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de Lemos JA, Linetzky B, le Roux CW, Laffin LJ, Vongpatanasin W, Fan L, Hemmingway A, Ahmad NN, Bunck MC, Stefanski A. Tirzepatide Reduces 24-Hour Ambulatory Blood Pressure in Adults With Body Mass Index ≥27 kg/m 2: SURMOUNT-1 Ambulatory Blood Pressure Monitoring Substudy. Hypertension 2024; 81:e41-e43. [PMID: 38314555 PMCID: PMC10956672 DOI: 10.1161/hypertensionaha.123.22022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Affiliation(s)
- James A. de Lemos
- Cardiovascular Division, University of Texas Southwestern Medical Center, Dallas (J.A.d.L., W.V.)
| | - Bruno Linetzky
- Eli Lilly and Company, Indianapolis, IN (B.L., L.F., A.H., N.N.A., M.C.B., A.S.)
| | - Carel W. le Roux
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Ireland (C.W.l.R.)
| | - Luke J. Laffin
- Cleveland Clinic Foundation, Department of Cardiovascular Medicine, Cleveland, OH (L.J.L.)
| | - Wanpen Vongpatanasin
- Cardiovascular Division, University of Texas Southwestern Medical Center, Dallas (J.A.d.L., W.V.)
| | - Ludi Fan
- Eli Lilly and Company, Indianapolis, IN (B.L., L.F., A.H., N.N.A., M.C.B., A.S.)
| | - Andrea Hemmingway
- Eli Lilly and Company, Indianapolis, IN (B.L., L.F., A.H., N.N.A., M.C.B., A.S.)
| | - Nadia N. Ahmad
- Eli Lilly and Company, Indianapolis, IN (B.L., L.F., A.H., N.N.A., M.C.B., A.S.)
| | - Mathijs C. Bunck
- Eli Lilly and Company, Indianapolis, IN (B.L., L.F., A.H., N.N.A., M.C.B., A.S.)
| | - Adam Stefanski
- Eli Lilly and Company, Indianapolis, IN (B.L., L.F., A.H., N.N.A., M.C.B., A.S.)
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Boehm M, Anker SD, Mahfoud F, Filippatos G, Ferreira JP, Pocock SJ, Brueckmann M, Linetzky B, Schueler E, Wanner C, Zannad F, Packer M, Butler J. Association of heart rate with heart failure outcomes and the effects of empagliflozin in patients with preserved ejection fraction – EMPEROR-Preserved trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and objective
High resting heart rate (HR) associates with cardiovascular death (CVD) and heart failure hospitalisation (HFH) in patients with reduced ejection fraction (HFrEF), but data are sparse in patients with preserved (HFpEF) or mildly reduced (HFmrEF) ejection fraction. Empagliflozin reduced the risk of CVD and HFH in HFpEF in the EMPEROR-Preserved trial. This study analyses the influence of HR on outcomes in patients with left ventricular ejection fraction (LVEF) >40% in EMPEROR-Preserved and evaluates the effects of empagliflozin across HR categories.
Methods
Patients (n=5988) with HFpEF (LVEF >40%) were categorised to HR <70 beats per minute (bpm), 70–75 bpm and >75 bpm. The composite of CVD or HFH (primary outcome), first HFH, CVD, recurrent HFH and all-cause mortality were studied in the HR groups and in patients separated by sinus rhythm (SR) or atrial fibrillation (AF) and true HFpEF (EF ≥50%) or HFmrEF (EF 40–49%).
Results
Empagliflozin did not influence HR over time. At HR >75 bpm, the primary outcome (hazard ratio: 1.31, 1.13–1.52, p=0.0003), time to first HFH (hazard ratio: 1.25, 1.04–1.49, p=0.02), recurrent HFH (hazard ratio: 1.29, 1.05–1.60, p=0.02), CVD (hazard ratio: 1.49, 1.21–1.84, p=0.0001) and all-cause mortality (hazard ratio: 1.49, 1.28–1.73, p<0.0001) were increased compared to HR of <70 bpm with HR 70–75 bpm showing intermediate results. The influence of HR on the primary outcome was only observed in SR (p trend=0.005), but not in AF (p trend=0.55). Patients with true HFpEF (≥50%) or HFmrEF (40–49%) showed similar effects. The treatment effects of empagliflozin to reduce the primary outcome, time to first HFH and recurrent HFH were not modified by HR.
Conclusions
HR in SR, but not in AF, predicts heart failure outcomes in HFpEF and HFmrEF, but the effects of empagliflozin were not modified by HR.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Boehringer Ingelheim & Eli Lilly and Company Diabetes Alliance
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Affiliation(s)
- M Boehm
- University Hospital of Saarland, Clinic for Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine , Homburg/Saar , Germany
| | - S D Anker
- Department of Cardiology (CVK); Charité Universitätsmedizin Berlin , Berlin , Germany
| | - F Mahfoud
- University Hospital of Saarland, Clinic for Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine , Homburg/Saar , Germany
| | - G Filippatos
- National & Kapodistrian University of Athens School of Medicine, Athens University Hospital Attikon , Athens , Greece
| | | | - S J Pocock
- London School of Hygiene and Tropical Medicine , London , United Kingdom
| | - M Brueckmann
- Boehringer Ingelheim International GmbH , Ingelheim , Germany
| | - B Linetzky
- Eli Lilly Interamerica Inc. , Buenos Aires , Argentina
| | | | - C Wanner
- Wuerzburg University Clinic , Wuerzburg , Germany
| | - F Zannad
- Université de Lorraine , Nancy , France
| | - M Packer
- Baylor University Medical Center , Dallas , United States of America
| | - J Butler
- Baylor Scott & White Health , Dallas , United States of America
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Böhm M, Butler J, Mahfoud F, Filippatos G, Ferreira JP, Pocock SJ, Slawik J, Brueckmann M, Linetzky B, Schüler E, Wanner C, Zannad F, Packer M, Anker SD. Heart failure outcomes according to heart rate and effects of empagliflozin in patients of the EMPEROR-Preserved trial. Eur J Heart Fail 2022; 24:1883-1891. [PMID: 36087309 PMCID: PMC9828798 DOI: 10.1002/ejhf.2677] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 08/27/2022] [Indexed: 01/12/2023] Open
Abstract
AIMS Empagliflozin reduces cardiovascular death (CVD) or heart failure hospitalization (HHF) in patients with heart failure and preserved ejection fraction (HFpEF). Treatment effects and safety in relation to resting heart rate (RHR) have not been studied. METHODS AND RESULTS The interplay of RHR and empagliflozin effects in EMPEROR-Preserved was evaluated. We grouped patients (n = 5988) according to their baseline RHR (<70 bpm [n = 2650], 70-75 bpm [n = 967], >75 bpm [n = 1736]) and explored the influence of RHR on CVD or HHF (primary outcome) and its components in sinus rhythm or atrial fibrillation/flutter (AF) and adverse events. We studied the efficacy of empagliflozin across the RHR spectrum. Compared to placebo, empagliflozin did not change heart rate over time. The primary outcome (p for trend = 0.0004) and its components CVD (p trend = 0.0002), first HHF (p for trend = 0.0099) and all-cause death (p < 0.0001) increased with RHR only in sinus rhythm but not AF. The risk increase with RHR was similar in patients with heart failure and mildly reduced ejection fraction (left ventricular ejection fraction [LVEF] 40-49%) and HFpEF (LVEF ≥50%). Baseline RHR had no influence on the effect of empagliflozin on the primary outcomes (p for trend = 0.20), first HHF (p for trend = 0.49). There were no clinically relevant differences in adverse events between empagliflozin and placebo across the RHR groups. CONCLUSION Resting heart rate associates with outcomes only in sinus rhythm but not in AF. Empagliflozin reduced outcomes over the entire RHR spectrum without increase of adverse events.
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Affiliation(s)
- Michael Böhm
- Klinik für Innere Medizin IIIUniversitätsklinikum des Saarlandes, Saarland UniversitySaarlandGermany,Cape Heart InstituteCape TownSouth Africa
| | - Javed Butler
- Department of MedicineUniversity of Mississippi School of MedicineJacksonMSUSA,Baylor Scott and White Research InstituteDallasTexasUSA
| | - Felix Mahfoud
- Klinik für Innere Medizin IIIUniversitätsklinikum des Saarlandes, Saarland UniversitySaarlandGermany
| | - Gerasimos Filippatos
- National and Kapodistrian University of Athens School of MedicineAthens University Hospital AttikonAthensGreece
| | - João Pedro Ferreira
- Centre d'Investigation Clinique‐ Plurithématique Inserm CIC‐P 1433Université de LorraineNancyFrance,France Inserm U1116, CHRU Nancy BraboisF‐CRIN INI‐CRCT (Cardiovascular and Renal Clinical Trialists)NancyFrance
| | - Stuart J. Pocock
- Department of Medical StatisticsLondon School of Hygiene & Tropical MedicineLondonUK
| | - Jonathan Slawik
- Klinik für Innere Medizin IIIUniversitätsklinikum des Saarlandes, Saarland UniversitySaarlandGermany
| | - Martina Brueckmann
- Boehringer Ingelheim InternationalIngelheimGermany,First Department of Medicine, Faculty of Medicine MannheimUniversity of HeidelbergMannheimGermany
| | - Bruno Linetzky
- Eli Lilly Interamerica Inc, Suc ArgentinaBuenos AiresArgentina
| | | | - Christoph Wanner
- Medizinische Klinik und Poliklinik 1, Schwerpunkt NephrologieUniversitätsklinikum WürzburgWürzburgGermany
| | - Faiez Zannad
- Centre d'Investigation Clinique‐ Plurithématique Inserm CIC‐P 1433Université de LorraineNancyFrance,France Inserm U1116, CHRU Nancy BraboisF‐CRIN INI‐CRCT (Cardiovascular and Renal Clinical Trialists)NancyFrance
| | - Milton Packer
- Baylor University Medical CenterDallasTXUSA,Imperial CollegeLondonUK
| | - Stefan D. Anker
- Department of Cardiology (CVK); and Berlin Institute of Health Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site BerlinCharité Universitätsmedizin BerlinBerlinGermany
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Forst T, Choudhary P, Schneider D, Linetzky B, Pozzilli P. A practical approach to the clinical challenges in initiation of basal insulin therapy in people with type 2 diabetes. Diabetes Metab Res Rev 2021; 37:e3418. [PMID: 33098260 PMCID: PMC8519070 DOI: 10.1002/dmrr.3418] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 07/17/2020] [Accepted: 08/09/2020] [Indexed: 12/18/2022]
Abstract
Initiating insulin therapy with a basal insulin analogue has become a standard of care in the treatment of type 2 diabetes mellitus (T2DM). Despite increasing choices in pharmacological approaches, intensified glucose monitoring and improvements in quality of care, many patients do not achieve the desired level of glycaemic control. Although insulin therapy, when optimized, can help patients reach their glycaemic goals, there are barriers to treatment initiation on both the side of the patient and provider. Providers experience barriers based on their perceptions of patients' capabilities and concerns. They may lack the confidence to solve the practical problems of insulin therapy and avoid decisions they perceive as risky for their patients. In this study, we review recommendations for basal insulin initiation, focussing on glycaemic targets, titration, monitoring, and combination therapy with non-insulin anti-hyperglycaemic medications. We provide practical advice on how to address some of the key problems encountered in everyday clinical practice and give recommendations where there are gaps in knowledge or guidelines. We also discuss common challenges faced by people with T2DM, such as weight gain and hypoglycaemia, and how providers can address and overcome them.
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Affiliation(s)
- Thomas Forst
- Department of Endocrinology and Metabolic DiseasesUniversitatsmedizin der Johannes GutenbergMainzGermany
- Clinical Research ServicesManhheimGermany
| | - Pratik Choudhary
- Department of Diabetes and Nutritional SciencesKing's CollegeLondonUK
| | | | | | - Paolo Pozzilli
- Department of Endocrinology and Metabolic DiseasesUniversità Campus Bio‐MedicoRomeItaly
- Centre of ImmunobiologyBarts and the London School of MedicineQueen Mary University of LondonUK
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Keystone EC, Taylor PC, Tanaka Y, Gaich C, DeLozier AM, Dudek A, Zamora JV, Cobos JAC, Rooney T, Bono SD, Arora V, Linetzky B, Weinblatt ME. Patient-reported outcomes from a phase 3 study of baricitinib versus placebo or adalimumab in rheumatoid arthritis: secondary analyses from the RA-BEAM study. Ann Rheum Dis 2017; 76:1853-1861. [PMID: 28798049 PMCID: PMC5705852 DOI: 10.1136/annrheumdis-2017-211259] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 06/22/2017] [Accepted: 06/24/2017] [Indexed: 11/08/2022]
Abstract
Background To assess the effect of baricitinib on patient-reported outcomes (PROs) in patients with active rheumatoid arthritis and an inadequate response to methotrexate (MTX). Methods In this double-blind phase 3 study, patients were randomised 3:3:2 to placebo (n=488), baricitinib 4 mg once daily (n=487), or adalimumab 40 mg biweekly (n=330) with background MTX. PROs included the SF-36, EuroQol 5-D (EQ-5D) index scores and visual analogue scale, Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), Health Assessment Questionnaire-Disability Index (HAQ-DI), Patient’s Global Assessment of Disease Activity (PtGA), patient’s assessment of pain and Work Productivity and Activity Impairment Questionnaire-Rheumatoid Arthritis (WPAI-RA), and measures collected in electronic patient daily diaries: duration and severity of morning joint stiffness (MJS), Worst Ttiredness and Worst Joint Pain. The primary study endpoint was at week 12. Treatment comparisons were assessed with logistic regression for categorical measures or analysis of covariance for continuous variables. Results Compared with placebo and adalimumab, baricitinib showed statistically significant improvements (p≤0.05) in HAQ-DI, PtGA, pain, FACIT-F, SF-36 physical component score, EQ-5D index scores and WPAI-RA daily activity at week 12. Improvements were maintained for measures assessed to week 52. Statistically significant improvement in patient diary measures (MJS duration and severity), worst tiredness and worst joint pain were observed for baricitinib versus placebo and adalimumab at week 12 (p≤0.05). Conclusions Baricitinib provided significantly greater improvement in most PROs compared with placebo and adalimumab, including physical function MJS, pain, fatigue and quality of life. Improvement was maintained to the end of the study (week 52). Trial registration NCT01710358.
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Affiliation(s)
- Edward C Keystone
- The Rebecca MacDonald Centre for Arthritis, Mt. Sinai Hospital, Toronto, Canada
| | - Peter C Taylor
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
| | - Yoshiya Tanaka
- University of Occupational and Environmental Health, Fukuoka, Japan
| | - Carol Gaich
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | | | | | | | | | | | | | - Vipin Arora
- Eli Lilly and Company, Indianapolis, Indiana, USA
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Linetzky B, Jiang D, Funnell MM, Curtis BH, Polonsky WH. Exploring the role of the patient-physician relationship on insulin adherence and clinical outcomes in type 2 diabetes: Insights from the MOSAIc study. J Diabetes 2017; 9:596-605. [PMID: 27368146 DOI: 10.1111/1753-0407.12443] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 06/21/2016] [Accepted: 06/27/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The 2-year prospective MOSAIc (Multinational Observational Study assessing Insulin use: understanding the challenges associated with progression of therapy) study is investigating whether patient-, physician-, and health system-related factors affect outcomes in patients with type 2 diabetes (T2D). This baseline subanalysis investigated how aspects of the patient-physician relationship are associated with diabetes-related distress, insulin adherence, and glycemic control. METHODS Patients with T2D taking insulin for ≥3 months were recruited at primary care and specialty practice sites in 18 countries. Physicians provided usual care. Clinical history and most recent HbA1c values were collected; patients were surveyed regarding their perception of physician interactions, diabetes-related distress level, and insulin adherence. RESULTS The analysis population comprised 4341 patients. Four (of six) domains showed a significant relationship with total diabetes-related distress (P < 0.01). Poor insulin adherence was associated with greater diabetes-related distress (adjusted odds ratio [aOR] 1.14; 95% confidence interval [CI] 1.06-1.22), higher Discrimination (aOR 1.13; 95% CI 1.02-1.27) and Hurried Communication (aOR 1.35; 95% CI 1.20-1.53) scores, and a lower Explained Results score (aOR 0.86; 95% CI 0.77-0.97). Poor insulin adherence was associated with a 0.43% increase in HbA1c, whereas a 1-unit increase in total diabetes-related distress and Hurried Communication scores was associated with a 0.171% and 0.145% increase in HbA1c, respectively. CONCLUSIONS Patients distressed about living with T2D, and dissatisfied with aspects of their interactions with physicians, exhibited poor insulin adherence. Perceived physician inattention and lack of engagement (and diabetes-related distress) directly affect insulin adherence and glycemic control.
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Affiliation(s)
| | | | | | | | - William H Polonsky
- Behavioral Diabetes Institute, San Diego, USA
- University of California, San Diego, USA
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Ferrante D, Linetzky B, Ponce M, Goldberg L, Konfino J, Laspiur S. Prevalence of overweight, obesity, physical activity and tobacco use in Argentine youth: Global School-Based Student Health Survey and Global Youth Tobacco Survey, 2007-2012. ARCH ARGENT PEDIATR 2016. [PMID: 25362906 DOI: 10.5546/aap.2014.496] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION In 2007 and 2012, the Global School-Based Student Health Survey (GSHS) and the Global Youth Tobacco Survey (GYTS) were implemented to estimate the prevalence of risk behaviors and protection factors among 13 to 15 year-old adolescents. OBJECTIVE To assess changes in dietary, body weight, tobacco and physical activity indicators in the past five years. POPULATION AND METHODS Cross-sectional study. A randomized, two-stage sampling with 600 schools selected at a national level was used. Students from randomly selected courses were invited to answer a self-administered questionnaire (either the GSHS or the GYTS). RESULTS In 2012, the GSHS was completed by 20 697 students from 544 schools, while the GYTS was completed by 2062 students from 73 schools. Between 2007 and 2012, overweight and obesity prevalence significantly increased (overweight: 24.5% in 2007, 28.6% in 2012; obesity 4.4% in 2007, 5.9% in 2012), while the consumption of sugar-sweetened beverages and fast food remained high. A slight improvement was observed in the level of physical activity (12.7% in 2007, 16.7% in 2012), although it remains below what is recommended. The prevalence of tobacco use was reduced (24.5% in 2007, 19.6% in 2012), but access to tobacco products and exposure to secondhand smoke remains high in public places, including schools. CONCLUSIONS The spread of the overweight and obesity epidemic calls for a need to consolidate actions tending towards a healthy diet and physical activity. Despite a decrease in the prevalence of tobacco use, it is necessary to continue strengthening tobacco control actions.
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Affiliation(s)
- Daniel Ferrante
- Dirección de Promoción de la Salud y Control de Enfermedades No Transmisibles, Ministerio de Salud de la Nación
| | - Bruno Linetzky
- Dirección de Promoción de la Salud y Control de Enfermedades No Transmisibles, Ministerio de Salud de la Nación
| | - Miguel Ponce
- Dirección de Promoción de la Salud y Control de Enfermedades No Transmisibles, Ministerio de Salud de la Nación
| | - Lucila Goldberg
- Dirección de Promoción de la Salud y Control de Enfermedades No Transmisibles, Ministerio de Salud de la Nación
| | - Jonathan Konfino
- Dirección de Promoción de la Salud y Control de Enfermedades No Transmisibles, Ministerio de Salud de la Nación
| | - Sebastián Laspiur
- Dirección de Promoción de la Salud y Control de Enfermedades No Transmisibles, Ministerio de Salud de la Nación
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Davidson JA, Manghi FP, Yu M, Linetzky B, Landó LF. EFFICACY AND SAFETY OF DULAGLUTIDE IN HISPANIC/LATINO PATIENTS WITH TYPE 2 DIABETES IN THE AWARD CLINICAL PROGRAM. Endocr Pract 2016; 22:1406-1414. [PMID: 27540883 DOI: 10.4158/ep161337.or] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this post hoc analysis was to assess the efficacy and safety of once-weekly dulaglutide in Hispanic/Latino patients with type 2 diabetes (T2D) in phase 3 AWARD trials 1 to 6. METHODS Hispanic/Latino data at Week 26 were pooled across studies for each dulaglutide dose to analyze the change from baseline in glycosylated hemoglobin (HbA1c), percent to HbA1c goal, and adverse events (AEs). Change from baseline in HbA1c, change from baseline in weight and hypoglycemia were analyzed by Hispanic/Latino and non-Hispanic/Latino subgroups for each study. RESULTS Of the 3,136 patients randomized to dulaglutide 1.5 or 0.75 mg, 949 were reported as having Hispanic/Latino ethnicity. Baseline characteristics were similar for Hispanic/Latino and overall populations, except there were slightly more Hispanic/Latino females and weight was slightly lower for Hispanic/Latino patients. Hispanic/Latino patients receiving dulaglutide 1.5 mg had a reduction in HbA1c of 1.25% (95% confidence interval [CI]: -1.35, -1.15); dulaglutide 0.75 mg had a reduction of 1.07% (95% CI: -1.18, -0.96). Reductions in HbA1c and percent to goal HbA1c <7% and ≤6.5% were similar between Hispanic/Latino patients and the overall population. Weight change and hypoglycemia were similar between Hispanic/Latino and non-Hispanic/Latino subgroups for all studies. Treatment-emergent AEs were consistent with the overall population. CONCLUSION Dulaglutide improved glycemic control with the potential for weight loss in Hispanic/Latino patients with T2D. Dulaglutide was well tolerated and had a low risk of hypoglycemia when used without insulin secretagogues or insulin. In the Hispanic/Latino population, dulaglutide efficacy and safety was consistent with that of the overall population. ABBREVIATIONS AE = adverse event AWARD = Assessment of Weekly AdministRation of dulaglutide in Diabetes BID = twice daily CARMELA = The Cardiovascular Risk Factor Multiple Evaluation of Latin America CI = confidence interval GLP-1 RA = glucagon-like peptide-1 receptor agonist HbA1c = glycosylated hemoglobin T2D = type 2 diabetes.
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Keystone E, Taylor P, Tanaka Y, Gaich C, DeLozier A, Dudek A, Velasco Zamora J, Covarrubias Cobos J, de Bono S, Arora V, Yang L, Linetzky B, Weinblatt M. THU0609 Patient-Reported Outcomes from A Phase 3 Study of Baricitinib versus Placebo or Adalimumab in Patients with Active Rheumatoid Arthritis and An Inadequate Response To Background Methotrexate Therapy: Table 1. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Linetzky B, Curtis B, Frechtel G, Montenegro R, Escalante Pulido M, Stempa O, de Lana JM, Gagliardino JJ. Challenges associated with insulin therapy progression among patients with type 2 diabetes: Latin American MOSAIc study baseline data. Diabetol Metab Syndr 2016; 8:41. [PMID: 27453733 PMCID: PMC4957288 DOI: 10.1186/s13098-016-0157-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 07/10/2016] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Poor glycemic control in patients with type 2 diabetes is commonly recorded worldwide; Latin America (LA) is not an exception. Barriers to intensifying insulin therapy and which barriers are most likely to negatively impact outcomes are not completely known. The objective was to identify barriers to insulin progression in individuals with type 2 diabetes mellitus (T2DM) in LA countries (Mexico, Brazil, and Argentina). METHODS MOSAIc is a multinational, non-interventional, prospective, observational study aiming to identify the patient-, physician-, and healthcare-based factors affecting insulin intensification. Eligible patients were ≥18 years, had T2DM, and were treated with insulin for ≥3 months with/without oral antidiabetic drugs (OADs). Demographic, clinical, and psychosocial data were collected at baseline and regular intervals during the 24-month follow-up period. This paper however, focuses on baseline data analysis. The association between glycated hemoglobin (HbA1c) and selected covariates was assessed. RESULTS A trend toward a higher level of HbA1c was observed in the LA versus non-LA population (8.40 ± 2.79 versus 8.18 ± 2.28; p ≤ 0.069). Significant differences were observed in clinical parameters, treatment patterns, and patient-reported outcomes in LA compared with the rest of the cohorts and between Mexico, Brazil, and Argentina. Higher number of insulin injections and lower number of OADs were used, whereas a lower level of knowledge and a higher level of diabetes-related distress were reported in LA. Covariates associated with HbA1c levels included age (-0.0129; p < 0.0001), number of OADs (0.0835; p = 0.0264), higher education level (-0.2261; p = 0.0101), healthy diet (-0.0555; p = 0.0083), self-monitoring blood glucose (-0.0512; p = 0.0033), hurried communication style in the process of care (0.1295; p = 0.0208), number of insulin injections (0.1616; p = 0.0088), adherence (-0.1939; p ≤ 0.0104), and not filling insulin prescription due to associated cost (0.2651; p = 0.0198). CONCLUSION MOSAIc baseline data showed that insulin intensification in LA is not optimal and identified several conditions that significantly affect attaining appropriate HbA1c values. Tailored public health strategies, including education, should be developed to overcome such barriers. Trial Registration NCT01400971.
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Affiliation(s)
- Bruno Linetzky
- />Eli Lilly and Company, Tronador 4890, Piso 12, CABA, C1430DNN Buenos Aires, Argentina
| | - Brad Curtis
- />Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285 USA
| | - Gustavo Frechtel
- />Servicio de Nutrición y Diabetes, Hospital Sirio Libanes, Campana 4658, C1419HN Buenos Aires, Argentina
| | - Renan Montenegro
- />School of Medicine of the Federal University of Ceará, Rua Capitao Francisco Pedro, 1290 Fortaleza, Ceara, 60430-370 Brazil
| | - Miguel Escalante Pulido
- />Hospital de Especialidades del Centro Médico de Occidente IMSS, Belisario Domínguez 1000, piso 2., Col. Independencia Guadalajara, Jalisco, Mexico
| | - Oded Stempa
- />Eli Lilly and Company, Barranca del Muerto 329-1, Col. San José Insurgentes, Delegación Benito Juárez, Mexico, 03900 Distrito Federal Mexico
| | | | - Juan José Gagliardino
- />CENEXA, Centro de Endocrinología Experimental y Aplicada (UNLP-CONICET La Plata), Calle 60 y 120, La Plata, Argentina
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Rojas A, Sposetti G, Gross JL, Barbieri DE, Duan R, Linetzky B, De Lana JM, Stempa O, Rodriguez A. Insulin lispro low mixture twice daily vs basal insulin glargine once daily and prandial insulin lispro once daily as insulin intensification strategies in patients with type 2 diabetes: Latin American subpopulation analysis of a randomized trial. Diabetol Metab Syndr 2016; 8:69. [PMID: 27660663 PMCID: PMC5027076 DOI: 10.1186/s13098-016-0163-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 07/10/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This post hoc analysis examined the efficacy and safety of twice-daily insulin lispro low mixture (LM25) and once-daily basal insulin glargine plus once-daily prandial insulin lispro (IGL) in a Latin American subpopulation with type 2 diabetes mellitus (T2DM). METHODS A phase 4, randomized, open-label, parallel-arm trial included participants aged 18-75 years with T2DM taking once-daily insulin glargine and stable doses of metformin and/or pioglitazone with glycated hemoglobin (HbA1c) 7.5-10.5 % and fasting plasma glucose ≤121 mg/dL. Participants were randomized 1:1 to receive their stable dose of metformin and/or pioglitazone plus twice-daily LM25 or IGL for 24 weeks. The primary efficacy outcome was change in HbA1c after 24 weeks of treatment. Results from participants in Argentina, Brazil, and Mexico are presented here. RESULTS 162 participants (80 LM25; 82 IGL) with mean ± standard deviation (SD) age = 57.3 ± 9.0 years and body mass index = 31.3 ± 5.2 kg/m(2) were included. Mean ± SD change in HbA1c from baseline to week 24 was -1.5 ± 1.0 % (LM25) and -1.1 ± 1.2 % (IGL). At week 24, 35.1 % (LM25) and 31.6 % (IGL) of participants achieved HbA1c <7.0 %. Mean ± SD weight gain from baseline to week 24 was 2.4 ± 2.9 kg in the LM25 group and 1.0 ± 3.1 kg in the IGL group. The mean ± SD rates of total hypoglycemia per year were 18.9 ± 27.3 (LM25) and 21.6 ± 31.1 (IGL). Rates of treatment-emergent adverse events were 46 % (LM25) and 39 % (IGL). CONCLUSIONS Our results suggest that both LM25 and IGL are viable treatment options for insulin intensification in Latin American patients with T2DM with suboptimal glycemic control on basal insulin glargine. The safety and tolerability profiles of LM25 and IGL are consistent between this Latin American population and the global trial-level population. Trial registration NCT01175824.
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Affiliation(s)
- Arturo Rojas
- Direccion-investigacion, Servicio Medico Nutricional S.C. (Centro de Diabetes de Coatzacoalcos), Revolucion # 522, 96400 Coatzacoalcos, VER México
| | - Georgina Sposetti
- Diabetes and Metabolism Research Department, Head en Instituto de Investigaciones Clínicas, Mar del Plata, Argentina
| | - Jorge L. Gross
- Centro de Pesquisas em Diabetes, Porto Alegre, Rio Grande do Sul Brazil
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Konfino J, De Maio F, Ondarsuhu D, Goldberg L, Linetzky B, Ferrante D. The sociodemographic patterning of opposition to raising taxes on tobacco and restricting tobacco advertisements in Argentina. Public Health 2015; 129:364-9. [PMID: 25698497 DOI: 10.1016/j.puhe.2014.12.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 12/11/2014] [Accepted: 12/28/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Argentina has enacted important tobacco control initiatives in recent years. Yet little is known about the social patterning of attitudes toward tobacco control. Research is needed to explore what predicts opposition to tobacco control initiatives such as higher taxes on tobacco and the prohibition of tobacco advertising. STUDY DESIGN Secondary analysis of Argentina's Global Adult Tobacco Survey (N = 6645). METHODS Binary logistic regression analysis examining opposition to raising tobacco taxes and banning tobacco publicity. Models were stratified by smoking status. RESULTS Respondents generally indicated very little opposition to either tobacco control measure, with only 15.6% of respondents opposed to increasing taxes on tobacco products and 9.6% opposed to banning tobacco advertisements. Smoking status is the most important predictor of opposition to increasing taxes (OR = 7.85, 95% CI = 6.60-9.34) and banning advertisements (OR = 1.72, 95% CI = 1.39-2.11). Opposition to these measures is most likely among young respondents (aged 15-24) and least likely among older age groups (55-64 and 65 or over), compared to the 25-34 age group. Stratified models suggest that the effect of age may be different for smokers and non-smokers. Low income is a significant predictor of opposition, but only in stratified models for smokers. CONCLUSION There is general support for stronger tobacco control measures in Argentina. Opposition to raising taxes on tobacco products and banning tobacco advertisement appears to be concentrated among young smokers with low and medium levels of household income.
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Affiliation(s)
- J Konfino
- Ministerio de Salud de la Nación, Buenos Aires, Argentina.
| | - F De Maio
- Department of Sociology, DePaul University, Chicago, IL, USA
| | - D Ondarsuhu
- Instituto Nacional de Estadística y Censos, Ministerio de Economía y Finanzas Públicas, Buenos Aires, Argentina
| | - L Goldberg
- Ministerio de Salud de la Nación, Buenos Aires, Argentina
| | - B Linetzky
- Ministerio de Salud de la Nación, Buenos Aires, Argentina
| | - D Ferrante
- Ministerio de Salud de la Nación, Buenos Aires, Argentina
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De Maio FG, Konfino J, Ondarsuhu D, Goldberg L, Linetzky B, Ferrante D. Sex-stratified and age-adjusted social gradients in tobacco in Argentina and Uruguay: evidence from the Global Adult Tobacco Survey (GATS). Tob Control 2014; 24:562-7. [PMID: 24985731 DOI: 10.1136/tobaccocontrol-2013-051525] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 06/08/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To examine social gradients in tobacco use in Argentina and Uruguay, using newly available directly comparable data sets. METHODS Secondary analysis of Global Adult Tobacco Survey data from Argentina (N=6645) and Uruguay (N=5581). Social gradients in current tobacco use, exposure to secondhand smoke, and cessation attempt were examined with sex-stratified and age-adjusted logistic regression. RESULTS Among men, there is evidence of higher odds of being a current smoker among respondents with lower levels of education, but the association is only statistically significant for respondents with less than primary education in Uruguay (OR=2.15, 95% CI 1.22 to 3.77). Similarly, women with lower levels of education have higher odds of being a current smoker in Uruguay. The association between education and exposure to secondhand smoke is broadly similar for both sexes in both countries, with generally higher odds among groups with low education, though the relationship is only statistically significant among men in Uruguay (OR=1.77, 95% CI 1.08 to 2.92). In both countries, respondents with lower levels of education in general have higher odds of having attempted to quit smoking in the past year, although these associations did not attain statistical significance. CONCLUSIONS Social gradients in tobacco use, exposure to secondhand smoke and cessation attempts are broadly similar in both countries. Efforts to evaluate the long-term effects of tobacco control efforts in these countries should monitor how policies affect national averages, and the social gradients that are embedded in aggregate data.
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Affiliation(s)
- F G De Maio
- Department of Sociology, DePaul University, Chicago, Illinois, USA
| | - J Konfino
- Ministerio de Salud de la Nación, Buenos Aires, Argentina
| | - D Ondarsuhu
- Instituto Nacional de Estadística y Censos, Ministerio de Economía y Finanzas Públicas, Buenos Aires, Argentina
| | - L Goldberg
- Ministerio de Salud de la Nación, Buenos Aires, Argentina
| | - B Linetzky
- Ministerio de Salud de la Nación, Buenos Aires, Argentina
| | - D Ferrante
- Ministerio de Salud de la Nación, Buenos Aires, Argentina
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Ferrante D, Konfino J, Linetzky B, Tambussi A, Laspiur S. Barriers to prevention of cardiovascular disease in primary care settings in Argentina. Rev Panam Salud Publica 2014; 33:259-66. [PMID: 23698174 DOI: 10.1590/s1020-49892013000400004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 12/15/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To identify main barriers to preventing cardiovascular disease and implementing clinical practice guidelines in primary care, to pilot implementation of a tailored enactment of the adapted World Health Organization guidelines to prevent cardiovascular disease, and to assess the impact of the intervention in risk stratification. METHODS A qualitative study was done with decision makers, health professionals, and staff from five primary health care centers, who were interviewed to identify the main barriers. A tailored intervention to apply the guidelines was then designed and implemented. To assess the impact of the intervention on risk factor screening, a before-and-after analysis was performed through a records review of independent samples of patients aged 40 years or older attending each center. RESULTS The main barriers identified were lack of awareness of guidelines and lack of knowledge about preventing cardiovascular disease, communication problems within health teams, lack of motivation, and organizational problems. Before (n = 226) and after (n = 234) the intervention, screening of the main risk factors increased: blood pressure measurement from 44.3% to 72.6%, cholesterol measurement from 20.7% to 49.7%, smoking status assessment from 20.4% to 56.1%, diabetes status assessment from 25.5% to 93.6%, and previous vascular event status from 33.2% to 74.3%. Global risk stratification was not done at baseline, compared with 45.1% after the intervention. CONCLUSIONS The main barriers identified were useful in designing a tailored intervention. Although no clinical outcomes were evaluated, this study shows that the implementation is feasible, with increased risk stratification as a first step at better patient management.
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Affiliation(s)
- Daniel Ferrante
- Programa Nacional de Prevención y Control de Enfermedades Cardiovasculares, Ministerio de Salud, Buenos Aires, Argentina.
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Linetzky B, Konfino J, Castellana N, De Maio F, Bahit MC, Orlandini A, Diaz R. Risk of cardiovascular events associated with positive serology for Chagas: a systematic review. Int J Epidemiol 2013; 41:1356-66. [PMID: 23045202 DOI: 10.1093/ije/dys125] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Chagas disease affects mainly poor populations in Latin America. This review assesses the evidence on the independent risk of cardiovascular events associated with positive Chagas serology. METHODS We searched for studies using the following outcomes: death, stroke, new onset heart failure, heart failure hospitalization or evidence of left ventricular dysfunction. Studies comparing patients with positive serology for Chagas with a control group with a follow-up longer than 1 year were selected. The Medline, Lilacs and Embase databases were searched on 21 January 2011 without restrictions. RESULTS From 5236 potentially relevant studies, 25 fulfilled the inclusion criteria. Fourteen included patients with heart failure, six with severe symptoms and nine with mild symptoms or asymptomatic patients with low ejection fraction. In four studies of patients in functional class III or IV and in three studies of patients with mild symptoms, a higher risk of death was reported among those with positive serology for Chagas. Of the 11 studies of patients without symptoms or low ejection fraction, 3 showed a higher risk of mortality related to Chagas exposure. Two of these were based on the same cohort of people aged >60 years. Overall, 8 out of the 14 heart failure studies and 2 out of the 11 heart damage studies adjusted for confounding factors. CONCLUSION Positive serology for Chagas is associated with a higher risk of death for patients with heart failure. However, there is little evidence to link positive serology for Chagas with cardiovascular events in asymptomatic subjects.
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De Maio FG, Linetzky B, Ferrante D. Changes in the social gradients for Pap smears and mammograms in Argentina: evidence from the 2005 and 2009 National Risk Factor Surveys. Public Health 2012; 126:821-6. [PMID: 23083845 DOI: 10.1016/j.puhe.2012.05.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 03/13/2012] [Accepted: 05/24/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To identify changes in the social gradients for Pap smears and mammograms in Argentina. STUDY DESIGN Secondary analysis of the 2005 and 2009 Argentine National Risk Factor Surveys. METHODS Logistic regression analysis was used to examine social gradients by income and education, adjusting for age and health insurance. RESULTS The proportion of women who received a Pap smear in the previous 2 years increased from 51.6% in 2005 to 60.5% in 2009 (χ(2) = 344.8, P < 0.001). A significant increase was also seen in the receipt of a mammogram in the previous 2 years by women aged ≥50 years, with an increase from 39.6% in 2005 to 52.6% in 2009 (χ(2) = 279.6, P < 0.001). In 2005, low-income women were most likely not to have received a Pap test [odds ratio (OR) = 3.27, 95% confidence interval (CI) = 2.70-3.98], followed by medium-income women (OR = 1.73, 95% CI = 1.41-2.12), compared with high-income women. The gradient by education was of a similar magnitude, and both income and education gradients remained stable from 2005 to 2009. Restricting the analysis to eight provinces that have been deemed to be high priority due to their high levels of mortality from cervical cancer reveals an increasing income-based gradient in Pap smears. In contrast, inequalities in mammography diminished across the country, with a significant reduction in the social gradient measured either by income or education. In contrast to high-income women, low-income women experienced higher odds of not having a mammogram, but the gap diminished over time [OR = 4.14 (95% CI = 2.96-5.78) in 2005 vs OR = 2.37 (95% CI = 1.81-3.11) in 2009]. CONCLUSION Social gradients in cancer screening are changing in Argentina. There are signs of a reduction in inequalities in mammograms, although this is attenuated by indications that inequalities in Pap smear utilization in priority provinces are growing. Surveillance of population indicators is needed to verify whether these short-term changes persist over time.
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Affiliation(s)
- F G De Maio
- Department of Sociology, DePaul University, 990 W. Fullerton Ave., Suite 1100, Chicago, IL 60614, USA.
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De Maio FG, Linetzky B, Ferrante D, Fleischer NL. Extending the income inequality hypothesis: Ecological results from the 2005 and 2009 Argentine National Risk Factor Surveys. Glob Public Health 2012; 7:635-47. [DOI: 10.1080/17441692.2012.663399] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Dehghan M, del Cerro S, Zhang X, Cuneo JM, Linetzky B, Diaz R, Merchant AT. Validation of a semi-quantitative Food Frequency Questionnaire for Argentinean adults. PLoS One 2012; 7:e37958. [PMID: 22662256 PMCID: PMC3360668 DOI: 10.1371/journal.pone.0037958] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 04/27/2012] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The Food Frequency Questionnaire (FFQ) is the most commonly used method for ranking individuals based on long term food intake in large epidemiological studies. The validation of an FFQ for specific populations is essential as food consumption is culture dependent. The aim of this study was to develop a Semi-quantitative Food Frequency Questionnaire (SFFQ) and evaluate its validity and reproducibility in estimating nutrient intake in urban and rural areas of Argentina. METHODS/PRINCIPAL FINDINGS Overall, 256 participants in the Argentinean arm of the ongoing Prospective Urban and Rural Epidemiological study (PURE) were enrolled for development and validation of the SFFQ. One hundred individuals participated in the SFFQ development. The other 156 individuals completed the SFFQs on two occasions, four 24-hour Dietary Recalls (24DRs) in urban, and three 24DRs in rural areas during a one-year period. Correlation coefficients (r) and de-attenuated correlation coefficients between 24DRs and SFFQ were calculated for macro and micro-nutrients. The level of agreement between the two methods was evaluated using classification into same and extreme quartiles and the Bland-Altman method. The reproducibility of the SFFQ was assessed by Pearson correlation coefficients and Intra-class Correlation Coefficients (ICC). The SFFQ consists of 96 food items. In both urban and rural settings de-attenuated correlations exceeded 0.4 for most of the nutrients. The classification into the same and adjacent quartiles was more than 70% for urban and 60% for rural settings. The Pearson correlation between two SFFQs varied from 0.30-0.56 and 0.32-0.60 in urban and rural settings, respectively. CONCLUSION Our results showed that this SFFQ had moderate relative validity and reproducibility for macro and micronutrients in relation to the comparison method and can be used to rank individuals based on habitual nutrient intake.
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Affiliation(s)
- Mahshid Dehghan
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
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Linetzky B, De Maio F, Ferrante D, Konfino J, Boissonnet C. Sex-stratified socio-economic gradients in physical inactivity, obesity, and diabetes: evidence of short-term changes in Argentina. Int J Public Health 2012; 58:277-84. [DOI: 10.1007/s00038-012-0371-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 05/02/2012] [Accepted: 05/03/2012] [Indexed: 11/30/2022] Open
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Linetzky B, Mejia R, Ferrante D, De Maio FG, Diez Roux AV. Socioeconomic status and tobacco consumption among adolescents: a multilevel analysis of Argentina's Global Youth Tobacco Survey. Nicotine Tob Res 2012; 14:1092-9. [PMID: 22394595 DOI: 10.1093/ntr/nts004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The relationship between poverty and tobacco consumption among adolescents has not been extensively studied, and what evidence exists has come almost entirely from developed countries. Moreover, the impact of contextual factors--such as school-level poverty--remains unclear. METHODS We obtained information about smoking behavior from the Global Youth Tobacco Survey in Argentina in 2007. School-level characteristics were derived by matching schools to census areas from the 2001 Census. Additional school-level information was obtained from the Ministry of Education. Random intercept models were used to evaluate the associations of school-level variables (poverty in the census area of the school, school receipt of social assistance, and public or private status) with current smoking, intention to quit, secondhand smoke exposure outside the home, support for smoke-free laws, purchase of single cigarettes among smokers, and susceptibility to smoking in 5 years among nonsmokers. RESULTS After controlling for age and sex, students attending schools receiving social assistance were more likely to smoke (odds ratio [OR] 1.35, 95% CI 1.02-1.80) and to purchase loose cigarettes (OR 1.66, 95% CI 1.08-2.54), whereas school poverty was significantly associated with secondhand smoke exposure (OR 1.27, 95% CI 1.04-1.58). CONCLUSION This study shows that an association exists between unfavorable contextual school characteristics and tobacco consumption and related measures among youth in Argentina. Efforts to prevent smoking may need to address the school-level factors that place youth at higher risk.
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Affiliation(s)
- Bruno Linetzky
- Dirección de Promoción de la Salud y Control de Enfermedades No Transmisibles, Ministerio de Salud de la Nación, Av 9 de julio 1925 9no, Ciudad de Buenos Aires, C1073ABA, Argentina.
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Linetzky B, Morello P, Virgolini M, Ferrante D. [Results from the First National School Health Survey: Argentina, 2007]. ARCH ARGENT PEDIATR 2011; 109:111-6. [PMID: 21465068 DOI: 10.1590/s0325-00752011000200004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Accepted: 12/22/2010] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The Global School Health Survey (EMSE, in Spanish) has been implemented globally since 2003 to estimate the prevalence of mayor risk behaviours and protective factors among teenagers aged 13 to 15 year old. In 2007, the first EMSE was implemented in Argentina. OBJECTIVE To describe the prevalence of certain risk factors among youth attending high school in Argentina. METHODOLOGY A low stage probabilistic sampling was used to select 50 schools nationwide. All students in randomly selected classes were invited to fill the self-administered questionnaire including 75 questions on demographics, alcohol, tobacco and other drugs use, eating habits, hygiene, violence, mental health, physical activity, sexual activity and protective factors. RESULTS Overall, the survey was answered by 1980 students from 47 schools. We include in this report data related to alcohol, tobacco and other drugs, weight, physical and sexual activity. In the last 30 days, 56,8% had consumed alcohol and 25,5% cigarettes. Overall, 11,7% had tried an illegal drug in their lifetime. Nineteen percent is overweight and less than 81% has completed the minimum required exercise for their age. Also, 33,6% had already had sex; 10,4% before age 13 and less than half of them always use a contraceptive method. CONCLUSIONS A high prevalence of sedentarism, overweight and substances use, like alcohol, tobacco and illegal drugs, was shown. The rate of condom use was low.
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Affiliation(s)
- Bruno Linetzky
- Dirección de Promoción de la Salud y Control de Enfermedades no Transmisibles, Ministerio de Salud de la Nación.
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Ferrante D, Linetzky B, Virgolini M, Schoj V, Apelberg B. Reduction in hospital admissions for acute coronary syndrome after the successful implementation of 100% smoke-free legislation in Argentina: a comparison with partial smoking restrictions. Tob Control 2011; 21:402-6. [PMID: 21602536 DOI: 10.1136/tc.2010.042325] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Several studies have shown a decrease in acute coronary syndrome (ACS) admissions after the implementation of 100% smoke-free legislation. However, no studies have been conducted in developing countries. METHODS We conducted a time series analysis of ACS hospital admissions in Santa Fe province and Buenos Aires city, Argentina. In 2006, Santa Fe implemented a 100% smoke-free law and Buenos Aires implemented a partial law with designated smoking areas and exceptions. Age-standardised ACS admissions rates were compared before and after the implementation of the laws in each district. Smoking prevalence, compliance with legislation and exposure to secondhand smoke (SHS) was also assessed in both districts. RESULTS In Santa Fe an immediate decrease in ACS admissions was observed after implementation (-2.5 admissions per 100,000, p=0.03; 13% reduction), compared with no change in Buenos Aires city (rate ratio Santa Fe vs Buenos Aires: 0.74, 95% CI 0.63 to 0.86, p≤0.001). In Santa Fe, the immediate effect was followed by a persistent decrease in admissions due to ACS (-0.26 admissions per 100,000 per month). Smoking prevalence did not change significantly in either district during the same period. In both districts, there was a reduction in self-reported SHS exposure, with a trend towards lower exposure in Santa Fe province. No other comprehensive tobacco control interventions were implemented during the study period. CONCLUSIONS A 100% smoke-free law was more effective than a partial restriction law in reducing ACS admissions. An immediate effect was followed by a sustained decrease in ACS admissions. Smoke-free initiatives can be also effective in decreasing acute coronary events in developing countries.
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Affiliation(s)
- D Ferrante
- Health Promotion Department, Ministry of Health, Buenos Aires, Argentina.
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Morello P, Linetzky B, Kaplan J. [Knowledge, attitudes, and practices of Argentine pediatricians regarding second hand smoke exposure in children]. ARCH ARGENT PEDIATR 2011; 108:318-24. [PMID: 20672189 DOI: 10.1590/s0325-00752010000400005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2009] [Accepted: 04/13/2010] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Passive smoking is a main public health problem in Argentina. It is estimated that about 55% of children live with a smoker at home. Several reports show that when parents and providers refrain from smoking at home and in the car, environmental tobacco exposure (ETS) and its health consequences decrease. OBJECTIVE To assess pediatricians' knowledge, beliefs and practices regarding passive smoking and its prevention. METHODOLOGY We surveyed a national sample of pediatricians, who participated in the National Pediatric Continuous Education Program (PRONAP) of the Argentine Pediatric Society, via e-mail. RESULTS Overall, 74% of the pediatricians that answered the questionnaire said that they always asked about ETS exposure during the pediatric visit, 50% writes that on the children's chart, 93% advises parents not to smoke at home, 64% motivates parents to quit smoking and 49% provides information materials about the topic. Overall, their knowledge about the diseases most associated with ETS is appropriate. Almost all pediatricians believe the topic is of public health importance and important for children's health. CONCLUSIONS The results of this survey show it is important to improve the training provided to pediatricians and to standardize the discussion and the treatment of ETS during the pediatric visit.
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Schoj V, Alderete M, Ruiz E, Hasdeu S, Linetzky B, Ferrante D. The impact of a 100% smoke-free law on the health of hospitality workers from the city of Neuquén, Argentina. Tob Control 2010; 19:134-7. [PMID: 20378587 PMCID: PMC2989166 DOI: 10.1136/tc.2009.032862] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives The objective of this study was to evaluate the impact of 100% smoke-free environment legislation on respiratory and sensory irritation symptoms and respiratory function among bar and restaurant workers from the city of Neuquén, Argentina. Methods Pre-ban and post-ban studies without a comparison group in an Argentinean city were conducted. A baseline survey and spirometric measurements were performed with a total of 80 bar and restaurant workers 1 month before (October 2007) and 3 months after (March 2008) the implementation of the new 100% smoke-free legislation. Results A significant reduction in secondhand smoke exposure was observed after the enactment and enforcement of the new legislation, and an important reduction in respiratory symptoms (from a pre-ban level of 57.5% to a post-ban level of only 28.8%). The reduction of sensory irritation symptoms was even higher. From 86.3% of workers who reported at least one sensory irritation symptom in October 2007, only 37.5% reported the same symptoms in March 2008. Also, data obtained by spirometry showed a significant forced vital capacity increase. Conclusions Consistent with other studies, 100% smoke-free legislation improved short-term health outcomes in the sample and should be implemented nationwide. Furthermore, undertaking this study has been highly important in promoting 100% smoke-free environment legislation at the workplace as a legitimate right of hospitality workers, and in reducing social acceptance of designated smoking areas in bars and restaurants.
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Affiliation(s)
- Veronica Schoj
- GRANTAHI (Programa de Control de Tabaco) y Servicio de Medicina Familiar, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
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Waldman SV, Diez JCL, Arazi HC, Linetzky B, Guinjoan S, Grancelli H. Burnout, perceived stress, and depression among cardiology residents in Argentina. Acad Psychiatry 2009; 33:296-301. [PMID: 19690109 DOI: 10.1176/appi.ap.33.4.296] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Because medical residency is a stressful time for training physicians, placing residents at increased risk for psychological distress, the authors studied the prevalence of burnout, perceived stress, and depression in cardiology residents in Argentina and examined the association between sociodemographic characteristics and these syndromes. METHODS The authors conducted a cross-sectional observational study of 106 cardiology residents in Argentina and a comparison group of 104 age- and gender-matched nonmedical professionals. The main outcome measures included the prevalence of burnout with the Maslach Burnout Inventory, distress with the Perceived Stress Scale, and depression with the Beck Depression Inventory. RESULTS One hundred six residents completed the survey. Of these, 31.3% were women, the mean age was 29.1 years old, and half were married. Respondents worked an average of 64 hours per week, and 60% of the residents needed a second job. High emotional exhaustion and depersonalization was found in the majority of respondents. Significant depressive symptoms were found in less than half of residents, and stress was on average 21.7 points on the Perceived Stress Scale. Residents who had a second job showed high levels of depersonalization. No other association was found with sociodemographic characteristics. There were no differences in sociodemographic characteristics of residents compared with nonmedical professionals, but nonmedical professionals worked less hours per week, had a lower percentage of second jobs, and higher salary. Burnout, depressive symptoms, and perceived stress were significantly lower in the reference group. CONCLUSION Cardiology residents in Argentina exhibit high levels of burnout, perceived stress, and depressive symptoms, which warrants greater attention to the psychological needs of residents.
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Affiliation(s)
- Silvina V Waldman
- Cardiology, Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia, Montañeses 2325, Buenos Aires, Argentina.
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De Maio FG, Linetzky B, Virgolini M. An average/deprivation/inequality (ADI) analysis of chronic disease outcomes and risk factors in Argentina. Popul Health Metr 2009; 7:8. [PMID: 19505309 PMCID: PMC2700078 DOI: 10.1186/1478-7954-7-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2008] [Accepted: 06/08/2009] [Indexed: 11/15/2022] Open
Abstract
Background Recognition of the global economic and epidemiological burden of chronic non-communicable diseases has increased in recent years. However, much of the research on this issue remains focused on individual-level risk factors and neglects the underlying social patterning of risk factors and disease outcomes. Methods Secondary analysis of Argentina's 2005 Encuesta Nacional de Factores de Riesgo (National Risk Factor Survey, N = 41,392) using a novel analytical strategy first proposed by the United Nations Development Programme (UNDP), which we here refer to as the Average/Deprivation/Inequality (ADI) framework. The analysis focuses on two risk factors (unhealthy diet and obesity) and one related disease outcome (diabetes), a notable health concern in Latin America. Logistic regression is used to examine the interplay between socioeconomic and demographic factors. The ADI analysis then uses the results from the logistic regression to identify the most deprived, the best-off, and the difference between the two ideal types. Results Overall, 19.9% of the sample reported being in poor/fair health, 35.3% reported not eating any fruits or vegetables in five days of the week preceding the interview, 14.7% had a BMI of 30 or greater, and 8.5% indicated that a health professional had told them that they have diabetes or high blood pressure. However, significant variation is hidden by these summary measures. Educational attainment displayed the strongest explanatory power throughout the models, followed by household income, with both factors highlighting the social patterning of risk factors and disease outcomes. As educational attainment and household income increase, the probability of poor health, unhealthy diet, obesity, and diabetes decrease. The analyses also point toward important provincial effects and reinforce the notion that both compositional factors (i.e., characteristics of individuals) and contextual factors (i.e., characteristics of places) are important in understanding the social patterning of chronic diseases. Conclusion The application of the ADI framework enables identification of the regions or groups worst-off for each outcome measure under study. This can be used to highlight the variation embedded within national averages; as such, it encourages a social perspective on population health indicators that is particularly attuned to issues of inequity. The ADI framework is an important tool in the evaluation of policies aiming to prevent or control chronic non-communicable diseases.
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Affiliation(s)
- Fernando G De Maio
- Department of Sociology & Anthropology, Simon Fraser University, Burnaby, British Columbia, Canada.
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Arazi HC, Capparelli FJ, Linetzky B, Rebolledo FP, Augustovski F, Wainsztein NA. Carotid endarterectomy in asymptomatic carotid stenosis: A decision analysis. Clin Neurol Neurosurg 2008; 110:472-9. [DOI: 10.1016/j.clineuro.2008.02.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2007] [Revised: 02/01/2008] [Accepted: 02/07/2008] [Indexed: 10/22/2022]
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