NURSE STAFFING
Understaffing a likely cause of shortage
Authors of a paper published in Nursing Outlook found that policies to prevent chronic hospital nurse understaffing have the greatest potential to stabilize the workforce at levels supporting good care and clinical well-being.
The authors conducted two cross-sectional studies. One was before the pandemic began and one was during the pandemic. A total of 151,335 RNs in New York and Illinois were included, along with a subset of 40,674 direct care nurses employed in 357 hospitals.
The authors sought to determine if staffing shortages were primarily due to the pandemic, which they presume will subside without intervention, or if the shortage was due to preexisting working conditions.
They did not find evidence of many nurses exiting healthcare or hospital practice during the first 18 months of the pandemic. Furthermore, nurses in hospitals with higher nurse staff levels and "more favorable" working conditions reported significantly better outcomes during the pandemic.
REFERENCE
Aiken LH, Sloane DM, McHugh MD, Pogue CA,Lasater KB. A repeated cross-sectional study of nurses immediately before and during the COVID-19 pandemic: implications for action. Nurs Outlook. 2022. doi:10.1016/j.outlook.2022.11.007.
CARDIOVASCULAR DEATH
Link between extreme temperatures, excess deaths
Extreme temperatures increase the risk of death from cardiovascular conditions, say the authors of a paper published in Circulation.
Hot and cold days accounted for 2.2 excess deaths for every 1,000 cardiovascular conditions. Heart failure was associated with the highest excess deaths proportion on hot and cold days, accounting for 2.6 and 12.8 excess deaths for every 1,000 heart failure deaths, respectively.
The paper's authors compiled daily counts of cardiovascular causes of death from 567 cities in 27 countries across 5 continents between 1979 and 2019. They included deaths from any cardiovascular cause (32,154,935), ischemic heart disease (11,745,880), stroke (9,351,312), heart failure (3,673,723), and dysrhythmia (670,859).
The authors also included city-specific daily ambient temperatures from weather stations and climate reanalysis models to construct a spectrum of percentiles.
To evaluate the associations of temperatures with cardiovascular deaths, the authors fit case-crossover models in each city. Then they used a mixed-effects meta-analytic framework to pool individual city estimates. In each location, extreme temperature percentiles were compared with the minimum mortality temperature (the lowest associated with mortality).
REFERENCE
Alahmad B, Khraishah H, Roye D, et al. Associations between extreme temperatures and cardiovascular causespecific mortality: results from 27 countries. Circulation. 2022;147(1):35-46. doi:10.1161/circulationaha.122.061832.
ALCOHOL-USE DISORDER
AUD-ED injury visits associated with increased mortality risk
Patients with alcohol use disorder (AUD) who present to the ED due to an injury are at an increased risk of death within 1 year, according to the authors of a paper in the Journal of Studies on Alcohol and Drugs.
Most ED injury visits in which the patient had a comorbid diagnosis of AUD were coded as unintentional. Such patients had an all-cause mortality of 5,205 per 100,000 person-years. The authors say this was five times higher than the demographically matched population.
Furthermore, patients classified as an unintentional ED injury whose AUD was for acute intoxication had significantly higher mortality. Most of these deaths were from natural causes; deaths resulting from external causes were relatively more common in other patient groups, the authors note.
The authors collected their data from statewide, longitudinally linked ED patient record and mortality data from California. Patients were selected from all residents presenting to a licensed ED between 2009 and 2012 with a nonfatal injury and a comorbid diagnosis of AUD. Injury intent was defined using the International Classification of Diseases, 9th Revision, Clinical Modification external cause-of-injury codes. The authors used a cox regression model for 12-month all-cause mortality. The authors state that age-, sex-, and race/ethnicity-adjusted standardized mortality ratios were calculated using statewide mortality data.
REFERENCE
Goldman-Mellor S, Kaplan MS, Qin P. Mortality risk following nonfatal injuries with alcohol use disorder involvement: a one-year follow-up of emergency department patients using linked administrative data. J Stud Alcohol Drugs. 2022;83(6):879-887. doi:10.15288/jsad.21-00444.
TYPE 2 DIABETES
Early-onset type 2 diabetes a growing adolescent concern
Early-onset type 2 diabetes is a growing global health problem in adolescents and young adults, authors of a paper published in BMJ found.
The prevalence is especially notable in countries with a low-middle and middle sociodemographic index and women under 30 years of age. However, after 30 years of age, this difference between the sexes flips.
According to the authors, the main attributable risk factor for early-onset type 2 diabetes is a high body mass index. Other contributors the authors noted include ambient particulate air pollution, smoking, higher proportions of household air pollution from solid fuels, and a diet low in fruits.
The paper's authors conducted a systematic analysis of age-standardized incidence rate, age-standardized disability-adjusted life years (DALY) rate, and age-standardized mortality for type 2 diabetes in people ages 15-39 years from 1990 to 2019, and proportional DALY attributable to different risk factors.
They noted that the age-standardized incidence rate (per 100,000 population) increased from 117.22 in 1990 to 183.36 in 2019, the age-standardized DALY rate (per 100,000 population) increased from 106.34 in 1990 to 149.61 in 2019, and the age-standardized mortality (per 100,000 population) increased from 0.74 in 1990 to 0.77 in 2019.
Countries with low-middle and middle sociodemographic indexes had the highest age-standardized incidence rate and age-standardized DALY rates in 2019. Countries with a low sociodemographic index had the lowest age-standardized incidence rate but the highest age-standardized mortality.
REFERENCE
Xie J, Wang M, Long Z, et al. Global burden of type 2 diabetes in adolescents and Young Adults, 1990-2019: systematic analysis of the global burden of disease study 2019. BMJ. 2022;379. doi:10.1136/bmj-2022-072385.