Risultati per: I numeri del cancro in Italia 2019

Stroke, Volume 54, Issue Suppl_1, Page AWP149-AWP149, February 1, 2023. Background:Racial disparity in ICH management and outcome is a major concern. We sought to evaluate the impact of race on ICH severity and outcome in a nationally representative database.Methods:A query of the 2000-2019 National Inpatient Sample was performed for patients admitted with ICH (ICD9 431, 432.9, ICD-10 I61, I62.9). Demographics, comorbidities, and outcomes were identified. Discharge location was used as a surrogate for functional outcome. Univariate analysis with t-tests or chi-square performed as appropriate, and significant variables were entered into a multivariate regression to generate adjusted odds ratios (AOR)/β-coefficients for race on outcomes. Significance set at an alpha level of

Stroke, Volume 54, Issue Suppl_1, Page ATP80-ATP80, February 1, 2023. Background:Mechanical thrombectomy (MT) has been proven to be a successful treatment option for patients with acute ischemic stroke (AIS) in numerous randomized controlled trials. The majority of trials underrepresent patients aged 70 and above, and there is little contemporary data on regional trends and variation in mortality.Methods:This retrospective study using the National Inpatient Sample (2016-2019) seeks to identify any regional relationships between geriatric patients’ in-hospital mortality after MT for AIS at urban facilities and trends in inpatient mortality. Regional Inpatient mortality based on sex and race and trends between 2016 and 2019 were assessed.Results:Our study group consisted of 52455 AIS-MT admissions (median 78 yrs, 57.1% male, 77.2% white, 89.6% Medicare enrollees) with a 14.1% inpatient mortality rate. Despite having a lower comparative burden of traditional CVD risk factors, the hospitals from the Northeast had a higher inpatient mortality rate (17.2%, n=1650) and risk (adjusted OR:1.25, 95% CI:1.03-1.51) than the other regions. Similar trends were observed in male (18.1%), females (16.6%), white (17.3%) and black (13.8%) participants (P

Stroke, Volume 54, Issue Suppl_1, Page AWMP82-AWMP82, February 1, 2023. Introduction:Endovascular therapy is a treatment option for patients with severe symptomatic intracranial atherosclerotic disease (ICAD). The utilization of angioplasty and stenting has varied since the development of stents for this disease in 2005. This study assesses the longitudinal trends for endovascular treatment of ICAD in the U.S.Methods:We performed a data search from the National Inpatient Sample (NIS) database using ICD9 and ICD10 procedure codes from 2008 through 2019. Data was collected for patients with stroke from ICAD who underwent stenting or angioplasty alone. We also assessed the utilization of stenting or angioplasty in thrombectomy cases for large vessel occlusion (LVO), the use of drug eluting stents, patient demographics, regional trends, length of stay, and mortality statistics.Results:Between 2008 and 2019, the nadir of ICAD stenting cases in the U.S. was in 2011 (n=242). There was over a 207% increase in stenting cases in 2015 (n=730), and another increase of 47% in ICAD stenting in 2018 and 2019 (2018=965, 2019=1,175). There was a significant increase in stenting for ICAD over the entire study period (p=0.003). The data also shows a significant increase in the use of stenting as adjunctive therapy to thrombectomy for LVO. In 2011, stenting with thrombectomy in LVO represented 17.8% (43/242) of patients stented with stroke from ICAD. In 2019, these cases represented 48.1% (565/1,175) of the patients stented. Over the study period, this increase in stent use during LVO treatment was significant (p

Stroke, Volume 54, Issue Suppl_1, Page ATP139-ATP139, February 1, 2023. Introduction:Dysphagia is a common complication among acute ischemic stroke (AIS) patients and is associated with increased mortality and morbidity. A complete understanding of the characteristics of patients who present with dysphagia after AIS is warranted.Objective:To identify the risk factors and outcomes of patients presenting with dysphagia after AIS over twenty years.Methods:A query of the 2000-2019 National Inpatient Sample was performed for patients admitted with AIS (ICD9 433, 43401, 43411, 43491, ICD-10 I63). Demographics, comorbidities, and outcomes were identified. Univariate analysis with t-tests or chi-square performed as appropriate. A 1:1 nearest neighbor propensity score matched cohort was generated. Variables with standardized mean differences >0.1 used in multivariate regression to generate adjusted odds ratios (AOR)/β-coefficients for dysphagia on outcomes. Significance set at an alpha level of

Stroke, Volume 54, Issue Suppl_1, Page AWP152-AWP152, February 1, 2023. Background:Seizure is a known complication following acute ischemic stroke (AIS) that can lead to severe morbidity. We sought to better characterize the risk factors for stroke following AIS and evaluate in-hospital outcomes in these patients.Methods:A query of the 2000-2019 National Inpatient Sample was performed for patients admitted with AIS (ICD9 433, 43401, 43411, 43491, ICD-10 I63). Demographics, comorbidities, and outcomes were identified. Univariate analysis with t-tests or chi-square performed as appropriate. A 1:1 nearest neighbor propensity score matched cohort was generated. Variables with standardized mean differences >0.1 used in multivariate regression to generate adjusted odds ratios (AOR)/β-coefficients for dysphagia on outcomes. Significance set at an alpha level of

Stroke, Volume 54, Issue Suppl_1, Page AWP145-AWP145, February 1, 2023. Background:Acute ischemic stroke (AIS) is associated with a high rate of morbidity and mortality. We aimed to characterize racial disparities in patients with AIS over a 20 year period and examine the prognostic impact of race on functional outcomes.Methods:A query of the 2000-2019 National Inpatient Sample was performed for patients admitted with AIS (ICD9 433, 43401, 43411, 43491, ICD-10 I63). Demographics, comorbidities, and outcomes were identified. Discharge location was used as a surrogate for functional outcome. Univariate analysis with t-tests or chi-square performed as appropriate, and significant variables were entered into a multivariate regression to generate adjusted odds ratios (AOR)/β-coefficients for race on outcomes. Significance set at an alpha level of

Stroke, Volume 54, Issue Suppl_1, Page AWP74-AWP74, February 1, 2023. Background:An increase in cannabis use disorder (CUD) has been associated with a rise in adverse cerebrovascular events in the United States. However, large-scale data on risk stratification of acute ischemic stroke (AIS) among young patients with CUD remains limited. We aim to determine predictors of AIS in the young CUD cohort using the Artificial Neural Network (ANN) model in a national cohort.Methods:We identified hospitalizations of young adults (18-44 years) with CUD (unweighted n=101094, weighted n=539125) using the National Inpatient Sample (2019). Later we grouped them into AIS and non-AIS cohorts. The neural network’s predictive factors were selected for AIS in CUD cohort. CUD admissions were randomly split between training (80%, n=80754) & testing datasets (20%, n=20340). Training data was used to calibrate ANN, while testing data was used to evaluate the algorithm’s accuracy. We compared the frequency of incorrect prediction between training and testing data and measured the area under the curve (AUC) to determine ANN’s efficacy in predicting AIS with CUD.Results:The 2019 cohort consisted of a total of 539125 admissions (56.1% male, 52.9% white, 28.7% blacks, 12.4% Hispanic, 6.0% Asian or Pacific Islander) in young adults with CUD with a median age of 30 (IQR 24-36) years. The rate of AIS admissions in young CUD cohort was 0.5% (n=2535). Training data showed improved predictions with a significantly low error rate (0.5%), thereby depicting better accuracy. The normalized importance of independent predictors of AIS in the CUD cohort is displayed inFig. 1a. History of PVD, prior stroke/TIA, hypertension and hyperlipidemia had the highest normalized importance. The AUC was 0.811(Fig. 1b)which shows an excellent ANN model for the prediction of AIS in young CUD cohort.Conclusion:The ANN model successfully revealed the order of prevalent independent predictors of AIS that can be utilized to screen high-risk young adults with CUD and improve outcomes.

Stroke, Volume 54, Issue Suppl_1, Page A142-A142, February 1, 2023. Background:Prediabetes (preDM) is known to double the risk of strokes and also predicts poor functional outcomes. With rising prevalence of preDM among the elderly population in the US, this study aimed to analyze the risk and trends in secondary stroke in elderly with preDM.Methods:We queried the National Inpatient Sample (2016-2019) to identify secondary stroke (with prior stroke/transient ischemic attack, TIA) hospitalizations in elderly population (≥65 years) with vs. without preDM by using ICD-10 codes after excluding patients with diabetes mellitus. Trends and risk of recurrent stroke events, demographics, comorbidities, and outcomes were compared between two cohorts (preDM+ vs. preDM-).Results:Overall prevalence of secondary stroke in geriatric preDM population for 2016-2019 was 2.01% (4045/201120, 50.8% female, 68.4% white) with preDM+ cohort often consisting of younger (median 77 vs 81yrs), male vs females (49.2% vs 44.8%), blacks (14.7% vs 10.7%), Hispanics (8.9% vs 5.4%), Asian/Pacific Islanders (7.2% vs 2.6%) (p

Stroke, Volume 54, Issue Suppl_1, Page AWP207-AWP207, February 1, 2023. Background:Outcome improvement in young stroke patients is of great interest given their long life expectancy and substantial societal burden. We aimed to investigate whether the treatment advancement has been made and translated into outcome improvement in young patients with acute ischemic stroke (AIS).Methods:From a prospective multicenter stroke registry in South Korea, young AIS patients (aged 18-50) hospitalized between 2008 and 2019 were identified. The study period was divided into 4 epochs. The secular trends of patient characteristics, treatments, and outcomes adjusted for potential confounders were analyzed.Results:This study included 7,050 young AIS patients (mean age 43.1; men 71.9%) from 70,567 enrolled during the period. The mean age decreased from 43.6 years in 2008-2010 to 42.9 years in 2017-19 (Ptrend=.009). Obesity increased (40.1% to 49.0%), but current smoking decreased (53.1% to 42.8%). Other vascular risk factors and sex proportions did not change (Ptrend’s > 0.5). Onset-to-arrival time and door-to-puncture time for mechanical thrombectomy did not change (Ptrend’s > 0.5), but door-to-needle time for intravenous thrombolysis improved (Ptrend

Stroke, Ahead of Print. BACKGROUND:It is unclear whether sodium intake had similar effects on mortality of stroke subtypes. The purpose of this study is to compare the long-term trends in mortality of stroke subtypes attributable to high sodium intake in China during 1990 to 2019.METHODS:Data for China in the GBD (Global Burden of Disease) 2019 study were obtained mainly from the Chinese surveillance systems and the KaiLuan Study. The trends in stroke mortality due to high sodium intake ( >5 g/d) were evaluated using join-point regression and age-period-cohort methods adjusting for age, period, and cohort.RESULTS:The age-standardized mortality rates of stroke attributable to high sodium intake showed downward trends during 1990 to 2019 in China, with an average annual percentage change of −0.6 (95% CI, −0.8 to −0.4) for ischemic stroke, −2.5 (95% CI, −2.8 to −2.2) for intracerebral hemorrhage, and −6.1 (95% CI, −6.6 to −5.7) for subarachnoid hemorrhage. The curves of local drifts, which reflected the average annual percentage change of stroke mortality due to high sodium intake across age groups, showed a slow upward trend with age for ischemic stroke, a slow downward trend for intracerebral hemorrhage, and a sharp downward trend for subarachnoid hemorrhage. The high sodium–related mortality increased dramatically with age for ischemic stroke and intracerebral hemorrhage, while it reached a peak at 50 to 70 years old for subarachnoid hemorrhage. The period and cohort rate ratios of stroke mortality due to high sodium intake decreased in the past 3 decades, with the greatest decline for subarachnoid hemorrhage and the weakest decrease for ischemic stroke. Notably, men had higher high sodium–related mortality and risk but slighter declines for all stroke subtypes than women.CONCLUSIONS:Our results provided powerful evidence that high sodium–related age-standardized mortality rates and risk of stroke in China decreased in the past 3 decades, with diverse changing patterns for different stroke subtypes, highlighting that salt reduction had distinct impact on stroke subtypes.

Differenze di genere e di reddito incidono su tassi mortalità

Spesa nazionale media pari all’8% di quella complessiva farmaci

Italia dei piccoli comuni, FIMMG: “Grazie al Presidente Mattarella per aver confermato e sottolineato il crescente disagio di questa popolazione per un ritiro dei servizi che meritava attenzione progettuale come da noi denunciato con il tour #adessobasta”

Objectives
To examine the potential for bias in the estimate of under-5 mortality due to birth defects recently produced by the WHO and the Maternal and Child Epidemiology Estimation research group.

Design
Systematic analysis.

Methods
We examined the estimated number of under-5 deaths due to birth defects, the birth defect specific under-5 mortality rate, and the per cent of under-5 mortality due to birth defects, by geographic region, national income and under-5 mortality rate for three age groups from 2000 to 2019.

Results
The under-5 deaths per 1000 live births from birth defects fell from 3.4 (95% uncertainty interval (UI) 3.1–3.8) in 2000 to 2.9 (UI 2.6–3.3) in 2019. The per cent of all under-5 mortality attributable to birth defects increased from 4.6% (UI 4.1%–5.1%) in 2000 to 7.6% (UI 6.9%–8.6%) in 2019. There is significant variability in mortality due to birth defects by national income level. In 2019, the under-5 mortality rate due to birth defects was less in high-income countries than in low-income and middle-income countries, 1.3 (UI 1.2–1.3) and 3.0 (UI 2.8–3.4) per 1000 live births, respectively. These mortality rates correspond to 27.7% (UI 26.6%–28.8%) of all under-5 mortality in high-income countries being due to birth defects, and 7.4% (UI 6.7%–8.2%) in low-income and middle-income countries.

Conclusions
While the under-5 mortality due to birth defects is declining, the per cent of under-5 mortality attributable to birth defects has increased, with significant variability across regions globally. The estimates in low-income and middle-income countries are likely underestimated due to the nature of the WHO estimates, which are based in part on verbal autopsy studies and should be taken as a minimum estimate. Given these limitations, comprehensive and systematic estimates of the mortality burden due to birth defects are needed to estimate the actual burden.

Objectives
This study was conducted to explore the epidemiology and microbiological pattern of the cholera outbreaks that occurred in Zimbabwe from 2018 to 2019.

Study setting and design
This descriptive study used secondary data of 9971 out of 10 730 suspected cases from the Zimbabwean National Diseases Surveillance system and microbiology data of 241 out of 371 patients from the National Microbiology Reference Laboratory in Harare, for the period 5 September 2018 and 3 January 2019. Descriptive analysis was performed to describe the characteristics of the outbreak in terms of person, place and time.

Results
A cumulative total of 10 730 suspected, 371 laboratory-confirmed cholera cases and 68 deaths were reported in Zimbabwe through the situation analysis report (sitrep). The attack rate during the outbreak was 174.6 per 100 000 with a case fatality rate of 0.63%. Most cases seen were among adults from Harare province. Antimicrobial sensitivity testing results showed that a multidrug resistant strain of Vibrio cholerae O1, Ogawa serotype was responsible for the outbreak. The treatment of cases was changed from the standard recommended medicine ciprofloxacin to azithromycin as confirmed by the antimicrobial sensitivity test results. Strategies employed to contain the outbreak included mass oral cholera vaccination in the hotspot areas of Harare, provision of improved and appropriate sanitation measures, provision of safe and adequate water, chlorination of water and improved waste management practice.

Conclusions
The recurrence of a cholera outbreak is a global concern, especially with the emergence of multi-drug resistant strains of the causal organism. Improving water, sanitation, hygiene infrastructure, health system strengthening measures and inter-sectoral collaboration in responding to the cholera outbreak was key to controlling the outbreak.

Negli ultimi sette giorni si registra un netto calo di tutti i parametri epidemici con un calo del 30% dei decessi e del 26% dei nuovi positivi