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Kim HJ, Ghang B, Kim J, Ahn HS. Regional variations of cardiovascular risk in gout patients: a nationwide cohort study in Korea. J Rheum Dis 2023; 30:185-197. [PMID: 37476678 PMCID: PMC10351371 DOI: 10.4078/jrd.2023.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/29/2023] [Accepted: 05/01/2023] [Indexed: 07/22/2023]
Abstract
Objective The extent of regional variations in cardiovascular risk and associated risk factors in patients with gout in South Korea remains unclear. Therefore, we aimed to investigate the risk of major cardiovascular events in gout patients in different regions. Methods This was a nationwide cohort study based on the claims database of the Korean National Health Insurance and the National Health Screening Program. Patients aged 20 to 90 years newly diagnosed with gout after January 2012 were included. After cardiovascular risk profiles before gout diagnosis were adjusted, the relative risks of incident cardiovascular events (myocardial infarction, cerebral infarction, and cerebral hemorrhage) in gout patients in different regions were assessed. Results In total, 231,668 patients with gout were studied. Regional differences in cardiovascular risk profiles before the diagnosis were observed. Multivariable analysis showed that patients with gout in Jeolla/Gwangju had a significantly high risk of myocardial infarction (adjusted hazard ratio [aHR], 1.27; 95% confidence interval [CI], 1.02~1.56; p=0.03). In addition, patients with gout in Gangwon (aHR, 1.38; 95% CI, 1.09~1.74; p<0.01), Jeolla/Gwangju (aHR, 1.41; 95% CI, 1.19~1.67; p<0.01), and Gyeongsang/Busan/Daegu/Ulsan (aHR, 1.37; 95% CI, 1.19~1.59; p<0.01) had a significantly high risk of cerebral infarction. Conclusion We found there were regional differences in cardiovascular risk and associated risk factors in gout patients. Physicians should screen gout patients for cardiovascular risk profiles in order to facilitate prompt diagnosis and treatment.
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Affiliation(s)
- Hyun Jung Kim
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Byeongzu Ghang
- Division of Rheumatology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Jinseok Kim
- Division of Rheumatology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Hyeong Sik Ahn
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea
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Gente M, Aufieri R, Agostino R, Fedeli T, Calevo MG, Massirio P, Bellini C. Nationwide survey of neonatal transportation practices in Italy. Ital J Pediatr 2019; 45:51. [PMID: 30999944 PMCID: PMC6471884 DOI: 10.1186/s13052-019-0640-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 03/29/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite regionalization of perinatal care provides for the "in utero" transfer of high-risk pregnancies, there will always be a number of neonates who undergo acute inter-facility transport. The presence of a well-organized Neonatal Emergency Transport Service (NETS) can prevent and reduce risks of transportation, especially for very preterm infants, and is therefore mandatory for any program of regionalization of perinatal care. Italian National Health System is highly decentralized and Regions are autonomous to structure, plan and delivery their regional health services. Consequently, organization models and resources available vary widely and significant regional differences in access and quality of health services have been reported in the past years. A national survey was conducted in 2015 by the neonatal transport study group of the Italian Society of Neonatology with the aim to describe neonatal transfer practices and to assess the Neonatal Emergency Transport Services (NETS) status in the 20 Italian regions. METHODS A questionnaire regarding neonatal transfer practices and NETS activity for the previous year (2014) was sent to the 44 NETS operating in the 20 Italian regions. Demographic data were obtained from the Italian National Statistical Institute (ISTAT). RESULTS The overall survey response rate was 100%. In 2014, only 12 (60%) of the 20 Italian regions were fully covered by NETS, 3 (15%) regions were partially covered, while neonatal transport was not available in 5 (25%) regions. Overall, in 2014, the 44 NETS operating in Italy transported a total of 6387 infants, including 522 (8.17%) having a gestational age < 28 weeks. CONCLUSIONS The organization of NETS in Italy is devolved on a regional basis, resulting in a large heterogeneity of access and quality to services across the country. Where available, NETS are generally well-equipped and organized but limited volume of activities often cannot guarantee adequate levels of skills of personnel or an appropriate cost-efficiency ratio. The regions reported with lack of NETS have managed, or are trying, to fill the gap, but continuing efforts to reduce regional differences in the availability and quality of services are still needed.
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Affiliation(s)
- Maurizio Gente
- Department of Pediatrics and Infant Neuropsychiatry, Neonatal Emergency Transport Service, Sapienza University of Rome, Rome, Italy
| | - Roberto Aufieri
- Division of Neonatology and Neonatal Intensive Care Unit, ASL Roma 2 - Ospedale Sant'Eugenio, Rome, Italy
| | - Rocco Agostino
- Division of Neonatology, Villa Margherita Private Nursing Home, Rome, Italy
| | - Tiziana Fedeli
- Neonatal Intensive Care Unit, Fondazione MBBM, Monza, Italy
| | - Maria Grazia Calevo
- Department of Epidemiology, Biostatistics and Committees, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Paolo Massirio
- Neonatal Intensive Care Unit, Neonatal Emergency Transport Service, Department Mother&Child, IRCCS Istituto Giannina Gaslini, Largo G. Gaslini, 5, 16147, Genoa, Italy
| | - Carlo Bellini
- Neonatal Intensive Care Unit, Neonatal Emergency Transport Service, Department Mother&Child, IRCCS Istituto Giannina Gaslini, Largo G. Gaslini, 5, 16147, Genoa, Italy.
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Stelmach R, Cerci Neto A, Fonseca ACDCF, Ponte EV, Alves G, Araujo-Costa IN, Lasmar LMDLBF, Castro LKKD, Lenz MLM, Silva P, Cukier A, Alves AM, Lima-Matos AS, Cardoso ADRO, Fernandes ALG, São-José BPD, Riedi CA, Schor D, Peixoto DM, Brandenburg DD, Camillo EGDS, Serpa FS, Brandão HV, Lima JAB, Pio JE, Fiterman J, Anderson MDF, Cardoso MDSDL, Rodrigues MT, Pereira MNEU, Antila M, Martins SM, Guimarães VGT, Mello YAM, Andrade WCCD, Salibe-Filho W, Caldeira ZMDR, Cruz-Filho ÁASD, Camargos P. A workshop on asthma management programs and centers in Brazil: reviewing and explaining concepts. J Bras Pneumol 2015; 41:3-15. [PMID: 25750669 PMCID: PMC4350820 DOI: 10.1590/s1806-37132015000100002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 11/17/2014] [Indexed: 11/22/2022] Open
Abstract
Objective: To report the results of a workshop regarding asthma management programs and centers (AMPCs) in Brazil, so that they can be used as a tool for the improvement and advancement of current and future AMPCs. Methods: The workshop consisted of five presentations and the corresponding group discussions. The working groups discussed the following themes: implementation of asthma management strategies; human resources needed for AMPCs; financial resources needed for AMPCs; and operational maintenance of AMPCs. Results: The workshop involved 39 participants, from all regions of the country, representing associations of asthma patients (n = 3), universities (n = 7), and AMPCs (n = 29). We found a direct relationship between a lack of planning and the failure of AMPCs. Based on the experiences reported during the workshop, the common assumptions about AMPCs in Brazil were the importance of raising awareness of managers; greater community participation; interdependence between primary care and specialized care; awareness of regionalization; and use of medications available in the public health system. Conclusions: Brazil already has a core of experience in the area of asthma management programs. The implementation of strategies for the management of chronic respiratory disease and their incorporation into health care system protocols would seem to be a natural progression. However, there is minimal experience in this area. Joint efforts by individuals with expertise in AMPCs could promote the implementation of asthma management strategies, thus speeding the creation of treatment networks, which might have a multiplier effect, precluding the need for isolated centers to start from zero.
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Affiliation(s)
- Rafael Stelmach
- University of São Paulo, School of Medicine, Hospital das Clínicas, São Paulo, Brazil. Department of Pulmonology, Heart Institute, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - HC-FMUSP, University of São Paulo School of Medicine Hospital das Clínicas - São Paulo, Brazil
| | - Alcindo Cerci Neto
- State University at Londrina, Londrina, Brazil. (Paraná) State University at Londrina; and Coordinator. Programa Respira Londrina (Breathe, Londrina Program), Londrina, Brazil
| | | | - Eduardo Vieira Ponte
- Jundiaí School of Medicine, Jundiaí, Brazil. Jundiaí School of Medicine, Jundiaí, Brazil
| | - Gerardo Alves
- Fortaleza Municipal Department of Health, Fortaleza, Brazil. Programa de Atenção Integral à Criança e Adulto com Asma de Fortaleza - PROAICA, Integrated Asthma Management Program for Chidren and Adults in Fortaleza - Fortaleza Municipal Department of Health, Fortaleza, Brazil
| | - Ildely Niedia Araujo-Costa
- University Hospital, Federal University of Maranhão, São Luís, Brazil. Asthma Patient Care Program, Federal University of Maranhão University Hospital, São Luís, Brazil
| | - Laura Maria de Lima Belizário Facury Lasmar
- Federal University of Minas Gerais, Belo Horizonte, Brazil. Federal University of Minas Gerais; and Pediatric Pulmonologist. Centro Multidisciplinar para Asma de Difícil Controle - CEMAD, Multidisciplinary Center for the Treatment of Difficult-to-Control Asthma - and Programa Criança que Chia (Wheezing Child Program), Belo Horizonte City Hall, Belo Horizonte, Brazil
| | - Luci Keiko Kuromoto de Castro
- Programa Respira Londrina, Londrina, Brazil. Programa Respira Londrina (Breathe, Londrina Program), Londrina, Brazil
| | - Maria Lucia Medeiros Lenz
- Conceição Hospital Group, Porto Alegre, Brazil. Asthma Program, Conceição Hospital Group, Porto Alegre, Brazil
| | - Paulo Silva
- Asthma Patient Management Program, Montenegro, Brazil. Asthma Patient Management Program - RESPIRAÇÃO - Montenegro, Brazil
| | - Alberto Cukier
- University of São Paulo, School of Medicine, Hospital das Clínicas, São Paulo, Brazil. Department of Pulmonology. Heart Institute, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil
| | - Alexssandra Maia Alves
- Fortaleza Municipal Department of Health, Fortaleza, Brazil. Fortaleza Municipal Department of Health, Fortaleza, Brazil
| | - Aline Silva Lima-Matos
- Bahia State Asthma Control Program, Salvador, Brazil. Programa para Controle da Asma na Bahia - ProAR, Bahia State Asthma Control Program - Salvador, Brazil
| | - Amanda da Rocha Oliveira Cardoso
- Goiânia Municipal Department of Health, Goiânia, Brazil. Programa Catavento (Pinwheel Program), Goiânia Municipal Department of Health, Goiânia, Brazil
| | - Ana Luisa Godoy Fernandes
- Federal University of São Paulo, Paulista School of Medicine, Department of Pulmonology, São Paulo, Brazil. Department of Pulmonology, Federal University of São Paulo Paulista School of Medicine, São Paulo, Brazil
| | - Bruno Piassi de São-José
- Federal University of Minas Gerais, Hospital das Clínicas, Belo Horizonte, Brazil. Pulmonology Outpatient Clinic, Federal University of Minas Gerais Hospital das Clínicas, Belo Horizonte, Brazil
| | - Carlos Antônio Riedi
- Federal University of Paraná, Curitiba, Brazil. Federal University of Paraná, Curitiba, Brazil
| | - Deborah Schor
- Federal University of Pernambuco, Hospital das Clínicas, Recife, Brazil. Allergy Outpatient Clinic, Recife Allergology Center; and Volunteer Preceptor. Asthma Outpatient Clinic, Federal University of Pernambuco Hospital das Clínicas, Recife, Brazil
| | - Décio Medeiros Peixoto
- Federal University of Pernambuco, Mother and Child Department, Recife, Brazil. Mother and Child Department, Federal University of Pernambuco, Recife, Brazil
| | - Diego Djones Brandenburg
- Porto Alegre Hospital de Clínicas, Montenegro, Brazil. Porto Alegre Hospital de Clínicas, Porto Alegre, Brazil and Asthma Patient Management Program - RESPIRAÇÃO - Montenegro, Brazil
| | | | - Faradiba Sarquis Serpa
- School of Medical Sciences, Santa Casa de Misericórdia de Vitória, Vitória, Brazil. Asthma Program, Santa Casa de Misericórdia de Vitória School of Medical Sciences, Vitória, Brazil
| | - Heli Vieira Brandão
- Bahia State University at Feira de Santana, Department of Pediatrics, Feira de Santana, Brazil. Department of Pediatrics, Bahia State University at Feira de Santana; and Coordinator. Feira de Santana Asthma and Allergic Rhinitis Control Program, Feira de Santana, Brazil
| | - João Antonio Bonfadini Lima
- Porto Alegre Municipal Department of Health, Porto Alegre, Brazil. Asthma Program, Porto Alegre Municipal Department of Health, Porto Alegre, Brazil
| | - Jorge Eduardo Pio
- Rio de Janeiro Municipal Department of Health, Rio de Janeiro, Brazil. Rio de Janeiro Municipal Department of Health, Rio de Janeiro, Brazil
| | - Jussara Fiterman
- Pontifical Catholic University of Rio Grande do Sul, School of Medicine, Porto Alegre, Brazil. Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS, Pontifical Catholic University of Rio Grande do Sul - School of Medicine, Porto Alegre, Brazil
| | - Maria de Fátima Anderson
- Brazilian Association of Asthma Patients, Rio de Janeiro, Brazil. Associação Brasileira de Asmáticos - ABRA, Brazilian Association of Asthma Patients - Rio de Janeiro, Brazil
| | - Maria do Socorro de Lucena Cardoso
- Federal University of Amazonas, Manaus, Brazil. Programa de Assistência e Controle da Asma - PACA, Asthma Care and Control Program - and Associate Professor. Universidade Federal do Amazonas - UFAM, Federal University of Amazonas - Manaus, Brazil
| | - Marcelo Tadday Rodrigues
- Santa Casa Sisters of Mercy, Hospital of Porto Alegre, Porto Alegre, Brazil. Universidade de Santa Cruz do Sul - UNISC, University of Santa Cruz do Sul - Santa Cruz do Sul, Brazil; and Pulmonologist. Pereira Filho Ward, Irmandade da Santa Casa de Misericórdia de Porto Alegre - ISCMPA, Santa Casa Sisters of Mercy Hospital of Porto Alegre - Porto Alegre, Brazil
| | - Marilyn Nilda Esther Urrutia Pereira
- Uruguaiana Municipal Department of Health, Uruguaiana, Brazil. Programa Infantil de Prevenção de Asma - PIPA, Children's Asthma Prevention Program - Uruguaiana Municipal Department of Health, Uruguaiana, Brazil
| | - Marti Antila
- Sorocaba Municipal Asthma Program, Sorocaba, Brazil. Sorocaba Municipal Asthma Program, Sorocaba, Brazil. Physician. Programa Respira Rio, Rio de Janeiro, Brazil. Programa Respira Rio (Breathe, Rio Program), Rio de Janeiro, Brazil
| | - Sonia Maria Martins
- Brazilian Society of Family and Community Medicine, Rio de Janeiro, Brazil. Grupo de Trabalho de Problemas Respiratórios - GRESP, Working Group on Respiratory Problems - Sociedade Brasileira de Medicina de Família e Comunidade - SBMFC, Brazilian Society of Family and Community Medicine - Rio de Janeiro, Brazil
| | - Vanessa Gonzaga Tavares Guimarães
- Brasília Mother and Child Hospital, Brasília, Brazil. Programa de Atendimento ao Paciente Asmático do Distrito Federal - PAPA-DF, Asthma Patient Management Program in the Federal District of Brasília - and Supervisor. Residency Program in Pediatric Allergy and Immunology, Brasília Mother and Child Hospital, Brasília, Brazil
| | - Yara Arruda Marques Mello
- Associação Brasileira de Asmáticos, São Paulo, Brazil. Department of Allergy and Immunology, Edmundo Vasconcelos Hospital Complex; and Director. Associação Brasileira de Asmáticos-São Paulo - ABRA, Brazilian Association of Asthma Patients-SP - São Paulo, Brazil
| | - Wenderson Clay Correia de Andrade
- Itabira Municipal Department of Health, Itabira, Brazil. Projeto Respirai (Breathe Project), Itabira Municipal Department of Health, Itabira, Brazil
| | - William Salibe-Filho
- São Camilo University Center, School of Medicine, São Paulo, Brazil. Department of Pulmonology, ABC School of Medicine, Santo André, Brazil; and Professor. São Camilo University Center School of Medicine, São Paulo, Brazil
| | - Zelina Maria da Rocha Caldeira
- Associação Brasileira de Asmáticos, São Paulo, Brazil. Niterói Municipal Health Foundation, Niterói, Brazil. Pediatrician and Director of Government Policy and International Relations. Associação Brasileira de Asmáticos-São Paulo - ABRA, Brazilian Association of Asthma Patients-SP - São Paulo, Brazil
| | - Álvaro Augusto Souza da Cruz-Filho
- Federal University of Bahia, School of Medicine, Salvador, Brazil. Federal University of Bahia School of Medicine; and Coordinator. Center of Excellence in Asthma, Salvador, Brazil
| | - Paulo Camargos
- Federal University of Minas Gerais, Department of Pediatrics, Belo Horizonte, Brazil. Department of Pediatrics, Federal University of Minas Gerais, Belo Horizonte, Brazil
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