Insomnia with objective short sleep duration is associated with cognitive impairment: a first look at cardiometabolic contributors to brain health

Study ObjectivesInsomnia with objective short sleep duration has been previously associated with adverse cardiometabolic health outcomes as well as poorer cognitive performance in otherwise noncognitively impaired adults. However, studies demonstrating an increased prevalence of cognitive impairment (CI) in this insomnia phenotype are lacking.MethodsWe analyzed data from Penn State Adult Cohort (N = 1,524; 48.9 ± 13.4 years; 53.4% women). Self-reported sleep difficulty was defined as normal sleep (n = 899), poor sleep (n = 453), and chronic insomnia (n = 172). Objective short sleep duration was defined as less than 6-h of sleep, based on in-lab, 8-h polysomnography. CI (n = 155) and possible vascular cognitive impairment (pVCI, n = 122) were ascertained using a comprehensive neuropsychological battery. Analyses adjusted for age, sex, race, education, body mass index, apnea/hypopnea index, smoking, alcohol, psychoactive medication, and mental and physical health problems.ResultsParticipants who reported poor sleep or chronic insomnia and slept objectively less than 6 hours were associated with a 2-fold increased odds of CI (OR = 2.06, 95% confidence limits [CL] = 1.15–3.66 and OR = 2.18, 95% CL = 1.07–4.47, respectively) and of pVCI (OR = 1.94, 95% CL = 1.01–3.75 and OR = 2.33, 95% CL = 1.07–5.06, respectively). Participants who reported poor sleep or chronic insomnia and slept objectively more than 6 hours were not associated with increased odds of either CI (OR = 0.72, 95% CL = 0.30–1.76 and OR = 0.75, 95% CL = 0.21–2.71, respectively) or pVCI (OR = 1.08, 95% CL = 0.42–2.74 and OR = 0.76, 95% CL = 0.16–3.57, respectively).ConclusionsInsomnia with objective short sleep duration is associated with an increased prevalence of CI, particularly as it relates to cardiometabolic health (i.e. pVCI). These data further support that this insomnia phenotype may be a more biologically severe form of the disorder associated with cardiovascular, cerebrovascular, and neurocognitive morbidity.     

What differs former,light and heavy smokers? Evidence from a post-conflict setting

BackgroundEvidence suggests that people who live in regions affected by the armed conflict are more likely to smoke.ObjectiveThe purpose of this study was to assess factors associated with smoking status in a sample of students in the northern Kosovo province.Materials and methodsA total of 514 students enrolled in University in Kosovska Mitrovica, Kosovo, were recruited between April to June 2015 at Student Public Health Center during mandatory health checks. Participants filled in socio-demographic and behavioral questionnaire and Beck Depression Inventory (BDI). Based on responses about smoking, students were categorized in non-smokers, former smokers, light smokers (1–13 cigarettes/day) and heavy smokers (> 13 cigarettes/day).ResultsOf 514 students, 116 (22.6%) classified themselves as smokers. Higher education level of fathers (Odds ratio [OR]=2.89, 95% confidence interval [CI] 1.30–6.44, p=0.009), not living with smokers (OR=0.42, 95%CI 0.15–0.97, p=0.017) and longer exposure to second hand smoke (OR=1.07, 95%CI 1.01–1.13, p=0.036) was associated with former smoking. Studying medical and natural sciences (OR=2.07, 95%CI 1.05–4.18, p=0.040), consuming alcohol (OR=2.98, 95%CI 1.19–10.03, p=0.020), living with smokers (OR=2.88, 95%CI 1.49–5.56, p=0.002), longer exposure to second hand smoke (OR=1.06, 95%CI 1.01–1.11, p=0.019) and having a more intense depressive symptoms (OR=1.08, 95%CI 1.03–1.13, p=0.002) was associated with light smoking. Being male (OR=0.22, 95%CI 0.07–0.41, p=0.001), older (OR=1.47, 95%CI 1.21–1.78, p=0.001), living with smokers (OR=3.78, 95%CI 1.69–8.07, p=0.001), longer daily exposure to second-hand smoke (OR=1.10, 95%CI 1.04–1.16, p=0.001), and having more severe depressive symptoms (OR=1.12, 95%CI 1.07–1.18, p=0.001) were associated with heavy smoking.ConclusionSmoking prevention and cessation programs should include the entire community, because exposure to environmental second hand smoke may facilitate initiation and more intense smoking. Screening of student smokers for depression should be prioritized in the process of rebuilding the framework for primary and secondary prevention in the post-conflict period.     

Brucellosis and its associated risk factors to humans and domestic ruminants in Kagera Ecosystem,Tanzania

BackgroundBrucellosis is an important disease for both veterinary and public health. A study was conducted to understand the seroprevalence of brucellosis and its associated risk factors in pastoral areas of Kagera, Tanzania.MethodsSera from 156 patients with malaria-like symptoms were analyzed using the commercial rapid agglutination test (specific for B.abortus and B.melitensis detection) and Fluorescence Polarization Assay (FPA). Sera from 426 cattle, 206 goats and 197 sheep were analyzed using Rose Bengal Plate (RBPT) and Competitive ELISA (c-ELISA) tests.ResultsIn humans, overall brucellosis, B. abortus, and B. melitensis sero-prevalences were 7.7% (95%CI: 3.8–12.2%), 1.9% (95% CI: 0.4–4.5%), and 5.8 % (95%CI: 2.6–10.6%), respectively. At animal level, seropositivity was 5.9% (95%CI: 4.0–8.6%), 2.5% (95%CI: 0.8–5.7%) and 0.5% (95%CI: 0.01–2.8%) in cattle, goats and sheep, respectively. At herd level, seropositivity was 18.2% (95%CI: 12.0–25.8%) in cattle and 6.9% (95%CI: 2.2–15.3%) in small ruminants. Brucellosis was associated with assisting in parturition without wearing protective gears (OR= 5.6; p= 0.02) in humans, herds of 50–200 animals (OR= 4.2, p= 0.01) and cattle (OR=3.5; p=0.01). The knowledge of brucellosis among pastoralists (OR=0.1; p<0.01) was a protective factor.ConclusionBrucella infections could be occurring in pastoralists and domestic ruminants in Kagera. Community health education is necessary for the control of brucellosis in Tanzania.     

Systematic review with meta-analysis: Non-alcoholic fatty liver disease and the association with pregnancy outcomes

Background/AimsMaternal and fetal outcomes in pregnant patients with Non-alcoholic fatty liver disease (NAFLD) have been largely unexplored. To determine the level of evidence associated with maternal and fetal outcomes in pregnant women with NAFLD.MethodsWe conducted a comprehensive literature search. The studies included pregnant patients with a previous, current or subsequent diagnosis of NAFLD. We used a random-effects model using odds ratios (OR) with 95% confidence intervals (CI).ResultsTwenty-two studies, with 13,641 female NAFLD patients were reviewed. The results highlight that NAFLD patients had a statistically significant increased likelihood of baseline diabetes mellitus (OR, 6.00; 95% CI, 2.21–16.31; P<0.001; n=7), baseline Hypertension (OR, 3.75; 95% CI, 2.13–6.59; P<0.001; n=4), gestational hypertension (OR, 1.83; 95% CI, 1.03–3.26; P=0.041; n=2), and pre-eclampsia (OR, 2.43; 95% CI, 1.46–4.04; P=0.001; n=3). The odds for a past and current history of gestational diabetes mellitus were OR, 3.78; 95% CI, 2.21–6.44; P<0.001; n=5 and OR, 3.23; 95% CI, 1.97– 5.31; P<0.001; n=6, respectively. As for fetal outcomes, pregnant NAFLD patients were significantly more likely to have a premature birth (OR, 2.02; 95% CI, 1.44–2.85; P<0.001; n=4), large for gestational age birth (OR, 2.01; 95% CI, 1.72–2.37; P<0.001; n=2) or a history of prior miscarriage or abortion (OR, 1.15; 95% CI, 1.02–1.30; P=0.02; n=2). Egger’s regression revealed no evidence of publication bias (P>0.05).ConclusionsThis meta-analysis provides pooled evidence that NAFLD is associated with a substantial increase in maternal diabetic and hypertensive complications and multiple adverse fetal outcomes. This data is important for clinicians managing these patients before, during and after pregnancy.     

On the way to universal coverage of maternal services in Iringa rural District in Tanzania. Who is yet to be reached?

BackgroundStrategies to tackle maternal mortality in sub-Saharan Africa include expanding coverage of reproductive services. Even where high, more vulnerable women may not access services. No data is available on high coverage determinants. We investigated this in Tanzania in a predicted high utilization area.MethodsData was collected through a household survey of 464 women with a recent delivery. Primary outcomes were facility delivery and ≥4 ANC visits. Determinants were analysed using multivariate regression.ResultsAlmost all women had attended ANC, though only 58.3% had ≥4 visits. ≥4 visits were more likely in the youngest age group (OR 2.7 95% CI 1.32–5.49, p=0.008), and in early ANC attenders (OR 3.2 95% CI 2.04–4.90, p<0.001). Facility delivery was greater than expected (87.7%), more likely in more educated women (OR 2.7 95% CI 1.50–4.75, p=0.002), in those within 5 kilometers of a facility (OR 3.2 95% CI 1.59–6.48, p=0.002), and for early ANC attenders (OR 2.4 95% CI 1.20–4.91, p=0.02).ConclusionRural contexts can achieve high facility delivery coverage. Based on our findings, strategies to reach women yet unserved should include promotion of early ANC start particularly for the less educated, and improvement of distant communities'' access to facilities.     

Association of GPs’ risk attitudes,level of empathy,and burnout status with PSA testing in primary care

BackgroundRates of prostate specific antigen (PSA) test ordering vary among GPs.AimTo examine whether GPs’ risk attitude, level of empathy, and burnout status are associated with PSA testing.MethodPSA tests from 2012 were retrieved from a register and classified as incident (that is, the first PSA test within 24 months), repeated normal, or repeated raised tests. This was merged with information on GPs’ risk attitudes, empathy, and burnout status from a 2012 survey.ResultsPatients registered with a GP with a high score on anxiety caused by uncertainty (odds ratio [OR] 1.03, 95% confidence interval [CI] = 1.00 to 1.06, P = 0.025) or concern about bad outcomes (OR 1.04; 95% CI = 1.00 to 1.08, P = 0.034) were more likely to have an incident PSA test, whereas those registered with a GP with increased tolerance for ambiguity were less likely (OR 0.98, 95% CI = 0.96 to 1.00, P = 0.025). Patients registered with a GP reporting high tolerance for ambiguity (OR 0.96, 95% CI = 0.94 to 0.99, P = 0.009) or high propensity to risk-taking (OR 0.97, 95% CI = 0.93 to 1.00, P = 0.047) were less likely to have a repeated normal PSA test.ConclusionVarious aspects of GPs’ risk-taking attitudes were associated with patients’ probability of having an incident and a repeated normal PSA test. The probability of having a repeated raised PSA test was not influenced by any of the psychological factors. Burnout and empathy were not associated with PSA testing.     

Associations of insomnia symptoms with subsequent health services use among community-dwelling U.S. older adults

Study ObjectivesDetermine the association of insomnia symptoms with subsequent health services use, in a representative sample of U.S. older adults.MethodsParticipants were 4,289 community-dwelling Medicare beneficiaries who had continuous fee-for-service Medicare coverage 30 days before, and 1 year after the National Health and Aging Trends Study (NHATS) Round 1 interview. Participants reported past-month insomnia symptoms (i.e. sleep onset latency >30 min, difficulty returning to sleep) which we categorized as 0, 1, or 2 symptoms. Outcomes were health services use within 1 year of interviews from linked Medicare claims: emergency department (ED) visits, hospitalizations, 30-day readmissions, home health care (all measured as yes/no), and number of hospitalizations and ED visits.ResultsOverall, 18.5% of participants were hospitalized, 28.7% visited the ED, 2.5% had a 30-day readmission, and 11.3% used home health care. After adjustment for demographics, depressive and anxiety symptoms, medical comorbidities, and BMI, compared to participants with no insomnia symptoms, those with two insomnia symptoms had a higher odds of ED visits (odds ratio [OR) = 1.60, 95% confidence interval [CI] = 1.24–2.07, p < 0.001), hospitalizations (OR = 1.29, 95% CI = 1.01–1.65, p < 0.05), and 30-day readmissions (OR = 1.88, 95% CI = 1.88–3.29, p < 0.05). Reporting 2 insomnia symptoms, versus no insomnia symptoms, was associated with a greater number of ED visits and hospitalizations (incidence rate ratio (IRR) = 1.52, 95% CI = 1.23–1.87, p < 0.001; IRR = 1.21, 95% CI = 1.02–1.44, p < 0.05, respectively) after adjusting for demographic and health characteristics.ConclusionsAmong older adults, insomnia symptoms are associated with greater health services use, including emergency department use, hospitalization, and 30-day readmission. Targeting insomnia may lower health services use.     

Patient characteristics and frequency of bodily distress syndrome in primary care: a cross-sectional study

BackgroundBodily distress syndrome (BDS) is a newly proposed diagnosis of medically unexplained symptoms, which is based on empirical research in primary care.AimTo estimate the frequency of BDS in primary care and describe the characteristics of patients with BDS.MethodData were obtained from GP one-page registration forms, patient questionnaires (including a checklist for BDS), and national registers.ResultsA total of 1356 primary care patients were included, of whom 230 patients (17.0%, 95% confidence intervals [CI] = 15.0 to 19.1) fulfilled the BDS criteria. BDS was more common among primary care patients aged 41–65 years (odds ratio [OR] = 1.9, 95% CI = 1.3 to 3.0) and was equally frequent among males and females (female sex, OR 0.9, 95% CI = 0.6 to 1.3). Patients with BDS were characterised by poor health-related quality of life (HRQOL) on the 12-item Short-Form Health Survey, that is, physical component summary scores <40 (OR 20.5, 95% CI = 12.9 to 32.4) and mental component summary scores <40 (OR 3.5, 95% CI = 2.2 to 5.6). Furthermore, patients with BDS were more likely to have high scores on the Symptom Checklist for anxiety (OR 2.2, 95% CI = 1.4 to 3.4) and depression (OR 5.1, 95% CI = 3.3 to 7.9), but regression analyses showed that mental morbidity did not account for the poor HRQOL.ConclusionBDS is common among primary care patients, and patients with BDS have a higher probability of poor HRQOL and mental health problems.     

Risk of Pregnancy Complications and Low Birth Weight Offsprings in Korean Women With Rheumatic Diseases: A Nationwide Population-Based Study

BackgroundTo determine the risk of pregnancy complications and adverse offspring outcomes in Korean women with rheumatic diseases (RDs).MethodsWomen aged 20–44 years with pregnancies ending in delivery were identified from the National Health Insurance Service-National Health Information Database (2009–2016). Women with RD including systemic lupus erythematosus (SLE), seropositive rheumatoid arthritis (SPRA), and ankylosing spondylitis (AS) (n = 4,284) were age-matched with controls (n = 26,023). Outcome variables included threatened abortion (TA), preterm birth (PB), preeclampsia/eclampsia (PE/E), intrauterine growth retardation (IGR), urinary tract infection, low birth weight (LBW) offsprings, and offspring death within 1 year of birth.ResultsWomen with RDs had increased risks for cesarean section delivery (odds ratio [OR], 1.5; 95% confidence interval [CI], 1.4–1.6), TA (OR, 1.4; 95% CI, 1.2–1.5), PB (OR, 2.4; 95% CI, 1.9–3.2), PE/E (OR, 4.4; 95% CI, 3.3–5.9), and IGR (OR, 2.4; 95% CI, 2.0–3.1) than the controls. The risk of pregnancy complications was increased in SLE and SPRA pregnancies but not in AS pregnancies. Offsprings of women with RDs had an increased risk of LBW (OR, 4.0; 95% CI, 3.2–4.9). The offspring mortality rate within 1 year of birth was higher in women with RDs (6.2/10,000 persons) than in the controls (4.9/10,000 persons).ConclusionWomen with RDs are at a risk of developing pregnancy complications, and the risk of LBW offsprings and offspring death within 1 year of birth is increased in these women. Therefore, this population requires special attention during their childbearing years.     

Risk Factors of Acoustic Neuroma: Systematic Review and Meta-Analysis

PurposeMany epidemiological studies have investigated environmental risk factors for the development of acoustic neuroma. However, these results are controversial. We conducted a meta-analysis of case-control studies to identify any potential relationship between history of noise exposure, smoking, allergic diseases, and risk of acoustic neuroma.ResultsEleven case-control studies were included in our meta-analysis. Acoustic neuroma was found to be associated with leisure noise exposure [odds ratio (OR)=1.33, 95% confidence interval (CI): 1.05–1.68], but not with occupational noise exposure and ever noise exposure (OR=1.20, 95% CI: 0.84–1.72 and OR=1.15, 95% CI: 0.80–1.65). The OR of acoustic neuroma for ever (versus never) smoking was 0.53 (95% CI: 0.30–0.94), while the subgroup analysis indicated ORs of 0.95 (95% CI: 0.81–1.10) and 0.49 (95% CI: 0.41–0.59) for ex-smoker and current smoker respectively. The ORs for asthma, eczema, and seasonal rhinitis were 0.98 (95% CI: 0.80–1.18), 0.91 (95% CI: 0.76–1.09), and 1.52 (95% CI: 0.90–2.54), respectively.ConclusionOur meta-analysis is suggestive of an elevated risk of acoustic neuroma among individuals who were ever exposed to leisure noise, but not to occupational noise. Our study also indicated a lower acoustic neuroma risk among ever and current cigarette smokers than never smokers, while there was no significant relationship for ex-smokers. No significant associations were found between acoustic neuroma and history of any allergic diseases, such as asthma, eczema, and seasonal rhinitis.     

Cerebrovascular accidents differ between patients with atrial flutter and patients with atrial fibrillation

IntroductionFew studies have explored the potential impact of atrial flutter (AFl) on ischaemic stroke (IS) outcome. The aim of the present study was to compare the clinical course of IS in patients with AFl and patients with atrial fibrillation (AF).Material and methodsA retrospective analysis of patients consecutively admitted to a tertiary care centre between 2013 and 2015 due to IS or transient ischaemic attack with permanent AFl or permanent or persistent AF was performed.ResultsThe study groups consisted of 528 patients, including 490 (92.8%) patients with AF and 38 (7.2%) patients with AFl. The mean age and prestroke CHA2DS2-VASc scores were similar between the patients with AFl and those with AF. Most IS cases in the AF group were classified as cardioembolic strokes (74.9% vs. 39.5% in AFl, p < 0.01), and lacunar strokes were the most common in the AFl group (47.4% vs. 14.3% in AF, p < 0.01). The multivariable analysis revealed that the presence of AF (OR = 8.6, 95% CI: 1.2–57, p = 0.02), lacunar stroke (OR = 0.1, 95% CI: 0.03–0.31, p < 0.001), baseline Rankin scale score (OR = 16.6, 95% CI: 9.8–28), lack of prestroke therapeutic anticoagulation (OR = 6.1, 95% CI: 1.1–33), diabetes (OR = 2.9, 95% CI: 1.3–6.5, p < 0.01), chronic heart failure (OR = 14.2, 95% CI: 5.8–34, p < 0.001), and current smoking (OR = 0.92, 95% CI: 0.39–0.99, p < 0.01) were significantly associated with the stroke outcome.ConclusionsDisabling or fatal IS was observed less often in patients with AFl than in patients with AF. This finding can possibly be explained by the more frequent occurrence of lacunar strokes in the AFl group compared with that in the AF group.     

Visual impairment and associated factors among primary school children in Gurage Zone,Southern Ethiopia

BackgroundVisual impairment is one of the major public health problems worldwide, especially in developing countries.ObjectiveTo determine the prevalence of visual impairment and its associated factors among school children in Gurage Zone, Southern EthiopiaMethodsA cross sectional study was conducted in eight primary schools of Gurage Zone. A total of 1064 pupils, of whom589 boys and 475 girls were selected using multistage sampling technique. Socio-demographic characteristics of the participants were collected using structured questionnaires and visual acuity was measured using Snellen''s chart. Logistic regression analysis was used to determine the associated factors of visual impairment.ResultsThe prevalence of visual impairment was 5.2%. Factors significantly associated with visual impairment were age group of 13–18 years (AOR = 9.44, 95% CI = 3.83 – 23.25), school grade level of 5- 8 (AOR = 2.97, 95% CI = 1.23 – 7.17), rural residents (AOR = 2.59, 95% CI = 1.22 – 5.54), family''s monthly income of less than 2000 Ethiopian Birr (AOR = 2.87, 95% CI = 1.08 – 7.61) and visually impaired parents (AOR = 2.16, 95% CI = 1.06 – 4.39).ConclusionThis study found that the prevalence of visual impairment was 5.2%.     

Visceral Fat Mass Has Stronger Associations with Diabetes and Prediabetes than Other Anthropometric Obesity Indicators among Korean Adults

PurposeThis study determined which obesity measurement correlates the best with diabetes and prediabetes.ResultsAfter adjusting for age and other potential confounding factors, participants with a visceral fat mass in the upper 10th percentile had a higher odds ratio (OR) for diabetes and prediabetes than the upper 10th percentile of other adiposity indices [men, OR=15.9, 95% confidence interval (CI)=6.4–39.2; women, OR=6.9, 95% CI=3.5–13.7]. Visceral fat mass also had the highest area under the curve with diabetes and prediabetes in both men (0.69, 95% CI=0.64–0.73) and women (0.70, 95% CI=0.67–0.74) compared to other anthropometric measurements of obesity.ConclusionVisceral fat mass measured using DXA is an indicator of diabetes or prediabetes, due to its ability to differentiate between abdominal visceral and subcutaneous fat.     

Role of frailty in prediction of hospitalized older adult patient’s outcomes: a prospective study

Background/aim Frailty is associated with an increased risk of negative short-term and long-term hospital outcomes. This study aimed to evaluate the role of frailty in predicting readmission, length of stay, and quality of life in the hospitalized older adults.Materials and methods This observational study was conducted at Ziaiyan Hospital, Tehran, Iran. In total, 304 participants (65–85 years), were enrolled through the inclusion criteria from August to December 2019. The frailty index (FI) was assessed by the minimum data set-home care. Readmission was obtained through telephone interviews. The length of stay was gathered by the patient’s hospital records, and the EuroQol questionnaire was used for assessing the quality of life. Data were collected by a researcher nurse at the admission time, 30, 60, and 90 days after discharge. The logistic regression model and repeated measures ANOVA were employed to analyze the association between frailty and outcomes.ResultsAccording to FI, 102 (33.55%) participants were pre-frail, whereas 35 (11.51%) were frail. In the fully-adjusted model for readmission, the pre-frail participants had a higher risk of readmission at the hospital in comparison with the nonfrail and frail groups (OR = 1.88, 95% CI = 1.90–3.26), and also for GP visits, frail patients showed nearly significant differences (OR = 2.45, 95% CI = 0.99–6.06) but there were no differences between frail and pre-frail patients in readmissions in the emergency ward. In a fully-adjusted prolonged stay model, pre-frail patients had a higher probability to stay longer in hospital (OR = 2.28, 95% CI: 1.24–4.18). The fully-adjusted model for QoL showed, frail patients were more prone to the declined levels of QoL in comparison with pre-frail patients (OR = 10.77, 95% CI: 3.97–29.18).ConclusionsThe findings indicated that frailty worsened negative outcomes and declined QoL. Early diagnosis in hospital settings could be beneficial for designing optimal care plans for the frail and pre-frail patients.     

How COVID-19 Affected Healthcare Workers in the Hospital Locked Down due to Early COVID-19 Cases in Korea

BackgroundThe healthcare workers (HCWs) were exposed to never-experienced psychological distress during the early stage of the coronavirus disease 2019 (COVID-19) pandemic. The aim of this study was to investigate how the COVID-19 pandemic affected the mental health of HCWs during the hospital lockdown period due to mass healthcare-associated infection during the early spread of COVID-19.MethodsA real-time online survey was conducted between April 14–18, 2020 among HCWs who worked at the university hospital where COVID-19 was confirmed in a patient, and the hospital was shut down for 3 weeks. Along with demographic variables and work-related information, psychological distress was measured using the Generalized Anxiety Disorder-7 (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), the Maslach Burnout Inventory-General Survey scale, and the Stress and Anxiety to Viral Epidemics-9.ResultsThe HCWs working in the cohort ward and those who have experienced social discrimination had significantly higher level of depression (PHQ-9 score; 5.24 ± 4.48 vs. 4.15 ± 4.38; P < 0.01 and 5.89 ± 4.78 vs. 3.25 ± 3.77; P < 0.001, respectively) and anxiety (GAD-7 score; 3.69 ± 3.68 vs. 2.87 ± 3.73; P < 0.05 and 4.20 ± 4.22 vs. 2.17 ± 3.06; P < 0.001, respectively) compared to other HCWs. Worries regarding the peer relationship and the skepticism about job were associated with depression (odds ratio [OR], 1.39; 95% confidence interval [CI], 1.07–1.79; P < 0.05 and OR, 1.69; 95% CI, 1.31–2.17; P < 0.001, respectively) and anxiety (OR, 1.73; 95% CI, 1.21–2.49; P < 0.01 and OR, 1.54; 95% CI, 1.09–2.17; P < 0.05, respectively), while fear of infection or worsening of health was not. Path analysis showed that work-related stress associated with the viral epidemic rather than anxiety about the viral epidemic mainly contributed to depression.ConclusionThe present observational study indicates that mental health problems of HCWs exposed to COVID-19 are associated with distress in work and social relationship. Early intervention programs focusing on these factors are necessary.     

Predictors of “Liking” Three Types of Health and Fitness-Related Content on Social Media: A Cross-Sectional Study

Background

Adolescence and young adulthood are key periods for developing norms related to health behaviors and body image, and social media can influence these norms. Social media is saturated with content related to dieting, fitness, and health. Health and fitness–related social media content has received significant media attention for often containing objectifying and inaccurate health messages. Limited research has identified problematic features of such content, including stigmatizing language around weight, portraying guilt-related messages regarding food, and praising thinness. However, no research has identified who is “liking” or “following” (ie, consuming) such content.

Objective

This exploratory study aimed to identify demographics, mental health, and substance use–related behaviors that predicted consuming 3 types of health and fitness–related social media content—weight loss/fitness motivation pages (ie, “fitspiration”), detox/cleanse pages, and diet/fitness plan pages—among young social media users.

Methods

Participants (N=1001; age: median 21.06, IQR 17.64-24.64; female: 723/1001, 72.23%) completed a cross-sectional 112-question online survey aimed at social media users aged between 15-29 years residing in Victoria, Australia. Logistic regression was used to determine which characteristics predicted consuming the 3 types of health and fitness–related social media content.

Results

A total of 378 (37.76%) participants reported consuming at least 1 of the 3 types of health and fitness–related social media content: 308 (30.77%) fitspiration pages, 145 (14.49%) detox pages, and 235 (23.48%) diet/fitness plan pages. Of the health and fitness–related social media content consumers, 85.7% (324/378) identified as female and 44.8% (324/723) of all female participants consumed at least 1 type of health and fitness–related social media content. Predictors of consuming at least one type of health and fitness–related social media content in univariable analysis included female gender (OR 3.5, 95% CI 2.5-4.9, P<.001), being aged 15-17 years (OR 3.0, 95% CI 2.2-4.0, P<.001), residing outside a major city (OR 2.0, 95% CI 1.4-2.9, P<.001), having no post–high school education (OR 2.2, 95% CI 1.7-2.9, P<.001), being born in Australia (OR 2.0, 95% CI 1.2-3.2, P=.006), having a self-reported eating disorder (OR 2.4, 95% CI 1.5-3.9, P<.001), being a victim of bullying (OR 1.7, CI 1.3-2.3, P<.001), misusing detox/laxative teas or diet pills (OR 4.6, 95% CI 2.8-7.6, P<.001), never using illegal drugs (OR 1.6, 95% CI 1.2-2.0, P=.001), and not engaging in risky single occasion drinking on a weekly basis (OR 2.0, 95% CI 1.3-3.0, P=.003).

Conclusions

Consumers of health and fitness–related social media content were predominantly teenaged girls. There is a need to ensure that this social media content portrays responsible health messages and to research further the role of fitspiration pages, detox pages, and diet/fitness plan pages in influencing body image and health behaviors.     

Inhaled Corticosteroid and Secondary Glaucoma: A Meta-analysis of 18 Studies

PurposeGuidelines and systematic reviews frequently warn of inhaled corticosteroid (ICS)-induced glaucoma. However, most of the published studies deny it.MethodsWe performed a systematic review of randomized, cohort, nested-case control, cross-sectional studies by using Meta-analyses of Observational Studies in Epidemiology statement. Four major databases, PubMed, EMBASE, Cochrane Search Manager, and the Web of Science Core Collection as well as meta-analysis were used. Studies comparing incidence, prevalence and intraocular pressure (IOP) between patients who were treated with and without ICSs were included. A random-model meta-analysis was performed using the inverse variance method.ResultsOut of 623 studies screened, 18 with 31,665 subjects were finally included. No significant difference between the 2 groups was observed for crude glaucoma incidence (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.86–1.04; P = 0.26; I ² = 0%; P for heterogeneity = 0.57) as a primary endpoint, adjusted glaucoma incidence (OR, 0.90; 95% CI, 0.65–1.24; P = 0.64), crude prevalence (OR, 1.82; 95% CI, 0.23–14.19; P = 0.57), adjusted prevalence (OR, 1.22; 95% CI, 0.50–2.96; P = 0.66), IOP change during ICS treatment (mean difference [MD] +0.01 mmHg; 95% CI, −0.19–0.20; P = 0.95), and single measurement IOP (MD +0.37 mmHg; 95% CI, −0.24–0.97; P = 0.23). Time-to-event analysis for glaucoma development as one of the secondary endpoints (adjusted hazard ratio, 0.52; 95% CI, 0.28–0.96) suggested a reverse association between ICS and glaucoma.ConclusionsThe ophthalmological side effects of ICSs, such as glaucoma and intraocular hypertension, should not be exaggerated.Trial RegistrationUniversity Hospital Medical Information Network Center Clinical Trial Registry Identifier: UMIN000040351     

Level of utilization and provider-related barriers to the use of hydroxyurea in the treatment of sickle cell disease patients in Jos,North-Central Nigeria

BackgroundHydroxyurea is underutilized by sickle cell health-care providers in Nigeria despite available evidence of its effectiveness in reducing the manifestations and complications of sickle cell disease (SCD).ObjectivesTo assess the level of utilization and provider-related barriers to the use of hydroxyurea in SCD therapy in Jos, Nigeria.MethodsA cross-sectional study conducted among 132 medical doctors providing care for SCD patients. Data on sociodemographics, utilization and barriers to hydroxyurea use were obtained. The barriers were fed cumulatively into the logistic regression model as predictors of utilization.ResultsOf the 132 care providers, 88 (67%) had been in medical practice for ≥6years. The level of utilization of hydroxyurea was 24.2%. The significant barriers that predicted the non-utilization of hydroxyurea included lack of expertise (OR=5.1; 95% CI=2.65–9.05), lack of clinical guidelines (OR=3.84; 95% CI=2.37–14.33), fear of side-effects (OR=0.50; 95% CI=0.22–0.68) and doubt about its effectiveness (OR=0.30; 95% CI=0.20–0.90).ConclusionThe level of utilization of hydroxyurea in the treatment of SCD among the care providers is sub-optimal with the lack of expertise in its use identified as the most prominent barrier. There is an urgent need for the training of sickle cell care-providers and the development of clinical guidelines on hydroxyurea use.     

Socio-demographic determinants of neonatal mortality in Algeria according to MICS4 data (2012–2013)

BackgroundNeonatal mortality remains a public health problem in developing countries, including Algeria. Information on this indicator makes it possible to assess government efforts to improve the living conditions of target populations.ObjectivesThis study aims to identify some determinants associated with this mortality from data of multiple indicator cluster survey conducted in Algeria in 2012–2013 (mics 4).MethodsA retrospective case-control study including 1047 cases and 1041 controls. From a logistic regression model, we appreciated the role of different factors, socio-demographic, economic and geographic (Mother''s age, level of education, wealth index, area of residence) in newborn survival.ResultsThe main factors associated with neonatal mortality were rural residence (p<0.01; OR= 1.3; CI 1.08–1.54), South geographical area (p<0.05; OR=1.5; CI 1.18–1.84), low education level of mother (p<0.01; OR= 2.10; CI 1.35– 3.29), early age of maternal procreation (p<0.001; OR=4.34; CI 2.19– 14.40), the birth rank “7 and over” (<0.01; OR = 1.57; CI 1.13 – 2.44) and the two lowest wealth indices (p <0.001; OR = 2; 1.45–2.62 and p <0.01; OR = 1.66; CI 1.23–2.26).ConclusionIn addition to the various reproductive health strategies already adopted by the authorities for health promotion and family planning, action should be taken to evaluate their implementation with sustained assistance for disadvantaged people and in risk areas.     

Spatio-temporal Analysis of District-level Life Expectancy from 2004 to 2017 in Korea

BackgroundHealth indicators, such as mortality rates or life expectancy, need to be presented at the local level to improve the health of local residents and to reduce health inequality across geographic areas. The aim of this study was to estimate life expectancy at the district level in Korea through a spatio-temporal analysis.MethodsSpatio-temporal models were applied to the National Health Information Database of the National Health Insurance Service to estimate the mortality rates for 19 age groups in 250 districts from 2004 to 2017 by gender in Korea. Annual district-level life tables by gender were constructed using the estimated mortality rates, and then annual district-level life expectancy by gender was estimated using the life table method and the Kannisto-Thatcher method. The annual district-level life expectancies based on the spatio-temporal models were compared to the life expectancies calculated under the assumption that the mortality rates in these 250 districts are independent from one another.ResultsIn 2017, district-level life expectancy at birth ranged from 75.5 years (95% credible interval [CI], 74.0–77.0 years) to 84.2 years (95% CI, 83.4–85.0 years) for men and from 83.9 years (95% CI, 83.2–84.6 years) to 88.2 years (95% CI, 87.3–89.1 years) for women. Between 2004 and 2017, district-level life expectancy at birth increased by 4.57 years (95% CI, 4.49–4.65 years) for men and by 4.06 years (95% CI, 3.99–4.12 years) for women. To obtain stable annual life expectancy estimates at the district level, it is recommended to use the life expectancy based on spatio-temporal models instead of calculating life expectancy using observed mortality.ConclusionIn this study, we estimated the annual district-level life expectancy from 2004 to 2017 in Korea by gender using a spatio-temporal model. Local governments could use annual district-level life expectancy estimates as a performance indicator of health policies to improve the health of local residents. The approach to district-level analysis with spatio-temporal modeling employed in this study could be used in future analyses to produce district-level health-related indicators in Korea.