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|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
31388453_p69
|
31388453
|
sec[1]/sec[1]/sec[1]/p[3]
|
Weight reduction
| 2.605469 |
biomedical
|
Other
|
[
0.861328125,
0.114990234375,
0.0235748291015625
] |
[
0.0005636215209960938,
0.990234375,
0.0064544677734375,
0.002960205078125
] |
The recommendations for weight reduction are to eat breakfast every morning, eat slowly, and avoid a high-carbohydrate diet, alcohol, snacks such as bread and cookies, and sweetened beverages. A high-fiber diet is recommended and a high-fat diet including food fried with oil is prohibited. Patients should try to eat as many fruits and vegetables as possible and to avoid meals containing large amounts of cholesterol and saturated fatty acids.
|
[
"Hae-Young Lee",
"Jinho Shin",
"Gheun-Ho Kim",
"Sungha Park",
"Sang-Hyun Ihm",
"Hyun Chang Kim",
"Kwang-il Kim",
"Ju Han Kim",
"Jang Hoon Lee",
"Jong-Moo Park",
"Wook Bum Pyun",
"Shung Chull Chae"
] |
https://doi.org/10.1186/s40885-019-0124-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
31388453_p70
|
31388453
|
sec[1]/sec[1]/sec[2]/p[0]
|
Moderation of alcohol consumption
| 1.907227 |
biomedical
|
Other
|
[
0.78662109375,
0.11309814453125,
0.10028076171875
] |
[
0.0011606216430664062,
0.99658203125,
0.0013628005981445312,
0.0009918212890625
] |
Recommendations Class Level References • It is recommended to moderate alcohol consumption to less than 2 drinks per day. I A
|
[
"Hae-Young Lee",
"Jinho Shin",
"Gheun-Ho Kim",
"Sungha Park",
"Sang-Hyun Ihm",
"Hyun Chang Kim",
"Kwang-il Kim",
"Ju Han Kim",
"Jang Hoon Lee",
"Jong-Moo Park",
"Wook Bum Pyun",
"Shung Chull Chae"
] |
https://doi.org/10.1186/s40885-019-0124-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999995 |
31388453_p71
|
31388453
|
sec[1]/sec[1]/sec[2]/p[1]
|
Moderation of alcohol consumption
| 3.121094 |
biomedical
|
Other
|
[
0.97119140625,
0.025238037109375,
0.0037784576416015625
] |
[
0.002559661865234375,
0.994140625,
0.0016622543334960938,
0.0017538070678710938
] |
BP tends to increase in patients who drink excessive amounts of alcohol and such patients are also resistant to antihypertensive drugs. An appropriate moderate daily amount of alcohol is less than 20–30 g for men or 10–20 g for women. A man or woman with lower-than-average body weight is more sensitive to alcohol and is therefore permitted half of the recommended amount. Heavy drinkers should be warned that they are high risk for stroke. One bottle of beer (720 mL), 1 glass of wine (200–300 mL), 1 glass of sake (200 mL), 2 shots of whisky (60 mL), or 2–3 glasses of soju corresponds to 30 g of alcohol.
|
[
"Hae-Young Lee",
"Jinho Shin",
"Gheun-Ho Kim",
"Sungha Park",
"Sang-Hyun Ihm",
"Hyun Chang Kim",
"Kwang-il Kim",
"Ju Han Kim",
"Jang Hoon Lee",
"Jong-Moo Park",
"Wook Bum Pyun",
"Shung Chull Chae"
] |
https://doi.org/10.1186/s40885-019-0124-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
31388453_p72
|
31388453
|
sec[1]/sec[1]/sec[3]/p[0]
|
Exercise
| 2.746094 |
biomedical
|
Other
|
[
0.798828125,
0.1793212890625,
0.0219573974609375
] |
[
0.0010728836059570312,
0.99072265625,
0.005565643310546875,
0.0028781890869140625
] |
Recommendations Class Level References • Regular aerobic exercise (e.g. at least 30 min of moderate dynamic exercise 5–7 days per week) is recommended. I A • It is recommended that isometric exercise or isometric exercise, such as lifting a heavy weight, can be performed concurrently with aerobic exercise, but should be avoided as BP may temporarily rise when BP is not controlled. I A
|
[
"Hae-Young Lee",
"Jinho Shin",
"Gheun-Ho Kim",
"Sungha Park",
"Sang-Hyun Ihm",
"Hyun Chang Kim",
"Kwang-il Kim",
"Ju Han Kim",
"Jang Hoon Lee",
"Jong-Moo Park",
"Wook Bum Pyun",
"Shung Chull Chae"
] |
https://doi.org/10.1186/s40885-019-0124-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
31388453_p73
|
31388453
|
sec[1]/sec[1]/sec[3]/p[1]
|
Exercise
| 4.019531 |
biomedical
|
Other
|
[
0.89892578125,
0.09466552734375,
0.00632476806640625
] |
[
0.006938934326171875,
0.6064453125,
0.374755859375,
0.0116119384765625
] |
The benefits of regular exercise are lowering of BP, improvement of cardiopulmonary function, reduction of body weight, improvement of the lipid profile (including elevation of HDL-cholesterol), and reduction of emotional stress. Aerobic exercises such as brisk walking, jogging, bicycling, swimming, jumping rope, playing tennis, and aerobic dancing are recommended for patients with HTN . The appropriate intensity of exercise is 60–80% of the maximal heart rate (220 minus age in years). Such exercise should be performed 5–7 times per week. Aerobic exercise should begin at low intensity for 10–20 min and then increase to appropriate intensity for another 30–60 min. It is best to exercise for 90–150 min or more per week. Warm-up and finish exercises before and after exercise session for five minutes is necessary. In addition, isotonic muscle strength and isometric exercise using muscular dumbbells two or three times a week is recommended not only to reduce BP but also to improve metabolic factors and strengthen muscles . Isometric exercises using a hand dynamometer is used to estimate the maximal handgrip power and then is held for 2 min at a strength of 30–40% of the maximum measured weight, followed by rest for 1 min for 4 times, three days a week. It is recommended that isometric exercise or isometric exercise, such as lifting a heavy weight, can be performed concurrently with aerobic exercise but should be avoided as BP may temporarily rise when BP is not controlled. Most patients with uncomplicated HTN can begin regular exercise without an initial evaluation and increase the duration and intensity to appropriate levels as possible. However, patients with known CVD or other risk factors are recommended to start the exercise only after complete evaluation by an exercise consultant and to follow a program.
|
[
"Hae-Young Lee",
"Jinho Shin",
"Gheun-Ho Kim",
"Sungha Park",
"Sang-Hyun Ihm",
"Hyun Chang Kim",
"Kwang-il Kim",
"Ju Han Kim",
"Jang Hoon Lee",
"Jong-Moo Park",
"Wook Bum Pyun",
"Shung Chull Chae"
] |
https://doi.org/10.1186/s40885-019-0124-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999999 |
31388453_p74
|
31388453
|
sec[1]/sec[1]/sec[4]/p[0]
|
Smoking cessation
| 1.77832 |
biomedical
|
Other
|
[
0.8828125,
0.055328369140625,
0.062103271484375
] |
[
0.0032501220703125,
0.97607421875,
0.018463134765625,
0.001987457275390625
] |
Recommendations Class Level References • Smoking cessation, supportive care, and referral to smoking cessation programs are recommended. I A [ 115 – 117 ]
|
[
"Hae-Young Lee",
"Jinho Shin",
"Gheun-Ho Kim",
"Sungha Park",
"Sang-Hyun Ihm",
"Hyun Chang Kim",
"Kwang-il Kim",
"Ju Han Kim",
"Jang Hoon Lee",
"Jong-Moo Park",
"Wook Bum Pyun",
"Shung Chull Chae"
] |
https://doi.org/10.1186/s40885-019-0124-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
31388453_p75
|
31388453
|
sec[1]/sec[1]/sec[4]/p[1]
|
Smoking cessation
| 3.830078 |
biomedical
|
Other
|
[
0.98486328125,
0.01316070556640625,
0.002079010009765625
] |
[
0.00714874267578125,
0.72998046875,
0.259033203125,
0.00389862060546875
] |
During smoking, the BP increases temporarily in response to nicotine. Among patients with white coat HTN, smokers maintain a higher daytime ambulatory SBP than do non-smokers with a similar office BP . Because smoking, like HTN, is a powerful risk factor for CVD , CV events are inevitable in patients who continue smoking regardless of BP control. Second-hand smoking is also harmful. Smoking cessation should be advised at every opportunity. Low-nicotine-containing replacement materials do not increase BP and can be recommended in combination with behavior therapy. During smoking cessation, regular exercise and diet therapy should be emphasized in order to prevent weight gain.
|
[
"Hae-Young Lee",
"Jinho Shin",
"Gheun-Ho Kim",
"Sungha Park",
"Sang-Hyun Ihm",
"Hyun Chang Kim",
"Kwang-il Kim",
"Ju Han Kim",
"Jang Hoon Lee",
"Jong-Moo Park",
"Wook Bum Pyun",
"Shung Chull Chae"
] |
https://doi.org/10.1186/s40885-019-0124-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
31388453_p76
|
31388453
|
sec[1]/sec[1]/sec[5]/p[0]
|
Healthy diet
| 1.821289 |
biomedical
|
Other
|
[
0.935546875,
0.026824951171875,
0.037750244140625
] |
[
0.001567840576171875,
0.99560546875,
0.002147674560546875,
0.0009145736694335938
] |
Recommendations Class Level References • Increased consumption of vegetables, fresh fruits, fish, nuts, and unsaturated fatty acids; low consumption of red meat; and consumption of low-fat dairy products I A
|
[
"Hae-Young Lee",
"Jinho Shin",
"Gheun-Ho Kim",
"Sungha Park",
"Sang-Hyun Ihm",
"Hyun Chang Kim",
"Kwang-il Kim",
"Ju Han Kim",
"Jang Hoon Lee",
"Jong-Moo Park",
"Wook Bum Pyun",
"Shung Chull Chae"
] |
https://doi.org/10.1186/s40885-019-0124-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
31388453_p77
|
31388453
|
sec[1]/sec[1]/sec[5]/p[1]
|
Healthy diet
| 4.035156 |
biomedical
|
Review
|
[
0.998046875,
0.0011262893676757812,
0.0008769035339355469
] |
[
0.07269287109375,
0.0022525787353515625,
0.9248046875,
0.00048041343688964844
] |
BP is lower in vegetarians than in people who mainly eat meat, and maintaining a vegetarian diet can reduce BP. The BP-lowering effect results not from decreasing the intake of animal protein but from increasing the intake of vegetables and fruits in combination with decreasing the intake of saturated fatty acids. In a study in elderly people, BP decreased by 3/1 mmHg when intake of vegetables and fruits was increased alone but by 6/3 mmHg when it was combined with a decrease in fat intake [ 121 – 123 ]. It is important for HTN patients to change the overall dietary pattern rather than diet that emphasizes specific nutrients . For example, Dietary Approaches to Stop Hypertension (DASH), which includes consumption of more fruits, vegetables, and fish and consumes less fat, can lower BP by 11/6 mmHg. Because it contains multiple food groups, the DASH diet is likely to have additional beneficial effects . Regular intake of fish reduces BP in obese HTN patients and improves lipid metabolism. In Korea, diets consisting of tofu, soybean, fruit, vegetables, and fish were associated with a low prevalence of HTN with a high dietary intake . Therefore, a healthy balanced diet such as DASH or a Mediterranean diet for HTN patients is recommended not only to lower BP but also to prevent CVD .
|
[
"Hae-Young Lee",
"Jinho Shin",
"Gheun-Ho Kim",
"Sungha Park",
"Sang-Hyun Ihm",
"Hyun Chang Kim",
"Kwang-il Kim",
"Ju Han Kim",
"Jang Hoon Lee",
"Jong-Moo Park",
"Wook Bum Pyun",
"Shung Chull Chae"
] |
https://doi.org/10.1186/s40885-019-0124-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
31388453_p78
|
31388453
|
sec[1]/sec[1]/sec[6]/p[0]
|
Others
| 3.603516 |
biomedical
|
Review
|
[
0.99658203125,
0.0016260147094726562,
0.0018358230590820312
] |
[
0.0125579833984375,
0.03857421875,
0.9482421875,
0.0007643699645996094
] |
Caffeine from various foods rapidly increases BP, but the effect does not progress to HTN because tolerance to caffeine develops. Emotional stress increases both BP and the risk for CVD, making the control of emotional stress important for the management and patient adherence of HTN. Further studies are required to examine the long-term effects of stress control on HTN and CVD. The effectiveness of various methods of stress management, such as relaxation and biofeedback, for the management of HTN remains uncertain. There is still no clear evidence for the effects of micronutrients, calcium, magnesium, and supplementary fiber on BP.
|
[
"Hae-Young Lee",
"Jinho Shin",
"Gheun-Ho Kim",
"Sungha Park",
"Sang-Hyun Ihm",
"Hyun Chang Kim",
"Kwang-il Kim",
"Ju Han Kim",
"Jang Hoon Lee",
"Jong-Moo Park",
"Wook Bum Pyun",
"Shung Chull Chae"
] |
https://doi.org/10.1186/s40885-019-0124-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
31388453_p79
|
31388453
|
sec[1]/sec[2]/p[0]
|
Pharmacological therapy for hypertension
| 3.158203 |
biomedical
|
Other
|
[
0.78076171875,
0.2137451171875,
0.005527496337890625
] |
[
0.0032138824462890625,
0.970703125,
0.0182647705078125,
0.007595062255859375
] |
Recommendations Class Level References • Prompt initiation of BP-lowering drug treatment is recommended in patients with high risk or grade 2 HTN, simultaneous with the initiation of lifestyle for achieving target goal BP. I A [ 126 – 128 ]
|
[
"Hae-Young Lee",
"Jinho Shin",
"Gheun-Ho Kim",
"Sungha Park",
"Sang-Hyun Ihm",
"Hyun Chang Kim",
"Kwang-il Kim",
"Ju Han Kim",
"Jang Hoon Lee",
"Jong-Moo Park",
"Wook Bum Pyun",
"Shung Chull Chae"
] |
https://doi.org/10.1186/s40885-019-0124-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
31388453_p80
|
31388453
|
sec[1]/sec[2]/p[1]
|
Pharmacological therapy for hypertension
| 3.929688 |
biomedical
|
Review
|
[
0.97998046875,
0.017547607421875,
0.002246856689453125
] |
[
0.00864410400390625,
0.128662109375,
0.85986328125,
0.0027484893798828125
] |
The occurrence of CV events in patients with HTN can be decreased by reducing the BP. Currently available antihypertensive drugs are more effective than placebo for prevention of CVD. This preventive effect is relatively larger for stroke than for CAD. The extent to which CV events are reduced depends on the degree of BP reduction. All major classes of antihypertensive drugs, including beta-blockers and diuretics, are suitable for first-line treatment. However, the individual drug should be prescribed with consideration of the patient’s individual situation, including age, comorbidities, and possible adverse effects. Simplifying the medication schedule, careful monitoring of the adverse effects, and checking the BP at home are useful for improving patient adherence and making the patient an active participant in the treatment.
|
[
"Hae-Young Lee",
"Jinho Shin",
"Gheun-Ho Kim",
"Sungha Park",
"Sang-Hyun Ihm",
"Hyun Chang Kim",
"Kwang-il Kim",
"Ju Han Kim",
"Jang Hoon Lee",
"Jong-Moo Park",
"Wook Bum Pyun",
"Shung Chull Chae"
] |
https://doi.org/10.1186/s40885-019-0124-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
31388453_p81
|
31388453
|
sec[1]/sec[2]/sec[0]/sec[0]/p[0]
|
Principles of drug selection
| 3.107422 |
biomedical
|
Other
|
[
0.658203125,
0.33447265625,
0.0074615478515625
] |
[
0.0023193359375,
0.986328125,
0.00527191162109375,
0.006114959716796875
] |
Recommendations Class Level References • In patients with BP higher than 160/100 mmHg or more than 20/10 mmHg above the target BP, two drugs can be prescribed in combination to maximize the antihypertensive effect and to achieve rapid BP control. IIa C
|
[
"Hae-Young Lee",
"Jinho Shin",
"Gheun-Ho Kim",
"Sungha Park",
"Sang-Hyun Ihm",
"Hyun Chang Kim",
"Kwang-il Kim",
"Ju Han Kim",
"Jang Hoon Lee",
"Jong-Moo Park",
"Wook Bum Pyun",
"Shung Chull Chae"
] |
https://doi.org/10.1186/s40885-019-0124-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999995 |
31388453_p82
|
31388453
|
sec[1]/sec[2]/sec[0]/sec[0]/p[1]
|
Principles of drug selection
| 4.074219 |
biomedical
|
Review
|
[
0.95068359375,
0.042449951171875,
0.0067138671875
] |
[
0.0043487548828125,
0.05279541015625,
0.939453125,
0.0031833648681640625
] |
For reducing long-term CV morbidity and mortality, it is essential to control most of the modifiable risk factors and to reduce the BP to less than 140/90 mmHg . Drug therapy is initiated at a low dose to avoid adverse effects. The preferred drugs are long-acting and can be taken only once a day . Drugs with a high trough/peak ratio (T/P ratio > 0.5) are helpful for improving adherence and to maintain a stable BP with minimal variability . When it is difficult to control BP with once-daily dosing, a twice-daily schedule is an alternative option. ACE inhibitors, ARBs, calcium channel blockers, beta-blockers, and diuretics are all agents suitable for initiation of antihypertensive treatment. The indications, contraindications, comorbidities, and presence of asymptomatic organ damage should all be considered in the choice of drug. Beta-blockers in the elderly are controversial for treatment benefits and should only be used if there is a specific indication. Concomitant use of beta-blockers and diuretics increases the risk of developing diabetes, so care should be taken in patients at high risk of developing DM . In patients with BP higher than 160/100 mmHg or more than 20/10 mmHg above the target BP, two drugs can be prescribed in combination to maximize the antihypertensive effect and achieve rapid BP control . Single pill combination drugs have multiple benefits, including maximizing reduction of BP, minimizing adverse effects, increasing adherence, and preventing CVD and target organ damage .
|
[
"Hae-Young Lee",
"Jinho Shin",
"Gheun-Ho Kim",
"Sungha Park",
"Sang-Hyun Ihm",
"Hyun Chang Kim",
"Kwang-il Kim",
"Ju Han Kim",
"Jang Hoon Lee",
"Jong-Moo Park",
"Wook Bum Pyun",
"Shung Chull Chae"
] |
https://doi.org/10.1186/s40885-019-0124-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
31388453_p83
|
31388453
|
sec[1]/sec[2]/sec[0]/sec[1]/p[0]
|
Selection of drugs
| 4.042969 |
biomedical
|
Review
|
[
0.98681640625,
0.0115966796875,
0.0017309188842773438
] |
[
0.023681640625,
0.03515625,
0.939453125,
0.0018167495727539062
] |
It is reasonable to choose drugs according to the patient’s comorbidities and clinical characteristics rather than his or her BP level. There are five available classes of first-line drugs with proven BP-lowering effects, safety, and acceptable adverse effects according to multiple studies. They are: 1) ACE inhibitors or ARBs; 2) beta-blockers; 3) calcium channel blockers; and 4) diuretics such as hydrochlorothiazide, chlorthalidone, or indapamide. All reduce BP to a similar extent when the dose has been adjusted. However, there might be individual differences in BP lowering, adverse effects, and long-term CV events, making it very important to choose the appropriate drugs according to the patient’s combined risk factors and comorbidities (Table 11 ). No antihypertensive drug is inherently superior, and the drugs most appropriate for the individual patient should be preferred (Table 12 ). Table 11 Compelling indications for choosing the antihypertensive drugs Disease conditions ACE inhibitors or Angiotensin receptor blockers Beta-blockers Calcium channel blockers Diuretics Congestive heart failure ○ ○ ○ Left ventricular hypertrophy ○ ○ Coronary artery disease ○ ○ ○ Chronic kidney disease ○ Stroke ○ ○ ○ Elderly, isolated systolic hypertension ○ ○ ○ Post-myocardial infarction ○ ○ Prevention of atrial fibrillation ○ Diabetes mellitus ○ ○ ○ ○ Table 12 Indications and contraindications of antihypertensive drugs Absolute indications Relative indications Need cautions Absolute contraindications Angiotensin-converting enzyme inhibitors/angiotensin receptor blockers Congestive heart failure, diabetic nephropathy (Bilateral) Renal artery stenosis, hyperkalemia Pregnancy, angioedema Beta-blockers Ischemic heart disease, myocardial infarction Tachyarrhythmia High blood glucose, peripheral artery disease Asthma, severe and symptomatic bradyarrhythmia Calcium channel blockers Elderly hypertension, isolate systolic hypertension, ischemic heart disease (non-DHP*) Congestive heart failure Severe and symptomatic bradyarrhythmia (non-DHP*) Diuretics Congestive heart failure, isolate systolic hypertension High blood glucose Gout, hypokalemia *Non-DHP: non-dihydropyridine calcium channel blockers.
|
[
"Hae-Young Lee",
"Jinho Shin",
"Gheun-Ho Kim",
"Sungha Park",
"Sang-Hyun Ihm",
"Hyun Chang Kim",
"Kwang-il Kim",
"Ju Han Kim",
"Jang Hoon Lee",
"Jong-Moo Park",
"Wook Bum Pyun",
"Shung Chull Chae"
] |
https://doi.org/10.1186/s40885-019-0124-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
31388453_p84
|
31388453
|
sec[1]/sec[2]/sec[1]/sec[0]/p[0]
|
Diuretics
| 3.673828 |
biomedical
|
Other
|
[
0.6474609375,
0.34326171875,
0.00946807861328125
] |
[
0.0018768310546875,
0.96435546875,
0.0200958251953125,
0.013427734375
] |
Recommendations Class Level References • Thiazide or thiazide-like diuretics can be used as first-line drugs with a preference for chlorthalidone or indapamide. IIa B • Loop diuretics can be considered in patients with CHF, advanced CKD of stage IV or stage V. IIa B • In patients with resistant HTN, aldosterone antagonists such as spironolactone can be considered in the absence of hyperkalemia. IIa B
|
[
"Hae-Young Lee",
"Jinho Shin",
"Gheun-Ho Kim",
"Sungha Park",
"Sang-Hyun Ihm",
"Hyun Chang Kim",
"Kwang-il Kim",
"Ju Han Kim",
"Jang Hoon Lee",
"Jong-Moo Park",
"Wook Bum Pyun",
"Shung Chull Chae"
] |
https://doi.org/10.1186/s40885-019-0124-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
31388453_p85
|
31388453
|
sec[1]/sec[2]/sec[1]/sec[0]/p[1]
|
Diuretics
| 4.179688 |
biomedical
|
Review
|
[
0.9716796875,
0.0234832763671875,
0.004772186279296875
] |
[
0.006412506103515625,
0.10015869140625,
0.88916015625,
0.004459381103515625
] |
Diuretics decrease BP initially by reducing reabsorption of sodium in the renal distal convoluted tubules and later by decreasing peripheral vascular resistance. High-dose thiazide-derivative diuretics can induce hypokalemia, glucose intolerance, hyperuricemia, arrhythmia, and adverse lipid metabolism, but low doses rarely have these effects. Combination of diuretics with beta-blockers is not recommended in patients with obesity or at high risk of diabetes because of adverse effects such as new-onset diabetes and adverse lipid metabolism. Thiazide-like diuretics such as chlorthalidone and indapamide have been found to be more effective than hydrochlorothiazide , but should be aware of hyponatremia or hypokalemia. Loop diuretics such as furosemide and torsemide are administered in the presence of CHF or when the GFR drops below 30 mL/min/1.73 m 2 . Spironolactone has proven effective in patients with heart failure and may be considered at low doses (25–50 mg) for treatment of resistant HTN.
|
[
"Hae-Young Lee",
"Jinho Shin",
"Gheun-Ho Kim",
"Sungha Park",
"Sang-Hyun Ihm",
"Hyun Chang Kim",
"Kwang-il Kim",
"Ju Han Kim",
"Jang Hoon Lee",
"Jong-Moo Park",
"Wook Bum Pyun",
"Shung Chull Chae"
] |
https://doi.org/10.1186/s40885-019-0124-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
31388453_p86
|
31388453
|
sec[1]/sec[2]/sec[1]/sec[1]/p[0]
|
Beta-blockers
| 4.128906 |
biomedical
|
Review
|
[
0.9658203125,
0.02716064453125,
0.00699615478515625
] |
[
0.003551483154296875,
0.0400390625,
0.9541015625,
0.0021038055419921875
] |
Selective beta-1 blockers are recommended for patients with HTN in combination with angina pectoris, myocardial infarction, or tachycardia. Beta-blockers are also effective in younger patients who have higher heart rates . However, they should be used with caution in patients with asthma, chronic obstructive pulmonary disease, second- or third-degree atrioventricular block, or peripheral vascular disease . Beta-blockers can have adverse effects on blood glucose and lipid metabolism and should therefore be used cautiously in elderly patients or patients with elevated blood sugar, diabetes, or metabolic syndrome . They should also be used carefully in patients with variant angina because they can worsen symptoms . Because atenolol is inferior for stroke prevention, it is not recommended for elderly patients with HTN . Concomitant use of beta-blockers and diuretics, which is not inferior in its BP-lowering effect, will increase the incidence of DM and should therefore be avoided in patients at high risk for developing DM . Vasodilatory beta-blockers might have different effects than atenolol, but no comparative study has yet been performed to date .
|
[
"Hae-Young Lee",
"Jinho Shin",
"Gheun-Ho Kim",
"Sungha Park",
"Sang-Hyun Ihm",
"Hyun Chang Kim",
"Kwang-il Kim",
"Ju Han Kim",
"Jang Hoon Lee",
"Jong-Moo Park",
"Wook Bum Pyun",
"Shung Chull Chae"
] |
https://doi.org/10.1186/s40885-019-0124-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
31388453_p87
|
31388453
|
sec[1]/sec[2]/sec[1]/sec[2]/p[0]
|
Calcium channel blockers
| 4.160156 |
biomedical
|
Review
|
[
0.96533203125,
0.0250701904296875,
0.009765625
] |
[
0.004016876220703125,
0.070556640625,
0.921875,
0.003345489501953125
] |
Long-acting calcium channel blockers are preferable to short-acting calcium channel blockers, which can cause tachycardia and increase cardiac workload. Because calcium channel blockers have a vasodilatory effect on the coronary artery, they are highly effective in patients with stable angina or variant angina, which is caused by coronary artery spasm. They are also effective for slowing the progression of carotid atherosclerosis and reducing cardiac hypertrophy . The non-dihydropyridine calcium channel blockers, verapamil, and diltiazem, are effective after myocardial infarction because they do not produce reflex tachycardia. They are also effective in patients with hypertrophic cardiomyopathy because they improve diastolic filling. The common side effects of dihydropyridine calcium channel blockers are tachycardia, ankle edema, headache, and facial flushing. Non-dihydropyridine calcium channel blockers may cause constipation, conduction delay, and decreased myocardial contractility and should therefore be prescribed cautiously to patients with systolic heart failure or heart block. In addition, special caution is needed when administering them in combination with beta-blockers in elderly patients.
|
[
"Hae-Young Lee",
"Jinho Shin",
"Gheun-Ho Kim",
"Sungha Park",
"Sang-Hyun Ihm",
"Hyun Chang Kim",
"Kwang-il Kim",
"Ju Han Kim",
"Jang Hoon Lee",
"Jong-Moo Park",
"Wook Bum Pyun",
"Shung Chull Chae"
] |
https://doi.org/10.1186/s40885-019-0124-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
31388453_p88
|
31388453
|
sec[1]/sec[2]/sec[1]/sec[3]/p[0]
|
Angiotensin converting enzyme inhibitors / angiotensin receptor blockers
| 4.113281 |
biomedical
|
Review
|
[
0.95068359375,
0.045654296875,
0.00368499755859375
] |
[
0.01154327392578125,
0.302734375,
0.67529296875,
0.01023101806640625
] |
ACE inhibitors/ARBs reduce mortality in patients with heart failure and help to inhibit the progression of renal disease. They also help to prevent LVH and atherosclerosis and have little effect on blood glucose or lipid metabolism . In addition, they can improve vascular endothelial cell function and promote vascular reverse remodeling. However, they can cause a hypotensive response in dehydrated or elderly patients . When administered to a patient with bilateral renal artery stenosis, they can produce adverse effects such as severe hypotension and deterioration of renal function. The serum creatinine level may increase within the first two months after the start of treatment. However, there is no need to discontinue the drug unless the serum creatinine increases to less than 30% rise than the baseline creatinine level or unless serum potassium is 5.5 mEq/L or higher . Care should be taken in patients with a serum creatinine level higher than 3.0 mg/dL . The blood potassium level and renal function should be checked before and within 1–4 weeks after administration of the drug and then again three or six months later. ACE inhibitors inhibit bradykinin degradation and can thus cause a dry cough, but this resolves within a few days to a few weeks after stopping the medication. Dry cough is more common in women and non-smokers. ARBs have no effect on bradykinin and therefore rarely cause cough. ACE inhibitors/ARBs are contraindicated in pregnant women because of their teratogenic effects on the fetus.
|
[
"Hae-Young Lee",
"Jinho Shin",
"Gheun-Ho Kim",
"Sungha Park",
"Sang-Hyun Ihm",
"Hyun Chang Kim",
"Kwang-il Kim",
"Ju Han Kim",
"Jang Hoon Lee",
"Jong-Moo Park",
"Wook Bum Pyun",
"Shung Chull Chae"
] |
https://doi.org/10.1186/s40885-019-0124-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999995 |
31388453_p89
|
31388453
|
sec[1]/sec[2]/sec[1]/sec[3]/p[1]
|
Angiotensin converting enzyme inhibitors / angiotensin receptor blockers
| 2.314453 |
biomedical
|
Other
|
[
0.970703125,
0.02685546875,
0.0024871826171875
] |
[
0.003231048583984375,
0.98974609375,
0.001373291015625,
0.005878448486328125
] |
Side effects include hyperkalemia, acute renal damage in bilateral renal artery stenosis, abnormal taste, leukopenia, angioedema, and rash.
|
[
"Hae-Young Lee",
"Jinho Shin",
"Gheun-Ho Kim",
"Sungha Park",
"Sang-Hyun Ihm",
"Hyun Chang Kim",
"Kwang-il Kim",
"Ju Han Kim",
"Jang Hoon Lee",
"Jong-Moo Park",
"Wook Bum Pyun",
"Shung Chull Chae"
] |
https://doi.org/10.1186/s40885-019-0124-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999995 |
31388453_p90
|
31388453
|
sec[1]/sec[2]/sec[1]/sec[4]/p[0]
|
Other agents
| 3.990234 |
biomedical
|
Review
|
[
0.98974609375,
0.007415771484375,
0.002880096435546875
] |
[
0.00379180908203125,
0.01898193359375,
0.97607421875,
0.001010894775390625
] |
Alpha-blockers can alleviate urinary symptoms in patients with prostate enlargement and also improve the metabolism of glucose and lipids. However, they can cause orthostatic hypotension and are associated with worsening of heart failure. Agents that act on the central nervous system, such as clonidine, methyldopa, and reserpine, have many side effects and are therefore not recommended as first-line drugs. Renin inhibitors have been developed and used in other countries but were not introduced in Korea. Renin inhibitors significantly reduced BP and proteinuria when used alone or in combination with diuretics. However, aliskiren has not been proven to improve the prognosis of patients with CVD. Methyldopa is still preferred for the treatment of HTN in pregnant women but is not the first choice because of its side effects. Hydralazine is a vasodilator that is relatively safe for pregnant women with HTN.
|
[
"Hae-Young Lee",
"Jinho Shin",
"Gheun-Ho Kim",
"Sungha Park",
"Sang-Hyun Ihm",
"Hyun Chang Kim",
"Kwang-il Kim",
"Ju Han Kim",
"Jang Hoon Lee",
"Jong-Moo Park",
"Wook Bum Pyun",
"Shung Chull Chae"
] |
https://doi.org/10.1186/s40885-019-0124-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
31388453_p91
|
31388453
|
sec[1]/sec[2]/sec[2]/p[0]
|
Combination therapy
| 3.941406 |
biomedical
|
Review
|
[
0.95166015625,
0.0450439453125,
0.003505706787109375
] |
[
0.011505126953125,
0.2283935546875,
0.7548828125,
0.005157470703125
] |
More than 2/3 of patients with HTN require drugs from more than two drug classes with different mechanisms to achieve control of HTN. Combination therapy is particularly helpful for patients receiving prolonged BP treatment, high risk patients, and patients with lower target BP. If the first drug used is not effective for BP control, then a drug of another class should be tried. If the efficacy is insufficient, the dose should be increased or another drug added. However, it is recommended to combine two different drugs in smaller doses rather than to increase the dosage of one drug because such low dose combinations lower BP more effectively and improve the adherence while decreasing the adverse effects . In high risk HTN, the prognosis can be improved as soon as BP is lowered below the target. Therefore, we recommend the use of combination therapy from the beginning in grade 2 or high risk HTN . In this case, single pill combination can be considered as a first-line treatment because it improves drug adherence . However, there is the disadvantage that the single pill combination cannot control the drug dose freely when the side effect of the drug occurs. Since there is no direct comparative study with the existing combination therapies, the choice of the single pill combination may be determined by adherence, possible adverse effects, and the target BP. Fig. 3 Choice of single drug or combination drugs according to the level of blood pressure and the global cardiovascular risk
|
[
"Hae-Young Lee",
"Jinho Shin",
"Gheun-Ho Kim",
"Sungha Park",
"Sang-Hyun Ihm",
"Hyun Chang Kim",
"Kwang-il Kim",
"Ju Han Kim",
"Jang Hoon Lee",
"Jong-Moo Park",
"Wook Bum Pyun",
"Shung Chull Chae"
] |
https://doi.org/10.1186/s40885-019-0124-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
31388453_p92
|
31388453
|
sec[1]/sec[2]/sec[2]/p[1]
|
Combination therapy
| 3.980469 |
biomedical
|
Review
|
[
0.986328125,
0.0109710693359375,
0.0026950836181640625
] |
[
0.00943756103515625,
0.03448486328125,
0.955078125,
0.0011272430419921875
] |
If BP is not controlled with a single drug, two drugs should be combined for BP control. Combination therapy is more effective than single-drug therapy at a higher dose . However, it has not been fully evaluated which combination is best. Combination therapy chosen from the renin-angiotensin system inhibitors, calcium channel blockers, and diuretics is recommended first because it has shown relatively good results , but beta-blockers can also be combined with drugs of other classes . However, the combination of beta-blockers and diuretics may increase the incidence of diabetes and metabolic disorders and thus requires regular monitoring. Combination therapy with ARBs and ACE inhibitors may be slightly more effective for reducing proteinuria but increases the risk for end-stage renal failure, stroke, and other CVD, therefore is not recommended [ 151 – 153 ]. Fig. 4 Recommended combination therapy, thick lines; preferred combination, thin line; feasible combination
|
[
"Hae-Young Lee",
"Jinho Shin",
"Gheun-Ho Kim",
"Sungha Park",
"Sang-Hyun Ihm",
"Hyun Chang Kim",
"Kwang-il Kim",
"Ju Han Kim",
"Jang Hoon Lee",
"Jong-Moo Park",
"Wook Bum Pyun",
"Shung Chull Chae"
] |
https://doi.org/10.1186/s40885-019-0124-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
31388453_p93
|
31388453
|
sec[1]/sec[2]/sec[3]/p[0]
|
Resistant hypertension
| 3.117188 |
biomedical
|
Other
|
[
0.740234375,
0.251953125,
0.0076751708984375
] |
[
0.002223968505859375,
0.9833984375,
0.00763702392578125,
0.00652313232421875
] |
Recommendations Class Level References •Examination of adherence and ambulatory BP monitoring or home BP monitoring is recommended to exclude pseudo-resistant HTN. I B • Addition of low-dose spironolactone can be considered for the treatment of resistant HTN. IIa B
|
[
"Hae-Young Lee",
"Jinho Shin",
"Gheun-Ho Kim",
"Sungha Park",
"Sang-Hyun Ihm",
"Hyun Chang Kim",
"Kwang-il Kim",
"Ju Han Kim",
"Jang Hoon Lee",
"Jong-Moo Park",
"Wook Bum Pyun",
"Shung Chull Chae"
] |
https://doi.org/10.1186/s40885-019-0124-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
31388453_p94
|
31388453
|
sec[1]/sec[2]/sec[3]/p[1]
|
Resistant hypertension
| 3.859375 |
biomedical
|
Review
|
[
0.998046875,
0.0016412734985351562,
0.0004341602325439453
] |
[
0.0838623046875,
0.26171875,
0.65185546875,
0.0023975372314453125
] |
Resistant HTN is defined as BP that cannot be controlled (BP ≥140/90 mmHg) despite treatment with more than three different classes of antihypertensive drugs, including diuretics. The prevalence of resistant HTN is reported to be 5–30% in other countries. However, considering the frequency of pseudo-resistant HTN, the prevalence of true resistant HTN is assumed to be below 10%. Patients with resistant HTN are at much higher risk for complications such as CVD and CKD .
|
[
"Hae-Young Lee",
"Jinho Shin",
"Gheun-Ho Kim",
"Sungha Park",
"Sang-Hyun Ihm",
"Hyun Chang Kim",
"Kwang-il Kim",
"Ju Han Kim",
"Jang Hoon Lee",
"Jong-Moo Park",
"Wook Bum Pyun",
"Shung Chull Chae"
] |
https://doi.org/10.1186/s40885-019-0124-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
31388453_p95
|
31388453
|
sec[1]/sec[2]/sec[3]/p[2]
|
Resistant hypertension
| 3.990234 |
biomedical
|
Study
|
[
0.994140625,
0.005756378173828125,
0.00022649765014648438
] |
[
0.4833984375,
0.216064453125,
0.291015625,
0.00959014892578125
] |
Among the wide range of causes of resistant HTN (Table 13 ), non-adherence is the most common. In addition, medications taken for relief of cold symptoms, non-steroidal anti-inflammatory drugs, adrenal cortical steroids, birth control pills, excessive salt intake, and excessive alcohol consumption can also cause resistant HTN. If diuretics have not been included in the regimen, volume overload can cause resistant HTN. Finally, secondary HTN can cause resistant HTN. Table 13 Differential diagnosis of uncontrolled hypertension Causes Conditions Inappropriate BP measurement White coat hypertension Calcified vessel in the elderly (pseudohypertension) Wrong cuff use, using too small cuff Lifestyle factors Severe weight gain, Heavy or binge drinking, Sleep apnea syndrome Volume overload Excess salt intake, Volume expansion by renal diseases, Insufficient use of diuretics Medication Poor compliance, Insufficient dose, or ineffective combination Drug interaction/adverse effects Nonsteroidal anti-inflammatory drugs (NSAIDs) Oral pills, Corticosteroid, Herbal licorice Secondary hypertension
|
[
"Hae-Young Lee",
"Jinho Shin",
"Gheun-Ho Kim",
"Sungha Park",
"Sang-Hyun Ihm",
"Hyun Chang Kim",
"Kwang-il Kim",
"Ju Han Kim",
"Jang Hoon Lee",
"Jong-Moo Park",
"Wook Bum Pyun",
"Shung Chull Chae"
] |
https://doi.org/10.1186/s40885-019-0124-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
31388453_p96
|
31388453
|
sec[1]/sec[2]/sec[3]/p[3]
|
Resistant hypertension
| 4.050781 |
biomedical
|
Other
|
[
0.8515625,
0.145751953125,
0.0027370452880859375
] |
[
0.0259857177734375,
0.88525390625,
0.0740966796875,
0.0146942138671875
] |
To diagnose resistant HTN, treatment adherence should be confirmed and then the home BP or ambulatory BP should be monitored in order to exclude white coat HTN. If BP cannot be controlled despite the use of effective doses of three different classes of drug, then the dose of diuretics should be increased, or thiazide diuretics changed to loop diuretics in patients with renal impairment. However, most patients with resistant HTN require a different mechanism for BP control, and the fourth drug added should be spironolactone, amiloride, or an alpha-blocker such as doxazosin [ 156 – 159 ]. When spironolactone or amiloride is added in patients treated with ACE inhibitors or ARBs, the blood potassium level should be checked within 1–2 weeks.
|
[
"Hae-Young Lee",
"Jinho Shin",
"Gheun-Ho Kim",
"Sungha Park",
"Sang-Hyun Ihm",
"Hyun Chang Kim",
"Kwang-il Kim",
"Ju Han Kim",
"Jang Hoon Lee",
"Jong-Moo Park",
"Wook Bum Pyun",
"Shung Chull Chae"
] |
https://doi.org/10.1186/s40885-019-0124-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
31388453_p97
|
31388453
|
sec[1]/sec[2]/sec[4]/p[0]
|
Device-based hypertension treatment
| 2.632813 |
biomedical
|
Other
|
[
0.96875,
0.0279693603515625,
0.003314971923828125
] |
[
0.00446319580078125,
0.9775390625,
0.01503753662109375,
0.002735137939453125
] |
Carotid baroreceptor stimulation or renal denervation may be tried in patients with true resistant HTN since the risk of procedure-related complication is low. However, there are non-responders and a lack of evidence of long-term effects, therefore it is not currently recommended .
|
[
"Hae-Young Lee",
"Jinho Shin",
"Gheun-Ho Kim",
"Sungha Park",
"Sang-Hyun Ihm",
"Hyun Chang Kim",
"Kwang-il Kim",
"Ju Han Kim",
"Jang Hoon Lee",
"Jong-Moo Park",
"Wook Bum Pyun",
"Shung Chull Chae"
] |
https://doi.org/10.1186/s40885-019-0124-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
31388453_p98
|
31388453
|
sec[1]/sec[2]/sec[5]/p[0]
|
Reduction or discontinuation of antihypertensive medications
| 3.568359 |
biomedical
|
Other
|
[
0.73876953125,
0.25537109375,
0.00566864013671875
] |
[
0.0027713775634765625,
0.98388671875,
0.005619049072265625,
0.0079498291015625
] |
In patients whose BP has been well controlled for years, or for an extended period, it may be possible to reduce the number and/or dosage of drugs. This may particularly be the case if BP control is accompanied by healthy lifestyle changes such as weight loss, exercise habits, and a low-fat and low-salt diet, which remove environmental pressor influences. A reduction of medications should be made gradually, and the patient should be checked frequently, for example at least for three months, because reappearance of HTN can occur frequently .
|
[
"Hae-Young Lee",
"Jinho Shin",
"Gheun-Ho Kim",
"Sungha Park",
"Sang-Hyun Ihm",
"Hyun Chang Kim",
"Kwang-il Kim",
"Ju Han Kim",
"Jang Hoon Lee",
"Jong-Moo Park",
"Wook Bum Pyun",
"Shung Chull Chae"
] |
https://doi.org/10.1186/s40885-019-0124-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
31388453_p99
|
31388453
|
sec[1]/sec[2]/sec[6]/p[0]
|
Managing concomitant cardiovascular disease risk
| 3.029297 |
biomedical
|
Other
|
[
0.974609375,
0.0229644775390625,
0.0023193359375
] |
[
0.00263214111328125,
0.97900390625,
0.0166473388671875,
0.0018491744995117188
] |
The goal of antihypertensive therapy is to reduce the overall CV risk in patients who have other risk factors such as diabetes, dyslipidemia, CAD, stroke, and CKD. Accordingly, these other risk factors should be treated concurrently.
|
[
"Hae-Young Lee",
"Jinho Shin",
"Gheun-Ho Kim",
"Sungha Park",
"Sang-Hyun Ihm",
"Hyun Chang Kim",
"Kwang-il Kim",
"Ju Han Kim",
"Jang Hoon Lee",
"Jong-Moo Park",
"Wook Bum Pyun",
"Shung Chull Chae"
] |
https://doi.org/10.1186/s40885-019-0124-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999995 |
31388453_p100
|
31388453
|
sec[1]/sec[2]/sec[6]/sec[0]/p[0]
|
Antiplatelet therapy
| 3.767578 |
biomedical
|
Other
|
[
0.95947265625,
0.0380859375,
0.0023136138916015625
] |
[
0.005863189697265625,
0.79052734375,
0.1973876953125,
0.006061553955078125
] |
Aspirin administration has been shown to produce an absolute benefit for the secondary prevention of CVD in patients with HTN . However, the role of aspirin for primary prevention remains a matter of debate, leaning towards the negative side. Low-dose aspirin (100 mg) can be prescribed to patients in high risk groups in order to reduce the risk of CVD . Antiplatelet agents should be administered after the BP is controlled, and patients should be checked periodically for gastrointestinal bleeding.
|
[
"Hae-Young Lee",
"Jinho Shin",
"Gheun-Ho Kim",
"Sungha Park",
"Sang-Hyun Ihm",
"Hyun Chang Kim",
"Kwang-il Kim",
"Ju Han Kim",
"Jang Hoon Lee",
"Jong-Moo Park",
"Wook Bum Pyun",
"Shung Chull Chae"
] |
https://doi.org/10.1186/s40885-019-0124-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999994 |
31388453_p101
|
31388453
|
sec[1]/sec[2]/sec[6]/sec[1]/p[0]
|
Lipid-lowering agents
| 3.861328 |
biomedical
|
Review
|
[
0.99609375,
0.002960205078125,
0.000988006591796875
] |
[
0.01611328125,
0.045013427734375,
0.93798828125,
0.001117706298828125
] |
Lipid-lowering agents have a protective effect on high risk patients with HTN. Although there is very little Korean data, a 50% reduction in LDL-cholesterol in patients who had an LDL-cholesterol level ≥ 130 mg/dL significantly lowered the risk of CVD . Lowering the LDL-cholesterol level to < 70 mg/dL should be recommended in patients with CAD . There is evidence for reducing the LDL-cholesterol level to < 135 mg/dL in patients with stroke , however, there is little data regarding the effects of lowering the LDL-cholesterol to < 70 mg/dL in such patients.
|
[
"Hae-Young Lee",
"Jinho Shin",
"Gheun-Ho Kim",
"Sungha Park",
"Sang-Hyun Ihm",
"Hyun Chang Kim",
"Kwang-il Kim",
"Ju Han Kim",
"Jang Hoon Lee",
"Jong-Moo Park",
"Wook Bum Pyun",
"Shung Chull Chae"
] |
https://doi.org/10.1186/s40885-019-0124-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
31388453_p102
|
31388453
|
sec[1]/sec[2]/sec[6]/sec[2]/p[0]
|
Glycemic control
| 3.867188 |
biomedical
|
Other
|
[
0.96484375,
0.033660888671875,
0.0015897750854492188
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[
0.0102081298828125,
0.859375,
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0.00574493408203125
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The goal of glycemic control in patients with DM is less than 6.5% of glycated hemoglobin, further lowering if there is no complication associated with early diabetes and low risk of hypoglycemia. Conversely, in patients with severe hypoglycemia, short life expectancy, advanced microvascular and macrovascular complications, and elderly people over 75 years of age, the goal of glycemic control can be individualized taking into account the risk of hypoglycemia .
|
[
"Hae-Young Lee",
"Jinho Shin",
"Gheun-Ho Kim",
"Sungha Park",
"Sang-Hyun Ihm",
"Hyun Chang Kim",
"Kwang-il Kim",
"Ju Han Kim",
"Jang Hoon Lee",
"Jong-Moo Park",
"Wook Bum Pyun",
"Shung Chull Chae"
] |
https://doi.org/10.1186/s40885-019-0124-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
31388453_p103
|
31388453
|
sec[1]/sec[2]/sec[7]/p[0]
|
Patient monitoring and follow-up
| 3.556641 |
clinical
|
Other
|
[
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[
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] |
Patients should generally be followed up once monthly, at least until the target BP is achieved. Patients with severe HTN (grade 2) require more frequent follow-up. The serum potassium and creatinine levels should be measured at least 1–2 times yearly. If the BP is controlled and stable, then the patient should be followed up every 3–6 months. A longer follow-up interval may be associated with low adherence. Therefore, patient adherence also must be monitored as well as the regular follow up tests for blood samples. A longer follow-up interval to monitor the status of BP control can be achieved by encouraging home BP measurement.
|
[
"Hae-Young Lee",
"Jinho Shin",
"Gheun-Ho Kim",
"Sungha Park",
"Sang-Hyun Ihm",
"Hyun Chang Kim",
"Kwang-il Kim",
"Ju Han Kim",
"Jang Hoon Lee",
"Jong-Moo Park",
"Wook Bum Pyun",
"Shung Chull Chae"
] |
https://doi.org/10.1186/s40885-019-0124-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
31388453_p104
|
31388453
|
sec[1]/sec[2]/sec[8]/p[0]
|
Adherence
| 3.617188 |
biomedical
|
Other
|
[
0.890625,
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[
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Trust between doctor and patient is the most important issue in the treatment of HTN, and the patient should therefore be encouraged to participate in the treatment plan. Many patients may have obtained information about various antihypertensive agents through various routes, so discussion may be necessary. First, identify the patient’s point of view to determine the relative importance of efficacy, cost-effectiveness, and side effects. It is necessary to reduce overall CV risk as much as possible while maintaining the patient’s adherence. Self-measurement of BP by using HBPM can improve adherence .
|
[
"Hae-Young Lee",
"Jinho Shin",
"Gheun-Ho Kim",
"Sungha Park",
"Sang-Hyun Ihm",
"Hyun Chang Kim",
"Kwang-il Kim",
"Ju Han Kim",
"Jang Hoon Lee",
"Jong-Moo Park",
"Wook Bum Pyun",
"Shung Chull Chae"
] |
https://doi.org/10.1186/s40885-019-0124-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
31366392_p0
|
31366392
|
sec[0]/p[0]
|
Introduction
| 3.894531 |
biomedical
|
Other
|
[
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[
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Neonatal diabetes mellitus (NDM) is a monogenic form of diabetes that is characterized by hyperglycemia and the need for insulin treatment within the first 6 months of life . Symptoms of NDM include frequent urination and dehydration. NDM can be diagnosed by finding elevated levels of glucose in blood or urine. In severe cases, the deficiency of insulin may cause the body to produce an excess of acid, resulting in a potentially life-threatening condition called ketoacidosis . NDM is a rare condition occurring in only one in 100,000 to 500,000 live births .
|
[
"Leyla Sahebi",
"Nikoo Niknafs",
"Hosein Dalili",
"Elahe Amini",
"Tahereh Esmaeilnia",
"Mahsa Amoli",
"Nahid Farrokhzad"
] |
https://doi.org/10.1186/s13256-019-2149-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
31366392_p1
|
31366392
|
sec[0]/p[1]
|
Introduction
| 4.019531 |
biomedical
|
Review
|
[
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[
0.10333251953125,
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Clinically, NDM can be divided into three subgroups: (i) transient NDM (TNDM) in which insulin secretion is spontaneously recovered by several months of age (at a median age of 3 month); (ii) permanent NDM (PNDM) requiring lifelong medication; and (iii) PNDM existing as part of a syndrome (syndromic NDM). This phenotypic classification is useful, as the most common causative genetic abnormalities differ by each subtype, although overlap exists .
|
[
"Leyla Sahebi",
"Nikoo Niknafs",
"Hosein Dalili",
"Elahe Amini",
"Tahereh Esmaeilnia",
"Mahsa Amoli",
"Nahid Farrokhzad"
] |
https://doi.org/10.1186/s13256-019-2149-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
31366392_p2
|
31366392
|
sec[0]/p[2]
|
Introduction
| 4.199219 |
biomedical
|
Study
|
[
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[
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Recent molecular analysis of NDM identified at least 12 responsible genes: chromosome 6q24, KCNJ11 , ABCC8 , INS , FOXP3 , GCK , IPF1 which is also known as pancreatic and duodenal homeobox 1 ( PDX1 ), PTF1A , EIF2AK3 , GLUT2 , HNF1β , and GLIS3 . Defects on chromosome 6q24 (approximately 70%) and the KCNJ11 mutation have been recognized as the major causes of TNDM and PNDM, respectively, in Caucasians imprinting . Early diagnosis as well as early insulin therapy initiation prevents the metabolic catastrophe of ketoacidosis and development of chronic and irreversible complications. Determination of clinical and molecular characteristics of this disorder helps to manage the short-term and long-term treatment, and, finally, it provides new achievements for future research. In this study, for the first time, we reported the case of an Iranian patient with NDM with novel homozygous mutation in PDX1 ( IPF1 ) gene located in exon 2.
|
[
"Leyla Sahebi",
"Nikoo Niknafs",
"Hosein Dalili",
"Elahe Amini",
"Tahereh Esmaeilnia",
"Mahsa Amoli",
"Nahid Farrokhzad"
] |
https://doi.org/10.1186/s13256-019-2149-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999999 |
31366392_p3
|
31366392
|
sec[1]/sec[0]/p[0]
|
Clinical manifestations
| 3.494141 |
clinical
|
Clinical case
|
[
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[
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Our patient was born by caesarean section in Vali-Asr Hospital, Tehran. He was an Iranian 65-day-old boy and was the second child of consanguineous healthy parents. It is noteworthy that his mother had a history of gestational diabetes and his parents’ relatives had diabetes mellitus type 2 history too (second-degree relatives). He was born at 38 weeks of gestation with birth weight of 1800 g (< third percentile) and length 46 cm (< third percentile). His blood pressure was 57–89.7 mmHg with failure to thrive (FTT). This newborn had normal anterior fontanelle, soft abdomen, and undescended testis. Other clinical examinations revealed heart rate (HR) 190 beats per minute, Saturation of Peripheral Oxygen (spO 2 ) 5 minutes 87%, without respiratory distress syndrome (RDS).
|
[
"Leyla Sahebi",
"Nikoo Niknafs",
"Hosein Dalili",
"Elahe Amini",
"Tahereh Esmaeilnia",
"Mahsa Amoli",
"Nahid Farrokhzad"
] |
https://doi.org/10.1186/s13256-019-2149-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
31366392_p4
|
31366392
|
sec[1]/sec[1]/p[0]
|
Laboratory diagnostic methods
| 3.259766 |
biomedical
|
Study
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[
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[
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A drop of capillary blood (drawn from the heel) was sampled and applied to a test strip (Gluco Easy; Kyunggi, South Korea) to measure level of glucose. Before sampling, the baby’s heel was warmed up by hand massage followed by disinfecting the spot, and then a blood sample was taken.
|
[
"Leyla Sahebi",
"Nikoo Niknafs",
"Hosein Dalili",
"Elahe Amini",
"Tahereh Esmaeilnia",
"Mahsa Amoli",
"Nahid Farrokhzad"
] |
https://doi.org/10.1186/s13256-019-2149-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
31366392_p5
|
31366392
|
sec[1]/sec[1]/p[1]
|
Laboratory diagnostic methods
| 4.09375 |
biomedical
|
Study
|
[
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[
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Two ml of arterial blood was taken by a trained nurse. White blood cell (WBC) were counted with automated counters by Wright or May–Grünwald–Giemsa technique. Hemoglobin (HGB) and platelet (PLT) determinations were performed by an automated cell counter too. C-reactive protein (CRP) was measured in ethylenediaminetetraacetic acid (EDTA)-blood samples by a rapid immunometric method. A standard enzymatic test was used to measure alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Bilirubin was measured by chromatography and amylase was measured by photometry (α-Amylase Kit).
|
[
"Leyla Sahebi",
"Nikoo Niknafs",
"Hosein Dalili",
"Elahe Amini",
"Tahereh Esmaeilnia",
"Mahsa Amoli",
"Nahid Farrokhzad"
] |
https://doi.org/10.1186/s13256-019-2149-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999995 |
31366392_p6
|
31366392
|
sec[1]/sec[2]/p[0]
|
Laboratory and imaging findings
| 2.441406 |
clinical
|
Clinical case
|
[
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[
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0.97900390625
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An ultrasound of our patient revealed duodenal atresia, fatty liver, and normal spleen and pancreas. Echocardiography showed atrial septal defects (ASDs). Ultrasound of his brain revealed germinal matrix hemorrhage (GMH); electroencephalography was abnormal.
|
[
"Leyla Sahebi",
"Nikoo Niknafs",
"Hosein Dalili",
"Elahe Amini",
"Tahereh Esmaeilnia",
"Mahsa Amoli",
"Nahid Farrokhzad"
] |
https://doi.org/10.1186/s13256-019-2149-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999995 |
31366392_p7
|
31366392
|
sec[1]/sec[2]/p[1]
|
Laboratory and imaging findings
| 2.585938 |
biomedical
|
Clinical case
|
[
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[
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A magnetic resonance imaging (MRI) study demonstrated hypogenesis of the corpus callosum. A lumbar puncture culture was negative.
|
[
"Leyla Sahebi",
"Nikoo Niknafs",
"Hosein Dalili",
"Elahe Amini",
"Tahereh Esmaeilnia",
"Mahsa Amoli",
"Nahid Farrokhzad"
] |
https://doi.org/10.1186/s13256-019-2149-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
31366392_p8
|
31366392
|
sec[1]/sec[2]/p[2]
|
Laboratory and imaging findings
| 4.085938 |
biomedical
|
Clinical case
|
[
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[
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Blood examination on the first day (day of birth) showed disseminated intravascular coagulation (DIC), anemia (Hb, 6/4), metabolic acidosis, thrombocytopenia (PLT, 116), hyperbilirubinemia, and neonatal cholestasis. The laboratory findings after the first 24 hours of birth are presented in Table 1 . Table 1 The clinical report, treatment process, and laboratory findings after the first 24 hours of birth Neonate’s age Clinical report Treatment progress Laboratory findings HB (g/dL) WBC (n/ml) CRP (mg/l) BS (mg/dl) Bili-T (mg/dl) Bili-D (mg/dl) Amylase AST (U/L) ALT (U/L) One-day-old to 7-day-old -Severe IUGR -Embryonic ultrasound document = duodenal atresia detection -HR = 130 -RR = 40 -spO 2 = 95% -Echocardiography = ASD -Admission in NICU -Oxygen therapy by oxygen hood -Broad-spectrum antibiotic therapy (ciprofloxacin, colistin, linezolid, amphotericin B) -Injection of pack cell, IVIG, fresh frozen plasma, cryoprecipitate, and G-CSF -Surgery of duodenal atresia 6.4 2.9 – – – – – – – 7-day-old to 20-day-old -BP = 75/43(mmHg) -Ultrasound of kidneys = normal Ultrasound of liver = normal Ultrasound of brain = GMH -Electroencephalography = Abnormal -Phenobarbital; 3 mg/kg 10.5 4.49 – – – – – – – 20-day-old to 25-day-old -Lumbar puncture culture = negative -Glucose test every 2 hours = hyperglycemia Subcutaneous insulin injection/0.03 unit – – – -First three levels every 2 hours were: 280, 300, 496 -After subcutaneous regular insulin injection: 360 – – – – – 26-day-old -spO 2 = 98% -BP = 92/48 -Glucose test every 2 hours = hyperglycemia -MRI = hypogenesis of the corpus callosum Subcutaneous regular insulin injection; 0.03unit 8.7 – – 157 – – – – – 26-day-old to 31-day-old -Glucose test every 2 hours -Stool exam = acholic Stool -Rubella IgG: high -CMV IgG: high -PCR CMV = negative -Subcutaneous regular insulin injection; 0.03 - 9.3 5.4 68.0 206 – – – – – 32-day-old -BP = 87/72 -Glucose test every four hours -Diarrhea Resistance to insulin Pancreas ultrasound = normal -Intravenous insulin injection; if patient is NPO (start the dose of 0.02 unit) – – – 200 4.4 3.9 2.9 57 42 32-day-old to 40-day-old -Genetic counseling -Pedigree determination -Genotyping -Probability of neonate diabetes – – – – – – – – – 40-day-old to 48-day-old Glucose test every 4 hours Stool exam = acholic Stool -Fisting in fingers -Severe FTT -Doppler ultrasound = fatty liver -Eye examination = normal - Intravenous insulin injection (0.1 u/Kg/hour; if BS > 250) Glibenclamide prescription -Ursobil (ursodeoxycholic acid) prescription 4.6 34.0 – – – – – – – 48-day-old to 53-day-old -Glucose test every 4 hours -If BS > 250 prescription insulin, if BS < 50 prescription dextrose 10% – – – – – – – – – 57-day-old -Glucose test every 4 hours -Regular insulin;0.2 and NPH insulin; 0.4 after 48 hours -After regular insulin; 0.2: 564 After NPH insulin; 0.4: 228 60-day-old Glucose test every 4 hours -If BS > 250 prescription insulin, if BS < 50 prescription dextrose 10% 166 65-day-old Discharged at 65-days old against medical advice ALT alanine aminotransferase, ASD atrial septal defect, AST aspartate aminotransferase, Bili-D bilirubin direct, Bili-T total bilirubin, BP blood pressure, BS blood sugar, CMV cytomegalovirus, CRP C-reactive protein, FTT FailureTo Thrive, G-CSF granulocyte colony-stimulating factor, GMH germinal matrix hemorrhage, HGB hemoglobin, HR heart rate, IUGR intrauterine growth retardation, IVIG intravenous immunoglobulin, MRI magnetic resonance imaging, NICU neonatal intensive care unit, NPH isophane insulin, NPO Nothing by Mouth, PCR polymerase chain reaction, RR respiratory rate, spO 2 Saturation of Peripheral Oxygen, WBC white blood cell
|
[
"Leyla Sahebi",
"Nikoo Niknafs",
"Hosein Dalili",
"Elahe Amini",
"Tahereh Esmaeilnia",
"Mahsa Amoli",
"Nahid Farrokhzad"
] |
https://doi.org/10.1186/s13256-019-2149-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999995 |
31366392_p9
|
31366392
|
sec[1]/sec[3]/p[0]
|
Genetic findings
| 4.078125 |
biomedical
|
Study
|
[
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[
0.970703125,
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Genetic analysis detected a homozygous mutation on PDX1 gene on chromosome 13: 27,920,020-27,926,231 (c.499 T>G) . (GRCh38): 13:27,919,981-27,926,313 with cytogenetic location: 13q12.2 and genomic coordinates (GRCh38): 13:27,919,981-27,926,313. Fig. 1 The sequenced data showing mutation in c.499 T>G of PDX1 gene
|
[
"Leyla Sahebi",
"Nikoo Niknafs",
"Hosein Dalili",
"Elahe Amini",
"Tahereh Esmaeilnia",
"Mahsa Amoli",
"Nahid Farrokhzad"
] |
https://doi.org/10.1186/s13256-019-2149-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
31366392_p10
|
31366392
|
sec[1]/sec[3]/p[1]
|
Genetic findings
| 4.371094 |
biomedical
|
Study
|
[
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[
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This transcript has two exons, is annotated with 18 domains and features, and associated with 214 variations and maps to 38 oligo probes. This gene is a member of the human consensus coding sequence (CCDS) set. It is a novel homozygous mutation in the PDX1 ( IPF1 ) gene located in exon 2 , p.Phe167Val. This mutation was confirmed by Sanger sequencing. Some PDX1 mutations and their phenotypes shown in Table 2 . Table 2 Some PDX1 mutations and their phenotypes Phenotype Mutation dbSNP Pancreatic agenesis 1 maturity-onset diabetes of the young, Type 4, included PDX1 , 1-BP DEL, 188C – Diabetes mellitus, Type Ii, susceptibility to PDX1 , ASP76ASN [rs137852783] Diabetes mellitus, Type Ii, susceptibility to PDX1 , GLN59LEU [rs137852784] Diabetes mellitus, Type Ii, susceptibility to PDX1 , 3-BP INS, 243CCG – Diabetes mellitus, Type Ii, susceptibility to PDX1 , CYS18ARG [rs137852785] Diabetes mellitus, Type Ii, susceptibility to PDX1 , ARG197HIS [rs137852786] Reclassified – variant of unknown significance PDX1 , GLU224LYS [rs137852787] Pancreatic agenesis 1 Diabetes mellitus, Type Ii, susceptibility to, included PDX1 , GLU164ASP [rs80356661] Pancreatic agenesis 1 PDX1 , GLU178LYS [rs80356662] Pancreatic agenesis 1 PDX1 , GLU178GLY [rs387906777] dbSNP The Single Nucleotide Polymorphism Database
|
[
"Leyla Sahebi",
"Nikoo Niknafs",
"Hosein Dalili",
"Elahe Amini",
"Tahereh Esmaeilnia",
"Mahsa Amoli",
"Nahid Farrokhzad"
] |
https://doi.org/10.1186/s13256-019-2149-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
31366392_p11
|
31366392
|
sec[1]/sec[3]/p[2]
|
Genetic findings
| 1.988281 |
biomedical
|
Other
|
[
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[
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Pedigree analyses demonstrated diabetes mellitus type 2 in our patient’s mother and some maternal relatives.
|
[
"Leyla Sahebi",
"Nikoo Niknafs",
"Hosein Dalili",
"Elahe Amini",
"Tahereh Esmaeilnia",
"Mahsa Amoli",
"Nahid Farrokhzad"
] |
https://doi.org/10.1186/s13256-019-2149-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
31366392_p12
|
31366392
|
sec[1]/sec[4]/p[0]
|
Follow-up and treatment
| 3.632813 |
clinical
|
Clinical case
|
[
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On the 28th day, he was diagnosed as having hyperglycemia (serum glucose level was 496 mg/dL) by blood examination and treatment with regular daily insulin injections (1.0 unit/kg per day) was started immediately. The insulin infusion rates were regularly titrated according to pre-prandial blood sugar levels; the type of lactation was breast with fortified formula. Weight and height trend in relation to initiation and follow-up of insulin injection is presented in Table 3 . Glibenclamide was added later (at 47 days of age) and stopped at the age of 60 days. However, the baby continued to get regular isophane insulin (NPH). Table 3 Patient’s weight and height trend in relation to initiation and follow-up of insulin injection Index Birthday 2 months and 22 days 4 months and 4 days 6 months and 4 days Weight (g) 1800 3000 4000 5000 Height (cm) 46 50 55 65
|
[
"Leyla Sahebi",
"Nikoo Niknafs",
"Hosein Dalili",
"Elahe Amini",
"Tahereh Esmaeilnia",
"Mahsa Amoli",
"Nahid Farrokhzad"
] |
https://doi.org/10.1186/s13256-019-2149-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
31366392_p13
|
31366392
|
sec[1]/sec[4]/p[1]
|
Follow-up and treatment
| 2.244141 |
clinical
|
Clinical case
|
[
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0.005290985107421875
] |
[
0.0033512115478515625,
0.02105712890625,
0.0015773773193359375,
0.97412109375
] |
Other treatment operations included infant oxygen hood (oxyhood), nasal continuous positive airway pressure (nCPAP), broad-spectrum antibiotics prescription, granulocyte colony-stimulating factor (G-CSF), human intravenous immunoglobulin (IVIG), fresh frozen plasma (FFP), cryoprecipitate, surgery of duodenum atresia (at 28 days of age), phototherapy, ursodeoxycholic acid (UDCA), fat-soluble vitamins prescription, and total parenteral nutrition (TPN) for 65 days. He was discharged at 65-days old against medical advice, transferred to the city of residence, and was supervised by a gynecologist.
|
[
"Leyla Sahebi",
"Nikoo Niknafs",
"Hosein Dalili",
"Elahe Amini",
"Tahereh Esmaeilnia",
"Mahsa Amoli",
"Nahid Farrokhzad"
] |
https://doi.org/10.1186/s13256-019-2149-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
31366392_p14
|
31366392
|
sec[1]/sec[4]/p[2]
|
Follow-up and treatment
| 1.828125 |
biomedical
|
Study
|
[
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[
0.7529296875,
0.1207275390625,
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0.00351715087890625
] |
A summary of relevant past interventions and their outcomes is presented in Table 1 .
|
[
"Leyla Sahebi",
"Nikoo Niknafs",
"Hosein Dalili",
"Elahe Amini",
"Tahereh Esmaeilnia",
"Mahsa Amoli",
"Nahid Farrokhzad"
] |
https://doi.org/10.1186/s13256-019-2149-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
31366392_p15
|
31366392
|
sec[2]/p[0]
|
Discussion and conclusions
| 3.933594 |
biomedical
|
Clinical case
|
[
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[
0.10968017578125,
0.05059814453125,
0.004367828369140625,
0.83544921875
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Here, we report a syndromic case of NDM with mutation in PDX1 gene. This was a novel homozygous mutation, p.Phe167Val, is located in the gene on chromosome 13 (c.499 T>G). His mother had suffered from gestational diabetes and some second-degree relatives had diabetes mellitus type 2. There was no evidence of agenesis of the pancreas. Various single gene and chromosomal abnormalities have been identified that cause different manifestations of NDM .
|
[
"Leyla Sahebi",
"Nikoo Niknafs",
"Hosein Dalili",
"Elahe Amini",
"Tahereh Esmaeilnia",
"Mahsa Amoli",
"Nahid Farrokhzad"
] |
https://doi.org/10.1186/s13256-019-2149-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
31366392_p16
|
31366392
|
sec[2]/p[1]
|
Discussion and conclusions
| 4.339844 |
biomedical
|
Study
|
[
0.99951171875,
0.0003314018249511719,
0.00022554397583007812
] |
[
0.69384765625,
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0.298095703125,
0.001010894775390625
] |
NDM is permanent in nearly half of the patients and may be caused by mutations affecting genes that play a critical role in cell development, cell survival, or cell function. Recently, monogenic causes were recognized in 50% of cases of permanent insulin-dependent diabetes occurring before the age of 6 months . Syndromic NDM is most commonly a result of mutations in FOXP3 , EIF2AK3 , PTF1A GLIS3 , NEUROD1 , HNF1B , immunodysregulation polyendocrinopathy enteropathy X-linked (IPEX) syndrome, and PDX1 . PDX1 also termed IPF1 encodes insulin promoter factor1 with additional features of agenesis of the pancreas .
|
[
"Leyla Sahebi",
"Nikoo Niknafs",
"Hosein Dalili",
"Elahe Amini",
"Tahereh Esmaeilnia",
"Mahsa Amoli",
"Nahid Farrokhzad"
] |
https://doi.org/10.1186/s13256-019-2149-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999995 |
31366392_p17
|
31366392
|
sec[2]/p[2]
|
Discussion and conclusions
| 4.519531 |
biomedical
|
Study
|
[
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[
0.96533203125,
0.0010290145874023438,
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0.0006108283996582031
] |
PDX1 has been reported as a main factor in pancreas development and function . Mutations in PDX1 may be involved in several disorders, including agenesis of the pancreas or congenital pancreatic hypoplasia and diabetes mellitus . Clearly, if a patient presents with features consistent with a syndrome, testing for the relevant mutation should be carried out first. However, if negative, testing for the most prevalent causes in descending order should be carried out. With the exception of IPEX and HNF1B -related diabetes, the syndromic causes of NDM are autosomal recessive, carrying a 25% recurrence risk in subsequent children. A correct diagnosis that allows the proper treatment to be selected should lead to better glucose control and improved health in the long term. Testing of other family members may also be indicated to determine whether they are at risk for diabetes. According to studies, the same defect that causes PNDM or TNDM can be present in parents or other first-degree relatives and be diagnosed as type 1 diabetes, monogenic diabetes of youth, or type 2 diabetes mellitus as subsequently detailed. Current evidence suggests that the mutation is likely to be pathogenic. The first cases (three patients from two families) with biallelic PDX1 mutations that had complete pancreatic agenesis were found by Nicolino et al . . Later, De Franco et al. identified three cases with permanent neonatal diabetes (2.9%). One proband and his affected brother were compound heterozygotes for a frameshift and a novel missense mutation (p.A34fsX191; c.98dupC and p.P87L; c.260C>T). The other two probands were homozygous for novel PDX1 missense mutations (p.A152G; c.455C>G and p.R176Q; c.527G>A) .
|
[
"Leyla Sahebi",
"Nikoo Niknafs",
"Hosein Dalili",
"Elahe Amini",
"Tahereh Esmaeilnia",
"Mahsa Amoli",
"Nahid Farrokhzad"
] |
https://doi.org/10.1186/s13256-019-2149-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999995 |
31366392_p18
|
31366392
|
sec[2]/p[3]
|
Discussion and conclusions
| 3.921875 |
biomedical
|
Study
|
[
0.99951171875,
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] |
[
0.99072265625,
0.007232666015625,
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0.0012445449829101562
] |
This study reported a novel mutation related to NDM with mutation in PDX1 gene. Mutation in this gene is rare but detection of it is vital. Correctly distinguishing monogenic NDM from type 1 diabetes presenting in infancy critically impacts treatment decisions, surveillance of complications and associated conditions, and has important genetic implications for siblings and offspring of affected individuals.
|
[
"Leyla Sahebi",
"Nikoo Niknafs",
"Hosein Dalili",
"Elahe Amini",
"Tahereh Esmaeilnia",
"Mahsa Amoli",
"Nahid Farrokhzad"
] |
https://doi.org/10.1186/s13256-019-2149-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
31366392_p19
|
31366392
|
sec[3]/p[0]
|
Conclusion
| 2.550781 |
biomedical
|
Other
|
[
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[
0.0127105712890625,
0.9833984375,
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] |
The PDX1 gene in mutation screening for syndromic NDM is introduced as a genetic diagnosis even in the absence of pancreas appearances.
|
[
"Leyla Sahebi",
"Nikoo Niknafs",
"Hosein Dalili",
"Elahe Amini",
"Tahereh Esmaeilnia",
"Mahsa Amoli",
"Nahid Farrokhzad"
] |
https://doi.org/10.1186/s13256-019-2149-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
31366392_p20
|
31366392
|
sec[4]/sec[0]/p[0]
|
Untitled Section
| 1.841797 |
biomedical
|
Other
|
[
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[
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] |
Additional file 1: Figures S1 and S2: Molecular genetic laboratory reports.
|
[
"Leyla Sahebi",
"Nikoo Niknafs",
"Hosein Dalili",
"Elahe Amini",
"Tahereh Esmaeilnia",
"Mahsa Amoli",
"Nahid Farrokhzad"
] |
https://doi.org/10.1186/s13256-019-2149-x
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
31370900_p0
|
31370900
|
sec[0]/p[0]
|
Introduction
| 3.597656 |
biomedical
|
Study
|
[
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[
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0.0004673004150390625
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Despite considerable progress in the reduction of air pollution and its corresponding impact on health, air pollution studies have attracted more attention . PM 2.5 is the most sensitive marker of air pollution and environmental risk factors . The effect of PM 2.5 on CVD risk has been widely reported by both short- and long-term epidemiological studies . However, there is limited evidence from countries where severe environmental pollution and cardiovascular morbidity and mortality have become a challenge, particularly in Asian developing countries .
|
[
"Endawoke Amsalu",
"Tianqi Wang",
"Haibin Li",
"Yue Liu",
"Anxin Wang",
"Xiangtong Liu",
"Lixin Tao",
"Yanxia Luo",
"Feng Zhang",
"Xinghua Yang",
"Xia Li",
"Wei Wang",
"Xiuhua Guo"
] |
https://doi.org/10.1186/s12940-019-0506-2
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
31370900_p1
|
31370900
|
sec[0]/p[1]
|
Introduction
| 4.101563 |
biomedical
|
Study
|
[
0.99951171875,
0.0003681182861328125,
0.0003459453582763672
] |
[
0.99951171875,
0.0001819133758544922,
0.0003142356872558594,
0.0000712275505065918
] |
In China, 27% of cities experience extreme air pollution, and morbidity and mortality from CVD have been rising . Several studies associate an increase in CVD morbidity and mortality with PM 2.5 air pollution [ 7 – 9 ]. However, most of these studies mainly focus on emergency room visits and cause-specific CVD mortality [ 10 – 12 ]. For instance, a multicity study in China showed that a 10 μg/m 3 increase of PM 2.5 was associated with an increase in daily cardiovascular disease mortality of 0.315% (95% CI: 0.133–0.497%) . Although the use of hospital admissions is a more sensitive indicator than mortality and has great public health importance, adverse short-term effects of PM 2.5 on cause-specific CVD hospital admissions are not well documented in large cities such as Beijing. Moreover, the impact of PM 2.5 on the city-specific level has not been comprehensively reported. In this study, we estimate the daily effect of PM 2.5 on admissions for CVD and its subtypes (coronary heart disease: CHD, heart failure: HF, and atrial fibrillation: AF) in Beijing using a single-pollutant model, a two-pollutant model, and several subgroup analyses.
|
[
"Endawoke Amsalu",
"Tianqi Wang",
"Haibin Li",
"Yue Liu",
"Anxin Wang",
"Xiangtong Liu",
"Lixin Tao",
"Yanxia Luo",
"Feng Zhang",
"Xinghua Yang",
"Xia Li",
"Wei Wang",
"Xiuhua Guo"
] |
https://doi.org/10.1186/s12940-019-0506-2
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
31370900_p2
|
31370900
|
sec[1]/sec[0]/p[0]
|
Cardiovascular data
| 4.027344 |
biomedical
|
Study
|
[
0.9990234375,
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] |
[
0.99951171875,
0.00024580955505371094,
0.0002110004425048828,
0.00008511543273925781
] |
Records from hospital admissions for CVD between 1 January 2013 and 31 December 2017 were extracted from the Beijing Public Health Information Center ( http://www.phic.org.cn/ ). We extracted information on the patient’s date of hospital admission, principal diagnosis, age, and sex from each hospital admission record. Cause-specific CVD hospitalizations were identified based on the International Classification of Diseases, 10th Revision (ICD-10) codes: CHD (ICD-10: I20-I25), AF (ICD-10: I48) and HF (ICD-10: I50). In this study, the total number of CVD admissions was calculated as the sum the number of CHD, AF and HF admissions. Hospital admissions for CVD for patients under 18 years old were excluded from the current analysis because of the small number of records.
|
[
"Endawoke Amsalu",
"Tianqi Wang",
"Haibin Li",
"Yue Liu",
"Anxin Wang",
"Xiangtong Liu",
"Lixin Tao",
"Yanxia Luo",
"Feng Zhang",
"Xinghua Yang",
"Xia Li",
"Wei Wang",
"Xiuhua Guo"
] |
https://doi.org/10.1186/s12940-019-0506-2
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999995 |
31370900_p3
|
31370900
|
sec[1]/sec[0]/p[1]
|
Cardiovascular data
| 1.198242 |
biomedical
|
Other
|
[
0.7763671875,
0.004024505615234375,
0.2198486328125
] |
[
0.04107666015625,
0.95703125,
0.0007886886596679688,
0.0008797645568847656
] |
We did not use individual data identifiers; therefore, informed consent was not specifically required, but an official permit was required to access the data. The Institutional Review Board of Capital Medical University approved the study protocol .
|
[
"Endawoke Amsalu",
"Tianqi Wang",
"Haibin Li",
"Yue Liu",
"Anxin Wang",
"Xiangtong Liu",
"Lixin Tao",
"Yanxia Luo",
"Feng Zhang",
"Xinghua Yang",
"Xia Li",
"Wei Wang",
"Xiuhua Guo"
] |
https://doi.org/10.1186/s12940-019-0506-2
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
31370900_p4
|
31370900
|
sec[1]/sec[1]/p[0]
|
Air pollution and meteorological data
| 2.640625 |
biomedical
|
Study
|
[
0.720703125,
0.0011224746704101562,
0.27783203125
] |
[
0.99658203125,
0.0032138824462890625,
0.0002613067626953125,
0.00009918212890625
] |
Air pollution data were obtained from 35 fixed-site air quality–monitoring stations from Beijing Municipal Environmental Protection Bureau ( http://www.bjepb.gov.cn/ ) between 1 January and 31 December 2017, covering nearly every district (at the county level) in Beijing. The 24-h average concentrations of five pollutants were used in this study: particulate matter with an aerodynamic diameter less than 2.5 μm (PM 2.5 ), carbon monoxide (CO), sulfur dioxide (SO 2 ), nitrogen dioxide (NO 2 ) and the daily maximum 8-h average ozone concentrations (O 3 ). In addition, the mean air pressure, the daily mean temperature and the mean relative humidity were extracted for the same study period from the China Meteorological Data Sharing Service System ( https://data.cma.cn/en ).
|
[
"Endawoke Amsalu",
"Tianqi Wang",
"Haibin Li",
"Yue Liu",
"Anxin Wang",
"Xiangtong Liu",
"Lixin Tao",
"Yanxia Luo",
"Feng Zhang",
"Xinghua Yang",
"Xia Li",
"Wei Wang",
"Xiuhua Guo"
] |
https://doi.org/10.1186/s12940-019-0506-2
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
31370900_p5
|
31370900
|
sec[1]/sec[2]/p[0]
|
Study design
| 4.007813 |
biomedical
|
Study
|
[
0.99951171875,
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] |
[
0.9990234375,
0.0003910064697265625,
0.0003504753112792969,
0.00006473064422607422
] |
An ecological time series design was conducted to estimate the association between the short-term effects of PM 2.5 and hospital admissions for CVD. A time-series analysis based on general additive models have been widely used in epidemiological studies of air pollution to explore the short-term effects of air pollutant exposure on the risk of acute events.
|
[
"Endawoke Amsalu",
"Tianqi Wang",
"Haibin Li",
"Yue Liu",
"Anxin Wang",
"Xiangtong Liu",
"Lixin Tao",
"Yanxia Luo",
"Feng Zhang",
"Xinghua Yang",
"Xia Li",
"Wei Wang",
"Xiuhua Guo"
] |
https://doi.org/10.1186/s12940-019-0506-2
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
31370900_p6
|
31370900
|
sec[1]/sec[3]/p[0]
|
Statistical analysis
| 4.207031 |
biomedical
|
Study
|
[
0.99951171875,
0.0004839897155761719,
0.00020897388458251953
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[
0.99853515625,
0.00035858154296875,
0.0009036064147949219,
0.00012230873107910156
] |
A generalized additive model using a quasi-Poisson distribution was applied to estimate the effect of PM 2.5 on hospital admissions for CVD. The core model adjusted for the season, public holidays, the day of the week (DOW), and a long-term trend was created. A spline S (.) with 7 degrees of freedom ( df ) per year for a given time period was used to control for seasons and long-term trends, and 3 degrees of freedom ( df ) were used for temperature and relative humidity. DOW was used as a categorical variable, and public holidays were included as a two-level factor. The degrees of freedom ( df ) for calendar time, temperature and relative humidity were selected based on the parameters used in previous studies and were further tested by sensitivity analyses. A nonlinearity test using smoothing splines and 3 df graphically described the relationship (lag 0–1). A delayed-effect association was analyzed with separate lag structures for single day lags (from lag 0 to lag 3) and multiday lags (lag 0–1 and lag 0–3). We calculated the percentage change from the relative risk and Z-value to test the statistical significance of each subgroup difference with the formula \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ \mathrm{Z}=\left({\beta}_1-{\beta}_2\right)/\sqrt{SE_1^2+{SE}_2^2} $$\end{document} Z = β 1 − β 2 / SE 1 2 + SE 2 2 , where β 1 and β 2 are the effect estimates for the two categories, and SE 1 and SE 1 are their respective corresponding standard errors . We used a two-step model. First, the model that included the main single pollutant (PM 2.5 ) was entered alone. Second, two-pollutant models for SO 2 , CO, O 3 , and NO 2 were created, and the effects were estimated. Subgroup analyses by sex, age, and seasonal variation were also performed. We mainly reported the effect of PM 2.5 using a 2-day moving average concentration (lag 0–1) because this lag was more strongly associated with health effects. Additionally, to avoid the likely bias of the estimate of the effect PM 2.5 due to an inadequate control of temporal trends, we also performed an analysis by period to evaluate possible temporal trends in the health effects. Therefore, we conducted an analysis for each year and reported the percentage change with 95% confidence intervals for a 10 μg/m 3 increase in PM 2.5 . All data analyses were conducted with R version 3.0.1 .
|
[
"Endawoke Amsalu",
"Tianqi Wang",
"Haibin Li",
"Yue Liu",
"Anxin Wang",
"Xiangtong Liu",
"Lixin Tao",
"Yanxia Luo",
"Feng Zhang",
"Xinghua Yang",
"Xia Li",
"Wei Wang",
"Xiuhua Guo"
] |
https://doi.org/10.1186/s12940-019-0506-2
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
31370900_p7
|
31370900
|
sec[1]/sec[4]/p[0]
|
Sensitivity analysis
| 2.140625 |
biomedical
|
Study
|
[
0.9716796875,
0.0008897781372070312,
0.0272064208984375
] |
[
0.98974609375,
0.009613037109375,
0.00043892860412597656,
0.000225067138671875
] |
We conducted a series of sensitivity analyses by using alternative degrees of freedom (df) for calendar time, temperature and humidity. We used 5–10 df per year for time and 3–10 df for temperature and humidity .
|
[
"Endawoke Amsalu",
"Tianqi Wang",
"Haibin Li",
"Yue Liu",
"Anxin Wang",
"Xiangtong Liu",
"Lixin Tao",
"Yanxia Luo",
"Feng Zhang",
"Xinghua Yang",
"Xia Li",
"Wei Wang",
"Xiuhua Guo"
] |
https://doi.org/10.1186/s12940-019-0506-2
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
31370900_p8
|
31370900
|
sec[2]/p[0]
|
Results
| 4.195313 |
biomedical
|
Study
|
[
0.9990234375,
0.0006852149963378906,
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[
0.9990234375,
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In total, 460,938 hospital admissions from CVD were reported during the 5-year study period in Beijing, including 378,090 CHD, 24,455 AF and 58,393 HF admissions. Of these admissions, 54.9% were men, and 37.6% were under 65 years of age (Additional file 1 ). Table 1 shows the statistical descriptions of the daily hospital admissions for CVD, air pollution concentrations, and weather conditions. There were 252 hospital admissions from CVD per day on average. Table 1 Statistical descriptions of cardiovascular admissions, atmospheric pollutants, and meteorological variables during the study period Minimum P 25 Median Mean (SD) P 75 Maximum Hospital admission Cardiovascular disease 9 106 192 252.4 (165.1) 405 749 Coronary heart disease 2 77 159 207.1 (141.8) 340 632 Atrial fibrillation 0 4 10 13.4 (10.5) 22 53 Heart failure 0 20 29 32.0 (15.5) 43 90 Atmospheric pollutants SO 2 (μg/m 3 ) 0 4 8 15.31 (18.31) 19 133 NO 2 (μg/m 3 ) 0 34 44. 49.69 (23.34) 61 155 O 3 (μg/m 3 ) 0 49 81 95.66 (63.039) 136 367 PM 10 (μg/m 3 ) 0 50 86 102.30 (75.88) 130 820 PM 2.5 (μg/m 3 ) 0 30 59 76.86 (66.38) 102 477 Meteorological factors Average Temperature (°C) −16.92 0.99 14.52 13.09 (12.34) 24.09 38.51 Maximum Temperature (°C) −13.41 11.88 24.60 24.62 (15.80) 35.83 59.89 Minimum Temperature (°C) −19.16 −3.88 6.98 6.16 (12.08) 17.06 30.94 Humidity (%) 1.121 5.24 7.47 24.38 (26.66) 43.30 95.30 Air pressure (hPa) 970.5 985.50 993.0 993.90 (10.51) 1001.5 1022.40 P 25 = 25th percentile. P 75 = 75th percentile. CO = carbon monoxide. PM 2.5 = particulate matter with an aerodynamic diameter less than 2.5 μm. SO 2 = sulfur dioxide. NO 2 = nitrogen dioxide. O 3 = ozone
|
[
"Endawoke Amsalu",
"Tianqi Wang",
"Haibin Li",
"Yue Liu",
"Anxin Wang",
"Xiangtong Liu",
"Lixin Tao",
"Yanxia Luo",
"Feng Zhang",
"Xinghua Yang",
"Xia Li",
"Wei Wang",
"Xiuhua Guo"
] |
https://doi.org/10.1186/s12940-019-0506-2
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
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During the study period, the mean daily pollution concentration was 76.9 μg/m 3 for PM 2.5 , 15.3 μg/m 3 for SO 2 , and 49.7 μg/m 3 for NO 2 , and the mean 8-h maximum concentration for O 3 was 95.7 μg/m 3 . The daily mean ambient temperature was 13.9 °C, the relative humidity was 24.4%, and the air pressure was 1016.7 hPa (Table 1 ).
|
[
"Endawoke Amsalu",
"Tianqi Wang",
"Haibin Li",
"Yue Liu",
"Anxin Wang",
"Xiangtong Liu",
"Lixin Tao",
"Yanxia Luo",
"Feng Zhang",
"Xinghua Yang",
"Xia Li",
"Wei Wang",
"Xiuhua Guo"
] |
https://doi.org/10.1186/s12940-019-0506-2
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
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To visualize seasonal and long-term trends, we plotted the CVD admissions, atmospheric pollutants and meteorological factors against time using time-series graphs . Fig. 1 Time series plot of atmospheric pollutants and total CVD admissions from 2013 to 2017
|
[
"Endawoke Amsalu",
"Tianqi Wang",
"Haibin Li",
"Yue Liu",
"Anxin Wang",
"Xiangtong Liu",
"Lixin Tao",
"Yanxia Luo",
"Feng Zhang",
"Xinghua Yang",
"Xia Li",
"Wei Wang",
"Xiuhua Guo"
] |
https://doi.org/10.1186/s12940-019-0506-2
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
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Table 2 shows Spearman’s correlations for different air pollution concentrations and weather conditions during the study period. There were strong-to-moderate positive correlations between PM 2.5 and CO ( r = 0.724), NO 2 ( r = 0.722) and PM 10 ( r = 0.841), but the correlation between PM 2.5 and O 3 was negative and weak . Table 2 Spearman’s correlations between each atmospheric pollutants and meteorological factors in Beijing, 2013-2017 b Variables SO 2 CO NO 2 O 3 PM 10 PM 2.5 Temp Humidity SO 2 1.000 CO 0.6039 1.0000 NO 2 0.6552 0.7221 1.0000 O 3 −0.3621 − 0.4185 −0.4062 1.0000 PM 10 0.5715 0.5783 0.7005 −0.0304 1.0000 PM 2.5 0.5607 0.7246 0.7170 −0.1127 0.8417 1.0000 Temp −0.4938 − 0.3407 − 0.3014 0.8102 − 0.0197 − 0.0588 1.0000 Humidity −0.3893 0.0429 −0.0118 0.0108 −0.0279 0.0779 0.1052 1.0000 b All correlation coefficients were statistically significant ( P < 0.001) Temp: Temperature
|
[
"Endawoke Amsalu",
"Tianqi Wang",
"Haibin Li",
"Yue Liu",
"Anxin Wang",
"Xiangtong Liu",
"Lixin Tao",
"Yanxia Luo",
"Feng Zhang",
"Xinghua Yang",
"Xia Li",
"Wei Wang",
"Xiuhua Guo"
] |
https://doi.org/10.1186/s12940-019-0506-2
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
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Fig. 2 shows the exposure-response relationship curve of the PM 2.5 concentrations with total and cause-specific CVD admissions at lag0–1. The estimated dose-response relationships of the PM 2.5 concentrations with total CVD and CHD admissions showed a linear relationship with a sharp increase in the dose-response function at lower concentrations (0–50 μg/m 3 ) and a moderate increase at higher concentrations. For HF, the curve tended to plateau at higher PM 2.5 concentrations (200 μg/m 3 ). For AF, there appeared to be a small increase in the risk until the PM 2.5 concentration exceeded approximately 190 μg/m 3 . Fig. 2 Exposure-response relationship curves for the association between hospital admissions for total and cause-specific cardiovascular disease and the 2-day moving average (lag 0–1) of PM 2.5 concentrations
|
[
"Endawoke Amsalu",
"Tianqi Wang",
"Haibin Li",
"Yue Liu",
"Anxin Wang",
"Xiangtong Liu",
"Lixin Tao",
"Yanxia Luo",
"Feng Zhang",
"Xinghua Yang",
"Xia Li",
"Wei Wang",
"Xiuhua Guo"
] |
https://doi.org/10.1186/s12940-019-0506-2
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
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Fig. 3 shows the effect of PM 2.5 (per 10 μg/m 3 increase) with 95% CIs for daily hospital admissions for CVD, CHD, HF and AF for single and cumulative lag days. We found evidence for significant positive associations for at least one exposure lag structure between day-to-day variations in the PM 2.5 concentration and hospital admissions for all cardiovascular outcomes, except for HF. The largest effect was observed at lag 3 for the single-day effect and at lag 0–3 for the cumulative day effect for total CVD, CHD and AF. A 10 μg/m 3 increase from the previous day to the current day (lag0–1) in the single-pollutant model was associated with significant increases in hospital admissions for CVD (0.30, 95% CI: 0.20, 0.39%), CHD (0.34, 95% CI: 0.22, 0.45%), and AF (0.29, 95% CI: 0.03, 0.55%). No significant association was observed for HF (all P > 0.05). Fig. 3 Percentage changes with 95% confidence intervals of hospital admissions for total and cause-specific cardiovascular disease associated with a 10 μg/m 3 increase in daily PM 2.5 concentrations with varying lag patterns
|
[
"Endawoke Amsalu",
"Tianqi Wang",
"Haibin Li",
"Yue Liu",
"Anxin Wang",
"Xiangtong Liu",
"Lixin Tao",
"Yanxia Luo",
"Feng Zhang",
"Xinghua Yang",
"Xia Li",
"Wei Wang",
"Xiuhua Guo"
] |
https://doi.org/10.1186/s12940-019-0506-2
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
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Table 3 shows the two-pollutant model for the effects of PM 2.5 at the current and previous lag day (lag 0–1) effect. The observed associations in the single-pollutant models were robust to the inclusion of the copollutants in the two-pollutant model. For CVD, the observed associations in the single pollutant model were robust but were attenuated with the inclusion of all copollutants except for O 3 (0.31, 95% CI: 0.22, 0.40%). For CHD, the observed associations in the single-pollutant model were robust to the inclusion of copollutants and the association with NO 2 was slightly increased (0.95, 95% CI: 0.75, 1.15%). For AF, the effect of PM 2.5 was eliminated after adjusting for other copollutants, except for O 3 . However, the model remained trivial for HF after controlling for all pollutants (Table 3 ). Table 3 Percentage changes with 95% confidence intervals for the increase in daily cardiovascular admissions with a 2-day moving average (lag 0–1) based on particulate matter (PM 2.5 ) concentrations with and without adjustment for copollutants in Beijing, 2013–2017 Pollutants CVD AF CHD HF Unadjusted PM 2.5 0.30 (0.2,0.39) 0.29 (0.03,0.55) 0.34 (0.22,0.45) 0.10 (− 0.07,0.26) Adjusted for SO 2 0.23 (0.11,0.36) 0.12 (−0.21,0.45) 0.27 (0.13,0.42) 0.09 (− 0.12,0.3) Adjusted for CO 0.26 (0.12–0.40) 0.28 (−0.19–0.75) 0.30 (0.14,0.46) 0.14 (− 0.24,0.52) Adjusted for NO 2 0.29 (0.16,0.42) 0.26 (−0.17,0.7) 0.95 (0.75,1.15) 0.13 (−0.18,0.39) Adjusted for O 3 0.31 (0.22,0.40) 0.31 (0.05,0.57) 0.35 (0.24,0.46) 0.11 (−0.05,0.27) Data are percentage changes (%) and 95% confidence intervals CO = carbon monoxide. PM 2.5 = particulate matter with an aerodynamic diameter less than 2.5 μm. SO 2 = sulfur dioxide. NO 2 = nitrogen dioxide. O 3 = ozone CVD: Cardiovascular disease. CHD: Coronary Heart Disease HF: Heart Failure. AF: Atrial Fibrillation
|
[
"Endawoke Amsalu",
"Tianqi Wang",
"Haibin Li",
"Yue Liu",
"Anxin Wang",
"Xiangtong Liu",
"Lixin Tao",
"Yanxia Luo",
"Feng Zhang",
"Xinghua Yang",
"Xia Li",
"Wei Wang",
"Xiuhua Guo"
] |
https://doi.org/10.1186/s12940-019-0506-2
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
31370900_p15
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Results
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Table 4 presents the analysis for the period. For the whole period 2013–2017, we found evidence of significant positive associations at lag 0–1 between day-to-day variations in the PM 2.5 concentration and hospital admissions for all cardiovascular outcomes. When models were analyzed for periods, the effect estimate for hospital admission become weaker and sharply decreased. A10 μg/m 3 increase in PM 2.5 exposure at lag 0–1 was associated with percent increase in hospital admissions for the total CVD (0.30, 95% CI; 0.20,0.39%) in 2013, (0.45, 95% CI; 0.30,0.60%) in 2014, (0.23, 95% CI;0.08,0.38%) in 2015, (− 0.30, 95%CI, − 0.69, 0.08%) in 2016 and (− 0.61, 95% CI, − 1.43, 0.22%) in 2017. A similar decline in effect estimate for cause-specific cardiovascular disease was also observed (Table 4 ). Table 4 Percent change per 10 μg/m 3 increase in PM 2.5 for each year for cardiovascular hospital admission in Beijing, China Year Cardiovascular Disease Coronary Heart Disease Heart Failure Atrial Fibrillation 2013 Lag0 0.22(0.09,0.35) 0.23(0.09,0.37) 0.26(− 0.04,0.56) − 0.24(− 0.7,0.23) Lag1 0.19(0.11,0.27) 0.20(0.11,0.29) 0.34(0.2,0.66) − 0.16(− 0.91,0.61) Lag2 0.19(0.12,0.26) 0.21(0.13,0.28) −0.01(− 0.34,0.32) 0.23(− 0.27,0.74) Lag3 0.21(0.14,0.28) 0.22(0.15,0.29) 0.01(−0.35,0.37) 0.59(0.11,1.07) Lag01 0.30(0.20,0.39) 0.12(−0.06,0.29) 0.43(− 0.05,0.80) − 0.31(− 1.14,0.52) Lag02 0.39(0.29,0.49) 0.10(− 0.12,0.32) 0.44(− 0.03,0.91) − 0.17(− 1.17,0.84) Lag03 0.54(0.42,0.67) 0.34(0.06,0.61) 0.52(− 0.06,1.10) 0.36(− 0.83,1.57) 2014 Lag0 0.34(0.22,0.46) 0.38(0.25,0.50) 0.12(−0.18,0.41) 0.50(0.09,0.92) Lag1 0.30(0.17,0.43) 0.33(0.19,0.47) 0.08(−0.21,0.38) 0.42(−0.03,0.88) Lag2 0.27(0.14,0.40) 0.09(−0.14,0.22) 0.15(−0.17,0.48) 0.30(− 0.16,0.75) Lag3 0.09(−0.30,0.21) 0.09(− 0.14,0.22) 0.15(− 0.17,0.48) 0.11(− 0.52,0.74) Lag01 0.45(0.30,0.60) 0.50(0.34,0.66) 0.14(−0.2,0.48) 0.66(0.15,1.18) Lag02 0.68(0.49,0.86) 0.76(0.55,0.96) 0.26(−0.17,0.70) 0.9(0.25,1.56) Lag03 0.84(0.60,1.07) 0.93(0.68,1.18) 0.36(−0.17,0.90) 1.26(0.45,2.07) 2015 Lag0 0.11(−0.02,0.24) 0.11(−0.03,0.26) 0.11(− 0.15,0.37) 0.29(− 0.09,0.67) Lag1 0.23(0.10,0.36 0.23(0.09,0.37) 0.18(−0.1,0.46) 0.39(−0.02,0.80) Lag2 0.10(−0.04,0.24) 0.11(−0.06,0.28) − 0.03(− 0.31,0.26) 0(−0.51,0.50) Lag3 0.14(0.02,0.27) 0.14(0.01,0.27) 0.08(−0.29,0.45) 0.31(−0.08,0.70) Lag01 0.23(0.08,0.38) 0.24(0.07,0.40) 0.19(−0.13,0.51) 0.47(0,0.95) Lag02 0.29(0.11,0.47) 0.30(0.01,0.50) 0.17(−0.22,0.56) 0.46(−0.12,1.03) Lag03 0.40(0.19,0.61) 0.42(0.09,0.64) 0.18(−0.28,0.64) 0.76(−0.06,1.58) 2016 Lag0 0.07(00.3, 0.17) −0.12(− 0.40,0.13) 0.27(− 0.14,0.69) −0.21(−1.50,1.09) Lag1 −0.45(− 0.81,-0.09) −0.52(− 1.00,-0.13) −0.19(− 0.86,0.48) −1.44(−2.35,-0.53) Lag2 −0.35(− 0.7,-0.01) −0.56(− 1.00,-0.13) −0.03(− 0.47,0.54) −0.24(− 1.21,0.74) Lag3 − 0.05(− 0.30,0.20) −0.035(− 0.30,0.23) 0.08(− 0.45,0.61) −0.25(− 1.15,0.66) Lag01 − 0.3(− 0.69,0.08) −0.38(− 0.79,0.03) 0.09(− 0.5,0.68) −1.44(− 2.56,-0.32) Lag02 −0.54(− 1.04,-0.03) −0.72(− 1.25,-0.20) 0.12(− 0.65,0.89) −1.74(− 2.99,-0.69) Lag03 −0.67(− 1.31,-0.03) −0.90(− 1.56,-0.23) 0.17(− 0.65,1.00) − 2.36(−4.01,-0.69) 2017 Lag0 − 0.66(− 1.04,-0.27) −0.56(− 1.01,-0.11) −0.58(− 1.26,0.10) −0.79(− 2.94,1.39) Lag1 − 0.0013(− 0.75,0.50) −0.53(− 1.05,-0.01) −0.13(− 0.75,0.50) −0.14(− 1.72,1.48) Lag2 − 0.025(− 1.15,1.10) −0.16(− 2.09,1.77) −0.04(− 0.15,0.07) −1.08(− 1.35,-0.81) Lag3 −0.96(− 1.39,1.54) −0.06(− 1.73,1.60) −0.09(− 0.39,0.21) −1.42(− 1.69,-0.57) Lag01 −0.66(− 1.43,0.10) −0.84(− 1.46,-0.21) −0.61(− 1.43,0.22) −1.01(− 3.39,1.37) Lag02 − 0.28(− 1.21,0.66) −0.01(− 0.94,0.92) −0.13(− 1.21,0.66) −0.10(− 2.72,2.52) Lag03 − 0.51(− 0.52,1.63) −0.015(− 0.12,2.18) −0.51(− 0.59,0.63) −3.34(− 0.22,-6.46)
|
[
"Endawoke Amsalu",
"Tianqi Wang",
"Haibin Li",
"Yue Liu",
"Anxin Wang",
"Xiangtong Liu",
"Lixin Tao",
"Yanxia Luo",
"Feng Zhang",
"Xinghua Yang",
"Xia Li",
"Wei Wang",
"Xiuhua Guo"
] |
https://doi.org/10.1186/s12940-019-0506-2
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
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Results
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biomedical
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Fig. 4 shows the associations between the PM 2.5 concentrations and hospital admissions for CVD, CHD, AF and HF stratified by age group (lag 0–1 days). We observed a significant difference between age groups at a moving average of lag0–1 , with an interaction P = 0.001, for total CVD. No significant difference was observed after stratifying by sex and season. Fig. 4 Percentage changes in daily hospital admissions for total and cause-specific cardiovascular disease for each 10 μg/m 3 increase in the 2-day moving average (lag0–1) concentration of PM 2.5 , stratified by sex (male and female), season (cold and warm) and age (< 65 and ≥ 65 years)
|
[
"Endawoke Amsalu",
"Tianqi Wang",
"Haibin Li",
"Yue Liu",
"Anxin Wang",
"Xiangtong Liu",
"Lixin Tao",
"Yanxia Luo",
"Feng Zhang",
"Xinghua Yang",
"Xia Li",
"Wei Wang",
"Xiuhua Guo"
] |
https://doi.org/10.1186/s12940-019-0506-2
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
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The effect estimate of PM 2.5 on CVD hospital admissions was relatively insensitive to the number of df specified for calendar time, for smoothing of temperature and for relative humidity (see Additional file 1 : Table S1), suggesting that our core model is relatively robust to model specification.
|
[
"Endawoke Amsalu",
"Tianqi Wang",
"Haibin Li",
"Yue Liu",
"Anxin Wang",
"Xiangtong Liu",
"Lixin Tao",
"Yanxia Luo",
"Feng Zhang",
"Xinghua Yang",
"Xia Li",
"Wei Wang",
"Xiuhua Guo"
] |
https://doi.org/10.1186/s12940-019-0506-2
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
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Discussion
| 4.066406 |
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In the present study, a time-series analysis based on a generative additive Poisson model was used to investigate the associations between PM 2.5 and hospitalizations for CVD in Beijing from 2013 to 2017. Short-term exposure to PM 2.5 was found to be significantly associated with an increased risk of hospital admissions for CVD, CHD and AF, but not for HF. Robust findings were found after controlling for other pollutants in the two-pollutant models.
|
[
"Endawoke Amsalu",
"Tianqi Wang",
"Haibin Li",
"Yue Liu",
"Anxin Wang",
"Xiangtong Liu",
"Lixin Tao",
"Yanxia Luo",
"Feng Zhang",
"Xinghua Yang",
"Xia Li",
"Wei Wang",
"Xiuhua Guo"
] |
https://doi.org/10.1186/s12940-019-0506-2
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
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Discussion
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Previously, studies have shown positive associations between PM 2.5 and CVD morbidity and mortality . For example, a study conducted by Xu et al. found that a 10 μg/m 3 increase in the PM 2.5 concentration was associated with a 0.56% increase in CHD admissions at lag0–1 (95% CI: 0.16–0.95%), a 0.81% increase in heart rhythm disturbances (HRD) at lag0–1 (95% CI: 0.05–1.57%) and a 1.21% increase heart failure (HF) emergency room visits on the same day (95% CI: 0.27–2.15%) . Chen C et al. conducted a multicounty time-series study demonstrated that a 10 μg/m 3 increase in PM 2.5 was associated with a 0.12% increase in cardiovascular disease (CVD) (95% CI, 0.001–0.25), a 0.42% increase in myocardial fraction (95% CI, 0.03–0.81), and a 0.17% increase in coronary heart disease (95% CI, − 0.04-0.40) . A case-crossover study conducted with 12,865 patients in Utah, USA found that a 10 μg/m 3 increase in PM 2.5 concentration was associated with a 4.5% increase in the risk of acute ischemic coronary events (95% CI, 1.1 to 8.0%) . A study conducted in Madrid, Spain, reported that a 10 μg/m 3 increase in PM 2.5 concentration on the same day was significantly associated with an 11.08%: (95% CI: 1.03, 1.13%) increase for hospital admissions due to circulatory causes . Moreover, in different studies, the impact of PM 2.5 on CVD is robust when adjusting for copollutants . For example, a study conducted by Qu et al. found that the estimated effects of PM 2.5 were robust after adjusting for SO 2 , O 3 , CO and NO 2 . Similarly, the association between PM 2.5 concentration and ischemic stroke at lag 0 to 1 days was maintained after adjusting for other air pollutants (NO 2 , photochemical oxidants, or SO 2 ) . Our current findings were consistent with those of previous studies that explored the association between PM 2.5 exposure and the risk of hospital admission for CVD after adjusting for CO, NO 2 , SO 2 and O 3.
|
[
"Endawoke Amsalu",
"Tianqi Wang",
"Haibin Li",
"Yue Liu",
"Anxin Wang",
"Xiangtong Liu",
"Lixin Tao",
"Yanxia Luo",
"Feng Zhang",
"Xinghua Yang",
"Xia Li",
"Wei Wang",
"Xiuhua Guo"
] |
https://doi.org/10.1186/s12940-019-0506-2
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
31370900_p20
|
31370900
|
sec[3]/p[2]
|
Discussion
| 4.101563 |
biomedical
|
Study
|
[
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[
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China, the largest developing country, has the highest ambient PM 2.5 levels worldwide because of rapid urbanization and its energy consumption is the highest . The high level of urban PM 2.5 in Chinese megacities (such as Beijing, Shanghai, Chongqing and Guangzhou) mainly originates from sources such as traffic-related emissions, road/soil dust, biomass burning, and agriculture activities as well as regional transported aerosols , but research remains limited and the adverse health effects of PM 2.5 on cardiovascular hospital admissions need to be quantified. Our findings were supported by a recent study conducted in Beijing, China that reported a 10 μg/m 3 increase in PM 2.5 concentrations on the same-day PM 2.5 concentrations was associated with a 0.31% increase in the daily admissions for ischemic stroke (95% CI, 0.17–0.45%) . A 10 μg/m 3 increase in PM 2.5 was associated with a 0.27% increase in CHD morbidity (95% CI 0.21 to 0.33%). Moreover, a per 10 μg/m 3 increase in PM 2.5 at lag 3 was associated with a 0.14% increase in cardiovascular visits (95% CI: 0.01–0.27%) . Our results were consistent with previous studies performed in different Chinese cities that reported a significant PM 2.5 exposure effect on lag 0 day and lag 1 day and a maximum PM 2.5 exposure effect on lag 3 days.
|
[
"Endawoke Amsalu",
"Tianqi Wang",
"Haibin Li",
"Yue Liu",
"Anxin Wang",
"Xiangtong Liu",
"Lixin Tao",
"Yanxia Luo",
"Feng Zhang",
"Xinghua Yang",
"Xia Li",
"Wei Wang",
"Xiuhua Guo"
] |
https://doi.org/10.1186/s12940-019-0506-2
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
31370900_p21
|
31370900
|
sec[3]/p[3]
|
Discussion
| 4.109375 |
biomedical
|
Study
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[
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[
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Estimates of short term effect using time series studies are not confounded by factors that vary slowly over time. Based on various time series review, Bell Ml et al. concluded that the effect estimates for particulate matter and mortality are unlikely to be biased to a large degree by inadequate control for temporal trend . However, proper adjustment for temporal trend is still a concern in today. In this study, we conducted an analysis by year for the effect estimate of PM 2.5 to evaluate some possible temporal trends in hospitalization for CVD. We found a trend of decline in short-term effect of PM 2.5 on hospitalization for CVD from 2013 to 2017. Our study provides the association between daily changes in PM 2.5 levels and hospitalization is decreased sharply over time. A declining trend in the short-term risk estimates is evidence that the day-to-day association between PM 2.5 and hospitalization from total and cause-specific CVD is getting weaker over time, possibly as a result of changes in the composition and toxicity of the PM 2.5 from the air quality control programs . Moreover, a time trend of declining effect may be possibly as a result of greater exposure measurement error at lower levels of PM 2.5 ; flattening of the exposure-response relation at lower concentrations of PM 2.5 ; and a change in the underlying susceptibility of the population, a decline in smoking or reducing CVD rates .
|
[
"Endawoke Amsalu",
"Tianqi Wang",
"Haibin Li",
"Yue Liu",
"Anxin Wang",
"Xiangtong Liu",
"Lixin Tao",
"Yanxia Luo",
"Feng Zhang",
"Xinghua Yang",
"Xia Li",
"Wei Wang",
"Xiuhua Guo"
] |
https://doi.org/10.1186/s12940-019-0506-2
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
31370900_p22
|
31370900
|
sec[3]/p[4]
|
Discussion
| 4.105469 |
biomedical
|
Study
|
[
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[
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The exposure-response relationship assessment is crucial for public health policy as is the need for decision-making regarding the air pollution limit for PM 2.5 . A linear relationship was observed between PM 2.5 levels and mortality due to diseases of the circulatory system in Madrid, Spain . Nevertheless, the exposure-response relationship in severe air pollution environments such as Beijing remains unclear. In this study, we conducted an exposure-response relationship analysis to explore the pattern and scope of the adverse response. We observed an approximately linear exposure-response relationship, which is consistent with the recent study that explored the exposure-response relationship pattern for respiratory emergency visits related to PM 2.5 . Similarly, our study was supported by a study of 63,956 first hospital admissions for ischemic stroke, suggesting that the relationship was approximately linear, with a small fluctuation at lower concentrations (< 100 μg/m 3 ) and a sharper increase at higher concentrations . Moreover, a study involving 369,469 ischemic heart disease cases in Beijing suggested that PM 2.5 at levels below 75 μg/m 3 do not significantly increase the risk of ischemic heart disease, which is consistent with our study . Based on these findings, we hypothesized that there might be a threshold concentration at which PM 2.5 becomes harmful enough to impose an adverse impact on the development and progression of cardiovascular disease. Future studies are needed to clarify this important issue.
|
[
"Endawoke Amsalu",
"Tianqi Wang",
"Haibin Li",
"Yue Liu",
"Anxin Wang",
"Xiangtong Liu",
"Lixin Tao",
"Yanxia Luo",
"Feng Zhang",
"Xinghua Yang",
"Xia Li",
"Wei Wang",
"Xiuhua Guo"
] |
https://doi.org/10.1186/s12940-019-0506-2
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
31370900_p23
|
31370900
|
sec[3]/p[5]
|
Discussion
| 4.097656 |
biomedical
|
Study
|
[
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[
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In this study, we also found that the association between short-term PM 2.5 exposure and hospital admission varied by cause-specific CVD. The adverse effect was obvious and robust for daily hospitalizations for CHD and AF but not for HF. Adverse effects due to a short-term exposure to PM 2.5 for CHD, AF and HF was also evident in other studies . However, some inconsistent results have been reported for PM 2.5 exposure for HF [ 33 – 36 ]. For example, Poloniecki et al. in London, United Kingdom, and Symons et al. in Baltimore, Maryland, USA, found no statistically significant associations between any pollutant and hospital admissions for HF . One explanation may be that HF is clinically heterogeneous and complicated by a large number of comorbid diseases that may result in outcome misclassification . Similarly, misclassification of cardiovascular events was detected among the study participants in Baltimore, Maryland . Furthermore, a study by Dabass et al. in the National Health and Nutrition Examination Survey (NHANES) confirmed no significant associations for either short-or long-term PM 2.5 exposure with HF risk in the general adult population, but stronger associations were found among clinically heterogeneous and comorbid disease participants .
|
[
"Endawoke Amsalu",
"Tianqi Wang",
"Haibin Li",
"Yue Liu",
"Anxin Wang",
"Xiangtong Liu",
"Lixin Tao",
"Yanxia Luo",
"Feng Zhang",
"Xinghua Yang",
"Xia Li",
"Wei Wang",
"Xiuhua Guo"
] |
https://doi.org/10.1186/s12940-019-0506-2
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
31370900_p24
|
31370900
|
sec[3]/p[6]
|
Discussion
| 4.269531 |
biomedical
|
Study
|
[
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[
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Increased vulnerability to PM 2.5 health effects might be more common among more exposed populations . Thus, consideration of the effect of PM 2.5 on different these groups is crucial for public health policy. Some studies reported an increased risk of cardiovascular admissions in women and elderly people . In the present study, a difference in effect was found among elderly people (age ≥ 65) with a 0.52% increased risk ( P = 0.001) for CVD hospitalization, but this effect was not present after stratifying by sex and season. Overall, our study found a more consistent and increased effect for CHD compared with AF and HF, which is supported by the 2010 evidence summary report from the American Heart Association (AHA) . The short-term association of PM 2.5 with CVD hospitalization is consistent with previous epidemiological studies, although the mechanisms of the PM 2.5 effect remain unclear. However, different potential mechanisms have been proposed, such as oxidative stress, inflammation, elevation in stress hormones and metabolic alterations . After inhalation of PM 2.5 , a local inflammatory response is developed, and several proinflammatory mediators, such as IL-6 and TNF-α, are also increased, which induces an increase in the concentrations of blood fibrinogen and C-reactive protein (CRP), which are important markers of cardiovascular events. Numerous studies have demonstrated that exposure to particulate matter is associated with increased fibrinogen and CRP, resulting in an increased risk of CVD [ 41 – 43 ]. PM 2.5 exposure can also disturb the autonomic nervous system (ANS) and results in heart rate variability (HRV), which is another potential mechanism for CVD . Recent research demonstrates that PM 2.5 also directly affects the cardiovascular system by entering into the systemic circulation and causing myocardial dysfunction through mechanisms of reactive oxygen species production, calcium ion interference, endothelial cell damage and vascular dysfunction .
|
[
"Endawoke Amsalu",
"Tianqi Wang",
"Haibin Li",
"Yue Liu",
"Anxin Wang",
"Xiangtong Liu",
"Lixin Tao",
"Yanxia Luo",
"Feng Zhang",
"Xinghua Yang",
"Xia Li",
"Wei Wang",
"Xiuhua Guo"
] |
https://doi.org/10.1186/s12940-019-0506-2
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
31370900_p25
|
31370900
|
sec[3]/p[7]
|
Discussion
| 4.070313 |
biomedical
|
Study
|
[
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[
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This study has several strengths. First, cardiovascular hospital admissions data were obtained from an established monitoring system covering more than 172 comprehensive hospitals in Beijing, which resulted in a relatively large sample size. Second, compared with previous studies, a relatively larger sample size and recent data over a 5-year period were used, which allowed us to examine the associations at high levels of validity and reliability. Third, the inclusion of all 35 monitoring sites for air pollution better represents the effects of air pollution than other studies. However, this study also has limitations. Similar to other studies involving explorations of the impact of air pollutants on health outcomes, we need to carefully interpret and infer the causal relationship between PM 2.5 exposure and hospitalizations for CVD due to the ecological design of the present study. Future epidemiological cohort studies are needed for the assessment of cause-specific cardiovascular disease, especially in elderly people.
|
[
"Endawoke Amsalu",
"Tianqi Wang",
"Haibin Li",
"Yue Liu",
"Anxin Wang",
"Xiangtong Liu",
"Lixin Tao",
"Yanxia Luo",
"Feng Zhang",
"Xinghua Yang",
"Xia Li",
"Wei Wang",
"Xiuhua Guo"
] |
https://doi.org/10.1186/s12940-019-0506-2
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
31370900_p26
|
31370900
|
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|
Conclusions
| 4.027344 |
biomedical
|
Study
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[
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This study shows that short-term exposure to ambient PM 2.5 significantly increased the risk of hospitalizations from total CVD, especially for CHD. Our results also provided evidence of the risk of air pollution due to PM 2.5 , which was relatively higher among older people. Precautions and protective measures and efforts to reduce exposure to PM 2.5 should be strengthened, especially for elderly people.
|
[
"Endawoke Amsalu",
"Tianqi Wang",
"Haibin Li",
"Yue Liu",
"Anxin Wang",
"Xiangtong Liu",
"Lixin Tao",
"Yanxia Luo",
"Feng Zhang",
"Xinghua Yang",
"Xia Li",
"Wei Wang",
"Xiuhua Guo"
] |
https://doi.org/10.1186/s12940-019-0506-2
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
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31370900_p27
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31370900
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|
Untitled Section
| 2.03125 |
biomedical
|
Study
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[
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[
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Additional file 1: of Acute effects of fine particulate matter (PM 2.5 ) on hospital admissions for cardiovascular disease in Beijing, China: A time-series study. (DOCX 19 kb)
|
[
"Endawoke Amsalu",
"Tianqi Wang",
"Haibin Li",
"Yue Liu",
"Anxin Wang",
"Xiangtong Liu",
"Lixin Tao",
"Yanxia Luo",
"Feng Zhang",
"Xinghua Yang",
"Xia Li",
"Wei Wang",
"Xiuhua Guo"
] |
https://doi.org/10.1186/s12940-019-0506-2
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
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31366408_p0
|
31366408
|
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|
Background
| 3.972656 |
biomedical
|
Review
|
[
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[
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The high prevalence of opioid use disorder (OUD) in the US continues to have serious public health repercussions, including overdose death. Approximately 1.9 million individuals report a current prescription-related OUD , and the prevalence of heroin-related OUD has more than tripled in the past decade . OUD is a chronic health condition that requires long-term multimodal clinical approaches to engage, treat, retain, promote long term recovery, and prevent additional opioid-related adverse events among patients, such as overdose . OUD in rural areas has taken a particularly heavy toll due to the dearth of health and human services resources available within these communities . Across the US, there likewise has been a continued shift in the cause of overdose deaths in the last 20 years from prescribed opioids, to heroin, to synthetic opioids . Given these rural health challenges, it is paramount to leverage existing resources and strengthen rural service systems to meet the needs of those with OUD.
|
[
"Gerald Cochran",
"Evan S. Cole",
"Jack Warwick",
"Julie M. Donohue",
"Adam J. Gordon",
"Walid F. Gellad",
"Todd Bear",
"David Kelley",
"Ellen DiDomenico",
"Jan Pringle"
] |
https://doi.org/10.1186/s13722-019-0154-4
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
31366408_p1
|
31366408
|
sec[0]/p[1]
|
Background
| 4.136719 |
biomedical
|
Study
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[
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[
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One area for potential rapid expansion of opioid addiction services is office-based prescribing of medication assisted treatment (MAT), primarily buprenorphine and buprenorphine/naloxone (hereafter defined as buprenorphine) and extended-release naltrexone in combination with psychosocial counseling services. Although office-based treatments, such as buprenorphine, have been shown to be effective in OUD treatment, recent data show 56% percent of rural counties in the US lack a buprenorphine prescriber, and 30% of rural residents in the US live in a county without a buprenorphine prescriber . Rural physician practices report a number of challenges with implementing buprenorphine prescribing. These challenges include concerns of buprenorphine diversion, lack of behavioral health providers/services to which patients can be referred, time constraints to learn about and to provide MAT services, lack of clinic staff to support patient needs, and lack of sufficient financial support/reimbursement for MAT services . In addition, providers also report stigma as a critical barrier faced in prescribing buprenorphine for OUD in rural areas . Given the need for rapid response to the opioid epidemic while considering the challenges of providing high quality office-based MAT, thoughtful and concerted efforts for expanding access to MAT in rural areas are crucial.
|
[
"Gerald Cochran",
"Evan S. Cole",
"Jack Warwick",
"Julie M. Donohue",
"Adam J. Gordon",
"Walid F. Gellad",
"Todd Bear",
"David Kelley",
"Ellen DiDomenico",
"Jan Pringle"
] |
https://doi.org/10.1186/s13722-019-0154-4
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
31366408_p2
|
31366408
|
sec[0]/sec[0]/p[0]
|
Expanding MAT through primary care
| 4.0625 |
biomedical
|
Study
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[
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Management of patients with chronic health conditions requires intentional efforts to target system- and patient-level factors necessary to significantly and clinically improve patient outcomes [ 9 – 13 ]. The Chronic Care Model importantly is recognized as an effective paradigm for the long term management of chronic conditions and has received attention regarding management of substance use disorder (SUD) . Building upon principles of chronic care management, the purpose of this article is to describe the protocol of a study working to expand access to MAT by utilizing an implementation science framework to initiate a MAT service model in 23 rural Pennsylvania (PA) counties. This project was among a series of initiatives funded by the Agency for Healthcare Research and Quality to expand access and quality of MAT in rural settings . The methods described in this paper have the potential to aid in the advancement of the current implementation science knowledgebase for expanding access to MAT services for OUD in rural areas of the US.
|
[
"Gerald Cochran",
"Evan S. Cole",
"Jack Warwick",
"Julie M. Donohue",
"Adam J. Gordon",
"Walid F. Gellad",
"Todd Bear",
"David Kelley",
"Ellen DiDomenico",
"Jan Pringle"
] |
https://doi.org/10.1186/s13722-019-0154-4
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
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31366408
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Study design and population
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[
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This project is a hybrid implementation study that is specifically recruiting, training, and supporting rural primary care providers (PCPs) in delivering MAT services to Medicaid enrollees served within their practices. Hybrid designs focus on assessing formative study outcomes related to implementation and summative outcomes related to intervention efficacy. This project leverages existing payers and local providers in identified rural communities to support MAT expansion in order to facilitate long-term service provision to patients with OUD . Individuals enrolled in Medicaid living in rural areas is a critical population of focus given that the Medicaid program provides health coverage to 24% of non-elderly adults in rural areas. Moreover, the Medicaid program provides health coverage for nearly 40% of those with OUD in the US . Fig. 1 Rural access to MAT in pennsylvania (RAMP) model diagram
|
[
"Gerald Cochran",
"Evan S. Cole",
"Jack Warwick",
"Julie M. Donohue",
"Adam J. Gordon",
"Walid F. Gellad",
"Todd Bear",
"David Kelley",
"Ellen DiDomenico",
"Jan Pringle"
] |
https://doi.org/10.1186/s13722-019-0154-4
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
31366408_p4
|
31366408
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other
|
Other
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[
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This project is currently being implemented among practices that serve Medicaid enrollees in 23 PA counties designated as rural by Rural–Urban Continuum Codes . Pennsylvania is 8th overall in overdose deaths within the US . The counties in this project were selected based on whether their OUD prevalence and/or overdose death rate was above the national average , and thus, represented areas of greatest need for OUD treatment expansion.
|
[
"Gerald Cochran",
"Evan S. Cole",
"Jack Warwick",
"Julie M. Donohue",
"Adam J. Gordon",
"Walid F. Gellad",
"Todd Bear",
"David Kelley",
"Ellen DiDomenico",
"Jan Pringle"
] |
https://doi.org/10.1186/s13722-019-0154-4
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
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31366408
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Project team
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This project is being executed through collaboration among a number of key state/private organizations, leaders, researchers, and stakeholders. The PA Department of Human Services (DHS), which is the state agency that administers the Medicaid program and is a large payer of MAT of the managed care Medicaid providers targeted in this project. DHS collaborates with the PA Department of Drug and Alcohol Programs and the following agencies to form a Steering Committee that guides the project: PA Medicaid Managed Care Organizations (MCOs). An Implementation Team located within the University of Pittsburgh School of Pharmacy. Addiction medicine clinical and educational programs within the UPMC Western Psychiatric Institute and Clinic and the University of Utah. Local care management professionals. A Project Evaluation Team based at the University of Pittsburgh and University of Utah; comprised of addiction medicine, internal medicine, health policy, and social work faculty and staff. Participating primary care practices and the patients which they serve.
|
[
"Gerald Cochran",
"Evan S. Cole",
"Jack Warwick",
"Julie M. Donohue",
"Adam J. Gordon",
"Walid F. Gellad",
"Todd Bear",
"David Kelley",
"Ellen DiDomenico",
"Jan Pringle"
] |
https://doi.org/10.1186/s13722-019-0154-4
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
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31366408_p6
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31366408
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Partner roles, site identification, and recruitment
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Other
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[
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PA DHS is facilitating all partnerships with the participating project collaborators and is managing all support components of the intervention for the participating primary care practices. PA DHS is also receiving active support and feedback from the project Steering Committee. PA DHS, Medicaid MCOs, and the Implementation Team work together to identify, recruit, and engage primary care practices. MCOs also specifically recommend practices to DHS based on their knowledge of their existing capabilities, Medicaid enrollee patient volume, and likelihood of successfully initiating and sustaining MAT. Once MCOs provide recommendations to DHS; the DHS team, MCO representatives, and the Implementation Team begin the recruitment and engagement process. The Implementation Team also has engaged in a number of additional outreach activities to contact potential practices, including directly contacting clinics, rural-based health systems, healthcare agencies, and provider associations as well as seeking referrals from behavioral health providers in the area. The goal is to recruit 24 practices within the 23 counties during the three project years.
|
[
"Gerald Cochran",
"Evan S. Cole",
"Jack Warwick",
"Julie M. Donohue",
"Adam J. Gordon",
"Walid F. Gellad",
"Todd Bear",
"David Kelley",
"Ellen DiDomenico",
"Jan Pringle"
] |
https://doi.org/10.1186/s13722-019-0154-4
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
31366408_p7
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31366408
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Practice-based MAT delivery model intervention
| 2.310547 |
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0.0012826919555664062
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The model of MAT implemented in all participating practices adheres to current guidelines from the American Society of Addiction Medicine (ASAM) on the use of medications in the treatment of OUD . The ASAM delivery model focuses on provider processes that include assessment, diagnosis, treatment, and considerations for populations with behavioral health needs.
|
[
"Gerald Cochran",
"Evan S. Cole",
"Jack Warwick",
"Julie M. Donohue",
"Adam J. Gordon",
"Walid F. Gellad",
"Todd Bear",
"David Kelley",
"Ellen DiDomenico",
"Jan Pringle"
] |
https://doi.org/10.1186/s13722-019-0154-4
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
31366408_p8
|
31366408
|
sec[1]/sec[4]/sec[0]/p[0]
|
Screening, care management referral, and assessment
| 3.96875 |
biomedical
|
Other
|
[
0.58740234375,
0.409423828125,
0.0032176971435546875
] |
[
0.36572265625,
0.603515625,
0.011444091796875,
0.019134521484375
] |
Participating practices are trained in and subsequently screen patients for OUD using the NIDA-Modified Alcohol, Smoking, and Substance Involvement Screening Test . Primary care practices are also trained in the provision of motivational interviewing principles for the purpose of engaging patients and motivating them to accept a referral to the Rural Access to MAT in Pennsylvania (RAMP) program. Patients that screen positive on the screening test are then referred to RAMP-involved care managers who conduct a confirmatory assessment for OUD using the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria and who also assess patients’ other mental health and psychosocial needs. From this assessment, patient eligibility for MAT is determined and the patient is enrolled with RAMP. Following enrollment, patients are given a comprehensive assessment, which includes a physical exam, screening for concomitant medical conditions, appropriate laboratory testing, pregnancy testing, and tobacco screening and cessation counseling. Following assessment, PCPs diagnose patients with OUD if confirmation is obtained via: (1) patient’s reported substance use behaviors during the confirmatory assessment, (2) communication with an ancillary prescribing provider, or (3) through a validated clinical scale (such as the Clinical Opioid Withdrawal Scale). Urine testing is also recommended whenever possible and deemed appropriate to help confirm patient histories.
|
[
"Gerald Cochran",
"Evan S. Cole",
"Jack Warwick",
"Julie M. Donohue",
"Adam J. Gordon",
"Walid F. Gellad",
"Todd Bear",
"David Kelley",
"Ellen DiDomenico",
"Jan Pringle"
] |
https://doi.org/10.1186/s13722-019-0154-4
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
31366408_p9
|
31366408
|
sec[1]/sec[4]/sec[0]/p[1]
|
Screening, care management referral, and assessment
| 3.544922 |
clinical
|
Other
|
[
0.378662109375,
0.60888671875,
0.01261138916015625
] |
[
0.2237548828125,
0.75634765625,
0.00782012939453125,
0.01195526123046875
] |
Patients are subsequently referred and provided with a warm handoff by the PCP and/or clinic staff using principles of motivational interviewing to care management professionals from organizations that participate in DHS’ OUD Centers of Excellence programs , county public SUD treatment management entities, local substance use treatment centers, or onsite nurse care managers who have volunteered to be trained by the Implementation Team in the Massachusetts nurse care manager model . DHS Centers of Excellence are a network of sites across PA that receive state support to provide OUD services to patients and support to health care providers who are caring for those with OUD ; Centers are specifically modeled after the behavioral health home model [ 27 – 29 ]. Care managers further assess the patient to determine the level of needed OUD care (e.g., whether patients require ambulatory detoxification). Assessment to determine the level of OUD care follows either the Pennsylvania Placement Criteria for Adults or the ASAM Criteria . Once the detoxification is completed or determined to not be needed, the care management professional and patient make a subsequent appointment with the PCP for MAT treatment recommendation and initiation.
|
[
"Gerald Cochran",
"Evan S. Cole",
"Jack Warwick",
"Julie M. Donohue",
"Adam J. Gordon",
"Walid F. Gellad",
"Todd Bear",
"David Kelley",
"Ellen DiDomenico",
"Jan Pringle"
] |
https://doi.org/10.1186/s13722-019-0154-4
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
31366408_p10
|
31366408
|
sec[1]/sec[4]/sec[1]/p[0]
|
Treatment recommendation and induction
| 2.529297 |
clinical
|
Other
|
[
0.230712890625,
0.7548828125,
0.01432037353515625
] |
[
0.028961181640625,
0.96142578125,
0.001590728759765625,
0.0082244873046875
] |
PCPs and the care management team consider patient preferences and treatment history when determining the optimal treatment recommendations and treatment settings for the patient, which focus in the current project is buprenorphine or extended-release naltrexone delivered in outpatient settings. However, if the PCP believes that after consultation with intervention supports (e.g., addiction medicine teleconsultation), the patient is best suited for a higher-level of care (e.g., inpatient treatment), the PCP makes such a referral in coordination with the care management professionals.
|
[
"Gerald Cochran",
"Evan S. Cole",
"Jack Warwick",
"Julie M. Donohue",
"Adam J. Gordon",
"Walid F. Gellad",
"Todd Bear",
"David Kelley",
"Ellen DiDomenico",
"Jan Pringle"
] |
https://doi.org/10.1186/s13722-019-0154-4
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
31366408_p11
|
31366408
|
sec[1]/sec[4]/sec[1]/p[1]
|
Treatment recommendation and induction
| 1.773438 |
biomedical
|
Other
|
[
0.454345703125,
0.32275390625,
0.22314453125
] |
[
0.044891357421875,
0.951171875,
0.0012969970703125,
0.0027294158935546875
] |
As part of recruitment of the implementation sites, we have found that not all participating PCPs are immediately comfortable with prescribing all types of medications for OUD. The Implementation Team assesses where each site is at with their readiness to provide MAT, and some practices begin by screening and referring, such as a “hub and spoke” model, and others pursue their DATA 2000 waiver to begin prescribing buprenorphine. However, the Implementation Team continues to work with PCPs with the ultimate goal of increasing their experience and comfort with offering MAT.
|
[
"Gerald Cochran",
"Evan S. Cole",
"Jack Warwick",
"Julie M. Donohue",
"Adam J. Gordon",
"Walid F. Gellad",
"Todd Bear",
"David Kelley",
"Ellen DiDomenico",
"Jan Pringle"
] |
https://doi.org/10.1186/s13722-019-0154-4
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
31366408_p12
|
31366408
|
sec[1]/sec[4]/sec[2]/p[0]
|
Care management and psychosocial services
| 2.373047 |
biomedical
|
Other
|
[
0.422119140625,
0.4111328125,
0.166748046875
] |
[
0.00548553466796875,
0.99169921875,
0.0015401840209960938,
0.0012874603271484375
] |
In concert with MAT initiation, care management professionals coordinate a number of different services to support the patient’s OUD treatment. These services include additional community behavioral health services, continuing patient engagement in OUD treatment, assisting patients navigating transitions of care (e.g., inpatient hospitalization to outpatient treatment), patient self-management training, peer support, supporting patients in ongoing behavioral health and OUD counseling services, and communication with law enforcement, such as parole or probation officials. Importantly, care management also involves connecting patients to community-based services and recovery support specialists to help them address housing, food security, or transportation needs.
|
[
"Gerald Cochran",
"Evan S. Cole",
"Jack Warwick",
"Julie M. Donohue",
"Adam J. Gordon",
"Walid F. Gellad",
"Todd Bear",
"David Kelley",
"Ellen DiDomenico",
"Jan Pringle"
] |
https://doi.org/10.1186/s13722-019-0154-4
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
31366408_p13
|
31366408
|
sec[1]/sec[4]/sec[3]/p[0]
|
PCP clinical support
| 2.037109 |
clinical
|
Other
|
[
0.267578125,
0.64306640625,
0.08941650390625
] |
[
0.02166748046875,
0.97412109375,
0.0009055137634277344,
0.003467559814453125
] |
As rural practices are enrolled in the project, they are offered clinical supports to ensure successful MAT service provision: which include peer consultation, peer support, and education. PCPs have access to a peer-to-peer teleconsultation service staffed by addiction medicine providers or that are facilitated by the Implementation Team. PCPs can contact specialists to receive consultation on treatment decisions for individual patients and discuss questions or concerns about the structure of MAT in their clinic. PCPs also have the option of obtaining consultation services via email. The project goal for responding to consultation requests is to return all provider phone queries within 30 min and email within 24 h. Teleconsultation addiction experts can also coordinate with the program website to communicate commonly asked questions and concerns.
|
[
"Gerald Cochran",
"Evan S. Cole",
"Jack Warwick",
"Julie M. Donohue",
"Adam J. Gordon",
"Walid F. Gellad",
"Todd Bear",
"David Kelley",
"Ellen DiDomenico",
"Jan Pringle"
] |
https://doi.org/10.1186/s13722-019-0154-4
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999995 |
31366408_p14
|
31366408
|
sec[1]/sec[4]/sec[3]/p[1]
|
PCP clinical support
| 2.460938 |
biomedical
|
Other
|
[
0.76806640625,
0.1807861328125,
0.051116943359375
] |
[
0.0257720947265625,
0.97216796875,
0.0007433891296386719,
0.0014057159423828125
] |
Clinical addiction specialists and the Implementation Team offers site-specific tailored intervention resources designed to improve and sustain access to MAT for OUD in primary care settings. Provision of such resources that are aimed at increasing the knowledgebase and clinical proficiency of prescribers and multidisciplinary providers have shown to improve the number of prescribers of MAT and to encourage and enhance high quality care . In the current project, the Implementation Team, project website, and consulting addiction specialist offer MAT training and education for each clinic site, a link to the DATA2000 waiver training for PCPs needing certification, a webinar series based on clinic questions and concerns or other related topics identified as needed by project staff, training and support for patient self-management, and consultation services.
|
[
"Gerald Cochran",
"Evan S. Cole",
"Jack Warwick",
"Julie M. Donohue",
"Adam J. Gordon",
"Walid F. Gellad",
"Todd Bear",
"David Kelley",
"Ellen DiDomenico",
"Jan Pringle"
] |
https://doi.org/10.1186/s13722-019-0154-4
|
OpenAccess
|
http://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |