Category: Nevin Manimala

BMC Health Serv Res. 2024 Aug 20;24(1):950. doi: 10.1186/s12913-024-11443-9.

ABSTRACT

BACKGROUND: Seasonal influenza vaccination coverage in Italian older adults is insufficient and well below the minimum target of 75%. In Italy, most influenza vaccine doses are administered by general practitioners (GPs), whose number has been declining. In parallel, the number of patients per GP and GP workload increased dramatically, which theoretically may impair vaccination counselling. In this ecological study, we aimed to assess whether influenza vaccination coverage in older adults is associated with the density of GPs having high number of patients.

METHODS: The study outcome was the influenza vaccination coverage rate in adults aged ≥ 65 years and registered in 20 Italian regions over the last 23 years. The independent variable of interest was the proportion of GPs with more than 1,500 adult patients, which is an imposed normative ceiling. This latter variable was considered as a proxy of GP overload. By adopting a panel regression approach, different specifications of fixed- and random-effects models were run to assess the association of interest, when adjusted for several social structural, economic and healthcare-related variables.

RESULTS: Over the last two decades, most regions showed a negative association between influenza vaccination coverage rates and the density of GPs with a high number of patients. This latter negative association was confirmed (P < 0.05) in different panel model specifications. In particular, in the fully adjusted two-way fixed-effects model, each 10% increase in the number of GPs with more than 1,500 patients was associated with a 1.7% decrease in influenza vaccination coverage. However, this association was present only in region-years where at least 18% of GPs were deemed overloaded.

CONCLUSIONS: In the upcoming years, the number of Italian GPs is projected to decline further. At the same time, the aging Italian population will determine an even greater workload for GPs. This study demonstrated that increased GP workload may partially explain the spatiotemporal variation in influenza vaccination uptake in the Italian elderly. With the imperative of increasing or at least maintaining influenza vaccination coverage rates, several short- and mid-term initiatives should be implemented in order to optimize GP workload during seasonal immunization campaigns.

PMID:39164724 | DOI:10.1186/s12913-024-11443-9

BMC Pulm Med. 2024 Aug 20;24(1):398. doi: 10.1186/s12890-024-03098-3.

ABSTRACT

BACKGROUND: Antigen removal is a cornerstone of treatment of hypersensitivity pneumonitis (HP), but its association with transplant-free survival remains unclear. Further, HP guidelines conflict as to whether antigen removal is a recommended diagnostic test in patients with suspected HP.

OBJECTIVE: The purpose of this study is to (1) evaluate the impact of antigen removal on transplant-free survival and (2) to describe the impact of antigen removal on pulmonary function testing and imaging in a retrospective cohort of patients with HP.

METHODS: We retrospectively identified HP patients evaluated between 2011 and 2020. Demographic, physiologic, radiographic, and pathologic data were recorded.

RESULTS: 212 patients were included in the cohort. Patients who identified and removed antigen had a better transplant-free survival than patients who did not identify antigen and patients who identified but did not remove antigen. Antigen removal was associated with improvement in FVC by 10% predicted in 16.9% of patients with fibrotic HP and 56.7% of patients with nonfibrotic HP.

DISCUSSION: Our results suggest that over 50% of nonfibrotic HP patients and 16.9% of fibrotic HP patients improve with exposure removal. In addition, antigen removal, rather than antigen identification, is associated with transplant-free survival in HP.

PMID:39164720 | DOI:10.1186/s12890-024-03098-3

BMC Public Health. 2024 Aug 20;24(1):2253. doi: 10.1186/s12889-024-19635-y.

ABSTRACT

BACKGROUND: Dietary diversity refers to the consumption of a variety of foods or food groups over a given reference period, which is crucial for improving nutrition and overall health. This longitudinal study aimed to investigate the association between dietary diversity and anthropometric indices in community-dwelling older adults living in Tehran in 2017 and 2021.

METHODS: The current study was conducted on 368 older adults [204 (55.4%) women and 164 (44.6%) men] over 60 years of age living in Tehran, who were selected by a systematic cluster sampling method at two-time points, 2017 and 2021. Anthropometric measures (weight, height, hip circumference, and waist circumference) were assessed with standard methods. The participants’ dietary intake was assessed by completing two non-consecutive 24-hour recalls, and dietary diversity score (DDS) was calculated based on Kant’s method. Statistical analysis was performed using R software by the mixed effect model method.

RESULTS: The mean DDS of the participants in 2017 (5.07 ± 1.20) was higher than that in 2021 (4.94 ± 1.09) (p < 0.05). DDS and dairy diversity score decreased significantly over time. After adjusting for confounders, there was an inverse relationship between the DDS and Body Mass Index (BMI) (B = -0.22; SE = 0.09), but the interaction effect of year × DDS (B = 0.19; SE = 0.10) was not significant (p = 0.06). However, there was a positive relationship between the DDS and A Body Shape Index (ABSI) (B = 0.00; p = 0.022), after adjusting for confounders, this relationship was no longer significant. Additionally, the interaction effect of year and DDS on the ABSI was not significant.

CONCLUSION: The dietary intake and dietary diversity of older adult residents of Tehran declined dramatically with age, and a higher DDS was associated with improved anthropometric indices. DDS had an inverse relationship with general obesity in the studied participants, and the passage of time did not affect this relationship. The DDS can be used as a predictive index and is a powerful tool for investigating changes in nutritional status in longitudinal studies of old age. However, longer-duration studies are needed to obtain more conclusive results.

PMID:39164719 | DOI:10.1186/s12889-024-19635-y

BMC Oral Health. 2024 Aug 20;24(1):967. doi: 10.1186/s12903-024-04745-1.

ABSTRACT

BACKGROUND: Effects of the aging process on the flexural strength of Y-TZP and different Y-PSZ ceramics of different thicknesses were investigated.

METHODS: 300 disc-shaped samples (12 mm diameter, 0.8 and 1.5 mm thicknesses) were made from 5 different zirconia materials 3Y-TZP LA, 4Y-PSZ, 5Y-PSZ, 3 + 5Y-PSZ and 4 + 5Y-PSZ. Experimental groups were artificially aged in an autoclave at 134 °C, 2 bar pressure for 1 and 5 h; control groups were not subjected to any treatment. Microstructural analysis was conducted using Scanning Electron Microscopy, and X-Ray Diffraction analysis determined the crystalline phase content. The impact of aging on flexural strength was investigated with the use of the biaxial flexural strength test. Data were analyzed using three-way ANOVA tests with a significance level of p < 0.05, applying Bonferroni correction for multiple comparisons.

RESULTS: Statistically significant differences in flexural strength were observed among the materials and the material thicknesses (p < 0.05), while there were no significant differences among the aging times (p > 0.05). The highest mean flexural strength values were recorded in the case of the 3 Y-TZP-1.5 mm-5 h group (744.1 ± 61.2 MPa), which was attributed to phase-transformation toughening. The lowest values were observed in the case of the 5 Y-PSZ-1.5 mm-5 h (338.3 ± 34.8 MPa) group.

CONCLUSIONS: Both material type and thickness significantly affect the flexural strength of zirconia ceramics, whereas aging time does not; thus, material selection and thickness are crucial considerations for clinicians.

PMID:39164712 | DOI:10.1186/s12903-024-04745-1

BMC Health Serv Res. 2024 Aug 20;24(1):952. doi: 10.1186/s12913-024-11343-y.

ABSTRACT

BACKGROUND: Evaluating health workers’ knowledge and practice of adverse drug reaction (ADR) reporting is an important step in identifying gaps in quality ADR reporting during public health interventions like the seasonal malaria chemoprevention (SMC) campaign. Pharmacovigilance (PV) monitoring is vital in SMC due to the number of children exposed to malaria medicines for a period of 4 or 5 months during the campaign. In Nigeria more than 10 million children are exposed to SMC medicines every year. The scale of this intervention emphasised the need for efficient and effective safety monitoring during the campaign. Thus, the objective of this study was to evaluate healthcare workers’ (HCW) awareness, knowledge, attitude and practice (KAP) of ADR reporting in health facilities participating in SMC campaign to identify pharmacovigilance gaps which may suggest possible ways to ensure safety during the campaign.

METHODS: World Health Organization’s service availability and readiness assessment (SARA) recommendations were used to sample 2,598 out of 5,195 used as supervising health facilities (HFs) during the 2022 SMC campaign across nine states of the country. Out of the sampled HFs, 2,144 eligible and consented health facility workers (HFWs) were assessed for awareness, and KAP of ADR using the validated 45-item self-administered questionnaire. The data was analysed using descriptive statistics and correlation analysis at p < 0.05.

RESULTS: The majority of the respondents are males (n = 1,333, 62.2%). The HFWs showed good awareness (n = 2,037, 95.0%) of pharmacovigilance (PV). However, only 809 (37.7%) of them had good knowledge scores. The mean ADR reporting attitude score (85.0 ± 15.3%) was good with many of the respondents (n = 1,548, 72.2%) having a good score. However, the respondents’ ADR practice was suboptimal, only 1,356 (63.2%) of them had encounters with ADR, and a lot of negative perceived barriers to ADR reporting were identified in the study. For example, 493 (23%) believed that ADRs were not reported because they were not serious and life-threatening while 248 (11.6%) reported a fear of liability. Correlation analysis revealed female gender (r = 0.163, p < 0.001), older age (r = 0.207, p < 0.001) and years of practice (r = 0.050, p = 0.021) as factors significantly associated with ADR knowledge and attitude scores.

CONCLUSION: The study indicated that HCWs across health facilities participating in SMC campaigns have ADR reporting knowledge and practice gaps. The study suggest training alone may not be effective in addressing gaps in ADR reporting. In addition to PV training, implementers can include continuous mentoring of health care workers or other similar interventions as part of strategy to improve ADR reporting. Also, context specific strategies to improve ADR reporting among health care worker needs to be implemented to address under-reporting of ADRs during SMC campaigns and other malaria public health interventions.

PMID:39164692 | DOI:10.1186/s12913-024-11343-y

BMC Psychiatry. 2024 Aug 20;24(1):569. doi: 10.1186/s12888-024-06009-2.

ABSTRACT

BACKGROUND: Young people and adults with ADHD are at risk of a range of physical health problems. There is limited guidance on how to approach health problems in ADHD, and especially around 16-25 year olds who will be transitioning from paediatric to adult care. The aim of this scoping review was to identify psychosocial interventions that target physical health in young people and adults with ADHD.

METHODS: We constructed searches in MEDLINE, PsycInfo, EMBASE of adolescents, young people and adults. Inclusion criteria were; studies of psychosocial interventions examining a component of physical health, applicable to people aged 16-25, with clinical or research diagnoses of ADHD. Data were extracted using a data extraction tool and tabulated, including study intervention framing/aims, population, intervention, and relevant outcomes (including specific statistics where relevant).

RESULTS: Our search identified 22 unique papers covering, psychosocial interventions targeting at least one of sleep (n=7), smoking (n=3), substance/alcohol use (n=4), physical health/exercise (n=6) and general health (n=3). Studies examined psychotherapy/behaviour interventions (n=12), psychoeducation (n=4), digital (n=2) and social interventions (n=4). There was significant heterogeneity in intervention framing, outcome measures and population.

CONCLUSION: Further work on the impact of targeted physical health interventions, with explicit reference to a conceptual framework of poor health in ADHD is required. Furthermore, future work standardising reporting of physical health outcomes in ADHD is crucial for the development of an evidence base in this field.

PMID:39164688 | DOI:10.1186/s12888-024-06009-2

BMC Public Health. 2024 Aug 20;24(1):2262. doi: 10.1186/s12889-024-19800-3.

ABSTRACT

BACKGROUND: Long-term care insurance (LTCI) in China provides financial and care security for persons with disabilities and includes caregivers in the paid labour workforce. However, it is unclear how the LTCI affects health outcomes in female recipients, female caregivers, and female non-recipients and female non-caregivers.

METHODS: Using the China Health and Retirement Longitudinal Study data and staggered difference-in-differences method, we evaluated the effect of LTCI on health outcomes in women with different roles, including female recipients, female caregivers, and female non-recipients and female non-caregivers, and discussed the heterogeneity of the effect on women’s health outcomes.

RESULTS: LTCI statistically significant increased self-rated health and reduced depression in women and improved the health in women with different roles by increasing self-rated health in female recipients, reducing chronic diseases in female caregivers, and reducing depression in female non-recipients and female non-caregivers. There was a more pronounced improvement in health outcomes among women in the west and northeast and women in rural village.

CONCLUSIONS: After the implementation of LTCI, health outcomes in female recipients, female caregivers, and female non-recipients and female non-caregivers were improved. LTCI’ improvement on women’s health outcomes was heterogeneous geographically and socially. Our findings highlight the importance of delivering differentiated health interventions for women with different roles in the implementation process of LTCI and minimizing women’s health inequalities in geography and society.

PMID:39164684 | DOI:10.1186/s12889-024-19800-3

BMC Endocr Disord. 2024 Aug 20;24(1):155. doi: 10.1186/s12902-024-01689-z.

ABSTRACT

OBJECTIVE: Neutrophil-to-lymphocyte ratio (NLR) has been shown to be an independent predictor for cardiovascular diseases and metabolic diseases. The role of NLR in metabolic syndrome (MS) has also been explored albeit with conflicting results. The objective of this study was to assess the predictive role of NLR in MS.

METHODS: We conducted a meta-analysis of observational studies to evaluate the predictive role of NLR in MS. Cochrane library, PubMed, Medline, Embase, and Scopus were systematically searched from their inception to December 2023. The Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines was followed. The statistical analysis was performed using RevMan 5.3 software. A randomeffect model was used.

RESULTS: Twenty six studies enrolling 70,937 individuals were included in this meta-analysis. Compared with the individuals without MS, NLR value was significantly higher in the patients of MS (mean difference (MD) 0.40, 95% confidence intervals (CI): 0.27-0.52, P < 0.00001, I² = 97%). The derived NLR value also was significantly higher in participants with MS than those without MS (MD 0.48, 95%CI: 0.13-0.84, P = 0.007, I² = 96%). There was no statistically significant association for NLR between the patients with 4 metabolic risk factors (MRF) and those with 3 MRF, or between patients with 5 MRF and those with 4 MRF (MD 0.16, 95%CI: -0.02-0.35, P = 0.10, I² = 84%; MD 0.12, 95%CI: -0.06-0.29, P = 0.20, I² = 68%). However, MS patients with 5 MRF had a significantly higher mean NLR value than those with 3MRF (MD 0.37, 95%CI: 0.05-0.68, P = 0.02, I² = 92%). Compared with the individuals with low NLR, incidence of MS was significantly higher in those with high NLR (OR 2.23, 95%CI: 1.25-3.98, P = 0.006, I² = 97%).

CONCLUSION: The findings of our meta-analysis suggested that the value of NLR and derived NLR were higher in MS patients. MS patients with 5 MRF had a significantly higher mean NLR value. High NLR also demonstrated a significantly increased the incidence of MS. NLR may be a good predictive biomarker in MS.

PMID:39164679 | DOI:10.1186/s12902-024-01689-z

BMC Public Health. 2024 Aug 20;24(1):2260. doi: 10.1186/s12889-024-19716-y.

ABSTRACT

BACKGROUND: Diabetes is a major public health problem in Qatar and is associated with an increased risk of depression. However, no study has been conducted in Qatar on the relationship between dietary patterns and depression symptoms in adults. The aim of this study was to assess the association between dietary patterns and depression symptoms among adults with or without diabetes in Qatar.

METHODS: A total of 1000 participants from the Qatar Biobank (QBB) were included in this cross-sectional study. Food intake was assessed using a computer-administered food frequency questionnaire (FFQ), and dietary patterns were identified using factor analysis. Depression symptoms were evaluated using the Patient Health Questionnaire-9 (PHQ-9).

RESULTS: Depression symptoms were present in 13.5% of the sample. Two dietary patterns were identified: “unhealthy” (high consumption of fast food, biryani, mixed dish (chicken/meat/fish), croissant) and “prudent” (high consumption of fresh fruit, salads/raw vegetables, canned/dried fruit, and dates). After adjusting for sociodemographic, lifestyle factors (smoking and physical activity), diabetes and medication use for diabetes and hypertension, a high intake of “unhealthy” pattern was associated with an increased prevalence of depressive symptoms in individuals with diabetes (prevalence ratio, PR = 1.41; 95% CI = 1.28, 1.56; p-value < 0.001), while there was no statistically significant association between depressive symptoms and the “prudent” dietary pattern. The “prudent” pattern was inversely and significantly associated with depressive symptoms in individuals with a normal body weight (PR = 0.21; 95% CI = 0.06, 0.76; p-value = 0.018).

CONCLUSION: The “unhealthy” dietary pattern was positively associated with depression symptoms in those with diabetes, whereas the “prudent” dietary pattern was inversely associated with depression symptoms in those with a normal body weight. Promoting healthy eating habits should be considered in the prevention and management of depression.

PMID:39164668 | DOI:10.1186/s12889-024-19716-y

J Environ Manage. 2024 Aug 19;368:122167. doi: 10.1016/j.jenvman.2024.122167. Online ahead of print.

ABSTRACT

Mitigating the environmental impact of composting by the reduction of greenhouse gases (N₂O, CH₄) and ammonia (NH₃) emissions is a major challenge. To meet this challenge, the understanding of the relationships between composted substrates initial physicochemical parameters and gas emissions is essential. From a long-term perspective, it will allow to guide the recipe formulation of the initial mixture to be composted, with a view to reducing gas emissions during composting. This study gathered literature data targeting sewage sludge composting and performed statistical correlation analyses between cumulative gas emissions and the following parameters: sewage sludge, bulking agent and composted mixture initial physicochemical parameters (pH, dry matter, total carbon, total nitrogen, C/N), the dry mass ratio of sewage sludge to bulking agent and the duration of composting. The average values of cumulative emissions show a large variability: 1.37 ± 2.71 gC.kg initial mix DM^-1, 0.13 ± 0.17 gN.kg initial mix DM^-1 and 2.23 ± 2.79 gN.kg initial mix DM^-1 for CH₄, N₂O and NH₃ emissions respectively. Although the correlation analysis highlighted some significant interesting correlations between initial physicochemical parameters and gas emissions (p.value < 0.05), reliable multiparametric model could not fit the data, meaning that the actual literature data are not sufficient to explain most part of gas emissions. Among the most interesting relationships, the study showed that the dry matter of the composted mixture is negatively correlated to N₂O emissions, while the ratio of sewage sludge to bulking agent and the duration of composting are positively correlated to N₂O emissions. It was also shown that the pH of the bulking agent is positively correlated to NH₃ emissions. Considering the large part of the emission variability that is not explained and the difficulty to link the correlation with their causality, it will be interesting to improve composting gas emissions knowledge in future research by analyzing free air space, bulking agent adsorption capacity and available and biodegradable organic matter. These parameters are of particular interest in solving the main problems associated with sewage sludge composting, namely porosity and nitrogen retention. This study also highlighted the necessity to extend the duration of the composting studies over 40 days in order to measure possible N₂O late release and better identify parameters influencing N₂O emissions.

PMID:39163668 | DOI:10.1016/j.jenvman.2024.122167