Health-care costs of losartan and candesartan in the primary treatment of hypertension

A recent study of two widely used angiotensin receptor blockers reported a reduced risk of cardiovascular events (−14.4%) when using candesartan compared with losartan in the primary treatment of hypertension. In addition to clinical benefits, costs associated with treatment strategies must be considered when allocating scarce health-care resources. The aim of this study was to assess resource use and costs of losartan and candesartan in hypertensive patients. Resource use (drugs, outpatient contacts, hospitalizations and laboratory tests) associated with losartan and candesartan treatment was estimated in 14 100 patients in a real-life clinical setting. We electronically extracted patient data from primary care records and mandatory Swedish national registers for death and hospitalization. Patients treated with losartan had more outpatient contacts (+15.6%), laboratory tests (+13.8%) and hospitalizations (+13.8%) compared with the candesartan group. During a maximum observation time of 9 years, the mean total costs per patient were 10 369 Swedish kronor (95% confidence interval: 3109–17 629) higher in the losartan group. In conclusion, prescribing candesartan for the primary treatment of hypertension results in lower long-term health-care costs compared with losartan

Differences in phenotypes, symptoms, and survival in patients with cardiomyopathy—a prospective observational study from the Sahlgrenska CardioMyoPathy Centre

IntroductionCardiomyopathy is the fourth most common cause of heart failure. The spectrum of cardiomyopathies may be impacted by changes in environmental factors and the prognosis may be influenced by modern treatment. The aim of this study is to create a prospective clinical cohort, the Sahlgrenska CardioMyoPathy Centre (SCMPC) study, and compare patients with cardiomyopathies in terms of phenotype, symptoms, and survival.MethodsThe SCMPC study was founded in 2018 by including patients with all types of suspected cardiomyopathies. This study included data on patient characteristics, background, family history, symptoms, diagnostic examinations, and treatment including heart transplantation and mechanical circulatory support (MCS). Patients were categorized by the type of cardiomyopathy on the basis of the diagnostic criteria laid down by the European Society of Cardiology (ESC) working group on myocardial and pericardial diseases. The primary outcomes were death, heart transplantation, or MCS, analyzed by Kaplan–Meier and Cox proportional regression, adjusted for age, gender, LVEF and QRS width on ECG in milliseconds.ResultsIn all, 461 patients and 73.1% men with a mean age of 53.6 ± 16 years were included in the study. The most common diagnosis was dilated cardiomyopathy (DCM), followed by cardiac sarcoidosis and myocarditis. Dyspnea was the most common initial symptom in patients with DCM and amyloidosis, while patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) presented with ventricular arrythmias. Patients with ARVC, left-ventricular non-compaction cardiomyopathy (LVNC), hypertrophic cardiomyopathy (HCM), and DCM had the longest time from the debut of symptoms until inclusion in the study. Overall, 86% of the patients survived without heart transplantation or MCS after 2.5 years. The primary outcome differed among the cardiomyopathies, where the worst prognosis was reported for ARVC, LVNC, and cardiac amyloidosis. In a Cox regression analysis, it was found that ARVC and LVNC were independently associated with an increased risk of death, heart transplantation, or MCS compared with DCM. Further, female gender, a lower LVEF, and a wider QRS width were associated with an increased risk of the primary outcome.ConclusionsThe SCMPC database offers a unique opportunity to explore the spectrum of cardiomyopathies over time. There is a large difference in characteristics and symptoms at debut and a remarkable difference in outcome, where the worst prognosis was reported for ARVC, LVNC, and cardiac amyloidosis

Suicide in cancer patients in South East England from 1996 to 2005: a population-based study

BACKGROUND: Studies from around the world have shown that suicide risk is increased in cancer patients, but no previous detailed analysis has been carried out in England

Practitioner review: twenty years of research with adverse childhood experience scores – advantages, disadvantages and applications to practice

Background: Adverse childhood experience (ACE) scores have become a common approach for considering childhood adversities and are highly influential in public policy and clinical practice. Their use is also controversial. Other ways of measuring adversity ‐ examining single adversities, or using theoretically or empirically driven methods ‐ might have advantages over ACE scores. Methods: In this narrative review we critique the conceptualisation and measurement of ACEs in research, clinical practice, public health and public discourse. Results: The ACE score approach has the advantages – and limitations – of simplicity: its simplicity facilitates wide‐ranging applications in public policy, public health and clinical settings but risks over‐simplistic communication of risk/causality, determinism and stigma. The other common approach – focussing on single adversities ‐ is also limited because adversities tend to co‐occur. Researchers are using rapidly accruing datasets on ACEs to facilitate new theoretical and empirical approaches but this work is at an early stage, e.g. weighting ACEs and including severity, frequency, duration and timing. More research is needed to establish what should be included as an ACE, how individual ACEs should be weighted, how ACEs cluster, and the implications of these findings for clinical work and policy. New ways of conceptualising and measuring ACEs that incorporate this new knowledge, while maintaining some of the simplicity of the current ACE questionnaire, could be helpful for clinicians, practitioners, patients and the public. Conclusions: Although we welcome the current focus on ACEs, a more critical view of their conceptualisation, measurement, and application to practice settings is urgently needed

Optimal control of a biomechanical multibody model for the dynamic simulation of working tasks

In this contribution a framework for digital human modelling using optimal control of a biomechanical multibody model is presented. The skeleton of the human body is represented as a multibody system, actuated by simplified Hill muscles. Motions of the digital human model are generated by optimal control with different objective functions. The optimal control problem is discretized by the DMOCC approach, using a variational integrator for the constrained equations of motion. With this approach, the task of "lifting of a box from a lower to a higher position" is simulated as a test example. Both arms are modeled with seven degrees of freedom each, actuated by 29 muscles. In the optimal control problem an arbitrary grasp position is included, as well as frictional contact between the box and the hand

Sexual Orientation Differences in Functional Limitations, Disability, and Mental Health Services Use: Results From the 2013–2014 National Health Interview Survey

ObjectivesThe authors investigated sexual orientation differences in risk for mental health morbidity, functional limitations/disability, and mental health services use among adults interviewed in the nationally representative 2013-2014 National Health Interview Survey.MethodRespondents were 68,816 adults (67,152 heterosexual and 1,664 lesbian, gay, and bisexual [LGB] individuals), age 18 and older. Fully structured interviews assessed sexual orientation identity, health status, and services use. Using sex-stratified analyses while adjusting for demographic confounding, the authors compared LGB and heterosexual individuals for evidence of mental health-related impairments and use of mental health services.ResultsLGB adults, as compared to heterosexual adults, demonstrated higher prevalence of mental health morbidity and functional limitations. However, this varied by gender with LGB women evidencing elevated risk for both mental health and substance abuse (MHSA) and non-MHSA limitations. Among men, sexual orientation differences clustered among MHSA-related limitations. Overall, LGB adults were more likely than heterosexual adults to use services, with the source of functional limitations moderating these effects among men.ConclusionMHSA-related morbidity is a significant concern among LGB individuals and is associated with higher levels of functional limitations/disability. The findings highlight that LGB persons use MHSA-related treatment at higher rates than heterosexuals do, and, among men, are more likely to do so absent MHSA or non-MHSA-related functional limitations. This presents a unique set of concerns within the integrated care setting, including the need to deliver culturally competent care sensitive to the context of probable sex differences among LGB individuals. (PsycINFO Database Recor

Human like motion generation for ergonomic assessment - a muscle driven Digital Human Model using muscle synergies

In this paper, an approach for digital human modelling and an appropriate simulation environment is presented. The human body or parts of it are modeled as a multibody system with Hill-type muscle models as actuators, and human like motions are created with an optimal control (OC) framework. The focus is on inner (muscle) loads for ergonomic assessment and human like motion generation. A basic reaching test is set up in a motion lab where muscle activation signals via EMG and upper body trajectories are measured with a motion capture system when performing a multitude of different reaching tasks. The measured data is used for validation of the simulation results and additionally muscle synergies are extracted from the EMG signals. These synergies can be used as control parameters in the musculoskeletal model, whereby the number of actuators is reduced. This leads to computational speedup, reduction of anatomical redundancy and captures human muscle activation profiles

Comparison of Measured EMG Data with Simulated Muscle Actuations of a Biomechanical Human Arm Model in an Optimal Control Framework - Direct Vs. Muscle Synergy Actuation

We developed a biomechanical digital human model (DHM) simulation framework that uses (synergetic) Hill type muscles as actuators and optimal control (OC) for motion generation. In this work, we start investigating the underlying actuation signals of the Hill type muscles. We have set up a weight lifting test (‘biceps curls’) in the motion lab, where we measure the muscle activation via electromyography (EMG). The via muscles actuated simulation model produces human like trajectories for different types of OC cost functions, whereas the underlying muscle actuations strongly differ from each other. Our first results indicate that a muscle synergy actuation is more robust concerning the variation of activation signals and that a specific mix of cost functions preserves the resulting motion behavior while producing more human like actuation signals