1
|
Vedanthan R, Ray M, Fuster V, Magenheim E. Hypertension Treatment Rates and Health Care Worker Density. Hypertension 2019; 73:594-601. [PMID: 30612489 PMCID: PMC6374168 DOI: 10.1161/hypertensionaha.118.11995] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 12/13/2018] [Indexed: 11/16/2022]
Abstract
Elevated blood pressure is the leading cause of death worldwide; however, treatment and control rates for hypertension are low. Here, we analyze the relationship between physician and nurse density and hypertension treatment rates worldwide. Data on hypertension treatment rates were collected from the STEPwise approach to Surveillance country reports, individual studies resulting from a PubMed search for articles published between 1990 and 2010, and manual search of the reference lists of extracted studies. Data on health care worker density were obtained from the Global Atlas of the Health Workforce. We controlled for a variety of variables related to population characteristics and access to health care, data obtained from the World Bank, World Development Indicators, United Nations, and World Health Organization. We used clustering of SEs at the country level. Full data were available for 154 hypertension treatment rate values representing 68 countries between 1990 and 2010. Hypertension treatment rate ranged from 3.4% to 82.5%, with higher treatment rates associated with higher income classification. Physician and nurse/midwife generally increased with income classification. Total healthcare worker density was significantly associated with hypertension treatment rate in the unadjusted model ( P<0.001); however, only nurse density remained significant in the fully adjusted model ( P=0.050). These analyses suggest that nurse density, not physician density, explains most of the relationship with hypertension treatment rate and remains significant even after adjusting for other independent variables. These results have important implications for health policy, health system design, and program implementation.
Collapse
Affiliation(s)
| | - Mondira Ray
- University of Pittsburgh School of Medicine, Pennsylvania, USA
| | | | | |
Collapse
|
2
|
Fiz F, Bauckneht M, Piccardo A, Campi C, Nieri A, Piva R, Ferrarazzo G, Artom N, Morbelli S, Marini C, Piana M, Bagnasco M, Canepa M, Sambuceti G. Metabolic and densitometric correlation between atherosclerotic plaque and trabecular bone: an 18F-Natrium-Fluoride PET/CT study. AMERICAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING 2018; 8:387-396. [PMID: 30697458 PMCID: PMC6334207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 10/24/2018] [Indexed: 06/09/2023]
Abstract
Increasing evidence links atherosclerosis to a decreased bone thickness. This correlation could reflect a bone/plaque interaction. Hereby we analyzed Hounsfield density (HU) and mineral turnover in bone and in the arterial calcifications (AC), using a computational method applied to PET/CT data. 79 18F-NaF PET/CT from patients with AC were retrospectively analyzed. Mean AC density and background-corrected uptake (TBR) were estimated after semi-automatic isocontour segmentation. The same values were assessed in the trabecular bone, using an automatic adaptive thresholding method. Patients were then stratified into terciles, according to their mean HU plaque density ("light", "medium" or "heavy" calcifications"). 35 18F-NaF PET/CT from patients without AC served as controls. Vertebral density and TBR were lower in patients than in controls (137±25 vs. 160±14 HU, P<0.001); (6.2±3.9 vs. 8.4±3.4, P<0.05). Mean trabecular TBR values were 8.3±4, 4.5±2.1 and 3.5±1.8 in light, medium and heavy AC groups, respectively (P<0.05 for light vs. medium and P<0.01 for light vs. heavy). Similarly, mean trabecular HU was 143±19, 127±26 and 119±18 in the three groups, respectively (P<0.01 for light vs. heavy). Mean AC density was inversely associated with the trabecular HU (R=-0.56, P<0.01). Conversely, plaques' TBR directly correlated with the one in trabecular bone (R=0.63, P<0.001). At multivariate analysis, the sole predictor of vertebral density was plaque HU (P<0.05). Our data highlight a correlation between plaque and bone morpho-functional parameters and suggest that observing skeletal bone characteristics could represent a novel window on atherosclerosis pathophysiology.
Collapse
Affiliation(s)
- Francesco Fiz
- Department of Internal Medicine, University of GenoaItaly
- Nuclear Medicine Unit, Department of Radiology, University of TübingenGermany
| | - Matteo Bauckneht
- Nuclear Medicine Unit, Department of Health Sciences, University of GenoaItaly
| | | | - Cristina Campi
- Nuclear Medicine Unit, Department of Medicine-DIMED, University Hospital of PaduaItaly
| | - Alberto Nieri
- Nuclear Medicine Unit, Department of Health Sciences, University of GenoaItaly
| | - Roberta Piva
- Nuclear Medicine Unit, Department of Health Sciences, University of GenoaItaly
| | - Giulia Ferrarazzo
- Nuclear Medicine Unit, Department of Health Sciences, University of GenoaItaly
| | - Nathan Artom
- Department of Internal Medicine, Local Healthcare UnitSavona, Italy
| | - Silvia Morbelli
- Nuclear Medicine Unit, Department of Health Sciences, University of GenoaItaly
| | | | - Michele Piana
- CNR-SPINGenoa, Italy
- Department of Mathematics, University of GenoaItaly
| | | | - Marco Canepa
- Department of Cardiology, University of GenoaItaly
| | - Gianmario Sambuceti
- Nuclear Medicine Unit, Department of Health Sciences, University of GenoaItaly
| |
Collapse
|
3
|
Steiner J, Guest PC, Martins-de-Souza D. Application of Proteomic Techniques for Improved Stratification and Treatment of Schizophrenia Patients. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 974:3-19. [PMID: 28353222 DOI: 10.1007/978-3-319-52479-5_1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
For major psychiatric disorders such as schizophrenia, there have been shortcomings in the translation of scientific findings into new treatments and this has led to diminished interest for large pharmaceutical companies. This chapter describes how incorporation of proteomic approaches into the clinical pipeline can lead to identification and implementation of biomarker tests for improved patient characterization, prediction of treatment response and monitoring treatment effects to help revitalize efforts in this important area. In addition, the construction of specific biomarker tests for disease prediction should smooth the progress of early intervention strategies which, in turn, may help to slow disease onset or progression. Finally, the development of purpose-built biomarker tests using lab-on-a-chip platforms with smartphone readouts will help to shift the diagnosis and treatment of this major psychiatric disorder into point-of-care settings for increased effectiveness and improved patient outcomes.
Collapse
Affiliation(s)
- Johann Steiner
- Department of Psychiatry, University of Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany.
| | - Paul C Guest
- Laboratory of Neuroproteomics, Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas (UNICAMP), Rua Monteiro Lobato 255 F/01, Cidade Universitária Zeferino Vaz, 13083-862, Campinas, Brazil
| | - Daniel Martins-de-Souza
- Laboratory of Neuroproteomics, Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas (UNICAMP), Rua Monteiro Lobato 255 F/01, Cidade Universitária Zeferino Vaz, 13083-862, Campinas, Brazil.,UNICAMP's Neurobiology Center, Rua Monteiro Lobato 255, Cidade Universitária Zeferino Vaz, 13083-862, Campinas, Brazil
| |
Collapse
|
4
|
Schmitt A, Martins-de-Souza D, Akbarian S, Cassoli JS, Ehrenreich H, Fischer A, Fonteh A, Gattaz WF, Gawlik M, Gerlach M, Grünblatt E, Halene T, Hasan A, Hashimoto K, Kim YK, Kirchner SK, Kornhuber J, Kraus TFJ, Malchow B, Nascimento JM, Rossner M, Schwarz M, Steiner J, Talib L, Thibaut F, Riederer P, Falkai P. Consensus paper of the WFSBP Task Force on Biological Markers: Criteria for biomarkers and endophenotypes of schizophrenia, part III: Molecular mechanisms. World J Biol Psychiatry 2017; 18:330-356. [PMID: 27782767 DOI: 10.1080/15622975.2016.1224929] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Despite progress in identifying molecular pathophysiological processes in schizophrenia, valid biomarkers are lacking for both the disease and treatment response. METHODS This comprehensive review summarises recent efforts to identify molecular mechanisms on the level of protein and gene expression and epigenetics, including DNA methylation, histone modifications and micro RNA expression. Furthermore, it summarises recent findings of alterations in lipid mediators and highlights inflammatory processes. The potential that this research will identify biomarkers of schizophrenia is discussed. RESULTS Recent studies have not identified clear biomarkers for schizophrenia. Although several molecular pathways have emerged as potential candidates for future research, a complete understanding of these metabolic pathways is required to reveal better treatment modalities for this disabling condition. CONCLUSIONS Large longitudinal cohort studies are essential that pair a thorough phenotypic and clinical evaluation for example with gene expression and proteome analysis in blood at multiple time points. This approach might identify biomarkers that allow patients to be stratified according to treatment response and ideally also allow treatment response to be predicted. Improved knowledge of molecular pathways and epigenetic mechanisms, including their potential association with environmental influences, will facilitate the discovery of biomarkers that could ultimately be effective tools in clinical practice.
Collapse
Affiliation(s)
- Andrea Schmitt
- a Department of Psychiatry and Psychotherapy , LMU Munich , Germany.,b Laboratory of Neuroscience (LIM27) , Institute of Psychiatry, University of Sao Paulo , Sao Paulo , Brazil
| | - Daniel Martins-de-Souza
- b Laboratory of Neuroscience (LIM27) , Institute of Psychiatry, University of Sao Paulo , Sao Paulo , Brazil.,c Laboratory of Neuroproteomics, Department of Biochemistry , Institute of Biology University of Campinas (UNICAMP), Campinas , SP , Brazil
| | - Schahram Akbarian
- d Division of Psychiatric Epigenomics, Departments of Psychiatry and Neuroscience , Mount Sinai School of Medicine , New York , USA
| | - Juliana S Cassoli
- c Laboratory of Neuroproteomics, Department of Biochemistry , Institute of Biology University of Campinas (UNICAMP), Campinas , SP , Brazil
| | - Hannelore Ehrenreich
- e Clinical Neuroscience , Max Planck Institute of Experimental Medicine, DFG Centre for Nanoscale Microscopy & Molecular Physiology of the Brain , Göttingen , Germany
| | - Andre Fischer
- f Research Group for Epigenetics in Neurodegenerative Diseases , German Centre for Neurodegenerative Diseases (DZNE), Göttingen , Germany.,g Department of Psychiatry and Psychotherapy , University Medical Centre Göttingen , Germany
| | - Alfred Fonteh
- h Neurosciences , Huntington Medical Research Institutes , Pasadena , CA , USA
| | - Wagner F Gattaz
- b Laboratory of Neuroscience (LIM27) , Institute of Psychiatry, University of Sao Paulo , Sao Paulo , Brazil
| | - Michael Gawlik
- i Department of Psychiatry and Psychotherapy , University of Würzburg , Germany
| | - Manfred Gerlach
- j Centre for Mental Health, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy , University of Würzburg , Germany
| | - Edna Grünblatt
- i Department of Psychiatry and Psychotherapy , University of Würzburg , Germany.,k Department of Child and Adolescent Psychiatry and Psychotherapy , Psychiatric Hospital, University of Zürich , Switzerland.,l Neuroscience Centre Zurich , University of Zurich and the ETH Zurich , Switzerland.,m Zurich Centre for Integrative Human Physiology , University of Zurich , Switzerland
| | - Tobias Halene
- d Division of Psychiatric Epigenomics, Departments of Psychiatry and Neuroscience , Mount Sinai School of Medicine , New York , USA
| | - Alkomiet Hasan
- a Department of Psychiatry and Psychotherapy , LMU Munich , Germany
| | - Kenij Hashimoto
- n Division of Clinical Neuroscience , Chiba University Centre for Forensic Mental Health , Chiba , Japan
| | - Yong-Ku Kim
- o Department of Psychiatry , Korea University, College of Medicine , Republic of Korea
| | | | - Johannes Kornhuber
- p Department of Psychiatry and Psychotherapy , Friedrich-Alexander-University Erlangen-Nuremberg , Erlangen , Germany
| | | | - Berend Malchow
- a Department of Psychiatry and Psychotherapy , LMU Munich , Germany
| | - Juliana M Nascimento
- c Laboratory of Neuroproteomics, Department of Biochemistry , Institute of Biology University of Campinas (UNICAMP), Campinas , SP , Brazil
| | - Moritz Rossner
- r Department of Psychiatry, Molecular and Behavioural Neurobiology , LMU Munich , Germany.,s Research Group Gene Expression , Max Planck Institute of Experimental Medicine , Göttingen , Germany
| | - Markus Schwarz
- t Institute for Laboratory Medicine, LMU Munich , Germany
| | - Johann Steiner
- u Department of Psychiatry , University of Magdeburg , Magdeburg , Germany
| | - Leda Talib
- b Laboratory of Neuroscience (LIM27) , Institute of Psychiatry, University of Sao Paulo , Sao Paulo , Brazil
| | - Florence Thibaut
- v Department of Psychiatry , University Hospital Cochin (site Tarnier), University of Paris-Descartes, INSERM U 894 Centre Psychiatry and Neurosciences , Paris , France
| | - Peter Riederer
- w Center of Psychic Health; Department of Psychiatry, Psychosomatics and Psychotherapy , University Hospital of Würzburg , Germany
| | - Peter Falkai
- a Department of Psychiatry and Psychotherapy , LMU Munich , Germany
| | | |
Collapse
|
5
|
Steiner J, Guest PC, Rahmoune H, Martins-de-Souza D. The Application of Multiplex Biomarker Techniques for Improved Stratification and Treatment of Schizophrenia Patients. Methods Mol Biol 2017; 1546:19-35. [PMID: 27896755 DOI: 10.1007/978-1-4939-6730-8_2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In the case of major psychiatric disorders such as schizophrenia, shortcomings in the conversion of scientific discoveries into newer and safer treatment options has led to a loss of confidence and precipitated a crisis for large pharmaceutical companies. This chapter describes how incorporation of multiplex biomarker approaches into the clinical pipeline can lead to better patient characterization, delivery of novel treatment approaches and help to renew efforts in this important area. The development of specific biomarker test panels for disease prediction should facilitate early intervention strategies, which may help to slow disease development or progression. Furthermore, the development of such tests using lab-on-a-chip and smartphone platforms will help to shift diagnosis and treatment of this major disorder into a point-of-care setting for improved patient outcomes.
Collapse
Affiliation(s)
- Johann Steiner
- Department of Psychiatry, University of Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany.
| | - Paul C Guest
- Laboratory of Neuroproteomics, Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas (UNICAMP), Rua Monteiro Lobato 255, Cidade Universitária Zeferino Vaz, 13083-862, Campinas, Brazil
| | - Hassan Rahmoune
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Pembroke Street, Cambridge, UK
| | - Daniel Martins-de-Souza
- Laboratory of Neuroproteomics, Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas (UNICAMP), Rua Monteiro Lobato 255, Cidade Universitária Zeferino Vaz, 13083-862, Campinas, SP, Brazil
| |
Collapse
|
6
|
Gianturco L, Bodini BD, Atzeni F, Colombo C, Stella D, Sarzi-Puttini P, Drago L, Galaverna S, Turiel M. Cardiovascular and autoimmune diseases in females: The role of microvasculature and dysfunctional endothelium. Atherosclerosis 2015; 241:259-63. [PMID: 25863777 DOI: 10.1016/j.atherosclerosis.2015.03.044] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 03/25/2015] [Accepted: 03/30/2015] [Indexed: 12/15/2022]
Abstract
Cardiovascular (CV) diseases are becoming increasingly frequent and associated with a high incidence of CV events, disability and death. It is known that there is a relationship between CV burden and systemic autoimmune diseases (SADs) that is mainly due to inflammation and autoimmunity, but the other mechanisms underlying the high CV risk of SAD patients have not yet been fully clarified. The aim of this review article is to discuss some of the specific factors associated with the accelerated atherosclerosis (ATS) characterising SADs (female sex, the microcirculation and the endothelium) in order to highlight the importance of an early diagnosis and the prompt implementation of preventive measures, as well as the possible role of new therapeutic strategies such as vaccine immunomodulation. Finally, as the natural history of ATS begins with endothelial injury (a potentially reversible process that is influenced by various factors) and microvascular damage plays a central role in the etiopathogenesis of SADs, it underlines the crucial need for the development of reliable means of detecting sub-clinical abnormalities in the microcirculation, particularly coronary microcirculation dysfunction.
Collapse
Affiliation(s)
- L Gianturco
- IRCCS Galeazzi Orthopedic Institute, Cardiology Unit, Milan, Italy
| | - B D Bodini
- IRCCS Galeazzi Orthopedic Institute, Rehabilitation Unit, Milan, Italy
| | - F Atzeni
- L. Sacco University Hospital, Rheumatology Unit, Milan, Italy; IRCCS Galeazzi Orthopedic Institute, Milan, Italy
| | - C Colombo
- IRCCS Galeazzi Orthopedic Institute, Cardiology Unit, Milan, Italy
| | - D Stella
- IRCCS Galeazzi Orthopedic Institute, Cardiology Unit, Milan, Italy
| | - P Sarzi-Puttini
- L. Sacco University Hospital, Rheumatology Unit, Milan, Italy
| | - L Drago
- Clinical-chemistry and Microbiology Lab., IRCCS Galeazzi Orthopedic Institute, University of Milan, Milan, Italy
| | - S Galaverna
- IRCCS Galeazzi Orthopedic Institute, Cardiology Unit, Milan, Italy
| | - M Turiel
- IRCCS Galeazzi Orthopedic Institute, Cardiology Unit, Milan, Italy.
| |
Collapse
|