bluuebunny/crossref_metadata_2025 huggingface dataset:
Endothelial glycocalyx integrity and microvascular perfusion are associated with novel echocardiographic markers and carotid intima-media thickness in patients with psoriasis
Authors: Ikonomidis I , Pavlidis G , Thymis J , Rafouli-Stergiou P , Makavos G , Kostelli G , Vrettou A R , Frogoudaki A , Katsimbri P , Lambadiari V , Parissis J , Iliodromitis E , Theodoropoulos K , Kapniari E , Papadavid E
Published: October 2021

Background/Introduction

Psoriasis has been associated with vascular and myocardial dysfunction through mechanisms of inflammation and oxidative stress.

Purpose

We aimed to evaluate sublingual microvascular perfusion and glycocalyx barrier properties in psoriasis patients, as well as their correlation with coronary microcirculatory function and markers of myocardial deformation and atherosclerosis (carotid intima-media thickness, cIMT).

Methods

We examined 297 patients with psoriasis and 150 controls, adjusted for age, sex, and atherosclerotic risk factors. Perfusion boundary region (PBR), a marker of glycocalyx barrier function, was measured non-invasively in sublingual microvessels with a diameter ranging from 5–25μm using a dedicated camera (Sidestream Dark Field imaging, Microscan, GlycoCheck). Increased PBR indicates reduced glycocalyx thickness. Indexes of microvascular perfusion, including red blood cell (RBC) filling percentage and functional microvascular density, were also calculated. We measured coronary flow reserve (CFR), cIMT and markers of myocardial deformation by speckle tracking imaging utilizing echocardiography [peak twisting, the percentage changes between peak twisting, and untwisting at mitral valve opening (%dpTw-UtwMVO), at peak (%dpTw-UtwPEF), and the end of early LV diastolic filling (%dpTw-UtwEDF)].

Results

Psoriasis patients had higher PBR5–25 compared to controls (2.13±0.29 versus 1.78±0.25μm, p<0.05). There was an inverse association of PBR5–25 with perfused microvascular density (r=−0.42, p<0.001) and RBC fraction (r=−0.80, p<0.001). In psoriatic population, PBR5–25 was inversely correlated to CFR (r=−0.30, p=0.045). Increased values of PBR5–9 were associated with reduced untwisting at the end of the mitral inflow E wave (r=−0.24, p=0.006) and reduced %dpTw-UtwMVO (r=−0.35, p<0.001). Furthermore, decreased RBC filling percentage and perfused microvascular density were related to worse LV longitudinal strain and increased cIMT (p<0.05). Finally, a positive correlation between perfused microvascular density and %dpTw-UtwMVO was observed in patients with psoriasis (p<0.05).

Conclusion

Endothelial glycocalyx thickness is reduced in patients with psoriasis and is associated with impaired coronary and myocardial function, and vascular atherosclerosis.

Funding Acknowledgement

Type of funding sources: None.
Cognitive dysfunction and adverse events during oral anticoagulant: a prospective cohort study
Authors: Massoure P , Nguyen C
Published: October 2021

Background

Oral anticoagulants (AC), represent the leading cause of iatrogenic morbimortality in France. AC are widely prescribed among the elderly. The assessment of the cognitive dysfunction (CD) is not included within the common thrombotic and bleeding risk scores.

Purpose

The objective of this study was to examine an association between CD and adverse events (AE) in patients receiving oral AC.

Methods

A prospective monocentric cohort study was conducted in patients (≥60 years-old) on oral AC. Death, hemorrhages, falls, hospital readmission, thromboembolic events were collected over 6 months follow-up. Patients were included during an hospitalization for any medical or surgical condition and divided in three groups, according to their Mini Mental State Examination (MMSE): Group 1 (absence of CD) MMSE ≥27, Group 2 (mild CD) 24<mmse<26, >≤MMSE≤26, Group 3 (significant CD) MMSE ≤23.

Results

Among 120 patients (mean age: 82,2±8,8 years), the all-causes mortality (n=25) was significantly higher in the Group 3 (n=17, p=0,006); this also applies to the incidence of falls (n=34, p=0,009) or major hemorrhages (n=10, p=0,023). There was no thromboembolic event. Minor hemorrhages and hospital readmissions were not different in the 3 groups. Multivariate analysis shows a significant risk of mortality (OR 4.3, (p=0,025, IC [1,20–15,42]) in group 3.

Conclusion

After 6 months of follow up, the cognitive dysfunction was associated with mortality, major hemorrhages and falls among the elderly receiving oral AC. A systematic assessment of cognitive functions of these patients seems to be essential to analyze the global risk and the risks related to the AC treatment.</mmse<26,>

Funding Acknowledgement

Type of funding sources: None.
Indications for prescription and deprescription in multimorbid independently living elderly outpatients
Authors: Popov A , Izmozherova N V , Gavrilova E I , Kuryndina A A , Shambatov M A , Bakhtin V M
Published: October 2021

Introduction

Global trend to population ageing is associated with inevitable increase of polypharmacy in multimorbid elderly population.

Purpose

To estimate the level and structure of comorbidity and pharmacotherapy in independently living patients of different age groups with high and extreme cardiovascular risk, when observed in outpatient clinics

Methods

282 consecutive patients of high cardiovascular risk have been enrolled. Inclusion criteria were: SCORE ≥5%, documented history of acute myocardial infarction (AMI), acute or transient cerebrovascular accident (CVD), coronary artery intervention, acute coronary syndrome (ACS), stable angina, intermittent claudication, type 2 diabetes mellitus (DM2) or type 1 DM with diabetic nephropathy, angiogram or ultrasound proved atherosclerotic plaques, total serum cholesterol level ≥8 mmol/L, blood pressure ≥180/110 mmHg and signed voluntary informed consent form. Current clinical conditions, pharmacologic treatment and indications for prescription and deprescription were studied.

STOPP criteria for prescribing potentially non-recommended drugs in people over 65 years of age, START criteria for not prescribing necessary drugs in people over 65 years of age, non-recommended in elderly people over 65 drug list were used to assess polypharmacy.

According to the WHO age classification, there were three groups: Group 1 (aged 45 to 59), Group 2 (aged 60 to 74) and Group 3 (aged 75 +).

Results

There were no differences in the frequency of statins administration (p=0.72) and antiplatelet agents (p=0.49) between 3 groups. Polypragmasia (administration of more than 5 drugs) was registered in 150 patients (53%) and was significantly more common in Group 3 (p=0.001). 48 cases of inadequate prescribing were registered in 46 (28%) elderly patients. 24 cases of prescribing potentially unacceptable medications for the elderly were reported.

Conclusion

Unavoidable polypragmasia was found in 53% multimorbid elderly patients.

Irrational drug treatment was detected in 28% elderly patients

STOPP criteria were met in 32.1% and START criteria were met in 30.4% cases.

Polypragmasia being inevitable in elderly multimorbid patients, administration of any new medication should be performed after a thorough risk-benefits balance assessment.

Funding Acknowledgement

Type of funding sources: None.
Efficacy of mindfulness-based cognitive therapy on symptoms of depression and anxiety in patients with coronary artery disease: insights from a prospective registry
Authors: Pascual-Madorran T , Zocca G , Ploumen E H , Szabo - Te Fruchte K , Buikema L , Kok M M , Van Buiten D G , Kuijpers P M J C , Von Birgelen C , De Man F
Published: October 2021

Introduction

Patients with coronary artery disease (CAD) report psychological distress and poor physical functioning after cardiovascular events. In cardiac rehabilitation, an exercise program is often used as A primary strategy; however, this is often not sufficient to address stress and psychosocial well-being.

Purpose

To investigate the effectiveness of a mindfulness-based cognitive therapy (MBCT) program on feelings of anxiety and depression in patients with CAD.

Methods

In this single-center prospective observational study, eligible cardiac rehabilitation patients with symptoms of anxiety or depression were recruited after referral for psychological consultation. During eight consecutive weeks, patients participated in group meetings. The program included psycho- education, cognitive behavioral therapy, meditation and slow abdominal breathing. Standard measures of depression, anxiety and blood pressure were obtained at baseline and after completion of the program. The Hospital Anxiety and Depression Scale (HADS) questionnaire was used as an instrument for detecting states of anxiety and depression.

Results

A total of 135 patients (mean age 56±9 years; 24% female) were enrolled. The mean HADS-Anxiety score improved from 11.0±3.7 at baseline to 6.6±3.4 after MBCT (p<0.001). The mean HADS-Depression score improved from 8.8±3.6 to 4.7±3.2 (p<0.001). In addition, during the MBCT program a significant decrease in blood pressure was noted: systolic from 140±18 to 130±17 mmHg and diastolic from 84±12 to 77±10 mmHg (p<0.001 for both).

Conclusion

This study provides evidence that a MBCT program has the potential to improve feelings of anxiety and depression in patients with CAD. Therefore, adding MBCT to cardiac rehabilitation in selected patients may be of great value.

Funding Acknowledgement

Type of funding sources: None.
Temporal trends in the inclusion of patient-reported outcomes in heart failure randomized trials published in high-impact medical journals: a systematic bibliometric review
Authors: Eliya Y , Averbuch T , Le N , Xie F , Thabane L , Mamas M , Van Spall H
Published: October 2021

Background

Patient reported outcomes (PROs) are important measures of health, particularly in symptomatic conditions such as heart failure (HF), and regulatory agencies have encouraged their collection in randomized controlled trials (RCTs).

Purpose

To assess temporal trends in the inclusion of patient-reported outcomes (PROs) in heart failure (HF) randomized controlled trials (RCTs) published in high-impact medical journals, explore trial characteristics associated with inclusion of PROs, and describe the quality of PRO reporting in HF RCTs.

Methods

We searched MEDLINE, EMBASE and CINAHL for studies published between January 1, 2000 and July 17, 2020. We included RCTs published in journals with impact factor ≥10. We assessed temporal trends using the Jonckheere-Terpstra test and conducted multivariable logistic regression analysis to explore trial characteristics independently associated with inclusion of PROs. We assessed the quality of PRO reporting using the Consolidated Standards for Trial Reporting PRO extension statement.

Results

We identified 12,342 articles, of which 417 RCTs met inclusion criteria. PROs were included in 224 RCTs (53.7%, 95% confidence interval [CI]: 48.8%-58.6%), of which 44 (19.6%) reported PRO as primary or co-primary endpoint. The proportion of RCTs with PROs increased significantly between 2000–2003 (37.4%) and 2016–2020 (65.1%) (p<0.001). PROs had higher odds of inclusion in RCTs that were multicenter (odds ratio [OR]: 1.95; 95% CI: 1.05–3.64; p=0.036); medium-sized (n=51–250) (OR: 2.29; 95% CI: 1.24–4.23; p=0.008); coordinated in in Central and South America (OR: 6.79; 95% CI: 1.34–34.36; p=0.021); and assessed health services (OR: 4.21; 1.97–8.98; p<0.001), device / surgical (OR: 6.24; 95% CI 3.05–12.80; p<0.001), or exercise and rehabilitation interventions (OR: 3.98; 95% CI 1.59–9.97; p=0.003). A majority (54.9%) of the 224 RCTs reported four or less of the eleven CONSORT-PRO items. The median number of CONSORT-PRO items reported was 4 (interquartile range [IQR] 3–6 items per trial), with improved reporting in trials with PRO as primary or co-primary endpoint.

Conclusions

PROs are included in in just over half of HF RCTs, with an increased reporting of PROs between 2000 and 2020. Large, pharmacotherapy trials conducted in North America and Europe were less likely to include PROs. The quality of PRO reporting in HF RCTs was modest, with trials most often reporting four of eleven CONSORT-PRO items.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Canadian Institutes of Health Research
A genetic risk score predicts recurrent events after myocardial infarction in young patients with a low level of traditional risk factors
Authors: Mendonca F , Mendonca M I , Temtem M , Santos M , Sousa J A , Sousa A C , Henriques E , Freitas S , Rodrigues M , Borges S , Guerra G , Drumond A , Palma Dos Reis R ,   GENEMACOR study
Published: October 2021

Introduction

Coronary Heart Disease (CAD) is a multifactorial disease, including environmental and genetic risk factors. Current smoking, dyslipidemia and diabetes have a significant impact in long- term mortality and morbidity. However, several genetic variants associated with CAD but not with traditional risk factors (TRFs) has been reported to improve prediction of events and extended mortality, in younger CAD people.

Aim

To evaluate the clinical utility of a GRS composed by variants from GWAS associated to CAD but not with TRF to predict life-long residual risk in patients under 55 years old and a low level of TRFs.

Methods

We conducted a prospective study with 573 consecutive patients aged <55 years presenting with AMI and a low level of TRFs (without diabetes and with LDL cholesterol >150 mg/ml). We analysed several biochemical markers and performed a GRS with variants not associated with TRFs (TCF21 rs12190287, CDKN2B-AS1 rs1333049, CDKN2B rs4977574, PHACTR1 rs1332844, MIA3 rs17465637, ADAMTS7 rs3825807, ZC3HC1 rs11556924, SMAD3 rs17228212 and GJA4 rs618675). We studied the GRS association with a primary composite endpoint of all-cause vascular morbidity and mortality including recurrent acute coronary syndrome (myocardial infarct and unstable angina), coronary revascularization (coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI), re-hospitalization for heart failure, ischemic stroke and cardiovascular dead.

Results

A total of 573 patients were studied and followed up for a mean of 4.7±4.0 years. There were 169 recurrent cardiovascular events. The GRS was sub-divided into terciles, verifying that patients in the third tercile (high risk) had a higher number of risk alleles. Compared with the low-risk GRS tercile, the multivariate-adjusted HR for recurrences was 1.520 (95% CI 1.011–2.286); p=0.044 for the intermediate-risk group and was 2.051 (95% CI 1.382–3.044); p<0.0001 for the high-risk group. Inclusion of the GRS in the model with TRFs alone (low risk) improved the C-statistic analysis (C-statistic = 0.030; p=0.004), cNRI (continuous net reclassification improvement) (30.8%), and the IDI (integrated discrimination improvement index) (0.022).

Conclusions

A multilocus GRS may identify young coronary disease patients with a low level of TRFs but at significant risk of long-term events recurrence. The genetic information may improve prediction discrimination, and reclassification over the conventional risk factors alone, providing better cost-effective therapeutic strategies.

Funding Acknowledgement

Type of funding sources: None. Figure 1
CD69 expression in regulatory T cells protects from the immune-mediated damage after myocardial infarction
Authors: Blanco-Dominguez R , De La Fuente H , Garcia-Guimaraes M M , Rodriguez C , Rodriguez-Arabaolaza I , Jimenez-Alejandre R , Sanchez-Diaz R , Alfonso F , Sanchez-Madrid F , Martinez-Gonzalez J , Martin P
Published: October 2021

CD69 depletion from the lymphoid compartment promotes a Th17/Treg imbalance and exacerbates the development of atherosclerosis. As atherosclerosis is the trigger of myocardial infarction, we have analyzed the role of CD69 in Treg cells after a) permanent occlusion of the left-anterior-descending coronary artery (LAD-ligation) in mice, and b) coronary angiography in two cohorts of acute myocardial infarction (MI) patients.

Our data show that CD69 expression in Treg cells is critical to maintain immune homeostasis after myocardial infarction and increases overall survival in mice after LAD-ligation. Cd69−/− mice develop IL17A+ gdT cell responses early after ischemia that increment myocardial inflammation and, consequently, worsen cardiac function. Furthermore, we found that CD69+ Treg cells induce apoptosis and diminish IL-17A production in gdT cells by a mechanism dependent on membrane CD39 ectonucleotidase activity. The adoptive transfer of CD69+ Treg cells to Cd69−/− mice after LAD-ligation reduces IL17A+ gdT cell recruitment, resulting in increased survival and improved outcome.

In accordance, data from two independent cohorts of patients indicate that increased levels of CD69+ Treg cells in the blood of patients early after MI is associated with lower risk of developing chronic heart failure. Our data support the role of CD69+ Treg cells to prevent excess of inflammation and damage after MI, whose value remains associated with improved heart function in the medium term.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Fondo de Investigaciones Sanitarias. Instituto de Salud Carlos III. Ministerio de Ciencia Innovaciόn y Universidades (Spanish Government). Summary immage
Vascular repair and regeneration in cardiometabolic diseases
Authors: Hess David A , Verma Subodh , Bhatt Deepak , Bakbak Ehab , Terenzi Daniella C , Puar Pankaj , Cosentino Francesco
Published: October 2021

Chronic cardiometabolic assaults during type 2 diabetes (T2D) and obesity induce a progenitor cell imbalance in the circulation characterized by overproduction and release of pro-inflammatory monocytes and granulocytes from the bone marrow alongside aberrant differentiation and mobilization of pro-vascular progenitor cells that generate downstream progeny for the coordination of blood vessel repair. This imbalance can be detected in the peripheral blood of individuals with established T2D and severe obesity using multiparametric flow cytometry analyses to discern pro-inflammatory vs. pro-angiogenic progenitor cell subsets identified by high aldehyde dehydrogenase activity, a conserved progenitor cell protective function, combined with lineage-restricted cell surface marker analyses. Recent evidence suggests that progenitor cell imbalance can be reversed by treatment with pharmacological agents or surgical interventions that reduce hyperglycaemia or excess adiposity. In this state-of-the-art review, we present current strategies to assess the progression of pro-vascular regenerative cell depletion in peripheral blood samples of individuals with T2D and obesity and we summarize novel clinical data that intervention using sodium-glucose co-transporter 2 inhibition or gastric bypass surgery can efficiently restore cell-mediated vascular repair mechanisms associated with profound cardiovascular benefits in recent outcome trials. Collectively, this thesis generates a compelling argument for early intervention using current pharmacological agents to prevent or restore imbalanced circulating progenitor content and maintain vascular regenerative cell trafficking to sites of ischaemic damage. This conceptual advancement may lead to the design of novel therapeutic approaches to prevent or reverse the devastating cardiovascular comorbidities currently associated with T2D and obesity.
Planetary health research: insights from The Lancet Planetary Health original articles
Authors: Cadeddu C , Pezzullo AM , Sapienza M , Castagna C , Regazzi L , Carini E , Messina R , Silenzi A , Villani L , Damiani G , Ricciardi W
Published: October 2021

Background

In 2017, the Lancet group launched The Lancet Planetary Health to promote the dissemination of research conducted in this field. Planetary health was also extensively discussed during the World Congress on Public Health 2020, which underlines the strategic importance recognized to this topic by experts and researchers active in public health at an international level. The aim was to investigate the role of public health university departments in the field of planetary health.

Methods

The Lancet Planetary Health database was queried from the inception to February 2021, to retrieve original articles or reviews whose first and/or last author was affiliated to a University Department of Public Health worldwide. We used the twenty-six EUPHA operational sections to define the research areas of the identified articles. The following data were extracted: study design, EUPHA area, research question, topic, identified gaps in the literature, and key concepts.

Results

Out of 543 entries, 44 original articles and reviews were included. Thirty-two percent studies were conducted in Asia, 20% in America, 13% in Europe, 8% in Oceania, 4% in Africa while 23% in a multicentric global context. The area investigated was mainly environmental and health (68%) followed by infectious disease control (14%). Collaboration across different disciplines is highly present in the authorships. Regarding the study design, 30% of the included articles were cohort studies.

Conclusions

From 2017 till February 2021, the number of studies performed by public health researchers published on The Lancet Planetary Health is gradually increasing.

Since published articles take advantage of the typical research methods and topics of public health and environmental health research, public health university departments can contribute to planetary health science if they seek transdisciplinary collaboration and adopt a planetary health vision.
Is COVID 19 introducing a new model of internal medicine ward?
Authors: Rosiello F , Pietrantonio F , Berardino A Di , Delli Castelli M , Ciamei A , Piccione A , Rainone M , Alessi E , Vinci A , Ruggeri M
Published: October 2021

Background

Covid 19 has recently been defined as a syndemia, because it combines the epidemic emergency of Sars Cov 2 with that of non-communicable diseases. This aspect is particularly known in internal medicine wards (IM), which have had to split up to support these new criticalities.

Methods

Delphi method has been used to make the Ishikawa's diagram to analyze the reasons of the death in COVID ward. Each item was attributed a score according to a pros/cons and opportunities/threats system, derived from evidence in the literature. Scores were presented in a Cartesian graph showing the positioning according to the potential value and the perceived risk associated with the items. In the end, the performances of MC (Covid ward, split in I wave, II wave and overall) and MCF (internal medicine Covid-free ward) have been compared through the Barber's nomogram.

Results

MCF hospitalized 790 patients (-23,90% compared to 2019), Overall-MC patients: 50% of the 2019 MCF. Main cause of mortality-risk: patients originating from local facilities (+7%) and comorbidities (58% Chronic renal failure, 41% cancer, 90% age, 70% COVID 19 WHO stage 3. >3 comorbidities: 100%, ≥5: 24,7%). Length of stay: 8-60 days (mean value, MV: 17) for MC, 2-12 (MV 8) for MCF. Turnover Index: 10 day for MC II, 8 MC I, 1 for MCF. 25% of patients in MC have been treated with Non Invasive Ventilation (NIV), with high cost hospitalization-related.

Conclusions

Internal-Medicine ward model is a ward strictly tied to the community both before and after hospitalization. COVID 19 proposes a new model of IM, nearly subintensive ward, with NIV and continuous monitoring of vital signs, long length of stay and low turnover index. Is this the internal medicine ward for the future?

Key messages

COVID 19 proposes a new model of Internal Medicine ward, nearly subintensive ward, with Non Invasive Ventilation and continuous monitoring of vital signs, long length of stay and low turnover index. Covid 19 mortality is strictly connected with the origin from territorial health-assisted residences.
Evaluation of a targeted COVID-19 vaccination strategy for Austria–a decision-analytic modeling study
Authors: Jahn B , Sroczynski G , Bicher M , Rippinger C , Mühlberger N , Santamaria J , Urach C , Ostermann H , Popper N , Siebert U
Published: October 2021

Background

The supply of COVID-19 vaccine was limited when introduced. We aimed to inform decision makers at an early stage about targeted COVID vaccination strategies, accounting for limited capacities and adherence to support vaccination prioritization in Austria.

Methods

We applied a dynamic agent-based population model to compare different vaccination prioritization strategies targeting the elderly (65 ≥ years), middle aged (45-64 years), younger (15-44 years), vulnerable (risk of severe disease due to comorbidities), and healthcare workers (HCW), to minimize COVID-19-related hospitalizations and deaths. First, outcomes were optimized for an initially available vaccine batch for 200,000 individuals. Second, stepwise optimization was performed, deriving a prioritization sequence for 2.5 million people. We considered sterilizing and non-sterilizing immunity, with different assumptions of effectiveness, over a 6-month period. The project team was advised by a Standing Policy and Expert Panel, consisting of Austrian decision makers, clinical and ethical experts as well as international modeling specialists.

Results

Maximum reduction of hospitalizations and deaths was achieved by starting vaccinations with the elderly and vulnerable, followed by middle-aged, HCW, and younger individuals. Optimizations for vaccinating 2.5 million individuals yielded the same prioritization and avoided about one third of deaths and hospitalizations. Starting vaccination with HCWs leads to slightly smaller reductions. The negative effects of COVID-19-related HCW absenteeism were not yet considered in our model.

Conclusions

Our decision-analytic study shows that the elderly and vulnerable should be prioritized for vaccination until further vaccines are available to minimize COVID-19-related hospitalizations and deaths. An important ethical aspect complementing our modeling results is the protection of HCW, maximizing their occupational safety and ensuring risk-compensatory justice.

Key messages

To minimize COVID-19-related hospitalizations and death the elderly and vulnerable should be prioritized for vaccination until further vaccines are available. Prioritizing health care workers for COVID-19 vaccination is slightly less effective in the simulation but they may be considered for occupational safety and to ensure risk-compensatory justice.
Reduction in Neurological Disease Hospitalization Rate During Covid-19 Pandemic in Abruzzo
Authors: D'Addezio M , Di Giovanni P , Cedrone F , Di Martino G , Meo F , Scampoli P , Staniscia T
Published: October 2021

Background

As a consequence of the Covid-19 outbreak, Italy has adopted unprecedented preventive measures such as large-scale application of social isolation and hospital rearrangements. These measures have led to difficulty in managing diseases and hospitalizations, particularly acute and severe conditions such as neurological morbidities. The aim of the present analysis is to investigate the change in hospital admissions for neurological diseases over the first nine months of 2020 in Abruzzo region.

Methods

Data were obtained from the Hospital Discharge Records of all Abruzzo. We analyzed all the hospitalizations included in Major Diagnostic Categories 1 (neurological diseases). First, we distinguished both between public or private hospitalizations and ordinary or day-hospital admissions. Second, we compared the first nine months of 2020 with a mean of the same months in the two previous years. Finally, we calculated the variable percentage.

Results

A huge reduction in MCD 1 series hospitalizations was observed in each subgroup. Specifically, ordinary regimen had a peak of -47,3% in April. Day-hospital admissions were the most affected by Covid-19 with a peak of more than 90% in April both in public and private hospitals. The largest reduction occurred in private hospitals, both in ordinary (-75% in April) and DH admissions (-93,8% in March).

Conclusions

Despite the severity of the diseases included in MDC 1 (i.e. ischemic stroke, intracranial hemorrhage), a significant decline was detected in hospital admissions in Abruzzo. Subsequently, a high number of subjects might have not received the necessary health assistance leading to an increase in mortality and morbidity for these severe pathologies. Additionally, patients might have avoided seeking hospital care in response to the fear of contagion triggered either by media or as a result of the stay-at-home government recommendations.

Key messages

An alarming reduction in all types of hospitalizations for neurological diseases occurred over the first months of pandemic in Abruzzo. Greater management efforts are needed to reduce the morbidity and mortality rates associated with the reduced hospital admissions during the pandemic.
An emerging innovative UV disinfection technology: virucide activity on SARS-CoV-2
Authors: Messina G , Della Camera A , Ferraro P , Amodeo D , Falcone V , Corazza A , Nante N , Cevenini G
Published: October 2021

Background

Surface sanitation is one of the key points to reduce the risk of transmission both in healthcare and other public spaces. UV-C is already used in hospital and laboratory's disinfection procedure furthermore some recent studies show effectiveness on SARS-CoV-2. UV-C may be generated by Lamps and Light Emitting Diode, but novel sources are emerging. The aim of the study was to test a device having UV chips for inactivating SARS-CoV2.

Methods

The descriptive study was conducted in the period between June and July 2019, in laboratories of the University of Siena and of the scientific park of Toscana life sciences. The device, shaped in a rectangular box, contained six UV chips (10 mW each, with a peak at 264nm nm ranging from 260 to 350 nm) placed in the bottom. Central and short side long positions were tested expecting different dose levels. Each experiment was conducted in triplicate, with and without the device lid, at 3, 6 and 10 minutes. All repetitions were tested for SARS-CoV-2 having a virus suspension of 10^7.2.

Results

The zones with the higher value of irradiance (max 187.9 µW/cm2) were near the corners of the box, while the lowest (min 61.9 µW/cm2) near one of the long sides. The light distribution was almost symmetrical. The tests revealed a viral charge reduction from an initial concentration of virus suspension of 10^7.2 TCID50/mL, of more than 99.9% after 3 minutes of UV exposure; at 6 minutes, the minimum Log10 attenuation value was over 5 Log10(99,999%); the maximum detectable attenuation value of Log10 = 5.7 was measured at 10 minutes.

Conclusions

This device is the first one which introduces this novel UV chip source, similarly it is the first time it was tested against the SARS-CoV-2. Objects that need to be disinfected may benefit of such devices according a proper exposition time for homogeneous disinfections of the surfaces.

Key messages

Implementation of cleaning and disinfection devices has been shown to reduce Sars-cov-2 infection incidence. In the hospital sanitation field, but also in public places and homes, using viable alternatives as UV-C can contribute to the reduction of pandemic spread.
Access to health services for non-Covid-19 causes during the pandemic. A literature review
Authors: Vázquez ML , Vargas I , Oliver A , Espinel V , Ronda E , Sanz-Barbero B , Diaz E , Pujolar G
Published: October 2021

Background

Negative effects of the Covid-19 pandemic on access to care for other diseases are currently at debate.

Aim

To review existing literature on care access for non-Covid-19 conditions since the pandemic onset.

Methods

Scoping review using various databases (Medline, VHL, Web of Science, 2020/21). Terms used: ‘access', ‘health services', ‘Covid-19'. Out of 4,060 identified articles, 37 were selected after reviewing and assessing titles, abstracts and full text. Aday and Andersen's framework guided the analysis.

Results

Of selected articles, 21 analyse impact on health services use; 8 on performance; 8 on access barriers. Most analyse specific services during early pandemic stages through register review, showing an initial decline in use with inconsistent results on recovery. Some indicate increased complexity of treated patients and treatment delays. Studies surveying professionals analyse the impact on services performance or clinical practice, reporting a decrease in consultations/interventions for diverse pathologies and response implementation (e.g. telemedicine), but not how they affected access. Few studies focus on social inequalities in use, showing a greater reduction in low-income or ethnic minority users. Studies on unmet needs, access or barriers based on user surveys or qualitative methods are scarce, focused on a pathology or clinical area. Particularly in Spain, studies analyse impact on use of emergency, primary care and cancer diagnosis, and on emergency and cardiology services functioning. Studies based on user surveys are lacking: only a qualitative study analysed access difficulties for chronic patients in confinement. Methodological weaknesses are identified.

Conclusions

Although currently emerging, studies analysing the pandemic impact on equal access to care for non-Covid-19 conditions are scarce, limited in focus and methodology, especially in Spain. Comprehensive medium/long-term impact assessments, including analysis of causes, are needed.

Key messages

Research is lacking on the impact of the COVID-19 pandemic on healthcare access, particularly for vulnerable groups. Further evidence is needed to improve health systems resilience in the future.
Determinants of healthcare workers’ willingness to receive the influenza vaccine in Tunisia
Authors: Cherif I , Kharroubi G , Bouabid L , Gharbi A , Boukthir A , Ben Alaya N , Ben Salah A , Bettaieb J
Published: October 2021

Background

Influenza is a contagious respiratory disease that may lead to severe illness. Given their frequent contact with ill individuals, healthcare workers (HCWs) are at elevated risk of developing influenza and of transmitting the disease to their patients. We aimed in this study to assess flu vaccination intention among Tunisian HCWs and to identify its determinants.

Methods

A cross sectional study was conducted among Tunisian HCWs with direct patient contact during the 2018-2019 influenza season. Participants were recruited in primary and secondary healthcare facilities according to a self-weighted multistage sampling. Factors associated with influenza vaccination intention were assessed using a multivariate logistic regression analysis.

Results

In this study, 1231 HCWs were enrolled with a mean age of 44.5±9.3 years and a sex ratio equal to 0.25. Among respondents, 43.1% (95% CI: [40.0-45.8]) declared their willingness to receive the IV if recommended for HCWs and provided for free. Participants who received the IV during the 2018-2019 influenza season ((ORa=34.42 [16.41-72.21]), who knew that IV is indicated annually for HCWs (ORa=1.66 [1.21-2.30]), who had high confidence regarding IV efficacy (ORa=1.99 [1.48-2.68]), who believed that IV should be mandatory for HCWs (ORa=2,36 [1.76-3.18]) and that HCWs' vaccination against influenza is important in order to protect patients (ORa=1.92 [1.37-2.69]) were more likely to be willing to receive the IV. However, nurses were less likely to be willing to receive the vaccine than physicians (ORa=0.66 [0.44-0.98]).

Conclusions

Less than half of participants reported their willingness to receive the IV. Our results suggest that flu vaccination acceptance is associated with higher IV uptake and with favorable attitudes regarding influenza vaccination. This highlights the need to implement regular flu awareness campaigns in healthcare facilities aiming to encourage vaccination among HCWs.

Key messages

Majority of healthcare workers reported their unwillingness to receive the influenza vaccine. Educating health personnel about the benefits of influenza vaccination to themselves and their patients is necessary.
Increasing cultural competence through experience-based learning: Preventing child Injury in Israel
Authors: Daudi L , Luder A , Spitzer-Shohat S , Rudolf M CJ
Published: October 2021

Background

Future practitioners need to learn to communicate with culturally diverse patients, understand their perspectives on disease and provide individually tailored guidance. SHABI (Keeping our Children Safe in Hebrew) is a program set up with a dual purpose of improving families' home-safety and providing students with experience-based learning. 11 medical/nursing students twice visited 135 families who were recruited in an emergency-room following unintentional injury of a preschool child on May 2019-March 2020. 50% of families were ultra-Orthodox Jews, 11% Arab, and 28% had ≥3 children ≤5 years old. Training included child injury prevention, communication skills and insights on religious communities led by a local ultra-Orthodox Rabbi and head of Arab municipal social services.

Objective

To examine SHABI's impact on students' cultural competence, evaluated through student interviews 8 months after baseline, their written reports after home visits (n = 233), parent interview calls (n = 212) and change in observed home safety assessed by a checklist 4 months later (n = 233).

Results

Students reported that training helped them to culturally adapt the visits, and that the home visits increased their understanding of cultural and religious groups with whom they had little familiarity. Students worried that they would be perceived as judgmental, but parents reported they were sensitive, and the visits were beneficial. Following the first visit, 64% of parents reported increased awareness about home safety and 59% that the visit improved home safety. Effectiveness of student skills were confirmed by observed 15% improvement in home-safety after 4 months.

Conclusions

This experience-based learning helped to develop students' self-perceived cultural competence and improve families' home safety. SHABI may serve as a model of how students can learn to engage with disadvantage populations after a medical encounter, promoting their skills while benefitting families.

Key messages

Participating in experience-based learning and engaging with diverse populations developed cultural competence and benefited local populations. The SHABI program presents a feasible model to introduce into healthcare education.
Magnitude, risk factors of addictive behaviors among school students in Southern Tunisia
Authors: Baklouti M , Ben Ayed H , Maamri H , Ketata N , Jdidi J , Kassis M , Feki H , Dammak J
Published: October 2021

Background

The use of addictive product is an important public health problem rapidly spreading around the world threatening the users, their families and environments, causing serious health problems and devastating societies in psychological and economical terms. During adolescence, these substances are harmful to health, affecting the developing of brain. This study aimed at investigating the prevalence, the determinants and the impact of addictive behaviors (AB) among school students (SS).

Methods

This was a cross-sectional study including a three-stage randomized sample of 1210 SS from different public schools of Southern Tunisia, on April 2021, using an anonymous self-administered questionnaire. AB were defined as the consumption of at least one of the following products: tobacco, illicit drugs and alcohol.

Results

Overall, 723 SS were females (59.8%), with a sex ratio (Male/Female) of 2.3. The average age was 15.64±2.05 years. In total, 793 cases (65.5%) were from rural areas. The prevalence of addictive behaviors was 18.7% (225). It was 13.9% (168) for current smoking, 3.1% (37) for alcohol consumption and 1.7% (20) for illicit drug use. Factors independently associated with AB in logistic multivariate analysis were male gender (Adjusted Odds Ratio (AOR)=10.2;p<0.001), secondary school studies (AOR=1.5;p=0.008), age ≥14 years (AOR=2.5;p<0.01) and living alone or sharing home with friend (AOR=2.29;p=0.004). These AB had statistically negative impact on SS, notably for low school marks and academic failure (OR = 2.5;p=0.01 and OR = 1.66;p=0.002, respectively). Moreover, the perceived stress scale was statistically higher among SS with AB (OR = 1.4;p=0.03).

Conclusions

Addictive behaviors among SS were alarmingly prevalent in Southern Tunisia, which was correlated with socio-demographic, cultural and educational factors. New preventive and therapeutic strategies should be urgently initiated to ensure a safe educational and psychological environment for SS.

Key messages

Addictive behaviors among SS were alarmingly prevalent in Southern Tunisia. Addictive behaviors among SS were correlated with socio-demographic, cultural and educational factors.
The dispersive velocity of compressional waves in magmatic suspensions
Authors: Carrara Alexandre , Lesage Philippe , Burgisser Alain , Annen Catherine , Bergantz George W
Published: October 2021

The geophysical detection of magma bodies and the estimation of the dimensions, physical properties and the volume fraction of each phase composing the magma is required to improve the forecasting of volcanic hazards and to understand transcrustal magmatism. We develop an analytical model to calculate P waves velocity in a three-phase magma consisting of crystals and gas bubbles suspended in a viscous melt. We apply our model to calculate the speed of sound as a function of the temperature in three magmas with different chemical compositions, representative of the diversity that is encountered in arc magmatism. The model employs the coupled phase theory that explicitly accounts for the exchanges of momentum and heat between the phases. We show that the speed of sound varies nonlinearly with the frequency of an acoustic perturbation between two theoretical bounds. The dispersion of the sound in a magma results from the exchange of heat between the melt and the dispersed phases that affects the magnitude of their thermal expansions. The lower bound of the sound speed occurs at low frequencies for which all the constituents can be considered in thermal equilibrium, whereas the upper bound occurs at high frequencies for which the exchange of heat between the phases may be neglected. The presence of gas in a magma produces a sharp decrease in the velocity of compressional waves and generates conditions in which the dispersion of the sound is significant at the frequencies usually considered in geophysics. Finally, we compare the estimates of our model with the ones from published relationships. Differences are largest at higher frequencies and are <10 per cent for typical magma.
An application of the ecological model to sexual harassment in informal areas of Cairo, Egypt
Authors: Hassan Rasha , Roushdy Rania , Sieverding Maia
Published: October 2021

Street-based sexual harassment is a prevalent but understudied form of gender-based violence that restricts women’s access to public spaces. Drawing on adaptations of the ecological model that identify the root causes of gender-based violence in patriarchy, in this study, we explore the causes of street harassment in informal areas of Greater Cairo. Our analysis is based on qualitative interviews and focus groups with male and female youth aged 13–29 years, parents of youth and community leaders in two informal areas. We supplement the qualitative data with descriptive analysis of a representative, 2016 survey of youth in informal areas of Cairo that measured experiences with and attitudes toward harassment. Harassment was prevalent in the study areas, and respondents tended to place the blame for harassment at the individual level of the ecological model, particularly women’s behavior. However, there were also community- and societal-level factors that contributed to the prevalence of harassment. Patriarchal norms and stigmatization of women who are harassed reinforced victim-blaming, such that most young women were afraid to report experiences of harassment due to social censure. In this context, educational or awareness raising interventions are unlikely to be effective in combating harassment, which is widely acknowledged to be a problem. Rather, interventions are needed along the different levels of the ecological model to target peer group and community norms that encourage harassment, address harassment in schools and strengthen reporting mechanisms.
Pre-exposure prophylaxis (PrEP) in Australia: are there challenges facing sexual health promotion?
Authors: Dunn Matthew , Barnett Anthony , McKay Fiona H
Published: October 2021

Pre-exposure prophylaxis (PrEP) for HIV refers to the daily use of antiretroviral medications by HIV uninfected persons to block a potential HIV infection. There is evidence to show that as the use of PrEP increases, the use of other safer sex practices such as condoms decreases, which may lead to an increase in sexually transmitted infections (STIs). This study aimed to explore whether PrEP had caused any challenges for organizations undertaking sexual health promotion activities in Australia. In-depth, semi-structured interviews were conducted with 17 participants (15 males, 2 females) who were purposively sampled from a range of HIV advocacy and health promotion settings. These included publicly funded HIV/AIDS councils and organizations representing people living with HIV/AIDS. Guided by an exploratory, inductive approach, the interviews were analyzed using thematic analysis. Three themes were constructed from the data analysis. First, organizations in different jurisdictions came to support PrEP in different ways, and this influenced the way organizations engaged with PrEP and the messaging that they disseminated to their community. Second, organizations faced some barriers to promoting PrEP, with the most significant being overcoming decades of HIV prevention campaigns that focused on barrier methods only. Third, there were social benefits to PrEP, such as shifting the onus of preventing HIV transmission from HIV positive to HIV negative people. PrEP is a highly effective biomedical intervention to reduce HIV transmission, and future challenges include designing campaigns for those at risk for HIV transmission outside the MSM community.