Elevated Risk Of Morbidity Research Articles

WP4.5 - Changes in Social Care Post Major Emergency General Surgery Procedures

Abstract Introduction Emergency General Surgery (EGS) is a major part of the provision of healthcare and patients undergoing EGS are at elevated risk of morbidity and mortality. The aim of this study is to determine factors contributing to patients losing their independence and being discharged to residential and nursing homes having previously lived in their own residences. Methods Data from patients in the NELA database (2014-2022) was analysed, considering demographics, ASA score, admission and discharge dates, presenting pathology, operation type, and discharge destination. Comparative analyses segmented patients based on post-discharge EGS destinations. Multivariable logistic regression identified factors linked to residential/nursing home placement post-discharge. Significance was set at p<0.05. Results Data from all patients in the NELA database (n=1,611) was analysed. Nearly one in ten patients over the age of 70 never returned home. Patients requiring additional support were on average 8.6 years older (p=0.008). Over the age of 80 years, the need for extra social support increased substantially with each increasing year in age and those over the age of 85 years old were more than twice as likely to require extra support than 80-year-olds (p<0.001). Patients who died were 11.4 years older compared to those discharged without additional support (p<0.001). Conclusion A significant proportion of patients, particularly the elderly, do not return to their usual place of residence and require a higher level of care post-emergency surgery. These important social factors need to be considered before operating as they may have significant quality of life and economic implications.

Surgical intervention for lung cancer in patients aged 75 and above: potential associations with increased mortality rates—a single-center observational study

BackgroundLung cancer, which is diagnosed two to three times more frequently in patients over the age of 70, is a leading cause of cancer-specific mortality. Given the elevated risk of morbidity and mortality, surgical intervention may not always be the most appropriate primary treatment option. This study aims to evaluate specific risk factors associated with postoperative morbidity and mortality in elderly patients and to optimize patient selection therefore improving surgical outcomes.Patients and methodsThe study encompassed a cohort of 73 patients aged 75 and above who underwent surgical treatment for non-small cell lung cancer (NSCLC) at the Department of Thoracic Surgery of the P. Hertsen Moscow Oncological Research Institute between 2015 and 2021. All patients underwent preoperative evaluation, including PET/CT staging and functional assessment, carried out by a multidisciplinary team comprising thoracic surgeons, anesthesiologists, and other medical specialists.ResultsThe investigation revealed a postoperative mortality rate of 5.5% and a postoperative morbidity incidence of 16.4%, with occurrences of atrial fibrillation in 41.6%, persistent air leak in 33.3%, and pneumonia in 25% of complicated cases. At the one-year follow-up, 88% of patients remained free from relapse, whereas at three years, this rate stood at 66%. During the follow-up period, 16 patients (22%) passed away, with a median survival duration of 44 months. Survival rates at one year, three years, and five years were 71%, 66%, and 35%, respectively. Multivariate analysis disclosed several significant factors predicting a complex postoperative period, including stage IIIb (p = 0.023), pN1 (p = 0.049), pN2 (p = 0.030), and central location (p = 0.007). Additionally, overall survival was primarily influenced by a Charlson comorbidity index of 6 (p = 0.044), stage Ia2 (p = 0.033), and the necessity for thoracotomy (p = 0.045).ConclusionEach case of lung cancer in patients aged 75 and older necessitates an individualized approach. Given the higher mortality rate relative to younger patients, comprehensive risk assessment and preoperative management of underlying comorbidities are imperative, with the involvement of anesthesiologists, intensive care physicians, cardiologists, and other relevant specialists as needed.

Cerebral microbleeds in patients with COVID-19: is there an inevitable connection?

The COVID-19 pandemic has underscored the critical interplay between systemic infections and neurological complications, notably cerebral microbleeds. This comprehensive review meticulously aggregates and analyses current evidence on cerebral microbleeds' prevalence, pathophysiological underpinnings and clinical implications within COVID-19 cohorts. Our findings reveal a pronounced correlation between cerebral microbleeds and increased severity of COVID-19, emphasizing the role of direct viral effects, inflammatory responses and coagulation disturbances. The documented association between cerebral microbleeds and elevated risks of morbidity and mortality necessitates enhanced neurological surveillance in managing COVID-19 patients. Although variability in study methodologies presents challenges, the cumulative evidence substantiates cerebral microbleeds as a critical illness manifestation rather than mere coincidence. This review calls for harmonization in research methodologies to refine our understanding and guide targeted interventions. Prioritizing the detection and study of neurological outcomes, such as cerebral microbleeds, is imperative for bolstering pandemic response strategies and mitigating the long-term neurological impact on survivors.

Risk perception of patients with chronic illnesses toward the SARS-CoV-2 in northeastern Ethiopia in 2020

IntroductionSever Acute Respiratory Syndrome Corona Virus 2 infections have been sharply rising in Ethiopia, and the virus significantly increases morbidity and fatality rates in patients with coexisting chronic conditions. Therefore, the purpose of this study was to evaluate Risk perception of patients with chronic illnesses toward the SARS-CoV-2 in northeastern Ethiopia in 2020. MethodsFrom July 21 to August 5, 2020, a cross-sectional study was carried out in a hospital setting with individuals who had chronic illnesses. The study populations included all patients with chronic conditions. The study employed multivariable logistic regression analysis to determine the factors that influence patients' evaluation of the Sever Acute Respiratory Syndrome Corona Virus 2 as low-risk. ResultsFour hundred thirteen chronic illness patients participated in this study. Overall, individuals' perceptions of their risk of contracting the Sever Acute Respiratory Syndrome Corona Virus 2 were low in 37.3 % (95 % CI: 32.4–41.9). The results of multivariable analysis showed that low perception of risk towards the outcome was strongly correlated with young adults (AOR = 2.21; 95 % CI: 1.26–3.87), female sex (AOR = 2.16; 95 % CI: 1.37–3.42), and face mask nonusers (AOR = 2.17; 95 % CI: 1.35–3.49). ConclusionAccording to this survey, a significant number of patients thought the pandemic posed little risk. The sense of low-risk towards the disease was independently predicted by being female, being a young adult, and not wearing face masks. Patients with chronic illnesses must get focused and enhanced health education in order to lower their elevated risk of morbidity and death.

Recent Progress in Molecular Probes for Imaging of Acute Kidney Injury.

Acute kidney injury (AKI), a prevalent and complex clinical condition associated with elevated risks of morbidity and mortality, necessitates the meticulous detection and monitoring of kidney damage globally. Biomedicine has shown keen interest in molecular probes and detectors for AKI due to their sensitivity, rapidity, and cost-effectiveness. Bioimaging technologies play a significant role in identifying and quantifying AKI indicators, enhancing diagnostic approaches, and potentially refining clinical therapies for immediate injury control. Molecular probes serve as valuable tools for drug screening, uncovering renoprotective components, signaling pathways, and the nephrotoxic effects of drugs. This review comprehensively summarizes the latest advancements in molecular probes, emphasizing their exceptional efficacy in various characteristics, including renal cleanability, multichannel detection capability, near-infrared-II responsiveness, and reactivity toward reactive oxygen species. These probes offer enhanced benefits for assessing kidney damage and evaluating the therapeutic effects of medications while simultaneously reducing toxic effects. Additionally, the review delves into future potentials and challenges in this field, aiming to inspire the development and enhancement of molecular bioimaging for the early diagnosis and treatment of kidney diseases.

Improving Influenza Vaccination Coverage in Patients with Cancer: A Position Paper from a Multidisciplinary Expert Group.

Patients with cancer can be immunocompromised because of their disease and/or due to anticancer therapy. In this population, severe influenza virus infections are associated with an elevated risk of morbidity and mortality. Influenza vaccination is therefore highly recommended in cancer patients, including those receiving anticancer therapy. However, vaccination coverage remains far below the recommended target for vulnerable subjects. Six specialists in oncology, hematology, immunology, and public health/vaccinology convened with the objective of developing strategies, based on evidence and clinical experience, for improving influenza vaccination coverage in cancer patients. This viewpoint provides an overview of current influenza vaccination recommendations in cancer patients, discusses barriers to vaccination coverage, and presents strategies for overcoming said barriers. New immunization issues raised by the COVID-19 pandemic are also addressed. Future directions include improving public education on influenza vaccination, providing the media with accurate information, improving knowledge among healthcare professionals, improving access to vaccines for cancer patients, co-administration of the influenza and COVID-19 vaccines, increased collaboration between oncologists and other health professionals, increased accessibility of digital vaccination registries to specialists, shared information platforms, and promoting immunization campaigns by healthcare systems with the support of scientific societies.

Rutin Promotes Wound Healing by Inhibiting Oxidative Stress and Inflammation in Metformin-Controlled Diabetes in Rats.

Diabetes mellitus (DM) is a metabolic disorder with a notable increase in global incidence in recent years. Individuals diagnosed with diabetes are at an elevated risk of morbidity and mortality compared with the general population. For several years, the potential of phytochemicals as anti-inflammatory agents to improve the healing of diabetic wounds has been under investigation. Rutin, a flavonoid, is a particularly promising candidate for use in wound healing. Our study aims to investigate the potential impact of a topical application of rutin nanoformulation on wound healing in streptozotocin (STZ)-induced hyperglycemic rats controlled with metformin, with a focus on its anti-inflammatory and antioxidant properties. Rats are randomized into 3 groups. GI: diabetic control group; wound untreated. GII: diabetes and rutin-NP-treated wound. GIII: diabetic + β-sitosterol-treated wound. The findings suggest that topical application of rutin-NPs has the potential to enhance the wound-healing process by attenuating oxidative stress, as evidenced by restoring GSH, CAT, and SOD antioxidants, and decreasing MDA production mediated by Nrf2 activation. Also, inflammation is suppressed, as indicated by the decreased CRP, IL-1β, IL-6, and TNF-α levels. Molecular docking data confirm the biological data of rutin, where rutin is docked into the catalytic site of the X-ray crystallographic structures of CRP, Keap-1, IL-1β, IL-6, and TNF-α via grid-based ligand docking. The binding affinity and binding energy of ligand-protein interactions demonstrate the affinity and binding to the specifically selected proteins.

Longitudinal adherence to surveillance for late effects of cancer treatment: a population-based study of adult survivors of childhood cancer.

Adult survivors of childhood cancer are at elevated risk of morbidity and mortality compared to the general population, but their adherence to lifelong periodic surveillance is suboptimal. We aimed to examine adherence to surveillance guidelines for high-yield tests and identify risk factors for nonadherence in adult survivors of childhood cancer. In this retrospective, population-based cohort study, we used health care administrative data from Ontario, Canada, to identify adult survivors of childhood cancer diagnosed between 1986 and 2014 who were at elevated risk of therapy-related colorectal cancer, breast cancer, or cardiomyopathy. Using a Poisson regression framework, we assessed longitudinal adherence and predictors of adherence to the Children's Oncology Group surveillance guideline. Among 3241 survivors, 327 (10%), 234 (7%), and 3205 (99%) were at elevated risk for colorectal cancer, breast cancer, and cardiomyopathy, respectively. Within these cohorts, only 13%, 6%, and 53% were adherent to recommended surveillance as of February 2020. During a median follow-up of 7.8 years, the proportion of time spent adherent was 14% among survivors at elevated risk for colorectal cancer, 10% for breast cancer, and 43% for cardiomyopathy. Significant predictors of adherence varied across the risk groups, but higher comorbidity was associated with adherence to recommended surveillance. Survivors of childhood cancer in Ontario are rarely up to date for recommended surveillance tests. Tailored interventions beyond specialized clinics are needed to improve surveillance adherence.

Changes in social care after major emergency general surgery procedures

IntroductionEmergency General Surgery (EGS) is a major part of the provision of healthcare and patients undergoing EGS are at elevated risk of morbidity and mortality. The aim of this study is to determine factors contributing to patients losing their independence and being discharged to residential and nursing homes having previously lived in their own residences. MethodsOur local data uploaded to the National Emergency Laparotomy Audit (NELA) database (2014-2022) was analysed. This national database encompasses all major emergency general surgery cases undertaken in the United Kingdom. The variables considered were patient demographics, ASA score, admission and discharge dates, presenting pathology, operation type, and discharge destination. Comparative analyses segmented patients based on post-discharge EGS destinations. Multivariable logistic regression identified factors linked to residential/nursing home placement post-discharge. Significance was set at p<0.05. ResultsData from all patients in the NELA database (n=1,611) was analysed. Nearly one in ten patients over the age of 70 never returned home. Patients requiring additional support were on average 8.6 years older (p=0.008). Over the age of 80 years, the need for extra social support increased substantially with each increasing year in age and those over the age of 85 years old were more than twice as likely to require extra support than 80-year-olds (p<0.001). Patients who died were 11.4 years older compared to those discharged without additional support (p<0.001). ConclusionA significant proportion of patients, particularly the elderly, do not return to their usual place of residence and require a higher level of care post-emergency surgery. These important social factors need to be considered before operating as they may have significant quality of life and economic implications.

Protocol for the ONLOOP trial: pragmatic randomized trial evaluating a province-wide system of personalized reminders for evidence-based surveillance tests in adult survivors of childhood cancer in Ontario

BackgroundChildhood cancer treatment while often curative, leads to elevated risks of morbidity and mortality. Survivors require lifelong periodic surveillance for late effects of treatment, yet adherence to guideline-recommended tests is suboptimal. We created ONLOOP to provide adult survivors of childhood cancer with detailed health information, including summaries of their childhood cancer treatment and recommended surveillance tests for early detection of cardiomyopathy, breast cancer, and/or colorectal cancer, with personalized reminders over time.MethodsThis is an individually randomized, registry-based pragmatic trial with an embedded process and economic evaluation to understand ONLOOP’s impact and whether it can be readily implemented at scale. All adult survivors of childhood cancer in Ontario overdue for guideline-recommended tests will be randomly assigned to one of two arms: (1) intervention or (2) delayed intervention. A letter of information and invitation will detail the ONLOOP program. Those who sign up will receive a personalized toolkit and a screening reminder 6 months later. With the participants’ consent, ONLOOP will also send their primary care clinician a letter detailing the recommended tests and a reminder 6 months later.The primary outcome will be the proportion of survivors who complete one or more of the guideline-recommended cardiac, breast, or colon surveillance tests during the 12 months after randomization. Data will be obtained from administrative databases. The intent-to-treat principle will be followed. Based on our analyses of administrative data, we anticipate allocating at least 862 individuals to each trial arm, providing 90% power to detect an absolute increase of 6% in targeted surveillance tests completed. We will interview childhood cancer survivors and family physicians in an embedded process evaluation to examine why and how ONLOOP achieved success or failed. A cost-effectiveness evaluation will be performed.DiscussionThe results of this study will determine if ONLOOP is effective at helping adult survivors of childhood cancer complete their recommended surveillance tests. This study will also inform ongoing provincial programs for this high-risk population.Trial registrationClinicalTrials.gov NCT05832138.

Technology and physical activity for preventing cognitive and physical decline in older adults: Protocol of a pilot RCT.

Cognitive frailty, defined as having both physical frailty and cognitive impairment that does not satisfy the criteria for Major Neurocognitive Disorder, represents an elevated risk for morbidity. Hence, it is crucial to mitigate such risks. Physical activity interventions have been found effective in protecting against physical frailty and cognitive deterioration. This pilot RCT examines if smartwatches and mobile phone applications can help to increase physical activity, thereby improving physical and cognitive outcomes. Older individuals (n = 60) aged 60 to 85 years old will have their physical activity tracked using a smartwatch. The subjects will be randomized into two arms: one group will receive daily notification prompts if they did not reach the recommended levels of PA; the control group will not receive prompts. Outcome variables of physical activity level, neurocognitive scores, and physical frailty scores will be measured at baseline, T1 (3 months), and T2 (6 months). Sleep quality, levels of motivation, anxiety, and depression will be controlled for in our analyses. We hypothesize that the intervention group will have higher levels of physical activity resulting in improved cognitive and physical outcomes at follow-up. This study was approved by the National University of Singapore's Institutional Review Board on 17 August 2020 (NUS-IRB Ref. No.: H-20-038). Wearable sensors technology could prove useful by facilitating self-management in physical activity interventions. The findings of this study can justify the use of technology in physical activity as a preventive measure against cognitive frailty in older adults. This intervention also complements the rapidly rising use of technology, such as smartphones and wearable health devices, in our lives today. This study has been retrospectively registered on clinicaltrials.gov on 5th January 2021 (NCT Identifier: NCT04692974), after the first participant was recruited.

Education and training on preparing complementary feeding (MP-ASI) from local ingredients to prevent stunting

Stunting can occur during fetal development and becomes apparent when the child reaches two years of age. Without proper intervention, such as balanced catch-up growth, stunting can lead to decreased overall growth. This issue is a significant public health concern, associated with an elevated risk of morbidity, mortality, and impediments to both motor and mental development. One proactive approach to address stunting involves education and training in the preparation of Complementary Feeding (MP-ASI) using locally sourced snakehead fish and Moringa leaves. Our observations, conducted until September 2022, revealed that out of 109 children in Sidoarum Village, 34 were identified as stunted. Our initiative commenced with socialization efforts and progressed to educational sessions and practical training in MP-ASI preparation using local ingredients. Participants in these sessions included 40 mothers of toddlers. Notably, 75% of the participants demonstrating high knowledge following the stunting education and MP-ASI preparation training. In addition to enhancing maternal understanding of stunting prevention, our service providers conducted assessments of toddlers' growth and development.

The Impact of Portal Hypertension Assessment Method on the Outcomes of Hepatocellular Carcinoma Resection: A Meta-Analysis of Matched Cohort and Prospective Studies.

Examine portal hypertension (PHT) impact on postoperative and survival outcomes in hepatocellular carcinoma (HCC) patients after liver resection (LR), specifically exploring distinctions between indirect signs and invasive measurements of PHT. PHT has historically discouraged LR in individuals with HCC due to the elevated risk of morbidity, including liver decompensation (LD). A systematic review was conducted using 3 databases to identify prospective-controlled and matched cohort studies until December 28, 2022. Focus on comparing postoperative outcomes (mortality, morbidity, and liver-related complications) and overall survival in HCC patients with and without PHT undergoing LR. Three meta-analysis models were utilized: for aggregated data (fixed-effects inverse variance model), for patient-level survival data (one-stage frequentist meta-analysis with gamma-shared frailty Cox proportional hazards model), and for pooled data (Freeman-Tukey exact and double arcsine method). Nine studies involving 1124 patients were analyzed. Indirect signs of PHT were not significantly associated with higher mortality, overall complications, PHLF or LD. However, LR in patients with hepatic venous pressure gradient (HVPG) ≥10mmHg significantly increased the risk of overall complications, PHLF, and LD. Despite elevated risks, the procedure resulted in a 5-year overall survival rate of 55.2%. Open LR significantly increased the risk of overall complications, PHLF, and LD. Conversely, PHT did not show a significant association with worse postoperative outcomes in minimally invasive LR. LR in the presence of indirect signs of PHT poses no increased risk of complications. Yet, in HVPG ≥10mmHg patients, LR increases overall morbidity and liver-related complications risk. Transjugular HVPG assessment is crucial for LR decisions. Minimally invasive approach seems to be vital for favorable outcomes, especially in HVPG ≥10mmHg patients.

Myostatin as a Prognostic Biomarker in Hepatic Cirrhosis Patients with Sarcopenia

Cirrhosis represents the advanced stage of numerous chronic liver conditions. Sarcopenia is a frequently overlooked complication in cirrhotic patients, resulting from factors such as insufficient protein intake, malabsorption, diminished muscle growth, and increased muscle breakdown. Sarcopenia is a multifaceted, chronic condition associated with elevated risks of morbidity and mortality. In the field of hepatology, sarcopenia is typically described as a phenotypic indication of muscle mass loss, affecting approximately 30-70% of liver cirrhosis patients. Sarcopenia has been scientifically linked to an increased risk of falls, reduced quality of life, the emergence of acute decompensated liver failure, and mortality in cirrhotic patients. Myostatin, classified as a cytokine within the transforming growth factor beta (TGF-β) family, is recognized for its role in disrupting protein synthesis. It functions as a negative regulator of muscle growth, inhibiting myogenesisand is linked to the onset of sarcopenia. Extensive literature supports the prognostic importance of sarcopenia in cirrhosis, and serum myostatin levels have the potential to serve as a valuable biomarker. Elevated myostatin concentrations have been linked to the presence of sarcopenia and decreased survival rates in individuals diagnosed with liver cirrhosis.

Advance Care Planning and Palliative Care Consultation in Kidney Transplantation

Because of the high risk of waitlist mortality and posttransplant complications, kidney transplant (KT) patients may benefit from advance care planning (ACP) and palliative care consultation (PCC). We quantified the prevalence and racial disparities in ACP and PCC among KT candidates and recipients. Prospective cohort study. 2,575 adult KT candidates and 1,233 adult recipients (2008-2020). Race and ethnicity. All reports of ACP and PCC were abstracted from chart review. ACP was defined as patient self-report of an advance directive, presence of an advance directive in the medical record, or a documented goals-of-care conversation with a provider. PCC was defined as an ordered referral or a documented palliative care note in the medical record. Racial/ethnic disparities in ACP/PCC were estimated using adjusted logistic regression. 21.4% of KT candidates and 34.9% of recipients engaged in ACP. There were racial/ethnic disparities in ACP among KT candidates (White, 24.4%; Black, 19.1%; Hispanic, 15%; other race and ethnicity, 21.1%; P=0.008) and recipients (White, 39.5%; Black, 31.2%; Hispanic, 26.3%; other race and ethnicity, 26.6%; P=0.007). After adjustment, Black KT recipients had a 29% lower likelihood of engaging in ACP (OR, 0.71; 95% CI, 0.55-0.91) than White KT recipients. Among older (aged≥65 years) recipients, those who were Black had a lower likelihood of engaging in ACP, but there was no racial disparity among younger recipients (P=0.020 for interaction). 4.2% of KT candidates and 5.1% of KT recipients engaged in PCC; there were no racial disparities in PCC among KT candidates (White, 5.3%; Black, 3.6%; Hispanic, 2.5%; other race and ethnicity, 2.1%; P=0.13) or recipients (White, 5.5%; Black, 5.6%; Hispanic, 0.0%; other race and ethnicity, 1.3%; P= 0.21). Generalizability may be limited to academic transplant centers. ACP is not common among KT patients, and minoritized transplant patients are least likely to engage in ACP; PCC is less common. Future efforts should aim to integrate ACP and PCC into the KT process. Kidney transplant (KT) candidates and recipients are at elevated risk of morbidity and mortality. They may benefit from completing a document or conversation with their palliative care provider that outlines their future health care wishes, known as advance care planning (ACP), which is a component of palliative care consultation (PCC). We wanted to determine how many KT candidates and recipients have engaged in ACP or PCC and identify potential racial disparities. We found that 21.4% of candidates and 34.9% of recipients engaged in ACP. After adjustment, Black recipients had a 29% lower likelihood of engaging in ACP. We found that 4.2% of KT candidates and 5.1% of KT recipients engaged in PCC, with no racial disparities found in PCC.

Diagnostic Utility of Aldosterone/Direct Renin Concentration Ratio in Iraqi Patients with High Arterial Blood Pressure: A Pilot Study

&#x0D; &#x0D; &#x0D; Objectives: Primary aldosteronism is a prevalent contributor to secondary hypertension, posing an elevated risk of morbidity and mortality. The initial step in diagnosing this condition involves screening individuals suspected of having it.&#x0D; Methods: In our study, we enrolled 50 patients who were suspected of having hyperaldosteronism. We provided specific recommendations and instructions to these patients concerning drug therapy and implemented measures to enhance testing accuracy. The tests were conducted using the Chemiluminescence Immunoassay (CLIA) system procedure, relying on plasma direct renin concentration rather than activity. Our findings were meticulously validated, compared, and aligned with the references from ARUP laboratories.&#x0D; Results: Among our participants, 4 patients (8%) were unequivocally diagnosed with primary aldosteronism based on the Aldosterone Direct Renin Concentration (ADRR) criteria. These patients exhibited the trifecta of hypokalemia, elevated aldosterone levels, and diminished renin levels, obviating the need for further confirmatory testing. Furthermore, 13 patients (26%) were deemed likely candidates for primary aldosteronism, given their plasma aldosterone levels exceeding 15 ng/dl and renin levels below 2.5 pg/ml. Additionally, 7 patients (14%) displayed strong indications of primary aldosteronism, characterized by plasma aldosterone levels surpassing 21 ng/dl and plasma renin concentrations below 2.5 pg/ml, accompanied by high ADRR values. However, both the "likely" and "strong indication" groups necessitated confirmatory testing. Notably, our results revealed no significant disparities in age, gender, personal or family history of atherosclerotic cardiovascular disease (ASCVD), or the presence of adrenal adenomas between patients diagnosed with primary aldosteronism and those in the non-aldosteronism group within the study.&#x0D; Conclusion: Primary aldosteronism is a prevalent health concern, warranting the screening of highly suspicious patients. Utilizing direct renin concentration, instead of renin activity, offers a straightforward, cost-effective, rapid, and reproducible method for diagnosis.&#x0D; &#x0D; &#x0D;

Does choice of outdoor heat metric affect heat-related epidemiologic analyses in the US Medicare population?

We calculated daily maximum, minimum, and mean outdoor air temperature (T), heat index (HI), wet-bulb globe temperature (WBGT), and Universal Thermal Climate Index (UTCI) for populous US counties and linked estimates with daily all-cause mortality and heat-related hospitalizations among Medicare beneficiaries (2006-2016). We fit distributed-lag nonlinear models for each metric and compared relative risks (RRs) at the 99th percentile. Across all heat metrics, extreme heat was statistically significantly associated with elevated risks of morbidity and mortality. Associations were more pronounced for maximum daily values versus the corresponding minimum for the same metric. The starkest example was between HImax (RR = 1.14; 95% confidence interval [CI] = 1.12, 1.15) and HImin (RR = 1.10; 95% CI = 1.09, 1.11) for hospitalizations. When comparing RRs across heat metrics, we found no statistically significant differences within the minimum and maximum heat values (i.e., no significant differences between Tmax/HImax/WBGTmax/UTCImax or between Tmin/HImin/WBGTmin/UTCImin). We found similar relationships across the National Climate Assessment regions. Among Medicare beneficiaries in populous US counties, daily maximum and mean values of outdoor heat are associated with greater RRs of heat-related morbidity and all-cause mortality versus minimum values of the same metric. The choice of heat metric (e.g., temperature versus HI) does not appear to substantively affect risk calculations in this population.

Intimate Partner Violence and Children Under 5 Morbidities and Mortality in Afghanistan: Findings From a National Survey.

Limited knowledge exists concerning the prevalence and drivers of intimate partner violence (IPV) against Afghan women and its association with child morbidity and mortality in Afghanistan. The study used data from the 2015 Afghanistan Demographic and Health Survey (ADHS 2015). The prevalence and associated sociodemographic factors of IPV were described by analyzing the data from Afghan women aged 15 to 49 years selected for the IPV module in ADHS 2015 (n = 24,070) whose children under 5 (n = 22,927) were included in the further analysis to estimate the morbidity and mortality of children and its association with IPV. It appeared that more than half of the Afghan women aged 15 to 49 years experienced IPV in the past year. Illiteracy (odds ratio [OR] = 1.69; 95% CI: 1.19, 2.39), living in rural areas (OR = 1.47; [1.19, 1.82]) being from the Pashtun, Tajik, Uzbek, and Pashai ethnic backgrounds were associated with a higher risk of IPV exposure. In general, the likelihood of child mortality within the first 5 years was higher among children born to mothers exposed to IPV, particularly physical and sexual even after adjustment for sociodemographic inequalities, the number of antenatal care, and marriage age. In addition, the odds of diarrhea, acute respiratory infection, and fever in the past 2 weeks were significantly higher among the children of victimized mothers in both adjusted and unadjusted models. Moreover, low birth weight and small birth size were more likely to be observed among the children of a mother who either experienced sexual or physical violence. The findings emphasized the elevated risk of morbidity and mortality among children under 5 born to mothers exposed to IPV and incorporating IPV screening into maternity and child care could reduce these adverse outcomes among Afghan women.

Accessing acute medical care to protect health: the utility of community treatment orders

BackgroundThe conclusion that people with severe mental illness require involuntary care to protect their health (including threats due to physical—non-psychiatric—illness) is challenged by findings indicating that they often lack access...

Adverse effects of fluid overload in different paediatric age groups

Fluid resuscitation is a routine procedure in the treatment of critically ill patients especially in paediatric intensive care units. Fluid overload can result from instability in fluid homeostasis caused by the administration of excessive fluids. Fluid overload can have a wide range of adverse impacts on paediatric critical care patients, including increased mortality risk. Fluid overload increases the length of hospital stay and ventilation time also elevates requirement for renal replacement treatment. The purpose of this research is to review the available information about adverse effects of fluid overload in different paediatric age groups. Literature suggests that fluid overload is associated with significant morbidity and mortality among children. Fluid overload percentage greater than 10% is linked to higher mortality rates among children. Respiratory failure can be triggered by pulmonary alveolar and interstitial edema caused by hypervolemia. Children suffering from acute kidney injury or other renal diseases experience more worsened conditions in presence of fluid overload. Fluid overload can impair organ performance, which can impact disease and fatality. Excessive fluid may alter the efficiency of the heart and perhaps impair cardiac function by considerably moving ventricular compliance to the right on the Frank-Starling curve. The negative effects of fluid overload make patients more susceptible to an elevated risk of morbidity and death even if fluid overload itself is not a direct indicator of mortality. Further research can in aid in developing preventive and management strategies for the fluid balance in paediatric settings.