Mortality Figures Research Articles

Abstract P167: Residential Exposure to Greenness and Mortality Following Percutaneous Coronary Intervention

Background: Evidence regarding environmental exposure to green spaces and outcomes in coronary disease patients is lacking. We evaluated the association between residential exposure to greenness and mortality in patients undergoing percutaneous coronary interventions (PCI). Methods: Consecutive patients undergoing PCI at the Rabin Medical Center in Israel between 2004-2014 (n = 12,104) were studied. Clinical data at the time of hospitalization were extracted from medical records. Mortality data (through 2017) were obtained from the Ministry of Health. Patients with incomplete information on residential addresses were excluded. Exposure to greenness was estimated using normalized difference vegetation index (NDVI), a satellite-based index derived from Landsat 30 m spatial resolution imagery, with larger values indicating higher levels of vegetative density. NDVI was estimated within a buffer of 300 m around each patient’s home and as the point value of each 30 m pixel (immediate living environment). Additional residential-based environmental measures were obtained. Cox models assessed the hazard ratios (HRs) for mortality associated with greenness measures. Results: Among 11,262 patients analyzed [median age, 69 (IQR 61-78) y, 24% women], median NDVI-300 was 0.15 (IQR 0.13-0.17) and median NDVI-30 was 0.14 (IQR 0.11-0.17). Patients with higher NDVI-300 were slightly older; NDVI-30 was inversely correlated to ambient air pollution. During a median follow-up of 8.1 (IQR 5.1-10.6) years, 3,217 participants died. After adjustment for sociodemographic and clinical factors, NDVI-30 -but not NDVI-300- was associated with lower mortality (Figure), with an HR of 0.96 (95% CI: 0.92-0.99) per 1 SD increase. Conclusions: In this PCI registry, residential exposure to green spaces in the immediate living environment was associated with lower mortality. Results for the extended area of the living environment were inconclusive. This inconsistency between different spatial resolutions warrants further investigation

Increases in ‘deaths of despair’ during the COVID-19 pandemic in the United States and the United Kingdom

ObjectivesThe COVID-19 pandemic significantly impacted mental health, health-related behaviours such as drinking and illicit drug use and the accessibility of health and social care services. How these pandemic shocks affected ‘despair’-related mortality in different countries is less clear. This study uses public data to compare deaths from alcohol, drugs and suicide in the United States and the United Kingdom to identify similarities or differences in the impact of the pandemic on important non-COVID causes of death across countries and to consider the public health implications of these trends. Study design and methodsData were taken from publicly available mortality figures for England and Wales, Northern Ireland, Scotland and the United States of America, 2001–2021, and analysed descriptively through age-standardised and age-specific mortality rates from suicide, alcohol and drug use. ResultsAlcohol-specific deaths increased in all countries between 2019 and 2021, most notably in the United States and, to a lesser extent, England and Wales. Suicide rates did not increase markedly during the pandemic in any of the included nations. Drug-related mortality rates rose dramatically over the same period in the United States but not in other nations. ConclusionsMortality from ‘deaths of despair’ during the pandemic has displayed divergent trends between causes and countries. Concerns about increases in deaths by suicide appear to have been unfounded, whereas deaths due to alcohol have risen across the United Kingdom and in the United States and across almost all age groups. Scotland and the United States had similarly high levels of drug-related deaths pre-pandemic, but the differing trends during the pandemic highlight the different underlying causes of these drug death epidemics and the importance of tailoring policy responses to these specific contexts.

Profile Of Chest Injury in the Peri-COVID-19 Period: A Single Centre Series

BACKGROUND: Chest traumas continue to constitute about 30% of all traumas and contribute to 25-50% of trauma-related deaths. COVID-19 has its primary pathophysiologies in the lung, and can worsen the morbidity and mortality of chest trauma if it occurs concomitantly. AIM: To Examine the profile and outcome of chest trauma across the peri-COVID-19 period. MATERIALS AND METHOD: A retrospective analysis of cases of chest trauma in the peri-COVID-19 period (mid-Nov 2019 to mid-March 2022) at GMC Doda. RESULTS: Eighty-five cases of chest trauma met inclusion criteria within the 28 months period, M:F = 7.5:1, age range 3-80years, mean age (38.60±17.40years) and median age of 37years. There were 54 (63.5%0) cases of blunt chest trauma and 31 (36.5%) cases of penetrating chest trauma. Thirty-one (36.5%) patients sustained haemothorax, 9 (10.6%) pneumothorax, 14 (16.5%) haemopneumothorax, 21 (24.7%) rib fractures, and 10 (11.8%) chest wall lacerations. Fifty-one (60%) patients had isolated chest trauma while the remaining 34 (40%) had associated injuries in one or more other organ systems. Closed thoracostomy tube drainage was definitive treatment in 48 (56.5%) patients while emergency thoracotomy was done in 5 (6%) patients. The treatment administered in the remaining 32 (37%) patients included intercostal nerve block for chest pain from rib fractures, wound exploration and wound repair. In the series, 75 (88%) had complete recovery, six (7%) patients left against medical advice, and four (5%) in-hospital mortality was recorded. CONCLUSION: The profile of chest trauma in the peri-COVID-19 period in our centre differed from the pre-COVID-19 years with a higher mortality figure. Management protocol also necessitated certain modifications.

A Probiotic to Improve Sleep Quality during COVID-19 Pandemic: A Questionnaire Study

Sleep quality has been related to the gut microbiome and probiotics were shown to improve sleep quality, especially in people under physical or mental stress. COVID-19 results in such mental stress, leading to sleeping disorders, especially in people working in health care. A large dataset of quality of life data from people working in pharmacies or doctors´ offices was collected before and after intake of a free sample of a multi-species probiotic during a marketing survey. 9841 anonymous datasets were available for analysis. Group differences and univariate and multivariate logistic regression analysis was performed. COVID-19 related data were obtained from publicly available datasets and matched to quality of life data via the postal code of the participants. We aimed to relate self-reported quality of life, especially sleep quality data from a marketing survey to objective criteria of COVID-19, such as incidence and mortality figures at the time of the survey. The intake of only a two-week course of a multi-species probiotic markedly improved sleep quality, mental health, vitality, stress resistance and performance. Improvement in the different categories of quality of life was influenced by sex, age, initial intestinal complaints, the initial stress level, the initial sleep quality, initial vitality and mental health. Quality of life was reduced during COVID-19 compared to pre-pandemic values of the general population. We also found some associations of changes in quality of life in relation to COVID-19 incidence rates in employees of pharmacies and doctors´ offices, however to a lesser extent than expected. Although not derived from a clinical trial, this analysis of marketing survey data provides evidence that there is a link between the gut microbiome, sleep and quality of life suggesting that gut microbiome modulation could be a valuable therapeutic approach in sleeping disorders.

Rising global, regional and national levels burden of cancer: the case of Benin and implications for national development

Background: Although cancer mortality rates in Africa are higher than in high-income countries, the disease has received little attention in the region. We aimed to highlight the rising cancer burden in the Republic of Benin, trends, characteristics, controversies, and their implications for national development. Methodology: A review of published studies and documents was conducted using keywords including cancer, incidence, mortality, Africa, The Republic of Benin, risk factors, behavioral issues, cultural disparity, psychosocial and ethnic background in Medline, Scopus, Pubmed, and Google. Some of the incidence and mortality figures retrieved from published papers and the GLOBOCAN website were subjected to graphical and frequency analyses. Findings: Breast cancer and lung cancer accounted for approximately 12% and 18% of all new cancer cases and deaths worldwide, respectively. Africa currently has the fourth highest age-standardized cancer mortality rate globally, with Sub-Saharan Africa having the highest incidence rates. Certain factors, such as westernized diet, urbanization, and possibly increased awareness, had been implicated, though their precise contributions had yet to be determined. Conclusion: Cancer will compound The Republic of Benin’s disease burden, increase poverty and gender inequality, and reverse global gains in maternal and neonatal mortality unless urgent action is taken.

The human cost of global fishing

Seafood is central to global protein and food security, and the livelihoods of millions worldwide. Yet the fishing sector is universally acknowledged as one of the most dangerous in the world (ILO, 1999). Conservative estimates over the past two decades have put the fatalities at between 24,000 and 32,000 a year – but these estimates are generally accepted to be significantly below the true figure. Emerging research by the FISH Safety Foundation reveals that fishing is even more dangerous than currently thought, with rates shown to be at least three to four times higher than currently accepted estimates. Beyond determining a more accurate mortality figure, the research also aimed to identify any contributing drivers to fisher fatalities. The research thus shows that fishing for the global community therefore comes at a staggeringly high cost of human life. This toll is most often paid by the most vulnerable communities around the globe, regardless of region, and their deaths are also less likely to be tracked or reported. Fishing is so dangerous – and affects the most marginalised – because people are often forced to take extraordinary risks to provide food for their families, communities, and world markets. Collective, international action is needed now to ensure fishing communities continue to provide sustainable, high-quality protein without such a staggering loss of life. While some reasons why fishing is so dangerous are difficult to tackle, others are tractable, including addressing data and reporting gaps and limitations, and international policy change.

Policing suicide: investigative officers’ views on criminalisation and enforcement of anti-suicide laws

ABSTRACT The global calls for the decriminalisation of suicide have been intense, leading to several countries repealing laws against suicide and suicidal behaviour. However, this opened up a gap in knowledge on suicide policing in countries that maintained statutes penalising suicide. Drawing from the case of Nigeria, one of the countries where attempted suicide attracts prison sentences, this study explored the opinions and experiences of police officers as regards the criminalisation of suicide and enforcement of anti-suicide laws. Sixty-four (64) suicide investigating police officers in six zonal commands of the Nigeria Police Force were engaged in a qualitative study under an interpretative paradigm. Participants reported negative perceptions of anti-suicide laws and policing of suicide through communities’ display of lack of belief, low level of trust, lukewarm or negative attitudes, uncooperative postures, and low level of support. The study sample held that the anti-suicide laws are not effective in the country as evidenced by the low rate of apprehensions and convictions, despite increasing figures of suicide mortality. The study findings highlighted the need for the Nigerian government to consider the decriminalisation of attempted suicide and be more responsive to socioeconomic factors driving the increase in suicide in the country.

Abstract 13648: Risk Profile and Prognostic Implications of Premature Advanced Atherosclerotic Disease Among Young Adults: The Coronary Artery Calcium Consortium

Introduction: Advanced atherosclerotic disease among young adults is an under-recognized and unique disease phenotype that has not been well characterized. Methods: We used data from 23,706 participants aged 30-50 years (mean age 43.9 ± 4.6 years; 74.7% men) from the Coronary Artery Calcium (CAC) Consortium, a cohort of individuals with no prior CVD history referred for CAC scanning. We defined advanced disease as CAC ≥ 90 th percentile for age, sex, and race, and compared risk factor profile of persons with advanced disease to those without CAC and those with CAC < 90 th percentile. Using multivariable-adjusted Cox proportional hazard and competing risks regression, we assessed the association of advanced disease with all-cause, cardiovascular (CV), and CHD mortality. Results: Of the 23,706 participants, 8,289 (35%) had CAC. Among them, 3,549 (43%) had CAC ≥ 90 th percentile. Compared to persons without CAC and those with CAC < 90 th percentile, those with CAC ≥ 90 th had higher prevalence of all the traditional CVD risk factors. Notably, 56% of those with CAC ≥ 90 th percentile had ≥ 2 risk factors, and 68% already had multivessel CAC compared to 34% of those with CAC < 90 th percentile. After a mean follow-up of 12.6 ± 3.6 years, the incidence of all-cause, CV, and CHD mortality was highest in those with advanced disease. Persons with CAC ≥ 90 th percentile had a higher multivariable-adjusted risk of all-cause (HR 2.11 [1.62 - 2.73]), CV (SHR 2.88 [1.74 - 4.78]), and CHD mortality (SHR 4.41 [2.16 - 8.98]), compared to those without CAC. When compared to those with CAC < 90 th percentile, only those with CAC ≥ 90 th percentile had significantly higher risk of all-cause, CV, and CHD mortality ( Figure ). Conclusions: Premature advanced atherosclerosis is a distinct clinical phenotype that strongly predicts all-cause and cause-specific mortality. Among persons with CAC at young age, those with scores ≥ 90th percentile have the highest risk of early death and should be a focus of clinical prevention.

Abstract 127: Urine Output And Mortality In Patients Resuscitated From Out Of Hospital Cardiac Arrest

Background: Urine output (UO) measurement utility after out-of-hospital cardiac arrest (OHCA) survivors who undergo targeted temperature management (TTM) is not well understood. Methods: We included 247 comatose adult patients who underwent TTM after OHCA between 2007 and 2017 and excluded those on maintenance dialysis. Groups were defined based on mean hourly UO during the first 24 hours: Group 1 (<0.5 ml/kg/hr, n=73), Group 2 (0.5-1 ml/kg/hr, n=81) and Group 3 (>1 ml/kg/hr, n=93). Kidney Disease: Improving Global Outcomes (KDIGO) serum creatinine criteria were used to define and stage acute kidney injury (AKI). Multivariable analysis was used to evaluate in-hospital mortality. Results: In-hospital mortality decreased as 24-hour mean UO increased (56.2% [41/73] vs 29.6% [24/81] vs 18.3% [17/93] in Groups 1, 2 and 3, respectively; adjusted OR 0.93 per 0.1 ml/kg/h higher, 95% CI 0.87-0.99, p = 0.03), and UO < 0.5 ml/kg/hr was strongly associated with in-hospital mortality (adjusted OR 4.2 [1.6-10.8], p=0.003). In-hospital mortality varied by the KDIGO stage and UO group (Figure), lowest in KDIGO stage 0 and highest in KDIGO stage 3. Both UO (adjusted OR 0.92 per 0.1 ml/kg/h higher, p = 0.002) and KDIGO stage (adjusted OR 1.62 per each stage, p = 0.002) were associated with in-hospital mortality when included in the same model. Among patients with KDIGO stage 0, lower UO portended higher mortality (Figure). Likewise, among patients with low UO (group 1), a higher KDIGO stage predicted higher mortality. Conclusion: Amongst OHCA survivors undergoing TTM, higher UO is incrementally associated with lower in-hospital mortality. The lowest mortality was observed at UO >=1 ml/kg/h, suggesting this as a target for resuscitation in OHCA patients undergoing TTM. Low UO remains associated with in-hospital mortality even when accounting for AKI by creatinine criteria, suggesting that oliguria is a more sensitive prognostic marker in the early post-OHCA phase.

One-year mortality after acute stroke: a prospective cohort study from a comprehensive stroke care centre, Kerala, India

ObjectivesThe primary objective was to report the 1-year all-cause mortality among patients with stroke. The secondary objectives were (1) to report the mortality stratified by type of stroke and sex...

Six-month Morbidity and Mortality in Patients after Recovery from COVID-19.

This telephonic survey was aimed to identify the proportion of coronavirus disease-2019 (COVID-19) patients who died from any cause, within 6 months of discharge from a tertiary COVID-19 care hospital. We also analyzed whether any clinical and/or laboratory variables were associated with post-discharge mortality. All adult patients (age ≥18 years) who had been discharged during the period between July 2020 and August 2020 from a tertiary COVID-19-care hospital after initial hospitalization for COVID-19 were included. A telephonic interview was conducted 6 months after discharge to assess morbidity and mortality in these patients. Out of the 457 patients who responded, 79 patients (17.21%) were symptomatic, and breathlessness was found as most common symptom (6.12%). Fatigue was noted in (5.93%) of study patients, followed by cough (4.59%), sleep disturbances (4.37%), and headache (2.62%). Of the 457 patients who responded, 42 patients (9.19%) required expert medical consultation for their persistent symptoms. Thirty-six patients (7.88%) required re-hospitalization for post-COVID-19 complications within 6 months of discharge. A total of 10 patients (2.18%) succumbed within 6 months of their discharge from the hospital. 6 patients were males and 4 females. Most of these patients (7/10) succumbed in the second month after discharge. Seven patients had moderate-to-severe COVID-19 disease and most of these (7/10) had not been treated in the intensive care unit (ICU). Post-COVID-19 mortality figures were not very high in our survey despite the high perceived risk of thromboembolic events after recovery from COVID-19. A significant proportion of patients reported persistent post-COVID-19 symptoms. Breathing difficulty was the most common symptom noted by us, closely followed by fatigue. Rai DK, Sahay N. Six-month Morbidity and Mortality in Patients after Recovery from COVID-19. Indian J Crit Care Med 2022;26(11):1179-1183.

Prevalence of Multidrug-Resistant Organism in ICU Burns Patients at Tertiary Care Hospital.

Burns carries a high-risk of mortality and morbidity. This with increased chances of drug-resistant infections makes the management complicated. Hence this study was conducted to find out the prevalence of multidrug-resistant organisms (MDRO) in burns patients admitted to the intensive care unit at a tertiary care hospital. A 2-year retrospective study was conducted where burn patients reporting MDRO were included. Statistical analysis was performed using SPSS version 26 where a P-value < .05 was considered statistically significant. Out of 97 patients, tissue cultures of 65 patients revealed the presence of MDRO in 27 (27.8%) patients. A male predominance (17, 63.0%) was noted with a mean age of 29.0-year-old. Fire burn (15, 55.6%) was reported to be the most common cause of burn with an average of 29.9% of Total Body Surface Area (TBSA) involved. MDR Pseudomonas aeruginosa was the commonest organism reported in 12 (44%) patients. The average length of stay (LOS) was noted to be 11.3 days with a mortality rate of 48.1% (overall, in all MDRO'S infections). Patients who reported MDRO showed a tendency for longer hospitalization with a higher risk of mortality as the TBSA increased. However, in presence of other factors in burns like higher TBSA, inhalation injury and lack of advanced skin substitute these mortality figures, and their association can be debated. Lastly, the implementation of control measures, as basic as hand hygiene, should be partaken to reduce the burden of MDR infections.

Estimated excess mortality figures in the year 2020-2021 in casentino municipalities (Italy)

Abstract Background In 2020, the total deaths from all causes were the highest ever recorded in Italy since World War II (15.6% excess), with peaks during Sars-Cov2 waves and reductions in periods of national lockdown. On the contrary, in 2021, the total number of deaths from all causes reduced compared to the previous year. Analysing local mortality data, our study aims to assess whether, in the Casentino Valley (Arezzo, Tuscany), an excess of deaths from all causes occurred between January 2020 and December 2021 compared to the five years 2015-2019. Methods We used the official mortality data from the Italian Institute of Statistics (ISTAT), and that are published in the Table of deaths by the municipality on March 2, 2022. From this database, we extrapolated all deaths from all causes between January 1, 2020, and December 31, 2021, in the 10 municipalities of Casentino. The data collected were processed using Microsoft Excel 2016 software. We then distinguished by total per month, gender, and age group and then compared these data with the previous five years’ average by calculating the percentage change. Results Overall, both the years 2020 and 2021, it is shown an increase in the deaths percentages compared to the previous five-year period, respectively 5.66% and 8.07%. In particular, there is an excess of mortality in November and December 2020. The increase in mortality is more remarkable for males (13% in 2020 and 20% in 2021). The highest percentage increase was recorded in 2021 for the 75-84 age group (+15%) and in 2020 for males over 85 (+29%). Conclusions The data analysed confirms the excess mortality in 2020-2021 compared to the average of the previous 5 years in Casentino. There are peaks in November and December 2020, corresponding with the second wave of Sars Cov2 infection. The results obtained establish the basis for subsequent analyses that will verify the correlation of mortality peaks with the incidence of Sars-Cov2 cases in the territory studied. Key messages • Between January 1, 2020, and December 31, 2021 there was an excess of all-cause mortality in our area. • This excess mortality appears to be related to peaks in Sars-Cov2 infection.

ADDITIVE VALUE OF NT-PROBNP RATIO IN THE MANAGEMENT OF MIXED AORTIC VALVE DISEASE PATIENTS

ADDITIVE VALUE OF NT-PROBNP RATIO IN THE MANAGEMENT OF MIXED AORTIC VALVE DISEASE PATIENTS

S1461 Investigating the Obesity Paradox in Hospitalized Patients With Chronic Obstructive Lung Disease Exacerbation in the United States

Introduction: Obesity is a public health concern that is common among individuals with chronic obstructive pulmonary disease (COPD) and is associated with increased dyspnea and poor quality of life. Despite these negative associations, however, evidence suggests that obese patients with COPD have lower mortality than underweight COPD patients. This “obesity paradox” has been studied in long-term outcomes of COPD, but studies evaluating the effect of obesity on in-hospital outcomes of COPD exacerbation are few. Herein we evaluate the obesity paradox in hospitalized patients with COPD exacerbation using the National Inpatient Sample (NIS) database. Methods: A cohort study was conducted using NIS data from 2016 to 2019. Adult hospitalizations with an admitting diagnosis of COPD exacerbation and a documented body mass index (BMI) were included in the study. Patients were stratified by BMI as underweight, normal weight, overweight, class 1 obesity, class 2 obesity, and class 3 obesity. The primary outcome was in-hospital mortality. Secondary outcomes were invasive mechanical ventilation (IMV), non-invasive ventilation (NIV), and hospital length of stay (LOS). Multivariate analysis was used to adjust for outcomes. Covariates were selected using a univariate screen and literature review. Results: A total of 1,474,985 COPD exacerbation admissions were identified. In-hospital mortality was 6.1% in underweight, 5.8% in normal weight, 3.4% in overweight, and 1.9%, 1.7%, and 2.1% in class 1, class 2 and class 3 obesity groups, respectively (Table). Obesity class 1 and 2 had the lowest rates of IMV. Compared to normal weight patients, obese patients had greater rates of NIV, with class 3 obesity having the highest rate. LOS was lower in obese patients. After adjusting for potential confounders, both overweight and obesity were independently associated with higher rates of NIV and lower rates of IMV and mortality (Figure). Conclusion: This study demonstrates lower rates of mortality and IMV in obese patients admitted with COPD exacerbation. These findings support the existence of the obesity paradox in hospitalized patients with COPD exacerbation. However, several factors may confound the relation between obesity, COPD, and mortality, thus further prospective studies are needed to shed light on this complex phenomenon and its implications on healthcare.Figure 1.: Adjusted odds ratios for mortality, invasive mechanical ventilation, and non-invasive ventilation across the different ranges of BMI in reference to normal weight (BMI 20-24.9). Table 1. - In-hospital outcomes in COPD exacerbation hospitalizations across multiple BMI ranges Outcome Underweight Normal weight Overweight Obesity class1 Obesity class 2 Obesity class 3 Mortality 6.1% (5.9% - 6.3%) 5.8% (5.4% - 6.1%) 3.4% (3.2% - 3.7%) 1.9% (1.8% - 2.0%) 1.7% (1.6% - 1.9%) 2.1% (2.1% - 2.2%) Invasive ventilation 9.9% (9.7% - 10.2%) 10.7% (10.3% - 11.2%) 9.5% (9.1% - 10.0%) 7.5% (7.1% - 7.6%) 7.4% (7.1% - 7.6%) 9.8% (9.6% - 10.0%) Non-invasive ventilation 15.4% (15.0% - 15.8%) 14.8% (14.2% - 15.4%) 16.0% (15.3% - 16.6%) 16.2% (15.7% - 16.8%) 16.9% (16.4% - 17.4%) 20.8% (20.3% - 21.3%) > 5 days length of stay 44.7% (44.3% - 45.2%) 48.7% (47.9% - 49.6%) 42.5% (41.7% - 43.4%) 35.8% (35.3% - 36.7%) 35.1% (34.6% - 35.6%) 38.9% (38.6% - 39.3%) Parenthetical ranges represent 95% confidence intervals.

385. OUTCOME FOLLOWING MINIMAL INVASIVE VERSUS OPEN ESOPHAGECTOMY FOR ESOPHAGEAL CARCINOMA PATIENTS WITH LIVER CIRRHOSIS: A PROPENSITY SCORE-MATCHED ANALYSIS

Abstract Although minimally invasive esophagectomy (MIE) has advanced into a safe and effective alternative to open esophagectomy (OE), its utility in cirrhotic esophageal cancer (EC) patients remained unknown. This study analyzed the perioperative outcomes of MIE for EC with LC compared with open esophagectomy (OE). We retrospectively reviewed the clinical charts of patients treated with esophagectomy for EC who had a concomitant diagnosis of LC. Of the 74 patients identified from our records, 43 underwent MIE and 31 OE. The two treatment groups underwent propensity scores (PS) matching using a logistic model that included the following covariates: type of preoperative therapy, Charlson comorbidity index, Child-Pugh class, and elective versus emergency surgery. Following PS matching, the MIE and OE groups consisted of 40 and 20 patients, respectively. Patients treated with MIE less frequently showed severe pneumonia (7.5% versus 30%, respectively, p = 0.049) and had a shorter length of stay (median: 16 versus 22 days, respectively, p = 0.009), albeit at the expense of a longer operating time (median: 465.5 versus 403 min, respectively, p = 0.015). Compared with OE, MIE was associated with a lower in-hospital mortality (25% versus 2.5%, respectively, p = 0.013). Moreover, MIE did not compromise the quality of resected specimens with similar R0 resection rate. EC patients with LC showed more favorable mortality figures and lower rates of severe pneumonia after MIE compared with those who underwent OE. MIE may serve as a safe and feasible alternative for selected EC patients with LC.

Decomposing socioeconomic inequality in blood pressure and blood glucose testing: evidence from four districts in Kerala, India

BackgroundNon-Communicable Diseases (NCDs) constitute a significant danger to the nation’s public health system, both in terms of morbidity and mortality, as well as the financial burden they inflict. Kerala is undergoing an epidemiologic transition, which has significantly impacted the state’s morbidity and mortality figures. For decades, the state has been putting in place myriad programs to reduce the burden of NCDs across population groups. Socioeconomic inequalities in NCD testing have been documented in India, although they are understudied in Kerala. The study aimed to estimate and characterize districtwise socioeconomic inequality in Blood Pressure (BP) and Blood Glucose (BG) testing.MethodsA cross-sectional household survey was conducted between July–October 2019 in Kasaragod, Alappuzha, Kollam and Thiruvananthapuram districts of Kerala, India. A total of 6383 participants aged 30 years and above were interviewed using multistage random sampling. Descriptive statistics were derived district-wise. We computed ratios, differences, equiplots, and Erreygers concentration indices for each district to measure socioeconomic inequality in BP and BG testing. Erreygers decomposition techniques were used to estimate the relative contribution of covariates to socioeconomic inequality.ResultsThere was a significant concentration of BP and BG testing favouring wealthier quintiles in Alappuzha, Kollam, and Thiruvananthapuram districts. The inequality in BP and BG testing was highest in Thiruvananthapuram (0.087 and 0.110), followed by Kollam (0.077 and 0.090), Alappuzha (0.083 and 0.073) and Kasaragod (0.026 and 0.056). Decomposition analysis revealed that wealth quintile and education contributed substantially to socioeconomic inequality in BP and BG testing in all four districts. It was also found that family history of NCDs significantly contributed to observed socioeconomic inequality in BP testing (29, 11, 16, and 27% in Kasaragod, Alappuzha, Kollam, and Thiruvananthapuram, respectively). Similarly, in BG testing, family history of NCDs substantially contributed to observed socioeconomic inequality, explaining 16–17% in Kasaragod, Alappuzha, Kollam, and Thiruvananthapuram respectively of the total inequality.ConclusionWhile the magnitude of socioeconomic inequality in NCD risk factor testing did not appear to be very high in four Kerala districts, although levels were statistically significant in three of them. Greater exploration is needed on how education and caste contribute to these inequalities and their relationship to NCD risk factors such as family history. From such analyses, we may be able to identify entry points to mitigate inequalities in testing access, as well as burden.

The Mortality of Released Prisoners and the Scale of Soviet Penal Mortality, 1939–45

The Mortality of Released Prisoners and the Scale of Soviet Penal Mortality, 1939–45 Stephen G. Wheatcroft (bio) I was delighted to be asked to comment on Mikhail Nakonechnyi's provocative and important work on Soviet penal mortality, which I hope marks the beginning of a much needed search for data to empirically test theories about the scale of Soviet penal mortality There is no doubt that the release of ill and near-to-death prisoners would have reduced the appearance of mortality in the labor camps and colonies. But whether these releases were carried out specifically to reduce the camp and colony mortality figures seems to me to be unlikely. The amount by which this process reduced the appearance of mortality in the labor camps and colonies remains unclear, but thanks to the recent work of Mikhail Nakonechnyi, it is now a little clearer. He has demonstrated that there is documentary evidence to show that in certain locations at certain times, when general mortality levels were high, the level of unrecorded mortality for released prisoners was very high. In Bezymianlag, the main camp investigated by Nakonechnyi, in the month of May 1943 it amounted to as much as 64 percent of the level of recorded mortality in the camp. In Kargopol´lag in September 1943, it was as much as 46 percent above the level recorded there. Nakonechnyi has wisely noted that "the temporal and spatial" width of this phenomenon are "as yet unknown" (804). But they seem to be significant. Can we do anything to test their significance further and to improve our understanding of the scale of mortality in the Soviet penal system? The second part of my commentary is an attempt to do that. It emphasizes the need to look carefully at the dynamics of the population studied as well as its mortality count. It recommends calculating per capita indicators of mortality. It begins by looking in more detail at per capita mortality in Bezymianlag. Then it looks at what we know about the overall indicators of per capita mortality for all of the Soviet penal system and draws attention to [End Page 851] our current lack of knowledge about the history and philosophy of the penal statistical systems, and the urgency of improving our understanding in this area. But before doing this, I would like to comment a little more on the importance of Nakonechnyi's research, correct some erroneous references that he makes to my own work, and provide a rough guide as to what levels of per capita mortality should be considered crisis levels for normal populations, for penal populations, and for wartime. Nakonechnyi's work is particularly important for countering the ungrounded assertions of Golfo Alexopoulos, who has claimed the enormous importance of the "release to die" claim that she thinks covered up about five million deaths in the camps.1 When this is compared with Zemskov's figure for direct mortality in the camps of one million,2 it can be seen that she is proposing a 500 percent correction to penal mortality for the entire period 1929–53 and not just the worst years of 1941–45. Nakonechnyi's work is the first serious attempt to test this claim, although he presents it as though his arguments were directed at others (including myself). Testing and looking for documentary evidence to support claims are something that Nakonechnyi and I certainly agree are important.3 The origins of the "release to die" argument can be traced back to the Russian historical demographer V. A. Isupov, who argued in 2000 that "the secret of reducing mortality in the Gulag lay not so much in improving medical services and the living conditions of the prisoners as much as in the so-called aktirovka of the prisoners." He pointed to the decree of the plenum of the Supreme Court on 1 August 1942 and the joint directives of the People's Commissariat of Internal Affairs (NKVD), the People's Commissariat of Justice (NKIust) and the Procuracy of 23 October 1942 allowing for the liberation of prisoners too ill to work.4 "In other words," he wrote, "prisoners were aktirovany [released] to die." Isupov pointed out...

Associative evidence for the potential of humidification as a non-pharmaceutical intervention for influenza and SARS-CoV-2 transmission.

BackgroundBoth influenza and SARS-CoV-2 viruses show a strong seasonal spreading in temperate regions. Several studies indicated that changes in indoor humidity could be one of the key factors explaining this.ObjectiveThe purpose of this study is to quantify the association between relevant epidemiological metrics and humidity in both influenza and SARS-CoV-2 epidemic periods.MethodsThe atmospheric dew point temperature serves as a proxy for indoor relative humidity. This study considered the weekly mortality rate in the Netherlands between 1995 and 2019 to determine the correlation between the dew point and the spread of influenza. During influenza epidemic periods in the Netherlands, governmental restrictions were absent; therefore, there is no need to control this confounder. During the SARS-CoV-2 pandemic, governmental restrictions strongly varied over time. To control this effect, periods with a relatively constant governmental intervention level were selected to analyze the reproduction rate. We also examine SARS-CoV-2 deaths in the nursing home setting, where health policy and social factors were less variable. Viral transmissibility was measured by computing the ratio between the estimated daily number of infectious persons in the Netherlands and the lagged mortality figures in the nursing homes.ResultsFor both influenza and SARS-CoV-2, a significant correlation was found between the dew point temperature and the aforementioned epidemiological metrics. The findings are consistent with the anticipated mechanisms related to droplet evaporation, stability of virus in the indoor environment, and impairment of the natural defenses of the respiratory tract in dry air.SignificanceThis information is helpful to understand the seasonal pattern of respiratory viruses and motivate further study to what extent it is possible to alter the seasonal pattern by actively intervening in the adverse role of low humidity during fall and winter in temperate regions.ImpactA solid understanding and quantification of the role of humidity on the transmission of respiratory viruses is imperative for epidemiological modeling and the installation of non-pharmaceutical interventions. The results of this study indicate that improving the indoor humidity by humidifiers could be a promising technology for reducing the spread of both influenza and SARS-CoV-2 during winter and fall in the temperate zone. The identification of this potential should be seen as a strong motivation to invest in further prospective testing of this non-pharmaceutical intervention.

Monkeypox in humans: a new outbreak.

Infection caused by Monkeypox Virus (MPVX) has small rodents as its natural reservoir and both monkeys and humans are occasional hosts. The causative agent is an Orthopoxvirus (MPVX) that was isolated in monkeys in 1958 and proved capable of passing to humans in 1970. It remained contained in Africa, causing isolated episodes of infection, until 2003 when an outbreak occurred in the United States following importation of animals from that continent. Since then, anecdotal cases have continued to be reported outside Africa, usually very clearly linked to travelers to those countries, but in May 2022, a broad outbreak of this disease has begun, now affecting several continents, with the emergence of human cases of MPVX (H-MPVX) infection mainly among Men that have Sex with Men (MSM). The disease has an incubation time ranging from 5 to 15 days and is characterized by the presence of pustules, fever, malaise and headache. The presence of significant regional lymphadenopathy is a differential feature with episodes of classical smallpox. Proctitis and pharyngitis, with minimal skin lesions, may be another form of presentation. Diagnosis can be confirmed by PCR testing of lesions or by demonstration of MPVX in other body fluids or tissues, although in the appropriate epidemiologic setting the clinical picture is highly suggestive of the disease. Effective drug treatment has been developed as part of programs to protect against potential bioterrorist agents and smallpox vaccinees are known to have high protection against monkeypox. New vaccines are available, but neither the drugs nor the vaccines are yet freely available on the market. The prognosis of the disease appears, at least in adults in developed countries, to be good, with very low mortality figures and much less aggressive behavior than that described in classical smallpox. Isolation measures, essential for the control of the outbreak, have been published by the health authorities.