Mean Incidence Rate Research Articles

Increased incidence of eosinophilic esophagitis among the child population of Zaragoza. An emerging disease.

Eosinophilic esophagitis is a chronic inflammatory disease characterized by esophageal dysfunction and progression to fibrosis. Its incidence is increasing in our setting with deep regional variations. To corroborate this hypothesis, a longitudinal, retrospective, multicenter observational study was carried out of patients who received a diagnosis of eosinophilic esophagitis from 2008 to 2022 at public hospitals in the province of Zaragoza. The annual incidence rates and mean incidence rate were calculated using the data for the reference population. A total of 104 patients were included. The mean incidence rate was 5.1 cases per 100,000 inhabitants < 15 years old/year (0.75-11.2). In the first five-year period (2008-2012) the rate was 1.2 cases per 100,000 inhabitants/year, compared with a rate of 6 cases per 100,000 inhabitants/year in the second 5-year period (2013-2017), [OR 5,68 (IC 95% 2,55 - 12,67, p < 0,05]; and 8.1 cases per 100,000 inhabitants/year in the third five-year period (2018-2022), [OR 7,74 (IC 95% 3,52 - 16,99, p < 0,05] It is concluded that eosinophilic esophagitis incidence has increased among the child population of Zaragoza over the past 15 years, with a 7-fold higher risk of having the condition in the third five-year period compared with the first one.

Análise espacial da incidência da febre de Chikungunya e dos fatores socioeconômicos, demográficos e de infestação vetorial associados, em municípios de Pernambuco, Brasil, 2015–2021

To identify the spatial patterns of chikungunya fever (CHIKF) and the associated socioeconomic, demographic, and vector infestation factors in the 1st Health Region of Pernambuco (1st HRP). This ecological study used a spatial analysis of Mean Incidence Rates (MIR) of probable cases of CHIKF reported among residents of the 19 municipalities of the 1st HRP, in 2015-2021. The univariate and bivariate global Moran indexes (I) were estimated. From the significant associations (p<0.05), clusters were identified using the local Moran index and maps. A predominance of the largest CHIKF rates was identified in the east. However, there was a heterogeneous distribution of rates across municipalities, which may have contributed to the absence of spatial autocorrelation of CHIKF (I=0.03; p=0.294) in univariate I. The bivariate I revealed a positive spatial correlation between CHIKF and the Municipal Human Development Index (MHDI) (I=0.245; p=0.038), but with a cluster of cities with low incidences and low MHDI in the west. There was no spatial correlation between CHIKF and the other variables analyzed: population density, Gini index, social vulnerability index, and building infestation index for Aedes aegypti. The results suggest that only the MHDI influenced the occurrence of CHIKF in the 1st HRP, so that municipalities in the west demonstrated spatial dependence between lower values of MHDI and MIR. However, this spatial correlation may have occurred due to possible underreporting in the area. These findings can assist in the (re)orientation of resources for surveillance and health care services.

Gastroenterology Specialist Supply and Early-Onset Colorectal Cancer Incidence and Mortality in the U.S., 2014-2018.

The burden of early-onset colorectal cancer (EoCRC) has been increasing among young adult populations in the U.S. The aim of this study was to investigate the relationship between the incidence and mortality of EoCRC and the supply of gastroenterology (GI) specialists and primary care physicians (PCP). This was an ecological study of EoCRC cases among US counties that occurred between 2014 and 2018. Data was obtained from US cancer statistics. County-level data, including sociodemographic (eg, percentage of female, non-White residents, poverty rate, rurality) and physician supply (GI specialists and PCPs) was obtained from area health resources files. We estimated linear mixed-effects models with the county as a random effect to examine the association of physician supply with 5-year average age-adjusted EoCRC incidence and mortality. Models were adjusted for aggregate county-level socioeconomic characteristics. Multicollinearity was tested through variation inflation. Analysis included 855 US counties. Mean age-adjusted EoCRC incidence and mortality rates between 2014-2018 were 9.5 (standard deviation [SD]: 2.7) and 2.7 (SD: 0.8) per 100,000 persons, respectively. In the adjusted model, GI supply was associated with lower EoCRC incidence (-5.6 percentage-point change per SD; 95% confidence interval,-11.0 to-0.1) but not with EoCRC mortality (P= .558). PCP supply was associated with lower EoCRC mortality (-27.0 percentage-point change per SD; 95% confidence interval,-46.1 to-7.8) but not with EoCRC incidence (P= .077). Greater GI specialist supply was associated with a reduction in EoCRC incidence but not improved mortality. Study findings suggest the need for early colorectal cancer screening efforts and the potential for expanding GI services and referrals in medically underserved areas.

Is There Horizontal Transmission of Creutzfeldt-Jakob Disease?

Background: Sporadic Creutzfeldt-Jakob disease (s-CJD) is a rare, fatal neurodegenerative disorder. Familial cases of Creutzfeldt-Jakob disease (f-CJD) due to mutations in the PRNP gene are even rarer around the world; however, in Israel there is a focus of f-CJD patients carrying the E200K mutation. As the number of CJD E200K carriers in Israel is high and increasing, transmission of CJD to normal people was suspected. If such transmission occurs, the incidence of s-CJD would be expected to increase as well, resulting in changes of the ratio of familial/sporadic cases. Methods: Using data from the National CJD Registry and official statistics on the Israeli population, we studied incidence rates of f-CJD and s-CJD for the period from 1985 to 2018 applying the Surveillance Epidemiology and End Results (SEER) statistical packet developed in the US National Cancer Institute. Results: In total, 621 CJD patients (405 f-CJD and 216 s-CJD) cases are included in the registry. In the cohort of f-CJD patients, the mean age-adjusted annual incidence rate over the abovementioned period was 1.88 ± 0.09 (95% CI: 1.7–2.08) per 1,000,000. In the cohort of s-CJD patients, the mean age-adjusted incidence rate over the same period was 0.93 ± 0.06 (95% CI: 0.81–1.06) per 1,000,000 people. No significant time trends were found over the observation period in either s-CJD or f-CJD. The ratio f-CJD/s-CJD decreases over the observation period from 2.2 to 1.80. Conclusion: Israel has a high predominance of f-CJD compared to s-CJD. The mean incidence rate of s-CJD in Israel is similar to most countries. Between 1985 and 2018, the annual age-adjusted incidence rates for both forms of CJD remained stable. Thus, there is no evidence that CJD is transmitted from affected individuals to others.

Mathematical analysis of a new nonlinear dengue epidemic model via deterministic and fractional approach

We developed a dengue epidemic model by considering hospitalized class and harmonic mean incidence rate. A qualitative study of the proposed model was conducted. The Basic reproduction number, and local and global stability are established. The highly dominant parameters on basic reproduction number R0 have been found by sensitivity analysis. NSFD and RK-4 schemes are used for numerical solutions. Furthermore, this manuscript considers the novel fractional-order operator developed by Atangana-Baleanu for transmission dynamics of the Dengue epidemic. Assuming the importance of the non-local Atangana-Baleanu fractional-order approach, the transmission mechanism of Dengue has been investigated while taking into account different phases of infection and various transmission routes of the disease. To conduct the proposed study, first of all, we shall formulate the model by using the classical operator of ordinary derivatives. We utilize the fractional order derivative and the model will be extended to a model containing fractional order derivatives. The operator being used is the fractional differential operator and has fractional order Φ1. The approach of newton’s polynomial is considered and a new numerical scheme is developed which helped in presenting an iterative process for the proposed ABC system. Based on this scheme, sample curves are obtained for various values of Φ1 and a pattern is derived between the dynamics of the infection and the order of the derivative.

1813. A Population-Based Multi-Year Assessment of the Incidence of High Inoculum Cefazolin (CZ) Resistance Amongst Methicillin-Susceptible Staphylococcus aureus (MSSA) Causing Bloodstream Infections (BSIs) over time in Calgary, Canada

Abstract Background Cefazolin (CZ) is a 1st-line therapy for methicillin-susceptible Staphylococcus aureus (MSSA) infections due to its tolerability, lower toxicity, and convenient dosing. However, some strains exhibit reduced susceptibility to CZ when present in high inoculum. Treatment failure and worsened outcomes are documented in BSI cohorts treated with CZ when infections are caused by strains demonstrating this inoculum effect (IE) (Miller, 2018). The objective of our study was to investigate the incidence of MSSA strains demonstrating IE over time across a general population, free of referral bias. Methods All initial isolates of first episodes of MSSA BSI from persons in Calgary, Canada were analyzed during 2012-14 and 2019. CZ minimum inhibitory concentration (MIC) was determined at standard (SI: 5x105 CFU/mL) and high inocula (HI: 5x107 CFU/mL) using the broth microdilution method at 24 hours as per 2009 CLSI criteria. Isolates were defined as having the CZ IE if they had a ≥ 4-fold difference between MIC at SI and HI. Isolates were defined as having a pronounced IE (pIE), if they were susceptible at SI but resistant at HI with an MIC ≥ 32µg/mL. Population density of Calgary was obtained from census data. Annual incidence rates (IR) were calculated by dividing the number of IE and pIE by the mid-year population data, and IR ratios (IRR) were calculated for IE and pIE by comparing 2019 to 2012 rates. Results During the years of study, 1040 individuals experienced at least one episode of MSSA BSI. The mean incidence rates of IE and pIE were 6.50 and 0.98 per 100,000 person-years, respectively. Comparing 2019 to 2012, rates of IE decreased significantly with an IRR of 0.67 (95% CI 0.47 – 0.95) but rates of pIE were not significantly different (IRR 1.24; 95% CI 0.43 – 3.86). Incidence rates of IE and pIE in Calgary, Canada in 2012-14 and 2019. MSSA BSIs in Calgary, Canada over the years are shown alongside corresponding rates of IE and pIE. The population density was used to find rates for IE/pIE per 100,000 person-years. Conclusion Population-based studies on MSSA BSI with the IE and pIE phenotype are lacking. Herein, we observed that while the incidence of MSSA with pIE has not changed, those occurring with the IE have decreased. Further studies on the clinical implications of pIE are needed. Disclosures All Authors: No reported disclosures.

Medial Pivot Designs Versus Conventional Bearing Types in Primary Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Medial pivot (MP) designs are growing in popularity. They provide increased sagittal plane stability and theoretically replicate some aspects of native joint kinematics, which may improve total knee arthroplasty outcomes. A systematic review was performed of randomized controlled trials (RCTs) that compared MP designs with cruciate-retaining, posterior-stabilized (PS), ultracongruent, or mobile-bearings in primary total knee arthroplasty, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The primary outcome measures were all clinical function scores, patient-reported outcome measures, and range of motion. The secondary outcome was complications. Two authors independently selected studies, performed data extraction, and risk-of-bias assessment. Studies at high risk of bias were excluded from meta-analysis. Treatment effects were assessed using random-effects meta-analysis and quantified using pooled mean differences or incidence rate differences as appropriate. Eight RCTs met inclusion criteria. Five compared MP with PS, two with ultracongruent, and one with cruciate-retaining and mobile-bearing. In total, 350 knees were randomized to MP and 375 to conventional bearings. One RCT was excluded from meta-analysis because of high risk of bias. Meta-analysis comparing MP with PS only was possible and found no differences at any time points for any outcome measure, including 2-year follow-up for Oxford Knee Score (MD = 0.35 favoring PS; 95% CI -0.49 to 1.20) and range of motion (MD = 1.58 favoring MP; 95% CI -0.76 to 11.92, P = 0.30) and 12 months for Western Ontario Arthritis Index (MD = 4.42 favoring MP; 95% CI -12.04 to 3.20, P = 0.09). There is no difference in clinical outcomes, with contemporary measurement tools, at any time points, between MP and PS. There are insufficient RCTs comparing MP with other bearings.

In Utero Exposure to Maternal Injury and the Associated Risk of Cerebral Palsy

Although maternal unintentional injury during pregnancy has shown negative impacts on the mother and fetus, the evidence on its long-term associations with children's neurodevelopment is limited. To examine the association between maternal unintentional injury and cerebral palsy (CP) in offspring. This was a population-based, longitudinal, cohort study of all in-hospital live births born between April 1, 2002, and March 31, 2017, in a publicly funded health care system setting of Ontario, Canada. Infants born more than 20 weeks' gestation were included and followed up until March 31, 2018. Excluded from the analysis were stillbirths, infants with missing or invalid records, and births with missing or invalid birth characteristics. Data were analyzed from March 1 to June 30, 2021. Maternal unintentional injury during pregnancy ascertained based on inpatient or emergency department diagnoses. CP diagnosis between birth and the end of follow-up in 2018 with the CP case definition of a single inpatient or 2 or more outpatient diagnoses at least 2 weeks apart between birth and age 16 years. Of 2 110 177 children included in this study (mean [SD] gestational age, 38.8 [1.9] weeks; 1 082 520 male [51.3%]), 81 281 (3.9%) were exposed in utero to maternal unintentional injury. During a median (IQR) follow-up time of 8 (4-12) years, 5317 children (0.3%) were diagnosed with CP (292 CP cases [5.5%] were exposed to maternal unintentional injury). The mean incidence rates of CP were 4.36 and 2.93 per 10 000 child-years in the exposed and the unexposed group, respectively. Children exposed to maternal unintentional injury had a modest increase in the risk of CP, compared with those unexposed (hazard ratio [HR], 1.33; 95% CI, 1.18-1.50) after adjusting for maternal sociodemographic and clinical characteristics. Severe injuries that resulted in hospitalization and delivery within 1 week from the injury conferred higher risks of CP (adjusted HR, 2.18; 95% CI, 1.29-3.68 and adjusted HR, 3.40; 95% CI, 1.93-6.00, respectively). Results were robust in multiple bias analyses. In this Canadian population-based birth cohort study, in utero exposure to maternal unintentional injury was associated with an increased risk of CP, with a higher risk with more severe injuries. These findings fill an important gap in knowledge on the potential role of maternal injury on children's neurodevelopment outcomes. Public health professionals and stakeholders should be aware of these potential long-term consequences on offspring when designing programs and providing recommendations about safety during pregnancy. Early monitoring and developmental assessment of children exposed to maternal injury might be warranted.

NIMG-40. RAPID EARLY PROGRESSION (REP) OF GLIOBLASTOMA IS AN INDEPENDENT NEGATIVE PROGNOSTIC FACTOR: RESULTS FROM A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract INTRODUCTION In patients with newly-diagnosed glioblastoma, rapid early progression (REP) refers to tumour regrowth between surgery and postoperative chemoradiotherapy. This systematic review and meta-analysis appraised published data on REP to better characterise and understand it. METHODS Systematic searches of MEDLINE, EMBASE and the Cochrane database from inception to 21/10/21. Studies describing the incidence of REP – tumour growth between the postoperative MRI scan and pre-radiotherapy MRI scan in newly-diagnosed glioblastoma, were included. The primary outcome was REP incidence. RESULTS From 1590 search results, 9 studies were included with 716 patients. The median age was 56.9 years (IQR 54.0-58.8 years). There was a male predominance with a median male-to-female ratio of 1.4 (IQR 1.1-1.5). The median number of days between MRI scans was 34 days (IQR 18-45 days). The mean incidence rate of REP was 45.9% (range 19.3%-72.0%) and significantly lower in studies employing functional imaging to define REP (p&amp;lt; 0.001). REP/non-REP groups were comparable with respect to age (p=0.99), gender (p=0.33) and time between scans (p=0.81). REP was associated with shortened overall survival (HR 1.78, 95% CI 1.30-2.43, p&amp;lt; 0.001), shortened progression-free survival (HR 1.78, 95% CI 1.30-2.43, p&amp;lt; 0.001), subtotal resection (OR 6.96, 95% CI 4-51-10.73, p&amp;lt; 0.001) and IDH wildtype versus mutant tumours (OR 0.20, 95% CI 0.02-0.38, p=0.03). MGMT promoter methylation was not associated with REP (OR 1.29, 95% CI 0.72-2.28, p=0.39). CONCLUSIONS REP occurs in almost half of patients with newly-diagnosed glioblastoma and has a strongly negative prognostic effect. Future studies should investigate its biology and effective treatment strategies.

Bronchiectasis in children following kidney transplantation in New Zealand.

Bronchiectasis is an acquired chronic respiratory condition with a relatively high incidence in New Zealand children. Bronchiectasis following kidney transplant has been reported internationally. This study aimed to identify the incidence rate of bronchiectasis following paediatric kidney transplantation. Secondary aims were to assess the impact on kidney allograft function and identify risk factors that might prompt earlier diagnosis. Case control study of children who developed bronchiectasis following kidney transplant in New Zealand. All children who were transplanted during the 16-year period from 2001 to 2016 were included. Each identified case was matched with two controls (children who did not develop bronchiectasis and received a kidney transplant within the closest time period to their matched case). Data were collected on baseline demographics, clinical variables, immunosuppression and allograft function. Of 95 children who had a kidney transplant during the specified time period, eight (8.4%) developed bronchiectasis at a median of 4 years post-transplant. The mean incidence rate of bronchiectasis was 526 cases per 100 000 paediatric kidney transplant population per year. The majority of children were Māori or Pasifika ethnicity and lived in areas of greater socio-economic deprivation. Immunosuppression burden and allograft function were not significantly different between groups. The incidence rate of bronchiectasis following paediatric kidney transplantation is substantially higher than the baseline paediatric incidence rate in New Zealand. A high index of suspicion for bronchiectasis and prompt investigation of children post kidney transplantation with a history of recurrent lower respiratory tract infection or chronic cough are advised.

Rapid Early Progression (REP) of Glioblastoma Is an Independent Negative Prognostic Factor: Results From a Systematic Review and Meta-Analysis

Abstract AIMS In patients with newly-diagnosed glioblastoma, rapid early progression (REP) refers to tumour regrowth between surgery and postoperative chemoradiotherapy. This systematic review and meta-analysis aimed to appraise published data on REP to better characterise and understand this phenomenon. METHOD Systematic searches of MEDLINE, EMBASE and the Cochrane database from inception to 21/10/21. Studies describing the incidence of REP – tumour growth between the postoperative MRI scan and pre-radiotherapy MRI scan in newly-diagnosed glioblastoma, were included. The primary outcome was REP incidence. RESULTS From 1590 search results, 9 studies were included with 716 patients. The median age was 56.9 years (IQR 54.0- 58.8 years). There was a male predominance with a median male-to-female ratio of 1.4 (IQR 1.1-1.5). The median number of days between MRI scans was 34 days (IQR 18-45 days). The mean incidence rate of REP was 45.9% (range 19.3%-72.0%) and significantly lower in studies employing functional imaging to define REP (p&amp;lt;0.001). REP/non-REP groups were comparable with respect to age (p=0.99), gender (p=0.33) and time between scans (p=0.81). REP was associated with shortened overall survival (HR 1.78, 95% CI 1.30-2.43, p&amp;lt;0.001), shortened progression-free survival (HR 1.78, 95% CI 1.30-2.43, p&amp;lt;0.001), subtotal resection (OR 6.96, 95% CI 4-51-10.73, p&amp;lt;0.001) and IDH wildtype versus mutant tumours (OR 0.20, 95% CI 0.02-0.38, p=0.03). MGMT promoter methylation was not associated with REP (OR 1.29, 95% CI 0.72-2.28, p=0.39). CONCLUSION REP occurs in almost half of patients with newly-diagnosed glioblastoma and has a strongly negative prognostic effect. Future studies should investigate its biology and effective treatment strategies.

Epidemiology, Treatment Strategy, Natural Disease Course and Surgical Outcomes of Patients with Ulcerative Colitis in Western Hungary - A Population-based Study Between 2007 and 2018: Data from the Veszprem County Cohort.

The number of population-based studies in ulcerative colitis [UC] from Eastern Europe is limited. Our aim here was to analyse the incidence, prevalence, disease phenotype, treatment strategy, disease course and colectomy rates in a prospective population-based inception cohort including UC patients diagnosed between 2007 and 2018. The present study is a continuation of the Veszprem IBD cohort since 1977. In total, 467 UC patients were included [male/female: 236/231; median age at diagnosis: 36 years, IQR: 25-54 years]. Both in-hospital and outpatient records were collected and comprehensively reviewed. The mean length of follow-up was 8.34 ± 3.6 years. Demographic data were derived from the Hungarian Central Statistical Office. The mean incidence rate was 11.02/105 person-years in this 12-year period. Prevalence was 317.79/105 persons in 2015. Disease extent at diagnosis was proctitis [E1] in 22.3%, left-sided colitis [E2] in 43.9% and extensive colitis [E3] in 33.8%. The probability of disease extent progression was 11.6% [SE: 1.8] after 5 years. The distribution of maximal therapeutic steps was 5-ASA in 46.9%, corticosteroids in 16.3%, immunosuppressives in 19.3% and biologicals in 16.5%. The probability of receiving biological therapy after diagnosis was 9.9% [SE: 1.4] at 3 years. The overall colectomy rate was 4.1% in the population. The probability of colectomy was 1.5% [SE: 0.6] at 1 year, 3.6% [SE: 0.9] at 5 years and 4.4% [SE: 1.0] at 10 years. The incidence of UC was high in Hungary, similar to high-incidence areas in Western Europe. Treatment strategies are in line with the biological era. The probability of progressing to proximal disease, and the medium- and long-term colectomy rates were both lower compared with data from Western European centres.

Myocarditis or Pericarditis Following the COVID-19 Vaccination in Adolescents: A Systematic Review.

Background: By 16 May 2022, 12,186,798,032 people had been vaccinated with COVID-19 vaccines. Our study found that myocarditis/pericarditis may occur in adolescents after COVID-19 vaccination. Methods: In this regard, we conducted a meta-analysis of seven groups of adolescents aged 12–19 years to compare the incidence of myocarditis/pericarditis after vaccination and compare the relative risk incidence after the first and second doses of a COVID-19 vaccine, and between males and females for risk incidence. Results: We analyzed 22,020,997 subjects from seven studies, including 130 cases of confirmed myocarditis/pericarditis. The overall mean incidence rate was 1.69 cases per 100,000 person-years. Of these, 19 of the 12,122,244 people who received a first dose of a COVID-19 vaccine had myocarditis/pericarditis, an incidence rate of 0.0022% (95% CI 0.0001–0.0034), and 111 of the 1,008,753 people who received a second dose had myocarditis/pericarditis, an incidence rate of 0.0107% (95% CI 0.0059–0.0155). The prevalence relative ratio (RR) after the first and second doses was RR = 5.53 (95% CI: 3.01–10.16), with a higher prevalence after the second dose than after the first dose of a COVID-19 vaccine. After a second dose of a COVID-19 vaccine, the RR for males relative to females was RR = 13.91 (95% CI: 4.30–44.95), with a more pronounced risk of disease in males than in females. Conclusions: Our study showed that myocarditis/pericarditis occurred after vaccination with the BNT162b2 or Comirnaty vaccine, especially after the second vaccination in male adolescents, but the incidence of myocarditis/pericarditis after vaccination with the above vaccines was very rare (0.0022%). Therefore, it is recommended that adolescents should be vaccinated with the COVID-19 universal vaccine as soon as possible and closely monitored for subsequent adverse reactions, which can be treated promptly.

Temporal trends in intraventricular hemorrhage in preterm infants: A Brazilian multicenter cohort

Intraventricular hemorrhage (IVH) is a serious problem in preterm infants. Brazilian national data are unknown. To evaluate the incidence and temporal trend of IVH in very low birth weight (VLBW) preterm infants of 18 centers of the Brazilian Network on Neonatal Research. National prospective multicenter cohort study including inborn VLBW preterm infants aged 230/7- 336/7 weeks' gestation, admitted between 2013 and 2018. The center with the mean incidence rate was used as reference. We applied two adjustments models using perinatal variables, and perinatal+neonatal diseases. Of 6,420 infants, 1951/30.4% (range 27.1-33.8%) had IVH and the disease showed a significant trend towards an overall increase in incidence over time (p=0.003), especially in three centers. Severe IVH (grade III or IV) occurred in 32.2% (range 29.2-34.5%) of those affected by IVH, with a stable incidence. After adjustments for perinatal variables, the differences persisted among centers: for global IVH, 7 centers had significantly lower rates (OR ranging from 0.31 to 0.62), and 2 presented rates higher than the reference center (OR ranging from 2.00 to 12.46) for severe HIV. Considering perinatal and neonatal variables, 6 centers had significantly lower rates (OR ranging from 0.36 to 0.60) for global IVH than the reference center and 3 had statistically higher rates (OR 1.72, 1.86 and 11.78) for severe forms. The incidence rate of IVH in this Brazilian cohort was high and it revealed an increasing trend towards over time. The severe IVH rate was also worrisome.

Epidemiological Trends of Trans-Boundary Tick-Borne Encephalitis in Europe, 2000-2019.

Tick-borne encephalitis is a neuroinfection widely distributed in the Euro–Asia region. Primarily, the virus is transmitted by the bite of infected ticks. From 2000–2019, the total number of confirmed cases in Europe reported to the European Centre for Disease Prevention and Control was 51,519. The number of cases decreased in 2014 and 2015; however, since 2015, a growing number of cases have been observed, with the involvement of countries in which TBE has not been previously reported. The determinant factors for the spread of TBE are host population size, weather conditions, movement of hosts, and local regulations on the socioeconomic dynamics of the local and travelling people around the foci areas. The mean incidence rate of tick-borne encephalitis from 2000–2019 in Europe was 3.27, while the age-adjusted mean incidence rate was 2.19 per 100,000 population size. This review used several articles and data sources from the European Centre for Diseases Prevention and Control.

Trends in the disease burden of congenital heart disease in China over the past three decades.

To investigate the disease burden of congenital heart disease (CHD) in China from 1990 to 2019. Using the data from Global Burden of Disease (GBD) study 2019, the incidence, age-standardized incidence rates, the mortality, age-standardized mortality rates, disability-adjusted life year (DALY) and age-standardized DALY rates of CHD were calculated. Time trend analysis of disease burden-related indicators was analyzed by Joinpoint regression model. Age-period-cohort model was used to describe age, period, and birth cohort effects in CHD mortality population. The relationship between age-standardized incidence, mortality, DALY rates of congenital heart disease and human development index (HDI) were analyzed by Pearson correlation. From 1990 to 2019, the mean annual percentage change (AAPC) in age-standardized incidence rate, mortality rate and DALY rate of CHD in China were -0.1%(95% CI: -0.7%-0.4%)、-3.5%(95% CI: -3.7%--3.2%) and -3.5%(95% CI: -3.7%--3.2%), respectively. CHD usually occurred in the first year of life. The mean incidence rate at birth was 2497.9/100 000, and the mean incidence rate under 1 year of age was 2626.6/100 000. During the period of 1995-2000, the incidence rate in newborn and <1 year children showed an exponential upward trend, then it remained a steady downward trend. However, there was an exponential increase in <1 year children during 2010-2013 and 2014-2015, followed by an exponential decrease to the lowest value in the last three decades. The mortality of CHD tended to decrease with age, with mortality of 101.67/100 000 for children under 5 years of age and a decrease after 5 years of age. However, there was a transient increase in mortality in age group 55-<60. From 1995 to 2019, the relative risk of death of patients with CHD showed a downward trend. Compared with 1995-1999, the rate ratio of death decreased by 24% in 2015-2019. Such downward trend was also observed in the birth cohort after 1945. Compared with the 1945-1949 birth cohort, the rate ratio of death for patients with CHD decreased by 75% in the 2015-2019 birth cohort. When HDI<0.58 (before 1999), the age-standardized incidence of CHD was positively correlated with HDI ( r=0.74, P<0.05). When HDI≥0.58 (after 1999), the age-standardized incidence of CHD was negatively correlated with HDI ( r=-0.76, P<0.01). The age-standardized mortality and DALY rates were negatively correlated with HDI ( r=-0.95 and -0.93, both P<0.01). During 1990 to 1999, the incidence of CHD increases and is positively correlated with the social development. During 1999 to 2019, the incidence of CHD decreases and is negatively correlated with the social development. The disease burden of CHD decreases and is negatively correlated with the social development. Some progress has been made in the field of prevention and control of CHD, but the disease burden remains high among younger population in China.

Epidemiology and Treatment of Distal Radius Fractures in Finland-A Nationwide Register Study.

A distal radius fracture (DRF) is one of the most common fractures in emergency units, the treatment of which requires considerable health care resources. We analyzed the incidence rate for DRFs and the incidence rate of operative treatment over a five-year period, 2015–2019, for the entire population of Finland and all ages. Data was obtained from the Finnish National Care Register for Health Care. The results were counted as cases per 100,000 person/years and standardized with the European Standard Population 2013. The mean annual incidence rate of DRF was 204.90 (203.21–206.59) in specialist care and 69.53 (68.55–70.52) in primary care. It peaked among the pediatric population and among elderly women, in whom it was more than four times as common compared to men of the same age. No increase in the incidence rate of DRFs was found. The mean incidence rate of operative treatment was 45.66 (45.66–45.66)/100,000 person/years, 2015–2019; women were more likely to undergo operative treatment. Altogether, 15–18% of DRFs were operated on over the study period. The annual incidence rate of operations seemed to plateau compared to earlier studies in Finland.

Backward relative to forward walking speed and falls in older adults with dementia

BackgroundAdults with dementia have a high risk of falls and fall-related injuries. A greater slowing of backward walking speed (BWS) relative to forward (FWS) has been indicated with older age, and slower BWS has been related to an increased risk of falls. Similarly, slow BWS relative to FWS has been observed in people with dementia. Research questionIs slower BWS, and slower BWS relative to FWS associated with increased risk of prospective falls in older adults with dementia? MethodsIn total, 52 women and 12 men with dementia living in nursing homes, mean age 86 years, and mean Mini-Mental State Examination score of 14.2 points were included. BWS and FWS was measured over 2.4 m, and the directional difference (DD) calculated (100*((FWS-BWS)/FWS)). Falls were followed for 6 months by review of fall incident reports in electronic medical records at nursing homes and the regional healthcare provider. ResultsAltogether, 95 falls occurred with mean incidence rate 3.1 falls per person-years. Of included participants, 15 (23%) fell once, and 17 (27%) fell twice or more. In negative binomial regression analyses, greater DD was associated with lower prospective incidence fall rate ratio, IRR (IRR= 0.96, p < .001), while BWS was not (IRR= 0.04, p = .126). SignificanceIn this study of adults with dementia, slower BWS was not associated with prospective falls. However, slower BWS relative to forward (greater DD) was associated with fewer falls, and possibly a protective response. This is novel research, yet results are promising and indicate that assessing walking speed in multiple directions may inform fall risk in adults with dementia.

The seasonality of cholera in sub-Saharan Africa: a statistical modelling study

SummaryBackgroundCholera remains a major threat in sub-Saharan Africa (SSA), where some of the highest case-fatality rates are reported. Knowing in what months and where cholera tends to occur across the continent could aid in improving efforts to eliminate cholera as a public health concern. However, largely due to the absence of unified large-scale datasets, no continent-wide estimates exist. In this study, we aimed to estimate cholera seasonality across SSA and explore the correlation between hydroclimatic variables and cholera seasonality.MethodsUsing the global cholera database of the Global Task Force on Cholera Control, we developed statistical models to synthesise data across spatial and temporal scales to infer the seasonality of excess (defined as incidence higher than the 2010–16 mean incidence rate) suspected cholera occurrence in SSA. We developed a Bayesian statistical model to infer the monthly risk of excess cholera at the first and second administrative levels. Seasonality patterns were then grouped into spatial clusters. Finally, we studied the association between seasonality estimates and hydroclimatic variables (mean monthly fraction of area flooded, mean monthly air temperature, and cumulative monthly precipitation).Findings24 (71%) of the 34 countries studied had seasonal patterns of excess cholera risk, corresponding to approximately 86% of the SSA population. 12 (50%) of these 24 countries also had subnational differences in seasonality patterns, with strong differences in seasonality strength between regions. Seasonality patterns clustered into two macroregions (west Africa and the Sahel vs eastern and southern Africa), which were composed of subregional clusters with varying degrees of seasonality. Exploratory association analysis found most consistent and positive correlations between cholera seasonality and precipitation and, to a lesser extent, between cholera seasonality and temperature and flooding.InterpretationWidespread cholera seasonality in SSA offers opportunities for intervention planning. Further studies are needed to study the association between cholera and climate.FundingUS National Aeronautics and Space Administration Applied Sciences Program and the Bill & Melinda Gates Foundation.

Effect of selective dry cow treatment on udder health and antimicrobial usage on Dutch dairy farms

Since 2013, selective dry cow treatment (SDCT) has been the standard approach in the Netherlands where farmers select cows for the use of antimicrobials at drying-off. Shortly after its introduction, antimicrobial usage decreased significantly, and no significant association was found between the level of SDCT and clinical mastitis (CM). Obviously, at that time long-term associations could not be evaluated. This study aimed to provide insight into the methods and level of implementation of SDCT on Dutch dairy farms with a conventional milking system (CMS) or an automatic milking system (AMS) in 2016 and 2017, several years after the implementation of SDCT. Udder health and antimicrobial use were also assessed. For this study, 262 farmers recorded dry cow treatments as well as all CM cases in the period from May 1, 2016, until April 30, 2017. Additionally, somatic cell count (SCC) data on cow and herd level, treatment data on herd level and questionnaire results on udder health management were collected. Data were analyzed using descriptive statistics with differences between milking systems being evaluated using nonparametric univariable statistics. In the study period, SDCT was applied on almost all (98.8%) of the participating dairy farms. The main reason for applying antimicrobials at drying-off was either the SCC history during the complete previous lactation or the SCC at the last milk recording before drying-off. The median percentage of cows treated with antimicrobials was 48.5%. The average incidence rate of CM was 27.3 cases per 100 cows per year. From all CM cases that were registered per herd, on average 32.8% were scored as mild, 42.2% as moderate, and 25.0% as severe CM. The mean bulk tank SCC of the herds was 168,989 cells/mL. A cow was considered to have subclinical mastitis (SCM) if individual SCC was ≥150,000 cells/mL for primiparous and ≥250,000 cells/mL for multiparous cows. Passing these threshold values after 2 earlier low SCC values was considered a new case of SCM. The mean incidence rate of SCM in these herds was 62.5 cases per 100 cows per year. Bulk tank SCC and the incidence rate of SCM on farms with a CMS were statistically lower than on farms with an AMS, whereas the incidence rate of CM did not significantly differ between both groups of farms. The AMS farms had more cows per herd treated with antimicrobials at drying-off and a larger proportion of severe CM cases than did CMS farms. It is unknown whether the differences are due to the milking system or to other differences between both types of farms. This study showed the level of adoption of SDCT, udder health, and antimicrobial usage parameters several years after the ban on the preventive use of antimicrobials in animal husbandry. It found that udder health parameters did not differ from those found in Dutch studies before and around the time of implementing SDCT, whereas SDCT was widely applied on Dutch dairy farms during the study period. Therefore, it was concluded that Dutch dairy farmers were able to handle the changed policy of antimicrobial use at drying-off while maintaining indicators of a good udder health.