of metformin in both groups were analyzed.Results
The mean (SD) age of both CG and SG were 55.54 ± 11.82 and 52.80 ± 11.75, respectively. Majority of the subjects in the study were males. The mean hospital stay of SG and CG were 7 days and 6 days, respectively. Poor glycemic control (HbA1c > 8) observed in SG (51.7%) vs CG (31.4%). HbA1c value <7 is associated protective factor for TB occurrence [OR = 0.52 (95% CI 0.29–0.93)]. The protective effect of metformin against TB was 3.9-fold in diabetics (OR = 0.256, 0.16–0.40).Conclusion
Poor glycemic control among diabetics is a risk factor for TB occurrence. The result shows metformin use is a protective agent against TB infection in diabetics. Hence, incorporation of metformin into standard clinical care would offer a therapeutic option for the prevention of TB. 相似文献5.
Marilina Santero Daniela Morelli Analía Nejamis Luz Gibbons Vilma Irazola Andrea Beratarrechea 《Primary Care Diabetes》2018,12(6):510-516
Aim
To evaluate the one-year post effect of the implementation of a diabetes program that includes mHealth interventions on the quality of diabetic care in public primary care centers.Method
It is a quasi-experimental study with outcome measurements at baseline, 6 and 12 months. The program includes primary care team training, a diabetes registry with a decision support tool in an app. and text messages for patients.Results
At baseline, 947 patients were included in the registry, 62.3% women with a mean age of 53.6 ± 11.5 years and 92% with type 2 diabetes. Common comorbidities were hypertension (61.3%) and obesity (59%). Only 16.9% had one HbA1c and 48.9% a cholesterol lab in the last year, 61.9% were screened for diabetic peripheral neuropathy, and 29.0% had one eye exam in the previous year. With respect to blood sugar, lipid and blood pressure control: 44.4% of those with HbA1c measurements had levels ≥8%, total cholesterol was over 200 mg/dL in 40.6% and 48.2% had uncontrolled blood pressure values.Conclusion
Patients with diabetes received a low quality of care at public primary care clinics. A diabetes registry allowed us to draw an epidemiological profile of diabetic patients and determine the quality of care provided. 相似文献6.
Ramya Kateel Alfred J. Augustine Shivananda Prabhu Sheetal Ullal Manohar Pai Prabha Adhikari 《Diabetes & Metabolic Syndrome: Clinical Research & Reviews》2018,12(1):27-30
Aim
To evaluate the clinical and microbiological profile of diabetic foot ulcer patients admitted to a tertiary care hospital.Methodology
This study recruited 120 diabetic foot ulcer patients of all grade. Their medical records were evaluated retrospectively.Results
We found that median age of patient was 60(52, 67.75) years. 68.3% of patients were males. Median duration of diabetes mellitus was 15(10, 20) years. Mean HbA1C and fasting glucose was 10.3 ± 2.3 and 167.6 ± 52.42 respectively. Neuropathy (35%) and peripheral vascular disease (23.3%) was major micro vascular and macro vascular complication associated. Different locations of ulcers were toe (23.3%), sole (20%), dorsum (18.3%), shin (16.6%), heel (13.3%), and ankle (8.3%). Bacterial infection was seen in 81.66% patients out of which 23.3% had poly microbial infection.Conclusion
Diabetic foot ulcer patient had poor blood glucose control with elevated HbA1C and fasting blood glucose level. Neuropathy and peripheral vascular disease, hypertension were major complications. Staphylococcus aureus, Pseudomonas aeruginosa were common infecting bacteria. 相似文献7.
Sharon H. Saydah Edward W. Gregg Henry S. Kahn Mohammed K. Ali 《Primary Care Diabetes》2018,12(1):3-12
Aims
Determine the mortality experience among adults with diabetes in meeting and not meeting less intense control for glycated hemoglobin (HbA1c), blood pressure (BP), and cholesterol.Methods
National Health and Nutrition Examination Survey 1999–2010 participants with self-report of diagnosed diabetes (N = 3335), measured HbA1c, BP and non-HDL cholesterol were linked to the National Death Index through December 31, 2011. Proportional hazards models were used to estimate hazard ratios (HR) of meeting HbA1c < 9% and BP < 160/110, and non-HDL cholesterol < 190 mg/dL. Models used age as the time scale and adjusted for demographics (sex, race/ethnicity, education), diabetes duration, history of cardiovascular and chronic kidney disease, and treatments for elevated glucose, BP, and cholesterol.Results
Over a mean 5.4 person-years of follow-up, participants meeting all less intense control had a 37% lower mortality (HR = 0.63, 95% CI 0.54, 0.74) relative to those who did not meet the goals. Of approximately 306,000 deaths per year that occur among Americans with diabetes, we estimate 39,400 might have been averted by improving the care of those who have not met these less intense control goals.Conclusions
Meeting the less intense control goals is associated with 37% reduction in mortality and could lead to 39,400 fewer deaths per year. 相似文献8.
T.G. Kebede C. Pink W. Rathmann B. Kowall H. Völzke A. Petersmann P. Meisel T. Dietrich T. Kocher B. Holtfreter 《Diabetes & metabolism》2018,44(3):243-249
Aim
As periodontitis may contribute to the pathogenesis of diabetes, the effects of periodontitis on diabetes incidence and HbA1c change was quantified in a prospective cohort.Methods
Data from an 11-year follow-up of the Study of Health in Pomerania were analyzed to evaluate the effects of periodontitis on incident diabetes and long-term HbA1c changes in 2047 subjects aged 20–81 years. Diabetes was based on self-reported physician diagnoses, antidiabetic medication use, or HbA1c ≥ 6.5% or non-fasting blood glucose levels ≥ 11.1 mmol/L. To assess periodontal status, periodontal pockets were probed, and their depth and clinical attachment levels measured. For both measures, means and percentages of sites ≥ 3 mm were calculated. In addition, all probing depths ≥ 4 mm were summed (cumulative probing depth). Modified Poisson and multivariable linear models were applied, adjusted for age, gender, highest level of general education, marital status, waist circumference, physical activity, smoking status and follow-up time.Results
Over a mean follow-up period of 11.1 years, 207 subjects developed diabetes. Baseline mean clinical attachment levels (CAL) and probing depths (PPD) were not significantly associated with either diabetes incidence [mean CALs, fourth quartile, incidence rate ratio = 0.819, 95% confidence interval (CI): 0.489–1.370; P = 0.446] or long-term changes in HbA1c (mean CAL, fourth quartile, β = ?0.086, 95% CI: ?0.187, ?0.016; P = 0.098). Sensitivity analyses using alternative exposure definitions confirmed these results.Conclusion
Contrary to the currently available literature, no convincing evidence was found of any potential association between periodontitis and diabetes incidence or HbA1c change. 相似文献9.
Aim
In this study, the impact of serum bilirubin on new-onset type 2 diabetes mellitus (T2DM) in Korean adults was investigated.Methods
Data were obtained from the Korean Genome and Epidemiology Study (KoGES), a population-based prospective cohort study. The study enrolled 8650 adults (4015 men and 4635 women), aged 40 to 69 years, who underwent a mean follow-up of 8.4 years. The study population was divided into quartiles (Q) of serum bilirubin levels, with cut-off points at 0.46, 0.61 and 0.82 mg/dL for men, and 0.35, 0.47 and 0.61 mg/dL for women. T2DM was defined based on the following data: fasting blood glucose ≥ 7.0 mmol/L, HbA1c level ≥ 6.5% or 2-h plasma glucose ≥ 11.1 mmol/L during a 75-g oral glucose tolerance test.Results
Over the mean 8.4-year follow-up, 786 participants (9.1%) developed T2DM. Compared with Q1, the odds ratios (ORs) and 95% confidence intervals (CIs) for T2DM incidence were 0.52 (0.36–0.74) in men and 0.56 (0.38–0.83) in women aged ≥50 years, respectively, in the highest Q group after adjusting for possible confounding factors. These significant results persisted in those with impaired glucose tolerance and impaired fasting glucose.Conclusion
The results of this study reveal a protective role for serum total bilirubin on new-onset T2DM in Korean men and women. In addition, serum total bilirubin had favourable effects on new-onset T2DM in those with impaired glucose tolerance and impaired fasting glucose. 相似文献10.
Mohammed R. Halawa Yara M. Eid Rana A. El-Hilaly Mona M. Abdelsalam Amr H. Amer 《Diabetes & Metabolic Syndrome: Clinical Research & Reviews》2018,12(2):99-104
Introduction
Foot disease is a common complication of type 2 diabetes that can have tragic consequences. Abnormal plantar pressures are considered to play a major role in the pathologies of neuropathic ulcers in the diabetic foot.Aim
To examine Relationship of Planter Pressure and Glycemic Control in Type 2 Diabetic Patients with and without Neuropathy.Materials and methods
The study was conducted on 50 type 2 diabetic patients and 30 healthy volunteers. BMI calculation, disease duration, Hemoglobin A1c and presence of neuropathy (by history, foot examination and DN4 questionnaire) were recorded. Plantar pressure was recorded for all patients using the Mat-scan (Tekscan, Inc.vers. 6.34 Boston USA) in static conditions (standing) and dynamic conditions (taking a step on the Mat-scan). Plantar pressures (kPa) were determined at the five metatarsal areas, mid foot area, medial and lateral heel areas and medial three toes.Results
Static and dynamic plantar pressures in both right and left feet were significantly higher in diabetic with neuropathy group than in control group in measured areas (P < 0.05). Static and dynamic pressures in right and left feet were significantly higher in diabetic with neuropathy group than in diabetic without neuropathy group in measured areas (P < 0.05). On comparison between controls and diabetic without neuropathy group there was a significant difference in plantar pressures especially in metatarsal areas (P < 0.05). No significant correlations were present between the studied variables age, disease duration, BMI and HbA1c and plantar pressures in all studied areas.Conclusion
Persons with diabetic neuropathy have elevated peak plantar pressure (PPP) compared to patients without neuropathy and control group. HbA1c% as a surrogate for glycemic control had no direct impact on peak planter pressure, yet it indirectly impacts neuropathy evolution through out disease duration eventually leading to the drastic planter pressure and gait biomechanics changes. 相似文献11.
Antonio Brugos-Larumbe Pablo Aldaz-Herce Francisco Guillen-Grima Francisco Javier Garjón-Parra Francisco Javier Bartolomé-Resano María Teresa Arizaleta-Beloqui Ignacio Pérez-Ciordia Ana María Fernández-Navascués María José Lerena-Rivas Jesús Berjón-Reyero Luisa Jusué-Rípodas Ines Aguinaga-Ontoso 《Primary Care Diabetes》2018,12(1):34-44
Objective
Assess compliance with the IDF recommendations for patients with Diabetes Type2 (DM2), and its variability, by groups of doctors and nurses who provide primary care services in Navarre (Spain).Materials and methodologies
A cross-sectional study of a population of 462,568 inhabitants, aged ≥18 years in 2013, attended by 381 units of doctor/nurse (quota). Clinical data were collected retrospectively through electronic records.Using cluster analysis, we identified two groups of units according to the score for each indicator. We calculated the Odds Ratio, adjusted for age sex, BMI, socioeconomic status and smoking, for complying with each recommendation whether a patient was treated by one of the quota from the highest score to the lowest.30,312 patients with DM2 were identified: prevalence: 6.39%; coefficient of variation between UDN: 22.8%; biggest cluster 7.7% and smallest 5.3%; OR = 1.54 (1.50–1.58).The HbA1c control at ≤8% was 82.8% (82.2–83.3) and >9% was 7.6% (7.3–8.0), with OR 1.79 (1.69–1.89) and 2.62 (2.36–2.91) respectively. Control of BP and LDL-C show significant differences between the clusters.Conclusions
An important variability was identified according to the doctor treating patients. The average HbA1c control is acceptable being limited in BP and LDL-C. 相似文献12.
B. Balkau M. Metzger F. Andreelli L. Frimat E. Speyer C. Combe M. Laville C. Jacquelinet S. Briançon C. Ayav Z. Massy R.L. Pisoni B. Stengel D. Fouque 《Diabetes & metabolism》2019,45(2):175-183
Aim
To describe current practices of glucose-lowering treatments in people with diabetes and chronic kidney disease (CKD), the associated glucose control and hypoglycaemic symptoms, with an emphasis on sex differences.Methods
Among the 3033 patients with CKD stages 3–5 recruited into the French CKD-REIN study, 645 men and 288 women had type 2 diabetes and were treated by glucose-lowering drugs.Results
Overall, 31% were treated only with insulin, 28% with combinations of insulin and another drug, 42% with non-insulin glucose-lowering drugs. In CKD stage 3, 40% of patients used metformin, 12% at stages 4&5, similar for men and women; in CKD stage 3, 53% used insulin, similar for men and women, but at stages 4&5, 59% of men and 77% of women used insulin. Patients were reasonably well controlled, with a median HbA1c of 7.1% (54 mmol/mol) in men, 7.4% (57 mmol/mol) in women (P = 0.0003). Hypoglycaemic symptoms were reported by 40% of men and 59% of women; they were not associated with the estimated glomerular filtration rate, nor with albuminuria or with HbA1c in multivariable analyses, but they were more frequent in people treated with insulin, particularly with fast-acting and pre-mixed insulins.Conclusion
Glucose-lowering treatment, HbA1c and hypoglycaemic symptoms were sex dependent. Metformin use was similar in men and women, but unexpectedly low in CKD stage 3; its use could be encouraged rather than resorting to insulin. Hypoglycaemic symptoms were frequent and need to be more closely monitored, with appropriate patient-education, especially in women. 相似文献13.
Siyu Chen Xuhong Hou Yu Sun Gang Hu Xiaoyan Zhou Huijuan Xue Peizhu Chen Jingzhu Wu Yuqian Bao Weiping Jia 《Primary Care Diabetes》2018,12(3):231-237
Aims
To assess whether an integrated hospital-community diabetes management program could improve major cardiovascular risk factor control among patients with diabetes in real-world clinical settings.Methods
985 adults with diabetes in the Shanghai Taopu community health service center were enrolled at baseline and 907 subjects completed the follow-up. The follow-up levels of the metabolic profiles were assessed by their averages during the follow up period.Results
After a mean 7-year follow-up period, heamoglobin A1c, systolic and diastolic blood pressure levels decreased by 0.6%, 5.7 mmHg, and 1.5 mmHg, respectively (all P < 0.001). There was a non-significant difference in low-density lipoprotein cholesterol, while high-density lipoprotein cholesterol increased 1.9 mg/dL and triglycerides decreased 28.3 mg/dL, respectively (all P < 0.001). The percentage of patients with diabetes who met any one of three Chinese Diabetes Society goals (heamoglobin A1c <7.0%, blood pressure <140/80 mmHg, and low-density lipoprotein cholesterol <100 mg/dL) increased from 58.2% to 70.1%. The chronic diabetes complication screening rates (diabetic retinopathy, diabetic neuropathy, diabetic nephropathy) have significantly increased, from almost zero to 12–78%.Conclusions
This long-term program has increased the proportions of attaining major cardiovascular risk factors control goals and diabetic chronic complication screening rates among patients with diabetes. 相似文献14.
Hayford Mawuli Avedzi Nonsikelelo Mathe Kate Storey Jeffrey Allen Johnson Steven Thomas Johnson 《Primary Care Diabetes》2018,12(1):71-79
Aim
We examined self-reported dietary behaviours and actual food intakes among adult men and women with type 2 diabetes participating in Alberta’s Caring for Diabetes (ABCD) Study.Methods
Participants completed 3-day food records and questions about glycemic index (GI) concept knowledge and dietary behaviours. Daily average GI and glycemic load (GL) were calculated for all carbohydrates consumed. Dietary intake was analyzed using ESHA FoodPro (version 10.13.1). Sex differences in nutrient intakes were explored across categories of GI knowledge and dietary practices.Results
Participants (N = 170) mean (SD) age 65.8 (9.6) years were 46.5% women, 90.6% Caucasian with a mean BMI of 31.3 (7.0) kg/m2 and diabetes duration of 13.4 (8.6) years. Overall, 60% of men versus 40% of women consumed carbohydrates in quantities below Acceptable Macronutrient Distribution Ranges (AMDR). About 80% of men versus 90% of women consumed proteins above AMDR whereas 60% versus 65% of women consumed fats above AMDR. Fibre intake among men was lower than recommended (p < 0.01). Men who reported having knowledge of the GI-concept also reported lower GI intake versus men who did not (p = 0.03).Conclusion
Sex differences exist in low-GI diabetes self-care dietary behaviours among adults with type 2 diabetes participating in this study. Gender-sensitive approaches for enhancing diabetes self-care low-GI dietary behaviour should be explored. 相似文献15.
F. Javier García-Fernández José Luis Ibáñez Criado Aurelio Quesada Dorador 《Revista espa?ola de cardiología》2018,71(11):941-951
Introduction and objectives
This report describes the findings of the 2017 Spanish Catheter Ablation Registry.Methods
Data collection was retrospective. A standardized questionnaire was completed by each of the participating centers.Results
A total of 15 284 ablation procedures were performed by 98 institutions (the highest number of ablations and institutions historically reported in this registry), with a mean of 156 ± 126 and a median of 136 procedures per center. For the first time, the most frequently treated ablation target was atrial fibrillation (n = 3457; 22.6%), followed by cavotricuspid isthmus (n = 3449; 22.5%) and atrioventricular nodal re-entrant tachycardia (n = 3429; 22.4%). The overall success rate was 87%. The rate of major complications was 2.6%, and the mortality rate was 0.09%. The percentage of procedures performed without fluoroscopic support increased to 6% of all ablations, and 2.3% of all ablations were performed in pediatric patients.Conclusions
The Spanish Ablation Catheter Registry systematically and uninterruptedly collects data on the ablation procedures performed in Spain, revealing that both the number of ablations and the number of centers performing them has progressively increased, while maintaining a high success rate and a low percentage of complications. 相似文献16.
Arupkumar Chakrabartty Pampa Basu Kazi Monjur Ali Aditi Kishore Sarkar Debidas Ghosh 《The Indian journal of tuberculosis》2018,65(2):145-151
Background
One major barrier to achieve goal of tuberculosis (TB) control program globally, is the stigma attached to the disease. Perceived stigma can delay sputum test in time. Delay will lead to spread of infection in the community. There is no scientific information available in India exactly looking into the association between delay in sputum examination and stigma.Aim
We conducted a study in rural West Bengal among persons with cough for 2 weeks or more to assess their level of stigma, its influence on delay for sputum test and identify factors those shape the level of stigma.Methods
A community based cross sectional survey was conducted from February to June 2015 in West Bengal, India. We interviewed 135 persons of 15–60 years. Data were collected using a pretested structured questionnaire. Chi-square and logistic regression analysis were done using SPSS 23.0 statistical software.Results
Among the ‘lower stigma’ group (score 4–24), ‘delay’ (14–25 days) is found among 46.2% respondents and ‘much delay’ (26–120 days) among 53.8%. Among the ‘higher stigma’ (score 25–36) group, ‘delay’ is found among 20.5% respondents and ‘much delay’ among 79.5%. Persons with lower stigma are 0.17 times likely to delay than persons with higher stigma [adjusted odds ratio (AOR): 0.17 (0.044–0.668), p = 0.011)]. Important influencers of stigma are caste [AOR: 5.90 (1.66–20.90), p = 0.006], number of family members [AOR: 3.46 (1.08–11.06), p = 0.009] and residence in urban or rural [AOR: 3.97 (1.03–15.27), p = 0.045].Conclusion
Revised National Tuberculosis Control Program in India should de-stigmatize the community giving priorities to lower castes, big families and rural areas. 相似文献17.
Francesco Fici Elif Ali Bakir Sengul Beyaz Wim Makel Nicolas Roberto Robles 《Primary Care Diabetes》2018,12(6):558-564
Background
Albuminuria is an early marker of kidney disease in patients with diabetes and/or hypertension undetected or untreated albuminuria is a leading cause of chronic kidney disease and cardiovascular events, The purpose of the present survey was to assess the prevalence of albuminuria in patients with diabetes and hypertension, treated with a combinations of renin angiotensin aldosterone system inhibitors and dihydropyridine calcium channel blockers.Methods
The survey was performed in 105 Primary Care Units in Turkey and involved outpatients, routinely visited by either a specialist or a non-specialist physician.Albuminuria was evaluated in a spot morning urine sample, as albumin–creatinine ratio, using the Multistic-Clinitek-device analyzer (Siemens), that has a strong correlation with 24-h urinary albumin excretion. Microalbuminuria was defined as a loss of 3.4–33.9 mg albumin/mmol creatinine and macroalbuminuria as a loss of >33.9 mg albumin/mmol creatinine. Diabetes was assessed through documented blood glucose concentration or use antidiabetic drugs, whereas hypertension through blood pressure measurement and current antihypertensive treatment.Results
The survey enrolled 1708 subjects with a prevalence of type 2 diabetes (87.6%). Albuminuria was detected in 52.0% of patients. Blood pressure was controlled in 37.0% and diabetes in 56.7%. The risk of albuminuria was significantly high in patients with uncontrolled diabetes (p < 0.001) and blood pressure (p = 0.009).Conclusions
In a large cohort of treated hypertensive patients with diabetes, albuminuria was present in about 50% and was correlated with poor diabetes and blood pressure control. Systematic screening of albuminuria, particularly in Primary Care, is an important tool for the early diagnosis of nephropathy. 相似文献18.
Mercedes Ramas Maria G. Donday Adrian G. McNicholl Javier P. Gisbert 《Gastroenterologia y hepatologia》2017,40(10):658-662
Background
A progressive decrease in Helicobacter pylori eradication rates has been described over the years, driving the need for new antibiotic treatments.Aim
To evaluate the efficacy and safety of the addition of rifaximin (Spiraxin®) to standard triple therapy (omeprazole, amoxicillin and clarithromycin) for the eradication of H. pylori.Methods
Independent prospective clinical trial (EUDRACT no.: 2013-001080-23). Forty consecutive adult patients were included with H. pylori infection, dyspeptic symptoms and naive to eradication treatment. A full blood test was performed in the first five patients enrolled to evaluate the safety of the treatment. H. pylori eradication was confirmed with the 13C-urea breath test at least four weeks after the end of treatment with rifaximin 400 mg/8 h, clarithromycin 500 mg/12 h, amoxicillin 1 g/12 h and omeprazole 20 mg/12 h for 10 days.Results
Forty patients were consecutively enrolled, 53% woman, mean age 44 years. Indication for eradication: 60% non-investigated dyspepsia, 38% functional dyspepsia and 2% gastric ulcer. Four patients did not attend the eradication confirmatory breath test. The eradication rate was 61% (95% CI: 45–77%) for the protocol and 55% (40–70%) for intention-to-treat. About 76% of the patients experienced adverse events (35% diarrhea, 14% nausea and 24% metallic taste), none of which was serious. The blood tests did not show significant alterations.Conclusion
Acceptable H. pylori eradication rates are not achieved with rifaximin associated with standard triple therapy for 10 days. 相似文献19.
Andrii Dudnyk Svitlana Blyzniuk Oleksandr Pavel’chuk Olena Zakharchenko Dmytro Butov Sergiі Zaіkov 《The Indian journal of tuberculosis》2018,65(1):63-69
Tuberculosis (TB) may have a similar spirometry findings as a chronic obstructive pulmonary disease but the prevalence of TB-induced airflow obstruction (AO) is still unknown.
Objectives
To measure frequency of AO in new TB cases at the beginning of treatment and to evaluate factors associated with obstructive abnormalities following TB diagnosis.Materials and Methods
317 patients that have no history of prior AO were recruited into the study with a median age of 39.0 years (IQR, 30.0–49.0). AO was defined using the FEV1/F(VC) < LLN.Results
AO was detected in 29.97% (95/317) new TB cases. These patients had a more severe clinical manifestation of TB with a greater likelihood of cough, OR = 5.47 (95%CI 1.90–15.70) and wheezing, OR = 10.51 (95%CI 5.72–19.27), p < 0.001. The frequency of AO was positively associated with bronchoscopic evidence of narrowing of the main airways. Furthermore, from multiple logistic regression analysis we would assume that higher FEV1 value in TB patients with AO was related to greater BMI and inversely associated with older age, female sex and radiographic extent (p < 0.05).Conclusions
Obstructive pattern on spirometry frequently occurs in new TB cases without previously detected AO. This category of patients should be targeted for detailed follow-up, particularly, in high TB burden countries. 相似文献20.
B.T. Fokkens R.P. van Waateringe D.J. Mulder B.H.R. Wolffenbuttel A.J. Smit 《Diabetes & metabolism》2018,44(5):424-430