bluuebunny/crossref_metadata_2025 huggingface dataset:
The impact of glomerular filtration rate estimation on cardiovascular events in elderly patients undergoing coronary angiography
Authors: Aker A , Eitan A , Saliba W , Jaffe R , Zafrir B
Published: October 2021

Objectives

Estimation of kidney function by glomerular filtration rate (eGFR) is affected by age and is important for decision making regarding treatment and prognosis of patients with cardiovascular disease. We aimed to investigate the impact of eGFR on long-term cardiovascular outcomes in an elderly population undergoing coronary angiography for evaluation or treatment of coronary artery disease.

Methods

GFR was estimated according to Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation in 3,690 elderly patients (aged 70–100 years) undergoing coronary angiography. Patients receiving maintenance dialysis were excluded. The association between eGFR and long-term major adverse cardiovascular events (MACE) including myocardial infarction, ischemic stroke or death, was investigated. GFR was further calculated according to Modification of Diet in Renal Disease (MDRD) and the Cockroft-Gault equations, and compatibility between estimations was analyzed.

Results

Cardiovascular comorbidities were more prevalent with the reduction in kidney function as was the proportion of patients presenting with acute coronary syndromes. The adjusted hazard ratio (95% confidence interval) for MACE during a mean follow-up of 5 years was 0.98 (0.80–1.19), 1.05 (0.85–1.30), 1.45 (1.15–1.82), 2.20 (1.64–2.95) and 3.87 (2.28–6.58) in patients with eGFR 60–89, 45–59, 30–44, 15–29 and <15 ml/min/1.73m2, respectively, compared to eGFR >90 ml/min/1.73m2. Reclassification of eGFR stages by MDRD (upward 23.8%, downward 0.4%) and Cockroft-Gault (upward 4.3%, downward 28.1%) compared to CKD-EPI estimation, was noted. However, the association between eGFR stages and MACE was similar between equations.

Conclusions

Kidney function, as manifested by eGFR, has a graded inverse association with the burden of cardiovascular comorbidities and long-term adverse events in elderly patients undergoing coronary angiography.

Funding Acknowledgement

Type of funding sources: None.
Effect of statins on mortality in patients with COVID-19: an updated meta-analysis of 147824 patients
Authors: Diaz-Arocutipa C , Melgar-Talavera B , Saravia-Bartra M , Cazorla P , Belzusarri I , Alvarado-Yarasca A , Hernandez A V
Published: October 2021

Background

Coronavirus disease 2019 (COVID-19) remains a public health problem worldwide. There is conflicting evidence about the impact of statins use on clinical outcomes in patients with COVID-19.

Purpose

We performed a systematic review and meta-analysis to assess the effect of statins use on mortality in these patients.

Methods

We searched electronic databases from inception to March 3, 2021 for cohort studies evaluating the association between chronic and/or inpatient use of statins and mortality. Risk of bias was assessed using the Newcastle-Ottawa Scale. We pooled unadjusted and adjusted effect estimates with their 95% confidence intervals (95% CI) using random-effects models.

Results

A total of 25 cohort studies involving 147824 patients were included. The mean age ranged from 44.9 to 70.9 years and 57% of patients were men. The use of statins was not associated with mortality according to the unadjusted risk ratio (uRR, 1.16; 95% CI, 0.86–1.57, 19 studies). In contrast, meta-analyses of adjusted odds ratio (aOR, 0.67; 95% CI, 0.52–0.86, 11 studies) and adjusted hazard ratio (aHR, 0.73; 95% CI, 0.58–0.91, 10 studies) showed that the use of statins was independently associated with a significant reduction of mortality. Adjusted confounders included age, sex, and cardiovascular comorbidities in most of cohorts. Eighteen studies were scored as low risk of bias, six studies as moderate risk of bias, and one study as high risk of bias.

Conclusion

The use of statins was associated with lower mortality in patients with COVID-19 based on adjusted effects of cohort studies. However, randomized controlled trials are needed to confirm these findings.

Funding Acknowledgement

Type of funding sources: None.
Statin therapy in hepatitis: a systematic review and meta-analysis of 9 studies with 195,602 participants
Authors: Vahedian-Azimi A , Shojaie S , Banach M , Heidari F , Cicero A F G , Fetrat M K , Jamialahmadi T , Sahabkar A F G
Published: October 2021

Background

Conflicting data suggest that statins could cause hepatitis in certain group of patients, while improving prognosis in patients affected by some chronic liver diseases. Therefore, we aimed to quantify the potential protective role of statins on some main liver-related health outcomes in clinical studies on patients affected by hepatitis.

Methods

We applied fixed-effects or random-effects meta-analyses with inverse variance weighting to calculate pooled estimates and confidence intervals (95% confidence intervals [CI]). We calculated the odds ratios (OR) and 95% CI for the targets of mortality and hepatocellular carcinoma, fibrosis, and cirrhosis.

Results

Nine studies (N: 195,602 patients) reported data on mortality of patients affected by chronic viral hepatitis, six studies (N: 72,960) reported data on the risk to develop hepatocellular carcinoma, two studies on fibrosis progression (N: 9678) and two studies (N: 85,205) on cirrhosis development. Statins reduce the risk to develop hepatocarcinoma (OR (95% CI) = 0.47 (0.28, 0.81), p=0.005) (Figure 1), liver fibrosis (OR (95% CI) = 0.55 (0.34, 0.87), p<0.001), and cirrhosis (OR (95% CI) = 0.59 (0.55, 0.62), p<0.0001). There was also no significant link between statin therapy and alanine (Figure 2) and aspartate aminotransferases levels. Moreover, statin therapy is associated with a significant reduction in mortality but only in studies longer than 3 years (OR (95% CI) = 0.38 (0.17, 0.85), p=0.006).

Conclusion

Long-term treatment with statins seems to be safe in patients affected by hepatitis, while significantly improving their prognosis. Extensive education should be continued in order to avoid discontinuing statin therapy in patients with liver diseases.

Funding Acknowledgement

Type of funding sources: None. Figure 1Figure 2
Trends in initiation of GLP-1 RA in patients with type 2 diabetes during 2014–2019: a US database study
Authors: Kosiborod M , Aroda V R , Broe Honore J , Husemoen L L N , Jensen A B , Matthiessen K S , Lingvay I
Published: October 2021

Background/Introduction

Evidence of cardiovascular (CV) benefit of certain glucagon-like peptide 1 receptor agonists (GLP-1 RAs) from CV outcomes trials (CVOTs) resulted in updates to international guidelines and label indications in patients with type 2 diabetes (T2D) at high CV risk.

Purpose

To evaluate the impact of new evidence, we investigated the incidence of new GLP-1 RA use and trends in prescriber and patient characteristics over a 5-year period encompassing key CVOT publications and an updated label indication.

Methods

Data from consecutive cross-sectional cohorts of patients with T2D and no GLP-1 RA prescription for ≥1 year prior to the start date, corresponding to each year between 2014 and 2019, were extracted retrospectively from US Optum's de-identified Clinformatics® Data Mart Database (2004–2020). For each year, incidence of new GLP-1 RA use, overall and according to prescriber speciality and the proportion of patients with atherosclerotic CV disease (ASCVD) among the new users were evaluated. Speciality was categorised using prescriber information within the database, while ASCVD was identified with ICD-9 CM or 10 CM codes reported prior to GLP-1 RA prescription or year-start date.

Results

During the study period, 2,966,970 eligible patients with T2D were identified, 108,541 of whom were new users of GLP-1 RAs. Overall incidence of new GLP-1 RA use increased each year, with a 3-fold increase in prescriptions from 727 to 2045 per 100,000 patient years between 2014 and 2019 (Figure a). Among new GLP-1 RA users, mean age was 60.1 years, increasing from 56.8 to 61.7 years. Mean HbA1c was 8.6% and was stable over time. Further analysis of new GLP-1 RA prescriptions identified family medicine as the greatest contributor to the absolute increase in incidence between 2014 and 2019, comprising nearly 40% of total prescriptions each year, whereas cardiology contributed the least, at <1% each year. The overall proportion of patients with ASCVD among those newly initiated on a GLP-1 RA and those initiated by a cardiology specialist increased after 2015, from 30.8–44.3% and 45.2–57.9% in 2019, respectively (Figure b). However, this increase in the proportion of patients with ASCVD was also observed among the total population of patients with T2D without new GLP-1 RA use (Figure b).

Conclusion

New use of GLP-1 RAs in patients with T2D increased in absolute terms between 2014 and 2019. Interestingly, the proportion of patients with ASCVD among those newly initiating the class has not changed relative to non-GLP-1 RA users over time, highlighting a gap in adoption of CVOT data in clinical practice by all specialities and the potential opportunity to further reduce CV risk in these patients.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Novo Nordisk
Patient acceptance of an electronically recruited beta blocker trial
Authors: Denman J , Roebuck A , Lee K ,   DREAM-LV
Published: October 2021

Background

Beta Blockers (BB) have been the standard of care after acute myocardial infarction (AMI) since the 1960's. There is good evidence of clinical effectiveness in the post AMI patient with impaired left ventricular function. However, there is little contemporary evidence in the post AMI patient with preserved left ventricular function. Data suggests that BB in preserved left ventricular function may not convey clinical benefit and indeed there is a suspicion that they may cause harm. BB are acknowledged to be associated with side effects that impact on patient's health related quality of life (HRQoL).

Purpose

NICE Guidelines for ACS (2020) recommend further research in this topic. We wanted to understand current UK practice. Whether patients felt further research was needed and if they would be likely to consent and participate in an electronic RCT?

Methods

Professional practice and patient experience was solicited using a purposeful mixed methodological electronic survey of x15 English Heart Attack Centres, x7 Primary Care Networks and cardiac support groups contacted via the British Heart Foundation Cardiac Support Group network.

Results

n=598 surveys were distributed with a response rate of 26% (n=157). In secondary care only 8% of patients routinely were reviewed. In primary care 73% of patients were reviewed. Across both provider localities 90% of respondents had not discussed stopping their beta blockers at x1 year. 20% of patients experienced side effects attributable to BB. Primary care reported that they were consulted at least once per week by a patient with side effects likely to be from their BB.

Patients reported side effects the severely impacted on HRQoL including tiredness/lethargy, reduced exercise tolerance, light-headedness and impotence. 86% of patients stated they would like to participate in further research. Of these responders 96% stated they would have been happy to have been contacted via an electronic record search. Most respondents preferred electronic communication.

Discussion

Despite lack of evidence for their clinical effectiveness in patients x1 year post AMI with preserved left ventricular function most patients had their therapy continued. Both patients and clinicians' report a high symptom burden impacting on HRQoL and health economics. Patients reported that given the lack of evidence they would welcome a discussion if they should continue BB therapy or not.

Most nations have databases of their post AMI patients. Electronic recruitment into an RCT from a database would reduce trial costs and the enrolment period. Respondents felt there was a need for further research. They were happy to be contacted after a database search and preferred electronic communication. These responses have significant implications for further large scale research and support the concept of enrolment in to a RCT via database interrogation.

Funding Acknowledgement

Type of funding sources: None. Patient reported side effects from BBPerceptions of an electronic RCT on BB
Christmas holiday triggers of myocardial infarction
Authors: Olsson A , Thoren I , Mohammad M , Rylance R , Platonov P , Sparv D , Erlinge D
Published: October 2021

Background

Christmas holidays have been associated with the highest incidence of myocardial infarction (MI). We wanted to assess possible triggers of MI during Christmas.

Method

A nationwide, retrospective postal survey with case-control design. All individuals suffering a MI during the Christmas holidays 2018 and 2019 in Sweden were identified through the SWEDEHEART registry and a control group matched in age and gender with chronic coronary syndrome who did not seek medical attention during Christmas, were asked for participation. Subjects completed a questionnaire asking them to rate 27 potential MI-triggers as having occurred more or less than usual.

Results

A total of 189 patients suffering a MI on Christmas Eve, Christmas Day, or Boxing Day and 157 patients in control-group responded to the questionnaire, representing response rates of 66% and 62%, respectively. Patients with MI on Christmas experienced more stress (36.7% vs 20.9%, p=0.002), depression (20.9% vs 10.5%, p=0.024) and worry (25.9% vs 10.1%, p<0.001) compared to the control-group. The food and sweets-consumption were increased in both groups, but to a greater extent in the control-group (33.0% vs 49.7%, p=0.002 and 32.4% vs 43.3, p=0.031). There were no increases in quarrels, anger, economic worries or reduced compliance with medication.

Conclusions

Patients suffering MI on Christmas holiday experienced higher levels of stress and emotional distress compared to patients with chronic coronary syndrome, possibly explaining the phenomenon of holiday heart attack. Understanding what factors increase the number of MI on Christmas may help reduce the excess number of MIs and cardiovascular burden.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Swedish Heart and Kund FoundationSwedish Scientific Research Council
Fully automatic detection and measurement of abdominal aortic aneurysm using artificial intelligence
Authors: Fujiwara J F , Orii O M , Araki K A , Ogura M O , Ito T I , Oyamada K O , Morino Y M , Yoshioka K Y
Published: October 2021

Background

Abdominal aortic aneurysm (AAA) is a life-threatening disease, and the decision to treat relies on the exact detection and size of AAA, which is time-consuming and prone to high inter-reader variability. Artificial intelligence (AI) has revealed new insights into the management of AAA, but it needs large amounts of contrast-enhanced CT data. Moreover, there has been few studies about the fully automatic detection and measurement of AAA.

Purpose

The aim of this study is to evaluate the accuracy of AI for the detection and measurement of AAA using small amounts of non-contrast CT.

Methods

We retrospectively collected 145 non-contrast CT scans of suspected AAA. The first step was to manually segment the 30 non-contrast CT scans to create training data for the AI, and the second step was to improve accuracy using 9 of non-contrast CT scans. Image processing is used to identify the AAA area and automatically measure the size. The AAA region was identified from the amount of change in the minor-axis, and the maximum minor-axis diameter was calculated using elliptical fitting. To evaluate the diagnostic utility of AI for the detection of AAA, the sensitivity and positive predictive value were calculated referred for the diagnostic report. The reproducibility in the size of AAA was assessed using intraclass correlation coefficients (ICCs) between the diagnostic report and AI.

Results

Among 145 of non-contrast CT scans, 111 had AAA. The sensitivity and positive predictive value of AI for the detection of AAA were 94.6% and 53.8%, respectively (Picture 1). The size of AAA calculated by the AI (42.5±8.8 mm) showed a strong correlation with the those of diagnostic reports (44.6±8.4 mm; ICCs = 0.97) (Picture 2).

Conclusions

AI represents a useful tool in the fully automatic detection and measurement of AAA using small amounts of non-contrast CT.

Funding Acknowledgement

Type of funding sources: None. Picture 1Picture 2
Readiness of cardiosurgical patients for digital rehabilitation programs
Authors: Pomeshkina S , Zvereva T N , Krupyanko E V , Pomeshkina E E , Barbarash O L
Published: October 2021

Introduction

To date, the methods of remote rehabilitation using the mobile applications for smartphones are increasingly introduced for a particular category of cardiac patients worldwide. Such programs are of a particular relevance due to a higher accessibility for a patient which is provided by the flexibility of the patients' home training schedule and the possibility of constant communication with a cardiologist and rehabilitation therapist.

Purpose

To study the readiness of the patients to participate in the remote digital cardiac rehabilitation program.

Methods

265 patients (180 (68%) men and 85 (32%) women) undergone a cardiac surgery and staying at the cardiac surgery department were examined. The mean age of the patients was 67±11.9 years. 157 (59%) patients undergone coronary artery bypass grafting (CABG), 73 (34%) patients – heart valves surgery, 13 (5%) patients – simultaneous CABG and heart valves surgery and 5 (2%) – hybrid CABG with carotid endarterectomy.

Prior to the discharge from the first inpatient rehabilitation stage (10–12 days after cardiac surgery), all the patients underwent a survey. The survey was conducted using a designed questionnaire including 5 questions, the answers to which determined the patients' awareness of the necessity and the structure of postoperative remote rehabilitation using the digital technologies, as well as the willingness and the possibility to participate in these programs.

Results

Analyzing the results obtained from the survey it turned out that the majority of patients (258 (97%)) believe that they need cardiac rehabilitation. However, only 86 (32%) patients answered positively to the question about their readiness to participate in remote digital rehabilitation programs. When analyzing the reasons for such a low readiness of patients to participate in remote programs it turned out that 98 (37%) patients didn't have smartphones. 10 (4%) patients despite the presence of a smartphone, refused to participate referring to their inability to use considering themselves incapable of learning it. 71 (27%) patients simply refused claiming that they don't understand the necessity for remote cardiac rehabilitation.

Conclusions

Thus, only a small number of the patients (32%) are ready to participate in remote digital programs of cardiac rehabilitation. A considerable amount of the patients (37%) can't afford to participate in a remote rehabilitation program only due to the absence of the smartphone and 27% of the patients are not ready to participate in a remote cardiac rehabilitation program not understanding the importance of distance cardiac rehabilitation for them.

Funding Acknowledgement

Type of funding sources: None.
Sex differences in cardiovascular research
Authors: Millenaar D N , Dillmann M , Fehlmann T , Flohr A , Mehran R , Al-Lamee R , Lauder L , Ukena C , Boehm M , Keller A , Mahfoud F
Published: October 2021

Background

Women are underrepresented in cardiovascular publications. We sought to investigate sex-specific differences in cardiovascular research over the last decade.

Methods and results

All 387,463 cardiovascular publications between 2010–2019 were retrieved from Web-of-Science and analyzed regarding the authors' sex, the average impact factor (IF), the number of citations, co-authors per article, and international collaborations. The number of cardiovascular research articles increased between 2010–2019 from 19,960 to 29,604 articles per year. The number of articles written by female first authors increased by 48.3% (6434 articles in 2010 and 11,343 articles in 2019) and by 35.0% for male first authors (13,526 articles in 2010 and 18,261 articles in 2019). The last/senior author was more likely to be female in articles with female first authors compared with male first authors (28.2% vs. 14.1%; odds ratio 2.48, 95% confidence interval 2.43–2.53, p<0.001). The average IF for articles by female first authors was lower compared to male (3.1±3.8 vs. 3.5±4.9, p<0.001). Likewise, the H-Index was lower for female than male first authors (1.07±0.74 vs. 1.25±0.98, p<0.001), as was the number of citations per articles (14.0±31.1 vs. 18.0±68.8 citations, p<0.001). Female first authors had fewer co-authors per article than their male peers (7.4±19.6 vs. 8.2±35.2; p<0.001) and were less represented in articles with >15 co-authors (3,623 articles by female and 8,941 by male first authors; ratio female to male 0.41). Scientific advancement as the ratio between female to male first authorships was highest in publications from Latin America (ratio 0.92) and lowest in Asia (ratio 0.40). Female authorship articles reached the highest IF in North America (average IF 3.7), the lowest Africa (average IF 1.8).

Conclusions

Publications in cardiovascular research have increased over the last decade, particularly by female authors. Female researchers are cited less often compared with their male peers and publish with fewer co-authors. The IF remains lower for articles by female researchers. Efforts to further increase women-led research activities are needed

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): German Cardiac SocietyGerman Research Foundation (DFG)
Genetic deletion of aryl hydrocarbon receptor activates cardiac NLRP3-inflammasome and suppresses apoptosis in mice with acute myocardial infarction
Authors: Tamayo M , Martin Nunes L , Piedras M J , Badosa M , Gil Fernandez M , Fernandez Velasco M , Delgado C
Published: October 2021

Background and purpose

There is great interest in understanding the role of immune cells in the inflammatory mechanisms associated with acute myocardial infarction (AMI). Resident cardiac immune cells are activated by damage-associated molecular patterns interacting with specific pattern recognition receptors (PRRs), triggering inflammatory responses. Activated immune cells and fibroblasts then promote prohypertrophic and profibrotic signalling, which induces cardiac hypertrophy, fibrosis and remodelling after AMI. Nucleotide-binding domain leucine-rich repeat-containing proteins (NLRs) are PRRs that have emerged as key therapeutic targets in cardiovascular disease. NLRP3 assembles the inflammasome, which serves as molecular signalling platform to activate caspase-1 and regulate maturation of the potent proinflammatory cytokine IL-1β.

The aryl hydrocarbon receptor (AhR) is a ligand-activated transcription factor of the basic Helix-Loop-Helix-PER-ARNT-SIM superfamily that mediates responses against environmental pollutants. Beyond its role in metabolising exogenous toxins as part of an adaptive chemical response, there is growing evidence that AhR is activated by endogenous ligands under physiological conditions. AhR has been proposed as a negative regulator of NLRP3-inflammasome activation. Here we studied the effects of defective AhR signalling on apoptosis, NLRP3-inflammasome activation and survival in a mouse model of AMI.

Methods and results

AMI was induced in 8–10-weeks-old AhR+/+ and AhR−/− mice by ligation of the left anterior descending coronary artery. Immunofluorescence analysis revealed that the number of TUNEL-positive nuclei and the expression of the apoptotic effector cleaved caspase-3 was higher in hearts from infarcted AhR+/+ mice than from sham-operated AhR+/+ mice 24 h after surgery. A similar analysis in AhR−/− mice revealed the absence of apoptotic markers after AMI. Gene analysis showed that cardiac levels of Nlrp3, apoptosis-associated speck-like protein (Asc) and Il1b were all significantly higher in AhR−/− mice than in AhR+/+ mice 24 h after AMI. Finally, survival analysis showed that 25% of AhR+/+ mice died 72 h after AMI surgery whereas the mortality in AhR−/− mice was 100%.

Conclusion

Our results show that loss of AhR inhibits cardiac apoptosis and increases NLRP3-mediated inflammation 24 h after AMI, highlighting a possible role for this nuclear receptor in cardiac remodelling post-AMI.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Spanish Ministry of Economy and Competitiveness and the European Regional Development Fund
Calcific aortic valve disease: from molecular and cellular mechanisms to medical therapy
Authors: Kraler Simon , Blaser Mark C , Aikawa Elena , Camici Giovanni G , Lüscher Thomas F
Published: October 2021

Calcific aortic valve disease (CAVD) is a highly prevalent condition that comprises a disease continuum, ranging from microscopic changes to profound fibro-calcific leaflet remodelling, culminating in aortic stenosis, heart failure, and ultimately premature death. Traditional risk factors, such as hypercholesterolaemia and (systolic) hypertension, are shared among atherosclerotic cardiovascular disease and CAVD, yet the molecular and cellular mechanisms differ markedly. Statin-induced low-density lipoprotein cholesterol lowering, a remedy highly effective for secondary prevention of atherosclerotic cardiovascular disease, consistently failed to impact CAVD progression or to improve patient outcomes. However, recently completed phase II trials provide hope that pharmaceutical tactics directed at other targets implicated in CAVD pathogenesis offer an avenue to alter the course of the disease non-invasively. Herein, we delineate key players of CAVD pathobiology, outline mechanisms that entail compromised endothelial barrier function, and promote lipid homing, immune-cell infiltration, and deranged phospho-calcium metabolism that collectively perpetuate a pro-inflammatory/pro-osteogenic milieu in which valvular interstitial cells increasingly adopt myofibro-/osteoblast-like properties, thereby fostering fibro-calcific leaflet remodelling and eventually resulting in left ventricular outflow obstruction. We provide a glimpse into the most promising targets on the horizon, including lipoprotein(a), mineral-binding matrix Gla protein, soluble guanylate cyclase, dipeptidyl peptidase-4 as well as candidates involved in regulating phospho-calcium metabolism and valvular angiotensin II synthesis and ultimately discuss their potential for a future therapy of this insidious disease.
The effect of smoking and smoking cessation on arterial stiffness: a systematic review and meta-analysis
Authors: Saz-Lara Alicia , Martínez-Vizcaíno Vicente , Sequí-Domínguez Irene , Álvarez-Bueno Celia , Notario-Pacheco Blanca , Cavero-Redondo Iván
Published: October 2021

Aims

One of the most important mechanisms by which smoking contributes to cardiovascular disease is endothelial dysfunction, including arterial stiffness. However, the effects of smoking and smoking cessation on arterial stiffness remain unclear. This meta-analysis aimed to evaluate the effect of smoking and smoking cessation on arterial stiffness in the adult population.

Methods and results

Random effects models were used to compute pooled estimates of effect size (ES) and their respective 95% confidence intervals (95% CIs) and %change in pulse wave velocity (PWv) (m/s) for the acute and chronic effect of smoking and smoking cessation, and for the effect of smoking cessation vs. the pooled ES estimate for the effect of smoking cessation vs. maintaining this behaviour. Thirteen studies were included in the meta-analysis. Smoking cessation decreased the PWv (ES −0.52, 95% CI −1.02 to −0.03, 3.5% m/s) compared to those maintaining this behaviour. Pooled estimates of both smoking conventional cigarettes and vaping significantly increased the PWv (ES 0.68, 95% CI 0.39–0.98, 10.0% m/s; and ES 0.37, 95% CI 0.14–0.61, 4.7% m/s, respectively). In addition, smoking cessation was effective in reducing arterial stiffness but only in healthy subjects (ES −0.95, 95% CI −1.85 to −0.05, −6.7% m/s). The chronic effect of smoking showed non-significant results on arterial stiffness.

Conclusion

Our results show that arterial stiffness levels decrease after smoking cessation. These findings are of clinical importance, as smoking cessation partially reverses the effects of smoking on arterial stiffness.
Focusing on inequalities and assessing vulnerabilities in the field to combat COVID-19
Authors: Lionis Christos
Published: October 2021

The COVID-19 pandemic exacerbated the existing health inequalities and highlighted many gaps in the European health care systems. This contribution will focus on the concepts of vulnerability and multiple vulnerability, as both have been discussed in the European Commission's Expert Panel on effective ways of investing in health (EXPH). The EXPH is the interdisciplinary expert group established by the European Commission to provide non-binding independent advice on matters related to effective, accessible and resilient health systems, to inform national policy making in improving the quality and sustainability of health systems, and to foster EU level cooperation towards improving information, expertise and the exchange of best practices. The equitable distribution of COVID-19 vaccines, will be discussed as a public health and policymaking challenge, incl. in the context of socioeconomic determinants in relation to vaccination hesitancy. A list of actions to minimize the effect of pandemic in terms of health inequalities and vulnerabilities, including the role the integration of public health with primary care, with due consideration to the perception of risk, health literacy and risk communication. Special mention will also be made to the European Commissions' effort to develop comprehensive expert reports to inform policy making on key topics with due consideration to vulnerable populations and multiple determinants.
Stress and perceived discrimination among Israeli Arabs: the mediation role of threat and trust
Authors: Satran C , Ali Selah O , Mashiach-Aizenberg M , Bord S
Published: October 2021

During pandemics, minorities may experience high stress levels, which could harm their health. This study explores stress among the Arab minority in Israel during the first wave of the COVID-19 outbreak, and its association with the population's perceived COVID-19 threat, trust in the healthcare system, adherence to guidelines, and perceived discrimination. The study analyzed a cross-sectional online survey of 626 Israeli Arabs. Most participants (65%) reported moderate levels of stress, and 10% reported severe levels. The Bedouin population reported significantly higher levels of stress compared to other minority groups. The participants also reported a high degree of perceived threat, a moderate-to-high level of discrimination, a moderate level of trust in the healthcare system, and very high adherence to guidelines. Structural equation modeling (SEM) revealed that the participants' perceived threat and trust mediated the association between their perceived discrimination and stress [indirect effect=0.13, SE = 0.03 CI = (0.08, 0.18)], whereby discrimination was negatively associated with trust (β=-0.52), which, in turn, was negatively associated with stress (β=-0.10). Furthermore, discrimination was positively associated with perceived threat (β = 0.21), which, in turn, was positively associated with stress (β = 0.35). Discrimination is an important social determinant of health - especially during health emergencies when trust in healthcare systems and perceived threats are crucial. Our findings could assist policymakers in developing fair policies, that are tailored to various population groups and that may reduce stress levels among minorities, thereby improving their mental and physical health.

Key messages

The results highlight the relationships between discrimination, trust, perceived threat and stress. To reduce minorities’ stress, it is vital to create a credible and fair atmosphere during pandemics.
WHO public health research agenda for managing infodemics
Authors: Mahajan A , Czerniak C , Lamichhane J , Phuong L , Purnat T , Nguyen T , Briand S
Published: October 2021

Background

Following the World Health Organization's initial infodemic consultation in April 2020, a major infodemic conference was organised virtually in June-July 2020. Hundreds of experts participated to define science of infodemiology and build a public health research agenda that serves as a playbook for conducting relevant researches. Research Agenda provides guidance to invest in research and innovation so that we have better interventions and tools to understand, measure and respond to infodemics, and steer people towards timely, accessible, understandable information for good health choices.

Methods

The research agenda was developed during a virtual meeting, followed by research question prioritization exercise. It consisted of eight days spread out over four weeks. These were made up of: public preconference meeting; scientific conference, consisting of opening/closing plenary meetings either side of four separate “topic sprint” days; final public meeting to present the meeting outcomes.

After the meeting, a process took place to gather and rank research questions based on the research agenda created during the meeting.

Results

The following five streams and 65 research questions were developed. Measuring and monitoring the impact of infodemics during health emergencies Detecting and understanding the spread and impact of infodemics Responding and deploying interventions that protect against the infodemic and mitigate its harmful effects Evaluating infodemic interventions and strengthening resilience of individuals and communities to infodemics Promoting the development, adaptation and application of tools for managing infodemics.

Conclusions

Five streams with 65 research questions were developed and prioritized to structuralise infodemic management based on evidence. The conference yielded on the development of an infodemiology glossary, which can be used by the community of research.

Key messages

Discuss investments in research and innovation to enable a whole-of-society response to infodemics. Explain the practice of infodemic management as a discipline.
COVID-HL: A cross-sectional study on digital health literacy in university students in Germany
Authors: Dadazcynski K , Rathmann K , Messer M , Okan O
Published: October 2021

Background

Digital communication technologies are playing an important role in the health communication strategies of university students during the COVID-19 pandemic. The internet and social media have become important sources of health-related information on COVID-19 and digital health literacy is a key competence to navigate web-based COVID-19 information. This study aimed to investigate university students' digital health literacy during the early stages of the COVID-19 pandemic in Germany.

Methods

A cross-sectional study among 14,916 university students from 130 universities in Germany was conducted using a web-based survey. Along with sociodemographics, the measures included five subscales from the Digital Health Literacy Instrument (DHLI), which was adapted to the specific context of the COVID-19 pandemic. Data were analyzed using univariate and bivariate analyses.

Results

Across DHL dimensions, the greatest difficulty was assessing the reliability of information and to determine whether it had commercial interest. Students indicated that they have problems finding the information they are looking for. Females achieved significant lower scores for information searching and evaluating reliability. Search engines, news portals, and websites of public bodies were most often used by the respondents to inform about COVID-19. Females were found to use social media and health portals more frequently, while male students used Wikipedia as well as YouTube more often. Social media use was associated with a low ability to critically evaluate information.

Conclusions

Although digital health literacy is well developed in university students, a significant proportion of students still face difficulties with certain abilities to evaluate information. There is a need to strengthen the digital health literacy capacities of university students using tailored interventions. Improving the quality of health-related information on the internet is also key.
Using the vignette methodology to measure access
Authors: Van Ginneken E
Published: October 2021

Background

A vignette is a short description of a person or situation designed to simulate key features of a real- world scenario. Usually this vignette is then presented to relevant professionals to solicit their hypothetical response or behaviour. In medical literature, vignettes are mostly used to study clinical judgments, compare hospital prices, self-assess health or examine how age, sex, socioeconomic or insurance status affects chosen treatment.

Methods

We aimed to develop a method to utilize case vignettes to gain a better understanding of health access challenges. To this end, we studied available access indicators and frameworks and vignette applications as well as possible ways to include internationally recommended care plans to increase comparability of results across countries.

Results

We developed a five-step approach consisting of (1) selection of vignettes, (2) drafting of vignettes and a questionnaire based on available access framework and best practice guidelines for treatment, (3) expert validation, (4) application of vignette in country context, and (5) systematic analysis of country feedback. Four detailed pilots were carried out for dental care, stroke, depression and palliative care, in up to 12 European countries.

Conclusions

The vignette approach has the potential to identify gaps in coverage and access as well as differences in treatment and quality. Four detailed pilots have provided valuable insights in the challenges and limitations of the method that can be addressed in future applications. These include suggestions to improve user friendliness, scope, expert selection and complementing the survey with more specific and quantitative questions.
The effect of nutrients on telomere length of fetal DNA: findings from the Mamma & Bambino cohort
Authors: Magnano San Lio R , Barchitta M , Maugeri A , La Rosa MC , Caruso M , Giunta G , Panella M , Cianci A , Agodi A
Published: October 2021

Background

In the first 1,000 days of life, from conception to two years of age, a variety of exposures could shape children's health. Identifying what maternal factors early affect biological aging in children represents a major public health mission. The present study aims to assess the relationship between maternal intake of nutrients in early pregnancy and telomere length of cell-free circulating fetal DNA (cffDNA) from amniotic fluid.

Methods

We used data and samples from the ongoing prospective “Mamma & Bambino” study, which recruits mother-child pairs from Catania (Italy) at the first prenatal visit. Maternal nutrient intakes were assessed using a Food Frequency Questionnaire referred to one-month prior the recruitment. Relative telomere length of cffDNA was assessed by real-time polymerase chain reaction, among those women who underwent amniocentesis.

Results

The study included 174 mother-child pairs (mean maternal age = 35.7 years) recruited from 4th to 20th gestational week. The intakes of iron, vitamin B1, and magnesium were positively correlated with relative telomere length (p-values based on Spearman's test = 0.05). However, only the intake of magnesium was positively associated with relative telomere length (β = 0.002; SE = 0.001; p = 0.024), after applying a linear regression model which included maternal age, smoking, pregestational body mass index, and total energy intake. Magnesium deficiency was negatively associated with relative telomere length after adjusting for the same covariates (β = -0.467; SE = 0.176; p = 0.009).

Conclusions

To our knowledge, this is the first evidence of a relationship between maternal nutrient intake and telomere length of cffDNA. The positive effect observed for magnesium is consistent with previous studies conducted in other settings. However, further efforts are needed to translate the transgenerational effect of maternal behaviors to effective public health strategies.

Key messages

It is crucial to understand the early effect of maternal diet on biological aging in children. The intake of magnesium positively modulates telomere length, a promising marker of aging before birth.
1.P. Workshop: European Public Mental Health Responses to COVID-19
Authors:   Organised by: EUPHA-PMH,   Chair persons: Jutta Lindert (EUPHA-PMH), Shari McDaid (UK)
Published: October 2021

The COVID-19 pandemic has resulted in an increase in multiple known risk factors for mental health problems globally. As such, evidence-based, intersectoral public mental health responses to reduce and mitigate the pandemic-related consequences are critical. However, studies exploring variations in public mental health responses to the pandemic from across Europe are limited. In order to shape and inform future public mental health responses to the crisis, there would be great value in knowing how mental health support systems have adapted to date. To fill the gap in knowledge of Public Mental Health responses, we organized this workshop in three parts: First, Naomi Wilson will give an overview on Public Mental Health service responses in the European region, second Shari McDaid will provide insights on the structure of Public Mental Health in Scotland and third Frank Wieber will give an overview on structures of Public Mental Health responses in Switzerland.

Key messages

Evidence-based, intersectoral public mental health responses to reduce and mitigate the COVID-19 pandemic-related consequences are critical given the increased risk factors for mental health problems. The workshop will provide an overview how mental health support systems in Europe have adapted to date.
Public engagement in the management of the COVID-19 pandemic: Views & expectations of the publics
Authors: Kemper S , Kupper JFH , Kangne Kamga LS , Brabers AEM , De Jong JD , Bongers MEJ , Timen A
Published: October 2021

Introduction

During an epidemic, like COVID-19, trade-offs have to be made between measures to reduce mortality and morbidity and associated social, economic and political consequences. Traditionally, epidemic management (EM) has been guided by experts and policymakers, and is executed most attentively. It can however still be controversial in the public sphere. The question arises if public engagement (PE) could be a means to improve the quality and effectiveness of EM, as it has proven to be for other domains of healthcare policy.

Methods

From June to October 2020, seven Deliberative Discussion Focus Groups were executed with 35 Dutch citizens between 19 and 84 years old, to discuss their views on PE in COVID-19 management. Timeline Interviews were conducted to elucidate meaningful experiences during the epidemic. Next, benefits, barriers, timing and possible forms of PE in EM were discussed.

Results

Almost all participants supported PE in EM, as the integration of experiences and ideas of the public would benefit the quality of EM, and PE would increase awareness and acceptance of measures. Also, participants emphasized the importance of receiving information on the process of EM, to overcome the perceived lack of transparency herein. Consultation was seen as a fitting form for PE since the public could share ideas and feedback on EM, particularly on communication campaigns and control measures, however final authority stayed with experts. PE could be executed after the first acute phase of the epidemic, but also during evaluations. Moreover, barriers for PE were identified such as time constraints and the lack of knowledge of the public.

Conclusions

A foundation of values and conditions for PE in EM from the perspective of the public was laid. Support for PE was identified and considered valuable for quality and effectiveness of EM. Next, the results should be confirmed within a broader audience and the views of experts and policymakers on PE in EM should be elucidated.

Key messages

According to participants, public engagement can increase quality and effectiveness of outbreak management, by sharing knowledge, experiences and ideas between the public, experts and policymakers. The focus groups in this study were executed whilst the COVID-19 pandemic unfolded, which yielded very relevant outcomes of current interest.
How to promote experiential knowledge in public health: a new training for French practitioners
Authors: Georgelin B , Porcherie M , Soudier B , Le Grand E , Gaspard S , Ferron C , Berdougo F , Rush E
Published: October 2021

Background

In France, Health Promotion (HP) practitioners lack tools to document and share how their interventions work. To bridge this gap, a national committee of HP practitioners, policymakers and researchers designed a new method to Capitalize, i.e. collect, analyse and share through summaries, Experiential Knowledge (EK) in HP (CEKHP). A training program was created in 2020 to disseminate CEKHP process and tools.

Objectives

After undertaking CEKHP training, participants shall be able to design and promote their own CEKHP projects. Each training session (30 hours in total) alternates short theoretical courses, workshops and the completion of a capitalization in real professional situation. Expert members of the committee designed the training following a skills-based approach. They sequentially identified: targeted occupations, competencies, how to assess them, then designed the curriculum. Two core competencies are built up: 1/ valuing EKHP, through advocacy and project design; 2/ guiding with CEKHP the collection of EK on HP interventions and its circulation. The training covers 11 competencies of the WHO-ASPHER Competency Framework. In 2021, 2 sessions were organised to test its relevance in an adult learning situation (group of 12 professionals) and in a master's degree program (group of 9 students).

Results

The learning-by-doing method was fruitful: all participants, in both settings, completed their capitalization. A few trainees chose to document interventions or organisational adaptations linked with the Covid-19 crisis, for which EK is especially valuable. They also reported added benefits: self-reinforcement, rare in-depth exchanges with fellow HP practitioners, etc.

Conclusions

A training strategy combining adult learning and student teaching can be effective to disseminate CEKHP. All trainees are now invited to join a community of practice, which will provide them with additional tools and network resources, through a national EKHP resource center.

Key messages

A training program focused on building up experiential knowledge capacities is a lever for disseminating experiential knowledge in France, among both current and future health promotion practitioners. The real-life case study, i.e. the completion under supervision of the capitalization of a health promotion intervention, is an essential component of the new experiential knowledge training program.