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Hao X, He H, Tao L, Zhao W, Wang P. Waistline to thigh circumference ratio as a predictor of MAFLD: a health care worker study with 2-year follow-up. BMC Gastroenterol 2024; 24:144. [PMID: 38658820 PMCID: PMC11044289 DOI: 10.1186/s12876-024-03229-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 04/15/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND This study aimed to determine whether the waist-to-thigh ratio (WTTR) is associated with the incidence of metabolic-associated fatty liver disease (MAFLD) in health care workers. METHODS There were 4517 health care workers with baseline data and results from 2 follow-up examinations. We divided the subjects into 3 groups according to baseline WTTR and used the Cox hazard regression model to estimate MAFLD risk. RESULTS The WTTRs were categorized by tertiles at baseline using the values 1.58 and 1.66. Patients with higher WTTR tended to have significantly greater values for the following factors, body mass index (BMI), fasting blood glucose (FPG), systolic blood pressure, diastolic blood pressure, total cholesterol (TC), triglycerides (TG), low-density lipoprotein-cholesterol (LDL-C) and neck circumference. The incidence of MAFLD significantly increased with increasing WTTR tertiles (5.74%, 12.75% and 22.25% for the first, second and third tertiles, respectively, P < 0.05 for trend). Kaplan-Meier(K-M) survival analysis revealed a significant tendency towards increased MAFLD risk with increasing WTTR tertile. In the fully adjusted model, the hazard ratios (95% CIs) for MAFLD in the second, third WTTR tertiles compared with the first quartile were 2.17(1.58,2.98), 3.63(2.70,4.89), respectively, third neck circumference tertiles compared with the first quartile were 2.84(1.89,4.25), 8.95(6.00,13.35), respectively. Compared with those of individuals with a BMI > 23 kg/m2, the associations between WTTR and MAFLD incidence were more pronounced in subjects with a BMI < 23 kg/m2. Similarly, the difference in neck circumference was more pronounced in these patients with a BMI < 23 kg/m2. CONCLUSIONS Our results revealed that the WTTR is an independent risk factor for MAFLD, and there was a dose‒response relationship between the WTTR and MAFLD risk. The neck circumference was significantly different in subjects with a BMI < 23 kg/m2. This approach provides a new way to predict the incidence rate of MAFLD.
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Affiliation(s)
- Xiaoyan Hao
- Medical examination center, Peking University, Third Hospital, North Garden Road & 49, Beijing, China
| | - Honghai He
- Medical examination center, Peking University, Third Hospital, North Garden Road & 49, Beijing, China
| | - Liyuan Tao
- Medical examination center, Peking University, Third Hospital, North Garden Road & 49, Beijing, China
| | - Wei Zhao
- Medical examination center, Peking University, Third Hospital, North Garden Road & 49, Beijing, China.
| | - Peng Wang
- Medical examination center, Peking University, Third Hospital, North Garden Road & 49, Beijing, China.
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Bodek A, Pommée M, Berger A, Giraki M, Müller BS, Schütze D. Blackbox error management: how do practices deal with critical incidents in everyday practice? A qualitative interview study. BMC Prim Care 2023; 24:251. [PMID: 38030963 PMCID: PMC10685626 DOI: 10.1186/s12875-023-02206-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 11/14/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Error management plays a key role in patient safety. It is a systematic approach aimed at identifying and learning from critical incidents by reporting, documenting and analyzing them. Almost nothing is known about the incidents physicians in outpatient care consider to be critical and how they deal with them. We carried out an interview study to explore outpatient physicians' views on error management, discover what they regard as critical incidents, and find out how error management is put into practice in ambulatory care. METHODS We conducted 72 semi-structured interviews with physicians from ambulatory practices. We asked participants what they considered to be a critical incident, how they reacted following an incident, how they discussed incidents with their coworkers, and whether they used critical incident reporting systems. The interviews were transcribed verbatim and analyzed using qualitative content analysis. RESULTS Interviewed physicians defined the term "critical incident" differently. Most participants reported that they recorded information on incidents and discussed them in their teams. Several physicians reported taking a 'pay better attention next time-approach' to the analysis of incidents. Systematic error management involving incident documentation, analysis, preventive measure development, and follow-up, was the exception. CONCLUSIONS To promote error management, medical training should include teaching on the topic, so that medical professionals can learn about critical incidents and how to deal with them in an open and structured manner. This would help establish the culture of safety that has long been called for internationally.
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Affiliation(s)
- Aljoscha Bodek
- Institute of General Practice, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt Am Main, Germany
| | - Marina Pommée
- Institute of General Practice, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt Am Main, Germany
- Association of Statutory Health Insurance Physicians Westphalia-Lippe, Robert-Schimrigk-Str. 4-6, 44141, Dortmund, Germany
| | - Alexandra Berger
- Institute of General Practice, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt Am Main, Germany
- Frankfurt Reference Centre for Rare Diseases, University Hospital of the Goethe University Frankfurt, Theodor Stern-Kai 7, 60590, Frankfurt, Germany
| | - Maria Giraki
- Department of Operative Dentistry, Center for Dentistry and Oral Medicine (Carolinum), Goethe University Frankfurt, Theodor-Stern-Kai 7, 60596, Frankfurt Am Main, Germany
| | - Beate Sigrid Müller
- Institute of General Practice, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt Am Main, Germany
- Faculty of Medicine and University Hospital Cologne, Institute of General Practice, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Dania Schütze
- Institute of General Practice, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt Am Main, Germany.
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Hatami M, Marzaleh MA, Bijani M, Peyravi M. Factors affecting the preparedness of Helicopter Emergency Medical Services (HEMS) in disasters: a systematic review. BMC Emerg Med 2023; 23:135. [PMID: 37953223 PMCID: PMC10641982 DOI: 10.1186/s12873-023-00908-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/07/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND One of the most significant advantages of Helicopter Emergency Medical Service (HEMS) in disaster relief efforts is their ability to reach inaccessible or remote areas quickly. This is especially important in the aftermath of natural disasters such as earthquakes, floods, or hurricanes, where roads may be blocked or damaged, and conventional ground transportation may not be available. There are many factors can affect the performance of Helicopter Emergency Medical Service (HEMS) in disasters. This study aims to investigate the factors affecting the Helicopter Emergency Medical Service (HEMS) in disasters. METHODS The systematic search in Cochran Library, PubMed, Scopus, Science Direct, Web of Science, ProQuest, and Google Scholar databases between the first of January in 1975 and the thirty-first of May in 2023. The articles were selected based on the keywords of the authors. At last, the criteria were extracted from the selected ones. RESULTS The primary search included 839 articles. After studying their title, abstract, and full context, only nine articles, including two qualitative and seven quantitative ones, were chosen for analysis. After analysis and extracting data from the final studies, the preparation factors were categorized into 6 general classes of human resources: training and practicing, management, instructions and standards, equipment, and structure. Among these, the role of training is highlighted by holding practice and maneuvers to improve and prepare the personnel and manage disasters and incidents. CONCLUSION The results obtained from this systematic review provide a total view of the factors affecting the preparation of the air ambulance during disasters and incidents. It is recommended that senior managers and policy makers use the findings of the present study to identify the factors which affect preparedness of HEMS in disasters and take the necessary measures to eliminate to obstacles.
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Affiliation(s)
- Mahmoud Hatami
- Department of Health in Disasters and Emergencies, Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Milad Ahmadi Marzaleh
- Department of Health in Disasters and Emergencies, Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mostafa Bijani
- Department of Medical Surgical Nursing, School of Nursing, Fasa University of Medical Sciences, Fasa, Iran
| | - Mahmoudreza Peyravi
- Department of Health in Disasters and Emergencies, Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
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Baehr A, Grohmann M, Guberina M, Schulze K, Lange T, Nestle U, Ernst P. Usability and usefulness of (electronic) patient identification systems-A cross-sectional evaluation in German-speaking radiation oncology departments. Strahlenther Onkol 2023:10.1007/s00066-023-02148-9. [PMID: 37713170 DOI: 10.1007/s00066-023-02148-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/13/2023] [Indexed: 09/16/2023]
Abstract
PURPOSE Patient misidentification in radiation oncology (RO) is a significant concern due to the potential harm to patient health and the burden on healthcare systems. Electronic patient identification systems (ePIS) are increasingly being used as an alternative or supplement to organizational systems (oPIS). The objective of this study was to assess the usability and usefulness of ePIS and oPIS in German-speaking countries. METHODS A cross-sectional survey was designed by a group of experts from various professional backgrounds in RO. The survey consisted of 38 questions encompassing quantitative and qualitative data on usability, user experience, and usefulness of PIS. It was available between August and October 2022. RESULTS Of 118 eligible participants, 37% had implemented some kind of ePIS. Overall, 22% of participants who use an oPIS vs. 10% of participants who use an ePIS reported adverse events in terms of patients' misidentification in the past 5 years. Frequent or very frequent drop-outs of electronic systems were reported by 31% of ePIS users. Users of ePIS significantly more often affirmed a positive cost-benefit ratio of ePIS as well as an improvement of workflow, whereas users of oPIS more frequently apprehended a decrease in staffs' attention through ePIS. The response rate was 8%. CONCLUSION The implementation of ePIS can contribute to efficient PI and improved processes. Apprehensions by oPIS users and assessments of ePIS users differ significantly in aspects of the perceived usefulness of ePIS. However, technical problems need to be addressed to ensure the reliability of ePIS. Further research is needed to assess the impact of different PIS on patient safety in RO.
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Affiliation(s)
- Andrea Baehr
- Department of Radiation Oncology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
- Department of Radiation Oncology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Maximilian Grohmann
- Department of Radiation Oncology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Maja Guberina
- Department of Radiotherapy, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Essen, Germany
| | - Katrin Schulze
- Department of Radiation Oncology, Fulda Community Hospital, Fulda, Germany
| | - Tim Lange
- Clinic for Radiotherapy, Hannover, Medical School, Hannover, Germany
| | - Ursula Nestle
- Department of Radiation Oncology, Kliniken Maria Hilf GmbH, Moenchengladbach, Germany
| | - Philipp Ernst
- Department of Radiation Oncology, Kliniken Maria Hilf GmbH, Moenchengladbach, Germany
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Syyrilä T, Vehviläinen-Julkunen K, Mikkonen S, Härkänen M. Measuring health professionals' perceptions of communication contributing to medication incidents in hospitals - scale development and primary results of weekly perceived communication challenges. BMC Nurs 2023; 22:285. [PMID: 37626368 PMCID: PMC10463788 DOI: 10.1186/s12912-023-01455-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Communication challenges are one of the main contributors for medication incidents in hospitals, but health professionals' perceptions about variety of the contributing communication factors and the factors' occurrence frequencies are studied little. This cross-sectional descriptive study aimed to (1) operationalize a literature-based framework into a scale for measuring health professionals' perceptions of communication factors, which contribute to medication incidents either directly or indirectly in hospitals, (2) to measure the construct validity and internal consistency of the scale and (3) to describe the primary results of the measured weekly perceived communication challenges. METHODS The structured online questionnaire with 82 communication related items was developed based on a framework in literature. A content validity index of expert panelists' answers was used for item reduction. Data was collected between November 1st, 2019, and January 31st, 2020, by convenience sampling. The study sample (n = 303) included multiple health professional groups in diverse specialties, unit types and organizational levels in two specialized university hospital districts in Finland. Exploratory factor analysis with Maximum Likelihood method and Oblique rotation produced a six factors scale consisting of 57 items and having acceptable construct validity and internal consistency. RESULTS The six communication factors contributing to medication incidents concerned (1) medication prescriptions, (2) guidelines and reporting, (3) patient and family, (4) guideline implementation,5) competencies and responsibilities, and 6) attitude and atmosphere. The most frequently perceived communication challenges belonged to the Medication prescription related factor. Detailed item frequencies suggested that the most usual weekly challenges were: (1) lack or unclarity of communication about medication prescriptions, (2) missing the prescriptions which were written outside of the regular physician-ward-rounds and (3) digital software restricting information transfer. CONCLUSIONS The scale can be used for determining the most frequent detailed communication challenges. Confirmatory factor analysis of the scale is needed with a new sample for the scale validation. The weekly perceived communication challenges suggest that interventions are needed to standardize prescribing documentation and to strengthen communication about prescriptions given outside of regular ward-rounds.
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Affiliation(s)
- Tiina Syyrilä
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland (UEF), PO Box 1627, Kuopio, 70211, Finland.
| | - Katri Vehviläinen-Julkunen
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland (UEF), PO Box 1627, Kuopio, 70211, Finland
- Kuopio University Hospital (KUH), Kuopio, Finland
| | - Santtu Mikkonen
- Department of Environmental and Biological Sciences, University of Eastern Finland (UEF), Kuopio, Finland
- Department of Technical Physics, Faculty of Science, Forestry and Technology, University of Eastern Finland (UEF), Kuopio, Finland
| | - Marja Härkänen
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland (UEF), PO Box 1627, Kuopio, 70211, Finland
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Wu VC, Chan CK, Wu WC, Peng KY, Chang YS, Yeh FY, Chiang JY, Lee YJ, Liu KL, Wang SM, Lin YH, Chueh JS, Chueh SCJ, Yang SY, Liu KL, Chang CC, Lee BC, Wang SM, Huang KH, Lin PC, Lin YH, Lin LY, Liao SC, Yen RF, Lu CC, Er LK, Hu YH, Chang CH, Wu CH, Tsai YC, Ho CH, Huang WC, Chen YY, Wu VC. New-onset diabetes mellitus risk associated with concurrent autonomous cortisol secretion in patients with primary aldosteronism. Hypertens Res 2023; 46:445-455. [PMID: 36481967 DOI: 10.1038/s41440-022-01086-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/03/2022] [Accepted: 10/04/2022] [Indexed: 12/14/2022]
Abstract
Concurrent autonomous cortisol secretion (ACS) in patients with primary aldosteronism (PA patients) is not uncommon. This work aimed to determine the effect of cortisol levels on incident new-onset type 2 diabetes mellitus (NODM) in PA patients. Using the prospectively designed observational TAIPAI cohort, the PA patients were grouped by cortisol level after an overnight low-dose dexamethasone suppression test (1-mg DST). Of the 476 PA patients, 387 (43.7% men; mean age 52.8 years) did not have baseline DM. After a mean follow-up of 4.3 ± 2.9 years, 32 patients (8.3%) developed NODM. The cutoff value obtained via a generalized additive model showed that a serum cortisol level ≥ 2.65 µg/dL after 1-mg DST was a risk factor for developing NODM (HR, 3.5, p = 0.031) by Cox proportional- hazards model.. In PA patients with a higher body mass index (>25 kg/m2; HR, 3.16), lower estimated glomerular filtration rate (<90 ml/min/1.73 m2; HR, 3.18), longer hypertension duration (>7 years; HR, 3.34), and higher waist-to-hip ratio (>0.9; HR, 3.07), a concomitant cortisol level ≥ 2.65 μg/dL after 1-mg DST were more likely to develop NODM. The high-cortisol group of patients with aldosterone-producing adenoma (APA) using mineralocorticoid receptor antagonist (MRA) was associated with an increased risk of NODM (HR, 5.72). Our results showed that PA patients with a concomitant cortisol level ≥ 2.65 µg/dL after 1-mg DST, independent of the aldosterone level, had a higher incidence of NODM. Such PA patients should be carefully evaluated and managed to achieve better glucose control and prevent metabolic syndrome.
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Affiliation(s)
- Vin-Cent Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chieh-Kai Chan
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu City, Taiwan
| | - Wan-Chen Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Kang-Yung Peng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yuan-Shian Chang
- Department of Internal Medicine, Postal Hospital, Taipei, Taiwan
| | - Fang-Yu Yeh
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jiun-Yang Chiang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yuan-Ju Lee
- Department of Urology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Kao-Lang Liu
- Medical Imaging, National Taiwan University Cancer Center, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shuo-Meng Wang
- Department of Urology, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Yen-Hung Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jeff S Chueh
- Department of Urology, College of Medicine, National Taiwan University, Taipei, Taiwan
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Topcagic M, Julardzija F, Pasalic A, Sehic A, Beganovic A, Osmic H, Tinjak E, Huskic A. Electronic On-line Incident Reporting System (IRS) as a Tool for Risk Assessment in Radiation Therapy. Acta Inform Med 2023; 31:222-225. [PMID: 37781492 PMCID: PMC10540742 DOI: 10.5455/aim.2023.31.222-225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 09/09/2023] [Indexed: 10/03/2023] Open
Abstract
Background Radiotherapy is one of the primary treatment options in cancer management, together with surgery and chemotherapy. Radiation therapy is technologically complex discipline involving professionals with various specialties, and using high energy radiation in treatment of wide range of different cancer types. Technical complexity, increasing number of patients, large workload, and delivery of radiation therapy treatment with lack of human, technical and financial resources in low and middle income countries creates environment with great potential to develop incidents. Emerging need of modern radiation therapy is to develop preventive approach to risk management i to improve the patient safety. Objective The objective of this research is to identify and assess risk associated with radiation therapy practice in Bosnia and Herzegovina. Methods An anonymous, voluntary electronic on-line radiation therapy incident reporting system (IRS) was created. IRS consists of four sections containing questions about working environment, incident occurrence, root causes and contributing factors, and incident severity assessment. Data collected using IRS were used to create taxonomy of incidents in radiation therapy. Risk assessment was made using Risk Matrix method. Research was made using the data collected from first 60 incidents reported to IRS. Results Based on probability and frequency of incident occurrence and severity of consequences, it was assessed that 41.7% of incidents had low risk level (L), 50% of incidents had moderate risk level (M), and 8.3% of incidents had high risk level (H). Radiation therapy risk profile based on risk assessment results clearly shows that incidents with low frequency, low occurrence probability, but high consequences severity level have highest level of risk. Conclusion The results of this research confirm that the electronic on-line radiation therapy IRS allows the identification and classification of the most significant risk factors in radiotherapy and prevention of serious incidents occurrence.
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Affiliation(s)
- Muhamed Topcagic
- Clinic of Oncology and Radiation Therapy, University Clinical Center Tuzla, Tuzla, Bosnia & Herzegovina
| | - Fuad Julardzija
- Faculty of Health Studies, University of Sarajevo, Sarajevo, Bosnia & Herzegovina
| | - Arzija Pasalic
- Faculty of Health Studies, University of Sarajevo, Sarajevo, Bosnia & Herzegovina
| | - Adnan Sehic
- Faculty of Health Studies, University of Sarajevo, Sarajevo, Bosnia & Herzegovina
| | - Adnan Beganovic
- Clinic of Oncology, University Clinical Center Sarajevo, Sarajevo, Bosnia & Herzegovina
| | - Hasan Osmic
- Clinic of Oncology and Radiation Therapy, University Clinical Center Tuzla, Tuzla, Bosnia & Herzegovina
| | - Enis Tinjak
- Clinic of Oncology, University Clinical Center Sarajevo, Sarajevo, Bosnia & Herzegovina
| | - Adnan Huskic
- Clinic of Oncology and Radiation Therapy, University Clinical Center Tuzla, Tuzla, Bosnia & Herzegovina
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Sheikhbardsiri H, Khademipour G, Davarani ER, Tavan A, Amiri H, Sahebi A. Response capability of hospitals to an incident caused by mass gatherings in southeast Iran. Injury 2022; 53:1722-1726. [PMID: 35027219 DOI: 10.1016/j.injury.2021.12.055] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 12/27/2021] [Accepted: 12/30/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND OBJECTIVES Hospitals are expected to provide a safe environment for patients, visitors, and employees during emergencies and disasters, as well as provide health care to disaster survivors. The aim of this study was to evaluate the response capability of hospitals to an incident caused by mass gatherings (MG) in Kerman province. METHODS This cross-sectional study was performed among hospitals of Kerman city in 2021. To collect data, the emergency response checklist-WHO (2011) was utilized with 90 questions prepared in nine domains. Data analysis was carried out using SPSS version 20 with descriptive tests. RESULTS In this incident, 438 people were injured and 61 killed (31 women and 30 men). Of the 438 injured taken to hospitals, 193 were treated on an outpatient basis, 146 were hospitalized and 99 were treated at Advanced Medical Post (AMP) and mobile hospital in the scene. Results showed a moderate response level of hospitals to an incidence (151.50±18.28). Among the components of hospitals' response to incidence, the command and control component had the highest mean score (159.16 ± 22.39) while the surge capacity component had the lowest mean score (129.78 ± 25.21). CONCLUSION Our hospitals faced new challenges in this incident; therefore, policymakers and executives managers of the health system in Iran should develop a comprehensive strategic plan to promote hospitals' preparedness for suitable and timely response to MG incidences and improve risk perception of mass gathering participants and hospitals personnel through training and implementing discussion and operation-based exercises.
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Affiliation(s)
- Hojjat Sheikhbardsiri
- Health in Disasters and Emergencies Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Gholamreza Khademipour
- Health in Disasters and Emergencies Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Asghar Tavan
- Health in Disasters and Emergencies Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Hadis Amiri
- Health in Disasters and Emergencies Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Sahebi
- Non-Communicable Diseases Research Center, Ilam University of Medical Sciences, Ilam, Iran.
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Szili-Torok T, Sokooti S, Osté MCJ, Gomes-Neto AW, Dullaart RPF, Bakker SJL, Tietge UJF. Remnant lipoprotein cholesterol is associated with incident new onset diabetes after transplantation (NODAT) in renal transplant recipients: results of the TransplantLines Biobank and cohort Studies. Cardiovasc Diabetol 2022; 21:41. [PMID: 35296331 PMCID: PMC8925054 DOI: 10.1186/s12933-022-01475-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/02/2022] [Indexed: 01/04/2023] Open
Abstract
Background New onset diabetes after transplantation (NODAT) is a frequent and serious complication of renal transplantation resulting in worse graft and patient outcomes. The pathophysiology of NODAT is incompletely understood, and no prospective biomarkers have been established to predict NODAT risk in renal transplant recipients (RTR). The present work aimed to determine whether remnant lipoprotein (RLP) cholesterol could serve as such a biomarker that would also provide a novel target for therapeutic intervention. Methods This longitudinal cohort study included 480 RTR free of diabetes at baseline. 53 patients (11%) were diagnosed with NODAT during a median [interquartile range, IQR] follow-up of 5.2 [4.1–5.8] years. RLP cholesterol was calculated by subtracting HDL and LDL cholesterol from total cholesterol values (all directly measured). Results Baseline remnant cholesterol values were significantly higher in RTR who subsequently developed NODAT (0.9 [0.5–1.2] mmol/L vs. 0.6 [0.4–0.9] mmol/L, p = 0.001). Kaplan-Meier analysis showed that higher RLP cholesterol values were associated with an increased risk of incident NODAT (log rank test, p < 0.001). Cox regression demonstrated a significant longitudinal association between baseline RLP cholesterol levels and NODAT (HR, 2.27 [1.64–3.14] per 1 SD increase, p < 0.001) that remained after adjusting for plasma glucose and HbA1c (p = 0.002), HDL and LDL cholesterol (p = 0.008) and use of immunosuppressive medication (p < 0.001), among others. Adding baseline remnant cholesterol to the Framingham Diabetes Risk Score significantly improved NODAT prediction (change in C-statistic, p = 0.01). Conclusions This study demonstrates that baseline RLP cholesterol levels strongly associate with incident NODAT independent of several other recognized risk factors.
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Affiliation(s)
- Tamas Szili-Torok
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sara Sokooti
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Maryse C J Osté
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Antonio W Gomes-Neto
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Robin P F Dullaart
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stephan J L Bakker
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Uwe J F Tietge
- Division of Clinical Chemistry, Department of Laboratory Medicine (LABMED), H5, Alfred Nobels Alle 8, Karolinska Institutet, 141 83, Stockholm, Sweden. .,Clinical Chemistry, Karolinska University Laboratory, Karolinska University Hospital, Stockholm, Sweden.
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Watt J, Fitzpatrick J, Sozio SM, Jaar BG, Estrella MM, Tereshchenko LG, Monroy-Trujillo JM, Walsh M, Parekh RS. Association of abnormal electrocardiograph metrics with prolonged recovery time in incident hemodialysis patients. BMC Nephrol 2022; 23:46. [PMID: 35086494 PMCID: PMC8796483 DOI: 10.1186/s12882-022-02664-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 12/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients receiving intermittent hemodialysis have variable times of recovery to feeling better after dialysis. QT prolongation, a precursor to clinical and subclinical cardiovascular events, may contribute to delayed recovery time. We hypothesized that abnormal electrocardiographic parameters indicating perturbations in ventricular action are associated with longer recovery times thus impacting a patient-centered quality of life. METHODS Among 242 incident in-center hemodialysis participants from the Predictors of Arrhythmic and Cardiovascular Risk in End Stage Renal Disease (PACE) study, corrected QT interval (QTc), QRST angle and heart rate variance were measured on non-dialysis days using a standard 5-min electrocardiograph recording. Left ventricular hypertrophy (LVH) was defined using the Cornell voltage product. Recovery time was ascertained during a phone interview with a standardized validated questionnaire. Associations between QTc, QRST angle, heart rate variance, and LVH and natural log-transformed recovery time were examined using linear regression adjusted for participant characteristics and electrolytes. RESULTS Mean age was 55 (standard deviation 13) years, 55% were male, 72% were African American. Longer QTc interval was associated with increased recovery time (per 10 ms increase in QTc, recovery time increased by 6.2%; 95% confidence interval: 0.0-10.5). QRST angle, heart rate, heart rate variability and LVH were not significantly associated with recovery time. CONCLUSION Longer QTc intervals are associated with longer recovery time independent of serum electrolytes. This supports a relationship between a patient's underlying arrhythmic status and time to recovery after hemodialysis. Future studies will determine if maneuvers to reduce QTc improves recovery time and quality of life of patients on hemodialysis.
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Affiliation(s)
- Jacqueline Watt
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jessica Fitzpatrick
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Stephen M Sozio
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD, USA
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Bernard G Jaar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD, USA
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Nephrology Center of Maryland, Baltimore, MD, USA
| | - Michelle M Estrella
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, USA
- Department of Medicine, San Francisco VA Medical Center, San Francisco, CA, USA
| | - Larisa G Tereshchenko
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Knight Cardiovascular Institute, Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | | | - Michael Walsh
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Rulan S Parekh
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
- Division of Nephrology, Department of Pediatrics and Medicine, The Hospital for Sick Children, University Health Network and University of Toronto, 555 University Ave, Toronto, ON, M5G 1X8, Canada.
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11
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Perry TA, Segal NA, Bowen C, Gates L, Arden N, Nevitt MC. Foot and ankle pain and risk of incident knee osteoarthritis and knee pain: Data from the Multicentre Osteoarthritis Study. Osteoarthr Cartil Open 2022; 3:100210. [PMID: 34977597 PMCID: PMC8683744 DOI: 10.1016/j.ocarto.2021.100210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 08/20/2021] [Indexed: 11/29/2022] Open
Abstract
Objectives To examine whether foot and/or ankle pain increases the risk of knee OA. Design We utilised longitudinal data from the Multicentre Osteoarthritis Study (MOST); a community-based cohort of risk factors for knee OA. Participants without frequent knee pain (clinic visit only) and radiographic knee OA (RKOA) at baseline and, with no evidence of inflammatory musculoskeletal disease and a history of knee-related surgery were followed for up to 84-months for incident outcomes; i) RKOA (Kellgren-Lawrence (KL) ≥2), ii) symptomatic RKOA (RKOA and frequent pain in the same knee) and iii) frequent knee pain only. At baseline, ankle and foot symptoms were assessed, with knee radiographs and symptoms also assessed at 30, 60 and 84-months. Our exposures included baseline ankle, foot, and ankle and foot pain (participant-level). Associations between foot and/or ankle pain and incident outcomes were assessed using multiple logistic regression, with adjustment for participant characteristics and ankle/foot pain. Results No statistically significant associations were observed between ankle, foot and, ankle and foot pain and incident RKOA, respectively. Ankle pain with (2.30, 95% CI 1.13 to 4.66) and without foot pain (OR: 2.53, 95% CI 1.34 to 4.80) were associated with increased odds of incident symptomatic RKOA and frequent knee pain. No statistically significant associations were observed between foot pain and these outcomes. Conclusions Ankle pain should be a focus point, more so than foot pain, in the management of knee OA. Future studies should include additional ankle joint-specific symptom questions to better elucidate the knee OA biomechanical pathway.
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Affiliation(s)
- Thomas A. Perry
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Old Road, Oxford, OX3 7LD, United Kingdom
- Centre for Sport, Exercise and Osteoarthritis Versus Arthritis, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
- Corresponding author. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Old Road, Oxford, OX3 7LD, United Kingdom.
| | - Neil A. Segal
- University of Kansas Medical Centre, Kansas City, KS, USA
- The University of Iowa, Iowa City, USA
| | - Catherine Bowen
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
- Centre for Sport, Exercise and Osteoarthritis Versus Arthritis, University of Southampton, Southampton, United Kingdom
| | - Lucy Gates
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
- Centre for Sport, Exercise and Osteoarthritis Versus Arthritis, University of Southampton, Southampton, United Kingdom
| | - Nigel Arden
- Centre for Sport, Exercise and Osteoarthritis Versus Arthritis, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, United Kingdom
| | - Michael C. Nevitt
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th St, San Francisco, CA 94158, USA
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12
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Ogle GD, James S, Dabelea D, Pihoker C, Svennson J, Maniam J, Klatman EL, Patterson CC. Global estimates of incidence of type 1 diabetes in children and adolescents: Results from the International Diabetes Federation Atlas, 10th edition. Diabetes Res Clin Pract 2022; 183:109083. [PMID: 34883188 DOI: 10.1016/j.diabres.2021.109083] [Citation(s) in RCA: 68] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 10/05/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Type 1 diabetes (T1D) incidence in children and adolescents varies widely, and is increasing in many nations. The 10th edition of the International Diabetes Federation Atlas estimated incident cases in 2021 for 215 countries/territories ("countries"). METHODS Studies on T1D incidence for young people aged 0-19 years were sourced and graded using previously described methods. For countries without studies, data were extrapolated from similar nearby countries. RESULTS An estimated 108,300 children under 15 years will be diagnosed in 2021, a number rising to 149,500 when the age range extends to under 20 years. The ratio of incidence in 15-19 years compared to those aged 0-14 years was particularly high in some countries in sub-Saharan Africa, North Africa/Middle East, and in Mexico. Only 97 countries have their own incidence data, with extrapolation required for some very populous nations. Most data published were not recent, with 27 countries (28%) having data in which the last study year was 2015 or afterwards, and 26 (27%) having no data after 1999. CONCLUSIONS Many countries have recent data but there are large gaps globally. Such data are critical for allocation of resources, teaching, training, and advocacy. All countries are encouraged to collect and publish current data.
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Affiliation(s)
- Graham D Ogle
- Life for a Child, Diabetes NSW, Glebe, New South Wales, Australia.
| | - Steven James
- Life for a Child, Diabetes NSW, Glebe, New South Wales, Australia; School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Petrie, Queensland, Australia
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Catherine Pihoker
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Jannet Svennson
- Department of Pediatric and Adolescents, Herlev and Gentofte University Hospital, Herlev, Denmark; Department of Clinical Medicine, Faculty of Health and Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jayanthi Maniam
- Life for a Child, Diabetes NSW, Glebe, New South Wales, Australia
| | - Emma L Klatman
- Life for a Child, Diabetes NSW, Glebe, New South Wales, Australia
| | - Chris C Patterson
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
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13
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Robinson PC, Frampton C, Phipps-Green A, Neogi T, Stamp L, Taylor W, Merriman TR, Dalbeth N. Longitudinal development of incident gout from low-normal baseline serum urate concentrations: individual participant data analysis. BMC Rheumatol 2021; 5:33. [PMID: 34452645 PMCID: PMC8399746 DOI: 10.1186/s41927-021-00204-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/21/2021] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Elevated serum urate (SU) concentration is the central risk factor for the development of gout. The aim of this study was to examine the incidence of gout in people with low and normal SU levels (< 7.00 mg/dL). METHODS Longitudinal cohort data from the Atherosclerosis Risk in Communities Study (ARIC), Coronary Artery Risk Development in Young Adults Study (CARDIA), and both the Original and Offspring cohorts of the Framingham Heart Study (FHS) were used to determine incident gout by baseline SU over 3, 5, 10, 12 and 15 year periods. A Cox proportional hazards model with covariables of age, gender, ethnicity, and cohort was calculated to report the hazard ratios (HR) for incident gout. RESULTS The incidence of gout at 15 years for a baseline SU < 4.00 mg/dL was 0.59%, 4.00-4.49 mg/dL was 1.28%, 4.50-4.99 mg/dL was 0.86%, 5.00-5.49 mg/dL was 0.94%, 5.50-5.99 mg/dL was 1.52%, 6.00-6.49 mg/dL was 2.91%, 6.50-6.99 mg/dL was 3.2%, and > 7.00 mg/dL was 12.2%. In an adjusted Cox proportional hazards model, compared to the referent baseline SU < 4.00 mg/dL, there was a non-significant increase in incident gout for baseline SU bands between 4.00-5.49 mg/dL, whereas incident gout was significantly increased for SU 5.50-5.99 mg/dL (HR 2.60), 6.00-6.49 mg/dL (HR 3.70), 6.50-6.99 mg/dL (HR 5.24) and > 7.00 mg/dL (HR 18.62). CONCLUSION A baseline SU of 5.50 mg/dL or more is a risk factor for development of gout over 15 years. However, incident gout does occur over time in a small proportion of people with lower baseline SU levels.
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Affiliation(s)
- Philip C Robinson
- University of Queensland Faculty of Medicine, Herston, Herston, Queensland, Australia.
- Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Queensland, Australia.
| | | | | | - Tuhina Neogi
- Department of Medicine, Boston University School of Medicine, Boston, USA
| | - Lisa Stamp
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - William Taylor
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Tony R Merriman
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, USA
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
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Malik MW, Ikram A, Safdar RM, Ansari JA, Khan MA, Rathore TR, Ashraf N, Basry R, Waqar W, Tahir MA, Qamar MA, Ahmed H. Use of public health emergency operations center (PH-EOC) and adaptation of incident management system (IMS) for efficient inter-sectoral coordination and collaboration for effective control of Dengue fever outbreak in Pakistan - 2019. Acta Trop 2021; 219:105910. [PMID: 33831344 DOI: 10.1016/j.actatropica.2021.105910] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/26/2021] [Accepted: 03/29/2021] [Indexed: 01/09/2023]
Abstract
Public Health Emergency Operations Center (PH-EOC) and Incident Management System (IMS) provides a platform for inter-sectoral coordination, and collaboration to enhance efficiency of response activities and help in effective control of disease outbreaks. Dengue fever (DF) is an emerging serious public health threat with a potential to transform into a public health emergency. Pakistan faced a heavy outbreak of Dengue fever (DF) from August to December 2019. National Institute of Health (NIH), Islamabad activated its Public Health Emergency Operations Center (PH-EOC) with an objective to implement principles and practices of IMS for control of the outbreak. The challenges during inter-sectoral collaboration for response activities were also identified. PH-EOC was activated on 16th September 2019, and remained operational for next 81 days till 05th December 2019. Incident management structure, incident action plan (IAP), and risk communication plan was developed and executed during this phase. Daily morning and evening meetings were held during all operational days. Federal and provincial health departments, district health offices (DHO), and government/private hospitals were coordinated for collection of the data pertaining to Dengue confirmed cases and deaths. As of 05th December 2019, a total of 52,877 confirmed Dengue cases were reported from all across Pakistan with maximum cases reported from Rawalpindi and Islamabad collectively i.e. 20,988 (40%), followed by Karachi 14,768 (28%), and Peshawar 2,699 (5%), while AJK reported 1,690 (3%). A total of 92 deaths happened all across Pakistan, out of which 43 (47%) happened in Karachi, 23 (25%) in Rawalpindi, and 22 (24%) in Islamabad. The response was coordinated through NIH based PH-EOC, but was carried out by relevant federal and provincial district health offices, vector surveillance programs, dengue control programs and sanitation departments respectively. As a part of response plan, vector surveillance, larva source management, and insecticidal spraying i.e. both fogging and indoor residual spraying activities were carried out in hotspots or the areas where confirmed cases were reported. Sanitation departments daily reported the removal of additional 80-100 ton of solid waste from hotspot areas. Hospitals were coordinated for reporting of isolation of DF patients and provision of quality clinical management for admitted patients. The International Federation for Red Cross/Crescent conducted community awareness, and covered 28,800 households in affected areas of Islamabad. Conversely, the DF outbreak was controlled 02-03 weeks ahead of previous years trends. All the coordinated activities were incorporated in a daily situation report (SitRep) and this was widely distributed among all the stakeholders through emails. Additionally, the data was displayed on the dashboard in PH-EOC. The data dashboard at PH-EOC served as an information management hub that visually mapped, tracked, analyzed, and displayed clusters of DF cases and hotspots. Accordingly, SitRep substantiated as the main reporting tool to monitor response activities initiated by rapid response teams at the national and subnational level. The inter-sectoral coordinating efforts made among concerned line departments resulted in a timely response leading to effective handling of a national public health threat. The information distilled from this experience was that the early and judicious activation of PH-EOC with adaptation of IMS under decision making leadership resulted in a well-managed and prompt response executed by different departments/stakeholders, and effective control of the outbreak before its transformation into a public health event/emergency of national or international concern.
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Affiliation(s)
- Muhammad Wasif Malik
- National Institute of Health (NIH), Islamabad, Pakistan; Field Epidemiology & Disease Surveillance Division, National Institute of Health (NIH), Islamabad, Pakistan.
| | - Aamer Ikram
- National Institute of Health (NIH), Islamabad, Pakistan
| | - Rana Muhammad Safdar
- National Institute of Health (NIH), Islamabad, Pakistan; Field Epidemiology & Disease Surveillance Division, National Institute of Health (NIH), Islamabad, Pakistan
| | - Jamil Ahmed Ansari
- Field Epidemiology & Disease Surveillance Division, National Institute of Health (NIH), Islamabad, Pakistan
| | - Mumtaz Ali Khan
- Field Epidemiology & Disease Surveillance Division, National Institute of Health (NIH), Islamabad, Pakistan
| | - Tayyab Razzi Rathore
- Field Epidemiology & Disease Surveillance Division, National Institute of Health (NIH), Islamabad, Pakistan
| | - Nosheen Ashraf
- Field Epidemiology & Disease Surveillance Division, National Institute of Health (NIH), Islamabad, Pakistan
| | - Rabia Basry
- Field Epidemiology & Disease Surveillance Division, National Institute of Health (NIH), Islamabad, Pakistan
| | - Wajiha Waqar
- Field Epidemiology & Disease Surveillance Division, National Institute of Health (NIH), Islamabad, Pakistan
| | - Majid Ali Tahir
- Field Epidemiology & Disease Surveillance Division, National Institute of Health (NIH), Islamabad, Pakistan
| | - Muhammad Akram Qamar
- Field Epidemiology & Disease Surveillance Division, National Institute of Health (NIH), Islamabad, Pakistan
| | - Haroon Ahmed
- Department of Biosciences, COMSATS University Islamabad (CUI), Park Road, Chakh shshzad, Islamabad, Pakistan
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15
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Crowley D, Avramovic G, Cullen W, Farrell C, Halpin A, Keevans M, Laird E, McHugh T, McKiernan S, Miggin SJ, Murtagh R, Connor EO, O'Meara M, Reilly DO, Lambert JS. New hepatitis C virus infection, re-infection and associated risk behaviour in male Irish prisoners: a cohort study, 2019. ACTA ACUST UNITED AC 2021; 79:97. [PMID: 34103080 PMCID: PMC8186141 DOI: 10.1186/s13690-021-00623-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 05/30/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Prisoners are recognised as a high-risk population and prisons as high-risk locations for the transmission of hepatitis c virus (HCV) infection. Injecting drug use (IDU) is the main driver of HCV infection in prisoners and harm reduction services are often suboptimal in prison settings. HCV prevalence and incident data in prisoners is incomplete which impacts the public health opportunity that incarceration provides in identifying, treating and preventing HCV infection. The aim of this study is to identify new HCV infection and associated risk factors in an Irish male prison. METHODS We conducted a follow up (18-month) cohort study on prisoners who had previously tested negative, self-cleared or had been successfully treated for HCV infection. We conducted the study in a male medium security prison located in Dublin Ireland (Mountjoy Prison) using HCV serology, a review of medical records and a researcher-administered questionnaire. RESULTS 99 prisoners with a mean age of 33.2 yrs. participated in the study and 82(82.8%) completed a research-administered questionnaire. Over half (51%) had a history of drug use from a young age (14.8 yrs.), 49.9% a history of heroin use and 39% a history of IDU. The prevalence of HIV and hepatitis B virus core antibody was 3% and HCV antibody was 22.2%. No new HCV infections were identified in those who had never been infected (n = 77), had self-cleared (n = 9) or achieved sustained virological response (n = 12). Small numbers of prisoners continued to engage in risk-behaviour including, IDU both in the prison (n = 2) and the community (n = 3), sharing syringes (n = 1) and drug taking paraphernalia (n = 6) and receiving non-sterile tattoos (n = 3). CONCLUSION Despite the high numbers of Irish prisoners with a history of IDU and HCV infection, new HCV infection is low or non-existent in this population. Small numbers of prisoners continue to engage in risk behaviour and larger studies are required to further understand HCV transmission in this cohort in an Irish and international context.
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Affiliation(s)
- Des Crowley
- School of Medicine, University College Dublin, Dublin, Ireland. .,Irish Prison Service, Dublin, Ireland.
| | | | - Walter Cullen
- School of Medicine, University College Dublin, Dublin, Ireland
| | | | | | | | | | - Tina McHugh
- Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | | | - Ross Murtagh
- School of Medicine, University College Dublin, Dublin, Ireland
| | | | | | | | - John S Lambert
- School of Medicine, University College Dublin, Dublin, Ireland.,Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland
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Hadaegh F, Asgari S, Toreyhi H, Eskandari F, Fahimfar N, Bozorgmanesh M, Hosseinpanah F, Azizi F. Sex-specific incidence rates and risk factors for fracture: A 16-year follow-up from the Tehran lipid and glucose study. Bone 2021; 146:115869. [PMID: 33529827 DOI: 10.1016/j.bone.2021.115869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 01/06/2021] [Accepted: 01/27/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine the population-based incidence of any-fracture and its potential risk factors in a sex-split cohort of the Iranian population. MATERIALS AND METHODS A total of 3477 men and 4085 women with a mean (SD) age of 47.92(13.1) and 45.88(11.47) years, respectively were entered into the study. The age-standardized incidence rates per 100,000 person-years were reported for the whole population and each sex separately. Cox proportional hazard models were used to estimate hazard ratios (HR) for potential risk factors. Only fractures requiring inpatients' care were considered as the outcome. We also defined major osteoporotic fractures (MOF) as the composite of the fractures that occurred in the vertebral, wrist, hip and pelvic sites among population aged ≥50 years. RESULTS During the median (IQR) follow-up of 15.9 years, 4.34%men and 3.75% women experienced at least one incident any-fracture. The annual age-standardized incidence rates (95% CI) among men and women were 330.9 (279.6-388.9) and 319.4(268.1-377.3) per 100,000 person-years, respectively; the corresponding values for incidence of MOF was 202.2(142.3-278.6) in men and 342.1(260.4-441.0) per 100,000 person-years for women. In the multivariable model, among the whole population, age groups ≥50 years, central obesity [HR: 95% CI 1.77(1.32-2.39)], current smoking [1.59(1.15-2.20)] and using steroid medications [2.20(1.04-4.67)] significantly increased the risk of incident fracture (all P < 0.05); however the impact of the first two risk factors were more prominent among women (P for interaction ≤0.01). Moreover, being obese was associated with a lower risk of incident first fracture in the total population [HR: 95% CI: 0.61(0.40-0.92)]. Being men [HR: 95% CI: 0.54(0.30-0.99)] and prediabetes status [HR: 95% CI: 0.53(0.30-0.95)] were also associated with lower risk for MOF. CONCLUSION This is the first report of long-term incidence rate of any-fracture and MOF conducted in the metropolitan city of Tehran. Among modifiable risk factors of fracture, in the whole population smoking habit and using steroid medications and particularly for women central obesity should be considered as main risk factors for preventive strategies. Prediabetes status was associated with lower risk of MOF.
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Affiliation(s)
- Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Samaneh Asgari
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Toreyhi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Eskandari
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Noushin Fahimfar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Farhad Hosseinpanah
- Obesity Research Center, Research Institute for Endocrine Sciences, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Bennet L, Udumyan R, Östgren CJ, Rolandsson O, Jansson SPO, Wändell P. Mortality in first- and second-generation immigrants to Sweden diagnosed with type 2 diabetes: a 10 year nationwide cohort study. Diabetologia 2021; 64:95-108. [PMID: 32979073 PMCID: PMC7716891 DOI: 10.1007/s00125-020-05279-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 08/11/2020] [Indexed: 12/23/2022]
Abstract
AIMS/HYPOTHESIS Non-Western immigrants to Europe are at high risk for type 2 diabetes. In this nationwide study including incident cases of type 2 diabetes, the aim was to compare all-cause mortality (ACM) and cause-specific mortality (CSM) rates in first- and second-generation immigrants with native Swedes. METHODS People living in Sweden diagnosed with new-onset pharmacologically treated type 2 diabetes between 2006 and 2012 were identified through the Swedish Prescribed Drug Register. They were followed until 31 December 2016 for ACM and until 31 December 2012 for CSM. Analyses were adjusted for age at diagnosis, sex, socioeconomic status, education, treatment and region. Associations were assessed using Cox regression analysis. RESULTS In total, 138,085 individuals were diagnosed with type 2 diabetes between 2006 and 2012 and fulfilled inclusion criteria. Of these, 102,163 (74.0%) were native Swedes, 28,819 (20.9%) were first-generation immigrants and 7103 (5.1%) were second-generation immigrants with either one or both parents born outside Sweden. First-generation immigrants had lower ACM rate (HR 0.80 [95% CI 0.76, 0.84]) compared with native Swedes. The mortality rates were particularly low in people born in non-Western regions (0.46 [0.42, 0.50]; the Middle East, 0.41 [0.36, 0.47]; Asia, 0.53 [0.43, 0.66]; Africa, 0.47 [0.38, 0.59]; and Latin America, 0.53 [0.42, 0.68]). ACM rates decreased with older age at migration and shorter stay in Sweden. Compared with native Swedes, first-generation immigrants with ≤ 24 years in Sweden (0.55 [0.51, 0.60]) displayed lower ACM rates than those spending >24 years in Sweden (0.92 [0.87, 0.97]). Second-generation immigrants did not have better survival rates than native Swedes but rather displayed higher ACM rates for people with both parents born abroad (1.28 [1.05, 1.56]). CONCLUSIONS/INTERPRETATION In people with type 2 diabetes, the lower mortality rate in first-generation non-Western immigrants compared with native Swedes was reduced over time and was equalised in second-generation immigrants. These findings suggest that acculturation to Western culture may impact ACM and CSM in immigrants with type 2 diabetes but further investigation is needed. Graphical abstract.
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Affiliation(s)
- Louise Bennet
- Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden.
- Department of Family Medicine, Lund University, Malmö, Sweden.
| | - Ruzan Udumyan
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Carl Johan Östgren
- Department of Health, Medicine and Caring Sciences, General Practice, Linköping University, Linköping, Sweden
| | - Olov Rolandsson
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden
| | - Stefan P O Jansson
- Institution of Medical Sciences, University Health Care Research Center, Örebro University, Örebro, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Per Wändell
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
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Zenske A, Koch A, Kähler W, Oellrich K, Pepper C, Muth T, Schipke JD. Assessment of a dive incident using heart rate variability. Diving Hyperb Med 2020; 50:157-163. [PMID: 32557418 DOI: 10.28920/dhm50.2.157-163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 02/23/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Scuba diving likely has an impact on the autonomic nervous system (ANS). In the course of conducting trials of underwater ECG recording for measurement of heart rate variability, there was an unexpected stressful event; one participant's regulator iced and began to free-flow. METHODS A custom-made, water- and pressure-tight aluminum housing was used to protect a portable Holter monitor. ECGs were recorded in three experienced divers who witnessed an unplanned moderately stressful incident during diving. The ECG signals were analysed for measures of heart rate variability (HRV). RESULTS Analysis for different short-term HRV measures provided consistent results if periods of interest were appropriately time-aligned. There was improvement in sympatho-vagal balance. One diver unexpectedly exhibited an increase in both sympathetic and vagal activity shortly after the incident. CONCLUSIONS A conventional open-water dive affected the ANS of experienced recreational divers as measured by HRV which provides a global evaluation of the ANS and alterations in its two branches. The heart rate variability data gathered from several participating divers around the time of this event illustrate the potential utility of this variable in quantifying stress during diving. HRV data may be useful in addressing relevant diving related questions such as effects of cold, exercise or different breathing gases on ANS function.
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Affiliation(s)
| | - Andreas Koch
- German Naval Medical Institute, Maritime Medicine, Kiel, Germany
| | - Wataru Kähler
- German Naval Medical Institute, Maritime Medicine, Kiel, Germany
| | - Kerstin Oellrich
- German Naval Medical Institute, Maritime Medicine, Kiel, Germany
| | - Clark Pepper
- Johanna Etienne Hospital, Dept. of Anaesthesiology, Neuss, Germany
| | - Thomas Muth
- Institute of Occupational, Social and Environmental Medicine, Heinrich Heine University, Düsseldorf, Germany
| | - Jochen D Schipke
- Forschungsgruppe Experimentelle Chirurgie, Universitäts-Klinikum, Düsseldorf, Germany.,Corresponding author: Professor Jochen D Schipke, c/o Forschungsgruppe Experimentelle Chirurgie, Universitäts-Klinikum Düsseldorf, DE, Moorenstrasse 5, D-40225 Düsseldorf,
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Moorthi RN, Fadel WF, Cranor A, Hindi J, Avin KG, Lane KA, Thadhani RI, Moe SM. Mobility Impairment in Patients New to Dialysis. Am J Nephrol 2020; 51:705-714. [PMID: 32781443 DOI: 10.1159/000509225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/08/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Impaired mobility is associated with functional dependence, frailty, and mortality in prevalent patients undergoing dialysis. We investigated risk factors for mobility impairment, (poor gait speed) in patients incident to dialysis, and changes in gait speed over time in a 2-year longitudinal study. METHODS One hundred eighty-three patients enrolled within 6 months of dialysis initiation were followed up 6, 12, and 24 months later. Grip strength, health-related quality of life, and comorbidities were assessed at baseline. Outcomes were (a) baseline gait speed and (b) change in gait speed over time. Gait speed was assessed by 4-meter walk. Multivariate linear regression was used to identify risk factors for low gait speed at baseline. For longitudinal analyses, linear mixed effects modeling with gait speed modeled over time was used as the outcome. RESULTS Participants were 54.7 ± 12.8 years old, 52.5% men, 73.9% black with mean dialysis vintage of 100.1 ± 46.9 days and median gait speed 0.78 (0.64-0.094) m/s. Lower health utility and grip strength, diabetic nephropathy, and walking aids were associated with lower baseline gait speed. Loss of 0.1 m/s gait speed occurred in 24% of subjects at 1 year. In multivariate mixed effects models, only age, walking aid use, lower health utility, and lower handgrip strength were significantly associated with gait speed loss. CONCLUSIONS In our cohort of incident dialysis patients, overall gait speed is very low and 54.2% of the subjects continue to lose gait speed over 2 years. Older age, lower handgrip strength, and quality of life are risk factors for slowness. Patients at highest risk of poor gait speed can be identified at dialysis initiation to allow targeted implementation of therapeutic options.
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Affiliation(s)
- Ranjani N Moorthi
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana, USA,
| | - William F Fadel
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Alissa Cranor
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Judy Hindi
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Keith G Avin
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana, USA
- School of Health & Human Sciences, Indiana University, Indianapolis, Indiana, USA
| | - Kathleen A Lane
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Sharon M Moe
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana, USA
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Mandal S, Edelstein M, Ramsay M. Public health leadership in the UK's response to hepatitis A and hepatitis B vaccine shortages. Vaccine 2020; 38:3515-3516. [PMID: 31948821 DOI: 10.1016/j.vaccine.2020.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 01/03/2020] [Accepted: 01/06/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Sema Mandal
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom.
| | - Michael Edelstein
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Mary Ramsay
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
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Manda CM, Hokimoto T, Okura T, Isoda H, Shimano H, Wagatsuma Y. Handgrip strength predicts new prediabetes cases among adults: A prospective cohort study. Prev Med Rep 2020; 17:101056. [PMID: 32071846 DOI: 10.1016/j.pmedr.2020.101056] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 01/10/2020] [Accepted: 01/21/2020] [Indexed: 12/22/2022] Open
Abstract
There was high prediabetes incidence among participants of medical examinations. Lower relative handgrip strength (HS) predicted higher prediabetes incidence risk. Results significant in individuals < 40 and ≥ 40 years old. HS predicted lower prediabetes incidence risk among normal weight individuals.
Conventional risk factors for prediabetes and type 2 diabetes such as obesity do not completely explain the higher prevalence of prediabetes; therefore, research to investigate the role of other independent risk factors is required. A few cross-sectional studies have reported an association between muscle strength and prediabetes among normal-weight adults, but the longitudinal relationship of muscle strength with incident prediabetes among adults has not been reported. This prospective cohort study was conducted to investigate whether relative handgrip strength in adults predicted prediabetes incidence after 2 years of follow-up. The study was conducted in Ibaraki prefecture, Japan and recruited individuals without prediabetes and diabetes attending lifestyle related medical examinations between April 2016 and March 2017 (n = 2054). Individuals who came for the follow-up medical examinations between April 2018 and March 2019 were included in the analysis (n = 1075). One hundred sixty-nine individuals (15.7%) developed prediabetes after a mean follow-up of 24.2 months (SD = 1.9 months). Multivariable adjusted hazard ratios (aHR) of new prediabetes cases were calculated using Cox regression. Higher baseline relative handgrip strength predicted a lower risk (aHR [95% CI] = 0.38 [0.21–0.71] of prediabetes incidence among adults. Importantly, relative handgrip strength predicted new prediabetes cases among normal weight individuals (aHR [95% CI] = 0.39 [0.16–0.96]). The findings suggest that handgrip strength measurement is useful to identify individuals at high risk of newly diagnosed prediabetes, importantly, among normal weight individuals. The identified individuals may benefit from early intervention to reduce the risk of prediabetes.
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Key Words
- BMI, body mass index
- CI, confidence interval
- COI, center of innovation
- FPG, fasting plasma glucose
- HDL, high density lipoprotein
- Handgrip strength
- HbA1c, hemoglobin A1c
- IQR, interquartile range
- Incident
- JA Ibaraki, agricultural cooperative of Ibaraki
- LDL, low density lipoprotein
- Muscle strength
- Normal weight
- OGTT, oral glucose tolerance test
- Physical activity
- Prediabetes
- SD, standard deviation
- aHR, adjusted hazard ratios
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Naude C, Serre T, Dubois-Lounis M, Fournier JY, Lechner D, Guilbot M, Ledoux V. Acquisition and analysis of road incidents based on vehicle dynamics. Accid Anal Prev 2019; 130:117-124. [PMID: 28285708 DOI: 10.1016/j.aap.2017.02.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 01/17/2017] [Accepted: 02/22/2017] [Indexed: 06/06/2023]
Abstract
Because motor vehicle crashes have decreased during the last decade in many countries in the world and are more diffuse, local authorities have difficulties to define road safety policies. An experiment with 51 cars of public fleets equipped with a specific Event Data Recorder was carried out in France during one year. The purposes of this research were to evaluate if incident data (critical driving situations) help to understand crashes, and to explore a new way for road infrastructure safety diagnosis. The analysis of 339 genuine incidents and 1237 simple events recorded illustrates the potentiality of such an experiment and provides: some insights about conditions in which incidents occur, a general overview of their distribution according to different road layouts, as well as information on the different levels of accelerations reached. It can be noticed that there is an overrepresentation of incidents in right curves compared to left curves. The simple events involving mostly the infrastructure could be used to detect road defects. Genuine incidents where the vehicle is subjected to important dynamic demands, related to potentially unsafe driving situations, can be used to improve knowledge of the motor vehicle crashes thanks to incident mechanisms analysis.
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Affiliation(s)
- Claire Naude
- IFSTTAR (French Institute of Science and Technology for Transport, Development and Network), Laboratory of Accident Mechanism Analysis, 304 Chemin de la Croix Blanche, 13300 Salon de Provence, France.
| | - Thierry Serre
- IFSTTAR (French Institute of Science and Technology for Transport, Development and Network), Laboratory of Accident Mechanism Analysis, 304 Chemin de la Croix Blanche, 13300 Salon de Provence, France.
| | - Maxime Dubois-Lounis
- IFSTTAR (French Institute of Science and Technology for Transport, Development and Network), Laboratory of Accident Mechanism Analysis, 304 Chemin de la Croix Blanche, 13300 Salon de Provence, France.
| | - Jean-Yves Fournier
- IFSTTAR (French Institute of Science and Technology for Transport, Development and Network), Laboratory of Accident Mechanism Analysis, 304 Chemin de la Croix Blanche, 13300 Salon de Provence, France.
| | - Daniel Lechner
- IFSTTAR (French Institute of Science and Technology for Transport, Development and Network), Laboratory of Accident Mechanism Analysis, 304 Chemin de la Croix Blanche, 13300 Salon de Provence, France.
| | - Michèle Guilbot
- IFSTTAR (French Institute of Science and Technology for Transport, Development and Network), Laboratory of Accident Mechanism Analysis, 304 Chemin de la Croix Blanche, 13300 Salon de Provence, France.
| | - Vincent Ledoux
- Cerema (Centre For Studies and Expertise on Risks, Environment, Mobility, and Urban and Country Planning), Technical Division for Territorial Development and Urban Planning 2 rue Antoine Charial, 69426 Lyon, France.
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Abstract
Background This study focuses on the identification of conserved genes involved in myocardial infarction (MI), and then analyzed the differentially expressed genes (DEGs) between the incident and recurrent events to identify MI-recurrent biomarkers. Methods Gene expression data of MI peripheral blood were downloaded from GSE97320 and GSE66360 datasets. We identified the common DEGs in these two datasets by functional enrichment analysis and protein–protein interaction (PPI) network analysis. GSE48060 was further analyzed to validate the conserved genes in MI and to compare the DEGs between the incident and recurrent MI. Results A total of 477 conserved genes were identified in the comparison between MI and control. Protein–protein interaction (PPI) network showed hub genes, such as MAPK14, STAT3, and MAPKAPK2. Part of those conserved genes was validated in the analysis of GSE48060. The DEGs in the incident and recurrent MI showed significant differences, including RNASE2 and A2M-AS1 as the potential biomarkers of MI recurrence. Conclusions The conserved genes in the pathogenesis of MI were identified, benefit for target therapy. Meanwhile, some specific genes may be used as markers for the prediction of recurrent MI. Electronic supplementary material The online version of this article (10.1186/s40001-019-0381-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Linlin Qiu
- Danyang People's Hospital of Jiangsu Province, Danyang, China
| | - Xueqing Liu
- Danyang People's Hospital of Jiangsu Province, Danyang, China.
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Karampourian A, Ghomian Z, Khorasani-Zavareh D. Qualitative study of health system preparedness for traumatic incidents in a religious mass gathering. Injury 2019; 50:1097-1104. [PMID: 30595410 DOI: 10.1016/j.injury.2018.12.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 12/08/2018] [Accepted: 12/12/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND OBJECTIVES Traumatic incidents may occur during religious mass gatherings. A lack of preparedness by the health system to respond to traumatic incidents may increase the mortality rate. This study investigated the factors that affect the preparedness of a health system to respond to traumatic incidents, and we provide appropriate suggestions for improving the response to such incidents during religious mass gatherings. METHODS A qualitative research method was used with a conventional content analysis approach. In total, 22 semi-structured interviews were conducted employing the content analysis method. The data were analyzed based on the means of the meaning units, condensed meaning units, sub-themes, themes, and codes. RESULTS Four main categories and nine sub-categories emerged from the data: factors that increased or decreased the occurrence of incidents (with three sub-categories comprising risk perception and fatalism, pilgrims' responses to incidents, and health system response to traumatic events); medical infrastructure (with two sub-categories comprising medical infrastructure in the host country and medical structures in border cities); organizational resource category (with two sub-categories comprising manpower, and equipment and facilities); and coordination of responsible organizations (with two sub-categories comprising inter-organizational coordination and inter-agency collaboration). All of the data were extracted from the experiences of the participants. CONCLUSION Similar to other mass gatherings, Arbaeen requires multi-sectoral and international planning, organizing, and management. The key factors that could improve the preparedness to respond to traumatic events in Arbaeen include training, increasing the perception of risk, changing the attitudes and behavior of pilgrims, developing a national strategic plan of the health system preparedness for policymakers, and implementing scenario-based exercises for executives.
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Affiliation(s)
- Arezou Karampourian
- Department of Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Zohreh Ghomian
- Department of Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Davoud Khorasani-Zavareh
- Department of Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Neurobiology, Care Sciences and Society (NVS), H1, Division of Family Medicine and Primary Care, Alfred Nobels Allé 23 141 83 Huddinge, Sweden.
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Abstract
Since February 2018, the Directive 2013/59/EURATOM (EU-BSS) requires all EU member states to implement a system for recording and analysis of all accidental or unintended medical exposures (Article 63). An ESR questionnaire in May 2018 among ESR member countries including all EU member states (MS) revealed a very heterogeneous and unsatisfactory situation in transposition of the EU-BSS. Some MS just translated this part of the directive, others used effective dose as reporting criteria and others used physical dose parameters from the modalities. This white paper will help national scientific organisations advice their national regulators and authorities on how to provide a simple and practicable implementation of the directive. ESR recommends notification and reporting criteria for significant events based on physical quantities and units and not on effective dose or text-based criteria like "significantly different" (EU-BSS, Article 4 (99)).
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Gabriel MM, Dunn DT, Speakman A, McCabe L, Ward D, Witzel TC, Harbottle J, Collins S, Gafos M, Burns FM, Lampe FC, Weatherburn P, Phillips A, McCormack S, Rodger AJ. Protocol, rationale and design of SELPHI: a randomised controlled trial assessing whether offering free HIV self-testing kits via the internet increases the rate of HIV diagnosis. BMC Infect Dis 2018; 18:531. [PMID: 30352556 PMCID: PMC6199717 DOI: 10.1186/s12879-018-3433-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 10/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Among men who have sex with men (MSM) in the UK, an estimated 28% have never tested for HIV and only 27% of those at higher risk test at least every 6 months. HIV self-testing (HIVST), where the person takes their own blood/saliva sample and processes it themselves, offers the opportunity to remove many structural and social barriers to testing. Although several randomised controlled trials are assessing the impact of providing HIVST on rates of HIV testing, none are addressing whether this results in increased rates of HIV diagnoses that link to clinical care. Linking to care is the critical outcome because it is the only way to access antiretroviral treatment (ART). We describe here the design of a large, internet-based randomised controlled trial of HIVST, called SELPHI, which aims to inform this key question. METHODS/DESIGN The SELPHI study, which is ongoing is promoted via social networking website and app advertising, and aims to enroll HIV negative men, trans men and trans women, aged over 16 years, who are living in England and Wales. Apart from the physical delivery of the test kits, all trial processes, including recruitment, take place online. In a two-stage randomisation, participants are first randomised (3:2) to receive a free baseline HIVST or no free baseline HIVST. At 3 months, participants allocated to receive a baseline HIVST (and meeting further eligibility criteria) are subsequently randomised (1:1) to receive the offer of regular (every 3 months) free HIVST, with testing reminders, versus no such offer. The primary outcome from both randomisations is a laboratory-confirmed HIV diagnosis, ascertained via linkage to a national HIV surveillance database. DISCUSSION SELPHI will provide the first reliable evidence on whether offering free HIVST via the internet increases rates of confirmed HIV diagnoses and linkage to clinical care. The two randomisations reflect the dual objectives of detecting prevalent infections (possibly long-standing) and the more rapid diagnosis of incident HIV infections. It is anticipated that the results of SELPHI will inform future access to HIV self-testing provision in the UK. TRIAL REGISTRATION DOI 10.1186/ISRCTN20312003 registered 24/10/2016.
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Affiliation(s)
- Michelle M. Gabriel
- MRC Clinical Trials Unit at UCL, London, UK
- Trial Sponsor – University College London via MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, 90 High Holborn, 2nd Floor, London, WC1V 6LJ UK
| | | | - Andrew Speakman
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, UCL, London, UK
| | | | | | - T. Charles Witzel
- Department of Social and Environmental Health Research, Sigma Research, Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Mitzy Gafos
- MRC Clinical Trials Unit at UCL, London, UK
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, London, UK
| | | | - Fiona C. Lampe
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, UCL, London, UK
| | - Peter Weatherburn
- Department of Social and Environmental Health Research, Sigma Research, Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Andrew Phillips
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, UCL, London, UK
| | | | - Alison J. Rodger
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, UCL, London, UK
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Faught E, Helmers S, Thurman D, Kim H, Kalilani L. Patient characteristics and treatment patterns in patients with newly diagnosed epilepsy: A US database analysis. Epilepsy Behav 2018; 85:37-44. [PMID: 29906700 DOI: 10.1016/j.yebeh.2018.05.019] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/10/2018] [Accepted: 05/10/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The objective of this study was to determine patient characteristics and antiepileptic drug (AED) treatment patterns in patients with newly diagnosed epilepsy in a United States (US) population followed for ≥180 days. METHODS In this retrospective cohort study, Commercial, Supplemental Medicare, and Medicaid insurance claims from US-based Truven Health MarketScan® claims database were analyzed for incident epilepsy cases (index date: January 2010-June 2013; prior baseline of 2 years [1 year for ages 1 to <2 years; none for those <1 year]). Cases met epilepsy criteria consistent with the International League Against Epilepsy diagnostic guidelines, with continuous medical and pharmacy enrollment without an epilepsy or seizure diagnosis or AED prescription during baseline. Treatment was classified as monotherapy (one AED for ≥90 continuous days), polytherapy (at least two AEDs for ≥90 days), or untreated (no AED claims but other pharmacy or healthcare claims). Treatment pattern comparisons used matched cohorts across seizure types. RESULTS Of 58,757 incident cases, 50,838 had a follow-up of ≥180 days. The median (range) follow-up duration was 529 (180-1096) days. Patient characteristics were similar across seizure types (matched focal vs. generalized epilepsy, N = 9949 each). At 6 and 12 months post-index, 46.8% and 52.2% of patients, respectively, had received AED treatment. Of 29,226 patients receiving treatment, 74.7% and 1.6% received monotherapy and polytherapy for ≥90 days, respectively, as first-line treatment; remaining patients received AED for <90 days and were excluded. The probability of remaining on initial treatment after 1 year was 61.0% for monotherapy and 36.5% for polytherapy. The most common first-line AEDs were levetiracetam (44.4%), phenytoin (6.5%), valproic acid (6.4%), lamotrigine (6.3%), oxcarbazepine (5.7%), topiramate (5.5%), and gabapentin (5.3%). CONCLUSION Although the majority of treated patients received AED monotherapy consistent with guidelines, suboptimal rates of AED treatment and persistence of first-line treatment after initial epilepsy diagnosis suggest that efforts are needed to improve patient care.
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Affiliation(s)
- Edward Faught
- Department of Neurology, Emory University School of Medicine, 12 Executive Park Drive NE, Atlanta, GA 30329, USA.
| | - Sandra Helmers
- Department of Neurology, Emory University School of Medicine, 12 Executive Park Drive NE, Atlanta, GA 30329, USA
| | - David Thurman
- Department of Neurology, Emory University School of Medicine, 12 Executive Park Drive NE, Atlanta, GA 30329, USA
| | - Hyunmi Kim
- Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Dr NE, Atlanta, GA 30322, USA.
| | - Linda Kalilani
- UCB Pharma, 8010 Arco Corporate Drive, Raleigh, NC 27617, USA.
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Eiamcharoenwit J, Akavipat P, Ariyanuchitkul T, Wirachpisit N, Pulnitiporn A, Pongraweewan O. Perioperative anaesthetic adverse events in Thailand (PAAd THAI) study: Incident report of perioperative convulsion. J Perioper Pract 2018; 28:152-158. [PMID: 29633915 DOI: 10.1177/1750458918767591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The aim of this study was to identify the characteristics of perioperative convulsion and to suggest possible correcting strategies. The multi-centre study was conducted prospectively in 22 hospitals across Thailand in 2015. The occurrences of perioperative adverse events were collected. The data was collated by site manager and forwarded to the data management unit. All perioperative convulsion incidences were enrolled and analysed. The consensus was documented for the relevant factors and the corrective strategies. Descriptive statistics were used. From 2,000 incident reports, perioperative convulsions were found in 16 patients. Six episodes (37.5%) were related to anaesthesia, 31.3% to patients, 18.8% to surgery, and 12.5% to systemic processes. The contributing factor was an inexperienced anaesthesia performer (25%), while the corrective strategy was improvements to supervision (43.8%). Incidents of perioperative convulsion were found to be higher than during the last decade. The initiation and maintenance of safe anaesthesia should be continued.
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Affiliation(s)
| | - Phuping Akavipat
- 1 Department of Anesthesiology, Prasat Neurological Institute, Bangkok
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Sanz M, Ceriello A, Buysschaert M, Chapple I, Demmer RT, Graziani F, Herrera D, Jepsen S, Lione L, Madianos P, Mathur M, Montanya E, Shapira L, Tonetti M, Vegh D. Scientific evidence on the links between periodontal diseases and diabetes: Consensus report and guidelines of the joint workshop on periodontal diseases and diabetes by the International diabetes Federation and the European Federation of Periodontology. Diabetes Res Clin Pract 2018; 137:231-241. [PMID: 29208508 DOI: 10.1016/j.diabres.2017.12.001] [Citation(s) in RCA: 143] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 12/01/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Diabetes and periodontitis are chronic non-communicable diseases independently associated with mortality and have a bidirectional relationship. AIMS To update the evidence for their epidemiological and mechanistic associations and re-examine the impact of effective periodontal therapy upon metabolic control (glycated haemoglobin, HbA1C). EPIDEMIOLOGY There is strong evidence that people with periodontitis have elevated risk for dysglycaemia and insulin resistance. Cohort studies among people with diabetes demonstrate significantly higher HbA1C levels in patients with periodontitis (versus periodontally healthy patients), but there are insufficient data among people with type 1 diabetes. Periodontitis is also associated with an increased risk of incident type 2 diabetes. MECHANISMS Mechanistic links between periodontitis and diabetes involve elevations in interleukin (IL)-1-β, tumour necrosis factor-α, IL-6, receptor activator of nuclear factor-kappa B ligand/osteoprotegerin ratio, oxidative stress and Toll-like receptor (TLR) 2/4 expression. INTERVENTIONS Periodontal therapy is safe and effective in people with diabetes, and it is associated with reductions in HbA1C of 0.27-0.48% after 3 months, although studies involving longer-term follow-up are inconclusive. CONCLUSIONS The European Federation of Periodontology (EFP) and the International Diabetes Federation (IDF) report consensus guidelines for physicians, oral healthcare professionals and patients to improve early diagnosis, prevention and comanagement of diabetes and periodontitis.
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Affiliation(s)
- Mariano Sanz
- ETEP Research Group, Faculty of Odontology, University Complutense of Madrid, Madrid, Spain.
| | - Antonio Ceriello
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Centro de Investigación Biomedica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain; Department of Cardiovascular and Metabolic Diseases, IRCCS Multimedica, Sesto San Giovanni, MI, Italy
| | - Martin Buysschaert
- Department of Endocrinology and Diabetes, University Clinic Saint Luc, UCL, Brussels, Belgium
| | - Iain Chapple
- School of Dentistry, Institute of Clinical Sciences, College of Medical & Dental Sciences, The University of Birmingham, Birmingham, UK
| | - Ryan T Demmer
- Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA
| | - Filippo Graziani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - David Herrera
- ETEP Research Group, Faculty of Odontology, University Complutense of Madrid, Madrid, Spain
| | - Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
| | - Luca Lione
- Territorial Diabetology, ASL 2 (Local Health Agency), Coordinator of Oral Care Study Group, AMD (Italian Diabetologists Association) Savona, Savona, Italy
| | - Phoebus Madianos
- Department of Periodontology, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Manu Mathur
- Public Health Foundation of India, Gurgaon, Haryana, India
| | - Eduard Montanya
- Hospital Universitari Bellvitge - IDIBELL CIBERDEM University of Barcelona, Barcelona, Spain
| | - Lior Shapira
- Department of Periodontology, Hebrew University - Hadassah Faculty of Dental Medicine, Jerusalem, Israel
| | - Maurizio Tonetti
- Department of Periodontology, The University of Hong Kong, Prince Philip Dental Hospital, Hong Kong
| | - Daniel Vegh
- Department of Prosthodontics, Semmelweis University Faculty of Dentistry, Budapest, Hungary
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Ishiyama H, Shuto N, Terazaki T, Noda S, Ishigami M, Yogo K, Hayakawa K. Risk factors for radiotherapy incidents: a single institutional experience. Med Dosim 2018; 44:26-29. [PMID: 29395460 DOI: 10.1016/j.meddos.2017.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 11/06/2017] [Accepted: 12/22/2017] [Indexed: 11/15/2022]
Abstract
We aimed to analyze risk factors for incidents occurring during the practice of external beam radiotherapy (EBRT) at a single Japanese center. Treatment data for EBRT from June 2014 to March 2017 were collected. Data from incident reports submitted during this period were reviewed. Near-miss cases were not included. Risk factors for incidents, including patient characteristics and treatment-related factors, were explored using uni- and multivariate analyses. Factors contributing to each incident were also retrospectively categorized according to the recommendations of the American Association of Physicists in Medicine (AAPM). A total of 2887 patients were treated during the study period, and 26 incidents occurred (0.90% per patient). Previous history of radiotherapy and large fraction size were identified as risk factors for incidents by univariate analysis. Only previous history of radiotherapy was detected as a risk factor in multivariate analysis. Identified categories of contributing factors were human behavior (50.0%), communication (40.6%), and technical (9.4%). The incident rate of EBRT was 0.90% per patient in our institution. Previous history of radiotherapy and large fraction size were detected as risk factors for incidents. Human behavior and communication errors were identified as contributing factors for most incidents.
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Affiliation(s)
- Hiromichi Ishiyama
- Department of Radiology and Radiation Oncology, Kitasato University School of Medicine, Kanagawa, Japan.
| | - Nobuaki Shuto
- Division of Radiation Oncology, Kitasato University Hospital, Kanagawa, Japan
| | - Tsuyoshi Terazaki
- Division of Radiation Oncology, Kitasato University Hospital, Kanagawa, Japan
| | - Shigetoshi Noda
- Division of Radiation Oncology, Kitasato University Hospital, Kanagawa, Japan
| | - Minoru Ishigami
- Division of Radiation Oncology, Kitasato University Hospital, Kanagawa, Japan
| | - Katsunori Yogo
- Division of Medical Physics, Hiroshima High-precision Radiotherapy Cancer Center, Hiroshima, Japan
| | - Kazushige Hayakawa
- Department of Radiology and Radiation Oncology, Kitasato University School of Medicine, Kanagawa, Japan
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Du C, Chai NL, Linghu EQ, Li HK, Sun YF, Xu W, Wang XD, Tang P, Yang J. Incidents and adverse events of endoscopic ultrasound-guided fine-needle aspiration for pancreatic cystic lesions. World J Gastroenterol 2017; 23:5610-5618. [PMID: 28852320 PMCID: PMC5558124 DOI: 10.3748/wjg.v23.i30.5610] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 06/12/2017] [Accepted: 06/19/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the diagnostic value and safety mainly regarding incidents of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for pancreatic cystic lesions (PCLs).
METHODS A total of 150 consecutive patients with suspected PCLs were prospectively enrolled from April 2015 to November 2016. We finally enrolled 140 patients undergoing EUS-FNA. We compared the diagnostic accuracy of EUS-FNA and pathological diagnosis, which is regarded as the gold standard, for PCLs. Patients undergoing EUS-FNA at least 1 wk preoperatively were monitored for incidents and adverse events to evaluate its safety.
RESULTS There were 88 (62.9%) women and 52 (37.1%) men among 140 patients, with a mean age of 50.1 (± 15.4) years. There were 67 cysts located in the head/uncinate of the pancreas and 67 in the body/tail, and 6 patients had at least 1 cyst in the pancreas. There were 75 patients undergoing surgery and 55 undergoing EUS-FNA with interval at least 1 wk before other operations, with 3 patients undergoing the procedure twice. The accuracy of EUS-FNA in differentiating benign and malignant lesions was 97.3% (73/75), while the accuracy of characterizing PCL subtype was 84.0% (63/75). The incident rate was 37.9% (22/58), whereas only 1 AE was observed in 58 cases.
CONCLUSION EUS-FNA is effective and safe for diagnosis of PCLs, however procedure-related incidents are common. Caution should be taken in patients undergoing EUS-FNA.
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Jeandarme I, Wittouck C, Vander Laenen F, Pouls C, Heimans H, Oei TI, Bogaerts S. Critical incidents and judicial response during medium security treatment. Int J Law Psychiatry 2017; 51:54-61. [PMID: 28131515 DOI: 10.1016/j.ijlp.2016.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 12/08/2016] [Indexed: 06/06/2023]
Abstract
This study examined inpatient incidents in three Flemish forensic medium security units and analyzed the subsequent judicial reactions to these incidents. During medium security treatment, incidents were reported for more than half of the participants. The most frequently registered incidents were non-violent in nature, such as absconding and treatment non-compliance. The base rate for physically violent incidents was low. Although crime-related incidents during medium security treatment were rarely prosecuted and adjudicated, the base rate of revocation - and hence drop-out from treatment - as a result of these incidents was high.
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Affiliation(s)
- Inge Jeandarme
- Knowledge Center Forensic Psychiatric Care (KeFor) OPZC Rekem, Daalbroekstraat 106, 3621 Rekem, Belgium.
| | - Ciska Wittouck
- Ghent University, De Pintelaan 185 K12, 9000 Ghent, Belgium; Ghent University, Universiteitstraat 4, 9000 Ghent, Belgium.
| | | | - Claudia Pouls
- Knowledge Center Forensic Psychiatric Care (KeFor) OPZC Rekem, Daalbroekstraat 106, 3621 Rekem, Belgium.
| | - Henri Heimans
- Commission for the Protection of Society at the prison of Ghent, Belgium.
| | - T I Oei
- Tilburg University, Warandelaan 2, 5037 AB Tilburg, The Netherlands.
| | - Stefan Bogaerts
- Tilburg University, Warandelaan 2, 5037 AB Tilburg, The Netherlands; KARID, FIVOOR, Forensic Psychiatric Center The Kijvelanden, Kijvelandsekade 1, 3172 AB Poortugaal, The Netherlands.
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Mozaffary A, Asgari S, Tohidi M, Kazempour-Ardebili S, Azizi F, Hadaegh F. Change in fasting plasma glucose and incident type 2 diabetes mellitus: results from a prospective cohort study. BMJ Open 2016; 6:e010889. [PMID: 27217283 PMCID: PMC4885425 DOI: 10.1136/bmjopen-2015-010889] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To investigate the association between changes in fasting plasma glucose (FPG) values and incident type 2 diabetes (T2D) in a cohort of the Iranian population. DESIGN Prospective cohort study. SETTING This study was conducted within the framework of the Tehran Lipid and Glucose Study (TLGS) to investigate the association between change in FPG between baseline examination (1999-2001) and the second visit (2002-2005) with incident T2D. PARTICIPANTS A total of 3981 non-diabetic participants aged ≥20 years. OUTCOME MEASURE T2D was defined if the participant was using antidiabetic drugs or if FPG was ≥7 mmol/L or if the 2 h post-challenge plasma glucose (2-hPCG) was ≥11.1 mmol/L. RESULTS During a median follow-up of 6.17 years, after the second examination, 288 new cases of T2D were identified. In a multivariate Cox proportional hazard analysis using age as timescale, we presented a simple model including FPG change (HR 1.19, 95% CI 1.07 to 1.33) and baseline waist circumference (WC) (HR 1.004, 95% CI 1.001 to 1.008) with a discriminative power (C-index) of 72%. Furthermore, we showed that the highest quartile of FPG change enhanced the T2D risk to 1.65 (95% CI 1.2 to 2.27) compared with the lowest quartile (p for trend=0.004).The independent risk of FPG change resisted further adjustment with 2-hPCG change. Adding the 2-hPCG change only slightly increased the discriminative power of the model including FPG change and baseline value of WC (0.73% vs 0.72%). After the study population had been limited to those with normal fasting glucose/normal glucose tolerance, FPG change remained an independent predictor (HR 1.57, 95% CI 1.31 to 1.88). CONCLUSIONS Two measurements of FPG obtained about 3 years apart can help to identify populations at risk of incident T2D independently of important traditional risk factors and their changes, including 2-hPCG change.
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Affiliation(s)
- Amirhossein Mozaffary
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences (RIES), Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Samaneh Asgari
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences (RIES), Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Maryam Tohidi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences (RIES), Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Sara Kazempour-Ardebili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences (RIES), Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Science, Tehran, Islamic Republic of Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences (RIES), Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
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Abstract
Roof bolting typically follows the extraction of a commodity to help keep the roof from collapsing. During 2004 to 2013, roof bolter operators had the highest number of machinery-related injuries, accounting for 64.7 percent, at underground coal mines. This paper analyzes U.S. roof bolter fatal and nonfatal lost-time injury data at underground work locations for all commodities from 2004 through 2013 and determines risk indices for six roof bolting tasks. For fatal and nonfatal incidences combined, the roof bolting tasks in order of the highest to lowest risk index were bolting, handling of materials, setting the temporary roof support (TRS), drilling, tramming, and traversing. For fatalities, the roof bolting tasks in order of the highest to lowest risk index were handling of materials, setting the TRS, bolting, drilling, traversing, and tramming. Age was found to be a significant factor. Severity of injury, indicated by days lost, was found to increase with increasing age as well as with increasing experience, largely due to the confounding of age and experience. The operation of the roof bolting machine used in underground mining should be a research priority given the high frequency and severity of incidents. The results also suggest that temporal factors may exist, so additional research is warranted to better understand these factors and potentially develop interventions. This research provides a data-driven foundation from which future research can be conducted for safety interventions to reduce the frequency and severity of incidences involving the roof bolter activities of bolting, handling of materials, and setting the TRS.
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Affiliation(s)
- J J Sammarco
- Office of Mine Health and Safety Research (OMSHR), National Institute for Occupational Safety and Health (NIOSH), Pittsburgh, PA, USA
| | - A Podlesny
- Office of Mine Health and Safety Research (OMSHR), National Institute for Occupational Safety and Health (NIOSH), Pittsburgh, PA, USA
| | - E N Rubinstein
- Office of Mine Health and Safety Research (OMSHR), National Institute for Occupational Safety and Health (NIOSH), Pittsburgh, PA, USA
| | - B Demich
- Office of Mine Health and Safety Research (OMSHR), National Institute for Occupational Safety and Health (NIOSH), Pittsburgh, PA, USA
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Abstract
Stressful life events are associated with the metabolic syndrome in cross-sectional studies, but prospective studies addressing this issue are rare and limited. We therefore evaluated whether the number of stressful life events is associated with incident metabolic syndrome. We assessed the association between the number of stressful life events experienced in the 5 years up until baseline and incident metabolic syndrome after 6.5 years at follow-up in the Hoorn study, a middle-aged and elderly population-based cohort. Participants with prevalent metabolic syndrome at baseline were excluded. Metabolic syndrome was defined according to the Adult Treatment Panel III, including fasting plasma glucose levels, HDL-C levels, triglyceride levels, waist circumference and hypertension. We included 1099 participants (47% male; age 60 ± 7 years). During 6.5 years of follow-up, 238 participants (22%) developed the metabolic syndrome. Logistic regression adjusted for age, sex, education level and follow-up duration showed a positive association between the number of stressful life events at baseline and incident metabolic syndrome [OR 1.13 (1.01-1.27) per event, p = 0.049]. In addition, a Poisson model showed a significant positive association between the number of stressful life events at baseline and the number of metabolic syndrome factors at follow-up [OR 1.05 (1.01-1.11) per event, p = 0.018]. Finally, we observed a significant association between the number of stressful life events at baseline and waist circumference at follow-up [adjusted for confounders β 0.86 (0.39-1.34) cm per event, p < 0.001]. Overall, we concluded that persons who reported more stressful life events at baseline had a significantly increased risk for developing metabolic syndrome during 6.5 years of follow-up, in a middle-aged and elderly population-based cohort.
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Affiliation(s)
- Femke Rutters
- a Department of Epidemiology and Biostatistics
- b EMGO + Institute for Health and Care Research, VU University Medical Centre , Amsterdam , the Netherlands
| | - Stefan Pilz
- c Department of Internal Medicine, Division of Endocrinology and Metabolism , Medical University of Graz , Graz , Austria
| | - Anitra D M Koopman
- a Department of Epidemiology and Biostatistics
- b EMGO + Institute for Health and Care Research, VU University Medical Centre , Amsterdam , the Netherlands
| | - Simone P Rauh
- a Department of Epidemiology and Biostatistics
- b EMGO + Institute for Health and Care Research, VU University Medical Centre , Amsterdam , the Netherlands
| | - Frans Pouwer
- d Centre of Research on Psychology in Somatic Diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University , Tilburg , the Netherlands
| | - Coen D A Stehouwer
- e Department of Internal Medicine and Cardiovascular Research Institute (CARIM) , Maastricht University Medical Centre , Maastricht , the Netherlands , and
| | - Petra J Elders
- b EMGO + Institute for Health and Care Research, VU University Medical Centre , Amsterdam , the Netherlands
- f Department of General Practice , VU University Medical Centre , Amsterdam , the Netherlands
| | - Giel Nijpels
- b EMGO + Institute for Health and Care Research, VU University Medical Centre , Amsterdam , the Netherlands
- f Department of General Practice , VU University Medical Centre , Amsterdam , the Netherlands
| | - Jacqueline M Dekker
- a Department of Epidemiology and Biostatistics
- b EMGO + Institute for Health and Care Research, VU University Medical Centre , Amsterdam , the Netherlands
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Chimba D, Kutela B. Scanning secondary derived crashes from disabled and abandoned vehicle incidents on uninterrupted flow highways. J Safety Res 2014; 50:109-116. [PMID: 25142367 DOI: 10.1016/j.jsr.2014.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 05/05/2014] [Accepted: 05/20/2014] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Extent of secondary crashes derived from primary incidents involving abandoned and disabled vehicles are presented in this paper. METHOD Using years 2004 to 2010 incident and crash data on selected Tennessee freeways, the study identified secondary crashes that resulted from disabled and abandoned vehicle primary incidents. The relationship between time and distance gaps before the secondary crash with respect to individual incident characteristics were evaluated through descriptive statistics and linear regression. RESULTS The time and distance gap analysis indicated that a large portion of secondary crashes occurred within 20 min after the primary incidents and within a distance of 0.5 miles upstream. While 76% of incidents involved shoulder, most secondary crashes were related to the closing of right lanes. Overall, 58% of the secondary crashes occurred within 30 min after the occurrence of the primary incidents. Most of the vehicles in the incidents that involved towing and caused secondary crashes were towed or removed out of the travel way within 60 min from the time of occurrence. The study found that most (95%) secondary crashes were property damage only (PDO), while 49% were rear-end crashes. The negative binomial model was used to evaluate the impact of roadway geometry and traffic factors associated with frequency of these secondary crashes. It was found that the posted speed limit, congested segments, segments with high percentages of trucks, and peak hour volumes increased the likelihood of secondary crash occurrence. Roadway segments with wider medians, shoulders, and multilanes decrease the likelihood of secondary crashes caused by abandoned and disabled vehicles as the primary incidents. Practical applications The paper recommends that wider shoulders be provided on any section of freeway to accommodate abandoned or disabled vehicles to avoid blocking of travel lane(s).
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Affiliation(s)
- Deo Chimba
- Civil Engineering Department, Tennessee State University, 3500 John A. Merritt Blvd., Torrence Hall, Room 108, Nashville, TN 37209, USA.
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Cottet P, d'Hollander A, Cahana A, Van Gessel E, Tassaux D. A new process-centered description tool to initiate meta-reporting methodology in healthcare - 7CARECAT™. Feasibility study in a post-anesthesia care unit. Ann Fr Anesth Reanim 2013; 32:e129-34. [PMID: 24075692 DOI: 10.1016/j.annfar.2013.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Accepted: 06/25/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND In the healthcare domain, different analytic tools focused on accidents appeared to be poorly adapted to sub-accidental issues. Improving local management and intra-institutional communication with simpler methods, allowing rapid and uncomplicated meta-reporting, could be an attractive alternative. METHODS A process-centered structure derived from the industrial domain - DEPOSE(E) - was selected and modified for its use in the healthcare domain. The seven exclusive meta-categories defined - Patient, Equipment, Process, Actor, Supplies, work Room and Organization- constitute 7CARECAT™. A collection of 536 "improvement" reports from a tertiary hospital Post anesthesia care unit (PACU) was used and four meta-categorization rules edited prior to the analysis. Both the relevance of the metacategories and of the rules were tested to build a meta-reporting methodology. The distribution of these categories was analyzed with a χ 2 test. RESULTS Five hundred and ninety independent facts were collected out of the 536 reports. The frequencies of the categories are: Organization 44%, Actor 37%, Patient 11%, Process 3%, work Room 3%, Equipment 1% and Supplies 1%, with a p-value <0.005 (χ 2). During the analysis, three more rules were edited. The reproducibility, tested randomly on 200 reports, showed a <2% error rate. CONCLUSION This meta-reporting methodology, developed with the 7CARECAT™ structure and using a reduced number of operational rules, has successfully produced a stable and consistent classification of sub-accidental events voluntarily reported. This model represents a relevant tool to exchange meta-informations important for local and transversal communication in healthcare institutions. It could be used as a promising tool to improve quality and risk management.
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