| 1. |
- Sumnik, Z., et al.
(författare)
-
Persistent heterogeneity in diabetes technology reimbursement for children with type 1 diabetes: The SWEET perspective
- 2019
-
Ingår i: Pediatric Diabetes. - : Hindawi Limited. - 1399-543X .- 1399-5448. ; 20:4, s. 434-443
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Frequent use of modern diabetes technologies increases the chance for optimal type 1 diabetes (T1D) control. Limited reimbursement influences the access of patients with T1D to these modalities and could worsen their prognosis. We aimed to describe the situation of reimbursement for insulins, glucometers, insulin pumps (CSII) and continuous glucose monitoring (CGM) for children with T1D in European countries participating in the SWEET Project and to compare data from EU countries with data from our previous study in 2009. Methods: The study was conducted between March 2017 and August 2017. First, we approached diabetes technology companies with a survey to map the reimbursement of insulins and diabetic devices. The data collected from these companies were then validated by members of the SWEET consortium. Results: We collected data from 29 European countries, whereas all types of insulins are mostly fully covered, heterogeneity was observed regarding the reimbursement of strips for glucometers (from 90 strips/month to no limit). CSII is readily available in 20 of 29 countries. Seven countries reported significant quota issues or obstacles for CSII prescription, and two countries had no CSII reimbursement. CGM is at least partially reimbursed in 17 of 29 countries. The comparison with the 2009 study showed an increasing availability of CSII and CGM across the EU. Conclusions: Although innovative diabetes technology is available, a large proportion of children with T1D still do not benefit from it due to its limited reimbursement. © 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
|
|
| 2. |
|
|
| 3. |
|
|
| 4. |
- Engström, Gunnar, et al.
(författare)
-
C-reactive protein, metabolic syndrome and incidence of severe hip and knee osteoarthritis. A population-based cohort study.
- 2009
-
Ingår i: Osteoarthritis and Cartilage. - : Elsevier BV. - 1063-4584. ; Aug 28, s. 168-173
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To explore the relationships between C-reactive protein (CRP), metabolic syndrome (MetS) and incidence of severe knee or hip osteoarthritis (OA) in a prospective study. METHODS: A population-based cohort (n=5171, mean age 57.5+/-5.9 years) was examined between 1991 and 1994. Data was collected on lifestyle habits, measures of overweight, blood pressure as well as high-density lipoprotein (HDL) cholesterol, triglycerides, glucose and CRP measured with high-sensitive methods. Incidence of severe OA, defined as arthroplasty due to knee or hip OA, was monitored over 12 years of follow-up, in relation to CRP levels and presence of the MetS according to the adult treatment panel III-national cholesterol education program (ATPIII-NCEP) definition. RESULTS: A total of 120 participants had severe hip OA and 89 had knee OA during the follow-up. After adjustment for age, sex, smoking, physical activity and CRP, presence of MetS was associated with significantly increased risk of knee OA (relative risk [RR]: 2.1, 95% confidence interval [CI]: 1.3-3.3). However, this relationship was attenuated and non-significant after adjustment for body mass index (BMI) (RR: 1.1, 95% CI: 0.7-1.8). MetS was not significantly associated with incidence of hip OA. In women, CRP was associated with knee OA in the age-adjusted analysis. However, there was no significant relationship between CRP and incidence of knee or hip OA after risk factor adjustments. CONCLUSION: The increased incidence of knee OA in participants with the MetS was largely explained by increased BMI. CRP was not associated with incidence of knee or hip OA when possible confounding factors were taken into account.
|
|
| 5. |
|
|
| 6. |
- Gerhardsson, P., et al.
(författare)
-
The SWEET Project 10-Year Benchmarking in 19 Countries Worldwide Is Associated with Improved HbA1c and Increased Use of Diabetes Technology in Youth with Type 1 Diabetes
- 2021
-
Ingår i: Diabetes Technology & Therapeutics. - : Mary Ann Liebert Inc. - 1520-9156 .- 1557-8593. ; 23:7
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: The international SWEET registry (NCT04427189) was initiated in 2008 to improve outcomes in pediatric diabetes. A 10-year follow-up allowed studying time trends of key quality indicators in 22 centers from Europe, Australia, Canada, and India in youth with type 1 diabetes (T1D). Methods: Aggregated data per person with T1D <25 years of age were compared between 2008-2010 and 2016-2018. Hierarchic linear and logistic regression models were applied. Models were adjusted for gender, age-, and diabetes duration groups. Results: The first and second time periods included 4930 versus 13,654 persons, 51% versus 52% male, median age 11.3 [Q1; Q3: 7.9; 14.5] versus 13.3 [9.7; 16.4] years, and T1D duration 2.9 [0.8; 6.4] versus 4.2 [1.4; 7.7] years. The adjusted hemoglobin A1C (HbA1c) improved from 68 (95% confidence interval [CI]: 66-70) to 63 (60; 65) mmol/mol (P<0.0001) or 8.4 (95% CI: 8.2-8.6) to 7.9 (7.6; 8.1) % (P<0.0001). Across all age groups, HbA1c was significantly lower in pump and sensor users. Severe hypoglycemia declined from 3.8% (2.9; 5.0) to 2.4% (1.9; 3.1) (P<0.0001), whereas diabetic ketoacidosis events increased significantly with injection therapy only. Body mass index-standard deviation score also showed significant improvements 0.55 (0.46; 0.64) versus 0.42 (0.33; 0.51) (P<0.0001). Over time, the increase in pump use from 34% to 44% preceded the increase in HbA1c target achievement (<53mmol/mol) from 21% to 34%. Conclusions: Twice yearly benchmarking within the SWEET registry was associated with significantly improved HbA1c on a background of increasing pump and sensor use for 10 years in young persons with T1D.
|
|
| 7. |
|
|
| 8. |
|
|
| 9. |
- Nordberg, Gunnar F., et al.
(författare)
-
Interactions and mixtures in metal toxicology
- 2021
-
Ingår i: Handbook on the Toxicology of Metals: Volume I: General Considerations. - London : Elsevier. - 9780128232927 ; , s. 319-347
-
Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Human exposures to metals, metalloids, and their compounds frequently occur as mixtures; therefore, the joint action of these elements should be considered with respect to mechanisms of action and risk assessment. When present at the same time in a system, multiple chemicals can influence toxicity. The joint action of metallic elements may produce additive, synergistic/potentiating, or antagonistic effects manifesting in an overall toxicity, differing from that of individual components of the mixture. Dose-response relationships may be further influenced by constitutive factors such as age, sex, and the expression of specific proteins. Mechanisms of importance for the development of potentiated or antagonistic toxicity include the expression of metal-binding proteins (metallothioneins or lead-binding proteins) and interference with metal transporters such as Divalent Metal Transporter (DMT-1) and the ZIP family of zinc transporting proteins. Compared to men, women of childbearing age generally absorb more Cd from the gastrointestinal tract because they typically have lower iron stores than men. Another example of synergism that occurs in humans is when inorganic arsenic and cadmium together induce kidney toxicity. In many cases, however, direct primary data on the joint action of toxic or essential elements are lacking, and so innovative derivative methods such as the binary weight-of-evidence method have been used to predict potential interactions among groups of metals and metalloids. Using this method, broad recommendations can be made for assessing the potential impact of interactions on the public health assessment of environmental mixtures. At present, there is much to be learned about the joint action of both toxic and essential elements, and this is clearly a critical area of research.
|
|
| 10. |
- Reddel, Helen K., et al.
(författare)
-
Heterogeneity within and between physician-diagnosed asthma and/or COPD : NOVELTY cohort
- 2021
-
Ingår i: European Respiratory Journal. - : European Respiratory Society. - 0903-1936 .- 1399-3003. ; 58:3
-
Tidskriftsartikel (refereegranskat)abstract
- Background Studies of asthma and chronic obstructive pulmonary disease (COPD) typically focus on these diagnoses separately, limiting understanding of disease mechanisms and treatment options. NOVELTY is a global, 3-year, prospective observational study of patients with asthma and/or COPD from real-world clinical practice. We investigated heterogeneity and overlap by diagnosis and severity in this cohort. Methods Patients with physician-assigned asthma, COPD or both (asthma+COPD) were enrolled, and stratified by diagnosis and severity. Baseline characteristics were reported descriptively by physician-assigned diagnosis and/or severity. Factors associated with physician-assessed severity were evaluated using ordinal logistic regression analysis. Results Of 11243 patients, 5940 (52.8%) had physician-assigned asthma, 1396 (12.4%) had asthma+COPD and 3907 (34.8%) had COPD; almost half were from primary care. Symptoms, health-related quality of life and spirometry showed substantial heterogeneity and overlap between asthma, asthma COPD and COPD, with 23%, 62% and 64% of patients, respectively, having a ratio of post-bronchodilator forced expiratory volume in 1 s to forced vital capacity below the lower limit of normal. Symptoms and exacerbations increased with greater physician-assessed severity and were higher in asthma+COPD. however, 24.3% with mild asthma and 20.4% with mild COPD had experienced >= 1 exacerbation in the past 12 months. Medication records suggested both under-treatment and over-treatment relative to severity. Blood eosinophil counts varied little across diagnosis and severity groups, but blood neutrophil counts increased with severity across all diagnoses. Conclusion This analysis demonstrates marked heterogeneity within, and overlap between, physician-assigned diagnosis and severity groups in patients with asthma and/or COPD. Current diagnostic and severity classifications in clinical practice poorly differentiate between clinical phenotypes that may have specific risks and treatment implications.
|
|
