Diabet. Med. 29, 1510–1514 (2012)
Aims We aimed to assess the relative risk for hypothyroidism in patients with Type 2 diabetes.
Methods In this study, 1112 patients with Type 2 diabetes (58% ...women, mean age 66.7 years, median duration of diabetes 10 years, 179 with previous history of thyroid disease) and 911 subjects without diabetes were evaluated.
Results The gender‐, age‐ and weight‐adjusted relative risk (odds ratio) of newly identified hypothyroidism in patients with Type 2 diabetes in comparison with control subjects was 2.81 (1.77–4.48). This odds ratio was significant in patients over 65 years 4.02 (1.95–8.31), as well as in both men 4.84 (1.58–14.80) and women 2.60 (1.54–4.38), in obese patients 2.56 (1.36–4.82) and non‐obese patients 3.11 (1.56–6.20) and in individuals with 4.26 (1.73–10.46) and without 2.93 (1.50–5.75) thyroid autoantibodies. Logistic regression analysis showed that newly diagnosed hypothyroidism was significantly and directly related not only with thyroid autoimmunity 19.15 (8.73–42.01), but also with the presence of macroangiopathy 2.85 (1.51–5.35) and metformin treatment 2.51 (1.28–4.92).
Conclusions Our results favour screening for hypothyroidism in patients with Type 2 diabetes older than 65 years, especially in the presence of diabetic macroangiopathy or treatment with metformin.
Space Systems have been historically characterised by high performance, high reliability and high cost. Every new generation of space systems tends to improve performance, keep as much as possible ...reliability, speeding the lead time and lower the cost. Aggressive approach is nowadays followed by some of the players of the new space ecosystem where, for instance, reliability can be relaxed thanks for the in-orbit redundancy or robustness to failures by having a constellation with a high number of satellites. This push towards the technology and system limit requires to investigate new methods for the manufacturing of RF/Microwave parts. RF devices such as those based on waveguide structures, benefit from an additive manufacturing approach in terms of radio frequency (RF) performance and compactness. However each manufacturing approach comes with specific features and limitations which need to be well understood and, in some cases, even taking advantage of them. This paper provides a short review of some of the RF/Microwave parts already manufactured using this technology. The paper will focus mainly on metal 3D printing parts since this technology is, at the moment, well accepted by the space community.
There is a great amount of ecological information for terrestrial arthropods in several types of habitats, but few studies have focused on populations living in tidal freshwater wetlands. During a ...two-year field survey, we studied the temporal dynamics of the harvestman Discocyrtus prospicuus inhabiting a freshwater wetland exposed to predictable tides and unpredictable floods. We also explored the effects of temperature, precipitation, and tide level on the population dynamics and reproductive phenology. Our findings are markedly different from those reported in other harvestman species living in different habitats and also from conspecific populations living in the mainland. Adults, subadults, and juveniles remain active throughout the year, and a long breeding season was observed. However, the number of adults, subadults, juveniles, and egg clutches showed clear variations over the year without a consistent seasonal pattern. Contrary to the general pattern in harvestmen, no climatic variables were significant predictors of abundance fluctuations. We discuss the potential masking effect of unpredictable flood events, obscuring the relationship between abundance and abiotic factors. In addition, given that climatic conditions seem to favor harvestmen activity throughout the year, we also hypothesized that abundance variations could be driven mainly by biotic rather than by abiotic interactions.
Summary
Background
Strong acid inhibition using esomeprazole increases cure rates with triple therapy and 10‐day treatments are more effective than 7‐day ones. The combination of amoxicillin plus ...metronidazole at full doses, and using a physiologically‐correct schedule three times a day, and has been shown to overcome metronidazole resistance and to achieve good eradication rates.
Aims
To assess the eradication rate of a new first‐line treatment regimen associating strong acid inhibition, amoxicillin and metronidazole and to evaluate tolerance.
Methods
Patients from eight hospitals were included. Helicobacter pylori status was assessed by at least one of the following: histology, culture, rapid urease test or urea breath test (UBT). Ten‐day treatment was prescribed comprising esomeprazole 40 mg twice a day plus amoxicillin 1 g and metronidazol 500 mg both three times a day. Helicobacter pylori cure was assessed by UBT.
Results
A hundred and thirty‐six patients were enrolled. Mean age was 52.6 ± 16 years and 59.6% of patients were men. Main indications for treatment were: uninvestigated dyspepsia (13.6%); functional dyspepsia (18.2%); gastric ulcer (21.8%); and duodenal ulcer (39.8%). Helicobacter pylori eradication was achieved in 112 of the 127 patients who returned for follow‐up. Eradication rates were 82.4% (95% CI: 74.7–88.1) by intention‐to‐treat analysis and 88.2% (95% CI: 81.2–92.8) by per protocol. Treatment was well tolerated and no major side effects were reported. Nine patients complained of mild side effects.
Conclusions
Cure rates of the combination of esomeprazole, amoxicillin and metronidazole are high and the treatment was well tolerated. This pilot study warrants the comparison of this schedule with current standards.
Prolactinomas are the most common type of pituitary adenomas. Macroprolactinomas are the name used for these tumors when their size is ≥ 1 cm. These tumors commonly cause symptoms due to the ...excessive production of prolactin as well as complaints caused by tumor mass and compression of neural adjacent structures. Clinical diagnosis and assessment of macroprolactinoma are based on the measurement of serum prolactin concentrations and the morphological evaluation of the pituitary gland by magnetic resonance imaging. Dopamine agonists are the first-line treatment modality, with cabergoline being preferred to bromocriptine, because of its better tolerance and feasibility of administration. Cabergoline therapy has been reported to achieve normalization of prolactin levels and gonadal function and reduction of tumor volume in >50% of patients with macroprolactinoma. Resistance or intolerance to dopamine agonists are the main indications for transsphenoidal adenomectomy in patients with macroprolactinoma. External radiation therapy has been used in patients with poor response to medical and surgical procedures. Clinically significant tumor growth may occur during pregnancy in women with macroprolactinomas, especially if they have not received prior surgical or radiation therapy. Visual fields should be assessed periodically during pregnancy and therapy with dopamine agonists is indicated if symptomatic tumor growth occurs. Cystic and giant prolactinomas as well as the rare cases of malignant prolactinomas have special peculiarities and entail a therapeutic challenge.
Abstract
Public institutions find an open window and greater transparency towards citizens in the digital sphere. So much so that the websites of local corporations can be considered an instrument of ...democratic inclusion and overall well-being. However, web accessibility continues to be a pending issue in order to encourage any person, regardless of their physical, mental or age capabilities, to interact without any kind of barrier. This paper analyses the web accessibility of 18 provincial capital city councils in Spain, comparing two periods to detect compliance with the requirements of adaptation to citizenship by applying the Web Content Accessibility Guidelines. The results show that accessibility to the websites of local corporations is still an unresolved issue. The commitment to web accessibility is not related to the size of cities or their budgetary level. It is necessary to undertake the appropriate improvements if they want, in their commitment to all citizens, to not leave out two key groups: people with functional diversity and the elderly. The contribution of this work goes beyond the need to use a type of analysis model to evaluate the democratisation of websites as digital public services and, consequently, it raises a series of practical implications relevant to the political decision-making bodies of local councils.
Compression is an effective and recommended treatment for venous leg ulcers. Although the four-layer bandage (4LB) is regarded as the gold standard compression system, it is recognised that the ...amount of compression delivered might be compromised by poor application technique. Also the bulky nature of the bandages might reduce ankle or leg mobility and make the wearing of shoes difficult. Two-layer compression hosiery systems are now available for the treatment of venous leg ulcers. Two-layer hosiery (HH) may be advantageous, as it has reduced bulk, which might enhance ankle or leg mobility and patient adherence. Some patients can also remove and reapply two-layer hosiery, which may encourage self-management and could reduce costs. However, little robust evidence exists about the effectiveness of two-layer hosiery for ulcer healing and no previous trials have compared two-layer hosiery delivering 'high' compression with the 4LB.
Part I To compare the clinical effectiveness and cost-effectiveness of HH and 4LB in terms of time to complete healing of venous leg ulcers. Part II To synthesise the relative effectiveness evidence (for ulcer healing) of high-compression treatments for venous leg ulcers using a mixed-treatment comparison (MTC). Part III To construct a decision-analytic model to assess the cost-effectiveness of high-compression treatments for venous leg ulcers.
Part I A multicentred, pragmatic, two-arm, parallel, open randomised controlled trial (RCT) with an economic evaluation. Part II MTC using all relevant RCT data - including Venous leg Ulcer Study IV (VenUS IV). Part III A decision-analytic Markov model.
Part I Community nurse teams or services, general practitioner practices, leg ulcer clinics, tissue viability clinics or services and wound clinics within England and Northern Ireland.
Part I Patients aged ≥ 18 years with a venous leg ulcer, who were willing and able to tolerate high compression.
Part I Participants in the intervention group received HH. The control group received the 4LB, which was applied according to standard practice. Both treatments are designed to deliver 40 mmHg of compression at the ankle. Part II and III All relevant high-compression treatments including HH, the 4LB and the two-layer bandage (2LB).
Part I The primary outcome measure was time to healing of the reference ulcer (blinded assessment). Part II Time to ulcer healing. Part III Quality-adjusted life-years (QALYs) and costs.
Part I A total of 457 participants were recruited. There was no evidence of a difference in time to healing of the reference ulcer between groups in an adjusted analysis hazard ratio (HR) 0.99, 95% confidence interval (CI) 0.79 to 1.25; p = 0.96. Time to ulcer recurrence was significantly shorter in the 4LB group (HR = 0.56, 95% CI 0.33 to 0.94; p = 0.026). In terms of cost-effectiveness, using QALYs as the measure of benefit, HH had a > 95% probability of being the most cost-effective treatment based on the within-trial analysis. Part II The MTC suggests that the 2LB has the highest probability of ulcer healing compared with other high-compression treatments. However, this evidence is categorised as low to very low quality. Part III Results suggested that the 2LB had the highest probability of being the most cost-effective high-compression treatment for venous leg ulcers.
Trial data from VenUS IV found no evidence of a difference in venous ulcer healing between HH and the 4LB. HH may reduce ulcer recurrence rates compared with the 4LB and be a cost-effective treatment. When all available high-compression treatments were considered, the 2LB had the highest probability of being clinically effective and cost-effective. However, the underpinning evidence was sparse and more research is needed. Further research should thus focus on establishing, in a high-quality trial, the effectiveness of this compression system in particular.
Current Controlled Trials ISRCTN49373072.
This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 18, No. 57. See the NIHR Journals Library website for further project information.
In network meta‐analysis (NMA), we synthesize all relevant evidence about health outcomes with competing treatments. The evidence may come from randomized clinical trials (RCT) or non‐randomized ...studies (NRS) as individual participant data (IPD) or as aggregate data (AD). We present a suite of Bayesian NMA and network meta‐regression (NMR) models allowing for cross‐design and cross‐format synthesis. The models integrate a three‐level hierarchical model for synthesizing IPD and AD into four approaches. The four approaches account for differences in the design and risk of bias (RoB) in the RCT and NRS evidence. These four approaches variously ignoring differences in RoB, using NRS to construct penalized treatment effect priors and bias‐adjustment models that control the contribution of information from high RoB studies in two different ways. We illustrate the methods in a network of three pharmacological interventions and placebo for patients with relapsing–remitting multiple sclerosis. The estimated relative treatment effects do not change much when we accounted for differences in design and RoB. Conducting network meta‐regression showed that intervention efficacy decreases with increasing participant age. We also re‐analysed a network of 431 RCT comparing 21 antidepressants, and we did not observe material changes in intervention efficacy when adjusting for studies' high RoB. We re‐analysed both case studies accounting for different study RoB. In summary, the described suite of NMA/NMR models enables the inclusion of all relevant evidence while incorporating information on the within‐study bias in both observational and experimental data and enabling estimation of individualized treatment effects through the inclusion of participant characteristics.
In the last decade, there have been an increasing number of studies on female entrepreneurship and its relationship with communication activity. However, as a worldwide current issue, there are no ...records in the scientific literature in which a bibliometric analysis has been performed in this field. This article aims to fill this gap by reviewing the present situation of research production and analyzing its evolution and trends. To this end, a systematic review of the existing literature is carried out, as well as the bibliometric analysis of the 1356 records found in the Scopus database and the analysis of bibliometric networks referring to authorship, citation, keywords and main affiliations of researchers with VOSviewer software. Among the results, it is worth noting the close correlation between advances in communication strategies on behalf of women entrepreneurs, mainly related to the digitization of processes and the reduction of gender disparities. Thus, there is a need to raise awareness of the importance of communication in business management and to promote training activities that encourage greater interaction between women entrepreneurs and their stakeholders.
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