Refine
Document Type
- Article (4)
Language
- English (4)
Has Fulltext
- yes (4)
Is part of the Bibliography
- no (4)
Keywords
- Anticoagulation (1)
- Behavior change (1)
- ET (1)
- Frankfurt (1)
- JAK2V617F (1)
- MPN (1)
- MPN-U (1)
- Major bleeding (1)
- PMF (1)
- PV (1)
Institute
Simple Summary: In patients with myeloproliferative neoplasms (MPN) and in patients with kidney dysfunction, a higher rate of thrombosis has been reported compared with the general population. Furthermore, MPN patients are more prone to develop kidney dysfunction. In our study, we assessed the importance of specific risk factors for kidney dysfunction and thrombosis in MPN patients. We found that the rate of thrombosis is correlated with the degree of kidney dysfunction, especially in myelofibrosis. Significant associations for kidney dysfunction included arterial hypertension, MPN treatment, and increased inflammation, and those for thrombosis comprised arterial hypertension, non-excessive platelet counts, and antithrombotic therapy. The identified risk factor associations varied between MPN subtypes. Our data suggest that kidney dysfunction in MPN patients is associated with an increased risk of thrombosis, mandating closer monitoring, and, possibly, early thromboprophylaxis.
Abstract: Inflammation-induced thrombosis represents a severe complication in patients with myeloproliferative neoplasms (MPN) and in those with kidney dysfunction. Overlapping disease-specific attributes suggest common mechanisms involved in MPN pathogenesis, kidney dysfunction, and thrombosis. Data from 1420 patients with essential thrombocythemia (ET, 33.7%), polycythemia vera (PV, 38.5%), and myelofibrosis (MF, 27.9%) were extracted from the bioregistry of the German Study Group for MPN. The total cohort was subdivided according to the calculated estimated glomerular filtration rate (eGFR, (mL/min/1.73 m2)) into eGFR1 (≥90, 21%), eGFR2 (60–89, 56%), and eGFR3 (<60, 22%). A total of 29% of the patients had a history of thrombosis. A higher rate of thrombosis and longer MPN duration was observed in eGFR3 than in eGFR2 and eGFR1. Kidney dysfunction occurred earlier in ET than in PV or MF. Multiple logistic regression analysis identified arterial hypertension, MPN treatment, increased uric acid, and lactate dehydrogenase levels as risk factors for kidney dysfunction in MPN patients. Risk factors for thrombosis included arterial hypertension, non-excessive platelet counts, and antithrombotic therapy. The risk factors for kidney dysfunction and thrombosis varied between MPN subtypes. Physicians should be aware of the increased risk for kidney disease in MPN patients, which warrants closer monitoring and, possibly, early thromboprophylaxis.
The organisation of parking is a key challenge to more sustainable mobility in urban areas, as its pricing and availability affect the rates of private car ownership and use. However, changing parking policies is a challenging issue for local politicians and planners because residents frequently oppose changes or restrictions to conditions they have taken for granted such as on-street parking in a public space. The aim of this paper is firstly to assess how the parking policy of an urban neighbourhood can be structured to contribute to more sustainable mobility and to increase liveability in the neighbourhood. The second aim is to apply the policies reviewed to an example neighbourhood. For this purpose, we systematically reviewed academic literature and identified five types of relevant parking policies: (i) maximum parking requirements, (ii) physical detachment of residence and parking space, (iii) residential parking permits and the limitation of available parking space, (iv) performance-based pricing and (v) parking as a demand management strategy. We discovered that most research focuses on econometric models about parking and that studies rarely address the effects of parking on the quality of life in neighbourhoods. Therefore, we need further research regarding the relationship of parking and liveability. We conclude that for the implementation of such parking policies in an example neighbourhood, the municipality needs to develop a mobility vision for its city. It has to understand parking as a tool for transportation demand management to increase the acceptance of parking policy concepts and to avoid spillover problems. Finally, in the German case, as in most other countries, states and municipalities need to redesign their legal frameworks to be able to manage parking supply better and to react to changes related to digital developments and parking. The findings have implications for other European neighbourhoods regarding the transfer from research to local circumstances and applications for the whole city.
Support for innovative on-street parking policies: empirical evidence from an urban neighborhood
(2020)
Municipalities and planners often hesitate to implement restrictive parking policies because residents regularly oppose any changes to on-street parking space. Residential parking is one key factor of parking management because its location and availability influence a household's car ownership and use. Moreover, as more residents regularly use other means of transportation that need space and infrastructure in the urban realm, and as parking takes up a vast amount of land, municipalities are considering the reuse of on-street parking space for other purposes. As public acceptability is a precondition for the successful implementation of a proposed policy, our empirical analysis investigates to what extent residents support restrictive and demand-oriented on-street parking policies in the dense, highly urbanized neighborhood of Frankfurt-Bornheim, Germany (N = 1027). Surprisingly, despite some variations, the majority of the residents in our survey are in favor of the policy options suggested. Support for the demand-oriented policies (extension of bicycle infrastructure, improved sharing supply and mobility hubs, neighborhood garages, and improved public transit supply) is higher than the acceptance of the restrictive policies, and of policies that are a combination of restrictive and demand-oriented policies. However, surprisingly, a majority is still in favor of many of these (extension of parking fees and parking restrictions, and reuse of parking space for better livability). Furthermore, we classify residents who live in a household with private cars into the stage model of self-regulated behavior change to analyze their intention towards a reduction in private car use. Results from linear regression analyses indicate that residents who have intentions to change their behavior towards car use reduction assess the policy options more similarly to car-free households and regular bike users, and not like the other car-owning households. The findings suggest that while the residents support financial-related policies the least, they are more receptive towards parking policies than policy makers and planners assume if the reuse of parking lots creates space for other users or if it increases the quality of life, for instance, by adding bike lanes, wider sidewalks or greenery. Hence, a combination of restrictive and demand-oriented on-street parking policies results in high acceptance among residents, and the communication from municipalities regarding the implementation of the different policies needs to vary depending on the kind of household.
Background: Patients with Ph-negative myeloproliferative neoplasms (MPN), such as polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF), are at increased risk for thrombosis/thromboembolism and major bleeding. Due to the morbidity and mortality of these events, antiplatelet and/or anticoagulant agents are commonly employed as primary and/or secondary prophylaxis. On the other hand, disease-related bleeding complications (i.e., from esophageal varices) are common in patients with MPN. This analysis was performed to define the frequency of such events, identify risk factors, and assess antiplatelet/anticoagulant therapy in a cohort of patients with MPN.
Methods: The MPN registry of the Study Alliance Leukemia is a non-interventional prospective study including adult patients with an MPN according to WHO criteria (2008). For statistical analysis, descriptive methods and tests for significant differences as well as contingency tables were used to identify the odds of potential risk factors for vascular events.
Results: MPN subgroups significantly differed in sex distribution, age at diagnosis, blood counts, LDH levels, JAK2V617F positivity, and spleen size (length). While most thromboembolic events occurred around the time of MPN diagnosis, one third of these events occurred after that date. Splanchnic vein thrombosis was most frequent in post-PV-MF and MPN-U patients. The chance of developing a thromboembolic event was significantly elevated if patients suffered from post-PV-MF (OR 3.43; 95 % CI = 1.39–8.48) and splenomegaly (OR 1.76; 95 % CI = 1.15–2.71). Significant odds for major bleeding were previous thromboembolic events (OR = 2.71; 95 % CI = 1.36–5.40), splenomegaly (OR = 2.22; 95 % CI 1.01–4.89), and the administration of heparin (OR = 5.64; 95 % CI = 1.84–17.34). Major bleeding episodes were significantly less frequent in ET patients compared to other MPN subgroups.
Conclusions: Together, this report on an unselected "real-world" cohort of German MPN patients reveals important data on the prevalence, diagnosis, and treatment of thromboembolic and major bleeding complications of MPN.