bluuebunny/crossref_metadata_2025 huggingface dataset:
Racial disparities in renal outcomes of pulmonary hypertension hospitalizations: analysis of 2016 to 2018 National Inpatient Sample
Authors: Thyagaturu H , Bolton A , Kumar A , Shah K , Li S
Published: October 2021

Background

Although the prevalence of pulmonary hypertension among black and white individuals are similar, black individuals have been reported to have worse prognosis. However, data on renal outcomes and racial disparities in pulmonary hypertension patients are extremely limited.

Purpose

To investigate the racial differences in acute renal failure outcome of pulmonary hypertension hospitalizations.

Methods

We queried 2016–2018 National Inpatient Sample (NIS) database to identify pulmonary hypertension patients using appropriate ICD-10 codes. Race variable in the database was used to categorize pulmonary hypertension patients into Blacks and Others groups (Whites, Hispanics, Asian or Pacific Islanders). We used Chi-square test to evaluate the difference between binary variable, and Student's t- test for differences between continuous variables. Multivariate logistic regression was used in outcomes analysis to adjust for potential hospital and patient level confounders.

Results

Among the total 1,362,765 pulmonary hypertension patients across three years, 68% (906,994) were Whites, 18.9% (251,530) were Blacks, 7.8% (104,169) Hispanics and 2% (30,139) Asian or Pacific Islanders. Blacks with pulmonary hypertension were younger (mean age, 64.1 vs. 73.1 years; p<0.01), more females (57.4% vs. 42.5%; p<0.01), higher prevalence of diabetes (47.2% vs. 39.9%; p<0.01), systolic heart failure (31.2% vs. 25.1%; p<0.01), chronic kidney disease (43.2% vs. 36.4%; p<0.01), end-stage renal disease (17.1% vs. 6.8%; p<0.01), obesity, obstructive sleep apnea and anemia compared to Other races. After adjusting for hospital and patient level confounders including above mentioned comorbidities, Blacks had higher odds of acute renal failure compared to Others [Adjusted Odds ratio: 1.15 (1.11 – 1.18); p<0.01]. Blacks with pulmonary hypertension were also associated with unadjusted longer length of stay (7.0 vs. 6.4 days; p<0.01) and similar total hospitalization charges (USD: $78,408 vs. $80,076; p=0.18) compared to Others.

Conclusions

Racial minorities are underrepresented among patients with pulmonary hypertension. Blacks with pulmonary hypertension have higher co-morbidity and are associated with worse in-hospital renal outcomes compared to other races. They are also associated with longer length of stay. Vigilant renal functions monitoring, and early nephrologists involvement are needed during hospitalization to prevent worse renal outcomes in this patient population.

Funding Acknowledgement

Type of funding sources: None.
Diagnostic potential of a novel fluoroscopic video analysis workstation (Radwisp) in patients with acute pulmonary thromboembolisms
Authors: Okumura Y
Published: October 2021

Background

Pulmonary thromboembolisms (APEs) are one of the leading causes of death, and they are increasing worldwide. Contrast-enhanced chest computed tomography (CT) is the most robust imaging tool for diagnosing APEs, but a fluoroscopic video analysis workstation (Radwisp™) was newly developed to evaluate the pulmonary circulation without using contrast medium (Figure), and it can be useful as a diagnostic device in APEs. Nonetheless, it has not been validated whether Radwisp has the potential to accurately diagnose APEs.

Methods

In this study, 10 consequence suspected APE patients (male:female ratio, 1:1, mean age 68.5±16 years) in our hospital were enrolled between January 2020 and April 2021. All patients were suspected of having APEs from their symptoms and physical examinations, and therefore, were scheduled for contrast-enhanced CT and cineradiographic imaging based on standard X-rays on the same day. The cineradiographic images were taken with a 20 second breath-hold followed by breathing. The cineradiographic X-ray images were moved to the fluoroscopic video analysis workstation (Radwisp™). Blinded to the patient information and contrast-enhanced CT images, four cardiologists evaluated the presence or absence of APEs, and if APEs were diagnosed, the extent of pulmonary artery filling defects due to thrombi, solely from the Radwisp-based images. We compared the findings from the Radwisp-based images to those from the contrast-enhanced CT imaging.

Results

Of a total of 10 patients, 7 were diagnosed with APEs from the contrast-enhanced CT imaging, while 3 were not. All images were created within 5 minutes and the image quality was high even during breathing. three doctors accurately diagnosed 7 patients with APEs and 3 without APEs. In all 7 patients, contrast-enhance CT imaging after treatment (rivaroxaban 30mg for average 12±4 days) identified full recovery of the pulmonary circulation over both lungs, which was correctly identified on the Radwisp image by 3 doctors.

Conclusions

In this validation study, the diagnostic accuracy of the Radwisp™ for APEs was reliably high. In addition, this imaging could correctly identify filling defects in pulmonary arteries. This novel Radwisp-based imaging can be a simple and reliable diagnostic tool for identifying not only APE patients, but also the severity of the pulmonary circulation caused by thrombi, and its therapeutic effects, especially in patients with severe dyspnea and renal disfunction. Radwisp™ can enable further diagnosis of the site of embolism and determination of therapeutic effect. Further studies will be needed to obtain a consistent diagnostic accuracy of APEs in patients with other pulmonary diseases.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Paramevia Pte. Ltd A Radwisp analysis show pulmonary defect
Aortic atherosclerotic plaques: the role of anticoagulation
Authors: Silverio Antonio P , Rodrigues T , Cunha N , Couto Pereira S , Brito J , Valente Silva B , Alves Da Silva P , Beatriz Garcia B , Martins M , Oliveira C , David C , Caldeira D , J Pinto F , G Almeida A
Published: October 2021

Introduction

Aortic atherosclerotic plaques (AAPs) are one of the major causes of spontaneous and iatrogenic stroke and peripheral emboli, carrying an high morbidity and mortality. Transoesophageal echocardiography (TOE) plays a key rule on detecting AAP. The therapeutic approach of this patients (pts) is not well stablished.

Purpose

To evaluate the impact of anticoagulation (ACO) therapy on major events in asymptomatic pts with AAP detected in TOE.

Methods

Single-center retrospective study of consecutive patients submitted to TOE between 2010 and 2019 with documentation of AAP. Plaques were described as complex (1) >4mm, (2) ulcerated and (3) mobile thrombi. The plaque location was also documented. We consulted pts data charts for clinical characterization and events recording during the follow up. Major events were defined as stroke, bleeding, hospital admissions (either cardiovascular (CV) and non-CV) and death. Statistical analysis was performed using Cox regression and Chi-square tests.

Results

We enrolled 177 pts with a mean age of 70±10.5 years, 63.8% males, 31.1% diabetic, 73.4% hypertensive, 54.2% with dyslipidaemia, 62.7% obese, 25.4% with peripheral arterial disease, 25.9% with previous stroke and 55.4% with supraventricular arrhythmia. Most of pts had plaques >4mm (80.8%), mobile thrombi in 11.9% and ulcerated plaques in 7.3%; most of the plaques were located in proximal descending aorta (50.3%) and aortic cross (38.4%). Regarding baseline therapy, 52% were under ACO and 50.3% under statin. The main indication of ACO was atrial fibrillation (45.8%).

During follow up (mean time: 1613±1255 days), 61.5% pts died (10.7% from CV causes, 13% with unknown cause), 17.5% had a stroke, 5.7% had other embolic event (lower limbs emboli, unilateral amaurosis and ischemic colitis). Bleeding occurred in 18.3% pts; 47% pts were hospitalized (28.3% from CV cause).

Adjusting for age and comorbidities, there were no significant differences between the group with and without ACO. ACO therapy prevented death from any cause, being also an independent predictor (p=0.08, OR 0.489, IC 95% 0.288–0.831) when adjusted for comorbidities and age. ACO was associated with bleeding events (p=0.003), but not with stroke or hospitalization from any cause (p=NS).

Conclusion

In this subset of pts, ACO therapy prevented death from any cause in pts with AAP. This may have therapeutic implications when approaching this pts, although larger studies to confirm these results are needed.

Funding Acknowledgement

Type of funding sources: None. Non-CV death and anticoagulation
Association of rs10507391 polymorphism with the development of acute cerebrovascular event
Authors: Chernova A , Nikulina S , Nikulin D
Published: October 2021

Purpose

To study SNP rs10507391 association (A> T) with development of Acute Cerebrovascular Event in the patients with cardiovascular pathology and risk factors of its development who are representatives of the east Siberian population.

Material and methods

260 patients with Acute Cerebrovascular Event participated in a research (age [57.0; 51.0–62.0]) and 272 patients of control group (age [55.0; 51.0–62.0].). Among the patients who transferred Acute Cerebrovascular Event, 157 men and 103 women. The control group included 170 men and 102 women. Inspection of the main group included: collecting complaints, anamnesis, clinical examination, computer tomography of a brain, electrocardiography, echo, ultrasonic of arteries, daily monitoring of arterial blood pressure and cardiac rhythm, analysis of a coagulant system of blood. Patients of the main group had the following cardiovascular pathology and risk factors: arterial hypertension, supraventricular tachycardia, dislipidemiya, atherosclerosis brachiocephalic of arteries, disturbances of a system of a hemostasis. The control group is examined within the international HAPIEE project. The molecular and genetic research was conducted by PCR method in real time. Statistical processing of material was carried out with use of set of the Statistica for Windows 7.0, Excel and SPSS 22 application programs.

Results

When studying SNP rs10507391 association (A> T) connection between a rare genotype of a TT and an allele of T and the increased risk of Acute Cerebrovascular Event is established with development of Acute Cerebrovascular Event in all analyzed groups and subgroups of patients.

Conclusion

A genotype of a TT and an allele of T of SNP rs10507391 (A> T) increases risk of development of an acute disorder of cerebral circulation in patients regardless of the previous cardiovascular pathology and risk factors, including at patients with arterial hypertension, supraventricular tachyarrhythmias, atherosclerosis the brachiocephalic of arteries, disturbance of lipidic exchange and the system of a hemostasis.

Funding Acknowledgement

Type of funding sources: None.
Management strategies for acutely decompensated aortic stenosis
Authors: Orzalkiewicz M , Donati F , Santona L , Marcelli C , Chietera F , Bendandi F , Bruno A G , Ghetti G , Taglieri N , Palmerini T , Marrozzini C , Galie N , Saia F
Published: October 2021

Background

Uncertainty exists over the optimal treatment strategy for patients presenting with acutely decompensated severe aortic stenosis (AS). The available options include a bridging balloon aortic valvuloplasty (BAV) or a direct transcatheter aortic valve implantation (TAVI).

Purpose

Our study compares TAVI outcomes in patients treated with two different strategies in acutely decompensated severe AS: bridged TAVI vs direct TAVI.

Methods

In this observational study all patients admitted with decompensated severe AS who underwent balloon aortic balloon valvuloplasty (BAV) and/or TAVI on the index admission were included. Comparison was made between bridged TAVI group (defined as initial BAV followed by TAVI) and direct TAVI group (TAVI on the index admission without bridging BAV). For this analysis we excluded patients in cardiogenic shock. Baseline characteristics, echocardiographic and periprocedural data were recorded in hospital database. Major adverse cardiovascular events (MACE) were defined as death, major bleeding, rehospitalisation for heart failure, or stroke). The follow-up data was obtained by outpatient visits and/or telephone calls.

Results

178 patients with acutely decompensated AS were analysed: 58 bridged TAVI, 23 direct TAVI, 9 bridged SAVR and 88 destination BAV (defined as BAV non followed by a definite treatment). There was no statistically significant difference between bridged TAVI and direct TAVI group in mean age (83.6±6.6 vs 80.4±8.3 years), the prevalence major comorbidities (coronary, respiratory, neurological or peripheral vascular disease), renal function (eGFR 43.4±18.9 vs 45.2±20.9 ml/min/m2), the mean LV ejection fraction (53.4±13.8 vs 48.6±14.6%) or aortic valve gradient (39.4±13.0 vs 34.1±12.3mmHg), respectively. Direct TAVI patients had a higher mean surgical risk scores (STS 6.1±3.7 vs 9.1±7.0%, logES 18.8±11.5 vs 30.8±20.9%, p=0.01) and higher prevalence of significant aortic regurgitation (5% vs 43%, p=0.0001). The femoral TAVI access was used in 98% of bridged and 78% of direct TAVI patients (p=0.006). The estimated 1-year survival and 1-year MACE-free survival did not differ significantly between the bridged TAVI and direct TAVI groups (86.8% vs 78.3%, p=0.20 and 79.7% vs 64.2%, p=0.11, respectively).

Conclusions

A large proportion of patients admitted with acutely decompensated AS were not eligible for definite treatment. There is no difference in procedural success, 1-year all-cause mortality and 1-year major adverse cardiovascular events between the bridged TAVI or direct TAVI strategies in acute decompensated aortic stenosis allowing to personalize treatment strategy for individual patient.

Funding Acknowledgement

Type of funding sources: None. Table 1. Clinical and procedural data
Does incidental calcium deposition in non-cardiac CT scans predict cardiovascular morbidity and mortality in young adults? A retrospective study
Authors: Aker A , Khalaili L , Naoum I , Abedalghani A , Zoubi R , Haber C C , Kassem S
Published: October 2021

Background

The calcium score in cardiac CT scan represents an effective tool in the diagnosis of coronary artery disease. However, few studies have examined the value of incidental arterial calcification (AC) in non-cardiac CT scans, especially in young adults with no prior cardiovascular morbidity.

Purpose

To evaluate the association between incidental AC and the incidence of cardiovascular events, as well as the association between atherosclerotic risk factors and AC in young adults with no known cardiovascular disease.

Methods

A retrospective study in patients aged 40–50 years old with no history of cardiovascular disease that underwent chest CT scan between 1.9.2012–31.8.2013 for reasons not related to cardiovascular disease. We assessed the presence of AC in the aorta and coronary arteries and its association with the rates of coronary catheterization for acute coronary syndrome (CCACS), emergency room (ER) visits or hospitalizations for cardiovascular disease and cardiac mortality. Furthermore, we examined the association between atherosclerotic risk factors (hypertension, smoking, hyperlipidemia and diabetes) and AC.

Results

308 patients were included in the study, 150 men and 158 women with average follow-up period of 7.2+0.29 years. AC was found in 88 (28.6%) patients. AC was more frequent in men than in women (35% vs. 20.9%, OR=2.18, P=0.006). Patients with AC underwent more CCACS than those without (11.6% vs. 0.5%, OR = 29.1, P=0.0001). Patients with AC had more ER and hospital admissions (33.7% vs. 14.4%, P<0.0001, OR=3). Individuals with hypertension, smoking, and hyperlipidemia exhibited higher rates of AC (OR=2.66, 4, and 1.9, respectively). A statistically significant excess mortality in those with AC was not demonstrated (P=0.076).

Conclusion

AC appears to be associated with cardiovascular morbidity and increased incidence of CCACS. Primary preventive strategies in patients with AC may reduce cardiovascular morbidity.

Funding Acknowledgement

Type of funding sources: None.
Prospective analysis of gender-related characteristics in relation to cardiovascular disease in a population-based cohort in Amsterdam: the HELIUS study
Authors: Bolijn R , Kunst A E , Appelman Y , Galenkamp H , Moll Van Charante E P , Stronks K , Tan H L , Van Valkengoed I G M
Published: October 2021

Background

Cardiovascular diseases (CVD) are a major public health problem in men and women worldwide. Differences in CVD incidence between men and women have been widely reported, although explanations for these differences remain unclear. Next to sex-related (biological) characteristics, gender-related (sociocultural) characteristics may partly explain how these differences arise.

Purpose

We aimed to establish the associations between selected gender-related characteristics and CVD incidence.

Methods

We linked baseline data of 18,058 participants without CVD from the multi-ethnic HELIUS study (Amsterdam, the Netherlands) to CVD incidence data, based on hospital admission and death records from Statistics Netherlands in 2013–2018. Using Cox regression analyses, we studied associations of time spent on household work, doing home repairs, primary earner status, type of employment, performing a male-dominated or female-dominated occupation, and desire for emotional support with CVD incidence, overall (with or without adjustment for sex) and stratified by sex. Analyses were adjusted for age, ethnicity, and socioeconomic status.

Results

In the fully adjusted analyses, most gender-related characteristics were not associated with higher CVD incidence, overall and among men. In women, homemakers had a higher hazard for CVD compared to fulltime workers (hazard ratio [HR] 2.34, 95% confidence interval [CI] 1.35–4.04), whereas those spending a moderate amount of time on household work had a lower hazard for CVD than those spending little time (HR 0.56, 95% CI 0.34–0.95).

Conclusion

Although most gender-related characteristics were not associated with CVD incidence in men, being the homemaker and time spent on household work were associated with CVD incidence in women. Thus, attention to gender-related characteristics may in future help to identify subgroups that may benefit from additional prevention strategies, particularly in women.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): ZonMw Gender and Health (grant number 8492ehab724.26598) and Gender and Prevention (grant number 555003016) programmes.European Union's Horizon 2020 research and innovation programme under acronym ESCAPE-NET (grant number 733381) and the COST Action PARQ (grant agreement number CA19137).
Post-COVID-19 syndrome: prospective evaluation of clinical and functional outcomes
Authors: Ybarra Falcon C , Aparisi A , Garcia Gomez M , Iglesias Echeverria C , Tobar J , Ladron R , Uribarri A , Jaurrieta Largo S , Catala P , Hinojosa W , Veras Burgos C , Marcos Mangas M , Carrasco Moraleja M , Amat Santos I J , San Roman Calvar A
Published: October 2021

Introduction

Coronavirus disease 2019 (COVID-19) is a highly pathogenic coronavirus characterized by by systemic inflammatory response with endothelial damage and a dysregulated coagulation system. Despite most patients survive the acute setting of COVID-19, their long-term clinical sequelae are highly unclear. We have sought to identify the impact of post-COVID-19 syndrome on mid-term follow-up and gain some additional insights about the potential explanation for persistence of dyspnea.

Methods

This is a 3-month prospective cohort study of previously hospitalised COVID-19 patients recruited from a single Spanish center, a small outpatient group without prior hospitalisation was also evaluated. Patients underwent serial testing with cardio-pulmonary exercise test (CPET), transthoracic echocardiogram, pulmonary lung test, six-minute walking test, serum biomarker analysis and quality of life questionaries. They were classify according to the presence of persistent dyspnea. Primary study outcome was predicted peak oxygen consumption (V02) according to CPET and predicted carbon monoxide diffusion capacity.

Results

Our study included 41 (58.6%) patients with dyspnea and 29 (41.4%) asymptomatic. Symptomatic patients had a higher proportion of females (73.2% vs. 51.7%), but comparable age and prevalence of cardiovascular risk factors. We did not observe differences among the assessed variables in transthoracic echocardiogram and pulmonary function test. Patients who referred dyspnea had smaller predicted peak O2 consumption (77.8 [64–92.5] vs. 99 [88–105]: p<0.001), total distance in the 6-minute walking test (535 [467–600] vs. 611 [550–650] meters; p=0.001), and quality of life (KCCQ-23 60.1±18.6 vs. 82.8±11.3; p<0.001). Additionally, abnormalities in CPET were suggestive of a ventilation/perfusion misthmach or hyperventilatory syndrome characterized by impaired ventilatory efficiency with a greater VE/VCO2 slope (32 [28.1–37.4] vs. 29.4 [26.9–31.4]; p=0.022) and low PETCO2 (34 [32–39] vs. 38 [36–40]; p=0.025).

Interpretation

In this study >50% of COVID-19 survivors present a symptomatic functional impairment irrespective of age or prior hospitalization. Compared to asymptomatic patients, among those who referred dyspnea our findings suggest potential ventilatory inefficiency.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Gerencia Regional de Salud de Castilla y Leόn; Grant from the Spanish Society of Cardiology Tabla de resultados
Digital therapeutics: a systematic review of clinical trials characteristics
Authors: Santoro E , Boscherini L , Caiani E G
Published: October 2021

Introduction

Digital therapeutics (DTx) are a subset of digital health tools delivering evidence-based therapeutic interventions that are driven by high quality software programs to prevent, manage, or treat a medical disorder or disease. They are studied using randomized clinical trial methodology and reviewed, cleared or certified by regulatory bodies as required to support product claims regarding risk, efficacy, and intended use.

Purpose

To perform a systematic review of clinical research/studies conducted in the field of DTx with the aim to describe studies where DTx were used, classifying them by digital intervention and condition, and analysing and reporting the characteristics of clinical trials.

Methods

The U.S. National Library of Medicine ClinicalTrials.gov was searched using the terms “digital therapeutics”, “digital therapeutic”, “digital therapy”, and “digital therapies” within the fields “Intervention/treatment” and “Title/Acronym”, and the resulting trial characteristics were extracted and analysed.

Results

In total, 560 clinical trials were retrieved on January 10, 2021. Most of them (n=424, 75.7%) were excluded because they were observational studies (n=82), non-randomized/single arm assignment studies (n=123), not involving any digital health tool (n=181), or involving digital health tools not classified as DTx (n=38). Of the remaining 136 trials, the DTx intervention was delivered through apps (n=57, 41.9%), web-based systems (n=35, 25.7%), videogames (n=12, 8.8%), virtual reality (n=6, 4.4%), text messages (n=5, 3.7%), social media platform (n=4, 2.9%), computer-based systems (n=3, 2.2%), or other (n=14, 10.3%), and applied to the following clinical scenarios: mental health (n=47, 34.6%), chronic pain and chronic diseases (n=26, 19.1%), smoking and other substances abuse or addiction (n=17, 12.5%), insomnia and sleeping disorders (n=12, 8.8%), obesity and physical activity (n=11, 8.1%), cardiovascular diseases (n=10, 7.3%), and other conditions (n=13, 9.6%). Apps were used more frequently for chronic pain (54%) and sleeping disorders (67%), while videogames and web-based systems were adopted for mental health in 21.3% and 38% of the trials, respectively, and text messages were preferred in 18.2% of obesity and 17.6% of addiction trials, respectively Sixty-eight trials (50%) started in the last three years (2019, 2020, and 2021), while 54.4% were ongoing, 33.8% completed, 2.9% stopped early, and 8.8% with status unknown.

Conclusions

The term “digital therapeutics” was very often incorrectly used by researchers when they register their trials in ClinicalTrials.gov, improperly including studies involving the use of digital health tools to support a drug intake or monitor a condition. Mobile apps, web-based systems and videogames were the most adopted technologies to deliver DTx, while mental health diseases, chronic pain, and addiction were the conditions in which they were most frequently studied.

Funding Acknowledgement

Type of funding sources: None.
The use of elctronic cigarettes among medical student in Casablanca
Authors: Tsoumbou-Bakana G , Alafifi Y , Traore B , Hassoune S , Nani S
Published: October 2021

Introduction

The electronic cigarette is an electronic device containing or not nicotine that produces vapours that are inhaled by users, thus mimicking the use of conventional cigarettes. These devices nevertheless contain components that are harmful to health. They have become particularly popular in recent years, especially among young people.

Objective

To estimate the frequency of e-cigarette use among medical students and to describe perceptions and practices of e-cigarette use.

Methods

This was a descriptive cross-sectional study conducted from August 2020 to March 2021 among medical students at the Faculty of Medicine and Pharmacy in Casablanca. The data were collected through a selfadministered, pre-tested, online questionnaire. The sample size was calculated a priori and statistical analyses were carried out using RStudio software.

Results

A total of 491 students were collected with a mean age of 21.03+/- 2.35 years, 66% were female, 51.9% were undergraduates and 20.6% were first year students. The frequency of e-cigarette use was 20.2%, and smoking was 20.8%. Of the 99 e-cigarette users, 75.75% had used e-cigarettes in the past 12 months. More than 21.9% of e-cigarette users used it daily, the most frequent reasons for use were curiosity (88.6%) and imitation (58.4%). Regarding perceptions, 22.1% felt more or less informed about the risks of e-cigarettes, 54.8% agreed that e-cigarettes are an effective way to quit smoking and 29.5% thought they would be more effective than nicotine replacement therapies.

Conclusions

The frequency of e-cigarette use is high among future doctors despite their knowledge of the health effects of its use. Preventive measures should be implemented to improve the health of students.

Key messages

Medical student are a subgroup particulary vulnarable to e-cigarette use. The perceptions of medical students, future health care providers, are heterogeneous.
Hospital Patients’ migration among Italian Regions
Authors: Nante N , Guarducci G , Messina G , Fabrizio M , Urbani A
Published: October 2021

Background

At the beginning of the 2000s the federalization of the Italian National Health Service gave to the Regions greater financial and political responsibility: 21 Regional Health Services were set up with administrative and planning independence. They are in a potential competitive regime, since the citizens are free to choose their place of treatment. The aim of our research was to analyze fulfillment of needs for hospital services on site and Patients' migration to hospitals of other Regions.

Methods

We conducted an observational cross sectional study on Hospital Discharge Cards provided by the Ministry of Health, upon specific request, from 2013 to 2017. The subjects of the analysis (catchment areas) were the hospital networks of Italian Regions. Interregional flows were carried out from data of Residents, Attractions and Escapes, which were developed through Attraction and Escape Indexes. Graphic representation was produced with Gandy's Nomogram.

Results

In the studied period, we observed an important decrease in hospitalizations and a simultaneous increase in interregional mobility. At the same time, admissions to hospital managed by Local Health Authorities and to Private Clinics increased. According to the Major Diagnostic Categories the main causes of hospitalizations in mobility were Musculoskeletal System And Connective Tissue Diseases (MDC 8), Cardiovascular System Diseases (MDC 5), Nervous System Diseases (MDC 1) and Digestive System Diseases (MDC 6). There were discrepancies between the Regions of Northern/Central Italy (higher Attraction Indexes) and Southern Italy (higher Escape Indexes). According to Gandy's Nomogram only nine Regions showed a good public hospital planning: Lombardy, A.P. of Bolzano, Veneto, Friuli V.G., E. Romagna, Tuscany, Umbria, Latium and Molise.

Conclusions

The North/Centre Regions have a public hospital planning able to be better to meet the care needs of their citizens and to attract Patients than the South ones.

Key messages

The study of Patients’ mobility is relevant in order to evaluate equity and quality of care provided by different Italian Regions. Patients' mobility has also an important economic implications.
Italian health workers’ knowledge, attitudes and behaviours towards COVID-19 vaccination
Authors: Regazzi L , Paladini A , Marziali E , Lontano A , Calabrò G E , Messina R , Laurenti P , Boccia S , Ricciardi W , Cadeddu C
Published: October 2021

Background

Vaccine hesitancy is the reluctance or refusal to be vaccinated. While it has been widely studied for various contagious diseases, there is still a lack of knowledge about this phenomenon for COVID-19, especially if health workers' hesitancy is considered.

Methods

An extensive review of the literature was conducted to identify the main determinants of vaccine hesitancy in health workers, as well as to find already validated surveys to evaluate the knowledge, attitudes and behaviors (KAB) of health workers towards vaccination, both in general and with specific regard to COVID-19. Building on the available information, a new survey was developed to assess the KAB of Italian health care workers towards COVID-19 vaccination after validation with a pilot study in a diverse sample of 30 Italian health workers.

Results

A new survey was validated to assess the KAB of health workers towards COVID-19 vaccination in Italian health workers. The survey requires about 6 minutes to complete and is composed of 30 questions, investigating different domains: socio-demographic and professional characteristics (6); health status (2); attitudes (11); behaviors (6); knowledge (4). The survey will be administered to a representative sample of at least 385 Italian health workers through the web platform SurveyMonkey in the period June-September 2021. Preliminary results will be available by the end of October 2021.

Conclusions

By analyzing KAB towards COVID-19 vaccination with a new tool, the magnitude and determinants of health worker's COVID-19 vaccine hesitancy will be evaluated to understand how to improve health workers' perception towards COVID-19 vaccination and, consequently, foster their positive influence on the general population.

Key messages

We explore the knowledge, attitudes and behaviors towards COVID-19 vaccination in all categories of health workers operating on the Italian territory to understand the reasons of vaccine hesitancy. Understanding the determinants of COVID-19 vaccine hesitancy in Italian health workers is necessary given their influence on the perception of the general population in Italy.
The impact of a printed educational booklet on disease awareness in women with gestational diabetes
Authors: Staynova R , Vasileva E , Stankova T , Yanachkova V
Published: October 2021

Background

Gestational diabetes mellitus (GDM) is a major health concern which could lead to adverse pregnancy outcomes. Women with newly diagnosed GDM need additional information and education about this pregnancy complication. The aim of current study was to evaluate the impact of a printed educational booklet on disease awareness in women with GDM.

Methods

One hundred and thirty-five pregnant women with newly diagnosed GDM who attended antenatal clinic were randomly assigned to either an intervention (n = 45) or a control group (n = 90). The women from intervention group received additional printed educational booklet about GDM management, while patients from the control group received standard care. The booklet includes information about risk factors, treatment alternatives, self-monitoring of blood glucose, nutritional management and lifestyle modification. After one month a self-administered written questionnaire was used for evaluation of women's knowledge about GDM management. Descriptive statistics and chi-square test were used to analyse the data.

Results

Demographic and maternal characteristics were similar in both groups. The overall mean age was 32.3 years ranging from 24 to 45. The correct answers about diabetes complications awareness were reported in more than 50% of women in both groups. There was a significant difference in knowledge about the risk factors for GDM (85% in the intervention group versus 44% in the control group, P < 0.001). The number of correct answers was higher in the intervention group regarding GDM treatment (92% compared to 79% in the control group, P < 0.01), self-monitoring of blood glucose and outcomes of GDM (P < 0.001). The differences in nutritional knowledge were not statistically significant.

Conclusions

The results from the study show that printed educational materials can improve patients' knowledge about GDM management as well as their health literacy and motivation.

Key messages

Providing a printed educational booklet in addition to standard pregnancy care for women with GDM may be beneficial for achieving therapeutic goals. The booklet used in this study could assist healthcare providers in improving the knowledge and educational process of women with GDM.
Adverse childhood experiences and risky behaviours in two Tunisian University Hospitals
Authors: Mlouki I , Nouira S , Omrane A , Ourchefeni M , Omri N , Youssef F Ben , Sfar H , El Absi M , El Mhamdi S
Published: October 2021

Introduction

According to the Health Word Organization (WHO), adverse childhood experiences (ACEs) have several harmful outcomes on mental health in adolescence and later life. We aimed at investigating the relationship between ACEs and risky behaviors among Tunisian health professionals.

Methods

A cross sectional study was conducted between November 2018 and March 2019 among health care workers in two University Hospitals in Tunisia. We assessed exposure to violence in the hospital, behavioral (cyberaddiction) and chemical addiction (tobacco and alcohol use). ACEs were screened using the Arabic validated version of the Adverse childhood experiences-International Questionnaire (ACE-IQ) developed by the WHO.

Results

A total of 546 health professionals were enrolled with a mean age of 34.5 ± 9.6 years and a majority being female (70%). Almost 34.8% were doctors. The majority of them (67.3%) reported exposure to physical violence at work by patient or their families. The most common hazardous practice was internet addiction (18.5%) followed by tobacco use (13.2%). All health risk behaviors were significantly more prevalent among males and youth (<35 years) (p < 0.01). After adjustment for violence at work and socidemographic characteristics, logistic regression revealed that ACEs especially physical violence (OR = 1.8; IC [1.1-2.9]), emotional abuse (OR = 4.5 [1.2-16.6]) and bullying (OR = 2.6 [1.6-4.2]) increase the risk of the adoption of addictive behaviors among health caregivers.

Conclusions

Policy makers might implement collaborative interventions with psychiatrics targeting the prevention of early life adversities, this could be helpful to delay the onset of risky behaviors.

Key messages

Exposure to early life adversities increase the risk of addictive behaviors among health caregivers. Collaborative interventions with psychiatrics targeting screening childhood adversities could be helpful to delay the onset of risky behaviours.
Risk factors associated with Salmonella specific antimicrobial resistance: animal and meat samples
Authors: Costa M , Cardo M , Cara d'Anjo M , Leite A
Published: October 2021

The food system is seen as a major source of antimicrobial resistance (AMR), a threat that has led to an increase of the global burden of infectious diseases. Thus, AMR occurrence was studied in animals and derived meat from Portugal, 2014-2018. AMR surveillance data from Portugal was used. Salmonella AMR was estimated for broilers, laying hens, broiler and pig meat. AMR associated factors were studied: population, year, season, sampler, (HACCP, industry, official, official/industry). AMR occurrence in more than half isolates was assessed using a multivariate logistic regression and a backward stepwise method for each antimicrobial class model, presenting adjusted odds ratio (aOR) and 95% confidence intervals (95%CI). This study included 832 Salmonella isolates. Resistance to more than half isolates was observed to (fluoro)quinolones (broilers:52%; broiler meat:53%), penicillins (pig meat:56%), tetracyclines (pig meat:80%), sulphonamides (pig meat:62%). AMR was more likely to occur to penicillins, tetracyclines, sulphonamides in broiler meat (respectively, aOR 3.18;95%CI 1.95-5.18, 3.38;95%CI 1.27-9.19, 2.46;95%CI 1.44-4.19) and pig meat (respectively, aOR 9.39;95%CI 6.01-14.51, 53.84;95%CI 21.61-144.91, 14.58;95%CI 9.16-23.66), compared to broilers. A lesser AMR chance was observed to (fluoro)quinolones in 2017 and 2018 (respectively, aOR 0.07;95%CI 0.00-0.36, 0.13;95%CI 0.06-0.24) while a higher chance was found to tetracyclines in 2016 and 2018 (respectively, aOR 8.08;95%CI 2.25-30.74, 2.56;95%CI 1.14-6.00), compared to 2014. A higher chance for resistance was detected in spring to (fluoro)quinolones (aOR 2.32;95%CI 1.23-4.46) and penicillins (aOR 2.11;95%CI 1.20-3.78) and summer to (fluoro)quinolones (aOR 2.77;95%CI 1.46-5.35), compared to winter. These results indicate a need to reinforce biosecurity and disease prevention during spring and summer to tackle penicillins, tetracyclines and sulphonamides AMR in animal meat, but also (fluoro)quinolones in broilers.

Key messages

Biosecurity and prevention measures need to be reinforced during spring and summer to mitigate Salmonella AMR occurrence across the food system. Critical AMR occurrence to (fluoro)quinolones was found to be more associated with broilers.
Studying mutation rate evolution in primates—the effects of computational pipelines and parameter choices
Authors: Pfeifer Susanne P
Published: October 2021

This commentary investigates the important role of computational pipeline and parameter choices in performing mutation rate estimation, using the recent article published in this journal by Bergeron et al. entitled “The germline mutational process in rhesus macaque and its implications for phylogenetic dating” as an illustrative example.
Physics-inspired pseudo-transient method and its application in modelling focused fluid flow with geological complexity
Authors: Wang Lawrence Hongliang , Yarushina Viktoriya M , Alkhimenkov Yury , Podladchikov Yury
Published: October 2021

Two-phase flow equations that couple solid deformation and fluid migration have opened new research trends in geodynamic simulations and modelling of subsurface engineering. Physical non-linearity of fluid-rock systems and strong coupling between flow and deformation in such equations lead to interesting predictions such as spontaneous formation of focused fluid flow in ductile/plastic rocks. However, numerical implementation of two-phase flow equations and their application to realistic geological environments with complex geometries and multiple stratigraphic layers is challenging. This study documents an efficient pseudo-transient solver for two-phase flow equations and describes the numerical theory and physical rationale. We provide a simple explanation for all steps involved in the development of a pseudo-transient numerical scheme for various types of equations. Two different constitutive models are used in our formulations: a bilinear viscous model with decompaction weakening and a viscoplastic model that allows decompaction weakening at positive effective pressures. The resulting numerical models are used to study fluid leakage from high porosity reservoirs into less porous overlying rocks. The interplay between time-dependent rock deformation and the buoyancy of ascending fluids leads to the formation of localized channels. The role of material parameters, reservoir topology, geological heterogeneity and porosity is investigated. Our results show that material parameters control the propagation speed of channels while the geometry of the reservoir controls their locations. Geological layers present in the overburden do not stop the propagation of the localized channels but rather modify their width, permeability, and growth speed.
The B∞-Structure on the Derived Endomorphism Algebra of the Unit in a Monoidal Category
Authors: Lowen Wendy , Van den Bergh Michel
Published: October 2021

Consider a monoidal category that is at the same time abelian with enough projectives and such that projectives are flat on the right. We show that there is a $B_{\infty }$-algebra that is $A_{\infty }$-quasi-isomorphic to the derived endomorphism algebra of the tensor unit. This $B_{\infty }$-algebra is obtained as the co-Hochschild complex of a projective resolution of the tensor unit, endowed with a lifted $A_{\infty }$-coalgebra structure. We show that in the classical situation of the category of bimodules over an algebra, this newly defined $B_{\infty }$-algebra is isomorphic to the Hochschild complex of the algebra in the homotopy category of $B_{\infty }$-algebras.
Prevalence and patterns of HIV drug resistance in patients with suspected virological failure in North-Western Tanzania
Authors: Henerico Shimba , Mikasi Sello Given , Kalluvya Samuel Elias , Brauner Jan M. , Abdul Seif , Lyimo Eric , Desderius Bernard , Korn Klaus , van Zyl Gert , Jacobs Graeme Brendon , Preiser Wolfgang , Kasang Christa
Published: October 2021

Background

More than 15 million people in sub-Saharan Africa receive ART. Treatment failure is common, but the role of HIV drug resistance in treatment failure is largely unknown because drug resistance testing is not routinely done. This study determined the prevalence and patterns of HIV drug resistance in patients with suspected virological failure.

Materials and methods

A single high viral load of >1000 viral RNA copies/mL of plasma at any point during ART was considered as suspected virological failure. HIV-1 RNA was extracted from plasma samples of these patients using the QIAamp Viral RNA kit. The protease and part of the RT regions of the HIV pol gene were characterized.

Results

Viral load was determined in 317 patients; 64 (20.2%) had suspected virological failure. We successfully genotyped 56 samples; 48 (85.7%) had at least one major resistance-associated mutation (RAM). Common mutations in RT were M184V (75%), T215Y (41.1%), K103N (39.3%), M41L (32.1%), D67DN (30.3%), G190A (28.6%) and A98G (26.8%). No RAMs were detected in ART regimens based on a ritonavir-boosted PI.

Conclusions

The Tanzanian national guidelines define ‘virological failure’ as two consecutive viral load measurement results, at 3 month intervals, above the WHO threshold (1000 copies/mL). Here, we show that a single viral load above the WHO threshold is associated with high rates of RAMs. This suggests that a single high viral load measurement could be used to predict virological failure and avoid delays in switching patients from first-line to higher genetic barrier second-line regimens.
Flake density and starch retrogradation influence in situ ruminal degradability characteristics of steam-flaked corn and predicted starch digestibility and energetic efficiency
Authors: Trotta Ronald J , Kreikemeier Kelly K , Royle Randy F , Milton Todd , Harmon David L
Published: October 2021

Five ruminally cannulated steers (body weight = 390 ± 7.86 kg) were used in two experiments to evaluate the effects of flake density and starch retrogradation on in situ ruminal degradation of steam-flaked corn. In experiment 1, sifted flakes with flake densities of 257, 296, 335, 373, and 412 g/L (enzymatic starch availabilities: 87%, 76%, 66%, 43%, and 49%, respectively) were evaluated in a randomized complete block design experiment. In experiment 2, the experimental design was a randomized complete block design with a 3 × 2 factorial arrangement of treatments. Three steam-flaked corn fractions corresponding to different particle sizes were used: flakes + fines (not sifted; >4 and <4 mm), sifted flakes (>4 mm), and sifted fines (<4 mm). Particle size fractions were stored for 3 d at either 23 °C or 55 °C (starch availabilities averaged across particle sizes: 53.3% and 25.5%, respectively) in heat-sealed foil bags. Samples were ruminally incubated for 0, 3, 6, 12, 24, 48, 72, or 96 h. Degradation data were modeled to obtain the rate and extent of degradation and passage rate was set to 6% per hour. In experiment 1, the rate of degradation decreased linearly (P < 0.01) and in situ ruminal dry matter (DM) degradability decreased linearly (P < 0.01) from 78.9% to 57.3% as flake density increased from 257 to 412 g/L. In experiment 2, storage of steam-flaked corn samples at 55 °C for 3 d decreased (P < 0.01) the rate of degradation by 37.6% across all particle sizes. Storing samples at 55 °C for 3 d decreased (P < 0.01) in situ ruminal DM degradability of flakes + fines, sifted flakes, and sifted fines by 20.9%, 22.6%, and 14.7%, respectively. Using data from experiment 1 and 2, enzymatic starch availability of sifted flakes was positively correlated (R2 = 0.97; P < 0.01) with in situ ruminal DM degradability. The results demonstrate that decreased starch availability resulting from either starch retrogradation or increased flake density is associated with decreased ruminal digestibility. Decreases in starch availability and in situ ruminal degradability may indicate that increasing flake density or starch retrogradation could potentially alter the site of digestion in cattle. Using prediction equations, decreases in ruminal starch digestibility of steam-flaked corn caused by increasing flake density or increasing starch retrogradation could increase energetic efficiency, depending on the rate of passage and if small intestinal starch digestibility is maintained.
Development of cisplatin resistance in breast cancer MCF7 cells by up-regulating aldo-keto reductase 1C3 expression, glutathione synthesis and proteasomal proteolysis
Authors: Kobayashi Mio , Yonezawa Ayano , Takasawa Hiroaki , Nagao Yukino , Iguchi Kazuhiro , Endo Satoshi , Ikari Akira , Matsunaga Toshiyuki
Published: October 2021

Cisplatin (CDDP) is widely prescribed for the treatment of various cancers including bladder cancers, whereas its clinical use for breast cancer chemotherapy is restricted owing to easy acquisition of the chemoresistance. Here, we established a highly CDDP-resistant variant of human breast cancer MCF7 cells and found that procuring the resistance aberrantly elevates the expression of aldo-keto reductase (AKR) 1C3. Additionally, MCF7 cell sensitivity to CDDP was decreased and increased by overexpression and knockdown, respectively, of AKR1C3, clearly inferring that the enzyme plays a crucial role in acquiring the CDDP resistance. The CDDP-resistant cells suppressed the formation of cytotoxic reactive aldehydes by CDDP treatment, and the suppressive effects were almost completely abolished by pretreating with AKR1C3 inhibitor. The resistant cells also exhibited the elevated glutathione amount and 26S proteasomal proteolytic activities, and their CDDP sensitivity was significantly augmented by pretreatment with an inhibitor of glutathione synthesis or proteasomal proteolysis. Moreover, the combined treatment with inhibitors of AKR1C3, glutathione synthesis and/or proteasomal proteolysis potently overcame the CDDP resistance and docetaxel cross-resistance. Taken together, our results suggest that the combination of inhibitors of AKR1C3, glutathione synthesis and/or proteasomal proteolysis is effective as an adjuvant therapy to enhance CDDP sensitivity of breast cancer cells.