Browsing by Author "Arāja, Diāna"
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Item Coaching to strengthen critical success factors in integrative care for chronic fatigue patients : the Patient Needs-Resources Model(2023-07-21) Arāja, Diāna; Krūmiņa, Angelika; Nora-Krūkle, Zaiga; Schneider, Marion; Berķis, Uldis; Murovska, Modra; Institute of Microbiology and Virology; Department of Infectology; Development and Project DepartmentTheoretical and empirical studies discover that an integrative approach is particularly important in chronic disorders and multiple long-term conditions, such as chronic fatigue. Chronic fatigue syndrome (CFS) is a classic example of a potentially severe, multisystemic illness with a wide diversity of symptoms and the corresponding diagnostic complexity. The prevalence of CFS-like syndromes expanded in the context of the COVID-19 pandemic, increasing the disorder and treatment burden. Thus, this article aimed to draw attention to the possibilities to strengthen the integrative approach to diagnosing and treating chronic disorders and multiple long-term conditions. The main critical success factors identified for integrative approaches were: a holistic approach, that provides a more comprehensive diagnostic and personalized treatment strategy, a multidisciplinary team, and patient engagement. The strengths and weaknesses of these factors were explored and coaching was identified as a potential unifying and reinforcing element. Coaching has a wide spectrum of manifestations clearly representing a holistic approach, that has been successfully used in multidisciplinary team building. Moreover, coaching exposes support addressing the patient engagement issues identified by the Patient Needs-Resources Model (PN-R Model) such as low levels of self-efficacy, optimism, and subjective well-being. Coaching may assist patients to identify and prioritize their goals, becoming aware of their personal resources, developing strategies for managing symptoms, and building skills to increase their self-efficacy and active engagement in the treatment process. Therefore, the authors emphasize coaching as a perspective element of optimization of patient care, that requires additional theoretical and long-term empirical research.Item Digital assistance to support integrated healthcare(2023-12-28) Arāja, Diāna; Berķis, Uldis; Murovska, Modra; Institute of Microbiology and Virology; Development and Project DepartmentItem Economic burden of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) to patients : comparative study(2019) Arāja, Diāna; Brenna, Elenka; Hunter, Rachael M; Pheby, Derek; Berķis, Uldis; Lunga, Asja; Murovska, Modra; Rīga Stradiņš UniversityItem Exploring the Joint Potential of Inflammation, Immunity, and Receptor-Based Biomarkers for Evaluating ME/CFS Progression(2023-12-20) Berķis, Uldis; Svirskis, Šimons; Krūmiņa, Angelika; Grāvelsiņa, Sabīne; Vilmane, Anda; Arāja, Diāna; Nora-Krūkle, Zaiga; Murovska, Modra; Development and Project Department; Institute of Microbiology and Virology; Department of InfectologyBackground: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating chronic condition with no identified diagnostic biomarkers to date. Its prevalence is as high as 0.89% according to metastudies, with a quarter of patients bed- or home-bound, which presents a serious public health challenge. Investigations into the inflammation-immunity axis is encouraged by links to outbreaks and disease waves. Recently, research of our group revealed that antibodies to beta2-adrenergic (anti-β2AdR) and muscarinic acetylcholine (anti-M4) receptors demonstrate sensitivity to the progression of ME/CFS. The purpose of this study is to investigate the joint potential of inflammatome - characterized by interferon (IFN)-γ, tumor necrosis factor (TNF)-α, interleukin (IL)-2, IL-21, Il-23, IL-6, IL-17A, Activin-B, immunome (IgG1, IgG2, IgG3, IgG4, IgM, IgA) and receptor-based biomarkers (anti-M3, anti-M4, anti-β2AdR) determined -, for evaluating ME/CFS progression, and to identify an optimal selection for future validation in prospective clinical studies. Methods: A dataset was used originating from 188 persons, including 54 healthy controls, 30 patients classified as "mild" by severity, 73 as "moderate," and 31 as "severe," clinically assessed by Fukuda/CDC 1994 and International consensus criteria. Markers characterizing inflammatome, immunome, and receptor-based biomarkers were determined in blood plasma via ELISA and multiplex methods. Statistical analysis was done via correlation analysis, principal component, and linear discriminant analysis, and random forest classification; inter-group differences tested via nonparametric Kruskal–Wallis H test followed by the two-stage linear step-up procedure of Benjamini, Krieger, and Yekutieli, and via Mann-Whitney U test. Results: The association between inflammatome and immunome markers is broader and stronger (coupling) in severe group. Principal component factoring separate components affiliated with inflammatome, immunome, and receptor biomarkers. Random forest modeling demonstrates an out-of-box accuracy for splitting healthy/with condition groups of over 90%, and of 45% for healthy/severity groups. Classifiers with the highest potential are anti-β2AdR, anti-M4, IgG4, IL-2, and IL-6. Discussion: Association between inflammatome and immunome markers is a candidate for controlled clinical study of ME/CFS progression markers that could be used for treatment individualization. Thus, coupling effects between inflammation and immunity have a potential for the identification of prognostic factors in the context of ME/CFS progression mechanism studies.Item The Implementation of Managed Entry Agreements in Central and Eastern Europe : Findings and Implications(2017-12-01) Ferrario, Alessandra; Arāja, Diāna; Bochenek, Tomasz; Čatić, Tarik; Dankó, Dávid; Dimitrova, Maria; Fürst, Jurij; Greičiūtė-Kuprijanov, Ieva; Hoxha, Iris; Jakupi, Arianit; Laidmäe, Erki; Löblová, Olga; Mardare, Ileana; Markovic-Pekovic, Vanda; Meshkov, Dmitry; Novakovic, Tanja; Petrova, Guenka; Pomorski, Maciej; Tomek, Dominik; Voncina, Luka; Haycox, Alan; Kanavos, Panos; Vella Bonanno, Patricia; Godman, Brian; Faculty of PharmacyBackground: Managed entry agreements (MEAs) are a set of instruments to facilitate access to new medicines. This study surveyed the implementation of MEAs in Central and Eastern Europe (CEE) where limited comparative information is currently available. Method: We conducted a survey on the implementation of MEAs in CEE between January and March 2017. Results: Sixteen countries participated in this study. Across five countries with available data on the number of different MEA instruments implemented, the most common MEAs implemented were confidential discounts (n = 495, 73%), followed by paybacks (n = 92, 14%), price-volume agreements (n = 37, 5%), free doses (n = 25, 4%), bundle and other agreements (n = 19, 3%), and payment by result (n = 10, >1%). Across seven countries with data on MEAs by therapeutic group, the highest number of brand names associated with one or more MEA instruments belonged to the Anatomical Therapeutic Chemical (ATC)-L group, antineoplastic and immunomodulating agents (n = 201, 31%). The second most frequent therapeutic group for MEA implementation was ATC-A, alimentary tract and metabolism (n = 87, 13%), followed by medicines for neurological conditions (n = 83, 13%). Conclusions: Experience in implementing MEAs varied substantially across the region and there is considerable scope for greater transparency, sharing experiences and mutual learning. European citizens, authorities and industry should ask themselves whether, within publicly funded health systems, confidential discounts can still be tolerated, particularly when it is not clear which country and party they are really benefiting. Furthermore, if MEAs are to improve access, countries should establish clear objectives for their implementation and a monitoring framework to measure their performance, as well as the burden of implementation.Item Insights into Trends and Challenges of the Pharmaceutical Industry : the Role of Scientific Business Research(2023-12-11) Arāja, Diāna; Rīga Stradiņš UniversityPurpose: As an important player in the healthcare sector, the pharmaceutical industry has received increased attention in the context of the coronavirus disease caused by the SARS-CoV-2 virus (COVID19) pandemic and medicine shortages. Given the profitability of the pharmaceutical industry, there is a rising focus on business analysis from a wide range of business analysts, as well as consulting and auditing companies. However, the role of scientific research in the analysis of the pharmaceutical industry has been unclear in recent years. Therefore, this study aims to provide insight into the role of scientific business research in the development of the pharmaceutical industry. Methodology: To achieve the research aim, a general review was conducted using Academy of Management journals’ resources, the Web of Science platform, and the Scopus database for the selection of scientific articles. In addition, the views of leading business analysts, as well as consulting and auditing companies, on trends and challenges in the pharmaceutical industry were considered within this framework. Findings: Overall, the trend over the last 15 years has been towards less fundamental research on the development of the pharmaceutical industry. It can be assumed that business analysts, as well as consulting and auditing companies, have taken over this function. However, it is probably the lack of fundamental theoretical research that is one of the determining factors for the uncertain trends and hidden challenges of an outwardly thriving industry. Research limitations: This research provides an overview of trends and challenges in the pharmaceutical industry. In-depth factor analysis is beyond the limitations of this study. Practical implications: This study encourages researchers to focus more on fundamental business research in the pharmaceutical industry, as empirical local market research currently dominates. Originality: The study identified a research gap in fundamental business research on the pharmaceutical industry and proposes to strengthen this research to support the healthcare sector and people’s health.Item Integrative approach as a dormant element of integrated healthcare(2023-12-28) Arāja, Diāna; Krūmiņa, Angelika; Berķis, Uldis; Nora-Krūkle, Zaiga; Murovska, Modra; Rīga Stradiņš UniversityItem Medikamentozās ārstēšanas izmaksu–derīguma analīzes iespēju noteikšana Latvijā(Rīgas Stradiņa universitāte, 2010) Arāja, Diāna; Department of Applied PharmacyUsage of the knowledge of pharmacoeconomics is gaining popularity and recognition all over the world due to the introduction of increasingly new technologies in medicine and pharmacy that facilitate achieving unexperienced summits in treating patients, however, simultaneously make the treatment process more expensive. Consequently, the issue about the efficiency of the applied technologies, including medicines, becomes topical. The assessment of the efficiency of medicines lies in the competence of pharmacoeconomics. The most popular methods of the pharmacoeconomic analysis are: • Cost-minimisation analysis • Cost-benefit analysis • Cost-effectiveness analysis • Cost-utility analysis • Quality-of-life analysis’s etc. Health-related quality of life is a multidimensional construct measuring the physical, social and emotional aspects that are relevant and important for a patient’s well-being. With regard to the instruments used to measure quality of life, there are those that ask the patient directly and those where the doctor assesses the patient’s quality of life (self-assessment and assessment by specialist). There are two types of questionnaires: disease-specific quality-of-life questionnaire and general quality-of-life questionnaire. The disease-specific quality-of-life questionnaires are instruments used for the quantitative determination of the subjective state of health or well-being of patients suffering from the same illness. The general quality-of-life questionnaires are used for measuring health-related quality of life and can be used for a wide range of illnesses of varying degrees of severity or for different types of treatment. These instruments are not concerned with just one specific illness but can be used for all types of ailment as well as for healthy people. In scope of this work the author investigates the possibilities of using cost-utility analysis of medication in Latvia. The cost-utility analysis is a sub-form of cost-effectiveness analysis where benefits are expressed as Quality-Adjusted Life Years (QALYs). With QALYs, both the quality and quantity of the years of life a patient is expected to have are assessed and summarised. QALYs are calculated by estimating the total life-years gained from a treatment and weighting each year with a quality-of-life score (from 0, representing worst health, to 1, representing best health). Author chooses the measure of marginal scope of the QALYs for a labour to use the cost-utility analysis. As the specialised literature does not provide a clear view on this marginal scope, the author has used the health-related quality-of-life questionnaire for the measuring of data of the pharmacies’ clients with the assumption that these data could be extrapolated to all adults, because every adult regularly visits pharmacies. The main conclusions are: 1. The cost-utility analysis as one of the pharmacoeconomic analysis methods could be successfully used in Latvia, but there is a lack of specialists which could perform the analysis and interpret data. Due this reason the Riga Stradins University study programme for clinic pharmacists which includes a course on pharmacoeconomics is appreciated. 2. In accordance with the questionnaires’ data the marginal scope of QALYs for retired persons in Latvia averagely reduces twice to 0.5. 3. Health-related quality-of-life questionnaires should be widely used in Latvia for assessment of treatment process and monitoring of health-related data. The international comparison of these data could be useful for an analysis of the impact of social, demographic, economic and geographical factors.Item Nutrition-related Diseases in the Medicines Reimbursement System of Latvia(2013) Arāja, DiānaIn Latvia, the medicine reimbursement system for outpatient treatment operates under conditions of limited resources, and the state budget financing has been reduced in recent years. Under such circumstances, a necessity to identify additional possibilities to optimise resources allocation to health care programmes and prevention activities is important. The aim of this research was to identify nutrition-related diagnoses in the Latvian medicine reimbursement system and to determine potential efficiency of the resource allocation to complementary nutrition programmes. To meet the aim defined, theoretical research methods (analysis of legislative documents and special literature analysis) were used alongside empirical research methods (data collection: documentary analysis, statistical database analysis). The results of this research showed that the largest amount of reimbursed diagnoses, such as cardiovascular diseases, diabetes, cancer, digestive diseases, and osteoporosis, are identified as nutrition-related diagnoses in the review of special literature. Determination of t he efficiency of complementary nutrition programmes is a crucial issue in the context of the evidence-based medicine, both in terms of direct and indirect costs to society and government, and in terms of disability-adjusted life years and other health determinants directly related to patients. For this reason, possibilities for the evaluation of relative efficiency of the nutrition programmes for reimbursed diagnoses are investigated in depth.Item Perceptions of European ME/CFS Experts Concerning Knowledge and Understanding of ME/CFS among Primary Care Physicians in Europe : A Report from the European ME/CFS Research Network (EUROMENE)(MDPI, 2022) Cullinan, John; Pheby, Derek F. H.; Arāja, Diāna; Berkis, Uldis; Brenna, Elenka; de Korwin, Jean-Dominique; Gitto, Lara; Hughes, Dyfrig A; Hunter, Rachael M; Trepel, Dominic; Wang-Steverding, Xia; Pheby, Derek F.H.; Friedman, Kenneth J.; Murovska, Modra; Zalewski, Pawel; Department of Applied Pharmacy; Institute of Microbiology and VirologyItem Potential barriers to public awareness of integrated healthcare(2023-12-28) Arāja, Diāna; Berķis, Uldis; Murovska, Modra; Rīga Stradiņš UniversityItem Severity of COVID-19 : Causes and Consequences — From Obesity to Chronic Fatigue Syndrome(2021-12-14) Arāja, Diāna; Rovīte, Vita; Murovska, Modra; Terentjeva, Anna; Vaidere, Diāna; Vecvagare, Katrīne; Vīksna, Ludmila; Institute of Microbiology and Virology; Rīga Stradiņš UniversityIn circumstances of COVID-19 epidemiological uncertainty, the causes and consequences of the disease remain important issues. The aim of this study was to investigate obesity as a potential predisposition and chronic fatigue syndrome (CFS) as a possible consequence of COVID-19. The study was conducted in two parts: a theoretical part, in which a literature review was performed, and an empirical part, in which COVID-19 patient survey data were analysed. To identify the main findings regarding the relationship between obesity and COVID-19, the literature review was focused on the investigation of systematic reviews and meta-analyses by three databases — Med-line (via PubMed), Cochrane COVID-19 Study Register, and PROSPERO (International prospective register of systematic reviews). The patient survey was performed to investigate the relationship between obesity and severity of the disease, as well as the presence of CFS symptoms in COVID-19 patients in Latvia. The main findings of the literature review showed that obesity increases the risk of hospitalisation, disease severity, clinical complications, poor outcomes, and mortality. The results of the patient survey showed that overweight and obesity were more critical factors for men (males) suffering with COVID-19 than for women (females) in Latvia. The patient group with obesity caused almost half of all hospitalisations. The research data assumed that CFS patients were not a high-risk group for COVID-19, but COVID-19 caused CFS-like symptoms in patients and potentially increased the number of undiagnosed patients. In the context of further epidemiological uncertainty and the possibility of severe post-viral consequences, preventive measures are becoming increasingly important.Item Vaccine Vigilance System : Considerations on the Effectiveness of Vigilance Data Use in COVID-19 Vaccination(2022-12-10) Arāja, Diāna; Krumina, Angelika; Nora-Krukle, Zaiga; Berkis, Uldis; Murovska, Modra; Institute of Microbiology and Virology; Department of Infectology; Development and Project Department(1) Background: The safety of medicines has been receiving increased attention to ensure that the risks of taking medicines do not outweigh the benefits. This is the reason why, over several decades, the pharmacovigilance system has been developed. The post-authorization pharmacovigilance system is based on reports from healthcare professionals and patients on observed adverse reactions. The reports are collected in databases and progressively evaluated. However, there are emerging concerns about the effectiveness of the established passive pharmacovigilance system in accelerating circumstances, such as the COVID-19 pandemic, when billions of doses of new vaccines were administered without a long history of use. Currently, health professionals receive fragmented new information on the safety of medicines from competent authorities after a lengthy evaluation process. Simultaneously, in the context of accelerated mass vaccination, health professionals need to have access to operational information—at least on organ systems at higher risk. Therefore, the aim of this study was to perform a primary data analysis of publicly available data on suspected COVID-19 vaccine-related adverse reactions in Europe, in order to identify the predominant groups of reported medical conditions after vaccination and their association with vaccine groups, as well as to evaluate the data accessibility on specific syndromes. (2) Methods: To achieve the objectives, the data publicly available in the EudraVigilance European Database for Suspected Adverse Drug Reaction Reports were analyzed. The following tasks were defined to: (1) Identify the predominant groups of medical conditions mentioned in adverse reaction reports; (2) determine the relative frequency of reports within vaccine groups; (3) assess the feasibility of obtaining information on a possibly associated syndrome—myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). (3) Results: The data obtained demonstrate that the predominant medical conditions induced after vaccination are relevant to the following categories: (1) “General disorders and administration site conditions”, (2) “nervous system disorders”, and (3) “musculoskeletal and connective tissue disorders”. There are more reports for mRNA vaccines, but the relative frequency of reports per dose administered, is lower for this group of vaccines. Information on ME/CFS was not available, but reports of “chronic fatigue syndrome” are included in the database and accessible for primary analysis. (4) Conclusions: The information obtained on the predominantly reported medical conditions and the relevant vaccine groups may be useful for health professionals, patients, researchers, and medicine manufacturers. Policymakers could benefit from reflecting on the design of an active pharmacovigilance model, making full use of modern information technologies, including big data analysis of social media and networks for the detection of primary signals and building an early warning system.