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1.
Microvasc Res ; 136: 104162, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33705823

RESUMO

BACKGROUND: Although the associations between measures of macrovascular and microvascular dysfunctions are well characterized in diabetes, there is limited data on these associations in individuals without diabetes. We compared the associations between macrovascular dysfunction and renal microvascular dysfunction in individuals with type 2 diabetes (T2D) and without diabetes. METHODS: Cross-sectional analyses of baseline data from the multiethnic Healthy Life in an Urban Setting (HELIUS) study (Amsterdam, the Netherlands), including 986 participants with T2D and 7680 participants without diabetes were done. Logistic regression analyses were used to examine the associations between macrovascular dysfunction [aortic stiffness, coronary artery disease (CAD), peripheral artery disease (PAD), and stroke] and renal microvascular dysfunction [albuminuria] with adjustments for age, sex, ethnicity, waist-to-hip ratio, systolic blood pressure, LDL-cholesterol, and smoking (and HbA1c and diabetes duration for the T2D group). RESULTS: In the fully adjusted models, aortic stiffness was associated with albuminuria in individuals with T2D [OR 2.55; 95% CI,1.30-4.98], but not without diabetes [0.96; 0.63-1.45]; stroke was associated with albuminuria in T2D [2.40;1.10-5.25], but not in non-diabetes [1.39;0.83-2.33]. In age-sex adjusted models, CAD was associated with albuminuria in T2D [1.65;1.09-2.50] and in non-diabetes [1.56;1.13-2.15]; the associations were no longer significant in the fully adjusted model. There were no associations between PAD and albuminuria in T2D and non-diabetes. CONCLUSIONS: Our study shows important differences in the associations between measures of macrovascular and renal microvascular dysfunction in T2D and non-diabetes. These findings provide opportunities for future research aimed at prevention and treatment strategies for individuals with vascular dysfunction.


Assuntos
Albuminúria/etnologia , Doença da Artéria Coronariana/etnologia , Diabetes Mellitus Tipo 2/etnologia , Nefropatias Diabéticas/etnologia , Doença Arterial Periférica/etnologia , Acidente Vascular Cerebral/etnologia , Adulto , Albuminúria/diagnóstico , Albuminúria/fisiopatologia , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/fisiopatologia , Estudos Transversais , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/fisiopatologia , Nefropatias Diabéticas/diagnóstico , Nefropatias Diabéticas/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/fisiopatologia , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Rigidez Vascular
2.
Patient Educ Couns ; 70(2): 256-65, 2008 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-18063340

RESUMO

OBJECTIVE: To determine self-referrals' motives to visit the accident & emergency departments (AED) and to compare their characteristics to patients contacting the GP cooperative. METHODS: Postal questionnaires were send to AED self-referrals and logistic regression analysis was used to contrast self-referrals to patients contacting the GP cooperative. RESULTS: For a study population of 62,000, during 4 months, 5547 contacts were registered with the GP cooperative, along with 808 AED contacts, 344 of whom (43%) were self-referrals. Main reasons to visit the AED were the perceived need for diagnostic facilities and the conviction that the hospital specialist was best qualified to handle the problem. Dissatisfaction with the GP cooperative among respondents was high. Self-referral to the AED was positively associated with injury, age between 15 and 64, musculoskeletal, cardiovascular and respiratory problems, and distance to the GP centre. CONCLUSION: Self-referrals emerge as patients with a strong preference for the AED, mainly based on assumptions on quality of care and necessary facilities. PRACTICE IMPLICATIONS: While self-referrals may, in part, make motivated and appropriate choices to visit the AED, new integrated care models should be studied that can adequately deflect those who are eligible for GP care.


Assuntos
Plantão Médico/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Medicina de Família e Comunidade , Motivação , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Adolescente , Adulto , Fatores Etários , Comportamento de Escolha , Medicina de Família e Comunidade/organização & administração , Feminino , Pesquisas sobre Atenção à Saúde , Acessibilidade aos Serviços de Saúde , Mau Uso de Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Modelos Psicológicos , Países Baixos , Pesquisa Metodológica em Enfermagem , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pesquisa Qualitativa , Encaminhamento e Consulta , Inquéritos e Questionários
3.
BMC Fam Pract ; 7: 74, 2006 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-17163984

RESUMO

BACKGROUND: Nowadays, nurses play a central role in telephone triage in Dutch out-of-hours primary care. The percentage of calls that is handled through nurse telephone advice alone (NTAA) appears to vary substantially between GP cooperatives. This study aims to explore which determinants are associated with NTAA and with subsequent return consultations to the GP. METHODS: For the ten most frequently presented problems, a two-week follow-up cohort study took place in one cooperative run by 25 GPs and 8 nurses, serving a population of 62,291 people. Random effects logistic regression analysis was used to study the determinants of NTAA and return consultation rates. The effect of NTAA on hospital referral rates was also studied as a proxy for severity of illness. RESULTS: The mean NTAA rate was 27.5%--ranging from 15.5% to 39.4% for the eight nurses. It was higher during the night (RR 1.63, CI 1.48-1.76) and lower with increasing age (RR 0.96, CI 0.93-0.99, per ten years) or when the patient presented >2 problems (RR 0.65; CI 0.51-0.83). Using cough as reference category, NTAA was highest for earache (RR 1.49; CI 1.18-1.78) and lowest for chest pain (RR 0.18; CI 0.06-0.47). After correction for differences in case mix, significant variation in NTAA between nurses remained (p < 0.001). Return consultations after NTAA were higher after nightly calls (RR 1.23; CI 1.04-1.40). During first return consultations, the hospital referral rate after NTAA was 1.5% versus 3.8% for non-NTAA (difference -2.2%; CI -4.0 to -0.5). CONCLUSION: Important inter-nurse variability may indicate differences in perception on tasks and/or differences in skill to handle telephone calls alone. Future research should focus more on modifiable determinants of NTAA rates.


Assuntos
Plantão Médico , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Medicina de Família e Comunidade/organização & administração , Enfermeiras e Enfermeiros/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Triagem , Adulto , Idoso , Grupos Diagnósticos Relacionados , Medicina de Família e Comunidade/estatística & dados numéricos , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Países Baixos , Enfermeiras e Enfermeiros/normas , Projetos Piloto , Qualidade da Assistência à Saúde , Encaminhamento e Consulta/estatística & dados numéricos , Análise de Regressão , Análise e Desempenho de Tarefas , Telefone
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