bluuebunny/crossref_metadata_2025_split huggingface dataset:
Atrial fibrillation in patients with a history of cancer and risk of bleeding complications associated with antithrombotic therapy
Authors: Chu G , Van Rein N , Huisman M V , Pedersen L , Klok F A , Cannegieter S C , Sorensen H T 
Published: October 2021

Abstract

Background
Up to one in four patients with atrial fibrillation (AF) has a cancer diagnosis. It is largely unknown to which extent a prior cancer diagnosis affects major bleeding and thromboembolic risk in AF patients. Moreover, data on major bleeding rates per antithrombotic treatment type are lacking in these patients.

Purpose
To examine the incidence rates of major bleeding per antithrombotic treatment in AF patients with prior cancer and to examine whether cancer type and the time-interval between AF and cancer influence major bleeding and thromboembolic risks.

Methods
This nationwide population-based cohort study included incident Danish AF patients aged ≥50 years between 01–01–1995 and 31–12–2016. Data on prior cancer, major bleeding and thromboembolisms (i.e. arterial and venous) were obtained from Danish health registries via International Classification of Diseases 10th Revision codes. We stratified according to prior cancer and by time between the AF and cancer diagnosis (i.e. &lt;1 year, 1–3 years, &gt;3 years), and cancer type. Data on antithrombotic exposure (e.g. no anticoagulant treatment, platelet inhibitors, vitamin K antagonists, direct oral anticoagulants, or combination of antithrombotic drugs) were evaluated as a time-dependent variable. We computed incidence rates per 100 patient-years and adjusted hazard ratios in a Cox regression model.

Results
We identified 39,178 AF patients with a prior cancer diagnosis. Bleeding risk increased with increasing number of antithrombotic drugs and was higher in AF patients with a history of cancer compared to those without, across all exposure categories (Figure 1). The increased bleeding risk was similar across different time intervals between cancer and AF diagnosis. The increased thromboembolic risk steeply declined with increasing time intervals between AF and cancer diagnosis (Figure 2). Prior gastrointestinal, intracranial, haematological, respiratory and urogenital cancers were associated with an increased bleeding risk. The two latter cancer types were also associated with increased thromboembolic risks.

Conclusion
We showed that patients with atrial fibrillation and a prior history of cancer experience higher rates of bleeding than those without cancer. Both respiratory and urogenital cancers had the highest rates of bleeding and thromboembolisms.

Funding Acknowledgement
Type of funding sources: None.
Renal decline in patients with atrial fibrillation treated with rivaroxaban or warfarin: a population-based cohort study in the United Kingdom
Authors: Garcia Rodriguez L A , Balabanova Y , Saez M E , Brobert G , Gonzalez-Perez A 
Published: October 2021

Abstract

Background
A recent observational study (1) has suggested that renal decline among patients with non-valvular atrial fibrillation (NVAF) could be faster in users of warfarin vs. rivaroxaban.

Purpose
To estimate renal decline in patients with NVAF and preserved renal function who started oral anticoagulant (OAC) therapy with rivaroxaban 20 mg or warfarin.

Methods
Using primary care electronic health records (EHRs) from the United Kingdom (UK), we identified patients with NVAF who initiated rivaroxaban (20 mg/day, N=5338) or warfarin (N=6314) from January 2014–March 2019. Patients were excluded if they had no estimated glomerular filtration rate (eGFR) or serum creatinine (sCr) values recorded in the year before OAC initiation, a history of end-stage renal disease (ESRD), or baseline eGFR &lt;50 ml/min/1.73m2.
We identified three renal decline outcomes during follow-up: a) doubling of sCr levels, b) ≥30% decline in eGFR (confirmed by a subsequent measurement), and c) ESRD (code for ESRD/stage 5 CKD/chronic dialysis, or eGFR &lt;15 ml/min/1.73m2 confirmed by subsequent measurement). To identify incident cases of each outcome, we followed patients from OAC initiation to the earliest of a renal decline event, death, or the end of the study period (September 2019). Cox regression was used to calculate adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for each outcome with rivaroxaban vs. warfarin use, overall and among heart failure and diabetes patient subgroups. We estimated the average eGFR slope using a mixed model regression among the subset of individuals with at least two eGFR measurements during follow-up, where the first was recorded within 120 days of the start of follow-up, and the last was recorded &gt;180 days after the first eGFR measurement (rivaroxaban n=2054, warfarin n=2464).

Results
After a mean follow-up of 2.5 years, the number of incident cases was: doubling sCr (n=322), ≥30% decline in eGFR (n=1179), and ESRD (n=22). As shown in the Table, after adjusting for age, sex, baseline renal function and comorbidity, HRs for the renal outcomes with rivaroxaban vs. warfarin users were: doubling sCr, 0.63 (95% CI: 0.49–0.81); ≥30% decline in eGFR, 0.76 (95% CI: 0.67–0.86); ESRD, 0.77 (95% CI: 0.29–2.04). Similar results were observed among patients with diabetes or heart failure. Estimated mean loss in renal function during the study period was 2.03 ml/min/1.73 m2 per year among warfarin users and 1.65 ml/min/1.73 m2 among rivaroxaban initiators (p=0.03).

Conclusion
The risk of renal decline events and rate of decline in renal function among patients with baseline eGFR &gt;50 ml/min/1.73m2 was lower in patients using rivaroxaban 20 mg vs. warfarin. As residual confounding could have been present, further research is needed to confirm/refute our findings.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Bayer AG
Quantifying preload alterations using a sensitive chest-mounted accelerometer
Authors: Schmidt S E , Kristensen C B , Soerensen K , Soegaard P , Mogelvang R 
Published: October 2021

Abstract

Seismocardiography (SCG) is a technology where the chest wall vibrations from the beating heart are measured using a highly sensitive accelerometer. SCG offers continuous measurement of cardiac function and potential applications include remote monitoring, diagnostic assessments, prognostic health checks and biventricular pacemaker optimization.

Aim
In the current study we examined how changes in preload influence SCG time intervals, by acute saline infusion.

Methods
We included twenty-six subjects, sixteen subjects with cardiac disease such as hypertrophic cardiomyopathy, dilated cardiomyopathy, aortic valve disease or ischemic heart disease (age 45.8±17.7 years and 93% male) and ten subjects without known cardiac conditions (age 42.1±14.4 years and 70% male). SCG was recorded from the xiphoid process using a custom-made sensor before and after acute infusion saline (median 2.0 L). The SCG signals were sampled with 5000 samples per second in 60 seconds, the individual heartbeats were identified using a dedicated segmentation algorithm and an average SCG beat was computed and used for the data analysis. Using a recently proposed nomenclature the following SCG fiducial points was identified: Es which coinciding with mitral valve closure, Gs which to some degree coincides with aortic opening, Bd coinciding with aortic valve closure and Fd coinciding with mitral valve opening [1]. The Es-Gs time interval was used as a measure of isovolumetric contraction time (IVCT), the Gs-Bd time interval was used as an estimate of ejection time (ET) and the Bd-Fd time interval as an estimate of isovolumetric relaxation time (IVRT). Paired t-test was used to test for significant response after infusion, while a two sample t-test was used to test for a significant difference in the observed response in subjects with or with our cardiac disease.

Results
For two subjects SCG after infusion was not obtained thus, twenty-four subjects were included in the final data analysis. In the whole group, acute saline infusion shortened the IVRT (Bd-Fd) from 91.0±15.3 ms to 82.7±15.3 ms (p=0.004) and prolonged the ET (Gs-Bd) from 329.4±35 ms to 343.4±33 ms (p&lt;0.001). There was no significant change in IVCT (Es-Gs) which was 39.5±15.1 ms at baseline and 38.1±14.9 ms post-infusion (p=0.88). There was no significant difference in response between subjects with or without cardiac disease.

Conclusion
Increase in preload shortened the SCG time intervals related to the isovolumetric relaxation period and prolonged the period related to ejection time. SCG time intervals capture changes in preload, which demonstrates that the SCG is a potential modality for quantification of cardiac dynamics.

Funding Acknowledgement
Type of funding sources: None.
Association between metabolic syndrome and incident colorectal cancer in young adults: analysis of a nationwide epidemiological database
Authors: Seki H , Kaneko H , Yano Y , Itoh H , Morita K , Kiriyama H , Kamon T , Fujiu K , Michihata N , Jo T , Takeda N , Morita H , Yasunaga H , Komuro I 
Published: October 2021

Abstract

Background
Colorectal cancer (CRC) is still increasing in young adults. Metabolic syndrome is reported to be associated with CRC incidence in middle-aged and elderly subjects. However, whether this association exists in young adults remains unclear. We sought to clarify whether metabolic syndrome was associated with incident CRC in young adults (aged&lt;50 years).

Methods
We studied 902,599 participants (Median age=41 [37–45] years; 55.4% men) enrolled in the JMDC Claims Database during 2005 and 2018. Participants who had a history of CRC, colorectal polyps, Crohn's disease, or ulcerative colitis were excluded. Study participants were categorized into two groups according to the presence of metabolic syndrome based on the Japanese criteria (waist circumference ≥85 cm for men and ≥90 cm for women, and ≥2 metabolic parameters including elevated blood pressure, elevated triglycerides, reduced high-density lipoprotein cholesterol, or elevated fasting plasma glucose).

Results
Metabolic syndrome was seen in 58,561 individuals (6.5%). Over a median follow-up of 1,008 (429–1,833) days, there were 1,884 CRC diagnoses. After multivariable adjustment, the hazard ratio (HR) of metabolic syndrome for CRC events was 1.26 (95% confidence interval [CI]=1.07–1.49). Cox regression analysis after multiple imputation for missing values showed that metabolic syndrome was associated with CRC incidence (HR=1.35, 95% CI=1.17–1.56), and metabolic syndrome was associated with a higher incidence of CRC in individuals with a follow-up period of ≥365 days (HR=1.33, 95% CI=1.10–1.60). This association was also observed when metabolic syndrome was defined according to the International Diabetes Federation criteria (HR=1.30, 95% CI=1.09–1.49) and the National Cholesterol Education Program Adult Treatment Panel III criteria (HR=1.39, 95% CI=1.12–1.72).

Conclusions
Metabolic syndrome was associated with a higher incidence of CRC among individuals aged &lt;50 years. These results could be informative for risk stratification of subsequent CRC among young adults.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): the Ministry of Health, Labour and Welfare, Japan (19AA2007 and H30-Policy-Designated-004) and the Ministry of Education, Culture, Sports, Science and Technology, Japan (17H04141)
Research Electronic Data Capture (REDCap): tackling data collection, management, storage, and privacy challenges
Authors: Van Bulck Liesbet , Wampers Martien , Moons Philip 
Published: October 2021

Abstract
Data are the basis of research; without data, there is no research. However, growing internationalization of research, increased complexity of study designs, and stricter legislation make high-quality data collection, management, and storage more important, but also more challenging than ever. This article provides an overview of common challenges clinical researchers face when collecting, managing, and storing data and how REDCap, Research Electronic Data Capture, can be a possible solution to address these challenges.
The response to COVID-19 and legal determinants
Authors: Lingri Dimitra 
Published: October 2021

Abstract
The panelist will focus on the distinction between ethics, law and on requirements towards building progressive alternatives from the legal perspective. It will also examine the impact legislative and regulatory framework and jurisprudence have on the enjoyment of the right of health during COVID-19. During the pandemic many national frameworks used emergency law in order to introduce containment and mitigation measures into society. Most of these were enacted as emergency legislation, and this poses certain additional challenges in terms of the rule of law, given the often limited impact assessment or the absence of judicial review. These key characteristics that carry an element which can only be deemed appropriate given temporal limitations. From divergent national responses to combat COVID-19 to broader multilateral agreements on global health security, inequities have come to the fore. Assessing the proportionality of measures adopted to achieve legal aims necessitates an interdisciplinary and cross-sectoral collaboration and examination, as well as embedding mechanisms to systematically monitor broader implications for global health, and societal cohesion and resilience. Law is a part of interdisciplinary collaboration needed to achieve efficient commitments in order to combat the COVID-19 pandemic effectively. Even though law itself is not a panacea, remedying broader societal inequities, it is an essential step needed towards implementation of effective health policies into society. Indicative examples on aspects of interest and steps taken by payers to ensure equitable access for all will be elaborated upon. An overview on the implications of dynamics between developed and developing countries will also be presented, with due emphasis on the future of both European and global health and partnerships for accessibility and accountability.
Child health and wellbeing in a changing climate
Authors: Sripada K 
Published: October 2021

Abstract
Children are one of the most sensitive groups to climate change, along with the elderly and those in small island developing states, according to the Intergovernmental Panel on Climate Change. UNICEF estimates that more than half a billion children are estimated to live in extremely high flood risk areas. Children are vulnerable to both the sudden events linked to climate change (e.g., flooding, heatwaves, and wildfires) as well as slower-onset impacts (e.g., water scarcity, shifting agricultural zones, rising sea levels, and increasing disease-vector ranges). Climate change has enormous potential to undermine development gains and livelihood options for today's children. This presentation will provide an overview of impacts on child health and development of both the sudden climate change effects, including extreme weather events, extreme heat, and effects on natural systems; and consequences of the changing climate, such as displacement, migration, and social instability. The trauma of living through a climate-related disaster can have substantial mental health impacts on children and youth. Some key challenges towards to studying and modelling these impacts will be shared. Finally, action and commitments to protect children from climate change will be highlighted.
1.K. Workshop: New working environments, occupational risks and socioeconomic inequalities during covid-19 pandemic
Authors:   Organised by: EUPHA-INJ, EUPHA-SSWH,   Chair persons: Maria Papadakaki (EUPHA-INJ), Gunnel Hensing (EUPHA-SSWH)
Published: October 2021

Abstract

Working from home has been mandated in many parts of the world as a temporary public health measure. Transition to such alternative working forms and environments have required new working arrangements and alternative working plans for job functions and tasks that were not fully anticipated by company policies, national laws and regulations. Risks arising in the new remote workspaces need to be identified to safeguard workers' health and mental well-being, especially among the most vulnerable workers. Workers' ability to carry out the tasks, their living arrangements, family responsibilities, and health conditions or disabilities need to be considered. Confidentiality, security, and an anti-harassment policy are also critical in remote working. Workplace policies and clear guidelines have been deemed necessary to address these challenges. Many countries around the world have begun legislating aspects of remote working to grant legal certainties and specify rights and responsibilities for both employers and workers. The workshop will attempt to map the work patterns that emerged during the covid-19 pandemic and to highlight the opportunities, challenges and risks arising from the new working environments. Health, economic and social impacts of new employment arrangements will be discussed with emphasis on systemic and structural factors increasing inequalities. Social protection gaps will be highlighted in line with human rights and international labour standards. The workshop will further discuss how to take advantage of the extensive potential of innovative tools and forms of work with regard to employee health and safety. Public policies, legislative initiatives and innovative ways of responding to the challenges will be presented. The workshop will conclude with policy recommendations taking into account the future of work that will be shaped due to COVID-19. Overall, the workshop will promote a discussion on emerging working environments, occupational risks and access of workers to social protection and social rights. It will further discuss the factors that increase workers' vulnerability, practice standards and organisational principles and policies as well as innovative ways to mitigate risks at individual, company and system level.

Key messages
Map new trends, risks and opportunities in the transition from traditional working environments to working from home and identify systemic and structural barriers to safe employment. Review public policies, legislative initiatives and innovative ways of responding to the challenges of new ways of working.
Vaccine adhesion before and after Vaxzevria suspension in a Local Health Unit of Piedmont - Italy
Authors: Catozzi D , Belliggiano D , Poli A , Bonino R , Pompili E , Scaioli G , Minniti D , Siliquini R 
Published: October 2021

Abstract

Introduction
The Oxford-AstraZeneca vaccine Vaxzevria is a viral-vector vaccine developed to prevent COVID-19 infection. Two doses scored 81.3% efficacy against symptomatic infection and 100% against hospitalization. In Italy, Vaxzevria use started in February. After two deaths among the Army, Italian Medicines Agency withdrawn the vaccine batch involved. News about fatal thrombosis increased, together with population concern. On March 14th, the Piedmont Region suspended another batch following a new time-related death. The following day, several European states suspended Vaxzevria administration waiting for indication from an EMA meeting on March 18th. The aim of Authors was to study the effect of suspension on adhesion among general population.

Methods
Authors registered vaccine adhesion of vaccination centers offering Vaxzevria. To access vaccination, people was requested to express willingness through a website. Then, access was granted with a summoning SMS or e-mail. Vaxzevria target populations were members of law enforcement agencies and school personnel of any age. Data from February 25th to April 12th form a Local Healthcare Unit in Piedmont Region (Italy).

Results
Vaccine adhesion ranged from 95 to 100% from February 25th to March 12th (mean 97%). During March 13th it decreased to 73%, then 48% on March 14th, the day of local withdraw of all Vaxzevria doses in Piedmont Region. Activity restarted on March 19th with a 65% of adhesion, and a mean of 75% (69-81%) in the following days. From March 24th-31th adhesion recovered, with a mean 89%. April 1st-12th recorded a plateau: 81-100%, mean 91%. From March 13th a total of 1478 people out of 8339 (17.7%) did not receive their scheduled vaccination.

Conclusions
Both news and official statements had an impact on trust and vaccine adhesion among population and dramatically slowed the COVID-19 vaccine campaign, with a possible effect on infection spreading. Further data and analysis will be provided in the following months.

Key messages
Vaxzevria temporary suspension had an impact on vaccine adhesion. Vaccine adhesion took one month to go back to previous values.
Knowledge and attitudes of young women regarding preconception health-An Italian survey
Authors: Zace D , Orfino A , Viteritti AM , Diakanthos M , Di Pietro ML 
Published: October 2021

Abstract

Introduction
Preconception care is a public health issue, concerning aspects that could have repercussions on pregnancy or child's health. Despite the importance, often there is a lack of knowledge among women, especially younger ones, who are at higher risk for unplanned pregnancies and less healthy lifestyles. In this context, the aim of this study is to explore knowledge and attitudes of young women regarding preconception health.

Methods
A cross-sectional study was conducted from July 2020 until April 2021, including women 18 to 25 years old. A questionnaire was created based on a systematic review and was shared via social media and different channels of high schools and universities. It collected information on physical, reproductive and mental health, vaccination and lifestyle (diet, smoke, alcohol, physical activity). T-test and analysis of variance (ANOVA) were used to determine if there was a statistically significant difference in knowledge mean score among different groups.

Results
A total of 337 women answered the questionnaire. 47.5% of participants had never heard of preconception health and 84% had never asked their gynaecologist/general practitioner about this topic. Only 15.9% of women were currently taking folic acid. The knowledge mean score was 67.5% (SD = 18.1). It was higher in subjects with Italian nationality (p &lt; 0.001), those who had a job (p &lt; 0.001), and those that had healthcare professionals as main font of preconception information compared to social media (p = 0.001). Knowledge mean score was significantly associated with seeing a mental health professional (p = 0.0006), however not a general practitioner or gynaecologist, during the last year.

Discussion
Identifying preconception health needs of women could assist in designing and implementing personalized interventions, to enhance the level of knowledge and promote healthy behaviours, in order to prevent eventual woman's and child's health problems.

Key messages
Women 18-25 years in the sample had relatively poor knowledge on preconception health, almost half had never heard of this topic and the vast majority had never asked their doctor about it. There is a need to enhance the level of knowledge and promote healthy behaviours and attitudes regarding preconception health, to prevent eventual woman’s and child’s health problems.