Mitigating the Prevalence of Diabetic Retinopathy in the United States: Utilization of the Chronic Care Model as a Public Health Framework

As the prevalence of diabetic retinopathy continues to be on the rise, the Chronic Care Model (CCM) offers a transformative, patient-focused approach for efficient diabetic retinopathy care, emphasizing the need for urgent and innovative strategies in the United States. The model integrates community resources, healthcare organizations, self-management support, delivery system design, decision support, and clinical information systems. Addressing challenges and solutions, the model emphasizes proactive and preventive measures, collaborative multidisciplinary care, technological integration, and overcoming resistance to change. This paper proposes the utilization of the Chronic Care Model (CCM) as a possible public health framework for comprehensive management of diabetic retinopathy in the United States. Implementing the CCM offers a comprehensive approach to diabetic retinopathy care, addressing both individual and systemic factors, essential for improving public health outcomes.

The Road to Universal Health Coverage in Myanmar Runs through Non-Communicable Disease Risk Factors: Supporting Evidence from WHO in 2009 and 2014 and the Global Burden of Disease Study 2016

Background: The recent surge in economic development in Myanmar will also contribute to accelerating the health burden shift from acute infectious to chronic non-communicable diseases (NCDs) across the country. With just 11 years to achieve its goal of universal health coverage by the year 2030, significant efforts will be needed to quantify the scale of the burden facing decision-makers about health system strengthening and redevelopment. Convergence of the health systems will be an additional challenge in Myanmar. Methods: Results from a WHO study in 2009 and 2014, combined with data from the 2016 Global Burden of Disease Study, were compiled and analysed for Myanmar to assess the levels and trends of selected NCDs and NCD risk factors. Results: The prevalence of major NCDs in Myanmar are in general higher than global and regional averages, with a significant increase in diabetes mellitus and chronic obstructive pulmonary diseases in the last 25 years. Major NCD risk factors in Myanmar include smoking, use of smokeless tobacco, alcohol consumption among men, low level of fruit and vegetable consumption, hypertension, and emerging of overweight and obesity, especially among women. Tobacco use increased in both sexes between 2009 and 2014, but only significantly in men. Rates of hypertension increased for both men and women, including those currently on medications—suggesting a need for better treatment regimens. Overweight and obesity rates increased in both men and women, although the increase in obesity for men was not significant. Alcohol consumption results were mixed—with lower levels of high level drinking in men, but generally increased consumption by women. Intake of fruit and vegetables increased slightly between 2009 and 2014 and rates of high levels of physical activity also increased. Diabetes prevalence rates increased significantly in women (X2 = 11.3;p = 0.01) and men (X2 = 9.6;p = 0.02) between 2009 and 2014. Conclusions: Improved awareness of risk factors, coupled with early diagnosis and effective treatment of conditions and risks, is paramount to keeping the population healthy and economically active, and maintaining health care costs. Proven cost-effective interventions to prevent and control NCD-related risk factors, notably increasing tobacco taxes, should be endorsed and implemented in the population. Inaction could hamper the country’s effort to achieve universal health coverage by the year 2030.

Association between gastrointestinal symptoms and affectivity in patients with bipolar disorder

AIM To study if anxiety, depression and experience of stress are associated with gastrointestinal(GI) symptoms in patients with bipolar disorder.METHODS A total of 136 patients with bipolar disorder(mean age 49.9 years; 61% women) and 136 controls from the general population(mean age 51.0 years; 60% women) were included in the study. GI symptoms were assessed with The Gastrointestinal Symptom Rating Scale-irritable bowel syndrome(GSRS-IBS), level of anxiety and depression with The Hospital Anxiety and Depression Scale(HADS) and stress-proneness with Perceived Stress Questionnaire. Over a ten year period, all visits in primary care were retrospectively recorded in order to identify functional GI disorders.RESULTS In subjects with low total HADS-score, there were no significant differences in GI-symptoms between patients and controls(GSRS-IBS 7.0 vs 6.5, P = 0.513). In the patients with bipolar disorder there were significant correlations between all GSRS and HADS subscores for all symptom clusters except for "constipation" and "reflux". Factors associated to GI symptoms in the patient group were female sex(adjusted OR = 2.37, 95%CI: 1.07-5.24) and high HADS-Depression score(adjusted OR = 3.64, 95%CI: 1.07-12.4). These patients had also significantly more visits for IBS than patients with low HADS-Depression scores(29% vs 8%, P = 0.008). However, there was no significant differences in consulting behaviour for functional GI disorders between patients and controls(25% vs 17%, P = 0.108).CONCLUSION Female patients and patients with high HADS depression score reported significantly more GI symptoms, whereas patients with low HADS scores did not differ from control subjects.

Associations of accelerometer-determined physical activity and sedentary behavior with sarcopenia and incident falls over 12 months in community-dwelling Swedish older adults

Purpose:This study was aimed to determine associations of accelerometer-determined time and bouts of sedentary behavior,light physical activity(LPA),and moderate-to-vigorous PA(MVPA)with sarcopenia and incident falls over 12 months.Methods:A total of 3334 Swedish 70-year-olds were assessed for sarcopenia,as defined by the revised definition of the European Working Group on Sarcopenia in Older People.Assessments were based on low scores for appendicular lean mass(dual-energy X-ray absorptiometry),hand grip strength,and the Timed Up and Go test.For 7 days after baseline,total time and total number of bouts(≥10 min of continuous activity at a given intensity)of activity performed at sedentary,LPA,and MVPA intensities were assessed by accelerometer.Incident falls were self-reported 6 months and 12 months after baseline.Results:Only 1.8%of participants had probable or confirmed sarcopenia.After multivariable adjustment for other levels of activity,only greater MVPA time was associated with a decreased likelihood of having low appendicular lean mass,low hand grip strength,and slow Timed Up and Go time as defined by the European Working Group on Sarcopenia in Older People criteria(all p<0.05),and only MVPA time was associated with lower likelihood of probable or confirmed sarcopenia(odds ratio=0.80,95%confidence interval:0.71-0.91 h/week).Similar associations were identified for total number of bouts,with no evidence of threshold effects for longer duration of bouts of MVPA.A total of 14%of participants reported-1 fall,but neither total time nor bouts of activity was associated with incident falls(all p>0.05).Conclusion:Higher amounts of accelerometer-determined MVPA are consistently associated with a decreased likelihood of sarcopenia and its components,regardless of the length of bouts or amounts of sedentary behavior.

The effect of cartilaginous rings on particle deposition by convection and Brownian diffusion

The deposition of spherical nanoparticles by convection and Brownian diffusion in a pipe with a cartilaginous ring structure is studied. Analytical results for a fully developed flow are found for small amplitude rings using the interactive boundary layer theory. It is found that the local deposition rate is at maximum at a position approximately one twelfth of the spacing between the rings before the minimum cross section of the tube. For larger ring amplitudes the problem is solved numerically and separation then takes place in the depressions between the rings, and maximum deposition is found at the point of reattachment of the flow approximately at the same point as in the analytical theory. Cumulative deposition results are also provided with larger deposition rates with the inclusion of the cartilaginous rings. Deposition results for a developing flow are also provided. For the same volume flux as for fully developed flow the deposition is about 25% larger. In general conclusions about the position of maximum deposition rate from the analytic theory of fully developed flow also applies qualitatively to the case of developing flow.

Iron Succinate Increased Ferritin and Transferrin Saturation in Non-Anaemic Patients with Heart Failure and Iron Deficiency—A Pilot Study

Introduction: Iron deficiency (ID) is often present (32% - 65%) in patients with heart failure (HF). Oral iron absorption in patients with HF is generally poor. This is the reason why oral treatment is not recommended. Aim: To test whether oral iron succinate significantly increases iron deposits in non-anaaemic patients with HF. Methods: ID was defined as ferritin < 100 μg/L or 100 - 299 μg/L with transferrin saturation (TSAT) < 20%. Forty-two patients were screened. Ferrous succinate was administered as one tablet (100 mg, including 32.48 mg Fe2+ plus 100 mg succinate) in the morning and one tablet at bedtime for at least 3 months. Hemoglobin, CRP, ferritin, iron, TSAT, and hepcidin were analyzed before starting treatment, at 6 weeks, and at 3 months end of study (EOS). Results: Five women and 15 men were included in the study. The level of ferritin increased significantly from baseline to 6 weeks (47 to 78 μg/L, p = 0.009) and baseline to EOS (47 to 85 μg/L, p = 0.001). TSAT increased significantly from baseline to 6 weeks (20% to 27%, p = 0.046) and baseline to EOS (20% to 25%, p = 0.043). Hepcidin increased significantly from baseline to 6 weeks (2.5 nmol/L to 4.8 nmol/L, p = 0.006) and baseline to EOS (2.5 to 4.2 nmol/L, p = 0.02). Conclusion: Oral iron succinate significantly increased iron uptake, almost doubling the ferritin levels and increasing the TSAT, in patients with HF. Our findings challenge the opinion that oral iron treatment cannot significantly increase iron deposits in non-anemic patients with ID and HF.

Effect of Integrated, Person-Centred Palliative Advanced Home and Heart Failure Care on NT-proBNP Levels: A Substudy of the PREFER Study

Objective: In 2012, we initiated a new person-centred model, integrated Palliative advanced home caRE and heart FailurE caRe (PREFER), to integrate specialised palliative home care with heart failure care. Natriuretic peptide-guided treatment is valuable for younger patients (age < 75 years), but its usefulness in palliative care is uncertain. We explored whether patients in PREFER reduced mean level of N-terminal pro B-type natriuretic peptide (NT-proBNP) more than the control group. Design: A pre-specified, exploratory substudy, analysed within the prospective, randomised PREFER study, which had an open, non-blinded design. Participants: Patients in palliative care with chronic heart failure, New York Heart Association class III-IV were randomly assigned to an intervention (n = 36;26 males, 10 females, mean age: 81.9 years) or control group (n = 36;25 males, 11 females, mean age:76.5 years). The intervention group received the PREFER intervention for 6 months. The control group received care as usual at a primary health care centre or heart failure clinic at the hospital. NT-proBNP was measured at the start and end of study. Results: Plasma levels of NT-proBNP differed significantly between groups at baseline. By the end of the study, no significant difference was found between the groups. The mean value for NT-proBNP decreased by 35% in the PREFER group but was not statistically significant (P = 0.074);NT-proBNP increased 4% in the control group. Conclusions: We found no statistically significant reductions of NT-proBNP levels neither between nor within the PREFER and the control group at the end of the study.

Internalized symptoms in adolescence as predictors of mental health in adulthood in the Northern Swedish cohort

Although mental health symptoms in children and adolescents are shown to predict young adult mental health outcomes, long-term prospective studies of childhood cohorts are few. The aim of the present study was to analyze the prospective importance of internalized mental health symptoms in adolescence for internalized symptoms in adulthood. Methods: A community-based prospective longitudinal cohort provided information by questionnaire about psychological status at age 16 and 43 (n=1010, representing 94.3% of those still alive). Socio-demographic variables which were indicative of possible childhood adversity (parental class, absence, illness, unemployment, relationship, crowding, number of moves) were treated as confounders and controlled for in ordinal regression. Results: For both women and men, internalizing mental health symptoms reported at 16 significantly predicted the same outcome at 43 years, after controlling for previous adverse environmental conditions (OR =1.2 for women, 1.3 for men). Conclusion: In this representative cohort studied over 27 years with excellent retention rates, the occurrence of self-reported worry, panic and sadness in mid-adolescence significantly increased the likelihood of similar states in middle adulthood.

Increased free androgen index is associated with hypertension in premenopausal women

Objective: Increased testosterone and decreased sex hormone-binding globulin (SHBG) are associated with a number of adverse cardiovascular risk factors in postmenopausal women. The aim of this population-based study of women aged 25 to 50 was to assess the relationship between free androgen index (FAI) and cardiovascular risk factors in premenopausal women. Methods: A population-based survey of 396 premenopausal women with no hormonal treatment was undertaken as part of the Northern MONICA study. The study involved questionnaires, anthropometry and assays of testosterone and SHBG. Results: Increased FAI was associated with a number of cardiovascular risk factors in premenopausal women but this relationship was strongly affected by body mass index (BMI). After adjustment for age and BMI, FAI was significantly associated with increased systolic and diastolic blood pressures. Conclusion: Hyperandrogenism is associated with increased blood pressure and these findings emphasize the need to assess cardiovascular risk factors in women with hyperandrogenism of all ages.

在成人调查中“是否患过儿童湿疹”的问题对于评估儿童期特应性湿疹有用吗?

Atopic eczema (AE) is a major risk factor for hand eczema. In Scandinavian population-based studies, the occurrence of AE in childhood has often been assessed by the question ‘ Have you had childhood eczema?’ In the present study, this question was validated. A questionnaire was sent to 600 cases with AE and 600 controls without eczema or allergic disease, identified in school medical records from the 1960s. The response rate was 70.5% , and the mean age of the respondents was 36.7 years. The specificity of the question was 70.7% and the sensitivity 89.9% . The sensitivity was higher and the specificity lower in a subgroup with current hand eczema compared with a group without hand eczema. The results showed that the question overestimated the prevalence of AE in childhood by a factor of 1.6. When used for risk assessment, the question provided a better estimate of the risk of current hand eczema as compared with the lifetime risk of hand eczema. In conclusion, the validated question overestimated prevalence of childhood AE and may overestimate AE as a risk factor for hand eczema in adult population surveys.

瑞典北部银屑病人群的银屑病治疗费用和性别期望值的研究

The aim was to analyse use of psoriasis care and expectations from a gender perspective in a psoriasis population. The study is based on questionnaire data from 1060 subjects. The response rate was 74% . The relation between care consumption and studied variables was measured using regression and chisquare analysis. Care consumption was strongly influenced by age, quality of life, income and joint symptoms. Men visited a dermatologist more often, while women visited a general practitioner and treated themselves topically more frequently. Important expectations among both women and men concerned the receiving of professional care and amelioration, while more women wanted to be treated politely. Expectations were ful-filled, except those regarding amelioration, especially among men. Awareness of gender differences is important among professionals. In order to decrease such differences decisionmakers should provide for a maintained specialized care as well as a local health care system of high standard.

Irritable bowel syndrome-like symptoms in treated microscopic colitis patients compared with controls:a cross-sectional study

Background:The prevalence of irritable bowel syndrome(IBS)-like symptoms is high in untreated patients with microscopic colitis(MC),but there is uncertainty of the prevalence of IBS-like symptoms in treated patients.We assessed the degree of IBS-like symptoms in patients with MC in comparison to control subjects,and investigated the association between IBS-like symptoms and faecal calprotectin(FC)in MC patients.Methods:Patients with an established MC diagnosis(n=57)were compared to sex-and age-matched controls(n=138)for scores in the GSRS-IBS(Gastrointestinal Symptom Rating Scale for Irritable Bowel Syndrome)and HADS(Hospital Anxiety Depression Scale).In MC patients,an FC level was simultaneously analysed.Results:The median interval from MC diagnoses to the time the subjects participated in the study was 5.5 years(25th-75th percentiles;4.5-9.5 years).The total GSRS-IBS score,subscores for abdominal pain,bloating,and diarrhoea were significantly higher in MC patients compared to controls(all P<0.001).There was a significant correlation between FC levels and reported bowel frequency(P=0.023),but there was no correlation between FC levels and GSRS-IBS scores.Patients with MC had significantly higher scores on anxiety(HADS-A)(P<0.001)and used more selective serotonin-reuptake-inhibitor drugs(P=0.016)than the control subjects.However,only the control subjects(not the patients with MC)showed significant correlations between GSRS-IBS scores and HADS scores.Conclusions:Patients with MC reported more IBS-like symptoms and anxiety than control subjects but neither FC levels nor symptoms of affectivity were significantly correlated with IBS-like symptoms.

Estimating the size of Aedes aegypti populations from dengue incidence data: Implications for the risk of yellow fever outbreaks

In this paper we present a model to estimate the density of aedes mosquitoes in a community affected by dengue.The method consists in fitting a continuous function to the incidence of dengue infections,from which the density of infected mosquitoes is derived straightforwardly.Further derivations allow the calculation of the latent and susceptible mosquitoes'densities,the sum of the three equals the total mosquitoes'density.The method is illustrated with the case of the risk of urban yellow fever resurgence in dengue infested areas but the same procedures apply for other aedes-transmitted infections like Zika and chikungunya viruses.

Fluctuating temperature modifies heat-mortality association around the globe

Studies have investigated the effects of heat and temperature variability(TV)on mortality.However,few assessed whether TV modifies the heat-mortality association.Data on daily temperature and mortality in the warm season were collected from 717 locations across 36 countries.TV was calculated as the standard deviation of the average of the same and previous days’minimum and maximum temperatures.