Greater Mortality Research Articles

Diverticulitis in Older Adults: Is Cognitive Impairment Associated With Outcomes?

IntroductionOlder age is associated with increased prevalence of both diverticulitis and cognitive impairment. The association between cognitive impairment and outcomes among older adults presenting to the emergency department (ED) for diverticulitis is unknown. MethodsAdults aged ≥65 y presenting to an ED with a primary diagnosis of colonic diverticulitis were identified using the Nationwide Emergency Department Sample (2016-2019) and stratified by cognitive impairment status in this retrospective cohort study. Multivariable Poisson regression models adjusted for patient age, sex, Elixhauser Comorbidity Index, primary payer status, and presence of complicated diverticulitis quantified relative risk of a) inpatient admission, b) operative intervention, and c) in-hospital mortality comparing patients with or without a diagnosis code suggestive of cognitive impairment. ResultsAmong 683,444 older adults with an ED encounter for diverticulitis from 2016 to 2019, there were 468,226 patients with isolated colonic diverticulitis and 26,388 (5.6%) with comorbid cognitive impairment. After adjustment, the risk of inpatient admission for those with cognitive impairment was 18% higher than for those without cognitive impairment (adjusted relative risks [aRR]: 1.18, 95% confidence interval [CI]: 1.17-1.20). Those with cognitive impairment were 34% more likely to undergo colectomy than those without cognitive impairment (aRR: 1.34, 95% CI: 1.24-1.44). Older adults with cognitive impairment had a 32% greater mortality than those without cognitive impairment (aRR: 1.32, 95% CI: 1.05-1.67). ConclusionsAmong older adults presenting for ED care with a primary diagnosis of colonic diverticulitis, individuals with cognitive impairment had higher rates of hospitalization, operative intervention, and in-hospital mortality than those without cognitive impairment.

The regulation of the rural market in waged labour in fourteenth-century England

AbstractThis article reconstructs the size and organisation of the rural market in hired labour in fourteenth-century England, providing a comparative reference point for arrangements elsewhere in medieval Europe. Quantitative assessment of 1,445 manorial court sessions from six manors casts new light on the English labour market, which was larger and less regulated than previously assumed and the government's wide-ranging labour legislation in the wake of the Black Death was novel in its scale and provisions. Contrary to received wisdom, manorial authorities made few efforts to regulate labour. The older view had placed an over-reliance on the early work of W.O. Ault and had ignored the significance of nil returns. The reasons for the lack of regulation, and its implications for our understanding of the complex interaction between pandemics, labour markets, and legal responses are explored. Finally, the study illustrates how legal responses to pandemics can have inadvertent yet profound consequences.

Management of Pulmonary Hypertension Associated with Chronic Lung Disease.

Pulmonary hypertension (PH) is a common complication of chronic lung diseases, particularly in chronic obstructive pulmonary disease (COPD) and interstitial lung diseases (ILD) and especially in advanced disease. It is associated with greater mortality and worse clinical course. Given the high prevalence of some respiratory disorders and because lung parenchymal abnormalities might be present in other PH groups, the appropriate diagnosis of PH associated with respiratory disease represents a clinical challenge. Patients with chronic lung disease presenting symptoms that exceed those expected by the pulmonary disease should be further evaluated by echocardiography. Confirmatory right heart catheterization is indicated in candidates to surgical treatments, suspected severe PH potentially amenable with targeted therapy, and, in general, in those conditions where the result of the hemodynamic assessment will determine treatment options. The treatment of choice for these patients who are hypoxemic is long-term oxygen therapy and pulmonary rehabilitation to improve symptoms. Lung transplant is the only curative therapy and can be considered in appropriate cases. Conventional vasodilators or drugs approved for pulmonary arterial hypertension (PAH) are not recommended in patients with mild-to-moderate PH because they may impair gas exchange and their lack of efficacy shown in randomized controlled trials. Patients with severe PH (as defined by pulmonary vascular resistance >5 Wood units) should be referred to a center with expertise in PH and lung diseases and ideally included in randomized controlled trials. Targeted PAH therapy might be considered in this subset of patients, with careful monitoring of gas exchange. In patients with ILD, inhaled treprostinil has been shown to improve functional ability and to delay clinical worsening.

14th century Yersinia pestis genomes support emergence of pestis secunda within Europe.

Pestis secunda (1356-1366 CE) is the first of a series of plague outbreaks in Europe that followed the Black Death (1346-1353 CE). Collectively this period is called the Second Pandemic. From a genomic perspective, the majority of post-Black Death strains of Yersinia pestis thus far identified in Europe display diversity accumulated over a period of centuries that form a terminal sub-branch of the Y. pestis phylogeny. It has been debated if these strains arose from local evolution of Y. pestis or if the disease was repeatedly reintroduced from an external source. Plague lineages descended from the pestis secunda, however, are thought to have persisted in non-human reservoirs outside Europe, where they eventually gave rise to the Third Pandemic (19th and 20th centuries). Resolution of competing hypotheses on the origins of the many post-Black Death outbreaks has been hindered in part by the low representation of Y. pestis genomes in archaeological specimens, especially for the pestis secunda. Here we report on five individuals from Germany that were infected with lineages of plague associated with the pestis secunda. For the two genomes of high coverage, one groups within the known diversity of genotypes associated with the pestis secunda, while the second carries an ancestral genotype that places it earlier. Through consideration of historical sources that explore first documentation of the pandemic in today's Central Germany, we argue that these data provide robust evidence to support a post-Black Death evolution of the pathogen within Europe rather than a re-introduction from outside. Additionally, we demonstrate retrievability of Y. pestis DNA in post-cranial remains and highlight the importance of hypothesis-free pathogen screening approaches in evaluations of archaeological samples.

The Influence of Diagnoses of Specific Viral Infections on In-Hospital Mortality, Length of Stay and Cost in Patients Admitted to Hospital with a Diagnosis of Myocarditis: An Analysis of the National Inpatient Sample.

The influence of different viral infections in patients with myocarditis is unknown. Myocarditis is an inflammatory disease of heart muscle that is commonly caused by viruses. The impact of different viral infections in patients with myocarditis is unknown. We conducted a retrospective cohort study using data between 2016-2020 in the National Inpatient Sample in the USA to evaluate admissions with myocarditis and concomitant viral infection. The outcomes of in-hospital mortality, length of stay (LoS), and cost, among patients hospitalized for myocarditis was evaluated. A total of 27,050 hospital admissions for myocarditis were included and 6750 (25.0%) had a co-diagnosis of viral infection. Patients with myocarditis and viral infection had significantly higher mortality compared to those without viral infection (23.6% vs. 4.4%, p 0.001). Viral infection was associated with increased in-hospital mortality (odds ratio (OR) 2.03, 95% CI 1.51 to 2.73, p 0.001), greater median LoS (7 vs. 3 days, p 0.001) and median hospitalization cost ($21,445 vs. $11,596, p 0.001), compared to patients without viral infection. The rate of death was greatest for patients with a diagnosis of coronavirus disease 2019 (COVID-19), viral pneumonia and herpes zoster, respiratory syncytial virus, chronic hepatitis, and influenza which was 36.0%, 34.3%, 27.3%, 21.4%, 20.0%, and 14.5%, respectively. In conclusion, the diagnosis of viral infection is present in one in four patients hospitalized with myocarditis and is correlated with greater mortality, LoS, and in-hospital cost.

Outcomes Among Patients Hospitalized With Non–COVID-19 Conditions Before and During the COVID-19 Pandemic in Alberta and Ontario, Canada

The association of inpatient COVID-19 caseloads with outcomes in patients hospitalized with non-COVID-19 conditions is unclear. To determine whether 30-day mortality and length of stay (LOS) for patients hospitalized with non-COVID-19 medical conditions differed (1) before and during the pandemic and (2) across COVID-19 caseloads. This retrospective cohort study compared patient hospitalizations between April 1, 2018, and September 30, 2019 (prepandemic), vs between April 1, 2020, and September 30, 2021 (during the pandemic), in 235 acute care hospitals in Alberta and Ontario, Canada. All adults hospitalized for heart failure (HF), chronic obstructive pulmonary disease (COPD) or asthma, urinary tract infection or urosepsis, acute coronary syndrome, or stroke were included. The monthly surge index for each hospital from April 2020 through September 2021 was used as a measure of COVID-19 caseload relative to baseline bed capacity. The primary study outcome was 30-day all-cause mortality after hospital admission for the 5 selected conditions or COVID-19 as measured by hierarchical multivariable regression models. Length of stay was the secondary outcome. Between April 2018 and September 2019, 132 240 patients (mean [SD] age, 71.8 [14.8] years; 61 493 female [46.5%] and 70 747 male [53.5%]) were hospitalized for the selected medical conditions as their most responsible diagnosis compared with 115 225 (mean [SD] age, 71.9 [14.7] years, 52 058 female [45.2%] and 63 167 male [54.8%]) between April 2020 and September 2021 (114 414 [99.3%] of whom had negative SARS-CoV-2 test results). Patients admitted during the pandemic with any of the selected conditions and concomitant SARS-CoV-2 infection exhibited a much longer LOS (mean [SD], 8.6 [7.1] days or a median of 6 days longer [range, 1-22 days]) and greater mortality (varying across diagnoses, but with a mean [SD] absolute increase at 30 days of 4.7% [3.1%]) than those without coinfection. Patients hospitalized with any of the selected conditions without concomitant SARS-CoV-2 infection had similar LOSs during the pandemic as before the pandemic, and only patients with HF (adjusted odds ratio [AOR], 1.16; 95% CI, 1.09-1.24) and COPD or asthma (AOR, 1.41; 95% CI, 1.30-1.53) had a higher risk-adjusted 30-day mortality during the pandemic. As hospitals experienced COVID-19 surges, LOS and risk-adjusted mortality remained stable for patients with the selected conditions but were higher in patients with COVID-19. Once capacity reached above the 99th percentile, patients' 30-day mortality AOR was 1.80 (95% CI, 1.24-2.61) vs when the surge index was below the 75th percentile. This cohort study found that during surges in COVID-19 caseloads, mortality rates were significantly higher only for hospitalized patients with COVID-19. However, most patients hospitalized with non-COVID-19 conditions and negative SARS-CoV-2 test results (except those with HF or with COPD or asthma) exhibited similar risk-adjusted outcomes during the pandemic as before the pandemic, even during COVID-19 caseload surges, suggesting resiliency in the event of regional or hospital-specific occupancy strains.

Paleogenomics of the Plague Agent and Prospects for Paleogenomic Studies in Russia

The review contains information on paleogenomic studies of the plague pathogen, Yersinia pestis, covering the prehistoric epoch, the periods of the first and second plague pandemics, epidemics and outbreaks of plague of the late XIX–XX centuries. We have summarized the data on the reconstruction of ancient Y. pestis genomes of the Late Neolithic, Bronze and Iron Ages, the Justinian Plague epidemic of the first plague pandemic, the Black Death epidemic and the subsequent epidemics of the second plague pandemic of the XIV–XVIII centuries, as well as on tracing the pathways of plague propagation waves in Eurasia and the course of plague agent evolution with the formation of a vector-borne transmission route with the help of arthropods. We present the results of our own research of Y. pestis genomes from the key sites of formation of etiological agents of the first and second plague pandemics in the Tien Shan Mountains, historical outbreaks in the Northern and North-Western Caspian sea region and other regions of Russia and adjoining countries in the late XIX–XX centuries. The paper discusses the areas of the Caucasus, Crimea, Northern Caspian, Siberia, and Tien Shan in the territory of Russia and neighboring states that are promising for national paleogenomic studies of plague.

Dismantling the diorama: A case study in “unknowable” human remains

AbstractBlack Americans have long been disproportionately represented among the victims of state‐sanctioned violence. In response, the Black community has mobilized around movements like Black Lives Matter and Say Her Name. However, the exploitation, objectification, and anonymization of Black bodies persists. In many academic disciplines, Black death and suffering are regularly presented as acceptable research findings. Here, we consider the role objectified Black bodies have played in upholding white supremacy within the context of the museum by piecing together the suspect itinerary of the individual whose skull is contained within Lion Attacking a Dromedary. This diorama, currently housed at the Carnegie Museum of Natural History in Pittsburgh, exemplifies how scientific institutions have perpetuated imperial scientific ideologies in their ongoing exhibitions. By engaging with Black feminism and decolonial frameworks, we present a path forward for such artifacts and consider how museums can truly support the Movement for Black Lives.

Acute physiology and chronic health evaluation score and mortality of patients admitted to intermediate care units of a hospital in a low- and middle-income country: A cross-sectional study from Pakistan.

Intermediate care units (IMCUs) serve as a bridge between general wards and intensive care units by providing close monitoring and rapid response to medical emergencies. We aim to identify the common acute medical conditions in patients admitted to IMCU and compare the predicted mortality of these conditions by acute physiology and chronic health evaluation-II (APACHE-II) score with actual mortality. A cross-sectional study was conducted at a tertiary care hospital from 2017 to 2019. All adult internal medicine patients admitted to IMCUs were included. Acute conditions were defined as those of short duration (<3 weeks) that require hospitalization. The APACHE-II score was used to determine the severity of these patients' illnesses. Mean (standard deviation [SD]) age was 62 (16.5) years, and 493 (49.2%) patients were male. The top three acute medical conditions were acute and chronic kidney disease in 399 (39.8%), pneumonia in 303 (30.2%), and urinary tract infections (UTIs) in 211 (21.1%). The mean (SD) APACHE-II score of these patients was 12.5 (5.4). The highest mean APACHE-II (SD) score was for acute kidney injury (14.7 ± 4.8), followed by sepsis/septic shock (13.6 ± 5.1) and UTI (13.4 ± 5.1). Sepsis/septic shock was associated with the greatest mortality (odds ratio [OR]: 6.9 [95% CI (confidence interval): 4.5-10.6]), followed by stroke (OR: 3.9 [95% CI: 1.9-8.3]) and pneumonia (OR: 3.0 [95% CI: 2.0-4.5]). Sepsis/septic shock, stroke, and pneumonia are the leading causes of death in our IMCUs. The APACHE-II score predicted mortality for most acute medical conditions but underestimated the risk for sepsis and stroke.

«Santé publique et libertés»: Considérations sur la peste dans «The Free-Thinker» (1718-1721)

In June 1720, a plague epidemic broke out in Marseille, killed half its population and, spread to Provence and Languedoc, thus arousing fears of contagion in England, where the memory of the Great Plague of London in 1664/5 was still vivid. While the English newspapers published short news on the mortality and measures taken by the French authorities, a leisure periodical, «The Free-Thinker», a bi-weekly essay paper published in London and circulated throughout the country between March 1718 and July 1721, chose to devote a series of twenty-five papers to the contagion between December 1720 and June 1721. The present study analyses the rational and liberal discourse of this periodical. It will show that at a time when the plague was the subject of many providentialist sermons, «The Free-Thinker» offered its readers an exclusively rational discourse based on the popularisation of medical, statistical and historical knowledge about the plague. «The Free-Thinker»’s arguments also echoed both the essentially preventive approach of the English government and medical polemics concerning two contagionist conceptions of the disease. Finally, although the periodical justified its series by using the argument of public good and put forward public health policies, its aim was primarily to counter a radical contagionist discourse which was considered harmful to the economic and political freedoms of its readers.

Chemical Compounds and Effectivity of Eucalyptus grandis Oil Against Sitophilus oryzae (Coleoptera: Curculionidae)

Indonesia has a lot of aromatic plants that can be distilled to obtain the essential oil. These essential oils can be used for primary component of botanical pesticides due to some components avoided by insect. The study aimed to define the component of Eucalyptus grandis and its potential to control the rice weevil Sitophilus oryzae. The formula of essential oil E. grandis with different concentrations including: 0,25%; 0,5%; 1%; 1,5%; 2%; and control were used to see the mortality of S. oryzae. The result shows that according to the Gas Chromatographic-Mass spectral (GCMS), the E. grandis contains Eucalyptol 46,86%, with the great mortality value of S. oryzae after 96 hours application was 75% at 2% concentration. Thus, the concentration of 1,88 μl/ml of E. grandis was effective to kill 50% of S. Oryzae on day 1. Meanwhile, the concentration of 17,29 μl/ml was effective to kill 95% S. oryzae on day 1. E. grandis contains the most Eucalyptol which tends to be repellent for insects. This suggests that E. grandis could be used as an insecticide alternative to control S. oryzae.

A Receita do Arcebispo de Lisboa em 1465-1466

In this paper, we analyse and publish a yet unknown account of the revenues collected by the archbishop of Lisbon in 1465-1466 kept in the British Library. When combined with other sources, this document contains new information about the control and management solutions developed by Portuguese dioceses. Also, the quantitive information it contains provides a rare window into the structural changes that agrarian output underwent in Portugal after the Black Death.

Medical and sanitary service of northern part of Bukovyna after the First World War (1918-1928)

The article deals with the main trends in the restoration and development of the medical and sanitary service in the territory of Northern Bukovyna in 1918-1928, during which martial law continued here, after which the territory became part of the Kingdom of Romania.In the first post-war period the population of the region found itself almost entirely without healthcare. Collapsed health system could not fight the spread of epidemic diseases through the region that also led to a complicated demographic situation in the post-war Bukovyna. The enduring spread of diseases among the population and, to a certain extent, the wish of Romanian authorities to use medicine for propaganda purposes forced the start of a comprehensive work to improve health and sanitary conditions in the region. The primary task that had to be urgently solved by the health service in the early post-war years has become the overcoming of the epidemics of infectious diseases that at the end of World War I led to great mortality among the population. Quite common among the residents of the region were dysentery, typhoid, typhus, relapsing fever, tuberculosis, and a number of pediatric respiratory infections – scarlet fever, measles, whooping cough, diphtheria, contagious parotitis, varicella and others. Some years there was an urgent need for the establishment of health centres, dispensaries. According to the law of 1923, the Health Service was divided into two parts: sanitary and hospital. The Sanitary Service was engaged in supervision, control and study of the health status of the settlements, the use of general and special preventive measures and prevention of epidemics, to provide medical care outside hospitals, educate the population about prevention and treatment of social diseases etc. The Hospital Service was responsible for hospital treatment and medical supervision of patients in hospitals. Bukovyna along with Khotyn district and the northern part of Moldova was included in the VIII sanitary region under the guidance of General Sanitary Inspectorate. For the operation of health service, Bukovyna was divided into five health areas, each headed by a Chief Physician. Areas were divided into sanitary districts. At the head of each one was the district doctor who had assistants, district midwives, and health agents. The duty of medical personnel was to countercheck social diseases. In this regard, 9 infirmaries and 27 dispensaries were founded in Bukovyna within 10 years (1918-1928).To avoid the spread of infectious diseases from abroad – an official centre «Grigore Ghica Vodӑ» was created to examine travellers at the border at the railway station in Nepolokivtsi.Also, in the first post-war decade for health services of the land the Sanitary Inspectorate has founded in Chernivtsi: Regional warehouse of medical instruments and devices; Regional warehouse of drugs, serums, vaccines and bandages, and the Institute of Hygiene.Compulsory preventive vaccination against smallpox and other infectious diseases was introduced. Doctors held free consultations in towns and villages both at home and in hospitals. At the same time, in the first post-war decade a decrease of doctors and paramedical staff is observed.Taking into consideration the shortage of a sufficient number of hospitals, clinics, doctors, nurses, lack of medicines, vaccines, therapeutic sera in Bukovyna, it should be ascertained that the state of epidemic diseases in the region in the early post-war years remained extremely hard. Only in the mid-20s such diseases as smallpox, typhus, and dysentery had been largely overcome thanks to vaccination, organizational and educational measures taken by the authorities. However, there remained high death rate from heart diseases, pneumonia, tuberculosis, due to difficult living conditions and inaccessibility of health care to the most.

Firearm Assaults in Communities: The Impact of COVID-19 Lockdown.

Firearm violence has increased nationwide, with recent surges linked to the COVID-19 pandemic. We measured traumatic assault trends at our urban Level I trauma center and assessed rates of firearm violence over time and pre/post local COVID-19 lockdown based on levels of socioeconomic disadvantage. We conducted a retrospective review (2016-2022) of assault patients 16years and older. Demographics and hospital outcomes were assessed by assault mechanism (firearm, knife, blunt). Patient address was correlated to Area Deprivation Index (ADI), a measure of socioeconomic disadvantage. COVID-19 lockdown onset was defined as initial date of lockdown (3/19/2020). Trend and time-series analyses compared all assault mechanisms and firearm-specific assaults pre/post-lockdown. Poisson regression assessed firearm assault risk. Of the 1583 total assaults, firearm patients (n = 335) were younger (median 29years), had longer hospital stays (median 2days), and greater mortality (12%) than other mechanisms. The 2years post-lockdown had significantly more firearm assaults (27% vs 15% pre-lockdown, P < .001) and time-series analysis found this abrupt and significant increase in firearm assaults occurred at lockdown onset (P = .01). Also post-lockdown, the rate of firearm assaults increased by 10% for every unit increase in socioeconomic deprivation (P < .01). There was no change in assault type by race/ethnicity. Firearm assaults increased dramatically immediately post-COVID lockdown at our center and have maintained higher rates through 2022. Greater ADI was associated with increasing firearm assaults and has magnified post-lockdown, demonstrating lower socioeconomic groups are disproportionately and increasingly affected by firearm violence.

Tobacco smoking is associated with combined pulmonary fibrosis and emphysema and worse outcomes in interstitial lung disease.

Tobacco smoking is an established cause of pulmonary disease whose contribution to interstitial lung disease (ILD) is incompletely characterized. We hypothesized that compared with nonsmokers, subjects who smoked tobacco would differ in their clinical phenotype and have greater mortality. We performed a retrospective cohort study of tobacco smoking in ILD. We evaluated demographic and clinical characteristics, time to clinically meaningful lung function decline (LFD), and mortality in patients stratified by tobacco smoking status (ever vs. never) within a tertiary center ILD registry (2006-2021) and replicated mortality outcomes across four nontertiary medical centers. Data were analyzed by two-sided t tests, Poisson generalized linear models, and Cox proportional hazard models adjusted for age, sex, forced vital capacity (FVC), diffusion capacity of the lung for carbon monoxide (DLCO), ILD subtype, antifibrotic therapy, and hospital center. Of 1,163 study participants, 651 were tobacco smokers. Smokers were more likely to be older, male, have idiopathic pulmonary fibrosis (IPF), coronary artery disease, CT honeycombing and emphysema, higher FVC, and lower DLCO than nonsmokers (P < 0.01). Time to LFD in smokers was shorter (19.7 ± 20 mo vs. 24.8 ± 29 mo; P = 0.038) and survival time was decreased [10.75 (10.08-11.50) yr vs. 20 (18.67-21.25) yr; adjusted mortality HR = 1.50, 95%CI 1.17-1.92; P < 0.0001] compared with nonsmokers. Smokers had 12% greater odds of death for every additional 10 pack yr of smoking (P < 0.0001). Mortality outcomes remained consistent in the nontertiary cohort (HR = 1.51, 95%CI = 1.03-2.23; P = 0.036). Tobacco smokers with ILD have a distinct clinical phenotype strongly associated with the syndrome of combined PF and emphysema, shorter time to LFD, and decreased survival. Smoking prevention may improve ILD outcomes.NEW & NOTEWORTHY Smoking in ILD is associated with combined pulmonary fibrosis and emphysema and worse clinical outcomes.

Religion in times of epidemics, a matter of public health: Great plague of Marseille (FRA, 1720–1722) Covid-19 (2020–…), a narrative review

Humans have always referred to religion in History to explain disasters, and epidemics, especially when science could not explain them. Religion has often been invoked as a mean of protection. The Covid outbreak in 2020 and the initial medical impotence brought up old fears, reminiscent of the plague for some people. Unable to rely on science only, some turned back to religion. A narrative review was conducted to compare the role of religion during the Great Plague of Marseille versus the early stages of Covid-19 pandemic. We mostly studied contemporary documents on the Great Plague of Marseille, and collected press articles on Covid-19. For both epidemics, some people see in the outbreak a sign of God's revenge. Logically, intensifying spiritual life and multiplying religious demonstrations can be a way to fight both epidemics. Studying religion in these times of epidemics also highlights its roles in public health: sometimes facilitating the contaminations if not regulated, sometimes supporting public health policies with some positions, as for Covid vaccines. Conclusion/Perspectives: The comparison of an ancient epidemic with the current pandemic allowed us to take a broader look at the current vision of contagious disease, in societies that have become highly medicalized. The fight against epidemics remains polymorphous, and one of the aspects is religious. Integrating this information in our practices can help improving holistic management of patients, and public health policies efficiency.

THE RELATIONSHIP BETWEEN VITAMIN D DEFICIENCY AND THE SEVERITY OF COVID-19

The global health issue known as the COVID-19 pandemic, resulting from the SARS-CoV-2 virus, has prompted extensive research into factors affecting the severity of the disease. Among these factors, the connection between vitamin D levels and the outcomes of COVID-19 has become an increasingly intriguing field of study.&#x0D; Vitamin D is a fat-soluble vitamin renowned for its importance in bone health and immune system regulation. According to the latest studies, inadequate levels of vitamin D might be linked to a higher susceptibility to various respiratory infections. As a result, researchers are investigating the potential impact of vitamin D on the severity of COVID-19.&#x0D; Multiple observational investigations have found a link among a lack of vitamin D and a higher vulnerability to respiratory infections such as COVID-19. Some studies have revealed that individuals with inadequate vitamin D levels had more severe COVID-19 symptoms, greater rates of admission to the hospital, and a greater mortality rate than those with adequate vitamin D levels. Vitamin D is thought to help regulate the immune response by influencing both the adaptive as well as the innate immune systems. Deficiency may affect immunological function, resulting in an altered antiviral response and increased inflammation, which may contribute to the development of COVID-19.&#x0D; It is crucial to emphasize, however, that the existing research on the connection with insufficient vitamin D levels and the severity of COVID-19 are continuously evolving, with contradicting findings reported. There are significant constraints to the extant research, particularly differences in study methodologies, sample sizes, also populations investigated. Furthermore, it remains uncertain whether there is a cause-and-effect relationship between vitamin D deficiency and COVID-19 severity, as the observed relationships might be impacted by other confounding variables. Given vitamin D's possible involvement in immune function and the existing data linking it to COVID-19 severity, further well-designed research, particularly randomized controlled trials, are needed to demonstrate a causal relationship.

Contextualising the Impact of COVID-19 Pandemic on Attitudes of People to Follow SOPs: Study of Smart Lockdown across Generation X, Y and Z in Pakistan

Pandemics such as the Black Death and cholera in the past sowed doubt among the human population and triggered widespread fear and panic. When it comes to the COVID-19 pandemic, people all around the world seem to have the same reactions. This study aimed to determine if and to what extent people's compliance with SOPs affects the rate at which the disease spreads. This study uses the theoretical underpinnings laid out by the Theory of Planned Behavior (TPB) and the Protection Motivation Theory (PMT) to inquire about people's awareness, understanding, and perspectives. Intentions toward COVID-19 SOPs were investigated by digging into these independent factors. Voluntary and non-voluntary control behaviour intents can be predicted by the independent variables. The research is conducted in two phases and used a combination of methods, i.e., quantitative and qualitative. The findings from Stage I's demographic exploration has been put to the test in Stage II's empirical analysis. Also, the results were compared over three generations (X, Y, and Z) to examine generational differences and determine whether or not adjusting to how individuals of different ages see pandemics will help reduce their societal impact. Among the three selected generations, Gen Z was the most influenced by information and advice campaigns to build a perception of danger that has shaped their protective behaviour, as evidenced by the results of the qualitative study's 42 face-to-face interviews. Yet, Gen Y and Z were more influenced by informal standards. In stage II, the questionnaire (n=510) was used to conduct empirical testing of the topics identified in qualitative thematic analysis, and the results indicated that risk perception was a significant predictor of protective behaviour. No substantial moderating influence of risk perception on knowledge and protective behaviour was found, according to mediation and moderation analysis.

Default prediction of small and medium enterprises: Portuguese construction sector

PurposeThis paper aims to study the default risk of small and medium-sized enterprises in the construction sector.Design/methodology/approachAn unbalanced sample of 2,754 Portuguese companies from the construction sector, from 2008 to 2020, is analysed. Companies are classified in default or compliant following an ex-ante criterion. Then, using the stepwise analysis, the most relevant variables are selected, which are later used in the logit model. To verify the robustness of the results, a sample of legally insolvent companies is added (mixed criterion) and the initial sample is split into two subperiods.FindingsFinancial variables are the most relevant to predict the pattern for this sample. The main conclusions show that smaller and older companies, more indebted, with more liquidity and with higher EBIT have a higher probability of default. These conclusions are confirmed using a mixed criterion to classify companies as default or compliant and including a macroeconomic dummy.Practical implicationsThis work not only contributes to enlarging the literature review but also makes relevant contributions to practice. Companies from the construction sector can understand which indicators must control to avoid financial problems. The government also has relevant information that can help in adapting or creating regulations for recovering or revitalizing companies.Originality/valueThis study proposed an ex-ante criterion that can be used for all types of companies. Most works use a legal or a mixed criterion that does not allow for detecting signs of financial problems in advance. Moreover, the sample used is almost unexplored – SMEs from a sector with great mortality rate.

Descriptive Study Evaluating Nurses Knowledge and Practices Regarding Tracheostomy Care in ICU Patients.

Background: ICU patient tracheostomy care is a fundamental nursing procedure. The tracheostomy might result in difficulties and causes a great deal of anxiety in patients. A low level of care can have negative consequences such as longer hospital stays, slower recovery times, and greater mortality rates. Aim: To evaluate nurses' tracheostomy care knowledge and practises in ICU patients. Study Design: The descriptive research study design was used. Methodology: 75 nurses who worked in the ICU of three public hospitals in Lahore—Mayo Hospital, Jinnah Hospital, and Shaikh Zayed Hospital—were included in the study's sample. Nurses' practises were assessed by direct observation using a checklist, and their knowledge was assessed using a self-structured questionnaire. The analysis of the data was done using SPSS v 20.0. Results: All participants in the study were ICU nurses. This data makes clear that 0 - 49% of nurses have low knowledge, while 50 - 64% of nurses have average knowledge, and &gt;65% of nurses have adequate knowledge. Conclusion: The majority of participants had sufficient understanding of tracheostomy care. Additionally, it demonstrates that out of 75 nurses, only 0–59% had insufficient skill and &gt; 60% had a sufficient level of performance. Practical Implementation: This study assisted researchers in examining the risk variables related to Tracheostomy treatment in ICU patients because of the increasing number of patients in the ICU. Conclusion: It was concluded that, despite having sufficient information, nurses performed poorly when providing tracheostomy care. Therefore, for the safety of patients, health care facilities must provide organized clinical guidelines and practices. Keywords: Assessment, Knowledge, Practice, Nursing Care and Tracheostomy.