المؤلفون: Wintemute, Garen, Robinson, Sonia, Crawford, Andrew, Tomsich, Elizabeth, Reeping, Paul, Shev, Aaron, Velasquez, Bradley, Tancredi, Daniel

المصدر: Injury Epidemiology. 11(1)

مصطلحات موضوعية: Civil war, Domestic violent extremism, Firearm violence, Political violence, QAnon, Racism, Violence and society

الوصف: BACKGROUND: A 2022 survey in the USA found concerningly high prevalences of support for and personal willingness to engage in political violence, of beliefs associated with such violence, and of belief that civil war was likely in the near future. It is important to determine the durability of those findings. METHODS: Wave 2 of a nationally representative cohort survey was conducted May 18-June 8, 2023; the sample comprised all respondents to 2022s Wave 1. Outcomes are expressed as weighted proportions; changes from 2022 to 2023 are for respondents who participated in both surveys, based on aggregated individual change scores. RESULTS: The completion rate was 84.2%; there were 9385 respondents. After weighting, 50.7% (95% confidence interval (CI) 49.4%, 52.1%) were female; weighted mean (SD) age was 48.5 (25.9) years. About 1 in 20 respondents (5.7%, 95% CI 5.1%, 6.4%) agreed strongly/very strongly that in the next few years, there will be civil war in the United States, a 7.7% decrease. In 2023, fewer respondents considered violence to be usually/always justified to advance at least 1 of 17 specific political objectives [25.3% (95% CI 24.7%, 26.5%), a 6.8% decrease]. However, more respondents thought it very/extremely likely that within the next few years, in a situation where they consider political violence justified, I will be armed with a gun [9.0% (95% CI 8.3%, 9.8%), a 2.2% increase] and I will shoot someone with a gun [1.8% (95% CI 1.4%, 2.2%), a 0.6% increase]. Among respondents who considered violence usually/always justified to advance at least 1 political objective, about 1 in 20 also thought it very/extremely likely that they would threaten someone with a gun (5.4%, 95% CI 4.0%, 7.0%) or shoot someone (5.7%, 95% CI 4.3%, 7.1%) to advance such an objective. CONCLUSIONS: In this cohort, support for political violence declined from 2022 to 2023, but predictions of firearm use in political violence increased. These findings can help guide prevention efforts, which are urgently needed.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/1ms6z5f5Test

المؤلفون: Smith, Taryn, Fischer, Philip, Trehan, Indi, Hiffler, Laurent, Sitthideth, Dalaphone, Jones, Kerry, Tan, Xiuping, Allen, Lindsay, Sayasone, Somphou, Kounnavong, Sengchanh, Hess, Sonja, Schick, Michael, Tancredi, Daniel, McBeth, Christine, Stein-Wexler, Rebecca, Hampel, Daniela, Arnold, Charles, Yeh, Jay

مصطلحات موضوعية: Southeast Asia, beriberi, cardiac distress, critical illness, encephalopathy, respiratory distress, thiamine deficiency, thiamine deficiency disorders, Humans, Laos, Infant, Male, Female, Thiamine Deficiency, Prospective Studies, Thiamine, Infant, Newborn, Vitamin B Complex, Southeast Asian People

الوصف: OBJECTIVE: To develop a predictive model for thiamine responsive disorders (TRDs) among infants and young children hospitalized with signs or symptoms suggestive of thiamine deficiency disorders (TDDs) based on response to therapeutic thiamine in a high-risk setting. STUDY DESIGN: Children aged 21 days to

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/38x3b7tjTest

المؤلفون: Manske, Mary Claire B, Wilson, Machelle D, Wise, Barton L, Melnikow, Joy, Hedriana, Herman L, James, Michelle A, Tancredi, Daniel J

المصدر: American Journal of Perinatology. 41(S 01)

مصطلحات موضوعية: Biomedical and Clinical Sciences, Midwifery, Public Health, Health Sciences, Reproductive Medicine, Pediatric, Health Disparities, Minority Health, 2.2 Factors relating to the physical environment, 2.4 Surveillance and distribution, Aetiology, Reproductive health and childbirth, Good Health and Well Being, Adult, Female, Humans, Infant, Newborn, Male, Pregnancy, Young Adult, Birth Injuries, Brachial Plexus, California, Hispanic or Latino, Incidence, Logistic Models, Maternal Age, Multivariate Analysis, Retrospective Studies, Risk Factors, Black or African American, brachial plexus birth injury, epidemiology, maternal demographic characteristics, perinatal outcomes, health disparities, Clinical Sciences, Paediatrics and Reproductive Medicine, Obstetrics & Reproductive Medicine, Paediatrics, Reproductive medicine

الوصف: Objective This study aimed to evaluate the incidence of brachial plexus birth injury (BPBI) and its associations with maternal demographic factors. Additionally, we sought to determine whether longitudinal changes in BPBI incidence differed by maternal demographics.Study design We conducted a retrospective cohort study of over 8 million maternal-infant pairs using California's Office of Statewide Health Planning and Development Linked Birth Files from 1991 to 2012. Descriptive statistics were used to determine BPBI incidence and the prevalence of maternal demographic factors (race, ethnicity, age). Multivariable logistic regression was used to determine associations of year, maternal race, ethnicity, and age with BPBI. Excess population-level risk associated with these characteristics was determined by calculating population attributable fractions.Results The incidence of BPBI between 1991 and 2012 was 1.28 per 1,000 live births, with peak incidence of 1.84 per 1,000 in 1998 and low of 0.9 per 1,000 in 2008. Incidence varied by demographic group, with infants of Black (1.78 per 1,000) and Hispanic (1.34 per 1,000) mothers having higher incidences compared with White (1.25 per 1,000), Asian (0.8 per 1,000), Native American (1.29 per 1,000), other race (1.35 per 1,000), and non-Hispanic (1.15 per 1,000) mothers. After controlling for delivery method, macrosomia, shoulder dystocia, and year, infants of Black (adjusted odds ratio [AOR] = 1.88, 95% confidence interval [CI] = 1.70, 2.08), Hispanic (AOR = 1.25, 95% CI = 1.18, 1.32), and advanced-age mothers (AOR = 1.16, 95% CI = 1.09, 1.25) were at increased risk. Disparities in risk experienced by Black, Hispanic, and advanced-age mothers contributed to a 5, 10, and 2% excess risk at the population level, respectively. Longitudinal trends in incidence did not vary among demographic groups. Population-level changes in maternal demographics did not explain changes in incidence over time.Conclusion Although BPBI incidence has decreased in California, demographic disparities exist. Infants of Black, Hispanic, and advanced-age mothers are at increased BPBI risk compared with White, non-Hispanic, and younger mothers.Key points· The incidence of BPBI has decreased over time.. · Demographic disparities in BPBI incidence and risk exist.. · Infants of Black, Hispanic, and advanced age mothers are at greatest risk of BPBI..

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/1p50j6t9Test
https://escholarship.org/content/qt1p50j6t9/qt1p50j6t9.pdfTest

المؤلفون: Vastola, Marie, Mumma, Bryn, Fine, Jeffrey, Tancredi, Daniel, Elder, Joshua, Jarman, Angela

مصطلحات موضوعية: analgesia, disparity, opioid, race, sex differences

الوصف: BACKGROUND: There is conflicting data about sex-based differences in the treatment of acute pain in the ED. Little is known about sex-based disparities in analgesia in pediatric ED patients. OBJECTIVES: Our objective was to determine whether analgesic administration rates differ between female and male pediatric patients presenting to the ED with abdominal pain. METHODS: We conducted a retrospective cohort study of ED patients 5-21 years old with abdominal pain between 6/1/19 and 6/30/21. The primary outcome was receipt of any analgesia, and secondary outcomes were receipt of opioid analgesia and time to receipt of analgesia. Multivariable regression models were fitted for each outcome. RESULTS: We studied 1,087 patients; 681 (63%) were female with a median age of 17 years (IQR 13, 19) and 406 (37%) were male with a median age of 14 years (IQR 9, 18). 371 female patients (55%) and 180 male patients (44%) received any analgesia. 132 female patients (19%) and 83 male patients (20%) received opioid analgesia. In multivariate analyses, female patients were equally likely to receive any analgesia (OR 1.30, 95% CI 0.97 - 1.74, p = 0.07), but time to analgesia was 14% longer (GMR 1.14, 95% CI 1.00 - 1.29, p = 0.04). Non-White patients were 32% less likely to receive opioids (OR 0.68, 95% CI 0.47 - 0.97, p = 0.04). CONCLUSIONS: Female pediatric ED patients were equally likely to receive any analgesia as male patients, but their time to analgesia was longer. Non-White patients were less likely to receive opioid analgesia than White patients.

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الوصول الحر: https://escholarship.org/uc/item/0146312bTest

المؤلفون: Fang, Shao-You, Crawford, Andrew, Tseregounis, Iraklis, Gasper, James, Shev, Aaron, Cartus, Abigail, Marshall, Brandon, Cerdá, Magdalena, Wintemute, Garen, Tancredi, Daniel, Henry, Stephen, Stewart, Susan

المصدر: Journal of General Internal Medicine. 39(3)

مصطلحات موضوعية: controlled substances, drug overdose, drug tapering, opiate overdose, opioid analgesics, prescription drug monitoring programs, risk factors, Humans, Analgesics, Opioid, Cohort Studies, Opiate Overdose, Drug Overdose, Practice Patterns, Physicians, Retrospective Studies, Endrin

الوصف: BACKGROUND: Both increases and decreases in patients prescribed daily opioid dose have been linked to increased overdose risk, but associations between 30-day dose trajectories and subsequent overdose risk have not been systematically examined. OBJECTIVE: To examine the associations between 30-day prescribed opioid dose trajectories and fatal opioid overdose risk during the subsequent 15 days. DESIGN: Statewide cohort study using linked prescription drug monitoring program and death certificate data. We constructed a multivariable Cox proportional hazards model that accounted for time-varying prescription-, prescriber-, and pharmacy-level factors. PARTICIPANTS: All patients prescribed an opioid analgesic in California from March to December, 2013 (5,326,392 patients). MAIN MEASURES: Dependent variable: fatal drug overdose involving opioids. Primary independent variable: a 16-level variable denoting all possible opioid dose trajectories using the following categories for current and 30-day previously prescribed daily dose: 0-29, 30-59, 60-89, or ≥90 milligram morphine equivalents (MME). KEY RESULTS: Relative to patients prescribed a stable daily dose of 0-29 MME, large (≥2 categories) dose increases and having a previous or current dose ≥60 MME per day were associated with significantly greater 15-day overdose risk. Patients whose dose decreased from ≥90 to 0-29 MME per day had significantly greater overdose risk compared to both patients prescribed a stable daily dose of ≥90 MME (aHR 3.56, 95%CI 2.24-5.67) and to patients prescribed a stable daily dose of 0-29 MME (aHR 7.87, 95%CI 5.49-11.28). Patients prescribed benzodiazepines also had significantly greater overdose risk; being prescribed Z-drugs, carisoprodol, or psychostimulants was not associated with overdose risk. CONCLUSIONS: Large (≥2 categories) 30-day dose increases and decreases were both associated with increased risk of fatal opioid overdose, particularly for patients taking ≥90 MME whose opioids were abruptly stopped. Results align with 2022 CDC guidelines that urge caution when reducing opioid doses for patients taking long-term opioid for chronic pain.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/0zb5p37dTest

المؤلفون: Wintemute, Garen, Robinson, Sonia, Tomsich, Elizabeth, Tancredi, Daniel

المصدر: PLoS One. 19(1)

مصطلحات موضوعية: United States, Democracy, Violence, Societies, Surveys and Questionnaires, Politics

الوصف: BACKGROUND: Identifying groups at increased risk for political violence can support prevention efforts. We determine whether Make America Great Again (MAGA) Republicans, as defined, are potentially such a group. METHODS: Nationwide survey conducted May 13-June 2, 2022 of adult members of the Ipsos KnowledgePanel. MAGA Republicans are defined as Republicans who voted for Donald Trump in the 2020 presidential election and deny the results of that election. Principal outcomes are weighted proportions of respondents who endorse political violence, are willing to engage in it, and consider it likely to occur. FINDINGS: The analytic sample (n = 7,255) included 1,128 (15.0%) MAGA Republicans, 640 (8.3%) strong Republicans, 1,571 (21.3%) other Republicans, and 3,916 (55.3%) non-Republicans. MAGA Republicans were substantially more likely than others to agree strongly/very strongly that in the next few years, there will be civil war in the United States (MAGA Republicans, 30.3%, 95% CI 27.2%, 33.4%; strong Republicans, 7.5%, 95% CI 5.1%, 9.9%; other Republicans, 10.8%, 95% CI 9.0%, 12.6%; non-Republicans, 11.2%, 95% CI 10.0%, 12.3%; p < 0.001) and to consider violence usually/always justified to advance at least 1 of 17 specific political objectives (MAGA Republicans, 58.2%, 95% CI 55.0%, 61.4%; strong Republicans, 38.3%, 95% CI 34.2%, 42.4%; other Republicans, 31.5%, 95% CI 28.9%, 34.0%; non-Republicans, 25.1%, 95% CI 23.6%, 26.7%; p < 0.001). They were not more willing to engage personally in political violence. INTERPRETATION: MAGA Republicans, as defined, are more likely than others to endorse political violence. They are not more willing to engage in such violence themselves; their endorsement may increase the risk that it will occur.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/8zb6p2sdTest

المؤلفون: Merenstein, Daniel, Pot, Bruno, Leyer, Gregory, Ouwehand, Arthur C, Preidis, Geoffrey A, Elkins, Christopher A, Hill, Colin, Lewis, Zachery T, Shane, Andi L, Zmora, Niv, Petrova, Mariya I, Collado, Maria Carmen, Morelli, Lorenzo, Montoya, Gina A, Szajewska, Hania, Tancredi, Daniel J, Sanders, Mary Ellen

المصدر: Gut Microbes. 15(1)

مصطلحات موضوعية: Biological Sciences, Genetics, Prevention, Nutrition, Biotechnology, Patient Safety, Complementary and Integrative Health, Infection, Anti-Bacterial Agents, Gastrointestinal Microbiome, Prebiotics, Probiotics, Probiotic, safety, next-generation probiotics, antibiotic resistance, microbiome, microbiota, genome sequencing, live biotherapeutic products, International Scientific Association for Probiotics and Prebiotics, ISAPP, Microbiology

الوصف: Probiotics are used for both generally healthy consumers and in clinical settings. However, theoretical and proven adverse events from probiotic consumption exist. New probiotic strains and products, as well as expanding use of probiotics into vulnerable populations, warrants concise, and actionable recommendations on how to work toward their safe and effective use. The International Scientific Association for Probiotics and Prebiotics convened a meeting to discuss and produce evidence-based recommendations on potential acute and long-term risks, risks to vulnerable populations, the importance for probiotic product quality to match the needs of vulnerable populations, and the need for adverse event reporting related to probiotic use. The importance of whole genome sequencing, which enables determination of virulence, toxin, and antibiotic resistance genes, as well as clear assignment of species and strain identity, is emphasized. We present recommendations to guide the scientific and medical community on judging probiotic safety.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/17v230fxTest

المؤلفون: Manske, M Claire, Wilson, Machelle D, Wise, Barton L, James, Michelle A, Melnikow, Joy, Hedriana, Herman L, Tancredi, Daniel J

المصدر: Obstetrics and Gynecology. 142(5)

مصطلحات موضوعية: Reproductive Medicine, Biomedical and Clinical Sciences, Pediatric, Clinical Research, Prevention, Physical Injury - Accidents and Adverse Effects, Reproductive health and childbirth, Good Health and Well Being, Pregnancy, Infant, Newborn, Female, Humans, Delivery, Obstetric, Shoulder Dystocia, Dystocia, Retrospective Studies, Birth Injuries, Risk Factors, Brachial Plexus, Paediatrics and Reproductive Medicine, Obstetrics & Reproductive Medicine, Reproductive medicine

الوصف: ObjectiveTo evaluate the association of maternal delivery history with a brachial plexus birth injury risk in subsequent deliveries and to estimate the effect of subsequent delivery method on brachial plexus birth injury risk.MethodsWe conducted a retrospective cohort study of all live-birth deliveries occurring in California-licensed hospitals from 1996 to 2012. The primary outcome was recurrent brachial plexus birth injury in a subsequent pregnancy. The exposure was delivery history (parity, shoulder dystocia in a previous delivery, or previously delivering a neonate with brachial plexus birth injury). Multiple logistic regression was used to model adjusted associations of delivery history with brachial plexus birth injury in a subsequent pregnancy. The adjusted risk and adjusted risk difference for brachial plexus birth injury between vaginal and cesarean deliveries in subsequent pregnancies were determined, stratified by delivery history, and the number of cesarean deliveries needed to prevent one brachial plexus birth injury was determined.ResultsOf 6,286,324 neonates delivered by 4,104,825 individuals, 7,762 (0.12%) were diagnosed with a brachial plexus birth injury. Higher parity was associated with a 5.7% decrease in brachial plexus birth injury risk with each subsequent delivery (adjusted odds ratio [aOR] 0.94, 95% CI 0.92-0.97). Shoulder dystocia or brachial plexus birth injury in a previous delivery was associated with fivefold (0.58% vs 0.11%, aOR 5.39, 95% CI 4.10-7.08) and 17-fold (1.58% vs 0.11%, aOR 17.22, 95% CI 13.31-22.27) increases in brachial plexus birth injury risk, respectively. Among individuals with a history of delivering a neonate with a brachial plexus birth injury, cesarean delivery was associated with a 73.0% decrease in brachial plexus birth injury risk (0.60% vs 2.21%, aOR 0.27, 95% CI 0.13-0.55) compared with an 87.9% decrease in brachial plexus birth injury risk (0.02% vs 0.15%, aOR 0.12, 95% CI 0.10-0.15) in individuals without this history. Among individuals with a history of brachial plexus birth injury, 48.1 cesarean deliveries are needed to prevent one brachial plexus birth injury.ConclusionsParity, previous shoulder dystocia, and previously delivering a neonate with brachial plexus birth injury are associated with future brachial plexus birth injury risk. These factors are identifiable prenatally and can inform discussions with pregnant individuals regarding brachial plexus birth injury risk and planned mode of delivery.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/8d0128g1Test

المؤلفون: Xie, Jianling, Kuppermann, Nathan, Florin, Todd, Tancredi, Daniel, Funk, Anna, Kim, Kelly, Salvadori, Marina, Yock-Corrales, Adriana, Shah, Nipam, Breslin, Kristen, Chaudhari, Pradip, Bergmann, Kelly, Ahmad, Fahd, Nebhrajani, Jasmine, Mintegi, Santiago, Gangoiti, Iker, Plint, Amy, Avva, Usha, Gardiner, Michael, Malley, Richard, Finkelstein, Yaron, Dalziel, Stuart, Bhatt, Maala, Kannikeswaran, Nirupama, Caperell, Kerry, Campos, Carmen, Sabhaney, Vikram, Chong, Shu-Ling, Lunoe, Maren, Rogers, Alexander, Becker, Sarah, Borland, Meredith, Sartori, Laura, Pavlicich, Viviana, Rino, Pedro, Morrison, Andrea, Neuman, Mark, Poonai, Naveen, Simon, Norma-Jean, Kam, April, Kwok, Maria, Morris, Claudia, Palumbo, Laura, Ambroggio, Lilliam, Navanandan, Nidhya, Eckerle, Michelle, Klassen, Terry, Payne, Daniel, Cherry, Jonathan, Waseem, Muhammad, Dixon, Andrew, Ferre, Isabel, Freedman, Stephen

المصدر: Open Forum Infectious Diseases. 10(10)

مصطلحات موضوعية: C-reactive protein, COVID-19, SARS-CoV-2, child, lymphopenia, procalcitonin

الوصف: BACKGROUND: To assist clinicians with identifying children at risk of severe outcomes, we assessed the association between laboratory findings and severe outcomes among severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected children and determined if SARS-CoV-2 test result status modified the associations. METHODS: We conducted a cross-sectional analysis of participants tested for SARS-CoV-2 infection in 41 pediatric emergency departments in 10 countries. Participants were hospitalized, had laboratory testing performed, and completed 14-day follow-up. The primary objective was to assess the associations between laboratory findings and severe outcomes. The secondary objective was to determine if the SARS-CoV-2 test result modified the associations. RESULTS: We included 1817 participants; 522 (28.7%) SARS-CoV-2 test-positive and 1295 (71.3%) test-negative. Seventy-five (14.4%) test-positive and 174 (13.4%) test-negative children experienced severe outcomes. In regression analysis, we found that among SARS-CoV-2-positive children, procalcitonin ≥0.5 ng/mL (adjusted odds ratio [aOR], 9.14; 95% CI, 2.90-28.80), ferritin >500 ng/mL (aOR, 7.95; 95% CI, 1.89-33.44), D-dimer ≥1500 ng/mL (aOR, 4.57; 95% CI, 1.12-18.68), serum glucose ≥120 mg/dL (aOR, 2.01; 95% CI, 1.06-3.81), lymphocyte count

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/7mz727pkTest

المؤلفون: Timberline, Sage, Bhatt, Avni, Sunderji, Sherzana, Tancredi, Daniel J, Lakshminrusimha, Satyan, Siefkes, Heather

المصدر: Journal of Perinatology. 43(10)

مصطلحات موضوعية: Paediatrics, Biomedical and Clinical Sciences, Lung, Infant Mortality, Pediatric, Perinatal Period - Conditions Originating in Perinatal Period, Clinical Research, Respiratory, Good Health and Well Being, Infant, Newborn, Child, Humans, Infant, Hypertension, Pulmonary, Persistent Fetal Circulation Syndrome, Retrospective Studies, Prospective Studies, Respiratory Insufficiency, Nitric Oxide, Administration, Inhalation, Clinical Sciences, Paediatrics and Reproductive Medicine, Pediatrics

الوصف: ObjectiveTo obtain preliminary validity data for a hypoxemic respiratory failure/pulmonary hypertension (HRF/PH) score for classifying persistent pulmonary hypertension of the newborn (PPHN).Study designRetrospective chart review of 100 consecutive neonates admitted to a Children's hospital from 2016-2021 with PPHN, gestational age ≥34 weeks, and echocardiograms in the first week. We assessed the correlation between HRF/PH score and short-term outcomes using linear and logistic regressions.ResultsHRF/PH scores ranged 2-12 (mean 8.5), and were classified mild (0-5), moderate (6-10), and severe (11-15), with 6%, 77% and 17% infants in respective categories. HRF/PH score category correlated with invasive ventilation, nitric oxide, high frequency ventilation, vasoactive infusions, extracorporeal life support and death. HRF/PH score category did not correlate with duration of support or length of stay.ConclusionThe HRF/PH score offers a promising representation of disease severity for PPHN. The tool requires further validation in prospective studies and evaluation for long-term outcomes.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/0rw1b1z7Test