Risultati per: Caratterizzazione dell'asma in base all'età di insorgenza: uno studio di coorte multi-database

Circulation, Volume 150, Issue Suppl_1, Page A4134922-A4134922, November 12, 2024. Background:Coronary artery disease (CAD), related to high blood lipid levels, is a significant contributor to adult mortality in the United States. This study examines the patterns of CAD-related deaths associated with high lipid levels in adults aged 25 and above, with a specific focus on variations related to geography, gender, and race/ethnicity from 1999 to 2020.Methods:This study employed a comprehensive retrospective analysis using death certificate data from the CDC WONDER database, covering 21 years from 1999 to 2020. We calculated age-adjusted mortality rates (AAMRs), annual percent change (APC), and average annual percentage change (AAPC) per 100,000 persons, categorized by year, gender, race/ethnicity, and geographic regions. This approach ensured a robust and reliable analysis of the trends in CAD-related deaths associated with high lipid levels.Results:Between 1999 and 2020, CAD in individuals with high levels of lipids resulted in 407,667 deaths among adults aged 25 and above in the United States. The majority of these deaths occurred in medical facilities (40.1%) and at home (37.3%). The AAMR for CAD in individuals with high lipid levels increased from 4.1 in 1999 to 12.1 in 2020, showing an AAPC of 4.44 (95% CI: 3.69 to 5.48, p < 0.000001). Men had a higher AAMR (12.4) than women (5.6), and both sexes experienced significant increases over time. Disparities in AAMRs by race/ethnicity revealed the highest rates among Whites (8.9), followed by American Indians/Alaska Natives (8.6), Blacks (7.3), Hispanics (6.5), and Asians/Pacific Islanders (5.9). The most significant increase was observed in Blacks (AAPC: 5.07, p < 0.000001). This detailed breakdown of the disparities in CAD mortality rates among different racial and ethnic groups provides a clear picture of the health inequalities that need to be addressed.Conclusion:This study emphasizes the discrepancies in CAD mortality related to high lipid levels among adults in the United States based on race, gender, and geographic location. The consistent rise in AAMRs between 1999 and 2020 emphasizes the necessity for specific public health interventions to tackle these increasing inequalities.

Circulation, Volume 150, Issue Suppl_1, Page A4146635-A4146635, November 12, 2024. Background:Stroke in malignancy is a significant cause of mortality among older adults. This study analyzes demographic trends and disparities in mortality rates due to stroke in malignancy among adults aged 65 and older from 1999 to 2020.Methods:A retrospective analysis was conducted using CDC WONDER death certificate data from 1999 to 2020. Age-adjusted mortality rates (AAMRs) were calculated per 100,000 persons stratified by year, sex, race/ethnicity, and geographical regions. Trends were assessed using Average Annual Percentage Change (AAPC) and annual percent change (APC).Results:Between 1999 and 2020, Stroke in Malignancy resulted in 198,659 deaths among adults (≥65 years) in the United States. Fatalities occurred predominantly in medical facilities (36.5%), followed by nursing homes (29.3%), and at decedents’ homes (24.2%). The overall age-adjusted mortality rate (AAMR) for Stroke in Malignancy-related deaths decreased from 32.8 in 1999 to 16.5 in 2020, with an Average Annual Percentage Change (AAPC) of -3.35 (p-value < 0.000001). Notably, there was a significant decline in AAMR from 1999 to 2018 (APC: -4.23, p-value < 0.000001), followed by a notable increase from 2018 to 2020 (APC: 5.33, p-value = 0.025595). Both men and women showed decreased AAMRs, with men having higher rates (men: 28.1; women: 17.5). AAMRs varied among racial/ethnic groups, with Black/African Americans having the highest AAMR (31.0), followed by Whites (21.8), American/Alaska Natives (18.6), Asian/Pacific Islanders (12.9), and Hispanics (12.5). AAMRs decreased across all races, with the most significant decline observed in Asians (AAPC: -4.62, p-value < 0.000001). Geographically, AAMRs varied among states, ranging from 11.0 in Arizona to 33.7 in Mississippi. Across regions, the Midwestern region had the highest mortality (AAMR: 23.4), with nonmetropolitan areas exhibiting slightly higher AAMRs (AAMR: 25.9). Both metropolitan and nonmetropolitan regions experienced decreased AAMRs over the study period (p-value < 0.000001).Conclusion:The analysis reveals substantial demographic disparities in mortality rates attributed to Stroke in malignancy among older adults. While the overall decline in mortality rates indicates progress, the concerning upsurge in recent years necessitates proactive measures. Addressing these disparities through targeted interventions and equitable healthcare access is imperative to optimize outcomes for this at-risk population.

Circulation, Volume 150, Issue Suppl_1, Page A4134912-A4134912, November 12, 2024. Background:Coronary artery disease (CAD) is a significant contributor to mortality among adults with diabetes mellitus (DM) in the United States. This study examines the patterns of CAD-related mortality in individuals aged 25 and above with DM, with a particular focus on geographic, gender, and racial/ethnic discrepancies from 1999 to 2020.Methods:The study analyzed death certificate information from the CDC WONDER database from 1999 to 2020. Age-adjusted mortality rates (AAMRs), annual percent change (APC), and average annual percentage change (AAPC) were computed per 100,000 individuals, categorized by year, gender, race/ethnicity, and geographic areas.Results:Between 1999 and 2020, CAD in individuals with DM resulted in 1,462,279 deaths among adults aged 25 and above in the United States. The majority of these deaths occurred in medical facilities (44.2%) and at home (29.3%). The overall age-AAMR for CAD in DM-related deaths decreased from 36.3 in 1999 to 31.7 in 2020, with an AAPC of -0.96 (95% CI: -1.29 to -0.77 p < 0.000001). Men had higher AAMRs (41.6) compared to women (22.6), with a more significant decrease in women (AAPC: -2.10, p < 0.000001) than in men (AAPC: -0.34, p = 0.001200). Racial/ethnic disparities showed the highest AAMRs in American Indians/Alaska Natives (43.6), followed by Blacks (37.8), Hispanics (33.8), Whites (29.7), and Asians/Pacific Islanders (22.5). The most significant decrease was in Hispanics (AAPC: -1.64, p < 0.000001). Geographically, AAMRs ranged from 13.7 in Nevada to 51.3 in West Virginia, with the highest mortality observed in the Midwest (AAMR: 34.5). Nonmetropolitan areas exhibited higher AAMRs (35.2) than metropolitan areas (29.7), with a more pronounced decrease in urban areas (AAPC: -1.22, p < 0.000001) compared to nonmetropolitan areas (AAPC: -0.03, p = 0.854629).Conclusion:The decrease in AAMRs for CAD among individuals with DM from 1999 to 2020 indicates improvements in healthcare management. However, the ongoing disparities based on race, gender, and geography call for targeted public health interventions to guarantee fair access to cardiovascular care. Additional endeavors are necessary to comprehend and alleviate the root causes of these inequalities.

Circulation, Volume 150, Issue Suppl_1, Page ASa904-ASa904, November 12, 2024. Background:The outcome of in-hospital cardiac arrest (IHCA) has improved over the past decade, although the survival rate is still approximately 25%. Some cases of IHCA are triggered by medical adverse events, and their outcomes might be different by time when how many staffs is available. But the relationship between the time of occurrence and outcome remains unclear. The aim of this study is to compare the survival outcomes of IHCA at night with those during the daytime using the nationwide medical adverse events database in Japan.Methods:We searched the Japan Council for Quality Health Care nationwide in-hospital adverse events database, which registered 1 million cases per year, from 2010 to 2023. We extracted cases of IHCA and analyzed the cases by time of occurrence, grouping them into day time shift (8am-4pm), midnight shift (4pm-0am), and late night shift (0am-8am). The primary outcome was survival to discharge, and we performed multivariate logistic regression to adjust for age, sex, holiday, cause of medical adverse events, event location, occupation of the involved party, occupational history of the involved party and assignment period of the involved party as potential confounders.Result:A total of 4,252 cases were included during the study period. The most common age group was over 70years old (54.2%, n = 2,303 /4,252). 2,627 patients (61.8%) were male. The number of IHCA per time period was 1949 (45.8%) in the day time shift, 1,349 (31.7%) in the midnight shift and 954 (22.4%) in the late night shift. The most common cause of medical adverse events in all time periods was treatment or procedures. However, the rate of medical care was higher in the late night shift. Regarding the location of the event, the general ward was the most common location at all times. Multivariate logistic regression for survival on discharge yielded an adjusted odds ratio of 1.56 (95% confidence interval [CI]: 1.30–1.86) ,1.33 (95% CI: 1.11–1.59) for the day time shift and midnight shift compared to the late night shift.Conclusion:Approximately 20% of in-hospital cardiac arrests due to medical adverse events occurred on the late night shift, with poor outcomes. Time of occurrence was associated with survival to discharge among IHCA cases that were identified in the nation-wide adverse events database.

Circulation, Volume 150, Issue Suppl_1, Page A4136776-A4136776, November 12, 2024. Introduction:Resting Heart Rate (HR) and Heart Rate Variability (HRV) reflect autonomic control, and are implicated as prognostic factors. We aimed to evaluate the prognostic value of HR and HRV in a cohort from a nationwide telemedicine network.Methods:We assessed unique ECGs recorded from patients ≥16 years-old, from the tele-ECG database of the Telehealth Network of Minas Gerais, Brazil, between 2010 and 2017. Variables of interest were HR and standard deviation of normal RR intervals (SDNN). Self-informed data were collected: sex, age, risk factors (hypertension, dyslipidemia, diabetes, smoking) and comorbidities (myocardial infarction, Chronic Obstructive Pulmonary Disease, and Chagas disease). Outcomes of interest were all-cause and cardiovascular mortality, assessed by ICD codes reported in death certificates, through linkage with the Mortality Information System. Cox regression was applied to evaluate the association between HR and HRV and the outcomes, in 4 models: 1. Unadjusted; 2. Adjusted for sex and age; 3. Model 2 + risk factors + clinical comorbidities; 4. Model 3 + HRV or HR, respectively.Results:At total 992.611 individuals were included, median age of 55 years, 60% women. In 6 years, there were 33.292 deaths (3,37%), 21% due to cardiovascular causes. Patients who died had higher prevalence of all risk factors and comorbidities, as well as higher HR: 76 (IQR 66-87) vs. 74 (IQR 65-83) bpm, p

Circulation, Volume 150, Issue Suppl_1, Page A4146016-A4146016, November 12, 2024. Introduction:Atrial Fibrillation is the most common arrhythmia, causing an irregular and rapid heart rate. This occurs due to electric and structural remodeling of the atria, which creates the rapidly discharging foci.Aims:This study aims to explore the national mortality trends resulting from Atrial Fibrillation and Flutter in the United States from 1999-2022 while also studying the discrepancies among the various socio- demographic groups.Methods:The death certificate data from the Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiological Research (CDC Wonder) database were explored to investigate the Atrial fibrillation and flutter mortality from 1999 to 2022, focusing on the Age-Adjusted Mortality Rate (AAMR) per 1,000,000 individuals. We employed Joinpoint Regression Analysis to compute Annual Percent Changes (APC) with a 95% Confidence Interval. The data was further stratified into epidemiological groups of age, gender, ethnicity, and census region.Results:There was a steady rise in mortality from 1999 to 2017 (APC: 2.96), followed by a rapid surge in mortality trends from 2017 to 2022 (APC: 7.35). The mortality rate rose fairly equally among both genders over the years, with males having a slightly steeper incline (Male AAPC: 4.27, Female AAPC: 3.43). African Americans had the greatest number of deaths due to atrial fibrillation and flutter and the greatest rise was during recent years from 2017 to 2022 (APC: 9.64). The atrial fibrillation and flutter related mortality was the greatest among 25-34-year-olds, with the mortality decreasing among the older populations. All US Census regions had similar mortality rates and trends.Conclusion:This study reveals an overall rise in mortality associated with atrial fibrillation and flutter. It also highlighted disparities across gender, age, and geographic regions. These findings emphasize the need for further research and the development of targeted interventions to reduce mortality and alleviate the burden of this debilitating condition.

Purpose
To study epidemiology, complications, risk factors, clinical course and treatment patterns of diabetes, the Nanjing Diabetes Cohort (NDC) was established using anonymised electronic health records from 650 hospitals and primary care since 2020. This cohort provides valuable data for researchers and policy-makers focused on diabetes management and public health strategies.

Participants
Diabetes was defined as having inpatient or outpatient encounters with a diagnosis of diabetes International Classification of Diseases-9/10 codes, any use of insulin or oral hypoglycaemic drugs, or one encounter with haemoglobin A1C >4.8 mmol/mol or 6.5%. Patients with diabetes have been continuously enrolled on hospitals and primary care in Nanjing since 2020. Demographic, medications and comorbidities data were extracted from clinical notes, diagnostic codes, labs, prescriptions and vital signs among different types of diabetes.

Findings to date
The NDC consisted of 1 033 904 patients from 1 January 2020 to 31 December 2022, the majority were male (50.62%) and from the Gulou district (30.79%). The clinical characteristics and medication usage of patients with type 1 diabetes, type 2 diabetes, gestational diabetes and other diabetes were assessed. The prevalences of hypertension, ischemic heart disease, and cerebrovascular disease were 49.72%, 17.85% and 24.90%, respectively.

Future plans
NDC will annually enrol eligible patients and include socioeconomic data in future updates. The data of NDC are maintained by the Department of Medical Informatics at Nanjing Medical University.

Introduction
Evidence suggests that sedentary behaviour (SB) and physical activity (PA) are important indicators of well-being and quality of life in older adults (OAs). However, OAs are the least active and highly sedentary of all the age groups. The present study intends to examine the feasibility of a wearable gadget to remind users to break sitting time (by standing up and moving more), coupled with a brief health coaching session, pamphlet and reminder messages to decrease SB and improve PA.

Methods and analysis
This study will employ a multi-methods approach that generates quantitative data from questionnaires and qualitative data from semi-structured interviews following OAs’ involvement in the study. This intervention will be informed by the socio-ecological model (SEM) and the habit formation model. The quantitative and qualitative data will be analysed separately and then integrated for interpretation and reporting, which will assist our knowledge of the feasibility of the programme.

Ethics and dissemination
Ethical approval for this study has been obtained from Swansea University (NM_ 2023 6667 6123). Informed consent will be obtained from participants. The findings of the study will be disseminated to the scientific community through conference presentations and scientific publications. The findings of the current study will determine the suitability of a future effectiveness trial.

Trial registration number
NCT06407557.

Introduction
ISMiHealth is a clinical decision support system, integrated as a software tool in the electronic health record system of primary care, that aims to improve the screening performance on infectious diseases and female genital mutilation (FGM) in migrants. The aim of this study is to assess the health impact of the tool and to perform a process evaluation of its feasibility and acceptability when implemented in primary care in Catalonia (Spain).

Methods and analysis
This study is a cluster randomised control trial where 35 primary care centres in Catalonia, Spain will be allocated into one of the two groups: intervention and control. The health professionals in the intervention centres will receive prompts, through the ISMiHealth software, with screening recommendations for infectious diseases and FGM targeting the migrant population based on an individualised risk assessment. Health professionals of the control centres will follow the current routine practice.
A difference in differences analysis of the diagnostic rates for all aggregated infections and each individual condition between the intervention and control centres will be performed. Mixed-effects logistic regression models will be carried out to identify associations between the screening coverage and predictor factors. In addition, a process evaluation will be carried out using mixed methodology.

Ethics and dissemination
The study protocol has been approved by the institutional review boards at Hospital Clínic (16 June 2022, HCB/2022/0363), Clinical Research Ethics Committee of the Primary Care Research Institute IDIAPJGol (22 June 2022, 22/113-P) and the Almería Research Ethics Committee (27 July 2022, EMC/apg). The study will follow the tenets of the Declaration of Helsinki and Good Clinical Practice. All researchers and associates signed a collaboration agreement in which they undertake to abide by good clinical practice standards.
Findings will be disseminated in peer-reviewed journals and communications to congresses.

Trial registration number
NCT05868005.

Introduction
Evidence summaries on the benefits and harms of treatment options support informed decisions under controlled conditions. However, few studies have investigated how such formats support decision-making across different social groups. There is a risk that only disadvantaged people will be able to make informed health decisions—possibly increasing the health equity gap. It is also unclear whether they support decision-making in the field at all. The aim of our study is to assess whether evidence summaries based on the fact box format can help people from different social groups make informed decisions about COVID-19 and influenza vaccinations, and thus reduce inequity in health communication.

Methods and analysis
In a multi-centre, cluster-randomised, controlled trial, health educators from usual care and outreach work in Germany will be randomised in a 1:1 ratio to provide either usual health communication plus an evidence summary (‘fact box’) or usual health communication. Health educators provide a flyer about COVID-19 or influenza vaccination which contains a link to an online study either with (intervention) or without (control) fact box on the reverse side. Flyer and online study will be available in Arabic, German, Turkish and Russian language. The primary outcome is informed vaccination intention, based on vaccination knowledge, attitudes, intentions and behaviour. Secondary outcomes include risk perception, decisional conflict and shared decision-making. We will use linear mixed models to analyse the influence of both individual (eg, education status) and cluster level factors and account for the expected cluster variability in realising usual health communication or the intervention. The statistical analysis plan includes the selection of appropriate measures of effect size and power calculation, assuming a sample size of 800 patients.

Ethics and dissemination
The trial has been approved by the Ethics Committee of the University of Potsdam, Germany (application numbers: 34/2021 and 57/2022).
Results will be disseminated through peer-reviewed journals, conferences and to relevant stakeholders.

Protocol version
Version 6 (4 October 2024); Preprint available on Research Square: https://doi.org/10.21203/rs.3.rs-3401234/v3

Trial registration number
NCT06076421.

Ricerca del Cro di Aviano pubblicata sul Journal of Pathology

Ricerca del Cro di Aviano pubblicata sul Journal of Pathology

Archaea are important components of the host microbiome, but their roles in colorectal cancer (CRC) remain largely unclear. We aimed to elucidate the contribution of gut archaea to CRC across multiple populations.

Nefrologa, ‘scudo a declino cognitivo e obesità’. Il ruolo della neuroinfiammazione

Tra le iniziative di Rachele Sacco anche il ‘bus rosa’