Risultati per: Studio REDUCE-IT e appropriatezza prescrittiva degli acidi grassi omega-3

Annals of Internal Medicine, Ahead of Print.

Our findings suggest that those responsible for public health can promote these beneficial interventions without major concerns about increasing inequalities but should be mindful that these interventions may work better in boys aged 5–11 years than girls. More data are needed, so we encourage future trialists to perform subgroup analyses on PROGRESS factors.

Propranolol reduced resting tremor both with and without a cognitive stressor, but levodopa remains the primary treatment for PD tremor.

Scoperti i messaggi cellulari della sindrome da neurotossicità

Purpose
Aspirin and omega-3 fatty acids (FAs) are potential disease modifiers of age-related macular degeneration (AMD), but previous studies have produced inconsistent findings. Randomised evidence for the efficacy and safety of aspirin and omega-3 FAs on AMD is presented in this study.

Design
ASCEND-Eye is a substudy of eye effects in the 2×2 factorial design ASCEND (A Study of Cardiovascular Events iN Diabetes) double-blind, randomised, placebo-controlled trial for the primary prevention of cardiovascular events. Reports of AMD diagnoses were sourced from 6 monthly ASCEND follow-up questionnaires and a Visual Function Questionnaire.

Participants
15 480 UK adults at least 40 years of age with diabetes but no evident cardiovascular disease.

Interventions
100 mg aspirin daily versus placebo and, separately, 1 g omega-3 FAs daily versus placebo.

Main outcome measure
The first post-randomisation reports of AMD.

Results
During 7.4 years of follow-up, 122 (1.6%) participants randomised to aspirin were reported as having AMD, compared with 138 (1.8%) randomised to placebo (rate ratio 0.88; 95% CI 0.69 to 1.12; p=0.31). AMD occurred in 130 (1.7%) participants randomised to omega-3 FAs, compared with 130 (1.7%) randomised to placebo (rate ratio 0.99; 95% CI 0.78 to 1.27; p=0.99).

Conclusion
No clinically-meaningful effects of aspirin or omega-3 FAs on AMD were found. Although the study had very limited statistical power to detect clinically relevant effects, these data overcome some methodological limitations of previous observational studies, providing randomised evidence of both treatments on AMD, which could contribute to future meta-analyses.

Trial registration number
ISRCTN60635500 and NCT00135226.

New England Journal of Medicine, Ahead of Print.

Circulation, Ahead of Print. BACKGROUND:Catheter ablation of ventricular arrhythmias, one of the most rapidly growing procedures in cardiac electrophysiology, is associated with magnetic resonance imaging–detected brain lesions in more than half of cases. Although a retrograde aortic approach is conventional, modern tools enable entry through a transseptal approach that may avoid embolization of debris from the arterial system. We sought to test the hypothesis that a transseptal puncture would mitigate brain injury compared with a retrograde aortic approach.METHODS:The TRAVERSE trial (Transseptal Versus Retrograde Aortic Ventricular Entry to Reduce Systemic Emboli) was a multicenter randomized controlled comparative effectiveness trial. Patients with left ventricular arrhythmias undergoing catheter ablation procedures were randomly assigned to a transseptal puncture approach compared (1:1) with a retrograde aortic approach. The primary outcome was the presence of an acute brain lesion detected by magnetic resonance imaging. Secondary outcomes included clinically manifest complications, procedural efficacy, and 6-month neurocognitive assessments.RESULTS:Among the 62 patients randomly assigned to a retrograde aortic approach with postoperative brain magnetic resonance imaging, 28 (45%) exhibited an acute brain lesion compared with 19 of the 69 (28%) of those randomized to a transseptal puncture (P=0.036). No differences in clinically manifest complications or procedural efficacy were observed. More patients in the retrograde aortic arm were categorized as having a high likelihood of cognitive impairment at 6 months (33% compared with 19% of those in the transseptal arm), but substantial loss to follow-up was present.CONCLUSIONS:Among patients undergoing left ventricular catheter ablation procedures, a transseptal approach reduced the risk of acute brain lesions by nearly half compared with a retrograde aortic approach without sacrificing safety or efficacy. Given a likely embolic pathogenesis, the brain magnetic resonance imaging findings may reflect a propensity to other organ damage; these findings may extend to other procedures requiring left ventricular entry.REGISTRATION:URL:https://www.clinicaltrials.gov; Unique identifier: NCT03946072

We read with great interest the work of Rui and colleagues, who developed and validated a machine learning-based model to predict the risk of moderate to severe hepatic inflammation in chronic hepatitis B patients with concurrent hepatic steatosis.1 The authors assessed the model’s performance in terms of discrimination, calibration and clinical utility within the training cohort. Calibration performance was evaluated using a calibration curve. Additionally, two validation cohorts were used for external validation, employing the same methods for discrimination, calibration and clinical utility as described above.

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

Background
Telemonitoring is a promising approach to facilitate patients’ self-management and improve health outcomes, especially among people with chronic health conditions. Yet, many healthcare organisations struggle to implement telemonitoring successfully. IT identity, an individual’s self-identification with an information technology (IT) tool, has been suggested to strongly predict and shape the use of technology. IT identity is related to three emotional responses: emotional energy, dependence and relatedness.

Objective
To explore how healthcare professionals’ IT identity is shaped, and how it affects their attitude towards and intended use of telemonitoring.

Design
Qualitative, semistructured interview study.

Setting
Primary care and hospitals (general and academic) in the Netherlands.

Participants
Sixteen nurses, pulmonologists, general practitioners and researchers working in chronic obstructive pulmonary disease (COPD) care.

Results
Participants expressed varying emotional responses regarding the use of telemonitoring. We associated participants’ responses with the three dimensions of IT identity. Regarding emotional energy, some expressed pride in innovating, while others lacked faith in using telemonitoring. Regarding dependence, different perceived intentions and needs for using telemonitoring were identified: to coach patients, prevent deterioration of health, achieve logistical advantages for patients and preserve the accessibility of healthcare. Regarding relatedness, some participants expressed a strong external but weak internal motivation to use telemonitoring.
Based on emotional responses, we identified five manifestations of IT identity that illustrate how different healthcare professionals use telemonitoring in COPD care: the Scientist, Innovator, Protector, Empowerer and Conversationalist. These manifestations differ in their readiness to innovate and in their beliefs what it means to be a good healthcare provider: to protect or to coach.

Conclusion
Healthcare professionals’ emotional energy, dependence and relatedness regarding telemonitoring in COPD care shaped their IT identity and how they used telemonitoring. Implementation strategies tailored towards the five manifestations of IT identity could help the sustainable implementation of telemonitoring in clinical practice.

Objectives
The primary objective was to assess the acceptability of a savings intervention in which female sex workers (FSW) would save part of their earnings and call back (withdraw) when faced with a financial need that could force them into HIV risk practices. The secondary objectives were to assess its feasibility, concerns and design considerations.

Design
A cross-sectional survey. Participants were asked for views on the intervention, their earnings, saving and spending practices, and suggestions for the intervention package.

Setting
Kisumu and Siaya counties, Kenya.

Participants
FSWs aged ≥18 years, self-identifying as sex workers and living in Kisumu or Siaya county.

Outcome measures
The primary outcome was the proportion of participants who believed the Jitegemee intervention would be acceptable to FSWs in Kenya. The secondary outcomes were the proportion who: could generate money to save (assessed from income, spending and loaning practices), reported potential challenges with the intervention and suggested components to inform the intervention package.

Results
We enrolled 369 FSWs, 88% aged 18–39 years, 78% unmarried, 94% cared for ≥1 child(ren) and 78% were household heads. Over half (52.1%) had been in sex trade for ≤4 years, with 62.3% reporting

Fatta luce sul ruolo della proteina Spry1

Introduction
In the UK, approximately 300 infants each year die suddenly and unexpectedly, with most deaths remaining unexplained. Population-wide ‘Safer Sleep’ messages have brought rates down but remaining deaths now predominantly occur within families experiencing poverty. Many of these deaths may be preventable as the majority have known, avoidable risks present. New resources and tools for health professionals and families have been developed to address modifiable barriers to implementing safer sleep advice in this priority group of families. This study aims to understand how the Baby Sleep Project resources work to improve the uptake of safer sleep advice, including for whom, and in what contexts they work best.

Methods and analysis
Realist evaluation will be used, including both qualitative and quantitative methods. Data will be collected both pre- and post-health professional training in the new resources. We will invite neonatal staff, health visitors and family nurse partnerships nurses, and primary caregivers of infants to take part. We will carry out qualitative interviews with health professionals and caregivers. Quantitative surveys looking at implementation for health professionals, changes in infant care knowledge and practice, and parenting self-efficacy will be conducted with caregivers. Mechanisms of action, contexts and outcomes from the new resources will be tested against the initial programme theory. The findings from this research will inform evidence-based explanations of how to improve the uptake of health advice in priority populations.

Ethics and dissemination
The study was given a favourable opinion by the South West—Frenchay Research Ethics Committee (ref: 23/SW/0119). We will publish our findings in academic journals and talk about them at conferences. We will make sure the people who took part in the study hear about them first. If the resources are shown to be useful, we will work with charities and the National Health Service to roll them out across the whole of the UK.

Trial registration number
ISRCTN3364337.