Consumption of antihypertensives in Slovenia and comparison with Norway

Izhodišča: Predpisovanje antihipertenzivnih zdravil v Sloveniji in po svetu narašča. V članku predstavljamo, kako se je v Sloveniji spreminjala poraba antihipertenzivnih zdravil med letoma 2002 in 2008. Za navedeno obdobje smo analizirali predpisovanje antihipertenzivnih zdravil v Sloveniji v skladu s slovenskimi smernicami ter primerjali porabo antihipertenzivnih zdravil med Slovenijo in Norveško v obdobju 2006– 2008. Metode: Statistične podatke o številu ambulantno predpisanih receptov (Rp) in o definiranih dnevnih odmerkih (DDD) na 1000 prebivalcev na dan smo pridobili iz publikacij Ambulantno predpisovanje zdravil v Sloveniji po anatomsko- -terapevtsko-kemijski klasifikaciji (ATC) Inštituta za varovanje zdravja, izdanih za vsako leto od leta 2002 do leta 2008. Izračunali smo število izdanih Rp za vsako v Sloveniji registrirano zdravilno učinkovino iz podskupin antihipertenzivnih zdravil C02, C03, C07, C08 in C09 ter za celotne podskupine. Podatke o porabi antihipertenzivnih zdravil na Norveškem smo pridobili na spletni strani norveškega Inštituta za varovanje zdravja. Rezultati: V Sloveniji se je število predpisanih Rp za antihipertenzivna zdravila na 1000 prebivalcev v obdobju 2002–2008 povečalo za 57 %, pri čemer je bil trend naraščanja statistično značilen. Najbolj se je poraba antihipertenzivnih zdravil povečala med letoma 2002 in 2003. Vsa- ko leto so v največji meri predpisovali zdravila z delovanjem na renin-angiotenzinski sistem, med njimi najpogosteje enalapril. V proučevanem obdobju smo v Sloveniji največjo rast predpisovanja ugotovili pri zaviralcih adrenergičnih receptorjev beta. V primerjavi z Norveško v Sloveniji relativno pogosteje predpisujejo antihipertenzivna zdravila iz podskupine C02 in zdravila z delovanjem na renin-angiotenzinski sistem (C09), manj pa diuretike (C03), zaviralce adrenergičnih receptorjev beta (C07) in zaviralce kalcijevih kanalčkov (C08). Zaključki: Poraba antihipertenzivnih zdravil se je v Sloveniji v obdobju 2002–2008 povečala za več kot polovico. Raziskave o povezanosti med večjo porabo antihipertenzivnih zdravil in kakovostjo nadzora arterijske hipertenzije v Sloveniji nimamo. Primerjava med Slovenijo in Norveško kaže, da med državama v predpisovanju antihipertenzivov obstajajo določene razlike: zdravljenje je pri nas v večji meri usmerjeno v uporabo zdravil, ki delujejo na renin-angiotenzinski sistem.Background: Prescribing antihypertensives is increasing in Slovenia and worldwide. This article is aimed to analyze changes in prescribing antihypertensives in Slovenia in the years 2002- 2008, as well as to find out to what extent the prescribing followed the Slovenian guidelines. Furthermore,the consumption of antihypertensives in Slovenia was compared withthe consumption in the same period in Norway. Methods: We acquired statistical data on the number of primary care prescriptions of antihypertensives and defined daily doses (DDD) per 1000 inhabitants per day from the publications Primary Care Prescribing of Drugs in Slovenia, based on Anatomical-Therapeutic-Chemical Classification (ATC), published by the National Institute of Public Health for each year from 2002 to 2008. We calculated the number of prescriptions of each active ingredient, registered in Slovenia, of antihypertensive subgroups C02, C03, C07, C08 and C09 as well as for whole subgroups. Data on the consumption of antihypertensives in Norwaywere acquired from the website of the Norwegian Institute of Public Health. Results: In Slovenia, the number of prescriptions for antihypertensives per 1000 inhabitants increased by 57 % during the period 2002-2008. The increase in prescribing antihypertensives was highest between 2002 and 2003. Each year, the most widely prescribed drugs in Slovenia were agents acting on the renin-angiotensin system and the most widely prescribed active ingredient from this subgroup was enalapril. During the studied period,the relative consumption of beta blocking agents increased the most. InSlovenia, relatively more antihypertensives from the C02 subgroup and agentsacting on the renin-angiotensin system (C09), but less diuretics (C03), beta blocking agents (C07) and calcium channel blockers (C08) were used, compared to Norway. Conclusions: Consumption of antihypertensives in Slovenia increased by more than a half in the period 2002-2008. The association between the increasing number of prescriptions for antihypertensives and the quality of arterial hypertension control in Slovenia has not been evaluated yet. Compared to Norway, Slovenia is more oriented to prescribing agents acting on the renin-angiotensin system

Visualizing Time-course and Efficacy of In-vivo Measurements of Uterine EMG Signals in Sheep

Abstract. A method for constructing condensed yet concise visualization of a long-term bioinformatics research project is presented. The chart combines information on data quality and chronology of research activities. It is implemented as Microsoft ® Excel spreadsheet with VBA automation. The project comprised 3100 hours of EMG measurements in 23 pregnant sheep, each monitored for up to 5 months during pregnancy and immediately after labor. EMG signals were recorded from the surface of the uterine wall by electrodes implanted at the horn and cervix. The signals were assessed for quality, stored in electronic EMG archive and queried from there for visualization. The spreadsheet shows subject data as time-sorted column headings and pregnancy time along rows, with cell color depicting measurement efficacy rating (signal unusable, partly usable, OK), and a symbol marking labor date. The chart is best read if rotated into landscape format. Project group members confirmed usefulness of the chart in assessing research progress and spotting measurement problems.

Ovrednotenje nadzora arterijske hipertenzije v ambulantah družinske medicine v Sloveniji

Objective: We performed a study on almost 20,000 Slovene patients with arterial hypertension (AH) to evaluate age- and gender-dependent blood pressure control, differences in the rate of AH control in the period 2002-2008, and to validate a potential impact of selected quality indicators on blood pressure control. Methods: The study was conducted as a part of the "Quality of Healthcare in Slovenia" project, in agreement with the National Medical Ethics Committee of the Republic of Slovenia. Appropriate statistical analyses were performed and the results evaluated. Results: Arterial hypertension control was relatively high (55.8%, 95% CI: 55.1-56.5) in the period 2002-2008 and improved significantly during that period. Based on our statistical model, the improved AH control in year 2006 compared to 2002 is particularly due to lower initial blood pressure values before treatment. Uncontrolled AH was largely attributed to uncontrolled systolic blood pressure. We found positive association between AH control and the frequency of blood pressure control in less than six-month time intervals. Conclusions: According to our results, AH control in family practice in Slovenia is relatively high compared to other European countries, but the results refer only to patients visiting their family medicine physicians.Izhodišča: V študiji, ki je vključevala okrog 20.000 slovenskih bolnikov z arterijsko hipertenzijo (AH), smo ugotavljali nadzor krvnega tlaka v odvisnosti od spola in starosti, nadzor AH v obdobju 2002-2008 in ocenili možni vpliv izbranih kazalnikov kakovosti na nadzor krvnega tlaka. Metode: Študija je potekala v okviru projekta "Kakovost v zdravstvu Slovenije" z dovoljenjem Komisije Republike Slovenije za medicinsko etiko. Rezultate smo statistično analizirali in jih ovrednotili. Rezultati: Nadzor AH v obdobju 2002-2008 je bil sorazmerno dober (55,8%, 95% CI: 55.1-56.5) in se je v tem obdobju značilno povečal. Rezultat, da gre za boljši nadzor v letu 2006 v primerjavi z 2002, je na podlagi našega statističnega modela predvsem posledica nižjega krvnega tlaka pred začetkom zdravljenja. Nenadzorovana AH je bila predvsem posledica nezadostno nadzorovanega sistoličnega krvnega tlaka. Nadzor AH je bil boljši pri bolj pogosti kontroli krvnega tlaka v intervalih, manjših od šestih mesecev. Zaključki: Glede na rezultate naše študije je nadzor AH v ambulantah družinske medicine v Sloveniji sorazmerno dober v primerjavi z drugimi evropskimi državami, vendar moramo pri tem upoštevati, da podatki veljajo samo za bolnike, ki so obiskali svojega zdravnika - specialista družinske medicine

Single cell RNA sequencing in autoimmune inflammatory rheumatic diseases

Single cell RNA sequencing (scRNA-seq) represents a new large scale and high throughput technique allowing analysis of the whole transcriptome at the resolution of an individual cell. It has emerged as an imperative method in life science research, uncovering complex cellular networks and providing indices that will eventually lead to the development of more targeted and personalized therapies. The importance of scRNA-seq has been particularly highlighted through the analysis of complex biological systems, in which cellular heterogeneity is a key aspect, such as the immune system. Autoimmune inflammatory rheumatic diseases represent a group of disorders, associated with a dysregulated immune system and high patient heterogeneity in both pathophysiological and clinical aspects. This complicates the complete understanding of underlying pathological mechanisms, associated with limited therapeutic options available and their long-term inefficiency and even toxicity. There is an unmet need to investigate, in depth, the cellular and molecular mechanisms driving the pathogenesis of rheumatic diseases and drug resistance, identify novel therapeutic targets, as well as make a step forward in using stratified and informed therapeutic decisions, which could now be achieved with the use of single cell approaches. This review summarizes the current use of scRNA-seq in studying different rheumatic diseases, based on recent findings from published in vitro, in vivo, and clinical studies, as well as discusses the potential implementation of scRNA-seq in the development of precision medicine in rheumatology

Pulse pressure in patients with arterial hypertension in Slovenia

Namen: Namen naše študije je bil določiti porazdelitev pulznega tlaka (PP), sistoličnega (SBP) in diastoličnega (DBP) krvnega tlaka v odvisnosti od spola in starosti ter ugotoviti odnos med PP, SBP in DBP. Analizirali smo podatke za 19972 bolnikov z arterijsko hipertenzijo v Sloveniji. Metode: Podatke o meritvah arterijskega krvnega tlaka (SBP, DBP) na nadlahti smo pridobili pri več kot 360 družinskih zdravnikih iz zdravstvenih kartotek bolnikov. Večino podatkov smo zbrali v obdobju 2002-2006. Rezultati: Povprečen PP je bil (71,2 +- 16,9) mmHg, povprečen SBP (172,8 +- 18,1) mmHg in povprečen DBP (101,6 +- 10,4) mmHg. Analiza z linearno regresijo je pokazala statistično značilno povezavo PP tako s starostjo (p < 0,001) kot tudi s spolom (p < 0,001). Pulzni tlak je naraščal s starostjo, pri moških in ženskah podobno. Ženske so imele statistično značilno višji PP (p < 0,001) kot moški v starostnem obdobju 35-65 let, razlika pa je bila manj izrazita po 80. letu starosti. Pulzni tlak je v črki U podobnem odnosu z DBP ter v skoraj linearnem odnosu s SBP. Zaključek: Rezultati naše študije kažejo, da je PP pri slovenskih bolnikih z arterijsko hipertenzijo odvisen tako od spola kot od starosti bolnika, na osnovi česar želimo spomniti na pomen upoštevanja PP pri načrtovanju antihipertenzivnega zdravljenja.Purpose: The aim of our study was to evaluate age- and gender-dependent pulse pressure (PP), systolic blood pressure (SBP), and diastolic blood pressure (DBP) distributions as well as their interconnected relationships in a large patient sample diagnosed with arterial hypertension in Slovenia. Methods: Data on brachial arterial pressure measurements (SBP, DBP) were taken from the medical records of 19,972 arterial hypertension patients. More than 360 family medicine physicians participated in the study. The majority of the data was collected from 2002 to 2006. Results: Mean PP, SBP and DBP were (71.2 Ž 16.9) mmHg, (172.8 +- 18.1) mmHg and (101.6 +- 10.4) mmHg, respectively. Linear regression analysis showed a significant association of PP with age (p < 0.001) and with gender (p < 0.001). Pulse pressure increased similarly with age for men and women. Women had significantly higher PP than men during ages of 35 to 65 years (p < 0.001), but the difference was less evident for those above 80 years. Pulse pressure had a U-shape-like relationship with DBP, and astrong, almost linear relationship with SBP. Conclusion: The results of our study show age- and gender- dependent differences in PP distribution for Slovene patients with arterial hypertension. These findings may remind family medicine physicians to take PP values into consideration when planning antihypertensive therapy

Recommendations from the COST action CA17116 (SPRINT) for the standardization of perinatal derivative preparation and in vitro testing

Many preclinical studies have shown that birth-associated tissues, cells and their secreted factors, otherwise known as perinatal derivatives (PnD), possess various biological properties that make them suitable therapeutic candidates for the treatment of numerous pathological conditions. Nevertheless, in the field of PnD research, there is a lack of critical evaluation of the PnD standardization process: from preparation to in vitro testing, an issue that may ultimately delay clinical translation. In this paper, we present the PnD e-questionnaire developed to assess the current state of the art of methods used in the published literature for the procurement, isolation, culturing preservation and characterization of PnD in vitro. Furthermore, we also propose a consensus for the scientific community on the minimal criteria that should be reported to facilitate standardization, reproducibility and transparency of data in PnD research. Lastly, based on the data from the PnD e-questionnaire, we recommend to provide adequate information on the characterization of the PnD. The PnD e-questionnaire is now freely available to the scientific community in order to guide researchers on the minimal criteria that should be clearly reported in their manuscripts. This review is a collaborative effort from the COST SPRINT action (CA17116), which aims to guide future research to facilitate the translation of basic research findings on PnD into clinical practice

Diminishing benefits of urban living for children and adolescents’ growth and development

Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1–6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5–19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was <1.1 kg m–2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background: Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods: We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5-19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI &lt;18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For school-aged children and adolescents, we report thinness (BMI &lt;2 SD below the median of the WHO growth reference) and obesity (BMI &gt;2 SD above the median). Findings: From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation: The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity. Funding: UK Medical Research Council, UK Research and Innovation (Research England), UK Research and Innovation (Innovate UK), and European Union