Nevin Manimala

Epidemics. 2022 Jan 19;38:100537. doi: 10.1016/j.epidem.2022.100537. Online ahead of print.

ABSTRACT

During a pandemic, data are very “noisy” with enormous amounts of local variation in daily counts, compared with any rapid changes in trend. Accurately characterizing the trends and reliable predictions on future trajectories are important for planning and public situation awareness. We describe a semi-parametric statistical model that is used for short-term predictions of daily counts of cases and deaths due to COVID-19 in Canada, which are routinely disseminated to the public by Public Health Agency of Canada. The main focus of the paper is the presentation of the model. Performance indicators of our model are defined and then evaluated through extensive sensitivity analyses. We also compare our model with other commonly used models such as generalizations of logistic models for similar purposes. The proposed model is shown to describe the historical trend very well with excellent ability to predict the short-term trajectory.

PMID:35078118 | DOI:10.1016/j.epidem.2022.100537

Child Abuse Negl. 2022 Jan 21;125:105511. doi: 10.1016/j.chiabu.2022.105511. Online ahead of print.

ABSTRACT

BACKGROUND: Adverse childhood experiences (ACEs) are common and have a wide range of impact on human physical and mental health. The role of positive childhood experiences (PCEs) and its interaction with ACEs on adolescent depression and anxiety are less known.

METHODS: A cross-sectional survey on Chinese primary and secondary school students was conducted to investigate information of ACEs, PCEs, depression, anxiety and demographic characteristics (n = 6363). Logistic regression analyses were performed to evaluate the association between specific types and cumulative of PCEs and ACEs and risk of depression, anxiety and its comorbidity. Interaction analyses were conducted to determine the moderation role of PCEs on the impact of ACEs.

RESULTS: ACEs were positively correlated with the risk of depression and anxiety and there was a significant positive does-response relationship between cumulative ACEs exposure and risk of depression, anxiety and its comorbidity. PCEs were negatively associated with the risk of depression and anxiety and there was an inverse does-response relationship between cumulative PCEs exposure and risk of depression. Adolescents with low ACEs (<4 counts) and high PCEs (6-7 counts) exposure showed significant lower risk of depression and there were negative additive interactions between PCEs and ACEs exposure on risk of depression and the comorbidity of depression and anxiety.

CONCLUSIONS: PCEs can moderate the impact of ACEs on mental health of adolescents. Early and proactively promoting PCEs contributes to promoting well-being, especially for adolescents with ACEs.

PMID:35078091 | DOI:10.1016/j.chiabu.2022.105511

Waste Manag. 2022 Jan 22;140:121-132. doi: 10.1016/j.wasman.2022.01.022. Online ahead of print.

ABSTRACT

Unused, damaged, and expired medicines (UEMs) pose disposal challenges globally, despite their importance. The environmental disposal of UEMs portends public health consequences, hence, this study in high-density (HDS) and low-density (LDS) urban households in Southwest Nigeria. The comparative, cross-sectional study utilised multi-stage samplingto enrol 404 females, experienced in use and medicines safekeeping. The response rate was 93%. Data were analysed by IBM-SPSS, version 20. Continuous and categorical variableswere presentedin tables as mean(±SD), proportions (%), respectively while χ² and logistic regression statistics determined differences between LDS and HDS (P_α > 0.05). 53.4% and 71.2% of respondents respectively had good knowledge and positive attitudes to safe disposal of UEMs. At least 31.5% of households don’t stock medicines while antimalarial (57.3%), analgesics (52.7%) and antibiotics (49.7%) predominate in households and significantly different between LDS and HDS. 72.9% and 67.8%; 47.9% and 55.6% respondents in LDS and HDS, respectively, disposed of solid and liquid UEMs in storage bins, though 34.9% (LDS) and 16.7% (HDS) disposed of liquid UEMs in toilet/sink. There were significant differences in medicines abundance and disposal practices between LDS and HDS for solid and liquid medicines. 37.1% of respondents perceived consequences for the poor UEMs disposal, including accidental ingestion (76.6% vs 26.7%), land pollution (69.6% vs 36.7%), water pollution (72.4% vs 32.8%) and toxicity (58.3% vs 32.8%), respectively in LDS and HDS. Respondents’ good knowledge and positive attitudes contrasted with poor UEMs disposal practices, which compromise public health. Legislation, compliance monitoring and enforcement are germane for incentive-driven UEMs recovery.

PMID:35078076 | DOI:10.1016/j.wasman.2022.01.022

J Environ Manage. 2022 Jan 22;307:114537. doi: 10.1016/j.jenvman.2022.114537. Online ahead of print.

ABSTRACT

Many studies that investigate mitigation strategies of greenhouse-gas (GHG) emissions from farming systems often build farm typologies from average data from multiple farms. Results from farm typologies are useful for general purposes but fail to represent variability in farm characteristics due to management practices or climate conditions, particularly when considering consequences of extreme environmental events. This limitation raises the issue of better distinguishing, within datasets of farms, farms that have average characteristics from those that deviate from average trends, in order to improve assessment of how climate variability influences farm performance. We applied the statistical method called Extreme Value Theory (EVT) to identify dairy farms that produced “extreme” amounts of forage. Applying EVT to a dataset of dairy farms from Normandy, Lorraine and Nord-Pas-de-Calais (France) identified subsamples of 10-30% of dairy farms with the smallest or largest amounts of grass from pastures or maize silage in each region. Characteristics of farms with extreme amounts of each forage often differed among regions due to the influence of geography and climate. Farms with the largest amounts of grass or the smallest amounts of maize silage had a variety of cow breeds in Normandy and Lorraine but had only Holstein cows in Nord-Pas-de-Calais. Conversely, most farms with the smallest amounts of grass or the largest amounts of maize silage had Holstein cows, regardless of region. The region also influenced whether farms were oriented more toward producing milk with higher fat and protein contents (Normandy and Lorraine) or toward producing larger amounts of milk (Nord-Pas-de-Calais). As the amount of a given forage changed from smallest to largest, a significant increase or decrease in the amount of milk produced usually changed GHG and enteric methane (CH₄) emissions per farm in the same direction as the amount of milk produced. For instance, an extreme increase in the amount of grass fed on farms (1314 vs. 5093 kg/livestock unit/year, respectively) in Normandy was associated with decreased mean milk production (8236 vs. 5834 l/cow/year, respectively) and GHG (7117 vs. 5587 kg CO₂ eq./farm/year) and enteric CH₄ (3870 vs. 3296 kg CO₂ eq./farm/year, respectively) emissions.

PMID:35078066 | DOI:10.1016/j.jenvman.2022.114537

Arch Gerontol Geriatr. 2022 Jan 19;100:104623. doi: 10.1016/j.archger.2022.104623. Online ahead of print.

ABSTRACT

BACKGROUND: Identifying elderly patients with proximal femoral fractures (PFF) who are at risk of postoperative mortality may influence the treatment decision-making process. The purpose of this study was to examine whether red blood cell distribution width (RDW) can serve as a predictor of postoperative mortality in these patients.

METHODS: A retrospective cohort study of electronic medical records at a single tertiary care hospital over a 3-year period between 2015 and 2018. We reviewed the records of 1574 patients aged > 65 years who underwent surgical treatment for PFF and who’s preoperative RDW levels were available. Data collected consisted of patient demographics, underlying illnesses at the time of admission, type of procedure performed as well as postoperative mortality and complications over the course of a 1-year follow-up period. The cohort was then divided into two groups based on their RDW levels at the time of admission: low (<14.5%) and high (>14.5%).

RESULTS: The mean age was 90.77±1.87 years; 68.7% were women. Majority of patients (69.1%) underwent closed reduction internal fixation; 414 (26.4%) underwent hemiarthroplasty, and 71 (4.5%) had total hip arthroplasty. At admission, 576 patients (36.6%) had high RDW levels and 998 (63.4%) had low RDW levels. There were no statistically significant differences between the groups with regard to age, gender, type of surgery, or duration. Patients with high RDW had more co-morbidities (p<0.001) and more abnormal laboratory test results when compared to patients with low RDW. Overall mortality rate within 1-year post-surgery was 17.5% (276 patients). All-cause mortality was greater for patients with high baseline RDW, at 3 months (p = 0.001), 6 months (p<0.0001), and 1-year post-surgery (p<0.0001). Forty-four (2.8%) patients had surgical site infection (SSI) without any significant association to baseline RDW levels.

CONCLUSIONS: Preoperative RDW levels, when combined with clinical and laboratory findings, may help to improve the risk stratification of older patients who are candidates for PFF. With further research, a treatment algorithm could be developed to potentially identify patients at high risk of preoperative mortality, allowing for more conservative management.

PMID:35078053 | DOI:10.1016/j.archger.2022.104623

Am J Emerg Med. 2022 Jan 17;53:236-239. doi: 10.1016/j.ajem.2022.01.022. Online ahead of print.

ABSTRACT

BACKGROUND: Obesity is a growing epidemic associated with higher rates of metabolic disease, heart disease and all-cause mortality. Heavier patients may require more advanced resources and specialized equipment. We hypothesize that increasing patient weight will be associated with longer prehospital on-scene times.

METHODS: We reviewed electronic patient care records for patients transported by two urban 9-1-1 emergency medical services (EMS) agencies. We collected age, sex, estimated patient weight, vital signs (systolic blood pressure, heart rate, pulse oximetry), provider impression, method of moving patient to ambulance, and on-scene times. We selected patients with time-sensitive diagnoses of stroke, ST-segment elevation myocardial infarction (STEMI), and trauma and compared on-scene times for patients who weighed above or below 300 pounds. We performed descriptive statistics, Mann-Whitney U tests for continuous variables and Chi-square tests for discrete variables. We constructed a generalized linear model to determine the effect of patient weight adjusted for covariates.

RESULTS: For a three-year period (May 1, 2018 to April 30, 2021) 48,203 patients were transported with an EMS impression of stroke, ST-segment elevation myocardial infarction (STEMI), and trauma. 23,654 (49.1%) patients were female, and the median age was 52 (IQR 34-68) years. The median weight was 175.0 (IQR 150.0-205.0) pounds. Patients above a dichotomous weight categorization of 300 pounds experienced a longer median scene time with any time-sensitive diagnosis (12.6 versus 11.9 min p < 0.001), STEMI (16.0 versus 13.1 min, p = 0.014) and blunt trauma (12.6 versus 11.9 min, p < 0.001)). They were more likely to be hypoxic (p < 0.001) and more likely to experience cardiac arrest (p < 0.001). They were less likely to walk to the ambulance (22.1% versus 32.2%, p < 0.001).

CONCLUSION: Patient weight above 300 pounds was associated with significantly longer on-scene time. These patients were more likely to be hypoxic, sustain a cardiac arrest, and less likely to walk to the ambulance.

PMID:35078052 | DOI:10.1016/j.ajem.2022.01.022

Am J Emerg Med. 2022 Jan 19;53:228-235. doi: 10.1016/j.ajem.2022.01.020. Online ahead of print.

ABSTRACT

BACKGROUND: Literature regarding trends for incidence and mortality of scleroderma renal crisis (SRC) in systemic sclerosis (SSc) within the United States (US) emergency departments (EDs) is limited.

OBJECTIVE: To study the mortality of SRC among SSc patient encounters within the US EDs.

METHODS: Data from the National Emergency Department Sample (NEDS) constitutes 20% sample of hospital-owned EDs and inpatient sample in the US were analyzed for SSc with and without SRC using ICD-9 codes. A linear p-trend was used to assess the trends.

RESULTS: Of the total 180,435 encounters with the diagnosis of SSc in NEDS for the years 2009 2014, 771 or 4.27/1000 patients (mean age 59.6 ± 15.5 years, 75.4% females) were recorded with SRC. The numerical differences in mortality among SRC (32 or 4.1%) and non-SRC subgroups (5487 or 3.1%) did not reach statistical significance (p = 0.3). Major complications among SRC in comparison to non-SRC subgroup include ischemic stroke (5.6% vs 0.98%, p = 0.001), new-onset AF (8% vs 6.9%, p = 0.001), new-onset congestive heart failure (24.1% vs 8.8%, p = 0.001), pulmonary arterial hypertension (15.8% vs 10.9%, p = 0.001), respiratory failure (27.5% vs 10.5%, p = 0.001), and deep vein thrombosis (4.7% vs 4.6%, p = 0.001). Congestive heart failure (CHF) was strongly associated with SRC among SSc (OR 4.3 95%CI 2.7-6.7; p < 0.001). The absolute yearly rate of SRC had increased over the study years from 2.11/1000 to 5.79/1000 (linear p-trend 0.002) while the mortality trend remained steady.

CONCLUSION: SRC is a relatively rare medical emergency. Although there has been a significant rise in the rate of SRC among SSc patients over the study years, mortality rates had remained steady. SSc patients with CHF should be considered to have low threshold for admission to inpatient services from EDs.

PMID:35078051 | DOI:10.1016/j.ajem.2022.01.020

Semin Arthritis Rheum. 2022 Jan 11;53:151950. doi: 10.1016/j.semarthrit.2022.151950. Online ahead of print.

NO ABSTRACT

PMID:35078035 | DOI:10.1016/j.semarthrit.2022.151950

J Osteopath Med. 2022 Jan 24. doi: 10.1515/jom-2021-0187. Online ahead of print.

ABSTRACT

CONTEXT: When choosing to incorporate osteopathic manipulative treatment (OMT) into a patient’s care, the risk-to-benefit ratio, the choice of treatment technique, as well as the frequency of treatments are always taken into consideration. This has been even more important during the COVID-19 pandemic, in which social distancing has been the best preventative measure to decrease exposure. By increasing treatment intervals, one could not only limit possible exposure/spread of viruses but also decrease the overall cost to the system as well as to the individual. This is an expansion of a previous study in which quantifiable changes in cervical hysteresis characteristics post-OMT were documented utilizing a durometer (Ultralign SA201^®; Sigma Instruments; Cranberry, PA USA). This study compared two treatment modalities, muscle energy (ME) and high-velocity low-amplitude (HVLA) postcervical treatment. Subjects in this study were allowed to re-enroll, provided that they could be treated utilizing the alternate treatment modality. By allowing repeat subjects, analysis of the data for lasting effects of OMT could be observed.

OBJECTIVES: To determine whether a significant change in cervical hysteresis would be observed after each treatment regardless of a short treatment interval.

METHODS: A total of 34 subjects were retrospectively noted to be repeat subjects from a larger, 213-subject study. These 34 subjects were repeat participants who were treated with two different direct-treatment modalities 7-10 days apart. Each subject was randomly assigned to receive a single-segmental ME or HVLA treatment technique directed toward a cervical (C) segment (C3-C5 only). Subjects were objectively measured pretreatment in all cervical segments utilizing the Ultralign SA201^®, then treated with cervical OMT to a single segment, and finally reassessed at all cervical levels with the Ultralign SA201^® posttreatment to assess for change in cervical hysteresis.

RESULTS: Statistically significant or suggestive changes (p-values 0.01-0.08) with good clinical effect size (0.30 or greater) were noted in all four components of the Ultralign SA201^® at multiple cervical levels after the first treatment, but only one component (frequency) had a statistically significant change after the second treatment (AA cervical level, p-value 0.01) with good clinical effect size (0.45). However, when comparing the post-first-treatment values to the pre-second-treatment values, no statistically significant differences (p-value 0.10 or higher) were observed between them.

CONCLUSIONS: Statistically significant changes were noted after the first treatment; however, when comparing cervical hysteresis changes after the first treatment to the cervical hysteresis values prior to the second treatment delivered 7-10 days later, there were no statistically significant or suggestive changes. This data suggest that several post-OMT changes noted after the first treatment were still in effect and may indicate that follow-up visits for direct manipulation may be deferred for a least two weeks.

PMID:35077638 | DOI:10.1515/jom-2021-0187

J Ayub Med Coll Abbottabad. 2021 Oct-Dec;33(Suppl 1)(4):S769-S772.

ABSTRACT

BACKGROUND: Dental composites are commonly used to restore teeth. However, to ensure adequate physical properties and biocompatibility, they require sufficient light intensity with the help of light curing units (LCU). This study aimed to evaluate the type and intensity of LCU being used in the dental setups of Rawalpindi and Islamabad.

METHODS: Dental clinics were visited and the type of the LCU was noted. Three consecutive intensity measurements were taken using a radiometer. For Quartz tungsten halogen (QTH) LCU, a light intensity below 300mW/cm2 was considered unsatisfactory, while for light-emitting diode (LED) LCU, a reading below 600mW/cm2 was considered unsatisfactory. To analyse the difference between the output intensities of the two LCU, Mann-Whitney U test was used (p<0.05), while Fisher’s Exact test was used for the association between the type of LCU and clinical acceptability of output intensity.

RESULTS: A total of 96 LCU were evaluated, out of which, eight were QTH and 88 were LED. A total of 16.7% LCU were considered unsatisfactory. Amongst them, 62.5% QTH had intensity less than 300mW/cm2, while for LED, 12.5% had intensity below 600mW/cm2. The mean intensity for LED was statistically significant compared to QTH LCU (p<0.05). A statistically significant association existed between the type of LCU and their intensity (p<0.05).

CONCLUSION: A trend towards the use of LED LCU in the dental setups of Islamabad and Rawalpindi was observed. LED LCU showed greater mean light intensity than QTH LCU. Periodic evaluation of LCU using radiometers is suggested to ensure optimal intensity output.

PMID:35077624