Association of Opioid Use Disorder With 2016 Presidential Voting Patterns: Cross-sectional Study in New York State at Census Tract Level

BackgroundOpioid overdose-related deaths have increased dramatically in recent years. Combating the opioid epidemic requires better understanding of the epidemiology of opioid poisoning (OP) and opioid use disorder (OUD).ObjectiveWe aimed to discover geospatial patterns in nonmedical opioid use and its correlations with demographic features related to despair and economic hardship, most notably the US presidential voting patterns in 2016 at census tract level in New York State.MethodsThis cross-sectional analysis used data from New York Statewide Planning and Research Cooperative System claims data and the presidential voting results of 2016 in New York State from the Harvard Election Data Archive. We included 63,958 patients who had at least one OUD diagnosis between 2010 and 2016 and 36,004 patients with at least one OP diagnosis between 2012 and 2016. Geospatial mappings were created to compare areas of New York in OUD rates and presidential voting patterns. A multiple regression model examines the extent that certain factors explain OUD rate variation.ResultsSeveral areas shared similar patterns of OUD rates and Republican vote: census tracts in western New York, central New York, and Suffolk County. The correlation between OUD rates and the Republican vote was .38 (P<.001). The regression model with census tract level of demographic and socioeconomic factors explains 30% of the variance in OUD rates, with disability and Republican vote as the most significant predictors.ConclusionsAt the census tract level, OUD rates were positively correlated with Republican support in the 2016 presidential election, disability, unemployment, and unmarried status. Socioeconomic and demographic despair-related features explain a large portion of the association between the Republican vote and OUD. Together, these findings underscore the importance of socioeconomic interventions in combating the opioid epidemic.     

Prevalence and Associated Factors of Sarcopenia in Singaporean Adults—The Yishun Study

ObjectivesTo describe the normative values of sarcopenia among community-dwelling adults (≥21 years of age); compare the prevalence of sarcopenia using Asian Working Group for Sarcopenia criteria, 2014 (AWGS2014), Asian Working Group for Sarcopenia criteria, 2019 (AWGS2019), and European Working Group on Sarcopenia in Older People criteria, 2018 (EWGSOP2) guidelines; and identify factors associated with sarcopenia.DesignParticipants were recruited through random sampling. Sarcopenia assessments were performed using a dual-energy x-ray absorptiometry scan (muscle mass), handgrip test (muscle strength), and usual walking test (physical performance). Questionnaires were administered to evaluate lifestyle and cognition.Setting and ParticipantsIn total, 542 community-dwelling Singaporeans were recruited (21?90 years old, 57.9% women).MethodsWe assessed anthropometry, body composition, and questionnaire-based physical and cognitive factors, and estimated sarcopenia prevalence according to the AWGS2014, AWGS2019, and EWGSOP2 recommendations, and examined associations using logistic regression.ResultsAccording to AWGS2019, the Singapore population-adjusted sarcopenia prevalence was 13.6% (men 13.0%; women 14.2%) overall, and 32.2% (men 33.7%, women 30.9%) in those aged 60 years and above. The cut-offs derived from young adult reference group for low appendicular lean mass index were 5.28 kg/m2 for men and 3.69 kg/m2 for women (lower than AWGS recommended cut-off); for gait speed it was 0.82 m/s, (AWGS2019 recommended cut-off 1.0 m/s, AWGS2014 cut-off was 0.8 m/s); and for handgrip strength it was 27.9 kg/m2 for men and 16.7 kg/m2 for women (close to AWGS2019 recommendation). Age, sex, marital status, alcoholism, physical activity, body mass index, waist circumference, and global cognition were associated with sarcopenia (P < .05).Conclusions and ImplicationsThis is the first study to provide reference values of muscle mass, strength, and gait speed across the adult lifespan of Singaporeans. Using AWGS2019 criteria, sarcopenia is prominent in older age (32.2% in ≥60 years old), but it is already nontrivial (6.9%) among young and middle-age persons. Multidomain lifestyle modifications addressing muscle strength, cognition, and nutrition over the adult lifespan are important to delay the development of sarcopenia.     

Machine Learning Algorithms to Predict Mortality and Allocate Palliative Care for Older Patients With Hip Fracture

ObjectivesTo evaluate a machine learning model designed to predict mortality for Medicare beneficiaries aged >65 years treated for hip fracture in Inpatient Rehabilitation Facilities (IRFs).DesignRetrospective design/cohort analysis of Centers for Medicare & Medicaid Services Inpatient Rehabilitation Facility–Patient Assessment Instrument data.Setting and ParticipantsA total of 17,140 persons admitted to Medicare-certified IRFs in 2015 following hospitalization for hip fracture.MeasuresPatient characteristics include sociodemographic (age, gender, race, and social support) and clinical factors (functional status at admission, chronic conditions) and IRF length of stay. Outcomes were 30-day and 1-year all-cause mortality. We trained and evaluated 2 classification models, logistic regression and a multilayer perceptron (MLP), to predict the probability of 30-day and 1-year mortality and evaluated the calibration, discrimination, and precision of the models.ResultsFor 30-day mortality, MLP performed well [acc = 0.74, area under the receiver operating characteristic curve (AUROC) = 0.76, avg prec = 0.10, slope = 1.14] as did logistic regression (acc = 0.78, AUROC = 0.76, avg prec = 0.09, slope = 1.20). For 1-year mortality, the performances were similar for both MLP (acc = 0.68, AUROC = 0.75, avg prec = 0.32, slope = 0.96) and logistic regression (acc = 0.68, AUROC = 0.75, avg prec = 0.32, slope = 0.95).Conclusion and ImplicationsA scoring system based on logistic regression may be more feasible to run in current electronic medical records. But MLP models may reduce cognitive burden and increase ability to calibrate to local data, yielding clinical specificity in mortality prediction so that palliative care resources may be allocated more effectively.     

湖北省以替诺福韦为初治抗逆转录病毒方案的HIV/AIDS患者肾功能情况及其影响因素分析

目的 评估替诺福韦（tenofovir,TDF）作为一线治疗方案的HIV/AIDS患者慢性肾病（chronic kidney disease,CKD）发生情况及其影响因素。方法 采用回顾性队列研究方法,收集分析TDF组和齐多夫定（zidovudine,AZT）组HIV/AIDS的人口学信息及临床检查资料,比较2组患者CKD的发生率和差异,多因素Cox比例风险模型分析TDF组患者CKD发生的影响因素。结果 共纳入432例HIV/AIDS患者,其中TDF组249例,AZT组193例,开始治疗时年龄中位数分别为32（26,50）、31（26,43）岁,传播途径主要以同性传播为主（分别为69.48%、82.90%）。TDF组与AZT组24个月CKD累积发生率分别是2.8%和0,差异有统计学意义（P<0.05）。各时间点肾小球滤过率（eGFR）值中,AZT组均高于TDF组（均P<0.01）。多因素Cox比例风险模型分析显示：TDF组患者中,女性（HR=57.46,95% CI：2.981~67.684）和基线eGFR异常（HR=4.75,95% CI：1.351~16.702）者发生CKD的风险更高。结论 TDF可以引起HIV/AIDS患者CKD的发生,但发生率较低,女性和基线eGFR异常者发生CKD的风险更高。在临床治疗过程中,要密切关注女性患者以及评估患者肾功能。     

微酸性电解水实验室微生物杀灭效果研究

 目的 研究某微酸性电解水实验室微生物杀灭效果。方法 选取某次氯酸水发生器现制微酸性电解水,测定不同有效氯含量、不同作用时间其对细菌繁殖体、芽孢以及真菌的杀灭效果。结果 该微酸性电解水有效氯含量为34.3~118 mg/L,有机干扰物牛血清白蛋白浓度为3.0%和0.3%时,分别作用1.0、3.0、5.0、10.0 min,对金黄色葡萄球菌、大肠埃希菌、铜绿假单胞菌的平均杀灭对数值均>5.00,对白假丝酵母菌的平均杀灭对数值均>4.00;有效氯含量为101~118 mg/L,牛血清白蛋白浓度为0.3%时,分别作用5.0、10.0、30.0 min,对枯草杆菌黑色变种芽孢的平均杀灭对数值均>5.00。结论 在特定实验条件下,该微酸性电解水对细菌的繁殖体、芽孢以及真菌均达到消毒剂消毒合格标准。     

阴沟肠杆菌对碳青霉烯类药物的耐药机制

 目的 研究耐碳青霉烯类阴沟肠杆菌分子流行病学特征和碳青霉烯耐药机制,为临床经验性用药及医院感染防控提供依据。方法 对某院2019年4—9月分离的耐碳青霉烯类阴沟肠杆菌进行菌种鉴定及药敏分析,mCIM联合eCIM试验筛选碳青霉烯酶,聚合酶链反应（PCR）方法检测碳青霉烯酶耐药基因,多位点序列分型（MLST）和脉冲场凝胶电泳（PFGE）进行分子流行病学特征分析。结果 8株耐碳青霉烯类阴沟肠杆菌中5株来自于重症监护病房（ICU）,对临床常用头孢类及加酶抑制剂药物均表现出高水平耐药的特性。所有菌株均携带金属β-内酰胺酶,7株为bla_NDM-1,1株为bla_IPM-4。MLST分子分型及PFGE同源性分析有6个ST序列类型,6个克隆群。ST596（3株）均为A群、ST121（1株）为C群、ST993（1株）为F群、ST91（1株）为E群、ST794（1株）为B群、ST88（1株）为D群。结论 该院耐碳青霉烯类阴沟肠杆菌主要来源于ICU,产金属酶bla_NDM-1β-内酰胺酶是其主要耐药机制。ST596 A群阴沟肠杆菌短时间内在ICU存在局部流行,应加强医院感染防控措施,遏制暴发流行。     

老年慢性病患者肺部感染与CD14及HLA基因多态性的关系

目的分析老年慢性病患者肺部感染与白细胞分化抗原14(CD14)和人类白细胞抗原(HLA)基因多态性的关系。方法选取2017年10月-2019年10月菏泽市单县中心医院老年慢性疾病患者615例,以其中合并肺部感染者97例(15.77%)为研究组,另在未合并肺部感染者中随机抽取92例为对照组,采集两组临床资料,检测并比较两组CD14-159 C/T、CD14-260 C/T和HLA-A、HLA-B和HLA-DRB1基因分布。结果两组患者性别、年龄、体质量指数(BMI)及基础疾病等临床资料比较差异无统计学意义,研究组合并慢性疾病种类较对照组多(P<0.05);两组CD14-159 C/T基因型分布差异显著(P<0.05),研究组CD14-159 C等位基因频率显著低于对照组,T等位基因频率显著高于对照组(P<0.05),两组CD14-260 C/T基因型及等位基因频率比较差异无统计学意义;研究组HLA-A*0101等位基因频率高于对照组,HLA-B*5201和HLA-DRB1*1502等位基因频率低于对照组,差异有统计学意义(P<0.05)。结论合并慢性疾病种类较多的老年慢性疾病患者容易发生肺部感染,感染可能与CD14和HLA基因多态性有关,CD14-159 TT和HLA-A*0101可能为易感基因。     

湘潭市5起新型冠状病毒肺炎聚集性疫情调查分析

目的 对湘潭市5起新型冠状病毒肺炎(简称新冠肺炎)聚集性疫情开展流行病学调查,分析病例的感染来源,并探讨其传播模式,提出针对性预防控制建议。 方法 应用现场流行病学方法调查病例及其密切接触者,描述流行特征,采集患者鼻咽拭子,利用反转录聚合酶链式反应技术进行病毒核酸检测。 结果 截至2020年3月5日,湘潭市累计报告42例新冠肺炎病例(其中6例为无症状感染者),重症及危重症病例8例。涉及5起新冠肺炎聚集性疫情,共发病19人(包括无症状感染者),占总病例数45.24%;其中4起因武汉返湘潭(简称潭)人员引起,1起因本地病例引起;男性8例、女性11例,年龄为1岁3月～84岁;临床表现出现咳嗽症状比例最高(占70.59%),病例从发病到就诊隔离间隔时间在0～10 d之间,中位数为2 d,发病时已住院隔离观察的病例占比最高为42.11%(8/19),从就诊隔离到确诊的间隔时间在0～7 d 之间,中位数为2 d。 结论 新型冠状病毒具有极强的传染性和隐匿性,人员密集、聚餐/会、家庭内传播是聚集性疫情的高危因素,应做好重点场所、重点人群新冠肺炎疫情防控工作,减少聚集性疫情的发生。     

2005—2015年全国肝癌发病趋势分析

目的 通过分析《中国肿瘤登记年报》中肝癌发病的变化趋势,为有效开展肝癌防治工作提供科学参考依据。 方法 整理2005—2015年肝癌发病数据,运用Joinpoint软件进行回归模型分析我国肝癌发病率变化趋势,利用R软件进行负二项回归模型分析肝癌在人群水平上发病的危险因素。 结果 2005—2015年我国肝癌标化发病率基本表现为农村高于城市,男性高于女性。肝癌标化发病率总体呈下降趋势(AAPC=-0.818,P<0.05);城乡男性肝癌年龄别发病率大多在30~岁年龄组呈快速上升趋势,农村和城市女性年龄别发病率分别在45~和50~岁年龄组,随时间增长呈快速上升趋势。城市人群的发病风险是农村人群的1.198倍(95%CI:1.041~1.379,P＜0.05),男性是女性的3.715倍(95%CI:3.228~4.275,P＜0.001),每增加5岁,肝癌的发病风险平均增大8.0%(OR=1.080,95%CI:1.077~1.083,P＜0.001)。 结论 2005—2015年我国肝癌发病情况总体呈下降趋势,但存在城乡、性别及年龄差异,需要制定更加有效完善的预防措施,从而达到预防肝癌的最优效果。     

让核心价值观成为员工的精神追求

血站文化建设的核心是促使全体职工形成统一的核心价值观。采用小组讨论、专题讲座、座谈沟通、问卷调查、专题研讨等方法提炼了组织核心价值观,并采用多种形式促进核心价值观落地。使核心价值观真正内化为职工的精神追求,外化为职工的自觉行动,有力地推动了无偿献血事业健康、可持续发展。