Pain and Sleep Disturbances are Associated with Post-stroke Anger Proneness and Emotional Incontinence

Background: Emotional disorders are common findings after a stroke episode. Despite evidence linking pain and sleep disorders to various post-stroke emotional conditions, their roles in the prevalence of post-stroke anger proneness (PSAP) and post-stroke emotional incontinence (PSEI) remain unclear. We investigated the influence of composite and different components of post-stroke pain (PSP) as well as post-stroke sleep disorders (PSSD) on PSAP and PSEI. Methods: Cross-sectional data on PSAP, PSEI, PSP and PSSD were evaluated through validated instruments and structured interviews for a total of 185 community-dwelling stroke survivors attending two Nigerian tertiary health facilities. Data on potential confounding variables were also assessed. Results: The rates of PSSD, PSP, PSAP and PSEI among Nigerian stroke survivors were 36.8%, 63.3%, 23.2% and 44.9%, respectively. The results of logistic regression models showed that composite PSP was associated with PSEI (adjusted odd ratio (aOR): 0.492; 95% confidence interval (CI): 0.251-0.965). While assessing the different components of PSSD and PSP, the results showed that sleep disturbances (aOR: 1.855; 95% CI: 1.096-3.140) and post-stroke headache (aOR: 0.364; 95% CI: 0.153-0.864) were associated with PSEI. In addition, being a domain of PSP, post-stroke headache was associated with PSAP (aOR: 0.052; 95% CI: 0.011-0.238). Conclusion: There is high prevalence of PSSD, PSP, PSAP and PSEI among Nigerian stroke survivors. Post-stroke headache is associated with both PSAP and PSEI, while sleep disturbances are associated with PSEI. Post-stroke headache and sleep disturbances are potential targets for interventions in patients with stroke to lessen the burden of PSAP and PSEI

Data-driven malaria prevalence prediction in large densely populated urban holoendemic sub-Saharan West Africa

Over 200 million malaria cases globally lead to half-million deaths annually. The development of malaria prevalence prediction systems to support malaria care pathways has been hindered by lack of data, a tendency towards universal "monolithic" models (one-size-fits-all-regions) and a focus on long lead time predictions. Current systems do not provide short-term local predictions at an accuracy suitable for deployment in clinical practice. Here we show a data-driven approach that reliably produces one-month-ahead prevalence prediction within a densely populated all-year-round malaria metropolis of over 3.5 million inhabitants situated in Nigeria which has one of the largest global burdens of P. falciparum malaria. We estimate one-month-ahead prevalence in a unique 22-years prospective regional dataset of > 9 × 10^{4} participants attending our healthcare services. Our system agrees with both magnitude and direction of the prediction on validation data achieving MAE ≤ 6 × 10^{-2}, MSE ≤ 7 × 10^{-3}, PCC (median 0.63, IQR 0.3) and with more than 80% of estimates within a (+ 0.1 to - 0.05) error-tolerance range which is clinically relevant for decision-support in our holoendemic setting. Our data-driven approach could facilitate healthcare systems to harness their own data to support local malaria care pathways

The use of insecticide treated nets by age: implications for universal coverage in Africa

BACKGROUND: The scaling of malaria control to achieve universal coverage requires a better understanding of the population sub-groups that are least protected and provide barriers to interrupted transmission. Here we examine the age pattern of use of insecticide treated nets (ITNs) in Africa in relation to biological vulnerabilities and the implications for future prospects for universal coverage. METHODS: Recent national household survey data for 18 malaria endemic countries in Africa were assembled to identify information on use of ITNs by age and sex. Age-structured medium variant projected population estimates for the mid-point year of the earliest and most recent national surveys were derived to compute the population by age protected by ITNs. RESULTS: All surveys were undertaken between 2005 and 2009, either as demographic health surveys (n = 12) or malaria indicator surveys (n = 6). Countries were categorized into three ITN use groups: or =20% and projected population estimates for the mid-point year of 2007 were computed. In general, the pattern of overall ITNs use with age was similar by country and across the three country groups with ITNs use initially high among children <5 years of age, sharply declining among the population aged 5-19 years, before rising again across the ages 20-44 years and finally decreasing gradually in older ages. For all groups of countries, the highest proportion of the population not protected by ITNs (38% - 42%) was among those aged 5-19 years. CONCLUSION: In malaria-endemic Africa, school-aged children are the least protected with ITNs but represent the greatest reservoir of infections. With increasing school enrollment rates, school-delivery of ITNs should be considered as an approach to reach universal ITNs coverage and improve the likelihood of impacting upon parasite transmission

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Disorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021. Methods: We estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined. Findings: Globally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer. Interpretation: As the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed. Funding: Bill & Melinda Gates Foundation

Heavy metal concentration in selected fish species from Eleyele reservoir Ibadan Oyo State South-western Nigeria

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Increasing Incremental Burden of Surgical Bleeding Associated with Multiple Comorbidities as Measured by the Elixhauser Comorbidity Index: A Retrospective Database Analysis

Mosadoluwa Afolabi,1,&ast; Stephen S Johnston,1,&ast; Pranjal Tewari,2,&ast; Walter A Danker3,&ast; 1MedTech Epidemiology and Real-World Data Sciences, Johnson and Johnson, New Brunswick, NJ, USA; 2Decision Science, Mu Sigma, Bangalore, India; 3Franchise Health Economics and Market Access, Ethicon, Johnson and Johnson, Raritan, NJ, USA&ast;These authors contributed equally to this workCorrespondence: Stephen S Johnston, Real-World Data Analytics and Research, 410 George Street, New Brunswick, NJ, 08901, USA, Tel +1 443-254-2222, Email [email protected]: Disruptive bleeding can complicate surgical procedures, increasing resource use, and impacting patients’ well-being. This study aims to elucidate the impact of comorbidity on the risk of disruptive surgical-related bleeding and selected transfusion-associated complications, as well as the incremental cost of such bleeding.Patients and Methods: This retrospective analysis of the Premier Healthcare Database included patients who were age ≥ 18 years and who had a procedure of interest between 1-Jan-2019— 31-Dec-2019: cholecystectomy, coronary artery bypass grafting, cystectomy, hepatectomy, hysterectomy, pancreatectomy, peripheral vascular, thoracic, and valve procedures (first=index). The Elixhauser comorbidity index was assessed on index date and patients were grouped by cumulative comorbidity score (0, 1, 2, 3, 4, 5, ≥ 6). Outcomes, all measured as in-hospital during index, included bleeding (diagnosis and/or intervention for bleeding), transfusion-associated complications (diagnosis of infection, acute renal failure, or vascular events), and incremental total hospital costs associated with bleeding. Multivariable generalized linear models were used to examine the association of comorbidity/bleeding with outcomes.Results: Of the 304,074 patients included, 7% experienced bleeding. The Elixhauser scores were distributed as follows: 0=29%, 1=23%, 2=18%, 3=12%, 4=8%, 5=5%, ≥ 6=5%. Odds of bleeding significantly increased with Elixhauser score: 1 comorbidity vs 0 (odds ratio [OR] =1.30, 95% confidence interval [95% CI] =1.19– 1.43), and this trend continued to surge (≥ 6 comorbidities [OR=3.22, 95% CI=2.94– 3.53]). Similarly, the odds of transfusion-associated complications significantly increased with comorbidities score: 1 comorbidity vs 0 (OR=2.14, 95% CI=1.88– 2.34), ≥ 6 comorbidities vs 0 (OR=12.37, 95% CI=10.80– 14.16). The incremental cost of bleeding also increased with comorbidities score; per-patient costs with and without bleeding were &dollar;18,132 vs &dollar;13,190, p < 0.001 among patients with 0 comorbidities and &dollar;28,952 vs &dollar;19,623, p < 0.001 among patients with ≥ 6 comorbidities.Conclusion: Higher comorbidity burden was associated with significant increases in the risk of surgical bleeding, subsequent transfusion-related complications, and incremental cost burden of bleeding.Keywords: bleeding complications, Elixhauser comorbidities, risk factors, observational, economic outcome