Category: Nevin Manimala

Appl Health Econ Health Policy. 2024 Jul 17. doi: 10.1007/s40258-024-00902-3. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Globally, emergency medical services (EMSs) report that their demand is dominated by non-emergency (such as urgent and primary care) requests. Appropriately managing these is a major challenge for EMSs, with one mechanism employed being specialist community paramedics. This review guides policy by evaluating the economic impact of specialist community paramedic models from a healthcare system perspective.

METHODS: A multidisciplinary team (health economics, emergency care, paramedicine, nursing) was formed, and a protocol registered on PROSPERO (CRD42023397840) and published open access. Eligible studies included experimental and analytical observational study designs of economic evaluation outcomes of patients requesting EMSs via an emergency telephone line (‘000’, ‘111’, ‘999’, ‘911’ or equivalent) responded to by specialist community paramedics, compared to patients attended by usual care (i.e. standard paramedics). A three-stage systematic search was performed, including Peer Review of Electronic Search Strategies (PRESS) and Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Two independent reviewers extracted and verified 51 unique characteristics from 11 studies, costs were inflated and converted, and outcomes were synthesised with comparisons by model, population, education and reliability of findings.

RESULTS: Eleven studies (n = 7136 intervention group) met the criteria. These included one cost-utility analysis (measuring both costs and consequences), four costing studies (measuring cost only) and six cohort studies (measuring consequences only). Quality was measured using Joanna Briggs Institute tools, and was moderate for ten studies, and low for one. Models included autonomous paramedics (six studies, n = 4132 intervention), physician oversight (three studies, n = 932 intervention) and/or special populations (five studies, n = 3004 intervention). Twenty-one outcomes were reported. Models unanimously reduced emergency department (ED) transportation by 14-78% (higher quality studies reduced emergency department transportation by 50-54%, n = 2639 intervention, p < 0.001), and costs were reduced by AU$338-1227 per attendance in four studies (n = 2962). One study performed an economic evaluation (n = 1549), finding both that the costs were reduced by AU$454 per attendance (although not statistically significant), and consequently that the intervention dominated with a > 95% chance of the model being cost effective at the UK incremental cost-effectiveness ratio threshold.

CONCLUSIONS: Community paramedic roles within EMSs reduced ED transportation by approximately half. However, the rate was highly variable owing to structural (such as local policies) and stochastic (such as the patient’s medical condition) factors. As models unanimously reduced ED transportation-a major contributor to costs-they in turn lead to net healthcare system savings, provided there is sufficient demand to outweigh model costs and generate net savings. However, all models shift costs from EDs to EMSs, and therefore appropriate redistribution of benefits may be necessary to incentivise EMS investment. Policymakers for EMSs could consider negotiating with their health department, local ED or insurers to introduce a rebate for successful community paramedic non-ED-transportations. Following this, geographical areas with suitable non-emergency demand could be identified, and community paramedic models introduced and tested with a prospective economic evaluation or, where this is not feasible, with sufficient data collection to enable a post hoc analysis.

PMID:39017994 | DOI:10.1007/s40258-024-00902-3

Inflammopharmacology. 2024 Jul 17. doi: 10.1007/s10787-024-01522-y. Online ahead of print.

ABSTRACT

The aim of this study was to develop and evaluate bilosomes loaded with Celecoxib (CXB) for the efficient treatment of Alzheimer. The thin-film hydration approach was utilized in the formulation of CXB bilosomes (CXB-BLs). The study used a 2³-factorial design to investigate the impact of several formulation variables. Three separate parameters were investigated: bile salt type (X₁), medication amount (X₂), and lipid-bile salt ratio (X₃). The dependent responses included entrapment efficiency (Y₁: EE %), particle size (Y₂: PS), and zeta potential (_Y3: ZP). The formulation factors were statistically optimized using the Design-Expert^® program. The vesicles demonstrated remarkable CXB encapsulation efficiency, ranging from 94.16 ± 1.91 to 98.38 ± 0.85%. The vesicle sizes ranged from 241.8 ± 6.74 to 352 ± 2.34 nm. The produced formulations have high negative zeta potential values, indicating strong stability. Transmission electron microscopy (TEM) revealed that the optimized vesicles had a spherical form. CXB release from BLs was biphasic, with the release pattern following Higuchi’s model. In vivo studies confirmed the efficiency of CXB-BLs in management of lipopolysaccharide-induced Alzheimer as CXB-BLs ameliorated cognitive dysfunction, decreased acetylcholinesterase (AChE), and inhibited neuro-inflammation and neuro-degeneration through reducing Toll-like receptor (TLR4), and Interleukin-1β (IL-1β) levels. The findings suggested that the created CXB-BLs could be a potential drug delivery strategy for Alzheimer’s treatment.

PMID:39017993 | DOI:10.1007/s10787-024-01522-y

Parasitol Res. 2024 Jul 17;123(7):273. doi: 10.1007/s00436-024-08288-w.

ABSTRACT

Blastocystis is an intestinal protist frequently identified in humans and other animals, though its clinical significance remains controversial. This study aimed to determine the prevalence and genetic diversity of Blastocystis in faecal samples from symptomatic (n = 55) and asymptomatic (n = 50) individuals seeking medical care in Meknes, Morocco. Detection of the protist was accomplished through coproparasitological examination and culture in Jones medium. Culture-positive samples were subjected to molecular analyses (PCR and Sanger sequencing) based on sequences of the small subunit ribosomal RNA gene. Epidemiological questionnaires on demographics and potential risk factors were collected from participating patients. The overall Blastocystis infection rate was 51.4% (54/105), with no differences between symptomatic (52.7%, 29/55) and asymptomatic (50.0%, 25/50) individuals. Sequence analyses identified three Blastocystis subtypes, with ST3 being the most prevalent (42.0%), followed by ST1 (34.0%), and ST2 (12.0%). Regarding intra-subtype diversity, allele 4 was found within ST1; alleles 11/12 and alleles 34/36 (alone or in combination) were identified within ST2 and ST3 respectively. Allele 34 in ST3 (40.8%) and allele 4 in ST1 (34.7%) were the most common genetic variants circulating in the surveyed clinical population. A statistically significant association between ST2 and the presence of flatulence was observed. This is the first study assessing the epidemiology and genetic diversity of Blastocystis sp. in the Meknes region, Morocco.

PMID:39017986 | DOI:10.1007/s00436-024-08288-w

Environ Geochem Health. 2024 Jul 17;46(9):330. doi: 10.1007/s10653-024-02036-w.

ABSTRACT

This study aims to assess the amount of organic carbon stored in soils, as it is an intention of knowing the sustainable soil management, by using two common methods for determining soil organic matter (SOM), namely oxidation with acidified wet dichromate (Walkley-Black method-WB) and loss on ignition (LOI). The study was carried with soil samples collected from a depth of 0 to 30 cm in the Saharan arid region of Ghardaïa (Algeria), with different land uses: agricultural, forest and pastoral. The results obtained from the LOI and WB methods were subjected to statistical analysis, and the relations between both methods were tested to investigate their relationship. The mean percentage of SOM values were 1.86, 2.42, 1.54 by using LOI, but, lower values of 0.34, 0.33, 0.36 were determined by using WB method, for agricultural, forest and pastoral soils respectively. A weak linear relationship between the two analytical procedures was obtained (R² of 0.19 and 0.13 for agricultural and forest soils), while a medium relationship (R² = 0.65) was found for pastoral soils when using linear adjustment. However, the opposite behaviour was found when we use the logarithmic adjustment. The study outcomes indicated discrepancies in the measurements of SOM values between the two methods, been higher those estimated with LOI. Finally, in order to identify the best methodology to measure soil organic matter in arid soils, more research is required in these extreme arid regions as they are a gap in world soil organic matter maps.

PMID:39017950 | DOI:10.1007/s10653-024-02036-w

Environ Geochem Health. 2024 Jul 17;46(9):331. doi: 10.1007/s10653-024-02112-1.

ABSTRACT

The research aims to evaluate the source, dispersion, and human health risk assessment of PAH-contaminated Talinum Triangulare grown along the polluted Ikpoba River. The freeze-dried vegetables were sonicated with dichloromethane for an hour and then concentrated using a rotary evaporator. The extract was purified using a glass column with anhydrous Na₂SO₄ and silica gel and analyzed using gas chromatography-mass spectrometry (GC-MS). The distribution of the contaminants showed that Pyrene < Benzo(a)anthracene ≤ Fluorene < Phenathrene ≤ Naphthalene ≤ Acenaphthene < Anthracene ≤ Acenaphthylene, while Pyrene < Benzo(a)anthracene < Fluorene < Phenathrene < Acenaphthalene ≤ Naphthalene < Anthracene < Acenaphthylene in wet and dry periods, respectively. The average ∑₈ PAHs was 0.85 mg/kg and 0.75 mg/kg in wet and dry periods, respectively, and showed a decrease of 17.64% from wet to dry periods. The daily average dose revealed that the infant male and the adult female consumed the least and highest doses of T. Triangulare (TT), respectively. Furthermore, the hazard quotient and hazard index were < 1 for all the target groups, with adult females having higher values in both seasons. However, the incremental life cancer risk of the target group was between potential and high-potential cancer risk, with adolescent males and adult females more prone to low and high cancer risk, respectively. The isomer ratio and multivariate statistics revealed the sources of the PAH-contaminated TT to be more from pyrolysis.

PMID:39017947 | DOI:10.1007/s10653-024-02112-1

Skeletal Radiol. 2024 Jul 17. doi: 10.1007/s00256-024-04744-x. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare radiographic measurements of lateral tibial slope (LTS), medial TS (MTS), and coronal TS (CTS) in MRI-defined intact, injured, and mucoid-degenerated native ACL knees and determine inter-reader reliability.

MATERIALS AND METHODS: Patient records from 2 years at tertiary care hospitals were reviewed for individuals aged 18-100 undergoing 3-Tesla knee MRI and radiographs. Two randomly selected cohorts, control, and pathologic ACLs on MRI with 86 patients each, were age, gender, and BMI-matched. A fellowship-trained musculoskeletal radiologist reevaluated curated images, characterizing ACL status. Two trained medical students independently collected clinical data and measured slopes on blinded radiographs. ICC, Cohen’s kappa, and case-control matching were performed using SPSS statistical package, with ICC and ANOVA used for comparisons.

RESULTS: Among 172 patients with 172 MRIs and radiographs, there were 86 controls and 86 ACL lesions. There were 108/172 (62.79%) males and 64/172 (37.21%) females. ICCs were 0.966 for MTS, 0.975 for LTS, and 0.978 for CTS. Mucoid degeneration patients had a higher BMI and were older than control (p < .05) or completely torn (p < .001) ACL patients. There was no difference in TS between normal and pathologic ACLs; however, LTS-MTS differences were larger with partial tears (2.5 ± 4.9) than normal ACLs by 4.5° (± 1.2, p < .001), complete tears by 4.5° (± 1.3, p < .001), and mucoid degeneration by 4.9° (± 1.5, p = .001).

CONCLUSION: Various TS measurements are reliable. LTS-MTS differences are associated with different ACL lesions compared to normal ACLs.

PMID:39017944 | DOI:10.1007/s00256-024-04744-x

J Esthet Restor Dent. 2024 Jul 17. doi: 10.1111/jerd.13283. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the in vitro influence of prior silane application on the microshear bond strength (μSBS) of Scotchbond Universal Plus to glass ceramic.

MATERIALS AND METHODS: Thirty blocks of lithium disilicate ceramic were etched with hydrofluoric acid for 20 s and distributed into Group 1 (no silane and no adhesive), Group 2 (adhesive), Group 3 (silane + adhesive). Three cylinders of resin cement were made on each ceramic block. Five blocks (n = 15 cylinders) were subjected to the μSBS test after 24 h, and the other five blocks (n = 15 cylinders) were tested after 6 months of water storage.

RESULTS: According to two-way ANOVA, followed by Tukey’s test, the means of μSBS (MPa), denoted by different letters, show significant differences (p < 0.05): after 24 h-Group 1 (31.7)^B, Group 2 (43.3)^A, and Group 3 (31.3)^B; after 6 months-Group 1 (14.8)^B, Group 2 (33.6)^A, and Group 3 (30.3)^A. After 6 months of storage, there was a significant decrease in μSBS for Groups 1 and 2, along with an increase in adhesive failures across all groups.

CONCLUSIONS: Prior application of silane did not increase the μSBS between Scotchbond Universal Plus and ceramic, and there was degradation at the bond interface over time.

CLINICAL SIGNIFICANCE: Prior application of a silane agent is not necessary when using Scotchbond Universal Plus for bonding to glass ceramics. Regardless of the prior application of silane, there is degradation at the bond interface over time.

PMID:39016071 | DOI:10.1111/jerd.13283

Int Endod J. 2024 Jul 17. doi: 10.1111/iej.14114. Online ahead of print.

ABSTRACT

INTRODUCTION: In endodontics, the number of umbrella reviews has increased significantly over the last few years, but there is no evidence that they were methodologically sound. The aim of the current study was to appraise the methodological quality of umbrella reviews in endodontics, and to identify possible predictive factors associated with methodological quality.

METHODS: Umbrella reviews published in the discipline of endodontics until December 2023 were included. The methodological quality of the reviews was evaluated using a checklist consisting of 11 items. Each item in the checklist was evaluated by two independent assessors who assigned a score of ‘1’ if it was fully addressed, ‘0.5’ if it was partially ddressed, and ‘0’ if it was not addressed. Bootstrapped multiple linear regression analysis was used to examine the association between the total scores awarded and five predictor variables (a priori protocol registration, year of publication, number of authors, journal impact factor (IF) and continent of the corresponding author). The statistical significance level was set as 5%.

RESULTS: A total of 27 reviews were included. Ninety-six per cent of the reviews adequately reported: eligibility criteria for selecting the reviews, details of the reviews, techniques for assessing the risk of bias or methodological quality of the individual systematic reviews they included. Only 30% of the reviews adequately managed overlapping primary studies within individual systematic reviews. Among the five predictors analysed, a priori protocol registration and journals with IFs were associated with significantly greater total methodological quality scores.

DISCUSSION: Several methodological shortcomings in the umbrella reviews published within the field of endodontics were revealed. Umbrella reviews published in journals with IFs and those with protocols registered a priori had significantly superior methodological quality scores.

CONCLUSION: In endodontics, authors intending to publish umbrella reviews should consider the limitations revealed in this study and follow the appropriate rules to ensure their reviews comply with the highest standards and provide accurate and dependable information and conclusions.

PMID:39016048 | DOI:10.1111/iej.14114

Cannabis Cannabinoid Res. 2024 Jul 17. doi: 10.1089/can.2023.0253. Online ahead of print.

ABSTRACT

Background: Patients have been known to use cannabinoids for treating established chemotherapy-induced peripheral neuropathy (CIPN) based on anecdotal information and retrospective reports suggesting that such might be beneficial. In response, a double-blinded, placebo-controlled, randomized, pilot clinical trial was developed to evaluate whether resultant data would support a phase III trial for testing whether a cannabidiol (CBD) cream might improve CIPN. Methods: Forty patients with established CIPN were randomized, in a double-blinded manner, to topical CBD or a placebo cream. The study product was applied for 2 weeks, followed by a crossover for 2 weeks. Neuropathy was evaluated using the European Organization of Research and Treatment of Cancer (EORTC)-CIPN20, the Chemotherapy-Induced Peripheral Neuropathy Assessment Tool, and the Global Impression of Change instruments. Side effects were recorded by symptom diaries. Results: The EORTC-CIPN20 scores were similar in the patients receiving CBD versus the placebo. Likewise, the toxicity scores were similar in patients who received the CBD versus the placebo. Conclusions: This pilot trial did not support that the studied CBD isolate cream improved painful established CIPN. It was well tolerated overall. Clinical Trial Registration Number: NCT05388058.

PMID:39016024 | DOI:10.1089/can.2023.0253

Int J Adolesc Med Health. 2024 Jul 18. doi: 10.1515/ijamh-2024-0073. Online ahead of print.

ABSTRACT

OBJECTIVES: The tools to measure knowledge, attitudes, and self-efficacy related to adolescent sexual and reproductive health have been developed, but with adolescent subjects over 15 years old and with specific topics. The needs and focus of SRH education in adolescents are different from those of young adults. This study aimed to develop a valid and reliable tool to measure adolescents’ knowledge, attitude, and self-efficacy regarding SRH.

METHODS: A total of 100 items were developed based on a literature search, focus group discussion, and expert panel encompassing three domains: knowledge, attitude, and self-efficacy. The Adolescent Sexual and Reproductive Health – Knowledge, Attitude, and Self-Efficacy Questionnaires (ASRH-KASeQ) then underwent a validation process that included content validity, face validity, and internal consistency reliability. This study was conducted on adolescents aged 12-15 years in secondary school in Yogyakarta, Indonesia. All statistical methods were analyzed using STATA software.

RESULTS: The average content validity (S-CVI/Ave) and face validity (S-FVI/Ave) for knowledge, attitude, and self-efficacy demonstrated good validity with scores of 0.93 and 0.94, 0.92 and 0.96, and 0.95 and 0.96, respectively. The internal consistency reliability using Cronbach’s alpha for the knowledge, attitude, and self-efficacy domains exceeded 0.6, with results of 0.7, 0.81, and 0.89, which were considered acceptable.

CONCLUSIONS: The final set of ASRH-KASeQ consisted of 100 items measuring knowledge (40 items), attitude (30 items), and self-efficacy (30 items) of adolescents SRH. ASRH-KASeQ was shown to be a reliable and valid tool for Indonesian adolescents, especially those aged 12-15 years.

PMID:39016023 | DOI:10.1515/ijamh-2024-0073