45 research outputs found
Supplemental material for Validity of hemoglobin A1c for diagnosing diabetes among people with and without HIV in Uganda
No full textSupplemental Material for Validity of hemoglobin A1c for diagnosing diabetes among people with and without HIV in Uganda by James Muchira, Eileen Stuart-Shor, Jen Manne-Goehler, Janet Lo, Alexander C Tsai, Bernard Kakukire, Samson Okello and Mark J Siedner in International Journal of STD & AIDS</p
Patients with pulmonary arterial hypertension related to HIV: Effects of antiretroviral and disease-specific PAH therapy
No full textPatients with pulmonary arterial hypertension related to HIV: Effects of antiretroviral and disease-specific PAH therapy
No full textCost-effectiveness of 7-day-Holter monitoring alone or in combination with transthoracic echocardiography in patients with cerebral ischemia
No full textBackground and purpose Prolonged Holter monitoring of patients with cerebral ischemia increases the detection rate of paroxysmal atrial fibrillation (PAF); this leads to improved antithrombotic regimens aimed at preventing recurrent ischemic strokes. The aim of this study was to compare a 7-day-Holter monitoring (7-d-Holter) alone or in combination with prior selection via transthoracic echocardiography (TTE) to a standard 24-h-Holter using a cost-utility analysis. Methods: Lifetime cost, quality-adjusted life years (QALY), and incremental cost-effectiveness ratios (ICER) were estimated for a cohort of patients with acute cerebral ischemia and no contraindication to oral anticoagulation. A Markov model was developed to simulate the long-term course and progression of cerebral ischemia considering the different diagnostic algorithms (24-h-Holter, 7-d-Holter, 7-d-Holter after preselection by TTE). Clinical data for these algorithms were derived from the prospective observational Find-AF study (ISRCTN 46104198). Results: Predicted lifelong discounted costs were 33,837 € for patients diagnosed by the 7-d-Holter and 33,852 € by the standard 24-h-Holter. Cumulated QALYs were 3.868 for the 7-d-Holter compared to 3.844 for the 24-h-Holter. The 7-d-Holter dominated the 24-h-Holter in the base-case scenario and remained cost-effective in extensive sensitivity analysis of key input parameter with a maximum of 8,354 €/QALY gained. Preselecting patients for the 7-d-Holter had no positive effect on the cost-effectiveness. Conclusions: A 7-d-Holter to detect PAF in patients with cerebral ischemia is cost-effective. It increases the detection which leads to improved antithrombotic regimens; therefore, it avoids recurrent strokes, saves future costs, and decreases quality of life impairment. Preselecting patients by TTE does not improve cost-effectiveness.Version of Recor
Real-world smartphone-based point-of-care diagnostics in primary health care to monitor HbA1c levels in people with diabetes
No full textBackgroundThe lack of accurate and affordable monitoring of glycated hemoglobin (HbA1c) is a common issue among patients with diabetes in low- and middle-income countries. We aimed to test a tablet- and smartphone-based point-of-care (TSB POC) device against a local laboratory-based measure of HbA1c for monitoring diabetes under real-world conditions.MethodsFor this cross-sectional clinical method applicability study, capillary and venous blood was collected in duplicate and analyzed at local primary health care centers. For a heterogeneity test, the tests were performed by an expert, and by a team of local nurses. The study was conducted in a multicenter design in rural and urban Aceh, Indonesia in 2019, and included a total of 533 adults. We mainly used Bland-Altman plots to assess the number of readings within the 95%-limits of agreement (LoA) and Deming regressions.ResultsThe results show a mean difference between capillary HbA1c on the test device and the reference method of −0.54 [CI0.95 = −1.6933; 0.6048] with 5.21% of measurements outside the LoA and a Pearson’s r = 0.91 in the Deming Regression. There is no significant difference in test concordance between local nurses and the expert (4.23% versus 5.13% results outside the LoA [CI0.95 = −0.0331; 0.0511]).ConclusionsTSB POC for analysis of HbA1c is an acceptable alternative for accessible monitoring of diabetes patients under these conditions. This method could provide access to high-quality diagnostic decisions through regular and cost-effective HbA1c monitoring directly in healthcare facilities, thus providing better access to essential health services.Plain language summary People with diabetes in low- and middle-income countries often lack access to reliable and affordable tests to monitor their long-term blood sugar levels, known as HbA1c. This study tested a simple tablet- or smartphone-based device to measure HbA1c directly at primary health centers. The study was conducted in urban and rural areas of Indonesia with 533 participants. The results showed that the device’s measurements were almost identical to laboratory tests. There was hardly any difference in the results, regardless of whether the tests were carried out by experienced experts or by nurses in the field. This method could provide a basis for regular and affordable HbA1c testing to improve diabetes care and access to basic health services for patients in these regions.Rhode et al. investigate the applicability of smartphone-based point-of-care diagnostics for monitoring HbA1c levels of diabetes patients under real-world conditions in a lower-middle income setting. They discover that the method offers an acceptable alternative for accessible monitoring under these conditions
Noninvasive Imaging of Endothelial Damage in Patients with different HbA1c-levels, a Proof-of-Concept Study
No full textThe aim of this study was to compare endothelial permeability, which is considered a hallmark of CAD, between patients with different HbA1c-levels using an albumin-binding-MR-probe. This cross-sectional-study included 26 patients with clinical indication for x-ray-angiography, which were classified into 3 groups according to their HbA1c-levels (HbA1c<5.7%,<39mmol/mol; HbA1c=5.7-6.4%,39-47mmol/mol; HbA1c≥6.5%,48mmol/mol). Subjects underwent gadofosveset-enhanced-coronary-magnetic-resonance and x-ray-angiography including optical-coherence-tomography (OCT) within 24hours. Contrast-to-noise-ratios were assessed to measure the probe-uptake in the coronary-wall by coronary segment, excluding those with culprit lesions in x-ray-angiography. In the group of patients with HbA1c-levels between 5.7-6.4% 0.30 increased normalized CNR values were measured, compared to patients with HbA1c-levels <5.7% (0.30; 95% CI:[0.04, 0.57]). In patients with HbA1c levels ≥6.5%, we found 0.57 higher normalized CNR values as compared to patients with normal HbA1c-levels (0.57;95% CI:[0.28,0.85]) and 0.26 higher CNR values for patients with HbA1c-level≥6.5% as compared to patients with HbA1c-levels between 5.7-6.4% (0.26; 95% CI: [-0.04, 0.57]). Additionally late atherosclerotic lesions were more common in patients with high HbA1c-levels (HbA1c ≥6.5%:n=14 (74%); HbA1c 5.7-6.4%:n=6 (60%); HbA1c<5.7%:n=10 (53%)).In conclusion, coronary-magnetic-resonance imaging in combination with an albumin-binding probe suggests that both patients with intermediate and high HbA1c-levels are associated with a higher extent of endothelial damage of the coronary arteries as compared to patients with HbA1c-levels below 5.7.</p
Diabetes diagnosis and care in sub-Saharan Africa: pooled analysis of individual data from 12 countries
No full textBACKGROUND:Despite widespread recognition that the burden of diabetes is rapidly growing in many countries in sub-Saharan Africa, nationally representative estimates of unmet need for diabetes diagnosis and care are in short supply for the region. We use national population-based survey data to quantify diabetes prevalence and met and unmet need for diabetes diagnosis and care in 12 countries in sub-Saharan Africa. We further estimate demographic and economic gradients of met need for diabetes diagnosis and care.
METHODS:We did a pooled analysis of individual-level data from nationally representative population-based surveys that met the following inclusion criteria: the data were collected during 2005-15; the data were made available at the individual level; a biomarker for diabetes was available in the dataset; and the dataset included information on use of core health services for diabetes diagnosis and care. We first quantified the population in need of diabetes diagnosis and care by estimating the prevalence of diabetes across the surveys; we also quantified the prevalence of overweight and obesity, as a major risk factor for diabetes and an indicator of need for diabetes screening. Second, we determined the level of met need for diabetes diagnosis, preventive counselling, and treatment in both the diabetic and the overweight and obese population. Finally, we did survey fixed-effects regressions to establish the demographic and economic gradients of met need for diabetes diagnosis, counselling, and treatment.
FINDINGS:We pooled data from 12 nationally representative population-based surveys in sub-Saharan Africa, representing 38 311 individuals with a biomarker measurement for diabetes. Across the surveys, the median prevalence of diabetes was 5% (range 2-14) and the median prevalence of overweight or obesity was 27% (range 16-68). We estimated seven measures of met need for diabetes-related care across the 12 surveys: (1) percentage of the overweight or obese population who received a blood glucose measurement (median 22% [IQR 11-37]); and percentage of the diabetic population who reported that they (2) had ever received a blood glucose measurement (median 36% [IQR 27-63]); (3) had ever been told that they had diabetes (median 27% [IQR 22-51]); (4) had ever been counselled to lose weight (median 15% [IQR 13-23]); (5) had ever been counselled to exercise (median 15% [IQR 11-30]); (6) were using oral diabetes drugs (median 25% [IQR 18-42]); and (7) were using insulin (median 11% [IQR 6-13]). Compared with those aged 15-39 years, the adjusted odds of met need for diabetes diagnosis (measures 1-3) were 2·22 to 3·53 (40-54 years) and 3·82 to 5·01 (≥55 years) times higher. The adjusted odds of met need for diabetes diagnosis also increased consistently with educational attainment and were between 3·07 and 4·56 higher for the group with 8 years or more of education than for the group with less than 1 year of education. Finally, need for diabetes care was significantly more likely to be met (measures 4-7) in the oldest age and highest educational groups.
INTERPRETATION:Diabetes has already reached high levels of prevalence in several countries in sub-Saharan Africa. Large proportions of need for diabetes diagnosis and care in the region remain unmet, but the patterns of unmet need vary widely across the countries in our sample. Novel health policies and programmes are urgently needed to increase awareness of diabetes and to expand coverage of preventive counselling, diagnosis, and linkage to diabetes care. Because the probability of met need for diabetes diagnosis and care consistently increases with age and educational attainment, policy makers should pay particular attention to improved access to diabetes services for young adults and people with low educational attainment
Private Equity und Familienunternehmen: eine Untersuchung unter besonderer Berücksichtigung deutscher Maschinen- und Anlagenbauunternehmen
No full textDespite the common view that there is inherently a relationship of confliction, it is now impossible to imagine the financing of family-owned enterprises in Germany without the alternative method of Private Equity financing. Based on a survey on Private Equity in family owned companies specialising in the mechanical engineering sector, this working paper identifies that Private Equity in general is not as unwanted as once assumed. Overall more than 3/4 of the surveyed companies do not exclude investment capital. However, the study demonstrates that the time of large buy-outs is arguably up, and minority capital has now come into vogue. This working paper examines, from the viewpoint of the managing directors of the studied companies, the conceptions and beliefs held by such persons about Private Equity. Generally speaking, besides loss of control, managing directors primarily fear Private Equity because of exaggerated returns on investment at the expense of the long-term development of the company. On the other hand, this paper also highlights that managing directors expect that Private Equity can have a positive element as it can enable bank independence, especially at a time when it becomes increasingly difficult to maintain creditworthiness. Further, this paper analyses the relationship between the managing director of the family enterprise and the Private Equity investor. Because of the special situation of the managing director in a family owned company, trust between that person and the Private Equity investor is one of the most important factors. If there is a lack of trust the business relation is troubled from the start. --Private equity,buyout,family owned enterprises,minority capital,credit crisis,MBO,MBI,return on investments,LBO,leveraged finance,M&A
Caracterização da resposta nociceptiva de camundongos às endotelinas e da contribuição destes peptídeos na resposta nociceptiva deflagrada por antígeno
No full textTese (doutorado) - Universidade Federal de Santa Catarina, Centro de Ciências Biológicas. Programa de Pós-Graduação em Farmacologia.O presente estudo investigou os efeitos nociceptivo, hiperalgésico e edematogênico de [endotelinas] (ETs) injetadas por via intraplantar na pata de camundongos. Além disso, avaliou a contribuição das ETs endógenas para a [nocicepção] (NOCI) e a [hiperalgesia] (HIPER) desencadeadas por ovoalbumina (OVA) em animais sensibilizados ao antígeno. A HIPER foi avaliada como a potencialização da NOCI induzida por capsaicina. A ET-1 causou efeitos nociceptivo, hiperalgésico e edematogênico dependentes de dose. Estas respostas foram bloqueadas por A-127722.5 ou BQ-123 (antagonistas ETA), mas não por BQ-788 (antagonista ETB). Além disso, sarafotoxina S6c (S6c) e IRL 1620 (agonistas ETB) não deflagram nenhum dos efeitos da ET-1. Porém, o BQ-788 revelou um efeito hiperalgésico à ET-3, e a S6c inibiu a HIPER à ET-1 sem alterar suas ações nociceptiva ou edematogênica. Em outros experimentos, a NOCI induzida por OVA em animais sensibilizados foi reduzida por bosentan (antagonista ETA/ETB), BQ-123 ou A-127722.5, e aumentada por A-192621.1 (antagonista ETB). Finalmente, a HIPER à capsaicina induzida por OVA foi bloqueada por bosentan, A-127722.5 ou A-192621.1. Estes resultados demonstram que as ETs contribuem para efeitos pró-nociceptivos (inclusive alérgico) e edematogênico mediados por receptores ETA em camundongos, enquanto os receptores ETB modulam distintamente estas respostas ao peptídeo
