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1.
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2.
Carola Saure Carolina Caminiti Julieta Weglinski Fernanda de Castro Perez Soledad Monges 《Diabetes & Metabolic Syndrome: Clinical Research & Reviews》2018,12(2):81-85
Introduction
Duchenne muscular dystrophy (DMD) is a severe muscular disease characterized by progressive loss of functional muscle mass followed by changes in body composition.Aim
To describe body composition, resting energy expenditure (REE), and metabolic disorders in DMD patients followed-up at a tertiary care center. To analyze the association with type of steroid and ambulatory status, and to compare obese DMD patients with patients with multifactorial obesity.Population and methods
A prospective, observational, cross-sectional study was conducted. Anthropometric measurements were taken, evaluating body composition with bioelectrical impedance analysis (BIA), REE with indirect calorimetry, and biochemical parameters in all DMD patients seen between June 2013 and April 2014.Results
63 boys between 5.4 and 18.7 years of age were evaluated. Diagnosis of obesity ranged from 28% measuring body mass indexZ-score (BMIZ-score) to 70% using percentage of fat mass (%FM). Patients who had lost gait had a significantly higher %FM than those in whom gait was preserved (72% vs 46%, p < 0.05).Insulin resistance was present in 29% associated with BMI Z-score and waist circumference and 40% had dyslipidemia associated with %FM, both of which were steroid independent. In obese DMD patients REE was lower than predicted and also lower than controls, and persist when dividing the patients into ambulators and non-ambulators.Conclusions
A high prevalence of obesity was observed. BMI-Z-score underestimates the degree of FM. No correlation was found between steroid type and body composition or metabolic disorders. No differences were found in REE between ambulators and non-ambulators. Obese DMD patients have a lower REE than controls. 相似文献3.
Caroline King Sidney Atwood Chris Brown Adrianne Katrina Nelson Mia Lozada Jennie Wei Maricruz Merino Cameron Curley Olivia Muskett Samantha Sabo Vikas Gampa John Orav Sonya Shin 《Primary Care Diabetes》2018,12(3):212-217
Objectives
To evaluate the role of primary care healthcare delivery on survival for American Indian patients with diabetes in the southwest United States.Methods
Data from patients with diabetes admitted to Gallup Indian Medical Center between 2009 and 2016 were analyzed using a log-rank test and Cox Proportional Hazards analyses.Results
Of the 2661 patients included in analysis, 286 patients died during the study period. Having visited a primary care provider in the year prior to first admission of the study period was protective against all-cause mortality in unadjusted analysis (HR (95% CI) = 0.47 (0.31, 0.73)), and after adjustment. The log-rank test indicated there is a significant difference in overall survival by primary care engagement history prior to admission (p < 0.001). The median survival time for patients who had seen a primary care provider was 2322 days versus 2158 days for those who had not seen a primary care provider.Conclusions
Compared with those who did not see a primary care provider in the year prior to admission, having seen a primary care provider was associated with improved survival after admission. 相似文献4.
Olga Horvat Jelena Popržen Ana Tomas Milica Paut Kusturica Zdenko Tomić Ana Sabo 《Primary Care Diabetes》2018,12(2):147-154
Aims
The aims of this study were to assess patients’ non-adherence and associated factors to antidiabetic medication in the primary care setting in the eastern part of Bosnia and Herzegovina (BiH).Methods
We conducted a retrospective chart review of 323 patients with type 2 diabetes mellitus (T2DM) attending the primary health care center of the Fo?a municipality in eastern part of BiH and measured adherence to antidiabetic medication. Adherence was measured using a pill count method.Results
The majority of patients were treated with oral therapy (84.21%). Half of the patients (48%) treated pharmacologically were non-adherent and patients on oral and insulin combination therapy showed better adherence than those on oral therapy. Age (B = ?0.749; p = 0.004), copayment (B = 0.549; p = 0.028) and oral therapy (B = 0.827; p = 0.045) were the strongest predictors of poor adherence.Conclusion
About half of the patients were non-adherent to antidiabetic medication. Interventions oriented towards policy changes regarding availability of antidiabetic medication through copayment reductions, and providing healt education to younger population and patients on oral therapy could lead to better adherence among T2DM patients in eastern part of BiH. 相似文献5.
João de Sousa Pedro Marques Vítor Martins António Hipólito-Reis Luís Duarte Inês Joaquim Diogo Monteiro Giuseppe Boriani Claudia Wolff Andrea Grammatico Luigi Padeletti 《Revista portuguesa de cardiologia》2018,37(12):973-978
Introduction
The MINERVA trial established that atrial preventive pacing and atrial antitachycardia pacing (DDDRP) in combination with managed ventricular pacing (MVP) reduces progression to permanent atrial fibrillation (AF) in patients with paroxysmal or persistent AF and bradycardia who need cardiac pacing, compared to standard dual-chamber pacing (DDDR). It was shown that AF-related health care utilization was significantly lower in the DDDRP + MVP group than in the control group. Cost analysis demonstrated significant savings related to this new algorithm, based on health care costs from the USA, Italy, Spain and the UK.Objective
To calculate the savings associated with reduced health care utilization due to enhanced pacing modalities in the Portuguese setting.Methods
The impact on costs was estimated based on tariffs for AF-related hospitalizations and costs for emergency department and outpatient visits in Portugal.Results
The MINERVA trial showed a 42% reduction in AF-related health care utilization thanks to the new algorithm. In Portugal, this represents a potential cost saving of 2323 euros per 100 patients in the first year and 17 118 euros over a 10-year period. Considering the number of patients who could benefit from this new algorithm, Portugal could save a total of 75 369 euros per year and 555 410 euros over 10 years. Additional savings could accrue if heart failure and stroke hospitalizations were considered.Conclusion
The combination of atrial preventive pacing, atrial antitachycardia pacing and an algorithm to minimize the detrimental effect of right ventricular pacing reduces recurrent and permanent AF. The new DDDRP + MVP pacing mode could contribute to significant costs savings in the Portuguese health care setting. 相似文献6.
Joseph Jonathan Lee Matthew James Thompson Juliet Alexandra Usher-Smith Constantinos Koshiaris Ann Van den Bruel 《Primary Care Diabetes》2018,12(3):254-264
Background
The epidemiology of type 1 diabetes mellitus (T1DM) suggests diagnostic delays may contribute to children developing diabetic ketoacidosis at diagnosis. We sought to quantify opportunities for earlier diagnosis of T1DM in primary care.Methods
A matched case-control study of children (0–16 years) presenting to UK primary care, examining routinely collected primary care consultation types and National Institute for Health and Care Excellence (NICE) warning signs in the 13 weeks before diagnosis.Results
Our primary analysis included 1920 new T1DM cases and 7680 controls. In the week prior to diagnosis more cases than controls had medical record entries (663, 34.5% vs 1014, 13.6%, odds ratio 3.46, 95% CI 3.07–3.89; p < 0.0001) and the incidence rate of face-to-face consultations was higher in cases (mean 0.32 vs 0.11, incidence rate ratio 2.90, 2.61–3.21; p < 0.0001). The preceding week entries were found in 330 cases and 943 controls (17.2% vs 12.3%, OR 1.49, 1.3–1.7, p < 0.0001), but face-to-face consultations were no different (IRR 1.08 (0.9–1.29, p = 0.42)).Interpretation
There may be opportunities to reduce time to diagnosis for up to one third of cases, by up to two weeks. Diagnostic opportunities might be maximised by measures that improve access to primary care, and public awareness of T1DM. 相似文献7.
Hosien Shahdadi Morteza Salarzaee Abbas Balouchi 《The Indian journal of tuberculosis》2018,65(2):159-163
Background
The quality of life is an important indicator of quality of care in chronic diseases such as diabetes and TB. The present research is conducted with an aim to assess the Quality of Life of Diabetic Patients with Smear Positive PTB.Methods
This cross-sectional study was conducted on 62 diabetic patients with smear positive PTB from January to May 2016 in a diabetes clinic in Zahedan city (southeast of Iran). A simple random sampling method was used in this study. Instrument for data collection was quality of life (SF-36) questioner.Results
Total quality of life score was 48 that showed an average level of quality of life. Sixty-five patients with diabetes and affected by smear positive pulmonary tuberculosis (PTB) with the average age of 51.30 ± 10.84 years participated in this research. Four patients (0.06%) suffered from type 1 diabetes and 58 (94%) from type 2 diabetes, and all of them were smear positive PTB patients. Study of their quality of life revealed that, in general, the average scores for quality of life in the two main subgroups of physical health and mental health were lower than the average and, among the eight studied dimensions, the highest scores were those for physical activity (60 ± 14.23) and the lowest (31.42 ± 12.14) for general health in the subgroup of physical health.Conclusion
Results indicated that the patients had a low quality of life although they received the care and treatments that are effective in patients with diabetes and suffering from smear-positive PTB. 相似文献8.
Per Lundberg Rune Andersson Elizabeth S. Machado Tomaz Pinheiro da Costa Cristina Barroso Hofer 《The Brazilian journal of infectious diseases》2018,22(5):412-417
Background
Perinatally HIV-infected children are surviving into adulthood, and getting pregnant. There is a scarcity of information on health and pregnancy outcomes in these women.Aim
To evaluate characteristics related to HIV disease and pregnancy outcomes in perinatally infected women, and to compare these women with a group of youth with behaviorally acquired HIV-infection, at a reference hospital in Rio de Janeiro, Brazil.Methods
A cohort study. Epidemiological, clinical, and laboratory data were compared between perinatally (PHIV) and behaviorally HIV-infected (BHIV) pregnant youth with the primary aim to study pregnancy outcomes in the PHIV group and compare with outcomes to BHIV group.Results
Thirty-two pregnancies occurred in PHIV group, and 595 in BHIV group. A total of seven (22%) PHIV women and 64 (11%) BHIV women had a premature delivery (p = 0.04), however, when adjusting for younger age at pregnancy, and antiretroviral therapy initiation in 1st trimester of pregnancy (OR = 18.66, 95%CI = 5.52–63.14), the difference was no longer significant. No cases of mother-to-child HIV transmission (MTCT) were observed in the PHIV group while there was a 2% MTCT rate in BHIV group.Conclusion
Pregnancy among PHIV was as safe as among BHIV. The differences between those groups were probably related to treatment and prolonged care in the first group. 相似文献9.
10.
E. Gedda A. Robbins M. Hentzien A. Giltat V. Pinel-Petit J. Souille Y. N’Guyen 《La Revue de médecine interne / fondée ... par la Société nationale francaise de médecine interne》2017,38(1):8-16
Introduction
We assessed (i) the frequency of consultations for faintness in the Emergency department (ED) of a University hospital centre (UHC), (ii) clinical epidemiology and (iii) cost of faintness, taking a particular interest into the determining risk factors for hospitalization.Methods
This epidemiological study has been conducted retrospectively, from data obtained for every patient having consulted for faintness in ED of Reims UHC (01/01/12–03/31/12). Every medical record was classified as syncope/lipothymia/brief consciousness loss on one hand and as syncope according to the definition of the French Health High Authority (FHHA).Results
Three hundred and forty-one patients out of 5953 (5.7%) were referred for faintness during the study period. Medical records were analysed for 296 patients. Sixty-two point eight percent were women, with a median age of 43 years. Physical examination was normal for 57% of patients. For 48% of cases, there was no complete consciousness loss thus corresponding to lipothymia, which is not taken into account by the FHHA definition. Median length of stay in the ED was 4 hours and 67 patients (22.6%) were hospitalized. Minimal estimated cost was 280,000 euros. Risk factors independently associated with hospitalization were age ≥ 60 and complete consciousness loss unlike predisposing circumstances to vagal hypertonia.Conclusion
Age ≥ 60 and complete consciousness loss seemed to be associated with hospitalization. 相似文献11.
Aims
In 1995, nutrition labeling became mandatory in South Korea. These regulations help consumers make reasonable choices when purchasing food based on nutritional value by providing the nutritional properties of processed foods. We investigated the association between perceptions about nutrition labeling and insulin resistance (IR) in people with no diagnosis of diabetes mellitus (DM).Methods
This study used data from the sixth Korea National Health and Nutrition Examination Survey (KNHANES VI-3 in 2015, n = 2931). We used multiple regression analysis to investigate the relationship between perceptions about nutrition labeling and the homeostatic model assessment for insulin resistance (HOMA-IR).Results
75.2% of participants were aware of nutrition labeling and 24.8% of participants checked nutrition labeling and actively used the information. “Actively checked and used the nutrition labeling” was inversely associated with HOMA-IR scores (check nutrition facts and make labeling-dependent purchase decisions: β = ?0.108, p = 0.0164). These associations were more significant in people who were obese or paid more attention to their health.Conclusion
High levels of perceptions about nutrition labeling and active use of such information could have positive effects on reducing IR and preventing DM. Therefore, it is necessary to improve public perception for effective implementation of healthcare programs. 相似文献12.
Sara Blanco-Conde Teresa Nebreda-Mayoral Cristina Labayru-Echeverría M. Fe Brezmes-Valdivieso Ramiro López-Medrano Begoña Nogueira-González 《Enfermedades infecciosas y microbiología clínica》2018,36(10):644-647
Introduction
Lady Windermere syndrome (LWS) is a pulmonary disease caused by Mycobacterium avium complex (MAC). The objective of this study is to ascertain its frequency and characteristics in the northern area of the autonomous community of Castile and León.Methods
A retrospective study of patients with MAC isolates in respiratory samples from five public hospitals in the autonomous community over a six-year period, following the ATS/IDSA criteria. The MAC strains were identified by GenoType Mycobacterium reverse hybridisation probes or PCR-RFLP analysis of the hsp65 gene.Results
Of 183 cases of MAC identified, only five women (2.7%) aged 68.8 ± 10.7 years met LWS criteria. In three cases, MAC was isolated jointly and intermittently with other pathogens. Only one patient was treated according to ATS/IDSA criteria.Discussion
LWS remains underestimated, with affected patients representing a significant burden on healthcare resources over long periods of time. As a result, greater microbiological and therapeutic knowledge of the syndrome is needed. 相似文献13.
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14.
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15.
16.
Ana Isabel Morales García Margarita Martínez Atienza María García Valverde Juan Fontes Jimenez Antonio Martínez Morcillo M. Angustias Esteban de la Rosa Pablo de Diego Fernández Miguel García González Rafael Fernández Castillo Irene Argüelles Toledo Juan Antonio Bravo Soto Rafael Esteban de la Rosa 《Nefrología : publicación oficial de la Sociedad Espa?ola Nefrologia》2018,38(2):190-196
Introduction
Although autosomal dominant polycystic kidney disease is the most common hereditary kidney disease, available data tend to be limited to after initiation of renal replacement therapy.Objective
To ascertain an overview of autosomal dominant polycystic kidney disease within the health area of Granada in southern Spain.Material and methods
From January 2007 to December 2016, we collected clinical, family and demographic information about all patients with autosomal dominant polycystic kidney disease, irrespective of whether or not they were treated with RRT, in the Granada health area. The computer software SPSS 15.0 and GenoPro were used.Results
50.6% of the 1,107 diagnosed patients were men. 99.1% were Caucasian and 4–6 generations/family were studied. The geographical distribution was heterogeneous. There was no family history in 2.43%. The mean age of diagnosis was 34.0 ± 17.80 years and the diagnosis was made after having offspring in 57.7% of cases. The main reason for diagnosis was family history (46.4%). The mean age of initiation of renal replacement therapy was 54.2 ± 11.05 years. 96.3% of the deceased had some degree of renal failure at the time of death. The mean age of death was 60.9 ± 14.10 years, the main cause of death being unknown in 33.5% of cases, followed by cardiovascular (27.8%).Conclusions
Cases and families were concentrated in certain geographical areas and a significant number of individuals were undiagnosed prior to cardiovascular death or diagnosed late after reproduction. Given that there is currently no curative treatment, the primary prevention strategy of preimplantation genetic diagnosis should play a leading role. 相似文献17.
Ana Madueño Jonathan González-García María del Mar Alonso Socas María Antonia Miguel Gómez María Lecuona 《Enfermedades infecciosas y microbiología clínica》2018,36(8):498-501
Introduction
Limited therapeutic options and high mortality make the management of OXA-48-like carbapenemase-producing Klebsiella pneumoniae (KPOXA-48) bacteraemia complicated. The aim of the study was to describe the clinical characteristics of KPOXA-48 bacteraemia between October 2013 and December 2016.Material and methods
The variables to analyse were retrospectively collected from medical records. Carbapenemase production was confirmed by phenotypic and molecular methods.Results
A total of 38 patients with bacteraemia were included, mainly classified as hospital-acquired (n = 31). The majority of cases were secondary bacteraemia (n = 26), most commonly arising from the urinary tract (n = 11). All isolates presented a multidrug-resistant profile with the extended spectrum beta-lactamase CTX-M-15 and the carbapenemase OXA-48-like production. The crude mortality rate with adequate targeted antibiotic therapy was 0%, rising to 55% with inadequate treatment (p = 0.0015).Conclusions
This study highlights the importance of identifying this resistance mechanism, the patient factors, type of bacteraemia and adequacy of antibiotic therapy in the outcome of bacteraemia. 相似文献18.
Manuel Gorostidi Mercedes Sánchez-Martínez Luis M. Ruilope Auxiliadora Graciani Juan J. de la Cruz Rafael Santamaría María D. del Pino Pilar Guallar-Castillón Fernando de Álvaro Fernando Rodríguez-Artalejo José R. Banegas 《Nefrología : publicación oficial de la Sociedad Espa?ola Nefrologia》2018,38(6):606-615
Background
Chronic kidney disease (CKD) is a public health problem worldwide. We aimed to estimate the CKD prevalence in Spain and to examine the impact of the accumulation of cardiovascular risk factors (CVRF).Material and methods
We performed a nationwide, population-based survey evaluating 11,505 individuals representative of the Spanish adult population. Information was collected through standardised questionnaires, physical examination, and analysis of blood and urine samples in a central laboratory. CKD was graded according to current KDIGO definitions. The relationship between CKD and 10 CVRF was assessed (age, hypertension, general obesity, abdominal obesity, smoking, high LDL-cholesterol, low HDL-cholesterol, hypertriglyceridaemia, diabetes and sedentary lifestyle).Results
Prevalence of CKD was 15.1% (95% CI: 14.3-16.0%). CKD was more common in men (23.1% vs 7.3% in women), increased with age (4.8% in 18-44 age group, 17.4% in 45-64 age group, and 37.3% in ≥ 65), and was more common in those with than those without cardiovascular disease (39.8% vs 14.6%); all P < .001. CKD affected 4.5% of subjects with 0-1 CVRF, and then progressively increased from 10.4% to 52.3% in subjects with 2 to 8-10 CVRF (P trend < .001).Conclusions
CKD affects one in seven adults in Spain. The prevalence is higher than previously reported and similar to that in the United States. CKD was particularly prevalent in men, older people and people with cardiovascular disease. Prevalence of CKD increased considerably with the accumulation of CVRF, suggesting that CKD could be considered as a cardiovascular condition. 相似文献19.
20.
Hamideh Lari Rahim Tahmasebi Azita Noroozi 《Diabetes & Metabolic Syndrome: Clinical Research & Reviews》2018,12(1):45-50