Rutgers University

NURSING MISC

Assignment 3

1)Since marijuana legalization, pediatric exposures to cannabis have increased. To date, pediatric deaths from cannabis exposure have not been reported. The authors report an 11-month-old male who, following cannabis exposure, presented with central nervous system depression after seizure, and progressed to cardiac arrest and died. Myocarditis was diagnosed post-mortem and cannabis exposure was confirmed. Given the temporal relationship of these two rare occurrences – cannabis exposure and sudden death secondary to myocarditis in an 11-month-old – as well as histological consistency with drug-induced myocarditis without confirmed alternate causes, and prior reported cases of cannabis- associated myocarditis, a possible relationship exists between cannabis exposure in this child and myocarditis leading to death. In areas where marijuana is commercially available or decriminalized, the authors urge clinicians to preventively counsel parents and to include cannabis exposure in the differential diagnosis of patients presenting with myocarditis.

1. 1. What kind of study is this and why is it used here?

1. 2. What is the comparison group?

1. 3. What is the measure of effect (if any)?

2. Background: The aim was to study whether number of visits to emergency department (ED) is associated with suicide, taking into consideration known risk factors. Methods: This is a population- based study     in a cohort. Computerized database on attendees to ED (during 2002-2008) was record linked to nation-wide death registry to identify 152 [suicides], and randomly selected 1520 [non-suicides]. The study was confined to patients attending the ED, who were subsequently discharged, and not admitted to hospital ward. Odds ratio (OR) and 95% confidence intervals (CI) of suicide risk according to number of visits (logistic regression) adjusted for age, gender, mental and behavioral disorders, non-causative diagnosis, and drug poisonings. Results: Suicides had on average attended the ED four times, while [non-suicides] attended twice. The OR for attendance due to mental and behavioral disorders was 3.08 (95% CI 1.61-5.88), 1.60 (95% CI 1.06- 2.43) for non-causative diagnosis, and 5.08 (95% CI 1.69-15.25) for poisoning. The ORs increased gradually with increasing number of visits. Adjusted for age, gender, and the above mentioned diagnoses, the OR for three attendances was 2.17, for five attendances 2.60, for seven attendances 5.97, and for nine attendances 12.18 compared with those who had one visit. Conclusions: Number of visits to the ED is an independent risk factor for suicide adjusted for other known and important risk factors. The prevalence of four or more visits was 40% among [suicides] compared with 10% among [non-suicides]. This new risk factor may open new venues for suicide prevention. [ABSTRACT FROM AUTHOR]
   1. What type of study is this and why might they have used this design?

1. 2. Describe the comparison groups.

1. 3. What was the main exposure the researchers were interested in?  

1. 4. From their results what would you say was the effect of this risk factor?

1. 5. What other risk factors did they also describe?

1. 6. List all of the confounders they said they controlled for.

3. There has been no worldwide XXXXXXXXXXXXX study on suicide as a global major public health problem. This study aimed to identify the variations in suicide specific rates using the Human Development Index (HDI) and some health related variables among countries around the world. In this XXXXXXXXXX study, we obtained the data from the World Bank Report 2013. The analysis was restricted to 91 countries for which both the epidemiologic data from the suicide rates and HDI were available. Overall, the global prevalence of suicide rate was 10.5 (95% confidence intervals: 8.8, 12.2) per 100,000 individuals, which significantly varied according to gender (16.3 in males vs. 4.6 in females, p < 0.001) and different levels of human development (11.64/100,000 individuals in very high development countries, 7.93/100,000 individuals in medium development countries, and 13.94/100,000 individuals in high development countries, p = 0.004). In conclusion, the suicide rate varies greatly between countries with different development levels. Our findings also suggest that male gender and HDI components are associated with an increased risk of suicide behaviors. Hence, detecting population subgroups with a high suicide risk and reducing the inequality of socioeconomic determinants are necessary to prevent this disorder around the world.

1. 1. What type of study is this and why might they have used this design?

1. 2. Describe the study population.

1. 3. Should suicide rates have been age standardized and why or why not?

4. For discussion: What is the best interpretation of these results and why?

5. Background: An increasing number of older patients undergo bariatric surgery.

Objective: To define the risk for complications and mortality in relation to age after gastric bypass.

Setting: A national registry-based study.

Methods: Patients (n=47,660) undergoing gastric bypass between May 2007 and October 2016 and registered in the Scandinavian Obesity Register were included. Risk between age groups was compared by multivariate analysis.

Results: The 30-day follow-up rate was 98.1%. In the entire cohort of patients, any complication within 30 days was demonstrated in 8.4%. For patients aged 50 to 54, 55 to 59, and ≥ 60 years, this risk was significantly increased to 9.8%, 10.0%, and 10.2%, respectively. Rates of specific surgical complications, such as anastomotic leak, bleeding, and deep infections/abscesses were all sig- nificantly increased by 14% to 41% in patients aged 50 to 54 years, with a small additional, albeit not significant, increase in risk in patients of older age. The risk of medical complications (thromboembolic events, cardiovascular, and pulmonary complications) was significantly increased in patients aged ≥60 years. Mortality was .03% in all patients without differences between groups.

Conclusions: In this large data set, rates of complications and mortality after 30 days were low. For many complications, an increased risk was encountered in patients aged ≥50 years. However, rates of complications and mortality were still acceptably low in these age groups. Taking the expected benefits in terms of weight loss and improvements of co-morbidities into consideration, our findings suggest that patients of older age should be considered for surgery after thorough individual risk assessment rather than denied bariatric surgery based solely on a predefined chronologic age limit. (Surg Obes Relat Dis 2018;14:437–444.)

1. 1. What type of study is this and how can you tell?

1. 2. What was the exposure?  

1. 3. What was the RR of deep infection/abscesses in 50 to 54 year olds compared to younger patients?  –

1. 4. Do you agree with their conclusions and why or why not (answer based on study design and results as given here)?

6. Abstract:      INTRODUCTION: A prominent effect of acute cannabis use is impaired motor coordination and driving performance. However, few studies have evaluated balance in chronic cannabis users, even though density of the CB1 receptor, which mediates the psychoactive effects of cannabis, is extremely high in brain regions critically involved in this fundamental behavior. The present study measured postural sway in regular cannabis users and used rambling and trembling analysis to quantify the integrity of central and peripheral nervous system contributions to the sway signal. METHODS: Postural sway was measured in 42 regular cannabis users (CB group) and 36 non- cannabis users (N-CB group) by asking participants to stand as still as possible on a force platform in the presence and absence of motor and sensory challenges. Center of pressure (COP) path length was measured, and the COP signal was decomposed into rambling and trembling components. Exploratory correlational analyses were conducted between sway variables, cannabis use history, and neurocognitive function. RESULTS: The CB group had significantly increased path length and increased trembling in the anterior-posterior (AP) direction. Exploratory correlational analyses suggested that AP rambling was significantly inversely associated with visuo-motor processing speed. DISCUSSION: Regular cannabis use is associated with increased postural sway, and this appears to be predominantly due to the trembling component, which is believed to reflect the peripheral nervous system's contribution to the sway signal.

1. 1. What type of study is this and how can you tell?

1. 2. What were the comparison groups based on?  

1. 3. What is the “outcome” researchers are interested in?

1. 4. What sort of effect measure was probably used?

1. 5. What are come some questions you might have about the study population?

1. 6. What are some other concerns (as an epidemiologist) you might have about concluding from this that issues with “postural sway” is due to cannabis use? (name at least 2)