Key Social Determinants to Narrow the Gap between Health-adjusted Life Expectancy and Life Expectancy in Megacities

ObjectiveImprovement in the quality of life is reflected in the narrowing of the gap between health-adjusted life expectancy (HALE) and life expectancy (LE). The effect of megacity expansion on narrowing the gap is rarely reported. This study aimed to disclose this potential relationship.MethodsAnnual life tables were constructed from identified death records and population counts from multiple administrative sources in Guangzhou, China, from 2010 to 2020. Joinpoint regression was used to evaluate the temporal trend. Generalized principal component analysis and multilevel models were applied to examine the county-level association between the gap and social determinants.ResultsAlthough LE and HALE in megacities are increasing steadily, their gap is widening. Socio-economic and health services are guaranteed to narrow this gap. Increasing personal wealth, a growing number of newborns and healthy immigrants, high urbanization, and healthy aging have helped in narrowing this gap.ConclusionIn megacities, parallel LE and HALE growth should be highly considered to narrow their gap. Multiple social determinants need to be integrated as a whole to formulate public health plans.     

Examining the temporality of vitamin E acetate in illicit THC-containing e-cigarette,or vaping,products from a public health and law enforcement response to EVALI — Utah, 2018-2020

BackgroundIn the summer of 2019, e-cigarette, or vaping, product use-associated lung injury (EVALI) was detected in the United States. Multiple agencies reported illicit tetrahydrocannabinol (THC)-containing e-cigarette, or vaping, products containing vitamin E acetate (VEA) as a substance of concern.MethodsAs an expansion of the Utah Department of Health's response to EVALI, the Utah Public Health Laboratory and the Utah Department of Public Safety screened 170 products from 96 seizures between October 2018 and January 2020. Using Pearson's correlation coefficient, we analyzed the temporal correlation of national, and Utah specific case counts, and the percentage of seizures indicating VEA by month.ResultsThe findings indicate strong and significant correlations between seizures indicating VEA and both the national (r = 0.70, p = 0.002) and Utah specific (r = 0.78, p < 0.001) case counts.ConclusionThese findings underscore that VEA should not be added to e-cigarettes, or vaping, products and the importance of collaboration with law enforcement when responding to outbreaks associated with illicit substances.     

Parental perceptions,attitudes and acceptance of childhood immunization in Saudi Arabia: A cross sectional study

ObjectivesThe widespread availability and use of vaccines have tremendously reduced morbidity, mortality and health care costs associated with infectious diseases. However, parental beliefs about vaccination are one of the major factors in achieving high vaccination rates. Thus, this study aims to assess the perceptions and attitudes regarding routine childhood immunization among Saudi parents.MethodsA cross sectional study with a pre-tested 18-item questionnaire was conducted using 467 randomly selected parents from the Hail region of Saudi Arabia in the period between February 1st, 2016, and February 1st, 2017. The validated questionnaire consisted of three sections that collected information on participants’ demographics, parents’ awareness of vaccine benefits, and parents’ practices regarding the immunization of their children.ResultsFemale and male parents comprised 54.5% (255) and 45.5% (212) of the sample, respectively, and the response and completion rates were 97%. The majority of the respondents had received a formal education (94.1%, 439), were gainfully employed (62.9%, 294) and had a regular monthly income (73.3%). The majority of the respondents were aware of childhood vaccinations (78.9%), completed vaccinations mandated for children up to 5 years (86.2%), encouraged other parents to do so (89.9%), and had easy access to vaccines (90.5%). Sixty to ninety percent of the respondents were knowledgeable regarding the health benefits of vaccinations in children, even though 18.4% of their children had experienced vaccination-related minor adverse effects during or after vaccination of which 23.2% required doctor's visits. Health care professionals were the most frequent source of parents’ vaccine-related information (65.2%), and vaccination reminder services provided by the Ministry of Health (MOH) via mobile phones were cited by 57.5% of respondents.ConclusionsConfidence in and acceptance of childhood vaccinations, perceptions of vaccine-related health benefits and ease of access to immunizations appeared to be quite good among Saudi parents.     

现场调查中零频数过多的统计分析方法

目的:研究零过多计数资料的分布拟合方法并应用于急性上呼吸道感染调查资料.方法:将数据分为两部分,一部分为零部分,另一部分为Poisson分布部分,然后通过转换,形成条件零堆积模型(ZTP),运用logit和log两种连接函数进行拟合.结果:在ZTP部分表示,低年龄和住在低层的发病次数多;logit部分显示年龄小、有锻炼习惯者、健康状况差和有慢性呼吸系统疾病史的人易发病.结论:转换后的零过多模型可以更好地对影响因素进行解释.     

多种危险因素疾病中各因素发病贡献值的测量方法研究

目的为了评价某一危险因素对个体发病所起的作用，并在多因素暴露情况下比较各个因素对发病的影响大小。方法运用贝叶斯公式，依据相关流行病学理论，建立由相对危险度数值等来测算单个危险因素对个体发病贡献权重的方法。结果建立的方法可以用来比较各个危险因素在个体发病中的贡献大小。结论该测算方法简单方便，结合人群研究及Meta分析结果，能够为疾病的病因学研究和临床决策提供一定依据。     

胚胎干细胞梗死区中心和周边移植治疗急性心肌梗死

背景: 现有治疗手段不足以补充梗死心肌,研究表明干细胞移植有可能促使心肌和血管再生,改善心功能和预后。 目的：观察急性心肌梗死区中心和周边移植胚胎干细胞后心肌组织形态学及血液动力学的变化。 设计、时间及地点：随机对照动物观察,于2007-03/2008-10在中南大学湘雅医学院人体解剖学与神经生物学系神经生物学实验室完成。 材料：SPF级Wistar大鼠40只,随机分为4组：正常对照组、梗死模型组、中心移植组、周边移植组,10只/组。胚胎干细胞-D3株(embryonic stem cells-D3, ES-D3)、布法罗大鼠肝细胞均由中国科学院上海细胞所提供。 方法：ES-D3细胞复苏后,以(2.0~5.0)× 107 L-1种植于培养瓶中,加入含布法罗大鼠肝细胞的条件培养基体外培养分化。除正常对照组外,余3组结扎冠状动脉左前降支建立急性心肌梗死模型。造模后1周接受细胞移植,ES-D3细胞于移植前1 d进行BrdU标记,以胚胎干细胞培养基调整密度至1×109 L-1。中心移植组在梗死区选3个点,每点注入10 μL细胞悬液(含104个细胞)至心室壁内;周边移植组在梗死区周边选3个点同法注入等量细胞悬液。 主要观察指标：免疫组化及血流动力学指标检测结果。 结果：布法罗大鼠肝细胞条件培养基体外培养的ES-D3细胞,呈相对规则的巢状集落样生长,分化8 d即可见部分拟胚体出现自发的节律性收缩活动,心肌肌钙蛋白T免疫染色呈阳性,电镜下可见肌管、肌纤维等肌性结构,证实已分化为心肌细胞。周边移植组BrdU免疫荧光染色呈阳性,而中心移植组呈阴性,进一步对BrdU免疫荧光染色阳性细胞行双抗染色,可见心肌肌钙蛋白T呈阳性表达。移植后4周与正常对照组比较,梗死模型组左室收缩、dp/dtmax均减小(P < 0.01),左室舒张末期压上升(P < 0.01),左室质量、左室质量指数均升高(P < 0.01)。与梗死模型组比较,中心移植组各项血流动力学指标无明显变化(P > 0.05);周边移植组左室收缩压、±dp/dtmax均显著升高(P < 0.01),左室舒张末期压显著减小(P < 0.01),左室质量、左室质量指数、梗死面积均显著减小(P < 0.01)。 结论：急性心肌梗死后于梗死周边区移植胚胎干细胞可以阻止心室重构、减少瘢痕面积、改善心功能。     

Family history,waist circumference and risk of ischemic stroke: A prospective cohort study among Chinese adults

Background and aimsThe associations between genetic factors and waist circumference (WC) with stroke risk have been evaluated in Western studies. However, evidence of this association has rarely been reported in the Chinese population. This study aimed to evaluate the association between WC and family history of stroke (FHS) with ischemic stroke (IS) risk among Chinese adults and to further explore the potential interaction of these associations.Methods and resultsThe China Kadoorie Biobank (CKB) study recruited 35,508 participants aged 30–79 years from the Qingdao urban area during 2004–2008. A total of 33,355 participants were included in study. Cox regression analysis was used to estimate the multivariable-adjusted hazard ratios (HR) and 95% confidence intervals (CI) for the independent and interactional associations between FHS and WC and IS risk. Participants with FHS had a 29% (HR = 1.29, 95% CI: 1.12–1.50) higher IS risk than those without FHS. Participants with excessive WC (85 cm for males and 80 cm for females) had a 78% (HR = 1.78, 95% CI: 1.51–2.10) higher IS risk than those with normal WC. The combined effect of FHS and excessive WC on IS was statistically significant (HR = 2.29, 95% CI: 1.84–2.86). The present study further found statistically significant multiplicative interactions of FHS and WC with IS risk (P _interaction < 0.001).ConclusionThe present study indicated that FHS and WC were significantly associated with an increased risk of IS. The association between FHS and IS was associated with excessive WC.     

Motorcycle casualties sustained during daytona beach bike week 2000: lessons learned

Study objective: In March 2000, an estimated 500,000 people attended an annual motorcycle rally in Daytona Beach, FL, where approximately 64,000 residents live year-round. The media reported 15 deaths during this 10-day event. To more comprehensively assess the extent of trauma and need for emergency medical care, we investigated all motorcycle crashes, regardless of outcome. Methods: Motorcycle-related crash data from local medical examiner, hospital, emergency medical services (EMS), and police sources were linked. Frequencies of crashes, injuries, hospitalizations, and deaths were determined, and EMS use data were analyzed. Results: During Bike Week 2000, 570 people were involved in 281 motorcycle-related crashes. Two hundred thirty (40%) people were injured, of which 147 (64%) sought treatment in emergency departments, 72 (31%) were hospitalized, and 11 (5%) died. In crashes between motorcycles and passenger cars, individuals exposed as motorcycle occupants were 8.7 times more likely to be injured than car occupants (95% confidence limit 1.7, 15.7). Of 205 EMS dispatches for motorcycle-related crashes, two thirds resulted in transport to an ED. Data needed to assess known risk factors (eg, alcohol use, speed, lack of helmet use) were not routinely ascertained at either the crash site or ED. Conclusion: Although fatalities first called attention to the problem, nonfatal injuries outnumbered deaths 20:1. The manpower resources of civil service and health resources could become overwhelmed or exhausted in circumstances in which many people are injured or killed throughout a relatively long period. The situation deserves future study. Better risk factor surveillance is needed to help prevent crashes. [Ann Emerg Med. 2003;41:792-797.]     

Incidence and risks for surgical site infection after adult tibial plateau fractures treated by ORIF: a prospective multicentre study

Tibial plateau fractures are difficult to treat and more likely complicated by subsequent surgical site infection (SSI). There is limited information about its characteristics and related risk factors for SSI. This study was designed as a prospective and multicentre one to address this issue. From July to 15 November in 2014, 235 patients with tibial plateau fractures were treated by open reduction and internal fixation (ORIF) and followed up with complete data. Twelve patients (5·1%, 12/235) developed SSI, with 2·1% for deep SSI and 3·0% for superficial SSI. Most of them (10/12) occurred during the hospital stays. The median occurrence time was 6 days after operation (range, 2–26 days). We use univariate and multivariate logistic regression models to investigate the potential risk factors. In the univariate analysis, open fracture, prolonged preoperative stay, smoking habitus and preoperative abnormal neutrophil (NEUT) count were significant risk factors for SSI occurrence. However, in multivariate analysis, only open fracture (OR, 3·31; 95%, 1·06–1·84) and current smoking status (OR, 5·68; 95% CI, 1·56–20·66) remained significant. We recommend that smoking cessation programme is introduced at the time of admission to the hospital and elaborative evaluation of fracture severity and soft‐tissue damage is performed with an aim of reducing the risk of post‐operative SSI.     

One-Year Temporal Changes in Long COVID Prevalence and Characteristics: A Systematic Review and Meta-Analysis

ObjectivesThis study aimed to explore the 1-year temporal change in prevalence, variety, and potential risk factors of long COVID symptoms and to further predict the prognostic trends of long COVID.MethodsWe searched electronic databases for related studies published from January 2020 to February 2022 and conducted 1-group meta-analysis and locally weighted regression to explore the monthly temporal change in the prevalence of each long COVID symptom in 1-year follow-up period.ResultsA total of 137 studies were included in meta-analysis, including 134 093 participants. The temporal change of any long COVID symptom showed a steep decrease initially (from 92% at acute phase to 55% at 1-month follow-up), followed by stabilization at approximately 50% during 1-year follow-up. Six months or more after the acute phase, the odds ratio of population characteristic–related factors increased, such as female (from 1.62 to 1.82), whereas the odds ratio value of acute phase–related factors (severe or critical cases and hospitalization) decreased. As for specific symptoms, approximately two-thirds of the symptoms did not significantly reduce during the 1-year follow-up, and the neuropsychiatric symptoms showed a higher long-term prevalence (approximately 25%) and longer persistence than physical symptoms.ConclusionsThe temporal changes in the prevalence and characteristics speculate that long COVID may persist longer than expected. In particular, we should pay more attention to neuropsychiatric symptoms and other symptoms for which there is no significant downward trend in prevalence. The influence of acute phase–related factors for long COVID gradually decreases over time, whereas the influence of population characteristic–related factors gradually increases.