Significant Increase In Deaths Research Articles

Final assessment of the COVID-19 pandemic impact between the different social and economic strata population of the city of Buenos Aires

BackgroundDuring the pandemic, epidemiological communications reported an estimation of excess deaths. However, the final calculation requires a detailed analysis. The study aim was to ascertain the number and distribution of COVID-19 fatalities among various socio-economic strata in a large, moderate to low-income city. Study designObservational time series analysis in a large city, treated as a natural experiment. MethodsAnalysis of death certificates, demographic data, and health system records of positive RT-PCR COVID-19 tests from 2015 to 2021, categorizing by age, sex, and place of residence. The study measured the pandemic's impact on mortality, including COVID and non-COVID deaths, using corrected Poisson regression models for different demographics and assessing socio-economic status impact via ecological community-level analysis. ResultsCompared to the pre-pandemic period (2015–2019, IRR = 1.00), the sex- and age-adjusted rate of all-cause death increased significantly during the pandemic (2020–2021) IRR = 1.109 [1.054–1.167], p < 0.0001. This was observed in both males (IRR = 1.158 [1.1–1.219], p < 0.0001) and females (IRR = 1.068 [1.016–1.124], p = 0.01). There was no observed effect of the pandemic on the historical trend in the progressive reduction of mortality in people under 35 years of age. The increase in deaths was at the expense of COVID (+11,175 deaths) and cardiovascular causes (IRR = 1.114 [1.020–1.217] p = 0.017). During the pandemic, there was a significant increase in deaths at home (IRR = 1.219 [1197–1.242], p < 0.0001), especially in people dying of cardiovascular causes (IRR = 1.391 [1.360–1.422], p < 0.0001). The increase in the adjusted mortality rate during the pandemic was socially conditioned. ConclusionsThe pandemic not only led to increased COVID-19 mortality but also heightened fatalities from non-COVID causes, reflecting a potential bias in healthcare resource allocation towards SARS-CoV-2 at the expense of chronic pathologies care.

Safety of Same-Day Discharge after Bariatric Surgery: Retrospective 6-Year North American Analysis.

With increasing implementation of Enhanced Recovery After Surgery protocols and rising demand for inpatient hospital beds accentuated by COVID-19, there has been interest in same-day discharge (SDD) for bariatric surgery. The aim of this study was to determine the national trends, safety profile, and risk factors for complications of SDD for minimally invasive bariatric surgery. We analyzed the MBSAQIP database from 2016 to 2021 to characterize trends in SDD for minimally invasive bariatric operation. Multivariate logistic regression was performed on preoperative patient characteristics predictive of increased complications associated with SDD. A comparative analysis of postoperative outcomes within 30 days was performed for SDD and admission after 1:1 nearest neighbor propensity score matching for patient demographics and preoperative comorbidities. SDD increased from 2.4% in 2016 to 7.4% in 2021. Major preoperative factors associated with increased complications for SDD included Black race, history of MI, renal insufficiency, deep vein thrombosis, and smoking. SDD for Roux-en-Y gastric bypass had 72% increased risk of postoperative complications compared with sleeve gastrectomy. The overall major complications were lower in SDD cohort vs admission cohort (odds ratio [OR] 0.62, p < 0.01). However, there was a significant increase in deaths within 30 days (OR 2.11, p = 0.01), cardiac arrest (OR 2.73; p < 0.01), and dehydration requiring treatment (OR 1.33; p < 0.01) in SDD cohort compared with admission cohort. Nationally, there has been a rise in SDD for bariatric operation from 2016 to 2021. Matched analysis demonstrates that SDD is associated with a significantly higher mortality rate. Additionally, the risk of complications with SDD is higher for RYGB compared with sleeve gastrectomy. Therefore, further studies are required to appropriately select patients for whom bariatric surgery can be safely performed as an outpatient.

Carbon monoxide and prognosis in smokers hospitalised with acute cardiac events: a multicentre, prospective cohort study

Smoking cigarettes produces carbon monoxide (CO), which can reduce the oxygen-carrying capacity of the blood. We aimed to determine whether elevated expiratory CO levels would be associated with a worse prognosis in smokers presenting with acute cardiac events. From 7 to 22 April 2021, expiratory CO levels were measured in a prospective registry including all consecutive patients admitted for acute cardiac event in 39 centres throughout France. The primary outcome was 1-year all-cause death. Initial in-hospital major adverse cardiac events (MAE; death, resuscitated cardiac arrest and cardiogenic shock) were also analysed. The study was registered at ClinicalTrials.gov (NCT05063097). Among 1379 patients (63±15 years, 70% men), 368 (27%) were active smokers. Expiratory CO levels were significantly raised in active smokers compared to non-smokers. A CO level >11parts per million (ppm) found in 94 (25.5%) smokers was associated with a significant increase in death (14.9% for CO>11ppm vs. 2.9% for CO≤11ppm; p<0.001). Similar results were found after adjustment for comorbidities (hazard ratio [HR] [95% confidence interval (CI)]): 5.92 [2.43-14.38]) or parameters of in-hospital severity (HR 6.09, 95% CI [2.51-14.80]) and propensity score matching (HR 7.46, 95% CI [1.70-32.8]). CO>11ppm was associated with a significant increase in MAE in smokers during initial hospitalisation after adjustment for comorbidities (odds ratio [OR] 15.75, 95% CI [5.56-44.60]) or parameters of in-hospital severity (OR 10.67, 95% CI [4.06-28.04]). In the overall population, CO>11ppm but not smoking was associated with an increased rate of all-cause death (HR 4.03, 95% CI [2.33-6.98] and 1.66 [0.96-2.85] respectively). Elevated CO level is independently associated with a 6-fold increase in 1-year death and 10-fold in-hospital MAE in smokers hospitalized for acute cardiac events. Grant from Fondation Coeur & Recherche.

Prescribed and Diverted Methadone Toxicity in South Australia: An Update.

Methadone is one of the most common medications currently prescribed for the treatment of opioid use disorders (OUDs). While methadone maintenance programs (MMPs) have been highly successful in the management and treatment of OUDs resulting in a reduced number of fatalities, the risk of overdose/toxicity remains. The current study was undertaken to analyze trends in overdoses attributed to prescribed and diverted methadone in South Australia (SA) between 2000 and 2019. Over the 20-year period, 344 methadone-related deaths occurred in SA with a significant increase in deaths over the study period ( P = 0.03). The mean age of decedents was 42.5 years with a male to female ratio of 1.8:1, with approximately 20% of decedents enrolled in a MMP at the time of death. Overall, only 5.2% of cases demonstrated methadone diversion, which was associated with methadone prescribed for chronic pain and was most likely to be diverted from a friend/housemate or a partner. However, the source of methadone in more than half of cases was unknown, so this is likely a significant underestimate of actual MMP methadone diversion and total methadone diversion.

Mortality in randomised controlled trials using paclitaxel-coated devices for femoropopliteal interventional procedures: an updated patient-level meta-analysis

Numerous randomised clinical trials and real-world studies have supported the safety of paclitaxel-coated devices for the treatment of femoropopliteal occlusive disease. However, a 2018 summary-level meta-analysis suggested an increased mortality risk for paclitaxel-coated devices compared with uncoated control devices. This study presents an updated analysis of deaths using the most complete and current data available from pivotal trials of paclitaxel-coated versus control devices. Ten trials comparing paclitaxel-coated versus control devices were included in a patient-level pooled analysis. Cox regression models were used to evaluate the effect of paclitaxel exposure on risk of death in both intention-to-treat (ITT; primary analysis) and three as-treated analysis sets accounting for treatment group crossover at the index procedure and over time. The effect of paclitaxel dose and baseline covariates were also evaluated. A total of 2666 participants were included with a median follow-up of 4·9 years. No significant increase in deaths was observed for patients treated with paclitaxel-coated devices. This was true in the ITT analysis (hazard ratio [HR] 1·14, 95% CI 0·93-1·40), the as-treated analysis (HR 1·13, 95% CI 0·92-1·39), and in two crossover analyses: 1·07 (0·87-1·31) when late crossovers were censored and 1·04 (0·84-1·28) when crossovers were analysed from the date of paclitaxel exposure. There was no significant effect of paclitaxel dose on mortality risk. This meta-analysis found no association between paclitaxel-coated device exposure and risk of death, providing reassurance to patients, physicians, and regulators on the safety of paclitaxel-coated devices. Becton Dickinson, Boston Scientific, Cook, Medtronic, Philips, Surmodics, and TriReme Medical.

Impacts of high sensitivity troponin T reporting on care and outcomes in clinical practice: Interactions between low troponin concentrations and participant sex within two randomized clinical trials

BackgroundThe impacts of high sensitivity cardiac troponin (hs-cTn) reporting on downstream interventions amongst suspected acute coronary syndrome (ACS) in the emergency department (ED), especially amongst those with newly identified hs-cTn elevations and in consideration of well-established sex-related disparities, has not been critically evaluated to date. This investigation explores the impact of hs-cTnT reporting on care and outcomes, particularly by participant sex. MethodsTwo similarly ED-based randomized controlled trials conducted between July 2011 to March 2013 (n = 1988) and August 2015 to April 2019 (n = 3378) were comparatively evaluated. Clinical outcomes were adjudicated to the Fourth Universal Definition of MI. Changes in practice were assessed at 30 days, and death or MI were explored to 12 months. ResultsThe HS-Troponin study demonstrated no difference in death or MI with unmasking amongst those with hs-cTnT <30 ng/L, whereas the RAPID TnT study demonstrated a significantly higher rate. In RAPID TnT, there was significant increase in death or MI associated with unmasking for females with hs-cTnT <30 ng/L (masked: 11[1.5%], unmasked: 25[3.4%],HR: 2.27,95%C.I.:1.87–2.77,P < 0.001). Less cardiac stress testing with unmasking amongst those <30 ng/L was observed in males in both studies, which was significant in RAPID TnT (masked: 92[12.0%], unmasked: 55[7.0%], P = 0.008). In RAPID TnT, significantly higher rates of angiography in males were observed with unmasking, with no such changes amongst females <30 ng/L (masked: 28[3.7%], unmasked: 51[6.5%],P = 0.01). ConclusionCompared with males, there were no evident impacts on downstream practices for females with unmasking in RAPID TnT, likely representing missed opportunities to reduce late death or MI.

Heart rate and death and hospitalization for heart failure in patients with persistent or permanent atrial fibrillation: Insights from the ARISTOTLE trial

Rate control is fundamental in the treatment of patients with atrial fibrillation (AF). The independent association of heart rate with outcomes and range of heart rate associated with best outcomes remains uncertain. We assessed the relationship between heart rate and clinical outcomes in patients with persistent or permanent AF enrolled in the randomized, double-blind ARISTOTLE trial. In patients with persistent or permanent AF, a faster heart rate is associated with a modest, but statistically significant increase in death and heart failure hospitalizations. Trial RegistrationClinicalTrials.gov (NCT00412984).

Major adverse cardiovascular events associated with testosterone treatment: a pharmacovigilance study of the FAERS database.

Background and purpose: Testosterone is an essential sex hormone in maintaining masculine characteristics, which is prescribed for male hypogonadism as testosterone replacement treatment (TRT). Herein, we investigated long-standing controversies about the association between TRT and major adverse cardiovascular events (MACEs), based on real world adverse event (AE) reports, registered in the Food and Drug Administration Adverse Event Reporting System (FAERS). Methods: Publicly available FAERS data from 1 January 2004 to 31 December 2022 were retrieved from the Food and Drug Administration (FDA) website. The data mining protocol including the reporting odds ratio (ROR) and the Bayesian confidence propagation neural network (BCPNN) was applied to analyze overreporting caused by risk factors and MACEs, including TRT, morbidities, and ages. The ROR and the BCPNN were also applied to investigate the annually developing trend of pharmacovigilance (PV) signals in the real world, retrospectively. Results: A total of 3,057 cases referring to MACEs, with a median age of 57 years old (yo), were identified from 28,921 cases of testosterone users. MACEs related to PV signals have emerged since 2014, including cardiac death, non-fatal myocardial infarction, and non-fatal stroke. Myocardial infarction (MI) (ROR: 9.46; IC025: 3.08), acute myocardial infarction (AMI) (ROR: 16.20; IC025: 3.72), ischemic cardiomyopathy (ROR: 11.63; IC025: 2.20), and cardiomyopathy (ROR: 5.98; IC025: 1.96) were the most significant signals generated, and weaker signals included cardiac failure acute (ROR: 4.01; IC025: 0.71), cardiac arrest (ROR: 1.88; IC025: 0.56), and ventricular fibrillation (VF) (ROR: 2.38; IC025: 0.38). The time-to-onset (TTO) of MACEs was calculated with a median of 246 days for AMI. Conclusion: For myocardial infarction and cardiomyopathy, TRT statistically tended to increase the risk of MACEs, while for cardiac arrhythmia, cardiac failure, and stroke, TRT demonstrated beneficial effects among the population with morbidities, such as testosterone deficiency (TD), diabetes mellitus (DM), and hypertension. MACEs were rare but led to serious outcomes including significant increase in death and disability. Since 2018, and before 2014, reports referring to TRT associated with MACEs were relatively scarce, which indicated that there might be a considerable number of cases that went unrecorded, due to neglection. Health workers and testosterone users might pay more attention to testosterone-induced MACEs.

Opioid presence rises in L.A. County's methamphetamine‐involved deaths

With fentanyl's influence accounting for most of the changes in local and national drug trends, it should come as no surprise that fentanyl appears to be responsible for a major shift in the profile of methamphetamine‐related deaths in Los Angeles County. A significant increase in deaths in which opioids were a contributing factor has been accompanied by a drop in deaths with associated cardiovascular factors, a primary danger of stimulant use.

Systemic thrombolysis in patients with acute stroke and active cancer: a systematic review and meta-analysis.

Cancer patients frequently have concomitant cerebrovascular diseases, which significantly worsen their prognosis. Prospective studies validating intravenous thrombolysis (IVT) safety profile in patients with acute ischemic stroke and active cancer are still lacking. Therefore, we aimed to evaluate IVT's efficacy and safety profile in acute ischemic stroke patients with comorbid active cancer. We included in a meta-analysis all relevant published studies, including patients with acute ischemic stroke with or without active cancer and receiving IVT, according to recommendations for IVT treatment for acute ischemic stroke. The primary outcomes were: any intracerebral hemorrhage, all-cause mortality, and good functional outcome reported as modified Rankin Scale (mRS) ≤ 2 at the end of the scheduled follow-up period. We included 11 studies in the meta-analysis. IVT was not associated with a significant increase in the incidence of intracerebral hemorrhage (OR 1.35; 95% CI 0.85-2.14; I2 76%), nor with a significant increase in death for any cause (OR 1.26; 95% CI 0.91-1.75; I2 71%); furthermore, IVT did not influence mRS between cancer and non-active cancer stroke patients (OR 0.72; 95% CI 0.35-1.49; I2 59%). IVT seems safe and effective in patients with ischemic stroke and concomitant cancer. Due to the low overall quality of the evidence, high-quality randomized controlled trials with adequate sample sizes are needed.

Histopathological Features of Skin changes caused by Electrocution: An Autopsy study

BACKGROUND: Dependency to electrical equipments and improper safety measures has led to a significant increase in deaths due to electrocution. Confirming the cause of death in electrocution is one of the biggest challenges. Skin is the most frequently involved tissue in electrocution and histopathology of skin from electric marks aids in proper diagnosis. OBJECTIVES: To study the histomorphological features of epidermis and dermis in skin tissue of entry and exit wounds in electrocution deaths. MATERIAL AND METHODS: This is an observational study done over a period of one year. Skin biopsy from medico legal autopsy of non-lightening electrocution deaths obtained from entry or exit wound site were included for the study. Gross and histopathological details were studied and data analyzed. RESULTS: Significant gross features were surface discoloration of skin 16 (61%) and ulceration 05 (20%). Microscopic features were coagulative necrosis 21 (80.7%), dermo-epidermal separation 20 (80.7%), focal ulceration of epithelium 05 (19%), clefting of epidermis (60%), streaming of nuclei (92.3%), elongation of nuclei (92.3%) and microblisters 02 (15.3%). CONCLUSION: One of the important causes of negative autopsy is electrocution deaths. In such cases dermatopathology is a diagnostic tool coupled with circumstantial evidence. Histological hallmark of electrocution skin injury is epidermal nuclear elongation.

Mortality by road transport injury in Brazilian municipalities between 2000 and 2018

ObjectivesThis study aimed to investigate patterns of mortality by road transport injury (RTI) in Brazilian municipalities, focused on deaths of motorcyclists, between 2000 and 2018, and their relation with population size and economic status. Study designThis was an ecological epidemiological study with a descriptive and analytical nature. MethodsThe age-standardized RTI mortality rates were calculated for the Brazilian municipalities, referring to the 3-year periods of 2000/2002 (T1), 2009/2011 (T2), and 2016/2018 (T3). The rates were stratified according to macroregion and population size and were compared in terms of percentage variation from one 3-year period to another. The Moran Global and Local indices were used in the spatial point-pattern analysis of the rates. To verify the association with the gross domestic product (GDP) per capita, the Spearman correlation coefficient was applied. ResultsA decline in RTI mortality rates was found between 2000 and 2018, with the most significant declines observed in municipalities from the South and Southeast regions of Brazil. However, increases were observed among motorcyclists. Clusters of municipalities were detected, which presented high mortality rates among the motorcyclists in the Northeast region and in some states of the North and Midwest regions. The mortality rates showed a negative correlation with the GDP per capita of the Brazilian municipalities. ConclusionsAlthough there were decreases in RTI mortality rates between 1990 and 2018, there was a significant increase in deaths among motorcyclists, especially in the Northeast, North, and Midwest regions of the country. Such differences can be explained by unequal growth in the size of the motorcycle fleet in those regions, by less law enforcement capability, and by the implementation of educational actions.

Acute Myeloid Leukemia Place of Death: Change over Two Decades

Introduction: Acute Myeloid Leukemia (AML) outcomes have improved over time, however end-of-life care for patients with AML is suboptimal with a low utilization of palliative care and hospice services. We analyzed AML mortality cause from 2000 to 2019 using the Mortality Data from the Centers of Disease Control and Prevention (CDC). Among AML deaths, we evaluated differences in place of death, cause of death and sociodemographic characteristics including gender, race and resident status. Methods: We conducted a retrospective cohort study using the Multiple Cause of Death Mortality Data from the National Vital Statistics System of the National Center for Health Statistics from January 1st 2000 to December 31st 2019. We obtained demographic characteristics of all the deaths during this period and those with AML. Among AML deaths, we examined principal cause of death and then used joinpoint regression to calculate trends in the rates of AML deaths by their location, which was represented using average annual percentage change (AAPC). Results: 195,923 AML deaths were captured from 2000 to 2019, from more than 50 million total deaths during this timeframe. At least 85.3% of AML deaths were attributed to AML (index cancer) and 2.7% of deaths were attributed to infection. 56.0% of AML deaths occurred in hospitals, 24.7% in decedent's homes, 7.5% in hospice facilities and 8.3% in nursing homes or long term care facilities. 56.6% of AML deaths were in males. 83.1% of AML deaths were in Non-Hispanic Whites (NH-White), 7.7% in NH-Blacks and 5.8% in Hispanics. 68.8% of AML deaths were residents of state in which the death occurred and 30.9% were in non-residents. Over the studied period, there was a statistically significant decrease in AML deaths in the hospital setting with AAPC (95% CI) being -1.5 (-1.9,-1.1) and nursing home setting AAPC (95% CI): -2.5 (-4.8, -0.2) along with a statistically significant increase in AML deaths at home with AAPC (95% CI): 28.6 (15.0, 43.7) (Figure 1). The AAPC for deaths in hospice facilities was statistically non-significant. Conclusions: Most AML deaths continue to occur in the hospital setting despite a statistically significant increase in deaths at home and trend of increased utilization of hospice facilities. Patients undergoing induction therapy for new or relapsed disease may be at higher risk of death from complications from their disease or therapy and die in the hospital setting. Young age at diagnosis, delayed goals of care discussions and hesitancy to forego transfusions may contribute to increased AML deaths in the hospital setting. This is the largest population study to date evaluating AML deaths to our knowledge, however we are limited by lacking information on the risk stratification of the AML, treatment received and circumstances of home death. We are also unable to determine the timing of goals of care conversations, whether or not patients were offered palliative care services or the timing of the hospice referral when it did occur. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

The Impact of the Highly Virulent SARS-CoV-2 Gamma Variant on Young Adults in the State of São Paulo: Was It Inevitable?

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic had and is still having a tremendous impact on people all over the world, but it has been particularly harsh in South America. Nine out of 13 South American countries are among the 50 countries with the highest COVID-19 death rates. The gamma severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant that emerged by the end of 2020 in the Brazilian Amazon quickly spread throughout the country causing the harsh COVID-19 second wave. This variant displayed high viral loads, high transmissibility, and increased virulence as compared to previous variants.AimsThe aim of this retrospective study is to revisit and analyse the epidemiology of the COVID-19 second wave in the state of São Paulo, the most populous Brazilian state. In addition to examining the possible factors that led to the emergence and propagation of the gamma variant, measures that could have prevented its spread and that of other highly virulent variants were also investigated.Materials and methodsData from São Paulo's official sources on morbidity, mortality, age distribution, and testing prior to and during the COVID-19 second wave (February - June 2021) and data regarding the distribution of SARS-CoV-2 variants in the country were parsed, analyzed, and compared to the period that anteceded the eruption of the second COVID-19 wave.ResultsIn the state of São Paulo, the toll of the COVID-19 second wave surpassed that of the first 11 months of the pandemic (from March 2020 to January 2021), as 56% of the deaths occurred in the five months of the second wave between February and June 2021. The mean age of COVID-19 victims, which was already below life expectancy in the state dropped even further in the pandemic's second wave, reaching an average of 60 years of age. The years of life lost per death per month doubled and the case-fatality rate (CFR) of young adults (20-39 years old) more than trebled during this period. A number of hypotheses have been raised that might explain the emergence and spread of the gamma variant and the measures that could have been taken to prevent it and minimise its impact on the population.ConclusionsOver 142,000 people died as a result of the SARS-CoV-2 gamma variant sweep in São Paulo in the first semester of 2021. Due to its high viral load, the gamma variant displayed high transmissibility and a high degree of virulence resulting in increased case fatality rates across most age tiers. Notably, this second wave was marked by a very significant increase in deaths among young adults. This increase was at least partially due to a deterioration in general health provoked by non-pharmaceutical interventions. In hindsight, a safer and more effective measure might have been to allow the free spread of the virus among the young and healthy in the first wave, thus conferring immunity against more virulent variants that emerged later on.

The association between 13 Reasons Why and suicidal ideation and behaviors, mental health symptoms, and help-seeking behaviors in youths: An integrative systematic review

Background: The series 13 Reasons Why (13RW) raised critical concerns regarding the deleterious impact of fictional suicide portrayal on suicidal behaviors as it depicted the suicide of an adolescent without following the recommendations on media reporting of suicide portrayal. We aimed to assess the impact of 13RW on suicide rates, suicide attempts (SA), and suicidal ideation (SI) prevalence, mental health symptoms, and help-seeking behaviors in youths. Method: Following PRISMA guidelines, we systematically searched for articles on three databases up to January 2022. Results: A total of 17 articles met the inclusion criteria. Five large studies reported a significant increase in deaths by suicide and SA in youths in the United States and Canada after the release of 13RW. Mood deterioration or more intensive depressive symptoms were reported in vulnerable adolescents who watched 13RW. Youths with previous history of depression, SA, or SI, and those who identified themselves with the main character were at higher risk to report an increase in SI or mood deterioration. Help-seeking behaviors significantly decreased, but the effects on mental health awareness tended to be positive after the release of 13RW. Conclusion: Our review reveals critical results about the impact of 13RW on youths. We report an alarming harmful impact on suicide and SA rates, especially in more vulnerable youths. The reported positive effects do not balance the deleterious impact of 13RW.

Relationship between births and deaths during the Covid-19 Pandemic in Brazil

The Covid-19 pandemic started in December 2019 in China and in March of the same year in Brazil, impacted the healthcare structure which, due to its expansion in recent decades, was able to absorb a large part of the patients of this new disease. Despite the robustness of the Brazilian Unified Health System, the country was among those that had the most deaths related to the new corona virus and its associated diseases. At the same time, for the second consecutive year there was a lower number of births in the country, anticipating an assessment of expected vegetative growth for approximately ten years. In an article published in the same periodical last year, we explored the panorama of deaths and Intensive Care Units, especially children, in Brazil. We found that we could forcibly have an increase in the number of beds and with the decrease in births in the country, we can stay close to the values ​​recommended by the Pediatrics Societies. Here we aim to maintain the pattern of analysis of the dead and the born, with a focus on those under twenty. The methodology used was a systematic review with exploration of related literature and public databases. The data suggest that Brazil is in a process of vegetative growth. This is due to a reduction in the number of births in the last two years compared to 2019 and a significant increase in deaths directly related to the new Corona virus pandemic. An important fact is that Covid-19 affects children and adolescents and that the decrease in cases is associated with intense vaccination in the country.

Associations between socioeconomic status and place of residence with survival after aneurysmal subarachnoid haemorrhage.

This study aims to understand early (<24 h post ictus) and late (up to 12 months) survival post aneurysmal subarachnoid haemorrhage (aSAH), with a focus on rurality and socioeconomic status. A statewide population-based cohort of aSAH cases in Tasmania, Australia, was established from 2010 to 2014 using multiple overlapping sources. Clinical data were collected from medical records and the Tasmanian Death Registry, with area-level rurality and socioeconomic status geocoded to participants' residential address. From a cohort of 237 (70% women, 36% disadvantaged, 38% rural) individuals over a 5-year period, 12-month mortality was 52.3% with 54.0% of these deaths occurring within 24 h post ictus. In univariable analysis of 12-month survival, outcome was not influenced by socioeconomic status, but rural geographical location was associated with a non-significant increase in death (hazard ratio (HR) 1.22; 95% confidence interval (CI) 0.85-1.75) along with hypertension (HR 1.78; 95% CI 1.07-2.98) and hypercholesterolaemia (HR 1.70; 95% CI 0.99-2.91). Multivariable analysis demonstrated a statistically significant increase in death to 12 months after aSAH for both hypertension (HR 1.81; 95% CI 1.08-3.03) and hypercholesterolaemia (HR 1.71; 95% CI 1.00-2.94) but not socioeconomic status or geographic location. We found high early death in this population-based aSAH Australian population. Survival to 12 months after aSAH was not related to either geographical location or socioeconomic status but modifiable risk factors increased the risk of death.

Resuscitation Decisions for Extremely Premature Infants: A UK NICU Experience

Background: Improvements in extreme preterm infant outcomes have led to an increasing recognition of the importance of antenatal optimization and delivery room (DR) management strategies for these infants. Methods: Retrospective cohort evaluation of every infant born at 22+0 to 25+6 weeks gestation in St Mary’s tertiary NICU between 2008 and 2018. Aiming to evaluate utilization of chest compressions and resuscitation medications during DR-resuscitation of extremely premature infants. Results: This study found that 90% of infants 22+0 to 22+6 weeks did not receive antenatal steroids. Whereas, for infants born between 23+0 and 23+6 weeks gestation, 75% did receive antenatal steroids. This difference is significant ( P value = .00006). This study shows there is a predisposition to not provide DR-chest compressions (DR-CC) and/or adrenaline (DR-CC+/−A) to extremely preterm For infants that received DR-CC, there was no statistically significant increase in death and no clear association with poorer long-term outcomes in survivors. Conclusions: Marked differences in provision of perinatal care were found dependent on gestational age. If infants are inadequately prepared for delivery and resuscitative measures are not fully utilized, it cannot be clear whether subsequently increased rates of death in the lower gestational age groups are solely due to gestational age or are influenced by the lack of preparative management.

Effectiveness of education using ha-man module on self-efficacy of adults in preventing coronary heart disease

Every year, there is a significant increase in deaths caused by coronary heart disease (CHD). Many programs have been implemented to reduce the morbidity and mortality of CHD. Early detection and control of CHD risk factors is a challenge in educating adults about lifestyle changes. Also, it is recognized that self-efficacy is a vital factor in initiating and maintaining healthy behaviors. Health education is given as an effort to increase self-efficacy, but educational media that are innovative in promoting CHD health are limited. This study aimed to determine differences in the self-efficacy of adults in preventing coronary heart disease before and after given health education. This was a quasi-experimental study with a pretest-posttest control group design. The sample were 60 respondents which were grouped into 30 respondents in the intervention group and control group through purposive sampling. The HA-Man education intervention was given 3 times for a-week, self-efficacy was evaluated through a structured questionnaire interview. The results showed that there were differences in self-efficacy before and after intervention in the intervention group (p &lt;0.05). This research is expected to provide information in the development of educational media in increasing awareness and self-efficacy of people who are at risk of CHD

Abstract 12811: Dual Antiplatelet Therapy Duration and Long-Term Risks of Adverse Outcomes After Percutaneous Coronary Intervention With Second-Generation Drug-Eluting Stents

Introduction: Randomized trials show that short dual antiplatelet (DAPT) regimens have similar adverse events to longer regimens in patients treated by percutaneous coronary intervention (PCI) using second-generation drug-eluting stents (DES2). However, these studies are underpowered for death. Hypothesis: After PCI with DES2, patients discontinuing DAPT before six months had higher risks of adverse ischemic outcomes than patients continuing DAPT for longer durations. Methods: We assessed adverse outcomes in patients having PCI between 2008-2016 in the Veterans Affairs Clinical Assessment Report and Tracking (CART) database. DAPT use was determined from the VA Pharmacy database. Outcomes after PCI were all-cause death (from the VA death index), and myocardial infarction, recurrent coronary revascularization, and major bleeding from ICD 9, ICD 10 and CPT codes in VA and Medicare/Medicaid records. Hazard ratios (HR) and 95% confidence intervals (95%CI) from Cox proportional hazards models weighted with a stabilized inverse probability of treatment weight were used to assess the risk of outcomes from stopping DAPT in 4 time intervals after PCI (1-5, 6-9, 10-12, and 13-18 months). Results: After exclusions, there were 40,871 PCIs with DES2 during the study period. Outcomes were followed for an average of 4.6 years. Compared to continuing DAPT, the risks for death were significantly higher for stopping DAPT 1-5 months after PCI (HR=2.04, 95%CI=1.82, 2.29) and stopping DAPT 6-9 months after PCI (HR=2.2, 95%CI=1.98, 2.44). There was no significant increase in death from stopping DAPT more than 10 months after PCI. Stopping DAPT 10 or more months after the index PCI associated with lower rates of myocardial infarction (HR=0.74, 95%CI=0.68, 0.81) and major bleeding (HR=0.81, 95%CI 0.73, 0.91), and lower repeat revascularization at all time periods. There was no interaction of effects with acute coronary syndrome at index PCI. Conclusion: Among Veterans having PCI with DES2, stopping DAPT less than 10 months after PCI was associated with a higher risk of death but no increased risk in myocardial infarction or major bleeding. Short DAPT regimens after PCI may increase the risk of death. Clinical trials of short DAPT duration should powered to assess this endpoint.