Higher Rates Of Diabetes Research Articles

Low rates of airway intervention in adult supraglottitis: A case series and meta-analysis.

Acute supraglottitis (SG) can potentially lead to rapid airway obstruction. The last few decades have witnessed a shift towards a more conservative approach in airway management of adult SG. This study aims to evaluate this watchful approach based on a large case series combined with a high-level meta-analysis of all reports in the English literature. Retrospective case series and meta-analysis. The medical records of all adult patients diagnosed as having SG who were hospitalized in a large-volume tertiary referral center between January 2007 and December 2018 were reviewed. A meta-analysis was conducted on all English literature published between 1990 and 2018. A total of 233 patients (median age 49.1years, 132 males), were admitted due to acute SG during the study period. No airway intervention was required in 228 patients (97.9%). Five patients (2.1%) required preventive intubation, and two of them (0.9%) were later surgically converted to a tracheotomy. Patients who required airway intervention had higher rates of diabetes (P=.001), cardiovascular diseases (P=.036) and other comorbidities (P=.022). There was no mortality. The meta-analysis revealed that the overall intubation rates random effects model was 8.8% [95% confidence interval (CI) 4.6%-14.0%] and that the tracheotomy random effects model was 2.2% (95% CI; 0.5%-4.8%). The overall mortality rate was 0.89%. This study provides evidence of low rates of surgical airway intervention in patients diagnosed with SG worldwide. A conservative approach in adult SG is safe and should be advocated. 2.

Abstract 67: Patient Selection For DIEP Flap Breast Reconstruction In The Obese Population: Stratifying Surgical Risk Factors For Patient Inclusion Or Exclusion

Purpose: Morbid obesity presents numerous challenges in autologous breast reconstruction. Along with considering other medical comorbidities, BMI alone can serve as an overall denominator in the decision-making process to recommend reconstruction Methods: Retrospective chart review was performed on N = 316 patients who underwent breast reconstruction using DIEP flaps (n=581 flaps). Patients were divided into two groups: patients with BMI < 35 (Group 1, N1=240 patients, n1=438 flaps), and patients with BMI ≥ 35 (Group 2, N2=76 patients, n2=143 flaps). Comorbidities including age, BMI, hypertension, diabetes, autoimmunity, smoking status, previous DVT/PE, and previous abdominal surgery were tracked. Donor site complications including wounds, infection, seroma, hematoma, and DVT/PE, and abdominal bulge were tracked. Flap losses, hospital stay, and completion of reconstruction (receipt of either nipple tattoo or nipple reconstruction) were tracked. Data was collected using a centralized REDCap database. Analysis was performed with SPSS: continuous variables were analyzed with t-tests, and binary variables were analyzed with Chi-Square (χ2). Univariate & multivariate analyses were used to control for group differences. Results: Age, comorbidities, and past medical histories were equivalent between groups, except for diabetes (Group 1 = 7%, Group 2 = 21%, p<.01) and prior abdominal surgery (Group 1 = 73%, Group 2 = 84%, p=.046). Rates of wounds requiring operation (p=.228), infections requiring IV antibiotics (p=.892), seromas requiring operation (p=.422), hematomas requiring operation (p=.580), pneumothorax (p=.538), DVT (p=.837), and PE (p=.315) were equivalent. Post-op SICU stay (p=.385) and total hospital stay (p=.173) were equivalent. Completion of reconstruction was significantly lower in Group 2 (49%) than in Group 1 (73%), p<.01. Flap loss was significantly higher in Group 2 (3/143, 2.1%) than in Group 1 (3/438, 0.68%), p<.01. Overall flap loss was 6/581 (1.03%). Conclusion: In our study, DIEP reconstruction in BMI ≥ 35 is associated with three-fold increase in flap loss, and lower likelihood of finishing the reconstruction process. This could be accounted by higher rates of diabetes and prior abdomininal surgery in Group 2, though this was controlled in our analysis. Rate of flap loss was still quite low in Group 2 (2.1%), and this is markedly lower than published rates of implant failure in obese patients (~10-15%). Based on individual practice patterns, patients with BMI ≥ 35 can be educated of their higher risks in consideration as a candidate for free flap breast reconstruction while keeping in mind that there is still a higher likelihood of success when compared to implants.

Using Mobile Health Tools to Engage Rural Underserved Individuals in a Diabetes Education Program in South Texas: Feasibility Study.

BackgroundAccess to diabetes education and resources for diabetes self-management is limited in rural communities, despite higher rates of diabetes in rural populations compared with urban populations. Technology and mobile health (mHealth) interventions can reduce barriers and improve access to diabetes education in rural communities. Screening, Brief Intervention, and Referral to Treatment (SBIRT) and financial incentives can be used with mHealth interventions to increase the uptake of diabetes education; however, studies have not examined their combined use for diabetes self-management in rural settings.ObjectiveThis two-phase Stage 1 feasibility study aimed to use a mixed methods design to examine the feasibility and acceptability of an mHealth diabetes education program combining SBIRT and financial incentives to engage rural individuals.MethodsIn Phase 1, we aimed to develop, adapt, and refine the intervention protocol. In Phase 2, a 3-month quasi-experimental study was conducted with individuals from 2 rural communities in South Texas. Study participants were individuals who attended free diabetes screening events in their community. Those with low or medium risk received health education material, whereas those with high risk or those with a previous diagnosis of diabetes participated in motivational interviewing and enrolled in the 6-week mHealth Diabetes Self-Management Education Program under either an unconditional or aversion incentive contract. The participants returned for a 3-month follow-up. Feasibility and acceptability of the intervention were determined by the rate of participant recruitment and retention, the fidelity of program delivery and compliance, and the participant’s satisfaction with the intervention program.ResultsOf the 98 screened rural community members in South Texas, 72 individuals met the study eligibility and 62 individuals agreed to enroll in the study. The sample was predominately female and Hispanic, with an average age of 52.6 years. The feedback from study participants indicated high levels of satisfaction with the mHealth diabetes education program. In the poststudy survey, the participants reported high levels of confidence to continue lifestyle modifications, that is, weight loss, physical activity, and diet. The retention rate was 50% at the 3-month follow-up. Participation in the intervention was high at the beginning and dissipated in the later weeks regardless of the incentive contract type. Positive changes were observed in weight (mean -2.64, SD 6.01; P<.05) and glycemic control index (-.30; P<.05) in all participants from baseline to follow-up.ConclusionsThe finding showed strong feasibility and acceptability of study recruitment and enrollment. The participants’ participation and retention were reasonable given the unforeseen events that impacted the study communities during the study period. Combining mHealth with SBIRT has the potential to reach individuals with need to participate in diabetes education in rural communities.

\u201cAt this age, a Moroccan woman\u2019s life\u2019s work is over\u201d-older Moroccan-Dutch migrant women\u2019s perceptions of health and lifestyle, with a focus on Ramadan experiences: qualitative research integrating education and consultation

BackgroundOlder Moroccan-Dutch migrant women exhibit high rates of diabetes, hypertension, overweight and obesity which is further compounded by their high risk of multi-morbidity. Healthcare professionals’ efforts to encourage this group to adopt a healthier lifestyle have little success. We ask ourselves whether the concepts used in health education and promotion relate to these women’s experiences and beliefs. Today’s pluralistic Dutch society requires a more differentiated and applied approach, not in an essentialist way but in awareness that translation of rather individualized concepts like health and lifestyle is not always adequate, as the meaning and interpretation of such concepts may differ and may be related to women’s other (fundamental) perceptions. This can have practical consequences for health promotion and education. The aim of this explorative, qualitative research, conducted between April and September 2015 and taking an intersectional approach, was to explore older Moroccan-Dutch women’s perceptions of health and lifestyle and to analyse these in a broader context, related to other fundamental forms of identity such as gender, culture and religion.MethodsWe recruited women with Moroccan backgrounds by approaching Moroccan women’s organisations and using the snowballing method (chain-referral sampling). Seven ‘natural’ group discussions were held (amongst women who regularly meet each other, aged between 22 and 69 years), and twelve in-depth interviews and an observation day (with women from 40 to 66 years). The transcripts were then analysed using thematic content analysis.ResultsFive major themes were identified. Health was perceived of in the terms used in prevailing health promotion discourses in the Netherlands, but lifestyle was interpreted in a much broader sense than the current health promotion debate allows; it is not seen as an individual responsibility or as something an individual could control on their own, and the social benefits of health behaviours appear to outweigh the health benefits themselves. Lifestyle was located in three main social identities of the women: Moroccan, Muslim and mother. Finally, Ramadan played a huge and dominant role in the lifestyle experience of older Moroccan women and was central in this research.ConclusionsThe finding that lifestyle is not seen as an individual responsibility but is located in social identities, can be applied to other settings that older migrant-Dutch women occupy. Further research will clarify this.

CARDIOVASCULAR AND DIABETES HEALTHCARE IN PATIENTS WITH SCHIZOPHRENIA

Introduction Schizophrenia is a severe and persistent mental illness associated with early mortality and a higher rate of medical comorbidity compared to the general population. Individuals with schizophrenia are at risk of healthcare disparities including reduced access to primary care and suboptimal health maintenance interventions. Barriers to care can include impairment communicating with healthcare providers, the stigma of psychiatric disease, and a poor understanding of medical condition and need for treatment all of which can delay diagnosis and timely treatment. However, only few studies exist related to healthcare access at the end-of-life. Because individuals with schizophrenia die 10-20?years younger than the general population, it is important to identify modifiable risk factors to improve care in this vulnerable population. Specifically, we aimed to investigate the prevalence of cardiovascular disease and diabetes compared to controls, and evaluate occurrence of routine laboratory studies and preventive health measures. Methods We conducted a retrospective examination of healthcare access among deceased individuals with and without schizophrenia. The Mayo Clinic Advanced Cohort Explorer was used to identify records with ICD -9/10 codes (295.0 – 295.9; F20.0 –F20.9) to establish a cohort of deceased patients with schizophrenia (N = 1191) and a date of death between 1/1/1999 – 1/1/2019. A control group without schizophrenia or any mental disorder was established (N = 1191) and matched by gender and age at time of death. Using a retrospective cohort design the prevalence of cardiovascular disease and diabetes were measured in subjects ≥ 50?years of age within the 3?years preceding death; the following routine health maintenance studies were also evaluated: complete blood count (CBC), low density lipoprotein (LDL), hemoglobin A1C (HbA1c), and electrocardiography (ECG).Between group differences were determined using chi-square (Х2) with p Results The average age of death was 71.4?years in both groups due to matching by age of death. The age range among patients and controls spanned from 50 to 104?years. Individuals with schizophrenia were significantly more likely to be single, divorced, or separated (p Conclusions Our findings indicate higher rates of diabetes and cardiovascular disease in individuals with schizophrenia compared to controls ≥ 50?years of age matched by gender and age of death which is consistent with other studies. However patients with schizophrenia were less likely to have received an ECG within the three years preceding death despite the aforementioned comorbidities. The schizophrenia group was significantly more likely to have received routine HbA1c and lipid panel testing however. This research was funded by: No funding sources were used for this project

Abstract P397: Social Determinants of Hypertension and Diabetes Among African Immigrants: The African Immigrant Health Study

Introduction: The differences in the risk of cardiovascular disease (CVD) among Black ethnic groups in the U.S. remain largely unexplained. African immigrants are particularly likely to have high rates of hypertension and diabetes, and less likely to be screened, diagnosed or receive treatment. Objective: To examine the association between social determinants of health (SDoH) and hypertension and diabetes among African immigrants. Methods: The African Immigrant Health Study was a cross-sectional study of 465 African immigrants living in the Baltimore-Washington metropolitan area. Data collection was performed through a combination of physical examinations and questionnaires. The outcomes were self-reported hypertension and diabetes. Elements of SDoH collected were education, income, health insurance, employment and marital status. Logistic regression analyses were used to assess the association between SDoH and hypertension/diabetes. Results: The mean age of participants was 46.8(±11.5) years and 60% were women; 64% had ≥ college degree, 83% were employed, 67% had health insurance, and 70% were married/co-habiting. Mean body mass index was 30.7 (±18.3) kg/m 2 . The prevalence of hypertension and diabetes was 32%, and 13% respectively. The odds of diabetes were higher amongst those who were unemployed [aOR: 2.86 (1.39-5.56)] ( Table ). Education, health insurance, income and marital status were not associated with hypertension or diabetes after accounting for age and sex. Conclusion: Among African immigrants, we observed that those who were unemployed had a higher likelihood of self-reported diabetes than those who were employed. Additional studies are needed to further study the contributions of social determinants of hypertension and diabetes as well as and developing health policy and interventions to improve cardiovascular health.

Herbal medicine from the perspective of type II diabetic patients and physicians: what is the relationship?

BackgroundDiabetes mellitus (DM) is a major public health problem and one of the most challenging diseases worldwide. According to the World Health Organization (WHO), the Kingdom of Saudi Arabia (KSA) has the second highest rate of diabetes in the Middle East and seventh highest globally. Some diabetic patients may prefer to use alternative approaches such as herbal remedies to control their blood glucose level and this study aims to assess the prevalence of herbal usage and to evaluate users’ and doctors’ knowledge, attitudes and beliefs about herbal medicine as well as the patient/doctor relationship in this regard.MethodA cross-sectional survey was conducted in several hospitals and medical centres in Makkah, KSA, between January and March 2019. Around 289 type II diabetic patients and 105 doctors were interviewed.ResultsWe found that 68% of the participants were frequent consumers of herbal remedies, especially cinnamon, ginger and fenugreek. Patients’ knowledge of herbal usage was mainly gleaned from family and friends as well as social media, and we found that many (71.4%) did not bother to consult or inform their doctors about their choice to self-medicate with herbs. Patients had no concerns regarding the efficacy and safety of herbal usage use in diabetes, as around half of the participants believe that herbal medicine is effective (54%) and safe (46%) for treating symptoms of diabetes. Two-thirds of the doctors (66%) routinely ask patients whether they use herbs for their condition. Although 25% of the doctors took a positive view of herbal medicine in relation to diabetes, others expressed concerns with the rise in herb use and want to see more attention paid to safety aspects.ConclusionThe study concludes that herbal remedies are commonly used by diabetic patients and that a gap exists in the relationship between patients and doctors concerning the disclosure of herbal remedy use and views on its safety.

Outcomes and Complications With Age in Spondylolisthesis: An Evaluation of the Elderly From the Quality Outcomes Database.

Prospective database analysis. To assess the effect of age on patient-reported outcomes (PROs) and complication rates after surgical treatment for spondylolisthesis SUMMARY OF BACKGROUND DATA.: Degenerative lumbar spondylolisthesis affects 3% to 20% of the population and up to 30% of the elderly. There is not yet consensus on whether age is a contraindication for surgical treatment of elderly patients. The Quality Outcomes Database lumbar registry was used to evaluate patients from 12 US academic and private centers who underwent surgical treatment for grade 1 lumbar spondylolisthesis between July 2014 and June 2016. A total of 608 patients who fit the inclusion criteria were categorized by age into the following groups: less than 60 (n = 239), 60 to 70 (n = 209), 71 to 80 (n = 128), and more than 80 (n = 32) years. Older patients showed lower mean body mass index (P < 0.001) and higher rates of diabetes (P = 0.007), coronary artery disease (P = 0.0001), and osteoporosis (P = 0.005). A lower likelihood for home disposition was seen with higher age (89.1% in <60-year-old vs. 75% in >80-year-old patients; P = 0.002). There were no baseline differences in PROs (Oswestry Disability Index, EuroQol health survey [EQ-5D], Numeric Rating Scale for leg pain and back pain) among age categories. A significant improvement for all PROs was seen regardless of age (P < 0.05), and most patients met minimal clinically important differences (MCIDs) for improvement in postoperative PROs. No differences in hospital readmissions or reoperations were seen among age groups (P < 0.05). Multivariate analysis demonstrated that, after controlling other variables, a higher age did not decrease the odds of achieving MCID at 12 months for the PROs. Our results indicate that well-selected elderly patients undergoing surgical treatment of grade 1 spondylolisthesis can achieve meaningful outcomes. This modern, multicenter US study reflects the current use and limitations of spondylolisthesis treatment in the elderly, which may be informative to patients and providers. 4.

Abstract P6-14-02: Does immediate breast reconstruction delay oncologic therapy?

Abstract Background: As life expectancy improves in women with breast cancer (BC), all efforts to enhance patients´ quality of life (QOL) have gained great importance. It is known that breast reconstruction (BR) surgery has a big impact in QOL and consequently it has become a valuable element in the multidisciplinary approach of BC patients. It is clear that as long as it does not suppose an interference for their oncologic treatment, patients must have offered immediate breast reconstruction as part of their surgical treatment. However, concerns about delay in oncologic therapy, especially because of postoperative complications may influence oncologic specialists to discourage patients to take this option in certain scenarios. In this study we evaluated the association between immediate BR and delay in time to oncologic treatment (TOT), defined as number of days between surgery and the initiation of oncologic adjuvant therapy (chemotherapy, endocrine and radiotherapy). Methods: IRB approval was obtained for a retrospective review of all patients undergoing BC surgery with immediate BR and received adjuvant oncologic therapy at the National Cancer Institute of Mexico from 2017 to 2019. We performed a 2:1 statistical matching with randomly selected patients from an institutional database who underwent only oncologic surgery and adjuvant therapy using year of surgery (2014-2016) and clinical stage as selection criteria. Demographic, tumor and surgical variables were analyzed in the bivariate analysis. According to the variable TOT, we categorized patients into 3 groups: &amp;lt;20, 20 to 50, and &amp;gt;50 days. We performed a quantile regression to identify the association with delay in TOT. A logistic regression was used to analyze postoperative complications in reconstructed patients as possible risk factors for delay. Results: We analyzed 456 patients undergoing BC surgery, of which 152 (33.3%) underwent immediate BR. Clinical Stage II was the most prevalent in all grousps. Among all patients 60% underwent total mastectomy (TM), 23.5% TM and alloplastic BR, 6.6% TM and autologous BR, 6.6% breast conservative surgery and 3.3% oncoplastic surgery. Patients not reconstructed had a higher median age (53.4 years versus 45.4; p=0.000), higher rates of diabetes (12.5% versus 5.9%; p=0.029) and higher rates of systemic hypertension (23.6% versus 10.5%; p=0.001). In the reconstructed group, the median TOT was 29 days (12 to 179) versus 29.5 days (6 to 188) in the not reconstructed (p=0.43). Among the 21% of reconstructed patients who experienced postoperative complications, we found 16 (10.5%) surgical site infections, 24 (15%) reinterventions, 4 (2.6%) hematoma and 1 (0.65%) flap loss. The complication group did not show delay in the TOT (p=0.09) with a median TOT of 41.5 days. There is a global BR failure rate of 11.8% and it has no association with delay in TOT (p=0.842). Conclusions: In our series, we found a median TOT of 29 days in both groups. There is no difference in TOT between the reconstructed and the not reconstructed groups in terms of delay of TOT. When analyzing the reconstructed group by incidence of postoperative complications, which is one of the main concerns, we also found they did not have a significant impact in delay of therapy. We considered that a multidisciplinary approach, an effective communication between the plastic and the oncologic team and careful patient education are of major importance to get an early detection of complications, prompt management and recanalization of patient to continue their oncologic therapy as planned. Our results support previous findings that breast reconstruction should continue to be encouraged in order to provide good QOL for BC patients without interfering with oncologic outcomes. Citation Format: Juan Enrique Bargallo-Rocha, Daniela Vargas-Salas, Luz M Gutiérrez-Zacarías, Juan Alejandro Torres-Domínguez, Luis Erick Juárez-Cabello, Paula Anel Cabrera-Galeana. Does immediate breast reconstruction delay oncologic therapy? [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-14-02.

Predictive factors and long-term prognosis of transcatheter aortic valve implantation-associated endocarditis.

There are still limited data regarding transcatheter aortic valve implantation (TAVI) endocarditis. The objective of the present study was to investigate the predictor and long-term outcome of TAVI endocarditis. Consecutive patients undergoing TAVI at the University of Bonn were prospectively enrolled in this study. Transcatheter heart valve (THV) endocarditis was defined according to Duke criteria. The primary outcome was all-cause death within a 5-year follow-up. 1448 successful TAVI patients were eligible for the study and 17 patients (1.2%) developed THV endocarditis during the follow-up period (median 294days). A multivariable logistic regression analysis identified age (odds ratio [OR] 0.90; P = 0.001) and residual paravalvular leakage (PVL) ≥ 2 after TAVI (OR 5.15; P = 0.015) as the main predictors for the occurrence of TAVI endocarditis. Additional analyses revealed that younger patients were significantly associated with higher rates of diabetes (P = 0.001), hemodialysis (P < 0.001), prior cardiac surgery (P < 0.001), and chronic obstructive pulmonary disease (COPD) (P < 0.001). A Kaplan-Meier analysis showed a significantly worse prognosis in TAVI patients with endocarditis than in patients without (log-rank; P = 0.03) during the 5-year follow-up. A multivariable Cox proportional hazard analysis revealed that TAVI endocarditis is an independent predictor of long-term mortality (hazard ratio 4.17; 95% CI 1.91-9.07; P < 0.001). Our study identified lower age and residual PVL ≥ 2 as predictors for THV endocarditis, which itself may be considered as an independent predictor of long-term mortality after TAVI.

CRT-300.04 Treatment of In-Stent Restenosis Using Excimer Laser Coronary Atherectomy and Bioresorbable Vascular Scaffold Guided by Optical Coherence Tomography

The rate of in-stent restenosis (ISR) has become increasingly prevalent with the exponential growth in stent implantation due to an aging population and a higher life expectancy, in addition to the high rates of obesity and diabetes. In this prospective, single-operator, all-comer study, we sought

Trends in Uninsured Rates Before and After Medicaid Expansion in Counties Within and Outside of the Diabetes Belt

To examine trends in uninsured rates between 2012 and 2016 among low-income adults aged <65 years and to determine whether the Patient Protection and Affordable Care Act (ACA), which expanded Medicaid, impacted insurance coverage in the Diabetes Belt, a region across 15 southern and eastern U.S. states in which residents have high rates of diabetes. Data for 3,129 U.S. counties, obtained from the Small Area Health Insurance Estimates and Area Health Resources Files, were used to analyze trends in uninsured rates among populations with a household income ≤138% of the federal poverty level. Multivariable analysis adjusted for the percentage of county populations aged 50-64 years, the percentage of women, Distressed Communities Index value, and rurality. In 2012, 39% of the population in the Diabetes Belt and 34% in non-Belt counties were uninsured (P < 0.001). In 2016 in states where Medicaid was expanded, uninsured rates declined rapidly to 13% in Diabetes Belt counties and to 15% in non-Belt counties. Adjusting for county demographic and economic factors, Medicaid expansion helped reduce uninsured rates by 12.3% in Diabetes Belt counties and by 4.9% in non-Belt counties. In 2016, uninsured rates were 15% higher for both Diabetes Belt and non-Belt counties in the nonexpansion states than in the expansion states. ACA-driven Medicaid expansion was more significantly associated with reduced uninsured rates in Diabetes Belt than in non-Belt counties. Initial disparities in uninsured rates between Diabetes Belt and non-Belt counties have not existed since 2014 among expansion states. Future studies should examine whether and how Medicaid expansion may have contributed to an increase in the use of health services in order to prevent and treat diabetes in the Diabetes Belt.

Disparities in Bariatric Surgery Utilization in Underserved Diabetes Populations.

Bariatric surgery is cost-effective for treating obesity and diabetes. There are higher rates of obesity and diabetes in medically-underserved populations, yet it is unclear if disparities in bariatric surgery utilization exist in this population. Bariatric surgery rates were calculated for underserved populations with obesity and diabetes using secondary data sets of four states in the diabetes belt (Florida, Georgia, Kentucky, South Carolina), a region in the southeast United States with higher rates of diabetes and obesity. Surgery rates were compared across states and demographic groups. Males, Blacks, and patients in rural areas had lower rates of bariatric surgery compared to females, Whites, and patients in urban areas. Payer rates were mixed across states. Surprisingly, minorities in Florida had higher surgery rates. Disparities exist in bariatric surgery rates in underserved populations with obesity and diabetes. It is vital to improve surgery access to this population to promote health equity.

Diabetes prevalence and demographics in 25 First Nations communities in northwest Ontario (2014-2017).

First Nations communities are known to have high rates of diabetes. The rural First Nations communities in northwest (NW) Ontario are particularly affected. Regional studies in 1985 and 1994 found a high prevalence of diabetes. More recently, they are estimated to have the highest prevalence in Ontario at 19%, double the provincial norm. The purpose of this study is to examine the epidemiology and prevalence of diabetes in the total population and cardiovascular comorbidities in the adult population of 25 First Nations communities in NW Ontario. This retrospective diabetes prevalence study used primary care electronic medical record data for a 3-year period, 1 August 2014-31 July 2017. Diabetes prevalence was calculated for both the total and the adult (18+) populations and comorbid hypertension and dyslipidaemia were identified in adults. The age-adjusted diabetes prevalence for the total population was 15.1% versus a Canadian prevalence of 8.8%. The age-adjusted adult prevalence was 14.1%, double Canada's average of 7.1%. The average age of adults with diabetes was 52 years (±14.9); 57% were female. Comorbid hypertension (58%) and dyslipidaemia (73%) were common. Metformin was the most commonly used medication (58%), followed by insulin/analogues (23%) and sulphonylureas (13%). The diabetes prevalence in the First Nations population of NW Ontario is double Canada's norm. Addressing it will require addressing relevant social determinants of health, including poverty and food security.

Prevalence of Diabetes and Associated Health Risk Factors among Adults in Dubai, United Arab Emirates: Results from Dubai Household Survey 2019

Background: The health and social burdens of diabetes mellitus (DM) are steadily increasing worldwide, reflecting the impact of urbanization, industrial transitions, and shifting to nonhealthy, sedentary life patterns’, as well as the high sugar, low-fiber food consumptions. All these factors have contributed to the global increase in the prevalence of DM and metabolic disorders. Objectives: The objective is to study the prevalence of DM among adult cohorts in Dubai and the extent of behavioral health risk factors associations. Methodology: A cross-sectional household health survey with multistage, stratified cluster random sample of 9,630 participants including 2,496 households was carried out in Dubai 2019. About 5,371 non-United Arab Emirates (UAE) national, 2,245 UAE-nationals, of different age-groups, gender, education, nationality, smoking, and marital status were included in the survey. The survey questionnaire was adapted from the one used in the World Bank’s Living Standards Measurement Surveys (LSMSs) and the WHO’s World Health Surveys (WHSs). Self-reported diabetes was considered as well as newly diagnosed diabetes based on HbA1C results. About 75 well-trained surveyors, 25 well-trained nurses, and other laboratory technicians conducted the survey. SPSS 21 and Stata 12 software was used for data management. Results: The data indicate that the prevalence of diabetes among Dubai Emiratis is much higher than Dubai expats (19.3 vs. 12.4% p = 0.000). The association between diabetes and age was evident regardless of nationality. Rates of diabetes were higher in males (15.4%) compared to females (11.8%) (p < 0.001). About 11.2% of those considered overweight have DM, while the prevalence is 21.5% in obese people (p = 0.000). Physical inactivity, smoking, and hypertension (HTN) were strongly associated with higher rates of DM. Regardless of nationality, lower levels of education were statistically significantly associated with the prevalence of DM (p = 0.000), while single marital status was associated with the lowest rate of DM. Conclusions: Dubai household health survey 2019 indicated that the prevalence of DM among Dubai adults was still high as an overall estimation. Higher rates of diabetes were significantly associated with Emirati nationality, older age-groups, male gender, physical inactivity, high BMI, HTN, smoking, marital status of divorced, separated or divorced as well as low educational level groups.

The Prevalence of Diabetes and Pre-Diabetes among the Dubai Population: Findings from Dubai Household Health Surveys, 2014 and 2017

Background: Diabetes mellitus is a leading cause of morbidity and mortality worldwide, imposing a considerable burden on health systems and societies as it affects both individuals and their families and has a large impact on the economic and social development of a country. Objectives: The purpose of this study was to study the prevalence of diabetes and pre-diabetes among the Dubai population and associations with diabetes risk factors. Methodology: A cross-sectional Diabetes Household Survey was carried out in the Emirates of Dubai during 2017 as a complementary stage of the Dubai Household Survey, 2014, which was a randomly selected, multistage, stratified, cluster survey. The sampling technique was selected to assess the rates of undiagnosed diabetes as well as the rates of pre-diabetes through screening with HbA1c. The size of the 2017 survey sample was estimated at 300 individuals for Emirati and 300 for non-Emirati. An additional 200 individuals were added to address non-response cases. These were added to those who were identified as diabetics in the 2014 Household Health Survey and then weighted to give a representative sample for the Dubai population. Results: The study revealed that the prevalence of diabetes in Dubai among UAE nationals was 19%, and it was 14.7% for expats. Consequently, the overall prevalence of diabetes in Dubai is 15.2%. Undiagnosed diabetes was 10% in UAE nationals and 10.9% in expats. Pre-diabetes in UAE national males was lower than in females, although this pattern was not observed among expats. Younger age, normal weight, and exercise were associated with lower rates of diabetes and pre-diabetes in UAE nationals and expats. Hypertension was associated with higher rates of diabetes regardless of nationality. Conclusions: The study concluded that the prevalence of diabetes among the Dubai population is alarmingly high and that a large proportion of the population are not aware of their diagnosis. A higher prevalence of diabetes is associated with multiple factors, such as age, male gender, hypertension, higher BMI, lack of exercise, and lower level or no education, as well as a family history of diabetes mellitus. Many of these factors can be easily modified, which could lead to a decrease in the burden of the disease.

Results from brief educational intervention and health screenings: A community health study of Latinos in Southwest Florida.

BACKGROUND:Latinos in the U.S., one of the fastest growing minority population, have low health-related knowledge and higher rates of diabetes and obesity.AIM:The study aims (1) to assess health-related knowledge levels and change in knowledge levels after brief educational intervention and (2) to assess undiagnosed diabetes, hypertension, and hypercholesterolemia in adult Latinos residing in Immokalee, Florida. A total of 164 participants completed pre–posttests while 161 participants took part in health screenings comprising blood pressure (BP), total cholesterol (TC), blood glucose (BG), and body mass index (BMI).METHODS:Health-related knowledge levels were assessed using 10 questions before and after the educational intervention via face-to face interviews. BP was measured using automated sphygmomanometer, BG and TC were measured using lipid and glucose analyzer, waist circumference using inch tape and BMI using digital scale. T test and Chi square were used to examine the differences in knowledge levels and distribution of screening results across demographic characteristics and self-reports respectively.RESULTS:Mean age was 40.1 ± 13.3 years; there were 77 males and 87 females. The knowledge levels based on 10 questions increased by 1.43 (0.42) after educational sessions (P < 0.001). Participants with college degree had statistically significantly higher pre–posttest scores than those with no formal or less than high school education (P = 0.041). More males than females had high BP in the age groups of 18–44 and ≥45 years (P < 0.001). More males in the age group of 18–44 years had high TC (P = 0.024). Differences between screening results and self-reports for diabetes and BP were statistically significant (P < 0.001 and P = 0.01, respectively). Mean BMI was 28.5 ± 5.1 and waist circumference was 38.6 ± 4.8 inch. Mean random and fasting BG levels and TC were higher in females than in males (P = 0.003, P = 0.022, and P = 0.004, respectively).CONCLUSIONS:The study highlights undiagnosed diabetes and hypertension in Latinos and more Latino males than females to have hypertension and hypercholesterolemia. Latinos' vulnerability to chronic diseases and associated complications is further confounded by limited health knowledge. However, the results of the brief educational program were encouraging and have implications in setting up structured educational interventions in health clinics and migrant education programs.

The Viability Of Liver Transplantation In Patients Age 70 And Older: An Updated Review

Presenter: Krishnaraj Mahendraraj MD | Cedars-Sinai Medical Center Background: Liver transplantation in the elderly has been regarded with caution due to lower survival and increased morbidity. In this study, postoperative outcomes of orthotopic liver transplantation (OLT) in patients age 70 and older are compared to younger cohorts to assess its safety and efficacy. Methods: Data on 55,267 OLT recipients were abstracted from the Scientific Registry of Transplant Recipients (SRTR) over a 10 year period (2007-2017). Three age-based subgroups were created: elderly (age 70 and over), middle-age (age 50-69), and young (age 18-49). Pediatric recipients (age < 18) were excluded. Standard statistical analysis was performed using donor and recipient data to compare indications, mortality and graft survival. Results: There were 1,622 elderly OLT patients (2.9%), compared to 40,271 middle-age patients (72.9%) and 13,374 young patients (24.2%). Significantly fewer elderly patients had a BMI>30 compared to other groups (26.6% vs. 37.2% and 33.4%, p<0.01). The median MELD-Na score of elderly patients was significantly lower (18.4 vs. 21.6 and 27.2, p<0.01), with 63.8% elderly patients being MELD < 20. Most elderly patients received OLT for hepatocellular carcinoma (HCC)-exception status (665 patients; 41%). Fewer elderly patients were Status 1. They had a significantly lower pretransplant INR and bilirubin, and higher albumin. Elderly patients spend a significantly longer time on the waitlist, and tended to receive organs from older age donors. Elderly patients received organs from donors with higher rates of diabetes, hypertension, history of malignancy and macrosteatosis. Elderly patients also received a higher proportion of DCD and ECD organs. Elderly patients had lower overall survival (66.15% vs. 71.4% and 71.7%) and lower graft survival (68.4% vs. 73.9% and 75.7%), p<0.01. There were more graft complications observed in the elderly including hepatic artery thrombosis, infection, primary non-function, primary graft failure and vascular thrombosis, but these were not statistically significant. Elderly patients had a significantly lower 6-month (6.9%) and 1-year (8.7%) rejection rate compared to other groups (12% and 14%, respectively). Kaplan-Meier survival analysis of 5-year graft survival was 3.98 years in the elderly compared to 4.03 years in middle-age and 4.76 years in young recipients, p<0.001. There was no significant difference between survival estimates of elderly patients with HCC vs. non-HCC. Conclusion: Elderly OLT recipients tended to be in a better state of health at the time of transplant, and tended to wait longer for donor organs with more marginal characteristics. Despite having a significantly lower overall and graft survival rate, this difference (less than 5%) was not clinically significant. These Results suggest that OLT is a safe and viable treatment for the elderly, even when using marginal donor organs.

Management of clozapine treatment during the COVID-19 pandemic.

Clozapine is the only available treatment for refractory schizophrenia but its use involves frequent physical contact with healthcare workers for the purpose of mandatory blood monitoring. During the COVID-19 pandemic, patients taking clozapine will be self-isolating to reduce the risk of infection, not least because these patients are at high risk of serious illness and fatality because of high rates of diabetes, obesity and pulmonary disease and an increased risk of pneumonia. Problems may also arise because both clozapine-induced myocarditis and neutropenic sepsis share signs and symptoms with COVID-19 (fever, chest pain, dyspnoea, etc.). We recommend decreasing the frequency of physical contacts by extending the blood monitoring interval to 12 weeks in those patients taking clozapine for more than 1 year. To distinguish COVID-19 from clozapine-related physical adverse effects, we suggest an urgent antigen test alongside a full blood count. In those taking clozapine who develop COVID-19, we suggest continuing with clozapine whenever possible (even during ventilation), reducing the dose if necessary in line with blood assay results. Blood monitoring should continue but clozapine should only cease if there is a significant fall in neutrophils (COVID-19 is linked to lymphopenia but not neutropenia). To protect against the likelihood and severity of respiratory infection, we recommend the use of vitamin D in all clozapine patients. Initiation of clozapine is likely to remain problematic while the risk of infection remains, given the degree of physical contact required to assure safety.

Integrating health care in Australia: a qualitative evaluation

BackgroundWith aging populations, a growing prevalence of chronic illnesses, higher expectations for quality care and rising costs within limited health budgets, integration of healthcare is seen as a solution to these challenges. Integrated healthcare aims to overcome barriers between primary and secondary care and other disconnected patient services to improve access, continuity and quality of care. Many people in Australia are admitted to hospital for chronic illnesses that could be prevented or managed in the community. Western Sydney has high rates of diabetes, heart and respiratory diseases and the NSW State Ministry of Health has implemented key strategies through the Western Sydney Integrated Care Program (WSICP) to enhance primary care and the outcomes and experiences of patients with these illnesses.MethodsWe aimed to investigate the WSICP’s effectiveness through a qualitative evaluation focused on the 10 WSICP strategies using a framework analysis. We administered 125 in-depth interviews in two rounds over 12 months with 83 participants including patients and their carers, care facilitators, hospital specialists and nurses, allied health professionals, general practitioners (GPs) and primary care nurses, and program managers. Most participants (71%) were interviewed twice. We analysed data within a framework describing how strategies were implemented and used, the experiences around these, their perceived value, facilitators and barriers, and participant-identified suggestions for improvement.ResultsCare facilitators helped patients access services within the hospital and in primary care and connected general practices with hospital specialists and services. Rapid access and stabilisation clinics with their patient hotlines assisted patients and carers to self-manage chronic illness while connecting GPs to specialists through the GP support-line. Action plans from the hospital informed GPs and their shared care plans which could be accessed by other community health professionals and patients. HealthPathways provided GPs with local, evidence-based guidelines for managing patients. Difficulties persisted in effective widespread access to shared records and electronic communication across sectors.ConclusionsThe combined WSICP strategies improved patient and carer experience of healthcare and capacity of GPs to provide care in the community. Information sharing required longer-term investment and support, though benefits were evident by the end of our research.