Incidence Of First Diagnosis Research Articles

Costs of Stroke and Incidence of First Diagnosis of Atrial Fibrillation at Time of Stroke. Neurology Ward Hospital Poznań, Poland 2018.

Stroke is a major cause of morbidity in industrialized countries, representing 8% of total deaths across Europe in 2017. It is also a very costly disorder, frequently caused by atrial fibrillation. We aimed to calculate the cost of stroke hospitalization in 2018 in Poznań (Poland). We also intended to present patients with the first AF diagnosis at the time of stroke. The study was conducted from January 2019 to July 2020. Data were obtained from hospital records and from the hospital accounting department. Out of 164 patients included in the study, 41 had AF and in 18 cases AF was first diagnosed at the time of stroke. The cost of hospitalization in Poznań was EUR 139,257.21 ( EUR 849.13). Among those with concomitant AF, the general cost of inpatient care was EUR 33,859.18 ( EUR 825.83). Considering those who had AF first diagnosed during hospitalization the cost was EUR 16,248.97 ( EUR 906.24). Stroke is associated with high costs of inpatient care, which turned out to be higher among those with AF first diagnosed at the time of stroke. The number of patients who used oral anticoagulants at the time of admission was relatively low. The most frequently used NOAC was dabigatran.

Abstract 19270: Heart Failure Incidence is Elevated in Adults With Simple Congenital Heart Defects Compared With the General Population: A Cohort Study

Heart failure (HF) is a major cause of morbidity and mortality in adults with congenital heart defects (CHD). However, few data exist on the long-term prognosis of simple CHD. We aimed to estimate the incidence of HF and use of HF drugs in individuals with simple CHD compared with the general population. Methods: We identified a nationwide population-based simple CHD cohort, defined by isolated and uncomplicated secundum atrial septal defect (ASD), persistent ductus arteriosus (PDA), ventricular septal defect (VSD) judged to be either muscular or with normal pulmonary flow resistance, or mild pulmonary stenosis (PS) verified by catheterization. Subjects were born and diagnosed from 1963 through 1973 in Denmark. We included patients with no childhood co-morbidity who were alive at 32 years of age (this age was determined by the establishment of a nationwide prescription register in 1995). For each CHD subject, we identified 10 control individuals from the general population using the Danish Civil Registration System, matched by sex and birth year. A unique personal identifier used in all Danish public registries enabled virtually complete follow-up for migration, death, use of HF drugs, or HF diagnoses as identified in a hospital discharge registry covering all Danish hospitals since 1977. Specific indications for drug use were unknown (could be e.g. hypertension). We computed cumulative incidence of first diagnosis of HF and first filling of a HF drug prescription, for CHD subjects and controls, and the corresponding hazard ratios (HR). Results: We identified 802 CHD subjects (ASD, n=115; VSD, n=437; PS, n=75; PDA, n=175) and 7,947 controls, 43% male. Cumulative incidence for CHD subjects by age 45 years of HF drug use was 22% (16% for controls), whereas it was 3% (0.4% for controls) for a HF hospital diagnosis. The corresponding HRs comparing CHD subjects with controls were 1.4(95% CI:1.2-1.6) and 6.9(95% CI:4.0-12). Conclusion: Adults with simple CHDs were at increased risk of HF. The data on HF drug use should be interpreted with caution as other cardiovascular conditions were likely the indications for many of the prescriptions. However; further studies on the effectiveness of medical follow-up programs for patients with simple CHDs appear warranted.

Association of Vitamin D Deficiency and Age-Related Macular Degeneration in Medicare Beneficiaries

Several studies have found an association between vitamin D deficiency and age-related macular degeneration (AMD).1-4 Vitamin D has been shown to have immunomodulatory and antiangiogenic properties, suggesting a biologically plausible role in the pathogenesis of AMD.5 This study examines the possible association of vitamin D deficiency and subsequent incidence of first diagnosis of nonneovascular and neovascular AMD in a cohort of Medicare beneficiaries. To our knowledge, this is the first study to evaluate incidence rather than prevalence of AMD in a large sample of vitamin D–deficient patients.

A bacterial immune-prophylactic approach against asthma for infants and children

Objective/purpose The prevalence of asthma in Canada (and worldwide) has been increasing over the last 20 years with currently over 3 million Canadians suffering from it. Asthma appears to result from environmental influences directing a genetically predisposed host towards a pro-allergic, Th2-dominated immune response. Studies in humans and animals identify the time around birth and early infancy as a period during which the decision of proallergic versus non-allergic immune responses to environmental stimuli appears to be made. Presumably this is the reason why the incidence of first diagnosis is highest in infants and children, although asthma can occur at any age. The very fact that all three components (environmental, genetic and developmental) are necessary for asthma to occur also offers the opportunity to intervene early in life through e.g. vaccination against allergies. Vaccination as a strategy to prevent or cure asthma is a tremendous opportunity. An ideal vaccine would be one that prevents or cures asthma after only one dose and protects for life. It is well established that the whole heat-killed bacterium Listeria monocytogenes (Lm) given as an adjuvant along with model allergens effectively prevent allergic sensitization and/or allergic inflammation in adult animals following local allergen challenge. We have successfully developed a novel, live, but highly attenuated neonatal vaccine platform based on the bacterium Listeria monocytogenes (Lm). Our published data suggest that our Lm-based vaccine platform is capable of inducing strong anti-allergic immune responses for an entire life only after one dose given to newborn mice. Now we have investigated whether our Lm-based vaccine platform will provide protection from allergic reactions upon challenge with the allergen, after only one immunization given around birth. Our specific aim addressed the following objective: Do our Listeria monocytogenes vaccine strains producing model allergen ovalbumin (OVA) and inducing a strong Th1 response, prevent allergic reactions upon challenge with the allergen in a neonatal mouse model?

Hospitalisation of Indigenous children in the Northern Territory for lower respiratory illness in the first year of life

To describe the epidemiology of acute lower respiratory infection (ALRI) and bronchiectasis in Northern Territory Indigenous infants hospitalised in the first year of life. A historical cohort study constructed from the NT Hospital Discharge Dataset and the NT Immunisation Register. All NT resident Indigenous infants, born 1 January 1999 to 31 December 2004, admitted to NT public hospitals and followed up to 12 months of age. Incidence of ALRI and bronchiectasis (ICD-10-AM codes) and radiologically confirmed pneumonia (World Health Organization protocol). Data on 9295 infants, 8498 child-years of observation and 15 948 hospitalised episodes of care were analysed. ALRI incidence was 426.7 episodes per 1000 child-years (95% CI, 416.2-437.2). Incidence rates were two times higher (relative risk, 2.12; 95% CI, 1.98-2.27) for infants in Central Australia compared with those in the Top End. The median age at first admission for an ALRI was 4.6 months (interquartile range, 2.6-7.3). Bronchiolitis accounted for most of the disease burden, with a rate of 227 per 1000 child-years. The incidence of first diagnosis of bronchiectasis was 1.18 per 1000 child-years (95% CI, 0.60-2.16). One or more key comorbidities were present in 1445 of the 3227 (44.8%) episodes of care for ALRI. Rates of ALRI and bronchiectasis in NT Indigenous infants are excessive, with early onset, frequent repeat episodes, and a high prevalence of comorbidities. These high rates of disease demand urgent attention.

Fenômeno de Lúcio (eritema necrosante) na gestação

O fenômeno de Lúcio, variante do estado reacional hansênico tipo 2, provavelmente mediado por imunocomplexos, caracteriza-se por reação cutânea necrosante grave que ocorre principalmente em doentes portadores de hanseníase virchowiana não nodular. Os autores relatam o caso de uma paciente de 27 anos, do sexo feminino, gestante de 32 semanas, com quadro de lesões eritêmato-purpúricas nos membros, bem delimitadas, confluentes, encimadas por bolhas, algumas necróticas e ulceradas, com uma semana de evolução, acompanhadas de febre e intensa dor local. A baciloscopia da linfa evidenciou bacilos álcool-acidorresistentes formando globias, e a histopatologia da pele confirmou hanseníase virchowiana, compatível com fenômeno de Lúcio. Foi iniciada prednisona e poliquimioterapia multibacilar com rifampicina, clofazimina e sulfona, com boa evolução. A gravidez tem sido associada à elevada incidência de aparecimento dos primeiros sinais ou ao agravamento da hanseníase por alterações hormonais que levam ao desequilíbrio imunológico, sendo considerado crítico o período compreendido entre o último trimestre de gestação e os primeiros três meses da lactação, quando a imunossupressão atinge seu ápice. Apesar da recomendação de se restringir a ingestão de drogas na gestação, o tratamento da hanseníase deve ser realizado, visto que seus benefícios superam os riscos.

Trends in the Population-Based Incidence of Squamous Cell Carcinoma of the Skin First Diagnosed Between 1984 and 1992

To examine the incidence of first diagnosis of invasive squamous cell carcinoma (SCC) of the skin over time. Retrospective, population-based incidence study. Enumerated, geographically isolated, semiurban population served by the Mayo Clinic and its affiliated hospitals and the Olmsted Medical Center, including its affiliated hospital in Rochester, Minn. Using the Rochester Epidemiology Project databases that capture virtually all medical care provided to the residents of Rochester, we identified and reviewed records of all documented residents in whom histologically proven, invasive SCC of the skin was first diagnosed between 1984 and 1992. Age and sex stratum-specific rates were calculated, and age-adjusted rates observed over time for individuals aged 35 years or older were analyzed using Poisson regression. Adjusted rates were compared with the results of other studies. Review of 1630 records identified 511 incidence cases of SCC. Tumors located on the head and neck accounted for 66.4% of tumors in females and 72.9% in males. The annual age- and sex-specific incidence rates per 100,000 increased from 0 cases among males aged 0 to 14 years to 1286.0 cases among males aged 85 years or older. Over time, the annual age-adjusted incidence rates per 100,000 females rose from 46.5 (95% confidence interval [CI], 32.4-60.6) for the 1984 to 1986 period to 99.6 (95% CI, 80.4-118.7) for the 1990 to 1992 period and were 71.2 (95% CI, 61.7-80.8) overall. The corresponding rates for males were 125.9 (95% CI, 95.3-156.4), 191.0 (95% CI, 156.9-225.0), and 155.5 (95% CI, 137.0-174.0). The age- and sex-adjusted SCC incidence rates for the period from 1987 to 1989 and 1990 to 1992 exceeded those for the period from 1984 to 1986 (P = .03 and P < .001, respectively). Our age-adjusted rates for SCC were within the ranges seen in other white populations from temperate climates. The frequencies of first diagnosis of SCC are increasing at rates beyond those explainable by demographic shifts alone.