Non-seatbelt use and associated factors among passengers.

Seatbelt use is the most effective way to save lives and reduce severe injuries. However, the percentage of non-seatbelt use is still high among drivers and passengers. Although the factors related to non-seatbelt use among drivers have been widely studied, the factors associated with non-seatbelt use among passengers have not been well documented. In addition, recent surveys showed that the driver's attitude has a significant impact on the passenger's seatbelt use. However, the lower response rate and less accurate of self-reported seatbelt use in survey studies, especially among participants who had a high level perception of penalty for non-seatbelt use. Therefore, we examined the association between passenger's seatbelt use and driver's seatbelt use with a statewide injury surveillance system. 36,012 passengers who were involved in motor vehicle crashes (MVC) in 2004-2013 were included in this study. Our results showed that if a driver wore a seatbelt, 92.6% of his/her passengers also wore seatbelts while if a driver did not wear a seatbelt, only 19.1% of his/her passengers wore seatbelts. Compared to the passenger whose driver wore a seatbelt, the passenger had a significantly higher probability of non-seatbelt use (odds ratio = 46.7; 95% confidence intervals, 42.7-51.1) if his/her driver did not wear a seatbelt. The driver has the greatest influence on the passenger's seatbelt use. The findings will provide important information for future public health practices to increase seatbelt use at the highest possible rate for passengers, such as educational interventions for drivers and seatbelt reminders use.

Seatbelt use to save money: Impact on hospital costs of occupants who are involved in motor vehicle crashes.

OBJECTIVE: Seatbelt use is the single most effective way to save lives in motor vehicle crashes (MVC). However, although safety belt laws have been enacted in many countries, seatbelt usage throughout the world remains below optimal levels, and educational interventions may be needed to further increase seatbelt use. In addition to reducing crash-related injuries and deaths, reduced medical expenditures resulting from seatbelt use are an additional benefit that could make such interventions cost-effective. Accordingly, the objective of this study was to estimate the correlation between seatbelt use and hospital costs of injuries involved in MVC. METHODS: The data used in this study were from the Nebraska CODES database for motor vehicle crashes that occurred between 2004 and 2013. The hospital cost information and information about other factors were obtained by linking crash reports with hospital discharge data. A multivariable regression model was performed for the association between seatbelt use and hospital costs. RESULTS: Mean hospital costs were significantly lower among motor vehicle occupants using a lap-shoulder seatbelt ($2909), lap-only seatbelt ($2289), children's seatbelt ($1132), or booster ($1473) when compared with those not using any type of seatbelt ($7099). After adjusting for relevant factors, there were still significantly decreased hospital costs for motor vehicle occupants using a lap-shoulder seatbelt (84.7%), lap-only seatbelt (74.1%), shoulder-only seatbelt (40.6%), children's seatbelt (95.9%), or booster (82.8%) compared to those not using a seatbelt. CONCLUSION: Seatbelt use is significantly associated with reduced hospital costs among injured MVC occupants. The findings in this study will provide important educational information for emergency department nurses who can encourage safety belt use for vehicle occupants.

Comorbid Conditions are Associated With Emergency Department Visits, Hospitalizations, and Medical Charges of Patients With Systemic Lupus Erythematosus.

BACKGROUND/OBJECTIVES: In addition to increase mortality, comorbidities can increase medical costs for systemic lupus erythematosus (SLE). Healthcare utilization can dramatically increase medical costs. It is essential to better understand the comorbidities that can lead to healthcare utilization, such as emergency department visit and/or hospitalization, for SLE patients. Therefore, the objective of this study was to examine the associations between comorbidities and healthcare utilization and medical charges of patients with SLE. METHODS: Nebraska statewide emergency departments (ED) discharge and hospitals discharge data from 2007 to 2012 were used to study the comorbid conditions of patients with SLE. SLE was defined using the standard International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnosis codes (710.0). RESULTS: There were more comorbid conditions in patients with SLE than patients without SLE. Comorbid conditions were majorly related to ED visits and hospitalizations of patients with SLE. Chest pain, abdominal pain, injury, acute respiratory infections, symptoms of digestive systems, headache, myalgia and myositis, noninfectious gastroenteritis and colitis, and symptoms of skin and other integumentary systems are common comorbid conditions for ED visits. Infections, cardiovascular diseases, fractures, chronic obstructive pulmonary disease (COPD) and allied conditions, cerebrovascular diseases, and episodic mood disorder are common comorbid conditions for hospitalizations of patients with SLE. In addition, the numbers of comorbid conditions were significantly associated with the length of hospital stay and hospital charges for SLE patients. CONCLUSION: The findings in this study indicated that comorbid conditions are associated with healthcare utilization and medical charges of patients with SLE.

Comorbid conditions are associated with healthcare utilization, medical charges and mortality of patients with rheumatoid arthritis.

This study aims to examine the associations between comorbid conditions and healthcare utilization, medical charges, or mortality of patients with rheumatoid arthritis (RA). Nebraska state emergency department (ED) discharge, hospital discharge, and death certificate data from 2007 to 2012 were used to study the comorbid conditions of patients with RA. RA was defined using the standard International Classification of Diseases (ICD-9-CM 714 or ICD-10-CM M05, M06, and M08). There were more comorbid conditions in patients with RA than in patients without RA. Comorbid conditions were majorly related to healthcare utilization and mortality of patients with RA. In addition to injury, fracture, sprains, and strains, symptoms of cardiovascular and digestive systems, respiratory infection, and chronic obstructive pulmonary disease (COPD) were common comorbid conditions for ED visits. In addition to joint replacement and fracture, infections, COPD and cardiovascular comorbidities were common comorbid conditions for hospitalizations. Cardiovascular, cerebrovascular, and respiratory comorbidities, dementia, malignant neoplasm, and diabetes mellitus were common comorbid conditions for deaths of patients with RA. In addition, the numbers of comorbid conditions were significantly associated with the length of hospital stay and hospital charges for patients with RA. The findings in this study indicated that comorbid conditions are associated with healthcare utilization, medical charges, and mortality of patients with RA.

Higher levels of serum lycopene are associated with reduced mortality in individuals with metabolic syndrome.

Metabolic syndrome increases the risk of mortality. Increased oxidative stress and inflammation may play an important role in the high mortality of individuals with metabolic syndrome. Previous studies have suggested that lycopene intake might be related to the reduced oxidative stress and decreased inflammation. Using data from the National Health and Nutrition Examination Survey, we examined the hypothesis that lycopene is associated with mortality among individuals with metabolic syndrome. A total of 2499 participants 20 years and older with metabolic syndrome were divided into 3 groups based on their serum concentration of lycopene using the tertile rank method. The National Health and Nutrition Examination Survey from years 2001 to 2006 was linked to the mortality file for mortality follow-up data through December 31, 2011, to determine the mortality rate and hazard ratios (HR) for the 3 serum lycopene concentration groups. The mean survival time was significantly higher in the group with the highest serum lycopene concentration (120.6 months; 95% confidence interval [CI], 118.8-122.3) and the medium group (116.3 months; 95% CI, 115.2-117.4), compared with the group with lowest serum lycopene concentration (107.4 months; 95% CI, 106.5-108.3). After adjusting for possible confounding factors, participants in the highest (HR, 0.61; P = .0113) and in the second highest (HR, 0.67; P = .0497) serum lycopene concentration groups showed significantly lower HRs of mortality when compared with participants in the lower serum lycopene concentration. The data suggest that higher serum lycopene concentration has a significant association with the reduced risk of mortality among individuals with metabolic syndrome.

The influence of BMI on the association between serum lycopene and the metabolic syndrome.

Overweight and obese individuals have an increased risk of developing the metabolic syndrome because of subsequent chronic inflammation and oxidative stress, which the antioxidant nutrient lycopene can reduce. However, studies indicate that different BMI statuses can alter the positive effects of lycopene. Therefore, the purpose of this study was to examine how BMI influences the association between serum lycopene and the metabolic syndrome. The tertile rank method was used to divide 13 196 participants, aged 20 years and older, into three groups according to serum concentrations of lycopene. The associations between serum lycopene and the metabolic syndrome were analysed separately for normal-weight, overweight and obese participants. Overall, the prevalence of the metabolic syndrome was significantly higher in the first tertile group (OR 38·6%; 95% CI 36·9, 40·3) compared with the second tertile group (OR 29·3%; 95% CI 27·5, 31·1) and the third tertile group (OR 26·6%; 95% CI 24·9, 28·3). However, the associations between lycopene and the metabolic syndrome were only significant for normal-weight and overweight participants (P0·05), even after adjusting for possible confounding variables. In conclusion, BMI appears to strongly influence the association between serum lycopene and the metabolic syndrome.

Increasing Public Health Burden of Arthritis and Other Rheumatic Conditions and Comorbidity: Results From a Statewide Health Surveillance System, 2007-2012.

OBJECTIVE: To describe the burden and changing trends of arthritis and other rheumatic conditions (AORCs) on health care and public health by estimating annual rates of emergency department (ED) visits, hospitalizations, and mortality, in addition to medical charges related to AORCs and their comorbidities in Nebraska from 2007 to 2012. METHODS: Nebraska state ED discharge, hospital discharge, and death certificate data from 2007 to 2012 were used to estimate disease burden. AORCs were defined using the standard International Classification of Diseases specified by the National Arthritis Data Workgroup. AORC conditions were defined by the presence of a diagnostic code anywhere on the corresponding record. To identify potential disparities in AORC burden, health care utilization was examined separately across 4 urban/rural categories. RESULTS: Rates of annual ED visits (34% increase), hospitalizations (22% increase) and mean charges (an approximate 30% to 70% increase) from visits involving AORCs increased significantly from 2007 to 2012. Annual rates of ED visits and hospitalizations involving AORCs were lower in urban metropolitan areas compared to other urban/rural designations. AORC-related mortality was highest in small rural communities. Disease profiles revealed that ED visits and hospitalizations involving gout and other crystal arthropathies increased disproportionately compared to other AORCs. CONCLUSION: The public health burden of AORCs increased significantly over the 6-year period studied, posing a growing challenge for patients, families, and the public health system, and AORCs appear to disproportionately impact nonmetropolitan and other rural communities.

Lycopene reduces mortality in people with systemic lupus erythematosus: A pilot study based on the third national health and nutrition examination survey.

INTRODUCTION: Persistent inflammation and oxidative stress are the main mechanisms that increase the risks of cardiovascular disease-related morbidity and mortality in systemic lupus erythematosus (SLE). As a natural antioxidant, lycopene can alleviate oxidative stress and suppress inflammation. We hypothesized that lycopene could have the potential to reduce mortality in SLE. METHOD: Thirty-seven participants with SLE from the NHANES III were divided into two groups (higher level group and lower level group) by rank method according to serum lycopene. These participants were followed-up from the date of interview (1988-1994) to 31 December 2006 for mortality. Mortality rate and survival function were compared between the two SLE groups. RESULTS: The mortality rate was significantly lower in the higher level group (5.3%) than that in the lower level group (33.3%). There was a significant survival difference between the higher level group and the lower level group (Log rank p = 0.0436). In addition, cardiovascular disease-related mortality was dramatically lower in the higher level group than that in the lower level group. CONCLUSIONS: These findings from nationally representative samples indicate that higher serum lycopene has the protective effect on mortality in SLE. Further studies with large sample size are needed to confirm these primary results.

Seat belt use to save face: impact on drivers' body region and nature of injury in motor vehicle crashes.

BACKGROUND: Seat belt use is the single most effective way to save lives and reduce injuries in motor vehicle crashes. However, some case reports described seat belt use as a double-edged sword because some injuries are related to seat belt use in motor vehicle crashes. To comprehensively understand the effects of seat belt use, we systemically investigated the association between seat belt use and injuries based on anatomic body region and type of injury in drivers involved in motor vehicle crashes. METHODS: The injury information was obtained by linking crash reports with hospital discharge data and categorized by using the diagnosis codes based on the Barell injury diagnosis matrix. A total of 10,479 drivers (≥15 years) in passenger vehicles involved in motor vehicle crashes from 2006 to 2011 were included in this study. RESULTS: Seat belt use significantly reduced the proportions of traumatic brain injury (10.4% non-seat belt; 4.1% seat belt) and other head, face, and neck injury (29.3% non-seat belt; 16.6% seat belt) but increased the proportion of spine: thoracic to coccyx injury (17.9% non-seat belt; 35.5% seat belt). Although the proportion of spine: thoracic to coccyx injury was increased in drivers with seat belt use, the severity of injury was decreased, such as fracture (4.2% with seat belt use; 22.0% without seat belt use). Furthermore, the total medical charges decreased due to the change of injury profiles in drivers with seat belt use from a higher percentage of fractures (average cost for per case $26,352) to a higher percentage of sprains and/or strains ($1,897) with spine: thoracic to coccyx injury. CONCLUSION: This study provide a comprehensive picture for understanding the protective effect of seat belt use on injuries based on anatomic body region and type of injury in drivers involved in motor vehicle crashes.

Age-associated parallel increase of Foxp3(+)CD4(+) regulatory and CD44(+)CD4(+) memory T cells in SJL/J mice.

Effector/memory T cells (Tem) are required to maintain successful immunity, while regulatory T cells (Treg) are required to prevent excessive/uncontrolled inflammation and/or autoimmunity. Although both Tem and Treg cells are increased during aging, the relationship between the increased proportion of Foxp3(+) Treg cells and CD44(+) Tem cells with aging is not clearly understood. We found in this report that Foxp3(+) Treg cells are increased in parallel with CD44(+) Tem cells in SJL/J mice with aging, and that all Foxp3(+) Treg cells are of CD44(+) Tem phenotype, suggesting that the increased Foxp3(+) Treg cells originated from the expanded pool of CD44(+) Tem cells with aging. Our in vitro kinetic studies further suggested that Foxp3(+) Treg cells are converted through the CD44(+) stage. Furthermore, we observed that although the balance between Foxp3(+) Treg and CD44(+)Foxp3(-) Tem cells remained with aging, the aged mice have higher ratios of both Tem and Treg cells vs. naïve T cells resulting in the "shrunken" naïve T cell pools. Our results suggest that an age-associated imbalance of T cell repertoire is a mechanism that contributes to spontaneous occurrence of Hodgkin's-like lymphoma in aged SJL/J mice.

CD4+CD25high T cell numbers are enriched in the peripheral blood of patients with rheumatoid arthritis.

Accumulating evidences support that CD4(+)CD25(high) T regulatory (Treg) cells play an essential role in controlling and preventing autoimmunity. Paradoxically, RA patients have elevated numbers of circulating CD4(+)CD25(high) T cells, however, the inflammation is still ongoing. Further identification of these CD4(+)CD25(high) T cells may contribute to a better understanding of underlying mechanisms. We show here that these CD4(+)CD25(high) T cells were composed of CD4(+)CD25(high)FoxP3(+) Treg cells and activated CD4(+)CD25(high)FoxP3(-) effector cells. Moreover, there were significantly more Treg cells and effector T cells expressing GITR, and more monocytes expressing GITR-L. Thus, although RA patients have elevated numbers of CD4(+)CD25(high) T cells, the suppressive function is not increased, because of the increased number of activated effector T cells. In addition, the GITR-GITR-L system was activated in RA patients, which might lead to diminish suppressive activity of Treg cells and/or lead to resistance of activated effector T cells to suppression by Treg cells, thus, contributing to the ongoing inflammation in RA patients.

[Application of modified reversed neurovascular flaps nourished by cutaneous nerve-superficial vein in lower extremity].

OBJECTIVE: To investigate the application and therapeutic effect of modified neurovascular flaps nourished by sural nerve and small saphenous venous, or saphenous nerve and great saphenous venous. METHODS: According to the anatomy and recipient area, we made some modifications for the two neurovascular flaps. 1) The small and great saphenous venous were ligated or anastomosed with the venous in recipient area; 2) The flap was delayed for 8 - 14 days if the donor area was above the middle and upper one third of leg; 3) The sural nerve and its branch were anastomosed to the nerve in recipient site to restore the sense of flap; 4) the lower turning point could be designed just 3 cm above the point of internal and external malleolus; 5) Partial gastrocnemius or soleus muscle could be included in the flap if needed; 6) Reversed cross leg flap was considered if the adjacent flap in the affected side could not be used. Sometimes, we adopted more than one modification in one patients. RESULTS: From Sep, 1994 to Apr, 2007, 63 cases were treated, including 51 cases of sural and 12 cases of saphenous neurovascular flaps. Partial necrosis (about 1 - 2 cm width) happened in the distal end of flaps in 2 cases which healed after dress changing. The patients were followed up for 3 months to 2 years with satisfied functional and cosmetic results. CONCLUSIONS: These two modified flaps have reliable blood supply and survival rate. The operation is easily performed and very practical. The flaps, or combined with other methods can repair about 70% of the refractory defects in legs.