Search

Background The relationship between blood pressure and mortality in type 2 diabetes (T2DM) is controversial, with concern for increased risk associated with excessively lowered blood pressure. Methods We evaluated whether prior cardiovascular disease (CVD) altered the relationship between baseline blood pressure and all-cause mortality in 5852 patients with T2DM and a recent acute coronary syndrome (ACS) who participated in the ELIXA (Evaluation of Lixisenatide in Acute Coronary Syndrome) trial. Risk of death was assessed in Cox models adjusted for age, sex, race, heart rate, BMI, smoking, diabetes duration, insulin use, HbA1c, eGFR, brain natriuretic peptide (BNP), urine albumin/creatinine ratio, treatment allocation and prior coronary revascularization. Results Although overall there was no significant association between systolic blood pressure (SBP) and mortality (hazard ratio per 10 mmHg lower SBP 1.05 (95% CI 0.99–1.12) P = 0.10), lower SBP was significantly associated with higher risk of death (hazard ratio per 10 mmHg lower SBP 1.13 (95% CI 1.04–1.22) P = 0.002) in 2325 patients with additional CVD (index ACS+ at least one of the following prior to randomization: myocardial infarction other than the index ACS, stroke or heart failure). In 3527 patients with only the index ACS no significant association was observed (hazard ratio per 10 mmHg lower SBP 0.95 (0.86–1.04) P = 0.26; P for interaction 0.005). Conclusions The association between blood pressure and mortality was modified by additional CVD history in patients with type 2 diabetes and a recent coronary event. When blood pressures measured after an acute coronary event are used to assess the risk of death in patients with type 2 diabetes, the cardiovascular history needs to be taken into consideration., Funding Agencies|Sanofi; Fulbright Commission; Swedish Heart Association; Swedish Society of Medicine; Region Ostergotland, Sweden

Reseña de Enrique Montero Cartelle, Speculum medicinae. Estudios de medicina latina antigua y medieval, Valladolid, Ediciones Universidad de Valladolid, 2018, 337 páginas, ISBN 978-84-8448-986-3

L'analyse des facteurs impliqués dans les processus d'adaptation ou d'abandon dans l'enseignement montre que la performance académique aux étapes précédentes, le développement des attentes de résultats favorables, les informations académiques disponibles et la maîtrise des compétences de base dans le cas des lycéens sont des prédicteurs pertinents pour expliquer l'intégration sociale et académique dans les cursus des études supérieures. Cet article aborde la question des transitions académiques, soulignant l'importance de l'orientation pour aider les jeunes à se préparer à l'accès aux études universitaires. Les conséquences qui peuvent découler d'une mauvaise transition mettent en évidence l'importance de l'orientation dans les étapes préuniversitaires. MÉTHODE. Par rapport à cette approche, l'objectif de l'étude est d'analyser la perception qu'un échantillon d'élèves du secondaire selon de facteurs clés différents pour faire face à la transition vers ses études supérieures. Suite à une approche de recherche quantitative basée sur une étude empiricoanalytique développant une méthodologie ex post facto, nous avons traité un échantillonnage représentatif de 616 lycéens de la province de Santa Cruz de Tenerife. RÉSULTATS. Les résultats montrent que les lycéens ont une perception sur euxmêmes en tant que compétents pour s'attaquer aux tâches académiques. Ils montrent des attentes favorables à la réussite de leurs études et soulignent le soutien de leur famille et de leurs amis lors de la prise de décisions. DISCUSSION. Les données obtenues constituent un point de référence intéressant pour proposer des actions d'orientation préventive qui servent à aider les lycéens à se préparer au passage du lycée à l'université. Pour ce faire, il faut une meilleure collaboration entre les professionnels et la mise en place de réseaux d'accompagnement visant à suivre les étudiants tout au long de leur parcours académique., Factors such as preuniversity academic performance, the development of expectations for favorable results, academic information, and mastery of basic competencies help predict the social and academic integration of students in university education. This article addresses the issue of academic transitions, highlighting the importance of Guidance to help young people prepare the access to university studies. The consequences that can be derived from a bad transition come to highlight the importance of Orientation in the preuniversity stages. METHOD. In relation to this approach, the objective of the study is to analyze the perception of a sample of High School students in relation to different key factors to face the transition to Higher Education. Following a quantitative research approach —based on an empiricalanalytical study— that develops an expostfacto methodology, we worked with a representative sample of 616 High School students from the province of Santa Cruz de Tenerife. RESULTS. The results highlight that High School students perceive themselves competent to tackle academic tasks, show favorable expectations of successfully completing their studies, and highlight the support of their family and friends when making decisions. DISCUSSION. The data obtained constitute an interesting reference point to propose preventive guiding actions that serve to help students prepare for the transition from High School to university. This requires a better collaboration between professionals and the creation of support networks aimed at monitoring students throughout their academic career., Factores como el rendimiento académico preuniversitario, el desarrollo de expectativas de resultados favorables, la información académica y el dominio de competencias básicas ayudan a predecir la integración social y académica del alumnado en la enseñanza universitaria. En este artículo se aborda el tema de las transiciones académicas, resaltando la importancia que tiene la orientación para ayudar a los jóvenes a preparar el acceso a los estudios universitarios. Las consecuencias que pueden derivarse de una mala transición vienen a destacar la importancia de la orientación en las etapas previas a la universidad. MÉTODO. En relación con este planteamiento, el objetivo del estudio es analizar la percepción que tiene una muestra de estudiantes de bachillerato respecto a distintos factores claves para afrontar la transición a la educación superior. Siguiendo un enfoque de investigación de corte cuantitativo basado en un estudio empíricoanalítico que desarrolla una metodología ex post facto, se trabajó con una muestra representativa de 616 estudiantes de bachillerato de la provincia de Santa Cruz de Tenerife. RESULTADOS. Los resultados ponen de relieve que los estudiantes de bachillerato se perciben competentes para abordar las tareas académicas, muestran expectativas favorables de terminar con éxito sus estudios y destacan el apoyo de sus familiares y amigos a la hora de tomar decisiones. DISCUSIÓN. Los datos obtenidos constituyen un referente interesante para proponer actuaciones orientadoras de carácter preventivo, que sirvan para ayudar a los estudiantes a preparar la transición de la secundaria a la universidad. Para ello se requiere una mejor colaboración entre profesionales y la creación de redes de apoyo destinadas al seguimiento del alumnado a lo largo de su trayectoria académica.

BACKGROUND: The relationship between blood pressure and mortality in type 2 diabetes (T2DM) is controversial, with concern for increased risk associated with excessively lowered blood pressure.METHODS: We evaluated whether prior cardiovascular disease (CVD) altered the relationship between baseline blood pressure and all-cause mortality in 5852 patients with T2DM and a recent acute coronary syndrome (ACS) who participated in the ELIXA (Evaluation of Lixisenatide in Acute Coronary Syndrome) trial. Risk of death was assessed in Cox models adjusted for age, sex, race, heart rate, BMI, smoking, diabetes duration, insulin use, HbA1c, eGFR, brain natriuretic peptide (BNP), urine albumin/creatinine ratio, treatment allocation and prior coronary revascularization.RESULTS: Although overall there was no significant association between systolic blood pressure (SBP) and mortality (hazard ratio per 10 mmHg lower SBP 1.05 (95% CI 0.99-1.12) P = 0.10), lower SBP was significantly associated with higher risk of death (hazard ratio per 10 mmHg lower SBP 1.13 (95% CI 1.04-1.22) P = 0.002) in 2325 patients with additional CVD (index ACS+ at least one of the following prior to randomization: myocardial infarction other than the index ACS, stroke or heart failure). In 3527 patients with only the index ACS no significant association was observed (hazard ratio per 10 mmHg lower SBP 0.95 (0.86-1.04) P = 0.26; P for interaction 0.005).CONCLUSIONS: The association between blood pressure and mortality was modified by additional CVD history in patients with type 2 diabetes and a recent coronary event. When blood pressures measured after an acute coronary event are used to assess the risk of death in patients with type 2 diabetes, the cardiovascular history needs to be taken into consideration. Trial registration ClinicalTrials.gov number NCT01147250, first posted June 22, 2010.

Aims: Chronic hyperglycaemia, assessed by elevated glycated haemoglobin (A1C), is a known risk factor for heart failure (HF) and cardiovascular (CV) death among subjects with diabetes. Whether this risk varies with left ventricular ejection fraction (LVEF) is unknown. This study evaluated whether A1C influences a composite outcome of either HF hospitalization or CV death differently along the spectrum of LVEF. Methods and results: We assessed the relationships of baseline A1C and LVEF with a composite outcome of either CV death or HF hospitalization in the 4091 patients with type 2 diabetes and a recent acute coronary syndrome enrolled in the ELIXA trial who had available LVEF. We assessed for interaction between A1C and LVEF as continuous variables with respect to this outcome. During a median follow-up of 25.7 months, 343 patients (8.4%) had HF hospitalization or died of CV causes. In a multivariable model, A1C and LVEF were each associated with an increased risk of HF hospitalization or CV death [adjusted hazard ratio (HR) 1.11, 95% confidence interval (CI) 1.01–1.21 per 1% higher A1C, and adjusted HR 1.39, 95% CI 1.27–1.51 per 10% lower in LVEF]. Both A1C and LVEF were independently and incrementally associated with risk without evidence of interaction (P for interaction = 0.31). Patients with A1C ≥ 8% and LVEF <40% were at threefold higher risk than those with A1C < 7% and LVEF ≥50% (adjusted HR 3.18, 95% CI 2.03–4.98, P < 0.001). Conclusion: In a contemporary cohort of patients with type 2 diabetes and acute coronary syndrome, baseline chronic hyperglycaemia was associated with an increased risk of HF hospitalization or CV death independently of LVEF.