Mortality from various diseases of the circulatory system in the Russian Mayak nuclear worker cohort: 1948–2018

The paper reports on findings of the study of mortality from diseases of circulatory system (DCS) in Russian nuclear workers of the Mayak Production Association (22,377 individuals with 25.4% of females) who were hired at the facility in 1948–1982 and followed up until end-2018. Using the AMFIT module of EPICURE software, relative risks and excess relative risks per unit absorbed dose (ERR/Gy) for the entire Mayak cohort, the subcohort of workers who were residents of the dormitory town of Ozyorsk and the subcohort of migrants from Ozyorsk were calculated based on maximum likelihood. The mean cumulative liver absorbed gamma-ray dose from external exposure was 0.45 (0.65) Gy (mean (standard deviation) gray) for males and 0.37 (0.56) Gy for females. The mean cumulative liver absorbed alpha dose from internal exposure to incorporated plutonium was 0.18 (0.65) Gy for males and 0.40 (1.92) Gy for females. By the end of the follow-up, 6019 deaths from DCS as the main cause of death were registered among Mayak PA workers (including 3828 deaths in the subcohort of residents and 2191 deaths in the subcohort of migrants) over 890,132 (622,199/267,933) person-years of follow-up. The linear model that took into account non-radiation factors (sex, attained age, calendar period, smoking status and alcohol drinking status) and alpha radiation dose (via adjusting) did not demonstrate significant associations of mortality from DCS, ischemic heart disease (IHD) and cerebrovascular disease (CeVD) with gamma-ray exposure dose in the entire cohort, the resident subcohort and the migrant subcohort (either in males or females). For the subcohort of residents, a significant association with gamma dose was observed for mortality from ischemic stroke in males with ERR/Gy=0.43 (95% CI 0.08; 0.99); there were no significant associations with liver absorbed gamma dose for any other considered outcomes. As for internal exposure, for males no significant associations of mortality from any of the DCS with liver absorbed alpha dose were observed, but for females positive associations were found for DCS (the entire cohort and the resident subcohort) and IHD (the entire cohort) mortality. No significant associations of mortality from various types of DCS with neutron dose were observed either in males or females, although neutron absorbed doses were recorded only in 18% of the workers.

Coverage and Determinants of Infant Postnatal Care in Nigeria: a Population-based Cross-sectional Study

Background: In 2019, Nigeria had the most under-5 child deaths globally, many of which occurred within the neonatal period, especially in the first week after birth. Despite the effectiveness of infant postnatal care (PNC) attendance recommended by the World Health Organization (WHO), this problem persists. Therefore, the study examined coverage and determinants of infant PNC attendance in Nigeria. Methods: Nigeria Demographic Health Survey (NDHS) 2018 data were used to evaluate infant PNC coverage and determinants. Infant PNC was defined as receipt of care within two days of birth. Children delivered up to two years before the 2018 NDHS were included. We examined predictors of infant PNC with Poisson regression models to estimate relative risks (RR).Results: The national coverage of infant PNC was 37.3% (95% CI: 35.8%–38.7%). Significant heterogeneity in PNC attendance exists at state and regional levels. Facility delivery was strongly associated with uptake of PNC (RR: 6.07; 95% CI: 5.60–6.58). Greater maternal education, maternal employment, urban residence, female head of household, and greater wealth were also associated with increased likelihood of PNC visits. Conclusions: Uptake of infant PNC in Nigeria is low. Interventions are urgently needed to promote equity in access and increase demand.

Health and Economic Burden of the 2017 Portuguese Extreme Wildland Fires on Children

Wildland fires release substantial amounts of hazardous contaminants, contributing to a decline in air quality and leading to serious health risks. Thus, this study aimed to understand the contributions of the 2017 extreme wildland fires in Portugal on children health, compared to 2016 (with burned area, in accordance with the average of the previous 15 years). The impact of long-term exposure to PM10 and NO2 concentrations, associated with wildland fires, on postneonatal mortality, bronchitis prevalence, and bronchitis symptoms in asthmatic children was estimated, as well as the associated costs. The excess health burden in children attributable to exposure to PM10 and NO2, was calculated based on WHO HRAPIE relative risks. Fire emissions were obtained from the Fire INventory from NCAR (FINN). The results obtained indicate that the smoke from wildfires negatively impacts children’s lung function (PM10 exposure: increase of 320 and 648 cases of bronchitis in 2016 and 2017; NO2 exposure: 24 and 40 cases of bronchitis symptoms in asthmatic children in 2016 and 2017) and postneonatal mortality (PM10 exposure: 0.2 and 0.4 deaths in 2016 and 2017). Associated costs were increased in 2017 by around 1 million € for all the evaluated health endpoints, compared to 2016.

Temporal trends of sex differences for COVID-19 infection, hospitalisation, severe disease, intensive care unit (ICU) admission and death: a meta-analysis of 229 studies covering over 10M patients

Background: This review aims to investigate the association of sex with the risk of multiple COVID-19 health outcomes, ranging from infection to death. Methods: Pubmed and Embase were searched through September 2020. We considered studies reporting sex and coronavirus disease 2019 (COVID-19) outcomes. Qualitative and quantitative data were extracted using standardised electronic data extraction forms with the assessment of Newcastle Ottawa Scale for risk of bias. Pooled trends in infection, hospitalization, severity, intensive care unit (ICU) admission and death rate were calculated separately for men and women and subsequently random-effects meta-analyses on relative risks (RR) for sex was performed. Results: Of 10,160 titles, 229 studies comprising 10,417,452 patients were included in the analyses. Methodological quality of the included studies was high (6.9 out of 9). Men had a higher risk for infection with COVID-19 than women (RR = 1.14, 95%CI: 1.07 to 1.21). When infected, they also had a higher risk for hospitalization (RR = 1.33, 95%CI: 1.27 to 1.41), higher risk for severe COVID-19 (RR = 1.22, 95%CI: 1.17 to 1.27), higher need for Intensive Care (RR = 1.41, 95%CI: 1.28 to 1.55), and higher risk of death (RR = 1.35, 95%CI: 1.28 to 1.43). Within the period studied, the RR for infection and severity increased for men compared to women, while the RR for mortality decreased for men compared to women. Conclusions: Meta-analyses on 229 studies comprising over 10 million patients showed that men have a higher risk for COVID-19 infection, hospitalization, disease severity, ICU admission and death. The relative risks of infection, disease severity and death for men versus women showed temporal trends with lower relative risks for infection and severity of disease and higher relative risk for death at the beginning of the pandemic compared to the end of our inclusion period. PROSPERO registration: CRD42020180085 (20/04/2020)

Systematic Review and Meta-Analysis of Dysphagia and Associated Pneumonia in Patients With Stroke From India: A Call to Arms

Objectives: This study aimed to determine the prevalence of reported dysphagia and associated pneumonia risk among patients with stroke in India. Method: We carried out a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The primary outcome of interest was dysphagia and pneumonia among patients with stroke in India. Two review authors independently assessed the quality of studies using the Newcastle–Ottawa Scale and extracted related data. Meta-analysis was performed for frequency of dysphagia, associated pneumonia, and its relative risk using a random-effects model. Statistical heterogeneity was computed using the I 2 index. Results: A total of 3,644 titles were screened, and only eight studies met our inclusion criteria. Based on data from these studies, we calculated the pooled prevalence of dysphagia (47.71%; 95% confidence interval [CI] [20.49%, 70.92%], p < .001) and pneumonia (20.43%; 95% CI [10.73%, 30.14%], p < .001) for patients with stroke in India. We found that the relative risks of pneumonia in patients with stroke and dysphagia versus those patients with stroke and no dysphagia was 9.41 (95% CI [5.60, 15.80], p < .001). Data on length of hospital stay and rates of mortality secondary to pneumonia are also presented. Conclusions: Despite the high incidence of dysphagia and associated pneumonia, the methodological quality of studies is fair and there is little research focused on epidemiological data. We call to arms to those SLPs working with patients with stroke in India to become proactive in both clinical practice and research domains. Supplemental Material https://doi.org/10.23641/asha.17701022

Efficacy of combined antioxidant therapy in male subfertility-A systematic review and meta-analysis

Antioxidant therapy is a potentially promising approach to improve clinical outcomes for couples undergoing assisted reproduction techniques long-term. The review aims to (a) collate evidence for the effectiveness of combined oral antioxidant supplementation, including a head-to-head comparison in the treatment of male subfertility, and (b) investigate whether other intervention features, including duration, specific combinations, or dosage affect clinical outcomes in this population. Randomized controlled trials (RCTs) that examined the effectiveness of combined antioxidants on male subfertility, electronic databases including PubMed, Embase, CINAHL, PSYCHINFO, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched. We also searched for unpublished data and references of identified articles. Two reviewers screened eligible studies according to pre-defined criteria and relevant data extracted. The Jadad scale assessed the quality of studies. The study used RevMan version 5.4.1 Meta-analysis software to analyze the effect of combination antioxidants for each outcome measure. Metadata was presented as relative risks for dichotomous outcomes and as standardized mean differences (or mean differences) for continuous outcomes. The systematic review and meta-analysis aimed to report available evidence of whether combination antioxidant is effective and safe in sub-fertile men undergoing assisted reproductive techniques. Also, this review highlighted whether any specific oral antioxidant combinations, dosage, or duration of therapy have a major influence on the clinical outcomes.

Features of formation somatic pathologies under chronic exposure to hydrofluoride in the manufacture of titanic alloys

Introduction. Most studies on the morbidity of workers with fluorine compounds are devoted to occupational medicine at aluminium industry enterprises. The aim of the study is to identify the exposure, gender and evolutionary features of the formation of general somatic morbidity associated with chronic occupational exposure to hydrofluoride in the production of titanium alloys. Materials and methods. The analysis of the prevalence of chronic pathology according to the medical examination of 562 workers in contact with hydrofluoride and the incidence of temporary disability according to 29949 disability sheets in comparison with non-exposed persons of the same enterprise is given. Results. With an increase in the degree of harmfulness of working conditions, there was an augmentation increase in the risk of developing pathology of the respiratory organs, eyes, musculoskeletal system, arterial hypertension and hypercholesterolemia. In the working conditions of Class 3.1, an increased prevalence of diseases of the nervous and genitourinary systems with a moderate degree of occupational conditionality was revealed (relative risks (RR) 1.6 and 2.0, respectively, р < 0.05), class 3.2 - a high degree of professional conditionality of respiratory diseases (RR = 2.8). When working in harmful working conditions, there was an average degree of occupational conditionality of nervous system diseases in women (RR = 1.9) and a small degree of arterial hypertension in men (RR = 1.2). The prevalence of general somatic pathology in all age groups was higher than in non-exposed persons of the same age. Conclusion. Hydrofluoride in the production of titanium alloys was proved to be a trigger contributing to the formation of the pathology of the respiratory, circulatory, digestive, ear, eyes, skin, blood, musculoskeletal, nervous, endocrine, and genitourinary systems.

Microscopic Colitis Is Associated With a Reduced Risk of Colorectal Adenoma and Cancer: A Meta-Analysis

Background The study sought to conduct a systematic review and meta-analysis of the risk of colorectal adenoma or cancer in patients with microscopic colitis (MC). Methods A comprehensive literature search of PubMed and EMBASE databases was performed. Pooled relative risks (RRs) and 95% confidence intervals (CIs) were calculated to examine the effect of MC on the risk of colorectal adenoma or cancer. Results Twelve studies reporting the outcomes of 50 795 patients with MC were eligible for this meta-analysis. MC was negatively associated with the risk of colorectal adenoma compared with participants without MC (RR, 0.44; 95% CI, 0.33-0.58; P &lt; .001; I2 = 87.3%). Also, the rate of colorectal cancer was lower in the patients with MC compared with the general population (RR, 0.62; 95% CI, 0.43-0.89; P = .01; I2 = 91.6%). In addition, sensitivity and subgroup analyses indicated that the results were robust. Conclusions The present systematic review indicated that patients with MC may be associated with a lower risk of colorectal adenoma or cancer. The clinical data support the current professional society guideline. A surveillance colonoscopy program is not recommended as standard for patients with MC.

Midazolam Increases The Risk of Delirium In Critically Ill Patients: A Propensity Score Analysis.

BACKGROUND: Midazolam is commonly administered in the intensive care unit (ICU) because of its limited effect on hemodynamics and stable calming and sleep-induction effects. Recent concerns about an increased risk of delirium associated with midazolam have resulted in decreased midazolam usage in the ICU. However, whether midazolam administration within 24 hours prior is related to the occurrence of delirium is still unknown.METHODS: We used real-world data from MIMIC III v1.4, MIMIC-IV v0.4 and eICU Collaborative Research to perform comparisons and assess the associated outcome effectiveness. We performed a systematic study with two cohorts to estimate the relative risks of outcomes among patients administered midazolam within 24 hours prior to delirium assessment. Propensity score matching was performed to generate a balanced 1:1 matched cohort and to identify potential prognostic factors. The outcomes included mortality, length of ICU stay, length of hospitalization, and odds of being discharged home.RESULTS: Propensity matching successfully balanced covariates for 9,348 patients (4,674 per group). There was no significant difference in hospitalization duration, (P = 0.03). However, compared to no administration of midazolam, midazolam administration was associated with a significantly higher risk for delirium (P<0.001). When compared with no midazolam administration, the use of midazolam, was associated with higher mortality and a longer ICU stay (P<0.001). Patients treated with midazolam were relatively less likely to be discharged home (P<0.001). CONCLUSIONS: Compared with no administration of midazolam, midazolam administration was associated with a difference in the incidence of delirium, mortality, ICU stay and likelihood of being discharged home but was not associated with hospitalization duration. These data suggest that midazolam may not be the preferred sedative drug for patients at risk for delirium.