Joint and distinct risk factors associated with micro- and macrovascular complications in a cohort of type 2 diabetic patients cared through disease management.

We analysed the risk factors associated with diabetic complications in the cohort of patients assisted by a type 2 diabetes mellitus (T2DM) shared-care program. We analysed registry data from 16,136 T2DM patients. Of them, 4,781 had microangiopathy, 3,469 CV events. They were 70.5 ± 17.1 years old, 50% were male, disease duration 13.3 ± 7.8 years, BMI 28.7 ± 4.9 kg/m², HbA1c 7.08 ± 1.23%, FBG 134.7 ± 35.7 mg/dl, 2hPPBG 163.9 ± 47.8 mg/dl, 12.5% smokers. Cholesterol 202.5 ± 37.6 mg/dl, HDL 51.4 ± 20.4 mg/dl, LDL 126.5 ± 36.0 mg/dl, triglyceride 146.2 ± 72.4 mg/dl, SBP 137.8 ± 14.2 mmHg, DBP 80.7 ± 10.8 mmHg, 10-year CV risk score 13.7 ± 9.1; 70.4% had no microangiopathy-i.e. renal, retinal, peripheral nerve disease-and 78.5% of patients had no CV events. Age-adjusted risk factors associated with diabetic complications were male gender, HbA1c, 2hPPBG, HDL, and triglyceride. FBG and SBP were associated with microangiopathy, whereas smoking with cardiovascular events. Optimal targets were reached in: FBG 17%, 2hPPBG 8%, HbA1c 21%, cholesterol 17%, HDL 8%, LDL 5%, triglyceride 20%, SBP 13%, DBP 30%. Drug profiles showed 13% using metformin, 28% sulphonilureas, 26% bitherapy, 4% insulin; 12% statins, 16% anti-platelets, 27% anti-hypertensives, 2% anti-coagulants. T2DM patients showed an acceptable CV risk profile. Joint risk factors for diabetic complications were male gender, HbA1c, 2hPPBG, HDL, and triglyceride. Distinct risk factors were FBG and SBP for micro- and smoking for macrovascular disease. A targeted-to-treat approach needs more attention in the care of T2DM patients.

Assessment of readability and learning of easy-to-read educational health materials designed and written with the help of citizens by means of two non-alternative methods.

OBJECTIVES: We compared two non-alternative methods to assess the readability and learning of easy-to-read educational health materials co-written by physicians, educators and citizens. METHODS: Data from seven easy-to-read materials were analyzed. Readability formulae, and ad hoc data on readability and learning were also computed. RESULTS: The respondents had a mean age of 48.5 +/- 8.3 (SD) years (range 31-57 years). More than two thirds of them were females. About half of the participants had a 'secondary' education or more. According to the readability scores - 54 on average - the booklets resulted to be "easy" for a reader who had received a 'secondary education' or more. Of the 747 participants, 70% of them found the booklet's language to be 'easy' or 'very easy' and 28% 'sufficiently easy' for laypersons to understand. About 98% of the readers found the booklets useful. After reading the booklet 92% (simple knowledge rate) of the readers answered the cognitive items correctly. The after-minus-before net increase in knowledge was 24 +/- 16% and ranged from 8 to 40% (cognitive or knowledge delta). CONCLUSIONS: The availability of readability scores is complementary and it does not replace the need to assess readability and learning by means of structured and tailored questionnaires.

Evaluation of easy-to-read information material on healthy life-styles written with the help of citizens' collaboration through networking.

The objective of this study was to evaluate if easy-to-read information material on the prevention of chronic-degenerative diseases through healthy lifestyle co-written by communicators, educators, physicians and citizens -using a networking strategy- could be judged comprehensible. Readability scores were computed. The survey involved 100 individuals attending our centralized booking centre for medical appointments during an "index week". They filled out an anonymous questionnaire, just before and after they had read the material. Readability and comprehensibility frequencies were calculated. The participants had a mean age of 59.1+/-15.1 (SD) years (range 19-81yrs), 62% were females. Twenty-six percent of them had received no education, 30% "primary", 28% "secondary", and 14% had a "degree". According to readability scores, the booklet was "readable" by all persons who had finished primary school. Of the 100 participants, 40 percent found the booklet's language to be "easy" or "very easy", 46% "sufficiently easy", and 14% "difficult" for laypersons to understand. Ninety-four percent of them found no unintelligible words in the text. Education levels showed no differences. Readers' answers were more correct after they had read the booklet. The pre-test showed that 61+/-26% of the readers answered the comprehensibility items correctly. After reading the booklet, 81+/-17% of them gave correct answers. The after-minus-before net increase in knowledge was +20% (95% CIs +8 to +32%). The booklet was designed and written using a networking strategy with the help of the local population. It was found to be easy to read and quite clear.

Surveillance of dietary habits and lifestyles among 5-6 year-old children and their families living in Central-North Italy.

OBJECTIVES: To study dietary habits and behaviours of a representative sample of 5-6-year-old children and their families. METHODS: A stratified population sample of the general population (5508 children out of 5551 residents) born in 1997 and attending a nursery school was analysed. Weight and height were measured. Information was collected via questionnaire. A "normal" body mass index (BMI) ranged between 13.61-18.09 and 13.31-19.79 kg/m2 for boys and girls respectively. RESULTS: The response rate was 89%. 79% of the boys had a normal BMI, 0.9% had a low BMI, 18% were overweight, and 1.8% was obese; 87% of the girls had a normal BMI, 2.6% had a low BMI, 10% were overweight, and 0.7% were obese. The main sources of dietary information were professionals of the national health system and mass-media. The main barriers to healthy dietary habits were busy daily activities, working timetable, time needed to cook and tasty and healthy food cost. The main changes in dietary habits occurred in the family habits after a child's birth. CONCLUSIONS: Our findings showed a crucial role played by professionals of the national health system and by mass-media on eating behaviours among children and their parents. Birth of a child is a receptive context to promote healthy habits.

Non-HDL cholesterol predicts coronary heart disease in primary prevention: findings from an Italian 40-69 year-old cohort in general practice.

OBJECTS: Non-HDL cholesterol is now recommended as an index of risk associated with combined dyslipidemia, and it has also been found useful in predicting coronary heart disease (CHD) risk in patients with diabetes. We studied the association between known CHD risk factors, enclosed non-HDL cholesterol, and a "high CHD risk condition", i.e. a "5-years CHD risk >15%" in general practice. METHODS: We studied 4,085 40-69 year-old diabetic (no. 489) and non-diabetic (no. 3,596) individuals from an opportunistic cohort. Cross-sectional descriptive statistics, and age- and gender-adjusted multiple logistic exponential betas have been calculated. RESULTS: About 12% of the participants had diabetes. Age- and gender-adjusted comparison showed that all the study variables were significantly worse in diabetic vs. non-diabetic individuals (except cigarette smoking, total blood cholesterol and the ratio of total to HDL cholesterol). They had a mean "5-year CHD-risk" significantly higher than non-diabetic individuals (18.8+/-11.9% vs 7.5+/-6.9%, P<0.01), and a four-fold prevalence of "5-years CHD risk >15%" (55.4% vs 11.1%, P<0.01). As to diabetic individuals, the study variables associated to a "high CHD risk condition" were cigarette smoking, systolic blood pressure, and non-HDL blood cholesterol levels. As to non-diabetic individuals cigarette smoking, systolic blood pressure, and HDL (inversely) and non-HDL blood cholesterol levels were associated to a "high CHD risk condition". CONCLUSIONS: Non-HDL cholesterol--and cigarette smoking and systolic blood pressure--strongly predicted a "high CHD risk condition" both in diabetic and non-diabetic individuals.

Improving the cardio-respiratory fitness in older people and cardiac patients: findings from an Italian participatory research.

OBJECTIVE: We performed a before-after study--in the setting of a participatory research--aimed at improving the cardio-respiratory fitness in older people and cardiac patients by means of tailored advices on diet and exercise administered by trained personnel. METHODS: A volunteer sample of 336 patients underwent a 2-km walk test before and after a comprehensive assessment of health status and after the administration of tailored advices on healthy diet and a personalized exercise program at home by trained personnel. The main outcome measures were before-after changes in the cardiorespiratory fitness index and in the oxygen consumption at a "fast 2-km walking test". RESULTS: The participants had a mean age of 60.9 +/- 6.5 years (range 50-78 years), 62.5% were males. At the end of the study period (3 months), we found a significant improvement of all the exercise test parameters. CONCLUSIONS: A simple diet and exercise individualized 3 months program--administered by trained personnel--was effective at improving the cardio-respiratory fitness in older people and cardiac patients.