bluuebunny/crossref_metadata_2025 huggingface dataset:
Gene-echocardiography: refining genotype-phenotype correlations in cardiomyopathy patients with restrictive phenotype
Authors: Zhou N
Published: October 2024

Background

The restrictive phenotype, the least frequent and genetically complex form of cardiomyopathy, is the focus of this investigation. The aim is to clarify the association between restrictive phenotype and genetic variants in cardiomyopathy patient.

Methods

We utilized whole-exome sequencing in a cohort of 568 cardiomyopathy patients and performed echocardiographic evaluations to identify restrictive phenotypes. Comprehensive analysis of cardiac characteristics and functionality was also undertaken.

Results

Among the cohort, 33 patients exhibited a restrictive phenotype. These patients were distributed as follows: 7 within the restrictive cardiomyopathy group (RCM), 20 in the hypertrophic cardiomyopathy group (HRCM), and 6 in the dilated cardiomyopathy group (HDRCM). A notable prevalence of gene mutations, mainly in the MYBPC3 gene, was found in these individuals. We observed that mutation carriers, characterized by smaller aortic sinus dimension, demonstrated an association with the mutation and diminished myocardial work. Furthermore, MYBPC3 mutation carriers showed a thicker ventricular wall and a higher predisposition for septal hypertrophy. Both HRCM and HDRCM groups displayed consistent hypertrophic manifestations, with the latter demonstrating a higher frequency of interventricular septal hypertrophy. The 5-year survival rate was calculated at 54.5%, with gene mutations not significantly affecting longevity.

Conclusion

Genetic factors profoundly influence the restrictive phenotype of cardiomyopathy. There is a strong link between restrictive phenotype and genetic variants in cardiomyopathy, providing a foundation for more accurate genetic testing and personalized management of patients. The emerging "gene-echocardiography" concept may refine the accuracy and productivity of genetic counseling and testing in cardiomyopathy.
A flexible, calibrated transformer-based risk model for prediction of clinical outcomes in patients with heart failure; an open cohort study using linked UK EHR
Authors: Rao S , Salimi-Khorshidi G , Rahimi K
Published: October 2024

Background

Numerous risk scores, both uni- and multi-variable, have been developed to conduct prognostication for a range of clinical outcomes in heart failure (HF) patients [1,2]. However, these models provide only modest discrimination and often depend on complex test data (e.g., ejection fraction) collected outside of routine clinical care [2]. Furthermore, transparency in reporting of key individual-level metrics (e.g., precision, recall) is notably lacking.

Purpose

We developed and validated a novel deep learning model, the second version of the Transformer-based Risk assessment survival model (TRisk2), for 36-month prediction of all-cause mortality, cardiovascular-related mortality, fatal and non-fatal cardiovascular events, and renal outcomes in patients with HF using routine, linked UK electronic health records (EHR) data.

Methods

An open cohort of 405 thousand patients with HF between 40 and 90 years of age was identified using linked EHR from 1,063 and 355 English general practices, which were used for TRisk2 model development and external validation, respectively. Comparison was conducted against MAGGIC [2], modified for use on routine linked EHR. Additional analyses compared discriminatory performance in other age groups, by sex, and by baseline disease. All analyses were repeated for prediction of cardiovascular-related mortality, fatal and non-fatal cardiovascular events, and renal outcomes.

Results

TRisk2 demonstrated superior discrimination with Concordance index (C-index) of 0.828; 95% confidence interval (CI): 0.824 to 0.832 for all-cause mortality prediction outperforming MAGGIC. The proposed model’s performance was found to be stable across stratified analyses by sex, age, and baseline disease status. Both models were overall well-calibrated, and TRisk2 demonstrated greater net benefit than MAGGIC across reasonable decision boundaries in decision curve analyses. At exemplar risk threshold of 50% for 36-month prediction, TRisk2 outperformed MAGGIC by 0.08 for both, precision and recall and identified 10% more events. At the same threshold for 12-month prediction, TRisk2 outperformed MAGGIC by 0.14 and 0.26 precision and recall respectively and captured 70% more events. The well-calibrated TRisk2 similarly outperformed MAGGIC in prediction of cardiovascular-related mortality, fatal and non-fatal cardiovascular events, and renal outcomes.

Conclusion

Utilising solely routine EHR from primary and secondary care, TRisk2 enabled more accurate prediction than MAGGIC with 10-20% gain in C-index across the four outcome investigations. Integration of TRisk2 into routine clinical care could simultaneously eliminate the reliance of complex tests and improve prognostication of key clinical outcomes, thereby refining management of HF.Models' discrimination on four outcomes
Risk factors of all-cause mortality in heart failure with mildly reduced ejection fraction patients with different post-discharge left ventricular ejection fraction variation patterns
Authors: Zhu Y L , Peng X , Liu Z C , Huang H B , Wu M X , Zhang L L , Liao M , Zhao W J , He W F , Tan D , Zeng J P
Published: October 2024

Background

The identification of risk factors for all-cause mortality in patients diagnosed with heart failure with mildly reduced ejection fraction (HFmrEF) and exhibiting varying post-discharge left ventricular ejection fraction (LVEF) patterns remains incomplete. This study aimed to determine the independent risk factors of all-cause mortality among HFmrEF patients with different LVEF variation patterns post-discharge.

Methods

This retrospective study analyzed data from 807 HFmrEF patients admitted to our hospital between January 2015 and August 2020. Patients were categorized into three groups based on LVEF variation patterns within 6 months to one year post-discharge: Group A (transitioning to heart failure with reduced ejection fraction [HFrEF], n=225), Group B (remaining as HFmrEF, n=335), and Group C (reverting to heart failure with preserved ejection fraction [HFpEF], n=227). Patients were followed up for a mean of 33 months, with all-cause mortality as the primary endpoint. Multivariate Cox regression analysis was conducted to identify independent risk factors for all-cause mortality in each group.

Results

The mortality rates for Groups A, B, and C were 43.11%, 23.94%, and 24.67%, respectively (P<0.001). Independent risk factors for all-cause mortality in Group A included age (HR=1.04, P=0.007), obesity (HR=1.76, P=0.040), higher creatinine (>100 µmol/L, HR=1.83, P=0.029), higher E/e’ (HR=1.06, P=0.001), absence of PCI (HR=0.51, P=0.019), and non-use of ACEI/ARB (HR=0.039, P=0.006). In Group B, independent risk factors for all-cause mortality were age (HR=1.06, P<0.001), higher NT-proBNP (>2505 pg/ml, HR=2.50, P=0.002), and absence of PCI (HR=0.040, P=0.005). Group C exhibited age (HR=1.04, P=0.002), pleural effusion (HR=2.38, P=0.007), higher creatinine (>100 µmol/L, HR=2.84, P<0.001), and non-use of ACEI/ARB (HR=0.42, P=0.021) as significant independent risk factors associated with increased all-cause mortality risk.

Conclusion

This study highlights distinct risk factors associated with all-cause mortality in HFmrEF patients exhibiting different post-discharge LVEF variation patterns. Age emerged as a consistent risk factor across all groups, underscoring the importance of age-related considerations in managing HFmrEF patients. Additionally, factors such as obesity, renal function, echocardiographic parameters, and medication adherence played varying roles in influencing mortality risk depending on the evolution of LVEF following discharge. These findings emphasize the need for personalized risk stratification and tailored management strategies for HFmrEF patients to improve outcomes and reduce mortality rates.
Prognostic impact of symptom relief under low and normal physical performance in patients hospitalized for worsening heart failure
Authors: Yamada Y , Konishi M , Kagiyama N , Kasai T , Kamiya K , Saito H , Saito K , Maekawa E , Kitai T , Iwata K , Jujo K , Wada H , Momomura S , Hibi K , Matsue Y
Published: October 2024

Background

Subjective symptoms, represented by the New York Heart Association (NYHA) class, are well-established prognostic indicators and treatment goals of heart failure (HF). However, older patients may be less likely to develop subjective symptoms due to an impaired physical performance.

Purpose

To evaluate the prognostic impact of symptom relief under low and normal physical performance in patients hospitalized for worsening HF.

Methods

We carried out a sub-analysis of FRAGILE-HF, a prospective multicenter study, including 1272 consecutive older (>=65 years) hospitalized patients with HF (median age 80; 57.2% male; left ventricular ejection fraction 46±17%). NYHA class and gait speed were documented before discharge. The patients were prospectively followed-up for two years after discharge.

Results

At the time of discharge, 715 patients (56%) remained symptomatic (NYHA2-4) whereas 557 patients (44%) were asymptomatic (NYHA1). Patients were classified into 4 groups according to symptom relief and physical performance represented by slow (<0.8 m/s) or normal (>=0.8 m/s) gait speed: 279 slow-asymptomatic, 278 normal-asymptomatic, 402 slow-symptomatic, and 313 normal-symptomatic patients, respectively. During the follow-up period, 266 patients (20.9%) died. Slow-asymptomatic (hazard ratio (HR) 1.72[1.09-2.72], p=0.019 in comparison with normal-asymptomatic patients as a reference) and slow-symptomatic (HR 1.85[1.21-2.82], p=0.004) status was associated with high mortality in a Cox regression analysis adjusted for the Meta-analysis Global Group in Chronic Heart Failure score and B-type natriuretic peptide level (Figure). Furthermore, the combined endpoint of HF rehospitalization and all-cause death within 90 days were more frequently observed in slow-asymptomatic (HR 1.94[1.05-3.60], p=0.034), normal-symptomatic (HR 1.89[1.06-3.36], p=0.031), and slow-symptomatic (HR 1.97[1.10-3.52], p=0.022) patients than normal-asymptomatic patients (Figure).

Conclusions

Symptom relief achieved at the time of discharge was not associated with a lower mortality in patients with low physical performance, for whom careful follow-up may be needed especially in the early period after discharge because the symptoms may be masked due to low physical performance.
Temporal trends in treatment patterns, morbidity, and mortality in patients with new-onset heart failure compared to heart failure survivors: a nationwide 23-year perspective
Authors: Boysen E , Koeber L , Kjoebek Lamberts M , Godsk Joergensen P , Ditlev Tuxen C , Wolsk E , Ersboell M , Barasa A , Rauhe Mouridsen M , Kiilerich Lauridsen T , Dridi N , Petersen M , Thune J J , Schou M , Elmegaard Malik M
Published: October 2024

Background

New therapy options have improved the prognosis of heart failure (HF) over recent decades. However, temporal trends in the prognosis and treatment disparities between patients with new-onset HF and HF survivors remain unexplored.

Purpose

To investigate temporal trends in HF treatment patterns, worsening HF and all-cause mortality, in new-onset HF patients compared to HF survivors.

Methods

We defined two separate cohorts of patients with HF, using the Danish nationwide registers. One cohort comprised all patients with new-onset HF each year from 1996 to 2018, included at the date of HF diagnosis (new-onset HF patients). The second cohort comprised patients with HF who have survived at least three years since being diagnosed with HF, included on January 1st of each year from 1996 to 2018 (HF survivors). Patients were allowed to contribute in both cohorts. The proportion of patients in guideline recommended therapy and the absolute five-year risk of worsening HF and all-cause mortality were assessed in the two cohorts separately, accounting for competing risks where relevant.

Results

From 1996 to 2018, the proportion of HF survivors tripled, while the number of yearly new-onset HF patients remained constant (figure 1). The proportion of new-onset HF patients who redeemed a prescription of BB increased from 17.1% in 1996 to 78.2% in 2018, while it increased from 15.9% to 69.4% in HF survivors during the same period. The proportion of patients in ACEi/ARB therapy increased from 49.1% to 81.5% in the new-onset HF patients, while it increased from 37.8% to 69.0% in HF survivors. The proportion of patients in MRA therapy increased from 14.4 to 33.0% in those with new-onset HF, and from 19.1% to 24.8% in HF survivors. The absolute risk (AR)[±95CI] for all-cause mortality decreased from 68.4% [67.9-68.9] in the first year group (1996-2000) to 45.7% [45.0-46.3] in the latest year group (2013-2018) for new-onset HF patients, while it decreased from 58.4% [58.2-58.9] to 39.7% [39.4-40.0] for the HF survivors. Additionally, the AR for worsening HF went from 27.4% [26.9-27.8] in the first year group to 27.8% [27.3-28.2] in the latest year group for the new-onset HF patients, whereas it for the HF survivors decreased from 19.6% [19.3-20.0] to 16.7% [16.4-19.9].

Conclusions

Over a 23-year period, the annual number of patients with incident HF has remained constant while the number of HF survivors has increased by 304%. Although HF survivors show a lower prescription redemption prevalence for essential HF medications compared to incident HF patients, they exhibit significantly lower risk of all-cause mortality and worsening HF.Figure 1:OverviewFigure 2:Prescription redememption rates
Survival in patients with chronic congestive heart failure and correlation of presence of risk factors and all-cause mortality
Authors: Hartmann C , Albrecht R , Westphal J G , Schulze P C
Published: October 2024

Background

Right heart function is known to be an independent risk factor for early mortality in patients with acute and chronic heart failure (HF). The prognostic value of cardiopulmonary exercise testing (CPET) is established for risk stratification in patients with Heart Failure. Further, markers of inflammation may predict clinical outcomes.

Purpose

We performed a single-center retrospective analysis of a large single center cohort and assessed all-cause mortality. A simple score including presence of RVD, systemic inflammation and reduced O2 uptake was applied to all patients and a subgroup survival analysis was performed.

Methods

A total of 612 patients with HF across the whole spectrum of left ventricular ejection fraction (LVEF) were analyzed. We stratified patients according to RV function, peak relative oxygen consumption in ml/min/kg (VO2max) and CRP levels. Patients were classified as RV Dysfunction when a right ventricular dilation (RVEDD > 40 mm or RVOT > 30 MM) or decreased tricuspid annular systolic excursion (TAPSE < 17 mm) was seen in the echocardiography. All patients were followed up by phone or by hospital records if available. The primary end-point of all-cause mortality was assessed.

Results

For the primary analysis, 612 patients (mean age 59.8 ± 13.8 years, 71.41% male) were included. According to LVEF 248 (40.5%) patients had preserved LVEF (HFpEF), 82 (13.0%) had mid-range LVEF (HFmrEF) and 282 (46.0%) had reduced LVEF (HFrEF). HF etiology was in 27% ischemic. Mean BNP values were 514.1 ± 827.1 pg/l. Mean VO2max 15,9 ± 5,9 ml/min per kg. Patients were followed up for a median of 4.0 years (IQR: 3.4 - 4.9 years). Over this period, the primary end-point occurred in 17.6% of patients. 135 (22%) of patients had evidence of RV dysfunction, 26% had increased CRP-levels and 256 (41.8%) had a VO2max < 14 ml/min per kg. Patients with elevated CRP, VO2max < 14 ml/min/kg and RV-dysfunction showed worse survival according to the Kaplan-Meier-Estimate with a significant difference (Log Rank: Chi²: 1480, p = 0.013) compared to patients with only RV dysfunction low VO2 max or only increased CRP values.

Conclusion

A combined evaluation of systemic inflammation, cardiopulmonal exercise testing and right ventricular dysfunction is useful in predicting long-term outcomes of patients with HF. Patients with both risk factors show worse survival than patients with signs of inflammation or RV dysfunction only.Kaplan-Meier-Estimates
Association of osteopontin and shrunken pore syndrome with hospitalization for renal failure in acute heart failure patients
Authors: Ohlsson M A , Holm H , Molvin J , Zaghi A , Dieden A , Nezami Z , Jujic A , Magnusson M
Published: October 2024

Background

Shrunken pore syndrome (SPS) emerges as a distinctive manifestation of glomerular filtration dysfunction mainly manifested by the impairment of moderate-sized molecular filtration, distinguished by a variance in renal filtration between cystatin C and creatinine. SPS exhibits correlations with adverse prognosis of various cardiovascular diseases. A decline in renal function correlates with a poor prognosis among individuals with heart failure (HF). Osteopontin (OPN), a protein involved to bone mineralization, has been linked to deteriorating renal function and heightened risk for adverse outcomes in patients with chronic kidney disease.

Purpose

To explore if OPN and SPS are associated with hospitalization for renal failure in patients with acute HF.

Methods

Cystatin C and creatinine were analyzed in 395 hospitalized HF patients, of which 324 also had osteopontin (OPN) analyzed using a proximity extension assay. SPS was calculated using the CKD-EPI Equations for Glomerular Filtration Rate and defined as a cystatin C-based estimated glomerular filtration rate (eGFR) <60% of the creatinine based eGFR. Hospitalization for renal failure was extracted from regional registries using ICD10 codes N17-N19. Logistic and Cox regression models were deployed to explore a) OPN’s association with SPS; b) OPN’s association with hospitalization for renal failure; and c) SPS’s association with hospitalization for renal failure, adjusting for age, sex, systolic blood pressure and use of renin-angiotensin-aldosterone system (RAAS) inhibitors.

Results

The study population had a mean age of 74.8 (±12.0) years, 32.4% were women and 104 (26.5%) patients presented with SPS (Table 1). During the median follow-up period of 71 (interquartile range 56-88) months, 35 (8.9%) patients were hospitalized for renal failure. OPN was associated with the prevalence of SPS (OR 1.66; 95%CI 1.08-2.27; p=0.002), as well as with higher risk of hospitalization due to renal failure (HR 2.71; 95%CI 1.61-4.56; p<0.001). Further, also prevalent SPS was associated with higher risk of hospitalization due to renal failure (HR 2.44; 95%CI 1.14-5.24; p=0.022).

Conclusions

Here, we demonstrate that higher OPN levels are associated with a higher prevalence of SPS and an elevated risk of hospitalization due to renal failure among patients with HF. Additionally, the presence of SPS was associated with a higher risk of renal failure-related hospitalizations. These findings highlight the potential utility of OPN and SPS as biomarkers for identifying heart failure patients at risk of renal function decline, underscoring the importance of early risk stratification and targeted interventions in this population.
Circulating secretoneurin concentrations predict 90-day mortality in patients with cardiogenic shock
Authors: Rosjo H , Azibani F , Kimmoun A , Harjola V P , Lassus J , Mebazaa A , Omland T
Published: October 2024

Background

Secretoneurin (SN) concentrations have been found to provide strong prognostic information in critically ill patients. Accordingly, in this study we hypothesized that SN would provide prognostic information in patients with cardiogenic shock.

Objectives

To evaluate the utility of SN concentrations to predict 90-day mortality in two multicenter, prospective clinical trials including patients with cardiogenic shock.

Methods

We measured SN concentrations with a CE-marked ELISA in patients with cardiogenic shock of all etiologies (Cohort #1, n=168) and in patients with post-myocardial infarction cardiogenic shock (Cohort #2, n=45). Inclusion criteria in both cohorts focused on systolic blood pressure <90 mmHg and evidence of tissue hypoperfusion, including increased lactate concentrations. We used Cohort #1 for primary analysis and Cohort #2 for validation. We assessed association between SN concentrations and mortality by Kaplan-Meier curves and by univariate and multivariable Cox proportional hazard regression analysis.

Results

Median age was 67 and 69 years (Cohort #1 and #2) and the patients were predominantly male (74% and 67%, respectively). Median SN concentration on study inclusion was 53 pmol/L in Cohort #1 and 50 pmol/L in Cohort #2, and SN concentrations decreased from study inclusion to 72 hours (p=0.03 for trend). 90-day mortality was 42% in Cohort #1 and patients with high SN concentrations had worse outcome (Figure A). Adjusting for variables that were associated with 90-day mortality in univariate analysis and not part of the inclusion selection, i.e., age, sex, comorbidities, blood pressure, estimated glomerular filtration rate, treatment, and N-terminal pro-B-type natriuretic peptide concentrations, SN concentrations on study inclusion were still associated with 90-day mortality: hazard ratio per 100 pmol/L increment 1.97 (1.29-3.01), p=0.002. 90-day mortality was 45% in Cohort #2 and SN concentrations were predictive of 90-day mortality also in Cohort #2 (Figure B).

Conclusion

SN concentrations provide incremental prognostic information to established risk indices in the early phase of cardiogenic shock.A. Cohort #1 with SN tertilesB. Cohort #2 divided by SN median
First insights in children’s health literacy in the Netherlands–results in a sample of 8-11 year olds
Authors: Rademakers J , Hahnraths M , Bollweg T , Okan O , Willeboordse M , Heijmans M
Published: October 2024

Background

There are few valid, age-appropriate tools to assess children’s HL. The German-language European Health Literacy Survey Questionnaire Adapted for Children (HLS-Child-Q15-DE) is a self-report questionnaire adapted from the adult European Health Literacy Survey Questionnaire. In 2021, this instrument was translated and validated in the Netherlands. In this presentation, we will describe the distribution of Health literacy in a sample of Dutch children, and relate their Health literacy level to certain aspects of their health behaviour such as food intake and physical activity.

Methods

The HLS-Child-Q15-DE was translated following WHO guidelines and administered digitally to 209 Dutch schoolchildren (eight-to-eleven-year-olds). Its psychometric properties were assessed and the sample’s HL distribution was explored by demographic characteristics. Associations with food intake and physical activity were computed.

Results

Of the sample, 17.2% had a low health literacy score (first quintile), 61.1% medium (second to fourth quintile) and 21.7% high (fifth quintile). Higher HL scores were observed for ten-to-eleven-year-olds (compared with eight-to-nine-year-olds; p = 0.021) and fourth-grade students (compared with third-grade; p = 0.019). A positive association between children’s HL and their vegetable consumption and PA behaviour was observed.

Conclusions

Children’s health literacy can have an impact on some aspects of their lifestyle. This supports the idea that health literacy evolves throughout life and stresses the importance of both parents and schools in this process.
Administrative data for public health: a regional data warehouse applied to dementia epidemiology
Authors: Clemens T , Blandi L , Bertuccio P , Brand H , Odone A
Published: October 2024

Administrative data can represent valuable sources of information for researchers seeking to advise policymakers. Several countries have established population-based data warehouses (DWH), integrating multiple data sources in single repositories through data linkage techniques. In Lombardy (Italy), a regional population-based DWH was established in the 1980s. It collects data about citizens from multiple sources in the social and health sectors, anonymising them immediately after their acquisition. Lombardy Region signed a specific agreement with the University of Pavia to investigate the epidemiology and access to care among people living with dementia (PLWD), using the DWH. A retrospective cohort study was conducted on hospitalised PLWD, including people aged ≥ 65 years with diagnoses of dementia at discharge from 2002 to 2020. The aim was to study the trends of hospitalisations among PLWD, computing these by calendar year, age, sex and cause of hospitalisation. A total of 340,144 hospital discharges were registered, of which 211,709 (63.0%) were women and 124,195 (37.0%) were men. The rate of hospitalisation decreased over the study period, ranging from 100.6/10,000 in 2002 to 65.1/10,000 in 2020. The average age at hospitalisation increased for men and women from 78.9 and 81.8 years in 2002 to 82.0 years and 84.2 years, respectively, in 2020. Respiratory diseases caused 10.4% of all hospitalisations in 2002 and grew steadily to 26.8% in 2020, becoming the leading cause of hospital admissions since 2017. Results allowed us to elaborate epidemiological measures and to characterise our population in a wide temporal trend, quantifying access to acute care by leading causes of hospitalisation. However, the analysis of administrative data comes along with several challenges, such as data incompleteness and biases. Researchers should take advantage of these data sources while keeping in mind the limitations and constraints related to data quality.
Sodium and potassium intake in adults: the Italian Health Examination Survey 2023 – CUORE Project
Authors: Donfrancesco C , Lo Noce C , Marcozzi B , Di Lonardo A , Vannucchi S , Morello M , Di Carlo S , Galeone D , Bellisario P , Palmieri L
Published: October 2024

Background

The WHO recommends a 30% relative reduction in mean population intake of salt/sodium within 2025 (baseline 2010) and an adequate potassium intake. To these ends, the Italian Ministry of Health (MoH) has strengthened prevention/health promotion. To update the assessment of the habitual salt and potassium intake in the Italian general adult population, national health examination surveys (HESs), funded by the MoH-CCM, are conducted within the CUORE Project.

Methods

In 2023 a new HES started including salt and potassium intake assessment by the use of 24h urine collection. Up to now, data from random samples of residents in 7 Regions (of 20 regions) distributed in North, Centre and South of Italy and aged 35-74 years are available (686 men, 702 women). Urinary excretion is assayed by a central lab. Persons with urinary volume < 500 ml and/or a urinary creatinine content referred to body weight outside the range of population mean ± 2 standard deviations are excluded.

Results

Out of 657 men and 671 women, mean level of salt per day was 9,2 g (95% CI: 9,0-9.5 g) and 7,1 g (6,9-7,3 g) respectively, and mean level of potassium per day was 2,9 g (2,8-3,0 g) and 2,4 g (2,3-2,5 g) respectively. A salt intake level lower than the WHO recommended target of 5g/day was detected in 9,5 % (5,2 -13,9 %) of men and 23,7 % (17,5 -29,9 %) of women and a potassium intake level higher than the WHO recommended target of 3510 mg/day was detected in 22,4 % (16,3 -28,6 %) of men and 9,7 % (5,4 -14,0 %) of women.

Conclusions

These preliminary data showed that in Italian adults the average salt intake is still higher and the average potassium intake is still lower than recommended. Compared to 2008, the habitual salt intake decreased of about 12% in 2018 and remained stable in 2023; the habitual potassium intake remained stable in 2008, 2018 and 2023.These results justify and encourage the ongoing preventive initiatives of MoH, facilitating the meeting of WHO targets.

Key messages

• In Italian adults the average salt intake is still higher than recommended and the habitual salt intake decreased compared to 15 years ago.

• In Italian adults the average potassium intake is still lower than recommended and remained stable compared to 15 years ago.
Data governance challenges on smart home involving multiple research sites
Authors: Wang K , Cao S , Morita P
Published: October 2024

Background

The development of Ambient Assisted Living (AAL) technology has great potential for ubiquitous health monitoring through collaboration between multiple research sites, but its use poses significant challenges to data governance. This study aims to investigate data governance challenges arising when smart home data flows across different research sites.

Methods

A four-analytic-dimension method was used to identify potential data-related issues that may occur when heterogeneous smart home data moves around multiple research sites. These dimensions include data domain, stakeholders, value, and governance goal.

Results

Data domain has difficulty in categorizing new data types generated by analytical models without a specified agreement, and determining the regulations for varying levels of anonymization and privacy protection is unclear in the AAL research field. Stakeholders in the AAL project may hold have different norms and practices for data use. Although some common values may be shared, such as improving the quality of homecare, conflicts may still arise and need to be regulated by data governance. Shifting AAL data between stakeholders may reduce its value, as different stakeholders may have varying interests. For instance, removing identifiable information from data to preserve privacy may reduce its value for researchers exploring individuals’ activity patterns. Governance goals are objectives for maintaining and facilitating data. While some governance goals can be widely acknowledged and shared, such as ensuring data security and privacy, conflicts may still exist over others, such as data access.

Conclusions

The big data generated by smart home technology highlights the need to develop proper data governance models to regulate data. This study’s implications include a better understanding of potential data-related challenges when data flows around multiple research sites, helping policymakers set up suitable data governance models.

Key messages

• AAL tech for health monitoring poses data governance challenges due to varying stakeholder norms and values.

• Proper data governance models need to be developed for AAL data as it remains challenges in data domain, stakeholders, value, and governance goal.
Human-swine interface: is the hepatitis E virus a real risk for humans?
Authors: Arnaboldi S , Righi F , Scarazzato A , Pavoni E , Filipello V , Lelli D , Trogu T , Lavazza A , Romanò L , Bertasi B
Published: October 2024

Background

Hepatitis E virus (HEV) is the agent of hepatitis E, an emerging public-health infection with an increasing incidence in Europe. Due to the apparent lack of species barriers, HEV is considered a zoonotic agent, with swine as the main reservoir. This study investigated HEV prevalence in humans and domestic pigs in Northern Italy, a highly anthropic area with the highest pig farm density, to gain insights into the risk of HEV transmission from swine to humans.

Methods

A total of 508 blood samples were collected from blood donors (341 males and 167 females; from 18 to 66 years old) and from 1619 pigs in 40 different farms. Serological analyses were performed with ELISA to detect anti-HEV antibodies. In addition, 120 faecal pool samples collected from the pig farms with the highest seroprevalence and 69 salami produced in the same area were analysed to detect viral genome by Real-time PCR.

Results

In humans, HEV seroprevalence was 4.9% (CI95% 0.03-0.07); positive donors were mainly males, with seroprevalence increasing up to 12% (CI95% 0.09-0.15) in the 46-55 age group. Seroprevalence in swine was 53.00% (CI95% 0.50-0.55), with HEV detected in only 1% (CI95% 0.001-0.045) faeces. All food samples tested negative.

Conclusions

Even if the seroprevalence in pigs highlighted that HEV was actively circulating in the farms, the low seroprevalence in humans, the scarce HEV detection in swine faeces, and the absence in food products suggested that HEV transmission via faecal-oral or foodborne routes is unlikely, probably due to the implementation of severe biosecurity measures and high standards of hygiene in swine farms, and the continuous assessment of the critical points in the pig supply chain (from farm to fork). The serological surveillance of humans and the monitoring of farmed animals are needed to support the competent authorities in timely managing public health issues, improving human health and veterinary safety from a One Health perspective.

Key messages

• In the human-swine interface is important to monitor HEV presence.

• The One Health approach is essential to control zoonotic diseases.
Next-generation public health surveillance: extreme heat event prediction and monitoring system
Authors: Zakir Hussain I , Oetomo A , Kaur J , Morita P P
Published: October 2024

Background

Extreme Heat Events (EHEs) are a growing threat to public health. The increase in the frequency of occurrence of once rarer EHEs and the rise in their average temperatures are dangerously drastic for public health outcomes. Despite this, existing public health surveillance (PHS) systems fail to leverage IoT and AI technologies to facilitate real-time, continuous monitoring of EHE indicators and its associated health risks. This study closes this gap by proposing a comprehensive PHS system that can, in real-time monitor and predict EHE indicators to provide timely alerts to public health authorities.

Methods

The EHE PHS system collects EHE detection metrics, including indoor temperature and humidity levels, from IoT sensors and thermostats to map them across Canada, primarily focusing on low-income communities. The system also integrates historical climate data (surface temperature, humidity, wind speed and direction, and air quality indicators) from Environment Canada. The system uses the data to train initial prediction models including CNN, LSTM and GNN. The validated model will be integrated into the system, enabling real-time EHE prediction. The output will be displayed in user-friendly visualizations on the EHE PHS system’s dashboard capabilities.

Results

The system allows for the analysis of real-time data through dashboards and provides alerts when certain indicators (e.g. excessive or prolonged heat) detrimental to public health outcomes are detected. The alerts enable valuable lead time for public health authorities to implement proactive measures, such as issuing heat advisories and deploying resources to vulnerable areas.

Conclusions

The EHE PHS system will serve as a blueprint for global public health researchers, utilizing IoT and AI technologies for proactive crisis prevention. This knowledge will inform the development of heat-resilient policies and set a precedent for global public health crisis prevention.

Key messages

• The proposed EHE PHS system uses AI and IoT technologies, to enhance EHE prediction, risk identification, and real-time monitoring for effective public health interventions.

• By integrating advanced predictive models and environmental data, the system facilitates early detection of EHE risk, which can significantly mitigate the health impact on vulnerable populations.
Patient and practice characteristics related to patient’s consent for health data exchange
Authors: Keuper J J , Hek K , van Tuyl LHD , Batenburg R S , Verheij R A
Published: October 2024

Background

Sharing patient health data electronically between healthcare providers can prevent medical errors and improve patient safety. In the Netherlands, exchange of health information is facilitated on a national level and is only allowed with patient consent. Consequently, it is important to know which factors are related to this patient consent.

Methods

Routine electronic health records data from up to 10% of Dutch general practices (sourced from the Nivel Primary Care Database) were utilized, covering the period from 2016 to 2020. We examined whether patient consent for health data exchange varied depending on patient and practice characteristics, which are expected to have a relationship with granting consent for health data exchange. Therefore, multilevel analysis was performed.

Results

The percentage of patients granting consent ranged between 40%-50% in the period 2016 to 2019, while this was 97% in 2020, due to the governmental corona opt-in regulation. Significant disparities were observed across several of the included patient and practice characteristics in relation to patient consent for all the years examined. In most years, patient consent provision varied by gender, age, socioeconomic position, location, and healthcare use. Practice characteristics showed notable differences in patient consent across information systems, patient volumes, and practice types over all years examined.

Conclusions

We observed significant variations in patient consent for health data exchange, both among the included patient (need) and practice characteristics. These differences may stem from unequal exposure to opportunities to grant consent, differences in risk of inadequate communication between healthcare providers, levels of health literacy, and practice resources. These factors should be taken into account by policymakers when further implementing and upscaling the national health data exchange system.

Key messages

• Variations in patient consent for health data exchange were observed among different patient groups and general practices.

• Variations in patient consent for health data exchange may stem from unequal exposure to opportunities to grant consent, levels of health literacy, and practice resources, among other factors.
Validation of the Multidimensional Scale of Perceived Social Support among LGBT population in Serbia
Authors: Stamenkovic Z , Todorovic J , Brkljac N
Published: October 2024

Background

Social support represents the belief that one is valued, cared for, and loved by others in a social network and a lack of it may lead to adverse outcomes such as a relapse into depression or emotional distress in physically ill patients. The Multidimensional Scale of Perceived Social Support (MSPSS) is an instrument aimed to measure an individual’s perception of how much he or she receives outside social support. This study aimed to examine the validity and reliability of the Serbian version of MSPSS in a sample of LGBT population in Serbia.

Methods

The cross-sectional study included 504 respondents, members of the LGBT population living in Serbia. The instrument used was the MSPSS as a self-report measure, containing twelve items rated on a 7-point Likert scale. MSPSS consists of three sub-scales: Family, Friends, and Significant Others. Exploratory (EFA) and confirmatory factor analyses (CFA) were performed with two independent random samples.

Results

The average score on the scale of social support was 5.58±0.84 (scale of social support by family 4.62±1.41, scale of social support by friends 5.93± 1.99, and scale of social support by the significant others 6.20±0.96, respectively). The Cronbach’s alpha for the entire social support scale was α = 0.772. The three-factor structure of the MSPSS was proved with EFA and CFA. The factor loadings varied between 0.630-0.817. The three factors explained a total of 52.68% of the variance (factor 1- 28.62%, factor 2. 13.16%, factor 3- 10,90%). The three-factor model was adopted during the CFA when the three-factor model CFI (comparative fit index) was 0.969.

Conclusions

The MSPSS has shown good reliability, internal validity and construct validity and can be used as a convenient measure of social support among the LGBT population. Both EFA and CFA yield a three-factor structure consistent with the theory underlying the measure’s development.

Key messages

• The results of the study suggest that the Multidimensional Scale of Perceived Social Support has acceptable psychometric properties for use with the LGBT population.

• This study supports the use of the MSPSS for assessing community-based collaboration using the three-factor model among the LGBT population.
Digital health literacy and associated socio-demographic characteristics in the French population
Authors: Quiviger A , Allaire C , du Roscoät E , Mancini J
Published: October 2024

Background

With the development of digital devices in the health field, digital health literacy has become an important issue in promoting and protecting people’s health. Digital health literacy was measured in a representative sample of the French adult population in order to assess its level and to identify the socio-demographic characteristics of individuals with the lowest literacy levels. Comparisons with works carried out in other European countries as well as implications for the implementation of digital interventions will be discussed.

Methods

Digital health literacy was assed using the HLS19-DIGI-HI Instrument. This 8-item scale measuring the skills related to dealing with digital health information was introduced in the 2023 Health Barometer survey, conducted by the French national public health agency. The survey included French-speaking individuals living in France, aged 18-85, selected through randomly generated phone numbers. 3007 persons were interviewed using a computer assisted telephone interview. A continuous score and categories were calculated to determine the level of Digital Health Literacy. Their associations with sociodemographic characteristics were studied using univariate and multivariate analysis.

Results

1902 persons declared they used internet to search information or advice on health on internet in the last 12 months and completed the Digital health literacy questionnaire. 61 % of these individuals have a low level of digital health literacy (29 % “inadequate” and 32% “problematic”). Multiple sociodemographic characteristics were associated with lower levels of literacy in univariate and multivariate analysis.

Conclusions

These results are useful to better understand and assess the digital health literacy of the population according to their socio-demographic characteristics. They will provide a knowledge base to implement web-based interventions for promoting targeted digital health interventions, according to targeted audiences.

Key messages

• This study in large random sample of the French population showed frequent difficulties to deal with online health information.

• Multiple sociodemographic characteristics were associated with digital health literacy and can help to support implementation of targeted digital health interventions.
Unintended pregnancies in the context of intimate partner violence: Findings from the ELSA-Study
Authors: Brzank P J , Jepsen D , Engelhard M , Winter K , Nowak M
Published: October 2024

Intimate partner violence against women (IPV) is a widespread problem with serious consequences for victims and for society. Women affected by IPV have an empirically proven particular risk of unintended pregnancies. ELSA “Experiences and Living Conditions of Unintended Pregnant Women - Counselling and Care Services” is the first study in Germany to analyse the connections between the situations of women and unintended pregnancies. Using an online questionnaire, women from 1) a random representative sample of residents with a child under 6 years of age and 2) a sample of 662 women from abortion facilities or counselling centres were surveyed in 2021. The data (n = 5,101) were analysed in order to compare the life situation and needs of victimized versus non-victimized women. 333 women (6.5% of the total sample; 95% CI [6.2, 7.6]) reported IPV. Victimized women had a 5.6 times higher risk for an unintended pregnancy (95% CI [4.2, 7.5]) and 3.2 times higher risk for an abortion (95% CI [2.0, 5.0]). The pregnancy was sig. more frequently the result of forced sex (CV= .210***). Victims with unintended pregnancies had a sig. poorer mental health before (t(510) = 7.081***), during (t(510) = 5.501***) and after birth (t(456) = 5.234***) as well as before (t(503) = 4.905***), during (t(224) = 3.408) and after (t(503) = 3.352***) abortion. They were sig. more likely to report feelings of guilt and shame (CV = .182***), self-blame (CV = .149***) and anxiety (CV = .190***) after the pregnancy was determined and they received sig. more unsolicited information from the medical staff (CV = .254**). The result shows that victimized women are in an increased risk situation in the context of unintended pregnancies. Health care professionals can play a special role in prevention and intervention. Nationwide awareness-raising training, protocols and commitment are required.

Key messages

• The study confirms international findings on IPV and unintended pregnancies for Germany.

• There is a need for a sensitive approach within the health system to enhance prevention.
Can a zero-shot learning Large Language Model code complex interview data?
Authors: Balt E , Salmi S , Bhulai S , Eikelenboom M , Gilissen R , Creemers D , Popma A , Mérelle S
Published: October 2024

Background

Psychological autopsy is essential to establish theories, explore trends and identify previously unexplored psychosocial risk factors in suicide research. However, qualitative research has been scrutinized for being prone to interpretation bias, problems with accuracy, challenges to reproducibility, and is very time- and cost intensive. The current study aimed to investigate if a Large Language Model can achieve sufficient agreement with a researcher in the deductive coding of interview data obtained in a psychological autopsy study of suicide, to be integrated with qualitative research procedures.

Methods

Data from 38 interviews was deductively coded by a researcher and a LLAMA 3 based language model. The model performance was evaluated in four increasingly difficult coding tasks, including binary classification and data summarization. Intercoder agreement scores were calculated using Cohen’s Kappa.

Results

The preliminary results showed that the LLM achieved substantial agreement with the human coders for the binary classification task (.78). The variability in performance was influenced by code definitions. The results of the quality of LLM interpretation and summarization will also be presented.

Conclusions

State-of-the-art LLM can be easily integrated into the qualitative analyses of psychological autopsy interviews and may improve real time monitoring of suicides. We recommend a human-AI collaborative model, whereby deductive coding by the LLM is complemented by human inductive coding and further interpretation.

Key messages

• Integrating an LLM with qualitative research procedures is feasible in a collaborative model.

• Integrating an LLM with qualitative research procedures allows near real-time monitoring based on qualitative data, which extends to other public health fields.