The Relationship Between Insufficient Sleep and Mental Health Distress in Ohio Compared to West Virginia and New Jersey

Objective: To compare and establish the importance of the relationship between insufficient sleep and the frequency of mental health distress in Ohio in contrast to that in West Virginia and New Jersey in 2022. Methods: The data used included information on insufficient sleep, frequency of mental health distress, and premature death per each state studied and was collected from County Health Rankings and then analyzed using a Pearson’s correlation, one way analysis of variance, and multiple linear regression. Ohio was chosen as the reference state with New Jersey and West Virginia as comparisons based on their equivalent population s ize and apparent differences in trends in the studied variables. Results: There was a strong and significant positive correlation between insufficient sleep and frequency of mental health distress in all three states in 2022. The percent of insufficient sleep in 2022 within Ohio (40.45%) was betwixt the states under study with New Jersey being lower (38.09%) and West Virginia being higher (43.34%). The percent of frequent mental health distress is highest in West Virginia (21.19%), then Ohio (17.76%), and lowest in New Jersey (13.11%) in 2022. A linear regression revealed that insufficient sleep could explain 87.3% of the variance in the frequency of mental health distress in 2022. When insufficient sleep was controlled for, t he percent of mental distress in Ohio was 1.8% lower than West Virginia and 3.33% higher than New Jersey in this measure in 2022. A linear regression indicated the frequency of mental health distress accounted for 65.5% of the variance in life expectancy in 2022. When controlled for frequency of mental health distress the life expectancy in Ohio was 2.22 years lower than New Jersey and 1.79 years higher than West Virginia in 2022

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Effect of Antiplatelet Therapy on Survival and Organ Support–Free Days in Critically Ill Patients With COVID-19

International audienc