Effects of the 1997–1998 El Ni?o Episode on Community Rates of Diarrhea

Objectives. To improve our understanding of climate variability and diarrheal disease at the community level and inform predictions for future climate change scenarios, we examined whether the El Niño climate pattern is associated with increased rates of diarrhea among Peruvian children.Methods. We analyzed daily surveillance data for 367 children aged 0 to 12 years from 2 cohorts in a peri-urban shantytown in Lima, Peru, 1995 through 1998. We stratified diarrheal incidence by 6-month age categories, season, and El Niño, and modeled between-subject heterogeneity with random effects Poisson models.Results. Spring diarrheal incidence increased by 55% during El Niño compared with before El Niño. This increase was most acute among children older than 60 months, for whom the risk of a diarrheal episode during the El Niño spring was nearly 100% greater (relative risk = 1.96; 95% confidence interval = 1.24, 3.09).Conclusions. El Niño–associated climate variability affects community rates of diarrhea, particularly during the cooler seasons and among older children. Public health officials should develop preventive strategies for future El Niño episodes to mitigate the increased risk of diarrheal disease in vulnerable communities.The effect of weather on disease transmission is well recognized for many infectious diseases that exhibit seasonal patterns,1 including diarrhea,2,3 respiratory infections,4 malaria,5 and dengue.6 There is growing concern that severe weather changes resulting from El Niño episodes and global climate change directly affect human health.7 Diarrheal illnesses are among the highest disease burdens in children younger than 5 years of age worldwide8 and are predicted to increase with climate change. However, specific estimates for the magnitude of this increase in the community setting remain uncertain, in part because epidemiological data on the relationship between community rates of diarrhea and extreme weather variability are scarce.9 Although the relationship between specific weather variables and infectious disease has been examined extensively with retrospective, hospital-based data,10–14 data from prospective population-based cohort studies are limited. Determining the effects of El Niño on rates of diarrhea with a cohort study would greatly improve our understanding of climate variability and diarrheal disease at the community level and inform predictions for other extreme weather episodes or future climate change scenarios.15The El Niño southern oscillation (ENSO) is a main driver of global interannual weather variation. Occurring every 3 to 7 years, the ENSO phenomenon leads to extreme worldwide weather events, such as heavy flooding and drought.16 The ENSO provides health researchers with an opportunity to model effects of local climate anomalies on infectious disease dynamics,17 and it has been linked to changes in rates of cholera,18–21 diarrhea,11,22,23 malaria,10 dengue,24 hantavirus,25 viral pneumonia,26 and Rift Valley fever.27The 1997–1998 El Niño episode altered weather conditions around the world—particularly severely along the Peruvian coastline. This El Niño episode has been described as the strongest yet recorded.28 Previously, we found that the number of pediatric hospital admissions for diarrheal diseases in Lima, Peru, increased substantially during this episode, especially during the winter months.11 A separate study found similar results for adults.22 In this study, we sought to examine the effects of the 1997–1998 El Niño episode on rates of childhood diarrhea and several parasitic agents in a peri-urban Peruvian community with cohort studies conducted between June 1995 and August 1998.     

Do Older Rural and Urban Veterans Experience Different Rates of Unplanned Readmission to VA and Non‐VA Hospitals?

ABSTRACT:  Context: Unplanned readmission within 30 days of discharge is an indicator of hospital quality. Purpose: We wanted to determine whether older rural veterans who were enrolled in the VA had different rates of unplanned readmission to VA or non-VA hospitals than their urban counterparts. Methods: We used the combined VA/Medicare dataset to examine 3,513,912 hospital admissions for older veterans that occurred in VA or non-VA hospitals between 1997 and 2004. We calculated 30-day readmission rates and odds ratios for rural and urban veterans, and we performed a logistic regression analysis to determine whether living in a rural setting or initially using the VA for hospitalization were independent risk factors for unplanned 30-day readmission, after adjusting for age, sex, length of stay of the index admission, and morbidity. Findings: Overall, rural veterans had slightly higher 30-day readmission rates than their urban counterparts (17.96% vs 17.86%; OR 1.006, 95% CI: 1.0004, 1.013). For both rural- and urban-dwelling veterans, readmission after using a VA hospital was more common than after using a non-VA hospital (20.7% vs 16.8% for rural veterans, 21.2% vs 16.1% for urban veterans). After adjusting for other variables, readmission was more likely for rural veterans and following admission to a VA hospital. Conclusions: Our findings suggest that VA should consider using the unplanned readmission rate as a performance metric, using the non-VA experience of veterans as a performance benchmark, and helping rural veterans select higher performing non-VA hospitals.     

Effects of l-Carnitine Supplementation on Serum Inflammatory Factors and Matrix Metalloproteinase Enzymes in Females with Knee Osteoarthritis: A Randomized,Double-Blind,Placebo-Controlled Pilot Study

Objective: Considering the importance of inflammation in the pathogenesis of osteoarthritis (OA) and induction of pain, this study was aimed to investigate the effect of L-carnitine supplementation on serum inflammatory mediators and OA-associated pain in females with knee OA.

Methods: In this clinical trial, 72 females with mild to moderate knee osteoarthritis started the study, divided into 2 groups to receive 750 mg/day L-carnitine (n = 36) or placebo (n = 36) for 8 weeks. Serum levels of Interleukine-1β (IL-1β), high-sensitivity C-reactive protein (hs-CRP), matrix metalloproteinases (MMPs)-1 and -13, and visual analog scale (VAS) for pain were assessed before and after supplementation. Data were analyzed by t test, Wilcoxon signed rank test, Mann-Whitney U test, and analysis of covariance.

Results: Only 69 patients (33 in the L-carnitine group and 36 in the placebo group) completed the study. L-Carnitine supplementation decreased serum IL-1β and MMP-1 levels significantly (p = 0.001 and p = 0.021, respectively); however, serum hs-CRP and MMP-13 levels did not change significantly (p > 0.05). In the placebo group, serum IL-1β levels increased significantly (p = 0.011), whereas other studied biomarkers did not change significantly. The mean VAS score decreased significantly in the L-carnitine and placebo groups by 52.67% and 21.82%, respectively (p < 0.001). Significant differences were only observed between the 2 groups in serum IL-1β (p < 0.001) and MMP-1 (p = 0.006) levels and mean VAS score (p = 0.002) after adjusting for baseline values and covariates.

Conclusion: Despite observed beneficial effects of short-term supplementation of L-carnitine in decreasing serum inflammatory mediators and improving pain in knee OA patients, further studies are needed to achieve concise conclusions.     

Effects of item and rater characteristics on checklist recording: what should we look for?

OBJECTIVE: Examinations based on using standardised patients (SPs) commonly use checklist recordings to evaluate students' clinical performance. This paper examines whether and to what extent item and rater characteristics affect the reliability of history checklist recording in an SP-based assessment. METHODS: Checklist items were reviewed for the presence or absence of 5 item characteristics and a 2-point versus 3-point scoring scale. Agreement between checklist recordings obtained from SPs and clinician-examiners (CEs) were compared by item characteristics, scoring scale and CEs' level of involvement in the assessment. RESULTS: Based on 3179 pairs of recordings, the overall percentage of agreement between SPs and CEs was 83% (kappa = 0.64). Agreement was significantly higher for items scored on a 2-point than on a 3-point scale, and when the CE was also the author and the trainer of the station. After controlling for other factors, item characteristics were only marginally associated with level of interrater agreement. CONCLUSIONS: This study suggests that attention should be paid to specific aspects of checklist development and checklist recording training when an SP or CE is used as recorder.     

The Impact of Sexual Satisfaction,Functioning, and Perceived Contraceptive Effects on Sex Life on IUD and Implant Continuation at 1 Year

Introduction

Contraceptives improve women's lives and public health, but many women discontinue their contraceptive method owing to dissatisfaction. An underexamined aspect of contraceptive discontinuation is sexual acceptability, or how contraception affects sexual experiences. Investigators' aims were two-fold: 1) to document changes in multiple domains of women's sexual experiences with their intrauterine device (IUD) or contraceptive implant over time and 2) to examine whether these sexuality factors were associated with method continuation at 12 months.

Effects of Prenatal Alcohol and Pair Feeding on Lipopolysaccharide-Induced Secretion of TNF-α and Corticosterone

Fetal alcohol exposure (FAE) produces profound alterations in immunological and neuroendocrine functions. The present study examined the effects of FAE on the secretion of tumor necrosis factor (TNF-α) and corticosterone following administration of lipopolysaccharide (LPS) in normal (N) adult rats, in adult offspring of dams fed a liquid diet supplemented with ethanol (E), and in pair-fed control offspring (P). LPS-induced TNF-α secretion was not affected by either gender or prenatal treatment. In contrast, LPS-induced corticosterone secretion was significantly greater in female than in male rats, and at 60-min post-LPS was significantly higher in E and P, compared to N females. Ovariectomy significantly inhibited LPS-induced TNF-α secretion in E, but not in P and N, rats and chronic replacement with 17-β-estradiol markedly inhibited TNF-α secretion in ovariectomized E and N, but not in P, rats. In contrast, ovariectomy reduced the effects of LPS on corticosterone secretion in all groups, and chronic replacement with 17-β-estradiol reversed this effect. These findings indicate that LPS-induced secretion of corticosterone, but not TNF-α, is affected by prenatal manipulations and by gender. In addition, alterations in the hormonal environment in females modulate LPS-induced corticosterone secretion in all prenatal treatment groups, but differentially influence TNF-α secretion in rats exposed to alcohol, restricted feeding, or normal diets in utero.     

Is Longer Waiting Time for Total Knee Replacement Associated with Health Outcomes and Medication Costs? Randomized Clinical Trial

BackgroundThe aim of this prospective randomized study was to evaluate the effect of waiting time (WT) on health-related quality of life (HRQoL), knee pain and physical function, and the use and costs of medication of patients awaiting total knee replacement.MethodsWhen placed on the waiting list, 438 patients were randomized into a short waiting time (SWT ≤ 3 months) or a nonfixed waiting time (NFWT > 3 months) group. HRQoL was measured by the 15D, and pain and physical function by modified Knee Society Clinical Rating System at baseline, admission, and 3 and 12 months postoperatively. The costs of medication due to osteoarthritis were calculated at the same measurement points. All analyses were performed using the intention-to-treat principle.ResultsThe mean WT was 94 and 239 days in the SWT and NFWT groups, respectively. Apart from higher weekly cost of medication in the SWT group at admission and better HRQoL in the NFWT group 1 year postoperatively, there were no statistically significant differences between the groups in other outcomes during the follow-up.ConclusionThose in the SWT group had higher weekly costs of medication at admission, and reached better HRQoL 3 months earlier than those in the NFWT group, but the latter had better HRQoL after operation. Otherwise, the length of WT was not associated with different health and HRQoL outcomes in the groups.     

Effects of Sublethal Chronic Copper Exposure on the Growth and Reproductive Success of the Florida Apple Snail (Pomacea paludosa)

Florida apple snails (Pomacea paludosa) were exposed to three concentrations of copper (Cu), in water (8 μg/L, 16 μg/L, 24 μg/L), for one generation to examine uptake and the effects on survival, growth, and reproduction of the F₀ generation and survival, growth, and whole body Cu of the F₁ generation. During a 9-month Cu exposure, apple snails exposed to 8–16 μg/L Cu had high Cu accumulation (whole body, foot, viscera, and shell) and significantly reduced clutch production (8–16 μg/L) and egg hatching (16 μg/L). Apple snails exposed to the 24 μg/L Cu had low survival and the treatment was therefore terminated. Concentrations of minerals (Na⁺, K⁺, Mg²⁺, Ca²⁺) in tissues were maintained regardless of Cu exposure, but the distribution of Cu in the body of snails differed, depending on exposure concentrations. Higher exposure concentrations resulted in a greater percentage of Cu accumulated in the viscera of the snail. Copper exposure to the F₀ generation did not affect the survival, growth, or whole body Cu concentrations in the F₁ generation. These finding are significant, given the importance of the Florida apple snail in the Everglades food chain. Changes in the abundance of apple snail populations, as a result of Cu exposure, could ultimately affect foraging success of predators.     

The Cost and Outcome Effectiveness of Total Hip Replacement: Technique Choice and Volume–Output Effects Matter

Background

Total hip replacement (THR) must be managed in a more sustainable manner. More cost-effective surgical techniques and the centralization/regionalization of services are two solutions. The former requires an assessment of newer minimally invasive and muscle-sparing surgical techniques. The latter necessitates an effective volume–outcome (VO) relationship. Prior studies have failed to evaluate and control for the VO relation.

Objective

The objective of this study was to evaluate the relative cost and outcome effectiveness of two minimally invasive and one muscle-sparing techniques while evaluating and controlling for a potentially endogenous VO relation.

Methods

An all payer claims database for all THR performed in Maine in 2011 was used. The cost and outcome effectiveness of newer minimally invasive (modified Hardinge) and muscle-sparing (modified Watson-Jones) techniques were compared with the standard bearer posterior minimally invasive method. Using regression analysis, the outcomes analyzed were as follows: total costs, length of hospital stay, nursing care and home discharges, and use of physical therapy. Regression analysis was also used to evaluate and control for VO effects.

Results

(1) Newer muscle-sparing and minimally invasive approaches are substantially more effective; (2) irrespective of technique, higher volume surgeons are more effective; (3) technique-specific VO effects for more complex techniques exist and show substantial savings when yearly volume exceeds 30–50; and (4) the anterolateral muscle-sparing technique is accessible to the average surgeon.

Conclusion

Reliance on newer surgical techniques and centralization/regionalization of THR services can reduce costs.

     

The Effects of News Coverage of Epidemics on Public Support for and Compliance with the CDC– An Experimental Study

Content analysis identified three dominant themes used by the news media to cover epidemics: the scientific, the pandemic, and the social. This study uses a randomized experimental design to test the effects of common news coverage patterns of epidemics on perceptions of efficacy, certainty, and trust in the CDC, and subsequently on intentions to comply with and support for the CDC during public health crises. The experiment also compares the effects of real-world coverage to that of hypothetical coverage that more closely follows the CDC’s recommendations for crisis communication. The results of the experiment (n = 321) demonstrate that exposure to articles from different themes affects perceptions of certainty and self-efficacy, that in turn affect intentions to comply with the CDC. Although organizational-efficacy and trust in the CDC are both correlated with intentions to support, and trust is also correlated with intentions to comply, exposure to different conditions did not affect these perceptions and there was no indirect effect from exposure to intentions. The results reveal the potential effects of real-world coverage on perceptions and intentions, and demonstrate the advantage of the hypothetical coverage that follows the CDC’s crisis communication guidelines. Implications for public health organizations and communicators are discussed.     

Effects of Combined Physical and Cognitive Exercises on Cognition and Mobility in Patients With Mild Cognitive Impairment: A Randomized Clinical Trial

Importance

Although participation in physical and cognitive activities is encouraged to reduce the risk of dementia, the preventive efficacy of these activities for patients with mild cognitive impairment is unestablished.

The Cascading Effects of Multiple Dimensions of Implementation on Program Outcomes: a Test of a Theoretical Model

This study tests a theoretical cascade model in which multiple dimensions of facilitator delivery predict indicators of participant responsiveness, which in turn lead to improvements in targeted program outcomes. An effectiveness trial of the 10-session New Beginnings Program for divorcing families was implemented in partnership with four county-level family courts. This study included 366 families assigned to the intervention condition who attended at least one session. Independent observers provided ratings of program delivery (i.e., fidelity to the curriculum and process quality). Facilitators reported on parent attendance and parents’ competence in home practice of program skills. At pretest and posttest, children reported on parenting and parents reported child mental health. We hypothesized effects of quality on attendance, fidelity and attendance on home practice, and home practice on improvements in parenting and child mental health. Structural Equation Modeling with mediation and moderation analyses were used to test these associations. Results indicated quality was significantly associated with attendance, and attendance moderated the effect of fidelity on home practice. Home practice was a significant mediator of the links between fidelity and improvements in parent-child relationship quality and child externalizing and internalizing problems. Findings provide support for fidelity to the curriculum, process quality, attendance, and home practice as valid predictors of program outcomes for mothers and fathers. Future directions for assessing implementation in community settings are discussed.     

Effects of Olive Oil on Markers of Inflammation and Endothelial Function—A Systematic Review and Meta-Analysis

The aim of the present systematic review was to synthesize data from randomized controlled trials investigating the effects of olive oil on markers of inflammation or endothelial function. Literature search in electronic databases Cochrane Trial Register, EMBASE, and MEDLINE was performed. Thirty studies enrolling 3106 participants fulfilled the selection criteria. Pooled effects of different interventions were assessed as mean difference using a random effects model. Olive oil interventions (with daily consumption ranging approximately between 1 mg and 50 mg) resulted in a significantly more pronounced decrease in C-reactive protein (mean difference: −0.64 mg/L, (95% confidence interval (CI) −0.96 to −0.31), p < 0.0001, n = 15 trials) and interleukin-6 (mean difference: −0.29 (95% CI −0.7 to −0.02), p < 0.04, n = 7 trials) as compared to controls, respectively. Values of flow-mediated dilatation (given as absolute percentage) were significantly more increased in individuals subjected to olive oil interventions (mean difference: 0.76% (95% CI 0.27 to 1.24), p < 0.002, n = 8 trials). These results provide evidence that olive oil might exert beneficial effects on endothelial function as well as markers of inflammation and endothelial function, thus representing a key ingredient contributing to the cardiovascular-protective effects of a Mediterranean diet. However, due to the heterogeneous study designs (e.g., olive oil given as a supplement or as part of dietary pattern, variations in control diets), a conservative interpretation of the results is necessary.     

Effects of flavonoids on α-glucosidase activity: potential targets for glucose homeostasis

ObjectiveFlavonoids are naturally occurring compounds widely distributed in plants, which have hypoglycemic potential and have been described as glucosidase inhibitors. This study evaluated the effect of flavonoids on intestinal glucosidase activity after in vivo and in vitro treatment.MethodsFor the in vivo studies animals received quercetin by gavage and for the in vitro assays a segment of the small intestine was used. To obtain the oral glucose tolerance curve fasted normal rats were loaded with glucose plus flavonoids. The glycemia was measured by the glucose oxidase method.ResultsQuercetin reduced the effect of sucrase and maltase in the in vivo and in vitro treatments. It was observed in the in vitro studies that the maximum inhibitory effect of kaempferitrin was around 23% for maltase activity. Also, for the sucrose substrate the specific enzyme activity was significantly decreased. Aglycone, flavonoids, and kaempferol decreased significantly the maltase activity at all concentrations assayed. Finally, rutin reduced maltase-specific activity at all concentrations studied. According to the oral glucose tolerance curve, rutin reduced the serum glucose levels at 15, 30, and 60 min when administered by oral gavage 30 min before glucose overload in rats.ConclusionBased on these results, we can conclude that disaccharidases are targets of flavonoids in the regulation of glucose absorption and consequently glucose homeostasis.     

Prevalence and reasons for delaying and foregoing necessary care by the presence and type of disability among working-age adults

Background

While it is commonly accepted that disparities in unmet need for care vary by age, race/ethnicity, income, education, and access to care, literature documenting unmet needs experienced by adults with different types of disabilities is developing.

Effects of β-endosulfan on the growth and reproduction of zebrafish (Danio rerio)

Because of persistent organic pollution in aquatic environments, the widely used organochlorine pesticide endosulfan, which is a potential endocrine disruptor, is expected to pose a significant risk to aquatic organisms. In the present study, we explored the potential endocrine-disrupting risk of β-endosulfan by investigating its effect on the growth, reproduction, plasma vitellogenin, and organ histology of adult zebrafish. We found that, although β-endosulfan did not significantly affect the growth of zebrafish, it greatly decreased the hatching rate, even at a concentration as low as 10 ng/L. Interestingly, the decrease of the hatching rate was highly correlated with pathological alterations of the testes. Additionally, the values of the gonadosomatic index were significantly reduced in female zebrafish treated with 200 ng/L β-endosulfan, which was also closely associated with ovarian histological changes. More importantly, a significant increase in the level of vitellogenin was observed in all male fish treated with β-endosulfan. Based on these findings, we conclude that β-endosulfan severely affects the reproductive function of zebrafish and the synthesis of vitellogenin in the liver, and thus, β-endosulfan has a serious endocrine disruption function in zebrafish.     

Evaluation of Communities That Care—Effects on Municipal Youth Crime Rates in Victoria,Australia: 2010–2019

Prevention Science - Internationally, youth crime is a significant social problem. Violent youth crime has been rising over the past decade in the state of Victoria, Australia. Communities That...     

Do Tobacco and Alcohol Modify Protective Effects of Diet on Oral Carcinogenesis?

Recent systematic reviews concluded that the frequent consumption of fruits and vegetables is inversely associated with the risk of oral cancer. We assessed this association, specifically comparing results obtained to nonsmokers and smokers, as well to nondrinkers and drinkers. We conducted a case-control study involving 296 patients with oral squamous cell carcinoma (cases) attended in 3 major hospitals of São Paulo, Brazil, paired with 296 controls, recruited from outpatient units of the same hospitals. Multivariate models assessed the effect of fruits and salads according to smoking and drinking. The intake of fruit was associated with the prevention of the disease in the specific assessment among light [odds ratio (OR) = 0.46; 95% confidence interval (CI) = 0.27–0.78) and heavy (OR = 0.30; 95% CI = 0.14–0.65) smokers. The same was observed for vegetables consumption. For nonsmokers, no fruit (OR = 50; 95% CI = 0.22–1.12) or vegetable (for tomato, OR = 0.53; 95% CI = 0.31–0.93) was associated with reduced risk of oral and oropharyngeal cancer. Similar results were found in the stratified analysis according to drinking status with OR = 0.51 (95% CI = 0.30–0.87) and 0.18 for fruits (95% CI = 0.07–0.45), respectively, for light and heavy drinkers. This observation suggests that the protective effect of fruit and salad intake may modulate the deleterious effects from tobacco and alcohol.     

Comparing the Effects of Grief and Burden on Caregiver Depression in Dementia Caregiving: A Longitudinal Path Analysis over 2.5 Years

ObjectivesCaregivers of persons with dementia can experience loss and grief long before the death of the person. Although the phenomenon of caregiver grief has been increasingly described, it is uncertain if caregiver grief has independent effects—separate from the well-studied construct of caregiver burden—on adverse outcomes such as caregiver depression. We sought to compare the effects of baseline grief and burden on caregiver depression at baseline and 2.5 years later.Design and SettingA cohort study with 2.5 years of follow-up.ParticipantsFamily caregivers of community-dwelling persons with dementia (n = 183).MeasuresParticipants completed questionnaires with scales that assessed caregiver grief, burden, and depression. Baseline grief and burden scores were included in a path analysis to predict depression at baseline and at 2.5 years.ResultsAt baseline, grief and burden had synergistic relationships with each other (P = .012), where the high levels of grief amplified the effect of burden on caregiver depression. Both grief and burden had longitudinal effects on caregiver depression at 2.5 years (P <.001 and P = .047, respectively), albeit with some differences in mechanism; both had effects which were indirectly mediated through baseline depression (P < .001 and P = .002, respectively), but only grief had a direct path toward depression at 2.5 years (P = .030), which was distinct from baseline depression.Conclusions and ImplicationsThe findings highlight the need to identify and address caregiver grief in dementia services. They present a window of opportunity to improve caregiving outcomes, especially during the “latent phase” when caregivers encounter loss and grief but have yet to fully experience the debilitating effects of depression.