Yan Bing† , Lei Yuan† , Ji Liu† , Zezhong Wang, Lifu Chen*, Jinhai Sun* and Lijuan Liu*

Department of Health Management, Naval Medical University, Shanghai, China

Purpose: To evaluate the overall health status and health-related abilities and problems of elderly patients with diabetes and multimorbidity compared with those with diabetes only. Additionally, we aimed to identify different subgroups of elderly, multimorbid patients with diabetes.

Methods: This cross-sectional study included 538 elderly patients with diabetes. The participants completed a series of questionnaires on self-rated health (SRH), diabetes self-management, self-efficacy, health literacy, depression, and diabetes distress. Differences in health-related abilities and problems were compared between elderly patients with diabetes and multimorbidity and those with diabetes only, with adjustments for covariates using propensity score matching. A cluster analysis was also performed to identify the overall health status subgroups of elderly, multimorbid patients with diabetes. Additionally, we  conducted a multinomial logistic regression analysis to examine the predictors of health related abilities and problem-cluster group membership.

Results: Elderly patients with diabetes and multimorbidity experienced more health-related abilities and problems than those with diabetes only, particularly within the domains of depression (p < 0.001), and diabetes distress. The level of health literacy (p < 0.001) and self-management (p = 0.013) in elderly, multimorbid patients with diabetes was also significantly higher than that in elderly patients with diabetes only. Cluster analysis of elderly, multimorbid patients with diabetes revealed three distinct overall health status clusters. Multinomial logistic regression analysis indicated that age (OR = 1.090, p = 0.043), sex (OR = 0.503, p = 0.024), living situation (OR = 2.769, p = 0.011), BMI (OR = 0.838, p = 0.034), regular exercise (OR = 2.912, p = 0.041 in poor vs. good; OR = 3.510, p < 0.001 in intermediate vs. good), and cerebral infarction (OR = 26.280, p < 0.001) independently and significantly predicted cluster membership.

Conclusion: Compared with elderly patients with diabetes only, those with diabetes and multimorbidity experienced more health-related abilities and problems within the domains of depression, and diabetes distress. Additionally, the level of health literacy and self-management in elderly, multimorbid patients with diabetes was significantly higher than that in those with diabetes only. Among the multimorbid diabetes group, old age, male sex, living without a partner, slightly lower BMIs, not exercising regularly, and experiencing cerebral infarctions were all positively correlated with worse overall health status.

KEYWORDS

multimorbidity, elderly, type 2 diabetes mellitus, overall health status, cluster group predictor

Federica Li Pomi 1 , Andrea d’Aloja 2 , Dario Valguarnera 2 , Mario Vaccaro 2 and Francesco Borgia 2,*

1 Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, 90127 Palermo, Italy; 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。

2 Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, 98125 Messina, Italy; 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。 (A.d.); 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。 (D.V.); 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。 (M.V.) * Correspondence: 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。

Academic Editor: Vita Lesauskaite.

Received: 3 January 2025

Revised: 14 January 2025

Accepted: 22 January 2025

Published: 24 January 2025

Citation: Li Pomi, F.; d’Aloja, A.;

Valguarnera, D.; Vaccaro, M.; Borgia, F.

Exploring Anti–Aging Effects of Topical Treatments for Actinic Keratosis. Medicina 2025, 61, 207.

https://doi.org/10.3390/ medicina61020207

Copyright: © 2025 by the authors.

Published by MDPI on behalf of the Lithuanian University of Health Sciences. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license

(https://creativecommons.org/ licenses/by/4.0/)

Abstract: Background and Objectives: Actinic keratosis (AK) is a precancerous cutaneous lesion driven by chronic ultraviolet (UV) exposure, often coexisting with features of photoaging, such as wrinkles and pigmentary irregularities. Recent evidence suggests that treatments for AK may also counteract photoaging through shared molecular pathways, including oxidative stress and inflammation. This narrative review explores the dual benefits of AK therapies, highlighting their potential anti-aging and skin-lightening effects, and implications for improving skin appearance alongside lesion clearance. Materials and Methods: The literature was analyzed to assess the efficacy, mechanisms, and cosmetic outcomes of commonly used AK treatments, including topical agents (5-fluorouracil (5-FU), imiquimod, diclofenac, and tirbanibulin), and photodynamic therapy (PDT). Studies highlighting their effects on photoaged skin, collagen remodeling, pigmentation, and patient satisfaction were reviewed. Results: PDT emerged as the most validated treatment, demonstrating improved collagen synthesis, skin texture, and pigmentation. 5-FU showed remodeling of the dermal matrix and increased procollagen levels, but local skin reactions represent a major limitation. Imiquimod enhanced dermal fibroplasia and reduced solar elastosis, while diclofenac provided mild photodamage improvements with minimal adverse effects. Tirbanibulin showed promising aesthetic outcomes, including skin lightening and a reduction in mottled pigmentation, with favorable tolerability. Conclusions: AK therapies offer a dual-purpose strategy, addressing both precancerous lesions and cosmetic concerns associated with photoaging. While PDT remains the gold standard, emerging agents like tirbanibulin ointment exhibit substantial potential. Future research should focus on optimizing treatment protocols and evaluating long-term cosmetic outcomes to enhance patient satisfaction and compliance.

Keywords: actinic keratosis; anti–aging; oxidative stress; photodynamic therapy; skin aging; skin lightening; solar lentigo; tirbanibulin; 5–fluorouracil

Suneeta Kochhar, Marcia Excell

This article reviews a service pathway offering people attending their diabetes eye screening appointments an opportunistic blood pressure check to support hypertension case finding and treatment to target. The pathway promotes patient choice and facilitates primary and secondary care collaboration, as well as utilisation of home blood pressure readings. From the 200 participants in the study, 91 (45.5%) had clinic blood pressure readings above 140/90 mmHg, of whom 48 agreed to undertake home blood pressure monitoring. Of those, 33 individuals had elevated home blood pressure readings – 13 with newly diagnosed hypertension and 20 requiring treatment to target of their pre-existing hypertension. All 33 were contacted to ensure that they had been followed up by their GP practice. Participant feedback was positive.

Citation: Kochhar S, Excell M (2024) Hypertension case finding and treatment to target as part of the NHS diabetes eye screening programme. Diabetes & Primary Care 26: [Early view publication]

Article points

1. People attending their diabetes eye screening appointments may be offered an opportunistic blood pressure check to support case finding and treatment to target of hypertension.

2. Pathways for raised blood pressure may utilise home blood pressure readings to facilitate supported self-management.

3. Interface working with community providers/secondary care and primary care providers may result in early treatment of hypertension, and treatment to target is known to improve cardiovascular outcomes especially in people with diabetes.

Key words

– Cardiovascular disease

– Hypertension

– Service delivery

Authors

Suneeta Kochhar, GP Principal and Clinical Lead for CVD Prevention, NHS Sussex; Marcia Excell, RN, East Sussex Healthcare NHS Trust, and Chief Nurse Fellow, University Hospitals Sussex NHS Foundation Trust.

Aim: In this article, we aim to raise awareness of some of the clinical concerns surrounding the management of oncology wounds, particularly malignant fungating wounds. We will also provide practical wound management recommendations for healthcare professionals to consider when managing this wound type. We aim to assess the potential of a 100% chitosan with bioactive microfibre gelling (BMG™) dressing (MaxioCel®), to support wound management and work in partnership with industry to deliver clinical education on the management of oncology wounds, including malignant fungating wounds.

Method: A case study series was undertaken over four weeks, using the chitosan BMG dressing.

Results: We recruited 10 patients during the study. The chitosan BMG dressing facilitated a significant improvement in wound tissue type, exudate levels, and periwound skin, as well as reduced malodour. A reduction in patient-reported pain levels was also noted throughout the evaluation process. 

Conclusion: The introduction of BMG fibre technology demonstrated good outcomes in this patient group, in a short period of time. Importantly for this patient group, the BMG dressing was able to remain in situ during radiotherapy treatment, allowing uninterrupted management of the wounds.

KEY WORDS

Bioburden

Case studies

Malignant fungating wounds

Odour reduction

Oncology wounds

Pathways

SUSY PRAMOD

Lead Nurse Tissue Viability, The Christie NHS Foundation Trust, Manchester

SUE RICE

National Clinical Development Manager, CD Medical, Bolton, Lancashire