bluuebunny/crossref_metadata_2025 huggingface dataset:
The Predictive role of speckle-tracking and left ventricular ejection fraction estimation using 2D and 3D echocardiography in the detection of chemotherapy related cardiotoxicity
Authors: Oliveira C C , Coutinho R , Flores R , Medeiros P , Pires C , Mane F , Silva R , Braga C , Vieira C , Pereira V H
Published: October 2021

Background

2D left ventricular ejection fraction (LVEF) estimation through echocardiography has been the classic parameter for cancer therapy–related cardiac dysfunction (CTrCD) detection. However, it is hypothesized that other parameters can be used in order to detect early stages of subclinical cardiotoxicity when LVEF is still preserved. Therefore, 3D LVEF and 2D and 3D strain parameters assessments have been evaluated in patients submitted to anthracyclines treatment.

Objectives

To compare 2D and 3D LVEF and strain parameters estimation using echocardiography regarding its ability to predict and detect subclinical and clinical cardiotoxicity during and after anthracyclines treatment.

Search methods and criteria

A systematic review was done and search was performed on PubMed and EMBASE from January 1st of 2000 to October 31th of 2020. Observational studies comparing 2D and 3D echocardiographic exams performed in adult patients submitted to anthracyclines were analyzed. Studies that evaluated survivors of pediatric cancer were excluded. 11 studies were included (n=844 patients).

Main results

2D and 3D LVEF decreased throughout the echocardiographic assessments of 7 studies, but 2D LVEF drops were not statistically significant in 4 studies and 3 studies showed that 3D LVEF detected a superior number of patients with abnormal LVEF. Compared to 3D LVEF,

2D GLS decreased at an earlier point of treatment and detected a superior number of patients with subclinical LV dysfunction. Despite 2D and 3D GLS decreased throughout treatment, 3D GLS measurements were consistently lower and had higher relative variation. All 3D strain parameters decreased during and after the treatment and have higher relative variations than 2D GLS, with the exception of 1 study. 3D GLS reference values are not yet recognized by guidelines, so subclinical LV dysfunction was not evaluated.

Conclusions

LVEF estimation through 3D proved to be a better parameter for CTrCD detection vs 2D imaging. GLS is superior to 3D LVEF in detecting earlier LV changes, even if calculated using 2D echocardiography. Moreover, GLS reduction can be a predictor of subsequent LVEF decrease. 3DE is a growing potential technique and may be superior to 2DE in detecting and predicting subclinical LVEF dysfunction and CTrCD, respectively. Though 3D strain parameters presented promising results, more studies are needed to prove its incremental value over 2D strain echocardiography

Funding Acknowledgement

Type of funding sources: None.
Prognosis of adverse outcomes in patients with ST-elevation myocardial infarction and acute ischemic kidney injury
Authors: Mitkovskaya N , Brankovskaya E
Published: October 2021

Background

The category of patients with ST-segment elevation myocardial infarction (STEMI) remains in the focus of attention of cardiologists across the globe due to the high rates of hospital and long-term mortality. Acute ischemic kidney injury represents one of the most serious complications of STEMI, due to its highly negative impact on the disease prognosis. Therefore, it is critical for a clinician to identify STEMI and acute ischemic kidney injury patients who are at high risk of developing adverse outcomes.

Purpose

To identify key prognostic markers of adverse outcomes in patients with STEMI and acute ischemic kidney injury.

Methods

The study included 173 patients (ages 37–75), who were admitted to the intensive care unit with STEMI. Two groups of patients were identified based on their renal function: a group with STEMI and acute ischemic kidney injury (main group, n=111) and a group with STEMI and normal renal function (comparison group, n=62). Acute ischemic kidney injury diagnosis was confirmed on the basis of KDIGO (2012) recommendations - when patients with MI were hospitalized with creatinine level increased by up to ≥1.5 times as compared to baseline creatinine level before hospital admission. A critical condition for confirming the diagnosis was absence of chronic kidney disease and urinary tract disorders in patients' medical history. To identify risk factors of adverse outcomes, multivariate logistic regression analysis was used.

Results

Regression analysis was performed in order to build a predictive model for the development of adverse outcomes (death from cardiovascular causes, recurrent MI, unstable angina within 12 months). The analysis was based on the results of clinical, laboratory and instrumental evaluations of the focus patients. The derived prognostic model included the following features: age, level of the N-terminal fragment of brain natriuretic peptide (NT-pro-BNP), C-reactive protein level, creatinine level and local contractility index. A mathematical model for predicting the likelihood of adverse outcomes was developed on the basis of regression analysis data. ROC analysis including building of a ROC curve was conducted in order to test the quality of the model; the AUC was 0,996. The resulting model achieved 90,6% sensitivity, 100% specificity and 97,1% positive predictive value.

Conclusion

The following prognostic markers of adverse outcomes development in patients with STEMI and acute ischemic kidney injury were identified as most critical: age, NT-pro-BNP level, C-reactive protein level, creatinine level and local contractility index based on echocardiography results. The mathematical model for predicting the likelihood of adverse outcomes, developed as a result of the study, will become a powerful clinical tool for improving the survival rate in patients with STEMI and acute ischemic kidney injury.

Funding Acknowledgement

Type of funding sources: None.
Predictive association of pulmonary hypertension with risks of adverse renal outcomes in type 2 diabetes
Authors: Wu M , Ren Q W , Yu Y J , Tse H F , Yiu K H
Published: October 2021

Background

Diabetic kidney disease is a major diabetic complication which contributes to the end-stage renal disease and renal deaths in diabetic patients. The aim of our study was to investigate the role of pulmonary hypertension (PHT) in the development of adverse renal outcomes in patients with type 2 diabetes (T2DM).

Methods

A total of 1479 diabetic patients (mean age 67±13 years; women, 44.7%) were recruited. Pulmonary artery systolic pressure (PASP) was estimated by transthoracic echocardiography at baseline. Adverse renal outcomes were defined as a composite endpoint of a sustained 40% decline in eGFR, end-stage renal disease requiring renal replacement therapy, kidney transplantation or renal deaths. Cox regression hazard model was used to assess the association between PHT and incident adverse renal outcomes.

Results

Patients were divided into three groups based on their baseline PASP: no PHT (n=1204, 75.1%), mild PHT (321, 20.0%) and significant PHT (78, 4.9%). A total of 474 adverse renal outcomes occurred during a median follow-up of 53 months, Kaplan-Meier survival curve showed that patients with significant PHT had highest risk of adverse renal outcomes. Multivariate cox regression demonstrated both mild PHT (HR=1.66, 95% CI 1.33, 2.06, P<0.001) and significant PHT (HR=2.09, 95% CI 1.45, 3.02, P<0.001) were independently associated with the incident adverse renal outcomes.

Conclusion

The presence of PHT was associated with adverse renal outcomes in patients with T2DM.

Funding Acknowledgement

Type of funding sources: None.
Behavioral economics strategies for promoting adherence to treatment in heart failure patients
Authors: Lipatova T , Malinova L , Eremin A
Published: October 2021

Heart failure (HF) is characterized by an increased risk of both fatal and nonfatal adverse cardiovascular events, which required life-long and costly treatment. At the same time every cardiology practitioner is well aware, that despite huge efforts on patient's education there remains a substantial part of patients who do not always make rational choices regarding their treatment. Patient's knowledge does not always translate into adherence, so we must find ways to minimize the intent-behavior gap to improve the efficacy of HF treatment. We presume that behavioral economics can provide us with tools that will promote positive present behavior of patients.

The purpose of the study was to examine the utility of behavioral economics-related concepts in understanding long-term treatment strategy in heart failure patients and acute heart failure survivors.

Methods

We performed an open prospective study involving male patients with both chronic and acute heart failure (CHF n=65 and AHF n=54). Involved patients were surveyed on symptom severity, behavioral economics “parameters”. Cognitive complexity was measured via “real life” case simulations. We assessed stress and depression with HADS and Zung's scales serially: on admission, 3d day of hospitalization and day before discharge. In patients with AHF, first assessment was performed after clinical stabilization. The primary outcomes were set as an adherence to prescribed medication assessed 6 and 36 months after discharge, rehospitalization due to cardiovascular reasons and self-assessed well-being.

Results

We observed opposite patterns of stress dynamics in CHF and AHF groups. AHF patients demonstrated significant reduction of stress level on the 3d day since admission: 9.0 (7.1; 9.9) vs 6.4 (5.7; 7.4) units, p=0.037, with further increase at discharge, while in CHF patients there was tendency to significant change in parameter was absent.

Patients who survived AHF demonstrated higher 6 month adherence to prescribed medication (62.9% vs 49.2%, p=0.047), at the same time there was the strong positive correlation between medication's price and self-induced therapy interruption (R=0.74, p<0.05). Both AHF and CHF reported financial planning as the major contributor for decision making in “real life” cases. Surprisingly in study population self-assessed well-being did not correlated with rehospitalization rate.

Parameters that were significantly associated with CV rehospitalization included symptoms at admission (OR 2.1 CI 1.4; 3.2, p=0.002), regularly saving money (OR =2.7 CI 1.9; 4.6, p=0.001) and stress level at discharge (OR 1.6 CI 1.1; 2.4, p=0.027).

Conclusion

Received results may be useful to identify heart failure patients at higher risk of self-induced treatment interruption. These patients could be offered focused support and counseling designed to enhance adherence to prescribed medication in order to improve long-term heart failure outcomes.

Funding Acknowledgement

Type of funding sources: None.
Gender bias in ACS management
Authors: Murray P , Blake W M , Ward D
Published: October 2021

Background

Cardiovascular disease is implicated in approximately 1 in every 3 deaths occurring in both women and men worldwide. Numerically, it is responsible for more female than male deaths each year, due largely to longer life expectancy amongst women. Consequently, guidelines from the major international bodies recommend against the use of sex as a discriminating factor in the evaluation of chest pain. Still there remains a public perception of excess cardiovascular risk in men, contributing to a delay in the seeking of medical attention by women with symptoms of acute coronary syndrome (ACS). We hypothesise the attendant concern that unconscious gender bias amongst clinicians influences the management of patients presenting with ACS from triage to invasive assessment and treatment.

Aim

To examine the relationship between patient gender and clinical management of ACS.

Methods

We conducted a retrospective cross sectional study of all patients in whom ACS was suspected during a year long period using the laboratory database of a tertiary cardiac referral centre in Ireland. In all patients for whom high sensitivity cardiac troponin T assay was ordered during the full calendar year 2019, age, sex and troponin level were recorded. We determined the likelihood of invasive angiography for male versus female patients after adjustment for age and troponin result.

Results

A total of 30,560 requests for high sensitivity cardiac troponin T (troponin) were made to the laboratory in the year ending December 2019. Excluding 464 for technical and sampling issues, 30,096 assays were included in the analysis. 43.84% (N=13,194) of samples were female and 56.16% (N=16,902) male. These samples were collected from 10,807 patients (5,294 female and 5,513 male). Median age was 58 for females and 57 for males. The upper limit of normal in our institution for serum troponin is <14ng/L and there is no adjustment for sex. 22.01% (N=1,165) of females and 33.39% (N=1,841) of males had at least one troponin level reported above the normal range. Of female patients with at least one troponin above the normal limit, 10.21% (N=119) underwent invasive coronary angiography compared to 18.52% (N=341) of males. Of females in whom all troponin results were normal, 5.84% (N=241) proceeded to invasive angiography versus 9.18% (N=337) of males.

Conclusion

Notwithstanding the limitations of lack of adjustment for risk profile, the results of this analysis demonstrate a higher rate of invasive angiography in males compared with females independently of troponin level. This is in keeping with previous research suggesting a gender gap in the approach of clinicians to ACS, and suggests an unconscious sex-based discrimination when making decisions around diagnosis and treatment. Education regarding the prevalence of coronary atherosclerosis, and interventions to alter the attitudes of clinicians, are some of the interventions suggested to close this gap.

Funding Acknowledgement

Type of funding sources: None.
Association between NPC1L1 and HMGCR gene polymorphisms with residual cholesterol risk in patients with premature triple-vessel disease
Authors: Li J , Zhao X , Yang Y , Gao R , Yuan J ,   State Key Laboratory of Cardiovascular Disease, Fuwai Hospital
Published: October 2021

Background

Management of dyslipidemia is the primary recommend in current guidelines in patients with coronary heart disease (CHD). Despite intense statins therapy, patients with low-density lipoprotein cholesterol (LDL-C) level of more than 1.8 mmol/L still have residual cholesterol risk. Premature triple-vessel disease (PTVD) is a severe CHD. Recent studies have established that both residual cholesterol risks and PTVD were associated with adverse cardiovascular events. Niemann-Pick C1-like 1 (NPC1L1) and 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) is involved in exogenous cholesterol absorption and endogenous cholesterol synthesis respectively, which play a vital part on dyslipidemia.

Purpose

The present study aimed to investigate the association between NPC1L1 and HMGCR gene polymorphisms and residual cholesterol risk in patients with PTVD.

Methods

A total of 609 PTVD patients treated with statins were consecutively enrolled from April 2004 to February 2011. Residual cholesterol risk was defined as low-density lipoprotein cholesterol (LDL-C) >1.8 mmol/L. According to LDL-C levels, the patients were divided into two groups: residual cholesterol risk group (n=521, >1.8 mmol/L) and non-residual cholesterol risk group (n=88, LDL-C ≤1.8 mmol/L). Four single nucleotide polymorphisms (SNP) of NPC1L1 gene including rs11763759, rs4720470, rs2072183 and rs2073547 and three SNPs of HMGCR gene including rs12916, rs2303151 and rs4629571 were genotyped.

Results

After adjusted for age and sex, multivariate logistic regression analysis showed that rs12916 of HMGCR gene was associated with 2.082 times higher residual cholesterol risk in recessive model (OR: 2.082, 95% CI: 1.156–3.749, P=0.015), and the homozygous TT of rs12916 (OR: 2.262, 95% CI: 1.155–4.429, P=0.017) was associated with 2.262 times higher residual cholesterol risk in codominant model while there was no significant association for the heterozygous CT of rs12916 in codominant model (OR: 1.140, 95% CI: 0.678–1.917, P=0.621). There was no significant association between the SNPs of NPC1L1 gene and residual cholesterol risk in various models (P>0.05).

Conclusions

We reported for the first time that the rs12916 on HMGCR gene were associated with residual cholesterol risk in patients with PTVD, providing new insight in genetic treatment in dyslipidemia.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): CAMS Innovation Fund for Medical Sciences (CIFMS); Key Science and Technology Project of Shihezi
Coronary artery cavitation as a trigger for atherosclerotic plaque progression: a numerical and computational fluid dynamic demonstration
Authors: Rigatelli G , Zuin M , Roncon L , Nguyen T
Published: October 2021

Background

Coronary cavitation is supposed to be generated by both concentric and eccentric coronary artery stenosis creating microbubbles which exploded when the fluid pressure was lower than the vapor pressure at a local thermodynamic state.

Aims

To assess, using computational fluid dynamic analysis (CFD), the potential role of cavitation in inducing coronary artery endothelial damage and promote atherosclerotic plaque progression.

Methods

We retrospectively reviewed the procedural records of consecutive patients evaluated between 1st January 2013 and 1st January 2014 with an isolated hemodynamically significant Left Main (LM) disease. Each bifurcation was reconstructed on the patient-specific geometries derived from the CCTA applying patient-specific hemodynamic features. Vapour has been modelled as discrete vapour bubbles and its trajectory determined using a Lagrangian frame of reference. Cavitation started with micro-cavitation nuclei which subsequently grow into bubbles undergoing different physical processes determined in a stochastic Monte-Carlo approximation.

Results

Among the 12 patients analysed [8 males, mean age 68.2±12.8 years old], the mean LM stenosis was 72.3±3.6%. In all subjects, LM stenoses induced cavitation which propagates downstream the vessel. The higher concentration of vapour region was detected before the carina (within 0.8 to 1.3 cm from the stenosis). The mean bubbles radius observed before the carina was 4.2±1.4 μm; their impact with the endothelial surface generated a mean peak pressure of 3.9±0.5 MPa determining a local shockwave (Figure 1).

Conclusion

The collapse of micro-bubbles alongside the endothelium generated micro-shockwaves determining repeated dynamic load measurable as an instantaneous pressure-peaks able to induce endothelial injury or dysfunction.

Funding Acknowledgement

Type of funding sources: None. Figure 1. (A) The simulation illustrates the vapour fraction iso-surfaces and the scattered bubble plots as predicted by the Langrangian model. Notably, most cavitation bubbles that form at the inlet of left main bifurcation do not collapse immediately but they are transported towards the vessel determining several interactions with the endothelium. (B) Graphical representation of the bubble radius modification and related pressure transmitted to the endothelium if the bubble collapse happened near to this last one. The magnification in boxes (B1-B4) evidences the dynamic modification of bubbles. The re-entry jet causing the collapse is evidenced with a red arrow.
Could the miniaturize techonologies improve patients adherence and assure better quality of life?
Authors: Rosiello F , Pietrantonio F , Di Lorenzo J , Bertani G , Anzidei A , Laurelli G , Cipriano E , Di Iorio C , Montagnese F , Pascucci M
Published: October 2021

Background

From 2000 to today, the use of information technology in the medical field is increasingly widespread, reaching a new milestone following the COVID 19 syndemia. It is increasingly evident that wireless monitoring allows patients to be followed more easily, detecting complications early at home and allowing to limit the contagion of healthcare personnel by reducing the interaction with patients in hospital rooms

Methods

A pilot Multicenter Open-label Randomized Controlled Trial (RCT) was performing comparing wearable wireless vital parameters continuous monitoring (WVPCM) system and regular monitoring. Data were collected to provide a clinical-economic impact (costs, program effectiveness and QALY gains) of complex patients (CPs) discharged from Internal Medicine Units. Cost were estimated by mean of the identification, measuring and valorisation of the resources uptake.

Results

143 patients (37 M/38 F, mean age: 78.7 years). Major complications: respiratory failure detection (6,5 vs 3,8); reduction of sudden deaths (9.3% vs 16% experimental); care-related infections (6,5 vs 7,5), glycemic decompensation (4,3 vs 1,9). Hospital readmission within 21 days were 7% vs 11%. Relevant cost driver was time spent by nurses: 58 minutes/day/patient (vs 132) allow to save €54-90/patient. One way and multiway sensitivity analyses confirmed the robustness of our results with nearly 99% of the replications involved

Conclusions

WVPCM, detecting early complication during the post-discharge CPs monitoring, may facilitate a timely response ensuring a more appropriate management of complex patients seen (>25% of total admissions), reduce the time to diagnosis, improve efficiency/efficacy of disease management and reduce unnecessary clinic visits and hospital (re)admissions. The miniaturized technologies can improve patient adherence and assure better quality of life. WVPCM allows patients to be sent home safely and to effectively integrate Hospital and Community services.

Key messages

Wearable wireless vital parameters continuous monitoring (WVPCM) system reduce time and cost of nursing. Wearable wireless vital parameters continuous monitoring (WVPCM) system can detect early complication improve patient adherence and assure better quality of life.
The Prevalence of Multiple Sclerosis in Liguria region, Italy, using the capture–recapture method
Authors: Ponzio M , Amicizia D , Brichetto G , Tacchino A , Piazza MF , Paganino C , Trucchi C , Astengo M , Battaglia MA , Ansaldi F
Published: October 2021

Background

In recent years, there has been a growing interest in developing methods based on health administrative databases to estimate prevalence of chronic diseases, hoping that this would lead to more precise and reliable estimates. The capture-recapture method can be used to improve the prevalence of a disease reducing the bias of case underestimation.

Objective

To assess the prevalence of multiple sclerosis (MS) in the Liguria region in Italy using routinely collected healthcare data.

Methods

Data from three sources collected in Liguria Health Authority (A.Li.Sa.) databases - hospital discharge records, drug-dispensing records, disease-specific payment exemptions from copayment to health care - and a capture-recapture method with log-linear models were used to estimate the prevalence of MS. The accuracy of the case-finding algorithm was tested using a sample of people residents in Liguria Region with a definite diagnosis of MS extracted from clinical records of Liguria AISM Rehabilitation Service as reference standard.

Results

The case-finding algorithm to capture people with MS from routinely collected healthcare data used in our study found an observed crude prevalence of MS in Liguria region on 31 December 2017, of 202.4 cases per 100,000 inhabitants (95% CI: 195.3-209.5). After linkage to clinical data, the algorithm showed a sensitivity of 82.7%, with 22.1% of MS cases undetected on capture-recapture models. Consequently, the capture-recapture method prevalence estimate of 259.7 per 100,000 inhabitants (95% CI: 251.7-267.8) suggest that this region constitutes a high-risk area for MS.

Conclusions

Our initial study of crude MS prevalence showed an overall regional prevalence of MS of 202.4 cases per 100,000, capture-recapture analysis would add another 20%, to those figures. This method could be considered a good alternative to the population-based study design for estimating the prevalence of MS.

Key messages

Studies based on routinely collected healthcare data could help estimate the prevalence of chronic disease. To reduce the bias of case underestimation, the capture–recapture method can be useful.
Nitrites and nitrates from food additives and cancer risk: results from the NutriNet-Santé cohort
Authors: Chazelas E , Pierre F , Druesne-Pecollo N , Gigandet S , Srour B , Huybrechts I , Julia C , Kesse-Guyot E , Deschasaux-Tanguy M , Touvier M
Published: October 2021

Nitrates and nitrites occur naturally in water and soil and are commonly ingested from water and dietary sources. They are also frequently used as food additives mainly in processed meats. Experimental data consistently suggest their involvement in carcinogenesis but human data is still limited. The aim was to investigate the relationship between nitrate and nitrite intakes and the risk of cancer in a large prospective cohort with detailed and up-to-date dietary assessment. Overall, 101,056 adults from the French NutriNet-Santé cohort study (2009-ongoing) were included. Consumption of nitrites and nitrates was evaluated using repeated 24h dietary records, linked to a comprehensive food composition database which includes details of commercial names/brands of industrial products. Prospective associations between nitrite and nitrate exposures and the risk of cancer were assessed by multivariable Cox hazard models. During follow-up, 3311 first incident cancer cases were diagnosed. Compared with non-consumers, higher consumers of nitrates as food additives had higher risk of breast cancer (HR = 1.24 (1.03-1.48), P = 0.02); this was more specifically observed for potassium nitrate e252, P = 0.01). Higher consumers of nitrites as food additives, and specifically for sodium nitrite (e250), had a higher risk of prostate cancer (HR = 1.58 (1.14-2.18), P = 0.008 and HR = 1.62 (1.17-2.25), P = 0.004, respectively). No significant association was observed for nitrates and nitrites from natural sources. In this large prospective cohort, nitrates as food additives were positively associated with breast cancer risk and nitrites as food additives were positively associated with prostate cancer risk. While these results need confirmation in other large-scale prospective studies, they provide new insights in a context of lively debate around the ban of nitrite additives in food products.

Key messages

Nitrates as food additives were positively associated with breast cancer risk. Nitrites as food additives were positively associated with prostate cancer risk.
Organization of specialized outpatient care in the context of integrated healthcare networks
Authors: de Andrade AT , Shimocomaqui GB , Santos LKO , Eshriqui I , Paresque MAC
Published: October 2021

Problem/Issue

The Specialized Outpatient Care (SOC) organization is a worldwide concern, aiming to ensure integrality and equity of health care.

Description of the problem

Implantation of SOC services regionalized and integrated in a healthcare network coordinated by Primary Care (PC) seems to be a potential strategy to restore balance between demand and supply by SOC. The “Health Care Planning” (HCP) method, proposes a population-based management SOC model with horizontal and collaborative relation between SOC and PC, different from the conventional model focused on medical specialties. Thus, SOC assumes three functions besides assistance: educational, research and supervisory. In 2018, the PlanificaSUS project started the implantation of this model in 25 regions of 19 Brazilian states. Each region chose one SOC service and one priority line of care, based on local epidemiological indicators. Workshops and tutoring activities were conducted and SOC teams were trained based on the continuous care cycle, in an inter-professional and collaborative way.

Results

Priority lines of care were chosen as follows: maternal and child (n = 17); elderly health (n = 1); mental health (n = 1); and hypertension and diabetes (n = 6). Each SOC service mapped PC services in region, defined evidence-based clinical guidelines in the healthcare network and organized SOC portfolio, composed of multi-professional team, equipment and physical structure. Team training was concluded in 19 SOC services, in which educational function was introduced with PC through a risk stratification course. This course was based on common clinical guideline between PC and SOC, contributing to shared and resolutive care.

Lessons

The proposed model for SOC organization could be a potential strategy to integrate SOC with PC in different settings, in spite of important challenges, such as: covid-19 pandemic, necessity local health managers' protagonism and politics to support SOC integration in healthcare network.

Key messages

Organization of SOC integrated in healthcare networks must be promoted to ensure integrality, equity and longitudinally of shared and resolutive care. Population-based management and a horizontal and collaborative relation between SOC and PC should be encouraged to improve quality and effectiveness of care in the healthcare network.
What can Europe learn from HCP knowledge and attitudes towards hepatitis A vaccination in the US?
Authors: Herrera-Restrepo O , Ghaswalla P , Davis K , Sweeney C , Davenport E , Andani A , Buck PO
Published: October 2021

Background

An estimated >100 million new hepatitis A (hepA) infections occur annually worldwide. Centres for disease control and prevention reported 38795 hepA cases in the US since 2016, and 4475 outbreak-confirmed cases in Europe between 2016-2018. HepA outbreaks resulted mainly from person-to-person contact, especially among homeless, illegal drug users (IDU) and men who have sex with men (MSM). In 2020, we surveyed US health care providers (HCPs) to understand their knowledge and attitudes towards hepA vaccination in these populations at higher risk of infection and complications.

Methods

This was a cross-sectional, web-based survey of 400 HCPs (primary care providers, nurse practitioners, gastroenterologists, internal medicine and infectious disease specialists [IDs], emergency room physicians [ERs]) who had recommended and/or administered hepA vaccines to ≥ 19-year-olds.

Results

85% of 371 HCPs reported recommending hepA vaccine to homeless, 87% of 393 to IDU and 83% of 397 to MSM, although vaccination may not actually occur after recommendation. Results varied by specialty, 16% fewer ERs than IDs reported recommending the vaccine in these at-risk populations. Moreover, 64%, 75% and 71% of all (400) HCPs reported extremely important that homeless, IDU and MSM, respectively, get vaccinated for hepA, while 6%, 7% and 8% of all HCPs reported this as slightly, or not important. Reasons for not recommending hepA vaccine to homeless, IDU and MSM included uncertainty on guidelines (reported by 22/56, 24/50 and 29/66 HCPs, respectively) and low risk of infection (reported by 20/56, 30/50 and 27/66 HCPs, respectively).

Conclusions

Despite recent hepA outbreaks and strengthened recommendations for vaccination in at-risk populations, knowledge gaps persist among US HCPs. This survey may motivate European countries to reinforce national hepA vaccination recommendations and, in parallel, consider efforts to raise vaccination awareness.

Funding

GlaxoSmithKline Biologicals SA

Key messages

Education on hepatitis A vaccination recommendations in at-risk populations is needed. Health care providers’ vaccination knowledge plays a critical role to control the hepatitis A outbreak in the US and preventing hepatitis A in Europe.
Increase in the influenza vaccination rates in Portugal: comparing 2020-2021 to the last 10 years
Authors: Guedes L , Figueiredo AL , Afonso AL , Couto ML , Natividade A , Gouveia AJ , Saldanha MG , Sousa MF , Oliveira P , Martinho C
Published: October 2021

Background

Annual influenza vaccine uptake is recommended by the Portuguese General-Directorate of Health to certain priority groups. In 2020, amidst the COVID-19 pandemic, some exceptional measures were adopted to operationalize the Portuguese influenza vaccination campaign, like the extension and phasing of the vaccination period. No major changes were introduced in the vaccination of healthcare workers. In Baixo Tâmega health cluster (Portugal), it was perceived that these workers' vaccine uptake had markedly increased in 2020-2021. This study aims to compare their influenza vaccination coverage rates in 2020-2021 to the last 10 seasons.

Methods

A cross-sectional study of the vaccine uptake among the health workers of Baixo Tâmega health cluster was developed. A descriptive analysis was carried out, calculating annual influenza vaccination coverage rates from 2010-2011 to 2020-2021, in doctors, nurses and other health workers. Inferential analysis was performed through chi-squared tests in IBM SPSS Statistics 27.0.1.0., considering significant p-values<0.05.

Results

The difference between health workers 2020-2021's influenza coverage rate and the last season's average rates was 22.81%. Before 2020-2021, average vaccination coverage rates were 51.60% (standard deviation 7.34%, 44.26-58.94%), 60.44% (standard deviation 4.12%, 56.32-64.56%) and 51.20% (standard deviation 7.66%, 43.54-58.86%), in doctors, nurses and other health workers, respectively. In 2020-2021, vaccination rates significantly increased to 79.34%, 79.52% and 74.24% in doctors, nurses and others, respectively (p < 0.001).

Conclusions

Influenza vaccination uptake increased in 2020-2021 among health workers. Further studies should be developed to evaluate this tendency on a larger scale and to better understand its associated factors, which could have been unstructured awareness-raising campaigns, perception of protection against COVID-19 or avoidance of COVID-19-like symptoms and coinfection.

Key messages

Influenza vaccination coverage rates increased in 2020-2021 among the healthcare workers of a Portuguese health cluster. The COVID-19 pandemic may have contributed to the increase in the influenza vaccination coverage rates.
Vaccination coverage after the introduction of mandatory law: results from an Italian Southern Region
Authors: Di Martino G , Di Giovanni P , Cedrone F , D'Addezio M , Meo F , Scampoli P , Staniscia T
Published: October 2021

Background

Over the latest decades, Europe has been facing the spreading of vaccine hesitancy. This growing phenomenon has resulted in decreasing vaccination coverage all over Europe, particularly in Italy for measles, mumps and rubella. In order to face up this problem, in 2017 Italy introduced compulsory vaccination against 10 different infectious diseases: diphtheria, tetanus, pertussis, polio, hepatitis B, haemophilus influenzae B (all included in the hexavalent vaccine), measles, mumps, rubella (included in the MMR vaccine) and chickenpox (from the 2017 cohort). The aim of this study was to evaluate vaccination coverages in 2019 in Abruzzo, an Italian Southern Region, after the introduction of compulsory vaccinations.

Methods

In this study the following indicators were taken into account: vaccination coverages at 24 months of age (2017 cohort of birth), vaccination coverages at 36 month of age (2016 cohort), vaccination coverages at 5/6 years of age (2013 and 2014 cohorts) and vaccination coverages at 16 and 18 years of age (2001 and 2003 cohorts). Vaccination coverage rates were calculated as the number of vaccinated patients for each disease over the total number of patients born in the year considered.

Results

At the end of 2019, the 2017 cohort reached 95% coverage for all vaccinations except for chickenpox (87.9%). Conversely, the 2016 cohort showed low rates for MMR and chickenpox, up to 90.8% and 52.1% respectively. Additionally, 2013 and 2014 teenager cohorts showed coverage rates lower than 95% for all the compulsory vaccinations.

Conclusions

After two years of mandatory vaccination law in Italy, vaccination coverages have reached the 95% threshold only among patients of 24 months of age. Older cohorts still show inadequate vaccination coverages despite the introduction of mandatory vaccination law. Health services at regional level should develop policies and strategies aiming to improve vaccination coverages and to reach herd immunity.

Key messages

After the introduction on mandatory vaccination, vaccination coverages reached the 95% threshold only among patients of 24 months of age. Health services should develop strategies aiming to improve vaccination coverages.
Video Game addiction among a Tunisian cohort of adolescents: Incidence and associated factors
Authors: Bannour R , Zammit N , Ben Fredj S , Ghammem R , El Echi A , Mlouki I , Maatoug J , Ghannem H
Published: October 2021

Background

The concept of Video Game addiction is not yet recognized in the scientific literature. However, several authors suggest relating excessive video game attachment to addiction behavior, especially among adolescents. The aim of the study is to determine the incidence of video game addiction and its associated risk factors among high school students during the 2018/2019 school year in the governorate of Sousse.

Methods

A prospective longitudinal study with a one-year follow-up was conducted among 404 high school students enrolled in four high schools randomly selected from the governorate of Sousse. The same questionnaire was self-administered to participants in their classrooms in 2017/2018 and then in 2018/2019. The Arabic version of the ‘Game Addiction Scale for Adolescents' was used to detect possible video game addiction.

Results

The mean age of participants was 16.4 ± 1.1 years. Girls represented 66.8% of the sample. During the 2018/2019 school year, 25 adolescent became addicted to video games, with an incidence rate of 6.2%. This incidence was of 10.4% among boys and 4.1% among girls (p = 0.012). Smoking, experimenting cannabis and inhalants were significantly associated with the transition to video game addiction with odds ratio of 3.3 [1.1-9.5], 8.0 [1.9-34.3] and 12.1 [2.5-57.6] respectively.

Conclusions

The current study highlights the extent of video game addiction among adolescents in the governorate of Sousse. A comprehensive approach to prevent and manage cross addictions must be implemented in the schools of Tunisia.

Key messages

Incidence of video game addiction is high in high-school adolescents of Sousse. Comprehensive prevention program targeting behavioral addictions and substances use is required in Tunisia.
COVID-19 outbreaks in places of worship worldwide: a systematic review
Authors: Peano A , Bert F , Lo Moro G , Previti C , Scaioli G , Siliquini R
Published: October 2021

Background

Since the beginning of the CoViD-19 pandemic, scientific community raised concerns about mass gatherings: religious ones in particular could become the perfect soil for the Sars-CoV-2 transmission due to the environmental conditions (e.g. not-ventilated worship hall, no distance between attendees, physical contact). Thus, this systematic review aimed to explore CoViD-19 outbreaks in places of worship worldwide.

Methods

A systematic search of three electronic databases (PubMed, Scopus and Embase) was performed, including years 2020 and 2021 until March, 29th. Criteria of inclusion were articles published in English, French, Italian, Spanish or Portuguese, dealing with CoViD-19 outbreaks reported in churches, mosques, synagogues and other places of worship, regardless of region or religion. Pilgrimages were excluded.

Preliminary Results

Out of 7655 articles found, 36 were included, for more than 50 outbreaks reported. The number of persons involved in each cluster varied from units to several thousands, while the geographic distribution displayed reports mainly concerned about East and Southeast Asia (65%), Europe (15%) and North America (15%), referring to gatherings carried out in the first semester of 2020, in particular in February and March. The most involved religions were the main monotheistic ones (i.e. Christianity, Islam and Judaism), although the eastern religions played an important role too.

Conclusions

In reason of religious gatherings, places of worship had had an important role in the virus transmission, becoming the first cause of contagion in several countries especially during the first wave of the pandemic, because of the absence of social distancing, masks use, danger awareness and, in some cases, poor hygiene conditions or CoViD-19 denial. Although there was a different risk associated with different religions, this systematic review highlighted how important is to evaluate worship-related outbreaks as a major public health concern.

Key messages

50+ worship-relate clusters with a variable range of persons involved were reported principally from Asia, Europe and North America. The main monotheistic religions were more implicated. Places of worship became the first cause of contagion in several countries especially during the first wave of the pandemic: these outbreaks should be considered as public health concerns.
EU-PEARL: Changing the paradigm of clinical trials in Europe
Authors: Cash-Gibson L , Pericàs JM , Spiertz C , van de Ketterij E , Molero E , Patalano F , Kalra D , Ussi A , Van Dessel A , Genescà J
Published: October 2021

Issue

Recently, innovative clinical trial designs have been proposed, which have the potential to revolutionize clinical research. Whereas classical trials mostly evaluate only one investigational drug, platform trials embed various trials under a shared master protocol to enable the evaluation of multiple interventions for a disease or condition. Platform trials have mostly been used to evaluate cancer therapies, but also recently for COVID-19. The EU Patient-cEntric clinicAl tRial pLatforms (EU-PEARL) project aims to expand the use of platform trials as the backbone of drug development.

Description of Issue

EU-PEARL is a Innovative Medicines Initiative 2 Joint Undertaking funded project (2019-2023), and a strategic public and private sector alliance, which aims to support the transformation of the classical trial approach into a cross-company collaborative, multi-compound platform, centred around patients, not diseases. How to operationalize and sustain this? A multi-stakeholder, mixed-methods approach is taken, focused around the concept of an integrated research platform (IRP), i.e., a common enabling framework for platform trials. The IRP will be established as a sustainable and scalable global solution, consisting of an infrastructure, workflows, and guidance on how to meet complex regulatory, ethical, legal, statistical and data requirements. Lessons from COVID-19 trials will be incorporated.

Results

A disease-agnostic IRP is being developed, as well as four disease specific IRPs in four areas of high public health relevance, i.e. major depressive disorder, tuberculosis, non-alcoholic steatohepatitis, and neurofibromatosis.

Lessons

Multi-stakeholder, multi-sector and multi-disciplinary collaborations are challenging in practice, but rewarding in outcomes. Given the complexity of setting-up these novel trials, clear communication and standardized terminology must be established, as well as continual awareness building of their components, challenges and benefits.

Key messages

EU-PEARL intends to stage the clinical trials of the future, which will be more adaptive, efficient and patient-centred by design and outcome. EU-PEARĹs efforts aim to contribute to timely societal access to affordable medicines and address unmet health needs.
Blm helicase facilitates rapid replication of repetitive DNA sequences in earlyDrosophiladevelopment
Authors: Ruchert Jolee M , Brady Morgan M , McMahan Susan , Lacey Karly J , Latta Leigh C , Sekelsky Jeff , Stoffregen Eric P
Published: October 2021

The absence of functional BLM DNA helicase, a member of the RecQ family of helicases, is responsible for the rare human disorder Bloom Syndrome, which results in developmental abnormalities, DNA repair defects, genomic instability, and a predisposition to cancer. In Drosophila melanogaster, the orthologous Blm protein is essential during early development when the embryo is under the control of maternal gene products. We show that lack of functional maternal Blm during the syncytial cell cycles of Drosophila embryonic development results in severe nuclear defects and lethality. Amongst the small fraction of embryos from Blm mutant mothers that survive to adulthood, a prominent sex-bias favors the class that inherits less repetitive DNA content, which serves as an endogenous source of replication stress. This selection against repetitive DNA content reflects a role for Blm in facilitating replication through repetitive sequences during the rapid S-phases of syncytial cell cycles. During these syncytial cycles, Blm is not required for complex DNA double-strand break repair; however, the progeny sex-bias resulting from the absence of maternal Blm is exacerbated by repetitive DNA sequences and by the slowing of replication fork progression, suggesting that the essential role for Blm during this stage is to manage replication fork stress brought about by impediments to fork progression. Additionally, our data suggest that Blm is only required to manage this replication stress during embryonic development, and likely only during the early, rapid syncytial cell cycles, and not at later developmental stages. These results provide novel insights into Blm function throughout development.
Perceptions of Risk: Perspectives on Crime and Safety in Public Housing for Older Adults
Authors: Sheppard Christine L , Gould Sarah , Austen Andrea , Hitzig Sander L
Published: October 2021

Background and Objectives

An increasing number of older adults are aging in place in public housing. Public housing is perceived to have higher rates of crime that have detrimental impacts on health and well-being. We used a qualitative approach to understand the experiences of safety and unsafety for older adults in public housing.

Research Design and Methods

Participants included older adult tenants (n = 58) as well as service providers (n = 58) who offer supports directly in the buildings. Semistructured qualitative interviews and focus groups were used to explore (a) what makes the buildings feel unsafe, (b) how safety concerns affect access to support services, and (c) strategies used to promote safety.

Results

Participants acknowledged the importance of safety for creating a home-like environment; however, many described feeling unsafe at home or work. Participants described extreme examples of antisocial behaviors that were pervasive and viewed as commonplace. Lack of building security was a key issue, which was compounded by a perceived lack of accountability. While service providers were willing to accept a certain level of risk, many acknowledged that unsafe situations forced them to withdraw in-home services or stop community programs, further contributing to feelings of unsafety. In the absence of effective formal security, participants described several measures taken to mitigate risk.

Discussion and Implications

Our findings point to the need for enhanced physical and environmental safety infrastructure, improved building management, increased on-site security, as well as other proactive measures to reduce risk by creating a greater sense of connection and community within the buildings.