OBJECTIVE -To estimate the global number of excess deaths due to diabetes in the year 2000.RESEARCH DESIGN AND METHODS -We used a computerized generic formal disease model (DisMod II), used by the World Health Organization to assess disease burden through modeling the relationships between incidence, prevalence, and disease-specific mortality. Baseline input data included population structure, age-and sex-specific estimates of diabetes prevalence, and available published estimates of relative risk of death for people with diabetes compared with people without diabetes. The results were validated with population-based observations and independent estimates of relative risk of death.RESULTS -The excess global mortality attributable to diabetes in the year 2000 was estimated to be 2.9 million deaths, equivalent to 5.2% of all deaths. Excess mortality attributable to diabetes accounted for 2-3% of deaths in poorest countries and over 8% in the U.S., Canada, and the Middle East. In people 35-64 years old, 6 -27% of deaths were attributable to diabetes.CONCLUSIONS -These are the first global estimates of mortality attributable to diabetes. Globally, diabetes is likely to be the fifth leading cause of death. Diabetes Care 28:2130 -2135, 2005D iabetes is a serious illness with multiple complications and premature mortality, accounting for at least 10% of total health care expenditure in many countries (1). However, routinely reported statistics based on death certification seriously underestimate mortality from diabetes (2), because individuals with diabetes most often die of cardiovascular and renal disease and not from a cause uniquely related to diabetes, such as ketoacidosis or hypoglycemia (3).Most international mortality statistics, including those published by the World Health Organization (WHO), are based solely on the "underlying cause of death" as recorded on the death certificate, even in the presence of other information. Complex methods have been developed for estimating cause-specific mortality for some conditions (AIDS, tuberculosis) but not for diabetes (4).Based on routine statistics, recent World Health Reports estimated mortality from diabetes in the world as 987,000 deaths for the year 2002 (5), which was 1.7% of total world mortality. There were estimated to be at least 170 million people with diabetes in the world in the year 2000 (6); therefore, mortality attributable to diabetes could be expected to be much higher, since diabetes is a serious and chronic condition. The aim of this study was to provide a more realistic estimate of the number of deaths attributable to diabetes. RESEARCH DESIGN AND METHODS Model and dataTo estimate the number of deaths attributable to diabetes in the year 2000, we used a software program, DisMod II, developed for the Global Burden of Disease 2000 study (7,8) and routinely used by WHO for disease estimates. The DisMod II disease model is that of a multistate life table that describes a single disease. There are two causes of death, from the disease and from "all othe...
In recent years there has been a significant expansion of information and advice for people with diabetes available on the Internet. Interestingly much of this is provided by lay people, who often have diabetes themselves. Consequently we decided to critically evaluate the quality of non-professional advice available on the Internet for people with diabetes. This was undertaken by identifying a dedicated diabetes newsgroup, which was analysed by a panel of specialist diabetologists who assessed the quality of postings and responses using a six point classification. Each message was rated independently by each of the five panel members and scores were compared for reliability of judgement. From the newsgroup used mainly by non-professionals 61 start messages comprised 54 questions, six statements and one commercial proposition. Sixteen questions related to diet, nine to glycaemic control and blood tests, ten to tablets and insulin, eight to complications, and there were 18 others. 61 start messages were categorised as four excellent, 24 less good -some details, 17 poor -little detail, 17 vague, but none were misleading or incomprehensible. After 5 days 61 messages had generated 242 responses, which were assessed as 13 evidence based excellent, 60 accepted wisdom, 137 personal opinion anecdote, 26 misleading or irrelevant, one false and five open to misinterpretation. There were 146 respondents (30 more than once), range of replies 1-15, identified as a doctor in four instances, but usually patient, relative or unknown. Newsgroups such as the one we analysed are clearly a valuable forum for persons with diabetes to interact with each other, share experiences and provide social support. For the most part the level of understanding about the condition was quite extensive, with the debate being largely technical in nature. Of the 242 responses, only six were regarded as either false or possibly dangerous. This raises important questions about how to ensure that the information provided on the Internet for persons with diabetes is accurate, sensible, evidence based and easily accessible.
Objective: A prospective regional survey was carried out to describe the current practice of temporary transvenous pacing in five hospitals in the Wessex region and identify factors that predispose to complications. Methods: Data were collected on patient characteristics, pacing indication and setting, operator grade, training, experience and supervision, venous access, procedure time, duration of pacing, complications, and eventual outcome. Results: A total of 144 procedures were performed on 111 patients (age 75 (12) I nsertion of a temporary transvenous pacemaker may be performed as an urgent procedure in the setting of acute haemodynamic collapse secondary to bradyarrhythmias or tachyarrhythmias, or as a prophylactic measure in high risk patients undergoing interventional procedures.1 The procedure may be performed in a wide range of settings, by operators with varying skills, training, technical knowledge, and experience. 3Previous studies have demonstrated high complication rates with little change over the last two decades.3-6 Studies performed in the UK were carried out before the introduction of the specialist registrar training grade. The present study was undertaken to determine whether the incidence of complications has changed with increasing physician numbers and a greater emphasis on subspecialty training. Operator and technical factors were also examined to identify current practices that may influence procedure outcome. METHODSBetween January and September 1999 a prospective study was performed at five hospitals in the Wessex region (four district general hospitals and the regional cardiothoracic centre). All temporary pacing procedures were performed after obtaining informed consent from the patient unless their condition or the urgency of the occasion necessitated immediate pacing. After each pacing procedure, a physician completed a form which documented demographic details, the indication for pacing, who performed and who supervised the procedure, plus operator experience and subspecialty. If more than one operator performed the procedure the most senior physician present was noted. Operator seniority in ascending order was house officer, senior house officer, registrar, specialist registrar, staff grade, and consultant. Experienced physicians were those who had performed at least 20 temporary pacing procedures, inexperienced physicians were those who had performed less than 20 procedures. Cardiologists/cardiology trainees were defined as those specialist registrars who were in a cardiology training programme, or consultants who had a specialist interest in cardiology. Procedure details, including venous access site, procedure duration, fluoroscopy time, sterile techniques, patient cooperation, and immediate outcomes and complications were noted. Ease of venous access was categorised into "first pass at a single venous site", "multiple stabs at a single venous site", and "multiple venous sites attempted".The form accompanied the patient throughout the duration of the temporary pacemaker per...
Roth spots are white-centred retinal haemorrhages, previously thought to be pathognomonic for subacute bacterial endocarditis. A number of other conditions can be associated with Roth spots. In this case, the authors describe the association of Roth spots and pernicious anaemia. This association has been rarely described in the medical literature. Correct diagnosis and treatment with intramuscular vitamin B(12) injections resulted in complete resolution of the anaemia and Roth spots. The authors hope to alert clinicians to think of various differentials of Roth spots, and initiate prompt investigation and management.
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