The association between neighbourhood-level deprivation and depression: evidence from the south african national income dynamics study

BACKGROUND: Depression contributes substantially to the burden of disease in South Africa. Little is known about how neighbourhoods affect the mental health of the people living in them. METHODS: Using nationally representative data (N=11,955) from the South African National Income Dynamics Study and the South African Indices of Multiple Deprivation (SAIMD) modelled at small-area level, this study tested associations between neighbourhood-level deprivation and depression, after controlling for individual-level covariates. RESULTS: Results showed a significant positive association between neighbourhood-level deprivation and depression using the composite SAIMD (β = 0.31 (0.15); p=0.04) as well as the separate deprivation domains. Living environment deprivation (β =0.53 (0.16); p=0.001) and employment deprivation (β = 0.38 (0.13); p=0.004), respectively, were the two most salient domains in predicting this relationship. CONCLUSIONS: Findings supported the hypothesis that there is a positive association between living in a more deprived neighbourhood and depression, even after controlling for individual-level covariates. This study suggests that alleviating structural poverty could reduce the burden of depression in South Africa

Anticoagulation trends in adults aged 65 years and over with atrial fibrillation: a cohort study.

Funder: Wellcome TrustObjectiveTo describe patterns of anticoagulation prescription and persistence for those aged ≥65 years with atrial fibrillation (AF).MethodsDescriptive cohort study using electronic general practice records of patients in England, who attended an influenza vaccination aged ≥65 years and were diagnosed with AF between 2008 and 2018. Patients were stratified by 10-year age group and year of diagnosis. Proportion anticoagulated, type of anticoagulation (direct oral anticoagulant (DOAC) or warfarin) initiated at diagnosis and persistence with anticoagulation over time are reported.Results42 290 patients (49% female), aged 65-74 (n=11 722), 75-84 (n=19 055) and 85+ (n=11 513) years at AF diagnosis are included. Prescription of anticoagulation at diagnosis increased over the time period from 55% to 86% in people aged 65-74 years, from 54% to 86% in people aged 75-84 years and from 27% to 75% in people aged 85 years and over. By 2018, 92% of patients with newly diagnosed AF were started on a DOAC. Survivor function for 5-year persistence in patients prescribed DOAC was 0.80 (95% CI 0.77 to 0.82) and for warfarin 0.71 (95% CI 0.70 to 0.72). Survivor function for any anticoagulation at 5 years was 0.79 (95% CI 0.78 to 0.81), 0.73 (95% CI 0.72 to 0.75) and 0.58 (95% CI 0.59 to 0.64) for people aged 65-74, 75-84 and 85+ years, respectively.ConclusionsRates of anticoagulation in AF in those aged ≥65 years have increased from 2008 to 2018, over which time period there has been a shift from initiating anticoagulation with warfarin to DOAC. Persistence with anticoagulation is higher in people on DOACs than on warfarin and in people aged <85 years

Hvordan kan operasjonssykepleier estimere kirurgisk blødning? En scoping review

SAMMENDRAG Bakgrunn: Blødning er en naturlig konsekvens av kirurgi og estimering av blodtap under operasjon er vanskelig og nesten umulig å utføre nøyaktig. Estimering av blødning komplise-res når andre væsker er innblandet med blod og når blodet havner utenfor operasjonsfeltet. Tidligere forskning viser at faren for over- og underestimering er høy og feilestimering av blødning kan potensielt ha alvorlige konsekvenser for pasienten. Formål: Vi ønsker med vår studie å kartlegge ulike metoder for estimering av blødning og undersøke hva som bidra til økt nøyaktighet i estimeringen. I tillegg vil vi også sette fokus på hvorfor estimering av blødning er viktig fra et pasientsikkerhets perspektiv. Metode: Vi har valgt å gjøre scoping review som gir oss mulighet for en bred tilnærming av emnet. Slik kan vi kartlegge litteraturen, identifisere eventuelle kunnskapshull og avdekke videre behov for forskning. Vi har gjennomført litteratursøk i relevante databaser og hentet ut relevante artikler for vår problemstilling. Resultater: Visuell estimering er unøyaktig og frarådes. Periodisk estimering og kombina-sjon av ulike metoder kan bidra til økt nøyaktighet. Ny teknologi utviklet for å estimere blø-ding ved bruk av applikasjon på mobil eller nettbrett anses å være nøyaktig. Andre væsker utfordrer nøyaktigheten til gravimetrisk metode. Implementering av verktøy som bildeguide kan øke nøyaktighet på etablerte metoder for estimering. Konklusjon: Operasjonssykepleier kan estimere kirurgisk blødning ved hjelp av ulike meto-der, en kombinasjon kan være hensiktsmessig. Gravimetrisk metode kan brukes i kombina-sjon med nyere teknologi og bildeguide for å inkludere all blødning. Nøkkelord: Operasjonssykepleier, operasjon, blodtap, estimere, måleABSTRACT Background: Bleeding is a natural consequence of surgery, and estimation of blood loss during surgery is difficult and almost impossible to perform accuratley. Etimation of blee-ding is complicated when other fluids are involved with blood, and when blood ends up out-side the surgical field. Previous research sjows that the risk of over- and underestimation is high, and incorrect estimation of bleeding can potentially have serious consequences for the patient. Objective: With our study we aim to identify various methods for estimating bleeding and investigate what contributes to increased accuracy in estimation. Additionally, we also want to focus on why estimating bleeding is important form a patient safety perspective. Method: We have chosen to conduct a scoping review that allos for a broad approach to the topic. This way we can map the litterature, identify any knowlage gaps, and uncover further research needs. We have conducted a litterature search in relevant databases and extracted relevant articles for our research question. Results: Visual estimation is inaccurate and not recommended. Periodic estimation and a combination of different methods can contribute to increased accuracy. New technology de-veloped to estimate bleeding using an application on a mobile device og tablet is considered accurate. Other fluids challenge the accuracy of the gravimetric method. Implementation og tools such as image guidance can increases the accuracy of established methods for estima-tion. Conclution: Surgical nurses can estimate surgical bleeding using various methods, and a combination can be useful. The gravimetric method can be used i combination with newer technology and image guidance to include all bleeding. Keywords: Surgical nurse, surgery, blood loss, estimate, measur

Palmitoylethanolamide and Cannabidiol Prevent Inflammation-induced Hyperpermeability of the Human Gut In Vitro and In Vivo—A Randomized, Placebo-controlled, Double-blind Controlled Trial

Background and aimsWe aimed to examine, for the first time, the effect of cannabidiol (CBD) and palmitoylethanolamide (PEA) on the permeability of the human gastrointestinal tract in vitro, ex vivo, and in vivo.MethodsFlux measurements of fluorescein-labeled dextrans 10 (FD10) and fluorescein-labeled dextrans 4 (FD4) dextran across Caco-2 cultures treated for 24 hours with interferon gamma (IFNγ) and tumour necrosis factor alpha (TNFα) (10 ng·mL−1) were measured, with or without the presence of CBD and PEA. Mechanisms were investigated using cannabinoid receptor 1 (CB1), cannabinoid receptor 2 (CB2), transient receptor potential vanilloid 1 (TRPV1), and proliferator activated receptors (PPAR) antagonists and protein kinase A (PKA), nitric oxide synthase, phosphoinositide 3-kinases, extracellular signal–regulated kinases (MEK/ERK), adenylyl cyclase, and protein kinase C (PKC) inhibitors. Human colonic mucosal samples collected from bowel resections were treated as previously stated. The receptors TRPV1, PPARα, PPARδ, PPARγ, CB1, CB2, G-coupled protein receptor 55 (GPR55), G-coupled protein receptor 119 (GPR119), and claudins-1, -2, -3, -4, -5, -7, and -8 mRNA were measured using multiplex. Aquaporin 3 and 4 were measured using enzyme-linked immunosorbent assay (ELISA). A randomized, double-blind, controlled-trial assessed the effect of PEA or CBD on the absorption of lactulose and mannitol in humans taking 600 mg of aspirin. Urinary concentrations of these sugars were measured using liquid chromatography mass spectrometry.ResultsIn vitro, PEA, and CBD decreased the inflammation-induced flux of dextrans (P < 0.0001), sensitive to PPARα and CB1 antagonism, respectively. Both PEA and CBD were prevented by PKA, MEK/ERK, and adenylyl cyclase inhibition (P < 0.001). In human mucosa, inflammation decreased claudin-5 mRNA, which was prevented by CBD (P < 0.05). Palmitoylethanolamide and cannabidiol prevented an inflammation-induced fall in TRPV1 and increase in PPARα transcription (P < 0.0001). In vivo, aspirin caused an increase in the absorption of lactulose and mannitol, which were reduced by PEA or CBD (P < 0.001).ConclusionCannabidiol and palmitoylethanolamide reduce permeability in the human colon. These findings have implications in disorders associated with increased gut permeability, such as inflammatory bowel disease

Arctic river temperature dynamics in a changing climate

Climate change in the Arctic is expected to have a major impact on stream ecosystems, affecting hydrological and thermal regimes. Although temperature is important to a range of in‐stream processes, previous Arctic stream temperature research is limited—focused on glacierised headwaters in summer—with limited attention to snowmelt streams and winter. This is the first high‐resolution study on stream temperature in north‐east Greenland (Zackenberg). Data were collected from five streams from September 2013 to September 2015 (24 months). During the winter, streams were largely frozen solid and water temperature variability low. Spring ice‐off date occurred simultaneously across all streams, but 11 days earlier in 2014 compared with 2015 due to thicker snow insulation. During summer, water temperature was highly variable and exhibited a strong relationship with meteorological variables, particularly incoming shortwave radiation and air temperature. Mean summer water temperature in these snowmelt streams was high compared with streams studied previously in Svalbard, yet was lower in Swedish Lapland, as was expected given latitude. With global warning, Arctic stream thermal variability may be less in summer and increased during the winter due to higher summer air temperature and elevated winter precipitation, and the spring and autumn ice‐on and ice‐off dates may extend the flowing water season—in turn affecting stream productivity and diversity

085: Heart failure with preserved ejection fraction: changes in clinical parameters between acute presentation and subsequent follow-up

PurposeIn the prospective KaRen registry of heart failure with preserved ejection fraction (HFPEF), changes in clinical and biological parameters and medications were assessed between acute presentation and out-patient follow-up in stable state.MethodsThe KaRen study included patients presenting with acute heart failure (HF) according to inclusion criteria: Framingham criteria for HF, left ventricular ejection fraction > or=45% and brain natriuretic peptide (BNP)>100pg/mL or NT-proBNP>300pg/mL. Once stabilized, 4-8 weeks after the index presentation, patients returned as out-patients for repeat assessment. Changes in clinical and biological parameters and medications between inclusion and follow-up were assessed with Students t-test and Chi-square testsResults577 patients were recruited and 458 returned for the 4-8 weeks visit. 56% were women. The median [25-75pctl] age was 79 [72-84] years. Medical history included 78% hypertension, 58% atrial arrhythmia, 26% type II diabetes and 27% serum creatinin >100 micromol/l. The table provides inclusion and follow-up dataConclusionsPatients presenting with HFPEF are elderly and a majority are women, with a high rate of hypertension and atrial arrhythmias. Blood pressure is incompletely controlled. At follow-up, blood pressure and NT-proBNP were reduced, but patients remain symptomatic. Still, efforts are needed to improve symptoms in HFPEF.Table (abstract 85) – Inclusion and follow-up data.Variable Mean (IQR)NYHA I / II / III / IVSBPCreatinineNT-proBNPACEI /ARBB-blockerANTICOAGInclusion0.8 / 9.4 / 40 / 49.8%148 [130-170]93 [74-128]2433 [1272-4790]60%65%41%Follow-up13 / 62.5 / 22.2 / 2.3140 [120-150]95 [75-129]1409 [514-2641]68%67.5%51.3%p<0.00010.003<0.000

Temporal trends in incidence of atrial fibrillation in primary care records: a population-based cohort study

Objectives: Atrial fibrillation (AF) is a heart condition associated with a fivefold increased risk of stroke. The condition can be detected in primary care and treatment can greatly reduce the risk of stroke. In recent years, a number of policy initiatives have tried to improve diagnosis and treatment of AF, including local National Health Service schemes and the Quality and Outcomes Framework. We aimed to examine trends in the incidence of recorded AF in primary care records from English practices between 2004 and 2018. Design: Longitudinal cohort study. Setting: English primary care electronic health records linked to Index of Multiple Deprivation data. Participants: Cohort of 3.5 million patients over 40 years old registered in general practices in England, contributing 22 million person-years of observation between 2004 and 2018. Primary and secondary outcome measures: Incident AF was identified through newly recorded AF codes in the patients’ records. Yearly incidence rates were stratified by gender, age group and a measure of deprivation. Results: Incidence rates were stable before 2010 and then rose and peaked in 2015 at 5.07 (95% CI 4.94 to 5.20) cases per 1000 person-years. Incidence was higher in males (4.95 (95% CI 4.91 to 4.99) cases per 1000 person-years vs 4.12 (95% CI 4.08 to 4.16) in females) and rises markedly with age (0.58 (95% CI 0.56 to 0.59) cases per 1000 person-years in 40–54 years old vs 21.7 (95% CI 21.4 to 22.0) cases in over 85s). The increase in incidence over time was observed mainly in people over the age of 75, particularly men. There was no evidence that temporal trends in incidence were associated with deprivation. Conclusions: Changes in clinical practice and policy initiatives since 2004 have been associated with increased rates of diagnosis of AF up until 2015, but rates declined from 2015 to 2018

Temporal trends in incidence of atrial fibrillation in primary care records: a population-based cohort study

Objectives: Atrial fibrillation (AF) is a heart condition associated with a fivefold increased risk of stroke. The condition can be detected in primary care and treatment can greatly reduce the risk of stroke. In recent years, a number of policy initiatives have tried to improve diagnosis and treatment of AF, including local National Health Service schemes and the Quality and Outcomes Framework. We aimed to examine trends in the incidence of recorded AF in primary care records from English practices between 2004 and 2018. Design: Longitudinal cohort study. Setting: English primary care electronic health records linked to Index of Multiple Deprivation data. Participants: Cohort of 3.5 million patients over 40 years old registered in general practices in England, contributing 22 million person-years of observation between 2004 and 2018. Primary and secondary outcome measures: Incident AF was identified through newly recorded AF codes in the patients’ records. Yearly incidence rates were stratified by gender, age group and a measure of deprivation. Results: Incidence rates were stable before 2010 and then rose and peaked in 2015 at 5.07 (95% CI 4.94 to 5.20) cases per 1000 person-years. Incidence was higher in males (4.95 (95% CI 4.91 to 4.99) cases per 1000 person-years vs 4.12 (95% CI 4.08 to 4.16) in females) and rises markedly with age (0.58 (95% CI 0.56 to 0.59) cases per 1000 person-years in 40–54 years old vs 21.7 (95% CI 21.4 to 22.0) cases in over 85s). The increase in incidence over time was observed mainly in people over the age of 75, particularly men. There was no evidence that temporal trends in incidence were associated with deprivation. Conclusions: Changes in clinical practice and policy initiatives since 2004 have been associated with increased rates of diagnosis of AF up until 2015, but rates declined from 2015 to 2018