Validity of CoaguChek S for home monitoring of anticoagulant therapy in pediatrics

BACKGROUND: CoaguChek S (Roche Diagnostics, Canada) is a portable device designed to monitor international normalized ratio (INR) by capillary puncture. Although the device is used in pediatrics, no study has evaluated its validity in patients of this population. OBJECTIVE: To evaluate the validity of CoaguChek S as an in-home INR monitor in patients younger than 18 years of age. METHODS: Data were based on 129 INR pairs collected from nine patients younger than 18 years of age followed up at an anticoagulation clinic between March 1, 2000, and January 19, 2004. The INRs from both the laboratory and CoaguChek S were used to evaluate concordance between the two methods using the intraclass correlation coefficient. RESULTS: The overall intraclass correlation coefficient between the CoaguChek S and the laboratory was 0.75 (95% CI 0.66 to 0.82). On average, CoaguChek S underestimated INRs by 0.11+/-0.54 units compared with those of the laboratory. INRs of 3.5 units and higher obtained with CoaguChek S were, on average, 0.49+/-1.09 units higher than those obtained in the laboratory. CONCLUSIONS: CoaguChek S appears to be a valid instrument for in-home INR monitoring for most patients younger than 18 years of age, with INR targets of 2.0 to 3.0 followed up by an anticoagulant therapy clinic's program. However, caution must be used when interpreting INRs higher than 3.5. Parents should perform a second test to confirm all CoaguChek S INR results higher than 4.0.     

Relationship between unemployment and health among health care professionals: health selection or health effect?

OBJECTIVE: The aim of this longitudinal study was to examine (a) the causal effect of unemployment 1990-1997 on health 1998-2001 (in-patient periods) and (b) the selection effect of health 1996-1999 on unemployment 2000-2002. We examined the effects of different diagnoses, namely, all causes, circulatory diseases, diseases of the digestive system, musculoskeletal diseases, and mental disorders. METHODS: The data from the Central Register of Health Care Professionals of persons born 1945-1970 were linked to data from employment statistics and Finnish Hospital Discharge Register including 78,195 women and 12,455 men aged 31 to 56 in 2001. The associations were analyzed with logistic regression analyses and expressed as odds ratios (OR) and their 95% confidence intervals (CI). RESULTS: After adjustments, existence of unemployment periods was associated with lower odds for in-patient periods due to musculoskeletal diseases for both women (OR=0.82, 95% CI=0.76-0.89) and men (OR=0.74, 95% CI=0.60-0.89). Unemployment periods were more likely among women (OR=1.65, 95% CI=1.33-2.04) and men (OR=2.54, 95% CI=1.44-4.48) having had in-patient periods due to mental diseases and among women also due to diseases of the digestive system (OR=1.17, 95% CI=1.04-1.31). CONCLUSION: The present study found evidence for selection to unemployment according to mental diseases and diseases of the digestive system among health care professionals. In addition, our results show that unemployment periods may protect health care workers from musculoskeletal diseases.     

Correlation between the total volume,transitional zone volume of the prostate,transitional prostate zone index and lower urinary tract symptoms (LUTS)

Objectives Currently available studies show controversial data between the symptoms of the lower urinary tract and the volume of the prostate gland. The objective of the present study is to evaluate the relationship between the score of the lower urinary tract symptoms assessed according to the International Prostate Symptoms Score (IPSS) and the total (TV) and transitional (TZV) zone volume of the prostate and transitional prostate zone index (TZI). Materials and methods From 223 men with a mean age of 59.3 years (varying from 50 to 75), the scores of lower urinary tract symptoms, measured by the IPSS and TV and TZV, determined by transrectal ultrasonographies, were obtained. Furthermore, the TZI was determined in all cases by the TZV to TV rate of the prostate. The relationship between TV, TZV, and TZI and the data obtained using the symptoms score was statistically determined. Results The TV of the prostate were 25.5 ± 10.3, 25.0 ± 9.3, and 28.9 ± 13.5 g in individuals with mild, moderate, and severe symptoms, respectively (P = 0.15). Similarly, there was no significant difference when the TZV (7.6 ± 6.3, 7.6 ± 5.8, and 9.6 ± 6.8 g, respectively; P = 0.22) and the TZI (0.26 ± 0.1, 0.27 ± 0.1, and 0.30 ± 0.1, respectively; P = 0.33) were compared in the groups of men with mild, moderate, and severe symptoms of urinary difficulty. However, the quality of life (QoL) scores presented progressively worse values (1.7 ± 1.3, 3.1 ± 1.4, and 4.4 ± 1.2) as the severity of the lower urinary tract symptoms became worse (P < 0.001). The Pearson correlation coefficient between the TV (r = 0.15; P = 0.02), TZV (r = 0.16; P = 0.02), and the TZI (r = 0.14; P = 0.03) with the prostate symptom scores showed low values although they were positive and statistically significant. The highest correlation was observed when the QoL related to urinary symptoms and symptom scores (r = 0.61; P < 0.001) was analyzed. Conclusions A low correlation was found between the score lower urinary tract symptoms assessed by IPSS and the different volumes of the prostate gland (TV, TZV) and prostate TZI, and, on the other hand, an inverse correlation between the intensity of urinary symptoms and QoL, supporting the idea of multifactorial aspects related to the genesis of urinary symptoms in men.     

Obesity and health in Europeans aged 50 years and older

BACKGROUND: Obesity is increasing globally across all population groups. Limited data are available on how obesity patterns differ across countries. OBJECTIVE: To document the prevalence of obesity and related health conditions for Europeans aged 50 years and older, and to estimate the association between obesity and health outcomes across 10 European countries. METHODS: Data were obtained from the 2004 Survey of Health, Ageing and Retirement in Europe, a cross-national survey of 22,777 Continental Europeans over the age of 50 years. The health outcomes included self-reported health, disability, doctor-diagnosed chronic health conditions and depression. Multivariate regression analysis was used to predict health outcomes across weight classes (defined by body mass index [BMI] from self-reported weight and height) in the pooled sample and individually in each country. RESULTS: The prevalence of obesity (BMI >or=30) ranged from 12.8% in Sweden to 20.2% in Spain for men and from 12.3% in Switzerland to 25.6% in Spain for women. Adjusting for compositional differences across countries changed little in the observed large heterogeneity in obesity rates throughout Europe. Compared with normal weight individuals, men and women with greater BMI had significantly higher risks for all chronic health conditions examined except heart disease in overweight men. Depression was linked to obesity in women only. Particularly pronounced risks of impaired health and chronic health conditions were found among severely obese people. The effects of obesity on health did not vary significantly across countries. CONCLUSIONS: Cross-country differences in the prevalence of obesity in older Europeans are substantial and exceed socio-demographic differentials in excessive body weight. Obesity is associated with significantly poorer health outcomes among Europeans aged 50 years and over, with effects similar across countries. Large heterogeneity in obesity throughout Europe should be investigated further to identify areas for effective public policy.     

Seven habits of highly effective global public-private health partnerships: practice and potential

Global public-private health partnerships (GHPs) have become an established mechanism of global health governance. Sufficient evaluations have now been conducted to justify an assessment of their strengths and weaknesses. This paper outlines seven contributions made by GHPs to tackling diseases of poverty. It then identifies seven habits many GHPs practice that result in sub-optimal performance and negative externalities. These are skewing national priorities by imposing external ones; depriving specific stakeholders a voice in decision-making; inadequate governance practices; misguided assumptions of the efficiency of the public and private sectors; insufficient resources to implement partnership activities and pay for alliance costs; wasting resources through inadequate use of recipient country systems and poor harmonisation; and inappropriate incentives for staff engaging in partnerships. The analysis highlights areas where reforms are desirable and concludes by presenting seven actions that would assist GHPs to adopt better habits which, it is hoped, would make them highly effective and bring about better health in the developing world.     

A case study of the elder care functions of a Chilean non-governmental organization

This paper examines the history and role of a faith-based Chilean nonprofit organization, Hogar de Cristo (Christ's Home), in providing elderly care in the context of recent economic and sociopolitical changes in the country. Chile has been at the forefront of market-based reforms in the delivery of social services and its experience provides insights into the intersecting roles of the state, the market, and the non-governmental sector in addressing basic human needs. Based on in-depth interviews, archival data, and field observations, we investigate the institutional, political, and social factors that account for the organization's success. These result from a number of factors including a capacity to adapt to changing client needs, the successful adoption of an entrepreneurial style of management and outreach, and the building of trust through effective public relations. Although conditions unique to the situation of this faith-based organization in a highly Catholic country may account for its success, the experience of Hogar de Cristo provides useful lessons for the future of elder care policy in the Americas.     

Accuracy and clinical usefulness of the CoaguChek S and XS Point of Care devices when starting warfarin in a hospital outreach setting

Objective

To assess clinical usefulness of CoaguChek S and XS monitors to measure International Normalised Ratio (INR) when starting warfarin in community patients.

Methods

INR in consecutive patients starting warfarin plus enoxaparin was measured in the laboratory and on capillary blood at home using CoaguChek S or XS point of care (POC) devices. INR was measured daily until > 2.0 for 2 consecutive readings. Linear regression and Bland Altman plots were derived to compare POC with laboratory INR. Percentages of POC measurements within 0.5 and 0.8 units of laboratory INR <2.0, 2.0-3.5 and > 3.5 were calculated. Clinical utility was assessed using previously reported criteria.

Results

200 CoaguChek S and 337 CoaguChek XS results were obtained from 57 and 98 patients respectively and paired with laboratory values. Correlation was acceptable between CoaguChek S and laboratory INRs (r² = 0.7732), and excellent between CoaguChek XS and laboratory INRs (r² = 0.9514). Bland-Altman plots showed an increasing difference between laboratory INR above 3.0 for CoaguChek S INRs but no systematic bias with increasing CoaguChek XS INRs. 83.5% of CoaguChek S and 93.5% of CoaguChek XS INRs were within 0.5 units of laboratory INR. 90% of CoaguChek S and 99.4% of the CoaguChek XS INRs were within 0.8 units of laboratory INR. Clinical agreement occurred in 89% and 99.7% of cases by expanded criteria and 82% and 99.4% of cases by narrow criteria when using CoaguChek S and CoaguChek XS respectively.

Conclusions

The CoaguChek XS is suitable for outpatient INR monitoring when starting warfarin.