bluuebunny/crossref_metadata_2025 huggingface dataset:
Epidemiology of time-loss injuries in international fencing: a prospective, 5-year analysis of Fédération Internationale d’Escrime competitions
Authors: Harmer Peter A
Published: January 2019

Objectives

The study aimed to determine the risk of time-loss injuries in international fencing and to characterise their type, location, severity and mechanism. Variations in risk associated with sex and discipline categories are also examined.

Methods

Data on participation and withdrawal due to injury from 809 competitions comprising the major events of the 2010–2014 seasons (inclusive) for the Fédération Internationale d’Escrime were compiled from official results. Athletes who withdrew due to injury sustained in each competition were contacted individually to obtain follow-up information including time lost from fencing participation (practice/competition) and sequelae.

Results

A total of 176 injuries were recorded from 637 776 athlete exposures (AEs) in 85 686 participants (men=47 869; women=37 817) over the study period, for an overall incidence of 0.28/1000 AEs (95% CI 0.24 to 0.32). Men had significantly greater risk than women (RR=1.42, 95% CI 1.05 to 1.94); épée had a significantly lower risk than foil or sabre (RR=0.52, 95% CI 0.35 to 0.76; RR=0.47, 95% CI 0.32 to 0.69, respectively). The majority of injuries were sprains (40.8%) and strains (20.1%), which occurred in the lower extremities (72.4%); ankle sprains were the most common specific injury (25.3%). Intrinsic effort of the fencer (non-contact injury) was the most common mechanism related to a time-loss injury (47.1% of cases). The overall median time loss was 4 weeks; 32.1% of the injuries involved 2 weeks or less away from fencing participation.

Conclusion

The data indicate that the risk of time-loss injury in international fencing is very low and primarily involves sprains and strains in the lower extremity.
Anterior cruciate ligament (ACL) reconstruction and meniscal repair rates have both increased in the past 20 years in England: hospital statistics from 1997 to 2017
Authors: Abram Simon G F , Price Andrew J , Judge Andrew , Beard David J
Published: January 2019

Objectives

We investigated the temporal trend and the geographical variation in the rate of an anterior cruciate ligament (ACL) reconstruction and meniscal repair (MR) performed in England during a 20-year window.

Methods

All hospital episodes for patients undergoing ACL reconstruction or MR between 1 April 1997 and 31 March 2017 were extracted by procedure code from the national hospital episode statistics. Age-standardised and sex-standardised rates of surgery were calculated using Office for National Statistics population data as the denominator and analysed over time both nationally and regionally by National Health Service clinical commissioning group (CCG).

Results

Between 1997–1998 and 2016–2017, there were 133 270 cases of ACL reconstruction (124 489 patients) and 42 651 cases of MR (41 120 patients) (isolated or simultaneous). Nationally, the rate of ACL reconstruction increased 12-fold from 2.0/100K population (95% CI 1.9 to 2.1) in 1997–1998 to 24.2/100K (95% CI 23.8 to 24.6) in 2016–2017. The rate of MR increased more than twofold from 3.0/100K (95% CI 2.8 to 3.1) in 1997–1998 to 7.3/100K (95% CI 7.1 to 7.5) in 2016–2017. Of these cases, the rate of simultaneous ACL reconstruction and MR was 2.6/100K (95% CI 2.5 to 2.8) in 2016/2017. In 2016–2017, for patients aged 20–29, the sex-standardised rate of ACL reconstruction was 76.9/100K (95% CI 74.9 to 78.9) and for MR was 19.8/100K (95% CI 18.8 to 20.9). Practice varied by region—in 2016–2017, 14.5% (30/207) of the CCGs performed more than twice the national average rate of ACL reconstruction and 15.0% (31/207) performed more than twice the national average rate of MR.

Conclusions

The rate of ACL reconstruction (12-fold) and MR (2.4-fold) has increased in England over the last two decades. There is variation in these rates across geographical regions and further work is required to deliver standardised treatment guidance for appropriate use.
Quantifying inequities in US federal response to hurricane disaster in Texas and Florida compared with Puerto Rico
Authors: Willison Charley E , Singer Phillip M , Creary Melissa S , Greer Scott L.
Published: January 2019

If disaster responses vary in their effectiveness across communities, health equity is affected. This paper aims to evaluate and describe variation in the federal disaster responses to 2017 Hurricanes Harvey, Irma and Maria, compared with the need and severity of storm damage through a retrospective analysis. Our analysis spans from landfall to 6 months after landfall for each hurricane. To examine differences in disaster responses across the hurricanes, we focus on measures of federal spending, federal resources distributed and direct and indirect storm-mortality counts. Federal spending estimates come from congressional appropriations and Federal Emergency Management Agency (FEMA) records. Resource estimates come from FEMA documents and news releases. Mortality counts come from National Oceanic and Atmospheric Administration (NOAA) reports, respective vital statistics offices and news articles. Damage estimates came from NOAA reports. In each case, we compare the responses and the severity at critical time points after the storm based on FEMA time logs. Our results show that the federal government responded on a larger scale and much more quickly across measures of federal money and staffing to Hurricanes Harvey and Irma in Texas and Florida, compared with Hurricane Maria in Puerto Rico. The variation in the responses was not commensurate with storm severity and need after landfall in the case of Puerto Rico compared with Texas and Florida. Assuming that disaster responses should be at least commensurate to the degree of storm severity and need of the population, the insufficient response received by Puerto Rico raises concern for growth in health disparities and increases in adverse health outcomes.
Exploring the utility of internal whistleblowing in healthcare via agent-based models
Authors: Rauwolf Paul , Jones Aled
Published: January 2019

Objective

The benefits of internal whistleblowing or speaking-up in the healthcare sector are significant. The a priori assumption that employee whistleblowing is always beneficial is, however, rarely examined. While recent research has begun to consider how the complex nature of healthcare institutions impact speaking-up rates, few have investigated the institutional processes and factors that facilitate or retard the benefits of speaking up. Here we consider how the efficacy of formal inquiries within organisations in response to employees’ speaking up about their concerns affects the utility of internal whistleblowing.

Design

Using computational models, we consider how best to improve patient care through internal whistleblowing when resource and practical limitations constrain healthcare operation. We analyse the ramifications of varying organisational responses to employee concerns, given organisational and practical limitations.

Setting

Drawing on evidence from international research, we test the utility of whistleblowing policies in a variety of organisational settings. This includes institutions where whistleblowing inquiries are handled with varying rates of efficiency and accuracy.

Results

We find organisational inefficiencies can negatively impact the benefits of speaking up about bad patient care. We find that, given resource limitations and review inefficiencies, it can actually improve patient care if whistleblowing rates are limited. However, we demonstrate that including softer mechanisms for internal adjustment of healthcare practice (eg, peer to peer conversation) alongside whistleblowing policy can overcome these organisational limitations.

Conclusion

Healthcare organisations internationally have a variable record of responding to employees who speak up about their workplace concerns. Where organisations get this wrong, the consequences can be serious for patient care and staff well-being. The results of this study, therefore, have implications for researchers, policy makers and healthcare organisations internationally. We conclude with a call for further research on a more holistic understanding of the interplay between organisational structure and the benefits of whistleblowing to patient care.
A cross-sectional analysis of respiratory ill-health among charcoal workers and its implications for strengthening occupational health services in southern Nigeria
Authors: Obiebi Irikefe Paul , Oyibo Patrick Gold
Published: January 2019

Objectives

This study was conducted to assess the concentration of air pollutants at charcoal sites, the dose-response relationship between site-based exposure levels to air pollutants and prevalence of respiratory symptoms among charcoal workers, and the measures these workers employ to safeguard their health.

Design

Cross-sectional but comparative design

Setting

Charcoal production kiln sites in Sapele, Delta State, Nigeria.

Participants

Overall 296 charcoal workers and age-matched, sex-matched and height-matched non-exposed traders (comparison group).

Primary and secondary outcome measures

The primary outcome measure was the prevalence of respiratory symptoms among charcoal workers while secondary outcomes included lung function indices as well as hazard control practices among charcoal workers.

Results

Majority (83.3%) of the sites had PM10and PM2.5values five times higher than the WHO standard. Charcoal workers were more likely to have respiratory symptoms; wheeze was statistically significant after adjusting for confounders, (OR 4.22; CI 1.37 to 12.99). The dose-response relationship between site-based exposure levels to air pollutants and the prevalence of respiratory symptoms among charcoal workers was statistically significant for all symptoms except chest tightness (p=0.167). Mean forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC) were considerably lower among workers with differences of −0.22 (−0.42 to −0.05) L and −0.52 (-0.76 to −0.29) L, respectively, whereas FEV1/FVC ratio and peak expiratory flow rate were higher among workers with mean differences of 5.68 (3.59–8.82)% and 0.31 (-23.70 to 24.43) L/min, respectively; but the mean difference was significant only for the FEV1/FVC ratio. Charcoal workers had poor hazard control practices; only 3.4% reportedly used personal protective equipment.

Conclusion

Air pollutants at kiln sites were higher than WHO standards. Despite the significantly higher prevalence of wheeze, chest tightness and chronic cough among charcoal workers, their hazard control practices were inadequate. Charcoal workers should adopt appropriate hazard control practices, and use improved devices which emit minimal pollutants.
Qualitative situational analysis of palliative care for adolescents with cancer and HIV in South Africa: healthcare worker perceptions
Authors: Ngwenya Nothando , Ambler Julia , Archary Moherndran
Published: January 2019

Objectives

The unmet palliative care need is intensified in resource-limited countries where there is inequitable access to healthcare and adolescents and young adults (AYA) fall between the cracks of paediatric and adult services. We aimed to examine palliative care for AYA with cancer and/or HIV in South Africa.

Design

Individual and small group interviews using process mapping.

Setting

Data were collected between November 2016 and March 2017 with staff from government hospitals, hospices and clinics from three provinces of South Africa.

Participants

Health and social care professionals (n=30) (eg, physicians, nurses, social workers, psychologists) from KwaZulu-Natal, Western Cape and Gauteng provinces.

Methods

In this qualitative situational analysis study, participants were recruited to interviews and process mapping used to try and identify palliative care pathways of AYA with palliative care needs. We developed a thematic framework using a deductive approach to analyse the interview data.

Results

Palliative care pathways were not easily identifiable, ambiguous and varied and participants reported on their experiences and perceptions of service provision. Participants expressed that resource challenges limited the service provision. A need for nurse prescribing of pain relief at community level was mentioned as AYA are reluctant to use hospitals and clinics. Lack of (1) palliative care education among professionals, (2) public awareness and (3) adolescent-specific care posed a challenge to service provision.

Conclusions

The changing burden of HIV and increase in cancer prevalence calls for integration of palliative care in mainstream health services. Despite good policies, the pragmatic aspect of training professionals will influence a change in practice. The main task will be to absorb palliative care philosophy and practice at all levels of care to avoid overburdening the care system and to integrate it in community care programmes.
Sex-specific intergenerational trends in morbidity burden and multimorbidity status in Hong Kong community: an age-period-cohort analysis of repeated population surveys
Authors: Lai Francisco T T , Guthrie Bruce , Wong Samuel Y S , Yip Benjamin H K , Chung Gary K K , Yeoh Eng-Kiong , Chung Roger Y
Published: January 2019

Objectives

Prevalence of multimorbidity has been increasing worldwide. While population ageing undoubtedly contributes, secular trends have seldom been decomposed into age, period and cohort effects to investigate intergenerational differences. This study examines the birth cohort effect on morbidity burden and multimorbidity in Hong Kong community.

Design

Sex-specific age-period-cohort analysis with repeated cross-sectional surveys.

Setting

A territory-wide population survey database.

Participants

69 636 adults aged 35 or above who participated in the surveys in 1999, 2001, 2005 or 2008.

Main outcome measures

Morbidity burden was operationalised as number of chronic conditions from a list of 14, while multimorbidity was defined as a dichotomous status of whether participants had two or more conditions.

Results

For both sexes, there was an upward inflection (positive change) of risk of increased morbidity burden starting from cohort 1955–1959. For men born after 1945–1954, there was a trend of lower risk (relative risk=0.63, 95% CI 0.50 to 0.80 for 1950–1954 vs 1935–1939) which continued through subsequent cohorts but with no further declines. In women, there had been a gradual increase of risk, although only significant for cohort 1970–1974 (relative risk=1.90, 95% CI 1.08 to 1.34 vs 1935–1939). Similar results were found for dichotomous multimorbidity status.

Conclusions

The trend of lower risk starting from men born in 1945–1954 may be due to a persistent decline in smoking rates since the 1980s. On the other hand, the childhood obesity epidemic starting from the late 1950s coincided with the observed upward inflection of risk for both sexes, that is, notably more drastic increase of risk in women and the levelling-off of the decline of risk in men. These findings highlight that the cohort effects on morbidity burden and multimorbidity may be sex-specific and contextual. By examining such effects in different world populations, localised sex-specific and generation-specific risk factors can be identified to inform policy-making.
Difficult patient–doctor encounters in a Swiss university outpatient clinic: cross-sectional study
Authors: Mota Pau , Selby Kevin , Gouveia Alexandre , Tzartzas Konstantinos , Staeger Philippe , Marion-Veyron Regis , Bodenmann Patrick
Published: January 2019

Introduction

Previous research has shown that multiple factors contribute to healthcare providers perceiving encounters as difficult, and are related to both medical and non-medical demands.

Aim

To measure the prevalence and to identify predictors of encounters perceived as difficult by medical residents.

Design and setting

Cross-sectional study at the Department of Ambulatory Care and Community Medicine (DACCM), a university outpatient clinic with a long tradition of caring for vulnerable patients.

Method

We identified difficult doctor–patient encounters using the validated Difficult Doctor–Patient Relationship Questionnaire (DDPRQ-10), and characterised patients using the patient’s vulnerability grid, a validated questionnaire measuring five domains of vulnerability, both completed by medical residents after each encounter. We used a multiple linear regression model with the outcome variable as the DDPRQ-10 score, controlling for resident characteristics.

Participants

We analysed 527 patient encounters performed by all 27 DACCM residents (17 women and 10 men). We asked each medical resident to evaluate 20 consecutive consultations starting on the same date.

Outcome

One hundred and fifty-seven encounters (29.8%) were perceived as difficult.

Results

After adjusting for differences among residents, all five domains of the patient vulnerability grid were independently associated with a difficult encounter: frequent healthcare user; psychological comorbidity; health comorbidity; risky behaviours and a precarious social situation.

Conclusion

Nearly a third of encounters were perceived as difficult by medical residents in our university outpatient clinic that cares for a high proportion of vulnerable patients. This represents twice the average ratio of difficult encounters in general practice. All five domains of patient vulnerability appear to have partial explanatory power on medical residents’ perception of difficult patient encounters.
More than experience: a post-task reflection intervention among team members enhances performance in student teams confronted with a simulated resuscitation task—a prospective randomised trial
Authors: Kündig Patrizia , Tschan Franziska , Semmer Norbert K , Morgenthaler Camille , Zimmermann Jasmin , Holzer Eliane , Huber Simon Andreas , Hunziker Sabina , Marsch Stephan
Published: January 2019

Background

Teams that regularly step back from action and deliberately reflect on their performance and strategies show higher performance. Ad hoc emergency teams with changing team composition cannot develop such habits but may engage in short postaction reflection to discuss shortcomings of past performance and potential adaptations of their strategies for future similar tasks. This study aimed to test the effect of a short postaction self-led reflective team briefing on resuscitation performance in a simulator setting in terms of three performance parameters: hands-on time, coordination between chest compression and ventilation, and defibrillation.

Methods

We performed a randomised controlled trial including 56 ad hoc formed teams of three fourth-year medical students each. All groups performed a resuscitation task, followed by a self-guided reflective briefing, based on a general instruction (n=28 teams), or an unrelated discussion session (control condition; n=29), followed by a second resuscitation task in the same team composition.

Results

Adjusted for performance in the first task, teams in the reflection condition showed higher performance gain in the second resuscitation than teams in the control condition (6.21 percentage points (95% CI 1.31 to 11.10, p<0.001)) for basic hands-on performance; 15.0 percentage points (95% CI 2 to 28, p<0.001) for coordinative performance but non-significantly lower performance for defibrillation (−9%, 95% CI −27% to –9%, p=0.312).

Conclusion

Even very short self-led postaction reflective briefings enhance basic resuscitation performance in ad hoc groups but may not influence more complex aspects of the task. We recommend including short self-led team debriefings as part of simulator training.
Exposing medical students to various difficulty levels of simulated endotracheal intubations improves success rate: a randomised non-blinded trial
Authors: Kazan Roy , Giacalone Marilù , Liu Jiaru , Brogi Etrusca , Cyr Shantale , Hemmerling Thomas M
Published: January 2019

Objective

Simulation training of endotracheal intubation (ETI) has proven to be an effective training tool. We used an adjustable airway mannequin that allows the achievement of various difficulty levels of laryngoscopy to train inexperienced medical students. The purpose of this study was to evaluate the effect of training using this novel airway mannequin on ETI success rates of medical students.

Methods

This was a randomised non-blinded trial conducted at the Steinberg Centre for Simulation and Interactive Learning. Twenty recruited medical students were randomly allocated to two different training groups. During training, the mixed training group was asked to perform successful intubations in three levels of difficulty; the standard training group was asked to perform the same number of successful intubations in one level of difficulty. After training, all participants were asked to perform intubations using both the adjustable airway mannequin and a standard mannequin. Success rates and airway surface area visualised were compared between the two groups.

Results

Students in the mixed training group had a significantly higher success rate both in the adjustable airway mannequin (p=0.01) and in the standard mannequin (p=0.02). Students in the mixed group had 51%, 59% and 47% significantly more visual area surface than students in the standard group during standard and difficult setup of the adjustable airway mannequin and the standard airway mannequin, respectively.

Conclusions

The use of an adjustable airway mannequin to train medical students leads to superior ETI success rates and better glottis visualisation.
Recent advances in monoclonal antibody therapy in IBD: practical issues
Authors: Tamilarasan Aravind Gokul , Cunningham Georgina , Irving Peter M , Samaan Mark A
Published: January 2019

The advent of monoclonal antibody therapies has revolutionised inflammatory bowel disease (IBD) treatment and delivered great benefits to patients. The optimal use of this class of drugs requires careful management and a clear understanding of their properties. In this review article, we consider how to maximise the benefit of our most novel biological agents, vedolizumab and ustekinumab. For each agent, we consider practical aspects including dose flexibility, evidence for use in combination with a conventional immunomodulator and the potential role of therapeutic drug monitoring. We also address positioning of the various mechanisms and agents in treatment algorithms as well as important aspects of managing patients receiving monoclonal antibodies, such as disease reassessment. Finally, we look ahead to the future of monoclonal antibodies, where not only have biosimilars increased the number of agents available but there are also a range of novel mechanisms currently in late phase clinical trials.
Tumour-associated macrophages-derived CXCL8 determines immune evasion through autonomous PD-L1 expression in gastric cancer
Authors: Lin Chao , He Hongyong , Liu Hao , Li Ruochen , Chen Yifan , Qi Yangyang , Jiang Qi , Chen Lingli , Zhang Peipei , Zhang Heng , Li He , Zhang Weijuan , Sun Yihong , Xu Jiejie
Published: January 2019

Objective

Our previous studies have identified CXCL8 as the crucial chemokine responsible for gastric cancer metastasis mediated by loss of RACK1. However, the regulatory effect of CXCL8 on immune surveillance in gastric cancer remains obscure.

Design

Flow cytometry analyses were performed to examine major source of CXCL8 and phenotypes of immune cells in fresh tumour tissues from 76 patients with gastric cancer. Real-time PCR was performed to analyse CXCL8 mRNA level in gastric cancer tissues. For immunohistochemical analyses, a total of 420 patients with gastric cancer undergoing curative resection were enrolled. In vitro culture of fresh tumour tissue was performed to evaluate the potential therapeutic effect of blocking CXCL8 pathway in gastric cancer.

Results

Increased level of CXCL8 indicates poor clinical outcome and tumour progression in patients with gastric cancer. In gastric cancer tissues, CXCL8 is predominantly secreted by macrophages and colony stimulating factor 2 (CSF-2) facilitates macrophage-derived CXCL8 secretion. High level of CXCL8 is associated with decreased CD8+T cells infiltration and Ki67+CD8+T cells proportion. Moreover, CXCL8 also inhibits CD8+T cells function by inducing the expression of PD-L1 on macrophages. Finally, we show that a small-molecule CXCR2 inhibitor, reparixin, drives the decreased programmed death-ligand 1 (PD-L1+) macrophages and promotes antitumour immunity. Accordingly, high levels of CXCL8+macrophages are positively correlated with poor prognosis in patients with gastric cancer.

Conclusions

CXCL8 is predominantly secreted by macrophages and contributes to the immunosuppressive microenvironment by inducing PD-L1+macrophages in gastric cancer. CXCL8 inhibitors may drive antitumour response, providing potential therapeutic effects for patients with gastric cancer.
Genome-wide association analysis of diverticular disease points towards neuromuscular, connective tissue and epithelial pathomechanisms
Authors: Schafmayer Clemens , Harrison James William , Buch Stephan , Lange Christina , Reichert Matthias C , Hofer Philipp , Cossais François , Kupcinskas Juozas , von Schönfels Witigo , Schniewind Bodo , Kruis Wolfgang , Tepel Jürgen , Zobel Myrko , Rosendahl Jonas , Jacobi Thorsten , Walther-Berends Andreas , Schroeder Michael , Vogel Ilka , Sergeev Petr , Boedeker Hans , Hinrichsen Holger , Volk Andreas , Erk Jens-Uwe , Burmeister Greta , Hendricks Alexander , Hinz Sebastian , Wolff Sebastian , Böttner Martina , Wood Andrew R , Tyrrell Jessica , Beaumont Robin N , Langheinrich Melanie , Kucharzik Torsten , Brezina Stefanie , Huber-Schönauer Ursula , Pietsch Leonora , Noack Laura Sophie , Brosch Mario , Herrmann Alexander , Thangapandi Raghavan Veera , Schimming Hans Wolfgang , Zeissig Sebastian , Palm Stefan , Focke Gerd , Andreasson Anna , Schmidt Peter T , Weitz Juergen , Krawczak Michael , Völzke Henry , Leeb Gernot , Michl Patrick , Lieb Wolfgang , Grützmann Robert , Franke Andre , Lammert Frank , Becker Thomas , Kupcinskas Limas , D’Amato Mauro , Wedel Thilo , Datz Christian , Gsur Andrea , Weedon Michael N , Hampe Jochen
Published: January 2019

Objective

Diverticular disease is a common complex disorder characterised by mucosal outpouchings of the colonic wall that manifests through complications such as diverticulitis, perforation and bleeding. We report the to date largest genome-wide association study (GWAS) to identify genetic risk factors for diverticular disease.

Design

Discovery GWAS analysis was performed on UK Biobank imputed genotypes using 31 964 cases and 419 135 controls of European descent. Associations were replicated in a European sample of 3893 cases and 2829 diverticula-free controls and evaluated for risk contribution to diverticulitis and uncomplicated diverticulosis. Transcripts at top 20 replicating loci were analysed by real-time quatitative PCR in preparations of the mucosal, submucosal and muscular layer of colon. The localisation of expressed protein at selected loci was investigated by immunohistochemistry.

Results

We discovered 48 risk loci, of which 12 are novel, with genome-wide significance and consistent OR in the replication sample. Nominal replication (p<0.05) was observed for 27 loci, and additional 8 in meta-analysis with a population-based cohort. The most significant novel risk variant rs9960286 is located near CTAGE1 with a p value of 2.3×10−10 and 0.002 (ORallelic=1.14 (95% CI 1.05 to 1.24)) in the replication analysis. Four loci showed stronger effects for diverticulitis, PHGR1 (OR 1.32, 95% CI 1.12 to 1.56), FAM155A-2 (OR 1.21, 95% CI 1.04 to 1.42), CALCB (OR 1.17, 95% CI 1.03 to 1.33) and S100A10 (OR 1.17, 95% CI 1.03 to 1.33).

Conclusion

In silico analyses point to diverticulosis primarily as a disorder of intestinal neuromuscular function and of impaired connective fibre support, while an additional diverticulitis risk might be conferred by epithelial dysfunction.
Education level and outcomes after acute myocardial infarction in China
Authors: Huo Xiqian , Khera Rohan , Zhang Lihua , Herrin Jeph , Bai Xueke , Wang Qianying , Lu Yuan , Nasir Khurram , Hu Shuang , Li Jing , Li Xi , Zheng Xin , Masoudi Frederick A , Spertus John A , Krumholz Harlan M , Jiang Lixin
Published: January 2019

Objective

To assess the association between educational attainment and acute myocardial infarction (AMI) outcomes in China to inform future healthcare interventions.

Methods

We used data from the China Patient-centred Evaluative Assessment of Cardiac Events-Prospective AMI study of 3369 consecutive patients hospitalised with AMI from 53 hospitals. Educational attainment was categorised as: high (senior high school, college or postgraduate degree), intermediate (junior high school) or low (primary school or illiterate). We used survival models to assess the relationship between education and 1-year major adverse cardiovascular events (MACE), all-cause mortality, both unadjusted and after adjustment for demographic characteristics and cardiovascular risk factors.

Results

The median participant age was 61 (52, 69) years, 23.2% were women, and 33.3% had high, 32.4% intermediate and 34.3% low educational attainment. In unadjusted analysis, compared with high educational attainment, low educational attainment was associated with a higher 1-year risk of MACE (HR 2.41, 95% CI 1.72 to 3.37) and death (HR for low vs high education 3.09, 95% CI 1.69 to 5.65). In risk-adjusted analyses, the association between education and death was attenuated and no longer statistically significant (adjusted HR 1.41, 95% CI 0.74 to 2.69, p=0.30). However, the risk of 1-year MACE (adjusted HR 1.68, 95% CI 1.18 to 2.41, p=0.004) remained significantly greaterin low educational attainment group.

Conclusions

In a national Chinese cohort of patients hospitalised with AMI, low educational attainment was associated with a higher risk of adverse events in the year following discharge. This association highlights the need to consider interventions to improve AMI outcomes in adults with low levels of education.

Clinical trial registration

NCT01624909; Results.
Effect of low-sodium salt substitutes on blood pressure, detected hypertension, stroke and mortality: A systematic review and meta-analysis of randomised controlled trials
Authors: Hernandez Adrian V , Emonds Erin E , Chen Brett A , Zavala-Loayza Alfredo J , Thota Priyaleela , Pasupuleti Vinay , Roman Yuani M , Bernabe-Ortiz Antonio , Miranda J Jaime
Published: January 2019

Objective

A systematic review and meta-analysis was conducted to assess the efficacy of low-sodium salt substitutes (LSSS) as a potential intervention to reduce cardiovascular (CV) diseases.

Methods

Five engines and ClinicalTrials.gov were searched from inception to May 2018. Randomised controlled trials (RCTs) enrolling adult hypertensive or general populations that compared detected hypertension, systolic blood pressure (SBP), diastolic blood pressure (DBP), overall mortality, stroke and other CV risk factors in those receiving LSSS versus regular salt were included. Effects were expressed as risk ratios or mean differences (MD) and their 95% CIs. Quality of evidence assessment followed GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology.

Results

21 RCTs (15 in hypertensive (n=2016), 2 in normotensive (n=163) and 4 in mixed populations (n=5224)) were evaluated. LSSS formulations were heterogeneous. Effects were similar across hypertensive, normotensive and mixed populations. LSSS decreased SBP (MD −7.81 mm Hg, 95% CI −9.47 to –6.15, p<0.00001) and DBP (MD −3.96 mm Hg, 95% CI −5.17 to –2.74, p<0.00001) compared with control. Significant increases in urinary potassium (MD 11.46 mmol/day, 95% CI 8.36 to 14.55, p<0.00001) and calcium excretion (MD 2.39 mmol/day, 95% CI 0.52 to 4.26, p=0.01) and decreases in urinary sodium excretion (MD −35.82 mmol/day, 95% CI −57.35 to –14.29, p=0.001) were observed. Differences in detected hypertension, overall mortality, total cholesterol, triglycerides, glucose or BMI were not significant. Quality of evidence was low to very low for most of outcomes.

Conclusions

LSSS significantly decreased SBP and DBP. There was no effect for detected hypertension, overall mortality and intermediate outcomes. Large, long-term RCTs are necessary to clarify salt substitute effects on clinical outcomes.
Ethnic differences in atrial fibrillation in patients with heart failure from Asia-Pacific
Authors: Tan Eugene S J , Tay Wan Ting , Teng Tiew-Hwa Katherine , Sim David , Leong Kui Toh Gerard , Yeo Poh Shuan Daniel , Ong Hean Yee , Jaufeerally Fazlur , Ng Tze Pin , Poppe Katrina , Lund Mayanna , Devlin Gerard , Troughton Richard W , Ling Lieng Hsi , Richards Arthur Mark , Doughty Robert N , Lam Carolyn S P
Published: January 2019

Objective

Ethnic differences in the prevalence of atrial fibrillation (AF) in heart failure (HF) remain unclear. We compared the prevalence and clinical correlates of AF among different ethnicities in an Asian-Pacific population with HF.

Methods

Patients with validated HF were prospectively studied across Singapore and New Zealand (NZ).

Results

Among 1746 patients with HF (62% Asian, 26% women, mean age 66 (SD 13) years, mean ejection fraction (EF) 37 (SD 16%), 39% had AF. The prevalence of AF was markedly lower in Singapore-Asians than NZ-Europeans (24% vs 63%; p<0.001), even after adjusting for age, clinical and echocardiographic covariates, regardless of EF group (pinteractionfor EF=0.39). Patients with AF were older, had higher body mass index and were more likely to have a history of hypertension, stroke, peripheral vascular disease, renal disease, chronic respiratory disease and increased alcohol intake, but less likely to have diabetes. Clinical correlates were similar for Asians and NZ-Europeans, except diabetes: Asian diabetic patients with HF had less AF compared with Asian patients without diabetes (OR 0.66, 95% CI 0.50 to 0.88), whereas among NZ-Europeans there was no significant association between diabetes and AF (OR 1.22, 95% CI 0.85 to 1.75) (pinteractionfor ethnicity=0.01). AF was associated with a higher crude composite outcome of mortality and HF hospitalisations at 2 years (HR 1.19, 95% CI 1.02 to 1.38).

Conclusion

There is a strikingly lower prevalence of AF among Asian compared with NZ-European patients with HF. The underlying mechanisms for the lower prevalence of AF among Asians, particularly in the presence of diabetes, deserve further study.

Trial registration number

ACTRN12610000374066.
Postmortem microbiology sampling following death in hospital: an ESGFOR task force consensus statement
Authors: Burton Julian L , Saegeman Veroniek , Arribi Ana , Rello Jordi , Andreoletti Laurent , Cohen Marta C , Fernandez-Rodriguez Amparo
Published: January 2019

Postmortem microbiology (PMM) is a valuable tool in the identification of the cause of death and of factors contributory to death where death has been caused by infection. The value of PMM is dependent on careful autopsy planning, appropriate sampling, minimisation of postmortem bacterial translocation and avoidance of sample contamination. Interpretation of PMM results requires careful consideration in light of the clinical history, macroscopic findings and the histological appearances of the tissues. This consensus statement aims to highlight the importance of PMM in the hospital setting and to give microbiological and pathological advice on sampling in deaths occurring in hospital.
Characteristics of the built environment and spatial patterning of type 2 diabetes in the urban core of Durham, North Carolina
Authors: Bravo Mercedes A , Anthopolos Rebecca , Miranda Marie Lynn
Published: January 2019

Background

Few studies examine relationships between built environment (BE) and type 2 diabetes mellitus (T2DM) using spatial models, investigate BE domains apart from food environment or physical activity resources or conduct sensitivity analysis of methodological choices made in measuring BE. We examine geographic heterogeneity of T2DM, describe how heterogeneity in T2DM relates to BE and estimate associations of T2DM with BE.

Methods

Individual-level electronic health records (n=41 203) from the Duke Medicine Enterprise Data Warehouse (2007–2011) were linked to BE based on census block. Data on housing damage, property disorder, territoriality, vacancy and public nuisances were used to estimate BE based on four different construction methods (CMs). We used race-stratified aspatial and spatial Bayesian models to assess geographic heterogeneity in T2DM and associations of T2DM with BE.

Results

Among whites, a 1 SD increase in poor quality BE was associated with a 1.03 (95% credible interval 1.01 to 1.06) and 1.06 (95 % credible interval 1.02 to 1.11) increased risk of T2DM for poor quality BE CM1 and CM2, respectively. Among blacks/African Americans, associations between T2DM and BE overlapped with the null for all CMs. The addition of BE to white models reduced residual geographic heterogeneity in T2DM by 4%–15%, depending on CM. In black/African–American models, BE did not affect residual heterogeneity.

Conclusion

Associations of T2DM with BE were sensitive to CM and geographic heterogeneity in T2DM differed by race/ethnicity. Findings underscore the need to consider multiple methods of estimating BE and consider differences in relationships by race/ethnicity.
Differential vulnerability to neighbourhood disorder: a gene×environment interaction study
Authors: Robinette Jennifer Williams , Boardman Jason D , Crimmins Eileen M
Published: January 2019

Background

Type 2 diabetes (T2D) is preventable, it is increasing in prevalence and it is a major risk factor for morbidity and mortality. Importantly, residents of neighbourhoods with high levels of disorder are more likely to develop T2D than those living in less disordered neighbourhoods and neighbourhood disorder may exacerbate genetic risk for T2D.

Method

We use genetic, self-reported neighbourhood, and health data from the Health and Retirement Study. We conducted weighted logistic regression analyses in which neighbourhood disorder, polygenic scores for T2D and their interaction predicted T2D.

Results

Greater perceptions of neighbourhood disorder (OR=1.11, p<0.001) and higher polygenic scores for T2D (OR=1.42, p<0.001) were each significantly and independently associated with an increased risk of T2D. Furthermore, living in a neighbourhood perceived as having high levels of disorder exacerbated genetic risk for T2D (OR=1.10, p=0.001). This significant gene×environment interaction was observed after adjusting for years of schooling, age, gender, levels of physical activity and obesity.

Conclusion

Findings in the present study suggested that minimising people’s exposure to vandalism, vacant buildings, trash and circumstances viewed by residents as unsafe may reduce the burden of this prevalent chronic health condition, particularly for subgroups of the population who carry genetic liability for T2D.
SMAD3pathogenic variants: risk for thoracic aortic disease and associated complications from the Montalcino Aortic Consortium
Authors: Hostetler Ellen M , Regalado Ellen S , Guo Dong-Chuan , Hanna Nadine , Arnaud Pauline , Muiño-Mosquera Laura , Callewaert Bert Louis , Lee Kwanghyuk , Leal Suzanne M , Wallace Stephanie E , Rideout Andrea L , Dyack Sarah , Aatre Rajani D , Boileau Catherine , De Backer Julie , Jondeau Guillaume , Milewicz Dianna M
Published: January 2019

Background

Pathogenic variants inSMAD3cause thoracic aortic aneurysms and dissections, along with aneurysms and rupture of other arteries. Here, we examined differences in clinical presentation of aortic events (dissection or surgical repair of an aneurysm) with respect to age and variant type in an international cohort of individuals withSMAD3variants.

Methods

Aortic status and events, vital status and clinical features were abstracted through retrospective review of medical records of 212 individuals with 51 uniqueSMAD3variants, including haploinsufficiency (HI) and missense substitutions in the MH2 domain, as well as novel in-frame deletions and missense variants in the MH1 domain.

Results

Aortic events were documented in 37% of cases, with dissections accounting for 70% of events. The median age at first aortic event was significantly lower in individuals withSMAD3MH2 missense variants than those with HI variants (42years vs 49 years; p=0.003), but there was no difference in frequency of aortic events by variant type. The cumulative risk of an aortic event was 50% at 54 years of age. No aortic events in childhood were observed.

Conclusions

SMAD3pathogenic variants cause thoracic aortic aneurysms and dissections in the majority of individuals with variable age of onset and reduced penetrance. Of the covariates examined, the type of underlyingSMAD3variant was responsible for some of this variation. Later onset of aortic events and the absence of aortic events in children associated withSMAD3variants support gene-specific management of this disorder.
Public health crises in popular media: how viral outbreak films affect the public’s health literacy
Authors: Kendal Evie
Published: January 2019

Infectious disease epidemics are widely recognised as a serious global threat. The need to educate the public regarding health and safety during an epidemic is particularly apparent when considering that behavioural changes can have a profound impact on disease spread. While there is a large body of literature focused on the opportunities and pitfalls of engaging mass news media during an epidemic, given the pervasiveness of popular film in modern society there is a relative lack of research regarding the potential role of fictional media in educating the public about epidemics. There is a growing collection of viral outbreak films that might serve as a source of information about epidemics for popular culture consumers that warrants critical examination. As such, this paper considers the motivating factors behind engaging preventive behaviours during a disease outbreak, and the role news and popular media may have in influencing these behaviours.
Night work and sick leave during pregnancy: a national register-based within-worker cohort study
Authors: Hammer Paula Edeusa Cristina , Garde Anne Helene , Begtrup Luise Moelenberg , Flachs Esben Meulengracht , Hansen Johnni , Hansen Åse Marie , Hougaard Karin Sørig , Kolstad Henrik A , Larsen Ann Dyreborg , Pinborg Anja Bisgaard , Specht Ina Olmer , Bonde Jens Peter
Published: January 2019

Objective

The aim of our study was to investigate the acute effect of night work during pregnancy on the risk of calling in sick the following day using register-based information and the workers as their own controls.

Methods

Using the payroll-based national Danish Working Hour Database, including all public hospital employees in Denmark, we identified 9799 pregnant women with ≥1 day shift and ≥1 night shift and ≥1 day of sick leave during the first 32 pregnancy weeks from January 2007 to December 2013. We performed fixed effects logistic regression, that is, within-worker comparisons, of the risk of sick leave of any duration starting within 24 hours after night shifts of different length versus day shifts.

Results

Most of the participants were nurses (64%) or physicians (16%). We found an increased relative risk of sick leave following night shifts compared with day shifts during all pregnancy trimesters. The risk was highest for night shifts lasting >12 hours (OR 1.37, 95% CI 1.15 to 1.63 for nurses; OR 1.87, 95% CI 1.69 to 2.08 for physicians) and among women aged >35 years (OR 1.42, 95% CI 1.24 to 1.63).

Conclusion

Among Danish public hospital employees night shifts during pregnancy, especially shifts longer than 12 hours, increased the risk of calling in sick the following day independent of personal factors and time-invariant confounders in all pregnancy trimesters.
ECG conduction disturbances and ryanodine receptor expression levels in occupational lead exposure workers
Authors: Xie Jie , Du Guihua , Zhang Yuanyuan , Zhou Fankun , Wu Junfang , Jiao Huan , Li Yanshu , Chen Ying , Ouyang Lu , Bo Dandan , Feng Chang , Yang Wei , Fan Guangqin
Published: January 2019

Objectives

A significant number of researches have evidenced that occupational lead (Pb) exposure increased risks of cardiovascular disease. However, evidences about the potential effects of Pb on the cardiac conduction system are sparse and inconclusive. Besides, ryanodine receptors (RyRs) induced dysfunction of cardiac excitation contraction coupling which is considered to be one of the mechanisms in cardiovascular diseases. Therefore, we examined the association between occupational Pb exposure and ECG conduction abnormalities, as well as RyRs in Pb-induced ECG abnormalities.

Methods

We investigated 529 Pb smelter workers, and measured blood lead (BPb), zinc protoporphyrin (ZPP), ECG outcomes and RyR expression levels. Based on BPb levels, the workers were divided into three groups: the BPb not elevated group, the BPb elevated group and the Pb poisoning group. Descriptive and multivariable analyses were performed.

Results

Compared with the BPb not elevated group, the Pb poisoning group had a higher incidence of high QRS voltage, and a lower level of RyR1 gene expression (p<0.05). Further unconditional multivariable logistic regression analyses showed that high QRS voltage was positively related to BPb (OR=1.045, 95% CI 1.014 to 1.078) and inversely associated with RyR1 expression (OR=0.042, 95% CI 0.002 to 0.980) after adjusting for potential confounders. In addition, multiple linear regression analyses showed that the QTc interval was positively associated with ZPP (β=0.299, 95% CI 0.130 to 0.468) after adjusting for potential confounders.

Conclusions

Our study provided evidences that occupational exposure to Pb may be associated with worse ECG outcomes (high QRS voltage), which might be related to decreased levels of RyR1.
Secondhand smoke alters arachidonic acid metabolism and inflammation in infants and children with cystic fibrosis
Authors: Kopp Benjamin T , Thompson Rohan , Kim Jeeho , Konstan Robert , Diaz Alejandro , Smith Bennett , Shrestha Chandra , Rogers Lynette K , Hayes Don , Tumin Dmitry , Woodley Frederick W , Ramilo Octavio , Sanders Don B , Groner Judith A , Mejias Asuncion
Published: January 2019

Background

Mechanisms that facilitate early infection and inflammation in cystic fibrosis (CF) are unclear. We previously demonstrated that children with CF and parental-reported secondhand smoke exposure (SHSe) have increased susceptibility to bacterial infections. SHSe hinders arachidonic acid (AA) metabolites that mediate immune function in patients without CF, and may influence CF immune dysfunction. We aimed to define SHSe’s impact on inflammation mediators and infection in children with CF.

Methods

Seventy-seven children with CF <10 years of age (35 infants <1 year; 42 children 1–10 years) were enrolled and hair nicotine concentrations measured as an objective surrogate of SHSe. AA signalling by serum and macrophage lipidomics, inflammation using blood transcriptional profiles and in vitro macrophage responses to bacterial infection after SHSe were assessed.

Results

Hair nicotine concentrations were elevated in 63% of patients. Of the AA metabolites measured by plasma lipidomics, prostaglandin D2 (PGD2) concentrations were decreased in children with CF exposed to SHSe, and associated with more frequent hospitalisations (p=0.007) and worsened weight z scores (p=0.008). Children with CF exposed to SHSe demonstrated decreased expression of the prostaglandin genes PTGES3 and PTGR2 and overexpression of inflammatory pathways. These findings were confirmed using an in vitro model, where SHSe was associated with a dose-dependent decrease in PGD2 and increased methicillin-resistant Staphylococcus aureus survival in human CF macrophages.

Conclusions

Infants and young children with CF and SHSe have altered AA metabolism and dysregulated inflammatory gene expression resulting in impaired bacterial clearance. Our findings identified potential therapeutic targets to halt early disease progression associated with SHSe in the young population with CF.