Category: Nevin Manimala

JMIR Mhealth Uhealth. 2024 Jun 19;12:e50248. doi: 10.2196/50248.

ABSTRACT

BACKGROUND: The high prevalence of uncontrolled hypertension in Pakistan is predominantly attributed to poor medication adherence. As more than 137 million people in Pakistan use cell phones, a suitable mobile health (mHealth) intervention can be an effective tool to overcome poor medication adherence.

OBJECTIVE: We sought to determine whether a novel mHealth intervention is useful in enhancing antihypertensive therapy adherence and treatment outcomes among patients with hypertension in a low- to middle-income country.

METHODS: A 6-month parallel, single-blinded, superiority randomized controlled trial recruited 439 patients with hypertension with poor adherence to antihypertensive therapy and access to smartphones. An innovative, multifaceted mHealth intervention (Multi-Aid-Package), based on the Health Belief Model and containing reminders (written, audio, visual), infographics, video clips, educational content, and 24/7 individual support, was developed for the intervention group; the control group received standard care. The primary outcome was self-reported medication adherence measured using the Self-Efficacy for Appropriate Medication Adherence Scale (SEAMS) and pill counting; the secondary outcome was systolic blood pressure (SBP) change. Both outcomes were evaluated at baseline and 6 months. Technology acceptance feedback was also assessed at the end of the study. A generalized estimating equation was used to control the covariates associated with the probability of affecting adherence to antihypertensive medication.

RESULTS: Of 439 participants, 423 (96.4%) completed the study. At 6 months post intervention, the median SEAMS score was statistically significantly higher in the intervention group compared to the controls (median 32, IQR 11 vs median 21, IQR 6; U=10,490, P<.001). Within the intervention group, there was an increase in the median SEAMS score by 12.5 points between baseline and 6 months (median 19.5, IQR 5 vs median 32, IQR 11; P<.001). Results of the pill-counting method showed an increase in adherent patients in the intervention group compared to the controls (83/220, 37.2% vs 2/219, 0.9%; P<.001), as well as within the intervention group (difference of n=83, 37.2% of patients, baseline vs 6 months; P<.001). There was a statistically significant difference in the SBP of 7 mmHg between the intervention and control groups (P<.001) at 6 months, a 4 mmHg reduction (P<.001) within the intervention group, and a 3 mmHg increase (P=.314) within the controls. Overall, the number of patients with uncontrolled hypertension decreased by 46 in the intervention group (baseline vs 6 months), but the control group remained unchanged. The variables groups (adjusted odds ratio [AOR] 1.714, 95% CI 2.387-3.825), time (AOR 1.837, 95% CI 1.625-2.754), and age (AOR 1.618, 95% CI 0.225-1.699) significantly contributed (P<.001) to medication adherence. Multi-Aid-Package received a 94.8% acceptability score.

CONCLUSIONS: The novel Multi-Aid-Package is an effective mHealth intervention for enhancing medication adherence and treatment outcomes among patients with hypertension in a low- to middle-income country.

TRIAL REGISTRATION: ClinicalTrials.gov NCT04577157; https://clinicaltrials.gov/study/NCT04577157.

PMID:38896837 | DOI:10.2196/50248

Otol Neurotol. 2024 Jun 19. doi: 10.1097/MAO.0000000000004230. Online ahead of print.

ABSTRACT

OBJECTIVE: To measure the inflammatory cytokines of middle ear effusion (MEE) in otitis media (OM) associated with asthma and chronic rhinosinusitis with nasal polyps (CRSwNP) with or without nonsteroidal anti-inflammatory drug (NSAID) sensitivity to strengthen our assumption that OM is part of the same inflammatory entity. The potential individual differences between MEE inflammatory cytokines could be used in clinical practice for more individual characterization of the inflammation.

STUDY DESIGN: Case-control study.

SETTING: Tertiary referral center.

PATIENTS: Convenience sample of 24 case patients with otitis media with effusion (OME) or chronic otitis media (COM), asthma, and CRSwNP, 14 of whom had NSAID intolerance, and 8 controls with OME but no history of asthma, CRSwNP, or NSAID intolerance.

INTERVENTION: Diagnostic.

MAIN OUTCOME AND MEASURE: Inflammatory cytokines including interleukins (IL)-4, IL-5, IL-6, IL-13, and interferon gamma (IFN-γ) in middle ear effusion.

RESULTS: The MEE mass fractions of IL-5 (p = 0.003) and IFN-γ (p = 0.048) were higher among our case patients with OME/COM than among the controls. For IL-4 and IL-13, the mass fractions were also higher among the case patients than the controls, but this difference was not statistically significant (p = 0.199 and p = 0.617, respectively). We found no difference between the IL-6 mass fractions of the groups. We found notable heterogeneity in individual patients’ cytokine levels.

CONCLUSIONS: According to our findings, OM, when present, should be considered part of the respiratory inflammatory process associated with asthma and CRSwNP. The individual differences in MEE cytokine levels could be useful as biomarkers.

PMID:38896805 | DOI:10.1097/MAO.0000000000004230

Otol Neurotol. 2024 Jun 19. doi: 10.1097/MAO.0000000000004232. Online ahead of print.

ABSTRACT

OBJECTIVES: Excessive noise levels in music venues can negatively impact long-term hearing health. We investigated the prevalence, characteristics, and factors associated with hearing protection use among music event attendees.

STUDY DESIGN: Cross-sectional cohort.

METHODS: Adult participants (2,352) from online music forums completed a questionnaire assessing attendance at music events, hearing protection (HP) usage, type, and frequency, along with history of hearing-related symptoms and medical history. Primary outcome was defined as HP use at music venues. Data were characterized using descriptive statistics, paired t tests, and Pearson’s chi-squared tests. Multivariable regression analysis elicited factors associated with any and regular HP use.

RESULTS: Our 2,352 respondents were primarily male (61.3%) and on average 28.7 years old (SD = 7.0). Of the respondents, 60.6% reported using HP, and 33.2% reported regular use; high-fidelity earplugs were the most used HP type (57.5%). HP use was associated with significantly fewer reports of negative hearing-related symptoms. In a multivariable regression model, factors associated with less likelihood of HP use included being female (vs male, OR = 0.74, CI = [0.55-0.98]), less concern about effects on hearing (OR = 0.53, CI = [0.45-0.61]), and pop music event attendance (vs EDM, OR = 0.40, CI = [0.22-0.72]). Increased attendance frequency in the past year was associated with higher likelihood of regular HP use (OR = 1.07, CI = [1.04-1.09]). Decreased attendance duration was associated with decreased likelihood (OR = 0.09, CI = [0.03-0.33]).

CONCLUSION: HP use prevalence was high, while frequent use remained low. HP use was significantly associated with reduced hearing-related symptoms. Demographic factors, otologic symp-tomology, and attendance-related characteristics were associated with HP use. These findings may guide interventions to increase adoption at music venues.

LEVEL OF EVIDENCE: 4.

PMID:38896784 | DOI:10.1097/MAO.0000000000004232

J Comput Assist Tomogr. 2024 Jun 18. doi: 10.1097/RCT.0000000000001633. Online ahead of print.

ABSTRACT

PURPOSE: Fluoroscopic-guided lumbar puncture (FG-LP) is a common neuroradiologic procedure. Traditionally, a minimum platelet count (MPC) of 50,000/μL for this procedure has been required; however, we recently adopted a lower MPC threshold of 20,000/μL. The purpose of this study was to compare adverse events in patients undergoing FG-LP with MPCs above to those below the conventional 50,000/μL threshold.

MATERIALS: This was an institutional review board-approved, retrospective study on adult patients with hematologic malignancy undergoing FG-LP in the neuroradiology division between May 2021 and December 2022, after lowering the minimal required MPC to 20,000/μL. Recorded data included indication for FG-LP, preprocedure and postprocedure MPC, need for and number of platelet transfusions within 24 hours of FG-LP, presence of traumatic tap, FG-LP-related complications, and any platelet transfusion-related adverse event. Patients were classified into 2 groups based on MPC: (1) those above 50,000/μL and (2) those below 50,000/μL. Descriptive statistics were used comparing these 2 groups.

RESULTS: One hundred twenty-eight patients underwent FG-LP, with 46 having an MPC between 20,000 and 50,000/μL and 82 having an MPC above 50,000/μL. No postprocedural complications were encountered in either group. Traumatic taps occurred in 10/46 (22%)​ with MPC below 50,000/μL versus 10/82 (12%)​ in those with MPC above 50,000/μL. Forty of 46 patients (87%) were transfused with platelets within 24 hours prior to FG-LP. One patient developed a transfusion-related reaction.

CONCLUSION: Lowering the MPC threshold from 50,000/μL to 20,000/μL for FG-LP did not result in a higher incidence of spinal hematoma.

PMID:38896759 | DOI:10.1097/RCT.0000000000001633

Rev Bras Parasitol Vet. 2024 Jun 17;33(2):e000524. doi: 10.1590/S1984-29612024029. eCollection 2024.

ABSTRACT

The saffron finch, Sicalis flaveola, a passerine bird, can be found in nearly all Brazilian territory and is also raised in captivity. The objective of this work was to determine the prevalence and load of oocysts in captive saffron finches in the municipality of Campos dos Goytacazes, state of Rio de Janeiro and in free-living saffron finches in the municipality of Eugenopolis, state of Minas Gerais. In this analysis, 30 captive and 30 wild birds were assessed. Feces eliminated in a 24-hour period were collected and weighed to determine the number of oocysts per gram of feces (OoPG). Statistical analyses were performed using Microsoft Excel and GraphPad Prism Software. All birds in the present study were positive for one or more species of coccidia. Captive birds had a mean total oocyst count higher than that of wild birds. No significant differences in OoPG counts were observed when comparing males and females or captive and wild birds. We can conclude that due to the fact that birds both eat and defecate in their cages, it is essential to keep them as clean as possible, since captive birds have a higher prevalence of coccidia.

PMID:38896754 | DOI:10.1590/S1984-29612024029

Arq Bras Cardiol. 2024 Feb;121(2):e20240079. doi: 10.36660/abc.20240079.

NO ABSTRACT

PMID:38896747 | DOI:10.36660/abc.20240079

Sao Paulo Med J. 2024 Jun 17;142(6):e2023241. doi: 10.1590/1516-3180.2023.0241.R2.25032024. eCollection 2024.

ABSTRACT

BACKGROUND: The magnitude of economic losses attributed to sleep problems and insufficient physical activity (PA) remains unclear. This study aimed to investigate the association between insufficient PA, sleep problems, and direct healthcare costs.

OBJECTIVE: To investigate the association between insufficient physical activity (PA), sleep problems, and direct healthcare costs among adults.

DESIGN AND SETTING: Adults aged ≥ 50 years attended by the Brazilian National Health Service were tracked from 2010 to 2014.

METHODS: Direct healthcare costs were assessed using medical records and expressed in US$. Insufficient PA and sleep problems were assessed through face-to-face interviews. Differences were identified using the analysis of covariance and variance for repeated measures.

RESULTS: In total, 454 women and 166 men were enrolled. Sleep problems were reported by 28.9% (95%CI: 25.2% to 32.4%) of the sample, while insufficient PA was reported by 84.8% (95%CI: 82.1% to 87.6%). The combination of sleep problems and insufficient PA explained 2.3% of all healthcare costs spent on these patients from 2010 to 2014, which directly accounts for approximately US$ 4,765.01.

CONCLUSION: The combination of sleep problems and insufficient PA plays an important role in increasing direct healthcare costs in adults. Public health stakeholders, policymakers, and health professionals can use these results to reinforce the need for strategies to improve sleep quality and increase PA, especially in nations that finance their National Health Systems.

PMID:38896745 | DOI:10.1590/1516-3180.2023.0241.R2.25032024

Codas. 2024 Jun 14;36(3):e20230098. doi: 10.1590/2317-1782/20242023098pt. eCollection 2024.

ABSTRACT

OBJECTIVE: To describe and analyze auditory and academic complaints of students and employees of a federal public university.

METHODS: The study was carried out using a non-probabilistic. The EAPAC Scale with adaptations was used to fulfill the research objectives. It has 14 questions about complaints related to listening skills and 12 questions related to the academic environment. Descriptive data analysis was performed through the frequency distribution of categorical variables and Pearson’s chi-square test was used for association analyses.

RESULTS: 646 individuals aged between 17 and 67 years old participated in the research. The most prevalent complaints were academic difficulty related to memory, concentration, and planning, hearing and understanding speech in noise, and memorization of tasks that were only heard. There was an association with bidirectional statistical significance between academic and auditory complaints.

CONCLUSION: It was possible to observe that there is an association between auditory and academic complaints in adults, marked by the relationship between cognitive and auditory aspects. It is relevant that these factors are considered when performing assessments of Central Auditory Processing when intervening in patients with auditory complaints, and in student life.

PMID:38896744 | DOI:10.1590/2317-1782/20242023098pt

Codas. 2024 Jun 14;36(3):e20230094. doi: 10.1590/2317-1782/20242023094pt. eCollection 2024.

ABSTRACT

PURPOSE: To verify the influence of verbal intellectual-cognitive skills on speech perception in noise, in elderly with sensorineural hearing loss, considering education, age, and degree of hearing loss.

METHODS: 36 elderly between 60 and 89 years old with bilateral sensorineural hearing loss participated in the study. After psychological assessment using the Wechsler Intelligence Scale for Adults (WAIS-III), they were grouped into (GI) 24 elderly without cognitive alteration and (GII) 12 elderly with risk of cognitive alteration. They underwent otorhinolaryngological assessment, audiological interview, pure tone audiometry, and assessment of speech perception in noise using the Hearing in Noise Test (HINT-Brazil). The Mann-Whitney U statistical test compared the results between the groups, and the Spearman correlation verified the variable’s age, degree of hearing loss, and level of education.

RESULTS: There was no difference between the groups in the ability to perceive speech in noise, except in the noise on the left condition, in which GII showed better performance in HINT-Brazil. The degree of hearing loss and level of education influenced the perception of speech in noise. The level of education was correlated with the WAIS-III results.

CONCLUSION: The decline in verbal intellectual-cognitive skills did not affect speech perception of noise in the elderly with hearing loss. The degree of hearing loss and level of education influenced the performance of the elderly in the speech perception test in noise. Performance in verbal cognitive skills varied according to the level of education.

PMID:38896743 | DOI:10.1590/2317-1782/20242023094pt

An Acad Bras Cienc. 2024 Jun 17;96(3):e20231343. doi: 10.1590/0001-3765202420231343. eCollection 2024.

ABSTRACT

Arapaima gigas, an emblematic species of the Amazon region and a longstanding primary fishing resource, currently holds a “Data Deficient” status on the International Union for Conservation of Nature Red List, and is listed as an endangered species in Brazil. The Tocantins River is the most extensively modified large tributary of the Amazon Basin, and thus can affect the dynamics of ichthyofaunal populations. Over a period of 1 year, representatives of the fishing communities and fishermen from 25 fishing communities from four municipalities in the lower Tocantins River region were interviewed, and the obtained information was evaluated based on the literature to survey the population abundance status of A. gigas in the region and its impact on local communities. Among the fishermen interviewed, only one reported still encountering and fishing A. gigas on Jaracuera Island. The disappearance of A. gigas in the region are viewed as having economically disastrous consequences for the residents. Additionally, other endemic fish species are no longer observed in this locality either. If fishery management officials do not work together with local communities, A. gigas could disappear from the northern region of Brazil, where information on the dynamics of A. gigas fishing is lacking.

PMID:38896742 | DOI:10.1590/0001-3765202420231343