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

INTRODUCTION: Differences between women and men matter in the prevalence and risk factors of dementia. We aimed to examine potential sex differences regarding the effectiveness by running a secondary analysis of the AgeWell.de trial, a cluster-randomized multicenter multi-domain lifestyle intervention to reduce cognitive decline. METHODS: Intention-to-treat analyses of women (n=433) and men (n=386) aged 60 to 77 years were used for models including interactions between intervention group allocation and sex followed by subgroup analysis stratified by sex on primary and secondary outcomes. Further, the same procedure was repeated for age groups (60-69 vs. 70-77) within sex-specific subgroups to assess the effectiveness in different age groups. TRIAL REGISTRATION: German Clinical Trials Register (ref. number: DRKS00013555). RESULTS: No differences were found between women and men in the effectiveness of the intervention on cognitive performance. However, women benefitted from the intervention regarding depressive symptoms while men did not. Health-related quality of life was enhanced for younger intervention participants (60-69 years) in both women and men. CONCLUSION: The AgeWell.de intervention was able to improve depressive symptoms in women and health-related quality of life in younger participants. Female participants between 60 and 69 years benefited the most. Results support the need of better individually targeted lifestyle interventions for older adults.

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

BACKGROUND: Ukrainian Family Doctors' knowledge and readiness for the implementation of new guidelines recommendations into practice has to be evaluated and taken into consideration, meanwhile they often use the old protocols of annual checkups. This study aimed to perform a linguistic and cultural validation of Ukrainian adopted questionnaire designed on the German prototype "Readiness of general practitioners to recommend and implement evidence-based screening recommendations questionnaire". METHODS: This was a mixed method study. The English version of the original German prototype questionnaire was translated into Ukrainian with forward-backward method. Additionally Ukrainian version was modified by including an extra questions about evidence based screening of cardiovascular risks, infectious diseases, type 2 diabetes mellitus, depression, and some old-fashioned annual checkups which are still commonly used in routine family doctors' practice. During the face validation process, 10 practicing general practitioners assessed all the items in the questionnaire as adequately structured, grammatically correct, and understandable. During qualitative part of content validation process 11 experts found and corrected some grammatical errors, indicated that items of the questionnaire were comprehensible and related to Ukrainian culture. During the quantitative part of content validation process experts accessed 5 of 6 items as essential, relevant, and clear. Internal consistency of the items, assessed by using Cronbach's alpha method was acceptable. To access how stable can be results provided by the questionnaire, test-retest reliability was performed, where 19 general practitioners filled in the same questionnaire twice over a period of two weeks. RESULTS: In our study CVR > 0.79 and CVI > 0.59 were acceptable. The internal consistency was evaluated by using Cronbach's alpha method and had to be above 0.7. According to the test-retest reliability results of weighted kappa and Cohen's kappa coefficients, test-retest agreement of the questionnaire was moderate for 29%, substantial for 38%, and almost perfect for 5% of the items (p ≤ 0.05). Kappa coefficients were not computed for 10% of items as there was no variability in the assessments. CONCLUSIONS: The Ukrainian version of the questionnaire can be used for the assessment Ukrainian Family Doctor's readiness to implement the evidence-based screening recommendations into their clinical practice.

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

OBJECTIVES: The epidemiological transition from infectious to chronic diseases leads to novel challenges in African health systems. The prevalence of diabetes mellitus (DM) is increasing dramatically. Undiagnosed and undertreated DM leads to numerous complications including end-organ damage and death. Our objectives were to collect the best locally generated evidence on DM interventions, identify knowledge gaps and determine underexplored research areas. DESIGN: A systematic review and meta-analysis of randomised controlled trials. PARTICIPANTS AND SETTING: African patients in primary, secondary and tertiary prevention, diagnosis and treatment DM type 1 (DM1), type 2 (DM2) and gestational DM (GDM). OUTCOME: All-cause mortality, glycaemic control, complications, quality of life, hospital admission, treatment adherence and costs. DATA SOURCES: Articles published in MEDLINE Ovid, CENTRAL, CINAHL, African Journals Online and African Index Medicus and the International Clinical Trials Registry Platform in English language without time restrictions. The systematic search was last updated in October 2020. RESULTS: Out of 3736 identified publications, we included 60 eligible studies conducted in 15 countries, 75% were conducted in urban healthcare settings, including 10 112 participants. We included 8 studies on DM1, 6 on GDM, 2 on pre-DM, 37 on mainly DM2 including 7 on DM-related complications. The design of the studied intervention was heterogeneous with a focus on educational strategies. The other studies investigated the efficacy of nutritional strategies including food supplementations, pharmacological strategies and strategies to enhance physical activity. Seven studies included interventions on DM-related complications. CONCLUSIONS: Research activities increased in recent years, but available evidence is still not representative for all African countries. There is a big lack of evidence in primary healthcare and rural settings, implementation research, pharmacological interventions, especially in poorer countries. Nevertheless, the identified studies offer a variety of effective interventions that can inform medical care and future research. PROSPERO REGISTRATION NUMBER: CRD42019122785.

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

OBJECTIVE: To evaluate, how participation in structured diabetes self-management education (DSME) programs is associated with perceived level of knowledge about diabetes, information needs, information sources and disease distress. METHODS: We included 796 ever- and 277 never-DSME participants of the population-based survey "Disease knowledge and information needs - Diabetes mellitus (2017)" from Germany. Data on perceived level of diabetes knowledge (12 items), information needs (11 items), information sources (13 items) and disease distress (2 indices) were collected. Multiple logistic regression analyses were used to examine the association of DSME-participation with these outcomes. RESULTS: DSME-participants showed a higher level of diabetes knowledge compared to never-DSME participants, particularly in aspects concerning diabetes in general (odds ratio 2.53; 95% confidence intervals 1.48-4.33), treatment (2.41; 1.36-4.26), acute complications (1.91; 1.07-3.41) and diabetes in everyday life (1.83; 1.04-3.22). DSME-participants showed higher information needs regarding late complications (1.51; 1.04-2.18) and acute complications (1.71; 1.71-2.48) than DSME never participants. DSME-participants more frequently consulted diabetologists (5.54; 3.56-8.60) and diabetes care specialists (5.62; 3.61-8.75) as information sources. DSME participation was not associated with disease distress. CONCLUSION: DSME is a valuable tool for improving individual knowledge about diabetes. However, DSME should focus more on psychosocial aspects to reduce the disease burden.

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

OBJECTIVES: This study investigates students' adoption of LeiKA, a new extracurricular longitudinal general practice (GP) teaching project. LeiKA aims to attract a broad range of students, not only those who are already planning to become GPs. This study compares participants' and non-participants' characteristics, career preferences and job-related value orientations to assess the programme's initial potential to increase the number of students subsequently entering GP careers. Additionally, students' motives for taking part in the programme were explored. DESIGN: We analysed administrative data and data from a cross-sectional questionnaire survey for the first three cohorts. LeiKA participants were compared with non-participants regarding baseline characteristics, career intentions and attitudes associated with GP careers. There was also a qualitative analysis of the reasons for taking part. SETTING: Faculty of Medicine, University of Leipzig, Germany. PARTICIPANTS: First-semester medical students in the years 2016-2018. RESULTS: In the first 3 years, 86 of 90 LeiKA slots were taken, 9.0% (n=86/960) of those eligible to apply. LeiKA participants were a mean of 0.6 years older (LeiKA: 21.5 vs whole cohort: 20.9 years, p<0.001) and slightly more interested in long-term doctor-patient relationships (3.6 vs 3.3, scale from 1 'unimportant' to 5 'very important', p=0.018), but did not differ regarding other characteristics and attitudes. Although more participants definitely favoured a GP career (13.1% vs 4.9%, p=0.001), it was a possible option for most students in both groups (78.6% vs 74.0%). Early acquisition of skills and patient contact were the main motives for taking part, stated by 60.7% and 41.7% of the participants, respectively. CONCLUSIONS: The extracurricular programme was taken up by a broad range of students, indicating its potential to attract more students to become GPs. The reasons for taking part that we identified may guide the planning of other similar projects.

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

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

[Recruitment for general practice - relationship between practice-based curriculum and career choice]. / Gewinnung hausärztlichen Nachwuchses - Zusammenhang zwischen praxisorientierter Lehre und Karriereentscheidung.

BACKGROUND: Demographic change and recruitment problems in general practice are increasingly threatening an adequate primary care workforce in many countries. Medical schools play an important role in attracting young physicians to this field. The influence of the general practice curriculum on the career choice of graduates has not yet been sufficiently investigated. METHODS: The present study combines continuously collected data of medical students concerning the participation in miscellaneous general practice courses with data of a later graduate survey. RESULTS: Response rate was 64.2%. Although only 4.7% of the participants preferred a career in general practice at study entry, this specialty was, at 12.3%, the second most frequent career choice. Among the future general practitioners, only 18.5% had initially planned this career. The future general practitioners took part significantly more frequently in all facultative general practice courses. They reported more frequently to have met role models in general practice and to have gained experience in rural areas. Future general practitioners would more often prefer to work in rural areas in the future. CONCLUSIONS: Overall, the present results indicate that a broad and practice-oriented general practice curriculum has the potential to attract medical students to the specialty.

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

BACKGROUND: Patients with diabetes and hypertension represent a large proportion of primary care patients. Evaluation of their parameters usually requires medical setting, body weight and height can be measured by the patients themselves and this is often the case. The aim of this retrospective study is to analyse and to compare the life-long data on weight and BMI of patients with diabetes and hypertension and those without these pathologic conditions. PATIENTS: Eventually selected 759 patients (337 men, 422 women) between 60 and 70 years of age in different primary care settings were involved. METHODS: Retrospective and recent self-recorded data on weight and height in every decade since the age of 20 years in both genders were collected. These were compared to the control group of persons free from diabetes and hypertension. RESULTS: The current body weight and BMI were significantly higher in all groups than at 20 years and less than their maximal values. Patients with diabetes started at higher weights and their greatest gain was observed between 20-30 years in men and between 30-40 years in women, and in the last decade prior to diagnosis in both genders. Weight gain in the control group was steady at a lower rate. CONCLUSIONS: Higher increases in body weight in the early youth decades were related to elevated hazard ratios for diabetes in men and for hypertension in women. More research with standardized methodology is needed to explore this relationship better: meanwhile more contribution is expected from primary care physicians in the weight management of their younger patients.

Primary care guidelines for geriatric assessment. A structured, comparative analysis.

A structured geriatric assessment (GA) improves the quality of health care; however, the quality of GA guidelines has hardly been investigated. Eight guidelines were identified by systematically searching guideline databases, web sites of guideline developers, and PubMed. The methodological quality was assessed by two appraisers using the German Guideline Evaluation Instrument (DELBI). Guideline content was extracted; organizational and medical recommendations were compared. The methodological appraisal revealed a broad range of quality. The domains "Scope and purpose" and "Clarity and presentation" showed good results. The domains "Applicability" and "Editorial independence" had results that were not as good. Medical recommendations agreed to a great extent. GA should be delivered continuously for all older people in their homes by one responsible assessor. In cooperation with relatives, patient-centered therapy goals should be defined. Differences were identified in profession, instruments, aims, and "tailoring." The quality of primary care guidelines for GA may be improved. Details of organization of a GA require further research.

Epidemiology of diabetes mellitus in German general practitioners' consultation--results of the SESAM 2-study.

The treatment of chronic diseases is of eminent importance in primary care, and type 2-diabetes mellitus is one of the most common dysfunctions. Its world-wide prevalence has been increasing from year to year. Thus, to estimate the prevalence and incidence of diabetes mellitus, we performed the SESAM (Sächsiche epidemiologische Studie in der Allgemeinmedizin) 2-study in cooperation with general practitioners (GPs) from the German state of Saxony; 270 of the 2510 (10.8%) solicited physicians participated. Cross-sectional data were collected from 1 October 1999 until 30 September 2000, from randomly selected patients previously known to the practitioner. From a total of 8877 consultations with 270 GPs, diabetes was prevalent in 14% (n = 1241) of the patients and the incidence was 0.3% (27 of 8877 cases). The consultation prevalence was estimated at 14.3% (n = 1268; CI 13.6-15%). Of the diabetic patients, 3.5% (n = 44) suffered from type 1-diabetes, while type 2-diabetes was found in 66.9% (n = 848) of the cases. "Other diabetes" was determined in 19.2% (n = 244), and "not further specified diabetes", in 10.4% (n = 132) of the cases. Related to the German population in general, the prevalence ranged from 7.9 to 9.2%. The estimated consultation prevalence is about four times higher than that in other European countries. These data are of importance in illustrating the epidemiology of diabetes in the population and the direct repercussions for GPs. They also point out the significance of diabetes as a major challenge to the German health care system.

[Beta-adrenoceptor antagonists and ACE-inhibitors. Carvedilol compared with metoprolol as combination partner in cases of diabetes and hypertension]. / Beta-Rezeptorenblocker und ACE-Hemmer. Vergleich von Carvedilol und Metoprolol als Kombinationspartner bei Diabetes und arterieller Hypertonie.

Nearly all type 2 diabetic patients are suffering from arterial hypertension. The latter usually becomes manifest earlier than the diabetic metabolic disturbances. Adequate treatment often requires a combination of angiotensin converting enzyme(ACE)-inhibitors and beta-adrenoceptor antagonists. Metoprolol is still the most frequently used beta-adrenoceptor antagonist in this setting. Some clinical trials have shown carvedilol to be superior in improving the metabolic situation and prevention of secondary disorders caused by diabetes. Therefore carvedilol may be the beta-adrenoceptor antagonist of choice for treatment of patients at high cardiovascular risk and especially for diabetes type 2. As comparisons to metoprolol succinate as well as to optimally dosed metoprolol tartrate are missing, a definite superiority of carvedilol cannot be assumed.

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

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