The management of acute venous thromboembolism in clinical practice. Results from the European PREFER in VTE Registry

Venous thromboembolism (VTE) is a significant cause of morbidity and mortality in Europe. Data from real-world registries are necessary, as clinical trials do not represent the full spectrum of VTE patients seen in clinical practice. We aimed to document the epidemiology, management and outcomes of VTE using data from a large, observational database. PREFER in VTE was an international, non-interventional disease registry conducted between January 2013 and July 2015 in primary and secondary care across seven European countries. Consecutive patients with acute VTE were documented and followed up over 12 months. PREFER in VTE included 3,455 patients with a mean age of 60.8 ± 17.0 years. Overall, 53.0 % were male. The majority of patients were assessed in the hospital setting as inpatients or outpatients (78.5 %). The diagnosis was deep-vein thrombosis (DVT) in 59.5 % and pulmonary embolism (PE) in 40.5 %. The most common comorbidities were the various types of cardiovascular disease (excluding hypertension; 45.5 %), hypertension (42.3 %) and dyslipidaemia (21.1 %). Following the index VTE, a large proportion of patients received initial therapy with heparin (73.2 %), almost half received a vitamin K antagonist (48.7 %) and nearly a quarter received a DOAC (24.5 %). Almost a quarter of all presentations were for recurrent VTE, with >80 % of previous episodes having occurred more than 12 months prior to baseline. In conclusion, PREFER in VTE has provided contemporary insights into VTE patients and their real-world management, including their baseline characteristics, risk factors, disease history, symptoms and signs, initial therapy and outcomes

L'influence de la régulation sur la contribution de la microfinance au développement: le cas de la Bolivie

International audienc

L'INFLUENCE DE LA RÉGULATION SUR LA CONTRIBUTION DE LA MICROFINANCE AU DÉVELOPPEMENT : LE CAS DE LA BOLIVIE

Bolivia, a microfinance pioneer, is also among the first countries that started regulating this activity. Firmly supported by international institutions, the country?s regulatory framework was designed to promote a commercial vision of the sector, encouraging growth and sustainability. The rules put into place standardized practices and gave priority to profitability and stability. Nevertheless, they hampered microfinance service providers from meeting the social mission they had initially set themselves. Given these shortcomings, the government introduced new public policies to put pressure on providers to intervene more in rural and productive sectors. To overcome these contradictory constraints, some actors put forward norms that combine social and financial criteria. In the current context, such evolutions can contribute to thought/discussions on how to improve financial regulation.Bolivia, microfinance, development, regulation, norms

Group dynamics, gender and microfinance in Bolivia

This paper examines the wider impacts, or externalities, of microfinance in Bolivia, an environment in which the loss of confidence in the formal banking system and the proactive role of the Superintendencia de Bancos in converting NGOs into deposit-taking institutions have been positive factors. Our focus is on the group-lending technology of ProMujer, which practises a 'credit plus' technology in which training, health and advisory services for women only are linked with lending (and savings services through FIE). There is some preliminary evidence that such groups have achieved the externality of stimulating collective public action outside of the immediate microfinance context (for example by lobbying for better public services or changes in policy); such growth seems to happen most readily where the group has collective experience of adversity, and|or where intragroup equality is high. They also have exemplary repayment rates, which-unlike those of most other microfinance institutions-did not fall off during the recent recession. This creates a second externality for the economy as a whole-a contribution to macro-economic stability. We hypothesise that the chain of causation goes from ProMujer's 'credit plus' ancillary services, to client loyalty to the institution, to high repayment rates, to ability to expand lending and investment. Copyright © 2004 John Wiley & Sons, Ltd.

The management of patients with venous thromboembolism in Italy: insights from the PREFER in VTE registry

Venous thromboembolism (VTE) is the third most common cardiovascular disease. Real-life data on the clinical presentation, risk factors, diagnosis, and treatment of VTE in Italy and Europe are required to optimize the management of this disease. The PREFER in VTE registry, a prospective non-interventional real-life study, was designed to assess clinical characteristics and management of patients with VTE, use of health care resources, and on-treatment patient quality of life. Eligible consecutive patients with objectively diagnosed VTE were enrolled in the registry and followed up for 12 months. Between January and December 2013, 816 Italian and 1027 patients from 6 European countries other than Italy (European patients) were enrolled in the registry, and followed up until December 2014. Italian patients were the oldest (mean age 65.7 years) among the European patients. The Italian patients with a history of cancer were 24.6 % of whom 63.2 % had an active cancer (18.2 and 57.0 %, respectively, in Europe). Parenteral heparin was given, as initial treatment, in 73.8 % of Italian patients (66.4 % in Europe); VKA in combination with other treatments in 45.8 % (34.7 % in Europe); and VKA as the only anticoagulant treatment in 24.4 % (17.2 % in Europe). Of the Italian patients, 43.2 and 90.6 % of patients were hospitalized for deep vein thrombosis and pulmonary embolism, respectively; 65.4 % were admitted to the hospital through the emergency department. Following a real world approach, PREFER in VTE shows that the Italian patients, among and compared to the European patients, are the oldest, have a history of cancer more commonly, receive an initial treatment with heparin more commonly, and are more commonly hospitalized, particularly if affected by PE