Understanding the association between county-level unemployment and health stratified by education and income in the southwestern United States.

Past research on the relationship between unemployment rates and population health has produced mixed findings. The relationship can be influenced by the kinds of health outcomes observed, time frame, level of geographic aggregation, and other factors. Given these mixed findings, there is a need to add to our knowledge about how unemployment rates and population health are related. There is limited research that examines the association of unemployment rates with both physical and mental health, while simultaneously stratifying populations by income and education levels. Using survey-based self-reported data, this first population-based study examined the association between unemployment rates and physically and mentally unhealthy days in the southwestern United States, by county-level stratification of income (high and low) as well as education (high and low), from 2015 to 2019. After controlling for covariates, associations were modelled using negative binomial regression, with autocorrelative residuals, and were reported as rate ratios (RR). Overall, we found that a 1% rise in unemployment rates was significantly associated with an increase in physically unhealthy days [adjusted RR 1.007; 95% CI, 1.004-1.011, P < 0.001] and mentally unhealthy days [RR 1.006; 95% CI, 1.003-1.009, P < 0.001]. Upon stratification, a significant risk was found among the high education and high income category [RR 1.035; 95% CI, 1.021-1.049, P < 0.001], as well as for the high education and low income category [RR 1.026; 95% CI, 1.013-1.040, P < 0.001]. A better understanding of how unemployment is associated with the health of communities with different education and income levels could help reduce the burden on society through tailored interventions and social policies not only in the United States, but also in other developed nations.

T2 mapping magnetic resonance imaging of cartilage in hemophilia.

Background: In hemophilia, recurrent hemarthrosis may lead to irreversible arthropathy. T2 mapping MRI may reflect cartilage changes at an earlier reversible stage of arthropathy as opposed to structural MRI. Objectives: To evaluate interval changes of T2 mapping compared with the International Prophylaxis Study Group (IPSG) structural MRI scores of ankle cartilage in boys with hemophilia receiving prophylaxis. Methods: Eight boys with hemophilia A (median age, 13; range, 9-17 years), 7 age- and sex-matched healthy boys (controls, median age, 15; range, 7-16 years). A multiecho spin-echo T2-weighted MRI sequence at 3.0T was used to obtain T2 maps of cartilage of boys with hemophilia and controls. Structural joint status was evaluated using the IPSG MRI score. Results: T2 relaxation times of ankle cartilage increased significantly over time in both persons with hemophilia and controls (P = .002 and P = .00009, respectively). Changes in T2 relaxation time strongly correlated with changes in IPSG cartilage scores (rs = 0.93 to rs = 0.78 [P = .0007 to P = .023]), but not with changes in age (P = .304 to P = .840). Responsiveness of T2 relaxation times were higher than that of IPSG cartilage scores, with standardized response means >1.4 for T2 mapping in all regions-of-interest compared with 0.84 for IPSG cartilage scores. Baseline T2 relaxation time strongly correlated with timepoint 2 IPSG cartilage score (rs = 0.93 to rs = 0.82 [P = .001 to P = .012]) and T2 relaxation time (rs = 0.98 to rs = 0.88 [P = .00003 to P = .004]) changes in most regions-of-interest. Conclusion: T2 mapping shows sensitivity to biochemical changes in cartilage prior to detectable damage using conventional MRI, offering potential for early detection of bleed-related cartilage damage in boys with hemophilia.

Warmer summer nocturnal surface air temperatures and cardiovascular disease death risk: a population-based study.

BACKGROUND: In recent summers, some populous mid-latitude to high-latitude regions have experienced greater heat intensity, more at night than by day. Such warming has been associated with increased cause-specific adult mortality. Sex-specific and age-specific associations between summer nocturnal surface air temperatures (SAT) and cardiovascular disease (CVD) deaths have yet to be established. METHODS: A monthly time series analysis (June-July, 2001-2015) was performed on sex-specific CVD deaths in England and Wales of adults aged 60-64 and 65-69 years. Using negative binomial regression with autocorrelative residuals, associations between summer (June-July) nocturnal SAT anomalies (primary exposure) and CVD death rates (outcome) were computed, controlling for key covariates. To explore external validity, similar associations with respect to CVD death in King County, Washington, USA, also were calculated, but only for men aged 60-64 and 65-69 years. Results are reported as incidence rate ratios. RESULTS: From 2001 to 2015, within these specific cohorts, 39 912 CVD deaths (68.9% men) were recorded in England and Wales and 488 deaths in King County. In England and Wales, after controlling for covariates, a 1°C rise in anomalous summer nocturnal SAT associated significantly with a 3.1% (95% CI 0.3% to 5.9%) increased risk of CVD mortality among men aged 60-64, but not older men or either women age groups. In King County, after controlling for covariates, a 1°C rise associated significantly with a 4.8% (95% CI 1.7% to 8.1%) increased risk of CVD mortality among those <65 years but not older men. CONCLUSION: In two mid-latitude regions, warmer summer nights are accompanied by an increased risk of death from CVD among men aged 60-64 years.

Sea surface temperature variability and ischemic heart disease outcomes among older adults.

Ischemic heart disease (IHD) is one of the leading causes of death worldwide. While extreme summer surface air temperatures are thought to be a risk factor for IHD, it is unclear whether large-scale climate patterns also influence this risk. This multi-national population-based study investigated the association between summer Pacific and Atlantic sea surface temperature (SST) variability and annual acute myocardial infarction (AMI) or IHD event rates among older adults residing in North America and the United Kingdom. Overall, a shift from cool to warm phase of the El Niño Southern Oscillation (ENSO) was associated with reduced AMI admissions in western Canada (adjusted rate ratio [RR] 0.89; 95% CI, 0.80-0.99), where this climate pattern predominatly forces below-normal cloud cover and precipitation during summertime, and increased AMI deaths in western United States (RR 1.09; 95% CI, 1.04-1.15), where it forces increased cloud cover and precipitation. Whereas, the Atlantic Multidecadal Oscillation (AMO) during a strong positive phase was associated with reduced AMI admissions in eastern Canada (RR 0.93; 95% CI, 0.87-0.98) and increased IHD mortality during summer months in the United Kingdom (RR 1.08; 95% CI, 1.03-1.14). These findings suggest that SST variability can be used to predict changes in cardiovascular event rates in regions that are susceptible.

Understanding Early Hemophilic Arthropathy in Children and Adolescents Through MRI T2 Mapping.

BACKGROUND: Persons with hemophilia experience hemarthrosis, which can lead to cartilage degeneration, causing physical impairment. MRI T2 mapping has the potential to be used as a tool to evaluate early arthropathic changes and cartilage degeneration in patients with hemophilia. PURPOSE: To assess the value of MRI-T2 mapping as a tool for investigating the cartilage status of children and adolescents with hemophilic arthropathy. STUDY TYPE: Prospective, cross-sectional. SUBJECTS: Twenty-eight boys with hemophilia (aged 5-17 years) and 23 healthy boys (aged 7-17 years). FIELD STRENGTH/SEQUENCES: A multiecho spin-echo T2 -weighted gradient echo sequence was used on a 3.0T magnet. ASSESSMENT: MRI-T2 maps of ankle (tibia-talus) (n = 19) or knee (femur-tibia) (n = 9) cartilage were assessed in hemophilia and healthy groups. An anatomically-based MRI score was also assigned to each ankle/knee. STATISTICAL TESTS: Pearson's correlation coefficient (r), linear regression, intraclass correlation coefficient (ICC), and analysis of variance (ANOVA) test. RESULTS: Negative associations between age and ankle/knee cartilage T2 relaxation times were found in hemophilia (r = -0.72 [P = 0.03] to -0.55 [P = 0.01]) and healthy (r = -0.84 [P < 0.001] to -0.55 [P = 0.20]) groups. There were nonsignificant associations between ankle cartilage T2 relaxation times and MRI scores (r = -0.15 [P = 0.54] to 0.31 [P = 0.19]). DATA CONCLUSION: Results of this clinical investigation emphasize the potential importance of MRI-T2 maps as a tool to understand the functional status of cartilage in children and adolescents with hemophilic arthropathy, while holding promise for the detection of early cartilage degeneration prior to macroscopic characterization by conventional MRI. MRI-T2 mapping may provide novel information that is not reflected in the anatomically-based MRI scoring system. LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY STAGE: 2.

Multivessel Coronary Artery Disease and Subsequent Thrombolysis in Myocardial Infarction Flow Grade After Primary Percutaneous Coronary Intervention.

Background In underdeveloped countries, coronary artery disease (CAD) has developed into a serious health issue due to the high rates of risk factors such as obesity and smoking amongst the population. This study has been performed to find the rate of multivessel CAD (MVD) and subsequent thrombolysis in myocardial infarction (TIMI) flow grade III in patients undergoing primary percutaneous coronary intervention (PCI). Methods This transverse study was carried out involving 110 patients from the emergency department of the National Institute of Cardiovascular Diseases, Karachi, Pakistan, from August 2015 to March 2016. All patients were diagnosed as ST-segment elevation myocardial infarction (STEMI) and had gone through primary PCI. Pre-procedure angiographic findings regarding the number of vessels involved and post-procedure TIMI flow grade were assessed and analysed. Results The average age of the study sample was 56.3 ± 11.4 years. The proportion of male patients was 81.8% (n=90), and hypertension was the most prevalent risk factor followed by type II diabetes with a frequency of 67.3% (n=74) and 40.0% (n=44), respectively. Coronary angiography showed MVD in 50.0% (n=55) of the patients, of whom 34 patients had two-vessel disease, and the remaining 21 had three-vessel disease. Ninety percent (n=99) of the patients exhibited TIMI flow grade III after the procedure with no significant difference between patients with MVD and those with single-vessel disease with a rate of 87.3% (n=48/55) versus 92.7% (n=51/55, P=0.527), respectively. Conclusion Post-procedure TIMI flow grade III was accomplished in almost 90% of the subjects with or without MVD. It can be concluded that primary PCI has a significant role in the early restoration of myocardial blood flow following STEMI regardless of the vessels involved.

Critical appraisal of the International Prophylaxis Study Group magnetic resonance image scale for evaluating haemophilic arthropathy.

A goal of the International Prophylaxis Study Group (IPSG) is to provide an accurate instrument to measure MRI-based disease severity of haemophilic arthropathy at various time points, so that longitudinal changes in disease severity can be identified to support decisions on treatment management. We review and discuss in this paper the evaluative purpose of the IPSG MRI scale in relation to its development and validation processes so far. We also critically appraise the validity, reliability and responsiveness of using the IPSG MRI scale in different clinical and research settings, and whenever applicable, compare these clinimetric properties of the IPSG MRI scale with those of its precursors, the compatible additive and progressive MRI scales.

Influence of Atlantic and Pacific Sea Surface Temperatures on Heat-Related Mortality in the United States.

The frequency and magnitude of extreme summer temperature events in the United States have increased in the past few decades. Long-term exposure to extreme summer temperatures can be detrimental to human health, due to potential risks of dehydration and thermoregulation strains on the cardiovascular system, which may often lead to heat-related mortality (HRM). The summer climate of the United States is influenced by variability in Atlantic and Pacific sea surface temperatures, driven in part by Atlantic Multidecadal Oscillation (AMO) and El-Nino Southern Oscillation (ENSO), respectively. However, the influence of AMO and ENSO on HRM in the United States has not been investigated. Here the longest time series of HRM spanning the past five decades is analyzed in relation with AMO and ENSO. We find that HRM doubled in the early-1990s, coinciding with the positive phase of the AMO. Furthermore, we note a positive association between the variability in HRM and summer temperatures across all regions of the United States, with the strongest association found over the Southern United States. Therefore, this research suggests that variability in Atlantic and Pacific sea surface temperatures has both a nationwide and regional impact on HRM in the United States. Hence, by understanding variability in sea surface temperatures, the future burden of heat-attributed emergencies during extreme summer temperature events can be reduced not only for the United States, but also worldwide.

Retraction: Medication Non-Adherence among Patients with Heart Failure.

[This retracts the article DOI: 10.7759/cureus.5346.].

Medication Non-Adherence among Patients with Heart Failure.

Introduction Poor adherence or non-adherence to the prescribed medications among heart failure (HF) patients is a common problem. This leads to hospital admission due to increased HF exacerbations, reduced physical function, and even death. The study was conducted to assess the heart failure medication adherence level, using Morisky Medication Adherence Scale (MMAS-8), among heart failure patients visiting the adult cardiology department of a tertiary care cardiac center in Karachi. Methods This cross-sectional study included patients diagnosed with heart failure visiting for the follow-up to both inpatient and outpatient departments of a tertiary care cardiac center of Karachi, Pakistan. Medication adherence level was assessed using a validated Morisky Medication Adherence Scale (MMAS-8). The total MMAS-8 score was calculated by adding all of the 8 individual question scores and patients with a score of eight were classified as adherent, otherwise non-adherent. Results A total of 200 patients were included in this study, out of which 61.5% (123) were male and 38.5% (77) were female. More than half, 54% (108), of the patients were rural residents and majority were Urdu (39.5%) speaking followed by Sindhi (19.5%) and Pashto (19.0%) speaking. Almost all, 99.5% (199) were married and 52% (104) patients were uneducated. Overall 76.5% (153) were adherent to the prescribed medication. And reaming 23.5% (47) were moderately adherent with MMAS-8 score of seven and six. Non-adherence to the prescribed medication is more common among rural residents and uneducated patients. Conclusion Non-adherence to the prescribed medication was observed in a significant number of heart failure patients (23.5%) in our population, and it was more common observation for the patients with rural residence and uneducated. It is important to counsel the patients about the importance of medication adherence to marginalize the re-hospitalization and complications these patients.

Outcomes of Primary Percutaneous Coronary Intervention through a Transradial Approach in a Tertiary Care Cardiac Center.

Background Transradial approach for percutaneous coronary intervention (PCI) is gaining popularity due to lesser bleeding and other access site related complications. This study aims to determine the in-hospital outcomes of primary PCI through a transradial approach in a tertiary care cardiac center. Methods Consecutive patients with ST-segment elevation myocardial infarction presenting within 12 hours with symptoms without a previous history of thrombolytic therapy, coronary angioplasty, or cardiac surgery were included in the study. All patients underwent a diagnostic angiogram followed by primary PCI of the infarct-related artery through a radial route and were kept under observation during the hospital stay for forearm hematoma or mortality. Results A total of 180 patients were included in this study, with a mean age of 52.04±7.31 years. Majority (87.2%) of the patients were male, and diabetes (72.8%) was the most commonly observed co-morbid condition followed by hypertension (67.2%). Hospital mortality rate was 3.9% (7 patients), and post-procedure forearm hematoma was noted in 5.6% (10 patients). An increased mortality rate was found to be associated with age above 50 years (7.1% vs. 0.0%; p=0.012) and non-hypertension (8.5% vs. 1.7%; p=0.026). An increased incidence of forearm hematoma was found to be associated with age above 50 years (10.2% vs. 0.0%; p=0.002), diabetic mellitus (7.6% vs. 0.0%; p=0.047), hyperlipidemia (11% vs. 0.0%; p=0.001), and non-smoking (10.2% vs. 0.0%; p=0.003). Conclusion Our study showed that primary PCI through a transradial approach is a safe option with excellent success rates in terms of both mortality rates and morbidity such as forearm hematoma.

Influence of the Scandinavian climate pattern on the UK asthma mortality: a time series and geospatial study.

OBJECTIVE: It is well known that climate variability and trends have an impact on human morbidity and mortality, especially during the winter. However, there are only a handful of studies that have undertaken quantitative investigations into this impact. We evaluate the association between the UK winter asthma mortality data to a well-established feature of the climate system, the Scandinavian (SCA) pattern. METHODS: Time series analysis of monthly asthma mortality through the period of January 2001 to December 2015 was conducted, where the data were acquired from the UK's Office for National Statistics. The correlations between indices of important modes of climate variability impacting the UK such as the North Atlantic Oscillation as well as the SCA and the asthma mortality time series were computed. A grid point correlation analysis was also conducted with the asthma data with sea level pressure, surface wind and temperature data acquired from the European Centre for Medium-Range Weather Forecasts. RESULTS: We find that sea level pressure and temperature fluctuations associated with the SCA explain ~20% (>95% CL) of variance in the UK asthma mortality through a period of 2001-2015. Furthermore, the highest winter peak in asthma mortality occurred in the year 2015, during which there were strong northwesterly winds over the UK that were the result of a sea level pressure pattern similar to that associated with the SCA. CONCLUSIONS: Our study emphasises the importance of incorporating large-scale geospatial analyses into future research of understanding diseases and its environmental impact on human health.

Environmental epidemiology of Kawasaki disease: Linking disease etiology, pathogenesis and global distribution.

BACKGROUND: The pathogenesis of Kawasaki disease (KD) is commonly ascribed to an exaggerated immunologic response to an unidentified environmental or infectious trigger in susceptible children. A comprehensive framework linking epidemiological data and global distribution of KD has not yet been proposed. METHODS AND FINDINGS: Patients with KD (n = 81) were enrolled within 6 weeks of diagnosis along with control subjects (n = 87). All completed an extensive epidemiological questionnaire. Geographic localization software characterized the subjects' neighborhood. KD incidence was compared to atmospheric biological particles counts and winds patterns. These data were used to create a comprehensive risk framework for KD, which we tested against published data on the global distribution. Compared to controls, patients with KD were more likely to be of Asian ancestry and were more likely to live in an environment with low exposure to environmental allergens. Higher atmospheric counts of biological particles other than fungus/spores were associated with a temporal reduction in incidence of KD. Finally, westerly winds were associated with increased fungal particles in the atmosphere and increased incidence of KD over the Greater Toronto Area. Our proposed framework was able to explain approximately 80% of the variation in the global distribution of KD. The main limitations of the study are that the majority of data used in this study are limited to the Canadian context and our proposed disease framework is theoretical and circumstantial rather than the result of a single simulation. CONCLUSIONS: Our proposed etiologic framework incorporates the 1) proportion of population that are genetically susceptible; 2) modulation of risk, determined by habitual exposure to environmental allergens, seasonal variations of atmospheric biological particles and contact with infectious diseases; and 3) exposure to the putative trigger. Future modelling of individual risk and global distribution will be strengthened by taking into consideration all of these non-traditional elements.

Impact of Multidecadal Climate Variability on United Kingdom Rickets Rates.

Children who receive inadequate exposure to sunlight have reduced levels of vitamin D, resulting in rickets, a disease that is characterized by bone deformity, stunted growth, and long term pronounced disability. The United Kingdom rickets incidence rates declined from the early 1960's to mid-1990's, after which there was a dramatic increase. The reason for this change is not well understood. Here we show that an important low frequency mode of climate variability, the Atlantic Multidecadal Oscillation (AMO), with a period of ~60-80 years, has an impact on rickets incidence rates in the United Kingdom through changes in sea level pressure, cloud cover and sunshine duration. This research highlights the important role that multidecadal climate variability can play in human morbidity and suggests that future changes in the AMO may modulate rickets incidence rates throughout the United Kingdom.