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1.
Nihon Koshu Eisei Zasshi ; 67(8): 501-508, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-32879236

RESUMO

Objectives Medical expenses for diabetes differ between Japan's 47 prefectures. The medical care expenditure regulation plan aims to reduce regional differences in outpatient medical costs through prevention of severe diabetes, promotion of specific health checkups and specific health guidance, promotion of generic drugs, and proper use of medicines. To achieve this goal, we need to conduct an in-depth analysis of inter-prefecture differences in diabetes care expenses. This study analyzed regional differences in prescription fees for dipeptidyl peptidase-4 (DPP-4) inhibitors and the use of generic sulfonylureas (SUs), glinides, biguanides, α-glucosidase inhibitors (α-GIs), and thiazoline derivatives, using the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB). Furthermore, we analyzed regional differences in consultancy fees for dialysis prevention.Methods We analyzed the 2nd NDB Open Data Japan website of the Ministry of Health, Labor, and Welfare. Pearson's correlation coefficient (r) was used to evaluate the relationship between the medical costs of diabetes and each factor. The correlation coefficient was analyzed with Student's t-test, and a P-value<0.05 was considered statistically significant.Results Regarding oral hypoglycemic drugs, prefectures with a large number of DPP-4 inhibitors tended to have higher medical costs of diabetes (r=0.40, P=0.0048). Furthermore, such expenses tended to be low in prefectures where the use of generic SU drugs was high (r=-0.43, P=0.0023).Conclusions In conclusion, the results revealed regional differences in the use of DPP-4 inhibitors and generic SU drugs, which may contribute to the regional differences in medical expenses for diabetes. This study suggests that NDB open data are useful for policy making to reduce regional differences in outpatient medical costs of diabetes.


Assuntos
Serviços de Saúde Comunitária/economia , Efeitos Psicossociais da Doença , Diabetes Mellitus/tratamento farmacológico , Diabetes Mellitus/economia , Inibidores Enzimáticos/administração & dosagem , Inibidores Enzimáticos/economia , Custos de Cuidados de Saúde , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/economia , Compostos de Sulfonilureia/administração & dosagem , Compostos de Sulfonilureia/economia , Análise de Dados , Diabetes Mellitus/prevenção & controle , Dipeptidil Peptidase 4 , Humanos , Japão , Honorários por Prescrição de Medicamentos , Encaminhamento e Consulta/economia
2.
Farm. comunitarios (Internet) ; 12(3): 21-50, jul. 2020. graf, ilus
Artigo em Espanhol | IBECS | ID: ibc-193727

RESUMO

JUSTIFICACIÓN: en España hay 6 millones de personas con diabetes. Canarias está 1,86 puntos porcentuales por encima de la media nacional. Aunque haya mejor conocimiento de la diabetes, el número de pacientes sigue aumentando. El farmacéutico comunitario puede jugar un papel importante a través de su formación académica como sanitario experto en el medicamento y por su cercanía al paciente. Por ello, son importantes proyectos de diseño y estandarización de servicios de seguimiento farmacoterapéutico en diabetes más un abordaje multidisciplinar. OBJETIVO: diseño de un servicio para atención a pacientes diabéticos y prediabéticos en farmacia comunitaria denominado DayBTS. Población diana: mayores de edad que acuden a la farmacia y cumplen al menos uno de estos requisitos: tratamiento con medicación antidiabética, presenten sobrepeso u obesidad, hipertensión arterial o hipercolesterolemia, presenten antecedentes familiares de diabetes o directamente soliciten el servicio. Estructura: serie de visitas divididas en dos fases. Fase inicio, comprende 5 visitas. Fase continuación, 2 visitas para seguimiento y nuevas dudas o problemas. Las actividades a realizar de forma general son: educación diabetológica, medición de variables clínicas (glucemia capilar, índice de masa corporal, hemoglobina glicosilada, patrones en glucemia), variables económicas (visitas a atención primaria, urgencias, número de medicamentos utilizados) y variables humanísticas (adherencia al tratamiento, calidad de vida, conocimientos sobre diabetes). Coste previsto: el coste por visita se estima en función de: tipo de visita, recursos materiales y tiempo del personal farmacéutico. Entre 5,95 € (paciente prediabético) a 20,90€ (paciente diabético) con precio propuesto de 7,44 € y 26,13 € para margen 20 %. El coste del servicio completo sería de 88,31-111 € (Prediabetes-Diabetes)


REASON: in Spain there are 6 million people with diabetes. The Canary Islands are 1.86 percentage points above the national average. Although information on diabetes has improved, the number of patients continues to increase. Community pharmacists can play a significant role thanks to their academic training as healthcare providers specialized in medications and their proximity to patients. For this reason, it is important to have projects for the design and standardization of pharmacotherapeutic monitoring services in diabetes, besides a multidisciplinary approach. OBJECTIVE: design of a treatment service for diabetic and prediabetic patients in community pharmacy called DayBTS. Target population: older people who visit the pharmacy and meet at least one of the following requirements: treatment with antidiabetic medication, are overweight or obese, arterial hypertension or hypercholesterolemia, with family history of diabetes or who ask for the service directly. Structure: series of visits in four phases. Initial phase, includes 5 visits. Continuation phase, 2 visits for monitoring and new doubts or issues. The activities to perform in general are as follows: diabetes education, measurement of clinical variables (blood glucose, body mass index, glycosylated hemoglobin, glycemic patterns), economic variables (visits at primary care, acute care, number of medications used) and human variables (treatment compliance, quality of life, knowledge of diabetes). Expected cost: the cost per visit is estimated according to: type of visit, material supplies and pharmaceutical staff time. Between 5.95 € (prediabetic patient) and 20.90 € (diabetic patient) with cost proposed 7.44 € and 26.13 € for a 20 % margin. The cost of the complete service would be 88.31-111 € (Prediabetes-Diabetes)


Assuntos
Humanos , Serviços Comunitários de Farmácia , Diabetes Mellitus/terapia , Diabetes Mellitus/prevenção & controle , Estado Pré-Diabético/prevenção & controle , Estado Pré-Diabético/terapia , Seguimentos
3.
PLoS Med ; 17(7): e1003224, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32722677

RESUMO

BACKGROUND: Sugar-sweetened beverage (SSB) consumption is associated with obesity, diabetes, and hypertension. Argentina is one of the major consumers of SSBs per capita worldwide. Determining the impact of SSB reduction on health will inform policy debates. METHODS AND FINDINGS: We used the Cardiovascular Disease Policy Model-Argentina (CVD Policy Model-Argentina), a local adaptation of a well-established computer simulation model that projects cardiovascular and mortality events for the population 35-94 years old, to estimate the impact of reducing SSB consumption on diabetes incidence, cardiovascular events, and mortality in Argentina during the period 2015-2024, using local demographic and consumption data. Given uncertainty regarding the exact amount of SSBs consumed by different age groups, we modeled 2 estimates of baseline consumption (low and high) under 2 different scenarios: a 10% and a 20% decrease in SSB consumption. We also included a range of caloric compensation in the model (0%, 39%, and 100%). We used Monte Carlo simulations to generate 95% uncertainty intervals (UIs) around our primary outcome measures for each intervention scenario. Over the 2015-2024 period, a 10% reduction in SSBs with a caloric compensation of 39% is projected to reduce incident diabetes cases by 13,300 (95% UI 10,800-15,600 [low SSB consumption estimate]) to 27,700 cases (95% UI 22,400-32,400 [high SSB consumption estimate]), i.e., 1.7% and 3.6% fewer cases, respectively, compared to a scenario of no change in SSB consumption. It would also reduce myocardial infarctions by 2,500 (95% UI 2,200-2,800) to 5,100 (95% UI 4,500-5,700) events and all-cause deaths by 2,700 (95% UI 2,200-3,200) to 5,600 (95% UI 4,600-6,600) for "low" and "high" estimates of SSB intake, respectively. A 20% reduction in SSB consumption with 39% caloric compensation is projected to result in 26,200 (95% UI 21,200-30,600) to 53,800 (95% UI 43,900-62,700) fewer cases of diabetes, 4,800 (95% UI 4,200-5,300) to 10,000 (95% UI 8,800-11,200) fewer myocardial infarctions, and 5,200 (95% UI 4,300-6,200) to 11,000 (95% UI 9,100-13,100) fewer deaths. The largest reductions in diabetes and cardiovascular events were observed in the youngest age group modeled (35-44 years) for both men and women; additionally, more events could be avoided in men compared to women in all age groups. The main limitations of our study are the limited availability of SSB consumption data in Argentina and the fact that we were only able to model the possible benefits of the interventions for the population older than 34 years. CONCLUSIONS: Our study finds that, even under conservative assumptions, a relatively small reduction in SSB consumption could lead to a substantial decrease in diabetes incidence, cardiovascular events, and mortality in Argentina.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus/prevenção & controle , Bebidas Adoçadas com Açúcar/efeitos adversos , Argentina/epidemiologia , Índice de Massa Corporal , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/mortalidade , Diabetes Mellitus/epidemiologia , Política de Saúde , Humanos , Incidência , Modelos Teóricos
4.
Chem Biol Interact ; 330: 109198, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32692981

RESUMO

Quercetin 3-O-beta-d-glucopyranoside (isoquercetin) is one of the most frequent metabolites of the Passiflora ligularis Juss. The purpose of this study was to investigate the effect of the aqueous extract and ethanol fraction from P. ligularis Juss leaves on glycaemia and the mechanism of action of isoquercetin on glucose uptake. In the glucose tolerance test, the aqueous extract and ethanol fraction from P. ligularis Juss (125 mg/kg to 500 mg/kg o. g.) reduced glycaemia and increased the hepatic and muscular glycogen content. Phytochemical analysis evidenced the dominant presence of isoquercetin in the extract and fraction from leaves of P. ligularis Juss. Isoquercetin mediates the stimulatory effect on glucose uptake independent of insulin receptor activation but, involve PI3K, MAPK, MEK/ERK pathways and de novo protein synthesis to GLUT-4 translocation. Overall findings revealed that isoquercetin and aqueous extract and ethanol fraction of P. ligularis Juss leaves might be a promising functional food or medicine for the treatment or prevention of diabetes.


Assuntos
Glucose/farmacocinética , Músculo Esquelético/metabolismo , Passiflora/química , Quercetina/análogos & derivados , Animais , Transporte Biológico , Diabetes Mellitus/prevenção & controle , Transportador de Glucose Tipo 4/metabolismo , Compostos Fitoquímicos/análise , Extratos Vegetais/química , Folhas de Planta/química , Quercetina/isolamento & purificação , Quercetina/farmacologia , Ratos
5.
Public Health ; 185: 167-173, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32634608

RESUMO

OBJECTIVE: With the continuing rise in the global incidence of diabetes, the prevention of diabetes and control of associated medical expenses has become a public health issue worldwide. This study aims to identify the medical expenses of patients with diabetes in different regions of China and examine the differences in inpatient medical expenses and the impacts of them on these patients. STUDY DESIGN: This study is a longitudinal analysis of medical expenses for inpatients with diabetes for different years; horizontal analysis of medical expenses among different regions; and literature review. METHODS: Data were derived from China's Medical Insurance Department database. We selected inpatients with diabetes in the eastern, central, and western regions of China for the period 2013-2015 and randomly selected data through systematic sampling. RESULTS: Among the 4150 patients with diabetes considered in this study, the patients' medical expenses were found to differ significantly across regions, years, ages, medical insurance types, medical institution levels, total medical expenses, medical insurance fund payments, and out-of-pocket (OOP) expenses. In addition, there were significant differences in total medical expenses for male and female patients. Furthermore, medical insurance type, patients' age, medical institution level, and year significantly influenced total medical expenses. CONCLUSIONS: Inpatients with diabetes in different regions exhibited significant differences in total medical expenses, medical insurance fund payments, and OOP expenses. China should invest more in chronic disease treatment in its central and western regions, narrow the regional differences in medical expenses, and endeavor to ensure equity in the availability and cost of medical services. Moreover, patients with diabetes must be encouraged to access primary care to reduce their medical expenses.


Assuntos
Diabetes Mellitus/economia , Diabetes Mellitus/epidemiologia , Gastos em Saúde , Pacientes Internados , Adulto , Idoso , China/epidemiologia , Diabetes Mellitus/prevenção & controle , Feminino , Humanos , Incidência , Seguro Saúde , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Literatura de Revisão como Assunto , Adulto Jovem
6.
Pharm. pract. (Granada, Internet) ; 18(2): 0-0, abr.-jun. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-194058

RESUMO

BACKGROUND: Social media can effectively mediate digital health interventions and thus, overcome barriers associated with face-to-face interaction. OBJECTIVE: To assess the impact of patient-centered diabetes education program administered through WhatsApp on glycosylated hemoglobin (HbA1c) values, assess the correlation, if any, between health literacy and numeracy on intervention outcomes. METHODS: During an 'intervention phase' spread over six months, target diabetic patients (N=109) received structured education through WhatsApp as per the American Association of Diabetes Educators Self-Care Behaviors recommendations. The control group with an equal number of participants received 'usual care' provided by health professionals void of the social media intervention. Changes in HbA1c levels were recorded thrice (at baseline, 3 and 6 months) for the test group and twice (baseline and 6 months) for the control group. Change in HbA1c values were compared and statistical significance was defined at p < 0.05. Baseline health literacy and diabetes numeracy were assessed for both groups (N=218) using the Literacy Assessment for Diabetes (LAD), and the Diabetes Numeracy Test (DNT), respectively, and values were correlated with HbA1c change p < 0.05. Participants' satisfaction with the intervention was also assessed. RESULTS: The average age of respondents was 41.98 (SD 15.05) years, with a diabetes history of 10.2 (SD 8.5) years. At baseline, the average HbA1c in the control and test groups were 8.4 (SD 1.06) and 8.5 (SD 1.29), respectively. After six months, a significant drop in HbA1c value was noticed in intervention group (7.7; SD 1.35; p= 0.001); with no significance in the control group (8.4; SD 1.32; p = 0.032, paired t-test). Moreover, the reduction in HbA1c was more in the test group (0.7%) than the control group (0.1%) with a difference of 0.6% which is considered clinically significant. There was no significant correlation between LAD score and HbA1c at baseline (r=-0.203, p = 0.064), 3 months (r=-0.123, p = 0.266) and 6 months (r=-0.106, p= 0.337) Pearson correlation. A similar result was observed with DNT, where DNT score and HbA1c at baseline, 3 months and 6 months showed no correlation (r=0.112, 0.959 and 0.886; respectively) with HbA1c levels. Eighty percent of the respondents found the social media intervention 'beneficial' and suggested it be used long term. CONCLUSIONS: Diabetes education via WhatsApp showed promising outcomes regardless of the level of patients' health literacy or numeracy


No disponible


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Diabetes Mellitus/prevenção & controle , Educação de Pacientes como Assunto , Mídias Sociais , Autocuidado/métodos , Ensaios Clínicos Controlados não Aleatórios como Assunto , Satisfação Pessoal , Hemoglobina A/administração & dosagem , Projetos de Pesquisa , Análise de Dados
7.
PLoS One ; 15(6): e0234486, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32525909

RESUMO

This article employs computer-assisted methods to analyse references to Aboriginal and Torres Strait Islander people(s) and issues in a newspaper corpus about diabetes. The objectives are to identify both the frequency and quality of social representation. The dataset consisted of 694 items from 12 Australian newspapers in a five-year period (2013-2017). The quantitative analysis focused on frequency (raw/normalised) and range (number/percentage of texts). The qualitative analysis focused on the identification of semantic prosody (co-occurrence with negative/positive words and phrases) and on selective social actor analysis. The qualitative analysis also compared choices made by the press to language practices recommended in relevant reporting guidelines. Key results include that references to Aboriginal and Torres Strait Islander people(s) or matters appear to be extremely rare. In addition, newspapers' language choices only partially align with guidelines. References that do occur can be classified into four categories: a) references to [groups of] people and other references to identity; b) names of services, institutions, professions, roles etc; c) non-human nouns related to health; d) non-human nouns related to culture. Qualitative analysis of the word COMMUNITY suggests that newspapers for the most part do recognise the existence of different communities at a national level. However, analysis of all references to [groups of] people shows that the vast majority occur in contexts to do with negativity, therefore having a negative semantic prosody. More specifically, there is a strong association with mentions of a higher risk, likelihood, or incidence of having or developing diabetes (or complications/effects). In sum, Aboriginal and Torres Strait Islander people(s) and issues lack in visibility in Australian diabetes coverage, and are associated with deficit framing, which can be disempowering. To change the discourse would require both an increased visibility as well as changing the deficit lens.


Assuntos
Análise de Dados , Diabetes Mellitus/epidemiologia , Jornais como Assunto/ética , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Semântica , Austrália/epidemiologia , Conjuntos de Dados como Assunto , Diabetes Mellitus/prevenção & controle , Necessidades e Demandas de Serviços de Saúde , Serviços de Saúde do Indígena/organização & administração , Serviços de Saúde do Indígena/estatística & dados numéricos , Humanos , Incidência , Jornais como Assunto/estatística & dados numéricos , Pesquisa Qualitativa
8.
Artigo em Inglês | MEDLINE | ID: mdl-32481572

RESUMO

The relationships between regular participation in annual physical examinations and the risk factors for noncommunicable diseases (NCDs) among adults with disabilities remains unclear. To address this gap, we used data from 130,899 individuals with disabilities in Shanghai (2014-2016) and evaluated four risk factors for NCDs: hypertension, hyperglycemia, hyperlipidemia, and being overweight. Overall, 4540 individuals participated in annual physical examinations across all three years and 11,388 missed examinations in 2015 (group without regular participation). Chi-squared tests and binary logistic regression were used to assess differences in patient characteristics and explore correlations between variables. Significant differences in age (χ2 = 102.620, p < 0.01), place of residence (χ2 = 94.308, p < 0.01), educational level (χ2 = 59.884, p < 0.01), marital status (χ2 = 16.414, p < 0.01) and disability type (χ2 = 56.499, p < 0.01) and severity (χ2 = 45.464, p < 0.01) were found between those who participated in regular physical examinations and those who did not. Regular participation was associated with reduced incidences of hypertension (odds ratio 0.799, 95% confidence interval (CI): 0.733-0.871) and hyperlipidemia (0.347, 95% CI: 0.307-0.392), but not with the incidence of diabetes (1.049, 95% CI: 0.944-1.166) or being overweight (0.907, 95% CI: 0.812-1.014). Hence, regular participation in annual physical examinations had different associations with risk factors for NCDs.


Assuntos
Pessoas com Deficiência , Doenças não Transmissíveis , Adulto , China , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/prevenção & controle , Feminino , Humanos , Hiperlipidemias/epidemiologia , Hiperlipidemias/prevenção & controle , Hipertensão/epidemiologia , Hipertensão/prevenção & controle , Masculino , Doenças não Transmissíveis/epidemiologia , Doenças não Transmissíveis/prevenção & controle , Fatores de Risco
9.
Enferm. actual Costa Rica (Online) ; (38): 260-271, Jan.-Jun. 2020. graf
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1090100

RESUMO

Resumo O objetivo da presente pesquisa foi identificar os tipos de abordagens metodológicas utilizadas nas intervenções educativas voltadas para as pessoas que convivem com Diabetes Mellitus. Revisão narrativa da literatura, com busca em quatro bases de dados (Scielo, CINAHL, Scopus e Web of Science), no período de 2014 a 2018. Foram identificados 143 estudos, a partir dos Descritores em Ciências da Saúde (DeCS): "Diabetes mellitus"; "Educação em Saúde" e "Adesão à medicação" para a busca na Biblioteca virtual SciELO. Os descritores MeSH (Medical Subject Headings), "Diabetes mellitus"e "Health education" foram empregados nas bases CINAHL, SCOPUS e Web Of Science. 14 artigos compuseram a amostra final. Foi possível identificar diversas modalidades de intervenções que ao serem selecionadas descrevem exatamente o objetivo que se quer alcançar e nesse contexto a abordagem que apresenta melhores resultados e uma vasta possibilidade de aplicação foi o mapa de conversação em conformação de grupo, apesar de ainda não ser considerada como "padrão-ouro" é uma ferramenta promissora na educação em diabetes.


Abstract The objective of this research was to identify the types of methodological approaches used in educational interventions aimed at people living with diabetes mellitus. Narrative literature review, searching four databases (Scielo, CINAHL, Scopus and Web of Science), from 2014 to 2018. We identified 143 studies from the Descriptors in Health Sciences (DeCS): "Diabetes mellitus "; "Health Education" and "Medication Adherence" to search the SciELO Virtual Library. The descriptors MeSH (Medical Subject Headings), "Diabetes mellitus" and "Health education" were used in CINAHL, SCOPUS and Web Of Science databases. 14 articles made up the final sample. It was possible to identify several modalities of interventions that, when selected, describe exactly the objective to be achieved and in this context the approach with the best results and a wide possibility of application was the group conformation conversation map, although it is not yet considered. as a "gold standard" is a promising tool in diabetes education.


Resumen El objetivo de esta investigación fue identificar los tipos de enfoques metodológicos utilizados en las intervenciones educativas dirigidas a personas con diabetes mellitus. Revisión de la literatura narrativa, buscando en cuatro bases de datos (Scielo, CINAHL, Scopus y Web of Science), de 2014 a 2018. Identificamos 143 estudios de los Descriptores en Ciencias de la Salud (DeCS): "Diabetes mellitus "; "Educación para la salud" y "Adherencia a la medicación" para buscar en la Biblioteca Virtual SciELO. Los descriptores MeSH (Medical Subject Headings), "Diabetes mellitus" y "Health education" se utilizaron en las bases de datos CINAHL, SCOPUS y Web of Science. 14 artículos constituyeron la muestra final. Fue posible identificar varias modalidades de intervenciones que, cuando se seleccionan, describen exactamente el objetivo a alcanzar y, en este contexto, el enfoque que presenta los mejores resultados y una amplia posibilidad de aplicación fue el mapa de conversación de conformación grupal, aunque aún no se considera. como un "estándar de oro" es una herramienta prometedora en la educación para la diabetes.


Assuntos
Humanos , Brasil , Educação em Saúde , Diabetes Mellitus/enfermagem , Diabetes Mellitus/prevenção & controle , Promoção da Saúde
11.
Endocrinol. diabetes nutr. (Ed. impr.) ; 67(5): 333-341, mayo 2020. tab
Artigo em Inglês | IBECS | ID: ibc-191309

RESUMO

BACKGROUND: It is estimated that 37% of Mexican adults have undiagnosed diabetes, and are therefore at high risk of developing the severe and devastating complications associated to it. In recent years, a variety of screening tools based on the characteristics of the adult Mexican population have been proposed in order to reduce the negative effects of the disease. OBJECTIVES: To assess the performance of screening models to diagnose diabetes in the Mexican adult population and to propose a screening model based on HbA1c measurements. MATERIALS AND METHODS: Data from the 2016 Halfway National Health and Nutrition Survey (NHNS) were used to assess the screening models and to develop and validate the proposed 2016 NHNS model, built using a multivariate logistic regression model. Explanatory variables included in the 2016 NHNS 2016 model were selected through a stepwise backward procedure, using sensitivity and specificity as performance indicators. RESULTS: Of the screening models assessed, only the model based on the 2006 NHNS survey showed a performance consistent with previous reports. The proposed 2016 NHNS model included age, waist circumference, and systolic blood pressure as explanatory variables and showed a sensitivity of 0.72 and a specificity of 0.80 in the validation data set. CONCLUSIONS: Age, waist circumference, and systolic blood pressure are variables of special importance for early detection of undiagnosed diabetes in Mexican adults. Based on the consistent performance of the 2006 NHNS model in different data sets, its use as a screening tool for adults with undiagnosed diabetes in Mexico is recommended


ANTECEDENTES: Se estima que el 37% de adultos mexicanos que padecen diabetes no han sido diagnosticados, teniendo un alto riesgo de desarrollar las graves y devastadores complicaciones asociadas. En los últimos años, con el objetivo de reducir los efectos negativos de la enfermedad, se han propuesto herramientas de detección basadas en las características de la población adulta mexicana. OBJETIVOS: Evaluar el funcionamiento de los modelos de detección de diabetes no diagnosticada en la población adulta mexicana y proponer un modelo de detección basado en mediciones de HbA1c. MATERIAL Y MÉTODOS: Se utilizaron datos de la Encuesta Nacional de Salud y Nutrición (NHNS) de Medio Camino 2016 para evaluar los modelos de detección y para desarrollar y validar el modelo NHNS 2016, construido usando un modelo de regresión logística multivariada. Las variables incluidas en el modelo NHNS 2016 se seleccionaron mediante un procedimiento de pasos hacia atrás, utilizando la sensibilidad y la especificidad como indicadores de funcionamiento. RESULTADOS: De los modelos de detección evaluados, únicamente el modelo basado en la encuesta NHNS 2006 mostró un funcionamiento consistente con lo reportado anteriormente. Las variables seleccionadas para el modelo propuesto (NHNS 2016) fueron edad, circunferencia de cintura y presión sistólica como variables explicativas, mostrando una sensibilidad de 0,72 y una especificidad de 0,80 en el conjunto de datos de validación. CONCLUSIONES: Edad, circunferencia de cintura y presión sistólica son variables de relevancia especial para la detección temprana de diabetes no diagnosticada en adultos mexicanos. Dada la consistencia en el funcionamiento mostrado por el modelo NHNS 2006 en diferentes conjuntos de datos, se recomienda su uso como herramienta de detección de adultos con diabetes no diagnosticada en México


Assuntos
Humanos , Masculino , Feminino , Adulto , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/prevenção & controle , Programas de Rastreamento , Diabetes Mellitus/diagnóstico , México/epidemiologia , Inquéritos Nutricionais , Relação Cintura-Quadril/métodos , Pressão Sanguínea , Sensibilidade e Especificidade , Circunferência Abdominal
13.
Med Care ; 58 Suppl 6 Suppl 1: S4-S13, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32412948

RESUMO

BACKGROUND: High deductible health plans linked to Health Savings Accounts (HSA-HDHPs) must include all care under the deductible except for select preventive services. Some employers and insurers have adopted Preventive Drug Lists (PDLs) that exempt specific classes of medications from deductibles. OBJECTIVE: The objective of this study was to examine the association between shifts to PDL coverage and medication utilization among patients with diabetes in HSA-HDHPs. RESEARCH DESIGN: A natural experiment comparing pre-post changes in monthly and annual outcomes in matched study groups. SUBJECTS: The intervention group included 1744 commercially-insured HSA-HDHP patients with diabetes age 12-64 years switched by employers to PDL coverage; the control group included 3349 propensity-matched HSA-HDHP patients whose employers offered no PDL. MEASURES: Outcomes were out-of-pocket (OOP) costs for medications and the number of pharmacy fills converted to 30-day equivalents. RESULTS: Transition to the PDL was associated with a relative pre-post decrease of $612 (-35%, P<0.001) per member OOP medication expenditures; OOP reductions were higher for key classes of antidiabetic and cardiovascular medicines listed on the PDL; the policy did not affect unlisted classes. The PDL group experienced relative increases in medication use of 6.0 30-day fills per person during the year (+11.2%, P<0.001); the increase was more than twice as large for lower-income (+6.6 fills, +12.6%, P<0.001) than higher-income (+3.0 fills, +5.1%, P=0.024) patients. CONCLUSION: Transition to a PDL which covers important classes of medication to manage diabetes and cardiovascular conditions is associated with substantial annual OOP cost savings for patients with diabetes and increased utilization of important classes of medications, especially for lower-income patients.


Assuntos
Custo Compartilhado de Seguro/métodos , Dedutíveis e Cosseguros , Hipoglicemiantes/economia , Poupança para Cobertura de Despesas Médicas , Pobreza/estatística & dados numéricos , Adolescente , Adulto , Criança , Diabetes Mellitus/economia , Diabetes Mellitus/prevenção & controle , Feminino , Financiamento Pessoal/economia , Financiamento Pessoal/estatística & dados numéricos , Humanos , Hipoglicemiantes/uso terapêutico , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Pobreza/economia , Adulto Jovem
15.
Int J Med Inform ; 137: 104072, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32200295

RESUMO

BACKGROUND: To explore attitudes about artificial intelligence (AI) among staff who utilized AI-based clinical decision support (CDS). METHODS: A survey was designed to assess staff attitudes about AI-based CDS tools. The survey was anonymously and voluntarily completed by clinical staff in three primary care outpatient clinics before and after implementation of an AI-based CDS system aimed to improve glycemic control in patients with diabetes as part of a quality improvement project. The CDS identified patients at risk for poor glycemic control and generated intervention recommendations intended to reduce patients' risk. RESULTS: Staff completed 45 surveys pre-intervention and 38 post-intervention. Following implementation, staff felt that care was better coordinated (11 favorable responses, 14 unfavorable responses pre-intervention; 21 favorable responses, 3 unfavorable responses post-intervention; p < 0.01). However, only 14 % of users would recommend the AI-based CDS. Staff feedback revealed that the most favorable aspect of the CDS was that it promoted team dialog about patient needs (N = 14, 52 %), and the least favorable aspect was inadequacy of the interventions recommended by the CDS. CONCLUSIONS: AI-based CDS tools that are perceived negatively by staff may reduce staff excitement about AI technology, and hands-on experience with AI may lead to more realistic expectations about the technology's capabilities. In our setting, although AI-based CDS prompted an interdisciplinary discussion about the needs of patients at high risk for poor glycemic control, the interventions recommended by the CDS were often perceived to be poorly tailored, inappropriate, or not useful. Developers should carefully consider tasks that are best performed by AI and those best performed by the patient's care team.


Assuntos
Inteligência Artificial/estatística & dados numéricos , Sistemas de Apoio a Decisões Clínicas/organização & administração , Diabetes Mellitus/prevenção & controle , Pessoal de Saúde/estatística & dados numéricos , Implementação de Plano de Saúde , Médicos de Atenção Primária/psicologia , Atenção Primária à Saúde/organização & administração , Instituições de Assistência Ambulatorial , Inteligência Artificial/tendências , Índice Glicêmico , Humanos , Melhoria de Qualidade , Software , Inquéritos e Questionários
16.
Rev Med Suisse ; 16(682): 366-369, 2020 Feb 19.
Artigo em Francês | MEDLINE | ID: mdl-32073772

RESUMO

In 2010 the canton of Vaud has innovated by launching the Cantonal Diabetes Program (PcD) aimed at reducing the impact of diabetes on the population. The evaluation after 7 years shows that some clinical examinations are performed more regularly and lower limb amputations tend to decrease. The contributions and interprofessional collaborations resulting from the PcD provide concrete guidelines for the implementation of a more comprehensive strategy of prevention and management of non-communicable diseases. It should be developed according to a chronicity model integrating social vulnerability.


Assuntos
Diabetes Mellitus/prevenção & controle , Diabetes Mellitus/terapia , Doenças não Transmissíveis/prevenção & controle , Doenças não Transmissíveis/terapia , Saúde Pública/educação , Amputação/estatística & dados numéricos , Diabetes Mellitus/epidemiologia , Humanos , Doenças não Transmissíveis/epidemiologia , Suíça/epidemiologia
17.
BMC Public Health ; 20(1): 139, 2020 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-32000738

RESUMO

BACKGROUND: Indigenous people in the United States are at high risk for diabetes. Psychosocial stressors like historical trauma may impede success in diabetes prevention programs. METHODS: A comparative effectiveness trial compared a culturally tailored diabetes prevention program (standard group) with an enhanced one that addressed psychosocial stressors (enhanced group) in 2015 to 2017. Participants were 207 Indigenous adults with a body mass index (BMI) of ≥30 and one additional criterion of metabolic syndrome, and were randomized to the standard or enhanced group. Both groups received a culturally tailored behavioral diabetes prevention program. Strategies to address psychosocial stressors were provided to the enhanced group only. Change in BMI over 12 months was the primary outcome. Secondary outcomes included change in quality of life, and clinical, behavioral, and psychosocial measures at 6 and 12 months. RESULTS: The two groups did not significantly differ in BMI change at 12 months. The two groups also did not differ in any secondary outcomes at 6 or 12 months, with the exception of unhealthy food consumption; the standard group reported a larger mean decrease (95% CI) in consumption of unhealthy food compared with the enhanced group (- 4.6 [- 6.8, - 2.5] vs. -0.7 [- 2.9, 1.4], p = 0.01). At 6 months, significant improvements in weight and the physical component of the quality of life measure were observed for both groups compared with their baseline level. Compared with baseline, at 12 months, the standard group showed significant improvement in BMI (mean [95% CI], - 0.5 [- 1.0, - 0.1]) and the enhanced group showed significant improvement in the physical component of the quality of life (2.9 [0.7, 5.2]). CONCLUSIONS: Adding strategies to address psychosocial barriers to a culturally tailored diabetes prevention program was not successful for improving weight loss among urban Indigenous adults. TRIAL REGISTRATION: (if applicable): NCT02266576. Registered October 17, 2014 on clinicaltrials.gov. The trial was prospectively registered.


Assuntos
Diabetes Mellitus/prevenção & controle , Grupos Populacionais , População Urbana , Adulto , Idoso , Assistência à Saúde Culturalmente Competente , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Grupos Populacionais/psicologia , Grupos Populacionais/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Psicologia , Estados Unidos , População Urbana/estatística & dados numéricos
18.
BMC Public Health ; 20(1): 166, 2020 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-32013917

RESUMO

BACKGROUND: Over the past few decades, the prevalence of Diabetes Mellitus (DM) has risen rapidly in Iran and other low and middle-income countries. We investigated the prevalence of DM, pre-diabetes, undiagnosed and uncontrolled diabetes and its relationship with some associated socioeconomic factors in the Yazd Greater Area in Iran. METHODS: Yazd Health Study is a longitudinal study conducted to determine the prevalence of non-communicable disease and related risk factors. In a two-step cluster sampling, 10,000 adults aged 20-69 years (200 clusters) were selected. In the recruitment phase, DM was considered if the patients had been either diagnosed DM by a physician or had fasting blood glucose ≥ 126 mg/dL. Chi square test was used for categorical variables to evaluate the differences and logistic regression model was applied to determine the predictors of diabetes.. P-value < 0.05 considered statistically significant. RESULTS: Of the 9965 individuals recruited, the crude self-reported prevalence of DM was 14.1% (95% CI: 13.4-14.7). The prevalence was higher in women than men (15.6 vs.12.4%), significantly. The age-standardized prevalence of DM was 8%. The prevalence was 14.9% in Yazd local people and 8.6% in those residents migrated from other provinces (P < 0.0001). We showed a significant association between DM prevalence and age, education, marital status, unemployment, insurance status, and positive family history (P < 0.0001). The prevalence of DM diagnosed by phycisians was 16.1% in participants (age-standardized prevalence: 8.3%). The subset analysis showed that 4.8% of patients were not aware of their disease. The prevalence of pre-diabetes was 25.8%. Of those with diabetes, 58.3% were not adequately controlled, which is not statistically significant with socio-economic status. CONCLUSION: The current study showed a high prevalence of DM in Yazd Greater Area which is closely related to some socio-demographic factors. The high prevalence of pre-diabetes is alarming. Effective strategies for DM prevention should be introduced. The majority of people with diabetes are aware, but half of them are not controlled. The ineffective care plan currently in use, should be reviewed. Patients needs to be encouraged to improve their lifestyle. Active follow-up of patients is recommended to ensure continuity of care.


Assuntos
Diabetes Mellitus/epidemiologia , Estado Pré-Diabético/epidemiologia , Adulto , Idoso , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/prevenção & controle , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Estilo de Vida , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estado Pré-Diabético/diagnóstico , Estado Pré-Diabético/prevenção & controle , Prevalência , Fatores de Risco , Fatores Socioeconômicos , Adulto Jovem
19.
Praxis (Bern 1994) ; 109(1): 31-34, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31910767

RESUMO

CoLaus: Diet, the Forgotten Key to Preventing Cardiovascular Diseases Abstract. Healthy eating is paramount for the prevention and management of cardiovascular diseases. Still, data from the CoLaus study show that dietary management of cardiovascular risk factors and cardiovascular disease is little implemented. Less than one fifth of participants with dyslipidemia reported being on a hypolipidemic diet, and only half of participants with diabetes reported being on an antidiabetic diet. Further, the occurrence of a myocardial infarction was not associated with an improvement in dietary quality.


Assuntos
Doenças Cardiovasculares , Diabetes Mellitus , Dieta , Dislipidemias , Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus/prevenção & controle , Dislipidemias/prevenção & controle , Humanos
20.
Minerva Med ; 111(2): 141-152, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31755668

RESUMO

Early life feeding habits may potentially alter future metabolic programming and body composition. Complementary feeding is the period of time when infants introduce food different from milk in their diet, together with a gradual reduction of the intake of milk (either breast milk or formula), to finally acquire the diet model of their family. This period is important in the transition of the infant from milk feeding to family foods, and is necessary for both nutritional and developmental reasons. The timing for introducing complementary foods and the method of feeding have changed over time. Available literature data show increasing interest and concerns about the impact of complementary feeding timing and modality on the onset of later non-communicable disorders, such as overweight and obesity, allergic diseases, celiac disease, or diabetes. While international scientific guidelines on complementary feeding have been published, many baby food companies' websites, blogs, and books, in most European countries exist. The aim of this manuscript is to look over current recommendations, and to revise "old myths." The adoption of an adequate weaning method is a cornerstone in the development of life-long health status. A correct strategy could reduce the risk of feeding disorders and other health problems later in life.


Assuntos
Alimentos Infantis , Fenômenos Fisiológicos da Nutrição do Lactente/fisiologia , Política Nutricional , Desmame , Fatores Etários , Anemia Ferropriva/etiologia , Anemia Ferropriva/prevenção & controle , Doença Celíaca/prevenção & controle , Diabetes Mellitus/etiologia , Diabetes Mellitus/prevenção & controle , Dieta Vegetariana , Nível de Saúde , Humanos , Hipersensibilidade/prevenção & controle , Lactente , Fórmulas Infantis , Infecções , Ferro/administração & dosagem , Ferro/deficiência , Política Nutricional/tendências , Obesidade Pediátrica/etiologia , Obesidade Pediátrica/prevenção & controle
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