Introduction: Acute flaccid paralysis (AFP) surveillance continues globally as part of the World Health Organization’s goal to eradicate poliomyelitis. The Australian Paediatric Surveillance Unit (APSU), Paediatric Active Enhanced Disease Surveillance (PAEDS) network, and National Enterovirus Reference Laboratory (NERL) collaborate in AFP surveillance in Australia, capturing and reviewing cases of AFP for all aetiologies in order to exclude poliovirus. We aimed to describe the AFP epidemiology in childhood over an 11 year period. Methods: Data were reported nationally by paediatricians via prospective APSU surveillance, PAEDS surveillance nurses at five tertiary paediatric hospitals and NERL from 2007 to 2017. Children aged 0–15 years with AFP were included. We combined APSU, PAEDS, and NERL datasets, analysed epidemiological trends, and described clinical features and investigations for major diagnoses. Results: Of 590 AFP-compatible cases, 49% were male; 47% were aged 0–4 years, 9% aged <1 year. Annual incidence of AFP was 1.3 cases per 100,000 children aged <15 years. Lower limb paralysis was the most frequent presenting symptom. The most frequent diagnoses were Guillain-Barre syndrome (GBS; 36%), transverse myelitis (TM; 17%), and acute disseminated encephalomyelitis (ADEM; 15%). No secular trend was seen in frequency of AFP cases nor amongst major diagnoses. Seasonality was observed with ADEM occurring more frequently in winter. We observed periods of increased AFP frequency in 2013 and 2016, coinciding with increased reporting of non-polio anterior horn cell disease (AHCD) and detection of non-polio enterovirus (NPEV). Conclusions: Estimated incidence of GBS, ADEM, and TM in Australian children was comparable with international rates. There was stable incidence of AFP in Australian children between 2007 and 2017. GBS, ADEM, and TM are the major causes of AFP. We observed clustering of cases associated with NPEV that emphasises a need for ongoing vigilance in surveillance given continue emerging infectious disease threats.

Introduction: Dementia prevention trials have so far shown little benefit of multidomain interventions against cognitive decline. Recruitment strategies in these trials often centre around dementia risk or cardiovascular risk profile, but it is uncertain whether this leads to inclusion of individuals who may benefit most from the intervention. We determined the effects of eligibility criteria on the recruitment of potential trial participants in the general population. Methods: In a systematic search until January 1, 2022, we identified all published and ongoing large (≥500 participants), phase-3 multidomain trials for the prevention of cognitive decline or dementia. We applied trial eligibility criteria to 5,381 participants of the population-based Rotterdam Study (mean age: 72 years, 58% women), to compare participant characteristics, predicted risk of cardiovascular disease, and dementia risk, between trial eligible and ineligible persons. Results: We identified 10 trials, of which 5 had been published (DR’s EXTRA, FINGER, preDIVA, MAPT, and HATICE) and 5 are ongoing (US-POINTER, MIND-CHINA, MYB, AgeWell.de, and J-Mint). Among all Rotterdam Study participants, eligibility across published trials ranged from 48% for MAPT to 87% for preDIVA, in line with original trial reports. Variability in eligibility was wider for ongoing trials, from 1% for US-POINTER to over 94% for MYB trial. Over 70% of trial eligible individuals are recommended preventive intervention in routine care based on their cardiovascular risk, similar for lipid-lowering (71%) and blood pressure-lowering treatment (73%). Ten-year risks of dementia were similar for eligible compared to ineligible individuals (12 vs. 11%). Conclusion: Multidomain dementia prevention trials fail to preferentially include those at the highest risk of dementia and mostly include individuals who qualify for interventions already on the basis of cardiovascular prevention guidelines. These findings call for better targeted enrolment of individuals for whom trial results can improve clinical decision-making.

Introduction: China has the most people with Parkinson disease (PD) in the world and is estimated to have over half of the worldwide PD population. The objective of this study was to analyze the corresponding burden of PD in China for the past decades. Method: Data on disease burden related to PD in China were retrieved from the Global Burden of Disease (GBD) 2019 study. The estimated annual percentage changes (EAPCs) were calculated to assess temporal trends, and the ratio of years lived with disability (YLDs) to disability-adjusted life years (DALYs) was used as an index to evaluate the healthcare system. Result: Nationally, the burden of PD increased from 1990 to 2019. Although the age-standardized incidence rate (ASIR) increased, the age-standardized death rate (ASDR) and age-standardized DALY rate both decreased. Age-standardized rates of PD in males remained higher than those in females, but trends in ASDR and the age-standardized DALY rate for females showed a pronounced decrease. The most remarkable increase in the ASIR was in individuals aged 45–49 years, with an EAPC of 1.74 (95% confidence interval, 1.26–2.21). The YLDs:DALYs ratio continuously increased compared with global figures and even with countries with high sociodemographic index (SDI). Conclusion: Although ASDR and age-standardized DALY rates for PD have been declining, the burden of PD still needs attention as the total numbers have increased over the period. Generally, the greater burden of PD was in males. A sound health system with services tailored to PD continues to be required in the future.

Introduction: Ischemic stroke incidence appears to have decreased during the last decades, but most studies focus on the first-ever events and epidemiological data on recurrent stroke are scarce. The aim of our study was to investigate trends in incidence, risk factors, and medication in patients with first-ever and recurrent ischemic stroke between 2010 and 2019 in Sweden. Methods: We included patients (≥18 years old) with ischemic stroke registered in the hospital-based Swedish Stroke Register (Riksstroke) 2010–2019. The coverage of Riksstroke was consistently high (about 90%) during this period. Data were stratified by first-ever and recurrent ischemic stroke in three different time periods (2010–2012, 2013–2016, and 2017–2019) and shown as crude and age-specific incidence rates per 100,000 person-years. Statistics Sweden provided census data on the Swedish population in different age groups. Results: During the study period, 201,316 cases of ischemic stroke were registered in Riksstroke, including 153,865 (76.4%) cases of first-ever ischemic stroke and 46,248 (23.0%) cases of recurrent ischemic stroke (0.6% of cases unclassified). The crude incidence of first-ever ischemic stroke decreased by 17% from 216 (95% CI 214–218) to 179 (95% CI 177–181) between 2010–2012 and 2017–2019, whereas recurrent ischemic stroke decreased by 33% from 72 (95% CI 71–73) to 48 (95% CI 47–49). Between these time periods, diminishing ischemic stroke incidence was seen in all age groups with highest decline noted in those aged 75–84 years (928 [95% CI 914–943] to 698 [95% CI 686–709]; −25% in first-ever ischemic stroke and 361 [95% CI 351–370] to 219 [95% CI 213–226]; −39% in recurrent ischemic stroke) and ≥85 years (1,674 [95% CI 1,645–1,703] to 1,295 [95% CI 1,270–1,320]; −23% in first-ever ischemic stroke and 683 [95% CI 664–702] to 423 [95% CI 409–437]; −38% in recurrent ischemic stroke). Treatment with anticoagulants in patients with atrial fibrillation and lipid-lowering drugs increased considerably in patients with first-ever and recurrent ischemic stroke both at admission and discharge during the study period. Conclusion: Whereas both first-ever and recurrent ischemic stroke rates declined in Sweden between 2010 and 2019, the proportional decline was almost double for recurrent ischemic stroke than for first-ever ischemic stroke and most pronounced in the elderly. Increased use of secondary preventive drugs, in particular anticoagulants in atrial fibrillation, appears to have contributed, but further studies on precise causes for the decline in recurrent ischemic stroke are needed.

Introduction: The association between within-visit blood pressure variability (BPV) and all-cause and stroke mortality remains uncertain. The aim of our study was to assess the association of within-visit BPV with all-cause and stroke mortality. Methods: The study was conducted among participants from Thai Epidemiologic Stroke Study, which is a prospective community-based cohort study that recruited participants from the general population from five regions of Thailand. This study included 19,614 participants aged 45–80 years, who were free of stroke and had three blood pressure (BP) measurements, taken 1 min apart, at baseline. Within-visit systolic blood pressure (SBP) and diastolic blood pressure (DBP) variability were expressed as the maximum absolute difference (MAD) between any two readings among the three repeated sequential measurements of SBP and DBP, respectively. The participants were followed up for mortality. Cox regression analysis was used to identify the association of within-visit BPV with all-cause and stroke mortality. Hazard ratio (HR) and 95% confidence intervals were used to illustrate the associations. Sensitivity analysis restricted to participants with mean SBP above 130 mm Hg and mean DBP above 90 mm Hg (n = 1,895) was performed. Results: During a median follow-up of 11.1 years, 305 participants died of stroke, and 3,173 participants died of nonstroke cause. In unadjusted analyses, high within-visit MAD of SBP was significantly associated with all-cause (HR, 1.19; 95% CI, 1.09–1.31; p < 0.001) and stroke mortality (HR, 1.87; 95% CI, 1.35–2.59; p < 0.001); high within-visit MAD of DBP was also significantly associated with all-cause mortality (HR, 1.19; 95% CI, 1.08–1.31; p < 0.001), in quartile 4 versus quartile 1. These associations did not persist after further adjustment for sex, age, and other potential confounders including mean BP. However, sensitivity analysis showed some inconsistent results regarding associations of within-visit MAD of SBP and DBP with all-cause and stroke mortality, respectively. Conclusion: In general population, within-visit systolic BPV and within-visit diastolic BPV do not have prognostic significance on stroke mortality and all-cause mortality, respectively.

Introduction: Little is known about racial differences in inpatient outcomes following hospitalizations for myasthenia gravis (MG). In this study, we used a claims-based database to assess racial differences in outcomes in hospitalized myasthenics. Methods: The 2006–2014 National Inpatient Sample database was queried using the International Classification of Diseases 9th Edition diagnosis code (358.01) to identify adult patients (age >17 years) undergoing hospitalization for MG. Race was categorized into – white, black/African American (AA), Asian or Pacific Islander, Hispanic, Native American, and other. Complications assessed included urinary tract infections, acute renal failure, cardiac complications, systemic infection, deep venous thrombosis, and pulmonary embolism. Multivariate logistic regression analyses were used to assess whether race was associated with a difference in outcomes, after controlling for baseline demographics, hospital characteristics, and treatment factors. Results: A total of 56,189 patient admissions, using a weighted sample, underwent hospitalization for MG between 2006 and 2014. Black/AA patients had significantly higher odds of experiencing systemic infections (odds ratio [OR] 1.35 [95% confidence intervals [CI] 1.16–1.58]; p < 0.001), deep venous thrombosis (OR 2.11 [95% CI 1.36–3.27]; p = 0.001), and renal failure (OR 1.19 [95% CI 1.05–1.35]; p = 0.005). Black/AA patients were more likely to be intubated (OR 1.09 [95% CI 1.01–1.19]; p = 0.028) and receive noninvasive mechanical ventilation (OR 1.62 [95% CI 1.46–1.79]; p < 0.001), however, were less likely to receive intravenous immunoglobulin (OR 0.77 [95% CI 0.73–0.82]; p < 0.001) and plasmapheresis (OR 0.77 [95% CI 0.72–0.82]; p < 0.001). Black/AA and Hispanic patients had lower mortality (OR 0.74 [95% CI 0.59–0.94; p = 0.012]. Conclusions: Significant racial differences exist in both treatment utilization and inpatient outcomes for patients hospitalized for MG.

Safety and efficacy of oral anticoagulation (OA) and antiplatelet therapy (AP) for cardiovascular prevention in Brazil are likely to be affected by economic and health access inequalities. This study aimed to assess the occurrence of intracerebral hemorrhage (ICH) in patients using OA or AP registered in the JOINVASC between 2015 and 2020. Higher mortality among OA or AP patients was seen, with a statistically significant difference in mortality within 90 days (38% versus 25%, p=0.025). For patients with OA at the time of ICH, high stroke severity was observed, with a 71% mortality rate. Managing bleeding episodes on OA and AP is key in the effort to prevent cardiovascular death and disability, and improved access to DOAC and reversal agents is in need for this patient population.

Background: The Gironde Central Nervous System (CNS) Tumor Registry, in collaboration with the French National Cancer Institute, is the largest population-based registry focused exclusively on primary CNS tumors in France and represents a population of 1.62 million. This report focuses on ependymal tumors to refine current knowledge and provide up-to-date data on the epidemiology of these rare tumors. Material and Methods: All of the ependymal tumors were extracted from the Gironde CNS Tumor Registry for the years 2000–2018. Demographic and clinical characteristics, incidence rates, and time trends as well as survival outcomes were analyzed. Results: One hundred forty-four ependymal tumors were retrieved, which represented 2.3% of all the CNS tumors recorded in the same period. Histological subtype was significantly dependent on age and topography in the CNS. The median age at diagnosis was 46 years. The annual incidence rates varied between 0.15/100,000 (2004) and 0.96/100,000 (2016), with a significant increase over the study period by 4.67% per year. Five-year and 10-year OS rates were 87% and 80%, respectively. Conclusion: An increase in the incidence of ependymal tumors was observed over the past two decades. Further studies are needed to confirm this result and provide etiological clues.

Background: Parkinson’s disease is a common, age-related progressive neurodegenerative disorder with considerable socioeconomic burdens, although the studies in incremental burdens to the disease’s rapid growth are incomplete and lag behind. We aim to assess global burdens of Parkinson’s disease based on a public database online. Methods: Based on the Global Burden of Disease, Injuries, and Risk Factors Study, we screened a range of indicators including prevalence cases, disability-adjusted life-years (DALYs), age-standardized prevalence rates (ASPRs), and age-standardized DALY rate (ASDR). The join point regression was used to assess the indicators, wherein the ASPR and the ASDR were referred to temporal trends for burdens of Parkinson’s disease. Results: Prevalence cases of global Parkinson’s disease were on the rise for 30 years, with an increase of 155.51% during 1990–2019. Temporal trend of ASDRs was on the rise during 1990–2002 but in decline during 2002–2019. The ASPRs had a turning point in 2017 and a decline during 2017–2019 (annual percentage change = −0.51%, p > 0.05). China, India, the USA, Japan, and Germany shared the five highest prevalence cases and DALYs in 2019. The Socio-Demographic Index (SDI) was in relation to a significantly positive ASPR (R = 0.61, p < 0.001) but not a significantly negative ASDR (R = −0.044, p = 0.53), respectively. Conclusions: In this study, a range of indicators for global burdens of Parkinson’s disease were on the rise during 1990–2019. Tremendous efforts should be in place to prevent Parkinson’s disease, especially among the populations of males, with advanced ages, in East Asia, and in regions with high SDI.

Despite projections of stroke being a leading cause of mortality in Africa, reliable estimates of stroke burden on the continent using rigorous methods are not available. We aimed to implement a mobile-Health community-based interactive Stroke Information and Surveillance System to sustainably measure stroke burden and improve stroke health literacy and outcomes in urban and rural sites in Nigeria. African Rigorous Innovative Stroke Epidemiological Surveillance (ARISES) is an observational cohort study, which will be conducted in urban (Ibadan North LGA Ward 3) and rural (Ibarapa Central LGA) sites with a combined base population of over 80,000 people. The study will use a consultative approach to establish an mHealth-based Stroke Information and Surveillance System comprising a Stroke Alert System and a Stroke Finding System. These systems will enable the community to report stroke events and the research team/health workers find stroke cases using phone calls, short message service, and Voice Over Internet Protocols (VoIP). We will update community household data and geo-locate all households. Over the 5 years of the study, the system will collect information on stroke events and educate the community about this disease. Reported stroke cases will be clinically adjudicated at home and in prespecified health facilities. Baseline and endline community surveys will be conducted to assess stroke occurrence and other important study variables. The proportion of strokes alerted and found will be determined over the study period. Focus group discussions and key informant interviews will be conducted to understand community stroke literacy and perspectives. The study will also assess any impact of these efforts on time from stroke onset to referral, community uptake of orthodox health services for stroke patients. ARISES is anticipated to establish proof of concept about using mHealth for stroke surveillance in Africa. The potential impact of the SISS on improving patient outcomes will also be determined.