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IntroductionCollection of real-world data on percutaneous coronary intervention (PCI) procedures and associated outcomes is useful from both quality assurance and clinical research perspectives. We sought to evaluate our PCI registry database for any emerging trends in PCI practice across the 3-year period 2022 to 2024.MethodsBaseline data was prospectively collected from hospital records, clinical events to discharge were collected in hospital and clinical events to 1 month were collected either at clinic visit or via telephone interview as standard as part of our hospital PCI database. All data was inpu ed into the “DENDRITE” pla orm. Data collected included: patient demographics, baseline characteristics, interventional devices used, X-ray and contrast media usage, catheterisation lab reporting data, PCI procedural data and 30-day outcomes. The data was collected across two centres, Mater Private Dublin and Mater Private Cork.ResultsA total of 3,118 PCI procedures (3,913 treated lesions) were performed across the two centres in the 3-year period, 2022 to 2024. The mean age of the patients treated was 69 ±10 years, the majority of patients (82%) were male and 27.3% of PCI procedures were performed for acute coronary syndromes. Intravascular imaging use increased year-on-year, from 36% of cases in 2022, 43.5% in 2023, and 51.7% of PCI cases in 2024. There was a rise in lesion complexity (ACC/AHA type), and a higher use of advanced calcium modification techniques (rotational atherectomy and intravascular lithotripsy) across the 3-year period (figure 1). Baseline characteristics and clinical outcomes are demonstrated in figure 2. Through to 30-day follow up, myocardial infarction and unplanned revascularization were most common adverse events, but event rates were low. Data on 30-day outcomes was collected for all patients (100%).Abstract 91 Figure 1[Image Omitted. See PDF.]Abstract 91 Figure 2[Image Omitted. See PDF.]ConclusionsTrends seen in our PCI registry reflect contemporary PCI practice with greater use of calcium modification therapies, rising lesion complexity and increasing intravascular imaging use.

Mechanical ventilation and intravenous sedation were initiated. Because of continuing spasms, intrathecal baclofen (1200 µg per day) was started on day 3 with a good clinical response. No recommendations about tetanus prophylaxis procedures for wound man agement in patients with blood diseases are available, except for bone-marrow transplantation.

Conceived in 2003 and born in 2005 with the launch of its first report and country profiles, the Countdown to 2015 for Maternal, Newborn, and Child Survival has reached its originally proposed lifespan. Major reductions in the deaths of mothers and children have occurred since Countdown's inception, even though most of the 75 priority countries failed to achieve Millennium Development Goals 4 and 5. The coverage of life-saving interventions tracked in Countdown increased steadily over time, but wide inequalities persist between and within countries. Key drivers of coverage such as financing, human resources, commodities, and conducive health policies also showed important, yet insufficient increases. As a multistakeholder initiative of more than 40 academic, international, bilateral, and civil society institutions, Countdown was successful in monitoring progress and raising the visibility of the health of mothers, newborns, and children. Lessons learned from this initiative have direct bearing on monitoring progress during the Sustainable Development Goals era.

Lower rates of smoking cessation are a major reason for the higher prevalence of smoking among socioeconomically disadvantaged adults. Because barriers to quitting are both more numerous and severe, socioeconomically disadvantaged smokers may benefit from more intensive intervention. We sought to determine whether a smoking cessation intervention delivered by public housing residents trained as Tobacco Treatment Advocates (TTAs) could increase utilization of cessation resources and increase abstinence. We conducted a group-randomized trial among Boston public housing residents who were interested in quitting smoking. Participants at control sites received standard cessation materials and a one-time visit from a TTA who provided basic counseling and information about cessation resources. Participants at intervention sites were eligible for multiple visits by a TTA who employed motivational interviewing, cessation counseling, and navigation to encourage smokers to utilize cessation treatment (Smokers' Quitline and clinic-based programs). Utilization and 7-day and 30-day point prevalence abstinence were assessed at 12 months. Self-reported abstinence was biochemically verified. Intervention participants (n = 121) were more likely than control participants (n = 129) to both utilize treatment programs (adjusted odds ratio [aOR]: 2.15; 95% confidence interval [CI]: 0.93-4.91) and 7-day and 30-day point prevalence abstinence (aOR: 2.60 (1.72-3.94); 2.98 (1.56-5.68), respectively). Mediation analysis indicated that the higher level of utilization did not explain the intervention effect. An intervention delivered by peer health advocates was able to increase utilization of treatment programs and smoking abstinence among public housing residents. Future studies of similar types of interventions should identify the key mechanisms responsible for success. In order to narrow the large and growing socioeconomic disparity in smoking rates, more effective cessation interventions are needed for low-income smokers. Individual culturally-relevant coaching provided in smokers' residences may help overcome the heightened barriers to cessation experienced by this group of smokers. In this study among smokers residing in public housing, an intervention delivered by peer health advocates trained in motivational interviewing, basic smoking cessation skills, and client navigation significantly increased abstinence at 12 months. Future research should address whether these findings are replicable in other settings both within and outside of public housing.

Efforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of “leaving no one behind”, it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health-related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990–2017, projected indicators to 2030, and analysed global attainment. We measured progress on 41 health-related SDG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health-related SDG index, we transformed the value for each indicator on a scale of 0–100, with 0 as the 2·5th percentile and 100 as the 97·5th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected for 2030, and then using the probability of attainment in 2030 calculated from 1000 draws. We also did a global attainment analysis of the feasibility of attaining SDG targets on the basis of past trends. Using 2015 global averages of indicators with defined SDG targets, we calculated the global annualised rates of change required from 2015 to 2030 to meet these targets, and then identified in what percentiles the required global annualised rates of change fell in the distribution of country-level rates of change from 1990 to 2015. We took the mean of these global percentile values across indicators and applied the past rate of change at this mean global percentile to all health-related SDG indicators, irrespective of target definition, to estimate the equivalent 2030 global average value and percentage change from 2015 to 2030 for each indicator. The global median health-related SDG index in 2017 was 59·4 (IQR 35·4–67·3), ranging from a low of 11·6 (95% uncertainty interval 9·6–14·0) to a high of 84·9 (83·1–86·7). SDG index values in countries assessed at the subnational level varied substantially, particularly in China and India, although scores in Japan and the UK were more homogeneous. Indicators also varied by SDI quintile and sex, with males having worse outcomes than females for non-communicable disease (NCD) mortality, alcohol use, and smoking, among others. Most countries were projected to have a higher health-related SDG index in 2030 than in 2017, while country-level probabilities of attainment by 2030 varied widely by indicator. Under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria indicators had the most countries with at least 95% probability of target attainment. Other indicators, including NCD mortality and suicide mortality, had no countries projected to meet corresponding SDG targets on the basis of projected mean values for 2030 but showed some probability of attainment by 2030. For some indicators, including child malnutrition, several infectious diseases, and most violence measures, the annualised rates of change required to meet SDG targets far exceeded the pace of progress achieved by any country in the recent past. We found that applying the mean global annualised rate of change to indicators without defined targets would equate to about 19% and 22% reductions in global smoking and alcohol consumption, respectively; a 47% decline in adolescent birth rates; and a more than 85% increase in health worker density per 1000 population by 2030. The GBD study offers a unique, robust platform for monitoring the health-related SDGs across demographic and geographic dimensions. Our findings underscore the importance of increased collection and analysis of disaggregated data and highlight where more deliberate design or targeting of interventions could accelerate progress in attaining the SDGs. Current projections show that many health-related SDG indicators, NCDs, NCD-related risks, and violence-related indicators will require a concerted shift away from what might have driven past gains—curative interventions in the case of NCDs—towards multisectoral, prevention-oriented policy action and investments to achieve SDG aims. Notably, several targets, if they are to be met by 2030, demand a pace of progress that no country has achieved in the recent past. The future is fundamentally uncertain, and no model can fully predict what breakthroughs or events might alter the course of the SDGs. What is clear is that our actions—or inaction—today will ultimately dictate how close the world, collectively, can get to leaving no one behind by 2030. Bill & Melinda Gates Foundation.

IntroductionRuptured brain arteriovenous malformations (bAVMs) present complex challenges in neurosurgical management, with timing of microsurgical treatment (MST) being a subject of ongoing debate. This study aims to evaluate the impact of MST timing on clinical outcomes in patients with ruptured bAVMs.MethodsWe conducted a systematic review and meta-analysis following PRISMA guidelines. A comprehensive search of PubMed, Embase, Scopus, and Web of Science databases identified relevant studies. The timing was defined as the duration from the rupture of bAVM to the MST. The patients were divided into four different groups based on MST timing: <48 hours, <1 week, <2 weeks, and <1 month. The primary outcome included favorable outcome defined as a modified Rankin Scale (mRS) score of 0-2 or a Glasgow Outcome Scale (GOS) score of 4-5 in the last clinical follow-up. Secondary outcomes were periprocedural mortality and complete excision.ResultsFifteen studies comprising 1026 patients were included in the meta-analysis. MST time >48 hours group had a significantly higher favorable outcome rate (odds ratio [OR]:9.71, 95% confidence interval [Cl]:3.09-30.57, p<0.01) and a lower mortality rate (OR:0.15, 95% Cl:0.02-0.88, p=0.04) compared to MST timing ≤48 hours group. (Figure 1) After excluding patients who underwent MST with preoperative EVT, MST time >48 hours were associated with a significantly higher favorable outcome rate (OR:9.39, 95% CI: 2.53–34.89, p<0.01). (Figure 2) There were no significant differences in terms of favorable outcomes, mortality, and complete excision when comparing MST times of ≤1 week versus >1 week, ≤2 weeks versus >2 weeks, and ≤1 month versus >1 month.Abstract O-072 Figure 1Abstract O-072 Figure 2ConclusionsOur findings suggest that delaying MST beyond 48 hours with and without preoperative EVT may improve favorable outcomes and reduce mortality rates in patients with ruptured bAVMs.DisclosuresA. Orscelik: None. B. Musmar: None. H. Matsukawa: None. M. Ismail: None. S. Elawady: None. S. Assad: None. C. Cunningham: None. M. Sowlat: None. R. Kasem: None. A. Spiotta: None.

Background Pakistan, being a developing country, presents the dismal picture of maternal and neonatal mortality and morbidity. The majority of maternal and neonatal deaths could be avoided if Continuum of Care (CoC) is provided in a structured pathway from pregnancy to birth and to the first week of life of the newborn child. This study aimed to analyse the trends of CoC at all three levels (antenatal care, skilled delivery and postpartum care) and to identify various factors affecting the continuation in receiving CoC in Pakistan during 2006 to 2012. Methods Secondary data analysis was performed on nationally representative data from the last two iterations of Pakistan Demographic and Health Survey (PDHS), conducted during 2006/07 to 2012/13. The analysis is limited to women of the reproductive age group (15–49 years) who gave birth during the last five years preceding both surveys. This leads to a sample size of 5,724 and 7,461 respondents from PDHS 2006/07 and 2012/13 respectively. The association between CoC and several factors, including individual attributes (reproductive status), family influences, community context, as well as cultural and social values was assessed in bivariate analyses in a first step. Furthermore, odds ratios and adjusted odds ratios with 95% confidence intervals using a binary and multivariable logistic regression were calculated. Results Our research presents the trends of a composite measure of CoC including antenatal care, delivery assistance and postpartum care. The largest gap in CoC was observed at antenatal care followed by delivery and postnatal care within 48 h after delivery. Results show that CoC completion rate has increased from 15% to 27% amongst women in Pakistan over time from 2006 to 2012. Women with high age at first birth, having less number of children, with higher education, belonging to richest quintile, living in Sindh province and urban areas, having high autonomy and exposure to mass media were most likely to avail complete CoC. Conclusions The findings show that women in Pakistan still lack the CoC. This calls for attention to develop and implement tailored interventions, focusing on the needs of women in Pakistan to provide CoC in an integrated manner, involving both public and private sectors by appropriately addressing the factors hindering CoC completion rates.

Health spending growth in the United States is projected to average 5.8 percent for 2014-24, reflecting the Affordable Care Act's coverage expansions, faster economic growth, and population aging. Recent historically low growth rates in the use of medical goods and services, as well as medical prices, are expected to gradually increase. However, in part because of the impact of continued cost-sharing increases that are anticipated among health plans, the acceleration of these growth rates is expected to be modest. The health share of US gross domestic product is projected to rise from 17.4 percent in 2013 to 19.6 percent in 2024.

The study investigates how institutional voids influence the growth of online gambling platforms in Brazil, focusing on virtual casinos and sports betting. The research adopts non-participatory netnography as its methodology, combining observations on two selected platforms with analyses of search trends on Google Trends™ (2019–2024). The findings indicate that institutional voids, characterized by the absence of regulatory norms and structures, allow platforms to exploit normative gaps to operate and attract consumers. Simultaneously, users expressed distrust regarding the integrity and transparency of the games, highlighting perceptions of manipulation and dissatisfaction with outcomes. The theoretical contribution of the study lies in applying the concept of institutional voids to a rapidly expanding digital market, thereby enhancing understanding of the impacts of deregulation in developing countries. Practically, the study underscores the urgency of establishing a regulatory framework that balances technological innovation, consumer protection, and social responsibility. The research also offers insights for public policy formulation aimed at enhancing the legitimacy of platforms and encouraging sustainable practices.