Search

The aim of this study was to observe the trends in (1) utilization of meniscus allograft transplantation (MAT), (2) demographics and comorbidities of patients undergoing transplants and (3) reimbursements for this procedure between the years of 2010 and 2019. Using a national database, patients who underwent MAT were observed. Incidence of MAT, percentage of female patients, average age, and average Charlson comorbidity index (CCI) were analyzed between 2010 and 2019. Average reimbursement during the index and postoperative 90-day bundle period were also calculated from 2010 to 2019. Compound annual growth rate (CAGR) of change in incidence, demographic and reimbursement was calculated, and linear regressionwas conducted for each trends analysis. In total, 744 patients underwent a MAT between the years of 2010 and 2019. The incidence of MAT increased from 0.12 per 100,000 to 0.15 per 100,000 during this period but was not statistically significant (p=0.345). There was no significant difference in age (p=0.462) and gender (p=0.831) among the patients, but the average CCI significantly increased from 2010 to 2019 (CAGR: +15.30; p=0.001). The total reimbursement in the index (p=0.451) and 90-day bundle period (p=0.191) did not significantly change from 2010 to 2019. Although MAT has been shown to be a safe and reliable surgery for the treatment of meniscus deficient knees, the incidence of MAT as well as the population undergoing MAT has minimally increased from 2010 to 2019. Future studies should seek to identify why the utilization of this efficacious surgery has not increased. IV; Descriptive Epidemiology Study [ABSTRACT FROM AUTHOR]

Background: The lack of Physical Activity (PA) and prolonged Recreational Screen Time (RST) among children and adolescents has been exacerbated during the COVID-19 pandemic, causing this issue to escalate into a crucial public health concern. This study aims to investigate the trends in PA and RST among Chinese children and adolescents from 2019 to 2022, thereby analyzing the short-term and long-term effects of the pandemic on PA and RST among Chinese children and adolescents. Methods: A nationally representative sample of Chinese primary, middle, and high school students was surveyed annually between September and December from 2019 to 2022 using a consistent set of questionnaires. Trends in PA and RST across different school levels, genders, areas (urban/rural), and regions (north/south) were analyzed using Segmented Linear Regression. Results: From 2019 to 2022, the PA and RST of children and adolescents displayed an inverted U-shaped trend, initially increasing and subsequently declining. Specifically, from 2019 to 2021, the PA of children and adolescents significantly increased but dramatically declined from 2021 to 2022. This trend in PA is more pronounced among primary, male, urban, and northern children and adolescent. The RST of children and adolescents increased from 2019 to 2020 but significantly decreased from 2020 to 2022. This trend in RST is more pronounced among primary, urban, and southern children and adolescent. Conclusions: This research unveils the effects of the pandemic on PA and RST in children and adolescents, suggesting short-term beneficial and long-term adverse effects on PA and short-term adverse and long-term beneficial effects on RST. These findings provide a foundation for formulating policies related to children and adolescents' PA and RST during the pandemic.

Abstract Background The prevalence of physical inactivity and sedentary behavior among children and adolescents is a growing public health concern. This study aims to examine the trends in Physical Activity (PA) and Recreational Screen Time (RST) amongst children and adolescents in China, considering variations in genders, school levels, areas (urban versus rural), and regions (north versus south). The findings provide a foundation to guide policy and strategy making for future health promotion and development. Methods An annual national cross-sectional survey was conducted in China from 2017 to 2019 cumulatively involving 52,503 (48% female) children and adolescents from grades 4 to 12 (aged 12.72 ± 2.12). Data on PA and RST were collected through self-administered questionnaires. Weighted least squares regression was used to analyze the trends and differences in PA and RST among the participants’ profiles. Results There was an annual decreased in PA compliance rate of approximately 3.43% (95% CI: 0.79-6.08%) for primary school students, primarily among males residing in rural areas, and in northern regions. Middle school students experienced a yearly decrease of about 5.23% (95% CI: 2.55-7.92%) in PA compliance across all genders, regions, and urban areas. Similarly, the RST compliance rates for primary school students declined by approximately 3.18% (95% CI: 1.57-4.78%) annually for all genders and areas, but only in the northern regions. Conclusions This research highlights a downward trend in PA and RST compliance amongst Chinese children and adolescents, with variations based on school level, gender, area, and region. Urgent policies and interventions are imperative to promote PA while mitigating excessive RST within these populations.

The COVID-19 pandemic causes serious economic and social consequences at a global level, which affect the problem of human trafficking. The pandemic is not the cause of human trafficking, but it can intensify the factors that contribute to the exploitation of people, especially those from the most vulnerable sectors. The aim of this publication is to analyze the impact of COVID-19 on human trafficking worldwide, with a focus on Bulgaria. We will explore how COVID-19 has changed the dynamics of human trafficking, how the conditions for exploitation of the victims have changed and what measures have been taken to combat human trafficking in the period of the pandemic. [ABSTRACT FROM AUTHOR]

Background: The prevalence of physical inactivity and sedentary behavior among children and adolescents is a growing public health concern. This study aims to examine the trends in Physical Activity (PA) and Recreational Screen Time (RST) amongst children and adolescents in China, considering variations in genders, school levels, areas (urban versus rural), and regions (north versus south). The findings provide a foundation to guide policy and strategy making for future health promotion and development. Methods: An annual national cross-sectional survey was conducted in China from 2017 to 2019 cumulatively involving 52,503 (48% female) children and adolescents from grades 4 to 12 (aged 12.72 ± 2.12). Data on PA and RST were collected through self-administered questionnaires. Weighted least squares regression was used to analyze the trends and differences in PA and RST among the participants' profiles. Results: There was an annual decreased in PA compliance rate of approximately 3.43% (95% CI: 0.79-6.08%) for primary school students, primarily among males residing in rural areas, and in northern regions. Middle school students experienced a yearly decrease of about 5.23% (95% CI: 2.55-7.92%) in PA compliance across all genders, regions, and urban areas. Similarly, the RST compliance rates for primary school students declined by approximately 3.18% (95% CI: 1.57-4.78%) annually for all genders and areas, but only in the northern regions. Conclusions: This research highlights a downward trend in PA and RST compliance amongst Chinese children and adolescents, with variations based on school level, gender, area, and region. Urgent policies and interventions are imperative to promote PA while mitigating excessive RST within these populations. [ABSTRACT FROM AUTHOR]

BackgroundAs primary total knee arthroplasty volume continues to increase, so will the number of revision total knee arthroplasty (rTKA) procedures. The purpose of this study is to provide an updated perspective on the incidence, indications, and financial burden of rTKA in the United States.Material and methodsThis was a retrospective epidemiologic analysis using the National Inpatient Sample. International Classification of Diseases ninth and tenth revision codes were used to identify patients who underwent rTKA and create cohorts based on rTKA indications from 2012 to 2019. National and regional trends for length of stay, cost, and discharge location were evaluated.ResultsA total of 505,160 rTKA procedures were identified. The annual number of rTKA procedures increased by 29.6% over the study period (56,490 to 73,205). The top 3 indications for rTKA were aseptic loosening (23.1%), periprosthetic joint infection (PJI) (20.4%), and instability (11.0%). Over the study period, the proportion of patients discharged to skilled nursing facility decreased from 31.7% to 24.1% (P < .001). Hospital length of stay decreased from 4.0 days in 2012 to 3.8 days in 2019 (P < .001). Hospital costs increased by $1300 from $25,730 to $27,077 (P < .001). The proportion of rTKA cases performed at urban academic centers increased (52.1% to 74.3%, P < .001) while that at urban nonacademic centers decreased (39.0% to 19.2%, P < .001).ConclusionThe top 3 indications for rTKA were aseptic loosening, PJI, and instability, with PJI becoming the most common indication in 2019. These cases are increasingly being performed at urban academic centers and away from urban nonacademic centers.Level of evidence3 (Retrospective cohort study).

Background/Aim: The mandible is one of the most fractured bones in the maxillofacial region. This study analyzes trends in mandibular fracture patterns, demographics, and mechanisms since the early 2000s. Material and Methods: Mandibular fractures were reviewed from the 2007, 2011, and 2017 National Trauma Data Bank including 13,142, 17,057, and 20,391 patients by year, respectively. This database contains hundreds of thousands of patients annually and represents the largest trauma registry in the United States. Variables included number of fractures, sex, age, injury mechanism, and fracture location. Mechanism of injury included assault, motor vehicle crash, fall, motorcycle, bicycle, pedestrian, and firearm. Anatomic locations based on ICD‐9/10 codes included symphysis, ramus, condyle, condylar process, body, angle, and coronoid process. Frequencies were compared using Chi‐square tests of homogeneity with effect sizes estimated using Cramer's V. Results: Mandibular fractures represent 2%–2.5% of all traumas reported in the database from 2001 to 2017. The proportion of patients sustaining a single reported mandibular fracture decreased from 82% in 2007 to 63% in 2017. Males consistently experienced 78%–80% of fractures. Eighteen to 54‐year‐olds experienced the largest percentages of fractures throughout the 21st century, while median age of fracture shifted from 28 to 32 between 2007 and 2017. The most common fracture mechanisms were assault (42% [2001–2005]–37% [2017]), motor vehicle crash (31%–22%) followed by falls (15%–20%). From 2001–2005 to 2017, a decrease was observed in assaults (−5%) and motor vehicle crash (−9%) and an increase in falls (+5%), particularly among elderly females. The mandibular body, condyle, angle, and symphysis represent approximately two‐thirds of all fractures without a consistent temporal trend among them. Conclusions: The temporal trends observed can be linked to shifting age demographics nationally that may aid clinicians in diagnosis and inform public safety policies aimed at reducing these injuries, particularly among the growing elderly population. [ABSTRACT FROM AUTHOR]

ObjectiveTo determine trends in real-world utilization and in-hospital adverse events from Watchman implantation since its approval by the Food and Drug Administration in 2015.BackgroundThe risk of embolic stroke caused by atrial fibrillation is reduced by oral anticoagulants, but not all patients can tolerate long-term anticoagulation. Left atrial appendage occlusion with the Watchman device has emerged as an alternative therapy.MethodsThis was a retrospective cohort study utilizing data from National Inpatient Sample for calendar years 2015-2017. The outcomes assessed in this study were associated complications, in-hospital mortality, and resource utilization trends after Watchman implantation. Trends analysis were performed using analysis of variance. Multivariable adjusted logistic regression analysis was performed to determine predictors of mortality.ResultsA total of 17 700 patients underwent Watchman implantation during the study period. There was a significantly increased trend in the number of Watchman procedures performed over the study years (from 1195 in 2015 to 11 165 devices in 2017, p

BackgroundTargeted Temperature Management (TTM) is a class I recommendation for the management of sudden cardiac arrest (SCA) patients with presumed brain injury. We aimed to study trends, predictors and outcomes in SCA patients from a nationally represented US population sample.MethodsWe utilized the National Inpatient Sample from years 2005 to 2014 for the purpose of our study. Patients with SCA and anoxic brain injury were selected using relevant ICD-9 codes. Data were analyzed for trends over the years and key outcomes were assessed. Logistic regression analysis was done to determine predictors of TTM utilization in our study population.ResultsA total of 78,465 patients with SCA and anoxic brain injury were identified from January 2005 to December 2014. Out of these, approximately 4,481 (5.7%) patients underwent TTM. Patients that underwent TTM were younger compared to patients without TTM utilization (60.67 vs. 63.27 years, P < 0.01). African Americans, Hispanics and women were less likely to undergo TTM. Myocardial infarction, electrolyte disorders and cardiogenic shock were associated with higher odds of TTM utilization. Sepsis, renal failure and diabetes were associated with underutilization of TTM. Inpatient mortality was higher in patients who did not undergo TTM when compared to patients who underwent TTM (67.30% vs. 65.10%, P < 0.01).ConclusionsAlthough TTM utilization increased over our study period, the overall application of TTM was still dismal. Factors that circumvent TTM utilization need to be addressed in future studies so more eligible patients could benefit from this life saving therapy.

Background: The use of robotics in arthroplasty continues to increase. Patient demand, patient expectations, and patient-directed marketing by industry and care providers each likely contributes to its increasing popularity. Trends in patient interest have not been well described. We used the online Google Trends tool to analyze trends in national public interest toward robotic and nonrobotic arthroplasty between 2011 and 2021. Material and methods: Google Trends online was queried for search terms related to nonrobotic hip and knee arthroplasty in addition to robotic hip, robotic knee, and general robotic arthroplasty between January 1, 2011, and December 31, 2021. Results: Google Trends Data demonstrated a significant linear increase in online searches related to nonrobotic total knee and hip arthroplasty. Online search volume for robotic hip arthroplasty was significant and linear, while that of robotic knee arthroplasty was significant and exponential. When combined, robotic joint arthroplasty demonstrated an exponential trend over the 10-year period. This increase was noted to be statistically significant when compared with nonrobotic arthroplasty search volume. Conclusion: Our study demonstrates that public interest in robotic total joint arthroplasty has increased significantly from 2011 through 2020. When compared with online search volume for conventional arthroplasty, this increasing growth is statistically significant. Public interest in robotic arthroplasty is anticipated to continue to increase, and care providers should be aware of this trend that impacts patient perceptions and expectations. Despite significant growth in interest for robotic arthroplasty, there is incomplete evidence supporting its use over nonrobotic arthroplasty. Additional high-quality studies are needed to inform provider decision-making and appropriately guide public interest in robot-assisted arthroplasty.

Amid subpar uptake of HPV vaccination in the United States, gender-generated disparities in HPV vaccination uptake have the potential to perpetuate existing disparities in HPV-associated cancers. Yet few studies have investigated the influence of parent–child gender on intentions to refuse HPV vaccination due to safety concerns/side effects. This study used nationally representative data, spanning 2010–2019, from the National Immunization Survey-Teen (NIS-Teen). NIS-Teen respondents are parents/guardians or primary caregivers of adolescents 13–17 years old living in the United States. Over the study period, intentions to refuse HPV vaccination due to safety concerns rose among all parent–child gender pairings but were highest among respondent mothers regarding their unvaccinated daughters. The results revealed a statistically significant increased likelihood of having intentions to refuse HPV vaccination due to safety concerns among all parent–child combinations compared with father–son pairs. These odds were consistently highest among mother–daughter pairs. In 2019, compared with father–son pairs, fathers were 1.94 (95% CI: 1.21–3.12) times more likely to report the intention to not vaccinate against HPV for their daughters, while mothers were 2.23 (95% CI: 1.57–3.17) and 2.87 (95% CI: 2.02–4.09) times more likely to report intentions to refuse HPV vaccination for their sons and daughters, respectively. These findings were persistent and constantly increased over the 10-year study period. Interventions aimed at correcting gender-based misperceptions and countering misinformation about the safety of the HPV vaccine are warranted.

Background: The lack of Physical Activity (PA) and prolonged Recreational Screen Time (RST) among children and adolescents has been exacerbated during the COVID-19 pandemic, causing this issue to escalate into a crucial public health concern. This study aims to investigate the trends in PA and RST among Chinese children and adolescents from 2019 to 2022, thereby analyzing the short-term and long-term effects of the pandemic on PA and RST among Chinese children and adolescents., Methods: A nationally representative sample of Chinese primary, middle, and high school students was surveyed annually between September and December from 2019 to 2022 using a consistent set of questionnaires. Trends in PA and RST across different school levels, genders, areas (urban/rural), and regions (north/south) were analyzed using Segmented Linear Regression., Results: From 2019 to 2022, the PA and RST of children and adolescents displayed an inverted U-shaped trend, initially increasing and subsequently declining. Specifically, from 2019 to 2021, the PA of children and adolescents significantly increased but dramatically declined from 2021 to 2022. This trend in PA is more pronounced among primary, male, urban, and northern children and adolescent. The RST of children and adolescents increased from 2019 to 2020 but significantly decreased from 2020 to 2022. This trend in RST is more pronounced among primary, urban, and southern children and adolescent., Conclusions: This research unveils the effects of the pandemic on PA and RST in children and adolescents, suggesting short-term beneficial and long-term adverse effects on PA and short-term adverse and long-term beneficial effects on RST. These findings provide a foundation for formulating policies related to children and adolescents' PA and RST during the pandemic., (© 2024 The Society of Chinese Scholars on Exercise Physiology and Fitness. Published by Elsevier (Singapore) Pte Ltd.)

Background: The quality of carbohydrate intake, as measured by the glycemic index (GI), has not been evaluated nationally over the past 2 decades in the United States., Objectives: We aimed to develop a comprehensive and nationally representative dietary GI and glycemic load (GL) database from 1999 to 2018 National Health and Nutrition Examination Survey (NHANES) and to examine GI and GL time trends and subpopulation differences., Methods: We used an artificial intelligence (AI)-enabled model to match GI values from 2 GI databases to food codes from United States Department of Agriculture, which were manually validated. We examined nationally representative distributions of dietary GI and GL from 1999 to 2018 using the multistage, clustered sampling design of NHANES., Results: Assigned GI values covered 99.9% of total carbohydrate intake. The initial AI accuracy was 75.0%, with 31.3% retained after manual curation guided by substantive domain expertise. A total of 7976 unique food codes were matched to GI values, of which soft drinks and white bread were top contributors to dietary GI and GL. Of the 49,205 NHANES adult participants, the mean dietary GI was 55.7 (95% confidence interval [CI]: 55.5, 55.8) and energy-adjusted dietary GL was 133.0 (95% CI: 132.3, 133.8). From 1999 to 2018, dietary GI and GL decreased by 4.6% and 13.8%, respectively. Dietary GL was higher among females (134.6; 95% CI: 133.8, 135.5) than among males (131.3; 95% CI: 130.3, 132.3), those with ≤high school degree (137.7; 95% CI: 136.8, 138.7) than among those with ≥college degree (126.5; 95% CI: 125.3, 127.7), and those living under the poverty level (140.9; 95% CI: 139.6, 142.1) than among those above the poverty level. Differences in race were observed (Black adults, 139.4; 95% CI: 138.2, 140.7; White adults, 131.6; 95% CI: 130.5, 132.6)., Conclusions: The national GI and GL database facilitates large-scale and high-quality surveillance or cohort studies of diet and health outcomes in the United States., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: This study evaluated national trends in cemented and uncemented reverse shoulder arthroplasty (RSA) for proximal humerus fractures using a comprehensive national surgical database. This study aimed to compare RSA used in the treatment of proximal humerus fractures with the literature and to determine the country's trend., Methods: A cross-sectional study was conducted using the health records of individuals aged ≥ 18 years who underwent RSA for proximal humerus fractures between 2016 and 2022. Patients were divided into cemented and uncemented groups, and demographic data (age, sex), duration of hospital stay, transfusions, revisions, mortality, and Charlson Comorbidity Index (CCI) scores were analyzed., Results: A total of 618 cemented RSA and 1,364 uncemented RSA procedures were reviewed. Patients who underwent cemented RSA were significantly older than those who had uncemented RSA ( p = 0.002). Transfusion rates were higher in the cemented RSA group ( p = 0.006). The frequency of revision surgery was 6.1%. Younger age and male sex were associated with revision ( p < 0.001). CCI scores were higher among transfused patients than non-transfused patients ( p < 0.001). The incidence of cemented RSA was 11.7% and 49% in 2016 and 2022, respectively. Differences were found among hospital types and geographical regions., Conclusions: While cemented RSA has been gaining attention and increased application in recent years for proximal humerus fractures, uncemented RSA still predominates. The choice between these 2 methods is largely influenced by regional and hospital-level factors. The type of RSA and high CCI scores were found to have no significant impact on the risk of surgical revision., Competing Interests: CONFLICT OF INTEREST: No potential conflict of interest relevant to this article was reported., (Copyright © 2024 by The Korean Orthopaedic Association.)

Background: As primary total knee arthroplasty volume continues to increase, so will the number of revision total knee arthroplasty (rTKA) procedures. The purpose of this study is to provide an updated perspective on the incidence, indications, and financial burden of rTKA in the United States. Material and methods: This was a retrospective epidemiologic analysis using the National Inpatient Sample. International Classification of Diseases ninth and tenth revision codes were used to identify patients who underwent rTKA and create cohorts based on rTKA indications from 2012 to 2019. National and regional trends for length of stay, cost, and discharge location were evaluated. Results: A total of 505,160 rTKA procedures were identified. The annual number of rTKA procedures increased by 29.6% over the study period (56,490 to 73,205). The top 3 indications for rTKA were aseptic loosening (23.1%), periprosthetic joint infection (PJI) (20.4%), and instability (11.0%). Over the study period, the proportion of patients discharged to skilled nursing facility decreased from 31.7% to 24.1% (P < .001). Hospital length of stay decreased from 4.0 days in 2012 to 3.8 days in 2019 (P < .001). Hospital costs increased by $1300 from $25,730 to $27,077 (P < .001). The proportion of rTKA cases performed at urban academic centers increased (52.1% to 74.3%, P < .001) while that at urban nonacademic centers decreased (39.0% to 19.2%, P < .001). Conclusion: The top 3 indications for rTKA were aseptic loosening, PJI, and instability, with PJI becoming the most common indication in 2019. These cases are increasingly being performed at urban academic centers and away from urban nonacademic centers. Level of Evidence: 3 (Retrospective cohort study).

Background: The age-adjusted rate of suicide death in the USA has increased significantly since 2000 and little is known about national trends in non-fatal suicidal behaviors (ideation, plan, and attempt) among adults and their associated sociodemographic and clinical characteristics. This study examined trends in non-fatal suicidal behaviors among adults in the USA. Methods: Data were obtained from adults 18–65 years of age who participated in the National Survey on Drug Use and Health (NSDUH), including mental health assessment, from 2009 to 2017 (n = 335 359). Examinations of data involved trend analysis methods with the use of logistic regressions and interaction terms. Results: Suicidal ideation showed fluctuation from 2009 to 2017, whereas suicide plan and attempt showed significantly positive linear trends with the odds increasing by an average of 3% and 4%, respectively. Suicide plan increased the most for females and adults ages 18–34, and attempt increased the most for adults with drug dependence. Both plan and attempt increased the most among adults who either had mental illness but were not in treatment or had no mental illness. Conclusions: Given attempted suicide is the strongest known risk factor for suicide death, reducing non-fatal suicidal behaviors including attempt are important public health and clinical goals. The interactional findings of age, sex, mental health status, and drug dependence point toward the importance of tailoring prevention efforts to various sociodemographic and clinical factors. [ABSTRACT FROM AUTHOR]

Background and Objective: Therapeutic options for pediatric inflammatory bowel disease (PIBD) have dramatically changed over the last 20 years. However, the impact of modern medical management on PIBD outcomes remains unclear. We aimed to fill this gap in the literature by using a large, validated, national database, to study the change in hospitalization rates, surgical rates, and postoperative complications in PIBD over the last decade. Methods: The National Inpatient Sample (NIS) Database and ICD-9-CM codes were utilized to identify inpatient admissions with a primary or secondary diagnosis of pediatric Crohn’s disease (CD) or ulcerative colitis (UC) from 2002-2015. Trends in hospitalizations, comorbidities (including malnutrition and weight loss), surgical procedures, and postoperative complications were examined using joinpoint regression analysis, a statistical modeling approach to evaluate the extent to which the rate of a condition changes over time. Results: There were 119,282 admissions for PIBD during the study period. The annual incidence of hospitalization increased significantly over time for both CD (average annual percent change [AAPC] 6.0%) and UC (AAPC 7.2%). The rate of intestinal resection decreased in CD patients (AAPC -6.4%) while postoperative complications remained unchanged. However, comorbidities increased significantly in CD patients (AAPC 6.8%). For pediatric UC patients, postoperative complications (AAPC 6.7%), and comorbidities (AAPC 10.2%) increased significantly over time while intestinal resection rates remained stable. Intestinal resection rate in pediatric CD has decreased over time, but not in pediatric UC. Conclusion and Global Health Implications: Annual incidence of hospitalization and comorbidities continue to increase in PIBD. Intestinal resection rate in pediatric CD has decreased over time, but not in pediatric UC. Our findings emphasize the critical need for prevention and novel therapeutic options for this vulnerable patient population. Copyright © 2021 Ihekweazu et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

• Ankylosing Spondylitis (AS) is an immunoinflammatory rheumatic condition with a significant impact on quality of life. • In our study, we aimed to study the impact of age on in-hospital complications and mortality in patients undergoing surgery for AS associated spine fractures. • Complications were seen in 57.3% of patients ≥ 70 years of age compared to 38.4% of patients < 70 years of age. • Also, 9.9 % of patients ≥ 70 years of age had in-hospital mortality compared to 3.1 % of patients < 70 years. • Elderly patients (≥70 years of age) were 3.2 times more likely to have in-hospital mortality. • Patients with SCI were 3.6 times more likely to have in-hospital mortality compared to those without SCI. The aim of this retrospective cohort study was to study the impact of age on in-hospital complications and mortality following surgery for Ankylosing Spondylitis (AS) associated spine fractures. We extracted data from the Nationwide Inpatient Sample (NIS) database (1998–2018) using ICD-9/10 codes. Patients with a primary diagnosis of AS associated spine fractures who underwent fusion surgery were included. Complications and in-hospital mortality were analyzed. A total cohort of 8526 patients was identified. Overall, the median age of the cohort was 69 years. AS associated fractures were equally distributed among cervical and thoracolumbar regions. Overall, complications were noted in 48% of patients and pulmonary complications were the most common (32%) followed by renal (13%) and infection (12%). Complications were seen in 57.3% of patients ≥ 70 years of age compared to 38.4% of patients < 70 years of age (p <.0001). Also, 9.9 % of patients ≥ 70 years of age had in-hospital mortality compared to 3.1 % of patients < 70 years of age (p <.0001). Based on surgical approaches, elderly patients (≥70 years) who underwent anterior, posterior, and anterior + posterior approaches had 19.8%, 7.4% and 16.4% in-hospital mortality compared to 5.3%, 2.2% and 7.4% respectively for patients < 70 years. Elderly patients (≥70 years of age) were 3.2 times more likely to have in-hospital mortality and higher complications compared to younger patients (57% vs. 38%). Cervical compared to thoracolumbar fractures and anterior compared to posterior surgical approaches were associated with higher complications and in-hospital mortality. [ABSTRACT FROM AUTHOR]

Background: Understanding the association between hypertension prevalence and socioeconomic and behavioral variables during a pandemic is essential, and this analysis should extend beyond short-term trends., Objective: This study aims to examine long-term trends in the prevalence of participants diagnosed with and receiving treatment for hypertension, using data collected by a nationally representative survey from 2009 to 2022, which includes the COVID-19 pandemic era., Methods: A nationwide, population-based, cross-sectional study used data collected from the South Korea Community Health Survey between 2009 and 2022. The study sample comprised 3,208,710 Korean adults over a period of 14 years. We aimed to assess trends in the prevalence of participants diagnosed with and receiving treatment for hypertension in the national population from 2009 to 2022, with a specific focus on the COVID-19 pandemic, using weighted linear regression models., Results: Among the included 3,072,546 Korean adults, 794,239 (25.85%) were aged 19-39 years, 1,179,388 (38.38%) were aged 40-59 years; 948,097 (30.86%) were aged 60-79 years, and 150,822 (4.91%) were aged 80 years or older. A total of 1,426,379 (46.42%) were men; 761,896 (24.80%) and 712,264 (23.18%) were diagnosed with and received treatment for hypertension, respectively. Although the overall prevalence over the 14-year period increased, the upward trends of patients diagnosed with and receiving treatment for hypertension decreased during the COVID-19 pandemic era compared with the prepandemic era (β difference for trend during vs before the pandemic -.101, 95% CI -0.107 to -0.094 vs -.133, 95% CI -0.140 to -0.127). Notably, the trends in prevalence during the pandemic were less pronounced in subgroups of older adults (≥60 years old) and individuals with higher alcohol consumption (≥5 days/month)., Conclusions: This nationwide representative study found that the national prevalence of participants diagnosed with and receiving treatment for hypertension increased during the prepandemic era. However, there was a marked decrease in these trends during the prepandemic era, compared with the pandemic era, particularly among specific subgroups at increased risk of negative outcomes. Future studies are needed to evaluate the factors associated with changes in the prevalence of hypertension during the COVID-19 pandemic., (©Hyeri Lee, Minji Kim, Selin Woo, Jaeyu Park, Hyeon Jin Kim, Rosie Kwon, Ai Koyanagi, Lee Smith, Min Seo Kim, Guillermo F López Sánchez, Elena Dragioti, Jinseok Lee, Hayeon Lee, Masoud Rahmati, Sang Youl Rhee, Jun Hyuk Lee, Ho Geol Woo, Dong Keon Yon. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 30.07.2024.)

Background There is a lack of contemporary data on cardiogenic shock (CS) in‐hospital mortality trends. Methods and Results Patients with CS admitted January 1, 2004 to December 31, 2018, were identified from the US National Inpatient Sample. We reported the crude and adjusted trends of in‐hospital mortality among the overall population and selected subgroups. Among a total of 563 949 644 hospitalizations during the period from January 1, 2004, to December 30, 2018, 1 254 358 (0.2%) were attributed to CS. There has been a steady increase in hospitalizations attributed to CS from 122 per 100 000 hospitalizations in 2004 to 408 per 100 000 hospitalizations in 2018 (Ptrend

Background The timing of endoscopic retrograde cholangiopancreatography (ERCP) in patients with acute biliary pancreatitis without cholangitis is unclear. We accessed a national database to analyze the outcomes of urgent (<24 h) and early (24-72 h) ERCP in this cohort. Methods The cohort was extracted from the Nationwide Inpatient Sample database. Hospital ERCP volumes were generated using unique hospital identifiers. Multivariate regression modeling was used to analyze the predictors of urgent vs. early ERCP use, and to determine various outcome variables between the 2 cohorts. Results Overall, 105,433 admissions were evaluated. There was a significant rise in urgent ERCP performed over the study period. Older patients, males, patients with comorbidities, African American and Hispanic patient populations were less likely to receive urgent ERCP. High ERCP volume hospitals, teaching hospitals, and hospitals in the Midwest and West were more likely to perform urgent ERCP. There were no differences in mortality rates or complication rates between the 2 cohorts. However, there were significant differences in length of stay and healthcare cost analysis. Conclusions The increasing use of urgent ERCP did not result in a clinically significant benefit in terms of mortality, length of stay, or healthcare cost analysis. The use of urgent ERCP is also not uniform across various demographic and hospital cohorts. Urgent ERCP may be over-utilized, and it may be reasonable to perform ERCP in this patient population based on the physician’s suspicion about the severity of disease. [ABSTRACT FROM AUTHOR]

Background Antibiotic resistance has been identified as a public health threat both in the United States and globally. The United States published the National Strategy for Combating Antibiotic Resistance in 2014, which included goals to reduce inappropriate outpatient antibiotic use. Methods This cross-sectional study was conducted using National Health and Nutrition Examination Surveys (NHANES) years 1999–2018. Weighted prevalence of past 30-day nontopical outpatient antibiotic use was calculated, as well as the change in prevalence from 1999–2002 to 2015–2018 and 2007–2010 to 2015–2018, both overall and for subgroups. Associations with past 30-day nontopical outpatient antibiotic use in 2015–2018 were examined using predictive margins calculated by multivariable logistic regression. Results The overall prevalence of past 30-day nontopical outpatient antibiotic use adjusted for age, sex, race/ethnicity, poverty status, time of year of the interview, and insurance status from 1999–2002 to 2015–2018 changed significantly from 4.9% (95% CI, 3.9% to 5.0%) to 3.0% (95% CI, 2.6% to 3.0%), with the largest decrease among children age 0–1 years. From 2007–2010 to 2015–2018, there was no significant change (adjusted prevalence ratio [adjPR], 1.0; 95% CI, 0.8 to 1.2). Age was significantly associated with antibiotic use, with children age 0–1 years having significantly higher antibiotic use than all other age categories >6 years. Being non-Hispanic Black was negatively associated with antibiotic use as compared with being non-Hispanic White (adjPR, 0.6; 95% CI, 0.4 to 0.8). Conclusions While there were declines in antibiotic use from 1999–2002 to 2015–2018, there were no observed declines during the last decade. [ABSTRACT FROM AUTHOR]

Visegrad Group (V4) containing Czechia, Hungary, Poland and Slovakia, is one of the examples of regional cooperation within the European Union (EU). Recently V4 has shown some coherence in case of migrant wave to the EU, as well as presented unifi ed position vis-à-vis climate change or leaders election in the EU. The Author has taken into consideration major political parties – both ruling and in the opposition – and their programs in all V4 countries and comes to following conclusions: 1. There is no coherence of V4, as Czech Republic and Slovakia are not ready to follow the footsteps of Hungary and Poland in creation of so called illiberal democracies. 2. All V4 countries are domestically highly polarized, with the exception of Hungary dominated by its charismatic leader Viktor Orbán. 3. Internal instability cannot bring a cohesive and unifi ed voice of V4 in the EU in more coordinated way. 4. If V4 countries will constantly undermine the core system of values, or Copenhagen criteria, of the EU, as Hungary and Poland is doing, combined with more and more problems with corruption, as all of them have, then un-famous East – West division line can reemerge in the EU and on the European continent leading to weakening of it on the global scene.

Little is known regarding the burden of sunburns leading to emergency department (ED) visits in the United States (US). The objectives of this research were to characterize the burden of sunburn ED visits, investigate predictors of severe sunburns, and evaluate risk factors for increased cost of care in patients presenting to the ED for sunburn. In this nationally representative cross-sectional study of the National Emergency Department Sample (NEDS, 2013–2015), multivariable models were created to evaluate adjusted odds for sunburn ED visits, seasonal/regional variation in sunburn ED visits, adjusted odds for second and third degree sunburns, and risk factors for increased ED expenditure. 82,048 sunburn ED visits were included in this study. On average, the cost of care for a sunburn ED visit was $1132.25 (± $28.69). The prevalence and cost of ED visits due to sunburn increased during the summer months. Controlling for sociodemographic factors, comorbidities, and hospital characteristics, patients presenting to the ED for all sunburns (and for severe sunburns) were most likely to be lower income young adult men. Older, higher income patients in metropolitan hospitals had more expensive ED visits. This research provides nationally representative estimates of visits to the ED due to sunburn in the US, as well as evaluates determinants for severe sunburns and more expensive sunburn ED visits. Ultimately, characterizing the national burden of ED visits due to sunburn is critical in the development of interventions to reduce the impact of sunburn ED visits on the US healthcare system. [ABSTRACT FROM AUTHOR]

Background: In-hospital ischemic stroke following acute ST-elevation myocardial infarction (STEMI) has not been evaluated on a national scale in the United States. Methods: We used 2003 to 2014 Nationwide Inpatient Sample data to identify adults with a principal diagnosis of STEMI. Patients were divided into two groups defined by presence or absence of ischemic stroke. Clinical characteristics and in-hospital outcomes were studied using relevant statistics. Multiple linear and logistic regression models identified factors associated with ischemic stroke, national trend of in-hospital stroke incidence and in-hospital mortality. Results: Of 1,842,529 STEMI patients hospitalized from 2003 to 2014, 22,268 (1.2%) developed acute in-hospital ischemic stroke. Those with acute strokes were older (age ≥ 65 years: 70% vs 46%), more likely female (51% vs 33%), and had higher rates of atrial fibrillation (28.9% vs 12.2%) and heart failure (40.5% vs 21.1%). Age and gender adjusted incidence of in-hospital ischemic stroke following STEMI remained stable; 1.4% in 2003 and 1.5% in 2014 (P trend = 0.50). However, age and gender adjusted in-hospital mortality declined in STEMI patients with and without in-hospital ischemic stroke [AOR 0.97 (0.95–0.99) P trend = 0.03, and AOR 0.98 (0.98–0.99) P trend

Background Patients with ascites resulting from chronic debilitating diseases often require non-oral enteral nutrition and undergo placement of a percutaneous endoscopic gastrostomy (PEG) tube. The aim of our study was to assess the nationwide trends and outcomes of PEG tube placement among patients with ascites. Methods Using the Nationwide Inpatient Sample (NIS), we conducted a retrospective analysis of adult patients (≥18 years) who underwent PEG tube placement (n=789,167) from 2010-2014. We divided these patients into 2 groups: with or without ascites. We compared demographics, complications, and in-hospital outcomes between the groups. STATA-13 was used for statistical analysis. Statistical significance was assigned at P<0.05. Results Patients with ascites who underwent PEG tube placement were found to have a significantly higher rate of complications, including peritonitis (7.52 vs. 0.72%; P<0.001), aspiration pneumonia (20.41 vs. 2.69%; P<0.001), hemoperitoneum (0.72 vs. 0.19%; P<0.001), procedure-related hemorrhage (1.69 vs. 0.9%; P<0.001) and esophageal perforation (0.51 vs. 0.47%; P<0.001). In addition, these patients also had higher in-hospital mortality (16.33% vs. 7.02%; P<0.001) despite having a relatively lower prevalence of comorbidities. Length of stay was longer in the ascites group (28.08 vs. 19.45 days; 0.001). Over the study period, however, we observed an increasing trend for PEG tube placement in hospitalized patients with ascites. Conclusion PEG tube placement in hospitalized patients with ascites is associated with significantly higher mortality, a longer stay, and more procedure-related complications. [ABSTRACT FROM AUTHOR]

Objective: To examine national trends in the medical and surgical treatment of benign prostatic hyperplasia (BPH) using Australian Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) population data from 2000 to 2018. Patients and methods: Annual data was extracted from the MBS, PBS and Australian Institute of Health and Welfare databases for the years 2000–2018. Population‐adjusted rates of BPH procedures and medical therapies were calculated and compared in relation to age. Cost analysis was performed to estimate financial burden due to BPH. Results: Overall national hospital admissions due to BPH declined between 2000 and 2018, despite an increased proportion of admissions due to private procedures (42% vs 77%). Longitudinal trends in the medical management of BPH showed an increased prescription rate of dutasteride/tamsulosin combined therapy (111 vs 7649 per 100 000 men) and dutasteride monotherapy (149 vs 336 per 100 000 men) since their introduction to the PBS in 2011. Trends in BPH surgery showed an overall progressive increase in rate of total procedures between 2000 and 2018 (92 vs 133 per 100 000 men). Transurethral resection of the prostate (TURP) remained the most commonly performed surgical procedure, despite reduced utilisation since 2009 (118 vs 89 per 100 000 men), offset by a higher uptake of photoselective vaporisation of prostate, holmium:YAG laser enucleation of prostate, and later likely due to minimally invasive surgical therapies including prostatic urethral lift and ablative technologies (including Rezūm™). Financial burden due to BPH surgery has remained steady since 2009, whilst the burden due to medical therapy has risen sharply. Conclusion: Despite reduced national BPH‐related hospitalisations, overall treatment for BPH has increased due to medical therapy and surgical alternatives to TURP. Further exploration into motivators for particular therapies and effect of medical therapy on BPH progression in clinical practice outside of clinical trials is warranted. [ABSTRACT FROM AUTHOR]

Laser interstitial thermal therapy (LITT) is a stereotactic-guided technique, which is increasingly being performed for brain lesions. The aim of our study was to report the national trends and factors predicting the clinical outcomes following LITT using the Nationwide Inpatient Sample. We extracted data from 2011–2016 using ICD-9/10 codes. Patients with a primary procedure of LITT were included. Patient demographics, complications, length of hospital stay, discharge disposition, and index-hospitalization charges were analyzed. A cohort of 1768 patients was identified from the database. Mean length of hospital stay was 3.2 days, 82% of patients were discharged to home, and in-hospitalization cost was $124,225. Complications and mortality were noted in 12.9% and 2.5% of patients following LITT, respectively. Non-Caucasian patients (estimate ratio [ER] 4.26), those with other insurance (compared with commercial, ER: 5.35), 3 and 4+ comorbidity indexes, patients with higher quartile median household income (second, third, and fourth quartile compared with first quartile), and those who underwent nonelective procedures were likely to have higher complications and less likely to be discharged home. Patients with 4+ comorbidity indexes were likely to have longer length of hospital stay (ER 1.39) and higher complications (ER: 7.95) and were less likely to be discharged home (ER: 0.17) and have higher in-hospitalization cost (ER: 1.21). LITT is increasingly being performed with low complication rates. Non-Caucasian race, higher comorbidity index, noncommercial insurance, and nonelective procedures were predictors of higher complications and being less likely to be discharged home. In-hospitalization charges were higher in patients with higher comorbidity index and those with noncommercial insurance. [ABSTRACT FROM AUTHOR]

Objectives: Despite reports of increasing use of hybrid surgery for lower extremity revascularization in Europe, little is known about the performance of hybrid procedures in the U.S. This study aims to investigate contemporary national trends in frequency and operator distribution of hybrid lower extremity revascularization and compare the perioperative outcomes of independent vascular surgeons and other surgical specialists. We hypothesized that hybrid procedures are increasingly performed, and independent vascular surgeons have superior outcomes compared to other surgical specialists. Methods: The 2005–2015 American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) database was used to identify patients undergoing open or hybrid lower extremity revascularization based on Current Procedural Terminology codes. Only patients treated for peripheral artery disease, based on International Classification of Diseases codes-9, were included. A trend of yearly hybrid lower extremity revascularization compared to open lower extremity revascularization was obtained. The most commonly performed hybrid procedure was identified as well as the specialties of the primary operators. Operators were categorized as "independent vascular surgeons" and "other surgeons" if the primary operator was a non-vascular surgeon or a vascular surgeon assisted by a second specialist as part of a team. Patients undergoing this hybrid lower extremity revascularization by independent vascular surgeons were selected and matched (2:1) to the patients who underwent the same procedure by other surgical specialists. Matching was based on age, gender, functional status, American Society of Anesthesiologists classification, transfer status, emergent surgery, and indication. The characteristics and perioperative outcomes of those two groups were compared. Results: The overall rate of hybrid procedures increased from 4% in 2005 to 14% in 2015 (p < 0.0001). During this period, vascular surgeons independently performed 92.9% of all hybrid surgeries, with no significant change in the yearly trend (p = 0.15). Femoral endarterectomy with retrograde aortoiliac intervention was identified as the most common procedure, accounting for 35.7% and 33.3% of hybrid lower extremity revascularization performed by independent vascular surgeons and other surgeons, respectively. After propensity matching, there were 212 patients treated by independent vascular surgeons and 106 patients treated by other surgeons, with no significant difference in demographics or comorbidities. There was no difference between independent vascular surgeons and other surgeons in mortality (1.4% and 2.8%, respectively, p = 0.30), overall morbidity (19.3% and 18.9% respectively, p = 0.91), and other complications. Conclusion: Hybrid lower extremity revascularization for peripheral artery disease has been increasingly used and is performed primarily by independent vascular surgeons. Simple hybrid procedures may be performed safely by vascular surgeons as well as other trained surgical specialists. [ABSTRACT FROM AUTHOR]

Background: Studies demonstrate an increase incidence of intertrochanteric fractures within the United States. Matched studies evaluating intertrochanteric fractures managed with either sliding hip screw (SHS) or intramedullary nail (IMN) within the Medicare population are limited. The purpose of this study was to investigate: 1) annual utilization trends; 2) patient demographics; and 3) complications including mortality., Methods: A retrospective query using a nationwide database was performed. Patients undergoing SHS or IMN for intertrochanteric fractures were identified. The query yielded a total of 37,929 patients utilizing SHS (n = 11,665) or IMN (n = 26,264). Patients were matched 1:1 based on comorbidities. Primary outcomes included: utilization trends, patient demographics, 90-day complications, and 90-day readmission rates. Linear regression analyses were used to compare utilization trends. Pearson's c2 analyses were used to compare patient-demographics, medical complications, and 90-day readmission rates. A p-value less than 0.05 was considered statistically significant., Results: Linear regression analysis demonstrated a statistically significant decrease in utilization of SHS for IT fractures (p<0.0001); whereas utilization for IMN stayed consistent (p=0.36). IMN had significantly higher prevalence of comorbidities compared to SHS, notably, hyperlipidemia (70.6 vs. 62.6%; p<0.0001). Based on 1:1 match, IMN patients had significantly higher rates of 90-day medical complications, such as respiratory failure (11.0 vs. 8.1%; p<0.0001) and VTE (4.2 vs. 3.2%; p<0.001; however, there was not a statistical difference in postoperative infection (1.4 vs. 1.5%, p=0.06). There was no statistical difference in 90-day mortality between IMN and SHS cohorts (0.19 vs .13%, p = 0.249)., Conclusion: This analysis demonstrates a difference in utilization of SHS and IMN for patients with IT fractures. Patients with IMN had significantly higher prevalence of comorbid conditions and incidence of 90-day postoperative complications compared to SHS patients. The study can be utilized by orthopaedic surgeons to potentially anticipate healthcare utilization depending on implant selection. Level of Evidence: III ., Competing Interests: Disclosures: The authors report no potential conflicts of interest related to this study., (Copyright © The Iowa Orthopaedic Journal 2023.)

Background: National prevalence and outcomes of Fontan operation in the USA is unknown. Study objective was to determine trends (temporal change) in the annual volume of Fontan operations, in-hospital mortality, postoperative complications and type of hospital discharge.Methods: Review of the Nationwide Inpatient Sample for patients that underwent Fontan operation from 2001 to 2014 using the International Classification of Diseases-Ninth Revision, Clinical Modification procedure code for Fontan operation, that is, 35.94. To evaluate for change in patients' demographics over the years, we divided the patient population into four groups based on procedure year (2001-2004, 2005-2008, 2009-2011 and 2012-2014).Results: An estimated 15 934 Fontan operations were performed in the USA from 2001 to 2014. Median (Q1-Q3) age was 3 (2-4) years and 39.8% were female. Hypoplastic left heart syndrome was the most common (29%) congenital heart disease diagnosis. An estimated 1175 procedures were performed in 2001 and 1340 in 2014, but there was no significant change in the number of procedures per year (p=0.47). There was significant decline in in-hospital mortality from 4.5% (53/1175) in 2001 to 1.1% (15/1340) in 2014 (p=0.009). When we compared event rates between 2001-2004 and 2012-2014 periods, there was significant decline in postoperative cardiac complications (12.6% (459/3640) to 8% (378/4706), p=0.007) and respiratory complications (17.1% (623/3640) to 10.2% (481/4706), p<0.001). However, there was increase in the number of patients discharged to home with healthcare assistance or transferred to another acute care facility (5.8% (211/3640) to 9.4% (443/4706), p=0.01) and inflation-adjusted hospitalisation cost (US$46 978 to US$60 383, p<0.001), but no significant change in length of stay (p=0.73).Conclusion: On the average, 1062 Fontan operations are performed annually in the USA with no change in volume of procedures but a decrease in in-hospital mortality and postoperative complications over a 15-year period. [ABSTRACT FROM AUTHOR]

Background: To determine national trends in the utilization of surgical procedures for the treatment of benign prostatic hyperplasia (BPH) in Australia over the last 20 years. Methods: The Medicare Australia and Australian Institute of Health and Welfare databases were used to determine the annual number of surgical procedures and hospital admissions for BPH. Results: From 1998 to 2017, surgical procedures for BPH have increased by 79% which is largely commensurate with population growth. From 1998 to 2008, transurethral resection of the prostate (TURP) was the predominant surgical therapy, accounting for 96% of all surgical treatments. From 2008 to 2017, TURP use reduced to 70% and in the last 5 years has been replaced with photoselective vaporization (16%), UroLift (8%) and holmium laser prostatectomy (6%). UroLift is used significantly more in younger men (P < 0.001). Conclusion: There has been a substantial increase in surgical treatments for BPH over the last 20 years. In the last 5 years, TURP use has declined due to an increase in laser prostatectomy and UroLift procedures. Over the last 20 years there have been substantial changes in the surgical management of benign prostatic hypertrophy in Australia. Over this time, surgical procedures have increased by 79%; TURP procedures have decreased from 96% to 73% and have been replaced by laser prostatectomy and UroLift procedures. There is substantial variation in utilisation of surgical procedures between the states. [ABSTRACT FROM AUTHOR]

Background: How youth perceive harmfulness of risk behaviors such as substance use relates to their engagement in those behaviors. Yet, little is known about how different substance use modes (i.e., variations in amounts and use frequencies) are perceived. We investigated how adolescent perceptions of harmfulness of various alcohol- and cannabis use modes changed over time, compared to one another, and related to actual substance use behaviors.Methods: We examined nationally-representative repeated cross-sectional samples of 16-year olds in Norway, assessed in 2007, 2011, and 2015 (NTotal = 9296) as part of the European School Survey Project on Alcohol and Other Drugs (ESPAD). Adolescents reported their: 1) lifetime alcohol- and cannabis use, and 2) perceived harmfulness of various alcohol- and cannabis use modes.Results: Prevalence estimates for perceived harmfulness: 1) remained high and stable, or increased for alcohol use modes, and 2) declined for all cannabis use modes (i.e., using 1-2 times, occasionally, and regularly) since 2007-cohort. High quantity daily drinking was more commonly perceived as harmful than minimal or occasional cannabis use. Even though culturally-relevant use modes (i.e., weekend heavy drinking and experimental cannabis use) were not most commonly endorsed as harmful, only perceptions of those use modes as harmful were inversely associated with actual substance use.Conclusions: How adolescents from Norway perceived harmfulness of alcohol- and cannabis use depended on the specific substance, its use modes, and secular cohort. Perceived harmfulness was associated with measures of actual substance use predominantly along the culturally- and adolescent-relevant modes of use. [ABSTRACT FROM AUTHOR]

The purpose of this study was to create national estimates for the incidence of pediatric infective endocarditis (IE) in the United States and to determine if these changed after the implementation of the 2007 American Heart Association IE guidelines. It also sought to determine the effect of congenital heart disease (CHD) status on outcomes in IE. Hospital discharges with the diagnosis of IE in patients < 18 years old from the Kids' Inpatient Database were identified from the years 2000, 2003, 2006, 2009, and 2012. Discharges were grouped into Pre- and Post-2007 groups to facilitate analysis surrounding the implementation of the guidelines in 2007. Patients were categorized by age, underlying CHD, and etiologic organism. Descriptive comparisons and changes in categorical variables were made between groups. Average annual IE hospitalization rates before and after the 2007 guidelines were 10.8 and 9.3 per 1,000,000 children, respectively. The proportion of IE patients with CHD was stable between time periods, (45% vs. 47%, p = 0.50). Mortality was higher in the Post-2007 time period for CHD patients than non-CHD patients (11.1% vs. 2.4%, respectively; p < 0.001), while there was no difference noted during the Pre-2007 time period (6.5% vs. 6.6%, respectively; p = 0.95). Streptococcus was more common among CHD patients than non-CHD patients (27% vs. 17%), while Staphylococcus was more common among non-CHD patients than CHD patients (34% vs. 24%, p < 0.001). Even though the incidence of IE was stable over time, mortality was higher in CHD patients after the implementation of the 2007 AHA IE prophylaxis guidelines. [ABSTRACT FROM AUTHOR]

Abstract Background The use of extracorporeal membrane oxygenation (ECMO) has emerged as a common therapy for severe cardiopulmonary dysfunction. We aimed to describe the relationship of institutional volume with patient outcomes and examine transfer status to tertiary ECMO centers. Materials and methods Using the National Inpatient Sample, we identified adult patients who received ECMO from 2008 to 2014. Individual hospital volume was calculated as tertiles of total institutional discharges for each year independently. Results Of the total 18,684 adult patients placed on ECMO, 2548 (13.6%), 5278 (28.2%), and 10,858 (58.1%) patients were admitted to low-, medium-, and high-volume centers, respectively. Unadjusted mortality at low-volume hospitals was less than that of medium- (43.7% versus 50.3%, P = 0.03) and high-volume hospitals (43.7% versus 55.6%, P < 0.001). Length of stay and cost were reduced at low-volume hospitals compared to both medium- and large-volume institutions (all P < 0.001). In high-volume institutions, transferred patients had greater postpropensity-matched mortality (58.5% versus 53.7%, P = 0.05) and cost ($190,299 versus $168,970, P = 0.009) compared to direct admissions. On exclusion of transferred patients from propensity analysis, mortality remained greater in high-volume compared to low-volume centers (50.2% versus 42.8%, P = 0.04). Predictors of mortality included treatment at high-volume centers, respiratory failure, and cardiogenic shock (all P < 0.001). Conclusions Our findings show increased in-hospital mortality in high-volume institutions and in patients transferred to tertiary centers. Whether this phenomenon represents selection bias or transfer from another facility deserves further investigation and will aid with the identification of surrogate markers for quality of high-risk interventions. [ABSTRACT FROM AUTHOR]