bluuebunny/crossref_metadata_2025_split huggingface dataset:
Contemporary use of beta-blockers in the outpatient treatment of heart failure with atrial fibrillation
Authors: Iwanaga Y , Nakai M , Kanaka K , Miyamoto Y 
Published: October 2024

Abstract

Background
Evidence of the effectiveness of β-blockers in heart failure (HF) and atrial fibrillation (AF) in a contemporary cohort is controversial. This study investigated the association between the use of β-blockers and prognosis in outpatients across a broad spectrum of HF with AF.

Methods
Patients hospitalized with the first episode of acute HF were identified from the National Database of Health Insurance Claims and Specific Health Checkups of Japan between 2014 and 2021. Associations of β-blocker use at discharge and prognosis were compared by propensity score matching among the AF or non-AF group. A multilevel mixed-effects survival model was used with hazard ratio (HR) and 95% confidence interval (CI).

Results
Among 428,650 patients discharged with HF in 4,433 hospitals, 175,174 (40.9%) were ≥85 years old, 151,873 (35.4%) had complicated AF, and 236,457 (55.2%) were β-blocker users. In a matched AF group, β-blocker use was associated with a lower composite outcome of all-cause mortality or HF rehospitalization (HR [95% CI], 0.95 [0.93–0.97]). A similar result was obtained in a matched non-AF group (0.95 [0.94–0.96]). In addition, the HRs in patients aged ≥85 years and female patients were 1.00 [0.98–1.02] and 1.01 [0.98–1.03] in the AF group and 1.03 [1.01–1.05] and 0.98 [0.97–1.00] in the non-AF group, respectively (Figure).

Conclusions
The favorable prognostic associations of β-blocker use were observed regardless of AF in outpatients across a broad spectrum of HF in a superaged society. However, β-blocker use may not be effective in older or female patients.
Development and validation of a predicting model for risk of mortality in heart failure patients with mildly reduced ejection fraction post discharge
Authors: Zhu Y L , Liu Z C , Huang H B , Wu M X , Zhang L L , Liao M , Zhao W J , He W F , Tan D , Zeng J P 
Published: October 2024

Abstract

Background
Prognostic prediction for heart failure with mildly reduced ejection fraction (HFmrEF) patients remains challenging. We aimed to create and validate a mortality risk prediction model for HFmrEF patients at 6-month, 1-year, and 3-year post discharge.

Methods
Clinical data of 1691 HFmrEF patients registered in the heart failure registry from 2015 to 2020 at the Heart Center of our hospital were analyzed. Patients were assigned into a training (1183 patients) and validation cohort (508 patients) at 7:3 ratio. Predictive variables for mortality at various period post discharge were identified by the Least Absolute Shrinkage and Selection Operator (LASSO) regression analysis. The predicting model was then established based on these variables. Model performance was evaluated with ROC curve and Decision Curve Analysis (DCA).

Results
Eight predictors were identified including age, NT-proBNP, hemoglobin levels, use of beta-blockers, ACEI/ARB, invasive ventilation, PCI procedures, and pulmonary artery systolic pressure values. The model achieved a C-index of 0.748 (training set) and 0.755 (validation set). Area Under the Curve (AUC) for training set at 6 months, 1 year, and 3 years were 0.813, 0.784, and 0.774, and AUC for validation set were 0.775, 0.744, and 0.770, respectively. The DCA analysis confirmed the favorable net benefit of the established nomogram model.

Conclusion
This predicting model might be used for post-discharge risk stratification and individual decision-making of post-discharge management in HFmrEF patients.
Chronotropic incompetence across heart failure categories
Authors: Magrì Damiano , Piepoli Massimo , Gallo Giovanna , Fiori Emiliano , Correale Michele , Attanasio Andrea , Beltrami Matteo , Lauretti Attilio , Palazzuoli Alberto , Agostoni Piergiuseppe 
Published: October 2024

Abstract
The heart failure (HF) syndrome is characterized by an autonomic unbalance with sympathetic hyperactivity, which contributes to increased myocardial oxygen demand, oxidative stress, peripheral vasoconstriction, afterload mismatch with a progressive desensitization, and down-regulation of cardiac β1-receptors. These changes, together with a few other structural and peripheral changes, lead to chronotropic incompetence (CI), such as the inability to increase heart rate (HR) consistently with activity or demand. Chronotropic incompetence, regardless of the method and cut-off adopted to define it, is associated with reduced exercise capacity and a worse prognosis. Furthermore, different pharmacological classes might interfere with the physiologic exercise-induced HR response, thus generating some confusion. In particular, the β-blockers, albeit lowering peak HR, are known to improve prognosis and left ventricular inotropic reserve so that their withdrawal should be avoided at least in HF with reduced and mildly reduced ejection fraction. Similarly, a still debated strategy to counterbalance a blunted exercise-induced HR response is represented by rate-adapting pacing. The present review, besides supplying an overview on possible CI definitions, discusses the clinical impact of CI and potential pharmacological and non-pharmacological therapeutic strategies.
Antimicrobial resistance trends in Italian hospitals: insights from two point prevalence surveys
Authors: Russotto A , Vicentini C , Bussolino R , Castagnotto M , Gastaldo C , Bresciano L , Bazzolo S , Gamba D , Zotti C M 
Published: October 2024

Abstract

Background
Antimicrobial resistance (AMR) presents a critical challenge to global healthcare systems, necessitating vigilant surveillance efforts. The European Centre for Disease Prevention and Control (ECDC) conducts point prevalence surveys (PPSs) to monitor AMR trends across European hospitals. This study focuses on comparing AMR patterns in Italian hospitals using data from two surveys: PPS2 (2016-2017) and PPS3 (2022-2023).

Methods
A total of 140 hospitals enrolling 28991 patients participated in PPS2, while 325 hospitals with 58506 patients contributed data to PPS3. Microbiological samples were collected and tested for antimicrobial susceptibility. Prevalence ratios (PR) with corresponding 95% confidence intervals (CI) were calculated to assess changes in resistance patterns between PPS2 and PPS3. Statistical significance was determined with p-value &lt;0.05.

Results
Staphylococcus aureus showed a trend towards decreased oxacillin resistance, (PR: 0.77, 95% CI: 0.60 - 0.99). Enterococcus faecalis exhibited a non-significant decrease in glycopeptide resistance. Pseudomonas aeruginosa and Acinetobacter baumannii maintained stable carbapenem resistance between the two surveys. Escherichia coli and Klebsiella pneumoniae showed a decreasing trend in resistance to carbapenems and third-generation cephalosporins, but only Klebsiella pneumoniae was found to be significant (PR: 0.69, 95% CI: 0.55 - 0.88, p 0.004 and PR: 0.78, 95% CI: 0.66 - 0.94, p 0.01, respectively).

Conclusions
These findings underscore the importance of surveillance in monitoring AMR trends. Observed decreases, especially in Klebsiella pneumoniae, suggest potential improvements. However, the overall stability of resistance highlights the ongoing challenge of combating AMR. A multifaceted approach, including antimicrobial stewardship and One Health initiatives, is crucial to address this global health threat effectively.

Key messages
• Surveillance efforts are crucial to understand antimicrobial resistance (AMR) trends, as demonstrated by comparing data from two surveys in Italian hospital.
• Results highlight the need for data-driven interventions, guiding future strategies within a One Health framework to address antimicrobial resistance comprehensively.
Assessing inequalities and inequities in Health Impact Assessment: a systematic review
Authors: Properzi S , Coa A A , Fiorilla C , Pasetto R 
Published: October 2024

Abstract

Background
Health Impact Assessment (HIA) procedures can include the assessment inequalities and inequities associated with the distribution of environmental health risks and benefits, attenuating the exacerbation of health disparities in this domain. However, prevailing approaches to tackle inequalities in accessing ecosystem services exhibit limitations. We explored how this kind of assessment in HIA procedures is documented within the international literature.

Methods
Following PRISMA Guidelines, we conducted a systematic review of scientific literature by searching in MEDLINE/PubMed, Scopus, and Embase databases up to 8 March 2024. Moreover, a grey literature analysis was conducted, examining the World Health Organization’s Institutional Repository for Information Sharing (IRIS) to identify guidance considering equity in HIA.

Results
Eight out of 158 documents identified on IRIS, using ‘health impact assessment’ as a filter, underscore the importance of integrating the equity domain into the HIA; of these, only 1 employs methodologies to actively consider it. Of the 806 literature studies analyzed, only 14 included used methods to evaluate inequalities and equity in HIA in various contexts, ranging from urban planning, such as green or redeveloped areas, and transport planning, to mining. Preliminary results show that in most studies, data were collected through surveys, focus group discussions, and peculiar “walks” with local experts. The predominant approaches in extant literature entail the use of socioeconomic status and health determinants as metrics for assessing equity and inequalities within HIA.

Conclusions
Our findings highlight a critical gap in integrating equity into HIA practices, with limited attention and methodological diversity observed across the analysed documents and studies.
Strategies for probing and mitigating inequalities can be strengthen by engaging different stakeholders and the residing population.

Key messages
• There are few and highly heterogeneous methods for assessing inequality in HIA.
• An effective and standardized strategy to asses inequality in HIA could involve stakeholders and the resident population.
Exposome, oxidative stress and inflammation in multiple sclerosis: the EXPOSITION study protocol
Authors: Monti M C , De Giuseppe R , Bertoli G , Tavazzi E , Kalmpourtzidou A , Alemayohu M A , Maccarini B , Oddone E , Montomoli C , Cena H 
Published: October 2024

Abstract

Background
The functional exposome approach examines the relationship between biological effects (internal exposome) and the sum of environmental exposures (external exposome). Multiple sclerosis (MS) is characterized by selective demyelination and acute inflammation; miRNAs and microbiota are emerging in the pathogenesis as inflammation and oxidative stress biomarkers. The EXPOSITION study protocol has been designed to study such biomarkers variation in response to the external exposome (air pollution, urbanization, lifestyles) in people with MS (pwMS).

Methods
EXPOSITION is a cross-sectional observational study collecting a sample of 200 pwMS residing in Lombardy, Northern Italy. Sample size is based on the prediction of differential expression of candidate miRNAs through bioinformatic analyses. All participants will be investigated for social, demographic and clinical data as well as general and specific external exposome factors. The internal exposome factors will be collected for each participant from blood and stool samples, as well as from nasal swabs. Exposome clustering and correlation statistical techniques will be applied and variation of miRNA and microbiota will be tested in association with the variation of the external exposome in urban and extra-urban environments.

Results and conclusions
The expected results will help pwMS and researchers understanding which biomarkers and which components of the external exposome are associated to oxidative stress and inflammation, to improve precision medicine and contrast disease progression. The relationship between urban exposome and biodiversity is an important dimension in the study of environmental impact on human health. This study may provide preliminary data to assess which nature-based solutions are suitable for enhancing the biodiversity of urban areas.

Key messages
• The functional exposome approach could be used to link environmental risk factors and disease biomarkers using the right methology.
• EXPOSITION will quantify the variation of miRNA and microbiota in association with the variation of external exposome, in urban and extra-urban environments.
How to run a qualitative methods short course in epidemiology: faculty and student perspectives
Authors: Gille F , Frei A , Kaufmann M , Lehmann A , Muñoz Laguna J , Papadopoulos K , Spörri A , Stanikić M , Tušl M , Zavattaro F 
Published: October 2024

Abstract

Background
Qualitative research and mixed methods are core competencies for epidemiologists. In response to the shortage of guidance on graduate course development, we wrote a course development to guide faculty and students designing similar courses in epidemiology curricula. We combine established educational theory with faculty and student experiences from a recent introductory course for epidemiology and biostatistics doctoral students at the University of Zurich and Swiss Federal Institute of Technology, Zurich.

Objectives
We propose a 1-ECTS, six session long, student-centred course with inverse in-person classroom teaching and practice exercises with faculty input. The overarching course objective is to introduce students to qualitative research and mixed methods. The proposed course covers learning outcomes in comprehension, knowledge, application, analysis, synthesis and evaluation.

Results
Following an introductory session, the students engage in face-to-face interviews, focus group interviews, observational methods, analysis and how qualitative and quantitative methods are integrated in mixed methods. Furthermore, the course covers interviewer safety, research ethics, quality in qualitative research and a practice session focused on the use of interview hardware, including video and audio recorders. The student-led teaching characteristic of the course allows for an immersive and reflective teaching-learning environment.

Conclusions
After implementation of the course and learning from faculty and student perspectives, we propose these additional foci: a student project to apply learned knowledge to a case study; integration in mixed-methods; and providing faculty a larger space to cover theory and field anecdotes. Based on: Gille, et al. A guide for a student-led doctoral-level qualitative methods short course in epidemiology: faculty and student perspectives, International Journal of Epidemiology, Volume 53, Issue 2, April 2024.

Key messages
• Qualitative research methods and mixed methods are core competencies for epidemiologists.
• Students appreciate a student-centred course design with inverse classroom teaching and practice exercises.
Trends in Regional Disparities of Cardiovascular Surgery and Mortality in South Korea
Authors: Jin D-L , Kim K-H , Chung E S , Yoon S-J 
Published: October 2024

Abstract

Objectives
Regional disparities in cardiovascular care in South Korea have led to uneven patient outcomes. Although procedure access and needs are increasing, few studies have linked regional service availability to mortality rates. This study analyzed variation in utilization of major cardiovascular procedures by region and association with short-term mortality to provide better evidence on links between healthcare resources distribution and patient survival.

Methods
A cross-sectional study was conducted using nationwide claims data on patients who underwent coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), stent insertion, or aortic aneurysm resection in 2022. Regional variation was assessed by a Relevance Index (RI). The associations between regional RI and 30-day mortality were analyzed.

Results
The RI was lowest for aortic aneurysm resection (mean, 26.2; standard deviation, 26.1), indicating the most uneven regional distribution among the surgical procedures. Patients undergoing this procedure in regions with higher RIs showed significantly lower 30-day mortality (adjusted odds ratio [aOR], 0.73; 95% confidence interval, 0.55 to 0.96; p = 0.026) versus those with lower RIs. This suggests that cardiovascular surgery regional availability, as measured by RI, has an impact on mortality rates for certain complex surgical procedures. The RI was not associated with significant mortality differences for more widely available procedures like CABG (aOR, 0.96), PCI (aOR, 1.00), or stent insertion (aOR, 0.91).

Conclusions
Significant regional variation and underutilization of cardiovascular surgery were found, with reduced access linked to worse mortality for complex surgeries. Addressing disparities through cooperation among hospitals and policy efforts is warranted to improve outcomes.

Key messages
• This study analyzed regional variations in major cardiovascular procedures using the Relevance Index and investigated their impact on mortality rates within 30 days of admission.
• Addressing regional disparities requires improved healthcare infrastructure and comprehensive networks of specialists to ensure timely and high-quality cardiovascular care across South Korea.
Using Unsupervised Learning Methods to Explore the Trajectory of Long-Term Care Service in Taiwan
Authors: Chang Y H , Lu H H , Chien S C , Yen C M , Lai C Y , Chung R H , Chiou H Y 
Published: October 2024

Abstract

Background
Understanding the temporal trends in long-term care (LTC) utilization enables more effective planning by government and service providers. This study employed machine learning methods to explore LTC utilization trajectories among care recipients in a southern county of Taiwan.

Methods
Administrative data from the government-funded LTC programme was utilized, with a total of 24,614 participants included after excluding those with less than six months of data. Daily service utilization records, mainly focusing on caregiving services, were aggregated, and the number of days each participant used LTC services within every 30-day period post-application was calculated. Utilization rates during 6 and 12 months post-application were separately analyzed. K-means clustering, an unsupervised machine learning method, was employed to select the optimal classification and identify LTC utilization trajectories using 10-fold cross validation. Temporal frequency variations of each caregiving service within each trajectory group were visualized using heatmaps.

Results
In the analysis of LTC utilization within the first 6 months post-application, trajectories were classified into 7 groups; while within 12 months, trajectories were divided into 4 groups. These trajectories can be categorized into 4 distinct patterns: High-Stable (6 mo: 21.3%; 12 mo: 35.7%), Low-Stable (6 mo: 33.1%; 12 mo: 37.2%), High-Decrease (6 mo: 12.8%; 12 mo: 10.7%), and Low-Increase (6 mo: 32.7%; 12 mo: 16.5%). We further explored differences in socio-demographic characteristics and needs factors among trajectory groups. Heatmaps were used to illustrate temporal variations in the utilization rates of specific service items, which played a significant role in determining the trajectories.

Conclusions
K-means clustering is useful in identifying distinct patterns among LTC users. Tailored service delivery strategies can be designed to meet the diverse needs of these different user groups.

Key messages
• The unsupervised machine learning method distinguished various temporal dynamic patterns in LTC utilization.
• Tailored service delivery strategies can be designed to meet the diverse needs of these different user groups.
Antimicrobial resistance and infection prevention in care for people with intellectual disabilities
Authors: Hidad-Nuh S , de Greeff S C , Haenen A , de Haan F , Leusink G L , Timen A 
Published: October 2024

Abstract

Background
Antimicrobial resistance (AMR) has become one of the major public health threats worldwide. However, little is known about antimicrobial resistance and infection prevention and control (IPC) in long-term care facilities for people with intellectual disabilities. This study aims to assess knowledge, attitudes and perceptions towards AMR and IPC among healthcare professionals working in long-term care facilities for people with intellectual disabilities (ID-LTCFs) in the Netherlands.

Methods
We conducted a web-based cross-sectional survey study among medical and nonmedical trained healthcare professionals working in ID-LTCFs in the Netherlands. The survey study was carried out between July and November 2023 and consisted of validated survey items expanded with expert opinion and setting-specific items.

Results
In total, 109 medical and nonmedical trained healthcare professionals working in 37 long-term care organizations for people with intellectual disabilities throughout the Netherlands completed the questionnaire. Overall, knowledge levels about AMR and IPC differed between medical and nonmedical trained healthcare professionals working in ID-LCTFs, with medically trained professionals having a significant overall higher score on both topics. Knowledge regarding the perceived protective value of glove use was found to be insufficient. Moreover, healthcare professionals expressed a need for easy-to-read resources and tailored setting-specific information on AMR and IPC targeting both healthcare professionals as well as people with disabilities.

Conclusions
There is room for improvement regarding setting-specific IPC and hygiene policies, such as appropriate glove use in ID-LTCFs. As nonmedically trained professionals comprise most of the workforce within this setting, it is important to further tailor follow-up studies to the underlying factors that influence knowledge, attitudes and perceptions of these specific professionals within ID-LTCFs.

Key messages
• Developing setting and context-specific policies for infection prevention and control is crucial, particularly in long-term care facilities for people with intellectual disabilities.
• Inclusive policy-making is key to combating antimicrobial resistance, and improving infection prevention and control in long-term care facilities for people with intellectual disabilities.