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Background Important disparities in the treatment and outcomes of women and men with atrial fibrillation are well recognized. Whether introduction of direct oral anticoagulants has reduced disparities in treatment is uncertain. Methods All patients who had an incident hospitalization from 2010 to 2019 with non-valvular atrial fibrillation in Scotland were included in this cohort study. Community drug dispensing data were used to determine prescribed oral anticoagulation therapy and comorbidity status. Logistic regression modelling was used to evaluate patient factors associated with treatment with vitamin K antagonists and direct oral anticoagulants. Results A total of 172,989 patients (48% women [82,833/172,989]) had an incident hospitalization with non-valvular atrial fibrillation in Scotland between 2010 and 2019. The proportion of patients with thromboembolic risk factors (CHA2DS2VASc score >0 in men and >1 in women) treated with oral anticoagulation therapy increased from 36.8% to 66.3% over this 10-year period. By 2019, factor Xa inhibitors accounted for 83.6% of all oral anticoagulants prescribed, while treatment with vitamin K antagonists and direct thrombin inhibitors declined to 15.9% and 0.6%, respectively. Women were less likely to be prescribed any oral anticoagulation therapy compared to men (adjusted odds ratio, aOR 0.68 [95% CI, CI 0.67–0.70]). This disparity was mainly attributed to vitamin K antagonists (aOR 0.68 [95% CI 0.66–0.70]), whilst there was less disparity in use of factor Xa inhibitors between women and men (aOR 0.92 [95% CI 0.90–0.95]). At 1 year following hospitalization with atrial fibrillation, patients not prescribed oral anticoagulation therapy were more likely to have subsequent major adverse cardiovascular events compared to those prescribed with oral anticoagulation therapy (38.8% [15,380/39,608] versus 17.0% [6,761/39,671] in women and 35.2% [12,977/36,868] versus 16.4% [7,395/45,093] in men). Conclusions Women with non-valvular atrial fibrillation were significantly less likely to be prescribed vitamin K antagonists compared to men. Most patients admitted to hospital in Scotland with incident non-valvular atrial fibrillation are now treated with factor Xa inhibitors and this is associated with less treatment disparities between women and men. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): This study was supported by the British Heart Foundation through a Clinical Research Training Fellowship (FS/18/25/33454), Intermediate Clinical Research Fellowship (FS/19/17/34172), Senior Clinical Research Fellowship (FS/16/14/32023) and a Research Excellence Award (RE/18/5/34216), and a research grant to NHS Lothian from Bristol Myers Squibb Pharmaceuticals Ltd and Pfizer UK Ltd.

Purpose Recognition of congestion and hypoperfusion in patients with chronic left ventricular dysfunction (LVD) has therapeutic and prognostic implications. In the present study we hypothesized that a multiparameter echocardiographic grading of right ventricular dysfunction (RVD) can facilitate the characterization of hemodynamic profiles. Methods Consecutive patients (n = 105, age 53 ± 14 years, males 77%, LV ejection fraction 28 ± 11%) referred for heart transplant or heart failure work-up, with catheterization and echocardiography within 48 h, were reviewed retrospectively. Three hemodynamic profiles were defined: compensated LVD (cLVD, normal pulmonary capillary wedge pressure (PCWP 2 ≥ 60%)); decompensated LVD (dLVD, with increased PCWP) and LV failure (LVF, increased PCWP and reduced SvO2). We established a 5-point RVD score including pulmonary hypertension, reduced tricuspid annular plane systolic excursion, RV dilatation, ≥ moderate tricuspid regurgitation and increased right atrial pressure. Results The RVD score [median (IQR 25%;75%)] showed significant in-between the three groups differences with 1 (0;1), 1 (0.5;2) and 3.0 (2;3.5) in patients with cLVD, dLVD and LVF, respectively. The finding of RVD score ≥ 2 or ≥ 4 increased the likelihood of decompensation or LVF 5.2-fold and 6.7-fold, respectively. On the contrary, RVD score Conclusions In this proof of concept study an echocardiographic RVD score identified different hemodynamic severity profiles in patients with chronic LVD and reduced ejection fraction. Further studies are needed to validate its general applicability. Graphical abstract

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Headache is the most common symptom of spontaneous intracranial hypotension (SIH). The present review focuses on data regarding headache features reported in the most relevant published articles and summarizes the main SIH headache features, namely, orthostatic headache, headache triggered by Valsalva maneuver, pattern of onset of headache, and location and quality of headache. Published data indicate that the clinical suspect of this disorder may be challenging, due to its protean presentation. Among the main implications for clinical practice, we suggest to suspect SIH in all patients with a new onset headache, as different forms of primary and secondary headache should be considered in the differential diagnosis of SIH, particularly cervicogenic headache, new daily persistent headache, and headaches precipitated by Valsalva maneuver. The clinical interview must include specific questions on the possible orthostatic feature of headache, although its absence should not make clinicians to reject the SIH hypothesis as headache cannot be orthostatic in each patient and in all periods of the natural history of the disease. Other disorders with orthostatic symptoms, such as in postural tachycardia syndrome (POTS) and persistent postural-perceptual dizziness (PPPD), should be considered in the differential diagnosis. Awareness that SIH can present with acute, sudden onset requires that clinicians working in the emergency settings should consider SIH in the range of diagnoses of thunderclap headache.

Introduction Subcutaneous sumatriptan, a 5HT1B/1D agonist, is the most effective drug in cluster headache acute treatment. About 25% of the patients do not respond to subcutaneous sumatriptan; the reasons for this are unknown. In this study, we compare clinical characteristics of cluster headache patients responding and non-responding to subcutaneous sumatriptan. Methods We retrospectively investigated the clinical records of 277 cluster headache patients. Patients reporting repeated satisfactory response to subcutaneous sumatriptan within 15 minutes were considered responders. Results Of 206 cluster headache patients who had used subcutaneous sumatriptan (mean age 45.6, 16% females, 48% chronic), 91% were responders, and 9% non-responders. Compared to responders, non-responders had longer and more frequent attacks: 60 (median; IQR 38–90) vs. 100 (60–120) minutes ( p = 0.028), 4 (2.5–5) vs. 3 (2–4) attacks/day ( p = 0.024). No other difference was found. Conclusions In cluster headache attacks with long duration and high frequency, pain mechanisms not involving 5HT1B/1D receptors may play a more relevant role.

Background: Despite improvements in management, infective endocarditis remains associated with high mortality and morbidity. We describe temporal changes in the incidence, microbiology, and outcomes of infective endocarditis and the effect of changes in national antibiotic prophylaxis guidelines on incident infective endocarditis. Methods: Using a Scotland-wide, individual-level linkage approach, all patients hospitalized with infective endocarditis from 1990 to 2014 were identified and linked to national microbiology, prescribing, and morbidity and mortality datasets. Linked data were used to evaluate trends in the crude and age- and sex-adjusted incidence and outcomes of infective endocarditis hospitalizations. From 2008, microbiology data and associated outcomes adjusted for patient demographics and comorbidity were also analyzed. An interrupted time series analysis was performed to evaluate incidence before and after changes to national antibiotic prophylaxis guidelines. Results: There were 7638 hospitalizations (65±17 years, 51% females) with infective endocarditis. The estimated crude hospitalization rate increased from 5.3/100 000 (95% CI, 4.8-5.9) to 8.6/100 000 (95% CI, 8.1–9.1) between 1990 and 1995 but remained stable thereafter. There was no change in crude incidence following the 2008 change in antibiotic prophylaxis guidelines (relative risk of change 1.06 [95% CI, 0.94–1.20]). The incidence rate in patients >80 years of age doubled from 1990 to 2014 (17.7/100 000 [95% CI, 13.4–23.3] to 37.9/100 000 [95% CI, 31.5–45.5]). The predicted 1-year age- and comorbidity-adjusted case fatality rate for a 65-year-old patient decreased in women (27.3% [95% CI, 24.6–30.2] to 23.7% [95% CI, 21.1–26.6]) and men (30.7% [95% CI, 27.7–33.8] to 26.8% [95% CI, 24.0–29.7]) from 1990 to 2014. Blood culture data were available from 2008 (n=2267/7638, 30%), with positive blood cultures recorded in 42% (950/2267). Staphylococcus (403/950, 42.4%) and streptococcus (337/950, 35.5%) species were most common. Staphylococcus aureus and enterococcus had the highest 1-year mortality (adjusted odds ratio 4.34 [95% CI, 3.12–6.05] and 3.41 [95% CI, 2.04–5.70], respectively). Conclusions: Despite changes in antibiotic prophylaxis guidelines, the crude incidence of infective endocarditis has remained stable. However, the incidence rate has doubled in the elderly. Positive blood cultures were observed in less than half of patients, with Staphylococcus aureus and enterococcus bacteremia associated with worse outcomes.

OBJECTIVES To evaluate the diagnostic performance of N-terminal pro-B-type natriuretic peptide (NT-proBNP) thresholds for acute heart failure and to develop and validate a decision support tool that combines NT-proBNP concentrations with clinical characteristics. DESIGN Individual patient level data meta-analysis and modelling study. SETTING Fourteen studies from 13 countries, including randomised controlled trials and prospective observational studies. PARTICIPANTS Individual patient level data for 10 369 patients with suspected acute heart failure were pooled for the meta-analysis to evaluate NT-proBNP thresholds. A decision support tool (Collaboration for the Diagnosis and Evaluation of Heart Failure (CoDE-HF)) that combines NT-proBNP with clinical variables to report the probability of acute heart failure for an individual patient was developed and validated. MAIN OUTCOME MEASURE Adjudicated diagnosis of acute heart failure. RESULTS Overall, 43.9% (4549/10 369) of patients had an adjudicated diagnosis of acute heart failure (73.3% (2286/3119) and 29.0% (1802/6208) in those with and without previous heart failure, respectively). The negative predictive value of the guideline recommended rule-out threshold of 300 pg/mL was 94.6% (95% confidence interval 91.9% to 96.4%); despite use of age specific rule-in thresholds, the positive predictive value varied at 61.0% (55.3% to 66.4%), 73.5% (62.3% to 82.3%), and 80.2% (70.9% to 87.1%), in patients aged 75 years, respectively. Performance varied in most subgroups, particularly patients with obesity, renal impairment, or previous heart failure. CoDE-HF was well calibrated, with excellent discrimination in patients with and without previous heart failure (area under the receiver operator curve 0.846 (0.830 to 0.862) and 0.925 (0.919 to 0.932) and Brier scores of 0.130 and 0.099, respectively). In patients without previous heart failure, the diagnostic performance was consistent across all subgroups, with 40.3% (2502/6208) identified at low probability (negative predictive value of 98.6%, 97.8% to 99.1%) and 28.0% (1737/6208) at high probability (positive predictive value of 75.0%, 65.7% to 82.5%) of having acute heart failure. CONCLUSIONS In an international, collaborative evaluation of the diagnostic performance of NT-proBNP, guideline recommended thresholds to diagnose acute heart failure varied substantially in important patient subgroups. The CoDE-HF decision support tool incorporating NT-proBNP as a continuous measure and other clinical variables provides a more consistent, accurate, and individualised approach. STUDY REGISTRATION PROSPERO CRD42019159407.

Background B-type natriuretic peptide (BNP) and mid-regional pro-atrial natriuretic peptide (MRproANP) testing are recommended to aid in the diagnosis of acute heart failure. However, the application of these biomarkers for optimal diagnostic performance is uncertain. Methods We performed a systematic review and harmonised individual patient-level data to evaluate the diagnostic performance of BNP and MRproANP for the diagnosis of acute heart failure using random-effects meta-analysis. We subsequently developed and externally validated a decision-support tool called CoDE-HF for both BNP and MRproANP that combines the natriuretic peptide concentrations with clinical variables using machine learning to report the probability of acute heart failure for an individual patient. Results Fourteen studies from 12 countries provided individual patient-level data in 8,493 patients for BNP and 3,847 patients for MRproANP, in whom, 48.3% (4,105/8,493) and 41.3% (1,611/3899) had an adjudicated diagnosis of acute heart failure, respectively. The negative and positive predictive values of guideline-recommended thresholds for BNP (100 pg/mL) and MR-proANP (120 pg/mL) were 93.6% (95% confidence interval 88.4–96.6%) and 68.8% (62.9–74.2%), and 95.6% (92.2–97.6%) and 64.8% (56.3–72.5%), respectively. However, we observed significant heterogeneity in the diagnostic performance across important patient subgroups (Figure 1). In the external validation cohort, CoDE-HF was well calibrated with excellent discrimination in those without prior acute heart failure for both BNP and MRproANP (area under the curve of 0.946 [0.933–0.958] and 0.943 [0.921–0.964], and Brier scores of 0.105 and 0.073, respectively). CoDE-HF performed consistently across all subgroups for both BNP and MRproANP, and identified 30% and 65.7% at low-probability (negative predictive value of 99.1% [98.8–99.3%] and 99.1% [98.8–99.4%]), and 30% and 17.3% at high-probability (positive predictive value of 91.3% [90.7–91.9%] and 70.0% [68.5–71.4%]) in those without prior heart failure, respectively (Figure 2). Conclusion In an international collaborative analysis, we observed that guideline-recommended thresholds for BNP and MRproANP to diagnose acute heart failure varied significantly across patient subgroups. A decision-support tool using machine learning to combine natriuretic peptides as a continuous measure and other clinical variables provides a more accurate and individualised approach. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): Medical Research Council and British Heart Foundation Figure 1. NPV of BNP threshold (100 pg/mL)Figure 2. NPV of the CoDE-HF rule-out score

Background In recent years, there has been a growing interest in developing methods based on health administrative databases to estimate prevalence of chronic diseases, hoping that this would lead to more precise and reliable estimates. The capture-recapture method can be used to improve the prevalence of a disease reducing the bias of case underestimation. Objective To assess the prevalence of multiple sclerosis (MS) in the Liguria region in Italy using routinely collected healthcare data. Methods Data from three sources collected in Liguria Health Authority (A.Li.Sa.) databases - hospital discharge records, drug-dispensing records, disease-specific payment exemptions from copayment to health care - and a capture-recapture method with log-linear models were used to estimate the prevalence of MS. The accuracy of the case-finding algorithm was tested using a sample of people residents in Liguria Region with a definite diagnosis of MS extracted from clinical records of Liguria AISM Rehabilitation Service as reference standard. Results The case-finding algorithm to capture people with MS from routinely collected healthcare data used in our study found an observed crude prevalence of MS in Liguria region on 31 December 2017, of 202.4 cases per 100,000 inhabitants (95% CI: 195.3-209.5). After linkage to clinical data, the algorithm showed a sensitivity of 82.7%, with 22.1% of MS cases undetected on capture-recapture models. Consequently, the capture-recapture method prevalence estimate of 259.7 per 100,000 inhabitants (95% CI: 251.7-267.8) suggest that this region constitutes a high-risk area for MS. Conclusions Our initial study of crude MS prevalence showed an overall regional prevalence of MS of 202.4 cases per 100,000, capture-recapture analysis would add another 20%, to those figures. This method could be considered a good alternative to the population-based study design for estimating the prevalence of MS. Key messages Studies based on routinely collected healthcare data could help estimate the prevalence of chronic disease. To reduce the bias of case underestimation, the capture–recapture method can be useful.

In medicine, the awareness of reducing medication errors and risk situations for patients has increased in recent years, due to different driving forces such as patient advocate movements, and quality management strategies of health centers and regulatory bodies. However, this awareness should be reflected in the integration of strategies to prevent errors and risks by training medical students, residents, and specialists in patient safety principles. The inclusion of technologies for tridimensional visualization, such as virtual reality enables the development of innovative training proposals that contribute to a patient safety culture. The objective of this project was to design a virtual reality environment for the training on patient safety culture by triangulating the perspectives of teachers, the hospital, and the school of medicine. The development consisted of the phases of planning, design, and implementation. Planning referred to the development of learning objectives and conceptualization of scenarios. The design consisted of the technical exploration of the different tools, and the iteration on the generation of a working prototype. As a result, a virtual setting was developed for medical students to familiarize themselves and understand the environment and the processes of quality care. The reported experience proposes key elements for new developers to consider, the link to the needs of the organization, and the technical feasibility of the systems that are now available in the market. Keywords: higher education, educational innovation, educational technology, virtual reality, medical education, patient safety

Background: We conducted a population-based cohort study to estimate mortality before, during and after the COVID-19 peak and to compare mortality in 2020 with rates reported in previous years, with a view to helping decision makers to apply containment measures for high-risk groups. Methods: All deaths were collected between 2015 and 2020 from municipal registry database. In 2020, weeks 1-26 were stratified in three periods: before, during and after the COVID mortality peak. The Poisson Generalized Linear regression Model showed the ���harvesting effect���. Three logistic regressions for 8 dependent variables (age and comorbidities) and a t-test of differences described all-cause mortality risk factors in 2019 and 2020 and differences between COVID and non-COVID patients. Results: A total of 47,876 deaths were collected. All-cause deaths increased by 38.5% during the COVID peak and decreased by 18% during the post-peak period in comparison with the average registered during the control period (2015-19), with significant mortality displacement in 2020. Except for chronic renal injuries in subjects aged 45-64 years, diabetes and chronic cardiovascular diseases in those aged 65-84 years, and neuropathies in those aged >84 years, the weight of comorbidities in deaths was similar or lower in COVID subjects than in non-COVID subjects. Discussions: Surprisingly, the weight of comorbidities in death, compared to weight in non-COVID subjects allows you to highlight some surprising results such as COPD, IBD and Cancer. The excess mortality that we observed in the entire period were modest in comparison with initial estimates during the peak, owing to the mild influenza season and the harvesting effect starting from the second half of May., Journal of Preventive Medicine and Hygiene, Vol. 62 No. 4 (2021): 2021624

We compute the “norm” of irreducible uniformly bounded representations of SL ( 2 , R ) . We show that the Kunze–Stein version of the uniformly bounded representations has minimal norm in its similarity class of uniformly bounded representations.

Breast cancer is the most common tumor in middle-aged and older women. In 2003, the European Parliament recommended to Member States that all women with breast cancer should be treated by a multidisciplinary team and that a network of certified breast centers be organized (the centers have been called Breast Units (BUs)). With the present study, we aim to explore the impact of the introduction of the BU organizational model in the Liguria region, Italy, through different outcome indicators. An explorative retrospective analysis was conducted through the period from 2013 to 2019 to assess the impact of the introduction of the BU model in our region. We identified two periods: before (2014–2015) and after (2017–2018) the introduction of this organizational model to assess its value impact through the definition of six measurable outcome indicators. Length of hospitalization, repeated specialist outpatient diagnostic procedures and the rate of subjects who started radiotherapy treatment within 60 days improved after the introduction of BUs. The passive health migration rate only improved significantly for one local health unit (LHU), while reintervention and diagnosis–surgery time did not show any enhancement after the introduction of the BU model. The BU model seems to provide an increase in several aspects of the healthcare offered to breast cancer patients in Liguria, specifically in those areas where a shared guideline could assist healthcare workers. Future research, such as pilot studies, are needed to assess the impact of the introduction of the BU model in our reality.

Los Objetivos de Desarrollo Sostenible (ODS) de la Organización de las Naciones Unidas (ONU)tienen como propósito crear un conjunto de objetivos mundiales relacionados con desafíosambientales, políticos y económicos, haciendo frente a la pobreza extrema y el hambre, entreotros, como prioridades del desarrollo. Los ODS son un llamado urgente para que el mundohaga la transición a una senda más sostenible.Sobre el desarrollo sostenible o sustentable se puede decir en líneas generales que es aqueldonde el desarrollo de la generación presente satisface sus necesidades sin limitar a lasgeneraciones futuras para que también puedan satisfacer sus necesidades.En el presente trabajo, se desarrolla una evaluación integral de los procesos de desarrollosostenible, desde una mirada estatal y desde la perspectiva de organizaciones internacionalescomo el PNUD. De este modo, se trata de una indagación profunda sobre patrones de bioética The Sustainable Development Goals (SDG) of the United Nations (UN) are intended to create aset of global objectives related to environmental, political and economic challenges, addressingextreme poverty and hunger, among others, as development priorities. The SDG’s are an urgentcall for the world to make the transition to a more sustainable path.About the sustainable or sustainable development can be said in general lines that is where thedevelopment of the present generation meets their needs without limiting future generations sothat they can also meet their needs.In the present work, a comprehensive evaluation of sustainable development processes isdeveloped, from a state perspective and from the perspective of international organizationssuch as the PNUD. In this way, it is a deep inquiry about bioethics patterns.

We describe clinical and laboratory findings in 35 consecutive patients tested positive for SARS-CoV-2 by reverse transcriptase-polymerase chain reaction on nasopharyngeal swab that presented one or multiple syncopal events at disease onset. Neurological examination and electrocardiographic findings were normal. Chest computed tomography showed findings consistent with interstitial pneumonia. Arterial blood gas analysis showed low pO2, pCO2, and P/F ratio indicating hypocapnic hypoxemia, while patients did not show the expected compensatory heart rate increase. Such mechanism could have led to syncope. We speculate that SARS-CoV-2 could have caused angiotensin-converting enzyme-2 (ACE2) receptor internalization in the nucleus of the solitary tract (NTS), thus altering the baroreflex response and inhibiting the compensatory tachycardia during acute hypocapnic hypoxemia.

The present article describes an educative intervention with the purpose of increasing self care abilities in a group of geriatric citizens in Puente Alto. The themes addressed include: management of decompensation of glycemia and blood pressure, first aid techniques, and exercises to prevent physical and cognitive deterioration. Methods: This study had a mixedmethods approach. The nursing research methods used were: Anderson and McFarlane’s Community as a Partner model, which focuses in the assessment of the core and environment, as well as the nursing process; and Jean Vella’s dialogue education model, in which the community has the leading role in their learning process through participatory methodologies. Implementation of the educative intervention included four 60 minute sessions and one 90 minute session. Results: In the last session guidelines were applied to assess the community's knowledge, in which an 87% achievement was obtained in contrast to the 67% achievement expected. Regarding the external effects, it is important to emphasize that the participants related to pass on the knowledge and abilities learnt on the session within their social circles, since most of them were representatives of senior citizens clubs. Conclusion: Due to the implementation of participatory methodologies focused on the community that were centered in their context, an effective learning was achieved, and this strengthened their self care agency. Key words: , ,, , ,, .

According to WHO estimates, varicella disease is responsible of a worldwide significant burden in terms of hospitalizations, complications, and deaths, with more than 90% of cases under 12 years old. This study aims at evaluating the clinical, epidemiological, and economic burden of varicella in Ligurian children, about comorbidities, organizational variables, and vaccination coverages from 2010 to 2017, in terms of Emergency Department accesses and hospitalizations. The overall hospitalization rate was 179.76 (per 100,000 inhab.), with a gradual but significant decline since 2015, when universal varicella vaccination was introduced in Liguria (p < 0.0001). The risk of being hospitalized for complicated varicella in subjects with at least one comorbidity was significantly higher than in subjects without comorbidities (p = 0.0016). The economic analysis showed higher costs in subjects with complicated varicella who were 0–3 years old. This age group showed higher costs also considering extra-hospital costs for both outpatient procedures and pharmaceutical costs (p < 0.0001). The results confirm the relevant burden of varicella, especially in the 0–3 age group and in children with comorbidities. Thus, vaccination with the achievement of adequate vaccination coverages is confirmed to be a necessary control strategy to reduce hospitalizations and associated complications with important economic benefits.

Background: While the association between anxiety and postpartum depression is well known, few studies have investigated the relationship between these two states and parenting stress. Furthermore, a number of studies have found that postpartum depression affects mother-infant emotion regulation, but there has been only one study on anxiety and emotion regulation and no studies at all on parenting stress and emotion regulation. Therefore, the primary aim of our study is to identify, in a community sample of 71 mothers, the relationship between maternal depression, anxiety, and parenting stress. The second aim is to examine the relationship between anxiety, postpartum depression, and parenting stress and mother-infant emotion regulation assessed at 3 months. Methods: Mother-infant interaction was coded with a modified version of the Infant Caregiver and Engagement Phases (ICEP) using a microanalytic approach. The Edinburgh Postnatal Depression Scale (EPDS), State-Trait Anxiety Inventory (STAI), and Parenting Stress Index-Short Form (PSI-SF) were administered to the mothers to assess depression, anxiety, and parenting stress, respectively. Results: Analysis revealed correlations between anxiety and depression, showing that parenting stress is associated with both states. In a laboratory observation, depression was correlated with both negative maternal states and negative dyadic matches as well as infant positive/mother negative mismatches; anxiety was correlated with both negative maternal states and infant negative states as well as mismatches involving one of the partners having a negative state. Multiple regression analysis showed that anxiety is a greater predictor than depression of less adequate styles of mother-infant emotion regulation. Parenting stress was not shown to predict such regulation.

This systematic review and meta-analysis aimed at summarizing available data on the impact of PCV10 and PCV13 in reducing the incidence of CAP hospitalizations in children aged5years.A systematic search of the literature was conducted. We included time-series analyses and before-after studies, reporting the incidence of hospitalization for pneumonia in the periods before and after the introduction of PCV10 or PCV13 into the immunization program. Pooled estimates of Incidence Rate Ratio (IRR) were calculated by using a random-effects meta-analytic model. Results were stratified according to age-groups (24months and 24-59months) and case definitions of pneumonia (clinically and radiologically confirmed pneumonia).A total of 1533 potentially relevant articles were identified. Of these, 12 articles were included in the analysis. In children aged24months, the meta-analysis showed a reduction of 17% (95%CI: 11-22%, p-value0.001) an of 31% (95%CI: 26-35%, p-value0.001) in the hospitalization rates respectively for clinically and radiologically confirmed pneumonia, respectively, after the introduction of the novel PCVs. In children aged 24-59months, the meta-analysis showed a reduction of 9% (95%CI: 5-14%, p-value0.001) and of 24% (95%CI: 12-33%, p-value0.001) in the hospitalization rates for clinically and radiologically confirmed pneumonia, respectively, after the introduction of the novel PCVs. High heterogeneity was detected among studies evaluating the hospitalization rate for clinically and radiologically confirmed pneumonia.The results of this study revealed a significant impact of PCV10 and PCV13 in reducing the hospitalizations for pneumonia, particularly in children aged24months and for radiologically confirmed disease. Further appropriately designed studies, comparing the impact of PCV10 and PCV13, are needed in order to obtain solid data on which to establish future immunization strategies.

Introduction Despite recent improvements in management, infective endocarditis remains associated with high morbidity and mortality. Over the last few decades, several factors have impacted on both the incidence and outcomes following infective endocarditis. Purpose Using a national linkage approach, we describe the changing age- and sex-stratified incidence and outcomes of infective endocarditis in Scotland over the last 25 years. Methods We conducted a consecutive retrospective individual patient linkage study across multiple national databases. Using data extracted from the Scottish hospital discharge dataset held by the Information Services Division of NHS National Services Scotland, we extracted episodes for all patients aged 20 years or older who were admitted with infective endocarditis between January 1, 1990, and December 31, 2014 in Scotland, UK. Patient episodes with infective endocarditis were linked to national prescribing and microbiology databases. The primary outcome was 1-year mortality following the index presentation. Generalised additive models were constructed to estimate the crude and age- and sex-stratified incidence rates (using a poison distribution) as well as trends in mortality (using a binomial distribution) adjusted for age, sex and comorbidity. Results Across 12,446 individual patients, there were a total of 12,667 hospitalisations (mean age 68±17 years, 55% females) with infective endocarditis using a 5-year look back period. The estimated crude rate of hospitalisation increased from 7.38 per 100,000 (95% CI 6.58 to 8.28) in 1990 to 15.09 per 100,000 (95% CI 13.90 to 16.39) in 2014 (p Conclusions Despite the crude incidence of infective endocarditis doubling over the last 25 years and case fatality remaining high, the risk of death has markedly fallen over the last two decades. Staphylococcus cultures remain an independent marker of poor prognosis in this cohort. Acknowledgement/Funding British Heart Foundation

Introduction Cardiac arrest is a major healthcare burden; survival has historically been poor. Contemporary therapies have been associated with improvements in out-of-hospital cardiac arrest survival in other healthcare systems. Purpose To determine temporal trends and predictors of 30-day and overall survival in patients with cardiac arrest who survive to hospital admission in Scotland. Methods We conducted a consecutive individual patient linkage study using data from the Scottish Morbidity Records held by the Information Services Division, National Health Service Scotland. We identified all patients who had an index cardiac arrest hospitalisation from 1st January 1990 to 31st December 2014. The primary outcome was 30-day mortality. Generalised additive models were used to estimate temporal trends. Year of admission was the primary explanatory variable, adjusted for age, sex, comorbidities (stroke, myocardial infarction, heart failure), Scottish Index of Multiple Deprivation (SIMD, a national deprivation score), and angiography within 30 days of admission. Cox regression models were constructed for overall mortality, adjusting for the above variables. Results In total, 47,692 patients had an index hospitalisation with cardiac arrest in Scotland between 1990 and 2014. The mean age was 69±16 years; 45% (n=21,257) were female. Most patients (n=24,867, 52.4%) were in top two SIMD quintiles (greater deprivation). Incidence was lowest in 1990 (27 per 100,000 population), rising until 1998 (47 per 100,000) before declining (mean 30 per 100,000 for 2010–2014) (Figure 1A). Overall rates of angiography and PCI at 30 days were low (5.4% and 3.1% respectively), albeit higher in more recent years (14.1% and 9.6% respectively for 2010–2014). Thirty-day mortality was high but decreased over time (73.7% from 1990–1994 to 63.1% from 2010–2014, p Temporal trends in cardiac arrest Conclusions Hospital episodes with cardiac arrest in Scotland peaked in the late 1990s and have since fallen. Thirty-day mortality remains high, with an improvement over time that is independent of baseline patient characteristics.

Marchi et al. in their article (Measles in pregnancy: a threat for Italian women? Hum Vaccin Immunother. 2019 Jun 20:1–3) observed that 96.9% of pregnant women were positive for anti-measles IgG (with a higher risk of contracting measles in those aged 19–29 years) emphasizing the importance of serological screening before pregnancy. We evaluated seroprotection/seropositivity rates to Measles, Mumps and Rubella in 324 adults with an acquired immune-deficiency needing an immunization program. We found that younger patients (20–29 years) had a seroprevalence below 85%. Overall, a relevant proportion (21.6%, 54/250) of patients was susceptible to at least one infection needing immunization. Our results confirm the usefulness of proper strategies for identifying individuals susceptible to vaccine-preventable infections and protecting them through vaccination.

This paper examines the first publicly documented western encounter with the ancient city of Palmyra as an archaeological site. This encounter was achieved in the late seventeenth century by a group of British merchants, who reached Palmyra and made drawings and reports of its ruins. The reports were then published in Philosophical Transactions in the mid 1690s. This paper points to the ways in which such accounts came into being, as well as how the city was described and publicly communicated for the first time in Philosophical Transactions. These articles had a great impact throughout the following centuries as a reference for the study of Palmyra. This paper therefore also stresses the pivotal role of Philosophical Transactions for the production and dissemination of Palmyra's archaeological legacy, as well as for the development of early modern archaeology within the early Royal Society.

Zircon LA-ICP-MS and CA-TIMS and molybdenite Re-Os geochronology for the El Abra porphyry copper deposit (Chile) document a ~8.6 Ma protracted magmatic-hydrothermal history. Initial magmatic events occurred at ~45 Ma, and continued to ~36 Ma. An ~1.8 m.y. magmatic lull is recorded in the early stages of magmatism, which is characterized by equigranular rocks from the Pajonal suite. Magmatism from ~41 to ~36 Ma, corresponding to the El Abra Granodiorite Complex, is more recurrent, ending in a ~1.4 m.y. period of porphyritic intrusions, which are coeval with Cu-Mo mineralization. Late porphyritic units reveal subtle zircon inheritance likely associated with early magmatic pulses. The young stages of magmatism indicate system rejuvenation based on plagioclase phenocryst compositions, suggesting that the porphyry system is ultimately linked to a less evolved magma. Although there are multiple porphyry and veining events, molybdenite Re-Os ages define a focused mineralization episode from 36.34 to 36.18 Ma. Molybdenite Re-Os ages from nearby related prospects belonging to the El Abra cluster expand the mineralization period in the district up to ~1.0 m.y., suggesting a multistage, long-lived hydrothermal system. Integration of the molybdenite Re-Os dates and those from previous works at the El Abra and Toki clusters, accompanied by available tectonic reconstruction along the Domeyko fault system suggest the development, by late Eocene times, of a single, large (~30 km across) porphyry copper cluster, which was subsequently separated by an offset of ~35 km along the West fault.

Let δ be the Jacobi Laplacian. We study the chaotic and hypercyclic behaviour of the strongly continuous semigroups of operators generated by perturbations of δ with a multiple of the identity on L p spaces. © 2012 Elsevier Inc.

We prove that Huygens’ principle and the principle of equipartition of energy hold for the modified wave equation on odd dimensional Damek–Ricci spaces. We also prove a Paley–Wiener type theorem for the inverse of the Helgason Fourier transform on Damek–Ricci spaces.

We prove several Paley–Wiener-type theorems related to the spherical transform on the Gelfand pair $$\big ({H_n}\rtimes {\text {U}(n)},{\text {U}(n)}\big )$$ , where $${H_n}$$ is the $$2n+1$$ -dimensional Heisenberg group. Adopting the standard realization of the Gelfand spectrum as the Heisenberg fan in $$\mathbb {R}^2$$ , we prove that spherical transforms of $${\text {U}(n)}$$ -invariant functions and distributions with compact support in $${H_n}$$ admit unique entire extensions to $$\mathbb {C}^2$$ , and we find real-variable characterizations of such transforms. Next, we characterize the inverse spherical transforms of compactly supported functions and distributions on the fan, giving analogous characterizations.

The objectives of this study were to assess the influence of weight-bearing on tibiofemoral osteoarthritis, including medial meniscal extrusion, by using a low-field (0.25 T) rotating clino-orthostatic permanent-magnet magnetic resonance (MR) scanner, and to analyse correlations of medial meniscal extrusion with the patient’s Kellgren–Lawrence score, body mass index, and all the osteoarthritis features of the WORMS scoring system. Twenty-six patients (69.2 % women and 30.8 % men; mean age 67 ± 9.7 years) with medial tibiofemoral knee osteoarthritis were prospectively enrolled and MR sequences were acquired in both clino- and orthostatic position. MR images were assessed by two independent radiologists, according to the WORMS scale. Medial meniscal extrusion was measured and its clino-orthostatic difference (∆MME) was calculated. Intra- and inter-observer agreement of the WORMS Global Score readings was high by Cohen’s K test (>0.81). No significant clino-orthostatic changes in the scoring parameters of the medial tibiofemoral joint were shown by Wilcoxon’s test. Medial meniscal extrusion measured on orthostatic images was significantly higher than that measured in clinostatic position (p

The topic of appropriateness was defined as the new frontier of development of health interventions. RH Brook in an Editorial published in the BMJ in 1994 defines the appropriateness "… an intervention for which the expected benefits are greater (with a sufficient margin) the possible negative consequences … excluding economic considerations". In workplaces the goal of appropriateness should cover not only the actions of health surveillance and health protocols, but also and primarily all stages of the risk assessment process.Only through an assessment of occupational risks that aims to identify, evaluate and measure the real professional risk factors in specific working environments, it is possible to meet the requirements of effectiveness, efficiency and protection of ethical principles in the identification of priorities (according to values of person, community and society) that represent the size of the appropriateness of an intervention. At the same time, the risk assessment should provide to the occupational pyisician instruments to study with scientific, justifiable and reproducible criteria the possible correlation between damage to the worker's health and the occupational risk factors.In the process of reporting of suspected technopathy, both for prevention purposes (according to art. 139 of Presidential Decree 1165/68, art. 10 of Legislative Decree 38/00 and DM 10 June 2014), both for insurance purposes (according to art. 53 of Presidential Decree 1165/68 and Ministerial Decree 9 April 2008), it should be considered two indispensable judgment elements to study the correlation between the disease and the work: on the one hand the level (measured or estimated) of the occupational risk factors; on the other hand the appropriateness of the risks assessment compared to the best and most current scientific evidence (Evidence Based Medicine - EBM), according to technical standards and specific guidelines.Our study underlines the importance of appropriateness in the risk assessment process to analyze the correlation between the exposure to specific occupational hazards and the suspected technopathy.Il tema dell’appropriatezza è stato definito come la nuova frontiera dello sviluppo degli interventi sanitari. RH Brook in un Editoriale pubblicato sul BMJ nel 1994 definisce l’appropriatezza “…un intervento i cui benefici attesi siano superiori (con un sufficiente margine) alle eventuali conseguenze negative…escludendo considerazioni di ordine economico”. In ambito occupazionale l’obiettivo dell’appropriatezza deve riguardare non solo gli interventi di sorveglianza sanitaria e di definizione dei protocolli sanitari, ma anche e prioritariamente tutte le fasi del processo di valutazione dei rischi. Solo attraverso una valutazione dei rischi occupazionali che miri a individuare, studiare, misurare e “dimensionare” rispetto allo stato di salute dei lavoratori esposti, i reali fattori professionali di rischio presenti negli specifici contesti lavorativi, è possibile da un lato rispondere ai requisiti di efficacia, efficienza e salvaguardia dei principi etici nella individuazione delle priorità (secondo valori di individuo, comunità e società) che rappresentano le dimensioni dell’appropriatezza di un intervento, dall’altro fornire al medico competente lo strumento per studiare e valutare con criteri scientifici, giustificabili e riproducibili la possibile correlazione fra l’alterazione dello stato di salute del lavoratore e gli stessi fattori occupazionali di rischio. Nel processo di segnalazione della malattia di sospetta origine professionale, sia ai fini prevenzionali (ai sensi dell’art. 139 del DPR 1165/68, dell’art.10 del D.Lgs 38/00 e del DM 10 giugno 2014), sia ai fini assicurativi (ai sensi dell’art. 53 del DPR 1165/68, e del DM 9 aprile 2008), un importante elemento di criticità è rappresentato dal fatto che non vengono richiesti due elementi di giudizio indispensabili per studiare secondo criteri scientifici e oggettivi la correlazione fra malattia e lavoro: da un lato il livello (misurato o stimato) dei fattori occupazionali di rischio causali della sospetta tecnopatia, dall’altro l’appropriatezza della stessa valutazione dei rischi specifici rispetto alle migliori e più attuali evidenze scientifiche e prove di efficacia (Evidence Based Medicine - EBM), con particolare riferimento a norme tecniche e linee guida specifiche. Il nostro studio vuole sottolineare l’importanza della appropriatezza (e del “grado” di appropriatezza) nel processo di valutazione dei rischi, nonché ribadire il ruolo insostituibile della stessa valutazione per il medico competente nel processo di analisi della correlazione fra l’esposizione a specifici fattori occupazionali di rischio e la comparsa di tecnopatia.

We prove that a Damek–Ricci space is symmetric if and only if the geodesic inversion preserves the set of horocycles.

Liberte de religion crucifiee? Laicite et ecoles italiennes devant la Cour europeenne des droits de l’hommeCet article explore la question de l’exposition obligatoire du crucifix dans l’ecole publique italienne, une matiere qui est reglee par des dispositions datant des annees 1920. La jurisprudence italienne sur cette question est contradictoire et a plusieurs reprises la Cour constitutionnelle a refuse de prendre position sur le sujet. La decision de la Cour europeenne des droits de l’homme dans l’affaire Lautsi a mis fin a une odyssee judiciaire de quelque neuf ans sur la presence des crucifix dans les ecoles italiennes. Selon la Cour, toute decision a ce sujet appartient a chaque Etat europeen. Ce faisant la Cour a renonce a jouer un role universaliste en faveur des systemes constitutionnels nationaux. Cependant, plusieurs questions restent ouvertes pour l’Italie: notamment la place des signes religieux dans les espaces publics, leur relation avec les notions d’une societe democratique, pluraliste et laique et les limites aux libertes de religion et de la religion tant a niveau individuel que collectif.

Objective Coarctation of the aorta (CoA) is a common condition. Adult patients with newly diagnosed CoA and patients with recurring or residual CoA require evaluation of the severity of aortic obstruction. Cardiac catheterization is considered the gold standard for the evaluation of hemodynamically significant CoA. The European Society of Cardiology (ESC) Guidelines for the management of grown-up congenital heart disease (GUCH) include noninvasive criteria for identifying significant CoA. Our aim was to investigate the ability of the Class I and Class IIa ESC recommendations to identify significant CoA at cardiac catheterization. Design Sixty-six adult patients with native or recurrent CoA underwent diagnostic cardiac catheterization at the GUCH unit at the Sahlgrenska University Hospital in Gothenburg from October 1998 to November 2013. Clinical and imaging data, as well as data about cardiac catheterization were retrospectively collected from patient records. Results The Class I ESC recommendations predicted significant CoA with a sensitivity of 0.57, a specificity of 0.63, a positive predictive value of 0.67, and a negative predictive value of 0.53. The combination of Class I and Class IIa recommendations predicted significant CoA with a sensitivity of 0.75, a specificity of 0.42, a positive predictive value of 0.66 and a negative predictive value of 0.52. Conclusions the noninvasive criteria proposed by the ESC guidelines to identify subjects with significant CoA performed poorly in our dataset. Further research is needed to develop more accurate, noninvasive criteria to evaluate CoA severity and thereby reduce the number of unnecessary cardiac catheterizations.

We prove several Paley–Wiener-type theorems related to the spherical transform on the Gelfand pair $$\big ({H_n}\rtimes {\text {U}(n)},{\text {U}(n)}\big )$$(Hn⋊U(n),U(n)), where $${H_n}$$Hn is the $$2n+1$$2n+1-dimensional Heisenberg group. Adopting the standard realization of the Gelfand spectrum as the Heisenberg fan in $$\mathbb {R}^2$$R2, we prove that spherical transforms of $${\text {U}(n)}$$U(n)-invariant functions and distributions with compact support in $${H_n}$$Hn admit unique entire extensions to $$\mathbb {C}^2$$C2, and we find real-variable characterizations of such transforms. Next, we characterize the inverse spherical transforms of compactly supported functions and distributions on the fan, giving analogous characterizations.

The aim of this study was to characterize total and specific IgE distribution in postmortem serum as well as pericardial and cerebrospinal fluid samples and evaluate the diagnostic usefulness of total and specific IgE determination in pericardial and cerebrospinal fluids in the forensic setting. Three groups were investigated (non-allergic deaths in non-atopic individuals, fatal allergic anaphylaxis deaths and non-allergic deaths in individuals without medical records). In the first group (non-allergic deaths in non-atopic individuals), total IgE concentrations in postmortem serum from femoral blood, pericardial and cerebrospinal fluids were lower than 40, 32 and 11kU/l, respectively. No specific IgE were identified in any of the sampled fluids. In the second group (fatal allergic anaphylaxis deaths), total IgE concentrations in postmortem serum from femoral blood ranged from 139kU/l to 818kU/l, in pericardial fluid from 89kU/l to 622kU/l and in cerebrospinal fluid from 4kU/l to 11kU/l. A positive Phadiatop® test and specific IgE antibodies >0.35kU/l were found exclusively in postmortem serum from femoral blood and pericardial fluid. In the third group (non-allergic deaths in individuals without medical records, possibly including atopic individuals), total IgE concentrations ranged from 42kU/l to 516kU/l in postmortem serum from femoral blood, from 34kU/l to 417kU/l in pericardial fluid and from 3kU/l to 12kU/l in cerebrospinal fluid. A positive Phadiatop® test and specific IgE antibodies >0.35kU/l were found exclusively in postmortem serum from femoral blood and pericardial fluid. These results seem to suggest that total and specific IgE may be measured in postmortem serum from femoral blood and pericardial fluid to estimate total and specific IgE titers at the time of death. Conversely, cerebrospinal fluid total and specific IgE measurement in suspected IgE mediated fatal anaphylaxis cases is of no value for diagnostic purposes.

Let N be an H-type group of homogeneous dimension e. We study the space of biradial Schwartz functions on N by means of the Gelfand transform. This enables us to characterize the class of biradial homogeneous distributions on N of degree alpha, with 0 less than or equal to alpha < Q, which are C-infinity away from the identity, via the Gelfand transform

Background: All over Europe, an increased use of public health services has been noticed, particularly referring to access and hospitalization among elderly in the emergency department (ED). Methods: Prospective study at a university teaching hospital in Turin, northern Italy, recruiting subjects aged >65 years consecutively attending the medical ED during 1 month. Demography, functional and cognitive status, comorbidity, severity of acute critical illness, previous ED accesses and hospitalization, diagnosis and other relevant data for ED admission and hospitalization were considered. Results: Data were collected for 1632 patients (average age 77.6 years), 89% of the 1834 older subjects who attended the ED during the study period (29.3% of the patients attending the ED). Six hundred and fifty older subjects were admitted to the hospital (62.2% of the hospital admissions). Severity of acute critical illness, presence of chronic obstructive pulmonary disease and heart failure, a high number of drugs being taken, functional dependence and advanced age were independently associated with hospital admission. One-third of the patients appeared to be frequent users of health services with more than two visits/admissions. Higher comorbidity, partial or complete functional dependence, chronic diseases (arrhythmia, pulmonary neoplasm, diseases of the large intestine) and politherapy were associated either with frequent use of the ED and multiple admissions. Conclusions: Elderly account for a high proportion of hospitalizations, mainly determined by critical health conditions, advanced age and functional dependence. Poor health conditions (high comorbidity and presence of chronic multi-organ diseases), functional dependence but not critical social factors were the main determinants of multiple hospital admissions.

Background: Blood pressure (BP) variations occurring after hospital discharge in a population of older hypertensives have not been previously investigated. Design: elderly (≥65 years) hypertensives admitted to the geriatric acute ward of a university-teaching hospital were enrolled in this prospective observational study. Methods: Exclusion criteria were terminal illness, discharge to institution, and changes in antihypertensive regimen. BP was recorded in the emergency room, at ward admission, daily during hospital stay, and at discharge. Home self blood pressure measurement was performed after discharge. Results: The study population included 106 patients. There was a significant decrease in systolic BP (SBP) and diastolic BP (DBP) throughout the study time points. SBP and DBP decreased after discharge (from 135.1 ± 15.0 to 131.5 ± 16.1 mmHg and from 77.2 ± 8.4 to 71.6 ± 8.7 mmHg, respectively), the difference being significant only for DBP ( p = 0.000). We further observed higher prevalence of critically low BP values (SBP Conclusions: We observed a decrease in BP values, and particularly DBP values, after hospital discharge, in a sample of older hypertensives. Critically low BP values were observed at home in a high proportion of subjects, suggesting wise use of antihypertensive therapy at discharge and early monitoring of BP values at home.

El objetivo fue estimar una función de producción que describa la relación que guarda la producción y los factores productivos de leche, en el sistema bovinos doble propósito en el municipio de Ahome, Sinaloa. Con información de 74 unidades de producción se estimó una función de producción de tipo Cobb Douglas. El modelo obtenido fue Y=0.78. De las tres variables analizadas, solo la superficie agrícola y el número de vacas adultas fueron significativas (P

Physical activity is effective in primary and secondary prevention of cardiovascular disease. In this study, we tested the hypothesis that exercise training improves glucose and lipid metabolism, the inflammatory/anti-inflammatory balance, and the outcome of elective percutaneous coronary intervention (PCI) in patients with stable coronary disease.Sixty-two patients scheduled to undergo PCI for stable angina were randomized to intensive physical activity (n=33) consisting of home-based exercise on a bicycle ergometer or maintain their usual sedentary life (n=29). The training program started 2 months before PCI and terminated 6 months afterwards. Clinical examination, blood sampling (fasting glucose, glycated hemoglobin, lipid profile, apolipoprotein B, apolipoprotein A1, C-reactive protein, serum amyloid A, interleukin-6, interleukin-8, and interleukin-10), and maximal exercise tests were performed at inclusion, 1 week before PCI, and 3 and 6 months afterwards.Fifty-six patients [28 per group, 45 men, mean age 63 (SD 7.8) years] completed the follow-up. According to self-reports, patients in the training group exercised more often and longer [4.9 (SD 1.1) vs. 0.6 (SD 1.3) days/week, 36 (SD 12) vs. 15 (SD 31) min/session, P0.0001]. Improvement in maximal exercise capacity was significantly better in the training group [27 (SD 27) vs. 9 (SD 27) W, P=0.02]. Exercise had no significant effects on glucose and lipid metabolism, plasma cytokines, or acute-phase reactants.A home-based training program significantly improved maximal exercise capacity but did not affect glucose or lipid metabolism or markers of inflammation.

Most strategies for delirium prevention in older hospitalized patients are common good clinical geriatric care. We investigated whether acute geriatric ward (AGW) hospitalization, compared with acute general medical ward (AGMW) hospitalization,is associated with reduced incident delirium in older medical inpatients.prospective observational study.a tertiary care, university hospital in Torino.consecutive medical patients 70 years or older admitted from the emergency department to an AGW and to an AGMW were included.Baseline measures included demography, functional and psychocognitive status, comorbidity, physiological and clinical severity of acute illness. Incident delirium was evaluated by qualified psychiatrists according to the Confusion Assessment Method and the Delirium Rating Scale.Delirium occurred in 8 of 121 patients admitted to AGW (6.6%) and in 20 of 131 patients admitted to AGMW (15.2%). After adjustment for significant differences in baseline covariates between groups, AGW hospitalization remained independently associated with less incident delirium (relative risk 0.90, 95% confidence interval: 0.024-0.331, p0.001). In a multivariable logistic model with delirium incidence as independent variable, AGW hospitalization was independently associated with lower delirium incidence (relative risk 0.039, 95% confidence interval: 0.007-0.214, p0.001), whereas greater cognitive impairment (p0.001), higher Acute Physiology and Chronic Health Evaluation II score (p 0.001) and recent stressful events (p0.001) were associated with increased delirium incidence.AGW hospitalization is associated with less incident delirium among older medical inpatients. Despite inherent limitations of observational studies, these hypothesis-generating findings add to previous evidence of potential benefit in delirium prevention from geriatric consultation in several hospital settings.