Podcast: Influenza-Associated Complications and the Impact of Vaccination on Public Health

Influenza is primarily considered an acute respiratory infection but can lead to a myriad of medium and long-term sequelae across every major organ system in the body. Increasing awareness, gaining broader understanding of its mechanistic pathways, identifying at-risk individuals, and determining how to better protect them could help minimize its impact. The aim of this podcast, featuring Dr Stefania Maggi, Dr Annemarijn de Boer, and Dr Melissa K. Andrew, is to outline the main influenza complications and their impact beyond acute respiratory disease, as well as highlighting vaccination as a tool at our disposal. Both physical and cognitive function can be affected as a result of influenza infection, notably in frailer individuals, which in turn may lead to a loss of independence. Observational studies have identified beneficial effects of vaccination for cardioprotection as well as preventing dementia, but more evidence is required. In conclusion, influenza can cause a wide array of complications, which vaccination may help prevent. Podcast available for this article

Data mining to retrieve smoking status from electronic health records in general practice

Aims Optimize and assess the performance of an existing data mining algorithm for smoking status from hospital electronic health records (EHRs) in general practice EHRs. Methods and results We optimized an existing algorithm in a training set containing all clinical notes from 498 individuals (75 712 contact moments) from the Julius General Practitioners’ Network (JGPN). Each moment was classified as either ‘current smoker’, ‘former smoker’, ‘never smoker’, or ‘no information’. As a reference, we manually reviewed EHRs. Algorithm performance was assessed in an independent test set (n = 494, 78 129 moments) using precision, recall, and F1-score. Test set algorithm performance for ‘current smoker’ was precision 79.7%, recall 78.3%, and F1-score 0.79. For former smoker, it was precision 73.8%, recall 64.0%, and F1-score 0.69. For never smoker, it was precision 92.0%, recall 74.9%, and F1-score 0.83. On a patient level, performance for ever smoker (current and former smoker combined) was precision 87.9%, recall 94.7%, and F1-score 0.91. For never smoker, it was 98.0, 82.0, and 0.89%, respectively. We found a more narrative writing style in general practice than in hospital EHRs. Conclusion Data mining can successfully retrieve smoking status information from general practice clinical notes with a good performance for classifying ever and never smokers. Differences between general practice and hospital EHRs call for optimization of data mining algorithms when applied beyond a primary development setting

Blood pressure and cholesterol measurements in primary care: cross-sectional analyses in a dynamic cohort

Background: Guidelines on cardiovascular risk management (CVRM) recommend blood pressure (BP) and cholesterol measurements every 5 years in men aged ≥40 years and (post-menopausal) women aged ≥50 years. Aim: To evaluate CVRM guideline implementation. Design & setting: Cross-sectional analyses in a dynamic cohort using primary care electronic health record (EHR) data from the Julius General Practitioners’ Network (JGPN) (n = 388 929). Method: Trends (2008–2018) were assessed in the proportion of patients with at least one measurement (BP and cholesterol) every 1, 2, and 5 years, in those with: 1. a history of cardiovascular disease (CVD) and diabetes mellitus (DM); 2. a history of DM only; 3. a history of CVD only; 4. a cardiovascular risk assessment (CRA) indication based on other medical history, or; 5. no CRA indication. Trends were evaluated over time using logistic regression mixed-model analyses. Results: Trends in annual BP and cholesterol measurement increased for patients with a history of CVD from 37.0% to 48.4% (P<0.001) and 25.8% to 40.2% (P<0.001). In the 5-year window from 2014– 2018, BP and cholesterol measurements were performed respectively in 78.5% and 74.1% of all men aged ≥40 years and 82.2% and 78.5% of all women aged ≥50 years. Least measured were patients without a CRA indication (men 60.2% and 62.4%; women 55.5% and 59.3%). Conclusion: The fairly high frequency of CVRM measurements available in the EHR of patients in primary care suggests an adequate implementation of the CVRM guideline. As nearly all individuals visit the GP at least once within a 5-year time window, improvement of CVRM remains possible, especially in those without a CRA indication

Sex Differences in Mortality Risk after the First Hospitalisation with Lower Extremity Peripheral Arterial Disease

OBJECTIVE: Lower extremity peripheral arterial disease (PAD) is a severe condition that increases the risk of major adverse cardiovascular events, major adverse limb events, and all cause mortality. This study aimed to investigate the mortality risk among females and males hospitalised for the first time with lower extremity PAD. METHODS: Three cohorts of patients who were admitted for the first time with lower extremity PAD in 2007 - 2010, 2011 - 2014, and 2015 - 2018 were constructed. For the 2007 - 2010 and 2011 - 2014 cohorts, the 28 day, one year, and five year mortality rates were calculated, assessing survival time from date of hospital admission until date of death, end of study period, or censoring. For the 2015 - 2018 cohort, only 28 day and one year mortality were investigated due to lack of follow up data. Mortality rates of these cohorts were compared with the general population using standardised mortality rates (SMRs), and the risk of death between sexes was evaluated using Cox proportional hazards models. Cox models were adjusted for age, cardiovascular disease, and diabetes mellitus to account for potential confounding factors. RESULTS: In total, 7 950, 9 670, and 13 522 patients were included in the 2007 - 2010, 2011 - 2014, and 2015 - 2018 cohorts, respectively. Over 60% of individuals in each cohort were males. Mortality rates at 28 day and one year remained stable across all cohorts, while the five year mortality rate increased for both males and females in the 2011 - 2014 cohort. The SMRs both of females and males with PAD were significantly higher than in the general population. Multivariable regression analyses found no significant differences in mortality risk between sexes at 28 day and one year. However, the five year mortality risk was lower in females, with a hazard ratio of 0.89 (95% confidence interval [CI] 0.83 - 0.97) in the 2007 - 2010 cohort and 0.88 (95% CI 0.82 - 0.94) in the 2011 - 2014 cohort. CONCLUSION: The five year mortality risk has increased, and females face a lower mortality risk than males. Lower extremity PAD still carries unfavourable long term consequences compared with the general population

Sex Differences in the Primary Prevention of Cardiovascular Diseases in a Dutch Primary Care Setting

BACKGROUND: Sex differences in the primary prevention of cardiovascular diseases (CVD) have been shown, but the evidence is mixed and fragmented. In this study, we assessed sex differences in cardiovascular risk factors assessment, risk factor levels, treatment, and meeting of treatment targets, within a Dutch primary care setting. METHODS: Data were obtained from individuals aged 40 to 70 years old, without prior CVD, registered during the entire year in 2018 at one of the 51 general practices participating in the Julius General Practitioner's Network (JGPN). History of CVD was defined based on the International Classification of Primary Care (ICPC). Linear and Poisson regressions were used to investigate sex differences in risk factor assessment, risk factor levels, treatment, and meeting of treatment targets. RESULTS: We included 83,903 individuals (50% women). With the exception of glycated hemoglobin (HbA1c), all risk factors for CVD were more often measured in women than in men. Lipid measurements and body mass index values were higher in women, while blood pressure (BP) and HbA1c levels were higher in men, along with estimated glomerular filtration rate (eGFR) levels. Among individuals with elevated BP or cholesterol levels, no sex difference was observed in the prescription of antihypertensive medications (RR 1.00, 95% CI: 0.94-1.06) but women were less likely than men to receive lipid-lowering medications (RR 0.87, 95% CI: 0.79-0.95). Among treated individuals, women were more likely than men to meet adequate levels of blood pressure (RR 1.17, 95% CI: 1.09-1.25) and less likely to meet target levels of cholesterol (RR 0.90, 95% CI: 0.83-0.98). CONCLUSION: While women were more likely to have their CVD risk factors measured, they were less likely to be prescribed lipid-lowering medications and to meet target levels. When treated, men were less likely to achieve adequate blood pressure control

Replication studies in the Netherlands:Lessons learned and recommendations for funders, publishers and editors, and universities

Drawing on our experiences conducting replications we describe the lessons we learned about replication studies and formulate recommendations for researchers, policy makers, and funders about the role of replication in science and how it should be supported and funded. We first identify a variety of benefits of doing replication studies. Next, we argue that it is often necessary to improve aspects of the original study, even if that means deviating from the original protocol. Thirdly, we argue that replication studies highlight the importance of and need for more transparency of the research process, but also make clear how difficult that is. Fourthly, we underline that it is worth trying out replication in the humanities. We finish by formulating recommendations regarding reproduction and replication research, aimed specifically at funders, editors and publishers, and universities and other research institutes

Ventilation and thermal conditions in secondary schools in the Netherlands: Effects of COVID-19 pandemic control and prevention measures

During the COVID-19 pandemic, the importance of ventilation was widely stressed and new protocols of ventilation were implemented in school buildings worldwide. In the Netherlands, schools were recommended to keep the windows and doors open, and after a national lockdown more stringent measures such as reduction of occupancy were introduced. In this study, the actual effects of such measures on ventilation and thermal conditions were investigated in 31 classrooms of 11 Dutch secondary schools, by monitoring the indoor and outdoor CO 2 concentration and air temperature, both before and after the lockdown. Ventilation rates were calculated using the steady-state method. Pre-lockdown, with an average occupancy of 17 students, in 42% of the classrooms the CO 2 concentration exceeded the upper limit of the Dutch national guidelines (800 ppm above outdoors), while 13% had a ventilation rate per person (VR p) lower than the minimum requirement (6 l/s/p). Post-lockdown, the indoor CO 2 concentration decreased significantly while for ventilation rates significant increase was only found in VR p, mainly caused by the decrease in occupancy (average 10 students). The total ventilation rate per classrooms, mainly induced by opening windows and doors, did not change significantly. Meanwhile, according to the Dutch national guidelines, thermal conditions in the classrooms were not satisfying, both pre- and post-lockdown. While opening windows and doors cannot achieve the required indoor environmental quality at all times, reducing occupancy might not be feasible for immediate implementation. Hence, more controllable and flexible ways for improving indoor air quality and thermal comfort in classrooms are needed

Detection of cardiovascular disease and cardiovascular risk factors in a changing world

In the past 40 years, the cardiovascular landscape has changed with dropping cardiovascular mortality rates due to improvements in primary and secondary prevention of cardiovascular disease (CVD) and more effective treatment in the acute setting. Even though much has improved, cardiovascular disease is still cause of death number 2 in the Netherlands. The dissertation entitled 'Detection of cardiovascular diseases and cardiovascular risk factors in a changing world' aims to give insight into the changing cardiovascular landscape and evaluate current and explore new strategies to detect CVD and cardiovascular risk factors. If detected, controlling for modifiable CVD risk factors can prevent a substantial proportion of CVD, or if CVD is detected at an early stage, further development can be prevented. In a screening program, it is important to screen those people who actually have a chance of having the disease. To make a screening program more efficient or effective, you can in advance select a group of people with a higher risk of developing the disease and measure only that group. For example, people with cardiovascular disease are more likely to have a dilation of their large abdominal artery (abdominal aortic aneurysm). When these people are screened you will find more dilations than if you do not make a selection in advance. In the case of a screening program for an increased risk of cardiovascular disease, it appears that more than three-quarters of men over 40 and women over 50 already have had their blood pressure and cholesterol measured by their GP within a five year window. Using this information, the group of people eligible for screening is already a lot smaller. In addition, previous research has shown that people who have an increased cardiovascular risk do not participate if you invite them for screening. An alternative to this so-called systematic screening method is to measure people when they visit on their own. This is called opportunistic screening. An example of such a place could be the general practice. We know that 75% of the inhabitants of the Netherlands visit their GP at least once a year. In a period of 5 years this will be almost everyone. The general practice could potentially be a good place to offer screening. Investing in complete, standardized, and accurate registration of morbidity and patient characteristics in primary care electronic health records is required to facilitate identification and prioritization of eligible individuals, and allows for a scientific evaluation of opportunistic screening efforts

Correction to: Podcast: Influenza-Associated Complications and the Impact of Vaccination on Public Health (Infectious Diseases and Therapy, (2024), 13, 3, (413-420), 10.1007/s40121-023-00885-z)

The following text was not present in the original article but has been included here for completeness. Original article has been updated. Medical Writing/Editorial Assistance Editorial assistance with the preparation of the podcast discussion guide and abstract was provided by Chloe Schon and Jonathon Ackroyd, Springer Healthcare Ltd., UK. Funding for this assistance was provided by Sanofi