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ObjectiveKnowledge about systemic lupus erythematosus (SLE) outcomes among US Asian patients is lacking. The present study was undertaken to examine SLE disease activity, severity, and damage among Asian patients of primarily Chinese and Filipino descent in a multiethnic cohort.MethodsCalifornia Lupus Epidemiology Study (n = 328) data were analyzed. Data were collected in English, Cantonese, Mandarin, or Spanish using validated instruments for disease activity (Systemic Lupus Erythematosus Disease Activity Index), disease severity (Lupus Severity Index [LSI]), and disease damage (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index). We assessed differences in SLE outcomes among racial/ethnic groups using multivariable linear regression including interaction terms for age at diagnosis and race/ethnicity.ResultsAsian was the largest racial/ethnic group (38% [Chinese = 22%; Filipino = 9%; Other = 7%]). Average age at diagnosis was younger among Asian patients (27.9 years), particularly Filipino patients (22.2 years), compared with White (29.4 years) and Black patients (34.0 years). After adjustment, disease activity and damage were not significantly different across groups. Disease severity among Asian patients was significantly higher than among White patients (LSI score 7.1 versus 6.5; P

BackgroundBlack men are more likely than Non-Hispanic White (NHW) men to be diagnosed with high-risk prostate cancer. We examined the extent to which social factors were associated with differences in prostate cancer risk profiles between Black men and NHW men [using a modification to the original D'Amico risk groups based on prostate specific antigen (PSA), Gleason score (GS), and TNM stage (stage)], based on individual and combined clinicopathologic characteristics.MethodsWe conducted a cross-sectional population-based study of 23,555 Black men and 146,889 NHW men diagnosed with prostate cancer in the California Cancer Registry from 2004 to 2017. We conducted multivariable logistic regression to examine the association of year of diagnosis, block group-level neighborhood socioeconomic status (nSES), marital status, and insurance type on differences in prostate cancer risk profiles between Black and NHW men.ResultsHigh PSA (>20 ng/mL), GS, stage, individually and combined prostate cancer risk profiles were more common among Black men versus NHW men. In fully adjusted models, relative to NHW men, we observed a persistent 67% increased odds of high PSA among Black men. nSES was the factor most strongly associated with racial disparity in high PSA, accounting for 25% of the difference. Marital status was the factor that was second most associated with a racial disparity.ConclusionsnSES was the factor most strongly associated with racial disparities in high PSA prostate cancer.ImpactThe influence of nSES on racial disparities in PSA, GS, stage, and prostate cancer risk profiles warrants further consideration.

Technical Guidance from the US National Marine Fisheries Service recommends Federal agencies use estimated thresholds for peak sound pressure levels and weighted cumulative sound exposure levels for the onset of permanent (and temporary) hearing threshold shifts in marine mammals. These dual metrics were developed to inform impact assessments within the US legal landscape. Despite its merits, the Technical Guidance contains uncertainties due to limited data on marine mammal hearing and auditory response to noise. The underlying assumptions about how representative existing data are for all marine mammal species also create limitations in the applicability of the Technical Guidance. These limitations warrant consideration before the Technical Guidance can be applied effectively in other jurisdictions with different legal standards. Using the Canadian legal framework as a working example, we found that many Canadian species are underrepresented in the dataset informing the Technical Guidance. The Technical Guidance also does not address all relevant noise impact types. Thus, the Technical Guidance alone cannot address all Canadian legal standards and, if the Technical Guidance is incorporated, some adjustments to the criteria within may be needed to meet the precautionary requirements of many Canadian legal standards. Key words: noise, marine mammals, stress, behavioural responses, impact, Canada, Background and context Marine mammals are highly adapted to sending and receiving acoustic signals within the aquatic environment as sound is their primary sensory mode. They use acoustic signals to [...]

Background: Access to the operating room (OR) is variable among emergency general surgery (EGS) services, with some having dedicated EGS ORs, and others only a shared queue. Currently in Canada, only a limited number of acute care surgery services have dedicated daytime operating room (OR) access; hence, we aimed to describe the burden of after-hours EGS operating in Canada and differences associated with OR access. Methods: In this multicentre retrospective cohort study, we used data from a previously conducted study designed to evaluate nonappendiceal, nonbiliary disease across 8 Canadian hospitals. We performed a secondary analysis to describe booking priorities and timing of operative interventions, compare sites with and without access to a dedicated EGS daytime OR, and identify differences in morbidity and mortality based on timing of operative intervention. Results: Among 1244 patients, operations were performed during weekday daytime in 521 cases (41.9%), in the evening in 279 (22.4%), on the weekend in 293 (23.6%) and overnight in 151 (12.1%). Operating room booking priority was more than 2 hours to 8 hours in 657 cases (52.8%), more than 8 hours to 24 hours in 334 (26.9%) and more than 24 hours to 48 hours in 253 (20.3%). Substantial variation in booking priority was observed for the same preoperative diagnoses. Sites with dedicated EGS ORs performed a greater proportion of cases during daytime versus overnight compared to sites without dedicated EGS ORs (198/237 [83.5%] v. 323/435 [74.2%], p = 0.006). No significant differences in outcome were found between cases performed during the daytime, evening and overnight. Conclusion: We found considerable variation in OR booking priority within the same preoperative diagnoses among EGS patients in Canada. Sites with dedicated EGS ORs performed more cases during weekday daytime compared to sites without dedicated EGS ORs; however, this study showed no evidence of compromised outcomes based on OR timing. Contexte : Tous les services de chirurgie générale d'urgence (CGU) n'ont pas le même accès aux blocs opératoires (BO). Certains ont des BO dédiés, d'autres doivent se placer dans une file d'attente partagée. ?€ l'heure actuelle, au Canada, seul un nombre limité de services de chirurgie d'urgence disposent de BO dédiés accessibles durant le jour. Nous avons donc voulu décrire le fardeau imposé aux services de CGU qui doivent opérer en dehors des heures régulières au Canada et les différences d'accès aux BO. Méthodes : Dans cette étude de cohorte multicentrique rétrospective, nous avons utilisé les données d'une étude précédente qui a porté sur des cas non liés à l'appendicite ou à la cholécystite dans 8 hôpitaux canadiens. Nous avons procédé à une analyse secondaire afin de décrire les priorités d'inscription et le moment des chirurgies, comparer les établissements pourvus ou non d'un accès à des BO dédiés pour les CGU durant le jour, et établir les différences de morbidité et de mortalité selon le moment des interventions. Résultats : Sur un total de 1244 cas, les opérations ont été effectuées un jour de semaine et durant le jour dans 521 cas (41,9 %), le soir dans 279 cas (22,4 %), un jour de fin de semaine dans 293 cas (23,6 %) et la nuit dans 151 cas (12,1 %). La priorité d'inscription aux BO était de plus de 2 heures à 8 heures dans 657 cas (52,8 %), de plus de 8 heures à 24 heures dans 334 cas (26,9 %) et de plus de 24 heures à 48 heures dans 253 cas (20,3 %). On a observé une variation substantielle des priorités d'inscription pour de mêmes diagnostics préopératoires. Les hôpitaux pourvus de BO dédiés pour les CGU ont pris en charge un plus grand nombre de cas durant le jour plutôt que la nuit, comparativement aux établissements dépourvus de BO dédiés aux CGU (198/237 [83,5 %] c. 323/435 [74,2 %], p = 0,006). On n'a observé aucune différence en ce qui concerne l'issue des interventions selon qu'elles avaient eu lieu le jour, le soir ou la nuit. Conclusion : Nous avons constaté une variation substantielle des priorités d'inscription aux BO pour les mêmes diagnostics préopératoires dans les cas de CGU au Canada. Les établissements pourvus de BO dédiés pour les CGU ont opéré un plus grand nombre de cas les jours de semaine durant le jour que les établissements dépourvus de BO dédiés aux CGU; par contre, cette étude n'a mis au jour aucune complication associée au moment d'utilisation des BO., Despite widespread implementation of the acute care surgery (ACS) model, after-hours emergency general surgery (EGS) care accounts for a sizeable proportion of the ACS workload in Canada. Although the ACS [...]

Introduction: Cannabis regulation and use are undergoing dramatic changes. New cannabis products and new ways of using are emerging.  These changes have the potential to affect exposure to cannabis smoke and other emissions from cannabis use.  Cannabis smoke is known to contain fine, respirable particles (PM2.5) and other toxicants and carcinogens. Objectives: To assess the potential for exposure to PM2.5 from novel cannabis aerosols, we measured PM2.5 concentrations in a cannabis retail outlet (a dispensary) that permits on-site consumption of cannabis via non-combustion methods including vaporization and dabbing.Methods: PM2.5 concentrations in the dispensary were measured around the clock for five weeks using 2 laser photometer instruments (429,604 data points collected over 38.69 days).  The instruments were calibrated gravimetrically using a controlled cigarette generation system at regular intervals during the experiment. Outdoor PM2.5 concentrations were taken from a nearby EPA monitoring station.Results: The average PM2.5 concentration in the dispensary retail space, during business hours, was 84 ± 124 µg/m3, with a median of 47 µg/m3.  The average PM2.5 concentration when the business was closed was 3 ± 7 µg/m3 with a median of 2 µg/m3.   The highest daily concentrations correlated with the hours with the most customers.Conclusion: Our results suggest that the use of cannabis products indoors, even by non-combustion methods, increases the concentration of PM2.5. These findings are of concern to the public health because the business studied was in compliance with local laws and because PM2.5 exposure is a known cause of cardiopulmonary and metabolic disease.

Gender-based violence (GBV) rates are high in Zimbabwe. Looking toward a partnership to prevent GBV in the Victoria Falls region, which lacks GBV prevention initiatives, the current study's aim was to learn about stakeholders' perceptions of GBV causes and their ideas for GBV prevention, and to gauge potential community reactions to GBV prevention. Focus group participants emphasized lack of women's empowerment, alcohol, violence normalization, and tourism as GBV causes, and ideas for prevention included school-based curricular, social marketing campaigns, involving men in prevention, and home visiting programs. Consistent with community-based models, participants emphasized involving all community stakeholders in prevention.

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease with manifestations that vary widely in severity. Although minority populations are at higher risk for SLE and have more severe outcomes (1), population-based estimates of mortality by race and ethnicity are often lacking, particularly for Asian and Hispanic/Latino persons. Among 812 patients in the California Lupus Surveillance Project (CLSP) during 2007-2009 (2,3), who were matched to the 2007-2017 National Death Index (NDI), 16.6% had died by 2017. This proportion included persons of White (14.4%), Black (25%), Asian (15.3%), and Hispanic/Latino (15.5%) race/ethnicity. Standardized mortality ratios (SMRs) of observed-to-expected deaths among persons with SLE within each racial/ethnic group were 2.3, 2.0, 3.8, and 3.9, respectively. These findings provide the first population-based estimates of mortality among Asian and Hispanic/Latino persons with SLE. Coordination of robust care models between primary care providers and rheumatologists could ensure that persons with SLE receive a timely diagnosis and appropriate treatments that might help address SLE-associated mortality.

ObjectiveHealth-related quality of life (HRQoL) is reduced in systemic lupus erythematosus (SLE), partly driven by comorbid depression. Among patients with SLE, the association between major depression and HRQoL, measured using the NIH's Patient-Reported Outcomes Measurement Information System (PROMIS), is not well characterized. The objective was to determine an association between major depression and HRQoL as measured by PROMIS.MethodsCross-sectional data were obtained from the California Lupus Epidemiology Study, a cohort of adults in the San Francisco Bay Area with SLE. We studied the association between major depression (score ≥10 on the Patient Health Questionnaire 8 depression scale) and T scores (scaled to population mean ± SD of 50 ± 10) on 12 PROMIS domains representing physical, mental, and social health. Mean T scores in depressed and nondepressed individuals were compared using multiple linear regression models adjusting for age, sex, race/ethnicity, disease activity, damage, body mass index, and household income.ResultsMean age of the 326 participants was 45 years; ~89% were women, 29% White, 23% Hispanic, 10% African American, and 36% Asian. One-fourth met the criteria for major depression. In multivariable analyses, major depression was independently associated with worse T scores on all 12 PROMIS domains (P < 0.001); compared with those without major depression, depressed individuals scored >10 points (1 SD) worse on fatigue, sleep impairment, negative psychosocial impact of illness, satisfaction in discretionary social activities, and satisfaction in social roles.ConclusionIn individuals with SLE, major depression is associated with markedly worse PROMIS scores in physical, mental, and social domains. Diagnosing and treating depression may help improve HRQoL in individuals with SLE.