2,558 research outputs found
How heterogeneous is microalbuminuria in diabetes mellitus? The case for 'benign' and 'malignant microalbuminuria.
No full textAssessing health systems for type 1 diabetes in sub-Saharan Africa: developing a 'Rapid Assessment Protocol for Insulin Access'
No full textBackground
In order to improve the health of people with Type 1 diabetes in developing countries, a clear analysis of the constraints to insulin access and diabetes care is needed. We developed a Rapid Assessment Protocol for Insulin Access, comprising a series of questionnaires as well as a protocol for the gathering of other data through site visits, discussions, and document reviews.
Methods
The Rapid Assessment Protocol for Insulin Access draws on the principles of Rapid Assessment Protocols which have been developed and implemented in several different areas. This protocol was adapted through a thorough literature review on diabetes, chronic condition management and medicine supply in developing countries.
A visit to three countries in sub-Saharan Africa and meetings with different experts in the field of diabetes helped refine the questionnaires. Following the development of the questionnaires these were tested with various people familiar with diabetes and/or healthcare in developing countries. The Protocol was piloted in Mozambique then refined and had two further iterations in Zambia and Mali. Translations of questionnaires were made into local languages when necessary, with back translation to ensure precision.
Results
In each country the protocol was implemented in 3 areas – the capital city, a large urban centre and a predominantly rural area and their respective surroundings. Interviews were carried out by local teams trained on how to use the tool. Data was then collected and entered into a database for analysis.
Conclusion
The Rapid Assessment Protocol for Insulin Access was developed to provide a situational analysis of Type 1 diabetes, in order to make recommendations to the national Ministries of Health and Diabetes Associations. It provided valuable information on patients' access to insulin, syringes, monitoring and care. It was thus able to sketch a picture of the health care system with regards to its ability to care for people with diabetes. In all countries where this tool was used the involvement of local stakeholders resulted in the process acting as a catalyst in bringing diabetes to the attention of the health authorities
Chosen logistics processes in Škoda JS
No full textThis master thesis deals with the purchase and sale process in Škoda JS company. The aim of this work is to assess whether the setting of the purchase and sale process is met by the company also within a real business case, in compliance with set controls, and whether the degree of perfect delivery is sufficient. In the introduction, the author specifies the basic terms: logistics, logistic chain, customer benefits, information systems in logistics, buying and selling. The following chapter introduces Škoda JS company, including the sphere of its entrepreneurial activity. This chapter also deals with the nuclear power industry. In the crucial chapter, the author describes the process of purchase and sale in Škoda JS company and compares it with a real business case. In conclusion, the author evaluates discrepancies and suggests recommendations to avoid them
PONE-D-17-02552R
No full textFrança GVAd, De Lucia Rolfe E, Horta BL, Gigante DP, Yudkin JS, Ong KK, et al. (2017) Genomic ancestry and education level independently influence abdominal fat distributions in a Brazilian admixed population. PLoS ONE 12(6): e0179085. https://doi.org/10.1371/journal.pone.017908
Haematocrit, type 2 diabetes, and endothelium-dependent vasodilatation of resistance vessels RID C-1988-2008
No full textAims In conditions such as type 2 diabetes, hypertension, and smoking, in which haematocrit (Hct) tends to be higher, endothetial function is impaired. In vitro, haemogtobin neutralizes nitric oxide very effectively. Whether red blood cells participate in the regulation of endothelial function in vivo has not been established. Methods and results Clinical and haematotogical parameters and forearm blood flow responses to acetylcholine (ACh) and sodium nitroprusside (SNP) were measured in 84 type 2 diabetic patients and 19 control subjects. Diabetics showed blunted doseresponse curves to both SNP and ACh. In diabetics, across quartites of Hct, ACh blood flow responses were progressively tower (881 +/- 96, 652 +/- 81, 513 +/- 54, 307 +/- 46%, P < 0.0001), and maximal SNP responses tended to be lower (706 +/- 72, 578 +/- 61, 607 +/- 69, 499 +/- 53%, P = 0.06) despite similar age, body mass index, gtycated haemogtobin (HbA(1c)), blood pressure, serum total and HDL-chotesterot levels, indices of insulin sensitivity, and markers of inflammation. After normalizing the ACh response for the SNP response (ACh/SNP ratio), a progressive reduction across Hct quartites (1.54 +/- 0.23, 1.22 +/- 0.15, 0.93 +/- 0.09, 0.66 +/- 0.09, P < 0.0001) was still observed, with patients in the III and IV quartite showing a blunted response compared with controls (1.44 +/- 0.08). Both in diabetics and controls, the ACh/SNP ratio was reciprocally related to Hct (r = -0.46 and r = -0.66, respectively, P < 0.002 for both). This association was independent of comorbidities, gender, metabolic control, plasma lipids, or concomitant treatments, was stronger in the subjects with preserved endotheliumdependent dilatation, and was unchanged when haemoglobin replaced Hct. Conclusion Both in diabetics and non-diabetics, haematocrit is inversely related to small vessel endothelium-dependent dilatation. Thus, in addition to blood rheology, a direct negative effect on nitric oxide availability might explain the link between high Hct and cardiovascular disease
Vascular effects of improving metabolic control with metformin or rosiglitazone in type 2 diabetes
No full textOBJECTIVE— The aim of this study was to test whether vascular reactivity is modified by improving metabolic control and peripheral insulin resistance in type 2 diabetes.
RESEARCH DESIGN AND METHODS— In a randomized, double-blind design, we assigned 74 type 2 diabetic patients to rosiglitazone (8 mg/day), metformin (1,500 mg/day), or placebo treatment for 16 weeks and measured insulin sensitivity (euglycemic insulin clamp),
ambulatory blood pressure, and forearm blood flow response to 1) intra-arterial acetylcholine
(ACh), 2) intra-arterial nitroprusside, 3) the clamp, and 4) blockade of nitric oxide (NO) synthase.
RESULTS— Compared with 25 nondiabetic subjects, patients had reduced insulin sensitivity
(301 vs. 413 mol min1 kg fat-free mass1; P0.001) and reduced maximal response to ACh (58642 vs. 88381%; P0.001). Relative to placebo, 16 weeks of rosiglitazone and
metformin similarly reduced fasting glucose (2.3 0.5 and 2.3 0.5 mmol/l) and HbA1c (1.2 0.3 and 1.6 0.3%). Insulin sensitivity increased with rosiglitazone (6 3 mol
min1 kg fat-free mass1; P0.01) but not with metformin or placebo. Ambulatory diastolic blood pressure fell consistently (2 1 mmHg; P 0.05) only in the rosiglitazone group. Nitroprusside dose response, clamp-induced vasodilatation, and NO blockade were not affected
by either treatment. In contrast, the slope of the ACh dose response improved with rosiglitazone
(40% versus baseline, P 0.05, 70% versus placebo, P 0.005) but did not change with either metformin or placebo. This improvement in endothelium-dependent vasodilatation was accompanied by decrements in circulating levels of free fatty acids and tumor necrosis factor.
CONCLUSIONS— At equivalent glycemic control, rosiglitazone, but not metformin, improves endothelium dependent vasodilatation and insulin sensitivity in type 2 diabetes
Vascular effects of improving metabolic control with melformin or rosiglitazone in type 2 diabetes RID C-1988-2008
No full textOBJECTIVE - The aim of this study was to test whether vascular reactivity is modified by improving metabolic control and peripheral insulin resistance in type 2 diabetes. RESEARCH DESIGN AND METHODS - In a randomized, double-blind design, we assigned 74 type 2 diabetic patients to rosiglitazone (8 mg/day), metformin (1,500 mg/day), or placebo treatment for 16 weeks and measured insulin sensitivity (euglycemic insulin clamp), ambulatory blood pressure, and forearm blood flow response to 1) intra-arterial acetylcholine (ACh), 2) infra-arterial nitroprusside, 3) the clamp, and 4) blockade of nitric oxide (NO) synthase. RESULTS - Compared with 25 nondiabetic subjects, patients had reduced insulin sensitivity (30 +/- 1 vs. 47 +/- 3 mumol (.) min(-1) (.) kg fat-free mass(-1); P < 0.001) and reduced maximal response to ACh (586 42 vs. 883 81.%; P < 0.001). Relative to placebo, 16 weeks of rosiglitazone and metformin similarly reduced fasting glucose (-2.3 +/- 0.5 and -2.3 +/- 0.5 mmol/l) and HbA(1c) (-1.2 +/- 0.3 and -1.6 +/- 0.3%). Insulin sensitivity increased with rosiglitazone (+6 +/- 3 mumol (.) min(-1) (.) kg fat-free mass(-1); P < 0.01) but not with metformin or placebo. Ambulatory diastolic blood pressure fell consistently (-2 +/- 1 mmHg; P < 0.05) only in the rosiglitazone group. Nitroprusside dose response, clamp-induced vasodilatation, and NO blockade were not affected by either treatment. In contrast, the slope of the ACh dose response improved with rosiglitazone (+40% versus baseline, P < 0.05, +70% versus placebo, P < 0.005) but did not change with either metformin or placebo. This improvement in endothelium-dependent vasodilatation was accompanied by decrements in circulating levels of free fatty acids and turner necrosis factor-alpha. CONCLUSIONS - At equivalent glycemic control, rosiglitazone, but not metformin, improves endothelium dependent vasodilatation and insulin sensitivity in type 2 diabetes
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