Mortality In Population Research Articles

A systematic study of emergency strategies for skin healing after pediatric burns: a comprehensive review and a multidisciplinary perspective.

Burn injuries are a significant cause of morbidity and mortality in pediatric populations. Our study aims to provide an in-depth overview of the current emergency treatment strategies for dermal injuries in children. While advances in burn care have led to improved outcomes for patients with dermal injuries, there remains considerable variability in treatment approaches, and numerous opportunities exist to enhance patient care through the adoption of novel therapies and more effective management of healthcare resources. Children with severe burns often experience profound physiological changes that can result in a range of complications, including infections, fluid and metabolism imbalance due to increased catabolism and protein requirements. Our systematic review focuses on emergency treatment approaches that have demonstrated direct application in pediatric burn care. To this aim, we consulted the scientific databases PubMed, Embase, Web of Science, and Cochrane Library, selecting n = 6 studies that outline the emergency therapeutic approach used in the pediatric setting after a burn, highlighting the most widely adopted techniques and their clinical applications. Study selection was guided by defined eligibility criteria; only original articles published in English that investigated emergency interventions in pediatric populations (0 to 17 years) were considered. Studies were excluded if they involved subjects over 17 years of age, focused on conditions unrelated to burns, employed in vitro or in vivo models, or were review articles. Through a comprehensive examination of these approaches, our study aims to identify areas for improvement and potential advancements in pediatric burn management, suggesting possible future approaches based on Advanced therapy medicinal products (ATMPs) storage approaches.

The independent and joint role of socioeconomic status and family relationships on mortality risk in China: cultural differences and health inequalities in the context of intergenerational cohabitation.

Socioeconomic status (SES) and family relationships are critical social determinants of health disparities. The mechanisms underlying their interactions remain insufficiently understood in Asian cultures with prevalent intergenerational cohabitation. This study investigates the independent and combined effects of SES and family relationships on all-cause mortality in China. A baseline survey was conducted in 2010 involving 9280 adult permanent residents from 12 counties (districts) in Guizhou Province, using stratified cluster random sampling. Two follow-ups (2016-2020, 2023) were conducted. SES was assessed using a composite score comprising household income, education, and occupation, while family relationships were classified as either "good" or "mediocre." The Cox proportional hazards model was employed to evaluate the independent and combined effects of SES and family relationships on all-cause mortality. Among 5949 participants were included, and the cumulative mortality rate was 6.4% over a median follow-up of 12years. With a decrease in mortality risk as SES increased (P < 0.001). Compared with SES ≤ 6, mortality risk with SES scores of 7, 8, and ≥ 9 decreased by 36.9% (HR = 0.631, 95% CI = 0.473-0.842), 36.6% (HR = 0.644, 95% CI = 0.469-0.886), and 73% (HR = 0.270, 95% CI = 0.183-0.397), respectively. The independent effect of family relationship on the risk of death was not statistically significant (HR = 0.847, 95% CI = 0.0.670- 1.070). The joint analysis showed the compensatory effect was significant when SES exceeded a threshold (SES ≥ 9), alleviating the mortality risk associated with family relationships (HR = 0.2197, 95% CI = 0.073-0.652). Findings demonstrate SES independently reduces mortality in Chinese populations, while the effect of family relationships is modulated by cultural background. The resource substitution hypothesis is valid at specific SES thresholds. Intervention efforts should prioritize the vulnerable group characterized by "low SES and weak family support".

Ischemic Stroke Mortality in Type 2 Diabetes in the U.S.: National Trends and Demographic Disparities From 1999 to 2019

ABSTRACTBackgroundThe pathological changes in the lining of blood vessels associated with diabetes are a well‐established risk factor for stroke, with some studies suggesting a two times increase in risk compared to non‐diabetics.MethodsDeath certificates from the CDC WONDER (Centers for Disease Control and Prevention Wide‐Ranging OnLine Data for Epidemiologic Research) database were examined from 1999 to 2019 for ischemic stroke‐related mortality in patients with type 2 diabetes mellitus (T2DM). Annual percent change (APC) and age‐adjusted mortality rates (AAMRs) per 100,000 persons were calculated and stratified by year, sex, and race/ethnicity.ResultsFrom 1999 to 2019 there were 18,135 deaths from ischemic stroke in patients with T2DM. The AAMR remained relatively constant from 0.31 in 1999 to 0.32 in 2004, gradually declining to 0.14 in 2014 (APC: −6.74), followed by a rapid increase to 0.44 in 2017 (APC: 53.11). Men showed consistently higher AAMR than women in 1999 (AAMR men: 0.34 vs. women: 0.29) and 2019 (AAMR men: 0.55 vs. women: 0.42). When comparing race, African Americans (AA) presented with a consistently higher AAMR in 1999 (AAMR AA: 0.4 vs. white: 0.29) and in 2019 (AAMR AA: 0.62 vs. white:0.44). Notably, a significant escalation in AAMR occurred from 2014 to 2019, affecting both populations; this trend reached its pinnacle in 2019 (2016 AAMR AA: 0.4 vs. white: 0.26) (2019 AAMR AA: 0.62 vs. white: 0.44).ConclusionThe findings highlight fluctuating trends in AAMRs with distinct shifts observed after 2014. Noteworthy gender and racial disparities in AAMRs were also evident. The study emphasises the need for ongoing vigilance and focused interventions to address the evolving dynamics of ischaemic stroke‐related mortality in the T2DM population.

Urine Cadmium and the Risk of Cardiovascular Morbidity and Mortality: Results from the Chang Gung Research Database.

To investigate the association between urine cadmium (U-Cd) and the risk of cardiovascular morbidity and mortality in an adult population from Taiwan. A total of 10,713 adults with data on U-Cd assessments in the Chang Gung Research Database were enrolled and stratified into quartiles according to baseline U-Cd levels. The primary outcome was major adverse cardiac and cerebrovascular events (MACCE), defined as a composite of acute myocardial infarction (AMI), coronary intervention, ischemic stroke, and cardiovascular mortality. Secondary outcomes included major adverse coronary events (MACE, comprising AMI and coronary intervention), ischemic stroke, cardiovascular mortality, and all-cause mortality. The median U-Cd concentration was 1.00 μg/g creatinine. In the fully adjusted Cox proportional hazard model, individuals in the highest (4th) U-Cd quartile were associated with significantly increased risks of MACCE (HR: 1.88; 95% CI:1.20-2.95), ischemic stroke (HR: 2.22; 95% CI: 1.07-4.61), cardiovascular mortality (HR: 2.56; 95% CI: 1.17-5.60), and all-cause mortality (HR: 1.67; 95% CI: 1.22-2.29) compared to those in the lowest (1st) U-Cd quartile. Restricted cubic splines analysis revealed a positive, nonlinear relationship between continuous U-Cd levels and these outcomes, which was approximately linear up to a U-Cd concentration of around 1.3 μg/g creatinine, after which the association plateaued. No significant association was observed for MACE (HR: 1.62; 95% CI: 0.75-3.50). The association between U-Cd and MACCE was consistent across all analyzed subgroups, including never-smokers, ever-smokers, and both sexes. Cd exposure was associated with an increased risk of cardiovascular morbidity and mortality in this representative Asian population.

Oral dosing of the nucleoside analog obeldesivir is efficacious against RSV infection in African green monkeys

Respiratory syncytial virus (RSV) is a significant cause of morbidity and mortality in high-risk populations. Although prophylactic options are available, there are no effective oral therapeutics for RSV infection. Obeldesivir (ODV) is an orally bioavailable prodrug of the nucleoside analog GS-441524, which is converted intracellularly to its active nucleoside triphosphate and inhibits the RSV RNA polymerase. Here we report the potent antiviral activity of ODV against geographically and temporally diverse RSV A and B clinical isolates (EC50: 0.20–0.66 μM). Resistance selection studies with ODV and GS-441524 against RSV identify a single amino acid substitution, I777L, in the L polymerase with reduced susceptibility (3.3-3.8-fold) to ODV and GS-441524, indicating a high barrier for resistance development. In an African green monkey RSV infection model, once-daily oral ODV doses of 30 or 90 mg/kg initiated ~24 hours post-infection significantly reduces log10 viral RNA copies/mL × day area under the curve by 69–92% in the upper and lower respiratory tracts. Together, these preclinical data support the clinical evaluation of ODV for the treatment of RSV infection.

A retrospective analysis from NHANES 2003–2018 on the associations between inflammatory markers and coronary artery disease, all-cause mortality and cardiovascular mortality

BackgroundThe objective of this research was to investigate the associations between inflammation markers and coronary artery disease (CAD), along with all-cause mortality and cardiovascular mortality.MethodsThis study utilized data from the National Health and Nutrition Examination Survey (NHANES) collected between 2003 and 2018. The platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and systemic immune inflammation index (SII) were calculated based on blood test results. The diagnosis of CAD was obtained from self-reported cardiovascular health questionnaires. Participants’ survival status was sourced from the National Death Index (NDI) of the National Center for Health Statistics (NCHS). Logistic and Cox regression models were employed to investigate the associations between PLR, NLR, MLR, and SII with CAD, all-cause mortality, and cardiovascular mortality.ResultsA total of 32,683 individuals from the 2003–2018 NHANES were involved. After adjusting for potential confounders, each 1-unit increase in log (NLR) and log (MLR) was associated with a 29% (95% CI: 1.15–1.46, P < 0.001) and 67% (95% CI: 1.40–1.99, P < 0.001) increase in the risk of CAD, respectively. Notably, when log (PLR) exceeded 4.93(PLR = 138.38) and log (SII) surpassed 6.11(SII = 450.34), the risk of CAD increased sharply (P < 0.001). Furthermore, individuals in the highest quartiles (Q4) of PLR, NLR, MLR, and SII had significantly higher risks of all-cause mortality (13%, 88%, 91%, and 42%, respectively) and cardiovascular mortality (48%, 194%, 139%, and 90%, respectively) compared to those in the lowest quartile (Q1), with all P-values <0.001. Moreover, MLR had the highest the area under the curve (AUC) value (AUC:0.642, 95% CI: 0.629–0.654), followed by NLR (AUC:0.600, 95% CI: 0.587–0.612) for distinguishing CAD.ConclusionIn this study, we found that PLR, NLR, MLR, and SII were associated with increased prevalence of CAD, as well as increased risks of all-cause and cardiovascular mortality. These inflammatory markers may serve as valuable clinical indicators for CAD, all-cause and cardiovascular mortality in the general population.

Endothelial activation and stress index for prediction of mortality in asthma

BackgroundEASIX (Endothelial Activation and Stress Index) has been shown to be associated with the prognosis of various diseases in numerous studies, but its relationship with short- and medium-term outcomes in asthma patients admitted to the ICU (Intensive Care Unit) remains unclear.MethodsThis retrospective cohort study included 3,737 asthma patients from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database (2008–2019). We calculated log2(EASIX) using platelet count, creatinine, and lactate dehydrogenase levels measured on ICU admission day 1. We analyzed the association between log2(EASIX) and 28-day and 60-day in-hospital mortality using multivariable Cox regression and restricted cubic splines. Proportional hazards assumptions were tested to ensure no time-dependent bias. Subgroup analyses and interaction tests were conducted to verify the stability. ROC (Receiver Operating Characteristic) analysis was performed to assess the prognostic performance of log2(EASIX).ResultsThe mean age of patients was 62.5 years, with 289 deaths at 28 days and 432 at 60 days. Higher log2(EASIX) was independently associated with increased mortality at both 28 days [hazard ratio (HR) = 1.14, 95% confidence interval (CI): 1.02–1.27, p = 0.017] and 60 days (HR = 1.13, 95% CI: 1.02–1.24, p = 0.017). The highest tertile had significantly higher mortality than the lowest tertile (28-day: HR = 1.84, 95% CI: 1.16– 2.90, p = 0.009; 60-day: HR = 1.65, 95% CI: 1.08–2.51, p = 0.019). A linear relationship was observed between log2(EASIX) and both 28-day and 60-day mortality (P for non-linearity test = 0.29 and 0.633). Subgroup analyses and interaction tests indicated that the association between log2(EASIX) and mortality was stable. The ROC curve analysis revealed AUC (Area Under the Curve) values for 28- and 60-day mortality of 0.892 and 0.881, respectively, with Youden indices of 0.63 and 0.61, indicating good predictive performance.ConclusionElevated log2(EASIX) levels are independently associated with increased in-hospital mortality in patients with asthma. Endothelial Activation and Stress Index show good predictive performance for short- and medium-term mortality in this patient population.

Letter regarding the article ‘Lung ultrasound and mortality in a cardiogenic shock population: A prospective registry‐based analysis’

Letter regarding the article ‘Lung ultrasound and mortality in a cardiogenic shock population: A prospective registry‐based analysis’

Depression as a mediator between socioeconomic status and risk of All-Cause and cardiovascular mortality in diabetes and prediabetes

There is a known association between socioeconomic status (SES) and increased mortality risk in individuals with diabetes and its pre-diabetic state. Depression has been identified as a significant risk factor for mortality in populations with low SES. this study aims to gain a deeper Understanding of the relationship between SES and all-cause and cardiovascular mortality risk in individuals with diabetes and its pre-diabetic state by exploring the mediating role of depression. This study included 17,823 participants who participated in the National health and nutrition examination survey (NHANES) between 2005 and 2018. Weighted multivariate COX regression analysis was conducted to evaluate the association between SES and all-cause and cardiovascular mortality risk in individuals with diabetes and its pre-diabetic state. Additionally, mediation analysis was performed to explore the mediating role of depression. After adjusting for multiple variables, low SES was associated with a hazard ratio (HR) of 1.71 (95% CI: 1.42–2.02; P < 0.0001) for all-cause mortality risk and an HR of 1.88 (95% CI: 1.35–2.63; P < 0.001) for cardiovascular mortality risk in individuals with diabetes and its pre-diabetic state. Furthermore, after adjusting for multiple variables, depression was associated with an HR of 1.51 (95% CI: 1.28–1.79; P < 0.0001) for all-cause mortality risk and an HR of 1.64 (95% CI: 1.18–2.27; P = 0.003) for cardiovascular mortality risk. Mediation model results revealed that after complete adjustment, depression accounted for 10.34% of the mediating effect of the relationship between SES and all-cause mortality risk in individuals with diabetes and its pre-diabetic state, and 9.30% of the mediating effect of the relationship between SES and cardiovascular mortality risk. Identifying individuals with depression and providing appropriate treatment May lower the risk of all-cause and cardiovascular mortality associated with diabetes and its pre-diabetic state in the low SES population.

Predicting MRI-diagnosed microvascular obstruction and its long-term impact after acute myocardial infarction.

Microvascular obstruction (MVO) at cardiac magnetic resonance imaging (CMR) is a well-described risk factor for cardiac events after acute myocardial infarction (MI). Predicting MVO using cardiac biomarkers and performing risk stratification according to extent of MVO. We conducted a retrospective study including all patients with an acute MI and a subsequent CMR during the same hospital stay between October 2008 and August 2023. Patients were grouped according to the presence of any MVO and of relevant MVO (defined as > 1.55% of LV myocardial mass). The prediction of MVO based on peak high sensitivity cardiac troponin T (hs-cTnT) levels was analyzed. Survival according to MVO status was assessed in the entire study population. We evaluated 597 patients with CMR 3days [interquartile range 2-4days] after myocardial infarction. MVO was present in 163 patients (27.3%) and relevant MVO in 100 patients (16.8%). Patients with MVO had significantly higher peak hs-cTnT levels compared to those without (p < 0.001). An hs-cTnT cut-off value of > 2455.0ng/L predicted present MVO (area under the curve (AUC) 0.824), while a cut-off value of 3975.0ng/L predicted relevant MVO (AUC 0.837). Relevant MVO was a predictor of all-cause mortality in the entire study population (hazard ratio (HR) 3.89 (1.50-10.09)), with an even stronger association in patients with an LVEF > 35% (HR 5.91 (1.79-19.56)). Higher peak hs-cTnT levels are strong predictors of MVO. Described cut-off values could serve as a screening tool. Relevant MVO is a significant predictor of all-cause mortality following acute MI, especially in patients with LVEF > 35%.

New opioid use and mortality in older people with dementia.

BackgroundOpioid use is frequent among older people with dementia. Opioid use has been associated with excess mortality in the general population, but whether this also applies to older people with dementia is unknown.ObjectiveInvestigate if new opioid use compared with no use was associated with excess mortality in older people with dementia.MethodsMatched cohort study using Danish nationwide registries including all residents (age 65+) diagnosed with dementia (including Alzheimer's disease) between 2008-2018. Exposure was defined as first opioid prescription after dementia diagnosis (1 year washout before). Persons exposed to opioids were matched with up to two unexposed persons on age and sex. Outcome was all-cause mortality within 180 days after exposure. Cox proportional hazards models compared rates of death and adjusted for potential confounders.ResultsForty-two percent (31,619/75,471) of older people with dementia initiated a prescription for an opioid after dementia diagnosis. 31,619 exposed persons were matched to 63,235 unexposed. Among the exposed, 8540 (27%) died within 180 days after initiating their first opioid prescription compared with 3803 (6.01%) of the unexposed, yielding a 5-fold excess mortality risk (adjusted Hazard ratio: 5.06 (95% CI, 4.86-5.29)). Transdermal fentanyl use was associated with an 8-fold excess mortality risk (8.26 (7.18-9.51)).ConclusionsOpioid use was associated with excess mortality, which may be due to the opioid, the indication or both. This observation calls for further research into the links between opioid use and excess mortality in elderly with dementia as it could have important implications for patient safety.

Dual-Branch Attention Fusion Network for Pneumonia Detection.

Pneumonia, as a serious respiratory disease caused by bacterial, viral or fungal infections, is an important cause of increased morbidity and mortality in high-risk populations (e.g.the elderly, infants and young children, and immunodeficient patients) worldwide. Early diagnosis is decisive for improving patient prognosis. In this study, we propose a Dual-Branch Attention Fusion Network based on transfer learning, aiming to improve the accuracy of pneumonia classification in lung X-ray images. The model adopts a dual-branch feature extraction architecture: independent feature extraction paths are constructed based on pre-trained convolutional neural networks (CNNs) and structural spatial state models, respectively, and feature complementarity is achieved through a feature fusion strategy. In the fusion stage, a Self-Attention Mechanism is introduced to dynamically weight the feature representations of different paths, which effectively improves the characterisation of key lesion regions. The experiments are carried out based on the publicly available ChestX-ray dataset, and through data enhancement, migration learning optimisation and hyper-parameter tuning, the model achieves an accuracy of 97.78% on an independent test set, and the experimental results fully demonstrate the excellent performance of the model in the field of pneumonia diagnosis, which provides a new and powerful tool for the rapid and accurate diagnosis of pneumonia in clinical practice, and our methodology provides a high--performance computational framework for intelligent pneumonia Early screening provides a high-performance computing framework, and its architecture design of multipath and attention fusion can provide a methodological reference for other medical image analysis tasks.&#xD.

Development of the Nordic Nutrition Recommendations 2023 food-based diet score and its association with all-cause mortality in two Swedish cohorts.

Development of the Nordic Nutrition Recommendations 2023 food-based diet score and its association with all-cause mortality in two Swedish cohorts.

Association between albumin to globulin ratio and all-cause and cardiovascular mortality among individuals with cardiovascular-kidney-metabolic syndrome: results from NHANES 2003 to 2018

ObjectiveThe albumin-to-globulin ratio (AGR) is a promising biomarker for inflammation and nutritional status. However, its association with mortality in individuals with Cardiovascular-Kidney-Metabolic (CKM) syndrome remains underexplored. This study investigates the relationship between AGR and mortality outcomes in CKM syndrome, aiming to provide insights for risk assessment and management in this population.MethodsWe conducted a cohort study utilizing data from the National Health and Nutrition Examination Survey (NHANES) 2003–2018, with mortality follow-up through 31 December 2019. Survey-weighted multivariable Cox hazards regression models assessed the associations between AGR and all-cause and cardiovascular disease (CVD) mortality. Nonlinear relationships and threshold effects were evaluated using smooth curve fitting and piecewise linear regression. Sensitivity analyses, subgroup analyses, and interaction tests were further performed to validate the findings.ResultsOver a median follow-up of 8.33 years, 1,745 all-cause deaths occurred, including 534 CVD-related deaths. After multivariable adjustment, a significant inverse dose–response relationship was observed between AGR and both all-cause and CVD mortality. Specifically, a nonlinear association was identified for all-cause mortality, with an inflection point at an AGR of 1.26, whereas the relationship with CVD mortality remained linear. Compared with the lowest AGR quartile, individuals in the highest AGR quartile had multivariable-adjusted hazard ratios (HR) of 0.55 (95% CI: 0.45–0.67) for all-cause mortality and 0.47 (95% CI: 0.34–0.64) for CVD mortality (P trend &amp;lt; 0.0001 for both outcomes). Each one-unit increase in AGR was associated with a 62% reduction in the risk of all-cause death and a 73% reduction in the risk of CVD mortality. The inverse association with all-cause mortality was more pronounced among individuals under 60 years, daily smokers, Mexican Americans and those in CKM stage 1, while the association with CVD mortality was stronger among individuals with a college degree, those under 60 years, and daily smokers. Sensitivity analyses confirmed these findings.ConclusionHigher AGR is significantly associated with reduced risks of both all-cause and CVD mortality in the CKM syndrome population. Notably, while the relationship with all-cause mortality is nonlinear, the association with CVD mortality follows a linear pattern. These findings suggest that AGR could serve as a valuable biomarker for mortality risk stratification in CKM syndrome.

Dietary inflammatory index and mortality in middle-aged and elderly patients with metabolic syndrome

BackgroundMetabolic Syndrome (MetS) significantly increases the risk of cardiovascular diseases and mortality, particularly in middle-aged and elderly populations. The Dietary Inflammation Index (DII) is a validated tool for assessing the inflammatory potential of an individual’s diet, with higher scores indicating a dietary pattern that is more favorable to inflammation. The MetS population is inherently characterized by chronic low-grade inflammation, and previous studies have demonstrated an association between the DII and a wide range of chronic diseases in the general population, but little is known about the relationship between dietary inflammation and risk of death in the MetS population. This study aimed to investigate the association between DII and all-cause and cardiovascular mortality among middle-aged and elderly MetS patients.MethodsThis retrospective cohort study was based on publicly available data from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2016. A total of 7,143 participants aged 40 years and older who were diagnosed with MetS were included. The MetS is based on the Joint Interim Statement criteria developed by the International Diabetes Federation (IDF) in 2009, which defines the MetS as the presence of any three or more of the following five items: central obesity, elevated triglycerides, lowered high-density lipoprotein (HDL) cholesterol, elevated blood pressure, and impaired glucose metabolism. Nutrient intake data were obtained from 24-hour dietary recalls. DII calculations were based on 28 food nutrient parameters, including energy, macronutrients, vitamins, minerals, and selected bioactive ingredients. Kaplan-Meier (KM) survival curves were used to analyze survival outcomes. Cox proportional hazards regression models were employed to assess the relationship between DII and mortality, with adjustments made for potential confounding factors. Restricted cubic spline (RCS) plots were used to explore the dose-response relationship.ResultsDuring a median follow-up period of 98 months, 1,026 participants (14.36%) died, including 284 (4.43%) from cardiovascular diseases. KM survival curves showed that higher DII quartiles were associated with lower survival rates (Log-rank P < 0.05). Cox regression results indicated that each unit increase in DII was associated with a higher risk of all-cause mortality (HR = 1.052, 95% CI: 1.006-1.100, P = 0.026) and cardiovascular mortality (HR = 1.157, 95% CI: 1.076–1.244, P < 0.001). Compared to the lowest quartile, participants in the highest DII quartile had significantly higher risks of all-cause mortality (HR = 1.289, 95% CI: 1.020–1.628, P = 0.033) and cardiovascular mortality (HR = 1.817, 95% CI: 1.194–2.764, P = 0.005). RCS analysis revealed a linear relationship between DII and both all-cause mortality (nonlinearity, P = 0.705) and cardiovascular mortality (nonlinearity, P = 0.275).ConclusionHigher DII scores were independently associated with increased all-cause and cardiovascular mortality among middle-aged and elderly MetS patients. Promoting an anti-inflammatory dietary pattern may be a cost-effective, non-pharmacologic approach to reducing the risk of cardiometabolic mortality in an aging population with a high cardiometabolic burden.

Environmental Exposures Increase Health Risks in Childhood Cancer Survivors

Childhood cancer survivors (CCSs) are at increased risk for chronic health issues due to late effects of cancer and its treatment. We address the impact of environmental exposures, such as air pollution, tobacco smoke, extreme weather events, and pesticides, on the health and survival of CCSs. These environmental hazards have been associated with worsening health outcomes and decreased survival among CCSs on a global scale. We also highlight that providers at a major pediatric cancer center in the United States have limited knowledge and practical skills about environmental risk factors and how to reduce exposures. Our survey results show that pediatric oncology providers would find an environmental referral service helpful and useful in their department. Integrating environmental health into pediatric cancer care can empower patients and families, promote healthier behaviors, and potentially reduce morbidity and mortality in this vulnerable population.

Machine learning model and hemoglobin to red cell distribution width ratio evaluates all-cause mortality in pulmonary embolism

The ratio of hemoglobin (Hb) to red blood cell distribution width (RDW), known as HRR, functions as an innovative indicator related to prognosis. However, whether HRR can predict the mortality for pulmonary embolism (PE) patients remains ambiguous. A retrospective cohort study was conducted using the MIMIC IV database (3.0), All patients were categorized into four groups based on the HRR. We investigated the association between HRR and PE mortality. Cox regression models were used to evaluate these associations, while restricted cubic spline (RCS) regressions assessed potential nonlinear relationships. In addition, six machine learning models, including random survival forest (RSF), conditional Inference Tree(ctree), gradient boosting machine (gbm), nearest neighbors (nn), and extreme gradient boosting (xgboost), were applied, with Shapley additive explanation (SHAP) are used to determine the importance of characteristics. 2,272 PE patients were eligible for analysis. Our study identified both age and HRR levels (both with OR > 1, P < 0.05) as significant predictors of 30-day and 365-day mortality in PE patients admitted to the ICU. In Cox regression analysis, both age and HRR (both with HR > 1, P < 0.05) also emerged as prognostic risk factors for 30-day and 365-day mortality in this patient population. KM analysis demonstrated that patients with PE who were older or had increased HRR levels while hospitalized or in the ICU exhibited considerably reduced survival rates in comparison to younger individuals or those with lower HRR levels (P < 0.0001). Additionally, the RCS analysis revealed a pronounced nonlinear association between HRR levels and the risk of mortality. Validation set, coxph (ROC: 0.772) demonstrated superior predictive accuracy for these endpoints. identifying HRR as a vital component of mortality. A lower HRR correlates with high mortality rate in patients with PE patients. This model could serve as a useful tool for guiding mortality, assisting in clinical decision-making and improving patient management outcomes.

The association between week-one red blood cell distribution width and one-year survival in critically ill patients: propensity score-based multicenter analysis

BackgroundRed blood cell distribution width (RDW), a marker of erythrocyte size variability, has been associated with adverse outcomes in various inflammatory and critical illnesses, but the impact on long-term outcomes in critically ill patients remains unclear. We hence aimed to address the association between RDW and one-year mortality in critically ill patients through using a propensity score-based analysis. MethodsThe data from three databases were aggregated: the Medical Information Mart for Intensive Care IV (MIMIC-IV), the Salzburg Intensive Care database (SICdb), and the Taichung Veterans General Hospital (TCVGH) critical care database. Cox regression, propensity score matching (PSM), and weighting methods consisting of inverse probability of treatment weighting (IPTW), stabilized IPTW, as well as covariate balancing propensity score (CBPS) were used to identify the independent association between RDW and one-year mortality.ResultsA total of 39,699 critically ill patients were included in the analysis, with a one-year mortality rate of 27.3%. High RDW was significantly associated with increased one-year mortality (adjusted hazard ratio 1.980, 95% confidence interval (CI) 1.898–2.066, p < 0.001) after adjusting for covariates. The association was stronger among patients with milder forms of critical illnesses. The association between high RDW and mortality in PSM, IPTW, stabilized IPTW and CBPS populations were 1.751 (95% CI 1.627–1.885), 1.960 (95% CI 1.873–2.051), 1.962 (95% CI 1.875–2.052) and 1.946 (95% CI 1.845–2.053).ConclusionWeek-one RDW is a robust predictor of one-year mortality in critically ill patients. Our data suggest that RDW may serve as a prognostic tool for early risk stratification of long-term outcomes in critical care.

Excess mortality of critically ill patients aged ≥90 years in intensive care units: A retrospective cohort study.

Excess mortality of critically ill patients aged ≥90 years in intensive care units: A retrospective cohort study.

Association of glucose to lymphocyte ratio with all-cause and cardio-cerebrovascular mortality in diabetic population

The objective of this study was to explore the association of glucose to lymphocyte ratio (GLR) with all-cause and cardio-cerebrovascular mortality in diabetic adults. The cohort of 8,149 adults with diabetes was included in this study. The association between GLR and mortality was examined using weighted multivariable Cox regression equations. Restricted cubic splines (RCS) were conducted to further explore the non-linear relationship. Kaplan-Meier (KM) survival analyses were performed to assess trends in the risk of mortality at different levels of GLR. Additionally, subgroup analyses and interaction tests were conducted to detect differences among groups. After adjusting for all covariates, we found that GLR presented a positive association with mortality. Further RCS revealed that this positive association was non-linear. GLR and mortality exhibited significance only after the inflection points, with HR (95% CI) of 1.21 (1.16, 1.27) for all-cause mortality and 1.33 (1.21, 1.43) for cardio-cerebrovascular mortality. KM survival analyses revealed that the risk of mortality increased with elevated GLR. This cohort study uncovered a non-linear positive association between GLR and mortality in the diabetic population, suggesting that GLR could be an indicator of poor prognosis in diabetes.