Trends in Mortality from Ischaemic Heart Disease and Cerebrovascular Disease in Europe: 1980-2009.

Background— Trends in cardiovascular mortality across Europe demonstrate significant geographical variation, and an understanding of these trends has a central role in global public health. Methods and Results— Ischemic heart disease and cerebrovascular disease age-standardized death rates (as per International Classification of Diseases , ninth and tenth revisions) were collated from the World Health Organization mortality database for member states of the European Union. Trends were characterized by using Joinpoint regression analysis. An overall trend for reduction in ischemic heart disease mortality was observed, most pronounced in Western Europe (&gt;60% for the Netherlands, United Kingdom, and Ireland) for both sexes from 1980 to 2009. Eastern European states, Romania, Croatia, and Slovakia, had modest mortality reductions. Most recently (2009), Lithuania had the highest mortality for males and females (318.1/100 000 and 166.1/100 000, respectively), followed by Latvia and Slovakia. France had the lowest mortality: 39.8/100 000 for males and 14.7/100 000 for females. Analysis of cerebrovascular disease mortality revealed that Austria had the largest reduction for both sexes (76.8% males, 76.5% females) from 1980 to 2009. The smallest improvement over this period was seen in Lithuania, Poland, and Cyprus (–5% to +20% approximately). France has the lowest present-day cerebrovascular disease mortality for both males and females (23.9/100 000 and 17.3/100 000, respectively). Conclusions— There is a growing disparity in cardiovascular mortality between Western and Eastern Europe, for which diverse explanations are discussed. The need for population-wide health promotion and primary prevention policies is emphasized. </jats:sec

Perspectives on procedure based assessments: a thematic analysis of semi-structured interviews with ten UK surgical trainees

Objectives: The introduction of competency-based training has necessitated development and implementation of accompanying mechanisms for assessment. Procedure based assessments (PBAs) are an example of workplace-based assessments that are used to examine focal competencies in the workplace. The primary objective was to understand surgical trainees’ perspective on the value of PBA. Design: Semi-structured interviews with 10 surgical trainees individually interviewed to explore their views. Interviews were audio-recorded and transcribed, following this they were open and axial coded. Thematic analysis was then performed. Results: Semi-structured interviews yielded several topical and recurring themes. In trainees’ experience the use of PBAs as a summative tool limits their educational value. Trainees reported a lack of support from seniors and variation in the usefulness of the tool based on stage of training. Concerns related to the validity of PBAs for evaluating trainees’ performance with reports of ‘gaming’ the system and trainees completing their own assessments. Trainees’ did identify the significant value of PBAs when used correctly. Benefits included the identification of additional learning opportunities, standardisation of assessment and their role in providing a measure of progress. Conclusions: The UK surgical trainees interviewed identified both limitations and benefits to PBAs, however we would argue based on their responses and our experience that their use as a summative tool limits their formative use as an educational opportunity. PBAs should either be used exclusively to support learning or solely used as a summative tool, if so further work is needed to audit, validate and standardise them for this purpose

Trends in mortality from aortic stenosis in Europe: 2000-2017

Background Trends in mortality from aortic stenosis across European countries are not well understood, especially given the significant growth in transcatheter aortic valve implantation (TAVI) in the last 10 years. Methods Age-standardised death rates were extracted from the World Health Organisation Mortality Database, using the International Classification of Diseases 10th edition code for non-rheumatic aortic stenosis for those aged >45 years between 2000 and 2017. The UK and countries from the European Union with at least 1,000,000 inhabitants and at least 50% available datapoints over the study period were included: a total of 23 countries. Trends were described using Joinpoint regression analysis. Results No reductions in mortality were demonstrated across all countries 2000-2017. Large increases in mortality were found for Croatia, Poland and Slovakia for both sexes (>300% change). Mortality plateaued in Germany from 2008 in females and 2012 in males, whilst mortality in the Netherlands declined for both sexes from 2007. Mortality differences between the sexes were observed, with greater mortality for males than females across most countries. Conclusions Mortality from aortic stenosis has increased across Europe from 2000 to 2017. There are, however, sizable differences in mortality trends between Eastern and Western European countries. The need for health resource planning strategies to specifically target AS, particularly given the expected increase with aging populations, is highlighted

Trends in lower limb amputation incidence in European Union 15+ Countries 1990-2017

Objective: Lower extremity amputation (LEA) carries significant mortality, morbidity and health economic burden. In the Westernworld,it most commonly results from complications of peripheral arterial occlusive disease (PAOD) or diabetic foot disease. Incidence of PAOD has declined in Europe,the United States and parts of Australasia.We aimed to assess trends in LEA incidence in European Union (EU15+) countries for the years 1990 to 2017. Design: Observational study using data obtained from the 2017 Global Burden of Disease (GBD) study. Materials: GBD Results Tool: http://ghdx.healthdata.org/gbd-results-too. Methods: Age-standardised incidence rates (ASIRs) for LEA (stratified into toe amputation,and LEA proximal to toes) were extracted from the GBD Results Tool for EU15+ countries foreach ofthe years 1990-2017.Trends were analysed using Join point regression analysis. Results: Between 1990 and 2017, variable trends in the incidence of LEA were observedin EU15+ countries. For LEAs proximal to toes, increasing trends were observed in 6 of 19 countries anddecreasing trends in 9 of 19 countries, with 4 countries showing varying trendsbetween sexes. For toe amputation, increasing trends were observed in 8 of 19 countries and decreasing trends in 8 of 19 countries for both sexes, with 3 countries showing varying trendsbetween sexes. Australia hadthe highest ASIRs for both sexes in all LEAs at all time 6 points, with steadily increasing trends. The USA observed the greatest reduction all LEAsin both sexes over the time periodanalysed (LEAs proximal to toes: females -22.93%, males -29.76%; toe amputation: females -29.93%, males -32.67%). The greatest overall increase in incidence was observed in Australia. Conclusions: Variable trends in LEA incidence were observed across EU15+ countries. These trends do not reflect previously observed reductions in incidence of PAO Dover the same time period

Paradoxical impact of socioeconomic factors on outcome of atrial fibrillation in Europe: trends in incidence and mortality from atrial fibrillation

Aims: To understand the changing trends in Atrial Fibrillation (AF) incidence and mortality across Europe from 1990 to 2017, and how socioeconomic factors and sex differences play a role. Methods and Results: We performed a temporal analysis of data from the 2017 Global Burden of Disease Database for 20 countries across Europe using Joinpoint regression analysis. Age-adjusted incidence, mortality and mortality to incidence ratios (MIRs) to approximate case fatality rate are presented. Incidence and mortality trends were heterogenous throughout Europe, with Austria, Denmark and Sweden experiencing peaks in incidence in the middle of the study period. Mortality rates were higher in wealthier countries with the highest being Sweden for both men and women (8.83 and 8.88 per 100,000, respectively) in 2017. MIRs were higher in women in all countries studied, with the disparity increasing the most over time in Germany (43.6% higher in women versus men in 1990 to 74.5% higher in women in 2017). Conclusion: AF incidence and mortality across Europe did not show a general trend, but unique patterns for some nations were observed. Higher mortality rates were observed in wealthier countries, potentially secondary to a survivor effect where patients survive long enough to suffer from AF and its complications. Outcomes for women with AF were worse than men, represented by higher MIRs. This suggests there is widespread healthcare inequality between the sexes across Europe, or that there are biological differences between them in terms of their risk of adverse outcomes from A

Middle East respiratory syndrome

The Middle East respiratory syndrome is caused by a coronavirus that was first identified in Saudi Arabia in 2012. Periodic outbreaks continue to occur in the Middle East and elsewhere. This report provides the latest information on MERS

Interstitial lung disease incidence and mortality in the United Kingdom and the European Union: an observational study, 2001-2017

Objective: To compare the trends in age-standardised incidence and mortality from interstitial lung diseases (ILD) in the United Kingdom (UK) and the European Union (EU). Design: Observational study using data obtained from the Global Burden of Disease Study. Setting and Participants: Residents of the UK and of the twenty-seven EU countries. Main outcome measures: ILD age-standardised incidence rates per 100 000 (ASIR), age-standardised death rates per 100 000 (ASDR), and mortality-to-incidence ratio (MIRs) are presented for males and females separately for each country, for the years 2001–2017. Trends were analysed using Joinpoint regression analysis. Results: For men, in 2017, the median incidence of ILD was 7.22 (IQR 5.57–8.96) per 100 000 population. For women, in 2017, the median incidence of ILD was 4.34 (IQR 3.36–6.29) per 100 000 population. For men, in 2017, the median ASDR attributed to ILD was 2.04 (IQR 1.13–2.71) per 100 000 population. For women, the median ASDR in 2017 for ILD was 1.02 (0.68–1.37) per 100 000 population. There was an overall increase in ASDR during the observation period with a median change of +20.42% (IQR 5.44–31.40) for men and an increase of +15.44% (IQR −1.01–31.52) for women. Despite increases in mortality over the entire observation period, there were decreasing mortality trends in the majority of countries at the end of the observation period (75% for men and 86% for women). Conclusion: Over the past two decades, there have been increases in the incidence and mortality of interstitial lung diseases in Europe. The most recent trends, however, demonstrate decreases in mortality from ILD in the majority of European countries for both men and women. These data support the ongoing improvements in the diagnosis and management of ILD

Geographies of landscape: Representation, power and meaning

Green criminology has sought to blur the nature-culture binary and this article seeks to extend recent work by geographers writing on landscape to further our understanding of the shifting contours of the divide. The article begins by setting out these different approaches, before addressing how dynamics of surveillance and conquest are embedded in landscape photography. It then describes how the ways we visualize the Earth were reconfigured with the emergence of photography in the 19th century and how the world itself has been transformed into a target in our global media culture