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Department: CLINICAL ROUNDS

Clinical Rounds

doi: 10.1097/01.NURSE.0000757200.97745.b7
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In Brief

HEALTHCARE DISPARITIES

Racial and ethnic gaps in mortality for patients with traumatic brain injuries

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According to a recent study published in Frontiers in Surgery, patients from ethnic and racial minority populations who have traumatic brain injuries (TBIs) are at an increased risk of mortality. The study authors examined outcomes for these patient populations compared with those for nonminority populations at a trauma I healthcare facility in Oregon between 2006 and 2017. Of 6,352 total patients with TBIs, a cohort made up of 1,504 patients from racial and ethnic minority backgrounds defined as non-White or Hispanic was compared with the remaining 4,848 patients in the nonminority cohort.

Although healthcare disparities related to the racial or ethnic backgrounds of patients in US healthcare settings are well documented, this represents the first study to assess these inequities as they relate to neurosurgical trauma. The authors examined outcomes for these patients and developed a hazard ratio and propensity score model that included factors such as the type of injury, patient status, and probability of survival. They found significant inequities in patient outcomes for patients from racial and ethnic minority backgrounds who had experienced a TBI compared with those in the nonminority cohort and advocated to reshape the current healthcare and social support models to better support these patients.

Sources: Health Day. Mortality increased for racial/ethnic minorities with TBI. 2021. https://consumer.healthday.com/increased-mortality-for-racial-ethnic-minorities-with-tbi-2653251105.html. Richie EA, Nugent JG, Raslan AM. Racial and ethnic inequities in mortality during hospitalization for traumatic brain injury: a call to action. Front Surg. 2021;8:690971.

COMMUNITY HEALTH

Mortality gap between rural and metropolitan areas

In a letter to the Journal of the American Medical Association regarding increasing disparities in mortality between rural and metropolitan communities, researchers from Duke University in Durham, N.C., noted increased mortality in rural areas. Based on online data from the CDC and categories established by the 2013 US Census, they studied and estimated age-adjusted mortality across the US based on age, gender, and race/ethnicity, as well as the annual percent change of these results among the surveyed individuals. Specifically, they found that rural areas had the highest age-adjusted mortality between 1999 and 2019, especially in individuals between ages 25 and 64 and those who identified as male.

In their letter, the authors urged for efforts to increase the understanding of factors that lead to higher mortality among these populations. To reverse these disparities, they noted that updated policies and public programs will be necessary.

Sources: Health Day. Gap between mortality in rural and urban areas has increased. 2021. https://consumer.healthday.com/gap-between-mortality-in-rural-and-urban-areas-has-increased-2653276720.html. Cross SH, Califf RM, Warraich HJ. Rural-urban disparity in mortality in the US From 1999 to 2019. JAMA. 2021;325(22):2312-2314.

COVID-19 UPDATE

US reaches vaccination landmark but demand has plateaued

As of June 21, 2021, 150 million individuals had received the COVID-19 vaccination in the US. At this point, approximately 45% of the total US population has received a complete dosage of the vaccine, with 53% having received one dose at minimum. Despite these promising figures, however, overall demand for the vaccine has plateaued.

Although the decreased rates of overall infection and mortality represent promising news, the results vary from state to state and the US remains below its goal. Experts also worry about further spread due to the likelihood of mutations and variants. As such, there will be many factors to consider leading into fall.

Source: Kunzelman M, Johnson CK, Miller Z. US hits encouraging milestones on virus deaths and shots. Associated Press. 2021. https://apnews.com/article/coronavirus-pandemic-health-21c3695fa27b59d65f05f3ac71fdcf55.

TYPE 2 DIABETES

Increased onset of diabetes in pediatric patients during COVID-19

According to research from the journal Diabetes, the COVID-19 pandemic may have had an indirect impact on the onset of type 2 diabetes in pediatric patients. The authors analyzed patient data from one Louisiana children's hospital and discovered an increase in admissions for type 2 diabetes from 2019 to 2020. Specifically, despite fewer total hospitalizations in 2020 with just 2,729, 17 patients were admitted with new-onset type 2 diabetes. Conversely, there were 2,964 total hospitalizations in 2019, but only 8 patients were admitted with new-onset type 2 diabetes.

Noting concerns that the data trends at their hospital may be representative of facilities across the country, the researchers concluded that factors such as restrictions during the COVID-19 pandemic may have contributed to an increased rate of type 2 diabetes in pediatric populations. However, they recommended additional research to confirm their findings and assess outcomes.

Sources: Monostra M. More hospitalizations for new-onset type 2 diabetes in children during COVID-19. Healio 2021. Hsia DS, Lim M, Beyl RA, Hasan HA, Gardner J. 153-LB: Initial presentation of children with type 2 diabetes during the COVID-19 pandemic. Diabetes. 2021;70(1):153.

HEALTH AND DIET

Can plant-based or pescatarian diets decrease the risk of moderate-to-severe COVID-19?

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In an international survey of 2,884 nurses and providers from six countries, 568 developed COVID-19, of which 138 cases were characterized as “moderate-to-severe,” and the remaining 2,316 healthcare professionals served as the control group. The researchers examined potential associations between diet and COVID-19 using a multivariable logistic regression model. Although there was no link discovered between diet and infection rates in the 2020 analysis, they found that those who described following a plant-based diet were 73% less likely to develop moderate-to-severe COVID-19, while those who followed pescatarian diets were 59% less likely. Conversely, individuals who followed diets that were low in carbohydrates and high in protein appeared to be at an increased risk of moderate-to-severe COVID-19, if infected.

The authors speculated that plant-based diets offer plenty of vitamins to support the immune system, while pescatarian diets offer anti-inflammatory support with high levels of vitamin D and omega-3 fatty acids. This is the first study to assess the relationship between diet and COVID-19, however, and the authors recommend further research.

Sources: Kim H, Rebholz CM, Hegde S, et al. Plant-based and pescatarian diets may lower odds for severe COVID-19. BMJ. 2021.

Miller J. Plant-based and pescatarian diets may lower odds for severe COVID-19. Healio. 2021. www.healio.com/news/primary-care/20210607/plantbased-and-pescatarian-diets-may-lower-odds-for-severe-covid19.

In August, celebrate:

VAPING

High rates of e-cigarette use among US adolescents

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The impact of vaping, or the use of electronic cigarettes (e-cigarettes), has been well documented, especially among adolescent populations. Recent research from the Journal of the American Medical Association (JAMA) assessed the results of the 2020 National Youth Tobacco Survey to determine participants' e-cigarette use within the last 30 days. Despite a decrease in prevalence of e-cigarette use among adolescents from 2019 to 2020, the authors of the JAMA study concluded that the practice remains popular among these populations and requires a continued effort to discourage it.

The researchers examined feedback from 14,531 middle and high-school-aged students from 180 schools in the US. They discovered that 19.6% of high-school students and 4.7% of middle-school students were current users. Of those participants, there seemed to be a preference for the flavored options, with 84.7% of high-school-aged users and 73.9% of middle-school-aged users reporting the use of flavored e-cigarettes.

Sources: Health Day. Prevalence of e-cigarette use high among U.S. students. 2021. https://consumer.healthday.com/prevalence-of-e-cigarette-use-high-among-u-s-students-2653251031.html.

Wang TW, Gentzke AS, Neff LJ, et al. Characteristics of e-cigarette use behaviors among US youth, 2020. JAMA Netw Open. 2021;4(6):e2111336.

Patterson M, Williams-Jones P, Lewis TP. Consequences of the vaping epidemic on adolescents. Nursing. 2020;50(7):30-37.

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