1,720,974 research outputs found
Effect of non‐surgical weight management on weight and glycaemic control in people with type 2 diabetes: a comparison of interventional and non‐interventional outcomes at 3 years
No full textAims
To examine the long‐term effectiveness of lifestyle weight management interventions, recommended in clinical guidelines for patients with type 2 diabetes mellitus (T2DM) and obesity.
Materials and methods
Electronic health records were used to follow 23 208 patients with T2DM and obesity in Glasgow, UK, for up to 3 years between 2005 and 2014. Patients were stratified by referral to and attendance at a lifestyle weight management intervention, and by attainment of a target weight loss of ≥5 kg over 7 to 9 sessions (“successful completers”). Outcomes were change in weight, glycated haemoglobin (HbA1c) and diabetes medications.
Results
A total of 3471 potentially eligible patients were referred to the service, and fewer than half of these attended (n = 1537). Of those who attended 7 to 9 sessions, >40% successfully completed and achieved 5‐kg weight loss (334/808). Successful completers maintained greater weight loss (change at 3 years −8.03 kg; 95% confidence interval [CI] −9.44 to −6.62) than the non‐completers (−3.26 kg; 95% CI −4.01 to −2.51; P < .001) and those not referred to the service (−1.00 kg; 95% CI −1.15 to −0.85; P < .001). Successful completers were the only patient group who did not increase their use of diabetes medication and insulin over 3 years. In adjusted models, successful completers had a clinically significant reduction in HbA1c (−3.7 mmol/mol; 95% CI −5.82 to −1.51) after 3 years; P ≤ .001) compared with non‐completers and unsuccessful completers.
Conclusions
A real‐life structured weight management intervention in patients with diabetes can reduce weight in the medium term, result in improved glycaemic control with fewer medications, and may be more effective than pharmacological alternatives. Challenges include getting a higher proportion of patients referred to and engaged with intervention
Targeting inflammation to reduce cardiovascular disease risk: a realistic clinical prospect?
Full text linkData from basic science experiments is overwhelmingly supportive of the causal role of immune-inflammatory response(s) at the core of atherosclerosis, and therefore the theoretical potential to manipulate the inflammatory response to prevent cardiovascular events. However, extrapolation to humans requires care and we still lack definitive evidence to show that interfering in immune-inflammatory processes may safely lessen clinical atherosclerosis. In this review, we discuss key therapeutic targets in the treatment of vascular inflammation, placing basic research in to a wider clinical perspective, as well as identifying outstanding questions
The association of oxidative stress with arterial compliance and vascular resistance in a bi-ethnic population: the SABPA study
No full textA loss of arterial elasticity increases the risk for cardiovascular events. Oxidative injury to the vessel wall may be one of the underlying mechanisms influencing arterial elasticity. We compared markers of oxidative stress, antioxidant capacity, inflammation, windkessel compliance (Cwk), and total peripheral resistance (TPR) in black and white South Africans. Associations of arterial compliance and vascular resistance (as indicated by TPR) with oxidative stress, antioxidant capacity and inflammatory markers were also investigated. We included 146 black and 181 white men and women. Measurements from the Finometer device were used to calculate Cwk and TPR while thiobarbituric acids reactive substances (TBARS), glutathione peroxidase (GPx), C-reactive protein (CRP), and interleukin-6 (IL-6) were analyzed in serum or urine samples. Black participants had higher TPR, TBARS, GPx, CRP, and IL-6 levels (all p ≤ 0.018) and lower Cwk (both p ≤ 0.013) compared to white participants. Multiple regression analyses revealed independent associations of Cwk (β = −0.27, p = 0.015) and TPR (β = 0.18, p = 0.018) with TBARS in black participants, while Cwk (β = −0.10; p = 0.019) and TPR (β = 0.13, p = 0.047) were independently associated with GPx in white participants. Decreased arterial compliance and increased vascular resistance associated with increased oxidative damage independent of hypertensive status in black participants. These results suggest that oxidative stress plays a role in early vascular changes in a black population prone to the development of cardiovascular diseas
Soluble urokinase plasminogen activator receptor as a prognostic marker of all-cause and cardiovascular mortality in a black population
No full textBackground: Elevated inflammatory markers such as C–reactive protein (CRP) and interleukin–6 (IL–6) are wellknown risk factors for cardiovascular mortality. The less familiar marker, soluble urokinase plasminogen activator receptor (suPAR), is known to predict cancer, infections and all–cause mortality. We determined whether suPAR, CRP and IL–6 are predictive of both all–cause and cardiovascular mortality in a black population, highly burdened by cardiovascular disease and HIV infection."
"Methods:We included 1425 black South Africans, of which 208 died within five years after baseline data collection. EDTA plasma biomarker levelswere determined, while all–cause and cardiovascular mortality were used as endpoints." "Results: At baseline suPAR, CRP and IL–6 were higher in non–survivors than in survivors (P b 0.001). SuPAR (HR 1.27, 95% CI 1.09 1.48), IL–6 (HR 1.49, 95% CI 1.24 1.78) and CRP (HR 1.39, 95% CI 1.17 1.65) predicted allcause mortality,while only suPAR (HR 1.40, 95% CI 1.04 1.87) and IL–6 (HR 1.61, 95% CI 1.10 2.35) predicted cardiovascular mortality. The prognostic value of suPAR was independent of IL–6 and CRP (P ? 0.015)." "Conclusion: SuPAR predicted both all–cause and cardiovascular mortality, independent of traditional risk factors, HIV and other inflammatory markers, underlining the prognostic value of suPAR in a black population
SuPAR Predicts 10-year Mortality in HIV Infected and Hypertensive Black South Africans
No full textObjective: Soluble urokinase plasminogen activator receptor (suPAR), a more reliable inflammatory marker than C-reactive protein (CRP), predicts risk of cancer and diabetes in the general population. We determined whether suPAR predicts mortality in a black population, double burdened by hypertension and HIV infection.
Methods: We included 1862 black South Africans from the Prospective Urban and Rural Epidemiology study. Plasma suPAR was determined with the suPARnostic® ELISA Kit, high-sensitivity CRP with the Konelab20iTM auto-analyzer, HIV with the First Response rapid HIV card test and blood pressure with the OMRON HEM-757 device.
Results: At baseline, participants had a median age of 48 (range: 29-94) years, 38.3% were male, 16.4% were HIV infected and 47.0% were hypertensive. Over the 10-year follow-up (median 5.3±1.1 years), 331 participants died. Baseline suPAR and CRP were higher in non-survivors than in survivors (all p<0.001) and predicted mortality (suPAR: HR 1.27; 95%CI 1.15-1.40; log-rank p<0.001 and CRP: HR 1.35; 95%CI 1.20-1.53; log-rank p<0.001) in the total group (Fig. 1 and 2). Similarly, the HIV infected group (n=306), suPAR and CRP were higher (all p<0.001) in non-survivors than in survivors and predicted mortality (suPAR: HR 1.44; 95%CI 1.13-1.84 and CRP: HR 1.45; 95%CI 1.16-1.82). However, in the hypertensive group (n=876), only suPAR was higher (p<0.001) in non-survivors than in survivors and predicted mortality (HR 1.32; 95%CI 1.12-1.54).
Conclusions: Our results identify suPAR as a prognostic marker of 10-year mortality risk in the presence of HIV infection and hypertension. This warrants further investigation into using suPAR to improve disease outcome in black South African
Cardiometabolic Changes in Treated Versus Never Treated HIV-Infected Black South Africans: The PURE Study
No full textBackground
The use of antiretroviral treatment is known to be accompanied by several negative health outcomes and may negatively affect a country such as South Africa, which is the most burdened by the human immunodeficiency virus (HIV) in the world. We aimed to determine whether receiving antiretroviral treatment changes the cardiometabolic profile of HIV-infected South Africans.
Methods
In this sub-study, embedded in the Prospective Urban and Rural Epidemiology (PURE) study, we compared the cardiometabolic profile in a cohort of 66 treated and 71 never treated HIV-infected participants from the North-West province, South Africa. By using standard techniques, these participants’ cardiometabolic, biochemical and lifestyle variables were assessed in 2005 and 2010, respectively.
Results
The treated group showed a higher percentage change in pulse pressure (13.3%; p = 0.004), systolic blood pressure (4.5%; p = 0.029) and CD4 cell count (9.2%; p = 0.009) levels over five years. During follow-up (2010), lipid variables were worse in the treated group. Further, antiretroviral treatment was associated with the percentage change in pulse pressure (R2 = 0.24; β = 0.19; p = 0.020).
Conclusions
We concluded that Africans receiving antiretroviral treatment had a greater increase in pulse pressure and systolic blood pressure, as well as an unfavourable lipid profile when compared to never treated participants. Whether, in the long term, antiretroviral treatment will lead to increased arterial stiffness and/or accelerated atherosclerosis among this HIV-infected African population remains to be seen
Bioavailable IGF-1 is beneficially associated with biomarkers of endothelial function in young healthy adults: The African-PREDICT study
No full textLow circulating levels of insulin-like growth factor-1 (IGF-1) are associated with endothelial dysfunction, subsequently leading to the development of cardiovascular disease.
Objective
To better understand the early phases of vascular deterioration in a young, healthy population, we investigated, cross-sectionally, whether biomarkers of endothelial function (intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1) and von Willebrand factor antigen (vWFag)) are associated with IGF-1 in a healthy study population forming part of the larger African Prospective study on the Early Detection and Identification of Cardiovascular diseases and Hypertension (African-PREDICT).
Method
We included 825 black and white men and women (aged 20–30 years) and determined IGF-1, IGF binding protein-3 (IGFBP-3), ICAM-1, VCAM-1 and vWFag from blood samples. We also measured 24-h blood pressure and health behaviours namely waist circumference, accelerometery, cotinine and gamma glutamyl transferase. We used the IGF-1/IGFBP-3 M ratio as an estimate of bioavailable IGF-1.
Results
In multivariable-adjusted regression analyses performed in the total group, VCAM-1 associated positively with IGFBP-3 (β = 0.21; p < .001) and negatively with IGF-1/IGFBP-3 (β = −0.18; p < .001). ICAM-1 showed a borderline negative association with IGF-1 (β = −0.09; p = .054) and IGF-1/IGFBP-3 (β = −0.08; p = .057). vWFag was not associated with IGF-1, IGFBP-3 or bioavailable IGF-1.
Conclusion
VCAM-1 is beneficially associated with IGF-1 in a young healthy cohort, independent of sex, ethnicity, blood pressure and health behaviours – thereby confirming the potential importance of bioavailable IGF-1 in early vascular endothelial protectio
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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