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PubMedDate not supplied

Estimating prevalence of community morbidity due to intestinal helminths: prevalence of infection as an indicator of the prevalence of disease.

The rational design of helminth control programmes for endemic areas requires that the limited resources be focused on the communities in greatest need. The process of locality-targetting would be facilitated by a simple, inexpensive method of assessing morbidity at the community level. This paper describes how a simple model of the distribution of infection in human populations can use infection prevalence data to predict the proportion of heavy, and potentially clinically significant, infections in a community. Analysis of observed data for Ascaris lumbricoides indicates that the risk of clinical ascariasis increases non-linearly with the prevalence of infection. The predicted prevalence of morbidity is low up to approximately 60% prevalence of infection, but increases very rapidly thereafter. Analyses of data for Trichuris trichiura, Schistosoma mansoni, S. haematobium and the hookworms suggests qualitatively similar patterns. The application of the model in predicting resource requirements for control is illustrated using infection prevalence data for A. lumbricoides in Brazil.

Ascariasis↗
PubMed2007

Prevalence of depressive symptoms in postmenopausal women with low bone mineral density and/or prevalent vertebral fracture: results from the Multiple Outcomes of Raloxifene Evaluation (MORE) study.

OBJECTIVE: To examine the prevalence of depressive symptoms in a cross-sectional study of postmenopausal women with osteoporosis with and without prevalent vertebral fracture. METHODS: Participants were a subset of English-speaking women (n = 3798, mean age 66.7 yrs) from the Multiple Outcomes of Raloxifene Evaluation trial, who had low bone mineral density (BMD) and/or prevalent vertebral fractures. Vertebral fractures were measured at baseline by radiography using a semiquantitative technique. Depressive symptoms were assessed at baseline using the Geriatric Depression Scale (GDS), a valid and reliable scale for depression screening in elderly patients. Women were considered as probably depressed if > or = 6 symptoms of depression were reported. RESULTS: Postmenopausal women with prevalent vertebral fracture reported more depressive symptoms as assessed by the GDS than women without prevalent vertebral fracture (1.54 vs 1.26; p = 0.001). There was an absolute increase of 2.5% (p = 0.008) in the prevalence of probable depression (GDS score > or = 6) in women with prevalent fracture compared to those without prevalent fracture. The prevalence of probable depression was 4.1% among women without prevalent vertebral fracture and 6.6% in women with a prevalent vertebral fracture. The prevalence of probable depression was 3-fold higher in women with at least 3 prevalent vertebral fractures compared to women without prevalent fracture (12.8% vs 4.1%; p < 0.001). CONCLUSION: Postmenopausal women with prevalent vertebral fractures had greater prevalence of depressive symptoms and probable depression as assessed by the GDS than women without vertebral fracture with low BMD. The dual diagnosis of depression and osteoporosis may mean worse health outcomes. Patients with prevalent vertebral fractures may be considered not only for interventions that address fracture risk reduction, but also for psychosocial interventions that address depressive symptoms.

Aged↗
PubMed2003

Prevalence of lower-limb ulceration: a systematic review of prevalence studies.

OBJECTIVE: To determine the prevalence of leg ulcers reported in the literature. DESIGN: A systematic review of prevalence studies of lower-limb ulceration in the adult population was conducted. Critical appraisal of the research papers was guided by published standards for methodologic review of prevalence studies, which were modified to address the issues related to leg ulcers. MAIN RESULTS: Twenty-two reports of prevalence studies were identified. Eight population-based prevalence studies used clinical validation and reported prevalence rates of open ulcers ranging from 0.12% to 1.1% of the population; the prevalence rate of open or healed ulcers was reported to be 1.8%. Seven population-based studies without clinical validation reported prevalence rates of open ulcers ranging from 0.12% to 0.32% of the population. Differences in the populations studied, study design, ulcer definition, ulcer etiology, inclusion of foot ulcers, method of clinical assessment, and clinical validation of ulcer cases indicate that it is inappropriate to pool the estimates of prevalence. In most studies that considered age and sex, the prevalence of ulcers increased with age and was higher for women. CONCLUSIONS: Better-quality prevalence studies are needed. These studies should clearly define the populations being studied, include large numbers of individuals and total populations, provide a clear definition of an ulcer, describe case identification procedures, and clinically confirm the presence of ulcers.

Age Distribution↗
PubMed2000

Diabetes prevalence and socioeconomic status: a population based study showing increased prevalence of type 2 diabetes mellitus in deprived areas.

OBJECTIVE: To establish the relation between socioeconomic status and the age-sex specific prevalence of type 1 and type 2 diabetes mellitus. The hypothesis was that prevalence of type 2 diabetes would be inversely related to socioeconomic status but there would be no association with the prevalence of type 1 diabetes and socioeconomic status. SETTING: Middlesbrough and East Cleveland, United Kingdom, district population 287,157. PATIENTS: 4313 persons with diabetes identified from primary care and hospital records. RESULTS: The overall age adjusted prevalence was 15.60 per 1000 population. There was a significant trend between the prevalence of type 2 diabetes and quintile of deprivation score in men and women (chi 2 for linear trend, p < 0.001). In men the prevalence in the least deprived quintile was 13.4 per 1000 (95% confidence intervals (95% CI) 11.44, 15.36) compared with 17.22 per 1000 (95% CI 15.51, 18.92) in the most deprived. For women the prevalence was 10.84 per 1000 (95% CI 9.00, 12.69) compared with 15.48 per 1000 (95% CI 13.84, 17.11) in the most deprived. The increased prevalence of diabetes in the most deprived areas was accounted for by increased prevalence of type 2 diabetes in the age band 40-69 years. There was no association between the prevalence of type 1 diabetes and socioeconomic status. CONCLUSION: These data confirm an inverse association between socioeconomic status and the prevalence of type 2 diabetes in the middle years of life. This finding suggests that exposure to factors that are implicated in the causation of diabetes is more common in deprived areas.

Adult↗
PubMed2002

Associating community prevalence of Schistosoma mansoni infection with prevalence of signs and symptoms.

Information on the prevalence of morbidity is needed for re-calculation of the Global Burden of Disease (WHO) due to Schistosoma mansoni. This study presents a statistical association which can be used to predict the prevalence of morbidity from the prevalence of S. mansoni in a community. We collected data from field studies reporting prevalence of infection and prevalence of morbidity. Data on infection prevalence were standardised to a default diagnostic sensitivity (i.e. Kato-Katz technique 41.7 mg). The data were described by an expression related to logistic regression. We determined associations between prevalence of infection and prevalence of early morbidity (diarrhoea, blood in stool and abdominal pain), hepatosplenic morbidity and late morbidity (haematemesis and ascitis). Diarrhoea and blood in stool due to S. mansoni infection mainly occurs in communities with a high prevalence of infection. An influence on hepatosplenic morbidity is already present at low community prevalence of infection. For the aspecific symptom abdominal pain we did not find an association.

Adult↗
PubMed1999

Can prevalence of infection in school-aged children be used as an index for assessing community prevalence?

Community data on the prevalence of helminth infections is important for guiding health policy, but expensive to collect. As a result most surveys focus on school-aged children, frequently using schools as a sentinel population. Since there already exists a vast amount of data on infection levels in school-aged children, but limited community-based data, we undertook a literature search on age-stratified infection data for intestinal nematode infections and schistosomiasis in Africa, to investigate whether estimates of the prevalence of infection in school-aged children could provide an index for determining community prevalence. The observed data on prevalence of infection in infants, school-aged children and adults were fitted using linear and logistic regression models which take into account variation in sample prevalences. Despite the wide variation in study sites, the observed relationship between community prevalence and school-aged prevalence was remarkably consistent for each parasite species. The prevalence of infection in school-aged children alone was shown to be higher than the predicted prevalence in the community, but the degree of overestimation was dependent on the parasite species and the level of infection. The results suggest that the prevalence of infection in school-aged children could provide a cost-effective predictive tool which can be used at a district/national level to identify target areas for control and to evaluate the numbers at risk of infection.

Adolescent↗
PubMed2003

COPD prevalence in 12 Asia-Pacific countries and regions: projections based on the COPD prevalence estimation model.

OBJECTIVE: COPD is a leading cause of mortality and morbidity worldwide. Despite the high rates of cigarette smoking, and the wide use of biomass fuels, there is very little objective data on the prevalence of COPD in Asia. METHODOLOGY: We used a COPD prevalence model to estimate the prevalence of COPD in 12 Asian countries. This model is a validated, computerized tool that uses epidemiological relationships and risk factor prevalence to project the prevalence of COPD within a given population aged 30 years and older. RESULTS: The total number of moderate to severe COPD cases in the 12 countries of this region, as projected by the model, is 56.6 million with an overall prevalence rate of 6.3%. The COPD prevalence rates for the individual countries range from 3.5% (Hong Kong and Singapore) to 6.7% (Vietnam). CONCLUSIONS: The COPD prevalence rates projected by the model reflect the high prevalence of the risk factors for the disease in Asia. The combined prevalence of 6.3% for these countries is considerably higher than the overall rate of 3.8% as extrapolated from WHO data for this region. These estimates highlight the need for further epidemiological studies to support appropriate allocation of resources for the prevention and management of COPD.

Asia↗
PubMed1991

The prevalence of dementia in Europe: a collaborative study of 1980-1990 findings. Eurodem Prevalence Research Group.

To obtain age- and gender-specific estimates of the prevalence of dementia in Europe and to study differences in prevalence across countries, we pooled and re-analysed original data of prevalence studies of dementia carried out in some European countries between 1980 and 1990. The study followed these steps: census of existing datasets, collection of data in a standardized format, selection of datasets suitable for comparison, comparison of age and gender patterns. From the 23 datasets of European surveys considered, 12 were selected for comparison. Only population-based studies in which dementia was defined by DSM-III or equivalent criteria and in which all subjects were examined personally were included. Studies in which institutionalized subjects were not investigated were excluded. Age- and gender-specific prevalences were compared within and across studies and overall prevalences were computed. Although prevalence estimates differed across studies, the general age- and gender-distribution was similar for all studies. The overall European prevalences for the five-year age groups from 60 to 94 years, were 1.0, 1.4, 4.1, 5.7, 13.0, 21.6 and 32.2%, respectively. In subjects under 75 years the prevalence of dementia was slightly higher in men than in women; in those aged 75 years or over the prevalence was higher in women. The prevalence figures nearly doubled with every five years of increase in age.

Adult↗
PubMed2000

Influence of monopoly privatization and market liberalization on smoking prevalence in Japan: trends of smoking prevalence in Japan in 1975-1995.

AIMS: In Japan, smoking prevalence in males has been among the highest among industrialized countries, while the prevalence in females has remained relatively low. There have been long-term declining trends since the early 1970s. In the mid-1980s, the public tobacco monopoly was privatized and the tobacco market was liberalized in Japan. This study examines whether the trends in smoking prevalence changed at the time of these market changes. DESIGN AND MEASUREMENTS: Smoking prevalence data, tabulated by age group and sex, were plotted over the period 1975-95. Trends of smoking prevalence were then analyzed by using linear regressions, and their changes at the time of monopoly privatization and market liberalization were examined by Chow tests. FINDINGS: The trends in smoking prevalence changed at the time of the monopoly privatization and trade liberalization in both males and females, except for the males in their twenties and thirties. Rates of decline in smoking prevalence diminished in many age groups and prevalence for younger females started to increase. CONCLUSIONS: Market changes, that result from the privatization of a public tobacco monopoly and trade liberalization, may adversely affect smoking prevalence in many age groups and in both sexes, unless effective countermeasures are taken.

Adult↗
PubMed1996

Prevalence of Helicobacter pylori infection in Korean children: inverse relation to socioeconomic status despite a uniformly high prevalence in adults.

The prevalence of Helicobacter pylori infection in US adults was shown to be inversely correlated with the socioeconomic status of the family during childhood, and it was suggested that this was additional evidence of transmission occurring in childhood. The present study of H. pylori infection was conducted in South Korea, which has emerged as a developed country in the last two decades. The authors attempted to determine whether there was a difference in prevalence of H. pylori infection in Korean children of different socioeconomic classes despite the high prevalence of infection in childbearing adults. The authors also attempted to identify the factors responsible for the different patterns of transmission by estimating the age-specific prevalence of H. pylori infection in 413 healthy 1- to 75-year-old asymptomatic volunteers who resided in Seoul. H. pylori status was evaluated using an enzyme-linked immunosorbent assay for anti-H. pylori immunoglobulin G. Demographic data were obtained from each individual, and socioeconomic class was assessed by the education level of the adults and of the children's parents as well as family income. H. pylori infection was present in 75% of adults and 22% of children, and its prevalence increased with age (p < 0.001). In adults, the rate of infection was high and independent of socioeconomic class. In children, it was inversely related to the socioeconomic class of the child's family: 12% among upper socioeconomic class, 25% among the middle class, and 41% among the lowest class (p = 0.016). No associations were found between prevalence of H. pylori infection and any factor tested including sex, smoking, and alcohol consumption. In addition, type of housing, whether owned or rented, number of family members living in the same household, water source, and type of community in which a child grew up were not found to be risk factors influencing H. pylori infection prevalence. The prevalence of H. pylori infection in Korea appears to be changing with markedly lower prevalence in children of families of higher socioeconomic status. The factor(s) responsible for the break in the pattern of transmission in children of the higher socioeconomic class was not discovered. Future studies will concentrate on possible differences, eating practices, hygiene, and sanitary practices.

Adolescent↗
PubMed2002

Predicting the prevalence of antibody to hepatitis C virus (HCV) in a community by the prevalence of elevated levels of alanine aminotransferase: a method to identify areas endemic for HCV.

To identify areas endemic for hepatitis C virus (HCV), we attempted to predict the prevalence of antibody to HCV (anti-HCV) in a community by the prevalence of elevated levels of alanine aminotransferase (ALT). The results of health examinations of 2,273 women > or = 40 years old in five townships in central Taiwan were analyzed. The overall prevalence of elevated ALT levels was 11.6%. A township (20.3%) and 10 villages were identified as having a high prevalence (17.9-40.0%) of elevated ALT levels. Five communities with variant rates of elevated ALT levels, which ranged from 8.0% to 27.3%, were selected for correlation with the prevalence of anti-HCV among adults (> or = 40 years old). The prevalence of anti-HCV, which ranged from 10.1% to 72.1%, were obtained by community screenings and/or hospital-based studies. The correlation equation used was the prevalence of anti-HCV (%) = 3.33 x (prevalence of elevated ALT levels (%) - 5.7%) (r2 = 0.94, P < 0.01). Using this method, areas endemic for HCV can be identified by determining the community prevalence of elevated ALT levels.

Adult↗
PubMed1997

Prevalence of infection, mean worm burden and degree of worm aggregation as determinants of prevalence of disease due to intestinal helminths.

Theoretical predictions of disease prevalence due to helminth infections based upon a simple probabilistic model which considers the infection prevalence, the mean worm burden and the degree of worm aggregation are presented. A numerical reappraisal of the likely estimates of the degree of aggregation based upon maximum likelihood estimates of the negative binomial distribution is presented. The prevalence of disease shows a positive relationship with the mean worm burden. This association is hyperbolic when helminth parasites are severely aggregated but is s-shaped when helminth parasites tend to be overdispersed. The prevalence of disease decreases with the degree of worm aggregation when the values of the mean intensity are low; as the mean intensity increases this association becomes positive. The relationship between prevalence of disease and prevalence of infection is hyperbolic for severe degrees of parasite aggregation and is s-shaped for intermediate degrees of aggregation. However, if the mean intensity is low and the degree of aggregation is high there could be a negative relationship between the prevalence of disease and the prevalence of infection. The presence of disease due to helminth parasites is feasible for determined ranges of values of the infection prevalence, mean intensity and the degree of worm clumping.

Animals↗
PubMedDate not supplied

Hypertension prevalence and the status of awareness, treatment, and control in the United States. Final report of the Subcommittee on Definition and Prevalence of the 1984 Joint National Committee.

Estimates of the prevalence of hypertension in the United States have varied owing to differences in interpretation and extrapolation of the data. In 1978 the National High Blood Pressure Education Program issued a consensus document estimating the prevalence of high blood pressure in the United States. Results from the 1976-1980 National Health and Nutrition Examination Survey (NHANES II) allow for a revised estimate. The purpose of this report was to arrive at consensus on a prevalence figure and also to provide information on the distribution of hypertension by blood pressure level, age, race, and sex. The prevalence estimates used are based on hypertension defined as blood pressure measurements greater than or equal to 140/90 mm Hg (average of 3 readings taken on 1 occasion) or self-reported taking of antihypertensive medication. Based on NHANES II data, blacks have a higher prevalence than whites (38% vs 29%) and men show a higher prevalence than women (33% vs 27%). These data again confirm the tendency for the prevalence of hypertension to increase with age in the U.S. population--this holds true for blacks, whites, men, and women. Progress in high blood pressure control efforts has traditionally been measured by changes in the status of awareness, treatment, and control. Changing the hypertension threshold from 160/95 to 140/90 mm Hg, as recently recommended, substantially lowers these measures: the percentage of hypertensives aware of their condition falls from 74% to 54%, the percentage taking antihypertensive medication falls from 56% to 33%, and the percentage with controlled hypertension decreases from 34% to 11%. These apparent decreases reflect a change in the frame of reference rather than changes in hypertension treatment status. In addition, hypertension prevalence rates from NHANES II (1976-1980) were applied to 1983 Bureau of the Census population figures to estimate the total number of Americans with hypertension and their distribution by age, sex, race, and severity of blood pressure level. Since NHANES II did not include persons 75 years of age or older in its sample, data from a pilot study on systolic hypertension in the elderly were used for prevalence estimates in this age group. Estimates for children under 6 years of age and hypertensive persons controlling their pressures without medication could not be included in this analysis because of a lack of reliable data on these groups.

Adolescent↗
PubMed2001

Using the prevalence of an elevated serum alanine aminotransferase level for identifying communities with a high prevalence of hepatitis C virus infection.

BACKGROUND: Antibody to hepatitis C virus (anti-HCV) is a widely accepted method for the diagnosis of HCV infection. However, it is too expensive to use in large-scale health surveys. OBJECTIVE: To investigate the use of the serum alanine aminotransferase (ALT) level to predict the prevalence of HCV infection. PATIENTS AND METHODS: A sample of 6095 residents aged 35 years old or older in a small township of southern Taiwan, Republic of China, were examined in a community health survey. These persons were walk-ins to the government-sponsored stations after an intensive health promotion for this survey. Blood samples were obtained and analyzed for serum ALT levels. The presence of hepatitis B surface antigen and anti-HCV were determined by enzyme immunoassay methods. RESULTS: The overall prevalences of hepatitis B surface antigens(+), anti-HCV(+), and elevated ALT levels were 11.8%, 15.0%, and 7.5%, respectively. Among the 13 villages in this community, the prevalence of hepatitis B surface antigen(+) ranged from 6.8% to 17.3%, anti-HCV(+) ranged from 7.2% to 37.6%, and an elevated ALT level ranged from 5.8% to 16.5%. A strong positive correlation was found between the prevalence of an elevated ALT level and anti-HCV(+) (r= 0.91, Spearman rank correlation; P<.001). However, nearly 0 correlation (r= -0.05, P=.87) was obtained between the prevalence of an elevated serum ALT level and hepatitis B surface antigen(+). CONCLUSION: The prevalence of an elevated serum ALT level in a community is a strong indicator of its prevalence of anti-HCV(+), even in areas where there is a similar prevalence of hepatitis B virus infection. This result is useful for economically identifying hyperendemic communities with HCV infection.

Alanine Transaminase↗
PubMed2005

Prevalence of alcohol use disorder in a South Korean community--changes in the pattern of prevalence over the past 15 years.

BACKGROUND: This study investigated the prevalence of alcohol use disorder in a Korean community and compared the results with 1984 epidemiological data. METHOD: A sample of 1,059 residents aged 18-64 years was interviewed using the Korean version of the Composite International Diagnostic Interview (K-CIDI). The results obtained were compared with those of a 1984 epidemiological study. RESULTS: Lifetime prevalence of alcohol use disorder was 15.6% (abuse 6.8%, dependence 8.8 %) and 1-year prevalence 7.5% (abuse 2.5%,dependence 5 %). The male-to-female ratio of life-time prevalence was 5.8,which markedly decreased with decreasing age. A cohort effect, i. e. increases of lifetime prevalence in younger cohorts, was observed, with the exception of the 60- to 64-year-old cohort. The mean age of onset was 27.7 years (male 28.2 years, female 24.2 years). When the results of the present study were compared with those of the 1984 study, it was found that, during the past 15 years, lifetime prevalence has decreased, prevalence ratios of abuse and dependence have become reversed, and the male-to-female ratio has decreased. CONCLUSION: Remarkable changes in the pattern of prevalence, which have occurred between 1984 and 1999, may be attributed to significant sociocultural changes and to a decrease in the proportion of a high-risk cohort in the populations.

Adolescent↗
PubMed2004

Relationship among prevalence of patients with Itai-itai disease, prevalence of abnormal urinary findings, and cadmium concentrations in rice of individual hamlets in the Jinzu River basin, Toyama prefecture of Japan.

This study investigated the associations among prevalence of patients with Itai-itai disease, and prevalence of abnormal urinary findings and cadmium (Cd) concentrations in rice in individual hamlets of the Jinzu River basin. From the 13,183 participants of the 1967 and 1968 health examinations, we selected 3,094 subjects as the target population who had resided in the current hamlet for a total of 30 years or longer and aged >/=50 years, and in the hamlet both the Cd concentration in rice and prevalence of patients with Itai-itai disease were known. When the inhabitants were divided into four groups according to the Cd concentration in rice or prevalence of abnormal urinary findings, significant relationships among three factors (Cd concentration in rice, prevalence of abnormal urinary findings and prevalence of patients with Itai-itai disease) were demonstrated clearly using the Cochran-Armitage test. Correlation coefficients among the three factors in 55 hamlets showed that the prevalence of the patients with Itai-itai disease increased according to increases in the mean Cd concentration in rice and increasing prevalence of urinary findings. This study demonstrated that Itai-itai disease is induced by exposure to environmental Cd and that renal dysfunction plays an important role in its development.

Aged↗
PubMed1998

HIV prevalence in pregnant women in Europe: differences in assessment methods and prevalence levels across countries.

OBJECTIVE: To describe methods used to assess HIV prevalence and to assess prevalence levels and time trends among pregnant women in various European countries. METHODS: We used the European HIV Prevalence Database to examine annual HIV prevalence data in pregnant women for the years 1990 to 1996 (20 countries). RESULTS: In Western Europe, prevalences were generally obtained through unlinked anonymous surveys, whereas in most Central, and Eastern European countries, they were based on testing programs (voluntary or mandatory). Prevalences (per 10,000) were highest (i.e., 10-30/10,000) in large western urban areas including Amsterdam, Barcelona, London, Milan, Paris, and Rome; between 1 and 2 in Scandinavian countries; and down to 0.5/10,000 in Central and Eastern European countries (except Ukraine, 1996: 5/10,000). Prevalences decreased in Rome, whereas they increased in London, the Czech Republic, and since 1995 in Russia and Ukraine; elsewhere, no time trends were detected. CONCLUSIONS: Methodologic differences and potential biases should be considered when comparing these data. HIV prevalence in pregnant women is useful for monitoring the AIDS epidemic and for assessing and improving prevention. Efforts should be made to offer voluntary counseling and testing to women at risk for HIV and provide treatment to those who are infected.

Europe↗
PubMed1995

Prevalence of known and previously unknown diabetes mellitus and impaired glucose tolerance in an adult Norwegian population. Indications of an increasing diabetes prevalence. The Nord-Trøndelag Diabetes Study.

OBJECTIVE: To establish the prevalence of known and undiagnosed diabetes mellitus and impaired glucose tolerance in a representative Norwegian adult population according to the 1980 World Health Organization Expert Committee diagnostic criteria. DESIGN: Screening survey applying questionnaire and non-fasting blood glucose followed by a fasting and an oral glucose tolerance test. SETTING: The county of Nord-Trøndelag, Norway, 1984-86. SUBJECTS: All inhabitants aged > or = 20 years (85,100); 90.3% participated. For previously unknown diabetes: all inhabitants > or = 40 years (53,001)--participation rate 84.7%. MAIN OUTCOME MEASURE: Prevalence. RESULTS: The prevalence of previously known diabetes was 2.6% in men and 3.2% in women. Total diabetes prevalence > or = 40 years was 4.8% in men and 5.6% in women. The prevalence increased continuously with age until 90 years. One patient in five was previously undiagnosed. Impaired glucose tolerance in those with an abnormal non-fasting value was rare; only 0.9% in men and 0.2% in women. The prevalence of known diabetes was three times higher than 20-30 years ago and four times higher than 50 years ago. Except for known diabetes in the very old the prevalence corresponded well with recent Nordic studies. IMPLICATIONS: The present diabetes prevalence was so high that interested general practitioners will get sufficient experience in follow-up of diabetic patients to facilitate a good quality of the care.

Adult↗