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Telo GH, Friedrich Fontoura L, Avila GO, Gheno V, Bertuzzo Brum MA, Teixeira JB, Erthal IN, Alessi J, Telo GH. Obesity bias: How can this underestimated problem affect medical decisions in healthcare? A systematic review. Obes Rev 2024; 25:e13696. [PMID: 38272850 DOI: 10.1111/obr.13696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/24/2023] [Accepted: 12/06/2023] [Indexed: 01/27/2024]
Abstract
INTRODUCTION Obesity is often labeled as a physical characteristic of a patient rather than a disease and it is subject to obesity bias by health providers, which harms the equality of healthcare in this population. OBJECTIVE Identifying whether obesity bias interferes in clinical decision-making in the treatment of patients with obesity. METHODS A systematic review of observational studies published between 1993 and 2023 in MEDLINE, Embase, and Cochrane Library on obesity bias and therapeutic decisions was carried out. The last search was conducted on June 30, 2023. The main outcome was the difference between clinical decisions in the treatment of individuals with and without obesity. The Newcastle-Ottawa scale for observational studies was used to assess for quality. After the selection process, articles were presented in narrative and thematic synthesis categories to better organize the descriptive analysis. RESULTS Of the 2546 records identified, 13 were included. The findings showed fewer screening exams for cancer in patients with obesity, who were also susceptible to less frequent pharmacological treatment intensification in the management of diabetes. Women with obesity received fewer pelvic exams and evidence of diminished visual contact and physician confidence in treatment adherence was reported. Some studies found no disparities in treatment for abdominal pain and tension headaches between patients presented with and without obesity. CONCLUSION The presence of obesity bias has negative effects on medical decision-making and on the quality of care provided to patients with obesity. These findings reveal the urgent necessity for reflection and development of strategies to mitigate its adverse impacts. (The protocol was registered with the international prospective register of systematic reviews, PROSPERO, under the number CRD42022307567).
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Affiliation(s)
- Guilherme Heiden Telo
- Medicine and Health Sciences Graduate Program, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
- Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Lucas Friedrich Fontoura
- Medicine and Health Sciences Graduate Program, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Georgia Oliveira Avila
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Vicenzo Gheno
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Julia Belato Teixeira
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Isadora Nunes Erthal
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Janine Alessi
- Medicine and Health Sciences Graduate Program, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
- Endocrinology Division, Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
- General Internal Medicine Division, Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Gabriela Heiden Telo
- Medicine and Health Sciences Graduate Program, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
- General Internal Medicine Division, Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
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da Costa FL, Matzenbacher LS, Gheno V, Brum MAB, de Barros LGB, Maia IS, Blank LM, Fontoura LF, Alessi J, Telo GH. Interactive virtual assistance for mental health promotion and self-care management in elderly with type 2 diabetes (IVAM-ED): study protocol and statistical analysis plan for a randomized controlled trial. Trials 2024; 25:205. [PMID: 38515201 PMCID: PMC10956275 DOI: 10.1186/s13063-024-08055-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 03/12/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND With one in five individuals aged 65 or older living with type 2 diabetes worldwide, it is crucial to acknowledge and address the challenges faced by this population. In this context, our study aims to evaluate the efficacy of a behavioral intervention model delivered through a smart speaker on mental health and diabetes self-care in the elderly with diabetes. METHODS This is a single-center, pragmatic, parallel two-arm open randomized clinical trial involving elderly patients with type 2 diabetes. We plan to enroll a total of 112 individuals who will be randomized 1:1 to receive the Smart Speaker EchoDot 3rd Gen device (Amazon Echo®) for home use (intervention arm) or to maintain usual care (control arm). The primary outcome is mental distress, assessed using the 20-item Self Reporting Questionnaire (SRQ-20) after a 12-week intervention period. Secondary outcomes include quality of life, adherence to diabetes self-care behaviors, perception of stress, glycemic control, blood pressure, and lipid profile. Analysis of covariance (ANCOVA) will be used to evaluate the effects of the intervention on the outcomes. DISCUSSION This study assesses the effectiveness of an interactive virtual assistance system for enhancing mental health and glycemic control among elderly individuals with type 2 diabetes. The findings may introduce smart speakers as a valuable tool for promoting diabetes-related self-care in this population. TRIAL REGISTRATION ClinicalTrials.gov NCT05329376. Registered on 15 April 2022. Enrollment began on 20 June 2023 and the last update of protocol was on 13 December 2023.
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Affiliation(s)
- Frederico Ludwig da Costa
- Post-Graduate Program in Medicine and Health Sciences, Pontifícia Universidade Católica Do Rio Grande Do Sul, Porto Alegre, Brazil
- Internal Medicine Division, Hospital São Lucas - Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Vicenzo Gheno
- School of Medicine, Pontifícia Universidade Católica Do Rio Grande Do Sul, Porto Alegre, Brazil
| | | | | | - Isabela Semmelmann Maia
- School of Medicine, Pontifícia Universidade Católica Do Rio Grande Do Sul, Porto Alegre, Brazil
| | - Luiza Machado Blank
- School of Medicine, Pontifícia Universidade Católica Do Rio Grande Do Sul, Porto Alegre, Brazil
| | - Lucas Friedrich Fontoura
- Post-Graduate Program in Medicine and Health Sciences, Pontifícia Universidade Católica Do Rio Grande Do Sul, Porto Alegre, Brazil
| | - Janine Alessi
- Internal Medicine Division, Hospital São Lucas - Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
- Medicine and Health Sciences Graduate Program, Pontifícia Universidade Católica Do Rio Grande Do Sul, Porto Alegre, Brazil
| | - Gabriela Heiden Telo
- Internal Medicine Division, Hospital São Lucas - Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.
- Medicine and Health Sciences Graduate Program, Pontifícia Universidade Católica Do Rio Grande Do Sul, Porto Alegre, Brazil.
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Foppa L, Nemetz B, de Matos R, Schneiders J, Telo GH, Schaan BD. The impact of patient navigation on glycemic control, adherence to self-care and knowledge about diabetes: an intervention study. Diabetol Metab Syndr 2023; 15:172. [PMID: 37592361 PMCID: PMC10433589 DOI: 10.1186/s13098-023-01147-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/03/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Patient navigation helps with better adherence to treatment, as well as better knowledge about diabetes and greater interest in performing, monitoring, and seeking health care. Therefore, this study aims to evaluate the effect of patient navigation on glycemic control, disease knowledge, adherence to self-care in people with type 1 diabetes mellitus. METHODS This is an intervention study using a single group pre-test post-test design, carried out in a tertiary public teaching hospital in Southern Brazil. Participants over 18 years of age and diagnosed with type 1 diabetes were included. In total, three teleconsultations and one face-to-face consultation were carried out, with three-month intervals, until completing one year of follow-up. The nurse navigator conducted diabetes education based on the guidelines of the Brazilian Diabetes Society and the Nursing Interventions Classification. The differences between glycated hemoglobin, adherence to self-care, and knowledge about initial and final diabetes were estimated to verify the effect of patient navigation by nurses, according to the tool applied in the first and last consultations. Interaction analyses between variables were also performed. Student's t-test, Generalized Estimating Equations, Wilcoxon test, and McNemar test were used. RESULTS The final sample consisted of 152 participants, of which 85 (55.9%) were women, with a mean age of 45 ± 12 years, and diabetes duration of 23.6 ± 11.1 years. Nurse navigators conducted 812 teleconsultations and 158 face-to-face consultations. After the intervention, glycemic control improved in 37 (24.3%) participants (p < 0.001), and knowledge about diabetes also improved in 37 (24.3%) participants (p < 0.001). Adherence to self-care increased in 82 (53.9%) patients (p < 0.001). The analysis of the interaction between glycemic control and the results from the questionnaire of knowledge about diabetes showed an interaction effect (p = 0.005). However, we observed no interaction effect between glycemic control and the results from the questionnaire on adherence to self-care (p = 0.706). CONCLUSIONS Our results showed improvement in glycemic control, adherence to self-care, and knowledge of diabetes in the study participants. In addition, they suggest that patient navigation performed by nurses is promising and feasible in improving care for patients with type 1 diabetes.
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Affiliation(s)
- Luciana Foppa
- Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos 2350, Porto Alegre, RS, 90035-003, Brazil.
- Post-Graduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2400, 2º Andar, Porto Alegre, RS, 90035-003, Brazil.
| | - Betina Nemetz
- Nurse School, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, Porto Alegre, RS, 90035-002, Brazil
| | - Rosimeri de Matos
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Avenida Ipiranga, 6680, Jardim Botânico, Porto Alegre, RS, 90619-900, Brazil
| | - Josiane Schneiders
- Post-Graduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2400, 2º Andar, Porto Alegre, RS, 90035-003, Brazil
| | - Gabriela Heiden Telo
- Pontifícia Universidade Católica do Rio Grande do Sul, Avenida Ipiranga, 6681, Partenon, Porto Alegre, RS, 90619-900,, Brazil
| | - Beatriz D Schaan
- Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos 2350, Porto Alegre, RS, 90035-003, Brazil
- Post-Graduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2400, 2º Andar, Porto Alegre, RS, 90035-003, Brazil
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Foppa L, Nemetz B, De Matos R, Schneiders J, Telo GH, Schaan BD. Knowledge about diabetes and its association with adherence to self-care and glycemic control in patients with type 1 diabetes in Southern Brazil. Arch Endocrinol Metab 2023; 67:e000648. [PMID: 37364150 PMCID: PMC10660993 DOI: 10.20945/2359-3997000000648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 03/14/2023] [Indexed: 06/28/2023]
Abstract
Objective To evaluate the association between knowledge about the disease, adherence to self-care, and glycemic control in people diagnosed with type 1 diabetes mellitus. Subjects and methods A cross-sectional study of patients aged over 18 years diagnosed with type 1 diabetes mellitus, treated at an outpatient clinic of a Brazilian university hospital. Participants with other types of diabetes, cognitive impairment, pregnancy, and outpatient discharge were excluded. Data were collected from January to March 2021 (by telephone call), with questions about the participants' profile, diabetes knowledge questionnaire (DKN-A), and self-care inventory revised (SCI-R) translated into and adapted for Brazilian Portuguese. Data analysis involved chi-square associations, Mann-Whitney U tests, and Poisson regression. Results Among 198 adult participants, the mean age was 42 ± 12 years, 53.5% were women, the mean glycated hemoglobin was 8.6 ± 1.6%, 140 (70.8%) had satisfactory knowledge about diabetes, 65 (32.8%) had adherence to self-care, and 46 (23.2%) had adequate glycemic control. We found an association between knowledge and adherence to self-care (p < 0.001). Knowledge was not associated with glycemic control (p = 0.705). Conclusion Knowledge about diabetes was associated with greater adherence to self-care in people with type 1 diabetes mellitus, but it did not reflect in better glycemic control.
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Affiliation(s)
- Luciana Foppa
- Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brasil,
- Programa de Pós-graduação em Endocrinologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Betina Nemetz
- Escola de Enfermagem, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Rosimeri De Matos
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Josiane Schneiders
- Programa de Pós-graduação em Endocrinologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Gabriela Heiden Telo
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Beatriz D Schaan
- Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brasil
- Programa de Pós-graduação em Endocrinologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
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Alessi J, Avila GO, de Pádua Borges R, da Rocha Oppermann ML, Telo GH, Schaan BD. Revisiting healthcare accessibility in gestational diabetes during the "pregnancy and infant loss awareness month": are we looking at the bigger picture? Acta Diabetol 2023; 60:323-324. [PMID: 35978139 DOI: 10.1007/s00592-022-01957-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 08/04/2022] [Indexed: 01/24/2023]
Affiliation(s)
- Janine Alessi
- Medical Science Program Endocrinology, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, Porto Alegre, 90035-000, Brazil.
- Postgraduate Program in Medicine and Health Sciences at the Pontifícia Universidade Católica do Rio Grande Do Sul, Porto Alegre, Brazil.
| | - Georgia Oliveira Avila
- School of Medicine, Pontifícia Universidade Católica do Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
| | - Roberta de Pádua Borges
- Medical Science Program Endocrinology, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, Porto Alegre, 90035-000, Brazil
| | | | - Gabriela Heiden Telo
- Postgraduate Program in Medicine and Health Sciences at the Pontifícia Universidade Católica do Rio Grande Do Sul, Porto Alegre, Brazil
- School of Medicine, Pontifícia Universidade Católica do Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
| | - Beatriz D Schaan
- Medical Science Program Endocrinology, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, Porto Alegre, 90035-000, Brazil
- Endocrinology Division, Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Brazil
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Franco DW, Alessi J, de Carvalho TR, Kobe GL, Oliveira GB, Knijnik CP, Amaral B, Becker AS, Schaan BD, Telo GH. The impact of a telehealth intervention on the metabolic profile of diabetes mellitus patients during the COVID-19 pandemic - A randomized clinical trial. Prim Care Diabetes 2022; 16:745-752. [PMID: 36266163 PMCID: PMC9553195 DOI: 10.1016/j.pcd.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 08/30/2022] [Accepted: 09/27/2022] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The objective of this study was to evaluate the impact of a telehealth intervention on metabolic outcomes and self-perceptions of the patients regarding their management of diabetes during the COVID-19 pandemic. METHODS This is a non-blind randomized controlled clinical trial to assess a telehealth intervention. We included adults with diabetes mellitus. The outcomes assessed were the level of HbA1c, lipid profile, blood pressure levels, weight, body mass index and self-perceptions about diabetes management. RESULTS A total of 150 individuals with diabetes participated in the study and at the end of telehealth intervention there were no changes in the patient's HbA1c levels between intervention and control groups for neither type 1 (8.1% vs. 8.6%; p = 0.11) nor type 2 diabetes (8.6% vs. 9.0%; p = 0.09), respectively. From the rest of the metabolic profile, triglyceride levels from type 1 diabetes group was the only variable that demonstrated improvement with telehealth intervention (66.5% intervention group vs. 86.5% control group; p = 0.05). CONCLUSIONS After 4 months of telehealth intervention, no statistically significant results were observed in HbA1c nor in secondary outcomes (with the exception of triglycerides for the type 1 diabetes group).
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Affiliation(s)
- Debora Wilke Franco
- Post-graduate program in Medicine and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul, Brazil; School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Brazil.
| | - Janine Alessi
- Internal Medicine department, Hospital São Lucas - Pontifícia Universidade Católica do Rio Grande do Sul, Brazil; Post-graduate program in Medical Science: Endocrinology, Universidade Federal do Rio Grande do Sul, Brazil
| | - Taíse Rosa de Carvalho
- Post-graduate program in Medicine and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul, Brazil; Internal Medicine department, Hospital São Lucas - Pontifícia Universidade Católica do Rio Grande do Sul, Brazil
| | - Gabriel Luiz Kobe
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Brazil
| | | | | | - Bibiana Amaral
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Brazil
| | | | - Beatriz D Schaan
- Post-graduate program in Medical Science: Endocrinology, Universidade Federal do Rio Grande do Sul, Brazil; School of Medicine, Universidade Federal do Rio Grande do Sul, Brazil; Endocrinology division, Hospital de Clínicas de Porto Alegre, Brazil
| | - Gabriela Heiden Telo
- Post-graduate program in Medicine and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul, Brazil; Internal Medicine department, Hospital São Lucas - Pontifícia Universidade Católica do Rio Grande do Sul, Brazil; School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Brazil
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de Pádua Borges R, Avila GO, Ritter AC, Alessi J, Reichelt AJ, Lucia da Rocha Oppermann M, Telo GH, Schaan BD. Healthcare of pregnant women with diabetes during the COVID-19 pandemic: a Southern Brazilian cross-sectional panel data. J Perinat Med 2022; 51:524-530. [PMID: 36398907 DOI: 10.1515/jpm-2022-0177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 09/27/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To evaluate the indirect effects of the COVID-19 pandemic on the care of women with pregnancies complicated by gestational or pre-existing diabetes, and their maternal-fetal outcomes. METHODS A cross-sectional panel data conducted in a University Hospital in Southern Brazil. Maternal-fetal outcomes and predictors of care from 235 pregnant women with type 1, type 2, or gestational diabetes were evaluated. Two time periods were compared: six months preceding the pandemic, in 2019, and the COVID-19 period from September 2020 to March 2021. Comparisons were performed using analysis of variance, Mann-Whitney U, Fisher's exact and T-tests. Risks were calculated using the Poisson regression with robust estimates. RESULTS Maternal age was lower (32.1 ± 6.8 vs. 34.4 ± 6.6, p=0.009) and rates of depression/anxiety were higher (16.5 vs. 7.4%, p=0.046) in the group evaluated during the COVID-19. Neonatal hypoglycemia (RR 4.04; 95% CI 1.37-11.98, p=0.012), and SGA rates (RR 4.29; 95% CI 1.93-9.54, p<0.001) were higher in the group assessed before the pandemic. CONCLUSIONS Despite economic, social and structural impacts of the pandemic, parameters of maternal care were similar; diabetes control improved, and neonatal hypoglycemia and SGA rates were lower among pregnant women with diabetes during the pandemic.
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Affiliation(s)
- Roberta de Pádua Borges
- Post-graduate Program in Medical Science Program: Endocrinology, Universidade Federal do Rio Grande do Sul (PPG Endo - UFRGS), Porto Alegre, Brazil
| | - Georgia Oliveira Avila
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Amanda Cunha Ritter
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Janine Alessi
- Post-graduate Program in Medical Science Program: Endocrinology, Universidade Federal do Rio Grande do Sul (PPG Endo - UFRGS), Porto Alegre, Brazil
| | - Angela Jacob Reichelt
- Post-graduate Program in Medical Science Program: Endocrinology, Universidade Federal do Rio Grande do Sul (PPG Endo - UFRGS), Porto Alegre, Brazil.,Endocrinology and Metabolism Division, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | | | - Gabriela Heiden Telo
- Internal Medicine Department, PUCRS, Porto Alegre, Brazil.,Medicine and Health Sciences Program, PUCRS, Porto Alegre, Brazil
| | - Beatriz D Schaan
- Post-graduate Program in Medical Science Program: Endocrinology, Universidade Federal do Rio Grande do Sul (PPG Endo - UFRGS), Porto Alegre, Brazil.,Endocrinology and Metabolism Division, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
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Sartor ITS, de David CN, Telo GH, Zavaglia GO, Fernandes IR, Kern LB, Polese-Bonatto M, Azevedo TR, Santos AP, de Almeida WAF, Porto VBG, Varela FH, Scotta MC, Rosa RG, Stein RT. Association between obesity and hospitalization in mild COVID-19 adult outpatients in Brazil: a prospective cohort study. Arch Endocrinol Metab 2022; 66:512-521. [PMID: 36074943 PMCID: PMC10697638 DOI: 10.20945/2359-3997000000486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 01/19/2022] [Indexed: 06/15/2023]
Abstract
Objective To evaluate the association between obesity and hospitalization in mild COVID-19 adult outpatients in Brazil. Methods Adults with signs and symptoms suggestive of acute SARS-CoV-2 infection who sought treatment in two hospital (public and private) emergency departments were prospectively enrolled. Patients with confirmed COVID-19 at inclusion were followed by phone calls at days D7, D14 and D28. Multivariable logistic regression models were employed to explore the association between obesity and other potential predictors for hospitalization. Results A total of 1,050 participants were screened, and 297 completed the 28-day follow-up and were diagnosed with COVID-19 by RT-PCR. The median age was 37.2 (IQR 29.7-44.6) years, and 179 (60.0%) were female. The duration of symptoms was 3.0 (IQR 2.0-5.0) days, and 10.0 (IQR 8.0-12.0) was the median number of symptoms at inclusion. Ninety-five (32.0%) individuals had obesity, and 233 (78.5%) had no previous medical conditions. Twenty-three participants (7.7%) required hospitalization during the follow-up period. After adjusting, obesity (BMI ≥ 30.0 kg/m2) (OR = 2.69, 95% CI 1.63-4.83, P < 0.001) and older age (OR = 1.05, 95% CI 1.01-1.09, P < 0.001) were significantly associated with higher risks of hospitalization. Conclusion Obesity, followed by aging, was the main factor associated with hospital admission for COVID-19 in a young population in a low-middle income country. Our findings highlighted the need to promote additional protection for individuals with obesity, such as vaccination, and to encourage lifestyle changes.
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Affiliation(s)
| | | | - Gabriela Heiden Telo
- Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | | | | | | | | | - Thaís Raupp Azevedo
- Responsabilidade Social, Hospital Moinhos de Vento, Porto Alegre, RS, Brasil
| | - Amanda Paz Santos
- Responsabilidade Social, Hospital Moinhos de Vento, Porto Alegre, RS, Brasil
| | | | | | - Fernanda Hammes Varela
- Responsabilidade Social, Hospital Moinhos de Vento, Porto Alegre, RS, Brasil
- Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Marcelo Comerlato Scotta
- Responsabilidade Social, Hospital Moinhos de Vento, Porto Alegre, RS, Brasil
- Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Regis Goulart Rosa
- Responsabilidade Social, Hospital Moinhos de Vento, Porto Alegre, RS, Brasil
| | - Renato T Stein
- Responsabilidade Social, Hospital Moinhos de Vento, Porto Alegre, RS, Brasil
- Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil
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da Rosa Carlos Monteiro LE, Garcia SP, Bottino LG, Custodio JL, Telo GH, Schaan BD. Precipitating factors of diabetic ketoacidosis in type 1 diabetes patients at a tertiary hospital: a cross-sectional study with a two-time-period comparison. Arch Endocrinol Metab 2022; 66:2359-3997000000480. [PMID: 35657124 PMCID: PMC9832855 DOI: 10.20945/2359-3997000000480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 03/02/2022] [Indexed: 11/23/2022]
Abstract
Objective To evaluate the precipitating factors of diabetic ketoacidosis (DKA) in patients with type 1 diabetes hospitalized through the emergency department of a tertiary hospital. Materials and methods Individuals with type 1 diabetes hospitalized for DKA from January 2005 to March 2010 (first period [P1], n = 75) and from April 2010 to January 2017 (second period [P2], n = 97) were identified through a query of electronic medical records. Data were collected by reviewing medical records. Only the first hospitalization of each participant in each period was included. Results In P2, 44 patients (45.4%) were women, mean age was 26.2 ± 14.5 years, and 74 patients (76.3%) had a previous diagnosis of type 1 diabetes. Only 1 patient had glycated haemoglobin (HbA1c) below 64 mmol/mol (8.0%). Most patients (62.2%) had had a previous episode of DKA. In P1, non-adherence was the main cause of DKA (38.7%), followed by infection (24.0%). In P2, these rates were 34.0% and 24.7%, respectively; no statistical difference was observed between the two study periods (p = 0.790). Conclusion Over time, non-adherence remained the main precipitating factor of DKA, followed by infection, and no significant difference was observed between the two study periods. Elevated HbA1c, outside the therapeutic range, indicates suboptimal diabetes care and may explain, at least in part, poor adherence as a precipitating factor of decompensation. Health strategies, such as improved self-management of type 1 diabetes, may contribute to a future reduction in DKA episodes.
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Affiliation(s)
| | - Sheila Piccoli Garcia
- Programa de Pós-graduação em Endocrinologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | | | - Julia Luchese Custodio
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Gabriela Heiden Telo
- Programa de Pós-graduação em Medicina e Ciências da Saúde, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil
- Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Beatriz D Schaan
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
- Programa de Pós-graduação em Endocrinologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
- Divisão de Endocrinologia, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
- Instituto Nacional de Ciência e Tecnologia para Avaliação de Tecnologias em Saúde - Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Porto Alegre, RS, Brasil,
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10
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Foppa L, Alessi J, Nemetz B, de Matos R, Telo GH, Schaan BD. Quality of care in patients with type 1 diabetes during the COVID-19 pandemic: a cohort study from Southern Brazil. Diabetol Metab Syndr 2022; 14:75. [PMID: 35598019 PMCID: PMC9123820 DOI: 10.1186/s13098-022-00845-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 01/15/2022] [Accepted: 05/10/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Optimal glycemic control is the main goal for patients with diabetes. The results of type 1 diabetes patients' neglected demands during the pandemic can determine a long-term negative clinical, social, and economic impact, and result in worse diabetes control and a higher incidence of chronic complications. Therefore, this study aims to evaluate the impact of the COVID-19 outbreak in the quality of care of patients with type 1 diabetes in Southern Brazil. METHODS Cohort study based on electronic medical records of patients with type 1 diabetes, with scheduled appointments between January 1st 2020, and November 6th 2020, at a university public hospital. The quality indicators used were: assessment of albuminuria and/or serum creatinine, lipid profile, thyroid-stimulating hormone, glycated hemoglobin, retinopathy, and neuropathy. McNemar test was used to analyze categorical variables and the Wilcoxon test for continuous variables. RESULTS Out of 289 patients, 49.5% were women aged 40 ± 12 years old. During the pandemic, 252 patients had at least one face-to-face appointment canceled. The quality of care indicators showed a significant worsening during the COVID-19 pandemic compared to the previous year (p < 0.001). In 2019, 23.2% of the participants had all the indicators evaluated, while in 2020, during the pandemic, only 3.5% had all of them evaluated. CONCLUSION The COVID-19 pandemic hindered the offer of comprehensive and quality care to patients with type 1 diabetes.
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Affiliation(s)
- Luciana Foppa
- Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos 2350, Porto Alegre, RS, 90035-003, Brazil.
- Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2400, 2º andar, Porto Alegre, RS, 90035-003, Brazil.
| | - Janine Alessi
- Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2400, 2º andar, Porto Alegre, RS, 90035-003, Brazil
| | - Betina Nemetz
- Nurse School, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, Porto Alegre, RS, 90035-002, Brazil
| | - Rosimeri de Matos
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Avenida Ipiranga, 6680, Jardim Botânico, Porto Alegre, RS, 90619-900, Brazil
| | - Gabriela Heiden Telo
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Avenida Ipiranga, 6680, Jardim Botânico, Porto Alegre, RS, 90619-900, Brazil
- Pontifícia Universidade Católica do Rio Grande do Sul, Avenida Ipiranga, Partenon, Porto Alegre, RS, 668190619-900, Brazil
| | - Beatriz D Schaan
- Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos 2350, Porto Alegre, RS, 90035-003, Brazil
- Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2400, 2º andar, Porto Alegre, RS, 90035-003, Brazil
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11
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Alessi J, Becker AS, Amaral B, de Oliveira GB, Franco DW, Knijnik CP, Kobe GL, de Brito A, de Carvalho TR, Telo GH, Schaan BD, Telo GH. Type 1 diabetes and the challenges of emotional support in crisis situations: results from a feasibility study of a multidisciplinary teleintervention. Sci Rep 2022; 12:8526. [PMID: 35595850 PMCID: PMC9120802 DOI: 10.1038/s41598-022-12227-z] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 04/19/2022] [Indexed: 11/09/2022] Open
Abstract
The association between type 1 diabetes and mental health disorders could be exacerbated in a stressful environment. This study aimed to evaluate the feasibility of a teleguided intervention on emotional disorders in patients with type 1 diabetes during the COVID-19 outbreak. This study was performed during the social distancing period in the COVID-19 outbreak in Brazil. Individuals with type 1 diabetes aged ≥ 18 years were selected to receive a teleguided multidisciplinary intervention or the usual care plus an educational website access. The proposed intervention aimed addressing aspects of mental health, diabetes care and lifestyle habits during the pandemic. The feasibility outcome included the assessment of recruitment capability and adherence to the proposed intervention. Moreover, we evaluated the presence of positive screening for emotional disorders (Self Report Questionnaire 20) after a 16-week intervention, patients' perceptions of pandemic-related changes, diabetes-related emotional distress, eating disorders, and sleep disorders. Data were analyzed with the intent-to-treat principle. Fifty-eight individuals (mean age, 43.8 ± 13.6 years) were included (intervention group, n = 29; control group, n = 29). At the end of the study, a total of 5 participants withdrew from the study in the intervention group compared to only 1 in the control group. Participants who dropout from the study had similar mean age, sex and income to those who remained in the study. The analysis of mental health disorders was not different between the groups at the follow up: a positive screening result was found in 48.3% and 34.5% of participants in the intervention and control groups, respectively (P = 0.29). The intervention group felt more supported in their diabetes care during the social distancing period (82.8% vs. 48.3% in the control group, P < 0.01). Our study identified a disproportionate higher number of withdrawals in the intervention group when compared to the control group. This difference may have compromised the power of the study for the proposed assessments and should be reevaluated in future studies.Trial registration: ClinicalTrials.gov (NCT04344210). Date of registration: 14/04/2020.
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Affiliation(s)
- Janine Alessi
- Medical Science Program: Endocrinology, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350, prédio 12, 4° andar, Porto Alegre, RS, 90035-003, Brazil. .,Internal Medicine Department, Hospital São Lucas-Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.
| | - Alice Scalzilli Becker
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Bibiana Amaral
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Débora Wilke Franco
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Gabriel Luiz Kobe
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Ariane de Brito
- Medical Science Program: Endocrinology, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350, prédio 12, 4° andar, Porto Alegre, RS, 90035-003, Brazil
| | - Taíse Rosa de Carvalho
- Medical and Health Sciences Program, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Guilherme Heiden Telo
- Medical and Health Sciences Program, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Beatriz D Schaan
- Medical Science Program: Endocrinology, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350, prédio 12, 4° andar, Porto Alegre, RS, 90035-003, Brazil.,School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Endocrinology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,National Institute of Science and Technology for Health Technology Assessment (IATS)-CNPq, Porto Alegre, Brazil
| | - Gabriela Heiden Telo
- Internal Medicine Department, Hospital São Lucas-Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.,School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.,Medical and Health Sciences Program, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
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12
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da Silveira DL, da Rosa Carlos Monteiro LE, da Silva Christofoli C, Schaan BD, Telo GH. Number of teeth lost on diet quality and glycemic control in patients with type 2 diabetes mellitus. Arch Endocrinol Metab 2022; 66:40-49. [PMID: 35029853 PMCID: PMC9991037 DOI: 10.20945/2359-3997000000429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To describe the oral health profile and evaluate the impact of tooth loss on diet quality and glycemic control among 66 patients with type 2 diabetes (T2DM) treated in an endocrinology outpatient clinic at a teaching hospital. METHODS Questionnaires about diabetes self-care (SDSCA), masticatory ability, diet quality, anxiety level about dental treatment, and oral health were applied. Laboratory tests were retrieved from medical records or newly collected samples. RESULTS The presence of fewer than 21 teeth was associated with an unsatisfactory self-perceived masticatory ability (r = 0.44; p = 0.007). Most participants reported not having received guidance on oral health from their endocrinologists (81.8%) and having had the last visit to the dentist 2 years or more before the study (36.8%). The mean HbA1c level in the group with fewer than 21 teeth was comparable to that in the group with functional dentition (8.9 ± 1.5 and 8.7 ± 1.6%, respectively; p = 0.60). CONCLUSION Adults with T2DM have a high prevalence of tooth loss and lack of information about oral hygiene care. Our results reinforce the need for more effective communication between medical and dental care teams.
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Affiliation(s)
- Danieli Londero da Silveira
- Programa de Pós-graduação em Endocrinologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil,
| | | | | | - Beatriz D Schaan
- Programa de Pós-graduação em Endocrinologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil.,Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil.,Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
| | - Gabriela Heiden Telo
- Programa de Pós-graduação em Medicina e Ciências da Saúde, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil
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13
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Alessi J, Becker AS, Amaral B, de Oliveira GB, Franco DW, Knijnik CP, Kobe GL, de Brito A, de Carvalho TR, Telo GH, Schaan BD, Telo GH. Type 1 diabetes and the challenges of emotional support in crisis situations: results from a randomized clinical trial of a multidisciplinary teleintervention. Sci Rep 2022; 12:3086. [PMID: 35197493 PMCID: PMC8866541 DOI: 10.1038/s41598-022-07005-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 06/21/2021] [Accepted: 02/09/2022] [Indexed: 11/15/2022] Open
Abstract
The association between type 1 diabetes and mental health disorders could be exacerbated in a stressful environment. This study aimed to evaluate the effectiveness of a teleguided intervention on emotional disorders in patients with type 1 diabetes during the COVID-19 outbreak. An open-label clinical trial was performed during the social distancing period in the COVID-19 outbreak in Brazil. Individuals with type 1 diabetes aged ≥ 18 years were randomized to receive a teleguided multidisciplinary intervention or the usual care plus an educational website access. The primary outcome was a positive screening for emotional disorders (Self Report Questionnaire 20) after a 16-week intervention. Secondary outcomes included evaluation of patients’ perceptions of pandemic-related changes, diabetes-related emotional distress, eating disorders, and sleep disorders. Data were analyzed with the intent‐to‐treat principle. Fifty-eight individuals (mean age, 43.8 ± 13.6 years) were included (intervention group, n = 29; control group, n = 29). The primary outcome was not different between the groups. The intervention group felt more supported in their diabetes care during the social distancing period (82.8% vs. 48.3% in the control group, P < 0.01). Both groups reported a similar self-perceived worsening of physical activity habits and mental health during the outbreak. There was no benefit to using the telehealth strategy proposed for emotional disorders in patients with type 1 diabetes during the COVID-19 outbreak. Further studies are needed to determine the impact on metabolic parameters and to understand why it is so difficult to emotionally support these patients. Trail Registration: ClinicalTrials.gov (NCT04344210), 14/04/2020.
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Affiliation(s)
- Janine Alessi
- Medical Science Program: Endocrinology, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350, prédio 12, 4° andar, Porto Alegre, RS, 90035-003, Brazil. .,Internal Medicine Department, Hospital São Lucas-Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.
| | - Alice Scalzilli Becker
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Bibiana Amaral
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Debora Wilke Franco
- Medical and Health Sciences Program, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Gabriel Luiz Kobe
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Ariane de Brito
- Medical Science Program: Endocrinology, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350, prédio 12, 4° andar, Porto Alegre, RS, 90035-003, Brazil
| | - Taíse Rosa de Carvalho
- Medical and Health Sciences Program, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Guilherme Heiden Telo
- Medical and Health Sciences Program, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Beatriz D Schaan
- Medical Science Program: Endocrinology, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350, prédio 12, 4° andar, Porto Alegre, RS, 90035-003, Brazil.,School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Endocrinology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,National Institute of Science and Technology for Health Technology Assessment (IATS)-CNPq/Brazil, Porto Alegre, Brazil
| | - Gabriela Heiden Telo
- Internal Medicine Department, Hospital São Lucas-Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.,School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.,Medical and Health Sciences Program, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
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14
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de Carvalho TR, Blume CA, Alessi J, Schaan BD, Telo GH. Polysomnography in pre-operative screening for obstructive sleep apnea in patients undergoing bariatric surgery: a retrospective cohort study. Int J Obes (Lond) 2022; 46:802-808. [PMID: 34983957 DOI: 10.1038/s41366-021-01055-2] [Citation(s) in RCA: 1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/29/2021] [Accepted: 12/16/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES To assess the impact of obstructive sleep apnea (OSA) screening with polysomnography on preventing cardiovascular and pulmonary complications in the postoperative period of bariatric surgery. SUBJECTS/METHODS This was a single-center retrospective cohort study, including 522 adults who underwent bariatric surgery between August 2010 and May 2019. Electronic medical records were accessed to obtain variables of interest. Screening for OSA was performed as a medical indication and registered as positive if apnea-hypopnea index was ≥5 events/hour in patients who did not have previous OSA diagnosis. The primary outcome was the presence of cardiac or pulmonary events in the 30-day postoperative period. Secondary outcomes included length of stay (days), need for an intensive care unit (ICU) after surgery, length of mechanical ventilation, and time from mechanical ventilation withdrawal. Statistical analyses were performed with χ2, Fisher's exact test, Student's t-test, Mann-Whitney U test, and Poisson regression. RESULTS Most participants (n = 326) did not have OSA screening with polysomnography, while 196 had performed this screening. There was no difference in cardiopulmonary events between the screening and non-screening groups (4.2% vs. 2.8%; P = 0.45). Polysomnography screening could not reduce cardiovascular or pulmonary complications in the postoperative period, RR = 1.73 (95% CI: 0.68-4.14). There was no difference in ICU admission, length of stay, and time from mechanical ventilation between groups in secondary outcomes. CONCLUSIONS Our study suggests that OSA screening with polysomnography in the pre-operative care of bariatric surgery is a dispensable procedure, as it does not change postoperative cardiopulmonary outcomes. Indications for polysomnography should be made at the individual level.
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Affiliation(s)
- Taíse Rosa de Carvalho
- Post-graduate Program in Medicine and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.
| | - Carina Andriatta Blume
- Post-graduate Program in Medical Science: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Janine Alessi
- Post-graduate Program in Medical Science: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Beatriz D Schaan
- Post-graduate Program in Medical Science: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Endocrinology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Gabriela Heiden Telo
- Post-graduate Program in Medicine and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
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15
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Cheuiche AV, Cureau FV, Madalosso MM, Telo GH, Schaan BD. Association between socioeconomic and nutritional factors and height of Brazilian adolescents: results from the Study of Cardiovascular Risk in Adolescents. CAD SAUDE PUBLICA 2022; 38:e00277321. [DOI: 10.1590/0102-311xen277321] [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] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 05/20/2022] [Indexed: 11/21/2022] Open
Abstract
This study aims to describe the mean height of adolescents from the five regions of Brazil and to evaluate socioeconomic and nutritional factors associated with normal growth. This is a cross-sectional study conducted in the Brazilian urban and rural areas with students aged 12 to 17 years (n = 71,553). Anthropometry, socioeconomic variables, physical activity, and diet were evaluated. Height-for-age z-scores were calculated and multiple linear regression models were used to investigate the association of exposure variables with height (outcome) by sex and age (12-13, 14-15, and 16-17 years). We observed a lower mean height in adolescents from the North Region and in individuals with low socioeconomic status. At 17 years of age, the closest to the final height in this sample, mean heights for girls and boys were 160.9 ± 0.1cm and 173.7 ± 0.3cm, respectively. In multiple linear regression analysis, physical activity (girls β = 0.119, 95%CI: 0.035; 0.202; boys β = 0.092, 95%CI: 0.012; 0.172) and high level of maternal education (girls β = 0.103, 95%CI: 0.001; 0.204; boys β = 0.39, 95%CI: 0.245; 0.534) were positively associated with height-for-age z-score in 16- to 17-year-old boys and girls. Other factors positively associated with height-for-age z-score in older students include higher protein consumption (β = 0.022, 95%CI: 0.010; 0.035) and obesity (β = 0.217, 95%CI: 0.084; 0.350) for boys, and low weight (β = 0.205, 95%CI: 0.028, 0.382) for girls. We observed differences in the mean height among adolescents from the five Brazilian regions. Normal growth, especially among older adolescents, was associated with high maternal education, practice of physical activity, protein consumption, and body mass index (BMI) categories.
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Affiliation(s)
| | | | | | | | - Beatriz D. Schaan
- Universidade Federal do Rio Grande do Sul, Brazil; Universidade Federal do Rio Grande do Sul, Brazil; Hospital de Clínicas de Porto Alegre, Brasil
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16
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Franco DW, Alessi J, Becker AS, do Amaral BB, de Oliveira GB, Schaan BD, Telo GH. Medical adherence in the time of social distancing: a brief report on the impact of the COVID-19 pandemic on adherence to treatment in patients with diabetes. Arch Endocrinol Metab 2021; 65:517-521. [PMID: 33939905 PMCID: PMC10522182 DOI: 10.20945/2359-3997000000362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 02/18/2021] [Indexed: 12/15/2022]
Abstract
We conducted a cross-sectional study to evaluate the impact of social distancing determined by the COVID-19 pandemic on treatment adherence using the Self-Care Inventory-revised in adults with diabetes mellitus. In type 1 diabetes, the adherence score was lower during than before social distancing.
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Affiliation(s)
- Debora Wilke Franco
- Programa de Pós-graduação em Medicina e Ciências da Saúde, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil
- Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil,
| | - Janine Alessi
- Programa de Pós-Graduação em Ciências Médicas: Endocrinologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Alice Scalzilli Becker
- Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Bibiana Brino do Amaral
- Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | | | - Beatriz D Schaan
- Programa de Pós-Graduação em Ciências Médicas: Endocrinologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
- Escola de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
- Divisão de Endocrinologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
| | - Gabriela Heiden Telo
- Programa de Pós-graduação em Medicina e Ciências da Saúde, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil
- Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil
- Departamento de Medicina Interna, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande, Porto Alegre, RS, Brasil
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17
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Alessi J, de Oliveira GB, Franco DW, Becker AS, Knijnik CP, Kobe GL, Amaral BB, de Brito A, Schaan BD, Telo GH. Telehealth strategy to mitigate the negative psychological impact of the COVID-19 pandemic on type 2 diabetes: A randomized controlled trial. Acta Diabetol 2021; 58:899-909. [PMID: 33723649 PMCID: PMC7959296 DOI: 10.1007/s00592-021-01690-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 02/22/2021] [Indexed: 01/22/2023]
Abstract
AIMS To assess the impact of teleintervention on mental health parameters in type 2 diabetes patients during the coronavirus disease 2019 (COVID-19) pandemic. METHODS This is a controlled randomized trial for a multidisciplinary telehealth intervention in Southern Brazil, with social distancing measures. Adults aged 18 years or older with previous diagnosis of type 2 diabetes were included in the study. The intervention performed was a set of strategies to help patients stay healthy during the COVID-19 pandemic and included the maintaining of telephone contacts and providing educational materials on issues related to mental health, healthy habits, and diabetes care. The primary outcome was a positive screening for mental health disorders (Self-Reporting Questionnaire) after 16 weeks of intervention. A positive screening for mental health disorders was considered when the survey scored greater than or equal to 7. Secondary outcomes included a positive screening for diabetes-related emotional distress (Problem Areas in Diabetes), eating (Eating Attitudes Test), and sleep disorders (Mini Sleep Questionnaire). Comparisons with χ2 tests for dichotomous outcomes, along with the Mann-Whitney U test, was used for between group analyses. RESULTS A total of 91 individuals agreed to participate (46 intervention group and 45 control group). There were no differences in demographic and clinical data at baseline. After 16 weeks of follow-up, a positive screening for mental health disorders was found in 37.0% of participants in the intervention group vs. 57.8% in the control group (P = 0.04). Diabetes-related emotional distress was found in 21.7% of participants in the intervention group vs. 42.2% in the control group (P = 0.03). No differences were found between groups with regard to eating and sleep disorders. CONCLUSION This study demonstrated that maintaining remote connections with health professionals during social distancing and quarantine have the potential to reduce the prevalence of positive screening for mental health disorders and diabetes-related emotional distress in adults with type 2 diabetes.
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Affiliation(s)
- Janine Alessi
- Postgraduate Program in Endocrinology, Universidade Federal Do Rio Grande Do Sul, Rua Ramiro Barcelos, nº 2400, 2° andar, Porto Alegre, RS, 90035-003, Brazil.
- Division of Internal Medicine, Hospital São Lucas da Pontifícia Universidade Católica Do Rio Grande Do Sul, Av. Ipiranga, nº 6690, 6º andar, Porto Alegre, RS, 90160-092, Brazil.
| | - Giovana Berger de Oliveira
- School of Medicine, Pontifícia Universidade Católica Do Rio Grande Do Sul, Av. Ipiranga, nº 6681, prédio 12A, Porto Alegre, RS, 90160-092, Brazil
| | - Debora Wilke Franco
- School of Medicine, Pontifícia Universidade Católica Do Rio Grande Do Sul, Av. Ipiranga, nº 6681, prédio 12A, Porto Alegre, RS, 90160-092, Brazil
| | - Alice Scalzilli Becker
- School of Medicine, Pontifícia Universidade Católica Do Rio Grande Do Sul, Av. Ipiranga, nº 6681, prédio 12A, Porto Alegre, RS, 90160-092, Brazil
| | - Carolina Padilla Knijnik
- School of Medicine, Pontifícia Universidade Católica Do Rio Grande Do Sul, Av. Ipiranga, nº 6681, prédio 12A, Porto Alegre, RS, 90160-092, Brazil
| | - Gabriel Luiz Kobe
- School of Medicine, Pontifícia Universidade Católica Do Rio Grande Do Sul, Av. Ipiranga, nº 6681, prédio 12A, Porto Alegre, RS, 90160-092, Brazil
| | - Bibiana Brino Amaral
- School of Medicine, Pontifícia Universidade Católica Do Rio Grande Do Sul, Av. Ipiranga, nº 6681, prédio 12A, Porto Alegre, RS, 90160-092, Brazil
| | - Ariane de Brito
- Postgraduate Program in Endocrinology, Universidade Federal Do Rio Grande Do Sul, Rua Ramiro Barcelos, nº 2400, 2° andar, Porto Alegre, RS, 90035-003, Brazil
| | - Beatriz D Schaan
- Postgraduate Program in Endocrinology, Universidade Federal Do Rio Grande Do Sul, Rua Ramiro Barcelos, nº 2400, 2° andar, Porto Alegre, RS, 90035-003, Brazil
- School of Medicine, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, nº 2400, 3° andar, Porto Alegre, RS, 90035-003, Brazil
- Endocrinology Division, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, prédio 12, 4° andar, Porto Alegre, RS, 90035-003, Brazil
| | - Gabriela Heiden Telo
- Division of Internal Medicine, Hospital São Lucas da Pontifícia Universidade Católica Do Rio Grande Do Sul, Av. Ipiranga, nº 6690, 6º andar, Porto Alegre, RS, 90160-092, Brazil
- School of Medicine, Pontifícia Universidade Católica Do Rio Grande Do Sul, Av. Ipiranga, nº 6681, prédio 12A, Porto Alegre, RS, 90160-092, Brazil
- Medicine and Health Sciences Program, Pontifícia Universidade Católica da PUCRS, Av. Ipiranga, nº 6681, prédio 12A, Porto Alegre, RS, 90160-092, Brazil
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Alessi J, de Oliveira GB, Feiden G, Schaan BD, Telo GH. Caring for caregivers: the impact of the COVID-19 pandemic on those responsible for children and adolescents with type 1 diabetes. Sci Rep 2021; 11:6812. [PMID: 33762633 PMCID: PMC7991637 DOI: 10.1038/s41598-021-85874-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [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: 10/12/2020] [Accepted: 03/04/2021] [Indexed: 12/17/2022] Open
Abstract
This study aimed to assess the psychological impact of the COVID-19 pandemic on guardians of children and adolescents with type 1 diabetes. An online survey was performed to assess the prevalence of pandemic-related emotional burden, mental health disorders and diabetes-specific emotional burden related to diabetes care during the COVID-19 pandemic. Caregivers of children and adolescents with diabetes under the age of 18 and caregivers of youth without diabetes for the non-diabetes group were invited to participate. For the primary outcome, mental health disorders were evaluated using the Self-Reporting Questionnaire (SRQ-20), while pandemic-related emotional burden and diabetes-specific emotional burden related to diabetes care were evaluated in different domains with specific questions. For analyses, a hierarchical testing strategy was performed. A total of 764 participants were included in the study. Regarding the pandemic period, caregivers of youth with type 1 diabetes endorsed significantly more pandemic-related emotional burden for both themselves (OR 1.67; 95% CI, 1.10 to 2.53) and for their child (OR 2.28; 95% CI, 1.54 to 3.38) when compared to the non-diabetes group. The emotional burden evaluation on different age ranges showed that the two groups were similar when the dependent youth was younger than 6 years. Moreover, a positive screening for mental health disorders during social distancing was higher in the diabetes group compared to the non-diabetes group (OR 2.43; 95% CI, 1.70 to 3.47), particularly in those aged under 12 years old. There was no difference between groups in mental health disorders among caregivers of adolescents older than 12 years. Our results allow to conclude that concern, burden and mental health disorders can be present in caregivers of youth with diabetes, and behavioral changes during the COVID-19 pandemic may enhance this situation.
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Affiliation(s)
- Janine Alessi
- Postgraduate Program in Medical Science: Endocrinology, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350, Prédio 12, 4° Andar, Porto Alegre, RS, 90035-003, Brazil. .,Internal Medicine Department, Hospital São Lucas - Pontifícia Universidade Católica Do Rio Grande Do Sul, Porto Alegre, Brazil.
| | - Giovana Berger de Oliveira
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Av. Ipiranga, 6681 - Partenon, Porto Alegre, RS, 90160-092, Brazil
| | - Gabriela Feiden
- Postgraduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350, Prédio 12, 4° Andar, Porto Alegre, RS, 90035-003, Brazil.,Associação de Apoio aos Diabéticos do Rio Grande do Sul (AADIRS), Porto Alegre, Brazil
| | - Beatriz D Schaan
- Postgraduate Program in Medical Science: Endocrinology, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350, Prédio 12, 4° Andar, Porto Alegre, RS, 90035-003, Brazil.,Endocrinology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,National Institute of Science and Technology for Health Technology Assessment (IATS) - CNPq/Brazil, Porto Alegre, Brazil
| | - Gabriela Heiden Telo
- Internal Medicine Department, Hospital São Lucas - Pontifícia Universidade Católica Do Rio Grande Do Sul, Porto Alegre, Brazil.,School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Av. Ipiranga, 6681 - Partenon, Porto Alegre, RS, 90160-092, Brazil.,National Institute of Science and Technology for Health Technology Assessment (IATS) - CNPq/Brazil, Porto Alegre, Brazil.,Graduate Program in Medicine and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul, Escola de Medicina da PUCRS, Av. Ipiranga, 6681 - Partenon, 90160-092, Porto Alegre, RS, Brasil
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Alessi J, de Oliveira GB, Franco DW, Brino do Amaral B, Becker AS, Knijnik CP, Kobe GL, de Carvalho TR, Telo GH, Schaan BD, Telo GH. Mental health in the era of COVID-19: prevalence of psychiatric disorders in a cohort of patients with type 1 and type 2 diabetes during the social distancing. Diabetol Metab Syndr 2020; 12:76. [PMID: 32879637 PMCID: PMC7457442 DOI: 10.1186/s13098-020-00584-6] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [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: 07/09/2020] [Accepted: 08/18/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND In patients with diabetes, the prevalence of depression and anxiety symptoms is about two to four times greater than in the general population. The association between diabetes and mental health disorders could be exacerbated in a stressful environment, and psychological distress could increase depressive symptoms and cause adverse diabetes outcomes. OBJECTIVES To assess the prevalence of mental health disorders in patients with diabetes during the social distancing period due to COVID-19 pandemic. METHODS This is a cross-sectional study developed to assess the impact of social distancing on a cohort of adults with type 1 (n = 52) and type 2 diabetes (n = 68) in Brazil. Inclusion criteria involved having an HbA1c test collected in the past 3 months and having a valid telephone number in electronic medical records. The primary outcome was the prevalence of minor psychiatric disorders, assessed by survey (SRQ-20). Secondary outcomes included the prevalence of diabetes related emotional distress, eating and sleeping disorders, all assessed by validated surveys at the moment of the study. Statistical analyses included unpaired t-test for continuous variables and χ 2 test for categorical variables. RESULTS Overall (n = 120), participants had a mean age of 54.8 ± 14.4 years-old, and HbA1c of 9.0 ± 1.6% (75 ± 17.5 mmol/mol); 93% of patients showed signs of current mental suffering based on the surveys measured. Almost 43% of patients showed evidence of significant psychological distress, with a significant greater tendency in patients with type 2 diabetes. The presence of diabetes related emotional distress was found in 29.2% of patients; eating disorders in 75.8%; and moderate/severe sleeping disorders in 77.5%. CONCLUSIONS We found a high prevalence of evidence of psychological distress among patients with diabetes during the COVID-19 pandemic and this highlights the need for mental health access and support for patients with type 1 and type 2 diabetes.
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Affiliation(s)
- Janine Alessi
- Post-Graduate Program in Medical Science: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Internal Medicine Department, Hospital São Lucas-Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
- Hospital de Clínicas de Porto Alegre, HCPA, Porto Alegre, Rio Grande do Sul, Brazil
| | - Giovana Berger de Oliveira
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
- Hospital São Lucas da PUCRS, Porto Alegre, Rio Grande do Sul Brazil
| | - Debora Wilke Franco
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
- Hospital São Lucas da PUCRS, Porto Alegre, Rio Grande do Sul Brazil
| | - Bibiana Brino do Amaral
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
- Hospital São Lucas da PUCRS, Porto Alegre, Rio Grande do Sul Brazil
| | - Alice Scalzilli Becker
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
- Hospital São Lucas da PUCRS, Porto Alegre, Rio Grande do Sul Brazil
| | - Carolina Padilla Knijnik
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
- Hospital São Lucas da PUCRS, Porto Alegre, Rio Grande do Sul Brazil
| | - Gabriel Luiz Kobe
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
- Hospital São Lucas da PUCRS, Porto Alegre, Rio Grande do Sul Brazil
| | - Taíse Rosa de Carvalho
- Post-Graduate Program in Medicine and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
- Hospital São Lucas da PUCRS, Porto Alegre, Rio Grande do Sul Brazil
| | - Guilherme Heiden Telo
- Post-Graduate Program in Medicine and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
- Hospital São Lucas da PUCRS, Porto Alegre, Rio Grande do Sul Brazil
| | - Beatriz D. Schaan
- Post-Graduate Program in Medical Science: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Endocrinology division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- National Institute of Science and Technology for Health Technology Assessment (IATS)–CNPq, Porto Alegre, Brazil
- Hospital de Clínicas de Porto Alegre, HCPA, Porto Alegre, Rio Grande do Sul, Brazil
| | - Gabriela Heiden Telo
- Internal Medicine Department, Hospital São Lucas-Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
- Post-Graduate Program in Medicine and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
- National Institute of Science and Technology for Health Technology Assessment (IATS)–CNPq, Porto Alegre, Brazil
- Hospital São Lucas da PUCRS, Porto Alegre, Rio Grande do Sul Brazil
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Cureau FV, Bloch KV, Henz A, Schaan CW, Klein CH, Oliveira CLD, Giannini DT, Leon EBD, Abreu GDA, Telo GH, Dias GM, Carvalho KMBD, Barufaldi LA, Kuschnir MCC, Szklo M, Montenegro Jr. R, Silva TLND, Ekelund U, Schaan BD. Challenges for conducting blood collection and biochemical analysis in a large multicenter school-based study with adolescents: lessons from ERICA in Brazil. CAD SAUDE PUBLICA 2017; 33:e00122816. [DOI: 10.1590/0102-311x00122816] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 01/06/2017] [Indexed: 11/21/2022] Open
Abstract
Abstract: The Study of Cardiovascular Risk in Adolescents (ERICA) is a pioneering study that aimed to assess the prevalence of cardiovascular risk factors, including metabolic syndrome components in Brazilian adolescents. This study aims to describe the methodological aspects related to blood collection as well as to report pertaining results of the preparation, transport, storage, and exams in ERICA. Exams in ERICA were performed in a single laboratory and blood samples were collected in schools in a standardized manner. Logistics involved air transportation of samples to the reference laboratory with controlled temperature since sample collection. The serum was stored in local biorepositories in four centers to be used in future analyses. During the study, 284,247 exams were performed and rate of participation in exams was 56.2%, thus involving 40,732 adolescents. From the total, 92.6% of the samples reached the reference laboratory maintaining the temperature between 0-10°C. No clinical significant changes in results due to temperature changes were identified. External quality control recorded satisfactory results in 98.7% of the evaluations. Four biorepositories with samples of 7,785 adolescents were created. Thus, we can consider that the logistics adopted in ERICA was fairly successful and description of this as well as the difficulties experienced in Brazil can inform and facilitate the planning of future studies, especially in developing countries.
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Affiliation(s)
| | | | - Aline Henz
- Universidade Federal do Rio Grande do Sul, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Beatriz D. Schaan
- Universidade Federal do Rio Grande do Sul, Brazil; Universidade Federal do Rio Grande do Sul, Brazil
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Telo GH, de Souza MS, Andrade TS, Schaan BD. Comparison between adherence assessments and blood glucose monitoring measures to predict glycemic control in adults with type 1 diabetes: a cross-sectional study. Diabetol Metab Syndr 2016; 8:54. [PMID: 27478510 PMCID: PMC4966590 DOI: 10.1186/s13098-016-0162-4] [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] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 07/10/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Adherence to treatment has been defined as the degree to which a patient's behavior corresponds to medical or health advice; however, the most appropriate method to evaluate adherence to diabetes care has yet to be identified. We conducted analyses to compare adherence assessments and blood glucose monitoring measures with regard to their ability to predict glycemic control in adults with type 1 diabetes. METHODS We analyzed four instruments to evaluate adherence: Self-Care Inventory-Revised, a self-administered survey; Diabetes Self-Monitoring Profile (DSMP), administered by trained researchers; a categorical (yes/no/sometimes) adherence self-evaluation; and a continuous (0-100) adherence self-evaluation. Blood glucose monitoring frequency was evaluated by self-report, diary, and meter download. RESULTS Participants (n = 82) were aged 39.0 ± 13.1 years with a mean diabetes duration of 21.2 ± 11.1 years; 27 % monitored blood glucose >4 times/day. The DSMP score was the strongest predictor of glycemic control (r = -0.32, P = 0.004) among adherence assessments, while blood glucose monitoring frequency assessed by meter download was the strongest predictor among blood glucose monitoring measures (r = -40, P < 0.001). All the self-report assessments had a significant but weak correlation with glycemic control (r ≤ 0.28, P ≤ 0.02). The final adjusted model identified the assessment of blood glucose monitoring frequency by meter download as the most robust predictor of HbA1c (estimate effect size = -0.58, P = 0.003). CONCLUSIONS In efforts to evaluate adherence, blood glucose monitoring frequency assessed by meter download has the strongest relationship with glycemic control in adults with type 1 diabetes.
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Affiliation(s)
- Gabriela Heiden Telo
- Internal Medicine Department, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcellos, 2350, Porto Alegre, CEP 90035-903 Brazil
| | - Martina Schaan de Souza
- Internal Medicine Department, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcellos, 2350, Porto Alegre, CEP 90035-903 Brazil
| | - Thais Stürmer Andrade
- Internal Medicine Department, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcellos, 2350, Porto Alegre, CEP 90035-903 Brazil
| | - Beatriz D’Agord Schaan
- Internal Medicine Department, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcellos, 2350, Porto Alegre, CEP 90035-903 Brazil
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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