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Felix Almaraz, Author and Teacher, "The Tragic Calvalier."(photograph)
No full textPhotograph of Felix Almaraz, Author and Teacher, "The Tragic Calvalier."
Qualitative und gesundheitsökonomische Bewertung von FH ALERT, einer neuen Strategie zur Verbesserung der Diagnoserate der familiären Hypercholesterinämie
No full textEinleitung
Die Dissertation behandelt die Pilotinitiative FH ALERT, bei der Einsendende seitens des Labors automatisch über erhöhte Cholesterinwerte ihrer Patientinnen und Patienten informiert werden. Im ersten Teil der Arbeit werden die Ergebnisse dieser Initiative ausgewertet. Im zweiten Teil folgt deren gesundheitsökonomische Evaluation mit Fokus auf die Kosteneffektivität.
Methodik
FH ALERT ist eine Pilotinitiative, die 2018 am SYNLAB MVZ Weiden GmbH durchgeführt wurde. Überstiegen routinemäßig angeforderte LDL- oder Gesamtcholesterinwerte vordefinierter Grenzwerte, erhielten Einsendende zusätzlich einen Ergänzungsbefund mit Hinweis auf erhöhtes Risiko für familiäre Hypercholesterinämie ihrer Patientinnen und Patienten.
Die Auswertung der Pilotinitiative im ersten Teil der Arbeit behandelte Kennzahlen wie Anzahl und Verteilung der Ergänzungsbefunde, Alter eingeschlossener Patientinnen und Patienten und weiterführende diagnostische Aktivitäten (z.B. Gendiagnostik). Darüber hinaus fließt das Feedback der Einsendenden und eines Gremiums aus Expertinnen und Experten ein.
Im zweiten Teil, der gesundheitsökonomischen Evaluation, wurde ein Markov-Modell konstruiert, bei dem Felix Bernhard Fath auf Basis der Ergebnisse von FH ALERT, zwei Szenarien vergleicht: In Szenario 1 wird keiner der Patientinnen und Patienten gendiagnostisch untersucht und alle werden entsprechend einer gewöhnlichen Hypercholesterinämie behandelt. In Szenario 2 werden alle Patientinnen und Patienten gendiagnostisch untersucht und gemäß ihrer realen Erkrankung behandelt.
Ergebnisse
Von 75.431 Cholesterintests führten 4,66 % zu einem Ergänzungsbefund. Es wurden 462 Einsendende mit mindestens einem Ergänzungsbefund kontaktiert und 26 Testkits zur genetischen Untersuchung zurückgeschickt, wovon 5 sich als eindeutige FH-Fälle erwiesen. Die Initiative erhielt positive Rückmeldungen, Expertinnen und Experten empfahlen eine Wiederholung.
Bei der gesundheitsökonomischen Evaluation lässt sich feststellen, dass die inkrementellen Kosten (ICERs) einer genetischen Untersuchung sich durch die gewonnenen Effekte der angeschlossenen Therapie durchaus amortisieren können. Das gilt insbesondere bei steigender Therapieintensität und geringerer Testkosten. Kaskadenscreening kann zusätzliche Einsparungen bieten.
Diskussion
Die Initiative FH ALERT war erfolgreich, indem sie weitere national und international empfohlene diagnostische Schritte auslöst. FH ALERT ist etwa 14-mal effizienter als die bisherige Benchmark, das Dutch Lipid Clinics Cascade Screening. Nach Meinung der Expertinnen und Experten liegt in FH ALERT ein großes mittel- und langfristiges Potenzial durch die Etablierung eines neuen Kommunikationsansatzes zwischen Labor und Einsendenden.
Die gesundheitsökonomische Evaluation bestätigt die positiven Ergebnisse und untermauert, dass FH ALERT mit angeschlossener genetischer Untersuchung und leitlinienkonformer Therapie kosteneffektiv ist. Es ergibt sich folgende Handlungsempfehlung: Alle Patientinnen und Patienten mit erhöhten Cholesterinwerten sollen zunächst mit Statinen und Ezetimib behandelt werden. Erreichen sie damit die Zielwerte nicht, die für Patientinnen und Patienten mit FH angelegt sind, soll eine gendiagnostische Untersuchung erfolgen. Somit würde die Gendiagnostik wird an einem effizienten Punkt in der Behandlung eingesetzt werden.
Fazit
FH ALERT bietet einen innovativen Ansatz zur verbesserten FH-Diagnose und liefert eine gesundheitsökonomisch fundierte Grundlage für künftige Screening-Initiativen
Parents’ assets and child marriage: are mother’s assets more protective than father’s assets?
No full textChild marriage places girls at an increased risk for dropping out of school early, sexually transmitted infections, teenage childbirth, and accompanying childbirth complications, including maternal mortality. The determinants of child marriage are not clearly understood, which hinders efforts to mount effective interventions. This study examined the link between economic resources and child marriage by investigating whether maternal and paternal asset ownership were longitudinally associated with daughters’ child marriage in Ethiopia. Drawing upon household bargaining theory, it was hypothesized that maternal assets would be more protective of daughters’ child marriage than paternal assets. Data for 4,293 girls from the nationally representative Ethiopia Socioeconomic Survey, fielded in 2011 and 2014, were employed. Logistic regression and instrumental variable analyses were used to examine the relationship between transition into child marriage during the study period and maternal and paternal assets, controlling for child-, family-, and community-level characteristics. Results show that a one standard deviation increase in mother’s assets was associated with 37–53% lower odds of daughter’s child marriage whereas a one standard deviation increase in paternal asset holdings was associated with 0–37% higher odds of daughter’s child marriage. Effects were strongest in regions where the dominant mode of marriage payments is bride price. These results suggest that the link between economic resources and child marriage depends on the gender of the parent who owns the resources. This study also highlights the interconnectedness of two targets of the gender equality Sustainable Development Goal—improvement of women’s ownership of assets and the elimination of child marriage—and suggests that the realization of one gender equality target could have implications for other targets.Peer reviewe
Disability among children of immigrants from India and China: is there excess disability among girls?
No full textWe investigate whether there is excess morbidity among daughters of Indian or Chinese immigrants in the US by studying the prevalence of disability among children. We use data from the 2012–14 American Community Surveys on approximately 20,000 US-born children of Indian and Chinese immigrants. Children of US natives are used as a comparison group to account for innate differences in disability between the sexes. Results indicate that there is excess disability among daughters compared with sons among children of Chinese immigrants and children of immigrants from northern or western Indian states; this excess disability declines with younger age at arrival or longer exposure to the host country. Analysis using children of Filipino immigrants as an alternative comparison group yields similar excess disability rates for females.Peer reviewe
Effect of Food Subsidies on Micronutrient Consumption
No full textIn this article, we study the effect of an exogenous increase in wheat and rice price subsidy to poor families resulting from a targeted food price subsidy program in India called the Targeted Public Distribution System (TPDS) on micronutrient intake in low-income families. Descriptive results show that wheat and rice have one of the lowest micronutrient density scores, suggesting that these are poor suppliers of micronutrients. Empirical analysis suggests that the increase in subsidy amount of Rs. 15-18 resulting from the TPDS expansion lowered calcium intake by 12-14 percent and had negligible to small (often negative) effects on the consumption of most micronutrients.Peer reviewe
Sex composition of children and spousal sexual violence in sub-Saharan Africa
No full textObjective
In societies with a cultural preference for sons over daughters, women who do not bear sons may be at increased risk for spousal violence. This study examined whether women with daughters only are at an elevated risk for spousal sexual violence compared to women with sons only in sub-Saharan Africa. The study tested the hypothesis that the association between sex composition of children and spousal sexual violence would be observed only in large families.
Methods
Data were from the most recent (as at February, 2016) Demographic and Health Surveys conducted in 22 sub-Saharan African countries for 37,915 women. Odds ratios comparing experience of spousal sexual violence of women with sons only to those with daughters only were estimated, separately for women with three or fewer children and those with four or more children, controlling for age, age at first cohabitation, age at first birth, educational attainment, urban residence, and household wealth.
Results
Having daughters only was associated with a greater likelihood of spousal sexual violence among women with many children (adjusted odds ratio [AOR] = 1.53; 95% CI = 1.02–2.30) but not among those with few children (AOR = 0.92; 95% CI = 0.82–1.04).
Conclusions for practice
A higher risk of sexual violence for women without sons suggests that son preference may have implications on women’s health and wellbeing. Efforts to further understand and address increased risk of sexual violence for women without sons should consider son preference and intra-couple conflict concerning fertility intentions.Peer reviewe
Culture, labor supply, and fertility across immigrant generations in the United States
No full textRecent immigration to the United States and other developed nations has increasingly been from countries that have relatively traditional gender norms. This study uses data from the Current Population Survey for 2000–14 to investigate how source-country gender norms influence the labor supply and fertility of married women across immigrant generations in the US. It finds that immigrants’ and descendants’ labor supply and fertility are associated with the female-to-male labor force participation ratio and total fertility rate in the source country; importantly, the association declines across successive generations. Husbands’ source-country characteristics are also associated with the labor supply and fertility of immigrant women. These findings indicate evolution and assimilation of traditional gender norms in the long run.Peer reviewe
The genome and proteome of a virulent Escherichia coli O157:H7 bacteriophage closely resembling Salmonella phage Felix O1
No full textBased upon whole genome and proteome analysis, Escherichia coli O157:H7-specific bacteriophage (phage) wV8 belongs to the new myoviral genus, "the Felix O1-like viruses" along with Salmonella phage Felix O1 and Erwinia amylovora phage φEa21-4. The genome characteristics of phage wV8 (size 88.49 kb, mol%G+C 38.9, 138 ORFs, 23 tRNAs) are very similar to those of phage Felix O1 (86.16 kb, 39.0 mol%G+C, 131 ORFs and 22 tRNAs) and, indeed most of the proteins have their closest homologs within Felix O1. Approximately one-half of the Escherichia coli O157:H7 mutants resistant to phage wV8 still serotype as O157:H7 indicating that this phage may recognize, like coliphage T4, two different surface receptors: lipopolysaccharide and, perhaps, an outer membrane protein
Felix Grant and Peter Ustinov
No full textFelix Grant and internationally renowned actor, author and playwright Peter Ustinov converse.Made available in DSpace on 2012-10-09T17:40:17Z (GMT). No. of bitstreams: 4
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Previous issue date: 2002-11-04Handwritten on back: "Felix Grant and / Peter Ustinof [sic]
Track seed classification with Deep Neural Networks
No full textauthor Felix DietrichMasterarbeit Universität Innsbruck 202
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