Riviste scientifiche

Ethnic disparities in initiation and intensification of diabetes treatment in adults with type 2 diabetes in the UK, 1990–2017: A cohort study

PLoS Medicine - Ve, 15/05/2020 - 23:00

by Rohini Mathur, Ruth E. Farmer, Sophie V. Eastwood, Nish Chaturvedi, Ian Douglas, Liam Smeeth

Background

Type 2 diabetes mellitus (T2DM) disproportionately affects individuals of nonwhite ethnic origin. Timely and appropriate initiation and intensification of glucose-lowering therapy is key to reducing the risk of major vascular outcomes. Given that ethnic inequalities in outcomes may stem from differences in therapeutic management, the aim of this study was to identify ethnic differences in the timeliness of initiation and intensification of glucose-lowering therapy in individuals newly diagnosed with T2DM in the United Kingdom.

Methods and findings

An observational cohort study using the Clinical Practice Research Datalink was conducted using 162,238 adults aged 18 and over diagnosed with T2DM between 1990 and 2017 (mean age 62.7 years, 55.2% male); 93% were of white ethnicity (n = 150,754), 5% were South Asian (n = 8,139), and 2.1% were black (n = 3,345). Ethnic differences in time to initiation and intensification of diabetes treatment were estimated at three time points (initiation of noninsulin monotherapy, intensification to noninsulin combination therapy, and intensification to insulin therapy) using multivariable Cox proportional hazards regression adjusted for factors a priori hypothesised to be associated with initiation and intensification: age, sex, deprivation, glycated haemoglobin (HbA1c), body mass index (BMI), smoking status, comorbidities, consultations, medications, calendar year, and clustering by practice. Odds of experiencing therapeutic inertia (failure to intensify treatment within 12 months of HbA1c >7.5% [58 mmol/mol]), were estimated using multivariable logistic regression adjusted for the same hypothesised confounders. Noninsulin monotherapy was initiated earlier in South Asian and black groups (South Asian HR 1.21, 95% CI 1.08–1.36, p < 0.001; black HR 1.29, 95% CI 1.05–1.59, p = 0.017). Correspondingly, no ethnic differences in therapeutic inertia were evident at initiation. Intensification with noninsulin combination therapy was slower in both nonwhite ethnic groups relative to white (South Asian HR 0.80, 95% CI 0.74–0.87, p < 0.001; black HR 0.79, 95% CI 0.70–0.90, p < 0.001); treatment inertia at this stage was greater in nonwhite groups relative to white (South Asian odds ratio [OR] 1.45, 95% CI 1.23–1.70, p < 0.001; black OR 1.43, 95% CI 1.09–1.87, p = 0.010). Intensification to insulin therapy was slower again for black groups relative to white groups (South Asian HR 0.49, 95% CI 0.41–0.58, p < 0.001; black HR 0.69, 95% CI 0.53–0.89, p = 0.012); correspondingly, treatment inertia was significantly higher in nonwhite groups at this stage relative to white groups (South Asian OR 2.68, 95% CI 1.89–3.80 p < 0.001; black OR 1.82, 95% CI 1.13–2.79, p = 0.013). At both stages of treatment intensification, nonwhite groups had fewer HbA1c measurements than white groups. Limitations included variable quality and completeness of routinely recorded data and a lack of information on medication adherence.

Conclusions

In this large UK cohort, we found persuasive evidence that South Asian and black groups intensified to noninsulin combination therapy and insulin therapy more slowly than white groups and experienced greater therapeutic inertia following identification of uncontrolled HbA1c. Reasons for delays are multifactorial and may, in part, be related to poorer long-term monitoring of risk factors in nonwhite groups. Initiatives to improve timely and appropriate intensification of diabetes treatment are key to reducing disparities in downstream vascular outcomes in these populations.

National and regional prevalence of posttraumatic stress disorder in sub-Saharan Africa: A systematic review and meta-analysis

PLoS Medicine - Ve, 15/05/2020 - 23:00

by Lauren C. Ng, Anne Stevenson, Sreeja S. Kalapurakkel, Charlotte Hanlon, Soraya Seedat, Boniface Harerimana, Bonginkosi Chiliza, Karestan C. Koenen

Background

People living in sub-Saharan Africa (SSA) are disproportionately exposed to trauma and may be at increased risk for posttraumatic stress disorder (PTSD). However, a dearth of population-level representative data from SSA is a barrier to assessing PTSD. This manuscript sought to calculate pooled PTSD prevalence estimates from nationally and regionally representative surveys in SSA.

Methods and findings

The search was conducted in PubMed, Embase, PsycINFO, and PTSDpubs and was last run between October 18, 2019, and November 11, 2019. We included studies that were published in peer-reviewed journals; used probabilistic sampling methods and systematic PTSD assessments; and included ≥ 450 participants who were current residents of an SSA country, at least 50% of whom were aged between 15 and 65 years. The primary outcomes were point prevalence estimates of PTSD across all studies, and then within subgroups. The protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) (registration number CRD42016029441). Out of 2,825 unique articles reviewed, 25 studies including a total of 58,887 eligible participants (54% female) in 10 out of the 48 countries in SSA were identified. Most studies enrolled any adult aged 18 years or older. However, some studies only enrolled specific age brackets or persons as young as 15 years old. Six studies were national surveys, and 19 were regional.There were 4 key findings in the meta-analysis: (1) the overall pooled prevalence of probable PTSD was 22% (95% CI 13%–32%), while the current prevalence—defined as 1 week to 1 month—was 25% (95% CI 16%–36%); (2) prevalence estimates were highly variable, ranging from 0% (95% CI 0%–0%) to 74% (95% CI 72%–76%); (3) conflict-unexposed regions had a pooled prevalence of probable PTSD of 8% (95% CI 3%–15%), while conflict-exposed regions had a pooled prevalence of probable PTSD of 30% (95% CI 21%–40%; p < 0.001); and (4) there was no significant difference in the pooled prevalence of PTSD for men and women. The primary limitations of our methodology are our exclusion of the following study types: those published in languages other than English, French, and Portuguese; smaller studies; those that focused on key populations; those that reported only on continuous measures of PTSD symptoms; and unpublished or non–peer-reviewed studies.

Conclusions

In this study, PTSD symptoms consistent with a probable diagnosis were found to be common in SSA, especially in regions exposed to armed conflict. However, these studies only represent data from 10 of the 48 SSA countries, and only 6 studies provided national-level data. Given the enormous heterogeneity expected across the continent, and also within countries and regions, this review cannot speak to rates of PTSD in any regions not included in this review. Thus, substantial gaps in our knowledge of PTSD prevalence in SSA remain. More research on population-level prevalence is needed to determine the burden of trauma symptoms and PTSD in SSA and to identify acceptable and feasible approaches to address this burden given limited mental healthcare resources.

Wound-healing patch of blue-green algae mends skin quickly

New Scientist - Ve, 15/05/2020 - 21:00
A skin patch filled with living blue-green algae pumps oxygen into wounds to help them mend faster, and may help people with chronic wounds caused by diabetes

Wound-healing patch of blue-green algae mends skin quickly

New Scientist - Ve, 15/05/2020 - 21:00
A skin patch made of living blue-green algae speeds up wound healing in mice, and may help to treat chronic wounds in people with diabetes

We may have missed half the microplastics in the ocean

New Scientist - Ve, 15/05/2020 - 19:35
Collecting microplastics on the ocean’s surface with three kinds of net has revealed far more stringy fibres of plastic than previous studies found

We may have missed half the microplastics in the ocean

New Scientist - Ve, 15/05/2020 - 19:35
Collecting microplastics on the ocean’s surface with three kinds of net has revealed far more stringy fibres of plastic than previous studies found

Covid-19 news: UK infection rate has risen in past week

New Scientist - Ve, 15/05/2020 - 19:30
The latest coronavirus news updated every day including coronavirus cases, the latest news, features and interviews from New Scientist and essential information about the covid-19 pandemic

Covid-19 news: UK infection rate has risen in past week

New Scientist - Ve, 15/05/2020 - 19:30
The latest coronavirus news updated every day including coronavirus cases, the latest news, features and interviews from New Scientist and essential information about the covid-19 pandemic

'Zombie' fires are burning the Arctic after smouldering under snow

New Scientist - Ve, 15/05/2020 - 17:34
Unprecedented Arctic fires from last summer appear to have smouldered in the underground peat of the tundra through winter and reignited this month as snow melted

'Zombie' fires are burning the Arctic after smouldering under snow

New Scientist - Ve, 15/05/2020 - 17:34
Unprecedented Arctic fires from last summer appear to have smouldered in the underground peat of the tundra through winter and reignited this month as snow melted

No evidence 'Madagascar cure' for covid-19 works, says WHO

New Scientist - Ve, 15/05/2020 - 16:47
There is no evidence a herbal drink promoted by the president of Madagascar as a cure for covid-19 is effective, according to the head of the World Health Organization in Africa

No evidence 'Madagascar cure' for covid-19 works, says WHO

New Scientist - Ve, 15/05/2020 - 16:47
There is no evidence a herbal drink promoted by the president of Madagascar as a cure for covid-19 is effective, according to the head of the World Health Organization in Africa

Two tiny outcrops in Hawaii are the top of the world’s largest volcano

New Scientist - Ve, 15/05/2020 - 14:02
An extinct Hawaiian volcano called Pūhāhonu is the largest on Earth, with a volume twice that of Mauna Loa, the next largest contender

Two tiny outcrops in Hawaii are the top of the world’s largest volcano

New Scientist - Ve, 15/05/2020 - 14:02
An extinct Hawaiian volcano called Pūhāhonu is the largest on Earth, with a volume twice that of Mauna Loa, the next largest contender

[Correspondence] Health inequity during the COVID-19 pandemic: a cry for ethical global leadership

The Lancet - Ve, 15/05/2020 - 09:41
Widespread reports of disproportionate impact of the COVID-19 pandemic among already vulnerable communities worldwide, from New York City to New Orleans and Chicago, to the shocking pictures of bodies lying in the streets in Ecuador, represent a prelude of the impact in low-income and middle-income countries, home to more than 80% of the world's population. Disadvantaged people are at higher risk of infection and death from COVID-19, and they have less access to care due to systems that treat health as a commodity and not a human right.

[Comment] Hypertension, renin–angiotensin–aldosterone system inhibition, and COVID-19

The Lancet - Ve, 15/05/2020 - 00:30
Few could have imagined that hypertension and its treatment with inhibitors of the renin–angiotensin–aldosterone system (RAAS) would become a hot topic during the global COVID-19 pandemic. Two factors have contributed to this: first, the observation that hypertension is one of the most common comorbidities associated with severe cases of COVID-19 in patients who have been admitted to hospital and their risk of death;1 and second, that like the severe acute respiratory syndrome coronavirus (SARS-CoV), SARS-CoV-2 infects cells via specific binding to angiotensin-converting enzyme 2 (ACE2), which is ubiquitously expressed in the lung and other tissues.

[Correspondence] Emergency ambulance services for heart attack and stroke during UK's COVID-19 lockdown

The Lancet - Ve, 15/05/2020 - 00:30
Attendance at Accident and Emergency departments in the UK is widely reported to have decreased precipitously since national lockdown was introduced on March 23, 2020. Anecdotal reports have suggested that heart attacks and strokes have “vanished from hospitals”,1 and that such patients “delay seeking help”.2 ST-segment elevation myocardial infarction (STEMI) and stroke are conditions for which hospital treatment is highly effective.

[Articles] Use of renin–angiotensin–aldosterone system inhibitors and risk of COVID-19 requiring admission to hospital: a case-population study

The Lancet - Ve, 15/05/2020 - 00:30
RAAS inhibitors do not increase the risk of COVID-19 requiring admission to hospital, including fatal cases and those admitted to intensive care units, and should not be discontinued to prevent a severe case of COVID-19.

[Comment] Global coordination on cross-border travel and trade measures crucial to COVID-19 response

The Lancet - Ve, 15/05/2020 - 00:30
When WHO declared the COVID-19 outbreak a Public Health Emergency of International Concern (PHEIC) on Jan 30, 2020, under the provisions of the International Health Regulations (2005) (IHR), it recommended against “any travel or trade restriction”.1 The recommendation was based on data available at the time, evidence from previous outbreaks, and principles underpinning the IHR. It formed an important part of WHO's messaging about how states could effectively respond in a coordinated way. Instead, over the following months, according to WHO, 194 countries adopted some form of cross-border measure—eg, travel restrictions, visa restrictions, border closures, among others—with little reproach from WHO or other actors in the international community.

[Correspondence] Personal protective equipment needs in the USA during the COVID-19 pandemic

The Lancet - Ve, 15/05/2020 - 00:30
Personal protective equipment (PPE) shortages (eg, masks, gloves, gowns) endanger patients and health-care workers alike during the coronavirus disease 2019 (COVID-19) pandemic.1 Policymakers and experts have called for donations of existing PPE, increased production by manufacturers, and novel fabrication strategies, such as 3D printing of masks.2,3 However, even as PPE sources are identified, a critical information challenge remains: tracking evolving PPE needs and matching them with existing or emerging PPE stockpiles.
Condividi contenuti