Risultati per: GPG: Versione 5.0 (25 Novembre 2019)

Fnomceo, ‘le pari opportunità sono la priorità del nuovo Comitato centrale’

Objective
People living with HIV (PLWH) are disproportionately affected by substance use disorder (SUD) and mood/anxiety disorders, which are barriers to sustained viral suppression and can contribute to increased healthcare utilisations. This study examined the impact of SUD and mood/anxiety disorders on healthcare utilisation of PLWH with sustained and unsustained viral suppression.

Design and participants
This retrospective population-based cohort study used administrative data from 9757 antiretroviral-treated PLWH (83% men, median age 40 years). Eligible PLWH were≥19 years of age, followed during 2001–2019, and achieved viral suppression at least once during follow-up.

Setting
This study was conducted in British Columbia, Canada.

Measurements
The exposure variable consisted of eight levels and included (1) sustained suppression, (2) SUD and mood/anxiety disorder diagnoses and the interaction between (1) and (2). Outcome variables included annual counts of primary care and specialist physician visits, laboratory visits, acute care hospitalisation, day surgery episodes and hospital length of stay (LOS). Statistical count models were used to determine the effect of exposure variables on each healthcare utilisation outcome while adjusting for socioeconomic confounders.

Results
In the presence of sustained suppression, having both disorders was significantly associated with over four times more acute-care hospitalisations (0.28 vs 0.05), three times longer LOS (9.1 vs 3.0 days) and almost double primary care physician (13.1 vs 6.9) and specialist (7.9 vs 4.0) visits. Overall, SUD alone was associated with increased use of all healthcare services (except day surgery). Regardless of disorder diagnoses, unsustained suppression was associated with higher healthcare utilisation (except day surgery).

Conclusion
In this study, SUD, mood/anxiety disorders and unsustained suppression, when combined, resulted in the highest healthcare utilisation among PLWH. The results suggest that providing comprehensive mental health and substance use services to PLWH and addressing barriers to sustained suppression could reduce the healthcare burden within this population.

Objective
To describe demographics, causative pathogens, hospitalisation, mortality and antimicrobial resistance (AMR) of bacterial bloodstream infections (BSIs) among beneficiaries in the global US Military Health System (MHS), a single-provider healthcare system with 10-year longitudinal follow-up.

Design
Retrospective cohort study.

Setting
Clinical and demographic data collected from the MHS Data Repository and collated with microbiological data obtained from the Defense Centers for Public Health-Portsmouth.
Participants: 12 748 MHS beneficiaries diagnosed with 15 357 bacterial BSIs (2010–2019).

Main outcome(s) and measure(s)
Demographic data and diagnosis codes preceding BSI episodes and during hospitalisations were collected. Inpatient admission data identified acute clinical diagnoses, intensive care unit (ICU) admission and mortality. BSI pathogens were evaluated for AMR, including difficult-to-treat resistance (DTR). Crude mortality trends were assessed.

Results
The decade analysed included 15 357 BSI episodes in 12 748 patients; 6216 patients (48.8%) were≥65 years and 83.7% of episodes had≥1 comorbidity (12 856 of 15 357). Approximately 29% of episodes with hospitalisation required ICU admission and~34% had concurrent urinary tract infections. Pathogen distribution was 53% and 47% for Gram-positive bacteria and Gram-negative bacilli (GNB), respectively. Inpatient mortality was 4.4%, and at 1 year was 23.4%; 0.5% (16 of 2977) of deaths were associated with DTR GNB. Among an average 8 145 778 individuals receiving care annually in the MHS, annual rates of overall BSI, methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus spp and DTR GNB BSI were 18.9, 1.30, 0.25 and 0.05 per 100 000 beneficiaries, respectively. Over the decade, annual mortality did not significantly increase for any pathogen and decreased by~2% for overall BSI (p=0.024) and~3% for lactose-fermenting GNB BSI (p=0.048).

Conclusions
In the global US MHS, the mortality burden associated with BSI was substantial (approximately one in four dying at 1 year), relatively unchanged over a decade, and associated with older age and comorbidities. First-line treatment options remained available for 99.7% of BSIs. Population-level improvements in BSI survival might be maximally influenced by focusing on prevention, early detection, prompt antibiotics and other novel therapies not contingent on in vitro activity.

Tra i motivi, ricerca di partner stabile e social freezing

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Usata soprattutto per dolore cronico, 28 mila pazienti trattati

Objective
To examine trends in the prevalence of depression and anxiety during the COVID-19 pandemic among US adult cancer patients and survivors (CPS) in comparison to those of non-CPS (NCPS).

Methods and analysis
National Health Interview Survey 2019–2022 data were analysed using spline logistic regression.

Results
A total of 115 664 participants completed the survey (mean age (SD), 52.8 (18.4) years; 54.3% female; 12.6% CPS). The age-adjusted prevalence of depression significantly increased from 26.53% in 2019 to 29.78% in 2022 among CPS, while that of anxiety increased from 24.02% in 2019 to 28.08% in 2022. Throughout the pandemic, there were consistently significant annual increases in the prevalence of both depression and anxiety with CPS experiencing significantly faster rates of increase compared with NCPS (average annual absolute increase 0.72% in NCPS vs 1.08% in CPS, p

Objectives
This study aimed to assess the global burden of oesophageal cancer (EC) attributable to alcohol consumption across 204 countries and territories from 1990 to 2019. Alcohol use is a major modifiable risk factor for EC, with unique biological and epidemiological effects compared with other contributors such as smoking, necessitating a focused analysis of its global impact.

Design
We analysed trends in EC attributable to alcohol consumption from 1990 to 2019 using data from the Global Burden of Disease (GBD) 2019 study.

Setting
Data were obtained from the GBD Results Tool, covering 204 countries and territories across 21 GBD regions.

Participants
Patients with EC attributable to alcohol consumption.

Main outcomes and measures
The number and age-standardised rates of deaths and disability-adjusted life-years (DALYs) due to EC attributable to alcohol consumption are presented by region for 1990 and 2019, along with the number of deaths, age-standardised mortality rates (ASMR) and age-standardised DALY rates (ASDR) in 204 countries and territories in 2019. Geographical variations were visualised using maps, and linear regression analyses were performed to assess the association between the Socio-Demographic Index (SDI) and EC mortality and DALY rates.

Results
In 2019, there were 113 600.3 deaths (95% uncertainty intervals (UIs): 84 062.5–144 685.6), contributing to 2818.2×103 DALYs (95% UI: 2109.6–3573.6). From 1990 to 2019, total deaths and DALYs associated with EC increased, while age-standardised rates decreased. ASMR and ASDR decreased in high SDI populations but plateaued in low-middle or low SDI populations for both genders. China recorded the highest death toll (61 887.7, 95% UI: 42 882.6–84 201.3), while Uganda had the highest ASMR (4.48, 95% UI: 3.06–6.26) and ASDR (119.21, 95% UI: 80.72–167.22). Males accounted predominantly for EC attributed to alcohol use.

Conclusions
Globally, there was a decline in ASMR and ASDR but an increase in overall deaths and DALYs related to EC from 1990 to 2019. The burden of EC varied across regions and countries, with Uganda exhibiting the highest ASMR, and China having the highest fatalities. The association between alcohol and EC was more pronounced in males than females.

In this age group, cervical cancer mortality has decreased dramatically in recent years.

Objective
Our study aims to evaluate the spatial and temporal changes of breast-conserving surgery (BCS) rates and influential factors of BCS in Guangdong Province, China.

Design, setting and participants
This registry-based cohort study analysed the data of patients of all age groups, from the medical record cover page, which was mandatorily collected for inpatients by the Health Administrative Department of Guangdong Province, China. Patients with non-metastatic breast cancer, who underwent breast surgery between 2013 and 2019, were included.

Main outcomes and measures
We analysed the BCS rate in Guangdong Province between 2013 and 2019. Logistic regression was applied to investigate the association between patient-level influential factors and BCS, respectively. We used restricted cubic spline regression to model the non-linear association between hospital volume rank with BCS rate. Linear regression was used to evaluate the association between city-level parameters with BCS rate of each city.

Results
A total of 93 521 patients with non-metastatic breast cancer, who underwent breast surgery, were included in the analyses. Among them, 10 949 (11.7%) had BCS, with the BCS rates increasing from 0.8% in 2013 to 19.2% in 2019. Patients who were older (vs

Stroke, Volume 56, Issue Suppl_1, Page A23-A23, February 1, 2025. Background:Functional impairments following stroke remain a significant therapeutic challenge. Vivistim, FDA-approved since 2021, has shown consistent results, providing 2-3 more improvement in arm and hand function compared to intensive rehabilitation alone. At Atlantic Health System, 25 patients underwent Vivistim implantation and received Paired VNS rehabilitation.Methods:A multidisciplinary team at AHS identified, educated, and implanted Vivistim in 25 post-acute stroke patients with moderate-to-severe motor impairments in the arm and hand. Post-implantation, patients were referred to one of 11 sites. Regular follow-ups were conducted by the implanting team to monitor side effects, safety and efficacy of this novel intervention.Results:All 25 patients successfully underwent outpatient implantation, with no reported infections at the implant sites. One patient developed a hematoma that resolved without intervention. Another required device explantation approximately 410 days post-therapy due to tingling sensations near the implant site likely unrelated to the device. This patient maintained a 25-point improvement on the Fugl-Meyer Assessment-Upper Extremity (FMA-UE) despite explantation, indicating sustained benefits. Of the 25, 22 completed the therapy protocol. The remaining three discontinued therapy due to unrelated complications: one experienced two grand mal seizures linked to changes in seizure medication, another sustained an arm injury from a fall, and the third developed double vision, impairing her ability to drive. Patient ages ranged from 40 to 80 years (mean 62.6), with time to implantation post-stroke ranging from 1 to 11 years (mean 3.6). The interval from implantation to therapy initiation varied from 8 to 32 days (mean 15.3). The baseline FMA-UE score averaged 33 (range 19-56), with an average post-therapy score of 43 (range 24-63), for a mean improvement of 9.53 points. Notably, the patient with the longest follow-up (22 months) showed continued progress, reducing her 9-Hole Peg Test time by 61.42 seconds over her assessment 6 months prior.Conclusion:This case series represents the largest cohort reported to date from a single implanting site in a real-world setting. Vivistim was implanted safely, with no infections or surgical complications. Patients showed positive responses to Paired VNS despite an average of 3.6 years post-stroke, supporting the efficacy of this innovative treatment in the chronic stroke population.

Stroke, Volume 56, Issue Suppl_1, Page A25-A25, February 1, 2025. Background:Rehabilitation therapy is an important component of acute ischemic stroke (AIS) recovery. A major hinderance is the inability to predict which patients benefit from mobilization during the first 24 hours (ERehab). We hypothesize serum biomarker analyses during the hyperacute phase can bridge the gap.Methods:This is a single center study of 20 AIS patients&14 age/sex matched controls enrolled from 3/2022-6/2023. Serum samples were collected at 4 time points – angiography suite before cerebral reperfusion or Neuro ICU at hospital admission, 12, 24&72 hours. Biomarker candidates were identified using a DisGeNET search for AIS associated proteins; 70% achieved an Evidence Index cutoff score of 1, indicating all publications support human gene-disease or variant-disease associations. Time course of serum proteome changes was evaluated using aptamer-based SomaScan assay, measuring 1500 proteins. NIH Database for Annotation, Visualization&Integrated Discovery (DAVID) Gene Functional Classification Tool compared shared genes and biomarkers for stroke (vs healthy controls)&unfavorable (vs favorable) outcome, characterized by modified Rankin Scale (mRS) score of 3-6 (vs 0-2), at hospital discharge&90 days (90d).Results:The mean age of AIS patients was 59 years, 65% were male. Median NIHSS score was 11, Charlson Comorbidity Index score was 5.5 and the median last known well to hospital admission was 6.6 hrs. The average time to first mobilization was 39 hrs, 25% received ERehab. The mean rehab duration during AIS hospitalization was 438 min; median length of stay was 8.4 days, 40% received post-acute rehabilitation. Median AIS volume was 36mL, 65% of patients had ICA or M1/MCA involvement. Approximately 65% received IV thrombolysis, 80% underwent cerebral reperfusion therapy, 94% achieved modified thrombolysis in Cerebral Infarction score ≥ 2b. The median mRS was 4 at hospital discharge, 3 at 90d. Mortality rate was 10%. DAVID analyses resulted in 22 biomarkers at hospital discharge&35 biomarkers at 90d associated with favorable outcome. Gene expression differences were present at each time point (Figure).Conclusions:We identified multiple serum biomarkers and gene clusters associated with favorable outcomes at hospital discharge and 90d in AIS patients, indicating a need for several biologic targets to predict ERehab response during the hyperacute phase. These findings provide an early framework for tailored stroke recovery interventions.

Stroke, Volume 56, Issue Suppl_1, Page A50-A50, February 1, 2025. Introduction:Hematoma expansion (HE) occurs in one-fourth of patients with acute intracerebral hematoma (ICH) and is associated with worse outcomes. Existing radiological markers of HE show modest predictive accuracy. We aim to investigate a novel radiological marker that co-localizes findings from non-contrast CT (NCCT) and CT angiography (CTA) to predict HE.Methods:We analyzed 200 consecutive acute ICH patients admitted at Foothills Medical Centre in Calgary, Canada (development cohort) and analyzed 304 patients from the multicenter observational study PREDICT (validation cohort). The Black-&-White (B&W) sign was defined as any visually identified spot sign on CTA co-localized with a hypodensity sign on the corresponding NCCT (Figure 1). The primary outcome was hematoma expansion (≥6mL or ≥33%). Secondary outcomes included absolute (

Stroke, Volume 56, Issue Suppl_1, Page AWMP64-AWMP64, February 1, 2025. Background and Objectives:Emerging literature suggests that non-stenotic carotid disease (

Stroke, Volume 56, Issue Suppl_1, Page AWMP53-AWMP53, February 1, 2025. Background:Treatment options and outcomes in stroke also depends on pre-hospital delays. The goal of this study is to describe onset-to-door times (ODT) across many countries and also investigate how the mode of arrival affects ODT.Methods:This is an analysis of the data from the Registry of Stroke Care Quality (RES-Q), years 2022&2023. RES-Q is used across the world for audit of clinical care. Data were stratified by the mode of arrival (EMS vs. non-EMS). Median ODT were analyzed, and 95% confidence intervals (CI) were calculated for each country and arrival mode.Results:Of 334,184 patients from 1,130 hospitals in 70 countries, 155,532 patients from 25 countries were diagnosed with acute ischemic stroke after excluding secondary transfers (n=32,349), cases from countries with fewer than 1,000 cases (n=128,660), and those with missing data or typing errors (n=17,643). The median ODT was 193 mins (95% CI: 164-223) for patients arriving by EMS and 309 mins (95% CI: 274-360) for those arriving by non-EMS. The percentage of EMS arrival by region was 34% (Africa), 30% (Asia), 39% (Latin America), and 87% (Europe). The percentage of EMS arrivals is shown in Figure 1. Compared to the patients who reached by non-EMS mode, patients who reached by EMS mode were more likely to receive intravenous thrombolysis (16% vs 44%,). The ODTs by mode of arrival and country are detailed in Figure 2.Conclusions:Transport via EMS was associated with a reduced arrival time nearly by 2 hours and tripled the chance of receiving thrombolysis as compared to non-EMS transportation. The percentage of patients arriving by EMS was higher in European countries as compared to Africa, Asia and Latin America and this is reflected by shorter ODT in many EU countries. Improvements in EMS infrastructure could improve stroke outcomes globally.