Institute of Population and Public Health

Environmental toxicology is a broad branch of science that studies the harmful effects of various chemical, biological, and physical substances on living organisms [...].

Although TJA substantially reduces HICP prevalence, 1 in 5 patients continues to experience significant postoperative pain. Early identification of at-risk individuals and the integration of targeted perioperative interventions are critical to optimize recovery and long-term outcomes.

Approximately one-third-of patients with transient new-onset atrial fibrillation (AF) during hospitalization for noncardiac surgery or medical illness will have recurrent AF within 1 year when assessed using two 14-day ECG monitors. The proportion of patients that would be diagnosed with recurrent AF with less monitoring is unknown. We used data from a prospective cohort of participants with transient new-onset AF while hospitalized for noncardiac surgery or medical illness, who wore one or two 14-day ECG monitors. We calculated the proportion of patients that would be diagnosed with recurrent AF with different durations of ECG monitoring and the median time-to-detection of recurrent AF lasting ≥30 s. A total of 139 participants (41.0 % female, median CHA2DS2-VASc 3) wore an ECG monitor a median of 1.5 months following hospital discharge; 83 (59.7 %) wore a second monitor at median of 5.8 months after the first monitor. Recurrent AF was detected in 5.0 % of participants by 1 day, 5.8 % by 2 days, 6.5 % by 3 days, 12.2 % by 7 days, 21.6 % by 14 days and in 28.8 % by the end of the second 14-day monitor. Median monitoring time to recurrent AF was 5.3 (IQR 1.4-9.7) days. In patients with transient new-onset AF during hospitalization for another reason, the rate of detection of recurrent AF increased with longer monitoring durations. Approximately 80 % of diagnoses were made after 2 days of monitoring; the likelihood of capturing recurrent AF was 4 times higher with 14 days of monitoring compared to 2 days.

Population dynamics play a pivotal role in development, exacerbating social, economic and environmental challenges. Yet, this factor remains largely understudied in undergraduate curricula in the United States. This study explores the perceptions of University of California (UC) faculty of the concept of population dynamics and its integration into their teaching. Through a mixed-methods approach, it investigates the meanings that faculty associate with this concept, the importance they attribute to it, and the barriers they face in teaching it. Findings reveal that UC faculty across multiple disciplines believe that understanding this topic is essential for college students’ future careers. However, study participants reported that population dynamics were infrequently integrated into undergraduate courses due to their interdisciplinary nature, lack of faculty training in demography and lack of prioritisation by the UC system. Other barriers to teaching this topic include the sensitive nature of associated themes like migration, family planning and gender norms. Our findings suggest that the teaching of this subject, as well as its integration into the curriculum, lacks a systematic and coordinated approach. Its inclusion (or lack thereof) depends largely on individual faculty’s preferences and their level of demographic expertise. The gap between its perceived importance and its representation in the curriculum highlights the need for universities to make a more consistent effort to support faculty in integrating this topic in meaningful ways. Adequate coverage of population dynamics within institutions of higher education will help students to increase awareness and contribute to efforts to address global demographic challenges.

Objective:We evaluated Australian adults’ knowledge on the risk factors and complications of hypertension to identify areas of poor understanding.Methods:In 2024, an adapted validated hypertension-knowledge survey was distributed to participants who had used kiosk BP stations in retail stores across metropolitan and remote Australia. Kiosk stations collected measured and self-reported data.Results:A total of 826 participants (51% male; mean age 52 ± 16 years; 36% with a history of hypertension) completed the survey. Participants generally demonstrated a good understanding of hypertension risk factors, with 90% recognizing that being overweight increases risk, and that exercise helps lower BP. Twenty-seven percent were unaware that hypertension is usually asymptomatic; 41% did not know that stress is not its main cause; and 42% were unaware of the importance of medication adherence. Seventy-three percent and 77% were unaware of the increased risk of dementia and kidney disease, respectively.People with a history of hypertension (vs. no hypertension; P = 0.01) and those in outer regional areas (vs. major cities, inner regional, or remote; P = 0.011) had better knowledge. Individuals who were unemployed or had lower educational backgrounds (both P < 0.001) had poorer knowledge. Kiosk BP readings and the use of antihypertensive medications were not associated with knowledge scores.Conclusions:Public misconceptions regarding hypertension persist. With three in four participants unaware that hypertension increases the risk of dementia and kidney disease, and with limited understanding of the importance of medication adherence, educational efforts are essential, particularly among people who are unemployed or have lower educational backgrounds.

BACKGROUND AND OBJECTIVES Racism and discrimination impact children’s health; there is little information about Multiracial children. The US Multiracial population grew from 2.9% in 2010 to 10.2% in 2020. This study investigates associations between racial and ethnic identification and perceived discrimination among Multiracial children in the multicenter ABCD Study®. METHODS Children were recruited at ages 9-10 in 2016 – 2018. Caregivers reported racial and ethnic identification; children self-reported experiences of discrimination. Generalized linear models with logit link function were used to assess associations between identity and discrimination experiences. Adjusted odds ratios and adjusted p-values were reported. RESULTS 1124 children (10.8%) identified as Multiracial. The largest Multiracial groups were White-Black (3.4%), White-Asian (3.0%), and White-AIAN (1.6%). The largest monoracial groups were White (65.4%) and Black (16.3%). White-Black participants had higher odds than their White monoracial counterparts of perceiving discrimination by other adults outside of school (OR 2.16 [1.24 - 3.77], p=0.014); other students (OR 1.65 [1.17 - 2.32], p=0.012; feeling that others behaved unfairly or in a negative way towards their ethnic group (OR 1.78, [1.16 – 2.72], p=0.014); feeling like other Americans had something against them (OR 2.50, [1.48 – 4.23], p&amp;lt;0.001); feeling discriminated against over the past 12 months due to race, ethnicity or color (OR 2.40, [1.51 – 3.82], p&amp;lt;0.001). CONCLUSION Multiracial children perceive discrimination at an early age, have different experiences based on race and ethnicity, and some groups have higher odds of certain types of discrimination than their component identity groups. These experiences impact health outcomes through complex pathways.

The transfer of public health responsibilities to local authorities has placed greater emphasis on the need for evidence-based decision-making to address health inequalities. Integral to this process is the involvement of the public and communities in research, ensuring that decisions are informed and equitable. While local authorities possess existing structures for community engagement, the establishment of NIHR Health Determinants Research Collaborations (HDRCs) presents a fresh opportunity to address power imbalances potentially inherent in traditional engagement practices. This chapter explores how HDRCs can establish sustainable research infrastructure to embed public involvement and community engagement (PICE) within local authority systems and foster long-term change which places communities at the heart of health inequalities research.

Patient-reported outcome measures (PROMs) are crucial for evaluating rhinoplasty outcomes, yet no standardized, validated PROM tailored to rhinoplasty exists. This systematic review examines existing PROMs, identifying gaps in their ability to capture both aesthetic and functional outcomes. A PRISMA-compliant systematic review was conducted using MEDLINE, Embase, Google Scholar, CENTRAL, Science Citation Index, and PubMed. The protocol was registered a priori (CRD42024513514). Risk of bias was assessed using Cochrane's Risk of Bias Tool, with study quality evaluated via the validated GRADE tool. Twelve randomized controlled trials involving 743 patients were analyzed. The mean follow-up was 9.1 months, with a mean patient age of 35.35 years (±5.95) and a male-to-female ratio of 1:1.91. Ten distinct PROMs were identified, with FACE-Q emerging as the most robust, meeting 19 of 21 development standards. However, FACE-Q lacked the ability to assess functional outcomes critical to rhinoplasty, such as nasal airway function and breathing. This review highlights the heterogeneity of PROMs in rhinoplasty research and the limitations of current tools in addressing both aesthetic and functional outcomes. While FACE-Q is the most robust for aesthetic evaluation, its functional limitations underscore the need for refinement or a dedicated PROM tailored to the comprehensive demands of rhinoplasty.

Objective: Patient Preference Information (PPI) provides important insight about patients’ thoughts about potential treatment options. Hypertension (HTN) remains global health concern with poor blood pressure (BP) control rates in US and globally. One key contributor to poor BP control is poor adherence to anti-hypertensive medication, which could be influenced by patient’s limited input in their disease management or treatment preference. RADIANCE studies demonstrated safety and efficacy of ultrasound renal denervation (uRDN) in lowering BP and was recently approved by US FDA as novel treatment option for patients with HTN. This prospective survey evaluates hypertensive patients’ preference towards uRDN as a treatment option. This study evaluates if factors such as: demographics, social and educational background, HTN severity and duration, number of anti-hypertensive medication, co-morbidities and anticipated BP reduction influence patient’s choice regarding preference for uRDN or device-based treatment for their HTN. Design and method: This prospective, single-centre, mixed qualitative-quantitative study uses an anonymised electronic survey completed by hypertensive patients 18-80 years age on their own in the clinic. Patients were shown uRDN animation, efficacy, and safety data from published studies before completing their treatment preference feedback Results: Total of 100 patients completed the survey and are included in the analysis. 45% of participants were in age range of 60-69 years, 70% male, 71% White Caucasian and 29% other races. Of those that completed the survey 30% found uRDN extremely appealing compared to 33% very, 25% somewhat, 7% slightly, and 2% not at all. When asked preference between having uRDN and continuing current treatment, 67% stated they would be more likely to choose renal denervation compared to 8% would continue current treatment and 22% did not know. Additional data regarding acceptable risk-benefit, preferred outcomes with uRDN, and what demographic factors influenced decision making will be presented at the conference. Conclusions: PPI survey is useful way of collecting hypertensive patients preference towards possible treatment options specifically uRDN as device based treatment option. PPI provides insight to health care providers and could improve patients adherence to treatments as they are more involved in their own care and decision making.