bluuebunny/crossref_metadata_2025 huggingface dataset:
COVID-19 in pregnant women with heart diseases. Adverse maternal and fetal outcomes. Case series from InCor registry of Pregnancy and Heart Disease
Authors: Kirschbaum M R , Devido M S , Azeka E , Demarchi L M M F , Santos J S , Pinto D V R , Hajjar L A , Tarasoutchi F , Park M , Avila W S ,   Registry- InCor of Pregnancy and Heart Disease
Published: October 2021

Background

Heart disease is the leading non-obstetric cause of maternal death during pregnancy. In this field, the emergence of pandemic COVID-19 has caused the worst-case scenario considering that pregnant women are more susceptible to viral infections, and preexisting cardiac disease is the most prevalent co-morbidity among COVID-19 deaths.

Purpose

To assess the maternal and fetal outcomes of COVID-19 during pregnancy of women with heart diseases.

Methods

During the year 2020, among 82 pregnant women with heart disease followed consecutively at the Instituto do Coração-InCor, seven of them with an average age of 33.2 years had COVID-19 during their pregnancies. The underlying heart diseases were rheumatic valve disease (5 pt), congenital heart disease (1 pt) and one case with acute myocarditis, without preexisting cardiopathy. The prescription (antibiotics, inotropes, corticosteroids and others) used was according to the clinical conditions required for each patient, however subcutaneous or intravenous heparin was used in all patients.

Results

Only one case had an uneventful maternal-fetal course, the other six women required hospitalization / ICU for an average of 25.3 days, including the need for mechanical ventilation in two of them. Serious complications were related to respiratory failure (ADRS), recurrent atrial flutter with hemodynamic instability, acute pulmonary edema, and cardiogenic shock associated with sepsis which caused two maternal deaths. There were two emergency mitral valve interventional, percutaneous balloon valvuloplasty and valve bioprosthesis replacement, respectively. There were five premature births with an average gestational age of 34.2 weeks of gestation, which resulted in one stillbirth. Pathological findings of three placental and the six-months follow-up of the babies did not confirm vertical transmission of COVID-19.

Conclusions

The uncertain evolution given of the overlapping complications of three conditions – COVID-19, pregnancy, and heart disease – implies an increased risk for women with heart diseases of childbearing age, for whom pregnancy should be discouraged and planned after vaccination

Funding Acknowledgement

Type of funding sources: None.
Atrial fibrillation self-screening, management and guideline recommended therapy (AF SELF SMART): improving AF screening in general practice by utilising self-screening stations in GP waiting rooms
Authors: Giskes K , Lowres N , Li J , Orchard J , McKenzie K , Hespe C , Freedman B
Published: October 2021

Background

Opportunistic screening for silent atrial fibrillation (AF) is recommended to reduce stroke, but screening rates are sub-optimal in Australian general practice (<15%), with practitioners reporting time constraints being the main barrier. Previous AF screening interventions in general practice have not been able to exceed screening rates of ∼34% eligible patients which is sub-optimal for stroke prevention.

Purpose

To increase the proportion of patients screened for AF in general practice by implementing AF self-screening stations in waiting rooms.

Methods

We developed and tested an AF self-screening station using a single-lead ECG and app with automated ECG analysis. We also developed customised software which fully integrates the self-screening station with GP medical software and the practice workflow (Figure 1). The system: 1) automatically identifies eligible patients (aged ≥65 years, no AF diagnosis) from the practice appointment diary, and sends an SMS regarding self-screening prior to their appointment; 2) automatically creates individualised patient QR codes, which provided to the patient by the receptionist; 3) the patient then scans QR code and self-screens at station in waiting room; 4) the ECG and result are automatically imported into patient record before the GP consultation.

Results

Three general practices in New South Wales, Australia, were recruited. Each practice participated for approximately 3-months (between August 2020 and March 2021). During this period 825 patients completed AF self-screening, mean age 74.2 years and 45% male. When expressed as a proportion of the actual eligible patients attending the practice during the study period, the mean proportion screened in practices was 52% (range 38–65%). The device algorithm indicated “Possible AF” in 37/825 patients (4.5%); mean age 77.2 years 43% male.

Conclusion

An AF self-screening station placed in GP waiting rooms that is integrated with the practice software and workflow may achieve higher screening rates for AF in general practice than standard practice, and therefore contribute to greater reductions in stroke.

Funding Acknowledgement

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Investigator-lead grant from Bristol Myers Squibb and Pfizer
Patient self-screening stations for atrial fibrillation in general practice waiting rooms: process evaluation
Authors: McKenzie K , Lowres N , Freedman B , Orchard J , Hespe C , Giskes K
Published: October 2021

Background

Our previous work has identified factors relevant to general practitioner (GP)-led screening for atrial fibrillation (AF) in Australian general practices, with GPs indicating significant time constraints. AF SELF SMART (Atrial fibrillation self-screening, management and guideline recommended therapy) allows for opportunistic patient self-screening using purpose-built screening stations located in GP waiting rooms (figure 1). It utilises a single-lead ECG, with results automatically imported into the patient medical record for review during the GP consultation. AF SELF SMART may increase screening rates, but acceptability by practice staff is unknown.

Purpose

Determine staff perspectives on opportunistic self-screening in practice waiting rooms, utilising AF SELF SMART.

Method

14 semi-structured interviews have been conducted with practice staff (GPs, receptionists and practice managers) across 3 practices participating in the AF SELF SMART pilot, with thematic analysis of results.

Results

Several themes were identified.

All staff acknowledged the importance of increasing screening for AF in the practice. GPs in particular placed a high value on AF screening for stroke prevention. GPs valued the increased information and accuracy provided by AF SELF SMART, as previously they checked patients for AF using manual methods, either routinely or as clinically indicated. There were differential impacts on workflow. GPs reported some small increase in workload but these were seen as being acceptable given the benefits of the program. Receptionists and Practice Managers reported significant interruptions to normal workflow associated with assisting patients. Receptionists routinely offered patients help with screening instead of patients screening independently. Staff perceived that patients were either unable to negotiate the self-screening process by themselves, or did not want to try. Given the increase in workload associated with assisting patients, and as screening was not receptionists' main priority, not all patients were offered self-screening during busy periods. Patient refusal was also identified as a factor limiting uptake.

Conclusion

While AF self-screening may increase screening rates, further process improvements are required to reduce impact on reception staff, and enhance the usability of the self-screening station for patients. Such improvements may increase acceptability and ongoing sustainability at a practice level.

Funding Acknowledgement

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Investigator initiated research grant from Bristol-Myers Squibb/Pfizer Alliance Figure 1. Self-screening station
Public awareness of acute myocardial infarction symptoms and emergency response in community residents
Authors: Ma J , Zhang N , Xiao J.-Y , Wang J.-X , Li X.-W , Wang J , Zhang Y , Zheng Q.-X , Zhao S.-Y , Han P , Yang Y.-N , Gao M.-D , Zhang X , Liu Y , Gao J
Published: October 2021

Background

Patient delay in seeking help has been reported to be a major factor that related to delay in care of acute myocardial infarction (AMI). Lack the knowledge of symptoms may translate to behavioral deficiencies which lead up to failing to seek medical assistant at early stage of AMI.

Purpose

The aim of present study is to investigate the awareness of AMI symptoms and the emergency responses among community residents over 35 years old.

Methods

The sample was proportionally distributed by age according to the national census data. The sex ratio was 1:1. The sample size is calculated according to the significance level of 0.05, the allowable error of 0.1, and the estimated Excellent awareness level of 10%. The final sample size is adjusted to 4200, considering non-response rate of 20%. Multi-stage stratified random sampling was used. On the first stage, two districts each in urban and rural regions were randomly selected. On the second stage, 3–10 community health service centers were randomly selected in each district. On the third stage, residents over 35 managed by the community health service center were proportionally sampled to be interviewed. A structured questionnaire was used and the survey was conducted in a face-to-face interview by clinical physicians. Logistic regression was applied to analyze factors related to Good knowledge.

Results

The top three symptom recognized by public is “pain or discomfort in the chest” (71.3%), followed by “difficulty breathing” (65.1%) and “pain or discomfort in the jaw, neck, or back” (60.9%). 85.0% chose to call an ambulance as first response when witness others having an AMI. Those who lives alone (OR=1.408; 95% CI, 1.005–1.972) and whose immediate family had been diagnosed with AMI (OR=1.510; 95% CI, 1.040–2.192) has better knowledge. A significant positive correlation was observed for those with hypertension (OR=1.199; 95% CI, 1.007–1.429), while a negative correlation was observed for those with diabetes (OR=0.788; 95% CI, 0.626–0.992). Public education could improve Good knowledge (OR=1.662; 95% CI, 1.388–1.990), while doctoral advise has been shown negative impact (OR=0.824; 95% CI, 0.691–0.984).

Conclusions

Our data provide first population-based estimates of public awareness in our country. Further promotional strategies to increase overall awareness in general public are seriously needed.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Major Science and Technology Projects of Tianjin Science and Technology Commission Multivariable logistic regression
Cost-minimisation analysis of acute myocardial infarction rule-out in low-risk patients: primary care emergency setting versus hospital setting
Authors: Johannessen T R , Halvorsen S , Atar D , Wisloff T , Munkhaugen J , Nore A K , Vallersnes O M
Published: October 2021

Background

Hospital management of low-risk chest pain contributes to extensive use of healthcare resources and emergency department crowding. High efficacy rule-out, with subsequent reduction in costs and length of stay, has been demonstrated for the ESC 0/1-hour algorithm using high-sensitivity cardiac troponins (hs-cTn) in hospital cohorts.

Purpose

To estimate potential differences in healthcare costs by assessing patients with low risk for acute coronary syndromes (ACS) in a primary care emergency setting using the ESC 0/1-hour algorithm compared to routine management in a hospital setting.

Methods

This cost-minimisation analysis compared direct costs of applying the 0/1-hour algorithm in a low-risk primary care cohort to a low-risk chest pain cohort at a large general hospital in Norway. Data from the prospective OUT-ACS study (One-hoUr Troponin in a low-prevalence population of Acute Coronary Syndrome,[1] inclusion period 2016–2018) were used to calculate costs per patient at a primary care emergency clinic. For the hospital setting estimates, anonymous data were extracted for all low-risk chest pain patients treated at a large general hospital in 2018. Cost items include complete hospital costs per different diagnosis-related groups as defined in national assessments, as well as resource items required to use the algorithm in primary care, including personnel time and test- and treatment costs. Primary outcome was the difference in healthcare costs when assessing the low-risk cohort in a primary care setting compared to a hospital setting. The secondary outcome was the difference in length of stay.

Results

The costs of assessing the low-risk cohort at the primary care emergency clinic and the general hospital were estimated at €178 and €1480, respectively (Table 1). Thus, the estimated reduction in health care costs among patients assessable by the 0/1-hour algorithm outside of hospital was €1302 per patient, with a mean decrease in length of stay of 18.9 hours. Additional diagnostic procedures (e.g. stress ECG and echocardiogram) were performed in 31.9% (n=181/567) of the low-risk hospital cohort, which was part of the cost-driving estimate.

Conclusion

Assessment of patients considered as low-risk for ACS with the ESC 0/1-hour algorithm in a primary care emergency setting seems to decrease healthcare costs significantly, in addition to a reduction in both length of stay and potentially unnecessary hospitalisations.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Norwegian Research Fund for General PracticeThe Norwegian Committee on Research in General Practice
Association between social deprivation status, age of presentation, and survival following ST-segment elevation myocardial infarction
Authors: Laffan J , Hogg M , Devlin P , Mailey J , Montgomery J , Johnston N , Spence M , Walsh S
Published: October 2021

Introduction

Many factors influence age of presentation with and survival following ST-segment myocardial infarction (STEMI). These include age, mode of, and time-delay to emergency treatment, diabetes and smoking. We sought to assess whether overall social deprivation status is associated with age of presentation and mortality following STEMI patients treated with primary PCI.

Methods

All patients treated emergently for STEMI in a large Northern Irish tertiary hospital from 2013 – 2017 were reviewed. Social deprivation is determined as a composite score relating to income, crime etc, and assigned to small geographical regions by the Northern Ireland Statistics and Research Agency. Deprivation score was assigned to patients based on their postcode. The database was ranked by social deprivation score and divided in to quintiles. The most (Grp 1) and least (Grp 5) deprived quintiles were compared. Mortality was determined from a national electronic health record.

Results

1,192 patients were included in the analysis. Mean follow up was 52.5 months (SD 15.6), minimum follow up was 35.6 months. There was no difference in gender: 70.1% male in Grp 1 vs 75.2% male in Grp 5 (p=0.68); no difference in ECG to balloon time: mean 89.9mins (95% CI 84.9–94.9) Grp 1 vs 90.5mins (95% CI 86.2–94.9) Grp 5 (p=0.86). The more deprived group was younger: mean age 60.6 (95% CI 59.5–61.6) vs 65.2 (95% CI 64.2–66.3) (p<0.000). Crude survival measured by Log-rank test was the same between the groups (p=0.52). Following Cox-regression adjustment for age, survival was longer in the least deprived group (p=0.042).

Conclusion

Social deprivation is associated with both a younger age of presentation with, and a higher mortality following STEMI. This is important variable is often overlooked in medical literature and should be further studied.

Funding Acknowledgement

Type of funding sources: None.
The transcriptional landscape of the clustered protocadherins in the cardiovascular system
Authors: Zhu W , Chhibbar P , Lo C
Published: October 2021

Background

The alpha, beta and gamma clustered protocadherins (cPcdhs) genes encode homotypic cell adhesion molecules that are highly expressed in the brain. They are well described to be expressed in a combinatorial fashion to specify neuronal identity for coding synaptic connectivity. Unexpectedly, we recently uncovered evidence from studies in mice and human showing PCHDA variants can cause congenital heart defects. As all the genes of the alpha or gamma PCDH cluster share a common 3' end and are highly homologous, the expression of these gene clusters has been underestimated or overlooked due to multimapping issues. This is especially problematic in single cell RNAseq (scRNA) data generated using 3' based amplification protocols.

Methods and results

We constructed a modified bioinformatic pipeline for analyzing the cPcdhs transcripts (Fig. 1a). Raw data of Publicly available scRNA datasets were downloaded and re-processed and analyzed for expression of the cPCDH transcripts using our custom pipeline. Integrating 10 scRNA datasets of mouse heart tissues from embryonic 7.75 (E7.75) to postnatal 30 months (PM30) were performed by Harmony and Seurat. This showed Pcdhg had the highest expression among the three Pcdh gene clusters, with next being Pcdhb and then Pcdha (Fig. 1b). Pcdhb and Pcdhg were enriched in endocardial cells and fibroblasts (Fig. 1b). Unlike gene expression in neurons, expression of the cPcdhs in cardiac cell types did not shown the stochastic, sparse, combinatorial expression patterns seen in neurons (Fig. 1b). Despite the relatively low level of Pcdha expression in all cardiac cell types, it is intriguing that independent scRNA datasets showed Pcdha is expressed most highly in the atrium in the early embryo, possibly due to known atrial dominance in the early embryo (Fig. 1c). Pcdhb is highly expressed in the OFT and atrioventricular canal of both human and mouse heart, suggesting its perturbation may contribute to outflow tract or AV valve abnormalities (Fig. 1c-d). Consistent with our previous finding of an important role for the Pcdha gene cluster in left ventricular outflow obstructive (LVOTO) lesions, we observed expression of Pcdhg was broadly upregulated in the Adamts19 homozygous knockout mice exhibiting aortic valve dysfunction, a CHD phenotype in the LVOTO spectrum (Fig. 1e).

Conclusions

Using a new bioinformatics pipeline, we systematically mapped the transcriptional landscapes of cPcdhs during heart development using scRNA data. This revealed cell type-specific and anatomical characteristics in the expression of the different cPcdhs. These findings show the cPcdhs are transcriptionally regulated very differently in the cardiovascular system from regulation observed in the brain. The single cell transcriptional profile for the cPcdhs in the cardiovascular system can serve as the foundation for future investigations into the broader role of the cPcdhs in cardiovascular development and disease.

Funding Acknowledgement

Type of funding sources: None.
Pericardial adipose tissue-derived leptin promotes myocardial apoptosis in high fat diet-induced obese rats through JAK2/ROS/NKA signaling pathway
Authors: Wang P , Luo C H , Song Y , Cao L F , Luan H , Zheng S P , Zhu D J , Tian G
Published: October 2021

Background

Pathophysiologic mechanisms underlying cardiac structural and functional changes in obesity are complex and linked to adipocytokines released from pericardial adipose tissue (PAT) and cardiomyocyte apoptosis. Although leptin is involved in various pathological conditions, its role in paracrine action of pericardial adipose tissue on myocardial apoptosis remains unknown.

Purpose

This study was designed to investigate the role of PAT-derived leptin on myocardial apoptosis in high fat diet-induced obese rats.

Methods and results

Hearts were isolated from lean or high fat diet-induced obese Wistar rats for myocardial remodeling studies. Obese rats had abnormal myocardial structure, diastolic dysfunction, greatly elevated cardiac apoptosis and increased oxidative stress level. Enzyme-linked immunosorbent assay (ELISA) detected significantly higher than circulating leptin level in PAT of obese, but not lean rats. Western blot and immunohistochemical analyses demonstrated increased leptin receptor density in obese heart. H9c2 rat cardiomyoblasts after exposed to PAT-conditioned medium of obese rats exhibited pronounced reactive oxygen species (ROS)-mediated apoptosis, which was partially reversed by leptin antagonist. Moreover, leptin derived from PAT of obese rats inhibited Na+/K+-ATPase activity of H9c2 cells through stimulating ROS, thereby activating calcium-dependent apoptosis. Pretreatment with specific inhibitors revealed that JAK2/STAT3 and PI3K/Akt signaling pathways was involved in the leptin-induced myocardial apoptosis.

Conclusion

PAT-derived leptin induces myocardial apoptosis in high fat diet-induced obese rats via activating JAK2/STAT3/ROS signaling pathway and inhibiting its downstream Na+/K+-ATPase activity.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Nature Science Foundation of ChinaKey Projects of Shaanxi Science and Technology Research and Development Plan
Overexpression of genes involved in lymphocyte activation and regulation are associated with reduced CRM-derived cardiac remodelling after STEMI
Authors: De Dios E , Rios-Navarro C , Perez-Sole N , Gavara J , Marcos-Garces V , Forteza M F , Oltra R , Vila J M , Chorro F J , Bodi V
Published: October 2021

Aims

Lymphopenia after ST-segment elevation myocardial infarction (STEMI) correlates with deleterious cardiac consequences and worse prognosis. An in-depth examination of genes implicated in lymphocyte proliferation, activation and regulation and their association with short- and long-term cardiac structure and function is therefore of great interest.

Methods

Peripheral blood mononuclear cells were isolated from 10 control subjects and 64 patients with a first STEMI treated with primary percutaneous coronary intervention and submitted to cardiac magnetic resonance after 1 week and 6 months. mRNA expression of genes implicated in lymphocyte activation (CD25 and CD69) and regulation [programmed death (PD)-1 and cytotoxic T-lymphocyte antigen (CTLA)-4] were determined by qRT-PCR.

Results

In comparison to controls, STEMI patients showed heightened mRNA expression of CD25 and lower PD-1 and CTLA-4 96h after coronary reperfusion. Patients with extensive infarctions (>30% of left ventricular mass) at 1 week displayed a notable reduction in CD25, CD69, PD-1, and CTLA-4 expression (p<0.05). However, CD25 was the only predictor of 1-week extensive infarct size in multivariate logistic regression analysis (odds ratio 0.019; 95% confidence interval [0.001–0.505]; p=0.018). Regarding long-term ventricular function, mRNA expression of CD25 under the mean value was associated with worse ventricular function and more adverse remodelling.

Conclusions

Following STEMI, heightened expression of genes expressed in regulatory T cells (CD25 and CD69) and immune checkpoints (PD-1 and CTLA-4) correlates with a better short- and long-term cardiac structure and function. Advancing understanding of the pathophysiology of lymphopenia and evaluating novel immunomodulatory therapies will help translate these results into future clinical trials.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): “Instituto de Salud Carlos III” and “Fondos Europeos de Desarrollo Regional FEDER”
Meta-analysis assessing cardiovascular outcomes with febuxostat versus allopurinol for patients with gout
Authors: Patoulias D , Boulmpou A , Tranidou A , Nikolaidis A , Papadopoulos C E , Vassilikos V , Bakatselos S , Damianidis G , Doumas M
Published: October 2021

Background

Gout, the most common inflammatory arthritis in the USA, represents an established risk factor for cardiovascular disease and coronary artery disease mortality. In addition, patients with gout experience an increased risk for non-fatal myocardial infarction, while they might also feature increased risk for stroke. Recent real-world data also highlight the association between gout and atrial fibrillation, which inevitably augments cardiovascular burden. Allopurinol, a xanthine oxidase inhibitor, remains the uric acid-lowering treatment option of first choice, while febuxostat is prescribed, when allopurinol is contraindicated or not tolerated. Unfortunately, medication adherence among gout patients is poor, associated with age and related co-morbidities.

Purpose

We sought to determine the comparative efficacy of febuxostat versus allopurinol across surrogate cardiovascular outcomes of interest, by pooling data from the 2 dedicated cardiovascular outcome trials available so far. The motive for this analysis was the U.S. Food and Drug Administration (FDA) warning raised after the publication of the CARES trial, regarding the increased risk for cardiovascular and all-cause death with febuxostat compared to allopurinol.

Methods

We pooled data from the 2 dedicated cardiovascular outcome trials (CARES and FAST) and we assessed the following cardiovascular outcomes of interest: cardiovascular death, all-cause death, non-fatal myocardial infarction (MI), non-fatal stroke, fatal MI, fatal stroke, transient ischemic attack, hospitalization for heart failure, coronary revascularization, cerebrovascular revascularization and atrial fibrillation. Risk of bias was low across the included studies.

Results

Our analysis in a total of 12,318 patients with gout showed that febuxostat compared to allopurinol treatment does not confer significant risk reduction for any of the assessed, prespecified surrogate outcomes in a study population with significant cardiovascular co-morbidities (Figure 1). One third of patients enrolled in the FAST trial and 40% of the patients enrolled in the CARES trial had pre-existing cardiovascular disease, as depicted in Figure 2. Heterogeneity was low for the vast majority of the assessed outcomes, except for cardiovascular and all-cause death and fatal MI.

Conclusions

There is no significant difference across surrogate cardiovascular outcomes of interest between febuxostat and allopurinol in patients with gout and cardiovascular co-morbidities. Febuxostat seems to be a safe treatment alternative to allopurinol, despite initial concerns in terms of its cardiovascular safety.

Funding Acknowledgement

Type of funding sources: None. Figure 1Figure 2
Inequalities in non-communicable diseases across the European Union: current state and trends from 2000 to 2019
Authors: Peñalvo JL , Mertens E , Devleeschauwer B , Grad DA , Hrzic R , Bikbov B , Abbafati C , Balaj M , Cuschieri S , Eikemo TA , Fischer F , Ghith N , Haagsma JA , Ngwa CH , Noguer-Zambrano I , O’Caoimh R , Paalanen L , Padron-Monedero A , Pallari E , Sarmiento Suárez R , Sulo G , Tecirli G , Vasco Santos J
Published: October 2021

Background

Non-communicable diseases (NCDs) remain the leading cause of disease burden in the European Union (EU). However, this burden varies across Member States, driven by the socioeconomic and demographic structure of the populations, as well as health care and social support systems in each country. This geographical gradient in the burden of NCDs represents health inequalities that may have expanded as a result of population ageing, migration, and economic crisis, and historic backgrounds.

Methods

Using data from the GBD 2019 study, we quantify the inequality gap between EU countries, characterize the geographical gradient of total and individual NCDs, and analyze the trends over the last 20 years.

Results

A considerable gap exists in the rates of NCD-related DALYs between the country with the lowest burden (Slovenia in 2019) and the highest (Bulgaria in 2019), with a constant (p-trend > 0.05) ratio of 1.6 (95%CI, 1.57; 1.64) since the year 2000. The largest inequality was observed for the burden of stroke between the lowest (France in 2019) and the highest (Bulgaria in 2019) with a ratio of 7.47 (6.78; 8.24) Increasing steadily (p-trend < 0.001) since 2000. Using the relative index of inequality to characterize the gradient of inequalities across the EU, a decreasing trend (p < 0.001) can be observed for NCD-related DALYs rates from 1.56 (1.44; 1.7) in 2000 to in 1.42 (1.33; 1.52) 2019.

Conclusions

Despite overall improvements in health, spatial disparities related to NCDs in the EU persist. Our estimates provide a baseline to inform future equitable health policies.
Multi-centric assessment of COVID-19 immunization access and demand among undocumented migrants
Authors: Genovese E , Fiorini G , Corrao G , Page K , Cailhol J , Franchi M , Tlili R , Cella SG , Jackson Y L
Published: October 2021

Background

Marginalization of undocumented migrants raises concerns about equitable access to COVID-19 immunization. This study describes their self-perceived accessibility of and demand for COVID-19 immunization.

Methods

A multi-centric cross-sectional survey was conducted in 4 health facilities providing care to undocumented immigrants in the USA, Switzerland, Italy, and France in February-April 2021. A convenience sample of minimum 100 patients per study site was recruited. Data was collected using an anonymous structured questionnaire including demographic variables, health status, and drivers/barriers for COVID-19 immunization. Descriptive statistics were used to characterize the primary and secondary outcomes: self-perceived accessibility of and demand for COVID-19 immunization.

Results

812 migrants completed the survey (54.3% Geneva, 17.5% Baltimore, 15.5% Milan, and 12.7% Paris). 60.9% were women, the median age was 40 years old (range 17-76), and 19 nationalities were represented: 55.9% Latin America, 12.7% Africa, 11.2% Western Pacific, 7.9% Eastern Mediterranean, 7.6% Europe, 4.7% Asia. Among participants, 14.1% and 26.2% reported prior COVID-19 infection and fear of developing severe COVID-19, respectively. Underlying co-morbidities were common (29.5%). Self-perceived accessibility of COVID-19 immunization was high (86.4%), yet demand was low (41.1%) correlating with age, co-morbidity, and views on immunization which were better for immunization in general (77.3%) than immunization against COVID-19 (56.5%). Hesitancy was mostly due to fear of adverse reactions (39.2%).

Conclusions

In this multi-centric study, undocumented migrants generally believed they would access local COVID-19 immunization programs. Yet, despite positive views about immunization in general, they reported limited confidence in COVID-19 immunization and willingness to be immunized.

Key messages

Self-perceived accessibility of COVID-19 immunization is high, yet demand is limited. COVID-19 immunization campaigns may engage communities and leverage confidence in immunization in general to address concerns about COVID-19 immunization.
Prevalence of SARS-CoV-2 and associated risk factors among asylum seekers living in centres
Authors: Morisod K , Grazioli V , Schlüter V , Bochud M , Gonseth Nusslé S , D'Acremont V , Felappi A , Bühler N , Bodenmann P
Published: October 2021

Background

Understanding the factors influencing SARS-CoV-2 transmission in asylum seekers and refugees living in centres is crucial to determine targeted public health policies protecting these populations. We explored the pandemic's spread into asylum centres during the first wave of the pandemic (May-June 2020) in Switzerland and factors associated with the presence of SARS-CoV-2 antibodies.

Methods

This research is part of SérocoVID, a seroepidemiologic study of SARS-CoV-2 infection conducted in Canton of Vaud, Switzerland. All migrants living in two asylum centres were invited to participate. Anti-Spike IgG and IgA antibodies were measured in all participants. Each participant completed a questionnaire measuring socio-demographic characteristics, medical history, health literacy, public health recommendations, behaviours and exposures. The association of independent variables with serologic test result were estimated using a multivariable logistic regression model.

Results

The mean (SD) age of the 124 participants (23% women) was 33.7 (11.6) years (Centre 1, n = 82; Centre 2, n = 42). The mean participation rate was 37%. The seroprevalence in Centres 1 and 2 were 13% [95% CI 3-14%] and 50 [34-65%], respectively. Next, 41% of SARS-CoV-2 positive people never developed symptoms, and no one had developed severe Covid-19 disease. After adjusting for individual characteristics and centre, seropositivity was higher among people with low health literacy (aOR 6.2, p = 0.010 [1.6, 24.8]) and non-smokers (aOR 5.4, p = 0.013 [1.4- 20.3]). No other significant associations were found.

Conclusions

Findings suggest that developing targeted public health measures, especially for low health literacy people, would be necessary to limit the risk of outbreaks in asylum centres and improve this population's safety. Further investigations are required to understand better the negative association between tobacco consumption and SARS-CoV-2 infection.

Key messages

Asylum centres require specific public health measures to guarantee their population's safety and limit the virus spread. Asylum seekers and refugees with low health literacy seem particularly vulnerable during the Covid-19 pandemic.
Prospective association between dietary pesticide exposure profiles and Type 2 Diabetes risk
Authors: Rebouillat P , Vidal R , Taupier-Letage B , Debrauwer L , Gamet-Payrastre L , Touvier M , Fézeu LK , Lairon D , Baudry J , Kesse-Guyot E
Published: October 2021

Background

Many modifiable risk factors have been identified for type 2 diabetes. However, emerging risk factors such as food contaminants could also play a role and studies are lacking on the subject. We aimed to assess the prospective associations between dietary pesticide exposure profiles and Type 2 Diabetes (T2D) risk among NutriNet-Santé cohort participants.

Methods

In 2014, participants completed a Food Frequency Questionnaire, assessing conventional and organic food consumption. Exposures to 25 active substances were estimated using a residue database accounting for farming practices from Chemisches und Veterinäruntersuchungsamt Stuttgart, Germany. Exposure profiles were established using Non-Negative Matrix Factorization (NMF), adapted for sparse data. Cox models adjusted for confounding factors were used to estimate hazard ratios (HR) and 95% confidence interval (95% CI), for the association between the four obtained NMF components and T2D risk.

Results

The sample comprised 33,013 participants aged 53 years old on average, among which 76% of women. During follow-up (median: 5.95 years), 340 incident T2D cases were diagnosed. Positive associations were detected between NMF component 1 (reflecting high exposure to azoxystrobin, chlorpyriphos, imazalil, malathion, profenofos, thiabendazole) and T2D risk: HRQ5 vs Q1=1.47, 95% CI(1.00, 2.18). NMF Component 3 (reflecting low exposure to several synthetic pesticides) was associated with a decrease in T2D risk, among those with high dietary quality only (high adherence to French dietary guidelines): HRQ5vsQ1=0.31, 95%CI(0.10, 0.94). No associations were found for NMF Components 2 and 4.

Conclusions

These associations between some pesticide mixtures and T2D diabetes risk need to be confirmed in other types of studies and settings. These results could have important implications for developing prevention strategies, through regulations or dietary guidelines.

Key messages

Specific pesticide mixtures could play a role in increased type 2 Diabetes risk. Organic eaters were less exposed to most synthetic pesticides.
Prevalence of Major Depressive Episode in 27 European Countries
Authors: Arias de la Torre J , Ronaldson A , Vilagut G , Peters M , Valderas JM , Serrano-Blanco A , Martín V , Dregan A , Alonso J
Published: October 2021

Background

Information about the prevalence of current Major Depressive Episode (MDE) across European countries is essential for its monitoring and for the development of evidence- based mental health policies. The aims were to: 1) estimate the prevalence of MDE by country in Europe; and 2) assess variations in prevalence between countries.

Methods

Data from participants of 27 countries that completed the questionnaire of the second wave of the European Health Interview Survey (EHIS-2) were analysed (n = 258,888). The prevalence of MDE was quantified using the Patient Health Questionnaire-8 (PHQ-8) with a cut-off score of ≥ 10. Prevalence and 95% Confidence Intervals (CI) were estimated for each country. Variation in prevalence (country vs the rest) was evaluated using bivariable and multivariable negative binomial regression models considering the specific country as the main explanatory variable. From these models, crude Prevalence Ratios (PR) and adjusted Prevalence Ratios (aPR) were obtained.

Results

The overall prevalence of current MDE in Europe was 6.38% (6.24%-6.52%). The country with the lowest prevalence was the Czech Republic (2.58%, 2.14%-3.02%) and the country with highest prevalence Iceland (10.33%, 9.33%-11.32%). In all the countries (except for Finland and Croatia) prevalence was higher in women than in men. The countries with the highest aPR were Germany (aPR: 1.80, 95% CI: 1.71-1.89) and Luxembourg (aPR: 1.50, 95% CI: 1.35-1.66), while Slovakia (aPR: 0.28, 95% CI: 0.24-0.33) and the Czech Republic (aPR: 0.32, 95% CI: 0.27-0.38) exhibited the lowest aPR.

Conclusions

Considerable variability in the prevalence of MDE by country in Europe was observed without a clear pattern. These results serve as baseline for monitoring the prevalence of MDE at a European level and suggest a need for developing preventive strategies against depression, particularly in those countries identified with the highest prevalence.

Key messages

The results of this study show that the overall prevalence of MDE is high (6.38%), with important variation across countries (ranging from 2.58% in the Czech Republic to 10.33% in Iceland). The results found could serve as a reference for the monitoring of MDE in Europe and for the development of screening and preventive strategies both at European level as well as at a country level.
Knowledge, perceptions and attitudes of university students regarding COVID-19, Cyprus
Authors: Middleton N , Tsioutis C , Kolokotroni O , Heraclides A , Nobelos PT , Mamais I , Pantelidou M , Christaki I , Nikolopoulos G , Dietis N
Published: October 2021

Background

University students represent an active group with important implications in the novel coronavirus transmission. Elucidating their knowledge, attitudes and perceptions was important for customizing communication material and other information activities.

Methods

The cross-sectional online INTERACT survey targeted students in conventional programs in the five main Universities in the Cyprus Republic between 17-31 March 2020, a week either side of the first national lockdown (24 March).

Results

A total of 3641 students completed the survey (19% response rate): 65.5% female, 80.9% Bachelor, 41% Health/Life sciences. Amongst participants, 68.8% and 20.6% responded correctly to at least six and eight of 10 knowledge-related questions. Objective knowledge did not vary substantially according to self-evaluation of knowledge. Misconceptions were identified in 25-30%. Only 29.1% expressed positive attitude towards a hypothetical person with COVID-19 without also projecting judgement or blame. Odds of expressing positive attitude increased by 18% (95%CI 13-24%) per unit increase in knowledge. Studying at postgraduate level was predictive of better knowledge (OR of ≥score8 1.81; 95%CI 1.34-2.46) and positive attitude (OR 1.35; 95%CI 1.01-1.80). With average knowledge score 6.4 (SD 1.6) vs 6.1 (SD 1.6), Health/Life Sciences students performed marginally better, but were not any more likely to express positive attitude.

Conclusions

Although Cypriot University students appeared relatively knowledgeable, there were specific gaps and misconceptions, some of which may be attributed to changes in information provided to the public. Attitudes should also be interpreted in the local context where reporting, though seemingly neutral, was not characterised by empathy towards people affected. Findings highlight the importance of continuous and good communication, especially as guidance changes, both in terms of content as well as effect.

Key messages

Misconceptions and negative attitudes related to COVID19 were identified among Cypriot University students, including those in Health Sciences. Good quality communication is important both in terms of content as well as its effect on shaping attitudes.
A self-help app for Syrian refugees with posttraumatic stress (Sanadak): results of a randomized controlled trial
Authors: Roehr S , Jung FU , Pabst A , Grochtdreis T , Nagl M , Renner A , Hoffmann R , Koenig H-H , Kersting A , Riedel-Heller S G
Published: October 2021

Background

Syrian refugees often develop posttraumatic stress as a result of the Syrian civil war and migration stressors. However, there is a lack of adequate treatments. The smartphone app Sanadak was developed and evaluated to provide cognitive behavioral therapy-based self-help in the Arabic language for Syrian refugees with posttraumatic stress.

Methods

In a randomized controlled trial, eligible individuals were allocated to the intervention group (IG; app) or control group (CG; psychoeducational reading material). Data were collected during structured face-to-face interviews at 3 assessments (preintervention/baseline, postintervention/after 4 weeks, follow-up/after 4 months). Using adjusted mixed-effects models, changes in posttraumatic stress and secondary outcomes were investigated as intention-to-treat (ITT) and per-protocol (PP) analysis.

Results

Of 170 screened individuals (aged 18-65 years), 133 were eligible and randomized to the IG (n = 65) or CG (n = 68). Although there was a pre-post reduction in posttraumatic stress, ITT showed no significant differences between IG and CG after 4 weeks (Posttraumatic Diagnostic Scale for DSM-5, Diff -0.90, 95%CI -0.24 to 0.47; P=.52) and after 4 months (Diff -0.39, 95%CI -3.24 to 2.46; P=.79). The same was true for PP. Regarding secondary outcomes, ITT indicated a treatment effect for self-stigma after 4 weeks (Self-Stigma of Mental Illness Scale/SSMIS-stereotype agreement: d = 0.86, 95%CI 0.46 to 1.25; stereotype application: d = 0.60, 95%CI 0.22 to 0.99) and after 4 months (d = 0.52, 95%CI 0.12 to 0.92; d = 0.50, 95%CI 0.10 to 0.90).

Conclusions

Sanadak reduced mild to moderate posttraumatic stress in Syrian refugees, but not superior to the control condition. Therefore, Sanadak may not be suitable as a standalone treatment. However, as the app usability was very good, no harms detected, and stigma significantly reduced, Sanadak has potential as a bridging aid within a stepped and collaborative care approach.
Impact of COVID-19 epidemic on Lombardy’s prisons (Italy): transmission and measure of prevention
Authors: Mazzilli S , Giuliani R , Arzilli G , Cairone C , Sebastiani T , Scardina G , Cocca G , Tavoschi L , Ranieri R
Published: October 2021

Background

Early on in the COVID-19 pandemic, scientific community highlighted the potential risk of epidemics occurring inside prisons. Consequently, specific operational guidelines were promptly released and stringent containment measures quickly implemented, including access restriction to essential staff only. During the 2nd epidemic wave prevention strategies were gradually relaxed, visitors were readmitted and people in prison (PiP) activities were repristinated. Here, we describe the spread of COVID-19 in 18 detention facilities in Lombardy region, Italy, during the 1st(Mar-Jul 2020) and 2nd(Oct 2020-Feb 2021) waves and the impact of prevention and control measures implemented in prison.

Methods

We conducted a descriptive retrospective analysis of cases' distribution. Moreover, a comparison among the epidemic burden affecting POs and PiP and a correlation analysis between the number of cases occurred and prevention measures implemented were carried out.

Results

Our population consists of a monthly average of 2269 prison officers (POs) and 7604 PiP. POs were at higher risk of contracting COVID-19 during both waves. Occurrence of cases among PiP was temporally associated with cases among POs. There was heterogeneity in the size of outbreaks across different prison facilities. During the second wave, COVID-19 spread more widely in prison both among POs (2ndwave attack rate (AR) per 1000 individuals: 27.2; monthly range (MR): 0.9-64.5 vs 1stwave AR 2.4; MR: 0.0-12.1) and PiP (2ndwave AR: 23.5; MR: 11.6-50.8 vs 1stwave AR 1.6; MR: 0-5.2).

Conclusions

Prevention and control measures adopted timely during the first wave were effective to limit Sars-CoV-2 spread within prison facilities. According to our findings, POs and PiP are population groups at high risk for acquiring and transmitting COVID-19 and should be prioritized for testing, active case finding and vaccination. This study highlights the importance of including prison settings within emergency preparedness plans.

Key messages

Stringent prevention and control measures when adopted timely were effective to protect detention facilities from Sars-CoV-2 spread. Our study, reporting the burden of COVID-19 epidemic experienced by prison of Lombardy, Italy, highlights the importance of including prison settings within emergency preparedness plans.
Preliminary assessment of COVID-19 serological situation in a high-risk cohort
Authors: Cornio AR , Bordino V , Meddis D , Garlasco J , Marengo N , Vicentini C , Di Tommaso S , Giacomuzzi M , Memoli G , Zotti CM
Published: October 2021

Introduction

Studies on the duration of immune response in subjects with COVID-19 could facilitate understanding of how immunity develops and persists during the natural course of infection, as well as providing epidemiological information useful in public health decisions on the use of vaccines. The study aims to analyse antibody response in a cohort of subjects with high-risk of exposure to SARS-CoV-2 due to the long-term care facility environment.

Methods

We recruited 657 subjects between guests and healthcare workers from Piedmontese nursing homes. IgG directed against the S1 domain of SARS-CoV-2 spike protein were assayed on serum. We used EUROIMMUN kit, which exploits ELISA method. Reference values are (RU/mL): positive ≥ 11; borderline 8 ≤ value < 11; negative < 8.

Results

Among the 657 subjects, we examined 494 health workers and 163 guests. The average age was 56.2. In relation to COVID-19, 402 subjects had a previous infection, 255 had not. About serology: positive 369; negative 261; borderline 27. The mean of the IgG values was 35.68 RU/mL. Swabs/serology: 77.36% with previous infection were positive to serology, 18.66% negative; of all subjects who were always negative to swabs, 72.94% were negative, 22.74% positive. Moreover, the mean time elapsed from positive swab to serology test was 144.08 days.

Conclusions

Preliminary results show that the antibody response is present and persistent in the study population, even a long time after the infection. According to literature, antibody persistence has great variability in our population, as no statistically significant correlations were found between antibody titer and other variables such as time elapsed since infection. The examined sample, belonging to high-risk category (long-term care facilities), is most likely to present repeated exposure to SARS-CoV-2, highlighted by the seropositivity of never infected subjects. These findings might help policy makers better address resources regarding vaccines.

Key messages

Antibody response is present and persistent in the study population, even a long time after the infection. Antibody persistence has great variability in our population, as no statistically significant correlations were found between antibody titer and other variables such as time elapsed since infection.