Correlation Air CO Level with HbCo Level, Hemoglobin, and Blood Pressure to Street Vendors in The Gading Fajar Sidoarjo Street Vendor Area

Motor vehicles emit exhaust gas emissions that produce pollutants, one of the compounds contained is carbon monoxide (CO). CO may cause intoxication in humans if exposed for a long time especially street vendors because the work area is filled with vehicle fumes containing CO gas. High CO levels in the air indicate HbCO levels to increase. The increased of HbCO levels will cause abnormal hemoglobin levels and induce vasoconstriction which makes blood pressure increase. The purpose of this study was to prove the correlation between CO levels in the air with HbCO, hemoglobin, and blood pressure levels to street vendors in the Gading Fajar Sidoarjo Street Vendor Area. This research uses the Conway diffusion cell method and is an analytic observational study with a cross sectional design implemented at the Surabaya Health Laboratory Center and the Hematology Laboratory of Medical Laboratory Technology Department Poltekkes Kemenkes Surabaya in March 2022. Blood tests was carried out on 25 street vendors using random sampling technique. The results showed that average air CO level was 11.0 ppm and 13.3 ppm; mean HbCO levels 0.87%; mean hemoglobin levels 14.4 g/dL; mean systolic blood pressure levels 128 mmHg; and the mean of diastolic blood pressure levels 80 mmHg. The data were analyzed using SPSS. The outcome of normality test showed that the data was not normally distributed. Statistical tests was performed using Spearman correlation. The conclusion showed there was correlation between air CO level with HbCO level, hemoglobin level, and blood pressure level on street vendors in the Gading Fajar Sidoarjo Street Vendor Area. If CO levels in the air increase, then HbCO levels and blood pressure also increase. Street vendors are expected to always use Personal Protective Equipment (PPE) such as mouth masks when working to reduce the risk of exposure to CO gas and doing a healthy lifestyle as a preventive effort to avoid health problems

Metformin: Current knowledge

Diabetes mellitus is a group of metabolic disorders in which the blood glucose is higher than normal levels, due to insufficiency of insulin release or improper response of cells to insulin, resulting in high blood pressure. The resultant hyperglycemia produces sever complications. Metformin drug has been shown to prevent diabetes in people who are at high risk and decrease most of the diabetic complications. Recent reports on metformin, not only indicate some implications such as renoprotective properties have been suggested for metformin, but some reports indicate its adverse effects as well that are negligible when its benefits are brought into account. We aimed here to review the new implications of metformin and discuss about the concerns in the use of metformin, referring to the recently published papers

Oxygen targeting in preterm infants: a physiological interpretation.

Randomized controlled trials evaluating low-target oxygen saturation (SpO2:85% to 89%) vs high-target SpO2 (91% to 95%) have shown variable results regarding mortality and morbidity in extremely preterm infants. Because of the variation inherent to the accuracy of pulse oximeters, the unspecified location of probe placement, the intrinsic relationship between SpO2 and arterial oxygen saturation (SaO2) and between SaO2 and partial pressure of oxygen (PaO2) (differences in oxygen dissociation curves for fetal and adult hemoglobin), the two comparison groups could have been more similar than dissimilar. The SpO2 values were in the target range for a shorter period of time than intended due to practical and methodological constraints. So the studies did not truly compare 'target SpO2 ranges'. In spite of this overlap, some of the studies did find significant differences in mortality prior to discharge, necrotizing enterocolitis and severe retinopathy of prematurity. These differences could potentially be secondary to time spent beyond the target range (SpO2 <85 or >95%) and could be avoided with an intermediate but wider target SpO2 range (87% to 93%). In conclusion, significant uncertainty persists about the desired target range of SpO2 in extremely preterm infants. Further studies should focus on studying newer methods of assessing oxygenation and strategies to limit hypoxemia (<85% SpO2) and hyperoxemia (>95% SpO2)

Wellness Lessons From Transportation Companies, Research Report WP 11-01

The purpose of this report is to describe wellness programs and offer two suggestions for improving how they are delivered to commercial drivers and operators. It is not a large sample empirical study from which generalizations can be made. Rather, the Mineta Transportation Institute commissioned brief case studies of transportation companies to show what several organizations have done. Stress, nicotine use, sleep apnea, obesity and lack of information are significant barriers to wellness in commercial drivers/operators. Many wellness programs ask the individual driver/operator to lose weight; exercise more; and monitor blood pressure, glucose, cholesterol and other such indicators of health. However, little is done to change the environment or adopt structural interventions such as forbidding nicotine use, as is possible in 20 states. Other structural interventions include those possible at the levels of the company and community, including access to healthy food rather than the junk food drivers often can find on the road. At the societal level, more public transit that gets people walking and out of their cars, cities designed for people to walk and cycle in rather than drive from work to a sprawling suburb, and encouraging food manufacturers to make healthy food (rather than a toxic mix of sodium, fat and sugar to boost one’s craving for a particular food) are just a few measures that could improve the health and well being of the public. The Union Pacific Corporation (rail transportation), and Con-way Freight (trucking) are included because they were willing to share information and are large publicly traded companies. The Utah Transit Authority (UTA) is included because other transit authorities recommended it to the authors, as it has a long history in wellness as part of local government and it too chose to participate. Two issues are discussed: the first is the importance of using the mitigation of erectile dysfunction in the promotion of wellness programs to commercial drivers/operators and the second issue is to urge employers to consider banning tobacco use, both on and off the job, where legal

Risk marker associations with venous thrombotic events: a cross-sectional analysis.

ObjectiveTo examine the interrelations among, and risk marker associations for, superficial and deep venous events-superficial venous thrombosis (SVT), deep venous thrombosis (DVT) and pulmonary embolism (PE).DesignCross-sectional analysis.SettingSan Diego, California, USA.Participants2404 men and women aged 40-79 years from four ethnic groups: non-Hispanic White, Hispanic, African-American and Asian. The study sample was drawn from current and former staff and employees of the University of California, San Diego and their spouses/significant others.Outcome measuresSuperficial and deep venous events, specifically SVT, DVT, PE and combined deep venous events (DVE) comprising DVT and PE.ResultsSignificant correlates on multivariable analysis were, for SVT: female sex, ethnicity (African-American=protective), lower educational attainment, immobility and family history of varicose veins. For DVT and DVE, significant correlates included: heavy smoking, immobility and family history of DVEs (borderline for DVE). For PE, significant predictors included immobility and, in contrast to DVT, blood pressure (BP, systolic or diastolic). In women, oestrogen use duration for hormone replacement therapy, in all and among oestrogen users, predicted PE and DVE, respectively.ConclusionsThese findings fortify evidence for known risk correlates/predictors for venous disease, such as family history, hormone use and immobility. New risk associations are shown. Striking among these is an association of PE, but not DVT, to elevated BP: we conjecture PE may serve as cause rather than consequence. Future studies should evaluate the temporal direction of this association. Oxidative stress and cell energy compromise are proposed to explain and predict many risk factors, operating through cell-death mediated triggering of coagulation activation

Sickle cell trait and risk of cognitive impairment in African-Americans: The REGARDS cohort

Background: Sickle cell anemia may be associated with cognitive dysfunction, and some complications of sickle cell anemia might affect those with sickle cell trait (SCT), so we hypothesized that SCT is a risk factor for cognitive impairment. Methods: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) study enrolled a national cohort of 30,239 white and black Americans from 2003 to 7, who are followed every 6 months. Baseline and annual global cognitive function testing used the Six-Item Screener (SIS), a validated instrument (scores range 0-6; ≤ 4 indicates cognitive impairment). Participants with baseline cognitive impairment and whites were excluded. Logistic regression was used to calculate the association of SCT with incident cognitive impairment, adjusted for risk factors. Linear mixed models assessed multivariable-adjusted change in test scores on a biennially administered 3-test battery measuring learning, memory, and semantic and phonemic fluency. Findings: Among 7743 participants followed for a median of 7·1 years, 85 of 583 participants with SCT (14·6%) developed incident cognitive impairment compared to 902 of 7160 (12·6%) without SCT. In univariate analysis, the odds ratio (OR) of incident cognitive impairment was 1·18 (95% CI: 0·93, 1·51) for those with SCT vs. those without. Adjustment did not impact the OR. There was no difference in change on 3-test battery scores by SCT status (all p > 0·11). Interpretation: In this prospective cohort study of black Americans, SCT was not associated with incident cognitive impairment or decline in test scores of learning, memory and executive function. Funding: National Institutes of Health, American Society of Hematology

Promoting Public Health In The Context Of The “Obesity Epidemic”: False Starts And Promising New Directions

In the battle to combat obesity rates in the United States, several misconceptions have dominated policy initiatives. We address those misconceptions, including the notion that restrictive diets lead to long-term weight loss, that stigmatizing obesity is an effective strategy for promoting weight reduction, and that weight and physical health should be considered synonymous with one another. In offering correctives to each of these points, we draw on psychological science to suggest new policies that could be enacted at both the local and national levels. Instead of policies that rely solely on individual willpower, which is susceptible to failure, we recommend those that make use of environmental changes to reduce the amount of willpower necessary to achieve healthy behavior. Ultimately, the most effective policies will promote health rather than any arbitrary level of weight

Development Of The Acute Decompensated Heart Failure Risk Model For Emergency Room Resident Training

The purpose of this study was to characterize patients hospitalized with acute decompensated heart failure with and without low systolic blood pressure using exploratory factor analysis (EFA). Direct and surrogate measurements were measured. The aim was to use EFA for data reduction to elicit a parsimonious set of factors summarizing the relationships between variables by measuring intercorrelations of the clinical variables collected as part of standard care, and abstracted from electronic medical records. A better understanding of the characteristics and outcomes of the target group could potentially lead to individualized treatment modalities tailored to effectively and economically improve care. Patients hospitalized are at a high risk for adverse outcomes after discharge. Prospectively collected new data is expensive, labor-, and time- intensive while the use of existing data allows a quicker, more efficient and less expensive source. A large urban, academic teaching hospital was the study site. Wayne State University Human Investigation Committee and Henry Ford Internal Review expedited review approval was obtained. Eligible cases were patients hospitalized with a primary diagnosis of acute decompensated heart failure for the 2014 year. Variables collected were identified based on review of the literature, Framingham criteria, clinical relevance, and were routinely availability. As is the case in empirical studies, determining sample size in EFA, a large sample size technique, is based on the minimum necessary to obtain reliable results from the analysis. Guidelines or a rule of thumb by expert opinions such as Gorsuch (1983) and Kline (1994) include absolute numbers of at least 100 cases. Dimension reduction of factors via SPSS (ver 23) was conducted on all cases regardless of presenting systolic blood pressure (Group 1), cases with normal to high systolic blood pressure (Group 2) and cases with low systolic blood pressure (Group 3) separately, for a total of groups. All cases were screened for entry criteria and the first 300 chronologically dated cases were identified. EFA was conducted on the data abstracted from 300 electronic medical records. The major findings of the study were that two factors, Anemia and Kidney Function were seen across the three groups. Several individual factors that affect kidney function were found. Data reduction using EFA is a highly pragmatic function. Computer software programs such as SPSS® allow for quick and easy computations and a large number of variables can be directly imported from databases such as Excel®. However, EFA is a complex procedure with fewer absolute guidelines or rules for selecting options compared to other statistical approaches. The steps taken were detailed, justified by the literature reviewed and alternate choices were discussed. The seven stages in factor analysis design as outlined by Hair et al. (2006) were employed in this analysis. The factors identified in each group using EFA can be tested in a future confirmatory factor analysis study. Once these factors are the confirmed, an Acute Decompensated Heart Failure Risk Model can be developed for Emergency Room Resident Training within the context of evidence-based medicine. The pedagogical approach in medical education where instruction is provided by the experienced physician to the novice, namely the medical resident, is in conflict of adult learning theory leading to a contributing factor to the success or failure of teaching evidence-based medicine. Risk models are powerful tools for assessing biomedical significance but the importance of how to teach and use a risk model cannot be underestimated. Building on what emergency room residents may know, or determining whether there is a knowledge deficit is extremely important. A step-by-step process layering information on what is already known (present level of understanding) by the leaner o the required knowledge level is needed. The results of the EFA conducted indicates that patients with and without low systolic blood pressure share common factors. These factors, anemia and kidney function also directly affect blood pressure. If emergency room residents do not know that these factors are shared, then the first step would be to educate them about this finding. If emergency room residents do know from prior knowledge, then the teacher would be adding to their knowledge base when teaching the residents the use of the risk model as is described by Knowles, Holton, and Swanson (2005) as the first underlying assumption. The shift to student centered learning is based on adult learning theory (Spencer, 1999) and transformational learning should be employed

Health of Philippine Emigrants Study (HoPES): study design and rationale.

BackgroundImmigrants to the United States are usually healthier than their U.S.-born counterparts, yet the health of immigrants declines with duration of stay in the U.S. This pattern is often seen for numerous health problems such as obesity, and is usually attributed to acculturation (the adoption of "American" behaviors and norms). However, an alternative explanation is secular trends, given that rates of obesity have been rising globally. Few studies of immigrants are designed to distinguish the effects of acculturation versus secular trends, in part because most studies of immigrants are cross-sectional, lack baseline data prior to migration, and do not have a comparison group of non-migrants in the country of origin. This paper describes the Health of Philippine Emigrants Study (HoPES), a study designed to address many of these limitations.MethodsHoPES is a dual-cohort, longitudinal, transnational study. The first cohort consisted of Filipinos migrating to the United States (n = 832). The second cohort consisted of non-migrant Filipinos who planned to remain in the Philippines (n = 805). Baseline data were collected from both cohorts in 2017 in the Philippines, with follow-up data collection planned over 3 years in either the U.S. for the migrant cohort or the Philippines for the non-migrant cohort. At baseline, interviewers administered semi-structured questionnaires that assessed demographic characteristics, diet, physical activity, stress, and immigration experiences. Interviewers also measured weight, height, waist and hip circumferences, blood pressure, and collected dried blood spot samples.DiscussionMigrants enrolled in the study appear to be representative of recent Filipino migrants to the U.S. Additionally, migrant and non-migrant study participants are comparable on several characteristics that we attempted to balance at baseline, including age, gender, and education. HoPES is a unique study that approximates a natural experiment from which to study the effects of immigration on obesity and other health problems. A number of innovative methodological strategies were pursued to expand the boundaries of current immigrant health research. Key to accomplishing this research was investment in building collaborative relationships with stakeholders across the U.S. and the Philippines with shared interest in the health of migrants