Examining trends in cardiovascular disease mortality across Europe: how does the introduction of a new European Standard Population affect the description of the relative burden of cardiovascular disease?

BACKGROUND: Some mortality statistics are misleading when comparing between countries due to varying age distributions in their populations. In order to adjust for these differences, age-standardised mortality rates (ASMRs) are often produced. ASMRs allow for comparisons between countries as if both had the same standardised population. We examined whether the updating of the standard population for Europe affected the description of the relative burden between countries in cardiovascular disease (CVD) mortality across the continent. METHODS: Mortality and population data were obtained from the World Health Organization (WHO) mortality database. ASMRs were calculated using the direct method and two European Standard Populations (ESP): 1976 ESP and 2013 ESP. We investigated differences in ASMR76 (calculated using 1976 ESP) and ASMR13 (calculated using 2013 ESP), changes in rankings of countries between the two ASMRs and differences in trends in CVD mortality in each country for the two ASMRs. RESULTS: CVD rates calculated using the 1976 ESP were on average half the size of rates calculated using the 2013 ESP. Spearman's rank coefficient showed that the ranks of countries by ASMRs calculated using the two ESPs were different for both sexes. Joinpoint analyses showed no difference in the direction of trend between ASMR76 and ASMR13 although differences in the magnitude of the change were found in some countries. CONCLUSION: ASMRs are commonly used in studying the epidemiology of a disease. It is crucial that policy makers understand the effect of changes in standard populations on these rates. This includes how populations with different age distributions compare to each other. Similar effects may be seen in other diseases that are also more prevalent in older age groups, such as cancer and dementia.

Safety and Efficacy of a Scar Cream Consisting of Highly Selective Growth Factors Within a Silicone Cream Matrix: A Double-Blinded, Randomized, Multicenter Study.

BACKGROUND: Several growth factors and hyaluronic acid are implicated in fetal scarless healing. Whether these factors can be applied to an adult scar to improve scar characteristics is unknown. OBJECTIVES: This study compared the efficacy and safety of SKN2017B, a proprietary topical cream consisting of selective synthetic recombinant human growth factors and hyaluronic acid in a silicone base containing a specifically formulated silicone cream for postsurgical scar treatment. METHODS: In this prospective, randomized, controlled, double-blinded study, unilateral or bilateral facial or truncal scars in adult surgical patients were randomly treated with SKN2017B or silicone cream. Study investigators, study patients, and 2 independent reviewers assessed improvement in scar characteristics after 4 and 12 weeks of treatment. RESULTS: Forty-nine bilateral and 12 unilateral scars in 45 patients were treated with SKN2017B or silicone. At 12 weeks, investigators rated 74% of scars treated with SKN2017B as showing overall improvement vs 54% of silicone-treated scars, a 73% relative improvement with SKN2017B (P < 0.0001). Patients rated a moderate-to-significant improvement in 85% of SKN2017B-treated scars vs 51% of silicone-treated scars, a 67% relative improvement with SKN2017B (P < 0.001). Independent reviewers rated 87% of scars treated with SKN2017B to be better overall vs 1% of scars treated with silicone (P < 0.0001). There were no tolerability issues or adverse reactions with either cream. CONCLUSIONS: SKN2017B consists of highly selective growth factors within a silicone cream matrix and is well tolerated and effective for surgical scar management.