Appointment keeping for medical review among patients with selected chronic diseases in an urban area of Uganda

Introduction: proper management of chronic diseases is important for prevention of disease complications and yet some patients miss appointments for medical review thereby missing the opportunity for proper monitoring of their disease conditions. There is limited information on missed appointments among chronic disease patients in resource limited settings. This study aimed to determine the prevalence of missed appointments for medical review and associated factors among chronic disease patients in an urban area of Uganda.

Methods: patients or caregivers of children with chronic diseases were identified as they bought medicines from a community pharmacy. They were visited at home to access their medical documents and those whose chronic disease status was ascertained were enrolled. The data was collected using: questionnaires, review of medical documents, and in-depth interviews with chronic disease patients.

Results: the prevalence of missed appointments was 42% (95%CI=35-49%). The factors associated with missed appointments were: monthly income ?30US Dollars (OR=2.56, CI=1.25–5.26), affording less than half of prescribed drugs (OR=3.92, CI=1.64–9.40), not experiencing adverse events (OR=2.66, CI=1.26–5.61), not sure if treatment helps (OR=2.84, CI=1.047.77), not having a medicines administration schedule (OR=6.77, CI=2.11–21.68), and increasing number of drugs (OR=0.72, CI=0.53–0.98). Conclusion: patients missed appointments mainly due to: financial and health system barriers, conflicting commitments with appointments, and perceptions of the disease condition. Patients should be supported with accessible and affordable health services.

Clinical trial designs for rare diseases: Studies developed and discussed by the International Rare Cancers Initiative

BACKGROUND: The past three decades have seen rapid improvements in the diagnosis and treatment of most cancers and the most important contributor has been research. Progress in rare cancers has been slower, not least because of the challenges of undertaking research.

SETTINGS: The International Rare Cancers Initiative (IRCI) is a partnership which aims to stimulate and facilitate the development of international clinical trials for patients with rare cancers. It is focused on interventional--usually randomized--clinical trials with the clear goal of improving outcomes for patients. The key challenges are organisational and methodological. A multi-disciplinary workshop to review the methods used in ICRI portfolio trials was held in Amsterdam in September 2013. Other as-yet unrealised methods were also discussed.

RESULTS: The IRCI trials are each presented to exemplify possible approaches to designing credible trials in rare cancers. Researchers may consider these for use in future trials and understand the choices made for each design.

INTERPRETATION: Trials can be designed using a wide array of possibilities. There is no 'one size fits all' solution. In order to make progress in the rare diseases, decisions to change practice will have to be based on less direct evidence from clinical trials than in more common diseases.

Manipulating the Bones: eating and augury in the Maltese Temples

Paper exploring the role of animals and food in the development of feasting ritual in Neolithic Malta

Lead concentrations in bones and feathers of the globally threatened Spanish imperial eagle

Raptors that consume game species may ingest lead fragments or shot embedded in their prey's flesh. Threatened Spanish imperial eagles Aquila adalberti feed on greylag geese in southern Spain in winter, and often ingest lead shot. We analysed bone and feather samples from 65 Spanish imperial eagle museum specimens collected between 1980 and 1999, to investigate the prevalence of elevated lead concentrations. Four of 34 birds (12%) had very elevated bone lead concentrations. All four birds were young and the concentrations were outliers to the distribution, suggesting probable exposure to lead gunshot. Excluding these elevated lead outliers, bone lead concentrations were correlated with the bird's age at death. Three of 41 feathers (7%) had elevated lead concentrations, indicative of high exposure during feather formation. When these outliers were omitted, feather lead concentration was correlated with the age of museum specimens, suggesting that a high proportion of feather lead was exogenous, deposited after specimen collection. Therefore, careful interpretation of feather lead concentrations is required to separate endogenous and exogenous lead. We discuss the potential significance of lead poisoning in Spanish imperial eagles and other raptors, and recommend measures for its reduction. © 2004 Elsevier Ltd. All rights reserved.

The macroeconomic impact of non-communicable diseases in China and India: Estimates, projections, and comparisons

This study provides estimates of the macroeconomic impact of non-communicable diseases (NCDs) inChina and India for the period 2012–2030. Our estimates are derived using the World Health Organization’sEPIC model of economic growth, which focuses on the negative effects of NCDs on labor supply andcapital accumulation. We present results for the five main NCDs (cardiovascular disease, cancer, chronicrespiratory disease, diabetes, and mental health). Our undiscounted estimates indicate that the cost ofthe five main NCDs will total USD 23.03 trillion for China and USD 4.58 trillion for India (in 2010 USD).For both countries, the most costly domain is cardiovascular disease. Our analyses also reveal that thecosts are much larger in China than in India mainly because of China’s higher and steeper income trajectory,and to a lesser extent its older population. Rough calculations also indicate that WHO’s best buys foraddressing the challenge of NCDs are highly cost-beneficial

Abundant genetic overlap between blood lipids and immune-mediated diseases indicates shared molecular genetic mechanisms

Epidemiological studies suggest a relationship between blood lipids and immune-mediated diseases, but the nature of these associations is not well understood. We used genome-wide association studies (GWAS) to investigate shared single nucleotide polymorphisms (SNPs) between blood lipids and immune-mediated diseases. We analyzed data from GWAS (n~200,000 individuals), applying new False Discovery Rate (FDR) methods, to investigate genetic overlap between blood lipid levels [triglycerides (TG), low density lipoproteins (LDL), high density lipoproteins (HDL)] and a selection of archetypal immune-mediated diseases (Crohn's disease, ulcerative colitis, rheumatoid arthritis, type 1 diabetes, celiac disease, psoriasis and sarcoidosis). We found significant polygenic pleiotropy between the blood lipids and all the investigated immune-mediated diseases. We discovered several shared risk loci between the immune-mediated diseases and TG (n = 88), LDL (n = 87) and HDL (n = 52). Three-way analyses differentiated the pattern of pleiotropy among the immune-mediated diseases. The new pleiotropic loci increased the number of functional gene network nodes representing blood lipid loci by 40%. Pathway analyses implicated several novel shared mechanisms for immune pathogenesis and lipid biology, including glycosphingolipid synthesis (e.g. FUT2) and intestinal host-microbe interactions (e.g. ATG16L1). We demonstrate a shared genetic basis for blood lipids and immune-mediated diseases independent of environmental factors. Our findings provide novel mechanistic insights into dyslipidemia and immune-mediated diseases and may have implications for therapeutic trials involving lipid-lowering and anti-inflammatory agents.

Economics of Non-Communicable Diseases in Indonesia

The Economics of Non-Communicable Diseases in Indonesia provides new data on the economic burden of NCDs in the country, and puts it in perspective by drawing a comparison with India and China. With this new addition to the series on the economics of NCDs, the World Economic Forum aims to advance the understanding of the expected economic output loss at the country level, particularly in countries in economic and epidemiological transition. The evidence presented provides a starting point in reorienting the dialogue on investing in healthy living and NCD prevention in Indonesia towards the view that a healthy population is an important factor for sustainable growth.

Battles, Boats & Bones:Archaeological Discoveries in Northern Ireland 1987-2008

How did our ancestors build their homes? What weapons did they use? What religious rituals did they follow? What did they eat? How did technology develop over the centuries? These are just some of the questions answered in Battles, Boats & Bones, which offers a fascinating insight into the daily lives of our ancestors stretching back as far as the Early Neolithic period. Bringing together details and interpretations of discoveries made as a result of 25 archaeological excavations across Northern Ireland over the last 20 years, the book is a window into our collective past. https://www.tsoshop.co.uk/gempdf/Timeline_Circles.swf