Traumatic brain injury related deaths in residents and non-residents of 30 European countries: a cross-sectional study.

The incidence and mortality of traumatic brain injuries (TBI) among non-residents to countries where they occur remains unknown, warranting epidemiological research. Epidemiological data are key to inform prevention and public health policies related to TBI, as well as to help promote safe travelling practice. The aim of this study was to analyse the epidemiological patterns of TBI-related deaths among residents and non-residents in 30 European countries in 2015 using standardised European level data on causes of death. A large-scale cross-sectional study analysing TBI-related deaths in 30 European countries in 2015 among residents and non-residents to the country of occurrence of the death was conducted. Data from death certificates collected on European level by Eurostat were used to calculate the numbers of TBI-related deaths and estimate crude and age-standardised mortality rates. Rates were stratified by country, sex, age-group and by resident status. External causes of the injury were determined using the provided ICD-10 codes. 40,087 TBI-related deaths were identified; overall about 3% occurred among non-residents with highest proportions in Turkey (11%), Luxembourg (9%) and Cyprus (5%). Taking into account tourism intensity in the countries, Bulgaria, Greece and Austria showed highest rates of TBI-related deaths in non-residents: 0.7,0.5 and 0.5 per million overnight stays, respectively. The pooled age-standardised TBI-related mortality in non-residents was 0.2 (95% CI 0.1-0.3), among residents 10.4 (95% CI 9.4-11.5) per 100,000. In non-residents, TBI-related deaths were shifted to younger populations (86% in < 35 years); in non-residents 78% were 15-64 years old. Falls were predominant among residents (47%), and traffic accidents among non-residents (36%). Male:female ratio was higher among non-residents (3.9), compared to residents (2.1). Extrapolating our findings, we estimate that annually 1022 TBI-related deaths would occur to non-residents in the EU-27 + UK and 1488 in Europe as a continent. We conclude, that the primary populations at risk of TBI-related deaths in European countries differ in several characteristics between residents and non-residents to the country of the occurrence of death, which warrants for different approaches in prevention and safety promotion. Our findings suggest that TBI occurring in European countries among non-residents present a problem worthy of attention from public health and travel medicine professionals and should be further studied.

International evidence-based guidelines on hypertension and type 2 diabetes mellitus: A systematic review.

This systematic review provides a high-quality, comprehensive summary of recommendations on hypertension (HT) and type 2 diabetes mellitus (T2DM), accentuating patient blood pressure, HbA1c levels, patterns of drug treatment, management, and screening of these diseases. The overall objective of the review is to support adapting existing clinical practice guidelines in Indonesia, Vietnam, and Myanmar. The database PubMed and the web search engines Google and Google Scholar were searched from October to December 2019 for evidence-based guidelines covering the overall disease management in Europe, the United States of America, and low and middle-income countries (Indonesia, Vietnam, and Myanmar-IVM later on). Nine studies were selected for the review, seven concerning HT and five T2DM. Guidelines in IVM and Europe identified HT as increased blood pressure (BP; ≥140/90 mmHg). IVM guidelines also recommended commencing drug treatment if lifestyle interventions were not successful. Four international HT guidelines recommended monitoring BP every few months, and the other three guidelines gave recommendations based on the patient's current BP levels. All five T2DM guidelines recommended target HbA1c levels below 7%-6.5%, but only IVM guidelines included re-examination every 3-6 months. Metformin was recommended as the first choice of medical treatment, if not contraindicated. Amid the guidelines' recommendations, there were no major variations in the Class of recommendation and Level of evidence (except IVM guidelines where COR and LOE were missing). Revision and completion of IVM guidelines by this grading system would enhance evidence-based and informed decisions in clinical care.

International evidence-based guidelines on hypertension and type 2 diabetes mellitus: a systematic review

This systematic review provides a high-quality, comprehensive summary of recommendations on hypertension (HT) and type 2 diabetes mellitus (T2DM), accentuating patient blood pressure, HbA1c levels, patterns of drug treatment, management, and screening of these diseases. The overall objective of the review is to support adapting existing clinical practice guidelines in Indonesia, Vietnam, and Myanmar. The database PubMed and the web search engines Google and Google Scholar were searched from October to December 2019 for evidence-based guidelines covering the overall disease management in Europe, the United States of America, and low and middle-income countries (Indonesia, Vietnam, and Myanmar­IVM later on). Nine studies were selected for the review, seven concerning HT and five T2DM. Guidelines in IVM and Europe identified HT as increased blood pressure (BP; ≥140/90 mmHg). IVM guidelines also recommended commencing drug treatment if lifestyle interventions were not successful. Four international HT guidelines recommended monitoring BP every few months, and the other three guidelines gave recommendations based on the patient's current BP levels. All five T2DM guidelines recommended target HbA1c levels below 7%­6.5%, but only IVM guidelines included re-examination every 3­6 months. Metformin was recommended as the first choice of medical treatment, if not contraindicated. Amid the guidelines' recommendations, there were no major variations in the Class of recommendation and Level of evidence (except IVM guidelines where COR and LOE were missing). Revision and completion of IVM guidelines by this grading system would enhance evidence-based and informed decisions in clinical care.

Burden of Traumatic Brain Injuries in Children and Adolescents in Europe: Hospital Discharges, Deaths and Years of Life Lost.

Children and adolescents are at high risk of traumatic brain injuries (TBI). To identify those most at risk across Europe, a comprehensive epidemiological study on the burden of TBI is needed. Our aim was to estimate the burden of TBI in the pediatric and adolescent population of Europe by calculating rates of hospital-based incidence, death and years of life lost (YLL) due to TBI in 33 countries of Europe in 2014 (most recent available data). We conducted a cross-sectional observational, population-based study. All cases with TBI in the age range 0 to 19, registered in the causes of death databases or hospital discharge databases of 33 European countries were included. Crude and age-standardized rates of hospital discharges, deaths and YLLs due to TBI; and pooled estimates for all countries combined were calculated. TBI caused 2303 deaths (71% in boys), 154,282 YLLs (68% in boys) and 441,368 hospital discharges (61% in boys) in the population of 0-19 year-olds. We estimated pooled age-standardized rates of death (2.8, 95% CI: 2.4-3.3), YLLs (184.4, 95% CI: 151.6-217.2) and hospital discharges (344.6, 95% CI: 250.3-438.9) for the analyzed countries in 2014. The population of 15-19 year-olds had the highest rates of deaths and YLLs, and the population of 0-4 year-olds had the highest rate of hospital discharges. Detailed estimates of hospital discharge, death and YLL rates based on high-quality, standardized data may be used to develop health policies, aid decision-making and plan prevention.

Characteristics and outcome of severe traumatic brain injuries based on occupational status.

PURPOSE: The association of TBI with socioeconomic characteristics of patients has not been studied extensively. The objective of this study was to analyse the differences in injury characteristics and outcome in TBI patients based on their occupational status. METHODS: Data on patients from 13 centres based in Austria, Croatia, Slovakia, Bosnia and Herzegovina, and Macedonia were included in the analysis. Demographic characteristics, injury characteristics, treatment and outcome at various post-injury stages were compared according to occupational status. Logistic regression was used to adjust for the effect of co-variates. ICU mortality, hospital mortality, 6 months mortality, and outcome at 6 months were used as dependent variables. RESULTS: Overall, 886 patients were analysed with a mean age of 45.5 years. High-level falls were most prevalent in the blue-collar group (19%), most low-level falls occurred in the retired group. Traffic accidents were most common in students. The injuries were most severe in the blue-collar group and students. Highest mortalities and unfavourable outcomes were in the retired, students and white-collar workers had the best outcomes. Compared to retired patients, all groups had higher odds of favourable outcome at 6 months after adjusting for co-variates-OR from 2.2 (95% CI 1.1-4.6) for entrepreneurs to 3.6 (95% CI 1.8-7.2) for the blue-collar group. CONCLUSION: Our paper provides clues pertaining specifically to variations in patterns and outcomes of TBI according to occupational status which can inform prevention and planning of services and can serve to plan priorities for further research.