4,326 research outputs found

    Strategies to prevent Type 2 Diabetes in the postnatal period, in women with history of Gestational Diabetes Exploring different research methodologies based on dietary and pharmacological interventions

    Get PDF
    Aim and objectives The aim of this thesis is to investigate methods to prevent the progression to type 2 diabetes in the immediate postnatal period, in women diagnosed with gestational diabetes mellitus (GDM). The objectives of this thesis are to explore the views of pregnant women diagnosed with gestational diabetes and healthcare professionals, with regards to the use of an app in the postnatal period which will provide information about diet for type 2 diabetes prevention. The development of a protocol for a single-arm feasibility study on a Mediterranean-style diet for the prevention of type 2 diabetes in the postnatal period. To pilot the trial design and study processes and assess the feasibility of a large-scale trial on the effectiveness of a Mediterranean-style diet in postnatal period for type 2 diabetes prevention. To examine the acceptability of a Mediterranean-style diet for type 2 diabetes prevention in women taking part in a feasibility study and explore the opinions of women and healthcare professionals on trial processes. To develop a protocol for a pilot trial on metformin for the prevention of type 2 diabetes in the postnatal period. Pilot the trial design and study processes and assess the feasibility of a large-scale trial on the effectiveness of metformin in postnatal period for type 2 diabetes prevention. Methods The methods employed in this thesis include a cross-sectional survey, a single arm mixed method feasibility study with qualitative evaluation (which included the use of an app) and a mixed method randomised controlled double blind feasibility study with the use of metformin or placebo. Results Survey The survey demonstrated that app usage is part of everyday life, with 84% (85/101) of pregnant GDM women and 82% (71/87) of healthcare professionals using apps daily. All pregnant women who participated in this survey had a device by which they could access apps (100%, 101/101) and 95% (179/188) of the participants had a smartphone. The participants agreed that an app which provides dietary information in the postnatal period for diabetes prevention would be welcomed by postnatal women with GDM history. Single arm feasibility study on a Mediterranean-style diet for the prevention of T2D in the postnatal period (MERIT) A total of 69% (83/121) of eligible multi-ethnic women agreed to participate and 67% (56/83) of those initially recruited commenced the intervention. The last visit (12 months postnatally) was completed by 73.2% (41/56) of participants. A higher number of participants completed visit 2 (which is at 6 months postnatally) 80.4% (45/56), but this visit was completed remotely due to COVID-19 pandemic lockdown restrictions, whereas visit 3 was completed face-to-face. Participants had high engagement with the coach, both face-to-face and via phone-calls or text messages. Adherence based on the ESTEEM diet questionnaire was high at the end of the study. There was a trend of reduction of total dysglycaemia, and the participants weight was also reduced by 1.3kg, from visit 1 (6 to 13 weeks) to visit 3 (12 months postnatally). Clinical effectiveness discussion is exploratory due to the small sample size. The intervention and trial processes were acceptable to women and healthcare professionals, adherence was high when women had a supportive environment, provided by their family and the health coach. The group chat function was not successful in this study. Randomised double-blind placebo-controlled pilot trial on metformin for the prevention of T2D in the postnatal period (OMAhA) A total of 57.9% (175/302) of eligible multi-ethnic women agreed to take part in the study, out of those 82.3% (144/175) were randomised to receive metformin or placebo. The attendance rates for visits 2 (6 months) and 3 (12 months) were similar, with 54.6% (71/130) and 55.7 (64/115) attending each visit respectively. Due to the COVID-19 pandemic visit 3 was completed over the phone for 21.7% (39/115) of the participants which led to limited blood samples collection. Total dysglycaemia reduction was evident in the metformin group (18.3%) compared to the placebo group (24.7%) but this discussion is exploratory, and the study is not powered to measure effectiveness. The metformin group maintained their weight throughout the study, whereas the placebo group gained 400g. Adherence was 54.1% (participants who took at least 75% of the recommended dosage). The study was acceptable to both women and healthcare professionals, but the element of peer-support should be included in future studies. Conclusion It is feasible and acceptable to recruit women in the postnatal period in studies that are focused on diabetes prevention and introduce dietary or pharmacological interventions. The MERIT protocol will have to be revised to address how follow-up rates can be improved. The OMAhA protocol will also be revised to target improvement in adherence and follow-up rates. The COVID-19 pandemic lockdown restrictions and staffing issues have impacted data collection of both studies. More research is needed in this population with larger sample sizes to be able to prove efficacy. The strongest motivator that affects adherence and retention is the woman’s perception of her own risk of developing diabetes. Future studies should include the element of peer support and an education session about the risk of Type 2 Diabetes in postnatal period

    Effects of municipal smoke-free ordinances on secondhand smoke exposure in the Republic of Korea

    Get PDF
    ObjectiveTo reduce premature deaths due to secondhand smoke (SHS) exposure among non-smokers, the Republic of Korea (ROK) adopted changes to the National Health Promotion Act, which allowed local governments to enact municipal ordinances to strengthen their authority to designate smoke-free areas and levy penalty fines. In this study, we examined national trends in SHS exposure after the introduction of these municipal ordinances at the city level in 2010.MethodsWe used interrupted time series analysis to assess whether the trends of SHS exposure in the workplace and at home, and the primary cigarette smoking rate changed following the policy adjustment in the national legislation in ROK. Population-standardized data for selected variables were retrieved from a nationally representative survey dataset and used to study the policy action’s effectiveness.ResultsFollowing the change in the legislation, SHS exposure in the workplace reversed course from an increasing (18% per year) trend prior to the introduction of these smoke-free ordinances to a decreasing (−10% per year) trend after adoption and enforcement of these laws (β2 = 0.18, p-value = 0.07; β3 = −0.10, p-value = 0.02). SHS exposure at home (β2 = 0.10, p-value = 0.09; β3 = −0.03, p-value = 0.14) and the primary cigarette smoking rate (β2 = 0.03, p-value = 0.10; β3 = 0.008, p-value = 0.15) showed no significant changes in the sampled period. Although analyses stratified by sex showed that the allowance of municipal ordinances resulted in reduced SHS exposure in the workplace for both males and females, they did not affect the primary cigarette smoking rate as much, especially among females.ConclusionStrengthening the role of local governments by giving them the authority to enact and enforce penalties on SHS exposure violation helped ROK to reduce SHS exposure in the workplace. However, smoking behaviors and related activities seemed to shift to less restrictive areas such as on the streets and in apartment hallways, negating some of the effects due to these ordinances. Future studies should investigate how smoke-free policies beyond public places can further reduce the SHS exposure in ROK

    Introduction to Psychology

    Get PDF
    Introduction to Psychology is a modified version of Psychology 2e - OpenStax

    Anwendungen maschinellen Lernens für datengetriebene Prävention auf Populationsebene

    Get PDF
    Healthcare costs are systematically rising, and current therapy-focused healthcare systems are not sustainable in the long run. While disease prevention is a viable instrument for reducing costs and suffering, it requires risk modeling to stratify populations, identify high- risk individuals and enable personalized interventions. In current clinical practice, however, systematic risk stratification is limited: on the one hand, for the vast majority of endpoints, no risk models exist. On the other hand, available models focus on predicting a single disease at a time, rendering predictor collection burdensome. At the same time, the den- sity of individual patient data is constantly increasing. Especially complex data modalities, such as -omics measurements or images, may contain systemic information on future health trajectories relevant for multiple endpoints simultaneously. However, to date, this data is inaccessible for risk modeling as no dedicated methods exist to extract clinically relevant information. This study built on recent advances in machine learning to investigate the ap- plicability of four distinct data modalities not yet leveraged for risk modeling in primary prevention. For each data modality, a neural network-based survival model was developed to extract predictive information, scrutinize performance gains over commonly collected covariates, and pinpoint potential clinical utility. Notably, the developed methodology was able to integrate polygenic risk scores for cardiovascular prevention, outperforming existing approaches and identifying benefiting subpopulations. Investigating NMR metabolomics, the developed methodology allowed the prediction of future disease onset for many common diseases at once, indicating potential applicability as a drop-in replacement for commonly collected covariates. Extending the methodology to phenome-wide risk modeling, elec- tronic health records were found to be a general source of predictive information with high systemic relevance for thousands of endpoints. Assessing retinal fundus photographs, the developed methodology identified diseases where retinal information most impacted health trajectories. In summary, the results demonstrate the capability of neural survival models to integrate complex data modalities for multi-disease risk modeling in primary prevention and illustrate the tremendous potential of machine learning models to disrupt medical practice toward data-driven prevention at population scale.Die Kosten im Gesundheitswesen steigen systematisch und derzeitige therapieorientierte Gesundheitssysteme sind nicht nachhaltig. Angesichts vieler verhinderbarer Krankheiten stellt die Prävention ein veritables Instrument zur Verringerung von Kosten und Leiden dar. Risikostratifizierung ist die grundlegende Voraussetzung für ein präventionszentri- ertes Gesundheitswesen um Personen mit hohem Risiko zu identifizieren und Maßnah- men einzuleiten. Heute ist eine systematische Risikostratifizierung jedoch nur begrenzt möglich, da für die meisten Krankheiten keine Risikomodelle existieren und sich verfüg- bare Modelle auf einzelne Krankheiten beschränken. Weil für deren Berechnung jeweils spezielle Sets an Prädiktoren zu erheben sind werden in Praxis oft nur wenige Modelle angewandt. Gleichzeitig versprechen komplexe Datenmodalitäten, wie Bilder oder -omics- Messungen, systemische Informationen über zukünftige Gesundheitsverläufe, mit poten- tieller Relevanz für viele Endpunkte gleichzeitig. Da es an dedizierten Methoden zur Ex- traktion klinisch relevanter Informationen fehlt, sind diese Daten jedoch für die Risikomod- ellierung unzugänglich, und ihr Potenzial blieb bislang unbewertet. Diese Studie nutzt ma- chinelles Lernen, um die Anwendbarkeit von vier Datenmodalitäten in der Primärpräven- tion zu untersuchen: polygene Risikoscores für die kardiovaskuläre Prävention, NMR Meta- bolomicsdaten, elektronische Gesundheitsakten und Netzhautfundusfotos. Pro Datenmodal- ität wurde ein neuronales Risikomodell entwickelt, um relevante Informationen zu extra- hieren, additive Information gegenüber üblicherweise erfassten Kovariaten zu quantifizieren und den potenziellen klinischen Nutzen der Datenmodalität zu ermitteln. Die entwickelte Me-thodik konnte polygene Risikoscores für die kardiovaskuläre Prävention integrieren. Im Falle der NMR-Metabolomik erschloss die entwickelte Methodik wertvolle Informa- tionen über den zukünftigen Ausbruch von Krankheiten. Unter Einsatz einer phänomen- weiten Risikomodellierung erwiesen sich elektronische Gesundheitsakten als Quelle prädik- tiver Information mit hoher systemischer Relevanz. Bei der Analyse von Fundusfotografien der Netzhaut wurden Krankheiten identifiziert für deren Vorhersage Netzhautinformationen genutzt werden könnten. Zusammengefasst zeigten die Ergebnisse das Potential neuronaler Risikomodelle die medizinische Praxis in Richtung einer datengesteuerten, präventionsori- entierten Medizin zu verändern

    Summer/Fall 2023

    Get PDF

    Syndromic molecular testing in adults hospitalized for suspected community-acquired pneumonia

    Get PDF
    Den mikrobielle etiologien hos pasienter med samfunnservervet lungebetennelse (CAP) blir ofte ikke avklart på grunn av utilstrekkelige mikrobiologiske metoder og vanskeligheter med å skaffe prøver fra nedre luftveier. Rask påvisning av luftveismikrober kan potensielt redusere unødvendig bruk av empirisk antimikrobiell behandling og øke andelen pasienter som får mikrobiologistyrt behandling. Moderne syndrombaserte PCR-paneler muliggjør rask deteksjon av både virale- og bakterielle luftveismikrober. CAPNOR Feasibility studien undersøkte gjennomførbarheten av flere viktige ledd fra vår planlagte CAPNOR RCT (Paper I). Studien viste at det var mulig å skaffe nedre luftveisprøver fra CAP pasienter allerede i akuttmottaket. Ved bruk av et syndrombasert PCR-panel, fant vi betydelig flere luftveismikrober på kortere tid, sammenliknet med bruk av standard metoder, noe som indikerer at det er mulig å oppnå mikrobiologiske resultater allerede i akuttmottaket. Vår CAPNOR RCT fokuserer på andelen som mottar mikrobiologistyrt behandling og tiden det tar. Prøver fra nedre luftveier ble randomisert til testing med kun standardmetoder eller med tillegg av et syndrombasert PCR-panel (Paper II). COVID-19 pandemien traff Norge da vi skulle starte vår RCT, noe som resulterte i forsinket start av studien og behov for justeringer av protokollen. I denne unike situasjonen valgte vi å undersøke pandemiens potensielle implikasjoner på både antall sykehusinnleggelser og detekterte mikrober hos pasienter med mistenkt CAP, ved å sammenlikne pasienter inkludert før og etter utbruddet av COVID-19 (Paper III). Smitteverntiltak relatert til COVID-19 forverret utfordringene med prøvetakning fra nedre luftveier ytterligere. Dette bidro til en studie som viste at testing av halsprøver med et syndrombasert PCR-panel oppdaget de vanligste bakterielle luftveismikrober med høy positiv og negativ prosentvis overensstemmelse sammenlignet med testing av nedre luftveisprøver (Paper IV). Dette antyder at halsprøver analysert av et syndrombasert PCR-panel kan representere en alternativ metode for rask mikrobiologisk testing i akuttmottaket. Oppsummert har våre studier demonstrert at det er mulig å oppnå omfattende mikrobiologiske resultater hos en stor andel CAP pasienter få timer etter innleggelse. Fremtidige studier av syndrombaserte PCR-paneler bør fokusere videre på kliniske endepunkter, kostnadseffektivitet og utvikling av implementeringsstrategier for innføring i klinisk praksis.The microbial etiology of patients with community-acquired pneumonia (CAP) is often not established due to insufficient methods for microbial detection and difficulties in obtaining lower respiratory tract (LRT) samples. Early microbial detections could potentially reduce unnecessary empirical antimicrobial treatment and improve the proportion of patients receiving pathogen-directed treatment. Recently introduced syndromic PCR-based panels enable rapid detection of both viral- and bacterial pathogens. The CAPNOR Feasibility study (Paper I) was initiated with a view to informing the design of a planned RCT and demonstrated that obtaining LRT samples from CAP patients in the emergency department (ED) was feasible. The microbial yield and time to results improved significantly by using a syndromic PCR-based panel compared to standard methods, indicating that it is possible to obtain microbiological results already in the ED. In the CAPNOR RCT, LRT samples were randomized to testing by either standard methods alone or with the addition of syndromic PCR-based testing, focusing on the time to, and provision of pathogen-directed treatment in CAP patients (Paper II). When we were about to initiate the CAPNOR RCT, Norway faced the COVID-19 pandemic, resulting in a delayed start, with mandatory adjustments needed in the protocol. Faced with this unprecedented situation, we evaluated the pandemic’s potential implications on both hospital admissions and microbial detections in patients with suspected CAP, i.e., before and after the outbreak of COVID-19 and the subsequent strict infection control measures (Paper III). Moreover, the COVID-19-related infection control measures further hampered the difficulties of LRT sampling. This fostered a study where we demonstrated that syndromic PCR-based testing of oropharyngeal (OP) swabs could detect the most common bacterial CAP pathogens with high positive and negative percent agreement compared with testing of LRT samples (Paper IV). These findings suggest that OP swabs analyzed by a syndromic panel could represent an alternative approach for rapid microbiological testing in the ED. In conclusion, our studies have demonstrated an ability to provide close to real-time microbiological results for CAP patients. Future studies should focus on the impact of rapid syndromic testing in terms of clinical outcomes, cost-effectiveness, and the development of implementation strategies to facilitate integration into clinical practice.Doktorgradsavhandlin

    Modern meat: the next generation of meat from cells

    Get PDF
    Modern Meat is the first textbook on cultivated meat, with contributions from over 100 experts within the cultivated meat community. The Sections of Modern Meat comprise 5 broad categories of cultivated meat: Context, Impact, Science, Society, and World. The 19 chapters of Modern Meat, spread across these 5 sections, provide detailed entries on cultivated meat. They extensively tour a range of topics including the impact of cultivated meat on humans and animals, the bioprocess of cultivated meat production, how cultivated meat may become a food option in Space and on Mars, and how cultivated meat may impact the economy, culture, and tradition of Asia

    Assessment and reporting of adverse drug reactions to iopromide: a study of risk perception and pharmacovigilance

    Get PDF
    Tesis por compendio de publicaciones[EN]To achieve the thesis goals, two original articles were performed, the first to evaluate patients’ awareness of ADR risks and the Portuguese Pharmacovigilance System and the second to provide a retrospective analysis of ADR to iopromide in a Portuguese private unit of radiology. In addition, to reinforce the background of the thesis, two review articles were incorporated: a narrative review of the safety assessment of iopromide focusing on adverse events and a scoping review of all-round approaches to increase adverse drug reaction reporting. [ES]Para lograr los objetivos de la tesis, organizada en compendio de artículos, se realizaron dos artículos originales, uno para evaluar el conocimiento de los pacientes sobre los riesgos de RAM y el Sistema de Farmacovigilancia de Portugal y otro para proporcionar un análisis retrospectivo de RAM a iopromida en una unidad privada de radiología portuguesa. Además, para reforzar los antecedentes de la tesis, se agregaron dos artículos de revisión, uno que utiliza una revisión narrativa de la evaluación de la seguridad de la iopromida que se centra en los eventos adversos y una revisión de alcance de enfoques integrales para aumentar la notificación de reacciones adversas a medicamentos
    corecore