Links Between Strokes and Hereditary Hemorrhagic Telangiectasia: A Population-Based Study.

BACKGROUND: Hereditary hemorrhagic telangiectasia (HHT) is a disease of abnormal vasculature where patients are predisposed to strokes of multiple etiologies. We assessed yearly stroke incidence among Albertans with HHT and compared with the general population. Given the tendency for stroke in HHT patients, we expected HHT patients to have higher stroke incidence, in particular at younger ages. METHODS: Population-based administrative health data on inpatient and ambulatory admissions were extracted over a 16-year period using International Classification of Diseases (ICD)-9 and ICD-10, Canada codes. We analyzed overall occurrence of strokes in Alberta by age, gender, stroke subtype, and diagnosis of HHT. RESULTS: The age-standardized incidence rate of stroke in HHT was 450 per 100,000 compared with 260 per 100,000 in the general population with a rate ratio of 1.73 (95% confidence interval (CI) [1.046-2.842]). This study found a higher HHT prevalence in Alberta (1 in 3800) compared to the world average of 1 in 5000. Women were also more likely to be diagnosed with HHT, with a 3.25:1 female gender preponderance in the yearly incidence.InterpretationThis study not only shows that HHT patients are at higher risk of having a stroke but also quantifies that risk using an age-adjusted metric in Alberta. This province has a higher than expected disease burden of HHT, with the majority of cases affecting women. Our study found that acute ischemic strokes and transient ischemic attacks are far more common than hemorrhage in HHT. As HHT is a rare, multi-system, chronic disease, these patients should be referred to an HHT Centre of Excellence.

CONTEXTE: La maladie de Rendu-Osler-Weber (MROW) est une maladie caractérisée par une anomalie du système vasculaire. Les patients qui en sont atteints deviennent prédisposés à être victimes d'AVC présentant de multiples étiologies. À cet égard, nous avons cherché à évaluer l'incidence annuelle d'AVC au sein de patients albertains atteints de la MROW comparativement à l'incidence annuelle d'AVC au sein de la population de cette province. Étant donné la prédisposition évoquée ci-haut, nous nous attendions à ce que l'incidence d'AVC chez des patients atteints de cette maladie soit plus élevée, particulièrement à un plus jeune âge. MÉTHODES: Des données administrative liées à la santé et basées sur une population déterminée ont été extraites au moyen des codes ICD-9 et ICD-10-CA. Elles concernaient des patients hospitalisés et ambulatoires au cours d'une période de 16 ans. Nous avons ensuite analysé l'incidence d'ensemble des AVC en Alberta en fonction de l'âge, du sexe, des sous-types d'AVC et de l'établissement préalable d'un diagnostic de MROW. RÉSULTATS: Le taux d'incidence normalisé selon l'âge des AVC chez les patients atteints de la MROW était de 450 pour 100 000 comparativement à 260 pour 100 000 au sein de la population générale. Le ratio des taux, lui, était de 1,73 (IC 95 % [1,046;2,842]). Notre étude a aussi constaté une prévalence plus élevée de la MROW en Alberta (1 sur 3 800) comparativement à la moyenne mondiale, qui est de 1 sur 5 000. Fait à souligner, les femmes étaient plus susceptibles de recevoir un diagnostic de MROW (prépondérance féminine de 3,25:1 sur une base annuelle). INTERPRÉTATION: Cette étude a montré que les patients atteints de la MROW étaient non seulement plus à risque d'être victimes d'un AVC mais a aussi quantifié ce risque au moyen d'un outil de mesure ajusté pour l'Alberta en fonction de l'âge. Cette province donne à voir une incidence plus élevée de MROW que ce à quoi on pouvait s'attendre, la majorité des patients étant de sexe féminin. Notre étude a en outre montré que les AVC ischémiques aigus et les accidents ischémiques transitoires (AIT) sont nettement plus courants que les hémorragies lorsqu'on est atteint de la MROW. Considérant qu'il s'agit d'une maladie chronique rare de nature multi-systémique, ceux et celles qui en sont atteints devraient être dirigés vers un centre d'excellence spécialisé dans son traitement.

Caffeine and cardiovascular health.

This report evaluates the scientific literature on caffeine with respect to potential cardiovascular outcomes, specifically relative risks of total cardiovascular disease (CVD), coronary heart disease (CHD) and acute myocardial infarction (AMI), effects on arrhythmia, heart failure, sudden cardiac arrest, stroke, blood pressure, hypertension, and other biomarkers of effect, including heart rate, cerebral blood flow, cardiac output, plasma homocysteine levels, serum cholesterol levels, electrocardiogram (EKG) parameters, heart rate variability, endothelial/platelet function and plasma/urine catecholamine levels. Caffeine intake has been associated with a range of reversible and transient physiological effects broadly and cardiovascular effects specifically. This report attempts to understand where the delineations exist in caffeine intake and corresponding cardiovascular effects among various subpopulations. The available literature suggests that cardiovascular effects experienced by caffeine consumers at levels up to 600 mg/day are in most cases mild, transient, and reversible, with no lasting adverse effect. The point at which caffeine intake may cause harm to the cardiovascular system is not readily identifiable in part because data on the effects of daily intakes greater than 600 mg is limited. However, the evidence considered within this review suggests that typical moderate caffeine intake is not associated with increased risks of total cardiovascular disease; arrhythmia; heart failure; blood pressure changes among regular coffee drinkers; or hypertension in baseline populations.

Exposure and health risks of metals in imported and local brands' lipsticks and eye pencils from Bangladesh.

Elemental contamination in cosmetics is a serious health concern as it can pose a cumulative effect on the user's body over a long period. The prime motive of the study was to assess the concentration of 10 concerning chemical elements (Pb, Cd, Cr, As, Co, Ni, Cu, Zn, Fe, and Mn) in imported and local lipsticks and eye pencil samples collected from retail outlets in central Bangladesh (Dhaka city) and to assess their dynamic health risks for users. A total of 18 lipsticks and 24 eye pencils were studied and concentrations of chemical elements were examined with atomic absorption spectrophotometer. The health risk assessment was performed for dermal and ingestion routes of the contaminants. The results reveal that the concentrations of the examined elements vary with colors, brands, and origins. Pb and As concentrations were found below the permissible limit but Cr concentration in some samples exceeded the allowable limit in cosmetics. Cd was not detected in any samples; however, other examined elements such as Co, Ni, Cu, Mn, Zn, and Fe were detected in considerable concentrations. Elements like Mn, Zn, and Fe were found at high levels. In the case of lipstick samples, elemental concentrations followed the order of Fe > Zn > Mn > Ni > Cr > Cu > Pb > Co > As, while the order was Fe > Cu > Mn > Zn > Ni > Cr > Co > Pb > As for eye pencil samples. Results of the hazards quotient (HQ) indicate that there were no non-carcinogenic or carcinogenic risks of elements in samples for dermal exposure. But the cancer risk values of Cr (HQ > 1 for ingestion) in brown color lipsticks and Ni indicate that lipsticks have some carcinogenic effects if they enter the user's body. Dermal cancer risk for eye pencils has also been calculated and for Pb, Cr, Ni, and As; the values were found within the acceptable ranges of 10-6-10-4. It is suggested that the allowable limit of all toxic elements in cosmetics must be established. Furthermore, continuous monitoring is urgently needed for personal care products like lipsticks and eye pencils commonly available in the local markets in the country like Bangladesh.

Characterization of microplastic pollution in the Pasur river of the Sundarbans ecosystem (Bangladesh) with emphasis on water, sediments, and fish.

An emerging concern of today's world, due to their universal dispersion worldwide, is the environment's microplastic pollution. The Sundarbans, the world's largest mangrove, have unique and dynamic environmental settings with numerous pollution risk exposures, including microplastics (MPs). Thus, the present study has focused on the MP pollution in water, sediment, and fish samples of the Sundarbans of Bangladesh for the first time. Water and sediment samples were collected (n = 30/each) from sampling locations along the Pasur river (Bangladesh). Furthermore, nine species of fish samples were collected from a local fish market situated at the Mongla port. Results show that 100 % of the analyzed samples have evidence of MPs. On average, 2.66 × 103 plastic particles/L and 1.57 × 105 particles/kg were found in water and sediment samples, respectively. Furthermore, results show a higher number of MPs in the animals' gastrointestinal tract (GIT) (10.41 particles/g), concerning the average concentration recorded in the muscles (4.68 particles/g). O. pama and H. nehereus were the species that showed the highest MPs accumulation in the GIT. In the muscles, the highest MP levels were observed in T. ilisha and L. calcarifer. Most of the particles were smaller than 1 mm; black-colored particles dominated the pool. FT-IR analysis revealed the presence of seven polymer types where polyamide was abundant in water and sediment samples. SEM analysis showed morphological structures and adsorbed particles on the surface of plastic samples, and the spatial distribution of MPs indicates that the location with high human intervention has elevated levels of MPs. Therefore, our study demonstrates that Sundarbans mangrove forests are highly contaminated with MPs and that its fisheries can be a potential source of human exposure to these pollutants.

Management of Children Admitted to Hospitals across Bangladesh with Suspected or Confirmed COVID-19 and the Implications for the Future: A Nationwide Cross-Sectional Study.

There is an increasing focus on researching children admitted to hospital with new variants of COVID-19, combined with concerns with hyperinflammatory syndromes and the overuse of antimicrobials. Paediatric guidelines have been produced in Bangladesh to improve their care. Consequently, the objective is to document the management of children with COVID-19 among 24 hospitals in Bangladesh. Key outcome measures included the percentage prescribed different antimicrobials, adherence to paediatric guidelines and mortality rates using purposely developed report forms. The majority of 146 admitted children were aged 5 years or under (62.3%) and were boys (58.9%). Reasons for admission included fever, respiratory distress and coughing; 86.3% were prescribed antibiotics, typically parenterally, on the WHO 'Watch' list, and empirically (98.4%). There were no differences in antibiotic use whether hospitals followed paediatric guidance or not. There was no prescribing of antimalarials and limited prescribing of antivirals (5.5% of children) and antiparasitic medicines (0.7%). The majority of children (92.5%) made a full recovery. It was encouraging to see the low hospitalisation rates and limited use of antimalarials, antivirals and antiparasitic medicines. However, the high empiric use of antibiotics, alongside limited switching to oral formulations, is a concern that can be addressed by instigating the appropriate programmes.

A computational tool for identifying minimotifs in protein-protein interactions and improving the accuracy of minimotif predictions.

Protein-protein interactions are important to understanding cell functions; however, our theoretical understanding is limited. There is a general discontinuity between the well-accepted physical and chemical forces that drive protein-protein interactions and the large collections of identified protein-protein interactions in various databases. Minimotifs are short functional peptide sequences that provide a basis to bridge this gap in knowledge. However, there is no systematic way to study minimotifs in the context of protein-protein interactions or vice versa. Here we have engineered a set of algorithms that can be used to identify minimotifs in known protein-protein interactions and implemented this for use by scientists in Minimotif Miner. By globally testing these algorithms on verified data and on 100 individual proteins as test cases, we demonstrate the utility of these new computation tools. This tool also can be used to reduce false-positive predictions in the discovery of novel minimotifs. The statistical significance of these algorithms is demonstrated by an ROC analysis (P = 0.001).

Surveillance of Hypertension Among Women of Reproductive Age: A Review of Existing Data Sources and Opportunities for Surveillance Before, During, and After Pregnancy.

Hypertension is one of the largest modifiable risk factors for cardiovascular disease in the United States, and when it occurs during pregnancy, it can lead to serious risks for both the mother and child. There is currently no nationwide or state surveillance system that specifically monitors hypertension among women of reproductive age (WRA). We reviewed hypertension information available in the Behavioral Risk Factor Surveillance System (BRFSS), National Health and Nutrition Examination Survey (NHANES), National Health Interview Survey (NHIS), and Pregnancy Risk Assessment and Monitoring System (PRAMS) health surveys, the Health care Cost and Utilization Project administrative data sets (National Inpatient Sample, State Inpatient Databases, Nationwide Emergency Department Sample, and State Emergency Department Database and the Nationwide Readmissions Database), and the National Vital Statistics System. BRFSS, NHIS, and NHANES and administrative data sets have the capacity to segment nonpregnant WRA from pregnant women. PRAMS collects information on hypertension before and during pregnancy only among women with a live birth. Detailed information on hypertension in the postpartum period is lacking in the data sources that we reviewed. Enhanced data collection may improve opportunities to conduct surveillance of hypertension among WRA.

Effectiveness of community health workers in the care of people with hypertension.

BACKGROUND: The contributions of community health workers (CHWs) in the delivery of culturally relevant programs for hypertension control have been studied since the 1970s. This systematic review examines the effectiveness of CHWs in supporting the care of people with hypertension. METHODS: Computerized searches were conducted of multiple bibliographic electronic databases from their inception until May 2006. No restrictions were applied for language or study design, and studies were restricted to those that reported at least one outcome among participants. RESULTS: Fourteen studies were identified, including eight randomized controlled trials (RCTs). Many of the studies focused on poor, urban African Americans. Significant improvements in controlling blood pressure were reported in seven of the eight RCTs. Several studies reported significant improvements in participants' self-management behaviors, including appointment keeping and adherence to antihypertensive medications. Four studies reported positive changes in healthcare utilization and in systems outcomes. Two of the RCTs showed significant improvements in other patient outcomes, such as changes in heart mass and risk of CVD. CONCLUSIONS: Community health workers may have an important impact on the self-management of hypertension. Programs involving CHWs as multidisciplinary team members hold promise, particularly for diverse racial/ethnic populations that are under-served.

Effectiveness of interventions to promote screening for diabetic retinopathy.

OBJECTIVE: To assess the effectiveness of interventions aimed to increase retinal screening among people with diabetes. METHODS: A systematic literature search was conducted of multiple electronic bibliographic databases up to May 2005. Studies were included if interventions were used to promote screening for diabetic retinopathy in any language and with any study design. RESULTS: Forty-eight studies (12 randomized controlled trials [RCTs], four nonrandomized studies, and 32 pre-post studies) with a total of 162,157 participants, examined a wide range of interventions, which focused on one or more of the following: (1) patients or populations, (2) providers or practices, and (3) healthcare system infrastructure and processes. Four of five RCTs focusing on patients demonstrated that interventions increased screening significantly, with relative risk ranging from 1.05 (95% confidence interval [CI]=1.01-1.08) to 2.01 (95% CI=1.48-2.73). Five RCTs with a focus on the system all demonstrated significant increases in screening with relative risk ranging from 1.12 (95% CI=1.03-1.22) to 5.56 (95% CI=2.19-14.10). Thirty-six non-RCTs, which included interventions with single or multiple foci, also generally demonstrated positive effects. CONCLUSIONS: Increasing patient awareness of diabetic retinopathy, improving provider and practice performance, and improving healthcare system infrastructure and processes, can significantly increase screening for diabetic retinopathy. Further research should explore strategies for increasing the rate of retinal screening among diverse or disadvantaged populations and the economic efficiency of effective interventions in large community populations.

Effectiveness of practices for improving the diagnostic accuracy of Non ST Elevation Myocardial Infarction in the Emergency Department: A Laboratory Medicine Best Practices™ systematic review.

OBJECTIVES: This article is a systematic review of the effectiveness of four practices (assay selection, decision point cardiac troponin (cTn) threshold selection, serial testing, and point of care testing) for improving the diagnostic accuracy Non-ST-Segment Elevation Myocardial Infarction (NSTEMI) in the Emergency Department. DESIGN AND METHODS: The CDC-funded Laboratory Medicine Best Practices (LMBP) Initiative systematic review method for quality improvement practices was used. RESULTS: The current ACC/AHA guidelines recommend using cardiac troponin assays with a 99th percentile upper reference limit (URL) diagnostic threshold to diagnose NSTEMI. The evidence in this systematic review indicates that contemporary sensitive cTn assays meet the assay profile requirements (sensitivity, specificity, PPV, and NPV) to more accurately diagnose NSTEMI than alternate tests. Additional biomarkers did not increase diagnostic effectiveness of cTn assays. Sensitivity, specificity, and NPV were consistently high and low PPV improved with serial sampling. Evidence for use of point of care cTn testing was insufficient to make recommendation, though some evidence suggests that use may result in reduction to patient length of stay and costs. CONCLUSIONS: Based on the review of and the LMBP(TM) A-6 Method criteria, we recommend the use of cardiac troponin assays without additional biomarkers using the 99th percentile URL as the clinical diagnostic threshold for the diagnosis of NSTEMI. We recommend serial sampling with one sample at presentation and at least one additional second sample taken at least 6h later to identify a rise or fall in the troponin level. No recommendation is made either for or against the use of point of care tests. DISCLAIMER: The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention/the Agency for Toxic Substances and Disease Registry (CDC/ATSDR).

Published norms underestimate the health-related quality of life among persons with type 2 diabetes.

OBJECTIVE: To assess health-related quality of life (HRQL) among adults with type 2 diabetes using the Short Form (SF)-36 and to obtain pooled estimates of HRQL for subpopulations defined by demographic characteristics, diabetes-related complications, and comorbidities. STUDY DESIGN AND METHODS: We conducted computerized searches of multiple electronic bibliographic databases, and studies in any language were selected in which HRQL was reported among adults with type 2 diabetes using the SF-36. Estimates were combined using a random-effects model. RESULTS: One hundred eighteen studies fulfilled the inclusion criteria. HRQL was lower in persons with type 2 diabetes, as measured by all the eight component scores of the SF-36 when compared with the existing U.S. population norms and with previously published type 2 diabetes norms. SF-36 component and summary scores were extremely heterogeneous, and subpopulation data were sparse; this precluded obtaining meaningful pooled scores for most populations of interest and made comparisons among subpopulations difficult. CONCLUSION: Our data suggest that previously published norms may underestimate the effect of diabetes on HRQL, and diabetes populations are extremely heterogeneous, making broad population "norms" for HRQL in type 2 diabetes of limited use. Additional research with important subpopulations and individual-level data are needed to further explore the effect of diabetes on HRQL.

Cost-effectiveness of interventions to prevent and control diabetes mellitus: a systematic review.

OBJECTIVE: To synthesize the cost-effectiveness (CE) of interventions to prevent and control diabetes, its complications, and comorbidities. RESEARCH DESIGN AND METHODS: We conducted a systematic review of literature on the CE of diabetes interventions recommended by the American Diabetes Association (ADA) and published between January 1985 and May 2008. We categorized the strength of evidence about the CE of an intervention as strong, supportive, or uncertain. CEs were classified as cost saving (more health benefit at a lower cost), very cost-effective ($100,000 per LYG or QALY). The CE classification of an intervention was reported separately by country setting (U.S. or other developed countries) if CE varied by where the intervention was implemented. Costs were measured in 2007 U.S. dollars. RESULTS: Fifty-six studies from 20 countries met the inclusion criteria. A large majority of the ADA recommended interventions are cost-effective. We found strong evidence to classify the following interventions as cost saving or very cost-effective: (I) Cost saving- 1) ACE inhibitor (ACEI) therapy for intensive hypertension control compared with standard hypertension control; 2) ACEI or angiotensin receptor blocker (ARB) therapy to prevent end-stage renal disease (ESRD) compared with no ACEI or ARB treatment; 3) early irbesartan therapy (at the microalbuminuria stage) to prevent ESRD compared with later treatment (at the macroalbuminuria stage); 4) comprehensive foot care to prevent ulcers compared with usual care; 5) multi-component interventions for diabetic risk factor control and early detection of complications compared with conventional insulin therapy for persons with type 1 diabetes; and 6) multi-component interventions for diabetic risk factor control and early detection of complications compared with standard glycemic control for persons with type 2 diabetes. (II) Very cost-effective- 1) intensive lifestyle interventions to prevent type 2 diabetes among persons with impaired glucose tolerance compared with standard lifestyle recommendations; 2) universal opportunistic screening for undiagnosed type 2 diabetes in African Americans between 45 and 54 years old; 3) intensive glycemic control as implemented in the UK Prospective Diabetes Study in persons with newly diagnosed type 2 diabetes compared with conventional glycemic control; 4) statin therapy for secondary prevention of cardiovascular disease compared with no statin therapy; 5) counseling and treatment for smoking cessation compared with no counseling and treatment; 6) annual screening for diabetic retinopathy and ensuing treatment in persons with type 1 diabetes compared with no screening; 7) annual screening for diabetic retinopathy and ensuing treatment in persons with type 2 diabetes compared with no screening; and 8) immediate vitrectomy to treat diabetic retinopathy compared with deferred vitrectomy. CONCLUSIONS: Many interventions intended to prevent/control diabetes are cost saving or very cost-effective and supported by strong evidence. Policy makers should consider giving these interventions a higher priority.

Surveillance of certain health behaviors and conditions among states and selected local areas - Behavioral Risk Factor Surveillance System, United States, 2007.

PROBLEM: Chronic diseases (e.g., heart disease, cancer, stroke, and diabetes) are the leading causes of death in the United States. Controlling health risk behaviors (e.g., smoking, physical inactivity, poor diet, and excessive drinking) and using preventive health-care services (e.g., cancer, hypertension, and cholesterol screenings) can reduce morbidity and mortality from chronic diseases. Monitoring health-risk behaviors, chronic health conditions, and preventive care practices is essential to develop health promotion activities, intervention programs, and health policies at the state, city, and county levels. REPORTING PERIOD COVERED: January 2007-December 2007. DESCRIPTION OF THE SYSTEM: The Behavioral Risk Factor Surveillance System (BRFSS) is a state-based, on-going, random--digit-dialed household telephone survey of noninstitutionalized adults aged >or=18 years residing in the United States. BRFSS collects data on health-risk behaviors and use of preventative health services related to the leading causes of death and disability in the United States. This report presents results for 2007 for all 50 states, the District of Columbia, the Commonwealth of Puerto Rico, Guam, the Virgin Islands, 184 metropolitan and micropolitan statistical areas (MMSAs), and 298 counties. RESULTS: In 2007, prevalence estimates of risk behaviors, chronic conditions, and the use of preventive services varied substantially by state and territory, MMSA, and county. The following is a summary of results listed by BRFSS question topic. Each set of proportions refers to the range of estimated prevalence for the disease, condition, or behavior, as reported by the survey subject. Adults who reported fair or poor health: 11% to 32% for states and territories and 6% to 31% for MMSAs and counties. Adults with health-care coverage: 71% to 94% for states and territories and 51% to 97% for MMSAs and counties. Annual influenza vaccination among adults aged >or=65 years: 32% to 80% for states and territories, 48% to 83% for MMSAs, and 44% to 88% for counties. Pneumococcal vaccination among adults aged >/=65 years: 26% to 74% for states and territories, 44% to 83% for MMSAs, and 39% to 87% for counties. Adults who had their cholesterol checked within the preceding 5 years: 66% to 85% for states and territories and 58% to 90% for MMSAs and counties. Adults who consumed at least 5 servings of fruits and vegetables per day: 14% to 33% for states and territories, 16% to 34% for MMSAs and 14% to 37% for counties. Adults who reported no leisure-time physical activity: 17% to 44% for states and territories and 9% to 38% for MMSAs and counties. Adults who engaged in moderate or vigorous physical activity: 31% to 61% for states and territories and 36% to 67% for MMSAs and counties. Adults who engaged in only vigorous physical activity: 19% to 40% for states and territories and 15% to 45% for MMSAs and counties. Cigarette smoking among adults: 9% to 31% for states and territories, 7% to 34% for MMSAs, and 7% to 30% for counties. Binge drinking among adults: 3% to 8% for states and territories. Adults classified as overweight: 33% to 40% for states and territories and 26% to 47% for MMSAs and counties. Adults aged >or=20 years who were obese: 20% to 34% for states and territories and 14% to 38% for MMSAs and counties. Adults who were told of a diabetes diagnosis: 5% to 13% for states and territories and 2% to 17% for MMSAs and counties. Adults with high blood pressure diagnosis: 21% to 35% for states and territories and 16% to 38% for MMSAs and counties. Adults who had high blood cholesterol: 28% to 43% for states and territories, 29% to 49% for MMSAs, and 26% to 51% for counties. Adults with a history of coronary heart disease: 2% to 14% for states and territories, MMSAs, and counties. Adults who were told of a stroke diagnosis: 1% to 7% for states and territories, MMSAs, and counties. Adults who were diagnosed with arthritis: 14% to 36% for states and territories and 16% to 40% for MMSAs and counties. Adults who had asthma: 5% to 10% for states and territories and 3% to 13% for MMSAs and counties. Adults with activity limitation associated with physical, mental, or emotional problems: 10% to 26% for states and territories. Adults who required special equipment because of health problems: 3% to 10% for states and territories and 3% to 14% for MMSAs and counties. INTERPRETATION: The findings in this report indicate substantial variation in self-reported health status, health-care coverage, use of preventive health-care services, health behaviors leading to chronic health conditions, and disability among U.S. adults at the state and territory, MMSA, and county levels. The findings underscore the continued need for surveillance of health-risk behaviors, chronic diseases and conditions, and the use of preventive services. PUBLIC HEALTH ACTIONS: Healthy People 2010 (HP 2010) objectives have been established to monitor health behaviors and the use of preventive health services. Local and state health departments and federal agencies use BRFSS data to identify populations at high risk for certain health behaviors, chronic diseases and conditions and to evaluate the use of preventive services. In addition, BRFSS data are used to direct, implement, monitor, and evaluate public health programs and policies that can lead to a reduction in morbidity and mortality.

The effects of interventions on health-related quality of life among persons with diabetes: a systematic review.

BACKGROUND: Health-related quality of life (HRQL) is increasingly used to measure the outcomes of interventions among people with chronic diseases. OBJECTIVES: To assess the effect of interventions for adults with diabetes on HRQL, as measured by the Short Form (SF)-36 questionnaire. RESEARCH DESIGN: The systematic review was conducted using the methods of the Cochrane Collaboration. Studies reporting SF-36 scores before and after an intervention focused on adults with diabetes were obtained from searches of multiple bibliographic databases. The mean changes and standardized mean differences between pre- and post-intervention were reported as outcome measures. Pooled estimates were obtained using random effects models. RESULTS: : We identified 33 studies examining a wide range of interventions, including diabetes education and behavioral modifications (15 studies), pharmacotherapy (11 studies), and surgery (7 studies). Interventions generally demonstrated improvement in HRQL. When all available profile scores were examined together, the ranges of mean changes in scores were as follows: surgery for treating diabetes comorbidities, 15.0 to 42.0 point improvement; surgery for treating diabetes complications, -13.0 to 37.9; pharmacotherapy using insulin to optimize glycemic control, -4.6 to 27.6; pharmacotherapy for treating comorbidities, 3.8 to 33.2; pharmacotherapy for treating complications, -2.6 to 14.6. Pooled effects from 5 randomized controlled trials of educational interventions demonstrated significantly improved physical function [3.4 (95% CI, 0.1-6.6)] and mental health [4.2 (95% CI, 1.8-6.6)], and a decrease in bodily pain [3.6 (95% CI, 0.6-6.7)]. CONCLUSIONS: A variety of interventions can improve HRQL among adults with diabetes, but the magnitude of effects varied with the interventions. The mechanism of these changes needs to be further examined in the future research.