Background and purpose: Fewer than 1 in 20 patients with acute ischemic stroke are treated with thrombolytic drugs, with threequarters of otherwise eligible patients being excluded secondary to delay in seeking medical treatment. Lack of symptom recognition may contribute to low treatment rates and is an important focus of public health education. The purpose of this study was to determine if an individual's cumulative number of stroke risk factors correlated with their ability to identify stroke symptoms. Methods: We surveyed adults about their stroke risk factors and knowledge of stroke symptoms at grocery stores and malls in a medium-sized university town in the Midwestern US. Results: In total, 245 adults completed surveys. Self-reported risk factors included high blood pressure (25%), high cholesterol (22%), diabetes (12%), tobacco use (11%), alcohol use (7%), heart disease (7%), and prior stroke (3%). Cumulatively, 56% of respondents had no risk factors, 41% had 1Á3 risk factors, and 4% had 4' risk factors. When administered a six-point stroke symptom knowledge test, respondents with 4' risk factors were significantly less knowledgeable, receiving a mean score of 3.2, compared to those with 1Á3 risk factors, who scored a mean of 4.6. Those with four or more years of college were significantly more knowledgeable than those with only a high-school education, receiving mean scores of 4.6 and 3.9, respectively. There was no association between stroke knowledge and use of a primary care physician. Conclusions: Although it is known that individuals with more risk factors are more likely to have a stroke, in our study these respondents were less able to recognize stroke symptoms compared to respondents with fewer risk factors. Future public stroke awareness campaigns should be targeted toward those most at risk so they learn to recognize stroke symptoms and thus seek treatment in a timely manner.

Background Pulmonary Arterial Hypertension (PAH) is a form of pulmonary hypertension, where the narrowing of arteries in the lungs restricts blood flow and so increases pressure in the vessels. Studies have demonstrated that initial combination therapies are optimal for PAH management. However, prescription of monotherapy treatment is still prevalent as a first line therapy. Purpose The purpose of this research was to investigate prescribing trends of physicians for first line patients with PAH in the UK, Germany, Italy and Spain. We investigated the proportions of newly diagnosed patients and the prescription trends for monotherapy and combination therapy prior to and during the COVID-19 pandemic. Methods A multi-country, multi-centre online medical chart review study of patients with PAH was conducted between April – June of 2019, 2020 and 2021 respectively. Recruited from a large access panel, 178 treating cardiologists, pulmonologists & rheumatologists in the UK (n=16), Germany (n=55), Italy (n=55) and Spain (n=52) were screened for duration of practice in their speciality and caseload (≥5 PAH patients in the last 3 months), and provided data on 694 PAH patients (UK = 71, Germany = 206, Italy = 208, Spain = 209). Reported patient data pertained to medical chart information reflecting the prior year, i.e., Q2 2021 data reflected the 2020 period (advent of the COVID-19 pandemic). Results In this dataset, there has been a consistent decrease in the proportion of newly diagnosed (i.e. diagnosed within 12 months of being reported) patients reported from 2019 to 2020 and 2021. In 2019, 49% of the reported patients were diagnosed within the last 12 months. However, the newly diagnosed patient population dropped to 37% in 2020 and continued to drop to 27% in 2021. Despite this, there has been an increase in reported first line patients within the newly diagnosed segment from 74% in 2019, to 75% in 2020, then at 87% in 2021. This increase can be seen to coincide with the ongoing COVID-19 pandemic. In 2019, 58% of reported newly diagnosed patients were recorded as receiving monotherapy. This did drop to 33% in 2020; however, in 2021 monotherapy uptake increased to 47%. Of note, the usage of the endothelin receptor antagonist (ERA) drug class increased from 67% in 2019 to 83% in 2020 but dropped to 69% in 2021. Conclusions This data set suggests a decreasing trend in newly diagnosed patients and a gradual shift in treatment type to first line monotherapy prescription, which coincided with the height of the COVID-19 pandemic. More newly diagnosed patients (those diagnosed within 12 months of being reported) are receiving monotherapy treatment at the expense of combination therapy, and this has also coincided with the pandemic. Further investigation using comparator cohort is warranted to assess whether the challenges physicians faced during the pandemic has had a causal effect on the prescribing habits for PAH therapies. Funding Acknowledgement Type of funding sources: None.

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Inappropriate admissions of respiratory diseases is high and difficult to regulate. The aim of this study was to identify the determinants of inappropriate admission to hospitalized patients with respiratory diseases in rural areas. Methods: In this study, 1141 inpatient records of respiratory diseases from 4 counties were collected by a stratified random sampling method in central and western China. An adjusted Appropriateness Evaluation Protocol (AEP) was used to evaluate the admission records of inpatients suffering from respiratory diseases. Determinants related to the inappropriate admissions to county hospital for respiratory diseases were analyzed by using a binary logistic regression. Results: The top five positive indicators of respiratory disease assessment were B14 acute hematopathy, severe medium-sized leukopaenia, thrombocytopaenia, leukocytosis, erythrocytosis, thrombocytosis or haemolysis-resulted symptoms, A2 treatment with varying dosages or drugs on a regular basis under direct medical supervision), A3 calculation of intake and output volume, B19 lung infection above 50% or leafy lesions according to X-ray examination and A8 stopping (at least once every 8 h) or continuing oxygen inhalation. The inappropriate admission rate of respiratory diseases was 33.7 %, among which Dingyuan County in Anhui Province was the highest (42.5%), and Huining County in Gansu Province was the lowest (27.6%). Inappropriate admissions were more likely in internal medicine (36.9%) and surgery (37.0%) department, mainly found for patients aged 40-59 years (41%) and who admitted in spring (37.7%) and the length of stay more than 14 days(48.6%). The logistic regression analysis showed that county, gender, age, season, admitted severity, health status and disease were determinants of inappropriate admission to patients with respiratory diseases in county hospitals. Conclusions: Policymakers must act to reduce the high prevalence of inappropriate admissions for respiratory diseases in county hospitals in rural China, by strengthening chronic disease prevention and control and changing the motivating mechanism of these hospitals.