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Sleep Health Jun 2024To investigate disparities in the work-sleep relationship between Native Hawaiian/Pacific Islanders (NHPIs) and non-Hispanic (NH)-White populations.
Disparities in sleep duration and quality by industry of employment and occupational class among Native Hawaiian/Pacific Islanders and non-Hispanic Whites in the United States.
OBJECTIVE
To investigate disparities in the work-sleep relationship between Native Hawaiian/Pacific Islanders (NHPIs) and non-Hispanic (NH)-White populations.
METHODS
Using data from a nationally representative sample of U.S. adults (n = 20,828) in the 2014 National Health Interview Survey, we estimated prevalence of short sleep duration (<7 hours) among NHPIs (10%) and NH-Whites for each of 7 employment industry categories and 3 occupational classes. Mean age was 41 ± 0.5years for NHPIs and 49 ± 0.2years for NH-Whites. Women comprised 52% of both groups.
RESULTS
NHPIs were more likely than NH-Whites to report short sleep duration across all industry of employment categories (except for food and accommodation services) and occupational classes. The disparity was widest among NHPI and NH-White workers in the "professional/management" industry category, with NHPIs having higher prevalence of very short (<6 hours; 20% vs. 7%) and short sleep (30% vs. 22%) durations and lower prevalence of recommended sleep duration (45% vs. 68%) and waking up feeling rested (53% vs. 67%). Among the occupational classes, the NHPI-White disparity was widest among participants who held support service occupations. Although professionals had the lowest and laborers had the highest prevalence of short sleep among the three occupational classes in both NHPI and NH-White groups, short sleep duration prevalence was higher among NHPI professionals (35%) than NH-White laborers (33%). NH-White workers across industry and occupational classes had higher sleep medication use prevalence compared to NHPI workers.
CONCLUSIONS
The work environment via occupation type may contribute to racial/ethnic disparities in short sleep. Further investigations are warranted.
PubMed: 38890042
DOI: 10.1016/j.sleh.2024.05.006 -
Laryngoscope Investigative... Jun 2024Trauma remains the leading cause of death for children over a year old. Motorized recreational conveyances (RCs) adds another potential cause of pediatric trauma. This...
OBJECTIVE
Trauma remains the leading cause of death for children over a year old. Motorized recreational conveyances (RCs) adds another potential cause of pediatric trauma. This study aims to determine the impact of adding electric motors to RCs on the severity and frequency of pediatric injuries and craniofacial fractures.
METHODS
Pediatric trauma information was obtained from the National Electronic Injury Surveillance System (NEISS) database between 2012 and 2021. Demographics, injury cause, diagnoses, and incident narrative were collected. Bivariate and multivariate regression analyses were used to determine injury factors associated with serious injuries.
RESULTS
One million five hundred ninety-six thousand five hundred fifty-nine encounters were examined; 113,905 (7.1%) were related to pediatric RCs and 5354 (5.4%) of those involved RCs with electric motors. 14.3% of injuries were related to scooters, 18.6% to skateboards, 54.2% to bicycles, and 12.9% to other RCs. There were significant differences in age, sex, race, helmet use, serious injuries, and craniofacial fractures between RC modalities. RC users were more likely to develop facial fractures (OR 2.12; 95%CI 2.01, 2.23; < .001) and be involved in serious injuries (OR 1.42; 95%CI 1.38, 1.46; < .001). Compared to their self-propelled counterparts, motorized scooters (OR 2.24; 95%CI 1.86, 2.69; < .001) but not motorized skateboards (OR 1.01; 95%CI 0.88, 1.17; = 0.88) were more likely to cause serious injuries. Helmet use was associated with fewer serious injuries (OR 0.5; 95%CI 0.46, 0.54; < .001), facial fractures (OR 0.48; 95%CI 0.41, 0.55; < .001), and skull fractures (OR 0.13; 95%CI 0.09, 0.17; < .001).
CONCLUSIONS
The addition of electric motors to RCs significantly increases the risk of pediatric craniofacial fractures and serious injuries.
LEVEL OF EVIDENCE
3.
PubMed: 38887704
DOI: 10.1002/lio2.1269 -
Scientific Data Jun 2024Despite the importance of measuring racial-ethnic segregation and diversity in the United States, current measurements are largely based on the Census and, thus, only...
Despite the importance of measuring racial-ethnic segregation and diversity in the United States, current measurements are largely based on the Census and, thus, only reflect segregation and diversity as understood through residential location. This leaves out the social contexts experienced throughout the course of the day during work, leisure, errands, and other activities. The National Experienced Racial-ethnic Diversity (NERD) dataset provides estimates of diversity for the entire United States at the census tract level based on the range of place and times when people have the opportunity to come into contact with one another. Using anonymized and opted-in mobile phone location data to determine co-locations of people and their demographic backgrounds, these measurements of diversity in potential social interactions are estimated at 38.2 m × 19.1 m scale and 15-minute timeframe for a representative year and aggregated to the Census tract level for purposes of data privacy. As well, we detail some of the characteristics and limitations of the data for potential use in national, comparative studies.
Topics: Humans; Cultural Diversity; Ethnicity; Racial Groups; United States
PubMed: 38886400
DOI: 10.1038/s41597-024-03490-y -
PloS One 2024This paper demonstrates how artificial-intelligence language analysis can inform understanding of human-nature relationships and other social phenomena. We demonstrate...
This paper demonstrates how artificial-intelligence language analysis can inform understanding of human-nature relationships and other social phenomena. We demonstrate three techniques by investigating relationships within the popular word2vec word embedding, which is trained on a sample from over 50,000 worldwide news sources. Our first technique investigates what theory-generated analogies are most similar to nature:people. The resource:user analogy is most similar, followed by the playground:child and gift:receiver analogies. Our second technique explores whether nature-related words are affiliated with words that denote race, class, or gender. Nature words tend slightly toward associations with femininity and wealth. Our third technique demonstrates how the relationship between nature and wellbeing compares to other concepts' relationships to wellbeing-e.g., spirituality-wellbeing, social relations-wellbeing. Nature is more semantically connected to wellbeing than money, social relations, and multiple other wellbeing correlates. Findings are consistent with previous social science and humanities research on human-nature relationships, but do not duplicate them exactly; our results thus offer insight into dominant trends and prevalence of associations. Our analysis also offers a model for using word embeddings to investigate a wide variety of topics.
Topics: Humans; Artificial Intelligence; Nature; Female; Male; Language
PubMed: 38885213
DOI: 10.1371/journal.pone.0297294 -
Annals of Surgery Open : Perspectives... Mar 2024We sought to determine if and how providers use elements of shared decision-making (SDM) in the care of surgical patients in the intensive care unit (ICU).
Is Everyone Beating Around the Bush?: A Qualitative Study Examining the Status of Shared Decision-Making Between Veterans Affairs Providers and Surgical Patients in the ICU.
OBJECTIVE
We sought to determine if and how providers use elements of shared decision-making (SDM) in the care of surgical patients in the intensive care unit (ICU).
BACKGROUND
SDM is the gold standard for decision-making in the ICU. However, it is unknown if this communication style is used in caring for critically ill surgical patients.
METHODS
Qualitative interviews were conducted with providers who provide ICU-level care to surgical patients in Veterans Affairs hospitals. Interviews were designed to examine end-of-life care among veterans who have undergone surgery and require ICU-level care.
RESULTS
Forty-eight providers across 14 Veterans Affairs hospitals were interviewed. These participants were diverse with respect to age, race, and sex. Participant dialogue was deductively mapped into 8 established SDM components: describing treatment options; determining roles in the decision-making process; fostering partnerships; health care professional preferences; learning about the patient; patient preferences; supporting the decision-making process; and tailoring the information. Within these components, participants shared preferred tools and tactics used to satisfy a given SDM component. Participants also noted numerous barriers to achieving SDM among surgical patients.
CONCLUSIONS
Providers use elements of SDM when caring for critically ill surgical patients. Additionally, this work identifies facilitators that can be leveraged and barriers that can be addressed to facilitate better communication and decision-making through SDM. These findings are of value for future interventions that seek to enhance SDM among surgical patients both in the ICU and in other settings.
PubMed: 38883948
DOI: 10.1097/AS9.0000000000000403 -
Research Square Jun 2024Permanent supportive housing (PSH) is an evidence-based practice for reducing homelessness that subsidizes permanent, independent housing and provides case...
BACKGROUND
Permanent supportive housing (PSH) is an evidence-based practice for reducing homelessness that subsidizes permanent, independent housing and provides case management-including linkages to health services. Substance use disorders (SUDs) are common contributing factors towards premature, unwanted ("negative") PSH exits; little is known about racial/ethnic differences in negative PSH exits among residents with SUDs. Within the nation's largest PSH program at the Department of Veterans Affairs (VA), we examined relationships among SUDs and negative PSH exits (for up to five years post-PSH move-in) across racial/ethnic subgroups.
METHODS
We used VA administrative data to identify a cohort of homeless-experienced Veterans (HEVs) (n = 2,712) who were housed through VA Greater Los Angeles' PSH program from 2016-2019. We analyzed negative PSH exits by HEVs with and without SUDs across racial/ethnic subgroups (i.e., African American/Black, Non-Hispanic White, Hispanic/Latino, and Other/Mixed [Asian, American Indian or Alaskan Native, and Native Hawaiian or Other Pacific Islander, and multi-race]) in controlled models and accounting for competing risk of death.
RESULTS
In competing risk models, HEVs with at least one SUD had 1.3 times the hazard of negative PSH exits compared to those without SUDs (95% CI: 1.00, 1.61). When stratifying by race/ethnicity, Other/Mixed race residents with at least one SUD had 6.4 times the hazard of negative PSH exits compared to their peers without SUDs (95% CI: 1.61-25.50). Hispanic/Latino residents with at least one SUD had 1.9 times the hazard compared to those without SUDs, also indicating a strong relationship with negative PSH exits; however, this association was not statistically significant (95% CI: 0.85-4.37). Black residents with at least one SUD had 1.2 times the hazard compared to those without SUDs (95% CI: 0.85-1.64), indicating no evidence of an association with negative PSH exits. Similarly, Non-Hispanic White residents with at least one SUD had 1.1 times the hazard compared to those without SUDs (95% CI: 0.75-1.66).
CONCLUSIONS
These findings suggest relationships between SUDs and negative PSH exits differ between race/ethnic groups and suggest there may be value in culturally specific tailoring and implementation of SUD services for these subgroups.
PubMed: 38883791
DOI: 10.21203/rs.3.rs-4442590/v1 -
MedRxiv : the Preprint Server For... Jun 2024Late predictions of hospitalized patient deterioration, resulting from early warning systems (EWS) with limited data sources and/or a care team's lack of shared...
IMPORTANCE
Late predictions of hospitalized patient deterioration, resulting from early warning systems (EWS) with limited data sources and/or a care team's lack of shared situational awareness, contribute to delays in clinical interventions. The COmmunicating Narrative Concerns Entered by RNs (CONCERN) Early Warning System (EWS) uses real-time nursing surveillance documentation patterns in its machine learning algorithm to identify patients' deterioration risk up to 42 hours earlier than other EWSs.
OBJECTIVE
To test our a priori hypothesis that patients with care teams informed by the CONCERN EWS intervention have a lower mortality rate and shorter length of stay (LOS) than the patients with teams not informed by CONCERN EWS.
DESIGN
One-year multisite, pragmatic controlled clinical trial with cluster-randomization of acute and intensive care units to intervention or usual-care groups.
SETTING
Two large U.S. health systems.
PARTICIPANTS
Adult patients admitted to acute and intensive care units, excluding those on hospice/palliative/comfort care, or with Do Not Resuscitate/Do Not Intubate orders.
INTERVENTION
The CONCERN EWS intervention calculates patient deterioration risk based on nurses' concern levels measured by surveillance documentation patterns, and it displays the categorical risk score (low, increased, high) in the electronic health record (EHR) for care team members.
MAIN OUTCOMES AND MEASURES
Primary outcomes: in-hospital mortality, LOS; survival analysis was used. Secondary outcomes: cardiopulmonary arrest, sepsis, unanticipated ICU transfers, 30-day hospital readmission.
RESULTS
A total of 60 893 hospital encounters (33 024 intervention and 27 869 usual-care) were included. Both groups had similar patient age, race, ethnicity, and illness severity distributions. Patients in the intervention group had a 35.6% decreased risk of death (adjusted hazard ratio [HR], 0.644; 95% confidence interval [CI], 0.532-0.778; P<.0001), 11.2% decreased LOS (adjusted incidence rate ratio, 0.914; 95% CI, 0.902-0.926; P<.0001), 7.5% decreased risk of sepsis (adjusted HR, 0.925; 95% CI, 0.861-0.993; P=.0317), and 24.9% increased risk of unanticipated ICU transfer (adjusted HR, 1.249; 95% CI, 1.093-1.426; P=.0011) compared with patients in the usual-care group.
CONCLUSIONS AND RELEVANCE
A hospital-wide EWS based on nursing surveillance patterns decreased in-hospital mortality, sepsis, and LOS when integrated into the care team's EHR workflow.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT03911687.
PubMed: 38883706
DOI: 10.1101/2024.06.04.24308436 -
Factors associated with incomplete resection for large, locally invasive non-small cell lung cancer.Journal of Thoracic Disease May 2024Large, node-negative but locally invasive non-small cell lung cancer (NSCLC) is associated with increased perioperative risk but improved survival if a complete...
BACKGROUND
Large, node-negative but locally invasive non-small cell lung cancer (NSCLC) is associated with increased perioperative risk but improved survival if a complete resection is obtained. Factors associated with positive margins in this population are not well-studied.
METHODS
We performed a retrospective cohort study using National Cancer Database (NCDB) for adult patients with >5 cm, clinically node-negative NSCLC with evidence of invasion of nearby structures [2006-2015]. Patients were classified as having major structure involvement (azygous vein, pulmonary artery/vein, vena cava, carina/trachea, esophagus, recurrent laryngeal/vagus nerve, heart, aorta, vertebrae) or chest wall invasion (rib pleura, chest wall, diaphragm). Our primary outcome was to evaluate factors associated with incomplete resection (microscopic: R1, macroscopic: R2). Kaplan-Meier analysis and cox multivariable regression models were used to evaluate overall survival (OS), 90-day mortality, and factors associated with positive margins.
RESULTS
Among 2,368 patients identified, the median follow-up was 33.8 months [interquartile range (IQR), 12.6-66.5 months]. Most patients were white (86.9%) with squamous cell histology (47.3%). Major structures were involved in 26.4% of patients and chest wall invasion was seen in 73.6%. Four hundred and seventy-eight patients (20.2%) had an incomplete resection. Multivariable analysis revealed that black race [hazard ratio (HR) 1.568, 95% confidence interval (CI): 1.109-2.218] and major structure involvement (HR 1.412, 95% CI: 1.091-1.827) was associated with increased risk of incomplete resection and surgery at an academic hospitals (HR 0.773, 95% CI: 0.607-0.984), adenocarcinoma histology (HR 0.672, 95% CI: 0.514-0.878), and neoadjuvant chemotherapy (HR 0.431, 95% CI: 0.316-0.587) were associated with decreased risk of incomplete resection. The 5-year OS was 43.7% in the entire cohort and 28.8% in patients with positive margins and 47.5% in patients with an R0 resection. Positive margin was also associated with a significantly higher 90-day mortality rate (9.9% versus 6.7%).
CONCLUSIONS
For patients with large, node-negative NSCLC invading nearby structures, R0 resection portends better survival. Treatment at academic centers, adenocarcinoma histology, and receipt of neoadjuvant chemotherapy are associated with R0 resection in this high-risk cohort.
PubMed: 38883676
DOI: 10.21037/jtd-23-989 -
Cannabis (Albuquerque, N.M.) 2024Simultaneous alcohol and cannabis use (i.e., marijuana, [SAM], using alcohol and cannabis so effects overlap) is associated with increased consumption and consequences...
OBJECTIVE
Simultaneous alcohol and cannabis use (i.e., marijuana, [SAM], using alcohol and cannabis so effects overlap) is associated with increased consumption and consequences compared to single-substance use. SAM use prevalence is increasing, yet there is heterogeneity in use patterns among those engaging in SAM use, which may lead to differential consequences.
METHOD
This study drew on daily data to characterize latent profiles of cannabis, alcohol, and SAM use patterns and to test class differences on related consequences after 3 months among college students engaging in SAM use (77.08% White, 51.67% female). Class indicators were 10 person-level substance use variables derived from repeated daily surveys.
RESULTS
Results yielded a three-class solution: Heavy Alcohol, Cannabis, and SAM (Heavy Use, = 105); Heavy Alcohol-Light Cannabis ( = 75); and Light Alcohol-Heavy Cannabis ( = 60). There were significant person-level differences between classes on all substance use indicators (e.g., quantity and frequency of alcohol, cannabis, and SAM) but not sex or race/ethnicity. At 3-month follow-up, the Heavy Use class endorsed more SAM consequences than the other classes. The Heavy Use class did not differ on alcohol or cannabis consequences compared to the Heavy Alcohol-Light Cannabis or Light Alcohol-Heavy Cannabis classes, respectively. The Light Alcohol-Heavy Cannabis class endorsed the fewest alcohol consequences. The Heavy Alcohol-Light Cannabis class endorsed the fewest cannabis consequences.
CONCLUSIONS
Findings highlight distinct patterns of co-use and their association with consequences at follow-up. Heavy alcohol or cannabis use was associated with consequences for that substance, but heavy use of only one substance was not indicative of SAM-specific consequences.
PubMed: 38883280
DOI: 10.26828/cannabis/2023/000184 -
Cureus May 2024Introduction The management of maxillofacial trauma can be challenging in different unique clinical presentations. While maxillofacial fractures vary in location based...
Introduction The management of maxillofacial trauma can be challenging in different unique clinical presentations. While maxillofacial fractures vary in location based on the mechanism of injury, the mandibular fracture is noted to be one of the most common facial fractures. The objective of this study was to explore the differences in injury patterns, outcomes, and demographics of isolated traumatic mandibular fractures between incarcerated and general populations. Methods This retrospective study analyzed consecutive patients presenting for trauma care from January 1, 2010, to December 31, 2020, at the Arrowhead Regional Medical Center (ARMC). Patients 18 years and older were included in this study. Patients diagnosed with mandibular fracture as the primary diagnosis at admission and discharge were identified using the International Classification of Disease, Ninth and Tenth Revision (ICD-9, ICD-10) Code. Patient demographics were extracted from their electronic medical records and included race, marital status, and insurance status. Results A total of 1080 patients with confirmed mandibular fractures were included in the final analysis. Among these patients, 87.5% (n=945) were males, 40% (n=432) of the patients were Hispanic, and the average age was 31.55 years old. The most common mechanism of injury was blunt trauma secondary to assault. Compared to the general population with mandibular fracture, the incarcerated patients with mandibular fracture were more likely to be males (96.1% vs 86.1% for incarcerated population vs. general population respectively, p=0.0005). No other variables were statistically different between these two groups. Conclusion The evidence from this study suggests that the patterns, outcomes, and demographics of mandibular fracture in both incarcerated and general populations are similar.
PubMed: 38883043
DOI: 10.7759/cureus.60458