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1.
Account Res ; 27(6): 396-400, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32543229

RESUMEN

The COVID-19 pandemic has accelerated the pace of research from its routine marathon to a sprint, and this can increase the risk of both human error (mistakes) as well as research misconduct. In an effort to save time, researchers can be tempted to "cut corners", discount ethical complexity, or use methods and approaches that fall outside of good research practice. Ethically, it is vital that research outputs during a pandemic be robust because clinical decision-making may reflect on these research results. Luxembourg, while a small European nation, is known for its well-ranked global research and innovation. Accordingly, Luxembourg's national organization for research integrity has taken several proactive measures to help researchers nationally and globally, foster robust research. This paper reports on these measures and encourages other nations to similarly assist the research community.


Asunto(s)
Investigación Biomédica/ética , Investigación Biomédica/normas , Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Betacoronavirus , Humanos , Luxemburgo , Pandemias , Reproducibilidad de los Resultados
3.
Environ Sci Process Impacts ; 22(2): 294-304, 2020 Feb 26.
Artículo en Inglés | MEDLINE | ID: mdl-31939971

RESUMEN

Pesticides are the class of compounds with the most dynamic behaviour in their surface water occurrence: their episodic release to surface waters is closely related to the date of application and the following weather conditions and poses substantial challenges to monitoring in order to yield accurate mass transfer figures. Moreover, pesticide use, dose and time of application are largely unknown catchment wide and pose an essential problem as to the realism and reliability of pesticide fate modelling as well as accurate farmer counselling. Spatially and temporally highly resolved monitoring establishing pesticide sources was logistically unthinkable until the advent of passive samplers which combine ease of deployment and continuous sampling. However, because research on passive sampler performance has been mainly driven by analytical precision issues, doubts were high as to whether passive samplers could yield accurate time weighted averages in the field, all the more so that the number of field validations is to this day very limited. Here we present a study that used a combination of spatially distributed passive- and autosamplers to capture the runoff dynamics of pesticides used for maize crops in a 82 km2 catchment in Luxembourg. We demonstrate that passive samplers are capable of accurately monitoring episodic emissions of pesticides through a longitudinal profile in a catchment, thus allowing the identification of pesticide source areas. Thanks to the time-proportional nature of the passive sampling it was furthermore possible to calculate event mean concentrations and loads which were behaving temporally according to the physico-chemical properties of the compounds and to the timing and extent of mobilising discharge.


Asunto(s)
Herbicidas , Plaguicidas , Contaminantes Químicos del Agua , Zea mays , Monitoreo del Ambiente , Inundaciones , Herbicidas/análisis , Luxemburgo , Reproducibilidad de los Resultados , Estaciones del Año , Contaminantes Químicos del Agua/análisis
4.
Ecotoxicology ; 29(1): 1-12, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31734834

RESUMEN

This study examined the concentration of total mercury (THg) and selenium (Se), as well as the molar ratio of Se:THg in hair samples of terrestrial animals. THg and Se concentrations were measured from the hair of raccoons (Procyon lotor) and European wildcats (Felis s. silvestris) from Germany and Luxembourg. Median THg concentrations in hair from raccoons and wildcats were 0.369 and 0.273 mg kg-1 dry weight (dw), respectively. Se concentrations were higher in the hair of raccoons than of wildcats (0.851 and 0.641 mg kg-1 dw, respectively). Total mercury concentration in hair of raccoons from Luxembourg was almost 5× higher that found in hair of raccoons from Germany; however, Se concentration was similar. Thus, molar ratio of Se:THg was ~4× higher in the hair of raccoons from Germany than those from Luxembourg. Significant negative correlation was found between THg concentration and Se:THg molar ratio in both wildcats and raccoons.


Asunto(s)
Monitoreo del Ambiente , Contaminantes Ambientales/análisis , Felis , Cabello/química , Mercurio/análisis , Mapaches , Selenio/análisis , Animales , Alemania , Luxemburgo
5.
Artículo en Inglés | MEDLINE | ID: mdl-31861763

RESUMEN

Purpose: To analyze the relationships between body mass index (BMI), ideal body, current declared body shape, and gap between ideal and declared body shape, and the associations that these have with social and cultural factors among 329 adolescents (11 to 15 years i.e., at two stages of adolescence, the early and late adolescence), attending an international school in Luxembourg, and 281 from Paris. Methods: A cross-sectional survey was conducted using an online questionnaire. Missing data were addressed using the data augmentation method in a Bayesian framework. Results: For both sets, higher the BMI and bigger their current body shape (CBS), the slimmer their ideal body shape, especially for those who perceive a link between body shape and beauty. For girls, slimness is a shared ideal; for boys, older they are, more they want a muscular body shape. Most students want slimmer bodies, but in affluent or intermediate social milieu students in relations to identification to personalities such as celebrities, while students from modest milieus, this is expressed in relation to success in love. In addition, they declared that their "talk diet with friends" were associated with large gap between ideal and declared body shape. Conclusions: A social control norm was revealed involving a displacement of values affecting body weight and health in the late stage of adolescence to early adolescence, especially for boys.


Asunto(s)
Insatisfacción Corporal/psicología , Índice de Masa Corporal , Psicología del Adolescente , Factores Socioeconómicos , Adolescente , Conducta del Adolescente , Teorema de Bayes , Imagen Corporal , Peso Corporal , Niño , Estudios Transversales , Femenino , Amigos , Humanos , Luxemburgo , Masculino , Paris , Instituciones Académicas , Estudiantes , Encuestas y Cuestionarios
6.
Respir Res ; 20(1): 231, 2019 Oct 24.
Artículo en Inglés | MEDLINE | ID: mdl-31651324

RESUMEN

BACKGROUND: The PROOF registry is an observational study initiated in October 2013 with the aim to monitor disease progression in a real-world population of patients with idiopathic pulmonary fibrosis (IPF). Here, we present longitudinal clinical outcomes from the PROOF registry. METHODS: Patients with IPF were enrolled across eight centers in Belgium and Luxembourg. For all patients, clinical outcomes data were collected, including mortality, lung transplant, acute exacerbations, and pulmonary hypertension. For patients treated with pirfenidone at any time during follow-up (2013-2017), for any duration of treatment (the pirfenidone-treated population): pirfenidone treatment patterns were collected; changes in pulmonary function (forced vital capacity [FVC] and carbon monoxide diffusing capacity [DLco]) were reviewed up to 24 months post-inclusion; and time-to-event analyses from the time of registry inclusion were performed. RESULTS: The PROOF registry enrolled a total of 277 patients. During follow-up, 23.1% of patients died, 5.1% received a lung transplant, 5.4% experienced an acute exacerbation, and 6.1% had comorbid pulmonary hypertension. In the pirfenidone-treated population (N = 233, 84.1%), 12.9% of patients had a temporary dose discontinuation and 31.8% had a temporary dose reduction; 4.3% of patients permanently discontinued pirfenidone due to an adverse drug reaction. Mean percent predicted FVC was 81.2% (standard deviation [SD] 19.0) at Month 0 and 78.3% (SD 25.0) at Month 24, and mean percent predicted DLco was 47.0% (SD 13.2) and 45.0% (SD 16.5), respectively. Rates of ≥ 10% absolute decline in percent predicted FVC and ≥ 15% absolute decline in percent predicted DLco over 24 months were 31.0% and 23.2%, respectively. Mean times from registry inclusion to categorical absolute decline in percent predicted FVC and percent predicted DLco were 20.1 (standard error [SE] 0.6) months and 23.4 (SE 0.5) months, respectively; mean time from registry inclusion to death was 31.0 (SE 0.9) months. CONCLUSIONS: The PROOF registry is a source of European data characterizing longitudinal clinical outcomes of patients with IPF. Over 12 months of follow-up, pulmonary function remained largely stable in patients with IPF who received pirfenidone for any duration of treatment. Pulmonary function remained similar at 24 months of follow-up, although patient numbers were lower. TRIAL REGISTRATION: PROOF is registered with the relevant authorities in Belgium and Luxembourg, with registration to Comité National d'Éthique et de Recherche (CNER) N201309/03-12 September 2013 and a notification to Comité National de Protection des Données (CNDP) for Luxembourg.


Asunto(s)
Antiinflamatorios no Esteroideos/uso terapéutico , Progresión de la Enfermedad , Fibrosis Pulmonar Idiopática/tratamiento farmacológico , Fibrosis Pulmonar Idiopática/mortalidad , Piridonas/uso terapéutico , Sistema de Registros , Anciano , Bélgica/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Fibrosis Pulmonar Idiopática/fisiopatología , Estudios Longitudinales , Luxemburgo/epidemiología , Masculino , Persona de Mediana Edad , Mortalidad/tendencias , Pruebas de Función Respiratoria/mortalidad , Pruebas de Función Respiratoria/tendencias , Resultado del Tratamiento
7.
Cancer Epidemiol ; 63: 101593, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31499377

RESUMEN

BACKGROUND: In Luxembourg, the human papillomavirus (HPV) vaccination program introduced in 2008, provided either bivalent (BV) or quadrivalent (QV) vaccines to girls aged 12-17 years. Here, we estimate the effectiveness of BV and QV vaccines combined and separately in reducing type-specific HPV prevalence eight years after the introduction of the vaccination program. METHODS: A cross-sectional prevalence study was conducted among women aged 18-29 years in 2015-2017. Seven hundred sixteen participants were recruited at family planning centres or private gynaecology practices in Luxembourg. Vaccination records were verified in the social security database. Cervical samples were tested using the Anyplex II HPV28 assay. Vaccine effectiveness was estimated using logistic regression. RESULTS: In total, 363/716 (50.7%) participants were HPV positive with any HPV and 209/716 (29.2%) with carcinogenic HPV genotypes. HPV vaccination offered high protection against HPV16/18 (adjusted odds ratio (AOR) = 0.13; 95% CI 0.03-0.63), HPV6/11 (AOR = 0.16; 95% CI 0.05-0.48) and cross-protection against HPV31/33/45 (AOR = 0.41; 95% CI 0.18-0.94). The AORs were generally enhanced when only considering vaccination before sexual debut corresponding to AORs: 0.05 (95% CI 0.00-0.88), 0.08 (95% CI 0.02-0.36) and 0.20 (0.06-0.65) against HPV16/18, HPV6/11 and HPV31/33/45, respectively. We observed significant protection against carcinogenic genotypes included in nonavalent vaccine for BV (AOR = 0.29; 95% CI 0.13-0.67), but not for QV (AOR = 0.81; 95% CI 0.47-1.40) (heterogeneity Chi2 P = 0.04). CONCLUSIONS: Our study suggests high effectiveness of HPV vaccination against HPV6/11, HPV16/18 and a cross-protection against HPV31/33/45. Vaccination effectiveness was slightly higher for women vaccinated before sexual debut.


Asunto(s)
Infecciones por Papillomavirus/tratamiento farmacológico , Vacunas contra Papillomavirus/inmunología , Vacunación/métodos , Adolescente , Adulto , Estudios Transversales , Femenino , Humanos , Luxemburgo , Infecciones por Papillomavirus/virología , Adulto Joven
8.
Environ Pollut ; 253: 992-999, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31352191

RESUMEN

While wastewater treatment plants have been identified as the most prominent source of emerging micropollutants in surface waters, prediction of their ambient concentrations remains a challenge. This is due to the variability of loads entering individual treatment plants and of the elimination capacity by the latter as well as potential attenuation in the river network. Although geospatially detailed models exist, they suffer from the same data input uncertainties. Here, we investigated the concentration profiles of 20 emerging pollutants in different river stretches in Luxembourg with variable sanitary pressures. Using carbamazepine as a recalcitrant wastewater indicator, the correlation of the compounds to the latter revealed source and fate variability as well as specific emitters. Relating carbamazepine to sanitary pressure, expressed as the sum of population equivalents in a catchment divided by its surface [PE ha-1] allowed predicting the impact of emerging pollutants on the entire river network. The limited variability of the pollutant profiles allowed for prioritization of impacted stretches depending on the different sanitary pressures at risk quotient exceedance. The main drivers of impact were triclosan, diclofenac, clarithromycine and diuron.


Asunto(s)
Monitoreo del Ambiente , Aguas Residuales/química , Contaminantes Químicos del Agua/análisis , Carbamazepina , Diclofenaco , Contaminantes Ambientales , Luxemburgo , Ríos , Triclosán , Eliminación de Residuos Líquidos
9.
Sci Total Environ ; 684: 113-125, 2019 Sep 20.
Artículo en Inglés | MEDLINE | ID: mdl-31153061

RESUMEN

In forest ecosystems, litter quality is a major driver for soil and understorey characteristics, but elevation, microtopography and subsoil properties may also be important. We tested the importance of each factor in two ancient mixed forests on decalcified marl, dominated by trees with different litter quality such as European hornbeam, with high-palatable litter, and beech, with low-palatable litter. We mapped elevation, differences in local height (microtopography), tree distribution and understorey cover on slopes ranging from crest to bottom, and sampled 200 7 × 7 m grid cells for characteristics of litter input, understorey, topsoil and subsoil. In both forests, elevation decreased gradually, but microtopography showed irregular patterns of depressions and mounds of a few cm below or above average local height. Tree distribution was not affected by elevation or subsoil properties, but clearly by microtopography. Adult beech was abundant on local mounds, while hornbeam was more common in local depressions. Topsoil and understorey characteristics were mainly affected by litter quality (tree species dominance) and microtopography. Litter quality had separate effects from microtopography, but could reinforce this. High litter quality (hornbeam) and low local height both led to high earthworm activity, low litter mass, high erosion, impermeable clay layers close to the surface, high pH, high soil moisture and high diversity of the understorey. Low litter quality (beech) and high local height both led to low earthworm activity, high litter mass, low erosion, low pH, low soil moisture and low plant diversity. Beech and hornbeam may act as ecosystem engineers, which change habitat conditions and local hydrology, and make habitats more suitable to themselves, and/or unsuitable to the other. However, they also increased spatial complexity of the forest and length of the habitat gradient. This may increase forest biodiversity as a whole, but also resilience to prolonged wet or dry periods.


Asunto(s)
Biodiversidad , Bosques , Dispersión de las Plantas , Suelo/química , Árboles/fisiología , Geografía , Luxemburgo
10.
PLoS One ; 14(5): e0215570, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31095576

RESUMEN

BACKGROUND: An outbreak of HIV infections among people who inject drugs (PWID) started in 2014 in Luxembourg. OBJECTIVES: We conducted phylogenetic and epidemiological analyses among the PWID infected with HIV in Luxembourg or attending the supervised drug consumption facility (SDCF) to understand the main causes of the outbreak. METHODS: Between January 2013 and December 2017, analysis of medical files were performed from all PWID infected with HIV at the National Service of Infectious Diseases (NSID) providing clinical care nationwide. PWID were interviewed at NSID and SDCF using a standardized questionnaire focused on drug consumption and risk behaviours. The national drug monitoring system RELIS was consulted to determine the frequency of cocaine/heroin use. Transmission clusters were analysed by phylogenetic analyses using approximate maximum-likelihood. Univariate and multivariate logistic regression analyses were performed on epidemiological data collected at NSID and SDCF to determine risk factors associated with cocaine use. RESULTS: From January 2013 to December 2017, 68 new diagnosis of HIV infection reported injecting drug use as the main risk of transmission at NSID. The proportion of female cases enrolled between 2013-2017 was higher than the proportion among cases enrolled prior to 2013. (33% vs 21%, p < 0.05). Fifty six viral sequences were obtained from the 68 PWID newly diagnosed for HIV. Two main transmission clusters were revealed: one HIV-1 subtype B cluster and one CRF14_BG cluster including 37 and 9 patients diagnosed since 2013, respectively. Interviews from 32/68 (47%) newly diagnosed PWID revealed that 12/32 (37.5%) were homeless and 27/32 (84.4%) injected cocaine. Increased cocaine injection was indeed reported by the RELIS participants from 53 to 63% in drug users with services contacts between 2012 and 2015, and from 5 to 22% in SDCF users between 2012 and 2016. Compared with PWID who injected only heroin (n = 63), PWID injecting cocaine and heroin (n = 107) were younger (mean of 38 vs 44 years, p≤0.001), reported more frequent piercing (≤0.001), shared and injected drugs more often (p≤0.01), and were more frequently HIV positive (p<0.05) at SDCF using univariate logistic regression analysis. Finally, in the multivariate analysis, use of heroin and cocaine was independently associated with younger age, piercing, sharing of drugs, and regular consumption (p<0.05). CONCLUSIONS: Injecting cocaine is a new trend of drug use in Luxembourg associated with HIV infection in this recent outbreak among PWID.


Asunto(s)
Cocaína/administración & dosificación , Brotes de Enfermedades , Infecciones por VIH/epidemiología , Abuso de Sustancias por Vía Intravenosa/epidemiología , Adulto , Cocaína/efectos adversos , Consumidores de Drogas , Femenino , VIH/clasificación , VIH/genética , Infecciones por VIH/transmisión , Humanos , Inyecciones , Modelos Logísticos , Luxemburgo , Masculino , Persona de Mediana Edad , Filogenia , Estudios Retrospectivos , Abuso de Sustancias por Vía Intravenosa/complicaciones
11.
Cardiovasc Diabetol ; 18(1): 33, 2019 03 16.
Artículo en Inglés | MEDLINE | ID: mdl-30878037

RESUMEN

BACKGROUND: To evaluate the characteristics of type 2 diabetes (T2DM) patients with or without chronic kidney disease (CKD) in Germany. METHODS: Using combined DPV/DIVE registry data, the analysis included patients with T2DM at least ≥ 18 years old who had an estimated glomerular filtration rate (eGFR) value available. CKD was defined as an eGFR < 60 mL/min/1.73 m2 or eGFR ≥ 60 mL/min/1.73 m2 and albuminuria (≥ 30 mg/g). Median values of the most recent treatment year per patient are reported. RESULTS: Among 343,675 patients with T2DM 171,930 had CKD. Patients with CKD had a median eGFR of 48.9 mL/min/1.73 m2 and 51.2% had a urinary albumin level ≥ 30 mg/g. They were older, had a longer diabetes duration and a higher proportion was females compared to patients without CKD (all p < 0.001). More than half of CKD patients (53.5%) were receiving long-acting insulin-based therapy versus around 39.1% of those without (p < 0.001). CKD patients also had a higher rate of hypertension (79.4% vs 72.0%; p < 0.001). The most common antihypertensive drugs among CKD patients were renin-angiotensin-aldosteron system inhibitors (angiotensin converting enzyme inhibitors 33.8%, angiotensin receptor blockers 14.2%) and diuretics (40.2%). CKD patients had a higher rate of dyslipidemia (88.4% vs 86.3%) with higher triglyceride levels (157.9 vs 151.0 mg/dL) and lower HDL-C levels (men: 40.0 vs 42.0 mg/dL; women: 46.4 vs 50.0 mg/dL) (all p < 0.001) and a higher rate of hyperkalemia (> 5.5 mmol/L: 3.7% vs. 1.0%). Comorbidities were more common among CKD patients (p < 0.001). CONCLUSION: The results illustrate the prevalence and morbidity burden associated with diabetic kidney disease in patients with T2DM in Germany. The data call for more attention to the presence of chronic kidney disease in patients with diabetes, should trigger intensified risk factor control up and beyond the control of blood glucose and HbA1c in these patients. They may also serve as a trigger for future investigations into this patient population asking for new treatment options to be developed.


Asunto(s)
Albuminuria/epidemiología , Diabetes Mellitus Tipo 2/epidemiología , Nefropatías Diabéticas/epidemiología , Insuficiencia Renal Crónica/epidemiología , Factores de Edad , Anciano , Albuminuria/diagnóstico , Albuminuria/tratamiento farmacológico , Albuminuria/fisiopatología , Antagonistas de Receptores de Angiotensina/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Austria/epidemiología , Comorbilidad , Bases de Datos Factuales , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Nefropatías Diabéticas/diagnóstico , Nefropatías Diabéticas/tratamiento farmacológico , Nefropatías Diabéticas/fisiopatología , Diuréticos/uso terapéutico , Femenino , Alemania/epidemiología , Tasa de Filtración Glomerular , Humanos , Hipoglucemiantes/uso terapéutico , Riñón/fisiopatología , Luxemburgo/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Sistema de Registros , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/tratamiento farmacológico , Insuficiencia Renal Crónica/fisiopatología , Medición de Riesgo , Factores de Riesgo , Factores Sexuales
12.
BMC Med Res Methodol ; 19(1): 27, 2019 02 04.
Artículo en Inglés | MEDLINE | ID: mdl-30717671

RESUMEN

BACKGROUND: It is challenging to manage data collection as planned and creation of opportunities to adapt during the course of enrolment may be needed. This paper aims to summarize the different sampling strategies adopted in the second wave of Observation of Cardiovascular Risk Factors (ORISCAV-LUX, 2016-17), with a focus on population coverage and sample representativeness. METHODS: Data from the first nationwide cross-sectional, population-based ORISCAV-LUX survey, 2007-08 and from the newly complementary sample recruited via different pathways, nine years later were analysed. First, we compare the socio-demographic characteristics and health profiles between baseline participants and non-participants to the second wave. Then, we describe the distribution of subjects across different strategy-specific samples and performed a comparison of the overall ORISCAV-LUX2 sample to the national population according to stratification criteria. RESULTS: For the baseline sample (1209 subjects), the participants (660) were younger than the non-participants (549), with a significant difference in average ages (44 vs 45.8 years; P = 0.019). There was a significant difference in terms of education level (P < 0.0001), 218 (33%) participants having university qualification vs. 95 (18%) non-participants. The participants seemed having better health perception (p < 0.0001); 455 (70.3%) self-reported good or very good health perception compared to 312 (58.2%) non-participants. The prevalence of obesity (P < 0.0001), hypertension (P < 0.0001), diabetes (P = 0.007), and mean values of related biomarkers were significantly higher among the non-participants. The overall sample (1558 participants) was mainly composed of randomly selected subjects, including 660 from the baseline sample and 455 from other health examination survey sample and 269 from civil registry sample (constituting in total 88.8%), against only 174 volunteers (11.2%), with significantly different characteristics and health status. The ORISCAV-LUX2 sample was representative of national population for geographical district, but not for sex and age; the younger (25-34 years) and older (65-79 years) being underrepresented, whereas middle-aged adults being over-represented, with significant sex-specific difference (p < 0.0001). CONCLUSION: This study represents a careful first-stage analysis of the ORISCAV-LUX2 sample, based on available information on participants and non-participants. The ORISCAV-LUX datasets represents a relevant tool for epidemiological research and a basis for health monitoring and evidence-based prevention of cardiometabolic risk in Luxembourg.


Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Encuestas Epidemiológicas/estadística & datos numéricos , Participación del Paciente/estadística & datos numéricos , Selección de Paciente , Adulto , Enfermedades Cardiovasculares/diagnóstico , Estudios Transversales , Femenino , Humanos , Luxemburgo/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo
13.
BMJ Open ; 9(1): e022345, 2019 01 17.
Artículo en Inglés | MEDLINE | ID: mdl-30782678

RESUMEN

INTRODUCTION: In 2011, WHO, the European Union and Luxembourg entered into a collaborative agreement to support policy dialogue for health planning and financing; these were acknowledged as core areas in need of targeted support in countries' quest towards universal health coverage (UHC). Entitled 'Universal Health Coverage Partnership', this intervention is intended to strengthen countries' capacity to develop, negotiate, implement, monitor and evaluate robust and integrated national health policies oriented towards UHC. It is a complex intervention involving a multitude of actors working on a significant number of remarkably diverse activities in different countries. METHODS AND ANALYSIS: The researchers will conduct a realist evaluation to answer the following question: How, in what contexts, and triggering what mechanisms, does the Partnership support policy dialogue for health planning and financing towards UHC? A qualitative multiple case study will be undertaken in Togo, Liberia, Democratic Republic of Congo, Cape Verde, Burkina Faso and Niger. Three steps will be implemented: (1) formulating context-mechanism-outcome explanatory propositions to guide data collection, based on expert knowledge and theoretical literature; (2) collecting empirical data through semistructured interviews with key informants and observations of key events, and analysing data; (3) specifying the intervention theory. ETHICS AND DISSEMINATION: The primary target audiences are WHO and its partner countries; international and national stakeholders involved in or supporting policy dialogues in the health sector, especially in low-income countries; and researchers with interest in UHC, policy dialogue, evaluation research and/or realist evaluation.


Asunto(s)
Reforma de la Atención de Salud/economía , Planificación en Salud/organización & administración , Política de Salud , Cobertura Universal del Seguro de Salud/organización & administración , Burkina Faso , Cabo Verde , República Democrática del Congo , Programas de Gobierno/economía , Reforma de la Atención de Salud/organización & administración , Humanos , Relaciones Interinstitucionales , Liberia , Luxemburgo , Niger , Formulación de Políticas , Proyectos de Investigación , Togo
14.
BMJ Open ; 9(1): e022206, 2019 01 21.
Artículo en Inglés | MEDLINE | ID: mdl-30670502

RESUMEN

OBJECTIVE: The aim of this study was to determine the burden and risk factors of prediabetes and diabetes in the general adult population of Luxembourg. DESIGN: Cross-sectional survey between 2013 and 2015. SETTING: Data were collected as part of the European Health Examination Survey in Luxembourg (EHES-LUX). PARTICIPANTS: 1451 individuals were recruited in a random sample of the 25-64-year-old population of Luxembourg. OUTCOMES: Diabetes was defined by a glycaemic biomarker (fasting plasma glucose (FPG) ≥7.0 mmol/L), self-reported medication and medical diagnosis; prediabetes by a glycaemic biomarker (FPG 5.6-6.9 mmol/L), no self-reported medication and no medical diagnosis. Undiagnosed diabetes was defined only from the glycaemic biomarker; the difference between total and undiagnosed diabetes was defined as diagnosed diabetes. Odds of diabetes and prediabetes as well as associated risk factors were estimated. RESULTS: The weighted prevalence of prediabetes and diabetes was 25.6% and 6.5%, respectively. Nearly 4.8% (men: 5.8%; women: 3.8%) were diagnosed diabetes and 1.7% (men: 2.6%; women: 0.7%) were undiagnosed diabetes. The multivariable-adjusted OR (MVOR) for diabetes risk were: age 1.05 (95% CI 1.01 to 1.09), family history of diabetes 3.24 (1.95-5.38), abdominal obesity 2.63 (1.53-4.52), hypertension 3.18 (1.76-5.72), one-unit increase of triglycerides 1.16 (1.10-1.22) and total cholesterol 0.74 (0.64-0.86). The MVOR for prediabetes risk were: age 1.04 (95% CI 1.02 to 1.06), male sex 1.84 (1.30-2.60), moderate alcohol consumption 1.38 (1.01-1.89), family history of diabetes 1.52 (1.13-2.05), abdominal obesity 1.44 (1.06-1.97), second-generation immigrants 0.61 (0.39-0.95) and a one-unit increase of serum high-density lipoprotein cholesterol 0.70 (0.54-0.90). CONCLUSIONS: In Luxembourg, an unexpectedly high number of adults may be affected by prediabetes and diabetes. Therefore, these conditions should be addressed as a public health priority for the country, requiring measures for enhanced detection and surveillance, which are currently lacking, especially in primary care settings.


Asunto(s)
Costo de Enfermedad , Diabetes Mellitus/epidemiología , Emigrantes e Inmigrantes/estadística & datos numéricos , Estado Prediabético/epidemiología , Salud Pública , Adulto , Distribución por Edad , Glucemia/análisis , Estudios Transversales , Diabetes Mellitus/diagnóstico , Femenino , Encuestas Epidemiológicas , Humanos , Hipertensión/epidemiología , Modelos Logísticos , Luxemburgo/epidemiología , Masculino , Persona de Mediana Edad , Obesidad/epidemiología , Estado Prediabético/diagnóstico , Factores de Riesgo , Distribución por Sexo
15.
Sci Total Environ ; 658: 1531-1538, 2019 Mar 25.
Artículo en Inglés | MEDLINE | ID: mdl-30678011

RESUMEN

Climate warming often results in species range shifts, biodiversity loss and accumulated climatic debts of biota (i.e. slower changes in biota than in temperature). Here, we analyzed the changes in community composition and temperature signature of stream invertebrate communities over 25 years (1990-2014), based on a large set of samples (n = 3782) over large elevation, latitudinal and longitudinal gradients in central Europe. Although warming was moderate (average 0.5 °C), we found a strong reorganization of stream invertebrate communities. Total abundance (+35.9%) and richness (+39.2%) significantly increased. The share of abundance (TA) and taxonomic richness (TR) of warm-dwelling taxa (TA: +73.2%; TR: +60.2%) and medium-temperature-dwelling taxa (TA: +0.4%; TR: +5.8%) increased too, while cold-dwelling taxa declined (TA: -61.5%; TR: -47.3%). The community temperature index, representing the temperature signature of stream invertebrate communities, increased at a similar pace to physical temperature, indicating a thermophilization of the communities and, for the first time, no climatic debt. The strongest changes occurred along the altitudinal gradient, suggesting that stream invertebrates use the spatial configuration of river networks to track their temperature niche uphill. Yet, this may soon come to an end due to the summit trap effect. Our results indicate an ongoing process of replacement of cold-adapted species by thermophilic species at only 0.5 °C warming, which is particularly alarming in the light of the more drastic climate warming projected for coming decades.


Asunto(s)
Biota , Calentamiento Global , Invertebrados , Ríos , Animales , Austria , Cambio Climático , República Checa , Alemania , Luxemburgo , Temperatura
16.
Arch Dis Child ; 104(4): 354-359, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-30327331

RESUMEN

OBJECTIVES: To investigate the frequency of coeliac disease (CD)-specific human leucocyte antigen (HLA) genotypes in paediatric patients with type 1 diabetes (T1D), who are known to have a higher prevalence of CD than the general population, and to evaluate whether HLA genotyping is a suitable first-line screening method for CD. STUDY DESIGN: The study was a multicentre observational analysis of patients with T1D aged <20 years of whom a subgroup had undergone HLA genotyping. Patient data were retrieved from the Diabetes Prospective Follow-up database, a large diabetes follow-up registry. The present analysis included data from 439 centres throughout Germany, Austria, Switzerland and Luxembourg. RESULTS: In March 2017, the database contained 75 202 patients with T1D (53% male, mean age (SD) 14.6 (4.1) years, mean age at diagnosis 8.8 (4.3) years and mean diabetes duration 5.8 (4.3) years). 1624 patients had undergone coeliac-specific HLA genotyping, of whom 1344 (82.8%) were positive for HLA-DQ2, HLA-DQ8 or both, while 17.2% had no coeliac-specific HLA-markers. 26.6% of at-risk patients had a clinical suspected diagnosis of CD, and 3.6% had biopsy-proven CD. CONCLUSIONS: Genotyping for HLA-DQ2, HLA-DQ8 or both is positive in the vast majority (>80%) of patients with T1D. Therefore, screening for coeliac-specific HLA genotypes as a first-line test is not a suitable method to exclude CD in T1D. Regular screening for coeliac-specific antibodies in T1D is still recommended.


Asunto(s)
Enfermedad Celíaca/diagnóstico , Diabetes Mellitus Tipo 1/complicaciones , Adolescente , Austria , Enfermedad Celíaca/complicaciones , Enfermedad Celíaca/inmunología , Niño , Diabetes Mellitus Tipo 1/inmunología , Diagnóstico Precoz , Femenino , Genotipo , Alemania , Antígenos HLA-DQ/genética , Prueba de Histocompatibilidad , Humanos , Luxemburgo , Masculino , Suiza
17.
Diabetes Metab ; 45(2): 140-151, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-29249613

RESUMEN

AIM: To investigate the relationship between metabolically healthy and unhealthy weight statuses and a wide range of related health issues, and healthcare and loss-of-productivity costs. METHODS: A total of 693 men and 729 women, aged 25-64 years, took part in the European Health Examination Survey conducted in Luxembourg between 2013 and 2015. Metabolically unhealthy normal-weight profiles were defined as having two or more cardiometabolic abnormalities (high blood pressure, high fasting glucose or triglycerides, low HDL cholesterol and/or previously diagnosed hypertension or diabetes) in people with normal weight. Metabolically healthy overweight/obesity was defined as having fewer than two of the above-mentioned abnormalities in people with overweight or obesity. For the present report, the participants' anthropometric, clinical, biological, sociodemographic, lifestyle and health-related data were analyzed. RESULTS: Of the participants with normal weight, 20% had a metabolically unhealthy profile, whereas 60% with overweight and 30% with obesity had a metabolically healthy profile. Comparisons between metabolically healthy and unhealthy normal weight, overweight and/or obesity status revealed that participants presented with a metabolically unhealthy profile independently of weight status (P<0.0001). People with a metabolically healthy profile were more likely to perceive their health as good (66%; P<0.0001), and to report no physical pain (64%; P=0.03), no limitations in daily activities (66%; P=0.0008), no difficulties getting in or out of a bed or chair (63%; P=0.02) or dressing and undressing (63%; P=0.003), going shopping (63%; P=0.053) or doing occasional heavy housework (64%; P=0.007); they also displayed fewer gastrointestinal (63%; P=0.02), arthrosis (64%; P=0.001) and sleep apnoea issues (63%; P=0.002) compared with those with a metabolically unhealthy profile. Healthcare- and loss-of-productivity-related costs were higher with a metabolically unhealthy profile, with differences of up to € 3000 (P=0.02). CONCLUSION: The present work has highlighted that, independently of weight status, people may develop a metabolically unhealthy profile associated with several health issues as well as higher healthcare and loss-of-productivity costs.


Asunto(s)
Costos de la Atención en Salud/estadística & datos numéricos , Estado de Salud , Peso Corporal Ideal/fisiología , Obesidad Metabólica Benigna/epidemiología , Obesidad/epidemiología , Sobrepeso/epidemiología , Adulto , Índice de Masa Corporal , Peso Corporal/fisiología , Femenino , Encuestas Epidemiológicas , Humanos , Estilo de Vida , Luxemburgo/epidemiología , Masculino , Persona de Mediana Edad , Obesidad/complicaciones , Obesidad/economía , Obesidad/metabolismo , Obesidad Metabólica Benigna/economía , Obesidad Metabólica Benigna/metabolismo , Sobrepeso/complicaciones , Sobrepeso/economía , Sobrepeso/metabolismo
18.
Crisis ; 40(2): 100-114, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30109963

RESUMEN

BACKGROUND: Bullying and suicidality are serious worldwide problems with negative effects on the young population and therefore international comparisons in this field are of paramount importance. AIMS: To analyze the prevalence of bullying and cyberbullying and their association with suicidal behavior among school-aged children in Israel, Lithuania, and Luxembourg. METHOD: In total, 3,814 15-year-olds from schools in Israel, Lithuania, and Luxembourg were surveyed in the Health Behavior in School-Aged Children (HBSC) cross-national survey in 2013/2014 using standardized anonymous questionnaires. Data analysis employed logistic regression and structural equation modeling (SEM). RESULTS: In all, 6.5% of the adolescents reported being cyberbullied, 15.6% reported being bullied at school. In the previous 12 months, 38.6% reported experiencing emotions that stopped them from doing their usual activities, 17.8% considered attempting suicide, 12.0% made a suicide plan, and 9.5% attempted suicide. Victims of cyberbullying and school bullying had a significantly higher risk of suicidal ideations, plans, and attempts. The SEM analysis confirmed a significant overall effect of bullying on adolescent suicidality. The strongest effect was seen among Israeli students. LIMITATIONS: The prevalence estimates were obtained by self-report. CONCLUSION: The prevalence of adolescent cyberbullying, school bullying, and suicidal behavior is relatively high in Israel, Lithuania, and Luxembourg. Cyberbullying is a strong predictor of adolescent suicidality.


Asunto(s)
Acoso Escolar/estadística & datos numéricos , Internet , Instituciones Académicas , Ideación Suicida , Intento de Suicidio/estadística & datos numéricos , Adolescente , Acoso Escolar/psicología , Estudios Transversales , Femenino , Humanos , Israel/epidemiología , Lituania/epidemiología , Luxemburgo/epidemiología , Masculino , Intento de Suicidio/psicología , Encuestas y Cuestionarios
19.
Trials ; 19(1): 665, 2018 Dec 04.
Artículo en Inglés | MEDLINE | ID: mdl-30509293

RESUMEN

BACKGROUND: In attempting to achieve optimal metabolic control, the day-to-day management is challenging for a child with type 1 diabetes (T1D) and his family and can have a major negative impact on their quality of life. Augmenting an insulin pump with glucose sensor information leads to improved outcomes: decreased haemoglobin A1c levels, increased time in glucose target and less hypoglycaemia. Fear of nocturnal hypoglycaemia remains pervasive amongst parents, leading to chronic sleep interruption and lack of sleep for the parents and their children. The QUEST study, an open-label, single-centre randomized crossover study, aims to evaluate the impact on time in target, in hypoglycaemia and hyperglycaemia and the effect on sleep and quality of life in children with T1D, comparing a sensor-augmented pump (SAP) with predictive low glucose suspend and alerts to the use of the same insulin pump with a flash glucose measurement (FGM) device not interacting with the pump. METHODS/DESIGN: Subjects meeting the inclusion criteria are randomized to treatment with the SAP or treatment with an insulin pump and independent FGM for 5 weeks. Following a 3-week washout period, the subjects cross over to the other study arm for 5 weeks. During the week before and in the last week of treatment, the subjects and one of their caregivers wear a sleep monitor in order to obtain sleep data. The primary endpoint is the between-arm difference in percentage of time in glucose target during the final 6 days of each treatment arm, measured by a blinded continuous glucose measurement (CGM). Additional endpoints include comparison of quantity and quality of sleep as well as quality of life perception of the subjects and one of their caregivers in the two different treatment arms. Recruitment started in February 2017. A total of 36 patients are planned to be randomized. The study recruitment was completed in April 2018. DISCUSSION: With this study we will provide more information on whether insulin pump treatment combined with more technology (SmartGuard® feature and alerts) leads to better metabolic control. The inclusion of indicators on quality of sleep with less sleep interruption, less lack of sleep and perception of quality of life in both children and their primary caregivers is essential for this study and might help to guide us to further treatment improvement. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03103867 . Registered on 6 April 2017.


Asunto(s)
Glucemia/efectos de los fármacos , Cuidadores , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Hipoglucemiantes/administración & dosificación , Sistemas de Infusión de Insulina , Insulina/administración & dosificación , Padres , Privación de Sueño/prevención & control , Sueño , Adolescente , Factores de Edad , Biomarcadores/sangre , Glucemia/metabolismo , Automonitorización de la Glucosa Sanguínea , Niño , Estudios Cruzados , Diabetes Mellitus Tipo 1/sangre , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 1/diagnóstico , Femenino , Humanos , Hipoglucemia/sangre , Hipoglucemia/inducido químicamente , Hipoglucemiantes/efectos adversos , Insulina/efectos adversos , Luxemburgo , Masculino , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Privación de Sueño/diagnóstico , Privación de Sueño/etiología , Privación de Sueño/fisiopatología , Factores de Tiempo , Resultado del Tratamiento
20.
PLoS One ; 13(11): e0206510, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30383839

RESUMEN

OBJECTIVE: This study evaluates the actual blood pressure control rate and its estimation by general practitioners, the use of single-pill or free combinations, and the attitude towards single-pill combinations in primary care. METHODS: Cross-sectional observational survey in primary care between January 2015 and September 2016 in Belgium and Luxembourg. The participating general practitioners enrolled hypertensive patients taking at least 2 antihypertensive molecules (as fixed or free associations). RESULTS: 742 general practitioners included a total of 8,006 patients, with a mean age of 66 ± 12 years. Systolic blood pressure and diastolic blood pressure were respectively 141 ± 17 mmHg and 82 ± 10 mmHg (means ± SD). These patients had a blood pressure control rate of 45%, whereas it was estimated by general practitioners to be 60%. General practitioners with 11-25 years' experience performed better than general practitioners with 36-51 years' experience in the evaluation of blood pressure control. Combinations used were free in 39%, single-pill in 34% and mixed in 27% of the patients. Patients receiving single-pill combinations were younger than those treated with free combinations (63 ± 12 vs. 68 ± 12 years, p < 0.001), with fewer comorbidities (39 vs. 55%, p < 0.001). In patients treated solely with free pill associations, 66% of patient cases, general practitioners were willing to switch to a single-pill combination. The main reasons were improved adherence (76%) and better blood pressure control (64%). CONCLUSION: In patients requiring at least two antihypertensive drugs, blood pressure control rate remains low and is overestimated by general practitioners. Free combinations remain largely used although many general practitioners seem willing to shift to single-pill combinations. Treatment simplification could improve adherence and blood pressure control rate, which has been shown to lead to reduced morbidity and mortality.


Asunto(s)
Antihipertensivos/administración & dosificación , Presión Sanguínea , Médicos Generales/estadística & datos numéricos , Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , Cumplimiento de la Medicación/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Bélgica/epidemiología , Presión Sanguínea/efectos de los fármacos , Determinación de la Presión Sanguínea/estadística & datos numéricos , Competencia Clínica/estadística & datos numéricos , Estudios Transversales , Combinación de Medicamentos , Quimioterapia Combinada , Femenino , Humanos , Hipertensión/fisiopatología , Luxemburgo/epidemiología , Masculino , Persona de Mediana Edad , Planificación de Atención al Paciente/estadística & datos numéricos , Atención Primaria de Salud , Encuestas y Cuestionarios , Resultado del Tratamiento
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