There was a high reported proportion of participants with an apparently good level of knowledge on antibiotic use and a high level of confidence in antibiotic prescribing, but the reported level of knowledge on local antibiotic resistance was low. The analysis was limited by the low number of studies included, and most of them had a medium quality.

Background Since the knowledge of the symptoms of acute myocardial infarction (AMI) may reduce the decision time for patients to seek help in case of an AMI, we aimed to summarize evidence on the knowledge of the AMI symptoms and the symptom attribution in case of an acute coronary syndrome (ACS). Methods Therefore, we systematically searched the databases PubMed, CINAHL, Embase, and Cochrane Library for relevant studies published between January 1, 2008 and 2019 (last search August 1, 2019). Results A total of 86 studies were included, with a composite sample size of 354,497 participants. The weighted mean of the knowledge scores for the symptoms of AMI of 14,420 participants from the general population, was 42.1% (when maximum score was considered 100%) and 69.5% for 7642 cardiac patients. There was a substantially better level of knowledge for six symptoms (‘chest pain or discomfort’, ‘shortness of breath’, ‘pain or discomfort in arms or shoulders’, ‘feeling weak, lightheaded, or faint’, ‘pain or discomfort in the jaw, neck, or back’, and ‘sweating’) (49.8–88.5%) compared to the four less obvious/atypical symptoms ‘stomach or abdominal discomfort’, ‘nausea or vomiting’, ‘headache’, and ‘feeling of anxiety’ (8.7–36.7%). Only 45.1% of 14,843 patients, who experienced ACS, have correctly attributed their symptoms to a cardiac cause. Conclusion In conclusion, we found a moderate to good knowledge of “classic” and insufficient knowledge of less obvious symptoms of AMI. This might suggest that increasing knowledge about less obvious symptoms of AMI could be beneficial. It appears also important to address cardiac attribution of symptoms.

Glycation and glycoxidative reactions have been recognised to be a major pathogenetic principle for biochemical and biophysical alterations of proteins in diabetes mellitus [1±3]. Both processes have been shown to increase in humans with age and even more in patients with diabetes mellitus with the duration of the disease [4±8].Glycoxidative reactions, e. g. the Maillard reaction, are initiated by the condensation of a reducing sugar with an e-amino group of lysyl-or hydroxylysyl-residues of proteins [9]. The resulting Schiff-base is stabilised subsequently by Amadori rearrangement and processed further in very diverse and not yet fully elucidated chemical reactions resulting in a variety of cross-linked compounds. Only a small number of those, including pentosidine, have been characterised in structure and chemical composition [2, 10±16]. Glycation of proteins is associated with the formation of high-molecular aggregates that are stabilised by non-reducible cross-linking components [13, 17±18] with characteristic fluorescence spectra [6,19,20]. Circular dichroism (CD) spectroscopy studies of glycated proteins exhibited a damaging effect of the modifications on protein structure and stability [21,22].In diabetic nephropathy the disordered morphology and functional deficiency of the glomerular basement membrane (GBM) has been explained by glycation of the collagen IV network providing the mechanical scaffold of the membrane texture. Collagen IV monomers consist of a collagenous major triplehelical domain with two specific cross-linking domains, the NC1 domain at the C-terminal end and the N-terminus the 7S domain [23±26], facilitating Diabetologia (1998) Summary Glycation of basement membrane collagen IV has been implicated as a major pathogenetic process leading to diabetic microvascular complications. To evaluate the relevance of carbohydrate-induced modifications on collagen IV in diabetic nephropathy, we isolated the cross-linking domains 7S and NC1 from the glomerular basement membrane (GBM) of patients with diabetes mellitus. Modifications characteristic for glycated proteins were identified when the domains from diabetic kidney were compared with the same domains from human placenta as an unmodified control. In both domains a marked formation of inter-and intramolecular cross links could be demonstrated by SDS-PAGE. Furthermore circular dichroism studies showed a decrease in helicity of the 7S domain from human diabetic kidneys of 13 %, indicating denaturation already at room temperature. Thermal transition profiles, showing a shift of the denaturation temperature towards a lower temperature, with loss of a distinct second melting point, confirmed this observation. Our data provide further evidence for a possible role of protein-modification by glycoxidative reactions in the onset of diabetic nephropathy in vivo. [Diabetologia (1998

Background: Smoking cessation is one of the most effective secondary prevention measures after acute myocardial infarction (AMI). However, around 50% of smokers do not quit smoking after AMI. The aim of the present study is to estimate the proportion of patients quitting smoking and to identify determinants of persistent smoking after AMI in a region with increased cardiovascular mortality. We also assessed the time of smoking cessation after AMI. Methods: We used follow-up data of patients registered with the Regional Myocardial Infarction Registry in Saxony-Anhalt (RHESA) in Germany. We assessed smoking status and determinants of persistent smoking six weeks after discharge from hospital after AMI. Information on smoking, sociodemographic characteristics, risk factors for AMI, experienced symptoms of AMI, and clinical care were gathered in a computer-assisted telephone interview and questionnaires filled out by study subjects and physicians or study nurses. Results: Out of 372 smokers at the time of AMI, 191 (51.3%) reported that they quit smoking within six weeks after discharge from hospital after AMI. Strongest determinant of persistent smoking was a previous AMI before the current one (OR = 2.19, 95%CI 1.10-4.38) and strongest determinants of smoking cessation were experiencing complications in the hospital (0.37, 95%CI 0.12-1.12) and having a life partner (0.56, 95%CI 0.34-0.95). Most individuals who stopped smoking did so during the initial stay in the hospital, before the cardiac rehabilitation (CR). Conclusions: Persistent smoking after AMI and its determinants were similar in our region to previous studies. CR cannot be viewed as determinant of smoking cessationmore likely the same teachable moment induces behavioural change with regard to smoking and participation in CR.

Background Cardiovascular diseases are still the main cause of death in the western world. However, diminishing mortality rates of acute myocardial infarction (AMI) are motivating the need to investigate the process of secondary prevention after AMI. Besides cardiac rehabilitation, disease management programs (DMPs) are an important component of outpatient care after AMI in Germany. This study aims to analyze outcomes after AMI among those who participated in DMPs and cardiac rehabilitation (CR) in a region with overall increased cardiovascular morbidity and mortality. Methods Based on data from a regional myocardial infarction registry and a 2-year follow-up period, we assessed the occurrence of major adverse cardiac events (MACE) in relation to participation in CR and DMP, risk factors for complications and individual healths well as lifestyle characteristics. Multivariable Cox regression was performed to compare survival time between participants and non-participants until an adverse event occurred. Results Of 1094 observed patients post-AMI, 272 were enrolled in a DMP. An association between DMP participation and lower hazard rates for MACE compared to non-enrollees could not be proven in the crude model (hazard ratio = 0.93; 95% confidence interval = 0.65–1.33). When adjusted for possible confounding variables, these results remained virtually unchanged (1.03; 0.72–1.48). Furthermore, smokers and obese patients showed a distinctly lower chance of DMP enrollment. In contrast, those who participated in CR showed a lower risk for MACE in crude (0.52; 0.41–0.65) and adjusted analysis (0.56; 0.44–0.71). Conclusions Participation in DMP was not associated with a lower risk of MACE, but participation in CR showed beneficial effects. Adjustment only slightly changed effect estimates in both cases, but it is still important to consider potential effects of additional confounding variables.