This study investigated the influence of acute reductions in arterial O
content (CaO
) via isovolumic haemodilution on global cerebral blood flow (gCBF) and cerebrovascular CO
reactivity (CVR) in 11 ...healthy males (age; 28 ± 7 years: body mass index; 23 ± 2 kg/m
). Radial artery and internal jugular vein catheters provided measurement of blood pressure and gases, quantification of cerebral metabolism, cerebral CO
washout, and trans-cerebral nitrite exchange (ozone based chemiluminescence). Prior to and following haemodilution, the partial pressure of arterial CO
(PaCO
) was elevated with dynamic end-tidal forcing while gCBF was measured with duplex ultrasound. CVR was determined as the slope of the gCBF response and PaCO
. Replacement of ∼20% of blood volume with an equal volume of 5% human serum albumin (Alburex® 5%) reduced haemoglobin (13.8 ± 0.8 vs. 11.3 ± 0.6 g/dL; P < 0.001) and CaO
(18.9 ± 1.0 vs 15.0 ± 0.8 mL/dL P < 0.001), elevated gCBF (+18 ± 11%; P = 0.002), preserved cerebral oxygen delivery (P = 0.49), and elevated CO
washout (+11%; P = 0.01). The net cerebral uptake of nitrite (11.6 ± 14.0 nmol/min; P = 0.027) at baseline was abolished following haemodilution (-3.6 ± 17.9 nmol/min; P = 0.54), perhaps underpinning the conservation of CVR (61.7 ± 19.0 vs. 69.0 ± 19.2 mL/min/mmHg; P = 0.23). These findings demonstrate that the cerebrovascular responses to acute anaemia in healthy humans are sufficient to support the maintenance of CVR.
Race/ethnicity and socioeconomic status (SES) are social categories that capture differential exposure to conditions of life that have health consequences. Race/ethnicity and SES are linked to each ...other, but race matters for health even after SES is considered. This commentary considers the complex ways in which race combines with SES to affect health. There is a need for greater attention to understanding how risks and resources in the social environment are systematically patterned by race, ethnicity and SES, and how they combine to influence cardiovascular disease and other health outcomes. Future research needs to examine how the levels, timing and accumulation of institutional and interpersonal racism combine with other toxic exposures, over the life-course, to influence the onset and course of illness. There is also an urgent need for research that seeks to build the science base that will identify the multilevel interventions that are likely to enhance the health of all, even while they improve the health of disadvantaged groups more rapidly than the rest of the population so that inequities in health can be reduced and ultimately eliminated. We also need sustained research attention to identifying how to build the political support to reduce the large shortfalls in health.
To design and validate an age and condition-specific health status instrument to best reflect the parental experience caring for these children with complex needs and home Nasogastric Tube (NGT) ...placement.
Combined Qualitative and Quantitative design, testing and implementation for item production and reduction, followed by formal validation by evaluating validity, reliability, and establishing a clinically meaningful change score.
Tertiary care, multi-disciplinary aerodigestive center.
All caregivers whose infant met criteria for eligibility for discharge home from the NICU or Special Care Nursery (SCN) with NGT in place were offered inclusion in this group.
Intervention/Exposure: Structured qualitative interviews of these caregivers to explore and define these concepts and domains, to item generate and then reduce, and then psychometric analyses.
Structured, moderated qualitative interviews with parents/caregivers of children who have undergone home NGT care of their children for item creation, design, and then reduction. Reliability was assessed by Cronbach alpha analysis. Construct validity and clinically meaningful change score was assessed using various query methods.
Cronbach's alpha to assess reliability, a priori hypotheses validity analyses, and minimally important clinical difference calculation.
Scaled scores of this condition specific instrument ranged from 14 to 74 where higher scores indicate better QOL related to managing the NGT. Cronbach's alpha with all 14 items was 0.93. Validity was assessed by a self-assessment question to discriminate between change (95% CI: 8.5–14.1; p < 0.0001) as well as by other comparators to identify the instrument's ability to discriminate among populations where parents felt a difference in experience. The minimally important difference was calculated at 18 points.
This represents the initial validation of the first condition and age-specific health status instrument to assess parent experience of caring for infants requiring a home NGT for dysphagia.
Background: Karnataka ranks third with regards the number of mines in India and Kolar, at one time, had the world’s deepest and most productive gold mines. Miners are exposed to hazardous agents like ...silica, coal and asbestos which adversely impact health. Objectives: To assess the health-related quality of life (HRQL) of ex-mine workers at Kolar Gold Fields (KGF), Kolar, Karnataka. Methodology: An analytical cross-sectional study was conducted among 240 (estimated 196 with 50% prevalence) male ex-mine workers of KGF. An interview scheduled, consisting of socio-demographic factors, COPD Assessment Test (CAT) and Kings Brief Interstitial Lung Disease (KBILD) was administered. Lower CAT score and higher KBILD score indicate better HRQOL. Results: The mean age of the participants was 69.71±8.56 years. Participants were previously involved in drilling (113-47%) and blasting (127-53%) activities in the mines, with a mean of 14.68±6.46 years of work exposure. The mean scores for CAT and KBILD were 15.80±7.42 and 52.83±8.77 respectively. Based on CAT scores, half (51%) of participants reported medium impact of COPD on their health. Participants with longer duration of work experience had significantly higher CAT scores OR-36.64 (12.14-110.6). KBILD score was significantly higher among those who worked in blasting (M=113. SD=52.14) than those involved in drilling (M=127, SD=53.43). Lower duration of work was significantly associated with higher KBILD scores (p<0.01). Adjusted logistic regression showed higher education and income had a positive impact on HRQL and an increase in age and longer work experience adversely affected HRQL. Conclusion: This study reveals the hazardous impact of drilling and blasting work on the health-related quality of life of ex-mine workers. Understanding this, for the future, it is important to educate workers, improve financial stability and minimize hazard exposure to enhance the quality of life of miners amidst the challenges of mining operations.
Steep socioeconomic hierarchy in post-industrial Western society threatens public health because of the physiological consequences of material and psychosocial insecurities and deprivations. ...Following on from their previous books, the authors continue their exploration of the geography of early mortality from age-related chronic conditions, of risk behaviors and their health outcomes, and of infant and child mortality, all due to rigid hierarchy. They divide the 50 states into those that gave their electoral college votes to Trump and those that gave theirs to Clinton in the 2016 presidential election and compare the two sets for socioeconomic and public health profiles. They deliberately apply only simple standard statistical methods in the public health analyses: t-test, Mann-Whitney test, bivariate regression, and backward stepwise multivariate regression. The book assumes familiarity with basic statistics. The authors argue that the unequal power relations that result in eroding public health in the nation and, in particular, in the Trump-voting states, largely cascade from the collapse of American industry, and they analyze the Cold War roots of that collapse. In two largely independent chapters on economics, they explore both the suppression of countervailing forces, such as organized labor, and the diversion of technical resources to the military as essential foundations to the population-level suffering that expressed itself in the 2016 presidential election. This interdisciplinary book has several primary audiences: creators of public policies, such as legislators and governmental staff, public health professionals and social epidemiologists, economists, labor union professionals, civil rights advocates, political scientists, historians, and students of these disciplines from public health through the social sciences. The Open Access version of this book, available at http://www.taylorfrancis.com, has been made available under a Creative Commons Attribution-Non Commercial-No Derivatives 4.0 license.
Abstract Background The values of the five-level EuroQol five-dimensional questionnaire (EQ-5D-5L) are elicited using composite time trade-off and discrete choice experiments. Unfortunately, data ...quality issues and interviewer effects were observed in the first few EQ-5D-5L valuation studies. To prevent these issues from occurring in later studies, the EuroQol Group established a cyclic quality control (QC) process. Objectives To describe this QC process and show its impact on data quality. Methods A newly developed QC tool provided information about protocol compliance, interviewer effects, and mean values by health state severity. In a cyclic process, this information is initially used to evaluate whether new interviewers meet minimal quality requirements and later to provide feedback about how their performance may be improved. To investigate the impact of this cyclic process, we compared the quality of the data in Dutch and Spanish valuation studies that did not have this QC process with that in the follow-up studies in the same countries that used the QC process. Data quality was measured using protocol violations, variability between interviewers, the proportion of inconsistent responders, and clustering of composite time trade-off values. Results In Spain, protocol violations were reduced from 87% in the valuation study to 5% in the follow-up study and in the Netherlands from 20% to 8%. In both countries, interviewers performed more homogeneously in the follow-up studies. The number of inconsistent respondents was reduced by 23.2% in Spain and 23.6% in the Netherlands. Values were less clustered in the follow-up studies. Conclusions The implementation of a strict QC process in EQ-5D-5L valuation studies increases interviewer protocol compliance and promotes data quality.
SHARE is a unique panel database of micro data on health, socio-economic status and social and family networks covering most of the European Union and Israel. To date, SHARE has collected three panel ...waves (2004, 2006, 2010) of current living circumstances and retrospective life histories (2008, SHARELIFE); 6 additional waves are planned until 2024. The more than 150 000 interviews give a broad picture of life after the age of 50 years, measuring physical and mental health, economic and non-economic activities, income and wealth, transfers of time and money within and outside the family as well as life satisfaction and well-being. The data are available to the scientific community free of charge at www.share-project.org after registration. SHARE is harmonized with the US Health and Retirement Study (HRS) and the English Longitudinal Study of Ageing (ELSA) and has become a role model for several ageing surveys worldwide. SHARE's scientific power is based on its panel design that grasps the dynamic character of the ageing process, its multidisciplinary approach that delivers the full picture of individual and societal ageing, and its cross-nationally ex-ante harmonized design that permits international comparisons of health, economic and social outcomes in Europe and the USA.
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