ObjectivesTo compare current all-cause mortality rates in rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), systemic lupus erythematosus (SLE) and systemic sclerosis (SSc) versus general population.MethodsIn this population-based, retrospective cohort study, anonymised data on 11 186 586 citizens, including all patients with RA (42 735, 79% female), AS (9707, 43% female), PsA (13 779, 55% female), SLE (10 440, 89% female) and SSc (2277, 88% female), (median age of 64/47/54/53/59 years at study entry, respectively), under prescribed treatment between 2015 and 2019, were extracted from the electronic database covering nearly 99% of the Greek population.ResultsAfter 1:5 (patients:general population) matching for gender/age, we found that survival was worse in SSc, followed by SLE and inflammatory arthritis. Compared with the general population HRs for death increased from the first 3 years to 5 years of observation possibly due to increases in disease duration: RA (from 0.63 to 1.13 (95% CI: 1.05 to 1.22), AS (from 0.62 to 1.01, (95% CI: 0.76 to 1.33)), PsA (from 0.68 to 1.06, (95% CI: 0.88 to 1.28)), SLE (from 1.52 to 1.98, (95% CI: 1.67 to 2.33)) and SSc (from 2.27 to 4.24, (95% CI: 3.19 to 5.63)). In both SLE and SSc mortality was increased in men than women and in patients younger than 50 years.ConclusionsSurvival rates over 5 years in inflammatory arthritis under treatment are currently becoming comparable (AS/PsA) or slightly higher (RA) than those of the general population. However, all-cause mortality is almost twofold and fourfold higher in SLE and SSc, respectively, being even higher for male and younger patients.
Objectives To investigate Covid-19-associated risk of hospitalization and death in rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), systemic lupus erythematosus (SLE) and systemic sclerosis (SSc) in comparison with the general population during pandemic’s first year and compare their overall mortality with 2019. Methods Interlinking nation-wide electronic registries, we recorded confirmed Covid-19-associated infections, hospitalizations and deaths, and all-cause deaths between 1-March-2020 and 28-February-2021 in all adults with RA, AS, PsA, SLE, and SSc under treatment (n = 74 970, median age 67.5, 51.2, 58.1, 56.2, 62.2 years, respectively) and in matched (1:5) on age, sex, and region of domicile random comparators from the general population. Deaths from all causes during 2019 were also recorded. Results Compared with the general population incidence rates (IR) for Covid-19-associated hospitalization were higher in RA [IR ratio (IRR):1.71(1.50–1.95)], SLE [2.0(1.4–2.7)] and SSc [2.28(1.29–3.90)], while Covid-19-associated death rates were higher in RA [1.91(1.46–2.49)]. When focusing only on SARS-CoV-2 infected subjects, after adjusting for age and gender, the odds ratio for Covid-19 associated death was higher in RA [1.47(1.11– 1.94)] and SSc [2.92(1.07–7.99)] compared with the general population. All-cause mortality rate compared with the general population increased in RA during the first pandemic year (IRR : 0.71) with reference to 2019 (0.59) and decreased in SSc (IRR : 1.94 vs 4.36). Conclusion Covid-19 may have more severe impact in patients with systemic rheumatic disease than the general population. Covid-19-related mortality is increased in subgroups of patients with specific rheumatic diseases, underscoring the need for priority vaccination and access to targeted treatments.
Purpose – Institutional repositories (IR) are usually used to archive and manage digital collections including research results, educational material, etc. Learning management systems (LMS) form a popular basis for e-learning and blended learning. This paper aims to study how to integrate IR and LMS to support accessibility of disabled students and students with learning difficulties (dyslexic students) in higher education. Customised ontologies focusing on disabled students can be used to facilitate indexing, and access of items in the repository. Design/methodology/approach – The authors propose a simple methodological approach to establish an integrating system for supporting accessibility. First, the authors review research works related to adaptive learning environments (ALEs) and blended learning, and discuss issues of the interoperability of IR and LMS. Then, based on the review, the authors discuss the use of an integrated ALE for supporting disabled students in the domain of higher technological education. The integrated system is based on IR, LMS and assistive and adaptive technology. The open source software platform DSpace is used to build up the repository applications Use of the web ontology language (OWL) ontologies is also proposed for indexing and accessing the various, heterogeneous items stored in the repository. Various open source LMS (e.g. openeclass) could be used to build up the integrated system. Finally, the authors describe experimentation with a prototype implemented to provide the mentioned capabilities. Findings – The technology is mature enough for building up integrated systems, combining capabilities of IR and LMS, for supporting disabled students. The use of ontologies focused on disabled students could facilitate the use of such integrated systems. Customisation and operation of a platform, for the selection and use of portions of OWL ontologies, could be based on the open source software Protégé. Such a platform forms a basis to create an appropriate ontology suitable for specific domains, e.g. the domain of technological education. Finally, the authors argue that the combined use of the OWL platform and the DSpace repository with open source LMS platforms could support domain experts for creating customised ontologies and facilitating searching. Originality/value – A new perception of the term integrated system for supporting disabled students in the higher education context is presented. This perception tries to combine the IR technology that supports the self-archiving approach of information, open LMS technology and the user-centred approach to support students and manage the “life of information”.
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