|Affiliation(s):||1Patient Safety, Consumers Advancing Patient Safety, Chicago, USA|
In this presentation you will learn of one family's experience with two serious medical system failures and hear about the creation of national and international consumer-led initiatives dedicated to consumer involvement. These initiatives are based on the development of the collective voice of the consumer and on the premise that safety will be improved if patients are included as full partners in creating better outcomes and in contributing to reporting medical errors, solutions, research and policy making. The speaker challenges health care providers, institutions, organizations, and agencies to recognize and embrace the value and power of partnerships in reshaping the future of healthcare so that it is safe, compassionate and just. Following this session, you will be able to describe how personal experience with medical errors resulted in a model of collaboration, partnership and nationwide change in patient safety; show the value and power of partnerships among consumers, health care providers, health care institutions, and agencies in ensuring better outcomes and driving sustainable improvements; and summarize national and global consumer movements in patient safety, including Consumers Advancing Patient Safety and the World Health Organization's Patients for Patient Safety.
|Affiliation(s):||1Chair of the WHO World Alliance for Patient Safety, Chief Medical Officer for England, UK|
|Summary (max 100 words):||
Ensuring the safety of patient care is a signifi cant challenge for all health services around the world, whether situated in developed or developing countries. Systematic attempts to improve safety and the transformations in culture, attitude, leadership and working practices necessary to drive that improvement are in their infancy, even in the countries where addressing patient safety has been on the agenda for some years. The experience of other high-risk industries, such as the aviation or nuclear industries, highlights the importance of sustained action over the long-term. This presentation, given by Sir Liam Donaldson, Chair of the WHO World Alliance for Patient Safety, will provide an overview of the latest thinking on approaches to safety internationally and set out a series of challenges for health-care leaders over the coming years to ensure that improving patient safety is at the top of the health-care policy agenda.
|Plenary session, PL04, Thursday, August 31 2006, 18:00-19:30|
|Chair(s): Peter Saladin, Switzerland, Elisabeth Leforestier, France|
|Hospitals Promoting Access to Healthcare|
|Gillian Morgan, The NHS Confederation, London, United Kingdom|
|Adeleke Olusegun Pitan, Honourable Commissioner for Education, Lagos State Ministry of Education, Lagos, Nigeria|
|Redesigning Hospital Care to Meet the Needs of the Community|
|Wim Schellekens, Centre for Innovation and Development, Dutch Inspectorate, Leiderdorp, The Netherlands|
|Optimizing Hospitals in the Health Sector|
|Saleh Meky, Minister of Health, Eritrea|
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Submitted by: Irene Amodei (ICVolunteers); Contributors: Melissa Bonnefin (ICVolunteers)
Hospitals have always played a pivotal role in the global healthcare system. They have power, authority and professional competences in both the rich and poor worlds. But what if we all begin to re-think the mission of hospital care and re-design the way we deliver it in order to increase access to health? The moment has arrived for reform in order to achieve optimal care, to learn from examples of real innovation and disseminate this knowledge, sharing ideas as well as best practices.
Mr. Adeleke Pitan, Honourable Commissioner for Education in Lagos' State Ministry of health from 1999 to 2006, began the plenary session with a detailed overview of the state of the health care delivery system in Nigeria and urban Africa. "Access to health has always been, and still remains, a problem in many urban areas" stated the former Minister, "due to uneven distribution of hospitals, inadequate health personnel, limited financial resources and weak motivation of the workforce". He then narrowed his focus criticizing the current inadequate knowledge and health education of the population (estimated at 150 million people) who still prefer alternative medicine practitioners. About 75% of Nigerian government hospitals are in urban areas and 25% in rural ones and on average 2.2 million patients are treated each year. The need to increase access to health has pushed the government to develop 'packages' to attract the elderly and most vulnerable groups; to introduce a number of free health services including free anti-natal care, free medical treatment for children aged between 0 and 12 years and for people over the age of 60. The Health Sector Reform programme also included free heart surgery for patients with heart defects, free eye treatment including surgery for cataracts and glaucoma and free breast cancer screening. Mr. Pitan described the opportunities that the reform offered such as Public-Private Partnership initiatives (PPP's), the B-O-T system (build, operate and transfer), transfer of technology, training and re-training of health personnel. While the reform process has helped to assist the most vulnerable part of the population, trying to bring health to the doorstep of all citizens continues to be a major problem due to the small number of hospitals, shortage of specialist manpower, the lack of equipment and under-funding of the health care system.
'Reform' was also the key word of the presentation by the Minister of Health in Eritrea, Mr. Saleh Meky, who explained in detail the series of strategies adopted nationally in order to increase the cost-effectiveness of the health system and of its delivery services. "Change means new ways of thinking and acting", stated Mr. Meky, "and must be managed to ensure the result is a real improvement. Moreover, the quality of clinical services must not suffer during periods of rapid change". As a result of the concerted efforts made in Eritrea to build new health facilities and give them the necessary equipment and skilled health personnel, access to primary health care within 10 km from the health structures increased in the last years to around 70%. A good deal, given that 50% of the population lives within an area of 5 km.
Mr. Meky illustrated the main goals of the national reform, namely:
- To ensure the equitable distribution of health services to rural and urban areas;
- To strengthen Primary Health Care especially in remote and inaccessible areas;
- Actively to promote the dissemination of accurate information on health practices;
- To use a strong evidence-based decision-making process.
According to Mr. Meky, the basic principles of any health system reform are the improvement of management (namely the Health Management Information System, HR management, quality and financial management) and the decentralization of functions "to that level where optimum value can be attained". A country in transformation, like Eritrea, has to deal with additional challenges, for example the urgent need to control both tropical (historical) and 'rich-countries' (new to Eritrea) diseases. For that reason, the decentralization process is often not easily manageable. As a solution Mr. Meky introduced the concept of "hospital autonomy", an alternative method of organizing and financing health care services. Hospital autonomy could also be seen as an effective merge of the best elements of the public and private sectors; a kind of parastatal hospital that works in a private way from the point of view of finance and bureaucratic reduction, which when properly implemented, enhances effectiveness and efficiency.
Mr. Meky ended his presentation by stressing the need for stronger community involvement as the only way to overcome the always present danger of brain drain. "Brain drain in health systems is a political issue" stated the Minister. "If we want to have some chance to stop it we must provide a comfortable ecological and financial environment, to train as many people as possible, to appeal to people's nationalism and, most importantly, to make people think that they really are the owners of their hospitals".
Mr. Wim Schellekens, CEO of the Center for Innovation and Development in The Netherlands, offered the plenary a mostly self-critical 'first-world' point of view. "How effective and safe is hospital care?" questioned Mr. Schellekens, "How to do a better job?".
Despite the progress of medical science, we still see a huge amount of errors in the way we deliver care (overuse, under use or misuse of drugs), in the way we organize care (coordination problems and delays) and in the way we take care (absence of transparency, empathy and patient-involvement). In the USA, there are 44,000 to 98,000 deaths in hospitals each year (8th-3rd cause of death) and there is no correlation between cost and mortality. Care for patients should be safe, effective, patient-centred, timely and efficient, with equity for all. Patients, of course, do not expect needless deaths, needless pain, unwanted waits and helplessness. In short, quality is the big issue. To support his claims Mr. Schellekens described the successful IHI Boston experience in 2004, which, with six simple interventions (like the creation of a Rapid Response Team), resulted in 122,300 lives saved in the 3,000 hospitals involved. The key to success is to have vision, a strategy and leadership ("First study, then act; first plan then do!"). The theory affirms that when we have convinced 20% of our target, the rest will automatically follow. In The Netherlands the "Better Faster" programme, that aimed to get breakthrough results in 20 % of Dutch hospitals in four years, succeeded by acting at four levels of intervention: system level, institutional level, level of care-process and patient level. According to Mr. Schellekens the mission of hospitals has shifted from "delivering specialized care to our patients" to "responsibility for the care in our region" to "promote health to all our citizens".
|Affiliation(s):||1Minister of Health, Eritrea|
|Summary (max 100 words):||As the highest centres that are expected to provide a high standard of healthcare, training and applied research, hospitals play a pivotal role in the healthcare system. Hospitals wealth of accumulated knowledge and experience can also be used to effectively influence professional practice in other health facilities and behaviours of individuals, families and communities. However, traditionally, hospitals have mainly focused on illness and curative care, not on all aspects of health. Hospitals consume between 40 per cent and 70 per cent of the national healthcare expenditure. Management of human resources for health is also becoming a major challenge to health systems development. As concerns are increasing over healthcare costs and diminishing resources around the world, and as retention of qualified health workers becomes more and more difficult in the low-income countries, many governments are looking for means of financial sustainability while improving the efficiency and quality of care of health services. Among the alternatives of reform for optimizing hospital service in the health sector are: hospital autonomy and reorienting hospital roles in health service, so that they promote health and healthy lifestyles and go to the root causes of diseases with preventive emphasis, along with their curative services. Hospital services need to be more targeted towards the needs of people, and not only to their organs or physiological parameters, in order to have a more substantial and long-lasting impact. Hospital autonomy is a form of decentralization that is more manageable than the decentralization process many countries went through, with little success. Hospital autonomy could also be seen as an effective merge of the best elements of the public and private sectors in how a hospital is managed and financed. When implemented properly, hospital autonomy can reduce the financial burden hospitals impose on government budgets while increasing community participation in decision-making, improving efficiency of operations and quality of care, and enhancing financial sustainability. However, there is no guarantee that hospital autonomy will automatically and consistently lead to improved system efficiency. A review of the successful experience of autonomous hospitals reveals that success is dependent upon the preparation done with the systems and management necessary for the proper operation of autonomous hospitals. One other factor for further advancement concerns strong evidence-based decisions, since the lack of evidence coupled with prevailing cost pressures in almost any healthcare system tends to make hospital autonomy, health promotion or any other escape programme an easy choice for budget cuts, without adequate preparations. Such ill-prepared choices are likely to fail. Evidence is needed both during preparations and equally important during implementation, so that corrective actions are made with the aim of continuous improvement.|
|Affiliation(s):||1Centre for Innovation and Development, Dutch Inspectorate, Leiderdorp, The Netherlands|
|Key issues:||Hospitals are an essential part of our healthcare system. In hospitals we see the progress of medical science. But how content can we be with the current status of our hospitals? What are the main issues in hospital care in most developed countries? Wherever we measure, we see a huge variation in the way care is offered and organised. We harm patients by the way we deliver and organize care which results in unnecessary suffering and even death. We have compartmentalized our care between disciplines, departments and institutions. Our care is too much doctor/organisation-centred instead of patient-centred. There is a wall between public health and our cure-system. Hospital care takes almost all our healthcare money, but what is the costeffectiveness ratio? In many places we see remarkable improvements and examples of real innovations of care. But what about implementation of this knowledge and dissemination of these best practices? What we need is interventions on four different levels: 1) Patient level: patients can be the main driving force for innovation and improvement; 2) Process level: here we need the innovation and improvement; 3) Organisational level: leadership, organisational support, redesign of the support processes, HRM and IT; 4) Level of the health care system: how about the financial incentives, the healthcare insurance system, the legal issues, etc.? Let me focus on some fundamental issues for innovation and change: 1. Leadership: I have seen a shift in the mission of hospitals: from delivering specialised care to patients, to responsibility for the healthcare in our region, to responsible to improve health in our region. Leaders are responsible for the level of ambition. They translate mission and vision into strategy and operational goals, and they are able to develop and apply a strategy for implementation and spread. They make the link between quality and finance. 2. A strategy to improve quality and safety: We need a quality-system, multidisciplinary cross-functional and cross-organisational collaboration, a framework of methods and tools, training, and a strategy for implementation and spread. 3. Involvement of patients: We have not so much experience in involvement of patients in our daily care-delivery or our improvement efforts. This will bring us to a new level of performance. 4. Specialisation and stratification of care: Quality results depend on the experience of the care team. It becomes a necessity to concentrate high-tech care and the care for rare diseases in centres of excellence and to focus on high quality standardized care for the common diseases and low/medium-tech care in our regular hospitals: a vertical integrated system. At the same time it shows that we can get much better results if we stratify our care in acute, elective and chronic care. 5. Outreach to public health: The knowledge and experience of hospital workers should be applied in public health primary prevention, immunisation programs, screening for early detection of diseases, self-help of patients and patient-groups, public information, etc. There still is a big gap between health care and social care, education, welfare, living, etc.|
|Conclusion (max 400 words):||Rethinking the mission of hospital care and redesigning the way we deliver hospital care is urgent. It is the task of leaders in this field to take up the challenge.|
|Affiliation(s):||1The NHS Confederation, London, United Kingdom|
|Key issues:||Hospitals play a critical role in the delivery of health services and are often the first point of access to healthcare. They are highly regarded by citizens and by politicians. They cannot, however, work in isolation and, as the pattern of disease changes in many parts of the world with increases in long-term, chronic conditions, then non-hospital care is increasingly more appropriate. In other countries hospitals need to become hubs for prevention as well as treatment, regrettably in many systems the public health and hospital sectors are entirely separate. Part of this is because of a suspicion about hospitals which use most healthcare resources. The inexorable increase in healthcare costs is only going to be dealt with by comprehensive community strategies which encompass health protection and promotion, develop an appropriate range of lower technology facilities and services to support the expert services delivered by hospitals. The entire range of services needs to be considered simultaneously so that the balance remains appropriate for the needs of local people. This is a challenge across the world and we can learn together. The focus must be on the services needed rather than on buildings. Hospitals are key in this but are not sufficient.|
|Parallel session PS10, Thursday, August 31 2006, 11:00-12:30|
|Chair(s): Peter Suter, Switzerland, Peter Saladin, Switzerland|
|Social Accountability of Medical Schools in a Globalized World|
|Kendall Ho, Continuing Professional Development & Knowledge Translation, University of British Columbia, Vancouver, Canada|
|Troped Network: Bringing Together European Institutions for Higher Education in International Health|
|Jean-Pierre Gervasoni, Unit for Cardiovascular Disease and Epidemiological Transition, IUMSP, and Swiss Tropical Institute, Basel, Switzerland|
|Capacity Building and Partnerships: ESTHER's Experience|
|Michel Lo Casto, Advisor for hospital relations, GIP ESTHER, France|
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|Parallel session PS08, Wednesday, May 28 2008, 11:00-12:30, Room 3|
|Chair(s): Eric de Roodenbeke, Incoming Director General, International Hospital Federation, France, Denis Hochstrasser, Head, Department of Genetic and Laboratory Medecine, University Hospitals of Geneva, Switzerland|
|Integration of Hospitals in Health Systems|
|Jean-Pierre Unger, Department of Public Health, Institute of Tropical Medicine, Belgium|
|Faith-Based Health Facilities in Ghana: Hospitals and First-Line Health Facilities|
|Gilbert Buckle, Executive Secretary, Department of Health, Ghana Catholic Bishops’ Conference, Ghana|
|Taking Technology to the Poor: Rural Inequalities, Public Polices and Private Hospitals|
|Madhan Balasubramanian, Research and Development Center, Apollo Hospitals Educational and Research Foundation, The Apollo Hospital Group, India|
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Submitted by: Cathy Matovu (ICVolunteers)
Technology has been the cornerstone of the 21st century. In a world where people have become dependent on technology, healthcare facilities around the world have found it crucial to implement technology into their systems. These changes, however, require a substantial amount of financial support and social cohesion.
The influence of technology in health systems around the world has changed many aspects of our healthcare, and each speaker gave his own outlook on the issue based on his area of expertise.
Dr. Jean-Pierre Unger from the Institute of Tropical Medicine in Antwerp, Belgium, offered us a European perspective, discussing the problems of the healthcare system in Belgium. He argued that prior to the 14-year hiatus on research run by a series of specialists, the Belgian healthcare system suffered from inefficiency, poor bureaucratic coordination and low use of information technology (IT). The system has benefited from several transformations. Most importantly, the role of the general practitioner (GP) has been enhanced. In-service training schemes were created to improve the GP's manual skills and handling of terminally ill patients. Participants appreciated the training and relationships improved within the local health system community. On a technical level, the increased access to computerized hospital files improved the management control systems within the hospitals. Dr. Unger maintained that this form of coordination can be reproduced, if there is a motivated group of health professionals working together. Most urban areas have systems in place that are quite effective, Dr. Unger points out; however, we must direct these developments towards rural areas.
Developing countries experience the world's technological advancements though on a small scale, particularly when it comes ot health systems. Dr. Madhan Balasubramanian from Apollo Hospitals Group, India, talked about how his organization has taken technology to rural areas. "The Apollo Hospital Group has been a pioneer in technology innovations in rural India," he pointed out. In the Stata of Andhra Pradesh, India, the Group is rapidly extending its services to rural care. Although it is a corporate organization, Dr Balasubramanian stated, the Group is looking at cheaper service costs for its rural hospitals in comparison to its urban hospitals, making it more accessible to the populations in these areas. Three main technological developments in the state of Andhra Pradesh are Tele-Health, Health-Highway and Apollo Reach, which all communicate the link between technology and rural healthcare.
Africa, more specifically Sub-Saharan Africa, is a region where technology is needed to aid the stagnant development of health systems in these countries. Dr. Georges Pariyo from Makerere University in Kampala, Uganda, discussed two important elements of technology and healthcare in Africa: firstly, the role of the hospital in Africa and secondly, the role of faith-based facilities which have become quite predominant in his native Uganda. "High-quality is acquainted with high tech," Dr. Pariyo said. The primary goal of the hospital should be to provide quality healthcare. Patients want quality and it is essential for them to receive quality care. However, hospitals in Uganda deal with severe problems due to under-staffing and under-financing, which do not permit them to provide the care needed. Also, high competition exists between public and private facilities. Dr. Pariyo gave the example of a recent open heart surgery that was performed at a private facility which was then followed by the national hospital Mulago. "[Other] hospitals cannot even offer a basic caesarian section," he remarked. Faith-based hospitals are often situated in rural areas and tend to be private, not-for-profit organizations. However, questions have been raised as to whether the poorer populations really have access to these facilities, because of the outstandingly high fees. Subsidies are being provided by the government of Uganda, Dr. Priyo explained, and as a result, there have been many political issues surrounding those institutions.
|Author(s):||Soraya Amar el Dusouqui|
|Affiliation(s):||1Geneva University Hospitals|
|1st countries of focus:||Togo and Cameroon|
|Relevant to the conference theme:||Innovation in practice|
|Summary:||Our project aims to focus on pathogen inactivation (PI) in donated whole blood. We be-lieve it is possible in the future to be able to stop transcription and replication of RNA and DNA in contaminating cells of donated human whole blood units. Developing a simple method would enable to tackle the problem of major transfusion transmitted diseases. In a few steps, collection, leucoreduction, and inactivation, without the use of external en-ergy sources, we would obtain safer products when transfusing patients in countries using mainly whole blood for transfusion.|
|What hallenges does your project address and why is it of importance?:||37% of whole blood in transitional countries and 72% in developing countries is not sep-arated into blood components. PI means stopping the ability of these pathogens to repli-cate so as to make the organism inoffensive and inactive in the patient once transfused.
If a donor is contaminated and his/her blood is used for blood transfusion then chronic infectious agents like HIV and of HCV and HBV can be transmitted to the patient.
42 countries worldwide are not able to screen all blood donations for one or more of the four transfusion-transmitted infections (HIV, hepatitis B, hepatitis C and syphilis) for which WHO recommends screening as being mandatory. In reality there are a lot of known agents causing transfusion-transmitted infections (TTI) including bacteria and parasites.
We have increasingly become aware of the need to deal with emerging agents after the lessons learned during the West Nile Virus epidemic in the USA and Canada in the year 2002 or that of the Chicungunya virus in the Indian ocean, parts of Africa and Asia in 2005 and 2006.
Today PI technologies are able to demonstrate therapeutic efficacy as well as safety based on photochemical treatment, using either UVA and psoralens or riboflavin and broadband UV, and are used daily in Europe. There is no feasible procedure for PI of RBCs (a separated component called red blood concentrates) or whole blood available yet.
S-303 used together with glutathione has been developed by CERUS Corporation to inac-tivate pathogens in blood components containing red blood cells such as whole blood or separated RBCs. The inactivation has been demonstrated after a 3-hour incubation at room temperature by comparing organism titer before and after incubation demonstrating 4–6 log inactivation efficacy for many tested microorganisms. This approach also inhibits leukocyte proliferation, cytokine synthesis and antigen presentation. Clinical in vivo and in vitro safety and efficacy trials have been completed and results are promising.
Our project is to use the same technology and concentration on whole blood units and demonstrate equivalent cellular viability, function and safety as in RBCs.
The focus has not been on whole blood inactivation and we believe that it is the right approach. We have been able to convince our partners of the necessity not to wait years before adapting this promising technology on whole blood units but to perform research in parallel to rapidly find an adequate solution for countries with limited resources.
Adapting this new technology will be faced with multiple challenges.
|How have you addressed these challenges? Do you see a solution?:||
|How do you know whether you have made a difference?:||The project is arousing awareness that more efforts have to be done to support research in developed countries that are spending millions of dollars on pathogen inactivation today. Resource rich countries have reduced TTI by 1500 fold in the last 20 years so the gain is mainly in terms of facing emerging infectious agents but not in managing TTI.
We have the moral obligation to act in the direction of adapting a rapidly budding tech-nology to the special needs of developing countries that transfuse whole blood most of the time and face a high TTI transmission risk.
In a global vision the balance in terms of benefit and enhancement of transfusion safety tilts clearly towards countries with low resources facing the huge problem of TTI lacking adequate means to reduce them. We are convinced that our project will therefore make a major difference.
|Have you or the project mobilized others and if so, who, why and how?:||Our project has gained a lot of interest very rapidly and we have been invited to present it in 2011 at the ICPIC in Geneva thanks to Professor Dr. PITTET and his team.
We are in the phase of signing a memorandum of understanding between HUG (university Hospitals of Geneva), CERUS and Swiss Transfusion – Swiss Red Cross towards a close and extended collaboration.
Transfusion Suisse CRS have accepted to support our project by helping in efforts to secure our budget as well as in facilitating contacts with national actors and health authorities.
The department of Professor Dr. LOUTAN is willing to support in facilitating con-tacts with local health actors as well as in eventually supporting future clinical trial funding. We would like to thank him and his team for the opportunity to take part in the Geneva Health Forum of 2012.
The clinical investigation unit - clinical research center of the University hospital of Geneva is currently examining the toxicological and safety criteria to determine extend investigation needs of the S-303 technology when adapted to whole blood units.
Members from the EFS (French Transfusion Service) who have contacts with de-veloping African nations have expressed interest in supporting this project along with other researchers in the UK and United States.
|When your donor funding runs out how will your idea continue to live?:||Developing a transfusion kit that uses this simple PI technology, without irradiation, in a closed system, needing no centrifugation no external energy and that could be transfused a few hours after collection allows us to look into the future and imagine that medical care workers in remote places would dispose of a transfusion unit that would be safe and easy to use.
The product that will be developed will be delivered at production costs and the manufac-turer has assured us that they will make no profits in African countries with limited re-sources.
|Author(s):||Tanica Lyngdoh1, Pascal Bovet1, Pedro Marques-Vidal1, Gerard Waeber1, Peter Vollenweider1, Murielle Bochud1|
|Affiliation(s):||Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland|
|1st country of focus:||Switzerland|
|Relevant to the conference theme:||Non-communicable chronic diseases|
|Summary (max 100 words):||Women and men differ in their serum uric acid (SUA) levels and fat distribution. As very few large scale population-based studies have systematically assessed sex differences in the relationship between SUA and markers of adiposity, we explored these associations in the CoLaus study. Our study supports previous findings that an elevated serum uric acid is closely associated with measures of adiposity. We present additional information on the differential effects of sex on the relationship. Our findings seem to suggest that the observed sex-differences are, in large part, explained by leptin.|
|Background (max 200 words):||High serum uric acid (SUA) is known to co-exist with the different components of metabolic syndrome including obesity. Epidemiological and clinical studies have established positive associations between SUA and different adiposity markers including waist circumference, body mass index, waist-hip ratio, visceral fat, subcutaneous fat and total body fat. Sex is an important determinant underlying the relationship between SUA and metabolic syndrome. This is evident by the finding that the association is stronger in females than in males. Furthermore, recent findings suggest the role of leptin as a plausible explanation for the sex differences observed in the metabolic pathways involved in metabolic syndrome. Although SUA concentrations, serum leptin, and body fat distribution show obvious sex differences, very few studies have tried to systematically assess sex-differences in the relationship between serum uric acid and the different markers of adiposity.|
|Objectives (max 100 words):||The objective of the current study was to explore sex differences in the relationship of serum uric acid with markers of adiposity and to assess if leptin could be a factor underlying the relationship between serum uric acid and adiposity.|
|Methodology (max 400 words):||In 6184 participants aged 35 to 75 years randomly selected from the general population in Lausanne, we measured SUA, leptin and anthropometric variables including weight, height, body mass index (BMI), waist circumference (WC), and fat and lean mass (using bioimpedance), and assessed lifestyle behaviors using a questionnaire. Fasting venous blood were collected after an overnight fasting. Uric acid was measured by uricase-PAP and leptin by ELISA. Multiple median regressions were used to test the association of SUA with the different adiposity markers (as dependent variable) one at a time. We tested the interaction of SUA with sex by adding a multiplicative interaction term in the model.|
|Results (max 400 words):||Mean SUA was higher in men (361.1 ± 75.7 µmol/L) than in women (270.6 ± 67.2 µmol/L). Men had higher mean weight, height, BMI and WC, while women had higher fat mass (p values <0.0001 for all). Positive correlations of SUA with weight, BMI, WC, and fat mass were stronger in women than in men (Spearman r: 0.35, 0.37, 0.40, and 0.41 in women, and 0.26, 0.30, 0.31, and 0.30 in men, respectively, p<0.0001 for all). In univariate analysis, SUA was strongly associated with weight, BMI, WC and fat mass in both men and women and the regression coefficients were almost twice as large in women than in men (p<0.001 for all associations). The associations remained significant upon adjustment for age, alcohol intake, smoking, Modification of the diet in Renal Disease (MDRD), diabetes, hypertension and the use of diuretics (regression coefficients ±SE for weight, BMI, WC and fat mass was 3.35 ±0.38; 1.25±0.10; 3.43±0.30; 2.00±0.15 in men and 5.61±0.38; 2.18±0.13; 6.21±0.32; 4.13±0.22 in women respectively, p<0.001 for all). In models including men and women together, there was a statistically significantly interaction by sex for all the associations between SUA and adiposity markers (p<0.001 for all). The interaction by sex was unaltered upon adjustment for insulin but was no longer significant upon adjustment for leptin.|
|Conclusion (max 400 words):||In this population-based study of Caucasians aged 35 to 75 years, we found a strong association between SUA and markers of adiposity, with women showing stronger associations than men. We observe the sex difference to be largely explained by leptin, consistent with a leptin resistance in maintaining higher fat mass in women.|