Diabetes care quality according to facility setting: A cross-sectional analysis in six Peruvian regions

ObjectiveTo characterize diabetes care across healthcare facilities in six Peruvian regions.MethodsCross-sectional study of patients with type 2 diabetes mellitus (T2DM), ranging from primary care facilities to hospital-based facilities, in six Peruvian regions. Data was collected by health staff trained between 2012 and 2016. We studied six diabetes care outcomes and four adequate diabetes care outcomes considering the healthcare facility as the exposure of interest. We estimated prevalence ratios (PR) and their 95% confidence intervals (95% CI) using Poisson regression with robust variance.ResultsData from 8879 patients with T2DM, mean age 59.1 years (SD ± 12.2), 53.6% males, was analyzed. Of these, 8096 (91.2%) were treated at primary care facilities. The proportions of patients who had HbA1c, LDL-c, and creatinine/microalbumin test performed increased with the setting of the healthcare facility. Overall, 39%–56% of patients had an adequate HbA1c control, being higher in hospital-based facilities with specialists in comparison to primary care facilities.ConclusionsWe observed that the higher the setting of the facility, the higher the rate of the assessed diabetes care outcomes and adequate diabetes care for four of the six targets (fasting glucose, HbA1c, LDL-c and creatinine or microalbumin) and for three of the four targets (glucose≤130 mg/dL, HbA1c ≤7%(53 mmol/mol) and LDL-c <100 mg/dL), respectively. Substantial gaps were observed at the primary care facilities, calling for the strengthening of diabetes care.     

Randomized comparison of low-dose versus high-dose interferon-alfa in chronic myeloid leukemia: prospective collaboration of 3 joint trials by the MRC and HOVON groups

The optimal dose of interferon-alfa (IFN) for chronic myeloid leukemia (CML) is unknown. Retrospective analyses suggest that low doses are as effective as high doses, with less toxicity and fewer patients abandoning the drug. The Dutch Hemato-Oncology Association (HOVON) and British Medical Research Council (MRC) cooperative groups jointly performed randomized trials in newly diagnosed CML patients, comparing high-dose IFN (5 MIU/m(2) daily) with low-dose (3 MIU, 5 times a week). Both arms allowed additional hydroxyurea to keep the white blood cell count lower than 5 x 10(9)/L. Quality of life data were collected in a subset of patients. Between 1993 and 2001, 407 patients were randomized. At a median follow-up of 53 months, there were no significant differences in overall survival (odds ratio = 1.09, 95% confidence interval, 0.81-1.46), progression-free survival, and complete hematologic or major cytogenetic responses. Fewer patients in the low-dose group abandoned IFN for reasons other than transplant or progressive disease (P =.002, 58% vs 72% at 5 years). Quality of life data showed comparable results in both arms for most factors. There is no evidence of benefit for high-dose IFN compared with low-dose for the treatment of CML. Therefore, when IFN is combined with other drugs, low-dose IFN is advised, to minimize toxicity and costs.     

Characterization of human blood dendritic cell subsets

Dendritic cells (DCs) are key antigen-presenting cells for stimulating immune responses and they are now being investigated in clinical settings. Although defined as lineage-negative (Lin(-)) HLA-DR(+) cells, significant heterogeneity in these preparations is apparent, particularly in regard to the inclusion or exclusion of CD14(+), CD16(+), and CD2(+) cells. This study used flow cytometry and a panel of monoclonal antibodies (mAbs), including reagents from the 7th Leukocyte Differentiation Antigen Workshop, to define the cellular composition of 2 standardized peripheral blood mononuclear cell (PBMCs)-derived Lin(-) HLA-DR(+) preparations. Lin(-) cells were prepared from PBMCs by depletion with CD3, CD14, CD19, CD11b, and either CD16 or CD56 mAbs. Analysis of the CD16-replete preparations divided the Lin(-) HLA-DR(+) population into 5 nonoverlapping subsets (mean +/- 1 SD): CD123 (mean = 18.3% +/- 9.7%), CD1b/c (18.6% +/- 7.6%), CD16 (49.6% +/- 8.5%), BDCA-3 (2.7% +/- 1.4%), and CD34 (5.0% +/- 2.4%). The 5 subsets had distinct phenotypes when compared with each other, monocytes, and monocyte-derived DCs (MoDCs). The CD85 family, C-type lectins, costimulatory molecules, and differentiation/activation molecules were also expressed differentially on the 5 Lin(-) HLA-DR(+) subsets, monocytes, and MoDCs. The poor viability of CD123(+) DCs in vitro was confirmed, but the CD16(+) CD11c(+) DC subset also survived poorly. Finally, the individual subsets used as stimulators in allogeneic mixed leukocyte reactions were ranked by their allostimulatory capacity as CD1b/c > CD16 > BDCA-3 > CD123 > CD34. These data provide an opportunity to standardize the DC populations used for future molecular, functional and possibly even therapeutic studies.     

Análisis de la relación dosis-respuesta de la actividad física recreativa con los eventos cardiovasculares y la mortalidad por todas las causas: el estudio REGICOR

Introduction and objectivesRegular leisure-time physical activity (LTPA) has been consistently recognized as a protective factor for cardiovascular diseases (CVD) and all-cause mortality. However, the pattern of this relationship is still not clear. The aim of this study was to assess the relationship of LTPA with incident CVD and mortality in a Spanish population.MethodsA prospective population-based cohort of 11 158 randomly selected inhabitants from the general population. LTPA was assessed by a validated questionnaire. Mortality and CVD outcomes were registered during the follow-up (median: 7.24 years). The association between LTPA and outcomes of interest (all-cause mortality and cardiovascular disease) was explored using a generalized additive model with penalized smoothing splines and multivariate Cox proportional hazard models.ResultsWe observed a significant nonlinear association between LTPA and all-cause and CVD mortality, and fatal and nonfatal CVD. Moderate-vigorous intensity LTPA, but not light-intensity LTPA, were associated with beneficial effects. The smoothing splines identified a cutoff at 400 MET-min/d. Below this threshold, each increase of 100 MET-min/d in moderate-vigorous LTPA contributed with a 16% risk reduction in all-cause mortality (HR, 0.84; 95%CI, 0.77-0.91), a 27% risk reduction in CVD mortality (HR, 0.73; 95%CI, 0.61-0.87), and a 12% risk reduction in incident CVD (HR, 0.88; 95%CI, 0.79-0.99). No further benefits were observed beyond 400 MET-min/d.ConclusionsOur results support a nonlinear inverse relationship between moderate-vigorous LTPA and CVD and mortality. Benefits of PA are already observed with low levels of activity, with a maximum benefit around 3 to 5 times the current recommendations.Full English text available from:www.revespcardiol.org/en     

The personal impact of pelvic floor symptoms and their relationship to age

Introduction and hypothesis

The aim was to evaluate the relationship between age and the impact of pelvic floor disorders (PFD) using a multi-dimensional pelvic floor questionnaire

Methods

Questionnaire data on 4,311 women attending urogynaecology clinics with PFD were stratified by age into four groups: ≤35, 36–50, 51–65 and >65 years. The symptom frequency (ranging from 0 to 100) was divided in to mild (0–33), moderate (34–67), and severe (68–100) symptoms. Impact scores for equivalent levels of symptom frequency (mild, moderate and severe symptoms) were compared in women of different ages.

Results

Overall, bowel continence was associated with the greatest bother and constipation the least. Older women were significantly less bothered by mild to moderate urinary, bowel and vaginal symptoms (except IBS and vaginal capacity) than younger women. There was no difference in the impact of severe symptoms in different ages. In contrast, for sexual symptoms, there was a significant difference in the impact in older women for all grades of severity.

Conclusions

Women’s views and attitudes towards symptoms are variable and age is a significant factor. In women attending urogynaecology clinics with pelvic floor symptoms the impact of most symptoms (particularly sexual dysfunction) become less bothersome with age.     

Whole-fat dairy food intake is inversely associated with obesity prevalence: findings from the Observation of Cardiovascular Risk Factors in Luxembourg study

Because research focusing on dairy food consumption and the risk for obesity is inconsistent and only a few studies have even examined specific dairy products, in regard to type of food and fat content, in relation to obesity risk, this cross-sectional study investigated whether dairy food consumption is associated with the prevalence of global and abdominal obesity. Data were analyzed from 1352 participants in the Observation of Cardiovascular Risk Factors in Luxembourg survey. We hypothesized that higher total dairy food consumption would be independently associated with reduced prevalence of obesity. A validated food frequency questionnaire was used to measure intakes of dairy foods. Odds for global obesity (body mass index ≥30 kg/m²) and abdominal obesity (waist circumference >102 cm for men and >88 cm for women) were determined based on total dairy food intake as well as intakes of individual low- and whole-fat dairy products (milk, yogurt, and cheese). Total dairy food intake was inversely associated with the likelihood of global obesity (odds ratio [OR], 0.51; 95% confidence interval [CI], 0.30-0.89; P < .05) and abdominal obesity (OR, 0.51; 95% CI, 0.32-0.83; P < .01). Participants in the highest tertile of whole-fat dairy intakes (milk, cheese, yogurt) had significantly lower odds for being obese (global obesity: OR, 0.45; 95% CI, 0.29-0.72; P < .01; abdominal obesity: OR, 0.35; 95% CI, 0.23-0.54; P < .001), compared with those in the lowest intake tertile, after full adjustment for demographic, lifestyle, dietary, and cardiovascular risk factor variables. Increasing consumption of dairy foods may have the potential to lower the prevalence of global and abdominal obesity.     

“Abortion—It Is My Own Body”: Women's Narratives About Influences on Their Abortion Decisions in Ghana

Globally, abortion has emerged as a critical determinant of maternal morbidity and mortality. The Ghana government amended the country's abortion law in 1985 to promote safe abortion. This article discusses the findings of a qualitative study that explored the decision-making experiences of 28 female abortion seekers aged between 15 and 30 years in Ghana. Key findings from the study are that individuals claimed autonomy in their abortion decisions; underlying the abortion decisions were pragmatic concerns such as economic difficulties, child spacing, and fear of parental reaction. In conclusion, we examine the health implications of Ghanaian women's abortion decisions.     

Validating Antonovsky's sense of Coherence scale

This study empirically supported Antonovsky's predictions that a person's Sense of Coherence is implicated in coping with life stresses and psychological distress. Sense of Coherence scales accounted for as much variance in criterion measures of Life Events stressors, Depression, and Anxiety as did traditional locus of control and social support predictor measures. Sense of Coherence scales emerged as useful additions for studies of personality characteristics implicated in personal reactions to distressing life events.