ABSTRACT
OBJECTIVES: Adherence to treatment strategies is critical for disease control and long-term clinical outcomes in patients with chronic diseases, such as diabetes and hypertension. Noncompliance is strongly correlated with lack of disease control and progression to life-threatening outcomes, including end-organ damage such as kidney failure. This study sought to determine the extent of adherence to disease management strategies, including drug compliance and lifestyle modification, among diabetic and hypertensive patients in Trinidad. DESIGN AND METHODS: A cross-sectional survey was conducted using an interviewer-administered pilot-tested de novo questionnaire during the period June to August 2013 at 22 randomly selected primary health centers throughout Trinidad. Data was analyzed using χ 2 and binary logistic regression. RESULTS: Four hundred and thirty-nine patients (439) were recruited; 179 were hypertensive only, 89 were diabetic only, and 171 had both conditions. Mean age and BMI were 61.2 + 10.7 years and 29.2 + 5.99 kg/m2 respectively. One hundred and six out of 350 hypertensive patients (or 30.1%) were controlled, whilst 108 out of 260 diabetic patients (or 41.5%) were controlled. Age (p = 0.015) and body mass index (BMI) (p = 0.028) were the only significant predictors for blood pressure control. Factors such as forgetfulness, adverse drug reactions, and symptoms negatively impacted adherence to drug therapy. CONCLUSIONS: Most hypertensive and diabetic patients attending primary healthcare facilities in Trinidad were not well controlled, which has serious implications for their long-term clinical outcomes. An approach is urgently needed to ensure higher rates of disease control to prevent progression to irreversible end-organ damage.
Subject(s)
Patient Compliance , Disease Management , Diabetes Mellitus , Hypertension , Trinidad and TobagoABSTRACT
BACKGROUND: It is unknown whether the incidence of peptic ulcer changes in areas with a high prevalence of Helicobacter pylori infection. AIM: To determine trends in peptic ulcer complications in a community with a high prevalence of H. pylori infection. METHODS: New endoscopic diagnoses of peptic ulcers and their complications from 1985 to 2000 were obtained. H. pylori infection in the adult population, the number of prescriptions for anti-secretory drugs and non-steroidal anti-inflammatory drugs were also evaluated. RESULTS: Although the global prevalence of H. pylori infection remains high in this population (>60%), a 41.4 to 25.4% decrease in the incidence of peptic ulcers and ulcer complications was observed. This was associated with a decrease in the prevalence of H. pylori infection in people under 65 years of age, a 3.5-fold increase in the number of prescriptions of proton-pump inhibitors and an increase in the number of prescriptions of non-steroidal anti-inflammatory drugs, especially coxibs. CONCLUSIONS: In an area with a high prevalence of H. pylori infection, the incidence of peptic ulcer and associated complications is declining rapidly. This was associated with a reduction of the prevalence of H. pylori infection in the young and a widespread use of proton-pump inhibitors. The increase in the use of non-steroidal anti-inflammatory drugs, especially coxibs, has not changed the tendency.
Subject(s)
Helicobacter Infections/epidemiology , Helicobacter pylori , Peptic Ulcer/epidemiology , Adult , Age Factors , Aged , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Cyclooxygenase Inhibitors/therapeutic use , Drug Prescriptions/statistics & numerical data , Female , Helicobacter Infections/complications , Humans , Incidence , Male , Middle Aged , Odds Ratio , Peptic Ulcer/diagnosis , Prevalence , Spain/epidemiologySubject(s)
Family , Ovarian Neoplasms/genetics , Adult , Aged , Case-Control Studies , Female , Humans , Italy/epidemiology , Middle Aged , Odds Ratio , Ovarian Neoplasms/epidemiologyABSTRACT
Serum PRL levels and its molecular heterogeneity were analyzed, basally and after 500 micrograms TRH given acutely, in four groups of men: normal (C, n = 12), chronic renal failure (CRF, n = 11), hemodialysis (HD, n = 12), and transplant recipients (T, n = 11). The mean basal PRL level was higher in group CRF than in group C and even higher in group HD. The basal hyperprolactinemia was due to increased concentrations of little PRL. The absolute levels of total and little PRL 20 min after TRH were comparable in the four groups. The disappearance index (DI = PRL20-PRL120/PRL20) for total and little PRL was lower in CRF than in C and even lower in HD. A positive correlation was found between the DIs of total and little PRL and creatinine clearance in group CRF. Group T had basal and 20 min serum PRL levels and a pattern of molecular distribution similar to those of group C but total and little PRL DI was lower. These results demonstrate that uremic hyperprolactinemia is due to increases in little PRL without major changes in big and big-big forms of PRL. The reduction of glomerular filtration rate seems to be one of the most important mechanisms responsible for little PRL accumulation.
