Nevin Manimala

Curr Probl Cardiol. 2023 Oct 29:102184. doi: 10.1016/j.cpcardiol.2023.102184. Online ahead of print.

ABSTRACT

Venous Thromboembolism (VTE) carries significant clinical implications, and with the rise in cannabis consumption, its potential influence on VTE outcomes warrants investigation. Using the National Inpatient Sample (NIS) database (2016-2019), we analyzed 2,217,184 hospitalized VTE patients. Among these, 1.8% (38,810) reported cannabis use. We compared demographics, comorbidities, in-hospital outcomes, and quality metrics between cannabis users and non-users with VTE. Cannabis users were chiefly younger males (average age 45 in cannabis users vs. 62 in non-cannabis users) from lower-income brackets. Notably, 5.4% discharged against medical advice. Although in-hospital mortality was initially lower for cannabis users (2.8% vs. 5.1%, OR 0.6, 95% CI 0.69-0.94, p=0.008), this difference became non-significant post-propensity-score matching (aOR 0.9, 95% CI 0.72-1.10, p=0.3). Non-users faced higher in-hospital complications, a trend that persisted post-PSM. Among cannabis users, key mortality predictors were peripheral vascular disease, acute kidney injury, vasopressor use, cardiogenic shock, myocardial infarction, invasive ventilation, and surgical embolectomy. Cannabis users also had a shorter hospital stay (4.2 vs. 5.4 days) and slightly reduced costs ($27,472.95 vs. $31,660.75). The significantly younger age of VTE patients who use cannabis, coupled with the considerable proportion discharging against medical advice, underscores the urgency for tailored care interventions. Additional research is vital to comprehensively understand the interplay between cannabis consumption and VTE outcomes.

PMID:37907189 | DOI:10.1016/j.cpcardiol.2023.102184

Am J Prev Med. 2023 Oct 29:S0749-3797(23)00434-8. doi: 10.1016/j.amepre.2023.10.018. Online ahead of print.

ABSTRACT

INTRODUCTION: This study evaluates the real-world impact of a lifestyle change program (LCP) on healthcare utilization in a large health system.

METHODS: Using electronic health record (EHR) data from a large health system in northern California, United States, LCP participant and propensity-score-matched non-participant outcomes were compared in the second year post-participation: (1) overall healthcare utilization, and (2) utilization and medications related to cardiometabolic conditions and obesity. Adult LCP participants between 2010-2017 were identified and matched 1:1 with replacement to comparable non-participants. Participants without EHR activity in the 12-36 months before baseline, or with conditions or procedures associated with substantial weight change, were excluded. Statistical analysis and modeling were performed in 2021-22.

RESULTS: Compared to matched non-participants, LCP participants in the 12-24 months post-baseline were more likely to have specialty-care visits (+4.7%, 95% CI +1.8%,+7.6%), electronic communications (8.6%, 95% CI +5.6%,+11.7%), and urgent-care visits (+6.5%, 95% CI +3.0%,10.0%). Participants also had more office visits for cardiometabolic conditions and obesity (+1.72 visits/patient, 95% CI +1.05,+2.39).

CONCLUSIONS: Compared with matched non-participants, LCP participation was associated with higher utilization of outpatient services post-participation. Additional research could assess whether this indicates an increase in preventive care that could lead to improved future outcomes.

PMID:37907133 | DOI:10.1016/j.amepre.2023.10.018

Acad Pediatr. 2023 Oct 29:S1876-2859(23)00399-6. doi: 10.1016/j.acap.2023.10.008. Online ahead of print.

ABSTRACT

OBJECTIVE: Fewer than 40% of U.S. children complete the human papilloma virus (HPV) vaccine series before their 13^th birthday. In our large pediatric primary care network, HPV vaccine completion rate by age 13 was 30%. We hypothesized that a phased quality improvement (QI) initiative would increase rates of HPV vaccine completion by age 13 across our network.

METHODS: This QI initiative was conducted in a network of 30 practices located across 2 states, in urban and suburban settings, consisting of teaching and non-teaching clinics, and ranging in size from 3 to 50 providers per office. We used a phased approach incorporating multicomponent network-wide and iterative practice-specific interventions. Key interventions included: updating clinical decision support to default order HPV vaccine due at preventive visits starting at age 9 instead of 11, data audit and feedback to providers and practices, encouraging use of a strong provider recommendation, and standing orders.

RESULTS: From April 2019 to October 2022, HPV vaccine completion by age 13 across our network increased from 30% to 55% and met criteria for special cause variation on statistical process control charts. A gap in median HPV vaccine completion by age 13 between patients with public insurance and patients with private or commercial insurance decreased from 9% to 1%.

CONCLUSION: A QI initiative was associated with a sustained increase in HPV vaccine series completion by age 13 and reduced variation in care across a large network of 30 primary care practices.

PMID:37907128 | DOI:10.1016/j.acap.2023.10.008

Sci Total Environ. 2023 Oct 29:168189. doi: 10.1016/j.scitotenv.2023.168189. Online ahead of print.

ABSTRACT

AIM: As an important toxic heavy metal, lead exposure can lead to the occurrence of chronic kidney disease (CKD). However, the analysis of its disease burden pattern on a global scale is lacking. This study aimed to analyze the CKD burden attributable to lead exposure globally, regionally and temporally, as well as to examine the role of socio-economic factors.

METHOD: This study used data from the Global Burden of Disease (GBD) study 2019. We obtained the global burden of CKD caused by lead exposure between 1990 and 2019, and stratified this burden according to factors such as gender, age, GBD regions, and countries. From 1990 to 2019, the changing trend of the disease burden of CKD attributed to lead exposure was estimated using Joinpoint regression model with the average annual percent change (AAPC) estimated. Finally, the relationship between country-level socio-economic factors and lead exposure related CKD burden was explored using a panel data model analysis.

RESULTS: In 2019, worldwide, there were 52.94 thousand deaths (95 % uncertainty interval (UI): 31.64, 76.23) and 1225.2 thousand disability-adjusted life years (DALYs) (95 % UI: 707.88, 1818) of CKD caused by lead exposure, accounting for 3.71 % of total CKD deaths and 2.95 % of total CKD DALYs. The age-standardized death and DALY rates per 100,000 population were 0.68 (95 % UI: 0.40, 0.98) and 15.02 (95 % UI: 8.68, 22.26) respectively, indicating an upward trend and stable trend between 1990 and 2019. However, the age-standardized rates attributed to lead exposure showed a wide variability across regions, with the highest rates in Central Latin America and the lowest in Eastern Europe. Moreover, the results of panel model analysis indicated that GDP growth was positively associated with lead exposure related CKD death rate and DALY rate. However, there were inverse associations between life expectancy at birth and hospital beds (per 1000 people) with lead exposure-related CKD DALY rate.

CONCLUSION: In summary, a significant burden of CKD can be attributed to lead exposure, with noticeable regional discrepancies. Findings here are valuable to deploy efficient measures at curbing lead exposure worldwide.

PMID:37907111 | DOI:10.1016/j.scitotenv.2023.168189

Sci Total Environ. 2023 Oct 29:168114. doi: 10.1016/j.scitotenv.2023.168114. Online ahead of print.

ABSTRACT

The evolution of insecticide resistance has been attributed to strong directional selection by lethal concentrations of insecticides, but there is growing evidence that sublethal doses may also modify resistance through the hormetic effects. Hormesis is a beneficial effect caused by exposure to low doses. However, the role of parental (transgenerational) effects on hormesis, and through that on insecticide resistance, is still unclear. We investigated the effects of several sublethal pyrethroid insecticide (Decis) doses on survival, body mass, and reproduction within four generations (F0, F1, F2, and F3) of the Colorado potato beetle (Leptinotarsa decemlineata). We found that insecticide exposure had mostly linear adverse within-generation effects: decreased larva-to-adult survival, adult body mass, and egg hatching. However, transgenerational exposure led to hormetic effects: increased larva-to-adult survival and pre-diapause adult body mass. Moreover, transgenerational effects were even more positive for offspring exposed to insecticides, leading to decreased larva-to-adult survival, increased body mass, and egg hatching. Our results show that despite mostly negative within-generation effects, transgenerational sublethal exposure to insecticide can cause unwanted positive hormetic effects in their offspring, making them to resist or tolerate the insecticides better, even though the underlying mechanisms are still unclear.

PMID:37907109 | DOI:10.1016/j.scitotenv.2023.168114

Sci Total Environ. 2023 Oct 29:168185. doi: 10.1016/j.scitotenv.2023.168185. Online ahead of print.

ABSTRACT

Being one of the most serious biomass burning regions in the world, the air pollution caused by spring combustion in the Indo-China Peninsula (ICP) has already had an impact on Yunnan Province’s beautiful environment and excellent air quality to some extent. In this study, considering the differences in geographical location and topography of Yunnan, we used the K-Means algorithm to divide it into five clustering zones according to the spatiotemporal variation characteristics of PM_2.5. Then this study explored the spatial and temporal characteristics of pollution in Yunnan Province and biomass combustion in ICP based on the multi-source data such as MOD14A1, GDAS1, and ground-based PM_2.5 data, and used HYSPLIT (Hybrid Single-Particle Lagrangian Integrated Trajectory) pollution tracer analysis and other data statistical methods. The results show that the spatiotemporal variation characteristics of PM_2.5 in Yunnan Province show large differences within each clustering zone (CZ). Spatially, CZ 2 has better air quality throughout the year, and the areas with higher PM_2.5 are mainly in CZ 1 and CZ 3. Temporally, the months with higher concentration values were mainly from February to April, and also this period owed high biomass burning activities in the ICP, which resulted in pollution values exceeding 60 μg/m³ within certain CZs. Finally, the results of the pollution tracer analysis showed that within CZs other than CZ 2, the contribution due to the burning in the ICP was variable, and that the countries with a high contribution of pollution to Yunnan Province were Myanmar, and the other sources of pollution are mainly caused by local and neighbouring anthropogenic activities. Therefore, based on overall improvement of air quality, Yunnan Province is necessary to prevent and control not only the pollutants from the ICP from February to April, but also the pollution caused by the emissions from rapid economic development.

PMID:37907099 | DOI:10.1016/j.scitotenv.2023.168185

J R Soc Interface. 2023 Nov;20(208):20230117. doi: 10.1098/rsif.2023.0117. Epub 2023 Nov 1.

ABSTRACT

Chemical reactions that couple to systems that phase separate have been implicated in diverse contexts from biology to materials science. However, how a particular set of chemical reactions (chemical reaction network, CRN) would affect the behaviours of a phase separating system is difficult to fully predict theoretically. In this paper, we analyse a mean field theory coupling CRNs to a combined system of phase separating and non-phase separating materials and analyse how the properties of the CRNs affect different classes of non-equilibrium behaviour: microphase separation or temporally oscillating patterns. We examine the problem of achieving microphase separated condensates by statistical analysis of the Jacobians, of which the most important motifs are negative feedback of the phase separating component and combined inhibition/activation by the non-phase separating components. We then identify CRN motifs that are likely to yield microphase by examining randomly generated networks and parameters. Molecular sequestration of the phase separating motif is shown to be the most robust towards yielding microphase separation. Subsequently, we find that dynamics of the phase separating species is promoted most easily by inducing oscillations in the diffusive components coupled to the phase separating species. Our results provide guidance towards the design of CRNs that manage the formation, dissolution and organization of compartments.

PMID:37907095 | DOI:10.1098/rsif.2023.0117

J R Soc Interface. 2023 Nov;20(208):20230296. doi: 10.1098/rsif.2023.0296. Epub 2023 Nov 1.

ABSTRACT

The spatial configuration of urban amenities and the streets connecting them collectively provide the structural backbone of a city, influencing its accessibility, vitality and ultimately the well-being of its residents. Most accessibility measures focus on the proximity of amenities in space or along transportation networks, resulting in metrics largely determined by urban density alone. These measures are unable to gauge how efficiently street networks can navigate between amenities, since they neglect the circuity component of accessibility. Existing measures also often require ad hoc modelling choices, making them less flexible for different applications and difficult to apply in cross-sectional analyses. Here, we develop a simple, principled and flexible measure to characterize the circuity of accessibility among heterogeneous amenities in a city, which we call the pairwise circuity (PC). The PC quantifies the excess travel distance incurred when using the street network to route between a pair of amenity types, summarizing both spatial and topological correlations among amenities. Measures developed using our framework exhibit significant statistical associations with a variety of urban prosperity and accessibility indicators when compared with an appropriate null model, and we find a clear separation in the PC values of cities according to development level and geographical region.

PMID:37907093 | DOI:10.1098/rsif.2023.0296

West Afr J Med. 2023 Oct 31;40(10):1096-1106.

ABSTRACT

BACKGROUND: Burnout remains a crucial occupational health challenge to healthcare professionals given its immediate and remote harmful effects. Doctors and nurses are highly susceptible to burnout due to the essence and demands of their services. The study aimed to establish and compare the prevalence of burnout among doctors and nurses working at the University of Uyo Teaching Hospital, Southern Nigeria.

MATERIALS AND METHODS: This was a comparative cross-sectional study among 553 doctors and nurses at the University of Uyo Teaching Hospital, South-South Nigeria. Study participants were selected by a stratified random sampling technique. A pretested, self-administered MBI – Human Services Survey for Medical Personnel – MBI-HSS (MP) was used for data collection and analysed with IBM Statistical Product and Service Solutions (SPSS) software version 23. The Chi-square and Fisher’s exact tests were applied with a statistical significance level set at α<0.05.

RESULTS: The mean ages for doctors and nurses were 37.1 ± 5.3 and 39.0 ± 9.2 respectively (p=0.003). Burnout prevalence among doctors was 9.7% compared to 5.5% among nurses (p =0.062). Out of 553 respondents, 247 (46.7%) had high emotional exhaustion (EE), 70 (12.7%) had high depersonalization (DP), and 342 (61.9%) had low personal accomplishments (PA). Furthermore, 132 (47.3%) doctors had high EE, 43 (15.4%) had high DP and 159 (57%) had low PA. While 115 (42%) nurses had high EE, 27 (9.9%) had high DP and 183 (66.8%) had a low PA (p=0.041). Excessive workload (p=0.042) and lengthy years spent in a workplace position (p=0.002) were significantly associated with burnout among doctors compared to family size (p=0.045) and workplace support or community (p=0.005) among nurses.

CONCLUSION: The study found burnout prevalence to be higher among doctors than nurses. Work-related factors contributed significantly to burnout development. Recreating or modifying workplace environments is essential to mitigating the adverse effects of burnout among healthcare workers.

PMID:37906955

Andes Pediatr. 2022 Oct;93(5):699-708. doi: 10.32641/andespediatr.v93i5.3686.

ABSTRACT

In Chile, there is a lack of information about wheezing and asthma epidemiology in children under 5 years of age.

OBJECTIVE: To determine at the national level the hospitalization and mortality rates in children aged under 5 years with diagnosis of acute bronchitis and asthma.

PATIENTS AND METHOD: Hospitalization rates were made using discharge data provided by the Department of Health Statis tics and Information, selecting only those corresponding to the ICD10 codes for asthma and acute bronchitis. Population sizes of those at risk of hospitalization were obtained from projections of the National Institute of Statistics. The mortality rate was obtained by calculating the quotient between the number of deaths due to acute bronchitis and asthma in children under 5 years of age and the exposed population. The evolution of the global and regional hospitalization rates from 2002 to 2017 was studied.

RESULTS: Most of the patients who were hospitalized had a diagnosis of acute bronchitis (93,6%), were under two years old, were male, and were hospitalized in winter. During the analyzed period, the acute bronchitis hospitalization rate dropped from 79.7 to 56.1 per 10,000 inhabitants, meanwhile, the asthma hospitalization rate increased from 2.4 to 7.6 per 10,000 inhabitants. The mortality rate in patients with acute bronchitis was 0.52 per 100,000 inhabitants. No mortality was observed in patients diagnosed with asthma.

CONCLUSIONS: During the analyzed period, a significant reduction in hospitalization rate due to acute bronchitis was observed in children aged under 5 years, with a low mortality rate.

PMID:37906890 | DOI:10.32641/andespediatr.v93i5.3686