Age, Sex, and Racial Differences in Neuroimaging Use in Acute Stroke: A Population-Based Study.

BACKGROUND AND PURPOSE: Limited information is available regarding differences in neuroimaging use for acute stroke work-up. Our objective was to assess whether race, sex, or age differences exist in neuroimaging use and whether these differences depend on the care center type in a population-based study. MATERIALS AND METHODS: Patients with stroke (ischemic and hemorrhagic) and transient ischemic attack were identified in a metropolitan, biracial population using the Greater Cincinnati/Northern Kentucky Stroke Study in 2005 and 2010. Multivariable regression was used to determine the odds of advanced imaging use (CT angiography/MR imaging/MR angiography) for race, sex, and age. RESULTS: In 2005 and 2010, there were 3471 and 3431 stroke/TIA events, respectively. If one adjusted for covariates, the odds of advanced imaging were higher for younger (55 years or younger) compared with older patients, blacks compared with whites, and patients presenting to an academic center and those seen by a stroke team or neurologist. The observed association between race and advanced imaging depended on age; in the older age group, blacks had higher odds of advanced imaging compared with whites (odds ratio, 1.34; 95% CI, 1.12-1.61; P < .01), and in the younger group, the association between race and advanced imaging was not statistically significant. Age by race interaction persisted in the academic center subgroup (P < .01), but not in the nonacademic center subgroup (P = .58). No significant association was found between sex and advanced imaging. CONCLUSIONS: Within a large, biracial stroke/TIA population, there is variation in the use of advanced neuroimaging by age and race, depending on the care center type.

Incidence of sexually transmitted infections in HIV-infected and HIV-uninfected adolescents in the USA.

Little is known about the incidence of bacterial sexually transmitted infections (STIs) among HIV-infected versus HIV-uninfected adolescents. This secondary analysis of a national, multisite study included adolescents aged 12-18 years who were behaviourally HIV-infected (n = 346) or HIV-uninfected but at-risk (n = 182). Incidence rates of bacterial STIs (gonorrhoea, chlamydia [CT] and trichomonas [TV; women]) were calculated using Poisson modelling. Factors associated with incident STIs were explored using Cox proportional hazards modelling. HIV-infected versus HIV-uninfected women had higher TV incidence (1.3 versus 0.6/100 person-months; P = 0.002). HIV-uninfected versus HIV-infected women had higher CT incidence (1.6 versus 1.1/100 person-months; P = 0.04). Among women, demographic, behavioural and HIV-related factors were associated with incident STIs. Among men, there were no differences in incident STIs. In this first analysis comparing STI incidence between HIV-infected and HIV-uninfected adolescents, bacterial STI incidence among women significantly differed by HIV status, and factors associated with incident STIs varied by STI and HIV status.

Population-based study of wake-up strokes.

OBJECTIVE: Previous studies have estimated that wake-up strokes comprise 8%to 28% of all ischemic strokes, but these studies were either small or not population-based. We sought to establish the proportion and event rate of wake-up strokes in a large population-based study and to compare patients who awoke with stroke symptoms with those who were awake at time of onset. METHODS: First-time and recurrent ischemic strokes among residents of the Greater Cincinnati/Northern Kentucky region (population 1.3 million) in 2005 were identified using International Classification of Diseases-9 codes 430-436 and verified via study physician review. Ischemic strokes in patients aged 18 years and older presenting to an emergency department were included. Baseline characteristics were ascertained, along with discharge modified Rankin Scale scores and 90-day mortality. RESULTS: We identified 1,854 ischemic strokes presenting to an emergency department, of which 273 (14.3%) were wake-up strokes. There were no differences between wake-up strokes and all other strokes with regard to clinical features or outcomes except for minor differences in age and baseline retrospective NIH Stroke Scale score. The adjusted wake-up stroke event rate was 26.0/100,000. Of the wake-up strokes, at least 98 (35.9%) would have been eligible for thrombolysis if arrival time were not a factor. CONCLUSIONS: Within our population, approximately 14% of ischemic strokes presenting to an emergency department were wake-up strokes. Wake-up strokes cannot be distinguished from other strokes by clinical features or outcome. We estimate that approximately 58,000 patients with wake-up strokes presented to an emergency department in the United States in 2005.

Use of (1-3)-beta-d-glucan concentrations in dust as a surrogate method for estimating specific fungal exposures.

UNLABELLED: Indoor exposure to fungi has been associated with respiratory symptoms,often attributed to their cell wall component, (1-3)-beta-D-glucan. Performing(1-3)-beta-D-glucan analysis is less time consuming and labor intensive than cultivation or microscopic counting of fungal spores. This has prompted many to use(1-3)-beta-D-glucan as a surrogate for fungal exposure. The aim of this study was to examine which indoor fungal species are major contributors to the (1-3)-beta-D-glucan concentration in field dust samples. We used the quantitative polymerase chain reaction (QPCR) method to analyze 36 indoor fungal species in 297 indoor dust samples. These samples were also simultaneously analyzed for (1-3)-beta-D-glucan concentration using the endpoint chromogenic Limulus Amebocyte lysate assay. Linear regression analysis, followed by factor analysis and structural equation modeling, were utilized in order to identify fungal species that mostly contribute to the (1-3)-beta-D-glucan concentration in field dust samples. The study revealed that Cladosporium and Aspergillus genera, as well as Epicoccum nigrum, Penicillium brevicompactum and Wallemia sebi were the most important contributors to the (1-3)-beta-D-glucan content of these home dust samples. The species that contributed most to the (1-3)-beta-D-glucan concentration were also the most prevalent in indoor environments. However, Alternaria alternata, a common fungal species in indoor dust, did not seem to be a significant source of (1-3)-beta-D-glucan. PRACTICAL IMPLICATIONS: This study revealed that the (1-3)-beta-D-glucan content of different fungal species varies widely. (1-3)-beta-D-glucan inhouse dust from the Greater Cincinnati area may be a good marker for some fungal species of the Cladosporium and Aspergillus genera. In contrast, Alternaria alternata did not contribute much to the (1-3)-beta-D-glucan load. Therefore, (1-3)-beta-D-glucan concentration in field samples as a surrogate for total fungal exposure should be used with caution.