Chronic Diseases and Translational Medicine最新文献

Trial-based economic value of prevention programs for diabetes is inexplicit. We aimed to review the cost-effectiveness of nonpharmacological interventions to prevent type-2 diabetes mellitus (T2DM) for high-risk people. Six electronic databases were searched up to March 2022. Studies assessing both the cost and health outcomes of nonpharmacological interventions for people at high-risk of T2DM were included. The quality of the study was assessed by the Consolidated Health Economic Evaluation Reporting Standards 2022 checklist. The primary outcome for synthesis was incremental cost-effectiveness ratios (ICER) for quality-adjusted life years (QALYs), and costs were standardized in 2022 US dollars. Narrative synthesis was performed, considering different types and delivery methods of interventions. Sixteen studies included five based on the US diabetes prevention program (DPP), six on non-DPP-based lifestyle interventions, four on health education, and one on screening plus lifestyle intervention. Compared with usual care, lifestyle interventions showed higher potential of cost-effectiveness than educational interventions. Among lifestyle interventions, DPP-based programs were less cost-effective (median of ICERs: $27,077/QALY) than non-DPP-based programs (median of ICERs: $1395/QALY) from healthcare perspectives, but with larger decreases in diabetes incidence. Besides, the cost-effectiveness of interventions was more possibly realized through the combination of different delivery methods. Different interventions to prevent T2DM in high-risk populations are both cost-effective and feasible in various settings. Nevertheless, economic evidence from low- and middle-income countries is still lacking, and interventions delivered by trained laypersons and combined with peer support sessions or mobile technologies could be potentially a cost-effective solution in such settings with limited resources.

This manuscript is a narrative review on experience in the healthcare public–private partnerships (PPP) field project in China. The PPP model allows healthcare officials to share the risk of building new facilities with the private sector. The objective of this study is to evaluate and to review the PPP of healthcare sector in China, and to investigate the critical success factors and best practice of PPP. We adapted the PPP evaluation framework of the World Bank Independent Evaluation Group as our conceptual framework to summarize the literatures. The current study systematically reviewed the evolution and current status of public and private hospitals development in China, and to investigate factors related to the successful and less successful deployment and performance of PPP in the healthcare sector of China, and to develop best practice models of PPP among hospitals of China. We found that the PPP organizations providing finance and political risk coverage, thus enabling specific PPP transactions to reach financial closure—potentially setting demonstration effects. Such PPPs may then contribute to improving access to infrastructure and social services, which drives economic growth and other optimal outcomes.

(A) Immunofluorescence staining showed moderate immunoglobulin A depositions in the mesangial areas (++) of glomeruli (Bars = 100 μm). (B) Segmentally mild mesangial proliferation and mesangial matrix expansion (arrowhead) with mild thickening of glomerular capillary walls (PAS, ×400).

Cardiovascular disease (CVD) is the most common noncommunicable disease and the leading cause of death globally.¹ It has resulted in enormous economic and social burdens, while posing a great challenge for the prevention and control of CVD worldwide, especially in China. Assessment and management of cardiovascular risk is the foundation of CVD prevention, and is strongly recommended by guidelines.^2-4 Additionally, it can help screen the target population who would benefit most from the lower-cost intervention, while informing them the cardiovascular risk, which will help in promoting self-management. It can also guide doctors in making logical management decisions, and implement precision prevention and treatment strategies to reduce the CVD burden.^{2, 4} Therefore, it is a key approach in achieving the goals of “Good Health and Well-being” in the United Nations and “Healthy China 2030” in China. Here, we briefly highlight several advances in cardiovascular risk assessments.

The Framingham Heart Study introduced the term “risk factor” in 1961, and identified a series of risk factors of CVD subsequently, such as cholesterol, blood pressure, glucose, and obesity.⁵ By integrating multiple conventional risk factors, a general cardiovascular risk instrument was further developed to assist in identifying and treating individuals at high risk.⁶ Since the concept of cardiovascular risk assessment and stratification was adopted by the third Adult Treatment Panel of the National Cholesterol Education Program in 2001, it has led to the development of effective treatment and preventive strategies in clinical practice.

A systematic approach to cardiovascular risk assessment includes the collection of information to calculate the cardiovascular risk, identification of the target high-risk population, and implementation of individual management according to the risk level. Therefore, risk-prediction models are major components of risk-based CVD prevention and control efforts. Several cardiovascular risk models have been developed using conventional risk factors to assist in clinical practice, such as the Reynolds Risk Score^{7, 8} and the Pooled Cohort Equations (PCE)⁹ in the United States, the QRISK in the United Kingdom,¹⁰ the ASSIGN Score in Scotland,¹¹ the Systematic Coronary Risk Evaluation (SCORE) model in Europe,¹² and the Prediction for Atherosclerotic CVD Risk in China (China-PAR) equations.¹³ In addition, World Health Organization has derived the risk prediction charts for 21 Global Burden of Disease regions to facilitate the risk-based CVD prevention in low- and middle-income countries.⁴ These models, taking account of balance between good performance and ac

The prevalence of cancer, especially in industrial countries, is a major problem for health and treatment systems. Cancer can affect the quality of life of all family members and has many negative effects on the community. Despite many advances in cancer treatment, this disease is still a major worldwide problem. There is strong evidence that dietary habits are effective in protecting against cancer and even helping in the disease treatment progress. Nuts with various biologically-active compounds, such as vitamins, phytosterols, isoflavones, flavonoids, and polyphenols have been reported to possess anticarcinogenic properties. Accordingly, this review provides an insight into the association between nut consumption and the prevention of some cancers. We considered the cancers related to the urogenital and genital tract, gastrointestinal tract, as well as women-related cancers. Both cell culture examinations and experimental animal studies alongside observational epidemiological studies demonstrated that regular consumption of a nut-enriched diet is able to reduce the risk of these cancers.

A second bone marrow aspiration and biopsy showed pure red cell aplasia in this case.

Family history of diabetes (FH+) has been associated with early metabolic alteration including insulin resistance, lipid metabolism, and ectopic fat accumulation even in healthy individuals.^1-3 Furthermore, normoglycemic first-degree relatives of type 2 diabetes mellitus (T2DM) have been documented having increased carotid intima-media thickness and pro-inflammatory cytokines.^{4, 5} Taken together, individuals with FH+, who were otherwise healthy, have shown to possess susceptibility for diabetes mellitus (DM) chronic complication. Hence, this study aimed to investigate whether FH+ increased the risk of chronic complications in patients with overt T2DM.

This was a cross-sectional study which included adult patients with T2DM visiting a private hospital integrated diabetes center in South Tangerang (urban area outskirt of Jakarta), Indonesia from December 2020 to November 2021. Those without any documented blood test results were excluded. FH+ was defined as having first- and/or second-degree relatives with T2DM. Chronic complications investigated were atherosclerotic cardiovascular diseases (ASCVD) including coronary artery disease (CAD), stroke, and peripheral artery disease; microvascular complications including diabetic retinopathy, diabetic peripheral neuropathy, and diabetic kidney disease (DKD); diastolic dysfunction and heart failure (HF). Data were taken from hospital electronic medical records and were explored from clinical signs and symptoms, history of previously known chronic complications, laboratory and radiological examinations, and diagnosis made by the physicians. Additionally, if any, other tests were used for diagnosis such as treadmill stress test and coronary arteries calcium scoring for CAD; ankle-to-brachial index of ≤0.9 and limb vessels stenosis of ≥50% on doppler ultrasound for peripheral artery disease; non-mydriatic funduscopy for retinopathy; 10 g monofilament test and 128 Hz tuning fork test for neuropathy; presence of micro-/macroalbuminuria or proteinuria and glomerular filtration rate ≤60 mL/min for DKD; echocardiography for diastolic dysfunction and HF.

Results were presented in n (%), and median (interquartile range, IQR) depends on data type. Chi-squared test was used to compare nominal data, while Mann–Whitney was used to compare numerical data. Logistic regression analysis was used to determine FH+ association with chronic complications adjusted for age, sex, DM duration, alcohol and smoking history, systolic and diastolic blood pressure, body mass index, HbA1c, low-density lipoprotein, triglyceride, and estimated glomerular filtration rate, with no family history of diabetes (FH−) as the reference.

A total of 1011 T2DM patients were included, 24.8% of whom had family history of T2DM (FH+) (Table 1). There were higher proportions of dyslipidemia, smoking and alcohol history found in FH+, whereas FH− had older age, higher systolic blood