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Most of the epidemiological investigations looking at the health benefits of green spaces have measured the level of green areas by using only one approach, mainly the Normalized Difference Index - NDVI (a satellite-derived indicator). We hypothesized a difference in the association between health and green space depending on the metric used to measure green exposure. This study considers students' academic performance as a proxy of cognitive abilities (a health indicator). We estimated the relationship between green areas and students' academic performance in the Federal District (FD), Brazil, with three different greenness metrics: NDVI, distance to green spaces (m) - obtained from land use data, and quantity of green spaces (m2) - also from land use data. We assessed student-level academic performance data provided by the Department of the Education in the FD. The data includes students from the public schools in the FD for 256 schools (all the public schools in the FD) and 344,175 students (all the students enrolled in the public schools in the FD in 2017-2020).). For the first metric represented by the distance to green spaces, we estimated the straight-line distance between each school and the nearest green area. For NDVI and quantity of green spaces, we estimated the area of all green spaces within buffers of 500 m, 750 m, and 1 km around the schools. We applied a cross-sectional study design using mixed-effects regression models to analyze the association exposure to green areas around schools and student-level academic performance. Our results confirmed our hypothesis showing that the impact of green areas on students' performance varied significantly depending on the type of green metric. After adjustments for the covariates, we estimated that NDVI is positively associated with school-level academic performance, with an estimated coefficient of 0.91 (95%CI: 0.83; 0.99) for NDVI values at a school's centroid. Distance to green areas was negatively associated with academic performance [-2.09 × 10-5 (95CI: 3.91 × 10-5; -2.84 × 10-6]. The quantity of green areas was estimated with mixed results (direction of the association), depending on the buffer size. Results from this paper suggest that epidemiological investigations must consider the different effects of greenness measures when looking at the association between green space and academic performance. More studies on residual confounding from this association with a different study design are needed to promote public health by making schools healthier.
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Rendimiento Académico , Benchmarking , Brasil , Estudios Transversales , Humanos , Instituciones Académicas , EstudiantesRESUMEN
In northern China, central heating, as an important source of urban particulate matter (UPM), causes more than half of the air pollution during the heating season and has significant spatial-temporal heterogeneity. Owing to the limitations of stationary air monitoring networks, few studies distinguish between heating/non-heating seasons and few have been conducted in urban areas. However, fixed monitoring cannot accurately capture the dynamic exposure of residents to UPM, and there is a lack of comprehensive evaluation of the factors affecting UPM. Therefore, this study used wearable Sniffer 4D equipment to monitor the concentrations of UPM (PM1, PM2.5, and PM10) in selected typical areas of Shenyang City from March 2019 to February 2020. A random forest model was combined with land use and point-of-interest data to analyze the contributions and marginal effects of multiple influences on UPM, in both heating and non-heating seasons. The results showed that in the eastern part of the study area, UPM showed completely opposite spatial distribution characteristics during the two seasons. The concentrations of UPM were higher during the heating season than during the non-heating season. The results indicated that temperature and humidity were important factors in diffusing UPM. The production and operation of boilers were important for the production of UPM. In two-dimensional landscape pattern indices, the percentage of forest and Shannon diversity index were the first and second most important factors, respectively. The three-dimensional pattern of buildings had important effects on the transport and diffusion of UPM (landscape height range >100, floor area ratio >1.3, and landscape volume density >5). Wearable devices could monitor the real situation of residents' exposure to UPM and quantify the factors influencing the spatial-temporal distribution of UPM in an ecological sense. These results provide a scientific basis for urban planning and for health risk reduction for residents.
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Contaminantes Atmosféricos , Contaminación del Aire , Dispositivos Electrónicos Vestibles , Contaminantes Atmosféricos/análisis , Contaminación del Aire/análisis , China , Monitoreo del Ambiente/métodos , Humanos , Material Particulado/análisis , Estaciones del AñoRESUMEN
Ultrafine particulate matter (UFP) air pollution is unevenly distributed across urban environments. Disparities in routine activity patterns, such as the exposure risk we face at work or on the commute, can contribute to chronic exposure-related health outcomes that place excess burdening on vulnerable population groups. In Canada, there is disagreement in the literature on the nature of these exposure-related inequalities, and our understanding of disparities associated with specific activity patterns such as commuting is limited. In the context of UFP specific exposure, these relationships are almost entirely unexplored in the environmental inequality literature. Our study presents an exploratory analysis of UFP exposure patterns in Toronto, Canada. We examined UFP dosage disparities experienced by children during routine school commutes. We estimated single trip dosages that accounted for variation in ambient UFP concentration, route morphology (distance, slope) and their effect on inhalation rate and trip duration. We aggregated these values at the dissemination-area level and collected socioeconomic status descriptors from the 2016 census. Our OLS model showed significant spatial autocorrelation (MI = 0.59, p < 0.001), and we instead applied a spatial error model to account for spatial effects in our dataset. We identified significant associations related to median income (ß = -0.087, p < 0.05), government transfer dependence (ß = -0.107, p < 0.005), immigration status (ß = 0.119, p < 0.001), and education rates (ß = -0.059, p < 0.05). Our results diverged from other pollutants in Toronto-based literature and could indicate that UFPs exhibit unique patterns of inequality. Our findings suggest a need to further study UFP dosage from an environmental inequality perspective.
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Contaminantes Atmosféricos , Contaminación del Aire , Contaminantes Atmosféricos/análisis , Canadá , Niño , Exposición a Riesgos Ambientales/análisis , Monitoreo del Ambiente , Humanos , Tamaño de la Partícula , Material Particulado/análisis , Instituciones Académicas , Clase Social , TransportesRESUMEN
The global lockdown to mitigate COVID-19 pandemic health risks has altered human interactions with nature. Here, we report immediate impacts of changes in human activities on wildlife and environmental threats during the early lockdown months of 2020, based on 877 qualitative reports and 332 quantitative assessments from 89 different studies. Hundreds of reports of unusual species observations from around the world suggest that animals quickly responded to the reductions in human presence. However, negative effects of lockdown on conservation also emerged, as confinement resulted in some park officials being unable to perform conservation, restoration and enforcement tasks, resulting in local increases in illegal activities such as hunting. Overall, there is a complex mixture of positive and negative effects of the pandemic lockdown on nature, all of which have the potential to lead to cascading responses which in turn impact wildlife and nature conservation. While the net effect of the lockdown will need to be assessed over years as data becomes available and persistent effects emerge, immediate responses were detected across the world. Thus, initial qualitative and quantitative data arising from this serendipitous global quasi-experimental perturbation highlights the dual role that humans play in threatening and protecting species and ecosystems. Pathways to favorably tilt this delicate balance include reducing impacts and increasing conservation effectiveness.
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INTRODUCTION: White matter hyperintensity (WMH) burden is a critically important cerebrovascular phenotype related to the diagnosis and prognosis of acute ischemic stroke. The effect of WMH burden on functional outcome in large vessel occlusion (LVO) stroke has only been sparsely assessed, and direct LVO and non-LVO comparisons are currently lacking. MATERIAL AND METHODS: We reviewed acute ischemic stroke patients admitted between 2009 and 2017 at a large healthcare system in the USA. Patients with LVO were identified and clinical characteristics, including 90-day functional outcomes, were assessed. Clinical brain MRIs obtained at the time of the stroke underwent quantification of WMH using a fully automated algorithm. The pipeline incorporated automated brain extraction, intensity normalization, and WMH segmentation. RESULTS: A total of 1,601 acute ischemic strokes with documented 90-day mRS were identified, including 353 (22%) with LVO. Among those strokes, WMH volume was available in 1,285 (80.3%) who had a brain MRI suitable for WMH quantification. Increasing WMH volume from 0 to 4 mL, age, female gender, a number of stroke risk factors, presence of LVO, and higher NIHSS at presentation all decreased the odds for a favorable outcome. Increasing WMH above 4 mL, however, was not associated with decreasing odds of favorable outcome. While WMH volume was associated with functional outcome in non-LVO stroke (p = 0.0009), this association between WMH and functional status was not statistically significant in the complete case multivariable model of LVO stroke (p = 0.0637). CONCLUSION: The burden of WMH has effects on 90-day functional outcome after LVO and non-LVO strokes. Particularly, increases from no measurable WMH to 4 mL of WMH correlate strongly with the outcome. Whether this relationship of increasing WMH to worse outcome is more pronounced in non-LVO than LVO strokes deserves additional investigation.
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Isquemia Encefálica/terapia , Leucoencefalopatías/diagnóstico por imagen , Imagen por Resonancia Magnética , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular/terapia , Anciano , Anciano de 80 o más Años , Isquemia Encefálica/complicaciones , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/fisiopatología , Evaluación de la Discapacidad , Femenino , Humanos , Leucoencefalopatías/complicaciones , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Recuperación de la Función , Sistema de Registros , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/fisiopatología , Factores de Tiempo , Resultado del TratamientoRESUMEN
Background and Purpose- Accurate prediction of acute ischemic stroke (AIS) caused by anterior large vessel occlusion (LVO) that is amendable to mechanical thrombectomy remains a challenge. We developed and validated a prediction model for anterior circulation LVO stroke using past medical history elements present on admission and neurological examination. Methods- We retrospectively reviewed AIS patients admitted between 2009 and 2017 to 3 hospitals within a large healthcare system in the United States. Patients with occlusions of the internal carotid artery or M1 or M2 segments of the middle cerebral artery were randomly split into 2/3 derivation and 1/3 validation cohorts for development of an anterior circulation LVO prediction model and score that was further curtailed for potential use in the prehospital setting. Results- A total of 1654 AIS were reviewed, including 248 (15%) with proximal anterior circulation LVO AIS. In the derivation cohort, National Institutes of Health Stroke Scale score at the time of cerebrovascular imaging, current smoking status, type 2 diabetes mellitus, extracranial carotid, and intracranial atherosclerotic stenosis was significantly associated with anterior circulation LVO stroke. The prehospital score was curtailed to National Institutes of Health Stroke Scale score, current smoking status, and type 2 diabetes mellitus. The areas under the curve for the prediction model, prehospital score, and National Institutes of Health Stroke Scale score alone were 0.796, 0.757, and 0.725 for the derivation cohort and 0.770, 0.689, and 0.665 for the validation cohort, respectively. The Youden index J was 0.46 for a score of >6 with 84.7% sensitivity and 62.0% specificity for the prediction model. Conclusions- Previously reported LVO stroke prediction scores focus solely on elements of the neurological examination. In addition to stroke severity, smoking, diabetes mellitus, extracranial carotid, and intracranial atherosclerotic stenosis were associated with anterior circulation LVO AIS. Although atherosclerotic stenosis may not be known until imaging is obtained, smoking and diabetes mellitus history can be readily obtained in the field and represent important elements of the prehospital score supplementing National Institutes of Health Stroke Scale score.
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Isquemia Encefálica/diagnóstico por imagen , Isquemia Encefálica/epidemiología , Trastornos Cerebrovasculares/diagnóstico por imagen , Trastornos Cerebrovasculares/epidemiología , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/epidemiología , Anciano , Anciano de 80 o más Años , Isquemia Encefálica/cirugía , Trastornos Cerebrovasculares/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Distribución Aleatoria , Estudios Retrospectivos , Factores de Riesgo , Accidente Cerebrovascular/cirugía , Trombectomía/tendenciasRESUMEN
Exposure to ultrafine particulate air pollution (UFP) contributes to adverse health effects in sensitive population groups such as children. There is a need to explore UFP exposure in terms of respiratory dosage, which leverages the effect of activity-specific ventilation rates. Commute-related dosage, which describes the dosage that occurs during travel between fixed locations on a routine schedule (i.e. morning school commute), is often underrepresented in air pollution studies. School commutes commonly utilize active transportation modes, and modelling dosage during such commutes requires the development of an approach that captures the influence of travel mode and terrain-enforced ventilation rates. The concept of low-dosage routing is discussed as a solution to UFP dose mitigation; however, it requires an in-depth understanding of the factors that control how dosage is accumulated at different points in the commute. This paper presents a modelling workflow for examining UFP dosage while walking to school. We apply a GIS-based approach that simulates school commute routes for 296,862 homes in Toronto. We use a physical exertion-dependent dosage model that reflects broad-scale variability in physiology, travel velocity, travel gradient, and ambient UFP concentration to evaluate route-specific commute dosage. Our results reveal the patterns of within-route variation in dosage and demonstrate the effects high regional UFP concentration and accelerated physical exertion (i.e. where ventilation rate increases during uphill travel) on creating sections of greater UFP dosage within a route. We use the model to examine UFP dosage under shortest-distance and lowest-dosage routing solutions and find that 13.4% of homes had low-dosage alternative routes, while 86.6% had shortest-distances route that were already the lowest-dosage. Our findings were consistent with studies in the literature that implement a dosage modelling approach. This study highlights the importance of dosage models that account for the dynamic nature of walking speed, ventilation rate, terrain, and pollution concentration along a school commute.
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Contaminación del Aire/estadística & datos numéricos , Exposición a Riesgos Ambientales/estadística & datos numéricos , Modelos Químicos , Material Particulado , Transportes/estadística & datos numéricos , Contaminantes Atmosféricos , Niño , Humanos , Tamaño de la Partícula , Instituciones AcadémicasRESUMEN
BACKGROUND: Little is known about the health risks of air pollution and cardiorespiratory diseases, globally, across regions and populations, which may differ because of external factors. OBJECTIVES: We systematically reviewed the evidence on the association between air pollution and cardiorespiratory diseases (hospital admissions and mortality), including variability by energy, transportation, socioeconomic status, and air quality. SEARCH METHODS: We conducted a literature search (PubMed and Web of Science) for studies published between 2006 and May 11, 2016. SELECTION CRITERIA: We included studies if they met all of the following criteria: (1) considered at least 1 of these air pollutants: carbon monoxide, sulfur dioxide, nitrogen dioxide, ozone, or particulate matter (PM2.5 or PM10); (2) reported risk for hospital admissions, mortality, or both; (3) presented individual results for respiratory diseases, cardiovascular diseases, or both; (4) considered the age groups younger than 5 years, older than 65 years, or all ages; and (5) did not segregate the analysis by gender. DATA COLLECTION AND ANALYSIS: We extracted data from each study, including location, health outcome, and risk estimates. We performed a meta-analysis to estimate the overall effect and to account for both within- and between-study heterogeneity. Then, we applied a model selection (least absolute shrinkage and selection operator) to assess the modifier variables, and, lastly, we performed meta-regression analyses to evaluate the modifier variables contributing to heterogeneity among studies. MAIN RESULTS: We assessed 2183 studies, of which we selected 529 for in-depth review, and 70 articles fulfilled our study inclusion criteria. The 70 studies selected for meta-analysis encompass more than 30 million events across 28 countries. We found positive associations between cardiorespiratory diseases and different air pollutants. For example, when we considered only the association between PM2.5 and respiratory diseases ( Figure 1 , we observed a risk equal to 2.7% (95% confidence interval = 0.9%, 7.7%). Our results showed statistical significance in the test of moderators for all pollutants, suggesting that the modifier variables influence the average cardiorespiratory disease risk and may explain the varying effects of air pollution. CONCLUSIONS: Variables related to aspects of energy, transportation, and socioeconomic status may explain the varying effect size of the association between air pollution and cardiorespiratory diseases. Public Health Implications. Our study provides a transferable model to estimate the health effects of air pollutants to support the creation of environmental health public policies for national and international intervention.
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Contaminación del Aire/efectos adversos , Enfermedades Cardiovasculares/epidemiología , Enfermedades Respiratorias/epidemiología , Contaminantes Atmosféricos/efectos adversos , Enfermedades Cardiovasculares/mortalidad , Femenino , Salud Global/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Enfermedades Respiratorias/mortalidadRESUMEN
Neighborhood characteristics affect an individual's quality of life. Although several studies have examined the relationship between neighborhood environments and human health, we are unaware of studies that have examined the distance-decay of this effect and then presented the risk results spatially. Our study is unique in that is explores the health effects in a less developed country compared to most studies that have focused on developed countries. The objective of our study is to quantify the distance-decay cardiorespiratory diseases risk related to 28 neighborhood aspects in the Federal District, Brazil and present this information spatially through risk maps of the region. Toward this end, we used a quantile regression model to estimate risk and GIS modeling techniques to create risk maps. Our analysis produced the following findings: i) a 2500 m increase in highway length was associated with a 46% increase in cardiorespiratory diseases; ii) 46,000 light vehicles in circulation (considering a buffer of ≤500 m from residences) was associated with 6 hospital admissions (95% CI: 2.6, 14.6) per cardiorespiratory diseases; iii) 74,000 m2 of commercial areas (buffer ≤1700 m) was associated with 12 hospital admissions (95% CI: 2.2, 20.8); iv) 1km2 increase in green areas intra urban was associated with less two hospital admissions, and; vi) those who live ≤500 m from the nearest point of wildfire are more likely to have cardiorespiratory diseases that those living >500 m. Our findings suggest that the approach used in this study can be an option to improve the public health policies.
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Exposición a Riesgos Ambientales/efectos adversos , Cardiopatías/etiología , Características de la Residencia/estadística & datos numéricos , Trastornos Respiratorios/etiología , Brasil/epidemiología , Estudios Transversales , Cardiopatías/epidemiología , Humanos , Admisión del Paciente/estadística & datos numéricos , Trastornos Respiratorios/epidemiología , Medición de Riesgo , Regresión EspacialRESUMEN
Many studies have suggested that socio-economic factors are strong modifiers of human vulnerability to air pollution effects. Most of these studies were performed in developed countries, specifically in the US and Europe. Only a few studies have been performed in developing countries, and analyzed small regions (city level) with no spatial disaggregation. The aim of this study was to assess the association between vehicle emissions and cardiorespiratory disease risk in Brazil and its modification by spatial clustering of socio-economic conditions. We used a quantile regression model to estimate the risk and a geostatistical approach (K means) to execute spatial cluster analysis. We performed the risk analysis in three stages. First, we analyzed the entire study area (primary analysis), and then we conducted a spatial cluster analysis based on various municipal-level socio-economic factors, followed by a sensitivity analysis. We studied 5444 municipalities in Brazil between 2008 and 2012. Our findings showed a significant association between cardiorespiratory disease risk and vehicular emissions. We found that a 15% increase in air pollution is associated with a 6% increase in hospital admissions rates. The results from the spatial cluster analysis revealed two groups of municipalities with distinct sets of socio-economic factors and risk levels of cardiorespiratory disease related to exposure to vehicular emissions. For example, for vehicle emissions of PM in 2008, we found a relative risk of 4.18 (95% CI: 3.66, 4.93) in the primary analysis; in Group 1, the risk was 0.98 (95% CI: 0.10, 2.05) while in Group 2, the risk was 5.56 (95% CI: 4.46, 6.25). The risk in Group 2 was 480% higher than the risk in Group 1, and 35% higher than the risk in the primary analysis. Group 1 had higher values (3rd quartile) for urbanization rate, highway density, and GDP; very high values (≥3rd quartile) for population density; median values for distance from the capital; and lower values (1st quartile) for rural population density. Group 2 had lower values (1st quartile) urbanization rate; median values for highway density, GDP, and population density; between median and third quartile values for distance from the capital; and higher values (3rd quartile) for rural population density. Our findings suggest that socio-economic factors are important modifiers of the human risk of cardiorespiratory disease due to exposure to vehicle emissions in Brazil. Our study provides support for creating effective public policies related to environmental health that are targeted to high-risk populations.
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Contaminantes Atmosféricos/análisis , Enfermedades Cardiovasculares/epidemiología , Enfermedades Respiratorias/epidemiología , Emisiones de Vehículos/análisis , Brasil/epidemiología , Monóxido de Carbono/análisis , Análisis por Conglomerados , Monitoreo del Ambiente , Hospitalización/estadística & datos numéricos , Humanos , Hidrocarburos/análisis , Metano/análisis , Óxidos de Nitrógeno/análisis , Material Particulado/análisis , Riesgo , Factores SocioeconómicosRESUMEN
Air pollution poses health concerns at the global scale. The challenge of managing air pollution is significant because of the many air pollutants, insufficient funds for monitoring and abatement programs, and political and social challenges in defining policy to limit emissions. Some governments provide citizens with air pollution health risk information to allow them to limit their exposure. However, many regions still have insufficient air pollution monitoring networks to provide real-time mapping. Where available, these risk mapping systems either provide absolute concentration data or the concentrations are used to derive an Air Quality Index, which provides the air pollution risk for a mix of air pollutants with a single value. When risk information is presented as a single value for an entire region it does not inform on the spatial variation within the region. Without an understanding of the local variation residents can only make a partially informed decision when choosing daily activities. The single value is typically provided because of a limited number of active monitoring units in the area. In our work, we overcome this issue by leveraging mobile air pollution monitoring techniques, meteorological information and land use information to map real-time air pollution health risks. We propose an approach that can provide improved health risk information to the public by applying neural network models within a framework that is inspired by land use regression. Mobile air pollution monitoring campaigns were conducted across Hamilton from 2005 to 2013. These mobile air pollution data were modelled with a number of predictor variables that included information on the surrounding land use characteristics, the meteorological conditions, air pollution concentrations from fixed location monitors, and traffic information during the time of collection. Fine particulate matter and nitrogen dioxide were both modelled. During the model fitting process we reserved twenty percent of the data to validate the predictions. The models' performances were measured with a coefficient of determination at 0.78 and 0.34 for PM2.5 and NO2, respectively. We apply a relative importance measure to identify the importance of each variable in the neural network to partially overcome the black box issues of neural network models.
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Contaminación del Aire/análisis , Monitoreo del Ambiente/métodos , Modelos Teóricos , Redes Neurales de la Computación , Medición de Riesgo/métodos , Contaminantes Atmosféricos/análisis , Humanos , Dióxido de Nitrógeno/análisis , Ontario , Material Particulado/análisis , Valor Predictivo de las Pruebas , Salud UrbanaRESUMEN
Urbanization has numerous benefits to human society, but some aspects of urban environments, such as air pollution, can negatively affect human health. Two major air pollutants, particulate matter (PM) and polycyclic aromatic hydrocarbons (PAH), have been classified as carcinogens by the International Agency for Research on Cancer. Here, we answer two questions: (1) What are the carcinogenic effects of PM and PAH exposure? (2) How does carcinogenic risk vary across geographical regions? We performed a comprehensive literature search of peer-reviewed published studies examining the link between air pollution and human cancer rates. Focusing on studies published since 2014 when the last IARC monograph on air pollution was published, we converted the extracted data into relative risks and performed subgroup analyses. Exposure to PM2.5 (per 10 µg/m3) resulted in an 8.5% increase in cancer incidence when all cancer types were combined, and risk for individual cancer types (i.e. lung cancer and adenocarcinoma) was also elevated. PM2.5 was also associated with 2.5% higher mortality due to cancer when all types of cancer were combined, and for individual cancer types (i.e., lung and breast cancer). Exposure to PM2.5 and PM10 posed the greatest risk to lung cancer incidence and mortality in Europe (PM2.5 RR 2.15; PM10 RR 1.26); the risk in Asia and the Americas was also elevated. Exposure to PAH and benzo[a]pyrene significantly increased the pooled risk of cancer incidence (10.8% and 8.0% respectively) at the highest percentile of exposure concentration. Our meta-analyses of studies over the past decade shows that urban air pollution in the form of PM2.5, PM10, and PAH all elevate the incidence and mortality of cancer. We discuss the possible mechanisms of carcinogenesis of PM and PAH. These results support World Health Organization's conclusion that air pollution poses among the greatest health risks to humans living in cities.
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Contaminantes Atmosféricos , Carcinógenos , Neoplasias , Material Particulado , Hidrocarburos Policíclicos Aromáticos , Humanos , Contaminación del Aire/estadística & datos numéricos , Carcinógenos/toxicidad , Exposición a Riesgos Ambientales/estadística & datos numéricos , Neoplasias/inducido químicamente , Neoplasias/epidemiología , Hidrocarburos Policíclicos Aromáticos/toxicidadRESUMEN
OBJECTIVES: Determine if systemic corticosteroids administration is associated with reduced length of stay, surgical intervention, and abscess formation in pediatric patients with orbital complications of rhinosinusitis. METHODS: Systematic review and meta-analysis were performed utilizing the PubMed and MEDLINE databases to identify articles published between January 1990 and April 2020. Retrospective cohort study of the same patient population over the same time period at our institution. RESULTS: Eight studies, 477 individuals, met criteria for inclusion in the systematic review. 144 patients (30.2%) received systemic corticosteroids, while 333 patients (69.8%) did not. Meta-analyses of frequency of surgical intervention and subperiosteal abscess showed no difference between those who did and did not receive systemic steroids ([OR = 1.06; 95% CI: 0.46 to 2.48] and [OR = 1.08; 95% CI: 0.43 to 2.76], respectively). 6 articles evaluated hospital length of stay (LOS). 3 of these reported enough data to perform meta-analysis, which showed patients with orbital complications who received systemic corticosteroids had shorter mean hospital LOS when compared with those who did not receive systemic steroids (SMD = -2.92, 95% CI: 5.65 to -0.19). CONCLUSION: While available literature was limited, systematic review and meta-analysis suggests systemic corticosteroids decrease length of stay for hospitalized pediatric patients with orbital complications of sinusitis. Further research is needed to more clearly define the role of systemic corticosteroids as an adjunctive treatment.
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Absceso , Sinusitis , Niño , Humanos , Absceso/tratamiento farmacológico , Absceso/etiología , Estudios Retrospectivos , Corticoesteroides/uso terapéutico , Esteroides , Sinusitis/complicaciones , Sinusitis/tratamiento farmacológicoRESUMEN
OBJECTIVES: Opioid analgesia has been integral in post-operative pain control for decades. The over-prescription of opioids, commonly in the surgical patient, has contributed to the current opioid epidemic. Liposomal bupivacaine (LB), a long-acting analgesia formulation, has demonstrated decreased post-operative pain and opioid requirements in patients treated across multiple surgical subspecialties. The aims of this retrospective study are to assess post-operative pain and opioid use in patients who received LB at the time of thyroidectomy. METHODS: A cohort-matched retrospective review of patients who underwent thyroidectomy by 2 surgeons between January 2010 and December 2019 was performed. Patients were divided into those that received LB intraoperatively and those that did not. Statistical analyses were performed using the Chi-square or Fisher's exact test, and 2-sample T-test or Wilcoxon rank sum test. RESULTS: Of the 201 patients included in this study, 113 patients received LB and 88 did not. Patients who received LB had a lower median visual analog scale (VAS) pain score (2 vs 3, P = .2252), lower maximum VAS pain score (6 vs 7, P = .0898), were less likely to require opioid medications (73.5% vs 85.2%, P = .0434), and had a lower percentage of daily morphine milligram equivalent value ≥45 (89.8% vs 95.3%, P = .1581) during the post-operative period when compared to those that did not. CONCLUSION: This study suggests a role for incisional infiltration with LB for post-operative pain management in patients undergoing transcervical thyroidectomy. We report reduced post-operative pain scores and opioid analgesia requirements in patients who received LB.
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Analgésicos Opioides , Bupivacaína , Humanos , Analgésicos Opioides/uso terapéutico , Bupivacaína/uso terapéutico , Anestésicos Locales/uso terapéutico , Estudios Retrospectivos , Tiroidectomía/efectos adversos , Liposomas/uso terapéutico , Dolor Postoperatorio/tratamiento farmacológicoRESUMEN
OBJECTIVE: Patient-provider communication is a major barrier to care, with some providers giving their personal phone number (PPN) to patients for increased accessibility. We investigated participant utilization of provider's PPN, its effect on participant satisfaction, provider's ability to predict abuse of this practice, and evolving provider perceptions. STUDY DESIGN: Prospective, randomized study. SETTING: Single institution, tertiary referral center. METHODS: During a 2-week period, otolaryngology patients were randomized to either receive their provider's PPN or not. Providers predicted the likelihood of abuse. All calls/texts were documented for 4 weeks. At the study's conclusion, participants were surveyed using Press Ganey metrics. Providers were surveyed before and after to assess their likelihood of providing patients with their PPN and its impact on work demands. RESULTS: Of the 507 participants enrolled, 266 were randomized to the phone number group (+PN). Of 44 calls/texts from 24 participants, 8 were considered inappropriate. Ten participants were predicted to abuse the PPN, but only one was accurately identified. Participants in the +PN group had a greater mean composite satisfaction score than the control group (4.8 vs 4.3; Welch's t-test, P < .0011). At the conclusion of the study, providers were more likely to share their PPN (Wilcoxon signed-rank test, P < .0313), and their perceived impact of this practice on workload was lower (Wilcoxon signed-rank test, P < .0469). CONCLUSION: This study demonstrates low patient utilization of provider PPNs, and poor provider predictive ability of patient abuse. Receipt of provider's PPN was associated with improved patient satisfaction.
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Comunicación , Otolaringología , Humanos , Estudios Prospectivos , Encuestas y Cuestionarios , Centros de Atención Terciaria , Satisfacción del PacienteRESUMEN
Pediatric vasculitis is a complex group of disorders that commonly presents with multisystem involvement. Renal vasculitis can be isolated to the kidneys or can occur as part of a broader multiorgan vasculitis. Depending on severity, renal vasculitis may present as acute glomerulonephritis (AGN) often associated with hypertension and sometimes with a rapidly deteriorating clinical course. Prompt diagnosis and initiation of therapy are key to preserving kidney function and preventing long-term morbidity and mortality. This review focuses on the clinical presentation, diagnosis, and treatment objectives for common forms of renal vasculitis seen in pediatric patients.
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Glomerulonefritis , Hipertensión , Enfermedades Renales , Vasculitis , Humanos , Niño , Vasculitis/diagnóstico , Vasculitis/terapia , Enfermedades Renales/diagnóstico , Enfermedades Renales/etiología , Enfermedades Renales/terapia , Cognición , Glomerulonefritis/diagnóstico , Glomerulonefritis/terapiaRESUMEN
Background: Air pollution exposure has been associated with critical neonatal morbidities, including low birth weight (LBW). However, little is known on short-term exposure to wildfire smoke and LBW. In this study, we estimated the association between birth weight following pregnancy and wildfire smoke exposure in more than 1.5 million newborns in Brazil (considered as a very fire-prone region worldwide). Methods: We applied a logistic regression model to estimate the percent variation in newborns with low birth weight when exposed to wildfire in different trimesters of the pregnancy. Findings: After adjusting the model with relevant covariates, we found that an increase of 100 wildfire records in Brazil was associated with an increase in low birth weight in the Midwest region [0.98% (95%CI:0.34; 1.63)] and in the South region [18.55% (95%CI:13.66; 23.65)] when the exposure occurred in the first trimester of pregnancy. Interpretation: Wildfires were associated with LBW and this should be of public health concern for policymakers. Funding: Brazilian Agencies National Council for Scientific and Technological Development (CNPq); Ministry of Science, Technology and Innovation in Brazil (MCTI); and Novo Nordisk Foundation Challenge Programme.
RESUMEN
Domestication of the donkey from the African wild ass transformed ancient transport systems in Africa and Asia and the organization of early cities and pastoral societies. Genetic research suggests an African origin for the donkey, but pinpointing the timing and location of domestication has been challenging because donkeys are uncommon in the archaeological record and markers for early phases of animal domestication are hard to determine. We present previously undescribed evidence for the earliest transport use of the donkey and new paleopathological indicators for early phases of donkey domestication. Findings are based on skeletal data from 10 approximately 5,000-year-old ass skeletons recently discovered entombed in an early pharaonic mortuary complex at Abydos, Middle Egypt, and a concurrent study of 53 modern donkey and African wild ass skeletons. Morphometric studies showed that Abydos metacarpals were similar in overall proportions to those of wild ass, but individual measurements varied. Midshaft breadths resembled wild ass, but midshaft depths and distal breadths were intermediate between wild ass and domestic donkey. Despite this, all of the Abydos skeletons exhibited a range of osteopathologies consistent with load carrying. Morphological similarities to wild ass show that, despite their use as beasts of burden, donkeys were still undergoing considerable phenotypic change during the early Dynastic period in Egypt. This pattern is consistent with recent studies of other domestic animals that suggest that the process of domestication is slower and less linear than previously thought.
Asunto(s)
Animales Domésticos , Equidae/anatomía & histología , Animales , Biometría , Análisis por Conglomerados , Fósiles , Artropatías/patología , Huesos del Metacarpo/anatomía & histología , Paleontología , Factores de TiempoRESUMEN
BACKGROUND: The Presidential Address of the American College of Surgeons (ACS) is an influential platform during the convocation for new Fellows every year. Recent work reported that most ACS presidents primarily discuss personal characteristics for success; however, these qualities were never specified. Therefore, this study aimed to identify the personal characteristics that are espoused in ACS presidential addresses as essential for success as a surgeon. STUDY DESIGN: Thematic analysis was completed for every ACS presidential address (98 addresses between 1913 and 2019). Full-text addresses were reviewed (2 team members), personal characteristics were coded (1 team member) and then assembled into patterns and themes (3 team-members' consensus). A temporal frame was adopted in grouping these themes in that personal qualities that appeared consistently throughout this period were classified as Enduring Characteristics and those that emerged only in later years were classified as Recent Characteristics. RESULTS: Enduring Characteristics that were present throughout the century included sincere compassion for patients; integrity; engagement (willingness to help shape the changing field at the institutional or national level); and commitment to lifelong learning. Recent Characteristics included humility and the interpersonal attributes of inclusivity and the ability to be a collaborative team leader. CONCLUSIONS: Surgery has experienced countless paradigm shifts since 1913, and the perceived characteristics for success have similarly evolved to include more interpersonal abilities. The importance of sincere compassion for patients, integrity, engagement, and commitment to lifelong learning remained consistent for more than a century.
Asunto(s)
Liderazgo , Cirujanos/ética , Cirujanos/psicología , Empatía , Ética Médica , Humanos , Aprendizaje , Profesionalismo , Estudios Retrospectivos , Habilidades Sociales , Sociedades Médicas , Estados UnidosRESUMEN
In the era of COVID-19, providers are delaying laboratory testing in people with HIV (PWH). The purpose of this study was to examine the clinical significance of renal, liver, and lipid testing. We reviewed the charts of 261 PWH who initiated care at an academic HIV clinic between January 1, 2016 and December 21, 2018. Analysis included one-sided binomial exact tests and multiple linear, Poisson, and Beta regression models. The most common abnormality was a glomerular filtration rate (GFR) <60 mL/min (10%). Age <40 years [estimated relative rate (rr) 0.017, 95% confidence interval (CI) 0.207 to 0.494], cobicistat (rr 0.284, 95% CI 0.128 to 0.63), and tenofovir alafenamide (rr 0.295 95% CI 0.151 to 0.573) were associated with a decreased risk of GFR <60 mL/min. An increased AST and ALT ≥2 × upper limit of normal (ULN) was found in 5% and 3%, respectively. Hepatitis C and use of darunavir and lopinavir were associated with increased AST or ALT. When a GFR was <60 mL/min or an AST or ALT was ≥2 × ULN, no action was taken in 53% of cases. In 18% of cases the only intervention was repeat testing. The most common interventions after lipid results were calculation of a 10-year cardiovascular risk score (31%) and addition of a statin (18%). Taking action after lipid results was strongly associated with age ≥40 (rr 7.37, 95% CI 3.0 to 18.3). Young PWH without hepatitis C rarely have renal, liver, or lipid test results that alter clinical care. Decreased testing should be considered.