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It was highlighted that in the original article [1] Fig. 2 was incorrect and the link for the Additional File was missing. This Correction article provides the correct Fig. 2 and the Additional File with its link. The original file has been updated.
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BACKGROUND: Promoting the well-being at all ages and reducing premature mortality from non-communicable diseases (NCDs) is a major target of the Sustainable Development Goals. In the frame of the JA-CHRODIS, a Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis was conducted to provide different countries' insights on what makes a policy/programme addressing NCDs applicable, sustainable and effective, with a focus on diabetes. METHODS: A qualitative study has been performed using a SWOT analysis on policies/programmes at the national/federal or subnational level. RESULTS: By March 2016, 14 SWOTs were conducted involving 11 European countries and 57 stakeholders and Ministries of Health, reporting and analysing a total of 44 policies. The main strengths, weaknesses, opportunities and threats have been outlined as well as and the main areas for governance improvement. A binding trans-sectoral approach is necessary to tackle the underlying risk factors of inequalities. The culture of disease prevention and health promotion is still low while the biomedical paradigm prevails. A systematic gender perspective is still missing. Sharing and exchange of best practices, as sponsored by the European Commission, is acting as a motivator. CONCLUSION: The SWOT analyses draw an overall picture of the complexity of designing and implementing good policies and programmes that are tailored to local needs. These results may apply to any context and can be used by decision-makers, managers, professionals and other stakeholders to focus on key issues, recognising areas for attention.
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Enfermedad Crónica/prevención & control , Promoción de la Salud/organización & administración , Enfermedades no Transmisibles/prevención & control , Diabetes Mellitus/prevención & control , Europa (Continente)/epidemiología , Gobierno Federal , Política de Salud , Promoción de la Salud/normas , Humanos , Investigación Cualitativa , Desarrollo SostenibleRESUMEN
BACKGROUND: The incretin-based medicines GLP1 analogues (GLP1a) and dipeptidyl peptidase-4 inhibitors (DPP4i) are hypoglycaemic agents licensed for the treatment of type 2 diabetes mellitus (T2DM). Although these drugs possess comparable efficacy and low risk of hypoglycaemia, differences in terms of route of administration (subcutaneous versus oral), effect on body weight and gastrointestinal tolerabily can impact their actual use in clinical practice. This study aimed to describe the real-world utilization of incretin-based medicines in the Italian clinical practice. METHODS: A multi-database, population-based, descriptive, cohort study was performed using administrative data collected between 2008 and 2014 from three Italian geographic areas. Subjects aged ≥18 were selected. New users were defined as those with ≥1 dispensing of GLP1a or DPP4i during the year of interest and none in the past. Trends of cumulative annual incidence of use in the general adult population were observed. New users of GLP1a or DPP4i were respectively described in terms of demographic characteristics and use of antidiabetic drugs during 1 year before and after the first incretin dispensing. RESULTS: The overall study population included 4,943,952 subjects. A total of 7357 new users of GLP1a and 41,907 of DPP4i were identified during the study period. Incidence of use increased between 2008 (0.2 for both GLP1a and DPP4i) and 2011 (GLP1a = 0.6; DPP4i = 2.5) and slightly decreased thereafter. In 2014, 61% of new GLP1a users received once-daily liraglutide while 52% of new DPP4i users received metformin/DPP4i in fixed-dose. The percentage of new DPP4i users older than 65 years of age increased from 30.9 to 62.6% during the study period. Around 12% of new users had not received any antidiabetic before starting an incretin. CONCLUSIONS: During the study period, DPP4i rapidly became the most prescribed incretin-based medicine, particularly among older new user. The choice of the specific incretin-based medicine at first prescription appeared to be directed towards those with higher convenience of use (e.g. oral DPP4i rather than subcutaneous GLP1a, once-daily liraglutide rather than twice-daily exenatide). The non-negligibile use of incretin-based medicines as first-line pharmacotherapy for T2DM warrants further effectiveness and safety evaluations to better define their place in therapy.
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Diabetes Mellitus Tipo 2/tratamiento farmacológico , Inhibidores de la Dipeptidil-Peptidasa IV/uso terapéutico , Utilización de Medicamentos/estadística & datos numéricos , Utilización de Medicamentos/tendencias , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Bases de Datos Factuales , Femenino , Estudios de Seguimiento , Humanos , Italia , Masculino , Persona de Mediana Edad , Pronóstico , Factores de Tiempo , Adulto JovenRESUMEN
INTRODUCTION: Aim of this paper is to present a guide for translating to practice an evidence-based set of Quality Criteria and Recommendations (QCR) to promote the implementation of policies and practices in the field of health promotion, disease prevention and care for people with chronic diseases. METHODS: The guide is based on real-world experiences of eight European pilot actions using QCR as a framework for practice design, development, implementation, monitoring and evaluation. All partners implemented their respective practices by following the same agreed process. RESULTS: The implementation method was summarized in seven steps where each of one outline a particular phase of the process. The guide provides a step-by-step tutorial for the implementation of QCR. CONCLUSIONS: Practical experiences from the pilot actions show the potential value of using the QCR in designing and implementing practices to improve the quality of care for people with chronic diseases.
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Promoción de la Salud , Políticas , Enfermedad Crónica , Humanos , Calidad de la Atención de SaludRESUMEN
INTRODUCTION: Managing non-communicable diseases (NCDs) requires redesigning health care delivery to achieve better coordination of services at all levels of health care. The aim of this study was improving prevention and strengthening high quality of care for NCDs by using type 2 diabetes as a model disease. METHODS: The mix method approach served to analyse the impact of the intervention processes. Source of information were routine health statistics, interviews and observation. Key Performance Indicators in defined Improvement Areas assisted in the quality of diabetes care assessment. RESULTS AND DISCUSSION: During the study the National Diabetes Centre (NDC) was established. The NDC experts organized numerous educational events, 316 physicians and nurses have participated. New electronic data base was implemented in 20 pilot Primary Health Care Centres (PHCCs) with 38,833 electronic diabetes records. CONCLUSIONS: The intervention led to establishment of the NDC, strengthening competences of health care professionals and to the renewal of the Diabetes Care Units in PHCCs included in the study.
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Atención a la Salud/normas , Diabetes Mellitus Tipo 2/terapia , Humanos , Guías de Práctica Clínica como Asunto , SerbiaRESUMEN
In the frame of joint action in chronic diseases (JA CHRODIS), an extensive process at the European Union level was carried out to identify a core set of quality criteria and to formulate recommendations that improved prevention, early detection, and quality of care for people with chronic diseases. Diabetes was used as a model disease. The core set of quality criteria may be applied to develop and improve practices, programs, strategies, and policies in various domains (e.g., prevention, care, health promotion, education, and training). The quality criteria are general enough to be applied in countries with different political, administrative, social, and health care organizations. Moreover, they can be applied to a number of other chronic diseases. JA CHRODIS recommendations and quality criteria are being tested in a series of pilot actions within the JA CHRODIS PLUS. A total of 15 partners representing nine European countries worked together to implement pilot actions and generate practical lessons that could contribute to the further uptake and use of JA CHRODIS recommendations. Special emphasis is given to meaningful patient involvement in co-designing the pilot actions and to the sustainability and scalability of the pilot actions. These insights were found to be at the core of the learning from pilot actions to foster high quality care for people with chronic diseases.
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Enfermedad Crónica/prevención & control , Guías de Práctica Clínica como Asunto , Calidad de la Atención de Salud , Atención a la Salud , Diagnóstico Precoz , Europa (Continente) , Unión Europea , Promoción de la Salud , Humanos , OrganizacionesRESUMEN
BACKGROUND AND PURPOSE: Type 2 diabetes mellitus is a strong predictor of cerebrovascular disease, yet few studies have assessed the incidence of stroke and the role of other risk factors in unselected type 2 diabetes mellitus populations. METHODS: We prospectively followed-up 14,432 type 2 diabetes mellitus patients, aged 40 to 97 years, with and without a history of cardiovascular disease at enrollment, and we estimated the incidence of stroke and the hazards ratios with respect to clinical variables. RESULTS: During a 4-year follow-up, 296 incident stroke events were recorded. In persons with no history of cardiovascular disease, the age-standardized incidence of stroke (per 1000 person-years) was 5.5 (95% confidence interval, 4.2 to 6.8) in men and 6.3 (95% confidence interval, 4.5 to 8.2) in women. In persons with a history of cardiovascular disease, it was 13.7 (95% confidence interval, 7.5 to 19.8) in men and 10.8 (95% confidence interval, 7.3 to 14.4) in women. The hazards ratios of stroke incidence varied according to age, sex, and history of cardiovascular disease. Among men with no history, HbA1c and smoking were predictors of stroke. Among patients with a history, the risk factors were, in men, therapy with insulin plus oral agents, treated high total cholesterol and low HDL cholesterol, whereas in women microvascular complications were a risk factor. Previous stroke was a strong predictor of stroke in both sexes. CONCLUSIONS: Age and previous stroke are the main predictors of stroke in diabetes. The combined role of Hba1c, microvascular complications, low HDL cholesterol, and treatment with insulin plus oral agents highlights the importance of diabetic history and clinical background in the development of stroke.
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Enfermedades Cardiovasculares/epidemiología , Complicaciones de la Diabetes/epidemiología , Diabetes Mellitus Tipo 2/epidemiología , Accidente Cerebrovascular/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Enfermedades Cardiovasculares/fisiopatología , HDL-Colesterol/sangre , Estudios de Cohortes , Comorbilidad , Complicaciones de la Diabetes/fisiopatología , Diabetes Mellitus Tipo 2/fisiopatología , Femenino , Estudios de Seguimiento , Hemoglobina Glucada , Hemoglobinas/metabolismo , Humanos , Hipoglucemiantes/uso terapéutico , Incidencia , Insulina/uso terapéutico , Italia/epidemiología , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Prevalencia , Estudios Prospectivos , Factores de Riesgo , Distribución por Sexo , Accidente Cerebrovascular/fisiopatologíaRESUMEN
BACKGROUND: Mild cognitive impairment (MCI) refers to a transitional zone between normal ageing and dementia. Despite the uncertainty regarding the definition of MCI as a clinical entity, clinical trials have been conducted in the attempt to study the role of cholinesterase inhibitors (ChEIs) currently approved for symptomatic treatment of mild to moderate Alzheimer disease (AD), in preventing progression from MCI to AD. The objective of this review is to assess the effects of ChEIs (donepezil, rivastigmine, and galantamine) in delaying the conversion from MCI to Alzheimer disease or dementia. METHODS AND FINDINGS: The terms "donepezil", "rivastigmine", "galantamine", and "mild cognitive impairment" and their variants, synonyms, and acronyms were used as search terms in four electronic databases (MEDLINE, EMBASE, Cochrane, PsycINFO) and three registers: the Cochrane Collaboration Trial Register, Current Controlled Trials, and ClinicalTrials.gov. Published and unpublished studies were included if they were randomized clinical trials published (or described) in English and conducted among persons who had received a diagnosis of MCI and/or abnormal memory function documented by a neuropsychological assessment. A standardized data extraction form was used. The reporting quality was assessed using the Jadad scale. Three published and five unpublished trials met the inclusion criteria (three on donepezil, two on rivastigmine, and three on galantamine). Enrolment criteria differed among the trials, so the study populations were not homogeneous. The duration of the trials ranged from 24 wk to 3 y. No significant differences emerged in the probability of conversion from MCI to AD or dementia between the treated groups and the placebo groups. The rate of conversion ranged from 13% (over 2 y) to 25% (over 3 y) among treated patients, and from 18% (over 2 y) to 28% (over 3 y) among those in the placebo groups. Only for two studies was it possible to derive point estimates of the relative risk of conversion: 0.85 (95% confidence interval 0.64-1.12), and 0.84 (0.57-1.25). Statistically significant differences emerged for three secondary end points. However, when adjusting for multiple comparisons, only one difference remained significant (i.e., the rate of atrophy in the whole brain). CONCLUSIONS: The use of ChEIs in MCI was not associated with any delay in the onset of AD or dementia. Moreover, the safety profile showed that the risks associated with ChEIs are not negligible. The uncertainty regarding MCI as a clinical entity raises the question as to the scientific validity of these trials.
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Inhibidores de la Colinesterasa/uso terapéutico , Inhibidores Enzimáticos/uso terapéutico , Trastornos de la Memoria/tratamiento farmacológico , Ensayos Clínicos Controlados Aleatorios como Asunto , Anciano , Anciano de 80 o más Años , Enfermedad de Alzheimer , Cognición , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
PURPOSE: To conduct a systematic review regarding psychosocial barriers to healthcare use in individuals with diabetes mellitus, using a well-established model of health-service use as a theoretical framework. METHODS: We used database-specific controlled vocabularies and additional free text terms, and conducted searches via MEDLINE, EMBASE, PsycINFO, CINAHL, Web of Science, OVID Journals. Included studies were rated according to the UK National Institute for Health and Care Excellence (NICE) criteria. A narrative data synthesis was conducted, using the Andersen model and developing categories from the included studies. PRINCIPAL RESULTS: In total, 2923 studies were identified, and 15 finally included. We identified barriers according to the main categories "population characteristics", "norms and values", and "healthcare services" on a contextual and individual level, as well as "health status". Frequently reported barriers were "socioeconomic status", and "physician characteristics". Ethnic minorities were frequently analysed and may have specific barriers, e.g. "cultural beliefs" and "language". MAJOR CONCLUSIONS: We identified a broad range of barriers to healthcare use in individuals with diabetes mellitus. However, the number of studies is low. Further research is needed to analyse barriers in more detail considering special subgroups.
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Diabetes Mellitus/terapia , Conocimientos, Actitudes y Práctica en Salud , Recursos en Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud , Aceptación de la Atención de Salud , Actitud del Personal de Salud , Características Culturales , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/psicología , Estado de Salud , Humanos , Lenguaje , Relaciones Médico-Paciente , Factores de Riesgo , Factores SocioeconómicosRESUMEN
AIMS: To provide data on hospitalization and incidence rates of Charcot neuroarthropathy (CN) and its relation to lower limbs' amputations/revascularizations in population with diabetes of Italy as well as of one of its regions (Tuscany). METHODS: Hospitalizations with CN diagnosis (codes ICD-9-CM: 7130, 7135, 7138) have been recorded in people with diabetes over years 2003-2013 in Italy and 2008-2015 in Tuscany. Amputations, peripheral vascular disease, revascularizations and infections were likewise evaluated. RESULTS: Between 2003 and 2013 CN hospitalizations were very infrequent in Italy ranging between 14×100,000 and 11×100,000 patients with diabetes. In Tuscany they declined to a minimum of 7×100,000 patients in 2015, after a previous increase to a maximum of 22×100,000 (p=NS for both). Yearly CN incidence remained constant in Italy, declining in Tuscany to a minimum of 3.4×100,000 diabetic patients in 2015 (p=0.047). CN patients were younger and with longer length of hospital stay than those with non-Charcot diabetic foot (p<0.05 for both). Amputation and infection rates were manifold higher in CN patients than in those with non-Charcot diabetic foot, while the revascularization rate was similar in both. CONCLUSIONS: Over last decade, in Italy and Tuscany yearly CN incidence and hospitalization rates concerned only a small percentage of patients, remaining constant over years and declining in Tuscany in the last couple of years. CN was significantly associated to younger age, longer hospital stay and greater risk of amputations and infections while the need of revascularization was similar to that of non-Charcot diabetic foot.
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Artropatía Neurógena/cirugía , Pie Diabético/cirugía , Anciano , Anciano de 80 o más Años , Amputación Quirúrgica , Artropatía Neurógena/epidemiología , Pie Diabético/epidemiología , Femenino , Hospitalización , Humanos , Incidencia , Italia/epidemiología , Masculino , Persona de Mediana Edad , PrevalenciaAsunto(s)
Diabetes Mellitus/epidemiología , Vigilancia de la Población , Clase Social , Adulto , Anciano , Diabetes Mellitus/economía , Escolaridad , Femenino , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Estado Nutricional , Obesidad/epidemiología , Pobreza , Factores de Riesgo , Conducta SedentariaRESUMEN
The Cronos Project is a post-marketing surveillance study implemented by the Italian Ministry of Health and the National Institute of Health whose main objectives are to characterise the population of Alzheimer's disease patients treated with acetylcholinesterase inhibitors and monitor effectiveness and drug safety in the field practice. In this project 503 Alzheimer's disease units were activated located throughout the country. The characteristics of these Alzheimer's disease units are presented for setting (territorial, university, hospital, extra-hospital), health personnel employed, examinations offered (CT and MRI scans and laboratory tests), counselling activities and relationship with caregiver associations in relation to neuropsychological tests.
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Enfermedad de Alzheimer/psicología , Unidades Hospitalarias/estadística & datos numéricos , Pruebas Neuropsicológicas , Vigilancia de Productos Comercializados , Instituciones Residenciales/estadística & datos numéricos , Enfermedad de Alzheimer/diagnóstico , Enfermedad de Alzheimer/tratamiento farmacológico , Enfermedad de Alzheimer/rehabilitación , Cuidadores/psicología , Inhibidores de la Colinesterasa/uso terapéutico , Consejo/organización & administración , Consejo/estadística & datos numéricos , Diagnóstico por Imagen/estadística & datos numéricos , Personal de Salud , Unidades Hospitalarias/organización & administración , Hospitales Universitarios/organización & administración , Hospitales Universitarios/estadística & datos numéricos , Humanos , Italia , Neurología , Nootrópicos/uso terapéutico , Educación del Paciente como Asunto/estadística & datos numéricos , Psicología , Investigación/estadística & datos numéricos , Instituciones Residenciales/organización & administración , Grupos de Autoayuda/organización & administración , Resultado del TratamientoRESUMEN
Within the Cronos Project, 503 Alzheimer's disease units were activated throughout the country. In June/July 2002 a questionnaire was sent to all Alzheimer's disease units to collect data on neuropsychological tests utilised in the diagnostic process of dementias. Only 196 of Alzheimer's disease units that have responded to the questionnaire (196/392) declare to utilize neuropsychological test while 97.8% use the mini mental state examination. This paper aims to collect, for the first time in Italy, data on use of the neuropsychological tests in the specialist units on dementia and to propose a discussion on the reliability of neuropsychological instruments.
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Enfermedad de Alzheimer/psicología , Unidades Hospitalarias/estadística & datos numéricos , Pruebas Neuropsicológicas/estadística & datos numéricos , Vigilancia de Productos Comercializados , Instituciones Residenciales/estadística & datos numéricos , Anciano , Enfermedad de Alzheimer/diagnóstico , Enfermedad de Alzheimer/tratamiento farmacológico , Enfermedad de Alzheimer/rehabilitación , Inhibidores de la Colinesterasa/uso terapéutico , Escolaridad , Femenino , Humanos , Italia , Masculino , Persona de Mediana Edad , Nootrópicos/uso terapéutico , Variaciones Dependientes del Observador , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Encuestas y CuestionariosRESUMEN
OBJECTIVE: Type 2 diabetes can be efficiently prevented by lifestyle intervention provided for people at high diabetes risk. The aim of this paper was to conduct a literature search on existing quality indicators for type 2 diabetes prevention and to collate and present a set of indicators that could be applied in European countries with different health care systems and cultures. METHODS: Scientific and grey literature was searched for relevant studies using electronic databases. We also hand searched previous systematic reviews and reference lists of relevant articles. RESULTS: The only publication identified was the report presenting the results from the IMAGE project. The IMAGE indicators were used as the basis for the proposed indicators. CONCLUSIONS: Publications on quality indicators of diabetes prevention programmes are scarce. The quality indicators presented here are a first step toward the definition of a core set of European indicators to monitor and improve the quality of diabetes prevention.
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Diabetes Mellitus Tipo 2/prevención & control , Promoción de la Salud/tendencias , Indicadores de Calidad de la Atención de Salud , Europa (Continente) , Promoción de la Salud/normas , Humanos , Estilo de VidaRESUMEN
OBJECTIVE: To contribute to the development of a set of quality criteria for patient education and health professionals training that could be applied in European countries. METHODS: Literature review quality criteria, pre-selection based on a comparison of the criteria, peer group and expert based selection of the criteria. RESULTS: 14 quality criteria were selected: goals, rationale, target group, setting, scheduling of the education/training sessions, environmental requirements, qualification of the trainers/educators, core components of the educator/trainer's role, curriculum, education methods, education didactics, monitoring of the effectiveness and quality of the program, implementation level and source of funding. DISCUSSION: A set of preliminary quality criteria for patient education and health professionals training was developed, which could be applied in European countries.
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Diabetes Mellitus Tipo 2/terapia , Educación Médica/normas , Educación Médica/tendencias , Promoción de la Salud/tendencias , Curriculum , Diabetes Mellitus Tipo 2/prevención & control , Europa (Continente) , Personal de Salud , Humanos , Indicadores de Calidad de la Atención de SaludRESUMEN
Healthcare systems do not fit well with the "modern" patient, who has a right to autonomy and self-determination. The services that are designed and delivered in policy contexts are not prone to encourage innovation. National Diabetes Plans, defined as "any formal strategy for improving diabetes policy, services and outcomes that encompass structured and integrated or linked activities which are planned and co-ordinated nationally and conducted at the national, regional, and local level", may hold a great potential not only to improve prevention and care for type 2 diabetes, but also for transforming healthcare delivery. Today, changes to adapt healthcare delivery tend to be implemented within existing provider structures, with limited understanding of specific context, structures, processes and potential for change. National Diabetes Plan can be a diagnostic tool for barriers, can be a driver for planning the change, and can help develop capacities and competences that are needed to strengthen healthcare systems to better address health promotion and chronic diseases.
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Atención a la Salud/organización & administración , Diabetes Mellitus/prevención & control , Diabetes Mellitus/terapia , Programas Nacionales de Salud/organización & administración , Atención a la Salud/tendencias , Diabetes Mellitus Tipo 2/prevención & control , Diabetes Mellitus Tipo 2/terapia , Promoción de la Salud , HumanosRESUMEN
AIM: To present the most common quality criteria in health promotion interventions in type 2 diabetes mellitus (T2DM). METHODS: A systematic literature search was conducted to identify review articles, health technology assessments and policy reports of evaluated health promotion interventions in T2DM. A descriptive analysis of study characteristics and evaluation criteria are presented. RESULTS: Seven studies met the inclusion criteria. The findings indicate that the most common health promotion interventions used in T2DM are initiatives targeting health care professionals. The main ambition of the programs was to increase the collaboration between health care professionals and patients, and between health care centres, program managers and community stakeholders. CONCLUSIONS: This investigation extends our knowledge of the most common health promotion interventions in T2DM and which structure, process and outcome measurements that are reported in such interventions. Future research could usefully explore how the effectiveness of multicomponent and complex interventions may be evaluated and extend the association of these factors into other settings and in relation to other lifestyle related chronic diseases.