Weekend Mortality in an Italian Hospital: Immediate versus Delayed Bedside Critical Care Treatment

Background: a number of studies highlighted increased mortality associated with hospital admissions during weekends and holidays, the so–call “weekend effect”. In this retrospective study of mortality in an acute care public hospital in Italy between 2009 and 2015, we compared inpatient mortality before and after a major organizational change in 2012. The new model (Model 2) implied that the intensivist was available on call from outside the hospital during nighttime, weekends, and holidays. The previous model (Model 1) ensured the presence of the intensivist coordinating a Medical Emergency Team (MET) inside the hospital 24 h a day, 7 days a week. Methods: life status at discharge after 9298 and 8223 hospital admissions that occurred during two consecutive periods of 1185 days each (organizational Model 1 and 2), respectively, were classified into “discharged alive”, “deceased during nighttime–weekends–holidays” and “deceased during daytime-weekdays”. We estimated Relative Risk Ratios (RRR) for the associations between the organizational model and life status at discharge using multinomial logistic regression models adjusted for demographic and case-mix indicators, and timing of admission (nighttime–weekends–holidays vs. daytime-weekdays). Results: there were 802 and 840 deaths under Models 1 and 2, respectively. Total mortality was higher for hospital admissions under Model 2 compared to Model 1. Model 2 was associated with a significantly higher risk of death during nighttime–weekends–holidays (IRR: 1.38, 95% CI 1.20–1.59) compared to daytime–weekdays (RRR: 1.12, 95% CI 0.97–1.31) (p = 0.04). Respiratory diagnoses, in particular, acute and chronic respiratory failure (ICD 9 codes 510–519) were the leading causes of the mortality excess under Model 2. Conclusions: our data suggest that the immediate availability of an intensivist coordinating a MET 24 h, 7 days a week can result in a better prognosis of in-hospital emergencies compared to delayed consultation.

Comparative Insecticidal Effects of Dry Ocimum Gratissium (Scent Leaves) and Rambo™ Paper on Mosquitoes in Jos, Nigeria

Insecticides are chemicals or biological substances that are used to kill or disable insects. Blood feeding mosquitoes are responsible for the intolerable biting nuisance and transmission of large number of diseases such as malaria, yellow fever, dengue fever, filarias is amongst others, causing serious health problems to humans and obstacles to socioeconomic development of developing nations like Nigeria. The insecticidal effect of scent leaves (Ocimum gratissum) and Rambo™ paper on mosquitoes was investigated. The study is aimed at comparing the insecticidal effects of Ocimum gratissimum and Rambo™ paper on mosquitoes in Jos. 100 mosquitoes were exposed to dried Ocimum gratissum and Rambo™ paper at different time intervals of 5, 10 and 12 min. Results obtained showed a time dependent insecticidal effect on mosquitoes, which was 54.2%, 54.0% and 55.6% total mortality of mosquitoes at respective time intervals on exposures to both Rambo™ paper insecticide and Osimum gratissum, indicating that there was a significant difference in the lethal effect of Rambo™ paper insecticide and scent leave on mosquitoes at (p<0.05). In comparing the lethal effect of Rambo™ paper insecticide and Ocimum grasstisimum on mosquitoes at differnt locations in Jos, at Dogon Karfe, after 10 min of treatment, Rambo™ paper had the highest lethal effect of 21 (84.0%) compared to scent leaves 6 (24.0%) and at Abattoir Jos, after 12 min of treatment, Rambo™ paper had the highest lethal effect of 17 (94.4%) compared to Ocimum grasstisimum 3 (16.7%). These comparisons were significant at p 0.05. This study provides evidence that Ocimum grasstisimum has a mosquitocidal effect. However, the Rambo™ paper gave a better mosquitocidal effect than Ocimum grasstisimum. There is a need to discover better additive or extract options that could give Ocimum grasstisimum a better effect as a natural product available in Africa towards the malaria eradication programme.

On Catastrophic Increase in Mortality and Measures to Save the People in Russia

How is it that in Russia, unlike in other countries, during the coronavirus pandemic the total mortality increased by a record amount and the income and consumption of the population decreased to the greatest extent? The point is that the crisis, caused by the coronavirus pandemic, is completely different from previous ones. It highlights the dilemma: should we use forces and means to prevent an economic recession with lower costs for anti-crisis measures, or focus on saving people's lives while minimizing additional mortality and maintaining real incomes of the population? Each country, depending on objectives, prevailing conditions and opportunities, chooses its “golden mean”. In many cases such choice is not fully conscious, since it's not possible to forecast with any certainty even over the near term. Decisions have to be taken up along the way, based on the situation and assessing the probability of certain events, including in view of the other countries' experience in combating the pandemic.

Efficacy and Safety of Shengmai Preparation Combined with Western Medicine for Coronary Heart Disease: A Systematic Review and Meta-Analysis

The efficacy and safety of Shengmai preparation combined with Western medicine (SMP–WM) to treat coronary heart disease (CHD) were reviewed. Twenty-five randomized controlled trials of SMP–WM treatment for CHD were retrieved from seven databases and other trial sources between their inception and April 10, 2021. The risk of bias domains was accessed by Cochrane Collaboration’s tool, and the data were statistically analyzed using RevMan 5.3 and Stata 12.0 software. The majority of included studies had a low or unclear risk of overall bias. Total mortality was not reduced (RR = 0.39, 95% CI: 0.13–1.19, [Formula: see text] = 0.10), but the cardiovascular events (RR = 0.35, 95% CI: 0.22–0.54, [Formula: see text] < 0.01), weekly frequency (SMD = −2.38, 95% CI: −2.89 – −1.88, [Formula: see text] < 0.01), and duration (SMD = −3.24, 95% CI: −3.76 – −2.71, [Formula: see text] < 0.01) of angina pectoris attacks were significantly decreased by SMP–WM. The SMP–WM combination exerted antiplatelet activity by reducing platelet adhesion (SMD = −0.97, 95% CI: −1.49 – −0.45, [Formula: see text] = 0.0003) and the platelet reactivity index (SMD = −1.75, 95% CI: −2.04 – −1.46, [Formula: see text] < 0.01). SMP–WM could protect endothelial function by increasing nitric oxide (SMD = 1.28, 95% CI: 0.54–2.02, [Formula: see text] < 0.01) and decreasing endothelin (SMD = −1.26, 95% CI: −1.85 – −0.66, [Formula: see text] < 0.01). The combination also improved hemorheology by reducing whole blood viscosity (SMD = −1.59, 95% CI: −2.32 – −0.85, [Formula: see text] < 0.01), plasma viscosity (SMD = −0.65, 95% CI: −0.86 – −0.45, [Formula: see text] < 0.01), and fibrinogen (SMD = −4.21, 95% CI: −4.58 – −3.83, [Formula: see text] < 0.01). The SMP–WM combination favorably impacts cardiovascular events, angina symptoms, endothelial function, platelet aggregation, and blood viscosity, with comparable safety to that of routine Western medicine. Further investigation is required to enhance the strength of the evidence.

EPIDEMIOLOGICAL STUDY OF TRAUMA IN A TERTIARY CARE CENTRE IN NORTHWEST INDIA

Objective: Traumatic injuries are a matter of concern worldwide. However, the rapidly changing socio economical dynamics in a developing country like India deeply influence the epidemiology behind trauma. The aim of this study was to document and analyze the epidemiological parameters and characteristics behind trauma victims admitted to our tertiary care centre. Methods: The observational study was carried out over a period of one year (January 2019 to December 2019) enrolling a total of 300 trauma patients. The age, sex, locality, delay in hospitalization, mechanism of injury, sites of injury and outcomes were documented. Results: Injuries occurred predominantly in the 20-40 age group with males being the chief victims. There was a considerable amount of delay in hospitalization ranging from one hour to more than 24 hours while only 7 patients arrived to the emergency within one hour of trauma. Vehicular trauma (54%) was the most common mechanism of injury. Injuries to the extremities (38.6%) and head (28.6%) were the most common sites. A considerable number of patients (45.3%) required care in the intensive care unit. A total of 172 patients required surgical interventions of various kinds and there was a total mortality rate of 6%. Amongst the polytrauma cases, 54 patients (81.8%) required ICU admission, 42 patients (63.6%) required surgical intervention and 6 patients (9.1%) died after admission. Conclusion: The results of this study highlight some of the problems with our existing infrastructure bringing to light the need for stricter enforcement of traffic safety laws and improvement of infrastructure particularly the roadways in rural areas as well as the referral systems. Vehicular trauma should be seen as a public health problem and appropriate interventions should be implemented. Keywords: Trauma, Road Traffic Accidents, Epidemiology, Head injuries

Growth Parameters of Sentani Gudgeon Fish (Oxyeleotris heterodon) in Sentani Lake, Papua

ABSTRACTThe Sentani Gudgeon Fish (Oxyeleotris heterodon, Weber 1907) from the family Butidae with the general name Sentani Gudgeon is known locally as Gabus Malas and Himen. Sentani Snakehead Fish is one source of animal protein that is very important for the community around Lake Sentani. The population of the Sentani Gudgeon Fish species is at a crucial level. The issue could be affected by environmental pressures, continuous catches, competition with introduced species from outside Papua, intensive predation systems, and imbalances in ecological systems. The condition made a decline in population size until it became extinct. Gudgeon Sentani fish is the main target of catching in the lake. This condition significantly affects stock, size when first captured, population decline, reproductive cycle, and average catch. Until now, data and information on the growth of snakehead fish as the basis for fisheries management in the waters of Lake Sentani are not widely known. Considering the importance of preserving the native species of Lake Sentani, especially the Snakehead Fish, efforts to manage the fisheries in Lake Sentani's waters are urgent. This research was conducted in March - October 2020, located at Lake Sentani. The specimens were obtained from the catch of fishers with various gill nets and chopsticks. Enumerators or field assistants assisted the recording of the number and measurement of the total length of fish caught by fishermen daily. The results of the analysis showed: asymptotic size (L?) 46.20 cm, growth coefficient (K) 0.29, the total mortality rate (Z) 0.80 per year, natural mortality (M) 0.74 per year, the mortality rate due to fishing (F) 0.06 per year and exploitation rate (E) 0.075 per year.

Are Wealthier Times Healthier in Cities? Economic Fluctuations and Mortality in Urban Areas of Latin America

Objective: To analyze the relationship between economic conditions and mortality in cities of Latin America.Methods: We analyzed data from 340 urban areas in ten countries: Argentina, Brazil, Chile, Colombia, Costa Rica, Guatemala, Mexico, Panama, Peru, and El Salvador. We used panel models adjusted for space‐invariant and time‐invariant factors to examine whether changes in area gross domestic product (GDP) per capita were associated with changes in mortality.Results: We find procyclical oscillations in mortality (i.e., higher mortality with higher GDP per capita) for total mortality, female population, populations of 0–9 and 45+ years, mortality due to cardiovascular diseases, malignant neoplasms, diabetes mellitus, respiratory infections and road traffic injuries. Homicides appear countercyclical, with higher levels at lower GDP per capita.Conclusions: Our results reveal large heterogeneity, but in our sample of cities, for specific population groups and causes of death, mortality oscillates procyclically, increasing when GDP per capita increases. In contrast we find few instances of countercyclical mortality.

Risk factors for excess all-cause mortality during the first wave of the COVID-19 pandemic in England: A retrospective cohort study of primary care data

Background The COVID-19 pandemic’s first wave in England during spring 2020 resulted in an approximate 50% increase in all-cause mortality. Previously, risk factors such as age and ethnicity, were identified by studying COVID-related deaths only, but these were under-recorded during this period. Objective To use a large electronic primary care database to estimate the impact of risk factors (RFs) on excess mortality in England during the first wave, compared with the impact on total mortality during 2015–19. Methods Medical history, ethnicity, area-based deprivation and vital status data were extracted for an average of 4.8 million patients aged 30–104 years, for each year between 18-March and 19-May over a 6-year period (2015–2020). We used Poisson regression to model total mortality adjusting for age and sex, with interactions between each RF and period (pandemic vs. 2015–19). Total mortality during the pandemic was partitioned into "usual" and "excess" components, assuming 2015–19 rates represented "usual" mortality. The association of each RF with the 2020 "excess" component was derived as the excess mortality ratio (EMR), and compared with the usual mortality ratio (UMR). Results RFs where excess mortality was greatest and notably higher than usual were age >80, non-white ethnicity (e.g., black vs. white EMR = 2.50, 95%CI 1.97–3.18; compared to UMR = 0.92, 95%CI 0.85–1.00), BMI>40, dementia, learning disability, severe mental illness, place of residence (London, care-home, most deprived). By contrast, EMRs were comparable to UMRs for sex. Although some co-morbidities such as cancer produced EMRs significantly below their UMRs, the EMRs were still >1. In contrast current smoking has an EMR below 1 (EMR = 0.80, 95%CI 0.65–0.98) compared to its UMR = 1.64. Conclusions Studying risk factors for excess mortality during the pandemic highlighted differences from studying cause-specific mortality. Our approach illustrates a novel methodology for evaluating a pandemic’s impact by individual risk factor without requiring cause-specific mortality data.

Stocking rate of extensive land-reform livestock farmers during 2018/2019 drought: Bloemfontein grassland biome case study

The study aimed to determine the average stocking rate among land reform beneficiary farmers specialising in livestock production in order to establish differences between calving percentage, fodder availability, and mortality rate of sampled farms, as well as to compare forage scarcities of Land Reform farms with their neighbouring farms during the midsummer drought of 2018/2019 in the Bloemfontein area. The average stocking rate was 5.9 ha/LSU in comparison with the Departmental grazing capacity norm of 6 ha/LSU for rangeland in good condition. However, 31% of the sampled farms were found to be severely overstocked, and the mortality rate on these farms, in relation to grazing capacity of 6 ha/LSU, was significantly higher (P < 0.05) than the mortalities on the other remaining farms. Naturally available fodder was found to be heterogeneous, with 37.9% of the respondents observing their available fodder as worse than that of their neighbours. The total mortality of 176.77 LSUs was recorded for the 29 sampled farms. These findings will assist the local extension personnel prevent future rangeland condition degradation and increase land reform farmers’ productivity. The study concluded that training is paramount to farmers’ development and further recommends more research undertakings.