Effective hypertension control in an indigent population

The blood pressure of 60 indigent hypertensive patients who were being treated in the general medicine clinic of a large state-run hospital was found to be unacceptably high after an average follow-up period of 107.5 months. Intensive treatment through a subspecialty clinic resulted in significant decreases in both the mean systolic pressure (from 176.2 to 144.9 mm Hg) and diastolic pressure (from 101.6 to 88.0 mm Hg). Improved blood pressure levels continued for as long as the patients were seen in the subspecialty clinic, but improvement was not maintained at an average of 17.1 months after discharge to the medicine clinic. The mean systolic and diastolic pressures were significantly higher at this time (161.2 and 94.4 mm Hg respectively). We conclude that treatment in a large medicine clinic is inefficient for hypertensive patients and that a subspecialty clinic format is much more successful.     

Potential adverse drug events in an indigent and homeless geriatric population.

OBJECTIVE: To identify potential adverse drug events (ADEs) in a geriatric ambulatory population using the modified Beers criteria. METHODS: This is a cross-sectional study of an indigent and homeless geriatric population served by a network of six primary healthcare clinics with clinical pharmacy services. Medical records of patients > or = 65 years old visiting the clinics between December 1999 and April 2000 were retrospectively reviewed by a clinical pharmacist. Medications meeting the modfied Beers criteria were evaluated for the most common drug classes involved, severity potential, and dose or disease state restrictions. Following the identification of medications meeting Beers criteria, the pharmacist left a written recommendation regarding use of alternative drugs or doses in the medical record. Physician acceptance of pharmacy recommendations was also evaluated. RESULTS: Medical records of 146 patients (71.9% women, average age 72.6 +/- 6.7 y) were reviewed. Overall, 52 patients (35.6%) had 70 medications with the potential for causing an ADE based on the modified Beers criteria The most commonly identified medication classes were narcotic analgesics (20.0%), antihypertensives (20.0%), and antihistamines (14.3%). Fifteen of these medications (21.4%) had a high severity potential. Identified medications met the following modified Beers criteria: 41.4% were inappropriate in a specific disease state, 38.6% were inappropriate for the elderly, 10.0% exceeded maximum dosage guidelines, and 10.0% were inappropriate for both the elerly and the patients disease state. Approximately 60% of pharmacy recommendations were accepted by physicians. CONCLUSIONS: The modified Beers criteria are a useful tool for reviewing medical records to identify potential ADEs in an ambulatory geriatric population.     

新疆和田地区维吾尔族人的瘦素与代谢综合征的临床研究

目的：研究新疆维吾尔族人瘦素水平与胰岛素抵抗的关系。方法选择新疆和田地区943例维吾尔族人进行瘦素水平测定,根据其瘦素的百分位数（瘦素P35＝0.46 ng/ml,瘦素P65＝1.56 ng/ml）分为3组：Ⅰ组330例（瘦素P35）,Ⅱ组286例（瘦素P35~65）,Ⅲ组327例（瘦素P65）,观察3组的体重指数、腰围、收缩压、舒张压、血糖、血脂、空腹胰岛素和HOMA-IR的变化。结果3组间的年龄、体重指数、腰围、收缩压、舒张压、甘油三酯、空腹胰岛素和 HOMA-IR 的比较具有统计学差异,Ⅲ组的体重指数、腰围、收缩压、舒张压、空腹胰岛素和HOMA-IR水平均较Ⅰ组和Ⅱ组明显升高（P＜0.01）。多元线性回归分析结果提示瘦素与体重指数和HOMA-IR呈正相关,回归方程＝-1.528-0.018腰围＋0.128体重指数＋0.001收缩压＋0.002舒张压＋0.229甘油三酯＋0.245HOMA-IR。结论新疆维吾尔族人的瘦素水平与胰岛素抵抗有关。     

Supportive and nonsupportive family behaviors: relationships to adherence and metabolic control in persons with type I diabetes

The Diabetes Family Behavior Checklist (DFBC) was administered to 54 adults and 18 adolescents (less than 19 yr of age) with insulin-dependent diabetes mellitus (IDDM). Subjects and family members completed parallel forms of the DFBC at initial and 6-mo follow-up home interviews. During each of these periods, adherence was assessed via self-report, 1 wk of self-monitoring, and 24-h dietary recalls. The results showed reliable differences between adolescents and adults. More negative interactions with family members were reported by adolescents and their family members, and adolescents were in poorer metabolic control. For adults but not adolescents, negative DFBC scores were prospectively predictive of poorer regimen adherence over the 6-mo interval for measures of glucose testing, insulin injection, and dietary adherence. In addition, higher negative DFBC scores for adults were marginally associated with higher HbA1 levels (P less than 0.10). We conclude that the DFBC is a promising measure of family interaction related specifically to the IDDM regimen and that, for adults, higher levels of nonsupportive family behaviors may be related to reduced regimen adherence and poor control.     

Attributions of adolescents with type 1 diabetes in social situations: relationship with expected adherence, diabetes stress, and metabolic control

OBJECTIVE: To examine the relationships among negative attributions of friend reactions (NAFRs) within a social context, anticipated adherence difficulties, diabetes stress, and metabolic control. RESEARCH DESIGN AND METHODS: A sample of 104 adolescents with type 1 diabetes completed instruments measuring demographics, attribution of friend reactions, anticipated adherence, and diabetes stress. Metabolic control was measured by HbA(1c) obtained during the clinic visit. RESULTS: Path analysis demonstrated an excellent fit of a model depicting an indirect relationship between NAFRs and metabolic control through the mechanisms of expected adherence difficulties and diabetes stress. CONCLUSIONS: Adolescents who make NAFRs are likely to find adherence difficult in social situations and have increased feelings of stress, with the latter associated with poorer metabolic control. Intervention efforts to address negative attributions may impact adherence behavior and feelings of stress, especially if specific contexts of self-care behavior are taken into account.     

The association between pulse wave velocity and metabolic syndrome in Korean

The objective of this study was to compare aortic (the common carotid to femoral artery) PWV, arm (the brachial to radial artery) PWV, and leg (the femoral to dorsalis pedis artery) PWV in people with or without component of the metabolic syndrome. We analyzed 3345 Korean subjects (1907 men, age 44.6?±?8.5, 1438 women, age 43.3?±?8.9). Unpaired t-test was used to compare mean values of various metabolic parameters between subjects with and without Metabolic Syndrome (MetS), and one-way analysis of variance was used to compare these variables among groups satisfying different numbers of the components of MetS. In addition, we compared of Pearson correlation coefficient between age and PWV (arotic PWV, arm PWV and leg PWV) levels of according to whether the subject had components of the metabolic syndrome or not. The present study shows that leg PWV level was found to be significantly associated with the features of the metabolic syndrome in Korean men and women. And, we confirmed that blood pressure is significantly associated with the PWV values at three locations. And, this study shows that Pearson correlation coefficient of arotic PWV and leg PWV were about 10% higher than without diabetes according to age. Further studies need to be performed to evaluate the optimal cut-off value of PWV for diabetes, hypertension, and MetS in Korean.

Implications for Rehabilitation

• Pulse wave velocity (PWV) reflects arterial stiffness, and it is a marker of both the severity of vascular damage and the prognosis of cardiovascular diseases in selected subjects, such as patients with hypertension or with abnormal glucose metabolism.

• Metabolic syndrome might be involved in the pathogenesis of PWV.

• Leg (the femoral to dorsalis pedis artery) PWV level was found to be significantly associated with the features of the metabolic syndrome in Korean.

     

The association between diabetes and cognitive changes during aging

Abstract

Background

Worldwide, we are observing a rising prevalence of dementia and mild cognitive impairments that often co-occur with the heightened incidence of non-communicable diseases in the elderly. It is suggested that type 2 diabetes and defects in glucose metabolism might predispose to poorer cognitive performances and more rapid decline in old age.     

代谢综合征与心血管疾病的关系及其组分间的交互作用

目的探讨代谢综合征(MS)及其组分与心血管病(CVD)的关系,以及MS组分间对CVD的影响是否存在交互作用。方法对舟山群岛新区8685名研究对象,按照多代谢异常和代谢综合征防治研究统一设计调查表。完成基线和随访调查包括病史问卷调查,人体指标测量及相关实验室检查,观察其组分交互作用的变化情况。结果按研究对象基线是否诊断为MS或是否具体有某项MS组分为协变量入COX比例风险模型,单因素分析显示MS与其组分中除腰围和低高密度脂蛋白外均与CVD有联系(模型1),其中血压升高的相对危险度(RR)最高3.96。模型2中调整了年龄、性别、吸烟、饮酒、高血压家属史、糖尿病家族史、高脂血症家病史、CVD家族史后,MS及其组分与CVD关系的aRR值有所下降,但MS、血压升高和高TG血症仍差异有统计学意义。模型3在模型2的基础上再对MS组间分进一步做了相互调查,发现除血压外,其他四项MS组分与CVD的关系均不显著。结论在MS组分中,血压是CVD的独立危险因素。血压与其他MS组分对于CVD的发生仅为各自的独立作用,当这些危险因素同时存在时并没有产生明显的交互作用。     

78例2型糖尿病患者药物治疗后血糖控制水平与血清同型半胱氨酸水平的关系

本文通过观察胰岛素治疗与非胰岛素治疗的2型糖尿病患者血糖控制水平与血清同型半胱氨酸水平的关系,阐述了检测血清同型半胱氨酸的重要性。     

癫痫患者服药依从性与药物信念的相关性研究

目的调查癫痫患者服药依从性及药物信念的现状,分析两者之间的相关性,为临床干预方案的制订提供参考。方法选取2018年1—8月在复旦大学附属静安区中心医院神经外科门诊就诊的癫痫患者200例作为研究对象,采用一般情况调查问卷、Morisky服药依从性量表、药物信念问卷进行调查。结果研究共发放问卷200份,回收有效问卷200份,有效回收率为100%。癫痫患者服药依从性得分为(5.98±1.63)分,药物信念必要性维度得分为(3.13±0.61)分,顾虑维度得分为(3.30±0.57)分,必要性与顾虑维度的得分差值为(-0.167±0.907)分;癫痫患者服药依从性与药物必要性呈正相关(r=0.564,P0.01)、与药物顾虑呈负相关(r=-0.459,P0.01)、与必要性与顾虑维度的得分差值呈正相关(r=0.673,P0.01)。结论癫痫患者服药必要性感知越低,顾虑感知越高,则其服药依从性越低。医务人员应帮助患者树立对药物的正确认知,减少服药顾虑,提高服药依从性,从而减少疾病对患者生活造成的不良影响。     

A comprehensive association analysis between homocysteine metabolic pathway gene methylation and ischemic stroke in a Chinese hypertensive population

BackgroundIschemic stroke (IS) is a serious global health burden. In order to improve our understanding of the risk factors associated with IS, we investigated the combined effect of the methylation of five genes related to the metabolism of homocysteine on developing IS.MethodsQuantitative methylation‐specific PCR was used to measure the levels of promoter methylation in hypertensive and stroke patients. The cutoff value calculated by the maximum Youden index was used to classify the levels of gene methylation as hypomethylation and hypermethylation. Logistic regression was used to explore the relationship between gene methylation and IS.ResultsThe methylation levels of the genes encoding methylenetetrahydrofolate dehydrogenase 1 [MTHFD1], cystathionine β‐synthase [CBS], and dihydrofolate reductase [DHFR] in hypertensive patients were higher than those in stroke patients (all p < 0.01). MTHFD1 hypermethylation, CBS hypermethylation, and DHFR hypermethylation were protective factors for stroke after adjustment for confounding factors. Compared with individuals carrying none of the biomarkers, the ORs [95% CIs] for stroke of those with 1 and 2 elevated biomarkers were 4.068 [1.670–9.913] and 15.345 [6.198–37.994] after adjustment for confounding factors. The participants with a larger number of biomarkers had an increased risk of stroke (p for trend <0.001). For the combination biomarkers, the area under the curve of the receiver operating characteristic was 0.716.ConclusionA significant linear relationship between the number of elevated biomarkers and the risk of stroke has been observed, suggesting that elevations of these biomarkers could be used for potentially predicting the disease.