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Atrese T, Fekadu L, Kune G, Shita A, Woldemikael K. Prevalence of undiagnosed diabetes mellitus and associated factors among adult residents of Mizan Aman town, Southwest Ethiopia: Community-based cross-sectional study. PLoS One 2024; 19:e0302167. [PMID: 38713690 DOI: 10.1371/journal.pone.0302167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 03/28/2024] [Indexed: 05/09/2024] Open
Abstract
BACKGROUND Diabetes mellitus continues to be a significant global public health concern, and it is currently a public health issue in developing nations. In Ethiopia, about three fourth of adult population with diabetes are unaware of their diabetic condition. However, there is a limited research on this specific topic particularly in the study area. OBJECTIVE To assess prevalence of undiagnosed diabetes mellitus and its associated factor among adult residents of Mizan Aman town, south West Ethiopia. METHODS AND MATERIAL A community-based cross-sectional study was conducted from May 23 to July 7, 2022, on 627 adult residents of Mizan Aman town. A multi stage sampling technique was used to obtain 646 study units. Interviewer-administered structured questionnaires were employed to gather socio-demographic and behavioral data. Anthropometric measurements were obtained and blood samples were taken from each participants. The fasting blood glucose level was measured after an 8-hour gap following a meal, using a digital glucometer to analyze a blood sample. Data were cleaned and entered into Epi-data v 3.1 and exported to SPSS v. 26 for analysis. Bi-variable analysis was done to select candidate variables and multivariable logistic regression model was fitted to identify independent predictors of undiagnosed diabetes mellitus. Adjusted odds ratio (AOR) with 95% CI was computed and variables with p-value < 0.05 were declared to be predictors of undiagnosed diabetes mellitus. RESULTS The study revealed that, the overall magnitude of undiagnosed diabetes mellitus was 8.13% (95% CI: 6.1, 10.6). Predictors of undiagnosed diabetes mellitus were; physical activity level less than 600 Metabolic equivalent/min per week (AOR = 3.39, 95%CI 1.08 to 10.66), family history of diabetes mellitus (AOR = 2.87, 95% CI 1.41, 5.85), current hypertension(AOR = 2.9, 95% CI 1.26, 6.69), fruit consumption of fewer than three servings per week(AOR = 2.64, 95% CI 1.18 to 5.92), and sedentary life(AOR = 3.33, 95% CI 1.63 to 6.79). CONCLUSION The prevalence of undiagnosed diabetes mellitus was 8.13%. Physical inactivity, family history of diabetes mellitus, current hypertension, sedentary life, and fruit servings fewer than three per week were independent predictors of undiagnosed diabetes mellitus.
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Affiliation(s)
- Tsegaye Atrese
- Department of Public Health, Mizan Aman Health Science College, Mizan Aman, South West Ethiopia
| | - Lata Fekadu
- Department of Epidemiology, College of Public Health, Jimma University, Jimma, South West Ethiopia
| | - Guta Kune
- Department of Epidemiology, College of Public Health, Jimma University, Jimma, South West Ethiopia
| | - Abel Shita
- Department of Public Health, Mizan Aman Health Science College, Mizan Aman, South West Ethiopia
| | - Kifle Woldemikael
- Department of Epidemiology, College of Public Health, Jimma University, Jimma, South West Ethiopia
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Beer L, Koenig LJ, Tie Y, Yuan X, Fagan J, Buchacz K, Hughes K, Weiser J. Prevalence of Diagnosed and Undiagnosed Depression Among US Adults with Human Immunodeficiency Virus: Data from the Medical Monitoring Project. AIDS Patient Care STDS 2024; 38:206-220. [PMID: 38662470 DOI: 10.1089/apc.2024.0031] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
People with human immunodeficiency virus (PWH) are disproportionately affected by depression, but the recent national estimates for US PWH encompassing both current symptoms and clinical diagnoses to assess missed diagnoses and lack of symptom remission are lacking. We used data from CDC's Medical Monitoring Project (MMP) to report nationally representative estimates of diagnosed and undiagnosed depression among US adult PWH. During June 2021 to May 2022, MMP collected interview data on symptoms consistent with major or other depression and depression diagnoses from medical records of 3928 PWH. We report weighted percentages and prevalence ratios (PRs) to quantify differences between groups on key social and health factors. Overall, 34% of PWH experienced any depression (diagnosis or Patient Health Questionnaire-8); of these, 26% had symptoms but no diagnosis (undiagnosed depression), 19% had both diagnosis and symptoms, and 55% had a diagnosis without symptoms. Among those with depression, persons with a disability (PR: 1.52) and food insecurity (PR: 1.67) were more likely to be undiagnosed. Unemployed persons (PR: 1.62), those experiencing a disability (PR: 2.78), food insecurity (PR: 1.46), or discrimination in human immunodeficiency virus (HIV) care (PR: 1.71) were more likely to have diagnosed depression with symptoms. Those with symptoms (undiagnosed or diagnosed) were less likely to be antiretroviral therapy (ART) dose adherent (PR: 0.88; PR: 0.73) or have sustained viral suppression (PR: 0.62; PR: 0.91) and were more likely to have unmet needs for mental health services (PR: 2.38, PR: 2.03). One-third of PWH experienced depression, of whom nearly half were undiagnosed or still experiencing clinically relevant symptoms. Expanding screening and effective treatment for depression could improve quality of life and HIV outcomes.
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Affiliation(s)
- Linda Beer
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Linda J Koenig
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Yunfeng Tie
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Xin Yuan
- DLH Corporation, Atlanta, Georgia, USA
| | - Jennifer Fagan
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kate Buchacz
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kamal Hughes
- Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, Tennessee, USA
| | - John Weiser
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Vidal-Cevallos P, Flores-García N, Chávez-Tapia NC, Chalasani NP. Occult liver disease: A multinational perspective. Ann Hepatol 2024; 29:101480. [PMID: 38354950 DOI: 10.1016/j.aohep.2024.101480] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 01/04/2024] [Indexed: 02/16/2024]
Abstract
Occult liver disease refers to the presence of unrecognized chronic liver disease and cirrhosis. Liver disease is currently the eleventh cause of death globally, representing 4% of all deaths in the world. Alcohol consumption is the leading cause of cirrhosis globally, accounting for approximately 60% of cases. The estimated global prevalence of non-alcoholic fatty liver disease (NAFLD) is 32.4% and has been steadily increasing over the last years. Viral hepatitis B and C accounted for 1.3 million deaths in 2020. Several studies in populations at high risk of chronic liver disease (elevated liver enzymes, type 2 diabetes, excessive alcohol consumption) have found an elevated prevalence of occult liver disease. Attempts should be made to assess the prevalence of occult liver disease in Latin America, a region with one of the highest rates of metabolic diseases and excessive alcohol consumption. Screening for NAFLD in high-risk subjects and screening for excessive drinking and alcohol use disorders at every level of medical care is relevant. Efforts should also focus on the early treatment of occult liver disease to try to reduce liver disease burden and, in the case of occult viral hepatitis infection, prevent further spreading.
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Affiliation(s)
- Paulina Vidal-Cevallos
- Obesity and Digestive Disease Unit, Medica Sur Clinic and Foundation, Puente de Piedra 150, Toriello Guerra, 14050, Mexico City, Mexico
| | - Nayelli Flores-García
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
| | - Norberto C Chávez-Tapia
- Obesity and Digestive Disease Unit, Medica Sur Clinic and Foundation, Puente de Piedra 150, Toriello Guerra, 14050, Mexico City, Mexico.
| | - Naga P Chalasani
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, United States.
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Abstract
ADRD underdiagnosis among minority populations is well-established and known to be more prevalent among women. Yet, it remains unclear if these patterns exist among adults of Middle Eastern and North African (MENA) descent. We estimated ADRD underdiagnosis among adults of MENA descent and other US- and foreign-born non-Hispanic Whites and compared sex-stratified results. We linked 2000-2017 National Health Interview Survey and 2001-2018 Medical Expenditure Panel Survey data (ages > = 65 years, n = 23,981). Undiagnosed ADRD was suspected if participants reported cognitive limitations without corresponding ADRD diagnosis. Undiagnosed ADRD was highest among adults of MENA descent (15.8%) compared to non-Hispanic Whites (US-born = 8.1%; foreign-born = 11.8%). Women of MENA descent had 2.52 times greater odds (95% CI = 1.31-4.84) of undiagnosed ADRD compared to US-born White women after adjusting for risk factors. This study contributes the first national estimates of undiagnosed ADRD among adults of MENA descent. Continued research is needed to facilitate policy changes that more comprehensively address health disparities and related resource allocation.
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Affiliation(s)
- Tiffany B Kindratt
- Public Health Program, Department of Kinesiology, College of Nursing and Health Innovation, University of Texas at Arlington, 500 West Nedderman Drive, Arlington, TX, 76019, USA.
| | - Kristine J Ajrouch
- Department of Sociology, Anthropology and Criminology, Eastern Michigan University, 712 Pray-Harrold, Ypsilanti, MI, 48197, USA
- Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI, 48104, USA
| | - Laura B Zahodne
- Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI, 48104, USA
- Department of Psychology, University of Michigan, 530 Church St., Ann Arbor, MI, 48109, USA
| | - Florence J Dallo
- School of Health Sciences, Oakland University, Rochester, MI, 48309-4452, USA
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Abstract
OBJECTIVE Confirmatory testing is recommended for diabetes diagnosis in clinical practice. However, national estimates of undiagnosed diabetes are based on single elevated test measures, potentially resulting in overestimation. Our objective was to update trends in undiagnosed diabetes using definitions consistent with clinical practice. RESEARCH DESIGN AND METHODS We included 30,492 adults (aged ≥20 years) from the National Health and Nutrition Examination Survey (1988-2020). Among adults without diagnosed diabetes, confirmed undiagnosed diabetes was defined as having both elevated levels of fasting plasma glucose (FPG) (≥126 mg/dL) and elevated glycated hemoglobin (HbA1c; ≥6.5%), and persistent undiagnosed diabetes was defined as having elevated HbA1c or FPG levels, adjusted for the within-person variability in HbA1c and FPG tests. RESULTS From the periods 1988-1994 to 2017 to March 2020, there was an increase in the prevalence of diagnosed diabetes (from 4.6% to 11.7%), but no change in prevalence of persistent undiagnosed diabetes (from 2.23% to 2.53%) or confirmed undiagnosed diabetes (from 1.10% to 1.23%). Consequently, the proportion of all undiagnosed diabetes cases declined from 32.8% to 17.8% (persistent undiagnosed diabetes) and from 19.3% to 9.5% (confirmed undiagnosed diabetes). Undiagnosed diabetes was more prevalent in older and obese adults, racial/ethnic minorities, and those without health care access. Among persons with diabetes, Asian Americans and those without health care access had the highest proportion of undiagnosed cases, with rates ranging from 23% to 61%. CONCLUSIONS From 1988 to March 2020, the proportion of undiagnosed diabetes cases declined substantially, suggesting major improvements in diabetes screening and detection. Undiagnosed diabetes currently affects 1-2% of US adults; up to 90% of all cases are diagnosed.
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Affiliation(s)
- Michael Fang
- Welch Center for Prevention, Epidemiology and Clinical Research and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Dan Wang
- Welch Center for Prevention, Epidemiology and Clinical Research and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Josef Coresh
- Welch Center for Prevention, Epidemiology and Clinical Research and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Biostatistics, Johns Hopkins University, Baltimore, MD
| | - Elizabeth Selvin
- Welch Center for Prevention, Epidemiology and Clinical Research and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Ochwedo KO, Omondi CJ, Magomere EO, Olumeh JO, Debrah I, Onyango SA, Orondo PW, Ondeto BM, Atieli HE, Ogolla SO, Githure J, Otieno ACA, Githeko AK, Kazura JW, Mukabana WR, Guiyan Y. Hyper-prevalence of submicroscopic Plasmodium falciparum infections in a rural area of western Kenya with declining malaria cases. Malar J 2021; 20:472. [PMID: 34930283 PMCID: PMC8685826 DOI: 10.1186/s12936-021-04012-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 12/07/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The gold standard for diagnosing Plasmodium falciparum infection is microscopic examination of Giemsa-stained peripheral blood smears. The effectiveness of this procedure for infection surveillance and malaria control may be limited by a relatively high parasitaemia detection threshold. Persons with microscopically undetectable infections may go untreated, contributing to ongoing transmission to mosquito vectors. The purpose of this study was to determine the magnitude and determinants of undiagnosed submicroscopic P. falciparum infections in a rural area of western Kenya. METHODS A health facility-based survey was conducted, and 367 patients seeking treatment for symptoms consistent with uncomplicated malaria in Homa Bay County were enrolled. The frequency of submicroscopic P. falciparum infection was measured by comparing the prevalence of infection based on light microscopic inspection of thick blood smears versus real-time polymerase chain reaction (RT-PCR) targeting P. falciparum 18S rRNA gene. Long-lasting insecticidal net (LLIN) use, participation in nocturnal outdoor activities, and gender were considered as potential determinants of submicroscopic infections. RESULTS Microscopic inspection of blood smears was positive for asexual P. falciparum parasites in 14.7% (54/367) of cases. All of these samples were confirmed by RT-PCR. 35.8% (112/313) of blood smear negative cases were positive by RT-PCR, i.e., submicroscopic infection, resulting in an overall prevalence by RT-PCR alone of 45.2% compared to 14.7% for blood smear alone. Females had a higher prevalence of submicroscopic infections (35.6% or 72 out of 202 individuals, 95% CI 28.9-42.3) compared to males (24.2%, 40 of 165 individuals, 95% CI 17.6-30.8). The risk of submicroscopic infections in LLIN users was about half that of non-LLIN users (OR = 0.59). There was no difference in the prevalence of submicroscopic infections of study participants who were active in nocturnal outdoor activities versus those who were not active (OR = 0.91). Patients who participated in nocturnal outdoor activities and use LLINs while indoors had a slightly higher risk of submicroscopic infection than those who did not use LLINs (OR = 1.48). CONCLUSION Microscopic inspection of blood smears from persons with malaria symptoms for asexual stage P. falciparum should be supplemented by more sensitive diagnostic tests in order to reduce ongoing transmission of P. falciparum parasites to local mosquito vectors.
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Affiliation(s)
- Kevin O. Ochwedo
- Department of Biology, Faculty of Science and Technology, University of Nairobi, Nairobi, Kenya
- Sub-Saharan Africa International Centre for Excellence in Malaria Research, Homa Bay, Kenya
| | - Collince J. Omondi
- Department of Biology, Faculty of Science and Technology, University of Nairobi, Nairobi, Kenya
- Sub-Saharan Africa International Centre for Excellence in Malaria Research, Homa Bay, Kenya
| | - Edwin O. Magomere
- Department of Biochemistry and Molecular Biology, Egerton University, Njoro, Kenya
| | - Julius O. Olumeh
- Department of Biology, Faculty of Science and Technology, University of Nairobi, Nairobi, Kenya
- Sub-Saharan Africa International Centre for Excellence in Malaria Research, Homa Bay, Kenya
| | - Isaiah Debrah
- West Africa Centre for Cell Biology of Infectious Pathogen, Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Accra, Ghana
| | - Shirley A. Onyango
- Sub-Saharan Africa International Centre for Excellence in Malaria Research, Homa Bay, Kenya
| | - Pauline W. Orondo
- Sub-Saharan Africa International Centre for Excellence in Malaria Research, Homa Bay, Kenya
| | - Benyl M. Ondeto
- Department of Biology, Faculty of Science and Technology, University of Nairobi, Nairobi, Kenya
- Sub-Saharan Africa International Centre for Excellence in Malaria Research, Homa Bay, Kenya
| | - Harrysone E. Atieli
- Sub-Saharan Africa International Centre for Excellence in Malaria Research, Homa Bay, Kenya
| | - Sidney O. Ogolla
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - John Githure
- Sub-Saharan Africa International Centre for Excellence in Malaria Research, Homa Bay, Kenya
| | - Antony C. A. Otieno
- Department of Biology, Faculty of Science and Technology, University of Nairobi, Nairobi, Kenya
| | - Andrew K. Githeko
- Sub-Saharan Africa International Centre for Excellence in Malaria Research, Homa Bay, Kenya
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - James W. Kazura
- Centre for Global Health and Diseases, Case Western Reserve University, Cleveland, OH USA
| | - Wolfgang R. Mukabana
- Department of Biology, Faculty of Science and Technology, University of Nairobi, Nairobi, Kenya
- Sub-Saharan Africa International Centre for Excellence in Malaria Research, Homa Bay, Kenya
| | - Yan Guiyan
- Program in Public Health, College of Health Sciences, University of California, Irvine, USA
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Presanis AM, Harris RJ, Kirwan PD, Miltz A, Croxford S, Heinsbroek E, Jackson CH, Mohammed H, Brown AE, Delpech VC, Gill ON, Angelis DD. Trends in undiagnosed HIV prevalence in England and implications for eliminating HIV transmission by 2030: an evidence synthesis model. Lancet Public Health 2021; 6:e739-e751. [PMID: 34563281 PMCID: PMC8481938 DOI: 10.1016/s2468-2667(21)00142-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 06/03/2021] [Accepted: 06/07/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND A target to eliminate HIV transmission in England by 2030 was set in early 2019. This study aimed to estimate trends from 2013 to 2019 in HIV prevalence, particularly the number of people living with undiagnosed HIV, by exposure group, ethnicity, gender, age group, and region. These estimates are essential to monitor progress towards elimination. METHODS A Bayesian synthesis of evidence from multiple surveillance, demographic, and survey datasets relevant to HIV in England was used to estimate trends in the number of people living with HIV, the proportion of people unaware of their HIV infection, and the corresponding prevalence of undiagnosed HIV. All estimates were stratified by exposure group, ethnicity, gender, age group (15-34, 35-44, 45-59, or 60-74 years), region (London, or outside of London) and year (2013-19). FINDINGS The total number of people living with HIV aged 15-74 years in England increased from 83 500 (95% credible interval 80 200-89 600) in 2013 to 92 800 (91 000-95 600) in 2019. The proportion diagnosed steadily increased from 86% (80-90%) to 94% (91-95%) during the same time period, corresponding to a halving in the number of undiagnosed infections from 11 600 (8300-17 700) to 5900 (4400-8700) and in undiagnosed prevalence from 0·29 (0·21-0·44) to 0·14 (0·11-0·21) per 1000 population. Similar steep declines were estimated in all subgroups of gay, bisexual, and other men who have sex with men and in most subgroups of Black African heterosexuals. The pace of reduction was less pronounced for heterosexuals in other ethnic groups and people who inject drugs, particularly outside London; however, undiagnosed prevalence in these groups has remained very low. INTERPRETATION The UNAIDS target of diagnosing 90% of people living with HIV by 2020 was reached by 2016 in England, with the country on track to achieve the new target of 95% diagnosed by 2025. Reductions in transmission and undiagnosed prevalence have corresponded to large scale-up of testing in key populations and early diagnosis and treatment. Additional and intensified prevention measures are required to eliminate transmission of HIV among the communities that have experienced slower declines than other subgroups, despite having very low prevalences of HIV. FUNDING UK Medical Research Council and Public Health England.
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Affiliation(s)
- Anne M Presanis
- Medical Research Council Biostatistics Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK.
| | | | - Peter D Kirwan
- Medical Research Council Biostatistics Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK; Public Health England, London, UK
| | - Ada Miltz
- Public Health England, London, UK; Institute of Global Health, University College London, London, UK
| | | | | | - Christopher H Jackson
- Medical Research Council Biostatistics Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | | | | | | | | | - Daniela De Angelis
- Medical Research Council Biostatistics Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK; Public Health England, London, UK
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Mahdi A, Armitage LC, Tarassenko L, Watkinson P. Estimated Prevalence of Hypertension and Undiagnosed Hypertension in a Large Inpatient Population: A Cross-sectional Observational Study. Am J Hypertens 2021; 34:963-972. [PMID: 34022036 PMCID: PMC8457434 DOI: 10.1093/ajh/hpab070] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 05/04/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Hypertension is a major cause of morbidity and mortality. In community populations the prevalence of hypertension, both in diagnosed and undiagnosed states, has been widely reported. However, estimates for the prevalence of hospitalized patients with average blood pressures (BPs) that meet criteria for the diagnosis of hypertension are lacking. We aimed to estimate the prevalence of patients in a UK hospital setting, whose average BPs meet current international guidelines for hypertension diagnosis. METHODS We performed a retrospective cross-sectional observational study of patients admitted to adult wards in 4 acute hospitals in Oxford, United Kingdom, between March 2014 and April 2018. RESULTS We identified 41,455 eligible admitted patients with a total of 1.7 million BP measurements recorded during their hospital admissions. According to European ESC/ESH diagnostic criteria for hypertension, 21.4% (respectively 47% according to American ACC/AHA diagnostic criteria) of patients had a mean BP exceeding the diagnostic threshold for either Stage 1, 2, or 3 hypertension. Similarly, 5% had a mean BP exceeding the ESC/ESH (respectively 13% had a mean BP exceeding the ACC/AHA) diagnostic criteria for hypertension, but no preexisting diagnostic code for hypertension or a prescribed antihypertensive medication during their hospital stay. CONCLUSIONS Large numbers of hospital inpatients have mean in-hospital BPs exceeding diagnostic thresholds for hypertension, with no evidence of diagnosis or treatment in the electronic record. Whether opportunistic screening for in-hospital high BP is a useful way of detecting people with undiagnosed hypertension needs evaluation.
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Affiliation(s)
- Adam Mahdi
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Laura C Armitage
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Lionel Tarassenko
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
- Sensyne Health, Oxford, UK
| | - Peter Watkinson
- Sensyne Health, Oxford, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, NIHR Biomedical Research Centre, Oxford University Hospitals NHS Trust, Oxford, UK
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Reiffel JA, Verma A, Kowey PR, Halperin JL, Gersh BJ, Wachter R, Elkind MSV, Pouliot E, Ziegler PD. Relation of Antecedent Symptoms to the Likelihood of Detecting Subclinical Atrial Fibrillation With Inserted Cardiac Monitors. Am J Cardiol 2021; 145:64-68. [PMID: 33497655 DOI: 10.1016/j.amjcard.2020.12.083] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/30/2020] [Accepted: 12/31/2020] [Indexed: 01/27/2023]
Abstract
Atrial fibrillation (AF) comes to attention clinically during an evaluation of symptoms, an evaluation of its adverse outcomes, or because of incidental detection during a routine examination or electrocardiogram. However, a notable number of additional individuals have AF that has not yet been clinically apparent or suspect-subclinical AF (SCAF). SCAF has been recognized during interrogation of pacemakers and defibrillators. More recently, SCAF has been demonstrated in prospective studies with long-term monitors-both external and implanted. The REVEAL AF trial enrolled a demographically "enriched" population that underwent monitoring for up to 3 years with an insertable cardiac monitor. SCAF was noted in 40% by 30 months. None of these patients had AF known before the study; however, some had nonspecific symptoms common to patients with known AF. The current study assessed whether patients with versus without such symptoms were more likely to have SCAF detected. We found that only palpitations had an association with AF detection when controlling for other baseline symptoms (hazard ratio 1.61 (95% confidence interval 1.12 to 2.32; p = 0.011). No other prescreening symptoms evaluated were associated with an increased likelihood of SCAF detection although patients without detected SCAF had an even higher frequency of symptoms than those with detected SCAF. Thus, REVEAL AF demonstrated that the presence of palpitations is associated with an increased likelihood of SCAF whereas other common symptoms are not; and, symptoms, per se, may more likely be consequent to associated disorders than they are a direct consequence of SCAF.
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Affiliation(s)
- James A Reiffel
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York City, New York.
| | - Atul Verma
- Southlake Regional Health Centre, Newmarket, University of Toronto, Toronto, Ontario, Canada
| | - Peter R Kowey
- Lankenau Institute for Medical Research, Wynnewood, PA, and, the Jefferson Medical College, Philadelphia, Pennsylvania
| | - Jonathan L Halperin
- The Cardiovascular Institute, Mount Sinai Medical Center, New York City, New York
| | | | - Rolf Wachter
- Clinic and Policlinic for Cardiology, University Hospital Leipzig, Leipzig, Germany
| | - Mitchell S V Elkind
- Department of Neurology, Vagelos College of Physician & Surgeons, Columbia University, New York City, New York; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, New York
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Vargas-Vázquez A, Bello-Chavolla OY, Ortiz-Brizuela E, Campos-Muñoz A, Mehta R, Villanueva-Reza M, Bahena-López JP, Antonio-Villa NE, González-Lara MF, Ponce de León A, Sifuentes-Osornio J, Aguilar-Salinas CA. Impact of undiagnosed type 2 diabetes and pre-diabetes on severity and mortality for SARS-CoV-2 infection. BMJ Open Diabetes Res Care 2021; 9:e002026. [PMID: 33593750 PMCID: PMC7887863 DOI: 10.1136/bmjdrc-2020-002026] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [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: 11/19/2020] [Revised: 01/25/2021] [Accepted: 01/31/2021] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Diabetes and hyperglycemia are risk factors for critical COVID-19 outcomes; however, the impact of pre-diabetes and previously unidentified cases of diabetes remains undefined. Here, we profiled hospitalized patients with undiagnosed type 2 diabetes and pre-diabetes to evaluate its impact on adverse COVID-19 outcomes. We also explored the role of de novo and intrahospital hyperglycemia in mediating critical COVID-19 outcomes. RESEARCH DESIGN AND METHODS Prospective cohort of 317 hospitalized COVID-19 cases from a Mexico City reference center. Type 2 diabetes was defined as previous diagnosis or treatment with diabetes medication, undiagnosed diabetes and pre-diabetes using glycosylated hemoglobin (HbA1c) American Diabetes Association (ADA) criteria and de novo or intrahospital hyperglycemia as fasting plasma glucose (FPG) ≥140 mg/dL. Logistic and Cox proportional regression models were used to model risk for COVID-19 outcomes. RESULTS Overall, 159 cases (50.2%) had type 2 diabetes and 125 had pre-diabetes (39.4%), while 31.4% of patients with type 2 diabetes were previously undiagnosed. Among 20.0% of pre-diabetes cases and 6.1% of normal-range HbA1c had de novo hyperglycemia. FPG was the better predictor for critical COVID-19 compared with HbA1c. Undiagnosed type 2 diabetes (OR: 5.76, 95% CI 1.46 to 27.11) and pre-diabetes (OR: 4.15, 95% CI 1.29 to 16.75) conferred increased risk of severe COVID-19. De novo/intrahospital hyperglycemia predicted critical COVID-19 outcomes independent of diabetes status. CONCLUSIONS Undiagnosed type 2 diabetes, pre-diabetes and de novo hyperglycemia are risk factors for critical COVID-19. HbA1c must be measured early to adequately assess individual risk considering the large rates of undiagnosed type 2 diabetes in Mexico.
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Affiliation(s)
- Arsenio Vargas-Vázquez
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, Mexico
- MD/PhD (PECEM) Program, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | - Edgar Ortiz-Brizuela
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, Mexico
| | - Alejandro Campos-Muñoz
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, Mexico
| | - Roopa Mehta
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, Mexico
- Department of Endocrinology and Metabolism, Salvador Zubiran National Institute of Medical Sciences and Nutrition, Tlalpan, Mexico
| | - Marco Villanueva-Reza
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, Mexico
| | - Jessica Paola Bahena-López
- MD/PhD (PECEM) Program, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Neftali Eduardo Antonio-Villa
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, Mexico
- MD/PhD (PECEM) Program, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
- Dirección de Investigación, Instituto Nacional de Geriatría, Mexico City, Mexico
| | - María Fernanda González-Lara
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, Mexico
| | - Alfredo Ponce de León
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, Mexico
| | - Jose Sifuentes-Osornio
- Dirección de Medicina, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Tlalpan, Mexico
| | - Carlos Alberto Aguilar-Salinas
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, Mexico
- Department of Endocrinology and Metabolism, Salvador Zubiran National Institute of Medical Sciences and Nutrition, Tlalpan, Mexico
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Rolland C, Lazarus C, Giese C, Monate B, Travert AS, Salomon J. Early Detection of Public Health Emergencies of International Concern through Undiagnosed Disease Reports in ProMED-Mail. Emerg Infect Dis 2021; 26:336-339. [PMID: 31961311 PMCID: PMC6986859 DOI: 10.3201/eid2602.191043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We conducted a retrospective analysis of all reports in ProMED-mail that were initially classified as undiagnosed diseases during 2007–2018. We identified 371 cases reported in ProMED-mail; 34% were later diagnosed. ProMED-mail could be used to supplement other undiagnosed disease surveillance systems worldwide.
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Ayano G, Demelash S, Yohannes Z, Haile K, Tsegay L, Tesfaye A, Haile K, Tulu M, Tsegaye B, Solomon M, Hibdye G, Assefa D, Dachew BA. Prevalence and correlates of diagnosed and undiagnosed epilepsy and migraine headache among people with severe psychiatric disorders in Ethiopia. PLoS One 2020; 15:e0241581. [PMID: 33216748 PMCID: PMC7678996 DOI: 10.1371/journal.pone.0241581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 10/16/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There is a paucity of research on the prevalence of diagnosed as well as undiagnosed neurological disorders with episodic manifestations such as epilepsy and migraine headaches in people with severe psychiatric disorders (SPD). To the best of our knowledge, this is the first study analyzing and comparing the prevalence of diagnosed and undiagnosed chronic neurological disorders with episodic manifestations including epilepsy and migraine headache in people with SPD. METHOD This quantitative cross-sectional survey was undertaken among 309 patients with SPD selected by a systematic random sampling technique. The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID) was used to confirm SPD among the participants. The International Classification of Headache Disorders (ICHD-3) and International League Against Epilepsy (ILAE) were used to define migraine headache and epilepsy, respectively]. Risk factors for chronic neurologic disorders were explored by using logistic regression models. RESULT In this study, the prevalence of overall neurological disorders, epilepsy, and migraine headache among people with SPD were found to be 5.2% (95%CI 3.2-8.3), 1.6% (95%CI 0.7-3.9), and 3.9% (95%CI 2.2-6.7), respectively. We found that a considerably higher proportion of people with SPD had undiagnosed overall neurological disorder (87.5%; 14/16), epilepsy (60%; 3/5), as well as migraine headaches (100%; 12/12). On the other hand, in this study, 12.5%, 40%, and 0% of patients with overall neurologic disorder, epilepsy, and migraine headaches respectively were diagnosed by the professionals. Higher disability score (WHODAS score) was associated with increased odds of having neurological disorders compared with the lower WHODAS score [OR = 1.30 (95% CI 1.02-1.66)]. CONCLUSION Whilst the prevalence estimates of neurological disorders with episodic manifestations including epilepsy and migraine headache was high among people with SPD, the vast majority of them remained undiagnosed. The diagnosis rates of those disorders were significantly low, perhaps surprisingly zero for migraine headache. High WHODAS score was associated with increased odds of having neurological disorders. Routine screening and management of epilepsy and migraine headache are imperative among people with SPD.
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Affiliation(s)
- Getinet Ayano
- Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
- School of Public Health, Curtin University, Perth, WA, Australia
| | | | - Zegeye Yohannes
- Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
| | - Kibrom Haile
- Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
| | - Light Tsegay
- Department of Psychiatric Nursing, College of Health Sciences, Axum University, Axum, Ethiopia
| | - Abel Tesfaye
- Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
- Department of Medicine, Hawassa University, Hawassa, Ethiopia
| | - Kelemua Haile
- Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
| | - Mikias Tulu
- Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
| | - Belachew Tsegaye
- Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
| | - Melat Solomon
- Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
| | - Getahun Hibdye
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Dawit Assefa
- Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
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Bruun-Rasmussen NE, Napolitano G, Kofoed-Enevoldsen A, Bojesen SE, Ellervik C, Rasmussen K, Jepsen R, Lynge E. Burden of prediabetes, undiagnosed, and poorly or potentially sub-controlled diabetes: Lolland-Falster health study. BMC Public Health 2020; 20:1711. [PMID: 33198690 PMCID: PMC7667788 DOI: 10.1186/s12889-020-09791-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 10/29/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND This study aimed to investigate prevalence and risk factors for prediabetes, undiagnosed diabetes mellitus, poorly and potentially sub-controlled diabetes in a rural-provincial general adult population in Denmark. METHODS Using cross-sectional data from the Lolland-Falster Health Study, we examined a total of 10,895 individuals aged 20 years and above. RESULTS Prevalence of prediabetes was 5.8% (men: 6.1%; women: 5.5%); of undiagnosed diabetes 0.8% (men: 1.0%; women: 0.5%); of poorly controlled diabetes 1.2% (men: 1.5%; women: 0.8%); and of potentially sub-controlled diabetes 2% (men: 3.0%; women: 1.3%). In total, 9.8% of all participants had a diabetes-related condition in need of intervention; men at a higher risk than women; RR 1.41 (95% CI 1.26-1.58); person aged + 60 years more than younger; RR 2.66 (95% CI 2.34-3.01); obese more than normal weight person, RR 4.51 (95% CI 3.79-5.38); smokers more than non-smokers, RR 1.38 (95% CI 1.19-1.62); persons with self-reported poor health perception more than those with good, RR 2.59 (95% CI 2.13-3.15); low leisure time physical activity more than those with high, RR 2.64 (95% CI 2.17-3.22); and persons with self-reported hypertension more than those without, RR 3.28 (95% CI 2.93-3.68). CONCLUSIONS In the Lolland-Falster Health Study, nearly 10% of participants had prediabetes, undiagnosed diabetes, poorly controlled, or potentially sub-controlled diabetes. The risk of these conditions was more than doubled in persons with self-reported poor health perception, self-reported hypertension, low leisure time physical activity, or measured obesity, and a large proportion of people with diabetes-related conditions in need of intervention can therefore be identified relatively easily.
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Affiliation(s)
| | - George Napolitano
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Stig Egil Bojesen
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Christina Ellervik
- Data and Development Support, Region Zealand, Sorø, Denmark
- Department of Laboratory Medicine, Boston Children's Hospital & Havard Medical School, Boston, MA, USA
| | - Knud Rasmussen
- Data and Development Support, Region Zealand, Sorø, Denmark
| | - Randi Jepsen
- Center for Epidemiological Research, Nykøbing Falster Hospital, Strandboulevarden 64, DK-4800, Nykøbing Falster, Denmark
| | - Elsebeth Lynge
- Center for Epidemiological Research, Nykøbing Falster Hospital, Strandboulevarden 64, DK-4800, Nykøbing Falster, Denmark
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15
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Dadwani RS, Skandari MR, GoodSmith MS, Phillips LS, Rhee MK, Laiteerapong N. Alternative type 2 diabetes screening tests may reduce the number of U.S. adults with undiagnosed diabetes. Diabet Med 2020; 37:1935-1943. [PMID: 32449198 PMCID: PMC7572743 DOI: 10.1111/dme.14330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/18/2020] [Indexed: 12/12/2022]
Abstract
AIM To evaluate the U.S. population-level impact of two alternatives for initial type 2 diabetes screening [opportunistic random plasma glucose (RPG) > 6.7 mmol/l and a 1-h 50-g glucose challenge test (GCT) > 8.9 mmol/l] compared with American Diabetes Association (ADA)-recommended tests. METHODS Using a sample (n = 1471) from the National Health and Nutrition Examination Survey (NHANES) 2013-2014 that represented 145 million U.S. adults at high risk for developing type 2 diabetes, we simulated a two-test screening process. We compared ADA-recommended screening tests [fasting plasma glucose (FPG), 2-h 75-g oral glucose tolerance test (OGTT), HbA1c ] vs. initial screening with opportunistic RPG or GCT (followed by FPG, OGTT or HbA1c ). After simulation, participants were entered into an individual-level Monte Carlo-based Markov lifetime outcomes model. Primary outcomes were representative number of U.S. adults correctly identified with type 2 diabetes, societal lifetime costs and quality-adjusted life years (QALYs). RESULTS In NHANES 2013-2014, 100 individuals had undiagnosed diabetes [weighted estimate: 8.4 million, standard error (se): 1.1 million]. Among ADA-recommended screening tests, FPG followed by OGTT (FPG-OGTT) was most sensitive, identifying 35 individuals with undiagnosed diabetes (weighted estimate: 3.2 million, se: 0.9 million). Four alternative screening strategies performed superior to FPG-OGTT, with RPG followed by OGTT being the most sensitive overall, identifying 72 individuals with undiagnosed diabetes (weighted estimate: 6.1 million, se: 1.0 million). There was no increase in average lifetime costs and comparable QALYs. CONCLUSIONS Initial screening using opportunistic RPG or a GCT may identify more U.S. adults with type 2 diabetes without increasing societal costs.
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Affiliation(s)
- R S Dadwani
- Pritzker School of Medicine, Chicago, IL, USA
| | - M R Skandari
- Imperial College Business School, Imperial College London, London, UK
| | | | - L S Phillips
- Division of Endocrinology and Metabolism, Department of Medicine, Emory School of Medicine, Atlanta, GA, USA
- Atlanta VA Medical Center, Decatur, GA, USA
| | - M K Rhee
- Division of Endocrinology and Metabolism, Department of Medicine, Emory School of Medicine, Atlanta, GA, USA
- Atlanta VA Medical Center, Decatur, GA, USA
| | - N Laiteerapong
- Section of General Internal Medicine, University of Chicago, Chicago, IL, USA
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16
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Lee D, Booth GL, Ray JG, Ling V, Feig DS. Undiagnosed type 2 diabetes during pregnancy is associated with increased perinatal mortality: a large population-based cohort study in Ontario, Canada. Diabet Med 2020; 37:1696-1704. [PMID: 31994233 DOI: 10.1111/dme.14250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2020] [Indexed: 01/11/2023]
Abstract
AIM To compare perinatal outcomes in women with undiagnosed diabetes with gestational diabetes alone, pre-existing diabetes and women without diabetes, and to identify risk factors which distinguish them from women with gestational diabetes alone. METHODS This population-based cohort study included administrative data on all women who gave birth in Ontario, Canada, during 2002-2015. Maternal/neonatal outcomes were compared across groups using logistic regression, adjusting for confounders. A nested case control study compared women with undiagnosed type 2 diabetes with women with gestational diabetes alone to determine risk factors that would help identify these women. RESULTS Among 995 990 women, 68 163 had gestational diabetes (6.8%) and, of those women with gestational diabetes,1772 had undiagnosed type 2 diabetes (2.6%). Those with undiagnosed type 2 diabetes were more likely to be older, from a lower income area, have parity > 3 and BMI ≥ 30 kg/m2 compared with gestational diabetes alone. Infants had a higher risk of perinatal mortality (OR 2.3 [1.6-3.4]), preterm birth (OR 2.6 [2.3-2.9]), congenital anomalies (OR 2.1 [1.7-2.5]), neonatal intensive care unit admission (OR 3.1 [2.8-3.5]) and neonatal hypoglycaemia (OR 406.0 [357-461]), which were similar to women with pre-existing diabetes. The strongest predictive risk factors included early gestational diabetes diagnosis, previous gestational diabetes and chronic hypertension. CONCLUSIONS Women diagnosed with gestational diabetes who develop diabetes within 1 year postpartum are at higher risk of adverse pregnancy outcomes, including perinatal mortality. This highlights the need for earlier diagnosis, preferably pre-pregnancy, and more aggressive treatment and surveillance of suspected type 2 diabetes during pregnancy.
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MESH Headings
- Adolescent
- Adult
- Case-Control Studies
- Cesarean Section/statistics & numerical data
- Cohort Studies
- Congenital Abnormalities/epidemiology
- Diabetes Mellitus, Type 2/epidemiology
- Diabetes, Gestational/epidemiology
- Female
- Fetal Macrosomia/epidemiology
- Humans
- Hyperbilirubinemia, Neonatal/epidemiology
- Hypertension, Pregnancy-Induced/epidemiology
- Hypoglycemia/epidemiology
- Income
- Infant, Newborn
- Infant, Newborn, Diseases/epidemiology
- Intensive Care Units, Neonatal
- Logistic Models
- Maternal Age
- Middle Aged
- Obesity, Maternal/epidemiology
- Ontario/epidemiology
- Parity
- Perinatal Mortality
- Pregnancy
- Pregnancy in Diabetics/epidemiology
- Premature Birth/epidemiology
- Residence Characteristics
- Respiratory Distress Syndrome, Newborn/epidemiology
- Shoulder Dystocia/epidemiology
- Undiagnosed Diseases/epidemiology
- Young Adult
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Affiliation(s)
- D Lee
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - G L Booth
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada
| | - J G Ray
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - V Ling
- ICES, Toronto, Ontario, Canada
| | - D S Feig
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, Sinai Health System, Mount Sinai Hospital, Toronto, Ontario, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Mount Sinai Hospital, Toronto, Ontario, Canada
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Denguezli M, Daldoul H, Harrabi I, Chouikha F, Ghali H, Burney P, Tabka Z. Prevalence and Characteristics of Undiagnosed COPD in Adults 40 Years and Older - Reports from the Tunisian Population-Based Burden of Obstructive Lung Disease Study. COPD 2020; 17:515-522. [PMID: 32781855 DOI: 10.1080/15412555.2020.1804848] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 04/08/2020] [Revised: 07/18/2020] [Accepted: 07/27/2020] [Indexed: 02/09/2023]
Abstract
This study aimed to investigate the underdiagnosis of COPD and its determinants based on the Tunisian Burden of Obstructive Lung Disease study. We collected information on respiratory history symptoms and risk factors for COPD. Post-bronchodilator (Post-BD) FEV1/FVC < the lower limit of normal (LLN) was used to define COPD. Undiagnosed COPD was considered when participants had post-BD FEV1/FVC < LLN but were not given a diagnosis of emphysema, chronic bronchitis or COPD. 730 adults aged ⩾40 years selected from the general population were interviewed, 661 completed spirometry, 35 (5.3%) had COPD and 28 (80%) were undiagnosed with the highest prevalence in women (100%). When compared with patients with an established COPD diagnosis, undiagnosed subjects had a lower education level, milder airway obstruction (Post-BD FEV1 z-score -2.2 vs. -3.7, p < 0.001), fewer occurrence of wheezing (42.9% vs. 100%, p = 0.009), less previous lung function test (3.6% vs. 42.8%, p = 0.019) and less visits to the physician (32.1% vs. 85.7%, p = 0.020) in the past year. Multivaried analysis showed that the probability of COPD underdiagnosis was higher in subjects who had mild to moderate COPD and in those who did not visit a clinician and did not perform a spirometry in the last year. Collectively, our results highlight the need to improve the diagnosis of COPD in Tunisia. Wider use of spirometry should reduce the incidence of undiagnosed COPD. Spirometry should also predominately be performed not only in elderly male smokers but also in younger women in whom the prevalence of underdiagnosis is the highest.
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Affiliation(s)
- Meriam Denguezli
- Laboratoire de recherche physiologie de l'exercice et physiopathologie: de l'intégré au moléculaire, LR19ES09, Faculty of Medicine Ibn El Jazzar, Sousse, Tunisia
- Faculty of Dental Medicine, Monastir, Tunisia
| | - Hager Daldoul
- Laboratoire de recherche physiologie de l'exercice et physiopathologie: de l'intégré au moléculaire, LR19ES09, Faculty of Medicine Ibn El Jazzar, Sousse, Tunisia
| | - Imed Harrabi
- Department of Epidemiology, University Hospital Farhat Hached, Sousse, Tunisia
| | - Firas Chouikha
- Department of Epidemiology, University Hospital Farhat Hached, Sousse, Tunisia
| | - Hela Ghali
- Department of Epidemiology, University Hospital Farhat Hached, Sousse, Tunisia
| | - Peter Burney
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Zouhair Tabka
- Laboratoire de recherche physiologie de l'exercice et physiopathologie: de l'intégré au moléculaire, LR19ES09, Faculty of Medicine Ibn El Jazzar, Sousse, Tunisia
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Hoffman BU. Significant relaxation of SARS-CoV-2-targeted non-pharmaceutical interventions may result in profound mortality: A New York state modelling study. PLoS One 2020; 15:e0239647. [PMID: 32970745 PMCID: PMC7514073 DOI: 10.1371/journal.pone.0239647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 09/11/2020] [Indexed: 12/24/2022] Open
Abstract
Severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) is the most significant global health crisis of the 21st century. The aim of this study was to develop a model to simulate the effect of undocumented infections, seasonal infectivity, immunity, and non-pharmaceutical interventions (NPIs) on the transmission, morbidity, and mortality of SARS-CoV-2 in New York State (NYS) based on data collected between March 4 and April 28, 2020. Simulations predict that undocumented infections significantly contribute to infectivity, NPIs are effective in reducing morbidity and mortality, and relaxation >50% of NPIs from initial lock-down levels may result in tens-of-thousands more deaths. Endemic infection is likely to occur in the absence of sustained immunity. As a result, until an effective vaccine or other effective pharmaceutical intervention is developed, the risks of significantly reducing NPIs should be carefully considered. This study employs modelling to simulate fundamental characteristics of SARS-CoV-2 transmission, which can help policymakers navigate combating this virus in the coming years.
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Affiliation(s)
- Benjamin U. Hoffman
- Vagelos College of Physicians and Surgeons, Columbia University, New York City, New York, United States of America
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
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Rutkowski M, Wojciechowska A, Śmigielski W, Drygas W, Piwońska A, Pająk A, Tykarski A, Kozakiewicz K, Waśniewska MK, Zdrojewski T. Prevalence of diabetes and impaired fasting glucose in Poland in 2005-2014: results of the WOBASZ surveys. Diabet Med 2020; 37:1528-1535. [PMID: 32445422 DOI: 10.1111/dme.14333] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/18/2020] [Indexed: 12/30/2022]
Abstract
AIMS To evaluate the prevalence of diabetes and impaired fasting glucose in Poland in 2013-2014 and to determine the temporal trends between 2003-2005 and 2013-2014. METHODS A questionnaire survey was conducted in a representative sample of Polish adults, complemented by anthropometric and fasting plasma glucose measurements. The research was part of the national cross-sectional WOBASZ study. Diabetes was assessed as self-reported or screened (fasting plasma glucose level ≥ 7 mmol/l, based on one blood sample). RESULTS In the years 2013-2014 among 5694 participants aged 20-74 years, 6.0% (95% CI 5.4-6.6) reported a previous diagnosis of diabetes (5.8% in women and 6.2% in men). In addition, 2.4% of the participants (95% CI 2.0-2.8) without a previous diagnosis of diabetes (1.8% of women and 3.1% of men) had a fasting blood glucose level ≥7.0 mmol/l in a single measurement. In a single measurement, 18.4% of the participants (95% CI 17.4-19.4; 13.2% of women and 23.8% of men) had impaired fasting glucose. The prevalence of dysglycaemia in the WOBASZ II study was significantly higher compared to the WOBASZ I study findings from 2003-2005, increased from 6.6% to 8.4% for diabetes and from 9.3% to 18.4% for impaired fasting glucose (after age and sex standardization to the 2013 Polish population). CONCLUSIONS The prevalence of diabetes in Poland is similar to that observed in other European populations and has increased significantly over the last decade.
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Affiliation(s)
- M Rutkowski
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - A Wojciechowska
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - W Śmigielski
- Unit of Demography and Social Gerontology, University of Lodz, Lodz, Poland
| | - W Drygas
- Department of Epidemiology, Cardiovascular Disease Prevention, and Health Promotion, Institute of Cardiology, Warsaw, Poland
- Department of Social and Preventive Medicine, Medical University of Lodz, Lodz, Poland
| | - A Piwońska
- Department of Epidemiology, Cardiovascular Disease Prevention, and Health Promotion, Institute of Cardiology, Warsaw, Poland
| | - A Pająk
- Epidemiology and Population Studies Department, Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland
| | - A Tykarski
- Department of Hypertension, Angiology, and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - K Kozakiewicz
- Third Department of Cardiology, Medical University of Silesia, Katowice, Poland
| | - M K Waśniewska
- Department of Social and Preventive Medicine, Medical University of Lodz, Lodz, Poland
| | - T Zdrojewski
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
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Teo WW, Ti LK, Lean LL, Seet E, Paramasivan A, Liu W, Wang J, Chua V, Liew LQ. The neglected perioperative population of undiagnosed diabetics - a retrospective cohort study. BMC Surg 2020; 20:188. [PMID: 32811495 PMCID: PMC7437967 DOI: 10.1186/s12893-020-00844-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 08/05/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Diabetes is known to increase morbidity and 30-day mortality in adults undergoing non-cardiac surgery, but longer term outcomes are less studied. This study was done to explore how undiagnosed and known diabetes affect 30-day and one-year morbidity and mortality outcomes. The secondary aim was to study the prevalence of undiagnosed diabetics in our perioperative Asian surgical population. METHODS A retrospective cohort study of 2106 patients aged > 45 years undergoing non-cardiac surgery in a single tertiary hospital was performed. Undiagnosed diabetics were identified (HbA1c ≥6.5% or fasting blood glucose ≥126 mg/dL) and relevant demographic, clinical and surgical data were analyzed to elicit the relationship to adverse outcomes. Univariate analysis was first performed to identify significant variables with p-values ≤0.1, which were then analyzed using multiple logistic regression to calculate the adjusted odds ratio. RESULTS The prevalence of undiagnosed diabetes was 7.4%. The mean and median HbA1c of known diabetics were 7.9 and 7.5%, while the mean and median HbA1c for undiagnosed diabetics were 7.2 and 6.8% respectively. 36.4% of known diabetics and 20.5% of undiagnosed diabetics respectively had a random blood glucose > 200 mg/dL. Undiagnosed diabetics had a three-fold increase in 1-year mortality compared to non-diabetics (adjusted OR 3.46(1.80-6.49) p < 0.001) but this relationship was not significant between known and non-diabetics. Compared to non-diabetics, known diabetics were at increased risks of new-onset atrial fibrillation (aOR 2.48(1.01-6.25) p = 0.047), infection (aOR 1.49(1.07-2.07) p = 0.017), 30-day readmission (aOR 1.62(1.17-2.25) p = 0.004) and 30-day mortality (aOR 3.11(1.16-8.56) p = 0.025). CONCLUSIONS Although undiagnosed diabetics have biochemically less severe disease compared to known diabetics at the point of testing, they are at a one-year mortality disadvantage which is not seen among known diabetics. This worrying trend highlights the importance of identifying and treating diabetes. Congruent to previous studies, known diabetics have higher morbidity and 30-day mortality compared to non-diabetics.
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Affiliation(s)
- Wei W. Teo
- Department of Anaesthesia, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074 Singapore
| | - Lian K. Ti
- Department of Anaesthesia, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074 Singapore
| | - Lyn L. Lean
- Department of Anaesthesia, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074 Singapore
| | - Edwin Seet
- Department of Anaesthesia, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828 Singapore
| | - Ambika Paramasivan
- Department of Anaesthesia, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074 Singapore
| | - Weiling Liu
- Department of Anaesthesia, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074 Singapore
| | - Jiexun Wang
- Department of Anaesthesia, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828 Singapore
| | - Vanessa Chua
- Department of Anaesthesia, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074 Singapore
| | - Lydia Q. Liew
- Department of Anaesthesia, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074 Singapore
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de Mestral C, Stringhini S, Guessous I, Jornayvaz FR. Thirteen-year trends in the prevalence of diabetes in an urban region of Switzerland: a population-based study. Diabet Med 2020; 37:1374-1378. [PMID: 31814147 DOI: 10.1111/dme.14206] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/05/2019] [Indexed: 01/24/2023]
Abstract
AIM To assess trends in prevalence of total and diagnosed diabetes, and in the probability of detecting undiagnosed diabetes in the Swiss population. METHODS The Bus Santé study is an annual cross-sectional study of adults residing in Geneva state, Switzerland. We included 8532 participants (51% women) from the years 2005 to 2017, when fasting plasma glucose data became available. Total diabetes was defined as the sum of diagnosed and undiagnosed diabetes, while diagnosed diabetes was defined as having a previous diagnosis, and undiagnosed diabetes as having fasting plasma glucose level of ≥7 mmol/l and no previous diagnosis. We calculated the probability of finding undiagnosed diabetes among participants without a diagnosis. We examined for linear and quadratic trends, grouping survey years into five survey periods. RESULTS In total, 711 diabetes cases were identified over 13 years. The age- and gender-standardized prevalence of total diabetes decreased between the periods 2005-2009 and 2012-2013 from 9.6% (95% CI 8.3, 10.9) to 7.1% (95% CI 5.8, 8.4), but increased to 8.6% (95% CI 7.3%, 9.9%) by 2016-2017 (P-quadratic <0.01). For diagnosed diabetes, the prevalence decreased between 2005-2009 and 2014-2015 from 8.3% (95% CI 7.0%, 9.5%) to 6.1% (95% CI 5.0%, 7.2%), but increased slightly again to 7.0% (95% CI 5.8%, 8.2%) by 2016-2017 (P-quadratic = 0.01). Men generally had a higher prevalence of total and diagnosed diabetes than women, except in 2016-2017, when the prevalence of total diabetes was 9.5% (95% CI 7.6, 11.5) among men and 7.7% (95% CI 6.0, 9.5) among women (P >0.05). The probability of finding undetected diabetes among participants without a diabetes diagnosis decreased slightly between 2005-2009 and 2012-2013 from 1.5% (95% CI 0.9, 2.0) to 1.0% (95% CI 0.5, 1.5), but increased afterwards to 1.7% (95% CI 1.0, 2.3) by 2016-2017 (P-quadratic = 0.06); in 2016-2017, it was 2.6% (95% CI 1.5, 3.7) among men and 0.7% (95% CI 0.1, 1.3) among women (P <0.01). CONCLUSION The prevalence of diabetes has remained relatively constant over time. However, the probability of finding undetected cases of diabetes in the population without diabetes may be increasing among men.
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Affiliation(s)
- C de Mestral
- Population Epidemiology Unit, Division of Primary Care Medicine, Department of Primary Care Medicine, University Hospitals of Geneva, Geneva, Switzerland
- Department of Epidemiology and Health Systems, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - S Stringhini
- Population Epidemiology Unit, Division of Primary Care Medicine, Department of Primary Care Medicine, University Hospitals of Geneva, Geneva, Switzerland
- Department of Epidemiology and Health Systems, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - I Guessous
- Population Epidemiology Unit, Division of Primary Care Medicine, Department of Primary Care Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - F R Jornayvaz
- Unit of Diabetology, Service of Endocrinology, Diabetology, Hypertension and Nutrition Services, Department of Medical Specialties, University Hospitals of Geneva, Geneva, Switzerland
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Song SK, Lee DH, Nam JH, Kim KT, Do JS, Kang DW, Kim SG, Cho MR. IgG Seroprevalence of COVID-19 among Individuals without a History of the Coronavirus Disease Infection in Daegu, Korea. J Korean Med Sci 2020; 35:e269. [PMID: 32715672 PMCID: PMC7384903 DOI: 10.3346/jkms.2020.35.e269] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [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: 06/14/2020] [Accepted: 07/09/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Seroprevalence studies of coronavirus disease 2019 (COVID-19) from many countries have shown that the number of undiagnosed missing cases is much larger than that of confirmed cases, irrespective of seroprevalence levels. Considering the strategy of Korea entailing massive testing and contact tracing from the beginning of epidemic, the number of undiagnosed missing cases in Korea may be negligible. This study was conducted to estimate the seroprevalence of COVID-19 among individuals who were never diagnosed with COVID-19 in Daegu, the epicenter of COVID-19 epidemic in Korea. METHODS Serologic testing for immunoglobulin G antibody based on immunochromatographic assay was conducted in 103 patients and 95 guardians aged 18 to 82 years without any history of COVID-19 diagnosis, who visited outpatient clinics of a single university-affiliated hospital from May 25 to June 5, 2020. RESULTS The estimated seroprevalence was 7.6% (95% confidence interval, 4.3%-12.2%) with 15 positive cases. Among them, only one had a polymerase chain reaction (PCR)-confirmed case among their close contacts and 13 did not experience COVID-19-related symptoms. Seroprevalence was similar between patients and guardians. Based on this figure, the number of undiagnosed missing cases in Daegu was estimated to be a dozen times more than the number of confirmed cases based on PCR testing. CONCLUSION Despite the limitation of a small and unrepresentative sample, this is the first study on seroprevalence of COVID-19 in Korea. Our study suggested that the number of undiagnosed missing cases was substantial even with the stringent strategy adopted in Korea, similar to that of other countries.
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Affiliation(s)
- Suk Kyoon Song
- Department of Orthopedics, Daegu Catholic University Hospital, Daegu, Korea
| | - Duk Hee Lee
- Department of Preventive Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jun Ho Nam
- Department of Orthopedics, Daegu Catholic University Hospital, Daegu, Korea
| | - Kyung Tae Kim
- Department of Orthopedics, Daegu Catholic University Hospital, Daegu, Korea
| | - Jung Suk Do
- Department of Orthopedics, Daegu Catholic University Hospital, Daegu, Korea
| | - Dae Won Kang
- Department of Orthopedics, Daegu Catholic University Hospital, Daegu, Korea
| | - Sang Gyung Kim
- Department of Laboratory Medicine, Daegu Catholic University Hospital, Daegu, Korea.
| | - Myung Rae Cho
- Department of Orthopedics, Daegu Catholic University Hospital, Daegu, Korea.
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Narváez J, Sánchez-Fernández SÁ, Seoane-Mato D, Díaz-González F, Bustabad S. Prevalence of Sjögren's syndrome in the general adult population in Spain: estimating the proportion of undiagnosed cases. Sci Rep 2020; 10:10627. [PMID: 32606345 PMCID: PMC7327007 DOI: 10.1038/s41598-020-67462-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 06/09/2020] [Indexed: 11/09/2022] Open
Abstract
To estimate the prevalence of Sjögren's syndrome (SS) in the adult Spanish population we performed a population-based multicenter cross-sectional study. Cases were defined by the American-European Consensus Group criteria proposed in 2002. A total of 4,916 subjects aged 20 years or over were included. The estimated prevalence of SS (including primary and secondary forms) in the adult population in Spain was 0.33% (95% CI 0.21-0.53). Extrapolating to the total population of the country aged ≥ 20 years (around 37.7 million persons), there would be around 125,000 cases of SS in Spain. Considering only primary SS, the estimated prevalence was 0.25% (95% CI 0.15-0.43) or 1 person in 400. The prevalence of primary SS in Spain is comparable to that reported in other European studies with a similar design and diagnostic criteria. Based on these results, primary SS could not be considered a rare (orphan) disease. Only 50% of cases had already been diagnosed with SS prior EPISER 2016 study, confirming the existence of a non-negligible proportion of undiagnosed cases in the general population.
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Affiliation(s)
- Javier Narváez
- Department of Rheumatology (Planta 10-2), Hospital Universitario de Bellvitge, Feixa Llarga, s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain.
| | | | - Daniel Seoane-Mato
- Unidad de Investigación, Sociedad Española de Reumatología, Madrid, Spain
| | - Federico Díaz-González
- Department of Rheumatology, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
| | - Sagrario Bustabad
- Department of Rheumatology, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
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Ajogbasile FV, Oguzie JU, Oluniyi PE, Eromon PE, Uwanibe JN, Mehta SB, Siddle KJ, Odia I, Winnicki SM, Akpede N, Akpede G, Okogbenin S, Ogbaini-Emovon E, MacInnis BL, Folarin OA, Modjarrad K, Schaffner SF, Tomori O, Ihekweazu C, Sabeti PC, Happi CT. Real-time Metagenomic Analysis of Undiagnosed Fever Cases Unveils a Yellow Fever Outbreak in Edo State, Nigeria. Sci Rep 2020; 10:3180. [PMID: 32081931 PMCID: PMC7035389 DOI: 10.1038/s41598-020-59880-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 02/03/2020] [Indexed: 01/21/2023] Open
Abstract
Fifty patients with unexplained fever and poor outcomes presented at Irrua Specialist Teaching Hospital (ISTH) in Edo State, Nigeria, an area endemic for Lassa fever, between September 2018 - January 2019. After ruling out Lassa fever, plasma samples from these epidemiologically-linked cases were sent to the African Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer's University, Ede, Osun State, Nigeria, where we carried out metagenomic sequencing which implicated yellow fever virus (YFV) as the etiology of this outbreak. Twenty-nine of the 50 samples were confirmed positive for YFV by reverse transcriptase-quantitative polymerase chain reaction (RT-qPCR), 14 of which resulted in genome assembly. Maximum likelihood phylogenetic analysis revealed that these YFV sequences formed a tightly clustered clade more closely related to sequences from Senegal than sequences from earlier Nigerian isolates, suggesting that the YFV clade responsible for this outbreak in Edo State does not descend directly from the Nigerian YFV outbreaks of the last century, but instead reflects a broader diversity and dynamics of YFV in West Africa. Here we demonstrate the power of metagenomic sequencing for identifying ongoing outbreaks and their etiologies and informing real-time public health responses, resulting in accurate and prompt disease management and control.
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Affiliation(s)
- Fehintola V Ajogbasile
- African Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer's University, Ede, Osun State, Nigeria
- Department of Biological Sciences, Faculty of Natural Sciences, Redeemer's University, Ede, Osun State, Nigeria
| | - Judith U Oguzie
- African Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer's University, Ede, Osun State, Nigeria
- Department of Biological Sciences, Faculty of Natural Sciences, Redeemer's University, Ede, Osun State, Nigeria
| | - Paul E Oluniyi
- African Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer's University, Ede, Osun State, Nigeria
- Department of Biological Sciences, Faculty of Natural Sciences, Redeemer's University, Ede, Osun State, Nigeria
| | - Philomena E Eromon
- African Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer's University, Ede, Osun State, Nigeria
| | - Jessica N Uwanibe
- African Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer's University, Ede, Osun State, Nigeria
- Department of Biological Sciences, Faculty of Natural Sciences, Redeemer's University, Ede, Osun State, Nigeria
| | - Samar B Mehta
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Beth Israel Deaconess Medical Center, Division of Infectious Diseases, Boston, Massachusetts, USA
| | - Katherine J Siddle
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Center for Systems Biology, Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, Massachusetts, USA
| | - Ikponmwosa Odia
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Sarah M Winnicki
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Nosa Akpede
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - George Akpede
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Sylvanus Okogbenin
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Ephraim Ogbaini-Emovon
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Bronwyn L MacInnis
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Onikepe A Folarin
- African Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer's University, Ede, Osun State, Nigeria
- Department of Biological Sciences, Faculty of Natural Sciences, Redeemer's University, Ede, Osun State, Nigeria
| | - Kayvon Modjarrad
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Stephen F Schaffner
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Center for Systems Biology, Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, Massachusetts, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Oyewale Tomori
- African Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer's University, Ede, Osun State, Nigeria
| | | | - Pardis C Sabeti
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Center for Systems Biology, Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, Massachusetts, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- Howard Hughes Medical Institute, Chevy Chase, Maryland, USA
| | - Christian T Happi
- African Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer's University, Ede, Osun State, Nigeria.
- Department of Biological Sciences, Faculty of Natural Sciences, Redeemer's University, Ede, Osun State, Nigeria.
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria.
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA.
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Claypool KT, Chung MK, Deonarine A, Gregg EW, Patel CJ. Characteristics of undiagnosed diabetes in men and women under the age of 50 years in the Indian subcontinent: the National Family Health Survey (NFHS-4)/Demographic Health Survey 2015-2016. BMJ Open Diabetes Res Care 2020; 8:e000965. [PMID: 32098896 PMCID: PMC7206915 DOI: 10.1136/bmjdrc-2019-000965] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/04/2019] [Accepted: 01/04/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Prior studies examining diabetes prevalence in India have found that nearly 50% of the diabetes population remains undiagnosed; however, the specific populations at risk are unclear. RESEARCH DESIGN AND METHODS First, we estimated the prevalence of undiagnosed diabetes in India for 750 924 persons between the ages of 15 years and 50 years who participated in the National Family Health Survey (NFHS-4)/Demographic Health Survey (2015-2016), a cross-sectional survey of all 29 states and 7 union territories of India. We defined 'undiagnosed diabetes' as individuals who did not know about their diabetes status but had high random (≥200 mg/dL) or fasting (≥126 mg/dL) blood glucose levels. Second, using Poisson regression, we associated 10 different factors, including the role of healthcare access, and undiagnosed diabetes. Third, we examined the association of undiagnosed diabetes with other potential comorbid conditions. RESULTS The crude prevalence of diabetes for women and men aged 15-50 years was 2.9%, 95% CI 2.9% to 3.1%, with self-reported diabetes prevalence at 1.7%, 95% CI 1.6 to 1.8. The overall prevalence of undiagnosed diabetes for 15-50 year olds was at 1.2%, 95% CI 1.2% to 1.3%. Forty-two per cent, 95% CI 40.7% to 43.4% of the individuals with high glucose levels were unaware of their diabetes status. Approximately 45%, 95% CI 42.9% to 46.4% of undiagnosed diabetes population had access to healthcare. Men, younger individuals, and those with lower levels of education were most at risk of being undiagnosed. Geographically, the Southern states in India had a significantly higher prevalence of undiagnosed diabetes despite having nearly universal access to healthcare. Risk factors combined with random glucose could predict undiagnosed diabetes (area under the curve of 97.8%, 95% CI 97.7% to 97.8%), Nagelkerke R2 of 66%). CONCLUSION Close to half (42%) of the people with diabetes in India are not aware of their disease status, and a large subset of these people are at risk of poor detection, despite having health insurance and/or having access to healthcare. Younger age groups and men are the most vulnerable.
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Affiliation(s)
- Kajal T Claypool
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
- Human Health and Performance Systems, MIT Lincoln Laboratory, Lexington, Massachusetts, USA
| | - Ming-Kei Chung
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew Deonarine
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
| | - Edward W Gregg
- Department of Epidemiology and Biostatistics, Imperial College London, London, London, UK
| | - Chirag J Patel
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
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Abstract
AIM Diabetes impairs the quality of life of people living with the condition and is a major public health concern. The aim of this paper is to create a state of the nation report of diabetes in the UK. METHODS Diabetes UK collates information about diabetes from diverse sources. This paper synthesizes these data to create a national report. RESULTS Some 7% of the UK population are now living with diabetes; approximately one million people have undiagnosed type 2 diabetes, 40 000 children have diabetes and more than 3000 children are diagnosed every year. Forty-nine per cent of people with type 1 diabetes were offered structured education, but only 7.6% attended; the corresponding figures for type 2 diabetes were 90% and 10.4%, respectively. Among people with diabetes, 28% reported having issues obtaining medication or equipment for self-management. Fifty-seven per cent of people with type 1 diabetes and 42% with type 2 diabetes do not receive all eight annual health checks. Around 40% of people with diabetes have diminished psychological well-being. One-third of people have a microvascular complication at the time of diagnosis of type 2 diabetes. Diabetes is responsible for 530 myocardial infarctions and 175 amputations every week. The National Health Service spends at least £10 billion a year on diabetes, equivalent to 10% of its budget; 80% is spent treating complications. One in six hospital inpatients has diabetes. CONCLUSION Diabetes continues to place a significant burden on the individual with diabetes and wider UK society. This report will be updated annually to understand how diabetes is changing across the UK.
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Affiliation(s)
- C A Whicher
- Southern Health NHS Foundation Trust, Research & Development Department, Moorgreen Hospital, University of Southampton, Southampton, UK
| | | | - R I G Holt
- Human Development and Health, University of Southampton, Southampton, UK
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Velez M, Chasan-Taber L, Goldwater E, VanKim N. Physical Activity and Risk of Diagnosed and Undiagnosed Prediabetes among Males and Females in the National Health and Nutrition Examination Survey, 2007-2014. J Diabetes Res 2020; 2020:3538746. [PMID: 32626778 PMCID: PMC7306088 DOI: 10.1155/2020/3538746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/26/2020] [Accepted: 05/28/2020] [Indexed: 01/02/2023] Open
Abstract
AIMS The purpose of the study was to assess the effect of leisure and occupational physical activity on the risk of diagnosed and undiagnosed prediabetes among females and males. METHODS A sample of 17,871 non-pregnant adults was drawn from the 2007-2014 National Health and Nutrition Examination Survey. Multinomial logistic regression tested associations between moderate-to-vigorous physical activity (MVPA) and risk of diagnosed prediabetes and undiagnosed prediabetes, compared to no prediabetes. RESULTS Females and males who met guidelines for total MVPA (i.e., ≥10 MET-hrs/week) had a statistically significant lower risk of undiagnosed prediabetes (OR range: 0.50-0.65) as compared to those with no MVPA, however findings were no longer statistically significant after adjustment for diabetes risk factors. In terms of diagnosed prediabetes, females meeting guidelines had lower risk (OR range: 0.65-0.76), while only males engaging in the most MVPA had lower risk; findings were no longer significant after adjustment. Patterns were similar for leisure-time MVPA, but conflicting for occupational PA; females with 10-20 MET-hrs/week had a higher risk of diagnosed prediabetes (OR =1.71, 95% CI 1.11-2.61) and males with >20 MET-hrs/week had a higher risk for undiagnosed prediabetes (OR =1.17, 95% CI 1.02-1.35) after adjustment. CONCLUSIONS This study adds to the sparse body of literature on physical activity and prediabetes, particularly with its inclusion of occupational MVPA.
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Affiliation(s)
- Mabeline Velez
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst Massachusets, USA
| | - Lisa Chasan-Taber
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst Massachusets, USA
| | - Eva Goldwater
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst Massachusets, USA
| | - Nicole VanKim
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst Massachusets, USA
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Bantie GM, Wondaye AA, Arike EB, Melaku MT, Ejigu ST, Lule A, Lingerew WM, Tamirat KS. Prevalence of undiagnosed diabetes mellitus and associated factors among adult residents of Bahir Dar city, northwest Ethiopia: a community-based cross-sectional study. BMJ Open 2019; 9:e030158. [PMID: 31676649 PMCID: PMC6830649 DOI: 10.1136/bmjopen-2019-030158] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To assess the prevalence of undiagnosed diabetes mellitus (DM) and associated factors among adult inhabitants of Bahir Dar city, northwest Ethiopia. DESIGN A community-based cross-sectional study was conducted on adults (n=607) of Bahir Dar city from 10 March to 20 May 2018. MEASUREMENTS Data were collected using structured interviewer-administered questionnaire, and anthropometric measurements were taken from each participant. Fasting blood sugar (FBS) level was determined by samples taken early in the morning and readings of FBS≥126 mg/dL were classified as diabetes. The multivariate logistic regression model was fitted to identify the predictors of undiagnosed DM; adjusted OR (AOR) with a 95% CI was computed to assess the strength of associations. RESULT The study revealed that the prevalence of undiagnosed DM was 10.2% with 95% CI 7.9 to 12.9. Ever checked blood glucose level (AOR=1.91, 95% CI 1.03 to 3.51), don't know the symptoms of diabetes (AOR=2.06, 95% CI 1.08 to 3.89), family history of DM (AOR=2.5, 95% CI 1.21 to 5.18) and body mass index (BMI) ≥25 kg/m2 (AOR=1.98, 95% CI 1.09 to 3.60) were factors associated with undiagnosed DM. CONCLUSION The magnitude of undiagnosed diabetes was high. Family history of DM, ever checked blood glucose level, don't know about the symptoms of diabetes and overweight BMI were predictors of undiagnosed DM. Hence, screening and treatment are mandatory for high-risk groups. In addition, this study suggests frequent screening for those with family history and awareness creating about the disease for early detection and treatment.
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Affiliation(s)
| | | | - Efrem Beru Arike
- Public Health, GAMBY College of Medical Sciences, Bahir Dar, Ethiopia
| | | | | | - Abel Lule
- Public Health, GAMBY College of Medical Sciences, Bahir Dar, Ethiopia
| | - Wondemagegn Mulu Lingerew
- Microbiology and Immunology, College of Medicine and Health Science,Bahir Dar University, Bahir Dar, Ethiopia
| | - Koku Sisay Tamirat
- Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Khanam R, Ahmed S, Rahman S, Kibria GMA, Syed JRR, Khan AM, Moin SMI, Ram M, Gibson DG, Pariyo G, Baqui AH. Prevalence and factors associated with hypertension among adults in rural Sylhet district of Bangladesh: a cross-sectional study. BMJ Open 2019; 9:e026722. [PMID: 31662350 PMCID: PMC6830635 DOI: 10.1136/bmjopen-2018-026722] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Low-income and middle-income countries are undergoing epidemiological transition, however, progression is varied. Bangladesh is simultaneously experiencing continuing burden of communicable diseases and emerging burden of non-communicable diseases (NCDs). For effective use of limited resources, an increased understanding of the shifting burden and better characterisation of risk factors of NCDs, including hypertension is needed. This study provides data on prevalence and factors associated with hypertension among males and females 35 years and older in rural Bangladesh. METHODS This is a population-based cross-sectional study conducted in Zakiganj and Kanaighat subdistricts of Sylhet district of Bangladesh. Blood pressure was measured and data on risk factors were collected using STEPS instrument from 864 males and 946 females aged 35 years and older between August 2017 and January 2018. Individuals with systolic blood pressure of ≥140 mm Hg or diastolic blood pressure of ≥90 mm Hg or taking antihypertensive drugs were considered hypertensive. Bivariate and multivariate analyses were performed to identify factors associated with hypertension. RESULTS The prevalence of hypertension was 18.8% (95% CI 16.3 to 21.5) and 18.7% (95% CI 16.3 to 21.3) in adult males and females, respectively. Among those who were hypertensive, the prevalence of controlled, uncontrolled and unaware/newly identified hypertension was 23.5%, 25.9% and 50.6%, respectively among males and 38.4%, 22.6% and 39.0%, respectively among females. Another 22.7% males and 17.8% females had prehypertension. Increasing age and higher waist circumference (≥90 cm for males and ≥80 cm for females) were positively associated with hypertension both in males (OR 4.0, 95% CI 2.5 to 6.4) and females (OR 2.8, 95% CI 2.0 to 4.1). CONCLUSIONS In view of the high burden of hypertension and prehypertension, a context-specific scalable public health programme including behaviour change communications, particularly to increase physical activity and consumption of healthy diet, as well as identification and management of hypertension needs to be developed and implemented.
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Affiliation(s)
- Rasheda Khanam
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | | | | | - Gulam Muhammed Al Kibria
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | | | | | - Malathi Ram
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Dustin G Gibson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - George Pariyo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Abdullah H Baqui
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Peden AH, Kanguru L, Ritchie DL, Smith C, Molesworth AM. Study protocol for enhanced CJD surveillance in the 65+ years population group in Scotland: an observational neuropathological screening study of banked brain tissue donations for evidence of prion disease. BMJ Open 2019; 9:e033744. [PMID: 31662408 PMCID: PMC6830687 DOI: 10.1136/bmjopen-2019-033744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Creutzfeldt-Jakob disease (CJD) is a human prion disease that occurs in sporadic, genetic and acquired forms. Variant CJD (vCJD) is an acquired form first identified in 1996 in the UK. To date, 178 cases of vCJD have been reported in the UK, most of which have been associated with dietary exposure to the bovine spongiform encephalopathy agent. Most vCJD cases have a young age of onset, with a median age at death of 28 years. In the UK, suspected cases of vCJD are reported to the UK National Creutzfeldt-Jakob Disease Research & Surveillance Unit (NCJDRSU). There is, however, a concern that the national surveillance system might be missing some cases of vCJD or other forms of human prion disease, particularly in the older population, perhaps because of atypical clinical presentation. This study aims to establish whether there is unrecognised prion disease in people aged 65 years and above in the Scottish population by screening banked brain tissue donated to the Edinburgh Brain Bank (EBB). METHODS Neuropathological screening of prospective and retrospective brain tissue samples is performed. This involves histopathological and immunohistochemical analysis and prion protein biochemical analysis. During the study, descriptive statistics are used to describe the study population, including the demographics and clinical, pathological and referral characteristics. Controlling for confounders, univariate and multivariate analyses will be used to compare select characteristics of newly identified suspect cases with previously confirmed cases referred to the NCJDRSU. ETHICS AND DISSEMINATION Brain tissue donations to EBB are made voluntarily by the relatives of patients, with consent for use in research. The EBB has ethical approval to provide tissue samples to research projects (REC reference 16/ES/0084). The findings of this study will be disseminated in meetings, conferences, workshops and as peer-reviewed publications. TRIAL REGISTRATION NUMBERS 10/S1402/69 and 10/S1402/70.
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Affiliation(s)
- Alexander Howard Peden
- Centre for Clinical Brain Sciences, National CJD Research & Surveillance Unit, Edinburgh, UK
| | - Lovney Kanguru
- Centre for Clinical Brain Sciences, National CJD Research & Surveillance Unit, Edinburgh, UK
| | - Diane L Ritchie
- Centre for Clinical Brain Sciences, National CJD Research & Surveillance Unit, Edinburgh, UK
| | - Colin Smith
- Centre for Clinical Brain Sciences, National CJD Research & Surveillance Unit, Edinburgh, UK
| | - Anna M Molesworth
- Centre for Clinical Brain Sciences, National CJD Research & Surveillance Unit, Edinburgh, UK
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Abu-Helalah M, Alshraideh HA, Al-Sarayreh SA, Al Shawabkeh AHK, Nesheiwat A, Younes N, Al-Hader A. A Cross-Sectional Study to Assess the Prevalence of Adult Thyroid Dysfunction Disorders in Jordan. Thyroid 2019; 29:1052-1059. [PMID: 31146635 DOI: 10.1089/thy.2018.0579] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Insufficient production of thyroid hormones results in hypothyroidism, while overproduction results in hyperthyroidism. These are common adult disorders, with hypothyroidism more common in the elderly. Jordan has had past problems with dietary iodine deficiency but there are no published studies assessing the population prevalence of these disorders in the Arab Middle East. Methods: A cross-sectional study was conducted in three representative areas of Jordan. There were 7085 participants with a mean age of 40.8 years. Participants completed a questionnaire and had blood taken for thyroid analysis. Results:Hypothyroidism: The prevalence of any hypothyroidism (already diagnosed and/or identified by blood testing) was 17.2% in females and 9.1% in males. Undiagnosed prevalence was 8% and 6.2% for females and males, respectively. The prevalence of subclinical hypothyroidism, defined as high serum thyrotropin (TSH) and normal serum-free thyroxine (fT4), was 5.98% among females and 4.40% among males. The prevalence of overt hypothyroidism, defined as high TSH and low fT4, was 2.00% among females and 1.80% among males. Only 53.5% (55.3% for females, 42.1% males) of those previously diagnosed with hypothyroidism had TSH levels within the appropriate range. Hyperthyroidism: The prevalence of any hyperthyroidism (already diagnosed and/or identified by blood testing) was 1.8% in females and 2.27% in males. The undiagnosed prevalence was 1.4% and 2.1% for females and males, respectively. The prevalence of subclinical hyperthyroidism (low TSH and normal fT4) was 1.20% and 1.80% among males and females accordingly. The prevalence of overt hyperthyroidism (low TSH and high fT4) was 0.2% among females and 0.3% among males. About 85.7% (83.3% for females, 100% males) of those previously diagnosed with hyperthyroidism had TSH levels within the appropriate range. Conclusions: The results of this study reveal that the total prevalence of thyroid dysfunction among adult females and males in Jordan is very high compared with international statistics, particularly in the rates of undiagnosed cases. This indicates the need for further assessment of the value of screening for adult hypothyroidism in Jordan.
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Affiliation(s)
- Munir Abu-Helalah
- 1Department of Public Health, Faculty of Medicine, Mutah University, Karak, Jordan
- 2Faculty of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
| | - Hussam Ahmad Alshraideh
- 3Industrial Engineering Department; Jordan University of Science and Technology, Irbid, Jordan
- 4Industrial Engineering Department, American University of Sharjah, Sharjah, United Arab Emirates
| | | | | | - Adel Nesheiwat
- 7King Hussein Medical Center, Royal Medical Services, Amman, Jordan
| | - Nidal Younes
- 8Department of Surgery, University of Jordan, Amman, Jordan
| | - AbdelFattah Al-Hader
- 9Department of Physiology, Faculty of Medicine; Jordan University of Science and Technology, Irbid, Jordan
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Lyu YS, Kim SY, Bae HY, Kim JH. Prevalence and Risk Factors for Undiagnosed Glucose Intolerance Status in Apparently Healthy Young Adults Aged <40 Years: The Korean National Health and Nutrition Examination Survey 2014-2017. Int J Environ Res Public Health 2019; 16:ijerph16132393. [PMID: 31284480 PMCID: PMC6651181 DOI: 10.3390/ijerph16132393] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 07/04/2019] [Accepted: 07/05/2019] [Indexed: 01/21/2023]
Abstract
Background: Early-onset diabetes results in longer lifetime hyperglycemic exposure that consequently leads to earlier chronic diabetes complications and premature death. The aim of this study was to quantify the prevalence and risk factors of undiagnosed diabetes and undiagnosed prediabetes in apparently healthy young adults aged <40 years. Methods: This study used data from the Korean National Health and Nutrition Examination Survey, a cross-sectional, nationally representative survey conducted by the Korean Ministry of Health and Welfare from 2014 to 2017. A total of 4442 apparently healthy young adults enrolled in this study. Multivariate logistic regression analyses were conducted separately to evaluate associated risk factors with undiagnosed diabetes and undiagnosed prediabetes in groups stratified by sex. Results: The prevalence of undiagnosed diabetes and undiagnosed prediabetes was 1.2% and 25.0%, respectively. Obesity (body mass index ≥ 30.0 kg/m2) was a significant risk factor of undiagnosed diabetes regardless of sex (men, odds ratio (OR): 9.808, 95% confidence interval (CI): 1.619–59.412; women, OR: 7.719, 95% CI: 1.332–44.747). Family history of diabetes was significantly associated with undiagnosed diabetes (OR: 3.407, 95% CI: 1.224–9.481) in women only. Increased age, obesity status, and family history of diabetes were significant risk factors for undiagnosed prediabetes. Alcohol consumption was found to be negatively associated with undiagnosed prediabetes in women. Conclusions: Increased attention and implementation of precise strategies for identifying young adults at high risk for undiagnosed diabetes would allow for increased wellbeing as well as reduced healthcare burdens associated with diabetes.
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Affiliation(s)
- Young Sang Lyu
- Department of Endocrinology and Metabolism, Chosun University Hospital, Gwangju 61453, Korea
| | - Sang Yong Kim
- Department of Endocrinology and Metabolism, Chosun University Hospital, Gwangju 61453, Korea
| | - Hak Yeon Bae
- Department of Endocrinology and Metabolism, Chosun University Hospital, Gwangju 61453, Korea
| | - Jin Hwa Kim
- Department of Endocrinology and Metabolism, Chosun University Hospital, Gwangju 61453, Korea.
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Russell E, Oh KM, Zhao X. Undiagnosed diabetes among Hispanic and white adults with elevated haemoglobin A 1c levels. Diabetes Metab Res Rev 2019; 35:e3153. [PMID: 30884138 DOI: 10.1002/dmrr.3153] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 03/03/2019] [Accepted: 03/09/2019] [Indexed: 01/03/2023]
Abstract
AIMS The aim of this study is to compare the frequency and correlates of undiagnosed diabetes between Hispanic and white American adults ages 20 and older with known diabetes or elevated HbA1c . METHODS Using 2007 to 2012 National Health and Nutrition Survey data, 1792 white and Hispanic Americans age 20 and older with known diabetes or elevated HbA1c (≥6.5%) were included in the analysis. Undiagnosed diabetes was defined as elevated HbA1c more than or equal to 6.5% without prior diabetes diagnosis. Covariates included demographics, health care access, and survey language. RESULTS Hispanics were younger (54.92 vs 61.45 y, p < .001) and had a higher rate of undiagnosed diabetes (28.2% vs 18.0%, p < .001) than their white counterparts. For Hispanics, those with undiagnosed diabetes had higher mean HbA1c than those with known diabetes (p = .03), but no significant difference was found between diagnosed and undiagnosed diabetes among whites. Covariates that decreased the odds of undiagnosed diabetes among Hispanic Americans included having a routine place to receive health care. For whites, covariates that decreased the odds of undiagnosed diabetes were a higher ratio of income to poverty level, having health insurance and having a routine place for health care. CONCLUSION The high proportion of unknown diabetes among Hispanic Americans suggests the need for a culturally competent health campaign to improve community diabetes awareness. Emphasizing the importance of having a routine place of health care for regular health check-ups and expanded community resources for diabetes early detection and prevention among this population could decrease the burden of diabetes.
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Affiliation(s)
- Elaine Russell
- School of Nursing, George Mason University, Fairfax, Virginia
| | - Kyeung Mi Oh
- School of Nursing, George Mason University, Fairfax, Virginia
| | - Xiaoquan Zhao
- Department of Communication, George Mason University, Fairfax, Virginia
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Baecker A, Kim S, Risch HA, Nuckols TK, Wu BU, Hendifar AE, Pandol SJ, Pisegna JR, Jeon CY. Do changes in health reveal the possibility of undiagnosed pancreatic cancer? Development of a risk-prediction model based on healthcare claims data. PLoS One 2019; 14:e0218580. [PMID: 31237889 PMCID: PMC6592596 DOI: 10.1371/journal.pone.0218580] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 06/04/2019] [Indexed: 12/22/2022] Open
Abstract
Background and objective Early detection methods for pancreatic cancer are lacking. We aimed to develop a prediction model for pancreatic cancer based on changes in health captured by healthcare claims data. Methods We conducted a case-control study on 29,646 Medicare-enrolled patients aged 68 years and above with pancreatic ductal adenocarcinoma (PDAC) reported to the Surveillance Epidemiology an End Results (SEER) tumor registries program in 2004–2011 and 88,938 age and sex-matched controls. We developed a prediction model using multivariable logistic regression on Medicare claims for 16 risk factors and pre-diagnostic symptoms of PDAC present within 15 months prior to PDAC diagnosis. Claims within 3 months of PDAC diagnosis were excluded in sensitivity analyses. We evaluated the discriminatory power of the model with the area under the receiver operating curve (AUC) and performed cross-validation by bootstrapping. Results The prediction model on all cases and controls reached AUC of 0.68. Excluding the final 3 months of claims lowered the AUC to 0.58. Among new-onset diabetes patients, the prediction model reached AUC of 0.73, which decreased to 0.63 when claims from the final 3 months were excluded. Performance measures of the prediction models was confirmed by internal validation using the bootstrap method. Conclusion Models based on healthcare claims for clinical risk factors, symptoms and signs of pancreatic cancer are limited in classifying those who go on to diagnosis of pancreatic cancer and those who do not, especially when excluding claims that immediately precede the diagnosis of PDAC.
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Affiliation(s)
- Aileen Baecker
- UCLA Fielding School of Public Health, Los Angeles, CA, United States of America
| | - Sungjin Kim
- Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Harvey A. Risch
- Yale School of Public Health, New Haven, CT, United States of America
| | - Teryl K. Nuckols
- Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Bechien U. Wu
- Kaiser Permanente Southern California, Research and Evaluation, Pasadena, CA, United States of America
| | | | - Stephen J. Pandol
- Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Joseph R. Pisegna
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States of America
| | - Christie Y. Jeon
- UCLA Fielding School of Public Health, Los Angeles, CA, United States of America
- Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States of America
- * E-mail:
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Holt E. Disputed figures do not hide Russia's HIV epidemic. Lancet HIV 2019; 6:e216-e217. [PMID: 30957747 DOI: 10.1016/s2352-3018(19)30085-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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