Clinical presentation and management strategies of cardiovascular autonomic dysfunction following a COVID‐19 infection: a systematic review

© 2023 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.Background: Cardiovascular autonomic dysfunction may reportedly occur after a coronavirus-disease-2019 (COVID-19) infection, but the available evidence is scattered. Here we sought to understand the acute and mid-term effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on cardiovascular autonomic function. Methods: We performed a systematic PubMed, Embase, Web of Science, medRxiv, and bioRxiv search for cases of cardiovascular autonomic dysfunction during an acute SARS-CoV-2 infection or post-COVID-19 condition. The clinical-demographic characteristics of individuals in the acute versus post-COVID-19 phase were compared. Results: We screened 6470 titles and abstracts. Fifty-four full-length articles were included in the data synthesis. One-hundred and thirty-four cases were identified: 81 during the acute SARS-CoV-2 infection (24 thereof diagnosed by history) and 53 in the post-COVID-19 phase. Post-COVID-19 cases were younger than those with cardiovascular autonomic disturbances in the acute SARS-CoV-2 phase (42 vs. 51 years old, p = 0.002) and were more frequently women (68% vs. 49%, p = 0.034). Reflex syncope was the most common cardiovascular autonomic disorder in the acute phase (p = 0.008) and postural orthostatic tachycardia syndrome (POTS) the most frequent diagnosis in individuals with post-COVID-19 orthostatic complaints (p < 0.001). Full recovery was more frequent in individuals with acute versus post-COVID-19 onset of cardiovascular autonomic disturbances (43% vs. 15%, p = 0.002). Conclusions: There is evidence from the scientific literature about different types of cardiovascular autonomic dysfunction developing during and after COVID-19. More data about the prevalence of autonomic disorders associated with a SARS-CoV-2 infection are needed to quantify its impact on human health.info:eu-repo/semantics/publishedVersio

Clinical autonomic nervous system laboratories in Europe: a joint survey of the European Academy of Neurology and the European Federation of Autonomic Societies

© 2022 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.Background and purpose: Disorders of the autonomic nervous system (ANS) are common conditions, but it is unclear whether access to ANS healthcare provision is homogeneous across European countries. The aim of this study was to identify neurology-driven or interdisciplinary clinical ANS laboratories in Europe, describe their characteristics and explore regional differences. Methods: We contacted the European national ANS and neurological societies, as well as members of our professional network, to identify clinical ANS laboratories in each country and invite them to answer a web-based survey. Results: We identified 84 laboratories in 22 countries and 46 (55%) answered the survey. All laboratories perform cardiovascular autonomic function tests, and 83% also perform sweat tests. Testing for catecholamines and autoantibodies are performed in 63% and 56% of laboratories, and epidermal nerve fiber density analysis in 63%. Each laboratory is staffed by a median of two consultants, one resident, one technician and one nurse. The median (interquartile range [IQR]) number of head-up tilt tests/laboratory/year is 105 (49-251). Reflex syncope and neurogenic orthostatic hypotension are the most frequently diagnosed cardiovascular ANS disorders. Thirty-five centers (76%) have an ANS outpatient clinic, with a median (IQR) of 200 (100-360) outpatient visits/year; 42 centers (91%) also offer inpatient care (median 20 [IQR 4-110] inpatient stays/year). Forty-one laboratories (89%) are involved in research activities. We observed a significant difference in the geographical distribution of ANS services among European regions: 11 out of 12 countries from North/West Europe have at least one ANS laboratory versus 11 out of 21 from South/East/Greater Europe (p = 0.021). Conclusions: This survey highlights disparities in the availability of healthcare services for people with ANS disorders across European countries, stressing the need for improved access to specialized care in South, East and Greater Europe.info:eu-repo/semantics/publishedVersio

EFAS/EAN survey on the influence of the COVID-19 pandemic on European clinical autonomic education and research

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.Purpose: To understand the influence of the coronavirus disease 2019 (COVID-19) pandemic on clinical autonomic education and research in Europe. Methods: We invited 84 European autonomic centers to complete an online survey, recorded the pre-pandemic-to-pandemic percentage of junior participants in the annual congresses of the European Federation of Autonomic Societies (EFAS) and European Academy of Neurology (EAN) and the pre-pandemic-to-pandemic number of PubMed publications on neurological disorders. Results: Forty-six centers answered the survey (55%). Twenty-nine centers were involved in clinical autonomic education and experienced pandemic-related didactic interruptions for 9 (5; 9) months. Ninety percent (n = 26/29) of autonomic educational centers reported a negative impact of the COVID-19 pandemic on education quality, and 93% (n = 27/29) established e-learning models. Both the 2020 joint EAN-EFAS virtual congress and the 2021 (virtual) and 2022 (hybrid) EFAS and EAN congresses marked higher percentages of junior participants than in 2019. Forty-one respondents (89%) were autonomic researchers, and 29 of them reported pandemic-related trial interruptions for 5 (2; 9) months. Since the pandemic begin, almost half of the respondents had less time for scientific writing. Likewise, the number of PubMed publications on autonomic topics showed the smallest increase compared with other neurological fields in 2020-2021 and the highest drop in 2022. Autonomic research centers that amended their trial protocols for telemedicine (38%, n = 16/41) maintained higher clinical caseloads during the first pandemic year. Conclusions: The COVID-19 pandemic had a substantial negative impact on European clinical autonomic education and research. At the same time, it promoted digitalization, favoring more equitable access to autonomic education and improved trial design.info:eu-repo/semantics/publishedVersio

Ökobilanzierung von Bürogebäuden : Analyse von Einflussfaktoren auf negative Umweltauswirkungen

Die Nachhaltigkeit von Gebäuden kann auf den drei Ebenen Ökologie, Ökonomie und Soziokultur bestimmt werden. Um potentielle Umweltwirkungen von Immobilien zu bestimmen, kommt der Methode der Ökobilanzierung (Life Cycle Assessment - LCA) immer größere Bedeutung zu. LCAs werden deswegen bereits in Immobilienbewertungssystemen auf internationaler Ebene angewandt (z.B. DGNB, LEED). Basierend auf den ISO-Normen 14040 und 14044 werden dabei Umweltauswirkungen von Gebäuden quantitativ messbar gemacht. Durch die Erstellung von Ökobilanzen von neun Nicht-Wohngebäuden (Bürogebäuden) und einem Wohngebäude wird in dieser Arbeit aufgezeigt, dass der Energieverbrauch während der Nutzungsphase mit durchschnittlich 55-78% für den Großteil der Umweltwirkung von Immobilien verantwortlich ist. Durchschnittlich werden pro Jahr und m Netto-Grundfläche 32 kg CO2e emittiert und weitere Umweltbelas-tungen (Versauerung, Eutrophierung, Ozonabbau, Sommersmog) ausgelöst. Mit steigender Netto-Grundfläche und sinkendem Oberflächen-zu-Volumen-Verhältnis nehmen die relativen Umweltbelastungen ab, d.h. Skaleneffekte sind nachweislich vorhanden. Um die Umweltauswirkgunen gering zu halten sollte bereits während der Planungsphase auf LCAs zurückgegriffen werden. Der Fokus sollte auf die Energieverbräuche während der Nutzungsphase gerichtet werden, wobei Augenmerk auf hohe Energieeffizienz und den möglichen Einsatz von erneuerbaren Energieträgern gelegt werden sollte. Dies kann mit Hilfe integrierter Planungsprozesse wie z.B. dem Integrated Energy Design ermöglicht werden. Neben der Optimierung eines Gebäudes im Energie-technischen Bereich sollte die Baukonstruktion und die Materialen gewählt werden, aus denen die geringsten Umweltauswirkungen resultieren. Hierfür stellt die Methode der Ökobilanzierung quantitative Antworten bereit.In order to meet the idea of sustainable development, buildings have to be assessed against ecologic, economic and socio-cultural criteria. Based on ISO Standards 14040 and 10444, life cycle assessments (LCA) enable the quantification of potential ecological effects. Hence the method is gaining in importance when ascertaining the environmental impacts of buildings and is therefore taken into account in international assessment methods for sustainable buildings globally (e.g. DGNB, LEED). Within this master thesis nine non-residential buildings and one residential building have been assessed utilising the LCA method. The results of the life cycle impact assessment (LCIA) demonstrate that the operational phase causes 55-78% of nega-tive environmental impacts measured by the selected environmental indicators. Carbon dioxide equivalents (describing the Global Warming Potential) average at 32 kg per (net floor space) square meter with other environmental impacts (acidification, eutrophication, ozone depletion and photochemical ozone creation) also being triggered. Analyses of economies of scale demonstrate that an increase in net floor space and a decrease in the surface-area-to-volume ratio result in declining relative environmental effects. Given the importance of the operation phase, the reduction of energy consumption needs to be prioritized via high standards in energy efficiency and the application of renewable energies (when feasible). Integrated planning processes such as the In-tegrated Energy Design support this idea. Next to optimizing the energy demand, the results of LCAs can support the decision-making for the selection of the building construction as well as materials. In this regard, LCAs contain significant potential given their comprehensive set of indicators and quantified results on environmental impacts.ausgeführt von Gregor SellnerZsfassung in engl. SpracheWien, Univ. für Bodenkultur, Masterarb., 2012(VLID)108339

Price elasticities and implied tax revenue for alcoholic beverages: Evidence from Poland, France and Spain

The study estimates the tax revenue effects of changes in alcohol excise taxes for Spain, France and Poland. In addition to excise tax and VAT revenue effects, the price pass-through and the impact on market volumes is estimated. The main parameters - the tax pass-through rate of excise duties to consumer prices and the price elasticities of demand for alcoholic beverages - are estimated via state-of-the-art econometric approaches based a combination of household-levels and macro data. In a first step, the literature survey finds very diverse estimates for price elasticities of alcoholic beverages. We find evidence that excise taxes are typically fully passed onto consumer prices. Using micro data at the household level, we find price elasticities of demand for Spain, France and Poland which are higher (in absolute terms) than those typically found in the literature. This implies that price increases lead to larger drops in sales volume and, thus, tax increases might not result in the expected additional tax revenues. A macro level estimation of the relation between excise tax rates and revenues confirms a Laffer-curve type relationship, i.e., tax revenues cease to increase if excise tax rates reach a certain threshold level. The empirical evidence in this study suggests that the tax rates for beer and wine are well below this revenue maximising saddle point, but the evidence is inconclusive for spirits in the countries in question. Using the simulation tool developed in this study, it is found that a 1 percent increase in the excise tax rates of each alcoholic beverage prevailing in 2017 in each of the countries will have the strongest negative effect on the market volumes of spirits, while for beer and wine these increases translate to by and large higher collected tax revenues. Noteworthily, in some scenarios excise tax increases result in decreases in VAT revenues due to a significant reduction in the higher value on-trade sales

Assessment of sustainability in Austrian wine production

The aim of the project was to find out whether environmental sustainability can be measured not only with regard to climate change and carbon consumption but also as to other criteria concerning material consumption, energy, soil, biodiversity and water. We investigated which measures in the vineyard and wine cellar can lead to “better” sustainability while ensuring a high quality standard. 343 activities were identified to fulfill 61 quality objectives. Of the 2,191 sustainability assessments that were determined the measurements of the individual sustainability criteria vary and are in some cases even negatively correlated. Nevertheless, it was still possible to differentiate sustainably managed wineries from others in all of the Austrian wine producing areas. In our approach, a specifically developed online tool can calculate the expression of ecological, economic and social sustainability and show the effects in a spider diagram in the form of a traffic light rating system. Moreover, an algorithm suggests adequately which quality improvements can be achieved. If part of the management system is changed the online tool will show the positive and negative sustainability effects

Assessment of sustainability in Austrian wine production

The aim of the project was to find out whether environmental sustainability can be measured not only with regard to climate change and carbon consumption but also as to other criteria concerning material consumption, energy, soil, biodiversity and water. We investigated which measures in the vineyard and wine cellar can lead to “better” sustainability while ensuring a high quality standard. 343 activities were identified to fulfill 61 quality objectives. Of the 2,191 sustainability assessments that were determined the measurements of the individual sustainability criteria vary and are in some cases even negatively correlated. Nevertheless, it was still possible to differentiate sustainably managed wineries from others in all of the Austrian wine producing areas. In our approach, a specifically developed online tool can calculate the expression of ecological, economic and social sustainability and show the effects in a spider diagram in the form of a traffic light rating system. Moreover, an algorithm suggests adequately which quality improvements can be achieved. If part of the management system is changed the online tool will show the positive and negative sustainability effects

Assessment of sustainability in Austrian wine production

The aim of the project was to find out whether environmental sustainability can be measured not only with regard to climate change and carbon consumption but also as to other criteria concerning material consumption, energy, soil, biodiversity and water. We investigated which measures in the vineyard and wine cellar can lead to “better” sustainability while ensuring a high quality standard. 343 activities were identified to fulfill 61 quality objectives. Of the 2,191 sustainability assessments that were determined the measurements of the individual sustainability criteria vary and are in some cases even negatively correlated. Nevertheless, it was still possible to differentiate sustainably managed wineries from others in all of the Austrian wine producing areas. In our approach, a specifically developed online tool can calculate the expression of ecological, economic and social sustainability and show the effects in a spider diagram in the form of a traffic light rating system. Moreover, an algorithm suggests adequately which quality improvements can be achieved. If part of the management system is changed the online tool will show the positive and negative sustainability effects

Clinical autonomic nervous system laboratories in Europe

Background and purpose: Disorders of the autonomic nervous system (ANS) are common conditions, but it is unclear whether access to ANS healthcare provision is homogeneous across European countries. The aim of this study was to identify neurology-driven or interdisciplinary clinical ANS laboratories in Europe, describe their characteristics and explore regional differences. ------ Methods: We contacted the European national ANS and neurological societies, as well as members of our professional network, to identify clinical ANS laboratories in each country and invite them to answer a web-based survey. ----- Results: We identified 84 laboratories in 22 countries and 46 (55%) answered the survey. All laboratories perform cardiovascular autonomic function tests, and 83% also perform sweat tests. Testing for catecholamines and autoantibodies are performed in 63% and 56% of laboratories, and epidermal nerve fiber density analysis in 63%. Each laboratory is staffed by a median of two consultants, one resident, one technician and one nurse. The median (interquartile range [IQR]) number of head-up tilt tests/laboratory/year is 105 (49-251). Reflex syncope and neurogenic orthostatic hypotension are the most frequently diagnosed cardiovascular ANS disorders. Thirty-five centers (76%) have an ANS outpatient clinic, with a median (IQR) of 200 (100-360) outpatient visits/year; 42 centers (91%) also offer inpatient care (median 20 [IQR 4-110] inpatient stays/year). Forty-one laboratories (89%) are involved in research activities. We observed a significant difference in the geographical distribution of ANS services among European regions: 11 out of 12 countries from North/West Europe have at least one ANS laboratory versus 11 out of 21 from South/East/Greater Europe (p = 0.021). ----- Conclusions: This survey highlights disparities in the availability of healthcare services for people with ANS disorders across European countries, stressing the need for improved access to specialized care in South, East and Greater Europe