How to perform better intervention to prevent and control diabetic retinopathy among patients with type 2 diabetes

This meta-analysis of randomized controlled trials (RCTs) aims to investigate how to perform better interventions targeting modifiable risk factors of diabetic retinopathy (DR) to prevent and control DR in patients with type 2 diabetes by comparing different intervention types and follow-up intervals. Literature published before June 1st, 2019 were searched on Pubmed, Embase and ScienceDirect. RCTs targeting modifiable risk factors of DR (including blood glucose, blood pressure, lipid, dietary, physical activity and smoking) were selected by two reviewers and double checked for accuracy. Random effects models were estimated to calculate pooled Odds Ratios (OR). Twenty-two RCTs (n = 22,511) were included. In general, interventions targeting modifiable risk factor of DR reduced the risk of developing DR (I 2 = 26.7%; OR = 0.60; 95% CI 0.45 to 0.79) and DR worsening (I 2 = 0.0%; OR = 0.62; 95% CI 0.47 to 0.80; P < 0.001). Multifactorial interventions had better effect on reducing the risk of development and progression of DR in comparison with other interventions, while only blood-pressure-control interventions showed significant effect on slowing down DR worsening. Additionally, interventions with follow-up >5 years had better effect on reduction of DR development, and interventions with follow-up >2 years had better effect on reducing the risk of DR worsenin

Processes and coastal dynamics in the Ensenada de Marbella: recent morphosedimentary evolution

La Ensenada de Marbella ha experimentado en las últimas décadas cambios físicos y socio-económicos sustanciales debidos fundamentalmente a una transformación en el modelo económico y un desarrollo acusado del turismo residencial y todos los impactos en los usos del suelo relacionado con ello. Sin embargo, las causas de la alteración de la dinámica litoral también hay que buscarlas en cambios en la morfología del nearshore y en la dinámica sedimentaria. Para analizar la morfodinámica de la ensenada en varios escenarios temporales, simulaciones de oleaje sobre batimetrías del 1888 y actuales revelan cambios importantes en los patrones dispersión de la energía y el funcionamiento de la bahía a través de complejas células litorales de transporte. El análisis de los procesos dinámicos en la zona del nearshore y el estudio volumétrico a través de modelos de batimetrías secuenciales muestran como dichos cambios morfológicos de los fondos costeros pueden o no estar relacionados con cambios a largo plazo en la línea de costa, y por tanto ser co-responsables de los procesos de erosión y acreción acelerados evidentes a lo largo de la Ensenada

The effect of a community-based group intervention on chronic disease self-management in a vulnerable population

Introduction:Chronic non-communicable diseases (NCDs) are predominantly related to modifiable health behaviors and account for 74% of global deaths at present. Behavior modification through self-management is a strategy to prevent NCDs. Chronic Disease Self-Management Programs (CDSMPs) have demonstrated improvements in health behaviors, health status, and use of healthcare. Objective:We evaluated the effects of a 6-week CDSMP on self-efficacy, health behaviors, mental health, health-related quality of life (HR-QoL), and health responsibilities among vulnerable populations with chronic disease in Europe. Methods: A prospective cohort study with a 6-month pre-post single-group design was conducted in five European countries. The intervention targeted adults with chronic conditions and low socioeconomic status, as well as their caregivers. The intervention was a 6-week community-based CDSMP in a group setting. Outcomes were measured per self-report questionnaire at baseline and 6-month follow-up: self-efficacy, health behaviors, mental health, HR-QoL, and health responsibilities. Results: Of 1,844 participants, 1,248 (67.7%) completed follow-up and attended ≥4 sessions. For the chronic condition group, the following outcome measures at follow-up significantly improved compared with baseline (all P &lt; 0.002): self-efficacy (SEMCD-6 6.7 vs. 6.4), mental health (PHQ-8 6.3 vs. 7.0), HR-QoL (SF-12 PCS 42.3 vs. 40.2, SF-12 MCS 42.8 vs. 41.4), health utility (EQ-5D-5L 0.88 vs. 0.86), self-rated health (EQ-5D-5L 67.2 vs. 63.9), communication with healthcare providers (2.28 vs. 2.11), understanding information (3.10 vs. 3.02), number of doctor visits (3.61 vs. 4.97), accident and emergency department visits (0.25 vs. 0.48), total nights in a hospital (0.65 vs. 1.13), and perceived medical errors (19.6 vs. 28.7%). No significant changes were detected in dietary habits, physical activity, substance use, and sleep and fatigue. For caregivers without a chronic condition, only doctor visits significantly decreased (1.54 vs. 2.25, P &lt; 0.001). Discussion: This CDSMP was associated with improvement in self-efficacy, depression, HR-QoL, and health responsibilities over 6 months in a diverse European population with a chronic condition. However, additional interventions targeting lifestyle risk factors are needed to improve health outcomes.</p

A coordinated preventive care approach for healthy ageing in five European cities: a mixed-methods study of process evaluation components

Aims: To evaluate specific process components of the Urban Health Centres Europe (UHCE) approach; a coordinated preventive care approach aimed at healthy ageing by decreasing falls, polypharmacy, loneliness and frailty among older persons in community settings of five cities in the United Kingdom, Greece, Croatia, the Netherlands and Spain. Design: Mixed methods evaluation of specific process components of the UHCE approach: reach of the target population, dose of the intervention actually delivered and received by participants and satisfaction and experience of main stakeholders involved in the approach. Methods: The UHCE approach intervention consisted of a preventive assessment, shared decision-making on a care plan and enrolment in one or more of four coordinated care-pathways that targeted falls, polypharmacy, loneliness and frailty. Quantitative data from a questionnaire and quantitative/qualitative data from logbooks were collected among older persons involved in the approach. Qualitative data from focus groups were collected among older persons, informal caregivers and professionals involved in the approach. Quantitative data were analysed by means of descriptive statistics and multilevel logistic regression models. Qualitative data were analysed through thematic analysis. Results: Having limited function was associated with non-enrolment in falls and loneliness care-pathways (both p < .01). The mean rating of the approach was 8.3/10 (SD 1.9). Feeling supported by a care professional and meeting people were main benefits for older persons. Mistrust towards unfamiliar care providers, lack of confidence to engage in care activities and health constraints were main barriers towards engagement in care. Conclusions: Although the UHCE approach was received generally positively, health constraints and psychosocial barriers prevented older person's engagement in care. Impact: Coordinated preventive care approaches for older community-dwelling persons should address health constraints and psychosocial barriers that hinder older person's engagement in care

Longitudinal Association Between Physical Activity and Frailty Among Community-Dwelling Older Adults

OBJECTIVES: To examine the longitudinal association between frequency of moderate physical activity (PA) and overall, physical, psychological, and social frailty among community-dwelling older adults older than 70 years. Second, we assessed the association between a 12-month change in frequency of moderate PA and frailty. DESIGN: Longitudinal cohort study. SETTING: Community settings in Spain, Greece, Croatia, the Netherlands, and the United Kingdom. PARTICIPANTS: A total of 1735 participants (61.1% female; mean age = 79.6 years; SD = 5.5 years). MEASUREMENTS: The frequency of self-reported moderate PA was measured and classified into two categories: “regular frequency” and “low frequency.” The 12-month change in frequency of moderate PA between baseline and follow-up was classified into four categories: “continued regular frequency,” “decreased frequency,” “continued low frequency,” and “increased frequency.” The 15-item Tilburg Frailty Indicato

Evaluation design of the Social Engagement Framework for Addressing the Chronic-disease-challenge (SEFAC)

Background: The Social Engagement Framework for Addressing the Chronic-disease-challenge (SEFAC) project intends to empower citizens at risk of or with type 2 diabetes (T2DM) and/or cardiovascular disease (CVD) to selfmanage their chronic conditions through the SEFAC intervention. The intervention combines the concepts of mindfulness, social engagement and information and communication technology support, in order to reduce the burden of citizens with chronic conditions and to increase the sustainability of the health system in four European countries. Methods: A prospective cohort study with a 6-month pre-post design will be conducted in four European countries: Croatia, Italy, the Netherlands and the United Kingdom. A total of 360 community-dwelling citizens ≥50 years of age will be recruited; 200 citizens at risk of T2DM and/or CVD in the next 10 years (50 participants in each country) and 160 citizens with T2DM and/or CVD (40 participants in each country). Effects of the intervention in terms of selfmanagement, healthy lifestyle behavior, social support, stress, depression, sleep and fatigue, adherence to medications and health-related quality of life will be assessed. In addition, a preliminary cost-effectiveness analysis will be performed from a societal and healthcare perspective. Discussion: The SEFAC project will further elucidate whether the SEFAC intervention is feasible and (cost-) effective among citizens at risk of and suffering from T2DM and/or CVD in different settings. Trial registration: ISRCTN registry number is ISRCTN11248135

Healthy Ageing: Health Promotion for People with Frailty and Chronic Conditions

In dit proefschrift hebben we gezondheidsbevordering bij mensen met kwetsbare en chronische aandoeningen bestudeerd om inzicht te krijgen in en richting te geven aan het ontwikkelen van gezondheidsbevordering ter ondersteuning van gezond ouder worden van ouderen. Toekomstig onderzoek naar de ontwikkeling en effecten van interventies bevelen we aan om mensen op jongere leeftijd te includeren om kwetsbaarheid op latere leeftijd te voorkomen en om gezond ouder worden te bevorderen. Doorlopende ondersteuning kan belangrijk zijn voor de preventie en een beter beheer van kwetsbare en chronische aandoeningen. We raden aan om strategieën te ontwikkelen om de duurzaamheid van nieuw ontwikkelde (effectieve) benaderingen mogelijk te maken

Admissible Consensus for Descriptor Multi-Agent Systems with Exogenous Disturbances

In this paper, we study the admissible consensus for descriptor multi-agent systems (MASs) with exogenous disturbances that are generated by some linear systems. The topology among agents is represented by a directed graph. For solving the admissible consensus problem, the exogenous disturbance observer and distributed control protocol are proposed. With the help of the graph theory and the generalized Riccati equation, some conditions for admissible consensus of descriptor MASs with exogenous disturbances are obtained. Finally, we provide a numerical simulation to effectively illustrate the results we have reached before

Chattering-Free Adaptive Sliding Mode Control for Attitude Tracking of Spacecraft with External Disturbance

The attitude tracking problem of spacecraft in the presence of unknown disturbance is investigated. By using the adaptive control technique and the Lyapunov stability theory, a chattering-free adaptive sliding mode control law is proposed for the attitude tracking problem of spacecraft with unknown disturbance. Simulation results are employed to demonstrate the effectiveness of the proposed control design technique in this paper