Background: The oocyte-secreted factors growth differentiation factor-9 (GDF9) and bone morphogenetic protein-15 (BMP15) are key regulators of female fertility and are predominantly expressed by ...oocytes. Recently, methods to quantitate these proteins in serum have demonstrated diagnostic potential. It is unknown if concentrations reflect ovarian and endocrine function, particularly in women with polycystic ovary syndrome (PCOS), where GDF9/BMP15 function is suggested to be aberrant.
Aim: To determine if serum GDF9/BMP15 are associated with ovarian and endocrine parameters, and the ovarian pathologies, PCOM and PCOS.
Method: Women aged 21-45 years (n=381) were from a cross-sectional study at the National University Hospital, Singapore, including healthy volunteers and referrals from gynecological clinics. Transvaginal ultrasound scans, blood tests and questionnaire were performed. Serum GDF9 and BMP15 were assessed relative to ovarian (cycle regularity, ovarian volume, AFC, AMH) and androgenic (testosterone, DHT, androstenedione, DHEAS, SHBG, mFG score) characteristics. PCOM and PCOS were determined using the Rotterdam criteria. Statistical analyses used parametric survival models and Kendall’s tau correlation appropriate for data containing values below the limit of detection.
Results: Serum GDF9 and BMP15 were detectable in 40% and 41% of women, respectively. Serum GDF9 positively correlated with ovarian volume (p=0.02), AFC (p=0.004), and weakly with AMH (p=0.05). Furthermore, irregular menstrual cycles were associated with high GDF9 (p=0.005), and similar, although non-significant associations were seen for BMP15. When stratified into PCOS (n=130), PCOM (n=59), and control (n=192), GDF9 and BMP15 concentrations were not significantly different, and were not associated with the majority of androgenic features of PCOS. However, the relationship between GDF9 and AFC was significantly different between PCOM, PCOS and control women (p=0.02).
Conclusion: These results suggest that serum GDF9 and BMP15 reflect ovarian characteristics but not androgenic characteristics of PCOS, and that the relationships between GDF9 and AFC may be aberrant in women with PCOM/PCOS.
to determine limitations and strengths of three methodologies developed to estimate HIV prevalence and the number of people living with HIV/AIDS (PLWHA).
the UNAIDS/WHO Workbook method; the ...Multiparameter Evidence Synthesis (MPES) adopted by the Health Protection Agency; and the UNAIDS/WHO Estimation and Projection Package (EPP) and Spectrum method were used and their applicability and feasibility were assessed. All methods estimate the number infected in mutually exclusive risk groups among 15-70-year-olds.
using data from the Netherlands, the Workbook method estimated 23 969 PLWHA as of January 2008. MPES estimated 21 444 PLWHA, with a 95% credible interval (CrI) of 17 204-28 694. Adult HIV prevalence was estimated at 0.2% (95% CrI 0.15-0.24%) and 40% (95% CrI 25-55%) were undiagnosed. Spectrum applied gender-specific mortality, resulting in a projected estimate of 19 115 PLWHA.
although outcomes differed between the methods, they broadly concurred. An advantage of MPES is that the proportion diagnosed can be estimated by risk group, which is important for policy guidance. However, before MPES can be used on a larger scale, it should be made more easily applicable. If the aim is not only to obtain annual estimates, but also short-term projections, then EPP and Spectrum are more suitable. Research into developing and refining analytical tools, which make use of all available information, is recommended, especially HIV diagnosed cases, as this information is becoming routinely collected in most countries with concentrated HIV epidemics.
Patients with the metabolic syndrome are more likely to develop type 2 diabetes and may have an increased risk of cardiovascular disease (CVD) events.We aimed to establish whether CVD event rates ...were influenced by the metabolic syndrome as defined by the World Health Organisation (WHO), the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) and the International Diabetes Federation (IDF) and to determine which component(s) of the metabolic syndrome (MS) conferred the highest cardiovascular risk in in 4900 patients with type 2 diabetes allocated to placebo in the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) trial.
We determined the influence of MS variables, as defined by NCEP ATPIII, IDF and WHO, on CVD risk over 5 years, after adjustment for CVD, sex, HbA1c, creatinine, and age, and interactions between the MS variables in a Cox proportional-hazards model.
About 80% had hypertension, and about half had other features of the metabolic syndrome (IDF, ATPIII). There was no difference in the prevalence of metabolic syndrome variables between those with and without CVD at study entry. The WHO definition identified those at higher CVD risk across both sexes, all ages, and in those without prior CVD, while the ATPIII definition predicted risk only in those aged over 65 years and in men but not in women. Patients meeting the IDF definition did not have higher risk than those without IDF MS.CVD risk was strongly influenced by prior CVD, sex, age (particularly in women), baseline HbA1c, renal dysfunction, hypertension, and dyslipidemia (low HDL-c, triglycerides > 1.7 mmol/L). The combination of low HDL-c and marked hypertriglyceridemia (> 2.3 mmol/L) increased CVD risk by 41%. Baseline systolic blood pressure increased risk by 16% per 10 mmHg in those with no prior CVD, but had no effect in those with CVD. In those without prior CVD, increasing numbers of metabolic syndrome variables (excluding waist) escalated risk.
Absence of the metabolic syndrome (by the WHO definition) identifies diabetes patients without prior CVD, who have a lower risk of future CVD events. Hypertension and dyslipidemia increase risk.
Multi-parameter evidence synthesis (MPES) is receiving growing attention from the epidemiological community as a coherent and flexible analytical framework to accommodate a disparate body of evidence ...available to inform disease incidence and prevalence estimation. MPES is the statistical methodology adopted by the Health Protection Agency in the UK for its annual national assessment of the HIV epidemic, and is acknowledged by the World Health Organization and UNAIDS as a valuable technique for the estimation of adult HIV prevalence from surveillance data. This paper describes the results of utilizing a Bayesian MPES approach to model HIV prevalence in the Netherlands at the end of 2007, using an array of field data from different study designs on various population risk subgroups and with a varying degree of regional coverage. Auxiliary data and expert opinion were additionally incorporated to resolve issues arising from biased, insufficient or inconsistent evidence. This case study offers a demonstration of the ability of MPES to naturally integrate and critically reconcile disparate and heterogeneous sources of evidence, while producing reliable estimates of HIV prevalence used to support public health decision-making.
Objectives
The objective of the article is to provide an overview of the results of the HepHIV 2017 Conference organized by the HIV in Europe initiative under the Maltese EU Presidency in January ...2017.
Methods
A thourough review of all conference presentations (oral and poster presentations) was performed to retrieve the key outcomes of the conference.
Results
The key result from the conference was a call to action summarising key priorities in HIV and viral hepatitis testing and linkage to care. This included improving monitoring of viral hepatitis and HIV, mixing testing strategies and ensuring policy support. The important contribution and outcomes of EU funded projects OptTEST and EuroHIVEdat was highlighted.
Conclusion
An integrated approach to earlier testing and linkage to care across diseases is needed in Europe and the HepHIV conferences create an important forum to reach this aim.
Ecological models of the determinants of health & the consequent importance of structural interventions have been widely accepted, but using these models in research & practice has been challenging. ...Examining the role of criminal law enforcement in the "risk environment" of injection drug users (IDUs) provides an opportunity to apply structural thinking to the health problems associated with drug use. This article reviews international evidence that laws & law enforcement practices influence IDU risk. It argues that more research is needed at four levels -- laws; management of law enforcement agencies; knowledge, attitudes, beliefs, & practices of frontline officers; & attitudes & experiences of IDUs -- & that such research can be the basis of interventions within law enforcement to enhance IDU health. 1 Figure, 153 References. Adapted from the source document.
Multi-parameter evidence synthesis (MPES) is receiving growing attention from the epidemiological community as a coherent and flexible analytical framework to accommodate a disparate body of evidence ...available to inform disease incidence and prevalence estimation. MPES is the statistical methodology adopted by the Health Protection Agency in the UK for its annual national assessment of the HIV epidemic, and is acknowledged by the World Health Organization and UNAIDS as a valuable technique for the estimation of adult HIV prevalence from surveillance data. This paper describes the results of utilizing a Bayesian MPES approach to model HIV prevalence in the Netherlands at the end of 2007, using an array of field data from different study designs on various population risk subgroups and with a varying degree of regional coverage. Auxiliary data and expert opinion were additionally incorporated to resolve issues arising from biased, insufficient or inconsistent evidence. This case study offers a demonstration of the ability of MPES to naturally integrate and critically reconcile disparate and heterogeneous sources of evidence, while producing reliable estimates of HIV prevalence used to support public health decision-making.
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