Heart failure in sub-Saharan Africa: a literature review with emphasis on individuals with diabetes

Purpose

Heart failure is the ultimate complication of cardiac involvements in diabetes. The purpose of this review was to summarize current literature on heart failure among people with diabetes mellitus in sub-Saharan Africa (SSA).

Method

Bibliographic search of published data on heart failure and diabetes in sub-Saharan Africa over the past 26 years.

Results

Heart failure remains largely unexplored in general population and among people with diabetes in Africa. Heart failure accounts for over 30% of hospital admission in specialized cardiovascular units and 3%–7% in general internal medicine. Over 11% of adults with heart failure have diabetes. Risk factors for heart failure among those with diabetes include classical cardiovascular risk factors, without evidence of diabetes distinctiveness for other predictors common in Africa. Prevention, management, and outcomes of heart failure are less well known; recent data suggest improvement in the management of risk factors in clinical settings.

Conclusions

Diabetes mellitus is growing in SSA. Related cardiovascular diseases are emerging as potential health problem. Heart failure as cardiovascular complication remains largely unexplored. Efforts are needed through research to improve our knowledge of heart failure at large in Africa. Multilevel preventive measures, building on evidences from other parts of the world must go along side.     

Immunogenicity and safety of the human papillomavirus vaccine in patients with autoimmune diseases: A systematic review

Whereas safety and efficacy of HPV vaccines in healthy women have been shown in several randomised controlled clinical trials and in post marketing analyses, only few data exist in patients affected by autoimmune diseases. These issues are significant as autoimmune conditions are recognised as a risk factor for the persistence of HPV infection. Herein we review and systematise the existing literature to assess immunogenicity and safety of HPV vaccination in patients with autoimmune diseases, including systemic lupus erythematosus and juvenile idiopathic arthritis.The results of our literature revision suggest that the HPV vaccines are efficacious and safe in most of the patients affected by autoimmune diseases. Yet, some points of concern remain to be tackled, including the effects of concomitant therapies, the risk of disease exacerbation and the cost-effectiveness of such immunisation programmes in these populations.     

A critical review of anti-adrenergic therapy in patients with heart failure and diabetes mellitus

Anti-adrenergic therapy has been widely accepted as an important therapeutic intervention in patients with chronic heart failure. However, there has been continuing controversy regarding the risks and clinical significance of metabolic effects of different anti-adrenergic drugs. This review summarizes what has been learned from clinical trial evidence regarding the benefits of anti-adrenergic drugs in diabetic patients with chronic heart failure.     

慢性阻塞性肺病合并左心衰竭患者的临床分析

目的探讨了慢性阻塞性肺病（COPD）合并左心衰竭的诊治情况。方法对笔者所在医院在2009年1月～2010年3月收治的95例COPD合并左心衰竭患者的临床资料进行回顾分析。结果本组治疗的总有效率为87．4％，Ⅰ级、Ⅱ级、Ⅲ级的治疗总有效率分别为100％、92．8％和74．3％，统计后发现Ⅲ级患者总有效率与Ⅰ级、Ⅱ级比较，差异均有统计学意义（P〈0．05）。结论若能及早诊断出左心衰竭的发生，必能改善患者的预后情况。     

系统评价妊娠期糖尿病胎盘差异表达蛋白对胎儿的影响

目的系统评价妊娠期糖尿病胎盘差异表达蛋白对胎儿的影响。方法于2019年6月计算机检索PubMed、Web of Science、Cochrane Library、EMBase、Medline (Ovid)、Scopus、中国生物医学文献数据库、中国知网、万方数据知识服务平台、维普中与妊娠期糖尿病胎盘蛋白表达有关的文献,检索时限为2010年1月-2019年6月。采用主题词与自由词结合的方式进行检索,同时手工检索相关文献的参考文献。运用纽卡斯尔渥太华量表评价纳入研究的方法学质量,进行描述性分析。结果最终纳入15篇文献,均为病例对照研究,共包含844名研究对象。系统评价结果显示:胎盘差异表达蛋白通过干扰葡萄糖、脂质代谢与转运,影响氨基酸转运和蛋白质合成,调整胎盘屏障,增加水、甘油和铁转运4个途径影响胎儿生长发育和妊娠结局。结论胎盘蛋白表达失调可能介导胎盘营养转运能力的改变和影响胎盘屏障,参与胎儿宫内生长发育和增加不良胎儿结局的风险。但其因果关系及调控机制尚不明确,有待进一步深入研究。     

The effectiveness of nudges in improving the self-management of patients with chronic diseases: A systematic literature review

In this systematic literature review, we identify evidence on the effectiveness of nudges in improving the self-management of adults with chronic diseases and derive policy recommendations. We included empirical studies of any design published up to April 12^th, 2018. We synthesized the results of the studies narratively by comparing statistical significance and direction of different nudge types’ effects on primary study outcomes. Lastly, we categorized the nudges according to their degree of manipulation and transparency.We identified 26 studies, where 13 were of high or moderate quality. The most commonly tested nudges were reminders, planning prompts, small financial incentives, and feedback. Overall, 8 of 9 studies with a high or moderate quality ranking, focused on self-management outcomes, i.e., physical activity, attendance, self-monitoring, and medication adherence, found that nudges had significant positive effects. However, only 1 of 4 studies of high or moderate quality, analyzing disease control outcomes (e.g., glycemic control), found that nudges had a significant positive effect for one intervention arm.In summary, this review demonstrates that nudges can improve chronic disease self-management, but there is hardly any evidence to date that these interventions lead to improved disease control. Reminders, feedback, and planning prompts appear to improve chronic disease self-management most consistently and are among the least controversial types of nudges. Accordingly, they can generally be recommended to policymakers.     

Towards conceptual convergence: A systematic review of psychological resilience in family caregivers of persons living with chronic neurological conditions

BackgroundThe demand for family caregiving in persons with chronic neurological conditions (CNCs) is increasing. Psychological resilience may empower and protect caregivers in their role. Thus, a synthesis of resilience evidence within this specific population is warranted.AimIn this systematic review we aimed to: (1) examine the origins and conceptualizations of resilience; (2) summarize current resilience measurement tools; and (3) synthesize correlates, predictors and outcomes of resilience in family caregivers of persons with CNCs.DesignWe sourced English articles published up to July 2020 across five databases using search terms involving CNCs, family caregivers and resilience.ResultsA total of 50 studies were retained. Nearly half (44%) of the studies used trait‐based resilience definitions, while about one third (36%) used process‐based definitions. Twelve different resilience scales were used, revealing mostly moderate to high‐resilience levels. Findings confirmed that resilience is related to multiple indicators of healthy functioning (e.g., quality of life, social support, positive coping), as it buffers against negative outcomes of burden and distress. Discordance relating to the interaction between resilience and demographic, sociocultural and environmental factors was apparent.ConclusionsIncongruity remains with respect to how resilience is defined and assessed, despite consistent definitional concepts of healthy adaptation and equilibrium. The array of implications of resilience for well‐being confirms the potential for resilience to be leveraged within caregiver health promotion initiatives via policy and practice.Patient or Public ContributionThe findings may inform future recommendations for researchers and practitioners to develop high‐quality resilience‐building interventions and programmes to better mobilize and support this vulnerable group.     

总胆固醇、甘油三酯水平与2型糖尿病患者心脑血管疾病死亡风险的前瞻性研究

目的 探讨2型糖尿病(Type 2 diabetes mellitus, T2DM)患者血清总胆固醇(Total Cholesterol, TC)、甘油三酯(Triglyceride, TG)水平与心脑血管疾病死亡风险的关系。方法 以江苏省常熟市、淮安市地区纳入基本公共卫生服务项目管理的19 973名T2DM患者作为观察队列,根据2013年基线血清TC、TG水平的五分位数分组,应用Cox比例风险回归模型计算T2DM患者血清TC、TG水平与心脑血管疾病死亡的风险比(hazard ratio,HR)及95%置信区间(confidence interval,CI)。运用限制性立方样条模型分析T2DM患者TC、TG水平与心脑血管疾病死亡风险的剂量反应关系。结果 截止2020年12月31日,研究人群中累计随访132 179.74人年,平均随访6.60年,随访期间共发生心脑血管疾病死亡905例,死亡密度为6.85/1 000人年。调整混杂因素后,多因素Cox比例风险回归模型显示,以Q1组为参照,TC的Q5组(TC≥6.07 mmol/L)心脑血管疾病死亡风险增加28%(95%CI:1.05～1.5...     

Socio-economic burden of rare diseases: A systematic review of cost of illness evidence

Cost-of-illness studies, the systematic quantification of the economic burden of diseases on the individual and on society, help illustrate direct budgetary consequences of diseases in the health system and indirect costs associated with patient or carer productivity losses. In the context of the BURQOL-RD project (“Social Economic Burden and Health-Related Quality of Life in patients with Rare Diseases in Europe”) we studied the evidence on direct and indirect costs for 10 rare diseases (Cystic Fibrosis [CF], Duchenne Muscular Dystrophy [DMD], Fragile X Syndrome [FXS], Haemophilia, Juvenile Idiopathic Arthritis [JIA], Mucopolysaccharidosis [MPS], Scleroderma [SCL], Prader-Willi Syndrome [PWS], Histiocytosis [HIS] and Epidermolysis Bullosa [EB]). A systematic literature review of cost of illness studies was conducted using a keyword strategy in combination with the names of the 10 selected rare diseases. Available disease prevalence in Europe was found to range between 1 and 2 per 100,000 population (PWS, a sub-type of Histiocytosis, and EB) up to 42 per 100,000 population (Scleroderma). Overall, cost evidence on rare diseases appears to be very scarce (a total of 77 studies were identified across all diseases), with CF (n = 29) and Haemophilia (n = 22) being relatively well studied, compared to the other conditions, where very limited cost of illness information was available. In terms of data availability, total lifetime cost figures were found only across four diseases, and total annual costs (including indirect costs) across five diseases. Overall, data availability was found to correlate with the existence of a pharmaceutical treatment and indirect costs tended to account for a significant proportion of total costs. Although methodological variations prevent any detailed comparison between conditions and based on the evidence available, most of the rare diseases examined are associated with significant economic burden, both direct and indirect.     

Self-efficacy instruments for patients with chronic diseases suffer from methodological limitations - a systematic review

Background  

Measurement of self-efficacy requires carefully developed and validated instruments. It is currently unclear whether available self-efficacy instruments for chronic diseases fulfill these requirements. Our aim was to systematically identify all existing self-efficacy scales for five major chronic diseases and to assess their development and validation process.     

A review of nateglinide in the management of patients with type 2 diabetes

Impaired insulin secretion occurs early in the pathogenesis of type 2 diabetes mellitus (T2DM) and is chronic and progressive, resulting initially in impaired glucose tolerance (IGT) and eventually in T2DM. As most patients with T2DM have both insulin resistance and insulin deficiency, therapy for T2DM should aim to control not only fasting, but also postprandial plasma glucose levels. While oral glucose-lowering treatment with metformin and thiazolidinediones corrects fasting plasma glucose, these agents do not address the problem of mealtime glucose spikes that have been shown to trigger atherogenic processes. Nateglinide is a derivative of the amino acid D-phenylalanine, which acts directly on the pancreatic beta-cells to stimulate insulin secretion. Nateglinide monotherapy controls significantly mealtime hyperglycemia and results in improved overall glycemic control in patients with T2DM by reducing glycosylated hemoglobin (HbA1c) levels. The combination of nateglinide with insulin-sensitising agents, such as metformin and thiazolidinediones, targets both insulin deficiency and insulin resistance and results in reductions in HbA1c that could not be achieved by monotherapy with other antidiabetic agents. In prediabetic subjects with IGT, nateglinide restores early insulin secretion and reduces postprandial hyperglycemia. Nateglinide has an excellent safety and tolerability profile and provides a lifetime flexibility that other antidiabetic agents could not accomplish. The aim of this review is to identify nateglinide as an effective "gate-keeper" in T2DM, since it restores early-phase insulin secretion and prevents mealtime glucose spikes throughout the day and to evaluate the results of ongoing research into its potential role in delaying the progression to overt diabetes and reducing its complications and mortality.     

Hospitalized patients with chronic mental diseases: review of the literature

Alternative approaches to manage mental illness have arisen all over the world with emphasis on outpatient community models. Little is said about chronically hospitalized patients. The purpose of this literature review was to access what researchers have proposed in the past decade concerning the work with chronic mentally ill inpatients. The articles found were divided in topics: characteristics of chronic mentally ill inpatients, their opinion about hospitalization and suggestions to improve the practice. As a conclusion, the authors propose a better assessment with serious studies concerning this clientele, their reality and the possibilities of intervention.     

A Cross-Country Network Analysis of Adolescent Resilience

PurposeIn situations of adversity, young people draw on individual, relational, and contextual (community and cultural) resources to foster their resilience. Recent literature defines resilience as a capacity that is underpinned by a network of interrelated resources. Although empirical studies show evidence of the value of a network approach, little is known regarding how different country contexts influence which resources are most critical within a resource network and how resources interact for adolescent resilience.MethodsNetwork analysis was conducted with data from studies that had used the Child and Youth Resilience Measure. Regularized partial correlation networks of 17 resources were estimated for 14 countries (Botswana, Canada, China, Colombia, Equatorial Guinea, India, Indonesia, Italy, Jordan, New Zealand, the Philippines, Romania, South Africa, and Syrian refugees living in Jordan). The sample size was 18,914 (mean age = 15.70 years, 48.8% female).ResultsWe observed mostly positive associations between the resources of interest. The salience and strength of associations between resources varied by country. The most central resource across countries was having supportive caregivers during stressful times because this resource had the most and strongest positive associations with other resources.ConclusionsThis study gives first empirical evidence from multiple countries that an interplay of social–ecological resources (such as individual skills, peer, caregiver and community support, and educational aspirations and opportunities) matter for adolescent resilience. Across countries, caregiver support appears to be most central for adolescent resilience. Future resilience interventions might apply this network approach to identify important, contextually relevant resources that likely foster additional resources.     

Associations between periodontal diseases and systemic diseases: a review of the inter-relationships and interactions with diabetes, respiratory diseases, cardiovascular diseases and osteoporosis

The aim of this review article is to examine the associations between periodontal diseases and common systemic diseases, namely diabetes, respiratory diseases, cardiovascular diseases and osteoporosis. A substantial number of review articles have been published to elucidate the relationships between these diseases; however, none provide a complete overview on this topic from the aspects of definition, classification, clinical characteristics and manifestations, inter-relationships and interactions, proposed schematic mechanisms, clinical implications and management of periodontal patients with these systemic diseases. The aim of this article is to provide an overall understanding and general concepts of these issues in a concise and inter-related manner.     

循环vaspin水平与妊娠糖尿病的关联:系统综述与Meta分析

目的  评价循环vaspin水平与妊娠糖尿病(gestational diabetes mellitus, GDM)的关联。 方法  系统检索PubMed、EMBASE、Web of Science、中国知网和万方数据库。检索时间截至2019年6月。使用随机效应模型或固定效应模型, 计算合并标准化均数差(standardized mean differences, SMD)及其95%置信区间(confidence interval, CI)。通过亚组分析、Meta回归分析、敏感性分析和发表偏倚分析评价结果的异质性与稳定性。所有统计分析均使用STATA 12.0软件。 结果  共纳入2013年至2019年期间发表的9篇文献(11个研究), 涵盖738例GDM患者和661例健康孕妇。GDM患者和健康孕妇之间总体循环vaspin水平差异有统计学意义(SMD=0.613, 95%CI:0.044~1.182, P=0.035)。根据vaspin水平所处的孕期和体重指数(body mass index, BMI)是否匹配进行亚组分析, 其相关方向与总结果相似; 按照种族进行亚组分析, 发现在“欧洲人”亚组中vaspin水平与GDM可能无关; 通过敏感性分析, 在排除了质量中等的研究和BMI没有匹配的研究后, 循环vaspin水平与GDM的关系依然存在。 结论  在亚洲人群中, 孕产妇循环vaspin水平可能与GDM的风险呈正相关。