Screening for type 2 diabetes is feasible, acceptable, but associated with increased short-term anxiety: A randomised controlled trial in British general practice

<p>Abstract</p> <p>Background</p> <p>To assess the feasibility and uptake of a diabetes screening programme; to examine the effects of invitation to diabetes screening on anxiety, self-rated health and illness perceptions.</p> <p>Methods</p> <p>Randomised controlled trial in two general practices in Cambridgeshire. Individuals aged 40–69 without known diabetes were identified as being at high risk of having undiagnosed type 2 diabetes using patient records and a validated risk score (n = 1,280). 355 individuals were randomised in a 2 to 1 ratio into non-invited (n = 238) and invited (n = 116) groups. A stepwise screening programme confirmed the presence or absence of diabetes. Six weeks after the last contact (either test or invitation), a questionnaire was sent to all participants, including non-attenders and those who were not originally invited. Outcome measures included attendance, anxiety (short-form Spielberger State Anxiety Inventory-STAI), self-rated health and diabetes illness perceptions.</p> <p>Results</p> <p>95 people (82% of those invited) attended for the initial capillary blood test. Six individuals were diagnosed with diabetes. Invited participants were more anxious than those not invited (37.6 vs. 34.1 STAI, p-value = 0.015), and those diagnosed with diabetes were considerably more anxious than those classified free of diabetes (46.7 vs. 37.0 STAI, p-value = 0.031). Non-attenders had a higher mean treatment control sub-scale (3.87 vs. 3.56, p-value = 0.016) and a lower mean emotional representation sub-scale (1.81 vs. 2.68, p-value = 0.001) than attenders. No differences in the other five illness perception sub-scales or self-rated health were found.</p> <p>Conclusion</p> <p>Screening for type 2 diabetes in primary care is feasible but may be associated with higher levels of short-term anxiety among invited compared with non-invited participants.</p> <p>Trial registration</p> <p>ISRCTN99175498</p

Cutaneous Methotrexate-Related Epstein&ndash;Barr Virus-Positive Diffuse Large B-Cell Lymphoma in a Patient with Granulomatous Cutaneous T-Cell Lymphoma: A Case Report and Literature Review

Chaninan Kositkuljorn,1 Suthinee Rutnin,1 Teerapong Rattananukrom,1 Teeraya Puavilai,2 Burana Khiankaew,3 Paisarn Boonsakan,3 Wimolsiri Iamsumang1 1Division of Dermatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 2Division of Hematology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 3Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, ThailandCorrespondence: Wimolsiri Iamsumang, Division of Dermatology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Rajthevi, Bangkok, 10400, Thailand, Tel +662-201-1141, Fax +662-201-1211, Email [email protected]: Methotrexate-related lymphoproliferative disorders (MTX-LPDs) are immunodeficiency diseases following methotrexate (MTX) administration, mainly occurring in rheumatoid arthritis patients. Although uncommon, MTX-LPDs have been reported in some patients with psoriasis, dermatomyositis, and cutaneous T-cell lymphoma (CTCL) who received MTX. Granulomatous mycosis fungoides (GMF) is a rare subtype of cutaneous T-cell lymphoma, where MTX is one of the treatment options in recalcitrant cases. Herein, we report a case of a 72-year-old female patient with GMF who additionally developed cutaneous Epstein–Barr virus (EBV)-positive diffuse large B-cell lymphoma (DLBCL) during MTX treatment. According to the 5th edition of the WHO classification of Haematolymphoid Tumors (WHO-HAEM), this condition is currently categorized as “lymphoma arising in immunodeficiency/dysregulation”. In this article, we also reviewed published literature on cutaneous MTX-LPDs in the setting of CTCL. This entity should be considered in cases of new, atypical skin nodules and/or plaques in CTCL patients receiving long-term MTX treatment.Keywords: cutaneous T-cell lymphoma, granulomatous mycosis fungoides, methotrexate, methotrexate-related lymphoproliferative disorder

Improved adherence in older patients with hypertension: An observational study of a community-based intervention

© 2019 John Wiley & Sons Ltd Aims and objectives: This study sought to assess the effect of a community-based intervention influencing adherence status at baseline, 1, 3 and 6 months, and to evaluate the impact that a community-based intervention and socio-economic factors have on adherence. Background: Although high-quality treatment and modern hypertension clinical practice guidelines have been developed worldwide, the outcomes of patients with hypertension in Thailand are not optimal. Implementing a person-centred and integrated health services model to improve hypertension management, such as a community-based intervention, is challenging for healthcare providers in Thailand. Design: An observational study of a community-based intervention. Methods: The study comprised residents in 17 villages in one province of Thailand. A sample of 156 participants was allocated into the intervention and the control groups. Inclusion criteria were people aged 60 years or older diagnosed with hypertension. Exclusion criteria included the latest record of extreme hypertension and having a documented history of cognitive impairment. The intervention group received the 4-week community-based intervention programme. Multiple linear regression was applied to predict the adherence status at each phase. Multiple logistic regression was then implemented to predict influencing factors between the groups. Results: Patients who received the intervention had significantly lower adherence scores (reflecting a higher level of adherence) at 3 and 6 months after intervention by 1.66 and 1.45 times, respectively, when adjusting for other variables. After 6 months, the intervention was associated with a significant improvement in adherence when adjusting for other variables. Conclusion: This study provides evidence to support the use of community-based interventions as an effective adjunct to hospital-based care of hypertension patients in Thailand. Implications for practice: Understanding factors between health outcomes and social determinants of health is crucial for informing the development of culturally appropriate interventions

CLINICAL CHARACTERISTICS AND OUTCOMES OF MYELODYSPLASTIC NEOPLASMS AND ACUTE MYELOID LEUKEMIA WITH MECOM REARRANGEMENT: RESULTS FROM A NATIONWIDE MULTICENTER STUDY.

Introduction: “AML with MECOM rearrangement” was recently categorized by WHO classification 2022 regardless of blast count, which included those present with MDS and AML into this group. We aim to explore frequency, clinical characteristics, and outcomes in this subtype among Thai myeloid neoplasms. Methods: MDS and AML data was collected from a multicenter study group. MDS and AML with MECOM rearrangements were analyzed and compared with other subtypes. Results: A total of 15 cases with MECOM rearrangement were detected, 5/166 (3%) were MDS while 10/1082 (0.9%) were AML. Eleven of 15 cases (73%) were female. MDS and AML with MECOM rearrangement showed lower hemoglobin, but higher platelet counts compared to others. Three MDS with MECOM rearrangement patients received azacitidine-based regimens and achieved complete hematologic response. In AML cases receiving intensive chemotherapy, MECOM rearrangement subgroup showed lower complete response (CR) rate compared to others (0% vs. 39.6%). Of note, among 10 AML with MECOM rearrangement, 7 patients received intensive chemotherapy but none of them responded. When combining 5 MDS and 10 AML with MECOM rearrangements, survival rate is comparable to the adverse group of AML and the very high risk group MDS with a 1-year survival rate of 27.5% (Figure 1A and 1B). Conclusions: In conclusion, MDS and AML with MECOM rearrangements are rare subtype, more common in female gender and associated with poor prognosis. Chemotherapy should be avoided, hypomethylating agent showed benefit. Novel therapy targeting MECOM gene should be further explored