bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incident HFpEF and time-dependent changes in markers of LVDD severity in women and men with pre-clinical LVDD
Authors: Van Ommen A M L , Dal Canto E , Diez-Benavente E , Cramer M J , Teske A J , Verhaar M , Taha K , Handoko M L , Duncker D J , Verhaar M , Rutten F H , Onland-Moret N C , Den Ruijter H M 
Published: October 2024

Abstract

Background
Over time, left ventricular diastolic dysfunction (LVDD) can progress towards heart failure with preserved ejection fraction (HFpEF). Yet, the identification of those at high risk of progression is challenging, and guidance on follow-up or preventive treatment is lacking.

Purpose
To study the incidence of HFpEF and changes over time in markers of LVDD severity in women and men with pre-clinical LVDD. In addition, we evaluate whether blood pressure and kidney function affect progression of LVDD.

Methods
We reinvited 146 participants from the HELPFul study (58% women and 42% men) with pre-clinical LVDD after a median follow-up of 4.3 [IQR: 3.9-4.7] years (Figure 1). The follow-up measurements were similar to baseline and encompassed a structured interview, physical examination, blood draw, electrocardiogram and (exercise) echocardiography. We determined HFpEF incidence and report changes over time in cardiovascular risk factors as well as echocardiographic characteristics and biomarkers of LVDD. Additionally, we studied whether changes in blood pressure and kidney function affected LVDD progression using generalized mixed models. LVDD progression was defined as an increase in plasma NT-proBNP levels and HFA-PEFF major functional and morphological abnormalities. All analyses were performed for women and men combined as well as stratified by sex.

Results
Fifteen (10%) of the 146 participants developed HF of whom 13 had HFpEF (9 women and 4 men) during follow-up. Over time, systolic and diastolic blood pressure levels remained stable while mean kidney function (eGFR) declined from 89±14 to 81±17 mL/min/1.73m2. Median NT-proBNP plasma levels increased from 71 [IQR: 44, 120] to 100 [IQR: 51, 157] pg/mL. The prevalence of major functional abnormalities according to the HFA-PEFF score increased from 84 to 91%, while the prevalence of morphological abnormalities increased from 25% to 39% (Figure 2). A higher systolic blood pressure in women and a higher diastolic blood pressure in men was associated with an increase in NT-proBNP plasma levels over time. Additionally, lower eGFR levels were related to increased NT-proBNP plasma levels over time in both men and women. There was a significant rise in the prevalence of major functional and morphological abnormalities with time, but blood pressure and kidney function did not affect this change over time.

Conclusions
A small proportion of women and men with preclinical LVDD developed incident HF over a 5-year follow-up period. High blood pressure and reduced kidney function were associated with increased levels of NT-proBNP over time. This highlights the need to further explore cardiorenal protection as a method to prevent HFpEF.Study design and HF outcomesLongitudinal changes in LVDD markers
Long-term outcomes in women diagnosed with heart failure in connection to delivery
Authors: Toska F , Thunstrom E , Schaufelberger M , Rosengren A , Pavdic A , Fu M , Basic C 
Published: October 2024

Abstract

Background
Heart failure (HF) among young patients may be from various causes, often triggered by heightened physical demands like pregnancy. Data regarding outcomes of women diagnosed with HF in conjunction to pregnancy and delivery are varied. There remains a notable gap in understanding the outcomes observed in women diagnosed with heart failure in conjunction with delivery. Also, long-term follow-up studies are crucial to elucidate the impact of pregnancy-associated HF on future cardiovascular.

Purpose
To study the interplay between pregnancy, HF, and subsequent cardiovascular risk.

Method
Using the personal identification numbers (PINs) that all individuals in Sweden have enables linkage of data between different registers. Data from the National Patient Register (NPR), Swedish Medical Birth Register (MBR) and the Cause of Death Register were also used. All women 18 to 50 years of age registered in the in MBR in the period 1st January 1997 to 31st December 2019 were included. Women with first-time HF in relation to delivery were identified using the international classification code for diseases (ICD-10) I50, I42, I43 and 090.3 together with co-morbidities. Every patient was compared with 5 controls without HF from the Total Population Register matched on age at delivery and calendar year of delivery. Outcomes: all-cause mortality, and any cardiovascular disease (CVD) diagnosed during the observation time.

Results
A total of 286 cases and 1,430 controls were included. The prevalence of comorbidities at baseline for both patients and controls was low; congenital heart disease (1.4%, vs. 0%), pulmonary hypertension (1.0% vs. 0%), valvular heart disease (5.9% vs. 0%), myocardial infarction 0.7% vs. 0%), arrhythmia (5.9% vs. 0%), hypertension (6.3 % vs. 0.1%), (all p&lt;0.05). Preeclampsia prior to HF diagnosis had 31% of patients vs. 0.2% of controls (p&lt;0.001). Patients exhibited higher mortality rates at 4.9% during median follow up 9.0 (IQR 5.6-13.0) years vs. 0.3%, median follow up 9.4 (6.2-13.5) years and hazard ratios (HR) for all-cause mortality HR (95% CI) of 18.20 (5.99 - 55.31) (p&lt;0.001) compared to controls. During median follow up of 3.2 (0.0-9.2) years 60.1% of patients were diagnosed with CVD both at in-/out-patient settings compared with 4.1% in controls during 9.4 (5.8-13.5) years of follow up. Comparing patients with controls the HR (95% CI) was 22.24 (16.50 - 29.96) p&lt;0.0001 for CVD diagnosis during follow-up, see Figure 1.

Conclusion
In conjunction with delivery, and in the years thereafter, women with heart failure diagnosis had more than eighteen times higher risk of mortality than women without heart failure. The risk of CVD event in the heart failure group is highest in conjunction with delivery.
Figure 1. Cumulative incidence functions for all-cause mortality, CVD in- or out-patient visit adjusted for death as competing risk, comparing cases with controls.
Resting heart rate and outcomes in patients with heart failure: impact of AF from the Thai-Heat Failure Registry (THFR - HRAF study)
Authors: Ariyachaipanich A , Chantrarat T , Chirakarnjanakorn S , Boonyaratavej-Songmuang S , Kanjanavanich R , Wongtheptien W , Thundee C , Chichareon P , Krittayaphong R 
Published: October 2024

Abstract

Introduction
Heart rate (HR) is a significant prognosis factor and target of the treatment in patients with heart failure (HF) but this relationship in heart failure patients with atrial fibrillation (AF) is uncertain.

Methods
A total of 2,996 patients with HF were enroll in the Thai-Heart Failure registry between 2023 to 2024, from 37 heart failure clinics in Thailand. Patients were classified by resting HR and whether having AF or not. The primary outcomes are all-cause death and/or HF. The continuous prognostic relationship and interaction were determined by Cubic-spline model.

Results
Total of 2,932 patients with available resting heart rate and AF status were analyzed (mean age 59.3±14.5 years, 67.9% male, mean LVEF 31.9%, 12.4% having AF). There were 273, 1,497, 895 and 267 patients have HR &lt;60, 60-80, 80-100 and &gt;100 bpm, respectively. From the lowest HR to the highest group, the all-cause death and/or HF were 16.5%, 10.4% 13.7% and 14.0%. Interestingly, the patients in the lowest, high and highest HR group were associated with poorer outcomes when compared to patients with normal HR (60-80 bpm). (p &lt;0.001, 0.004 and 0.033, respectively). There were no statistic significances in patient with LVEF &gt;40% (p= 0.37, 0.48 and 0.41, respectively). The hazard ratio is lowest between 64 to 91 bpm. The relationship is the same in patient with AF (p for interaction 0.071) but higher hazard ratio at any giving heart rate.

Conclusion
The normal heart rate (between 60-80 bpm) is associated with the best outcomes, not lower is better. HR is a significant prognosis factor whether having AF or not. The relationship is mainly in patient with HFrEF.Figure
Relationship between 3-dimensional aortic geometry and the risk of new-onset heart failure
Authors: Beeche C , Dib M J , Azzo J D , Maynard H , Salman O , Witschey W , Chirinos J 
Published: October 2024

Abstract

Introduction
Aortic geometric assessments to date have typically involved cross-sectional imaging of discrete aortic segments. However, the complex 3D geometry of the thoracic aorta, and its relationship to the risk of cardiovascular disease has not been assessed in large studies.

Methods
We segmented the thoracic aorta in SSFP axial MRI images from 49,282 UK Biobank participants using a deep convolutional neural network (U-Net). We then computed geometric measurements (centerline length, arch height, arch width, arch height-width ratio, arch unfolding index [inverse of tortuosity], curvature and mean, minimum and maximum diameters) in the overall thoracic aorta as well as in 6 subsegments. We quantified their relationship to the risk of cardiomyopathy and heart failure (HF) using multivariable Cox-proportional hazards models. All hazard ratios are standardized. Centerline length was allometrically indexed to body height.

Results
In models adjusted for age, sex, BMI kg/m2, low-density lipoprotein mg/dl, high-density lipoprotein mg/dl, triglycerides mg/dl, systolic blood pressure and diastolic blood pressure, the curvature of the aorta (HR=0.63; 95% CI=0.39, 0.99; P&lt;0.05), particularly the aortic arch (HR=0.54; 95% CI= 0.35, 0.87; P&lt;0.05) was strongly related to a lower risk of incident cardiomyopathy. A higher arch unfolding index (HR=1.46; 95% CI=1.03, 2.07; P&lt;0.05), higher width-to-height ratio (HR=1.10; 95% CI= 1.02, 1.19; P&lt;0.05) and lower aorta tortuosity (HR=1.20; 95% CI= 1.09, 1.32; P&lt;0.05) were all associated with a higher risk of cardiomyopathy. This aortic geometric pattern was also associated with a greater risk of a new HF diagnosis (arch unfolding [HR=1.23; 95% CI= 1.07, 1.42; P&lt;0.05], width to heigh ratio [HR=1.06; 95% CI= 1.01, 1.11; P0.05]).

Conclusion
We demonstrate that 3-D thoracic aortic geometric indices are strongly associated with incident cardiomyopathy and HF, independent of classic risk factors. This is likely related to abnormal afterload and ventricular-arterial interactions since adverse geometric remodeling affects left ventricular pulsatile load.Cardiomyopathy & Heart Failure Hazards
Electrocardiographic markers of depolarization and repolarization in lead V1 predict right ventricular dysfunction in patients with heart failure
Authors: Moldovan M P , Eotvos E A , Coseriu G , Burde A , Avram T , Lazar R D , Zehan I , Sarb A , Mocan L , Blendea E D , Tentea P , Gusetu G , Pop S , Blendea D 
Published: October 2024

Abstract

Background
Right ventricular (RV) dysfunction is an important predictor of survival in patients with heart failure (HF) with both preserved (HFpEF) and reduced ejection fraction (HFrEF). To date there is limited data on the value of the electrocardiogram in predicting RV function.

Purpose
Given these considerations the aim of our study was to assess the possible relationship between several electrocardiographic (ECG) parameters and right ventricular function evaluated by echocardiography.

Methods
We included 109 patients (age 61±14 years, 68men) of whom 89 had HF (HFpEF N=62 and HFrEF N=27) and 20 patients without HF. Twelve-lead ECG and echocardiograms were performed in all patients. We assessed echocardiographic parameters of global and regional RV function.

Results
Time to Intrinsicoid deflection in lead V1 (TID-V1) and the QTc interval measured in lead V1 (QTc-V1) were significantly more prolonged in patients with HF vs. patients with no HF (36±24ms vs. 23±15ms; p=0.03, and 450±40ms vs. 427±20ms; p=0.047 respectively).
TID-V1 correlated significantly with the tricuspid annulus systolic excursion (TAPSE) and RV fractional area change (FAC; r=-0.31; p=0.02, and r=-0.35; p=0.029 respectively). QTc-V1 correlated with parameters of global and regional RV function including FAC, RV apex longitudinal strain, RV free wall strain, and global RV strain (r=-0.42; p=0.0004, r=0.35; p=0.0032, r=0.21; p=0.045, and r=0.41; p=0.0005).
RV dysfunction as defined by RV-FAC&lt;35% was predicted by TID-V1 &gt; 30ms with a sensitivity of 61% and specificity of 75%; AUC=0.752 and by QTc-V1&gt;440ms with a sensitivity of 80% and specificity of 57%; AUC=0.888, and by a multivariate logistic regression model that also included TID-V1 and QTcV1, age, TAPSE, and LV ejection fraction with an AUC=0.967 (Figure).

Conclusions
Lead V1 time to intrinsic deflection and QTc-V1 predict RV dysfunction independent of echocardiographic parameters of ventricular function in patients with HF.
2.H. Round table: Health system description and comparison: lessons from the WHO/Observatory Insights series
Authors:   Organised by: WHO/Europe, European Observatory on Health Systems and Policies,   Chair persons: Bernd Rechel (European Observatory), Natasha Azzopardi Muscat (WHO/Europe)
Published: October 2024

Abstract

The European Observatory on Health Systems and Policies has been working for more than 25 years on the systematic description, analysis and comparison of health systems in Europe. This workshop explores experiences so far with a new series of health system profiles, the Health Systems in Action (HSiA) Insights, launched in 2021 in collaboration with the WHO Regional Office for Europe. The first round of the Insights in 2021 was a pilot series, covering just five countries (Georgia, Kyrgyzstan, North Macedonia, Ukraine, and Uzbekistan). Since then, the series has grown to 13 countries in 2022 and in 2024 is covering almost all WHO Member States that are outside of the European Union (EU). The Insights aim to provide short and easily accessible documents that provide core information on a country’s health system, its key strengths and challenges, how it compares to other health systems in Europe, and how it impacts on the health of its population. This roundtable provides a platform for sharing experiences with devising, writing and using the series so far, bringing in country and comparative perspectives and involving the audience. The objectives of the roundtable are to a) identify best practices for the comparative description and analysis of health systems in the form of a series of country profiles; b) explore the challenges of drawing up country profiles where comparative data are lacking, incomplete or politicized; c) identify ways of disseminating and using country profiles; d) establish an opportunity for cross-country learning and skills development for the writing of health system descriptions and analyses. The roundtable will consist of four speakers. It will start with three very brief country presentations on the Insights for Israel, North Macedonia and Kazakhstan, followed by a brief comparative perspective on how to capture, compare and analyse health workforce trends across a broad set of countries, which is the Spotlight section of the 2024 round of Insights. This will be followed by a broad discussion with audience interventions to bring in the experience of other experts and countries. The moderated discussion will emphasise key learning points on how to devise a comparative series, how to write health system profiles and how best to use them to inform health policy-making.

Key messages
• The regular monitoring of health systems and policies is challenging, but essential for improving them.
• Health system summaries require systematised approaches and up-to-date comparative data.

Speakers/Panelists
Ruth Waitzberg
Technische Universitat Berlin, Berlin, Germany
Yerbol Spatayev
WHO Country Office Kazakhstan, Astana, Kazakhstan
Simona Atanasova
WHO Country Office North Macedonia, Skopje, Republic of North Macedonia
Tomas Zapata
WHO/Europe, Copenhagen, Denmark
Seroprevalence and associated factors of toxoplasmosis in female children and adolescents in Germany
Authors: Giese L , Seeber F , Aebischer A , Kuhnert R , Schlaud M , Stark K , Wilking H 
Published: October 2024

Abstract

Background
Toxoplasmosis is a parasitic disease that causes a high burden of disease worldwide. Infections occur mainly through the consumption of undercooked meat or the ingestion of contaminated cat feces from the environment. In Germany, seroprevalence in adults is exceptionally high by international comparison (50%), which could be due to the frequent consumption of raw pork products. Comparable analyses for children and adolescents are missing but are needed to estimate the public health problem and to suggest countermeasures.

Methods
As part of the second wave of the representative German Health Interview and Examination Survey for Children and Adolescents (2014-2017), serum of 1,453 girls aged 3 to 17 years was tested for the presence of T. gondii IgG antibodies using enzyme linked fluorescence assay (ELFA). We calculated overall and stratified seroprevalence and used multivariable logistic regression models based on Directed Acyclic Graphs to identify associated factors. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) are being reported.

Results
Overall, 94 out of 1,453 girls tested positive for T. gondii resulting in a seroprevalence of 6.3% (95% CI: 4.7-8.0). With each year of life, the chance of being seropositive increased significantly by 1.2 (95% CI 1.1-1.3). A low social status (aOr 2.7; 95% CI 1.3-5.9) and living in rural (aOR 2.6; 95% CI 1.1-5.7) or urban (aOR 2.2; 95% CI 1.1-4.4) areas were found to be associated with seropositivity. No regional distribution patterns or differences between vegetarians and non-vegetarians were seen.

Conclusions
Six out of 100 girls become infected with T. gondii during the first 18 years of life. Independent risk factors identified in our study have also been associated with seropositivity in other countries. Meat consumption appears to have a reduced impact on the risk of infection in children and adolescents compared to adults, calling for different prevention strategies in this population.

Key messages
• Toxoplasmosis causes a high infection pressure for girls and young women in Germany.
• Transmission pathways might differ between age groups with more environmentally associated infections in children and adolescents.
Capacity mapping of comprehensive sexuality education in Gabon: A qualitative analysis
Authors: Koumba Maguena R J , Ngoungou E B , Van den Broucke S 
Published: October 2024

Abstract

Background
Access to comprehensive sexuality education (CSE) is crucial for adolescent health and well-being. Following UNESCO’s recommendations, Gabon revised its sex education policy in 2017 to better address adolescents’ sexual health needs. This study aims to map the capacities of the public health and education sector to implement Gabon’s CSE policy.

Methods
Semi-structured interviews were held with 15 professionals from ministries, NGOs, and development partners. Thematic analysis guided by Aluttis et al’s public health capacity model allowed to assess the existing capacities and gaps in leadership, organizational structures, partnerships, resources, and knowledge development for CSE.

Results
The implementation of CSE in Gabon is hindered by sociocultural and political factors, including the taboo on adolescent sexuality influencing perceptions of CSE content, natalist policies, and socio-economic disparities. Governmental involvement in CSE is limited to key ministries. Organizational structures for CSE lack cohesion due to changes in governance regimes and a lack of support for civil society organizations. Human resources are unevenly distributed, and financial constraints impede government initiatives, causing a strong reliance on external funding. An important role in supporting CSE is played by development partners and partnerships between stakeholders. While knowledge development for CSE is underway, monitoring and evaluation procedures are insufficient, and evidence mobilization by key professionals is insufficient.

Conclusions
Enhancing stakeholder collaboration, addressing structural constraints, and mobilizing human and financial resources are critical for effective CSE implementation in Gabon. Addressing these barriers requires coordinated efforts among stakeholders and addressing systemic challenges. This study provides insights for policymakers and practitioners to strengthen CSE programs and promote adolescent sexual health in Gabon.

Key messages
• CSE implementation is hindered by taboos on adolescent sexuality, natalist policies, and socio-economic gaps.
• Evaluation and evidence mobilization deficits limit effectiveness.
Visualizing science - the rise of graphical abstracts in public health journals
Authors: Vital Brito D 
Published: October 2024

Abstract

Background
As graphical abstracts (GA) gain popularity in scientific journals, they enhance visibility and engagement by summarizing research articles visually, while reaching both scientists and lay audiences more effectively. This study assesses the integration of GA in public health journals, focusing their role in enhancing scientific dissemination.

Methods
We conducted a descriptive quantitative analysis of 163 top-tier journals in Public Health, Environmental, and Occupational Health, using SCImago rankings. The analysis focused on factors such as mentions of GA and video abstracts (VA) in guidelines, mandatory use of GA, accessibility to GA, and adherence to GA’s best practices, which include graphical support, titles, and basic explanations.

Results
Of the journals analysed, 43 (26.4%) mention GA in their guidelines; only three (1.8%) require their mandatory use. Eight journals (4.9%) offer GA as part of paid promotional services, while 16 (9.8%) provide easy access to GA in their articles, and just six adhere to basic best practices. VA is mentioned in 25 journals (15.3%), with only nine (5.5%) featuring both GA and VA. Dedicated website sections for GA or VA are found in six journals (3.7%). Elsevier B.V. and Wiley-Blackwell are leaders in promoting GA usage, with 19 and nine mentions in guidelines, respectively.

Conclusions
The adoption of GA in public health journals is increasing, yet full adherence to best practices is not widespread. This trend points to a more visually engaging form of scientific communication, potentially influencing publication standards and research dissemination. The study underscores the need for further training in GA production and promotion among researchers and editors. Additionally, the emergence of GA as a paid promotional tool indicates a novel approach to broadening research outreach, with relevant implications for the standardization of scientific communication across Europe.

Key messages
• Only 26.4% of public health journals mention graphical abstracts, highlighting the need for wider adoption to enhance research visibility.
• Graphical abstracts boost engagement, but adherence to best practices remains low, underlining the need for better training in visual communication.