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Journal of Occupational and... Jul 2024To determine the association between the occupational history as a wildland firefighter (WFF) and clinical indicators of cardiovascular health.
OBJECTIVE
To determine the association between the occupational history as a wildland firefighter (WFF) and clinical indicators of cardiovascular health.
METHODS
Among 2,862 WFFs we evaluated associations between the number of total days assigned on fire and high-risk categories of three clinically measured cardiovascular indicators.
RESULTS
Almost one-third (32%) of WFFs had one or more clinical measures that would place them in high-risk categories for BMI, blood pressure, and total cholesterol. WFF work history was associated with some of these measures: odds ratio (and 95% confidence interval) for highest versus lowest tertile of days on fire were 1.4 (1.2, 1.8) and 1.2 (1.0, 1.5) for high-risk categories of BMI and cholesterol, respectively.
CONCLUSION
More frequent screening and targeted health promotion programs for WFFs are warranted to increase awareness of cardiovascular risk and prevention strategies.
PubMed: 38955802
DOI: 10.1097/JOM.0000000000003172 -
East Asian Archives of Psychiatry :... Dec 2023To identify factors associated with the use and duration of physical restraint (PR) in a psychiatric unit in Japan.
OBJECTIVE
To identify factors associated with the use and duration of physical restraint (PR) in a psychiatric unit in Japan.
METHODS
Medical records of 1308 patients admitted first time to the psychiatric emergency unit of Showa University Northern Yokohama Hospital between 1 January 2014 and 31 December 2021 were retrospectively reviewed. Data collected included patient age, sex, outpatient treatment, living arrangements, disability pension status, diagnosis (based on ICD-10), and psychotropic medication use at admission (chlorpromazine equivalent dose, imipramine equivalent dose, diazepam equivalent dose, and number of mood stabilisers administered). Logistic regression analysis and multiple regression analysis were used to identify factors associated with the use and duration of PR, respectively.
RESULTS
Of 1308 patients, 399 (30.5%) were subjected to PR and 909 (69.5%) were not. Among the 399 patients subjected to PR, 54 were excluded from the multiple regression analysis for duration of PR as they remained subject to PR on the day of discharge. The remaining 345 patients were subject to PR for a median of 10 days. PR utilisation was associated with male sex (odds ratio [OR] = 1.420), treatment at our hospital (OR = 0.260), treatment at other hospitals (OR = 0.645), F3 diagnosis (depression) [OR = 0.290], F4-9 diagnosis (OR = 0.309), and imipramine equivalent dose at admission (unit OR = 0.994). The log-transformed duration of PR was independently associated with the age group of 50 to 69 years (β = 0.248), the age group of ≥70 years (β = 0.274), receiving a disability pension (β = 0.153), an F1 diagnosis (β = -0.187), an F4-9 diagnosis (β = -0.182), chlorpromazine equivalent dose at admission (β = 0.0004), and number of mood stabilisers administered at admission (β = -0.270).
CONCLUSION
Identifying factors associated with the use and duration of PR may lead to reduction in the use and duration of PR.
Topics: Humans; Male; Female; Japan; Retrospective Studies; Restraint, Physical; Middle Aged; Adult; Mental Disorders; Aged; Psychiatric Department, Hospital; Sex Factors; Young Adult
PubMed: 38955784
DOI: 10.12809/eaap2334 -
Zhonghua Yu Fang Yi Xue Za Zhi [Chinese... Jun 2024To determine the causal relationship between educational attainment and the risk of allergic rhinitis and (or) eczema using Mendelian randomization (MR) analyses. This...
[Educational attainment increases the risk of developing allergic rhinitis and (or) eczema: a Mendelian randomization study based on genome-wide association studies in European patients].
To determine the causal relationship between educational attainment and the risk of allergic rhinitis and (or) eczema using Mendelian randomization (MR) analyses. This study was a secondary data analysis based on the summary data of genome-wide association studies (GWAS), which involved 293 723 participants (educational attainment) from the Social Science Genetics Association Consortium and 462 013 participants [allergic rhinitis and (or) eczema] from the UK Biobank. Genetic variants that were closely related to educational attainment were identified as instrumental variables. Two-sample MR analyses, including inverse-variance weighted (IVW), MR-Egger regression, weighted median method and weighted model-based estimation, were performed to investigate the causal relationship between educational attainment and the risk of allergic rhinitis and (or) eczema, in which the odds ratio () values were used as indicators. A total of 70 single-nucleotide polymorphisms (SNPs) were chosen as instrumental variables. The MR-Egger regression results suggested that the genetic pleiotropy was unlikely to bias our results (=0.107). In the univariable MR analyses, IVW regression showed that the risk of allergic rhinitis and (or) eczema was =1.044 (95%: 1.020-1.069, 0.001) and =1.170 (95%: 1.074-1.256, 0.001), respectively, for the increase in the duration of education by one year or one standard deviation () (3.71 years). In the reverse MR analysis, IVW regression showed little evidence that allergic rhinitis and (or) eczema affected educational attainment (=1.020, 95%: 0.927-1.023, 0.683). The results of the weighted median method and weighted mode-based estimation were consistent with the results of IVW. This study suggests that there is a positive causal relationship between educational attainment and the risk of allergic rhinitis and (or) eczema, which means that educational attainment can increase the occurrence of allergic rhinitis and (or) eczema.
Topics: Humans; Genome-Wide Association Study; Mendelian Randomization Analysis; Rhinitis, Allergic; Polymorphism, Single Nucleotide; Eczema; Educational Status; Risk Factors; Genetic Predisposition to Disease
PubMed: 38955725
DOI: 10.3760/cma.j.cn112150-20230830-00138 -
Heart, Lung & Circulation Jul 2024Acute coronary syndrome (ACS) admissions and percutaneous coronary intervention (PCI) volume declined during periods of COVID-19 lockdown internationally in 2020. The...
BACKGROUND
Acute coronary syndrome (ACS) admissions and percutaneous coronary intervention (PCI) volume declined during periods of COVID-19 lockdown internationally in 2020. The effect of lockdown on emergency medical service (EMS) utilisation, and PCI volume during the initial phase of the pandemic in Australia has not been well described.
METHOD
We analysed data from the Victorian Cardiac Outcomes Registry (VCOR), a state-wide PCI registry, linked with the Ambulance Victoria EMS registry. PCI volume, 30-day major adverse cardiovascular and cerebrovascular events (MACCE; composite of mortality, myocardial infarction, stent thrombosis, unplanned revascularisation, and stroke), and EMS utilisation were compared over four time periods: lockdown (26 Mar 2020-12 May 2020); pre-lockdown (26 Feb 2020-25 Mar 2020); post-lockdown (13 May 2020-10 Jul 2020); and the year prior (26 Mar 2019-12 May 2019). Interrupted time series analysis was performed to assess PCI trends within and between consecutive periods.
RESULTS
The EMS utilisation for ACS during lockdown was higher compared with other periods: lockdown 39.4% vs pre-lockdown 29.7%; vs post-lockdown 33.6%; vs year prior 27.1%; all p<0.01. Median daily PCI cases were similar: 31 (IQR 10, 38) during lockdown; 39 (15, 49) pre-lockdown; 39.5 (11, 44) post-lockdown; and, 42 (10, 49) the year prior; all p>0.05. Median door-to-procedure time for ACS indication during lockdown was shorter at 3 hours (1.2, 20.6) vs pre-lockdown 3.9 (1.7, 21); vs post-lockdown 3.5 (1.5, 21.26); and, the year prior 3.5 (1.5, 23.7); all p<0.05. Lockdown period was associated with lower odds for 30-day MACCE compared to pre-lockdown (odds ratio [OR] 0.55 [0.33-0.93]; p=0.026); post-lockdown (OR 0.66; [0.40-1.06]; p=0.087); and the year prior (OR 0.55 [0.33-0.93]; p=0.026).
CONCLUSIONS
Contrary to international trends, EMS utilisation for ACS increased during lockdown but PCI volumes remained similar throughout the initial stages of the pandemic in Victoria, with no observed adverse effect on 30-day MACCE during lockdown. These data suggest that the public health response in Victoria was not associated with poorer quality cardiovascular care in patients receiving PCI.
PubMed: 38955597
DOI: 10.1016/j.hlc.2024.02.018 -
Neurospine Jun 2024To investigate the correlation between magnetic resonance imaging-based vertebral bone quality (VBQ) score and screw loosening after dynamic pedicle screw fixation with...
Prediction of Screw Loosening After Dynamic Pedicle Screw Fixation With Lumbar Polyetheretherketone Rods Using Magnetic Resonance Imaging-Based Vertebral Bone Quality Score.
OBJECTIVE
To investigate the correlation between magnetic resonance imaging-based vertebral bone quality (VBQ) score and screw loosening after dynamic pedicle screw fixation with polyetheretherketone (PEEK) rods, and evaluate its predictive value.
METHODS
A retrospective analysis was conducted on the patients who underwent dynamic pedicle screw fixation with PEEK rods from March 2017 to June 2022. Data on age, sex, body mass index, hypertension, diabetes, hyperlipidemia history, long-term smoking, alcohol consumption, VBQ score, L1-4 average Hounsfield unit (HU) value, surgical fixation length, and the lowest instrumented vertebra were collected. Logistic regression analysis was employed to assess the relationship between VBQ score and pedicle screw loosening (PSL).
RESULTS
A total of 24 patients experienced PSL after surgery (20.5%). PSL group and non-PSL group showed statistical differences in age, number of fixed segments, fixation to the sacrum, L1-4 average HU value, and VBQ score (p < 0.05). The VBQ score in the PSL group was higher than that in the non-PSL group (3.56 ± 0.45 vs. 2.77 ± 0.31, p < 0.001). In logistic regression analysis, VBQ score (odds ratio, 3.425; 95% confidence interval, 1.552-8.279) were identified as independent risk factors for screw loosening. The area under the receiver operating characteristic curve for VBQ score predicting PSL was 0.819 (p < 0.05), with the optimal threshold of 3.15 (sensitivity, 83.1%; specificity, 80.5%).
CONCLUSION
The VBQ score can independently predict postoperative screw loosening in patients undergoing lumbar dynamic pedicle screw fixation with PEEK rods, and its predictive value is comparable to HU value.
PubMed: 38955540
DOI: 10.14245/ns.2448184.092 -
Neurospine Jun 2024To establish a novel classification system for predicting the risk of intraoperative neurophysiological monitoring (IONM) events in surgically-treated patients with...
The Role of Spinal Cord Compression in Predicting Intraoperative Neurophysiological Monitoring Events in Patients With Kyphotic Deformity: A Magnetic Resonance Imaging-Based Study.
OBJECTIVE
To establish a novel classification system for predicting the risk of intraoperative neurophysiological monitoring (IONM) events in surgically-treated patients with kyphotic deformity.
METHODS
Patients with kyphotic deformity who underwent surgical correction of cervicothoracic, thoracic, or thoracolumbar kyphosis in our center from July 2005 to December 2020 were recruited. We proposed a classification system to describe the morphology of the spinal cord on T2-weighted sagittal magnetic resonance imaging: type A, circular/symmetric cord with visible cerebrospinal fluid (CSF) between the cord and vertebral body; type B, circular/oval/symmetric cord with no visible CSF between the cord and vertebral body; type C, spinal cord that is fattened/deformed by the vertebral body, with no visible CSF between the cord and vertebral body. Furthermore, based on type C, the spinal cord compression ratio (CR) < 50% was defined as the subtype C-, while the spinal cord CR ≥ 50% was defined as the subtype C+. IONM event was documented, and a comparative analysis was made to evaluate the prevalence of IONM events among patients with diverse spinal cord types.
RESULTS
A total of 294 patients were reviewed, including 73 in type A; 153 in type B; 53 in subtype C- and 15 in subtype C+. Lower extremity transcranial motor-evoked potentials and/or somatosensory evoked potentials were lost intraoperatively in 41 cases (13.9%), among which 4 patients with type C showed no return of spinal cord monitoring data. The 14 subtype C+ patients (93.3%) had IONM events. Univariate logistic regression analysis showed that patients with a type C spinal cord (subtype C-: odds ratio [OR], 10.390; 95% confidence interval [CI], 2.215-48.735; p = 0.003; subtype C+, OR, 497.000; 95% CI, 42.126- 5,863.611; p < 0.001) are at significantly higher risk of a positive IONM event during deformity correction compared to those with a type A. In further multiple logistic regression analysis, the spinal cord classification (OR, 5.371; 95% CI, 2.966-9.727; p < 0.001) was confirmed as an independent risk factor for IONM events.
CONCLUSION
We presented a new spinal cord classification system based on the relative position of the spinal cord and vertebrae to predict the risk of IONM events in patients with kyphotic deformity. In patients with type C spinal cord, especially those in C+ cases, it is essential to be aware of potential IONM events, and adopt standard operating procedures to facilitate neurological recovery.
PubMed: 38955539
DOI: 10.14245/ns.2448160.080 -
Saudi Medical Journal Jul 2024To estimate the incidence of post tonsillectomy bleeding and to identify its predisposing factors among the pediatric population.
OBJECTIVES
To estimate the incidence of post tonsillectomy bleeding and to identify its predisposing factors among the pediatric population.
METHODS
A retrospective cohort study included 1280 pediatric patients (18 years or younger) who underwent tonsillectomy at King Abdullah Specialized Children Hospital, Riyadh, Saudi Arabia between 2019 and 2020. The study sample was divided into 2 groups based on the development of postoperative bleeding and were compared using Chi-square test and independent t-test. Significant variables (-value ≤0.05) were included in the logistic regression model to determine the predictors of bleeding following tonsillectomy.
RESULTS
The bleeding rate following tonsillectomy was 3.4% in 43 (95% confidence interval [CI] 2.4-4.5) patients. In the multivariable logistic regression model, the significant predictors of post tonsillectomy bleeding were age ≥12 years (odds ratio [OR]: 2.685, =0.027), decreased postoperative oral intake (OR: 4.244, =0.042), and single use of postoperative analgesia (OR: 53.124, <0.001). Out of the 43 patients, 39 (90.7%) patients experienced secondary bleeding, and more than half of the patients who developed bleeding required surgical intervention 27 (62.8%).
CONCLUSION
Tonsillectomy is a safe and common surgical procedure but carries risks for postoperative bleeding. Age ≥12 years, poor postoperative oral intake, and the use of a single postoperative analgesic increase the risk of bleeding. We encourage healthcare providers to ascertain early resumption of oral intake and ensure effective pain management. We recommend a dual alternating analgesic regimen with weight-based dosing for optimal pain control. Furthermore, educating caregivers about the importance of adequate oral intake following tonsillectomy may improve patient outcomes.
Topics: Humans; Tonsillectomy; Retrospective Studies; Postoperative Hemorrhage; Child; Incidence; Male; Female; Adolescent; Saudi Arabia; Child, Preschool; Risk Factors; Age Factors; Cohort Studies; Pain, Postoperative; Logistic Models; Infant
PubMed: 38955443
DOI: 10.15537/smj.2024.45.7.20240253 -
Beneficial Microbes Jul 2024Previous studies reporting the association between gut microbiota dysbiosis and maternal obesity were mostly confined at the phylum level or at postpartum period. This...
Previous studies reporting the association between gut microbiota dysbiosis and maternal obesity were mostly confined at the phylum level or at postpartum period. This study aimed to investigate the dynamic changes in gut microbial communities associated with maternal obesity at different time points of pregnancy. We performed 16S rRNA gene V3-V4 amplicon sequencing on stool samples from 110 women in all three trimesters and 1-month postpartum. Maternal gut microbial communities associated with maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) were explored. The influence of maternal obesity on gut microbiota trajectories was determined based on longitudinal shifts in community clusters across the trimesters. The richness index of alpha diversity decreased with the progression of pregnancy, particularly in women with excessive GWG. The evenness index in 2nd trimester was found inversely associated with GWG. Various taxonomic differences in 1st trimester were associated with excessive GWG, whereas limited taxonomic differences in 2nd and 3rd trimesters were associated with pre-pregnancy BMI or GWG. Meanwhile, the gut microbiota trajectory with especially depleted genus Faecalibacterium in 1st trimester was associated with excessive GWG (adjusted odds ratio 5.7, 95% confidence interval 1.2-28.1). Moreover, the longitudinal abundances of genus Lachnospiraceae ND3007 group across gestations were depleted in women with overweight/obese pre-pregnancy BMI, while genus Bifidobacterium enriched in women with excessive GWG. Our study shows that dysbiosis of the gut microbiota in early pregnancy may have a significant impact on excess GWG. The abundance of the genus Faecalibacterium in 1st trimester may be a potential risk factor. Clinical trial number: NCT03785093 (https://classic.clinicaltrials.gov/ct2/show/NCT03785093).
PubMed: 38955351
DOI: 10.1163/18762891-bja00018 -
Archives of Gerontology and Geriatrics Jun 2024This study endeavors to decipher the association between Activin A and PRISm, thereby addressing the potential of Activin A as a serum biomarker for early detection and...
INTRODUCTION
This study endeavors to decipher the association between Activin A and PRISm, thereby addressing the potential of Activin A as a serum biomarker for early detection and long-term clinical outcome prediction of PRISm and subsequent all-cause mortality.
METHODS
The study sample comprised middle-aged and older adults from the I-Lan Longitudinal Aging Study. Pulmonary function including forced vital capacity (FVC) and forced expiratory volume in one second (FEV) were measured. Demographic data and laboratory data (including serum Activin A levels) were also collected. Multivariate logistic regression and Cox proportional hazards models were used to identify independent predictors of PRISm and all-cause mortality, respectively.
RESULTS
Among 711 eligible participants, 34 % had PRISm. The risk of PRISm elevated with Activin A levels in group quartiles (adjusted odds ratio (aOR), Q2: 1.606 [95 % CI 0.972-2.652], p = 0.064, Q3: 2.666 [1.635-4.348], p < 0.001, Q4: 3.225 [1.965-5.293], p < 0.001). On the other hand, lower hemoglobin (aOR: 1.122, p = 0.041) and higher blood urea nitrogen (BUN) levels (aOR: 1.033, p = 0.048) were associated with increased risk of PRISm. In addition, the PRISm group had a higher all-cause mortality rate (non-PRISm 4.5% vs. PRISm 8.3 %, p = 0.038). Multivariate Cox models also identify a higher level of Activin A as a risk factor of all-cause mortality (aHR: 1.001 [1.000-1.003], p = 0.042).
CONCLUSIONS
Higher Activin A quartiles were linked to increased risk of PRISm, along with lower hemoglobin and higher BUN levels. Additonally, elevated Activin A was a significant risk factor of all-cause mortality.
PubMed: 38954987
DOI: 10.1016/j.archger.2024.105539 -
Clinical Neurology and Neurosurgery Jun 2024Subarachnoid hemorrhage (SAH) is associated with high rates of mortality and morbidity, particularly among elderly patients. The presence of frailty may impact survival... (Review)
Review
BACKGROUND
Subarachnoid hemorrhage (SAH) is associated with high rates of mortality and morbidity, particularly among elderly patients. The presence of frailty may impact survival rates in patients with SAH. In this study, we aim to investigate the impact of frailty on the clinical outcomes in SAH patients.
METHODS
We conducted a systematic review and meta-analysis following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Relevant papers through December 2023 were retrieved from PubMed, Scopus, Web of science, and Embase.
RESULTS
A total of 5 studies met inclusion/exclusion criteria with an aggregate 39,221 non-frail patients (mean age 52.4 ± 5.2 yr; 62.1 % Female), and 79,416 frail patients (mean age 61.1 ± 5.4 yr; 69.0 % Female). Frailty was significantly associated with higher mortality ratio (Odds ratio (OR)= 2.09; CI [1.04: 4.20], p= 0.04), and increased length of hospital stay (OR= 1.40; CI [1.07: 1.83], p= 0.015). Additionally, frailty was associated with higher odds of external ventricular drain insertion, the need of tracheostomy/endoscopic gastrostomy, increased risk of deep vein thrombosis, and postoperative neurological complications.
CONCLUSION
Frailty is associated with worse clinical outcomes and higher mortality rates in SAH patients. Our findings highlight that frailty, when considered alongside other established prognostic factors, serves as crucial predictor for peri-operative complications and overall hospital course in SAH patients.
PubMed: 38954868
DOI: 10.1016/j.clineuro.2024.108413