Peritoneal dialysis in Dalmatian County, Croatia: 21 years of a single-center experience.

INTRODUCTION: With end-stage renal disease becoming more prevalent, the importance of continuous ambulatory peritoneal dialysis (CAPD) is expected to rise even more. However, CAPD is associated with several infections with peritonitis being of the biggest importance. METHODS: We collected data regarding acute peritonitis episodes (APEs), date of birth and CAPD start, BMI, diabetes mellitus (DM) prevalence, year of renal disease discovery, and details about renal replacement therapies. Primary outcomes included death, transplantation, and a switch to hemodialysis (HD). RESULTS: Hundred and twenty-nine men and 123 women were analyzed. 63 patients had DM. The median age at the start of CAPD was 56. The median length of CAPD treatment was 24 months. In the end, 147 patients were still alive of which 97 were transplanted, 33 were on CAPD, and 26 were switched to HD. A total of 327 APE were observed. CONCLUSION: Although the incidence is decreasing, efforts are required to enhance the prevention and treatment of APE.

Assessing the quality and completeness of reporting in health systems guidance for pandemics using the AGREE-HS tool.

Background: During health emergencies, leading healthcare organisations, such as the World Health Organization (WHO), the European Centre for Disease Control and Prevention (ECDC), and the United States Centers for Disease Control and Prevention (CDC), provide guidance for public health response. Previous studies have evaluated clinical practice guidelines (CPGs) produced in response to epidemics or pandemics, yet few have focused on public health guidelines and recommendations. To address this gap, we assessed health systems guidance (HSG) produced by the WHO, the ECDC, and the CDC for the 2009 H1N1 and COVID-19 pandemics. Methods: We extracted HSG for the H1N1 and COVID-19 pandemics from the organisations' dedicated repositories and websites. After screening the retrieved documents for eligibility, five assessors evaluated them using the Appraisal of Guidelines Research & Evaluation - Health Systems (AGREE-HS) tool to assess the completeness and transparency of reporting according to the five AGREE-HS domains: "Topic", "Participants", "Methods", "Recommendations", and "Implementability". Results: Following the screening process, we included 108 HSG in the analysis. We observed statistically significant differences between the H1N1 and COVID-19 pandemics, with HSG issued during COVID-19 receiving higher AGREE-HS scores. The HSG produced by the CDC had significantly lower overall scores and single-domain scores compared to the WHO and ECDC. However, all HSG scored relatively low, under the median of 40 total points (range = 10-70), indicating incomplete reporting. The HSG produced by all three organisations received a median score <4 (range = 1-7) for the "Participants", "Methods", and "Implementability" domains. Conclusions: There is still significant progress to be made in the quality and completeness of reporting in HSG issued during pandemics, especially regarding methodological approaches and the composition of the guidance development team. Due to their significant impact and importance for healthcare systems globally, HSG issued during future healthcare crises should adhere to best reporting practices to increase uptake by stakeholders and ensure public trust in healthcare organisations.

Sleep quality and patterns of young West Balkan adults during the third wave of COVID-19 pandemic: a cross-sectional study.

OBJECTIVES: To evaluate the sleep patterns among young West Balkan adults during the third wave of the COVID-19 pandemic. DESIGN AND SETTING: Cross-sectional study conducted using an anonymous online questionnaire based on established sleep questionnaires Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI) (February-August 2021). PARTICIPANTS: Young adults of Bosnia and Herzegovina, Croatia and Serbia. RESULTS: Of 1058 subjects, mean age was 28.19±9.29 years; majority were women (81.4%) and students (61.9%). Compared with before the pandemic, 528 subjects (49.9%) reported a change in sleeping patterns during the pandemic, with 47.3% subjects reporting sleeping less. Mean sleeping duration during the COVID-19 pandemic was 7.71±2.14 hours with median sleep latency of 20 (10.0-30.0) min. Only 91 (8.6%) subjects reported consuming sleeping medications. Of all, 574 (54.2%) subjects had ISI score >7, with majority (71.2%) having subthreshold insomnia, and 618 (58.4%) PSQI score ≥5, thus indicating poor sleep quality. Of 656 (62.0%) tested subjects, 464 (43.9%) were COVID-19 positive (both symptomatic and asymptomatic) who were 48.8%, next to women (70%), more likely to have insomnia symptoms; and 66.9% were more likely to have poor sleep quality. Subjects using sleep medication were 44 times, and subjects being positive to ISI 15.36 times more likely to have poor sleep quality. In contrast, being a student was a negative independent predictor for both insomnia symptoms and poor sleep quality, and mental labour and not working were negative independent predictors for insomnia symptoms. CONCLUSIONS: During the third wave of the pandemic, sleep patterns were impaired in about half of young West Balkan adults, with COVID-19-positive subjects and being women as positive independent predictors and being a student as negative independent predictor of impaired sleep pattern. Due to its importance in long-term health outcomes, sleep quality in young adults, especially COVID-19-positive ones, should be thoroughly assessed.

Health impacts of air pollution exposure from 1990 to 2019 in 43 European countries.

Air pollution is the fourth greatest overall risk factor for human health. Despite declining levels in Europe, air pollution still represents a major health and economic burden. We collected data from the Global Burden of Disease Study 2019 regarding overall, as well as ischemic heart disease (IHD), stroke, and tracheal, bronchus and lung cancer-specific disability adjusted life years (DALYs), years of life lost (YLL) and mortality attributable to air pollution for 43 European countries between 1990 and 2019. Concentrations of ambient particulate matter (aPM2.5), ozone, and household air pollution from solid fuels were obtained from State of Global Air 2020. We analysed changes in air pollution parameters, as well as DALYs, YLL, and mortality related to air pollution, also taking into account gross national income (GNI) and socio-demographic index (SDI). Using a novel calculation, aPM2.5 ratio (PMR) change and DALY rate ratio (DARR) change were used to assess each country's ability to decrease its aPM2.5 pollution and DALYs to at least the extent of the European median decrease within the analysed period. Finally, we created a multiple regression model for reliably predicting YLL using aPM2.5 and household air pollution. The average annual population-weighted aPM2.5 exposure in Europe in 1990 was 20.8 µg/m3 (95% confidence interval (CI) 18.3-23.2), while in 2019 it was 33.7% lower at 13.8 µg/m3 (95% CI 12.0-15.6). There were in total 368 006 estimated deaths in Europe in 2019 attributable to air pollution, a 42.4% decrease compared to 639 052 in 1990. The majority (90.4%) of all deaths were associated with aPM2.5. IHD was the primary cause of death making up 44.6% of all deaths attributable to air pollution. The age-standardised DALY rate and YLL rate attributable to air pollution were more than 60% lower in 2019 compared to 1990. There was a strong positive correlation (r = 0.911) between YLL rate and aPM2.5 pollution in 2019 in Europe. Our multiple regression model predicts that for 10% increase in aPM2.5, YLL increases by 16.7%. Furthermore, 26 of 43 European countries had a positive DARR change. 31 of 43 European countries had a negative PMR change, thus not keeping up with the European median aPM2.5 concentration decrease. When categorising countries by SDI and GNI, countries in the higher brackets had significantly lower aPM2.5 concentration and DALY rate for IHD and stroke. Overall, air pollution levels, air pollution-related morbidity and mortality have decreased considerably in Europe in the last three decades. However, with the growing European population, air pollution remains an important public health and economic issue. Policies targeting air pollution reduction should continue to be strongly enforced to further reduce one of the greatest risk factors for human health.