Introduction: Whilst treatment algorithms direct care, less is known about the lived experience of patients with type 2 diabetes (T2D).
Methods: Design thinking methods were applied to describe the ...lived experience of 16 patients with T2D, the care they receive, and the potential for technology to support care. Patients used design probes to document how diabetes influences their experiences at home and work, and while shopping and socialising - all used to inform a semi-structured workshop. Eight healthcare professionals took part in a semi-structured workshop exploring the lived experience of delivering care.
Results: Thematic analyses of design probes and workshops revealed that the lived experience of T2D and associated care are disconnected. Patients describe awareness and importance of managing their behaviours, while also recognizing the complexity of managing/changing behaviours at home and work, and while shopping or socialising. Care teams emphasised the importance of patient behaviour, but reported lacking the skills and tools to influence patient behaviour change during brief consultations. Patients and care teams reported the importance of early communication, education, and behavioural change, but expressed a lack of opportunity, particularly early in their diagnosis. Care teams described a knowledge-implementation gap (knowing what needs to be done but lacking time and resources to do it). Focus is on medications rather than lifestyle treatment approaches, including diet. Both groups were positive about using technology to bridge this gap but emphasised the importance of evidence-informed resource, ease of use and implementation.
Conclusions: The lived experience of T2D and its care are disconnected. Patients and care teams articulate this gap, despite education and support being a core element of diabetes care. Patients and care teams were positive about the potential use of technology, but emphasised ease of use and implementation.
Disclosure
L.C.Taylor: Employee; Changing Health Ltd, Other Relationship; Abbott Diabetes. L.Avery: None. L.Corner: None. S.Sulo: Employee; Abbott. R.Rueda: Employee; Abbott Nutrition, Stock/Shareholder; Abbott Nutrition. M.Trenell: Other Relationship; Abbott Diabetes, Stock/Shareholder; Changing Health Ltd.
Funding
Abbott Nutrition (Aversa)
Display omitted
•Human rabies reporting is poor in endemic countries because of the disease’s neglect and fatality.•Active surveillance shows that passive reporting systems can result in ...underreporting by up to two orders of magnitude.•Our best estimates of the true burden of canine rabies come from modelling studies.•Surveillance systems need to be strengthened and used in order for them to demonstrate their value.
Current passive surveillance data for canine rabies, particularly for the regions where the burden is highest, are inadequate for appropriate decision making on control efforts. Poor enforcement of existing legislation and poor implementation of international guidance reduce the effectiveness of surveillance systems, but another set of problems relates to the fact that canine rabies is an untreatable condition which affects very poor sectors of society. This results in an unknown, but potentially large proportion of rabies victims dying outside the health system, deaths that are unlikely to be recorded by surveillance systems based on health center records. This article critically evaluates the potential sources of information on the number of human deaths attributable to canine rabies, and how we might improve the estimates required to move towards the goal of global canine rabies elimination.
The Philippine government has an extensive network of 513 Animal Bite Treatment Centers (ABTCs) to supply rabies post exposure prophylaxis (PEP), reaching over 1 million bite victims in 2016. The ...network was evaluated using a review of existing national and provincial data, key informant interviews and surveys in sample ABTCs to determine the cost-effectiveness of this network in preventing human rabies deaths.
One urban and one rural ABTC in each of three selected provinces were studied in more detail. PEP delivery generally followed national guidance based on best practices, but there was evidence of operational challenges in supplying all ABTCs with adequate biologics and recently trained staff. Funding was contributed by different levels of government and in some clinics, patients paid for a significant fraction of the total cost. From a health provider perspective including both fixed and variable costs, the average PEP course delivered cost USD 32.91 /patient across urban ABTCs (with higher patient throughput) and USD 57.21 /patient across rural ABTCs. These costs suggests that PEP provision in the Philippines cost USD 37.6 million in 2016, with a cost per life saved of USD 8,290. An analysis of the 2,239 suspected rabies deaths from 2008 to 2016 showed no significant decline, and from 2014-16 an average of 8,534 years of life were lost annually. The incidence of rabies deaths from 2014-16 was not clearly related to the provision of ABTCs (per 100,000 population) or human population density, but deaths were more common in higher income provinces.
In the context of comprehensive rabies control (including dog vaccination and public awareness) ways to reduce this high expenditure on PEP should be explored, to most cost-effectively reach the elimination of human rabies deaths. This paper is accompanied by another containing data on the operation of ABTCs network from a patient perspective.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The Philippines has built an extensive decentralised network of Animal Bite Treatment Centers (ABTCs) to help bite victims receive timely rabies post-exposure prophylaxis (PEP) at little cost. This ...study surveyed patients in the community and at ABTCs of three provinces to assess animal bite/scratch incidence, health-seeking behaviour and PEP-related out-of pocket expenses (OOPE).
During community surveys in 90 barangays (neighbourhoods), 53% of households reported at least one animal bite /scratch injury over the past 3 years, similar across urban and rural barangays. Overall bite/scratch incidences in 2016-17 were 67.3, 41.9 and 48.8 per 1,000 population per year for Nueva Vizcaya, Palawan and Tarlac respectively. Incidences were around 50% higher amongst those under 15 years of age, compared to -those older than 15. Household awareness of the nearest ABTCs was generally over 80%, but only 44.9% sought proper medical treatment and traditional remedies were still frequently used. The proportion of patients seeking PEP was not related to the distance or travel time to the nearest ABTC. For those that did not seek medical treatment, most cited a lack of awareness or insufficient funds and almost a third visited a traditional healer. No deaths from bite/scratch injuries were reported. A cohort of 1,105 patients were interviewed at six ABTCs in early 2017. OOPE varied across the ABTCs, from 5.53 USD to 37.83 USD per patient, primarily dependent on the need to pay for immunization if government supplies had run out. Overall, 78% of patients completed the recommended course, and the main reason for non-completion was a lack of time, followed by insufficient funds. Dog observation data revealed that 85% of patients were not truly exposed to rabies, and education in bite prevention might reduce provoked bites and demand for PEP. An accompanying paper details the ABTC network from the health provider's perspective.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Introduction
The effect of socioeconomic status on adolescent substance abuse may be mediated by family socialization practices. However, traditional mediation analysis using a product or difference ...method is susceptible to bias when assumptions are not addressed. We aimed to use a potential outcomes framework to assess assumptions of exposure‐mediator interaction and of no confounding of the results.
Method
We revisited a traditional mediation analysis with a multiple mediator causal mediation approach using data from 17,761 Norwegian young people (13–18 years), 51% female. Data were collected through a print questionnaire. Socioeconomic status was operationalized as parental education and employment status (employed or receiving welfare); drinking behavior as the frequency of alcohol consumption and frequency of intoxication in the past year; and socialization practices as general parenting measures, alcohol‐related parental permissiveness, and parent drinking behavior.
Results
There was no consistent evidence of exposure‐mediator interaction. Formal sensitivity analysis of mediator‐outcome confounding was not possible in the multiple mediator model, and this analysis supported the hypothesis that socioeconomic status effects on adolescent substance abuse are fully mediated by family socialization practices, with apparently stronger effects in younger age groups observed in plots.
Conclusion
We found that the effect of socioeconomic status on adolescent substance abuse was fully mediated by family socialization practices. While our analysis provides more rigorous support for causal inferences than past work, we could not completely rule out the possibility of unmeasured confounding.
The most commonly used denture base material, polymethyl methacrylate, lacks ideal mechanical properties, which are reflected in its relatively high failure rate. Several methods have been explored ...to reinforce the material and reduce the cost of denture repair and replacement. In this study, various surface modified filler particles at different concentrations were dispersed in conventional and high-impact denture base materials and tested for their improvement in mechanical properties. Inorganic filler particles were coated with different silane coupling agents using an ultrasonic device. The particulates were dispersed in the resin and the composites polymerised through an innovative dual-cure technique. Charpy impact test, single-edge notch three-point bend fracture toughness test and Biaxial Flexural Strength (BFS) were performed on the specimens. The results showed that mechanical properties of the denture base resin can be improved by incorporating filler particles; however, the surface characteristics, quantity and level of dispersion of the particles play critical role in the mechanical behaviour of the composites. The results of this study are a promising step towards developing more fracture-resistant denture base materials.
Free-roaming dogs and rabies transmission are integrally linked across many low-income countries, and large unmanaged dog populations can be daunting to rabies control program planners. Dog ...population management (DPM) is a multifaceted concept that aims to improve the health and well-being of free-roaming dogs, reduce problems they may cause, and may also aim to reduce dog population size. In theory, DPM can facilitate more effective rabies control. Community engagement focused on promoting responsible dog ownership and better veterinary care could improve the health of individual animals and dog vaccination coverage, thus reducing rabies transmission. Humane DPM tools, such as sterilization, could theoretically reduce dog population turnover and size, allowing rabies vaccination coverage to be maintained more easily. However, it is important to understand local dog populations and community attitudes toward them in order to determine whether and how DPM might contribute to rabies control and which DPM tools would be most successful. In practice, there is very limited evidence of DPM tools achieving reductions in the size or turnover of dog populations in canine rabies-endemic areas. Different DPM tools are frequently used together and combined with rabies vaccinations, but full impact assessments of DPM programs are not usually available, and therefore, evaluation of tools is difficult. Surgical sterilization is the most frequently documented tool and has successfully reduced dog population size and turnover in a few low-income settings. However, DPM programs are mostly conducted in urban settings and are usually not government funded, raising concerns about their applicability in rural settings and sustainability over time. Technical demands, costs, and the time necessary to achieve population-level impacts are major barriers. Given their potential value, we urgently need more evidence of the effectiveness of DPM tools in the context of canine rabies control. Cheaper, less labor-intensive tools for dog sterilization will be extremely valuable in realizing the potential benefits of reduced population turnover and size. No one DPM tool will fit all situations, but if DPM objectives are achieved dog populations may be stabilized or even reduced, facilitating higher dog vaccination coverages that will benefit rabies elimination efforts.
Implementing Pasteur’s vision for rabies elimination Lankester, Felix; Hampson, Katie; Lembo, Tiziana ...
Science (American Association for the Advancement of Science),
09/2014, Letnik:
345, Številka:
6204
Journal Article
Recenzirano
Odprti dostop
It has been 129 years since Louis Pasteur's experimental protocol saved the life of a child mauled by a rabid dog, despite incomplete understanding of the etiology or mechanisms by which the miracle ...cure worked (1). The disease has since been well understood, and highly effective vaccines are available, yet Pasteur's vision for ridding the world of rabies has not been realized. Rabies remains a threat to half the world's population and kills more than 69,000 people each year, most of them children (2). We discuss the basis for this neglect and present evidence supporting the feasibility of eliminating canine-mediated rabies and the required policy actions.
The Ecology of Genetically Diverse Infections Read, Andrew F.; Taylor, Louise H.
Science (American Association for the Advancement of Science),
05/2001, Letnik:
292, Številka:
5519
Journal Article
Recenzirano
Microparasite infections often consist of genetically distinct clonal lineages. Ecological interactions between these lineages within hosts can influence disease severity, epidemiology, and ...evolution. Many medical and veterinary interventions have an impact on genetic diversity within infections, but there is little understanding of the long-term consequences of such interventions for public and animal health. Indeed, much of the theory in this area is based on assumptions contradicted by the available data.
Oxidative stress is considered to be an important component of various diseases. A vast number of methods have been developed and used in virtually all diseases to measure the extent and nature of ...oxidative stress, ranging from oxidation of DNA to proteins, lipids, and free amino acids.
An increased understanding of the biology behind diseases and redox biology has led to more specific and sensitive tools to measure oxidative stress markers, which are very diverse and sometimes very low in abundance.
The literature is very heterogeneous. It is often difficult to draw general conclusions on the significance of oxidative stress biomarkers, as only in a limited proportion of diseases have a range of different biomarkers been used, and different biomarkers have been used to study different diseases. In addition, biomarkers are often measured using nonspecific methods, while specific methodologies are often too sophisticated or laborious for routine clinical use.
Several markers of oxidative stress still represent a viable biomarker opportunity for clinical use. However, positive findings with currently used biomarkers still need to be validated in larger sample sizes and compared with current clinical standards to establish them as clinical diagnostics. It is important to realize that oxidative stress is a nuanced phenomenon that is difficult to characterize, and one biomarker is not necessarily better than others. The vast diversity in oxidative stress between diseases and conditions has to be taken into account when selecting the most appropriate biomarker.
PDF
