Continued improvement of cardiovascular mortality in Hungary - impact of increased cardio-metabolic prescriptions

<p>Abstract</p> <p>Background</p> <p>During the last 35 years the poor ranking of Hungary on the list of life expectancy at birth among European countries, has not changed. In 1970 our lag behind the leading European countries was the smallest. The gap was growing between 1970 and 1993 but from 1994 onwards the life expectancy at birth in Hungary has increased continuously and somewhat faster than in other European countries. The aim of this study was to analyze the association between decreasing cardiovascular mortality rates, as a main cause of death and the increase in cardio-metabolic prescriptions and possible changes in lifestyle behavior.</p> <p>Methods</p> <p>Analyses were conducted on national data concerning cardiovascular mortality and the number of cardio-metabolic drug prescription per capita. The association between yearly rates of cardiovascular events and changes in antihypertensive, antilipidemic and antidiabetic prescription rates was analyzed. The changes in other cardiovascular risk factors, like lifestyle were also considered.</p> <p>Results</p> <p>We observed a remarkable decline of mortality due to stroke and acute myocardial infarction (AMI). The fall was significantly associated with all prescription rates. The proportion of each treatment type responsible for suppression of specific mortality rates is different. All treatment types comparably improved stroke mortality, while antilipidemic therapy improved AMI outcome.</p> <p>Conclusions</p> <p>These results emphasize the importance of a comprehensive strategy that maximizes the population coverage of effective treatments. Hungary appears to be at the beginning of the fourth stage of epidemiologic transition, i.e. it has entered the stage of delayed chronic noninfectious diseases.</p

Dental Health and Mortality in People With End-Stage Kidney Disease Treated With Hemodialysis: A Multinational Cohort Study

Background Dental disease is more extensive in adults with chronic kidney disease, but whether dental health and behaviors are associated with survival in the setting of hemodialysis is unknown. Study Design Prospective multinational cohort. Setting & Participants 4,205 adults treated with long-term hemodialysis, 2010 to 2012 (Oral Diseases in Hemodialysis [ORAL-D] Study). Predictors Dental health as assessed by a standardized dental examination using World Health Organization guidelines and personal oral care, including edentulousness; decayed, missing, and filled teeth index; teeth brushing and flossing; and dental health consultation. Outcomes All-cause and cardiovascular mortality at 12 months after dental assessment. Measurements Multivariable-adjusted Cox proportional hazards regression models fitted with shared frailty to account for clustering of mortality risk within countries. Results During a mean follow-up of 22.1 months, 942 deaths occurred, including 477 cardiovascular deaths. Edentulousness (adjusted HR, 1.29; 95% CI, 1.10-1.51) and decayed, missing, or filled teeth score ≥ 14 (adjusted HR, 1.70; 95% CI, 1.33-2.17) were associated with early all-cause mortality, while dental flossing, using mouthwash, brushing teeth daily, spending at least 2 minutes on oral hygiene daily, changing a toothbrush at least every 3 months, and visiting a dentist within the past 6 months (adjusted HRs of 0.52 [95% CI, 0.32-0.85], 0.79 [95% CI, 0.64-0.97], 0.76 [95% CI, 0.58-0.99], 0.84 [95% CI, 0.71-0.99], 0.79 [95% CI, 0.65-0.95], and 0.79 [95% CI, 0.65-0.96], respectively) were associated with better survival. Results for cardiovascular mortality were similar. Limitations Convenience sample of clinics. Conclusions In adults treated with hemodialysis, poorer dental health was associated with early death, whereas preventive dental health practices were associated with longer survival

3 years of liraglutide versus placebo for type 2 diabetes risk reduction and weight management in individuals with prediabetes: a randomised, double-blind trial

Background: Liraglutide 3·0 mg was shown to reduce bodyweight and improve glucose metabolism after the 56-week period of this trial, one of four trials in the SCALE programme. In the 3-year assessment of the SCALE Obesity and Prediabetes trial we aimed to evaluate the proportion of individuals with prediabetes who were diagnosed with type 2 diabetes. Methods: In this randomised, double-blind, placebo-controlled trial, adults with prediabetes and a body-mass index of at least 30 kg/m2, or at least 27 kg/m2 with comorbidities, were randomised 2:1, using a telephone or web-based system, to once-daily subcutaneous liraglutide 3·0 mg or matched placebo, as an adjunct to a reduced-calorie diet and increased physical activity. Time to diabetes onset by 160 weeks was the primary outcome, evaluated in all randomised treated individuals with at least one post-baseline assessment. The trial was conducted at 191 clinical research sites in 27 countries and is registered with ClinicalTrials.gov, number NCT01272219. Findings: The study ran between June 1, 2011, and March 2, 2015. We randomly assigned 2254 patients to receive liraglutide (n=1505) or placebo (n=749). 1128 (50%) participants completed the study up to week 160, after withdrawal of 714 (47%) participants in the liraglutide group and 412 (55%) participants in the placebo group. By week 160, 26 (2%) of 1472 individuals in the liraglutide group versus 46 (6%) of 738 in the placebo group were diagnosed with diabetes while on treatment. The mean time from randomisation to diagnosis was 99 (SD 47) weeks for the 26 individuals in the liraglutide group versus 87 (47) weeks for the 46 individuals in the placebo group. Taking the different diagnosis frequencies between the treatment groups into account, the time to onset of diabetes over 160 weeks among all randomised individuals was 2·7 times longer with liraglutide than with placebo (95% CI 1·9 to 3·9, p&lt;0·0001), corresponding with a hazard ratio of 0·21 (95% CI 0·13–0·34). Liraglutide induced greater weight loss than placebo at week 160 (–6·1 [SD 7·3] vs −1·9% [6·3]; estimated treatment difference −4·3%, 95% CI −4·9 to −3·7, p&lt;0·0001). Serious adverse events were reported by 227 (15%) of 1501 randomised treated individuals in the liraglutide group versus 96 (13%) of 747 individuals in the placebo group. Interpretation: In this trial, we provide results for 3 years of treatment, with the limitation that withdrawn individuals were not followed up after discontinuation. Liraglutide 3·0 mg might provide health benefits in terms of reduced risk of diabetes in individuals with obesity and prediabetes. Funding: Novo Nordisk, Denmark

Fluid inertia consideration in sucker rod pump diagnosis

Due to the character of the original source materials and the nature of batch digitization, quality control issues may be present in this document. Please report any quality issues you encounter to [email protected], referencing the URI of the item.Includes bibliographical references.artificial lift in the U.S.A. It has been reported numerous times in the literature to exceed 85% of non-flowing well's lift systems. The efficient maintenance and operation of these wells is essential for them to remain profitable and productive petroleum assets. Diagnostic models have been developed to determine the working condition of down hole pumps in rod pump operations. Several methods have been used with good success to interpret surface measurements in order to diagnose and monitor pump conditions. However, existing state-of-the-art diagnostic models neglect fluid-inertia forces. In shallow wells with large lifting rates, dynamic fluid forces can be significant and result in poor diagnostic model performance. This research is motivated by the need for a diagnostic model that can more accurately and reliably diagnose wells with significant dynamic fluid loads. In this research, an accurate and useful finite difference diagnostic model that considers fluid inertia forces has been developed. The model is verified with simulated results and validated with field data. Additionally, the effects of fluid inertia are investigated in order to quantify when these forces are significant and this new model is applicable. The diagnostic model developed in this research is the first to consider dynamic fluid forces. It can be applied to rod pumped systems operating in a range where dynamic forces due to the acceleration of the fluid column are significant. These wells are typically shallow, high rate wells. The tables developed during this research are useful for determining the operating conditions in which this model is most applicable. In conclusion, this fluid inertia diagnostic model is very useful for monitoring and diagnosing the condition of rod-pumped wells that are difficult to diagnose due to large dynamic fluid forces

Correlations between prescription of anti-hypertensive medication and mortality due to stroke

Abstract Background One of the most important risk factors for stroke is hypertension. A number of studies have attempted to identify the most effective anti-hypertensive therapeutic group for stroke prevention. Using an epidemiologic approach we aimed to find correlations based on Hungarian data on stroke-mortality and on prescription routine of anti-hypertensive therapeutics in three different counties, showing significant difference in stroke mortality. Methods We have used the official yearly reports on stroke-mortality for the period 2003-2008. Based on the significant differences in the change in mortality due to stroke three counties were selected: Baranya, Bekes and Hajdu-Bihar. The usage of antihypertensive therapeutic groups was analyzed. The correlation of stroke mortality difference and different antihypertensive treatment habits was analyzed by using normality test, time series analyses, correlation coefficient, paired samples test, one sample test and chi-square test. Results For the year 2003 stroke-mortality standardized with the county population number was highest in county Bekes, followed by county Baranya and county Hajdu-Bihar. For each year stroke mortality has shown significant (p Conclusions The authors acknowledge that by limiting the study to three counties the findings cannot be generalized to the whole Hungarian population. Two trends can still be identified: i) increased number of days of treatment (and therefore the probable use) of high-ceiling diuretics is associated with reduction in mortality due to stroke and its immediate complications; ii) reduction in the use of non-dihidropiridin CCBs does not seem justified, as their use appears to be advantageous in stroke prevention. Authors put emphasis on the importance of the adherence of the patients to the preventive therapies. Health care professionals could provide an important added value to the life long preventive therapies by improving the compliance of their patients, giving personalized care and advice.</p

Dental Health and Mortality in People With End-Stage Kidney Disease Treated With Hemodialysis: A Multinational Cohort Study

BackgroundDental disease is more extensive in adults with chronic kidney disease, but whether dental health and behaviors are associated with survival in the setting of hemodialysis is unknown.Study DesignProspective multinational cohort.Setting & Participants4,205 adults treated with long-term hemodialysis, 2010 to 2012 (Oral Diseases in Hemodialysis [ORAL-D] Study).PredictorsDental health as assessed by a standardized dental examination using World Health Organization guidelines and personal oral care, including edentulousness; decayed, missing, and filled teeth index; teeth brushing and flossing; and dental health consultation.OutcomesAll-cause and cardiovascular mortality at 12 months after dental assessment.MeasurementsMultivariable-adjusted Cox proportional hazards regression models fitted with shared frailty to account for clustering of mortality risk within countries.ResultsDuring a mean follow-up of 22.1 months, 942 deaths occurred, including 477 cardiovascular deaths. Edentulousness (adjusted HR, 1.29; 95% CI, 1.10-1.51) and decayed, missing, or filled teeth score ≥ 14 (adjusted HR, 1.70; 95% CI, 1.33-2.17) were associated with early all-cause mortality, while dental flossing, using mouthwash, brushing teeth daily, spending at least 2 minutes on oral hygiene daily, changing a toothbrush at least every 3 months, and visiting a dentist within the past 6 months (adjusted HRs of 0.52 [95% CI, 0.32-0.85], 0.79 [95% CI, 0.64-0.97], 0.76 [95% CI, 0.58-0.99], 0.84 [95% CI, 0.71-0.99], 0.79 [95% CI, 0.65-0.95], and 0.79 [95% CI, 0.65-0.96], respectively) were associated with better survival. Results for cardiovascular mortality were similar.LimitationsConvenience sample of clinics.ConclusionsIn adults treated with hemodialysis, poorer dental health was associated with early death, whereas preventive dental health practices were associated with longer survival