Who Benefited the Most? Effectiveness of a Lifestyle Intervention Against Cognitive Decline in Older Women and Men - Secondary Analysis of the AgeWell.de-trial

INTRODUCTION

Differences between women and men matter in the prevalence and risk factors of dementia. We aimed to examine potential sex differences regarding the effectiveness by running a secondary analysis of the AgeWell.de trial, a cluster-randomized multicenter multi-domain lifestyle intervention to reduce cognitive decline.

METHODS

Intention-to-treat analyses of women (n=433) and men (n=386) aged 60 to 77 years were used for models including interactions between intervention group allocation and sex followed by subgroup analysis stratified by sex on primary and secondary outcomes. Further, the same procedure was repeated for age groups (60-69 vs. 70-77) within sex-specific subgroups to assess the effectiveness in different age groups.

TRIAL REGISTRATION

German Clinical Trials Register (ref. number: DRKS00013555).

RESULTS

No differences were found between women and men in the effectiveness of the intervention on cognitive performance. However, women benefitted from the intervention regarding depressive symptoms while men did not. Health-related quality of life was enhanced for younger intervention participants (60-69 years) in both women and men.

CONCLUSION

The AgeWell.de intervention was able to improve depressive symptoms in women and health-related quality of life in younger participants. Female participants between 60 and 69 years benefited the most. Results support the need of better individually targeted lifestyle interventions for older adults.

Validation of a modified questionnaire to assess Ukrainian Family Physicians’ readiness to implement the evidence-based screening recommendations into their clinical practice, using a mixed method study

Background

Ukrainian Family Doctors' knowledge and readiness for the implementation of new guidelines recommendations into practice has to be evaluated and taken into consideration, meanwhile they often use the old protocols of annual checkups. This study aimed to perform a linguistic and cultural validation of Ukrainian adopted questionnaire designed on the German prototype “Readiness of general practitioners to recommend and implement evidence-based screening recommendations questionnaire”.

Methods

This was a mixed method study. The English version of the original German prototype questionnaire was translated into Ukrainian with forward–backward method. Additionally Ukrainian version was modified by including an extra questions about evidence based screening of cardiovascular risks, infectious diseases, type 2 diabetes mellitus, depression, and some old-fashioned annual checkups which are still commonly used in routine family doctors’ practice. During the face validation process, 10 practicing general practitioners assessed all the items in the questionnaire as adequately structured, grammatically correct, and understandable. During qualitative part of content validation process 11 experts found and corrected some grammatical errors, indicated that items of the questionnaire were comprehensible and related to Ukrainian culture. During the quantitative part of content validation process experts accessed 5 of 6 items as essential, relevant, and clear. Internal consistency of the items, assessed by using Cronbach’s alpha method was acceptable. To access how stable can be results provided by the questionnaire, test–retest reliability was performed, where 19 general practitioners filled in the same questionnaire twice over a period of two weeks.

Results

In our study CVR > 0.79 and CVI > 0.59 were acceptable. The internal consistency was evaluated by using Cronbach’s alpha method and had to be above 0.7. According to the test–retest reliability results of weighted kappa and Cohen's kappa coefficients, test–retest agreement of the questionnaire was moderate for 29%, substantial for 38%, and almost perfect for 5% of the items (p ≤ 0.05). Kappa coefficients were not computed for 10% of items as there was no variability in the assessments.

Conclusions

The Ukrainian version of the questionnaire can be used for the assessment Ukrainian Family Doctor’s readiness to implement the evidence-based screening recommendations into their clinical practice.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-022-01818-4.

Structured diabetes self-management education and its association with perceived diabetes knowledge, information, and disease distress: Results of a nationwide population-based study

OBJECTIVE

To evaluate, how participation in structured diabetes self-management education (DSME) programs is associated with perceived level of knowledge about diabetes, information needs, information sources and disease distress.

METHODS

We included 796 ever- and 277 never-DSME participants of the population-based survey "Disease knowledge and information needs - Diabetes mellitus (2017)" from Germany. Data on perceived level of diabetes knowledge (12 items), information needs (11 items), information sources (13 items) and disease distress (2 indices) were collected. Multiple logistic regression analyses were used to examine the association of DSME-participation with these outcomes.

RESULTS

DSME-participants showed a higher level of diabetes knowledge compared to never-DSME participants, particularly in aspects concerning diabetes in general (odds ratio 2.53; 95% confidence intervals 1.48-4.33), treatment (2.41; 1.36-4.26), acute complications (1.91; 1.07-3.41) and diabetes in everyday life (1.83; 1.04-3.22). DSME-participants showed higher information needs regarding late complications (1.51; 1.04-2.18) and acute complications (1.71; 1.71-2.48) than DSME never participants. DSME-participants more frequently consulted diabetologists (5.54; 3.56-8.60) and diabetes care specialists (5.62; 3.61-8.75) as information sources. DSME participation was not associated with disease distress.

CONCLUSION

DSME is a valuable tool for improving individual knowledge about diabetes. However, DSME should focus more on psychosocial aspects to reduce the disease burden.

Randomised controlled trials on prevention, diagnosis and treatment of diabetes in African countries: a systematic review

OBJECTIVES

The epidemiological transition from infectious to chronic diseases leads to novel challenges in African health systems. The prevalence of diabetes mellitus (DM) is increasing dramatically. Undiagnosed and undertreated DM leads to numerous complications including end-organ damage and death. Our objectives were to collect the best locally generated evidence on DM interventions, identify knowledge gaps and determine underexplored research areas.

DESIGN

A systematic review and meta-analysis of randomised controlled trials.

PARTICIPANTS AND SETTING

African patients in primary, secondary and tertiary prevention, diagnosis and treatment DM type 1 (DM1), type 2 (DM2) and gestational DM (GDM).

OUTCOME

All-cause mortality, glycaemic control, complications, quality of life, hospital admission, treatment adherence and costs.

DATA SOURCES

Articles published in MEDLINE Ovid, CENTRAL, CINAHL, African Journals Online and African Index Medicus and the International Clinical Trials Registry Platform in English language without time restrictions. The systematic search was last updated in October 2020.

RESULTS

Out of 3736 identified publications, we included 60 eligible studies conducted in 15 countries, 75% were conducted in urban healthcare settings, including 10 112 participants. We included 8 studies on DM1, 6 on GDM, 2 on pre-DM, 37 on mainly DM2 including 7 on DM-related complications. The design of the studied intervention was heterogeneous with a focus on educational strategies. The other studies investigated the efficacy of nutritional strategies including food supplementations, pharmacological strategies and strategies to enhance physical activity. Seven studies included interventions on DM-related complications.

CONCLUSIONS

Research activities increased in recent years, but available evidence is still not representative for all African countries. There is a big lack of evidence in primary healthcare and rural settings, implementation research, pharmacological interventions, especially in poorer countries. Nevertheless, the identified studies offer a variety of effective interventions that can inform medical care and future research.

PROSPERO REGISTRATION NUMBER

CRD42019122785.

Asking future doctors: what support options do medical students want to cope with medical school?

Aim

Medical school is demanding, and research aimed at improving the mental health of medical students is scarce. No quantitative study about which specific measures students actually prefer to reinforce their health has been performed yet. The aim of this survey is to find out which types of support should be given to medical students according to students’ own perspectives.

Subject and methods

A classroom survey of medical students (N = 1108, years 1–5) was carried out regarding various support options and depressive symptoms. The statistical analysis was finalized using chi-square tests, t-tests, and the Kolmogorov–Smirnov test.

Results

The support options with the highest average scores were accessible sports classes, desire for free water/fruit during lectures, and a clear study structure. Groups to exchange experiences with, including social media groups, were favored less. Depressive symptoms in students correlated with a higher level of applicability of support options.

Conclusion

Medical students require supportive study conditions. Specific subgroups of medical students could not be correlated to a particular support program. Thus, we need a support program that addresses students’ wishes, not a program based on feasibility, staff interests or passions.

Patient-assessed quality of care in type 2 diabetes in a German nationwide health survey 2017

Background

Patient-assessed quality of chronic illness care is important to guide medical care for patients with diabetes and other complex chronic diseases, but information from epidemiological studies is scarce. Thus, we examined self-assessed quality of care among adults with type 2 diabetes (T2D) based on a population-based design.

Methods

The study population was drawn from a nationwide survey on diabetes-related knowledge and information needs conducted in Germany in 2017 and included participants aged ≥18 years with known type 2 diabetes (T2D) in the last 12 months (n = 1,328). A German short version of the “Patient assessment of chronic illness care (PACIC-DSF)” consisting of 9 items based on 5-point Likert scale was applied to assess self-reported quality of care in diabetes which was operationalized by a standardized PACIC sum score ranging from 1 to 5. Linear regression with different stages of adjustment was applied to assess the association of basic characteristics and diabetes-related factors with the PACIC score.

Results

Quality of care was assessed less favorably by women than by men (PACIC score: 2.38 vs. 2.47) overall and decreased along with age. The PACIC score significantly increased in participants with insulin use (β = 0.16, p = 0.024), ever participating in a diabetes education program (β = 0.33, p < 0.001), following a diet plan at least once a week (β = 0.33, p < =0.001) as well as performing daily self-examination of feet (β = 0.14, p = 0.023), self-control of blood glucose (β = 0.34, p < 0.001), and being physically active for at least 30 min (β = 0.21, p < 0.001) compared to participants without the respective trait.

Conclusions

Self-assessed quality of care by adults with known T2D from this population-based study is moderate and seems lower compared to findings from clinical studies.

Key messages

An active involvement of people with type 2 diabetes into the implementation of care is essential and may contribute to improved self-perceived quality of care. To identify and overcome obstacles in diabetes care based on the patient’s perspective remains a public health challenge.

LeiKA: an optional German general practice teaching project for first-semester medical students: who is taking part and why? A cross-sectional study

OBJECTIVES

This study investigates students' adoption of LeiKA, a new extracurricular longitudinal general practice (GP) teaching project. LeiKA aims to attract a broad range of students, not only those who are already planning to become GPs. This study compares participants' and non-participants' characteristics, career preferences and job-related value orientations to assess the programme's initial potential to increase the number of students subsequently entering GP careers. Additionally, students' motives for taking part in the programme were explored.

DESIGN

We analysed administrative data and data from a cross-sectional questionnaire survey for the first three cohorts. LeiKA participants were compared with non-participants regarding baseline characteristics, career intentions and attitudes associated with GP careers. There was also a qualitative analysis of the reasons for taking part.

SETTING

Faculty of Medicine, University of Leipzig, Germany.

PARTICIPANTS

First-semester medical students in the years 2016-2018.

RESULTS

In the first 3 years, 86 of 90 LeiKA slots were taken, 9.0% (n=86/960) of those eligible to apply. LeiKA participants were a mean of 0.6 years older (LeiKA: 21.5 vs whole cohort: 20.9 years, p<0.001) and slightly more interested in long-term doctor-patient relationships (3.6 vs 3.3, scale from 1 'unimportant' to 5 'very important', p=0.018), but did not differ regarding other characteristics and attitudes. Although more participants definitely favoured a GP career (13.1% vs 4.9%, p=0.001), it was a possible option for most students in both groups (78.6% vs 74.0%). Early acquisition of skills and patient contact were the main motives for taking part, stated by 60.7% and 41.7% of the participants, respectively.

CONCLUSIONS

The extracurricular programme was taken up by a broad range of students, indicating its potential to attract more students to become GPs. The reasons for taking part that we identified may guide the planning of other similar projects.

Early and Menopausal Weight Gain and its Relationship with the Development of Diabetes and Hypertension

Background: Previous research has revealed a clear relationship between weight gain of persons and their metabolic diseases developing later. These studies have covered only short periods lasting 4-8 years.Our goal was to collect decades' old and often life-long anthropometric data and correlate the figures with the presence of hypertension and diabetes or both. Methods: A retrospective international study was planned and organized to compare self-recorded data of lifelong weight gain among 60-70-year-old patients, analyze their correlation with metabolic diseases they developed, with special attention to women's weight gain around pregnancy, delivery and menopause in primary care settings in Germany, Hungary, Italy, Slovakia and the Ukraine. Results: Of the recruited 815 participants, 319 men and 496 women presented all the required data. Diabetics of both genders had the highest baseline weight at 20 years of age. The weight and BMI of the whole study population increased steadily until their seventies, but to a lesser extent after their fifties. Compared to the control group, changes over decades were the greatest among diabetics and also greater among patients with hypertension. Weight increase in the first decades (20-30-year-old men and 30-40-year-old women) was a significant risk factor for the development of diabetes (OR=1.044; p=0.002; 95% CI: 1.01-1.07). Among patients with diabetes and hypertension, both diagnoses were set up earlier than among those with a single morbidity.Among females, weight increase around pregnancy and menopause correlated significantly with higher odds for the diagnoses of diabetes and/or hypertension, irrespective of the number of children. Conclusions: During their decade-long relationship with their patients, family physicians are expected to identify the higher weight gain of their patients, especially among younger generation and intervene, if necessary.

[Recruitment for general practice - relationship between practice-based curriculum and career choice]

BACKGROUND

Demographic change and recruitment problems in general practice are increasingly threatening an adequate primary care workforce in many countries. Medical schools play an important role in attracting young physicians to this field. The influence of the general practice curriculum on the career choice of graduates has not yet been sufficiently investigated.

METHODS

The present study combines continuously collected data of medical students concerning the participation in miscellaneous general practice courses with data of a later graduate survey.

RESULTS

Response rate was 64.2%. Although only 4.7% of the participants preferred a career in general practice at study entry, this specialty was, at 12.3%, the second most frequent career choice. Among the future general practitioners, only 18.5% had initially planned this career. The future general practitioners took part significantly more frequently in all facultative general practice courses. They reported more frequently to have met role models in general practice and to have gained experience in rural areas. Future general practitioners would more often prefer to work in rural areas in the future.

CONCLUSIONS

Overall, the present results indicate that a broad and practice-oriented general practice curriculum has the potential to attract medical students to the specialty.

Life-long weight change can predict metabolic diseases. Retrospective primary care study on the weight gain differences between elderly patients with diabetes and hypertension

BACKGROUND

Patients with diabetes and hypertension represent a large proportion of primary care patients. Evaluation of their parameters usually requires medical setting, body weight and height can be measured by the patients themselves and this is often the case. The aim of this retrospective study is to analyse and to compare the life-long data on weight and BMI of patients with diabetes and hypertension and those without these pathologic conditions.

PATIENTS

Eventually selected 759 patients (337 men, 422 women) between 60 and 70 years of age in different primary care settings were involved.

METHODS

Retrospective and recent self-recorded data on weight and height in every decade since the age of 20 years in both genders were collected. These were compared to the control group of persons free from diabetes and hypertension.

RESULTS

The current body weight and BMI were significantly higher in all groups than at 20 years and less than their maximal values. Patients with diabetes started at higher weights and their greatest gain was observed between 20-30 years in men and between 30-40 years in women, and in the last decade prior to diagnosis in both genders. Weight gain in the control group was steady at a lower rate.

CONCLUSIONS

Higher increases in body weight in the early youth decades were related to elevated hazard ratios for diabetes in men and for hypertension in women. More research with standardized methodology is needed to explore this relationship better: meanwhile more contribution is expected from primary care physicians in the weight management of their younger patients.

Circadian and age-dependent expression patterns of GLUT2 and glucokinase in the pancreatic beta-cell of diabetic and nondiabetic rats

Alterations in glucose sensing are well-known in both humans and animal models of non-insulin-dependent diabetes mellitus. However, the circadian- and age-dependent expression of glucose-sensing genes has not previously been investigated in vivo. In the present paper, we show a progressive loss of beta-cell GLUT2-mRNA and, by immunocytochemistry, a gain of soluble, cytoplasmic GLUT2-protein in Goto-Kakizaki rat islets. We report that GLUT2-mRNA shows significant diurnal variation, which is stronger in metabolically healthy rats. We also demonstrate the significant diurnal variation of glucokinase-mRNA, with higher levels in the pancreas of 6-week-old Goto-Kakizaki rats than in Wistar rats. This leads to a maximum glucose phosphorylation capacity in-phase with food intake, enhanced glucose-stimulated insulin secretion, and prevents postprandial hyperglycemia. Perfusion experiments showed a reduction in glucose-stimulated insulin secretion in Goto-Kakizaki rat islets with an impaired first phase. Hyperglycemia and hypoinsulinemia in newborn and up to 3-week-old Goto-Kakizaki rats are thus probably due to reduced pancreatic beta-cell content, reduced beta-cell insulin content and impaired glucose sensing. The de-compensation of the metabolic situation in 42-week-old Goto-Kakizaki rats is likely to be caused by beta-cell destruction accompanied by negligible accumulation of GLUT2 in the cell membrane and further reduction of glucokinase expression.