Estimated glomerular filtration rate progression in UK primary care patients with type 2 diabetes and diabetic kidney disease: a retrospective cohort study.

AIMS: To examine the rates of diabetic kidney disease (DKD) progression and associated factors, we undertook a study of estimated glomerular filtration rate (eGFR) in a historical cohort of UK primary care patients with type 2 diabetes mellitus (T2DM) and associated DKD from the Clinical Practice Research Datalink. METHODS: Our eligible population were patients with definitive T2DM from a recorded diagnostic code with either a diagnosis of chronic kidney disease (CKD) or renal function test values and renal abnormalities consistent with a CKD diagnosis, identified between 1 October 2006 and 31 December 2011. Only patients with albuminuria results reported in mg/l were used for the longitudinal statistical analyses of the eGFR rate of change using multilevel models. RESULTS: We identified 111,030 patients with T2DM. Among them 58.6% (95% confidence interval (CI): 58.3-58.9) had CKD and 37.2% (95% CI: 36.9-37.5%) had presumed DKD at baseline. Only 19.4% of patients had urinary albumin test results expressed as mg/l in the year prior to index date. Almost two-thirds (63.8%) of patients with T2DM and presumed DKD received prescriptions for angiotensin-converting enzyme (ACE) inhibitors or angiotensin type 1 receptor blockers (ARB) or both. Time-dependent variables that predict subsequent eGFR decline include increased albuminuria, time from index date and older age. CONCLUSION: Only a minority of diabetic patients with DKD had quantitative albuminuria assessments. The relatively low proportion of DKD patients with ACEi or ARB prescriptions suggests a gap between healthcare practice and available scientific evidence during the study period. Increased albuminuria and older age were the most consistent predictors of subsequent eGFR decline.

Investigación del envejecimiento: un reto para la salud pública y para la sociedad / Investigation of aging: A challenge for public health and for society

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Informe global del grupo de investigadores en el área de envejecimiento del encuentro Mahón-2000 / Global Report of the Investigator Group in the Area of Aging of the Mahon Meeting 2000

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Interferon and ribavirin vs interferon alone in the re-treatment of chronic hepatitis C previously nonresponsive to interferon: A meta-analysis of randomized trials.

CONTEXT: Hepatitis C is the leading cause of chronic liver disease in the United States. Several trials have found that interferon and ribavirin combination therapy is more efficacious than interferon monotherapy for previously untreated patients and those who relapsed after prior interferon monotherapy, but its effectiveness for nonresponders to prior interferon monotherapy is unclear. OBJECTIVE: To assess the efficacy and safety of interferon and ribavirin vs interferon alone for treatment of patients with chronic hepatitis C who previously did not respond to interferon monotherapy. DATA SOURCES: A systematic search was performed using MEDLINE and the Science Citation Index for publications from 1966 to December 1999. A manual reference search and a manual review of relevant specialty journals also were performed, and input from clinical hepatology experts was sought. STUDY SELECTION: Included studies were randomized, controlled clinical trials comparing interferon and ribavirin with interferon alone and reporting virological and biochemical outcomes after a follow-up period. Of 50 identified studies, 12 trials (941 patients) were included in the analysis. DATA EXTRACTION: Two investigators reviewed trials independently for methods, inclusion and exclusion criteria, and outcomes. Disagreements were resolved by discussion. Abstracted data included study and patient characteristics and virological, biochemical, and histological outcomes. A quality evaluation questionnaire was used to score studies. DATA SYNTHESIS: The pooled virological response rate for combination therapy was 14% (95% confidence interval [CI], 11%-17%), with a risk difference favoring combination therapy of 7% (95% CI, 2%-13%). Use of interferon alfa-2a/2b and ribavirin, 1000 to 1200 mg/d, was associated with a pooled virological response rate of 18% and a risk difference of 16% (95% CI, 11%-21%). When interferon alfa-n/n3 and a lower dosage of ribavirin (600-800 mg/d) were used, the risk difference was 0% (95% CI, -7% to 7%). Combination therapy was associated with more adverse effects and an increased rate of discontinuation of treatment compared with interferon monotherapy. CONCLUSIONS: For chronic hepatitis C that is nonresponsive to prior interferon monotherapy, combination therapy is more effective than re-treatment with interferon alone. Response rates remain less than 20% even in the most responsive subgroups, demonstrating a need for better therapeutic options.

Nutrient intakes and adequacy among an older population on the eastern shore of Maryland: the Salisbury Eye Evaluation.

OBJECTIVE: To describe the reported usual dietary intakes of the participants in the Salisbury Eye Evaluation (SEE) project and to estimate the prevalence of inadequate nutrient intakes using the probability approach. SUBJECTS/SETTING: A representative sample of elderly residents (aged 65 to 85 years) of Salisbury, Md. DESIGN: Cross-sectional survey, using a food frequency questionnaire to obtain nutrient intakes. We estimated energy and protein; percent of energy intake from carbohydrates, fat, and protein; as well as usual intakes of cholesterol, vitamin A, carotenoids, vitamin C, thiamin, riboflavin, vitamin B-6, vitamin E, niacin, iron, calcium, zinc, and folate. Estimates of prevalence of inadequate nutrient intakes were calculated using the probability approach among the 2,655 participants with complete nutrient intake information. STATISTICAL ANALYSES PERFORMED: The chi 2 test for independence and analysis of variance. A P < .05 was considered significant in a 2-sided test. RESULT: On average, white participants of both genders reported higher mean energy and nutrient intakes than did black participants. Zinc had the highest estimated prevalences of inadequacy across all gender and race categories, followed by calcium, vitamin E, and vitamin B-6. Vitamin C, with estimated prevalences of inadequacy lower than 13%, and folate, with prevalences lower than 17%, had the lowest estimated prevalences of inadequacy across all gender, race, and age categories. CONCLUSIONS: In this population, there are race differences in estimated prevalences of inadequate nutrient intake. According to the current nutrient requirements for adults aged 51 years and older, many elderly persons have inadequate dietary intakes of key nutrients.

Anthropometric status and cataract: the Salisbury Eye Evaluation project.

BACKGROUND: Weight or body mass index (BMI; in kg/m2) is frequently identified as a risk factor for cataract, but the nature of the association is unclear. OBJECTIVE: We aimed to characterize the relation between BMI and stature and risk of different types of cataract. DESIGN: We analyzed data from participants in the Salisbury Eye Evaluation (SEE), a cross-sectional survey of visual status and demographic, nutritional, and environmental factors conducted between 1993 and 1995 in a representative sample of community-dwelling older persons in Salisbury, MD. Multiple logistic regression techniques were used to compare risk factors between individuals with nuclear, cortical, or posterior subcapsular (PSC) opacities and individuals with no cataract. RESULTS: Risk of nuclear opacification was greater in participants with lower BMIs [adjusted odds ratio of 1.13 (95% CI: 1.02, 1.27) with a BMI of 22.5 compared with 28.0] and of taller stature [1.12 (95% CI: 1.01, 1.25) with a stature of 170.5 cm compared with 164]. In contrast, risk of cortical opacification was greater in participants with higher BMIs and of taller stature, but the relation for stature diminished in magnitude and was not significant after adjustment for other risk factors. BMI was not related to risk of PSC opacities, but there was some evidence that taller stature is a risk factor for PSC opacification (P = 0.06) after adjustment for other risk factors. CONCLUSIONS: Both BMI and stature are independent risk factors for cataracts in the SEE population, with the nature of the risk dependent on cataract type.

[Towards evidence-based public health?]. / Hacia una salud pública basada en la evidencia?

Evidence-based public health can be viewed as a way of facing community health problems by which the decisions are taken accordingly to the available evidence. A complete multidisciplinary approach should be introduced, with the goal of identifying and articulating the different dimensions which are present when trying to respond to the challenges or problems for the people's health. In addition to clinical medicine, disciplines such as epidemiology, biostatistics, health services research, economics, behavioural sciences, demography, nutrition, gerontology or computing sciences, among others, may contribute to health promotion and disease prevention. This open approach should not be exempt of a captious attitude toward the obtainable information, while it is essential to have a comprehensive spirit to combine this information with the previous experience and the peculiarities of each situation. Searching for evidence begins with a clear operational statement of the problem. This helps to select and obtain the key pieces of information. The information obtained must be judged critically, and related to the specifics of the problem. Lastly, it should be accepted that search for evidence does not mean finding certitude. Idolizing evidence can end up being as inappropriate as the implementation of a health program ignoring the previous information about its potential effectiveness, if such information were available. Many decisions in public health have to be taken conscious that scientific evidence does not rule out uncertainty, as other elements such as the cultural context, the individual preferences and other social factors may have a decisive influence in the success or failure of public health interventions.

Drug and alcohol use in Spain: consumption habits, attitudes and opinions.

To estimate the lifetime prevalence of drug and alcohol use and its sociodemographic determinants and to investigate opinions towards drug use in Spain, we examined a representative nation-wide sample of 2495 adult Spaniards, males and females, aged 18 y or older, selected by a multistaged random strategy during 1989. Information was obtained by at-home interviews using a structured closed questionnaire. Participants were asked for their lifetime prevalence of use of cannabis, sedatives and sleeping pills, alcohol, amphetamines, inhalants, cocaine and heroin, as well as for their sociodemographic characteristics and their opinions towards drug use. Alcohol had the highest lifetime prevalence of consumption (55.7%), followed by cannabis (12.3%), sedatives and sleeping pills (12.0%), amphetamines (4.3%), cocaine (3.0%), inhalants (0.8%) and heroin (0.6%). Being male, young, separated or divorced, and unemployed were the main determinants of alcohol and drug use. A higher use of illicit drugs was also observed in the higher socio-economic groups. Regular use of any drug was considered a risky health habit by more than 80% of the sample. We conclude that the consumption of drugs and alcohol is a rather extended habit in Spain. Drug users tend to share some common sociodemographic characteristics (being male, young, separated or divorced, and unemployed) which may help target intervention programs.

[Disability evaluation: Barthel's index]. / Valoración de la discapacidad física: el indice de Barthel.

In Public Health exists a growing tendency to evaluate the impact of health problems both on the quality of life of the persons involved as well as the use of health services. In this sense, the evaluation of incapacity is acquiring ever greater relevance. The Barthel Index is an instrument widely used to this end and measures the capacity of the person for the execution of ten basic activities in daily life, obtaining a quantitative estimation of the subject's level of dependency. The Barthel Index has been used, since its introduction in 1955, resulting in numerous versions, as well as serving as a standard of comparison with other scales. It is an easily applicable method, with a high level of reliability and validity, capable of detecting changes, easy to interpret and the application of which is not problematic. On the other hand, its adaptation to different cultural environments is almost immediate. Although it has a few limitations, the Barthel Index may be recommended as a selection method for measuring physical incapacity, both in clinical practice as well as in epidemiological investigation and Public Health.