Social determinants and spatio-temporal variation of Ischemic Heart Disease in Manitoba.

INTRODUCTION: The aim was to study any spatial and/or temporal patterns of ischemic heart disease (IHD) prevalence and measure the effects of selected social determinants on these spatial and space-time patterns. METHODS: Data were obtained from the Population Research Data Repository housed at the Manitoba Centre for Health Policy to identify persons who were diagnosed with IHD between 1995 and 2018. These persons were geocoded to 96 geographic regions of Manitoba. An area-level socioeconomic factor index (SEFI-2) and the proportion of the population who was Indigenous were calculated for each geographic region using the 2016 Canadian Census data. Associations between these factors and IHD prevalence were measured using Bayesian spatial Poisson regression models. Temporal trends and spatio-temporal trends were measured using Bayesian spatio-temporal Poisson regression models. RESULTS: Univariable models showed a significant association with increased regional Indigenous population proportion associated with a higher prevalence of IHD (RR: 0.07, 95% CredInt: (0.05, 0.10)) and for SEFI-2 (RR: 0.17, 95% CredInt: (0.11, 0.23)). Using a multivariable model, after accounting for the proportion of the population that was Indigenous, there was no evidence of an association between IHD prevalence and area-level socioeconomic factor. Spatio-temporal models showed no significant overall temporal trend in IHD prevalence, but there were significant spatially varying temporal trends within the 96 regions. CONCLUSIONS: Association between Indigenous population proportion and IHD is consistent with previous research. No significant overall temporal trend was measured. However, regions with significantly increasing trends and significantly decreasing trends in IHD prevalence were identified.

An evaluation of renin-angiotensin system markers in youth with type 2 diabetes and associations with renal outcomes.

AIMS/HYPOTHESIS: Youth with type 2 diabetes (T2D) have high rates of obesity, hypertension and suboptimal glycemic control. We hypothesized that renin-angiotensin system (RAS) activation is present in youth with T2D and associated with poor glycemic control and renal outcomes. METHODS: Cross-sectional analysis of 183 youth with T2D and 100 controls from the Improving renal Complications in Adolescents with T2D through REsearch cohort. Diabetes youth stratified by urine albumin:creatinine ratio (ACR) < or ≥2 mg/mmol. RAS levels measured with enzyme-linked immunosorbent assay (ELISA) and enzyme activities by synthetic substrates. In T2D, levels log transformed and Tobit linear regressions evaluated for associations with hemoglobin A1c (HbA1c), mean arterial pressure (MAP), estimated glomerular filtration rate (eGFR), ACR. RESULTS: Youth were 14 to 15 years, with diabetes duration 1.7 to 1.8 years; 21.3% albuminuria. Serum: differences in plasma renin activity (<0.0001), and angiotensin converting enzyme (ACE) activity (P = .003) in T2D vs controls. Urine: higher ACE activity and ACE2 protein/activity (all P < .0001) in T2D, higher levels in T2D with albuminuria. Multivariable regressions: higher serum ACE activity (ß = 0.03, SE 0.01;P < .01), urine ACE activity (ß = 0.44, SE 0.18;P < .01), ACE2 (ß = 0.51, SE 0.19;P < .01) positively associated with HbA1c; urine angiotensinogen (AGT) negatively associated (ß = -0.28 [SE 0.06;P < .01]). Higher serum aldosterone (ß = 0.11 [SE 0.04;P < .01]) and urine AGT (ß = 0.32 [SE 0.07;P < .01]) significantly associated with ACR and urine ACE2 (ß = 0.21 [SE 0.13;P < .03]). No associations between RAS markers and eGFR/MAP. CONCLUSIONS/INTERPRETATION: RAS activation present in youth with T2D and associated with higher HbA1c. Higher serum aldosterone and urine AGT associated with albuminuria. The prognostic significance of the combined effect of glycemia and RAS activation on renal outcomes requires additional investigation.

Characteristics of vomiting as a predictor of intracranial injury in pediatric minor head injury.

OBJECTIVES: Vomiting is common in children after minor head injury. In previous research, isolated vomiting was not a significant predictor of intracranial injury after minor head injury; however, the significance of recurrent vomiting is unclear. This study aimed to determine the value of recurrent vomiting in predicting intracranial injury after pediatric minor head injury. METHODS: This secondary analysis of the CATCH2 prospective multicenter cohort study included participants (0-16 years) who presented to a pediatric emergency department (ED) within 24 hours of a minor head injury. ED physicians completed standardized clinical assessments. Recurrent vomiting was defined as ≥ four episodes. Intracranial injury was defined as acute intracranial injury on computed tomography scan. Predictors were examined using chi-squared tests and logistic regression models. RESULTS: A total of 855 (21.1%) of the 4,054 CATCH2 participants had recurrent vomiting, 197 (4.9%) had intracranial injury, and 23 (0.6%) required neurosurgical intervention. Children with recurrent vomiting were significantly more likely to have intracranial injury (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.7-3.1), and require neurosurgical intervention (OR, 3.5; 95% CI, 1.5-7.9). Recurrent vomiting remained a significant predictor of intracranial injury (OR, 2.8; 95% CI, 1.9-3.9) when controlling for other CATCH2 criteria. The probability of intracranial injury increased with number of vomiting episodes, especially when accompanied by other high-risk factors, including signs of a skull fracture, or irritability and Glasgow Coma Scale score < 15 at 2 hours postinjury. Timing of first vomiting episode, and age were not significant predictors. CONCLUSIONS: Recurrent vomiting (≥ four episodes) was a significant risk factor for intracranial injury in children after minor head injury. The probability of intracranial injury increased with the number of vomiting episodes and if accompanied by other high-risk factors, such as signs of a skull fracture or altered level of consciousness.