Concurrent trajectories of residential region in relation to a sustainable working life among Swedish twins.

BACKGROUND: Residential regions may impact the possibilities to achieve a sustainable working life (SWL, i.e. not having interruptions due to sickness absence, disability pension or unemployment) due to disparities in social security and labour market. We aimed to investigate concurrent trajectories of regions and SWL among Swedish twins. METHODS: National register data were used for the degree of SWL in each year, old-age pension, emigration, death and residential regions classified in three categories (cities; towns and suburbs; or rural areas) of Swedish twins in 1998-2016 (n = 80 398). Group-based multi-trajectory modelling and multinomial regression for relative risks with 95% confidence intervals were calculated. RESULTS: The six-group solution had the best fit to data with trajectories: stable living in towns and suburbs with SWL (33.8%); stable living in cities with SWL (22.1%); stable living in towns and suburbs with increasing SWL (13.9%); stable living in towns and suburbs with lack of SWL (13.2%); stable living towns and suburbs with decreasing SWL (8.8%); and stable living towns and suburbs with decreasing and ultimately lack of SWL (8.3%). Age and being woman increased and being married and higher education decreased the likelihood of belonging to groups 2-6 (vs. 1). CONCLUSIONS: The simultaneous assessment of trajectories of three residential regions and SWL indicated that most people in Sweden seem to live continuously over time in towns and suburbs, but the degree of SWL may vary. More fine-grained assessment of residential regions would be needed to clarify the associations with SWL.

Assessing urban flooding risk in response to climate change and urbanization based on shared socio-economic pathways.

Global climate change and rapid urbanization, mainly driven by anthropogenic activities, lead to urban flood vulnerability and uncertainty in sustainable stormwater management. This study projected the temporal and spatial variation in urban flood susceptibility during the period 2020-2050 on the basis of shared socioeconomic pathways (SSPs). A case study in Guangdong-Hong Kong-Macao Greater Bay Area (GBA) was conducted for verifying the feasibility and applicability of this approach. GBA is predicted to encounter the increase in extreme precipitation with high intensity and frequency, along with rapid expansion of constructed areas, resulting in exacerbating of urban flood susceptibility. The areas with medium and high flood susceptibility will be expected to increase continuously from 2020 to 2050, by 9.5 %, 12.0 %, and 14.4 % under SSP1-2.6, SSP2-4.5, and SSP5-8.5 scenarios, respectively. In terms of the assessment of spatial-temporal flooding pattern, the areas with high flood susceptibility are overlapped with that in the populated urban center in GBA, surrounding the existing risk areas, which is consistent with the tendency of construction land expansion. The approach in the present study will provide comprehensive insights into the reliable and accurate assessment of urban flooding susceptibility in response to climate change and urbanization.

[Investigation and health risk assessment of veterinary drug residues in chickens and eggs sold in Ningxia from 2016 to 2020].

OBJECTIVE: To understand the monitoring status of veterinary drug residues in chickens and eggs sold in Ningxia from 2016 to 2020, and to evaluate the health risks of human intake. METHODS: A total of 303 chicken and 237 eggs were collected from 2016 to 2020, and the veterinary drug residues in chickens and eggs sold in Ningxia were detected and analyzed by high performance liquid chromatography-tandem mass spectrometry. The food safety index method was used to assess the health risks in combination with the dietary intake of residents. RESULTS: The detection rate of veterinary drug residues in chicken was 38.0%(115/303), and the over-standard rate was 7.6%(23/303). The detection rate of veterinary drug residues in eggs was 26.6%(63/237), and the over-standard rate was 19.8%(47/237). The food safety index of doxycycline in chicken was 4.59, and the food safety indexes of doxycycline, flumequine and flufenicol in eggs were 7.09, 26.5 and 2.33, respectively, all of which were much higher than 1, suggesting that there were health risks. The food safety indexes of other substances were all less than 1, and the food safety indexes were all acceptable. CONCLUSION: Veterinary drugs were widely detected in chicken and eggs in Ningxia from 2016 to 2020. Some veterinary drugs had hidden health risks.

Designing coupled LID-GREI urban drainage systems: Resilience assessment and decision-making framework.

As flooding risks rise in urban areas, research suggests combining low impact development (LID) and grey infrastructure (GREI) in urban drainage systems. Several frameworks have been proposed to plan such coupled systems, but there is not a comprehensive framework to assess their resilience under diverse failure scenarios and sources of uncertainty. This study proposes a framework which considers both technological and operational resilience. Technological resilience has to do with the performance of the system under extreme loads. Operational resilience has to do with the performance and long-term efficiency of the system after structural damage or degradation, using appropriate probability distributions to quantify the likelihood of failures. The proposed framework is based on an optimization and multi-criteria decision-making platform. It improves on previous research, which lacked consideration of uncertainty in resilience over the life span. We also apply the proposed framework to a real-world test case, and find that in a high-density urban area, a coupled system is more cost-effective than GREI alone. Furthermore, decentralized systems with greater flexibility show significantly better technological and operational resilience. The proposed framework can better support decision-making for planning robust and cost-effective urban drainage systems, particularly in highly urbanized areas.

Assessment of 2D and 3D imaging for patients undergoing laparoscopic bariatric surgery.

<b>Aim:</b> The aim of this study is to compare the association of 2D and 3D imagery with technical performance and operative time during laparoscopic surgery. </br></br> <b> Material and methods:</b> A systematic review of the literature was conducted through an online search in databases such as PubMed, Cochrane, Embase and CNKI in order to identify articles published in English and Chinese from 2010 to 2020 that compared the clinical results of 2D and 3D laparoscopic gastric bypass surgery. </br></br> <b> Results:</b> A total of 50 articles were included in the qualitative analysis. Out of these, 5 articles that met the inclusion criteria were selected for analysis, according to which 3D laparoscopic surgery had a shorter surgery time than 2D laparoscopic surgery. </br></br> <b>Conclusions:</b> Compared with a 2D laparoscopic system, a 3D laparoscopic system can significantly reduce the operative time and errors and can increase the comfort of the surgeons performing laparoscopic gastric bypass surgery.

Clinical manifestations, prognosis, and treat-to-target assessment of pediatric lupus nephritis.

BACKGROUND: Pediatric lupus nephritis (pLN) is one of the most refractory secondary kidney diseases in childhood. The treat-to-target (T2T) strategy has become the standard treatment for systemic lupus erythematosus (SLE). This study reviewed clinical features, overall remission status, and factors affecting prognosis, to guide pLN management according to T2T strategy. METHODS: This single-center retrospective study studied 220 children diagnosed with LN from January 2012 to December 2018, with > 6-month follow-up data on 173 and complete data on 137 patients. Primary outcome was treatment failure (deterioration or no response) at the latest follow-up. RESULTS: The most common pLN manifestation was proteinuria (81.36%). Females presented more often with rash (P<0.001) and alopecia (P=0.026) than males. Class IV LN (33.33%) was the most common grade on kidney biopsy. Median follow-up was 27.20 months (IQR, 15.78-44.45 months). One-, 3-, and 5-year cumulative overall survival rates were 93.5%, 87.8%, and 86.5%, respectively. The 5-year cumulative kidney survival rate was 97.1%. Regarding initial therapy, efficacy of corticosteroids combined with immunosuppressive agents was significantly better than corticosteroids alone (P=0.010). Factors with P<0.05 in univariate analysis, including hypoalbuminemia, higher SCr at diagnosis, lower eGFR at diagnosis, anti-dsDNA positivity, heavy proteinuria, hypertension, nervous-system involvement, treatment non-compliance, and SLEDAI-2K score, were used for logistic regression analysis. Logistic regression analysis showed hypertension (OR=0.845, P=0.011), nervous-system involvement (OR=4.240, P=0.005), treatment non-compliance (OR=6.433, P=0.001), and lower estimated glomerular filtration rate at diagnosis (OR=1.020, P=0.021) affected prognosis. At end of follow-up, 34.31% achieved varying levels of remission, and 8.76% were in low disease activity state (LDAS). CONCLUSIONS: pLN usually presented with proteinuria, and class IV LN was the dominant pathology. Hypertension, nervous-system involvement, treatment non-compliance, and lower eGFR at diagnosis were independent risk factors for poor prognosis of kidney outcomes. Compared with renal remission rate and cumulative overall survival rate, the proportion of targets achieved was not ideal, suggesting T2T strategy should be used to guide pLN management. A higher resolution version of the Graphical abstract is available as Supplementary information.

Spatial-temporal dynamics, ecological risk assessment, source identification and interactions with internal nutrients release of heavy metals in surface sediments from a large Chinese shallow lake.

The surface sediment concentrations of heavy metals (Cu, Zn, Pb, Cd, Cr, Hg, and As), major metals (Fe and Mn), and the nutrient concentrations in the interstitial water of Lake Houguan, a large eutrophic shallow lake, were surveyed for three years. The results showed that Cu, Zn, and Fe were significantly higher in the east lake parts, and Cd in November was significantly higher than April. 19% of Hg and all of As were larger than the probable effect concentrations (PECs) according to the consensus-based sediment quality guidelines (SQGs), and the geo-accumulation index (Igeo) indicated As, Hg, and Cd were slightly polluted to severely polluted. The RI value (average 704.2) of the potential ecological risk index (PERI) suggested that heavy metals posed very high ecological risks with most of the contributions induced by Cd and Hg. The consequence of hierarchical clustering analysis (HCA) and principle component analysis (PCA) identified Cd, As, and Pb might originate from urbanization, industrial pollution, and agricultural activity; Hg might be from atmospheric deposition and anthropogenic sources above; Cu, Zn, Cr, Fe, and Mn might be from both natural and anthropogenic sources. The Spearman correlation analysis indicated Pb and As were significantly positively correlated with total nitrogen, while Cd significantly negatively correlated with sulfate; As was significantly correlated with ammonia, sulfate, and nitrate in the interstitial water. These results suggested eutrophication might affect sedimental heavy metals by increasing organic matter or influencing the redox potentials in the sediment.

Comparability of thyroid-stimulating hormone immunoassays using fresh frozen human sera and external quality assessment data.

BACKGROUND: This study aimed to assess the comparability among assays using freshly frozen human sera and external quality assessment (EQA) data in China. METHODS: Twenty-nine serum samples and two commercial EQA materials, obtained from the National Center for Clinical Laboratories (NCCL), were analyzed in triplicate using eight routine TSH assays. The commutability of commercial EQA materials (NCCL materials) was evaluated in accordance with the CLSI EP30-A and IFCC bias analysis. Median values obtained for the NCCL EQA materials were used to determine the systematic and commutability-related biases among immunoassays through back-calculation. The comparability of TSH measurements from a panel of clinical samples and NCCL EQA data was determined on the basis of Passing-Bablok regression. Furthermore, human serum pools were used to perform commutable EQA. RESULTS: NCCL EQA materials displayed commutability among three or five of seven assay combinations according CLSI or IFCC approach, respectively. The mean of systematic bias ranged from -13.78% to 9.85% for the eight routine TSH assays. After correcting for systematic bias, averaged commutability-related biases ranged between -42.26% and 12.19%. After correction for systematic and commutability -related biases, the slopes indicating interassay relatedness ranged from 0.801 to 1.299 using individual human sera, from 0.735 to 1.254 using NCCL EQA data, and from 0.729 to 1.115 using pooled human serum EQA(the commutable EQA). CONCLUSIONS: The harmonization of TSH measurement is challenging; hence, systematic and commutability-related biases should be determined and corrected for accurate comparisons among assays when using human individual serum and the commercial EQA materials.

Loss function of SL (sekiguchi lesion) in the rice cultivar Minghui 86 leads to enhanced resistance to (hemi)biotrophic pathogens.

BACKGROUND: Serotonin, originally identified as a neurotransmitter in mammals, functions as an antioxidant to scavenge cellular ROS in plants. In rice, the conversion of tryptamine to serotonin is catalyzed by SL (sekiguchi lesion), a member of cytochrome P450 monooxygenase family. The sl mutant, originated from rice cultivar Sekiguchi-asahi, exhibits spontaneous lesions, whereas its immune responses to pathogens have not been clearly characterized. RESULTS: Here we identified three allelic mutants of SL in an indica rice restore line Minghui 86 (MH86), named as sl-MH-1, - 2 and - 3, all of which present the typical lesions under normal growth condition. Compared with those in MH86, the serotonin content in sl-MH-1 is dramatically decreased, whereas the levels of tryptamine and L-trytophan are significantly increased. The sl-MH-1 mutant accumulates high H2O2 level at its lesion sites and is more sensitive to exogenous H2O2 treatment than the wild type. When treated with the reductant vitamin C (Vc), the lesion formation on sl-MH-1 leaves could be efficiently suppressed. In addition, sl-MH-1 displayed more resistant to both the blast fungus and blight bacteria, Pyricularia oryzae (P. oryzae, teleomorph: Magnaporthe oryzae) and Xanthomonas oryzae pv. Oryzae (Xoo), respectively. The pathogen-associated molecular patterns (PAMPs)-triggered immunity (PTI) responses, like reactive oxygen species (ROS) burst and callose deposition, were enhanced in sl-MH-1. Moreover, loss function of SL resulted in higher resting levels of the defense hormones, salicylic acid and jasmonic acid. The RNA-seq analysis indicated that after P. oryzae infection, transcription of the genes involved in reduction-oxidation regulation was the most markedly changed in sl-MH-1, compared with MH86. CONCLUSIONS: Our results indicate that SL, involving in the final step of serotonin biosynthesis, negatively regulates rice resistance against (hemi)biotrophic pathogens via compromising the PTI responses and defense hormones accumulation.

COVID-19 Outbreak and Management Approach for Families with Children on Long-Term Kidney Replacement Therapy.

BACKGROUND AND OBJECTIVES: During the coronavirus disease 2019 outbreak, the treatment of families with children on long-term KRT is challenging. This study was conducted to identify the current difficulties, worries regarding the next 2 months, and mental distress experienced by families with children on long-term KRT during the coronavirus disease 2019 outbreak and to deliver possible management approaches to ensure uninterrupted treatment for children on long-term KRT. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A multicenter online survey was conducted between February 10 and 15, 2020, among the families with children on long-term KRT from five major pediatric dialysis centers in mainland China. The primary caregivers of children currently on long-term KRT were eligible and included. Demographic information, severe acute respiratory syndrome coronavirus 2 infection status, current difficulties, and worries regarding the next 2 months were surveyed using a self-developed questionnaire. The Patient Health Questionnaire-9 and the General Anxiety Disorder Scale-7 were used to screen for depressive symptoms and anxiety, respectively. RESULTS: Among the children in the 220 families included in data analysis, 113 (51%) children were on dialysis, and the other 107 (49%) had kidney transplants. No families reported confirmed or suspected cases of coronavirus disease 2019. Overall, 135 (61%) and 173 (79%) caregivers reported having difficulties now and having worries regarding the next 2 months, respectively. Dialysis supply shortage (dialysis group) and hard to have blood tests (kidney transplantation group) were most commonly reported. A total of 29 (13%) caregivers had depressive symptoms, and 24 (11%) had anxiety. After the survey, we offered online and offline interventions to address their problems. At the time of the submission of this paper, no treatment interruption had been reported. CONCLUSIONS: The coronavirus disease 2019 outbreak has had physical, mental, logistical, and financial effects on families with children on long-term KRT.

IPDN-China promotes the development of pediatric dialysis in China.

BACKGROUND: In mainland China, dialysis for children with end-stage renal disease (ESRD) was not introduced until the 1980s. To describe the development of pediatric dialysis in different regions of China, a national pediatric dialysis network, namely, International Pediatric Dialysis Network-China (IPDN-China) ( www.pedpd.org.cn ), was launched in 2012. METHODS: Original and updated information from the renal centers registered with the IPDN-China was collected between 2012 and 2016 from two sources, namely, the registry and the survey, and demographic features were analyzed. RESULTS: Due to promotion by the IPDN-China, the number of registered renal centers increased from 12 to 39 between 2012 and 2016, with a significant increase in the coverage of the Chinese administrative divisions (from 26.5 to 67.6%) (p < 0.01); and the coverage of the pediatric (0~14 years old) population increased to nearly 90% in 2016. The distribution of renal centers indicated that East China had the highest average number of registered centers per million population (pmp) 0~14-year-old age group. Seventeen relatively large dialysis centers were distributed across 14 divisions. Various modalities of renal replacement therapy (RRT) were available in most centers. The IPDN-China has promoted collaborations between dieticians, psychologists, and social workers on dialysis teams to provide better service to children with ESRD and their families. The proportion of centers with all three types of paramedic support (i.e., dieticians, psychologists, and social workers) as well as the proportion of centers with a partial paramedic team significantly increased between 2012 (25.0%) and 2016 (69.2%) (p < 0.05). In terms of the point prevalent cases of patients (aged < 18 years), data from the survey of 39 registered centers revealed that the number of children with ESRD who were on RRT was 578 (49% received a kidney transplant) at the end of 2016, which was more than that reported in previous surveys. Data from the registry showed that 349 dialysis patients had been enrolled as of the end of 2016. The median age at RRT start was 9.5 years, and the leading cause of ESRD was congenital abnormalities of the kidney and urinary tract (CAKUT). CONCLUSIONS: The IPDN-China has helped to promote the development of pediatric dialysis for ESRD in China by improving the organization of care for dialysis patients and increasing the availability and the quality of RRT for patients who need it. To improve knowledge about the epidemiology and outcomes of pediatric RRT around the country, a sustained effort needs to be made by the IPDN-China to increase the enrollment of dialysis patients and increase the number of registered centers in the future.

Cost-benefit analysis of low-impact development at hectare scale for urban stormwater source control in response to anticipated climatic change.

Investigation of the cost-effectiveness of low-impact development (LID) practices at the hectare scale in response to impacts of possible climate change was conducted using representative concentration pathways (RCPs). An LID project in Guangzhou has been selected to illustrate changes in the hydrologic performance for alternative source control strategies for a variety of future climate models and scenarios. Frequent storms of shorter duration in RCP 8.5 cause more dramatic fluctuation of hydrologic performance. Hydrologic performance of LID practices on reducing runoff volume and peak flow in test catchment are different in climate scenarios. Based on the constraints of life cycle costs and environmental impacts of LID alternatives, comprehensive strategies were found effective in managing surface runoff at the source to adapt to the influence of climate change. The methodology described herein could be useful in considering LID practices for critical source management with limited budgets and considering environmental impacts under long-term climate change.

Is student loan debt good or bad for full-time employment upon graduation from college?

Student loan debt represents an important phenomenon in the United States, as around 61% of bachelor's degree recipients graduate with a debt of over $28,100. Although studies emphasize that holding student loan debt delays the transition to adulthood in terms of marriage and home ownership, little is known about its impact on employment and this limited research offers, at best, equivocal evidence. The current study draws from Conservation of Resources theory to argue that student loan debt acts as a major financial stressor for new labor market entrants during job search. Using archival data from 1,248 graduating seniors from 4 geographically diverse universities in the United States collected in the context of a prospective study design, we found evidence for 2 countervailing mechanisms through which student loan debt may influence full-time employment upon graduation. On the one hand, college students who had student loan debt were more likely to experience financial strain, and subsequently more job search strain, which was negatively related to college seniors' odds of securing full-time employment upon graduation. On the other hand, this financial strain was also positively related to students' work hours while in the last semester of college, which was positively related to their odds of securing full-time employment upon graduation. Further mediation tests revealed that only the 3-stage indirect effect through job search strain (i.e., student loan debt → financial strain → job search strain → full-time employment) was statistically significant. The theoretical and practical implications of these findings are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

A step-economic and one-pot access to chiral Cα-tetrasubstituted α-amino acid derivatives via a bicyclic imidazole-catalyzed direct enantioselective C-acylation.

Cα-Tetrasubstituted α-amino acids are ubiquitous and unique structural units in bioactive natural products and pharmaceutical compounds. The asymmetric synthesis of these molecules has attracted a lot of attention, but a more efficient method is still greatly desired. Here we describe the first sequential four-step acylation reaction for the efficient synthesis of chiral Cα-tetrasubstituted α-amino acid derivatives from simple N-acylated amino acids via an auto-tandem catalysis using a single nucleophilic catalyst. The synthetic efficiency is improved via a direct enantioselective C-acylation; the methodology affords the corresponding Cα-tetrasubstituted α-amino acid derivatives with excellent enantioselectivities (up to 99% ee). This step-economic, one-pot, and auto-tandem strategy provides facile access to important chiral building blocks, such as peptides, serines, and oxazolines, which are often used in medicinal and synthetic chemistry.

The Undervalued Effects of Polychlorinated Biphenyl Exposure on Breast Cancer.

The incidence of breast cancer across the world has been on the rise in recent decades. Because identified risk factors can only explain a relatively small portion of the cases, environmental exposure to organic pollutants is suspected to play a role in breast cancer etiology. Polychlorinated biphenyls (PCBs) are among the most abundant pollutants, and the impact of their exposure on breast cancer risk has been extensively studied in recent decades. However, the results of most epidemiologic studies do not support an association between PCB exposure and breast cancer risk. We hypothesized that the effects of PCBs on breast cancer might have been undervalued for reasons such as insufficient recognition of the confounding effects of several factors and lack of attention on the innate heterogeneity of PCB mixtures or breast cancer. After reviewing the evidence in the existing literature, we concluded that early life exposure, known risk factors of breast cancer, and impact of exposure to other pollutants are the main sources of confounding effects and have potentially masked the associations between PCBs and breast cancer. Because PCBs are mixtures of congeners with varied properties, and because breast cancers of different subtypes are etiologically distinct diseases, the absence of stratified subgroup analysis on individual PCBs and patients with specific biological subtypes and insufficient attention paid to the results of these subgroup analyses may result in an underestimation of the correlations between PCBs and breast cancer. In future studies, these factors must be taken into consideration when exploring the effect of PCB exposure on breast cancer risk.

Sociodemographic, labour market marginalisation and medical characteristics as risk factors for reinfarction and mortality within 1 year after a first acute myocardial infarction: a register-based cohort study of a working age population in Sweden.

OBJECTIVES: Research covering a wide range of risk factors related to the prognosis during the first year after an acute myocardial infarction (AMI) is insufficient. This study aimed to investigate whether sociodemographic, labour market marginalisation and medical characteristics before/at AMI were associated with subsequent reinfarction and all-cause mortality. DESIGN: Population-based cohort study. PARTICIPANTS: The cohort included 15 069 individuals aged 25-64 years who had a first AMI during 2008-2010. PRIMARY AND SECONDARY OUTCOME MEASURES: The outcome measures consisted of reinfarction and all-cause mortality within 1 year following an AMI, which were estimated by univariate and multivariable HRs and 95% CIs by Cox regression. RESULTS: Sociodemographic characteristics such as lower education showed a 1.1-fold and 1.3-fold higher risk for reinfarction and mortality, respectively. Older age was associated with a higher risk of mortality while being born in non-European countries showed a lower risk of mortality. Labour market marginalisation such as previous long-term work disability was associated with a twofold higher risk of mortality. Regarding medical characteristics, ST-elevation myocardial infarction was predictive for reinfarction (HR: 1.14, 95% CI: 1.07 to 1.21) and all-cause mortality (HR: 3.80, 95% CI: 3.08 to 4.68). Moreover, diabetes mellitus, renal insufficiency, stroke, cancer and mental disorders were associated with a higher risk of mortality (range of HRs: 1.24-2.59). CONCLUSIONS: Sociodemographic and medical risk factors were identified as risk factors for mortality and reinfarction after AMI, including older age, immigration status, somatic and mental comorbidities. Previous long-term work disability and infarction type provide useful information for predicting adverse outcomes after AMI during the first year, particularly for mortality.

Risk factors for subsequent work disability in patients with acute myocardial infarction.

BACKGROUND: Scientific knowledge on risk factors for work disability in terms of long-term sickness absence (SA) and disability pension (DP) following acute myocardial infarction (AMI) is limited. The study aimed to investigate socio-demographic, work-related and medical characteristics as risk factors for long-term SA (>90 days) and DP in patients with a first AMI. METHODS: This is a population-based cohort study of 8199 individuals aged 19-60 years who had a first AMI during 2008-10 and were alive 30 days after AMI. Univariate and multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) with regard to long-term SA and DP with a 3-year follow-up were estimated by Cox regression. RESULTS: We found a higher risk of long-term SA and DP after AMI in women, those with lower education and previous SA (range of HRs: 1.29-7.34). Older age and being born in non-European countries were associated with a 2- to 3-fold higher risk of DP. Moreover, ST-elevation myocardial infarction (STEMI), musculoskeletal and common mental disorders (CMDs) were risk factors for long-term SA and DP, while diabetes mellitus and stroke were associated with a higher risk of DP (range of HRs: 1.12-2.98). Coronary artery bypass grafting (CABG) compared with percutaneous coronary intervention was associated with a 2-fold higher risk of work disability. CONCLUSIONS: Older women, those with lower education and non-European immigrants had a higher risk of work disability after AMI, particularly permanent work disability. STEMI, CABG, diabetes mellitus, stroke, musculoskeletal disorders and CMDs provide important clinical information for work disability after AMI.

Determinants of work disability following lumbar spine decompression surgery.

AIMS: Scientific knowledge about risk factors for work disability in terms of long-term sickness absence and disability pension following lumbar spine decompression surgery remains insufficient. This study aimed to investigate the associations between socio-demographic, work-related, and medical characteristics with subsequent long-term sickness absence (>90 days) and disability pension for individuals who underwent lumbar spine decompression surgery. METHODS: A prospective cohort study of all individuals aged 19-60 years with diagnosed dorsopathies, who underwent lumbar spine decompression surgery 2008-10 in Sweden ( n=7373) was performed. Univariate and multivariate hazard ratios with 95% confidence intervals regarding long-term sickness absence and disability pension with a 3-year follow-up period were estimated by Cox proportional regression. RESULTS: Low educational level, being a non-European immigrant and preoperative sickness absence were risk factors for both long-term sickness absence and disability pension (hazard ratios: 1.2-3.8). Female sex was a risk factor for long-term sickness absence (hazard ratios: 1.3) whereas age >44 years and being a Nordic immigrant were risk factors for disability pension (hazard ratios: 1.9-2.6). Medical factors as common mental disorders, other mental disorders, prescribed psychiatric medication and somatic comorbidity were risk factors for both long-term sickness absence and disability pension (hazard ratios: 1.2-3.4). A simultaneous lumbar fusion surgery and high preoperative pain severity were risk factors for long-term sickness absence (hazard ratios 1.2-1.8). CONCLUSIONS: To prevent long-term work disability after lumbar spine decompression surgery, specific focus is required on older and female patients, those with mental or somatic comorbidities, high levels of preoperative pain or sickness absence, with a simultaneous lumbar fusion surgery, a low educational level or a non-European immigrant background.

Risk of health morbidity for the uninsured: 10-year evidence from a large hospital center in Boston, Massachusetts.

OBJECTIVE: To investigate the independent contribution of insurance status toward the risk of diagnosis of specific clinical comorbidities for individuals admitted to intensive care unit (ICU). DESIGN: Retrospective analysis of secondary database. SETTING: Ten years of public de-identified ICU electronic medical records from a large hospital in USA. PARTICIPANTS: Patients (18-65 years old) who had private insurance or no insurance were extracted from the database. MAIN OUTCOME MEASURES: Independent association of insurance status (uninsured vs. privately insured) with the risk of diagnosis of specific clinical comorbidities. RESULTS: Among 14 268 (from 11 753 patients) admissions to ICU between 2001 and 2012, 96% of them were covered by private insurance. Patients with private insurance had higher proportion of females, married, White race, longer ICU stay and more procedures during stay, and fewer deaths. A lower CCI was observed in uninsured patients. At multivariable analysis, uninsured patients had higher odds of death and of admissions for accidental falls, substance or alcohol abuse. CONCLUSIONS: Patients with no insurance coverage were at higher risk of death and of admission for physical and substance-related injury. We did not observe a higher risk for acute life-threatening diseases such as myocardial infarction or kidney failure. The lower CCI observed in the uninsured may be explained by under diagnosis or voluntary withdrawal from coverage in the pre-Affordable Care Act era. Replication of findings is warranted in other populations, among those with government-subsidized insurance and in the procedure/prescription domains.

Work-disability in low back pain patients with or without surgery, and the role of social insurance regulation changes in Sweden.

BACKGROUND: The aims were to study the differences in work-disability in patients with low back pain (LBP) in relation to (i) treatment provided (non-surgical or lumber spine surgery (decompression or fusion), and (ii) two time points, i.e. before and after the social insurance regulation changes in the in 2008. METHODS: All non-pensioned individuals, aged 19-60 years, living in Sweden, diagnosed with LBP in 2004-06 or 2008-10 were included (n = 153739). Hazard ratios (HRs) with 95% confidence intervals for long-term sickness absence (>90 days, LTSA) and disability pension (DP) for LBP-patients (non-surgical, decompression, fusion, both surgeries) were estimated by Cox regression compared with the matched references from the general population without LBP (n = 566008). RESULTS: LBP-patients had a higher risk of subsequent work-disability compared with the references before and after insurance regulation changes. LBP-patients receiving decompression surgery had similar risk for later work-disability as those treated non-surgically. However, following regulation changes, LBP-patients undergoing fusion surgery had higher risk estimates of both LTSA (HR: 3.3) and DP (HR: 4.8) than patients treated non-surgically (HR: LTSA 2.1; DP 2.5) or with decompression (HR: LTSA 2.6; DP 2.1). In the adjusted models, risk estimates mainly attenuated after controlling for previous sickness absence. CONCLUSION: Risk for subsequent work-disability among LBP-patients was higher compared with people without LBP and lumbar spine surgery. Discrepancies in risk were explained by the treatment provided previous sickness absence and changes in the social insurance regulations, specifically LBP-patients treated with fusion surgery had an increased risk of subsequent work-disability after changes in regulations.