bluuebunny/crossref_metadata_2025 huggingface dataset:
Post-marathon decline in right ventricular radial motion component among amateur sportsmen
Authors: Lewicka-Potocka Z , Dabrowska-Kugacka A , Lewicka E , Kaleta-Duss A M , Danilowicz-Szymanowicz L , Kubik M , Faran A , Szymeczko P , Galaska R , Fijalkowski M , Raczak G
Published: October 2021

Introduction

Running the marathon may be followed by post-exercise “cardiac fatigue” manifesting as transient right ventricular (RV) systolic and diastolic impairment. It is the thin-walled RV that is predominantly affected by the exercise-induced overload, with little if any, impact on the left ventricle (LV) [1]. The 2-D echocardiographic (ECHO) assessment of RV is challenging and may be incomplete since conventional measures reflect only the longitudinal motion (displacement of tricuspid annulus towards the apex) [2]. The mechanics of RV can be separated into two more components, anteroposterior (stretching RV wall by contracting septum) and radial (internal relocation of the RV free wall) [2]. The significance and relative contribution of motion components to global RV function may not be equal, and their interplay can vary depending on concomitant diseases [3].

Purpose

We aimed to analyse the pathophysiology of RV exhaustion associated with a marathon run with 3-D ECHO, which allows precise estimation of all RV motion components and their contribution to RV global function.

Methods

The study included 34 healthy males (mean age of 40±8 years), amateurs, who finished the marathon in northern Poland. The 3-D ECHO was performed 2 weeks before (stage I), at the marathon finish line (stage II) and 2 weeks after the competition (stage III). According to the ReVISION method (Right ventricular separate wall motion quantification) the global RV function was decomposed to longitudinal (L_), anteroposterior (AP_) and radial (R_) [3]. By dividing componential ejection fractions (EF) with global RV EF, L_EFi, AP_EFi, and R_EFi ratios were obtained.

Results

When comparing results from stage I and III there were no significant differences (Table 1). The analysis revealed post-run decline in RV EF with no changes in LV EF. The quantification of the RV motion components showed reduction in R_EF after the marathon with no changes in AP_EF or L_EF. The relative contribution of componential EF to global RV function were permanent and was not influenced by the competition.

Conclusions

Marathon run resulted in transient RV dysfunction arising from decline in radial shortening. Noteworthy, the componential interplay between wall motion compartments was preserved in pre- and post-run assessment. The ReVISION method enables the comprehensive analysis of the competing RV.

Funding Acknowledgement

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): The study was supported by the project POWR.03.05.00-00-z082/18 co-financed by the European Union through the European Social Fund under the Operational Programme Knowledge Education Development 2014–2020
The impact of anxiety level on medical decisions of non-COVID patients during the pandemic outbreak
Authors: Koren O , Abu Rajab S , Barbour M , Shachar M , Shahar A , Zubidat K , Slim W , Igbariya D , Rozner E , Turgeman Y , Mader E
Published: October 2021

Background

High anxiety levels (HAL) were widely reported in patients during the COVID outbreak. We assess whether HAL influenced medical decision-making (MDM) of Non-COVID patients.

Method

We prospectively recruited patients with cardiovascular complaints during February and September 2020. We assessed anxiety levels using the GAD-7, Beck Inventory, the cardiac anxiety questionnaires, and a newly designed MDM questionnaire.

Results

We recruit 287 patients. The mean age was 52.6±14.9 (females represent 36.2%). HAL was reported in 261 (90.3) patients and was more prevalent in old (p<0.001 for all questionnaires), married, and unemployed patients (significant p-value for all). Cardiovascular comorbidities and a history of anxiety, depression, and psychiatric disorder were independent factors for HAL (p<0.001 for all). Coronary catheterization was performed more in HAL (p<0.001 for all), yet the rate of significant coronary artery disease was lower than in patients with low anxiety level (LAL) (p<0.001 for all). 161 (56.9) patients reported that their MDM was affected (<0.001), and 149 (76.8) patients indicated that they would have gone earlier to the hospital if not the pandemic (p=0.03 for high DM-19 score). Patients with HAL seek medical care longer than LAL patients (p=0.02). Correlation analysis revealed a positive correlation between MDM and HAL (p<0.001 for all).

Conclusion

Our study shows a strong and positive correlation between anxiety level and MDM. Old patients with cardiovascular comorbidities and a history of mental disorders were at particularly high risk for HAL and sought medical treatment significantly longer than LAL patients.

Funding Acknowledgement

Type of funding sources: None.
Speckle tracking echocardiography as a promising tool for the prognostic assessment of patients with sarcoidosis
Authors: Pastore M C , Cameli P , Mandoli G E , D'Alessandro M , De Carli G , Vigna M , Bergantini L , Patti G , Bargagli E , Cameli M
Published: October 2021

Background

Sarcoidosis is a chronic granulomatous disease characterized by multiorgan inflammatory involvement and recurrent relapses with significant impact on morbidity and mortality. The prognostic assessment of these patients is still challenging. Although the international guidelines didn't recommend basic transthoracic echocardiography (TTE) for diagnostic and prognostic assessment of sarcoidosis, speckle tracking echocardiography (STE) has emerged as more sensitive for the early detection of cardiac sarcoidosis and outcome.

Purpose

This prospective study aimed to assess the potential value of STE parameters for the prediction of major adverse cardiac events (MACE) and sarcoidosis relapse.

Methods

Consecutive patients with confirmed diagnosis of sarcoidosis who underwent transthoracic echocardiography (TTE) and subsequent pulmonary function tests (PFTs) were enrolled. Patients with acute events or treatment escalation between TTE and PFTs and previous cardiac surgery were excluded. All patients were followed for sarcoidosis relapse requiring increase in step-up therapy and MACE (cardiovascular death, cardiovascular hospitalizations, arrhythmias).

Results

172 patients were included (111 females, 57.4±12.6 years); 56 patients showed extrapulmonary localizations of sarcoidosis; at baseline, 99 patients were on steroid and/or immunosuppressive therapy. During a median follow up of 2217 days, 8 deaths (3 cardiovascular deaths), 23 MACE and 36 sarcoidosis relapses were reported. Patients with MACE were older (p=0.0022), but didn't show significant differences in PFTs and sarcoidosis phenotype. LV global longitudinal strain (GLS) was the only echocardiographic index to show significant differences (lower values) in patients with MACE (p=0.025). LV GLS ≤17.13% (absolute value) was identified as a fair predictor of MACE both with ROC curves (AUC=0.64) and Kaplan Meier analysis (Fig. 1).

No significant differences of demographic, clinical, functional, and therapeutic data were observed between patients with/without sarcoidosis relapse. TTE revealed a significant reduction of LV ejection fraction (p=0.0432), tricuspid annular plane systolic excursion (TAPSE, p=0.0272) and global peak atrial longitudinal strain (PALS, p=0.0012) in patients with relapse. Among these 3 parameters, PALS ≤28.5% showed to be the best predictor of sarcoidosis relapse with ROC (AUC=0.7155) and Kaplan Meier curves (Fig. 2).

Conclusions

Our results highlight a potential role of LV GLS and PALS as prognostic markers in sarcoidosis, suggesting the use of STE in the clinical management of these patients, regardless the evidence or the suspect of cardiac localizations of the disease.

Funding Acknowledgement

Type of funding sources: None. Figure 1Figure 2
Left ventricular diastolic function in patients with breast cancer treated with anthracycline-based chemotherapy
Authors: Mincu R , Lampe L , Rassaf T , Totzeck M
Published: October 2021

Background

Despite major progress in novel breast cancer therapeutic regimens, anthracycline-based chemotherapy (ANT) remains among the most effective therapies. Cardiotoxicity, one of the most severe adverse events of ANT, has been defined as a reduction in left ventricular ejection fraction (LVEF) or global longitudinal strain (GLS). However, the role of early diastolic dysfunction has been insufficiently researched. We aimed to determine if diastolic dysfunction could early diagnose and predict ANT cardiotoxicity.

Methods

Studies that reported on echocardiographic parameters of diastolic function before and at the end of ANT in breast cancer patients without cardiac disease were included. We evaluated parameter derived from pulsed wave Doppler interrogation of the mitral valve inflow (E/A ratio and mitral E-wave deceleration time (EDT)) and tissue Doppler (mean velocities of the mitral ring in the early diastole (E') and E/E' ratio).

Results

A total of 892 patients from 13 studies were included. E/A ratio was significantly reduced at the end of ANT (OR 2.34, 95% CI [1.49, 3.68], p<0.001), while EDT was not significantly influenced (OR 0.74, 95% CI [0.50, 1.08], p=0.121). Tissue Doppler velocity of the mitral ring E' and the LV filling pressure analysed through E/E' ratio did not show significant changes after ANT (OR 2.32, 95% CI [0.94, 5.72], p=0.068, and OR 0.79, 95% CI [0.56, 1.12], p=0.197, respectively). A modest reduction in LVEF and global longitudinal strain (GLS) was observed at the end of the ANT therapy with a difference in means of 3.77% and −1.08%, respectively. Patients receiving ANT doses over 400 mg/m2 doxorubicin or epirubicin therapeutic equivalent doses showed a significant change in E/A and E' after the therapy. Cardioprotective therapy like carvedilol, nebivolol and spironolactone did not have a significant impact on the parameter of diastolic function.

Conclusion

ANT has a modest early impact on LV diastolic function in patients with breast cancer without cardiac disease and cannot be validated as an early diagnostic or prognostic tool of ANT-induced cardiotoxicity. Randomized studies on larger population, using new parameter e.g. left atrial function parameter and multimodality imaging are required.

Funding Acknowledgement

Type of funding sources: None.
Safety of Digoxin in Nonagenarian Patients with Atrial Fibrillation. Lessons from a Spanish multicenter registry
Authors: Dominguez Erquicia P , Raposeiras Roubin S , Abu-Asi E , Cespon Fernandez M , Alonso Rodriguez D , Camacho Freire S J , Curbelos Fernandez N , Lopez Masjuan Rios A , Melendo Viu M , Iniguez Romo A
Published: October 2021

Background

The association between digoxin and mortality is an unclear issue. In older patients with atrial fibrillation (AF), where the use of digoxin is frequent, the evidence of its safety is very scarce.

Aim

Our aim is to assess the safety of digoxin in nonagenarian patients with AF in terms of mortality.

Methods

We evaluated data from 795 patients ≥90 years old of a multicenter Spanish retrospective registry of nonagenarian patients with non-valvular AF and rate control. We analyzed the relationship between digoxin and mortality with a Cox proportional-hazards model and Kaplan-Meier survival curves.

Results

The follow-up was 27.7±18.3 months. Mean age was 92.5±3.8 years (inter quartilile range 90.0–112.7), and 71% of patients were female. Digoxin was not associated with increased risk of mortality (aHR 1.16; 95% CI: 0.96–1.41, P=0.128) in the total sample. However, we found a significant increase in mortality in the group with estimated glomerular filtration rate (eGFR) <30 ml /min/1.73 m2 (aHR 2.01; 95% CI: 1.13–3.57, P=0.018), but not in the other subgroups of eGFR (30–59/≥60 ml/min/1.73 m2). When exploring the risk of mortality according to gender, the male subgroup was associated with an increase in mortality (aHR 1.48; 95% CI: 1.02–2.14, P=0.041). This was not observed in female subgroup (aHR 1.03; 95% CI: 0.81–1.29, P=0.829). Based on the presence or absence of a history of heart failure (HF), we did not find significant differences in the association between digoxin and all-cause mortality (aHR 1.20; 95% CI: 0.87–1.65, P=0.268 vs aHR 1.15; 95% CI: 0.90–1.47, P=0.273, respectively).

Conclusions

In our large registry of nonagenarian patients with AF, we did not find an association between digoxin and mortality in the total sample. However, in the subgroup analyses, we found an increase in mortality with the use of digoxin in men and in patients with an eGFR<30ml /min/1.73 m2.

Funding Acknowledgement

Type of funding sources: None. Kaplan-Meier estimates survival functionMortality by subgroups
Latent class cluster analysis of knowledge on acute myocardial infarction symptoms and risk factors in community residents
Authors: Liu Y , Ma J , Zhang N , Xiao J.-Y , Wang J.-X , Li X.-W , Wang J , Zhang Y , Gao M.-D , Zhang X , Wang Y , Wang J.-X , Xu S.-B , Gao J
Published: October 2021

Background

Knowledge of Acute Myocardial Infarction (AMI) symptoms and risk factors (RF) have been studied worldwide in various populations. However, the studied specific symptom and RF of different surveys varies, the number of surveyed symptom and RF varies, and the criteria for judging good/high knowledge and bad/low knowledge are different (group classification criteria include the number, the percentages or the scores), which makes the results difficult to compare.

Purpose

The aim was to identify clusters of knowledge on symptoms and modifiable RFs using Latent Cluster Analysis, and to further compare characteristics and the awareness of the need for prompt treatment among different clusters.

Methods

A structured questionnaire was used to interview 4122 community residents over 35 years old on their knowledge about AMI symptoms and RFs. Latent GOLD Statistical Package was used to identify and classify the respondent subtypes (latent classes) of the knowledge on AMI symptoms or modifiable RFs. An individual's class membership probabilities are computed from the estimated model parameters and the observed scores. The multivariable logistic regression was performed in order to identify factors that predicted High knowledge membership.

Results

Two and three distinct clusters were identified in terms of knowledge of symptoms and RFs. 62.7% (Symptom High Knowledge Cluster) and 39.5% (RF High Knowledge Cluster) of the respondents were able to identify most symptoms and modifiable RFs. A number of common differences were observed with respect to higher probability of having high knowledge on symptom and RF, which was mostly better among those with higher education and average monthly income, insured, having annual physical examination, have disease history of AMI RFs, AMI history in immediate family member or acquaintance and have been exposed to AMI related public education. There was also significant difference in awareness of the prompt treatment in case of AMI occurs among different symptom or RF clusters.

Conclusions

A moderate or relatively low knowledge regarding AMI symptoms and modifiable RFs was observed in our study. Identification of Symptom or RF knowledge clusters can be a way to detect specific targeted groups that are most likely to possess lower knowledge of AMI with readily identifiable characteristics, which may facilitate health education and further reduce the pre-hospital delay and improve patient outcomes.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Key Project of Scientific and Technological Support Plan of Tianjin in 2020 Cluster category chartProfile plot
Temporal shift and accuracy of machine learning in heart transplant outcomes
Authors: Sabovcik F , Miller R , Cauwenberghs N , Hoffmann R , Haddad F , Kuznetsova T
Published: October 2021

Background

Accurate prediction of outcomes following a heart transplant is critical to explaining risks and benefits to patients and decision-making when considering potential organ offers. Given the large number of potential variables to be considered, this task may be most efficiently performed using machine learning (ML).

Purpose

We trained and tested different ML algorithms to accurately predict outcomes following a cardiac transplant using the United Network of Organ Sharing (UNOS) database.

Methods

We included 67 939 adult and pediatric patients enrolled in the UNOS database between January 1994 and December 2016 who underwent cardiac transplantation (median age 53 [IQR 38 – 60], 72.7% males). In our models, as an input, we included 114 features that have been collected from recipients and donors prior to transplant. The primary outcome was all-cause mortality at one-year post-transplant. We evaluated three different ML methods: XGBoost, Random Forest (RF) and L2 regularized logistic regression. Algorithms were trained and tested using shuffled 10-fold cross-validation (CV) as well as rolling CV. In the rolling CV, to mimic prospective procedure, ML models were trained by incrementally adding patients according to transplant year and testing models on the data in the following year. The hyperparameters, controlling the learning process, were tuned using Bayesian optimization. Prognostic accuracy for one-year all-cause mortality was characterized using the area under the receiver-operating characteristic curve (AUC).

Results

In total, 8,394 patients died within 1 year of transplant. We observed a substantial difference in prognostic accuracy between the shuffled 10-fold CV and the rolling CV. In the 10-fold CV, XGBoost and RF achieved high predictive performance with AUC of 0.848 (95% CI: 0.842–0.854) and 0.891 (95% CI: 0.886–0.896), respectively. In the rolling CV, which is a more realistic setting, AUC dropped to 0.673 (95% CI: 0.661–0.684) for XGBoost and 0.670 (0.657–0.683) for RF. Predictive performance of L2 regularized logistic regression remained stable across the two CV procedures, achieving AUC 0.669 (95% CI: 0.662–0.676) in the 10-fold shuffled CV and 0.665 (95% CI: 0.649–0.680) in the rolling CV procedure (Figure).

Conclusions

Our study suggests that ML models could be used to predict mortality in the first year post-transplant. We also show that the choice of CV procedure is crucial for evaluating ML models, particularly in data collected over a long period of time. The difference between the shuffled and rolling CV in the predictive performance of the tree-based ML models might indicate temporal dataset shift. In the rolling CV, all three methods achieved similar predictive performance.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Research Foundation Flanders (FWO)
Structural and molecular markers of aging heart: Sechenov University classification
Authors: Kogan E A , Syrkin A L , Blagova O V
Published: October 2021

Background

The process of aging at the level of the cells is connecting with arising of senescence cell, that are characterized by several possible signs, including damage to the mitochondria and contraction of telomeres, epigenetic changes, impaired regulation of protein metabolism, sensitivity to nutrients, mitochondrial dysfunction, stem cell collapse, impaired intercellular communication. Postmitotic cells may also develop senescence and are called amitosenescence cells (AMCs).

Goal

To investigate structural and molecular characteristic of aging heart with special identification of AMCs and creating classification of aging heart status.

Methods

Study was performed on 52 biopsies (endomyocardial and operative) of the heart and 48 autopsy cases (38 women and 62 men) with diagnosis of dilated cardiomyopathies, chronic ischemic heart disease, hypertensive cardiomyopathies, rheumatic heart disease and their combination. All patients were divided in two groups according to the age of patients: 1 group included 80 patients (average age 72.9±13.3 years) and 2 control group - 20 patients (average age 42.9±13.3 years). Serial paraffin sections were stained with hematoxylin and eosin, picrofuchsin; p16ink, Apocas, CD68 and CD 45 were detected by immunohistochemistry (DakoCytomation). We have calculated percent of AMC, Apo and RCB in 30 fields of vision on X400 magnification.

Results

AMCs were found in the myocardium of 77 aging patients and only in 2 young patients (premature aging?). AMCs were characterized by prominent degenerative changes, p16ink expression and accumulation of lipofuscin. Reduction of capillary bad (RCB), increased number of apoptotic bodies and presence of CD68+ macrophages and CD45+ lymphocytes were found in stroma. There were three aging heart status degree: 1 – presence less than 15% of AMCs, 0,1% of Apo and RCB –less than 15% (20 patients); 2 – presence 16–30% of AMCs, 0,2- 1% of Apo and RCB – 16–30% (35); 3 – presence more than 31% of AMCs, 1–2% of Apo and RCB – more than 31% (27).

Conclusion

Aging heart has increased number of amitosenecence cells that results severity and chronicity of heart diseases in aging patients.

Funding Acknowledgement

Type of funding sources: None.
Reduced RNA editing in the failing human heart mediates alternative circular RNA splicing
Authors: Kokot K , Kneuer J , John D , Moebius-Winkler M , Mueller M , Andritschke M , Gaul S , Sheikh B , Haas J , Thiele H , Leuschner F , Dimmeler S , Meder B , Laufs U , Boeckel J N
Published: October 2021

Background and purpose

Post-transcriptional RNA editing is an important mechanism in the development of human diseases. RNA editing can affect RNA stability and alternative splicing. The aim of our study was to characterize RNA editing and its impact on alternative RNA splicing in the healthy and failing human heart.

Methods and results

Human heart samples of heart failure (HF) patients (n=20) and controls (n=10) were analyzed using RNA sequencing with subsequent analysis of RNA editing. We identified adenosine-to-inosine (A-to-I) editing as the major form of RNA editing in human hearts, being reduced in HF patients. Consistently, we found the editing enzyme ADAR2 reduced in HF patients. A-to-I RNA editing predominantly occurred in intronic regions of protein-coding genes, specifically in repetitive, primate-specific Alu elements which can affect RNA splicing. Indeed, we found 173 circular RNAs (circRNAs) regulated by alternative mRNA splicing in the failing heart.

Loss of ADAR2 led to reduced RNA editing concomitant with an increase of circRNA, while overexpression reduced circRNA expression and enhanced RNA editing.

Conclusion

A-to-I editing is the major type of RNA editing in the human heart, being reduced in HF. We demonstrate a primate-specific alternative RNA splicing mechanism mediated by RNA editing in human hearts. The findings may be relevant to diseases with reduced RNA editing such as cancer, neurological and cardiac diseases.

Funding Acknowledgement

Type of funding sources: None.
Improvement in mitochondrial oxidative phosphorylation of cardiomyocytes derived from human-induced pluripotent stem cells using micropatterned anisotropic substrates
Authors: Jouve C , Donnarumma E , Seguret M , Pereira C , Vermersch E , Al-Sayed Z , Wai T , Hulot J S
Published: October 2021

Background/Introduction

Alterations in cellular bioenergetic events owing to metabolic dysfunctions are well demonstrated in heart failure (HF). Cardiomyocytes derived from human-induced pluripotent stem cells (hiPSC-CMs) have the potential to model metabolic alterations as observed in the human failing hearts, which however requires precise arrangements of the respiratory chain complexes.

Purpose

Develop a method to improve the hiPSC-CMs architecture by using a micropatterned substrate (repeated lines of 30 μm-width separated with a cell repellant) that promotes elongation and anisotropy.

Methods

Cardiomyocyte differentiation was performed using a chemically defined method and 35 days later the generated hiPSC-CMs were cultured on unpatterned vs. micropatterned substrates for 7 additional days. Energy metabolic profiles were then measured using the Seahorse analyzer and mitochondrial components were analyzed by fluorescence microscopy and western blot.

Results

Cultures on micropatterned anisotropic substrates resulted in the generation of elongated cell morphology, rod-shaped hiPSC-CMs with improved sarcomere organization scores, and more aligned Z-lines. We first found a specific increase in oxidation phosphorylation (OXPHOS) activity in micropatterned CMs with a significant increase in the oxygen consumption rate (OCR) linked to basal respiration (58.4±24.0 vs 40.6±21.0 pmol/min, p<0.01), ATP production (49.6±19.1 vs 33.2±18.8 pmol/min, p<0.001) and maximal respiration (239.1±119.0 vs 123.0±68.5 pmol/min, p<0.001). Micropatterned CMs showed a better electron transport chain activity that explains the significantly decreased glycolytic function observed by Seahorse (17.2±9.9 vs 23.9±7.2 mpH/min, p<0.001). Micropatterned CMs displayed a more organized mitochondrial network, without evident change in mitochondrial mass. Transcriptomic profiling of micropatterned vs. unpatterned CMs revealed no significant differences. We next evaluated the proteomic profiling and found no significant change in the micropatterned CMs OXPHOS proteins expression.

Conclusion(s)

We developed a novel method for modeling metabolic activity in hiPSC-CMs based on micropatterned cultures. Our data show that the linear architectural pattern drives the formation and efficiency of OXPHOS function in cardiomyocytes with a mitochondrial structural reorganization.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Agence Nationale de la Recherche
The state of health in the European Union in 2019
Authors: Vasco Santos J , Padron Monedero A , Bikbov B , Grad DA , Plass D , Mechili E-A , Gazzelloni F , Fischer F , Sulo G , Ngwa CH , Noguer-Zambrano I , Peñalvo J , Haagsma JA , Kissimova-Skarbek K , Monasta L , Ghith N , Sarmiento-Suarez R , Hrzic R , Haneef R , O'Caoimh R , Cuschieri S , Mondello S , Kabir Z , Devleesschauwer B
Published: October 2021

Background

The European Union (EU) faces many health-related challenges. Accurate and timely data on mortality and morbidity from diseases and injuries and their trends over time are essential for health planning and priority setting.

Methods

We use the GBD 2019 study estimates and 95% uncertainty intervals for the whole EU and each country to evaluate age-standardized death, YLL, YLD and DALY rates for Level 2 causes. We evaluate trends by comparing estimates for the year 2019 with those for the year 2010.

Results

In 2019, the age-standardized death and DALY rates in the EU were 465.8 and 20 251.0 per 100 000 inhabitants, respectively. Between 2010 and 2019, there were significant decreases for age-standardized, death and YLL rates across EU countries. However, YLD rates remained mainly unchanged, with increases in the Netherlands and the ‘. The largest decreases in age-standardized DALY rates were observed for HIV/AIDS and sexually transmitted diseases and transport injuries (both -19%). On the other hand, only diabetes and kidney diseases showed a significant increase for age-standardized DALY rates in the EU (3.5%). Mental disorders showed an increasing age-standardized YLD rate, as well.

Conclusions

Overall, there was a visible trend of improvement in the health status in the EU with substantial differences between countries. EU health policy makers need to tackle incidence of diseases and injuries, with specific attention to causes such as mental disorders. There are many opportunities for mutual learning among otherwise similar countries with different patterns of disease.
Burden of diseases and injuries attributable to risk factors in the European Union in 2019
Authors: Vasco Santos J , Padron Monedero A , Kocbach Bolling A , Bikbov B , Unim B , Grad DA , Plass D , Fischer F , Violante FS , Sulo G , Ngwa CH , Noguer-Zambrano I , Peñalvo J , Haagsma JA , Kissimova-Skarbek K , Monasta L , Ghith N , Sigurvinsdóttir R , Sarmiento-Suarez R , Haneef R , Mondello S , Breitner S , Kabir Z , Devleesschauwer B
Published: October 2021

Background

In addition to information on mortality and morbidity from diseases and injuries, it is important to identify the attributable burden of risk factors to allow for health planning and prioritization.

Methods

For the whole EU and each country, using estimates and 95% uncertainty intervals from the GBD 2019 study, we report attributable (all-cause and by level 2 risk factors) age-standardized death and DALY rates, as well as summary exposure values (SEV). We evaluate trends by comparing estimates for the year 2019 with those for the year 2010.

Results

Age-standardized death and DALY rates attributable to risk factors declined by 10.7% (95%UI 13.8%-7.6%) and 9.1% (95%UI 12.0%-6.3%), between 2010 and 2019 in the EU. While there was a decreasing trend for both age-standardized death and DALY rates for almost all risk factors, some showed an increasing trend on SEV, including low physical activity and intimate partner violence.

Conclusions

Despite the improvement of health metrics attributable to risk factors, several modifiable behavioral and metabolic risk factors remain unchanged over the years. It is crucial to ensure a swift implementation of evidence-based policies and interventions in EU member states to achieve the targets of the Sustainable Development Goals.
The resetting of a local health system: an opportunity for health promotion
Authors: Bou Monclús MA , Casamitjà Sot MT , Mantas Jiménez S , Mallolas Jiménez J , Ventura Taberner N , Sunyer Serrat J , Parreño Ariza RM , González Cateura A , Rodríguez Arjona MD ,   HP Group of Professionals for Health Promotion of Girona
Published: October 2021

Background

The COVID-19 pandemics brings a window of opportunity for the 2021-2025 Health Plan of Catalonia to better address the social determinants of health. Different public organisms are leading the Health Promotion (HP) agenda without a real integration of the approach. An interdisciplinary group of health professionals working on HP carried out a qualitative study to assess barriers, facilitators and recommendations of health professionals and public policy managers for applying HP.

Methods

Six focus groups with 52 purposively selected professionals of different health disciplines and three in-depth interviews with public policy managers were conducted between March 2017-February 2020 until saturation was reached. An external expert on Sociology conducted all interviews and codification was done by three researchers from the group. Literature review helped to complete triangulation.

Results

The salutogenic approach was mostly unknown. The health system was not set with a people-centred perspective and HP not integrated within health services. Different public organisms competed for leadership and resources in HP. There was limited expenditure for the primary health care services working on HP. Coordination across healthcare services levels and sectors was scarce. Roles and responsibilities related to HP were not defined. Health professionals were not aware of evidence-based approaches. Some interdepartmental public health plans were already designed but not fully deployed, mainly due to lack of funding and disaggregated mechanisms of governance and financing. Initiatives such as the Municipal Health Committees or social prescription were positively perceived.

Conclusions

The Catalan Public Health Agency and health providers should work aligned. Financing and reallocation of resources for Public Health and HP should be enhanced. Health should be a core value in educational plans. Local and regional stakeholders should have a higher role in resetting health services.

Key messages

Governance for Health in All Policies needs intersectoral partnerships. The health system should be rebuilt to properly address the social determinants of health in the post-COVID era.
Cross-sectional associations between number and ages of children and maternal physical activity
Authors: Simpson RF , Hesketh KR , Crozier SR , Baird J , Cooper C , Godfrey KM , Harvey NC , Westgate K , Inskip HM , van Sluijs EMF
Published: October 2021

Background

Physical activity (PA) has many health benefits, but parenthood is often associated with reduced PA in mothers. Determinants of adult PA are diverse, but ages and number of children may be key factors linked to maternal PA. Few studies have compared PA levels of mothers of school-aged children with those who have younger children, which is vital considering that maternal PA patterns may change at transition to formal schooling. Studies using device-assessment to investigate this association are also sparse. We aimed to investigate the association between number and ages of children and maternal device-measured moderate-to-vigorous PA (MVPA).

Methods

Cross-sectional analyses were conducted using data from 848 mothers from the Southampton Women's Survey when the index child was 4 or 6-7 years old. Two-level random intercept linear models were run to investigate associations between self-reported number (1, 2, 3+) and ages (4y and under, 5y and over, both age groups) of children, and their potential interaction, and accelerometer-assessed log-transformed minutes of maternal MVPA. Results are presented as % difference in minutes of MVPA.

Results

41% of mothers met PA guidelines (150 minutes of MVPA/week). Women who had any children 5y and over engaged in more MVPA than those with only children 4y and under (e.g. % difference in minutes of MVPA: 42.2, 95% CI 18.7 to 70.4 for mothers with only children 5y and over vs those with only children 4y and under). Mothers with 2 or 3+ children did less MVPA than those with 1 child (e.g. 13.9, 1.0 to 25.2 less MVPA for women with 2 children vs those with 1 child).

Conclusions

Mothers with multiple children or any children 4y and under do less MVPA than those with 1 child or only school-aged children. Interventions and policies are needed to support these mothers to increase their time spent doing MVPA, especially considering the additional health benefits associated with this level of intensity of PA.

Key messages

Most mothers are insufficiently physically active to gain the associated health benefits. Interventions to increase MVPA particularly need to target mothers of younger children and those with multiple children.
Managing the pandemic in the reception system for migrants: the Italian experience
Authors: Sisti LG , Cammilli M , Diodati A , Menghini M , Fazioli C , Petrelli A , Di Napoli A , Cavani A , Mirisola C , Costanzo G
Published: October 2021

Issue

Italy represents a well-known European transit and destination country for Migrants and Refugees (M&Rs) with more than 77.000 migrants currently hosted in the reception system. Pandemic did not impact the M&Rs' influx with more than 30.000 disembarked in 2020. In line with the WHO and international organizations alerts to protect the health of M&Rs, Italy included M&Rs in its pandemic response.

Description of the practice

With the mandate of the Ministry of Health and thanks to the collaboration with the Ministry of the Interior and other institutional and governmental bodies, the Italian National Institute for Health, Migration and Poverty developed a comprehensive strategy to protect M&Rs' health in Italy during the COVID-19 pandemic, either into the reception system and outside.

Results

Interim evidence - based operating procedures including instructions regarding the early detection and the management of potential suspected and confirmed COVID-19 cases, from the first arrival throughout the entire reception system path, have been published. A national survey on the incidence of COVID-19 cases in the reception system has been performed in 2020. Dedicated information flows on the incidence of COVID-19 cases at the arrival in Italy and in the reception system and a periodic monitoring of the implementation of the afore-mentioned operating procedures have been established in 2021. Data collected have shown a daily mean incidence ratio lower for migrants hosted in the reception system than for the general population, as well as the same regarding the new COVID-19 cases among newly arrived migrants.

Lessons

The strategy adopted was found to be effective in protecting M&Rs' health during the pandemic. In particular, the Italian reception system has globally shown a good performance in limiting the COVID-19 spread. Moreover, the influx of newly arrived migrants did not represent an additional epidemiological risk in terms of burden of infection.

Key messages

The production of evidence-based procedures and the establishment of effective information flows have proved to be effective in managing and monitoring the pandemic in regards to M&Rs. The Italian reception system has turned to play as a protective factor in limiting the COVID-19 spread and the systematic screening of newly arrived M&Rs did not shown an additional COVID-19 burden.
Impact of COVID-19 on economic and working conditions in Italy. Data from PASSI and PASSI d’Argento
Authors: Possenti V , Minardi V , Contoli B , Lana S , Scardetta P , Masocco M
Published: October 2021

Background

Having affected multiple life aspects globally, the COVID-19 pandemic will generate long-term consequences on productive sector and economy. The two Italian population-based surveillance systems PASSI (18-69yy) and PASSI d'Argento (65+) have annexed a COVID-module to the standard questionnaires' sections to investigate also changes of economic and working conditions related to the COVID-19 crisis.

Methods

We analysed data on a sample of 2,613 PASSI and 2,288 PASSI d'Argento interviews, collected between August and December 2020.

Results

Among adults, 34% refers a worsening of their financial resources because of the COVID-19 crisis: above all if socially deprived people, with many difficulties (52%) or with a low educational level (41%). Despite keeping up working, 31% of employed people worked less due to the COVID crisis, with a lower wage; 5.5% lost the job and a certain number had to give it up. The worsening of economic resources correlates to changes in working conditions due to the pandemic crisis, but the latter did not fully determine the former. Economic losses are more frequent among people in search of employment (52% vs 35% of occupied or 28% of inactive), those who lost their job (76%) or, despite keeping up working, earn less (66%), but interest also individuals who have not undergone changes per the working condition and volume (19%). The association between worsened economic resources and social disadvantage (low education and economic difficulties) is significant, even adjusting for job or wage loss. Even among older persons, a lower but non-negligible quota (16%) declares economic worsening due to the pandemic-related crisis. The percentage triples (29%) on difficulty making ends meet.

Conclusions

Since the analysis of preliminary findings, it emerges how the impact of this crisis is and will not be the same to all, but will emphasize inequalities, at the expense of the most vulnerable individuals, at any age.

Key messages

In Italy, the COVID-19 pandemic has affected the main social determinants of people health because it has worsened economic and working conditions. This crisis is emphasizing health inequalities, at the expense of the most vulnerable individuals, at any age.
Perceived Stress related to COVID-19 among Tunisian adults during the lockdown period
Authors: Bannour R , Ghammem R , Mlouki I , Ben Fredj S , Zammit N , Ben Nasrallah C , Horri N , Maatoug J , Ghannem H
Published: October 2021

Background

Public health emergencies such as the Covid-19 pandemic can affect the health, safety and well-being of individuals and communities. This pandemic may lead to emotional reactions such as stress, anxiety and depression in the general population.

Aim

To evaluate the perceived stress among Tunisian adults during the period of lockdown.

Methods

A cross-sectional study was conducted during the lockdown period targeting adults using online social networks. The data was collected through a “Google Form” questionnaire published on Face book. Perceived stress was measured using the ‘Perceived Stress scale'.

Results

A total of 164 adults participated in our study with a majority of women (77.4%) and a mean age of 34.57 ± 12.1 years. Almost half of our participants (48.1%) were from the Governorate of Sousse. Among the respondents, 58.5% felt in perpetual threat and only 15.4% knew how to manage their stress. Univariate analyses showed that perpetual threat was significantly associated with age (p = 0.015), being single (p = 0.03) jobless (p = 0.02), and spending more than one hour documenting on COVID-19 (p = 0.02). After adjusting to sex and age; the multivariate analysis showed a statistically significant association between stress level and anxiety p < 10-3; OR: 8.62; IC [3.1-23.8]); fear of catching the virus (p = 0.031; OR: 3.10; IC [1.1-6.7]) and insomnia (p = 0.001; OR: 7.46; IC [2.4-24.7]).

Conclusions

Our results showed that there is a high prevalence of stress in the general population during confinement. A national program of population mental health management should be implemented along with the pandemic management.

Key messages

The COVID 19 may lead to emotional reactions such as stress, anxiety and depression in the general population. A national program of population mental health management should be implemented along with the pandemic management.
Field evaluation of BNT162b2 COVID-19 vaccine response in healthcare workers: a 3-month follow-up
Authors: Ferrara P , Madotto F , Conti S , Vitale A , Della Ragione G , Romano ML , Borrelli M , Schiavone B , Mantovani LG , Ponticelli D
Published: October 2021

Background

Effective and rapid immunologic response to vaccines is a crucial strategy for the control SARS-CoV-2 pandemic. Here, we present the results of an ongoing longitudinal observational study conducted among the healthcare workers (HCWs) of the Pineta Grande Hospital (Castel Volturno, Italy), who were administered the two-dose prime-boost mRNA vaccine BNT162b2.

Methods

Volunteer HCWs underwent either (i) six RT-PCR assay for qualitative detection of SARS-CoV-2 nucleic acid in nasopharyngeal/oropharyngeal swabs; (ii) or six quantitative serology testing for the research of virus-specific immunoglobulins (Ig) through chemiluminescent immunoassay with a reactivity cut-off of an Index of ≥ 1.0. The first tests were taken before the administration of the vaccine and then according to a predefined timeline. An active surveillance follow-up of SARS-CoV-2 infections was set amongst the vaccinees after the end of the study.

Results

Overall, among the 435 HCWs who accepted to participated in the study, 9.3% reported a previous laboratory-confirmed infection with SARS-CoV-2, though all subjects tested negative at the time of first vaccine dose. In the swab cohort, seven subjects tested positive in the first 15 days after the first vaccine dose and one about a week from the second dose. At 45- and 60-day follow-ups all vaccinees tested negative, but two positive tests were registered at the third month. In the second cohort, two weeks after the first vaccine dose anti-SARS-CoV-2 antibodies exceeded the reactivity cut-off in 82.5% the participants. At one-month follow-up, almost all (98.4%) the vaccinees had reached the maximum Index value of 10. No statistically significant associations were found between antibody response and HCWs' characteristics.

Conclusions

Our results showed that surveillance is a critical component of providing safe healthcare during COVID-19 pandemic, also after extended vaccination campaigns, thus enhancing the protection of patients and HCWs.

Key messages

All healthcare facilities should implement continuous post-vaccination surveillance programs in order to ensure patients and healthcare workers safety, and limit in-hospital transmission of SARS-CoV-2. Longer field follow-ups are indispensable to investigate immunogenicity trends and effectiveness of COVID-19 vaccines over time, and to consider booster doses, especially in high-risk population.
COVID-19 prevention and outbreak control in a large Spanish prison: an intersectoral approach
Authors: Boned-Ombuena A , Bonet Igual MJ , Sáez-Lloret I , Martí-Serra J , Deltoro MG , Cardona C Gimeno , Melero-Garcia MM , Soriano P , Orts-Ríos E , Roig Sena J
Published: October 2021

Issue

The COVID-19 pandemic poses a challenge for prison settings, given their population vulnerability and the complexity of their internal functioning. We summarize the actions and outcomes concerning outbreak prevention and control in the Antoni Asunción Hernández (AAH) Prison (Valencian Region, Spain), one of the largest in Europe.

Description

An intersectoral commission was established in March 2020 at the Valencia General Hosp Health Dept to coordinate the COVID-19 response in penitentiary centres. A contingency plan was developed, with successive contention layers: general measures, restriction of interaction with the community (including suspension of visits), 14 days quarantine on admission and return, reduction of activities, modular confinement, voluntary confinement in cells, occupational risks prevention, vaccination, epi surveillance, outbreak management (incl sectorisation), isolation of cases (PCR at discharge), contact tracing and 14d quarantine (PCR at 0,7&14d), expanded testing and healthcare services.

Results

On 8 Jan 2021, with a regional 14d cum incidence of 394/100,000 pop, an outbreak was declared. The index case initiated symptoms the 14th day after return from leave, after quarantine discharge. In 57 days 281 confirmed cases were diagnosed: 274 inmates (out of 1,823) and 7 workers (of 890). Mean age 40,7 years (SD 12,0), 9 cases + 65 year-olds, 99,3% men. 7 out of 32 modules and the nursing unit were affected, with an overall attack rate of 38,5% (range 6,1-77,4%). 5 inmates were hospitalised, of which 2 in ICU. All patients had an uneventful recovery. Case fatality rate 0. No new variant was detected.

Lessons

Intersectoral coordination mechanisms, involving prison officials, public health authorities and healthcare services, are crucial to unfold an appropriate COVID-19 response. Tailored, rigorous, dynamic and proportionate measures are essential to reduce COVID-19 impact on the health and well-being of prisons' population and their communities.

Key messages

Prisons are at risk of large COVID-19 outbreaks, with potentially severe consequences, given their population vulnerability and organisational complexity. We recommend a 14d quarantine duration. Intersectoral coordination mechanisms are crucial to unfold an appropriate COVID-19 response, wich should include tailored, rigorous, dynamic and proportionate prevention and control measures.