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Introduction: We aim to implement healthcare transition (HCT) education for youth with congenital heart disease (CHD) and assess HCT preparedness for cardiac self-care. Methods: An HCT clinic was implemented at an academic pediatric cardiology clinic for CHD youth 17 years of age and older. An educator used transition readiness assessment questionnaires and discussed HCT material. The percentage of eligible youth who received HCT education and the cause for missed occurrences were tracked. Plan-do-study-act cycles began in August 2020 to improve the number of youths reached. Secondary analyses assessed improvement differences among those without cardiac procedures or disabilities. Results: HCT education provision improved from a mean of 38% to 73% in the 17-year and older age group by December 2022. Communication failure was the leading cause of missed visits in 2021 (30%), reduced to 0 by 2022 following plan-do-study-act cycles. Other missed HCT visits included clinic add-ons after screening, limited staff availability, and unidentified eligibility. Readiness assessments were similar for youth with and without prior cardiac procedures, for example, confidence in taking charge of their health care (P = 0.47) and moving to adult care (P = 0.22). Adolescents with disabilities were significantly less confident than those without disabilities in taking charge of their heart health care (6.3 versus 7.5, P = 0.04) and moving to adult care (4.9 versus 7.4, P < 0.001). Conclusions: Implementation of a CHD HCT clinic improved successful education delivery. Provider engagement and clinic staffing are important for sustainability. HCT knowledge gaps exist for all adolescents, yet those with disabilities had the greatest deficits.
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Visceral hyperalgesia is common among children with complex medical conditions. Infants with complex congenital heart disease, specifically single ventricle interstage patients, are often found to have feeding intolerance and irritability. Gabapentin treatment has shown promise for symptomatic improvement for visceral hyperalgesia in some patients. We present a case series of five patients in which four of the five patients showed improvement within 48 h of starting gabapentin. The use of gabapentin in single ventricle interstage patients to treat visceral hyperalgesia shows promise based on our case series, but future multi-center prospective studies would be beneficial.
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Cardiopatias Congênitas , Síndrome do Coração Esquerdo Hipoplásico , Coração Univentricular , Lactente , Criança , Recém-Nascido , Humanos , Gabapentina/uso terapêutico , Estudos Prospectivos , Hiperalgesia , Ventrículos do Coração/anormalidades , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Study objective: Improve the efficiency of an inpatient clinical decision support tool (CDS) for patients with adult congenital heart disease (ACHD). Design: The efficiency of a CDS was evaluated across two time periods and compared. Setting: An academic, tertiary care center. Participants: ACHD patients roomed in an inpatient setting. Intervention: Plan-Do-Study-Act (PDSA) methods were applied starting in 2021 and included refinement of diagnostic codes and the addition of department encounter codes. Main outcome measures: True positive and false positive CDS alerts. Results: Baseline data from 2017 had a median (IQR) of 38 (17) and 2019 baseline data had 65 (19) total alerts per month. Combining both baseline data years, the median true positive CDS alerts was 47.3 %. There were 71 (6) total alerts per month for the 2021-2022 time period and with ongoing PDSA cycles and optimization in the CDS the true positive alerts improved substantially resulting in a shifting of the median to 78.9 % within 9 months. Conclusion: CDS can efficiently notify providers when an ACHD patient is encountered. The use of ICD 10 codes alone to identify ACHD patients has limited accuracy with a high proportion of false positives. Ongoing revision of the CDS system methods is important to improving efficiency and minimizing provider alert fatigue.
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BACKGROUND: Poor self-management of heart failure (HF) contributes to devastating health consequences. Our innovative sensor-controlled digital game (SCDG) integrates data from sensors to trigger game rewards, progress, and feedback based on the real-time behaviors of individuals with HF. OBJECTIVE: The aim of this study is to compare daily weight monitoring and physical activity behavior adherence by older adults using an SCDG intervention versus a sensors-only intervention in a feasibility randomized controlled trial. METHODS: English-speaking adults with HF aged 55 years or older who owned a smartphone and could walk unassisted were recruited from Texas and Oklahoma from November 2019 to August 2020. Both groups were given activity trackers and smart weighing scales to track behaviors for 12 weeks. The feasibility outcomes of recruitment, retention, intervention engagement, and satisfaction were assessed. In addition to daily weight monitoring and physical activity adherence, the participants' knowledge, functional status, quality of life, self-reported HF behaviors, motivation to engage in behaviors, and HF-related hospitalization were also compared between the groups at baseline and at 6, 12, and 24 weeks. RESULTS: A total of 38 participants with HF-intervention group (IG; 19/38, 50%) and control group (CG; 19/38, 50%)-were enrolled in the study. Of the 38 participants, 18 (47%) were women, 18 (47%) were aged 65 years or older, 21 (55%) had been hospitalized with HF in the past 6 months, and 29 (76%) were White. Furthermore, of these 38 participants, 31 (82%)-IG (15/19, 79%) and CG (16/19, 84%)-had both weight monitoring and physical activity data at the end of 12 weeks, and 27 (71%)-IG (14/19, 74%) and CG (13/19, 68%)-participated in follow-up assessments at 24 weeks. For the IG participants who installed the SCDG app (15/19, 79%), the number of days each player opened the game app was strongly associated with the number of days the player engaged in weight monitoring (r=0.72; P=.04) and the number of days with physical activity step data (r=0.9; P<.001). The IG participants who completed the satisfaction survey (13/19, 68%) reported that the SCDG was easy to use. Trends of improvement in daily weight monitoring and physical activity in the IG, as well as within-group improvements in HF functional status, quality of life, knowledge, self-efficacy, and HF hospitalization in both groups, were observed in this feasibility trial. CONCLUSIONS: Playing an SCDG on smartphones was feasible and acceptable for older adults with HF for motivating daily weight monitoring and physical activity. A larger efficacy trial of the SCDG intervention will be needed to validate trends of improvement in daily weight monitoring and physical activity behaviors. TRIAL REGISTRATION: ClinicalTrials.gov NCT03947983; https://clinicaltrials.gov/ct2/show/NCT03947983.
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BACKGROUND: Difficulties in coping with and self-managing heart failure (HF) are well known. The COVID-19 pandemic may further complicate self-care practices associated with HF. OBJECTIVE: The aim of this study was to understand COVID-19's impact on HF self-care, as well as related coping adaptations that may blunt the impact of COVID-19 on HF health outcomes. METHODS: A qualitative study using phone interviews, guided by the framework of vulnerability analysis for sustainability, was used to explore HF self-care among older adults in central Texas during the late spring of 2020. Qualitative data were analyzed using directed content analysis. RESULTS: Seventeen older adults with HF participated (mean [SD] age, 68 [9.1] years; 62% female, 68% White, 40% below poverty line, 35% from rural areas). Overall, the COVID-19 pandemic had an adverse impact on the HF self-care behavior of physical activity. Themes of social isolation, financial concerns, and disruptions in access to medications and food indicated exposure, and rural residence and source of income increased sensitivity, whereas adaptations by healthcare system, health-promoting activities, socializing via technology, and spiritual connections increased resilience to the COVID-19 pandemic. CONCLUSIONS: The study's findings have implications for identifying vulnerabilities in sustaining HF self-care by older adults and empowering older adults with coping strategies to improve overall satisfaction with care and quality of life.
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COVID-19 , Insuficiência Cardíaca , Idoso , Feminino , Insuficiência Cardíaca/terapia , Humanos , Masculino , Pandemias , Qualidade de Vida , SARS-CoV-2 , AutocuidadoRESUMO
BACKGROUND: Poor self-management of heart failure (HF) has contributed to poor health outcomes. Sensor-controlled digital games (SCDGs) integrates data from behavior-tracking sensors to trigger progress, rewards, content, and positive feedback in a digital game to motivate real-time behaviors. OBJECTIVES: To assess the usability of an SCDG prototype over a week of game-playing among 10 older adults with HF in their homes. METHODS: During initial play, participants' SCDG experiences were observed in their homes using a checklist based on the seven-item Serious Game User Evaluator (SeGUE) instrument. After a week of game-playing, participants completed a survey guided by the Intrinsic Motivation Inventory, to provide their perceptions of the SCDG's usability. Qualitative analysis via semistructured interview-derived themes on experiences playing the SCDG, perceptions regarding engaging with the SCDG, and any usability issues encountered. RESULTS: Ten HF participants (50% women and 50% White) played the SCDG for an average of 6 out of 7 days. Nine found the SCDG to be interesting, satisfying, and easy to play. The average step count over a week was 4,117 steps (range: 967-9,892). Average adherence with weight monitoring was 5.9 days in a week. Qualitative analysis yielded outcomes regarding attitudes toward SCDG, and barriers and facilitators that influenced participants' engagement with the SCDG. CONCLUSION: To the best of the authors' knowledge, this usability and feasibility study is the first to report an SCDG designed to improve HF self-management behaviors of older adults in their homes. Future research should consider several issues, such as user profiles, prior game-playing experiences, and network conditions most suitable for connected health interventions for older adults living in the community.
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Insuficiência Cardíaca , Idoso , Exercício Físico , Feminino , Humanos , Masculino , Design Centrado no Usuário , Interface Usuário-Computador , Jogos de VídeoRESUMO
The dramatic increase in bacterial resistance over the past three decades has greatly reduced the effectiveness of nearly all clinical antibiotics, bringing infectious disease to the forefront as a dire threat to global health. To combat these infections, adjuvant therapies have emerged as a way to reactivate known antibiotics against resistant pathogens. Herein, we report the evaluation of simplified α-pyrone adjuvants capable of potentiating penicillin G against Pseudomonas aeruginosa, a Gram-negative pathogen whose multidrug-resistant strains have been labeled by the Centers for Disease Control and Prevention as a serious threat to public health.
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Antibacterianos/farmacologia , Penicilina G/farmacologia , Pseudomonas aeruginosa/efeitos dos fármacos , Pironas/farmacologia , Antibacterianos/química , Relação Dose-Resposta a Droga , Testes de Sensibilidade Microbiana , Estrutura Molecular , Penicilina G/química , Pironas/química , Relação Estrutura-AtividadeRESUMO
Encouragement of students across all communities through scientific outreach programs is critical to engaging the next generation, exciting young minds to pursue careers in science and medicine. Herein, we present a uniquely structured and widely influential science outreach program. Founded in 2005, the Duke Chemistry Outreach (DCO) employs a pedagogical approach to outreach that aims to teach its audience a new scientific concept, while instilling a pure enjoyment of science. DCO has performed 583 events reaching over 70,000 participants throughout 2,270 hours, with the majority of events in Durham, the surrounding North Carolinian communities, and across 8 other states. The flexibility and diversity of this outreach program creates a framework amendable for others to adopt in both secondary and higher education settings.
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Química/educação , Relações Comunidade-Instituição , Ciência/educação , Universidades , Relações Comunidade-Instituição/economia , Humanos , North Carolina , Pesquisadores , EstudantesRESUMO
Over the past 30 years, there has been a dramatic rise in the number of infections caused by multidrug-resistant bacteria, which have proliferated due to the misuse and overuse of antibiotics. Over this same time period, however, there has also been a decline in the number of antibiotics with novel mechanisms of action coming to market. Therefore, there is a growing need for an increase in the speed at which new antibiotics are discovered and developed. Natural products produced by bacteria have been and continue to be a robust source of novel antibiotics; however, new and complementary methods for screening large bacterial libraries for novel antibiotic production are needed due to the current agar methods being limited in scope, time consuming, and prone to error. Herein, we describe a rapid, robust, and quantitative high-throughput liquid culture screening method for antibiotic production by bacteria. This method has the ability to screen both mono- and coculture mixtures of bacteria in vitro and be adapted to other phenotypic natural product analyses. Over 260 bacterial species were screened in monoculture, and 38 and 34% were found to produce antibiotics capable of inhibition of Staphylococcus aureus or Escherichia coli, respectively, with 8 and 4% being classified as strong producers (≥30% growth inhibition), respectively. Bacteria found to not produce antibiotics in monoculture were also screened in coculture using an adaptation of this method. Of the more than 270 cocultures screened, 14 and 30% were found to produce antibiotics capable of inhibition of S. aureus or E. coli, respectively. Of those bacteria found to produce antibiotics in monoculture, 43 bacteria were subjected to 16S rRNA sequencing and found to be majority Pseudomonas (37%), Serratia (19%), and Bacillus (14%) bacteria, but two novel producers, Herbaspirillum and Kluyvera, were also found.
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OBJECTIVES: Echocardiography is used to quantitatively characterize cardiovascular function in fetuses with cardiac abnormalities and inform decisions for fetal or perinatal interventions. It is clinically important to understand the reproducibility of these measures, particularly between testers. While studies have reported intra-observer variability and inter-observer variability, little is known about test-retest variability for these measures. We hypothesized that even in a high volume echocardiography laboratory, quantitative measurements will demonstrate higher test-retest variability compared with inter-observer variability and intra-observer variability of the same measurements. METHODS: Prospective study of uncomplicated, singleton pregnancies to evaluate fetal measures of cardiovascular function obtained by echocardiography. One sonographer obtained predefined variables, and then, a second sonographer obtained the same variables 15 minutes after the first sonographer. Separate data acquisitions were obtained by the two sonographers to evaluate test-retest variability. Intra-observer variability and inter-observer variability were also evaluated. RESULTS: Thirty fetuses between 17- and 36-week gestation were enrolled. Time-based variables had the best intra-observer agreement and inter-observer agreement (1.2%-7.4%), while 2D (7.5%-10%), M-mode (4.9%-10.1%), and velocity-time integral (VTI; 2.6%-13.8%) measurements had poorer agreement. For all variables, test-retest agreement was worse (3%-32.1%), particularly for measurement of myocardial performance index (MPI; 19.7%-21.1%), cardiac output estimation (27.2%-27.9%), and VTI-based indices (14.7%-32.1%). CONCLUSIONS: In a laboratory highly experienced in quantitative fetal echocardiography, intra-observer agreement and inter-observer agreement are good for most quantitative parameters. However, test-retest agreement is fair or poor for several variables, notably the MPI, cardiac output estimation, and VTI-based indices. Understanding how these measures vary between separate acquisitions is important for clinical interpretation and decision making.
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Cardiopatias Congênitas/diagnóstico por imagem , Ultrassonografia Doppler/métodos , Ultrassonografia Pré-Natal/métodos , Estudos de Avaliação como Assunto , Feminino , Humanos , Variações Dependentes do Observador , Gravidez , Estudos Prospectivos , Reprodutibilidade dos TestesRESUMO
The purpose of this study was to assess the diagnostic capabilities of transesophageal echocardiography (TEE) compared to completion angiography for detection of residual post-operative pulmonary artery lesions. This is a retrospective review of 19 consecutive surgical cases involving the pulmonary arteries that had post-operative TEE and completion angiography from 2014 to 2017. The echocardiograms were reviewed by 2 blinded examiners and categorized as adequate or inadequate visualization of the surgical repair. Based on TEE images, the surgical repair was graded as no revision necessary, residual lesion present requiring revision, or unable to assess. TEE was compared to completion angiography to determine the ability of each method to detect residual pulmonary artery lesions. Fifty-three percent of TEE imaging was graded as inadequate. Based on TEE, surgical revision was indicated in 2 of 19 cases. Completion angiography documented 4 additional residual lesions resulting in surgical revision in 6 of 19 patients. TEE sensitivity for detecting residual pulmonary artery lesions was 40%. One Glenn patient with adequate image quality and repair by TEE had moderate left pulmonary artery stenosis by completion angiography. All other discrepancies occurred in patients with inadequate TEE imaging. No patient with pulmonary artery abnormalities had hemodynamic instability or excessive desaturations. Completion angiography-related complications included three transient arrhythmias with no increased incidence of acute kidney injury. Completion angiography may be more effective than TEE at detecting post-operative pulmonary artery lesions even in patients not manifesting clinical symptoms. Documentation of residual lesions with completion angiography allows immediate surgical revision potentially limiting necessity for future interventions.
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Angiografia/métodos , Ecocardiografia Transesofagiana/métodos , Artéria Pulmonar/diagnóstico por imagem , Estenose da Valva Pulmonar/diagnóstico por imagem , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Artéria Pulmonar/anormalidades , Artéria Pulmonar/cirurgia , Reoperação , Estudos RetrospectivosRESUMO
: In 1994 Mycoplasma gallisepticum was found to be the etiologic agent of House Finch ( Haemorhous mexicanus) conjunctivitis, a rapidly expanding epidemic caused by a genetically discrete, House Finch-associated strain of M. gallisepticum (HFMG). While most prominent in House Finches, HFMG has been reported in other members of the family Fringillidae, including American Goldfinches ( Spinus tristis), Purple Finches ( Haemorhous purpureus), Pine Grosbeaks ( Pinicola enucleator), and Evening Grosbeaks ( Coccothraustes vespertinus). Herein we report two new potential host species of HFMG strain, the Lesser Goldfinch ( Spinus psaltria), belonging to the Fringillidae family, and the Western (California) Scrub Jay ( Aphelocoma californica), belonging to the Corvidae family. The latter is one of only two reports of HFMG being found outside the Fringillidae family, and of these is the only one reported outside of captivity. Furthermore, non-HFMG M. gallisepticum was identified in an American Crow ( Corvus brachyrhynchos), indicating presence of additional strains in wild birds. Strain typing of M. gallisepticum isolates was done via HFMG-specific quantitative PCR analysis and validated using random amplified polymorphic DNA analysis. Our results suggested an expanded host range of HFMG strain, and further suggested that the host range of HFMG was not limited to members of the family Fringillidae.
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Doenças das Aves/microbiologia , Infecções por Mycoplasma/veterinária , Mycoplasma gallisepticum/isolamento & purificação , Passeriformes , Reação em Cadeia da Polimerase/métodos , Animais , DNA Bacteriano/genética , Infecções por Mycoplasma/microbiologia , Mycoplasma gallisepticum/genéticaRESUMO
Dystrophic myocardial calcification occurs in the setting of myocardial injury and normal serum calcium. We present a case of a neonate with prominent dystrophic calcification and severe left ventricular systolic dysfunction in the setting of enterovirus myocarditis. These findings are superbly illustrated by multiple imaging modalities. The patient was treated with the novel antiviral, pocapavir, in addition to a standard heart failure regimen. The dystrophic calcification persisted but the left ventricle remodeled significantly. To our knowledge, this is the first reported use of pocapavir for this indication. The literature regarding enterovirus myocarditis and pocapavir is briefly reviewed.
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The complex mixture of volatile organic compounds (VOCs) present in the headspace of Trappist and craft beers was studied to illustrate the efficiency of thermal desorption (TD) comprehensive two-dimensional gas chromatography time-of-flight mass spectrometry (GC×GC-TOFMS) for highlighting subtle differences between highly complex mixtures of VOCs. Headspace solid-phase microextraction (HS-SPME), multiple (and classical) stir bar sorptive extraction (mSBSE), static headspace (SHS), and dynamic headspace (DHS) were compared for the extraction of a set of 21 representative flavor compounds of beer aroma. A Box-Behnken surface response methodology experimental design optimization (DOE) was used for convex hull calculation (Delaunay's triangulation algorithms) of peak dispersion in the chromatographic space. The predicted value of 0.5 for the ratio between the convex hull and the available space was 10% higher than the experimental value, demonstrating the usefulness of the approach to improve optimization of the GC×GC separation. Chemical variations amongst aligned chromatograms were studied by means of Fisher Ratio (FR) determination and F-distribution threshold filtration at different significance levels (α=0.05 and 0.01) and based on z-score normalized area for data reduction. Statistically significant compounds were highlighted following principal component analysis (PCA) and hierarchical cluster analysis (HCA). The dendrogram structure not only provided clear visual information about similarities between products but also permitted direct identification of the chemicals and their relative weight in clustering. The effective coupling of DHS-TD-GC×GC-TOFMS with PCA and HCA was able to highlight the differences and common typical VOC patterns among 24 samples of different Trappist and selected Canadian craft beers.
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Cerveja/análise , Cromatografia Gasosa-Espectrometria de Massas/métodos , Compostos Orgânicos Voláteis/química , Canadá , Cromatografia Gasosa-Espectrometria de Massas/instrumentação , Análise de Componente Principal , Microextração em Fase Sólida/métodos , Compostos Orgânicos Voláteis/isolamento & purificaçãoRESUMO
Evidence for an association between cortisol and clinical pregnancy in women undergoing In Vitro Fertilisation (IVF) is mixed with previous studies relying exclusively on short term measures of cortisol in blood, saliva, urine, and/or follicular fluid. Hair sampling allows analysis of systemic levels of cortisol over the preceding 3-6 months. The present study sought to explore the relationship between cortisol and clinical pregnancy outcome in women undergoing IVF utilising multiple indices of cortisol derived from both saliva and hair measured prior to commencing gonadotrophin treatment. A total of 135 women (mean age 34.5 SD+/-4.8) were recruited from an English fertility clinic (December 2012-April 2014) 60% of whom became pregnant (n=81). Salivary cortisol data were obtained over two days: upon awakening, 30min post awakening, and at 22:00. A subsample (n=88) of the women providing salivary samples were approached consecutively to provide hair samples for the measurement of cortisol. Independent Logistic regression analyses revealed that salivary cortisol measures including cortisol awakening response (CAR) (p=0.485), area under the curve with respect to ground (AUCg) (p=0.527), area under the curve with respect to increase (AUCi) (p=0.731) and diurnal slope (p=0.889) did not predict clinical pregnancy. In contrast, hair cortisol concentrations significantly predicted clinical pregnancy (p=0.017). Associations between hair cortisol and clinical pregnancy remained when controlling for accumulations of salivary cortisol (p=0.034) accounting for 26.7% of the variance in pregnancy outcome. These findings provide preliminary evidence that longer term systemic cortisol may influence reproductive outcomes; and in turn suggests that interventions to reduce cortisol prior to commencing IVF could improve treatment outcomes.
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Fertilização in vitro , Cabelo/química , Hidrocortisona/análise , Infertilidade Feminina/metabolismo , Gravidez/metabolismo , Saliva/química , Adulto , Feminino , HumanosRESUMO
OPINION STATEMENT: Two-dimensional (2D) and Doppler echocardiography has become both an essential component in the assessment of anatomic anomalies of the fetal heart and an important tool in the assessment of fetal cardiac function. Various techniques for assessing fetal cardiovascular function exist and can be used to characterize systolic and diastolic ventricular function and estimate fetal cardiac output. These techniques can be utilized to assess fetuses with cardiovascular compromise due to a number of cardiac and non-cardiac conditions, including twin-twin transfusion syndrome, high-cardiac output lesions such as fetal tumors and vascular malformations, and primary fetal cardiomyopathy. As many of these conditions can now be treated by a variety of fetal therapeutic techniques, it is now important to be able to understand and identify fetal cardiac dysfunction. Characterization of fetal cardiac dysfunction now has the potential to provide clinicians with the means to better select patients for intervention, predict outcome, and perform follow-up following fetal interventional procedures.
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BACKGROUND: The Fontan circulation is associated with an increased risk of thromboembolic events (TEs). As many as 25% of these thrombotic events result in fatality. More subtle adverse effects on the pulmonary circulation from embolic thrombi may further impair adequate functioning of the circuit. Despite these well-documented phenomena, the most optimal approaches to thromboprophylaxis are still not clearly defined. OBJECTIVE: A meta-analysis of published trials in English on PubMed and Cochrane libraries that evaluated the role of using TE prophylaxis in patients who underwent the Fontan procedure was conducted. METHODS: 10 studies with a total number of 1200 patients with an average follow-up time of 7.1â years were identified. A random effect model was used. RESULTS: The incidence of TE was significantly less in patients who received TE prophylaxis (using either aspirin or warfarin) compared with patients who did not receive TE prophylaxis (OR 0.425, 95% CI 0.194 to 0.929, p<0.01, I(2)=37%). The incidence of TE was significantly lower in patients who received aspirin compared with no TE prophylaxis (OR 0.363, 95% CI 0.177 to 0.744, p<0.01, I(2)=0%) and who received warfarin compared with no TE prophylaxis (OR 0.327, 95% CI 0.168 to 0.634, p<0.01, I(2)=2.5%). There was no significant difference in incidence of TE between warfarin and aspirin (OR 0.936, 95% CI 0.609 to 1.438, p=0.54, I(2)=0%). Furthermore, there was no significant difference in incidence of early TE (within 6â months of the operation) or late TE (>6â months) between patients receiving warfarin and aspirin (OR 0.784, 95% CI 0.310 to 1.982, p=0.37, I(2)=8%) and (OR 0.776, 95% CI 0.249 to 2.42, p=0.3, I(2)=45%), respectively. When only total cavopulmonary connection patients were included, there was again no difference between warfarin and aspirin in the incidence of TE (OR 0.813, 95% CI 0.471 to 1.401, p=0.34, I(2)=11%). CONCLUSIONS: This study shows a significantly lower incidence of TE after Fontan procedure if either aspirin or warfarin is used. This meta-analysis suggests no significant difference in incidence of early or late TE in patients receiving aspirin compared with warfarin.
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Aspirina/uso terapêutico , Técnica de Fontan/efeitos adversos , Complicações Pós-Operatórias , Tromboembolia , Varfarina/uso terapêutico , Anticoagulantes/uso terapêutico , Quimioprevenção/métodos , Pesquisa Comparativa da Efetividade , Técnica de Fontan/métodos , Humanos , Incidência , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Tromboembolia/epidemiologia , Tromboembolia/etiologia , Tromboembolia/prevenção & controleRESUMO
The authors examined the development of diabetic retinopathy in a population-based cohort of persons with incident type 1 diabetes to investigate the possibility of lowered retinopathy prevalence and severity compared with previous US studies. A total of 474 diabetic persons from Wisconsin were followed from diagnosis through 4-14 years' duration during 1990-2002. Retinopathy was determined by fundus photography at 4, 7, 9, and 14 years' duration. Risk of developing retinopathy was modeled on demographic and diabetes-care characteristics by means of a generalized linear model using the complementary log-log link for interval-censored data. Prevalence of retinopathy increased with duration of diabetes, from 6% at 4 years to 73% at 14 years, and was highest among adults (> or =20 years of age). Risk of developing retinopathy increased with increasing duration, worse glycemic control, and age up to 20 years. Indicators of diabetes care were related to retinopathy through their effect on glycemic control. Improvements in diabetes care leading to better glycemic control may have contributed to the much lower prevalence and less severe retinopathy observed than expected on the basis of a previous report from the same region of Wisconsin. The observed decreased prevalence has important implications for persons with type 1 diabetes, since retinopathy is a serious microvascular complication.
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Diabetes Mellitus Tipo 1/epidemiologia , Retinopatia Diabética/epidemiologia , Adolescente , Criança , Retinopatia Diabética/patologia , Feminino , Hemoglobinas Glicadas/análise , Humanos , Incidência , Modelos Lineares , Estudos Longitudinais , Masculino , Prevalência , Estudos Prospectivos , Sistema de Registros , Fatores de Risco , Índice de Gravidade de Doença , Wisconsin/epidemiologiaRESUMO
CONTEXT: Delayed menarche is associated with subsequent reproductive and skeletal complications. Previous research has found delayed growth and pubertal maturation with type 1 diabetes and poor glycemic control. The effect of diabetes management on menarche is important to clarify, because tighter control might prevent these complications. OBJECTIVE: The objective of this study was to investigate age at menarche in young women with type 1 diabetes and examine the effect of diabetes management [e.g. total glycosylated hemoglobin (GHb) level, number of blood glucose checks, insulin therapy intensity, and insulin dose] on age at menarche in those diagnosed before menarche. DESIGN: The Wisconsin Diabetes Registry Project is a follow-up study of a type 1 diabetes population-based incident cohort initially enrolled between 1987 and 1992. SETTING: This study was performed in 28 counties in south-central Wisconsin. PATIENTS OR OTHER PARTICIPANTS: The study participants were recruited through referrals, self-report, and hospital/clinic ascertainment. Individuals with newly diagnosed type 1 diabetes, less than 30 yr old, were invited to participate. Of 288 young women enrolled, 188 reported menarche by 2002; 105 were diagnosed before menarche. INTERVENTIONS: There were no interventions. MAIN OUTCOME MEASURE: The main outcome measure was age at menarche. RESULTS: Mean age at menarche was 12.78 yr, compared with 12.54 yr in the United States (P = 0.01). Ages at menarche and diagnosis were not associated. For those diagnosed before menarche, age at menarche was delayed 1.3 months with each 1% increase in mean total GHb level in the 3 yr before menarche. CONCLUSIONS: Age at menarche was moderately delayed in young women with type 1 diabetes. Delayed menarche could potentially be minimized with improved GHb levels.