RESUMEN
AIM: The worldwide prevalence of type 2 diabetes mellitus is increasing, with most individuals with the disease being overweight or obese. Weight loss can reduce disease-related morbidity and mortality and weight losses of 10-15 kg have been shown to reverse type 2 diabetes. This review aimed to determine the effectiveness of community-based educational interventions for weight loss in type 2 diabetes. METHODS: This is a systematic review and meta-analysis of randomized controlled trials (RCT) in obese or overweight adults, aged 18-75 years, with a diagnosis of type 2 diabetes. Primary outcomes were weight and/or BMI. CINAHL, MEDLINE, Embase, Scopus and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception to June 2019. Trials were classified into specified a priori comparisons according to intervention type. A pooled standardized mean difference (SMD) (from baseline to follow-up) and 95% confidence intervals (95% CI) between trial groups (difference-in-difference) were estimated through random-effects meta-analyses using the inverse variance method. Heterogeneity was quantified using I2 and publication bias was explored visually using funnel plots. RESULTS: Some 7383 records were screened; 228 full-text articles were assessed and 49 RCTs (n = 12 461 participants) were included in this review, with 44 being suitable for inclusion into the meta-analysis. Pooled estimates of education combined with low-calorie, low-carbohydrate meal replacements (SMD = -2.48, 95% CI -3.59, -1.49, I2 = 98%) or diets (SMD = -1.25, 95% CI -2.11, -0.39, I2 = 95%) or low-fat meal replacements (SMD = -1.15, 95%CI -2.05, -1.09, I2 = 85%) appeared most effective. CONCLUSION: Low-calorie, low-carbohydrate meal replacements or diets combined with education appear the most promising interventions to achieve the largest weight and BMI reductions in people with type 2 diabetes.
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Diabetes Mellitus Tipo 2/terapia , Obesidad/terapia , Sobrepeso/terapia , Educación del Paciente como Asunto , Programas de Reducción de Peso/métodos , Adolescente , Adulto , Anciano , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Obesidad/complicaciones , Obesidad/epidemiología , Sobrepeso/complicaciones , Sobrepeso/epidemiología , Educación del Paciente como Asunto/métodos , Ensayos Clínicos Controlados Aleatorios como Asunto/estadística & datos numéricos , Pérdida de Peso/fisiología , Adulto JovenRESUMEN
OBJECTIVES: To explore factors associated with maintenance of moderate-to-vigorous physical activity (MVPA) in community-dwelling adults aged ≥65 years after completing a 24-week exercise programme. STUDY DESIGN: This is a cohort study nested within a randomised controlled trial evaluating group- and home-based exercise programmes for older people in England. METHODS: MVPA levels and factors potentially associated with physical activity (PA) were self-reported at recruitment, 6, 12, 18 and 24 months after exercise programme. Multilevel logistic regression estimated odds ratios (ORs) for achieving target MVPA level (150 min/week) 6-24 months after exercise programmes ended. RESULTS: Older people (OR per year increase: 0.89, 95% confidence interval [CI] 0.86, 0.93) and women (OR 0.47, 95% CI 0.33, 0.67) were less likely to achieve target MVPA. Those physically active at recruitment (OR 11.28, 95% CI 7.95, 16.01), with wider social networks (OR per unit increase in Lubben Social Network Scale: 1.06, 95% CI 1.03, 1.10) and performing more sit-to-stands in 30 s (OR for quartile 3 compared with quartile 1: 1.87, 95% CI 1.12, 3.10), were more likely to achieve target MVPA. Negative exercise expectations increased the odds of achieving target MVPA but only among the less active at recruitment (OR per unit increase in Outcome and Expectation for Exercise negative subscale: 1.90, 95% CI 1.39, 2.60). Associations did not differ significantly across the follow-up period. CONCLUSION: A range of factors are associated with maintenance of PA 6-24 months after exercise programmes. Factors are not more strongly associated with shorter vs longer term PA maintenance. Commissioners and providers should consider targeting maintenance interventions to those least likely to maintain PA.
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Terapia por Ejercicio , Ejercicio Físico , Factores de Edad , Anciano , Estudios de Cohortes , Inglaterra , Ejercicio Físico/fisiología , Ejercicio Físico/psicología , Terapia por Ejercicio/métodos , Femenino , Servicios de Atención de Salud a Domicilio , Humanos , Vida Independiente , Masculino , Evaluación de Programas y Proyectos de Salud , Psicoterapia de Grupo , Autoinforme , Factores Sexuales , Red SocialRESUMEN
PURPOSE: To demonstrate the impact of psychological morbidity 1 month post-injury on subsequent post-injury quality of life (HRQoL) in a general injury population in the UK to inform development of trauma care and rehabilitation services. METHODS: Multicentre cohort study of 16-70-year-olds admitted to 4 UK hospitals following injury. Psychological morbidity and HRQoL (EQ-5D-3L) were measured at recruitment and 1, 2, 4 and 12 months post-injury. A reduction in EQ-5D compared to retrospectively assessed pre-injury levels of at least 0.074 was taken as the minimal important difference (MID). Multilevel logistic regression explored relationships between psychological morbidity 1 month post-injury and MID in HRQoL over the 12 months after injury. RESULTS: A total of 668 adults participated. Follow-up rates were 77% (1 month) and 63% (12 months). Substantial reductions in HRQoL were seen; 93% reported a MID at 1 month and 58% at 12 months. Problems with pain, mobility and usual activities were commonly reported at each time point. Depression and anxiety scores 1 month post-injury were independently associated with subsequent MID in HRQoL. The relationship between depression and HRQoL was partly explained by anxiety and to a lesser extent by pain and social functioning. The relationship between anxiety and HRQoL was not explained by factors measured in our study. CONCLUSIONS: Hospitalised injuries result in substantial reductions in HRQoL up to 12 months later. Depression and anxiety early in the recovery period are independently associated with lower HRQoL. Identifying and managing these problems, ensuring adequate pain control and facilitating social functioning are key elements in improving HRQoL post-injury.
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Ansiedad/psicología , Depresión/psicología , Morbilidad/tendencias , Perfil de Impacto de Enfermedad , Heridas y Lesiones/psicología , Adolescente , Adulto , Anciano , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
Precise diagnosis of presenile dementia is a great challenge. The only valuable classification of dementia is the neuropathological one. We present the first series of stereotactic biopsies in 28 presenile patients (18 males, age 39 less than or equal to 58 less than or equal to 69 years, and 10 females, age 23 less than or equal to 52 less than or equal to 66 years). The results demonstrate that the clinical and paraclinical diagnosis (including positron emission tomography scan, neuropsychological examinations, computed tomography scan, electroencephalogram) in only one third of all cases and only in 50% of the Alzheimer and Creutzfeld-Jakob cases. This is very important to be kept in mind when epidemiology or efficacy of drugs are investigated without any neuropathological confirmation.
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Enfermedad de Alzheimer/patología , Biopsia/instrumentación , Encéfalo/patología , Demencia/patología , Técnicas Estereotáxicas/instrumentación , Adulto , Anciano , Diagnóstico Diferencial , Femenino , Lóbulo Frontal/patología , Humanos , Sistema Límbico/patología , Masculino , Persona de Mediana Edad , Lóbulo Temporal/patologíaRESUMEN
A study of neurotransmitter release has been performed on human brain biopsies obtained during the course of a therapeutic neurosurgical procedure. The electrically evoked-release of 3H-dopamine and 3H-acetylcholine was studied on slices from the thalamus of two parkinsonian and two non-parkinsonian subjects. Electrical stimulation of the non-parkinsonian thalamus increased the dopamine release but had no effect on acetylcholine release. This characteristic response had been previously observed in the normal rat thalamus. In contrast, the parkinsonian thalamus responded with a sharp increase in acetylcholine release without concomitant increase in dopamine release indicating the possible existence of an inhibitory control effect action of dopamine on acetylcholine release as seen in rat striatum.
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Acetilcolina/farmacocinética , Dopamina/farmacocinética , Enfermedad de Parkinson/metabolismo , Núcleos Talámicos/metabolismo , Anciano , Animales , Biopsia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedad de Parkinson/cirugía , Ratas , Ratas Endogámicas , Técnicas EstereotáxicasRESUMEN
Early detection and precise diagnosis of dementias are important since they determine subsequent medical care. Presently the only way to classify these syndromes is by neuropathological examination. Between 1972 and 1988, 246 stereotactic serial brain biopsies were performed in 28 selected demented patients. Comparison between preoperative clinical diagnosis and histological finding gives the following results: the diagnosis has been confirmed in 32%, corrected or specified in 67% and stereotactic brain biopsies only showed unspecific pathological gliosis in 8%. This emphasizes the difficulties to assess precisely the diagnosis. This must be kept in mind when evaluating drug trials.
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Encéfalo/patología , Demencia/patología , Adulto , Anciano , Biopsia/métodos , Demencia/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Técnicas EstereotáxicasRESUMEN
Early detection and precise diagnosis of presenile dementias are important since they determine subsequent medical care. Presently the only way to classify these syndromes is by neuropathological examination. Between 1972 and 1987, 222 stereotactic serial brain biopsies were performed in 25 selected demented patients. Comparison between preoperative clinical diagnosis and histological finding gives the following results: in 32% the clinical diagnosis has been confirmed, in 60% the diagnosis has been corrected or specified and in 8% the stereotactic brain biopsies only showed unspecific pathological gliosis.