bluuebunny/crossref_metadata_2025 huggingface dataset:
Barriers to cardiac rehabilitation: a first national survey
Authors: Farah R , Groot W G , Pavlova M P
Published: October 2021

Introduction

Cardiovascular diseases (CVD) are among the leading causes of morbidity and mortality worldwide. Over three quarters of the cardiovascular deaths take place in low-and middle-income countries. CVD represent half of all death in the country. Despite the benefits and clinical recommendations from ESC/AHA and WHO, Cardiac Rehabilitation (CR) is still not routinely and not universally available. Numerous studies have found that barriers to access to CR are correlated with providers, patients and environment characteristics.

Purpose

This first national survey on CR assesses and identifies what the main barriers to access to CR are. In addition, this study provides suggestions for the implementation of CR in the country. This study takes into consideration the recommendations of cardiologists and cardiac surgeons for further expansion of CR practice. Until 2018, no local comprehensive CR program had been realised. Nevertheless, secondary cardiovascular preventive programs such as CR are not a priority.

Methods

A quantitative cross-sectional study design was adopted using a structured, self-administrated questionnaire. The survey was conducted in December 2018 among cardiologists and cardiac surgeons. A 25item questionnaire was used to collect information on CR. Responses were analysed using descriptive statistics SPSS software (version 24).

Results

The respondents' rate was 41.5% (n=83). 77.7% of Physicians will face barriers to refer patients to a CR program. The top 3 barriers are: first “the lack of specialist”, second barrier to overcome is “the lack of patient motivation” and third “financial covering of CR”. Supplementary learning about the benefits of CR is highly recommended to enrol more patients with CVD. CR need to be covered by a insurances and government policies above all during this time of pandemic.

Conclusions

The role of physicians in promoting patient enrolment should be optimised and exploited in the country. The access barriers identified can help to develop CR programs and to improve CR referral and enrolment rates. Funds from private parties and a budget from the government are needed to launch new CR programs in the country. Further research is needed.

Funding Acknowledgement

Type of funding sources: None.
Associations of the ITGB3 gene rs5918T>C and the APOA1 gene rs1799837C>T markers with serum lipid metabolism in coronary artery disease patients
Authors: Conkbayir C , Ergoren M , Cobanogullari H , Balcioglu O , Abras I , Eminsel T , Oztas D , Ugurlucan M , Temel S
Published: October 2021

Aim

The relationship between hypercholesterolemia, particularly elevated low density lipoprotein-cholesterol (LDL-C) levels and coronary artery disease is recognized by the evidence from previous epidemiologic studies. Importantly, genetic polymorphisms on different genes have been reported to be associated with plasma lipid levels. In this particular study, we aimed to investigate the relationship between the ITGB3 gene rs5918 T>C and APO-A1 gene rs1799837 C>T markers and serum lipid metabolism.

Patients and methods

A total of 100 subjects with CAD and 250 healthy subjects were involved in the current study. A basic biochemical analysis, including serum glucose, total serum cholesterol, HDL-C, LDL-C and triglycerides, was performed for each participant. Genotyping for the ITGB3 gene and APO-A1 gene polymorphisms was performed by polymerase chain reaction followed by restriction fragment length polymorphism (RFLP) analysis.

Results

With respect to the genotype and allele distributions of ITGB3 rs5918 T>C polymorphism, the frequency of the C allele was higher in the coronary artery disease (CAD) group compare to control group (p=0.001). Moreover, there was a statistically significant association detected between ITGB3 rs5918 CC genotype and serum total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C) (p=0.0006, p=0.016 respectively) in CAD group. However there was no statistically significant association was identified between the APOA1 rs1799837 C>T polymorphism and biochemical parameters in control and CAD group.

Conclusion

The results demonstrated that rs5918 T>C variant within the ITGB3 gene might have a clinical importance as a genetic marker which increases the susceptibility to CAD. Therefore, the ITGB3 gene rs5918 C allele may be offered as a screening option for CAD in Turkish Cypriot population who come in for medical check-up.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Near East University
Transcriptional profiles of genes related to electrophysiological function in scn5a+/− murine hearts
Authors: Takla M , Edling C E , Zhang K , Saadeh K , Tse G , Salvage S C , Huang C L H , Jeevaratnam K
Published: October 2021

Background

The Scn5a gene encodes the major pore-forming Nav1.5 (α) subunit, of the voltage-gated Na+ channel in cardiomyocytes. The key role of Nav1.5 in action potential initiation and propagation in both atria and ventricles predisposes organisms lacking Scn5a or carrying Scn5a mutations to cardiac arrhythmogenesis. Loss-of-function Nav1.5 genetic abnormalities account for many cases of the human arrhythmic disorder Brugada Syndrome (BrS) and related conduction disorders. A murine model with a heterozygous Scn5a deletion recapitulates many electrophysiological phenotypes of BrS.

Purpose

This study examines relationships between its Scn5a+/− genotype, resulting transcriptional changes and the consequent phenotypic presentations of BrS.

Methods

Atrial and ventricular tissue samples were obtained from aged (11±3 months) wild-type (WT) and homozygous Scn5a+/− mice. Quantitative PCR was used to examine transcription of 60 genes underlying cardiac tissue excitability.

Results

Of selected protein-coding genes related to cardiomyocyte electrophysiological or homeostatic function, concentrations of mRNA transcribed from 15 differed significantly from WT. Despite halved apparent ventricular Scn5a transcription heterozygous deletion did not significantly downregulate its atrial expression, raising possibilities of atria-specific feedback mechanisms. Most of the remaining 14 genes whose expression differed significantly between WT and Scn5a+/− animals involved Ca2+homeostasis specifically in atrial tissue, with no overlap with any ventricular changes. All significant differences shown by the atria and ventricles were up- and downregulations, respectively.

Conclusion

This investigation demonstrates the value of future experiments exploring for and clarifying links between transcriptional control of Scn5a and of genes whose protein products coordinate Ca2+ regulation and examining their possible roles in BrS.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): University of Surrey; Medical Research Council
Time and frequency domain analysis of long-term heart rate variability in an experimental model of diet-induced metabolic syndrome
Authors: Lozano W M , Arias-Mutis O J , Calvo C J , Bizy A , Such-Miquel L , Chorro F J , Zhao J , Alberola A , Zarzoso M
Published: October 2021

Background

Metabolic syndrome (MetS) is defined as the set of at least three of the following conditions: central obesity, elevation of triglycerides, decreased in high-density lipoproteins, systemic hypertension and glucose intolerance. MetS is linked with a high prevalence of cardiovascular disease, including sudden cardiac death and atrial arrhythmias, which may be a consequence of changes related to the structure, function and autonomic control of the heart. One of the underlying mechanisms responsible could be the alteration of sinus node automaticity. Heart rate variability (HRV) analysis is a useful non-invasive tool for evaluating alterations in neural control of cardiac automaticity.

Purpose

To examine the changes in long-term HRV using time- and frequency- domain analyses in an experimental model of diet-induced MetS which develops all its components.

Methods

Male NZW rabbits were randomly assigned to control (n=10) or MetS group (n=10), fed with high-fat (10% coconut oil and 5% lard) and high sucrose (15% dissolved in water) diet during 28 weeks. At week 28, 24 hour ECG recording was performed (eMotion Faros 180, Mega Electronics®, 1 kHz). We analyzed 60 minutes of RR time series, comparing day (from 8:00 to 19:59 h) and night (from 20:00 to 7:59 h), and quantified the standard parameters of time and frequency domains: 1) Time domain: RR, SDNN, triangular index (Ti), RMSSD and TINN; 2) Frequency domain: very low (VLF), low (LF), high frequency (HF), and LF/HF index. Multivariate analysis of variance (MANOVA, factorial model) was used for statistical analysis (p<0.05).

Results

Time domain analysis showed a decrease in RR interval (p<0.001) and geometrical Ti (p=0.036) in MetS animals (Figure, A-B), indicative of an increased heart rate. The rest of parameters in the time domain (SDNN, RMSSD, TINN) were not modified. Further, in the frequency domain at FFT spectrum, we did find a significant decrease in the LF band (p=0.032) in MetS animals (Figure, C). The rest of the frequency domain parameters (VLF, HF and LF/HF index) remained unchanged.

Conclusion

MetS decreased RR interval duration and triangular index, suggesting an increased sympathetic activity during day and night. Those changes were reflected in LF modifications, and might be attributable to a deficiency in sympathetic-parasympathetic control, which requires adjustments to maintain normal autonomic balance. Collectively, these results could give insight into the autonomic mechanisms that underlie increased atrial arrhythmia susceptibility in MetS.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Generalitat Valenciana, University of Valencia
Light-controllable recellularized ventricular and atrial tissues
Authors: Ghiringhelli M , Gruber A , Abboud Y , Shiti A , Ballan N , Huber I , Arbel G , Gepstein L
Published: October 2021

Introduction

Construction of three-dimensional ventricular and atrial patches using decellularized extracellular matrix could allow the creation of “organ-like” structures for disease modeling, drug testing and regenerative medicine applications. To engineer functional artificial anatomical hearts several obstacles need to be overcome including generation of chamber-specific cells, prevention of immune reaction and donor/host tissue electrical coupling.

Purpose

In order to tackle these challenges we aimed to combine human induced pluripotent stem cell (hiPSC) technology, developmental biology inspired differentiation system to generate chamber-specific cardiomyocytes, decellularization/recellularization processes, and optogenetics utilizing light-sensitive ion channels to generate light-controllable atrial/ventricular tissue engineered patches.

Material and method

Atrial and ventricular patches of adult rats were decellularized using 1% SDS, 3% triton-X. The decellularized scaffolds were then recellularized with hiPSC- derived cardiomyocytes (2x107 atrial or ventricular cells). Adenoviral transduction was used to express the light-sensitive cationic channel ChR2 in the tissue engineered constructs.

Results and discussion

Eight days after cell seeding, we observed the development of spontaneous contraction of the atrial/ventricular tissues. Immunostaining for atrial (Cx40) or ventricular (MLC-2V) markers, gene expression, action-potential morphology, and the response to chamber-specific pharmacology confirmed the atrial/ventricular specific identity of the patches. Histological examination confirmed the preservation of the macro/micro- atrial/ventricular anatomical features in the generated chamber-specific recellularized patches. Optical mapping, using an EM-CCD camera, was used to characterize the conduction and repolarization properties of the generated tissues. The engineered patches could be paced and their electrical activity controlled by either electrical or optogenetic stimulation. Finally, arrhythmogenic reentrant arrhythmias could be induced in the tissue models and terminated by using optogenetic stimulation (“optogenetic-defibrillation”).

Conclusions

Three-dimensional light-sensitive chamber-specific engineered heart patches could be generated that could be controlled and manipulated through electrical and light pacing. These tissue could be used for several pathophysiological, drug testing, disease modeling and regenerative medicine applications.

Funding Acknowledgement

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): H2020-ERC-COG
Quercetin enhances the efficacy of telmisartan in myocardial ischaemia/reperfusion injury in rats
Authors: Ahmed L , El-Mokadem B , Khattab M , El-Abhar H
Published: October 2021

Background

The clinical outcome of myocardial ischaemia/reperfusion (I/R) injury is still unpredictable and detrimental despite the use of several agents including renin-angiotensin system inhibitors. Quercetin (QN), one of the most prevalent flavonoids, has attracted great attention in the recent years due to its protective role against I/R injury. Interestingly, a recent experimental study showed an important role for β-catenin in the regulation of myocardial I/R injury following heterotopic heart transplantation.

Purpose

The present investigation was directed to estimate the role GSK-3β/β-catenin signaling as a possible mechanistic pathway, through which QN could modulate the therapeutic effect of telmisartan (Tel) in myocardial I/R injury in rats.

Methods

Myocardial I/R was induced by ligation of the left descending coronary artery for 30 min followed by reperfusion for 2 h. Rats were pretreated with Tel (12 mg/kg/day, po), QN (25 mg/kg/day) or a combination of both agents for 3 days before the experiment. Electrocardiographic abnormalities were assessed at the end of ischemic and reperfusion periods. Animals were then sacrificed to assess the cardiac injury surrogate markers; viz., serum CK-MB and cTn-I levels and cardiac energy content (ATP) as well as oxidative stress (ROS, MDA, SOD and TAC), inflammation-related (TNF-α, NF-κB, ICAM-1 and MPO) and apoptotic markers (caspase 3 and Bcl-2). Moreover, the hallmark of fibrosis (TGF-β1) was estimated in addition to GSK-3β/β-catenin signaling. Finally, histological examinations were performed to assess the severity of myocardial damage.

Results

Combined Tel/QN therapy showed an additional improvement compared to each therapy alone (p<0.05) toward reducing myocardial I/R-induced oxidative stress, inflammatory, fibrogenic, and apoptotic markers which subsequently restored Wnt/β-catenin signaling through inhibition of GSK-3β upregulation together with spiking up of β-catenin content. All these changes were associated with restoration of myocardial energy content and prevention of I/R-induced damage in histological examination.

Funding Acknowledgement

Type of funding sources: None.
Analysing drivers of routine and COVID-19 vaccination in migrants to develop tailored interventions
Authors: Crawshaw AF , Farah Y , Deal A , Goldsmith LP , Carter J , Rustage K , Campos-Matos I , Vandrevala T , Forster AS , Hargreaves S
Published: October 2021

Background

Migrants in Europe are at risk of under-immunisation and may also have lower COVID-19 vaccination intent and uptake. There is an urgent need to better understand the drivers of uptake in these groups to inform the development of migrant-sensitive interventions for COVID-19 vaccination and routine vaccination beyond the pandemic.

Methods

We did a systematic review (PROSPERO: CRD42020219214) following PRISMA guidelines to explore factors influencing vaccine uptake in migrants in the EU/EEA and identify determinants of under-immunisation. We also held 3 participatory workshops with multinational migrant community leaders (n = 23) in London, to explore solutions and approaches to strengthen COVID-19 vaccine roll-out.

Results

We included 66 papers reporting data on 262,761 migrants in the review. Numerous access-related factors (e.g. government policy, communication barriers) influenced uptake. Vaccine hesitancy was attributed to lack of information, concerns about side-effects, and cultural beliefs/stigma around specific vaccinations. Migrants who had recently arrived, were older, female or of African and Eastern Mediterranean origin were at risk for under-immunisation for key vaccine-preventable diseases. Migrant community leaders reported considerable hesitancy towards COVID-19 vaccination in their communities and misinformation circulating via social media. Leaders requested support in producing simple COVID-19 guidance that could be translated and adapted locally, alongside more meaningful engagement and partnership-working.

Conclusions

Access barriers and vaccine hesitancy may affect vaccine uptake in some migrant populations in Europe, which needs to be urgently addressed for COVID-19 vaccine roll-out but also beyond the pandemic to strengthen uptake of routine vaccinations. Actively involving migrant communities in the planning, co-production and implementation of tailored and targeted approaches will be essential.

On behalf of ESGITM.

Key messages

Access barriers and vaccine hesitancy (from information gaps, cultural factors) contribute to low vaccine uptake in some migrant populations in the EU/EEA, with implications for COVID-19 vaccination. Meaningful engagement and co-production of tailored approaches with under-immunised migrants are urgently needed to ensure their inclusion in COVID-19 and routine vaccination programmes.
A COVID-19 screening method based on eyes photographs and artificial intelligence
Authors: Li F , Xue XY , Boned Fustel P , Rong SS , Sun Q , Tang HC , Wang WX , Fu Y , Boned-Ombuena A , Gu MW
Published: October 2021

Background

SARS-CoV-2 can spread both from symptomatic and asymptomatic individuals. Ocular manifestations due to SARS-CoV-2 have been described, being conjunctival inflammation the most common affectation. Evidence shows that conjunctivitis could be the first and/or only manifestation of COVID-19. This study aimed to develop and validate a COVID-19 screening method based on eyes photographs and artificial intelligence.

Methods

In this multicentre study, 1,200 participants were enrolled from Shanghai Public Health Clinical Center (SPHCC) Fudan University, AIMOMICS LAB and La Fe University and Polytechnic Hospital (LFUPH) of Valencia (Spain). Pictures of participants' ocular surface were taken in four different positions with mobile phone cameras, and a Deep Learning System (DLS) was developed through machine learning to identify characteristic conjunctival inflammation patterns. The study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committees of SPHCC and LFUPH.

Results

The area under the receiver-operating-characteristic curve (AUC), sensitivity, specificity, and accuracy were calculated according to the results of our binary classification network. Bootstrapping with 1,000 replicates was used to estimate 95% confidence intervals of the performance metrics, with photography as the resampling unit. On the subject-level classification, the network achieved the AUC of 0.976 (95% CI 0.965-0.988) among Asian population and 0.892 (95% CI 0-763-1.000) among Caucasian population.

Conclusions

Preliminary results show that this DLS performed well in identifying probable asymptomatic COVID-19 cases through the analysis of participants' eyes pictures. This method could be an innocuous, accessible, low cost and quick COVID-19 screening method. Eventually, it could potentially contribute to pandemic control.

Key messages

In the context of the COVID-19 pandemic it would be useful to have a screening method to easily and quickly detect asymptomatic individuals, in addition to using temperature control. Preliminary results show that this Deep Learning System (DLS) based on eyes pictures taken with mobile phone cameras could be an innocuous, accessible, low cost and quick COVID-19 screening method.
Implementation of student experiential learning in health & wellbeing in a large university setting
Authors: Heffernan M , Mullins B , Bermingham AK , Neville R , Dervan N , Corish CA , Murrin CM , Fitzpatrick P
Published: October 2021

Background

Healthy UCD is a health promotion initiative in University College Dublin (UCD). Working together with university academic staff, we have provided opportunities for graded experiential learning for students in health and wellbeing-related courses. This abstract presents how experiential learning was implemented in the 2020/21 academic year.

Objectives

The first objective was to provide a public health nutrition learning opportunity to MSc in Clinical Nutrition & Dietetics students through the design, implementation and evaluation of UCD Healthy Eating Week in Autumn 2020. Secondly, we aimed to facilitate the running of a wellbeing event by BSc Sport & Exercise Management students with Healthy UCD as their client in Spring 2021. The students had the additional challenge this year of delivering the content online.

Results

MSc Clinical Nutrition & Dietetics students utilised Healthy UCD's website and social media channels to deliver a virtual Healthy Eating Week. Infographics, videos, articles and podcasts were produced which generated 1,000 website visits and reached over 3,000 on social media. Most students involved agreed that the event was successful (95%) and that they were sufficiently supported by Healthy UCD and their tutors (65%). BSc Sport & Exercise Management students devised and delivered a week-long event titled “Wellbeing Your Way”, creating wellbeing seminars and live exercise classes with each receiving an average of 460 views. The students reported gaining valuable experience of the responsibilities of running a professional event and operating as a team.

Conclusions

These examples of experiential learning for credit demonstrate how university campus health promotion teams can facilitate student learning and simultaneously reap the benefit for university faculty and students. The key requirements are committed academic engagement and supported students.

Key messages

University campus health promotion provides excellent opportunities for experiential learning. Health promotion practical experience can have benefits both for students and for the university.
The impact of childhood adversity on addictive behaviours through impulsivity among adolescents
Authors: Mlouki I , Elomma Mrabet H , Bouanene I , Sioud I , Bchir A , Omri N , Ben Youssef F , Sfar H , El Absi M , El Mhamdi S
Published: October 2021

Background

Little is known about the mechanism by which Adverse childhood experience (ACE) affects adolescent's engagement in addictive behaviours in the African context. We investigated the role of impulsivity in the link between ACE and behavioural addiction among schooled youth in Tunisia.

Methods

We performed a cross sectional study among 1940 schooled adolescents in the region of Mahdia (Tunisia) from January to February 2020. We used the validated Arabic version of the World Health Organization ACE questionnaire. The Barratt Impulsivity Scale as well as the Internet Addiction Test were used as screening tools for impulsivity and internet addiction.

Results

A total of 1940 adolescents returned the questionnaires. About 97.5% reported experiencing at least one ACE. We found that ACEs score predict addictive behaviours through impulsiveness (p < 0.001; % mediated = 16.7%). Particularly, intra-familial ACEs (p < 0.001; % mediation = 27.8%) demonstrated the most mediation by impulsivity followed by exposure to extra-familial ACEs (p < 0.001; % mediation = 10.5%). There were interactions between ACE and impulsivity in terms of their impact on internet addiction (p < 0.001; % mediation = 37.5%).

Conclusions

The mediation part of impulsivity in the association between ACE and cyberaddiction is alarming.

Key messages

Impulsive behaviors mediates the effect of childhood adversity on addictive behaviors. Great mediation part of impulsivity (37.5%) for internet addiction among Tunisian youth.
COVID-19 impact on the health and emotional well-being of the general population
Authors: Cabrera-Léon A , Sánchez-Cantalejo C , Rueda MM , Saez M , Enrique I , Ferri R , Castro L , Barceló MA , Villegas R , Daponte A
Published: October 2021

A tremendous number of studies describe results on the evolution of the COVID-19 impact on infected patients, hospital admissions, deaths, mental health and well-being of the population. However, there are hardly any reports on its impact and evolution since the beginning of the pandemic with clinical, contextual and individual perception information. Our work describes the research project called Health Care and Social Survey (ESSOC, Encuesta Sanitaria y SOCial). It arises from the need to provide specific, reliable, early, and timely data on the impact of COVID-19 that can be considered when making decisions to prepare and provide an effective Public Health response in the different affected populations. It is linked to official statistical operations included in the Andalusian Regional Government and has also been granted a favorable opinion by the Research Ethics Committee. The ESSOC is based on a Real-World Data design. It integrates observational data extracted from multiple sources including information based on surveys and clinical, epidemiological, population, and environmental registries. The surveys have an overlapping panel design with a total of over 22,000 effective interviews being carried out over three years from the beginning of the state of alarm in Spain. Their geographical scope is the Autonomous Region of Andalusia (8.4MM people, the fifth most populated region in Europe), and the population scopes are general population, population residing in disadvantaged areas, and population over the age of 55. The conceptual approach of this study encompasses all aspects affecting health that will contribute to an extraordinary increase in the current knowledge of the impact of the COVID-19 pandemic. Its results will be very useful for cross-disciplinary comparisons in population-based studies, and the methodology developed will serve as a model to be applied in other epidemiological studies.

Key messages

It is needed to provide specific, reliable, early, and timely data on the impact of COVID-19 that can be considered when making decisions to prepare and provide an effective Public Health response. Our research project integrates observational data extracted from multiple sources including information based on surveys and clinical, epidemiological, population, and environmental registries.
Incidence rate of Healthcare Associated Infections in a COVID-19 Intensive Care Unit
Authors: Marte M , Marotta D , Giannini D , Mazzalai E , Barone LC , Baccolini V , Migliara G , Marzuillo C , De Giusti M , Villari P
Published: October 2021

Background

Intensive Care Units (ICU) faced a high pressure under the COVID-19 pandemic. It is recognized that patients admitted in these wards are more susceptible to Healthcare Associated Infections (HAIs). This study aims at comparing the incidence of HAIs in a COVID-19 ICU to a No-COVID ward.

Methods

A retrospective cohort study including patients admitted to the ICU of the Teaching Hospital Policlinico Umberto I in Rome from April 2020 to March 2021 was performed. Data on age, gender, hospitalization, different types of devices (ventilation, central venous and urinary catheter), number and type of device-related HAI were collected. Statistical analyses were performed with Episheet and STATA 13.

Results

Out of 347 patients admitted in the ICUs, 329 were included in the study (217 had COVID-19 and 112 had not). In the COVID-19 group, patients were mainly male (69.58%) with a mean age of 62.5±13.5 years, whereas the other group was slightly older (63.2±16.2 years) and more balanced between the two sexes (52.68% male). A total of 133 patients developed at least one HAI, 94 of which were SARS-CoV-2 positive. Globally, 246 HAIs were diagnosed: 163 occurred in the COVID group and 83 in the No-COVID one. The cumulative days of hospitalization were 3233 for the COVID group and 2134 for the No-COVID. The incidence of HAI considered for 1000 days of hospitalization among COVID patients was 50.42 (IC 95%: 42.97-58.78), compared to 38.89 (IC 95%: 30.98-48.22) for the No-COVID one, for an incidence rate ratio of 1.30 (IC 95%: 0.99-1.71).

Conclusions

Even though the confidence interval contains the value 1, the results point out that there is an increase in the incidence rate of HAI among COVID-19 patients. Further investigations are needed to better understand the reasons behind the present findings.

Key messages

Patients admitted to Intensive Care Units are more susceptible to Healthcare Associated Infections. Our study aims at describing the impact of COVID-19 on the risk of developing such conditions. Being infected with COVID-19 leads to an increase in the incidence rate of Healthcare Associated Infections. Further studies are needed to understand the underlying reasons.
Use of antidepressants during COVID19 outbreak: a real-world drug-utilization study
Authors: Fornari C , Antonazzo IC , Paoletti O , Cei E , Bartolini C , Conti S , Ferrara P , Mantovani LG , Gini R , Mazzaglia G
Published: October 2021

Background

Lockdown measures implementation (LMI) to prevent COVID19 disease diffusion was associated to increased depression and anxiety cases. The main aim was to evaluate whether LMI affected prevalence and incidence of antidepressants (ADs) use, and ADs treatment interruption (TI) in the general population.

Methods

Adults (≥18 years) with at least 1 dispensing of ADs between 01/01/2019-26/09/2020 were selected from a regional Italian healthcare administrative database. Patients presenting an AD dispensing in the year preceding the first observation were considered as prevalent otherwise as incident users. We divided the studied period into 3 parts: pre-lockdown (01/01/2019-08/03/2020), lockdown (09/03/2020-14/06/2020) and post-lockdown (15/06/2020-27/09/2020). The weekly prevalence (WP) and incidence (WI) per 10,000 inhabitants were compared among periods. Incidence of TI (no dispensing refill within 30 days of the end of its validity) was computed among prevalent AD users.

Results

The WP (mean of 552.3 per 10,000 pre-lockdown vs 505.5 lockdown phase; relative change: -9%) and WI (5.2 vs 3.7; -29%) of ADs use decreased after LMI. During the post-lockdown phase WP (505.5 vs 495.9; -2%) decreased whereas the WI (3.7 vs 4.3; 16%) slightly increased in relation to the lockdown period, although differences were not statistically significant. Conversely, the incidence of TI increased during lockdown (344.7 vs 384.3; 12%) and post-lockdown (384.3 vs 394.2; 3%) periods, even not always statistically significant.

Conclusions

Our analysis showed a reduction of ADs use during the early phase of lockdown. Several factors might have impacted on the observed phenomenon (i.e, patient reluctance to start new AD treatment). Considering the mutation of the virus and the potential waves that might occur in the next months, a continuous monitoring of the impact of COVID19 on mental diseases onset and treatment adherence are suggested.

Key messages

In Italy, the implementation of lockdown measures was followed by a reduction in antidepressants use, even though evidences are that diagnoses of psychiatric disorders increased. Future studies should monitor if these phenomena led to an increase in adverse events potentially correlated with inappropriate treatment of depression.
Using machine learning to analyse large volume of public health data to drive service improvement
Authors: Papakonstantinou T , Bondaronek P , Stefanidou C , Gold N , Chadborn T
Published: October 2021

Background

The UK government's approach to the pandemic relies on a test, trace and isolate strategy, mainly implemented via the digital Contact Tracing and Advice Service (CTAS). Feedback on user experience is central to the successful development of public-facing services. As the situation dynamically changes and data accumulate, interpretation of feedback by humans becomes time-consuming and unreliable. The aim was to evaluate the use of Machine Learning (ML) techniques as tools to understand the issues with the Service as expressed in the free-text responses of the users. The specific objectives were to 1) conduct an analysis of supervised and unsupervised techniques to develop the most optimal model, 2) generate actionable themes that can be used to increase user satisfaction of the CTAS.

Methods

We evaluated and compared 5 supervised classification algorithms in terms of serviceability and accuracy. We proceeded by evaluating an unsupervised Topic Modelling approach, testing models with 5-40 topics and differing covariates in terms of coherence, residuals and interpretability by human coders. Two human coders conducted thematic analysis to interpret the topics.

Results

Due to the low accuracy, the degree of human involvement and broadness of themes we found that a supervised ML approach was not well suited to our objective. We identified a Structural Topic Model with 25 topics and metadata as covariates as the most appropriate for acquiring insights. Preliminary results from analysis of the feedback by 16,262 users from May 2020 to March 2021 highlighted issues with the Service falling within three major themes: lack of data coordination, ineffective communication, and technical issues.

Conclusions

Structural Topic Modelling was found to be the most effective technique to rapidly acquire user insights. The 25 topics provided highly specific insights of issues that can be utilized towards improving the CTAS.

Key messages

A ML approach can be a quick and cost-effective method to provide high quality, actionable insights from free-text feedback in order to optimize public health services. Topic models can rapidly provide highly specific user insights with minimal human involvement and low maintenance requirements, making them ideal evaluation tools for pandemic response services.
The COVID-19 policy and strategic documents storm: a heartfelt request from the battlefield
Authors: Boned-Ombuena A , Merino-Egea C , Orenga-Damigo I , Taberner Cuevas A , Canós-Cerdá M , Orrit-Ferrer G , Grau Darás MT , Recuenco Díez L , Monteagudo-Giménez A , Boned Fustel P
Published: October 2021

Issue

The COVID-19 pandemic declared by WHO on 11 March 2020 brought not only a big threat to the global population but also a huge number of technical, policy and strategic documents with a very varied level of quality and accessibility. It has been a great challenge for frontline public health workers to surf the information wave, in order to effectively apply it in the context of crisis management.

Description

COVID-19 related policy, strategic and operational documents analysed and implemented by our team -at a public health centre at health department level, in the Valencian Region (Spain)- during the pandemic were reviewed. Key elements considered were: length, quality of structure and content, validity period, as well as dissemination channel.

Results

From February 2020 to date, the European Centre for Disease Prevention and Control (ECDC) alone has published 90 guidance and technical reports, representing 1,503 pages (mean length 16,7 pages, SD 14,0, range 3-92). As regards the Spain national COVID-19 strategy, i.e., a total of 26 versions have been issued so far, between 24 January 2020 and 26 February 2021. Mean length was 19,8 pages (SD 6,8, range 8-31) and average validity period of versions was 15,7 days (SD 16,4, range 1-70). They did not include a summary of recent changes. They were made publicly available through the official Ministry of Health website. As for regional-level documents, 5,3% (21) did not have a date, and their main channel of dissemination was via email.

Lessons

We strongly recommend that policy and strategic documents at all levels comply with a minimum set of quality standards -including essential elements such as organization, title, publication date, page numbers, table of contents, key messages, and summary of changes in comparison with previous versions- and are disseminated through internet or intranet knowledge management systems. This would efficiently save a large number of hours and headaches to frontline professionals.

Key messages

In the context of public health crisis management, timely and appropriate access of frontline public health professionals to updated and concise information is crucial. COVID19 policy and strategic documents at all levels were reviewed. They should comply with a minimum set of quality standards, including a summary of recent changes, and be adequately disseminated.
Mental health during the COVID-19 pandemic in Portugal
Authors: Santos O , Virgolino A , Heitor MJ , Fialho M , Costa A , Rasga C , Martiniano H , Costa J , Vicente A , Caldas de Almeida T
Published: October 2021

Background

Mental health is being impacted by COVID-19, as a result of both the globalized perception of health risk and the massive social and economic measures, required to control the pandemic. A main goal of this study, the SM-COVID19, was to characterize the mental health of the general population and to identify vulnerable groups, during the first lockdown in Portugal.

Methods

Cross-sectional online survey, conducted between May 22 and July 20, 2020, with a nationwide non-probabilistic sample of adults residing in Portugal (≥18 years old). Data were collected with sound psychometric scales for symptoms of anxiety, depression and post-traumatic stress disorder (PTSD), work-life balance, resilience, work-related variables, and sociodemographics. Logistic regression models were used to assess risk and protective factors for mental health suffering.

Results

Overall, 3982 individuals participated in the study (female, 79.1%; mean age, 45.15±12.31 years; 71.0% completed higher education studies). The prevalence of symptoms of moderate to severe anxiety was 26.5% (95% Confidence Interval (CI): 24.0-29.1), of depression symptoms was 26.0% (95%CI, 23.6-28.7), and of PTSD symptoms was 26.5% (95%CI, 24.0-29.2). Moreover, more than one third of the respondents (41.2%; 95%CI: 38.3-44.1) reported symptomatology for at least one of these three psychiatric disorders. Women, individuals who suspended their professional activity (or in layoff or unemployed) during the lockdown, and those with difficulties in managing work and family demands had higher odds for psychological suffering.

Conclusions

The COVID-19 pandemic is a public health crisis with major interpersonal, social and economic impacts at the individual level. Mental health and wellbeing are being severely affected, as confirmed by the high prevalence of symptoms of psychological suffering herein. Mental health protection measures need to be defined and implemented, mainly targeting the most vulnerable groups.

Key messages

COVID-19 pandemic is associated with high prevalence of anxiety, depression and PTSD. Observed mental health inequities imply effective vulnerable-groups-focused mental health promotion programs.
Sex differences and trends of self-rated health in population aged 25-64 years from 1988 to 2017
Authors: Gafarov V , Panov D , Gromova E , Krymov E , Gagulin I , Gafarova A
Published: October 2021

Aim

To determine gender differences in the dynamic of self-rated health in an open population of 25-64 years over 29 years in Russia.

Methods

Within the framework of the screening in 1988-89 under the WHO MONICA-psychosocial (MOPSY) program (n = 1676, 49.5% males, mean age 44.1±0.4y), MOPSY screening in 1994-95 (n = 1527, 43% males, 44.85 ± 0.4y), in 2003-2005 under the international project HAPIEE (n = 1650, 34.9% males, 54.25±0.2y), in 2013-2016 (n = 975, 43.8% males, 34.5±0.4y) and 2016-2017 (n = 663, 41.3% males, 51.95±0.32y) within the framework of the budgetary theme No. AAAA-A17-117112850280-2, random representative samples of men and women in one of districts in Novosibirsk were examined. Self-rated health was assessed using the questionnaire ‘Knowledge and attitude towards own's health'.

Results

Rates of negative self-reported health in open population was extremely high in 1988. The share of women who consider themselves healthy was 13.7%, men - 37.9%. Gender differences increased with age. Only 10.5% of women and 29.7% of men had no complaints about their health. In 2013, there was an increase in positive health estimation among males and females and a decrease in the frequency of complaints, especially in female part of the population - by 2-2.5 times. The favorable trend which began in 2013 continued in 2017, when men and women more often self-esteemed own health status as “good” compared to earlier periods of observation. The proportion of women believed that taking comprehensive care of their health rose to 15% by 2017, equaling that of men. With the exception of 2013, women were more likely than men to report that “taking care of their health is not enough”, although by 2017 this proportion had dropped to 20%.

Conclusions

Sex differences in self-rated health increase with age, but the frequency of health complaints increases proportionally in men and women. There were found favorable tendencies in assessments of health, especially in female population.

Key messages

Rates of negative self-reported health in open population was extremely high in 1988 but subsequently favorable tendencies in assessments of health was found by 2017. Sex differences in self-rated health increase with age, but the frequency of health complaints increases proportionally in men and women.
An investigation protocol to manage a foodborne outbreak in a disaster event
Authors: Mandato D , Fraulo P , Romano A , Mazzone P , Colarusso G , Noschese R , Peruzy MF , Ambrosio RL , Galiero G , Baldi L
Published: October 2021

Background

During disaster events, the displaced populations living in tent camps are at high risk from foodborne illness outbreaks (FBO) as in these circumstances it is difficult to follow proper hygienic procedures during food handling and storage. When an outbreak occurs, an epidemiological investigation able to identify the source(s) of the exposure is essential to rapidly establish control measures to prevent continuing episodes of illness. This work aimed to evaluate the effectiveness and the applicability under simulated field conditions of an investigation protocol to be used during a FBO. Moreover, the application of the software ‘TOSSINFO' for data analysis was evaluated.

Methods

In May 2018, a FBO associated with the consumption of a tuna affecting 46 out of 75 people present in a tent camp in southern Italy was simulated. During the simulation, two teams of doctors and veterinarians participated in the investigation. The investigation protocol involved three steps: environmental inspection, epidemiological investigation, and data analysis through TOSSINFO. This software allows calculating different epidemiological indicators, several measures of association, and the visualization of the progression of the outbreak through epidemic curves.

Results

At the end of the exercise, both teams were able to trace the source of the infection. After data collection and data analysis, the groups demonstrated a strong association between illness people and tuna consumption. Furthermore, the teams achieved similar

Results

RR (7.50 vs 7.01), OR (27 vs 28), and Chi-square (12.1 vs 10.1).

Conclusions

The results demonstrated the validity of the procedure and the simple execution of the software analysis. These guidelines represent an opportunity for the implementation of foodborne disease management strategies and could be used throughout the community, leading to an improvement of the Public Health surveillance system.

Key messages

These guidelines allow for effective management of a food toxinfection episode. The original software TOSSINFO used in this procedure enables quick and easy identification of infected food.
Clinical Practice Guide and risk population ID card for monitoring and controlling leptospirosis
Authors: Gómez Martín MC , Rodriguez Benjumeda LM , Lozano Dominguez MC , De Eguilior Mestre C , Luque Marquez R , Aznar Martín J , Jodar Sanchez F , Luque Romero LG
Published: October 2021

Issue/problem

Leptospirosis is an endemic disease which is mandatorily notifiable in Spain. It is associated with occupational activities in which workers come into contact with rat urine. In our region, this disease's rates of prevalence and incidence are highest among red swamp crayfish collectors (Procambarus clarkii) (RSCC). The increase in outbreaks of leptospirosis over the last 7 years has motivated us to design and implement a Clinical Practice Guide (CPG) for health workers, informational material for the general population, and ID cards and specific information aimed at RSCCs, as a means of reducing the incidence rate. The guide may also serve as a useful tool in other regions and countries with activities associated with Leptospira-infected wetlands.

Description of the problem

The material we have designed is the result of a research project funded by the Consejería de Salud de Andalucía to identify leptospirosis incidence, prevalence, and risk factors among wetland RSCCs. Hardly any CPGs or informational material exist about this disease. The GPC and the educational material designed may be very useful in other environments with a high risk of leptospirosis.

Results

Prevalence of the disease was higher among RSCCs than among the general population (9.8% vs 3.1%) (OR: 3.4; CI 95%: 1.1-12.7) and accumulated incidence was 17.4%. Less than half of the workers adopted appropriate individual preventive measures.

Lessons

The risk of contracting leptospirosis is 3.4 times greater for the RSCC population than it is for the general population. Early detection and antibiotic therapy prevent aggravation of the disease in serious cases and may even prevent deaths. Education and the promotion of preventive measures among RSCCs reduces the risk of infection. The training of health professionals and the design of decision algorithms shorten and improve the quality of treatment for leptospirosis patients.

Key messages

Early detection and antibiotic therapy reduce the incidence of severe forms of leptospirosis. The material designed will help the risk population to adopt preventive measures and seek medical attention.