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Saving lives from sudden cardiac arrest: every second and action counts 挽救心脏骤停患者的生命:分秒必争。
IF 7.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-07-01 DOI: 10.1016/j.lanwpc.2024.101163
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引用次数: 0
A new framework for Australian specialty colleges and other healthcare leaders to address bullying, discrimination, and harassment that involves doctors 澳大利亚专科院校和其他医疗保健机构领导者解决涉及医生的欺凌、歧视和骚扰问题的新框架
IF 7.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-07-01 DOI: 10.1016/j.lanwpc.2024.101118
Thomas Lawson Haskell , Jim Stankovich , Nancy Louisa Merridew

Bullying, discrimination, and harassment (BDH) within healthcare teams is a global issue that risks healthcare worker wellbeing, patient safety, public health, and industry reputations. Collectively, fragmented regulation, weak detection and correction processes, conflicts of interest, and fear of retribution for complainants create an environment that enables perpetrators. Specialty training Colleges and other stakeholders can collaborate to address this issue more effectively. This paper examines Australian processes and proposes that the existing disparate mechanisms should be replaced with a national BDH framework that is supported by an independent investigation body. The authors seek to stimulate discussion to reform practice in Australia and in other countries with similar health systems.

医疗团队中的欺凌、歧视和骚扰(BDH)是一个全球性问题,危及医疗工作者的健康、患者安全、公众健康和行业声誉。分散的监管、薄弱的检测和纠正程序、利益冲突以及对投诉者报复的恐惧,共同营造了一个助长犯罪者的环境。专业培训学院和其他利益相关者可以通力合作,更有效地解决这一问题。本文对澳大利亚的程序进行了研究,并建议用一个由独立调查机构支持的国家 BDH 框架来取代现有的不同机制。作者试图激发讨论,以改革澳大利亚及其他具有类似医疗体系的国家的做法。
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引用次数: 0
Australia's first human case of H5N1 and the current H7 poultry outbreaks: implications for public health and biosecurity measures 澳大利亚首例人类感染 H5N1 病例和当前的 H7 家禽疫情:对公共卫生和生物安全措施的影响
IF 7.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-07-01 DOI: 10.1016/j.lanwpc.2024.101141
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引用次数: 0
Global epidemiology of severe fever with thrombocytopenia syndrome virus in human and animals: a systematic review and meta-analysis 严重发热伴血小板减少综合征病毒在人类和动物中的全球流行病学:系统回顾和荟萃分析
IF 7.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-07-01 DOI: 10.1016/j.lanwpc.2024.101133
Haoliang Cui , Shijing Shen , Lin Chen , Zhiyu Fan , Qian Wen , Yiwen Xing , Zekun Wang , Jianyi Zhang , Jingyuan Chen , Bin La , Yujie Fang , Zeping Yang , Shuhan Yang , Xiangyu Yan , Shaojun Pei , Tao Li , Xiaoming Cui , Zhongwei Jia , Wuchun Cao

Background

Since the initial identification of the Severe Fever with Thrombocytopenia Syndrome (SFTS) in ticks in rural areas of China in 2009, the virus has been increasingly isolated from a diverse array of hosts globally, exhibiting a rising trend in incidence. This study aims to conduct a systematic analysis of the temporal and spatial distribution of SFTS cases, alongside an examination of the infection rates across various hosts, with the objective of addressing public concerns regarding the spread and impact of the disease.

Methods

In this systematic review and meta-analysis, an exhaustive search was conducted across multiple databases, including PubMed, Web of Science, Embase, and Medline, CNKI, WanFang, and CQVIP. The literature search was confined to publications released between January 1, 2009, and May 29, 2023. The study focused on collating data pertaining to animal infections under natural conditions and human infection cases reported. Additionally, species names were unified using the National Center for Biotechnology Information (NCBI) database. The notification rate, notification death rate, case fatality rate, and infection rates (or MIR) were assessed for each study with available data. The proportions were pooled using a generalized linear mixed-effects model (GLMM). Meta-regressions were conducted for subgroup analysis. This research has been duly registered with PROSPERO, bearing the registration number CRD42023431010.

Findings

We identified 5492 studies from database searches and assessed 238 full-text studies for eligibility, of which 234 studies were included in the meta-analysis. For human infection data, the overall pooled notification rate was 18.93 (95% CI 17.02–21.05) per ten million people, the overall pooled notification deaths rate was 3.49 (95% CI 2.97–4.10) per ten million people, and the overall pooled case fatality rate was 7.80% (95% CI 7.01%–8.69%). There was an increasing trend in notification rate and deaths rate, while the case fatality rate showed a significant decrease globally. Regarding animal infection data, among 94 species tested, 48 species were found to carry positive nucleic acid or antibodies. Out of these, 14 species were classified under Arthropoda, while 34 species fell under Chordata, comprising 27 Mammalia and 7 Aves.

Interpretation

This systematic review and meta-analysis present the latest global report on SFTS. In terms of human infections, notification rates and notification deaths rates are on the rise, while the case fatality rate has significantly decreased. More SFTSV animal hosts have been discovered than before, particularly among birds, indicating a potentially broader transmission range for SFTSV. These findings provide crucial insights for the prevention and control of SFTS on a global scale.

Funding

None.

背景自2009年在中国农村地区的蜱虫中首次发现严重发热伴血小板减少综合征(SFTS)病毒以来,全球范围内从不同宿主中分离出的病毒越来越多,发病率呈上升趋势。本研究旨在对SFTS病例的时间和空间分布进行系统分析,同时考察不同宿主的感染率,以解决公众对该疾病传播和影响的担忧。文献搜索仅限于 2009 年 1 月 1 日至 2023 年 5 月 29 日期间发布的出版物。研究的重点是整理自然条件下动物感染和人类感染病例报告的相关数据。此外,还利用美国国家生物技术信息中心(NCBI)数据库统一了物种名称。对每项研究的通报率、通报死亡率、病例死亡率和感染率(或 MIR)进行了评估。使用广义线性混合效应模型(GLMM)对比例进行汇总。对亚组分析进行了元回归。本研究已在 PROSPERO 正式注册,注册号为 CRD42023431010。研究结果我们通过数据库搜索确定了 5492 项研究,并对 238 项全文研究进行了资格评估,其中 234 项研究被纳入荟萃分析。就人类感染数据而言,总体汇总通知率为每 1000 万人 18.93 例(95% CI 17.02-21.05),总体汇总通知死亡人数为每 1000 万人 3.49 例(95% CI 2.97-4.10),总体汇总病死率为 7.80%(95% CI 7.01%-8.69%)。通报率和死亡率呈上升趋势,而全球病死率则显著下降。在动物感染数据方面,在检测的94个物种中,发现48个物种携带阳性核酸或抗体。其中,14 种属于节肢动物门,34 种属于脊索动物门,包括 27 种哺乳动物和 7 种鸟类。在人类感染方面,通报率和通报死亡率均呈上升趋势,而病例死亡率则显著下降。与以往相比,发现了更多的 SFTSV 动物宿主,尤其是在鸟类中,这表明 SFTSV 的传播范围可能更广。这些发现为在全球范围内预防和控制SFTS提供了重要启示。
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引用次数: 0
Current and future burden of Ross River virus infection attributable to increasing temperature in Australia: a population-based study 澳大利亚气温升高导致罗斯河病毒感染的当前和未来负担:一项基于人口的研究
IF 7.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-07-01 DOI: 10.1016/j.lanwpc.2024.101124
Yohannes Tefera Damtew , Blesson Mathew Varghese , Olga Anikeeva , Michael Tong , Alana Hansen , Keith Dear , Ying Zhang , Geoffrey Morgan , Tim Driscoll , Tony Capon , Michelle Gourley , Vanessa Prescott , Peng Bi

Background

Ross River virus (RRV), Australia's most notifiable vector-borne disease transmitted through mosquito bites, has seen increased transmission due to rising temperatures. Quantifying the burden of RRV infection attributable to increasing temperatures (both current and future) is pivotal to inform prevention strategies in the context of climate change.

Methods

As RRV-related deaths are rare in Australia, we utilised years lived with disability (YLDs) associated with RRV infection data from the Australian Institute of Health and Welfare (AIHW) Burden of Disease database between 2003 and 2018. We obtained relative risks per 1 °C temperature increase in RRV infection from a previous meta-analysis. Exposure distributions for each Köppen-Geiger climate zone were calculated separately and compared with the theoretical-minimum-risk exposure distribution to calculate RRV burden attributable to increasing temperatures during the baseline period (2003–2018), and projected future burdens for the 2030s and 2050s under two greenhouse gas emission scenarios (Representative Concentration Pathways, RCP 4.5 and RCP 8.5), two adaptation scenarios, and different population growth series.

Findings

During the baseline period (2003–2018), increasing mean temperatures contributed to 35.8 (±0.5) YLDs (19.1%) of the observed RRV burden in Australia. The mean temperature attributable RRV burden varied across climate zones and jurisdictions. Under both RCP scenarios, the projected RRV burden is estimated to increase in the future despite adaptation scenarios. By the 2050s, without adaptation, the RRV burden could reach 45.8 YLDs under RCP4.5 and 51.1 YLDs under RCP8.5. Implementing a 10% adaptation strategy could reduce RRV burden to 41.8 and 46.4 YLDs, respectively.

Interpretation

These findings provide scientific evidence for informing policy decisions and guiding resource allocation for mitigating the future RRV burden. The current findings underscore the need to develop location-specific adaptation strategies for climate-sensitive disease control and prevention.

Funding

Australian Research Council Discovery Program.

背景罗斯河病毒(RRV)是澳大利亚通过蚊虫叮咬传播的最常见的病媒传染病,由于气温升高,该病的传播率有所上升。由于澳大利亚很少发生与RRV相关的死亡事件,我们利用了澳大利亚健康与福利研究所(AIHW)疾病负担数据库中2003年至2018年期间与RRV感染相关的残疾生存年数(YLDs)数据。我们从之前的一项荟萃分析中获得了温度每升高 1 °C,RRV 感染的相对风险。我们分别计算了每个柯本-盖革(Köppen-Geiger)气候区的暴露分布,并将其与理论最小风险暴露分布进行了比较,从而计算出基线期(2003-2018 年)温度升高导致的 RRV 负担,以及在两种温室气体排放情景(代表性浓度途径,RCP 4.5 和 RCP 8.5)下 2030 年代和 2050 年代的预计未来负担。研究结果在基线期间(2003-2018 年),平均气温的升高造成了 35.8 (±0.5) YLDs(19.1%)的澳大利亚 RRV 负担。不同气候区和管辖区的平均气温造成的RRV负担各不相同。在两种 RCP 情景下,尽管有适应方案,但预计未来 RRV 负担仍会增加。到2050年代,如果不采取适应措施,RRV负担在RCP4.5下可能达到45.8YLDs,在RCP8.5下可能达到51.1YLDs。这些研究结果提供了科学证据,可为减轻未来RRV负担的政策决策和资源分配提供指导。目前的研究结果突出表明,有必要制定针对具体地点的适应战略,以控制和预防对气候敏感的疾病。
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引用次数: 0
Integrating depression and acute coronary syndrome care in low resource hospitals in China: the I-CARE randomised clinical trial 中国低资源医院的抑郁与急性冠脉综合征整合护理:I-CARE 随机临床试验
IF 7.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-07-01 DOI: 10.1016/j.lanwpc.2024.101126
Yangfeng Wu , Xin Yu , Yidan Zhu , Chuan Shi , Xian Li , Ronghuan Jiang , Sheng Niu , Pei Gao , Shenshen Li , Lijing Yan , Pallab K. Maulik , Guifang Guo , Anushka Patel , Runlin Gao , James A. Blumenthal

Background

Acute coronary syndrome (ACS) often co-occurs with depression, which adversely affects prognosis and increases medical costs, but effective treatment models are lacking, particularly in low-resource settings. This study aims to determine the effectiveness of an ACS and depression integrative care (IC) model compared to usual care (UC) in improving depression symptoms and other health outcomes among patients discharged for ACS in Chinese rural hospitals.

Methods

A multicentre, randomised controlled trial was conducted in sixteen rural county hospitals in China, from October 2014 to March 2017, to recruit consecutively all ACS patients aged 21 years and older after the disease stablised and before discharge. Patients were randomly assigned in a 1:1 ratio to receive either the IC or UC, stratified by hospital and depression severity. Patients allocated to IC received an ACS secondary prevention program and depression care including case screening, group counselling, and individual problem-solving therapy. Patients allocated to UC received usual care. The primary outcome was change in Patient Health Questionnaire-9 (PHQ-9) from baseline to 6 and 12 months. Main secondary outcomes included major adverse events (MAEs) composed of all-cause death, non-fatal myocardial infarction and stroke, and all-cause re-hospitalisation. Participants were followed up till March 2018. All data were collected in person by trained assessors blinded to treatment group and MAEs were adjudicated centrally. This trial is registered with ClinicalTrials.gov, NCT02195193.

Findings

Among 4041 eligible patients (IC: 2051; UC: 1990), the mean age was 61 ± 10 years and 63% were men. The mean PHQ-9 score lowered at both 6 and 12 months in both groups but was not lower in IC compared to UC at 6 months (mean difference (MD): −0.04, 95% confidence interval (CI): −0.20, 0.11) or 12 months (MD: −0.06, 95% CI: −0.21, 0.09). There were no treatment group differences for MAEs or other secondary outcomes except for secondary prevention medications at 12 months (45.2% in IC vs 40.8% in UC; relative risk: 1.21, 95% CI: 1.05–1.40). Pre-specified subgroup analyses showed that IC, compared to UC, may be more effective in lowering PHQ-9 scores in women, older patients, and patients with low social support, but less effective in moderately and severely depressed patients (all p for interaction <0.05).

Interpretation

The study found that the cardiology nurse-led ACS- and depression-integrated care, compared to usual care, did not improve depression symptoms in all patients discharged with ACS. Greater benefits in certain subgroups warrants further studies.

Funding

R01MH100332 National Institute of Mental Health.

背景急性冠状动脉综合征(ACS)常合并抑郁症,这对预后产生不利影响并增加医疗费用,但目前缺乏有效的治疗模式,尤其是在资源匮乏的环境中。本研究旨在确定与常规护理(UC)相比,急性冠脉综合征和抑郁症综合护理(IC)模式在改善中国农村医院急性冠脉综合征出院患者抑郁症状和其他健康结局方面的有效性。方法2014年10月至2017年3月,在中国16家农村县级医院开展了一项多中心随机对照试验,连续招募所有病情稳定后、出院前的21岁及以上急性冠脉综合征患者。患者按1:1的比例随机分配接受IC或UC治疗,并根据医院和抑郁严重程度进行分层。被分配到综合治疗方案的患者将接受 ACS 二级预防方案和抑郁症护理,包括病例筛查、小组咨询和个人问题解决疗法。接受综合治疗的患者则接受常规治疗。主要结果是患者健康问卷-9(PHQ-9)从基线到6个月和12个月的变化。主要次要结果包括主要不良事件(MAEs),包括全因死亡、非致命性心肌梗死和中风,以及全因再住院。参与者随访至2018年3月。所有数据均由训练有素的评估员亲自收集,并对治疗组设置盲区,MAE 由中央裁定。该试验已在ClinicalTrials.gov注册,编号为NCT02195193。研究结果在4041名符合条件的患者中(IC:2051人;UC:1990人),平均年龄为61±10岁,63%为男性。两组患者在 6 个月和 12 个月时的 PHQ-9 平均得分均有所下降,但在 6 个月时,IC 患者的 PHQ-9 平均得分并不低于 UC 患者(平均差异 (MD):-0.04,95% 置信度:0.05):-0.04,95% 置信区间(CI):在 6 个月(平均差异 (MD):-0.04,95% 置信区间 (CI):-0.20, 0.11)或 12 个月(平均差异 (MD):-0.06,95% 置信区间 (CI):-0.21, 0.09)时,IC 组与 UC 组相比没有降低。除了 12 个月的二级预防用药(IC 45.2% vs UC 40.8%;相对风险:1.21,95% CI:1.05-1.40)外,MAEs 或其他次要结果没有治疗组差异。预先指定的亚组分析表明,与 UC 相比,IC 在降低女性、老年患者和社会支持度较低患者的 PHQ-9 评分方面可能更有效,但对中度和重度抑郁患者的效果较差(交互作用的 p 均为 0.05)。对某些亚组患者的益处更大,值得进一步研究。
{"title":"Integrating depression and acute coronary syndrome care in low resource hospitals in China: the I-CARE randomised clinical trial","authors":"Yangfeng Wu ,&nbsp;Xin Yu ,&nbsp;Yidan Zhu ,&nbsp;Chuan Shi ,&nbsp;Xian Li ,&nbsp;Ronghuan Jiang ,&nbsp;Sheng Niu ,&nbsp;Pei Gao ,&nbsp;Shenshen Li ,&nbsp;Lijing Yan ,&nbsp;Pallab K. Maulik ,&nbsp;Guifang Guo ,&nbsp;Anushka Patel ,&nbsp;Runlin Gao ,&nbsp;James A. Blumenthal","doi":"10.1016/j.lanwpc.2024.101126","DOIUrl":"https://doi.org/10.1016/j.lanwpc.2024.101126","url":null,"abstract":"<div><h3>Background</h3><p>Acute coronary syndrome (ACS) often co-occurs with depression, which adversely affects prognosis and increases medical costs, but effective treatment models are lacking, particularly in low-resource settings. This study aims to determine the effectiveness of an ACS and depression integrative care (IC) model compared to usual care (UC) in improving depression symptoms and other health outcomes among patients discharged for ACS in Chinese rural hospitals.</p></div><div><h3>Methods</h3><p>A multicentre, randomised controlled trial was conducted in sixteen rural county hospitals in China, from October 2014 to March 2017, to recruit consecutively all ACS patients aged 21 years and older after the disease stablised and before discharge. Patients were randomly assigned in a 1:1 ratio to receive either the IC or UC, stratified by hospital and depression severity. Patients allocated to IC received an ACS secondary prevention program and depression care including case screening, group counselling, and individual problem-solving therapy. Patients allocated to UC received usual care. The primary outcome was change in Patient Health Questionnaire-9 (PHQ-9) from baseline to 6 and 12 months. Main secondary outcomes included major adverse events (MAEs) composed of all-cause death, non-fatal myocardial infarction and stroke, and all-cause re-hospitalisation. Participants were followed up till March 2018. All data were collected in person by trained assessors blinded to treatment group and MAEs were adjudicated centrally. This trial is registered with <span>ClinicalTrials.gov</span><svg><path></path></svg>, <span>NCT02195193</span><svg><path></path></svg>.</p></div><div><h3>Findings</h3><p>Among 4041 eligible patients (IC: 2051; UC: 1990), the mean age was 61 ± 10 years and 63% were men. The mean PHQ-9 score lowered at both 6 and 12 months in both groups but was not lower in IC compared to UC at 6 months (mean difference (MD): −0.04, 95% confidence interval (CI): −0.20, 0.11) or 12 months (MD: −0.06, 95% CI: −0.21, 0.09). There were no treatment group differences for MAEs or other secondary outcomes except for secondary prevention medications at 12 months (45.2% in IC vs 40.8% in UC; relative risk: 1.21, 95% CI: 1.05–1.40). Pre-specified subgroup analyses showed that IC, compared to UC, may be more effective in lowering PHQ-9 scores in women, older patients, and patients with low social support, but less effective in moderately and severely depressed patients (all p for interaction &lt;0.05).</p></div><div><h3>Interpretation</h3><p>The study found that the cardiology nurse-led ACS- and depression-integrated care, compared to usual care, did not improve depression symptoms in all patients discharged with ACS. Greater benefits in certain subgroups warrants further studies.</p></div><div><h3>Funding</h3><p>R01MH100332 <span>National Institute of Mental Health</span>.</p></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":null,"pages":null},"PeriodicalIF":7.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666606524001202/pdfft?md5=85e2f6296ff945363b278e78cafb48be&pid=1-s2.0-S2666606524001202-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141483893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Intensive blood pressure control in isolated systolic hypertension: a post hoc analysis of a cluster randomized trial 孤立性收缩期高血压的强化血压控制:分组随机试验的事后分析
IF 7.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-07-01 DOI: 10.1016/j.lanwpc.2024.101127
Chang Wang , Songyue Liu , Wei Miao , Ning Ye , Ziyi Xie , Lixia Qiao , Nanxiang Ouyang , Yangzhi Yin , Yingxian Sun , Guozhe Sun

Background

The isolated systolic hypertension (ISH) is of high prevalence, with a relatively poor prognosis. However, there is still no direct evidence to demonstrate the benefits of intensive blood pressure (BP) control among these patients. We aimed to evaluate intensive BP control with the target of <130/80 mmHg in ISH.

Methods

This was a post hoc analysis of patients with ISH in the China Rural Hypertension Control Project (CRHCP), defined as systolic blood pressure (SBP) ≥ 140 mmHg and diastolic blood pressure (DBP) < 90 mmHg. The primary outcome was cardiovascular disease (CVD) including stroke, myocardial infarction, heart failure, and CVD death. Mixed-effect Cox proportional regression and generalized estimating equation models were used for analysis.

Findings

In total, 7981 patients were randomly assigned to the intervention group and 8005 to the usual care group between May 8 and November 27, 2018. The median follow-up was 3.02 years (25–75%: 2.98–3.06). Mean systolic/diastolic BP at the end of 36 months follow-up was 126.5/71.2 mmHg in the intensive BP control group and 148.1/78.6 mmHg in the usual care group. The intervention group presented a substantially lower rate of composite CVD compared with the usual care group (1.52% versus 2.30%/year; multiple-adjusted hazard ratio (HR): 0.64; 95% confidence interval (CI): 0.57–0.72; P < 0.001), especially for stroke (multiple-adjusted HR: 0.61; 95% CI: 0.53–0.70; P < 0.001), HF (multiple-adjusted HR: 0.57; 95% CI: 0.36–0.91; P = 0.017) and CVD death (multiple-adjusted HR: 0.64; 95% CI: 0.50–0.83; P < 0.001). The primary composite outcome was substantially reduced by 36% in the intervention group compared with the usual care group. The further interaction analysis revealed that the reduction of primary outcome by intervention was consistent across subgroups of sex, age, education level, history of CVD, use of antihypertensive medication and baseline DBP (P > 0.05 for all interaction test). The incidences of symptomatic hypotension, syncope injurious falls and renal outcomes did not differ between the two groups, even though hypotension was increased in intervention group (RR:1.71; 95% CI: 1.28–2.28; P < 0.001).

Interpretation

Intensive BP control (<130/80 mmHg) was effective and safe in patients with ISH for the prevention of CVD events.

Funding

The Ministry of Science and Technology (China) of China and the Science and Technology Program of Liaoning Province, China.

背景孤立性收缩期高血压(ISH)发病率高,预后相对较差。然而,目前仍没有直接证据表明强化血压控制对这些患者有好处。方法这是对中国农村高血压控制项目(CRHCP)中的 ISH 患者进行的一项事后分析,ISH 的定义是收缩压(SBP)≥ 140 mmHg 和舒张压(DBP)≥ 90 mmHg。主要结果是心血管疾病(CVD),包括中风、心肌梗死、心力衰竭和心血管疾病死亡。采用混合效应 Cox 比例回归和广义估计方程模型进行分析。研究结果在 2018 年 5 月 8 日至 11 月 27 日期间,共有 7981 名患者被随机分配到干预组,8005 名患者被随机分配到常规护理组。中位随访时间为 3.02 年(25%-75%:2.98-3.06 年)。随访36个月结束时,强化血压控制组的平均收缩压/舒张压分别为126.5/71.2 mmHg,常规护理组的平均收缩压/舒张压分别为148.1/78.6 mmHg。与常规护理组相比,干预组的复合心血管疾病发生率大大降低(1.52% 对 2.30%/年;多重调整危险比(HR):0.64;95% 置信区间(CI):0.57-0.72;P < 0.001),尤其是中风(多重调整HR:0.61;95% CI:0.53-0.70;P <;0.001)、HF(多重调整HR:0.57;95% CI:0.36-0.91;P = 0.017)和心血管疾病死亡(多重调整HR:0.64;95% CI:0.50-0.83;P <;0.001)。与常规护理组相比,干预组的主要综合结果大幅降低了 36%。进一步的交互分析表明,在不同性别、年龄、教育水平、心血管疾病史、使用降压药和基线 DBP 的亚组中,干预对主要结果的降低是一致的(所有交互检验的 P > 0.05)。尽管干预组低血压发生率增加,但两组间症状性低血压、晕厥损伤性跌倒和肾脏疾病的发生率并无差异(RR:1.71;95% CI:1.28-2.28;P< 0.001)。
{"title":"Intensive blood pressure control in isolated systolic hypertension: a post hoc analysis of a cluster randomized trial","authors":"Chang Wang ,&nbsp;Songyue Liu ,&nbsp;Wei Miao ,&nbsp;Ning Ye ,&nbsp;Ziyi Xie ,&nbsp;Lixia Qiao ,&nbsp;Nanxiang Ouyang ,&nbsp;Yangzhi Yin ,&nbsp;Yingxian Sun ,&nbsp;Guozhe Sun","doi":"10.1016/j.lanwpc.2024.101127","DOIUrl":"https://doi.org/10.1016/j.lanwpc.2024.101127","url":null,"abstract":"<div><h3>Background</h3><p>The isolated systolic hypertension (ISH) is of high prevalence, with a relatively poor prognosis. However, there is still no direct evidence to demonstrate the benefits of intensive blood pressure (BP) control among these patients. We aimed to evaluate intensive BP control with the target of &lt;130/80 mmHg in ISH.</p></div><div><h3>Methods</h3><p>This was a post hoc analysis of patients with ISH in the China Rural Hypertension Control Project (CRHCP), defined as systolic blood pressure (SBP) ≥ 140 mmHg and diastolic blood pressure (DBP) &lt; 90 mmHg. The primary outcome was cardiovascular disease (CVD) including stroke, myocardial infarction, heart failure, and CVD death. Mixed-effect Cox proportional regression and generalized estimating equation models were used for analysis.</p></div><div><h3>Findings</h3><p>In total, 7981 patients were randomly assigned to the intervention group and 8005 to the usual care group between May 8 and November 27, 2018. The median follow-up was 3.02 years (25–75%: 2.98–3.06). Mean systolic/diastolic BP at the end of 36 months follow-up was 126.5/71.2 mmHg in the intensive BP control group and 148.1/78.6 mmHg in the usual care group. The intervention group presented a substantially lower rate of composite CVD compared with the usual care group (1.52% versus 2.30%/year; multiple-adjusted hazard ratio (HR): 0.64; 95% confidence interval (CI): 0.57–0.72; <em>P</em> &lt; 0.001), especially for stroke (multiple-adjusted HR: 0.61; 95% CI: 0.53–0.70; <em>P</em> &lt; 0.001), HF (multiple-adjusted HR: 0.57; 95% CI: 0.36–0.91; <em>P</em> = 0.017) and CVD death (multiple-adjusted HR: 0.64; 95% CI: 0.50–0.83; <em>P</em> &lt; 0.001). The primary composite outcome was substantially reduced by 36% in the intervention group compared with the usual care group. The further interaction analysis revealed that the reduction of primary outcome by intervention was consistent across subgroups of sex, age, education level, history of CVD, use of antihypertensive medication and baseline DBP (<em>P</em> &gt; 0.05 for all interaction test). The incidences of symptomatic hypotension, syncope injurious falls and renal outcomes did not differ between the two groups, even though hypotension was increased in intervention group (RR:1.71; 95% CI: 1.28–2.28; <em>P</em> &lt; 0.001).</p></div><div><h3>Interpretation</h3><p>Intensive BP control (&lt;130/80 mmHg) was effective and safe in patients with ISH for the prevention of CVD events.</p></div><div><h3>Funding</h3><p>The <span>Ministry of Science and Technology (China) of China</span> and the <span>Science and Technology Program of Liaoning Province</span>, China.</p></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":null,"pages":null},"PeriodicalIF":7.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666606524001214/pdfft?md5=d082d25c14c642b5b2533628cd569a17&pid=1-s2.0-S2666606524001214-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141483895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The co-benefits of climate change mitigation strategies on cardiovascular health: a systematic review 气候变化减缓战略对心血管健康的共同效益:系统性综述
IF 7.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-07-01 DOI: 10.1016/j.lanwpc.2024.101098

Background

Climate change is a significant threat to global human health and a leading cause of premature death. Global warming, leading to more extreme weather (in particular extreme heat events), and air pollution has been associated with increased cardiovascular disease (CVD) morbidity and mortality. According to the Global Burden of Disease Study 2019, 62% of the deaths attributable to climate change were from CVD. Climate change mitigation is a slow, steady process, and the concept of co-benefits has arisen to promote climate action. This systematic review examines how numerous mitigation strategies, such as plant-based diets, increasing green spaces, increasing active transport, using renewable energy sources, and smoking cessation, may have the co-benefit of reducing CVD.

Methods

A mixed methods systematic review with narrative synthesis was conducted on four databases, according to the PRISMA guidelines. The articles retrieved (published between 2012 and 2022) had a mitigation strategy as the exposure, and CVD related morbidity or mortality reduction as an outcome.

Findings

The review found that renewable energy has a stronger association with cardiovascular co-benefits compared to emission reduction targets. Multimodal transport is more beneficial for both the climate and cardiac health than zero emission vehicles. Diet modification, such as Mediterranean and plant-based-diets, is positively associated with CVD reduction. Proximity to green spaces and reducing urbanisation may also improve cardiac health.

Interpretation

This systematic review demonstrates that implementing four mitigation strategies - increasing renewable energy use, active transport, green spaces, and plant-based diets; could lead to the co-benefit of reducing CVD morbidity and mortality. Furthermore, it illustrates the importance of plant-based diets and active transport to improve cardiovascular health.

Funding

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

背景气候变化是对全球人类健康的重大威胁,也是导致过早死亡的一个主要原因。全球变暖导致更多极端天气(尤其是极端高温事件)和空气污染,这与心血管疾病(CVD)发病率和死亡率的增加有关。根据《2019 年全球疾病负担研究》,气候变化导致的死亡中有 62% 来自心血管疾病。减缓气候变化是一个缓慢而稳定的过程,为促进气候行动,产生了共同效益的概念。本系统综述研究了植物性饮食、增加绿地、增加积极的交通方式、使用可再生能源和戒烟等多种减缓气候变化的策略如何能够带来减少心血管疾病的共同效益。方法根据PRISMA指南,在四个数据库中进行了叙述性综合的混合方法系统综述。研究结果综述发现,与减排目标相比,可再生能源与心血管共同效益的关系更为密切。多式联运比零排放车辆更有利于气候和心脏健康。地中海饮食和植物性饮食等饮食调整与心血管疾病的减少呈正相关。本系统综述表明,实施四种减缓策略--增加可再生能源的使用、积极的交通、绿地和植物性饮食--可带来降低心血管疾病发病率和死亡率的共同效益。此外,它还说明了植物性膳食和主动交通对改善心血管健康的重要性。
{"title":"The co-benefits of climate change mitigation strategies on cardiovascular health: a systematic review","authors":"","doi":"10.1016/j.lanwpc.2024.101098","DOIUrl":"10.1016/j.lanwpc.2024.101098","url":null,"abstract":"<div><h3>Background</h3><p>Climate change is a significant threat to global human health and a leading cause of premature death. Global warming, leading to more extreme weather (in particular extreme heat events), and air pollution has been associated with increased cardiovascular disease (CVD) morbidity and mortality. According to the Global Burden of Disease Study 2019, 62% of the deaths attributable to climate change were from CVD. Climate change mitigation is a slow, steady process, and the concept of co-benefits has arisen to promote climate action. This systematic review examines how numerous mitigation strategies, such as plant-based diets, increasing green spaces, increasing active transport, using renewable energy sources, and smoking cessation, may have the co-benefit of reducing CVD.</p></div><div><h3>Methods</h3><p>A mixed methods systematic review with narrative synthesis was conducted on four databases, according to the PRISMA guidelines. The articles retrieved (published between 2012 and 2022) had a mitigation strategy as the exposure, and CVD related morbidity or mortality reduction as an outcome.</p></div><div><h3>Findings</h3><p>The review found that renewable energy has a stronger association with cardiovascular co-benefits compared to emission reduction targets. Multimodal transport is more beneficial for both the climate and cardiac health than zero emission vehicles. Diet modification, such as Mediterranean and plant-based-diets, is positively associated with CVD reduction. Proximity to green spaces and reducing urbanisation may also improve cardiac health.</p></div><div><h3>Interpretation</h3><p>This systematic review demonstrates that implementing four mitigation strategies - increasing renewable energy use, active transport, green spaces, and plant-based diets; could lead to the co-benefit of reducing CVD morbidity and mortality. Furthermore, it illustrates the importance of plant-based diets and active transport to improve cardiovascular health.</p></div><div><h3>Funding</h3><p>This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.</p></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":null,"pages":null},"PeriodicalIF":7.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666606524000920/pdfft?md5=131a077ee2b266070d346fda16b78e7d&pid=1-s2.0-S2666606524000920-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141728938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Unveiling the black box: imperative for explainable AI in cardiovascular disease (CVD) prevention–author reply 揭开黑匣子:在心血管疾病(CVD)预防中实现可解释的人工智能势在必行--作者回复
IF 7.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-07-01 DOI: 10.1016/j.lanwpc.2024.101146
Mayank Dalakoti , Scott Wong , Roger Foo
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引用次数: 0
Unveiling the black box: imperative for explainable AI in cardiovascular disease prevention 揭开黑匣子:在心血管疾病预防中采用可解释的人工智能势在必行
IF 7.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-07-01 DOI: 10.1016/j.lanwpc.2024.101145
Yanyi Wu , Chenghua Lin
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引用次数: 0
期刊
The Lancet Regional Health: Western Pacific
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