Risultati per: Report aggiornato sulla qualità dell’aria in Europa (2015)

This cross-sectional study calculates years of life lost to drug overdose in non-Hispanic Black female individuals and describes the changes in years of life lost that have occurred during the current overdose crisis.

One-third of US public health workers experienced stigma, threats, harassment, and other negative treatment during the COVID-19 pandemic, based on responses from more than 26 000 workers surveyed in the spring of 2021.

Stroke, Volume 54, Issue 3, Page e75-e85, March 1, 2023. Atrial fibrillation (AF) is one of the strongest risk factors for ischemic stroke, which is a leading cause of disability and death. Given the aging population, increasing prevalence of AF risk factors, and improved survival in those with cardiovascular disease, the number of individuals affected by AF will continue increasing over time. While multiple proven stroke prevention therapies exist, important questions remain about the optimal approach to stroke prevention at the population and individual patient levels. Our report summarizes the National Heart, Lung, and Blood Institute virtual workshop focused on identifying key research opportunities related to stroke prevention in AF. The workshop reviewed major knowledge gaps and identified targeted research opportunities to advance stroke prevention in AF in the following areas: (1) improving risk stratification tools for stroke and intracranial hemorrhage; (2) addressing challenges with oral anticoagulants; and (3) delineating the optimal roles of percutaneous left atrial appendage occlusion and surgical left atrial appendage closure/excision. This report aims to promote innovative, impactful research that will lead to more personalized, effective use of stroke prevention strategies in people with AF.

Intanto l’Organizzazione mondiale della Sanità ha abbandonato i progetti di fase due dell’indagine scientifica sull’origine del Covid

Esperto a Trieste al workshop sui cibi sostenibili del futuro

From January 1, 2022, through January 27, 2023, more than 85 000 confirmed human mpox (monkeypox) cases in 110 countries and 86 deaths were reported to the World Health Organization.

Objective
Performance of maternal death surveillance and response (MDSR) relies on the system’s ability to identify and notify all maternal deaths and its ability to review all maternal deaths by a committee. Unified definitions for indicators to assess these functions are lacking. We aim to estimate notification and review coverage rates in 30 countries between 2015 and 2019 using standardised definitions.

Design
Repeat cross-sectional surveys provided the numerators for the coverage indicators; United Nations (UN)-modelled expected country maternal deaths provided the denominators.

Setting
30 low-income and middle-income countries responding to the Maternal Health Thematic Fund annual surveys conducted by the UN Population Fund between 2015 and 2019.

Outcome measures
Notification coverage rate () was calculated as the proportion of expected maternal deaths that were notified at the national level annually; review coverage rate () was calculated as the proportion of expected maternal deaths that were reviewed annually.

Results
The average annual for all countries increased from 17% in 2015 to 28% in 2019; the average annual increased from 8% to 13%. Between 2015 and 2019, 22 countries (73%) reported increases in the —with an average increase of 20 (SD 18) percentage points—and 24 countries (80%) reported increases in by 7 (SD 11) percentage points. Low values of contrasts with country-published review rates, ranging from 46% to 51%.

Conclusion
MDSR systems that count and review all maternal deaths can deliver real-time information that could prompt immediate actions and may improve maternal health. Consistent and systematic documentation of MDSR efforts may improve national and global monitoring. Assessing the notification and review functions using coverage indicators is feasible, not affected by fluctuations in data completeness and reporting, and can objectively capture progress.

Circulation, Ahead of Print. BACKGROUND:Andexanet alfa is a modified recombinant inactive factor Xa (FXa) designed to reverse FXa inhibitors. ANNEXA-4 (Andexanet Alfa, a Novel Antidote to the Anticoagulation Effects of Factor Xa Inhibitors) was a multicenter, prospective, phase-3b/4, single-group cohort study that evaluated andexanet alfa in patients with acute major bleeding. The results of the final analyses are presented.METHODS:Patients with acute major bleeding within 18 hours of FXa inhibitor administration were enrolled. Co-primary end points were anti-FXa activity change from baseline during andexanet alfa treatment and excellent or good hemostatic efficacy, defined by a scale used in previous reversal studies, at 12 hours. The efficacy population included patients with baseline anti-FXa activity levels above predefined thresholds (≥75 ng/mL for apixaban and rivaroxaban, ≥40 ng/mL for edoxaban, and ≥0.25 IU/mL for enoxaparin; reported in the same units used for calibrators) who were adjudicated as meeting major bleeding criteria (modified International Society of Thrombosis and Haemostasis definition). The safety population included all patients. Major bleeding criteria, hemostatic efficacy, thrombotic events (stratified by occurring before or after restart of either prophylactic [ie, a lower dose, for prevention rather than treatment] or full-dose oral anticoagulation), and deaths were assessed by an independent adjudication committee. Median endogenous thrombin potential at baseline and across the follow-up period was a secondary outcome.RESULTS:There were 479 patients enrolled (mean age, 78 years; 54% male, 86% White; 81% anticoagulated for atrial fibrillation at a median time of 11.4 hours since last dose, with 245 (51%) on apixaban, 176 (37%) on rivaroxaban, 36 (8%) on edoxaban, and 22 (5%) on enoxaparin. Bleeding was predominantly intracranial (n=331 [69%]) or gastrointestinal (n=109 [23%]). In evaluable apixaban patients (n=172), median anti-FXa activity decreased from 146.9 ng/mL to 10.0 ng/mL (reduction, 93% [95% CI, 94–93]); in rivaroxaban patients (n=132), it decreased from 214.6 ng/mL to 10.8 ng/mL (94% [95% CI, 95–93]); in edoxaban patients (n=28), it decreased from 121.1 ng/mL to 24.4 ng/mL (71% [95% CI, 82–65); and in enoxaparin patients (n=17), it decreased from 0.48 IU/mL to 0.11 IU/mL (75% [95% CI, 79–67]). Excellent or good hemostasis occurred in 274 of 342 evaluable patients (80% [95% CI, 75–84]). In the safety population, thrombotic events occurred in 50 patients (10%); in 16 patients, this occurred during treatment with prophylactic anticoagulation that began after the bleeding event. No thrombotic episodes occurred after oral anticoagulation restart. Specific to certain populations, reduction of anti-FXa activity from baseline to nadir significantly predicted hemostatic efficacy in patients with intracranial hemorrhage (area under the receiver operating characteristic curve, 0.62 [95% CI, 0.54–0.70]) and correlated with lower mortality in patients

Circulation, Volume 147, Issue 8, Page e622-e622, February 21, 2023.

Tra emergenze anche sovraffollamento e alti tassi suicidio

Rapporto Cergas Bocconi-Essity, troppa eterogeneità tra Regioni

Objectives
To identify the factors associated with transcatheter aortic valve implantation (TAVI) use of TAVI in inpatients with aortic stenosis (AS) in Portugal and its geographical distribution.

Methods
A quantitative, observational and retrospective study using the Portuguese National Health Service inpatient discharge database from 2015 to 2017. Surgical aortic valve replacement (SAVR) and TAVI procedures were selected using the International Classification of Diseases. First, we mapped the yearly age-standardised rate for each procedure using QGIS. Then, we performed 2 tests, independent t-tests and logistic regressions to study the factors associated with TAVI use.

Results
From 2015 to 2017, 8398 hospitalisations were selected, 88.5% SAVR and 11.5% TAVI. From 2015 to 2017, SAVR use increased in the Northern region and decreased in the Lisbon region, while the opposite was observed for TAVI. TAVI was performed among the most complex (p

Objectives
Self-monitoring of physical activity (PA) has the potential to contribute to successful behaviour change in PA interventions in different populations, including people with inflammatory joint diseases (IJDs). The objectives of this study were to describe the use and knowledge of self-report-based and device-based PA measures in people with IJDs in four European countries, and to explore if the use of such devices, sociodemographic or disease-related variables were associated with adherence to the recommendations of at least 150 min of moderate to vigorous PA per week.

Setting
Cross-sectional survey, performed in 2015–2016.

Participants
People with IJDs in Belgium, Denmark, Ireland and Sweden.

Primary and secondary outcome measures
Use of self-report and device-based PA measures, receipt of instructions how to use PA measures, confidence in using them, adherence to PA recommendations and associated factors for adherence to PA recommendations.

Results
Of the 1305 respondents answering questions on PA measures, 600 (46%) reported use of any kind of self-report or device-based measures to self-monitor PA. Between country differences of 34%–58% was observed. Six per cent and four per cent received instructions from health professionals on how to use simple and complex devices, respectively. Independent associated factors of fulfilment of recommendations of PA were living in Ireland (OR=84.89, p

Contagi in lieve aumento nel mondo, specie nelle Americhe

Stroke, Volume 54, Issue Suppl_1, Page AWMP98-AWMP98, February 1, 2023. Objective:There are known associations between long-term air pollution exposure and greater stroke incidence, morbidity, and mortality; however, there is little research on the association of pollutant exposure with poststroke hospital readmission.Methods:We assessed associations of average annual CO, NO2, O3, PM2.5, and SO2exposure with 30-day all-cause hospital readmission in US fee-for-service Medicare beneficiaries age ≥65 years hospitalized for ischemic stroke in 2014-2015. We fit Cox models to assess 30-day readmission as a function of these pollutants, adjusted for patient and hospital factors and temperature. We repeated the models stratified by performance of the treating hospital on the Centers for Medicare & Medicaid Services (CMS) risk-standardized 30-day all-cause readmission for stroke measure to determine if the results were independent of performance: Low (CMS rate for hospital 75thpercentile), and Middle (all others).Results:There were 448148 patients discharged with stroke in 2014-2015 of whom 12.5% were readmitted. Average 2-year CO, O3, PM2.5, and SO2values during the study were below national standards. In adjusted analyses, each 1 standard deviation increase in average annual NO2and SO2exposure was associated with a 3.6% (95% CI 2.9%-4.4%) and a 2.0% (95% CI 1.1%-3.0%) increased readmission risk within 30-days, respectively (Table). Associations between long-term air pollution exposure and increased readmissions persisted across performance categories.Conclusion:Long-term air pollution exposure was associated with increased 30-day readmissions after stroke at pollutant levels below national standards across hospital performance categories. Additional research is needed to determine whether improvements in air quality lead to reductions in poststroke hospital readmissions.

Stroke, Volume 54, Issue Suppl_1, Page AWMP41-AWMP41, February 1, 2023. Introduction:Although stroke death rates declined since 1950s, age-adjusted rates remained higher among non-Hispanic Black (NHB) than among non-Hispanic White (NHW) persons. No study has examined changes in disparities of stroke mortality among NHB and NHW before and during the COVID-19 pandemic.Methods:We calculated age-adjusted (US 2000 population) stroke death rates per 100,000 people among NHB and NHW ages ≥35 years from 2015-2021 using CDC WONDER. We compared NHB and NHW stroke death rates from 2015-2019 (before pandemic) to 2020-2021 (during pandemic) with respect to changes in rates, rate ratios (RR) and difference-in-difference in rates.Results:Trends and disparities of overall stroke death rates before the pandemic remained consistent between NHB (100.9 to 101.6 per 100,000 people) and NHW (69.1 to 70.6 per 100,000 people), with an average difference in rates of 31.3/100,000 and RR of 1.45. During the pandemic, stroke death rates increased but with different magnitudes among NHB (110.0 and 113.4 per 100,000) and NHW (72.0 and 73.1 per 100,000). Between pre-pandemic and pandemic periods, the absolute difference in rates increased 25% from 31.3 (95% confidence interval 30.8-31.7) to 39.1 (38.3-39.8) per 100,000 and the relative difference measured by RR increased from 1.45 (1.44-1.46) to 1.54 (1.53-1.55) (p