Background: Firearm-related deaths are a substantial public health crisis in America, with studies reporting an increasing rate in the past decade. Effective public health interventions rely on comprehensive information about risk and protective factors. Aim: This study aims to provide a comprehensive examination of trends in firearm-related deaths over the past 55 years, shedding light on the changing landscape and identifying key risk and protective factors associated with firearm-related deaths in the United States. Methods: This retrospective study utilizes data from the Centers for Disease Control and Prevention's Web-based Injury Statistics Query and Reporting System (WISQARS) for 1968-2022 to determine trends in firearm-related deaths. A multivariate logistic regression model was employed to identify independent predictors of firearm-related suicides, homicides, and unintentional deaths, exploring intersectionality by introducing interaction terms between race/ethnicity and level of education. Results: Firearm-related deaths showed a fluctuating but upward trend from 12.0/100,000 persons in 1968 to 14.5/100,000 in 2022, with firearm-related suicides consistently accounting for a significant proportion of firearm-related deaths, from 45.7% in 1968 to 56.1% in 2022, with a peak of 63% in 2013. From the multivariate regression analysis, individuals aged 10-19 years had the highest risk of firearm-related suicides (OR = 3.04, 95% CI = 2.92-3.16) and homicides (OR = 2.87, 95% CI = 2.77-2.97). In addition, White people with higher education (OR = 1.42, 95% CI = 1.40-1.45) had the highest risk of firearm-related suicides, while Black people with lower educational attainment (OR = 6.68, 95% CI = 6.50-6.87) had the highest risk of firearm-related homicides. Conclusion: Our findings underscore the urgent need for targeted, evidence-driven public health interventions and policies. Primary suicide prevention strategies focusing on means restriction and reshaping perceptions around firearm ownership emerge as critical components. Comprehensive, multidimensional approaches that engage firearm owners and communities and address structural factors are imperative to curbing the multifaceted challenges associated with firearm-related injuries and deaths. Targeted interventions must include individuals aged 10-19 and specifically focus on suicides and homicides in the most relevant demographic segments of the population.
Introduction: Colon cancer screening (CRC) rates among Hispanics have lagged behind their non-Hispanic white counterparts. It has been shown that CRC screening uptake increases with the degree of formal education achievements. It is unknown how education influences CRC screening among Hispanics. Aim: To evaluate CRC screening uptake among Hispanics and assess the effect of education on this association. Methods: We analyzed 1,682 respondents (weighted population size of 103,106,551) respondents to the 2018 Health Information National Trends Survey (HINTS 5 cycle 2). The respondents answered survey questions related to their race-ethnicity. We limited our analysis to Hispanics and non-Hispanic Whites. Hispanic respondents (n = 271, weighted population size = 17,041,047) and non-Hispanic White respondents (n = 1,411, weighted population size = 86,065,505) responded to questions about their highest education achievement and CRC history. Survey weights were used in all analyses, and we used logistic regression models to calculate the odds ratios (OR) with 95% confidence intervals (CI). Our final adjusted model included sex, income, marital status, insurance, BMI, and cigarette smoking. Results: Hispanics were more likely to be male (P = < 0.01), have only high school education or less (P < 0.001), have a lower income (p = < 0.001), and were more likely to be obese (p = 0.04) but were less likely to have health insurance (P = 0.03) or a history of cigarette smoking (P = < 0.001). Overall, Hispanics had non-significant reduced odds of CRC screening when compared with non-Hispanic Whites (56.1% vs 67%; OR = 0.62; 95% CI: 0.35-1.11). However, educational status did not significantly influence rates of CRC screening among Hispanics and non-Hispanic Whites, but a pattern of increased CRC screening with higher formal education was noted among Hispanics (Table 1). Conclusion: In this nationally representative survey of adults in the United States, Hispanics have slightly lower rates of CRC screening compared to non-Hispanic whites without any influence of formal education. There is a need to improve CRC screening among Hispanics. Table 1. - Comparison of CRC Screening by Educational Status Among Hispanics and Non-Hispanic Whites Non-Hispanic Whites Hispanics Educational status % Screened for CRC OR (95% CI) Educational status % Screened for CRC OR (95% CI) High School or less, N = 315 63.3% Reference High School or less, N = 130 48.6% Reference Some college, N = 452 64.4% 0.83 (0.47-1.48) Some college, N = 68 56.4% 0.83 (0.24-2.79) College graduate, N = 639 74.4% 1.32 (0.70-2.46) College graduate, N = 71 78.2% 2.48 (0.53-11.73) Multivariate model adjusted for sex, income, marital status, insurance, BMI, and cigarette smoking.
Introduction The obesity epidemic is an important public health problem in the United States. Previous studies have revealed the association between obesity and various surgical complications. Tracheostomy which is an important lifesaving procedure may prove technically challenging in an obese patient. This study sought to evaluate the association between obesity and early complications following standard tracheostomy using a national registry. Methods Adult patients who underwent tracheostomy from 2007 to 2017 were analyzed using the Nationwide Inpatient Sample (NIS). The population was stratified into obese and non-obese groups. Early complications following standard tracheostomy were identified and compared between the two groups. Multivariable logistic regression analyses were performed to assess the association between obesity and early complications following tracheostomy. Results Data pertaining to 205 032 adult patients were evaluated. Obese patients accounted for 12.1% (n = 21 816) of the entire cohort. The most common complication in the cohort was perioperative bleeding (4316 [2.1%]). A total of 1382 (0.67%), 949 (0.46%), and 134 (0.07%) patients developed pneumothorax/pneumomediastinum, stoma/surgical site infection, and tracheal injury following standard tracheostomy, respectively. There was no difference in the odds of tracheal injury, perioperative bleeding, and pneumomediastinum/pneumothorax following standard tracheostomy in the obese and non-obese group in multivariable analysis. However, obesity was associated with 60% increased odds of developing stoma/surgical site infection following standard tracheostomy (OR 1.60 [1.33-1.92], P < 0.01). Conclusion Obesity is associated with an increased risk of developing stoma/surgical site infection following standard tracheostomy. This adds to the growing need for measures to help curb the obesity epidemic in a bid to improve surgical outcomes.
Hypertrophic scar (HTS) formation is a common challenge for patients after burn injury. Dermal microvascular endothelial cells (DMVECs) are an understudied cell type in HTS. An increase in angiogenesis and microvessel density can be observed in HTS. Endothelial dysfunction may play a role in scar development. This study aims to generate a functional and expression profile of HTS DMVECs. We hypothesize that transcript and protein-level responses in HTS DMVECs differ from those in normal skin (NS). HTSs were created in red Duroc pigs. DMVECs were isolated using magnetic-activated cell sorting with ulex europaeus agglutinin 1 (UEA-1) lectin. Separate transwell inserts were used to form monolayers of HTS DMVECs and NS DMVECs. Cell injury was induced and permeability was assessed. Gene expression in HTS DMVECS versus NS DMVECs was measured. Select differentially expressed genes were further investigated. HTS had an increased area density of dermal microvasculature compared to NS. HTS DMVECs were 17.59% less permeable than normal DMVECs (p < 0.05). After injury, NS DMVECs were 28.4% and HTS DMVECs were 18.8% more permeable than uninjured controls (28.4 ± 4.8 vs 18.8 ± 2.8; p = 0.11). PCR array identified 31 differentially expressed genes between HTS and NS DMVECs, of which 10 were upregulated and 21 were downregulated. qRT-PCR and ELISA studies were in accordance with the array. DMVECs expressed a mixed profile of factors that can contribute to and inhibit scar formation. HTS DMVECs have both a discordant response to cellular insults and baseline differences in function, supporting their proposed role in scar pathology. Further investigation of DMVECs is warranted to elucidate their contribution to HTS pathogenesis.
Violent deaths, including suicides and homicides, pose a significant public health challenge in the United States. Understanding the trends and identifying associated risk factors is crucial for targeted intervention strategies.
