Normocalcaemic primary hyperparathyroidism: a pragmatic approach.

It is well recognised that over the past three to four decades the incidence of asymptomatic primary hyperparathyroidism has increased significantly. However, more recently this pattern has further evolved into a presentation with normocalcaemia and raised parathyroid hormone (PTH) level without the presence of a recognised stimulus for its rise, in the form of vitamin D deficiency or renal impairment. A diagnostic label of normocalcaemic hyperparathyroidism (NPHPT) has been given to this phenotype and in most such individuals, the initial PTH measurement is driven by the presence of metabolic bone disease. The reported prevalence, degree of end-organ involvement and the rate of progression vary considerably and are related to patients studied and the biochemical cut-offs used in its definition. A majority of patients are diagnosed during assessment of metabolic bone disease of varying degrees. Once the diagnosis is confirmed by excluding confounding factors, the patient should undergo full assessment of end-organ involvement, which is the main determinant of further therapeutic decisions. Surgery, with prior localisation, is considered in patients with significant end-organ involvement in keeping with the guidance for hypercalcaemic patients. If a patient does not meet these criteria, annual clinical and biochemical surveillance is recommended to identify progression to hypercalcaemia or worsening end-organ involvement. It is less clear if patients identified during 'routine' requests for evaluation of unrelated symptoms require similar close monitoring. In conclusion, in this review on NPHPT we focus on its definition, planning of further investigations, selection of patients for intervention and devising an appropriate follow-up strategy.

Effectiveness of personalized written asthma action plans in the management of children with partly controlled asthma in Trinidad: a randomized controlled trial.

BACKGROUND: The provision of written asthma action plans (WAAPs) is regarded by regional and international guidelines as an essential component of patient education and self-management. However, the evidence for this practice in children is deficient. AIM: To evaluate the effectiveness of adding a personalized WAAP in the treatment of children with partly controlled asthma. METHODS: Children with partly controlled asthma were randomized to receive a personalized WAAP or no plan, in addition to standard care including education. They were followed up with serial measurement of outcome variables. The primary outcome measured was the number of emergency room (ER) revisits. RESULTS: Ninety-one children participated, 45 in the intervention group and 46 in the control group. Comparison with pretrial data revealed significantly improved outcomes with respect to the numbers of ER visits ( p = 0.005 and 0.0002) and acute asthmatic attacks ( p = 0.0064 and 0.0006) in both arms of the study. Children in receipt of a personalized WAAP had fewer ER visits ( p = 0.78), asthma attacks ( p = 0.84), missed school days ( p = 0.28), night-time awakenings ( p = 0.48) and unscheduled doctor visits ( p = 0.69) than those who did not receive a plan. CONCLUSION: The results of this study suggest that the provision of personalized WAAPs may play a useful role in the management of children with partly controlled asthma but is no better than standard care. Asthma education is a critical component in the prevention of exacerbations in children with partly controlled asthma.

The role of gender in compliance and attendance at an outpatient clinic for type 2 diabetes mellitus in Trinidad.

OBJECTIVES: To explore the association between gender and (1) attendance and (2) compliance with treatment in a population of patients with diabetes who attended outpatient clinics in the island of Trinidad (Trinidad and Tobago). METHODS: A cross-sectional study was conducted with a sample of 360 patients who met the selection criteria. Simple consecutive sampling and a questionnaire were used to interview clinic attendees at two urban clinics in east and south Trinidad. RESULTS: 74.2% (267) of the participants were women. A higher percentage of women than men were unemployed (79.4% vs. 59.1%, P < 0.001). Men were more likely to consume alcohol (26.9% vs. 11.6%, P < 0.001) and smoke cigarettes (20.4% vs. 5.6%, P < 0.001). Women were more compliant than men regarding diet (39.3% vs. 22.6%, P < 0.005) and prescribed medication (71.9% vs. 65.6%, P < 0.04). Women were more satisfied than men with dispensary (81.3% vs. 71.0%, P < 0.04) and clinic conditions (92.1% vs. 84.9%, P < 0.05). CONCLUSIONS: More women attended the clinic, and their compliance with the treatment regimen was better than in men. The latter were more likely to engage in health risk behaviors such as drinking and smoking. Efforts focused on men with diabetes mellitus in Trinidad and Tobago are needed to encourage greater compliance.

The role of gender in compliance and attendance at an outpatient clinic for type 2 diabetes mellitus in Trinidad

OBJETIVOS: Explorar la asociación entre el género y 1) la asistencia a consultas y 2) el cumplimiento del tratamiento en una población de pacientes con diabetes sacarina (mellitus) atendida en clínicas ambulatorias de la isla de Trinidad (en Trinidad y Tabago). MÉTODOS: Se llevó a cabo un estudio transversal con una muestra de 360 pacientes que llenaron los requisitos de inclusión. Se realizó un muestreo sencillo de pacientes consecutivos y se aplicó un cuestionario para entrevistar a personas atendidas en dos clínicas ambulatorias urbanas del oriente y sur de Trinidad. RESULTADOS: De los participantes, 74,2% eran mujeres. En términos porcentuales, más mujeres que hombres estaban sin empleo (79,4% frente a 59,1%; P < 0,001). Los hombres mostraron una mayor tendencia que las mujeres a consumir alcohol (26,9% frente a 11,6%; P < 0,001) y a fumar cigarrillos (20,4% frente a 5,6%; P < 0,001). Las mu-jeres observaron más el régimen alimentario que los hombres (39,3% frente a 22,6%; P < 0,005) y se ciñeron más que estos a los medicamentos prescritos (71,9% frente a 65,6%; P < 0,04). Las mujeres se mostraron más satisfechas que los hombres con las condiciones imperantes en los dispensarios (81,3% frente a 71,0%; P < 0,04) y clínicas (92,1% frente a 84,9%; P < 0,05). CONCLUSIONES: Más mujeres que hombres asistían a la clínica y el acatamiento del régimen terapéutico fue mayor entre las mujeres que entre los hombres. Estos se mostraron más propensos que las mujeres a incurrir en conductas peligrosas para la salud, tales como beber y fumar. Se necesitan intervenciones dirigidas hacia los hombres con diabetes sacarina en Trinidad y Tabago a fin de fomentar un mayor cumplimiento del tratamiento prescrito.

The role of gender in compliance and attendance at an outpatient clinic for type 2 diabetes mellitus in Trinidad

OBJECTIVES. To explore the association between gender and (1) attendance and (2) compliance with treatment in a population of patients with diabetes who attended outpatient clinics in the island of Trinidad (Trinidad and Tobago). METHODS. A cross-sectional study was conducted with a sample of 360 patients who met the selection criteria. Simple consecutive sampling and a questionnaire were used to interview clinic attendees at two urban clinics in east and south Trinidad. RESULTS. 74.2 percent (267) of the participants were women. A higher percentage of women than men were unemployed (79.4 percent vs. 59.1 percent, P less than 0.001). Men were more likely to consume alcohol(26.9 percent vs. 11.6 percent, P less than 0.001) and smoke cigarettes (20.4 percent vs. 5.6 percent , P less than 0.001). Women were more compliant than men regarding diet (39.3 percent vs. 22.6 percent, P percent 0.005) and prescribed medication (71.9 percent vs. 65.6 percent, P less than 0.04). Women were more satisfied than men with dispensary (81.3 percent vs. 71.0 percent, P less than 0.04) and clinic conditions (92.1 percent vs. 84.9 percent, P less than 0.05). CONCLUSIONS. More women attended the clinic, and their compliance with the treatment regimen was better than in men. The latter were more likely to engage in health risk behaviors such as drinking and smoking. Efforts focused on men with diabetes mellitus in Trinidad and Tobago are needed to encourage greater compliance.