Risultati per: GPG: Versione 5.6.2.1 (Aprile 2021)

Stroke, Volume 55, Issue Suppl_1, Page AWMP60-AWMP60, February 1, 2024. Introduction:Extensive evidence shows that social inequities create health disparities. However, limited information exists on how demographic and clinical factors are associated with social inequities among older patients hospitalized with acute ischemic stroke (AIS) during COVID-19.Methods:We analyzed data on Medicare fee-for-service beneficiaries aged ≥65 years hospitalized with AIS from April 1, 2020, to December 31, 2021. All patients were followed until March 31, 2023. We used US Centers for Disease Control and Prevention’s 2020 Social Vulnerability Index (SVI) and compared demographic and clinical features by SVI tertiles (low 0-0.33, moderate 0.34-0.66, high 0.67-1.0).Results:Among 249299 Medicare FFS beneficiaries with AIS, there were 57814 (23.2%) with low, 88565 (35.5%) moderate, and 102920 (41.3%) high SVI. Demographic and clinical features differed significantly across SVI tertiles. Compared to AIS patients living in low SVI communities, patients living in high SVI areas were significantly younger (median age 79.0 vs 79.9 years), more likely to be non-Hispanic Black (15.4% vs 4.3%), had more severe stroke at admission per National Institutes of Health Stroke Scale (NIHSS) score (9.4% NIHSS ≥20 vs 8.4%), more history of COVID-19 (7.7% vs 6.3%), higher proportion of death at the end of follow-up (40.4% vs 38.2%), and more comorbidities.Conclusion:Medicare patients with AIS hospitalizations live in communities with higher SVI. These data identified racial disparities and more severe outcomes among AIS patients living in areas with higher social vulnerabilities, signaling a need for multisectoral interventions and policies that impact AIS outcomes.

Stroke, Volume 55, Issue Suppl_1, Page AWP280-AWP280, February 1, 2024. Introduction:Veterans represent a unique population who may be at higher risk of developing stroke. The association between Veteran status and stroke and associated outcomes have not been well described.Methods:We performed a retrospective, cross-sectional analysis of the 2021 Behavioral Risk Factor Surveillance System. Participants were stratified based on Veteran status. Demographics, social factors, and vascular risk factors were compared between the two groups. Logistical regression models were created to explore the association between Veteran status and stroke. Health and functional limitations were also compared between Veterans and Non-Veterans with stroke.Results:We identified 52,518 Veterans and 382,958 Non-Veterans. Veterans more often self-reported a history of stroke compared to non-veterans (6.2% vs. 3.6%, p

Stroke, Volume 55, Issue Suppl_1, Page A43-A43, February 1, 2024. Objectives:To examine whether thrombolysis care metrics have improved in all races and ethnicities with the launch and advance of Target: Stroke (TS) national quality initiatives.Methods:This cohort study included patients presenting to Get With The Guidelines (GWTG)-Stroke participating hospitals within 4.5 hours of ischemic stroke onset from 2003 to 2021. Thrombolysis rates and speed of treatment during TS phase I (2010-2013), II (2014-2018), and III (2019-2021) were compared with the pre-TS period (2003-2009).Results:Among all the patients with ischemic stroke, Asian, Black, and Hispanic individuals, compared with White, were significantly more likely to present after the 4.5-hour thrombolysis treatment window (Figure/Panel A and B). Among the 1,182,182 patients arriving within 4.5 hours, 33,375 were Asian, 180,315 Black, 86,831 Hispanic, and 881,661 White. Unadjusted rates of thrombolysis treatment increased in all race-ethnic groups from 2003 to 2021 (Figure/Panel C) with no significant disparities. Disparities were evident in adjusted analyses (Figure/Panel D) and persisted in TS:III when, compared with White patients, Asian, Black, and Hispanic patients had significantly lower odds of receiving thrombolysis (0.85, 0.76, and 0.86) (all p values

Aumenta la circolazione di medicinali per perdere peso contraffatti

Background
Chongqing, the most populous city in Southwest China. This study aims to examine the equity of health resource allocation in Chongqing using the latest statistics, analyse possible shortcomings and propose strategies to address these issues.

Methods
This cross-sectional study used healthcare resource, population, area and gross domestic product data from the Seventh National Census Bulletin of Chongqing, the National County Statistical Yearbook, the Chongqing Municipal Bureau of Statistics and the Chongqing Health Statistical Yearbook 2022. We also studied the equity of health resource allocation in Chongqing by using the Gini coefficient, Lorenz curve and Theil index, and used the Analytical Hierarchy Process and Technique for Order of Preference by Similarity to Ideal Solution (AHP–TOPSIS) method to comprehensively evaluate the health resources in the four major regions of Chongqing.

Results
The Gini coefficient of health resources in Chongqing in 2021 was the highest when allocated according to geographical area, between 0.4285 and 0.6081, both of which exceeded 0.4, and the Gini coefficient of medical equipment was the highest and exceeded 0.6. The inter-regional Theil index of each resource was greater than the intraregional Theil index, and the contribution of inter-regional differences ranged from 64.83% to 80.21%. The results of the AHP–TOPSIS method showed that the relative proximity between health resources and ideal solutions in four regions of Chongqing ranged from 0.0753 to 0.9277.

Conclusion
The allocation of health resources in Chongqing exhibits pronounced inequities, particularly in the distribution of medical equipment according to geographical area. Moreover, there exists a substantial gap in the equity of health resource allocation among the four regions of Chongqing. As such, this study emphasises the need for Chongqing, China, to prioritise the equitable allocation of health resources and increase consideration of geographic factors. Implementing measures to promote equitable allocation of health resources, particularly in geographic terms, is critical.

Objective
To evaluate the hospitalised patients with uterine fibroids (UFs) and describe treatment patterns in hospital-treated patients in central China from 2018 to 2021.

Design
A retrospective analysis.

Setting
The gynaecology departments of class A and class B secondary and tertiary hospitals in Hubei Province, China.

Participants
101 008 patients diagnosed with UFs from 1 January 2018 to 31 December 2021.

Results
The hospitalised patients with UFs increased with age, reaching a peak at ages 45–49 years and then gradually decreasing. Among these patients, 19.05% had anaemia symptoms. Women aged 25–29 years were more likely to be treated with laparoscopic myomectomy (62.22%), while women aged 20–24 years tend to choose open myomectomy (34.58%). Women over age 45 years who had entered perimenopause tended to be treated with laparoscopic hysterectomy (64.85% for those aged 65–69 years). Patients with fibroid with moderate-to-severe anaemia mostly chose hysterectomy. As a whole, the proportion of patients who chose laparoscopic hysterectomy was similar to that of patients who chose laparoscopic myomectomy (31.38% vs 31.14%). Only 2.08% of UFs were treated with high-frequency MRI-guided focused ultrasound surgery (MRgFUS). The number of patients who choose laparoscopic surgery or MRgFUS treatment was increasing year by year. After stratifying by hospital grade, we found that women treated at class A tertiary hospitals were more likely to have laparoscopic than open surgery (66.12% vs 31.26%). At class B secondary hospitals, 61.9% of the patients underwent myomectomy. By contrast, hysterectomy was used to treat the majority of patients at class A secondary hospitals and class B tertiary hospitals (57.79% and 57.57%, respectively). Use of MRgFUS was mainly concentrated within class A tertiary hospitals.

Conclusion
UFs affect mainly women in childbearing period. Most patients chose to receive treatment at class A tertiary hospitals, among which laparoscopic myomectomy was the mainstream surgical method for patients in Hubei Province.

Trial registration number
NCT05840042.

This Medical News story discusses the latest data on measles cases, deaths, and vaccination coverage worldwide.

Objective
This research aimed to assess COVID-19 vaccine acceptance and the factors influencing it among the population of the Somali region in Ethiopia through a cross-sectional COVID-19 survey.

Design
Community-based cross-sectional study.

Setting
The survey was conducted in eight selected districts of the Somali region in Ethiopia from 20 October 2021 to 30 October 2021.

Participants
Participants were chosen using simple random sampling and data analysis used Stata V.14. Both bivariable and multivariable binary logistic regression methods were applied, with variables having a p value below 0.2 considered for inclusion in the final model, where statistically significant factors were identified at p

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

Circulation, Volume 148, Issue 24, Page e281-e281, December 12, 2023.

Objectives
The study aim was to evaluate vaccine effectiveness (VE) of COVID-19 vaccines in preventing symptomatic COVID-19 among healthcare workers (HCWs) in Zambia. We sought to answer the question, ‘What is the vaccine effectiveness of a complete schedule of the SARS-CoV-2 vaccine in preventing symptomatic COVID-19 among HCWs in Zambia?’

Design/setting
We conducted a test-negative case–control study among HCWs across different levels of health facilities in Zambia offering point of care testing for COVID-19 from May 2021 to March 2022.

Participants
1767 participants entered the study and completed it. Cases were HCWs with laboratory-confirmed SARS-CoV-2 and controls were HCWs who tested SARS-CoV-2 negative. Consented HCWs with documented history of vaccination for COVID-19 (vaccinated HCWs only) were included in the study. HCWs with unknown test results and unknown vaccination status, were excluded.

Primary and secondary outcome measures
The primary outcome was VE among symptomatic HCWs. Secondary outcomes were VE by: SARS-CoV-2 variant strains based on the predominant variant circulating in Zambia (Delta during May 2021 to November 2021 and Omicron during December 2021 to March 2022), duration since vaccination and vaccine product.

Results
We recruited 1145 symptomatic HCWs. The median age was 30 years (IQR: 26–38) and 789 (68.9%) were women. Two hundred and eighty-two (24.6%) were fully vaccinated. The median time to full vaccination was 102 days (IQR: 56–144). VE against symptomatic SARS-CoV-2 infection was 72.7% (95% CI: 61.9% to 80.7%) for fully vaccinated participants. VE was 79.4% (95% CI: 58.2% to 90.7%) during the Delta period and 37.5% (95% CI: –7.0% to 63.3%) during the Omicron period.

Conclusions
COVID-19 vaccines were effective in reducing symptomatic SARS-CoV-2 among Zambian HCWs when the Delta variant was circulating but not when Omicron was circulating. This could be related to immune evasive characteristics and/or waning immunity. These findings support accelerating COVID-19 booster dosing with bivalent vaccines as part of the vaccination programme to reduce COVID-19 in Zambia.

Scompaiono quasi 500 strutture territoriali

Objectives
To assess work-related stress (WRS) and associated factors among health professionals working in Ambo town governmental health facilities, in 2021.

Design
Institution-based analytical cross-sectional study.

Setting
Institution-based analytical cross-sectional study was conducted in Ambo town from 15 July 2021 to 15 August 2021. A simple random sampling technique was used to select 420 participants. Data were collected by using structured self-administered questionnaire. Descriptive statistics was used to show the magnitude of WRS. Multivariate logistic regression was employed to identify variables that are significantly associated with WRS at 95% CI and p value

Objective
China concentrates a large part of the global burden of HBV infection, playing a pivotal role in achieving the WHO 2030 global hepatitis elimination target.

Methods
We searched for studies reporting HBV surface antigen (HBsAg) seroprevalence in five databases until January 2023. Eligible data were pooled using a generalised linear mixed model with random effects to obtain summary HBsAg seroprevalence. Linear regression was used to estimate annual percentage change (APC) and HBsAg prevalence in 2021.

Results
3740 studies, including 231 million subjects, were meta-analysed. HBsAg seroprevalence for the general population decreased from 9.6% (95% CI 8.4 to 10.9%) in 1973–1984 to 3.0% (95% CI 2.1 to 3.9%) in 2021 (APC=–3.77; p

A recent analysis found only a modest difference in outcomes after in-person medical visits compared with telemedicine during the COVID-19 pandemic, “suggesting that telephone or video telemedicine was still capable of addressing most patient clinical concern areas,” the researchers wrote.