RESUMO
Abstract The aim of this research was to examine the effects of healthcare mistreatment and cultural beliefs on psychological, behavioral, and biological phenomena relevant to treatment adherence and health outcome among patients with Type 2 Diabetes Mellitus (T2DM). The study was conducted in Chile, where the prevalence of T2DM is one of the highest in Latin America and is increasing at an accelerated rate. The research was guided by Betancourt's Integrative Model and bottom-up mixed-method cultural research approach. Consistent with the hypotheses of the study, the test of a structural equation model based on the Integrative Model, including exposure to healthcare mistreatment, diabetes-related cultural beliefs, psychological distress, and medical avoidance as determinants of HbA1c, a biological measure of diabetes control, fit the data. The fact that the analysis of structural equations accounted for significant variance in HbA1c provides supporting evidence for extending the Integrative Model, to explain biological phenomena based on cultural and psychological factors.
Resumen El propósito de este trabajo fue evaluar los efectos de la negligencia médica y las creencias culturales sobre fenómenos biológicos, conductuales y psicológicos relevantes para la adherencia al tratamiento y consecuencias de salud en pacientes con diabetes mellitus tipo 2 (DMT2). El estudio se llevó a cabo en Chile, donde la prevalencia de DMT2 es una de las más altas de América Latina y sigue en aumento de manera acelerada. La investigación se basó en el Modelo Integrativo de Betancourt y en el enfoque mixto-abajo-arriba de investigación cultural. Congruente con las hipótesis del estudio, el modelo de ecuaciones estructurales basado en el modelo integrativo, que incluyó la exposición a negligencia médica, creencias culturales vinculadas a la diabetes, estrés psicológico, y evitación médica como determinantes del HbA1c, una medición biológica de control diabético, mostró buen ajuste. El hecho de que el modelo de ecuaciones estructurales explique gran parte de la varianza del HbA1c aporta suficiente evidencia para ampliar el modelo integrativo en la explicación del fenómeno biológico con base en factores culturales y psicológicos.
RESUMO
BACKGROUND: Despite the strong association between obesity and binge eating, limited research has examined the implications of binge eating on dietary adherence and psychological factors in ethnically diverse type 2 diabetes patients. PURPOSE: This study investigated the prevalence of binge eating and its association with dietary adherence, glycemic control, and psychological factors among indigenous and non-indigenous type 2 diabetes patients in Chile. METHOD: Participants were 387 indigenous (Mapuche) and non-indigenous (non-Mapuche) adults with type 2 diabetes. Self-report measures of binge eating, dietary adherence, diet self-efficacy, body image dissatisfaction, and psychological well-being were administered. Participants' weight, height, and glycemic control (HbA(1c)) were also obtained. RESULTS: Approximately 8 % of the type 2 diabetes patients reported binge eating. The prevalence among Mapuche patients was 4.9 %, and among non-Mapuche patients, it was 9.9 %. Compared to non-binge eaters, binge eating diabetes patients had greater body mass index values, consumed more high-fat foods, were less likely to adhere to their eating plan, and reported poorer body image and emotional well-being. CONCLUSION: Results of this study extend previous research by examining the co-occurrence of binge eating and type 2 diabetes as well as the associated dietary behaviors, glycemic control, and psychological factors among indigenous and non-indigenous patients in Chile. These findings may increase our understanding of the health challenges faced by indigenous populations from other countries and highlight the need for additional research that may inform interventions addressing binge eating in diverse patients with type 2 diabetes.
Assuntos
Glicemia/análise , Bulimia , Diabetes Mellitus Tipo 2 , Dieta para Diabéticos/psicologia , Obesidade , Adulto , Idoso , Imagem Corporal , Índice de Massa Corporal , Peso Corporal , Bulimia/epidemiologia , Bulimia/fisiopatologia , Chile/epidemiologia , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/dietoterapia , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Obesidade/psicologia , Cooperação do Paciente/psicologia , Cooperação do Paciente/estatística & dados numéricos , Prevalência , AutoeficáciaRESUMO
OBJECTIVES: We systematically reviewed clinical trials on the safety and efficacy of cefepime in pediatric patients in view of recent reports, which suggested that cefepime is associated with increased 30-day all-cause mortality rates. STUDY DESIGN: We searched the Cochrane Central Registry of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and other published and unpublished sources. Randomized clinical trials of cefepime in patients<19 years of age were selected. RESULTS: Sixteen clinical trials were included. All-cause mortality rates did not differ between cefepime and comparator groups (risk difference, 0.00; 95% CI, -0.01-0.02). The risks of overall clinical failure (relative risk, 0.93; 95% CI, 0.82-1.04; P>.05) and failure in microbiologically confirmed infections (relative risk, 0.91; 95% CI, 0.68-1.22; P>.05) were not greater in subjects treated with cefepime. Rates of adverse events were similar in each group in all trials except 1. All studies had significant methodological flaws. CONCLUSIONS: Comparisons of the safety and efficacy of cefepime relative with other antimicrobial agents in pediatric patients are limited by small numbers of trials and enrolled subjects and poor study methodology. This review, however, suggests that cefepime therapy in pediatric patients is not associated with an increased risk of adverse outcomes.
Assuntos
Antibacterianos/efeitos adversos , Cefalosporinas/efeitos adversos , Cefepima , Criança , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do TratamentoRESUMO
To confirm and refine associations of human leukocyte antigen (HLA) genotypes with variable antibody (Ab) responses to hepatitis B vaccination, we have analyzed 255 HIV-1 seropositive (HIV(+)) youth and 80 HIV-1 seronegatives (HIV(-)) enrolled into prospective studies. In univariate analyses that focused on HLA-DRB1, -DQA1, and -DQB1 alleles and haplotypes, the DRB1*03 allele group and DRB1*0701 were negatively associated with the responder phenotype (serum Ab concentration > or = 10 mIU/mL) (P = 0.026 and 0.043, respectively). Collectively, DRB1*03 and DRB1*0701 were found in 42 (53.8%) out of 78 non-responders (serum Ab <10 mIU/mL), 65 (40.6%) out of 160 medium responders (serum Ab 10-1,000 mIU/mL), and 27 (27.8%) out of 97 high responders (serum Ab >1,000 mIU/mL) (P < 0.001 for trend). Meanwhile, DRB1*08 was positively associated with the responder phenotype (P = 0.010), mostly due to DRB1*0804 (P = 0.008). These immunogenetic relationships were all independent of non-genetic factors, including HIV-1 infection status and immunodeficiency. Alternative analyses confined to HIV(+) youth or Hispanic youth led to similar findings. In contrast, analyses of more than 80 non-coding, single nucleotide polymorphisms within and beyond the three HLA class II genes revealed no clear associations. Overall, several HLA-DRB1 alleles were major predictors of differential Ab responses to hepatitis B vaccination in youth, suggesting that T-helper cell-dependent pathways mediated through HLA class II antigen presentation are critical to effective immune response to recombinant vaccines.