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Non-communicable Diseases such as anaemia, hypertension and diabetes and their treatment may upsurge the risk of childbirth-related complications for both women and their babies. The present study is an attempt to assess the level and determinants of Anaemia, Hypertension and Diabetes among pregnant women using the fourth round of National Family Health Survey-4 (2015-16) data. Bivariate and logistic regression techniques have been used for data analysis. Study findings suggest that the prevalence of anaemia among pregnant women was found to be 25.9%, whereas the corresponding figure for hypertension and diabetes were 4.4% and 2.4%, respectively. Further, substantial socio-economic differentials have been observed in the prevalence of Anaemia, Hypertension and Diabetes among pregnant women. Results of regression analysis suggest that anaemia and hypertension were significantly higher among women in their third trimester [(OR = 2.10; p < 0.001) and (OR = 1.63; p < 0.001)], respectively, compared to women in the first trimester. Similarly, pregnant women in the age group 35-49 were at an elevated risk of hypertension (OR = 2.78; p < 0.001)) and diabetes (OR = 2.50; p < 0.001)) compared to women aged 15-24. Further, the risk of anaemia was found to be significantly lower among pregnant women from the richest quintile (OR = 0.71; p < 0.001) and women with higher educational level (OR = 0.72; p < 0.001) when compared to women from the poorest wealth quintile and women with no formal education respectively. Similarly, pregnant women from the richest quintile (OR = 1.68; p < 0.001) and women from other religion (OR = 1.75; p < 0.001) are significantly more likely to develop diabetes compared to women from the poorest quintile and women from the Hindu religion, respectively. In conclusion, early screening for predicting the risk of gestational anaemia, gestational diabetes, and gestational hypertension is critical in minimizing maternal and reproductive outcomes. The existing guidelines for Screening and Management of Gestational Diabetes, Gestational Hypertension need to be contextualized and modified according to a local need for effective treatment.
The aim of this study is to review the literature in Commonwealth of Independent States (CIS) countries with regard to their response to non-communicable diseases (NCDs) and the implementation of the World Health Organization (WHO) Package of Essential Non-communicable (PEN) disease interventions for primary health care.
NCDs are estimated to account from 62% to 92% of total deaths in CIS countries. Current management of NCDs in CIS countries is focused on specialists and hospital care versus primary health care (PHC) as recommended by the WHO.
This paper uses a scoping review of published and grey literature focusing on diabetes and hypertension in CIS countries. These two conditions are chosen as they represent a large burden in CIS countries and are included in the responses proposed by the WHO PEN.
A total of 96 documents were identified and analysed with the results presented using the WHO Health System Building Blocks. Most of the publications identified focused on the service delivery (41) and human resources (20) components, while few addressed information and research (17), and only one publication was related to medical products. As for their disease of focus, most studies focused on hypertension (14) and much less on diabetes (3). The most studies came from Russia (18), followed by Ukraine (21) and then Kazakhstan (12). Only two countries Moldova and Kyrgyzstan have piloted the WHO PEN. Overall, the studies identified highlight the importance of the PHC system to better control and manage NCDs in CIS countries. However, these present only strategies versus concrete interventions. One of the main challenges is that NCD care at PHC in CIS countries continues to be predominantly provided by specialists in addition to focusing on treatment versus preventative services.
The human health benefits of cardiometabolic disease prevention can be accompanied by planetary co-benefits. Focusing efforts towards young people, including children and adolescents, is conducive to disease prevention. In the context of cardiometabolic disease prevention, this review paper critically summarises the available literature on the acute cardiometabolic responses to physical activity and breakfast manipulations among young people. Given the seriousness of global climate change, which will disproportionally affect our younger generations, this review paper offers new insights into the inherent interactions between child–adolescent behaviour and cardiometabolic health from an environmental sustainability perspective to aid climate change mitigation efforts, including exploring future research avenues. A growing evidence base suggests acute moderate- to high-intensity exercise bouts can attenuate postprandial plasma glucose, insulin and triacylglycerol concentrations for up to 24–48 h in young people. Whether accumulating physical activity throughout the day with short, frequent bouts promotes cardiometabolic risk marker attenuations is unclear. Breakfast consumption may enhance free-living physical activity and reduce glycaemic responses to subsequent meals for a possible additive impact. If repeated habitually, attenuations in these cardiometabolic risk factors would be conducive to disease prevention, reducing the greenhouse gas emissions associated with disease diagnosis and treatment. To progress current understanding with high public health and planetary relevance, research among samples of ‘at risk’ young people that span cellular-level responses to ecologically valid settings and address human and planetary health co-benefits is needed. Indeed, certain physical activity opportunities, such as active travel to school, offer important direct co-benefits to humans and planetary health.
Women over the age of 40 years are at a higher risk of early pregnancy complications such a miscarriage or ectopic pregnancy. They are also more likely to have pre-existing medical conditions which further increase their risk of early pregnancy pathology, for example, previous pelvic inflammatory disease leading to a tubal ectopic, or uncontrolled diabetes increasing the risk of a miscarriage. Women in this age group are also more likely to have conceived through fertility treatment, and may present with complications of this, such as multiple pregnancy or ovarian hyperstimulation syndrome. A woman’s history of assisted reproductive technology and pre-existing subfertility is significant not only in accurately dating the pregnancy but also with regards to the psychological impact in case of a poor outcome. Early pregnancy units have become well established in most hospitals as a dedicated department providing specialist early pregnancy care. This chapter provides an overview of the optminal management of the first trimester of pregnancy for women over 40 and the management of the common conditions.
To evaluate the cost-effectiveness of the nonsurgical periodontal treatment (NSPT) compared with supragingival therapy in type II diabetics with periodontitis.
A decision tree analysis was used to estimate the costs and health outcomes of two periodontal therapies in a hypothetical cohort of type II diabetics with periodontitis. The analysis was developed from the perspective of a third-party payer at 1 year and 5 years. Probabilities were derived from two systematic reviews. The costs and resource use were validated by a Delphi expert panel. All costs were expressed in USD, using the 25 May 2021 Colombian pesos market exchange rate (USD 1 = COP 3,350).
NSPT was a dominant alternative compared with subsidized supragingival therapy in type II diabetics with periodontitis, generating savings of USD 87 and 400, during the first year or up to 5 years, respectively, and improving dental survival from 32 to 69 percent.
NSPT can generate savings by reducing the complications derived from uncontrolled periodontitis and tooth loss.
This chapter explains the challenges involved with bariatric surgery and how they can be navigated to optimise patient care. Due to the increasing global rates of obesity, increasing numbers of bariatric patients are presenting for surgery. Obesity is associated with several physiological and psychological effects, and it is essential that these are considered in order to plan and deliver safe, effective, patient-centred perioperative care.
Many dietary guidelines recommend restricting the consumption of processed red meat (PRM) in favour of healthier foods such as fish, to reduce the risk of chronic conditions such as hypertension and diabetes. The objective of this study was to estimate the potential effect of replacing PRM for fatty fish, lean fish, red meat, eggs, pulses, or vegetables, on the risk of incident hypertension and diabetes. This was a prospective study of women in the E3N cohort study. Cases of diabetes and hypertension were based on self-report, specific questionnaires, and drug reimbursements. In the main analysis, information on regular dietary intake was assessed with a food frequency questionnaire, and food substitutions were modelled using cox proportional hazard models 95 % confidence intervals were generated via bootstrapping. 71,081 women free of diabetes and 45,771 women free of hypertension were followed for an average of 18.7 and 18.3 years respectively. 2,681 incident cases of diabetes and 12,327 incident cases of hypertension were identified. Replacing PRM with fatty fish was associated with a 15 % lower risk of diabetes (HR = 0.85, 95 CI [0.73: 0.97]), and hypertension (HR =0 .85 [0.79: 0.91]). Between 3 – 10 % lower risk of hypertension or diabetes was also observed when replacing PRM with vegetables, unprocessed red meat, or pulses. The replacement of PRM with alternative protein sources such as fatty fish, unprocessed red meat, vegetables, or pulses was associated with a reduced risk of hypertension and diabetes.
Metabolic Syndrome (MS) is highly prevalent in patients with bipolar disorder(BD), and may affect the functionality of this population.The increased rate of MS in BD might be due to poorer access to physical health care, unhealthy lifestyle related with psychiatric symptoms and adverse effects of pharmacological treatments.
We sought to compare differences in clinical features of patients with Bipolar Disorder Type 1 (BPD-1)with and without MS in euthymic period.
This study included 67 euthymic BPD-1 patients without MS and 33 age- and sex-matched BPD-1 patients with MS. All participants completed a sociodemographic form; took the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI) and Young Mania Rating Scale score. MS was diagnosed according to the International Diabetes Federation (IDF) criteria.
Age at onset of disease was significantly lower in BPD-1 group with MS than without MS (p < 0.05). Number of suicide attempts, psychiatric hospitalisation, was significantly higher in BPD-1 group with MS than without MS (p < 0.05). Catatonic and melancholic depression were significantly more prevalent in the BPD-1 with MS than without MS (p < 0.05). Having history of comorbid psychiatric diseases, mixed episodes, are significantly more prevalent in the BPD-1 with MS than without MS (p < 0.05). There was not significant difference between groups in terms of the medication between groups (p>0.05)
Our findings suggest that MS might have an effect on the course of BD patients. The development and testing of interventions for preventing and treating the MS and its components in patients with BD might be important .
People with diabetes are vulnerable to diabetes-related distress and are more likely to experience depressive and anxiety symptoms than the general population. Diabetes distress, depressive, and anxiety symptoms also tend to commonly co-occur.
This study aimed to apply network analysis to explore the associations between diabetes distress, depressive, and anxiety symptoms in a cohort of adults with type 2 diabetes.
Data were from the baseline (2011) assessment of the Evaluation of Diabetes Insulin Treatment (EDIT) study (N = 1,796; 49% female; mean age = 60, SD = 8) from Quebec, Canada. A first network using the 17 items of the diabetes distress scale (DDS-17) was estimated. A second network was estimated using the 17 items of the DDS-17, the 9 depressive items of the PHQ-9, and the 7 anxiety items of the GAD-7. Symptom centrality, network stability, and bridge symptoms were examined.
Regimen-related and physician-related distress symptoms were amongst the most central (highly connected) in the diabetes distress network. Worrying too much (anxiety), Not feeling motivated to keep up diabetes self-management
(diabetes distress), and Feeling like a failure (depression) were the most central symptoms in the combined network. Feeling like a failure (depression) was highly connected to diabetes distress symptoms, representing a potential bridge between diabetes distress and depression.
Identifying central and bridge symptoms may provide new insights into diabetes distress, depressive, and anxiety symptom maintenance and comorbidity in people with type 2 diabetes.
As it is well known, diabetes and depression are highly prevalent conditions and affect significantly overall health (Egede & Ellis,2010). This presentation aims to describe the impact of a chronic disease (diabetes) on mental health and its comorbidity with depression. Additionally, it presents the psychotherapeutic process and beneficial effects of coaching on an adolescent patient.
The current study tries to present the comorbidity and interaction between diabetes and depression. It explores the therapeutic path followed, so that the patient could cope effectively with the comorbidity of these diseases and break the vicious circle of sadness that he had been into.
A case study of an adolescent with diabetes is presented. It depicts how the sudden appearance and diagnosis of diabetes led to depressive impasse and cancellation of his dream to become a pilot. The role of coaching is described.
Through monthly coaching the young adolescent discovered his hidden talents and thus he was able to redirect his professional goals and to design a pathway that would lead to the fulfillment of his new life plans. Working closely together with his therapist, step by step, his depressive symptoms were diminished and anti-depressive medication was reduced gradually. Consequently, his diabetes was well regulated, and his overall health was radically improved.
Psychotherapeutic coaching is proved to be appropriate for patients with comorbidity in order to cope effectively with their chronic disease and discover new meaning in their own lives. Last, but not least, self-management skills and diabetes education are required in addition to psychological interventions.
Cardiovascular disease represent the leading cause of death worldwide, and is also responsible for the consumption of many medical resources, work absenteeism and worse Quality of Life. On the other hand, psychiatric diseases have recently gained more relevance worldwide as one of the principal causes of disability.
Evaluate a possible relationship between cardiovascular risk factors (CVRF) and anxious or depressive symptoms.
Observational and cross-sectional study in a non-probabilistic and convenience sample, composed by patients followed on five primary healthcare facilites, who voluntarily accepted to answer the questionnaire through an interview, between July 2020 and January 2021. After an informed consent, a questionnaire was carried out including sociodemographic characterization, presence of cardiovascular disease and/or cardiovascular risk factors and the Portuguese version of HADS. Descriptive and inferential statistics were performed, using Mann-Whitney U test. A value of p<0,05 was considered statistically significant.
Sample of 179 people, 53,1% female, with an average age of 51,05 ± 22,02 years, in which 57,5% had one or more CVRF and 59,8% had CVD and/or CVFR and the most prevalent CVRF were hypertension (48%) and dyslipidemia (43,6%). There was a statistically significant relationship between diabetes and anxiety (p<0,05).
There was a greater prevalence of anxiety symptoms in people with diabetes compared to people without diabetes. This suggests the importance of giving attention to anxiety in patients with diabetes, given the relevance of this comorbidity in their quality of life. The main limitation of the study is related with the sample size.
There is a well-established association between anger, hostility, and an increased risk of cardiovascular disease. Emerging evidence also suggests associations between anger/hostility and type 2 diabetes (T2D), though evidence from longitudinal studies has not yet been synthesized.
To systematically review findings from existing prospective cohort studies on trait anger/hostility and the risk of T2D and diabetes-related complications.
Electronic searches of MEDLINE (PubMed), PsychINFO, Web of Science, and CINAHL were performed for articles/abstracts published up to December 15, 2020. Peer-reviewed longitudinal studies conducted with adult samples, with effect estimates reported for trait anger or hostility and incident T2D or diabetes-related complications, were eligible for inclusion. Risk of bias/study quality was assessed. The review protocol was published a priori in PROSPERO (CRD42020216356) and was in keeping with PRISMA guidelines. Screening for eligibility, data extraction, and quality assessment was conducted by two independent reviewers.
Four studies with a total of 155,146 participants met the inclusion criteria. A narrative synthesis of extracted data was conducted according to the Synthesis Without Meta-Analysis guidelines. While results were mixed, our synthesis suggested a positive association between high trait-anger/hostility and increased risk of incident T2D. No longitudinal studies were identified relating to anger/hostility and incident diabetes-related complications. Geographical locations of the study samples were limited to the USA and Japan.
Further research is needed to investigate whether trait-anger/hostility predicts incident type 2 diabetes after adjustments for potential confounding factors. Longitudinal studies are needed to investigate trait-anger/hostility and the risk of diabetes-related vascular complications.
Does eating more carbohydrates, or fats, cause one to put on more weight? Are ketone bodies toxins or vital products that keep us alive during starvation? Does the concept of 'fat-burning exercise' hold true? In this game-changing book, Keith Frayn, an international expert in human metabolism and nutrition, dispels common misconceptions about human metabolism, explaining in everyday language the important metabolic processes that underlie all aspects of our daily lives. Illustrated throughout with clear diagrams of metabolic processes, Frayn describes the communication systems that enable our different organs and tissues to cooperate, for instance in providing fuel to our muscles when we exercise, and in preserving our tissues during fasting. He explores the impressive adaptability of human metabolism and discusses the metabolic disorders that can arise when metabolism 'goes wrong'. For anyone sceptical of information about diet and lifestyle, this concise book guides the reader through what metabolism really involves.
Hyperglycemia during the first trimester leads to an increased risk of innate malformations as well as death at times close to delivery dates. The methylated genes include those from paternal H19 and PEG3 and those from maternal MEST and MEG3 that are necessary for the growth and regulation of the human fetus and its placenta. The aim of this study was to evaluate and compare the expression of these genes in the cord blood of healthy infants born to mothers with gestational diabetes mellitus (GDM) and healthy mothers.
This case-control study was conducted on the cord blood of 40 infants born to mothers with GDM and 35 infants born to healthy mothers. Mothers were identified by measuring oral glucose tolerance in the 24th–26th week of pregnancy. Cord blood was obtained post-delivery, and cord blood mononuclear cells were immediately extracted, using Ficoll solution. Then, RNA extraction and cDNA synthesis were performed, and gene expression of MEG3, PEG3, H19, and MEST was assessed through quantitative real-time PCR.
Findings show that the expression levels of MEG3, PEG3, H19, and MEST genes were significantly decreased in mononuclear cord blood cells of infants born to mothers with GDM when compared to those of the healthy control group.
These findings reveal that the reduction of imprinted genes in mothers with GDM is most likely due to changes in their methylation by an epigenetic process. Considering the importance of GDM due to its high prevalence and its side effects both for mother and fetus, recognizing their exact mechanisms is of high importance. This has to be studied more widely.
Our study aimed to investigate the epidemiology of extrapulmonary tuberculosis (EPTB) and analyse the epidemiological characteristics of EPTB patients with or without pulmonary tuberculosis (PTB). EPTB cases admitted in our hospital from January 2015 to December 2020 were included. Uni- and multi-variable logistic regression analysis was carried out to identify risk factors and prognostic factors of concomitant EPTB and PTB or exclusively EPTB. A total of 3488 EPTB patients were reviewed, including 2086 patients with concurrent PTB and EPTB, and 1402 patients with exclusively EPTB. Logistic regression analysis showed that age >60 years (OR = 1.674, 95% CI = 1.438–1.949, P < 0.001) and female (OR = 1.325, 95% CI = 1.155–1.520, P < 0.001) were risk factors of exclusively EPTB, while co-morbidities (OR = 0.676, 95% CI = 0.492–0.929, P = 0.016) and severe symptoms (OR = 0.613, 95% CI = 0.405–0.929, P = 0.021) were risk factors for concurrence of EPTB and PTB. Age >60 years was an independent prognostic factor in EPTB patients with or without PTB (HR = 11.059, 95%CI = 5.097–23.999, P < 0.001; HR = 23.994, 95%CI = 3.093–186.151, P = 0.0020). Female gender was an independent prognostic factor in patients with concurrent PTB and EPTB (HR = 23.994, 95%CI = 3.093–186.151, P = 0.002). Our study disclosed the differential epidemiological characteristics of EPTB patients with or without PTB in China.
Most current nutrition policies and dietary recommendations still reflect decades of research addressing the mechanism of action or health risks of individual nutrients. Yet, most high-income countries including the UK are far from reaching the dietary intakes which are recommended for good health. Food-based dietary patterns (DPs) can help target specific combinations of foods that are associated with disease risk, recognising the coexistence of multiple nutrients within foods and their potential synergistic effects. Reduced rank regression (RRR) has emerged as a useful exploratory approach which uses a priori knowledge of the pathway from diet to disease to help identify DPs which are associated with disease risk in a particular population. Here we reviewed the literature with a focus on longitudinal cohort studies using RRR to derive DPs and reporting associations with non-communicable disease risk. We also illustrated the application of the RRR approach using data from the UK Biobank study, where we derived DPs that explained high variability in a set of nutrient response variables. The main DP was characterised by high intakes of chocolate and confectionery, butter and low-fibre bread, and low intakes of fresh fruit and vegetables and showed particularly strong associations with CVD, type 2 diabetes and all-cause mortality, which is consistent with previous studies that derived ‘Western’ or unhealthy DPs. These recent studies conducted in the UK Biobank population together with evidence from previous cohort studies contribute to the emerging evidence base to underpin food-based dietary advice for non-communicable disease prevention.
Se is an indispensable trace element for the human body, and telomere length is considered a marker of biological ageing. Previous studies have shown that dietary Se intake is associated with telomere length. However, the relationship between Se intake and telomere length in patients with diabetes has not been well studied. Therefore, this study aimed to investigate the relationship between dietary Se intake and telomere length in patients with diabetes. We extracted 878 participants with diabetes from the National Health and Nutrition Examination Survey database for 1990–2002. Dietary Se intake was assessed using the 24 h dietary recall method, and telomere length was measured using quantitative PCR. Generalised linear models were constructed to assess the relationship between dietary Se intake and telomere length. After controlling for the confounders, 1 μg increase in dietary Se intake in female patients with diabetes, and telomere length increased by 1·84 base pairs (β = 1·84 (95 % CI: 0·15, 3·53)), there was a line relationship between dietary Se intake and telomere length in female patients with diabetes and telomere length increased with increasing dietary Se intake within the range of 0–250 μg. The study demonstrates that dietary Se intake is significantly associated with telomere length only in the female population with diabetes in the USA. However, further prospective studies are required to confirm this finding.
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. It has been known for some time as a both a reproductive and a metabolic disorder but more recently, mainly as a result of large longitudinal population-based studies, is becoming recognized as a complex multisystem disorder with comorbidities and long-term health implications. PCOS is associated not only with reproductive and metabolic features but also with cardiovascular abnormalities, psychological illness and endometrial cancer. Data are also emerging about possible long-term health consequences for the offspring of women with PCOS. Their children are more likely to be obese with metabolic disorders and are more likely to develop neurodevelopmental or psychiatric disorders. In this chapter, the long-term health consequences of PCOS for women and their offspring are described, together with a discussion on how they should best be managed.
This study is performed to figure out how the presence of diabetes affects the infection, progression and prognosis of 2019 novel coronavirus disease (COVID-19), and the effective therapy that can treat the diabetes-complicated patients with COVID-19. A multicentre study was performed in four hospitals. COVID-19 patients with diabetes mellitus (DM) or hyperglycaemia were compared with those without these conditions and matched by propensity score matching for their clinical progress and outcome. Totally, 2444 confirmed COVID-19 patients were recruited, from whom 336 had DM. Compared to 1344 non-DM patients with age and sex matched, DM-COVID-19 patients had significantly higher rates of intensive care unit entrance (12.43% vs. 6.58%, P = 0.014), kidney failure (9.20% vs. 4.05%, P = 0.027) and mortality (25.00% vs. 18.15%, P < 0.001). Age and sex-stratified comparison revealed increased susceptibility to COVID-19 only from females with DM. For either non-DM or DM group, hyperglycaemia was associated with adverse outcomes, featured by higher rates of severe pneumonia and mortality, in comparison with non-hyperglycaemia. This was accompanied by significantly altered laboratory indicators including lymphocyte and neutrophil percentage, C-reactive protein and urea nitrogen level, all with correlation coefficients >0.35. Both diabetes and hyperglycaemia were independently associated with adverse prognosis of COVID-19, with hazard ratios of 10.41 and 3.58, respectively.
Severe acute malnutrition may lead both concurrently and subsequently to malabsorption and impaired glucose metabolism from pancreatic dysfunction. We conducted a systematic review to investigate the associations of current and prior postnatal wasting malnutrition with pancreatic endocrine and exocrine functions in humans. We searched PubMed, Google Scholar, Web of Science and reference lists of retrieved articles, limited to articles in English published before 1 February 2022. We included sixty-eight articles, mostly cross-sectional or cohort studies from twenty-nine countries including 592 530 participants, of which 325 998 were from a single study. Many were small clinical studies from decades ago and rated poor quality. Exocrine pancreas function, indicated by duodenal fluid or serum enzymes, or faecal elastase, was generally impaired in malnutrition. Insulin production was usually low in malnourished children and adults. Glucose disappearance during oral and intravenous glucose tolerance tests was variable. Upon treatment of malnutrition, most abnormalities improved but frequently not to control levels. Famine survivors studied decades later showed ongoing impaired glucose tolerance with some evidence of sex differences. The similar findings from anorexia nervosa, famine survivors and poverty- or infection-associated malnutrition in low- and middle-income countries (LMIC) lend credence to results being due to malnutrition itself. Research using large, well-documented cohorts and considering sexes separately, is needed to improve prevention and treatment of exocrine and endocrine pancreas abnormalities in LMIC with a high burden of malnutrition and diabetes.