Narcanazo: Community Activation of Antiracist Epidemiology.

The Latinx (Hispanic) social construct obscures differences in the overdose risk levels of groups within this category. When national data are disaggregated, stateside Puerto Rican mortality increases exponentially, so much that this community has the highest rates of overdose deaths across years. Developed by Bronx-based Puerto Ricans, Narcanazo is an empowered upstander campaign that uses local overdose data to mobilize community members as trained naloxone dispensers. This health promotion campaign was grounded in antiracist epidemiological analysis. (Am J Public Health. 2024;114(S6):S463-S466. https://doi.org/10.2105/AJPH.2024.307605) [Formula: see text].

ENGINE-An EHS Project for Future Guidelines.

Clinical guidelines are evidence-based recommendations developed by healthcare organizations or expert panels to assist healthcare providers and patients in making appropriate and reliable decisions regarding specific health conditions, aiming to enhance the quality of healthcare by promoting best practices, reducing variations in care, and at the same time, allowing tailored clinical decision-making. European Hernia Society (EHS) guidelines aim to provide surgeons a reliable set of answers to their pertinent clinical questions and a tool to base their activity as experts in the management of abdominal wall defects. The traditional approach to guideline production is based on gathering key opinion leader in a particular field, to address a number of key questions, appraising papers, presenting evidence and produce final recommendations based on the literature and consensus. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) method offers a transparent and structured process for developing and presenting evidence summaries and for carrying out the steps involved in developing recommendations. Its main strength lies in guiding complex judgments that balance the need for simplicity with the requirement for complete and transparent consideration of all important issues. EHS guidelines are of overall good quality but the application of GRADE method, began with EHS guidelines on open abdomen, and the increasing adherence to the process, has greatly improved the reliability of our guidelines. Currently, the need to application of this methodology and the creation of stable and dedicated group of researchers interested in following GRADE in the production of guidelines has been outlined in the literature. Considering that the production of clinical guidelines is a complex process, this paper aim to highlights the primary features of guideline production, GRADE methodology, the challenges associated with their adoption in the field of hernia surgery and the project of the EHS to establish a stable guidelines committee to provide technical and methodological support in update of previously published guideline or the creation of new ones.

County-level industrial composition of the labor force and drug overdose mortality rates in the United States in 2018-2021.

BACKGROUND: Drug mortality risks vary among industries, creating distinctive geographic patterns across US counties. However, less is known about how local labor market structure relates to drug overdose mortality amid the synthetic opioid era in the United States. This study investigates the relationship between industry-specific job composition and drug overdose mortality at the county level while exploring how fentanyl's presence in illicit drug supplies may moderate the relationship. METHODS: Data were derived from the National Center for Health Statistics' Multiple Cause of Death files for the rates of drug overdose mortality of any intent, linked with four other sources on industry-specific job shares, drug supply, and county-level sociodemographic characteristics and opioid prescribing rates from the US Census Bureau, the CDC, and the Drug Enforcement Administration. Negative binomial regression models were employed to examine associations between county industry-specific job composition and drug overdose mortality, with tests for moderating effects of state-level fentanyl seizure rates. RESULTS: Our models indicate negative associations between job shares of manufacturing, retail trade, and educational services industries and drug overdose mortality. Positive associations were found for arts/entertainment/recreation and public administration. State-level fentanyl seizure rates had moderating effects on administrative/support/waste management/remediation (A/S/WM/R) and educational services. CONCLUSION: Counties with a higher concentration of arts/entertainment/recreation and public administration jobs need targeted efforts to mitigate drug-related overdose risks. Additionally, areas with higher concentrations of A/S/WM/R service jobs, particularly where fentanyl seizure rates are higher, may require proactive harm reduction strategies for reducing overdose risks.

Systematic review and meta-analysis of the incidence of incisional hernia in urological surgery.

PURPOSE: To evaluate the incidence of incisional hernia in patients undergoing direct access to the abdominal cavity in urological surgery. METHODS: We conducted a systematic review in Pubmed, Embase, and Cochrane Central from 1980 to the present according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Eighty-four studies were selected for inclusion in this analysis, and meta-analysis and meta-regression were performed. RESULTS: The total incidence in the 84 studies was 4.8% (95% CI 3.7% - 6.2%) I2 93.84%. Depending on the type of incision, it was higher in the open medial approach: 7.1% (95% CI 4.3%-11.8%) I2 92.45% and lower in laparoscopic surgery: 1.9% (95% CI 1%-3.4%) I2 71, 85% According to access, it was lower in retroperitoneal: 0.9% (95% CI 0.2%-4.8%) I2 76.96% and off-midline: 4.7% (95% CI 3.5%-6.4%) I2 91.59%. Regarding the location of the hernia, parastomal hernias were more frequent: 15.1% (95% CI 9.6% - 23%) I2 77.39%. Meta-regression shows a significant effect in reducing the proportion of hernias in open lateral, laparoscopic and hand-assisted compared to medial open access. CONCLUSION: The present review finds the access through the midline and stomas as the ones with the highest incidence of incisional hernia. The use of the lateral approach or minimally invasive techniques is preferable. More prospective studies are warranted to obtain the real incidence of incisional hernias and evaluate the role of better techniques to close the abdomen.

Home range in genus Capra: from polygons to Brownian bridges of scabietic and healthy Iberian ibexes (Capra pyrenaica).

Home range and home range overlap can be used to describe use of space and movement of wildlife. During the last years, advancements in technology have greatly improved our understanding of animal movement, especially among large herbivores. Wild ungulate abundance and distribution have increased in temperate areas. Moreover, their diseases-including sarcoptic mange in the Iberian Ibex (Capra pyrenaica)-have become a cause of concern for livestock, public health, and wildlife conservation. In this study, we first reviewed existing literature on the home range of species in the genus Capra. We then analyzed data from 52 GPS-GSM-collared Iberian ibexes, of which 33 were healthy and 19 were affected by sarcoptic mange from 3 different populations in the southeastern Iberian Peninsula to analyze: (1) differences in size and characteristics of home ranges obtained by the 3 most commonly used methodologies-minimum convex polygon, kernel density estimation, and Brownian bridges movement models (BBMMs); and (2) the impact of endemic sarcoptic mange on Iberian Ibex home range. The literature review revealed that available information on spatial behavior of Capra spp. was based only on 3 species, including the Iberian Ibex, estimated through a diversity of methods which made it difficult to compare results. We found positive correlations among the different home range estimation methods in the Iberian Ibex, with BBMMs proving to be the most accurate. This study is the first to use BBMMs for estimating home range in this species, and it revealed a marked seasonal behavior in spatial use, although sarcoptic mange smoothed such seasonal pattern. The seasonal overlaps obtained suggest that core areas of the Iberian Ibex change within wider home range areas, which are ecological parameters relevant to identifying key areas for species management and conservation.

Black Americans' Drug Mortality Increases and Local Employment Opportunities, 2010‒2021.

Objectives. To test the associations between local employment opportunities for the Black workforce and drug mortality among Black Americans, while examining the potential moderating effects of fentanyl seizure rates. Methods. We derived data from the National Center for Health Statistics' restricted-access Multiple Cause of Death file, linked with county-level job counts, drug supply, and other characteristics from the US Census Bureau and the Centers for Disease Control and Prevention. After examining the characteristics of counties by the magnitudes of increases in drug mortality from 2010‒2013 to 2018-2021, we conducted a first-differenced regression analysis to test the associations between the job-to-Black workforce ratio and age-adjusted drug mortality rates among Black Americans in US counties and test the moderating effects of state-level fentanyl seizure rates. Results. One more job per 100 Black workers was associated with 0.29 fewer drug overdose deaths per 100 000 Black Americans in the county. This negative association was stronger in the counties of the states with higher increases in fentanyl seizure rates. Conclusions. Increasing employment opportunities can be an important strategy for preventing Black Americans' drug mortality, especially among those living in areas with higher increases in fentanyl seizure rates. (Am J Public Health. 2024;114(7):729-732. https://doi.org/10.2105/AJPH.2024.307646).

Racial/ethnic inequality in homelessness and drug overdose deaths in US States.

PURPOSE: This study examined whether state-level racial disproportionality in homelessness is associated with racial disproportionality in overdose mortality. METHODS: Counts of individuals experiencing homelessness (2015-2017; by state and racial/ethnic group) were obtained from the US Department of Housing and Urban Development; population estimates and counts of drug overdose deaths (2018-2021; by state and racial/ethnic group) were obtained from the National Center for Health Statistics. Homelessness and overdose mortality disproportionality scores were calculated to indicate the extent to which each racial group was over- or under- represented among those experiencing homelessness, or among overdose deaths, respectively (relative to each racial group's proportional share in the general population). For each racial group examined, ordinary least squares regression models with robust standard errors (SEs) examined associations between state-level disproportionality in homelessness and disproportionality in overdose mortality, adjusting for percent aged 18-64 and US Census Region, as well as disproportionality in educational attainment and unemployment. RESULTS: State-level racial disproportionality in homelessness was significantly and positively associated with racial disproportionality in overdose mortality for Black (b = 0.16 [SE = 0.05]; p < .01), American Indian/Alaska Native (b = 0.71 [SE = 0.23]; p < .01), and Hispanic populations (b = 0.17 [SE = 0.05]; p < .01), in models adjusting for region and percent aged 18-64. The significant positive associations in these three populations persisted after adjusting for educational attainment disproportionality, yet the association was no longer significant in the Black population after adjusting for unemployment disproportionality. CONCLUSION: States with the highest levels of racial/ethnic minority overrepresentation in homelessness generally also had relatively higher levels of racial/ethnic minority overrepresentation in overdose deaths.

Effect of Functionalization of Texturized Polypropylene Surface by Silanization and HBII-RGD Attachment on Response of Primary Abdominal and Vaginal Fibroblasts.

Soft tissue defects, such as incisional hernia or pelvic organ prolapse, are prevalent pathologies characterized by a tissue microenvironment rich in fragile and dysfunctional fibroblasts. Precision medicine could improve their surgical repair, currently based on polymeric materials. Nonetheless, biomaterial-triggered interventions need first a better understanding of the cell-material interfaces that truly consider the patients' biology. Few tools are available to study the interactions between polymers and dysfunctional soft tissue cells in vitro. Here, we propose polypropylene (PP) as a matrix to create microscale surfaces w/wo functionalization with an HBII-RGD molecule, a fibronectin fragment modified to include an RGD sequence for promoting cell attachment and differentiation. Metal mold surfaces were roughened by shot blasting with aluminum oxide, and polypropylene plates were obtained by injection molding. HBII-RGD was covalently attached by silanization. As a proof of concept, primary abdominal and vaginal wall fasciae fibroblasts from control patients were grown on the new surfaces. Tissue-specific significant differences in cell morphology, early adhesion and cytoskeletal structure were observed. Roughness and biofunctionalization parameters exerted unique and combinatorial effects that need further investigation. We conclude that the proposed model is effective and provides a new framework to inform the design of smart materials for the treatment of clinically compromised tissues.

A virtual simulation approach to assess the effect of trocar-site placement and scar characteristics on the abdominal wall biomechanics.

Analyses of registries and medical imaging suggest that laparoscopic surgery may be penalized with a high incidence of trocar-site hernias (TSH). In addition to trocar diameter, the location of the surgical wound (SW) may affect TSH incidence. The intra-abdominal pressure (IAP) exerted on the abdominal wall (AW) might also influence the appearance of TSH. In the present study, we used finite element (FE) simulations to predict the influence of trocar location and SW characteristics (stiffness) on the mechanical behavior of the AW subject to an IAP. Two models of laparoscopy patterns on the AW, with trocars in the 5-12 mm range, were generated. FE simulations for IAP values within the 4 kPa-20 kPa range were carried out using the Code Aster open-source software. Different stiffness levels of the SW tissue were considered. We found that midline-located surgical wounds barely deformed, even though they moved outwards along with the regular LA tissue. Laterally located SWs hardly changed their location but they experienced significant variations in their volume and shape. The amount of deformation of lateral SWs was found to strongly depend on their stiffness. Trocar incisions placed in a LA with non-diastatic dimensions do not compromise its mechanical integrity. The more lateral the trocars are placed, the greater is their deformation, regardless of their size. Thus, to prevent TSH it might be advisable to close lateral trocars with a suture, or even use a prosthetic reinforcement depending on the patient's risk factors (e.g., obesity).

Abdominal wall surgery units accreditation. The Spanish model.

The Spanish Association of Surgeons (AEC) deems it essential to define and regulate the acquisition of high-specialization competencies within General Surgery and Gastrointestinal Surgery and proposes the Regulation for the accreditation of specialized surgical units. The AEC aims to define specialized surgical units as those functional elements of the health system that meet the defined requirements regarding their provision, solvency, and specialization in care, teaching, and research. In this paper we present the proposed accreditation model for Abdominal Wall Surgery Units, as well as the results of a survey conducted to assess the status of such units in our country. The model presented represents one of the pioneering initiatives worldwide concerning the accreditation of Abdominal Wall Surgery Units.

Xylazine in Overdose Deaths and Forensic Drug Reports in US States, 2019-2022.

Importance: Xylazine is increasingly reported in street drugs and fatal overdoses in the US, yet state-level data are limited, hampering local public health responses. Objective: To gather available state-level data on xylazine involvement in overdose deaths and in forensic drug reports. Design, Setting, and Participants: This cross-sectional study was a secondary analysis of 2019 to 2022 data from the National Forensic Laboratory Information System (NFLIS), National Center for Health Statistics, and individual states' medical examiner or public health agency reports. Data were analyzed from August to October 2023. Exposure: State. Main Outcomes and Measures: Yearly xylazine-related overdose deaths per 100 000 residents; xylazine NFLIS drug reports, both per 100 000 residents and as a percentage of all NFLIS drug reports (from samples of drugs seized by law enforcement and analyzed by NFLIS-participating laboratories). Results: A total of 63 state-years were included in analyses of mortality rates, while 204 state-years were included in analyses of NFLIS reports. According to the publicly available data compiled in this study, at least 43 states reported at least 1 xylazine-related overdose death from 2019 to 2022, yet yearly totals of xylazine-related deaths were available for only 21 states. Of states with data available, xylazine-involved overdose death rates were highest in Vermont (10.5 per 100 000 residents) and Connecticut (9.8 per 100 000 residents) in 2022. In 2019, 16 states had zero xylazine reports included in NFLIS reports; in 2022, only 2 states had zero xylazine reports and all but 3 states had recorded an increase in xylazine's representation in NFLIS reports. In 2022, xylazine represented 16.17% of all NFLIS reports in Delaware and between 5.95% and 7.00% of NFLIS reports in Connecticut, Maryland, District of Columbia, New Jersey, and Rhode Island, yet less than 1.0% of NFLIS reports in 35 different states. Conclusions and Relevance: In this cross-sectional study of publicly available data on fatal overdoses and drugs analyzed by forensic laboratories, xylazine's reported presence in overdose deaths and forensic reports was concentrated in the eastern US yet extended across the country to encompass nearly all states. In spite of xylazine's geographic reach, yearly state-level numbers of xylazine-related overdose deaths were publicly available for less than half of all states.

A scoping review of law enforcement drug seizures and overdose mortality in the United States.

BACKGROUND: Leveraging law enforcement drug seizure data to better respond to the overdose crisis requires an understanding of available evidence and knowledge gaps regarding relationships between drug seizures and overdose mortality. OBJECTIVE: This scoping review summarized peer-reviewed literature on associations between law enforcement drug seizures and drug-related mortality in the United States (US) in the era of illicitly-manufactured fentanyl, comparing study data sources, measures, methodologies, settings, and findings. METHODS: We identified 388 non-duplicate records from three online databases searched on May 23, 2023. After title/abstract and full-text screening by two independent reviewers, 14 studies met the criteria for inclusion. The included studies tested the association between a measure related to law enforcement drug seizures and an overdose mortality outcome in the US and were published in English, in peer-reviewed journals, during or after 2013. RESULTS: Four of 14 studies (29%) included data from the entire US, while the remaining studies focused on an individual state/city/county or a group of states/cities/counties. Synthetic opioid/fentanyl seizures represented the most frequently examined drug seizure category, and overdose deaths overall (involving any drugs) represented the most frequently examined outcome. Most studies used counts/rates of drug seizures, with fewer studies examining dosage/weight, drug combinations, the proportion of drug seizures involving a specific drug, or spatiotemporal distribution. The majority (86%) of studies reported at least one statistically significant positive association between a law enforcement drug seizure measure and an overdose mortality outcome, most consistently for fentanyl-related seizures. Results were relatively less consistent for seizures involving stimulants and other drugs. CONCLUSIONS: Studies in this review provided consistent evidence that fentanyl-related seizure measures are positively associated with overdose mortality outcomes, despite the limitations inherent in drug seizure data, even in the absence of available information regarding seizure weight or dosage.

Prophylactic mesh does not prevent parastomal hernia in long-term: Meta-analysis and trial sequential analysis.

BACKGROUND: Previous randomized clinical trials, systematic reviews, and meta-analyses evaluating parastomal hernia prevention with mesh placement during end colostomy formation have reported contradictory results. This review aimed to assess the efficacy of this strategy in long-term follow-up according to the latest available data. METHODS: Medline, EMBASE, Cochrane Library, Web of Science, and Google Scholar were searched. Randomized clinical trials were included if they compared mesh with no mesh during initial end colostomy creation in adult patients to prevent parastomal hernia with a follow-up longer than 2 years. A meta-analysis was performed to evaluate parastomal hernia incidence (primary outcome), parastomal hernia repair rate, and mortality. Subgroup analysis included surgical approach and mesh position, and trial sequential analysis was performed. RESULTS: Eight randomized clinical trials involving 537 patients met the inclusion criteria. Based on long-term follow-up, the incidence of parastomal hernia was not reduced when a prophylactic mesh was placed (relative risk = 0.68 [95% confidence interval:0.46-1.02]; I2 = 81%, P =.06). The parastomal hernia repair rate was low; however, no difference was found between the groups (relative risk = 0.90 [95% confidence interval:0.51-1.56]; I2 = 0%; P = .70), and no difference was detected between the groups when mortality was assessed (relative risk = 1.03 [95% confidence interval: 0.77-1.39]; I2 = 21%; P = .83). Subgroup analyses did not show differences according to the surgical approach or mesh position used. Regarding trial sequential analysis, an optimal information size was not achieved. CONCLUSION: Prophylactic mesh placement during end colostomy formation does not prevent parastomal hernia in the long term. The parastomal hernia repair rate and mortality rate did not vary between the included groups. Heterogeneity among the included randomized clinical trials might restrict the reliability of the results.