AimsThe relevance of lipoprotein(a) [Lp(a)] concentrations and low-molecular-weight (LMW) apo(a) phenotypes in peripheral arterial disease (PAD) has only been investigated by few studies. Therefore, we analysed this association in three independent cohorts and performed a Mendelian Randomization approach using instrumental variable regression.Methods and resultsLp(a) concentrations, apo(a) phenotypes, and one SNP in the LPA gene (rs10455872) were measured in the CAVASIC study, including 241 male patients with intermittent claudication and 246 age- and diabetes-matched controls as well as in the two population-based studies KORA F3 (n = 3184) and KORA F4 (n = 3080). In KORA F3/F4, 109/80 persons suffered from intermittent claudication, 200/144 from PAD, and 128/103 showed an ankle–brachial index (ABI) <0.9. In CAVASIC, adjusted logistic regression analyses revealed significant associations between an increase of log-Lp(a) per one standard deviation (SD) (OR = 1.28, P = 0.02) as well as LMW apo(a) phenotypes and symptomatic PAD (OR = 1.65, P = 0.03). Linear regression models with continuous ABI showed a significant association in the combined analyses of KORA F3/F4: an increase in log-Lp(a) per one SD (β = −0.006, P = 0.005) and the presence of LMW apo(a) phenotypes (β = −0.011, P = 0.02) or the minor allele of rs10455872 (ß = −0.016, P = 0.03) were associated with a decrease in ABI in the fully adjusted linear and instrumental variable regression models.ConclusionAnalyses in three independent populations showed significant associations of Lp(a) concentrations, LMW apo(a) phenotypes, and rs10455872 with PAD. This points to a causal relationship between Lp(a) and PAD since the genetically determined apo(a) phenotypes and SNP alleles are indeed associated with PAD.

The COVID-19 pandemic and the measures taken created opportunities in various areas of life, but also created new challenges or increased existing ones, which can also have a (direct or indirect) impact on health and well-being of the population or certain population groups. This health impact assessment (HIA) was commissioned to provide an overview of these effects. The foundation of gathering information for the impact assessment was a national literature research and analysis combined with an online survey. In addition, a search of international literature was conducted by the European Observatory on Health Systems and Policies. The impact assessment and an initial collection of recommendations for action were carried out together with relevant stakeholders in the context of several thematically merged online assessment workshops. Positive and negative - direct as well as indirect - impacts on health in different areas of life could be identified, with the negative impacts predominating in proportion. In addition to identifying the impacts, the HIA also identified groups that were particularly affected by the pandemic. In the course of this HIA, it became clear that the direct in indirect health impacts in many areas of life are interrelated (e. g., job loss, family climate, social inclusion, and psychological well-being) and that a separate discussion often fell short. This HIA provides an overview of various impacts and allows first impressions on actions for future measures in regard to the pandemic in various areas of life, according to the HiAP approach.

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INTRODUCTION:The medical equipment sector is characterized by a large share of overall health budgets spent for the provision of capital investment goods such as medical scanners and radiotherapy units. A high variability in provision and utilization rates of medical equipment can be observed too. The objective for this study was to contribute to effective cross-border cooperation between European Union (EU)-Member States by pooling resources for high-cost medical equipment investments (1).METHODS:Potential cost-intensive and highly specialised medical equipment, where cross-border investment resource pooling may be recommended, were identified by a combined evidence search and expert consultation. An efficiency assessment of medical equipment potential savings for EU-countries was done by a benchmark-approach and a best-practice-approach. Furthermore six examples for cross-border cooperation were investigated and two surveys have been conducted.RESULTS:The following medical equipment can be considered as cost-intensive and highly specialized across EU-Member States: Magnetic Resonance Imaging (MRI) scanners, Computed Tomography (CT) scanners, Stereotactic systems and Surgical robots.The efficiency assessment using the benchmark approach was performed for MRI, CT scanners, Positron Emission Tomography (PET) scanners, Angiography units, Gamma cameras and Lithotriptors. The results of the best-practice approach showed potential cost savings due to under-or overutilization per device group and EU-Member State. However, as this analysis offers a view on health systems on a very macro level it was not possible to give detailed insights at the country-level.The six selected cross-border examples demonstrated a wide variety of options regarding the structure, extent and organization of cross-border cooperation: Five of six cross-border examples were cooperation close to the border, in four of six examples EU funds played an important role.CONCLUSIONS:The study highlighted that cross-border cooperation in the field of cost-intensive/highly specialized medical equipment could bring economic advantages for many EU-Member States. Despite this, still only little is done by EU-Member States in terms of cooperation. Reasons are diverse and can be ascribed to lacking information, differences of national health systems, organizational and administrative hurdles, and lacking political support.

Zusammenfassung Hintergrund Hodenkrebs tritt v. a. bei jungen Männern zwischen 25 und 45 Jahren auf und ist die häufigste Krebserkrankung in diesem Alter. Mögliche Hodenkrebsfrüherkennungsmaßnahmen bei asymptomatischen Männern ab 16 Jahren, wie die ärztliche Tast- und Ultraschalluntersuchung (TUS) bzw. die Tasteigenuntersuchung (TEU) könnten Todesfälle und aggressive Spättherapien vermeiden. Deshalb wurde untersucht, ob diese Maßnahmen einen Zusatznutzen im Vergleich zur gegenwärtigen Situation sowie relevante ethische, rechtliche, soziale und organisatorische Aspekte aufweisen. Methoden Die Methodik dieses Reviews folgt den „Allgemeine[n] Methoden Version 5.0“ des IQWiG. Zusätzlich wurde zur Abschätzung der theoretisch möglichen Nutzen- und Schadenspotenziale eines Screenings eine ergänzende Darstellung zur Nutzenbewertung anhand veröffentlichter Daten aus Tumorregistern und Daten zu prädiktiven Werten aus Diagnosestudien herangezogen. Ergebnisse Es wurden keine Interventionsstudien identifiziert, deshalb können keine evidenzbasierten Aussagen zu einem zusätzlichen Nutzen oder Schaden der untersuchten Früherkennungsmaßnahmen getroffen werden. Epidemiologischen Daten zeigen, dass pro 100 000 jährlich am Screening teilnehmenden Männern maximal 1,2 fortgeschrittene Tumoren und 0,4 Todesfälle vermeidbar wären. Schadensberechnungen ergeben, dass bei der TUS von 100 000 Männern mit 1 bis 22 unnötigen Hodenfreilegungen oder -entfernungen zu rechnen ist, bei der TEU wären es 2 Fälle. Diese Angaben zum möglichen Schaden des Screenings sind jedoch mit großer Unsicherheit behaftet. Schlussfolgerungen Es liegen keine Interventionsstudien vor, die nachweisen könnten, dass der Nutzen eines Hodenkrebsscreenings bei Männern ab 16 Jahren den Schaden überwiegt. Der maximal mögliche Zusatznutzen ist gering und Entdeckungs- und Heilungschancen sind auch ohne Screening gut. Derzeit kann ein Hodenkrebsscreening nicht empfohlen werden.

objective was to estimate the added benefit of UAS therapy in a simulated cohort of Austrian patients. Methods: A previously published Markov state-transition model based on multivariate risk equations and other published sources was populated with risk factors, lifetables, and baseline event rates for Austria. The model predicted cardiovascular disease (CVD) mortality, myocardial infarction (MI), stroke, motor vehicle collisions (MVC), and unadjusted and quality-adjusted survival. We computed 10-year relative event risks and lifetime survival gain for UAS compared to no treatment in a cohort with mean age of 54.5 years, under the assumption of a maintained reduction in mean apnea-hypopnea index (AHI) from 32.0 to 11.5 events/ hour as observed in 3-year follow-up of the STAR trial. Results: Over the 10-year horizon, UAS was projected to reduce risk of CVD death from 5.8% to 3.5% (RR: 0.60), MI from 12.7% to 7.5% (RR: 0.59), and stroke from 6.3% to 4.5% (RR: 0.71). MVC events were reduced from 12.6% to 4.2% (RR: 0.34). UAS treatment was projected to increase survival from 21.08 to 22.51 life years (+1.43 LYs), and to add 1.86 quality-adjusted life years over the patient's lifetime (13.55 vs. 15.41 QALYs). Assuming a reduced treatment effect in line with 12-month STAR results (AHI 15.3), projected lifetime gains were 1.18 LYs and 1.54 QALYs. ConClusions: Our projection suggests that UAS treatment of patients with moderate-to-severe obstructive sleep apnea might lead to pronounced event risk reductions over the long run, and be associated with meaningful gains in unadjusted and quality-adjusted life expectancy for patients in Austria.