The Beneficial Role of Endotracheal Lidocaine in Mitigating Hemodynamic Responses During Elective Surgical Tracheostomy in Head and Neck Cancer Patients.

BACKGROUND: The effectiveness of endotracheal lidocaine administration to reduce sympathetic stimulus after tracheostomy is still uncertain. PURPOSE: This study aimed to compare the hemodynamic responses of patients undergoing tracheostomy with and without pre-tracheostomy administration of endotracheal lidocaine. STUDY DESIGN, SETTING AND SAMPLE: A prospective cohort study was conducted at a tertiary care cancer center in the United Kingdom. Patients who underwent tracheostomy as part of their head and neck cancer surgery were included. Exclusion criteria comprised tracheostomies involving special requirements and subjects with documented cardiac history or taking specific medications. PREDICTOR VARIABLE: The predictor variable was pre-tracheostomy anesthetic management defined as the administration of endotracheal 4 ml 4% lidocaine before tracheostomy coded as lidocaine used or not used. OUTCOME VARIABLE: The primary outcome measures in this study were the observed hemodynamic responses after tracheostomy, including heart rate, systolic blood pressure, and diastolic blood pressure. The secondary outcome measure in the two groups was the time it took for subjects to return to their pre-tracheostomy baseline hemodynamic parameters, measured in minutes. ANALYSES: Data analyses included χ2, t-test, analysis of variance, and multivariable regression models. P values < .05 were considered statistically significant. COVARIATES: The patients' age, sex, body mass index, smoking status, tracheostomy tube size, and tumor stage were evaluated. RESULTS: The sample included 50 consecutive patients, the majority of whom were male (55%) with a mean age of 62 years (standard deviation[SD] 12) and a mean body mass index of 28 (SD 4). Most patients had stage III or IV oral cancers (59%). Following surgical tracheostomy, the group that received endotracheal lidocaine demonstrated significantly less hemodynamic variability when compared with the control group. The case group exhibiting lower systolic blood pressure (117 [SD 10] vs 136 [SD 18]), diastolic blood pressure (62 [SD 4] vs 68 [SD 4]), and heart rate (72 [SD 4] vs 78 [SD 4]), with statistical significance (P < .05). However, there was no significant difference in the time taken for the two groups to return to their pre-tracheostomy baseline hemodynamic parameters. CONCLUSIONS AND RELEVANCE: This study demonstrates an association between the preadministration of 4% endotracheal lidocaine with an observed attenuation in hemodynamic response following surgical tracheostomy in head and neck cancer patients.

Sustainable Treatment of Oral Traumatic Ulcers with Licorice Containing Hydrogels: Integrating Computational Modeling, Quality by Design, Green Synthesis, and Molecular Biological Evaluation.

The urge to implement innovative approaches that align with eco-friendly practices and hold promise for enhancing oral health while promoting environmental sustainability has been increasing. This current work aims to develop a sustainable treatment for oral traumatic ulcers using licorice-based hydrogels (LHGs) containing hydroxyethyl cellulose (HEC) as the green gelling agent. Licorice root aqueous extract was phytochemically profiled using UPLC-ESI-MS/MS. Forty-three compounds were detected, with Glycyrrhizic acid being the major component of the extract (34.85 ± 2.77%). By implementing a Quality by Design (QbD) approach, the study investigates the effects of different licorice extract and HEC concentrations on key variables such as pH and viscosity of the prepared formulations, ulcer and wound healing scores, and tissue growth factors via a Full Factorial Experimental Design. The LHGs exhibited desirable consistency, spreadability, and clarity. Statistical analysis, employing an ANOVA test, revealed the high significance of the constructed models with the licorice concentration being the key independent factor affecting all dependent outputs. The pH as well as the viscosity of the prepared LHGs were positively influenced by licorice extract concentration, with higher concentrations leading to increased alkalinity and viscosity. Rheological behavior analysis revealed a pseudoplastic flow with demonstrated thixotropy which is advantageous for application and prolongation of residence time. The wound healing process was assessed through ulcer size, traumatic ulcer healing score (UHS), collagen-1 expression (COL-1), growth factors (EGF, VEGF), pro-inflammatory markers (TNF-α), wound healing score (WHS). LHGs prepared using higher levels of both factors, 30% dried licorice root extract and 4% HEC, demonstrated enhanced wound healing, elevated growth factor expression of 66.67% and 23.24%, respectively, and 88% reduced inflammation compared to the control group, indicating their potential in expediting oral ulcer recovery. Overall, these findings highlight the promising role of green licorice-based hydrogels in promoting sustainable oral mucosal healing.

Does the Geohealth domain require a body of knowledge?

To answer the question if the Geohealth domain requires a body of knowledge (BoK), we need a general understanding of concepts associated with this field. Two years ago, the United Nation (UN) committee of experts on global geospatial information management identified "semantic- and ontology-linked data" as something that "will become essential to support the next generation of autonomous systems" (UN-GGIM, 2020). The term ontology is closely related to BoK. Unlike data models, ontologies are independent of application; they are generic, can be used in different ways and have clear advantages but they are challenging to create and even more difficult to maintain. The brief description below summarizes what ontologies are, why they are needed to support linked data, what the role of the semantic web is, what is already going on within the Geohealth domain on ontologies and how a BoK can assist.

Using Routinely Collected Health Records to Identify the Fine-Resolution Spatial Patterns of Soil-Transmitted Helminth Infections in Rwanda.

Background. Soil-transmitted helminths (STH) are parasitic diseases with significant public health impact. Analysis is generally based on cross-sectional prevalence surveys; outcomes are mostly aggregated to larger spatial units. However, recent research demonstrates that infection levels and spatial patterns differ between STH species and tend to be localized. Methods. Incidence data of STHs including roundworm (Ascaris lumbricoides), whipworm (Trichuris trichiura) and hookworms per primary health facility for 2008 were linked to spatially delineated primary health center service areas. Prevalence data per district for individual and combined STH infections from the 2008 nationwide survey in Rwanda were also obtained. Results. A comparison of reported prevalence and incidence data indicated significant positive correlations for roundworm (R2 = 0.63) and hookworm (R2 = 0.27). Weak positive correlations were observed for whipworm (R2 = 0.02) and the three STHs combined (R2 = 0.10). Incidence of roundworm and whipworm were found to be focalized with significant spatial autocorrelation (Moran's I > 0: 0.05−0.38 and p ≤ 0.03), with (very) high incidence rates in some focal areas. In contrast, hookworm incidence is ubiquitous and randomly distributed (Moran's I > 0: 0.006 and p = 0.74) with very low incidence rates. Furthermore, an exploratory regression analysis identified relationships between helminth infection cases and potential environmental and socio-economic risk factors. Conclusions. Findings show that the spatial distribution of STH incidence is significantly associated with soil properties (sand proportion and pH), rainfall, wetlands and their uses, population density and proportion of rural residents. Identified spatial patterns are important for guiding STH prevention and control programs.

Bayesian geostatistical modelling of stunting in Rwanda: risk factors and spatially explicit residual stunting burden.

BACKGROUND: Stunting remains a significant public health issue in Rwanda and its prevalence exhibits considerable geographical variation. We apply Bayesian geostatistical modelling to study the spatial pattern of stunting in children less than five years considering anthropometric, socioeconomic and demographic risk factors in Rwanda. In addition, we predict the spatial residuals effects to quantify the burden of stunting not accounted for by our geostatistical model. METHODS: We used the data from the 2015 Rwanda Demographic and Health Survey. We fitted two spatial logistic models with similar structures, only differentiated by the inclusion or exclusion of spatially structured random effects. RESULTS: The risk factors of stunting identified in the geostatistical model were being male (OR = 1.32, 95% CI: 1.16, 1.47), lower birthweight (kg) (OR = 0.96, 95% CI: 0.95, 0.97), non-exclusive breastfeeding (OR = 1.24, 95% CI: 1.04, 1.45), occurrence of diarrhoea in the last two weeks (OR = 1.18, 95% CI: 1.02, 1.37), a lower proportion of mothers with overweight (BMI ≥ 25) (OR = 0.82, 95% CI: 0.71, 0.95), a higher proportion of mothers with no or only primary education (OR = 1.14, 95% CI: 0.99, 1.36). Also, a higher probability of living in a house with poor flooring material (OR = 1.22, 95% CI: 1.06, 1.41), reliance on a non-improved water source (OR = 1.13, 95% CI: 1.00, 1.27), and a low wealth index were identified as risk factors of stunting. Mapping of the spatial residuals effects showed that, in particular, the Northern and Western regions, followed by the Southern region of Rwanda, still exhibit a higher risk of stunting even after accounting for all the covariates in the spatial model. CONCLUSIONS: Further studies are needed to identify the still unknown spatially explicit factors associated with higher risk of stunting. Finally, given the spatial heterogeneity of stunting, interventions to reduce stunting should be geographically targeted.

Transport geography: Implications for public health.

The obstruction of traffic between France and UK due to efforts to rein in coronavirus 2019 (COVID-19), together with the recent, week-long blockade of the Suez Canal, underline how interconnected and thus vulnerable the world has become. What this has to do with public health may not be immediately evident. However, as illustrated by two papers published in this issue of Geospatial Health dealing with the ongoing waves of COVID-19 spread (Mahmud et al., 2021; Tiwari and Aljoufie, 2021), transport geography - with its focus on geographical dimensions of travel, transport and mobility - does indeed have a direct impact on health and epidemiology...

Modeling schistosomiasis spatial risk dynamics over time in Rwanda using zero-inflated Poisson regression.

The recorded clinical cases of S. mansoni at primary health facility level contain an excessive number of zero records. This could mean that no S. mansoni infection occurred (a true zero) in the health facility service area but it could also that at least one infection occurred but none were reported or diagnosed (a false zero). Standard statistical analysis, using exploratory or confirmatory spatial regression, fail to account for this type of data insufficiency. This study developed a zero-inflated Poisson model to explore the spatiotemporal variation in schistosomiasis risk at a fine spatial scale. We used environmental data generated at primary health facility service area level as explanatory variables affecting transmission risk. Identified risk factors were subsequently used to project the spatial variability of S. mansoni infection risk for 2050. The zero-inflated Poisson model shows a considerable increase of relative risk of the schistosomiasis over one decade. Furthermore, the changes between the risk in 2009 and forecasted risk by 2050 indicated both persistent and emerging areas with high relative risk of schistosomiasis infection. The risk of schistosomiasis transmission is 69%, 29%, and 50% higher in areas with rice cultivation, proximity to rice farms, and proximity to a water body respectively. The prediction and forecasting maps provide a valuable tool for monitoring schistosomiasis risk in Rwanda and planning future disease control initiatives in wetland ecosystem development context.

Geographic clustering and region-specific determinants of obesity in the Netherlands.

As a leading cause of morbidity and premature mortality, obesity has become a major global public health problem. It is therefore important to investigate the spatial variation of obesity prevalence and its associations with environmental and behavioral factors (e.g., food environment, physical activity), to optimize the targeting of scarce public health resources. In this study, the geographic clustering of obesity in the Netherlands was explored by analyzing the local spatial autocorrelation of municipal-level prevalence rates of adulthood obesity (aged ≥19 years) in 2016. The potential influential factors that may be associated with obesity prevalence were first selected from five categories of healthrelated factors through binary and Least Absolute Shrinkage and Selection Operator (LASSO) regressions. Geographically Weighted Regression (GWR) was then used to investigate the spatial variations of the associations between those selected factors and obesity prevalence. The results revealed marked geographic variations in obesity prevalence, with four clusters of high prevalence in the north, south, east, and west, and three clusters of low prevalence in the north and south of the Netherlands. Lack of sports participation, risk of anxiety, falling short of physical activity guidelines, and the number of restaurants around homes were found to be associated with obesity prevalence across municipalities. Our findings show that effective, region-specific strategies are needed to tackle the increasing obesity in the Netherlands.

Spatial Lifecourse Epidemiology Reporting Standards (ISLE-ReSt) statement.

Spatial lifecourse epidemiology is an interdisciplinary field that utilizes advanced spatial, location-based, and artificial intelligence technologies to investigate the long-term effects of environmental, behavioural, psychosocial, and biological factors on health-related states and events and the underlying mechanisms. With the growing number of studies reporting findings from this field and the critical need for public health and policy decisions to be based on the strongest science possible, transparency and clarity in reporting in spatial lifecourse epidemiologic studies is essential. A task force supported by the International Initiative on Spatial Lifecourse Epidemiology (ISLE) identified a need for guidance in this area and developed a Spatial Lifecourse Epidemiology Reporting Standards (ISLE-ReSt) Statement. The aim is to provide a checklist of recommendations to improve and make more consistent reporting of spatial lifecourse epidemiologic studies. The STrengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement for cohort studies was identified as an appropriate starting point to provide initial items to consider for inclusion. Reporting standards for spatial data and methods were then integrated to form a single comprehensive checklist of reporting recommendations. The strength of our approach has been our international and multidisciplinary team of content experts and contributors who represent a wide range of relevant scientific conventions, and our adherence to international norms for the development of reporting guidelines. As spatial, location-based, and artificial intelligence technologies used in spatial lifecourse epidemiology continue to evolve at a rapid pace, it will be necessary to revisit and adapt the ISLE-ReSt at least every 2-3 years from its release.

Stunting spatial pattern in Rwanda: An examination of the demographic, socio-economic and environmental determinants.

Stunting is recognised as a major public health problem in Rwanda. We therefore aimed to study the demographic, socio-economic and environmental factors determining the spatial pattern of stunting. A cross-sectional study using the data from the 2014- 2015 Rwanda Demographic and Health Survey and environmental data from external geospatial datasets were conducted. The study population was children less than two years old with their mothers. A multivariate linear regression model was used to estimate the effects of demographic, socio-economic and biophysical factors and a proxy measure of aflatoxins exposure on height-for-age. Also, a spatial prediction map of height-for-age to examine the stunting pattern was produced. It was found that age of child, height of mother, secondary education and higher, a child being male and birth weight were associated with height-for-age. After adjusting for demographic and socioeconomic factors, elevation and being served by a rural market were also significantly associated with low height-for-age in children. The spatial prediction map revealed the variability of height-for-age at the cluster-level that was lost when the levels are aggregated at the district level. No associations with height-for-age were found for exclusive breastfeeding, use of deworming tablets, improved water source and improved sanitation in the study population. In addition to the child and mother factors known to determine height-for-age, our study confirms the influence of environmental factors in determining the height-of-age of children in Rwanda. A consideration of the environmental drivers of anthropometric status is crucial to have a holistic approach to reduce stunting.

Top 10 Research Priorities in Spatial Lifecourse Epidemiology.

The International Initiative on Spatial Lifecourse Epidemiology (ISLE) convened its first International Symposium on Lifecourse Epidemiology and Spatial Science at the Lorentz Center in Leiden, Netherlands, 16­20 July 2018. Its aim was to further an emerging transdisciplinary field: Spatial Lifecourse Epidemiology. This field draws from a broad perspective of scientific disciplines including lifecourse epidemiology, environmental epidemiology, community health, spatial science, health geography, biostatistics, spatial statistics, environmental science, climate change, exposure science, health economics, evidence-based public health, and landscape ecology. The participants, spanning 30 institutions in 10 countries, sought to identify the key issues and research priorities in spatial lifecourse epidemiology. The results published here are a synthesis of the top 10 list that emerged out of the discussion by a panel of leading experts, reflecting a set of grand challenges for spatial lifecourse epidemiology in the coming years. https://doi.org/10.1289/EHP4868.

Good things come in small packages: New trends in acquisition of remotely-sensed data.

Not available.

Predictors of stunting with particular focus on complementary feeding practices: A cross-sectional study in the northern province of Rwanda.

OBJECTIVES: The aim of this study was to review the factors associated with stunting in the northern province of Rwanda by assessing anthropometric status, dietary intake, and overall complementary feeding practices. METHODS: This was a cross-sectional study with 138 children 5 to 30 mo of age. A structured questionnaire was used to collect information on sociodemographic characteristics of each mother and child and breastfeeding and complementary feeding practices. Anthropometric status was assessed using height-for-age z-scores for children and body mass index for caregivers. Dietary intakes were estimated using a 24-h recall. Multiple linear and logistic regression models were performed to study the predictors of height-for-age z scores and stunting. RESULTS: There was a 42% stunting prevalence. Prevalence of continued breastfeeding and exclusive breastfeeding were 92% and 50%, respectively. Most children (62%) fell into the low dietary diversity score group. The nutrient intake from complementary foods was below recommendations. The odds of stunting were higher in children >12 mo of age (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.08-1.29). Exclusive breastfeeding (OR, 0.22; 95% CI, 0.10-0.48) and deworming tablet use in the previous 6 mo (OR, 0.25; 95% CI, 0.07-0.80) decreased significantly the odds of stunting in children. Also, the body mass index of the caretaker (ß = 0.08 kg/m2; 95% CI, 0.00-0.17) and dietary zinc intake (ß = 1.89 mg/d; 95% CI, 0.29-3.49) were positively associated with the height-for-age z scores. CONCLUSION: Interventions focusing on optimal nutrition during the complementary feeding stage, exclusive breastfeeding, and the use of deworming tablets have the potential to substantially reduce stunting in children in the northern province of Rwanda.

Data on child complementary feeding practices, nutrient intake and stunting in Musanze District, Rwanda.

Stunting prevalence in Rwanda is still a major public health issue, and data on stunting is needed to plan relevant interventions. This data, collected in 2015, presents complementary feeding practices, nutrient intake and its association with stunting in infants and young children in Musanze District in Rwanda. A household questionnaire and a 24-h recall questionnaire were used to collect the data. In total 145 children aged 5-30 months participated in the study together with their caregivers. The anthropometric status of children was calculated using WHO Anthro software [1] according to the WHO growth standards [2]. The complementary feeding practices together with households' characteristics are reported per child stunting status. The nutrient intake and food group consumption are presented per age group of children. Also, the percentage contribution of each food groups to energy and nutrient intake in children is reported. The data also shows the association between zinc intake and age groups of children. Using multiple linear regression, a sensitivity analysis was done with height-for-age z-score as the dependent variable and exclusive breastfeeding, deworming table use, BMI of caregiver, dietary zinc intake as independent variables. The original linear regression model and a detailed methodology and analyses conducted are presented in Uwiringiyimana et al. [3].

Spatio-temporal dynamics of schistosomiasis in Rwanda between 2001 and 2012: impact of the national Neglected Tropical Disease control programme.

Schistosomiasis is recognised as a major public health problem in Rwanda. We aimed to identify the spatio-temporal dynamics of its distribution at a fine-scale spatial resolution and to explore the impact of control programme interventions. Incidence data of Schistosoma mansoni infection at 367 health facilities were obtained for the period 2001-2012. Disease cluster analyses were conducted using spatial scan statistics and geographic information systems. The impact of control interventions was assessed for three distinct sub-periods. Findings demonstrated persisting, emerging and re-emerging clusters of schistosomiasis infection across space and time. The control programme initially caused an abrupt increase in incidence rates during its implementation phase. However, this was followed by declining and disappearing clusters when the programme was fully in place. The findings presented should contribute to a better understanding of the dynamics of schistosomiasis distribution to be used when implementing future control activities, including prevention and elimination efforts.