Breaking the Taboo: Illicit Drug Use among Adolescents with Type 1 Diabetes Mellitus

Background. 

The aim of the study was to explore the prevalence of illicit drug use in a group of Polish adolescents with type 1 diabetes (DM1) in comparison with a national cohort of their healthy peers. 

Methods. 

Two hundred and nine adolescents with DM1, aged 15-18 years, were studied in 2013 with an anonymous questionnaire prepared for the European School Survey Project on Alcohol and Other Drugs (ESPAD). The control group was a representative sample of 12114 students at the same age who took part in ESPAD in 2011. Metabolic control was regarded as good if self-reported HbA1c was <8% or poor if HbA1c was ≥8%. 

Results. 

Lifetime prevalence of illicit drug use was lower among adolescents with DM1 than in the control group [58 (28%) versus 5524 (46%), p = 10(-5)]. Cannabis preparations were the most frequently used substances [38 (18.3%) versus 3976 (33.1%), p = 10(-5)], followed by tranquilizers, sedatives, and amphetamine. Lifetime and last 12-month use of cannabis were associated with poorer glycemic control (HbA1c ≥ 8%), p < 0.01 and 0.02, respectively. 

Conclusions. 

Adolescents with DM1 report using illicit drugs to a lesser extent than their healthy peers. The use of cannabis is associated with a poorer metabolic control in teens with DM1.

Below:  The proportion of patients who tried or did not try marijuana, according to HbA1c levels, p = 0.03; response rate to that question was 189/209.

Purchase full article at:  http://goo.gl/CJHZ5r

By:  Hogendorf AM1, Fendler W1, Sieroslawski J2, Bobeff K3, Wegrewicz K3, Malewska KI3, Przudzik MW3, Szmigiero-Kawko M4, Sztangierska B4, Mysliwiec M4,Szadkowska A1, Mlynarski W1.

• 1Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, 91-738 Lodz, Poland.
• 2Department of Studies on Alcoholism and Other Dependencies, Institute of Psychiatry and Neurology, 02-957 Warsaw, Poland.
• 3Students' Scientific Circle at the Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, 91-738 Lodz, Poland.
• 4Department of Pediatrics, Diabetology and Endocrinology, Medical University of Gdańsk, 80-211 Gdańsk, Poland.
• J Diabetes Res. 2016;2016:4153278. doi: 10.1155/2016/4153278. Epub 2015 Dec 29. 

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Liver Fibrosis in HIV Patients Receiving a Modern cART: Which Factors Play a Role?

Liver-related death in human immunodeficiency virus (HIV)-infected individuals is about 10 times higher compared with the general population, and the prevalence of significant liver fibrosis in those with HIV approaches 15%. 

The present study aimed to assess risk factors for development of hepatic fibrosis in HIV patients receiving a modern combination anti-retroviral therapy (cART).This cross-sectional prospective study included 432 HIV patients, of which 68 (16%) patients were anti-hepatitis C virus (HCV) positive and 23 (5%) were HBsAg positive.Health trajectory including clinical characteristics and liver fibrosis stage assessed by transient elastography were collected at inclusion. Liver stiffness values >7.1 kPa were considered as significant fibrosis, while values >12.5 kPa were defined as severe fibrosis. Logistic regression and Cox regression uni- and multivariate analyses were performed to identify independent factors associated with liver fibrosis.

Significant liver fibrosis was detected in 10% of HIV mono-infected, in 37% of HCV co-infected patients, and in 18% of hepatitis B virus co-infected patients. The presence of diabetes mellitus (odds ratio [OR] = 4.6) and FIB4 score (OR = 2.4) were independently associated with presence of significant fibrosis in the whole cohort. Similarly, diabetes mellitus (OR = 5.4), adiposity (OR = 4.6), and the FIB4 score (OR = 3.3) were independently associated with significant fibrosis in HIV mono-infected patients. Importantly, cumulative cART duration protected, whereas persistent HIV viral replication promoted the development of significant liver fibrosis along the duration of HIV infection.

Our findings strongly indicate that besides known risk factors like metabolic disorders, HIV may also have a direct effect on fibrogenesis. Successful cART leading to complete suppression of HIV replication might protect from development of liver fibrosis.

Below:  FIGURE 1. (A) Distribution of fibrosis among subgroups. (B–D) Association between LS and HIV duration, time naive, and DM. (E–H) Association between LS and BMI, DM, HIV duration, and time naive in HIV mono-infected patients compared with coinfected patients. Data are presented as mean ± SEM. BMI = body mass index, DM = diabetes mellitus, HIV = human immunodeficiency virus, LS = liver stiffness, SEM = standard error of the mean.

Full article at:   http://goo.gl/1el3nx

By:   Mohr R1, Schierwagen R, Schwarze-Zander C, Boesecke C, Wasmuth JC, Trebicka J, Rockstroh JK.

• 1From the Department of Medicine I, University Hospital Bonn, Bonn, Germany (RM, RS, CS-Z, CB, J-CW, JT, JKR); German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Bonn, Germany (RM, CS-Z, CB, J-CW, JKR); and Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark (JT). 

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Tadalafil 5 mg Once Daily for the Treatment of Erectile Dysfunction During a 6-month Observational Study (EDATE): Impact of Patient Characteristics and Comorbidities

To explore the impact of patient-characteristics and relevant comorbidities on treatment continuation rates, effectiveness, and satisfaction in patients with erectile dysfunction (ED) who started or switched to tadalafil 5 mg once daily (TAD-OaD) at baseline.

In the EDATE observational study, phosphodiesterase-type-5 (PDE5)-inhibitor pretreated or naïve ED patients who started or switched to TAD-OaD were prospectively followed for 6 months. Time to discontinuation of TAD-OaD was estimated using the Kaplan-Meier product-limit method at Months 2, 4, and 6 in subgroups stratified by age (18 − 65 years and >65 years), PDE5-inhibitor pretreatment, ED-severity (mild, moderate, severe), and presence or absence of relevant comorbidities (BPH, diabetes, CVD, hypertension, dyslipidemia). LSmean change from baseline in International Index of Erectile Function (IIEF) and Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) scores and associated 95 % CIs were assessed using a mixed-model for repeated measures. Visit, ED etiology, and subgroups were included as fixed-effects.

Overall, 778 patients received prescriptions for initiating or switching to TAD-OaD at baseline. At Month 2, >90 % of patients remained on TAD-OaD, except those aged >65 years (86.7 %) and patients with severe ED (89.0 %). More than 80 % of patients in all subgroups, except those aged >65 years (75.0 %), continued TAD-OaD at Month 6. There was a significant LSmean negative effect on IIEF- EF domain-score improvement for BPH, previous PDE5-inhibitor treatment, and mild vs moderate ED; the latter possibly linked with a bigger treatment-effect in those with more severe ED at baseline. The LSmean effect on change in IIEF-EF was significantly positive for diabetes, most likely because those with diabetes had more severe ED at baseline. For all other parameters, no statistically significant LSmean effects in IIEF-EF changes were observed. No comorbidity or baseline-characteristic except age affected changes in EDITS.

Under routine clinical conditions, treatment continuation rate or satisfaction does not seem to be significantly affected by the presence of comorbidities in men who choose ED-treatment with TAD-OaD. The magnitude of treatment effectiveness was affected by certain baseline characteristics and comorbid conditions.

Full article at:  http://goo.gl/eMo8Fx

By: Dimitrios Hatzichristou¹, Gianluca d’Anzeo^2*, Hartmut Porst³, Jacques Buvat⁴, Carsten Henneges⁵, Andrea Rossi², Karim Hamidi⁶ and Hartwig Büttner⁵

¹Centre for Sexual and Reproductive Health and 1st Department of Urology, Aristotle University of Thessaloniki, Thessaloniki, Greece

²Medical Advisor Urology, Eli Lilly Italy S.p.A., Via A. Gramsci 731/733, Sesto Fiorentino, 50019, FI, Italy

³Private Practice of Urology and Andrology, Hamburg, Germany

⁴Centre d’Etude et de Traitement de la Pathologie de l’Appa reil Reproducteur et de la Psychosomatique (CETPARP), Lille, France

⁵Lilly Deutschland GmbH, Bad Homburg, Germany

⁶Eli Lilly and Company, Neuilly sur Seine, France

 

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Increased Risk of Dementia in Patients with Erectile Dysfunction: A Population-Based, Propensity Score-Matched, Longitudinal Follow-Up Study

Erectile dysfunction (ED) is a well-known predictor for future cardiovascular and cerebrovascular disease. However, the relationship between ED and dementia has rarely been examined. This study investigates the longitudinal risk for Alzheimer's disease and non-Alzheimer dementia in patients with ED.

We collected a random sample of 1,000,000 individuals from Taiwan's National Health Insurance database. From this sample, we identified 4153 patients with newly diagnosed ED between 2000 and 2009 and compared them with a matched cohort of 20,765 patients without ED. All patients were tracked for 7 years from the index date to identify which of them subsequently developed dementia.

During the 7-year follow-up period, the incidence rate of dementia in the ED cohort was 35.33 per 10,000 person-years. In the comparison groups, it was 21.67 per 10,000 person-years. After adjustment for patients characteristics and comorbidities, patients with ED were 1.68-times more likely to develop dementia than patients without ED (95% CI = 1.34–2.10, P < 0.0001). In addition, older patients and those with diabetes, hypertension, chronic kidney disease, stroke, depression, and anxiety were found to be at increased risk for dementia. Analyzing the data by dementia type, we found the hazard risk for Alzheimer's disease and non-Alzheimer dementia to be greater in patients with ED (adjusted HR 1.68, 95% CI = 1.31–2.16, P < 0.0001 and 1.63, 95% CI = 1.02–2.62, P = 0.0429, respectively). Log-rank test revealed that patients with ED had significantly higher cumulative incidence rates of dementia than those without (P < 0.0001).

Patients with ED are at an increased risk for dementia later in life.

Below:  The cumulative incidence rate for dementia for patients with erectile dysfunction (ED) and without ED (log-rank P value < 0.0001)

Below:  The cumulative incidence rate for Alzheimer's disease for patients with erectile dysfunction (ED) and without ED (log-rank P value = 0.0001)

Below:  The cumulative incidence rate for non-Alzheimer dementia for patients with erectile dysfunction (ED) and without ED (log-rank P value = 0.0533)

Full article at: http://goo.gl/ioj6Bs

By: Chun-Ming Yang, MD, Yuan-Chi Shen, MD, Shih-Feng Weng, PhD, Jhi-Joung Wang, PhD, and Kai-Jen Tien, MD

From the Department of Neurology, Chi Mei Medical Center, Tainan (C-MY); Department of Urology, Kaohsiung Chang Gung Memorial Hospital (Y-CS); Cheng Shiu University, Kaohsiung (Y-CS); Department of Medical Research, Chi Mei Medical Center (S-FW, J-JW); Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science (S-FW); Division of Endocrinology and Metabolism, Department of Internal Medicine, Chi Mei Medical Center (K-JT); and Department of Senior Citizen Service Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan (K-JT).

Correspondence: Kai-Jen Tien, Department of Endocrinology and Metabolism, Department of Internal Medicine, Chi Mei Medical Center, No. 901, Zhonghua Rd., Yongkang Dist., Tainan City 710, Taiwan, R.O.C. (e-mail: moc.liamg@jktcmmc).

   

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Ethnicity & Neighbourhood Deprivation Determines the Response Rate in Sexual Dysfunction Surveys

Background

Self-administered questionnaires provide a better alternative to disclose sensitive information in sexual health research. We describe the factors that determine the positive response (initial recruitment) to an initial invitation and subsequent completion of study to a postal questionnaire on sexual dysfunction.

Methods

South Asians (SA) and Europids with and without diabetes (DM) were recruited from GP clinics in UK. Men who returned the properly filled consent form (‘recruited-group’) were sent the questionnaire and those who returned it were considered as the ‘completed-group’. Index of Multiple Deprivation Scores (IMDs) were generated using UK postcodes. We calculated the recruitment rate and completion rate of the recruited and the study-completed groups respectively.

Results

Total approached sample was 9100 [DM: 2914 (32 %), SA: 4563 (50.1 %)]. Recruitment rate was 8.8 % and was higher in Europids and in patients with DM. Mean IMDs for the recruited group was 20.9 ± 11.9, and it was higher among recruited SA compared to Europids (p < 0.001). Mean IMDs was higher in the recruited group compared to non-recruited (p < 0.01). All four recruited groups (SA/Europid and DM/non-DM) had lower IMDs compared to non-recruited. Completion rate was 71.5 % (n 544) (SA: 62.3 %, Europids: 77.4 %; p < 0.05).

Conclusion

Recruitment for postal sexual health surveys is positively influenced by presence of investigated disease, older age, being from lesser deprived areas and Europid ethnicity. Furthermore, Europids were more likely to complete survey than South Asians irrespective of disease status.

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