Geospatial determinants of maternal and child exposure to fine particulate matter in Kintampo, Ghana: Levels within the household and community, by surrounding building density and near roadways
Danielle N. MedgyesiMohammed MujtabaQiang YangSulemana Watara AbubakariAlison LeeJeremy R. PorterSteven N. ChillrudSeyram KaaliDarby JackKwaku Poku Asante
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Quartile
Exposure Assessment
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BACKGROUND Pediatric hospital discharge is a complex process. Although morning discharges are operationally preferred, little is known about the association between discharge time of day and discharge outcomes. We assessed whether children discharged from the hospital in the evening have a higher 30-day hospital reutilization rate than those discharged in the morning or afternoon. METHODS We conducted a retrospective cohort study on discharges from a children’s hospital between July 2016 and December 2019. The cohort was divided into morning, afternoon, and evening discharges. Multivariable modified least-squares regression was used to compare 30-day all-cause hospital reutilization rates between morning, afternoon, and evening discharges while adjusting for demographic and clinical characteristics. RESULTS Among 24 994 hospital discharges, 6103 (24.4%) were in the morning, 13 786 (55.2%) were in the afternoon, and 5105 (20.4%) were in the evening. The unadjusted 30-day hospital reutilization rates were 14.1% in children discharged in the morning, 18.2% in children discharged in the afternoon, and 19.3% in children discharged in the evening. The adjusted 30-day hospital reutilization rate was lowest in the morning (6.1%, 95% confidence interval [CI] 4.1%–8.2%), followed by afternoon (9.0%, 95% CI 7.0%–11.0%) and evening discharges (10.1%, 95% CI 8.0%–12.3%). Morning discharge had a significantly lower adjusted 30-day all-cause hospital reutilization rate compared with evening discharge (P < .001), whereas afternoon and evening discharges were not significantly different (P = .06). CONCLUSIONS The adjusted 30-day all-cause hospital reutilization rate was higher for evening discharges compared with morning discharges, whereas the rate was not significantly different between afternoon and evening discharges.
Day hospital
Hospital discharge
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Time of day
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The response of plasma TSH to 30 min stay in sauna was compared in the morning and in the evening. Both in the morning and in the evening plasma TSH was significantly elevated after sauna, with more prolonged response in the evening. This difference resembles the different reactivity of TSH to exogenous TRH administration in various times of day.
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Home blood pressure (HBP) is usually measured in the morning and evening, but the evening HBP tends to be influenced by an individual's behavior pattern, such as bathing and drinking, which are often seen in the Japanese. In this study, in order to elucidate the influence of nighttime drinking on the evening and next morning HBP and heart rate (HR), HBP measurement was performed in Japanese normotensives under conditions in which the influence of bathing was minimized. Among 700 registered volunteers, 245 normotensives (189 male, 56 female, mean age; 35.8 ± 0.5 years old) whose data consisted of a combination of drinking and non-drinking on workdays were selected. A semi-automatic device was lent to all participants, and they were asked to perform triplicate morning and evening measurements on seven consecutive days between October 16, 2002, and November 13, 2002. The differences in evening HBP and HR between the drinking and non-drinking days were calculated, as were the differences in the next morning HBP and HR. Only data of evening HBP measured at least 30 min after bathing were accepted. Evening SBP and DBP on drinking days were significantly lower (2.5 ± 0.5 mmHg, 3.1 ± 0.5 mmHg) than those on non-drinking days. On the other hand, evening HR on drinking days was significantly higher (7.7 ± 0.8 b.p.m.) than that on non-drinking days. Although there was no difference in morning SBP after days with and without drinking, morning DBP the day after drinking was slightly (0.8 ± 0.3 mmHg) but significantly lower than that the day after non-drinking. Morning HR the day after drinking was significantly higher (2.4 ± 0.4 b.p.m.) than that after non-drinking. Because nighttime drinking influenced the evening HBP even in normotensives, it was suggested that morning HBP could give more stable values than evening HBP in Japanese people.
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Objectives: Studies have reported that home blood pressure (HBP) is a better predictor of cardiovascular mortality and morbidity than office blood pressure (BP). Guidelines recommend averaging the morning and evening HBP measurements to derive the mean awake BP. However recommendation in guidelines regarding the timing of evening HBP measurements is not consistent. Furthermore it is not convenient for most patients to measure the evening HBP before dinner. Hence this study aimed to compare the mean awake HBP when done in the morning and evening to HBP done in the morning and before going to bed. Methods: This is a cross-sectional study of 306 hypertensive patients in a primary care setting in Malaysia. A convenience sampling method was used to recruit patients. Patients were educated according to the standard guidelines on how to measure HBP using a validated oscillometric BP device. Two consecutive BP measurements were taken three times a day (morning, evening before dinner and at bedtime) for seven days. After excluding the measurements of the first day, the remaining measurements were used to derive the mean awake BP. Paired t-test was used for analysis. Results: The mean age of the population was 67 ± 10 years, 46.6% were males. The mean morning HBP was 129.5 mm ± 15 mmHg; mean evening BP taken before dinner was 126.9 ± 14.3 mmHg and bedtime 125.7 ± 15.9mmHg. The mean awake BP using morning and evening was 128.0 mmHg compared with 127.5 mmHg based on morning and bedtime readings, a difference of 0.5 mmHg (p = 0.13). Conclusion: There is no difference in awake HBP whether it is measured in the evening or before bedtime. For convenience of the patients, it would appear to be acceptable the HBP to be done before bed instead of the recommended time of evening before dinner.
Bedtime
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Plasma ACTH and cortisol responses to corticotropin-releasing factor (CRF) were determined in the morning and evening in seven normal men. Either 100 micrograms synthetic ovine CRF or saline was given intravenously at 0900 h and at 2200 h. Blood samples were collected before and 15, 30, 45, 60, 90, and 120 min after CRF or saline injection. Plasma ACTH concentrations before and after CRF injection in the morning were significantly higher (P less than 0.05) than those in the evening at all times except 45 min after injection. Plasma cortisol concentrations before and at all times after CRF injection in the morning were also significantly higher (P less than 0.05) than those in the evening. However, neither the maximum increments in plasma ACTH and cortisol above the control levels nor increments at each time point following CRF injection in the morning differed significantly from those in the evening. Increments in the area under the ACTH and cortisol concentration curves after CRF injection in the morning also did not differ significantly from those in the evening. These results suggest that the responsiveness of the pituitary to CRF in the morning and in the evening does not differ significantly, although actual values of plasma ACTH and cortisol are higher in the morning.
Cortisol awakening response
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The purpose of this study was to research to the differences of blood parameters between morning exercise and
evening exercises. 12 participants, in younger adults aged 20 years, were recruited and their blood was taken four
times, from 8:00 to 9:00 (pre and post) for morning exercise and from 20:00 to 21:00 (pre and post) for evening
exercise. The results found that leukocytes (WBC, NE and LY), erythrocytes (RBC, HGB, HCT, MCH and MCHC)
and thrombocyte (PLT, MPV and PCT) show resulting differences (p<0.05) between the morning and evening
exercises. Additionally, no significant differences were found in the other parameters in blood. In conclusion;
Hematologic parameters display different behaviors exhibit acute exercise at different times of day. Leukocytes,
erythrocytes and thrombocyte levels display different behaviors as exercises at morning and evening.
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Patients’ satisfaction with the functional capacity and attitude of the permanent staff working in the morning hours in the emergency department (ED) of a community hospital was compared with that of the staff working during the evening and night shifts. A total of 285 patients given care in the ED were interviewed according to a ‘satisfaction’ questionnaire regarding the function and attitude of the ED staff during the morning and evening/night shifts. The mean waiting time until a doctor was seen during the morning shift was 25 ± 17 minutes for non-hospitalized patients and 25 ± 8 minutes for the hospitalized ones, whereas during the evening and night hours the waiting times were 22 ± 17 minutes and 19 ± 13 minutes respectively. The number of laboratory examinations performed during the evening and night shifts markedly exceeded that carried out during the morning. The mean staying time in the ED for both non-hospitalized and hospitalized patients during the morning was by 23% shorter than that during the evening and night shifts. The patients expressed their overall satisfaction with the ED staff in both shifts with high evaluation marks. It is concluded that the survey indicates that the permanent ED staff during the morning hours are more efficient compared with those working during the evening and night shifts.
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