Contemporary (2019) prevalence of cardiovascular disease in adults with type 2 diabetes in Brazil: the cross-sectional CAPTURE study

Background Type 2 diabetes (T2D) is a known risk factor for cardiovascular disease (CVD), and CVD is a major cause of mortality in patients with T2D. The CAPTURE study investigated the contemporary (2019) prevalence of established CVD in adults with T2D around the world. We report the findings from Brazil. Methods The multinational, non-interventional, cross-sectional CAPTURE study was conducted across 13 countries from five continents. The current manuscript explores data for the CAPTURE study sample in Brazil. Standardized demographic and clinical data were collected from adults with T2D aged ≥ 18 years attending a single routine healthcare visit in primary or specialized care between December 2018 and September 2019. Data were analyzed descriptively. Results Data from 912 adults with T2D were collected in the CAPTURE study in Brazil, with 822 patients from primary care and 90 patients from specialized care. Median (interquartile range [IQR]) patient characteristics were as follows: age 64 years (57; 71), diabetes duration 11 years (6; 19), glycated hemoglobin 7.7% (6.7; 9.1), and body mass index 29.5 kg/m2 (26.4; 33.5); 59% were female. The CVD prevalence and atherosclerotic CVD prevalence in the Brazil sample were 43.9% (95% confidence interval [CI] 40.9; 46.8) and 37.6% (95% CI 34.7; 40.5), respectively. The majority of patients with CVD had atherosclerotic CVD (85.8%). For the specific CVD subtypes, coronary heart disease prevalence was 27.9% (95% CI 25.2; 30.5), heart failure was 12.4% (95% CI 10.4; 14.4), cerebrovascular disease was 8.7% (95% CI 6.8; 10.5), and carotid artery disease was 3.4% (95% CI 2.3; 4.5). Glucagon-like peptide-1 receptor agonists and/or sodium-glucose co-transporter-2 inhibitors with proven cardiovascular benefit were prescribed to 15.5% of patients with CVD, compared with 18.4% of patients without CVD. Conclusions CAPTURE was the first multinational, standardized study to provide contemporary data on CVD prevalence in adults with T2D in Brazil, and it demonstrated that almost one in two adults with T2D had established CVD. Except for carotid artery disease, the prevalence of all CVD subtypes in adults with T2D in Brazil appeared higher than the global CAPTURE prevalence. Trial registration NCT03786406, NCT03811288

Telemedicine

Using telemedicine systems, physicians around the world have been able to provide health access to their own communities and others abroad. Telemedicine is still a developing field in the health sciences, but much progress has been made with the advent of new communication technologies. Today, telemedicine offers an alternative to traditional physician consultations, especially for those patients with different needs. Patients with mobility issues, low socioeconomic standing, and far away from big cities have seen benefits from this form of patient care. Not only has telemedicine been able to just bridge these gaps, but it has also provided a new way for the international community of health practitioners to cooperate and aid areas in need of specialized care in the developing world. New cooperation programs between developed and developing countries have been developed to bring specialist knowledge to areas that otherwise would not have access to it. Telemedicine is a way to take care of patients in this technological area and perhaps will become the new standard of care.

Transformaciones familiares y política social en el México contemporáneo

The document develops an analysis of the family situation faced during the last decades in Mexico, particularly in the social transformation and their connection with the heterogeneity of the family groups, based on a series of analytical categories focused on family strategies that point out their daily life, taking up the proposal of Mallardi (2018) around: a) strategies aimed at obtaining subsistence resources, b) strategies linked to the specialized care, c) room strategies linked to the conditions life, d) strategies associated with health-disease processes and e) strategies for socialization, learning and use of free time. These strategies are approached as categories of analysis, for which their operationalization is carried out based on the review and reflection regarding some of the main changes observed during the last decades in Mexico; as well as the way in which these transformations are traversed by a series of social determinants, particularly those of gender and class, as well as their relationship with social policies directed at family groups. The analysis presented, without being exhaustive, shows the way in which the indicated elements and their linkage come to impact the daily life of families during the last decades. In this way, the daily life of family groups shows a series of tensions, ambivalences and contradictions derived to a large extent from the present relationship between the pressures exerted, on the one hand, from the social policy itself implemented and with it the demands and mandates generated from their socio-historical, economic and political context. On the other hand, the growing material and subjective needs of its members, which demand immediate responses that provide the minimum possibilities for the survival of the family group. El documento desarrolla un análisis de la situación familiar enfrentada durante las últimas décadas en México, en particular de las transformaciones sociales y su vínculo con la heterogeneidad de los grupos familiares, a partir de una serie de categorías analíticas centradas en las estrategias familiares que dan cuenta de la vida cotidiana, retomando para ello la propuesta de Mallardi (2018) en torno a: a) estrategias destinadas a la obtención de los recursos de subsistencia, b) estrategias vinculadas a la organización del cuidado, c) estrategias habitacionales vinculadas a las condiciones de vida, d) estrategias asociadas a los procesos de salud-enfermedad y e) estrategias de socialización, aprendizaje y uso del tiempo libre. Dichas estrategias son abordadas como categorías de análisis, por lo cual su operacionalización es realizada partiendo de la revisión y reflexión respecto a algunos de los principales cambios observados durante las últimas décadas en México; asimismo, se analiza la manera en que esas transformaciones se encuentran atravesadas por una serie de determinantes sociales, particularmente las de género y clase. Otro aspecto que se analiza es la relación de las transformaciones familiares observadas con las políticas sociales dirigidas a los grupos familiares. El análisis presentado, sin ser exhaustivo, muestra la manera en que los elementos señalados y su vinculación llegan a impactar la vida cotidiana de las familias durante las últimas décadas. De esa manera, la vida cotidiana de los grupos familiares muestra una serie de tensiones, ambivalencias y contradicciones derivadas en gran parte de la relación presente entre las presiones ejercidas, por un lado, desde la propia política social implementada y con ello las demandas y mandatos generados desde su contexto sociohistórico, económico y político. Así como, por otro lado, las crecientes necesidades materiales y subjetivas de sus miembros, las cuales exigen respuestas inmediatas que brinden las posibilidades mínimas para la sobrevivencia del grupo familiar.

Delayed Diplopia After Sports-Related Concussion: A Multidisciplinary Approach to Evaluation and Management

ObjectiveTo highlight a multidisciplinary approach to the diagnosis and management of unilateral abducens palsy after a sports-related concussion.BackgroundMild traumatic brain injury (TBI) often leads to disruptions in visual functioning, affecting convergence, saccades, smooth pursuit, and accommodation. More severe TBI injuries may result in structural injuries to the ocular muscles, nerves, or the brain itself.Design/MethodsNA.ResultsCase: We present the case of a 33-year-old male with unilateral abducens nerve palsy after a sports-related concussion with loss of consciousness and multiple hemorrhagic contusions. The patient's visual symptoms manifested several days after the injury. With a multi-disciplinary evaluation involving specialists representing neurosurgery, endovascular neurology and neuro-ophthamology, unenhanced magnetic resonance imaging revealed multiple foci of intraparenchymal microhemorrhages and siderosis consistent with diffuse axonal injury (DAI), and an incidental parasagittal cavernoma. The delayed development of a sixth nerve palsy raised our suspicion for secondary axotomy, as has been described following TBI. While the probability of recovery is high, close follow up is imperative to address evolution of the patient's symptoms. In this case, the patient developed imbalance and headaches in association with his visual symptoms. For the imbalance we use physical therapy with therapists trained in vestibular therapy and for the visual symptoms we use vision therapy with trained optometrists.ConclusionsDelayed post-traumatic abducens palsy is concerning for DAI and secondary axotomy. Multidisciplinary assessment imparts the ability to evaluate for all possible causes and provide additional specialized care for recovery.

Analysis of Clinical Parameters, Drug Consumption and Use of Health Resources in a Southern European Population with Alcohol Abuse Disorder During COVID-19 Pandemic

The disruption in healthcare attention to people with alcohol dependence, along with psychological decompensation consequence of lockdown derived from COVID-19 pandemic, could have a negative impact on people who suffers from alcohol abuse disorder. Retrospective observational study of 9,966 men aged ˃16 years registered as having diagnosis of alcohol abuse disorder in the electronic medical records (EMR) of the Aragon Regional Health Service (Spain). Of those who were not infected during the study period (9,576), clinical (Glutamate-oxaloacetate -GOT-, Glutamate pyruvate -GPT-, creatinine, glomerular filtration, systolic blood pressure -SBP-, diastolic blood pressure -DBP-, total cholesterol, LDL, HDL, triglycerides, and body mass index -BMI-), pharmacological (dose per inhabitant per day -DHD- of drugs used in addictive disorders, benzodiazepines and antidepressants) and health resource use variables (primary and specialized care) were considered. Student´s T-test for matched samples was performed. After carrying out the Levene´s test, the Student´s T-test was used to analyze the changes in clinical variables between alcohol abuse disorder patients with and without COVID-19. Only creatinine and LDL show a significant but clinically irrelevant changes just after and 6 months after the end of strict lockdown. The total number of DHDs for all drugs included in the study (except for Benzodiazepines), decreased. In the same way, the use of health services by these patients also decreased. The impact of COVID-19 among this group of patients has been moderate. The reorganization of health and social services after the declaration of the state of alarm in our country, made possible the maintenance of care for this vulnerable patients.

Healthcare Service Utilization Patterns and Patient Experience in Persons With High Healthcare Needs: A Comparison Across 22 Countries

BackgroundPersons with complex health conditions, e.g. spinal cord injury (SCI), frequently visit numerous clinical settings. Their service utilization and patient experience is a comprehensive indicator of how a system is functioning overall. This study compared the patient experience of persons with chronic SCI in relation to healthcare service utilization patterns in 22 countries, hypothesizing that primary-care oriented patterns would offer better experience.MethodsThis study was based on International Spinal Cord Injury Survey with 12 588 participants from 22 countries worldwide. Utilization clusters were identified by cluster analysis, experience score was attained by partial credit model. The association between the two was explored by regression analysis. ResultsHighest share of visits was to primary care physician (18%) and rehabilitation physician (16%). Utilization patterns had diverse orientation: from primary care to specialized and from inpatient to outpatient. The experience was reported as very good and good across different dimensions: 78% reported respectful treatment; 75% – clear explanations; 71% – involvement in decision making; 63% – satisfaction with care. Average experience score on 0-100-point scale was 64, highest – 74 (Brazil) and lowest – 52 (Japan, South Korea). Service utilization patterns were associated with patient experience, but no uniformly better patient experience was found for neither primary or specialized care-oriented systems. ConclusionWhile there are distinct utilization patterns between countries of how persons with chronic SCI use the healthcare system, neither the more primary care oriented nor the specialized care system leads to a uniformly better patient experience.

Geriatric Patients With Breast Cancer: G8 as a Frailty Screening Tool

Purpose The highest incidence of breast cancer is in senile patients. Treatment decisions are often based on their age and ECOG. The implementation of the G8 in the oncology consultation is useful for timely referral of vulnerable patients to specialized care, in order to generate an improvement on their treatment and prognosis.The aim of this work is to determine, using the G8, the proportion of patients aged >65 years with breast cancer, which requires a comprehensive geriatric assessment (CGA).Material and methodsThe G8 questionnaire was applied to patients >65 years with breast cancer. The baseline characteristics were prospectively collected. Descriptive statistics were used for the characteristics of the patients and the assessment tools. The difference between groups was assessed using Pearson's chi square with Yates correction. Additional scores were calculated using the Kaplan-Meier method and compared between groups using the log rank test. The hazard ratio (HR) with a 95% confidence interval (CI) was estimated using a Cox proportional hazard analysis, considering an abnormal G8 score as an exposure variable. A Spearman correlation was made between age and G8 score. SPSS v22 software (IBM, USA) was used for all analyzes.ResultsFrom December 2019 to May 2020, 357 patients were recruited. The mean age was 73.57 years. Seventy-four percent had an ECOG 1; 44.3% required a CGA (n = 158), but only 55.1% (n = 87) were performed. The G8 most affected domains were polypharmacy (51%) and ingestion (28.3%). We found significant association between the requirement for CGA and ECOG, p <0.0001. ConclusionThe G8 is a tool that allows us to discern which patients require a CGA in order to carry out interventions to improve cancer treatment, so it should be implemented routinely in the oncology consultation.*ECOG: Eastern Cooperative Oncology Group

The State of Gerontological Training in Ghana: Implications for a Specialized Workforce and the Aging Population

The rise in older population in Ghana is accompanied by several challenges that may require trained professionals with specialized knowledge in geriatrics and gerontology to help address. Extensive review of existing literature, however, indicates a lack of comprehensive geriatric focused training in Ghana’s education system. Unfortunately, the scope of this training deficiency, potential impact on the geriatric workforce, as well as the health and wellbeing of the aging population on the national level have not been extensively examined. With the older adult population set to increase over the next few years, the need for geriatric-trained human service professionals in diverse disciplines, including medicine, nursing, psychology, social work and public health has become more pronounced. This paper is a review of the current state of gerontological education in higher institutions in Ghana. Specifically, authors examined (1) current geriatric-focused training programs available to students in all public/government owned institutions, (2) existing national level programs, and policies addressing training deficiencies, and (3) the implications of findings for future geriatric workforce as well as the health and wellbeing of older Ghanaians. The findings call attention to the need for a nationwide geriatric-focused training system and policies aimed at prioritizing specialized care for the older population. Culturally appropriate recommendations for integrating gerontological training and education in tertiary institutions are discussed. Guidelines and standards based on the Academy for Gerontology in Higher Education (AGHE) Competencies for Undergraduate and Graduate Education are proposed.