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1.
Diabet Med ; 33(11): 1499-1507, 2016 11.
Artículo en Inglés | MEDLINE | ID: mdl-26526088

RESUMEN

AIMS: People with diabetes and poor glycaemic control are at higher risk of diabetes-related complications and incur higher healthcare costs. An understanding of the sociodemographic and clinical characteristics associated with poor glycaemic control is needed to overcome the barriers to achieving care goals in this population. METHODS: We used linked administrative and laboratory data to create a provincial cohort of adults with prevalent diabetes, and a measure of HbA1c that occurred at least 1 year following the date of diagnosis. The primary outcome was poor glycaemic control, defined as at least two consecutive HbA1c measurements ≥ 86 mmol/mol (10%), not including the index measurement, spanning a minimum of 90 days. We used multivariable Cox proportional hazards models to evaluate the association between baseline sociodemographic and clinical factors and poor glycaemic control. RESULTS: In this population-based cohort of 169 890 people, younger age was significantly associated with sustained poor glycaemic control, with a hazard ratio (HR) of 3.08, 95% CI (2.79-3.39) for age 18-39 years compared with age ≥ 75 years. Longer duration of diabetes, First Nations status, lower neighbourhood income quintile, history of substance abuse, mood disorder, cardiovascular disease, albuminuria and high LDL cholesterol were also associated with poor glycaemic control. CONCLUSIONS: Although our results may be limited by the observational nature of the study, the large geographically defined sample size, longitudinal design and robust definition of poor glycaemic control are important strengths. These findings demonstrate the complexity associated with poor glycaemic control and indicate a need for tailored interventions.


Asunto(s)
Glucemia/metabolismo , Complicaciones de la Diabetes/sangre , Complicaciones de la Diabetes/epidemiología , Hemoglobina Glucada/metabolismo , Factores Socioeconómicos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Diabetes Mellitus Tipo 1/sangre , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 1/epidemiología , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/epidemiología , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Prevalencia , Adulto Joven
2.
Diabet Med ; 31(12): 1586-93, 2014 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-25131338

RESUMEN

AIM: To determine the prescribing of and adherence to oral hypoglycaemic agents, insulin, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and statin therapy among South-Asian, Chinese and white people with newly diagnosed diabetes. METHODS: The present study was a population-based cohort study using administrative and pharmacy databases to include all South-Asian, Chinese and white people aged ≥ 35 years with diabetes living in British Columbia, Canada (1997-2006). Adherence to each class of medication was measured using proportion of days covered over 1 year with optimum adherence defined as ≥ 80%. RESULTS: The study population included 9529 South-Asian, 14 084 Chinese and 143 630 white people with diabetes. The proportion of people who were prescribed angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, statin or oral hypoglycaemic agents was ≤ 50% for all groups. South-Asian and Chinese people had significantly lower adherence for all medications than white people, with the lowest adherence to angiotensin-converting enzyme inhibitor treatment (South-Asian people: adjusted odds ratio 0.37, 95% CI 0.34-0.39; P<0.0001; Chinese people: adjusted odds ratio 0.50, 95% CI 0.47-0.54; P<0.0001) and statin therapy (South-Asian people: adjusted odds ratio 0.47, 95% CI 0.41 - 0.53, P < 0.0001; Chinese people: adjusted odds ratio 0.72, 95% CI 0.67 - 0.77; P<0.0001) compared with white people. CONCLUSION: Adherence to evidence-based pharmacotherapy was substantially worse among the South-Asian and Chinese populations. Care providers need to be alerted to the high levels of non-adherence in these groups and the underlying causes need to be investigated.


Asunto(s)
Antagonistas de Receptores de Angiotensina/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Pueblo Asiatico/estadística & datos numéricos , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Hipoglucemiantes/uso terapéutico , Cumplimiento de la Medicación/etnología , Pautas de la Práctica en Medicina/estadística & datos numéricos , Población Blanca/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Asia Occidental/etnología , Colombia Británica , China/etnología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Clase Social
3.
Diabet Med ; 31(12): 1610-4, 2014 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-24890340

RESUMEN

AIMS: To determine the association between participation in a brief introductory didactic diabetes education programme and change in HbA1c among individuals with newly diagnosed diabetes. METHODS: We identified a population-based cohort of adults newly diagnosed with diabetes between October 2005 and June 2008 in Calgary, Canada, and conducted a retrospective cohort study by linking administrative and laboratory data with programme attendance data. We matched individuals who attended the programme within the first 6 months after diagnosis with those who did not attend, based on their propensity scores. We measured the change in HbA1c between time of diagnosis and 6-18 months later to determine the association between programme participation and change in HbA1c . RESULTS: HbA1c was measured at baseline and follow-up for 7793 individuals, including 803 programme participants. After propensity score matching, programme participation was associated with a significantly greater adjusted mean reduction in HbA1c between baseline and follow-up of 3.3 mmol/mol (95% CI 2.2-4.3) or 0.30% (95% CI 0.20-0.39). There was a significant interaction between baseline HbA1c and programme participation-the difference in adjusted mean reduction in HbA1c associated with programme participation ranged from 2.7 mmol/mol (0.25%) at baseline HbA1c of 53 mmol/mol (7%) to 6.2 mmol/mol (0.56%) at baseline HbA1c of 97 mmol/mol (11%). CONCLUSION: Despite its brevity, participation in a diabetes education programme was associated with an additional reduction in HbA1c in newly diagnosed people that was comparable with that reported in trials of programmes targeted at those with prevalent diabetes.


Asunto(s)
Diabetes Mellitus Tipo 2/terapia , Hemoglobina Glucada/metabolismo , Educación del Paciente como Asunto/estadística & datos numéricos , Adolescente , Adulto , Anciano , Alberta , Estudios de Cohortes , Recolección de Datos , Diabetes Mellitus Tipo 2/metabolismo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto Joven
4.
Diabet Med ; 30(5): 567-73, 2013 May.
Artículo en Inglés | MEDLINE | ID: mdl-23323955

RESUMEN

AIM: To identify the clinical and socio-demographic factors associated with hospitalization for diabetic ketoacidosis in adults with Type 1 diabetes. METHODS: We combined clinical and administrative health data from a large urban diabetes clinic to perform a data linkage study. We identified adults (aged ≥ 18 years old) with Type 1 diabetes and linked to hospital discharge abstracts to assess for diabetic ketoacidosis hospitalization. The study period was between 1 January 2004 and 31 December 2009, with all individuals living in the same geographic area. Multivariate logistic regression was used to identify potential predictors of diabetic ketoacidosis hospitalization. RESULTS: We identified 255 individuals with a diabetic ketoacidosis hospitalization and 1739 without a diabetic ketoacidosis hospitalization. Mean (standard deviation) age was 40.0 (15.8) years, 51.7% were men and mean duration of diabetes was 17.8 (12.9) years. Diabetic ketoacidosis hospitalization was associated with shorter duration of diabetes (odds ratio 0.96 per year; 95% confidence interval 0.95-0.98), gastroparesis (odds ratio 4.13; 95% confidence interval 1.82-9.35), psychiatric diagnosis (odds ratio 1.98; 95% confidence interval 1.22-3.19), and higher HbA1c (odds ratio 1.25 per 1% increase; 95% confidence interval 1.16-1.35). CONCLUSIONS: This study identifies specific clinical factors associated with diabetic ketoacidosis hospitalization in adults with Type 1 diabetes. This information can help to inform the detection of high-risk patients, for whom special attention and interventions may be warranted to prevent diabetic ketoacidosis.


Asunto(s)
Diabetes Mellitus Tipo 1/complicaciones , Cetoacidosis Diabética/etiología , Hemoglobina Glucada/metabolismo , Hospitalización/estadística & datos numéricos , Adulto , Canadá/epidemiología , Recolección de Datos , Diabetes Mellitus Tipo 1/sangre , Diabetes Mellitus Tipo 1/epidemiología , Cetoacidosis Diabética/sangre , Cetoacidosis Diabética/epidemiología , Femenino , Humanos , Modelos Logísticos , Masculino , Oportunidad Relativa , Medición de Riesgo , Factores de Riesgo , Factores Socioeconómicos , Factores de Tiempo , Población Urbana
5.
Clin Obes ; 8(4): 275-284, 2018 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-29896935

RESUMEN

Preliminary evidence suggests exercise in polycystic ovary syndrome (PCOS) may improve reproductive and cardiometabolic parameters. Our primary aim was to determine the impact of exercise training on reproductive health in women with PCOS. Our secondary aim was to determine the effect of exercise training on cardiometabolic indices. A systematic review of published literature was conducted using MEDLINE and EMBASE based on a pre-published protocol (PROSPERO CRD42017065324). The search was not limited by year. Randomized controlled trials, non-randomized controlled trials and uncontrolled trials that evaluated an exercise intervention in women with PCOS and reported reproductive outcomes were included. Reproductive outcomes were analysed semi-quantitatively and a meta-analysis was conducted for reported cardiometabolic outcomes. Of 517 screened abstracts, 14 studies involving 617 women with PCOS were included: seven randomized controlled trials, one non-randomized controlled trial and six uncontrolled trials. There were insufficient published data to describe the effect of exercise interventions on ovulation quantitatively, but semi-quantitative analysis suggested that exercise interventions may improve menstrual regularity, pregnancy and ovulation rates. Our meta-analysis found that exercise improved lipid profiles and decreased waist circumference, systolic blood pressure and fasting insulin. The impact of exercise interventions on reproductive function remains unclear. However, our meta-analysis suggests that exercise interventions may improve cardiometabolic profiles in women with PCOS.


Asunto(s)
Terapia por Ejercicio , Síndrome del Ovario Poliquístico/terapia , Femenino , Corazón/fisiopatología , Humanos , Ciclo Menstrual , Síndrome del Ovario Poliquístico/fisiopatología , Embarazo , Ensayos Clínicos Controlados Aleatorios como Asunto , Reproducción
6.
Neurology ; 73(2): 89-97, 2009 Jul 14.
Artículo en Inglés | MEDLINE | ID: mdl-19439720

RESUMEN

BACKGROUND: Among patients with a patent foramen ovale (PFO) and a prior cryptogenic ischemic stroke or TIA, the absolute and relative risk of recurrent events is unclear. METHODS: We conducted a systematic review and meta-analysis of clinical studies in any language published up to February 2008. We included studies reporting original data on recurrent cerebrovascular events in patients with prior cryptogenic stroke or TIA and PFO. Two authors independently extracted data and evaluated study quality. RESULTS: We identified 15 eligible studies, four with a non-PFO comparison group. In these four studies, the pooled relative risk (RR) for recurrent ischemic stroke or TIA in patients with vs without a PFO was 1.1 (95% confidence interval [CI] 0.8 to 1.5). For ischemic stroke, the pooled RR was 0.8 (95% CI 0.5 to 1.3). We tabulated the absolute rate of recurrent events in all 15 studies. The pooled absolute rate of recurrent ischemic stroke or TIA in patients with PFO was 4.0 events per 100 person-years (95% CI 3.0 to 5.1) while the rate of recurrent ischemic stroke was 1.6 events per 100 person-years (95% CI 1.1 to 2.1). CONCLUSIONS: In medically treated patients with prior cryptogenic stroke, while the absolute rate of recurrent events is variable, available evidence does not support an increased relative risk of recurrent ischemic events in those with vs without a patent foramen ovale. Patent foramen ovale closure in these patients cannot be recommended until the results of ongoing clinical trials are reported.


Asunto(s)
Isquemia Encefálica/epidemiología , Isquemia Encefálica/etiología , Foramen Oval Permeable/complicaciones , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología , Factores de Edad , Isquemia Encefálica/mortalidad , Isquemia Encefálica/terapia , Foramen Oval Permeable/epidemiología , Foramen Oval Permeable/mortalidad , Foramen Oval Permeable/terapia , Humanos , Ataque Isquémico Transitorio/epidemiología , Ataque Isquémico Transitorio/etiología , Ataque Isquémico Transitorio/mortalidad , Ataque Isquémico Transitorio/terapia , Recurrencia , Riesgo , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/terapia , Resultado del Tratamiento
7.
Can J Cardiol ; 24(6): 491-6, 2008 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-18548147

RESUMEN

BACKGROUND: Clinical practice recommendations for hypertension do not make recommendations specific to men or women. However, the sex hormones appear to modulate differently the renin-angiotensin system (RAS), which plays a central role in the regulation of blood pressure. Today, little is known about the effects of sex on the efficacy of therapies that antagonize the RAS, such as angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs). OBJECTIVE: To identify randomized controlled trials evaluating the efficacy of ACEIs and ARBs in preventing major cardiovascular outcomes, determine what proportion of the trial participants were female, and evaluate whether there was any evidence of a sex difference in the efficacy of these agents. METHODS: A systematic review of the literature was conducted to identify randomized controlled trials that used either ACEIs or ARBs for the treatment of hypertension. RESULTS: Thirteen ACEI trials and nine ARB trials were identified. Sex-specific outcome data were available in six of the ACEI trials and three of the ARB trials. These trials enrolled 74,105 patients; 39.1% were women. Seven of the nine trials indicated that ACEIs or ARBs may be slightly more beneficial in men. The magnitude of these differences, in most trials, was small. CONCLUSIONS: Sex-specific data are reported in 43% of large hypertension clinical trials. Review of the trials reporting sex-specific effect sizes indicates that ACEIs and ARBs may be more effective in men.


Asunto(s)
Bloqueadores del Receptor Tipo 1 de Angiotensina II/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Hipertensión/epidemiología , Ensayos Clínicos Controlados Aleatorios como Asunto , Humanos , Hipertensión/tratamiento farmacológico , Morbilidad/tendencias , Cooperación del Paciente , Distribución por Sexo , Factores Sexuales , Resultado del Tratamiento
8.
Child Psychiatry Hum Dev ; 22(3): 199-211, 1992.
Artículo en Inglés | MEDLINE | ID: mdl-1555490

RESUMEN

This study provides an overview of children, their families, and their circumstances at the time that the child entered foster care in Israel. Data regarding a representative sample of 800 children were collected as part of the ongoing operation of a clinical information system set up for Israel's foster care service in 1988. Implications of our findings for interventions are discussed.


Asunto(s)
Protección a la Infancia/estadística & datos numéricos , Familia , Cuidados en el Hogar de Adopción/estadística & datos numéricos , Adolescente , Factores de Edad , Niño , Preescolar , Femenino , Humanos , Lactante , Sistemas de Información , Israel , Masculino , Relaciones Padres-Hijo , Factores Sexuales
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