Association of Perfluoroalkyl Substance with Lung Function in the US Population

Background/Aim: Perfluoroalkyl substances (PFASs) are chemical compounds used in consumer products and are linked with increases in cholesterol, thyroid disease, and pregnancy-induced hypertension. However, their association with lung function is not completely understood.Methods: Cross-sectional 2011-2012 US population data from the National Health and Nutrition Examination Survey (NHANES) were analyzed (n = 1450, aged 12 to 79 years, 50.5% females). Serum concentrations of 4 PFASs, perfluoronon-anoic acid (PFNA), perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), and perfluorohexane sulfonic acid (PFHxS), were assessed using mass spectrometry and categorized into quartiles. Lung function was measured by spirome-try as forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and the ratio of FEV1/FVC (%). Survey weighted sex stratified adjusted linear regression analysis was used to predict lung function with PFASs quartiles.Results: In males, compared to females, all 4 PFASs serum concentrations and lung function indices were higher, except FEV1/FVC (%) which was lower than females. No association of any PFAS with decrease in lung function was seen in multivariable-adjusted models in both males and females.Conclusion: In this exploratory analysis, PFAS exposure was not associated with lung function. PFAS contamina-tion has been ongoing for many years across the US and Ohio, and cleanup efforts are now underway. The association between PFAS exposure and lung function needs further exploration in longitudinal studies

Antipsychotic prescribing for vulnerable populations: a clinical audit at an acute Australian mental health unit at two-time points

Background: Antipsychotics are recognised as a critical intervention for schizophrenia and bipolar disorder. Guidelines globally endorse the routine practice of antipsychotic monotherapy, at the minimum effective dose. Even in treatmentresistant schizophrenia, clozapine use is endorsed before combining antipsychotics. This aim of this study was to review antipsychotic polytherapy alone, high-dose therapy alone, polytherapy and highdose prescribing patterns in adults discharged from an inpatient mental health unit at two time-points, and the alignment of this prescribing with clinical guideline recommendations. Additionally, associations with polytherapy and high-dose antipsychotic prescribing, including patient and clinical characteristics, were explored. Methods: A retrospective clinical audit of 400 adults (200 patients at two different time-points) discharged with at least one antipsychotic. Preliminary findings and education sessions were provided to physicians between Cohorts. Outcomes (polytherapy alone, high-dose therapy alone, polytherapy and high-dose therapy) were compared between study Cohorts using chi-squared and rank-sum tests. Associations between outcomes and covariates were assessed using multivariable logistic regression. Results: Most patients (62.5%) were discharged on a single antipsychotic within the recommended dose range. There was a clear preference for prescribing second generation antipsychotics, and in this respect, prescribing is aligned with current evidence-based guidelines. However, sub-optimal prescribing practices were identified for both Cohorts in relation to polytherapy and high-dose antipsychotic rates. Involuntary treatment, frequent hospitalisations and previous clozapine use significantly increased the risk of all three prescribing outcomes at discharge. Conclusions: In a significant minority, antipsychotic prescribing did not align with clinical guidelines despite increased training, indicating that the education program alone was ineffective at positively influencing antipsychotic prescribing practices. Further consideration should be given when prescribing antipsychotics for involuntary patients, people with frequent hospitalisations, and those who have previously trialled clozapine

Orexin-A and Orexin-B During the Postnatal Development of the Rat Brain

Orexin-A and orexin-B are hypothalamic neuropeptides isolated from a small group of neurons in the hypothalamus, which project their axons to all major parts of the central nervous system. Despite the extensive information about orexin expression and function at different parts of the nervous system in adults, data about the development and maturation of the orexin system in the brain are a bit contradictory and insufficient. A previous study has found expression of orexins in the hypothalamus after postnatal day 15 only, while others report orexins detection at embryonic stages of brain formation. In the present study, we investigated the distribution of orexin-A and orexin-B neuronal cell bodies and fibers in the brain at three different postnatal stages: 1-week-, 2-week-old and adult rats. By means of immunohistochemical techniques, we demonstrated that a small subset of cells in the lateral hypothalamus, and the perifornical and periventricular areas were orexin-A and orexin-B positive not only in 2-week-old and adult rats but also in 1-week-old animals. In addition, orexin-A and orexin-B expressing neuronal varicosities were found in many other brain regions. These results suggest that orexin-A and orexin-B play an important role in the early postnatal brain development. The widespread distribution of orexinergic projections through all these stages may imply an involvement of the two neurotransmitters in a large variety of physiological and behavioral processes also including higher brain functions like learning and memory

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

The 2021 WHO catalogue of Mycobacterium tuberculosis complex mutations associated with drug resistance: a genotypic analysis.

Background: Molecular diagnostics are considered the most promising route to achievement of rapid, universal drug susceptibility testing for Mycobacterium tuberculosis complex (MTBC). We aimed to generate a WHO-endorsed catalogue of mutations to serve as a global standard for interpreting molecular information for drug resistance prediction. Methods: In this systematic analysis, we used a candidate gene approach to identify mutations associated with resistance or consistent with susceptibility for 13 WHO-endorsed antituberculosis drugs. We collected existing worldwide MTBC whole-genome sequencing data and phenotypic data from academic groups and consortia, reference laboratories, public health organisations, and published literature. We categorised phenotypes as follows: methods and critical concentrations currently endorsed by WHO (category 1); critical concentrations previously endorsed by WHO for those methods (category 2); methods or critical concentrations not currently endorsed by WHO (category 3). For each mutation, we used a contingency table of binary phenotypes and presence or absence of the mutation to compute positive predictive value, and we used Fisher's exact tests to generate odds ratios and Benjamini-Hochberg corrected p values. Mutations were graded as associated with resistance if present in at least five isolates, if the odds ratio was more than 1 with a statistically significant corrected p value, and if the lower bound of the 95% CI on the positive predictive value for phenotypic resistance was greater than 25%. A series of expert rules were applied for final confidence grading of each mutation. Findings: We analysed 41 137 MTBC isolates with phenotypic and whole-genome sequencing data from 45 countries. 38 215 MTBC isolates passed quality control steps and were included in the final analysis. 15 667 associations were computed for 13 211 unique mutations linked to one or more drugs. 1149 (7·3%) of 15 667 mutations were classified as associated with phenotypic resistance and 107 (0·7%) were deemed consistent with susceptibility. For rifampicin, isoniazid, ethambutol, fluoroquinolones, and streptomycin, the mutations' pooled sensitivity was more than 80%. Specificity was over 95% for all drugs except ethionamide (91·4%), moxifloxacin (91·6%) and ethambutol (93·3%). Only two resistance mutations were identified for bedaquiline, delamanid, clofazimine, and linezolid as prevalence of phenotypic resistance was low for these drugs. Interpretation: We present the first WHO-endorsed catalogue of molecular targets for MTBC drug susceptibility testing, which is intended to provide a global standard for resistance interpretation. The existence of this catalogue should encourage the implementation of molecular diagnostics by national tuberculosis programmes. Funding: Unitaid, Wellcome Trust, UK Medical Research Council, and Bill and Melinda Gates Foundation

CT Scan Effective Radiation Dose Reduction in Pediatric Trauma Patients

This project attempts to address the problem of excessive radiation exposure via CT imaging for pediatric patients presenting at adult regional trauma centers. To answer this question, we utilized the pediatric trauma registry to conduct a retrospective chart review of consisting of all patients under 14 years of age that received trauma related CT imaging and that were transferred from an adult trauma center to Dayton Children’s Hospital in the time period of January 2019 to December 2019.Cases of unnecessary imaging will be determined by subject matter expert review, based on ACS and Image Gently guidelines. Cases of overexposure to radiation were determined via DLP and effective radiation dose, in conjunction with subject matter expert review. Results showed that 48 pediatrics patients were transferred to Dayton Children’s Hospital from 12 different adult trauma, from January to December 2019. In total, 118 scans were performed on these 48 patients. Of these, 41 scans were identified as an opportunity for improvement. The most common opportunity for improvement was a reduction in unnecessary cervical spine scans. From a patient safety perspective, this project emphasizes the need for increased knowledge of pediatric imaging guidelines at adult trauma centers. Such knowledge includes knowing when a scan can be reformatted from an existing image, as well as an understanding of weight-based pediatric imaging. A follow up project could be to assess for change after implementation of guidelines at the adult trauma centers

Suicide Rates in Rural Ohio: The Role of Population Density, Social Association, and Healthcare Access

Background: This study explores differences between adult suicide rates in counties in Ohio from 2007-2016, specifically differences between urban and rural counties. Nationally, the least densely populated states in the nation have the highest rates of completed suicide, and that same trend was hypothesized to exist in the least densely populated counties in Ohio. Methods: Simple demographics and rates for sub-populations and counties were retrieved for adults over 18 years of age, and separated by rural and urban counties. A random effects meta-regression model was developed to assess the association among suicide death rate, rate of emergency rooms, rate of mental health providers, rate of social associations, and rural or urban counties. Results: There were differences in suicide rate between urban and rural counties. Suicide death rates were significantly associated with rate of mental health facilities, rate of social associations, and type of county (e.g., rural versus urban). As the rate of mental health providers increased, there was a significant decrease in the rate of suicide deaths. Conclusions: This study illustrates the positive effect that access to mental health service providers can have on decreasing suicides in rural areas. More studies are needed focusing on unmet needs in rural areas, specifically those looking at individual level predictors of suicide. Key words: Suicide, Population Density, Social Association, Mental Health, and Rura

Health Disparities Report

Through a Centers for Disease Control and Prevention Community Transformation Grant (CTG), Public Health – Dayton & Montgomery County (PHDMC) is working to improve the health of our community by reducing preventable chronic diseases such as lung cancer, heart disease, stroke, and type 2 diabetes. Our CTG initiatives focus on engaging community partners to implement policy, systems, and environmental (PSE) changes to promote tobacco-­free living, active living and healthy eating, and clinical preventive services. These PSE changes are intended to reduce death and disability due to tobacco use, rate of obesity, and death and disability due to heart disease and stroke. This report augments the chronic disease data in our 2010 Montgomery County Community Health Assessment. The purpose of this data report is to ensure that PHDMC applies a “health equity lens” to all of our proposed CTG PSE strategies aimed at tobacco­‐free living, active living and healthy eating, and clinical preventive services. The guiding principle for these strategies is to reduce disparities in health outcomes among population groups and to advance health equity. For reference, PHDMC uses the National Stakeholder Strategy for Achieving Health Equity definition for health disparity: “a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial and/or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.” This report is an assessment of existing population data sets related to chronic disease rates and risk factors based on age, gender, race, income, and disability. Rural versus urban analysis was not possible as Montgomery County is an urban county, with only a small proportion of the western portion of the county living in rural conditions. Ethnicity data was not analyzed due to small numbers of Hispanics in Montgomery County. Data sources include the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System (BRFSS), Ohio Department of Health Vital Statistics, and the Ohio Cancer Incidence Surveillance System (OCISS)