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Objectives: The US Preventive Services Task Force lowered the recommended starting age for colorectal cancer (CRC) screening in average‐risk adults from 50 to 45 years. We aimed to estimate the global burden and trends of colorectal cancer in adults aged 20–49 years (early‐onset CRC). Methods: This is an analysis of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019). The GBD 2019 estimation methods were used to describe the incidence, mortality, and disability‐adjusted life years (DALYs) of early CRC from 1990 to 2019. Data from 204 countries and geographic areas were available. Results: The global incidence rate of early‐onset CRC increased from 4.2/100 000 to 6.7/100 000 from 1990 to 2019. Mortality and DALYs of early‐onset CRC also increased. The CRC incidence rate increased faster in younger adults (1.6%) than in adults aged 50–74 years (0.6%) as measured by the annual percentage change. The increase in early‐onset CRC incidence was consistently observed in all five socio‐demographic index (SDI) regions and 190 out of 204 countries and territories. Middle and high‐middle SDI regions had faster annual increases in early‐onset CRC, which warrants further attention. Conclusions: The global incidence, mortality, and DALYs of early‐onset CRC increased from 1990 to 2019. The increase in early‐onset CRC incidence was prevalent worldwide. Several countries were found to have higher incidence rates than the United States or fast increase in early‐onset CRC, which warrants further attention. [ABSTRACT FROM AUTHOR]

Background: Primary thyroid lymphoma (PTL) is a rare thyroid malignancy, there are few large sample studies on PTL and no standardized treatment regimen has been established due to the rarity. The aims of this study were to explore the incidence and prognostic factors of PTL and construct visual prognostic prediction models for post-chemotherapy and postoperative patients. Methods: The incidence of PTL in 1975–2017 was extracted from the US Surveillance, Epidemiology, and End Results (SEER) database, then assessed using joinpoint regression software. A total of 1616 eligible PTL patients diagnosed in 1998–2016 were brought into prognostic analysis. Multivariate Cox regression analyses were carried out to reveal independent prognostic elements for overall survival (OS) and cancer-specific survival (CSS). Results: PTL incidence showed a relatively steady increase in 1975–1994, which annual percent change (APC) was 4.0%, and steady decreasing in 1994–2017(APC − 2.4%). Age, marital status, lymphoma Ann Arbor stage, histological subtypes, surgery, chemotherapy, and radiation were significantly correlated to OS and CSS. Nomograms were constructed to predict OS and CSS in post-chemotherapy and postoperative PTL patients separately, and were verified to have good reliability. Conclusions: The incidence of PTL increased and subsequently decreased. We revealed the prognostic implications and constructed reliable nomograms for post-chemotherapy and postoperative PTL patients. [ABSTRACT FROM AUTHOR]

To address the growing concerns on water pollution caused by pesticide losses, this study aimed at refining a contaminant transport model and applying it to health risk assessment for pesticide-contaminated water. It was an advance of the previous modeling works by integrating a dynamic two-big-leaf multilayer pesticide emission module with the existing pesticide runoff loss simulation model (PeLM). A risk assessment approach was further employed to evaluate the health effects based on the simulation of pesticide pollution by the refined model. The modeling performance and feasibility were examined through a case study conducted in the Auglaize-Blanchard Watershed, OH, USA. A widely used herbicide, atrazine, was targeted. Both the original and refined PeLM were tested and compared. The results indicated that the refined model had advantages in accounting for more pesticide transport processes and improving the simulation accuracy. The risk assessment results disclosed that atrazine concentrations in the river were usually lower than the American standards. To further explore the potential pesticide pollution problems and the associated health risks, a more stringent standard (i.e., Canadian guideline) was also employed. The results indicated that the daily average concentrations of the pesticide sometimes markedly surpassed the guideline, particularly during the wet season (May to August). Correspondingly, the maximum values of the chronic and acute hazard indices could exceed over 1.3 times of the recommended thresholds. The developed methodologies and findings would help raise concerns on pesticide pollution and provide support for decision making related to water pollution mitigation and quality management. [ABSTRACT FROM AUTHOR]

It is well known that individuals with liver cirrhosis are considered at high risk for cardiac surgery, with an increased risk for morbidity and mortality as the liver disease progresses. In the last decade, there have been considerable advances in transcatheter aortic valve implantation (TAVI) as an alternative to surgical aortic valve replacement (SAVR) in individuals deemed to be at high risk for surgery. However, research surrounding TAVI in the setting of liver cirrhosis has not been as widely studied. In this national population-based cohort study, we evaluated the trends of mortality, complications, and healthcare utilization in liver cirrhotic patients undergoing TAVI, as well as analyzed the basic demographics of these individuals. We found that from 2011 to 2020, the amount of TAVI procedures conducted in cirrhotic patients was increasing annually, while mortality, procedural complications, and healthcare utilization trends in these cirrhotic patients undergoing TAVI decreased. Overall, TAVI does seem to be reasonable management for aortic stenosis patients with liver cirrhosis who need aortic valve replacement., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background and Aim: We aimed to determine the rate of 30-day hospital readmissions of uncomplicated choledocholithiasis and its impact on mortality and health care use in the United States., Methods: Nonelective admissions for adults with uncomplicated choledocholithiasis were selected from the Nationwide Readmission Database 2016-2018. The primary outcome was the all-cause 30-day readmission rate. Secondary outcomes were reasons for readmission, readmission mortality rate, procedures, and resource use (length of stay and total hospitalization costs and charges). Independent risk factors for readmission were identified using Cox regression analysis., Results: The 30-day rate of readmission was 9.3%. Biliary and pancreatic disorders and postprocedural complications accounted for 36.6% and 10.3% of readmission, respectively. The mortality rate among patients readmitted to the hospital was higher than that for index admissions (2.0% vs. 0.4%, P <0.01). Readmitted patients were less likely to receive endoscopic retrograde cholangiopancreatography (61% vs. 69%, P <0.01) and laparoscopic cholecystectomy (12.5% vs. 26%, P <0.01) during the index admissions. A total of 42,150 hospital days was associated with readmission, and the total health care in-hospital economic burden was $112 million (in costs) and $470 million (in charges). Independent predictors of readmission were male sex, Medicare (compared with private) insurance, higher Elixhauser Comorbidity Index score, no endoscopic retrograde cholangiopancreatography or laparoscopic cholecystectomy, postprocedural complications of the digestive system, hemodynamic or respiratory support, urban hospitals, and lower hospital volume of uncomplicated choledocholithiasis., Conclusions: The uncomplicated choledocholithiasis 30-day readmission rate is 9.3%. Readmission was associated with higher mortality, morbidity, and resource use. Multiple independent predictors of readmission were identified., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Subclinical hypothyroidism (SCH) is the most common thyroid dysfunction, and its relationship with blood pressure (BP) has been controversial. The aim of the study was to analyze the association between SCH and newly-diagnosed hypertension., Methods: Based on data from the Thyroid disease, Iodine nutrition and Diabetes Epidemiology (TIDE) study, 49,433 euthyroid individuals and 7,719 SCH patients aged ≥18 years were enrolled. Patients with a history of hypertension or thyroid disease were excluded. SCH was determined by manufacturer reference range. Overall hypertension and stage 1 and 2 hypertension were diagnosed according to the guidelines issued by the American College of Cardiology/American Heart Association in 2017., Results: The prevalence of overall hypertension (48.7%), including stage 1 (28.9%) and 2 (19.8%) hypertension, increased significantly in SCH patients compared with euthyroid subjects. With elevated serum thyroid stimulating hormone (TSH) level, the hypertension prevalence also increased significantly from the euthyroid to different SCH subgroups, which was more profound in females or subjects aged <65 years. The age- and sex-specific regression analysis further demonstrated the same trends in the general population and in the 1:1 propensity matched population. Similarly, several BP components (i.e., systolic, diastolic, and mean arterial BP) were positively associated with TSH elevation, and regression analysis also confirmed that all BP components were closely related with SCH in female subjects aged <65 years., Conclusion: The prevalence of hypertension increases for patients with SCH. SCH tends to be associated with hypertension and BP components in females younger than 65 years.

Background: The relationship between body weight and outcomes of endoscopic retrograde cholangiopancreatography (ERCP) is unclear., Objectives: This study aimed to investigate the impact of obesity and morbid obesity on mortality and ERCP-related complications in patients who underwent ERCP., Methods: We conducted a US population-based retrospective cohort study using the Nationwide Readmissions Databases (2013-2014). A total of 159,264 eligible patients who underwent ERCP were identified, of which 137,158 (86.12%) were normal weight, 12,522 (7.86%) were obese, and 9584 (6.02%) were morbidly obese. The primary outcome was in-hospital mortality. The secondary outcomes were the length of stay, total cost, and ERCP-related complications. Multivariate analysis and propensity score (PS) matching analysis were performed. The analysis was repeated in a restricted cohort to eliminate confounders., Results: Patients with morbid obesity, as compared to normal-weight patients, were associated with a significantly higher in-hospital mortality (hazard ratio [HR]: 5.54; 95% confidence interval [CI]: 1.23-25.04). Obese patients were not associated with significantly different mortality comparing to normal weight (HR: 1.00; 95% CI: 0.14-7.12). Patients with morbid obesity were also found to have an increased length of hospital stay and total cost. The rate of ERCP-related complications was comparable among the three groups except for a higher cholecystitis rate after ERCP in obese patients., Conclusions: Morbid obesity but not obesity was associated with increased mortality, length of stay, and total cost in patients undergoing ERCP., (© 2021 The Authors. United European Gastroenterology Journal published by Wiley Periodicals LLC. on behalf of United European Gastroenterology.)

Background: Previous literature suggests that higher ambient temperature may play a role in increasing the risk of suicide. However, no multi-country study has explored the shape of the association and the role of moderate and extreme heat across different locations., Objectives: We examined the short-term temperature-suicide relationship using daily time-series data collected for 341 locations in 12 countries for periods ranging from 4 to 40 y., Methods: We conducted a two-stage meta-analysis. First, we performed location-specific time-stratified case-crossover analyses to examine the temperature-suicide association for each location. Then, we used a multivariate meta-regression to combine the location-specific lag-cumulative nonlinear associations across all locations and by country., Results: A total of 1,320,148 suicides were included in this study. Higher ambient temperature was associated with an increased risk of suicide in general, and we observed a nonlinear association (inverted J-shaped curve) with the highest risk at 27°C. The relative risk (RR) for the highest risk was 1.33 (95% CI: 1.30, 1.36) compared with the risk at the first percentile. Country-specific results showed that the nonlinear associations were more obvious in northeast Asia (Japan, South Korea, and Taiwan). The temperature with the highest risk of suicide ranged from the 87th to 88th percentiles in the northeast Asian countries, whereas this value was the 99th percentile in Western countries (Canada, Spain, Switzerland, the UK, and the United States) and South Africa, where nearly linear associations were estimated. The country-specific RRs ranged from 1.31 (95% CI: 1.19, 1.44) in the United States to 1.65 (95% CI: 1.40, 1.93) in Taiwan, excluding countries where the results were substantially uncertain., Discussion: Our findings showed that the risk of suicide increased with increasing ambient temperature in many countries, but to varying extents and not necessarily linearly. This temperature-suicide association should be interpreted cautiously, and further evidence of the relationship and modifying factors is needed. https://doi.org/10.1289/EHP4898.

This review discusses the occurrence, impact, analysis and treatment of metformin and guanylurea in coastal aquatic environments of Canada, USA and Europe. Metformin, a biguanide in chemical classification, is widely used as one of the most effective first-line oral drugs for type 2 diabetes. It is difficult to be metabolized by the human body and exists in both urine and faeces samples in these regions. Guanylurea is metformin's biotransformation product. Consequently, significant concentrations of metformin and guanylurea have been reported in wastewater treatment plants (WWTPs) and coastal aquatic environments. The maximum concentrations of metformin and guanylurea in surface water samples were as high as 59,000 and 4502ngL -1 , respectively. Metformin can be absorbed in non-target organisms by plants and in Atlantic salmon (Salmo salar). Guanylurea has a confirmed mitotic activity in plant cells. Analysis methods of metformin are currently developed based on high-performance liquid chromatography (HPLC) and gas chromatography-mass spectrometry (GC-MS). The removal of metformin from aquatic environments in the target regions is summarized. The review helps to fill a knowledge gap and provides insights for regulatory considerations. The potential options for managing these emerging pollutants are outlined too., (© 2018 Elsevier Ltd All rights reserved.)

Healthcare empowerment (HCE) is patient controlled and includes the process and state of being engaged, informed, collaborative, committed, and tolerant of uncertainty. Understanding psychosocial factors that impact HCE for persons living with HIV is critical for their treatment and care. A sample of 1494 male and female participants living with HIV in the United States with a mean age of 45.6 (standard deviation = 11.4) completed a one-time online survey about their demographic characteristics, social support, healthcare provider relationship, HIV treatment knowledge, perceived HIV-related stigma, lifetime trauma, depressive symptoms, HCE, and antiretroviral therapy (ART) adherence. A path analysis was conducted using structural equation modeling software to fit a theory-based model of HCE. Results included statistically significant direct pathways between depressive symptoms, healthcare provider relationship, lifetime trauma, and ART adherence, as well as between healthcare provider relationship, HIV treatment knowledge, and HCE. Specifically, ART adherence was positively linked to healthcare provider relationship and negatively linked to depressive symptoms and lifetime trauma. In addition, healthcare provider relationship and HIV treatment knowledge were positively associated with HCE. The indirect effects of healthcare provider relationship and HIV treatment knowledge on adherence through HCE were also significant. In particular, ART adherence was indirectly and positively affected by healthcare provider relationship and HIV treatment knowledge through HCE. Multi-level interventions are urgently needed to address the effects of these psychosocial factors on ART adherence., Competing Interests: Author Disclosure Statement No competing financial interests exist.