Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Whole-genome sequencing reveals host factors underlying critical COVID-19

Critical COVID-19 is caused by immune-mediated inflammatory lung injury. Host genetic variation influences the development of illness requiring critical care1 or hospitalization2,3,4 after infection with SARS-CoV-2. The GenOMICC (Genetics of Mortality in Critical Care) study enables the comparison of genomes from individuals who are critically ill with those of population controls to find underlying disease mechanisms. Here we use whole-genome sequencing in 7,491 critically ill individuals compared with 48,400 controls to discover and replicate 23 independent variants that significantly predispose to critical COVID-19. We identify 16 new independent associations, including variants within genes that are involved in interferon signalling (IL10RB and PLSCR1), leucocyte differentiation (BCL11A) and blood-type antigen secretor status (FUT2). Using transcriptome-wide association and colocalization to infer the effect of gene expression on disease severity, we find evidence that implicates multiple genes—including reduced expression of a membrane flippase (ATP11A), and increased expression of a mucin (MUC1)—in critical disease. Mendelian randomization provides evidence in support of causal roles for myeloid cell adhesion molecules (SELE, ICAM5 and CD209) and the coagulation factor F8, all of which are potentially druggable targets. Our results are broadly consistent with a multi-component model of COVID-19 pathophysiology, in which at least two distinct mechanisms can predispose to life-threatening disease: failure to control viral replication; or an enhanced tendency towards pulmonary inflammation and intravascular coagulation. We show that comparison between cases of critical illness and population controls is highly efficient for the detection of therapeutically relevant mechanisms of disease

A new approach to the regulation of body-image discrepancies: examining associations between self-talk and personality

Body image discrepancies influence both body dissatisfaction and likelihood of engaging in unhealthy behaviours, such as eating disorders. What is poorly understood, however, are the cognitive mechanisms by which individuals seek to reduce discrepancies, that is, the way in which they regulate their pursuit or avoidance of projected selves. Furthermore, individual-level antecedents of goal-directed self-talk (e.g., personality, goal states) have received limited previous examination. Thus, the present study examined predictors of individuals’ use of motivationally adaptive versus inhibitive ways of self-regulating, and how these might differentially relate to body-image discrepancies. An opportunistic sample of 116 individuals (49 males, 67 females), completed a battery of questionnaires measuring body fatness discrepancies, self-talk, conscientiousness and neuroticism. Personality dimensions were related to self-talk in the manner expected, with conscientiousness positively related to informational self-talk, and neuroticism predicting the use of more controlling, pressurising, and amotivational self-talk. Contrary to hypotheses, ideal-actual discrepancies predicted the use of less informational self-talk, and more controlling and amotivational self-talk. This suggests that in the context of body image discrepancies, the pursuit of the ideal self is regulated in a more controlling way when the goal state is distal. By identifying for the first time the relationships between goal-discrepancies and how individuals interpret their associated cognition, this study should serve as a starting point for further research examining the modification of body image concerns through targeted cognitive interventions

Seven-year itch: The UK Government’s difficult relationship with the food and drink industry since ‘Healthy Lives, Healthy People: A call to action on obesity in England (2011)

Objective: Unhealthy food and drink consumption is associated with a range of physical and mental health concerns. In response, public health policies have been developed targeting a reduction in obesity in particular. In the present commentary we argue that government–industry partnerships have reduced the effectiveness of resultant policies and explore why. Design: Perspectives of authors. Setting: UK. Participants: Populations in the UK; UK Government. Results: Industry involvement has presented three interrelated challenges for the UK Government: (i) balancing collaboration while maintaining appropriate distance from industry stakeholders; (ii) resultant production of ‘watertight’ and effective legislation or intervention; and (iii) actual or perceived limited sanctioning or bargaining power. Conclusions: Industry involvement in public health policy making has led to weak action. Support with policy implementation (rather than development) and genuine ‘buy-in’ from industry could accelerate the pace of public health improvement