Exploring relationships between drought and epidemic cholera in Africa using generalised linear models

Abstract Background Temperature and precipitation are known to affect Vibrio cholerae outbreaks. Despite this, the impact of drought on outbreaks has been largely understudied. Africa is both drought and cholera prone and more research is needed in Africa to understand cholera dynamics in relation to drought. Methods Here, we analyse a range of environmental and socioeconomic covariates and fit generalised linear models to publicly available national data, to test for associations with several indices of drought and make cholera outbreak projections to 2070 under three scenarios of global change, reflecting varying trajectories of CO2 emissions, socio-economic development, and population growth. Results The best-fit model implies that drought is a significant risk factor for African cholera outbreaks, alongside positive effects of population, temperature and poverty and a negative effect of freshwater withdrawal. The projections show that following stringent emissions pathways and expanding sustainable development may reduce cholera outbreak occurrence in Africa, although these changes were spatially heterogeneous. Conclusions Despite an effect of drought in explaining recent cholera outbreaks, future projections highlighted the potential for sustainable development gains to offset drought-related impacts on cholera risk. Future work should build on this research investigating the impacts of drought on cholera on a finer spatial scale and potential non-linear relationships, especially in high-burden countries which saw little cholera change in the scenario analysis.

Download Full-text

Exploring relationships between drought and epidemic cholera in Africa using generalised linear models

10.1101/2021.07.16.21260629 ◽

2021 ◽

Author(s):

Gina E C Charnley ◽

Ilan Kelman ◽

Nathan Green ◽

Wes Hinsley ◽

Katy A M Gaythorpe ◽

...

Keyword(s):

Sustainable Development ◽

Linear Models ◽

Significant Risk ◽

Significant Risk Factor ◽

Cholera Outbreak ◽

Generalised Linear Models ◽

Positive Effects ◽

Temperature And Precipitation ◽

Linear Relationships ◽

The Impact

Background: Temperature and precipitation are known to affect Vibrio cholerae outbreaks. Despite this, the impact of drought on outbreaks has been largely understudied. Africa is both drought and cholera prone and more research is needed in Africa to understand cholera dynamics in relation to drought. Methods: Here, we analyse a range of environmental and socioeconomic covariates and fit generalised linear models to publicly available national data, to test for associations with several indices of drought and make cholera outbreak projections to 2070 under three scenarios of global change, reflecting varying trajectories of CO₂ emissions, socio-economic development, and population growth. Results: The best-fit model implies that drought is a significant risk factor for African cholera outbreaks, alongside positive effects of population, temperature and poverty and a negative effect of freshwater withdrawal. The projections show that following stringent emissions pathways and expanding sustainable development may reduce cholera outbreak occurrence in Africa, although these changes were spatially heterogeneous. Conclusions: Despite an effect of drought in explaining recent cholera outbreaks, future projections highlighted the potential for sustainable development gains to offset drought-related impacts on cholera risk. Future work should build on this research investigating the impacts of drought on cholera on a finer spatial scale and potential non-linear relationships, especially in high-burden countries which saw little cholera change in the scenario analysis.

Download Full-text

1487. Pneumonia due to Co-Infection in the ICU: Detection and Clinical Significance

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1668 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S745-S746

Author(s):

Casey S Zelus ◽

Michael Blaha ◽

Kaeli Samsom ◽

Jasmine R Marcelin ◽

Trevor C Van Schooneveld ◽

...

Keyword(s):

Clinical Significance ◽

Diagnostic Testing ◽

Significant Risk ◽

Significant Risk Factor ◽

Categorical Variables ◽

Chi Square ◽

Mechanically Ventilated ◽

Critical Care Units ◽

Outcomes Measures ◽

The Impact

Abstract Background Pneumonia is a significant cause of morbidity and mortality, with increasing interest in the detection and clinical significance of co-infection. However, the impact of methodology to obtain lower respiratory samples along with the utility of various microbiological diagnostic testing remains unclear. Methods A single-center retrospective analysis was performed on bronchoalveolar lavage (BAL) samples obtained from mechanically ventilated adults treated in critical care units from August 2012 to December 2017. BAL methodology (bronchoscopic vs blinded), microbiological diagnostic testing, and outcomes measures were obtained. Associations between categorical variables were assessed using Chi-Square or Fisher’s exact tests. Kruskal Wallace tests analyzed differences in distributions of measures between categories based on number of organism types detected. SAS software version 9.4 (SAS Institute Inc., Cary, NC). Results Analysis of the 803 samples that met inclusion criteria found a significant linear association between mortality and number of organism types detected by BAL, with 30 day mortality rates of 43.0%, 47.8%, and 58.3% among those with zero, one, and two or more organisms respectively (p = 0.003). Comparing BALs with at least one organism isolated, the detection of viruses specifically was associated with increased mortality, with the presence and absence of viral organisms corresponding to 56.3% and 46.5% mortality at thirty days (p = 0.03). No association was found between mortality and isolation of acid-fast bacilli, bacteria, or fungi. Co-infection was detected more frequently among bronchoscopic BALs than blinded BALs (26.3% vs 8.6%, p < 0.0001), with more viruses detected bronchoscopic BALs (41.9% vs 13.1%, p < 0.0001), and more bacteria in blinded BALs (41.8% vs 33.0%, p = 0.01). 30 Day Mortality vs Isolation of Specific Organism Types from BAL Number of Organism Types Isolated from BAL Compared to BAL Methodology BAL Methodology vs Isolation of Specific Organism Types Conclusion Co-infection in mechanically ventilated adult patients with pneumonia appears to be a significant risk factor for mortality, with the detection of viral organisms potentially playing an independent role. Within this population, bronchoscopic BALs may have a valuable diagnostic and prognostic methodology. Disclosures All Authors: No reported disclosures

Download Full-text

The impact of levothyroxine exposure on delivery outcome in hypothyroid pregnant women (PETAL study): A five-year retrospective cohort study

Obstetric Medicine ◽

10.1177/1753495x211064108 ◽

2021 ◽

pp. 1753495X2110641

Author(s):

Diana Oprea ◽

Nadine Sauvé ◽

Jean-Charles Pasquier

Keyword(s):

Cohort Study ◽

Pregnant Women ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Caesarean Delivery ◽

Significant Risk ◽

Significant Risk Factor ◽

Singleton Pregnancy ◽

Delivery Outcome ◽

The Impact

Background Hypothyroidism affects 3% of pregnant women, and to date, no studies have addressed the impact levothyroxine-treated hypothyroidism on delivery outcome. Methods This retrospective cohort study was conducted among 750 women with a singleton pregnancy who gave birth between 2015 and 2019. Delivery modes were compared between 250 hypothyroid women exposed to levothyroxine and 500 euthyroid control women. The aim of this study was to determine the impact of levothyroxine exposure on delivery outcome. Results Multiple logistic regression showed no significant association between exposure to levothyroxine and the overall rate of caesarean delivery (aOR 1.1; 95% CI 0.8 to 1.6). Mean TSH concentrations were significantly higher throughout the pregnancy in hypothyroid women despite levothyroxine treatment. Maternal and neonatal outcomes in both groups were not different. Conclusion Hypothyroidism treated with levothyroxine during pregnancy according to local guidelines is not a significant risk factor for caesarean delivery.

Download Full-text

Obesity Does Not Increase Mortality after Emergency Surgery

Journal of Obesity ◽

10.1155/2014/492127 ◽

2014 ◽

Vol 2014 ◽

pp. 1-3 ◽

Cited By ~ 5

Author(s):

Paula Ferrada ◽

Rahul J. Anand ◽

Ajai Malhotra ◽

Michel Aboutanos

Keyword(s):

Wound Infection ◽

Emergency Surgery ◽

Significant Risk ◽

Significant Risk Factor ◽

Patient Characteristics ◽

Obese Patients ◽

Exact Test ◽

Icu Admission ◽

Nonobese Patients ◽

The Impact

Objective.The aim of this study is to evaluate the impact of obesity on patient outcomes after emergency surgery.Methods.A list of all patients undergoing emergent general surgical procedures during the 12 months ending in July 2012 was obtained from the operating room log. A chart review was performed to obtain the following data: patient characteristics (age, gender, BMI, and preexisting comorbidities), indication for surgery, and outcomes (pulmonary embolus (PE), deep venous thrombosis (DVT), respiratory failure, ICU admission, wound infection, pneumonia, and mortality). Obesity was defined as a BMI over 25. Comparisons of outcomes between obese and nonobese patients were evaluated using Fischer’s exact test. Predictors of mortality were evaluated using logistic regression.Results.341 patients were identified during the study period. 202 (59%) were obese. Both groups were similar in age (48 for obese versus 47 for nonobese,P=0.42). Obese patients had an increased incidence of diabetes, (27% versus 7%,P<0.05), hypertension (52% versus 34%,P<0.05), and sleep apnea (0% versus 5%,P<0.05). There was a statistically significant increased incidence of postoperative wound infection (obese 9.9% versus nonobese 4.3%,P<0.05) and ICU admission (obese 58% versus nonobese 42%,P=0.01) among the obese patients. Obesity alone was not shown to be a significant risk factor for mortality.Conclusions.A higher BMI is not an independent predictor of mortality after emergency surgery. Obese patients are at a higher risk of developing wound infections and requiring ICU admission after emergent general surgical procedure.

Download Full-text

Maternal Obesity and Rectovaginal Group B Streptococcus Colonization at Term

Infectious Diseases in Obstetrics and Gynecology ◽

10.1155/2015/586767 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5 ◽

Cited By ~ 12

Author(s):

Shelby M. Kleweis ◽

Alison G. Cahill ◽

Anthony O. Odibo ◽

Methodius G. Tuuli

Keyword(s):

Risk Factor ◽

Maternal Obesity ◽

Management Strategies ◽

Group B Streptococcus ◽

Significant Risk ◽

Positive Culture ◽

Significant Risk Factor ◽

Entire Cohort ◽

Group B ◽

The Impact

Objective. To test the hypothesis that maternal obesity is an independent risk factor for rectovaginal group B streptococcus (GBS) colonization at term.Study Design. Retrospective cohort study of consecutive women with singleton term pregnancies admitted in labor at Barnes-Jewish Hospital (2004–2008). Maternal BMI ≥ 30 Kg/m2(obese) or <30 Kg/m2(nonobese) defined the two comparison groups. The outcome of interest was GBS colonization from a positive culture. Baseline characteristics were compared using Student’st-test and Chi-squared or Fisher’s exact test. The association between obesity and GBS colonization was assessed using univariable and multivariable analyses.Results. Of the 10,564 women eligible, 7,711 met inclusion criteria. The prevalence of GBS colonization in the entire cohort was relatively high (25.8%). Obese gravidas were significantly more likely to be colonized by GBS when compared with nonobese gravidas (28.4% versus 22.2%,P<0.001). Obese gravidas were still 35% more likely than nonobese women to test positive for GBS after adjusting for race, parity, smoking, and diabetes (adjusted OR 1.35 [95% CI 1.21–1.50]).Conclusion. Maternal obesity is a significant risk factor for GBS colonization at term. Further research is needed to evaluate the impact of this finding on risk-based management strategies.

Download Full-text

Television Viewing and Cognitive Dysfunction of Korean Older Adults

Healthcare ◽

10.3390/healthcare8040547 ◽

2020 ◽

Vol 8 (4) ◽

pp. 547

Author(s):

Mi Sook Jung ◽

Eunyoung Chung

Keyword(s):

Older Adults ◽

Cognitive Dysfunction ◽

Cognitive Aging ◽

Significant Risk ◽

Multivariate Logistic Regression Analysis ◽

Later Life ◽

Significant Risk Factor ◽

Tv Viewing ◽

Increased Risk ◽

The Impact

This study examined the association between television (TV) viewing and cognitive dysfunction in elderly Koreans. Among participants of the 2014 National Survey of Older Koreans, 9644 were considered in this study. To better identify the association between two factors, propensity score (PS) matching with exact method was used. Finally, 168 viewers and non-viewers each were selected based on estimated PS on key variables and eliminating double matches. Multivariate logistic regression analysis was performed when controlling for possible covariates. Viewers were more likely to have cognitive dysfunction than non-viewers, with significant differences in most covariates. After correcting confounding effects of these covariates with PS matching, TV viewing was found to be a significant risk factor of cognitive dysfunction, along with absence of diagnosed hypertension and non-participation in physical leisure activities. TV viewing might be associated with increased risk of cognitive dysfunction in later life. Appropriate education and strategies to minimize TV viewing among older adults should be established to contribute to attenuating cognitive aging. More interventional studies can help older adults, caregivers, and healthcare professionals explore the cognitively beneficial alternatives to TV use considering the impact of socioeconomic factors of selecting TV viewing as a preferred leisure activity.

Download Full-text

Comparison of adverse perinatal outcomes after single-needle and double-needle CVS techniques

Journal of Perinatal Medicine ◽

10.1515/jpm-2015-0360 ◽

2017 ◽

Vol 45 (2) ◽

Author(s):

Cenk Gezer ◽

Atalay Ekin ◽

Gokhan Goynumer ◽

Kaan Pakay ◽

Hicran Acar ◽

...

Keyword(s):

Significant Risk ◽

Perinatal Outcomes ◽

Invasive Procedure ◽

Significant Risk Factor ◽

Adverse Outcomes ◽

Control Group ◽

Needle Technique ◽

Adverse Perinatal Outcomes ◽

Chorion Villus ◽

The Impact

AbstractObjective:To determine the impact of the chorion villus sampling (CVS) technique on adverse perinatal outcomes.Methods:In this case-control study, 412 women who underwent CVS at 11–14 weeks of gestation and 231 women who did not undergo any invasive procedure were retrospectively evaluated. The women in the CVS group were further divided into two groups according to the use of single-needle technique (n=148) vs. double-needle technique (n=264). The adverse outcomes were compared between controls and the two CVS groups, and regression analysis was used to determine the significance of independent contribution.Results:The rate of preeclampsia for the control group was 2.2%, for the double-needle group was 3% and for the single-needle group was 8.1%. CVS with single-needle technique was found to be an independent and statistically significant risk factor for preeclampsia [odds ratio (OR)=2.1, 95% confidence interval (CI); 1.4–2.7, P=0.008].Conclusion:The risk of preeclampsia after CVS appears to be increased with single-needle technique compared with double-needle technique.

Download Full-text

Study on the Relations of Supply Chain Digitization, Flexibility and Sustainable Development—A Moderated Multiple Mediation Model

Sustainability ◽

10.3390/su131810043 ◽

2021 ◽

Vol 13 (18) ◽

pp. 10043

Author(s):

Qian Zhou ◽

Shuxiang Wang

Keyword(s):

Sustainable Development ◽

Supply Chain ◽

Sustainable Growth ◽

Mediating Effect ◽

Collaborative Management ◽

Chain Flexibility ◽

The Sustainable Development ◽

Positive Effects ◽

Supply Chain Flexibility ◽

The Impact

In the face of an external environment featuring a high level of risk, multiple changes, and high uncertainty, the supply chain’s emergency replenishment, collaborative management, regulation of organic commodity, and low-cost rapid response will promote its’ sustainable growth and development, which is necessary for today’s economic development. The digitization and flexibility of the supply chain are of great value in obtaining the sustainable development of the supply chain. When dealing with an uncertain environment and market risk, current supply chain flexibility not only functions through its internal organizational flexibility, but also through collaborative creation and an extended supply chain network which will proactively form a replenishment supply sub-chain driven by the need for change responsiveness. This article constructs an associated model consisting of digitization, supply chain flexibility, and sustainability using an empirical analysis method to explore the implicit correlation of these factors. The analysis results of the mediating effect model show that both digitization and flexibility have significant positive effects on the sustainable development of the supply chain. Collaborative knowledge creation and supply chain flexibility play multiple mediating roles while market uncertainty positively moderates the impact of supply chain flexibility on supply chain sustainable development.

Download Full-text

Smoking and Incidence of Insomnia: a systematic review and meta-analysis of cohort studies

10.21203/rs.3.rs-27889/v3 ◽

2020 ◽

Author(s):

Nan Hu ◽

Chunyi Wang ◽

Yan Liao ◽

Qichen Dai ◽

Shiyi Cao

Keyword(s):

Systematic Review ◽

Cohort Studies ◽

Fixed Effects ◽

Meta Analysis ◽

Significant Risk ◽

Significant Risk Factor ◽

Pooled Analysis ◽

Study Characteristics ◽

Meta Analyses ◽

The Impact

Abstract Background: Both smoking and insomnia are worldwide problems and this study aims to investigate the impact of smoking on the incidence of insomnia. Methods: PubMed, EMBASE and OVID were searched through March, 2020. Cohort studies reporting the effect of smoking on the incidence of insomnia were included. We quantitatively analyzed the basic framework and study characteristics, and then pooled estimate effects with 95% confidence intervals (CIs) of outcomes of each included studies using fixed-effects meta-analyses. Results: This systematic review included six cohort studies involving 12445 participants. Quantitatively summarized results suggested smoking could significantly increase the incidence of insomnia (OR: 1.07, 95%CI: 1.02,1.13). Regular smoking was significantly associated with incidence of insomnia (OR=1.07, 95% CI:1.01,1.13). As for occasional smokers and ex-smokers, the pooled analysis didn’t indicate a significant association (occasional smoker: OR=2.09, 95% CI:0.44,9.95; ex-smoker; OR=1.02, 95% CI:0.67,1.54). Subgroup analysis by age, gender ratio and region showed statistically significant relationship between smoking and incidence of insomnia in specific groups. Conclusions: Integrated longitudinal observational evidence identified smoking as a significant risk factor of insomnia. Considering the limited amount of available studies, more high-quality and prospective cohort studies of large sample sizes are needed to explore details of this association.

Download Full-text

Cobalamin and Folate Evaluation: Measurement of Methylmalonic Acid and Homocysteine vs Vitamin B12 and Folate

Clinical Chemistry ◽

10.1093/clinchem/46.8.1277 ◽

2000 ◽

Vol 46 (8) ◽

pp. 1277-1283 ◽

Cited By ~ 217

Author(s):

George G Klee

Keyword(s):

Vitamin B12 ◽

Methylmalonic Acid ◽

Megaloblastic Anemia ◽

Significant Risk ◽

Vitamin B12 Deficiency ◽

Significant Risk Factor ◽

Nerve Degeneration ◽

Early Evaluation ◽

B12 Deficiency ◽

The Impact

Abstract Vitamin B12 and folate are two vitamins that have interdependent roles in nucleic acid synthesis. Deficiencies of either vitamin can cause megaloblastic anemia; however, inappropriate treatment of B12 deficiency with folate can cause irreversible nerve degeneration. Inadequate folate nutrition during early pregnancy can cause neural tube defects in the developing fetus. In addition, folate and vitamin B12 deficiency and the compensatory increase in homocysteine are a significant risk factor for cardiovascular disease. Laboratory support for the diagnosis and management of these multiple clinical entities is controversial and somewhat problematic. Automated ligand binding measurements of vitamin B12 and folate are easiest to perform and widely used. Unfortunately, these tests are not the most sensitive indicators of disease. Measurement of red cell folate is less dependent on dietary fluctuations, but these measurements may not be reliable. Homocysteine and methylmalonic acid are better metabolic indicators of deficiencies at the tissue level. There are no “gold standards” for the diagnosis of these disorders, and controversy exists regarding the best diagnostic approach. Healthcare strategies that consider the impact of laboratory tests on the overall costs and quality of care should consider the advantages of including methylmalonic acid and homocysteine in the early evaluation of patients with suspected deficiencies of vitamin B12 and folate.

Download Full-text