Prevalences of overweight, obesity, hyperglycaemia, hypertension and dyslipidaemia in the Gulf: systematic review.

OBJECTIVES: To examine the prevalence of risk factors for diabetes and its complications in the Co-operation Council of the Arab States of the Gulf (GCC) region. DESIGN: Systematic review. SETTING: Co-operation Council of the Arab States of the Gulf (GCC) states (United Arab Emirates, Bahrain, Saudi Arabia, Oman, Qatar, Kuwait). PARTICIPANTS: Residents of the GCC states participating in studies on the prevalence of overweight and obesity, hyperglycaemia, hypertension and dyslipidaemia. MAIN OUTCOME MEASURES: Prevalences of overweight, obesity and hyperglycaemia, hypertension and hyperlipidaemia. RESULTS: Forty-five studies were included in the review. Reported prevalences of overweight and obesity in adults were 25-50% and 13-50%, respectively. Prevalence appeared higher in women and to hold a non-linear association with age. Current prevalence of impaired glucose tolerance was estimated to be 10-20%. Prevalence appears to have been increasing in recent years. Estimated prevalences of hypertension and dyslipidaemia were few and used varied definitions of abnormality, making review difficult, but these also appeared to be high and increasing, CONCLUSIONS: There are high prevalences of risk factors for diabetes and diabetic complications in the GCC region, indicative that their current management is suboptimal. Enhanced management will be critical if escalation of diabetes-related problems is to be averted as industrialization, urbanization and changing population demographics continue

Survey of patient and public perceptions of electronic health records for healthcare, policy and research: Study protocol

BACKGROUND: Immediate access to patients’ complete health records via electronic databases could improve healthcare and facilitate health research. However, the possible benefits of a national electronic health records (EHR) system must be balanced against public concerns about data security and personal privacy. Successful development of EHR requires better understanding of the views of the public and those most affected by EHR: users of the National Health Service. This study aims to explore the correlation between personal healthcare experience (including number of healthcare contacts and number and type of longer term conditions) and views relating to development of EHR for healthcare, health services planning and policy and health research. METHODS/DESIGN: A multi-site cross-sectional self-complete questionnaire designed and piloted for use in waiting rooms was administered to patients from randomly selected outpatients’ clinics at a university teaching hospital (431 beds) and general practice surgeries from the four primary care trusts within the catchment area of the hospital. All patients entering the selected outpatients clinics and general practice surgeries were invited to take part in the survey during August-September 2011. Statistical analyses will be conducted using descriptive techniques to present respondents’ overall views about electronic health records and logistic regression to explore associations between these views and participants’ personal circumstances, experiences, sociodemographics and more specific views about electronic health records. DISCUSSION: The study design and implementation were successful, resulting in unusually high response rates and overall recruitment (85.5%, 5336 responses). Rates for face-to-face recruitment in previous work are variable, but typically lower (mean 76.7%, SD 20). We discuss details of how we collected the data to provide insight into how we obtained this unusually high response rate

Quality of Type 2 Diabetes Management in the States of The Co-Operation Council for the Arab States of the Gulf: A Systematic Review

Type 2 diabetes mellitus is a growing, worldwide public health concern. Recent growth has been particularly dramatic in the states of The Co-operation Council for the Arab States of the Gulf (GCC), and these and other developing economies are at particular risk. We aimed to systematically review the quality of control of type 2 diabetes in the GCC, and the nature and efficacy of interventions. We identified 27 published studies for review. Studies were identified by systematic database searches. Medline and Embase were searched separately (via Dialog and Ovid, respectively; 1950 to July 2010 (Medline), and 1947 to July 2010 (Embase)) on 15/07/2009. The search was updated on 08/07/2010. Terms such as diabetes mellitus, non-insulin-dependent, hyperglycemia, hypertension, hyperlipidemia and Gulf States were used. Our search also included scanning reference lists, contacting experts and hand-searching key journals. Studies were judged against pre-determined inclusion/exclusion criteria, and where suitable for inclusion, data extraction/quality assessment was achieved using a specifically-designed tool. All studies wherein glycaemic-, blood pressure- and/or lipid- control were investigated (clinical and/or process outcomes) were eligible for inclusion. No limitations on publication type, publication status, study design or language of publication were imposed. We found the extent of control to be sub-optimal and relatively poor. Assessment of the efficacy of interventions was difficult due to lack of data, but suggestive that more widespread and controlled trial of secondary prevention strategies may have beneficial outcomes. We found no record of audited implementation of primary preventative strategies and anticipate that controlled trial of such strategies would also be useful

Liraglutide withdrawal rates : ‘real world’ practice

Important side effects and potential clinical hazards have emerged from long-term follow up in some drug classes used in type 2 diabetes treatment. Systematic phase 4 post-marketing data in early use of newer diabetes drugs may have a role in informing drug choice in practice and assist in pharmacoeconomic assessments of these drug choices. We carried out a comparison of the prevalence of drug withdrawals derived from both liraglutide registration trial data, and a systematic, prospective case-note review of all new liraglutide prescriptions (n=176) from a specialist diabetes clinic over the first 12 months of drug introduction. Trial data used for the marketing authorisation application for liraglutide reported 7.0% withdrawal due to adverse events. Equal numbers of patients experienced mild, moderate and severe side effects. By contrast, data derived from a 'real world' clinical group describe 14.8% withdrawal due to adverse events, with withdrawal typically occurring early, by three months. Adverse events were more frequently responsible for treatment withdrawal at lower, compared to higher, doses of liraglutide therapy. Systematic observations of withdrawals in early use of new drugs in current clinical practice are higher than reported in registration trial data. These data highlight that postmarketing surveillance should inform guideline recommendations and pharmacoeconomic evaluations. Copyright © 2012 John Wiley & Sons

Coupling of Propylene Oxide and Lactide at a Porphyrin Chromium(III) Center

5,10,15,20-Tetraphenylporphyrin chromium chloride (TPPCrCl) with added [Ph₃PNPPh₃]⁺Cl^– (PPN⁺Cl^–) selectively polymerizes lactide (l and <i>rac</i>) dissolved in neat propylene oxide (PO) to yield polylactide (PLA) terminated by the −OCHMeCH₂Cl group. At 0 °C and below, <i>rac</i>-LA yields polymers highly enriched in isotactic tetrads (<i>iii</i>). At 25 °C, some stereoselectivity is lost as transesterification becomes significant, and at 60 °C and above, enchainment of PO leads to the formation of 3,6-dimethyl-1,4-dioxan-2-one by a backbiting mechanism. At 0 °C, after the enchainment of l-(<i>S</i>,<i>S</i>)-LA in neat (<i>R</i>)-(+)-PO, the formation of (3<i>S</i>,6<i>R</i>)-3,6-dimethyl-1,4-dioxan-2-one occurs, while at higher temperatures the ratio of (3<i>S</i>,6<i>R</i>)-3,6-dimethyl-1,4-dioxan-2-one to (3<i>R</i>,6<i>R</i>)-3,6-dimethyl-1,4-dioxan-2-one falls to 3:2

Coupling of Propylene Oxide and Lactide at a Porphyrin Chromium(III) Center

5,10,15,20-Tetraphenylporphyrin chromium chloride (TPPCrCl) with added [Ph₃PNPPh₃]⁺Cl^– (PPN⁺Cl^–) selectively polymerizes lactide (l and <i>rac</i>) dissolved in neat propylene oxide (PO) to yield polylactide (PLA) terminated by the −OCHMeCH₂Cl group. At 0 °C and below, <i>rac</i>-LA yields polymers highly enriched in isotactic tetrads (<i>iii</i>). At 25 °C, some stereoselectivity is lost as transesterification becomes significant, and at 60 °C and above, enchainment of PO leads to the formation of 3,6-dimethyl-1,4-dioxan-2-one by a backbiting mechanism. At 0 °C, after the enchainment of l-(<i>S</i>,<i>S</i>)-LA in neat (<i>R</i>)-(+)-PO, the formation of (3<i>S</i>,6<i>R</i>)-3,6-dimethyl-1,4-dioxan-2-one occurs, while at higher temperatures the ratio of (3<i>S</i>,6<i>R</i>)-3,6-dimethyl-1,4-dioxan-2-one to (3<i>R</i>,6<i>R</i>)-3,6-dimethyl-1,4-dioxan-2-one falls to 3:2