Greater Mortality Research Articles

Predicting Recidivism of Male Offenders with Driving under Influence in a Correctional Setting in Taiwan

Objectives: Alcohol consumption is a public health challenge, contributing to the global burden of diseases and about three million deaths worldwide in 2016. Drunk driving has great morbidity, mortality, and social consequences. In this study, we intended to identify predictors of recidivism among male driving under influence (DUI) offenders and to focus on the interplay between sociodemographic factors, alcohol or tobacco use, and other health risk behaviors. Methods: A cross-sectional questionnaire survey was done in male DUI offenders referred from the Tainan Detention Center, Tainan, Taiwan, between January 2014 and June 2018. We used the Alcohol Use Disorders Identification Test and the Drug-taking Confidence Questionnaire-8 for Alcohol to assess study participants’ alcohol consumption patterns and coping self-efficacy. We also did logistic regression analysis to identify predictors of drunk driving recidivism and to examine factors of sociodemographic characteristics, smoking habits, and other health risk behaviors. Results: The study included 1,435 male participants, with a recidivism rate of 10%. Factors significantly associated with recidivism included lower education levels (p < 0.01), unemployment (p < 0.01), and tobacco use (p < 0.01). The results of logistic regression on those variables showed that tobacco use, odd ratio [OR] (95% confidence interval [CI]) = 11.07 (3.14–39.02), p < 0.01, and unemployed individuals, OR (95% CI) = 6.8 (4.48–10.3), p < 0.01, had significantly higher odds of recidivism. Conclusion: This study identifies key predictors of male DUI recidivism, emphasizing that individuals who are unemployed, with taboo use, and who have lower levels of education are more likely to be recidivists. The recurrence of drunk driving among individuals who also use tobacco suggests that tobacco use might influence the risk of driving under the influence of alcohol, a relationship that warrants further exploration. Recidivist offenders have specific characteristics, indicating that the therapeutic interventions are necessary for considering the circumstances of individual cases.

Serum Albumin as a Marker of Metabolic Response to Injury and its Role with Calorie Intake Regarding Length of Stay, Readmission Rates and Hospital Survival

Background: Studies have shown a relationship between albumin level & hospital mortality, but none have looked at low serum albumin, calorie intake and survival. Aim: To evaluate the relationship between serum albumin level, calorie intake, length of hospital stay (LOS), readmission rates and hospital mortality in a large population of disadvantaged and underinsured patients at a County of Los Angeles Medical Center. Design: Prospective observational study using data collected over a 6-year period of hospital survival, LOS and readmission rate in 11,441 patients. Calorie intake in those 400 patients with serum albumin <1.5 g/dL was collected. Our hypothesis was to test if the relationship of admission serum albumin to mortality was linear or exponential. In addition, in those with a serum albumin <1.5 g/dL, we evaluated calorie intake and hospital survival. Methods: A total of 11,441 patients were included in the dataset. ANOVA and regression analysis were performed. Calorie intake was extracted from dietary and intravenous intake data of each of the 400 patients with an albumin <1.5 g/dL. Results: Serum albumin was obtained within the first 7 days of admission in all patients. Mortality increased in patients with admission serum albumin <3.5 g/dL (8.8% vs 2.3%, p<0.05). Serum albumin was exponentially related to mortality (mortality = 32 / albumin2; p <0.01). The group of patients with albumin <1.5 g/dL had the greatest mortality rate (18%), approximately seven times that of patients with normal serum albumin levels. These patients also had an average LOS of 14.7 days (p<0.05), twice that of patients with normal albumin values. 30-day admission rates for this group were three times greater (6.3% vs. 1.9%, p<0.05). Calorie intake was associated with a dose response curve with regards to hospital mortality. Conclusion: A single measurement of serum albumin identifies patients who are at high risk for prolonged hospital stay, readmission and mortality. Calorie intake may modify mortality risk, but prospective studies are needed.

Retrospective cohort study investigating the relationship between diarrhea during the preweaning period and subsequent survival, health, and production in dairy cows

The primary objective of this study was to evaluate the association between preweaning diarrhea and measures of survival, health, and production. The measures of interest included survival (mortality before first calving and time to removal from the herd), health (retained fetal membranes, metritis, mastitis, and SCC), and production (305-d mature-equivalent milk yield and time to first calving). A secondary objective was to investigate if these associations varied according to the age of the calf when the case of diarrhea occurred. Herd records from a farm located in Southern Australia were used to conduct a retrospective cohort study where subjects (calves) with diarrhea were enrolled at the time of their first case along with 2 subjects without diarrhea, matched for age (±3 d) and date of birth (±15 d), amounting to 9,833 calves in the dataset. Survival analysis was conducted to determine whether preweaning diarrhea was associated with death in the short term (first 20 d after enrollment), medium term (21-100 d after enrollment) and long term (101 d after enrollment to first calving). Crude incidence rate ratios, Kaplan-Meier curves, and hazard ratios (HR, Cox regression) were derived for each event-based outcome (e.g., death, calving, mastitis). Multivariable linear models were used for continuous outcomes. Calves with preweaning diarrhea had greater mortality rates in the short term (HR = 2.48, 95% CI: 1.87-3.29) and medium term (HR = 1.89, 95% CI: 1.41-2.55), but not in the long term (HR = 0.98, 95% CI: 0.79-1.22). A small negative association between preweaning diarrhea and time to first calving was found, with calves with diarrhea calving 4 d later than calves without diarrhea (HR = 0.95, 95% CI: 0.91-1.00). Rates of postcalving removal from the herd (death or culling) were higher in calves with a history of preweaning diarrhea (HR = 1.13, 95% CI: 1.01 to 1.26), as were peak lactation log SCC (+0.08, 95% CI: 0.02 to 0.14). Further research is needed to replicate these novel findings, as they are based on exploratory analyses and could be spurious findings. No substantial associations were observed for the other measures of interest. Our study findings support existing research demonstrating the importance of preweaning diarrhea as a substantial cause of calf mortality and raise new hypotheses about other potential impacts during lactation.

Child Opportunity Index and Pediatric Extracorporeal Membrane Oxygenation Outcomes; the Role of Diagnostic Category.

To study the impact of social determinants of health (SDoH) on pediatric extracorporeal membrane oxygenation (ECMO) outcomes. Retrospective study of children (< 18 yr) supported on ECMO (October 1, 2015 to March 1, 2021) using Pediatric Health Information System (44 U.S. children's hospitals). Patients were divided into five diagnostic categories: neonatal cardiac, pediatric cardiac, neonatal respiratory, pediatric respiratory, and sepsis. SDoH included the Child Opportunity Index (COI; higher indicates social advantage), race, ethnicity, payer, and U.S. region. Children without COI were excluded. Diagnostic category-specific clinical variables related to baseline health and illness severity were collected. None. Children supported on ECMO experienced a 33% in-hospital mortality (2863/8710). Overall, children with lower COI, "other" race, Hispanic ethnicity, public insurance and from South or West regions had greater mortality. Associations between SDoH and ECMO outcomes differed between diagnostic cohorts. Bivariate analyses found that only pediatric cardiac patients had an association between COI or race and mortality. Multivariable logistic regression analyses examined relationships between SDoH, clinical variables and mortality within diagnostic categories. Pediatric cardiac patients had 5% increased odds of death (95% CI, 1.01-1.09) for every 10-point decrement in COI, while Hispanic ethnicity was associated with higher survival (adjusted odds ratio [aOR] 0.72 [0.57-0.89]). Children with heart disease from the highest COI quintile had less cardiac-surgical complexity and earlier cannulation. Independent associations with mortality were observed in sepsis for Black race (aOR 1.62 [1.06-2.47]) and other payer in pediatric respiratory patients (aOR 1.94 [1.23-3.06]). SDoH are statistically associated with pediatric ECMO outcomes; however, associations differ between diagnostic categories. Influence of COI was observed only in cardiac patients while payer, race, and ethnicity results varied. Further research should investigate differences between diagnostic cohorts and age groups to understand drivers of inequitable outcomes.

Clinical overview of phototherapy for neonatal hyperbilirubinaemia.

The most efficient emission spectrum of light for phototherapy is blue-green light emission diode light with peak emission at 478 nm. In the irradiance interval of phototherapy, the relationship between efficacy and irradiance is almost linear, and it is negatively related to the haemoglobin. The action sites of phototherapy are the extravascular compartment and cutaneous blood. The most immature neonates treated aggressively had not only a lower frequency of neurodevelopmental impairment than conservatively treated, but also greater mortality. Intermittent and continuous phototherapy are assumed to be equally efficient. Home-based fibreoptic phototherapy is effective and safe. Important progress is still occurring in phototherapy.

Assessing the existence of the male-female health-survival paradox in the past: Dental caries in medieval London.

This study seeks to identify signals of the male-female health-survival paradox in medieval London. This study uses skeletal data on age, sex, dental caries (n = 592) and antemortem tooth loss (n = 819) from adult individuals from medieval London cemeteries (c. 1200-1540 CE). The association between age and dental caries was assessed using binary logistic regression. The associations among age, time period (pre- vs. post-Black Death), oral biomarker (dental caries or antemortem tooth loss), and sex were tested using hierarchical log-linear analysis. The analyses reveal significantly higher odds of dental caries with increasing adult ages, more older adults after the Black Death, different age distributions of dental caries between the sexes, and a greater decrease in the prevalence of dental caries for females after the Black Death. These results appear not to be an artifact of trends in AMTL. However, this study does not yield evidence suggesting that females experienced both a survival advantage and a decline in oral health at late adult ages after the Black Death relative to males. These results do not provide evidence of the existence of a male-female health-survival paradox, but they do corroborate existing evidence of improvements in health in general in the aftermath of the Black Death. The decreased prevalence of dental caries after the Black Death may reflect dietary improvements or the effects of selective mortality during the epidemic.

From Ponds to Pine Plantations in 9000 Years: The Environmental Archaeology of Beck Burn, Solway Moss, Cumbria

ABSTRACT This article explores the evidence for environmental change at Beck Burn, Solway Moss, on the English/Scottish border. The analysed pollen, non-pollen palynomorphs (NPP) and microscopic charcoal particles permit several palaeoenvironmental events to be interpreted, supported by radiocarbon dating. These and previously published data suggest the presence of very early Mesolithic water-edge activity, later Mesolithic woodland management, clearance and small-scale cultivation during the early Neolithic period, followed by low-level disturbance for pastoral farming in the early Bronze Age. Woodland clearance and cereal cultivation are dated to the middle Bronze Age, with significant clearance and cultivation identified during the late Iron Age or early Roman period. The medieval period is characterised by evidence for a mixed subsistence economy, with reduced activity possibly coincident with the Wars of Scottish Independence, famines and the Black Death of the fourteenth century, as well as the Little Ice Age. Renewed activity, with evidence for both arable and pastoral farming, is dated to the late medieval to early post-medieval period. Pine plantations were then created, possibly in the eighteenth century or later. The data reveal the importance of palaeoenvironmental archaeology, in the absence of significant finds or features, in creating a link with the past.

Infectious Diseases Epidemics (Hawar / The Plague) In Islamic History in The Middle Ages and Its Effects on Socioeconomic Aspects

The COVID-19 pandemic, which began in China in late 2019 and swiftly spread globally, has had a profound impact, infecting 188 countries and causing significant mortality. As of May 28, 2020, over 5.7 million cases and 356,131 deaths were reported worldwide, with the United States, Brazil, and Russia among the hardest-hit. Despite the absence of a definitive cure, treatments involve antibiotics and intensive care. Interestingly, pandemics are not unprecedented. Historical records reveal similar outbreaks, such as the Black Death in the Middle Ages, which originated in Central Asia and spread globally, including to the Middle East during the Mamluk Kingdom. This research objectives is to focus on the socioeconomic impact of the Plague in Egypt and Syria during this period. Understanding these historical precedents provides valuable insights into managing and mitigating the effects of current and future pandemics. This research is conducted by using qualitatives descriptives literature review. The result of shown It caused difficulties for the government, aristocracy and bourgeois, ordinary people, farmers, manufacturers, entrepreneurs, traders, and workers. It also drove many deaths among the population, loss of jobs and livelihoods, high demand, raised prices of goods and wage rates, and declined productivity. In essence, this study underscores the importance of historical context in addressing current and future pandemics, emphasizing that lessons from the past can guide us toward more resilient and informed responses.

GENETIC ABLATION OF THE C-TYPE LECTIN RECEPTOR CLEC2D INCREASES PERITONITIS MORTALITY, INFLAMMATION, AND PHYSIOLOGY WITHOUT DIMINISHING ORGAN INJURY.

Background: Sepsis accounts for substantial morbidity and mortality motivating investigators to continue the search for pathways and molecules driving the pathogenesis of the disease. The current study examined if the novel C-type lectin receptor (CLR), Clec2d, plays a significant role in the pathogenesis of sepsis. Methods: Clec2d knockout (KO) mice were fully backcrossed onto the C57/BL6 background. Acute endotoxemia was induced with an intraperitoneal injection of lipopolysaccharide (LPS). Sepsis was induced in two different models, cecal ligation and puncture (CLP) and Pseudomonas aeruginosa pneumonia. Both models were treated with antibiotics and fluid resuscitation. In the sepsis models, physiologic and hematologic measurements were measured at 24 h by collecting a small sample of peripheral blood. Mortality was followed for 14 days. Results : A total of 197 mice were studied, 58 wild type (WT) and 54 knock-out (KO) in the LPS model; 27 wild type and 21 KO mice in the CLP model; and 22 WT and 15 KO mice in the pneumonia model. Clec2d KO mice had greater mortality in the LPS and CLP studies but not the pneumonia model. There were significant differences in multiple parameters determined 24 h post sepsis between mice who subsequently died and those lived. Consistent with previous reports in the CLP model, higher concentrations of IL-6, increased numbers of peripheral blood lymphocytes and greater renal injury were found in the dying mice. In contrast, in the pneumonia model, IL-6 was higher in the surviving mice; however, the IL-6 levels in the pneumonia model (0.6 ± 0.3 ng/mL mean ± SEM) were less than 2% of the IL-6 levels of mice that died in the CLP model (41 ± 9 ng/mL, mean ± SEM). There were no differences in the lymphocyte count or renal injury between living and dying mice in the pneumonia model. In both sepsis models, dying mice had lower heart rates, respiratory rates, and body temperatures. These values were also lower in the KO mice compared to the WT in CLP, but the breath rate and body temperature were increased in the KO pneumonia mice. Conclusion: The C-type lectin receptor Clec2d plays a complicated role in the pathogenesis of sepsis, which varies with source of infection as demonstrated in the models used to study the disease. These data highlight the heterogeneity of the responses to sepsis and provide further evidence that a single common pathway driving sepsis organ injury and death likely does not exist.

The Epidemiology and Outcomes of Perineal and Genital Burn Injury in Low- and Middle- Income Countries: A Global Burn Registry Study

IntroductionThe epidemiology, care, and outcomes of perineal and genital burns (PG) in high-income countries have been previously described, but an analysis of this topic in LMICs has yet to be performed. We use the World Health Organization’s Global Burn Registry to fill this gap. MethodsThe GBR was searched from inception to November 2023 to identify all burn patients, excluding cases from high-income countries. Demographics and mechanism of injury were retrieved. Primary outcomes were length of hospital stay (LOHS), surgical intervention, discharge with physical impairment, and mortality. A multivariate regression analysis was performed controlling for burnt total body surface area (TBSA), age, sex, inhalation injury, mechanism of burn and care center characteristics. ResultsOf 9041 patients identified, 1213 (13.4 %) had PG burns with 136 (1.6 %) isolated to the PG region. PG patients had higher TBSA (p < 0.001) and more inhalation injury (p < 0.001). They had better access to rehabilitation and lower access to theater space for burns (p < 0.001). Multivariable analysis showed that PG patients had longer LOHS (p = 0.001), greater mortality (p < 0.001), were less likely to undergo surgery (p = 0.01) or be discharged home with physical impairment (p = 0.03). ConclusionSimilarities and differences exist between high- and low/middle-income countries in terms of the patterns of injury, care, and recovery in patients with PG burns. The longer LOHS and higher mortality among PG patients, previously reported in high-income countries, are verified. This highlights the importance of greater vigilance when caring for such patients.

Ethnic Disparities for Survival and Mortality in New Zealand Patients With Head and Neck Cancer

It is essential to identify inequitable cancer care for ethnic minority groups, which may allow policy change associated with improved survival and decreased mortality and morbidity. To investigate ethnic disparities in survival and mortality among New Zealand (NZ) patients with head and neck cancer (HNC) and the association of other variables, including socioeconomic status, tumor stage, and age at diagnosis, with survival rates. This retrospective cohort study was conducted among NZ patients diagnosed with specific HNCs from 2010 to 2020. Anonymized data were obtained from the NZ Cancer Registry, including patients diagnosed from International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes C00-C14 and C30-C32. Data were analyzed from July 2020 through January 2024. Censored Kaplan-Meier estimates were used to analyze survival distribution. Cox regression models were used to estimate the association of age, tumor stage at diagnosis, and socioeconomic status with survival rates. Age-standardized mortality rates were assessed. Among 6593 patients with HNCs (4590 males [69.6%]; 4187 patients aged 51-75 years [63.5%]), there were 706 Māori individuals (10.7%) and 5887 individuals with other ethnicity (89.3%), including 4327 NZ European individuals (65.6%; defined as New Zealanders of European descent). Māori individuals had a decreased survival proportion at all years after diagnosis compared with individuals with other ethnicity (eg, 66.1% [95% CI, 62.6%% to 69.8%] vs 71.2% [95% CI, 70.0% to 72.4%] at 2 years). At 1 year after diagnosis, Māori individuals did not have a significantly increased mortality rate compared with 5795 individuals with other ethnicity with data (193 deaths [27.3%] vs 1400 deaths [24.2%]; P = .06), but the rate was significantly increased at 5 years after diagnosis (277 deaths [39.3%] vs 2034 deaths [35.1%]; P = .03); there was greater disparity compared with NZ European individuals (1 year: 969 deaths [22.4%]; P = .003; 5 years: 1441 deaths [33.3%]; P = .002). There were persistent age-adjusted mortality rate disparities: 40.1% (95% CI, -25.9% to 71.2%) for Māori individuals and 18.8% (95% CI, -15.4% to 24.4%) for individuals with other ethnicity. Māori individuals were diagnosed at a mean age of 58.0 years (95% CI, 57.1-59.1 years) vs 64.3 years. (95% CI, 64.0-64.7 years) for individuals with other ethnicity, or 5 to 7 years younger, and died at mean age of 63.5 years (95% CI, 62.0-64.9 years) compared with 72.3 years (95% CI, 71.8-72.9 years) for individuals with other ethnicity, or 7 to 10 years earlier. Māori individuals presented with proportionally more advanced disease (only localized disease, 102 patients [14.5%; 95% CI, 12.0%-17.4%] vs 1413 patients [24.0%; 95% CI, 22.9%-25.1%]; P < .001) and showed an increase in regional lymph nodes (276 patients [39.1%; 95% CI, 35.5%-42.9%] vs 1796 patients [30.5%; 95% CI, 29.3%-31.8%]; P < .001) at diagnosis compared with individuals with other ethnicity. Socioeconomic status was not associated with survival. This study found that Māori individuals experienced worse survival outcomes and greater mortality rates from HNC in NZ and presented with more advanced disease at a younger age. These findings suggest the need for further research to alleviate these disparities, highlight the importance of research into minority populations with HNC globally, and may encourage equity research for all cancers.

The inescapable haunt(ing): Dressing trans life after death

This article traces the material effects of Black trans death on Black trans life, particularly in the dimensions of aesthetics, fashion and beauty. I use a Black trans hauntological approach to analyse recordings of Balls, film and television, and personal anecdotes of Black transness in order to develop a transtemporal mapping between ghosts and their haunted subjects. On the one hand, my research builds upon a growing field of work in Black queer and trans studies that looks at Black trans life and its relationship with the ‘afterlife’. On the other, it critiques the liberal humanism that grounds much of fashion studies, thus foregrounding subjects, methodologies and worlds that are still under-researched within the field. By focusing on the practice of dressing, and specifically on the autonomous garmenting of trans people, I show how the violated and murdered Black trans person’s haunting can be traced materially. At the centrepiece of this article is the interrogation of how contemporary dressing practices of ‘living’ Black trans people invoke and are possessed by the ghosts of anti-trans violence. Found in the reciprocal relationship of invocation and possession is the mutual care transmitted between and through the barriers of Black trans life and death.

Association between genetic susceptibility and mortality in triple-negative breast cancer.

e13130 Background: We sought to determine if positive germline genetic tests in patients with triple negative breast cancer (TNBC) was associated with mortality. Methods: Retrospective review. Inclusion criteria: female, 18-85, stage 1-3 TNBC, 2010-2015; 5-year follow-up period from date of cancer diagnosis, or follow-up until death if sooner. Results: Out of the total population of 219 patients, 37.9% (83/219) underwent genetic testing. All patients who underwent genetic testing were Caucasian; most were non-Hispanic (78/83, 94.0%). The average age of the population of patients who underwent genetic testing was 49.6; there were no differences in age between those with a positive genetic test (PT) versus(vs) a negative genetic test (NT) (p=0.963). The average ECOG score was 0.2 and this was similar between the PT and NT groups (p=0.725). The average tumor size was 25.3 and this was similar between PT and NT groups(p=0.992). Among those who underwent testing, a PT was observed in 22.9% (19/83) and a NT in 77.1% (64/83). Within the PT group, 15.8% (3/19) experienced recurrent disease, while 18.8% (12/64) in the NT group experienced recurrent disease (p=1.000).Within the PT group, 5.3% (1/19) were deceased compared with 28.1% (18/64) in the NT group (p=0.590). When recurrent versus nonrecurrent disease was compared regardless of genetic test results, 73.3% (11/15%) in the recurrence group were deceased, compared with 11.8% (8/68) in the non-recurrence group (p&lt;0.001). When the genetic test population was stratified by recurrence, there was no association between genetic test results and living status in recurrent disease (p=0.154), or non-recurrent disease (p=0.183). Conclusions: Most patients who underwent genetic testing were Caucasian, and the average age of the cohort was approximately 49 years. Otherwise, the demographic characteristics were comparable between patients with a positive genetic test and those with a negative genetic test. Positive genetic test results were not associated with recurrent TNBC, or tumor size. However, the presence of recurrence was associated with a higher incidence of mortality, irrespective of genetic test results. Our study shows that genetic susceptibility to breast cancer was not associated with greater mortality. More has to be done to determine if racial disparities occur in offering genetic testing to racial minorities who meet criteria.

Severity and mortality of acute respiratory failure in pediatrics: A prospective multicenter cohort in Bogotá, Colombia.

Acute respiratory failure (ARF) is the most frequent cause of cardiorespiratory arrest and subsequent death in children worldwide. There have been limited studies regarding ARF in high altitude settings. The aim of this study was to calculate mortality and describe associated factors for severity and mortality in children with ARF. The study was conducted within a prospective multicentric cohort that evaluated the natural history of pediatric ARF. For this analysis three primary outcomes were studied: mortality, invasive mechanical ventilation, and pediatric intensive care unit (PICU) length of stay. Eligible patients were children older than 1 month and younger than 18 years of age with respiratory difficulty at the time of admission. Patients who developed ARF were followed at the time of ARF, 48 h later, at the time of discharge, and at 30 and 60 days after discharge. It was conducted in the pediatric emergency, in-hospital, and critical-care services in three hospitals in Bogotá, Colombia, from April 2020 to June 2021. Out of a total of 685 eligible patients, 296 developed ARF for a calculated incidence of ARF of 43.2%. Of the ARF group, 90patients (30.4%) needed orotracheal intubation, for a mean of 9.57 days of ventilation (interquartile range = 3.00-11.5). Incidence of mortality was 6.1% (n = 18). The associated factors for mortality in ARF were a history of a neurologic comorbidity and a higher fraction of inspired oxygen at ARF diagnosis. For PICU length of stay, the associated factors were age between 2 and 5 years of age, exposure to smokers, and respiratory comorbidity. Finally, for mechanical ventilation, the risk factors were obesity and being unstable at admission. ARF is a common cause of morbidity and mortality in children. Understanding the factors associated with greater mortality and severity of ARF might allow earlier recognition and initiation of prompt treatment strategies.

Creative infestation

The fourteenth-century outbreak of Bubonic Plague, known as the Black Death, exerted a transformative impact upon Western Europe, facilitating the development of more empirical and observational forms of medicine and science, weakening the hold of the Catholic Church, and dealing a major blow to the feudalistic state organization and manorial economies. Western society after the Black Death would never look the same again. The Black Death should thus be viewed as laying the foundations of, and a major catalyst for, the emergence of modernity in Western Europe.

Comorbidities, acute kidney injury and long-term mortality in elderly patients hospitalized because of hip fracture: a moderation analysis

IntroductionFemoral fractures in elderly individuals present significant health challenges, often leading to increased morbidity and mortality. Acute kidney injury (AKI) during hospitalization further complicates outcomes, yet the interaction between AKI severity and comorbidities, as quantified by the Charlson Comorbidity Index (CCI), remains poorly understood in this population. This study aimed to assess the associations between AKI severity and the CCI and between AKI severity and one-year mortality postfemoral fracture in elderly patients.MethodologyThis study utilized data from the Multiparameter Intelligent Monitoring in Intensive Care (MIMIC-IV) database and focused on elderly patients (> 65 years) admitted with hip fractures. Patients were categorized based on AKI stage according to the KDIGO criteria and CCI scores. The primary outcome assessed was all-cause mortality one year after hospital discharge. The statistical analyses included logistic regression, Cox proportional hazards regression and moderation analysis with the Johnson–Neyman technique to evaluate associations between AKI and long-term mortality and between the CCI and long-term mortality.ResultsThe analysis included 1,955 patients and revealed that severe AKI (stages 2 and 3) was independently associated with increased one-year mortality. Notably, the CCI moderated these associations significantly. A lower CCI score was significantly correlated with greater mortality in patients with severe AKI. The impact of severe AKI was greater for those with a CCI as low as 3, more than doubling the observed one-year mortality rate. In contrast, higher CCI scores (≥8) did not significantly impact mortality. Sensitivity analyses supported these findings, underscoring the robustness of the observed associations.ConclusionThis study elucidates the complex interplay between AKI severity and comorbidities and long-term mortality in elderly hip fracture patients. These findings underscore the importance of considering both AKI severity and comorbidity burden in prognostic assessments and intervention strategies for this vulnerable population. Targeted interventions tailored to individual risk profiles may help mitigate the impact of AKI on mortality outcomes, ultimately improving patient care and outcomes. Further research is warranted to explore the underlying mechanisms involved and refine risk stratification approaches in this population.

The implementation of national labour legislation in England after the Black Death, 1349–1400

AbstractThe responses of labour markets to global pandemics are attracting renewed interest, although the English labour laws in response to the Black Death of 1348/9 – capping wages, imposing annual contracts, and restricting mobility – have a long and established scholarship. The conventional wisdom is that the legislation represented an extension of existing local practices and created common cause among all categories of employer. Yet this view is hard to reconcile with the fact that, despite subsequent revisions, the legislation soon failed. These arguments are tested through original research into how the legislation was actually enforced in a variety of legal tribunals (manorial, borough, and royal). A clear distinction is maintained between public presentments and private litigation, and a robust methodology is pursued to record their absence as well as quantifying their presence. This casts new light on the novelty of the labour laws, the reasons for their failure, and their influence on contract law. The analysis exemplifies the potential for short‐term legal responses to infectious diseases to have unintended and unanticipated long‐term consequences.

Trends and socioeconomic inequality of the burden of congenital abnormalities of the kidney and urinary tract among children and adolescents.

Although congenital abnormalities of the kidney and urinary tract (CAKUT) is the leading cause of childhood onset chronic kidney disease (CKD) and kidney failure, comprehensive information on the disease burden among children and adolescents globally is lacking. We aim to report the trends and socioeconomic inequality of CAKUT burden for people aged 0-24 years from 1990 to 2019·. We reported the prevalence, mortality and disability-adjusted life-years (DALYs) for CAKUT based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, quantified the association of disease burden and socio-demographic index (SDI), calculated the slope index of inequality (SII) the relative index of inequality (RII) and concentration index. In 2019, the global prevalence, mortality, and DALYs of CAKUT among individuals aged 0-24 years were 167.11 (95%Confident Interval 166.97, 167.25), 0.30 (0.29, 0.30), and 32.22 (32.16, 32.29) per 100 000 population. The greatest prevalence, mortality and DALYs were recorded in the 0-4 year age group. The greatest mortality and DALYs were recorded in low SDI countries and territories. During 1990 to 2019, the prevalence, mortality and DALYs decreased globally, while in low and low-middle countries and territories the reduction was much less slower. India, Nigeria and Pakistan had the highest DALYs. Saudi Arabia and China exhibited a markedly decrease of CAKUT burden. Globally for every 0.1 increase in SDI, there was a 20.53% reduction in mortality, a 16.31% decrease in DALYs, but a 0.38% rise in prevalence. Inequality for disease burden of varying SDI was increasing globally. Thus, specific preventive and health service measures are needed to reduce the global burden from CAKUT.

Obesity as a risk factor for developing breast cancer: systematic review

Background: Obesity and breast cancer represent an important public health problem given the high frequency of both conditions in the world population. The objective of the present study is to systematically review and analyze the most current scientific evidence regarding the association between obesity and the development of breast cancer in premenopausal and postmenopausal women. Material and methods: A systematic review of the literature was carried out using a highly sensitive search in the main databases of Pubmed, Embase, Scholar google and Cochrane using observational studies and clinical trials that have been studied as inclusion criteria Obesity as a risk factor for breast cancer. Results: Obesity and overweight are associated with a greater risk of breast cancer development, specifically ER+, a worse prognosis, and a greater mortality rate. The association between body fat, early age and breast cancer is contradictory, but can play a protective role in both pre and postmenopausal women. Conclusion: It is possible to infer that with regard to body weight, the best way to prevent breast cancer is to maintain an adequate weight, mainly through a healthy lifestyle. However, it is necessary to define, through studies, the amount of body weight gained and the period of life in which the risk of breast cancer increases

Association of suPAR, ST2, and galectin-3 with eGFR decline and mortality in patients with advanced heart failure with reduced ejection fraction.

Patients with heart failure with reduced ejection fraction (HFrEF) are at risk for chronic kidney disease (CKD). Elevated levels of circulating biomarkers soluble urokinase plasminogen activator receptor (suPAR), galectin-3, soluble suppression of tumorigenicity 2 (ST2), and N-terminal prohormone B-type natriuretic peptide (NT-proBNP) are associated with CKD progression and mortality. The predictive value of these biomarkers in a population with HFrEF and kidney disease is relatively unknown. We sought to determine whether these biomarkers were associated with longitudinal trajectory of estimated glomerular filtration rate (eGFR) in HFrEF and assess their association with mortality using a joint model to account for competing risks of ventricular assist device (VAD) implantation and heart transplantation. We included participants from the Registry Evaluation of Vital Information for Ventricular Assist Devices in Ambulatory Life with repeated eGFR measures over 2 years. Of 309 participants, mean age was 59 years, median eGFR 60 ml/min/1.73 m2, 45 participants died, 33 received VAD, and 25 received orthotopic heart transplantation. Higher baseline serum standardized suPAR (β coefficient = -0.36 √(ml/min/1.73 m2), 95% confidence interval (-0.48 to -0.24), p < 0.001), standardized galectin-3 (-0.14 √(ml/min/1.73 m2) (-0.27 to -0.02), p = 0.02), and log NT-proBNP (-0.23 √(ml/min/1.73 m2) (-0.31 to -0.15), p < 0.001) were associated with eGFR decline. ST2 and log NT-proBNP were associated with mortality. Higher baseline suPAR, galectin-3, and NT-proBNP are associated with eGFR decline in patients with HFrEF. Only ST2 and NT-proBNP are associated with greater mortality after controlling for other factors including change in eGFR. These biomarkers may provide prognostic value for kidney disease progression in HFrEF and inform candidacy for advanced heart failure therapies.