bluuebunny/crossref_metadata_2025 huggingface dataset:
The prevalence and safety of direct oral anticoagulants in patients with non-atrial fibrillation associated intra-cardiac thrombus
Authors: Kanwal A , Zulty M , Rao S , Young R
Published: October 2021

Background

The standard of care in management of intra-cardiac thrombus has been the use of vitamin K antagonists (VKAs). The emergence and use of direct oral anticoagulants (DOACs) in other conditions has led to the consideration of their use in patients with intra-cardiac thrombus. Thus far, case-reports have provided the majority of data regarding the efficacy of DOACs in this population.

Purpose

The aim of this observational study was to investigate the safety and efficacy of DOACs in intracardiac thrombus not associated with atrial fibrillation, compared to the current standard of care, VKAs.

Methods

An observational study was conducted between 10 hospitals in our region. The study was conducted between 2013 and 2019 in patients with a diagnosis of intracardiac thrombus. All left and right, atrial and ventricular thrombi were included. Patients with atrial fibrillation were excluded. Patient information was collected from the hospital electronic record. The primary endpoints were clinically significant bleeding requiring transfusion and thromboembolic events, excluding myocardial infarction.

Results

1153 patients had a diagnosis of intracardiac thrombus. 878 out of 1153 patients were discharged on warfarin and 275 were discharged on a DOAC. In the warfarin population 73 of 878 patients (8.3%) had clinically significant bleeding events compared to 21 of 275 patients (7.6%) in the DOAC population (p=0.801). The median ages were 60.5 and 58 respectively. The median time period to a bleeding event was 151 and 198 days respectively. In the warfarin population, 116 of 878 patients (13.2%) had thromboembolic disease versus 34 of 275 patients (12.4%) in the DOAC arm (p=0.759). The median ages were 62 and 62.5 respectively. The median time period to a thromboembolic event was 114 and 184 days respectively. In the warfarin arm, 3 patients had systemic thromboembolism and 113 patients had embolic strokes. In the DOAC arm, 2 patients had systemic thromboembolism, 32 patients had embolic strokes.

Conclusion

The data from this study suggests that DOACs may be a feasible alternative to warfarin in patients with intracardiac thrombus. There was no statistically significant difference in the rates of clinically significant bleeding or in incidence of thromboembolic disease. To our knowledge, this is the largest observational study to date on this topic. Randomized controlled trials are needed to fully establish the efficacy of DOACs in this patient population.

Funding Acknowledgement

Type of funding sources: None. Table 1
Edoxaban treatment in real-world practice is highly concordant with ESC atrial fibrillation guidelines: results from the non-interventional global ETNA-AF program
Authors: Morrone D , Chen C , Dinshaw L , Jiang W , Kim Y.-H , Kirchhof P , Koretsune Y , Pecen L , Reimitz P.-E , Wang C.-C , Yamashita T , Unverdorben M , De Caterina R
Published: October 2021

Background

The ESC atrial fibrillation management guidelines recommend a risk-based approach to oral anticoagulant (OAC) therapy. How clinical practice aligns with these recommendations is of interest.

Purpose

To analyse real world data from Global ETNA-AF program in patient groups stratified by stroke and bleeding risk scores according to ESC guidelines.

Methods

Global ETNA-AF is a multicentre, prospective, noninterventional program evaluating the safety and effectiveness of edoxaban in patients from European and Asian countries. Baseline characteristics and clinical event data at 2-year follow-up were analysed in 4 subgroups defined by CHA2DS2-VASc score (≥3 for female / ≥2 for male [OAC recommended] vs 2 for female / 1 for male [OAC should be considered]) and HAS-BLED score (≥3 [Bleeding risk high] vs <3 [Bleeding risk low]) (Table 1).

Results

Of 27,616 patients included in this analysis, 23,152 (83.8%) were in the “OAC recommended” category and 3,539 (12.8%) were in the “OAC should be considered” category. Only 3.3% of patients did not meet ESC guideline criteria for OAC initiation. Among patients with high bleeding risk, 98% were in the “OAC recommended” category. A similar distribution was observed across regions (Table 2). The recommended edoxaban dose was used in the vast majority (>80%) of patients across all risk stratification subgroups. In the “OAC recommended” category, patients with high bleeding risk had higher rates of thromboembolic, bleeding, and death events than those with low bleeding risk.

Conclusion

Data from routine clinical practice in Global ETNA-AF demonstrate high concordance of edoxaban treatment with ESC guidelines. Edoxaban dose is consistent with label recommendation in the vast majority (>80%) of patients. Clinical event rates were generally low across all risk groups, including acceptable bleeding rates in anticoagulated patients with high bleeding risk.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Daiichi Sankyo Table 1. Subgroups as per ESC guidelinesTable 2. Patient characteristics & events
Protective mechanisms of betablockers for coronary artery disease are by distal vasoconstriction and slower speed: a study by angiographic assessment and artificial intelligence program
Authors: Duong H , Nguyen T , Ho D , Le M , Thai M
Published: October 2021

Background

Patients with coronary artery disease (CAD) were protected with betablockers (BB) for lower mortality and lower rate of new myocardial infarction. What are the protective mechanisms? In prior studies, our hypothesis was that damage to the intima of the coronary arteries was caused by cavitation or rupture of bubbles which was seen frequently in industrial pipes. The bubbles ruptured when they flew in areas of different pressures among the layers and segments of the coronary flows. How did BB change the dynamic of coronary flow?

Methods

After percutaneous coronary interventions (PCI) patients were started on BB. Later, when there was indication, the patient underwent another angiogram. The diameter of the distal LAD was measured and compared between the two angiograms. The distance reached the coronary flow after 0.6seconds was calculated in both angiograms and compared. In the reviewing protocol, the coronary angiograms were done with the contrast injected until the index coronary artery was completely opacified. As the injection of contrast stopped, the blood in white color moved in and displaced the contrast in black color. The morphologies, movements, directions, and interactions of the blood flow in white color above a black background were reviewed frame by frame by investigators analyzing flow dynamics. At the same time, the artificial intelligence (AI) program has 2 models (build on Python), The model 1 was built based on U-net and Densenet-121 for vessel segmentation. Model 2 was used for classification of stagnant flow or normal, the model 2 was trained based on the convolutional neural network with the dataset selected from model 1 results.

Results

In total, 50 patients were included with a total of 50 pairs of angiograms. In 80% patients, the diameter of the distal segment of the LAD was 20% smaller in BB compared with before BB (p≤0.05). In 75%, the speed of the coronary after BB was lower (p<0.05), A lower speed guaranteed laminar flow and less chance for cavitation. The above data was confirmed by the AI programs.

Conclusion

BB improved the coronary flow by decreasing the diameter of the arteries so decreased the turbulent flow and promoted laminar flow. BB also decreased the speed of the flow so decreased the chance for cavitation. Both decreased the possibility of ACS.

Funding Acknowledgement

Type of funding sources: None. Artery with centerlineMeasuring the diameter of the artery by
Analysis of telephone demand in a heart failure unit: something more than a simple call
Authors: Luna M , Cruzado Alvarez C , Perez Cabeza A I , Robles Mezcua A , Martinez Carmona J D , Diaz Exposito A , Gomez Doblas J J , Jimenez Rubio C , Morcillo Hidalgo L , Garcia Pinilla J M
Published: October 2021

Introduction

Specific care programs for HF patients significantly reduce readmissions, which is why they are recommended in clinical practice guidelines with the highest level of evidence. Telephone assistance is a service offered to patients within these programs.

Purpose

The main objective was to evaluate the most frequent reasons for consultation and the ability to resolve them after the call.

Methods

This is a descriptive, retrospective study of all the telephone consultations registered between June 2020 and January 2021. The calls are attended by the HF consultation nurse, commenting with Cardiology on those that imply changes in the pharmacological treatment.

Sociodemographic and clinical variables, reasons for the call and their frequency were collected. Categorical variables were expressed as percentages and quantitative variables as means ± standard deviation.

Results

During the analyzed period, 1.608 consultations were attended, 494 were telephone calls, which represents 31% of the overall activity of the nursing consultation. 423 consultations were analyzed, 55.7% (235) reactive, and 44.3% (187) proactive. 72.5% of the patients were under follow-up by the nurse, compared to 27.5% who had completed drug titration.

The mean age was 65 (± 12.3) years, 65.6% were men, 98.4% had a caregiver, 77% of the patients had an LVEF <40%, Charlson modified mean 4.7 (± 3.6) and 92.3% were on treatment with beta-blockers, 89.1% with ACE inhibitors/ARBs/ARNI and 82.3% with MRA. The mean number of drugs per patient was 8.6 (± 3).

Reasons for the reactive calls were in 46% of the cases the consultation of symptoms, 20% to consult doubts about the treatment or procedures, 16% for problems related to the prescription of pharmacological treatment and 14% for the appointment management.

Reasons for proactive calls were 40% for symptoms control, 30.5% for appointment management, 27.3% for drug titration and 2.1% related to other causes.

When the reason for consultation was the appearance of symptoms, the mean number of calls required was 1.4 (± 0.8), 77.6% of the calls were solved through the telephone, 16.4% required a face-to-face visit in the nursing consultation and 2.7% were referred to the emergency room. Queries related to doubts, problems with the prescription or appointment management were solved in a single telephone consultation.

Conclusions

The most common telephone request when the patient made the call was the worsening of HF symptoms. The telephone consultation is presented as an effective tool in these cases, by favoring the accessibility of patients and avoiding unnecessary trips to the health center.

Funding Acknowledgement

Type of funding sources: None. Table 1. Descriptive details of patientsTable 2. Call reasons
Using a machine learning algorithm to detect depressed ejection fraction from a single-lead ECG
Authors: Guo L , Le L , Kieu S , Tiwari U , Currie C , Shenthar J , Padmanabhan D , Pressman G , Maidens J , Saltman A
Published: October 2021

Background

Multiple studies demonstrate the benefit of intervention for left ventricular ejection fraction (LVEF) below 40%, so the development of a low ejection fraction algorithm to detect LVEF below 40% can aid in early screening of initial asymptomatic Heart Failure with reduced Ejection Fraction (HFrEF).

Objective

To demonstrate the performance of a low ejection fraction algorithm using single-lead ECG data to detect LVEF below 40%.

Methods

We collected 1325 single-lead ECG recordings (15s duration) at various chest positions using an electronic stethoscope from 197 patients. We analyzed these ECG recordings using a deep neural network model trained on individual leads extracted from a 12-lead ECG to discriminate left ventricular ejection fractions (EFs) above or below different thresholds. We compared the model output to ejection fraction measured using echocardiograms.

Results

Across all recordings from all patients, we obtained an AUROC of 0.89, with a sensitivity of 88% and specificity of 74% using a model output threshold of 0.35 (Figure 1). The AUROC of recordings taken at different orientations and stances ranged from 0.85 to 0.92 (Table 1), with a sensitivity of at least 78% and specificity of at least 66% at any orientation.

Conclusion

Using a single lead ECG measured by an electronic stethoscope and a deep neural network model, we were able to detect depressed ejection fraction (≤40%) with a sensitivity of 88% and specificity of 74%. This work demonstrates the utility of a low-cost electronic stethoscope and machine learning for early screening and detection of depressed left ventricular ejection fraction.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Eko Health
Cost burden and cost-effective analysis of the nationwide implementation of the Quality in Acute Stroke Care protocol in Australia
Authors: Marquina C M , Ademi Z A , Zomer E Z , Ofori-Asenso R O A , Tate R T , Liew D L
Published: October 2021

Background

The Quality in Acute Stroke Care (QASC) protocol is a multidisciplinary approach to implement evidence-based treatment after acute stroke that reduces death and disability.

Aim

This study sought to evaluate the cost-effectiveness of implementing the QASC protocol across Australia, from a healthcare and a societal perspective.

Methods

A decision-analytic model was constructed to reflect one-year outcomes post-stroke, aligned with the stroke severity categories of the modified Rankin scale (mRS). Decision analysis compared outcomes following implementation of the QASC protocol versus no implementation. Population data were extracted from Australian databases and data inputs regarding stroke incidence, costs, and utilities were drawn from published sources. The analysis assumed a progressive uptake and efficacy of the QASC protocol over five years. Health benefits and costs were discounted by 5% annually. The cost of each year lived by an Australian, from a societal perspective, was based on the Australian Government's “value of statistical life year” (AUD 213,000).

Results

Over five years, the model predicted 263,722 strokes among the Australian population. The implementation of the QASC protocol was predicted to prevent 1,154 deaths and yield a gain of 876 years of life (0.003 per stroke), and 3,180 quality-adjusted life years (QALYs) (0.012 per stroke). There was an estimated net saving of AUD 65.2 million in healthcare costs (AUD 247 per stroke) and AUD 251.7 million in societal costs (AUD 955 per stroke).

Conclusions

Implementation of the QASC protocol in Australia represents both a dominant (cost-saving) strategy, from a healthcare and a societal perspective.

Funding Acknowledgement

Type of funding sources: None. Decision treePSA
Activation of GPER limits adverse changes to Ca2+ signalling and arrhythmogenic activity in cardiomyocytes of ovariectomised guinea pigs
Authors: Francis A J , Firth J M , Gorelik J , MacLeod K T
Published: October 2021

Background

Post-menopausal women have an enhanced risk of developing cardiovascular disease and disturbances of cardiac rhythm, generally attributed to declining oestrogen levels during menopause. In an animal model that mimics menopause, the long-term withdrawal of oestrogen dysregulated Ca2+ signalling and increased the formation of a pro-arrhythmic substrate. Selective targeting of the membrane bound G-protein coupled oestrogen receptor 1 (GPER) eliminated such arrhythmogenic activity associated with the loss of oestrogen.

Purpose

We aim to assess the “cardioprotective” role of GPER in response to oestrogen withdrawal.

Methods

Ovariectomy (OVx) or sham surgeries were conducted on female guinea pigs. Left ventricular cardiomyocytes were isolated 150-days post-operatively for experimental use. GPER expression was quantified by western blot. Myocytes were incubated in solutions containing GPER agonist G-1 for >2h before recording some electrophysiological and Ca2+ regulatory parameters.

Results

GPER expression was 32% higher in OVx. OVx cardiomyocytes had prolonged action potential duration (APD) compared with sham and in the presence of G-1, APD90 shortened by 12% and 22% in sham and OVx, respectively. G-1 reduced early after depolarisation (EAD) formation by >99% in OVx. OVx cells had larger sarcoplasmic reticulum (SR) Ca2+ content (by 13%), compared with sham. While G-1 had little effect on SR content, it reduced Ca2+ transient amplitude (by 40%), SR fractional release (by 11%) and sarcomere shortening (by 29%) in OVx cells. The frequency of occurrence of spontaneous Ca2+ waves evoked by periods of rapid stimulation reduced by 40% and wave-free survival time prolonged in OVx cells incubated with G-1.

Conclusions

In the hearts of an animal species whose electrophysiology and intracellular Ca2+ regulation is akin to humans, we show that following oestrogen deficiency, GPER expression increased and its activation induces negative inotropic responses in cardiomyocytes. It limits the adverse changes to Ca2+ signalling and induces anti-arrhythmogenic behaviours in OVx.

Funding Acknowledgement

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): British Heart Foundation
The role of obesity in structural and functional characteristics of left cardiac chambers
Authors: Trofimova E , Bogdanova A , Konstantinova E , Bogdanov A , Gilyarov M
Published: October 2021

Purpose of study

To evaluate the role of obesity in structural and functional characteristics of left cardiac chambers according to the echocardiographic study.

Materials and methods

The retrospective analysis of 1760 echocardiographic studies in patients 30–65 years old with hyperlipoproteinemia IIa and IIb types was evaluated. The body mass index (BMI) of the patients varied from normal to morbid obesity.

Results

The achieved results showed positive correlation between structural and functional heart characteristics and BMI. Anteroposterior size and BMI reliable correlated (KK=0,70, p<0,05). In obese patients the thickness of left ventricular wall increased in 20% (1,25±0,15sm), compared to 1,0±0,19sm in patients with normal weight. The thickness of interventricular wall raised from 1,02±0,15sm to 1,23±0,14sm. End-diastolic volume in obese patients was higher than in normal weight patients (70±16 and 123±32,3sm3). End-systolic volume of left ventricle grows to 45% (from 30±8,5 to 54,3±20,5sm3). Impact volume in patients with obesity increased from 52±9,8 ml to 68,4±15,0ml. In patients with BMI 25–39.9kg/m2 the left ventricle mass myocardium index raised in 10%, and in patients with BMI over 40kg/m2 – more than 20%.

Concentric remodeling of left ventricle was found in 28,18% women and 43,39% men with normal BMI, in 30,76% women and 34,12% men with obesity, and in 15,9% women and 15,26% men with morbid obesity.

Concentric hypertrophy of left ventricle wall was diagnosed in 10% women and 10,74% men with normal BMI, in 33,38% women and 32,4% men with obesity and in 59,36% women and 54,82% men with morbid obesity.

Eccentric hypertrophy of left ventricle wall was diagnosed in 4,61% women and 2,89% men with normal BMI, in 9,42% women and 16,74% men with obesity and in 14,87% women and 25,9% men with morbid obesity. The proportion of women with normal LV geometry decreased more than 6 times as obesity progressed, proportion of men decreased by 9 times.

Conclusions

Thus, the typical presentation of structural and functional changes in the left heart chambers of obesity is the combination of concentric hypertrophy and/or remodeling of LV myocardium, diastolic LV dysfunction and dilatation of the left atrium. All these changes are the basis for the formation of dilated cardiopathy in obesity.

Funding Acknowledgement

Type of funding sources: None.
IL-8 promotes the calcification of human aortic valve interstitial cells, which is prevented through antagonizing CXCR1 and CXCR2 receptors
Authors: Dhayni K , Chabry Y , Henaut L , Ouled-Haddou H , Avondo C , Tribouilloy C , Caus T , Zibara K , Kamel S , Bennis Y
Published: October 2021

Background/Introduction

Inflammation is a key feature of calcific aortic valve stenosis (CAVS) against which there is currently no pharmacological treatment.

Purpose

To verify the hypothesis that interleukin-8 (IL-8), a pro-inflammatory factor involved in arterial calcifications, also promotes the calcification of human aortic valve interstitial cells (hVICs).

Methods

Primary hVICs were isolated from healthy pieces of aortic valves harvested from patients undergoing surgical valve replacement. They were cultured in a pro-calcifying condition (Pi-3.8mM) with or without IL-8 (5 to 50 pg/ml) for up to 21 days. Calcification was analysed by alizarin red staining and calcium content was measured with the o-cresolphthalein complexone method. The viability of hVICs was verified by the MTT assay. The expression of osteogenic (BMP2, OPN, osterix and ALP) and myofibrotic (alpha-SMA, collagen-1, collagen-3 and elastin) markers as well as that of metalloproteases (MMP-2, -9 and -12) was analysed by RT-qPCR. The expression of IL-8 receptors, CXCR-1 and CXCR-2 was evaluated by Western blot and flow cytometry, and the effects of IL-8 were tested in the presence or absence of SCH527123, an antagonist of CXCR-1 and CXCR-2. Finally, the expression of CXCR-1 and -2 and elastin was analysed by immunohistochemistry in the calcified and non-calcified areas of human aortic valve samples. All of these experiments were carried out from valves of at least 5 different donors and a P<0.05 was considered statistically significant.

Results

IL-8 (15 pg/mL) caused a significant ∼2-fold increase in the calcification of hVICs in the Pi condition, compared to the Pi-only condition, without modulation of cell viability. In the presence of Pi, IL-8 exposure significantly stimulated the expression of the transcripts of elastin and MMP-12, an elastase, and reduced that of OPN, a well-known inhibitor of calcification. The effects of IL-8 on hVICs calcification and on the expression of MMP-12, elastin and OPN transcripts were significantly prevented by the addition of SCH527123. In addition, the expression of CXCR-1 and -2 was confirmed in histological samples of human aortic valves. This expression was more pronounced in calcified areas compared to non-calcified areas and co-localized with degraded elastin.

Conclusion

IL-8 promoted the calcification of hVICs in culture. This effect was significantly prevented by antagonizing CXCR-1 and CXCR-2 IL-8 receptors, which we showed for the first time to be expressed by human VICs and aortic valves of patients with CAVS. Further studies are underway to clarify the cellular mechanisms involved.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Fédération Hospitalo-Universitaire REMOD-VHF
Alcohol and drug abuse as a manifestation of social stress due to the COVID-19 pandemic
Authors: Semyonova VA , Sabgayda TP , Zubko AV , Ivanova AE , Evdokushkina GN
Published: October 2021

During the pandemic, deaths associated with mental health deterioration due to social stress have contributed to excess mortality. The purpose of the study is to evaluate changes in mortality from causes associated with social stress during the pandemic in Moscow. The analysis is based on the Rosstat statistics and RFS-EMIAS database (Medical death certificates issued by the Moscow health institutions) in 2019-2020. Deaths from mental disorders and suicides during the maximum and minimum excess mortality in Moscow in 2020 were compared to 2019 (May and December, when mortality exceeded the 2019 indicators by 57.2% and 56.7%, and July with the 7.1%) excess. First, the excess mortality from mental disorders in these months was almost entirely due to disorders related to alcohol and drug abuse. Second, alcohol and drug abuse also results in deaths from poisoning. This necessitates a joint evaluation of deaths associated with alcohol and drugs (from mental disorders and poisoning). The evaluation shows that excess deaths from alcohol abuse in men in May 2020 compared to May 2019 equaled to 65%, falling down to 52.3% in July, followed by its maximum (2.5-fold) in December. Females show a steady increase: 52.9%, 76.5% and 2.1-fold, respectively. Distribution by sex of the total deaths associated with drug addiction (mental disorders and poisoning) was reversed: a steady increase in males (55.4% in May, 67% in July and 2.1-fold in December) and a significant decrease in females: 63.6%, 31.6% and 2.7-fold, respectively. Third, the pandemic has paradoxically affected deaths from suicide (including hangings, falls and undetermined intent poisoning). In men, excess deaths equaled to zero in May, 1.2% in July and decreased by 20.6% in December. The female excess suicidal mortality increased: 13.5%, 30.6% and 36.7%, respectively. Thus, the male reaction to social stress caused by the pandemic was passive (alcohol and drug abuse), while the female reaction was aggravated by suicides.

Key messages

During the pandemic, deaths associated with mental health deterioration due to social stress contributed to excess mortality. Alcohol and drug abuse results in deaths not only due to mental disorders.
Data is the new oil. How Covid-19 boosted information transparency in Austria
Authors: Habl CA , Hummer M , Maier G
Published: October 2021

Background

Austria has no tradition of sharing administrative or routine (health) data collected by public authorities with researchers and accordingly no corresponding data infrastructure exists. Triggered by the GDPR and the pandemic situation an increasing demand from scientific institutions to obtain access to health care data (e.g. use of resources, patient pathways) for research purposes emerged. The latest governmental program addressed this fundamental request even before the start of the pandemic mainly because one of the members of the current coalition, the Green Party, values information transparency very high. The abolishment of “professional secrecy” and the promotion of research by enabling a comprehensive secondary use of data are cornerstones of their political agenda.

Mathods

The agenda was boosted by the outbreak of the Covid-19 pandemic that made the need for joint and real-time data-based research into SARS-CoV-2 and COVID-19 evident and eventually led to the establishment of the Covid-19 data platform https://datenplattform-covid.goeg.at in April 2020, which is run by the Austrian National Public Health Institute (GÖG). Since June 2020 national and international scientific institutions can obtain, free of cost, data from the Epidemiological reporting system which includes core information on COVID-19 infections in Austria. Institutions need to apply with GÖG for accreditation which is granted (or denied) by the Scientific Advisory Board of the Platform. Data provision is continuously expanded and includes as of now, data on hospital and ICU admissions due to COVID-19 as well as data on SARS-CoV-2 genome sequencing.

Results

In April 2021, 84 institutions (8 international) had applied for access. 60 have been accredited, in line with the rules of procedure (incl. a plausibility check of the applicant against OECD's Frascati-criteria. In total, nine articles using data from the Covid-19 platform have been submitted to scientific journals.

Key messages

On a national level, the Covid-19 data platform, commissioned by the Austrian Ministry of Health (BMSGPK) is an important step towards a modern and transparent health care administration system. Covid-19 and the data platform triggered a debate around the need for a (national) data-governance framework balancing benefits from data usage vs the right to data protection of citizens’ health data.
1.H. Workshop: Health, risk factors and inequalities in the EU: insights from the Global Burden of Disease study
Authors:   Organised by: COST Action CA18218–European Burden of Disease Network,   Chair persons: Brecht Devleesschauwer (Belgium)
Published: October 2021

Since the 1990s, the Global Burden of Disease (GBD) study is providing a wealth of information on the health status of the world's population, at an increasing level of detail. The key metric of the GBD study is the Disability-Adjusted Life Year (DALY), which allows integrating the impact of morbidity and mortality into a single indicator, thereby providing a more comprehensive basis for evaluating, comparing and ranking the health impact of diseases, injuries, and risk factors. The GBD 2019 study, conducted by the Institute for Health Metrics and Evaluation, generated burden estimates for 369 diseases and injuries, and 87 risk factors, in 204 countries and territories, for the period 1990-2019.

Leveraging the GBD 2019 study results, this workshop will paint a picture of the state of health in the European Union, focusing on the main causes of ill health, the main contributing risk factors, and the prevailing health inequalities. The workshop is organized by the European Burden of Disease Network (COST Action CA18218), which actively works to integrate and strengthen the capacity and knowledge in burden of disease assessment assessment across Europe and beyond. As a practical exercise in knowledge translation, the workshop will be an opportunity for participants to get familiar with the concept and importance of burden of disease, the GBD study, and the use of DALYs for population health monitoring and reporting.

Key messages

The Global Burden of Disease study provides comprehensive and comparable worldwide estimates of the population health impact of diseases, injuries, risk factors, and inequalities. Participants will receive a picture of the state of health in the European Union, including the main causes of ill health, the main contributing risk factors, and the prevailing health inequalities.
Occupational inequalities during the pandemic: epidemiological evidence
Authors: Dragano N
Published: October 2021

COVID-19 infection risks at work as well as psychosocial risks following the fundamental changes in the economy during the pandemic were equally distributed across the workforce. Obviously, certain occupations (e.g. health care) had particular high health risks but apart from that it has also been hypothesised that workers in precarious employment or with low occupational positions are also disproportionally affected. This contribution summarizes the epidemiological evidence on the association between occupational inequalities and COVID-19 related burden of disease. It will also comment on the possible mechanisms linking different aspects of precarious work with health during the pandemic - including social protection and occupational safety and health policies at the company level. The presentation relies on an unsystematic literature review conducted in Spring 2021 and on the results of statistical analyses of different datasets including hospitalisation data, official data on COVID-19 cases and a large German cohort study. Briefly, preliminary results suggest occupational inequalities in a) infection risks, b) risk of severe disease in COVID-19 patients, and c) non-COVID-19 outcomes such as depression or anxiety. It has to be noted, howewer, that the number of empirical studies on that issue is surprisingly low - in particular in regard to direct infection risks. The reasons for this lack of data and the possible implications for a timely policy responses have to be discussed.
Risk behavior among people who inject drugs
Authors: Jakubauskiene M , Lindert J
Published: October 2021

Background

Addiction to illicit drugs is considered as medical condition requiring effective measures to prevent the disease and minimize harms of this addiction. Injecting drug use increases the risk for acquiring blood-borne infections among people who inject drugs (PWID). The aim of the study was to assess the risk behavior related to the use of intravenous narcotic and psychotropic substances among PWID in Lithuania.

Methods

A cross sectional survey using respondent driven sampling (RDS) of active intravenous drug users (n = 369) in Lithuania has been conducted in 2018-2019. RDS is a peer-referral sampling methodology applied to estimate characteristics of underserved populations that cannot be sampled randomly. 8 seeds were selected in 5 different sites across the country to recruit the study subjects. Descriptive statistics and logistic regression were conducted.

Results

Data collection was completed using 4 waves. Each seed yielded 3 to 24 eligible recruits. 80% of the sample were males, 20% - females. Age mean is 36.8 years, SD-7.69. The age of debut injecting drugs was 13 years, average age 20 years, SD 4.8. Average injecting duration was 12 years. 76% were incarcerated during their lifetime. 59% of PWID reported injecting heroin, 39% phentanyl, 13% amphetamines. 79% reported using sterile needles and syringes while injecting the last time and 21% were not. 17% were sharing non sterile injecting equipment during the last 30 days.

Conclusions

Younger age when started injecting drugs, duration of injecting drugs and imprisonment increased the risk of using unsterile needles and syringes and sharing injecting equipment.

Main messages

Behavioural risk factors are related to higher risks of drug use related infectious diseases. Targeted psychosocial interventions are needed to prevent the behavioural risks of injecting drug use.
Health workforce protection and preparedness during COVID-19: a rapid assessment of EU countries
Authors: Kuhlmann E , Brînzac M , Burau V , Correia T , Ungureanu M-I
Published: October 2021

Background

Healthcare workers face high pressures and new threats during the COVID-19 pandemic, and health systems and governance are key to improve preparedness and protection. This study aims to introduce a tool for rapid assessment based on an integrated multi-level governance approach and to empirically explore preparedness and protection.

Methods

The study is explorative in nature and applies a comparative approach. The assessment tool comprises four major dimensions of governance: system, sector, occupational and sociocultural issues (focus on gender issues and migrant healthcare workers) of protection and preparedness. Secondary sources and expert information serve the empirical exercise, using material from Denmark, Germany, Portugal and Romania.

Results

We revealed similar developments across countries: action has been taken to improve physical protection, vaccination of healthcare workers and digitalisation, while social and mental health support programmes were poor or lacking. Developments were more diverse in relation to occupational/ organisational preparedness: some ad-hoc transformations of work routines and tasks were observed in all countries, yet skill-mix innovation and collaboration were strong in Demark and weak in Portugal and Romania. We are able to identify major governance gaps in relation to integration of education and health systems, social and mental health support programmes, gendered issues of health workforce capacity, integration of migrant healthcare workers, and comprehensive surveillance and monitoring.

Conclusions

There is a need to step up efforts and make health systems more accountable to the needs of healthcare workers during global public health emergencies.
Combining personalised medicine and patient-centered care in breast cancer: a systematic review
Authors: Castagna C , Pellegrino R , Morsella A , Boccia S , Pastorino R , De Belvis AG
Published: October 2021

Background

Breast Cancer (BC) is estimated to cause 2.3 million yearly new cases worldwide. Efforts towards standardized, quality assured and effective care have led to an increasing complexity and specialization of BC management. This systematic review's aim is to describe the state-of-the art of available literature investigating the enactment of personalised medicine and patient-centered care models in BC practice and build a framework towards personalised BC care within a patient-centered model.

Methods

Databases were searched to retrieve articles reporting on BC management, evaluated in terms of patient-centered and personalised medicine approaches, assessing success factors or limits, in English, from the inception to December 2020. The investigated dimensions for patient-centered care models were audits, communication, informative systems and multidisciplinarity. Concerning Personalised Medicine, investigations were related to molecular boards, genetic testing and shared-clinical decision-making.

Results

Out of 1885 records, 25 studies were included in the qualitative analysis. The main success factors are multi-professional collaborations with defined roles and responsibilities, training programs on genomic tools and adequate communication strategy (i.e universal genomic language) to involve patients in the decision-making process. Among detected barriers, delays in genetic testing use were linked to the lack of public reimbursement and of clarity in timing and appropriateness.

Conclusions

Both these models are complementary and needed to ensure effective changes in the path of BC patient management. Our framework aims to the transformation of standardized application of evidence-based medicine into a dynamic and personalised care pathway.

Key messages

The combination of the two care delivery approaches is scarcely investigated in literature. Our framework would allow to fill such gap and attributes a key role to sharing the decision-making process.
Chronic Kidney Disease and Adverse Pregnancy Outcomes: A Systematic Review and Meta-analysis
Authors: Al Khalaf SY , Bodunde E , Maher G , O'Reilly ÉJ , McCarthy FP , O'Shaughnessy M , O’Neill SM , Khashan AS
Published: October 2021

Objective

Chronic kidney disease (CKD) has been linked with adverse pregnancy outcomes, but few studies have examined the influence of cause and severity. The aim of this meta-analysis was to synthesize the evidence on CKD and adverse pregnancy outcome, by cause and severity of CKD where reported.

Data sources

We searched PubMed, Embase, and Web of Science from inception to May 2021. Study selection and Data Extraction: Studies reporting associations between CKD and adverse pregnancy outcomes were included according to pre-defined eligibility criteria (PROSPERO protocol registration: CRD42020211925). Two reviewers independently screened titles, abstracts, and full-text articles and performed data extraction. The certainty of the evidence was assessed using the GRADE approach.

Main Outcomes and Measures: We used random-effects meta-analyses to calculate pooled estimates. Primary outcomes included pre-eclampsia, Caesarean section (CS), preterm birth (PTB <37 wk.) and small for gestational age (SGA).

Results

In total, 31 studies were included. The certainty of the evidence was deemed to be ‘very low' for all outcomes using the GRADE approach as expected given the observational study design. Pre-pregnancy CKD was associated with pre-eclampsia [pooled adjusted odds ratio (aOR)=2.58 (1.33-5.01)], CS [aOR=1.65 (1.21-2.25)], PTB [aOR=1.73 (1.31-2.27)] and SGA [aOR= 1.93 (1.06-3.52)]. Subgroup analyses suggested that different causes of CKD had differing risks for adverse pregnancy outcomes, and later stages of CKD, compared to earlier stages, were associated with higher odds of pre-eclampsia [crude OR = 2.77 (1.73-4.44)], PTB [4.21 (2.99-5.92)], and SGA [2.43 (1.33-4.46)].

Conclusions

CKD was associated with a higher risk of adverse pregnancy outcomes, and the degree of risk varied by cause and severity. These findings highlight the need for further studies of a more robust quality evaluating the effects of cause and severity of kidney disease on adverse pregnancy outcomes.

Key messages

Pre-pregnancy CKD was associated with higher risk of adverse pregnancy outcomes. The risk of adverse pregnancy outcomes varied by CKD cause and severity.
Public Mental Health services in the European region during the COVID-19 pandemic
Authors: Wilson N , McDaid S , Wieber F , Lindert J
Published: October 2021

The European Public Health Association (EUPHA), in conjunction with the Mental Health Foundation UK, conducted a purposely designed online survey of public and mental health professionals from across Europe, exploring public mental health responses to the pandemic in different regions, nations and localities. Participants were recruited from EUPHAs mental health division and through snowballing. Four broad areas were explored, namely; (1) perceived changes in available mental health supports during the pandemic; (2) whether or not a public mental health response plan had been developed; (3) if any demographic groups or priority areas had been given particularly consideration in this response and (4) how the response had been developed (i.e. whether intersectoral approaches had been adopted and the perceived degree to which service users and carers had been included in its development). Forty-four survey responses from twenty different European nations were collected and grouped according to whether respondents were practising in countries with low, medium or high COVID-19 incidence rates. The majority of responses were from public health professionals with over 20 years of experience. Results indicated wide variations in policy responses to the crisis and in the way mental health services have adapted to date. However, in the majority of countries surveyed, while an increase in online mental health supports during the pandemic was reported, no change in long term funding for mental health supports was observed. In addition, in the majority of countries, several vulnerable groups were rarely given specific attention in policy responses, namely low-income families, people with long-term health conditions or disabilities and ethnic minorities. In this workshop we will discuss the findings from this survey and explore what insights might be learned from experiences across Europe to date.
The effects of the COVID-19 pandemic on population mental health policy: A Scottish case study
Authors: McDaid S
Published: October 2021

The COVID-19 pandemic has challenged many mental health systems across Europe. As whole populations experienced extended social restrictions of various levels, there has been an emerging appreciation of the importance of prevention and early intervention to population mental health. In response some countries and nations produced COVID-19-specific mental health plans or updated existing strategies. Mental health policy development can play an important role in countries' recovery from the effects of the pandemic. Policy can be defined as the position that a government takes on a particular issue including descriptions of how the government will respond, statements of scope, values, responsibilities, resource allocation, delivery, engagement and governance structures, as well as detailed commitments to actions. Policy frames the allocation of resources and effort in the direction of agreed social goals. Scotland had a progressive history regarding mental health service delivery, but less focus on prevention in its policy. This workshop will explore the mental health response to the pandemic in Scotland with a focus on prevention and early intervention. It will describe the pandemic context in Scotland, drawing on findings from the Coronavirus: Mental Health in the Pandemic study led by the Mental Health Foundation in partnership with Cambridge, Swansea and Strathclyde Universities and Queens University Belfast. This study has utilized repeated cross-sectional surveys of a representative sample of adults in Scotland to explore the emotional and psychological responses of adults to the evolving circumstances of the COVID-19 pandemic. The workshop will then describe the process of developing Scotland's COVID-specific mental health policy and highlights of the policy. It will report on implementation of the preventative and early intervention policy elements to date and discuss the implications of the pandemic for Scotland's medium-term mental health policy landscape.
Health Catch-UP!: digital innovations in UK primary care to strengthen multi-disease screening and catch-up vaccination and to promote general health in at-risk migrants
Authors: Goldsmith Lucy
Published: October 2021

Dr Carter will describe a new digital tool - Health Catch-UP! - currently being tested in UK primary care to aid clinical decision-making around screening recommendations for multi-disease testing and catch-up vaccination requirements in presenting adult migrants, alongside a general health check.
Economic crisis, epidemiology and resilience in Italian Regions
Authors: Nante N , Vanacore F , Monaci P , Diaferia F , Moirano F , Messina G
Published: October 2021

Introduction

Avoidable Mortality is an indicator of the effectiveness of Health Services. We know that Gross Domestic Product (GDP) and other macroeconomic indicators are related to health indicators. The aim was to study the impact of economic indicators on Avoidable Mortality, in Italy, with attention to the periods following the economic crisis and COVID-19 epidemic.

Methods

GDP, Gini Coefficient (GC) and other economic and epidemiologic data were collected from the beginning of the Century up to the present from the Italian National Institute of Statistics database (ISTAT) and the Italian National Institute of Health (ISS). Mortality data (597 causes coded by ICD-9) was divided in Preventable, Amenable and Avoidable categories. Spearman's rank Correlation Coefficient was carried out with STATA software. The analysis was performed, also using JOINPOINT software, on the entire Italian territory and then specifically on the 20 Regions.

Results

GDP trend showed two decreasing phases occurred between 2008-2009 and 2012-2013. A negative correlation (p.<0.05) has been demonstrated in 7 Regions between GDP values and Avoidable Mortality, 5 Regions for Preventable and Amenable Mortality. GC showed a fluctuating but growing trend without any correlation with all categories of Avoidable Mortality. In 2020, after the start of the COVID-19 pandemic (in February 2020 in Italy), GDP and Employment Rate (ER) declined rapidly, but not always homogeneously.

Conclusions

The upward trend of the GC reflects an increase in inequality in the period following the economic crisis. GDP trend reflects the phases of the economic crisis impacting on epidemiological indicators with a latency of about 4 years. The negative correlation between GDP and Avoidable Mortality can not be observed in all Regions. This may be explained by heterogeneous administrative policies and different levels of resilience among Regions: another description of the “european microcosm” represented by Italy.

Key messages

The impact of the economic crisis on Avoidable Mortality has about 4 years of latency. COVID-19 pandemic has a faster impact on GDP and ER. Italian Regions show different levels of resilience.