Mortality risk among adult americans living with cancer and elevated CRP.

The role of C Reactive Protein (CRP) in predicting long-term outcomes among people living with cancer has not been well explored. We aimed to assess the role of elevated CRP in predicting all-cause mortality among a community-based sample of adult Americans living with cancer. The National Health and Nutrition Examination Survey, 1999-2010 was linked with mortality files up to December 2019 from the National Death Index. Sociodemographic and health-related variables of 30,711 participants (mean age=46.5 years) were analyzed to compute adjusted hazard ratios (HR) for all-cause mortality. The risk of mortality, in unadjusted analysis, was significantly higher among those with cancer compared to those without cancer 3.53 (95% CI= 3.13-3.98, p < 0.001). In adjusted analysis, when stratified by CRP levels (elevated=cutoff point at ≥2 mg/dL), among individuals with elevated CRP but no cancer history, the risk of mortality was significantly higher (HR=1.67, 95% CI=1.24-2.25) compared to those without cancer or elevated CRP. Among individuals with cancer but without elevated CRP as well, the risk of mortality was 20% higher compared to their counterparts. The highest risk of mortality was observed among those with both cancer and elevated CRP (HR=2.10, 95% CI=1.11-4.33). Age and income were significant predictors of these relationships. Among people living with cancer, CRP may serve as a marker for mortality and future studies should explore the pathways by which the risk of mortality may increase due to variation of CRP in cancer patients.

Firearm Mortality of Non-Hispanic Black Americans by Law Enforcement, 2011-2020.

Law enforcement officers in the U.S. are more likely to use lethal force against non-Hispanic Black citizens than on their non-Hispanic White counterparts. The purpose of this study was to assess estimates of the national prevalence of fatal firearm violence by law enforcement officers (LEOs) against non-Hispanic Black Americans. The Web-Based Injury Statistics Query and Reporting System (WISQARS) from the Centers for Disease Control and Prevention (CDC) were analyzed using descriptive statistics and joinpoint regression from 2011 to 2020. During the decade (2011-2020) LEOs fatally shot 5,073 citizens and 1,170 were non-Hispanic Black (23%). The vast majority (96%) were males and two-thirds (66%) of those killed were ages 20-39 years. The region with the highest number of LEO fatal shootings was the Western U.S. Firearm deaths of non-Hispanic Blacks were the dominant (82%) method of LEO-induced deaths. Non-Hispanic Black Americans experience LEO firearm-related injuries and deaths at a much higher rate than their non-Hispanic White counterparts. In the context of the racial disparities among people who die following LEO-related gunshot wounds, changes to police training systems and an examination of implicit biases among LEOs should be investigated as the next step in reducing the use of lethal force practices.

Fatal Firearm Violence Among American Indians and Alaska Natives.

There is a dearth of population-based studies regarding firearm-related deaths and years of potential life lost among American Indians and Alaska Natives (AI/AN). Using the Centers for Disease Control and Prevention's (CDC) We Based Injury Statistics Query and Reporting System (WISQARS) data for the three most recent years (2018-2020), we analyzed the demographic characteristics of AI/ANs who succumbed to firearm violence. AI/ANs averaged almost 500 firearm-related deaths per year. The majority of these deaths were observed among individuals 20-39 years of age (53%), males (84.4%), and in the West (55.3%). A plurality of these firearm-related deaths were suicides (48.9%) followed by homicides (43.5%). During the 3-year study period, the age-adjusted firearm death rate increased almost 5 times the growth of the AI/AN population. Also, a staggering 67,050 years of potential life were lost before the age of 80 years (YPLL80) during this period. Firearm suicides were responsible for the largest proportion of YPLL80s (48.5%). Traditional legal interventions [e.g., child access prevention (CAP) laws and extreme risk protection orders (ERPO)], if expanded to more states could potentially help reduce AI/AN firearm mortality. None of the 10 states with the highest firearm mortality of AI/AN have ERPOs and 8 of the 10 do not have CAP laws. Also, a renewed focus on cultural continuity and indigenous protective factors is essential to ameliorate the level of firearm violence in AI/ANs.

Comprehensive Knowledge about HIV/AIDS among Women of Reproductive Age in India.

HIV/AIDS has been a major threat to global public health, with India ranking third when it comes to the global burden of people living with HIV, especially women. It is imperative to assess the level of knowledge women have about transmission and prevention of this infection. This study sought to delineate the determinants of the comprehensive knowledge of HIV/AIDS among women in the reproductive age groups in India. Data from the fifth round of the National Family Health Survey conducted in India were analyzed. The sample included 95,541 women aged 15-49 years. Multilevel logistic regression was fitted with individual characteristics, household characteristics, and community characteristics to identify determinants of comprehensive knowledge on HIV/AIDS. Nearly a fourth (24.8%) of the women aged 15-49 in India who had ever heard of HIV had comprehensive knowledge of HIV/AIDS. Multilevel logistic regression showed that the likelihood of comprehensive knowledge of HIV/AIDS was higher among women aged 40-44 (AOR = 1.57) and 30-34 (AOR = 1.56). The likelihood of having comprehensive knowledge increased with the increase in the level of education. Women with secondary and higher levels of education were 1.9 times and 3.38 times more likely to have comprehensive knowledge, respectively, than those with no education. Household wealth, access to mass media, and having ever tested for HIV were also significant determinants of comprehensive knowledge of HIV/AIDS among women. The odds of having comprehensive knowledge about HIV/AIDS were higher for women with higher community wealth (AOR = 1.31), higher community education (AOR = 1.09), and higher community employment (AOR = 1.12). Factors at both the individual and community levels were shown to be indicators of comprehensive knowledge of HIV/AIDS. Policymakers and public health practitioners in India should come up with plans to close the information gaps about HIV/AIDS that exist among women and their demographic subgroups.

Depression increases the risk of mortality among people living with diabetes: Results from national health and nutrition examination survey, USA.

INTRODUCTION: Type 2 Diabetes (T2D) and depression are leading global public health problems associated with profound disability and lower quality of life. Extensive evidence suggests that the two disorders are frequently comorbid. However, long-term effects such as the risk of mortality due to depression among people living with T2D are not well explored. METHODS: Data from the National Health and Nutrition Examination Survey, 2005-2010 were linked with mortality files from the National Death Index up to December 31st, 2019. RESULTS: A total of 14,920 American adults were included in the study sample; nearly a tenth of them had depression (9.08 %) or T2D (10 %). In adjusted analysis, individuals with T2D were 1.70 times more likely (95 % CI = 1.42-2.03) to die than those without T2D. Among people living with T2D without depression, the risk of mortality was 1.55 times higher, but those with both T2D and depression had a 4.24 times higher risk of mortality. CONCLUSIONS: Given the greater risk of morbidity and premature mortality with cooccurring T2D and depression, widespread screening is warranted with a focus on high-risk groups. Integrated and collaborative care models can help address the psychosocial needs of people with T2D and should be widely implemented with the sensitization of clinicians and care teams in primary and specialist care for T2D.

Monkeypox Patients Living with HIV: A Systematic Review and Meta-Analysis of Geographic and Temporal Variations.

This index meta-analysis estimated the pooled prevalence of human immunodeficiency virus (HIV) among individuals with monkeypox (mpox) globally. We searched seven databases: PubMed, Scopus, Web of Science, EMBASE, ProQuest, EBSCOHost, and Cochrane, for human studies published in English till 4 January 2023, as per International Prospective Register of Systematic Reviews (PROSPERO) registration protocol (CRD42022383275). A random effects regression model was used to estimate the pooled prevalence owing to high heterogeneity. The risk of bias in the included studies was assessed using the National Heart, Lung, and Blood Institute (NHLBI) quality assessment tool. The systematic search yielded 677 articles; finally, 32 studies were found eligible for systematic review and 29 studies for meta-analysis. The pooled prevalence of HIV infection was 41% (95% confidence interval [CI], 35-48). All studies were rated as fair or good quality. Studies from Europe and North America reported a high prevalence of HIV infection among individuals with mpox- 41% (95% CI 33-49) and 52% (95% CI 28-76), respectively, while studies from Nigeria, Africa reported a relatively low prevalence of HIV infection of 21% (95% CI 15-26). A history of sexual orientation and sexual partners in the last 21 days must be taken from individuals with mpox to identify the potential source and contacts for quarantining and testing them.

Cardiovascular Disease Outcomes Associated with Obstructive Sleep Apnea in Diabetics: A Systematic Review and Meta-Analysis.

BACKGROUND: There is significant pathogenic and epidemiological overlap between diabetes and obstructive sleep apnea (OSA). This systematic review aimed to ascertain the association between OSA and cardiovascular disease (CVD) in a diabetic population. METHODS: The study protocol was registered with PROSPERO (CRD42023404126). On 15 July 2023, a comprehensive search of the literature was performed in PubMed, EBSCO, Scopus, ProQuest, and Web of Science, using keywords and synonyms of OSA, diabetes, and CVD, coupled with specific terms for different CVDs. Only observational studies that reported CVD events in diabetics (with and without OSA) were included. The quality of the studies included in the analysis was assessed using the Newcastle-Ottawa Scale. RESULTS: In the primary literature search, 8795 studies were identified, of which 9 met the inclusion criteria and included 17,796 participants. Eight studies were eligible for meta-analysis, and a pooled risk ratio (RR) of 1.29 (95% CI = 0.91-1.83) was found for developing CVD in diabetics with OSA at a 95% prediction interval of 0.30-5.60. The included studies showed significant heterogeneity with an I2 value of 91%. CONCLUSION: These findings show the possible association between OSA and diabetes and their impact on CVDs. Identifying and managing OSA in individuals with diabetes at an early phase could potentially reduce the risk of CVDs and its related complications.

Lethal Force Usage by Law Enforcement Officers Against Hispanics, 2011-2020.

Most research on lethal force by law enforcement officers (LEOs) has focused on firearm deaths by LEOs among certain racial groups (e.g., African Americans). Specifically, not much is known about LEOs-induced lethal injuries among Hispanics. The purpose of this study was to characterize LEOs induced fatal injuries, the methods used, among various demographic groups of Hispanics, and the years of potential life lost before the age of 80 years due to lethal force by LEOs. Data from the Web-Based Injury Statistics Query and Reporting System (WISQARS) were analyzed for the years 2011-2020. LEOs killed 1,158 Hispanics; most were males (96.2%) with the majority being shot (89.9%). Two-thirds (66.9%) of those killed were Hispanics 20-39 years of age and from the Western U.S. These Hispanic deaths resulted in 53,320 YPLLs. Males and those ages 20-39 years lost the most YPLLs. The rate of fatal encounters with LEOs for Hispanics grew by 44.4% over the decade, with the highest rate in 2020. Mitigation of unnecessary Hispanic deaths by LEOs needs to include changes in law enforcement agency policies, hiring practices for LEOs, improved data collection for LEOs use of lethal force, improved mental healthcare and training for LEOs, use of less lethal strategies for citizen control by law enforcement, deference education for all young adults, and long-term changes in social forces that have created and maintained disenfranchised communities of color.

Parents' expectation of antibiotic prescriptions for respiratory infections in children: a systematic review and meta-analysis.

Objectives: Despite most childhood infections being self-limiting, children are among the leading consumers of antibiotics. Little is known about parental expectations of antibiotics for childhood infections. A comprehensive systematic review and meta-analysis was conducted to explore the nature and extent of parental expectations of antibiotic prescriptions for children with respiratory infections. Design: Systematic review and meta-analysis. Methods: An extensive literature search using six major scientific databases was conducted for all published articles until 7 December 2022. Primary studies reporting parents' expectations of antibiotics for children with upper respiratory tract infections were included after assessment for quality. Heterogeneity between the studies was assessed using the I2 statistic and publication bias was analyzed using funnel plots and Egger regression tests. The primary outcome was a summary estimate of the percentage of parents who expect antibiotics from their physicians when their child presents with an upper respiratory tract infection. Results: From a total of 4510 studies found in the initial searches, a final pool of 19 eligible studies with 15,664 individuals was included in this meta-analysis. Nine of the 19 studies were from the United States or Saudi Arabia. The pooled prevalence of parental expectations of antibiotics in the population reviewed was 55.78% (95% CI = 44.60-66.41). There was significant heterogeneity between the studies, but funnel plot and meta-regression did not detect any publication bias. Conclusion: More than half of parents expect antibiotics for their children during consultation for upper respiratory tract infections. Such practices may cause undue side effects among children, contribute to the growing burden of antibiotic resistance, and lead to treatment failure for many common infections in the future. To optimize efforts to tackle antimicrobial resistance, shared decision-making and education emphasizing the proper and judicious use of antibiotics are much needed in pediatric healthcare settings. This can also help to manage parents' expectations when seeking antibiotics for their children. Despite pressure from parents, pediatric healthcare providers should continue to advocate for antibiotic use only when warranted and help improve knowledge and awareness amongst parents. Registration: The protocol has been registered with PROSPERO (CRD42022364198).

Effect of Fenugreek on Hyperglycemia: A Systematic Review and Meta-Analysis.

Fenugreek is used for medicinal purposes in various traditions. Some studies have demonstrated that the seeds of this plant may have an anti-diabetic effect by lowering fasting blood sugar levels and improving glucose tolerance. We conducted a systematic review of the hypoglycemic effects of fenugreek. An electronic literature search was carried out in the PubMed, Google Scholar, Scopus, and Cochrane Library databases through 18 November 2022 to find trials that assessed fasting blood glucose, postprandial blood glucose, and HbA1c changes in participants treated with fenugreek and in the control group. The mean difference with 95% confidence intervals (CI) was calculated to represent the analysis. Fourteen trials, consisting of 894 participants, were included in the meta-analysis. The results showed a reduction in fasting blood glucose levels (MD: 3.70, 95% CI of -27.02, 19.62; p = 0.76), postprandial blood glucose (MD: -10.61, 95% CI of -68.48, 47.26; p = 0.72), and HbA1c (MD: -0.88, 95% CI -1.49, -0.27; p = 0.00) with fenugreek consumption. While this review and included trials that found beneficial effects of fenugreek consumption on glycemic control, the quality and heterogeneity of studies remain a concern. Given the wider availability and lower cost of fenugreek, rigorous double-blinded randomized controlled trials should be conducted with fenugreek to understand its true potential as a diabetes control herbal agent.

Mental Health System Responsiveness during COVID-19 in People with Pre-Existing Psychiatric Disorders: Experiences from Iran.

Mental health system responsiveness (MHSR) is one of the important indicators in measuring the performance of mental health systems. Recognizing this function can be effective in responding appropriately to the needs of People with Pre-Existing Psychiatric Disorders (PPEPD). This study aimed to investigate MHSR during the COVID-19 period in PPEPD in Iran. Using stratified random sampling, 142 PPEPD who were admitted to a Psychiatric Hospital in Iran one year before the onset of the COVID-19 pandemic were recruited for this cross-sectional study. Participants completed a demographic and clinical characteristics questionnaire as well as a Mental Health System Responsiveness Questionnaire through telephone interviews. The results show that the indicators of prompt attention, autonomy, and access to care were reported as the worst-performing and the confidentiality indicator as the best-performing. The type of insurance affected the access to care and the quality of basic amenities. MHSR has been reported to be poor in Iran in general and this problem worsened during the COVID-19 pandemic. Considering the prevalence of psychiatric disorders in Iran and the degree of disability of these disorders, structural and functional changes are needed for adequate MHSR.

Firearm Mortality Among Pre-school Age Children, 2010-2020.

Firearms are a substantial cause of death for pre-school children (ages 0-5 years). The purpose of this study was to characterize fatal firearm violence in this age group. The Web-Based Injury Statistics Query and Reporting System (WISQARS) data from the Centers for Disease Control and Prevention (CDC) were analyzed for the years 2010-2020. There were 1,220 firearm deaths during the study period with a 75% increase in the rate of deaths per 100,000 population. Most deaths (two-thirds) were among males. Non-Hispanic Blacks comprised 56.4% of all deaths in 2020, a 172% increase from 2010 and the rate for non-Hispanic Whites increased by 15.4% from 2010 to 2020. The majority of the deaths occurred in the South. Almost two-thirds (65.9%) of all firearm deaths were homicides, 30% were unintentional, and 4.1% were undetermined. Homicides were also the majority of deaths for non-Hispanic Blacks (64.9%), non-Hispanic Whites (60.8%), and Hispanics (81.3%). The years of potential life lost before 80 years of age were 94,105, with a plurality (43.3%) of losses occurring among non-Hispanic Black children. Sustained awareness campaigns should be implemented to make parents and guardians aware of the profound dangers of unlocked and loaded or unsafely stored firearms in the home. Child healthcare providers should counsel parents and guardians on firearm safety in households. Public health professionals should advocate for laws that can help protect children from firearm violence (e.g., Domestic Violence Restraining Orders, Child Access Prevention laws, and Extreme Risk Protection Order laws).

Child Access Prevention Laws and Non-Hispanic Black Youth Firearm Mortality.

Firearm injuries are the leading cause of death for youths 19 and younger in general and the third leading cause of death for non-Hispanic Black youths. Child Access Prevention (CAP) laws have been explored concerning their impact on firearm mortality reduction among heterogenous groups of youth, but not specifically among non-Hispanic Black youths. We analyzed data related to non-Hispanic Black youth firearm mortality, non-Hispanic Black poverty rates, firearm dealer density, and CAP laws for each state to ascertain the impact of CAP laws from 2015 to 2019. During the study period, a total of 6778 non-Hispanic Black youths died due to firearm trauma with the leading causes of death being homicides (85.8%); mostly seen among males (96%), and in the South (53.2%). When compared by CAP laws, the states with the strongest laws had statistically significantly lower rates of firearm mortality than states with the weakest laws. After adjusting for state poverty and firearm dealer density, the differences were not statistically significant but still, stronger CAP laws were associated with lower rates of firearm mortality among non-Hispanic Black youth. CAP laws alone can have a modest impact on non-Hispanic Black youth firearm mortality. To adequately reduce firearm mortality among non-Hispanic Black youths, the state and local governments should, along with CAP laws, enact policies to reduce poverty, crime, access to firearms by criminals, and neighborhood dysfunction among non-Hispanic Black communities.

Caregivers' experiences and perspectives of factors associated with relapse in Iranian people living with schizophrenia: A qualitative study.

BACKGROUND: Relapse in People Living with Schizophrenia (PLS) has several reasons and recognizing these can increase the effectiveness of treatment interventions. Formal and informal caregivers are an informed source to reduce relapse in PLS. AIM: This study explores the caregivers' perspective in Iran on the factors affecting relapse in PLS. METHOD: A total of 28 caregivers (16 formal caregivers and 12 informal caregivers) of PLS were enrolled in our qualitative study. A content analysis was conducted using individual and group, semi-structured in-depth interviews with informal and formal caregivers of PLS. This study was conducted in a hospital, three universities, and a non-governmental organization in Tehran, Iran. RESULTS: The majority (69%) of the participants were females. About half of the informal caregivers were over 60 years old and about 40% of the formal caregivers were in the age range of 30 to 40 years. The average number of years of work for informal caregivers was 17.6 years and the average of work experience among the formal caregivers was 14.1 years. Seven key dual themes were identified from data: 'awareness-stigma', 'social support-social exclusion', 'treatment adherence-treatment discontinuation', 'holistic approach - one-dimensional approach', 'supported employment-social dysfunction', 'emotional management in family - family with high emotional expression', and 'access to treatment-treatment gap'. CONCLUSION: The results of this research can help practitioners and policymakers to enable evidence-based practices to reduce relapse in PLS by emphasizing and acting on factors identified in our analyses.

The design and process of a family and community-based intervention for relapse prevention in people living with schizophrenia in Iran.

BACKGROUND: People living with schizophrenia (PLS) suffer frequent relapse accompanied by emergency room visits, premature mortality, lower quality of life and a substantial social and economic burden on families and health systems. There is a dearth of community-based relapse prevention interventions (RPIs) in Iran. AIMS: To determine an ideal model for a community-based RPIs for PLS. METHODS: A qualitative study with 27 experts in Iran was carried out to understand the ideal RPIs for PLS and the key components of such interventions. RESULTS: In 16 semi-structured interviews and 8 group-discussions, the participants identified six major stages of family and community-based RPIs including preparation, social mobilization, local team formation, design an RPI, implementing the RPI, participatory monitoring, and evaluation of the RPI. CONCLUSIONS: Given the suboptimal healthcare systems and lack of professionals and services, PLS in Iran may benefit from family and community-based RPIs. Our findings warrant pilot testing of such initiatives across developing communities like Iran to improve health outcomes of PLS.

Potentially Asymptomatic Infection of Monkeypox Virus: A Systematic Review and Meta-Analysis.

Background: Monkeypox is a global public health concern, given the recent outbreaks in non-endemic countries where little scientific evidence exists on the disease. Specifically, there is a lack of data on asymptomatic monkeypox virus infection. This study aims to evaluate the overall prevalence of asymptomatic monkeypox virus infection. Methods: In this systematic review and meta-analysis, we performed an extensive literature search in PubMed, Scopus, Web of Science, ProQuest, EMBASE, EBSCOHost, Cochrane, and preprint servers (medRxiv, arXiv, bioRxiv, BioRN, ChiRxiv, ChiRN, and SSRN) and assessed all published articles till September 2022. Primary studies reporting monkeypox infections among asymptomatic participants were included after quality assessment. The characteristics of the study and information on the number of cases and symptomatic status were extracted from the included studies. The heterogeneity between studies was assessed using the I2 statistic. Publication bias was analyzed using funnel plots and Egger regression tests. The primary outcome was the pooled prevalence of asymptomatic infections within the examined population. Results: A total of 16 studies were included for qualitative synthesis, while five studies, including 645 individuals, were included for quantitative synthesis. There was substantial heterogeneity between studies (I2 = 94.86%; p < 0.01), with a pooled percentage of asymptomatic infections in the studied population of 10.2% (95%CI, 2.5−17.9%). Conclusion: This meta-analysis suggests that many people infected with the monkeypox virus are asymptomatic and difficult to detect. Therefore, prompt detection of these cases of monkeypox virus and appropriate subsequent management is of utmost importance to global public health.

Socioeconomic Inequalities in the Prevalence of Non-Communicable Diseases among Older Adults in India.

Understanding socioeconomic inequalities in non-communicable disease prevalence and preventive care usage can help design effective action plans for health equality programs among India's aging population. Hypertension (HTN) and diabetes mellitus (DM) are frequently used as model non-communicable diseases for research and policy purposes as these two are the most prevalent NCDs in India and are the leading causes of mortality. For this investigation, data on 31,464 older persons (aged 60 years and above) who took part in the Longitudinal Ageing Survey of India (LASI: 2017-2018) were analyzed. The concentration index was used to assess socioeconomic inequality whereas relative inequalities indices were used to compare HTN, DM, and preventive care usage between the different groups of individuals based on socioeconomic status. The study reveals that wealthy older adults in India had a higher frequency of HTN and DM than the poor elderly. Significant differences in the usage of preventive care, such as blood pressure/blood glucose monitoring, were found among people with HTN or DM. Furthermore, economic position, education, type of work, and residential status were identified as important factors for monitoring inequalities in access to preventive care for HTN and DM. Disparities in non-communicable diseases can be both a cause and an effect of inequality across social strata in India.

COVID-19 Infection among Family and Friends: The Psychological Impact on Non-Infected Persons.

Little is known about the mental health impact of having a family member or friend infected with COVID-19. Thus, the purpose of this study was to conduct a comprehensive national assessment of the psychological impact of COVID-19 infection, hospitalization, or death among family members and friends. A multi-item valid and reliable questionnaire was deployed online to recruit adults in the U.S. A total of 2797 adult Americans without a history of COVID-19 infection participated in the study and reported that they had a family member or friend infected with (54%), hospitalized due to (48%), or die (36%) of COVID-19 infection. Symptoms of depression, anxiety, or both (i.e., psychological distress) were statistically significantly higher among those who had family members/friends infected, hospitalized, or die due to COVID-19. Also, this study found that the greater the number of family members/friends affected by COVID-19, or the more severe the COVID-19 infection outcome (i.e., hospitalization vs. death), the higher the odds of symptoms of depression, anxiety, or both. There is an urgent need to develop educational interventions and implement policy measures that address the growing mental health needs of this subgroup of the population that was not infected but indirectly affected by COVID-19 infections among social networks.