Objective: To describe which combinations of long term conditions were associated with a higher risk of hospital admission or death during winter 2021-22 (the third wave of the covid-19 pandemic) in adults in England.
Design: Population based cohort study.
Setting: Linked primary and secondary care data from the General Practice Extraction Service Data for Pandemic Planning and Research (GDPPR) database, Hospital Episode Statistics, and Office for National Statistics death registry, comprising pseudoanonymised routinely collected electronic medical records from the whole population of England registered at a general practice, 1 December 2021 to 31 March 2022.
Background: People hospitalised for coronavirus disease 2019 (COVID-19) have elevated incidence of diabetes. However, it is unclear whether this is due to shared risk factors, confounding or stress hyperglycaemia in response to acute illness.
Methods: We analysed a multicentre prospective cohort study (PHOSP-COVID) of people ≥18 years discharged from NHS hospitals across the United Kingdom following COVID-19.
My Kidneys & Me (MK&M), a digital health intervention delivering specialist health and lifestyle education for people with CKD, was developed and its effects tested (SMILE-K trial, ISRCTN18314195, 18/12/2020). 420 adult patients with CKD stages 3-4 were recruited and randomised 2:1 to intervention (MK&M) (n = 280) or control (n = 140) groups. Outcomes, including Patient Activation Measure (PAM-13), were collected at baseline and 20 weeks.
View Article and Find Full Text PDFUnlabelled: Dietary fibre improves glycaemic control in type 2 diabetes, but its therapeutic role in women with diabetes in pregnancy is unclear. We assessed the effect of dietary fibre on markers of glycaemic control in women with diabetes in pregnancy.
Methods: We searched four databases (Cochrane Library, MEDLINE, Embase and Web of Science) to identify RCTs exploring the effect of dietary fibre, high-fibre diets or fibre supplementation on fasting blood glucose (FBG), 2-h postprandial blood glucose (PBG) and requirement for insulin therapy, among other glycaemic makers in pregnant women with diabetes.
Objectives: To describe the direct impact of coronavirus disease 2019 (COVID-19) infection on morbidity and mortality in people with multiple long-term conditions (MLTCs).
Design: A systematic review and meta-analysis including observational studies.
Setting: Studies conducted between 1 January 2020 and 4 May 2023 across 51 countries were identified from five databases.
Background: Social capital can be used as a conceptual framework to include social context as a predictor of human papillomavirus (HPV) vaccination and cervical cancer screening behaviours. However, the effectiveness of interventions that use social capital as a mechanism to improve uptake of immunization and screening remains elusive.
Objective: To synthesize empirical evidence on the impact of social capital interventions on HPV immunization and cervical cancer screening and describe key characteristics of such interventions.
Aims: Research in diabetes-related foot conditions (DRFC) often focuses on ulcer-related care, whilst the patient experience and influence of sociodemographic factors are under-researched. This systematic review investigated patient-reported outcomes and experience in people with DRFC.
Methods: Multiple databases were searched from inception to 16 August 2023.
Background: Preschool-aged children have among the highest burden of acute wheeze. We investigated differences in healthcare use, treatment and outcomes for recurrent wheeze/asthma in preschoolers from different ethno-socioeconomic backgrounds.
Methods: Retrospective cohort study using data from the Clinical Practice Research Datalink linked to Hospital Episode Statistics in England.
Interactions with the police can impact an individual's short and long-term physical, mental, and social wellbeing, as well as levels of violence and unrest within a community. As such, this study aimed to explore experiences with the police among individuals experiencing socioeconomic disadvantages in Edmonton, Canada. For this qualitative study, participants (n = 39) were recruited from an emergency shelter for women, a drop-in community organization supporting individuals experiencing socioeconomic disadvantages, and a centre providing settlement support for newcomers to Canada.
View Article and Find Full Text PDFAim: To assess the differential association of risk factors with severe and non-severe hypoglycaemia.
Materials And Methods: The Hypoglycaemia Assessment Tool study evaluated the risk of hypoglycaemia over a 4-week period in patients with type 1 diabetes (T1D) and type 2 diabetes (T2D) on insulin in 24 countries. Negative binomial regressions were applied to examine the associations of several risk factors with severe and non-severe hypoglycaemia.
Aims: To investigate in women with prior gestational diabetes mellitus (GDM), differences by ethnicity and socioeconomic status in the incidence of recurrent GDM, type 2 diabetes (T2D), hypertension, and depression.
Methods: This was a retrospective cohort study including 10,868 women diagnosed with GDM in the Clinical Practice Research Datalink (CPRD GOLD) between January 01, 2000 and November 05, 2018. Linked data were obtained for Hospital Episode Statistics and the Index of Multiple Deprivation.
The goal of this project was to determine whether various measures of mammary development differed between gilts and multiparous sows at the end of gestation. During gestation, Yorkshire × Landrace gilts ( = 19) and sows (second and third gestations, = 17) were fed one daily meal of a conventional corn-based diet, where the amount fed was based on body weight (BW) and backfat thickness (BF) at mating. On day 110 ± 1 of gestation, a jugular blood sample was obtained from all gilts and sows to measure insulin-like growth factor-1 (IGF-1), glucose, free fatty acids, and urea.
View Article and Find Full Text PDFAim: Conduct a systematic review to investigate current beliefs, practices, perceptions, and motivations towards deprescribing practices from the healthcare professional perspective in older adults residing in long term care facilities with cardiometabolic conditions, using a narrative approach.
Methods: Studies were identified using a literature search of MEDLINE, CINAHL and Web of Science from inception to June 2023 Two reviewers (EH and AA) independently extracted data from each selected study using a standardised self-developed data extraction proforma. Studies reviewed included cross-sectional and observational studies.
Aim: We aimed to determine the macrovascular and microvascular outcomes of intensive versus standard glucose-lowering strategies in type 2 diabetes (T2D) and investigate the relationships between these outcomes and trial arm glycated haemoglobin (HbA1c) reduction.
Materials And Methods: In this systematic review and meta-analysis, we identified relevant trials from MEDLINE, Embase, the Cochrane Library, and bibliographies up to August 2023. Macrovascular and microvascular outcomes, along with safety outcomes, were evaluated.
Cardiovascular disease (CVD) risk in those with diabetic foot disease is very high. Non-pharmacological interventions may improve this risk, though no previous evidence synthesis has been completed. This systematic review aimed to investigate the impact of non-pharmacological interventions on CVD risk factors in diabetic ulcer disease.
View Article and Find Full Text PDFAim: Using a systematic review and meta-analysis of placebo-controlled cardiovascular outcome trials (CVOTs) of newer glucose-lowering agents [sodium-glucose cotransporter-2 inhibitors (SGLT-2is), glucagon-like peptide-1 receptor agonists (GLP-1RAs), and dipeptidyl peptidase-4 inhibitors (DPP-4is)] in type 2 diabetes (T2D), we aimed to determine the macrovascular and microvascular outcomes of these agents and clarify the relationships between glycated haemoglobin (HbA1c) reduction and risk of these outcomes.
Materials And Methods: Randomized controlled trials were identified from MEDLINE, Embase and the Cochrane Library until September 2023. Study-specific hazard ratios with 95% confidence intervals (CIs) were pooled, and meta-regression was used to assess the relationships between outcomes and between trial arm HbA1c reductions.
Background: Practitioners who deliver enhanced empathy may improve patient satisfaction with care. Patient satisfaction is associated with positive patient outcomes ranging from medication adherence to survival.
Purpose: To evaluate the effect of health care practitioner empathy on patient satisfaction, using a systematic review of randomized trials.
Many different malignancies occur in children, but overall, cancer in childhood is rare. Survival rates have improved appreciably and are higher compared with most adult tumour types. Treatment schedules evolve as a result of clinical trials and are typically complex and multi-modality, with radiotherapy an integral component of many.
View Article and Find Full Text PDFAims: Amongst elderly people with type 2 diabetes (T2D) over prescribing can result in emergency ambulance call-outs, falls and fractures and increased mortality, particularly in frail patients. Current clinical guidelines, however, remain focused on medication intensification rather than deintensification where appropriate. This study aims to evaluate the effectiveness of an electronic decision-support system and training for the deintensification of potentially inappropriate medications amongst older frail people with T2D, when compared to 'usual' care at 12-months.
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