Acute coronary syndrome in COVID-19 times: could it be business as usual?

Funding Acknowledgements

Type of funding sources: None.

Background

In an attempt to cope with the COVID-19 pandemic, several measures of social distancing and reorganization of health care systems have been adopted. In Portugal, these included suspending elective clinical activity and a temporary national lockdown. Data from multiple centres, including central hospitals in Portugal, has shown a reduction in hospital admissions for acute coronary syndrome (ACS) during the COVID-19 outbreak. Fear of going to the hospital and physical inactivity have been pointed as possible explanations.

Purpose

to assess the impact of this pandemic and the measures taken against it on the pattern of admissions and treatment of patients with ACS in a district hospital. 

Methods

A single-centre retrospective study was conducted in the Cardiology Department of a Portuguese district hospital, capable of performing 24h percutaneous coronary intervention. We analyzed the admissions for ACS during the peak of the first COVID-19 outbreak in Portugal (16th of March to 3rd of May 2020, coinciding with the suspension of elective activity) and compared it with two control periods: one immediately preceding the study period (27th of January to 15th of March - 2020 control) and one exactly one year before (16th of March to 3rd of May 2019 - 2019 control).

Results

During the 7 weeks of the first COVID-19 outbreak, 46 patients were hospitalized for ACS in our department, while 54 had been admitted during the 2020 control period and 40 in the 2019 control period, with a mean of 7 admissions/week (vs 8 and 6, respectively; p > 0.05). There were no significant differences between the study group and both controls regarding basal characteristics. Their presentation did not differ: the majority of patients (57%) was admitted for ST-elevation myocardial infarction and median time from symptom onset to admission to the emergency room was 3 hours, with 4% of patients presenting in Killip class ≥III (p > 0.05 for all). We also found no significant differences in the treatment administered nor in the outcomes (96% submitted to coronary angiography, median length of hospitalization of 4 days and in-hospital mortality rate of 2%, p > 0.05 for all). 

Conclusions

Our study suggests that the reduction in admissions for ACS during the COVID-19 outbreak is not universal. Additionally, severity at presentation, treatment administered and outcomes did not seem to differ. The relatively low prevalence of COVID-19 in our hospital"s region might be the cause, since people might fear and refrain less from going to the hospital. Larger studies with other centres in low-prevalence regions are needed to confirm this hypothesis.

Cold Urticaria. Characterizing the Population From an Urticaria Outpatient Clinic

INTRODUCTION

Cold Urticaria (ColdU) is a type of chronic inducible urticaria (CIndU) where recurrent pruritic wheals and/or angioedema occur after exposure to cold stimulus. Although it usually only affects exposed areas, systemic reactions can occur in severe cases. In this study, we seek to characterize the ColdU cases within our Centre's population of patients.

MATERIAL AND METHODS

Retrospective study based on clinical files of patients diagnosed with ColdU followed in an urticaria outpatient clinic in Portugal prior to October 2020.

RESULTS

We included 52 patients total (40 women) with median age of 35 years, 19 patients with symptom onset before 18 years-old. ColdU was classified as acquired in all patients. Cold provocation tests were negative in 9 patients and these were classified as atypical ColdU. No significant differences were found between those with pediatric or adult onset of disease. Most of the patients had a localized form of the disease (52%). Despite not being statistically significant, it was found that patient's temperature threshold, assessed with TempTest® 4.0, was higher and stimulation time was shorter in more severe groups. All patients were treated with non-sedating antihistamines (daily or on-demand), finding that those controlled with standard dosages had lower temperature thresholds than those needing higher dosages (p<0.01). One patient was under treatment with omalizumab.

CONCLUSION

ColdU is an heterogenous disease that can have life-threatening event consequences. Cold provocation tests and threshold assessment can be an important tool in the management treatment and in identifying severity groups.

[Lung involvement of pyoderma gangrenosum: Diagnostic and therapeutic discussion based on a case report and a targeted literature review]

INTRODUCTION

Pyoderma gangrenosum (PG) is a rare, mainly dermatological condition, whose unusual and little-known lung involvement presents a diagnostic and therapeutic challenge.

CASE REPORT

A 66-year-old man, followed for 6 years for an IgA monoclonal gammopathy of undetermined significance and an initially cutaneous corticosteroid-dependent PG, received a pneumonectomy for a mass suspected of neoplasia, that turns out to be a PG pulmonary localisation. During successive pneumopathies, sometimes dyspneic and excavated, several hypotheses are discussed. Various infectious and immunological explorations, and various antibacterial/fungal or immunosuppressive therapies are conducted, to finally conclude to pulmonary and/or cutaneous recurrences of PG. The outcome at 14 months seems finally favourable with tofacitinib.

CONCLUSION

The recognition of cutaneous involvement of PG, which is essential for the diagnosis of its lung involvement, is probably the mirror of its evolution under treatment. Only multidisciplinary confrontation of reported cases will allow the elaboration of diagnostic and therapeutic recommendations.

Does age at aortic coarctation repair have an impact on left ventricle size and function?

Funding Acknowledgements

Type of funding sources: None.

Introduction

Adults with repaired aortic coarctation (CoA) require lifelong follow-up due to late complications, including left ventricular (LV) myocardial dysfunction. Age at the time of CoA repair is an important prognostic factor in these patients (pts).

Purpose

To evaluate LV size, ejection fraction (EF) and global longitudinal strain (GLS) values using 2D speckle tracking echocardiography (STE) in a population of adult pts with repaired CoA and to assess the relationship between these echocardiographic parameters and age at the time of CoA repair.

Methods

Retrospective analysis of adult pts with repaired CoA, followed in a Grown Up Congenital Heart Disease Centre. Pts with hemodynamically significant concomitant cardiac lesions were ruled out. Epidemiologic and clinical data were obtained from clinical records. Transthoracic echocardiograms were reviewed in order to assess GLS using 2DSTE (Echopac Software, GE).

Results

The study population consisted of 63 pts (61.9% male), with a mean age of 35.3 years at the time of the echocardiographic evaluation. The mean age at the time of the CoA repair was 117 months (95% CI 89.8-144.1 months).

Surgical repair was performed in 46 pts (73%): resection with subclavian artery flap aortoplasty (n = 21); patch aortoplasty (n = 15) and head-to-head anastomosis (n = 10). In 10 pts there was no data regarding the type of surgical repair. Seven pts (11.1%) were submitted to percutaneous intervention (6 with aortic stent implantation and 1 with balloon aortic angioplasty).

Mean LVEF was 63.4% (CI 95% 55.6 – 71.2%) and mean LV end-diastolic diameter (LVEDD) was 50mm (CI 95% 43-57mm). Mean GLS was - 17.3 (CI 95% 14.8- 19.8), which is inferior to the mean normal values reported for the software used.

Age at the time of CoA repair had a statistically significant positive linear relationship with LVEDD (r= 0.282; p= 0.026) and a linear negative relationship with both GLS (r= -0,29; p= 0.022) and LVEF (r= -0.33; p= 0.05).

Conclusion

Older age at the time of CoA repair was associated with increased LVEDD and decreased GLS and LVEF. Also, GLS may be an important tool for the identification of subclinical LV dysfunction in adult pts with repaired CoA.

Ceftazidime-avibactam resistance and restoration of carbapenem susceptibility in KPC-producing Klebsiella pneumoniae infections: A case series

OBJECTIVES

Since the introduction of the β-lactam/β-lactamase inhibitor ceftazidime-avibactam (CZA), rapid evolution of resistance has been reported in different KPC-producing Klebsiella pneumoniae isolates. In this multicenter retrospective study, we describe the emergence of CZA resistance and evaluate the mutations that might be responsible for the restoration of carbapenem susceptibility.

METHODS

During a study period of 18 months, KPC-producing K. pneumoniae isolates of five hospitalized patients were collected with phenotypic development of CZA resistance.

RESULTS

In vitro restoration of carbapenem susceptibility during treatment was observed in 3 isolates. Whole genome sequencing of these isolates showed a D179Y mutation in the KPC gene of 2 variants and a KPC-2 with a Δ242-GT-243 deletion (KPC-14). Two KPC-3 variants showed CZA resistance with sustained carbapenemase activity without genomic adaptations in the KPC gene.

CONCLUSIONS

This study confirms the emergence of CZA resistance in KPC K. pneumoniae. The role of carbapenems in treating patients with these variants is unclear and combination therapies warrant further investigation.

[Incidence of dislocation and relationship with the surgical approach in a historic cohort of 1,738 hips of the National Register of Uruguay]

INTRODUCTION

In Uruguay, all replacements have been registered by law since 1980. Instability is the second cause of revision in hip replacements.

OBJECTIVE

To know the incidence of instability, and its relationship with the surgical approach.

MATERIAL AND METHODS

Observational and analytical study of a historical cohort of 1,738 hip replacements conducted in 2014. Random sample stratified according to the surgical approach: posterior (AP) and anterolateral (AAL). All patients who had suffered any dislocation were identified, their incidence was estimated and bivariate and multivariate tests were performed, to identify factors related, associated with the patient, to the surgeon (surgical approach and experience), to the environment, and to the implant.

RESULTS

633 patients, minimum follow-up of three years and 16 patients with dislocation, with an incidence of 1.95% (95% CI: 1.14-3.31) in general, 1.4% (95% CI: 0.64-3.03) in AAL and 4.9% (95% CI: 2.67-8.83) in AP (p = 0.009, RR = 3.35). Factors associated with dislocation were: a) AP with an OR of 6.18 (CI 95%: 1.99-19.26); b) patient from the private health subsector with an OR of 13.74 (95% CI: 1.87-101.15); c) antecedent of hypothyroidism with an OR of 3.51 (IC 95%: 1.09-11.29); d) osteoarthritis secondary to inflammatory arthritis and dysplasia with an OR of 5.24 (CI 95%: 1.16-23.66); e) surgical center number three with an OR of 8.80 (CI 95%: 1.50-51.51).

CONCLUSIONS

The incidence of early dislocation was within the usual ranges. Posterior surgical approach with increased risk of instability from preoperative risk factors.

Evaluating the effects of polices on nursing care as promoted by the Veneto region: the research protocol and its implications for public health

Study design

Multi-centre mixed-method study design organised into several phases.

Background

The Veneto region has recently defined a set of policies on nursing care by determining the needed amount of daily care in minutes and by initiating a systematic measurement of nursing outcomes; also, with a more recent policy, missed nursing care (MNC) has been established as a process measure of interest. To measure the effect of these policies, a research protocol - aimed at evaluating several end points - has been designed, involving a large target population and hospital units. The aim of this manuscript is to briefly present the research protocol and to discuss the public health implications of its expected end-points.

Methods

The endpoints of the protocol are: (a) to describe the frequency of MNC as perceived by nurses; (b) to identify contributing factors; (c) to identify practices adopted in low-occurrence MNC units and to assess the effectiveness of implementing them in units with higher levels of MNC; (d) to explore the relationship between the amount of nursing care provided, MNC, and patient outcomes; and (e) to validate a tool that measures MNC as perceived by patients/caregivers. A total of 3,460 nurses, 5,000 patient/day and 160 nursing coordinators of the medical and surgical units of public hospitals in the Veneto Region will be included.

Conclusions

Measuring the association between the amount of nursing care and patient outcomes, as well as evaluating the role of MNC as perceived by nurses and patients in hindering or increasing the risk of some patient outcomes can provide a body of evidence capable of further informing policies in the field, both at the national and at the international level. Moreover, emerging good practices capable of preventing or minimising MNC, sharing and implementing them in other units where high levels of missed care are reported and evaluating their effectiveness, can also inform public health policies.

Coronary artery fistulas: a single-center case series

Introduction

Coronary artery fistulas (CAFs) are rare anomalous connections between a coronary artery and a major vessel or cardiac chamber. Currently they are being increasingly encountered due to the more widespread use of various imaging modalities and coronary angiography. Although the vast majority of CAFs are incidentally diagnosed and have no clinical relevance, they can cause significant morbidity such as myocardial infarction, congestive heart failure and endocarditis.

Methods

A consecutive series of 55867 coronary arteriograms performed in our Cardiology Department from 2007 to 2019 was retrospectively investigated for the presence of coronary artery fistulas. Patients clinical, angiographic and therapeutic data up to november 2019 were analyzed. Data were obtained from medical records of hospital stay and subsequent consultations.

Results

We identified 50 patients who were diagnosed with one or more CAFs, with ages between 5 and 85 years (mean 59 years). 62% (n=31) were males.

The great majority of patients had a single fistula (n=34, 68%), 11 patients had two fistulas (22%), 1 patient had 3 fistulas (2%) and 4 patients had multiple fistulas (8%).

CAFs arose more frequently from the left anterior descending artery (n=27), followed by the right coronary (n=18), left circumflex (n=15), left main (n=5) and intermediate artery (n=2). The most frequent drainage site was the pulmonary artery (n=38).

The majority of CAFs were incidentally found (n=32; 64%) and thought to have no significance for the patients' clinical status. As for the rest of the patients, CAFs were diagnosed during evaluation of: a heart murmur (n=7); exertional chest pain with no associated significant atherosclerotic coronary artery disease (n=7); exertional dyspnea (n=2); positive exercise stress test (n=1); NSTEMI and cardiac arrest (n=1).

Regarding treatment, watchful waiting was the main approach (n=40; 80%). 3 patients had their CAFs closed during surgery for another heart condition (CABG/aortic valve replacement). In 1 patient, heart surgery was specifically conducted for fistula closure. 6 patients (12%) underwent fistula transcatheter closure.

Conclusion

CAFs are rare coronary anomalies and the majority has no clinical relevance, so watchful waiting is the commonest approach. When they are hemodynamically significant or symptoms/complications arise, surgical or transcatheter closure should be considered. This study describes the angiographic, clinical and therapeutic data of CAFs detected along the last 12 years in a single tertiary care center catheterization laboratory.

Funding Acknowledgement

Type of funding source: None

Mesenchymal stromal cells for articular cartilage repair: preclinical studies

Rheumatic diseases such as osteoarthritis (OA) are a major social and economic burden because of the population aging and the lack of curative solutions. An effective cell therapy may be the best treatment option for OA and other cartilage diseases. However, the main cellular strategy used to repair articular cartilage, the transplantation of autologous chondrocytes, is limited to a small number of patients with traumatic lesions. The use of joint replacement after years of disease progression proves the great medical need in current practice. Mesenchymal stromal/stem cells (MSCs) provide an alternative cell source for cartilage regeneration due to numerous advantages, comprising relative ease to isolate and culture, chondrogenic capacity, and anti-inflammatory effects. Initial clinical trials with MSCs have led to encouraging results, but many variables have to be considered to attain true amelioration of disease or repair (type and status of cartilage disease, source and conditions of cells, administration regime, combinatorial approaches). Particularly, allogeneic MSCs are an advantageous cellular product. The animal models chosen for preclinical evaluation are also relevant for successful translation into clinical practice. Considering the limitations in the field, rigorous comparative and validating studies in well-established animal models (including large animals) are still needed to set up the bases for additional clinical trials. The present review of studies performed in small and large animal models should help clarify the applicability of MSC-based therapies for articular cartilage repair.

Advanced basal cell carcinoma treated with vismodegib: impact on the lives of patients and their families

Locally advanced basal cell carcinoma (laBCC) represented an uncommon, difficult-to-treat form of skin cancer until the recent approval of the Hedgehog inhibitor vismodegib. Approximately 80% of laBCCs occur in the head and neck region, causing disfiguring skin changes that have an impact on patient quality of life (QoL). Because the lives of patients with advanced BCCs are severely disrupted, it would be expected that the QoL family members involved in caregiving would also be affected. The aim of our study was to quantify the QoL of both patients and family members during vismodegib treatment using the Dermatology Life Quality Index and the Family Dermatology Life Quality Index, respectively.

Exo-Ocean Exploration with Deep-Sea Sensor and Platform Technologies

One of Saturn's largest moons, Enceladus, possesses a vast extraterrestrial ocean (i.e., exo-ocean) that is increasingly becoming the hotspot of future research initiatives dedicated to the exploration of putative life. Here, a new bio-exploration concept design for Enceladus' exo-ocean is proposed, focusing on the potential presence of organisms across a wide range of sizes (i.e., from uni- to multicellular and animal-like), according to state-of-the-art sensor and robotic platform technologies used in terrestrial deep-sea research. In particular, we focus on combined direct and indirect life-detection capabilities, based on optoacoustic imaging and passive acoustics, as well as molecular approaches. Such biologically oriented sampling can be accompanied by concomitant geochemical and oceanographic measurements to provide data relevant to exo-ocean exploration and understanding. Finally, we describe how this multidisciplinary monitoring approach is currently enabled in terrestrial oceans through cabled (fixed) observatories and their related mobile multiparametric platforms (i.e., Autonomous Underwater and Remotely Operated Vehicles, as well as crawlers, rovers, and biomimetic robots) and how their modified design can be used for exo-ocean exploration.

AB1213 DIFFERENT IMMUNOSUPPRESSIVE REGIMENS WITH NO EFFECT ON INFLUENZA-LIKE ILLNESS

Background:

Autoimmune disease (AID) has been associated with increased risk of influenza and influenza-like illness (ILI) and its worse clinical outcomes complications.

Objectives:

We aimed to assess the influence and difference of several immunosuppressive (IS) treatments in the incidence of ILI, including glucocorticoids (GC), classic DMARDs and biologic DMARDs.

Methods:

We conducted a cross-sectional study in two autoimmune clinics. Patients were invited to answer a survey reporting ILI symptoms between October 2017 and March 2018. ILI definition was considered according to the European Center for Disease Control. Data regarding current IS, diagnostic, disease activity, comorbidities, and vaccination coverage were collected from electronic registry. Patients with history of cancer, HIV, IGIV treatment, or lack of information were excluded. Univariate and multivariate logistic regression analysis were used to access predictors of ILI.

Results:

We included 109 patients, with mean age 51 years and 81% female gender. The majority of patients had autoimmune arthropathy (n=54) or a connective tissue disease (n=44). Active disease was present in in 39% of patients. IS treatment was: GC 31%, classic DMARD 44%, biologic DMARD 28%. Vaccine coverage was 51%. Overall 41% reported ILI. We did not find any association between studied variables and ILI, including univariate and multivariate analysis. Univariate odds ratio calculation for IS treatment were: GC [OR 1,68 IC 0,7-3,8], classic DMARD [OR 1,03 IC 0,5-2,2], and biologic DMARD [OR 0,86 IC 0,4-2,0]. Comorbidity of pulmonary disease (n=8) may contribute to higher risk to ILI [OR 2,76 IC 0,8-10,0].

Conclusion:

There was no difference in risk of ILI within different IS treatment regimens, although GC may increase the risk. The study is limited by the subjectivity of the ILI survey and the small size of the sample. The stratification of influenza risk will help in designing better vaccine coverage strategies in this population.

References:

[1]Nakafero G, Grainge MJ, Myles PR, Mallen CD, Zhang W, Doherty M, Nguyen-Van-Tam JS, Abhishek A. Predictors and temporal trend of flu vaccination in auto-immune rheumatic diseases in the UK: a nationwide prospective cohort study. Rheumatology (Oxford). 2018 Oct 1;57(10):1726-1734.

[2]Danza A, Ruiz-Irastorza G. Infection risk in systemic lupus erythematosus patients: susceptibility factors and preventive strategies. Lupus. 2013 Oct;22(12):1286-94.

[3]McLean-Tooke A, Aldridge C, Waugh S, Spickett GP, Kay L. Methotrexate, rheumatoid arthritis and infection risk: what is the evidence? Rheumatology (Oxford). 2009 Aug;48(8):867-71.

[4]Lacaille D, Guh DP, Abrahamowicz M, Anis AH, Esdaile JM. Use of non biologic disease-modifying antirheumatic drugs and risk of infection in patients with rheumatoid arthritis. Arthritis Rheum. 2008 Aug 15;59(8):1074-81.

[5]Bernatsky S, Hudson M, Suissa S. Anti-rheumatic drug use and risk of serious infections in rheumatoid arthritis. Rheumatology (Oxford). 2007 Jul;46(7):1157-60.

[6]Doran MF, Crowson CS, Pond GR, O’Fallon WM, Gabriel SE. Predictors of infection in rheumatoid arthritis. Arthritis Rheum. 2002 Sep;46(9):2294-300.

[7]Fessler BJ. Infectious diseases in systemic lupus erythematosus: risk factors, management and prophylaxis. Best Pract Res Clin Rheumatol. 2002 Apr;16(2):281-91. Review.

[8]Singh JA, Wells GA, Christensen R, Tanjong Ghogomu E, Maxwell L, Macdonald JK, Adverse effects of biologics: a network meta-analysis and Cochrane overview. Cochrane Database Syst Rev. 2011 Feb 16;(2):CD008794.

Acknowledgments:

None.

Disclosure of Interests:

None declared

RESIST-5 O.O.K.N.V. and NG-Test Carba 5 assays for the rapid detection of carbapenemase-producing Enterobacterales from positive blood cultures: a comparative study

We prospectively compared the performance of RESIST-5 O.O.K.N.V. and NG-Test Carba 5 assays directly from blood cultures spiked with 130 characterized Enterobacterales isolates. Overall, both assays yielded 100% sensitivity to detect KPC-type carbapenemases and OXA-48-like carbapenemases. Both assays failed to detect KPC-31 and KPC-33, D179Y point mutation variants of KPC-3 and KPC-2, that are deprived of carbapenemase activity and confer resistance to ceftazidime-avibactam. On blood culture bacterial pellets, NDM- and VIM-type carbapenemases were detected in 50.0% and 52.2%, respectively, by RESIST-5 O.O.K.N.V. vs 100% by NG-Test Carba 5. The sensitivity of RESIST-5 O.O.K.N.V. improved to 100% and 95.6%, respectively, by performing the assay on 4-h early subculture.

On the relevance of cocaine detection in a fingerprint

The finding that drugs and metabolites can be detected from fingerprints is of potential relevance to forensic science and as well as toxicology and clinical testing. However, discriminating between dermal contact and ingestion of drugs has never been verified experimentally. The inability to interpret the result of finding a drug or metabolite in a fingerprint has prevented widespread adoption of fingerprints in drug testing and limits the probative value of detecting drugs in fingermarks. A commonly held belief is that the detection of metabolites of drugs of abuse in fingerprints can be used to confirm a drug has been ingested. However, we show here that cocaine and its primary metabolite, benzoylecgonine, can be detected in fingerprints of non-drug users after contact with cocaine. Additionally, cocaine was found to persist above environmental levels for up to 48 hours after contact. Therefore the detection of cocaine and benzoylecgonine (BZE) in fingermarks can be forensically significant, but do not demonstrate that a person has ingested the substance. In contrast, the data here shows that a drug test from a fingerprint (where hands can be washed prior to donating a sample) CAN distinguish between contact and ingestion of cocaine. If hands were washed prior to giving a fingerprint, BZE was detected only after the administration of cocaine. Therefore BZE can be used to distinguish cocaine contact from cocaine ingestion, provided donors wash their hands prior to sampling. A test based on the detection of BZE in at least one of two donated fingerprint samples has accuracy 95%, sensitivity 90% and specificity of 100% (n = 86).

Accuracy of the ELITe MGB assays for the detection of carbapenemases, CTX-M, Staphylococcus aureus and mecA/C genes directly from respiratory samples

INTRODUCTION

Bacterial lower respiratory tract infections (BLRTI) may represent serious clinical conditions which can lead to respiratory failure, intensive care unit admission and high hospital costs. The detection of carbapenemase- and extended-spectrum β-lactamase (ESBL)-producing Enterobacterales, as well as meticillin-resistant Staphylococcus aureus (MRSA), has become a major issue, especially in healthcare-associated infections. This study aimed to determine whether molecular assays could detect genes encoding carbapenemases, ESBL and MRSA directly from respiratory samples in order to expedite appropriate therapy and infection control for patients with BLRTI.

METHODS

The carbapenem-resistant enterobacterales (CRE), ESBL and MRSA/SA ELITe MGB assays were performed directly on 354 respiratory specimens sampled from 318 patients admitted with BLRTI. Molecular results were compared with routine culture-based diagnostics results.

RESULTS

Positive (PPV) and negative (NPV) predictive values of the CRE ELITe MGB kit were 75.9% [95% confidence interval (CI) 60.3-86.7] and 100%, respectively. PPV and NPV of the ESBL ELITe MGB kit were 80.8% (95% CI 63.6-91.0) and 99.1% (95% CI 96.6-99.8), respectively. PPV and NPV of the MRSA/SA ELITe MGB kit were 91.7% (95% CI 73.7-97.7)/100% and 98.3% (95% CI 89.8-99.3)/96.8% (95% CI 81.6-99.5), respectively.

DISCUSSION

Validity assessment of molecular assays detecting the main antibiotic resistance genes directly from respiratory samples showed high accuracy compared with culture-based results. Molecular assays detecting the main carbapenemase, ESBL, S. aureus and meticillin resistance encoding genes provide an interesting tool with potential to expedite optimization of antibiotic therapy and infection control practices in patients with BLRTI.

Geospatial data sources to produce new evidence for routine population health monitoring

Background

Many public agencies collect geospatial data in relation to Environment and Territorial Planning. This data is harmonized, standardized, made available online, and it is often collected for a group of countries. These characteristics make this data particularly useful for population health studies, yet in public health there is a certain lack of knowledge with regard to this type of data. The large datasets, the data format and the ways to access this data all hamper their use. The aim of this work is to present an overview of geospatial databases that produce routinely available geospatial data able to support population health monitoring and interventions. The process of how to transform this data in evidence at the local scale will also be highlighted.

Methods

First, we conducted a survey via the websites of international public institutes with relevant geospatial data gathered for Europe. Second, we identified how we could transform the data into evidence relevant to both, population health studies and decision makers, namely at the local level.

Results

At the EU level, the European Territorial Observatory Network (ESPON), EUROSTAT, the Joint Research Centre and the Environment European Agency (EEA) are some examples of public agencies both producing and offering access to geospatial data. They are responsible for collecting data regarding, e.g., land use, road and rail networks, amenities and pollution.

Although geospatial data has been compiled all over Europe, it can be used to produce evidence at the local level. For instance, it is possible to extract information on the greenspace area at a local administrative level from the Corine Land Cover project, managed by the EEA, and then, measure the share of area per inhabitant.

Conclusions

Geospatial data have much more to offer than the obvious location factor. It brings new evidence at the local level, supporting studies and empowering decision-makers at all levels.

Population health indicators availability at regional level across the European Union

Background

The availability of reliable and comparable data at the regional level is extremely important to measure regional health inequalities. The aim of this research is to assess the data availability of the indicators included in EURO-HEALTHY’s Population Health Index (PHI), a multidimensional tool developed to measure population health across European regions.

Methods

Three consecutive steps where implemented: i) assessment of data availability and reliability of the indicators for the regional level and for the last year with data available; ii) application of a protocol to solve cases of missing data and assure the database completeness and iii) development of an availability scoring system, ranging from 0 (no data available) to 1 (all data available), by indicator and EU region.

Results

A set of 39 population health indicators were assessed. The mean availability is 0.8, ranging from 0.46 (worst) to 1 (best). Indicators such as ’Unemployment’, ’Higher education’, ’Ageing index’, ’Teenage motherhood’, ’Victims in road accidents’, ’Fatality rate’, ’Life expectancy’ and ’Infant mortality’ present the highest scores (&gt;0.95). ’Daily smokers’, ’Pure alcohol consumption’, ’Number of rooms per person’ and access to ’Public water supply’ and ’Wastewater treatment’ present the lowest availability scores (&lt;0.60), mostly due to the availability at the national level only.

Conclusions

This study provides a comprehensive assessment of data availability of population health indicators from multiple areas of concern, at the EU regional level. The results highlight the urgent need for sub-national data in several domains that are important to close the health gap between and within countries. Still, as data collection in EU is driven by a policy derived framework, it is essential to give awareness to the regional scale, prior to the policy development.

Key messages

There is an urgent need for sub-national data in several domains that are important to close the health gap between and within countries. As data collection in EU is driven by a policy derived framework, it is essential to give awareness to the regional scale, prior to the policy development.

Valor nutritivo do capim-xaraés em três intensidades luminosas

RESUMO Este trabalho teve como objetivo avaliar o valor nutritivo e a força de cisalhamento da cultivar de Urochloa brizantha (syn Brachiaria brizantha) cv Xaraés submetida a três intensidades luminosas e quatro cortes. O experimento foi conduzido na FMVZ - Unesp de Botucatu, com delineamento experimental em blocos ao acaso, sendo os tratamentos: luminosidade natural, redução de 30% e 60% de luz, com quatro cortes e três repetições. As análises realizadas foram: composição bromatológica, digestibilidade e a força de cisalhamento. Não houve diferença na digestibilidade entre os tratamentos em nenhum dos cortes, mas a qualidade forrageira foi influenciada pelos níveis de intensidade de luz, tendo o tratamento com 60% de redução de luminosidade apresentado maiores concentrações de proteína bruta e cinzas, menores teores de fibra em detergente neutro, hemicelulose, celulose e força de cisalhamento. Em relação aos cortes estudados, o primeiro teve o menor intervalo de corte e produziu forragem com qualidade superior em comparação ao último, pois obteve menor teor de fibra em detergente ácido, lignina, hemicelulose, celulose e consequente menor força de cisalhamento. Portanto, a redução de 60% de luminosidade é benéfica à qualidade e à força de cisalhamento da cultivar Xaraés.