Fidest – Agenzia giornalistica/press agency

Quotidiano di informazione – Anno 31 n° 259

Posts Tagged ‘mortality’

Heart failure mortality is inversely related to wealth of country

Posted by fidest press agency su martedì, 2 maggio 2017

Paris, France. Death in patients with heart failure is inversely related to the wealth of the country they live in, according to late breaking results from the INTERCHF study presented today at Heart Failure 2017 and the 4th World Congress on Acute Heart Failure.1 Death rates in India and Africa were three to four times higher than those documented in Western countries. “Heart failure is a common condition that causes morbidity and mortality worldwide,” said lead author Dr Hisham Dokainish, a principal investigator at the Population Health Research Institute (PHRI), McMaster University, Hamilton, Canada.“Most data on heart failure have come from Western countries but the majority of the world’s population lives elsewhere,” he continued. “This study was conducted to fill large gaps in knowledge about congestive heart failure in non-Western countries.”
The International Congestive Heart Failure (INTERCHF) study was an observational cohort study that enrolled 5 823 patients with heart failure in 16 countries grouped into six regions: Africa (Mozambique, Nigeria, South Africa, Sudan, Uganda), China, India, the Middle East (Egypt, Qatar, Saudi Arabia), Southeast Asia (Malaysia, the Philippines), and South America (Argentina, Chile, Colombia, and Ecuador).Data on each patient was collected at baseline, six months and one year and entered into the electronic data management system at PHRI. Baseline data included demographics (age, sex), cardiac and non-cardiac factors (previous heart attack or stroke, duration of congestive heart failure, diabetes mellitus, renal failure, chronic obstructive pulmonary disease), medications, socioeconomic factors (education level, literacy, employment, urban/rural setting), and heart failure aetiology.At six months and one year data was collected on the frequency and cause of any hospitalisations in the previous six months. Information was also recorded on death and cause of death. The investigators calculated death rates in each region and adjusted for 20 variables which included demographic, clinical, and socioeconomic factors, medications, and cause of heart failure.The overall all-cause mortality rate for the entire study population was 17%. It was highest in Africa (34%) and India (23%), intermediate in Southeast Asia (15%), and lowest in the Middle East (9%), South America (9%) and China (7%).Dr Dokainish said: “Mortality in patients with heart failure was inversely related to the wealth of the country. The poorer the country, the higher the mortality, and the richer the country, the lower the mortality.” “In Western countries the one-year mortality rate for patients with heart failure is 5–10%,” added Dr Dokainish. “We’re finding two to three times that death rate in African and Indian patients.” “We were very surprised by the much higher mortality rates,” he continued. “You could say maybe the patients in Africa or India were sicker, or didn’t take their medicines, or had poorer heart function, but we adjusted for all of those things and don’t really understand why their death rates were so much higher.”The researchers hypothesised that variables not measured in the study contributed to the high death rates, such as access to and quality of healthcare, and cardiac biomarkers. These variables will be measured in the next phase of the research programme, the Global Congestive Heart Failure (G-CHF) study, which aims to recruit 25 000 heart failure patients from all inhabited continents and income levels. Genetic analyses will also be conducted in a G-CHF substudy.
Dr Dokainish said: “INTERCHF has shown that there are large differences in the risk of heart failure patients dying at one year depending on where they live. We hope to discover why these differences exist through the G-CHF study. If that identifies barriers to receiving care that are due to the way a healthcare system is structured, access to healthcare, or quality of healthcare, then that would need to be addressed.” Authors: ESC Press Office.

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Delirium is associated with 5-fold increased mortality in acute cardiac patients

Posted by fidest press agency su sabato, 18 marzo 2017

Sophia Antipolis. Delirium is associated with a five-fold increase in mortality in acute cardiac patients, according to research pSophia Antipolisublished today in European Heart Journal: Acute Cardiovascular Care.1 Delirium was common and affected over half of acute cardiac patients aged 85 years and older.Delirium is a clinical syndrome caused by a disturbance in the normal functioning of the brain. Delirious patients are less aware of, and responsive to, their environment. They can be disorientated, incoherent, and in a dream-like state, with hallucinations, disordered speech and memory disturbances.Delirium affects at least one in ten hospitalised patients and is more common in the elderly. These patients have worse long-term prognosis and more complications during their hospital stay.“Among hospitalised patients, those admitted to an intensive care unit are more likely to develop delirium and there are strategies to limit its consequences,” said lead author Dr Giovanni Falsini, interventional cardiologist, San Donato Hospital, Arezzo, Italy. “Less is known about delirium and its significance in patients admitted to cardiac intensive care units. This study investigated the incidence and clinical impact of delirium in patients with acute cardiac diseases.”The study included all patients aged 65 years and older admitted to two cardiac intensive care units during a period of 15 months. Only non-intubated patients were enrolled. Validated score systems and questionnaires were used to detect and diagnose the presence of delirium at admission or during the hospital stay.Delirious patients were closely followed by nursing and medical staff who used a flowchart for delirium treatment. This included treating pain and anxiety, and discontinuing medications known to cause delirium. Patient survival at six months was determined by telephone call.The investigators found that delirium was a frequent condition among elderly patients with acute cardiac diseases. The study population consisted of 726 patients with an average age of 79 years, of whom 15% had delirium (at admission or during the hospital stay). More than half (52%) of patients aged 85 years and older were delirious.Patients with delirium had a worse prognosis, with a five-fold increase in both in-hospital and 30-day mortality and a two-fold increase in six-month mortality. Delirium was not only a strong and independent factor in predicting mortality, but was also associated with longer hospital stay and more frequent rehospitalisations during follow-up.“Delirium is a common and serious condition in acute cardiac patients,” said Dr Falsini. “They stay in hospital longer, return to hospital more often, and are more likely to die in the short- and long-term.”Dr Falsini said elderly patients may be at higher risk because they usually have pre-existing issues that can predispose to delirium such as dementia, visual and hearing impairments, depression, use of psychoactive drugs, infections, or electrolyte disturbances.He said: “The more complex and frail the patient is, the higher the rate of delirium and subsequent worse outcomes. It is unknown whether delirium can be treated to improve prognosis in critically ill patients, or whether it is a marker of organ dysfunction or systemic disease and an early sign that complications are likely. Monitoring delirium has been linked with reduced in-hospital mortality in mechanically ventilated patients and it is possible that similar benefit might occur in acute non-intubated patients.” Dr Falsini concluded: “Delirium is common, serious, costly and under-recognised. A protocol is needed to identify and treat delirium in high-risk settings, like cardiac intensive care units.”

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Il diabete tra di noi

Posted by fidest press agency su venerdì, 10 febbraio 2017

diabete_21-300x224Con gli oltre 4 milioni di cittadini italiani affetti da diabete è possibile affermare che praticamente il diabete è presente in ogni famiglia: se non è un genitore o un figlio, si tratta di un fratello, un nonno, uno zio, un nipote.I dati trovano conferma da più parti. È stata recentemente pubblicata la mappa mondiale delle malattie che maggiormente sono causa di morte, il Mortality and Causes of Death Collaborators 20151: il rapporto è il più grande sforzo per identificare e quantificare la letalità delle malattie a livello mondiale con l’inclusione, per la prima volta, anche di paesi a demografia complessa, come Brasile, India, Sudafrica, Giappone, Kenya, Arabia Saudita, Svezia e Stati Uniti, che si aggiungono a quelli già disponibili in precedenza. I dati relativi al diabete sono particolarmente drammatici: la mortalità totale per diabete risulta aumentata dal 2005 al 2015 del 32.1%, 1.5 milioni di morti in più. I dati quanto anticipato dalla settima edizione del Diabetes Atlas2, a cura della International Diabetes Federation. Ma le conferme arrivano anche in ambito farmaceutico, il British Medical Journal3 segnala l’aumento delle prescrizioni per farmaci anti-diabetici del 33% in 5 anni, dai 26 milioni del 2011 si è passati ai 35 milioni del 2015 e il numero continua a crescere. Questo incremento nella prescrizione dei farmaci, se da un lato sta a significare maggiore attenzione alla diagnosi e al precoce trattamento, dall’altro indica che, con i ritmi di crescita attuali, si prevedono in Italia 5 milioni di persone affette da diabete tipo 2 entro il 2020. Se ne fa il punto in occasione del 2nd AME Diabetes Update 2017, che riunirà nei prossimi giorni a Bologna numerosi esperti nazionali e la cui segreteria scientifica è stata curata da Giorgio Borretta, Olga Eugenia Disoteo, Edoardo Guastamacchia e Silvio Settembrini.Lo studio EMPA-REG OUTCOME4, pubblicato sul New England Journal of Medicine, ha valutato l’empagliflozin, farmaco per la terapia del diabete di tipo 2, che ha mostrato una riduzione del 38% del rischio di morte per cause cardiovascolari e del 32% del rischio di morte per tutte le cause.
Mentre lo studio LEADER5 condotto su persone con diabete di tipo 2 ad alto rischio di eventi cardiovascolari maggiori, pubblicato sulla medesima rivista, ha dimostrato che l’analogo del GLP-1 liraglutide, somministrato in aggiunta alla terapia standard, non si limita ad agire sulla riduzione della glicemia e sulla perdita di peso, ma riduce del 22% il rischio di morte per cause cardiovascolari e del 12% il rischio di infarto miocardico e ictus non fatali”, conclude Borretta.
Il diabete è tra noi, e comporta costi che ricadono soprattutto sul paziente e sulla sua famiglia, con giorni di assenza dal lavoro, necessità di esami in ospedale, ricoveri e accessi in PS ma anche rinunce a tradizionali momenti di convivialità per curare, rallentare o prevenire la patologia. Comporta modifica di abitudini alimentari per non creare troppe difformità a tavola fra chi ha e chi non ha il diabete o, più saggiamente, per seguire tutti uno stile di vita più sano che riduca il rischio che altri della famiglia sviluppino la malattia.Ed è questo il punto: la prevenzione per mantenere le persone sane e per riportare le persone che non presentano un diabete conclamato, ma sono a rischio, a contrastare ed allontanare la malattia. Per chi ha già una diagnosi, è fondamentale instaurare terapie adeguate per ritardare o addirittura impedire l’insorgenza delle cronicità, causa di riduzione della qualità della vita, ma anche incremento esponenziale dei costi diretti e indiretti del diabete.

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Maternal mortality and complications

Posted by fidest press agency su mercoledì, 10 ottobre 2012

“Preventable deaths occur in considerable numbers during pregnancy and childbirth in the developing world where maternal mortality ranges from 200 to 2,000 per 100,000 live births. Moreover, for each woman who dies, an estimated 16 to 30 survive avoidable complications, often miserably,” said Professor Gamal Serour, President of the International Federation of Gynecology and Obstetrics (FIGO), presenting the most recent FIGO Initiatives for the prevention and treatment of post-partum haemorrhage and obstetric fistula in low-resource countries at the FIGO2012 World Congress in Rome, Italy (7-12 October 2012).Post-partum haemorrhage (PPH) is the first cause of maternal mortality in low-resource countries, accounting for approximately 30% of maternal deaths, and is one of the most preventable. For PPH prevention and treatment uterotonic therapy is key and the most widely recommended agent is oxytocin. But oxytocin requires parenteral administration, as well as sterile equipment, and refrigeration, all factors hindering its use in low-resource settings. When injectable uterotonics are neither available nor feasible, misoprostol, a synthetic E1 prostaglandin analogue, has increasingly been adopted as an alternative strategy for PPH care – one endorsed by FIGO and other international bodies. Misoprostol is available in tablet form, stable at room temperature, well absorbed orally and sublingually, and requires few skills to administer. “Our PPH Initiative, funded by a grant to Gynuity Health Projects from the Bill & Melinda Gates Foundation, advocates for and disseminates evidence-based information on misoprostol for PPH, aimed at healthcare providers and clinical policymakers. It is part of a global project for translating scientific and operational research into effective policies, programmes and practice,” Professor Hamid Rushwan, FIGO Chief Executive, explained. “Another major concern for women who give birth in low-resource countries is obstetric fistula, perhaps the most tragic of preventable childbirth complications, as affected women in nearly all cases lose their babies, suffer from health problems, including chronic incontinence, and are often abandoned by their husbands, forced to live in shame and social segregation,” he continued.Obstetric fistula is a hole in the birth canal usually caused by prolonged obstructed labour. It is preventable and largely avoidable by delaying the age of first pregnancy, stopping harmful traditional practices, and granting timely access to obstetric care. According to the World Health Organization, each year between 50,000 to 100,000 women develop obstetric fistula. More than 2,000,000 women live with untreated obstetric fistula in sub-Saharan Africa and Asia, where too few physicians are equipped with the skills needed to repair fistulae and care for patients following surgery.

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G8: Donne in prima linea per salvare vite umane

Posted by fidest press agency su mercoledì, 8 luglio 2009

Roma 10 luglio presso la sede del WFP via Cesare Giulio Viola 68/70, Parco de’ Medici Le consorti, che accompagneranno i delegati al Summit G8, parteciperanno a un incontro dal titolo: “Donne in prima linea per salvare vite umane”. L’evento vuole sottolineare l’importanza del ruolo delle donne nella lotta contro la fame nel mondo e promuovere la salute materna e infantile. L’incontro è organizzato in collaborazione con il White Ribbon Alliance for Safe Motherhood. Sarah Brown, moglie del primo ministro britannico, Gordon Brown, è partner globale del White Ribbon Alliance for Safe Motherhood eco-presidente del Leadership Group on Maternal Mortality.

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Protection against a virus

Posted by fidest press agency su sabato, 6 giugno 2009

The World Health Organization has recommended that rotavirus vaccination be included in all national immunization programmes in order to provide protection against a virus that is responsible for more than 500,000 diarrheal deaths and two million hospitalizations annually among children. More than 85 percent of these deaths occur in developing countries in Africa and Asia. This new policy will help ensure access to rotavirus vaccines in the world’s poorest countries. The new recommendation by the WHO’s Strategic Advisory Group of Experts (SAGE), extends an earlier recommendation made in 2005 on vaccination in the Americas and Europe, where clinical trials had demonstrated safety and efficacy in low and intermediate mortality populations. New data from clinical trials which evaluated vaccine efficacy in countries with high child mortality has led to the recommendation for global use of the vaccine. This is reported in the Weekly Epidemiological  The GAVI Alliance, vaccine manufacturers, and the public health community made an unprecedented commitment to understand how these vaccines would work in developing-world conditions. The clinical trial, funded in part by GAVI and conducted by PATH, WHO, GlaxoSmithKline (GSK), and research institutions in high-mortality, low-socioeconomic settings of South Africa and Malawi, found that the vaccine significantly reduced severe diarrhea episodes due to rotavirus. In 2006, the GAVI Alliance added rotavirus vaccines to its portfolio of vaccines for which it provides financial support to developing countries, underscoring GAVI’s commitment to reduce the traditional 15 to 20 year lag between the introduction of new vaccines in wealthy countries and their availability in the developing world. Today, WHO’s global recommendation paves the way for low-income countries in Africa and Asia to apply to GAVI for introduction of rotavirus vaccines— just three years after new rotavirus vaccines became available in the US, Europe, and Latin America.  Because oral vaccines can have variable efficacy in different populations, it was important to demonstrate vaccine performance in high-mortality settings. The studies in Africa were conducted among populations with high infant and child mortality, poor sanitary conditions, high diarrheal disease mortality and high maternal HIV prevalence.  The clinical trial investigators from Malawi and South Africa will present and publish their data on the GSK RotarixTM vaccine later this summer. Clinical trial sites in Bangladesh and Vietnam—along with sites in Ghana, Mali, and Kenya—evaluated the performance of Merck’s rotavirus vaccine, RotaTeq®, and data are expected in Fall 2009. While efficacy data from Asian countries are forthcoming, SAGE recommended rotavirus vaccines for all populations, including Asia, since available evidence indicates that efficacy data can be extrapolated to populations with similar mortality patterns regardless of geographic location.  WHO, UNICEF, and other GAVI partners are working together in a new accelerated and integrated approach to combat rotavirus diarrhea and pneumonia, the two biggest vaccine-preventable diseases which together account for more than 35 percent of all child deaths each year, the majority of which are in the developing world.

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