The impact of information on patient preferences in different delivery patterns : a contingent valuation study of prescription versus OTC drugs

Our analysis assessed the impact of information on patients' preferences in prescription vs over-the-counter (OTC) delivery systems. A contingent valuation (CV) study was implemented, randomly assigning 1594 people into the receipt of limited or extended information concerning new influenza drugs. In each information arm, people answered two questions: the first asked about willingness to pay (WTP) for the new prescription drug; the second asked about WTP for the same drug sold OTC. We show that WTP is higher for the OTC scenario and that the level of information plays a significant role in the valuation of the OTC scenario, with more information increasing the WTP. In contrast, the level of information has no impact on WTP for prescription medicine. Thus, for the kind of drug (i.e. safe, not requiring medical supervision) considered here, a switch to OTC status can be expected to be all the more beneficial as the patient is provided with more information concerning the capability of the drug. Conclusions: Our results shed some light on one of the most challenging issues that health policy makers are currently faced with, namely the threat of a bird flu pandemic. Drug delivery is a critical component of pandemic influenza preparedness. Furthermore, the congruence of our results with the agency and demand theories provides an important test of the validity of using WTP based on CV methods.WTP, CV, OTC versus prescription, neuraminidase inhibitors, interval-censored regression

Eliciting educated preferences of health care professionals : cost-effectiveness and cost-benefit analysis of Amphotericine B

[Contents] 1. Introduction. 2. Cost-effectiveness analysis. 3. Results. 4. Conculusion of the cost-effectiveness analysis. 6. Cost benefit analysis. 7. The contingent valuation method or "willingness to pay" (WTP). 8. Pilot study to elicit educated preferences from health care professionals for high cost antifungal drugs. 9. Results. 10. Conclusion. At the University Hospital (CHUV), global budget put a major constraint on all departments and services. In this context, it happened that the division of infectious diseases experienced for several years important deficits in their drug budget, due to the use of systemic antifungal drugs. A cost-effectiveness analysis has been performed, in order to establish a valid policy about the use of available antifungal drugs. During the cost-effectiveness evaluation, the discussions with the medical and nursing team showed that they had clear drug preferences. Therefore, the author was interested in investigating the problem of drug preferences and their impact on drug choices. In a pilot study , he used the willingness to pay (WTP) method to show the possibilities and limits of this method as a tool for evaluating educated preferences of health care professionals. This study, will, after an introductory part, present both the cost-effectiveness analysis and the cost-benefit analysis, which was based on the results of the previous study

Milk as an essential source of iodine in Latvian population

Publisher Copyright: © 2017 De Gruyter Open Ltd. All rights reserved. Copyright: Copyright 2018 Elsevier B.V., All rights reserved.Milk and dairy products are studied as alternative iodine sources, because salt iodisation is controversial due to high salt consumption leading to cardiovascular diseases. However, the iodine concentration in milk markedly varies. This study evaluated the iodine concentration in cow's milk available in the Latvian market. Iodine and fat concentration was analysed with a spectrophotometer "Varian Cary 50" based ISO 2446:2008 in 20 milk samples. Data from the Central Statistical Bureau and survey among pregnant women were used to analyse milk product consumption and its impact on iodine status. Average iodine concentration in milk samples was 457.6 (179.6) μg/L, winter samples had a higher concentration of iodine than summer samples: 563.4 (329.6) μg/L and 469.2 (162.0) μg/L, but this is not statistically significant p < 0.05. Iodine concentration in skimmed milk was 490 μg/L, milk with the reduced fat content 501.7 (174.8) μg/L, and whole milk - 422.6 (192.1)1 μg/L. Milk consumption decreased from 2002 to 2014, while yogurt and cheese consumption increased. Higher consumption of milk and milk products was related to higher urinary iodine concentration ρ = 0.115; p = 0.003. Milk and milk products are an important iodine source in Latvia and their consumption should be promoted.publishersversionPeer reviewe

Heterogeneity of tissue IL-17 and tight junction proteins expression demonstrated in patients with autoimmune thyroid diseases

Funding Information: Funding/support: This study was supported in part by the Latvian National Research Program “BIOMEDICINE” No. 5.2.4. For the statistical analyses, the authors were assisted by the Department of Public Health and Epidemiology at Riga Stradins University. Publisher Copyright: Copyright © 2018 the Author(s). Published by Wolters Kluwer Health, Inc.Th17 cells together with their hallmark cytokine interleukin (IL)-17 were identified as crucial contributing factors in the pathogenesis of thyroid autoimmunity. The cytokine-regulated tight junction (Tj) disruption is thought to be essential in the initiation and/or development of several diseases. Still, the role of IL-17 maintaining Tj integrity in autoimmune thyroid diseases (AITDs) has not yet been evaluated. We aimed to investigate integrity of the thyroid follicle by studying immunoexpression of cellular Tj - zonula occludens (ZO)-1 and claudin-1 proteins coupled to IL-17A and CD68 detection in AITD patients compared with controls. Thirty-five adult patients undergoing thyroidectomy and presenting 18 cases of Hashimoto thyroiditis (HT), 7 of Graves' disease (GD) as well as 10 subjects of colloid goiter without autoimmune component served as controls were enrolled in this study. An immunohistochemical analysis including IL-17A, ZO-1, claudin-1, and CD68 detection was performed in each case. The correlation of IL-17A with Tj and CD68 in patients with AITD was also analyzed. Apart from inflammatory cells, we evidenced a stronger expression level of IL17A in the thyroid follicular cells in HT patients when compared with GD or colloid goiter. A significant reduction of ZO-1 immunoreactivity was observed in the thyrocytes in HT patients, whereas no significant differences were found in claudin-1 expression in HT and GD compared with colloid goiter patients. A significantly higher number of thyroid follicles with CD68-positive cells was found in HT patients than that in patients with GD or colloid goiter. In HT patients, the expression of IL-17A in the follicular cells was positively correlated with CD68 immunopositivity, whereas no association with claudin-1 or ZO-1 expression was found. GD patients did not reveal any significant correlation of IL-17A with Tj and CD68. Strong overexpression of IL-17A observed in the thyroid epithelial cells is associated with the presence of intrafollicular CD68-positive cells in HT patients. We evidenced the changes in molecules of thyrocyte junctional complexes highlighting impairment of the thyroid follicle integrity in HT, but no association with IL-17A was found.publishersversionPeer reviewe

Immunological mechanisms of autoimmune thyroid diseases : A shift in the traditional TH1/TH2 paradigm

Funding Information: This work was supported by the Latvian Council of Science project No. lzp-2018/2-0059. Publisher Copyright: © 2019 Tatjana Zaķe et al., published by Sciendo 2019.Autoimmune thyroid diseases (AITD) mainly include Hashimoto's thyroiditis (HT) and Graves' disease (GD), which are characterised by the presence of circulating antibodies against various thyroid autoantigens and infiltration of the thyroid gland by autoreactive lymphocytes. Despite the significant advancement in the knowledge of AITD pathogenesis in the last decade, the specific immunological mechanisms responsible for development of the disease are not thoroughly understood. Classically, HT has long been considered as a T helper (Th)1-mediated disease, while a Th2-driven autoimmune response is dominant for GD development. However, this classification has changed due to the description of Th17 lymphocytes, which suggested participation of these cells in AITD, particularly HT pathogenesis. Moreover, a shift in the balance between Th17 and T regulatory (Treg) cells has been observed in thyroid autoimmunity. We have observed overexpression of IL-17, the prominent effector cytokine of Th17, within thyroid tissues from HT and GD patients in our studies. The present review will focus on recent data regarding the role of Treg and Th17 lymphocytes in AITD pathogenesis. In addition, the impact and proposed mechanisms of the predominant environmental factors triggering the autoimmune response to the thyroid will be discussed.publishersversionPeer reviewe

Investigation of extruded cereals enriched with plant by-products and their use in fermented beverage production

ArticleThe aim of the study was to analyse the quality of extruded cereals enriched with plant by-products and to obtain fermented drinks from production rejects. Extrusion was performed with co-rotating twin-screw extruder (compression ratio 8:1) at MILZU Ltd. from rye and oat flour (80:20, control samples) with addition of apple (ABF), carrot (CBF) and pumpkin (PBF) by-product flour in various amounts (10%, 15% and 20%). Naturally fermented kvass production process was used for non-alcoholic fermented beverage production. Total dietary fibre (TDF), textural properties and sensory features of extruded products after addition of by-products (BP) were determined. Dry matter, active acidity and sensory properties were analysed in fermented beverages. The obtained results showed a 12-55% increase in TDF of extruded cereals (11.8 g 100 g -1 ) after addition of plant by-products. All extruded samples with BP showed lower hardness levels than control (35.55 ± 2.95 N); samples with PBF were the least hard (P < 0.05). Samples with the lowest bulk density were obtained by the addition of 10% and 15% PBF, and 15% CBF, whereas addition of apple by-product flour in all tested concentrations gave the samples a higher bulk density compared to control. Highest taste and aftertaste scores using 5-point hedonic scale were given to samples with addition of 15% and 20% ABF, which also showed high consumer acceptance. With regards to fermented drinks, the highest dry matter content was found in PBF and ABF drink, 8.1 ± 0.1 and 7.0 ± 0.1, respectively. Sensory evaluation of fermented beverages showed that the intensity of flavour, acidity and aroma was most pronounced in sample with ABF, whereas colour was most pronounced in sample with PBF. In order to reduce production costs, it is possible to use production rejects of extruded cereals enriched with plant by-products to obtain new products

Fasting-Mimicking Diet Reduces Trimethylamine N-Oxide Levels and Improves Serum Biochemical Parameters in Healthy Volunteers

Funding Information: Funding: This study was performed within the Latvian Council of Science project “Trimethylamine-N-oxide as a link between unhealthy diet and cardiometabolic risks” No. Izp-2018/1-0081, supervised by M.D.; and M.V. received funding from the European Social Fund and the state budget within the project No. 8.2.2.0/20/I/004 “Support for involving doctoral students in scientific research and studies”. Publisher Copyright: © 2022 by the authors.Elevated plasma levels of trimethylamine N-oxide (TMAO) have been proposed as a diet-derived biomarker of cardiometabolic disease risk. Caloric restriction is the most common dietary intervention used to improve cardiometabolic health; however, novel trends suggest a fasting-mimicking diet (FMD) as a more feasible alternative. FMD is a variation of intermittent fasting, based on caloric restriction and limitation of protein sources of animal origin, applied in daily cycles during a 5-day period. As TMAO is intensively produced by gut microbiota after the consumption of animal-derived products, we aim to investigate whether a 5-day FMD affects plasma TMAO levels and markers of metabolic health. To investigate whether an increase in vegetable intake possesses similar effects on TMAO levels and metabolic parameters, healthy volunteers (n = 24) were subjected to a 5-day FMD and 19 volunteers served as a reference group (VEG). This group of volunteers consumed an additional four servings of vegetables per day, but otherwise stayed on their usual diet. FMD resulted in a twofold decrease in plasma TMAO levels, which was not evident in the volunteers from the VEG group. Moreover, FMD led to a weight loss of 2.8 ± 0.2 kg and a subsequent reduction in BMI compared to baseline. The FMD group exhibited a significant elevation in plasma ketone bodies (14-fold compared to baseline) and a decrease in IGF-1 levels by 37 ± 8 ng/mL. Since fasting glucose and C-peptide levels decreased, all volunteers in the FMD group showed improved insulin sensitivity and a decreased HOMA-IR index. In contrast, in the VEG group, only a slight reduction in plasma levels of fasting glucose and triglycerides was noted. In conclusion, we show that FMD is a viable strategy to reduce plasma levels of TMAO by limiting caloric intake and animal-derived protein consumption. The reduction in the level of TMAO could be an additional benefit of FMD, leading to a reduced risk of cardiometabolic diseases.publishersversionPeer reviewe

Melatonin concentrations and sleep quality in patients with type 2 diabetes and obesity

Funding Information: The publication was supported in part by grant No. 2014.10-4/VPP-1.1.2 and -5.1.2 in the framework of the Latvian National Programme. Publisher Copyright: © 2019 Ieva Kalere et al., published by Sciendo 2019.There is a close relationship between melatonin as a circadian regulator and insulin, glucagon and somatostatin production. This study aimed to describe subgroups of type 2 diabetes mellitus (T2DM) patients that may benefit from melatonin clock-targeting properties. The study involved 38 participants: 26 T2DM patients, and 12 participants without diabetes in the control group. Subjects were asked to complete the questionnaire of Pittsburgh Sleep Quality Index (PSQI). Standard biochemical venous sample testing was performed, and a sample of saliva was collected for melatonin testing. Melatonin concentration in participants without obesity (body mass index (BMI) < 30 kg/m 2 ) was significantly higher than in obese participants: 13.2 (6.4; 23.50) pg/ml vs 5.9 (0.78; 13.1) pg/ml, p = 0.035. Subjects with BMI 30 kg/m 2 had a significantly higher PSQI score than non-obese subjects: 7 (4.5; 10) vs 5.5 (3; 7), p = 0.043. T2DM patients showed significantly lower levels of melatonin than the control group: 6.1 (0.78; 12.2) pg/ml vs 17.8 (8.2; 25.5) pg/ml, p = 0.003. T2DM patients using short-acting insulin analogues showed a significantly higher PSQI score than patients not using insulin: 9 (6; 10) vs 6 (3; 8), respectively (p = 0.025). Poor sleep quality was more prevalent in patients with diabetic retinopathy than in those without this complication (p = 0.031). Lower melatonin levels were detected in T2DM and obese patients. Furthermore, poor sleep quality was observed in T2DM patients using short-acting insulin analogues and those with diabetic retinopathy, and obese individuals.publishersversionPeer reviewe

Consumption of thyroid medications as an indicator of increase of thyroid morbidity in Latvia from 2011 to 2014

Funding Information: EU Horizon 2020 research and innovation programme under grant agreement No 634453; project EUthyroid. The authors thank the EUthyroid project leader Henry Völzke and the work package leader Betina H. Thuesen for designing, planning and managing the project and, in particular, morbidity data collection. Publisher Copyright: © 2019 Ieva Kalere et al., published by Sciendo 2019.The most common autoimmune disorders with clinically opposite manifestations are hypothyroidism in Hashimoto's thyroiditis and hyperthyroidism in Graves' disease. The healthcare burden of thyroid disease is substantial, resulting in substantial health care costs. The aim of the present analysis is to assess the use of thyroid medications in Latvia from 2011 to 2014 by age and gender. Our study used reimbursed medication prescriptions data, collected by the National Health Service of Latvia. The main indicator was the number of prevalent users of thyroid medications each year from 2011 to 2014, stratified by age and gender. From 2011 to 2014, the number of thyroxine users per 100 000 revealed a statistically significant increase in all age and gender groups, except in 0- to 9-year-old girls. The number of Thiamazole users among men increased in the age group from 40 to 89 years and in women age groups above 49 years. Increasing sales of both thyroid hormones and antithyroid medications are also observed in Estonia and Lithuania, indicating that growing thyroid morbidity is an issue in the whole region. The substantial increase in number of patients highlights the necessity for national guidelines on the use of thyroid function tests and standards of medical care.publishersversionPeer reviewe