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      The spoils of war and the long-term spoiling of health conditions of entire nations


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          The healthcare system of Ukraine was already suffering from several shortfalls before February 2022, but the war of aggression started by the Russian leadership is poised to inflict a further severe blow that will have long-lasting consequences for the health of all Ukrainians. In pre-war Ukraine, noncommunicable diseases (NCDs) contributed to 91% of deaths, especially cardiovascular diseases (67%). Ukrainians have a high prevalence of risk factors for NCDs ranking among the highest levels reported by the World Health Organization (WHO) in the European (EU) Region. Cardiovascular disease is one of the key health risks for the conflict-affected Ukrainian population due to significant limitations in access to health care and interruptions in the supply of medicines and resources. The excess mortality observed during the COVID-19 pandemic, due to a combination of viral illness and chronic disease states, is bound to increase exponentially from poorly treated NCDs. In this report, we discuss the impact of the war on the public health of Ukraine and potential interventions to provide remote health assistance to the Ukrainian population.

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          Most cited references10

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          European Society of Cardiology: cardiovascular disease statistics 2021

          Aims This report from the European Society of Cardiology (ESC) Atlas Project updates and expands upon the widely cited 2019 report in presenting cardiovascular disease (CVD) statistics for the 57 ESC member countries. Methods and results Statistics pertaining to 2019, or the latest available year, are presented. Data sources include the World Health Organization, the Institute for Health Metrics and Evaluation, the World Bank, and novel ESC sponsored data on human and capital infrastructure and cardiovascular healthcare delivery. New material in this report includes sociodemographic and environmental determinants of CVD, rheumatic heart disease, out-of-hospital cardiac arrest, left-sided valvular heart disease, the advocacy potential of these CVD statistics, and progress towards World Health Organization (WHO) 2025 targets for non-communicable diseases. Salient observations in this report: (i) Females born in ESC member countries in 2018 are expected to live 80.8 years and males 74.8 years. Life expectancy is longer in high income (81.6 years) compared with middle-income (74.2 years) countries. (ii) In 2018, high-income countries spent, on average, four times more on healthcare than middle-income countries. (iii) The median PM2.5 concentrations in 2019 were over twice as high in middle-income ESC member countries compared with high-income countries and exceeded the EU air quality standard in 14 countries, all middle-income. (iv) In 2016, more than one in five adults across the ESC member countries were obese with similar prevalence in high and low-income countries. The prevalence of obesity has more than doubled over the past 35 years. (v) The burden of CVD falls hardest on middle-income ESC member countries where estimated incidence rates are ∼30% higher compared with high-income countries. This is reflected in disability-adjusted life years due to CVD which are nearly four times as high in middle-income compared with high-income countries. (vi) The incidence of calcific aortic valve disease has increased seven-fold during the last 30 years, with age-standardized rates four times as high in high-income compared with middle-income countries. (vii) Although the total number of CVD deaths across all countries far exceeds the number of cancer deaths for both sexes, there are 15 ESC member countries in which cancer accounts for more deaths than CVD in males and five-member countries in which cancer accounts for more deaths than CVD in females. (viii) The under-resourced status of middle-income countries is associated with a severe procedural deficit compared with high-income countries in terms of coronary intervention, ablation procedures, device implantation, and cardiac surgical procedures. Conclusion Risk factors and unhealthy behaviours are potentially reversible, and this provides a huge opportunity to address the health inequalities across ESC member countries that are highlighted in this report. It seems clear, however, that efforts to seize this opportunity are falling short and present evidence suggests that most of the WHO NCD targets for 2025 are unlikely to be met across ESC member countries.
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            Fixed-dose combination therapies with and without aspirin for primary prevention of cardiovascular disease: an individual participant data meta-analysis

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              Wearable devices for remote vital signs monitoring in the outpatient setting: an overview of the field

              Early detection of physiological deterioration has been shown to improve patient outcomes. Due to recent improvements in technology, comprehensive outpatient vital signs monitoring is now possible. This is the first review to collate information on all wearable devices on the market for outpatient physiological monitoring. A scoping review was undertaken. The monitors reviewed were limited to those that can function in the outpatient setting with minimal restrictions on the patient’s normal lifestyle, while measuring any or all of the vital signs: heart rate, ECG, oxygen saturation, respiration rate, blood pressure and temperature. A total of 270 papers were included in the review. Thirty wearable monitors were examined: 6 patches, 3 clothing-based monitors, 4 chest straps, 2 upper arm bands and 15 wristbands. The monitoring of vital signs in the outpatient setting is a developing field with differing levels of evidence for each monitor. The most common clinical application was heart rate monitoring. Blood pressure and oxygen saturation measurements were the least common applications. There is a need for clinical validation studies in the outpatient setting to prove the potential of many of the monitors identified. Research in this area is in its infancy. Future research should look at aggregating the results of validity and reliability and patient outcome studies for each monitor and between different devices. This would provide a more holistic overview of the potential for the clinical use of each device.

                Author and article information

                Elsevier B.V.
                21 May 2022
                21 May 2022
                [1]Interventional Cardiology and Cardiovascular Medicine Research, Department of Cardiology, Poland
                [2]Internal Medicine, Nicolaus Copernicus University, Bydgoszcz, Poland
                [3]Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada
                [4]Interventional Cardiology and Cardiovascular Medicine Research, Department of Cardiology, Poland
                [5]Di Summa - Perrino Hospital, Brindisi, Italy
                [6]ICU/Cardiology Unit, Camberlingo Hospital, Francavilla Fontana (Br), Italy
                [7]Interventional Cardiology and Cardiovascular Medicine Research, Department of Cardiology, Poland
                [8]Department of Preventive Cardiology and Lipidology, Medical University of Lodz (MUL), Poland
                [9]Department of Adult Cardiology and Congenital Defects, Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland
                [10]Copenhagen University Hospital, Rigshospitalet, Department of Clinical Biochemistry, Copenhagen, Denmark
                [11]Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
                [12]Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
                [13]Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, IRCCS MultiMedica, Milan, Italy
                [14]Institute of Genetic Epidemiology, Medical University of Innsbruck, Innsbruck, Austria
                [15]Department of Medicine, University of Cambridge, Cambridge, UK
                [16]Université de Paris, Inserm, Paris, France
                [17]Hôpital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon, INSERM UMR 1060 Carmen, Université Claude Bernard Lyon 1, Lyon, France
                [18]Wihuri Research Institute, Helsinki, Finland
                [19]Imperial Centre for CVD Prevention, Department of Primary Care and Public Health, Imperial College London, London, UK
                [20]Department of Internal Medicine, Erasmus MC University Medical Center, Erasmus MC, Rotterdam, the Netherlands
                [21]Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
                [22]Cardiology Department Sahlgrenska University Hospital, Gothenburg Sweden
                [23]Department of Medical and Clinical Sciences, University Magna Graecia Catanzaro, Italy
                [24]Hacettepe University, Ankara, Turkey
                [25]Institute of Clinical Chemistry, University of Zurich and University Hospital of Zurich, Zurich, Switzerland
                [26]Department of Medicine - DIMED, University of Padova, Italy
                [27]Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada
                Author notes
                []Corresponding author. 8440 112 Street, 2C2.09, Edmonton, AB T6G 2B7, Canada.
                © 2022 Elsevier B.V. All rights reserved.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                : 15 May 2022
                : 17 May 2022

                ukraine,war,healthcare systems,cardiovascular disease,remote monitoring
                ukraine, war, healthcare systems, cardiovascular disease, remote monitoring


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