Weakness of lower limb muscle in symptomatic peripheral artery disease with media sclerosis detected by ultrasound shear wave elastography

<jats:p> Zusammenfassung. Der in der TEDS-M-Studie (Teacher Education and Development Study: Learning to Teach Mathematics) entwickelte Test zur Erfassung pädagogischen Wissens am Ende der Lehramtsausbildung hat sich in diversen Untersuchungen als zuverlässiges Messinstrument erwiesen, für das eine Reihe von Ergebnissen vorliegt, die die Validität der Testwertinterpretationen bei (angehenden) Lehrkräften in unterschiedlichen Ausbildungsstadien und –kontexten unterstreichen. Ein wesentlicher Validierungsschritt steht jedoch noch aus: Die Überprüfung, ob sich der Test eignet, um quantitative und qualitative Aussagen zum pädagogischen Wissen von berufstätigen Mathematiklehrkräften zu treffen. Im Rahmen des Projekts TEDS-Validierung wurde an 113 Mathematiklehrkräften geprüft, ob der Test das Wissen der Lehrkräfte reliabel und differenziert erfasst. Darauf aufbauend wurde im Sinne der Konstruktrepräsentation ( Embretson, 1983 ) untersucht, ob er konstruktrelevante, kognitive Bearbeitungsprozesse erfordert, wie sie von König (2009) und Klemenz und König (2019) modelliert wurden. Die Analysen bestätigen, dass der Test auch bei berufstätigen Mathematiklehrkräften ein reliables Messinstrument darstellt und unterstreichen, dass die kognitive Komplexität der erforderlichen Bearbeitungsprozesse einen bedeutsamen Anteil der Schwierigkeitsvarianz aufklärt. Sie liefern somit einen ersten Hinweis für die Konstruktrepräsentation und die Grundlage für eine qualitative Interpretation der Testwerte. Diese Interpretation wird durch Varianzanalysen validiert, die zeigen, dass Personen, die kognitiv komplexere Bearbeitungsprozesse im pädagogischen Wissenstest vollziehen können, auch ausgeprägtere situationsspezifische, pädagogische Fähigkeiten aufweisen als Vergleichspersonen. </jats:p&gt

Association of BMI, lipid-lowering medication, and age with prevalence of type 2 diabetes in adults with heterozygous familial hypercholesterolaemia: a worldwide cross-sectional study

Background: Statins are the cornerstone treatment for patients with heterozygous familial hypercholesterolaemia but research suggests it could increase the risk of type 2 diabetes in the general population. A low prevalence of type 2 diabetes was reported in some familial hypercholesterolaemia cohorts, raising the question of whether these patients are protected against type 2 diabetes. Obesity is a well known risk factor for the development of type 2 diabetes. We aimed to investigate the associations of known key determinants of type 2 diabetes with its prevalence in people with heterozygous familial hypercholesterolaemia. Methods: This worldwide cross-sectional study used individual-level data from the EAS FHSC registry and included adults older than 18 years with a clinical or genetic diagnosis of heterozygous familial hypercholesterolaemia who had data available on age, BMI, and diabetes status. Those with known or suspected homozygous familial hypercholesterolaemia and type 1 diabetes were excluded. The main outcome was prevalence of type 2 diabetes overall and by WHO region, and in relation to obesity (BMI ≥30·0 kg/m2) and lipid-lowering medication as predictors. The study population was divided into 12 risk categories based on age (tertiles), obesity, and receiving statins, and the risk of type 2 diabetes was investigated using logistic regression. Findings: Among 46 683 adults with individual-level data in the FHSC registry, 24 784 with heterozygous familial hypercholesterolaemia were included in the analysis from 44 countries. 19 818 (80%) had a genetically confirmed diagnosis of heterozygous familial hypercholesterolaemia. Type 2 diabetes prevalence in the total population was 5·7% (1415 of 24 784), with 4·1% (817 of 19 818) in the genetically diagnosed cohort. Higher prevalence of type 2 diabetes was observed in the Eastern Mediterranean (58 [29·9%] of 194), South-East Asia and Western Pacific (214 [12·0%] of 1785), and the Americas (166 [8·5%] of 1955) than in Europe (excluding the Netherlands; 527 [8·0%] of 6579). Advancing age, a higher BMI category (obesity and overweight), and use of lipid-lowering medication were associated with a higher risk of type 2 diabetes, independent of sex and LDL cholesterol. Among the 12 risk categories, the probability of developing type 2 diabetes was higher in people in the highest risk category (aged 55-98 years, with obesity, and receiving statins; OR 74·42 [95% CI 47·04-117·73]) than in those in the lowest risk category (aged 18-38 years, without obesity, and not receiving statins). Those who did not have obesity, even if they were in the upper age tertile and receiving statins, had lower risk of type 2 diabetes (OR 24·42 [15·57-38·31]). The corresponding results in the genetically diagnosed cohort were OR 65·04 (40·67-104·02) for those with obesity in the highest risk category and OR 20·07 (12·73-31·65) for those without obesity. Interpretation: Adults with heterozygous familial hypercholesterolaemia in most WHO regions have a higher type 2 diabetes prevalence than in Europe. Obesity markedly increases the risk of diabetes associated with age and use of statins in these patients. Our results suggest that heterozygous familial hypercholesterolaemia does not protect against type 2 diabetes, hence managing obesity is essential to reduce type 2 diabetes in this patient population. Funding: Pfizer, Amgen, MSD, Sanofi-Aventis, Daiichi-Sankyo, and Regeneron