Val247Leu beta2-glycoprotein-I allelic variant is associated with antiphospholipid syndrome: Systematic review and meta-analysis

[EN] Previous studies have suggested that the possession of the Val/Val genotype of the Val247Leu polymorphism of the β2-glycoproteinI (β2-GPI) gene may be associated with antiphospholipid syndrome (APS), and, among patients with APS, with the production of anti-β2-GPI antibodies or the development of thrombosis. Given the controversial results reported, the aim of this work is to combine previous findings by means of a systematic review and a meta-analysis. Methods: We retrieved studies analyzing the genotype of the above-mentioned polymorphism among patients with APS by means of electronic database search. A meta-analysis was conducted in a random effects model and calculations of odds ratio (OR) and confidence intervals (CI) were done. Sensitivity analysis and tests for heterogeneity of the results were performed. Results: Eight previous studies analyzed the association of APS, anti-β2-GPI antibodies and/or thrombosis with the Val247Leu polymorphism. After meta-analysis, patients with APS had a significantly higher prevalence of the Val/ Val genotype of this genetic variant when compared with controls (OR=2.04; 95% CI: 1.12, 3.73; P=0.02). Among patients with APS, those with anti-β2-GPI antibodies had a higher prevalence of this genotype (OR=1.73; 95% CI: 1.04, 2.87; P=0.03). No significant results were found for the presence of arterial or venous thrombosis. Conclusions: Val/Val genotype of β2-GPI gene is associated with a significant excess risk to suffer from APS and, among patients with APS, to have anti-β2-GPI antibodies. No definite conclusions can be made regarding the association of this polymorphism with thrombosis among APS patients. © 2

Estudio del equilibrio y cinética de adsorción de Cd(II), Ni(II) y Cr(VI) usando Quitosano y Quitosano modificado con cobre

In this paper, the equilibrium and adsorption kinetics of Cr(VI), Cd(II) and Ni(II) onto Chitosan and Cu-chitosan was studied. Metal ion solutions at different initial concentration were put in contact with chitosan and Cu-chitosan and the mixture was agitated by 3 – 4 h. Afterwards, the samples were analyzed by atomic absorption spectroscopy. The experimental data of adsorption equilibrium were evaluated by application of Langmuir and Freundlich isotherms; while the kinetics experimental data were evaluated using kinetic models of pseudo-first order and pseudo-second order. The results showed that the metallic ions were effectively adsorbed by the chitosan (Cd and Ni) and Cu-chitosan (Cr). Besides, it was found that the experimental data of adsorption equilibrium of Cr(VI) and Ni(II) fit the Langmuir model, while the equilibrium adsorption data of Cd(II) were better fitted by Freundlich model. The maximum adsorption capacity of chromium (29.7 mg/g Cu-chitosan), cadmium (102.0 mg/g chitosan) and nickel (83.31 mg/g chitosan) was determined using the Langmuir model. The results of adsorption kinetics of the metallic ions showed that the experimental data were better adjusted by pseudo-second order model. Therefore, the rate-limiting step is the adsorption reaction and not mass transfer processes. DOI: http://dx.doi.org/10.5377/nexo.v26i2.1285 Nexo Revista Científica Vol. 26, No. 02, pp. 56-68/Diciembre 2013En este trabajo, se estudió el equilibrio y la cinética de adsorción de Cd(II), Ni(II) en quitosano y Cr(VI) en quitosano modificado con cobre. Para ello, soluciones de iones metálicos a diferentes concentraciones, fueron puestas en contacto con el adsorbente y se agitaron por un período de 3 – 4 h. Al final del proceso, las muestras fueron analizadas en un espectrómetro de absorción atómica. Los datos experimentales del equilibrio de adsorción de los iones metálicos fueron evaluados aplicando las isotermas de Langmuir y Freundlich; mientras los datos cinéticos fueron evaluados utilizando los modelos cinéticos de pseudo-primer orden y pseudo-segundo orden. Los resultados del  proceso demostraron que los iones fueron eficazmente adsorbidos por el quitosano (Cd y Ni) y por el Cu-quitosano (Cr). Además, se comprobó que los datos experimentales del equilibrio de adsorción de Cr(VI) y Ni(II) se ajustan al modelo de Langmuir; mientras que los datos experimentales del Cd(II) fueron mejor ajustados por el modelo de Freundlich. Mediante el uso de la isoterma de Langmuir se determinó la capacidad máxima de adsorción de cromo (29.7 mg/g Cu-quitosano), cadmio (102.0 mg/g quitosano) y níquel (83.31 mg/g quitosano). Los resultados de la cinética de adsorción de los iones metálicos mostraron que los datos experimentales fueron mejor ajustados por el modelo de pseudo-segundo orden; es decir, el paso limitante en la velocidad es la reacción de adsorción y no la transferencia de masa. DOI: http://dx.doi.org/10.5377/nexo.v26i2.1285 Nexo Revista Científica Vol. 26, No. 02, pp. 56-68/Diciembre 201

Comparing the effectiveness and cost-effectiveness of self-management interventions in four high-priority chronic conditions in Europe (COMPAR-EU): a research protocol

Introduction Population ageing and increasing chronic illness burden have sparked interest in innovative care models. While self-management interventions (SMIs) are drawing increasing attention, evidence of their efficacy is mostly based on pairwise meta-analysis, generally derived from randomised controlled trials comparing interventions versus a control or no intervention. As such, relevant efficacy data for comparisons among dif

GRADE Guidelines 30: the GRADE approach to assessing the certainty of modeled evidence—An overview in the context of health decision-making

Objectives: The objective of the study is to present the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) conceptual approach to the assessment of certainty of evidence from modeling studies (i.e., certainty associated with model outputs). / Study Design and Setting: Expert consultations and an international multidisciplinary workshop informed development of a conceptual approach to assessing the certainty of evidence from models within the context of systematic reviews, health technology assessments, and health care decisions. The discussions also clarified selected concepts and terminology used in the GRADE approach and by the modeling community. Feedback from experts in a broad range of modeling and health care disciplines addressed the content validity of the approach. / Results: Workshop participants agreed that the domains determining the certainty of evidence previously identified in the GRADE approach (risk of bias, indirectness, inconsistency, imprecision, reporting bias, magnitude of an effect, dose–response relation, and the direction of residual confounding) also apply when assessing the certainty of evidence from models. The assessment depends on the nature of model inputs and the model itself and on whether one is evaluating evidence from a single model or multiple models. We propose a framework for selecting the best available evidence from models: 1) developing de novo, a model specific to the situation of interest, 2) identifying an existing model, the outputs of which provide the highest certainty evidence for the situation of interest, either “off-the-shelf” or after adaptation, and 3) using outputs from multiple models. We also present a summary of preferred terminology to facilitate communication among modeling and health care disciplines. / Conclusion: This conceptual GRADE approach provides a framework for using evidence from models in health decision-making and the assessment of certainty of evidence from a model or models. The GRADE Working Group and the modeling community are currently developing the detailed methods and related guidance for assessing specific domains determining the certainty of evidence from models across health care–related disciplines (e.g., therapeutic decision-making, toxicology, environmental health, and health economics)

Monitoring and evaluation of breast cancer screening programmes : Selecting candidate performance indicators

In the scope of the European Commission Initiative on Breast Cancer (ECIBC) the Monitoring and Evaluation (M&E) subgroup was tasked to identify breast cancer screening programme (BCSP) performance indicators, including their acceptable and desirable levels, which are associated with breast cancer (BC) mortality. This paper documents the methodology used for the indicator selection. The indicators were identified through a multi-stage process. First, a scoping review was conducted to identify existing performance indicators. Second, building on existing frameworks for making well-informed health care choices, a specific conceptual framework was developed to guide the indicator selection. Third, two group exercises including a rating and ranking survey were conducted for indicator selection using pre-determined criteria, such as: relevance, measurability, accurateness, ethics and understandability. The selected indicators were mapped onto a BC screening pathway developed by the M&E subgroup to illustrate the steps of BC screening common to all EU countries. A total of 96 indicators were identified from an initial list of 1325 indicators. After removing redundant and irrelevant indicators and adding those missing, 39 candidate indicators underwent the rating and ranking exercise. Based on the results, the M&E subgroup selected 13 indicators: screening coverage, participation rate, recall rate, breast cancer detection rate, invasive breast cancer detection rate, cancers > 20 mm, cancers ≤10 mm, lymph node status, interval cancer rate, episode sensitivity, time interval between screening and first treatment, benign open surgical biopsy rate, and mastectomy rate. This systematic approach led to the identification of 13 BCSP candidate performance indicators to be further evaluated for their association with BC mortality

Eligibility criteria for Menopausal Hormone Therapy (MHT): a position statement from a consortium of scientific societies for the use of MHT in women with medical conditions. MHT Eligibility Criteria Group

This project aims to develop eligibility criteria for menopausal hormone therapy (MHT). The tool should be similar to those already established for contraception A consortium of scientific societies coordinated by the Spanish Menopause Society met to formulate recommendations for the use of MHT by women with medical conditions based on the best available evidence. The project was developed in two phases. As a first step, we conducted 14 systematic reviews and 32 metanalyses on the safety of MHT (in nine areas: age, time of menopause onset, treatment duration, women with thrombotic risk, women with a personal history of cardiovascular disease, women with metabolic syndrome, women with gastrointestinal diseases, survivors of breast cancer or of other cancers, and women who smoke) and on the most relevant pharmacological interactions with MHT. These systematic reviews and metanalyses helped inform a structured process in which a panel of experts defined the eligibility criteria according to a specific framework, which facilitated the discussion and development process. To unify the proposal, the following eligibility criteria have been defined in accordance with the WHO international nomenclature for the different alternatives for MHT (category 1, no restriction on the use of MHT; category 2, the benefits outweigh the risks; category 3, the risks generally outweigh the benefits; category 4, MHT should not be used). Quality was classified as high, moderate, low or very low, based on several factors (including risk of bias, inaccuracy, inconsistency, lack of directionality and publication bias). When no direct evidence was identified, but plausibility, clinical experience or indirect evidence were available, "Expert opinion" was categorized. For the first time, a set of eligibility criteria, based on clinical evidence and developed according to the most rigorous methodological tools, has been defined. This will provide health professionals with a powerful decision-making tool that can be used to manage menopausal symptoms

GRADE Guidelines 30: The GRADE Approach to Assessing the Certainty of Modelled Evidence - an Overview in the Context of Health Decision-making.

OBJECTIVES: To present the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) conceptual approach to the assessment of certainty of evidence from modelling studies (i.e. certainty associated with model outputs). STUDY DESIGN AND SETTING: Expert consultations and, an international multi-disciplinary workshop informed development of a conceptual approach to assessing the certainty of evidence from models within the context of systematic reviews, health technology assessments, and health care decisions. The discussions also clarified selected concepts and terminology used in the GRADE approach and by the modelling community. Feedback from experts in a broad range of modelling and health care disciplines addressed the content validity of the approach. RESULTS: Workshop participants agreed, that the domains determining the certainty of evidence previously identified in the GRADE approach (risk of bias, indirectness, inconsistency, imprecision, reporting bias, magnitude of an effect, dose-response relation, and the direction of residual confounding) also apply when of assessing the certainty of evidence from models. The assessment depends on the nature of model inputs and the model itself and on whether one is evaluating evidence from a single model or multiple models. We propose a framework for selecting the best available evidence from models: 1) developing de novo a model specific to the situation of interest, 2) identifying an existing model the outputs of which provide the highest certainty evidence for the situation of interest, either "off the shelf" or after adaptation, and 3) using outputs from multiple models. We also present a summary of preferred terminology to facilitate communication among modelling and health care disciplines. CONCLUSIONS: This conceptual GRADE approach provides a framework for using evidence from models in health decision making and the assessment of certainty of evidence from a model or models. The GRADE Working Group and the modelling community are currently developing the detailed methods and related guidance for assessing specific domains determining the certainty of evidence from models across health care-related disciplines (e.g. therapeutic decision-making, toxicology, environmental health, health economics)