bluuebunny/crossref_metadata_2025 huggingface dataset:
A machine-learning-based bio-psycho-social model for the prediction of non-obstructive and obstructive coronary artery disease
Authors: Raparelli V , Proietti M , Romiti G F , Seccia R , Di Teodoro G , Tanzilli G , Marrapodi R , Flego D , Corica B , Cangemi R , Palagi L , Basili S , Stefanini L ,   EVA Group
Published: October 2021

Background

Although cardiovascular disease is the leading cause of mortality in both females and males, women are more likely to have non-obstructive ischemic heart disease (IHD) than men. However, the underlying sex- and gender-specific mechanisms and differences in IHD manifestations are still not fully understood.

Aim

To develop an interpretable machine learning (ML) model to gain insight on the clinical, functional, biological and psychosocial features playing a major role in the supervised prediction of non-obstructive versus obstructive CAD.

Methods

From the EVA study, we analyzed a consecutive unselected cohort of adults hospitalized for IHD undergoing coronary angiography. Non-obstructive CAD was defined by a coronary stenosis at the angiogram <50%. Baseline clinical and psycho-socio-cultural characteristics were used for computing a frailty index based on Rockwood and Mitnitsky model, and gender score according to GENESIS-PRAXY methodology. The serum concentration of inflammatory cytokines was measured with a multiplex flow cytometric assay. An XGBoost classifier combined to an explainable artificial intelligence tool (SHAP) was employed to identify the most influential features in discriminating obstructive versus non-obstructive CAD.

Results

Among the overall EVA cohort (n=509), 311 individuals (mean age 67±11 years, 38% females; 67% obstructive CAD) with complete data were analyzed. The ML-based model (83% accuracy and 87% precision) revealed that while obstructive CAD associated with higher frailty index (i.e., lower physiological reserve), older age and a cytokine signature characterized by IL-1β, IL-12p70 and IL-33, non-obstructive CAD was more likely associated with higher gender score (i.e., social characteristics traditionally ascribed to women, regardless of biological sex) and with a cytokine signature characterized by IL-18, IL-8, IL-23.

Conclusions

Integrating clinical, biological and psycho-social features, we have optimized a sex- and gender-unbiased model that discriminates obstructive and non-obstructive CAD. Further mechanistic studies will shed light on the biological plausibility of the observed associations.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Italian Ministry of Education, Research and University, Scientific Independence of young Researcher (SIR)
Case-ascertainment of acute myocardial infarction hospitalisations across two national data sources for an English cardio-oncology cohort
Authors: Coles B , Teece L , Adlam D , Sweeting M J ,   the VICORI collaborative
Published: October 2021

Background

Cardio-oncology is an emerging field aimed at minimising cardiovascular morbidity and mortality in survivors of cancer. Though cardio-oncology patients make up a significant proportion of hospital admissions, they are typically excluded from clinical trials. Electronic health record-based research is a good alternative to understand the risk of cardiovascular disease in these patients. However, completeness and validity of cardiovascular outcome ascertainment may vary by data source.

Purpose

1) Determine ascertainment of acute myocardial infarction (AMI) hospitalisations across two national data sources for English cancer patients, and 2) understand factors that affect ascertainment in this population.

Methods

English cancer patients were obtained from the National Cancer Registration and Analysis Service. AMI hospital admissions occurring during 2010–2017 were identified from two sources: the Myocardial Ischaemia National Audit Project (MINAP) registry and Hospital Episode Statistics (HES). Admissions were ascertainable from both MINAP and HES, or “matched”, if dated within 30 days.

Results

112,502 hospital admissions for 95,509 patients were identified of which 57,265 (50.9%) admissions were captured in MINAP and HES, 26,104 (23.2%) in MINAP only, and 29,133 (25.9%) in HES only. Case-ascertainment percentages were similar across cancer site, stage and grade of disease. Cases ascertained from MINAP only were younger, had fewer comorbidities, and were more likely to have ST-elevated MI and better survival than those ascertained from HES only. The percentage of admissions that could be ascertained from both MINAP and HES has improved from over time.

Conclusions

MINAP and HES define different populations of cancer patients with AMI. Only half of AMI hospital admissions were captured in both MINAP and hospital records. Therefore, these results support the use of multiple linked data sources for observational cardio-oncological research into AMI.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): British Heart Foundation and Cancer Research UK
Adopting digital health interventions for secondary prevention of cardiovascular disease: clinician perspectives
Authors: Gao Y , Diab A , Sharma A , Khoury S , Huynh P , Spaulding E , Martin S , Marvel F
Published: October 2021

Background

Cardiovascular disease (CVD) remains the leading cause of death globally, taking an estimated 18 million lives each year. Digital health interventions (DHI), such as wearables and smartphone applications, have shown promise in CVD detection, prevention, and management. However, there are scarce data regarding clinician perspectives on the utility of DHI and identification of key elements to support adoption in clinical practice.

Method

In this cross-sectional study, a web-based survey was administered to 107 clinicians directly involved in the care of cardiac inpatients across multiple academic health care systems in the United States, between January 2020 and March 2021. Participants (1) reported their perceptions of DHI impact on their ability to care for patients with CVD, (2) rated the importance of factors related to DHI adoption, and (3) shared perspectives on using DHI for secondary CVD prevention to support guideline-directed medical therapy in patients after acute myocardial infarction. Descriptive statistics were analyzed and summarized as frequencies with percentages.

Results

Among survey respondents, 41% were women; 22% specialized in cardiovascular medicine; and 31% were practicing attendings (Table). Overall, 92% (86/94) of respondents believed that DHI would be important in offering advantages in cardiovascular patient care (Figure). Increasing patient adherence was reported as the most important benefit of DHI adoption by 39% of clinicians, followed by improvement in the patient-clinician relationship (29%), enabling remote care (18%), and improving patient experience (14%). Clinicians under age 40 years old, cardiologists, and internists were the groups more likely to consider DHI important in remote patient care, disease monitoring, and tele-visits, as compared to clinicians over age 40 years old or in other clinical specialties.

Conclusion

Our results highlight clinician perspectives on the advantages of DHI and the potential for its adoption for secondary prevention of CVD.

Funding Acknowledgement

Type of funding sources: None. Table 1. Characteristics of RespondentsFigure 1. Clinician Survey
Process evaluation of the TeleClinical Care pilot study
Authors: Indraratna P , Biswas U , Liu H , Lovell N H , Ooi S
Published: October 2021

Background

A novel smartphone app-based model of care (TeleClinical Care – TCC) for patients with acute coronary syndrome (ACS) and heart failure (HF) was evaluated in a two-site, pilot randomised control trial of 164 participants in Australia. The trial demonstrated improvements in readmission rates, cardiac rehabilitation completion and medication compliance for participants in the intervention arm.

Purpose

A process evaluation was designed with the aims of identifying contextual factors and mechanisms that influenced the results of the trial, as well as identifying methods of improving site and participant recruitment and the delivery of the intervention, for a planned larger effectiveness trial of over 1000 patients across the state of New South Wales (TCC-Cardiac).

Methods

Multiple data sources were used in this mixed-methods process evaluation including interviews with four TCC team members, three general practitioners and three cardiologists. Cardiac rehabilitation completion (CR) rates, heart failure outreach service (HFOS) referrals and cardiologist follow-up appointments were audited. A patient questionnaire was also analysed for evidence of improved self-care as a mechanism of benefit of the TCC app.

Results

Several factors were identified that influenced the success of the trial. Rates of HFOS referral and cardiologist follow-up were high in both arms, and were not significantly different. Team members were largely positive towards their introduction into the trial, but highlighted several factors that could be optimised for the TCC-Cardiac trial, namely streamlining of the enrolment process and improving the reach of the trial, by maximising the screening of potential participants. In their interviews, the GPs and cardiologists viewed the intervention favourably in regard to potential benefit of closely monitoring, and responding to abnormalities in their patients. Several factors were suggested to be optimised prior to the commencement of TCC-Cardiac, such as additional workload and delineation of which party was responsible for alert management. Several patients commented on improved self-management as a result of TCC participation.

Discussion

The TCC trial was successful with the results likely influenced by high rates of follow-up from HFOS and cardiologists. Improved self-care likely drove several benefits including higher engagement with cardiac rehabilitation. The conduct and delivery TCC-Cardiac will be improved by extending recruitment to patients in non-cardiac wards, ensuring team members have adequate time (>15 hours per week) to optimise recruitment, establishing the responsibilities of GPs and cardiologists as part of the model and provision of summary data to them.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): Prince of Wales Hospital
Impact of telehealth in the outpatient management of atrial fibrillation during the COVID-19 pandemic
Authors: Shatla I , Sammour Y , Kennedy K , Wimmer A P
Published: October 2021

Background

The COVID-19 pandemic accelerated adoption of a telehealth model to replace outpatient visits. We studied quality indicators and clinical outcomes associated with virtual visits in comparison to in-person ambulatory visits for patients with atrial fibrillation (AF) seen by electrophysiology providers.

Methods

Quality indicators and outcomes for patients with primary diagnosis of AF seen by electrophysiology providers (6 physicians and 4 nurse practitioners) for the 12 week period of March 22–June 13, 2020 were compared with those from the 12 week period of March 24–June 15, 2019.

Result

We identified 2340 clinic visits for AF (1081 in 2019 and 1259 in 2020). Telehealth was not used in 2019, and was used in 90.5% of the 2020 visits. On multivariate analysis during 120 days following each encounter, there was no difference in hospital admissions between 2019 and 2020 (OR 0.89; 95% CI 0.69–1.14; p=0.3624), and there was trend towards lower emergency department visits in 2020 compared with 2019 (OR 0.77; 95% CI 0.6–1; p=0.0509). There were 36 deaths at 120 days, mortality was similar in 2020 as compared with 2019 (OR 1.5; 95% CI 0.74–3.03; p=0.2601). There was no difference in completed procedures including permanent pacemakers, cardiac resynchronization therapy devices, implantable cardioverter-defibrillators and catheter ablations. There was a significant difference in anticoagulant (OR 0.71; 95% CI 0.52–0.99; p=0.0412) and antiarrhythmic (OR 0.78; 95% CI 0.61–0.99; p=0.0384) dose adjustment or new prescriptions in 2019 compared with 2020.

Conclusion

Telehealth was associated with similar intermediate-term clinical outcomes when compared to traditional ambulatory encounters. However, adjusting or providing new prescriptions for anticoagulant or anti-arrhythmic medications was more common with in-person than with virtual visits.

Funding Acknowledgement

Type of funding sources: None.
Effects of medical graphic narratives (patient comic) on Patient Reported Outcome Measures (PROMs) in patients undergoing coronary angiography and PCI
Authors: Brand A , Gao L , Dreger H , Hamann A , Crayen C , Brand H , Squier S M , Stangl K , Kendel F , Stangl V
Published: October 2021

Background/Introduction

Increasing evidence suggests that patients scheduled for invasive cardiac procedures such as coronary angiography / PCI feel insufficiently informed about the planned procedure.

Purpose

To improve the Patient Informed Consent (IC) before coronary angiography by using “medical graphic narratives” (patient comic) that illustrate central IC-related aspects in a simple and understandable manner.

Methods

A patient comic illustrating central steps of the procedure, risks, treatment alternatives and behavioural measures was created in collaboration with professional scientific visual communicators. In a randomised, controlled, prospective trial, we included 121 patients undergoing coronary angiography/PCI. Patients were randomised to a group that was informed about the procedure using the usual Patient IC approach (official consent form and conversation with physician; Control group) or a group that additionally obtained a patient comic for reading (graphic illustrations of central IC aspects based on the official consent form; Comic group). Patient Reported Outcome Measures (PROMs), i.e. satisfaction with and perceived quality of the patient IC, were tested in both groups comparing single items of the Client Satisfaction Questionnaire-8 (CSQ-8) and self-designed single items in both IC groups. Differences were compared using the Fisher's exact test. A p-value <0.05 was considered statistically significant.

Results

PROMs showed significant benefits in favour of the Comic group: Quality of the patient IC was perceived to be “very good” in 45.0% of the Comic group compared to 24.9% of patients in the Control group (p=0.023). Only 23.0% of the patients in the Control group, compared to 40.0% in the Comic group, stated that the IC procedure completely met their expectations (p=0.012). 57.4% in the Control group and 76.7% in the Comic group stated that all of their questions were satisfactorily adressed before the procedure (p=0.015). 43.3% in the Comic group, in contrast to 18.0% in the Control group, declared to feel “very satisfied” with the obtained IC procedure (p=0.002). The acceptance of the patient comic was very high: no patient (0%) expressed feelings of not being taken seriously by reading the patient comic.

Conclusions

Our data confirm pronounced limitations of the usual Patient IC practice before coronary angiography. The use of a patient comic that narratively illustrates central steps of the procedure positively impacts on patient-centered endpoints and significantly improves the patient IC procedure.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Friede Springer Herz Stiftung
The experience of cardiovascular professional training across europe: preliminary results from the ESC young cardiovascular professionals survey
Authors: Castelletti S , Kosiuk J , Ladeiras Lopes R , Sohaib A , Bohm A ,   the ESC Board Committee for young cardiovascular professionals
Published: October 2021

Background and aim

There are differences in the training programs among European Countries and some sub-specialities are not even recognized in all the training programs. However, discrepancies amongst the Countries and the needs of the trainees are not well known. As such, a survey on the experience of Cardiovascular Professional Training across Europe was created by the ESC Board Committee for Young Cardiovascular professionals to provide a detailed picture of the training programs in the European Countries with deep insights into the needs and expectations of trainees

Methods

Between February and April 2021 a survey with 35 questions on the structure of the training program and on the expectations and needs of the young professionals was launched and advertised through all the official ESC social media and communications channels.

Results

643 under 40-year-old young professionals participated to the survey, 72% cardiologists, 14% other professionals, 3% nurses. The majority of the participants were in practice (59%) and male (57%), mean age was 33 year-old. The current working environment was university hospital (52%), local hospitals (18%), other tertiary locations (13%) and private sector (12%). The majority (54%) of the participants declared not being satisfied with the structure of their training programme and almost all would like a standardised European training programme (94%). The feeling was that more time should be allocated to active participation in interventions (currently 30%, suggested 46%) and that they do not have easy access to all subspecialities (52%). Only 39% of the participants were aware that a 2020 ESC Core curriculum exists and 36% declared that it used in their own Country. Nevertheless, the majority consult the ESC's online education contents (33%, 25% and 17% once per week, per month and per day respectively) and attend Congresses regularly (41% both national and international, 33% only national). Although the majority feel sufficiently recognized for their work by patients, supervisors and society (84%, 65% and 60% respectively), they are unsatisfied from a financial point of view (71%).

Conclusions

The majority of the young cardiovascular professionals feel that their training programme is not satisfactory and a standardised European programme should be implemented. However the ESC Core Curriculum is not well known among the young and not widely used in European Countries. These findings suggest more efforts will be needed to implement a standardized training programme by the ESC and national cardiac societies.

Funding Acknowledgement

Type of funding sources: None. Interventional training needsRecognition feelings of the participants
Impact of adverse events on quality of life and hospital costs in secondary cardiovascular disease prevention
Authors: Lui N M J , Williams C , Keng M J , Hopewell J , Bowman L , Landray M , Gray A , Mihaylova B ,   HPS3/TIMI55-REVEAL Collaborative Group
Published: October 2021

Background and purpose

People with atherosclerotic vascular disease remain at high risk of cardiovascular (CVD) events despite effective risk factor management 1. There is little research on impacts of adverse events on quality of life (QoL) and hospital cost to inform evaluations of novel interventions in this population. We estimate QoL and annual hospital costs associated with a range of adverse events of interests using the individual participant data from the Randomized Evaluation of the Effects of Anacetrapib through Lipid Modification (REVEAL) trial.

Methods

Data from the 30,449 participants with atherosclerotic vascular disease receiving effective statin therapy in REVEAL, were used to estimate regression models for participants' hospital costs and QoL using participants' characteristics at entry (socio-demographic, clinical, prior diseases and treatments) and time-updated adverse events. We estimate costs and QoL in the year of an event, and in subsequent years, using stepwise covariate selection (p-value <0.01). Standard errors were adjusted for clustering of participant annual costs.

Hospital episodes were costed (2019 UK£) using the UK Healthcare Resource Groups reference costs 2. One- and two-part generalized linear regression models (GLMs) for annual hospital costs (part 1: logistic model for estimating probability of incurring cost, part 2: GLM with Gaussian, Poisson or Gamma distributions with identity or log links for estimating costs, conditional on incurring any) were compared.

EQ-5D-5L questionnaires, completed by study participants at entry and final follow-up visits in the study, were mapped into QoL utility scores 3. QoL utility at final follow-up was used to estimate QoL decrements of adverse events using GLM linear model and adjusting for QoL at entry in addition to other participants characteristics.

Results

The two-part model with gamma distribution and identity link, indicated by specification tests and model fit statistics, was selected for modelling annual hospital costs (Figure 1). Non-haemorrhagic stroke, non-coronary revascularization, coronary revascularization and incident cancer were associated with highest hospital costs. The QoL model (Figure 2) indicated large QoL decrements associated with non-fatal non-haemorrhagic stroke, heart failure hospitalization, incident cancer and non-coronary revascularization, and comparatively small QoL decrement associated with experiencing non-fatal myocardial infarction.

Conclusion

These cost and QoL models in a well-managed contemporary high CVD risk patient population would assist in assessments of long-term net effects and cost-effectiveness of novel interventions to reduce cardiovascular risk.

Funding Acknowledgement

Type of funding sources: Other. Main funding source(s): Merck Sharp & Dohme and UK Medical Research Council Figure 1Figure 2
Trends in infective endocarditis mortality in the United Kingdom and EU 15+ countries between 1990–2019: an analysis of the Global Burden of Diseases database
Authors: Hammond-Haley M , Hartley A , Delago A J , Goodall R , Marshall D , Salciccioli J D , Shalhoub J
Published: October 2021

Background

Infective Endocarditis (IE) is a relatively uncommon but lethal condition, with no convincing evidence to date of improving mortality trends (1). The epidemiology of IE is complex, driven by a wide range of constantly evolving factors. While marked international variation has been recently reported (2), temporal trends in mortality over recent decades remain unclear.

Purpose

To describe trends in IE mortality in high income countries over the last 30 years.

Methods

Age-standardised mortality rates (ASMR) for IE, stratified by sex, were extracted from the Global Burden of Disease (GBD) database (3) between 1990 and 2019. The United Kingdom and selected countries with comparable health expenditure (EU15+ countries) were included. Relative changes in ASMR over the observation period were determined and trends were analysed using Joinpoint regression analysis.

Results

Between 1990–2019 ASMR from IE increased for both sexes in all included countries except Finland (−20.1% in males, −15.1% in females) and Austria (−8.98% in males, −22.6% in females). The largest increase in ASMR in males was observed in Greece (+197%), while the largest increase in females was observed in Italy (246%). Joinpoint regression analysis identified multiple significant trends within this observation period (Figure 1; clear squares indicate males, filled circles indicate females and lines represent modelled trends based on joinpoint data). At the end of the observation period the Netherlands had the highest ASMR in both males and females (2.28/100,000 in males and 2.37/100,000 in females), while Finland had the lowest ASMR in both males and females (0.45/100,000 and 0.23/100,000 respectively).

Conclusions

Significant international variation in IE mortality rates were observed. While mortality from IE has generally increased over the last 30 years, recent data suggest this trend may now be plateauing or even reversing in certain countries.

Funding Acknowledgement

Type of funding sources: None. Figure 1
Trial leadership by women is associated with racial diversity among heart failure clinical trial participants: a systematic bibliometric review 2000–2020
Authors: Wei S , Le N , Zhu J W , Breathett K , Greene S J , Mamas M A , Zannad F , Van Spall H G C
Published: October 2021

Background

For the results of randomized controlled trials (RCTs) to be generalizable, they should report on and include the broad range of patients who have the disease.

Purpose

We assessed temporal trends and trial factors associated with 1) the reporting of race or ethnicity data and 2) the enrolment of Black, Indigenous, and people of colour (BIPOC) in Heart Failure (HF) RCTs.

Methods

We searched MEDLINE, EMBASE, and CINAHL for RCTs that recruited adults with HF and were published in journals with an impact factor ≥10 between January 1, 2000 and June 17, 2020. We extracted data in duplicate and used the Cochran-Armitage and Jonchkeere-Terpstra tests to examine temporal trends. We used multivariable regression to assess the independent association between trial factors and the outcomes of interest.

Results

A total of 414 RCTs met inclusion criteria, of which a vast majority (90.6%; 95% CI 87.4–93.2%) were coordinated in either Europe or North America. Only 157 of the 414 RCTs (37.9%; 95% CI 33.2–42.8%) reported race/ethnicity data; among the 158,200 participants in these trials, only 29,512 (18.7%; 95% CI 18.5–18.9%) were BIPOC. There was a significant increase in the reporting of race or ethnicity data (from 26.9% in 2000–2001 to 54.2% in 2019–2020, p<0.001) and in enrollment of BIPOC (from 16.5% in 2000–2001 to 23.9% in 2019–2020, p=0.038) between 2000–2020. Trial leadership by a woman was associated with twice the adjusted odds of reporting of race or ethnicity data (OR 2.0; 95% CI 1.1–3.8; p=0.028) and an 8.4% (95% CI 1.9–15.0%; p=0.012) adjusted increase in enrollment of BIPOC. The race/ethnicity of trial leaders was not available for analysis.

Conclusions

Among HF RCTs published between 2000–2020, <38% reported data on race or ethnicity, although this increased over time. Among trials reporting such data, <19% of participants were BIPOC, with modest increases in enrollment over time. Trials led by women had greater adjusted odds of reporting race/ethnicity data and enrollment of BIPOC.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): CIHR
Single-cell RNA sequencing of human fetal epicardium reveals novel markers and regulators of EMT
Authors: Streef T J , Van Herwaarden T , Goumans M J , Smits A M
Published: October 2021

Background

The heart is covered by the epicardium, consisting of epithelial cells and a mesenchymal layer. The epicardium has been shown to be essential during cardiac development by contributing cells through epithelial-to-mesenchymal transition (EMT) and the secretion of paracrine factors. In the adult, the epicardium conveys a cardioprotective response after myocardial infarction, albeit suboptimal compared to the epicardial contribution to heart development. Although the developing epicardium has been characterised in mice and zebrafish, knowledge on the human fetal epicardium derives mostly from cell culture models. Therefore, direct analysis of the human fetal epicardium is vital as it provides new insights into the cellular and biochemical interactions within the developing heart, which can potentially contribute to enhancing the post-injury response.

Aim

To study the human fetal epicardium using single-cell RNA sequencing (scRNA seq) in order to determine its cellular composition. The data are further explored to e.g. identify regulators of epicardial EMT.

Methods

Epicardial layers were isolated from four fetal human hearts (14–15 weeks gestation, obtained under informed consent and according to local ethical approval). Tissue was digested, and single live cells were sorted into 384-wells plates and sequenced. Data analysis was performed using R-packages RaceID3 and StemID2. Findings were validated using qPCR and immunohistochemistry.

Results

Analysis of 2073 cells reveals a clear clustering of the epicardial epithelium and the mesenchymal population. Importantly, we found that “classical” markers, such as Wilms' Tumor 1 and T-box transcription factor 18, are not specific enough to reliably identify the epicardium, but our analysis has provided markers that do allow for robust identification of the epicardium. Additionally, we were able to identify epicardial subpopulations based on their expression profile and validated these using immunohistochemistry in human fetal and adult heart tissue sections. To establish the regulation of epicardial activation we are focussing on the process of EMT within our dataset using RaceID2. From our analysis, several regulators of epicardial EMT are proposed that will be followed up on in vitro.

Conclusions

We identify various novel markers of the fetal epithelial epicardium, as well as characterizing markers of the mesenchymal layer. We also identified novel factors involved in epicardial EMT, and these are currently being validated in our cell-culture model. These data can provide new insights into the post-injury response in the adult heart.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Dutch Heart Foundation
Positronium life-time as a new approach for cardiac masses imaging
Authors: Stepien E , Kubicz E , Grudzien G , Dulski K , Leszczynski B , Moskal P
Published: October 2021

Background/Introduction

Positron Emission Tomography (PET), also a standard in cardiovascular imaging, enables semi-quantitative myocardial perfusion evaluation and assessment of atherosclerosis. PET is based on positron-electro annihilation inside a patient's body and in about 40% events it proceeds via formation of positronium. Positronium is an exotic atom created from an electron and a positron in a patient during standard PET imaging. Positronium is not stable and its life-time depends on molecular environment. Recently, it was shown that with the new generation of high sensitivity long-axial field of view PET systems is possible to perform simultaneous imaging of the metabolism rate of administered pharmaceutical and imaging of positronium life-time. Positronium life-time informs about tissue nanostructure and allows distinguishing pathology.

Purpose

Purpose of the presented study is the evaluation of positronium life-time as a biomarker for cardiac masses, namely cardiac myxoma (CM) and normal tissues, obtained from symptomatic patients.

Methods

CM and adipose tissue samples were obtained during a surgery from six symptomatic patients with ECHO confirmed cardiac masses in a left atrium. Immediately after sampling, sample were analyzed with the dedicated positronium-life time measurement system. Samples were irradiated with positrons emitted from the 22Na radionuclide. The system enabled to measure the time-difference spectrum between the formation and annihilation of positronium atom within the studied samples. The life-time spectrum was used for the extraction of a mean positronium life-time. The sample underwent histopathological and micro-computer-tomography (micro-CT) examinations, which confirmed a diagnosis and revealed microstructure of a cardiac mass.

Results

It was established that positronium life-time in CM tissues is significantly (at the level of 10 standard deviations) smaller than in adipose tissue. At the same time, the determined positronium life-time in CM samples from different patients was the same within two standard deviations. Micro-CT imaging showed that CM samples had different calcification spots, but did not revealed existing microvasculature.

Conclusion

Obtained results confirm that positronium life-time differentiates between cardiac pathologies (CM) and normal tissues. And may be used as a biomarker in cardiac masses assessment available during PET examination.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Foundation for Polish Science through the TEAM POIR.04.04.00-00-4204/17 Programme, the National Science Centre.
Birth weight and young adult body mass index for predicting the risk of developing adult heart failure in men
Authors: Bygdell Maria , Ohlsson Claes , Lilja Lina , Celind Jimmy , Martikainen Jari , Rosengren Annika , Kindblom Jenny M
Published: October 2021

Aims

Hospitalizations for heart failure among young adults and middle-aged individuals have increased. The aims of the present study were to evaluate the association between birth weight and risk of adult heart failure and the importance of change from low birth weight to overweight/obesity at young adulthood.

Methods and results

We used the population-based body mass index (BMI) Epidemiology Study cohort Gothenburg (n = 35 659) with birth weight and young adult BMI (20 years) available from child healthcare records, school health records, and military conscription register for men born 1945–1961. The cohort includes all children who finished school, which was mandatory, in Gothenburg, Sweden. Information on heart failure diagnosis was retrieved from the National Patient Register and the Cause of Death Register (n = 415). In cox regression analyses, there was an inverse association between birth weight and risk of heart failure [hazard ratio (HR) 0.83 per standard deviation (SD), 95% confidence interval (CI) 0.76–0.90], and a direct association for young adult BMI (HR 1.48 per SD, 95% CI 1.36–1.61). Of note, individuals with birth weight in the lowest tertile, who were overweight/obese in young adulthood had a five-fold risk of heart failure (HR 4.95, 95% CI 3.36–7.31) compared with individuals in the middle birth weight tertile who were normal weight at 20 years.

Conclusions

Birth weight was inversely associated with the risk of hospitalization due to heart failure. The combination of low birth weight and overweight/obesity in young adulthood results in excess risk of heart failure beyond that of low birth weight or young adult overweight/obesity separately. These findings indicate the need of a life course perspective in heart failure prevention and risk assessment.
The role of socioeconomic and educational determinants in the context of COVID-19
Authors: Costa Giuseppe
Published: October 2021

The Ministry of Health has committed a health inequalities impact assessment of the pandemic and policy response to the pandemic in Italy. The document reviewed the knowledge available to estimate the effect of the main mechanisms for generating health that primarily deserve mitigation. The results recommend to give priority to interventions of proportionate universalism that avoid in short term the social discrimination related to a) the recovery of non-COVID-19 treatments that have been displaced due in the lockdown, b) the access to prevention, immunization and territorial care for people most susceptible to unfavourable outcomes of COVID-19 due to comorbidity and most vulnerable to social disadvantage due to lockdown; c) the loss of social support for fragile and disabled people. In the medium to long term priorities are to protect those with low income and precarious work from social exclusion and the effects on mental and physical health; enable children from families at risk of poverty to benefit from suitable development opportunities; promote resilient and inclusive local communities to reduce isolation and generate help resources; also valuing the beneficial aspects of the pandemic: trust assets to health and adherence to health promotion, more physical exercise, etc. The report has also identified priorities for research including mechanisms that are more difficult to investigate, such as studying the interaction between environmental risks and the risk of COVID-19 infection and progression and the unequal mental health effects of the pandemic and confinement.
Mental health in the general population over 1 year of the Covid-19 pandemic: findings from Ireland
Authors: Troya MI
Published: October 2021

Background

The effects of the Covid-19 pandemic and associated public health measures on mental health is a cause of increasing concern. We have measured indices of mental health among adults in the general population in the Republic of Ireland (ROI) during the period of May 2020-April 2021.

Methods

Nationally representative cross-sectional telephone survey with data collected in ROI during four study waves involving 3,920 participants: Wave 1: May 26-June 17, 2020 (N = 969), Wave 2: July 1-23, 2020 (N = 1014), Wave 3: September 5-28, 2020 (N = 1008), Wave 4: April 16-28, 2021 (N = 929). Participants were recruited from adults resident in RoI, aged 18 years+ using random-digit-dialling of land lines and mobile phones and interviewed by a professional market research organisation (Ipsos MRBI). Data from Waves 1-4 will be presented including trends over the 12-month period. Finding from Waves 1 and 2 are presented here. Mental health was assessed using the Patient Health Questionnaire Anxiety Depression Scale (PHQ-ADS), including standard questions on self-harm and/or suicidal thoughts.

Results

Of the 1,983 participants from Waves 1-2, 27.7% (n = 549; 95%CI:0.26%-30%) reported symptoms of depression and anxiety, 74 (3.8%;95%CI:3%-5%) disclosed self-harm and/or suicidal thoughts. Female participants (RR:1.60, 95%CI:1.37-1.87), employed individuals experiencing work change (RR:1.50,95%CI:1.24-1.82), participants cocooning due to a health condition (RR:1.34,95%CI:1.08-1.66), those self-isolating (RR:1.25,95%CI:1.03-1.51) and those reporting moderate-heavy drinking (RR:1.27,95%CI:1.09-1.47) were at increased risk of depression and anxiety symptoms. Participants aged 18-29 and those in the two lowest income categories were most likely to report self-harm and/or suicidal thoughts.

Conclusions

The prevalence of țanxiety and depression in the general population has increased relative to pre-pandemic estimates in response to the Covid-19 pandemic and associated public health measures.

Key messages

In nationally representative telephone surveys of Irish adults conducted following the onset of the Covid-19 pandemic, the prevalence of anxiety and depression is estimated at approximately 30%. Higher than average levels of anxiety or depression were reported in females, those who had experienced a change in their work, individuals cocooning and those with moderate to heavy drinking.
Poor physical activity as a risk factor for mental health disorders
Authors: Stubbs B
Published: October 2021

Rates of common mental disorders appear to be increasing among both adolescent and adult population affecting life quality and expectancy. Availability of the treatments il limited to a large portion of the global population thus new approaches toward the prevention and treatment of mental illnesses need to emerge in order to reduce the global and growing burden of these conditions. A great body of evidence has linked both the onset and symptoms of various mental disorders to lifestyle factors such as physical activity and diet. Given their modifiable nature, there has been an increasing interest in the implementation of physical activity in the prevention and adjunctive treatment among people with mental illnesses. Robust evidence indicates that physical activity may in fact, by influencing a range of biological and psychosocial processes, contribute to healthy aging, improve sleep and preserve cognition across the lifespan as well as affect associated with mental disorders serious physical health comorbidities including cardiovascular disease, metabolic risk factors such as adiposity and premature mortality. The plausible effects of physical activity toward mental health may be at least partially explained by its potential in modulating hippocampal neurogenesis and synaptic plasticity. Finally, higher levels of physical activity have been consistently associated with a reduced risk of both affective and cognitive disorders.
Vulnerability risk assessment in the context of climate change – the need for interdisciplinarity
Authors: Haigh F
Published: October 2021

Addressing wicked problems such as climate change vulnerability require a process whereby evidence of different kinds, interests, values and meanings are brought together in order to understand and anticipate the effects of change (such as a climate change) on health and health inequities in a population and then decide how best to respond. Understanding and addressing climate change vulnerability requires understanding complex climate science, policy making and politics, individual level decision making, history, nature, society, culture, urban planning, economics, structure and agency - the list goes on.

Health Impact Assessment provides a framework and process for carrying out this task of bringing together different stakeholders and types of disciplinary knowledge. However, this involves intellectual, social, and practical challenges including:

This presentation will:
Digital health literacy and online information-seeking behaviour of Lebanese university students
Authors: Bouclaous C , Kamand A Al , Daher R , Razim A Al , Haddad I , Kaedbey HD
Published: October 2021

Background

This cross-sectional study evaluates digital health literacy (DHL) and web-based information-seeking behaviour of Lebanese university students in light of the coronavirus pandemic and the ‘infodemic'.

Methods

18 universities took part in the study. Ethical approval was sought from the ethics committees of the participating universities. Data collection was carried out in May-August 2020. The survey was discontinued due to the devastating explosion that shook Beirut early August.

Results

A total of 602 students (60.1% females), 20.6 years (±4.3) took part in the study. 54% reported using the Internet to seek for COVID-19 information in the past month. Students in fields other than health and social sciences (HHS), and not using official sources, had limited DHL for information seeking (26.6%). Lebanese students, at undergraduate level, with a health impairment, and not using official sources and news portals had limited DHL for adding self-generated content (35.9%). Students at undergraduate level, who used social media for information, had limited DHL for evaluating reliability (42.7%). Non-HHS, with a health impairment, and not using official sources had limited DHL for determining relevance (32.0%). Graduate students had higher odds of having sufficient DHL for adding self-generated content (OR = 2.304; 95% CI = 1.076, 4.937) and evaluating reliability (OR = 2.440; 95% CI = 1.171, 5.087). Frequent users of official sources had higher odds (OR = 1.684; 95% CI = 1.065, 2.665) of having sufficient DHL for adding self-generated content. Those who regularly used social media for information had lower odds (OR = 0.577; 95% CI = 0.351, 0.946) regarding evaluating reliability.

Conclusions

Health education programmes in Lebanon need to strengthen digital health literacy in university students, particularly in undergraduates, in fields other than health and social sciences, in those relying on social media, and those with a health impairment.
Substance use instruments for refugees-systematic review
Authors: Marth S , Jakubauskiene M , Schäfer Ingo , Lindert J
Published: October 2021

Background

Substance use is a problem among refugee populations. Instruments which assess substance use have been translated into different languages, but are not culturally sensitive. This research gap has to be filled to acquire information about substance use disorders in refugee populations, especially from Arabic countries, as a confession to using substances in those countries is culturally problematic.

Methods

Following databases were systematically searched: EMBASE, PubMed, CINAHL, Web of Sciences and PsychInfo resulting in 2659 hits. After removing 5 duplicates, 2650 studies were screened. After exclusion of irrelevant studies, 264 studies were assessed for eligibility and 128 studies were, so far included. Inclusion criteria were original studies, migrant or refugee participants, minimum age 18 years, usage of quantitative measures and substance use as the outcome. A data extraction sheet was developed with three reviewers working on it.

Results

49 studies were found to use validated instruments. Most frequently used was the AUDIT (n = 17), followed by the WMH-CIDI (n = 11) and the CAGE questionnaire (n = 9). The majority of the studies (n = 55) used self-developed instrument with few items. To our knowledge, no study used a culturally sensitive adapted questionnaire.

Conclusions

More studies used self-developed items for assessing substance use than validated instruments. None of the studies used a culturally sensitive adapted instrument. This is a clear indication that such an instrument is needed for research and treatment. With a culturally sensitive instrument, the care for refugees and migrants could be improved and adjusted, possibly resulting in better public health outcomes.

Main messages

As refugee populations continue to grow, an adequate screening instrument for substance abuse/dependence for these individuals is missing. With the development of a culturally sensitive instrument, identification and treatment of refugees and migrants can be improved.
1.M. Workshop: Protecting and preparing healthcare workers: what to learn from COVID-19 to strengthen resilience?
Authors:   Organised by: EUPHA-HWR, European Observatory, WHO,   Chair persons: Ellen Kuhlmann (EUPHA-HWR), Matthias Wismar (European Observatory)
Published: October 2021

Background

This workshop is dedicated to the WHO International Year of Health and Care Workers in 2021 in recognition of their commitment during the COVID-19 pandemic. During the first wave of the pandemic healthcare workers were lionised, yet societies' and health policymakers' appreciation of their new ‘heroes' was decreasing when corona fatigue was increasing. Health systems and policymakers have not fully understood the new emergent threats during the COVID-19 pandemic. Health workforce protection and pandemic preparedness are not limited to individual healthcare workers, but strongly impact in health system resilience.

Objectives

This workshop sets the focus on the protection and preparedness of healthcare workers for global public health emergencies, like the COVID-19 pandemic. It aims to identify strengths and weaknesses of health workforce policy during COVID-19 and to highlight the need for a health system and governance approach. The following major questions will be addressed: How can the protection and pandemic preparedness of healthcare workers be improved? How can the capacities of the health workforce be used and governed more effectively during a pandemic? What policy priorities can be identified to support the health and wellbeing of healthcare workers and prevent infection and deaths, as well as post-COVID fatigue, burn-out and job leaves? How can we build back better and more equitable, including strengthening gender equality and establishing solidarity-based health workforce migration policy?

Results

The workshop introduces novel results drawn from four European comparative studies. A number of important policy recommendations are emerging from the research, which include among others: (1) improve attention to the complex health and social needs of healthcare workers, (2) implement comprehensive surveillance and monitoring systems, (3) establish European health workforce governance to mitigate shortages and inequality between countries and globally, and (4) take action to implement gender equality policies and to better protect female healthcare workers.

Conclusions

The workshop will stimulate critical debate and improve knowledge exchange across countries and between researchers. It will contribute to creating resilience of the health workforce and health systems and to build back better after COVID-19 in a fair and equitable manner.

Key messages

Health systems must be accountable for the protection and preparedness of healthcare workers. Action is needed to develop a health workforce surveillance system on national and EU level.