An Analysis of Preterm Birth Related to SARS-COV-2 Infection by Race

Research investigating the association between pregnant women with COVID-19 infection and adverse birth outcomes, including preterm birth, having been contradicting. Individual differences between study populations, e.g., racial composition, may explain some of these inconsistencies. The aim of the present study is to determine if the association between SARS-CoV-2 infection and pre-term birth varies according to race. A cross-sectional study was conducted using data from the Vizient Clinical Data Base/Research Manager (CDB/RM). The study participants were women who gave birth in one of the Vizient facilities between March 2020 and January 2021. A positive COVID-19 test status was the primary exposure with preterm birth (\u3c37 weeks) being the primary outcome of interest. Logistic regression was used to estimate the association between COVID-19 and preterm birth adjusted for demographic and clinical characteristics, stratified by race. There were 641,598 deliveries in the study population of which 12,035 (1.9%) were to women who had ever tested positive for SARS-CoV-2. The results suggested among those who were Black, Hispanic, or of other racial/ethnic group there was an increased odds ratio for the association between COVID-19 and preterm birth. Current results suggest that COVID-19 is independently associated with pre-term birth in most racial and ethnic groups. The odds for some poor pregnancy outcomes also seem to be iv higher among those who were COVID-19 positive. Future studies that explore the effects of COVID-19 on pregnancy outcomes should consider accounting for possible racial and ethnic variation

Diabetes eye screening in urban settings serving minority populations: detection of diabetic retinopathy and other ocular findings using telemedicine.

IMPORTANCE: The use of a nonmydriatic camera for retinal imaging combined with the remote evaluation of images at a telemedicine reading center has been advanced as a strategy for diabetic retinopathy (DR) screening, particularly among patients with diabetes mellitus from ethnic/racial minority populations with low utilization of eye care. OBJECTIVE: To examine the rate and types of DR identified through a telemedicine screening program using a nonmydriatic camera, as well as the rate of other ocular findings. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional study (Innovative Network for Sight [INSIGHT]) was conducted at 4 urban clinic or pharmacy settings in the United States serving predominantly ethnic/racial minority and uninsured persons with diabetes. Participants included persons aged 18 years or older who had type 1 or 2 diabetes mellitus and presented to the community-based settings. MAIN OUTCOMES AND MEASURES: The percentage of DR detection, including type of DR, and the percentage of detection of other ocular findings. RESULTS: A total of 1894 persons participated in the INSIGHT screening program across sites, with 21.7% having DR in at least 1 eye. The most common type of DR was background DR, which was present in 94.1% of all participants with DR. Almost half (44.2%) of the sample screened had ocular findings other than DR; 30.7% of the other ocular findings were cataract. CONCLUSIONS AND RELEVANCE: In a DR telemedicine screening program in urban clinic or pharmacy settings in the United States serving predominantly ethnic/racial minority populations, DR was identified on screening in approximately 1 in 5 persons with diabetes. The vast majority of DR was background, indicating high public health potential for intervention in the earliest phases of DR when treatment can prevent vision loss. Other ocular conditions were detected at a high rate, a collateral benefit of DR screening programs that may be underappreciated

Reducing Crash Risk in Visually-Impaired Older Drivers: Medical-Surgical versus Educational Interventions

OBJECTIVES The aim of this paper is to compare the effectiveness of a medical-surgical intervention and an educational intervention in reducing the rate of crash involvement among visually impaired older drivers. Visual impairment is a common functional problem in older adults. Older drivers with visual processing deficits have an increased crash risk. Interventions that reduce these risks need to be identified in order to enhance driver safety. METHODS We have conducted two studies in an effort to examine two types of interventions to lower crash risk in visually impaired drivers. In a prospective cohort study we focused on 277 older drivers with cataracts, about half of who elected surgery and intraocular lens implantation at baseline, and the other half who declined surgery. They were followed for police-reported crash involvement for four to six years. In a second study, 403 older drivers who were visually impaired (acuity and/or useful field of view deficit) were randomly assigned to an individually administered and tailored educational intervention plus usual care, or to usual-care-only. The educational intervention promoted the use of self-regulatory driving strategies and was based on current models of health behavior change. Usual care was a comprehensive eye exam. In this study, subjects were also followed for police-reported crash involvement. RESULTS With respect to the study evaluating the cataract surgery intervention, patients who underwent cataract surgery had half the rate of crash involvement during follow-up compared with cataract patients who did not undergo surgery (rate ratio [RR] 0.47, 95% confidence interval [CI] 0.23 to 0.94; p0.05) CONCLUSIONS Cataract surgery has a previously undocumented benefit for older driver safety. However, an individualized educational intervention to promote safe driving strategies did not enhance driver safety. The most effective public health initiatives for reducing crash risk in older drivers may be to focus on the timely treatment of chronic medical conditions in order to prevent, reverse, or slow functional decline. Evidence that educational programs improve older driver safety remains unavailable

Reducing Crash Risk in Visually-Impaired Older Drivers: Medical-Surgical versus Educational Interventions

OBJECTIVES The aim of this paper is to compare the effectiveness of a medical-surgical intervention and an educational intervention in reducing the rate of crash involvement among visually impaired older drivers. Visual impairment is a common functional problem in older adults. Older drivers with visual processing deficits have an increased crash risk. Interventions that reduce these risks need to be identified in order to enhance driver safety. METHODS We have conducted two studies in an effort to examine two types of interventions to lower crash risk in visually impaired drivers. In a prospective cohort study we focused on 277 older drivers with cataracts, about half of who elected surgery and intraocular lens implantation at baseline, and the other half who declined surgery. They were followed for police-reported crash involvement for four to six years. In a second study, 403 older drivers who were visually impaired (acuity and/or useful field of view deficit) were randomly assigned to an individually administered and tailored educational intervention plus usual care, or to usual-care-only. The educational intervention promoted the use of self-regulatory driving strategies and was based on current models of health behavior change. Usual care was a comprehensive eye exam. In this study, subjects were also followed for police-reported crash involvement. RESULTS With respect to the study evaluating the cataract surgery intervention, patients who underwent cataract surgery had half the rate of crash involvement during follow-up compared with cataract patients who did not undergo surgery (rate ratio [RR] 0.47, 95% confidence interval [CI] 0.23 to 0.94; p0.05) CONCLUSIONS Cataract surgery has a previously undocumented benefit for older driver safety. However, an individualized educational intervention to promote safe driving strategies did not enhance driver safety. The most effective public health initiatives for reducing crash risk in older drivers may be to focus on the timely treatment of chronic medical conditions in order to prevent, reverse, or slow functional decline. Evidence that educational programs improve older driver safety remains unavailable

Evaluation of the AARP Driver Safety Program in Florida

OBJECTIVES Older drivers are the fastest growing group of drivers on the road in the United States, both in terms of the number of drivers and annual mileage; also, per-mile-driven, this group has a crash rate nearly equivalent to that of younger drivers. One approach to reducing crash risk in this population has been educational programs aimed at improving driving skills and/or changing driving behaviors. This retrospective cohort study describes the impact of the AARP Driver Safety Program (DSP) in Florida on motor vehicle collisions and violations. METHODS Information on individuals who participated in the AARP DSP in the state of Florida in 2001 and 2002 was provided by the AARP. The Florida Department of Highway Safety and Motor Vehicles (FDHSMV) provided licensure information on all licensed drivers who were aged 60 and older as of January 1, 2001. With respect to violations and collisions, information dating from the mid-1990s to early 2005 was provided. A total of 232,192 unique records for DSP participants were available; however, of these, 38,321 records were excluded because they contained out-of-state, erroneous or missing driver’s license numbers and therefore could not be matched to the data provided by the FDHSMV. Of the remaining 193,871 records with legitimate Florida driver’s license numbers, a total of 140,282 (72.4%) could be linked to the data provided by the FDHSMV. Two separate analyses were conducted. The first analysis compared violation and collision rates for DSP participants before and after DSP participation. The second analysis compared violation and collision rates between DSP participants and DSP non-participants. RESULTS Overall, DSP participants experienced a 7% statistically significant decrease in collisions (rate ratio [RR] 0.93, 95% confidence interval [CI] 0.89-0.97); a similar decrease was observed for injury-related collisions (RR 0.92, 95% CI 0.88-0.98) but not for fatal collisions (RR 1.20, 95% CI 0.74-1.94). The decline in the overall collision rate can be attributed to a decline in not-at-fault collisions (RR 0.85, 95% CI 0.80-0.91); there was no change in at-fault collisions (RR 1.00, 95% CI 0.94-1.07). Following DSP participation, violation rates significantly decreased 15% (RR 0.85, 95% CI 0.83-0.87). This decrease was observed for all types of violations with the exception of failure to yield, improper turning and improper lane changing, all of which showed no change, and careless driving, which showed a statistically significant 11% increase (RR 1.11, 95% CI 1.03- 1.20). Prior to DSP participation, those who participated in the DSP had a significantly higher collision rate (RR 1.11, 95% CI 1.07-1.14) compared to DSP non-participants, independent of age, gender, and race. This significantly elevated rate was consistent across all types of collisions. Following DSP participation, the overall collision rate for DSP participants was higher than that of non-participants (RR 1.21, 95% CI 1.17-1.25), though there was no difference for injurious or fatal collisions. The RR for not-at-fault and at-fault collisions indicated a lower collision rate for participants compared to non-participants. With respect to violations, prior to DSP participation, those who ultimately took part in the DSP had a lower violation rate (RR 0.96, 95% CI 0.95-0.98), however, this was mostly attributable to seat belt usage (RR 0.64, 95% CI 0.61-0.68). For all other types of violations, DSP participants had higher rates than the rest of the population. After DSP participation, participants had a higher violation rate compared to non-participants (RR 1.09, 95% CI 1.08-1.11), as well as elevated rates for most types of violations. There was no difference for failure to obey traffic signals, careless/improper driving, or improper backing. DSP participants had a lower rate of seat belt violations. CONCLUSIONS The results of this analysis suggest that though individuals who participated in the DSP had an overall reduction in collision rates, this reduction was attributable to not-at-fault collisions. This likely indicates that DSP participants modified their driving habits following the program (e.g., reduced their exposure) and did not necessarily improve their driving skills. There was also a reduction is some types of collisions, as well as an increase in careless driving-related offenses. These reductions may reflect a greater adherence to traffic laws or may simply reflect a reduction in driving brought about by changes in driving habits. Compared to similarly aged Florida drivers who did not participate in the DSP, participants had higher collision rates prior to the DSP. After DSP participation, the observed differences between participants and non-participants were either diminished or inverted such that participants had lower rates compared to non-participants. Participants had an overall lower violation rate prior to the DSP but for the most common types of violations they had elevated rates. Following participation, DSP participants had a higher crash rate compared to the rest of the population. For specific types of violations the elevated rates persisted but were diminished in magnitude

The relationships between golf and health:A scoping review

OBJECTIVE: To assess the relationships between golf and health. DESIGN: Scoping review. DATA SOURCES: Published and unpublished reports of any age or language, identified by searching electronic databases, platforms, reference lists, websites and from consulting experts. REVIEW METHODS: A 3-step search strategy identified relevant published primary and secondary studies as well as grey literature. Identified studies were screened for final inclusion. Data were extracted using a standardised tool, to form (1) a descriptive analysis and (2) a thematic summary. RESULTS AND DISCUSSION: 4944 records were identified with an initial search. 301 studies met criteria for the scoping review. Golf can provide moderate intensity physical activity and is associated with physical health benefits that include improved cardiovascular, respiratory and metabolic profiles, and improved wellness. There is limited evidence related to golf and mental health. The incidence of golfing injury is moderate, with back injuries the most frequent. Accidental head injuries are rare, but can have serious consequences. CONCLUSIONS: Practitioners and policymakers can be encouraged to support more people to play golf, due to associated improved physical health and mental well-being, and a potential contribution to increased life expectancy. Injuries and illnesses associated with golf have been identified, and risk reduction strategies are warranted. Further research priorities include systematic reviews to further explore the cause and effect nature of the relationships described. Research characterising golf's contribution to muscular strengthening, balance and falls prevention as well as further assessing the associations and effects between golf and mental health are also indicated

Using ordinal logistic regression to evaluate the performance of laser-Doppler predictions of burn-healing time

Background Laser-Doppler imaging (LDI) of cutaneous blood flow is beginning to be used by burn surgeons to predict the healing time of burn wounds; predicted healing time is used to determine wound treatment as either dressings or surgery. In this paper, we do a statistical analysis of the performance of the technique. Methods We used data from a study carried out by five burn centers: LDI was done once between days 2 to 5 post burn, and healing was assessed at both 14 days and 21 days post burn. Random-effects ordinal logistic regression and other models such as the continuation ratio model were used to model healing-time as a function of the LDI data, and of demographic and wound history variables. Statistical methods were also used to study the false-color palette, which enables the laser-Doppler imager to be used by clinicians as a decision-support tool. Results Overall performance is that diagnoses are over 90% correct. Related questions addressed were what was the best blood flow summary statistic and whether, given the blood flow measurements, demographic and observational variables had any additional predictive power (age, sex, race, % total body surface area burned (%TBSA), site and cause of burn, day of LDI scan, burn center). It was found that mean laser-Doppler flux over a wound area was the best statistic, and that, given the same mean flux, women recover slightly more slowly than men. Further, the likely degradation in predictive performance on moving to a patient group with larger %TBSA than those in the data sample was studied, and shown to be small. Conclusion Modeling healing time is a complex statistical problem, with random effects due to multiple burn areas per individual, and censoring caused by patients missing hospital visits and undergoing surgery. This analysis applies state-of-the art statistical methods such as the bootstrap and permutation tests to a medical problem of topical interest. New medical findings are that age and %TBSA are not important predictors of healing time when the LDI results are known, whereas gender does influence recovery time, even when blood flow is controlled for. The conclusion regarding the palette is that an optimum three-color palette can be chosen 'automatically', but the optimum choice of a 5-color palette cannot be made solely by optimizing the percentage of correct diagnoses

A Discrete Event Simulation model to evaluate the treatment pathways of patients with Cataract in the United Kingdom

Background The number of people affected by cataract in the United Kingdom (UK) is growing rapidly due to ageing population. As the only way to treat cataract is through surgery, there is a high demand for this type of surgery and figures indicate that it is the most performed type of surgery in the UK. The National Health Service (NHS), which provides free of charge care in the UK, is under huge financial pressure due to budget austerity in the last decade. As the number of people affected by the disease is expected to grow significantly in coming years, the aim of this study is to evaluate whether the introduction of new processes and medical technologies will enable cataract services to cope with the demand within the NHS funding constraints. Methods We developed a Discrete Event Simulation model representing the cataract services pathways at Leicester Royal Infirmary Hospital. The model was inputted with data from national and local sources as well as from a surgery demand forecasting model developed in the study. The model was verified and validated with the participation of the cataract services clinical and management teams. Results Four scenarios involving increased number of surgeries per half-day surgery theatre slot were simulated. Results indicate that the total number of surgeries per year could be increased by 40% at no extra cost. However, the rate of improvement decreases for increased number of surgeries per half-day surgery theatre slot due to a higher number of cancelled surgeries. Productivity is expected to improve as the total number of doctors and nurses hours will increase by 5 and 12% respectively. However, non-human resources such as pre-surgery rooms and post-surgery recovery chairs are under-utilized across all scenarios. Conclusions Using new processes and medical technologies for cataract surgery is a promising way to deal with the expected higher demand especially as this could be achieved with limited impact on costs. Non-human resources capacity need to be evenly levelled across the surgery pathway to improve their utilisation. The performance of cataract services could be improved by better communication with and proactive management of patients.Peer reviewedFinal Published versio