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Cardiovascular Outcomes of Sodium-Glucose Cotransporter-2 Inhibitors Therapy in Patients With Type 2 Diabetes Mellitus and Chronic Kidney Disease: A Systematic Review and Updated Meta-Analysis

  • Nicole Felix;Mateus M. Gauza;Larissa Teixeira;Maria Eduarda S. Guisso;Alleh Nogueira;Caroline S. Dagostin;Amanda Godoi;Sandro A. G. Ribeiro;Juan C. Duque;Jose A. Moura-Neto;Rhanderson Cardoso
    • Korean Circulation Journal
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    • v.54 no.9
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    • pp.549-561
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    • 2024
  • Background and Objectives: The efficacy of sodium-glucose cotransporter-2 inhibitors (SGLT2i) may depend on renal function, and this raises theoretical concern over its effects on cardiovascular outcomes in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). Methods: This systematic review and updated meta-analysis of randomized controlled trials (RCTs) compared cardiovascular outcomes of patients with T2DM and CKD treated with SGLT2i to placebo. PubMed, Embase, and Cochrane were systematically searched. Prespecified subgroup analyses were performed in strata of estimated glomerular filtration rate (eGFR) of <45 mL/min/1.73 m2 and 45 to 59 mL/min/1.73 m2. Results: Nine RCTs comprising 29,146 patients were selected. Average follow-up ranged from 0.75 to 4.2 years. SGLT2i were shown to reduce the risk of all-cause mortality (hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.79-0.97; p=0.01), the composite of cardiovascular mortality or hospitalizations for heart failure (HHF: HR, 0.71; 95% CI, 0.65-0.78; p<0.001), cardiovascular mortality (HR, 0.86; 95% CI, 0.76-0.98; p=0.02), HHF (HR, 0.62; 95% CI, 0.55-0.71; p<0.001), major adverse cardiovascular events (HR, 0.85; 95% CI, 0.77-0.94; p=0.002), stroke (HR, 0.76; 95% CI, 0.59-0.97; p=0.03), and myocardial infarction (HR, 0.78; 95% CI, 0.67-0.91; p=0.001). These findings were consistent over strata of eGFR, albeit with a lower incidence of stroke in patients treated with SGLT2i with eGFR <45 mL/min/1.73 m2 (p-value for interaction=0.04). Conclusions: Compared with a placebo, patients with T2DM and CKD treated with SGLT2i experience a reduction in all-cause mortality, cardiovascular mortality, and HHF.

Influence of COVID-19 Knowledge, Risk Perception, Anxiety on Preventive Behaviors of Nursing Students (간호대학생의 코로나19 관련 지식, 감염 위험지각, 불안이 감염예방 행위에 미치는 영향)

  • Yu-Jeong Kim
    • Journal of the Health Care and Life Science
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    • v.11 no.2
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    • pp.207-217
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    • 2023
  • The purpose of this study was to investigate COVID-19 Knowledge, Risk Perception, Anxiety and Preventive Behaviors, and to identify the influencing factors on Preventive Behaviors of nursing students. Data were collected using questionnaires from 342 nursing students in Gwangju, November 2021. The collected data was analyzed by descriptive statistics, pearson's correlation coefficient and stepwise multiple regression using IBM SPSS 21.0 program. The total mean scores were as follows: COVID-19 Knowledge, 13.25±1.38; Risk Perception; 4.57±1.34, Anxiety; 44.55±9.66, Preventive Behaviors; 7.66±1.55. Preventive Behaviors was found to have significant positive correlations with COVID-19 Knowledge and Risk Perception). The most influential factors influencing the Preventive Behaviors of nursing students were Experience in education related COVID-19 prevention, Risk Perception, COVID-19 Knowledge. In conclusion, in order to develop the Preventive Behaviors of nursing students, it is necessary to apply a program that improve the COVID-19 prevention education and Knowledge, and to control Risk Perception according to the individual level.

Factors Affecting Concerns About Economic Damage of Adults Due to COVID-19 (COVID-19로 인한 성인의 경제적 피해 염려에 영향을 주는 요인)

  • Seung-Ok Shin
    • Journal of the Health Care and Life Science
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    • v.9 no.2
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    • pp.355-361
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    • 2021
  • In the context of COVID-19, the economic downturn affects health as well as concerns about economic damage to individuals. In this study, among a total of 15,047 people who were economically active during the community health survey for those aged 19 and over, health behaviors related to the impact of changes in daily life due to the demographic and social and economic characteristics of COVID-19 were concerned about economic damage. was analyzed to determine whether it had an effect on Factors affecting the fear of economic damage were gender, education level, monthly income level, status, subjective health level, physical activity, and smoking, which had more influence on the fear of economic damage than other characteristics. In this study, males(p=0.024), high school graduates(p<0.001), monthly income level of 1,000,001 to 3,000,000won(p-=0.002), wage workers(p<0.001), subjects who responded that their subjective health level was 'similar'(p=0.009), subjects who responded 'similar' in physical activity(p<0.001), and smoked 'similar'(p=0.016) Those who answered high were more concerned about economic damage. Considering that COVID-19 is highly likely to be prolonged and social distancing cannot be ruled out, which affects health care due to economic damage, it is necessary to reflect it in health program development and economic-related fiscal policies.

The Effects of Shift Work Nurses' Job Stress, Job Involvement, and Goal Orientation on Work-Life Balance (교대근무간호사의 직무스트레스, 직무몰입, 목표지향성이 일과 삶의 균형에 미치는 영향)

  • Su Mi Choi;Nam Joo Je
    • The Journal of the Convergence on Culture Technology
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    • v.10 no.5
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    • pp.29-39
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    • 2024
  • This study attempted to determine the effect of job stress, job involvement, and goal orientation on work-life balance for shift nurses. The subjects of the study were 128 shift nurses working at a hospital in city C of province G. Date were conducted from April 01 to April 15, 2024 using a Google questionnaire. The collected data were analyzed by correlation and multiple regression analysis. The total explanatory power was 28.0%. The results of this study showed significant differences in job stress(β=.405, p<.001), goal orientation(β=-265, p=.002), and job involvement(β=.174, p=.037) as factors affecting the work-life balance of shift nurses. Therefore, it is expected to have a positive impact on patient health by contributing to the improvement of the quality of nursing services by forming an organizational culture that avoids excessive goal setting and allows employees to concentrate on their work with appropriate stress management. This suggests that nurses are not only individuals but also professional medical practitioners, and that maintaining a healthy work-life balance is crucial for the country's human resources, which requires institutional support at the government level.

Distribution Survey of Babesia and Assessment of Tick-borne Diseases in Jeju, Republic of Korea (Babesia의 제주 지역 내 분포 조사)

  • Jiro KIM;YoungMin YUN
    • Korean Journal of Clinical Laboratory Science
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    • v.56 no.3
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    • pp.189-197
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    • 2024
  • From March to November 2021, a study conducted in Jeju used the dry ice trap method to collect 17,855 ticks across six regions, examining their distribution and potential as disease vectors. The ticks were identified and categorized by species and growth stage. In addition, the study focused on Babesia, a disease transmitted by hard ticks. Of 17,641 ticks from which DNA had been extracted, 581 pools underwent polymerase chain reaction testing. Of these, 43 pools tested positive for Babesia, with the highest positivity found in Western Seogwipo (23 pools, 53.5%), followed by eastern Seogwipo and central Jeju. The peak times for positive results were April and July. This study highlights an increased risk of tick bites linked to the rising number of abandoned pets in Jeju, necessitating ongoing environmental management and monitoring. These findings provide fundamental data for formulating strategies to prevent and manage tick-borne diseases in Jeju. This involves reducing the disease incidence through targeted preventive measures and detailed epidemiological research. These results underscore the necessity for continued vigilance and proactive intervention to address the health challenges ticks pose in the region.

A Study on Health Behavior of the Populations in Urban and Rural Area (도시·농촌지역 주민의 건강행태에 관한 연구)

  • Lee, Jeong-Mi;Kwon, Keun-Sang;Lee, Ju-Hyoung;Jeon, Gap-Sung
    • Journal of agricultural medicine and community health
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    • v.30 no.2
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    • pp.213-225
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    • 2005
  • Objectives: This study was carried out to evaluate the socio-demographic, style of living, and health related behaviors of community residents between urban and rural areas in Jeonbuk province. Methods: The data was obtained from 2,086 residents who lived in Jeonbuk province from July to September 2001 which included 1,238 residents in urban area and 848 residents in rural area. Results: The results were as follows; There were significant differences socio-demographic characteristics including occupation and educational level of the populations between urban and rural areas. In the urban populations, housewives, professional classes, and people who received collage graduate education were significantly higher, people who were engaged in the primary industries and lower educational classes(below middle school), in contrast, were significantly lower than in the rural populations. In the practice of health behavior, consumption of health foods and amount of exercise in urban populations were significantly higher than in the rural, whereas the state of health, prevalence of chronic disease, Body Mass Index(BMI), consumption of ethanol and cigarette, and hours of sleep were not significantly different between the urban and rural populations. In the eating habits, rate of surfeit, vaccination of hepatitis B, and screening of cancer in the urban populations were significantly higher than in the rural, rate of regular meal, taste of salted food, consumption of vegetables, in contrast. were significantly lower than in the rural. But, consumption of coffee, intake of meat, and periodic medical checkup were not significantly different between urban and rural communities. Logistic regression analysis revealed that the factors associated with subjective thought on health state were sex, age, occupation, educational level, exercise, and consumption of coffee. Logistic regression analysis to find related factor with prevalence of chronic disease was conducted. As a results, age, educational level, BMI, intake of meat, screening of cancer, and consumption of health foods were related to prevalence of chronic disease. Conclusions: The study showed that special attention to device the health plan are necessary and it suggested that consideration of regional differences are required to provide the community health projects.

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A clinical analysis of juvenile dermatomyositis; focus on clinical manifestations at diagnosis (소아기 피부근염의 임상적 고찰; 진단시 임상증상을 중심으로 한 고찰)

  • Lee, So Young;Bang, Ji Seok;Kim, Hee Seok;Kim, Joong Gon
    • Clinical and Experimental Pediatrics
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    • v.50 no.11
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    • pp.1116-1124
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    • 2007
  • Purpose : Juvenile dermatomyositis (JDM) is the most common of the idiopathic inflammatory myopathies in children. The purpose of this study is to observe demographic, initial presentations, duration of time between disease onset and diagnosis, clinical manifestations and laboratory findings at diagnosis of patients with JDM. Methods : Forty seven patients identified at Seoul National University Children's Hospital from January 1986 to May 2007. Medical records were reviewed retrospectively focusing on initial presentations, clinical manifestations and laboratory findings at the time of diagnosis of patients with JDM. Results : Male and female patients were 25 and 22, respectively and sex ratio was 1.14:1. The average age at the time of diagnosis was 6.51 years. Skin rash (94%) was the most common symptom, followed by the proximal muscle weakness (89%). The disease activity score was 10.8. The duration between the onset of the skin rash and the muscle weakness and diagnosis was 7.18 and 4.70 months, respectively. The serum muscle enzymes, LDH, AST, CK and aldolase, were elevated in the patient with JDM. Autoimmune antibodies, antinuclear antibody, anti SSA antibody and anti SSB antibody, were negative findings. Electromyography findings were consistent with JDM in 88% of the patients, the muscle biopsy was in 91% and all MRI findings were compatible with those of patients with JDM. The most common symptom besides musculocutaneous lesions was the calcinosis (62.5%). The most common site of calcinosis was the pelvic area and buttocks. Conclusion : This study shows that the major symptoms are proximal muscle weakness and cutaneous lesion, and they are important to diagnose JDM.

Pulse wave velocity and ankle brachial index in obese adolescents (비만 청소년에서 맥파 속도와 발목 상완 동맥압 지수에 대한 연구)

  • Kim, Ji Hye;Koo, Hee Sun;Hong, Young Mi
    • Clinical and Experimental Pediatrics
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    • v.50 no.11
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    • pp.1078-1084
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    • 2007
  • Purpose : The prevalence of childhood obesity has doubled over the last 30 years. Obesity-associated sequelae in the vasculature begins in the early stages of life. The purpose of this study was to investigate how pulse wave velocity (PWV) and ankle brachial index (ABI) change with height, weight and body mass index (BMI) in obese adolescents. Methods : Seventy-nine obese adolescents (group 1: $85th{\leq}BMI<95th$ percentile, n=40; group 2 ($BMI{\geq}95th$ percentile, n=39) were included. The control group(group 3) included 99 healthy adolescents. Brachial- ankle (ba) PWV and ABI were estimated with blood pressure from four extremities. Heart rate (HR), and pre-ejection period/ejection time (PEP/ET) were also estimated. BMI was calculated from individual height and weight. Linear regression analysis was performed to evaluate the correlations between BMI and PWV. Results : Blood pressure and baPWV were significantly higher in group 2, compared to either group 1 or group 3. However, there was no significant difference in ABI, HR and PEP/ET between the groups. PWV showed linear correlation with both BMI and body weight. Conclusion : Obesity was associated with higher arterial stiffness in adolescents, which was demonstrated by an increase in PWV. There was no significant correlation between obesity and ABI.

A literal study on the Gu-Chang (구창의 문헌연구)

  • Jung Han Sol;Park Jong Hoon;Ryuk Sang Won;Lee Kwang Gyu
    • Journal of Physiology & Pathology in Korean Medicine
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    • v.16 no.1
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    • pp.32-44
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    • 2002
  • Gu-Chang is a disorder characterized by recurring ulcers confined to the oral mucosa. Despite much clinical and research attention, the causes remain poorly understood. In this paper, we will compare Gu-Chang with Recurrent Aphthous Stomatitis(RAS) in order to know what is the similiarity between Gu-Chang and RAS. So we will arrange various oriental and western medical literatures which are important. As a result of arrangement of the causes, symptoms and therapys of Gu-Chang, we can conclude through the studies as follows. 1. The etiologies of Gu-chang are following. In the Sthenia syndrome, there are evil heat of external factor, heat of heart and spleen, insomnia, heat of upper warmer, stress and diet, heat of lung and heart, excessive heat of upper warmer, inappropriate food intake, heat conveyance of organ, heat of stomach merdian, moistured heat of spleen and stomach and stasis of liver energy. In the Asthenia syndrome, there are deficiency of stomach energy, deficiency of upper warmer leading to heat, deficiency of middle warmer leading to cold, deficiency of lower warmer leading to heat, deficiency of middle energy, deficiency of blood, decreased fire and deficiency of soil, yin fire of lower warmer, deficiency of heart yin, deficiency of spleen yin and deficiency of qi and blood. 2. In western medicine the causes of RAS is presumed as local, microbial, systemic, nutritional, genetic, immunologic factors. 3. Once Gu-chang is compared with RAS, in the deficiency of yin leading to hyperactivity of fire, deficiency of yin leading to floating of fire and stasis of liver energy, recurring of Gu-chang is similar to RAS. Although recurring of Gu-chang due to tripple warmer of excessive fire has no recurrance, since there are the degree of Pain, site of lesion, dysphagia etc, it is similar to major RAS. It is may be believed that Sthenia Gu-chang is similar to major RAS, shape of recurring, site of lesion, degrree of Pain and white color of Asthenia Gu-chang are similar to minor RAS, but there is no similarity concerning herpes RAS in the literatures that describe the symptoms. 4. Generally, the treatment of Gu-chang is divided into Asthenia and Sthenia Syndrome. The method of cure to Sthenia syndrome is heat cleaning and purge fire, Asthenia syndrome is nourish yin to lower and adverse rising energy and strength the middle warmer and benefit vital energy. 5. Following is the medication for Sthenia syndrome. Heat of heart and spleen is Do Jok San, Yang Gyek San, Juk Yup Suk Go Tang, evil heat of external factor is Yang Gyek San Ga Gam, Stasis of liver energy is Chong Wi Fae Dok Yum, moistured heat of spleen and stomach is Chong Gi Sam Syep Tang. The medication for Asthenia Syndrome is following. Deficiency of upper warmer leading to heat is Bo Jung Ik Gi Tang, deficiency of middle warmer leading to cold is Bu Ja Lee Jung Tang, deficiency of lower warmer leading to heat is Yuk Mi Ji Hwang Tang, deficiency of yin leading to hyperactivity of fire is Ji Baek Ji Hwang Hwan, deficiency of yin leading to floating of fire is Lee Jung Tang Ga Bu Ja Medicine for external use were Yang Suk San, Boo Wyen San, Rok Po San, Yoo Hwa San ate. 6. In western medicine, there is no specific treatment for RAS, and management strategies depend on dinical presentation and symptoms and includes antibiotics, oral rinses, glucocorticoids, immunomodulatory drugs, vitamines, analgesics, laser and antiviral agents.

The study on outpatient-clinic practice by shift system at a hospital in Taegu (대구지역 한 중소병원의 교대제 근무에 의한 외래진료에 관한 연구)

  • Song, Jung Hup;Kim, Jing Kyun;Ha, Young Ae;Yeh, Min Hae
    • Quality Improvement in Health Care
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    • v.1 no.2
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    • pp.44-59
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    • 1994
  • Medical consumers(patients) want evening-clinic because of busy work. For patient's convenience and improving service, hospital should accept it. Considering payment system and patient's demand, personnel expenses, hospital can not accept. The practice of shift system to accept patient's demand and hospital's economic aspect was made. To analysis the effect of the system and probability to alternative to evening clinic this study was done. This study was composed of basal study, intervention, evaluation of effect. The basal study were composed of studying demand on evening clinic, the number of beds, doctors employee, the time table of practice and work, and the number of patients at arrival time. The intervention composed of changing of practice time, changing of working time by the number of patients at arrival time, increasing of employee. The evaluation of effect were composed of evaluating the number of patient at time, the effect of shift system, the comparison of the number of in and out patients and questionnairing the practice of shift system. In the practice time at 2 shift system First team works 7-15 hours and Second team 12-20 hours. there are no lunch and supper time. At 18-20 hours the number of patients were 25-30. The number of patient a depart were 6-7. The number of out-patient increase in 13% and inpatient increase in 10% before the system. Doctors(100%), employee(94.6%), and patients(86.4%) approved this system. The advantage of this system were utilization of surplus time, lengthen the practice time, even distribution of patients and shortening of waiting time, rapid treatment of emergent patients. The disadvantage of this system were shortage of manpower, not all depart practice, continuity of practice, no lunch and supper time, irregular rounding. At present because of small Demanding on evening clinic, this shift system was economical. To succeed this study more effectively all depart in hospital participate. But because of economical reason it is impossible for hospital to do it. If the government assist the economic loss that all depart participate in this system it is very helpful for hospital to succeed in implementing this system more early.

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