ObjectiveTo examine whether SMS text messaging facilitates a reduction of weight and waist circumference (WC) and favourable changes in lipid profile and insulin levels in clinically healthy overweight and obese subjects.DesignA randomised controlled trial.Setting and interventionPrimary care health centre in Riga, Latvia. Text messaging once in two weeks.SubjectsA total of 123 overweight and obese men and women aged 30–45 years with no cardiovascular diseases (CVDs) or diabetes.Main outcome measures: changes in anthropometric parameters (weight, WC, body mass index (BMI)) and biochemical parameters (lipids, fasting glucose and insulin).ResultsWe found a statistically significant decrease in weight (2.4%), BMI and WC (4.8%) in the intervention group, while the control group showed a statistically non-significant increase in weight and BMI and decrease in WC. Between group results obtained over the course of a year showed statistically significant mean differences between weight (–3.4 kg (95% CI –5.5, –1.3)), BMI kg/m2 (–1.14 (95% CI –1.9, –0.41)), WC (–4.6 cm (95% CI –6.8, –2.3)), hip circumference (–4.0 cm (95% CI –5.9, –2.0)) and fasting insulin (2.43 μU/ml (95% CI 0.6, 4.3)). Mean differences of changes in glucose and lipid levels were statistically non significant: fasting glucose (–0.01 mmol/l (95% CI –0.19, 0.17)), TC mmol/l (–0.04 mmol/l (95% CI –0.29, 0.21)), HDL-C (0.14 mmol/l (95% CI –0.65, 0.09)), LDL-C (–0.02 mmol/l (95% CI –0.22, 0.18)) and TG (0.23 mmol/l (95% CI –0.06, 0.52)).ConclusionsSMS messaging in clinically healthy overweight and obese subjects facilitates a slight decrease in weight, BMI and WC. It is anticipated that the implications of this strategy might facilitate the design of preventive and promotive strategies among high risk groups in Latvia.

ObjectiveA potential mechanism by which obesity could promote hypertension and kidney diseases is through accumulation of adipose tissue in the renal sinus (RS). The aim of the study was to quantify RS and abdominal adipose tissue volumes and to evaluate serum kidney injury molecule (sKIM)-1 and fibroblast growth factor (FGF)-21 association with different adipose tissue compartments.MethodsThe cross-sectional study included 280 and follow-up study-40 asymptomatic participants; aged 38.30 ± 4.10. For all study participants computed tomography examination was performed, sKIM-1 and FGF-21 levels were measured.ResultsThe results indicated asymmetrical deposition of adipose tissue into the RS even after corresponding kidney volume adjustment. The cross-sectional and the follow-up studies showed that sKIM-1 level was positively associated with RS adipose tissue volume increase for both genders. FGF-21 was positively associated with RS and retroperitoneal adipose tissue amount.ConclusionsRegardless of gender adipose tissue in RS accumulates asymmetrically–the left RS accumulates a significantly higher amount of adipose tissue. Thus, primarily RS adipose tissue effects should be assessed on the left kidney. Accumulation of adipose tissue in the RS is related with the visceral adipose amount, KIM-1 and FGF-21 concentration increase in the blood serum.

Theme: 'Reducing the risk of chronic diseases in general practice/family medicine'

Chronic diseases in most cases belong to the category of non-communicable diseases (NCDs), which are the main cause of mortality globally. Cardiovascular diseases, diabetes, chronic obstructive pulmonary disease and cancer are the four NCDs responsible for 82% of NCD deaths. Prevention of NCDs implies health promotion activities that encourage healthy lifestyle and limit the initial onset of chronic diseases. Prevention also includes early detection activities, such as screening at-risk populations, as well as strategies for appropriate management of existing diseases and related complications. Early intervention, reducing morbidity and mortality rates could be an appealing idea for patients, physicians and governmental institutions but could also cause harm. Healthcare is undergoing profound changes, and the role of technology in diagnostics and management of chronic diseases in primary healthcare (PHC) is increasing remarkably. However, studies show that the standards of care for chronic diseases and preventive care are met by less than 50%. We still lack clear standards for patients with multiple chronic diseases. The applicability of a single evidence-based guideline to multimorbid patients is limited and can be problematic. Well-designed PHC studies focusing on the impact of medical interventions on morbidity, mortality and quality of life in the fields of early diagnosis, early treatment and multimorbidity are still needed.

Background Although self-limiting viral infections are predominant, children with acute infections are often prescribed antibiotics by family physicians. The aim of the study is to evaluate the impact of two interventions, namely C-reactive protein point-of-care testing and educational training, on antibiotic prescribing by family physicians. Methods This randomised controlled intervention study included acutely ill children consulted by 80 family physicians from urban and rural practices in Latvia. The family physicians were divided into two groups of 40. The family physicians in the intervention group received both interventions, i.e. C-reactive protein point-of-care testing and educational training, whereas the family physicians in the control group continued to dispense their standard care. The primary outcome measure was the antibiotic prescribing at the index consultation (delayed or immediate prescription) in both study groups. The secondary outcome was CRP testing per study group. Patient- and family physician- related predictors of antibiotic prescribing were analysed as associated independent variables. Practice location effect on the outcomes was specially addressed, similar to other scientific literature. Results In total, 2039 children with acute infections were enrolled in the study. The most common infections observed were upper and lower respiratory tract infections. Overall, 29.8% (n = 607) of the study population received antibiotic prescription. Our binary logistic regression analysis did not find a statistically significant association between antibiotic prescriptions and the implemented interventions. In the control group of family physicians, a rural location was associated with more frequent antibiotic prescribing and minimal use of CRP testing of venous blood samples. However, in the intervention group of family physicians, a rural location was associated with a higher level of C-reactive protein point-of-care testing. Furthermore, in rural areas, a significant reduction in antibiotic prescribing was observed in the intervention group compared with the control group (29.0% (n = 118) and 37.8% (n = 128), respectively, p = 0.01). Conclusion Our results show that the availabilty of C-reactive protein point-of-care testing and educational training for family physicians did not reduce antibiotic prescribing. Nevertheless, our data indicate that regional variations in antibiotic-prescribing habits exist and the implemented interventions had an effect on family physicians practices in rural areas.