Short-term Health Research Articles

Soil health improvements under cover crops are associated with enhanced soil content of cytokinins.

Cytokinins (CKs) are phytohormones produced by plants and other soil life. including bacteria, fungi, insects, and earthworms. These organisms can release CKs to the soil, which may have positive implications for soil health and plant growth. However, no studies have examined phytohormones as soil health indicators. In custom-designed rhizo-pots that separated rhizosphere and bulk soils, the cover crops tillage radish and cereal rye were used to manipulate soil health parameters: soil pH, soil organic matter, soil active carbon, soil microbial community diversity, and extracellular enzyme activities involved in C, N and P cycling. Data were compared to impacts of cover crops on CKs that were purified from the complex soil and measured with HPLC-HRMS/MS. From soil we detected free base-CKs (trans-zeatin (tZ), isopentenyladenine (iP)), riboside-CKs (RB-CKs), cis-zeatin riboside (cZR), isopentenyladenosine (iPR) and four methylthiolated CKs: 2-methylthio-zeatin (2MeSZ), 2-methylthio-zeatin ribosides (2MeSZR), 2-methylthio-isopentenyladenine (2MeSiP), and 2-methylthio-isopentenyladenine riboside (2MeSiPR). These CK levels were significantly enhanced in cover cropped soil compared to uncultivated soil, and reflect a positive relationship between soil CK profiles and other soil health parameters - notably, between total CK and active C levels and soil microbial community diversity. This is the first detailed soil CK analysis and assessment of its potential use as a novel, reliable, short-term soil health parameter. The increased CK concentrations in cover cropped soils likely reflects the activity levels of soil life (plants, microbes, animals) and provides a rationale to use CKs as tools to evaluate soil health as influenced by agricultural management strategies.

Development of squamous cell carcinoma at the bite sites several years following suspected cobra (Naja naja) envenomings

Introduction Snakebite envenoming is a multidimensional issue that causes severe functional and life-challenging consequences among rural communities in tropical countries. Current research and treatments are largely focused on the acute effects of envenomation and short-term health outcomes. The knowledge of snakebite-induced long-term consequences is highly limited. Case series We report the development of squamous cell carcinoma at the bite site several years later in four patients who are suspected to have been bitten by cobras (Naja naja). Following bites, the victims presented typical symptoms of cobra envenomings including ptosis, altered sensorium, and breathing difficulties. However, difficult-to-heal wounds were a chronic health sequelae with frequent desquamation cycles which led to squamous cell carcinoma. Surgery as the primary therapeutic approach was used for all patients to address this issue. Discussion These patients highlight the importance of squamous cell carcinoma in previously damaged tissue from snakebites as a possible long-term consequence. This emphasises the need for surveillance systems focused on a broad range of snakebite-induced consequences including long-term pathological, psychological, and socioeconomic conditions. Conclusion This case series describes pathological complications following cobra bites that require further research to determine mechanistic and epidemiological insights in the most affected regions by snakebites, specifically in India.

Climate Change Impact on Outdoor Organizations Today.

Outdoor recreation and tourism providers, education programs, and outdoor recreation facilities are experiencing the effects of climate change and severe weather firsthand. This research assessed the impact that climate change was having on these operations in 2023. Respondents from 127 outdoor organizations completed an online survey assessing the impacts of climate change and severe weather. Any outdoor operation that owed a duty of care to clients who they take outdoors or host at their facilities was invited to participate. This included outdoor tourism and recreation providers, outdoor education programs (both school and expedition based), groups involved in conservation work, and facilities such as parks, ski areas, and other outdoor recreation facilities. Respondents were from Canada's far north to Mexico, with 14% from further international locations. Climate change is having moderate to serious impacts on outdoor operations. Extreme heat and air quality were of primary concern, with storm event flooding, wildfires, snowpack, and changes in the ranges of disease-carrying insects top concerns. Fewer than half the operations have established criteria to aid in decision making, yet most had to revise operational plans in 2023 due to extreme weather. There was pervasive uncertainty regarding decisions involving extreme heat and air quality, particularly the short-term health impacts on clients and the long-term health impacts on workers. There was uncertainty regarding trusted sources for guidance and the many overlapping or contradictory jurisdictional recommendations. Practical direction is required for operations and decision makers, as is further research specific to this sector's needs.

Health Effect of Elderly Family Planning Subsidy on Older Chinese with Only One Child

ABSTRACT The decades-long one-child policy in China has led to a growing number of older individuals with only one child. The Elderly Family Planning Subsidy (EFPS) policy was introduced to provide extra financial support to this group and was expanded nationwide in 2012. This study investigated the relationship between EFPS use and health among EFPS-eligible older Chinese using data from the China Health and Retirement Longitudinal Study. A total of 1,981 respondents were eligible for EFPS (i.e. aged 60 and above, had only one child, or were rural residents with two daughters). Respondents self-reported if they received EFPS in 2011, 2013, and 2015 and were followed up to 2018. Propensity score matching was used to match EFPS non-users with users based on their probability of using EFPS. Among the EFPS-eligible respondents, 256 (12.92%) used the benefit. Analysis revealed no significant differences between EFPS users and non-users with respect to mortality and other health outcomes (i.e. self-reported health, cognition, activities of daily living, chronic diseases, and depressive symptoms). Findings do not provide evidence that EFPS improved the short-term health of older Chinese with only one child.

Effect of patulin on the growth and nutrient composition of black soldier fly larvae

Abstract Black solider fly (BSF, Hermetia illucens) is a common insect in most part of North America, Europe, and Asia, and it is one of the most promising alternative protein sources for animal consumption. BSF can be fed on food waste and agricultural byproducts, which are usually contaminated with mycotoxins. Therefore, it is important to study the fate of mycotoxins in BSF and how mycotoxins will affect the growth and nutrient composition of BSF. Patulin is one of the major mycotoxins found in rotten fruits and consumption of patulin contaminated food can cause both long term and short-term health problems in both human and livestock. In this study clean and patulin spiked apple puree were provided to 50 three days old black soldier fly larvae (BSFL) for 3, 6, 9 and 17 days. Patulin bioaccumulation and degradation by BSFL, survival rate, weight gain and nutrient composition of BSFL were evaluated. During the treatment period, no patulin bioaccumulation was found in BSFL. BSFL was able to degrade patulin and convert patulin into (E)-ascladiol. By day 17, BSFL degraded 89.7% of patulin, 5.7% of patulin was converted into (E)-ascladiol, and 10.3% of patulin remained in its original form. While patulin treatment led to lower biomass and growth rate in BSFL, greater protein content and lower lipid content was observed in patulin treated BSFL. Thus, we conclude that BSFL do not accumulate patulin, and it is able to degrade patulin and converts patulin into its derivatives. The applied patulin negatively affects the development of BSLF resulting in lower biomass, growth rate and lipid content, but it induces higher protein content in BSFL.

Sleep Management: The Use of Continuous Physiological Monitoring to Support Patient Self-Care

Circadian misalignment (CM) is a sleep disruption where an individual’s circadian rhythm and actual sleep-wake cycle are unsynchronized. CM is frequently misdiagnosed and difficult to treat but can adversely impact short-term and long-term health outcomes. CM often interacts bidirectionally with chronic conditions affecting cognitive and physical functionality. Continuous physiological monitoring (CPM) of the hormone melatonin would support real-time, patient-driven interventions to address CM. However, patient-driven self-care tasks involve complex information processing and decision-making. Effective CPM use requires situation awareness regarding current circadian health and projected future status, sufficient background knowledge to identify circadian intervention alternatives, and selection of appropriate alternatives given their current state. Melatonin data has characteristics distinct from biomarkers previously subject to CPM, introducing further challenges around data presentation. Task analysis efforts can identify the cognitive processes involved in five different tasks associated with a continuous melatonin monitor to identify necessary informational elements to include in interface design.

Air pollution control and health economic burdens: Evidence from a megacity in China from 2014 through 2022

The Guangdong-Hong Kong-Macao Greater Bay Area (GBA) stands as China's foremost region in air pollution control. Shenzhen, as a model city, was selected to quantify the health-economic gains brought about by pollution control efforts. The paper showcased the exemplary practices of GBA in safeguarding the blue sky, providing a template for other regions. We assessed the variation of health impacts and economic burdens in Shenzhen from 2014 to 2022 using the proportional hazards model based on Poisson regression, along with the value of a statistical life, the cost of illness, and the willingness-to-pay approach. The results showed that only the premature mortality and economic burdens attributable to PM2.5 exhibited improvement prior to the COVID-19, with a total reduction of 9846.65 (95%Cl: 9846.65–9846.65) premature deaths and a cost saving of 63.93 (95%Cl: 63.93–63.93) million dollars. Short-term public health policies may affect the outcomes of air quality management, most types of health impacts and economic burdens showed a cliff decline during the pandemic. In addition, the study revealed that cardiovascular health economic burdens outweighed respiratory ones at the premature mortality level, while the opposite scenario was observed at the hospitalization level. This paper advocated for the strengthening of pollution control efforts, especially focusing on industrial emission reduction and intelligent transportation. The theoretical study of O3 and the synergistic management of O3 and PM2.5 should be advanced. Additionally, health education should be emphasized, and residents should be encouraged to cultivate personal hygiene habits.

Overweight and obesity among Israeli adolescents and the risk for serious morbidity in early young adulthood: a nationwide retrospective cohort study.

Morbidities related to obesity are usually associated with its severity and duration. Yet, the onset of serious morbidities in early adulthood among otherwise healthy adolescents with obesity is understudied. We aimed to investigate the association between adolescent BMI and serious morbidities before age 25 years. In this nationwide, retrospective cohort study, we included Israeli conscripts aged 17-21 years who underwent pre-recruitment medical evaluation between Jan 1, 1996, and Dec 31, 2017, were deemed medically eligible for military service, and were recruited to the Israeli Defense Forces between 1998 and 2018. Exclusion criteria were missing height or weight or service ineligibility for non-medical or medical reasons. Baseline BMI was converted into age-specific and sex-specific percentiles and classified using the US Centers for Disease Control and Prevention categories. The primary outcome was incidence of serious morbidity disqualifying individuals from completing mandatory service. Participants were followed from enlistment until end of service (3 years for males and 2 years for females), onset of serious morbidity, or Dec 31, 2021. Cox models with adjustment to various socio-economic confounders were applied to calculate the hazard ratio (HR) and 95% CI for serious morbidity for the BMI categories. A total of 1 264 355 adolescents aged 16-20 years were assessed for military service. 145 702 were excluded; 144 705 were considered ineligible for service (133 112 for non-medical reasons and 11 593 for medical reasons), and 2867 had missing height or weight data. The study included 1 118 653 individuals (622 989 [55·7%] males and 495 664 [44·3%] females), with 23 347 cases of serious morbidity recorded over 2 534 873 person-years. Incidence of serious morbidity increased across BMI groups in both sexes. Among males, compared with those with normal BMI, the adjusted HRs were 0·89 (95% CI 0·83-0·95) for underweight, 1·21 (1·16-1·27) for overweight, 1·39 (1·32-1·47) for obesity class 1, 2·82 (2·60-3·06) for obesity class 2, and 5·14 (4·37-6·04) for obesity class 3. For females, the respective ratios were HR 0·95 (95% CI 0·84-1·09) for underweight, 1·27 (1·17-1·37) for overweight, 1·63 (1·45-1·82) for obesity class 1, 4·00 (3·46-4·61) for obesity class 2, and 7·30 (5·65-9·43) for obesity class 3. Results persisted in sensitivity analyses restricted to those with unimpaired health at baseline or those in civilian-equivalent office employments. Obesity in otherwise healthy adolescents was linked with increased risk of serious morbidity before age 25 years. Reducing adolescent obesity will have substantial short-term and long-term health benefits in young adults. Sheba Medical Center.

Spatial associations of daily PM2.5 concentration with cardiovascular and pulmonary morbidity in Korea

Air pollution, particularly fine particulate matter less than 2.5 μm in diameter (PM2.5), contributes to respiratory and cardiovascular diseases and poses significant public health risks worldwide. This study evaluated the short-term effects of PM2.5 on hospital admissions for cardiovascular and respiratory diseases, with additional analyses to identify vulnerable populations based on regional characteristics.The present study analyzed data from 249 Korean communities between 2006 and 2021. Data on daily hospital admissions for cardiovascular and respiratory diseases were obtained from the National Health Insurance Service. Data on PM2.5 concentrations were sourced from air quality modeling. Additional data on regional characteristics, including the regional deprivation index, proportion of elderly residents, education levels, and greenness levels, were also collected. We used case time series analysis to assess the associations between PM2.5 concentrations and hospital admissions for cardiovascular and respiratory diseases and explored effect modification by regional characteristics with stratified analyses.The mean numbers of daily cardiovascular admissions and respiratory admissions were 5.68 ± 5.46 and 6.46 ± 8.03, respectively. The mean PM2.5 concentrations were 23.58 ± 13.66 μg/m3. A10 μg/m³ increment in daily PM2.5 concentration was associated with increase of cardiovascular and respiratory hospitalization by 0.94% (95% CI: 0.84%, 1.04%) and 1.43% (95% CI: 1.34%, 1.52%), respectively. Regional characteristics analysis showed significant disparities, with higher risks for hospital admissions in areas with lower deprivation and low greenness.This study highlights the significant short-term health impacts of PM2.5 on respiratory and cardiovascular hospital admissions in Korean communities. The findings underscore the critical role of regional and demographic factors in modulating these effects, identifying socio-economic areas, age structure of the population, lower education levels, and low greenness as key vulnerability factors.

Relationships among intensive blood pressure control, morning blood pressure surge and 24-hour blood pressure variability

Abstract Objectives This study aimed to investigate the relationships between cardiovascular outcomes and blood pressure (BP) reduction, 24-hour BP variability (BPV), morning BP surge (MBPS), and visit-to-visit BPV. Methods This study involved 897 participants from the Systolic Blood Pressure International Trial (SPRINT), for whom biochemical and demographic data, medication history, and various blood profile information were collected. Univariate and multivariate linear regression models were used to assess the impact of intensive BP management on 24-hour BPV and the MBPS. Results Among the 897 participants (average age 71.48 ± 9.42 years; 640 males), 453 received intensive treatment. Those in the intensive group were more likely to be on ACE inhibitors, CCBs, or diuretics. This group showed significant reductions in 24-hour systolic and diastolic BP, as well as in both short-term and long-term BPVs, such as average real variability (ARV) and MBPS. The analysis demonstrated strong associations between intensive BP management and improvements in various BPV measures, including systolic ARV, diastolic BP ARV, and cumulative BP loads. A significant correlation was also found between intensive BP lowering and the primary composite outcome of the SPRINT study. Conclusions This study highlighted the significant associations between intensive BP management and reductions in the MBPS and 24-hour BPV, which affect both short-term and long-term health outcomes. The primary benefits of intensive BP control appear to stem from direct BP reduction rather than changes in BPV. However, further extensive randomized controlled trials are needed to confirm these findings.

Health-Related Experiences of Geophagia Among Women of Reproductive Age in Tshwane District, Gauteng Province: An Exploratory Qualitative Study.

Women of reproductive age are reported to be the largest population that practises geophagia. The short-term and long-term health related conditions originating from the practise of geophagia are often not understood by geophagic women of reproductive age. This study has explored the health-related experiences of geophagia among women of reproductive age of Tshwane District, Gauteng Province. This was a qualitative study design following inductive thematic content analysis. In-depth interviews and focus group discussions were used to collect data using an interview guide and audio record. Data collection took place in 2023. Mental health disorders, pregnancy complications, appendicitis, cancers, breathing complications, fatigue, premature deaths, worms, piles, and nutrients deficiencies were reported as some of the health-related challenges and diseases experienced by women of reproductive age of Tshwane District, Gauteng Province resulting from the practise of geophagia. The practise of geophagia was associated with various negative health outcomes. The reproductive health statuses of women of reproductive age were negatively impacted by the practise of geophagia affecting maternal and childhood mortalities and morbidities.

Concentrations and short-term health effects of VOCs in explored subway, bus and taxi in Beijing, China

The transportation environment is one we are exposed to every day. However, previous research on exposure to volatile organic compounds (VOCs) and their acute health effects in various public transportation is limited. To address this gap, we conducted a panel study involving 25 healthy adults, investigating the exposures and acute health effects of exposures to 24 VOC species during 40-min commutes in Beijing's subways, buses and taxis during early spring 2023. Our findings revealed that exposure to multiple VOC species, including toluene, styrene, tetrachloroethylene, ethylacetate, resulted in a decrease in Heart Rate Variability (HRV). Specifically, SDNN decreased by 4.37 ms (95%CI: −8.52, −0.21) with per interquartile range (IQR) increase in ethylacetate; rMSSD decreased by 9.93 ms (95%CI: −19.01, −0.86), 4.75 ms (95%CI: −8.63, −0.86), and 7.00 ms (95%CI: −13.20, −0.81) with per IQR increase in toluene, styrene, and tetrachloroethylene, respectively; HF decreased by 154.07 ms2 (95%CI: −284.03, −24.11) with per IQR increase in carbon tetrachloride. For joint effect of these VOC species, we found significant associations with HRV only in taxis. Moreover, higher cyclohexane and methylcyclohexane exposures were linked to reports of sick car syndrome. Despite wearing masks during the COVID-19 period, comparative results from a supplementary experiment conducted post-COVID-19 without masks indicated that masks may not significantly reduce the adverse effects of VOC exposure. Our findings indicated the potential acute health risks of short-term VOC exposures in public transportation, particularly in taxis, highlighting the necessity to improve air quality and related standards in these micro-environments.

Environmental health risk assessment and acute effects of sulfur dioxide (SO2) inhalation exposure on traditional sulfur miners at Ijen Crater Volcano, Indonesia

The Ijen Crater volcano is one of the geological wonders recognized by UNESCO. Inside it is a blue lake with a high acidity level, and a blue fire phenomenon has formed due to the very high concentration of sulfur. This crater is also one of Indonesia's largest sources of sulfur and is used by locals as a traditional sulfur mine. This study aims to measure SO2 concentrations and assess the health risks of SO2 exposure in traditional sulfur mine workers. The SO2 measurements were taken using impingers at six sample points along the mine workers' path. In addition, anthropometric data, work activity patterns, and health complaints during work were collected through direct interviews with 30 respondents selected based on inclusion criteria. Short-Term Health Impact Method was carried out based on a comparison of threshold level values and acute effects obtained from interviews regarding health complaints. The Hazard Question Index (HQ Index) of SO2 exposure was calculated using the health risk assessment method. The SO2 concentrations between 3.14 and 18.24 mg/m3. All sample points were above the quality standard threshold set by the EPA of 1.97 mg/m3. The most common health complaints workers experienced were eye irritation and coughing while working, followed by headache, shortness of breath, and skin irritation. The HQ index of SO2 exposure in workers was 1.02 for real-time exposure and 2.15 for long-term exposure. An HQ index ≥ 1 indicates a potential health risk for workers. Therefore, it is important to control workers' SO2 exposure.

Health benefits of US light-duty vehicle electrification: Roles of fleet dynamics, clean electricity, and policy timing

We present a dynamic perspective to quantify the air quality-related health impacts of the electrification of light-duty vehicles in the United States between 2022 and 2050. Using a fleet turnover model and future electricity generation mix scenarios, we compare ambitious vehicle electrification to fleet renewal relying on newer internal combustion engine vehicles, without electric vehicles. The model includes vehicle-level pollutant emission factors and a reduced complexity air quality and valuation model and covers direct (tailpipe, brake wear, and tire wear) and indirect (production of electricity and liquid fuels) emissions of NOx, SO2, PM2.5, NH3, and VOCs, with a breakdown at the county level to identify geographical disparities in the distribution of health impacts. Short-term health benefits are mostly generated by reductions in NOx emissions from newer gasoline vehicles, while fleet electrification generates further benefits in the long term. The electricity mix plays a crucial role in the success of electrification policies. With continued grid decarbonization, electrification would reduce harmful air quality-related health impacts cumulatively by 84 to 188 billion USD over the study period, compared with fleet renewal without electric vehicles. In contrast, artificially freezing the 2022 grid would make electrification responsible for 32 to 71 billion USD additional health disbenefits compared with fleet renewal. Finally, we show that while fleet electrification achieves most of its benefits over fleet renewal in the long term, delaying the implementation of such policies would sacrifice meaningful cumulative benefits.

Gestational diabetes: an update sixty years after O'Sullivan and Mahan.

Sixty years after the landmark publication by O'Sullivan and Mahan, the current paper seeks to review and place into context the importance of gestational diabetes (GDM) both as a marker of increased risk of adverse maternal and fetal pregnancy outcomes and as an indicator of future maternal and infant health risks. We review the evolution of GDM as a diagnosis, the ongoing debate regarding diagnostic approaches, the underlying pathophysiology, the epidemiology and the importance of GDM in the context of the global epidemics of diabetes and obesity. Focusing on clinical management, we review lifestyle based therapy and pharmacotherapy for GDM, consider obstetric management and outline the short term and lifelong health risks posed by a GDM diagnosis.

Improving mental health response in earthquake-prone regions: recommendations following the recent earthquake in Türkiye

We are members of Students’ Education, Empowerment and Development in Mental Health, a group of medical students and psychiatrists from around the globe under the Psychiatry, Medicine and Primary Care Section of the World Psychiatric Association. In this article, we put forward recommendations to help improve the mental health response in disaster-prone regions such as Türkiye. We recommend a three-step multi-tiered mental health response system that could significantly help to address the immediate, short-term and long-term mental health needs of communities directly affected by a disaster. The recommendation draws from the relevant literature and, most importantly, from our lived experiences of living in earthquake-prone countries.

Nutrition support in children with medical complexity and chronic critical illness: A narrative review.

Children with medical complexity (CMC) and children with chronic critical illness (CCI) represent growing populations with high healthcare use and dependence on specialized care, both in the hospital and community setting. Nutrition assessment and delivery represent critical components of addressing the short-term and long-term health needs for these populations across the care continuum. This article provides a framework and reviews existing literature for the assessment of nutrition status and subsequent delivery of nutrition prescriptions in CMC and children with CCI. The specific aims are to (1) describe the epidemiology of health services experience for CMC and children with CCI, with a focus on their nutrition outcomes; (2) detail how to assess their nutrition status and energy requirements; (3) review methods of delivery of the nutrient prescription; (4) introduce perioperative considerations; (5) highlight examples of special populations of CMC and children with CCI; and (6) propose future research initiatives to improve nutrition and overall outcomes for these populations.

The association between fracture and short-term adverse health outcomes among children with cerebral palsy

BackgroundChildren with cerebral palsy (CP) have a high risk of fracture; yet, little is known about their post-fracture health outcomes. A fracture is an unplanned event in contrast to surgeries or procedures where there is a pre-operative period to optimize body composition and health and planned post-operative follow-up care. Fractures may be associated with significant outcomes due to the unplannable nature and reactionary care. The objective of this study was to determine if fractures were associated with an increased rate of short-term adverse health outcomes among children with CP, and if these associations were dependent on age. MethodsThis retrospective cohort study used commercial claims from 01/01/2001–12/31/2018. The primary cohort was children 2–18 years old with CP and an incident fracture (CP + Fx). Comparison cohorts were propensity score matched 1:1 to CP + Fx on demographic and health-related indicators: CP without fractures (CPw/oFx); without CP with (w/oCP + Fx) or without (w/oCPw/oFx) a fracture. The incidence rate (IR) and IR ratios (IRR) of 30-day and 31–90-day pneumonia and 90-day emergency department (ED) visit were estimated. Cox regression tested for effect modification by age and sex. ResultsThe CP + Fx cohort (n = 1670) had higher IRs of 30-day pneumonia (IRR range, 1.53–4.54) and 90-day ED visit (IRR range, 1.45–2.37) (all P < 0.05), and higher IRs of 31–90-day pneumonia but this did not reach statistical significance (IRR, 1.41 to 2.32, all P > 0.05). Notably, there was evidence of effect modification by age. The rate of 30-day pneumonia became more problematic for CP + Fx with older age relative to comparison cohorts and for 90-day ED visit compared to CPw/oFx. The rate of 90-day ED visit for CP + Fx was more problematic at younger ages compared to w/oCP + Fx. ConclusionsFractures among children with CP were associated with an increased rate of short-term pneumonia and ED visit, which was more problematic with older age.

Effect of heat stress in the first 1000 days of life on fetal and infant growth: a secondary analysis of the ENID randomised controlled trial

The intersecting crises of climate change, food insecurity, and undernutrition disproportionately affect children. Understanding the effect of heat on growth from conception to 2 years of age is important because of mortality and morbidity implications in the near term and over the life course. In this secondary analysis, we used longitudinal pregnancy cohort data from the Early Nutrition and Immunity Development (ENID) randomised controlled trial in West Kiang, The Gambia, which occurred between Jan 20, 2010, and Feb 10, 2015. The ENID trial assessed micronutrient supplementation in the first 1000 days of life starting from 20 weeks' gestation, during which anthropometric measurements were collected prospectively. We used multivariable linear regression to assess the effect of heat stress (defined by Universal Thermal Climate Index [UTCI]) on intrauterine growth restriction based on length-for-gestational age Z score (LGAZ), weight-for-gestational age Z score (WGAZ), and head circumference-for-gestational age Z score (HCGAZ) at birth, and assessed for effect modification of supplement intervention on the relationship between heat stress and infant anthropometry. We used multivariable, multilevel linear regression to evaluate the effect of heat stress on infant growth postnatally based on weight-for-height Z score (WHZ), weight-for-age Z score (WAZ), and height-for-age Z score (HAZ) from 0 to 2 years of age. Complete data were available for 668 livebirth outcomes (329 [49%] female infants and 339 [51%] male infants). With each 1°C increase in mean daily maximum UTCI exposure, in the first trimester, we observed a reduction in WGAZ (-0·04 [95% CI -0·09 to 0·00]), whereas in the third trimester, we observed an increase in HCGAZ (0·06 [95% CI 0·00 to 0·12]), although 95% CIs included 0. Maternal protein-energy supplementation in the third trimester was associated with reduced WGAZ (-0·16 [-0·30 to -0·02]) with each 1°C increase in mean daily maximum UTCI exposure, while no effect of heat stress on WGAZ was found with either standard care (iron and folate) or multiple micronutrient supplementation. For the postnatal analysis, complete anthropometric data at 2 years were available for 645 infants (316 [49%] female infants and 329 [51%] male infants). Postnatally, heat stress effect varied by infant age, with infants aged 6-18 months being the most affected. In infants aged 12 months exposed to a mean daily UTCI of 30°C (preceding 90-day period) versus 25°C UTCI, we observed reductions in mean WHZ (-0·43 [95% CI -0·57 to -0·29]) and mean WAZ (-0·35 [95% CI -0·45 to -0·26]). We observed a marginal increase in HAZ with increasing heat stress exposure at age 6 months, but no effect at older ages. Our results suggest that heat stress impacts prenatal and postnatal growth up to 2 years of age but sensitivity might vary by age. In the context of a rapidly warming planet, these findings could have short-term and long-term health effects for the individual, and immediate and future implications for public child health. Wellcome Trust.

Impact of the Hospital Frailty Risk Score on Outcomes following Primary Total Elbow Arthroplasty

The Hospital Frailty Risk Score (HFRS) has demonstrated strong correlation with adverse outcomes in various joint replacement surgeries, yet its applicability in total elbow arthroplasty (TEA) remains unexplored. The purpose of this study is to assess the association between HFRS and postoperative complications following elective primary TEA. The Nationwide Readmissions Database was queried to identify patients undergoing primary TEA from 2016 to 2020. The HFRS was used to compare medical, surgical, and clinical outcomes of frail vs. non-frail patients. Mean and relative costs, total hospital length of stay (LOS), and discharge disposition for frail and non-frail patients were also compared. We identified 2,049 primary TEA in frail patients and 3,693 in non-frail patients. Frail patients had increased complication rates including acute respiratory failure (13.6% vs. 1.1%; p < 0.001), urinary tract infections (12.3% vs. 0.0%; p < 0.001), transfusions (3.9% vs. 1.1%; p < 0.001), pneumonia (1.1% vs. 0.2%; p < 0.001), acute respiratory distress syndrome (3.2% vs 0.6%; p < 0.001), sepsis (0.7% vs. 0.1%; p < 0.001), and hardware failure (1.2% vs 0.1%; p < 0.001). Frail patients also experienced higher rates of readmission (37% vs. 25%; p < 0.001) and death (1.7% vs. 0.2%; p < 0.001), while being less likely to undergo revision (6.5% vs. 17%; p < 0.001). Frail patients incurred higher healthcare costs ($28,497 vs. $23,377; p < 0.001) and longer LOS (5.3 days vs. 2.6 days; p < 0.001), with reduced likelihood of routine hospital stays (36% vs. 71%; p < 0.001) and increased utilization of short-term hospitalization (p < 0.001), care facilities (p < 0.001), and home health care services (p < 0.001). HFRS is a validated indicator of frailty and is strongly associated with increased rates of complications in patients undergoing elective primary TEA. These findings should be considered by orthopedic surgeons when assessing surgical candidacy and discussing treatment options in this at-risk patient population.