Risultati per: BPCO: Trattamento farmacologico di follow-up (GOLD 2021)

The global trends for incidence, mortality, and DALYs related to pediatric neuroblastoma initially increased and then decreased, although an overall increasing trend was observed. However, the burden of disease remains significant in low-, low-middle-, and middle-SDI regions. A comprehensive understanding of the epidemiology of neuroblastoma in children is crucial for enhancing disease prevention and control efforts.

Objectives
Although primary care is central to healthcare provision, inconsistent methods and data sources mean that relatively little is known about long-term trends in general practice consultation rates. We aimed to explore long-term trends in English general practice consultation rates using two electronic health records databases, Clinical Practice Research Datalink Gold and Aurum, from 1995 to 2021.

Methods
Consultations were identified and classified using a set of rules and code lists. Consultation rates were calculated as the ratio of the count of consultations and the registration duration. We used negative binomial regression to model the relationship between the number of consultations and the patient’s age, sex and year from each database. These models are then used to estimate annual crude consultation rates for England.

Results
The number of general practices in the Gold database decreased from 346 (1995) to 41 (2021), while in Aurum, it increased from 555 (1995) to 1347 (2021). In Gold, the average number of consultations per person-year increased from 2.91 in 1995 to 5.12 in 2012, then fell to 4.59 in 2019 and to 4.12 in 2021. In Aurum, average consultations per person-year rose from 2.17 (1995) to 4.89 (2012), then fell to 4.76 (2019) and rose again to 5.40 (2021). Half of the total increase in consultations from Aurum was due to a new consultation code, for ‘AccurX consultations’, an electronic messaging system for communication with patients.

Conclusion
Trends in general practice consultation showed three distinct epochs: rising from 1995 to 2012, falling from 2012 to 2019 and rising in Aurum but falling in Gold from 2019 to 2021. Consultation rates in Gold were higher than Aurum until the inclusion of a new consultation code in Aurum in 2019, which underscores the need for operational definitions of a consultation.

New England Journal of Medicine, Volume 391, Issue 22, Page 2170-2172, December 5, 2024.

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

Objectives
This study aimed to assess the prevalence of treatment-resistant depression (TRD) and associated factors among patients with major depressive disorder (MDD) on follow-up at Amanuel Mental Specialised Hospital, Addis Ababa, Ethiopia, 2021.

Design and setting
An institution-based cross-sectional study design was employed using systematic random sampling techniques from 17 February to 26 March 2021.

Participants
The study enrolled 412 participants with a response rate of 97.6%. The study population consisted of Saint Amanuel Mental Specialised Hospital follow-up patients with MDDs and all adult patients aged above 18.

Main outcome measures
The main outcome of this study was TRD, which was measured using the Hospital Anxiety and Depression Scale-Depression (HADS-D). The collected data were entered into Epi-data software version 3.1 and exported to the statistical package for social science version 20 for analysis. Bivariate and multivariate logistic regression analyses were used to identify associated factors with TRD. The OR with a 95% CI was used to assess the strength of the association.

Results
The prevalence of TRD was 41.5% (95% CI: 37.2 to 46.1). Female sex [AOR=2.43, 95% CI: 1.57 to 3.75], comorbid psychosis [AOR=1.89, 95% CI: 1.19 to 2.99], comorbid medical illness [AOR=1.67, 95% CI: 1.09 to 2.55] and family history of mental illness [AOR=2.27, 95% CI: 1.38 to 3.74] were factors significantly associated with TRD.

Conclusion and recommendation
In this study, the prevalence of TRD among patients with MDDs on follow-up was high. Therefore, to improve outcomes, screening for TRD and creating specific diagnostic techniques are necessary. Additionally, preventive interventions against TRD must be established.

Introduction
Hysterosalpingography (HSG) and hysterosalpingo-foam sonography (HyFoSy) are commonly used tubal patency tests during the fertility work-up. Besides its diagnostic purpose, HSG with oil-based contrast can also be applied for its fertility-enhancing effect, by tubal flushing. HyFoSy is considered as less painful compared with HSG, it lacks exposure to iodinated contrast medium and ionising radiation. The fertility-enhancing effects of HyFoSy are less studied and randomised controlled trials comparing pregnancy rates after HSG and HyFoSy are lacking. This study (FOil study) is initiated to compare the effectiveness of tubal flushing during HSG with oil-based contrast and HyFoSy.

Methods and analysis
The FOil study is a nationwide, multicentre, open label, randomised controlled trial with a superiority design. Infertile women with an indication for tubal patency testing during their fertility work-up will be randomly assigned to HSG with oil-based contrast medium or HyFoSy. The primary outcome is conception within 6 months after randomisation leading to live birth. To demonstrate or refute an 8% difference in conception leading to live birth in favour of HSG with oil-based contrast, 1102 women will be included in the trial. A cost-effectiveness analysis from a societal perspective will be performed alongside the trial.

Ethics and dissemination
The trial is approved by the Medical Ethics Review Committee of the Amsterdam University Medical Centers (Ref. No. 2022.0884, date: 17 March 2023) and by the boards of the participating hospitals. The findings will be disseminated in peer-reviewed journals and participants will be informed through the patient organisation.

Trial registration number
NCT05882188.

Objective
To examine the contribution of the active job openings-to-applicants ratio, a macroeconomic indicator, to the number of ambulance dispatches.

Design
Longitudinal ecological study.

Setting
Japan, between January 2003 and December 2021.

Participants
All ambulance dispatches.

Primary and secondary outcome measures
The contribution of the active job openings-to-applicants ratio in a month, adjusted by the number of older people, mean temperature and total population, to the number of ambulance dispatches in that specific month was examined and the primary model was compared to the conventional model considering only the older population, mean temperature, and total population.

Results
There were 108 724 969 ambulance dispatches during this period. The active job openings-to-applicants ratio was significantly associated with the number of ambulance dispatches (the increase rate of monthly ambulance dispatches for 1% rise in the active job openings-to-applicants ratio, 1.00082; 95% CI 1.00052 to 1.00112). Additionally, the primary model effectively demonstrated better fitness to the actual trend than the conventional model (the quasi-likelihood under the independence model criteria were –2 626 817 720 and –2 626 775 185, respectively).

Conclusions
The number of ambulance dispatches was correlated with the active job openings-to-applicants ratio. Macroeconomic perspectives may be needed to address the issue of increasing ambulance dispatches.

Introduction
The allostatic load (AL) is a framework for conceptualising the physiological multisystemic impact of prolonged exposure to stress and its related side effects on mental health.
Stress due to AL can influence the development and outcomes of cardiovascular diseases. AL increases the risk of coronary and peripherical artery diseases. AL emerges from the detection of emotional dimensions related to the disease, low psychosocial functioning and high rates of psychopathological signs in patients with hypertension or coronary heart disease.

Method and analysis
The primary endpoint of the PLAY-UP protocol is the implementation of a multidimensional model underlying the clinical treatment of patients with cardiovascular disease through the integration of medical and psychological clinical variables.
PLAY-UP is a cohort study that will last for 24 months. 200 participants will be recruited and divided into three groups: early disease, midterm disease and long disease. All patients will undergo a clinical evaluation based on the detection of biological, medical and psychological indicators and variables. The evaluation battery will comprise three types of measurements: medical, psychological and pharmacological treatments. Clinical and psychological measurements will be processed in an integrated manner through the combination of all variables examined, elaborating the Allostatic Load Index from a longitudinal time perspective. The Allostatic Load Index will be calculated by measuring the z-score.

Ethics and dissemination
Ethical Committee Approval was obtained from CEtRA Abruzzo Region (IT) (ID 0461499/23). The results of the present project will be published in peer-reviewed journals, disseminated electronically and in print, and presented as abstracts and/or personal communications during national and international conferences.

Objective
This study was conducted to assess knowledge of stroke risk factors and prevention among hypertensive patients on follow-up at Addis Ababa University Tertiary Hospital, Addis Ababa, Ethiopia.

Design
Cross-sectional study design.

Setting
This study was conducted at Addis Ababa University Tertiary Hospital in Addis Ababa, Ethiopia.

Participants
The sample size was determined using the single population proportion calculation. A list of all patients with hypertension on follow-up was framed from the appointment book of the cardiovascular clinic. Then, 316 participants were recruited by simple random sampling procedure from 18 April 2022 to 19 May 2022. The study included all patients with hypertension >18 years of age who were on follow-up during the data-collecting period. In contrast, patients with memory loss or cognitive impairment and who are unable to communicate were excluded from the study.

Result
With a response rate of 96.8%, 306 respondents in total were questioned. The average age of the participants was 53.6 years (SD±13.4). More than half of participants (52.9%) were female. The average score for understanding stroke risk factors and prevention is 44.1% and 49.7%, respectively. Knowledge of stroke risk factors was substantially correlated with residency and educational level, while knowledge of stroke prevention was significantly associated with sex, income and educational level.

Conclusion
This study indicates that patients with hypertension who participated in the study had poor knowledge of stroke risk factors and prevention. The mean score of knowledge on risk factors and prevention strategies of stroke is 44.1% and 49.7%, respectively, and needs improvement.

Studio italiano, da domani il congresso di Pneumologia a Milano

Objectives
With a projected rise in care home residency and the disproportionate impact of epilepsy and seizures on older adults, understanding seizure-related needs in this population is crucial. Data silos and inconsistent recording of residence status make this challenging. We thus leveraged ambulance data to investigate seizure call-out incidence, characteristics, management and costs in care homes compared with the wider community.

Design
Retrospective analysis of dispatch data from a regional English ambulance service over four 9-month periods between 2014/2015 and 2021/2022. Suspected seizures in adults (≥16 years) were identified, with data on location, patient age, severity and management extracted. Incidence rates, trends over time and case characteristics were compared. Costs of ambulance response were estimated, and factors influencing emergency department (ED) conveyance were analysed using logistic regression.

Setting
North West Ambulance Service National Health Service Trust, serving an adult population of ~5.5 million.

Participants
Dispatch data for 98 752 suspected seizure cases.

Results
Care homes, accommodating ~0.8% of the regional population, accounted for 7.2% of seizure call-outs. Incidence was higher in care homes than the wider community (55.71 vs 5.97 per 1000 person/year in 2021/2022) and increased over time. Care home cases peaked around 8:00–9:00. Despite similar or lower severity, they had a higher ED conveyance rate (78.3% vs 70.6%). Conveyance likelihood was influenced by factors beyond severity: reduced in homes specialising in learning disabilities (adjusted OR=0.649) and increased in homes with nursing provision (adjusted OR=1.226). Care homes accounted for 7.26% of the £24 million cost.

Conclusions
This study highlights the growing seizure-related needs in care homes. Despite similar severity, most cases result in ED conveyance. Future research should examine the appropriateness and implications of these transfers, ensuring specialist services support the care home population effectively.

Introduction
Post-intensive care syndrome (PICS) seriously affects the quality of life of intensive care unit (ICU) survivors, their ability to return to work and society and the quality of life of their families, increasing overall care costs and healthcare expenditures. ICU follow-up services have important potential to improve PICS. However, the best clinical practice model of ICU follow-up service has not been fully defined and its benefits for ICU survivors are not clear. This review will synthesise and map the current types of follow-up services for ICU survivors and summarise the impact of follow-up services on PICS.

Methods and analysis
This scoping review will be conducted by applying the five-stage protocol proposed by Arksey and O’Malley in an updated version of the Joanna Briggs Institute. Eight academic databases including the Cochrane Library, MEDLINE, Web of Science, Embase, EBSCO Academic, CINAHL, PsycInfo and SinoMed (China Biology Medicine) will be systematically searched from inception to the present. Peer-reviewed literature and grey literature will be included. Qualitative, quantitative and mixed methods studies will be included. Studies published in English or Chinese will be included. There will be no time restriction. Two reviewers will screen and select the articles independently and if there is any disagreement, the two reviewers will discuss or invite a third reviewer to make decisions together. Descriptive analysis will be used to conduct an overview of the literature. The results will be presented in a descriptive format in response to the review questions accompanied by the necessary tables or charts.

Ethics and dissemination
Ethical approval is not required for this scoping review because data could be obtained by reviewing published primary study results and do not involve human participants. Findings should be disseminated at scientific meetings and published in peer-reviewed journals.