Nevin Manimala

Health Rep. 2022 Jul 20;33(7):24-35. doi: 10.25318/82-003-x202200700003-eng.

ABSTRACT

BACKGROUND: Vaping is more prevalent among younger than older Canadians. While vaping is less harmful than combustible tobacco, it is not without health risk.

DATA AND METHODS: Data from the 2019 Canadian Health Survey on Children and Youth were used to estimate vaping prevalence. Logistic regression models assessed the association of sociodemographic, youth, parenting and peer factors with vaping. The 2020 Canadian Community Health Survey identified adolescents who reported vaping before tobacco smoking. Data from the 2019 Canadian Tobacco and Nicotine Survey were used to examine vaping of e-liquids containing nicotine and flavours.

RESULTS: Vaping rates for 15- to 17-year-olds were nearly four times (21.3%) higher than those of 12- to 14-year-olds (5.4%). Two-thirds (66.1%) of 12- to 17-year-olds who had used both tobacco and e-cigarettes reported trying e-cigarettes first. E-liquids containing nicotine were used by 89.3% of 15- to 19-year-olds who reported vaping in the past 30 days; comparable with older adults. For both younger and older adolescents, having friends who engaged in negative behaviours, having been employed, and having consumed alcohol increased the odds. For 12- to 14-year-olds, attention deficit hyperactivity disorder was a risk factor, whereas having parents who usually knew who they were with and higher relatedness scores were protective. Among older adolescents, being male, being Canadian-born, having lower grades, and using tobacco or cannabis increased the odds of vaping.

INTERPRETATION: An adolescent’s risk of vaping was most strongly correlated with other substance use, although other youth, parenting and peer characteristics also mattered. Because most of the data presented were collected before the COVID-19 pandemic and new vaping regulations, ongoing monitoring remains important.

PMID:35862070 | DOI:10.25318/82-003-x202200700003-eng

Math Med Biol. 2022 Jul 21:dqac009. doi: 10.1093/imammb/dqac009. Online ahead of print.

ABSTRACT

We focus on modelling of cancer hyperthermia driven by the application of the magnetic field to iron oxide nanoparticles. We assume that the particles are interacting with the tumour environment by extravasating from the vessels into the interstitial space. We start from Darcy’s and Stokes’ problems in the interstitial and fluid vessels compartments. Advection-diffusion of nanoparticles takes place in both compartments (as well as uptake in the tumour interstitium), and a heat source proportional to the concentration of nanoparticles drives heat diffusion and convection in the system. The system under consideration is intrinsically multi-scale. The distance between adjacent vessels (the micro-scale) is much smaller than the average tumour size (the macro-scale). We then apply the asymptotic homogenisation technique to retain the influence of the micro-structure on the tissue scale distribution of heat and particles. We derive a new system of homogenised partial differential equations (PDEs) describing blood transport, delivery of nanoparticles and heat transport. The new model comprises a double Darcy’s law, coupled with two double advection-diffusion-reaction systems of PDEs describing fluid, particles and heat transport and mass, drug and heat exchange. The role of the micro-structure is encoded in the coefficients of the model, which are to be computed solving appropriate periodic problems. We show that the heat distribution is impaired by increasing vessels’ tortuosity and that regularization of the micro-vessels can produce a significant increase (1-2 degrees) in the maximum temperature. We quantify the impact of modifying the properties of the magnetic field depending on the vessels’ tortuosity.

PMID:35862063 | DOI:10.1093/imammb/dqac009

JAMA Netw Open. 2022 Jul 1;5(7):e2219416. doi: 10.1001/jamanetworkopen.2022.19416.

ABSTRACT

IMPORTANCE: Patients with acute ischemic stroke often undergo magnetic resonance imaging (MRI) in addition to computed tomography (CT), but its association with clinical outcomes is uncertain.

OBJECTIVE: To assess whether clinical outcomes of patients with acute ischemic stroke with initial CT alone were noninferior to those with additional MRI.

DESIGN, SETTING, AND PARTICIPANTS: A retrospective observational propensity score-matched cohort study of clinical outcomes at discharge and 1 year for patients hospitalized with acute ischemic stroke was conducted at an academic medical center between January 2015 and December 2017. Data collection from an electronic medical record system performed from May 2020 through January 2022 was not completely blinded. Noninferiority margins were based on the designs of previous randomized clinical trials of ischemic stroke treatments. Statistical analysis was performed in January 2022. Participants were adults hospitalized with acute ischemic stroke with admission diagnosis based on CT. Exclusion criteria were primarily missing data. From 508 eligible patients, all 123 cases with additional MRI were propensity-score matched to 123 controls without.

EXPOSURE: MRI after initial diagnosis.

MAIN OUTCOMES AND MEASURES: Death or dependence at hospital discharge (modified Rankin Scale score of 3-6) and stroke or death occurring in survivors within 1 year after discharge.

RESULTS: Among 246 participants, the median age was 68 years (IQR, 58-78.8 years) and 131 (53.0%) were men. Death or dependence at discharge occurred more often in patients with additional MRI (59 of 123 [48.0%]) than in those with CT alone (52 of 123 [42.3%]; absolute difference, 5.7%; 95% CI, -6.7% to 18.1%), meeting the -7.50% criterion for noninferiority. Stroke or death within 1 year after discharge determined for 225 of 235 (96%) survivors occurred more often in patients with additional MRI (22 of 113 [19.5%]) than in those with CT alone (14 of 112 [12.5%]; relative risk, 1.14; 95% CI, 0.86-1.50), meeting the 0.725 relative risk criterion for noninferiority.

CONCLUSIONS AND RELEVANCE: This propensity score-matched cohort study of patients hospitalized with acute ischemic stroke found that a diagnostic imaging strategy of initial CT alone was noninferior to initial CT plus additional MRI with regard to clinical outcomes at discharge and at 1 year. Further research is needed to determine which patients hospitalized with acute ischemic stroke benefit from MRI.

PMID:35862046 | DOI:10.1001/jamanetworkopen.2022.19416

JAMA Netw Open. 2022 Jul 1;5(7):e2223033. doi: 10.1001/jamanetworkopen.2022.23033.

ABSTRACT

IMPORTANCE: Opioid overdose is a leading public health problem in the United States; however, national data on overdose deaths are delayed by several months or more.

OBJECTIVES: To build and validate a statistical model for estimating national opioid overdose deaths in near real time.

DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study, signals from 5 overdose-related, proxy data sources encompassing health, law enforcement, and online data from 2014 to 2019 in the US were combined using a LASSO (least absolute shrinkage and selection operator) regression model, and weekly predictions of opioid overdose deaths were made for 2018 and 2019 to validate model performance. Results were also compared with those from a baseline SARIMA (seasonal autoregressive integrated moving average) model, one of the most used approaches to forecasting injury mortality.

EXPOSURES: Time series data from 2014 to 2019 on emergency department visits for opioid overdose from the National Syndromic Surveillance Program, data on the volume of heroin and synthetic opioids circulating in illicit markets via the National Forensic Laboratory Information System, data on the search volume for heroin and synthetic opioids on Google, and data on post volume on heroin and synthetic opioids on Twitter and Reddit were used to train and validate prediction models of opioid overdose deaths.

MAIN OUTCOMES AND MEASURES: Model-based predictions of weekly opioid overdose deaths in the United States were made for 2018 and 2019 and compared with actual observed opioid overdose deaths from the National Vital Statistics System.

RESULTS: Statistical models using the 5 real-time proxy data sources estimated the national opioid overdose death rate for 2018 and 2019 with an error of 1.01% and -1.05%, respectively. When considering the accuracy of weekly predictions, the machine learning-based approach possessed a mean error in its weekly estimates (root mean squared error) of 60.3 overdose deaths for 2018 (compared with 310.2 overdose deaths for the SARIMA model) and 67.2 overdose deaths for 2019 (compared with 83.3 overdose deaths for the SARIMA model).

CONCLUSIONS AND RELEVANCE: Results of this serial cross-sectional study suggest that proxy administrative data sources can be used to estimate national opioid overdose mortality trends to provide a more timely understanding of this public health problem.

PMID:35862045 | DOI:10.1001/jamanetworkopen.2022.23033

JAMA Netw Open. 2022 Jul 1;5(7):e2223225. doi: 10.1001/jamanetworkopen.2022.23225.

ABSTRACT

IMPORTANCE: New-onset postoperative arrhythmia, which most often presents as postoperative atrial fibrillation (AF), is a frequent complication in patients undergoing visceral surgery of the upper gastrointestinal tract. Its relevance for patients’ outcomes is unknown.

OBJECTIVE: To assess the incidence of arrhythmia after upper gastrointestinal surgery, its risk factors, and its short- and long-term implications for patient outcomes.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study included 1210 patients who underwent surgery of the upper gastrointestinal tract (esophagus, stomach, or pancreas) at the University Medical Center Göttingen in Germany between January 2012 and December 2018. Follow-up was performed between February and May 2020. Patients were excluded if they had a preexisting cardiac arrhythmia or pacemaker.

MAIN OUTCOMES AND MEASURES: The incidence of atrial fibrillation (AF) was recorded in most cases of postoperative arrhythmia; therefore, the analysis focused on postoperative AF. A multivariable logistic regression model was used to assess associations between surgical complications and postoperative AF occurrence, with odds ratios and 95% CIs reported.

RESULTS: A total of 1210 patients (median [IQR] age, 62 [19-90] years; 704 [58.2%] men) were enrolled in this study. Postoperative arrhythmia was recorded in 100 patients (8.3%). Among the different procedures, esophagectomy was associated with the highest incidence of postoperative AF (45.5% in complex esophageal resections and 17.1% in elective thoracoabdominal esophagectomies). The incidence of postoperative AF was associated with prolonged length of stay in the intensive care unit (23.4 days for patients with postoperative AF vs 5.9 days for those without; P < .001). Four factors were associated with the occurrence of postoperative AF: patients’ age (OR, 1.06; 95% CI, 1.03-1.08; P < .001), intraoperative surgical complications (OR, 2.47; 95% CI, 1.29-4.74; P = .006), infections (OR, 2.23; 95% CI, 1.31-3.80; P = .003), and organ failure (OR, 4.01; 95% CI, 2.31-6.99; P < .001). In the multivariable analysis, postoperative AF (OR, 7.08; 95% CI, 2.75-18.23; P < .001) and sepsis (OR, 10.98; 95% CI, 3.91-30.81; P < .001) were associated with in-hospital mortality. At a median 19-month follow-up, 20 of 74 patients (27.0%) with postoperative AF developed recurring episodes of arrhythmia after discharge.

CONCLUSIONS AND RELEVANCE: This cohort study found that the postoperative AF was associated with an increased length of stay in the intensive care unit and in-hospital mortality in patients after upper gastrointestinal tract surgery. In addition, postoperative AF was associated with development of permanent or paroxysmal arrhythmia after discharge.

PMID:35862044 | DOI:10.1001/jamanetworkopen.2022.23225

Hosp Pract (1995). 2022 Jul 21. doi: 10.1080/21548331.2022.2102777. Online ahead of print.

ABSTRACT

OBJECTIVES: Sleep disorders associated with COVID-19 pandemic are termed as “COVID-somnia”. In this study, we sought to assess the prevalence of COVID-somnia in healthcare workers, establish the factors that trigger this condition, and to investigate its relationship with anxiety and depression symptoms.

METHODS: This cross-sectional study was conducted between April 2021 and June 2021, and it included healthcare workers who served during the pandemic. Participants’ demographic data, Beck Depression and Anxiety Inventories, Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Insomnia Severity Index (ISI) were used, and the results were statistically analyzed. Multiple analyses of factors affecting ESS and ISI scores were evaluated using binary logistic regression model and PSQI score were analyzed using a multiple linear regression model.

RESULTS: A total of 1,111 healthcare workers who served during the pandemic voluntarily enrolled to the study. The mean age was 37.3 ± 8.48 years, and 63.5% were females. Our study showed that the healthcare workers, evaluated with the PSQI, experienced a deterioration of sleep quality. Primary factors affecting this are working on the front line, the presence of chronic diseases, depression, and anxiety. Regression analyses identified depression and anxiety as the common factors affecting ESS, ISI, and PSQI scores.

CONCLUSION: Raising awareness regarding COVID-somnia among healthcare workers, who play a leading role in curbing the pandemic, would reduce sleep disturbances, depression, and anxiety. It would also contribute to the planning and implementation of preventive and therapeutic mental health programs with a multidisciplinary approach.

PMID:35861139 | DOI:10.1080/21548331.2022.2102777

Clin Oral Implants Res. 2022 Jul 21. doi: 10.1111/clr.13983. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the impact of reducing the radiographic field-of-view (FOV) on the trueness and precision of the alignment between cone beam computed tomography (CBCT) and intraoral scanning data for implant planning.

MATERIALS AND METHODS: Fifteen participants presenting with one of three clinical scenarios: single tooth loss (ST, n=5), multiple missing teeth (MT, n=5), and presence of radiographic artifacts (AR, n=5) were included. CBCT volumes covering the full arch (FA) were reduced to the quadrant (Q) or the adjacent tooth/teeth (A). Two operators, an expert (exp) in virtual implant planning and an inexperienced clinician, performed multiple superimpositions, with FA-exp serving as a reference. The deviations were calculated at the implant apex and shoulder levels. Thereafter, linear mixed models were adapted to investigate the influence of FOV on discrepancies.

RESULTS: Evaluation of trueness compared to FA-exp resulted in the largest mean (AR-A: 0.10 ± 0.33 mm) and single maximum discrepancy (AR-Q: 1.44 mm) in the presence of artifacts. Furthermore, for the ST group, the largest mean error (-0.06 ± 0.2 mm, shoulder) was calculated with the FA-FOV, while for MT, with the intermediate volume (-0.07 ± 0.24 mm, Q). In terms of precision, the mean SD intervals were ≤0.25 mm (A-exp). Precision was influenced by FOV volume (FA<Q<A) but not by operator expertise.

CONCLUSIONS: For single posterior missing teeth, an extended FOV does not improve registration accuracy. However, in the presence of artifacts or multiple missing posterior teeth, caution is recommended when reducing FOV.

PMID:35861131 | DOI:10.1111/clr.13983

Clin Oral Implants Res. 2022 Jul 21. doi: 10.1111/clr.13982. Online ahead of print.

ABSTRACT

OBJECTIVES: Optical impressions of implants in the edentulous arch are challenged by the absence of distinct surface morphology between multiple implant scan bodies. The purpose of this in vitro study was to evaluate a newly developed scan aid in various designs and colors to improve the accuracy of multi-implant scans.

MATERIAL AND METHODS: A universal scan aid in three different designs (circular, square, irregular) and three different materials (colors: beige, gray, white) was applied to the implant scan bodies of a master model of 6 implants in an edentulous maxilla. Ten scans using an intra-oral scanner of each scan aid were acquired. Reference scanning was performed using a desktop optical scanner. Alignment of scans was performed at the first scan body in a three-dimensional modeling and inspection software and deviations for trueness and precision were calculated using the signed nearest neighbor method and then statistically analyzed (α=.05).

RESULTS: Overall, the beige irregular scan aid had the highest trueness and showed significant differences compared to unsplinted scans. The precision showed more heterogenous results and decreased when using the scan aid. Ease of use was observed with the irregular gray scan aid due to its increased elongation at break.

CONCLUSIONS: The evaluated scan aid led to improved trueness when compared to unsplinted scans. Even though the irregular design in beige color showed highest trueness, the poor fracture strength of the tested material requires further improvement.

PMID:35861128 | DOI:10.1111/clr.13982

Clin Exp Allergy. 2022 Jul 21. doi: 10.1111/cea.14207. Online ahead of print.

ABSTRACT

It is increasingly recognised that children with asthma are at a higher risk of other non-allergic concurrent diseases than the non-asthma population. A plethora of recent research has reported on these comorbidities and progress has been made into understanding the mechanisms for comorbidity. The goal of this review was to assess the most recent evidence (2016-2021) on the extent of common comorbidities (obesity, depression & anxiety, neurodevelopmental disorders, sleep disorders and autoimmune diseases) and the latest mechanistic research, highlighting knowledge gaps requiring further investigation. We found the majority of recent studies from around the world demonstrates that children with asthma are at an increased risk of having at least one of the studied comorbidities. A range of potential mechanisms were identified including common early life risk factors, common genetic factors, causal relationships, asthma medication and embryologic origins. Studies varied in their selection of population, asthma definition and outcome definitions. Next steps in future studies should include using objective measures of asthma, such as lung function and immunological data, as well as investigating asthma phenotypes and endotypes. Larger complex genetic analyses are needed, including genome wide association studies, gene expression- functional as well as pathway analyses, or Mendelian Randomization techniques; and identification of gene-environment interactions, such as epi-genetic studies or twin analyses, including omics and early life exposure data. Importantly, research should have relevance to clinical and public health translation including clinical practice, asthma management guidelines and intervention studies aimed at reducing comorbidities.

PMID:35861116 | DOI:10.1111/cea.14207

Przegl Epidemiol. 2022;76(1):104-117. doi: 10.32394/pe.76.11.

ABSTRACT

INTRODUCTION: In 2020, the world was gripped by a global pandemic caused by a new strain of coronavirus called SARS-CoV-2. Highly contagious, rapidly spreading virus caused massive infections around the world and forced isolation of patients and quarantine of contact persons. Social isolation, caused by the introduction of compulsory distance or resulting from the course of the quarantine process, may result in the loss of emotional ties between individuals, thus leading to the weakening of the social support network.

OBJECTIVE: The aim of the study was to assess whether and to what extent the restrictions caused by the first wave of SARS-CoV-2 virus pandemics affected emotional state and everyday behavior of students of Polish universities.

MATERIAL AND METHODOLOGY: 1,095 students took part in the study – 82.1% of women and 17.9% men, aged 19 and over up to 55 years of age, living mostly in cities. The diagnostic survey method was applied using proprietary questionnaires. The questionnaire was distributed by Internet. The results were processed using the Statistica v.13.3 program with the application of descriptive statistics and tests χ2 and Anova.

RESULTS: According to 80% of respondents, the SARS-CoV-2 pandemic is a serious threat for health. During the first wave of the pandemic, students were accompanied mainly by difficult emotions: uncertainty (61%), depression (28.9%), worry (28.7%), nervousness (37.7%) and anger (24%). According to 50.2%, their relations with household members were not changed, while students declaring changes in family relationships pointed to their loosening and limitation.

CONCLUSIONS: A significant majority of students stated that the COVID-19 pandemic is a serious threat to health and has a regular interest in epidemiological data concerning coronavirus. Medical students declared the highest risk. The first wave of the pandemic resulted in the intensification of difficult emotions and for half of the respondents changes in the functioning of their family relationships.

PMID:35861098 | DOI:10.32394/pe.76.11