Three-year outcomes related to coronary stenting; a registry-based real-life population study.

Objectives. Developments in medication and coronary interventions have improved coronary artery disease (CAD) treatment. We studied long-term outcomes in an observational, real-life population of CAD patients undergoing percutaneous coronary intervention (PCI) depending on the presentation and the stent type used. Design and results. Register included 789 consecutive patients undergoing PCI. Follow up period was three years with primary composite outcome (MACE) of all cause -mortality, myocardial infarction and target lesion revascularization. Mean age was 65 ± 11 and 69% were male. New-generation drug-eluting stents (DES-2) were associated with lower adjusted rates of MACE (HR 0.47; 95% CI 0.29-0.77) but not mortality (HR 0.50; 95% CI 0.22-1.14) in comparison to bare-metal stents. Patients with STEMI (14.4%) or NSTEMI (13.7%) had higher crude mortality rates than those with unstable (4.5%) or stable CAD (3.1%; p < .001). The association diminished after adjustments in NSTEMI (HR 2.01; 95% CI 0.88-4.58). Among smokers 45% quitted and 36% achieved recommended cholesterol levels. Conclusions. The overall prognosis was good. Irrespective of comorbidities, NSTEMI was not associated with worse outcome than stable CAD. DES-2 was associated with lower rates of MACE than BMS without affecting mortality rate. Patients succeeded better in smoking cessation than reaching recommended cholesterol levels.

Pain avoidance predicts disability and depressive symptoms three years later in individuals with whiplash complaints.

BACKGROUND: Longstanding symptoms due to whiplash are commonly associated with decreased levels of emotional and physical functioning. To date, there is strong empirical support for the relationship between psychological in/flexibility and pain-related functioning, but the predictive role for future health is largely unknown. Hence, the aim of this study was to investigate if psychological in/flexibility (i.e. avoidance and cognitive fusion) predicted pain disability and depressive symptoms 3 years later in individuals with whiplash complaints. METHODS: Data were collected at baseline and at a 3 year follow-up from 368 members of a national patient organization for people with whiplash-associated disorder. In a series of hierarchical regression analyses, background variables, pain related variables, psychological distress and psychological inflexibility at baseline were evaluated as predictors of levels of pain disability and depressive symptoms at follow-up. RESULTS: Results showed that psychological inflexibility, and more specifically avoidance, was a unique predictor of pain disability and depressive symptoms, also when controlling for background variables, pain related variables and psychological distress. Level of education was also found to predict both pain disability and symptoms of depression. Lastly, pain variability predicted pain disability, and anxiety predicted depressive symptoms. CONCLUSION: Pain avoidance significantly predicted pain disability and depressive symptoms 3 years later. Although tentative, results warrant more studies to further explore the importance of pain avoidance for future health.

Technologies for capturing and analysing animal health data in near real time.

Information technologies are rapidly advancing the way in which animal health data and information are collected, analysed and shared in order to support animal health management, disease surveillance and response, and decision-making. However, the full potential of these technologies for early detection and response to natural or intentional disease events has not been fully realised in animal health at the global level. This paper discusses advances made in these technologies and examples of how they have been applied in animal health for near real-time data collection and analysis. The technologies reviewed include: i) mobile health (mHealth) technologies, wireless sensors and biosensors for remote data collection; ii) crowdsourced and Internet-based data collection; and iii) electronic health (eHealth) technologies for data integration and analysis. Experiences of implementing these technologies, and challenges with their use, are also discussed so as to provide recommendations on their future application in animal health. The world is ripe with opportunities to develop and enhance mHealth and eHealth technologies that are cost effective and capable of near real-time data collection and analysis. Such technologies have been shown to be valuable and capable of being implemented in both developing and developed countries, and ultimately will strengthen disease surveillance and reporting across the globe. International mechanisms and data standards are needed to facilitate the sharing and analysis of animal and human health data between countries. Identifying ways in which animal and human health data collection and analysis can be better integrated within a 'One Health' approach will enhance the coordination and capability of disease detection and response at the human-animal interface.

Les technologies de l'information font rapidement progresser la façon dont les données et l'information sur la santé animale sont recueillies, analysées et partagées afin de soutenir la gestion de la santé animale, les activités de surveillance et de réponse en cas de maladies et les processus de décisions. Toutefois, le potentiel de ces technologies n'a pas encore été entièrement exploité au niveau mondial dans le but d'assurer la détection précoce et d'organiser la réponse du secteur de la santé animale à des événements sanitaires dus à des causes naturelles ou intentionnelles. Les auteurs examinent les avancées accomplies par ces technologies, en particulier les exemples d'applications en santé animale pour la collecte et l'analyse de données en temps quasi réel. L'article aborde les technologies suivantes : i) les technologies mobiles de santé, les capteurs sans fil et biocapteurs pour la collecte de données à distance ; ii) la collecte de données via l'internet ou des initiatives de masse ; et iii) les technologies numériques de santé pour l'intégration et l'analyse des données. Les auteurs examinent également des exemples de mise en place de ces technologies, font état des difficultés rencontrées lors de leur utilisation et formulent quelques recommandations sur les applications futures en santé animale. Le moment est venu de saisir les possibilités de développement et d'amélioration de technologies mobiles et numériques de santé qui soient à la fois rentables et capables d'assurer la collecte et l'analyse des données en temps quasi réel. L'utilité de ces technologies a été démontrée, ainsi que leur aptitude à être appliquées dans les pays développés et en développement, ce qui à terme renforcera la surveillance des maladies et leur notification à l'échelle planétaire. Le monde doit se doter de mécanismes internationaux et de normes sur les données afin de faciliter le partage et l'analyse des données relatives à la santé humaine et animale entre les pays. Les modalités d'intégration de la collecte et l'analyse des données de santé publique et de santé animale dans une approche « Une seule santé ¼ permettront d'améliorer la coordination et les capacités de détection et de lutte à l'interface humains-animaux.

Las tecnologías de la información están haciendo progresar con rapidez los procedimientos con que se obtienen, analizan y ponen en común la información y los datos de sanidad animal que sirven para respaldar las labores de gestión zoosanitaria, vigilancia de enfermedades, respuesta a ellas y adopción de decisiones. Sin embargo, en el ámbito de la sanidad animal aún no se aprovechan plenamente, a escala mundial, todas las posibilidades que ofrecen estas tecnologías para detectar con prontitud episodios infecciosos de origen natural o intencionado y responder rápidamente a ellos. Los autores describen los progresos realizados en estas tecnologías y ofrecen ejemplos de cómo se han aplicado en sanidad animal para reunir y analizar datos en tiempo casi real, deteniéndose especialmente en las siguientes grandes familias: i) tecnologías móviles de salud, biosensores y sensores inalámbricos para la obtención de datos a distancia; ii) obtención de datos por sistemas de participación popular o por Internet; y iii) tecnologías de cibersalud para la integración y el análisis de datos. Los autores también examinan la experiencia adquirida hasta ahora con la aplicación de estas tecnologías y los problemas que plantea su utilización, y a partir de ahí formulan recomendaciones sobre su aplicación futura en la sanidad animal. El mundo rebosa de oportunidades para desarrollar y perfeccionar tecnologías móviles de salud y tecnologías de cibersalud que sean eficaces en relación con el costo y permitan obtener y analizar datos en tiempo casi real. Está demostrado que estas tecnologías son interesantes y pueden implantarse en países tanto desarrollados como en desarrollo, y que a la larga servirán para reforzar la vigilancia y notificación de enfermedades en todo el planeta. Para facilitar el intercambio y el análisis de datos sanitarios y zoosanitarios entre los países hacen falta mecanismos y normas internacionales referidos a estos datos. Abordando la cuestión desde los postulados de «Una sola salud¼ es posible dar con fórmulas para integrar en mayor medida entre sí la obtención y el análisis de los datos de salud humana y de los de sanidad animal, cosa que servirá para mejorar la coordinación y la capacidad de detección y respuesta ante las enfermedades en la interfaz del hombre con los animales.

United Nations Secretary-General's Mechanism.

The credibility and legitimacy of the United Nations Secretary-General's Mechanism (UNSGM) for investigating the alleged use of biological weapons relies in part on qualified experts trained to undertake fact-finding missions using an empirical scientific approach. As observed in the 2013 investigation into the alleged use of chemical weapons in the Syrian Arab Republic, this mechanism can be an effective tool in the verification of and as a deterrent against the use of chemical and biological weapons. The World Organisation for Animal Health (OIE) has a memorandum of understanding with the United Nations Office for Disarmament Affairs, supporting the UNSGM and providing experts for its roster for missions. As the majority of biological agents are of animal origin, the expertise of the OIE in this area, and its involvement in the UNSGM, are of paramount importance. Since 2014, experts from the OIE have participated in relevant training and are available for deployment to investigate any alleged use of a biological weapon anywhere in the world if the UNSGM were triggered.

La crédibilité et la légitimité du Mécanisme du Secrétaire général des Nations Unies visant à enquêter rapidement sur les allégations relatives à l'emploi possible d'armes biologiques reposent en partie sur le travail d'experts qualifiés et formés aux enquêtes d'établissement des faits, qui font appel à une méthode scientifique empirique. Comme cela a été constaté lors de l'enquête de 2013 concernant l'emploi allégué d'armes chimiques en République arabe syrienne, ce mécanisme peut constituer un outil efficace de vérification et de dissuasion en matière d'utilisation d'armes chimiques et biologiques. L'Organisation mondiale de la santé animale (OIE) a conclu un Mémorandum d'accord avec le Bureau des affaires de désarmement des Nations Unies, par lequel l'OIE s'engage à soutenir le Mécanisme du Secrétaire général et à mettre à disposition des experts pour participer aux missions. Les agents biologiques étant majoritairement d'origine animale, les compétences de l'OIE dans ce domaine et sa contribution au Mécanisme du Secrétaire général des Nations Unies sont d'une importance capitale. Depuis 2014, les experts de l'OIE ont participé aux formations requises ; en cas d'activation du mécanisme, ils sont donc opérationnels pour prendre part aux missions d'enquête sur l'emploi allégué d'armes biologiques partout dans le monde.

La credibilidad y legitimidad del Mecanismo del Secretario General de las Naciones Unidas para la Investigación del Presunto Empleo de Armas Químicas, Biológicas o Toxínicas reposa en parte en la participación de expertos cualificados y formados para llevar a cabo misiones de esclarecimiento de los hechos empleando métodos científicos experimentales. Como dejó patente la investigación sobre el presunto uso de armas químicas en la República Árabe Siria realizada en 2013, este mecanismo puede constituir una eficaz herramienta de verificación y un factor disuasorio del uso de armas químicas o biológicas. La Organización Mundial de Sanidad Animal (OIE) tiene suscrito con la Oficina de Asuntos de Desarme de las Naciones Unidas un memorando de entendimiento en virtud del cual presta apoyo al Mecanismo del Secretario General y proporciona expertos que figuran en la lista de especialistas llamados a participar en sus misiones. Toda vez que la mayoría de los agentes biológicos son de origen animal, la competencia técnica de la OIE en este ámbito, así como su participación en el Mecanismo, revisten una importancia capital. Desde 2014, expertos de la OIE han participado en actividades de formación sobre el tema y están disponibles para desplegarse en cualquier lugar del mundo e investigar todo caso de presunta utilización de un arma biológica en cuanto se active el Mecanismo del Secretario General.

A validation of the pain interference index in adults with long-standing pain.

BACKGROUND: Chronic pain is a major health problem and more knowledge is needed regarding the interference of pain on behaviors in different life domains. Clinically useful and statistically sound pain interference measures are highly important. Studies on youths have shown that the Pain Interference Index (PII) is a reliable and valid instrument that is sensitive to change following behavioral treatment. This measure may also have utility for adults, but no study has so far evaluated the statistical properties of the PII for long-standing pain in adults. METHODS: Data were collected from 239 consecutive adults with non-specific chronic pain referred to a tertiary pain clinic. We investigated the factor structure of items using a principal component analysis. Cronbach's alpha was calculated to assess internal consistency. The questionnaire's ability to predict levels of, e.g., disability was analyzed by means of regression analyses. RESULTS: Analyses illustrated the adequacy of a one-factor solution with six items. Cronbach's alpha (0.85) suggested a satisfactory internal consistency among items. The PII explained significant amounts of variance in pain disability, physical, and mental health-related quality of life and depression, suggesting concurrent criteria validity. CONCLUSION: The PII is a brief questionnaire with reliable and valid statistical properties to assess pain interference in adults. Other studies support the reliability and validity of PII for use with youths, and now the PII can be used to analyze the influence of pain on behaviors across age groups. Potentially, the PII can also be used as an outcome measure in clinical trials.

Determinants of survival in sudden cardiac arrest manifesting with pulseless electrical activity.

OBJECTIVE: The proportion of sudden cardiac arrests (SCA) manifesting with pulseless electrical activity (PEA) has increased significantly, and the survival rate remains lower than ventricular fibrillation (VF). However, a subgroup of PEA-SCA cases does survive and may yield key predictors of improved outcomes when compared to non-survivors. We aimed to identify key predictors of survival from PEA-SCA. METHODS: Our study sample is drawn from two ongoing community-based, prospective studies of out-of-hospital SCA: Oregon SUDS from the Portland, OR metro area (Pop. approx. 1 million; 2002-2017) and Ventura PRESTO from Ventura County, CA (Pop. approx. 850,000, 2015-2021). For the present sub-study, we included SCA cases with PEA as the presenting rhythm where emergency medical services (EMS) personnel attempted resuscitation. RESULTS: We identified 1,704 PEA-SCA cases, of which 173 (10.2%) were survivors and 1,531 (89.8%) non-survivors. Patients whose PEA-SCA occurred in a healthcare unit (16.9%) or public location (18.1%) had higher survival than those whose PEA-SCA occurred at home (9.3%) or in a care facility (5.7%). Young age, witness status, PEA-SCA location and pre-existing COPD/asthma were independent predictors of survival. Among witnessed cases the survival rate was 10% even if EMS response time was >10 minutes. CONCLUSIONS: Key determinants for survival from PEA-SCA were young age, witnessed status, public location and pre-existing COPD/asthma. Survival outcomes in witnessed PEA cases were better than expected, even with delayed EMS response.

Characteristics of women with ischemic sudden cardiac death.

BACKGROUND: Sudden cardiac death (SCD) is a significant mode of death causing 15-20% of all deaths in high-income countries. Coronary artery disease (CAD) is the most common cause of SCD in both sexes, and SCD is often the first manifestation of underlying CAD in women. This case-control study aimed to determine the factors associated with SCD due to CAD in women. METHODS: The study group consisted of women with CAD-related SCD (N = 888) derived from the Fingesture study conducted in Northern Finland from 1998 to 2017. All SCDs underwent medicolegal autopsy. The control group consisted of women with angiographically verified CAD without SCD occurring during the 5-year-follow-up (N = 610). To compare these groups, we used medical records, autopsy findings, echocardiograms, and electrocardiograms (ECGs). RESULTS: Subjects with SCD were older (73.2 ± 11.3 vs. 68.8 ± 8.0, p < 0.001) and were more likely to be smokers or ex-smokers (37.1% vs. 27.6%, p = 0.045) compared to control patients. The proportion of subjects with prior myocardial infarction (MI) was higher in controls (46.9% vs. 41.4% in SCD subjects, p = 0.037), but in contrast, SCD subjects were more likely to have underlying silent MI (25.6% vs. 2.4% in CAD controls, p < 0.001). Left ventricular hypertrophy (LVH) was more common finding in SCD subjects (70.9% vs. 55.1% in controls, p < 0.001). Various electrocardiographic abnormalities were more common in subjects with SCD, including higher heart rate, atrial fibrillation, prolonged QTc interval, wide or fragmented QRS complex and early repolarization. The prevalence of Q waves and T inversions did not differ between the groups. CONCLUSIONS: Underlying LVH and previous MI with myocardial scarring are common and often undiagnosed in women with CAD-related SCD. These results suggest that untreated CAD with concomitant myocardial disease is an important factor in SCD in women.

Underlying LVH and previous MI with myocardial scarring are common and often undiagnosed in women with ischemic SCD.Untreated CAD with concomitant myocardial disease is an important factor in SCD among women.Improvements in the diagnosis and management of ischemic cardiomyopathy are likely to reduce the SCD burden in women.

ReCOV: recovery and rehabilitation during and after COVID-19 - a study protocol of a longitudinal observational study on patients, next of kin and health care staff.

BACKGROUND: The knowledge of the long-term consequences of covid-19 is limited. In patients, symptoms such as fatigue, decreased physical, psychological, and cognitive function, and nutritional problems have been reported. How the disease has affected next of kin, as well as staff involved in the care of patients with covid-19, is also largely unknown. The overall aim of this study is therefore three-fold: (1) to describe and evaluate predictors of patient recovery, the type of rehabilitation received and patients' experiences of specialized rehabilitation following COVID-19 infection; (2) to study how next of kin experienced the hospital care of their relative and their experiences of the psychosocial support they received as well as their psychological wellbeing; (3) to describe experiences of caring for patients with COVID-19 and evaluate psychological wellbeing, coping mechanisms and predictors for development of psychological distress over time in health care staff. METHODS: This observational longitudinal study consists of three cohorts; patients, next of kin, and health care staff. The assessments for the patients consist of physical tests (lung function, muscle strength, physical capacity) and questionnaires (communication and swallowing, nutritional status, hearing, activities of daily living, physical activity, fatigue, cognition) longitudinally at 3, 6 and 12 months. Patient records auditing (care, rehabilitation) will be done retrospectively at 12 months. Patients (3, 6 and 12 months), next of kin (6 months) and health care staff (baseline, 3, 6, 9 and 12 months) will receive questionnaires regarding, health-related quality of life, depression, anxiety, sleeping disorders, and post-traumatic stress. Staff will also answer questionnaires about burnout and coping strategies. Interviews will be conducted in all three cohorts. DISCUSSION: This study will be able to answer different research questions from a quantitative and qualitative perspective, by describing and evaluating long-term consequences and their associations with recovery, as well as exploring patients', next of kins' and staffs' views and experiences of the disease and its consequences. This will form a base for a deeper and better understanding of the consequences of the disease from different perspectives as well as helping the society to better prepare for a future pandemic.

Advanced fiber tracking in early acquired brain injury causing cerebral palsy.

BACKGROUND AND PURPOSE: Diffusion-weighted MR imaging and fiber tractography can be used to investigate alterations in white matter tracts in patients with early acquired brain lesions and cerebral palsy. Most existing studies have used diffusion tensor tractography, which is limited in areas of complex fiber structures or pathologic processes. We explored a combined normalization and probabilistic fiber-tracking method for more realistic fiber tractography in this patient group. MATERIALS AND METHODS: This cross-sectional study included 17 children with unilateral cerebral palsy and 24 typically developing controls. DWI data were collected at 1.5T (45 directions, b=1000 s/mm(2)). Regions of interest were defined on a study-specific fractional anisotropy template and mapped onto subjects for fiber tracking. Probabilistic fiber tracking of the corticospinal tract and thalamic projections to the somatosensory cortex was performed by using constrained spherical deconvolution. Tracts were qualitatively assessed, and DTI parameters were extracted close to and distant from lesions and compared between groups. RESULTS: The corticospinal tract and thalamic projections to the somatosensory cortex were realistically reconstructed in both groups. Structural changes to tracts were seen in the cerebral palsy group and included splits, dislocations, compaction of the tracts, or failure to delineate the tract and were associated with underlying pathology seen on conventional MR imaging. Comparisons of DTI parameters indicated primary and secondary neurodegeneration along the corticospinal tract. Corticospinal tract and thalamic projections to the somatosensory cortex showed dissimilarities in both structural changes and DTI parameters. CONCLUSIONS: Our proposed method offers a sensitive means to explore alterations in WM tracts to further understand pathophysiologic changes following early acquired brain injury.

Coping behavior of the rape victim.

The coping behavior of rape victims can be analyzed in three distinct phases--the threat of attack, the attack itself, and the period immediately thereafter. The authors analyzed the reported coping behavior of 92 women diagnosed as having rape trauma. Most of the women used verbal, physical, or cognitive strategies when threatened, although 34 were physically or psychologically paralyzed. The actual rape prompted coping behaviors in all but 1 victim. Escaping the situation or the assailant is the primary task immediately after the attack. In counseling the rape victim, it is important to understand her individual style of coping, to be supportive of it, and to suggest alternatives for future stressful situations.

Adaptive strategies and recovery from rape.

The authors conducted a follow-up study of 81 rape victims to analyze the effect of adaptive or maladaptive response to rape on recovery over a 4-6 year period. They found that victims recovering fastest used more adaptive strategies, including positive self-assessment; defense mechanisms of explanation, minimization, suppression, and dramatization; and increased action. Victims who had not yet recovered had more maladaptive mechanisms, such as negative self-assessments, inaction, substance abuse, and action on suicidal thoughts.

Rape: power, anger, and sexuality.

Accounts from both offenders and victims of what occurs during a rape suggest that issues of power, anger, and sexuality are important in understanding the rapist's behavior. All three issues seem to operate in every rape, but the proportion varies and one issue seems to dominate in each instance. The authors ranked accounts from 133 offenders and 92 victims for the dominant issue and found that the offenses could be categorized as power rape (sexuality used primarily to express power) or anger rape (use of sexuality to express anger). There were no rapes in which sex was the dominant issue; sexuality was always in the service of other, nonsexual needs.

Using additive noise in back-propagation training.

The possibility of improving the generalization capability of a neural network by introducing additive noise to the training samples is discussed. The network considered is a feedforward layered neural network trained with the back-propagation algorithm. Back-propagation training is viewed as nonlinear least-squares regression and the additive noise is interpreted as generating a kernel estimate of the probability density that describes the training vector distribution. Two specific application types are considered: pattern classifier networks and estimation of a nonstochastic mapping from data corrupted by measurement errors. It is not proved that the introduction of additive noise to the training vectors always improves network generalization. However, the analysis suggests mathematically justified rules for choosing the characteristics of noise if additive noise is used in training. Results of mathematical statistics are used to establish various asymptotic consistency results for the proposed method. Numerical simulations support the applicability of the training method.

Neural and statistical classifiers-taxonomy and two case studies.

Pattern classification using neural networks and statistical methods is discussed. We give a tutorial overview in which popular classifiers are grouped into distinct categories according to their underlying mathematical principles; also, we assess what makes a classifier neural. The overview is complemented by two case studies using handwritten digit and phoneme data that test the performance of a number of most typical neural-network and statistical classifiers. Four methods of our own are included: reduced kernel discriminant analysis, the learning k-nearest neighbors classifier, the averaged learning subspace method, and a version of kernel discriminant analysis.

Insomnia in paediatric chronic pain and its impact on depression and functional disability.

BACKGROUND: Children and adolescents attending health care due to chronic pain commonly presents with insomnia. Previous research suggests that problems with sleep are associated with depression and functional disability. However, more research is needed to clarify the relationship between pain, insomnia and disability. OBJECTIVE: This study aims to investigate the frequency, severity and importance of insomnia in paediatric patients with chronic pain and to evaluate the mediating role of insomnia in explaining the relationship between pain and depression as well as between pain and functioning. In addition, to ascertain the adequacy of using a Swedish translation of the Insomnia Severity Index (ISI) with youths, analyses included a statistical evaluation of the instrument. METHOD: Correlational analyses of cross-sectional data from 154 consecutive paediatric patients with chronic pain referred to a tertiary pain clinic. RESULTS: Insomnia explained a significant amount of variance in depression and functional disability when controlling for demographic characteristics and pain. Indirect effects of insomnia were found for both the relationship between pain and depression, and between pain and functional disability. ISI showed satisfactory psychometric properties in this sample, including internal consistency and concurrent criteria validity. CONCLUSIONS: Insomnia is highly important in explaining depression and functional disability in paediatric chronic pain and can be adequately assessed using the ISI.