Diagnosis Rate Research Articles

Association of COVID-19 Vaccine Intake with Diagnosis, Hospitalization, and Oxygenation/Ventilation: A Longitudinal Analysis, 2021–2022, Japan

Background/Objectives: Japan’s COVID-19 vaccination campaign achieved high coverage by 2022, yet limited national-level data has hindered evaluations of vaccine effectiveness. This study analyzed the impact of vaccines on infection outcomes while considering socioeconomic and behavioral factors in the Japanese population. Methods: A total of 19,482 individuals aged 16–81 years, who participated in both the 2021 (baseline) and 2022 (follow-up) waves of an Internet-based survey, were analyzed. Vaccine intake during the follow-up period (0/1/2+ doses) served as the exposure, while outcomes included COVID-19 diagnosis, hospitalization, and receipt of oxygenation/ventilation. Adjusted prevalence ratios (APRs) were calculated using Poisson regression models, controlling for baseline characteristics such as vaccination status, infection history, underlying medical conditions, socioeconomic factors, and preventive behaviors. Results: Overall, 81.6% of respondents received at least 1 dose of COVID-19 vaccine during the follow-up period. Among those without COVID-19 history at baseline (N = 19,182), 10.9% were diagnosed with COVID-19 in the past year, and 6.6% in the past 2 months. Respondents who received 1 or 2+ doses had lower diagnosis rates (APR = 0.76 and 0.43, respectively). For the past 2 months, only those with 2+ doses showed a significant reduction (APR = 0.51). Among 1999 diagnosed cases, those with 1 or 2+ doses showed lower hospitalization and oxygenation/ventilation likelihoods, though these differences were not statistically significant. Conclusions: The results supported the protective effect of COVID-19 vaccines against infection. Continued research is essential to further clarify the complex influence of vaccination, individual characteristics, and preventive behaviors on COVID-19 morbidity at the population level.

Magnetic resonance imaging-guided single-fraction preoperative radiotherapy for early-stage breast cancer (the RICE trial): feasibility study

BackgroundOver the past decade, the adoption of screening programs, digital mammography, and magnetic resonance imaging (MRI) has increased early-stage breast cancer diagnosis rates. Mortality rates have decreased due to early detection and improved treatments, including personalized therapies. Accelerated partial-breast irradiation (APBI) is emerging as a convenient and effective treatment for some patients, with studies exploring its preoperative use. Preoperative APBI, especially with MRI guidance, offers improved tumor targeting and potentially reduced side effects. Magnetic Resonance Imaging-Guided Single-Fraction Pre-Operative Radiotherapy for Early-Stage Breast Cancer (RICE trial) aims to assess the feasibility and efficacy of MRI-guided single-dose radiotherapy (RT) for early-stage breast cancer.MethodsThe RICE study is a prospective, single-arm study evaluating single-fraction preoperative, APBI treatment for patients with early-stage breast cancer using a magnetic resonance imaging linear accelerator (MRI linac). Eligible patients enrolled in this study will have a core biopsy to confirm estrogen receptor-positive and HER2-negative sub-type. RT planning will use a planning computed tomography (CT) co-registered with a MRI with the patient in either the supine or prone position. For the diagnostic workup, [18F] fluorodeoxyglucose positron emission tomography/CT ([18F] FDG PET/CT) and [18F] fluoroestradiol positron emission tomography/CT ([18F] FES PET/CT) will be performed prior to treatment. Thirty patients will receive a single ablative RT dose of 21 Gray to the tumor. Pre-treatment and post-treatment MRI scans will be acquired at baseline and 5 weeks post-RT respectively. Breast-conserving surgery will be scheduled for 6 weeks after APBI treatment using the MRI linac.The primary study endpoint is the successful administration of a single fraction of preoperative breast RT under the guidance of an MRI linac. Secondary endpoints include evaluating the utility of MRI, [18F] FDG PET/CT, and [18F] FES PET/CT as a non-invasive method for assessing treatment response in patients undergoing single-fraction preoperative APBI.ConclusionThe RICE trial represents a significant step in breast cancer treatment, offering insights that could lead to treatment protocols with minimized RT appointments and enhanced patient outcomes.Trial registrationThis trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR). Registered 31st of May 2021. Registration number: ACTRN12621000659808.

Mobile stroke units services in Germany: A cost-effectiveness modeling perspective on catchment zones, operating modes, and staffing.

Investigating the cost-effectiveness of future mobile stroke unit (MSU) services with respect to local idiosyncrasies is essential for enabling large-scale implementation of MSU services. The aim of this study was to assess the cost-effectiveness for varying urban German settings and modes of operation. Costs of different operating times together with different personnel configurations were simulated. Different possible catchment zones, ischemic stroke incidence, circadian distribution, rates of alternative diagnoses, as well as missed cases were incorporated to model case coverage and patient numbers. Based on internationally reported clinical outcomes of MSUs, a 5-year Markov model was applied to analyze the cost-effectiveness for the different program setups. Compared with standard stroke care, MSUs achieved an additional 0.06 quality-adjusted life years (QALYs) over a 5-year time horizon. Assuming a catchment zone of 750,000 inhabitants and 8 h/7 day operation resulted in an incremental cost-effectiveness ratio (ICER) of €37,182 per QALY from a societal perspective and €45,104 per QALY from a healthcare perspective. Lower ICERs were possible when coverage was expanded to 16 h service on 7 days per week and larger populations. Sensitivity analyses revealed that missing ischemic strokes significantly deteriorated economic performance of MSU. Major determinants of cost-effectiveness should be addressed when setting up novel MSU programs. Catchment zones of more than 500,000-700,000 inhabitants and operating times of at least 12-16 h per day, 7 days per week could enable the most cost-effective MSU services in the German healthcare system.

Community-Based Point-of-Care Screening for Hepatitis B Virus and Hepatocellular Carcinoma in Rural Tanzania.

Sub-Saharan Africa has a high burden of hepatitis B virus (HBV) and hepatocellular carcinoma (HCC). The lack of surveillance programs has led to low rates of diagnosis and treatment, particularly in rural areas. We conducted mobile HBV-HCC screening clinics in rural Tanzania between March 2021 and February 2023. After undergoing informed consent, patients completed a questionnaire about HBV. A rapid point-of-care (POC) assay measured HBV surface antigen (HBsAg), and HBsAg-positive patients underwent POC ultrasound to screen for HCC and POC hepatitis C (HCV) antibody testing. The primary outcome was number of HBV diagnoses, and the secondary outcome was prevalence of liver masses in HBsAg-positive individuals. Data were analyzed with descriptive statistics. Five hundred and one patients were screened for HBV; 63% (n = 303) were female with median (interquartile range [IQR]) age of 40 (28-55) years. Only 6% (n = 30) reported being vaccinated against HBV, 92% (n = 453) reported no vaccination, and 2% (n = 12) did not know their vaccination status. Seventy-six percent (n = 340) did not know they should get vaccinated, and 4% (n = 16) reported that vaccination was too expensive. Two percent (n = 11) of patients were positive for HBsAg, with 55% (n = 6) of those being female with median (IQR) age of 36 (34-43) years. None of the HBsAg-positive patients reported being vaccinated against HBV, and all were negative for HCV. On ultrasound, one patient had a liver mass, and another had ascites. We demonstrated that community-based HBV and HCC screening can be implemented in Africa with local partnerships, and this model could be used to promote awareness and improve early detection of disease.

Clinicopathological features of lacrimal gland biopsy lesions in 582 Chinese patients

Background This study was conducted to assess the clinicopathological characteristics of biopsy lesions in the lacrimal gland, in response to evolving pathological technologies and the emergence of new diseases. A retrospective review of case notes was conducted for 582 patients with biopsied lacrimal gland lesions at West China Hospital of Sichuan University in China. This study, spanning from January 1, 2010, to December 31, 2021, recorded demographics, clinical features, imaging findings, histopathological diagnoses, and recurrence rates. In a cohort of 582 patients, the mean age was 47.5 years, with 318 being female. Bilateral disease was present in 127 patients. Common signs and symptoms included a palpable mass, lid swelling, proptosis, and decreased ocular movements or diplopia. The predominant pathologies identified were inflammation, epithelial tumors, and lymphoproliferative lesions. Patients with inflammation (mean 32.8 months) experienced symptoms for a longer period compared to those with lymphoproliferative lesions (mean 22.2 months) (95% confidence interval [CI] 1.53–19.27, P = 0.022). Younger patients tended to have structural lesions (mean 42.5 years) (95%CI 4.74–21.59, P = 0.003), inflammation (mean 42.9 years) (95%CI 0.46–6.57, P<0.001), or epithelial tumors (mean 46.4 years) (95%CI 6.21–12.38, P<0.001), while older patients more frequently had lymphoproliferative lesions (mean 55.7 years). The period from 2016 to 2021 saw a higher diagnosis rate of biopsied lacrimal gland lesions than from 2010 to 2015. During this later period, there was an increase in cases of immunoglobulin G4-related ophthalmic disease (IgG4-ROD) and malignant epithelial tumors, while lymphoid hyperplasia cases declined. Adenoid cystic carcinoma showed the highest recurrence rate, with lesion extent and Ki-67 index identified as independent risk factors in our study. Inflammation, epithelial tumors, and lymphoproliferative lesions were the three primary causes of lacrimal gland lesions in our study group. Among the inflammatory conditions, IgG4-ROD was the most specific. The incidence of lacrimal gland lesions has risen, particularly for IgG4-ROD. Adenoid cystic carcinoma among the lacrimal gland lesions was prone to recurrence, with the extent of the lesion and Ki-67 index serving as independent risk factors.

Current and Novel Therapies for Cluster Headache: A Narrative Review.

Cluster headache (CH) is an excruciating and debilitating primary headache disorder. The prevalence is up to 1.3%, and the typical onset is around age 30. Often misdiagnosed as migraine, particularly in children, the diagnosis rate of CH has been increasing among women. CH is characterized by intense unilateral pain and autonomic symptoms, significantly impacting patients' quality of life, mental health, and productivity.Genetic associations suggest a familial risk for developing CH, with lifestyle factors also potentially playing a role. The pathophysiology involves alterations in both central and peripheral nervous system, with the hypothalamus, trigeminocervical complex, and neuropeptides such as calcitonin gene-related peptide (CGRP) being implicated.Nonpharmacological treatments focus on patient education and lifestyle modifications, while pharmacological treatments include acute therapies such as oxygen and subcutaneous or nasal sumatriptan, as well as preventive therapies like verapamil, lithium, and CGRP monoclonal antibodies. Transitional options include oral corticosteroids and greater occipital nerve injections. Emerging interventional procedures offer new avenues for managing refractory cases. Noninvasive vagal nerve stimulation and occipital nerve stimulation show promise for both acute and preventive treatment. Careful consideration of safety profiles is crucial in specific populations such as pregnant patients and children.Current treatments still leave patients highly burdened by limited efficacy and side effects. Future research continues to explore novel pharmacological targets, interventional procedures, and the potential role of psychedelics in CH management. Comprehensive, multifaceted treatment strategies are essential to improve the daily functioning and quality of life for individuals with CH.

Effects of Sex and Gender in Immediate Beta-Lactam Antibiotic Allergy: A Systematic Review and Meta-analysis

BackgroundBeta-lactams are the most common antibiotic class reported to cause allergic drug reactions. Previous literature suggests an increased prevalence of penicillin drug allergy in female patients in both inpatient and outpatient settings. However, the effects of sex and gender have not been well characterized regarding the entire class of beta-lactam antibiotics. ObjectiveThis systematic review and meta-analysis aimed to identify sex and gender-based differences in the prevalence of immediate beta-lactam allergy. MethodsWe performed an electronic search of Ovid MEDLINE/PubMed, Embase, Web of Science, Scopus, and the Cochrane Library between 2013-2023. Patients with a documented beta-lactam allergy who underwent allergy testing with skin testing, oral drug challenge, or serum-specific IgE were included. We quantitatively assessed sex- and gender-based differences in beta-lactam allergy with meta-analysis. ResultsWe included 69 primary studies, assessing 53,989 participants from outpatient and inpatient cohorts. 7,558 patients had a confirmed beta-lactam allergy. There was no difference in the prevalence of positive beta-lactam allergy test between males and females. Sub-group analysis of studies that performed oral challenges did show a higher risk of beta-lactam allergy in females than males (RR 1.40, 95% CI 1.18-1.66, p < 0.001, I2 =77.8%). Finally, there was a higher proportion of females (64.8%) than males enrolled in beta-lactam allergy studies. ConclusionsOur findings suggest both sex-based and gender-based differences in the prevalence of immediate beta-lactam allergy. Both biological factors, such as sex hormones, and gender-based behaviors, including increased healthcare utilization, may contribute to higher rates of beta-lactam allergy diagnosis in females.

More women, young adults being diagnosed with autism

A large analysis of autism spectrum disorder diagnoses over more than 10 years finds significant increases in young adults, women, and children in some racial or ethnic groups. Led by Kaiser Permanente researchers, the study was published in JAMA Network Open. The analysis covered the years 2011 to 2022 at 12 integrated delivery sites of the eight health systems that participate in the Mental Health Research Network, covering up to 12 million people, Kaiser's Division of Research reported Oct. 30. The study found increases in autism diagnosis across the study period for all groups, and faster increases among certain groups. The autism diagnosis rate was highest among 5‐ to 8‐year‐olds and rose during the study period, from 2.3 per 1,000 in 2011 to 6.3 per 1,000 in 2022. Increases in diagnosis in children by ethnicity were higher among Hispanic children (315% increase) than non‐Hispanic children (146%). By race, increases were greater among Native Hawaiian/Pacific Islander (428%), Black/African American (307%), and Asian (259%) children compared to white children (161%). Among adults, increases in diagnosis rates from 2011 to 2022 were greater among white adults (275%) than any other group. The study authors said the findings likely reflect both increased screening for autism along with other potential factors that should be explored in future research.

Postburn Abdominal Pain of Gastrointestinal Origin: A Scoping Review.

After burn injury, patients may have abdominal pain due to several causes and etiologies, some of which could be life-threatening, including pancreatitis, stress ulcers, Clostridium difficile infection, and so forth. This pain sometimes poses a major diagnostic challenge. This scoping review is the first reported review to address and discuss this entity of patients after burn injury in abdominal pain of gastrointestinal origin. A scoping review of PubMed, Google Scholar, and other electronic research sites was performed. All relevant articles of any study design were included in this review. Variables included in this study were sex distribution, age, related total burn surface area, incidence rate, characteristics of pain, diagnosis, management, outcomes, and mortality rate. The medical literature identified 114 articles. According to our inclusion criteria, 91 articles were reviewed in this article. Through these articles, we reviewed in detail the characteristics of postburn abdominal pain, the relevant diseases responsible for this complaint, the epidemiologic features of these diseases, and potential management approaches aiming to help burn specialists in making earlier diagnosis and, thus, timely treatment. Early recognition of postburn abdominal pain, as well as timely diagnosis and treatment, play a significant role in prognosis and mortality. Thus, it is extremely important for burn specialists and plastic surgeons to thoroughly investigate postburn abdominal pain. Also, one of the aims of this review was to shed light on the important role of the multidisciplinary team in burn patient management to improve the prognosis.

Retrospective analysis in in situ ductal carcinoma; 11 years of experience

Objective: To describe our experience in the diagnosis, treatment and follow up of patients with ductal carcinoma in situ (DCIS). Materials and methods: 953 breast carcinomas treated in the Mastology service of the Department of Gynecology and Obstetrics of the Hospital Aleman of Buenos Aires, between January 2004 and December 2014, are retrospectively analyzed. 206 biopsies (BRQ 25-mammotome 151-core biopsy 30) of ductal carcinomas in situ were identified, resulting after definitive pathological evaluation in 172 (18%) pure ductal carcinomas in situ of the total of 953 patients analyzed. Results: 206 biopsies (BRQ 25-mammotome 151-core biopsy 30) of ductal carcinomas in situ were identified, resulting after definitive pathological evaluation in 172 (18%) pure ductal carcinomas in situ of the total of 953 patients analyzed. The imaging report in the total of the 206 patients showed microcalcifications in 80.1%. The diagnosis of carcinoma in situ was made in 181 (87%) patients by preoperative microinvasive procedures and in the remaining 25 (13%) patients by radiosurgical biopsy (BRQ). There was evidence of 18.8% underdiagnosis after microinvasive procedures. In our case series, 84.3% were GH3/GH2 while 15.7% were GH 1. When comparing the size of the surgical specimens and correlating it with the 34 cases of invasive and microinvasive carcinoma, it showed that 54.8% of invasion in those tumors greater than 30 mm, 50.4% in those that exceeded 21 mm and in no case in those less than 10 mm. 20% of multicentric lesions were associated with invasive tumor. Sentinel lymph node technique was performed in 23.8% patients in the first surgery, resulting negative in all cases. When evaluating radiation and hormonal treatment, radiotherapy was performed in 131 patients (85.6%) and hormonal treatment was performed in 75% of the patients. In the follow-up until December 2014, 11 relapses (5.23%) were recorded. Conclusion: Our results are consistent with the international indexed literature in reference to diagnosis, treatment and recurrence rate pure of DCIS.

Economic impact case study of a wearable medical device for the diagnosis of obstructive sleep apnoea

BackgroundAcuPebble SA100 (‘AcuPebble’) is a novel wearable medical device to diagnose obstructive sleep apnoea (OSA). This paper investigates the potential economic impact of the technology in the UK through cost savings analysis, and the redirection of savings into further diagnoses.MethodsA cost comparison study was conducted, comparing AcuPebble to the standard diagnostic approach of home respiratory polygraphy (HRP) and in-clinic polysomnography (PSG), estimating the net benefit value (NBV) and return on investment (ROI). Cohort size was varied to model the effects of volume discounted pricing and staff training costs. To demonstrate the potential for cost savings, data on the healthcare costs of undiagnosed OSA patients were used to quantify the benefit of increased OSA diagnosis rates, as facilitated by AcuPebble.ResultsFor 500 uses of AcuPebble, the NBV in the diagnostic pathway over one year would be in excess of £101,169, increasing to £341,665 for 1,500 uses, £1,263,993 for 5,000 uses, and to £2,628,198 for 10,000 uses, with ROIs of 2.02, 3.03, 5.05, and 6.56, respectively. Given an initial cohort of 1,500 patients, 4,555 extra AcuPebble studies could be completed by redirecting resources from HRP/PSG. Direct cost savings to the NHS from resultant lower undiagnosed rates could be between £24,147 and £4,707,810, based on the cost per use and the percentage of tests that result in a positive diagnosis (varied from 25 to 75% positives).ConclusionsAcuPebble presents an opportunity for substantial healthcare savings, enabling an increase in the number of people tested, diagnosed and treated for OSA.

Evaluating Catatonia Care in the Psychiatric Emergency Room: A Retrospective Study

BackgroundCatatonia, characterized by motor, affective, and speech disturbances, is a prevalent yet frequently misdiagnosed syndrome in the psychiatric domain, with reported prevalence ranging from 5% to 18%. This study aimed to ascertain the incidence of catatonia diagnoses and the quality of care provided within the psychiatric emergency room (ER), while also evaluating psychiatrists' general awareness of the syndrome through a survey. MethodsA retrospective analysis of psychiatric ER records spanning June 18th to August 20th, 2022, was conducted to assess catatonia diagnosis frequency and treatment approaches. A Google Survey was distributed to full-time psychiatrists in the ER, querying their knowledge about catatonia prevalence, diagnostic modalities, and treatment strategies. ResultsAnalysis of 1,118 patient records revealed a catatonia diagnosis rate of 0.36% (four cases) in the psychiatric ER. Remarkably, 75% of diagnosed patients were assessed by a single psychiatrist among nine available. Survey responses from all nine ER psychiatrists highlighted that 44% considered encountering catatonia as infrequent, while 33% regarded it as generally rare. Furthermore, 33% expressed willingness to employ potent antipsychotic interventions. ConclusionThe study revealed a markedly low catatonia detection rate in the psychiatric ER, coupled with inconsistent treatment approaches. Survey findings reflected a considerable proportion of psychiatrists holding outdated perceptions of catatonia.

The effects of the paramedics’ field work on their mental status in Jeddah

ABSTRACT Background: Paramedics are continuously exposed to stressful events, making them liable to mental disorders. This study assesses the health of paramedics in Jeddah, focusing on their mental, emotional, and physical well-being. Methods: This cross-sectional study included fieldwork paramedics in Jeddah through an online survey distributed on social media. With a response rate of 86.09%, 192 complete responses were analyzed. Outcomes included mental health, mood and somatic effect, self-esteem, and sleep. Results: Most participants were males (83.85%), married (50%), non-heavy smokers (51.04%), and non-alcohol drinkers (51.04%). A significant number reported health-related work or daily life difficulties, with 62.5%–67.18% attributing these to physical and emotional issues, respectively. Over half rated their mental health as poor or somewhat poor, impacting their relationships significantly. Additionally, 70.31% frequently felt anger, and many faced limitations in physical activities. About 14.58% had a prior mental illness diagnosis, with nearly a quarter on medication, and 61.98% had recently sought psychiatric help. Sleep deprivation affected 61.98%, with 38.53% reporting poor sleep quality. Conclusions: The findings highlight the negative impact on paramedics’ mental health, showing a substantial diagnosis rate of mental disorders, activity limitations, negative mood, and relationship issues. Despite significant sleep problems, a positive aspect is their proactive psychiatric help-seeking behavior.

Exploring $\&lt;i&gt;beta$&lt;/i&gt;-Basic Rough Sets and Their Applications in Medicine

Advancements in the rough set theory of Pawlak have opened new avenues for enhancing decision-making processes, particularly in identifying disease risk factors in medical diagnoses. While traditional rough set methodologies have provided a solid foundation, there is a continuous need for improvements to increase accuracy and reliability. This study introduces mathematical techniques grounded in basic rough sets, incorporating $\beta$-open concepts to enhance precision. We present nearly basic rough sets and $\beta$-basic-approximations ($\beta _b$-approximations), examining their core properties and interrelationships. Our findings reveal that these novel constructs offer superior accuracy compared to traditional methods. Both theoretical analysis and practical examples support this, with our approach achieving a 100% accuracy rate in the medical diagnosis of COVID-19. This significant improvement highlights the potential of the methods of us to outperform existing ones in terms of precision and reliability. The introduction of $\beta _b$-approximations represents a significant advancement in rough set theory, offering enhanced accuracy in decision-making applications. Our results indicate that these methods can substantially outperform traditional techniques, especially in critical areas such as medical diagnosis. Additionally, we provide a mathematical algorithm suitable for implementation in programming languages, facilitating future research and applications across various theoretical and applied fields. This work lays the groundwork for further exploration and utilization of advanced rough set methodologies in diverse domains.

Incidence of malignant neoplasms and organizational aspects of cancer care in the Republic of Kazakhstan

BackgroundThis study aims to investigate the incidence and mortality rates of malignant neoplasms in Kazakhstan in 2022 and to analyze the organizational aspects of cancer care. MethodsData from 33,177 patients with malignant neoplasms registered in oncological institutions in 2022 were analyzed. The study focused on treatment completion rates and the distribution of treatment modalities, including surgical, radiation, medicinal, combined, comprehensive, and chemo-radiation therapies. Comparative analysis with international data was conducted to assess the effectiveness and adherence to global oncological standards. ResultsThe analysis revealed that 55.2 % of patients completed specialized treatment, with complex treatment being the most common modality (94.3 %). High completion rates were observed in breast cancer (65.9 %) and cervical cancer (68.8 %), reflecting the effectiveness of early detection and multidisciplinary approaches. However, lower completion rates were noted in liver cancer (26.2 %) and leukemia (23.0 %), highlighting the need for improved diagnostic and treatment strategies. Comparative international data indicated similar trends, with countries like the USA, UK, Japan, and Australia demonstrating the effectiveness of multidisciplinary and comprehensive treatment approaches. ConclusionThe study underscores the importance of a multidisciplinary approach in treating malignant neoplasms, with Kazakhstan's practices largely aligning with international standards. Nevertheless, there is a need to enhance early diagnosis and treatment completion rates for specific cancers such as liver cancer and leukemia. Strengthening screening programs, improving access to modern treatments, and integrating international best practices can further improve patient outcomes in Kazakhstan.

Autism Diagnosis Among US Children and Adults, 2011-2022

An improved understanding of autism spectrum disorder (ASD) prevalence over time and across the lifespan can inform health care service delivery for the growing population of autistic children and adults. To describe trends in the prevalence of ASD diagnoses using electronic records data from a large network of health systems in the US. This cross-sectional study examined annual diagnosis rates in health records of patients in US health systems from January 1, 2011, to December 31, 2022. Eligible individuals were included in the study sample for a given calendar year if they were enrolled in a participating health system for at least 10 months out of the year. Data were extracted from 12 sites participating in the Mental Health Research Network, a consortium of research centers embedded within large, diverse health care systems. Diagnoses of ASD were ascertained using International Classification of Diseases, Ninth Revision (ICD-9) and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) revision codes. Annual diagnosis rates were calculated as the number of unique members diagnosed, divided by the total members enrolled. A total of 12 264 003 members were enrolled in 2022 (2 359 359 children aged 0 to 17 years [19.2%]; 6 400 222 female [52.2%]; 93 002 American Indian or Alaska Native [0.8%], 1 711 950 Asian [14.0%], 952 287 Black or African American [7.8%], 2 971 355 Hispanic [24.2%], 166 144 Native Hawaiian or Pacific Islander [1.4%], and 6 462 298 White [52.7%]). The ASD diagnosis rate was greatest among 5-to-8-year-olds throughout the study period and increased by 175% among the full sample, from 2.3 per 1000 in 2011 to 6.3 per 1000 in 2022. The greatest relative increase in diagnosis rate from 2011 to 2022 occurred among 26-to-34-year-olds (450%) and increases were greater for female vs male individuals among children (305% [estimated annual percentage change (EAPC), 13.62 percentage points; 95% CI, 12.49-14.75 percentage points] vs 185% [EAPC, 9.63 percentage points; 95% CI, 8.54-10.72 percentage points], respectively) and adults (315% [EAPC, 13.73 percentage points; 95% CI, 12.61-14.86 percentage points] vs 215% [EAPC, 10.33 percentage points; 95% CI, 9.24-11.43 percentage points]). Relative increases were greater in racial and ethnic minority groups compared with White individuals among children, but not adults. In this cross-sectional study of children and adults in the US, ASD diagnosis rates increased substantially between 2011 and 2022, particularly among young adults, female children and adults, and children from some racial or ethnic minority groups. Diagnosis prevalence trends generated using health system data can inform the allocation of resources to meet the service needs of this growing, medically complex population.

Pregnancy Outcomes in Grand Multiparity Women With Antiphospholipid Antibodies.

In recent years antiphospholipid syndrome (APS) as well as antiphospholipid antibodies (aPL) prevalence has demonstrated an upward trend in women during reproductive age. There is a lack of data concerning its effects on women with grand multiparity (GMP) (parity ≥5). Hence, this study aimed to assess pregnancy outcomes among GMP aPL/APS patients. We retrospectively assembled the births of GMP women with aPL/APS, between 2017 and 2022 in the Sheba Medical Center. We compared their deliveries with those of two control groups: (1) the "aPL/APS-controls"-of pregnant women with aPL/APS and parity <5. (2) The "GMP-controls"- parity ≥5 without aPL/APS. We examined demographics, aPL characteristics, pregnancy, and neonatal outcomes between the groups. In total, 42 deliveries in the study group were compared to 461 deliveries in the "aPL/APS-controls" group and 84 deliveries of the "GMP-controls." Most parameters were similar across groups. However, the study group had a higher rate of obstetric APS diagnosis (64.64%vs. 83.33%, p<0.01) and showed significant differences such as older maternal age, higher BMI, more polyhydramnios cases, and larger babies compared to controls (33.91vs. 36.19, p=0.05; 23.2vs. 28.89, p=0.02; 3.68vs. 11.9, p=0.01; and 2.17vs. 14.28, p<0.01, respectively). Our findings reveal that perinatal outcomes in aPL/APS GMP women are comparable and not inferior to those in aPL/APS women with <5 pregnancies or in comparison to the general GMP population. The minor differences observed may all be related to GMP women's older age and higher BMI.

Piezo1: the key regulators in central nervous system diseases.

The occurrence and development of central nervous system (CNS) diseases is a multi-factor and multi-gene pathological process, and their diagnosis and treatment have always posed a serious challenge in the medical field. Therefore, exploring the relevant factors in the pathogenesis of CNS and improving the diagnosis and treatment rates has become an urgent problem. Piezo1 is a recently discovered mechanosensitive ion channel that opens in response to mechanical stimuli. A number of previous studies have shown that the Piezo channel family plays a crucial role in CNS physiology and pathology, especially in diseases related to CNS development and mechanical stimulation. This article comprehensively describes the biological properties of Piezo1, focuses on the potential association between Piezo1 and CNS disorders, and explores the pharmacological roles of Piezo1 agonists and inhibitors in treating CNS disorders.

The use of myocardial perfusion scintigraphy to screen for asymptomatic coronary artery disease prior to kidney transplantation

Abstract Background and Objectives Advanced chronic kidney disease (CKD) is associated with an increased risk of cardiovascular disease (CVD), including significant asymptomatic coronary artery disease (CAD) [1], compared to the general general public. Additionally, CVD is the leading cause of mortality in kidney transplant recipients [2]. Given the relative scarcity of available organs, individuals are commonly screened for CAD with non-invasive cardiac testing such as Myocardial Perfusion Scintigraphy (MPS). However, the benefits of screening for asymptomatic CAD are unproven and in the absence of an established screening protocol, investigations vary centre to centre and can result in uncertain interpretation of results and unnecessary delays in transplantation. The objective of this study was to assess the benefits of asymptomatic CVD screening of potential kidney transplant recipients, and its impact on transplantation outcomes. Methods This retrospective analysis included all MPS requested by the transplant team during patients’ assessment process between 2015 and 2023. Any resultant coronary angiograms (CA) were reviewed for evidence of significant CAD. Transplant decisions were reviewed to assess the impact of CVD screening on individuals’ transplant status. Results 689 individuals underwent MPS. Of these, 90% required no further cardiovascular investigations. 6% (42 individuals) had subsequent CA. &amp;lt;1% (5) required percutaneous intervention (PCI) whilst the rest (37) were deemed to have no significant CAD. A further 4% (29) required coronary angiography at a later date (&amp;gt;2 years after their MPS), with similar rates of PCI (1%). All three outcome groups (negative MPS, CA referral, CA in the future) had similar rates of diabetes (40%) and previous diagnoses of CAD (14%). The average wait for CA was 283 days post-MPS. Transplant decisions took a further 286 days after CA, which in combination with the delays associated with CA resulted in average delays of 1.5 years. Conclusions The use of MPS to screen for significant asymptomatic CAD identifies only a small proportion of individuals requiring intervention prior to kidney transplantation and significantly delays transplant decisions. These results suggest transplant centres should review their use of CVD screening prior to listing.

1.O. Scientific session: Trans &amp; Gender-Diverse Individuals’ Mental &amp; Behavioral Health Risks &amp; Intervention Needs

Abstract Transgender and gender-diverse (TGD) individuals are at a greater risk for various poor mental and behavioral health outcomes than cisgender individuals, including higher rates of suicide, psychiatric diagnoses, and behavioral health problems. For example, research has documented a seven-fold increased risk for lifetime suicide attempts among young TGD people, compared with the general population. Less is known about the age of onset of such mental and behavioral health disparities and how these disparities may vary across other intersectional socio-demographic variables. It has been well-documented that trans and gender-diverse individuals often encounter discrimination and transphobia across various social, educational, professional, administrative, and healthcare settings. This discrimination, as highlighted in the literature, frequently poses obstacles to accessing both general and trans-specific healthcare services due to experiences of discrimination (e.g., misgendering, refusal of care, lack of adequate services). The right and ability to self-determine and the accessibility to gender-affirming care without discrimination are key to closing the gap in TGD individuals’ mental and behavioral health outcomes, and for them to live authentically and thrive. Tailored and affirming mental and behavioral health interventions to reduce these health inequities are pivotal for TGD individuals to achieve the highest attainable standard of physical and mental health: a key fundamental human right. Considerable gaps in the literature remain concerning the onset and determinants of gender identity-based health disparities and healthcare approaches that are respectful, inclusive, non-pathologizing, and grounded in human rights principles for TGD individuals. This workshop intends to address these knowledge gaps by delving into the mental and behavioral health needs of TGD individuals. The workshop seeks to further foster dialogue on strategies to overcome resistance to implementing approaches that uphold the human rights and well-being of these communities. Dr. Richard Bränström (Karolinska Institutet) will present a study that explores the age at which gender identity-based disparities in psychiatric diagnoses and treatment can be first identified. Dr. Gonzales (Vanderbilt University) will examine disparities in mental health and social determinants of health among TGD individuals with private insurance. Dr. Moleiro (Lisbon University Institute) will review TGD persons’ ways of identifying with the choices and trajectories in social, legal, and affirmative healthcare processes in Portugal. Dr. Lelutiu-Weinberger (Columbia University School of Nursing) will present findings from a study that assessed tobacco use and cessation attitudes, facilitators, and barriers to quitting, and intervention components and delivery modality acceptability among TGD individuals, as well as sexual minority individuals, in Romania to inform a tailored and affirming smoking cessation intervention. Key messages • Transgender and gender-diverse are at increased risk for a variety of poor mental and behavioral health compared with the general public. • There is a critical need to foster healthcare services for transgender and gender-diverse individuals that are tailored and affirming.