Firearm-Related Injuries and the US Opioid and Other Substance Use Epidemic: A Nationwide Evaluation of Emergency Department Encounters.

INTRODUCTION: There has been a sharp climb in the Unites States' death rate among opioid and other substance abuse patients, as well as an increased prevalence in gun violence. We aimed to investigate the association between substance abuse and gun violence in a national sample of patients presenting to US emergency departments (EDs). METHODS: We queried the 2018-2019 Nationwide Emergency Department Sample for patients ≥18 years with substance abuse disorders (opioid and other) using International Classification of Diseases, 10th Revision, Clinical Modification codes. Within this sample, we analyzed characteristics and outcomes of patients with firearm-related injuries. The primary outcome was mortality; secondary outcomes were ED charges and length of stay. RESULTS: Among the 25.2 million substance use disorder (SUD) patients in our analysis, 35,306 (0.14%) had a firearm-related diagnosis. Compared to other SUD patients, firearm-SUD patients were younger (33.3 versus 44.7 years, P < 0.001), primarily male (88.6% versus 54.2%, P < 0.001), of lower-income status (0-25th percentile income: 56.4% versus 40.5%, P < 0.001), and more likely to be insured by Medicaid or self-pay (71.6% versus 53.2%, P < 0.001). Firearm-SUD patients had higher mortality (1.4% versus 0.4%, P < 0.001), longer lengths of stay (6.5 versus 4.9 days, P < 0.001), and higher ED charges ($9269 versus $5,164, P < 0.001). Firearm-SUD patients had a 60.3% rate of psychiatric diagnoses. Firearm-SUD patients had 5.5 times greater odds of mortality in adjusted analyses (adjusted odds ratio: 5.5, P < 0.001). CONCLUSIONS: Opioid-substance abuse patients with firearm injuries have higher mortality rates and costs among these groups, with limited discharge to postacute care resources. All these factors together point to the urgent need for improved screening and treatment for this vulnerable group of patients.

Comparing the Fried frailty phenotype versus the Veterans Affairs frailty index among dialysis dependent patients.

INTRODUCTION: Frailty in dialysis patients is a modifiable disease state which can increase mortality if left untreated but remains underdiagnosed as frailty evaluations can be arduous or time consuming. We evaluate the agreement between a clinical frailty construct (Fried frailty phenotype, FFP) against and an electronic health record-based Veterans Affairs Frailty Index (VAFI) and their association with mortality. METHODS: A retrospective cohort analysis of 764 participants from the ACTIVE/ADIPOSE study was performed. Frailty as measured by VAFI and FFP was obtained and Kappa statistic estimating concordance between the two scores were calculated. Differences in mortality risk were analyzed according to presence or absence of frailty. FINDINGS: When assessing agreement between the VAFI and FFP, the kappa statistic was 0.09 (95% confidence interval [CI] 0.02-0.16) suggesting a low level of agreement. Frailty was independently associated with higher mortality risk (hazards ratio [HR] 1.40-1.42 in fully adjusted models depending upon frailty construct). Discordantly frail patients by construct had a higher risk of mortality though this was not statistically significant after adjustment. However, concordantly frail patients had much higher mortality risk compared to concordantly nonfrail (adjusted HR 2.08, 95% CI 1.44-3.01). DISCUSSION: Poor agreement between constructs is likely reflective of the multifactorial definition of frailty. While further longitudinal studies are needed to determine if the VAFI would be beneficial in the reassessment of frailty, it may be beneficial as a cue for further frailty testing (e.g., with FFP) with the combination of multiple frail constructs providing improved prognostic information.

Research on the evolution and the driving forces of land use classification for production, living, and ecological space in China's Qilian Mountains Nature Reserve from 2000 to 2020.

With the rapid development of the economy, problems such as resource depletion, environmental degradation, and increasingly strained human-land relations have become increasingly prominent. The rational layout of the production, living, and ecological spaces is the basis for solving the contradiction between economic development and environmental protection. This paper analyzed the spatial distribution pattern and evolution characteristics of the Qilian Mountains Nature Reserve based on the theory of production, living, and ecological space. The results show that the production and living function indexes are rising. The most advantaged areas are in the northern part of the research area, where the terrain is flat and transportation is convenient. The ecological function index rises, falls, then rises again. The high-value area is located in the south of the study area, and its ecological function is intact. The study area is dominated by ecological space. During the study period, the area of production space increased by 858.5 km2 and the living space area increased by 341.12 km2. The intensification of human activities has separated the continuity of ecological space. The area of ecological space has decreased by 233.68 km2. Among geographical factors, altitude has a significant impact on the evolution of living space. Population density is the main socioeconomic factor in changing the areas of production space and ecological space. This study is expected to provide a reference basis for land use planning and sustainable development of resources and environment in nature reserves.

A comparative study of environmental responsibility behavior in ecotourism from the perceptions of residents and tourists: A case of Qilian Mountains National Park in China.

The environmentally responsible behaviors of residents and tourists are great significance to the protection of natural resources and sustainable development of ecotourism. This paper takes China's Qilian Mountains National Park as the case place. By constructing a theoretical model of perceived value on environmentally responsible behavior and studying the relationship between residents' and tourists' perceived value, satisfaction and environmentally responsible behavior from both subject and object perspectives, the study shows that. Educational level and occupational distribution have significant effects on residents' and tourists' perceptions of ecotourism environmentally responsible behaviors, but age only has a significant effect on residents' perceptions of ecotourism environmentally responsible behaviors. Gender differences do not affect residents' and tourists' perceptions of ecotourism environmentally responsible behaviors. The theoretical model between residents' perceptions of environmentally responsible behaviors, environmentally responsible behaviors, and satisfaction was basically confirmed. Perceived environmentally responsible behaviors of tourists does not affect satisfaction. Satisfaction has a positive effect on tourists' environmentally responsible behaviors. Perceived environmental responsibility of tourists has a significant positive effect on tourists' environmentally responsible behaviors. The overall level of residents' perception of environmentally responsible behaviors in ecotourism is higher than tourists' perception. Residents and tourists have a poor perception of ecological and environmental protection policies. This paper expects to strengthen residents' and tourists' perceptions of ecologically responsible behaviors. Establishing the sentiment of satisfaction and commitment to environmental protection motivates residents and tourists to implement environmentally responsible behaviors and contribute to the sustainable development of ecotourism.