Experiencing a psychiatric episode within the first 30 days post-partum appears to be associated with an increased risk of developing bipolar affective disorder, according to a report published Online First by Archives of General Psychiatry, one of the JAMA/Archives journals. "Childbirth has an important influence on the onset and course of bipolar affective disorder, and studies have shown that episodes of post-partum psychosis are often best considered as presentations of bipolar affective disorder occurring at a time of dramatic psychological and physiological change," the authors write as background information in the article. "It is also clear, however, that a high number of women with the new onset of a psychiatric disorder in the immediate post-partum period do not receive a diagnosis of bipolar disorder."
Trine Munk-Olsen, Ph.D., of the National Centre for Register-Based Research, Arhus University, Arhus, Denmark, and colleagues collected data on 120,378 women born in Denmark from 1950 to 1991 who were alive in 2006 and had a history of a first-time psychiatric contact with any type of psychiatric disorder (admission or outpatient contact) with any type of psychiatric disorder excluding bipolar affective disorder. Each woman was followed up with individually from the day of discharge, with data collected on inpatient or outpatient psychiatric contacts during the follow-up period.
A total of 2,870 of these women had their initial psychiatric contact within the first year after delivery of their first child. During follow-up, 3,062 of the 120,378 women received diagnoses of bipolar affective disorder, of which 132 had their initial psychiatric contact 0 to 12 months post-partum. After adjusting for first diagnosis and family history of psychiatric illness, conversion rates to bipolar disorder were significantly predicted by the timing of initial psychiatric contact. The authors found a significantly higher conversion rate to bipolar affective disorder in women having their initial contact within the first post-partum month. Additionally, the authors found evidence that the severity of the initial post-partum psychiatric episode may be important, as inpatient admissions were associated with a higher conversion rate than were outpatient contacts.
Fifteen years after initial contact, 13.87 percent of women with onset in the immediate post-partum period (0 to 30 days) had converted to bipolar disorder, 4.69 percent of women with later onset (31 to 365 days post-partum) and 4.04 percent of women with onset at other points had converted to bipolar disorder. Additionally, an extended analysis showed that 18.98 percent of women with onset in the immediate post-partum period had converted to bipolar disorder within 22 years after initial psychiatric contact. Conversely, 6.51 percent of women with later post-partum onset and 5.43 percent of women with onset at other points had converted to bipolar disorder after 22 years.
"The present study confirms the well-established link between childbirth and bipolar affective disorder and specifically adds to this field of research by demonstrating that initial psychiatric contact within the first 30 days post-partum significantly predicted conversion to bipolar affective disorder during the follow-up period," the authors conclude. "Results indicate that the presentation of mental illness in the early post-partum period is a marker of possible underlying bipolarity."
**Source: JAMA and Archives Journals
06 December 2011
State laws mandating P.E., recess linked with increased in-school physical activity among children
State and school district-level policies mandating minimum requirements for in-school physical education and recess time are associated with increased odds of schools in those states and districts meeting physical activity recommendations for students, according to a report published Online First by Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals. "Children spend the majority of their waking hours in school, thus schools are important locations to focus obesity prevention activities, such as increasing physical activity opportunities," the authors write as background information in the article. "The national recommendation for school physical education [PE] -- endorsed by the National Association of Sports and Physical Education (NASPE) and the American Heart Association -- is that elementary school students be offered at least 150 minutes/week of PE. However, fewer than 20 percent of third grade students in the United States were offered this amount during the 2007-2008 school year."
Sandy J. Slater, Ph.D., and colleagues with the University of Illinois at Chicago, examined the association between state and local school district-level policies requiring or recommending minimum requirements for in-school physical activity and the odds that elementary schools within those states and districts meet the levels of physical activity recommended, with an emphasis on physical education and recess. The authors collected data on existing state PE and recess-related laws and collected data at the local school level through mail-back surveys that included questions on the number of days per week and number of minutes for which PE class was scheduled during a typical week for a third grade student. The study sample included 47 states, 690 districts and 1,761 schools, during the 2006-2007 through 2008-2009 school years.
The authors found that approximately 70 percent of schools included in the analysis offered at least 20 minutes of daily recess, and 17.9 percent offered 150 minutes/week of physical education. The majority of states (83 percent) offered no daily recess law and less than half offered some kind of law addressing the recommended 150 minutes/week of physical education. The authors found that the odds of schools meeting the NASPE recommendation for physical activity increased if they were located in states or school districts having a law requiring 150 minutes/week of physical education.
Schools in states with policies encouraging daily recess had higher odds of having 20 minutes of recess daily, however district policies were not significantly associated with school-level recess practices. The authors also found that adequate physical education time was inversely associated with recess, with schools offering at least 150 minutes/week of physical education being 50 percent less likely to meet recommendations on recess time. Additionally, schools with students of predominantly white race/ethnicity were more likely than all other racial/ethnic groups to have daily recess, and schools with the highest number of students receiving free or reduced-cost lunch were less likely to have 20 minutes of recess daily.
"Our results show that mandating only increased physical education or recess time does not result in more overall physical activity as schools and/or districts appear to compensate for any increased physical activity in one area by decreasing other physical activity opportunities," the authors conclude. "By mandating physical education or recess, policy makers can effectively increase school-based physical activity opportunities for youth."
**Source: JAMA and Archives Journals
Sandy J. Slater, Ph.D., and colleagues with the University of Illinois at Chicago, examined the association between state and local school district-level policies requiring or recommending minimum requirements for in-school physical activity and the odds that elementary schools within those states and districts meet the levels of physical activity recommended, with an emphasis on physical education and recess. The authors collected data on existing state PE and recess-related laws and collected data at the local school level through mail-back surveys that included questions on the number of days per week and number of minutes for which PE class was scheduled during a typical week for a third grade student. The study sample included 47 states, 690 districts and 1,761 schools, during the 2006-2007 through 2008-2009 school years.
The authors found that approximately 70 percent of schools included in the analysis offered at least 20 minutes of daily recess, and 17.9 percent offered 150 minutes/week of physical education. The majority of states (83 percent) offered no daily recess law and less than half offered some kind of law addressing the recommended 150 minutes/week of physical education. The authors found that the odds of schools meeting the NASPE recommendation for physical activity increased if they were located in states or school districts having a law requiring 150 minutes/week of physical education.
Schools in states with policies encouraging daily recess had higher odds of having 20 minutes of recess daily, however district policies were not significantly associated with school-level recess practices. The authors also found that adequate physical education time was inversely associated with recess, with schools offering at least 150 minutes/week of physical education being 50 percent less likely to meet recommendations on recess time. Additionally, schools with students of predominantly white race/ethnicity were more likely than all other racial/ethnic groups to have daily recess, and schools with the highest number of students receiving free or reduced-cost lunch were less likely to have 20 minutes of recess daily.
"Our results show that mandating only increased physical education or recess time does not result in more overall physical activity as schools and/or districts appear to compensate for any increased physical activity in one area by decreasing other physical activity opportunities," the authors conclude. "By mandating physical education or recess, policy makers can effectively increase school-based physical activity opportunities for youth."
**Source: JAMA and Archives Journals
El pescado rico en omega 3 protege del riesgo cardiovascular en mujeres jóvenes
El consumo de pescado rico en ácidos grasos omega 3, como el bacalao, el salmón, el arenque y la caballa, podría reducir el riesgo de enfermedad cardiovascular en mujeres jóvenes en edad fértil, de acuerdo con una investigación que se publica hoy en Hypertension.
Según los investigadores, aquellas mujeres que no comían pescado o lo hacía en ocasiones contadas tenían un 50% más de problemas cardiovasculares a los ocho años de seguimiento del estudio que las que comían pescado con regularidad. En comparación con las mujeres que comían pescado rico en omega-3 semanales, el riesgo era de un 90% más elevado para aquellas que nunca o casi nunca ingerían pescado.
Los investigadores analizaron los datos de una cohorte de población nacional danesa de 49.000 mujeres con edades entre los 15 y 49 años. Los investigadores registraron 577 eventos cardiovasculares durante un periodo de ocho años, incluyendo cinco muertes por enfermedades cardiovasculares en mujeres sin diagnóstico previo de la enfermedad. En total, 328 eventos se debieron a la enfermedad hipertensiva, 146 a enfermedad cerebrovascular y 103 por enfermedad isquémica del corazón.
-Mujeres jóvenes
«Este es el primer estudio de este tamaño que se ha centrado exclusivamente en mujeres en edad fértil», dijo Marín Strøm, del Statens Serum Institut en Copenhague (Dinamarca). El mensaje de este estudio, señaló, es que a pesar de que se pensaba que los beneficios del consumo de pescado rico en omega 3 pueden no ser evidentes durante 30 o 40 años, nuestro estudio muestra que no siempre es así. «Hemos visto una fuerte asociación con la enfermedad cardiovascular en las mujeres que todavía estaban todavía en la treintena».
«Hombres y mujeres comparten muchos factores de riesgo cardiovascular, pero algunos estudios han demostrado que también puede haber diferencias de género. Por ejemplo, los niveles de inflamación, colesterol y triglicéridos pueden tener una influencia más negativa en las mujeres», dijo Strom.
En este estudio, incluso las mujeres que comían pescado sólo un par de veces al mes se beneficiaron, pero es importante destacar que para obtener el mayor beneficio de pescado y aceites de pescado se debe ingerir pescado como plato principal al menos dos veces a la semana.
**Publicado en "ABC SALUD"
Según los investigadores, aquellas mujeres que no comían pescado o lo hacía en ocasiones contadas tenían un 50% más de problemas cardiovasculares a los ocho años de seguimiento del estudio que las que comían pescado con regularidad. En comparación con las mujeres que comían pescado rico en omega-3 semanales, el riesgo era de un 90% más elevado para aquellas que nunca o casi nunca ingerían pescado.
Los investigadores analizaron los datos de una cohorte de población nacional danesa de 49.000 mujeres con edades entre los 15 y 49 años. Los investigadores registraron 577 eventos cardiovasculares durante un periodo de ocho años, incluyendo cinco muertes por enfermedades cardiovasculares en mujeres sin diagnóstico previo de la enfermedad. En total, 328 eventos se debieron a la enfermedad hipertensiva, 146 a enfermedad cerebrovascular y 103 por enfermedad isquémica del corazón.
-Mujeres jóvenes
«Este es el primer estudio de este tamaño que se ha centrado exclusivamente en mujeres en edad fértil», dijo Marín Strøm, del Statens Serum Institut en Copenhague (Dinamarca). El mensaje de este estudio, señaló, es que a pesar de que se pensaba que los beneficios del consumo de pescado rico en omega 3 pueden no ser evidentes durante 30 o 40 años, nuestro estudio muestra que no siempre es así. «Hemos visto una fuerte asociación con la enfermedad cardiovascular en las mujeres que todavía estaban todavía en la treintena».
«Hombres y mujeres comparten muchos factores de riesgo cardiovascular, pero algunos estudios han demostrado que también puede haber diferencias de género. Por ejemplo, los niveles de inflamación, colesterol y triglicéridos pueden tener una influencia más negativa en las mujeres», dijo Strom.
En este estudio, incluso las mujeres que comían pescado sólo un par de veces al mes se beneficiaron, pero es importante destacar que para obtener el mayor beneficio de pescado y aceites de pescado se debe ingerir pescado como plato principal al menos dos veces a la semana.
**Publicado en "ABC SALUD"
Según un estudio el arsénico contenido en el arroz es un riesgo en el embarazo
Un estudio recién publicado en «Proceedings of the National Academy of Sciences» (PNAS) por un equipo de científicos de la Universidad de Dartmouth, analiza las fuentes de exposición humana al arsénico y centra su atención en el consumo de niveles peligrosos de arsénico a través de arroz.
El arsénico se encuentra naturalmente en el ambiente y, en concentraciones elevadas, puede ser perjudicial para la salud humana. Común en las aguas subterráneas, la Organización Mundial de la Salud establece límites para los niveles de arsénico en el agua potable (actualmente 10 microgramos por litro).
Las preocupaciones sobre la exposición al arsénico se extienden ahora más allá del agua hasta llegar al caso del arroz; el arroz es susceptible a la contaminación debido a su capacidad para extraer el arsénico del medio ambiente.
«La exposición al arsénico durante el embarazo es un problema de salud pública, debido a los riesgos potenciales para la salud del feto», afirma Margaret Karagas, profesora de Medicina en
China ya controla los límites en el contenido de arsénico en el arroz pero EE. UU. y Europa no lo hacenDartmouth y autora principal del artículo. Karagas señala que otras investigaciones ya han relacionado el arsénico en niveles muy altos con la mortalidad infantil, la reducción del peso al nacer, la obstaculización de la función inmune y el aumento de la mortalidad por cáncer de pulmón en el futuro.
«El estudio se basa en una muestra de 229 mujeres embarazadas de New Hampshire, cuya concentración de arsénico se midió mediante su orina», explica Diane Gilbert-Diamond, coautora principal del artículo. Las mujeres en el estudio fueron divididas en dos grupos en función de si habían, o no, comido arroz dos días antes de la recolección de orina -también se analizó la concentración de arsénico en el agua del grifo de sus hogares. Las concentraciones urinarias de arsénico para los 73 sujetos del estudio que habían ingerido arroz mostraron una media de 5,27 microgramos por litro, mientras que la media de los 156 sujetos que no habían consumido arroz fue de 3,38 microgramos por litro, una diferencia estadísticamente significativa entre los dos grupos.
Los autores concluyen que sus hallazgos subrayan la necesidad de controlar el arsénico en los alimentos, teniendo en cuenta que China ya controla los límites legales en el contenido de arsénico en el arroz (0,15 microgramos de arsénico inorgánico por kilogramo de alimento), pero Estados Unidos y Europa no lo hacen. Karagas añade que «si bien este estudio revela el potencial de exposición al arsénico a partir del arroz, se necesita mucha investigación adicional antes de que podamos determinar si hay efectos reales para la salud debido a esta fuente de exposición».
El arsénico se encuentra naturalmente en el ambiente y, en concentraciones elevadas, puede ser perjudicial para la salud humana. Común en las aguas subterráneas, la Organización Mundial de la Salud establece límites para los niveles de arsénico en el agua potable (actualmente 10 microgramos por litro).
Las preocupaciones sobre la exposición al arsénico se extienden ahora más allá del agua hasta llegar al caso del arroz; el arroz es susceptible a la contaminación debido a su capacidad para extraer el arsénico del medio ambiente.
«La exposición al arsénico durante el embarazo es un problema de salud pública, debido a los riesgos potenciales para la salud del feto», afirma Margaret Karagas, profesora de Medicina en
China ya controla los límites en el contenido de arsénico en el arroz pero EE. UU. y Europa no lo hacenDartmouth y autora principal del artículo. Karagas señala que otras investigaciones ya han relacionado el arsénico en niveles muy altos con la mortalidad infantil, la reducción del peso al nacer, la obstaculización de la función inmune y el aumento de la mortalidad por cáncer de pulmón en el futuro.
«El estudio se basa en una muestra de 229 mujeres embarazadas de New Hampshire, cuya concentración de arsénico se midió mediante su orina», explica Diane Gilbert-Diamond, coautora principal del artículo. Las mujeres en el estudio fueron divididas en dos grupos en función de si habían, o no, comido arroz dos días antes de la recolección de orina -también se analizó la concentración de arsénico en el agua del grifo de sus hogares. Las concentraciones urinarias de arsénico para los 73 sujetos del estudio que habían ingerido arroz mostraron una media de 5,27 microgramos por litro, mientras que la media de los 156 sujetos que no habían consumido arroz fue de 3,38 microgramos por litro, una diferencia estadísticamente significativa entre los dos grupos.
Los autores concluyen que sus hallazgos subrayan la necesidad de controlar el arsénico en los alimentos, teniendo en cuenta que China ya controla los límites legales en el contenido de arsénico en el arroz (0,15 microgramos de arsénico inorgánico por kilogramo de alimento), pero Estados Unidos y Europa no lo hacen. Karagas añade que «si bien este estudio revela el potencial de exposición al arsénico a partir del arroz, se necesita mucha investigación adicional antes de que podamos determinar si hay efectos reales para la salud debido a esta fuente de exposición».
Chinese health coverage increases with new government efforts
Health care coverage increased dramatically in parts of China between 1997 and 2006, a period when government interventions were implemented to improve access to health care, with particularly striking upswings in rural areas, according to new research by Brown University sociologist Susan E. Short and Hongwei Xu of the University of Michigan. The findings appear in the December issue of Health Affairs.
Led by Xu, a former Brown graduate student, the study analyzed data from the China Health and Nutrition Survey, which follows households in nine provinces that are home to more than 40 percent of China's population. Xu and Short specifically focused on patterns of coverage among rural and urban residents.
Their analysis shows that overall, the percentage of individuals in the sample with insurance increased from 24 percent in 1997 to 28 percent in 2004, then rose sharply to 49 percent in 2006. Furthermore, during that period, rural and urban levels of insurance coverage became more similar. Xu and Short call the increase in rural areas "nothing short of dramatic," saying that it likely benefited millions of rural Chinese residents.
"There's been great concern about increasing inequality in China, and particularly urban-rural inequalities," said Short, professor of sociology and faculty associate of Brown's Population Studies and Training Center. "This work shows that at least in one sphere -- health insurance coverage -- urban-rural inequality may be decreasing."
Location matters
The analysis revealed that levels and trends of health care coverage were significantly different depending on whether the individuals lived in urban or rural areas. In villages, the coverage rates declined from 1997 to 2000, while rates changed little in suburbs, cities, and towns during the same period. Notably, during that time, the government's efforts to establish a new rural insurance program was limited to a few pilot rural counties and did not include financial subsidies for the rural population.
However, after 2000, the coverage rate in villages began to rise, almost tripling between 2004 and 2006, from 17.9 percent to 51 percent. Rates also rose significantly in towns and suburbs during that time frame, but changed only modestly in cities. The dramatic rise in rural coverage rates coincided with the efforts to develop new insurance programs and provide increased subsidies for rural participants.
Short was surprised by the magnitude of change in rural villages. "It is especially impressive to see this pattern in data such as these, that follow the same individuals over time," she said. "We are witnessing real change in many people's lives in the way that urban, and especially rural, individuals experience health insurance coverage."
Reimbursement Rates
While the analysis shows higher rates of individual coverage, it also suggests that disparities may persist in the quality of insurance. Xu and Short found that residents of cities, suburbs, and towns experienced higher reimbursement rates for outpatient and inpatient care than insured villagers, indicating that insured urban residents continue to have an advantage over insured rural residents. However, the authors state that these results should be interpreted with caution due to incomplete self-reported reimbursement rates.
"The findings from this research highlight the recovery in health insurance coverage in general -- and more importantly the significant reduction in the rural-urban inequality in the coverage in particular -- largely due to the great efforts by the Chinese government, in a quite short time period," said Xu, a faculty fellow at the Survey Research Center, Institute for Social Research at Michigan. "On the other hand, the suggestive finding of continued rural disadvantage in terms of health insurance benefits suggests we should not overestimate the success of the policy interventions."
Xu and Short hope that the study will further inform understanding as China strives to improve health insurance coverage for its citizens.
"The changing landscape of health and and health care in China, which is unfolding against a backdrop of rapid economic growth and growing inequalities, makes health insurance an important issue," Short said. "All families want to promote the best health they can for their loved ones. Understanding the changing landscape of health insurance is important to understanding how families accomplish this as well as the challenges that some face."
Led by Xu, a former Brown graduate student, the study analyzed data from the China Health and Nutrition Survey, which follows households in nine provinces that are home to more than 40 percent of China's population. Xu and Short specifically focused on patterns of coverage among rural and urban residents.
Their analysis shows that overall, the percentage of individuals in the sample with insurance increased from 24 percent in 1997 to 28 percent in 2004, then rose sharply to 49 percent in 2006. Furthermore, during that period, rural and urban levels of insurance coverage became more similar. Xu and Short call the increase in rural areas "nothing short of dramatic," saying that it likely benefited millions of rural Chinese residents.
"There's been great concern about increasing inequality in China, and particularly urban-rural inequalities," said Short, professor of sociology and faculty associate of Brown's Population Studies and Training Center. "This work shows that at least in one sphere -- health insurance coverage -- urban-rural inequality may be decreasing."
Location matters
The analysis revealed that levels and trends of health care coverage were significantly different depending on whether the individuals lived in urban or rural areas. In villages, the coverage rates declined from 1997 to 2000, while rates changed little in suburbs, cities, and towns during the same period. Notably, during that time, the government's efforts to establish a new rural insurance program was limited to a few pilot rural counties and did not include financial subsidies for the rural population.
However, after 2000, the coverage rate in villages began to rise, almost tripling between 2004 and 2006, from 17.9 percent to 51 percent. Rates also rose significantly in towns and suburbs during that time frame, but changed only modestly in cities. The dramatic rise in rural coverage rates coincided with the efforts to develop new insurance programs and provide increased subsidies for rural participants.
Short was surprised by the magnitude of change in rural villages. "It is especially impressive to see this pattern in data such as these, that follow the same individuals over time," she said. "We are witnessing real change in many people's lives in the way that urban, and especially rural, individuals experience health insurance coverage."
Reimbursement Rates
While the analysis shows higher rates of individual coverage, it also suggests that disparities may persist in the quality of insurance. Xu and Short found that residents of cities, suburbs, and towns experienced higher reimbursement rates for outpatient and inpatient care than insured villagers, indicating that insured urban residents continue to have an advantage over insured rural residents. However, the authors state that these results should be interpreted with caution due to incomplete self-reported reimbursement rates.
"The findings from this research highlight the recovery in health insurance coverage in general -- and more importantly the significant reduction in the rural-urban inequality in the coverage in particular -- largely due to the great efforts by the Chinese government, in a quite short time period," said Xu, a faculty fellow at the Survey Research Center, Institute for Social Research at Michigan. "On the other hand, the suggestive finding of continued rural disadvantage in terms of health insurance benefits suggests we should not overestimate the success of the policy interventions."
Xu and Short hope that the study will further inform understanding as China strives to improve health insurance coverage for its citizens.
"The changing landscape of health and and health care in China, which is unfolding against a backdrop of rapid economic growth and growing inequalities, makes health insurance an important issue," Short said. "All families want to promote the best health they can for their loved ones. Understanding the changing landscape of health insurance is important to understanding how families accomplish this as well as the challenges that some face."
**Source: Brown University
05 December 2011
Los nuevos datos identifican el mecanismo Stretta® en el tratamiento de la GERD
Mederi Therapeutics Inc. ha anunciado hoy los resultados de un nuevo estudio controlado por grupo con intervención simulada de doble ciego de Stretta para el tratamiento de la enfermedad de reflujo gastroesofágico (GERD). El estudio evaluó el mecanismo de acción en la aplicación de energía de radiofrecuencia (RF). Esta revolucionaria investigación sugiere el mecanismo por el que la terapia Stretta causa un descenso en las relajaciones del esfínter esofágico más bajo transiente (LES) y un incremento en la presión gástrica, y por tanto reduce el reflujo; y, como resultado, mejora los síntomas en pacientes con GERD médicamente refractoria. Los resultados del estudio se publicaron en el American Journal of Gastroenterology.
"En este estudio de doble ciego controlado por grupo con intervención simulada, nuestros datos confirman que Stretta mejora la fisiología del esfínter esofágico menor, y que este es el mecanismo para la mejora de los síntomas en GERD", dijo Jan Tack, M.D., Ph.D., uno de los autores del estudio y responsable de Clínica en el Departamento de Gastroenterología en la Universidad de Leuven, Bélgica. "Además de la efectividad del tratamiento Stretta, creemos que el método que empleamos en el estudio podía excluir la fibrosis como la causa destacada de la reducción significativa observada en el cumplimiento de GEJ".
"El profesor Tack y sus colegas nos han ayudado a dar un gran paso hacia delante para explicar y aclarar este mecanismo para Stretta", dijo el doctor Mark D. Noar, director en el Heartburn and Reflux Study Center, Towson, MD. "Estos descubrimiento sobre el mecanismo de acción explican los resultados que los profesionales médicos y sus pacientes, con GERD refractorio médicamente, esperan de Stretta".
"Estos resultados se añaden al cuerpo de investigación significativo en Stretta. El tratamiento funciona excepcionalmente bien para reducir o eliminar los síntomas en los pacientes de GERD, pero la forma exacta en que funciona se entiende ahora más claramente", dijo Will Rutan, consejero delegado de Mederi Therapeutics, fabricante de Stretta. "Con 67 publicaciones que respaldan Stretta como un tratamiento sano, efectivo y duradero, Stretta ofrece una excelente alternativa a la cirugía invasiva.
"En este estudio de doble ciego controlado por grupo con intervención simulada, nuestros datos confirman que Stretta mejora la fisiología del esfínter esofágico menor, y que este es el mecanismo para la mejora de los síntomas en GERD", dijo Jan Tack, M.D., Ph.D., uno de los autores del estudio y responsable de Clínica en el Departamento de Gastroenterología en la Universidad de Leuven, Bélgica. "Además de la efectividad del tratamiento Stretta, creemos que el método que empleamos en el estudio podía excluir la fibrosis como la causa destacada de la reducción significativa observada en el cumplimiento de GEJ".
"El profesor Tack y sus colegas nos han ayudado a dar un gran paso hacia delante para explicar y aclarar este mecanismo para Stretta", dijo el doctor Mark D. Noar, director en el Heartburn and Reflux Study Center, Towson, MD. "Estos descubrimiento sobre el mecanismo de acción explican los resultados que los profesionales médicos y sus pacientes, con GERD refractorio médicamente, esperan de Stretta".
"Estos resultados se añaden al cuerpo de investigación significativo en Stretta. El tratamiento funciona excepcionalmente bien para reducir o eliminar los síntomas en los pacientes de GERD, pero la forma exacta en que funciona se entiende ahora más claramente", dijo Will Rutan, consejero delegado de Mederi Therapeutics, fabricante de Stretta. "Con 67 publicaciones que respaldan Stretta como un tratamiento sano, efectivo y duradero, Stretta ofrece una excelente alternativa a la cirugía invasiva.
Impact of Early Insulin Initiation on Glycemic Control in Asian People with Type 2 Diabetes
Two studies presented at World Diabetes Congress 2011 provide further evidence of the benefits to patients of early glycemic control on co-morbidities Sanofi announced today new results from sub-analyses of the First Basal INsulin Evaluation in Asia (FINE Asia) Registry study, and the Cardiovascular Risk Evaluation in People with Type 2 Diabetes on Insulin Therapy (CREDIT) study.
FINE Asia was a six-month, 11-Asian-country prospective observational study to assess the effect of 'time to basal insulin initiation' on glycemic control and co-morbidities in insulin-naïve adults with type 2 diabetes (T2D), uncontrolled on oral antidiabetic medications. Patients (n=2,673) were grouped according to duration of diabetes since diagnosis (<6y; 6-11y; or greater than or equal to12y). Results showed that people with T2D who are initiated on insulin therapy earlier in the progression of their diabetes achieved greater glycemic control.
Across the FINE Asia sub-analysis groups, baseline HbA1c was similar (9.8%), and the patients who had the shortest time to insulin initiation (71-79% insulin glargine users) showed the greatest (mean) improvement in HbA1c at 6 months: <6y: 7.5%; 6-11y: 7.8%; greater than or equal to12y: 7.9% (p<0.001 for all three groups).
Likewise, the percentage of patients reaching the target goal (HbA1c<7%) was less with increasing disease duration; those who had diabetes for less than 6 years were significantly more likely to achieve target HbA1c than those who had the disease for over 12 years: <6y: 53.4%; 6-11y: 39.5%; greater than or equal to12y: 32.8% (p<0.001 for all three groups). The percentage of patients experiencing hypoglycemic events was similar across groups.
Patients whose disease duration was relatively shorter experienced a significantly lower incidence of several co-morbidities, including retinopathy, neuropathy, nephropathy, coronary artery disease, hypertension and dyslipidemia. Early initiation of insulin therapy was associated with a reduction of diabetes-related complications, as well as other common co-morbidities. The levels of improvement following six months of basal insulin therapy varied with the number of years since disease diagnosis. The FINE Asia sub-analysis was not part of the original study protocol.
These results are supported by recent findings from a one-year real-life study of Cardiovascular Risk Evaluation in People with Type 2 Diabetes on Insulin Therapy (CREDIT), an international, multicenter observational study designed to assess the metabolic and diabetes parameters of people with T2D on long-term insulin therapy.
Results from a Japanese sub-analysis indicated that early initiation of insulin resulted in better glycemic control (HbA1c: 10.7% vs 7.9%; fasting plasma glucose [FPG]: 12.1mmol/l vs 7.7mmol/l; post-prandial glucose [PPG]: 16.5mmol/l vs 9.9mmol/l, p<0.001), with a low incidence of severe hypoglycemia and improved cardiovascular (CV) risk parameters at one year. The results from CREDIT are in line with the FINE Asia sub-analysis in supporting early insulin initiation in order to improve glycemic control and CV risk profile in people with type 2 diabetes.
"The results of the FINE Asiasub-analysis, as supported by the CREDIT 1-year Japanese study,indicate that in Asian people with type 2 diabetes, early treatment with insulin may be associated withsignificant improvements in glycemic control. Most importantly, early glycemic control may lead to significant improvement in cardiovascular risk parameters and reduction inthe incidence of co-morbidities," said Riccardo Perfetti, Vice President, Medical Affairs, Sanofi Diabetes.
Both the FINE Asia sub-analysis and the 1-year follow-up of the CREDIT study are presented today at the International Diabetes Federation (IDF) World Diabetes Congress, Dubai
FINE Asia was a six-month, 11-Asian-country prospective observational study to assess the effect of 'time to basal insulin initiation' on glycemic control and co-morbidities in insulin-naïve adults with type 2 diabetes (T2D), uncontrolled on oral antidiabetic medications. Patients (n=2,673) were grouped according to duration of diabetes since diagnosis (<6y; 6-11y; or greater than or equal to12y). Results showed that people with T2D who are initiated on insulin therapy earlier in the progression of their diabetes achieved greater glycemic control.
Across the FINE Asia sub-analysis groups, baseline HbA1c was similar (9.8%), and the patients who had the shortest time to insulin initiation (71-79% insulin glargine users) showed the greatest (mean) improvement in HbA1c at 6 months: <6y: 7.5%; 6-11y: 7.8%; greater than or equal to12y: 7.9% (p<0.001 for all three groups).
Likewise, the percentage of patients reaching the target goal (HbA1c<7%) was less with increasing disease duration; those who had diabetes for less than 6 years were significantly more likely to achieve target HbA1c than those who had the disease for over 12 years: <6y: 53.4%; 6-11y: 39.5%; greater than or equal to12y: 32.8% (p<0.001 for all three groups). The percentage of patients experiencing hypoglycemic events was similar across groups.
Patients whose disease duration was relatively shorter experienced a significantly lower incidence of several co-morbidities, including retinopathy, neuropathy, nephropathy, coronary artery disease, hypertension and dyslipidemia. Early initiation of insulin therapy was associated with a reduction of diabetes-related complications, as well as other common co-morbidities. The levels of improvement following six months of basal insulin therapy varied with the number of years since disease diagnosis. The FINE Asia sub-analysis was not part of the original study protocol.
These results are supported by recent findings from a one-year real-life study of Cardiovascular Risk Evaluation in People with Type 2 Diabetes on Insulin Therapy (CREDIT), an international, multicenter observational study designed to assess the metabolic and diabetes parameters of people with T2D on long-term insulin therapy.
Results from a Japanese sub-analysis indicated that early initiation of insulin resulted in better glycemic control (HbA1c: 10.7% vs 7.9%; fasting plasma glucose [FPG]: 12.1mmol/l vs 7.7mmol/l; post-prandial glucose [PPG]: 16.5mmol/l vs 9.9mmol/l, p<0.001), with a low incidence of severe hypoglycemia and improved cardiovascular (CV) risk parameters at one year. The results from CREDIT are in line with the FINE Asia sub-analysis in supporting early insulin initiation in order to improve glycemic control and CV risk profile in people with type 2 diabetes.
"The results of the FINE Asiasub-analysis, as supported by the CREDIT 1-year Japanese study,indicate that in Asian people with type 2 diabetes, early treatment with insulin may be associated withsignificant improvements in glycemic control. Most importantly, early glycemic control may lead to significant improvement in cardiovascular risk parameters and reduction inthe incidence of co-morbidities," said Riccardo Perfetti, Vice President, Medical Affairs, Sanofi Diabetes.
Both the FINE Asia sub-analysis and the 1-year follow-up of the CREDIT study are presented today at the International Diabetes Federation (IDF) World Diabetes Congress, Dubai
Subscribe to:
Comments (Atom)