bluuebunny/crossref_metadata_2025 huggingface dataset:
Resolution of silent left atrial thrombi and clinical outcomes in patients with atrial fibrillation: insight from the LAT trial
Authors: Koichi I , Okada M , Tanaka N , Mishima T , Ozaki T , Osaki S , Masuda M , Sunaga A , Sotomi Y , Hikoso S , Nakatani D , Sakata Y
Published: October 2024

Background

Silent thrombi in the left atrium (LA), which are thrombi that have not yet caused thromboembolism, are occasionally observed in patients undergoing transesophageal echocardiography (TEE) for atrial fibrillation (AF). However, there is limited data regarding the impact of resolving these silent LA thrombi (LAT) on patient outcomes.

Methods

We conducted a retrospective review of clinical records from 2010 to 2018 at six hospitals, involving 17,436 TEE procedures for patients with AF. Among these, 297 patients (1.7%) were identified with silent LAT. Of these, 169 patients with follow-up TEE or cardiac computed tomography data for assessing the resolution of LAT were included in this study. The study population were categorized into two groups: the successful resolution group, defined as those with complete LAT resolution without any related events (N=130), and the failed resolution group (N=39). The latter included patients with residual LAT at the last follow-up (N=26), individuals with thromboembolic events (N=8), or those who required surgical intervention for LAT (N=5).

Results

During the median follow-up period of 394 days (interquartile range, 373-421 days) following thrombi detection, ischemic stroke and systemic thromboembolism (IS/SE) were observed in 10 cases, major bleeding in 23 cases, and all-cause death in 8 cases. In comparison to the successful resolution group, the failed resolution group not only exhibited a higher incidence of IS/SE (1.5% in the successful vs. 20.5% in the failed resolution group, Log-rank p < 0.001) but also showed trends toward increased major bleeding (10% vs. 23.1%, p = 0.033) and higher total mortality rates (3.1% vs. 10.3%, p = 0.05). These differences in composite endpoints were also statistically significant (13.9% vs. 35.9%, p = 0.001).

Conclusion

In patients with silent LATs were identified, non-resolution of these LATs was associated with not only a higher incidence of IS/SE but also increased rates of major bleeding and all-cause mortality. Conversely, patients who experienced LAT resolution exhibited more preferable prognoses. The status of LAT resolution is closely associated with patient outcomes, underscoring the importance of monitoring LAT resolution in stratifying patient prognoses.
Maintenance of sinus rhythm is associated with lower incidence of stroke in patients with drug-refractory atrial fibrillation
Authors: Kim S , Choi Y , Park S , Kim S H , Oh Y S , Kim H
Published: October 2024

Introduction

Recent studies have demonstrated that early rhythm control for first-line treatment of atrial fibrillation (AF) improved cardiovascular outcomes. However, there is limited data regarding the long-term outcome of patients who failed antiarrhythmic drugs and who refuse radiofrequency catheter ablation (RFCA).

Methods

Patients with AF who were refractory to antiarrhythmic drugs and had refused further rhythm control attempts via RFCA were retrospectively identified and propensity-score matched with who had been treated with RFCA. The primary outcome of interest was all-cause mortality or ischemic stroke.

Results

A total of 169 patients who refused rhythm control with RFCA and propensity-score matched 169 patients who had been treated with RFCA were included for analysis. During a mean follow-up of 4.3[2.3;6.9] years, maintenance of sinus rhythm was more achieved in RFCA group (7 [4.1%] in Refuse group vs. 133 [78.7%] in RFCA group, p<0.001). the incidence of ischemic stroke was significantly higher in patients who refused RFCA compared with patients who underwent RFCA (24 [14.2%] vs. 6 [3.5%], log-rank p<0.001), but all-cause mortality was not significantly different (log-rank p=0.8). Refusal of attempted rhythm control via RFCA was an independent risk factor for ischemic stroke on multivariate Cox analysis (hazard ratio 3.2; 95% confidence interval 1.2 to 8.53, p=0.02). The risk of major adverse cardiovascular events (MACE) were also significantly higher in Refuse group (31 [18.3%] vs. 12 [7.1%], HR 3.83, 95% CI 1.57-9.37, p=0.003).

Conclusion

In patients with antiarrhythmic drug-refractory AF, maintenance of sinus rhythm was significantly different dependent on rhythm control via RFCA, therefore the risk of stroke was significantly higher in patients who refused rhythm control via RFCA compared with that of those treated with RFCA.
A mcgyvering way to left bundle branch area pacing : using the treadmill test machine ECG system and modified V1 / V6 leads connected to the pacing system analyser for left bundle branch area pacing
Authors: Pattu Valappil S , Pasupati U S , Krishnaswamy S , Jaiswal P K , Prasad G N , Jayanthi K , Srinath T S
Published: October 2024

Background

Left bundle branch area pacing (LBBaP) is a novel pacing modality which provides physiological synchronisation of both the ventricles. However, its use and adoption requires the presence of a standardised electrophysiological (EP) system with 12 lead ECG to show left bundle branch area capture.

Purpose

The aim of the study was to assess the feasibility and outcomes of using the conventional treadmill test (TMT) machine 12 lead ECG system and modified V1 and V6 leads connected to the pacing system analyser (PSA) to demonstrate conduction system capture during left bundle branch area pacing (LBBaP).

Methods

LBBaP was attempted by a single operator in a mixed cohort of patients at peripheral hospitals lacking the standardised EP system. The presence of LBB area capture was tested with the aid of the 12 lead ECG system connected to the standard TMT machine (1). Conduction system capture was also assessed using modified V1 and V6 leads connected to the PSA for measurement of V6 left ventricular activation time (LVAT)(2) . The baseline clinical, procedural, pacing, electrocardiographic parameters, echocardiographic response (> 10% improvement in ejection fraction {EF}) and clinical response to LBBaP were assessed.

Results

LBBaP was attempted in 19 patients and was successful in 18 patients (94.7%). Patient characteristics include age 66.7 +/- 11.47 years, female 47.37%, male 52.63%, ischaemic cardiomyopathy 10.52% and non-ischaemic cardiomyopathy 5.26% .The mean baseline EF and QRS duration was 45%+/-14% and 130.18 +/-10.45 milliseconds(ms) respectively. LBBaP threshold was 0.59 +/-0.168 volts and R wave amplitude was 12+/-3.5 millimetres , which remained stable during the mean follow up of 15.9 +/-13.67 months. The mean fluoroscopic duration was 11.57 +/-2.58 minutes and procedural time was 108.78+/-29.20 minutes. LBBaP resulted in impressive narrowing of the QRS duration to 102.39 +/-10.55 ms (p<0.001) with LVAT of 68.94 +/-9.94 ms. LVEF improved in the patients with cardiomyopathy from 33.4 +/- 5.77 % to 48.2+/-12.37 % (p=0.028) .Clinical and echocardiographic response was noted in 87.5% of patients with cardiomyopathy.

Conclusion

The 12 lead ECG system with the standardised TMT machine in conjunction with the modified V1 and V6 leads connected to the PSA is a feasible alternative to the EP system to perform successful left bundle branch area pacing.ECG leads connected during LBBapClinical profile of patients
Long-term efficacy of cardiac resynchronization therapy with triple-site ventricular stimulation in heart failure patients
Authors: Ogano M , Iwasaki Y , Kimura K , Kawanaka H , Tajiri M , Tanabe J , Shimizu W , Asai K
Published: October 2024

Background

Cardiac resynchronization therapy (CRT) reduces cardiac electrical dyssyncrhony and improves clinical outcomes in selected symptomatic patients with left ventricular (LV) systolic dysfunction. However, patients after conventional CRT (Bi-V) have residual cardiac electrical dyssynchrony. CRT with multi-site pacing has gained attention to improve short-term outcome refractory to BiV. However, long-term follow up outcome is still uncertain. We evaluated the efficacy of CRT with triple-site ventricular stimulation (Tri-V), involving 2 LV lead in 2 anatomically separated veins and a single RV lead in RV apex for long-term follow up period.

Methods

Ninety-two consecutive patients with New York Heart Association class II-IV heart failure, LV ejection fraction <0.35, and QRS interval >120ms, who underwent CRT implantation between 2010 and 2016, were enrolled. Acute hemodynamic responses to temporary dual-site and triple-site ventricular pacing were evaluated, and patients were assigned to either the Bi-V or Tri-V group based on the results. The primary endpoint was the HF clinical composite score, which scores patients as improved, unchanged, or worsened. The secondary endpoint included cumulative survival from any cause of death and HF hospitalization.

Results

Tri-V was successfully implanted in 32 patients. Five patients were excluded during follow-up because of uncaptured pacing in one of the LV leads. One year post-implantation, the clinical composite score significantly improved in 84% of Tri-V patients compared to 57% in the Bi-V group (p=0.026). After a median follow-up of 12.0 years, there was no significant difference about all-cause mortality between Tri-V and Bi-V (p=0.147). However, Tri-V group showed significant lower HF hospitalization (p=0.005) than Bi-V group. The number of battery exchange was not significantly different between Tri-V than Bi-V group (1.4±0.7 vs. 1.2±0.8, p=0.361).

Conclusion

CRT with Tri-V, characterized by stable lead parameters, appears to offer greater long-term benefits than Bi-V in terms of clinical status without excessive battery exchanges.figure
Estimated transmitral E- and A-wave overlapping predicted prognosis in patient with heart failure with preserved ejection
Authors: Iwakura K , Tanaka N , Okada M , Okamura A , Watanabe H , Seo M , Hayashi T , Yano M , Yamada T , Yasumura Y , Hikoso S , Okada K , Nakatani D , Sotomi Y , Sakata Y
Published: October 2024

Background

The impact of heart rate (HR) variability on clinical outcomes in patients with heart failure with preserved ejection fraction (HFpEF) is not fully understood. Variations in HR may affect transmitral blood flow and consequently left ventricular filling and left atrial pressure. Changes in HR can cause the transmitral E-wave and A-wave to merge at higher HRs, while their interval lengthens at slower HRs (Figure: left). A recent study (Izumida. ESC Heart Fail. 2020;7:3231) demonstrated that the degree of overlap or interval between E- and A-waves can be estimated using resting HR and the deceleration time of the E-wave (DcT) on Doppler echocardiography.

Purpose

This study aims to investigate the relationship between the estimated overlap length between E- and A-waves and prognosis in patients with HFpEF.

Methods

Echocardiography was performed before hospital discharge in 398 patients (80±9 years, 59.0% female) hospitalized for decompensated HFpEF who were registered in the PURSUIT-HFpEF (Prospective, Multicenter, Observational Study of Patients with Heart Failure with Preserved Ejection Fraction) registry. The overlap length between E- and A waves was estimated using the formula [6.2 × HR (bpm) + 0.81 × DcT (ms) -589 (ms)] as previously described (a negative value means distance between two waves). Patients were divided into four groups based on quartiles of overlap length (Q1 to Q4, with Q4 representing the highest overlap length) and followed for a median duration of 759 days (interquartile range: 370, 1107 days) to observe all-cause mortality.

Results

The estimated overlap length in the study patients was -167±85 ms, and 105 deaths occurred during follow-up. The overlap length was selected as an independent predictor for all-cause mortality by Cox proportional hazards regression analysis (p=0.04), whereas HR or DcT was not. Kaplan-Meier curves indicated the difference in all-cause mortality among 4 groups (Figure: Right, p=0.02 by log-rank test), and the Q4 group (335 to -123ms) showed significantly higher mortality than the Q2 (-124 to -173 ms, p=0.03).

Conclusion

The overlap length of E and A predicted mortality in HFpEF patients, and the presence of overlap or shorter interval were associated with higher mortality. Optimal HR based on overlap length may be a new target for HFpEF therapy.Figure 1
Contemporary use of beta-blockers in the outpatient treatment of heart failure with atrial fibrillation
Authors: Iwanaga Y , Nakai M , Kanaka K , Miyamoto Y
Published: October 2024

Background

Evidence of the effectiveness of β-blockers in heart failure (HF) and atrial fibrillation (AF) in a contemporary cohort is controversial. This study investigated the association between the use of β-blockers and prognosis in outpatients across a broad spectrum of HF with AF.

Methods

Patients hospitalized with the first episode of acute HF were identified from the National Database of Health Insurance Claims and Specific Health Checkups of Japan between 2014 and 2021. Associations of β-blocker use at discharge and prognosis were compared by propensity score matching among the AF or non-AF group. A multilevel mixed-effects survival model was used with hazard ratio (HR) and 95% confidence interval (CI).

Results

Among 428,650 patients discharged with HF in 4,433 hospitals, 175,174 (40.9%) were ≥85 years old, 151,873 (35.4%) had complicated AF, and 236,457 (55.2%) were β-blocker users. In a matched AF group, β-blocker use was associated with a lower composite outcome of all-cause mortality or HF rehospitalization (HR [95% CI], 0.95 [0.93–0.97]). A similar result was obtained in a matched non-AF group (0.95 [0.94–0.96]). In addition, the HRs in patients aged ≥85 years and female patients were 1.00 [0.98–1.02] and 1.01 [0.98–1.03] in the AF group and 1.03 [1.01–1.05] and 0.98 [0.97–1.00] in the non-AF group, respectively (Figure).

Conclusions

The favorable prognostic associations of β-blocker use were observed regardless of AF in outpatients across a broad spectrum of HF in a superaged society. However, β-blocker use may not be effective in older or female patients.
Development and validation of a predicting model for risk of mortality in heart failure patients with mildly reduced ejection fraction post discharge
Authors: Zhu Y L , 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

Prognostic prediction for heart failure with mildly reduced ejection fraction (HFmrEF) patients remains challenging. We aimed to create and validate a mortality risk prediction model for HFmrEF patients at 6-month, 1-year, and 3-year post discharge.

Methods

Clinical data of 1691 HFmrEF patients registered in the heart failure registry from 2015 to 2020 at the Heart Center of our hospital were analyzed. Patients were assigned into a training (1183 patients) and validation cohort (508 patients) at 7:3 ratio. Predictive variables for mortality at various period post discharge were identified by the Least Absolute Shrinkage and Selection Operator (LASSO) regression analysis. The predicting model was then established based on these variables. Model performance was evaluated with ROC curve and Decision Curve Analysis (DCA).

Results

Eight predictors were identified including age, NT-proBNP, hemoglobin levels, use of beta-blockers, ACEI/ARB, invasive ventilation, PCI procedures, and pulmonary artery systolic pressure values. The model achieved a C-index of 0.748 (training set) and 0.755 (validation set). Area Under the Curve (AUC) for training set at 6 months, 1 year, and 3 years were 0.813, 0.784, and 0.774, and AUC for validation set were 0.775, 0.744, and 0.770, respectively. The DCA analysis confirmed the favorable net benefit of the established nomogram model.

Conclusion

This predicting model might be used for post-discharge risk stratification and individual decision-making of post-discharge management in HFmrEF patients.
Chronotropic incompetence across heart failure categories
Authors: Magrì Damiano , Piepoli Massimo , Gallo Giovanna , Fiori Emiliano , Correale Michele , Attanasio Andrea , Beltrami Matteo , Lauretti Attilio , Palazzuoli Alberto , Agostoni Piergiuseppe
Published: October 2024

The heart failure (HF) syndrome is characterized by an autonomic unbalance with sympathetic hyperactivity, which contributes to increased myocardial oxygen demand, oxidative stress, peripheral vasoconstriction, afterload mismatch with a progressive desensitization, and down-regulation of cardiac β1-receptors. These changes, together with a few other structural and peripheral changes, lead to chronotropic incompetence (CI), such as the inability to increase heart rate (HR) consistently with activity or demand. Chronotropic incompetence, regardless of the method and cut-off adopted to define it, is associated with reduced exercise capacity and a worse prognosis. Furthermore, different pharmacological classes might interfere with the physiologic exercise-induced HR response, thus generating some confusion. In particular, the β-blockers, albeit lowering peak HR, are known to improve prognosis and left ventricular inotropic reserve so that their withdrawal should be avoided at least in HF with reduced and mildly reduced ejection fraction. Similarly, a still debated strategy to counterbalance a blunted exercise-induced HR response is represented by rate-adapting pacing. The present review, besides supplying an overview on possible CI definitions, discusses the clinical impact of CI and potential pharmacological and non-pharmacological therapeutic strategies.
Antimicrobial resistance trends in Italian hospitals: insights from two point prevalence surveys
Authors: Russotto A , Vicentini C , Bussolino R , Castagnotto M , Gastaldo C , Bresciano L , Bazzolo S , Gamba D , Zotti C M
Published: October 2024

Background

Antimicrobial resistance (AMR) presents a critical challenge to global healthcare systems, necessitating vigilant surveillance efforts. The European Centre for Disease Prevention and Control (ECDC) conducts point prevalence surveys (PPSs) to monitor AMR trends across European hospitals. This study focuses on comparing AMR patterns in Italian hospitals using data from two surveys: PPS2 (2016-2017) and PPS3 (2022-2023).

Methods

A total of 140 hospitals enrolling 28991 patients participated in PPS2, while 325 hospitals with 58506 patients contributed data to PPS3. Microbiological samples were collected and tested for antimicrobial susceptibility. Prevalence ratios (PR) with corresponding 95% confidence intervals (CI) were calculated to assess changes in resistance patterns between PPS2 and PPS3. Statistical significance was determined with p-value <0.05.

Results

Staphylococcus aureus showed a trend towards decreased oxacillin resistance, (PR: 0.77, 95% CI: 0.60 - 0.99). Enterococcus faecalis exhibited a non-significant decrease in glycopeptide resistance. Pseudomonas aeruginosa and Acinetobacter baumannii maintained stable carbapenem resistance between the two surveys. Escherichia coli and Klebsiella pneumoniae showed a decreasing trend in resistance to carbapenems and third-generation cephalosporins, but only Klebsiella pneumoniae was found to be significant (PR: 0.69, 95% CI: 0.55 - 0.88, p 0.004 and PR: 0.78, 95% CI: 0.66 - 0.94, p 0.01, respectively).

Conclusions

These findings underscore the importance of surveillance in monitoring AMR trends. Observed decreases, especially in Klebsiella pneumoniae, suggest potential improvements. However, the overall stability of resistance highlights the ongoing challenge of combating AMR. A multifaceted approach, including antimicrobial stewardship and One Health initiatives, is crucial to address this global health threat effectively.

Key messages

• Surveillance efforts are crucial to understand antimicrobial resistance (AMR) trends, as demonstrated by comparing data from two surveys in Italian hospital.

• Results highlight the need for data-driven interventions, guiding future strategies within a One Health framework to address antimicrobial resistance comprehensively.
Assessing inequalities and inequities in Health Impact Assessment: a systematic review
Authors: Properzi S , Coa A A , Fiorilla C , Pasetto R
Published: October 2024

Background

Health Impact Assessment (HIA) procedures can include the assessment inequalities and inequities associated with the distribution of environmental health risks and benefits, attenuating the exacerbation of health disparities in this domain. However, prevailing approaches to tackle inequalities in accessing ecosystem services exhibit limitations. We explored how this kind of assessment in HIA procedures is documented within the international literature.

Methods

Following PRISMA Guidelines, we conducted a systematic review of scientific literature by searching in MEDLINE/PubMed, Scopus, and Embase databases up to 8 March 2024. Moreover, a grey literature analysis was conducted, examining the World Health Organization’s Institutional Repository for Information Sharing (IRIS) to identify guidance considering equity in HIA.

Results

Eight out of 158 documents identified on IRIS, using ‘health impact assessment’ as a filter, underscore the importance of integrating the equity domain into the HIA; of these, only 1 employs methodologies to actively consider it. Of the 806 literature studies analyzed, only 14 included used methods to evaluate inequalities and equity in HIA in various contexts, ranging from urban planning, such as green or redeveloped areas, and transport planning, to mining. Preliminary results show that in most studies, data were collected through surveys, focus group discussions, and peculiar “walks” with local experts. The predominant approaches in extant literature entail the use of socioeconomic status and health determinants as metrics for assessing equity and inequalities within HIA.

Conclusions

Our findings highlight a critical gap in integrating equity into HIA practices, with limited attention and methodological diversity observed across the analysed documents and studies.

Strategies for probing and mitigating inequalities can be strengthen by engaging different stakeholders and the residing population.

Key messages

• There are few and highly heterogeneous methods for assessing inequality in HIA.

• An effective and standardized strategy to asses inequality in HIA could involve stakeholders and the resident population.
Exposome, oxidative stress and inflammation in multiple sclerosis: the EXPOSITION study protocol
Authors: Monti M C , De Giuseppe R , Bertoli G , Tavazzi E , Kalmpourtzidou A , Alemayohu M A , Maccarini B , Oddone E , Montomoli C , Cena H
Published: October 2024

Background

The functional exposome approach examines the relationship between biological effects (internal exposome) and the sum of environmental exposures (external exposome). Multiple sclerosis (MS) is characterized by selective demyelination and acute inflammation; miRNAs and microbiota are emerging in the pathogenesis as inflammation and oxidative stress biomarkers. The EXPOSITION study protocol has been designed to study such biomarkers variation in response to the external exposome (air pollution, urbanization, lifestyles) in people with MS (pwMS).

Methods

EXPOSITION is a cross-sectional observational study collecting a sample of 200 pwMS residing in Lombardy, Northern Italy. Sample size is based on the prediction of differential expression of candidate miRNAs through bioinformatic analyses. All participants will be investigated for social, demographic and clinical data as well as general and specific external exposome factors. The internal exposome factors will be collected for each participant from blood and stool samples, as well as from nasal swabs. Exposome clustering and correlation statistical techniques will be applied and variation of miRNA and microbiota will be tested in association with the variation of the external exposome in urban and extra-urban environments.

Results and conclusions

The expected results will help pwMS and researchers understanding which biomarkers and which components of the external exposome are associated to oxidative stress and inflammation, to improve precision medicine and contrast disease progression. The relationship between urban exposome and biodiversity is an important dimension in the study of environmental impact on human health. This study may provide preliminary data to assess which nature-based solutions are suitable for enhancing the biodiversity of urban areas.

Key messages

• The functional exposome approach could be used to link environmental risk factors and disease biomarkers using the right methology.

• EXPOSITION will quantify the variation of miRNA and microbiota in association with the variation of external exposome, in urban and extra-urban environments.
How to run a qualitative methods short course in epidemiology: faculty and student perspectives
Authors: Gille F , Frei A , Kaufmann M , Lehmann A , Muñoz Laguna J , Papadopoulos K , Spörri A , Stanikić M , Tušl M , Zavattaro F
Published: October 2024

Background

Qualitative research and mixed methods are core competencies for epidemiologists. In response to the shortage of guidance on graduate course development, we wrote a course development to guide faculty and students designing similar courses in epidemiology curricula. We combine established educational theory with faculty and student experiences from a recent introductory course for epidemiology and biostatistics doctoral students at the University of Zurich and Swiss Federal Institute of Technology, Zurich.

Objectives

We propose a 1-ECTS, six session long, student-centred course with inverse in-person classroom teaching and practice exercises with faculty input. The overarching course objective is to introduce students to qualitative research and mixed methods. The proposed course covers learning outcomes in comprehension, knowledge, application, analysis, synthesis and evaluation.

Results

Following an introductory session, the students engage in face-to-face interviews, focus group interviews, observational methods, analysis and how qualitative and quantitative methods are integrated in mixed methods. Furthermore, the course covers interviewer safety, research ethics, quality in qualitative research and a practice session focused on the use of interview hardware, including video and audio recorders. The student-led teaching characteristic of the course allows for an immersive and reflective teaching-learning environment.

Conclusions

After implementation of the course and learning from faculty and student perspectives, we propose these additional foci: a student project to apply learned knowledge to a case study; integration in mixed-methods; and providing faculty a larger space to cover theory and field anecdotes. Based on: Gille, et al. A guide for a student-led doctoral-level qualitative methods short course in epidemiology: faculty and student perspectives, International Journal of Epidemiology, Volume 53, Issue 2, April 2024.

Key messages

• Qualitative research methods and mixed methods are core competencies for epidemiologists.

• Students appreciate a student-centred course design with inverse classroom teaching and practice exercises.
Trends in Regional Disparities of Cardiovascular Surgery and Mortality in South Korea
Authors: Jin D-L , Kim K-H , Chung E S , Yoon S-J
Published: October 2024

Objectives

Regional disparities in cardiovascular care in South Korea have led to uneven patient outcomes. Although procedure access and needs are increasing, few studies have linked regional service availability to mortality rates. This study analyzed variation in utilization of major cardiovascular procedures by region and association with short-term mortality to provide better evidence on links between healthcare resources distribution and patient survival.

Methods

A cross-sectional study was conducted using nationwide claims data on patients who underwent coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), stent insertion, or aortic aneurysm resection in 2022. Regional variation was assessed by a Relevance Index (RI). The associations between regional RI and 30-day mortality were analyzed.

Results

The RI was lowest for aortic aneurysm resection (mean, 26.2; standard deviation, 26.1), indicating the most uneven regional distribution among the surgical procedures. Patients undergoing this procedure in regions with higher RIs showed significantly lower 30-day mortality (adjusted odds ratio [aOR], 0.73; 95% confidence interval, 0.55 to 0.96; p = 0.026) versus those with lower RIs. This suggests that cardiovascular surgery regional availability, as measured by RI, has an impact on mortality rates for certain complex surgical procedures. The RI was not associated with significant mortality differences for more widely available procedures like CABG (aOR, 0.96), PCI (aOR, 1.00), or stent insertion (aOR, 0.91).

Conclusions

Significant regional variation and underutilization of cardiovascular surgery were found, with reduced access linked to worse mortality for complex surgeries. Addressing disparities through cooperation among hospitals and policy efforts is warranted to improve outcomes.

Key messages

• This study analyzed regional variations in major cardiovascular procedures using the Relevance Index and investigated their impact on mortality rates within 30 days of admission.

• Addressing regional disparities requires improved healthcare infrastructure and comprehensive networks of specialists to ensure timely and high-quality cardiovascular care across South Korea.
Using Unsupervised Learning Methods to Explore the Trajectory of Long-Term Care Service in Taiwan
Authors: Chang Y H , Lu H H , Chien S C , Yen C M , Lai C Y , Chung R H , Chiou H Y
Published: October 2024

Background

Understanding the temporal trends in long-term care (LTC) utilization enables more effective planning by government and service providers. This study employed machine learning methods to explore LTC utilization trajectories among care recipients in a southern county of Taiwan.

Methods

Administrative data from the government-funded LTC programme was utilized, with a total of 24,614 participants included after excluding those with less than six months of data. Daily service utilization records, mainly focusing on caregiving services, were aggregated, and the number of days each participant used LTC services within every 30-day period post-application was calculated. Utilization rates during 6 and 12 months post-application were separately analyzed. K-means clustering, an unsupervised machine learning method, was employed to select the optimal classification and identify LTC utilization trajectories using 10-fold cross validation. Temporal frequency variations of each caregiving service within each trajectory group were visualized using heatmaps.

Results

In the analysis of LTC utilization within the first 6 months post-application, trajectories were classified into 7 groups; while within 12 months, trajectories were divided into 4 groups. These trajectories can be categorized into 4 distinct patterns: High-Stable (6 mo: 21.3%; 12 mo: 35.7%), Low-Stable (6 mo: 33.1%; 12 mo: 37.2%), High-Decrease (6 mo: 12.8%; 12 mo: 10.7%), and Low-Increase (6 mo: 32.7%; 12 mo: 16.5%). We further explored differences in socio-demographic characteristics and needs factors among trajectory groups. Heatmaps were used to illustrate temporal variations in the utilization rates of specific service items, which played a significant role in determining the trajectories.

Conclusions

K-means clustering is useful in identifying distinct patterns among LTC users. Tailored service delivery strategies can be designed to meet the diverse needs of these different user groups.

Key messages

• The unsupervised machine learning method distinguished various temporal dynamic patterns in LTC utilization.

• Tailored service delivery strategies can be designed to meet the diverse needs of these different user groups.
Antimicrobial resistance and infection prevention in care for people with intellectual disabilities
Authors: Hidad-Nuh S , de Greeff S C , Haenen A , de Haan F , Leusink G L , Timen A
Published: October 2024

Background

Antimicrobial resistance (AMR) has become one of the major public health threats worldwide. However, little is known about antimicrobial resistance and infection prevention and control (IPC) in long-term care facilities for people with intellectual disabilities. This study aims to assess knowledge, attitudes and perceptions towards AMR and IPC among healthcare professionals working in long-term care facilities for people with intellectual disabilities (ID-LTCFs) in the Netherlands.

Methods

We conducted a web-based cross-sectional survey study among medical and nonmedical trained healthcare professionals working in ID-LTCFs in the Netherlands. The survey study was carried out between July and November 2023 and consisted of validated survey items expanded with expert opinion and setting-specific items.

Results

In total, 109 medical and nonmedical trained healthcare professionals working in 37 long-term care organizations for people with intellectual disabilities throughout the Netherlands completed the questionnaire. Overall, knowledge levels about AMR and IPC differed between medical and nonmedical trained healthcare professionals working in ID-LCTFs, with medically trained professionals having a significant overall higher score on both topics. Knowledge regarding the perceived protective value of glove use was found to be insufficient. Moreover, healthcare professionals expressed a need for easy-to-read resources and tailored setting-specific information on AMR and IPC targeting both healthcare professionals as well as people with disabilities.

Conclusions

There is room for improvement regarding setting-specific IPC and hygiene policies, such as appropriate glove use in ID-LTCFs. As nonmedically trained professionals comprise most of the workforce within this setting, it is important to further tailor follow-up studies to the underlying factors that influence knowledge, attitudes and perceptions of these specific professionals within ID-LTCFs.

Key messages

• Developing setting and context-specific policies for infection prevention and control is crucial, particularly in long-term care facilities for people with intellectual disabilities.

• Inclusive policy-making is key to combating antimicrobial resistance, and improving infection prevention and control in long-term care facilities for people with intellectual disabilities.
Balancing public health and public safety: a situational analysis of a substance use pathway
Authors: Mills T , Jarrett M , Chaplin E , Mallion J , Wills J , Sykes S
Published: October 2024

Background

Public health solutions to substance use harms are of interest across Europe, where the level of health need among detainee populations is broadly consistent. A need for multiagency working is widely recognised, as well as role changes with a view to the police engaging in health generating activity, as part of the wider public health workforce. This qualitative study explores the prospect for a multiagency, public health pathway in an English county district. This involved multiagency working across the community and custody settings.

Methods

25 semi-structured interviews with senior and frontline staff of diverse agencies involved in pathway development, including public health, police, treatment providers and the NHS. A ‘frame-critical’ situational analysis sought to understand the strengths, weaknesses, opportunities and threats presented by the pathway. Data were organised into themes.

Results

Three themes highlighted the challenges and opportunities for addressing substance use harms via multiagency collaboration across the community and custody settings. The themes highlighted how 1) agencies’ shared commitment to public health was unsettled by subtle differences on the meaning of prevention; 2) community police were more accepting of new health activity than custody police; 3) a trade-off impeded a proactive approach: the need for substance worker capacity to support police in the custody suite (a reactive approach) meant that limited community outreach was possible, despite opportunities for preventative community work involving substance workers and community police.

Conclusions

Public health solutions are challenging to develop in a context of contrasting understandings of ‘public health’, unclear national policy and resource constraints. The design of multiagency public health pathways must be participatory and inclusive to ensure staff buy-in: in particular, new health activities need to align with police staff’s sense of role congruence.

Key messages

• Multiagency public health collaborations should start by establishing a shared understanding of what ‘public health’ and ‘prevention’ mean.

• A long-term perspective on training and motivational alignment (e.g., via feedback) is necessary to implement health-related activity among custody police staff.
Factors associated with tobacco consumption during pregnancy in Portugal: a cross-sectional study
Authors: Gomes F , Leite A , Machado A
Published: October 2024

Background

Tobacco consumption during pregnancy hinders mother and foetus health. Previous studies in Portugal have attempted to assess tobacco consumption and its associated factors; but none have studied representative samples.

Objectives

We aimed to estimate the prevalence of tobacco consumption during pregnancy in Portugal, and to determine sociodemographic, economic and healthcare access associated factors.

Methods

We performed a cross-sectional study using 2019 National Health Survey data. Women reporting a pregnancy between 2010 and 2019 were included. The outcome was daily or occasional tobacco consumption during pregnancy. Exposure variables were age group, nationality, marital status, region of residence, educational level, occupation/professional area, social support, net monthly income, and pregnancy trimester in the first surveillance appointment. Populational prevalence of tobacco consumption, and crude (PR) and adjusted prevalence ratios (aPR) with 95% confidence intervals (95%CI) were obtained using Poisson regression.

Results

Prevalence was 8.1% (95%CI: 5.6-11.4) (n = 744). PR was higher in young (PR: 1.4, 95%CI: 0.7-2.8), Portuguese (PR: 4.2, 95%CI: 1.1-16.4), single (PR: 1.6, 95%CI: 0.7-4.0) pregnant women, living in Azores (PR: 2.9, 95%CI: 1.0-7.9), with the 9th grade (PR: 4.9, 95%CI: 1.8-13.9), manual job (PR: 4.2, 95%CI: 1.2-14.2), weak social support (PR: 3.3, 95%CI: 1.3-8.7), 3rd income quintile (PR: 4.5, 95%CI: 1.0-19.9), 2nd or 3rd trimester appointment (PR: 2.1, 95%CI: 0.8-6.0). aPR was higher in pregnant women with the 9th grade (aPR: 4.7, 95%CI: 1.7-13.4) or high school (aPR: 4.0, 95%CI: 1.5-10.8) and weak social support (aPR: 2.9, 95%CI: 1.2-6.6).

Conclusions

The prevalence of tobacco consumption during pregnancy in Portugal was comparable to the European Region. Portuguese pregnant women, with less than tertiary education, and weak social support showed higher prevalences.

Key messages

• The prevalence of tobacco consumption during pregnancy in Portugal was 8.1%. Pregnant women with less than tertiary education, and weak social support showed higher prevalences of tobacco consumption.

• Overall, smoking is more prevalent in socioeconomically disadvantaged pregnant women thus contributing to increased health inequities.
Assessing the health risks from flooding and chemical contamination: a scoping review
Authors: Kovats S , Karakas F , Rother H A , Duarte-Davidson R
Published: October 2024

Flooding can increase the mobilization of hazardous chemicals in the environment. This scoping review provides an overview of the evidence on how flood events effect our health through chemical contamination and describes the exposure pathways to guide prevention and response measures. Flooding includes surface water flooding, coastal flooding, river flooding, storm surge, monsoon rainfall and high tide. We found 110 papers that looked at the association between flooding and chemicals in the environment, with most studies looking at heavy metals, polyhydroxyalkanoates (PAHs), and arsenic. There was a lack of information on rural populations and studies on mobilisation of pesticides. Very few studies mapped or modelled human exposures, including for high-risk populations (e.g., children), and this remains an important evidence gap. Studies considering climate change highlighted the likelihood of chemical contamination and health risks to be exacerbated. Our results highlighted new pathways by which flood events mobilise chemicals and pose risks to human health (i.e., urban runoff, industrial sources). Although found extensively in the environment, gaps were identified in the evidence for pesticides, microplastics and heavy metals. Limited studies reported response measures to address the chemical contamination linked to flooding despite the health risks likely to increase due to poor infrastructure and management measures despite the extent of contaminated land and landfill sites. A dual risk management strategy (i.e., the coordinated management of both flood-related and chemical release risks is required to address flooding events, chemical releases, and health impacts.
A source and a destination country for migrant healthcare workers: the case of Ireland
Authors: Hanlon H , Humphries N
Published: October 2024

Background

Ireland has a long tradition of emigration, particularly to countries such as the United Kingdom and the USA. Since 2000, Ireland has become increasingly reliant upon migrant healthcare workers. At present, 43% of nurses and 45% of physicians registered in Ireland, trained internationally.

Methods

This study draws on literature and available data (migration and registration data) to illustrate recent patterns of healthcare worker migration into and out of Ireland.

Results

The data show that Ireland depends heavily on migrant healthcare workers to staff its health system. In 2021-22, internationally trained healthcare workers comprised 71% of new entrants to the medical register and 69% of new entrants to the nursing register. In terms of outward migration, the data also indicate a consistent pattern of outward migration of physicians to countries such as Australia, the United Kingdom, Canada, and New Zealand.

Conclusions

A heavy (and growing) reliance on migrant healthcare workers to staff the Irish health system implies a failure to train or retain sufficient healthcare workers locally and indicates weak healthcare workforce planning capacity. It also highlights a disconnect between Irish healthcare workforce planning and the WHO global code on the international recruitment of health personnel. This study will consider some of the risks associated with high rates of inward and outward healthcare worker migration in the Irish context.
Diabetes among people with intellectual disabilities vs the general population: a register study
Authors: Stroh E , Sandberg M , Kristensson J , Axmon A
Published: October 2024

People with intellectual disabilities have an increased risk of diabetes mellitus (DM). They tend to develop it at earlier ages than the general population, resulting in even higher risks in younger people. However, few studies have separated Type 1 and Type 2 DM. The aim of this study was to assess prevalence of different types of DM in different age groups in relation to the general population. We categorized all people in Skåne, Sweden, as ID (service and support for people with ID and/or autism, or a diagnosis of ID or Down syndrome; n = 14 716) or general population (gPop; excluding family members of people in ID; n = 1 226 955). Data regarding diagnoses of Type 1 (E10 in ICD-10) and Type 2 (E11) DM were collected for 2014-2021. Age at inclusion (i.e., 2014) was considered as children (0-12 years), adolescents (13-18), young adults (19-24), adults (25-44), lower middle-age (45-54), upper middle-age (55-64), older people (65+). The overall prevalence of Type 1 DM was 2.3% in ID and 1.6% in gPop (relative risk [RR] 2.14, 95% confidence interval 1.93-2.38). In ID, the prevalence was below 2% in the youngest age groups, and then increased with age until upper middle-age, where it reached 6.0%. The risk of Type 1 DM among people with ID compared to gPop was relatively stable, with the RR ranging between 1.16 (older people) to 2.83 (adults). For Type 2 DM, the overall prevalence was 7.2% in ID and 7.8% in gPop (RR 2.00, 1.89-2.13). There was a consistent age-related increase in prevalence in ID, from 0.3% among children to 27.4% among older people. The opposite pattern was found for the risk compared to gPop, with the higher risks (RR 3.63-6.98) in the younger age groups and lower risks (RR 1.27-4.41) in the older age groups. Both types of DM were more prevalent among people with intellectual disabilities than in the general population. However, the patterns of prevalence and risk compared to the general population differed for the two types.

Key messages

• People with intellectual disabilities have increased risk of both Type 1 and Type 2 diabetes mellitus.

• Type 1 and Type 2 diabetes mellitus displays different age patterns among people with intellectual disabilities.
Joint effect of tobacco and meat on cardiovascular disease and treatment adherence in Indian Women
Authors: Ferdous J , Jin-Kyoung O H
Published: October 2024

Background

Cardiovascular disease (CVD) is a leading cause of death for both men and women in India. But it is often overlooked in women. Tobacco and meat consumption are common risk factors for CVD. While individual studies have explored the link between tobacco or meat consumption and CVD, their joint effect remained understudied.

Methods

The study analyzed data from the National Family Health Survey 2019-21, of 711431 women aged 15 to 49 in India. Univariate and multivariate logistic regression were used to assess the risk of individual and joint effects of tobacco and meat consumptions on self-reported CVD prevalence. Age, BMI, education, wealth index, residency, region, religion, and alcohol were used as covariates. Additionally, interactions model was assessed. Lastly, treatment adherence for CVD was studied, considering treatment behavior, insurance, and healthcare access barriers.

Results

Cardiovascular disease prevalence was 0.72%. The risk of CVD was higher among the smokers [aOR: 2.26(1.83-2.73)] than smokeless tobacco [aOR: 1.34(1.21-1.49)] consumers. In contrast daily meat consumers showed higher risk [aOR: 1.23(1.03-1.47)] than meat non-consumers. Women who were consumers of both tobacco and meat had risk of [aOR: 1.15 (1.02 - 1.30)] CVD compared to who did not consume both tobacco and meat. Interaction was not detected between tobacco and meat consumption. CVD treatment adherence was higher among the women who possess an insurance [OR: 1.11(1.04-1.19)]. The risk of treatment non-adherence was higher among women who were aged below 40 with no education and from the poorest section of the society. Barriers for accessing health care facilities were solo attendance, provider availability, and drug access.

Conclusions

Tobacco and meat both need to be addressed to control CVD among women. Empowering women and bringing them under government insurance with an improve health care system are crucial.

Key messages

• The joint effect of tobacco and meat consumption increased the risk of cardiovascular diseases among women. However, there was no interaction effects observed between tobacco and meat consumption.

• Healthcare facilities needs to be improved and awareness among young adults are extremely crucial for better CVD treatment management among women in India.