47 research outputs found
The impact of diabetes on multiple avoidable admissions: a cross-sectional study
Background
Multiple admissions for ambulatory care sensitive conditions (ACSC) are responsible for an important proportion of health care expenditures. Diabetes is one of the conditions consensually classified as an ACSC being considered a major public health concern. The aim of this study was to analyse the impact of diabetes on the occurrence of multiple admissions for ACSC.
Methods
We analysed inpatient data of all public Portuguese NHS hospitals from 2013 to 2015 on multiple admissions for ACSC among adults aged 18 or older. Multiple ACSC users were identified if they had two or more admissions for any ACSC during the period of analysis. Two logistic regression models were computed. A baseline model where a logistic regression was performed to assess the association between multiple admissions and the presence of diabetes, adjusting for age and sex. A full model to test if diabetes had no constant association with multiple admissions by any ACSC across age groups.
Results
Among 301,334 ACSC admissions, 144,209 (47.9%) were classified as multiple admissions and from those, 59,436 had diabetes diagnosis, which corresponded to 23,692 patients. Patients with diabetes were 1.49 times (p < 0,001) more likely to be admitted multiple times for any ACSC than patients without diabetes. Younger adults with diabetes (18–39 years old) were more likely to become multiple users.
Conclusion
Diabetes increases the risk of multiple admissions for ACSC, especially in younger adults. Diabetes presence is associated with a higher resource utilization, which highlights the need for the implementation of adequate management of chronic diseases policies.NOVASaudeinfo:eu-repo/semantics/publishedVersio
Age-related change in brain metabolite abnormalities in autism: a meta-analysis of proton magnetic resonance spectroscopy studies
Abnormal trajectory of brain development has been suggested by previous structural magnetic resonance imaging and head circumference findings in autism spectrum disorders (ASDs); however, the neurochemical backgrounds remain unclear. To elucidate neurochemical processes underlying aberrant brain growth in ASD, we conducted a comprehensive literature search and a meta-analysis of 1H-magnetic resonance spectroscopy (1H-MRS) studies in ASD. From the 22 articles identified as satisfying the criteria, means and s.d. of measure of N-acetylaspartate (NAA), creatine, choline-containing compounds, myo-Inositol and glutamate+glutamine in frontal, temporal, parietal, amygdala-hippocampus complex, thalamus and cerebellum were extracted. Random effect model analyses showed significantly lower NAA levels in all the examined brain regions but cerebellum in ASD children compared with typically developed children (n=1295 at the maximum in frontal, P<0.05 Bonferroni-corrected), although there was no significant difference in metabolite levels in adulthood. Meta-regression analysis further revealed that the effect size of lower frontal NAA levels linearly declined with older mean age in ASD (n=844, P<0.05 Bonferroni-corrected). The significance of all frontal NAA findings was preserved after considering between-study heterogeneities (P<0.05 Bonferroni-corrected). This first meta-analysis of 1H-MRS studies in ASD demonstrated robust developmental changes in the degree of abnormality in NAA levels, especially in frontal lobes of ASD. Previously reported larger-than-normal brain size in ASD children and the coincident lower-than-normal NAA levels suggest that early transient brain expansion in ASD is mainly caused by an increase in non-neuron tissues, such as glial cell proliferation
Understanding the acceptability of e-mental health - attitudes and expectations towards computerised self-help treatments for mental health problems
Peer support to decrease diabetes-related distress in patients with type 2 diabetes mellitus: design of a randomised controlled trial
The effect of gender on the neuroanatomy of children with autism spectrum disorders: a support vector machine case-control study
Cortisol, cognition and the ageing prefrontal cortex
The structural and functional decline of the ageing human brain varies by brain
region, cognitive function and individual. The underlying biological mechanisms are
poorly understood. One potentially important mechanism is exposure to
glucocorticoids (GCs; cortisol in humans); GC production is increasingly varied with
age in humans, and chronic exposure to high levels is hypothesised to result in
cognitive decline via cerebral remodelling. However, studies of GC exposure in
humans are scarce and methodological differences confound cross-study comparison.
Furthermore, there has been little focus on the effects of GCs on the frontal lobes and
key white matter tracts in the ageing brain. This thesis therefore examines
relationships among cortisol levels, structural brain measures and cognitive
performance in 90 healthy, elderly community-dwelling males from the Lothian
Birth Cohort 1936. Salivary cortisol samples characterised diurnal (morning and
evening) and reactive profiles (before and after a cognitive test battery). Structural
variables comprised Diffusion Tensor Imaging measures of major brain tracts and a
novel manual parcellation method for the frontal lobes. The latter was based on a
systematic review of current manual methods in the context of putative function and
cytoarchitecture. Manual frontal lobe brain parcellation conferred greater spatial and
volumetric accuracy when compared to both single- and multi-atlas parcellation at
the lobar level. Cognitive ability was assessed via tests of general cognitive ability,
and neuropsychological tests thought to show differential sensitivity to the integrity
of frontal lobe sub-regions. The majority of, but not all frontal lobe test scores shared
considerable overlap with general cognitive ability, and cognitive scores correlated
most consistently with the volumes of the anterior cingulate. This is discussed in
light of the diverse connective profile of the cingulate and a need to integrate
information over more diffuse cognitive networks according to proposed de-differentiation
or compensation in ageing. Individuals with higher morning, evening
or pre-test cortisol levels showed consistently negative relationships with specific
regional volumes and tract integrity. Participants whose cortisol levels increased
between the start and end of cognitive testing showed selectively larger regional
volumes and lower tract diffusivity (correlation magnitudes <.44). The significant
relationships between cortisol levels and cognition indicated that flatter diurnal
slopes or higher pre-test levels related to poorer test performance. In contrast, higher
levels in the morning generally correlated with better scores (correlation magnitudes
<.25). Interpretation of all findings was moderated by sensitivity to type I error,
given the large number of comparisons conducted. Though there were limited
candidates for mediation analysis, cortisol-function relationships were partially
mediated by tract integrity (but not sub-regional frontal volumes) for memory and
post-error slowing. This thesis offers a novel perspective on the complex interplay
among glucocorticoids, cognition and the structure of the ageing brain. The findings
suggest some role for cortisol exposure in determining age-related decline in
complex cognition, mediated via brain structure