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Awad E, Klapthor B, Morgan MH, Youngquist ST. The impact of time to defibrillation on return of spontaneous circulation in out-of-hospital cardiac arrest patients with recurrent shockable rhythms. Resuscitation 2024; 201:110286. [PMID: 38901663 DOI: 10.1016/j.resuscitation.2024.110286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/26/2024] [Accepted: 06/13/2024] [Indexed: 06/22/2024]
Abstract
OBJECTIVE Optimal timing for subsequent defibrillation attempts for Out-of-hospital cardiac arrest (OHCA) patients with recurrent VF/pVT is uncertain. We investigated the relationship between VF/pVT duration and return of spontaneous circulation (ROSC) in OHCA patients with recurrent shockable rhythms. METHODS We analyzed data from the Salt Lake City Fire Department (SLCFD) spanning from 2012 to 2023. The implementation of rhythm-filtering technology since 2011 enabled real-time rhythm interpretation during CPR, with local protocols allowing early defibrillation for recurrent/refractory VF/pVT cases. We included patients experiencing four or five episodes of VF and pVT rhythms and employed generalized estimating equation (GEE) regression analysis to examine the association between VF/pVT durations preceding recurrent defibrillation and return of spontaneous circulation (ROSC). RESULTS Analysis of 622 appropriate shocks showed that patients achieving ROSC had significantly shorter median VF/pVT duration than those who did not achieve ROSC (0.83 minutes vs. 1.2 minutes, p = 0.004). Adjusted analysis of those with 4 VF/pVT episodes (N = 142) revealed that longer VF/pVT durations were associated with lower odds of achieving ROSC (odds ratio: 0.81, 95% CI: 0.72-0.93, p = 0.005). Every one-minute delay in intra-arrest defibrillation is predicted to decrease the likelihood of achieving ROSC by 19%. CONCLUSION Every one-minute increase in intra-arrest VF/pVT duration was associated with a statistically significant 19% decrease in the chance of achieving ROSC. This highlights the importance of reducing time to shock in managing recurrent VF/pVT. The findings suggest reevaluating the current recommendations of two minutes intervals for rhythm check and shock delivery.
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Affiliation(s)
- Emad Awad
- Department of Emergency Medicine, Faculty of Medicine, University of Utah, Salt Lake City, UT, USA; BC RESURECT: Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Brent Klapthor
- Department of Emergency Medicine, Faculty of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Michael H Morgan
- Department of Emergency Medicine, Faculty of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Scott T Youngquist
- Department of Emergency Medicine, Faculty of Medicine, University of Utah, Salt Lake City, UT, USA; Salt Lake City Fire Department (SLCFD), Salt Lake City, UT, USA
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Nkansah-Amankra S. Revisiting the Association Between "Gateway Hypothesis" of Early Drug Use and Drug Use Progression: A Cohort Analysis of Peer Influences on Drug Use Progression Among a Population Cohort. Subst Use Misuse 2020; 55:998-1007. [PMID: 32077787 DOI: 10.1080/10826084.2020.1720245] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background and objective: Findings from observational studies indicate that early drug use is a strong predictor of further drug abuse. Because competing explanations abound in cross-sectional studies, causal interpretations from these investigations pose considerable challenge. We evaluated the relationship between early drug use and progression, while estimating modifying influences of adolescents' social contexts. Method: We applied a national longitudinal survey of 11,182 adolescents growing into adulthood over a 14-year period. The data provided a natural setting to evaluate the relationship between early drug use and drug use in three subsequent waves. We applied generalized estimating equation models to analyze these relationships. Results: Evidence showed over a relatively short period (approximately one year) early drug use was an independent predictor of illicit drugs in adolescence but not adulthood. The adjusted odds ratio for using substances in adulthood were marijuana (aOR, 1.33; 95% CI: 1.11-1.60), illicit drugs (aOR, 1.49; 95% CI: 1.04-2.12) and cocaine (aOR, 5.00; 95% CI: 2.75-9.10). Further, drug use was higher among older adolescence living in a neighborhood and reporting drug use as a big problem. In adulthood, neighborhood drug problems appear to have minimal influence on drug use escalation. Conclusion: The current findings call into question the causal interpretation of early drug use among adolescents as determinants of future drug escalation in adulthood. The overall impact of peer relationships on future drug escalation might depend on not only the extent of adolescent closeness to peers but also on continuity of friendship over time and other influencing social contexts.
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Affiliation(s)
- Stephen Nkansah-Amankra
- Department of Behavioral & Community Health (BCH), School of Public Health, University of Maryland, College Park, MD, USA
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Smith KA, Liu T, Freeman KA, Betz C, Clayton GH, Castillo H, Castillo J, Tu D, Speybroeck AV, Walker WO. Differences in continence rates in individuals with spina bifida based on ethnicity. J Pediatr Rehabil Med 2019; 12:361-368. [PMID: 31744028 PMCID: PMC7875209 DOI: 10.3233/prm-180556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Ethnic disparities in continence rates in spina bifida (SB) have been studied regionally but not nationally. National SB Patient Registry (NSBPR) data were analyzed to explore differences in prevalence of bowel and bladder continence and interventions between Hispanics/Latinos and others. METHODS Participants 5 to 21 years were categorized into Hispanic/Latino and non-Hispanic/non-Latino. Bladder/bowel continence was defined as dry/no involuntary stool leakage during the day or none/⩽ monthly incontinence. Chi-square test, Wilcoxon Two Sample Test, and generalized estimating equation (GEE) were used for statistical analysis. RESULTS Twenty-five percent of the 4,364 patients were Hispanic/Latino. At their most recent clinic visit, Hispanics/Latinos demonstrated lower rates of urinary continence (38.6% vs. 44.9%; p= 0.0003), bowel continence (43.9% vs. 55.8%, p< 0.0001), private insurance (p< 0.0001), bowel (p< 0.0001) or bladder surgeries (p= 0.0054), and more vesicostomies (p= 0.0427) compared to others. In multiple GEE models, Hispanic/Latino participants demonstrated lower odds of bowel continence as compared to non-Hispanic/non-Latino participants (estimated odds ratio, 0.82, 95% CI, 0.72-0.94, p= 0.0032). CONCLUSIONS After controlling for covariates, Hispanics/Latinos with SB are less likely to report bowel continence. Clinicians are encouraged to consider the risk of negative health disparities for Hispanic patients with SB and work to mitigate this risk.
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Affiliation(s)
- Kathryn A Smith
- Children's Hospital Los Angeles, Los Angeles, CA, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Tiebin Liu
- Rare Disorders and Health Outcomes Team, Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kurt A Freeman
- Institute on Development and Disability, Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
| | - Cecily Betz
- Children's Hospital Los Angeles, Los Angeles, CA, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Gerald H Clayton
- Children's Hospital Colorado, Aurora, CO, USA.,University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Heidi Castillo
- Section of Developmental-Behavioral Pediatrics, Department of Pediatrics, Texas Children's Hospital, Houston, TX, USA.,Baylor College of Medicine, Houston, TX, USA
| | - Jonathan Castillo
- Section of Developmental-Behavioral Pediatrics, Department of Pediatrics, Texas Children's Hospital, Houston, TX, USA.,Baylor College of Medicine, Houston, TX, USA
| | - Duong Tu
- Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital, Houston, TX, USA.,Baylor College of Medicine, Houston, TX, USA
| | - Alexander Van Speybroeck
- Children's Hospital Los Angeles, Los Angeles, CA, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - William O Walker
- Division of Developmental Medicine, Seattle Children's Hospital, Seattle, WA, USA.,University of Washington School of Medicine, Seattle, WA, USA
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Alibhai A, Kipp W, Saunders LD, Rubaale T, Mill J, Konde-Lule J. Relationship between characteristics of volunteer community health workers and antiretroviral treatment outcomes in a community-based treatment programme in Uganda. Glob Public Health 2016; 12:1092-1103. [PMID: 27080727 DOI: 10.1080/17441692.2016.1170179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Community health workers (CHWs) can help to redress the shortages of health human resources needed to scale up antiretroviral treatment (ART). However, the selection of CHWs could influence the effectiveness of a CHW programme. The purpose of this observational study was to assess whether sociodemographic characteristics and geographic proximity to patients of volunteer CHWs were predictors of clinical outcomes in a community-based ART (CBART) programme in Kabarole, Uganda. Data from CHW surveys for 41 CHWs and clinic charts for 185 patients in the CBART programme were analysed using multivariable logistic and Cox regression models. Time to travel to patients was the only statistically significant characteristic of CHWs associated with ART outcomes. Patients whose CHWs had to travel one or more hours had a 71% lower odds of virologic suppression (adjusted OR = 0.29, 95% CI = 0.13-0.65, p = .002) and a 4.52 times higher mortality hazard rate (adjusted HR = 4.52, 95% CI = 1.20-17.09, p = .026) compared to patients whose CHWs had to travel less than one hour. The findings show that the sociodemographic characteristics of CHWs were not as important as the geographic distance they had to travel to patients.
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Affiliation(s)
- Arif Alibhai
- a School of Public Health , University of Alberta , Edmonton , Canada
| | - Walter Kipp
- a School of Public Health , University of Alberta , Edmonton , Canada
| | - L Duncan Saunders
- a School of Public Health , University of Alberta , Edmonton , Canada
| | - Tom Rubaale
- b Community-Based ARV Project , Fort Portal , Uganda
| | - Judy Mill
- c Faculty of Nursing , University of Alberta , Edmonton , Canada
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Affiliation(s)
- Marc J. Mazerolle
- Centre de recherche en biologie forestière, Pavillon Abitibi-Price, Faculté de Foresterie et de Géomatique, Université Laval, Sainte-Foy, Québec G1K 7P4, Canada,
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Careau V, Lecomte N, Bêty J, Giroux JF, Gauthier G, Berteaux D. Hoarding of pulsed resources: Temporal variations in egg-caching by arctic fox. ECOSCIENCE 2015. [DOI: 10.2980/15-2-3097] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Vincent Careau
- Groupe de recherche en écologie comportementale et animale, Département des sciences biologiques, Université du Québec à Montréal, P.O. Box 8888, Stn Centre-ville, Montréal, Québec H3C 3P8, Canada
| | - Nicolas Lecomte
- Département de biologie and Centre d'études nordiques, Université Laval, Québec, Québec G1V 0A6, Canada
| | - Joël Bêty
- Centre d'études nordiques, Université du Québec à Rimouski, 300 Allée des Ursulines, Rimouski, Québec G5L 3A1, Canada
| | - Jean-François Giroux
- Groupe de recherche en écologie comportementale et animale, Département des sciences biologiques, Université du Québec à Montréal, P.O. Box 8888, Stn Centre-ville, Montréal, Québec H3C 3P8, Canada
| | - Gilles Gauthier
- Département de biologie and Centre d'études nordiques, Université Laval, Québec, Québec G1V 0A6, Canada
| | - Dominique Berteaux
- Chaire de recherche du Canada en conservation des écosystèmes nordiques and Centre d'études nordiques, Université du Québec à Rimouski, 300 Allée des Ursulines, Rimouski, Québec G5L 3A1, Canada
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Abstract
BACKGROUND Provider continuity (PC) occurs when a patient is treated by the same physician over time. A perceived benefit of PC is decreased test repetition. Repeat tests make up a significant proportion of overall laboratory utilization. This study determined whether test repetition increases when PC decreases. METHODS Cohort study of adults in eastern Ontario, Canada between September 1999 and September 2000 using population-based clinical databases. The primary study outcome was the probability that 7 common laboratory tests (hemoglobin, sodium, creatinine, thyrotropin, total cholesterol, ferritin, and hemoglobin A1C) were repeated at physician visits subsequent to the index test. We determined whether the probability of test repetition changed if the follow-up physician ordered the index test. We adjusted for multiple factors regarding the patient (age, sex, days in hospital, and number of physician visits in previous year), index test (normality and location), follow-up visit (location and time from index test), and follow-up physician (age and specialty). RESULTS The study included 881,353 patients, 1,419,438 index laboratory tests, and 7,622,938 follow-up physician visits. After adjusting for other important factors, we found that tests were significantly more likely to be repeated if the follow-up physician ordered the index test (adjusted odds ratio range 2.5-5.9). This association was consistent in most subgroups. CONCLUSIONS For these common laboratory investigations, PC was associated with increased, not decreased, test repetition. This suggests that increased PC alone will likely not decrease test utilization.
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Affiliation(s)
- Carl van Walraven
- Network of Eastern Ontario Medical Laboratories (NEO-MeL), Ottawa, ONT Canada.
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Morrow-Howell N, Hinterlong J, Rozario PA, Tang F. Effects of volunteering on the well-being of older adults. J Gerontol B Psychol Sci Soc Sci 2003; 58:S137-45. [PMID: 12730314 DOI: 10.1093/geronb/58.3.s137] [Citation(s) in RCA: 364] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study tests the effects of volunteering on the well-being of older adults, including the effect of level of engagement, the moderating effects of demographic and social factors, and the effects of the nature of the volunteer experience. METHODS This is a secondary data analysis of three waves of data from the Americans' Changing Lives Study. Self-rated health, functional dependency, and depression are regressed on the well-being measures from the previous waves, other control variables and volunteer status, volunteer hours, type and number of volunteer organizations, and the perceived benefit to others of the volunteer work. RESULTS Older adults who volunteer and who engage in more hours of volunteering report higher levels of well-being. This positive effect was not moderated by social integration, race, or gender. There was no effect of the number of organizations for which the older adult volunteered, the type of organization, or the perceived benefit of the work to others. DISCUSSION This work contributes to a knowledge base that points to the development of social programs and policies that maximize the engagement of older adults in volunteer roles. The findings suggest that targeting efforts may not be warranted, in that there are not differential benefits according to personal characteristics of the volunteer. Future studies have to address the nature of the social institutions that will maximize the number of elders in these roles and the benefits that they accrue.
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Affiliation(s)
- Nancy Morrow-Howell
- Center for Social Development, George Warren Brown School of Social Work, Washington University, St Louis, Missouri 63130, USA.
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