Delayed emergencies: The composition and magnitude of non-respiratory emergency department visits during the COVID-19 pandemic.

IMPORTANCE: COVID-19 has been associated with excess mortality among patients not diagnosed with COVID-19, suggesting disruption of acute health care provision may play a role. OBJECTIVE: To determine the degree of declines in emergency department (ED) visits attributable to COVID-19 and determine whether these declines were concentrated among patients with fewer comorbidities and lower severity visits. DESIGN: We conducted a differences-in-differences analysis of all commercial health insurance claims for ED visits in the first 20 weeks of 2018, 2019, and 2020. The intervention period began March 9 (week 11) of 2020, following state stay-at-home orders. SETTING: We analyzed claims from Blue Cross Blue Shield of Louisiana (BCBSLA), located in a state with an early US COVID-19 outbreak. Visit and patient risk was assessed through comorbidities previously described as increasing the risk of COVID-19 decompensation, the hospital location's COVID-19 outbreak status, and the Ambulatory Care Sensitive Condition algorithm. PARTICIPANTS: The study population comprised all ED visits from all BCBSLA members, whether admitted or discharged. There were 332,917 ED visits over the study period. The study population spanned member demographics including sex, age, and geography. Uninsured adults were not included due to data limitations. EXPOSURES: The COVID-19 outbreak beginning March 9, 2020 in Louisiana. MAIN OUTCOMES AND MEASURES: The main outcome of interest for this analysis is the difference (percent change) in all ED visits, categorized as either respiratory or non-respiratory, from week 1-20 in 2019 and week 1-10 in 2020, compared to week 11-20 in 2020. RESULTS: In this differences-in-differences study using data from a commercial health insurer, we found that non-respiratory ED visits declined by 39%, whereas respiratory visits did not experience a significant decline. Visits that were potentially deferrable or from lower risk patient populations showed greater declines, but even high-risk patients and non-avoidable visits experienced large declines in non-respiratory ED visits. Non-respiratory ED visits declined by only 18% in areas experiencing COVID outbreak. CONCLUSIONS AND RELEVANCE: COVID-19 has resulted in significant avoidance of ED care, comprising a mix of deferrable and high severity care. Hospital and public health pronouncements should emphasize appropriate care seeking.

Irisin: A myokine with locomotor activity.

The mechanisms underlying alterations in brain functions in response to physical exercise are not fully understood. The present study examined the central effect of irisin, a 112 amino acid polypeptide hormone secreted from the skeletal muscle after exercise, on the locomotion in rats. Central administration of irisin significantly increased the locomotion. Relative to control animals treated with IgG Fc peptide, rats receiving irisin demonstrated a marked increase in total travel distance, ambulatory counts and time, and vertical counts and time. These changes were associated with a significant decrease in resting time. Central treatment of irisin also induced significant increases in oxygen consumption, carbon dioxide production and heat production, indicating an increase in metabolic activity. Our study suggests that physical activity may signal to the central nervous system to coordinate locomotion with metabolic activity via irisin.

Central and peripheral irisin differentially regulate blood pressure.

INTRODUCTION: Irisin is a newly identified 112 amino acid hormone, derived as a product of fibronectin type III domain containing 5 (FNDC5), which is highly related to metabolic activity in skeletal muscle and brown fat. The effects of irisin on cardiovascular functions are unknown. PURPOSE: To explore the effects of central and peripheral irisin on cardiovascular functions. METHODS: Irisin was either administrated into 3rd ventricle of rats or intravenously, and its effects on blood pressure and cardiac contractibility measured. RESULTS: Administration of recombinant human irisin into the 3rd brain ventricle of rats activated neurons in the paraventricular nuclei of the hypothalamus. Central administration of irisin increased blood pressure and cardiac contractibility. Exogenous irisin reversed atenolol-induced inhibition of cardiac contractibility. In contrast, peripheral administration of irisin reduced blood pressure in both control and spontaneously hypertensive rats. Irisin dilated mesenteric artery rings through ATP-sensitive potassium channels. CONCLUSION: Our studies indicate that central and peripheral irisin may differentially regulate cardiovascular activities.