Search Results for: Gestione dei sintomi del tratto urinario inferiore femminili (LUTS - Lower Urinary Tract Symptoms)

Colpisce il 20-50% degli operati. Proposta giornata nazionale

To the Editor The Indiana Palliative Excellence in Alzheimer Care Efforts (IN-PEACE) trial investigated the integration of palliative care within dementia care management for community-dwelling individuals with moderate to severe dementia and their caregivers. Although the trial reported a significant reduction in emergency department (ED) visits and hospitalizations, the lack of improvement in neuropsychiatric symptoms and caregiver distress raises important clinical questions.

The American Heart Association’s PREVENT calculator, released in 2023, estimates 10-year and 30-year risks of cardiovascular events. In addition to predicting myocardial infarction, or heart attack, and stroke, a new study in the Journal of the American Heart Association found that the 10-year estimates accurately predicted subclinical atherosclerosis, a condition in which plaques are present but don’t cause symptoms or signs of disease.

Screen use, the time spent engaging with electronic devices such as mobile phones and tablets, can become addictive when individuals experience difficulty stopping despite attempts to do so, as well as symptoms of withdrawal, tolerance, conflict, and relapse (BoxBox). Adolescence is a vulnerable period for addictive behaviors, and recent findings suggest that young adolescents are particularly susceptible to screen addiction. Notably, in the US, 48% of young adolescents report losing track of how much they are using their phone, 25% use social media to forget about their problems, and 25% admit to spending a considerable amount of time thinking about social media apps. Furthermore, 17% have tried to reduce their social media use but cannot, and 11% acknowledge that their screen use has negatively affected their schoolwork. These statistics highlight the need to study screen addiction and its specific health effects, as understanding these behaviors is crucial for addressing the risks they pose to adolescents’ well-being.

In Reply We appreciate the thoughtful letter from Drs Zhang and Wang regarding the publication of the main results of our IN-PEACE trial of palliative care integrated into dementia care management, including excellent questions and suggestions, as well as highlighting the finding of reducing ED visits and hospitalizations by half. We agree with several suggestions made by the authors for future interventions, such as a stepped-care approach to provide greater resources to vulnerable or underserved populations, patients with more severe symptoms, and caregivers with higher levels of depression or distress.

Circulation, Ahead of Print. BACKGROUND:The association of overall cardiovascular health (CVH) with changes in DNA methylation (DNAm) has not been well characterized.METHODS:We calculated the American Heart Association’s Life’s Essential 8 score to reflect CVH in 5 cohorts with diverse backgrounds (mean age 54 years, 55% women, and enrollment year ranging from 1989 to 2012). Epigenome-wide association studies (EWAS) for Life’s Essential 8 score were conducted, followed by bioinformatic analyses. DNAm loci significantly associated with Life’s Essential 8 score were used to calculate a CVH DNAm score. We examined the association of the CVH DNAm score with incident cardiovascular disease (CVD), cardiovascular disease–specific mortality, and all-cause mortality.RESULTS:We identified 609 cytosine-phosphate-guanines (CpGs) associated with Life’s Essential 8 score at false discovery rate

In a contemporary cohort of patients with NICM and ICD/CRT-D, we report an increased enrollment of females and minorities, an increase in the use of novel guideline-directed medical therapy (GDMT) over time, and a lower risk of ventricular arrhythmias or death in females as compared to men at one year.

Use of this drug should be limited to treating infections with organisms that are resistant to first-line agents.

Più casi per surriscaldamento, sintomi difficili da distinguere

We replicated four sepsis phenotypes in the EXIT-SEP cohort, with patterns similar to previously established phenotypes. XBJ treatment was associated with lower 28-day mortality in patients with phenotypes γ and δ, but these findings require further validation.

Circulation, Ahead of Print. BACKGROUND:Abdominal aortic aneurysms (AAA) present with high morbidity and mortality when they occasionally rupture. No medical therapy has successfully been proven to reduce AAA growth, though both metformin and statins have been identified as potential treatments in multiple meta-analysis. This study aimed to investigate a potential relationship between statin use and AAA growth rates and risk of undergoing repair, rupture, or death.METHODS:The study population included all men with screening-detected AAAs (30–55 mm) from the 2 large, population-based, randomized screening trials; the Viborg Vascular Screening trial (inclusion, 2008–2011) and the Danish Cardiovascular Screening trial (inclusion, 2014–2018). The clinical database was supplemented with data from the nationwide Danish Healthcare Registries, including prescription and outcome data. Statin exposure was quantified by defined daily doses (DDD). The primary outcome was AAA growth rate, whereas secondary outcomes included the need for repair and a composite of repair, rupture, and all-cause death. Growth rates were calculated using linear regression. To evaluate the risk of repair, patients were followed from inclusion until surgery, rupture, death, 5-year follow-up, or December 31, 2021.RESULTS:A total of 998 aneurysmal men (median age, 69.5 [interquartile range (IQR), 67–72] years; median AAA diameter, 35.4 [IQR, 32–41.2] mm) were included. Statin use was significantly associated with reduced AAA growth rate; an increase of 1 DDD statin per day was associated with an adjusted change in growth rate of −0.22 mm/year [95% CI, −0.39 to −0.06];P=0.009). The 5-year adjusted hazard ratio for undergoing repair per doubling of statin dose presented a significantly reduced adjusted hazard ratio (HR) of 0.82 ([95% CI, 0.70–0.97];P=0.023), which was significant after 2.5 years. Statin use was associated with a significantly lower risk of the composite outcome (surgery, rupture, and death) in a dose-dependent manner, with an adjusted HR of 0.83 ([95% CI, 0.73–0.94];P=0.003) per doubling of statin dose. Findings were robust in a variety of sensitivity analyses.CONCLUSIONS:High-dose statin use was associated with decreased AAA growth rates and lowered risk of undergoing repair, rupture, and death. This nonrandomized study suggests that patients with AAA could benefit from high-dose statin use, beyond only targeting associated risk factors.

Circulation, Ahead of Print. BACKGROUND:Primary aldosteronism (PA), an overt form of renin-independent aldosterone production, leads to a disproportionately high rate of major adverse cardiovascular events (MACEs). Mounting evidence suggests that milder forms of renin-independent aldosterone production (subclinical PA) are highly prevalent; however, the link between subclinical PA and MACE remains uncertain.METHODS:This prospective study included 2017 Canadian adults 40 to 69 years of age from the randomly sampled, population-based CARTaGENE cohort (Québec, Canada), in which aldosterone and renin concentrations at enrollment (2009–2010) were measured. Follow-up data were obtained via provincial health care administrative database linkage. MACE outcomes consisted of a composite of myocardial infarction, stroke, hospitalization for heart failure, and cardiovascular death. Multivariable linear and nonlinear Cox regression models measured the associations of concentrations of aldosterone, renin, and the aldosterone-to-renin ratio with MACE. Outcome-derived optimal thresholds for these markers were then determined.RESULTS:The mean (SD) age of participants was 56 (8) years, and 45% were women. Mean blood pressure was 129 (15)/76 (10) mm Hg, with hypertension being present in 27%. Over a median follow-up time of 10.8 years, 57 (3%) MACE outcomes occurred. Lower renin concentration (adjusted hazard ratio [aHR], 2.22 [95% CI, 1.02–4.76]) and higher aldosterone-to-renin ratio (aHR, 2.43 [95% CI, 1.15–5.12]) were associated with a higher risk for MACE, whereas no significant association was found with aldosterone concentration (aHR, 1.57 [95% CI, 0.42–5.90]). Renin concentration exhibited a nonlinear relationship with MACE risk. The outcome-derived optimal thresholds to discriminate a higher MACE risk were renin concentration ≤4.0 ng/L (aHR, 2.12 [95% CI, 1.21–3.72]) and aldosterone-to-renin ratio ≥70 pmol/L per ng/L (aHR, 2.03 [95% CI, 1.09–3.80]). All aforementioned associations were independent of blood pressure.CONCLUSIONS:Independent of blood pressure, the subclinical PA biochemical phenotype is associated with an increased risk of MACE. Future studies are necessary to determine whether early identification and targeted treatment of subclinical PA mitigates this risk.

RCTs on labour induction without IPD-sharing are more likely to have lower quality, more trustworthiness concerns, and exaggerated effect estimates than those with shared IPD. IPD-sharing and IPD meta-analyses should be encouraged. Trustworthiness and quality assessment should be prioritised whenever using RCTs for evidence synthesis and clinical guidelines development to ensure better evidence informs clinical practice.

Background
This study addresses the limited evidence of the impact of product characteristics on demand for and the substitutability of electronic cigarettes (e-cigarettes) or heated tobacco products for combusted cigarettes among people who smoke and have newly begun to use e-cigarettes.

Methods
A sample of 318 adults who smoke and recently initiated/reinitiated e-cigarette use participated in an online volumetric choice experiment in 2020–2021 to assess stated preferences for consumption and own and cross-price elasticities of three e-cigarette options (cig-a-like, vape pen or tank, closed pod system), heated tobacco product (IQOS) and their usual brand of cigarettes. Product attributes manipulated were price, flavour, level of harm, how well the product reduces cravings to smoke, and how discretely the product can be used. Multilevel zero-inflated negative binomial models were used to model the purchased quantities.

Results
Cigarettes were preferred over all alternatives. However, demand for cig-a-likes, but not IQOS, increased when cigarette prices were higher. Higher prices for e-cigarettes and IQOS did not increase demand for cigarettes. The odds of buying e-cigarettes/IQOS were higher when their harm was stated as low or unknown versus being similar to cigarettes (ie, very high). Other attributes (including various flavour options) were not significantly associated with demand for e-cigarettes or IQOS.

Conclusions
People who smoke and recently began using e-cigarettes might substitute cig-a-likes for cigarettes when cigarette prices are higher. Policies to increase the cost of combusted cigarettes as well as communicate lower relative harm and low absolute harm of e-cigarettes may facilitate switching behaviour.