Increase In Prevalence Of Patients Research Articles

Pharmacotherapy of diabetes mellitus in patients with heart failure - a nation-wide analysis of contemporary treatment.

Retrospective national sub-analysis of antidiabetic pharmacotherapy in patients with diabetes mellitus (DM) and heart failure (HF) based on data reported to the National Register of Paid Health Services in the Czech Republic between 2012-2018. In 2012, there were 75,022 patients with HF and DM (i.e. 42.5% of patients with HF), 6 years later 117,265 (i.e. 41.0% of HF patients in 2018). The most represented antidiabetic drug was metformin (45.6%). Of the insulins and analogues, glargine showed the largest positive trend (5.8% 2012; 14.8% 2018). Empagliflozin was the most prescribed SGLT-2 inhibitor (1.8% in 2018). A decrease in prescribing was observed for saxagliptin (0.5% 2012; 0.1% 2018) and for sulfonylurea derivates - gliclazide (13.0% 2012; 10.3% in 2018) and glimepiride (12.9% 2012; 9.0% 2018). Linagliptin was the most prescribed dipeptidyl peptidase inhibitor (0.7% 2012; 6.8% 2018). In the Czech Republic, between 2012 and 2008, there was an increase in prevalence of patients with heart failure and concomitant diabetes mellitus, their proportion being similar. In correspondence with other registries, metformin was used mostly. A positive trend was observed in prescription of DDP-4 and SGLT-2 inhibitors, while there was a significant decrease in patients taking sulfonylureas.

Trends in Clinical, Demographic, and Biochemical Characteristics of Patients With Acute Myocardial Infarction From 2003 to 2008: A Report From the American Heart Association Get With The Guidelines Coronary Artery Disease Program

BackgroundAn analysis of the changes in the clinical and demographic characteristics of patients with acute myocardial infarction could identify successes and failures of risk factor identification and treatment of patients at increased risk for cardiovascular events.Methods and ResultsWe reviewed data collected from 138 122 patients with acute myocardial infarction admitted from 2003 to 2008 to hospitals participating in the American Heart Association Get With The Guidelines Coronary Artery Disease program. Clinical, demographic, and laboratory characteristics were analyzed for each year stratified on the electrocardiogram at presentation. Patients with non–ST-segment–elevation myocardial infarction were older, more likely to be women, and more likely to have hypertension, diabetes mellitus, and a history of past cardiovascular disease than were patients with ST-elevation myocardial infarction. In the overall patient sample, significant trends were observed of an increase over time in the proportions of non–ST-segment–elevation myocardial infarction, patient age of 45 to 65 years, obesity, and female sex. The prevalence of diabetes mellitus decreased over time, whereas the prevalences of hypertension and smoking were substantial and unchanging. The prevalence of “low” high-density lipoprotein increased over time, whereas that of “high” low-density lipoprotein decreased. Stratum-specific univariate analysis revealed quantitative and qualitative differences between strata in time trends for numerous demographic, clinical, and biochemical measures. On multivariable analysis, there was concordance between strata with regard to the increase in prevalence of patients 45 to 65 years of age, obesity, and “low” high-density lipoprotein and the decrease in prevalence of “high” low-density lipoprotein. However, changes in trends in age distribution, sex ratio, and prevalence of smokers and the magnitude of change in diabetes mellitus prevalence differed between strata.ConclusionsThere were notable differences in risk factors and patient characteristics among patients with ST-elevation myocardial infarction and those with non–ST-segment–elevation myocardial infarction. The increasing prevalence of dysmetabolic markers in a growing proportion of patients with acute myocardial infarction suggests further opportunities for risk factor modification. (J Am Heart Assoc. 2012;1:e001206 doi: 10.1161/JAHA.112.001206.)

Regional trends in paediatric home enteral tube feeding 1997–2009

<h3>Introduction</h3> Home enteral tube feeding (HETF) is increasingly used to support patients with chronic childhood conditions, but with little data published regarding the prevalence and outcome of paediatric HETF. The British Artificial Nutrition Survey report of 2008 estimated that BANS captured only 59% of paediatric HETF patients. <h3>Aims</h3> (1) To identify the true prevalence and incidence of children receiving HETF during a 13-year period after the introduction of a regional nutrition support team (NST). (2) To describe the characteristics of these children including sex, route of feeding and duration of HETF. (3) To describe outcome of HETF. <h3>Methods</h3> Retrospective review of all aged &lt;19 years commencing HETF in a defined UK region from 1 May 1997 to 1 May 2009 (stable population of 1.25 million people). Data were obtained from the enteral feeding database (this database collates data from all district general hospitals and the regional tertiary centre), hospital computerised records, and medical and dietetic notes where necessary. <h3>Results</h3> 730 patients (51% male) were identified. Point prevalence increased from 65 in May 5 1997 to 186 in May 5 2001, followed by a period of stability, and then a further increase from 2008, with current prevalence on May 5 2009 the highest ever at 214. The incidence of new HETF starts rose from 1997 to 2000, again with a period of stability until the increase from 2007 to 2008. Median (range) age at HETF start was 2.1 (0.0–18.9) years. Median (range) length of time on HETF was 2.6 (0.1–21.2) years. Only 4% of patients required jejunal feeding. At study end, 28% of patients remained on active HETF, 10% were transferred to adult services on HETF, 41% of patients returned to full oral feeds, 8% left the region on HETF and 13% died on HETF (none due to HETF complications). <h3>Conclusion</h3> Following formation of a regional NST, a large number of children requiring HETF were identified, resulting in rapid increase in prevalence of patients on HETF, followed by stability and then a more recent increase in the last 2 years. A minority of patients return to full oral feeding. These trends provide valuable information to aid development and funding of HETF services.

MODIFIED ILEAL NEOBLADDER FOR CONTINENT URINARY DIVERSION: FUNCTIONAL RESULTS AFTER 9 YEARS OF EXPERIENCE

We report the continence status and urodynamic findings in 59 patients who underwent radical cystectomy and orthotopic bladder reconstruction using a modified S-ileal neobladder technique between January 1993 and July 2002. Continence status was assessed using patient interview, frequency-volume charts and the need for protective devices. Reservoir sensation, compliance, capacity and activity were assessed by enterocystometry. Post-void residual urine volume greater than 100 ml was the indication for clean intermittent self-catheterization. Daytime continence was reported by 95.5% and 100% of our patients at 1 and 5 years, respectively. Overall, 77.7% of patients reported nighttime continence at 1 year and 96.5% at 5 years. The need for a protective device decreased with time and most of the patients would have undergone the operation again. Enterocystometric capacity and maximum reservoir pressure remained remarkably stable at 391.6 versus 440 ml, and 30 versus 20 cm H2O, 6 months and 5 years after surgery, respectively. Nevertheless, median post-void residual urine volume increased from 35 ml at 6 months to 55 ml at 5 years with an increase in prevalence of patients requiring intermittent self-catheterization due to post-void residual urine greater than 100 ml from 1.8% at 6 months to 10% at 5 years. Orthotopic bladder substitution with the modified S-ileal neobladder technique has an excellent functional outcome over time, resulting in high daytime and nighttime continence levels as well as high acceptability rates from our patients.

Increasing use of Dutch mental health care: an investigation.

In the Netherlands, a previous study has shown an increase in the 1-year prevalence of patients in mental health care during the 1990s. Though the number of inpatients decreased, this decrease was far outweighed by a large increase of patients in community care, causing an increase in total year prevalence. The current study aimed at an explanation. The Groningen psychiatric case register was used to determine treated incidence and prevalence over a 9-year period for different age groups. Incidence rates proved fairly stable. The increased prevalence was primarily caused by the growing number of existing cases. People had their first encounter with mental health care at an earlier age and remained in care for a larger part of their life. Results indicate that the accessibility of Dutch mental health care was increased by the implementation of community care. In contrast to other countries, Dutch community care lowered the threshold for mental health care utilization without broadening the target group of mental health services.