To investigate differences in the performance of the Finnish Diabetes Risk Score (FINDRISC) as a screening tool for glucose abnormalities after shifting from glucose-based diagnostic criteria to the ...proposed new hemoglobin (Hb)A1c-based criteria.
A cross-sectional primary-care study was conducted as the first part of an active real-life lifestyle intervention to prevent type 2 diabetes within a high-risk Spanish Mediterranean population. Individuals without diabetes aged 45-75 years (n = 3,120) were screened using the FINDRISC. Where feasible, a subsequent 2-hour oral glucose tolerance test and HbA1c test were also carried out (n = 1,712). The performance of the risk score was calculated by applying the area under the curve (AUC) for the receiver operating characteristic, using three sets of criteria (2-hour glucose, fasting glucose, HbA1c) and three diagnostic categories (normal, pre-diabetes, diabetes).
Defining diabetes by a single HbA1c measurement resulted in a significantly lower diabetes prevalence (3.6%) compared with diabetes defined by 2-hour plasma glucose (9.2%), but was not significantly lower than that obtained using fasting plasma glucose (3.1%). The FINDRISC at a cut-off of 14 had a reasonably high ability to predict diabetes using the diagnostic criteria of 2-hour or fasting glucose (AUC = 0.71) or all glucose abnormalities (AUC = 0.67 and 0.69, respectively). When HbA1c was used as the primary diagnostic criterion, the AUC for diabetes detection dropped to 0.67 (5.6% reduction in comparison with either 2-hour or fasting glucose) and fell to 0.55 for detection of all glucose abnormalities (17.9% and 20.3% reduction, respectively), with a relevant decrease in sensitivity of the risk score.
A shift from glucose-based diagnosis to HbA1c-based diagnosis substantially reduces the ability of the FINDRISC to screen for glucose abnormalities when applied in this real-life primary-care preventive strategy.
Type 2 diabetes is an important preventable disease and a growing public health problem. Based on information provided by clinical trials, we know that Type 2 diabetes can be prevented or delayed by ...lifestyle intervention. In view of translating the findings of diabetes prevention research into real-life it is necessary to carry out community-based evaluations so as to learn about the feasibility and effectiveness of locally designed and implemented programmes. The aim of this project was to assess the effectiveness of an active real-life primary care strategy in high-risk individuals for developing diabetes, and then evaluate its efficiency.
Cost-Effectiveness analysis of the DE-PLAN (Diabetes in Europe - Prevention using Lifestyle, physical Activity and Nutritional intervention) project when applied to a Mediterranean population in Catalonia (DE-PLAN-CAT). Multicenter, longitudinal cohort assessment (4 years) conducted in 18 primary health-care centres (Catalan Health Institute). Individuals without diabetes aged 45-75 years were screened using the Finnish Diabetes Risk Score - FINDRISC - questionnaire and a 2-h oral glucose tolerance test. All high risk tested individuals were invited to participate in either a usual care intervention (information on diet and cardiovascular health without individualized programme), or the intensive DE-PLAN educational program (individualized or group) periodically reinforced. Oral glucose tolerance test was repeated yearly to determine diabetes incidence. Besides measuring the accumulated incidence of diabetes, information was collected on economic impact of the interventions in both cohorts (using direct and indirect cost questionnaires) and information on utility measures (Quality Adjusted Life Years). A cost-utility and a cost-effectiveness analysis will be performed and data will be modelled to predict long-term cost-effectiveness.
The project was intended to evidence that a substantial reduction in Type 2 diabetes incidence can be obtained at a reasonable cost-effectiveness ratio in real-life primary health care setting by an intensive lifestyle intervention. As far as we know, the DE-PLAN-CAT/PREDICE project represents the first assessment of long-term effectiveness and cost-effectiveness of a public healthcare strategy to prevent diabetes within a European primary care setting.
Although its incidence is low, cardiovascular disease is the most common cause of morbidity and mortality in Spain. A number of different algorithms can be used to calculate cardiovascular disease ...risk for primary prevention, but their ability to identify patients who will experience a cardiovascular event is not well understood. The objective of this study was to compare the results of using the original Framingham algorithm and two adaptations for low-risk countries: the REGICOR (Registre Gironí del COR) and SCORE (Systematic COronary Risk Evaluation) algorithms.
All cardiovascular events during 5-year follow-up in a cohort of patients without coronary disease in nine autonomous Spanish regions were recorded. The levels of different cardiovascular risk factors were measured between 1995 and 1998. Participants were considered high-risk if their 10-year risk was ≥20% with the Framingham algorithm, ≥10%, ≥15% or ≥20% with REGICOR, and ≥5% with SCORE.
In total, 180 (3.1%) coronary events (112 in men and 68 in women) occurred among the 5732 (57.3% female) participants during follow-up. Of these, 43 died from cerebrovascular disease, and 24 had a non-coronary vascular event. The REGICOR algorithm had the highest positive predictive value for coronary and cardiovascular disease in all age groups. Moreover, with a 10-year risk limit of 10%, it classified less of the population aged 35-74 years as high-risk (i.e., 12.4%) than the Framingham algorithm (i.e., 22.4%). The SCORE and Framingham algorithms classified 8.4% and 16.6% of the population aged 35-64 years, respectively, as having a high cardiovascular disease risk; with REGICOR, the figure was 7.5%.
The REGICOR adapted algorithm was the best predictor of cardiovascular events and classified a smaller proportion of the Spanish population aged 35-74 years as high risk than alternative algorithms.
A pesar de que presentan una baja incidencia, las enfermedades cardiovasculares son la causa más frecuente de morbimortalidad en España. Se dispone de diversas funciones para calcular el riesgo cardiovascular en la prevención primaria, cuya capacidad para identificar a los pacientes que desarrollarán acontecimientos cardiovasculares es poco conocida. Comparamos el rendimiento de las funciones de Framingham original, adaptada de REGICOR (Registre Gironí del COR) y SCORE (Systematic COronary Risk Evaluation) para países de bajo riesgo.
Se registraron todos los acontecimientos cardiovasculares en un seguimiento de 5 años de una cohorte sin enfermedad coronaria en 9 comunidades autónomas. Se midieron los factores de riesgo cardiovascular entre 1995 y 1998. Se consideró que el riesgo era elevado a los 10 años en ≥ 20% para Framingham, ≥ 10, ≥ 15 y ≥ 20% para REGICOR y ≥ 5% para SCORE.
Se produjeron 180 (3,1%) acontecimientos coronarios (112 en varones y 68 en mujeres) en las 5.732 personas (57,3% de mujeres) en las que se realizó el seguimiento. Se produjo muerte cerebrovascular en 43 personas, así como 24 acontecimientos vasculares no coronarios. Con la función REGICOR se obtuvo el mayor valor predictivo positivo para enfermedad coronaria y cardiovascular a cualquier edad, y, tomando un límite de 10% de riesgo a los 10 años, se clasificó a menos población de alto riesgo de 35-74 años (12,4%) que con la función de Framingham (22,4%). SCORE y Framing-ham clasificaron al 8,4 y al 16,6% de la población de 35-64 años como de alto riesgo cardiovascular y REGICOR, al 7,5%.
La función adaptada de REGICOR es la opción aplicable hasta los 74 años que muestra el mejor equilibrio en la capacidad de clasificación de riesgo de acontecimientos cardiovasculares. Su aplicación permite la clasificación de alto riesgo a individuos con un perfil más adecuado para ser candidatos a tratamiento hipolipemiante.
A pesar de que presentan una baja incidencia, las enfermedades cardiovasculares son la causa más frecuente de morbimortalidad en España. Se dispone de diversas funciones para calcular el riesgo ...cardiovascular en la prevención primaria, cuya capacidad para identificar a los pacientes que desarrollarán acontecimientos cardiovasculares es poco conocida. Comparamos el rendimiento de las funciones de Framingham original, adaptada de REGICOR (Registre Gironí del Cor) y SCORE (Systematic COronary Risk Evaluation) para países de bajo riesgo.
Se registraron todos los acontecimientos cardiovasculares en un seguimiento de 5 años de una cohorte sin enfermedad coronaria en 9 comunidades autónomas. Se midieron los factores de riesgo cardiovascular entre 1995 y 1998. Se consideró que el riesgo era elevado a los 10 años en ≥ 20% para Framingham, ≥ 10, ≥ 15 y ≥ 20% para REGICOR y ≥ 5% para SCORE.
Se produjeron 180 (3,1%) acontecimientos coronarios (112 en varones y 68 en mujeres) en las 5.732 personas (57,3% de mujeres) en las que se realizó el seguimiento. Se produjo muerte cerebrovascular en 43 personas, así como 24 acontecimientos vasculares no coronarios. Con la función REGICOR se obtuvo el mayor valor predictivo positivo para enfermedad coronaria y cardiovascular a cualquier edad, y, tomando un límite de 10% de riesgo a los 10 años, se clasificó a menos población de alto riesgo de 35-74 años (12,4%) que con la función de Framingham (22,4%). SCORE y Framingham clasificaron al 8,4 y al 16,6% de la población de 35-64 años como de alto riesgo cardiovascular y REGICOR, al 7,5%.
La función adaptada de REGICOR es la opción aplicable hasta los 74 años que muestra el mejor equilibrio en la capacidad de clasificación de riesgo de acontecimientos cardiovasculares. Su aplicación permite la clasificación de alto riesgo a individuos con un perfil más adecuado para ser candidatos a tratamiento hipolipemiante.
Although its incidence is low, cardiovascular disease is the most common cause of morbidity and mortality in Spain. A number of different algorithms can be used to calculate cardiovascular disease risk for primary prevention, but their ability to identify patients who will experience a cardiovascular event is not well understood. The objective of this study was to compare the results of using the original Framingham algorithm and two adaptations for low-risk countries: the REGICOR (Registre Gironí del cor) and SCORE (Systematic COronary Risk Evaluation) algorithms.
All cardiovascular events during 5-year follow-up in a cohort of patients without coronary disease in nine autonomous Spanish regions were recorded. The levels of different cardiovascular risk factors were measured between 1995 and 1998. Participants were considered high-risk if their 10-year risk was ≥20% with the Framingham algorithm, ≥10%, ≥15% or ≥20% with REGICOR, and ≥5% with SCORE.
In total, 180 (3.1%) coronary events (112 in men and 68 in women) occurred among the 5732 (57.3% female) participants during follow-up. Of these, 43 died from cerebrovascular disease, and 24 had a non-coronary vascular event. The REGICOR algorithm had the highest positive predictive value for coronary and cardiovascular disease in all age groups. Moreover, with a 10-year risk limit of 10%, it classified less of the population aged 35-74 years as high-risk (i.e., 12.4%) than the Framingham algorithm (i.e., 22.4%). The SCORE and Framingham algorithms classified 8.4% and 16.6% of the population aged 35-64 years, respectively, as having a high cardiovascular disease risk; with REGICOR, the figure was 7.5%.
The REGICOR adapted algorithm was the best predictor of cardiovascular events and classified a smaller proportion of the Spanish population aged 35-74 years as high risk than alternative algorithms.
Summary
Background
Onset during old age has been reported in upto 10% of total cases of inflammatory bowel disease (IBD).
Aim
To evaluate phenotypic characteristics and the use of therapeutic ...resources in patients with elderly onset IBD.
Methods
Case‐control study including all those patients diagnosed with IBD over the age of 60 years since 2000 who were followed‐up for >12 months, identified from the IBD databases. Elderly onset cases were compared with IBD patients aged 18 to 40 years at diagnosis, matched by year of diagnosis, gender and type of IBD (adult‐onset).
Results
One thousand three hundred and seventy‐four elderly onset and 1374 adult‐onset cases were included (62% ulcerative colitis (UC), 38% Crohn's disease (CD)). Among UC patients, elderly onset cases had a lower proportion of extensive disease (33% vs 39%; P < 0.0001). In CD, elderly onset cases showed an increased rate of stenosing pattern (24% vs 13%; P < 0.0001) and exclusive colonic location (28% vs 16%; P < 0.0001), whereas penetrating pattern (12% vs 19%; P < 0.0001) was significantly less frequent. Regarding the use of therapeutic resources, there was a significantly lower use of corticosteroids (P < 0.0001), immunosuppressants (P < 0.0001) and anti‐TNFs agents (P < 0.0001) in elderly onset cases. Regarding surgery, we found a significantly higher surgery rate among elderly onset UC cases (8.3% vs 5.1%; P < 0.009). Finally, elderly onset cases were characterised by a higher rate of hospitalisations (66% vs 49%; P < 0.0001) and neoplasms (14% vs 0.5%; P < 0.0001).
Conclusions
Elderly onset IBD shows specific characteristics and they are managed differently, with a lower use of immunosuppressants and a higher rate of surgery in UC.
Linked ContentThis article is linked to Everhov et al and Mañosa and Domènech papers. To view these articles visit https://doi.org/10.1111/apt.14598 and https://doi.org/10.1111/apt.14622.
Abstract Objective To derive and validate a set of functions to predict coronary heart disease (CHD) and stroke, and validate the Framingham-REGICOR function. Method Pooled analysis of 11 ...population-based Spanish cohorts (1992–2005) with 50,408 eligible participants. Baseline smoking, diabetes, systolic blood pressure (SBP), lipid profile, and body mass index were recorded. A ten-year follow-up included re-examinations/telephone contact and cross-linkage with mortality registries. For each sex, two models were fitted for CHD, stroke, and both end-points combined: model A was adjusted for age, smoking, and body mass index and model B for age, smoking, diabetes, SBP, total and HDL cholesterol, and for hypertension treatment by SBP, and age by smoking and by SBP interactions. Results The 9.3-year median follow-up accumulated 2973 cardiovascular events. The C-statistic improved from model A to model B for CHD (0.66 to 0.71 for men; 0.70 to 0.74 for women) and the combined CHD-stroke end-points (0.68 to 0.71; 0.72 to 0.75, respectively), but not for stroke alone. Framingham-REGICOR had similar C-statistics but overestimated CHD risk. Conclusions The new functions accurately estimate 10-year stroke and CHD risk in the adult population of a typical southern European country. The Framingham-REGICOR function provided similar CHD prediction but overestimated risk.
Cabre and Sola-Morales study bounded solutions in a nonlinear problem. These solutions are monotone increasing, say from minus 1 to 1 in one of the y-variables. Cabre and Sola-Morales call them layer ...solutions of the nonlinear problem, and they study their existence, uniqueness, symmetry, and variational properties, as well as their asymptotic behavior. The interest in such increasing solutions comes from some models of boundary phase transitions.
Background and Purpose
Opioid‐based drugs are the gold standard medicines for pain relief. However, tolerance and several side effects (i.e. constipation and dependence) may occur upon chronic opioid ...administration. Photopharmacology is a promising approach to improve the benefit/risk profiles of these drugs. Thus, opioids can be locally activated with high spatiotemporal resolution, potentially minimizing systemic‐mediated adverse effects. Here, we aimed at developing a morphine photo‐derivative (photocaged morphine), which can be activated upon light irradiation both in vitro and in vivo.
Experimental Approach
Light‐dependent activity of pc‐morphine was assessed in cell‐based assays (intracellular calcium accumulation and electrophysiology) and in mice (formalin animal model of pain). In addition, tolerance, constipation and dependence were investigated in vivo using experimental paradigms.
Key results
In mice, pc‐morphine was able to elicit antinociceptive effects, both using external light‐irradiation (hind paw) and spinal cord implanted fibre‐optics. In addition, remote morphine photoactivation was devoid of common systemic opioid‐related undesired effects, namely, constipation, tolerance to the analgesic effects, rewarding effects and naloxone‐induced withdrawal.
Conclusion and Implications
Light‐dependent opioid‐based drugs may allow effective analgesia without the occurrence of tolerance or the associated and severe opioid‐related undesired effects.
LINKED ARTICLES
This article is part of a themed issue on Advances in Opioid Pharmacology at the Time of the Opioid Epidemic. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v180.7/issuetoc
Diabetes mellitus (DM) is the leading cause of polyneuropathy in the Western world. Diabetic neuropathy (DNP) is the most common complication of diabetes and is of great clinical significance mainly ...due to the pain and the possibility of ulceration in the lower limbs. Early detection of neuropathy is essential in the medical management of this complication. Early unmyelinated C-fiber dysfunction is one of the typical findings of diabetic neuropathy and the first clinical manifestation of dysfunction indicating sudomotor eccrine gland impairment. In order to assess newly developed technology for the measurement of dermal electrochemical conductance (DEC), we analyzed the feasibility and effectiveness of DEC (quantitative expression of sudomotor reflex) as a screening test of DNP in primary health care centers. The study included 197 people (with type 2 diabetes, prediabetes and normal tolerance) who underwent all the protocol tests and electromyography (EMG). On comparing DEC with EMG as the gold standard, the area under the receiver operating characteristic (ROC) curve (AUC, area under the curve) was 0.58 in the whole sample, AUC = 0.65 in the diabetes population and AUC = 0.72 in prediabetes, being irrelevant in subjects without glucose disturbances (AUC = 0.47). Conclusions: In usual clinical practice, DEC is feasible, with moderate sensitivity but high specificity. It is also easy to use and interpret and requires little training, thereby making it a good screening test in populations with diabetes and prediabetes. It may also be useful in screening general populations at risk of neuropathy.
Steroids are recommended in severe alcohol-induced hepatitis, but some data suggest that artificial nutrition could also be effective. We conducted a randomized trial comparing the short- and ...long-term effects of total enteral nutrition or steroids in these patients. A total of 71 patients (80% cirrhotic) were randomized to receive 40 mg/d prednisolone (n = 36) or enteral tube feeding (2,000 kcal/d) for 28 days (n = 35), and were followed for 1 year or until death. Side effects of treatment occurred in 5 patients on steroids and 10 on enteral nutrition (not significant). Eight enterally fed patients were prematurely withdrawn from the trial. Mortality during treatment was similar in both groups (9 of 36 vs. 11 of 35, intention-to-treat) but occurred earlier with enteral feeding (median 7 vs. 23 days; P = .025). Mortality during follow-up was higher with steroids (10 of 27 vs. 2 of 24 intention-to-treat; P = .04). Seven steroid patients died within the first 1.5 months of follow-up. In contrast to total enteral nutrition (TEN), infections accounted for 9 of 10 follow-up deaths in the steroid group. In conclusion, enteral feeding does not seem to be worse than steroids in the short-term treatment of severe alcohol-induced hepatitis, although death occurs earlier with enteral nutrition. However, steroid therapy is associated with a higher mortality rate in the immediate weeks after treatment, mainly because of infections. A possible synergistic effect of both treatments should be investigated.
(Hepatology 2000;32:36-42.)
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