Análisis del cumplimiento de los objetivos de energía y clima para el año 2030 en la Unión Europea. Caso de estudio: el estado español

La Unión Europea, movida por el creciente interés de la sociedad por la sostenibilidad en la actividad del ser humano, pretende abordar el problema del cambio climático y la contaminación en el futuro estableciendo objetivos para mejorar diferentes problemáticas climáticas y energéticas: la reducción de emisiones de gases de efecto invernadero producidas por la actividad de los seres humanos, el uso de fuentes de energía renovables y la mejora de la eficiencia energética y el ahorro de energía. Este trabajo pretende realizar una diagnosis del estado de cumplimiento de los principales objetivos de la Unión Europea para 2030 en un caso de estudio: el Estado español. Para ello revisar la situación de las tres problemáticas principales tratadas por esos objetivos en diferentes niveles de enfoque: un enfoque mundial y un enfoque de la Unión Europea en su conjunto. De esta manera, conocer el estado del arte de las problemáticas a estudiar y utilizar esa información para la diagnosis centrada en el Estado español, con la que lograr exponer la realidad del caso de estudio ante los objetivos de 2030, en la actualidad y en el futuro, y realizar propuestas de mejora, en caso de ser necesarias, para mejorar la perspectiva de futuro del cumplimiento de los objetivos en 203

Healthcare workers hospitalized due to COVID-19 have no higher risk of death than general population. Data from the Spanish SEMI-COVID-19 Registry

Aim To determine whether healthcare workers (HCW) hospitalized in Spain due to COVID-19 have a worse prognosis than non-healthcare workers (NHCW). Methods Observational cohort study based on the SEMI-COVID-19 Registry, a nationwide registry that collects sociodemographic, clinical, laboratory, and treatment data on patients hospitalised with COVID-19 in Spain. Patients aged 20-65 years were selected. A multivariate logistic regression model was performed to identify factors associated with mortality. Results As of 22 May 2020, 4393 patients were included, of whom 419 (9.5%) were HCW. Median (interquartile range) age of HCW was 52 (15) years and 62.4% were women. Prevalence of comorbidities and severe radiological findings upon admission were less frequent in HCW. There were no difference in need of respiratory support and admission to intensive care unit, but occurrence of sepsis and in-hospital mortality was lower in HCW (1.7% vs. 3.9%; p = 0.024 and 0.7% vs. 4.8%; p<0.001 respectively). Age, male sex and comorbidity, were independently associated with higher in-hospital mortality and healthcare working with lower mortality (OR 0.211, 95%CI 0.067-0.667, p = 0.008). 30-days survival was higher in HCW (0.968 vs. 0.851 p<0.001). Conclusions Hospitalized COVID-19 HCW had fewer comorbidities and a better prognosis than NHCW. Our results suggest that professional exposure to COVID-19 in HCW does not carry more clinical severity nor mortality

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

Análisis del cumplimiento de los objetivos de energía y clima para el año 2030 en la Unión Europea. Caso de estudio: el estado español

La Unión Europea, movida por el creciente interés de la sociedad por la sostenibilidad en la actividad del ser humano, pretende abordar el problema del cambio climático y la contaminación en el futuro estableciendo objetivos para mejorar diferentes problemáticas climáticas y energéticas: la reducción de emisiones de gases de efecto invernadero producidas por la actividad de los seres humanos, el uso de fuentes de energía renovables y la mejora de la eficiencia energética y el ahorro de energía. Este trabajo pretende realizar una diagnosis del estado de cumplimiento de los principales objetivos de la Unión Europea para 2030 en un caso de estudio: el Estado español. Para ello revisar la situación de las tres problemáticas principales tratadas por esos objetivos en diferentes niveles de enfoque: un enfoque mundial y un enfoque de la Unión Europea en su conjunto. De esta manera, conocer el estado del arte de las problemáticas a estudiar y utilizar esa información para la diagnosis centrada en el Estado español, con la que lograr exponer la realidad del caso de estudio ante los objetivos de 2030, en la actualidad y en el futuro, y realizar propuestas de mejora, en caso de ser necesarias, para mejorar la perspectiva de futuro del cumplimiento de los objetivos en 203

Comparison of international normalized ratio audit parameters in patients enrolled in GARFIELD-AF and treated with vitamin K antagonists

Vitamin K antagonist (VKA) therapy for stroke prevention in atrial fibrillation (AF) requires monitoring of the international normalized ratio (INR). We evaluated the agreement between two INR audit parameters, frequency in range (FIR) and proportion of time in the therapeutic range (TTR), using data from a global population of patients with newly diagnosed non-valvular AF, the Global Anticoagulant Registry in the FIELD\u2013Atrial Fibrillation (GARFIELD-AF). Among 17\ua0168 patients with 1-year follow-up data available at the time of the analysis, 8445 received VKA therapy (\ub1antiplatelet therapy) at enrolment, and of these patients, 5066 with 653 INR readings and for whom both FIR and TTR could be calculated were included in the analysis. In total, 70\ua0905 INRs were analysed. At the patient level, TTR showed higher values than FIR (mean, 56\ub70% vs 49\ub78%; median, 59\ub77% vs 50\ub70%). Although patient-level FIR and TTR values were highly correlated (Pearson correlation coefficient [95% confidence interval; CI], 0\ub7860 [0\ub7852\u20130\ub7867]), estimates from individuals showed widespread disagreement and variability (Lin's concordance coefficient [95% CI], 0\ub7829 [0\ub7821\u20130\ub7837]). The difference between FIR and TTR explained 17\ub74% of the total variability of measurements. These results suggest that FIR and TTR are not equivalent and cannot be used interchangeably