Background: We report contemporary trends in nationwide incidence of intracerebral hemorrhage (ICH) across demographic and regional strata over a 15-year period. Methods: Utilizing the Nationwide Inpatient Sample (2004–2018) and US Census Bureau data, we calculated ICH incidence rates for age, race/ethnicity, sex, and hospital region sub-cohorts across 5 consecutive 3-year periods (2004–2006 to 2016–2018). We fit Poisson and log binomial regression models to evaluate demographic and regional differences in ICH incidence and trends in prevalence of hypertension and past/current anticoagulant use among hospitalized ICH patients. Results: Overall, the annual incidence rate (95% CI) of ICH per 100 000 was 23.15 (23.10–23.20). The 3-year incidence of ICH (per 100 000) increased from 62.79 in 2004 to 2006 to 78.86 in 2016 to 2018 (adjusted incidence rate ratio, CI: 1.11 [1.02–1.20]), coinciding with increased 3-year prevalence of hypertension and anticoagulant use among hospitalized ICH patients (adjusted risk ratio, CI: hypertension—1.16 [1.15–1.17]; anticoagulant use—2.30 [2.14–2.47]). We found a significant age-time interaction, whereby ICH incidence increased significantly faster among those aged 18 to 44 years (adjusted incidence rate ratio, CI: 1.10 [1.05–1.14]) and 45 to 64 years (adjusted incidence rate ratio, CI: 1.08 [1.03–1.13]), relative to those aged ≥75 years. Conclusions: Rising ICH incidence among young and middle-aged Americans warrants ICH prevention strategies targeting these economically productive age groups.
Background Hepatitis B virus (HBV) infection is highly endemic in Nigeria. The primary objective of this study is to describe the knowledge, self-reported vaccination status, and intention of healthcare workers to receive hepatitis B vaccine at a tertiary referral center in conflict-ravaged northeastern Nigeria. Methods This was cross-sectional analytical study among medical practitioners, nurses, laboratory workers, health attendants, pharmacists, and radiographers working at Federal Medical Center Nguru, Yobe State. Written informed consent was obtained from all study participants. Data were obtained using questionnaires and entered into a Microsoft Excel spreadsheet, cleaned and analyzed using JMP Pro software. Results Of the 182 participants, we found that 151 (82.97%), 81 (44.51%), 85 (46.70%), and 33 (18.13%) had good knowledge of HBV, good knowledge of hepatitis B vaccine, were vaccinated against HBV by the least dose, and had a complete hepatitis B vaccination status, respectively. The lack of availability of the vaccine was the main reason for not receiving the vaccine among the unvaccinated 36/91 (39.56%), followed by not knowing where to access the vaccine 19/91 (20.88%). Conclusion The study highlights the need for strategies to ensure the availability of hepatitis B vaccine in conflict settings and need for vaccinology training given the suboptimal level of awareness and uptake of the hepatitis B vaccine among the healthcare workers.
Background Sex differences in post-stroke cognitive decline have not been systematically evaluated in a nationally representative cohort. We use a quasi-experimental design to investigate sex differences in rate of post-stroke cognitive decline. Methods Utilizing the event study design, we use the Health and Retirement Study (HRS) data (1996–2016) to evaluate the differences (percentage points [95% Confidence interval]) in the rate of change in cognitive function, measured using the modified version of the Telephone Interview for Cognitive Status (TICS-m) score, before and after incident stroke, and among patients with and without incident stroke. We estimated this event study model for the overall study population and separately fit the same model for male and female participants. Results Of 25,872 HRS participants included in our study, 14,459 (55.9%) were females with an overall mean age (SD) of 61.2 (9.3) years. Overall, 2,911 (11.3%) participants reported experiencing incident stroke. Participants with incident stroke (vs. no stroke) had lower baseline TICS-m score (15.6 vs. 16.1). Among participants with incident stroke, the mean pre-stroke TICS-m score was higher than the mean post-stroke TICS-m score (14.9 vs. 12.7). Event study revealed a significant short-term acceleration of cognitive decline for the overall population (4.2 [1.7–6.6] percentage points, p value = 0.001) and among female participants (5.0 [1.7–8.3] percentage points, p value = 0.003). We, however, found no evidence of long-term acceleration of cognitive decline after stroke. Moreover, among males, incident stroke was not associated with significant changes in rate of post-stroke cognitive decline. Conclusion Females, in contrast to males, experience post-stroke cognitive deficits, particularly during early post-stroke period. Identifying the sex-specific stroke characteristics contributing to differences in post stroke cognitive decline may inform future strategies for reducing the burden of post-stroke cognitive impairment and dementia.
Introduction Malaria is the second leading cause of death in children after diarrheal disease, with low- and middle-income countries (LMICs) accounting for over 9 in 10 incidence and deaths. Widespread acceptance and uptake of the RTS,S vaccine, recently approved by the world health organization (WHO), is projected to significantly reduce malaria incidence and deaths. Therefore, we conducted this systematic review and meta-analysis with the aim to determine the malaria vaccine acceptance rate and the factors associated with acceptance. Methods We searched six databases including Google Scholar, PubMed, Cochrane, African Index Medicus, The Regional Office for Africa Library, and WHO Institutional Repository for Information Sharing (IRIS) to identify studies evaluating the malaria vaccine acceptance rate. This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Studies were included if they were original articles published in the English language in peer-reviewed journals and assessed the prevalence of willingness to accept a free malaria vaccine, and not qualitative. The risk of publication bias was checked using both Beggar’s funnel plot and Egger’s test, while the I2 statistic was used to assess the heterogeneity of the included studies. Study quality was determined using the Newcastle-Ottawa scale. A meta-analysis was performed using a random effects model to evaluate the pooled prevalence of malaria vaccine acceptance. The protocol for this article was registered prospectively on the International Prospective Register for Systematic Reviews (PROSPERO), with ID number CRD42022334282). Results Our analysis included 11 studies with a total sample size of 14, 666 participants. The aggregate malaria vaccine acceptance rate was 95.3% (95% CI:93.0%–97.2%). Among the general population, the acceptance rate was 96.3% (95% CI:92.0%–99.0%) and among mothers, it was 94.4% (95% CI:90.8%–97.2%). By country, Nigeria had the highest acceptance rate (97.6%, 95% CI:96.0%-98.8%), followed by Ghana (94.6%, 95% CI:93.8%-95.3%) and Tanzania (92.5%, 95% CI:84.4%-97.8%). Sociodemographic determinants of vaccine acceptance included place of residence, tribe, age, sex, occupation, and religion. Reasons for low acceptance included safety concerns, efficacy profile, vaccine’s requirement for multiple injections, and poor level of awareness. Conclusion Future efforts should be focused on identifying factors that may improve the actual uptake of the RTS,S vaccine in malaria-endemic communities.
Introduction There is paucity of data for transgender persons who undergo genital or bottom gender-affirming surgery (GAS). Objective To provide nationwide estimates of frequency, length of stay, charges, and mortality for bottom GAS hospitalizations among transgender persons diagnosed with gender dysphoria and to characterize socio-demographic, clinical, and hospital-related characteristics of transgender persons with gender dysphoria (GD) who undergo GAS. Methods We analyzed the National Inpatient Sample (NIS) for years 2016 to 2018, representing 90% of all US hospitalizations. Utilizing International Classification of Disease (ICD) version 10 codes, we identified transgender persons with gender dysphoria with and without bottom GAS. Between these groups, we compared socio-demographic characteristics (age, administratively documented sex, race, median income for zip code, insurance type, US region) and comorbidity profiles via the Charlson Comorbidity Index (CCI - a composite score comprising age and 17 multi-system conditions). Mental health comorbidities and substance abuse disorders were also evaluated. We provide an account of hospital characteristics where GAS procedures were conducted along with estimates of charges, length of stay, and in-hospital mortality among GD patients with GAS. We utilized survey weights and reported nationally representative estimates as odds ratios (OR) and 95% confidence intervals (CI). Results The 2016 - 2018 NIS had 37,870 GD hospitalization encounters. The proportion of GD hospitalizations increased over the 3-year period, OR (CI): 1.55(1.43-1.68). From among these encounters, 2,925 (7.7) had at least one GAS procedure documented. The absolute count of GD hospitalizations with GAS also increased over 3 years. GD patients with GAS (37.4 years) (vs. no-GAS group - 31.6 years) were significantly older; OR (CI): 1.02(1.01-1.02), were more likely to be administratively documented as male; OR (CI): 1.62(1.02-2.58), and more likely to belong to a higher socio-economic group. GAS procedures were also associated with higher rates of private insurance (vs. Medicare); OR (CI): 3.17(2.16-4.66). GD patients who underwent GAS (vs. no-GAS) had significantly lower comorbidities, OR (CI) for low vs. high CCI: 2.28(1.32-3.93). Likewise, a lower proportion of GAS GD patients (vs. non-GAS GD) had documented substance abuse and mental health disorders. OR (CI) for alcohol abuse: 0.09(0.07–0.12), smoking: 0.44(0.35–0.56), drug use: 0.07(0.3–0.15), depression: 0.67(0.48–0.92), and psychosis: 0.23(0.14–0.37). Higher rates of GAS were observed in Western US region; OR (CI) vs. Midwest 5.90(2.89-12.04) and vs. South 3.58(1.52-8.44). GD GAS procedures were predominantly performed in urban hospitals with the mean hospital charges, mean length of stay, and proportional in-hospital mortality of $101,654, 4.3 days, and 0.3%, respectively. Conclusions Nationally, older GD patients who are privately insured, with lower systemic and mental comorbidities, and lower rates of substance abuse are more likely to undergo GAS, predominantly in the Western US. Current lack of data among transgender persons with gender dysphoria invites anecdotal experience to drive decision making, and better characterization of this population may optimize GAS outcomes. Disclosure Work supported by industry: no.
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