192 resultados para TYPE-2 HYPERCHOLESTEROLEMIA
Resumo:
The aim of the study was to determine the effect of a single bout of exercise on GLUT4 gene expression in muscle of patients with type 2 diabetes (T2D) and control subjects, matched for age and body mass index. Nine patients with T2D and nine control subjects performed 60 min of cycling exercise at ∼55% peak power (Wmax). Skeletal muscle biopsies were obtained at baseline, immediately post and 3-h post exercise. GLUT4 mRNA expression increased (p < 0.05) to a similar extent immediately post exercise in control (∼60%) and T2D (∼66%) subjects, and remained elevated (p < 0.05) 3-h post exercise with no differences between groups. Similarly, p-AMP-activated protein kinase, p38 mitogen-activated kinase and proliferator-activated receptor gamma co-activator-alpha mRNA expression were increased (p < 0.05) post exercise, and were not different between the groups. In conclusion, a single bout of exercise increased skeletal muscle GLUT4 mRNA expression in patients with T2D to a similar extent as in control subjects.
Resumo:
Background
The aim of this study was to describe the clinical characteristics, causative pathogens, clinical management and outcomes of patients presenting to a tertiary adult Australian intensive care unit (ICU) with a diagnosis of necrotizing fasciitis (NF).
Methods
This retrospective observational study was conducted in a 19-bed, level III, adult ICU in a 450-bed tertiary, regional hospital. Clinical databases were accessed for patients diagnosed with NF and admitted to The Geelong Hospital ICU between 1 February 2000 and 1 June 2011. Information on severity of sepsis, surgical procedures and microbiological results were collected.
Results
Twenty patients with NF were identified. The median age was 52.5 years and 38% were female. The overall mortality rate was 8.3%. Common co-morbidities were diabetes (21%) and heart failure (17%), although 50% of patients had no co-morbidities. Group A Streptococcus was the identified pathogen in 11 (46%) patients, and Streptococcus milleri group in 5 (21%) patients. Hyperbaric oxygen therapy was not used in the majority of patients. The initial antibiotics administered were active against subsequently cultured bacteria in 83% of patients. Median time to surgical debridement was 20 h. Diagnosis and management was delayed in the nosocomial group.
Conclusions
This study reports physiological data, aetiology and therapeutic interventions in NF for an adult tertiary hospital. We demonstrate one of the lowest reported mortality rates, with early surgical debridement being achieved in the majority of patients. The main delay was found to be in the diagnosis of NF.
Resumo:
Aims : The mean age of onset of Type 2 diabetes mellitus is decreasing in Australia and internationally. We conducted an internet-based survey to improve our understanding of the emotional well-being and unmet needs of younger adults with Type 2 diabetes, and to inform service provision for this group.
Methods : A random sample of National Diabetes Services Scheme registrants (n = 1,417) with Type 2 diabetes, aged 18–39 years, living in the Australian state of Victoria received an invitation to complete the online survey. The study was also advertised state-wide. The survey included validated scales (PAID-5: diabetes-related distress; WHO-5: general emotional well-being) and study-specific items. A total of 149 eligible respondents participated.
Results : Almost two-thirds (63%) of respondents reported severe-diabetes related distress; more than a quarter (27%) had impaired general emotional well-being. Most (82%) were overweight or obese (BMI ≥ 25); most (77%) had at least one other co-morbidity. Lack of motivation, feeling burned out, and being time-poor were identified as top barriers to self-management. More than half (59%) of respondents had not participated in structured diabetes education. Respondents perceived that younger adults with Type 2 diabetes had different health-care needs than their older counterparts (68%), and that most Type 2 diabetes information/services were aimed at older adults (62%). Of a range of potential new services, respondents indicated greatest interest in an online forum specifically for younger adults with Type 2 diabetes.
Conclusions : Younger adults with Type 2 diabetes have impaired emotional well-being and physical health. Population-based research is needed to confirm the current findings, to further inform service delivery and optimise outcomes for this group.
Resumo:
Aims To undertake further psychometric validation of the W-BQ28 to determine its suitability for use in adults with Type 2 diabetes in the UK using data from the AT.LANTUS follow-on study.
Methods A total of 353 people with Type 2 diabetes participated in the AT.LANTUS Follow-on study, completing measures of well-being (W-BQ28), treatment satisfaction (DTSQ) and self-care (SCI-R). Confirmatory factor analyses was used to confirm the W-BQ28 structure and internal consistency reliability was assessed. Additional statistical tests were conducted to explore convergent, divergent and known-groups validity. Minimal important differences were calculated using distribution and anchor-based techniques.
Results Structure of the W-BQ28 (seven four-item subscales plus 16-item generic and 12-item diabetes-specific scales) was confirmed (comparative fit index = 0.917, root mean square error of approximation (RMSEA) = 0.057). Internal consistency reliability was satisfactory (four-item subscales: alpha = 0.73–0.90; 12/16-item scales: α = 0.84–0.90). Convergent validity was supported by expected moderate to high correlations (rs = 0.35–0.67) between all W-BQ28 subscales (except Energy); divergent validity was supported by expected low to moderate correlations with treatment satisfaction (rs = −0.03–0.52) and self-care (rs = 0.02–0.22). Known-groups validity was supported with statistically significant differences by sex, age and HbA1c for expected subscales. Minimal important differences were established (range 0.14–2.90).
Conclusions The W-BQ28 is a valid and reliable measure of generic and diabetes-specific well-being in Type 2 diabetes in the UK. Confirmation of the utility of W-BQ28 (including establishment of minimal important differences) means that its use is indicated in research and clinical practice.
Resumo:
Background Type 2 diabetes (T2DM) is increasingly prevalent in young adults but there is very little information about what information they need to undertake diabetes self-management.
Aim To undertake a structured literature review to identify what information people with type 2 diabetes aged 25 to 45 years need to manage their diabetes and how they would like to receive it.
Methods A structured literature search was conducted. The MEDLINE, CINAHL, AMI, APAIS-Health databases were searched for articles published between 1980 and 2011. The reference list of journals and relevant websites were searched. Inclusion criteria were: literature about T2DM in young adults and literature about education and information needs of young adults with T2DM.
Results Only one article specifically focussed on the information needs of young people with T2DM and two reports included some information about T2DM and young adults. The limited data available suggested young adults with T2DM have specific information needs that are not sufficiently addressed in current resources, and have some needs different from young people with type 1 diabetes. Young people with T2DM want clear, consistent information from credible sources, delivered in a range of formats. They also want psychological support and counselling, age-specific education groups, after hours access to health professionals and education provided to family members and the community about T2DM in young people and about how to support people with T2DM.
Conclusion With the prevalence of T2DM in young adults continuing to increase, the need to address the specific information needs and learning styles of people with T2DM aged 25 to 45 is increasingly important.
Resumo:
The primary aim of this pilot study is to provide cross-cultural and detailed insights into how psychological and social factors impact on younger people with type 2 diabetes (T2DM) and self-management skille (20-40 years). The specific objectives are to: identify self-management strategies used by younger people with T2DM during life transitions in the period from 20-40 years of age; investigate participants' perception of self-management to identify the specific needs of younger people with T2DM. This research will provide health professionals with insights to the specific needs for young adults with T2DM and will add ground breaking innovative information by investigating cultural comparison between Australia and Denmark.
Resumo:
Background:
The use of pharmacological agents has been shown to slow down the progression of microvascular and macrovascular complications. Most clinical trials address one pharmacological intervention at a time. To date, only a few studies explored multi-factorial pharmacological interventions in T2DM individuals for preventing CVD related complications. Given the current therapeutic inertia in pharmacological management of CVD risk factors, it is important to establish the benefits of a more holistic approach. Therefore, the aim of this review is to assess the efficacy of multiple pharmacological interventions for cardiovascular diseases (CVD) risk factors with or without conventional care in reducing all cause mortality, CVD mortality, stroke and cardiovascular events among adults with type 2 diabetes. Current evidence fails to support the benefit of multiple pharmacological interventions on all cause mortality and death from cardiovascular causes. However, beneficial effects were seen on the reduction of the overall number of cardiovascular events and there were promising trends for secondary outcomes such as stroke, myocardial infarction, revascularisation and amputation.
Resumo:
Objective
Ethnicity influences health in many ways. For example, type 2 diabetes (T2DM) is disproportionately prevalent among certain ethnic groups. Assessing ethnicity is difficult, and numerous proxy measures are used to capture its various components. Australian guidelines specify a set of variables for measuring ethnicity, and how such parameters should be categorised. Using T2DM data collections as an illustrative example, this study sought to examine how ethnicity is measured in Australian health databases and, by comparing current practice with Australia’s existing benchmark recommendations, to identify potential areas for improvement of the health data landscape.
Design
We identified databases containing information from which ethnic group-specific estimates of T2DM burden may be gleaned. For each database, details regarding ethnicity variables were extracted, and compared with the Australian guidelines.
Results
Data collection instruments for 32 relevant databases were reviewed. Birthplace was recorded in 27 databases (84%), but mode of birthplace assessment varied. Indigenous status was commonly recorded (78%, n=25), but only nine databases recorded other aspects of self-perceived race/ethnicity. Of 28 survey/audit databases, 14 accommodated linguistic preferences other than English, and 11 either excluded non-English speakers or those for whom a translator was not available, or only offered questionnaires in English.
Conclusions
Considerable variation exists in the measurement of ethnicity in Australian health data- sets. While various markers of ethnicity provide complementary information about the ethnic profile within a data-set, nonuniform measurement renders comparison between data-sets difficult. A standardised approach is necessary, and identifying the ethnicity variables that are particularly relevant to the health sector is warranted. Including self identified ethnicity in Australia’s set of recommended indicators and as a core component of the national census should be considered. Globalisation and increasing migration mean that these findings have implications internationally, including for multi-ethnic countries throughout North America and Europe.
Resumo:
Background:
Achieving optimal outcomes in type 2 diabetes (T2DM) involves several demanding self-care behaviours, e.g. managing diet, activity, medications, monitoring glucose levels, footcare. The Self-Care Inventory-Revised (SCI-R) is valid for use in people with T2DM in the US. Our aim was to determine its suitability for use in the UK.
353 people with T2DM participated in the AT.LANTUS Follow-on study, completing measures of diabetes self-care (SCI-R), generic and diabetes-specific well-being (W- BQ28), and diabetes treatment satisfaction (DTSQ). Statistical analyses were conducted to explore structure, reliability, and validity of the SCI-R.
Results:
Principal components analysis indicated a 13-item scale (items loading >0.39) with satisfactory internal consistency reliability (α = 0.77), although neither this model nor any alternatives were confirmed in the confirmatory factor analysis. Acceptability was high (>95% completion for all but one item); ceiling effects were demonstrated for six items. As expected, convergent validity (correlations between self-care behaviours) was found for few items. Divergent validity was supported by expected low correlations between SCI-R total and well-being (rs = 0.02-0.21) and treatment satisfaction (rs = 0.29). Known-groups validity was partially supported with significant differences in SCI-R total by HbA1c (≤7.5% (58 mmol/mol): 72 ± 11, >7.5% (58 mmol/mol): 68 ± 14, p < 0.05) and diabetes duration (≤16 years: 67 ± 13, >16 years: 71 ± 12, p < 0.001) but not by presence/absence of complications or by insulin treatment algorithm.
Conclusions:
The SCI-R is a brief, valid and reliable measure of self-care in people with T2DM in the UK. However, ceiling effects raise concerns about its potential for responsiveness in clinical trials. Individual items may be more useful clinically than the total score.
Resumo:
Background:
Ethnic diversity is increasing through migration in many developed countries. Evidence indicates that type 2 diabetes mellitus (T2DM) prevalence varies by ethnicity and socio- economic status (SES), and that in many settings, migrants experience a disproportionate burden of disease compared with locally-born groups. Given Australia’s multicultural demography, we sought to identify groups at high risk of T2DM in Victoria, Australia.
Using population data from the Australian National Census and diabetes data from the National Diabetes Services Scheme, prevalence of T2DM among immigrant groups in Victoria in January 2010 was investigated, and prevalence odds versus Australian- born residents estimated. Distribution of T2DM by SES was also examined.
Results:
Prevalence of diagnosed T2DM in Victoria was 4.1% (n = 98671) in men and 3.5% (n = 87608) in women. Of those with T2DM, over 1 in 5 born in Oceania and in Southern and Central Asia were aged under 50 years. For both men and women, odds of T2DM were higher for all migrant groups than the Australian-born reference population, including, after adjusting for age and SES, 6.3 and 7.2 times higher for men and women born in the Pacific Islands, respectively, and 5.2 and 5.0 times higher for men and women born in Southern and Central Asia, respectively. Effects of SES varied by region of birth.
Large socio-cultural differences exist in the distribution of T2DM. Across all socio-economic strata, all migrant groups have higher prevalence of T2DM than the Australian-born population. With increasing migration, this health gap potentially has implications for health service planning and delivery, policy and preventive efforts in Australia.
Resumo:
This paper introduces a new type reduction (TR) algorithm for interval type-2 fuzzy logic systems (IT2 FLSs). Flexibility and adaptiveness are the key features of the proposed non-parametric algorithm. Lower and upper firing strengths of rules as well as their consequent coefficients are fed into a neural network (NN). NN output is a crisp value that corresponds to the defuzzified output of IT2 FLSs. The NN type reducer is trained through minimization of an error-based cost function with the purpose of improving modelling and forecasting performance of IT2 FLS models. Simulation results indicate that application of the proposed TR algorithm greatly enhances modelling and forecasting performance of IT2 FLS models. This benefit is achieved in no cost, as the computational requirement of the proposed algorithm is less than or at most equivalent to traditional TR algorithms.
Resumo:
Stock price forecast has long been received special attention of investors and financial institutions. As stock prices are changeable over time and increasingly uncertain in modern financial markets, their forecasting becomes more important than ever before. A hybrid approach consisting of two components, a neural network and a fuzzy logic system, is proposed in this paper for stock price prediction. The first component of the hybrid, i.e. a feedforward neural network (FFNN), is used to select inputs that are highly relevant to the dependent variables. An interval type-2 fuzzy logic system (IT2 FLS) is employed as the second component of the hybrid forecasting method. The IT2 FLS’s parameters are initialized through deployment of the k-means clustering method and they are adjusted by the genetic algorithm. Experimental results demonstrate the efficiency of the FFNN input selection approach as it reduces the complexity and increase the accuracy of the forecasting models. In addition, IT2 FLS outperforms the widely used type-1 FLS and FFNN models in stock price forecasting. The combination of the FFNN and the IT2 FLS produces dominant forecasting accuracy compared to employing only the IT2 FLSs without the FFNN input selection.
