Non-alcoholic fatty liver disease increases risk of carotid atherosclerosis and ischemic stroke: An updated meta-analysis with 135,602 individuals

Background/Aims@#Non-alcoholic fatty liver disease (NAFLD) is associated with the development of cardiovascular disease. While existing studies have examined cardiac remodeling in NAFLD, there has been less emphasis on the development of carotid atherosclerosis and stroke. We sought to conduct a meta-analysis to quantify the prevalence, risk factors, and degree of risk increment of carotid atherosclerosis and stroke in NAFLD. @*Methods@#Embase and Medline were searched for articles relating to NAFLD, carotid atherosclerosis, and stroke. Proportional data was analysed using a generalized linear mixed model. Pairwise meta-analysis was conducted to obtain odds ratio or weighted mean difference for comparison between patients with and without NAFLD. @*Results@#From pooled analysis of 30 studies involving 7,951 patients with NAFLD, 35.02% (95% confidence interval [CI], 27.36–43.53%) had carotid atherosclerosis with an odds ratio of 3.20 (95% CI, 2.37–4.32; P<0.0001). Pooled analysis of 25,839 patients with NAFLD found the prevalence of stroke to be 5.04% (95% CI, 2.74–9.09%) with an odds ratio of 1.88 (95% CI, 1.23–2.88; P=0.02) compared to non-NAFLD. The degree of steatosis assessed by ultrasonography in NAFLD was closely associated with risk of carotid atherosclerosis and stroke. Older age significantly increased the risk of developing carotid atherosclerosis, but not stroke in NAFLD. @*Conclusions@#This meta-analysis shows that a stepwise increment of steatosis of NAFLD can significantly increase the risk of carotid atherosclerosis and stroke development in NAFLD. Patients more than a third sufferred from carotid atherosclerosis and routine assessment of carotid atherosclerosis is quintessential in NAFLD.

Decompression Illness Incidence and Hypoxia Symptoms After Prebreathing in Hypobaric Hypoxia Training.

INTRODUCTION: Hypobaric hypoxia training utilizing the environmental chamber is often preceded by prebreathing of 100% oxygen with the goal of reducing decompression illness (DCI). We aimed to study the impact of prebreathing 100% oxygen for 30 min prior to hypobaria exposure to 7600 m (25,000 ft) on the incidence rate of DCI, as well as the impact of prebreathing on hypoxia symptoms felt during training.METHODS: Records of participants who underwent hypobaric hypoxia training in the Republic of Singapore Air Force (RSAF) from 2011 to 2014 (before introduction of prebreathing) were compared to those who underwent similar training from 2014 to 2017 (after introduction of prebreathing) to determine the incidences of DCI for both groups. Participants who underwent hypobaric hypoxia training from January 2017 to July 2017 completed a survey to assess the impact of prebreathing on the presentation and severity of hypoxia symptoms.RESULTS: Two DCI events were recorded in 1530 hypobaric chamber exposures without prebreathing while two DCI events were recorded in 1729 exposures with prebreathing. There was no significant difference in the incidence of DCI between the two groups. The survey findings showed no significant difference in the presentation and severity of hypoxia symptoms with 30 min of prebreathing.DISCUSSION: Incidence of DCI remains low during hypobaric chamber training, with no statistical difference with or without prebreathing. Possible reasons were the short duration of hypobaric exposure of 10 min during hypoxia training, and that 30 min of prebreathing was insufficient to further decrease or eliminate the risk of DCI in short duration hypobaric exposures.Cheok LJ, Goh BLY, Soh FW, Chuan BTB. Decompression illness incidence and hypoxia symptoms after prebreathing in hypobaric hypoxia training. Aerosp Med Hum Perform. 2021; 92(5):289293.

DETERMINANTS OF BURNOUT AND OTHER ASPECTS OF PSYCHOLOGICAL WELL-BEING IN HEALTHCARE WORKERS DURING THE COVID-19 PANDEMIC: A MULTINATIONAL CROSS-SECTIONAL STUDY

BackgroundThe Covid-19 pandemic has placed unprecedented pressure on healthcare systems and workers around the world. Such pressures may impact on working conditions, psychological wellbeing and perception of safety. In spite of this, no study has assessed the relationship between safety attitudes and psychological outcomes. Moreover, only limited studies have examined the relationship between personal characteristics and psychological outcomes during Covid-19. MethodsFrom 22nd March 2020 to 18th June 2020, healthcare workers from the United Kingdom, Poland, and Singapore were invited to participate using a self-administered questionnaire comprising the Safety Attitudes Questionnaire (SAQ), Oldenburg Burnout Inventory (OLBI) and Hospital Anxiety and Depression Scale (HADS) to evaluate safety culture, burnout and anxiety/depression. Multivariate logistic regression was used to determine predictors of burnout, anxiety and depression. ResultsOf 3,537 healthcare workers who participated in the study, 2,364 (67%) screened positive for burnout, 701 (20%) for anxiety, and 389 (11%) for depression. Significant predictors of burnout included patient-facing roles: doctor (OR 2.10; 95% CI 1.49-2.95), nurse (OR 1.38; 95% CI 1.04-1.84), and other clinical (OR 2.02; 95% CI 1.45-2.82); being redeployed (OR 1.27; 95% CI 1.02-1.58), bottom quartile SAQ score (OR 2.43; 95% CI 1.98-2.99), anxiety (OR 4.87; 95% CI 3.92-6.06) and depression (OR 4.06; 95% CI 3.04-5.42). Factors significantly protective for burnout included being tested for SARS-CoV-2 (OR 0.64; 95% CI 0.51-0.82) and top quartile SAQ score (OR 0.30; 95% CI 0.22-0.40). Significant factors associated with anxiety and depression, included burnout, gender, safety attitudes and job role. ConclusionOur findings demonstrate a significant burden of burnout, anxiety, and depression amongst healthcare workers. A strong association was seen between SARS-CoV-2 testing, safety attitudes, gender, job role, redeployment and psychological state. These findings highlight the importance of targeted support services for at risk groups and proactive SARS-CoV-2 testing of healthcare workers.

What Has Been the Impact of Covid-19 on Safety Culture?

IntroductionCovid-19 has placed an unprecedented demand on healthcare systems worldwide. A positive safety culture is associated with improved patient safety and in turn patient outcomes. To date, no study has evaluated the impact of Covid-19 on safety culture. MethodsThe Safety Attitudes Questionnaire (SAQ) was used to investigate safety culture at a large UK teaching hospital during Covid-19. Findings were compared with baseline data from 2017. Incident reporting from the year preceding the pandemic was also examined. ResultsSignificant increased were seen in SAQ scores of doctors and other clinical staff, there was no change in the nursing group. During Covid-19, on univariate regression analysis, female gender, age 40-49 years, non-white ethnicity, and nursing job role were all associated with lower SAQ scores. Training and support for redeployment were associated with higher SAQ scores. On multivariate analysis, non-disclosed gender (-0.13), non-disclosed ethnicity (-0.11), nursing role (-0.15), and support (0.29) persisted to significance. A significant decrease (p<0.003) was seen in error reporting after the onset of the Covid-19 pandemic. DiscussionThis is the first study to report SAQ during Covid-19 and compare with baseline. Differences in SAQ scores were observed during Covid-19 between professional groups and compared to baseline. Reductions in incident reporting were also seen. These changes may reflect perception of risk, changes in volume or nature of work. High-quality support for redeployed staff may be associated with improved safety perception during future pandemics. WHAT IS ALREADY KNOWN ON THE SUBJECTO_LISafety culture is associated with patient safety and outcomes C_LIO_LIThis is the first study to investigate safety culture during the Covid-19 pandemic C_LIO_LIThis study uses the Safety Attitudes Questionnaire (SAQ) and Datix incident reporting data to investigate determinants of safety climate during the Covid-19 pandemic. C_LIO_LISafety climate is context specific, this study is strengthened by the availability of benchmarking data from before the onset of the Covid-19 pandemic. C_LIO_LISignificant differences in SAQ scores between professional groups were observed during Covid-19. C_LIO_LIGender, ethnicity and job role were significant determinants of safety attitudes. C_LIO_LISupport during redeployment was associated with improved safety attitudes. C_LIO_LIThe number of incidents that were reported reduced significantly during Covid-19, although the number of events leading to harm remained constant. C_LI