Healthcare Outcomes and Resource Utilization Associated with Neonatal Hypoglycemia: Analysis of Data from the HCUP Kid’s Inpatient Database

Neonatal hypoglycemia is the most common metabolic abnormality in infants and is associated with neurological damage and death. The risk of developing hypoglycemia among infants born from diabetic mothers is even higher. Although much work has been performed addressing issues for treatment and care, research related to neonatal hypoglycemia has been focused on the clinical or individual level risk factors. Contextual risk factors such as hospital characteristics, neighborhood economic status, and regional variations were not considered in earlier studies. Additionally, although healthcare resources utilization of hypoglycemia has been adequately addressed in the adult population, this topic has not been studied in hypoglycemic neonates. The overarching purpose of this dissertation was to investigate healthcare outcomes and resource utilization related to neonatal hypoglycemia. The first purpose was to conduct a systematic review in order to investigate whether previous studies only focused on clinical risk factors or included a broader health service-related contextual risk factors in assessing the determinants of neonatal hypoglycemia. The second purpose was to identify the key factors associated with increased hospital cost associated with neonatal hypoglycemia in the United States. The third and final purpose of the dissertation was to construct multi-level models that include individual-level and contextual-level characteristics. The systematic review (Project I) determined that previous studies mainly focus on the clinical characteristics of infants and mothers. The systematic review suggested that contextual variables should be included in future research. Project II found that increased cost was observed, when more than five procedures were performed during the same hospitalization, when hospital bed size was between 100 and 300 or ≥ 400, when hospital length of stay exceeded 15 days, in teaching hospitals, in the presence of chronic conditions, comorbidities, prematurity, and death. In project III we found that infant of diabetic mothers had more than 5-fold increased risk of developing neonatal hypoglycemia compared to infants of non-diabetic mothers. Infants born in urban and teaching hospitals also had significantly higher chance of developing neonatal hypoglycemia. Project III also determined that the inclusion of the contextual risk factors improved the final model that was constructed to predict neonatal hypoglycemia

Toxic Environmental Risk Factors for Alzheimer\u27s Disease: A Systematic Review

There is growing evidence of a possible association between toxic environmental factors and Alzheimer’s disease (AD), a disabling neurodegenerative condition with no known cause. Previous reviews of toxic environmental factors for AD either focused on occupational exposures or used a non-systematic methodology. The objective of this systematic review is to assess the evidence on the link between AD and exposure to a variety of toxic environmental risk factors beyond the work environment. Structured database search was used to identify relevant studies. Twenty-nine eligible studies examining the effect of various toxic environmental agents including electromagnetic fields, solvents, pesticides, toxic metals, and air pollutants were identified. Six out of 11 cohort studies and only two out of 18 case-control studies were considered high quality. Eight out of 12 studies found electromagnetic fields exposure to be a significant risk factor for AD. Significant evidence was also found for pesticide, aluminum, and solvent exposures. Evidence is now emerging of a possible association between air pollution and AD. However, more research is needed to substantiate this evidence. Key methodological issues especially those relating to the assessment of exposure(s) need to be addressed in future studies to facilitate interpretation and synthesis of study result

Neonatal Hypoglycemia in Diabetic Mothers: a Systematic Review

Hypoglycemia occurs in approximately 8-30% of neonates born to mothers with diabetes. The full extent of the individual and contextual risk factors of hypoglycemia remains unclear and no systematic review of the available studies exists to date. We identified published studies using PubMed and EBSCO host search engines. A modified STROBE statement was used to assess studies\u27 strengths, weaknesses, and generalizability. A total of 16 articles were eligible for full text review. The clinical risk factors in these studies were broadly classified into two: infant-related and mother-related risk factors. The identified infant-related risk factors were SGA, macrosomia, prematurity, lower cord blood glucose, ponderal index and male sex. On the other hand, mother-related risk factors includes maternal hyperglycemia, ethnic origin, diabetes diagnosed prior to 28 weeks of gestation, pre-pregnancy BMI of ≥ 25 kg/m², blood glucose, maternal diabetes type and maternal HbA1c. Irrespective of diabetes type, infants born to diabetic mothers appear to have a higher risk of developing hypoglycemia compare to those born to normal mothers. The overall evidence suggested that these studies mainly focus on the clinical characteristics of infants and mothers. Future research should focus on the identification of risk factors at the individual and contextual levels that can independently predict neonatal hypoglycemia. Appropriate emphasis should also be given to better define neonatal hypoglycemia

Sexual behavior and drug consumption among young adults in a shantytown in Lima, Peru

<p>Abstract</p> <p>Background</p> <p>Risky sexual behaviors of young adults have received increasing attention during the last decades. However, few studies have focused on the sexual behavior of young adults in shantytowns of Latin America. Specifically, studies on the association between sexual behaviors and other risk factors for sexually transmitted infections (STI) and HIV/AIDS transmission, such as the consumption of illicit drugs or alcohol are scarce in this specific context.</p> <p>Methods</p> <p>The study participants were 393 men and 400 women between 18 and 30 years of age, from a shantytown in Lima, Peru. Data were obtained via survey: one section applied by a trained research assistant, and a self-reporting section. Logistic regression was used to estimate associations between use of any illicit drug, high-risk sexual behaviors and reported STI symptoms, adjusting for alcohol consumption level and various socio-demographic characteristics.</p> <p>Results</p> <p>Among men, age of sexual debut was lower, number of lifetime sexual partners was higher, and there were higher risk types of sexual partners, compared to women. Though consistent condom use with casual partners was low in both groups, reported condom use at last intercourse was higher among men than women. Also, a lifetime history of illicit drug consumption decreased the probability of condom use at last sexual intercourse by half. Among men, the use of illicit drugs doubled the probability of intercourse with a casual partner during the last year and tripled the probability of reported STI symptoms.</p> <p>Conclusion</p> <p>Drug consumption is associated with high-risk sexual behaviors and reported STI symptoms in a Lima shantytown after controlling for alcohol consumption level. Development of prevention programs for risky sexual behaviors, considering gender differences, is discussed.</p

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century