This population-based study was carried out in a rural area in Sweden. The impact of duration of diabetes, metabolic control, albuminuria, and mode of detection (screening or presence of overt symptoms at the time of diagnosis) on retinopathy in patients with type 2 diabetes aged under 70 years was investigated at a primary health care centre. Ninety-nine percent of all known persons with Type 2 diabetes were under care at the centre. The fundi were examined in all but one of those under 70 years, and a 100% attendance rate was noted with regard to other variables such as albuminuria, glycated haemoglobin, and blood lipids. A team approach (general practitioner, nurse specialist, dietitian, and chiropodist) with patient education as an integral part of the treatment has been practised for the past 15 years. Retinopathy was associated with duration of disease, glycaemic control, systolic blood pressure, detection by overt symptoms, and albuminuria. The risk of retinopathy was not associated with smoking or treatment category. The prevalence of retinopathy was 26.5% in the whole population, and 18.8% among the patients who had been treated for their diabetes at the centre from the time of diagnosis. The importance of an appropriate organization in primary health care for early case finding, near-normal glycaemia, team approach, and structured collaboration with a department of ophthalmology is emphasized in order to realize the aims of the St Vincent declaration to reduce eye complications due to Type 2 diabetes.
The object with the present study was to present prevalence data in a rural area in Sweden regarding overweight, obesity and abdominal obesity presented by waist circumference. The study was population-based in primary health care. The target group was aged 20 years or more. A total of 91% (n = 6,686) participated. 45% of men and 32% of women were overweight (BMI 25-29.9 kg/m2), 12% of men and 17% of women were obese (BMI > or = 30 kg/m2). The programme found among men 25.8% with a waist circumference 94-101.9 cm and 18.0% > or = 102 cm and among women 22.7% with 80.0-87.9 cm and 27.2% > or = 88 cm. The relative risk for type 2 diabetes increased with waist circumference. Making health care personnel and patients aware of overweight, obesity and abdominal obesity and the risk of associated diseases and encourage a healthy life style is urgent in time of an obesity epidemic.
The present population-based study comprises 84% of all known diabetics cared for at a rural primary health care centre. Patient education has been given high priority as an integral part of the treatment provided by a specially trained nurse and dietician under the supervision of the general practitioners. Most of the patients were under good metabolic control, as reflected by HbA1 (diet-treated, n = 119, 7.3 +/- 1.3%; oral agent-treated, n = 127, 7.8% +/- 1.3%; insulin-treated, n = 110, 8.0 +/- 1.3%; reference range 5.3-7.3%). Obvious reasons for any high HbA1 values were found.
The aim was to investigate whether the fascia suture technique (FST) can reduce access closure time and procedural costs compared with the Prostar technique (Prostar) in patients undergoing endovascular aortic repair and to evaluate the short- and mid-term outcomes of both techniques.
In this two center trial, 100 patients were randomized to access closure by either FST or Prostar between June 2006 and December 2009. The primary endpoint was access closure time. Secondary outcome measures included access related costs and evaluation of the short- and mid-term complications. Evaluation was performed peri- and post-operatively, at discharge, at 30 days and at 6 months follow up.
The median access closure time was 12.4 minutes for FST and 19.9 minutes for Prostar (p
Department of Vascular Surgery and Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital and Academy, Blå Stråket 5, S-413 45 Gothenburg, Sweden. Electronic address: firstname.lastname@example.org.
The use of an intraoperative shunt is an established technique used to reduce the ischemic time after acute arterial obstruction or in the prevention of hypoperfusion due to complex open vascular or endovascular operative procedures. To date, described methods of temporary extremity blood perfusion have required open surgical techniques.
An endovascular shunt (ES) was formed by connecting two introducer sheaths to each other, one positioned proximal and one distal to an arterial obstruction. The ES method was used in patients considered to be at high risk for prolonged lower limb ischemia in conjunction with a vascular procedure and where shunt creation by open surgical technique was not considered to be a practical alternative. The flow capacity of the ES was defined in a desktop model.
The ES method was used clinically in 15 vascular interventions including eight complex endovascular aortic procedures, three open aortic operations, and four procedures for acute limb ischemia. The shunts were functional in all patients and there were no shunt occlusions. Postoperatively, there were no evident clinical reperfusion injuries. Flow analysis revealed that the ES had a flow capacity of 73% flow capacity compared to a Pruitt-Inahara shunt.
A new method of temporary blood shunting in connection to vascular procedures has been demonstrated.
Reports of preventive management resulting in reduction, by 50 percent or more, of the incidence of major amputation due to foot ulceration in diabetics have now been published from seven different localities, five in Europe (Umeå, Kisa, Lund, London and Geneva) and two in the USA (Tucson and Louisville). The methods used to achieve the reduction are remarkably similar, being based on systematic check-ups for incipient foot ulceration and its putative risk factors. In all three Swedish reports, the work has entailed close liaison with community health centres in the respective areas, which is considered to be of the utmost importance in reaching all diabetics at risk of foot ulcers. Another important prerequisite is a specialised foot clinic for diabetic patients in each area, where the skills of a chiropodist, a physician specialised in diabetes, an orthopaedic surgeon and an orthopaedic shoemaker are available.
The clinical set-up in primary health care, with a specially trained nurse, a dietician, and a chiropodist under the supervision of general practitioners and giving patient education high priority, is evaluated after ten years in practice. Of the 391 patients cared for, 352 had non-insulin-dependent diabetes mellitus, treated as follows; diet 128, oral agents 132, insulin 91. Forty patients had insulin-dependent diabetes mellitus. The metabolic control was good in the great majority of the patients. The mean HbA1C value for the whole diabetic population taken care of at the centre was 5.83% +/- 1.16%, -reference range 3.2-6.0%. The metabolic control is presented according to the European NIDDM Policy Group. On comparing two five-year periods the number of amputations decreased from 18 to 4 (p less than 0.01).