Health-related quality of life in adults with type 2 diabetes mellitus starting with new glucose lowering drugs: An inception cohort study.

AIMS: To assess baseline and change after 26-weeks in health-related quality of life (HRQoL) among adults with type 2 diabetes mellitus (T2DM) initiating one of the new glucose lowering drugs (GLD) in daily practice. METHODS: Inception cohort of patients who initiated one of dipeptidyl peptidase 4 inhibitors (DPP-4), glucagon-like peptide-1 analogues (GLP-1) or sodium-glucose cotransporter inhibitors (SGLT2) drugs. A baseline questionnaire collected socio-demographic and self-reported clinical data. HRQoL was assessed by the Euroqol-5D. Participants were divided into: (1) incident new users (INU) (who used for the first time one of the monitored GLD and had no current or prior experience with DPP-4/GLP-1/SGLT2) and (2) prevalent new users (PNU) (who had previously used at least one GLD of the monitored drug classes, but not the inception drug). Multivariate regression explored factors associated with a meaningful change in HRQoL. RESULTS: 1303 patients. Over 26weeks, a mean positive change in the EQ-5D scores, were observed. No differences between INU and PNU were found. Participants with worse health conditions (e.g. presence and number of chronic diseases, obese) at baseline were more likely to experience larger improvements in HRQoL. CONCLUSIONS: Over 26-weeks, T2DM patients starting with, or switching to new GLD maintained or modestly increased their HRQoL.

Effect of different methods for estimating persistence and adherence to new glucose-lowering drugs: results of an observational, inception cohort study in Portugal.

PURPOSE: Several methods have been developed for assessing medication-taking behavior; understanding the determinants and variability in estimates obtained is crucial in interpreting results. We estimated persistence and adherence levels to new glucose-lowering drugs (GLDs) in type 2 diabetes mellitus (T2DM) patients using different methods: through the collection of pharmacy records and combining pharmacy records with self-reported data. METHODS: We conducted a prospective observational cohort study of T2DM patients initiating a new GLD. Data were collected at baseline through interviews (demographic and clinical data). Follow-up data included pharmacy records (refill dates and medication possession) and telephone questionnaires (self-declared monitored GLD refill in another pharmacy, reasons for drug withdrawal). The cohort was divided into incident and prevalent new users. Persistence and adherence (proportion of days covered) were estimated for patients using pharmacy records exclusively (Method 1) and ≥1 self-declared statement of being persistent (Method 2). Log-rank tests were used to compare Kaplan-Meier curves of time to nonpersistence. RESULTS: A total of 1,328 patients were recruited. When considering Method 1, 38.7% (95% confidence interval [95% CI]: 36.0-41.5) of patients were persistent, whereas combining with self-reported information, this estimate increased to 65.6% (95% CI: 62.9-68.2). Using Method 1, the risk of persistence failure was associated with using an oral GLD, living alone and living in a suburban/urban setting. Three hundred and twenty-seven (24.8%) patients stopped to use the inception GLD. CONCLUSION: Regardless of the method used, results indicated low levels of persistence and adherence to a new GLD; however, when combining self-reported information, higher estimates were obtained. Considering pharmacy records exclusively, prevalent new users, who were more complex patients in terms of T2DM disease but more likely to be pharmacy-loyal patients, were significantly more adherent than the incident new users. Barriers and reasons leading to GLD withdrawal, namely adverse drug event management, should be addressed, since they represent half of the reasons for treatment switching or discontinuation.

Real-world prevalence of mild to moderate hypoglycemic episodes in type 2 diabetes in Portugal: Results from the HIPOS-PHARMA study.

AIMS: This study aimed to characterize and estimate prevalence and frequency of mild to moderate hypoglycemia and potentially associated factors in a population of type 2 diabetes mellitus (T2DM) patients treated at ambulatory care level. METHODS: HIPOS-PHARMA was a nationwide observational, cross-sectional, multicenter study conducted in community pharmacies, which surveyed T2DM patients treated for at least 3 months. RESULTS: Overall, 233 pharmacies recruited 1890 patients (males: 50.6%) with mean 67.1 years. On average, participants reported having diabetes for 11.8 years. A total of 86.9% had at least one chronic illness or complication of diabetes, and 76.8% were usually followed in the primary care setting. Fifty eight percent were treated without a secretagogue or insulin. Overall prevalence of mild to moderate hypoglycemic episodes in the 3 months prior to recruitment was 17.8%. A 3.13% prevalence of severe hypoglycemia was observed in the last 12 months. Results suggested that men and patients on antihyperglycemic therapies excluding secretagogues or insulin were less likely to have mild to moderate hypoglycemic episodes. CONCLUSIONS: Mild to moderate hypoglycemic episodes were commonly reported, and factors like type of antihyperglycemic therapy, duration of disease and due complications may contribute. Almost half of episodes were not reported. Such factors should be considered in T2DM management.

Envelhecimento Humano e os cursos de Psicologia / Human Aging and Psychology courses

O presente artigo aborda a questão de como os profissionais da área da Psicologia estão sendo preparados diante do envelhecimento humano e da inversão da pirâmide populacional no Brasil e no mundo. O estudo é de abordagem qualitativa; analisou o discurso de coordenadores de cursos de Psicologia localizados no estado do Rio Grande do Sul, Brasil, objetivando compreender como e com que frequência ocorre a inserção da temática nos currículos. Constatou-se que os cursos investem pouco nos estudos sobre o envelhecimento.(AU)

This present paper approaches the issue of how the Psychology professionals are being prepared considering the human aging and the inversion of social pyramid in Brazil and in the world. In this qualitative study was analyzed the speech of Psychology’s courses coordinators located in south of Brazil, having as a main goal understand how and how often occurs the insertion of these topics in the study program. It was noted that the courses invest a little on aging studies.(AU)

Envelhecimento humano e os cursos de psicologia / Human aging and psychology courses

O presente artigo aborda a questão de como os profissionais da área da Psicologia estão sendo preparados diante do envelhecimento humano e da inversão da pirâmide populacional no Brasil e no mundo. O estudo é de abordagem qualitativa; analisou o discurso de coordenadores de cursos de Psicologia localizados no estado do Rio Grande do Sul, Brasil, objetivando compreender como e com que frequência ocorre a inserção da temática nos currículos. Constatou-se que os cursos investem pouco nos estudos sobre o envelhecimento.

This present paper approaches the issue of how the Psychology professionals are being prepared considering the human aging and the inversion of social pyramid in Brazil and in the world. In this qualitative study was analyzed the speech of Psychology’s courses coordinators located in south of Brazil, having as a main goal understand how and how often occurs the insertion of these topics in the study program. It was noted that the courses invest a little on aging studies.

A novel AF9 breakpoint in MLL-AF9-positive acute monoblastic leukemia.

MLL-AF9 is the most frequent MLL rearrangement in childhood acute myeloid leukemia (AML) and it may be also found in acute lymphoblastic leukemia (ALL) of patients younger than 1-year-old (infants). We report a novel AF9 breakpoint site, located between previously reported sites A and B, detected in an infant who was diagnosed with AML-FAB M5. The occurrence of this new breakpoint should be considered when designing RT-PCR assays for the screening of MLL abnormalities. The precise characterization of the MLL-AF9 transcript is important to carry out the minimal residual disease analysis during the follow-up of the patients.

Nuevos Blancos Terapéuticos en Leucemia Aguda Pediátrica : Caracterización de las Mutaciones Del Gen Flt3

El tratamiento de elección para las leucemias agudas pediátricas es la quimioterapia convencional, que ha permitido obtener tasas de sobrevida que actualmente parecen difíciles de superar. En los últimos años se han intensificado las investigaciones dirigidas a descubrir nuevos blancos terapéuticos, entre los que se encuentra el receptor FLT3. Los blastos leucémicos pueden presentar formas mutadas de dicho receptor, siendo las más frecuentes mutaciones internas en tándem (FLT3-ITD) y mutaciones puntuales en la zona de activación (FLT3-ALM). Objetivos: Poner a punto las técnicas para la detección de mutaciones de FLT3, analizar su prevalencia en nuestra población de pacientes con diagnóstico de Leucemia Mieloblástica Aguda (LMA) o de Leucemia Linfoblástica Aguda en Infantes (LLA-I), y evaluar su asociación con parámetros clínicos y de laboratorio. Pacientes y Método: La detección de las mutaciones se realizó por RT-PCR, en un total de 144 pacientes (109 LMA y 35 LLA-I). Resultados: Se detectaron mutaciones en el 16,5 por ciento de las LMA y en 8,6 por ciento de las LLA-I. La prevalencia de las FLT3-ITD mostró un aumento gradual con la edad de los pacientes, y la media de edad fue significativamente mayor. Con respecto a asociaciones con recuentos leucocitarios, alteraciones genéticas, subtipos FAB y valor pronóstico, si bien hubo diferencias, éstas no fueron significativas. Conclusiones: Este es el primer estudio de mutaciones en FLT3 realizado en población pediátrica en nuestro país. La detección de estas mutaciones permite individualizar a los niños candidatos a recibir, en el futuro, drogas inhibidoras de FLT3 actualmente en desarrollo.

Nuevos Blancos Terapéuticos en Leucemia Aguda Pediátrica : Caracterización de las Mutaciones Del Gen Flt3

El tratamiento de elección para las leucemias agudas pediátricas es la quimioterapia convencional, que ha permitido obtener tasas de sobrevida que actualmente parecen difíciles de superar. En los últimos años se han intensificado las investigaciones dirigidas a descubrir nuevos blancos terapéuticos, entre los que se encuentra el receptor FLT3. Los blastos leucémicos pueden presentar formas mutadas de dicho receptor, siendo las más frecuentes mutaciones internas en tándem (FLT3-ITD) y mutaciones puntuales en la zona de activación (FLT3-ALM). Objetivos: Poner a punto las técnicas para la detección de mutaciones de FLT3, analizar su prevalencia en nuestra población de pacientes con diagnóstico de Leucemia Mieloblástica Aguda (LMA) o de Leucemia Linfoblástica Aguda en Infantes (LLA-I), y evaluar su asociación con parámetros clínicos y de laboratorio. Pacientes y Método: La detección de las mutaciones se realizó por RT-PCR, en un total de 144 pacientes (109 LMA y 35 LLA-I). Resultados: Se detectaron mutaciones en el 16,5 por ciento de las LMA y en 8,6 por ciento de las LLA-I. La prevalencia de las FLT3-ITD mostró un aumento gradual con la edad de los pacientes, y la media de edad fue significativamente mayor. Con respecto a asociaciones con recuentos leucocitarios, alteraciones genéticas, subtipos FAB y valor pronóstico, si bien hubo diferencias, éstas no fueron significativas. Conclusiones: Este es el primer estudio de mutaciones en FLT3 realizado en población pediátrica en nuestro país. La detección de estas mutaciones permite individualizar a los niños candidatos a recibir, en el futuro, drogas inhibidoras de FLT3 actualmente en desarrollo.

Nuevos Blancos Terapéuticos en Leucemia Aguda Pediátrica : Caracterización de las Mutaciones Del Gen Flt3

El tratamiento de elección para las leucemias agudas pediátricas es la quimioterapia convencional, que ha permitido obtener tasas de sobrevida que actualmente parecen difíciles de superar. En los últimos años se han intensificado las investigaciones dirigidas a descubrir nuevos blancos terapéuticos, entre los que se encuentra el receptor FLT3. Los blastos leucémicos pueden presentar formas mutadas de dicho receptor, siendo las más frecuentes mutaciones internas en tándem (FLT3-ITD) y mutaciones puntuales en la zona de activación (FLT3-ALM). Objetivos: Poner a punto las técnicas para la detección de mutaciones de FLT3, analizar su prevalencia en nuestra población de pacientes con diagnóstico de Leucemia Mieloblástica Aguda (LMA) o de Leucemia Linfoblástica Aguda en Infantes (LLA-I), y evaluar su asociación con parámetros clínicos y de laboratorio. Pacientes y Método: La detección de las mutaciones se realizó por RT-PCR, en un total de 144 pacientes (109 LMA y 35 LLA-I). Resultados: Se detectaron mutaciones en el 16,5 por ciento de las LMA y en 8,6 por ciento de las LLA-I. La prevalencia de las FLT3-ITD mostró un aumento gradual con la edad de los pacientes, y la media de edad fue significativamente mayor. Con respecto a asociaciones con recuentos leucocitarios, alteraciones genéticas, subtipos FAB y valor pronóstico, si bien hubo diferencias, éstas no fueron significativas. Conclusiones: Este es el primer estudio de mutaciones en FLT3 realizado en población pediátrica en nuestro país. La detección de estas mutaciones permite individualizar a los niños candidatos a recibir, en el futuro, drogas inhibidoras de FLT3 actualmente en desarrollo.