COVID-19: Contrasting experiences of South African physiotherapists based on patient exposure

Background: The coronavirus disease 2019 (COVID-19) pandemic has exposed physiotherapists to unique work-related challenges. However, there is a lack of research regarding the mental health and lived experiences of South African physiotherapists during the COVID-19 pandemic.Objectives: To determine levels of mental and physical health, burnout, depression, anxiety and resilience and coping strategies used by a sample of South African physiotherapists with and without exposure to patients with COVID-19. Lived work experience, perceived health and sources of support were also explored.Method: A non-experimental, cross-sectional, mixed-method design was used. Physiotherapists completed an online survey comprising: a demographic questionnaire; scales assessing mental and physical health, burnout, depression, anxiety and coping strategies and six open-ended questions. A total of 171 physiotherapists participated in our study, 43.3% of whom were exposed to patients with COVID-19.Results: The exposure group scored significantly higher on self-reported mental health, anxiety, depression and burnout than the non-exposure group. No significant differences were reported for physical health and resilience. Significantly more maladaptive coping strategies were employed by the exposure group. Participants’ lived experiences highlighted similar experiences, as well as work-related challenges. Both groups reported that primary sources of support were significant others, but highlighted the lack of organisational support.Conclusion: Irrespective of the degree of exposure to COVID-19, the mental health and lived experiences of physiotherapists working in South Africa has been negatively impacted by COVID-19.Clinical implications: Understanding physiotherapists’ well-being and lived experiences during the pandemic may guide workplace interventions. Our findings suggest the need for psycho-educational intervention programmes to be implemented at an organisational level.

Propensity score analysis of the association between maternal exposure to second-hand tobacco smoke and birth defects in Northwestern China

Previous studies have suggested that maternal active smoking can increase the risk of birth defects, but evidence on second-hand tobacco smoke (SHS) is limited. We aimed to assess the association between maternal exposure to SHS and birth defects in a Chinese population. The data were based on a large-scale cross-sectional survey conducted in Shaanxi Province, China. Considering the characteristics of survey design and the potential impact of confounding factors, we adopted propensity score matching (PSM) to match the SHS exposure group and the non-exposure group to attain a balance of the confounders between the two groups. Subsequently, conditional logistic regression was employed to estimate the effect of SHS exposure on birth defects. Furthermore, sensitivity analyses were conducted to verify the key findings. After nearest neighbor matching of PSM with a ratio of 2 and a caliper width of 0.03, there were 6,205 and 12,410 participants in the exposure and control group, respectively. Pregnant women exposed to SHS were estimated to be 58% more likely to have infants with overall birth defects (OR = 1.58, 95% CI: 1.30–1.91) and 75% more likely to have infants with circulatory system defects (OR = 1.75, 95% CI: 1.26–2.44). We also observed that the risk effect of overall birth defects had an increasing trend as the frequency of exposure increased. Additionally, sensitivity analyses suggested that our results had good robustness. These results indicate that maternal exposure to SHS likely increases the risk of overall birth defects, especially circulatory system defects, in Chinese offspring.

Toxicity Evaluation of Chlorpyrifos Metabolite 3,5,6-trichloro-2-pyridinol to Eisenia Fetida in Different Soils

The present study utilized a biomarker response method to evaluate the effect of 3,5,6-trichloro-2-pyridinol (TCP) in artificial and natural soils on Eisenia fetida after 7, 14, 28, 42 and 56 days exposure. Results indicated that TCP induced excessive reactive oxygen species, caused oxidative stress and DNA damage to Eisenia fetida. Biomarker responses were standardized to calculate the Integrated Biomarker Response (IBR) index. The IBR index of three enzymes activities showed that TCP induced the enzymes activities of earthworm in red clay was stronger than the other three soils. Specifically, chlorpyrifos exposure group showed a lower toxicity than TCP exposure group after 28 days exposure but a higher toxicity than TCP exposure group after 56 days exposure. Despite the deficiencies of this study, the above information is of great significance for assessing the risk of chlorpyrifos and its metabolite TCP pollution in soil ecosystems.

Brain Activity after Intermittent Hypoxic Brain Condition in Rats

Hypoxic brain injury is accompanied by a decrease in various functions. It is also known that obstructive sleep apnea (OSA) can cause hypoxic brain injury. This study aimed to produce a model of an intermittent hypoxic brain condition in rats and determine the activity of the brain according to the duration of hypoxic exposure. Forty male Sprague–Dawley rats were divided into four groups: the control group (n = 10), the 2 h per day hypoxia exposure group (n = 10), the 4 h per day hypoxia exposure group (n = 10), and the 8 h per day hypoxia exposure group (n = 10). All rats were exposed to a hypoxic chamber containing 10% oxygen for five days. Positron emission tomography–computed tomography (PET-CT) brain images were acquired using a preclinical PET-CT scanner to evaluate the activity of brain metabolism. All the rats were subjected to normal conditions. After five days, PET-CT was performed to evaluate the recovery of brain metabolism. Western blot analysis and immunohistochemistry were performed with vascular endothelial growth factor (VEGF) and brain-derived neurotrophic factor (BDNF). The mean SUV was elevated in the 2 h per day and 4 h per day groups, and all brain regions showed increased metabolism except the amygdala on the left side, the auditory cortex on the right side, the frontal association cortex on the right side, the parietal association cortex on the right side, and the somatosensory cortex on the right side immediately after hypoxic exposure. However, there was no difference between 5 days rest after hypoxic exposure and control group. Western blot analysis revealed the most significant immunoreactivity for VEGF in the 2, 4, and 8 h per day groups compared with the control group and quantification of VEGF immunohistochemistry showed more expression in 2 and 4 h per day groups compared with the control group. However, there was no significant difference in immunoreactivity for BDNF among the groups. The duration of exposure to hypoxia may affect the activity of the brain due to angiogenesis after intermittent hypoxic brain conditions in rats.

Lack of pulmonary fibrogenicity and carcinogenicity of titanium dioxide nanoparticles in 26-week inhalation study in rasH2 mouse model

Background: With the rapid development of alternative methods based on the spirit of animal welfare, the publications of animal studies evaluating endpoints such as cancer have been extremely reduced. There have been no systemic inhalation exposure studies of titanium dioxide nanoparticles (TiO2 NPs) using CByB6F1-Tg(HRAS)2Jic (rasH2) 26-week study mice model for detecting carcinogenicity. Methods: Male and female rasH2 mice were exposed to 2, 8 or 32 mg/m3 of TiO2 NPs for 6 hours/day, 5 days/week for 26 weeks using a whole-body inhalation exposure system, with reference to the Organization for Economic Co-operation and Development principles of Good Laboratory Practice. All tissues including lungs, and blood were collected and subjected to biological and histopathological analyses. Additionally, Ki67 positive index were evaluated in mice lung alveolar epithelial type 2 cell (AEC2). Results: This study established a stable method for generating and exposing TiO2 NPs aerosol, and clarified the dose-response relationship by TiO2 NPs inhalation to rasH2 mice. TiO2 NPs exposure induced deposition of particles in lungs and mediastinal lymph nodes in a dose-dependent manner in each exposure group. Additionally, alveolar inflammation was only observed in 32 mg/m3 exposure group in both the sexes. Exposure to TiO2 NPs, as well as other organs, did not increase the incidence of lung tumors in any group, and pulmonary fibrosis and pre-neoplastic lesions were not observed in all groups. Finally, the cell proliferative activity of AEC2 was examined, and it was not increased by exposure to TiO2 NPs. Conclusions: This is the first report showing the lack of pulmonary fibrogenicity and carcinogenicity (no evidence of carcinogenic activity) of TiO2 NPs in 26-week inhalation study in rasH2 mice exposed up to 32 mg/m3, which is considered to be a high concentration. Macrophages undergoing phagocytosis due to TiO2 NPs exposure formed inflammatory foci in the alveolar regions of exposed mice but did not develop fibrosis or hyperplasia or tumors. Moreover, the cell proliferative ability of AEC2 in lesions was not increased. In addition, no carcinogenicity was observed for any organs other than the lungs in this study.

Combined Negative Effects of Microplastics and Plasticizer DEHP: the Increased Release of Nets Delays Wound Healing

Introduction: Environmental pollutants microplastics (MPs) and di (2-ethyl) hexyl phthalate (DEHP) can cause damage to multiple organs by causing oxidative stress. Oxidative stress participates in the healing of skin wounds through the release of neutrophil extranets (Nets). Here, we studied the effects of DEHP and MPs on skin wound healing in mice after single and combined exposure for 1 month. Results: The results showed that MPs delayed the healing of skin wounds, and the combination of the two delayed wound healing more significantly. The results of in vivo and in vitro experiments showed that the release of oxidative stress and Nets in the single exposure group increased, and the combined exposure group increased more. Further mechanism studies showed that the skin chemokines of the single exposure group increased, the NF-κB pathway was activated, the Wnt pathway was inhibited, and the epidermal growth factor and fibrosis-related indicators decreased. The combined exposure group showed a more obvious trend.Conclusion: In summary, the above results indicate that DEHP combined with MPs induces an increase in the release of Nets by causing excessive skin ROS production and increases the expression of chemokines and interferes with the expression of healing factors by regulating the NF-κB and Wnt pathways.

Association between magnesium in drinking water and atrial fibrillation incidence: a nationwide population-based cohort study, 2002–2015

Background Atrial fibrillation (AF) is a common heart rhythm disorder and a risk factor of adverse cardiovascular diseases. Established causes do not fully explain the risk of AF and unexplained risk factors might be related to the environment, e.g. magnesium in drinking water. Low magnesium levels in drinking water might be associated with higher risk of cardiovascular diseases including AF. With detailed individual data from nationwide registries and long-term magnesium exposure time series, we had a unique opportunity to investigate the association between magnesium in drinking water and AF. Objective We evaluated the association between magnesium concentration in drinking water and AF risk. Methods A nationwide register-based cohort study (2002–2015) was used including individuals aged ≥30 years. Addresses were linked with water supply areas (n = 2418) to obtain time-varying drinking water magnesium exposure at each address. Five exposure groups were defined based on a 5-year rolling time-weighted average magnesium concentration. AF incidence rate ratios (IRRs) between exposure groups were calculated using a Poisson regression of incidence rates, adjusted for sex, age, and socioeconomic position. Robustness of results was investigated with different exposure definitions. Results The study included 4,264,809 individuals (44,731,694 person-years) whereof 222,998 experienced an incident AF. Magnesium exposure ranged from 0.5 to 62.0 mg/L (mean = 13.9 mg/L). Estimated IRR (95% CI) compared to the referent exposure group (< 5 mg/L) was 0.98 (0.97–1.00) for the second lowest exposure group (5–10 mg/L), and 1.07 (1.05–1.08) for the two highest exposure groups (15–62 mg/L). Strongest positive associations were observed among those aged ≥80 years and with lowest education group. An inverse association was found among individuals with highest education group. Conclusion There might be a small beneficial effect on AF of an increase in magnesium level in drinking water up to 10 mg/L, though an overall positive association was observed. The unexpected positive association and different associations observed for subgroups suggest a potential influence of unaccounted factors, particularly in vulnerable populations. Future research on magnesium in drinking water and cardiovascular diseases needs to focus on contextual risk factors, especially those potentially correlating with magnesium in drinking water.

Neonatal Magnesemia in Preterm Neonates Unexposed to Maternal MgSO4 Administration and in Neonates Exposed for Fetal Neuroprotection or Maternal Eclampsia Prevention.

Objective - To compare neonatal magnesemia in the first fifteen days of neonatal life between three groups: a control group not exposed to MgSO4, a neuroprotection group, and an eclampsia prevention group, and to explore its’ associations with child outcomes. Design - Retrospective single-centre cohort study. Setting - Tertiary care setting. Population - Infants admitted at the neonatal intensive care unit born between 24 and 32 weeks’ gestation, regardless of etiology of preterm birth.Methods - Linear mixed regression of neonatal magnesemia on exposure group and day of life. Generalised estimating equations models of child outcomes on neonatal magnesemia according to exposure group and day of life. Main outcome measures - Neonatal magnesemia (mmol/l). Results - Neonatal magnesemia is significantly higher in the preeclampsia group compared to the control and neuroprotection group. On the day of birth, this is irrespective of maternal magnesemia (preeclampsia vs control group), and the maternal total dose or duration of MgSO4 administration (preeclampsia vs neuroprotection group). No differences were found in short-term composite outcome between the three groups. Conclusions - We found mean differences in neonatal magnesemia between children not exposed to MgSO4 antenatally, children exposed for fetal neuroprotection, and children exposed for maternal eclampsia prevention. A 4g loading and 1g/h maintenance dose, for fetal neuroprotection and eclampsia prevention, appears to be safe on the short term for the neonate.

Identifying high-risk comorbidities of short and long-term opioid prescription use

Background Electronic health records (EHR) are useful tools for understanding complex medical phenotypes, but they have been underutilized for opioid use disorders (OUD). Patterns of prescription opioid use might provide an objective measure of OUD risk. Methods We extracted data for over 2.6 million patients across three health registries (Vanderbilt University Medical Center, Mass General Brigham, Geisinger) between 2005 and 2018. We defined three groups based on levels of opioid exposure: No Prescription, Minimal Exposure (2 prescriptions within 90 days at least once, but never 3 prescriptions <90 days apart), and Chronic Exposure (≥10 opioid prescriptions in a year), and compared them to the full registries and to patients with OUD diagnostic codes. We extracted demographic and clinical characteristics known to co-occur with OUD, including psychiatric and substance use disorders, pain-related diagnoses, HIV, and hepatitis C. Results The prevalence of substance (alcohol, tobacco, cannabis) use disorders was higher in patients with OUD and Chronic Exposure than those with No Prescription or Minimal Exposure. Patients in the OUD and Chronic Exposure groups had more psychiatric (anxiety, depression, schizophrenia, bipolar disorder) and medical comorbidities (pain, hepatitis C, HIV) than those in the Minimal Exposure group. Notably, patients in the Minimal Exposure group had different comorbidity profiles (higher rates of substance use and psychiatric disorders, more pain conditions) than those in the Unscreened or No Prescription groups, highlighting the value of including opioid exposure in studies of OUD. Conclusions Long-term opioid prescription use may serve as an additional tool to characterize OUD risk.

Scaling a Community-Wide Campaign Intervention to Manage Hypertension and Weight Loss

Public health impacts can be achieved when evidence-based interventions are implemented to those most in need. Too often implementation never or slowly occurs. The community-wide campaign intervention Tu Salud ¡Si Cuenta! has evidence of improving health outcomes related to chronic disease among low-income, Latinos. Using the RE-AIM Framework, this study examined if the scaled-up version of the intervention is associated with improvements in hypertension and obesity in 12 locations. Each element of the RE-AIM framework was examined. For “Effectiveness,” we examined outcomes overall and by implementing location. We used linear and logistic regression to assess if exposure in the intervention was associated with improvement in hypertension and weight loss. Participants were stratified into “low exposure” (2–3 outreach visits) vs. “high exposure” (4–5 outreach visits). Based on the RE-AIM Framework, the intervention “reached” its intended population of low-income Latinos, demonstrated “effectiveness” in improving hypertension and obesity, was “adopted” at a high level in all but one site, was “implemented” with fidelity to the intervention model with moderate success across locations, and showed high “maintenance” over time. For effectiveness specifically, we found that out of 5,019 participants, 2,508 (50%) had a baseline hypertensive blood pressure (BP) reading. Of the 2,508, 1,245 (49.9%) recovered to normal blood pressure or pre-hypertension stage by last follow-up. After adjusting for baseline BP and potential confounders in multivariable linear regression models, the high exposure group had significantly more reduction in systolic BP (adjusted mean difference in % change = −0.96; p = 0.002) and diastolic BP (adjusted mean difference in % change = −1.61; p &lt; 0.0001) compared to the low exposure group. After controlling for baseline weight and other confounders, the high exposure group had significantly greater decrease in weight compared to the low exposure group (adjusted mean difference in % change = −1.28; p &lt; 0.0001). Results from the multivariable logistic regression models indicated that compared to the low exposure group the high exposure group was more likely to achieve a clinically significant minimum 5% weight loss [adjusted odds ratio (OR) = 2.97; p &lt; 0.0001). This study contributes evidence that a Community-Wide Campaign model holds promise for addressing hypertension and obesity among low-income Latinos.