Increase In Relative Risk Research Articles

Актуальна динаміка видової структури етіологічних збудників інфекції сечової системи в дітей та антибактеріальної чутливості цих патогенів

Understanding the structure of etiopathogenes of urinary tract infections (UTIs) in children, the state of antibacterial resistance (ABR) is an important component of the empirical choice of antibiotics in treatment. Purpose - to study the species structure of UTIs pathogens in children, the prevalence of ABR the rate of its formation at the present stage. Materials and methods. The study involved 2754 hospital and outpatient children aged 0 to 18 years with UTIs in the active phase of the disease for the period 2009-2019. The contingent of subjects was divided into 3 groups: patients for 2009, 2014 and 2019 years of follow-up. Results. Escherichia coli was recognized as the leading uropathogen in all observation groups: in the 1st group (2009) its share was 47% (158/337), in the 2nd (2014) - 64% (210/328), in 3rd (2019) - 66.5% (252/379). The high dynamics of ABR prevalence of Escherichia coli was recognized: an increase of 11% in 2019 compared to 2014; by 18.8% compared to 2009. Thus, in 2019, every second child had resistance (57.6%±1.6 (1586/2754)) and every third - polyresistance (27.4%±3), 04 (755/2754)). We found an increase in the relative risk of ABR in 2019 1.6 times compared to 2014 and 3 times compared to 2009. The mathematical forecast of the prevalence of resistant strains of Escherichia coli for 15 years approached 100% (y=9.5x6+41=98%) at R² = 0.9918. For 10 years the indicator corresponded to 88.5%, for 5 years - 79%. The prognostic increase in ABR relative risk of 2.9-3.7 times in the next 5-10 years has been established. Conclusions. The obtained data are of great practical importance for general practitioners and specialists, as they indicate a high rate of formation of resistant strains of Escherichia coli and other pathogens among children with UTIs, which complicates the empirical choice of antibacterial therapy. The study was conducted in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of all the institutions mentioned in the work. Informed consent of the children's parents was obtained for the research. The authors declare no conflict of interest. Key words: urinary tract infection, children, etiological pathogens, antibacterial resistance.

Clinical factors and outcomes associated with immune non-response among virally suppressed adults with HIV from Africa and the United States

A significant minority of people living with HIV (PLWH) achieve viral suppression (VS) on antiretroviral therapy (ART) but do not regain healthy CD4 counts. Clinical factors affecting this immune non-response (INR) and its effect on incident serious non-AIDS events (SNAEs) have been challenging to understand due to confounders that are difficult to control in many study settings. The U.S. Military HIV Natural History Study (NHS) and African Cohort Study (AFRICOS). PLWH with sustained VS (< 400 copies/ml for at least two years) were evaluated for INR (CD4 < 350 cells/µl at the time of sustained VS). Logistic regression estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for factors associated with INR. Cox proportional hazards regression produced adjusted hazard ratios (aHRs) for factors associated with incident SNAE after sustained VS. INR prevalence was 10.8% and 25.8% in NHS and AFRICOS, respectively. Higher CD4 nadir was associated with decreased odds of INR (aOR = 0.34 [95% CI 0.29, 0.40] and aOR = 0.48 [95% CI 0.40, 0.57] per 100 cells/µl in NHS and AFRICOS, respectively). After adjustment, INR was associated with a 61% increase in relative risk of SNAE [95% CI 1.12, 2.33]. Probability of "SNAE-free" survival at 15 years since sustained VS was approximately 20% lower comparing those with and without INR; nearly equal to the differences observed by 15-year age groups. CD4 monitoring before and after VS is achieved can help identify PLWH at risk for INR. INR may be a useful clinical indicator of future risk for SNAEs.

Is preoperative S-albumin associated to postoperative complications and readmission in patients with adult spinal deformity: a prospective analysis of 128 patients using the Spine AdVerse Event Severity (SAVES) system.

To assess the association between preoperative S-albumin and postoperative outcome following adult spinal deformity (ASD) surgery. All patients undergoing ASD surgery from February 1, 2017 and January 31, 2018 at a single quaternary referral center were prospectively included. Adverse events (AE) during admission were assessed using the Spine AdVerse Events Severity (SAVES) system. Based on preoperative S-albumin, patients were categorized as "normal" or "abnormal" and compared regarding postoperative outcome, adverse events (AEs), 30- and 90-day readmission, revision surgery, and mortality. A total of 128 patients aged ≥ 18years were included, and S-albumin was available in 88%. Of these, 73% (n = 93) were classified as "normal", 16% (n = 20) as "abnormal", and 12% (n = 15) as "missing". The "normal" albumin group had less comorbidity burden [ASA score 2 (2, 3) vs 3 (2, 3), p = 0.011], higher hemoglobin levels (8.4 (± 0.9) mmol/L vs 7.4 (± 1.1) mmol/L, p < 0.001), and higher S-albumin (38.9 (± 2.7) g/L vs 31.9 (± 4.4) g/L, < 0.001). The rate of 90-day readmission was significantly increased in the "abnormal" group (65% vs 36%), corresponding to a relative risk increase of 1.25 (95% CI 1.02-1.52, p = 0.029). Similar increased risks were found in subsequent logistic regression analyses, although results were not significant in multivariable analysis (p = 0.102). Comparing remaining outcome parameters, point estimates revealed increased AEs, 30-day readmission, and revision in the "abnormal" albumin group, although effects did not reach statistical significance. In a prospective, consecutive, single-center cohort of 128 patients undergoing ASD surgery, we found a significant association between "abnormal" preoperative S-albumin and increased 90-day readmission. Furthermore, although the findings were not statistically significant, we did find that AEs, 30-day readmission, and revision were numerically more frequent in the "abnormal" group, suggesting an expected tendency that should be further investigated. We conclude that nutritional status prior to ASD surgery could be important to consider and suggest validation in larger prospective cohorts. Prognostic II.

Comorbid conditions as risk factors for West Nile neuroinvasive disease in Ontario, Canada: a population-based cohort study.

West Nile neuroinvasive disease (WNND) is a severe neurological illness that can result from West Nile virus (WNV) infection, with long-term disability and death being common outcomes. Although WNV arrived in North America over two decades ago, risk factors for WNND are still being explored. The objective of this study was to identify WNND comorbid risk factors in the Ontario population using a retrospective, population-based cohort design. Incident WNV infections from laboratory records between 1 January 2002 - 31 December 2012 were individually-linked to health administrative databases to ascertain WNND outcomes and comorbid risk factors. WNND incidence was compared among individuals with and without comorbidities using risk ratios (RR) calculated with log binomial regression.Three hundred and forty-five individuals developed WNND (18.3%) out of 1884 WNV infections. West Nile encephalitis was driving most associations with comorbidities. Immunocompromised (aRR 2.61 [95% CI 1.23-4.53]) and male sex (aRR 1.32 [95% CI 1.00-1.76]) were risk factors for encephalitis, in addition to age, for which each 1-year increase was associated with a 2% (aRR 1.02 [95% CI 1.02-1.03]) relative increase in risk. Our results suggest that individuals living with comorbidities are at higher risk for WNND, in particular encephalitis, following WNV infection.

Impact of Maternal BMI on Urinary Pathology Severity in Pregnancy

The objective of this study is to compare the severity of urinary pathology among women of normal weight, class 1,2 and class 3 obesity. We conducted a retrospective cohort study of women with UTI (acute cystitis or asymptomatic bacteriuria) at a single healthcare system from 7/2013-5/2019. Demographic, infectious, antepartum, and intrapartum data were abstracted. Women with missing BMI or infection data were excluded. Subjects were categorized into < 25 BMI, 30-40 and > 40 based on BMI at their new prenatal visit. The primary outcome was progression to pyelonephritis, and secondary outcomes were recurrent UTI and pyelonephritis-related morbidities. Simple statistics were used to analyze the data and regression analyses were performed to control for confounders. Of 419 patients who met inclusion criteria, 171 had normal weight, 184 had BMI 30-40, and 64 had BMI > 40. As BMI increased, subjects were more likely to be Black, multiparous, and have chronic hypertension and diabetes mellitus type II (p < 0.001). Progression to pyelonephritis did not differ as BMI increased, nor did pyelonephritis-related morbidity, though these were rare (Table). Mothers with BMI 30-40 and > 40 had a slightly increased risk of recurrent UTIs compared to normal weight women (Table). When controlling for confounders, no increase in relative risk of developing pyelonephritis was seen (BMI 30-40:RR=1.06,95%CI 0.58-1.93; BMI > 40:RR=0.59,95%CI:0.24-1.41). Though women with BMI 30-40 did have increased risk of developing recurrent infection (RR=1.68,95%CI:1.10-2.59), this did not extend to women with BMI > 40 (RR=1.04,95%CI:0.62-2.07). Women with recurrent infection were not more likely to develop pyelonephritis or pyelonephritis-related morbidity (data not shown). In this cohort, BMI did not impact risk of developing pyelonephritis. Even among patients with recurrent UTI, BMI did not impact the risk of progressing to pyelonephritis. Larger studies are needed to further investigate these findings to better understand the relationship between increasing BMI and severity of urinary pathology.

Excess Mortality by Individual and Spousal Education for Recent and Long-Term Widowed.

ObjectivesThe loss of a spouse is followed by a dramatic but short-lived increase in the mortality risk of the survivor. Contrary to expectations, several studies have found this increase to be larger among those with high education. Having a spouse with high education is associated with lower mortality, which suggests that losing a spouse with high education means the loss of a stronger protective factor than losing a spouse with low education. This may disproportionately affect the high educated because of educational homogamy.MethodsWe use Swedish total population registers to construct an open cohort of 1,842,487 married individuals aged 60–89 during 2007–2016, observing 239,276 transitions into widowhood and 277,946 deaths. We use Poisson regression to estimate relative and absolute mortality risks by own and spousal education among the married and recent and long-term widows.ResultsWe find an absolute increase in mortality risk, concentrated to the first 6 months of widowhood across all educational strata. The relative increase in mortality risk is larger in higher educational strata. Losing a spouse with high education is associated with higher excess mortality, which attenuates this difference.DiscussionWhen considering the timing and the absolute level of excess mortality, we find that the overall patterns of excess mortality are similar across educational strata. We argue that widowhood has a dramatic impact on health, regardless of education.

Spatial epidemiological analysis of Lyme disease in southern Ontario utilizing Google Trends searches

Lyme disease is of growing concern in Ontario with endemic areas increasing in size. Differential diagnosis of Lyme disease patients should include their exposure status assuming knowledge of high-risk areas. The goal of this study was a spatial analysis of Lyme disease in southern Ontario for the years 2015–2019 with a focus on the association between Lyme disease prevalence and Internet search frequencies recorded by Google Trends. A choropleth map visualized the raw prevalence of Lyme disease across the 28 public health units of southern Ontario. A disease cluster comprising five public health units was identified in eastern Ontario using the flexible scan statistic (standard morbidity ratio = 4.9, p = 0.01). Poisson regression modeling revealed an association between Lyme disease prevalence and the search term “Lyme disease” in Google Trends (p = 0.032). Lyme disease prevalence was correlated with Google Trend searches, with an increase in relative risk by a factor of 1.19 (CI95%: 1.03, 1.39) for every 1% increase in search activity. Knowledge of the existence and location of high-risk or exposure areas for Lyme disease is important to properly diagnose patients. Exploiting the association between Lyme disease and Internet search activity by the population at risk can also further disease surveillance.

Use of demineralized cortical fibers is associated with reduced risk of pseudarthrosis after pedicle subtraction osteotomy for adult spinal deformity.

To assess the effect of demineralized cortical fibers (DCF) on postoperative pseudarthrosis requiring revision surgery in patients undergoing pedicle subtraction osteotomy (PSO) for adult spinal deformity (ASD). The use of DCF was introduced across all procedures in 2017 and subsequent patients undergoing PSO surgery were prospectively and consecutively registered. Following sample-size estimation, a retrospective cohort was also registered undergoing the same procedure immediately prior to the implementation of DCF. The non-DCF group underwent surgery with ABG. Minimum follow-up was 2years in both groups. The main outcome was postoperative pseudarthrosis, either CT-verified or verified intraoperatively during revision surgery due to rod breakage and assessed using Kaplan-Meier survival analyses. A total of 48 patients were included in the DCF group and 76 in the non-DCF group. The DCF group had more frequently undergone previous spine surgery (60% vs 36%) and had shorter follow-up (32 ± 2 vs 40 ± 7months). Pseudarthrosis occurred in 7 (15%) patients in the DCF group and 31 (41%) in the non-DCF group, corresponding to a relative risk increase of 2.6 (95%CI 1.3-2.4, P < 0.01). 1-KM survival analyses, taking time to event into account and thus the difference in follow-up, also showed increased pseudarthrosis in the non-DCF group (log-rank P = 0.022). Similarly, multivariate logistic regression adjusted for age, instrumented levels and sacral fusion was also with significantly increased odds of pseudarthrosis in the non-DCF group (OR: 4.3, 95%CI: 1.7-11.3, P < 0.01). We found considerable and significant reductions in pseudarthrosis following PSO surgery with DCF compared to non-DCF. III.

Increased Risk of Decompression Sickness When Diving With a Right-to-Left Shunt: Results of a Prospective Single-Blinded Observational Study (The "Carotid Doppler" Study).

Introduction: Divers with a patent Foramen Ovale (PFO) have an increased risk for decompression sickness (DCS) when diving with compressed breathing gas. The relative risk increase, however, is difficult to establish as the PFO status of divers is usually only determined after a DCS occurrence.Methods: This prospective, single-blinded, observational study was designed to collect DCS data from volunteer divers after screening for right-to-left shunt (RLS) using a Carotid Doppler test. Divers were blinded to the result of the test, but all received a standardized briefing on current scientific knowledge of diving physiology and “low-bubble” diving techniques; they were then allowed to dive without restrictions. After a mean interval of 8 years, a questionnaire was sent collecting data on their dives and cases of DCS (if any occurred).Results: Data was collected on 148 divers totaling 66,859 dives. There was no significant difference in diving data between divers with or without RLS. Divers with RLS had a 3.02 times higher incidence of (confirmed) DCS than divers without RLS (p = 0.04). When all cases of (confirmed or possible DCS) were considered, the Relative Risk was 1.42 (p = 0.46). DCS occurred mainly in divers who did not dive according to “low-bubble” diving techniques, in both groups.Conclusion: This prospective study confirms that DCS is more frequent in divers with RLS (such as a PFO), with a Relative Risk of 1.42 (all DCS) to 3.02 (confirmed DCS). It appears this risk is linked to diving behavior, more specifically diving to the limits of the adopted decompression procedures.

Racial/ethnic differences in cardiovascular outcomes in a universal healthcare system: insights from the CARTaGENE cohort

Abstract Background While prior studies have shown racial/ethnic differences in cardiovascular (CV) outcomes within private or mixed health care systems, it remains uncertain whether inequalities in cardiovascular outcomes exist between different races and ethnicities in universal health care contexts. We aimed to determine whether there are racial/ethnicity disparities in long-term CV outcomes within a single-payer universal health care system. Methods The CARTaGENE study is a population-based prospective cohort study with enrollment of 19,996 individuals between 40–69 years in 2009, in the province of Quebec, Canada. Participants residing in four large metropolitan areas were randomly chosen from the provincial health insurance registry by strata of age, sex, and postal codes. Follow-up was available up to 2016. For this analysis, we retained only participants without prior known CV disease. The primary composite endpoint was time to the first CV event or intervention (CV death, acute coronary syndrome, heart failure, coronary revascularization, ischemic stroke, or peripheral vascular event or revascularization). We used unadjusted and adjusted Cox proportional hazard models to evaluate the association of self-defined race/ethnicity with the primary endpoint. Results There were 17,802 eligible participants with a mean age of 51 years (52.5% females) with 111,312 person-years of follow-up (median follow-up of 6.6 years). South Asian (SA) participants had the highest prevalence of diabetes mellitus (29%) and hypertension (32%). After adjustment for age and sex, SA ethnicity was associated with a 95% relative increase in risk for CV events, while East/Southeast Asian (ESA) ethnicity was associated with a 42% relative decrease in risk for CV events compared to White participants. After further adjustment for socioeconomic status and CV risk factors, ESA ethnicity remained associated with a similar decreased CV risk. In contrast, the association of SA ethnicity with increased CV risk was attenuated after full adjustment for baseline characteristics (Table 1). Conclusions Racial/ethnic disparities in long-term CV outcomes are present in a single-payer universal healthcare setting. ESA ethnicity was associated with a lower risk of long-term CV outcomes. Future studies are needed to corroborate the reduced risk of long-term major CV events associated with ESA ethnicity. Understanding the reasons related to potential CV protection with ESA ethnicity could facilitate endeavors to reduce long-term CV outcomes in other races/ethnicities. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): McGill Health University Center

RACIAL/ETHNIC DIFFERENCES IN CARDIOVASCULAR OUTCOMES IN A UNIVERSAL HEALTHCARE SYSTEM: INSIGHTS FROM THE CARTAGENE COHORT

BACKGROUND While prior studies have shown racial/ethnic differences in cardiovascular (CV) outcomes within private or mixed health care systems, it remains uncertain whether inequalities in cardiovascular outcomes exist between different races and ethnicities in universal health care contexts. We aimed to determine whether there are racial/ethnicity disparities in long-term CV outcomes within a single-payer universal health care system. METHODS AND RESULTS The CARTaGENE study is a population-based prospective cohort study with enrollment of 19,996 individuals between 40-69 years in 2009, in the province of Québec, Canada. Participants residing in four large metropolitan areas were randomly chosen from the provincial health insurance registry by strata of age, sex, and postal codes. Follow-up was available up to 2016. For this analysis, we retained only participants without prior known CV disease. The primary composite endpoint was time to the first CV event or intervention (CV death, acute coronary syndrome, heart failure, coronary revascularization, ischemic stroke, or peripheral vascular event or revascularization). We used unadjusted and adjusted Cox proportional hazards to evaluate the association of self-defined race/ethnicity with the primary endpoint. There were 17,802 eligible participants with a mean age of 51 years (52.5% females) with 111,312 person-years of follow-up (median follow-up of 6.6 years). South Asian (SA) participants had the highest prevalence of diabetes mellitus (29%) and hypertension (32%). After adjustment for age and sex, SA ethnicity was associated with a 95% relative increase in risk for CV events, while East/Southeast Asian (ESA) ethnicity was associated with a 42% relative decrease in risk for CV events compared to White participants. After further adjustment for socioeconomic status and CV risk factors, ESA ethnicity remained associated with a similar decreased CV risk. In contrast, the association of SA ethnicity with increased CV risk was attenuated after full adjustment for baseline characteristics (Table 1). CONCLUSION Racial/ethnic disparities in long-term CV outcomes are present in a single-payer universal healthcare setting. ESA ethnicity was associated with a lower risk of long-term CV outcomes. Future studies are needed to corroborate the reduced risk of long-term major CV events associated with ESA ethnicity. Understanding the reasons related to potential CV protection with ESA ethnicity could facilitate endeavors to reduce long-term CV outcomes in other races/ethnicities. While prior studies have shown racial/ethnic differences in cardiovascular (CV) outcomes within private or mixed health care systems, it remains uncertain whether inequalities in cardiovascular outcomes exist between different races and ethnicities in universal health care contexts. We aimed to determine whether there are racial/ethnicity disparities in long-term CV outcomes within a single-payer universal health care system. The CARTaGENE study is a population-based prospective cohort study with enrollment of 19,996 individuals between 40-69 years in 2009, in the province of Québec, Canada. Participants residing in four large metropolitan areas were randomly chosen from the provincial health insurance registry by strata of age, sex, and postal codes. Follow-up was available up to 2016. For this analysis, we retained only participants without prior known CV disease. The primary composite endpoint was time to the first CV event or intervention (CV death, acute coronary syndrome, heart failure, coronary revascularization, ischemic stroke, or peripheral vascular event or revascularization). We used unadjusted and adjusted Cox proportional hazards to evaluate the association of self-defined race/ethnicity with the primary endpoint. There were 17,802 eligible participants with a mean age of 51 years (52.5% females) with 111,312 person-years of follow-up (median follow-up of 6.6 years). South Asian (SA) participants had the highest prevalence of diabetes mellitus (29%) and hypertension (32%). After adjustment for age and sex, SA ethnicity was associated with a 95% relative increase in risk for CV events, while East/Southeast Asian (ESA) ethnicity was associated with a 42% relative decrease in risk for CV events compared to White participants. After further adjustment for socioeconomic status and CV risk factors, ESA ethnicity remained associated with a similar decreased CV risk. In contrast, the association of SA ethnicity with increased CV risk was attenuated after full adjustment for baseline characteristics (Table 1). Racial/ethnic disparities in long-term CV outcomes are present in a single-payer universal healthcare setting. ESA ethnicity was associated with a lower risk of long-term CV outcomes. Future studies are needed to corroborate the reduced risk of long-term major CV events associated with ESA ethnicity. Understanding the reasons related to potential CV protection with ESA ethnicity could facilitate endeavors to reduce long-term CV outcomes in other races/ethnicities.

Lowering Nighttime Blood Pressure With Bedtime Dosing of Antihypertensive Medications: Controversies in Hypertension - Con Side of the Argument.

Lowering Nighttime Blood Pressure With Bedtime Dosing of Antihypertensive Medications: Controversies in Hypertension - Con Side of the Argument.

MP50-15 QUANTIFYING THE PROBABILITY OF NEEDING SALVAGE RADIOTHERAPY FOLLOWING ROBOTIC PROSTATECTOMY: STRATIFICATION USING PROSPECTIVE CLINICAL, RADIOLOGICAL AND PATHOLOGICAL DATA

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy III (MP50)1 Sep 2021MP50-15 QUANTIFYING THE PROBABILITY OF NEEDING SALVAGE RADIOTHERAPY FOLLOWING ROBOTIC PROSTATECTOMY: STRATIFICATION USING PROSPECTIVE CLINICAL, RADIOLOGICAL AND PATHOLOGICAL DATA John Withington, Alice Russell, Tom Cahill, Bradley Russell, Julia Murray, Chris Parker, Simon Hughes, Steve Hazell, Netty Kinsella, and Declan Cahill John WithingtonJohn Withington More articles by this author , Alice RussellAlice Russell More articles by this author , Tom CahillTom Cahill More articles by this author , Bradley RussellBradley Russell More articles by this author , Julia MurrayJulia Murray More articles by this author , Chris ParkerChris Parker More articles by this author , Simon HughesSimon Hughes More articles by this author , Steve HazellSteve Hazell More articles by this author , Netty KinsellaNetty Kinsella More articles by this author , and Declan CahillDeclan Cahill More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002076.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robotic radical prostatectomy (RARP) is a standalone therapeutic modality, with the need for salvage radiotherapy often treated as an unpredictable setback. In fact it’s an added therapeutic factor. We analysed prospectively collected clinical, radiological and pathological data from a single surgeon series of RARPs. METHODS: Data from patients undergoing RARP between 2015 and 2020, with a minimum of 12 months’ follow up were analysed. Descriptive statistical analysis was conducted, and relative risk was calculated for selected variables of interest. RESULTS: 802 cases were reviewed; 800 were included for analysis, minimum follow-up of 35 months, median follow-up 15.1months. Median age 62.5; median PSA at presentation 7.0. Overall, 17.1% (n = 134) required salvage radiotherapy. On surgical histopathology, positive margins were associated with a relative risk increase of 2.45 (95% CI 1.81, 3.33; p<0.01) and lymphovascular invasion with a relative risk increase of 3.50 (95% CI 2.62, 4.67; p<0.01). CONCLUSIONS: This comprehensive dataset represents part of one of the largest series for radical prostatectomy in the UK. Analysis of these data have allowed us to precisely advise our patients on the likelihood that they will need salvage radiotherapy after radical prostatectomy, enabling optimally informed conversations both before and after surgery. Also to set expectations and optimism for cure. As functions of disease, not surgery, it is reasonable to expect these results to be generalisable. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e892-e892 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information John Withington More articles by this author Alice Russell More articles by this author Tom Cahill More articles by this author Bradley Russell More articles by this author Julia Murray More articles by this author Chris Parker More articles by this author Simon Hughes More articles by this author Steve Hazell More articles by this author Netty Kinsella More articles by this author Declan Cahill More articles by this author Expand All Advertisement Loading ...

Associations of Short-term Exposure to Air Pollution and Ambient Temperature Increase with Psychiatric Admissions in Elderly Adults

BACKGROUND AND AIM: Little is known about the associations between ambient environmental exposures and risk of acute episodes of psychiatric disorders. We aim to estimate the risk of acute psychiatric hospital admission associated with short-term exposure to ambient air pollutants and temperature increase in the US elderly population. METHODS: Daily ambient levels of air pollutants (PM2.5, O3, and NO2) and daily ambient surface temperature were assigned to participants by zip code. A time-stratified case-crossover study design was applied to estimate the relative risk increases (RRI) and annual absolute risk differences (ARD) in targeted psychiatric admission rate per 5 units increase in ambient exposures (μg/m³ for PM2.5, ppb for ozone and NO2, °C for temperature). We included all emergency and urgent admissions with primary diagnosis of depression (n=458,492), schizophrenia (n=165,572) and bipolar disorder (n=166,833) from 2000 to 2016 in the entire US Medicare population. RESULTS:Each 5 μg/m³ increase in short-term exposure to PM2.5 was associated with an RRI of 0.62% (95% CI: 0.23%, 1.02%) for depression, an RRI of 0.77% (95% CI: 0.11%, 1.44%) for schizophrenia, and an RRI of 1.19% (95% CI: 0.49%, 1.90%) for bipolar disorder. Each 5 ppb increase in short-term exposure to NO2 was linked with an RRI of 0.35% (95% CI: 0.03%, 0.66%) for depression, as well as an RRI of 0.64% (95% CI: 0.20%, 1.08%) for schizophrenia. For each 5 °C increase in short-term exposure to cold season temperature, relative risk increased by 3.66% (95% CI: 3.06%, 4.26%), 3.03% (95% CI: 2.04%, 4.02%) and 3.52% (95% CI: 2.38%, 4.68%) for depression, schizophrenia and bipolar disorder, respectively. No associations were found with ozone and warm season temperature. CONCLUSIONS:In the US nationwide Medicare elderly population, short-term exposure to elevated levels of PM2.5, NO2 and cold season ambient temperature was significantly associated with increased risk of acute psychiatric admissions. KEYWORDS: Air pollution, Temperature, Mental health outcomes, Short-term exposure, Multi-pollutant

FRAX-based intervention thresholds for Pakistan.

The fracture risk assessment algorithm FRAX® has been recently calibrated for Pakistan, but guidance is needed on how to apply fracture probabilities to clinical practice. The age-specific 10-year probabilities of a major osteoporotic fracture were calculated in women with average BMI to determine fracture probabilities at two potential intervention thresholds. The first comprised the age-specific fracture probabilities associated with a femoral neck T-score of - 2.5. The second approach determined age-specific fracture probabilities that were equivalent to a woman with a prior fragility fracture, without bone mineral density (BMD). The parsimonious use of BMD was additionally explored by the computation of upper and lower assessment thresholds for BMD testing. When a BMD T-score ≤ - 2.5 was used as an intervention threshold, FRAX probabilities in women aged 50years were approximately two-fold higher than in women of the same age but with no risk factors and average BMD. The relative increase in risk associated with the BMD threshold decreased progressively with age such that, at the age of 80years or more, a T-score of - 2.5 was actually protective. The 10-year probability of a major osteoporotic fracture by age, equivalent to women with a previous fracture, rose with age from 2.1% at the age of 40years to 17%, at the age of 90years, and identified women at increased risk at all ages. Intervention thresholds based on BMD alone do not effectively target women at high fracture risk, particularly in the elderly. In contrast, intervention thresholds based on fracture probabilities equivalent to a 'fracture threshold' target women at high fracture risk.

Improving postpartum hemorrhage risk prediction using longitudinal electronic medical records.

ObjectivePostpartum hemorrhage (PPH) remains a leading cause of preventable maternal mortality in the United States. We sought to develop a novel risk assessment tool and compare its accuracy to tools used in current practice.Materials and MethodsWe used a PPH digital phenotype that we developed and validated previously to identify 6639 PPH deliveries from our delivery cohort (N = 70 948). Using a vast array of known and potential risk factors extracted from electronic medical records available prior to delivery, we trained a gradient boosting model in a subset of our cohort. In a held-out test sample, we compared performance of our model with 3 clinical risk-assessment tools and 1 previously published model.ResultsOur 24-feature model achieved an area under the receiver-operating characteristic curve (AUROC) of 0.71 (95% confidence interval [CI], 0.69-0.72), higher than all other tools (research-based AUROC, 0.67 [95% CI, 0.66-0.69]; clinical AUROCs, 0.55 [95% CI, 0.54-0.56] to 0.61 [95% CI, 0.59-0.62]). Five features were novel, including red blood cell indices and infection markers measured upon admission. Additionally, we identified inflection points for vital signs and labs where risk rose substantially. Most notably, patients with median intrapartum systolic blood pressure above 132 mm Hg had an 11% (95% CI, 8%-13%) median increase in relative risk for PPH.ConclusionsWe developed a novel approach for predicting PPH and identified clinical feature thresholds that can guide intrapartum monitoring for PPH risk. These results suggest that our model is an excellent candidate for prospective evaluation and could ultimately reduce PPH morbidity and mortality through early detection and prevention.

Changes in Selected Food Groups Consumption and Quality of Meals in Japanese School Children during the COVID-19 Pandemic.

In 2020, a state of emergency was declared to control the devastating impact of coronavirus, leading to temporary school closures in Japan, meaning that school lunches were not provided to the majority of schoolchildren. Using questionnaires completed by participants’ guardians, we examined the relationship between household income and the quality of meals in Japanese schoolchildren before, during, and after the state of emergency. Participants (1111 children, 10–14 years old) were chosen to form a nationally representative sample of the Japanese population. “Well-balanced dietary intake” was defined as the intake of (i) meat, fish, or eggs and (ii) vegetables. The desired prevalence was defined as equal to or more than twice a day. Household income was divided into quartiles. “Well-balanced dietary intake” was lower in all households during the state of emergency compared with before. The proportion of those with a “well-balanced dietary intake” at least twice a day was notably low in both Q3 and Q4 during the state of emergency compared with before the declared state of emergency; relative risk increase (95% CI) were Q1: −19.0% (−19.6% to −18.4%), p < 0.001, Q2: −21.3% (−22.1% to −20.6%) p < 0.001, Q3: −25.4% (−26.1% to −24.7%), p < 0.001, and Q4: −34.8% (−35.6% to −34.0%), p < 0.001. The interaction p (vs. Q1) of Q2, Q3, and Q4 were all <0.001. Guardians from low-income households had significantly higher rates of having less: time, psychological room, and financial position to prepare meals during the state of emergency. Our results suggest that schoolchildren’s quality of meals worsened during the state of emergency, especially in low-income households, because school lunches were not provided.

Mortality associated with non-melanoma skin cancer in Spain from 1979 to 2018: trends and age-adjusted rates.

Non-melanoma skin cancers (NMSCs) are the most frequent group of malignant tumours worldwide. Objectives: The aim of the present research was to analyse mortality associated with NMSC in Spain between 1979 and 2018 and highlight changes regarding trend in mortality and differences according to age groups and gender. Death records and mid-year population data were collected from the National Statistics Institute. Age-standardized mortality rates were calculated. Significant changes in mortality trends were identified using Joinpoint regression. The independent effects of age, period and cohort and potential years of life lost due to NMSC were also analysed. Mortality rates associated with NMSC in Spain were reported as 2.49 per 100,000 inhabitants in 1979 (95%CI: 2.24-2.77) and 1.27 per 100,000 inhabitants in 2018 (95%CI; 1.16-1.39) for the overall population. Women who were born after the 70 s showed a significant increase in relative risk of death due to NMSC. Mortality associated with NMSC in Spain shows a decreasing overall trend that appears to have stabilized since 2005, with the exception of women between 35 and 64 years old.

Duration of Diabetes and Incident Heart Failure: The ARIC (Atherosclerosis Risk In Communities) Study

ObjectivesThis study assessed the association of diabetes duration with incident heart failure (HF). BackgroundDiabetes increases HF risk. However, the independent effect of diabetes duration on incident HF is unknown. MethodsWe included 9,734 participants (mean age 63 years, 58% women, 22% Black) at ARIC (Atherosclerosis Risk In Communities) Visit 4 (1996-1998) without HF or coronary heart disease. We calculated diabetes duration at Visit 4 (baseline), utilizing diabetes status at the first 4 ARIC visits spaced 3 years apart, and self-reported diagnosis date for those with diabetes diagnosed before Visit 1. We used Cox regression to estimate associations of diabetes duration with incident HF, accounting for intercurrent coronary heart disease and other risk factors. We performed analyses stratified by age (<65 years or ≥65 years), race, sex, and glycemic control (hemoglobin A1C [HbA1C] consistently <7%, vs HbA1C ≥7%), with tests for interaction. ResultsOver 22.5 years of follow-up, there were 1,968 HF events. Compared to those without diabetes, HF risk rose with longer diabetes duration, with the highest risk among those with ≥15 y diabetes duration (HR: 2.82; 95% CI: 2.25-3.63). Each 5-year increase in diabetes duration was associated with a 17% (95% CI: 11-22) relative increase in HF risk. Similar results were observed across HF subtypes. The HF and diabetes duration associations were stronger among those aged <65 years, those with HbA1C ≥7%, those with a body mass index ≥30 kg/m2, women, and Blacks (all P interactions <0.05). ConclusionsDelaying diabetes onset may augment HF prevention efforts, and therapies to improve HF outcomes might target those with long diabetes duration.

Temporal sequences of suicidal and nonsuicidal self-injurious thoughts and behaviors among inpatient and community-residing military veterans

BackgroundSuicidal and nonsuicidal self-injurious thoughts and behaviors (SITBs) are major health concerns among military veterans yet little is known about the temporal relations among these outcomes. This study examined the temporal relations between suicidal and nonsuicidal SITBs among higher-risk veterans. Specifically, we identified when SITBs emerged and evaluated the role of nonsuicidal self-injury (NSSI) in the medical lethality of suicide attempts (SA), relative risk, and survival time of suicidal SITBs (i.e., suicide ideation [SI], suicide plan, SA). MethodCross-sectional data were collected from two samples examining suicide risk among veterans receiving inpatient psychiatric care (n = 157) and community-residing veterans with current depression and/or past month SI (n = 200). Participants completed an interview to assess SITBs. ResultsSITBs emerged between ages 14-28 years with behaviors emerging, on average, earlier among inpatient veterans. The time lag between SITBs was not significantly different between groups. Inpatient veterans had a significantly shorter time lag from SI to SA. NSSI history predicted an increase in relative risk for all suicidal SITBs and shorter survival time. There was no association between NSSI history and medical lethality of the most serious SA for both groups. LimitationsLimitations included use of cross-sectional, retrospective self-report with age-of-onset endorsed in years and not all SITBs were assessed (e.g., passive SI). ConclusionsVeterans with a NSSI history are at high risk for suicidal SITBs and have a shorter survival time. Results showed thoughts (i.e., NSSI thoughts, SI) emerged before behavior (i.e., NSSI, SA) and NSSI emerged before SA.