RESUMEN

The evolution of our lives has forced changes to the healthcare system and consequently established healthcare marketing as an essential element of health services, including primary health care (PHC). This article aims to analyze the size, structure, and dynamics of research on primary healthcare marketing to identify the main topics and research trends in this area. The authors conducted a bibliographic analysis based on the methods of performance analysis and scientific mapping. The bibliographical analysis covered 1981 publications selected from the Scopus database and was carried out with the use of the MS Excel and VOSviewer applications. The results were supplemented with an in-depth analysis of 34 publications selected based on bibliographic coupling analysis to determine key research trends and results, which increased the understanding of the research area. The conducted research proves that the issue of marketing in primary health care is rarely addressed by researchers, which translates into very limited research results and little impact on the decision-making process in this area. This research field requires much greater commitment, especially in the areas indicated in the future research agenda recommendations.

RESUMEN

Vitamin K (VK) plays many important functions in the body. The most important of them include the contribution in calcium homeostasis and anticoagulation. Vascular calcification (VC) is one of the most important mechanisms of renal pathology. The most potent inhibitor of this process-matrix Gla protein (MGP) is VK-dependent. Chronic kidney disease (CKD) patients, both non-dialysed and hemodialysed, often have VK deficiency. Elevated uncarboxylated matrix Gla protein (ucMGP) levels indirectly reflected VK deficiency and are associated with a higher risk of cardiovascular events in these patients. It has been suggested that VK intake may reduce the VC and related cardiovascular risk. Vitamin K intake has been suggested to reduce VC and the associated cardiovascular risk. The role and possibility of VK supplementation as well as the impact of anticoagulation therapy on VK deficiency in CKD patients is discussed.

Asunto(s)

RESUMEN

BACKGROUND: The FreeStyle Libre is a flash glucose monitoring (FGM) system, and glucose levels are measured when the reader is brought to the sensor. Additional readers allow for the conversion into a continuous glucose monitoring (CGM) system. These transmitters read data from the sensor and send them to a bluetooth-enabled device thanks to which the user acquires glucose measurements automatically. This modification allows the patient to receive alerts when blood glucose values are abnormal. METHODS: The study relied on the results of an anonymous online survey conducted among patients with diabetes or their caregivers who use Facebook groups. A total of 132 respondents who met certain criteria (diabetic who use FGM system longer than 3 months, at least 14 days per month) were enrolled in the study. RESULTS: A significant decrease in self-reported glycated hemoglobin levels was found in adults and children using readers (variable: age P = .008; time P < .001), regardless of the age. The use of additional readers was associated with a significant decrease in the number of self-reported episodes of hypoglycemia (P < .001) and an improvement in the quality of life (based on self-reported limitations in everyday activities, social contacts, work/school, or doing sports). CONCLUSION: The use of additional readers for FGM system improves the metabolic control of diabetes and the quality of life, and has a positive effect on the safety of treatment. Flash glucose monitoring used together with additional readers operates as a CGM system and seems to be helpful for patients for the monitoring of interstitial levels of glucose; however, they should be careful when they use do it yourself solution.

Asunto(s)

RESUMEN

OBJECTIVE: Introduction: The Nightscout system is a free Do It Yourself solution. This system appeared in Poland in 2016. The concept of the project is to provide insight into measurements from the system of continuous glucose monitoring in interstitial fluid by authorized persons. The aim: The study was carried out to assess the functionality of the Nightscout system and its effect onmetabolic control, safety and the incidence of complications in patients with type 1 diabetes mellitus. PATIENTS AND METHODS: Material and methods:The study comprised 98 patients with type 1 diabetes. The study was conducted online using an anonymous questionnaire targeted at members of the "Nightscout Polska (Poland)" group on the Facebook. RESULTS: Results: Severe hypoglycaemic episodes with loss of consciousness were more frequent before using the Nightscout system and were reported by 3 adults (1-2 episodes). No severe hypoglycaemic episodes were reported when using the Nightscout system. The number of ketoacidosis episodes was reduced from 5 before using the Nightscout system to 2 episodes during the use of the system in children, and from 3 to 0 episodes in adults. Levels of glycated haemoglobin were lower in patients using the Nightscout system, both compared to control groups and values before the use it. In people using the Nightscout system glycated hemoglobin values were lower than their values before using this system. It was also shown that people using the Nightscout system had lower glycated hemoglobin than people from the control group. CONCLUSION: Conclusions: Using the Nightscout system can positively affect the safety of insulin therapy and the treatment process of type 1 diabetes. The Nightscout system can be an improvement of the system of continuous glucose monitoring in interstitial fluid.

Asunto(s)

RESUMEN

Nightscout is a non-commercial Do-It-Yourself (DIY) system, developed in 2014 by the parents of children with type 1 diabetes. In Poland it has been available and supported since 2016. The Nightscout system is not an officially registered solution and patients use it at their own responsibility. The idea of the project is to give authorized users online access to data on continuous glucose monitoring in interstitial fluid. Data are stored on external servers. Glucose data can be read on any number of devices with access to the Internet. This article describes the Nightscout system - required components, operating costs, and other usage options. It also presents the current evaluation of the Nightscout system in scientific publications.

Asunto(s)

RESUMEN

BACKGROUND: The aim of this cross-sectional study was to examine the relationship between obesity and lipid markers. MATERIAL AND METHODS: We divided 66 non-diabetic adult obese patients (mean age: 55.8±11.6 years) into 3 groups according to body mass index (BMI). All patients were measured for waist circumference (WC), hip circumference (HC), body mass index (BMI), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), body adiposity index (BAI), and visceral adiposity index (VAI). Serum levels of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG) were determined, and lipid indices TC/HDL, LDL/HDL, and TG/HDL were also estimated. RESULTS: TC and LDL-C in Group III were lower than in Group I (5.0±1.0 vs. 6.0±1.0 mmol/L, and 2.9±0.9 vs. 3.8±1.2 mmol/L; p<0.05 for both). Negative correlations were found between: BMI and TC, LDL, and HDL (r=-0.291; r=-0.310, r=-0.240, respectively); and WC, WHR, VAI, and HDL (r=-0.371, r=-0.296, r=-0.376, respectively). Positive correlations were found between WC, WHR, and TG/HDL (r=0.279, r=0.244, respectively) and between VAI and: TC (r=0.327), TG (r=0.885), TC/HDL (r=0.618), LDL/HDL (r=0.480), and TG/HDL (r=0.927). CONCLUSIONS: Obesity is associated with lipid disturbances, especially with HDL-C reduction, in obese non-diabetic patients. VAI is strongly related to lipid profile and thus may be the most valuable obesity index in obese patients with dyslipidemias.

Asunto(s)

RESUMEN

BACKGROUND: The aim of this study was to estimate associations between inflammatory markers and obesity indices in normo- and hypertensive subjects. METHODS: 65 obese adult subjects were divided into two groups: (A) of hypertensives (n = 54) and (B) of normotensives (n = 11). Waist circumference (WC), body mass index (BMI), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), visceral adiposity index (VAI), body adiposity index (BAI) and tumor necrosis factor-α (TNF-α), interleukin (IL)-6 and high sensitivity C-reactive protein (hsCRP) serum concentrations were estimated. RESULTS: In group A WHtR was higher (0.69 ± 0.07 vs 0.63 ± 0.06; p < 0.01), hsCRP correlated with BMI and WHtR (r = 0.343; p = 0.011 and r = 0.363; p < 0.01, respectively). BAI correlated with hsCRP in group A and B (r = 0.329; p < 0.05 and r = 0.642; p < 0.05; respectively) and in females and males (r = 0.305; p = 0.05 and r = 0.44; p < 0.05, respectively). In females hsCRP was higher (3.2 ± 2.2 mg/l vs 2.1 ± 1.5 mg/l; p < 0.05). In patients without lipid lowering treatment hsCRP and IL-6 were higher (3.2 ± 1.7 mg/l vs 2.4 ±2.2 mg/l; p = 0.01 and 15.9 ± 7.2 pg/ml vs 13.6 ± 9.9 pg/ml; p < 0.01, respectively). CONCLUSIONS: WHtR is a sensitive index associated with chronic inflammation in obese hypertensive subjects. BAI correlates with hsCRP independently of hypertension and sex. hsCRP is more sensitive marker associated with obesity than IL-6 and TNF-α. Lipid lowering treatment influence chronic inflammation.

Asunto(s)

RESUMEN

We compared the obesity parameters and selected adipokines-leptin, adiponectin, and resistin-in obese patients with hypertension and normotensive patients. A total of 67 nondiabetic obese outpatients were divided into 2 groups: A-hypertensive and B-normotensive. Serum levels of leptin, adiponectin, resistin, and insulin were measured. Weight, height, waist circumference, and hip circumference were measured to calculate waist-to-hip ratio (WHR), weight-to-height ratio, visceral adiposity index, and body adiposity index (BAI). Among patients with hypertension, significant positive correlations were observed between leptin and body mass index and BAI (r = .31 and r = .63, respectively). In normotensive patients, leptin positively correlated with BAI (r = .73, P < .01) and negatively with WHR (r = -.55, P < .0001); adiponectin negatively correlated with WHR (r = .38, P < .01) and BAI (r = .52; P < .0001), and resistin negatively correlated with WHR (r = -.36, P < .05). In conclusion, visceral obesity and leptin are associated with hypertension in obese patients.

Asunto(s)

RESUMEN

We compared adipokines and inflammatory markers in obese insulin-sensitive (group A, n = 16) and insulin-resistant (group B, n = 48) patients divided according to homeostasis model assessment of insulin resistance (HOMA-IR). Serum levels of adiponectin, leptin, resistin, high-sensitivity C-reactive protein, interleukin 6, and tumor necrosis factor α were measured. Weight, height, waist (WC) and hip circumferences, waist to hip ratio , weight to height ratio, visceral adiposity index (VAI), and body adiposity index (BAI) were measured. The WC and VAI were significantly higher in group B (113.9 ± 11.1 vs 105.3 ± 9.8 cm; P < .01 and 2.3 ± 1.1 vs 1.6 ± 0.9; P < .05, respectively), while serum adiponectin levels were higher in group A (24.5 ± 14.6 vs 15.1 ± 9.6 ng/mL; P < .005). The BAI strongly correlated with adiponectin and leptin in group B (r = .479; P < .001 and r = .705; P < .001). Insulin resistance is associated with visceral adiposity described by VAI and WC. The BAI may be a useful index in obese patients, especially with insulin resistance.

Asunto(s)

RESUMEN

BACKGROUND: The aim of this study was to estimate obesity parameters: waist circumference (WC), waist-to-hip ratio (WHR), weight-to-height ratio (WHtR), visceral adiposity index (VAI), body adiposity index (BAI), and serum adipokines (leptin, adiponectin, resistin) and their associations with estimated glomerular filtration rate (eGFR), serum creatinine, and microalbuminuria (MA) in patients with early stages of CKD and in non-CKD obese patients. MATERIAL AND METHODS: 67 non-diabetic obese (BMI ≥ 30 mg/kg(2) out-clinic patients (25 males, 42 females), aged from 36.5 to 64 years were divided into 2 groups: Group A (n=15)--patients with early stages of CKD (eGFR between 30 and 60 ml/min/1.73 m(2) or with MA >20 mg/l in morning urine sample independently from GFR) and Group B--patients without chronic CKD (n=52). RESULTS: In Group A compared to Group B, BAI and leptin were higher (42.2 ± 7.1 vs. 37.5 ± 7.0; p<0.05 and 51.8 ± 26.7 ng/mL vs. 35.3 ± 24.9 ng/mL; p<0.05; respectively) and negative correlations occurred between eGFR and BAI (r=-0.709; p=0.003), leptin (r=-0.68; p=0.005), and resistin (r=-0.528; p<0.05). In Group B, negative correlations occurred between creatinine and VAI (r=-0.332; p<0.05), BAI (r=-0.619; p<0.0001), leptin (r=-0.676; p<0.0001), and adiponectin (r=-0.423; p=0.002), and between eGFR and resistin (r=-0.276; p<0.05). CONCLUSIONS: BAI may be a valuable obesity parameter as a predictor of early stages of CKD in patients with obesity. Leptin may be an important pathogenic factor in obese patients with early stages of CKD. Resistin is associated with eGFR in obese patients, independently of CKD.

Asunto(s)

RESUMEN

INTRODUCTION: Hypertension often coexists with obesity. Adipokines, ghrelin and insulin play important roles in the pathogenesis of both diseases. The aim of this study was to compare adiponectin, leptin, resistin, insulin and ghrelin mean serum concentrations and insulin resistance (HOMA-IR) in normo- and hypertensive patients with obesity. MATERIAL AND METHODS: ALL INCLUDED PATIENTS WERE DIVIDED ON THE FOLLOWING GROUPS: non-diabetic hypertensive patients with class I obesity (group A, n = 21) and class II/III obesity (group B, n = 10), and normotensive obese (class I)patients (group C, n = 7). Correlations between obesity indices (body mass index [BMI], waist-to-hip ratio [WHR], waist circumference [WC]), HOMA-IR, and hormone and adipokine serum levels were also analyzed. RESULTS: Leptin level and HOMA-IR were significantly higher in group B compared to group C (9.74 ±3.88 ng/ml vs. 4.53 ±3.00 ng/ml; p < 0.02 and 3.30 ±1.59 vs. 1.65 ±0.41; p < 0.02, respectively). A negative correlation between WC and adiponectin level (R = -0.6275; p < 0.01) and a positive correlation between WC and insulin concentration (R = 0.5122; p< 0.05) as well as with HOMA-IR (R = 0.5228; p < 0.02) were found in group A. Negative correlations between BMI and ghrelin level (R = -0.7052; p < 0.05), WHR and adiponectin level (R = -0.6912; p < 0.05) and WHR and leptin level (R = -0.6728; p < 0.05) were observed in group B. CONCLUSIONS: Insulin resistance and leptin may be important pathogenic factors in hypertensive patients with severe obesity. Indices of abdominal obesity (WC, WHR) correlate better than BMI with HOMA-IR, insulin, adiponectin and leptin serum levels in hypertensive obese patients.

RESUMEN

BACKGROUND: The aim of the study was to estimate the association between anthropometric obesity parameters, serum concentrations of ghrelin, resistin, leptin, adiponectin and homeostasis model assessment (HOMA-IR) in obese non-diabetic insulin-sensitive and insulin-resistant patients. MATERIAL/METHODS: Study subjects included 37 obese (body mass index [BMI] ≥ 30 kg/m2) out-clinic patients aged 25 to 66 years. Insulin resistance was evaluated by HOMA-IR. Serum fasting concentrations of glucose, insulin, ghrelin, adiponectin, resistin and leptin were measured by using the ELISA method. Body weight, waist and hip circumferences were measured to calculate BMI and waist-to-hip ratio (WHR) values for all the patients. According to HOMA-IR, patients were divided into two groups: A, insulin sensitive (n=19); and B, insulin resistant (n=18). RESULTS: Patients with insulin resistance have greater mean waist circumference (WC) higher mean serum insulin level and leptin concentration, but lower concentrations of adiponectin and ghrelin. In the insulin-sensitive patient group we observed positive correlations between BMI and HOMA-IR, WC and HOMA-IR, and adiponectin and leptin, and negative correlations between ghrelin and HOMA-IR, WC and adiponectin, and WHR and adiponectin. In the insulin-resistant group, there was a positive correlation between resistin and ghrelin and a negative correlation between WHR and leptin. CONCLUSIONS: Waist circumference, adiponectin, leptin and ghrelin are associated with insulin resistance and may be predictors of this pathology.

Asunto(s)

RESUMEN

Central arterial systolic blood pressure is a very important factor in the pathophysiology of cardiovascular diseases. Central arterial pressure is a better predictor of cardiovascular risk than peripheral brachial blood pressure. Measurement of central blood pressure is useful for a diagnosis of spurious systolic hypertension in young people. Antihypertensive drugs have a different impact on central blood pressure, for example angiotensin converting enzyme inhibitors, antagonists of angiotensin II receptors, calcium channel blockers more effectively lower central blood pressure than betablockers, despite all of those drugs (including beta-blockers) having a similar impact on peripheral pressure. This mechanism may be responsible for the beneficial effect of some antihypertensive drugs on cardiovascular end points observed in clinical trials, despite a low peripheral hypotensive effect. However, further clinical trials are required to provide more evidence for the prognostic and therapeutic implications of the measurement of central blood pressure before adopting its routine application in clinical practice.

Asunto(s)

RESUMEN

INTRODUCTION: In every case of upper gastrointestinal bleeding suspicion, an endoscopic examination ought to be performed as a matter of urgency. Finding active bleeding, a visible non-bleeding vessel or a lesion with an adherent clot should be followed by application of an available method of endoscopic therapy. The aim of the study was to compare the effectiveness of various endoscopic treatment techniques such as epinephrine injections, coagulation methods and mechanical methods in the treatment of non-varicose upper gastrointestinal bleeding. MATERIAL AND METHODS: Sixty cases of non-varicose upper gastrointestinal bleeding were analysed in terms of the effectiveness of the above-mentioned procedures used in monotherapy or in combination therapy comprising epinephrine injections and clips application. The choice of the applied procedure depended on morphological features and location of the bleeding source, the patient's general condition, as well as technical equipment and manual skills of the endoscopy staff. RESULTS: The study confirmed the effectiveness of endoscopic treatment of non-varicose upper gastrointestinal bleeding applying the above-mentioned methods. In most patients, this treatment enabled traumatic surgical intervention to be avoided; it was required in only 3 (5%) out of 60 patients with confirmed upper gastrointestinal bleeding. With the first endoscopy, haemostasis was achieved in 47 cases (78.3%) and the second endoscopy, performed due to bleeding recurrence, was successful in the remaining 10 cases (16.7%). CONCLUSIONS: In non-varicose upper gastrointestinal bleeding, urgent diagnostic and therapeutic endoscopy should be the first-line management. If the lesion that is the source of bleeding is possible to localize, the endoscopic techniques should be applied. Among the endoscopic procedures used in monotherapy, clips appeared to be the most effective, their effectiveness being comparable to combination therapy. In bleeding from extensive lesions, coagulation methods are considered to be the most efficacious.

RESUMEN

BACKGROUND: Statins are the first-line drug therapy in the treatment of hypercholesterolemia. The beneficial clinical impact of statins on the cardiovascular system results not only from their lipid-lowering action but also from other effects. Recently, it has been suggested that statins can reduce blood pressure, especially in hypertensive patients. AIM: The role of the hypotensive action of statins and other mechanisms which reduce cardiovascular risk in hypertensive patients are discussed in this review. METHODS: Electronic databases searched were [MEDLINE (1966 - February 2009), EMBASE and SCOPUS (1965 - February 2009), DARE (1966 -- February 2009)]. Additionally, abstracts from national and international cardiovascular meetings were studied to identify unpublished studies. The main data search terms were: blood pressure, hypertension, hypercholesterolemia and statins. FINDINGS: At present, it is difficult to unequivocally assess the impact of statins on blood pressure. However, according to most authors, the impact of statins on the decrease in BP is slight, but significant, especially among patients with hypertension.

Asunto(s)

RESUMEN

UNLABELLED: Atherosclerosis is one of the most common causes of mortality in developed countries. One of the many factors in its etiopathogenesis are reactive oxygen species (ROS), excess of which comes from disturbances of enzymatic and nonenzymatic mechanisms of antioxidant barrier. THE AIM OF THIS STUDY was to estimate relations between the activity of chosen parameters antioxidant barrier and the lipid levels in children with atherosclerosis risk factors. MATERIAL AND METHODS: The study was carried out on 48 children with atherosclerosis risk factors. The control group consisted of 25 healthy children. Total cholesterol (TC), Triglycerides (TG), HDL-C, LDL-C were determined by enzymatic method. The activity of superoxide dismutase (SOD) was estimated by Misra and Fridivich's method, glutathione peroxidase (GSH-Px) with method proposed by Sedlak and Lindsay in modyfication Little and Brien and the activity o catalase (CAT) by Beer and Sizer's method. Malonyl dialdehyde (MDA) concentration was determined by Placer's method. RESULTS: Obesity, lipid disorders, and hypertension were the most frequent risk factors in the investigated children. Statistically significant higher concentration of TC, LDL-C, TG and lower HDL-C were observed in children with atherosclerosis risk factors. Activity of glutathion peroxidase was statistically significant higher in children with atherosclerosis risk factors (p < 0.001), activity of catalase was lower (p < 0.05). No significant differences in activity of superoxide dismutase and malonyl dialdehyde were observed in the investigated groups. CONCLUSION: Modificated activity of selected antioxidants in children with atherosclerosis risk factors could determine an index of antioxidant barrier and might potencially constitute the marker of early atherosclerotical risk development.

Asunto(s)

RESUMEN

UNLABELLED: Atherosclerosis begins in childhood. At present among numerous risk factors of atherosclerosis the role of hiperhomocysteinemia in development of cardiovascular heart disease is taken under consideration. Atherogenic effect of homocystein is related to its cytotoxin action, conducting to endothelial dysfunction and damage. It is correlated with increase of the lipid levels in the blood serum and change of expression of the soluble forms of adhesion molecules. The aim of this study was to estimate relations between the homocystein serum concentration, expression of the selected adhesion molecules and the lipid levels in the blood serum in children with atherosclerosis risk factors. MATERIAL AND METHODS: The group consisted of 670 children, 76 of them had atherosclerosis risk factors. In further examination 48 children have taken a part, whose parents were agreed for theirs participation in the program. The comparative group composed of 25 children without the risk factors. We determined total cholesterol (TC), triglycerides (TG), LDL cholesterol fraction (LDL-C), HDL cholesterol fraction (HDL-C), serum homocysteine concentration (Hcy), the expression of the soluble forms of adhesion molecules (sCAM): sP-selectin and sVCAM-1 (vascular cell adhesion molecule-1). RESULTS: Obesity, hypertension and lipid disorders in the shape of higher concentration of TC, LDL-C, TG and lower HDL-C were the most frequent risk factors in the investigated children. No significant differences in serum homocysteine concentration were observed between the investigated groups. However, its concentration was significantly higher in children with two atherosclerosis risk factors. No significant differences in expression of s-VCAM-1 were observed in the investigated groups, concentration of sP-selectin was significantly higher in children with atherosclerosis risk factors (p<0.05). Statistically significantly higher serum concentrations of lipid levels were found in children with hyperhomocysteinemia. CONCLUSION: Higher concentration of the serum homocysteine and chosen adhesion molecules in children with atherosclerosis risk factors might potentially constitute the marker of early atherosclerotical risk development.

Asunto(s)

Asunto(s)

RESUMEN

OBJECTIVES: The aim of this study was to compare the usefulness and credibility of ambulatory self-measurement of blood pressure (SMBP) by hypertensive patients to automatic ambulatory blood pressure monitoring (ABPM). METHODS: The study was performed in 51 patients with primary hypertension (19 F, 32 M), aged 25-67 y divided into 3 groups: I-without treatment (n = 13), II-receiving monotherapy (n = 17) and III-treated at least with 2 hypotensive drugs (n = 21). For three consecutive days, patients measured their systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) three times a day at 2 minute intervals during the following periods 06:00-08:00, 15:00-17:00 and 20:00-22:00. Afterwards, the process was repeated for three days using the automatic OMRON HEM-705C device. Results obtained on the second and third days were included in the calculation of SBP, DBP and HR mean values for the period 06:00-22:00. On the fourth day of the study, ABPM was performed with a Tycos Quiet Trak recorder. The parameters were measured every 20 minutes between 06:00 and 22:00. The average values for SBP, DBP and HR that were obtained with these two methods of blood pressure monitoring using the time period 06:00-22:00, were then compared. RESULTS: There was a significant correlation between SMBP and ABPM for SBP, DBP and HR in groups I, II and III (for SBP r = 0.81; 0.80; 0.82; for DBP r = 0.61; 0.62; 0.83; for HR r = 0.53; 0.69; 00.81). According to statistical tests, significant differences in the mean values of SBP, DBP and HR were found in the first (3.9 mmHg, 5.7 mmHg and 8 min-1 and second (4.9 mmHg, 6.2 mmHg and 6.2 min-1) groups. Only the HR (7.7 min-1) was statistically significant in the third group. CONCLUSIONS: Self-measurement of BP with automatic device is comparable to ABPM method of blood pressure monitoring, especially if multi-drug therapy is used for sustained hypertension. However, SMBP is not a completely alternative method for ABPM.

Asunto(s)