Nationwide Hospital-based Registry Research Articles

Contemporary diagnosis and treatment of valvular heart disease in Korea: a nationwide hospital-based registry study

BackgroundThis study was designed to determine the current status of diagnosis and treatment of valvular heart disease (VHD) in Korea.MethodsA nationwide registry study was conducted in 45 hospitals in Korea involving adult patients with at least moderate VHD as determined by echocardiography carried out between September and October of 2019. Of a total of 4,094 patients with at least moderate VHD, 1,482 had severe VHD (age, 71.3 ± 13.5 years; 49.1% male). Echocardiographic data used for the diagnosis of each case of VHD were analyzed. Experts from each center determined the diagnosis and treatment strategy for VHD based on current guidelines and institutional policy. The clinical outcome was in-hospital mortality.ResultsEach valve underwent surgical or transcatheter intervention in 19.3% cases of severe mitral stenosis, 31.4% cases of severe primary mitral regurgitation (MR), 7.5% cases of severe secondary MR, 43.7% cases of severe aortic stenosis, 27.5% cases of severe aortic regurgitation, and 7.2% cases of severe tricuspid regurgitation. The overall in-hospital mortality rate for patients with severe VHD was 5.4%, and for secondary severe MR and severe tricuspid regurgitation, the rates were 9.0% and 7.5%, respectively, indicating a poor prognosis. In-hospital mortality occurred in 73 of the 1,244 patients (5.9%) who received conservative treatment and in 18 of the 455 patients (4.0%) who received a surgical or transcatheter intervention, which was significantly lower in the intervention group (P = 0.037).ConclusionsThis study provides important information about the current status of VHD diagnosis and treatment through a nationwide registry in Korea and helps to define future changes.

Carbon-Ion Radiation therapy for Adenocarcinoma of the Uterine Cervix: Clinical Outcomes of a Multicenter Prospective Registry-Based Study in Japan (2016-2020)

Cases of adenocarcinoma of the uterine cervix (AUC) have poorer prognoses than those of squamous cell carcinoma. Carbon-ion radiation therapy (CIRT) outcomes for AUC have been reported in retrospective or single-institutional prospective studies but not prospective multicenter studies. We present the results of CIRT for AUC in a prospective multicenter study using a nationwide hospital-based registry in Japan. Patients with locally advanced untreated AUC who received CIRT at 4 Japanese centers between June 2016 and April 2020 were included in this study. In the absence of organ dysfunction, up to 5 weekly 40 mg/m2 cisplatin courses were administered. The primary endpoints were 2-year overall survival and local control rates. The secondary endpoints were 2-year disease-free survival rate and late adverse events (AEs). Forty-two patients were enrolled with a median age of 54 years (range, 34-76 years). Patients were diagnosed with stage IIB (n = 26), IIIB (n = 12), or IVA (n = 4) disease. The median follow-up period was 24 months. The 2-year overall survival, local control, and disease-free survival rates were 97.5% (95% CI, 92.7%-100.0%), 80.9% (95% CI, 66.9%-94.8%), and 64.3% (48.1%-80.4%), respectively. Two patients developed grade 3 rectum/sigmoid AE. One patient required urinary diversion surgery during a salvage operation for local tumor recurrence (grade 3 genitourinary AE). No other grade 3 or worse toxicities were reported. CIRT is an effective treatment for locally advanced AUC. Further research is required to validate the safety and efficacy of CIRT for AUC.

Quantification of the Heat-Related Risk and Burden of Hospitalizations for Cause-Specific Injuries and Contribution of Human-Induced Climate Change: A Time-Stratified Case-Crossover Study in China.

Although ambient temperature has been linked with injury incidence, there have been few nationwide studies to quantify the temperature-related risk and burden of cause-specific injury hospitalizations. Additionally, the impact of human-induced climate change to injury burden remains unknown. Our objectives are to examine the associations between ambient temperature and injury hospitalizations from various causes and to quantify the contribution of human-induced warming to the heat-related burden. We collected injury hospitalization data from a nationwide hospital-based registry in China during 2000-2019. Using a time-stratified case-crossover design, we investigated the associations between daily mean temperature (°C) and cause-specific injury hospitalizations. We also quantified the burden of heat-related injuries under the scenarios with and without anthropogenic forcing, using the Detection and Attribution Model Intercomparison Project to assess the contribution of human-induced warming. Our study included a total of 988,087 patients with hospitalization records for injuries. Overall, compared to the temperature at minimum risk of hospitalization (), the relative risk of hospitalization at extreme hot temperature (30.8°C, 97.5th percentile) was 1.18 [95% confidence interval (CI): 1.14, 1.22], with an approximately linear association between temperature and hospitalization. Vulnerability to heat-related injuries was more pronounced among males, young ( years of age) or middle-aged (45-64 years of age) individuals, and those living in the North. The heat-related attributable fraction increased from 23.2% in the 2000s to 23.6% in the 2010s, with a corresponding increase in the contribution of human-induced change over time. In the 2010s, the heat-related attributable fractions for specific causes of injury ranged from 12.4% to 54.4%, with human-induced change accounting for 6.7% to 10.6% of the burden. This nationwide study presents new evidence of significant associations between temperature and cause-specific injury hospitalizations in China and highlights the increasing contribution of human-induced warming to the injury burden. https://doi.org/10.1289/EHP14057.

Fine and coarse particulate air pollution and hospital admissions for a wide range of respiratory diseases: a nationwide case-crossover study.

The associations between fine and coarse particulate matter (PM2.5 and PM2.5-10) air pollution and hospital admissions for full-spectrum respiratory diseases were rarely investigated, especially for age-specific associations. We aim to estimate the age-specific associations of short-term exposures to PM2.5 and PM2.5-10 with hospital admissions for full-spectrum respiratory diseases in China. We conducted an individual-level case-crossover study based on a nationwide hospital-based registry including 153 hospitals across 20 provincial regions in China in 2013-20. We applied conditional logistic regression models and distributed lag models to estimate the exposure- and lag-response associations. A total of 1 399 955 hospital admission records for various respiratory diseases were identified. The associations of PM2.5 and PM2.5-10 with total respiratory hospitalizations lasted for 4 days, and an interquartile range increase in PM2.5 (34.5 μg/m3) and PM2.5-10 (26.0 μg/m3) was associated with 1.73% [95% confidence interval (95% CI): 1.34%, 2.12%)] and 1.70% (95% CI: 1.31%, 2.10%) increases, respectively, in total respiratory hospitalizations over lag 0-4 days. Acute respiratory infections (i.e. pneumonia, bronchitis and bronchiolitis) were consistently associated with PM2.5 or PM2.5-10 exposure across different age groups. We found the disease spectrum varied by age, including rarely reported findings (i.e. acute laryngitis and tracheitis, and influenza) among children and well-established associations (i.e. chronic obstructive pulmonary disease, asthma, acute bronchitis and emphysema) among older populations. Besides, the associations were stronger in females, children and older populations. This nationwide case-crossover study provides robust evidence that short-term exposure to both PM2.5 and PM2.5-10 was associated with increased hospital admissions for a wide range of respiratory diseases, and the spectra of respiratory diseases varied by age. Females, children and older populations were more susceptible.

Abstract WMP71: Changes In Severity And Outcomes Of Ischemic Stroke Associated With Atrial Fibrillation In A Long-lasting Nationwide Hospital-based Registry: Japan Stroke Data Bank

Background: To determine secular changes in severity and functional outcomes of acute atrial fibrillation (AF)-associated stroke patients using a large population. Methods: Ischemic stroke patients with known AF or AF diagnosed after stroke onset, who were registered within 7 days after symptom onset into a hospital-based prospective registry, Japan Stroke Data Bank, from Jan 2000 to Dec 2020 were compared with those without AF. The co-primary outcomes were the initial neurological severity assessed by NIHSS and favorable outcome assessed by mRS of 0 to 2 at hospital discharge. Secondary outcomes included unfavorable outcome assessed by mRS of 5 to 6 and in-hospital death. Results: Of 142,351 patients studied, 33,870 had AF (women 45.1%, median age 79 years, non-valvular 94.3%). Patients with AF had higher initial NIHSS score (median 9 vs. 3, adjusted coefficient 5.383, 95% CI 5.245 - 5.520) as compared to patients without AF (women 38.2%, median age 79 years). Anticoagulation prior to the index stroke showed a significant interaction with the frequency of the NIHSS score ≥10 in patients with AF relative to those without AF (aOR: 2.047 for anticoagulated patients vs. 4.189 for the others). The NIHSS score decreased over the 21-year period in AF patients (adjusted coefficient -0.104, 95% CI -0.133 - -0.074 per year). Favorable outcome was less common in patients with AF than those without AF in unadjusted analysis (48.4% vs. 70.4%) but was more common after multivariable adjustment including the initial NIHSS score (aOR 1.096, 95% CI 1.040 - 1.156). Unfavorable outcome (aOR 1.108) and in-hospital death (1.506) were also more common in AF patients. The proportion of favorable outcome showed an increase over time (aOR 1.018, 95% CI 1.009 - 1.026 per year) in AF patients but the increase was no longer significant after further adjustment by receiving reperfusion therapy (1.007, 0.998 - 1.016). The proportion of unfavorable outcome and that of in-hospital death showed a yearly decrease over time. Conclusions: AF patients showed favorable clinical outcome after ischemic stroke relative to patients without AF by adjustment using the NIHSS score and others. Initial stroke severity became milder and functional outcomes tended to improve in AF patients during the past 21 years.

Revision of ‘golden hour’ for hemodynamically unstable trauma patients: an analysis of nationwide hospital-based registry in Japan

BackgroundThe ‘golden hour’ is a well-known concept, suggesting that shortening time from injury to definitive care is critically important for better outcome of trauma patients. However, there was no established...

China Registry of Hepatitis B (CR-HepB): Protocol and implementation of a nationwide hospital-based registry of hepatitis B

Aims: The disease burden of chronic HBV infection in China remains high, although the rate of new infections has become extremely low. To facilitate real-world clinical study of chronic HBV infection, we established a nationwide hospital-based electronic platform, named the China Registry of Hepatitis B (CR-HepB). Methods: This internet-based registry for chronic hepatitis B recruited patients from tertiary or secondary hospitals that have particular interest and expertise in managing hepatitis B patients. The main inclusion criteria for the database were men or women with hepatitis B surface antigen positivity ≥ 6 months, hepatitis B e antigen positive or negative, with or without cirrhosis, and with or without treatment. At the first time of data entry, demographics, medical history, virology, biochemistry, hematology and radiology reports, as well as diagnosis and treatment information, are recorded. Registered patients then receive a standard of care and follow-up every three (optional) to six months (required) for changes in virology, biochemistry and radiology, as well as clinical progression. Results and Conclusions: To date, 47 hospitals have joined the CR-HepB. This platform can be used to demonstrate the clinical pattern and treatment profile of chronic HBV infection, evaluate long-term efficacy and safety of antiviral therapy and provide real-world evidence for policy-making in China. Trial registration: ClinicalTrials.gov ID: NCT03108794.

Surgery for acute infective endocarditis: epidemiological data from a Spanish nationwide hospital-based registry.

Infective endocarditis (IE) is a serious and eventually lethal disease with rising incidence in the past couple of decades. The aim of this study was to evaluate the contemporary epidemiological trends of surgical endocarditis patients, to analyse the clinical outcomes and to study their profile, associated prognostic factors and costs. This is a retrospective study of all patients admitted for IE in Spanish hospitals and discharged between 1 January 1997 and 31 December 2014. Data were extracted from the minimum basic data set of the National Surveillance System for Hospital Data in Spain provided by the Spanish Ministry of Health. Hospitalizations, comorbidities, outcomes and costs were analysed. In total, 34 399 patients with IE were included; 15.7% of patients received surgical treatment and 84.3% received medical treatment only. Surgical patients were mostly men (71.9%) and had a lower mean age (59.2 ± 16.08 years) than the medical treatment group (P < 0.0001). Mortality among surgical patients showed a decreasing trend between 1997 (32.0%) and 2014 (22.7%) and increased with age (47.6% in ≥85 years of age). Length of hospital stay and the percentage of patients with organ dysfunction were also higher in this group. The cost of the surgical treatment group was higher and increased since 1997 (15 259.22 euros), remaining stable from 2010 (40 700 euros) (P < 0.0001). Surgical treatment in IE has trended upwards in Spain during the last 2 decades. Patients are getting older and more frequently experience organ dysfunction. Mortality ratio steadily declined without changes in the length of hospital stay.

239 Mortality of Motor Vehicle Accidents by Elderly Drivers: A Nationwide Hospital-Based Registry in Japan

Japan is the leading aging country, and motor vehicle accidents (MVAs) by elderly drivers have been exceedingly increasing in recent years. However, there were no clinical studies evaluating the impact of MVAs by elderly drivers in Japan. We aimed to assess the MVA incidence and outcomes by elderly drivers, especially by those aged >=75 years who were transported to emergency department and registered in the Japan Trauma Data Bank. This was a prospective nationwide hospital-based registry for trauma patients from 256 institutions in Japan, and enrolled all MVA drivers having more than legal age for driving between 2004 and 2015. We divided the registered patients into the following three groups; the adult (aged =<64 years), the young-old (aged 65-74 years), and the old-old (aged >=75 years). The primary outcome was in-hospital mortality, and the secondary outcome was length of hospital stay (LOS) and discharge place. The trend in the proportion of MVAs caused by the young-old or the old-old group was evaluated using the Cochran-Armitage trend test. To assess the association of the old-old group with in-hospital mortality compared to the adult group, we applied a multivariable logistic regression analysis. During the study period, a total of 236,698 trauma patients were registered, and 39,691 patients were eligible for our analysis. The proportion of MVAs caused by the young-old and the old-old group significantly increased from 8.1% and 3.6% in 2004 to 10.6% and 13.2% in 2015, respectively (each P for trend<0.001). As for the primary outcome, unadjusted in-hospital mortality rate increased with age, but the mortality rate decreased year by year irrespective of age group. In the multivariable logistic regression analysis, in-hospital mortality rate was significantly higher in the old-old group than in the adult group (17.3% [584/3372] versus 8.0% [2556/31,985], adjusted odds ratio 4.80; 95% confidence interval 4.06-5.67). In addition, among survival cases, LOS was longer in the old-old group than in the adult group (median [interquartile range], 19 [8-41] versus 13 [4-31], p<0.001), and the old-old group was more likely to discharge to health care facilities such as nursing home or long-term care institutions than the adult group (46.9% [1580/3372] versus 33.0% [10,553/31,985], p<0.001). In the super-aging society of Japan, the proportion of MVAs by elderly drivers increased year by year, and the mortality rate was highest in the old-old group. We should pay further attention to the trend in the MVA incidence and outcomes by elderly drivers, especially the old-old group, to decrease the MVA mortality in Japan.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Acute Stroke Registry Malaysia, 2010-2014: Results from the National Neurology Registry

Stroke remains a major health burden worldwide. The incidence and prevalence rates of stroke are decreasing in developed countries, an opposite trend is taking place in the Asia Pacific, where an increasing number of patients are being diagnosed with acute stroke. The results of the present study on acute stroke in multi-ethnic Malaysia will significantly contribute to the global stroke epidemiological data. We aimed to present epidemiological data of stroke including incidence and prevalence rates as well as associated risk factors from a prospective nationwide hospital-based registry from 2010 to 2014. Patients diagnosed with stroke upon admission at the hospital were prospectively enrolled into the registry from January 1, 2010, to December 31, 2014. Descriptive analyses were performed. A total of 7668 patients were available for analysis. On average, patients were aged 62.7 years (standard deviation of 12.5). Ischemic stroke accounts for 79.4% of the cohort with a slightly higher proportion of male patients (55%). Ischemic stroke incidence is estimated to increase annually by 29.5% and hemorrhagic stroke by 18.7%. Hypertension is a major risk factor for both ischemic and hemorrhagic strokes regardless of stroke event with an excess of 8.4% hypertensive female compare to male patients (P ≤ .001). Majority of patients with ischemic and hemorrhagic strokes experienced mild and moderate stroke with 11.7% and 21.1%, respectively, documented as severe (P ≤ .001). The incidence and prevalence of stroke in Malaysia increased dramatically in the 5-year study period. Therefore, implementation of risk factor control strategies is important to prevent further increase of stroke burden in the country.

Clinical and Neuropsychological Characteristics of a Nationwide Hospital-Based Registry of Frontotemporal Dementia Patients in Korea: A CREDOS-FTD Study

Background: We investigated the demographic, clinical, and neuropsychological characteristics of frontotemporal dementia (FTD) from the Clinical Research Center for Dementia of South Korea (CREDOS)-FTD registry. Methods: A total of 200 consecutive patients with FTD recruited from 16 neurological clinics in Korea were evaluated by cognitive and functional assessments, a screening test for aphasia, behavioral questionnaires, motor assessments, and brain MRI or PET. Results: In our registry, 78 patients were classified as having been diagnosed with behavioral-variant FTD (bvFTD), 70 with semantic dementia (SD), 33 with progressive nonfluent aphasia (PNFA), and 8 with motor neuron disease plus syndrome (MND-plus). The patients with language variants of dementia were older than those with bvFTD. There were no differences in sex ratio, duration of illness, or level of education among the four subgroups. Overall, the patients with bvFTD showed a significantly better performance in cognitive tests. A higher frequency of motor symptoms and a lower frequency of behavioral symptoms were found in PNFA than in bvFTD and SD. The Global Language Index was significantly lower in SD than in bvFTD and PNFA. The MND-plus group had a poorer performance than all the others in all cognitive domains. Conclusion: The neuropsychological, behavioral, motor, and language characteristics of the four subtypes are comparable with those from other series. However, the proportion of SD (37.0%), which was similar to that of bvFTD (41.3%), was higher in our registry than in other series.

P630 Epidemiological and phenotypic characteristics of IBD patients in Romania – results of a nationwide hospital-based registry

C. Gheorghe1, A. Dimitriu1 *, R. Iacob1, M. Cojocaru1, C. Lupei1, R. Vadan1, D. Dobru2, A. Trifan3, M. Tantau4, A. Goldis5, G. Constantinescu6, S. Gologan7, B. Mateescu8, D. Gheonea9, L. Gheorghe1, M. Diculescu1, on behalf of the IBDPROSPECT Study Group. 1Fundeni Clinical Institute, Digestive Diseases and Liver Transplantation Center, Bucharest, Romania, 2Municipal Hospital Targu Mures, Gastroenterology, Targu Mures, Romania, 3Gastroenterology and Hepatology Institute Iasi, Gastroenterology, Iasi, Romania, 43rd Medical Clinic Cluj-Napoca, Gastroenterology, Cluj-Napoca, Romania, 5District Hospital Timisoara, Gastroenterology, Timisoara, Romania, 6Floreasca Emergency Hospital, Gastroenterology, Bucharest, Romania, 7Elias Universitary Hospital, Gastroenterology, Bucharest, Romania, 8Colentina Clinical Hospital, Gastroenterology, Bucharest, Romania, 9University of Medicine and Pharmacy Craiova, Romania, Immunology, Craiova, Romania

Geographic and urban–rural disparities in the total prevalence of neural tube defects and their subtypes during 2006–2008 in China: a study using the hospital-based birth defects surveillance system

BackgroundPrevious reports on the prevalence of neural tube defects (NTDs) in China did not include cases of NTDs that were less than 28 weeks of gestational age (GA) and hence did not accurately reflect the total prevalence of NTDs or the geographic and urban–rural disparities in their prevalence. This article includes cases of NTDs that were less than 28 weeks of GA.MethodsData used in this study were collected from 2006 to 2008 using a nationwide hospital-based registry, the Chinese Birth Defects Monitoring Network. The total prevalence ratio (PR) of NTDs and their subtypes, the ratios of PR (PRR), and 95% confidence intervals (CI) were used to analyse geographic disparities at both the regional (north, south) and provincial levels and to analyse disparities between rural and urban areas.ResultsOverall, the total PR of NTDs was 14.0 per 10,000 births. The PRR of NTDs of rural women between the north and south region was 2.26 (95% CI: 2.04-2.52), which was much higher than that of urban women (PRR: 1.56, 95% CI: 1.41-1.72). The three subtypes of NTDs had different geographic distribution at the level of province. The urban–rural PRR of NTDs was 2.14 (95% CI: 1.94-2.34) in the north but only 1.47 (95% CI: 1.31-1.66) in the south.ConclusionsThere is a high total prevalence of NTDs, which remains one of the major public health concerns in China. Eliminating the geographic and urban–rural disparities in the disease burden is a priority for future intervention.

National Prostate Cancer Registry 2010 in Spain

ObjectivesTo estimate the 2010 incidence of PCa in Spain and describe the clinical profile of newly diagnosed cases using a nationwide hospital-based registry. Material and methodsNational epidemiological study in 25 public hospitals with a specific reference population according to the National Health System. Sociodemographic and clinical variables of all newly diagnosed, histopathological confirmed PCa cases were collected in 2010, in the area of influence of each center. The age-standardized PCa incidence was determined based on the age distribution of the Spanish population in Spain and in 3 regions: Andalusia, Catalonia and Region of Madrid. Results4087 new cases of PCa were diagnosed for a reference population of 4,933,940 men (21.8% of the Spanish male population). The estimated age-standardized PCa incidence was 82.27 cases per 100,000 men in Spain, 70.38 in Andalusia, 85.70 in Catalonia and 92.29 in the Region of Madrid. Mean age at diagnosis was 69 years. Median PSA was 8ng/ml. Gleason score was ≤6 in 56.5%, 7 in 26.7% and >7 in 16.8% of patients. At diagnosis, 90% had localized disease. ConclusionsIn the 3 Regions analyzed, around 80–90% of the cases are diagnosed in a clinical localized stage. The incidence rates in Andalusía, Catalonia and Region of Madrid show a great difference between them due to several factors.

Registro nacional de cáncer de próstata 2010 en España

ObjectivesTo estimate the 2010 incidence of PCa in Spain and describe the clinical profile of newly-diagnosed cases using a nationwide hospital-based registry. Material and methodsNational epidemiological study in 25 public hospitals with a specific reference population according to the National Health System. Sociodemographic and clinical variables of all newly diagnosed, histopathological confirmed PCa cases were collected in 2010, in the area of influence of each centre. The age–standardised PCa incidence was determined based on the age distribution of the Spanish population in Spain and in 3 regions: Andalusia, Catalonia and Region of Madrid. Results4,087 new cases of PCa were diagnosed for a reference population of 4,933,940 men (21.8% of the Spanish male population). The estimated age-standardised PCa incidence was 82.27 cases per 100,000 men in Spain, 70,38 in Andalusia, 85,70 in Catalonia and 92,29 in the Region of Madrid. Mean age at diagnosis was 69 years. Median PSA was 8 ng/ml. Gleason score was ≤6 in 56.5%, 7 in 26.7% and >7 in 16.8% of patients. At diagnosis, 90% had localised disease. ConclusionsIn the 3 Regions analyzed, around 80-90% of the cases are diagnosed in a clinical localised stage. The incidence rates in Andalusía, Catalonia and Region of Madrid show a great difference between them due to several factors.

Prostate cancer incidence and newly diagnosed patient profile in Spain in 2010

What's known on the subject? and What does the study add? Prostate cancer (PCa) accounts for 12% of newly diagnosed cases of cancer in Europe. It is one of the most frequently diagnosed tumours in the developed world. Since the introduction of prostate specific antigen as a test for early detection of PCa, the rate of diagnosis has increased significantly and specific mortality has reduced in most western countries. Most of the data on the incidence of PCa are obtained from population-based cancer registries which frequently do not cover the whole population. This first national hospital-based PCa registry aims not only to estimate the incidence of the disease but to ascertain the clinical profile of newly diagnosed PCa patients, a useful tool for evaluating the impact of the disease and its socio-health management. • To estimate the 2010 incidence of prostate cancer (PCa) in Spain. • To describe the clinical profile of newly diagnosed cases using a nationwide hospital-based registry. • This was a national epidemiological observational study in 25 public hospitals with a specific reference population according to the National Health System. • Sociodemographic and clinical variables of all newly diagnosed, histopathologically confirmed PCa cases were collected in 2010, in the area of influence of each centre. Cases diagnosed in private practice were not collected (estimated nearly 10% in Spain). • Data monitoring was external to guarantee quality and homogeneity. • The age-standardized PCa incidence was determined based on the age distribution of the European standard population. • In all, 4087 new cases of PCa were diagnosed for a reference population of 4933940 men (21.8% of the Spanish male population). • The estimated age-standardized PCa incidence was 70.75 cases per 100000 men. • Mean age at diagnosis was 69 years; 11.6% of patients presented with tumour-related symptoms and 39.5% with LUTS. Median PSA was 8 ng/mL. Gleason score was ≤ 6 in 56.5%, 7 in 26.7% and >7 in 16.8% of patients. At diagnosis, 89.8% had localized, 6.4% locally advanced and 3.8% metastatic disease. • This study on PCa incidence in Spain, a western country with intensive opportunistic PSA screening, shows that PCa is a high incidence tumour, diagnosed close to 70 years, usually asymptomatic. • Almost 40% of cases have low risk disease with a risk of over-diagnosis and over-treatment. • Around 55% of patients with intermediate or high risk disease are candidates for active therapy which may result in a reduction of cancer-specific mortality.

Clinical Characteristics of a Nationwide Hospital-based Registry of Mild-to-Moderate Alzheimer's Disease Patients in Korea: A CREDOS (Clinical Research Center for Dementia of South Korea) Study

With rapid population aging, the socioeconomic burden caused by dementia care is snowballing. Although a few community-based studies of Alzheimer's disease (AD) have been performed in Korea, there has never been a nationwide hospital-based study thereof. We aimed to identify the demographics and clinical characteristics of mild-to-moderate AD patients from the Clinical Research Center for Dementia of Korea (CREDOS) registry. A total of 1,786 patients were consecutively included from September 2005 to June 2010. Each patient underwent comprehensive neurological examination, interview for caregivers, laboratory investigations, neuropsychological tests, and brain MRI. The mean age was 74.0 yr and the female percentage 67.0%. The mean period of education was 7.1 yr and the frequency of early-onset AD (< 65 yr old) was 18.8%. Among the vascular risk factors, hypertension (48.9%) and diabetes mellitus (22.3%) were the most frequent. The mean score of the Korean version of Mini-Mental State Examination (K-MMSE) was 19.2 and the mean sum of box scores of Clinical Dementia Rating (CDR-SB) 5.1. Based on the well-structured, nationwide, and hospital-based registry, this study provides the unique clinical characteristics of AD and emphasizes the importance of vascular factors in AD in Korea.

Residence Near Power Lines and Risk of Childhood Leukemia in Two Northern Italy Municipalities

ISEE-0265 Background and Objective: Some epidemiological studies suggest an association between electromagnetic fields exposure, such as that induced by residence near high-voltage power lines, and childhood leukemia, but null results have also been yielded and the possibility of bias induced by unmeasured confounders has been suggested. Methods: We identified the corridors along the high-voltage power lines in the municipalities of Modena and Reggio Emilia, northern Italy, with estimated magnetic fields exposure cutoffs of 0.1, 0.2 and 0.4 μT. We identified all cases of leukemia diagnosed in children (age 0–13) residing in these two municipalities during the 1986–2006 period through a nation-wide hospital-based registry. As a control group we randomly selected four residents for each case, matched for year of birth, sex and municipality of residence. We collected information about historical residence and parental education for all study subjects. We included this information in a GIS database and calculated the risk of childhood leukemia associated with residence for at least 6 months in the exposed area. Results: Among the 47 cases and 188 controls included in the study, only 1 case and 2 controls had a historical residence in the exposed areas. The risk of leukemia associated with antecedent residence in the area with exposure exceeding 0.1 μT was 2.0 (4.16 in the analysis adjusted for parental education), but this estimate was statistically unstable; its 95% confidence interval being 0.2–22.1. Conclusion: The number of exposed children in this study was too low to allow firm conclusions, suggesting the need to substantially increase the study population. Though on the basis of these results an excess risk of leukemia among children exposed to electromagnetic fields from high-voltage power lines cannot be ruled out, the possibility of no association must also be considered.

Time trends in oral clefts in Chinese newborns: Data from the Chinese National Birth Defects Monitoring Network

Although the prevalence of oral clefts in China is among the highest in countries worldwide, little is known about its descriptive epidemiology. Data used in this study were collected from 1996 to 2005 using the nationwide hospital-based registry, the Chinese Birth Defects Monitoring Network. A total of 4,891,472 newborns (live or still births with 28 weeks of gestation or more) delivered in member hospitals were assessed for birth defects within 7 days following birth. The prevalence of nonsyndromic, syndromic, and overall clefts was 14.23, 2.40, and 16.63 per 10,000, respectively. An upward time trend in the prevalence of nonsyndromic cleft palate and nonsyndromic cleft lip was detected. Cleft lip with or without cleft palate showed a different pattern by gender, urban-rural classification, and geographic location when compared to cleft palate, particularly for nonsyndromic cases. Maternal age was associated with prevalence of all oral clefts. Neonates with oral clefts had increased rates of mortality. The observed complex patterns of prevalence of oral clefts from the Chinese national birth defects registry indicate that oral cleft subtypes by either cleft location or syndromic status should be considered in the development of intervention measures and in future analytical studies.