Google Trends (GT) is a useful real-time surveillance tool for epidemic outbreaks such as monkeypox (Mpox). GT provides hour-by-hour (real-time) data for the last seven days of Google searches. ...Non-real-time data are a random sample that encompasses search trends from 2004 and up to 72 h. Google Health Trends (GHT) API extracts daily raw search probabilities relative to the time period and size of the underlying population. However, little is known about the utility of GT real-time surveillance and GHT API following the public health announcements. Thus, this study aimed to analyzed Mpox GT real-time, non-real-time, and GHT API data 72 h before and after the WHO declared Mpox a public health emergency of international concern (PHEIC) in the top five Mpox-affected countries. Joinpoint regression was used to measure hourly percentage changes (HPC) in search volume. The WHO PHEIC statement on Mpox generated 18,225.6 per 10 million Google searches in the U.S. and Germany (946.8), and in 0–4 h, the HPC increased by an average of 103% (95% CI: 37.4–200.0). This study showed the benefits of real-time surveillance and the GHT API for monitoring online demand for information on emerging infectious diseases such as Mpox.
ObjectivesThis study examines the impact of the type of method used on the estimation of the burden of diseases.DesignComparison of methods of estimating disease burden.SettingFour metrics of burden ...of disease estimation, namely, years of potential life lost (YPLL), non-age weighted years of life lost (YLL) without discounting and YLL with uniform or non-uniform age weighting and discounting were used to calculate the burden of selected diseases in three countries: Australia, USA and South Africa.ParticipantsMortality data for all individuals from birth were obtained from the WHO database.OutcomesThe burden of 10 common diseases with four metrices, and the relative contribution of each disease to the overall national burden when each metric is used.ResultsThere were variations in the burden of disease estimates with the four methods. The standardised YPLL estimates were higher than other methods of calculation for diseases common among young adults and lower for diseases common among the elderly. In the three countries, discounting decreased the contributions of diseases common among younger adults to the total burden of disease, while the contributions of diseases of the elderly increased. After discounting with age weighting, there were no distinct patterns for diseases of the elderly and young adults in the three countries.ConclusionsGiven the variability in the estimates of the burden of disease with different approaches, there should be transparency regarding the type of metric used and a generally acceptable method that incorporates all the relevant social values should be developed.
There is growing evidence in the literature that patients' age is associated with increased risk of death in acute pesticide poisoning. However, few studies have investigated whether the age effect ...differs between males and females. We aimed to examine the association between age-sex and risk of death in acute pesticide self-poisoning.
A prospective cohort of deliberate pesticide-poisoned patients admitted to ten rural Sri Lankan hospitals between March 2002 and December 2019. The pesticide ingested was identified based on identification of container or history. A mixed effects logistic regression was fitted to investigate the effect of age-sex on death in acute pesticide self-poisoning adjusting for clinical symptoms on admission, measured by Glasgow Coma Scale and Poison Severity Score, and controlling for clustering among hospital sites.
In total, 201 different pesticides were ingested by patients. 6,643 patients ingested an unknown pesticide. A single pesticide was co-ingested with alcohol by 4,603 patients. Of the 28,303 patients enrolled, 2,028 patients died, resulting in case fatality of 7.2% (95% CI 6.9-7.5). The effect of age on case fatality was stronger for males after 21 years of age. The odds of dying for each 5 years increase in age was 1.26 (95% CI 1.23-1.28) times higher for males versus 1.14 (95% CI 1.10-1.19) times higher for females. Missing data were handled by multiple imputation.
Patient's age-sex are important risk factors for death in acute pesticide self-poisoning even after controlling for clinical effects. The age effect on the odds of dying was significantly different for males and females, with this effect being stronger for males. Given that patient's age and sex are very easy to collect on admission, our study highlights the need for incorporating these risk factors in policy and clinical decisions.
Background
The chronic recreational inhalation of nitrous oxide (N2O) ‘nanging’, can have adverse neurological and psychiatric effects.
Aim
To evaluate cases of chronic N2O use presenting to two ...hospitals, as well as to evaluate nationally N2O deaths reported to the coroner and trends in Internet searches and social media posts related to N2O.
Methods
Retrospective review of two toxicology units, from July 2017 to October 2020, of patients presenting with chronic N2O use and neurological and/or psychiatric symptoms. We evaluated 10 years (2010–2019) of Internet search and social media trends involving N2O and the National Coronial Information System (NCIS) database for deaths across Australia.
Results
Twenty‐two patients were identified: median age 22 years, half female, 17 Asian background and 15 students. Presentations included decreased mobility or unsteady gait (n = 15) and psychiatric symptoms (n = 5). The median reported bulb use/day was 300 (interquartile range (IQR): 200–370), for a median of 6 months (IQR: 3–24). On magnetic resonance imaging, 10/18 had subacute combined degeneration of the spinal cord and 7/7 sensorimotor neuropathy on nerve conduction studies. All received high‐dose intramuscular vitamin B12 and 11 methionine. Despite prolonged rehabilitation, nine required walking aids on discharge. Since 2017, social media posts and Internet searches for N2O increased rapidly, the latter mostly directed at obtaining N2O canisters. From the NCIS, 36 deaths were identified, 12 unintentional (recreational drug use), 20 intentional self‐harm and 4 traumatic.
Conclusion
We report a case series of symptomatic chronic N2O use, many with ongoing neurological sequelae. Furthermore, a sharp increase in Internet searches to obtain N2O cannisters was noted. Education of high‐risk student groups on the long‐term sequelae is important.
This article describes the development of a measuring instrument to monitor support offered by preceptors during their accompaniment of students in clinical facilities.
A quantitative methodological ...study design was used to develop the instrument.
Data were collected by means of a self-completed questionnaire. Total sampling of 192 undergraduate nursing students was done. Descriptive data analysis was conducted regarding the biographical characteristics, Cronbach's alpha was computed to determine the reliability, and an exploratory factor analysis was done to describe the construct validity of the developed instrument.
The Cronbach's alpha of 0.98 indicates high reliability and high internal consistency. Three constructs regarding clinical support, namely cognitive-, emotional- and system support were identified by means of the exploratory factor analysis.
The new conceptualisation of support gives insight into the value of the preceptor's role. The instrument designed for this study could be used to assess and monitor the support offered by preceptors while they accompany students in clinical practice.
Considering the need to strengthen nursing and midwifery education systems, this instrument contributes to measuring and monitoring clinical accompaniment of students by preceptors.
Pesticide poisoning is among the most common means of suicide globally, but can be prevented with regulation of the most hazardous agents. We aimed to compare the lethality of pesticides ingested by ...our cohort, seek evidence on variation between human and regulatory animal toxicity, and establish change over time in the case fatality of individual pesticides in Sri Lanka.
We examined the case fatality of agricultural pesticides in a prospective cohort in nine hospitals serving rural populations in Sri Lanka. We included all patients (>11 years) who had presented to a South Asian Clinical Toxicology Research Collaboration study hospital during the study period. Patients were enrolled by clinical research assistants and were regularly reviewed. Identification of the ingested pesticide was generally on the basis of history or positive identification of the container, supported by nested blood analysis.
From March 31, 2002, to Dec 31, 2019, 34 902 patients (median age 29 years IQR 21–40; 23 060 66·1% male) presented with a possible or known pesticide self-poisoning. We identified 23 139 specific pesticides that were ingested. Poisoning was fatal in 2299 (6·6%) patients. Case fatality varied greatly from 0·0% (several substances) to 41·8% (paraquat). The three most toxic agents (ie, paraquat, dimethoate, and fenthion) were banned between 2008 and 2011. Since 2013, the five agents causing the most deaths (ie, profenofos, propanil, fenobucarb, carbosulfan, and quinalphos) had a case fatality of 7·2–8·6%. A steady decline was seen in overall case fatality of pesticide poisoning (10·5% for 2002–06 to 3·7% for 2013–19), largely attributable to pesticide bans. A modest fall in case fatality for non-banned pesticides was also seen.
Declines seen in case fatalities of poisonings with non-banned pesticides suggest that medical management improved over time. The human data for acute toxicity of pesticides should drive hazard classifications and regulation. We believe that a global benchmark for registration of pesticides should include a less than 5% case fatality after self-poisoning, which could prevent many deaths and have a substantial effect on global suicide rates.
The Wellcome Trust and the National Health and Medical Research Council of Australia.
For the Sinhala and Tamil translations of the abstract see Supplementary Materials section.
Franzén (2023: 1) has warned of ‘big problems’ when researchers attempt to use Google Trends (GT) data. The evidence she provides is examined, additional evidence is obtained and analysed, and a new ...set of conclusions are derived. The anomalies previously encountered are due to a combination of factors, but can be explained by noting that Google samples its data to provide GT results, these data are also scaled, which can exacerbate variation between samples, and Denmark is a small country and Jakob Scharf a low-probability search term, both of which would increase variation in search probabilities provided by GT. When multiple samples are obtained and aggregated (medians are best for low-probability search terms), this variation is controlled, and a stable time series is derived. Researchers should not see GT as an easy source of data, but should do the work required to understand the data, and should use it, and interpret their results, within the limitations inherent in these data. It is important to aggregate multiple samples (preferably with the median for each time point) in order to obtain more stable estimates from GT.
2-Methyl-4-chlorophenoxyacetic acid (MCPA) is a widely used chlorophenoxy herbicide. MCPA poisoning causes mitochondrial dysfunction, which can lead to kidney injury and death. The objective of this ...study is to describe the epidemiology, case fatality and extent of renal injury in a large cohort of MCPA self-poisonings. The study consists of two parts: (1) A report of epidemiological data and clinical outcomes in MCPA poisoned patients in Sri Lanka between 2002 and 2019; (2) Evaluation of acute kidney injury (AKI) using renal biomarkers in a subset from this cohort. Serum creatinine (sCr) and biomarkers were measured soon after hospitalization (2 IQR 1-3 h) and at different time intervals. We measured serum biomarkers: sCr, cystatin C (sCysC), creatine kinase (CK), and urinary biomarkers: creatinine, kidney injury molecule-1 (KIM-1), clusterin, albumin, beta-2-microglobulin (β2M), cystatin C, neutrophil gelatinase-associated lipocalin (NGAL), osteopontin (OPN), trefoil factor 3 (TFF3) and cytochrome C (CytoC). Kidney Disease Improving Global Outcomes (KDIGO) criteria was used to define acute kidney injury (AKI). There were 1653 patients; 65% were male. The median time from ingestion to examination was 3:54 (IQR 2:19-6:57) h. The overall case-fatality rate was 5.3%. Patients who died were older (42 IQR 33.5-54 vs 27 IQR 20-37 for survivors). The median estimated amount of MCPA ingested by patients who died was also greater (88 IQR 34-200 vs. 30 IQR 15-63 ml in survivors). Moderate to severe AKI (AKI2/3) was uncommon (6/59 patients in the biomarker study had KDIGO stage 2 or 3). Most patients in AKI2/3 group with increased sCr were older (median age 35 years IQR 27-41) compared to No AKI (23 years (19-29) years) or AKI1 (26 years (21-40) years) group who had no or mild increase in sCr. These patients had no pre-existing kidney diseases. In these patients, serum creatinine (maximum medium concentration; 1.12 IQR 0.93-1.67 mg/dl) and CK (maximum medium concentration; 284 IQR 94-428 U/l) were increased but sCysC (maximum medium concentration; 0.79 IQR 0.68-0.81 mg/l) remained in the normal range within 72 h. All urinary biomarkers performed poorly in diagnosing AKI (area under the receiver operating characteristic curve < 0.68). The higher numbers of men with MCPA poisoning likely reflects greater occupational access to pesticides. Fatal outcome and higher ingested dose were more common in the elderly. Significant AKI with tubular injury biomarkers was uncommon. Most people with raised sCr were older and appeared to have no pre-existing kidney disease.
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