Citations

Background: Despite the well-established potent benefit of mechanical thrombectomy (MT) for large vessel occlusion (LVO) stroke, access to MT has not been studied globally. We conducted a worldwide survey of countries on 6 continents to define MT access (MTA), the disparities in MTA, and its determinants on a global scale. Methods: Our survey was conducted in 75 countries through the Mission Thrombectomy 2020+ global network between November 22, 2020, and February 28, 2021. The primary end points were the current annual MTA, MT operator availability, and MT center availability. MTA was defined as the estimated proportion of patients with LVO receiving MT in a given region annually. The availability metrics were defined as ([current MT operators×50/current annual number of estimated thrombectomy-eligible LVOs]×100 = MT operator availability) and ([current MT centers×150/current annual number of estimated thrombectomy-eligible LVOs]×100= MT center availability). The metrics used optimal MT volume per operator as 50 and an optimal MT volume per center as 150. Multivariable-adjusted generalized linear models were used to evaluate factors associated with MTA. Results: We received 887 responses from 67 countries. The median global MTA was 2.79% (interquartile range, 0.70–11.74). MTA was <1.0% for 18 (27%) countries and 0 for 7 (10%) countries. There was a 460-fold disparity between the highest and lowest nonzero MTA regions and low-income countries had 88% lower MTA compared with high-income countries. The global MT operator availability was 16.5% of optimal and the MT center availability was 20.8% of optimal. On multivariable regression, country income level (low or lower–middle versus high: odds ratio, 0.08 [95% CI, 0.04–0.12]), MT operator availability (odds ratio, 3.35 [95% CI, 2.07–5.42]), MT center availability (odds ratio, 2.86 [95% CI, 1.84–4.48]), and presence of prehospital acute stroke bypass protocol (odds ratio, 4.00 [95% CI, 1.70–9.42]) were significantly associated with increased odds of MTA. Conclusions: Access to MT on a global level is extremely low, with enormous disparities between countries by income level. The significant determinants of MT access are the country’s per capita gross national income, prehospital LVO triage policy, and MT operator and center availability.

AbstractBackgroundThe association between mid‐life cardiovascular diseases or risk factors and cognition decline has been reported. However, sex differences in these associations have rarely been examined.MethodWe included 2,351 participants enrolled in the population‐based Mayo Clinic Study of Aging who were aged 30‐69 years at baseline. Participants were evaluated every 15 months by a coordinator, neurologic evaluation, and neuropsychological testing. The neuropsychological testing used nine tests to calculate global cognitive and domain‐specific (memory, language, executive function, and visuospatial skills) z‐scores. Nurse abstractors reviewed participant medical records to determine the presence and age at onset of cardiovascular diseases and risk factors. Linear mixed‐effect models evaluated the association between baseline cardiovascular conditions (coronary heart disease, myocardial infarction, atrial fibrillation, angina) or risk factors (hypertension, diabetes, dyslipidemia) and global and domain‐specific cognitive decline. Multivariable models adjusted for demographics, APOE, depression, and other medical conditions. Interactions between sex and each cardiovascular conditions or risk factors were examined; results were stratified by sex if the interaction was p<0.05.ResultOverall, 1651 (70.3%) participants had at least one cardiovascular condition or risk factor; the proportion of men was higher than women (875 (74.9%) vs.777 (65.7%), p<0.0001). Cross‐sectionally, baseline cardiovascular conditions and risk factors were not associated with cognitive performance in multivariable analyses and there were no sex differences. Longitudinally, several cardiovascular conditions and risk factors were associated with declines in global and/or domain‐specific z scores, with the exception of visual spatial z‐scores. Most cardiovascular conditions were more strongly associated with cognition among women: coronary heart disease, myocardial infraction, and angina were associated with global cognition decline only in women. Additionally, diabetes, dyslipidemia, and coronary heart disease were associated with language z‐score decline only in women.ConclusionMiddle aged cardiovascular conditions and risk factors are associated with mid‐life cognitive decline. Moreover, some specific cardiovascular conditions and risk factors, such as coronary artery disease, myocardial infraction, and angina have stronger associations with cognition decline among women.

Abstract Background: The influence of prenatal diethylstilbestrol (DES) exposure on cancer incidence among middle-aged men has not been well-characterized. We investigated whether exposure to DES before birth impacts overall cancer risk, and risk of site-specific cancers. Methods: Men (mean age in 2016 = 62.0 years) who were or were not prenatally DES exposed were identified between 1953 and 1994 and followed for cancer primarily via questionnaire approximately every 5 years between 1994 and 2016. The overall and site-specific cancer rates of the two groups were compared using Poisson regression and proportional hazards modeling with adjustment for age. Results: DES exposure was not associated with either overall cancer [hazard ratio (HR), 0.94; 95% confidence interval (CI), 0.77–1.15] or total prostate cancer rates (HR, 0.95; 95% CI, 0.68–1.33), but was inversely associated with urinary tract cancer incidence (HR, 0.48; 95% CI, 0.23–1.00). Conclusions: There was no increase in either overall or prostate cancer rates among men prenatally DES exposed relative to those unexposed. An unexpected risk reduction was observed for urinary system cancers among the exposed relative to those unexposed. These findings suggest that prenatal DES exposure is unlikely to be an important contributor to cancer development in middle-aged men. Impact: The results of this study could lend reassurance to middle-aged men who were prenatally DES exposed that their exposure does not adversely influence their overall cancer risk.

Abstract Restless legs syndrome (RLS), a common neurologic disorder, is more prevalent in women than in men. Evidence indicates the potential role of female hormones in the pathophysiology of RLS. However, few studies have examined the relationship between premenopausal bilateral oophorectomy (BSO) and the risk of RLS. The Mayo Clinic Cohort Study of Oophorectomy and Aging-2 (MOA-2) includes all women residents of Olmsted County, Minnesota, who underwent premenopausal BSO before the age of 50 years for a non-cancer reason between 1988 and 2007 (n=1,653). In addition, 1,653 age-matched (± 1 year) referent women who did not undergo BSO prior to index-date were included. Survival analyses were used to examine the association between BSO and risk of RLS (defined by DSM-IV criteria) after adjustments using inverse probability weighting. The median (IQR) age at index-date was 40.0 (40.0-47.0) years for the BSO and 40.0 (40.0-47.0) for the non-BSO cohorts. Women who underwent BSO before menopause had a higher risk of RLS (HR,1.47; 95% CI, 1.08-2.01). In addition, women who underwent BSO before 46 years (HR:1.53, 95% CI, 1.03-2.28) or received BSO without benign ovarian indications (e.g., cysts, endometriosis, HR: 1.69, 95% CI, 1.11-2.56) were at greater risk of RLS. Estrogen use after BSO did not affect the risk of RLS. Premenopausal women who underwent BSO had an increased risk of RLS, especially those younger than 46 years and without benign medical indication. Women considering BSO for ovarian cancer prevention should be informed of the increased risk of neurological disorder including RLS.