Highest Number Of Deaths Research Articles

Systematic analysis and prediction of the burden of lower respiratory tract infections attribute to non-optimal temperature, 1990-2019.

Lower respiratory infections (LRIs) remain one of the most deadly infectious diseases in the world, and non-optimal temperature is a risk factor for LRIs. The aim of this study was to analyze the global burden of LRI attribute to non-optimal temperature and its trends from 1990 to 2019, and to project long-term trends. Excerpts from the release of the 2019 Global Burden of Disease (GBD) study, which analyses the burden of lower respiratory infections due to non-optimal temperatures from 1990 to 2019 using data on deaths and disability adjusted life years (DALYs); explores differences across regions, populations and seasons, and projects future trends in burden. Between 1990 and 2019, there is a significant downward trend in the global burden of deaths and DALYs, but it remains high in infants and young children, the older adult, African countries and LOW SDI regions. Differences in geographical risk factors and economic levels lead to heterogeneous disease burdens across regions. In 2019, low SDI regions will have the highest burden, but high SDI regions will have the highest number of deaths. In addition, increasing SDI values were associated with decreasing trends in age-standardized mortality rates and disability-adjusted life years. BAPC model projections suggest a downward trend in the future burden of death and DALYs from the disease, but the improvement in the burden of death for women was not significant. Our study comprehensively elucidates the distribution and dynamic trends in the burden of lower respiratory tract infections due to non-optimal temperatures from 1990 to 2019 along multiple dimensions. The burden of deaths and DALYs showed an overall decreasing trend, but the improvement was uneven in different regions. In addition, the results suggest that efforts should be made to reduce lower respiratory health losses in infants, young children, and older adult populations. Effective public health policies and interventions to reduce the burden of lower respiratory tract infections should be sustained globally.

8702 Age-Sex Differences in Global Burden of Ischemic Heart Disease Attributable to High LDL in the Last 3 Decades:Global, Regional, National Variations, Age Dynamics, and Implications for Global Health

Abstract Disclosure: V. Adedara: None. K. Maddineni: None. A. Dekhne: None. M. Chinthapalli: None. G. Potluri: None. A. Parisapogu: None. K. Markandu: None. H. Desai: None. Background: Ischemic Heart Disease (IHD) stands as the foremost cause of mortality globally, contributing to 9.6 million deaths. Elevated levels of low-density lipoprotein cholesterol (LDL-C) consistently feature among the risk factors associated with IHD. Methods: Employing the Global Burden of Disease framework, we computed mortality and DALYs linked to IHD attributable to LDL-C, stratified by age-sex, year, and covering 204 countries and territories during the period from 1990 to 2019. Non-fatal health outcomes were estimated using DISMOD MR 2.1, Bayesian meta-regression tool for epidemiological modelling. Results were expressed in absolute counts and age-standardized rates (ASR) per 100,000 person-years. Results: The total number of deaths attributed to IHD due to elevated LDL-C increased from 2.5 million (95% Uncertainty Interval: 2-3.1 million) in 1990 to 3.7 million (95% UI: 2.8-4.8 million) in 2019. Concurrently, DALYs increased from 60.4 million (95% UI: 50.4-70.7 million) in 1990 to 84.9 million (95% UI: 69.5-101.3 million) in 2019. In terms of ASR, the annual percentage change (APC) in death rates decreased by 36%, and DALY rates decreased by 32% from 1990 to 2019. Regionally, East Asia exhibited the highest increase in APC in death counts by 191%, followed by Commonwealth Low-Income countries at 164%, and Oceania at 160% during the same period. Conversely, the Commonwealth High-Income region experienced the highest decrease at 41%. Males displayed higher APC in death (48% vs. 44%) and DALYs (42% vs. 38%) compared to females over the last three decades. In terms of ASR, males observed a higher decrease compared to females. In 2019, the age group 80-84 years had the highest number of deaths at 534,079 (264,177-813,898), while DALYs were most pronounced in the 55-59 year age group, reaching 10.6 million (8.9-12.3 million). Conclusion: IHD remains a significant global health challenge, with high LDL-C levels being a crucial modifiable risk factor. Age-sex disparities in the burden of IHD are evident, driven by variations in LDL-C metabolism, hormonal changes, and lifestyle factors. Recognizing and addressing these disparities is essential for developing effective prevention and treatment strategies tailored to different populations and age groups. Presentation: 6/2/2024

SOCIAL IMPACT ON PUBLIC ADMINISTRATION: TRAFFIC ACCIDENTS ON BRAZILIAN HIGHWAYS

The aim of this research was to evaluate statistical relationships between variables inherent to accidents and traffic incidents on Brazilian federal highways in 2020. This is an applied study with a quantitative, exploratory, and descriptive approach. The data source was the website of the Brazilian Federal Highway Police, and the locus was the entire Brazilian territory. Data analysis was inferential, given the application of statistical methods via significance hypothesis tests. The Northeast and Southeast regions had the highest number of deaths from traffic accidents (1,571 and 1,371), respectively. On weekends, the majority (21,087) of incidents were recorded during the day (34,397), however, fatal accidents were predominantly recorded at night. The straight track layout had the majority of records (38,336), collisions between vehicles were the most lethal type of accident (2,955), and rural areas recorded twice as many deaths compared to urban areas. In 2020, the COVID-19 pandemic occurred, where restrictive measures on human movement directly influenced traffic accident statistics, especially in the period from March to April 2020, especially in the Southeast and South regions, impacting social relations and public administration due to traffic victimization.

The Archaeology of Absence in Kamila Shamsie’s <i>A God in Every Stone</i>

Approximately 1.4 million Indians were recruited to the First World War. Despite their role in the war and the high number of deaths, most of the literature in English on the Great War has been narrowed down to British experience. However, in recent years their stories have been emerging through fiction, in academic research and educational projects resulting in a more complete picture of the war and who was involved. A British arts education group engaged students in a project designed to teach and share the stories of forgotten soldiers from World War I. Writing about the project in The Guardian in 2018 Kamila Shamsie claimed the aim was to teach school children about the war and the involvement of non-British recruits whose narratives had up till then been unknown. In academia, respected scholars such as Santanu Das or Claire Buck have undergone thorough research on the representation of Indian recruits through an analysis of literary texts and artefacts states that war memories of the Indian sepoy whose stories were left behind and forgotten on the battle ground. According to Das, the lack of stories by Indian recruits does not mean that history cannot be rectified since it is possible to recover the experience and memory of the recruits. Recently emerging literary representation of the Indian recruit provided historical insight into their experience shedding light on new perspectives of the War. The aim of this article is to analyse the representation of Indian recruits and their experience of World War I in Kamila Shamsie’s 2014 novel <i>A God in Every Stone.</i> I argue that through fiction, it is possible to construct a broader and more inclusive understanding of this historical event as well as to uncover deeper complexities and anxieties on the Indian colonial experience.

Genome-wide fitness analysis of Salmonella enterica reveals aroA mutants are attenuated due to iron restriction in vitro.

Salmonella enterica is a globally disseminated pathogen that is the cause of over 100 million infections per year. The resulting diseases are dependent upon host susceptibility and the infecting serovar. As S. enterica serovar Typhimurium induces a typhoid-like disease in mice, this model has been used extensively to illuminate various aspects of Salmonella infection and host responses. Due to the severity of infection in this model, researchers often use strains of mice resistant to infection or attenuated Salmonella. Despite decades of research, many aspects of Salmonella infection and fundamental biology remain poorly understood. Here, we use a transposon insertion sequencing technique to interrogate the essential genomes of widely used isogenic wild-type and attenuated S. Typhimurium strains. We reveal differential essential pathways between strains in vitro and provide a direct link between iron starvation, DNA synthesis, and bacterial membrane integrity.IMPORTANCESalmonella enterica is an important clinical pathogen that causes a high number of deaths and is increasingly resistant to antibiotics. Importantly, S. enterica is used widely as a model to understand host responses to infection. Understanding how Salmonella survives in vivo is important for the design of new vaccines to combat this pathogen. Live attenuated vaccines have been used clinically for decades. A widely used mutation, aroA, is thought to attenuate Salmonella by restricting the ability of the bacterium to access particular amino acids. Here we show that this mutation limits the ability of Salmonella to acquire iron. These observations have implications for the interpretation of many previous studies and for the use of aroA in vaccine development.

Mortality associated with osteoporosis and pathological fractures in the United States (1999–2020): a multiple-cause-of-death study

BackgroundOsteoporosis with pathological fractures is a significant public health issue, contributing to morbidity, disability, diminished quality of life, and increased mortality. Understanding mortality trends related to this condition is crucial for developing effective interventions to reduce mortality and improve healthcare outcomes. This study aimed to analyze trends and causes of death associated with osteoporosis and pathological fractures in the United States using a multi-cause approach.MethodsAnnual death and age-standardized mortality rate (ASMR) data from 1999 to 2020 were obtained from the Centers for Disease Control and Prevention (CDC) mortality database. Death certificates listing ICD-10 M82 (osteoporosis with pathological fracture) as an underlying or related cause of death were analyzed. Epidemiological data were analyzed, and the ASMR data were calculated for each year, and trends were assessed using the Cochran-Armitage trend test.ResultsFrom 1999 to 2020, there were 40,441 deaths related to osteoporosis with pathological fractures in the United States, with a female-to-male ratio of 5.6:1. Among these, 12,820 deaths (31.7%) listed osteoporosis with pathological fractures as the underlying cause of death (UCD), yielding a female-to-male ASMR ratio of approximately 5.0-7.7:1. When classified as a non-UCD, the ASMR ratio was approximately 4.8–6.2:1. At the same time, we found that the total number of deaths classified as UCD and multiple causes of death (MCD), but the trend ratio of the two groups in different years did not change statistically significant (P > 0.05), and the ASMR of both groups showed a downward trend. The UCD-to-MCD ratio increased between 1999 and 2007, then decreased from 2007 to 2020. As MCD, the number of female deaths was more than that of male, and both showed a decreasing trend, but there was no statistical significance in the change of trend ratio in different years (P > 0.05). Deaths were predominantly concentrated in individuals over 75 years of age, with those over 84 years being the most affected. The number of deaths in different age groups showed a decreasing trend, and the change of trend ratio in different years was statistically significant (P < 0.05). White individuals had the highest number of deaths. The leading causes of death were heart diseases, chronic lower respiratory diseases, and alzheimer’s disease. In addition, the number of deaths of patients with prostate cancer and breast cancer showed a significant downward trend, and the change of trend ratio between the two groups in different years was statistically significant (P < 0.05).ConclusionsAlthough mortality from osteoporosis with pathological fractures is decreasing, anti-osteoporosis therapy remains essential for elderly patients. Healthcare providers should remain vigilant for potential complications, including malignant neoplasms, and ensure timely diagnosis and treatment to further reduce mortality in this population.

Assessment of anticoagulant potential of Halocnemum strobilaceum (Pall.) against black rat (Rattus rattus Lin.) from Algeria

BackgroundBlack rats (Rattus rattus; Rodentia: Muridae) cause significant damage to agricultural and human health, and they are considered a reservoir for a variety of diseases. ObjectivesThe current study aimed to evaluate the toxicity of oral anticoagulants derived from Halocnemum strobilaceum (Pall.) M. Bieb. to these dangerous animals. MethodFour selected doses (100, 150, 200 and 300 mg/day/kg of individual weight) and one control were utilized, with 10 repetitions of each dose (5 ♂ and 5 ♀). The extract was powdered on dates as bait. ResultsUPLC-ESI/MS-MS chromatography identified three distinct coumarins (coumaric acid, p-coumaric acid and 4-hydroxycoumarin). The results showed that the fourth dose used caused the highest number of deaths (100 % after three days of treatment). In contrast, after 48 h of therapy, all rats examined showed lethargy, anorexia and unconsciousness, followed by rapid death at 72 h in the treated individuals. The LD50 was recorded at 146.4 mg.kg−1 with a LT50 of 59.37 h. At the end of the experiment, the autopsies of all deceased individuals allowed us to observe the bleeding of their internal organs. The analysis of PT and aPTT demonstrated that the halophyte under investigation possesses anticoagulant activity that increased with the concentration. Histological sections of the liver revealed cellular alteration and significant necrosis. As well, the kidneys had vascular occlusion with an inflammatory filtrate. ConclusionsTo reduce food losses and wastes caused by these pests, H. strobilaceum will be an important plant for use in protecting against invasive rodents, especially in environmental and stored product programs focused at eradicating rodent pests.

Asbestos exposure and asbestosis mortality in Italian cement-asbestos cohorts: Dose-response relationship and the role of competing death causes.

In Italy, asbestos was used intensively until its ban in 1992, which was extended for asbestos cement factories until 1994. The aim of this study was to evaluate the dose-response between asbestos exposure and asbestosis mortality across a pool of Italian occupational cohorts, taking into account the presence of competing risks. Cohorts were followed for vital status and the cause of death was ascertained by a linkage with mortality registers. Cause-specific (CS) Cox-regression models were used to evaluate the dose-exposure relationship between asbestosis mortality and the time-dependent cumulative exposure index (CEI) to asbestos. Fine and Gray regression models were computed to assess the effect of competing risks of death. The cohort included 12,963 asbestos cement workers. During the follow-up period (1960-2012), of a total of 6961 deaths, we observed 416 deaths attributed to asbestosis, 879 to lung cancer, 400 to primary pleural cancer, 135 to peritoneal cancer, and 1825 to diseases of the circulatory system. The CS model showed a strong association between CEI and asbestosis mortality. Dose-response models estimated an increasing trend in mortality even below a CEI of 25 ff/mL-years. Lung cancer and circulatory diseases were the main competing causes of death. Asbestos exposure among Italian asbestos-cement workers has led to a very high number of deaths from asbestosis and asbestos-related diseases. The increasing risk trend associated with excess deaths, even at low exposure levels, suggests that the proposed limit values would not have been adequate to prevent disability and mortality from asbestosis.

Determinants of Pneumonia Symptoms in Toddlers in the Paal V Health Center Working Area of Jambi City

ABSTRACT Pneumonia is a disease in children under five which causes the highest number of deaths at the global level. Pneumonia cases in toddlers continue to increase and Indonesia is ranked 8th in the world. The aim of this research is to determine the factors associated with pneumonia symptoms in toddlers in the working area of the Paal V Health Center, Jambi City. Cross sectional research design. The research was conducted in the Paal V Community Health Center Working Area, Jambi City. The total sample was 70 toddlers taken using Accidental Sampling. The independent variables are house temperature, house humidity, residential density, house ventilation, lighting, smoking habits, mother's knowledge and exclusive breastfeeding. Data were analyzed using the Chi Squar e or Fisher Exact test. Toddlers with Pneumonia Symptoms are 65.7%. Factors associated with pneumonia symptoms in toddlers are house humidity (PR=0.60; 95% CI=0.37-0.95), house lighting (PR=0.55; 95% CI=0.29-1, 04), smoking habits (PR=1.50; 95% CI=098-2.28) and maternal knowledge (PR=2.46; 95% CI=1.08-1.97). Meanwhile, those that are not related to pneumonia symptoms in toddlers are house temperature, house ventilation, residential density and exclusive breastfeeding. Risk factors for pneumonia symptoms in toddlers are house humidity that does not meet the requirements, house lighting that does not meet the requirements, the presence of smoking habits in the house, poor maternal knowledge. It is hoped that mothers who have toddlers will pay attention to the physical environment of the house and reduce smoking habits in the house Keywords: Pneumonia, Environment, Child, Mother

The relationship between nutritional status and the incidence of ARI In toddlers aged 1-5 years

Background: Acute Respiratory Infection (ARI) is a disease that causes the highest number of deaths (mortality) and morbidity (morbidity) in children under five in both developed and developing countries, including Indonesia. The prevalence of ARI cases in Indonesia increases every year, according to the Indonesian Ministry of Health, ARI pneumonia cases reached 386,724 (38.78%) in 2022 with 69.2% (267,733 cases) of them occurring in the 1-5 year age group. Objective: This study aims to analyze the relationship between nutritional status and the incidence of ARI in toddlers aged 1-5 years in the working area of ​​the Mulyorejo Community Health Center, Surabaya, Indonesia. Method: This research uses an analytical observational study with a cross sectional approach. The samples in this research were toddlers who visited the Mulyorejo Community Health Center, Surabaya for the period November 2023-April 2024. The sampling technique used non-probability sampling, namely the purposive sampling method. The sample size was 100 toddlers. The research instrument is medical records. Research data was analyzed using the Mann-Whitney U Test. Result: Most (76%) respondents had normal nutritional status. The results of the Mann-Whitney U test to analyze the relationship between the nutritional status of toddlers and the incidence of ARI in toddlers obtained P Value = 0.492. Conclusion: These data show that there is no relationship between nutritional status and the incidence of ARI in toddlers aged 1-5 years in the working area of ​​the Mulyorejo Community Health Center, Surabaya, Indonesia.

Overview of Endovascular Treatment of Infra Renal Abdominal Aortic Aneurysms Over the Last 21 Years in Brazil

Introduction: Endovascular treatment of abdominal aortic aneurysms (EVAR) has emerged as an innovative therapeutic alternative with significant growth potential. Despite its advantages, factors such as costs, short- and long-term benefits and patient characteristics are still being analyzed and make it difficult to increase the number of these procedures when compared to the traditional open technique. Objectives: To describe the statistical behavior of endovascular treatment for AAA repair over the last 21 years in Brazil. Materials and Methods: Retrospective and descriptive study of data available in the DataSUS database, where variables relating to the number of hospitalizations, number of deaths, average length of stay and hospital and professional costs were analyzed. Results: Among the 1,618 hospitalizations for endovascular treatment of abdominal aortic aneurysms in Brazil between 2002 and 2023, 680 occurred in the South region, followed by the Southeast region with 674 hospitalizations. The mortality rate was 7.94% in this period and the number of deaths was 130. The highest number of deaths was recorded in the Southeast, while the highest mortality rates were in the North and Midwest, 66.67 and 47, respectively. Discussion: The results showed regional inequalities and the influence of socio-economic indices on access to healthcare in Brazil, so that the more economically developed regions showed better results in terms of hospitalizations and mortality. Conclusion: Although the study has limitations, it showed a growing trend in the use of EVAR in Brazil, with the South and Southeast regions having better results in terms of hospitalizations and mortality, while the North and Midwest regions had lower hospitalization rates and higher mortality rates, pointing to underreporting and limited access to advanced treatments.

The Relationship of Cleanliness and Vulva Hygiene in Postpartum Mothers' Perineal Wound Infection

Infection during the postpartum period is one of the reasons for the high number of deaths in Mothers. Data from the 2018 WHO shows that infection is the second cause of postpartum maternal deaths in the world. In Indonesia, infection contributes to 10% of deaths of mothers in Indonesia (Sarwono, 2018). Infection perineal wounds were 207 cases (West Java Health Office, 2021). Guard cleanliness and vulva hygiene with Correct can prevent infection of the mother's perineum postpartum. Research objectives This is, for now, the connection between cleanliness and vulva hygiene in infections postpartum mother's perineal wounds at PMB Midwife M in 2023. Types and Designs Study This use method survey analytic observational with a cross-sectional approach. Research sample This is a total sampling technique where the sample size is the same as the population, namely 30 people. Method of collecting data in research: This is done through questionnaires and sheet observations. Then, the data is analyzed in a way univariate and bivariate with the Chi-square test (X 2) at a significant level ? 0.05. The results of the study show that there were six respondents who did not do vulva hygiene well, and 1 of them experienced infection. Got its mark from variable vulva hygiene with incident infection perineal wounds p = 0.000. Results p value &lt;0.05, then Ha is accepted. Yes, there is a connection between cleanliness and vulva hygiene with incident infection perineal wounds in mothers postpartum in PMB M, the expected public can increase the role of active Mothers postpartum to get information about health, especially about vulva hygiene.

Time from admission to the onset of methicillin-resistant Staphylococcus aureus bacteremia in a single acute care hospital in Japan.

The spread of antimicrobial-resistant organisms (AROs) poses a major threat to animal and human health. In Japan, the estimated disability-adjusted life years (DALYs) due to infections with AROs is 137.9 per 100,000 persons, with methicillin-resistant Staphylococcus aureus (MRSA) being the main contributor. The factors that can contribute to DALYs in Japan include younger age and a higher number of deaths in patients with MRSA bacteremia. Moreover, longer hospital stays may contribute to higher rates of MRSA bacteremia in Japan than in Western countries. We reviewed diagnosis procedure combination data collected from January 1, 2016, to December 31, 2020, in an acute care hospital in Tokyo, Japan. We found that the median time from admission to MRSA bacteremia onset was 26 days, which is longer than that in Western countries but similar to that in South Korea. Further, our cohort was older than that in the United States and South Korea, potentially contributing to the higher number of years of life lost in Japan. These results underscore the need to develop strategies to reduce hospitalization in Japan. Larger multicenter studies are needed to comprehensively evaluate the economic and health burden of MRSA bacteremia in Japan.

Fatty liver as a risk factor for cardiovascular diseases: retrospective analysis of data from patients of the Geriatrics Clinic of University Clinical Hospital in Wrocław

Non-alcoholic fatty liver disease (NAFLD) is currently the most common liver disorder affecting about 25% of the global population. The causes of its development include poor diet, low physical activity, overweight, obesity, older age, diabetes, and lipid disorders. Non-alcoholic fatty liver disease is identified by some researchers as a hepatic manifestation of metabolic syndrome. It has been observed that patients with NAFLD have an increased risk of cardiovascular events, as well as a higher number of deaths from myocardial infarction compared to the general population. A retrospective analysis was conducted on the data of 237 patients diagnosed with hepatic steatosis, treated in the Department of Geriatrics at the University Clinical Hospital in Wrocław from 2019 to 2022, focusing on coexisting overweight, obesity, and concomitant diseases. Laboratory results and the degree of left ventricular muscle hypertrophy were analyzed. Parameters assessed by echocardiography, including interventricular septal thickness in diastole (IVSd), left ventricular posterior wall thickness in diastole (LVPWd), and IVSd + LVPWd/2, were used to evaluate left ventricular hypertrophy. Data from 237 patients were analyzed: 79 men (age: 77.2±7.1 years) and 158 women (age: 78.4±7.7 years). Body mass index (BMI) values for men and women were 30.5±5.0 kg/m² and 31.9±5.6 kg/m², respectively. There was a positive correlation between BMI and the degree of left ventricular hypertrophy for the parameters IVSd (ρ = 0.36, p < 0.001), LVPWd (ρ = 0.36, p < 0.001), and IVSd + LVPWd/2 (ρ = 0.38, p < 0.001). The study demonstrated a moderate positive correlation between BMI and the degree of left ventricular hypertrophy in patients diagnosed with hepatic steatosis. These findings indicate the necessity of actively searching for cardiovascular risk factors, including the evaluation of echocardiographic parameters in patients with NAFLD. Med Pr Work Health Saf. 2024;75(3):223-231.

MORTALITY FROM MALIGNANT MELANOMA IN BRAZIL BETWEEN THE YEARS 2013 AND 2022: Regional trends, in relation to gender, ethnicity and age group

Introduction: Skin cancer is the most common type of cancer in Brazil, with a high cure rate if treated early. Melanoma, an aggressive type of skin cancer, accounts for 79% of deaths from skin cancer. Its incidence is increasing globally due to sun exposure and other behavioral changes. This study analyzes mortality from cutaneous melanoma in Brazil, considering regional, gender, and ethnic factors. Methodology: Retrospective and observational study based on data from the Mortality Information System (SIM) from 2013 to 2022. Data on deaths from malignant melanoma of the skin were analyzed across various regions, genders, age groups, and ethnicities. Relevant literature selection was conducted through searches in BVS and PubMed. Results: The mortality rate from melanoma ranged from 1,547 to 1,959 deaths annually from 2013 to 2022. The Southeast region had the highest number of deaths, followed by the South and Northeast. The Southeast recorded a total of 7,821 deaths during the period, while the North had the lowest number, with 471 deaths. Men were more affected than women, accounting for 57.5% of deaths. White ethnicity accounted for 82.1% of deaths. Mortality increased progressively with age, stabilizing after age 70. Discussion: Melanoma mortality exhibited fluctuating patterns in Brazil, with peaks in 2019 and declines in 2020-2021. Regional disparities reflect differences in healthcare access, cultural habits, and socioeconomic factors. Higher mortality among men may be linked to greater exposure to risk factors and lower rates of early diagnosis. The high incidence among white individuals underscores the need for specific health policies. Preventive strategies should focus on raising awareness about sun exposure, early diagnosis, and improving healthcare infrastructure. Conclusion: The study highlights the need for public health policies tailored to regional specificities to reduce melanoma mortality in Brazil. Awareness campaigns, screening programs, and improved treatment access are essential to mitigate the effects of cutaneous melanoma.

Emergency Call versus General Practitioner Requested Ambulances - Patient Mortality, Disease Severity and Pattern.

Ambulance requests by general practitioners for primary care patients (GP-requested) are often omitted in studies on increased demand within emergency care but may comprise a substantial patient group. We aimed to assess acute severity, intensive care unit (ICU) admission, and diagnostic pattern, including comorbidity, and mortality among GP-requested ambulance patients, compared to emergency call ambulance patients. Our hypothesis was that emergency call patients had more severe health issues than GP-requested ambulance patients. Historic population-based cohort study of ambulance patients in the North Denmark Region, 2016-2020. Hospital contact data including diagnoses, ambulance data, vital signs and vital status was linked using each patient's unique identification number. Primary outcome measure was mortality within 1, 7, and 30 days. Secondary outcomes were disease severity expressed as modified National Early Warning Score (NEWS2), and ICU admission. Admission status and hospital diagnostic pattern, including comorbidity were described and compared. We included 255,487 patients. GP-requested patients (N = 119,361, 46.7%) were older (median years [IQR] 73 [58-83] versus 61 [37-76]) and more had moderate/severe comorbidity (11.9%, N = 13,806 versus 4.9%, N = 6145) than the emergency call patients. Prehospital mNEWS2 median scores were lower for GP-requested patients. For both groups, mNEWS2 was highest among patients aged 66+. GP-requested patients had higher 30-day mortality (9.0% (95% CI: 8.8-9.2), N = 8996) than emergency call patients (5.2% (95% CI: 5.1-5.4), N = 6727). Circulatory (12.0%, 11,695/97,112) and respiratory diseases (11.6%, 11,219/97,112) were more frequent among GP-requested patients than emergency call patients ((10.7%, 12,640/118,102) and (5.8%, 6858/118,102)). The highest number of deaths was found for health issues 'circulatory diseases' in the emergency call group and 'other factors' followed by "respiratory diseases" in the GP-requested group. GP-requested patients constituted nearly half of the EMS volume, they were older, with more comorbidity, had serious conditions with substantial acute severity, and a higher 30-day mortality than emergency call patients.

Panorama da mortalidade por cardiopatia reumática crônica entre 2017 e 2021, no Rio Grande do Sul

Introduction: Chronic rheumatic heart disease is a complication of rheumatic fever (RF), a disease that results from pharyngotonsillitis, causing acquired heart disease in young people and can lead to valvular sequelae and death. The objective of the study is to evaluate mortality from rheumatic heart disease in Rio Grande do Sul, with emphasis on voluntary involvement, and to analyze a possible association between age group and sex. Material and Methods: This research consists of a cross-sectional study using the database of the Department of Information Technology’s Unified Health System (DataSUS). Deaths from rheumatic heart diseases were included, divided by sex and age, during the period from 2017 to 2021 in Rio Grande do Sul. For statistical analysis, the Chi-Square test (χ²) was used, using the software SPSS. Results: 321 deaths from rheumatic valve disease were found between 2017 and 2021, the majority of which were caused by mitral valve disease. Women had a higher number of deaths from mitral valve disease and men from other heart diseases. Regarding the age group, deaths due to mitral valve disease were more prevalent among those aged 40 to 49 years, while in tricuspid valve disease, there was a greater association with individuals aged 80 years or older. In other diseases, no association was demonstrated. Conclusion: From this, an association was established between sex and age group in the incidence of rheumatic heart disease among the studied population. Therefore, a more comprehensive therapeutic approach is needed, associated with the development of campaigns that publicize the importance of correct treatment in order to reduce mortality rates.

A bird's-eye view of disparity from public historic cancer mortality data in the US: Advocacy for gastrointestinal cancers and for inter-agency data harmonization.

e13723 Background: We searched into public datasets released by CDC to answer a question raised during an NCI Health Disparity Workshop: "Can we have a bird’s-eye view of health disparity in cancer care in the US?" By looking into the historic data reported, we hope to identify not only health disparity reflected by the different cancer mortality rates for major cancer types, but also what might be missing from the data-reporting. Methods: We analyzed 2016-2020 US Cancer Statistics (USCS) cancer burden data to assess cancer disparity as reflected by rates of death in different races or ethnicities. We then looked into the recently available “Single Race 15” grouping for the underlying cause-of-death data in WONDER@CDC to count cancer deaths 2018-2021 in California comparing cancer mortality among 7 Asian minority groups, including Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, and other Asians. We then matched census data for these Asian minority groups published by Census 2020. Results: We identified gastrointestinal (GI) cancers as an area of cancer health disparity. 5 GI cancers (colon and rectum, pancreas, liver and bile duct, stomach, and esophagus) contributed to a quarter of cancer deaths, and cancers in the pancreas, liver and bile duct, and esophagus still have very poor outcomes. Based on USCS data, Black non-Hispanic Americans are more likely to die from cancers of colon/rectum or pancreas. All minority races or ethnicities are more likely to die from cancers in liver and bile duct, or stomach than white non-Hispanic Americans. Cancers in colon and rectum, liver and bile duct, or stomach also cause high numbers of death in the under-50 US population. Since the 2022 AACR report on cancer in Asian Americans raised concerns on liver and stomach cancers, we counted cancer deaths in recent 4 years for different Asian groups in California that numbered about 7 million (alone or in combination) in 2020 Census. This includes 1.8 million Chinese, 1.7 million Filipino, 900k Asian Indian, 800k Vietnamese, 560k Korean, 470k Japanese, and other Asian ethnicities. Chinese has the highest numbers of deaths (2.8k) in 4 years from these 5 GI cancers followed by Filipino (2k), Vietnamese (1.2k), Korean (1.1k), Japanese (800), other Asians (1.1k), and Asian Indian (&lt; 400). The lower cancer deaths in Asian Indians may be associated with their younger median age based on Census. With anecdotal stories suggesting immigrants may seek end-of-life care in their birth country to access more culture-concordant services, we looked into how cancer deaths abroad were reported. The data appeared missing. Conclusions: We identified gastrointestinal cancers as focuses for cancer health disparity advocacy. Harmonized consulate report of death abroad to include detailed race/ethnicity information will complete view of cancer mortality data in the US.

Results of neoadjuvant therapy for patients with triple negative breast cancer in a public hospital in Brazil (Federal District).

e12660 Background: Breast cancer is the neoplasm with the highest number of deaths among women in Brazil. Triple negative breast cancer contributes to the worsening of this condition, considering that it is more aggressive, accounting for 15% of deaths. Furthermore, more aggressive treatments and new medications have recently been added to neoadjuvant protocols, improving the complete pathological response, but with more side effects. In this way, it is predictive to understand the profile and treatment of choice for patients diagnosed with triple negative breast cancer, contributing to a better understanding of the treatment outcome, survival and quality of life in patients with this health condition. Methods: observational and cross-sectional study with retrospective data collection, in the electronic medical record of the TrakCare system. Patients diagnosed with triple-negative breast cancer between January 2020 and December 2021 and who underwent neoadjuvant treatment were included. Information was collected regarding the date of treatment, age, color/race, comorbidity, staging, type of chemotherapy used, postoperative response rate, and patient evolution during follow-up. Results: 78 patients with triple-negative breast cancer were included. The average age of patients was 56.3 years (26 – 83 years) and approximately 38.5% of patients were under 50 years of age. Around 42.3% of patients had hypertension and 33.3% were obese. Only 28.2% of patients did not have associated comorbidities. Approximately 59% of patients were staged T4 and 35.9% staged T3. Pathological complete response (cPR) was achieved in 56.4%, but progression was recorded in 13% of cases. In 88.5% of patients, the AC-T protocol was used (doxorubicin and cyclophosphamide followed by weekly paclitaxel) and 52% obtained CPR. On the other hand, only 11.5% (9 patients) used the AC-TC protocol (doxorubicin and cyclophosphamide followed by paclitaxel and carboplatin) with a CPR of 89% (p=0.016), with no record of progression or death. Conclusions: Triple negative patients were young and tended to have at least one comorbidity in addition to a highest rate of locally advanced tumor. The more aggressive protocol (AC-TC) was used less often, but has a higher rate of cRP and should be used more frequently in this scenario despite the greater complexity of these patients.

Legal Protection of Health Workers on the Installation of Mechanical Ventilation of Covid-19 Patients in Hospitals

Corona Virus Disease-2019 (Covid-19) is a disease that causes an epidemic with a high number of deaths and morbidity in Indonesia. Covid-19 sufferers often experience respiratory failure, so they need to receive mechanical ventilation assistance. This research aims to find out the rules for legal protection for health workers in the act of installing mechanical ventilation for Covid-19 patients in hospitals and to find out the implementation of legal protection. This type of research is normative juridical based on a legal approach. Data collection is based on literature study, taken from legislation, research results and literature books. The results of the research found that the provision of health services was carried out responsibly, safely, of good quality and evenly and non-discriminatory. The position faced by medical personnel or health workers is sometimes problematic because installing mechanical ventilators for Covid-19 patients from a criminal law perspective is a mistake if it is done outside of their authority, even though the medical personnel or health workers are dealing with the function and task of carrying out actions. for patient safety which is of course tied to the Hippocratic Oath as an ethical and moral basis. The suggestion in this research is that the government must provide legal protection to medical personnel whose rights are not fulfilled by policy organizers, even though their obligations have been fulfilled by health personnel.