ABSTRACT
BACKGROUND: In Germany approximately 20,500 women and 41,000 men were resuscitated after out-of-hospital cardiac arrest (OHCA) each year. We are currently experiencing a discussion about the possible undersupply of women in healthcare. The aim of the present study was to examine the prevalence of OHCA in Germany, as well as the outcome and quality of resuscitation care for both women and men. METHODS: We present a cohort study from the German Resuscitation Registry (2006-2022). The quality of care was assessed for both EMS and hospital care based on risk-adjusted survival rates with the endpoints: "hospital admission with return of spontaneous circulation" (ROSCadmission) for all patients and "discharge with favourable neurological recovery" (CPC1/2discharge) for all admitted patients. Risk adjustment was performed using logistic regression analysis (LRA). If sex was significantly associated with survival, a matched-pairs-analysis (MPA) followed to explore the frequency of guideline adherence. RESULTS: 58,798 patients aged ≥ 18 years with OHCA and resuscitation were included (men = 65.2%, women = 34.8%). In the prehospital phase the male gender was associated with lower ROSCadmission-rate (LRA: OR = 0.79, CI = 0.759-0.822). A total of 27,910 patients were admitted. During hospital care, men demonstrated a better prognosis (OR = 1.10; CI = 1.015-1.191). MPA revealed a more intensive therapy for men both during EMS and hospital care. Looking at the complete chain of survival, LRA revealed no difference for men and women concerning CPC1/2discharge (n = 58,798; OR = 0.95; CI = 0.888-1.024). CONCLUSION: In Germany, 80% more men than women experience OHCA. The prognosis for CPC1/2discharge remains low (men = 10.5%, women = 7.1%), but comparable after risk adjustment. There is evidence of undersupply of care for women during hospital treatment, which could be associated with a worse prognosis. Further investigations are required to clarify these findings.
Subject(s)
Cardiopulmonary Resuscitation , Emergency Medical Services , Out-of-Hospital Cardiac Arrest , Adult , Humans , Male , Female , Cohort Studies , Out-of-Hospital Cardiac Arrest/epidemiology , Out-of-Hospital Cardiac Arrest/therapy , RegistriesABSTRACT
Imaging studies showed that the structure of the corpus callosum (CC) is affected in amyotrophic lateral sclerosis (ALS). Some clinical studies also suggest that interhemispheric connectivity is altered, since mirror movements seem to occur in ALS. Finally, reduced interhemispheric inhibition (IHI), studied by transcranial magnetic stimulation (TMS), has been reported. It is not known whether there is any association between these findings. Here, we studied the integrity of the CC in ALS on the morphological, the functional, the electrophysiological, and the clinical level. Twenty-seven right-handed ALS patients and 21 healthy right-handed controls were included. Mirror activity (MA) was quantified using surface EMG. Diffusion tensor imaging tractography was used to segment the CC and quantify fractional anisotropy (FA). We studied the diffusivity of the intra-axonal markers N-acetylaspartate+N-acetyl aspartyl glutamate D(tNAA) within the CC. IHI was studied as a marker of CC function using a double-pulse TMS protocol. ALS patients showed significantly decreased FA in the motor segment of the CC (p < 0.01), and IHI was significantly reduced compared to controls (p = 0.01). However, no differences were observed regarding D(tNAA) and MA. The morphological as well as the functional integrity of the CC are altered in ALS. IHI was reduced in ALS, associated with decreased FA in the motor CC. Patients did not exhibit increased MA. Also, no differences within the CC were observed using diffusion-weighted spectroscopy. IHI might serve as a marker of transcallosal pathway disruption in ALS, even before clinical deficits become apparent.
