Risultati per: Linee guida ESC/ERS 2022 per la diagnosi e il trattamento dell'ipertensione polmonare

Stroke, Volume 56, Issue Suppl_1, Page ATMP37-ATMP37, February 1, 2025. Introduction:Limited studies have examined racial disparities in long-term survival after acute ischemic stroke (AIS) with inconsistent findings. We examined these disparities among Medicare fee-for-service (FFS) beneficiaries in U.S.Methods:We analyzed data on 1,997,487 Medicare FFS beneficiaries aged ≥65 years hospitalized with incident AIS (ICD-10 code I63) and survived >30 days from January 1, 2000 to December 31, 2017, and were followed-up until December 31, 2022. Cox proportional hazard models estimated the adjusted hazard ratio (aHR, 95% CI) and adjusted survival curves by race/ethnicity (non-Hispanic White (White), non-Hispanic Black (Black), Hispanic and Other). Models were adjusted for age, sex, and comorbidities.Results:The median age at AIS hospitalization was 78 years (IQR 72.0-84.0); 57.0% were women; 81.8%, 10.8%, 4.8% and 2.6% were White, Black, Hispanic and Other, respectively. Over a median follow-up of 4.9-years (IQR 1.7-8.8), there were 1,738,452 all-cause deaths. Adjusted 5-year survival after AIS improved from 2000-2004 to 2015-2017 for White (46.5% (95% CI 46.4-46.6) to 50.9% (50.7-51.1)), and Black (46.0% (45.8-46.3) to 48.9% (48.3-49.2)). For Hispanic and Other, survival remained largely unchanged: 54.4% (54.1-54.8) to 54.2% (53.6-54.8)) for Hispanic and 55.9% (55.4-56.4) to 54.7% (54.0-55.5) for Other. A clear pattern of long-term survival after AIS emerged by race/ethnicity showing similar survival between Hispanic and Other and between White and Black people (Figure). Stroke mortality risk was ~25% higher for White and Black compared to Hispanic and Other (aHR 1.25 (1.24-1.26)). This pattern was consistent across age groups and sex.Conclusions:Long-term survival after AIS has improved for White and Black Medicare FFS beneficiaries over time, while it remained largely unchanged for Hispanic and Other groups. This indicates persistent racial disparities in stroke outcomes.

Stroke, Volume 56, Issue Suppl_1, Page ATP327-ATP327, February 1, 2025. Self-reported stroke prevalence has increased among US adults aged 18-64 over the past decade and is projected to rise. As younger stroke survivors live longer, access to healthcare is essential for the detection, treatment, and monitoring of cardiovascular disease (CVD) risk factors to prevent recurrent stroke or other acute CVD events. Adults aged 1 personal healthcare provider, the ability to afford to see a doctor in the past year, and a routine checkup within the past year).Most stroke survivors reported healthcare access: 86.3% (95% CI 85.7 – 86.8 had insurance coverage and >1 personal healthcare provider); 26.6% (95% CI 25.9 – 27.3) couldn’t afford a doctor in the past year; and 81.2% (95% CI 80.6 – 81.1) had a routine checkup in the past year. Statistically significant differences (p < 0.05) were found across all sociodemographic groups. Younger adults (aged 18-29 and 30-44), men, and those with lower education reported less healthcare access. Varying measures of access were reported across racial/ethnic groups.Overall, most stroke survivors reported access to healthcare, although opportunities exist to improve access for younger adults, men, different racial/ethnic minorities, and those with lower education. Prior access to healthcare might have contributed to stroke survival for some individuals. Continued and improved healthcare access could help prevent recurrent stroke or other acute CVD event among stroke survivors.

Stroke, Volume 56, Issue Suppl_1, Page ATMP27-ATMP27, February 1, 2025. Background:In 2022, stroke shifted from the fourth to the fifth leading cause of death in the U.S. as COVID-19 temporarily took its place. Despite this change, stroke remains a significant cause of mortality and long-term disability in the U.S. This study analyzes trends in in-hospital mortality among stroke-related hospitalizations in California from 2016 to 2022, with a particular focus on the pandemic years.Methods:This retrospective analysis utilized patient discharge data from the California Department of Health Care Access and Information, screening nearly 25 million inpatient events for stroke-related ICD-10-CM diagnosis codes (I60-I63) among individuals 20 and older. Multivariate logistic regression (MLR) analysis assessed the impact of the pre- and post-COVID-19 periods on in-hospital mortality, adjusting for confounders such as age, gender, race and ethnicity, geographic regions, and payer source. Results were interpreted using Adjusted Odds Ratios (AOR).Results:The study identified 590,801 stroke-related hospitalizations and 66,096 in-hospital deaths (11.2%). Initially, the age-and-sex-adjusted in-hospital mortality rate decreased from 28.88 per 100,000 in 2016 to 27.38 in 2019. However, with the onset of COVID-19 in 2020, the rate increased to 27.94, peaking in 2021 at 30.78 during the pandemic’s height. In 2022, the rate slightly declined to 28.30 but remained above pre-pandemic levels.Similar trends from 2016 to 2022 were observed in age-adjusted rates for males, which increased from 27.77 to 29.73, and for females, which decreased from 29.91 to 26.98. The gap between male and female mortality rates widened significantly during the pandemic, with male mortality peaking in 2021 with a difference of 3.75.MLR analysis revealed a 22.6% increase in in-hospital mortality during the post-COVID period compared to the pre-COVID period (AOR=1.23, p

Stroke, Volume 56, Issue Suppl_1, Page ADP13-ADP13, February 1, 2025. Background:People with stroke are at high risk of dementia. There have been reductions in stroke case fatality and disability but temporal trends in the incidence and absolute burden of post-stroke dementia have not been described.Methods:We did a population-wide analysis of over 15 million people in Ontario, Canada between 2002-2022. Using linked administrative databases, we identified all 90-day dementia-free survivors of first acute ischemic stroke or intracerebral hemorrhage (ICH). We evaluated dementia incidence from 90-days after stroke onwards using a validated definition which included hospitalization, physician claims, and dementia medications. We calculated 1-year and 5-year incidence of dementia as percentages and per 100 person-years for each fiscal year, age-/sex-standardized by the 2002 population and with follow-up until March 2022. We stratified incidence trends by sex, stroke type, and severity (90-day home time of

Stroke, Volume 56, Issue Suppl_1, Page A129-A129, February 1, 2025. Background:The most common cause of arterial ischemic stroke (AIS) in previously healthy children, focal cerebral arteriopathy (FCA) can progress rapidly over days with worsening brain injury. A 2017 retrospective study of corticosteroid treatment for FCA changed practice at many pediatric stroke centers. To assess its impact, we compared FCA treatment rates and outcomes in FCA cohorts from the two Vascular effects of Infection in Pediatric Stroke studies.Methods:The (VIPS II) study prospectively enrolled and centrally confirmed 205 children (29 days to 18 years) with AIS at 22 centers (North America, Australia), 12/2016-1/2022. Study neuroradiologist (M.W.) and pediatric vascular neurologist (H.J.F.) independently reviewed all baseline and follow-up brain and vascular imaging and clinical data to classify the AIS etiology using published definitions from the original VIPS I study and confirm recurrent strokes; disagreements were resolved through discussion. M.W. measured the FCA Severity Score (FCASS); higher scores reflect more severe disease. We compared the FCA patients in VIPS II to those in VIPS I (2010-2014), the prospective cohort study with similar methods.Results:Of 75 children with definite arteriopathy enrolled in VIPS II, 43% had FCA, compared to 32% of 127 definite arteriopathy cases in VIPS I (Table). Treatment changed dramatically between the two studies, with 56% of VIPS II FCA cases receiving IV corticosteroids, compared to only 5% of FCA cases in VIPS I. The use of anticoagulation declined in favor of antiplatelets. Compared to VIPS I, the VIPS II FCA cases were more severe at baseline (median FCASS 6 versus 4; p=0.006). Among cases with short-term follow-up imaging, the increase in FCASS was not significantly different: median + 2 points in VIPS II (n=24) and +3 in VIPS I (n=33; p=0.76). The 12-month neurological outcomes were similar.Conclusions:Treatment of FCA with corticosteroids increased dramatically between the VIPS I and VIPS II studies, reflecting a major shift in clinical practice on the basis of modest evidence. VIPS II cases were more severe at baseline, but we observed no significant difference in disease progression or neurological outcomes. Pediatric stroke centers should enroll FCA patients into ongoing FCA corticosteroid treatment trials—PASTA in Europe and Australia and FOCAS in North America—that will provide rigorous data regarding the effectiveness and safety of this intervention.

Background
Anaemia is a worldwide public health problem affecting over 800 million reproductive-age women. In developing countries, postpartum anaemia is a significant cause of maternal morbidity and mortality. In Ethiopia, postpartum anaemia remains a public health issue.

Objective
To assess the magnitude of immediate postpartum anaemia and associated factors among postpartum mothers who delivered at public hospitals in the North Shoa Zone, Oromia regional state, Ethiopia, in 2022.

Design
A cross-sectional study was conducted. A systematic random sampling method was used to select study participants. Data were collected using Kobo Collect software and exported to the Statistical Package for the Social Sciences (SPSS) version 26 for analysis. Bivariable and multivariable logistic regression analyses were performed to examine associations between variables. Statistical significance was declared at a p-value of

Un servizio per le donne nelle prime settimane di gravidanza

Objectives
This study aimed to investigate the relationship between changes in physical activity and frailty among middle-aged and older adults in Korea, using panel data from the 2006–2022 Korean Longitudinal Study of Aging (KLoSA).

Design
Retrospective observational study.

Setting
For this longitudinal panel study, data were sourced from the KLoSA dataset.

Participants
We analysed data from 5594 participants (2855 males and 2739 females) extracted from KLoSA data collected between 2006 and 2022.

Primary and secondary outcome measures
The frailty index was calculated based on 6 clinical domains comprising 34 age-related health deficits. Changes in physical activity were categorised as persistently inactive, decreased, increased or persistently active. Logistic regression analysis using generalised estimating equations was conducted to assess the association between changes in physical activity and frailty.

Results
The persistently active group (OR=0.45, 95% CI: 0.40 to 0.50) showed a lower likelihood of frailty than did the persistently inactive group. In the group that increased their physical activity, the OR was 0.57 (95% CI: 0.52 to 0.63), and higher ORs were observed for current smokers and those residing in rural areas.

Conclusions
This study demonstrated that persistent and increased physical activity is associated with lower frailty in middle-aged and older adults in Korea. Therefore, participation in physical activity in the older adults is one of the important ways to prevent frailty.

Studio pubblicato nella rivista Nature Communications

Objectives
Health research that significantly impacts global clinical practice and policy is often published in high-impact factor (IF) medical journals. These outlets play a pivotal role in the worldwide dissemination of novel medical knowledge. However, researchers identifying as women and those affiliated with institutions in low- and middle-income countries (LMICs) have been largely under-represented in high-IF journals across multiple fields of medicine. To evaluate disparities in gender and geographical representation among authors who have published in any of five top general medical journals, we conducted scientometric analyses using a large-scale dataset extracted from the New England Journal of Medicine, Journal of the American Medical Association, The BMJ, The Lancet and Nature Medicine.

Methods
Author metadata from all articles published in the selected journals between 2007 and 2022 were collected using the DimensionsAI platform. The Genderize.io Application Programming Interface was then used to infer each author’s likely gender based on their extracted first name. The World Bank country classification was used to map countries associated with researcher affiliations to the LMIC or the high-income country (HIC) category. We characterised the overall gender and country income category representation across the five medical journals. In addition, we computed article-level diversity metrics and contrasted their distributions across the journals.

Results
We studied 151 536 authors across 49 764 articles published in five top medical journals, over a period spanning 15 years. On average, approximately one-third (33.1%) of the authors of a given paper were inferred to be women; this result was consistent across the journals we studied. Further, 86.6% of the teams were exclusively composed of HIC authors; in contrast, only 3.9% were exclusively composed of LMIC authors. The probability of serving as the first or last author was significantly higher if the author was inferred to be a man (18.1% vs 16.8%, p

Studio della Karolinska Institutet con l’Università Milano-Bicocca

Objective
To assess the acceptance of multiple micronutrient supplements and current iron and folic acid supplement utilisation among pregnant and lactating women in rural Ethiopia.

Design
Community-based cross-sectional study using a mixed method.

Setting
This study was carried out in five regions (Oromia, Gambela, Sidama, SNNPR (Southern Nations, Nationalities and Peoples Region) and Somali) of Ethiopia, 2022. A multistage random sampling technique was employed. A structured questionnaire was used to collect data from 410 pregnant and lactating women. A purposive sampling technique was used to select participants for the five Focused Group Discussions and fifteen Key Informant Interviews. Both bivariable and multivariable logistic regression analysis was conducted with a p value

Objective
This study aimed to assess the informed consent practice process and associated factors among healthcare workers for major surgical procedures at Gurage zone hospitals, in 2022.

Methods and materials
Institution-based cross-sectional study was employed.

Settings
This study was conducted in Gurage zone hospitals.

Participants
All healthcare workers who have been working in Gurage zone hospitals of surgical, operation rooms and obstetrics/gynaecology wards had exposure to patients who had undergone surgery during the study period

Outcome
The primary outcome of the study was the practice of informed consent practice among healthcare workers in Gurage zone hospitals.

Result
A total of 448 study participants were involved in this study giving a response rate of 98%. The mean (±SD) age of the study participants was 29.16 (±4.06) years. The mean score of study participants towards the surgical informed consent was 19.5, and 260 (58%, 95% CI: 53.7, 62.5) of them had good practice in the surgical informed consent. In multivariable logistic analysis model, factors like favourable attitude towards informed consent 2.4 (1.556, 3.596), work experience participants 4.9 (2.8, 8.7), adequate knowledge of informed consent 2.5 (1.6, 3.9) and communication challenge 1.6 (1.07, 2.50) were independently associated with the practice of informed consent at a p value of