Search

Abstract: Arterial stiffness is a major contributor to the development of atherosclerosis and consequently cardiovascular disease. This study aimed to examine whether 6 months of accumulated (3 × 10 minutes, 5 days/week) brisk walking was sufficient to reduce arterial stiffness in sedentary, overweight individuals. Seventy-seven individuals (19 men, 58 women; age, 30-55 years) were randomly allocated to one of three groups; two groups completed 30 minutes of accumulated walking with either monthly or weekly telephone support; the third group (control) performed stretching exercises. The walking groups were combined and telephone support included as a covariate. Anthropometry, blood pressure (BP), blood lipids, pulse wave velocity (PWV), and NOx (surrogate marker for nitric oxide) were measured at baseline, post-intervention and 4 months post-intervention. No changes were observed for anthropometry, BP, or lipids. However, at the end of the intervention, there was a decrease in PWV (P < .001) accompanied by an increase in NOx (P < .001), with changes maintained 4 months post-intervention. A strong negative correlation between PWV and NOx was also observed (P < .001; r = −0.65). A lifestyle approach to meeting current physical activity guidelines results in favorable alterations in arterial function in overweight individuals. [Copyright &y& Elsevier]

Abstract: Aim: There is conflicting information on the impact of socioeconomic deprivation on outcomes in diabetes. Our aim was to study the relationship between socioeconomic deprivation and clinical outcome indicators in a patient cohort with type 2 diabetes mellitus [T2DM]. Methods: We recruited a random sample of 446 patients with T2DM [57% male] stratified by Income Deprivation Measure. Data on patient specific socioeconomic status, educational attainment, behaviour and attitudes were gathered by patient interview. Data analysis was by logistic and linear regression with correction for age, gender and duration of diabetes. Results: The study cohort showed high levels of deprivation with 80% reporting a household annual income of <£20,000 and 69.5% having no formal educational qualification. The cohort was actively managed with high usage of lipid lowering [90.1%], antihypertensive [80.6%] and antiplatelet agents [78%] and correspondingly good control of modifiable risk factors: HbA1c 7.6 [1.4]%, systolic blood pressure 134.2 [20.6], diastolic blood pressure 72.7 [11.2]mmHg, total cholesterol 4.0 [0.9]mmol/L. Socioeconomic disadvantage was strongly related to measures of integration and attitude to diabetes. Despite this there were no significant or consistent relationships between Income Deprivation Measure/self-reported annual household income/educational attainment on metabolic or cardiovascular risk factors. Conclusions: Successful management of modifiable risk factors can be achieved in a way that is independent of socioeconomic position. [ABSTRACT FROM AUTHOR]

• Obtaining valid inferences from observational research using electronic health records is challenging due to selection bias, confounding and missing data. • Use of target trial emulation may increase the value of results from observational research by reducing the risk of selection bias, immortal time bias and confounding. • Target trial emulation can be a means to reduce the risk of bias by comparing the observational study performed to the perfect target trial. • When using EHR data to emulate a target trial, samples containing sufficient information on outcome measures and variables to adjust for confounding and selection bias are essential given the risk of missing data. Electronic health records (EHRs) are increasingly used in effectiveness and safety research. However, these studies are often at risk of bias. This study demonstrates the relevance, and discusses challenges, of using target trial emulation to avoid bias, such as selection bias, immortal time bias and confounding when performing observational research with EHRs. Target trial emulation can be used to identify and address some of the drawbacks of observational research in a systematic way. Potential sources of bias are identified by describing key components of an ideal randomized controlled trial and comparing this to the observational study actually performed. The methods were applied to assess treatment response to antidiabetic treatment using EHRs from patients with diabetes treated in secondary care. Using target trial emulation ensured prevalent users were excluded and patients were not included based on information generally not available when initiating a clinical trial. Furthermore, applying these methods demonstrated how the number of records eligible for use can rapidly decrease. Hereafter, adjustments were performed to address potential sources of bias and it was shown that missing variables essential for adjustment can be an important issue. Using target trial emulation, sources of selection bias and confounding were identified and adjusted for accordingly when analysing treatment response in patients with type 2 diabetes. However, when using EHR data to emulate a target trial, samples containing sufficient information on outcome measures and variables to adjust for confounding and selection bias are essential given the risk of missing data. [ABSTRACT FROM AUTHOR]