OBJECTIVE -The aim of this study was to evaluate the frequency of sympathetic versus parasympathetic neuropathy among type 1 and type 2 diabetic patients.RESEARCH DESIGN AND METHODS -There were 43 patients with type 1 and 17 with type 2 diabetes who were investigated. Sympathetic nerve function was assessed by measurement of the vasoconstriction (VAC) index by laser Doppler perfusion imaging of a locally heated finger followed by indirect cooling. Parasympathetic nerve function was assessed by R-R interval variation during deep breathing as measured by the expiration/inspiration (E/I) ratio. Results were expressed as age-corrected z scores in SD; VAC index Ͼ1.64 SD and E/I ratio ϽϪ1.64 SD were considered abnormal.RESULTS -VAC index was abnormal in 40% with type 1 and 41% with type 2 diabetes, whereas the E/I ratio was abnormal in 42% with type 1 and 65% with type 2 diabetes. There was a clear association between VAC index and E/I ratio among type 1 (r s ϭ 0.525; P ϭ 0.0002) but not among type 2 (r s ϭ 0.10) diabetic patients. Among type 2 diabetic patients, the degree of dysfunction was most severe regarding parasympathetic function (P ϭ 0.0167).CONCLUSIONS -Sympathetic and parasympathetic neuropathy were frequent in both type 1 and type 2 diabetic patients. However, there was a difference between the two types of diabetes. Sympathetic and parasympathetic nerve functions correlated in type 1 but not in type 2 diabetic patients. The explanation for this discrepancy might be that parasympathetic nerve function was most severely affected among type 2 diabetic patients. Diabetes Care 27:2936 -2941, 2004D iabetic autonomic neuropathy is associated with an increased mortality (1-3). Autonomic neuropathy includes both parasympathetic and sympathetic dysfunction. Prospective studies on patients after myocardial infarction suggest that parasympathetic neuropathy is related to increased cardiovascular mortality (4,5).Recent studies indicate, however, that sympathetic neuropathy may be important as well. Among diabetic patients, sympathetic denervation impairs myocardial coronary blood flow (6) and myocardial contractility (7). To clarify the relationship between autonomic neuropathy and cardiovascular morbidity and mortality, it is important to evaluate both parasympathetic and sympathetic nerve functions.Reduced R-R interval variation, as measured by the expiration/inspiration (E/I) ratio during deep breathing, is a reliable sign of parasympathetic neuropathy with a coefficient of variation of 4.8% (8,9). Recently, prolonged registration of electrocardiogram up to 24 h with spectral analysis of the R-R intervals by time domain or frequency domain analysis has come into use (10). However, there is a close correlation between parasympathetic neuropathy as demonstrated by a 1-min deep breathing test and parasympathetic neuropathy as demonstrated by spectral analysis (11-13). Indeed, compared with spectral analysis, the E/I ratio is considered as most informative regarding the assessment of parasympathetic nerve function (14...

BackgroundMedical adherence is important in the treatment of depression. Primary medical adherence, i.e. patients collecting their newly prescribed medications from pharmacies, is very different depending on the drug prescribedObjectiveTo assess the rate of primary medical adherence in patients prescribed antidepressants and to identify characteristics that make patients less likely to pick up prescriptions.MethodsAn observational study was performed using primary health care data from Sweden on patients who were prescribed antidepressants. Univariate and multivariate logistic regression was used to determine differences in pick-up rate according to patient characteristics.Main outcomePick-up rate, defined as collection of a prescription within 30 days.ResultsA total of 11 624 patients received an antidepressant prescription during the study period, and the overall pick-up rate was 85.1%. The pick-up rate differed according to country of birth: individuals born in the Middle East and other countries outside Europe had lower primary medical adherence than Swedes, with adjusted odds ratios (ORs) of 0.58 and 0.67, respectively. Patients at ages 64–79 years had a higher pick-up rate compared with those aged 25–44 years (OR 1.71). Divorced patients had a lower rate compared with married patients (OR 0.80).ConclusionImmigrants from the Middle East and other countries outside Europe and younger and divorced patients had lower primary medical adherence, which calls for clinical attention and preventive measures. Key pointsPrimary medical adherence is important in the treatment of depression.Are patient characteristics associated with primary medical adherence?The overall primary medical adherence rate was 85%.The rate differed by country of birth, age at diagnosis of depression, and marital status.Clinical attention is needed in patients who do not pick up their antidepressants.

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In some aspects, medical students are only as knowledgeable as their non-medical peers. These results call for higher quality plastic surgery teaching, to secure referral of the correct patients and successful specialist recruitment to plastic surgery.