Harnessing Behavioral Economics Principles to Promote Better Surgeon Accountability for Operating Room Cost: A Prospective Study

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Adverse childhood experiences,inflammation, and depressive symptoms in later life: a prospective cohort study

BackgroundExposure to adverse childhood experiences (ACEs) has been associated with both inflammation and depression. However, little research has examined the potential mediational role of inflammation in the link between ACEs and depression using longitudinal data. Therefore, we investigated the direct and indirect effects of ACEs on inflammation, depression, and their change trajectories over time.MethodsWe used data from the English Longitudinal Study of Ageing. Four ACE categories were assessed retrospectively at wave 3 (2006–07): abuse (physical or sexual abuse or physical assault), family dysfunction (parent arguments, parent mental illness or substance abuse, or parent separation or divorce), poor parent–child bonding (maternal or paternal), and loss of an attachment figure (separation from mother for >6 months, parent death, foster care or adoption, or institutionalisation). A cumulative ACE score was calculated representing the total number of ACEs experienced by the participants. Concentration of C-reactive protein (CRP), an inflammatory marker, was measured at waves 2 (2004–05), 4 (2008–09), and 6 (2012–13). Depressive symptoms were ascertained using the 8-item Centre for Epidemiological Studies Depression Scale from waves 6 to 8 (2016–17). The longitudinal direct and indirect effects of ACEs were estimated using parallel process latent growth curve modelling. All analyses were adjusted for relevant confounders. Missing data were estimated using multiple imputation.ResultsAmong the study sample (N=4382; mean age 70 years; 56% female), 24% of participants reported one ACE and 13% had two or three ACEs. The percentage of participants with three or more depressive symptoms was 21% at baseline. Greater cumulative exposure to ACEs was associated with increased CRP concentration (β=0·042, p=0·010) and depressive symptoms (β=0·164, p<0·0001) at baseline and predicted a steeper increase in these outcomes throughout the study (β_CRP=0·074, p=0·011; β_Depression=0·338, p<0·0001). However, indirect effects of ACEs on depression mediated by CRP were not observed, with only weak associations between CRP and depressive symptoms (β_iDepression=0·032, p=0·173; β_sDepression=0·067, p=0·240). Sensitivity analyses using only somatic depressive symptoms as the outcome revealed a positive association between CRP and somatic symptoms at baseline (β_iDepression=0·068, p=0·008), although the indirect effects remained non-significant in this model.InterpretationBiological mechanisms other than inflammation might underlie the relationship between ACEs and depression. Psychosocial interventions to reduce the negative effects of ACEs on children's development could help to reduce the risk of depression and of other medical conditions linked to inflammation.FundingEconomic and Social Research Council–Biotechnology and Biological Sciences Research Council Soc-B Centre for Doctoral Training (ES/P000347/1).     

Correlates of cigarette and alternative tobacco product use among young tobacco users experiencing homelessness

IntroductionMost young people experiencing homelessness smoke cigarettes, but little is known about use of alternative tobacco products (ATPs) such as e-cigarettes or other electronic nicotine delivery systems (ENDS) and little cigars/cigarillos (LCCs). This study examines past month use and correlates of cigarettes and ATP among young tobacco users experiencing homelessness.MethodsWe surveyed a probability sample of N = 469 unaccompanied homeless 13–25 year olds (mean age = 22; 71% male), who reported past month use of any type of tobacco product, from 25 service and street sites in Los Angeles County.ResultsNearly all (90%) participants reported smoking regular cigarettes, and 78% reported using at least one tobacco product other than regular cigarettes. The most commonly used of these other products was natural cigarettes (55%), followed by LCCs (43%), ENDS (34%), cigars (31%), hookah (14%), chewing tobacco (7%), and snus (5%). Multivariable models indicated that correlates of past month use differed by product, but included sociodemographic characteristics, homelessness severity, depression, exposure to other people who used the product, and product perceptions (e.g., relative access, cost, and harm compared to cigarettes).ConclusionUse of cigarettes and ATPs are both widespread among young homeless tobacco users, suggesting that efforts to reduce tobacco use in this population should have a broad focus that includes a variety of products. The effectiveness of these efforts may be enhanced by addressing their considerable exposure to other tobacco users, as well as their perceptions of certain products as being less harmful or more cost-effective options than regular cigarettes.     

A peripherally inserted central catheter misplacement into lateral thoracic vein: A case report

IntroductionCentral venous catheter applications and complications are closely related to the tip position. Previous studies have reported some rare cases of catheter misplacement. Here, we report a case of misplacement of a peripherally inserted central catheter into the lateral thoracic vein.Case reportA 56-year-old cancer patient underwent placement of a peripherally inserted central catheter through the left basilic vein under ultrasound-guided puncture. The catheterisation procedure was uneventful, so the catheter was believed to be in the superior vena cava. However, the post-anterior chest X-ray image revealed that after the catheter advanced towards the axilla, it turned downwards and outwards in the direction of the left lateral thoracic region, with the projection of the catheter tip giving the appearance of termination in the subcutaneous tissue of the lateral thoracic wall on the two-dimensional image. The catheter was then repositioned in the distal superior vena cava.DiscussionPeripherally inserted central catheters can be potentially misplaced into the lateral thoracic vein because these catheters can pass through the orifice of the lateral thoracic vein which flows into the axillary vein. Some pathological cases and clinical conditions can cause dilatation of the lateral thoracic vein, which increases the probability of catheter misplacement. Three principles were proposed to avoid this rare complication: a comprehensive review of the patients’ medical history, real-time image-guided catheterisation and routine radiographic identification of the tip position.     

Non alcoholic fatty liver disease and risk of incident diabetes in subjects who are not obese

Background and aims

It is not known whether non alcoholic fatty liver disease (NAFLD) is a risk factor for diabetes in non obese, non centrally-obese subjects. Our aim was to investigate relationships between fatty liver, insulin resistance and a biomarker score for liver fibrosis with incident diabetes at follow up, in subjects who were neither obese nor centrally-obese.

Effect of acupressure at Sanyinjiao on albuminuria in patients with early diabetic nephropathy: A single-blind,randomized, controlled preliminary study

BackgroundElevated urinary albumin excretion is a clinical manifestation of early-stage diabetic nephropathy (DN).PurposeTo investigate effect of acupressure at Sanyinjiao on albuminuria in patients with early DN.MethodsTotal included 53 patients with DN and albuminuria; 21 were assigned to the sham group without acupressure, and 32 were assigned to the experimental group with acupressure at Sanyinjiao (SP6) for 8weeks. The experimental group was divided into experiment A (acupressure <45 days) and experiment B (acupressure ≥45 days). The primary outcome measure was the urine albuminuria/creatinine ratio (UACR) or logarithmic transformed urine microalbumin creatinine ratio (log-UACR) changes, and the secondary outcome measures were the estimated glomerular filtration rate and hemoglobin A1c.ResultsThe difference in UACR and log-UACR before and after the study was higher in the experiment B group than in the experiment A and sham groups.ConclusionAcupressure at Sanyinjiao for 8 weeks may reduce albuminuria in patients with DN. However, this study was a preliminary design.