RESUMEN
AIMS: We aimed to confirm the hypothesis that dysglycaemia including in the pre-diabetes range affects a majority of patients admitted with acute coronary syndrome (ACS) and is associated with worse outcomes. METHODS: In this prospective observational cohort study, consecutive inpatients agedâ¯≥â¯54â¯years with ACS were uniformly tested and categorised into diabetes (prior diagnosis/ HbA1câ¯≥â¯6.5%, ≥48â¯mmol/mol), pre-diabetes (HbA1c 5.7-6.4%, 39-47â¯mmol/mol) and no diabetes (HbA1câ¯≤â¯5.6%, ≤38â¯mmol/mol) groups. RESULTS: Over two years, 847 consecutive inpatients presented with ACS. 313 (37%) inpatients had diabetes, 312 (37%) had pre-diabetes and 222 (25%) had no diabetes. Diabetes, compared with no diabetes, was associated with higher odds of acute pulmonary oedema (APO, odds ratio, OR 2.60, pâ¯<â¯0.01), longer length of stay (LOS, incidence rate ratio, IRR 1.18, pâ¯=â¯0.02) and, 12-month ACS recurrence (OR 1.86, pâ¯=â¯0.046) after adjustment, while no significant associations were identified for pre-diabetes. Analysed as a continuous variable, every 1% (11â¯mmol/mol) increase in HbA1c was associated with increased odds of APO (OR 1.28, Pâ¯=â¯0.002) and a longer LOS (IRR 1.05, Pâ¯=â¯0.03). CONCLUSIONS: The high prevalence of dysglycaemia and association with poorer clinical outcomes justifies routine HbA1c testing to identify individuals who may benefit from cardioprotective anti-hyperglycaemic agents and, lifestyle modification to prevent progression of pre-diabetes.
Asunto(s)
Síndrome Coronario Agudo/epidemiología , Diabetes Mellitus/fisiopatología , Hospitalización/estadística & datos numéricos , Pacientes Internos/estadística & datos numéricos , Estado Prediabético/fisiopatología , Anciano , Anciano de 80 o más Años , Australia/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Pronóstico , Estudios ProspectivosRESUMEN
AIMS: Diabetes is a major risk factor for stroke. We aimed to investigate the prevalence of diabetes and pre-diabetes within a stroke cohort and examine the association of glycaemia status with mortality and morbidity. METHODS: Inpatients aged ≥54 who presented with a diagnosis of stroke had a routine HbA1c measurement as part of the Austin Health Diabetes Discovery Initiative. Additional data were attained from hospital databases and Australian Stroke Clinical Registry. Outcomes included diabetes and pre-diabetes prevalence, length of stay, 6-month and in-hospital mortality, 28-day readmission rates, and 3-month modified Rankin scale score. RESULTS: Between July 2013 and December 2015, 610 patients were studied. Of these, 31% had diabetes while 40% had pre-diabetes. Using multivariable regression analyses, the presence of diabetes was associated with higher odds of 6-month mortality (ORâ¯=â¯1.90, pâ¯=â¯0.022) and higher expected length of stay (IRRâ¯=â¯1.29, pâ¯=â¯0.004). Similarly, a higher HbA1c was associated with higher odds of 6-month mortality (ORâ¯=â¯1.27, pâ¯=â¯0.005) and higher expected length of stay (IRRâ¯=â¯1.08, pâ¯=â¯0.010). CONCLUSIONS: 71% of this cohort had diabetes or pre-diabetes. Presence of diabetes and higher HbA1c were associated with higher 6-month mortality and length of stay. Further research is necessary to determine if improved glycaemic control may improve stroke outcomes.
Asunto(s)
Pruebas Diagnósticas de Rutina , Trastornos del Metabolismo de la Glucosa/diagnóstico , Hemoglobina Glucada/análisis , Accidente Cerebrovascular/sangre , Accidente Cerebrovascular/diagnóstico , Anciano , Anciano de 80 o más Años , Glucemia/análisis , Complicaciones de la Diabetes/sangre , Complicaciones de la Diabetes/diagnóstico , Complicaciones de la Diabetes/epidemiología , Diabetes Mellitus/sangre , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiología , Pruebas Diagnósticas de Rutina/métodos , Pruebas Diagnósticas de Rutina/estadística & datos numéricos , Femenino , Trastornos del Metabolismo de la Glucosa/sangre , Trastornos del Metabolismo de la Glucosa/complicaciones , Trastornos del Metabolismo de la Glucosa/epidemiología , Mortalidad Hospitalaria , Humanos , Masculino , Persona de Mediana Edad , Morbilidad , Estado Prediabético/sangre , Estado Prediabético/complicaciones , Estado Prediabético/diagnóstico , Estado Prediabético/epidemiología , Prevalencia , Pronóstico , Factores de Riesgo , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/epidemiologíaRESUMEN
AIM: Studies have shown increasing Internet use for health information. We aimed to broadly examine parents' utilisation of information sources for their children's health, their trust in them and to define the role of the Internet for children's health information METHODS: Interview of a convenience sample of parents of patients presenting to a tertiary paediatric emergency department (ED) (Royal Children's Hospital, Melbourne, Australia) in 2006/2007. RESULTS: A total of 360 parents completed the interview. Parents had used on average five sources of health information for their children in the previous 6 months. In the previous 6 months and immediately prior to the ED visit, general practitioners were consulted for health information by 87% and 39%, chemists by 44% and 2%, the Internet by 43% and 6% and telephone advice health lines by 30% and 10%, respectively. Of these sources, parents 'greatly trusted' Royal Children's Hospital ED doctors and nurses 82% (n = 112) their regular general practitioners in 73% (n = 303), chemists in 45% (n = 160), telephone advice health lines (Nurse-On-Call) in 42% (n = 90) and the Internet in general in 10% (n = 112). Overall, 52% had sought health information for their children on the Internet. Only 20% knew and 11% had ever used the regional children's hospital web site (http://www.rch.org.au/kidsinfo), but 97% of the Internet users reported they would trust this information. CONCLUSION: While using numerous different sources, parents in this study mostly use and trust traditional sources of health information. Scores of respondents use the Internet to seek health information for their children and would value easier access to Internet sources that they trust.