Matched Control Periods Research Articles

Moderate Anthropogenic Noise Exposure Does Not Affect Navy Bottlenose Dolphin (Tursiops truncatus) Whistle Rates

Bottlenose dolphins (Tursiops truncatus) rely on frequency- and amplitude-modulated whistles to communicate, and noise exposure can inhibit the success of acoustic communication through masking or causing behavioral changes in the animal. At the US Navy Marine Mammal Program (MMP) in San Diego, CA, dolphins are housed in netted enclosures in the San Diego Bay and exposed to noise from vessels, unmanned underwater vehicles, and other remote sensing devices. The acoustic behavior of 20 dolphins was monitored and whistle rates during noise events were quantified. Whistle rates during the onset of the event (i.e., the first 5 min) did not significantly differ from the pre-onset (5 min immediately preceding). Whistle rates were also not significantly different for the entire duration of the event compared to a matched control period. The noise’s frequency range (i.e., control, mid-frequency (0–20 kHz) or high-frequency (21–80 kHz)), signal-to-noise ratio, and sound pressure level were not significantly related to the dolphins’ whistle rate. Considering this is a location of frequent and moderate noise output, these results lend support to established guidelines on anthropogenic noise exposure for cetaceans, suggesting that moderate noise exposure levels may not impact communication efforts in bottlenose dolphins.

Are Dental Procedures Associated With Pyogenic Vertebral Osteomyelitis?

Dental procedures can lead to bacteremia and have been considered a potential risk factor for pyogenic vertebral osteomyelitis (PVO). However, data on the association between dental procedures and PVO are limited. (1) After controlling for relevant confounding variables, are dental procedures associated with an increased risk of PVO? (2) Does antibiotic prophylaxis before dental procedures effectively decrease the risk of PVO? A case-crossover study was conducted to investigate the association between dental procedures and PVO using a Japanese claims database. The advantage of this study design is that confounding factors that do not vary over time are automatically adjusted for, because cases act as their own controls. From April 2014 to September 2021, the database included 8414 patients who were hospitalized for PVO. Of these, 50% (4182 of 8414) were excluded because they had not undergone any dental procedures before the index date, a further 0.1% (10 of 8414) were excluded because they were younger than 18 years at the index date, and a further 7% (623 of 8414) were excluded because they did not have at least 20 weeks of continuous enrollment before the index date, leaving 43% (3599 of 8414) eligible for analysis here. The mean age was 77 ± 11 years, and 55% (1985 of 3599) were men. Sixty-five percent (2356 of 3599) of patients had a diagnosis of diabetes mellitus, and 42% (1519 of 3599) of patients had a diagnosis of osteoporosis. We compared the frequency of dental procedures between a 4-week hazard period before the admission date for PVO and two control periods, 9 to 12 weeks and 17 to 20 weeks before the admission date for PVO, within individuals. We calculated odds ratios and 95% confidence intervals using conditional logistic regression analysis. Comparing the hazard and matched control periods within individuals demonstrated that dental procedures were not associated with an increased risk of PVO (OR 0.81 [95% CI 0.72 to 0.92]; p < 0.001). Additional analysis stratified by antibiotic prophylaxis use showed that antibiotic prophylaxis was not associated with a lower OR of developing PVO after dental procedures (with antibiotic prophylaxis: OR 1.11 [95% CI 0.93 to 1.32]; p < 0.26, without antibiotic prophylaxis: OR 0.72 [95% CI 0.63 to 0.83]; p < 0.001). Our sensitivity analyses, in which the exposure assessment interval was extended from 4 to 8 or 12 weeks and exposure was stratified by whether the dental procedure was invasive, demonstrated results that were consistent with our main analysis. Dental procedures were not associated with an increased risk of subsequent PVO in this case-crossover study. The effectiveness of antibiotic prophylaxis was not demonstrated in the additional analysis that categorized exposure according to the use of antibiotic prophylaxis. Our results suggest that the association between dental procedures and PVO may have been overestimated. Maintaining good oral hygiene may be important in preventing the development of PVO. The indications for antibiotic prophylaxis before dental procedures should be reconsidered in view of the potential risk of adverse drug reactions to antibiotic prophylaxis and the emergence of drug-resistant pathogens. Larger randomized controlled trials are needed to confirm these findings and assess the role of antibiotic prophylaxis. Level III, therapeutic study.

The impact of COVID-19 restrictions on acute hospital presentations due to alcohol-related harm in Waitematā Auckland, New Zealand.

New Zealand's public health response to the COVID-19 pandemic has largely been considered successful, although there have been concerns surrounding the potential harms of the lockdown restrictions enforced, including alteration of alcohol consumption. New Zealand utilised a four-tiered alert level system of lockdowns and restrictions, with Level 4 denoting strict lockdown. This study aimed to compare alcohol-related hospital presentations during these periods with corresponding calendar-matched dates from the preceding year. We conducted a retrospective case-controlled analysis of all alcohol-related hospital presentations between 1 January 2019 to 2 December 2021 and compared COVID-19 restriction periods to corresponding calendar-matched pre-pandemic periods. A total of 3,722 and 3,479 alcohol-related acute hospital presentations occurred during the four COVID-19 restriction levels and corresponding control periods respectively. Alcohol-related presentations accounted for a greater proportion of all admissions during COVID-19 Alert Levels 3 and 1 than the respective control periods (both p⁢0.05), but not during Levels 4 and 2 (both p>0.30). Acute mental and behavioural disorders accounted for a greater proportion of alcohol-related presentations during Alert Levels 4 and 3 (both p≤0.02), although alcohol dependence was present in a lower proportion of presentations during Alert Levels 4, 3, and 2 (all p⁢0.01). There was no difference in acute medical conditions including hepatitis and pancreatitis during all alert levels (all p>0.05). Alcohol-related presentations were unchanged compared to matched control periods during the strictest level of lockdown, although acute mental and behavioural disorders accounted for a greater proportion of alcohol-related admissions during this period. New Zealand appears to have avoided the general trend of increased alcohol-related harms seen internationally during the COVID-19 pandemic and its lockdown restrictions.

Impact of COVID-19 on Hospital Admissions for COPD Exacerbation: Lessons for Future Care.

Background and Objectives: Chronic obstructive pulmonary disease (COPD) is a leading cause of death worldwide. Acute exacerbations (AECOPD) are common and often triggered by viral infection. During the COVID-19 pandemic social restrictions, including ‘shielding’ and ‘lockdowns’, were mandated. Multiple, worldwide studies report a reduction in AECOPD admissions during this period. This study aims to assess the effect of the pandemic and Lockdown on the rates of admission with AECOPD and severity of hospitalised exacerbations in the North-East of England. Materials and Methods: Data were extracted for patients presenting with a diagnosis of AECOPD or respiratory failure secondary to AECOPD during the ‘COVID-19 period’ (26/3/20–31/12/20) and a date-matched control period from the year previous. We present descriptive statistics and regression analysis of the effects of the COVID-19 period on the rates of hospital admission. Results: Compared to the matched control period, the COVID-19 period was associated with fewer AECOPD admissions (COVID-19 = 719, control = 1257; rate ratio 0.57, p < 0.001) and shorter length of stay (COVID-19 = 3.9 ± 0.2, control = 4.78 ± 0.2 days; p = 0.002), with similar in-hospital plus 30-day post-discharge mortality. Demographics were similar between periods. Only six patients had a positive COVID-19 PCR test. Conclusion: During the COVID-19 period there was a substantial reduction in AECOPD admissions, but no increase in overall severity of exacerbations or mortality. Rather than fear driving delayed hospital presentation, physical and behavioural measures taken during this period to limit transmission of COVID-19 are likely to have reduced transmission of other respiratory viruses. This has important implications for control of future AECOPD.

1222Estimating the causal effect of mobility on Dengue during the COVID-19 pandemic

1222Estimating the causal effect of mobility on Dengue during the COVID-19 pandemic

Parent-infant skin-to-skin contact reduces the electrical activity of the diaphragm and stabilizes respiratory function in preterm infants.

BackgroundThe physiological benefit of parent–infant skin-to-skin contact (SSC) is uncertain for preterm infants with ventilatory support. We aimed to investigate whether SSC stabilizes the respiration compared to incubator care in mechanically ventilated preterm infants.MethodsThe prospective observational study was performed in Turku University Hospital, Finland. Preterm infants were eligible if they were born before 36 weeks gestation and received respiratory support with either invasive or non-invasive neurally adjusted ventilatory assist (NAVA). SSC was applied as soon as possible after birth. Respiratory variables were collected from the ventilator log data, and SSC episodes were compared with matched control periods during incubator care.ResultsA total of 167 episodes of SSC were recorded from 17 preterm infants: 138 episodes during invasive NAVA and 29 episodes during non-invasive NAVA. During invasive NAVA, peak electrical activity of the diaphragm (Edi), minimum Edi, respiratory rate, time on backup ventilation, peak inspiratory pressure, and mean airway pressure were significantly lower in SSC than in incubator care. During non-invasive NAVA, peak Edi, minimum Edi, time on backup ventilation, and peak inspiratory pressure were significantly lower in SSC than in incubator care.ConclusionsSSC stabilized and improved the respiratory physiology in mechanically ventilated preterm infants.Impact Skin-to-skin contact reduced work of breathing compared to incubator care in mechanically ventilated preterm infants.Skin-to-skin contact reduced the need for backup ventilation during neurally adjusted ventilatory assist in preterm infants.Skin-to-skin contact among ventilated preterm infants was not only safe but also stabilized and improved their respiratory physiology.

Hosting pre-registration physiotherapy students in Australian private practices does not change service and economic outcomes; an economic analysis

BackgroundDespite perceived economic barriers to hosting physiotherapy students in private practice settings, no research to date has investigated the effect of hosting students on service delivery and income during clinical placements. ObjectivesThe aim of this study was to determine the effect of student placement provision on service delivery and income in private practice settings. MethodsA retrospective economic analysis using a temporal synthetic control period was undertaken. Physiotherapy private practices who had hosted at least one pre-registration physiotherapy student with a matched control period in the subsequent or previous year were invited to participate. Direct service and economic comparisons were conducted across five-week periods and individual placement weeks. ResultsNo significant differences in occasions of service and income were found when students were hosted and not hosted, and this remained non-significant after controlling for practice-specific characteristics. The overall mean income per practice was higher for week one of the student placement (95% CI: 657.35 to 1240.95) as compared to week one of the control period, but this finding was not significant. Overall mean income per practice was significantly higher in weeks two to five of the student placement (95% CI: 29.03 to 1732.19) when compared to weeks two to five of the control period. ConclusionHosting pre-registration physiotherapy students within private practice settings is not associated with a reduction in service and economic outcomes. Hosting physiotherapy students has a positive economic effect following their initial placement week.

Abstract 213: Disruption of Mitochondrial Cristae Integrity in Lethal Myocardial Ischemia-Reperfusion Injury: Association or Cause-and-Effect?

Background: Considerable attention has focused on the concept that disruption of mitochondrial structure/function is a determinant of cell death in cardiomyocytes subjected to ischemia-reperfusion (IR). However, the details of this relationship, and the precise mitochondrial event(s) that precipitate lethal IR injury, remain unresolved. Aim: Emerging evidence has revealed that cardiomyocytes subjected to IR display: i) degradation of optic atrophy protein-1 (OPA1), the inner mitochondrial membrane protein responsible for maintaining cristae junction integrity, followed by ii) inappropriate release of OPA1 into the cytosol. Accordingly, our goal was to establish whether degradation of OPA1 plays a causal, mechanistic role in determining cardiomyocyte fate. Methods and Results: In Protocol 1 , HL-1 cardiomyocytes underwent 2.5 hrs of simulated ischemia. This was preceded by either a classic intervention known to attenuate IR injury (ischemic preconditioning: IPC) or a matched control period. Cell viability was quantified at 24 hrs post-R, and release of OPA1 into the cytosol was measured at 30 min post-R. In Controls, IR resulted in ~50% cell death and a &gt;15-fold increase in OPA1 in the cytosol - effects that were both attenuated by IPC (Figure: top). In Protocol 2 : to discern whether these data reflect an association between OPA1 degradation and cell death or cause-and-effect , HL-1 cells were transfected with either siRNA targeting OPA1 (resulting in near-total knockdown of OPA1 expression: data not shown) or scrambled siRNA. Cardiomyocytes then underwent IPC/no intervention and IR as in Protocol 1. If OPA1 disruption contributes to IR injury, we reasoned that OPA1 knockdown would exacerbate cell death in Controls and attenuate IPC-mediated protection. However, OPA1 knockdown had no effect on cell death in either cohort (Figure: bottom). Conclusion: Disruption of OPA1 and loss of cristae junction integrity does not play a causal role in lethal IR injury.

Concentration-response relationships between hourly particulate matter and ischemic events: A case-crossover analysis of effect modification by season and air-mass origin

Most studies linking cardiovascular disease with particulate matter (PM) exposures have focused on total mass concentrations, regardless of their origin. However, the origin of an air mass is inherently linked to particle composition and possible toxicity. We examine how the concentration-response relation between hourly PM exposure and ischemic events is modified by air-mass origin and season. Using telemedicine data, we conducted a case-crossover study of 1855 confirmed ischemic cardiac events in Israel (2005–2013). Based on measurements at three fixed-sites in Tel Aviv and Haifa, ambient PM with diameter < 2.5 μm (PM2.5) and 2.5–10 μm (PM10–2.5) concentrations during the hours before event onset were compared with matched control periods using conditional logistic regression that allowed for non-linearity. We also examined effect modification of these associations based on the geographical origin of each air mass by season. Independent of the geographical origin of the air mass, we observed concentration-response curves that were supralinear. For example, the overall odds ratios (ORs) of ischemic events for an increase of 10-μg/m3 in the 2-h average of PM10–2.5 were 1.08 (95% confidence interval (CI): 1.03–1.14) and 1.00 (0.99–1.01) at the median (17.8 μg/m3) and 95th percentile (82.3 μg/m3) values, respectively. Associations were strongest at low levels of PM10–2.5 when air comes from central Europe in the summer (OR: 1.27; 95% CI: 1.06, 1.52). Our study demonstrates that hourly associations between PM2.5 and PM10–2.5 and ischemic cardiac events are supralinear during diverse pollution conditions in a single population that experiences a wide range of exposure levels.

Cerebral Oxygenation and Autoregulation in Very Preterm Infants Developing IVH During the Transitional Period: A Pilot Study.

Background: The transitional period, defined as the first 72 h after preterm birth, is often characterized by a significant hemodynamic instability, which represents an important risk factor for such neurological complications of prematurity as intraventricular hemorrhage (IVH). The impairment of cerebral autoregulation plays a key role in the pathogenesis of IVH, whose incidence is highest during the transitional period. This pilot study aimed to evaluate whether patterns of cerebral autoregulation and oxygenation differ in relation to IVH development in very preterm infants during the transitional period.Methods: Infants <32 weeks' gestation were enrolled within 12 h from birth. A simultaneous monitoring of cerebral oxygenation (CrSO2) by near-infrared spectroscopy and of heart rate and peripheral oxygen saturation by pulse oximetry was performed over the first 72 h. Cerebral fractional oxygen extraction (cFTOE) and tissue oxygenation-heart rate reactivity index (TOHRx), which represents a marker of cerebrovascular reactivity, were calculated. Daily cranial and cardiac ultrasound scans were performed, in order to assess the hemodynamic status and to detect a possible IVH onset. CrSO2 and cFTOE, clustered on 6-hour epochs, were compared between infants who developed IVH during the study period and those who did not. A between-group comparison of TOHRx before and after IVH detection was also performed.Results: Twenty preterm infants with a median gestational age of 27 weeks (interquartile range, IQR: 25-30 weeks) and median birth weight of 895 g (IQR: 822-1208 g) were enrolled. Of these, 8 developed IVH. The median age at IVH detection was 40 h (IQR: 30-48 h). Pre-IVH TOHRx was significantly higher compared to matched control periods (p <0.001). CrSO2 was significantly lower from 12 to 30 h and from 42 h onwards in cases compared to controls; however, a temporary CrSO2 rise preceded IVH detection. Similarly, cFTOE was significantly higher in IVH infants from 12 to 30 h and from 48 to 72 h, with a transient decrease between the two periods.Conclusions: In preterm infants during the transitional period, the development of IVH is preceded by transient changes in cerebral oxygenation and oxygen extraction which, in turn, may underlie an early impairment of cerebral autoregulation. Larger studies are needed to confirm these preliminary findings.

Impacts of Intergroup Interactions on Intragroup Behavioral Changes in Javan Gibbons (Hylobates moloch)

Agonistic intergroup interactions can cause individual costs such as physical injuries, increased physiological stress, and disrupted intragroup social relationships. Therefore, individuals should employ behavioral strategies to minimize the cost associated with aggressive intergroup encounters (IGEs). We investigated the behavioral strategies of territorial, pair-living Javan gibbons (Hylobates moloch) in response to intergroup aggression, including 1) changes in activity budgets, 2) affiliative behaviors within pairs, and 3) potential intergroup avoidance strategies, such as sleeping tree selection. We observed 129 encounters in three habituated gibbon groups surrounded by four unhabituated groups in Gunung Halimun-Salak National Park, Java, from 2014 to 2016. Overall, gibbons significantly altered their activity budgets during IGEs: they foraged less and were less active than when there was no encounter. We also found a decrease in grooming within pairs following IGEs compared to a matched-control period. However, we did not find any effects of the intensity of aggression, outcome, length of, or female participation in IGEs on grooming within pairs in the hour after an encounter. Male gibbons slept farther away from the IGE location after aggressive IGEs than after neutral encounters. Our results suggest that not only primates living in large groups but also primates living in small groups, such as Javan gibbons, may develop behavioral strategies to deal with direct (during encounters), immediate (within 1 h after encounters), and possibly longer (at the end of a day with encounters) effects of intergroup interactions.

Intravenous iron supplementation does not increase infectious disease risk in hemodialysis patients: a nationwide cohort-based case-crossover study

BackgroundStudies have reported conflicting findings on the infection risk posed by intravenous iron supplementation among hemodialysis (HD) patients. We used a novel study design to assess associations between intravenous iron and infectious diseases.MethodsPatients initiating HD between 1998 and 2008 were extracted from Taiwan’s National Health Insurance Research Database. Their first infectious disease in the period between 1.5 years after dialysis initiation and 2010 was identified and defined as the index date. Through the case-crossover design, the odds of exposure to intravenous iron within the 1-month period immediately preceding the index date (i.e., the case period) were compared with iron exposure in three different matched control periods for the same enrollee, thus possibly reducing some unmeasured confounders.ResultsA total of 1410 patients who met our enrollment criteria were extracted from incident HD patients. The odds of intravenous iron exposure during the case period versus total control periods exhibited no significant difference (odds ratio: 1.000, 95% confidence interval: 0.75–1.33). In subgroup analyses, this association remained nonsignificant across patients with diabetes mellitus, heart failure, chronic lung disease, venous catheter for HD, and higher iron load.ConclusionsWe found that intravenous iron supplementation did not increase short-term infection risk among HD patients.

Evaluating the Behavior and Temperament of African Penguins in a Non-Contact Animal Encounter Program.

Simple SummaryAs animal ambassador programs increase across zoos, it is important to assess the impact they may have on animal welfare. We investigated possible behavioral impacts of a penguin encounter program at the Lincoln Park Zoo in Chicago, Illinois, on a colony of 15 African penguins. We also investigated whether individual characteristics, including temperament, related to penguins’ voluntary participation in the program. We collected 16 weeks of behavioral data, during which 43 Penguin Encounters occurred, which allowed zoo guests to enter part of the penguins’ enclosure. We found no significant differences in colony affiliative or aggressive behavior between days with or without encounter programs, suggesting that offering encounters did not disrupt social behavior in the colony. We also measured penguin temperament on a shy-bold continuum by recording birds’ responses to novel objects and found that temperament, as well as age and sex were predictive of their voluntary participation. We concluded that this program had a neutral or positive impact on penguin welfare, possibly due to aspects of the ambassador program that provided penguins with control over their involvement.Animal ambassador programs are increasingly prevalent in zoos, yet few studies have investigated their impact on animal welfare. We assessed the effects of an ambassador program on the behavior of a colony (N = 15) of zoo-housed African penguins (Spheniscus demersus) and evaluated whether individual characteristics were predictive of participation. Behavioral data were collected for 16 weeks and included 43 “penguin encounters”, during which zoo visitors entered a designated portion of the penguins’ enclosure. When comparing colony behavior following encounters to behavior during a matched control period lacking an encounter, we found no significant difference between affiliative or aggressive behaviors, suggesting that the encounters did not disrupt interactions in the colony. The same was true when comparing behavior preceding the encounter to a matched control period, indicating that any anticipatory period was similarly non-disruptive. Space use during encounters suggested comfort near visitors. We also measured penguin temperament on the shy-bold continuum by recording the birds’ response to novel objects and found that penguins’ temperament, sex, and age were predictive of participation. We concluded that this program had a neutral or positive impact on penguin welfare and considered the findings in relation to aspects of the ambassador program that provided penguins with control over their involvement.

Observing grooming promotes affiliation in Barbary macaques.

Observing friendly social interactions makes people feel good and, as a result, then act in an affiliative way towards others. Positive visual contagion of this kind is common in humans, but whether it occurs in non-human animals is unknown. We explored the impact on female Barbary macaques of observing grooming, a behaviour that physiological and behavioural studies indicate has a relaxing effect on the animals involved. We compared females' behaviour between two conditions: after observing conspecifics groom, and in a matched control period. We found that observing grooming was associated with reduced behavioural indicators of anxiety, suggesting that seeing others groom is, in itself, relaxing. Observing grooming was also associated with a shorter latency to becoming involved in a grooming bout (and higher likelihood both of initiating that bout and being the groomer rather than groomee), and with elevated rates of other affiliative behaviours. These results provide evidence for positive visual contagion; this phenomenon may contribute fundamentally to group cohesion not just in this species, but also in the many mammal and bird species where grooming occurs. Our study highlights the importance of exploring social behaviour beyond the level of the interacting individuals, within the broader social context where it occurs.

The association between antidepressant use and deaths from road traffic accidents: a case-crossover study.

Antidepressants are some of the most commonly used psychiatric medications, but little information is available about the effects of antidepressant treatment on the risk of traffic accidents across classes of antidepressants or associated with each substance individually. To investigate the relationship between exposure to antidepressants and risk of fatality in road traffic accidents. We used a Korean national road traffic authority database linked with a national health insurance database between January 1, 2010 and December 31, 2014 and applied a case-crossover design. The study subjects were drivers in South Korea who died from traffic accidents and who had prescriptions for antidepressants within 1year prior to the date of the accident. We compared the status of prescription for antidepressants with the hazard period and four matched control periods using conditional logistic regression, adjusting for other drug use. The trends of antidepressant utilization were described in terms of the number of prescriptions. A case-case-time-control design was applied to drugs with an increasing trend in use and a significant case-crossover odds ratio (OR). A total of 1250 antidepressant-using drivers were included, and an increased risk was observed during the 30-day hazard period (adjusted OR 1.30; 95% CI 1.03-1.63). Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) showed significant risks, but tricyclic antidepressants did not. However, the associations of all antidepressants, SSRIs, SNRIs, escitalopram, and duloxetine did not remain significant after adjusting for trends in utilization. Paroxetine and milnacipran were associated with increased risks, with no obvious increase in their utilization, but the possibility of confounding by indication could have affected the results for milnacipran. Considering the trends of antidepressant prescription and utilization, the use of paroxetine increased the risk of fatal traffic accidents.

Fine and Coarse Particulate Matter Exposures and Associations with Acute Cardiac Events among Participants in a Telemedicine Service: A Case-Crossover Study.

Background:Subclinical cardiovascular changes have been associated with ambient particulate matter (PM) exposures within hours. Although the U.S. Environmental Protection Agency continues to look for additional evidence of effects associated with sub-daily PM exposure, this information is still limited because most studies of clinical events have lacked data on the onset time of symptoms to assess rapid increased risk.Objective:Our objective was to investigate associations between sub-daily exposures to PM and acute cardiac events using telemedicine data.Methods:We conducted a case-crossover study among telemedicine participants of age who called a service center for cardiac-related symptoms and were transferred to a hospital in Tel Aviv and Haifa, Israel (2002–2013). Ambient and measured by monitors located in each city during the hours before the patient called with symptoms were compared with matched control periods. We investigated the sensitivity of these associations to more accurate symptom onset time and greater certainty of diagnosis.Results:We captured 12,661 calls from 7,617 subscribers experiencing ischemic (19%), arrhythmic (31%), or nonspecific (49%) cardiac events. PM concentrations were associated with small increases in the odds of cardiac events. For example, odds ratios for any cardiac event in association with a increase in 6-h and 24-h average were 1.008 [95% confidence interval (CI): 0.998, 1.018] and 1.006 (95% CI: 0.995, 1.018), respectively, and for were 1.003 (95% CI: 1.001, 1.006) and 1.003 (95% CI: 1.000, 1.007), respectively. Associations were stronger when using exposures matched to the call time rather than calendar date and for events with higher certainty of the diagnosis.Conclusions:Our analysis of telemedicine data suggests that risks of cardiac events in telemedicine participants of age may increase within hours of PM exposures. https://doi.org/10.1289/EHP2596

Antidepressants and the risk of arrhythmia in elderly affected by a previous cardiovascular disease: a real-life investigation from Italy.

The study aimed to fill existing knowledge gaps on the safety of antidepressant drugs (ADs) by estimating the risk of hospitalization for arrhythmia associated with use of selective serotonin reuptake inhibitors (SSRIs) and newer atypical ADs (NAAs) among elderly with previous cardiovascular (CV) events. The cohort was composed by 199,569 individuals aged ≥65years from five Italian healthcare territorial units who were discharged for cardiovascular outcomes in the years 2008-2010. The 17,277 patients who experienced hospital admission for arrhythmia during follow-up were included as cases. Odds of current ADs use among cases (i.e., 14days before hospital admission) was compared with (i) odds of current use of 1:5 matched controls (between-patients case-control) and with (ii) odds of previous use during 1:5 matched control periods (within-patient case-crossover). The risk of arrhythmia associated with ADs current use was modelled fitting a conditional logistic regression. A set of sensitivity analyses was performed to account for sources of systematic uncertainty. Current users of SSRIs and NAAs were at increased risk of arrhythmia with case-control odds ratios (OR) of 1.37 (95% confidence interval, CI 1.18 to 1.58) and 1.41 (1.16 to 1.71) and case-crossover OR of 1.48 (1.20 to 1.81) and 1.72 (1.31 to 2.27). An increased risk of arrhythmia was associated with current use of trazodone (NAA) consistently in case-control and case-crossover designs. Evidence that current use of SSRIs and NAAs is associated to an increased risk of arrhythmia among elderly with CV disease was consistently supplied by two observational approaches.

Dental procedures, antibiotic prophylaxis, and endocarditis among people with prosthetic heart valves: nationwide population based cohort and a case crossover study

Objective To assess the relation between invasive dental procedures and infective endocarditis associated with oral streptococci among people with prosthetic heart valves.Design Nationwide population based cohort and a case crossover...

Dental Procedures and the Risk of Infective Endocarditis.

Infective endocarditis (IE) is an uncommon but potentially devastating disease. Recently published data have revealed a significant increase in the incidence of IE following the restriction on indications for antibiotic prophylaxis as recommended by the revised guidelines. This study aims to reexamine the basic assumption behind the rationale of prophylaxis that dental procedures increase the risk of IE.Using the Longitudinal Health Insurance Database of Taiwan, we retrospectively analyzed a total of 739 patients hospitalized for IE between 1999 and 2012. A case-crossover design was conducted to compare the odds of exposure to dental procedures within 3 months preceding hospitalization with that during matched control periods when no IE developed.In the unadjusted model, the odds ratio (OR) was 0.93 for tooth extraction (95% confidence interval [CI] 0.54-1.59), 1.64 for surgery (95% CI 0.61-4.42), 0.92 for dental scaling (95% CI 0.59-1.42), 1.69 for periodontal treatment (95% CI 0.88-3.21), and 1.29 for endodontic treatment (95% CI 0.72-2.31). The association between dental procedures and the risk of IE remained insignificant after adjustment for antibiotic use, indicating that dental procedures did not increase the risk of IE.Therefore, this result may argue against the conventional assumption on which the recommended prophylaxis for IE is based.

Population census of a large common tern colony with a small unmanned aircraft.

Small unmanned aircraft systems (UAS) may be useful for conducting high-precision, low-disturbance waterbird surveys, but limited data exist on their effectiveness. We evaluated the capacity of a small UAS to census a large (>6,000 nests) coastal Common tern (Sterna hirundo) colony of which ground surveys are particularly disruptive and time-consuming. We compared aerial photographic tern counts to ground nest counts in 45 plots (5-m radius) throughout the colony at three intervals over a nine-day period in order to identify sources of variation and establish a coefficient to estimate nest numbers from UAS surveys. We also compared a full colony ground count to full counts from two UAS surveys conducted the following day. Finally, we compared colony disturbance levels over the course of UAS flights to matched control periods. Linear regressions between aerial and ground counts in plots had very strong correlations in all three comparison periods (R 2 = 0.972–0.989, P < 0.001) and regression coefficients ranged from 0.928–0.977 terns/nest. Full colony aerial counts were 93.6% and 94.0%, respectively, of the ground count. Varying visibility of terns with ground cover, weather conditions and image quality, and changing nest attendance rates throughout incubation were likely sources of variation in aerial detection rates. Optimally timed UAS surveys of Common tern colonies following our method should yield population estimates in the 93–96% range of ground counts. Although the terns were initially disturbed by the UAS flying overhead, they rapidly habituated to it. Overall, we found no evidence of sustained disturbance to the colony by the UAS. We encourage colonial waterbird researchers and managers to consider taking advantage of this burgeoning technology.