RESUMO
BACKGROUND: the scientific literature is deficient in studies looking at the achievement of primary care diabetes treatment targets as stipulated by best practice guidelines in the Caribbean. AIMS: assessment of treatment goals attained by patients according to the Caribbean Health Research Council (CHRC)/Pan-American Health Organization (PAHO) guidelines for diabetes management in primary care centres in North Trinidad. The primary interest of this study was the extent to which stated intermediate outcome measures were achieved. Secondarily, process measures and adherence to specific recommendations on pharmacotherapy were evaluated. METHODS: this was a cross-sectional study where 225 patients with diabetes from five primary care centres were interviewed in October and November 2007. Data collected included age, sex, ethnicity, religious background, educational level and duration, diabetes type and duration since diagnosis, the presence of hypertension, current blood pressure, level of physical activity and current medications. Last documented serum cholesterol and HbA1c within the past year were obtained from patient records. Anthropometric measurements recorded were weight, height and waist and hip circumferences. RESULTS: of patients with available values, 49.3% achieved the target total cholesterol of less than 200 mg/dL while 56.6% had an HbA1C level of less than 6.5%. Only 47.7% attained a blood pressure target of less than or equal to 130/80 mmHg. 25.2% had a Body Mass Index (BMI) of less than 25 kg/m(2). For waist circumference measurements, 40.8% of males and 2.1% of females were within recommended limits. Only 13.5% had 20 minutes or more of at least moderate exercise daily. No patient met all recommended target values for these six parameters. CONCLUSIONS: there is poor achievement of treatment goals as set by best practice diabetes management guidelines. Results from this study may serve to inform primary care strategy revisions aimed at more widespread achievement of control targets which would ultimately abate the burden of illness in this population.
Assuntos
Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 2/terapia , Fidelidade a Diretrizes , Avaliação de Resultados em Cuidados de Saúde , Guias de Prática Clínica como Assunto , Atenção Primária à Saúde/normas , Antropometria , Estudos Transversais , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Trinidad e Tobago/epidemiologiaRESUMO
Biomarkers that could possibly discriminate between healthy controls and patients with dementias of the Alzheimer's type (AD) and vascular dementia (VaD) were investigated. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition TR (DSM IV TR) was used to diagnose for dementia in Trinidad. Healthy seniors greater than 60 years old were controls. All participants were administered the Mini-Mental State Examination (MMSE) and had blood analyzed for levels of C-reactive protein (CRP), total homocysteine (tHcy) and microglial antibodies (MgAb). Plasma tHcy was determined on the Abbot AxSym, serum CRP concentrations were measured using the Tina-Quant sCRP (Latex) high sensitive immunoturbidimetric assay and serum MgAb were examined on frozen rat brain sections. The study was carried out on 29 patients that fulfilled the inclusion criteria and 46 controls. Of the patients 65.5% had AD and 34.5% had VaD. Significant differences were found between the mean MMSE scores of the different types of dementias and controls. MgAb presence as well as tHcy were able to distinguish between controls and dementia of the AD and VaD type, respectively. The MMSE is a good discriminative tool for dementias. Serum MgAbs are a possible biomarker for Alzheimer disease pathology and tHcy is elevated in patients with vascular dementia.