McLaren Northern Michigan

Background: Congenital heart anomalies (CHA) remain one of the leading causes of childhood morbidity and mortality worldwide, with significant implications for long-term health outcomes and healthcare systems. Method: Utilizing global burden of disease 2021 study standardized methodology we estimated CHA burden for all 27 European Union countries from1990-2021. Age-standardized rates of deaths, prevalence, and years lived with disability (YLDs) were analyzed, and annualized percentage changes (APC) were calculated for multiple time intervals to assess temporal and sex-specific trends. Result: From 1990 to 2000, the APC in deaths due to CHA declined significantly by -5.72%, followed by a continued but less steep decline of -3.90% from 2000 to 2021. In contrast, the prevalence showed a slight annual decrease of -0.12% during 1990–2000, which reversed to a modest annual increase of 0.19% in the period 2000–2021. YLDs demonstrated a similar trend, with an annual decline of -0.58% from 1990 to 2000 and a slight increase of 0.12% annually from 2000 to 2021. The age-standardized death rate (ASMR) declined annually by -5.10% from 1990 to 2000 and -4.00% from 2000 to 2021, while the age-standardized prevalence rate (ASPR) remained largely stable during 1990–2000 (0.006% per year) and rose slightly thereafter (0.11% per year); similarly, YLDs (ASYLDsR) showed a mild decline in the first decade (-0.17%) followed by a gradual annual increase of 0.19% from 2000 to 2021. Nationally, the highest APC in ASPR observed in Austria by 0.66%, followed by Ireland 0.23%, Portugal 0.22%, Croatia 0.19%, Malta 0.16%. From 2000 to 2010, the ASMR declined annually by -4.30% in males and -4.58% in females, with a slower decline observed from 2010 to 2021 (-3.48% in males, -3.80% in females). The prevalence rate showed a modest annual increase in males (0.28%) and a slight decline in females (-0.05%) during 2000–2010, followed by a small rise in both sexes from 2010 to 2021 (0.02% in males, 0.18% in females). YLDs remained stable in females (-0.007%) and increased marginally in males (0.23%) from 2010 to 2021. Conclusion: While the mortality due to CHA has steadily declined across 3 decades and sexes, both prevalence and disability burden have shown a gradual upward trend since 2000, particularly among males. These findings highlight a shifting burden from fatal to non-fatal outcomes, underscoring the need for long-term care strategies and quality-of-life interventions.

Background: ARDS affects 200,000 patients annually with 35-60% mortality. Cardiac dysfunction occurs in 60-78% of patients, yet systematic monitoring exists in <30% of ICUs despite point-of-care echo availability in 85% of facilities. This represents a critical quality gap with immediate improvement opportunity using existing technologies. Objective: Systematically evaluate cardiac monitoring evidence in ARDS and develop practical implementation framework for immediate deployment across diverse ICU settings using currently available technologies. Methods: Systematic search of MEDLINE, EMBASE, Cochrane through November 2024 for studies evaluating cardiac monitoring in ARDS using standard ICU equipment. Included RCTs and observational studies (≥20 patients) assessing cardiovascular effects of ventilation strategies. Evidence quality assessed using GRADE methodology. Surveyed technology availability and developed tiered protocols based on resource capabilities. Results: Seven studies (892 patients, low-moderate evidence quality) demonstrated cardiac dysfunction associated with increased mortality (OR 2.3, 95% CI: 1.6-3.2) but significant implementation gaps. Point-of-care echo available in 85% of ICUs, cardiac biomarkers in 98% of hospitals, yet protocols exist in <30%. Developed three-tier framework: Tier 1 (basic assessment, >95% ICUs, 6-12 months, <$50,000), Tier 2 (enhanced monitoring, 60-70% ICUs), Tier 3 (advanced centers). Barriers were organizational rather than technological. Conclusions: Despite limited evidence, immediate systematic cardiac monitoring implementation is feasible using existing technologies. Three-tier framework addresses resource limitations through scalable protocols. Pilot implementation in motivated centers could demonstrate feasibility while generating real-world evidence, transforming evidence limitations into quality improvement opportunities. Impact: Could improve recognition in 140,000 ARDS patients annually, potentially reducing mortality and ICU length of stay while establishing infrastructure for future research.

Heart failure (HF) is a growing global health concern, and cirrhosis is an increasingly recognized non-cardiac contributor through mechanisms like volume overload, systemic inflammation, and cirrhotic cardiomyopathy. As the global prevalence of liver disease rises, especially from nonalcoholic fatty liver disease (NAFLD), alcohol use, and viral hepatitis, understanding the burden of HF due to cirrhosis is essential. We estimated the non-fatal burden of HF attributable to cirrhosis across five etiologies—NAFLD, alcohol use, hepatitis C, hepatitis B, and other causes—in 204 countries and territories from 1990 to 2021 using data from the Global Burden of Disease Study 2021. Non-fatal burden was estimated by applying standardized severity distributions and disability weights to the prevalence of each cause to quantify impairment. Age-standardized prevalence rates (ASPRs) and annualized percentage changes (APCs) were calculated by SDI, age, and sex. Future prevalence to 2050 was projected using a log-linear regression model. Between 1990 and 2021, total prevalence counts rose substantially across all cirrhosis subtypes. NAFLD-related HF increased from 9,202 (95% UI: 6,417–12,641) to 30,092 (20,452–42,009); alcohol-related from 35,701 (27,666–45,427) to 82,258 (61,635–108,803); hepatitis C from 47,484 (37,044–60,873) to 92,079 (70,272–120,432); hepatitis B from 59,974 (47,824–74,529) to 112,111 (87,717–142,335); and other causes from 99,977 (77,246–129,309) to 133,311 (102,461–169,414). The highest ASPR increase was seen in low SDI regions (APC: 2.49%), followed by high SDI (2.24%), middle (1.73%), high-middle (1.67%), and low-middle SDI (1.60%) regions. In 2021, children aged 5–9 years exhibited the highest burden within the under-20 group (26,749 cases), while adults aged 65–69 years had the peak burden among older individuals (51,379 cases). Females showed a marginally higher annual growth in total prevalence (APC: 0.79%) and ASPR (0.04%) compared to males (0.78% and 0.01%, respectively). Projections estimate the prevalence of heart failure due to cirrhosis will increase to 788,332 cases globally by 2050. HF attributable to cirrhosis is a growing global health concern with rising prevalence across all etiologies, disproportionately impacting low-SDI regions and older adults. The projected surge by 2050 underscores an urgent need for integrated liver-cardiac care, early detection, and policy interventions targeting modifiable liver disease risk factors.

BackgroundSubstance use often begins in adolescence, making early identification and prevention essential to avert downstream harms, including substance use disorders. This study evaluated the impact of a peer-led, school-based storytelling program on participating middle- and high school students.MethodsA cross-sectional, anonymous, online survey was distributed from 2014 to 2020 to Midwestern middle and high-schoolers who had attended a school-based event, “Ignite & Engage,” led by a recovery community organization (RCO). Descriptive statistics summarized quantitative and an inductive thematic analysis summarized qualitative survey results.ResultsOf 10,438 surveyed students, 2,853 (27.3%) reported ever using substances The majority (55.2%) reported initiating substance use between the ages of 14 and 16 years, and 29.2% initiated it at an earlier age. The program impact was rated by 996 respondents, with 71.3% of them viewing it favorably and 76.3% noting presenters’ personal recovery stories as the most valuable elements, and 51.2% feeling less likely to use alcohol or drugs afterwards, an effect stronger in middle- than high school youth (60.3% vs. 49.5%, respectively, p < 0.001). Qualitative feedback (N = 2,884) echoed the quantitative findings, emphasizing students’ greater intent to avoid substance use, seek help, support peers, and reflect on recovery.ConclusionThis school-based storytelling program, delivered by presenters with lived experience of addiction recovery, represents a promising, novel approach to substance use prevention and harm reduction among middle- and high school students.