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Chrysant SG. The debate over the optimal blood pressure treatment target of less than 130/80 mmHg. Postgrad Med 2023; 135:208-213. [PMID: 35285378 DOI: 10.1080/00325481.2022.2052516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The objective of this study was to analyze the controversy regarding the optimal blood pressure (BP) target of <130/80 mmHg as proposed by the 2017 American College of Cardiology/American Heart Association (ACC/AHA) across all age groups. Hypertension is a major risk factor for cardiovascular disease (CVD), stroke, and chronic kidney disease (CKD), and its optimal control is associated with lessening or preventing these complications. A recent study has argued that this BP level is universally accepted as an optimal and safe BP level. However, this argument is not accepted by other investigators, arguing that higher BP levels are as effective and safe. METHODS In order to investigate the current status of this level of BP control, a Medline search of the English literature was conducted between 2017 and February 2022, and 25 pertinent papers were selected. RESULTS The analysis of data from these studies indicates that these BP are effective in lowering the BP and preventing cardiovascular disease, heart failure, and chronic kidney disease, and they are indeed universally accepted. CONCLUSION Based on the current evidence, the current proposed by the 2017 ACC/AHA treatment guidelines are effective in lowering the BP and decreasing its cardiovascular complications and should followed, till perhaps, new data come out to the contrary.
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Affiliation(s)
- Steven G Chrysant
- Department of Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Chen B, Dou Y, Yu X, Ma D. Influence of Internet-Based Health Management on Control of Clinical Parameters in Patients With Hypertension: Four-Year Longitudinal Study. J Med Internet Res 2023; 25:e42896. [PMID: 36939826 PMCID: PMC10131880 DOI: 10.2196/42896] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 12/22/2022] [Accepted: 02/24/2023] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND In recent years, more and more studies have shown that internet-based health management can help patients with hypertension control their blood pressure. However, there is a lack of similar research in China. OBJECTIVE We designed this study to clarify the impact of long-term internet-based health management on the control of clinical parameters in patients with hypertension. These results are also expected to identify the relevant factors affecting the control of clinical parameters in hypertension more accurately toward developing more targeted health management strategies. METHODS This was a longitudinal study of internet-based health management in the five provinces of northwest China. The inclusion criteria were aged ≥18 years and no serious cognitive disease or mental disorder. After collecting the physical examination data of 8567 people in the five northwest provinces in 2013, we conducted online health management (including diet, exercise, and behavior) and follow-up. In the physical examination in 2013, 1008 new patients with hypertension were identified, who were divided into a good blood pressure control group and poor blood pressure control group. Physical examination and a questionnaire survey were conducted every 2 years to understand the changes of health management on the subjects' health-related behaviors. We then analyzed the changes of clinical indicators related to hypertension and the influencing factors related to blood pressure control in patients with hypertension. All statistical analyses were performed using R software (version 4.1.2) and a P value <.05 was considered statistically significant. RESULTS A total of 8567 people met the inclusion criteria and underwent health management. Self-comparison showed that after 4 years of health management, the smoking cessation rate and amount of exercise significantly increased (both P<.001). The low-density lipoprotein-cholesterol levels also increased (P=.005), whereas the high-density lipoprotein-cholesterol levels decreased (P=.007). The newly discovered patients with hypertension in 2013 were further screened. After 4 years of health management, their smoking cessation rate increased significantly (P=.03) and the amount of exercise increased but not significantly (P=.08). In terms of clinical indicators, the diastolic blood pressure considerably decreased (P<.001) and the systolic blood pressure slightly decreased (P=.13). The correlation analysis of blood pressure control in patients with new-onset hypertension showed that gender (female) and changing relevant factors according to health management behaviors (BMI; cereals and potatoes intake; fish, livestock meat, and eggs intake; fruit intake; and physical activity) were the protective factors of blood pressure control. CONCLUSIONS Internet-based health management has a significant and long-term effect on blood pressure control in patients with hypertension.
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Affiliation(s)
- Botian Chen
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - Yuqi Dou
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - Xue Yu
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - Defu Ma
- School of Public Health, Peking University Health Science Center, Beijing, China
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Kocak Z, Bayir B, Goksoy I, Taskapu HH. The effect of perceived social support levels on coping methods for urinary incontinence in elderly men. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:452-457. [PMID: 36921201 PMCID: PMC10004299 DOI: 10.1590/1806-9282.20221395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/08/2022] [Indexed: 03/12/2023]
Abstract
OBJECTIVE This study aimed to determine the effect of the perceived social support level on coping methods for urinary incontinence among men aged 65 years and over with urinary incontinence. METHODS A total of 92 male patients over the age of 65 years with urinary incontinence and adequate cognitive levels were included in the study. The coping methods, the environmental support, and the Multidimensional Scale of Perceived Social Support were used to collect data. RESULTS The most common method of coping was changing clothes (64 [69.6%]). The Multidimensional Scale of Perceived Social Support total mean score was 55.83±14.8, which was considered above the medium-level support. The perception level of social support caused significant differences in coping methods in individuals with urinary incontinence. CONCLUSION The view that urinary incontinence is a problem related to aging is regarded as an obstacle to seeking healthcare. Society should be made aware that urinary incontinence is not a normal condition related to aging and that it is not an insoluble problem that the elderly must endure.
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Affiliation(s)
- Zehra Kocak
- Karatay Ticaret Odası Karatay Üniversitesi, High School of Health Sciences, Department of Nursing - Konya, Turkey
| | - Berna Bayir
- Karatay Ticaret Odası Karatay Üniversitesi, High School of Health Sciences, Department of Nursing - Konya, Turkey
| | - Ibrahim Goksoy
- Necmettin Erbakan Üniversitesi, Meram Faculty of Medicine, Department of Urology - Konya, Turkey
| | - Hakan Hakki Taskapu
- Necmettin Erbakan Üniversitesi, Meram Faculty of Medicine, Department of Urology - Konya, Turkey
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Li X, Bai X, Wang J, Bai T, Zhu Y, Li S, Ren W, Niu X, Zheng J, Kou C. Metabolic outcomes in patients with type 2 diabetes mellitus after metabolic management center. Medicine (Baltimore) 2022; 101:e31342. [PMID: 36397365 PMCID: PMC9666176 DOI: 10.1097/md.0000000000031342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The Chinese Medical Doctor Association has initiated metabolic management center (MMC) program for 6 years since 2016 nationwide. It is worth investigating the level of control metabolic outcomes in patients with type2 diabetes (T2DM) after MMC model in Yan'an, northwest China. Patients with T2DM was admitted to MMC in Yan'an University Affiliated Hospital from November 2018 to July 2021. They were asked to revisit hospital every 3 months. Blood glucose, blood pressure and blood lipids at baseline were compared to its counterparts after 1 year MMC management. Glycosylated hemoglobin and low density lipoprotein cholesterol (LDL-C) level in T2DM patients after 1 year management were lower than their baseline level (glycosylated hemoglobin 7.74 ± 1.94% vs 8.63 ± 2.26%, P < .001; LDL-C 1.81 ± 0.73mmol/L vs 2.18 ± 1.49mmol/L, P < .001). Mean HOMA-β increased after management (65.89 ± 90.81% vs 128.38 ± 293.93%, P < .05). After 1 year of management, patients in high school or above group achieved higher control rate of body mass index than those in middle school or below group (71.82% vs 28.18%, P = .043). high density lipoprotein cholesterol control rate was higher in high income group (42.86% vs 34.97%, 16.28%, P = .012), while LDL-C control rate was higher in low-income group (97.67% vs 78.57%, 84.51%, P = .018). fasting plasma glucose control rate in new diagnosis group was higher than that of the middle and long course groups (71.43% vs 52.38%, 42.44%, P = .002). The comprehensive control rate increased from 9.83% at baseline to 26.15% after 1 year MMC management. The metabolic outcomes and their control rate in T2DM patients were improved after 1 year MMC management. It indicated that patients may achieve more benefits with MMC management.
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Affiliation(s)
- Xia Li
- Department of Endocrinology and Metabolism, Yan’an University Affiliated Hospital, Yan’an, Shaanxi, China
| | - Xiaogang Bai
- Department of Endocrinology and Metabolism, Yan’an University Affiliated Hospital, Yan’an, Shaanxi, China
| | - Jing Wang
- Department of Endocrinology and Metabolism, Yan’an University Affiliated Hospital, Yan’an, Shaanxi, China
| | - Ting Bai
- Department of Endocrinology and Metabolism, Yan’an University Affiliated Hospital, Yan’an, Shaanxi, China
| | - Yali Zhu
- Department of Endocrinology and Metabolism, Yan’an University Affiliated Hospital, Yan’an, Shaanxi, China
| | - Sheli Li
- Department of Endocrinology and Metabolism, Yan’an University Affiliated Hospital, Yan’an, Shaanxi, China
- * Correspondence: Sheli Li Department of Endocrinology and Metabolism, Yan’an University Affiliated Hospital, Yan’an, Shaanxi, China (e-mail: )
| | - Wenjing Ren
- Department of Endocrinology and Metabolism, Yan’an University Affiliated Hospital, Yan’an, Shaanxi, China
| | - Xiaoling Niu
- Department of Endocrinology and Metabolism, Yan’an University Affiliated Hospital, Yan’an, Shaanxi, China
| | - Jiayin Zheng
- Department of Endocrinology and Metabolism, Yan’an University Affiliated Hospital, Yan’an, Shaanxi, China
| | - Changqin Kou
- Department of Endocrinology and Metabolism, Yan’an University Affiliated Hospital, Yan’an, Shaanxi, China
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Yokokawa H, Suzuki M, Aoki N, Sato Y, Naito T. Achievement of target blood pressure among community residents with hypertension and factors associated with therapeutic failure in the northern territory of Japan. J Int Med Res 2022; 50:3000605221126878. [PMID: 36314244 PMCID: PMC9623383 DOI: 10.1177/03000605221126878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE This study aimed to determine the rate of achieving the target blood pressure (BP) defined by Japanese hypertension management guidelines and to examine factors associated with achieving the target BP. METHODS This cross-sectional study, which was conducted between January 2012 and December 2015, examined the BP control status and associated factors among 9,016 Japanese community residents with hypertension. Residents were divided into the following six groups: G1, young, middle-aged, and early-phase elderly patients; G2, patients with cerebrovascular disease; G3, patients with coronary artery disease; G4, patients with chronic kidney disease with proteinuria; G5, patients with diabetes; and G6, patients with chronic kidney disease without proteinuria. BP target achievement rates were calculated for each group. A multivariate analysis identified factors associated with "therapeutic failure" of target BP. RESULTS The target BP was achieved by 52.6% participants in G1, 84.3% in G2, 50.6% in G3, 45.6% in G4, 48.7% in G5, and 75.0% in G6. The body mass index and receiving antilipidemic medication were associated with therapeutic failure. CONCLUSION This study shows that achievement rates for treatment goals among Japanese patients with hypertension are still low. Body mass index and treatment of dyslipidemia may be associated with the control of BP.
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Affiliation(s)
- Hirohide Yokokawa
- Department of General Medicine, Juntendo University Faculty of
Medicine, Tokyo, Japan,Hirohide Yokokawa, Department of General
Medicine, Juntendo University Faculty of Medicine Hongo 2-1-1, Bunkyo-ku, Tokyo
113-8421, Japan.
| | - Mai Suzuki
- Department of General Medicine, Juntendo University Faculty of
Medicine, Tokyo, Japan
| | - Nozomi Aoki
- Department of General Medicine, Juntendo University Faculty of
Medicine, Tokyo, Japan
| | - Yuki Sato
- National Institute of Occupational Safety and Health Japan,
Japan Organization of Occupational Health and Safety, Kawasaki City, Japan
| | - Toshio Naito
- Department of General Medicine, Juntendo University Faculty of
Medicine, Tokyo, Japan
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Kurtkulagi O, Aktas G, Taslamacioglu Duman T, Bilgin S, Atak Tel BM, Kahveci G. Correlation between serum triglyceride to
HDL
cholesterol ratio and blood pressure in patients with primary hypertension. PRECISION MEDICAL SCIENCES 2022. [DOI: 10.1002/prm2.12080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ozge Kurtkulagi
- Department of Internal Medicine Canakkale Onsekiz Mart University Hospital Turkey
| | - Gulali Aktas
- Department of Internal Medicine Abant Izzet Baysal University Hospital Bolu Turkey
| | | | - Satilmis Bilgin
- Department of Internal Medicine Abant Izzet Baysal University Hospital Bolu Turkey
| | | | - Gizem Kahveci
- Department of Internal Medicine Abant Izzet Baysal University Hospital Bolu Turkey
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Chen CL, Cai AP, Nie ZQ, Huang YQ, Feng YQ. Systolic Blood Pressure and Mortality in Community-Dwelling Older Adults: The Role of Frailty. J Nutr Health Aging 2022; 26:962-970. [PMID: 36259585 DOI: 10.1007/s12603-022-1850-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate whether frailty modifies the association of systolic blood pressure (SBP) with cardiovascular mortality and all-cause mortality in community-dwelling older adults. DESIGN A prospective cohort study. SETTING A population-based study of nationally representative older Chinese adults in a community setting. PARTICIPANTS This study included participants aged 65 years or older from the Chinese Longitudinal Healthy Longevity Survey 2002-2014 and followed up to 2018. MEASUREMENTS Participants were divided into two groups according to a frailty index based on the accumulation of a 44-items deficits model. The association between SBP and mortality was analyzed using multivariable-adjusted Cox proportional hazards models. RESULTS Among 18,503 participants included, the mean age was 87.2 years and the overall median follow-up time was 42.7 months. We identified 7808 (42.2%) frail participants (mean frailty index=0.33), in which 7533 (96.5%) died during the follow-up. Effect modification by frailty was detected (P for interaction=0.032). Among frail participants, a U-shaped association was found with hazard ratios of 1.16 (95% CI, 1.02-1.32) for SBP < 100 mmHg, and 1.11 (95% CI, 1.00-1.24) for SBP ≥ 150 mmHg compared with SBP 120-130 mmHg. For non-frail older adults, a tendency toward higher risk among those with SBP ≥ 130 mmHg was observed. The analyses towards cardiovascular mortality showed similar results. CONCLUSION Our results suggest the presence of effect modification by frailty indicating a possible negative effect for elevated SBP in non-frail older adults and a U-shaped relationship of SBP in frail older adults with respect to mortality even after adjusting for diastolic blood pressure.
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Affiliation(s)
- C L Chen
- Professor Yingqing Feng or Professor Yuqing Huang, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China. 510080, (Y.Q. Feng) and (Y.Q. Huang). Tel: 86-20-83827812. Fax: 86-20-83827812
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Wang Y, Hu XJ, Wang HHX, Duan HY, Chen Y, Li YT, Luo ZL, Li X, Wang JJ, Mercer SW. Follow-up care delivery in community-based hypertension and type 2 diabetes management: a multi-centre, survey study among rural primary care physicians in China. BMC FAMILY PRACTICE 2021; 22:224. [PMID: 34774003 PMCID: PMC8590343 DOI: 10.1186/s12875-021-01564-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 10/12/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Follow-up care is crucial but challenging for disease management particularly in rural areas with limited healthcare resources and clinical capacity, yet few studies have been conducted from the perspective of rural primary care physicians (PCPs). We assessed the frequency of follow-up care delivered by rural PCPs for hypertension and type 2 diabetes - the two most common long-term conditions. METHODS We conducted a multi-centre, self-administered survey study built upon existing general practice course programmes for rural PCPs in four provinces. Information on follow-up care delivery were collected from rural PCPs attending centralised in-class teaching sessions using a set of close-ended, multiple choice questions. Binary logistic regression analysis was performed to examine physician-level factors associated with non-attainment of the target frequency of follow-up care for hypertension and type 2 diabetes, respectively. The final sample consisted of rural PCPs from 52 township-level regions. The Complex Samples module was used in the statistical analysis to account for the multistage sample design. RESULTS The overall response rate was 91.4%. Around one fifth of PCPs in rural practices did not achieve the target frequency of follow-up care delivery (18.7% for hypertension; 21.6% for type 2 diabetes). Higher education level of physicians, increased volume of daily patients seen, and no provision of home visits were risk factors for non-attainment of the target frequency of follow-up care for both conditions. Moreover, village physicians with less working experiences tended to have less frequent follow-up care delivery in type 2 diabetes management. CONCLUSIONS Efforts that are solely devoted to enhancing rural physicians' education may not directly translate into strong motivation and active commitment to service provision given the possible existence of clinical inertia and workload-related factors. Risk factors identified for target non-attainment in the follow-up care delivery may provide areas for capacity building programmes in rural primary care practice.
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Affiliation(s)
- Yi Wang
- School of Public Health, Sun Yat-Sen University, No.74 Zhongshan Road 2, Guangzhou, 510080, People's Republic of China
| | - Xiu-Jing Hu
- School of Public Health, Sun Yat-Sen University, No.74 Zhongshan Road 2, Guangzhou, 510080, People's Republic of China.,The Center for Disease Control and Prevention of Zhejiang Province, Hangzhou, People's Republic of China
| | - Harry H X Wang
- School of Public Health, Sun Yat-Sen University, No.74 Zhongshan Road 2, Guangzhou, 510080, People's Republic of China. .,JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR.
| | - Hong-Yan Duan
- Department of General Practice, Henan Provincial People's Hospital, Zhengzhou, People's Republic of China
| | - Ying Chen
- School of Public Health, Kunming Medical University, Kunming, People's Republic of China
| | - Yu-Ting Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Zi-Lin Luo
- School of Public Health, Sun Yat-Sen University, No.74 Zhongshan Road 2, Guangzhou, 510080, People's Republic of China.,Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xin Li
- Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Jia-Ji Wang
- Guangdong-Provincial Primary Healthcare Association, Guangdong, People's Republic of China.,School of Public Health, Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Stewart W Mercer
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK
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Kawabata N, Okada K, Ando A, Kurashina T, Takahashi M, Wakabayashi T, Nagata D, Kusano E, Mogi S, Sato T, Ishikawa S, Ishibashi S. Comparison of the effects of frequent versus conventional nutritional interventions in patients with type 2 diabetes mellitus: A randomized, controlled trial. J Diabetes Investig 2021; 13:271-279. [PMID: 34480785 PMCID: PMC8847137 DOI: 10.1111/jdi.13657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/23/2021] [Accepted: 08/27/2021] [Indexed: 12/01/2022] Open
Abstract
Aims/Introduction This randomized controlled trial aimed to determine whether frequent nutritional education improves the clinical parameters associated with the onset and progression of diabetic kidney disease in type 2 diabetes mellitus patients. Materials and Methods A total of 96 patients with type 2 diabetes and diabetic kidney disease were randomly assigned to the intensive intervention group that received nutritional education at every outpatient visit, and the usual intervention group that received nutritional education once a year. The anthropometric parameters, blood pressure, blood chemistry, albuminuria, protein and salt intake, and prescribed medications of 87 patients who completed the 2‐year follow up were analyzed. Results In the intensive intervention group, body mass index and salt intake significantly decreased over the study period. Hemoglobin A1c levels and body fat percentage were significantly lower in the intensive intervention group than in the usual intervention group. At the end of the 2‐year intervention period, the intensive intervention group had significantly lower salt intake (8.1 vs 9.4 g/day) than the usual intervention group. A significant positive correlation was found between salt intake and albuminuria in the overall group and intensive intervention group (r = 0.26, P = 0.02, and r = 0.36, P = 0.02, respectively). The intensive intervention group had a significantly lower insulin use rate than the usual intervention group after the 2‐year intervention period (18% vs 42%). No differences were found in estimated glomerular filtration rate and albuminuria. Conclusion Intensive nutritional education is useful for alleviating the risk factors associated with the onset and progression of diabetic kidney disease.
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Affiliation(s)
- Nao Kawabata
- Department of Clinical Nutrition, Jichi Medical University Hospital, Shimotsuke, Japan
| | - Kenta Okada
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Akihiko Ando
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Tomoyuki Kurashina
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Manabu Takahashi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Tetsuji Wakabayashi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Daisuke Nagata
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Eiji Kusano
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Satsuki Mogi
- Department of Clinical Nutrition, Jichi Medical University Hospital, Shimotsuke, Japan
| | - Toshiko Sato
- Department of Clinical Nutrition, Jichi Medical University Hospital, Shimotsuke, Japan
| | | | - Shun Ishibashi
- Department of Clinical Nutrition, Jichi Medical University Hospital, Shimotsuke, Japan.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan
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Dessie G, Burrowes S, Mulugeta H, Haile D, Negess A, Jara D, Alem G, Tesfaye B, Zeleke H, Gualu T, Getaneh T, Kibret GD, Amare D, Worku Mengesha E, Wagnew F, Khanam R. Effect of a self-care educational intervention to improve self-care adherence among patients with chronic heart failure: a clustered randomized controlled trial in Northwest Ethiopia. BMC Cardiovasc Disord 2021; 21:374. [PMID: 34344316 PMCID: PMC8336108 DOI: 10.1186/s12872-021-02170-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 07/20/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND As the burden of cardiovascular disease increases in sub-Saharan Africa, there is a growing need for low-cost interventions to mitigate its impact. Providing self-care health education to patients with chronic heart failure (CHF) is recommended as an intervention to prevent complications, improve quality of life, and reduce financial burdens on fragile health systems. However, little is known about health education's effectiveness at improving CHF self-management adherence in sub-Saharan Africa. Therefore the present study aimed to assess the effectiveness of an educational intervention to improve self-care adherence among patients with CHF at Debre Markos and Felege Hiwot Referral Hospitals in Northwest Ethiopia. METHODS To address this gap, we adapted a health education intervention based on social cognitive theory comprising of intensive four-day training and, one-day follow-up sessions offered every four months. Patients also received illustrated educational leaflets. We then conducted a clustered randomized control trial of the intervention with 186 randomly-selected patients at Debre Markos and Felege Hiwot referral hospitals. We collected self-reported data on self-care behavior before each educational session. We analyzed these data using a generalized estimating equations model to identify health education's effect on a validated 8-item self-care adherence scale. RESULTS Self-care adherence scores were balanced at baseline. After the intervention, patients in the intervention group (n = 88) had higher adherence scores than those in the control group (n = 98). This difference was statistically significant (β = 4.15, p < 0.05) and increased with each round of education. Other factors significantly associated with adherence scores were being single (β = - 0.25, p < 0.05), taking aspirin (β = 0.76, p < 0.05), and having a history of hospitalization (β = 0.91, p < 0.05). CONCLUSIONS We find that self-care education significantly improved self-care adherence scores among CHF patients. This suggests that policymakers should consider incorporating self-care education into CHF management. TRIAL REGISTRATION NUMBER PACTR201908812642231.
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Affiliation(s)
- Getenet Dessie
- Department of Nursing, School of Health Science, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Sahai Burrowes
- Public Health Program, College of Education and Health Sciences, Touro University California, Vallejo, USA
| | - Henok Mulugeta
- Departments of Nursing, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Dessalegn Haile
- Departments of Nursing, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Ayenew Negess
- Departments of Human Nutrition and Food Science, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Dubie Jara
- Department of Public Health, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Girma Alem
- Department of Midwifery, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Bekele Tesfaye
- Departments of Nursing, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Haymanot Zeleke
- Departments of Nursing, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Tenaw Gualu
- Departments of Nursing, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Temsgen Getaneh
- Department of Midwifery, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Getiye Dejenu Kibret
- Australian Centre for Public and Population Health Research, School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Desalegne Amare
- Department of Nursing, School of Health Science, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Endalkachew Worku Mengesha
- Department of Reproductive Health and Population Studies, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Fasil Wagnew
- Departments of Nursing, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Rasheda Khanam
- School of Commerce, Centre for Health Research, University of Southern Queensland, Toowoomba City, Australia
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Bilgin S, Meryem Atak Tel B, Taslamacioglu Duman T, Kurtkulagi O, Bakir Kahveci G, Sagdic T, Aktas G. Комплаєнс до лікування левотироксином хворих на гіпотиреоз під час пандемічної ери SARS-CoV-2. INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (UKRAINE) 2021; 17:103-107. [DOI: 10.22141/2224-0721.17.2.2021.230563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
Актуальність. Гіпотиреоз потребує замісної терапії левотироксином (L-T4), щоб підтримувати в пацієнтів стан еутиреозу. Кількість госпіталізацій з приводу хронічних захворювань зменшилась протягом ери COVID-19. Мета дослідження— встановити частоту госпіталізацій пацієнтів з гіпотиреозом під час пандемії COVID-19 порівняно з аналогічним періодом часу в 2019 році. Матеріали та методи. Дослідження було проведене серед пацієнтів, які звернулись у відділення внутрішньої медицини університетської лікарні Abant Izzet Baysal та отримували замісну терапію L-T4 внаслідок гіпотиреозу. 108 пацієнтів з гіпотиреозом були включені в дослідження, підписавши інформаційну згоду. Пацієнти були розділені на дві групи відповідно до прихильності до лікування: хворі, які відповідали вимогам лікування, і хворі, які не дотримувались режиму лікування. Результати. Рівень тиреотропного гормона (ТТГ) перед включенням у дослідження у групі осіб, які відповідали вимогам лікування, був вірогідно нижчим, ніж у групі хворих, які не дотримувались режиму лікування (p<0,001). При цьому рівень вільного тироксину (вТ4) серед пацієнтів першої групи був вірогідно вищим, ніж в осіб другої групи (p=0,04). Медіана нерегулярного прийому левотироксину становила 35 (10–90) днів у групі осіб, які не відповідали вимогам лікування, і 0 (0–0) днів у групі осіб, які відповідали вимогам лікування (p<0,001). Кількість днів, коли левотироксин використовувався нерегулярно, вірогідно позитивно корелювала з останнім значенням ТТГ (r=0,564, p<0,001) та негативно— з останнім значенням вT4 (r=–0,492, p<0,001). Середній об’єм еритроцитів (MCV) у хворих першої та другої груп становив 85 (69,1–97,5) та 89 (66–96,6) фл відповідно (p=0,03). Ретроспективний характер та порівняно невелика кількість досліджуваних були двома основними обмеженнями проведеного дослідження. Висновки. Дотримання режиму лікування є дуже важливим для досягнення стану еутиреозу в пацієнтів з гіпотиреозом під час пандемії COVID-19. Підвищений рівень MCV може передбачати невідповідність лікування у хворих на гіпотиреоз.
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Dessie G, Mulugeta H, Amare D, Negesse A, Wagnew F, Getaneh T, Endalamew A, Adamu YW, Tadesse G, Workineh A, Lebu S. A systematic analysis on prevalence and sub-regional distribution of undiagnosed diabetes mellitus among adults in African countries. J Diabetes Metab Disord 2020; 19:1931-1941. [PMID: 33553047 PMCID: PMC7843872 DOI: 10.1007/s40200-020-00635-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/13/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite the high prevalence of diabetes in Africa, the extent of undiagnosed diabetes in the region is still poorly understood. This systematic review and meta-analysis was designed to determine the pooled prevalence of undiagnosed diabetes mellitus among adults in Africa. METHODS We conducted a systematic desk review and electronic web-based search of PubMed, Google Scholar, EMBASE, and the World Health Organization's Hinari portal (which includes the SCOPUS, African Index Medicus, and African Journals Online databases), identifying peer-reviewed research studies on the prevalence of undiagnosed diabetes among adult individuals using pre-defined quality and inclusion criteria. We ran our search from June 1, 2018 to Jun 14, 2020. We extracted relevant data and presented descriptive summaries of the studies in tabular form. The I2 test was used to assess heterogeneity across studies. A random effects model was used to estimate the pooled prevalence of undiagnosed diabetes mellitus at a 95% confidence interval (CI). Funnel plot asymmetry and Egger's tests were used to check for publication bias. The final effect size was determined by applying a trim and fill analysis in a random-effects model. RESULTS Our search identified 1442 studies amongst which 23 articles were eligible for inclusion in the final meta-analysis. The average pooled prevalence of undiagnosed diabetes mellitus among adults was 3.85 (95% CI: 3.10-4.60). The pooled prevalence of undiagnosed diabetes mellitus based on geographic location was 4.43 (95% CI: 3.12-5.74) in Eastern Africa; 4.72 (95% CI: 2.64-6.80) in Western Africa; 4.27 (95% CI: 1.77-6.76) in Northern Africa and 1.46 (95%CI: 0.57-2.34) in southern Africa respectively. CONCLUSION Our findings indicate a high prevalence of undiagnosed diabetes in Africa and suggest that it may be more prevalent in Western Africa than the rest of the regions. Given the high levels of undiagnosed diabetes in the Africa region, more attention should be paid to incorporating diabetes screening and treatment services into existing diabetes related programs to reduce the prevalence of undiagnosed cases.
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Affiliation(s)
- Getenet Dessie
- Department of Nursing, School of Health Science, College of Medicine and Health Science, Bahr Dar University, Bahr Dar, Ethiopia
| | - Henok Mulugeta
- grid.449044.90000 0004 0480 6730Department of Nursing, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Desalegne Amare
- Department of Nursing, School of Health Science, College of Medicine and Health Science, Bahr Dar University, Bahr Dar, Ethiopia
| | - Ayenew Negesse
- grid.449044.90000 0004 0480 6730Department of Human Nutrition and Food Science, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Fasil Wagnew
- grid.449044.90000 0004 0480 6730Department of Nursing, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Temsgen Getaneh
- grid.449044.90000 0004 0480 6730Department of Midwifery, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Akililu Endalamew
- Department of Nursing, School of Health Science, College of Medicine and Health Science, Bahr Dar University, Bahr Dar, Ethiopia
| | - Yibeltal Wubale Adamu
- Department of Biomedical Science, College of Medicine and Health Science, Bahr Dar University, Bahr Dar, Ethiopia
| | - Gizachew Tadesse
- Department of Biostatics and Epidemiology, School of public health, College of Medicine and Health Science, Bahr Dar University, Bahr Dar, Ethiopia
| | - Aster Workineh
- grid.47840.3f0000 0001 2181 7878School of Public Health, University of California, Berkeley, Berkeley, CA USA
| | - Sarah Lebu
- grid.47840.3f0000 0001 2181 7878School of Public Health, University of California, Berkeley, Berkeley, CA USA
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