27 research outputs found
Challenges associated with insulin therapy progression among patients with type 2 diabetes: Latin American MOSAIc study baseline data
No full textPoor glycemic control in patients with type 2 diabetes is commonly recorded worldwide; Latin America (LA) is not an exception. Barriers to intensifying insulin therapy and which barriers are most likely to negatively impact outcomes are not completely known. The objective was to identify barriers to insulin progression in individuals with type 2 diabetes mellitus (T2DM) in LA countries (Mexico, Brazil, and Argentina).Fil: Linetzky, Bruno. Ely Lilly Interamerica ; ArgentinaFil: Curtis, Brad. Eli Lilly and Company; Estados UnidosFil: Frechtel, Gustavo Daniel. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Inmunología, Genética y Metabolismo. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Inmunología, Genética y Metabolismo; Argentina. Hospital Sirio Libanés; ArgentinaFil: Montenegro, Renan. Universidade Estadual do Ceará; BrasilFil: Escalante Pulido, Miguel. Hospital de Especialidades del Centro Médico de Occidente IMSS; MéxicoFil: Stempa, Oded. Eli Lilly and Company Mexico; MéxicoFil: De Lana, Janaina Martins. Eli Lilly and Company Brasil; BrasilFil: Gagliardino, Juan Jose. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - la Plata. Centro de Endocrinología Experimental y Aplicada. Universidad Nacional de la Plata. Facultad de Ciencias Médicas. Centro de Endocrinología Experimental y Aplicada; Argentin
Burnout, perceived stress, and depression among cardiology residents in Argentina.
No full textObjective: Because medical residency is a stressful time for training physicians, placing residents at increased risk for psychological distress, the authors studied the prevalence of burnout, perceived stress, and depression in cardiology residents in Argentina and examined the association between sociodemographic characteristics and these syndromes. Methods: The authors conducted a cross-sectional observational study of 106 cardiology residents in Argentina and a comparison group of 104 age- and gender-matched nonmedical professionals. The main outcome measures included the prevalence of burnout with the Maslach Burnout Inventory, distress with the Perceived Stress Scale, and depression with the Beck Depression Inventory. Results: One hundred six residents completed the survey. Of these, 31.3% were women, the mean age was 29.1 years old, and half were married. Respondents worked an average of 64 hours per week, and 60% of the residents needed a second job. High emotional exhaustion and depersonalization was found in the majority of respondents. Significant depressive symptoms were found in less than half of residents, and stress was on average 21.7 points on the Perceived Stress Scale. Residents who had a second job showed high levels of depersonalization. No other association was found with sociodemographic characteristics. There were no differences in sociodemographic characteristics of residents compared with nonmedical professionals, but nonmedical professionals worked less hours per week, had a lower percentage of second jobs, and higher salary. Burnout, depressive symptoms, and perceived stress were significantly lower in the reference group. Conclusion: Cardiology residents in Argentina exhibit high levels of burnout, perceived stress, and depressive symptoms, which warrants greater attention to the psychological needs of residents.Fil: Waldman, Silvina. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; ArgentinaFil: Lopez Diez, Juan Cruz. No especifíca;Fil: Cohen Arazi, Hernán. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; ArgentinaFil: Linetzky, Bruno. No especifíca;Fil: Guinjoan, Salvador Martín. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; ArgentinaFil: Hugo Grancelli. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; Argentin
Adolescentes que viven en áreas pobres tienen más posibilidades de fumar : ¿qué se podría hacer desde el gobierno para evitar este problema?
No full textAn average/deprivation/inequality (ADI) analysis of chronic disease outcomes and risk factors in Argentina
No full textAbstract Background Recognition of the global economic and epidemiological burden of chronic non-communicable diseases has increased in recent years. However, much of the research on this issue remains focused on individual-level risk factors and neglects the underlying social patterning of risk factors and disease outcomes. Methods Secondary analysis of Argentina's 2005 Encuesta Nacional de Factores de Riesgo (National Risk Factor Survey, N = 41,392) using a novel analytical strategy first proposed by the United Nations Development Programme (UNDP), which we here refer to as the Average/Deprivation/Inequality (ADI) framework. The analysis focuses on two risk factors (unhealthy diet and obesity) and one related disease outcome (diabetes), a notable health concern in Latin America. Logistic regression is used to examine the interplay between socioeconomic and demographic factors. The ADI analysis then uses the results from the logistic regression to identify the most deprived, the best-off, and the difference between the two ideal types. Results Overall, 19.9% of the sample reported being in poor/fair health, 35.3% reported not eating any fruits or vegetables in five days of the week preceding the interview, 14.7% had a BMI of 30 or greater, and 8.5% indicated that a health professional had told them that they have diabetes or high blood pressure. However, significant variation is hidden by these summary measures. Educational attainment displayed the strongest explanatory power throughout the models, followed by household income, with both factors highlighting the social patterning of risk factors and disease outcomes. As educational attainment and household income increase, the probability of poor health, unhealthy diet, obesity, and diabetes decrease. The analyses also point toward important provincial effects and reinforce the notion that both compositional factors (i.e., characteristics of individuals) and contextual factors (i.e., characteristics of places) are important in understanding the social patterning of chronic diseases. Conclusion The application of the ADI framework enables identification of the regions or groups worst-off for each outcome measure under study. This can be used to highlight the variation embedded within national averages; as such, it encourages a social perspective on population health indicators that is particularly attuned to issues of inequity. The ADI framework is an important tool in the evaluation of policies aiming to prevent or control chronic non-communicable diseases.</p
An Average/Deprivation/Inequality (ADI) Analysis of Chronic Disease Outcomes and Risk Factors in Argentina
No full textHospital malnutrition in Latin America: A systematic review
No full textSummaryBackgroundDisease-related malnutrition is a major public health issue in both industrialised and emerging countries. The reported prevalence in hospitalised adults ranges from 20% to 50%. Initial reports from emerging countries suggested a higher prevalence compared with other regions, with limited data on outcomes and costs.MethodsWe performed a systematic literature search for articles on disease-related malnutrition in Latin American countries published between January 1995 and September 2014. Studies reporting data on the prevalence, clinical outcomes, or economic costs of malnutrition in an adult (≥18 years) inpatient population with a sample size of ≥30 subjects were eligible for inclusion. Methodological quality of the studies was assessed by two independent reviewers using published criteria.ResultsWe identified 1467 citations; of these, 66 studies including 29 ,474 patients in 12 Latin American countries met the criteria for inclusion. There was considerable variability in methodology and in the reported prevalence of disease-related malnutrition; however, prevalence was consistently in the range of 40%–60% at the time of admission, with several studies reporting an increase in prevalence with increasing duration of hospitalisation. Disease-related malnutrition was associated with an increase in infectious and non-infectious clinical complications, length of hospital stay, and costs.ConclusionDisease-related malnutrition is a highly prevalent condition that imposes a substantial health and economic burden on the countries of Latin America. Further research is necessary to characterise screening/assessment practices and identify evidence-based solutions to this persistent and costly public health issue
A practical approach to the clinical challenges in initiation of basal insulin therapy in people with type 2 diabetes
No full textInitiating insulin therapy with a basal insulin analogue has become a standard of care in the treatment of type 2 diabetes mellitus (T2DM). Despite increasing choices in pharmacological approaches, intensified glucose monitoring and improvements in quality of care, many patients do not achieve the desired level of glycaemic control. Although insulin therapy, when optimized, can help patients reach their glycaemic goals, there are barriers to treatment initiation on both the side of the patient and provider. Providers experience barriers based on their perceptions of patients' capabilities and concerns. They may lack the confidence to solve the practical problems of insulin therapy and avoid decisions they perceive as risky for their patients. In this study, we review recommendations for basal insulin initiation, focussing on glycaemic targets, titration, monitoring, and combination therapy with non-insulin anti-hyperglycaemic medications. We provide practical advice on how to address some of the key problems encountered in everyday clinical practice and give recommendations where there are gaps in knowledge or guidelines. We also discuss common challenges faced by people with T2DM, such as weight gain and hypoglycaemia, and how providers can address and overcome them
Extending the income inequality hypothesis: Ecological results from the 2005 and 2009 Argentine National Risk Factor Surveys
No full textTirzepatide and change in uric acid and its association with weight reduction: post hoc analyses of the SURMOUNT-1 randomised placebo-controlled trial
No full textObjectives:
This study aimed to test whether tirzepatide, a dual GLP-1RA/GIP agonist, approved for weight management, would be associated with lowered serum uric acid (SUA) levels via its weight reduction properties.
Methods:
A post hoc analysis of the SURMOUNT-1 trial, a randomised placebo-controlled trial involving 2539 adults with obesity or overweight (body mass index [BMI] ≥ 30 kg/m2 or ≥27 kg/m2 and at least 1 weight-related complication), randomised to tirzepatide (5, 10, or 15 mg) or placebo for 72 weeks. Tirzepatide treatment over 72 weeks decreased weight by up to 20.9%. SUA was measured at baseline and multiple time points during the 72-week study across the 3 active trial arms, and changes were compared to the placebo arm. The association between weight changes and SUA changes was evaluated by mediation analysis.
Results:
Treatment with all dose groups of tirzepatide was associated with significant reductions in SUA, compared to placebo. At week 72, the mean change in SUA was -0.69 mg/dL (SE: 0.04), -0.92 mg/dL (0.04), and -0.95 mg/dL (0.04) with 5, 10, and 15 mg of tirzepatide (all P < .001), respectively, and -0.18 mg/dL (0.04) with placebo. SUA levels reduced significantly over time compared to placebo, regardless of baseline uric acid quartiles (P = .610) and baseline BMI values (P = .362). Mediation analysis suggested that weight reduction explained 72.7% of SUA reduction.
Conclusions:
In this post hoc analysis, in participants with obesity or overweight, tirzepatide was associated with meaningfully reduced SUA levels, regardless of participants’ baseline BMI or SUA levels, and appeared to be so primarily via weight reduction. These findings warrant further investigation into the possible role that tirzepatide/intentional weight loss may play in the treatment of patients with gout living with obesity
Exploring the role of the patient–physician relationship on insulin adherence and clinical outcomes in type 2 diabetes: Insights from the MOSAIc study
No full textBackgroundThe 2‐year prospective MOSAIc (Multinational Observational Study assessing Insulin use: understanding the challenges associated with progression of therapy) study is investigating whether patient‐, physician‐, and health system‐related factors affect outcomes in patients with type 2 diabetes (T2D). This baseline subanalysis investigated how aspects of the patient–physician relationship are associated with diabetes‐related distress, insulin adherence, and glycemic control.MethodsPatients with T2D taking insulin for ≥3 months were recruited at primary care and specialty practice sites in 18 countries. Physicians provided usual care. Clinical history and most recent HbA1c values were collected; patients were surveyed regarding their perception of physician interactions, diabetes‐related distress level, and insulin adherence.ResultsThe analysis population comprised 4341 patients. Four (of six) domains showed a significant relationship with total diabetes‐related distress (P < 0.01). Poor insulin adherence was associated with greater diabetes‐related distress (adjusted odds ratio [aOR] 1.14; 95% confidence interval [CI] 1.06–1.22), higher Discrimination (aOR 1.13; 95% CI 1.02–1.27) and Hurried Communication (aOR 1.35; 95% CI 1.20–1.53) scores, and a lower Explained Results score (aOR 0.86; 95% CI 0.77–0.97). Poor insulin adherence was associated with a 0.43% increase in HbA1c, whereas a 1‐unit increase in total diabetes‐related distress and Hurried Communication scores was associated with a 0.171% and 0.145% increase in HbA1c, respectively.ConclusionsPatients distressed about living with T2D, and dissatisfied with aspects of their interactions with physicians, exhibited poor insulin adherence. Perceived physician inattention and lack of engagement (and diabetes‐related distress) directly affect insulin adherence and glycemic control.背景为期2年的前瞻性MOSAIc(Multinational Observational Study assessing Insulin use: understanding the challenges associated with progression of therapy,评估胰岛素使用情况的多国观察性研究:了解治疗进展带来的挑战)研究调查了患者‐、医生‐、医疗卫生系统‐相关因素是否会对2型糖尿病患者的临床结局产生影响。这项基线亚组分析调查了患者‐医生关系对糖尿病相关的不适、胰岛素依从性以及血糖控制可造成何种影响。方法在18个国家的初级保健以及专业医疗机构中招募胰岛素使用时间≥ 3个月的2型糖尿病患者。医生提供了常规的医疗护理。收集临床病史以及最近的HbA1c值;调查患者对医患之间关系的看法、与糖尿病相关的不适程度以及胰岛素依从性。结果分析人群包含了4341名患者。(在6个领域中)有4个方面与总的糖尿病相关不适之间具有显著的相关性(P < 0.01)。胰岛素依从性差与较高的糖尿病相关不适(校正过的优势比[aOR]为1.14;95%置信区间[CI]为1.06‐1.22)、较高的歧视(aOR为1.13;95% CI为1.02‐1.27)和仓促沟通(aOR为1.35;95% CI为1.20‐1.53)得分以及更低的解释病情得分(aOR为0.86;95% CI为0.77‐0.97)相关。胰岛素依从性差可导致HbA1c升高0.43%,然而总的糖尿病相关不适以及仓促沟通得分每增加1个单位就可以导致HbA1c分别升高0.171%与0.145%。结论患者感到苦恼的是2型糖尿病影响到了他们的生活,对于与医生的交流感到不够满意,而且表现为胰岛素依从性差。患者觉得医生不关心自己、缺乏交流(以及糖尿病本身造成的相关痛苦)会直接影响到胰岛素依从性以及血糖控制。HighlightsPatient perceptions of the quality of their interactions with their physicians have a significant association with total diabetes‐related distress. Diabetes‐related distress and patient–physician interactions have a significant independent association with insulin adherence and HbA1c level.This study delineates specific aspects of the patient–physician interaction that are linked to diabetes‐related distress, insulin adherence behavior, and glycemic control.Path analysis showing associations between patient–physician interactions, diabetes‐related distress, insulin adherence, and HbA1c level. The model is not adjusted for baseline covariates and shows only those factors with at least one significant interaction. Parameter coefficients in the path analysis are shown.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/137500/1/jdb12443.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/137500/2/jdb12443_am.pd
