Managing atrial fibrillation in the global community: The European perspective.

Atrial fibrillation is a common, global problem, with great personal, economic and social burdens. As populations age it increases in prevalence and becomes another condition that requires careful chronic management to ensure its effects are minimised. Assessment of the risk of stroke using well established risk prediction models is being aided by modern computerised databases and the choice of drugs to prevent strokes is ever expanding to try and improve the major cause of morbidity in AF. In addition, newer drugs for controlling rhythm are available and guidelines are constantly changing to reflect this. As well as medications, modern techniques of electrophysiology are becoming more widely embraced worldwide to provide more targeted treatment for the underlying pathophysiology. In this review we consider these factors to concisely describe how AF can be successfully managed

The United Nations Security Council Sanctions and International Human Rights

Peer reviewedPostprin

China and the Future of Asian Electronics Trade

China’s emergence as a key player in the global electronics industry has ignited concerns among its East Asian neighbors. Upper and middle-income economies fear that China’s rise is hollowing out their electronics industrial base. Lower-income economies worry that they cannot compete with China’s seemingly endless supply of cheap labor. In this chapter, we describe the forces behind China’s rise in electronics, and we consider the implications for regional electronics trade and production patterns. Using a unique world electronics production data set, we investigate the upgrading trajectories of East Asian economies within the industry. Consistent with the theory of international production fragmentation, we find that Japan and the NIEs have a more sophisticated production mix than their lower-income neighbors. These latter economies, however, are upgrading their electronics industries more rapidly. L'émergence de la Chine comme étant un joueur clé dans l'industrie électronique mondiale a suscité de l’inquiétude parmi ses voisins de l'Asie de l'Est. Les économies à revenus élevé et moyen craignent que la montée de la Chine nuise à leur centre industriel électronique. Les économies plus pauvres, pour leur part, s'inquiètent du fait qu'elles ne pourront pas être compétitives face à la main d’œuvre bon marché sans limite de la Chine. Dans ce chapitre, nous décrivons les forces à l’origine de la montée de la Chine dans le domaine de l'électronique, et en étudions les conséquences pour le commerce électronique régional et les modèles de production. Employant une banque de données unique sur la production électronique mondiale, nous examinons les trajectoires de perfectionnement des économies de l’Asie de l’Est dans l’industrie. En accord avec la théorie de fragmentation de la production internationale, nous trouvons que le Japon et les nouvelles économies industrialisées détiennent une combinaison de production plus sophistiquée que leurs voisins à faible revenu. Ces derniers, cependant, voient leurs industries de l'électronique progresser plus rapidement.China, trade, technological upgrading, electronics, Chine, commerce, perfectionnement technologique, électronique

External Validation of Cardiovascular Risk Scores in the Southern Cone of Latin America: Which Predicts Better?

Introducción: La estimación inexacta del riesgo cardiovascular poblacional puede llevar a un manejo inadecuado de las intervenciones médicas preventivas, como, por ejemplo, el uso de estatinas. Objetivo: Evaluar la validez externa de ecuaciones de predicción de riesgo cardiovascular en población general del Cono Sur de Latinoamérica. Material y métodos: Se evaluaron ecuaciones que incluyen variables evaluadas en el estudio CESCAS y que predicen tanto morbilidad como mortalidad cardiovascular global (CUORE, Framingham, Globorisk y Pooled Cohort Studies Equations). Para cada ecuación se realizó un análisis independiente en el que se tuvieron en cuenta los eventos cardiovasculares relevados. Se evaluó la discriminación de cada ecuación a través del cálculo del estadístico-C y el índice Harrell C. Para evaluar la calibración se graficó la proporción de riesgos observados vs. estimados por quintilos de riesgo para cada ecuación y se calculó la pendiente β de regresión lineal para las estimaciones. Se calculó sensibilidad y especificidad para la detección de personas con elevado riesgo cardiovascular. Resultados: La mediana del tiempo de seguimiento de la cohorte al momento del análisis es de 2,2 años, con un rango intercuartilo de 1,9 a 2,8 años. Se incorporaron a los análisis 60 eventos cardiovasculares. Todos los valores de estadístico-C y del índice de Harrell fueron superiores a 0,7. El valor de la pendiente β más alejado de 1 fue el de Pooled Cohort Studies Euations. Conclusiones: Si bien los parámetros de validación externa evaluados fueron similares, CUORE, Globorisk y el índice de Framingham fueron las ecuaciones con mejores indicadores globales de predicción de riesgo cardiovascular.Background: Inaccurate estimates of demographic cardiovascular risk may lead to an inadequate management of preventive medical interventions such as the use of statins. Objectives: The aim of this study was to evaluate the external validity of cardiovascular risk equations in the general population of the Southern Cone of Latin America. Methods: Equations including variables evaluated in the CESCAS cohort study and that estimate overall cardiovascular mortality (CUORE, Framingham, Globorisk and Pooled Cohort Studies) were assessed. For each equation, an independent analysis was performed taking into account the cardiovascular events originally considered. Discrimination of each equation was evaluated through C-statistic and Harrell’s C-index. To assess calibration, a graph was built for each equation with the proportion of observed events vs. the proportion of estimated events by risk quintiles and the β slope of the resulting linear regression was calculated. Sensitivity and specificity were determined for the detection of people at high cardiovascular risk. Results: The median follow-up time of the cohort at the time of the analysis was 2.2 years, with an interquartile range of 1.9 to 2.8 years. Sixty cardiovascular events were incorporated into the analysis. All C-statistic and Harrell’s-C index values were greater than 0.7. The value of the β slope farthest from 1 was that of the Pooled Cohort Studies score. Conclusions: Although the external validation parameters evaluated were similar, CUORE, Globorisk and the Framingham equations showed the best global performance for cardiovascular risk estimation in our population.Fil: Gulayin, Pablo Elías. Universidad Nacional de La Plata; Argentina. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Danaei, Goodarz. Harvard University. Harvard School of Public Health; Estados UnidosFil: Gutierrez, Laura. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Poggio, Rosana. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Ponzo, Jaqueline. Universidad de la República; UruguayFil: Lanas, Fernando. Universidad de La Frontera; ChileFil: Rubinstein, Adolfo Luis. Ministerio de Salud de la Nación; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Irazola, Vilma. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentin

The Impact of Risk Factors Reduction Scenarios on Hospital Admissions, Disability-Adjusted Life Years and the Hospitalisation Cost of Cardiovascular Disease in Thailand

Cardiovascular disease (CVD) is considered to be one of the leading health issues in Thailand. CVD not only contributes to an increase in the number of hospital admissions year by year but also impacts on the rising health care expenditure for the treatment and long-term care of CVD patients. Therefore, this study is aimed at examining the impacts of risk reduction strategies on the number of CVD hospital admissions, Disability-Adjusted Life Years (DALYs) and the costs of hospitalisation. To estimate such impacts a CVD cost-offset model was applied using a Microsoft Excel spreadsheet. The number of the mid-year population was classified by age, gender and the CVD risk factor profiles from the recent Thai National Health Examination Survey (NHES) IV. This survey was chosen as the baseline population. The CVD risk factor profiles included age, gender, systolic blood pressure, total cholesterol, and smoking status. The Asia-Pacific Collaborative Cohort Study (APCCS) equation was applied to predict the probability of developing CVD over the next eight-year period. Estimates on the following were obtained from the model: 1) the CVD events both fatal and non-fatal; 2) the difference between the projected number of deaths and the actual number of deaths in that population; 3) the number of patients who are expected to live with CVD; 4) the DALYs from the estimated number of fatal and non-fatal events; 5) the cost of hospital admissions. Four CVD risk strategy scenarios were investigated as follows: 1) the do-nothing scenario; 2) the optimistic scenario; 3) achieve the UN millennium development goal; and 4) the worst-case scenario. The findings showed that over the next eight years, there are likely to be 3,297,428 recorded cases of CVD; 5,870,049 cases of DALYs; and, approximately ฿57,000 million, ($1.9 billion), is projected as the total cost of hospital admissions. However, if the current health policy can reduce the levels of risk factors as defined in the optimistic scenario or such policy meets the specifications of the UN millennium development goal, there would be a significant reduction in the number of hospital admissions. These are estimated to be a reduction of 522,179 male and 515,416 female cases. With these results, it is expected that health care costs would save approximately ฿9000 million, ($298.3 million), for CVD and 900,000 million DALYs over the next eight years. However, if there is an upward trend in the risk factors as predicted in the worst-case scenario, then there will be an increase of 428,220 CVD cases; consequently, DALYs cases may rise by 766,029 while the hospitalisation costs may increase by approximately ฿7000 million, ($232.1 million). Based on our findings, reducing the levels of CVD risk factors in the population will drastically reduce: 1) the number of CVD cases; 2) DALYs cases; and 3) health care costs. Therefore it is recommended that the health policy should enhance the primary prevention programs which would be targeted at reducing the CVD risk factors in the population

Digitalis for treatment of heart failure in patients in sinus rhythm

<b>Background</b><p></p> Digitalis glycosides have been in clinical use for the treatment of heart failure (HF) for longer than 200 years. In recent years, several trials have been conducted to address concerns about their efficacy and toxicity.<p></p> <b>Objectives</b><p></p> To examine the effectiveness of digitalis glycosides in treating HF in patients with normal sinus rhythm. To examine the effects of digitalis in patients taking diuretics and angiotensin-converting enzyme inhibitors; in patients with varying severity and duration of disease; in patients with prior exposure to digitalis versus no prior exposure; and in patients with "HF due to systolic dysfunction" versus "HF with preserved ejection fraction."<p></p> <b>Search methods</b><p></p> Searches on the following databases were updated in May 2013: The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and Dissertation Abstracts. Annual meeting abstracts of the American Heart Association, the American College of Cardiology, and the European Society of Cardiology were searched from 1996 to March 2013. In addition, reference lists provided by the pharmaceutical industry (GlaxoSmithKline and Covis Pharma) were searched.<p></p> <b>Selection criteria</b><p></p> Included were randomized placebo-controlled trials of 20 or more adult participants of either sex with symptomatic HF who were studied for seven weeks or longer. Excluded were trials in which the prevalence of atrial fibrillation was 2% or greater, or in which any arrhythmia that might compromise cardiac function or any potentially reversible cause of HF such as acute ischemic heart disease or myocarditis was present.<p></p> <b>Data collection and analysis</b><p></p> Articles selected from the searches described above were evaluated in a joint effort of the review authors. The staff of the Cochrane Heart Group ran searches on the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE.<p></p> <b>Main results</b><p></p> No new studies were identified in the updated searches. Thirteen studies (7896 participants) are included, and major endpoints of mortality, hospitalization, and clinical status, based respectively on 8, 4, and 12 of these selected studies, were recorded and analyzed. The data show no evidence of a difference in mortality between treatment and control groups, whereas digitalis therapy is associated with lower rates of both hospitalization and clinical deterioration. The largest study, in which most participants were taking angiotensin-converting enzyme inhibitors, showed a significant rise in “other cardiac” deaths, possibly due to arrhythmias. However collectively, these findings were based on studies done before beta-blockers, as well as angiotensin receptor blockers and aldosterone antagonists, became widely used to treat HF.<p></p> <b>Authors' conclusions</b><p></p> The literature indicates that digitalis may have a useful role in the treatment of patients with HF who are in normal sinus rhythm. New trials are needed to elucidate the importance of the dosage of digitalis and its usefulness in the era of beta-blockers and other agents shown to be effective in treating HF.<p></p&gt

Limitations on Jurisdiction and Arbitration Agreements Based on Applicable Law and the Identity of the Carrier in Cargo Claim Disputes

The article demonstrates through an analysis of the limitations on choice of forum or arbitration agreements following the invalidity of a choice of law clause included in a charter party and/or a bill of lading (B/L). It is equally difficult enforcing a jurisdiction or arbitration clause included in a B/L if the parties are not clearly defined in the contract for the carrige of goods by sea. The article delivers some conclusions and suggests the approach to be taken by maritime contracting parties to overcome any feasible invalidity of a choice of forum or arbitration agreement based on the choice of law by European Member (EU) States’ courts

CoViD-19, capital humain et crise économique en Afrique subsaharienne : une analyse prospective

Depuis quelques mois, le monde fait face à une grave crise sanitaire liée à la pandémie de la CoViD-19. Cette crise menace de faire trébucher l’Afrique subsaharienne en inversant les progrès économiques qu’elle a réalisés ces dernières années. L’objectif de cet article est de mener une étude prospective des effets économiques de la pandémie de la CoViD-19 en Afrique subsaharienne, sur la base d’une analyse de la théorie de la croissance endogène (capital humain), des résultats des travaux empiriques sur le lien santé-croissance et des prévisions axées sur les scénarios projetés par les organismes internationaux (le FMI, notamment) et les études antérieures. Selon le FMI (2020), cette pandémie entrainera une contraction du taux de croissance de 1,6% en Afrique subsaharienne en 2020. Pour faire face à cette crise sanitaire et économique, la priorité selon le FMI (2020) est d’accroître les capacités et les dépenses de santé pour sauver des vies et contenir la pandémie. Par ailleurs, pour répondre aux importants besoins de financement engendrés, tous les partenaires du développement devraient apporter leur soutien, en plus d’alléger la dette des pays les plus vulnérables de cette sous-région. Les politiques budgétaires, monétaires et financières doivent être orientées vers la protection des groupes vulnérables en atténuant les pertes économiques et en soutenant la reprise. For the past few months, the world has been facing a serious health crisis linked to the CoViD-19 pandemic. This crisis threatens to trip subSaharan Africa by reversing the economic progress it has made in recent years. The objective of this article is to conduct a prospective study of the economic effects of the CoViD-19 pandemic in sub-Saharan Africa, based on an analysis of the endogenous growth theory (human capital), of the results of empirical works on the link between health and growth and forecasts focusing on the scenarios projected by international organizations (the IMF, in particular) and previous studies. According to the IMF (2020), this pandemic will lead to a contraction of the growth rate of 1.6% in sub-Saharan Africa in 2020. To deal with this health and economic crisis, the priority according to the IMF (2020) is to increase health capacities and spending to save lives and contain the pandemic. In addition, to meet the significant financing needs generated, all development partners should provide support, in addition to reducing the debt of the most vulnerable countries in this sub-region. Fiscal, monetary and financial policies must be geared towards protecting vulnerable groups, by mitigating economic losses and supporting the recovery