• Muscle wasting in patients with chronic heart failure: results from the studies investigating co-morbidities aggravating heart failure (SICA-HF)

      Fülster, Susann; Tacke, Matthias; Sandek, Anja; Ebner, Nicole; Tschöpe, Carsten; Doehner, Wolfram; Anker, Stefan D.; von Haehling, Stephan (Oxford University Press, 2012-11-23)
      Aims To assess the prevalence and clinical impact of reductions in the skeletal muscle mass of patients with chronic heart failure (HF). Chronic HF is accompanied by co-morbidities that influence the quality of life and outcomes. Methods and results We prospectively enrolled 200 patients with chronic HF. The appendicular skeletal muscle mass of the arms and the legs combined, was assessed by dual energy X-ray absorptiometry. We analysed the muscle strength in arms and legs, and all patients underwent a 6-min walk test, a 4-m walk test, and spiroergometry testing. Muscle wasting was defined as the appendicular muscle mass 2 SD below the mean of a healthy reference group of adults aged 18–40 years, as suggested for the diagnosis of muscle wasting in healthy ageing (sarcopenia). Muscle wasting was detected in 39 (19.5%) subjects. Patients with muscle wasting had significantly lower values for handgrip and quadriceps strength as well as lower total peak oxygen consumption (peakVO2, 1173 ± 433 vs. 1622 ± 456 mL/min), lower exercise time (7.7 ± 3.8 vs. 10.22 ± 3.0 min, both P < 0.001), and lower left ventricular ejection fraction (LVEF, P = 0.05) than patients without. The distance walked during 6 min and the gait speed during the 4-m walk were lower in patients with muscle wasting (both P < 0.05). Serum levels of interleukin-6 were significantly elevated in patients with muscle wasting (P = 0.001). Logistic regression showed muscle wasting to be independently associated with reduced peak VO2 adjusted for age, sex, New York Heart Association class, haemoglobin, LVEF, distance walked in 6 minutes, and the number of co-morbidities (odds ratio 6.53, p = 0.01). Conclusion Muscle wasting is a frequent co-morbidity among patients with chronic HF. Patients with muscle wasting present with reduced exercise capacity and muscle strength, and advanced disease.
    • Midregion prohormone adrenomedullin and prognosis in patients presenting with acute dyspnea: results from the BACH (Biomarkers in Acute Heart Failure) trial

      Maisel, Alan; Mueller, Christian; Nowak, Richard M; Peacock, W. Frank; Ponikowski, Piotr; Mockel, Martin; Hogan, Christopher; Wu, Alan H.B.; Richards, Mark; Clopton, Paul; et al. (American College of Cardiology, 2011-08-30)
      The aim of this study was to determine the prognostic utility of midregion proadrenomedullin (MR-proADM) in all patients, cardiac and noncardiac, presenting with acute shortness of breath.
    • Inverse relation of body weight and weight change with mortality and morbidity in patients with type 2 diabetes and cardiovascular co-morbidity: an analysis of the PROactive study population

      Doehner, Wolfram; Erdmann, Erland; Cairns, Richard; Clark, Andrew L.; Dormandy, John A.; Ferrannini, Ele; Anker, Stefan D.; Charité Medical School (Elsevier, 2012-12-15)
      Although weight reduction is a recommended goal in type 2 diabetes mellitus (T2DM), weight loss is linked to impaired survival in patients with some chronic cardiovascular diseases.
    • Impaired insulin sensitivity as an underlying mechanism linking hepatitis C and posttransplant diabetes mellitus in kidney recipients

      Baid-Agrawal, S.; Frei, U.; Reinke, P.; Schindler, R.; Kopp, M.A.; Martus, P.; Berg, T.; Juergensen, J.S.; Anker, Stefan D.; Doehner, Wolfram; et al. (Wiley, 2009-12)
      Aim of this study was to investigate the mechanism/s associating hepatitis C virus (HCV) infection and posttransplant diabetes mellitus in kidney recipients. Twenty HCV-positive and 22 HCV-negative kidney recipients, 14 HCV-positive nontransplant patients and 24 HCV-negative nontransplant (healthy) subjects were analyzed. A 3-h intravenous glucose tolerance test was performed; peripheral insulin sensitivity was assessed by minimal modeling. Pancreatic insulin secretion, hepatic insulin uptake, pancreatic antibodies and proinflammatory cytokines in serum (tumor necrosis factor-alpha, intereukin-6, high-sensitive C-reactive protein) were also assessed. HCV-positive recipients showed a significantly lower insulin sensitivity as compared to HCV-negative recipients (3.0 +/- 2.1 vs. 4.9 +/- 3.0 min(-1).microU.mL(- 1).10(4), p = 0.02), however, insulin secretion and hepatic insulin uptake were not significantly different. Pancreatic antibodies were negative in all. HCV status was an independent predictor of impaired insulin sensitivity (multivariate analysis, p = 0.008). The decrease of insulin sensitivity due to HCV was comparable for transplant and non-transplant subjects. No significant correlation was found between any of the cytokines and insulin sensitivity. Our results suggest that impaired peripheral insulin sensitivity is associated with HCV infection irrespective of the transplant status, and is the most likely pathogenic mechanism involved in the development of type 2 diabetes mellitus associated with HCV infection.
    • Impact of remote telemedical management on mortality and hospitalizations in ambulatory patients with chronic heart failure: the telemedical interventional monitoring in heart failure study.

      Koehler, Friedrich; Winkler, Sebastian; Schieber, Michael; Sechtem, Udo; Stangl, Karl; Böhm, Michael; Boll, Herbert; Baumann, Gert; Honold, Marcus; Koehler, Kerstin; et al. (American Heart Association, 2011-05-03)
      This study was designed to determine whether physician-led remote telemedical management (RTM) compared with usual care would result in reduced mortality in ambulatory patients with chronic heart failure (HF).
    • Impact of diabetes on physical function in older people

      Sinclair, Alan J.; Conroy, Simon P.; Bayer, Antony J.; University of Bedfordshire; Nottingham University; Cardiff University (American Diabetes Association, 2007-11-16)
      Objective: To explore the nature of functional impairment in older people with diabetes Research design and methods: A population based case-control study, with detailed assessment of diabetes and functional status, was undertaken. Results: 403 cases and 403 matched controls were studied, median age 75 years, 51% female. Subjects with diabetes had more comorbidities than controls (mean 2.5 v 1.9, p<0.0001) and were more likely to have severe functional impairment (4% v 1%, Barthel score <5, p<0.001). Health status pertaining to physical function was reduced in cases (SF36 60 v 40, p<0.0001). In a multivariate model controlling for age, hypertension, cerebrovascular disease, COPD, cancer, osteoarthritis and dementia, diabetes remained significantly associated with mobility limitation (OR 2.1, p<0.001). Conclusions: Older people with diabetes have considerable functional impairment associated with reduced health status. This population may benefit from comprehensive geriatric assessment and tailored diabetes management.
    • Higher levels of endogenous estradiol are associated with frailty in postmenopausal women from the Toledo study for healthy aging

      Carcaillon, Laure; García-García, F. J.; Tresguerres, J. A. F.; Gutiérrez Avila, G.; Kireev, R.; Rodríguez-Mañas, Leocadio; Hospital Universitario de Getafe, Toledo (Endocrine Society, 2012-08)
      Adverse effects of higher endogenous estradiol (E2) levels on various clinical outcomes and on determinants of the frailty syndrome have recently been reported. However, there are no data about the potential relationship between E2 and frailty. We aimed to study the association between E2 levels and frailty among older postmenopausal women not taking hormonal therapy.
    • Ferric carboxymaltose in patients with heart failure and iron deficiency

      Anker, Stefan D.; Comin Colet, Josep; Filippatos, Gerasimos S.; Willenheimer, Ronnie; Dickstein, Kenneth; Drexler, Helmut; Lüscher, Thomas F.; Bart, Boris; Banasiak, Waldemar; Niegowska, Joanna; et al. (New England Journal of Medicine, 2009-12-17)
      Background Iron deficiency may impair aerobic performance. This study aimed to determine whether treatment with intravenous iron (ferric carboxymaltose) would improve symptoms in patients who had heart failure, reduced left ventricular ejection fraction, and iron deficiency, either with or without anemia. Methods We enrolled 459 patients with chronic heart failure of New York Heart Association (NYHA) functional class II or III, a left ventricular ejection fraction of 40% or less (for patients with NYHA class II) or 45% or less (for NYHA class III), iron deficiency (ferritin level <100 μg per liter or between 100 and 299 μg per liter, if the transferrin saturation was <20%), and a hemoglobin level of 95 to 135 g per liter. Patients were randomly assigned, in a 2:1 ratio, to receive 200 mg of intravenous iron (ferric carboxymaltose) or saline (placebo). The primary end points were the self-reported Patient Global Assessment and NYHA functional class, both at week 24. Secondary end points included the distance walked in 6 minutes and the health-related quality of life. Results Among the patients receiving ferric carboxymaltose, 50% reported being much or moderately improved, as compared with 28% of patients receiving placebo, according to the Patient Global Assessment (odds ratio for improvement, 2.51; 95% confidence interval [CI], 1.75 to 3.61). Among the patients assigned to ferric carboxymaltose, 47% had an NYHA functional class I or II at week 24, as compared with 30% of patients assigned to placebo (odds ratio for improvement by one class, 2.40; 95% CI, 1.55 to 3.71). Results were similar in patients with anemia and those without anemia. Significant improvements were seen with ferric carboxymaltose in the distance on the 6-minute walk test and quality-of-life assessments. The rates of death, adverse events, and serious adverse events were similar in the two study groups. Conclusions Treatment with intravenous ferric carboxymaltose in patients with chronic heart failure and iron deficiency, with or without anemia, improves symptoms, functional capacity, and quality of life; the side-effect profile is acceptable. (ClinicalTrials.gov number, NCT00520780.)
    • Endothelial dysfunction in aged humans is related with oxidative stress and vascular inflammation

      Rodríguez-Mañas, Leocadio; El-Assar, Mariam; Vallejo, Susana; López-Dóriga, Pedro; Solís, Joaquin; Petidier, Roberto; Montes, Manuel; Nevado, Julián; Castro, Marta; Gómez-Guerrero, Carmen; et al. (Wiley, 2009-06)
      Vascular endothelial dysfunction occurs during the human aging process, and it is considered as a crucial event in the development of many vasculopathies. We investigated the underlying mechanisms of this process, particularly those related with oxidative stress and inflammation, in the vasculature of subjects aged 18-91 years without cardiovascular disease or risk factors. In isolated mesenteric microvessels from these subjects, an age-dependent impairment of the endothelium-dependent relaxations to bradykinin was observed. Similar results were observed by plethysmography in the forearm blood flow in response to acetylcholine. In microvessels from subjects aged less than 60 years, most of the bradykinin-induced relaxation was due to nitric oxide release while the rest was sensitive to cyclooxygenase (COX) blockade. In microvessels from subjects older than 60 years, this COX-derived vasodilatation was lost but a COX-derived vasoconstriction occurred. Evidence for age-related vascular oxidant and inflammatory environment was observed, which could be related to the development of endothelial dysfunction. Indeed, aged microvessels showed superoxide anions (O(2)(-)) and peroxynitrite (ONOO(-)) formation, enhancement of NADPH oxidase and inducible NO synthase expression. Pharmacological interference of COX, thromboxane A(2)/prostaglandin H(2) receptor, O(2)(-), ONOO(-), inducible NO synthase, and NADPH oxidase improved the age-related endothelial dysfunction. In situ vascular nuclear factor-kappaB activation was enhanced with age, which correlated with endothelial dysfunction. We conclude that the age-dependent endothelial dysfunction in human vessels is due to the combined effect of oxidative stress and vascular wall inflammation.
    • Elevated plasma levels of neuropeptide proenkephalin A predict mortality and functional outcome in ischemic stroke

      Doehner, Wolfram; von Haehling, Stephan; Suhr, Jennifer; Ebner, Nicole; Schuster, Andreas; Nagel, Eike; Melms, Arthur; Wurster, Thomas; Stellos, Konstantinos; Gawaz, Meinrad; et al. (American College of Cardiology, 2012-07)
      Objectives The purpose of this study was to investigate neuropeptides in patients presenting with symptoms of acute cerebrovascular disease. Background The precursor neuropeptides proenkephalin A (PENK-A) and protachykinin (PTA) are markers of blood-brain barrier integrity and have been recently discussed in vascular dementia and neuroinflammatory disorders. Methods In a prospective observational study, we measured plasma PENK-A and PTA concentrations in 189 consecutive patients who were admitted with symptoms of acute stroke. Plasma concentrations were determined by sandwich immunoassay; lower detection limits were 15.6 pmol/l (PENK-A) and 22 pmol/l (PTA). Clinical outcome was assessed at 3 months for mortality, major adverse cerebro/cardiovascular events, and functional outcome (modified Rankin scale). Results PENK-A was significantly elevated in patients with ischemic stroke (n = 124; 65.6%) compared to patients with transient ischemic attack (n = 16; 8.5%) and to patients with nonischemic events (n = 49; 25.9%): median (interquartile range), stroke 123.8 pmol/l (93 to 160.5); transient ischemic attack 114.5 pmol/l (85.3 to 138.8); and nonischemic event 102.8 pmol/l (76.4 to 137.6; both groups vs. stroke p < 0.05). High concentrations of PENK-A, but not PTA, were related to severity of stroke as assessed by National Institutes of Health Stroke Scale (NIHSS [r = 0.225; p = 0.002]) and to advanced functional disability (modified Rankin Scale score 3 to 6 vs. 0 to 2: 135.1 pmol/l [99.2 to 174.1] vs. 108.9 pmol/l [88.6 to 139.5]; p = 0.014). After adjusting for age, NIHSS, and brain lesion size (computed tomography), PENK-A predicted mortality (hazard ratio [HR] for log-10 PENK-A in pmol/l: 4.52; 95% confidence interval [CI]: 1.1 to 19.0; p < 0.05) and major adverse cerebro/cardiovascular events (HR: 6.65; 95% CI: 1.8 to 24.9; p < 0.05). Patients in the highest quartile of PENK-A (cutoff >153 pmol/l) had an increased risk of mortality (HR: 2.40; 95% CI: 1.02 to 5.40; p < 0.05) and of major adverse cerebro/cardiovascular events (HR: 2.23; 95% CI: 1.10 to 4.54; p < 0.05). Conclusions PENK-A is a prognostic biomarker in the acute phase of ischemic stroke. Elevated PENK-A concentrations are associated with ischemic stroke, severity of cerebral injury, and may have prognostic value for fatal and nonfatal events.
    • Effectiveness of acute geriatric units on functional decline, living at home, and case fatality among older patients admitted to hospital for acute medical disorders: meta-analysis

      Baztan, J. J; Suarez-Garcia, F. M; Lopez-Arrieta, J.; Rodríguez-Mañas, Leocadio; Rodríguez Artalejo, Fernando; Hospital Central Cruz Roja, Madrid; Health Department, Principado de Asturias, Oviedo, Spain; La Paz-Cantoblanco Universitary Hospital, Madrid; Universitary Hospital, Getafe, Madrid; Universidad Autónoma de Madrid; et al. (BMJ Publishing Group, 2009-01-22)
      Objective To assess the effectiveness of acute geriatric units compared with conventional care units in adults aged 65 or more admitted to hospital for acute medical disorders. Design Systematic review and meta-analysis. Data sources Medline, Embase, and the Cochrane Library up to 31 August 2008, and references from published literature. Review methods Randomised trials, non-randomised trials, and case-control studies were included. Exclusions were studies based on administrative databases, those that assessed care for a single disorder, those that evaluated acute and subacute care units, and those in which patients were admitted to the acute geriatric unit after three or more days of being admitted to hospital. Two investigators independently selected the studies and extracted the data. Results 11 studies were included of which five were randomised trials, four non-randomised trials, and two case-control studies. The randomised trials showed that compared with older people admitted to conventional care units those admitted to acute geriatric units had a lower risk of functional decline at discharge (combined odds ratio 0.82, 95% confidence interval 0.68 to 0.99) and were more likely to live at home after discharge (1.30, 1.11 to 1.52), with no differences in case fatality (0.83, 0.60 to 1.14). The global analysis of all studies, including non-randomised trials, showed similar results. Conclusions Care of people aged 65 or more with acute medical disorders in acute geriatric units produces a functional benefit compared with conventional hospital care, and increases the likelihood of living at home after discharge.
    • Decentralization and district health services in Nepal: understanding the views of service users and service providers

      Regmi, Krishna; Naidoo, Jennie; Pilkington, Paul A.; Greer, Alan; University of the West of England (Oxford University Press, 2010-09)
      Within the decentralization framework of Government, the Ministry of Health (MoH) Nepal initiated the decentralization of primary care services closer to citizens. This paper aims to examine and understand the effect of decentralization at the district health service from the perspectives of service users and providers.
    • Copeptin as a prognostic factor for major adverse cardiovascular events in patients with coronary artery disease

      von Haehling, Stephan; Papassotiriou, Jana; Morgenthaler, Nils G.; Hartmann, Oliver; Doehner, Wolfram; Stellos, Konstantinos; Wurster, Thomas; Schuster, Andreas; Nagel, Eike; Gawaz, Meinrad; et al. (Elsevier, 2012-12)
      Background C-terminal portion of provasopressin (copeptin) has recently been discussed as a novel biomarker for the early rule-out of acute myocardial infarction (AMI). The aim is to investigate the prognostic value of copeptin with regard to mortality and morbidity in patients with symptomatic coronary artery disease (CAD). Methods We consecutively recruited a cath lab cohort of 2,700 patients (74.1% male; AMI, n = 1316; stable angina pectoris, n = 1384) presenting to the emergency department of a large primary care hospital. All patients received coronary angiography. Copeptin and other laboratory markers were sampled at the time of presentation or in the cath lab. Clinical outcomes were assessed by hospital chart analysis and telephone interviews. 2621 patients (97.1%) have been successfully followed-up at three months. The primary endpoint was a combined endpoint of rehospitalization for cardiovascular events, stroke, and all-cause death. Results Using receiver operating characteristic curves, we calculated areas under the curve of 0.703 (95%confidence interval(CI):0.681–0.725) for the composite endpoint after three months (myocardial reinfarction, stroke, all-cause death;n = 183), and 0.770 (95%CI:0.736–0.803) for all-cause death (n = 76) for copeptin. A cutoff value of 21.6 pmol/L for the composite endpoint yielded a sensitivity of 56.3% and a specificity of 78.6%. The predictive performance of copeptin was independent of other clinical variables or cardiovascular risk factors, and superior to that of troponin I or other cardiac biomarkers (all:P < 0.0001). Conclusions Copeptin may help in the prediction of major adverse cardiovascular events in patients with symptomatic CAD. Further studies should substantiate the findings and support the suggested cutoff value of the present study.
    • Black families’ perceptions of barriers to the practice of a healthy lifestyle: a qualitative study in the UK

      Ochieng, Bertha (Taylor & Francis, 2011)
      While studies have focused on tangible indicators of the practice of healthy lifestyles, there remains a dearth of research exploring the inter-relationships between the practice of healthy lifestyles and the prevailing living circumstances of Black and other visible minority ethnic communities in Western societies. This article presents an account of African Caribbean men and women's beliefs and perceptions about the barriers of practising a healthy lifestyle, focusing specifically on the effects of social exclusion, racism and ethnic identity. A total of 18 participants from the north of England participated in the study, with in-depth interviews conducted in their homes. The participants believed that principles of healthy lifestyles were largely not relevant to their lived experiences because they failed to take into account their experiences of racism, social exclusion, ethnic identity, values and beliefs. Indeed, participants argued that, with their emphasis on illness prevention and perceived Eurocentric approaches, the principles of healthy lifestyle were part of the social exclusion paradigm experienced by their community. The study concludes by suggesting that it is essential to place notions of socio-economic disadvantage, discrimination, marginalisation and racism at the centre rather than the periphery when considering strategies to make healthier choices an easier option for Black and other visible minority ethnic communities.
    • Black African migrants: the barriers with accessing and utilizing health promotion services in the UK

      Ochieng, Bertha (Oxford University Press, 2013-04)
      The inequalities for different ethnicities and social classes in accessing health services is well documented, but although a number of recent policy developments have aimed to tackle health inequalities, very little is known about the experiences of Black African migrant communities in accessing health promotion information and services. The aim of the study were to examine the experiences of Black African migrant families in accessing health promotion services.
    • Biochemical and spectroscopic studies of human melanotransferrin (MTf): electron-paramagnetic resonance evidence for a difference between the iron-binding site of MTf and other transferrins

      Farnaud, Sébastien; Amini, Maryam; Rapisarda, Chiara; Cammack, Richard; Bui, Tam; Drake, Alex F.; Evans, Robert W.; Rahmanto, Yohan Suryo; Richardson, Des R.; University of Westminster; et al. (Elsevier, 2008-01)
      Melanotransferrin (MTf) is a member of the transferrin (Tf) family of iron (Fe)-binding proteins that was first identified as a cell-surface marker of melanoma. Although MTf has a high-affinity Fe-binding site that is practically identical to that of serum Tf, the protein does not play an essential role in Fe homeostasis and its precise molecular function remains unclear. A Zn(II)-binding motif, distinct from the Fe-binding site, has been proposed in human MTf based on computer modelling studies. However, little is known concerning the interaction of its proposed binding site(s) with metals and the consequences in terms of MTf conformation. For the first time, biochemical and spectroscopic techniques have been used in this study to characterise metal ion-binding to recombinant MTf. Initially, the binding of Fe to MTf was examined using 6 M urea gel electrophoresis. Although four different iron-loaded forms were observed with serum Tf, only two forms were found with MTf, the apo-form and the N-monoferric holo-protein, suggesting a single high-affinity site. The presence of a single Fe(III)-binding site was also supported by EPR results which indicated that the Fe(III)-binding characteristics of MTf were unique, but somewhat comparable to the N-lobes of human serum Tf and chicken ovo-Tf. Circular dichroism (CD) analysis indicated that, as for Tf, no changes in secondary structure could be observed upon Fe(III)-binding. The ability of MTf to bind Zn(II) was also investigated using CD which demonstrated that the single high-affinity Fe-binding site was distinct from a potential Zn(II)-binding site.
    • Assessing the impact of diabetes on the quality of life of older adults living in a care home: validation of the ADDQoL Senior

      Speight, J.; Sinclair, Alan J.; Browne, J. L.; Woodcock, A.; Bradley, C.; Australian Centre for Behavioural Research in Diabetes; Deakin University; AHP Research; Bedfordshire and Hertfordshire Postgraduate Medical School; Royal Holloway, University of London (Wiley, 2013-01)
      Aims  Around a quarter of UK care-home residents have diabetes. Diabetes is known to impact quality of life but existing diabetes-specific quality of life measures are unsuitable for elderly care-home residents. We aimed to develop and evaluate a new measure for use with older adults, to be particularly suitable for use with care-home residents: the Audit of Diabetes-Dependent Quality of Life (ADDQoL) Senior*. Methods  Content and format changes were made to the 19-domain ADDQoL, informed by related measures for people with visual impairments (12 domain-specific items were retained, four items were revised/added and three items were removed). This revision was modified further following cognitive debriefing interviews with three older adults living in a care home. Psychometric evaluation of the newly developed 17-domain ADDQoL Senior was conducted using data from 90 care-home residents with diabetes who took part in a broader intervention study. Results  The life domains most impacted by diabetes were ‘independence’ and ‘freedom to eat as I wish’. The ADDQoL Senior demonstrated good factor structure and internal consistency (Cronbach’s alpha = 0.924). Domain scores were, as expected, significantly intercorrelated. Conclusions  The ADDQoL Senior measures the perceived impact of diabetes on quality of life in older adults, and has been found to be suitable for those living in care homes if administered by interview. The scale has demonstrated acceptability and excellent psychometric properties. It is anticipated that the number of items may be reduced in the future if our current findings can be replicated.
    • An examination of concordance and cultural competency in the diabetes care pathway: South Asians living in the United Kingdom

      Randhawa, Gurch; Wilkinson, Emma; University of Bedfordshire (Medknow Publications, 2012)
      The Care Pathway project used a multilevel and multimethod approach to explore access to the care pathway for diabetic renal disease. Taking what was known about the outcomes of ethnic minority patients with diabetic renal disease; the study sought to explore and further understand how and why South Asian patients’ experiences may be different from the majority of population in relation to access. Through improved understanding of any observed inequalities, the study aimed to inform the development of culturally competent diabetes services. The design incorporated audits of patient indicators for diabetes and renal health at key points in the pathway: Diagnosis of diabetes and referral to specialist renal services in two years- 2004 and 2007, and qualitative individual interviews with patients and providers identified through the 2007 samples. This article describes the care provider perspective of access to diabetes care from a thematic analysis of 14 semistructured interviews conducted with professionals, at three study sites, with different roles in the diabetes pathway. National policy level initiatives to improve quality have been mirrored by quality improvements at the local practice level. These achievements, however, have been unable to address all aspects of care that service providers identified as important in facilitating access to all patient groups. Concordance emerged as a key process in improving access to care within the pathway system, and barriers to this exist at different levels and are greater for South Asian patients compared to White patients. A conceptual model of concordance as a process through which access to quality diabetes care is achieved and its relation to cultural competency is put forward. The effort required to achieve access and concordance among South Asian patients is inversely related to cultural competency at policy and practice levels. These processes are underpinned by communication.
    • A qualitative study on the food habits and related beliefs of pregnant British Bangladeshis

      Yeasmin, Syeda Fahmida; Regmi, Krishna; University of East London; University of Bedfordshire (Taylor & Francis, 2013-05)
      It is quite challenging to deal with the health care needs of migrant populations in general, especially pregnant women, due to their diverse sociopolitical and cultural beliefs and practices. In this article, we aim to examine and understand the food habits and beliefs of pregnant British Bangladeshis using qualitative methods. Our results indicate some positive associations between the increased intakes of particular foods to ensure healthy outcomes. We also note that migration affects pregnant Bangladeshi women's physical and mental conditions. We conclude that effective health care and awareness about traditional food beliefs and habits, and their subsequent reflection into the national and local policy agendas, may bring forth positive changes and improve the overall health of pregnant women.
    • A multi-centre qualitative study exploring the experiences of UK South Asian and White Diabetic Patients referred for renal care

      Wilkinson, Emma; Randhawa, Gurch; Feehally, John; Farrington, Ken; Greenwood, Roger; Choi, Peter; Lightstone, Liz; University of Bedfordshire (BioMed Central, 2012)
      Background An exploration of renal complications of diabetes from the patient perspective is important for developing quality care through the diabetic renal disease care pathway. Methods Newly referred South Asian and White diabetic renal patients over 16 years were recruited from nephrology outpatient clinics in three UK centres - Luton, West London and Leicester – and their experiences of the diabetes and renal care recorded. A semi-structured qualitative interview was conducted with 48 patients. Interview transcripts were analysed thematically and comparisons made between the White and South Asian groups. Results 23 South Asian patients and 25 White patients were interviewed. Patient experience of diabetes ranged from a few months to 35 years with a mean time since diagnosis of 12.1 years and 17.1 years for the South Asian and White patients respectively. Confusion emerged as a response to referral shared by both groups. This sense of confusion was associated with reported lack of information at the time of referral, but also before referral. Language barriers exacerbated confusion for South Asian patients. Conclusions The diabetic renal patients who have been referred for specialist renal care and found the referral process confusing have poor of awareness of kidney complications of diabetes. Healthcare providers should be more aware of the ongoing information needs of long term diabetics as well as the context of any information exchange including language barriers.