Patient versus general practitioner perception of problems with treatment adherence in type 2 diabetes: from adherence to concordance.

OBJECTIVES: To determine the prevalence of problems with treatment adherence among type-2 diabetic patients with regards to medication, dietary advice, and physical activity; to identify the associated clinical and psychosocial factors; and to investigate the degree of agreement between patient-perceived and GP-perceived adherence. METHODS: Consecutive patients were solicited during visits to 39 GPs. In total, 521 patients self-reported on treatment adherence, anxiety and depression, and disease perception. The GPs reported clinical and laboratory data and patients' adherence. A multivariate analysis identified the factors associated with adherence problems. RESULTS: Problems of adherence to medication, dietary advice, and physical activity recommendations were reported by 17%, 62%, and 47% of the patients, respectively. Six independent factors were found associated with adherence problems: young age, body-mass index (BMI) > 30 kg/m(2), glycosylated haemoglobin (HbA(1c)) > 8%, single life, depression, and perception of medication as a constraint. Agreement between patients' and GPs' assessments of treatment problems reached 70%. CONCLUSION: In type 2 diabetes, problems with dietary advice or physical activity are far more frequent than problems with medication, and not all physicians are fully aware of patients' problems. More active listening and shared decision-making should enhance adherence and improve outcomes.

The effect of non-medical factors on variations in the performance of colonoscopy among different health care settings

BACKGROUND: Previous published studies have shown significant variations in colonoscopy performance, even when medical factors are taken into account. This study aimed to examine the role of nonmedical factors (ie, embodied in health care system design) as possible contributors to variations in colonoscopy performance. METHODS: Patient data from a multicenter observational study conducted between 2000 and 2002 in 21 centers in 11 western countries were used. Variability was captured through 2 performance outcomes (diagnostic yield and colonoscopy withdrawal time), jointly studied as dependent variables, using a multilevel 2-equation system. RESULTS: Results showed that open-access systems and high-volume colonoscopy centers were independently associated with a higher likelihood of detecting significant lesions and longer withdrawal durations. Fee for service (FFS) payment was associated with shorter withdrawal durations, and so had an indirect negative impact on the diagnostic yield. Teaching centers exhibited lower detection rates and longer withdrawal times. CONCLUSIONS: Our results suggest that gatekeeping colonoscopy is likely to miss patients with significant lesions and that developing specialized colonoscopy units is important to improve performance. Results also suggest that FFS may result in a lower quality of care in colonoscopy practice and highlight the fact that longer withdrawal times do not necessarily indicate higher quality in teaching centers.

Opinions on smoking policies in Switzerland

Purpose: to assess the opinions regarding smoking ban policies in Switzerland. Methods: cross sectional study on 2,601 women and 2,398 men, aged 35-75 years, living in Lausanne, Switzerland. Nine questions on smoking policies (restrictions, advertising, taxes and prevention) were applied. Results: 95% of responders supported policies that would help smokers to quit, 92% supported no selling of tobacco to subjects aged less than 16 years, 87% a smoking ban in public places and 86% a national campaign against smoking. A further 77% supported a total ban on tobacco advertising, 74% the reimbursement of nicotine replacement therapies and 70% increasing the price of cigarettes. Conversely, a lower support was found for a total ban of tobacco sales (35%) or the promotion of light cigarettes (22%). Multivariate analysis showed that women, lower educational level, older age, being physically active or non-smoker were associated with tougher policies against tobacco, whereas current drinking or smoking and higher educational level were associated with lower levels of support. Conclusion: opinions regarding smoking poli ci es vary considerably according to the policy type considered and also the characteristics of the subjects. Those findings provide interesting data regarding which anti-smoking policies would be more acceptable by the lay public, as well as the subjects who might oppose them.

Not all inflammatory markers are linked to kidney function: results from a population-based study.

BACKGROUND: Several studies have reported increased levels of inflammatory biomarkers in chronic kidney disease (CKD), but data from the general population are sparse. In this study, we assessed levels of the inflammatory markers C-reactive protein (hsCRP), tumor necrosis factor α (TNF-α), interleukin (IL)-1β and IL-6 across all ranges of renal function. METHODS: We conducted a cross-sectional study in a random sample of 6,184 Caucasian subjects aged 35-75 years in Lausanne, Switzerland. Serum levels of hsCRP, TNF-α, IL-6, and IL-1β were measured in 6,067 participants (98.1%); serum creatinine-based estimated glomerular filtration rate (eGFR(creat), CKD-EPI formula) was used to assess renal function, and albumin/creatinine ratio on spot morning urine to assess microalbuminuria (MAU). RESULTS: Higher serum levels of IL-6, TNF-α and hsCRP and lower levels of IL-1β were associated with a lower renal function, CKD (eGFR(creat) <60 ml/min/1.73 m(2); n = 283), and MAU (n = 583). In multivariate linear regression analysis adjusted for age, sex, hypertension, smoking, diabetes, body mass index, lipids, antihypertensive and hypolipemic therapy, only log-transformed TNF-α remained independently associated with lower renal function (β -0.54 ±0.19). In multivariate logistic regression analysis, higher TNF-α levels were associated with CKD (OR 1.17; 95% CI 1.01-1.35), whereas higher levels of IL-6 (OR 1.09; 95% CI 1.02-1.16) and hsCRP (OR 1.21; 95% CI 1.10-1.32) were associated with MAU. CONCLUSION: We did not confirm a significant association between renal function and IL-6, IL-1β and hsCRP in the general population. However, our results demonstrate a significant association between TNF-α and renal function, suggesting a potential link between inflammation and the development of CKD. These data also confirm the association between MAU and inflammation.

Lettre d'un ancien professeur en medecine de la faculté de Paris, a M. Vandermonde, auteur du Journal de medecine, censeur royal, &c. Pour servir de réponse à la Lettre d'un médecin de province à un médecin de Paris . Cette lettre fait la troisiéme piéce d'un ecrit intitulé Recueil de plusieurs piéces concernant le Traité des tumeurs & ulceres, &c.

Comprend : Lettre d'un médecin de province à un médecin de Paris

Mirror extreme BMI phenotypes associated with gene dosage at the chromosome 16p11.2 locus.

Both obesity and being underweight have been associated with increased mortality. Underweight, defined as a body mass index (BMI) ≤ 18.5 kg per m(2) in adults and ≤ -2 standard deviations from the mean in children, is the main sign of a series of heterogeneous clinical conditions including failure to thrive, feeding and eating disorder and/or anorexia nervosa. In contrast to obesity, few genetic variants underlying these clinical conditions have been reported. We previously showed that hemizygosity of a ∼600-kilobase (kb) region on the short arm of chromosome 16 causes a highly penetrant form of obesity that is often associated with hyperphagia and intellectual disabilities. Here we show that the corresponding reciprocal duplication is associated with being underweight. We identified 138 duplication carriers (including 132 novel cases and 108 unrelated carriers) from individuals clinically referred for developmental or intellectual disabilities (DD/ID) or psychiatric disorders, or recruited from population-based cohorts. These carriers show significantly reduced postnatal weight and BMI. Half of the boys younger than five years are underweight with a probable diagnosis of failure to thrive, whereas adult duplication carriers have an 8.3-fold increased risk of being clinically underweight. We observe a trend towards increased severity in males, as well as a depletion of male carriers among non-medically ascertained cases. These features are associated with an unusually high frequency of selective and restrictive eating behaviours and a significant reduction in head circumference. Each of the observed phenotypes is the converse of one reported in carriers of deletions at this locus. The phenotypes correlate with changes in transcript levels for genes mapping within the duplication but not in flanking regions. The reciprocal impact of these 16p11.2 copy-number variants indicates that severe obesity and being underweight could have mirror aetiologies, possibly through contrasting effects on energy balance.

Composição química da solução do solo nas diferentes classes de poro do solo

A composição química da solução do solo pode ser considerada indicadora da presença de nutrientes ou contaminantes no solo. Para analisar a variação dessa composição nos poros do solo, utilizou-se um sistema de extração sequencial da solução do solo em diferentes classes de diâmetro de poro. Colunas de PVC foram construídas e preenchidas com terra fina seca ao ar de um Cambissolo Háplico distrófico, e irrigadas com água destilada (T1), efluente de estação de tratamento de esgoto sanitário EETE (T2) e EETE + 1,2 g L-1 CaSO4 (T3), aplicando lâminas de 150 e 300 mm. Antes da irrigação e após cada lâmina, aplicaram-se na base de cada coluna os seguintes potenciais: 0, 13,3, 26,7, 40,0 e 53,3 kPa para extração e coleta da solução do solo nas faixas de poros: Ø > 76,2 µm, 44,6 < Ø < 76,2 µm, 29,6 < Ø < 44,6 µm, 25,2 < Ø < 29,6 µm, e 23,3 < Ø < 25,2 µm. Os atributos analisados nas soluções extraídas foram pH, condutividade elétrica e as concentrações de Na+, Ca2+, NO3-e NH4+. A variação das concentrações iônicas na porosidade do solo foi semelhante, sendo 3 a 10 vezes maior na microporosidade (Ø < 44,6 m) do que na macroporosidade (Ø > 44,6 m). Todos os dados foram ajustados significativamente ao modelo linear Y = a - b.log(X), onde Y é o atributo avaliado e X o diâmetro de poro do solo. Embora a concentração de NO3-na microporosidade supere o valor limite [NO3-]lim para água doce potável (Classe 1), a baixa concentração na macroporosidade (sempre inferior a [NO3-]lim/4) limita o risco de contaminação por lixiviação. Constatou-se também que a adição de gesso promove a redução da concentração de NO3-e de Na+ no solo.

Pore size distribution in soils irrigated with sodic water and wastewater

Soil porosity, especially pore size distribution, is an important controlling factor for soil infiltration, hydraulic conductivity, and water retention. This study aimed to verify the effect of secondary-treated domestic wastewater (STW) on the porosity of a sandy loam Oxisol in the city of Lins, state of São Paulo, Brazil. The two-year experiment was divided into three plots: soil cultivated with corn and sunflower and irrigated with STW, soil cultivated and irrigated with sodic groundwater, and non-irrigated and non-cultivated soil (control). At the end of the experiment, undisturbed core samples were sampled from 0 to 2.0 m (8 depths). The water retention curves were obtained by tension plates and Richard's pressure plate apparatus, and the pore size distribution inferred from the retention curves. It was found that irrigation with treated wastewater and treated groundwater led to a decrease in microporosity (V MI), defined as the pore class ranging from 0.2 to 50 μm diameter. On the other hand, a significant increase in cryptoporosity (V CRI) (< 0.2 μm) was identified throughout the soil profile. The presence of Na+ in both waters confirmed the role of this ion on pore size distribution and soil moisture (higher water retention).