Regional differences in STEMI care in Spain. Data from the ACI-SEC Infarction Code Registry

Introduction and objectives: Geographical and organizational differences between different autonomous communities (AC) can generate differences in care for ST-segment elevation myocardial infarction (STEMI). A total of 17 heart attack code programs have been compared in terms of incidence rate, clinical characteristics, reperfusion therapy, delay to reperfusion, and 30-day mortality. Methods: National prospective observational study (83 centers included in 17 infarction networks). The recruitment period was 3 months (April 1 to June 30, 2019) with clinical follow-up at 30 days. Results: 4366 patients with STEMI were included. The incidence rate was variable between different AC (P <.0001), as was gender (P =.003) and the prevalence of cardiovascular risk factors (P <.0001). Reperfusion treatment was primary angioplasty (range 77.5%-97.8%), fibrinolysis ( range 0%-12.9%) or no treatment (range 2.2%- 13.5%). The analysis of the delay to reperfusion showed significant differences (P <.001) for all the intervals analyzed. There were significant differences in 30-days mortality that disappeared after adjusting for clinical and healthcare network characteristics. Conclusions: Large differences in STEMI care have been detected between the different AC, in terms of incidence rate, clinical characteristics, reperfusion treatment, delay until reperfusion, and 30-day mortality. The differences in mortality disappeared after adjusting for the characteristics of the patient and the care network

Review of Concrete Structures Strengthened with FRP Against Impact Loading

Recent global terrorism activities and threats imposed prominent danger to the public civil infrastructure, and thus blast and impact resistance design of structures has become an indispensable requirement in the design processes. Fiber reinforced polymer (FRP) can be used as an excellent material to improve the blast and impact resistance of structures. Up to now most studies concentrate on blast-resistance of FRP strengthened structures. The number of studies about impact resistance of structures strengthened with FRP is very limited and the findings in these studies are controversial. Since structures under blast and impact loadings do not necessarily behave the same, it also is important to understand the performance of FRP strengthened structures subjected to impact loads. This study aims to provide an overview of the impact resistance of structures strengthened with FRP, which include reinforced concrete (RC) beams, RC slabs, RC columns and masonry walls. This study also reviews the dynamic properties of FRP materials. Although some issues still need to be investigated and clarified, it would be suggested that FRP can be used to strengthen and protect structures against impact events or terrorism activities. © 2016 Institution of Structural Engineers

Applying a Weight Stigma Lens to Australian and International Obesity-Related Policies for Women Across the Preconception, Pregnancy and Postpartum Periods: A Mapping Review

ABSTRACTIssue AddressedWeight stigma significantly affects preconception, pregnant and postpartum (PPP) women. Existing policies and guidelines do not adequately address weight stigma and may inadvertently contribute to it. This mapping review aimed to identify gaps in addressing weight stigma in current Australian and international obesity‐related policies relevant to PPP women.MethodsWe conducted a mapping review of Australian state‐based and national and international obesity‐related policies relevant to PPP women through government websites and guideline databases. Policy screening and data extraction followed three frameworks (Attribution Theory; Health Stigma and Discrimination Framework; Framework for Policy Mobilisation). Analyses were stratified by the policy's direct or indirect relevance to PPP women, and Australian and international policies were compared. Strength and gaps in relation to weight stigma were identified.ResultsForty‐one Australian and 18 international policies were included. Ten (24%) Australian policies explicitly mentioned weight stigma and 13 (31%) met criteria for potentially blaming people for their weight or body size. Acknowledgement of drivers and impacts of weight stigma and adequate mobilisation plans were scarce. Findings were consistent across state and national Australian policies, PPP populations and international comparisons. Strengths of policies comprehensively addressing weight stigma were incorporating lived experience consumers' voices and acknowledging obesity's complex and multifactorial nature. Potential improvements included focussing on nonstigmatising language and discourse.ConclusionsWeight stigma is rarely recognised or not adequately addressed in obesity‐related policies for PPP women.So What?Eliminating weight stigma in policies can improve public narratives around obesity, clinical practice and reproductive‐aged women's experiences and outcomes

Impact of the COVID-19 pandemic on interventional cardiology activity in Spain

Introduction and objectives: The COVID-19 epidemic and the declaration of the state of alarm have led to a decrease in healthcare activity in interventional cardiology units. The objective of this study is to quantify these changes in activity, with special interest in the treatment of patients with ST-segment elevation myocardial infarction (STEMI). Methods: A telematic survey of 81 centers involved in STEMI networks in the 17 autonomous communities of Spain. Information was collected on diagnostic activity, percutaneous coronary intervention (PCI), structural interventions, and PCI in STEMI on changes in the organization of STEMI networks, and on the prevalence of COVID-19 among interventional cardiologists. Data was compared for the week of February 24 through March 1 (before the outbreak) and for the week of March 16 through March 22 (during the outbreak). Results: Response has been obtained from 73 centers (90%). A very significant decrease in the number of diagnostic procedures (-56%), PCI (-48%), structural interventions (-81%) and PCI in STEMI (-40%) has been observed. A slight increase in the use of pharmacological thrombolysis has been reported, although primary angioplasty remains the leading reperfusion strategy. Up to 5% of interventional cardiologists ( 17) had COVID-19. Conclusions: An important reduction in the activity in interventional cardiology has been observed during the COVID-19 epidemic. Likewise, a great decrease has been detected in the number of patients treated in the STEMI networks, with the risk of increased morbidity and mortality that this represents. Scientific societies and health authorities have to promote that patients presenting STEMI compatible symptoms proceed with no delay to access the health system to receive reperfusion treatment in an appropriate way