Category: Nevin Manimala

Circ Heart Fail. 2024 Jun 21:e011475. doi: 10.1161/CIRCHEARTFAILURE.123.011475. Online ahead of print.

ABSTRACT

BACKGROUND: Caring for someone with heart failure takes an emotional and physical toll. Engaging in self-care may decrease stress and improve the health of informal caregivers. We conducted a randomized controlled trial testing the efficacy of a virtual health coaching intervention, compared with health information alone, on the self-care, stress, coping, and health status of heart failure caregivers.

METHODS: We enrolled 250 caregivers providing care at least 8 hours/week, reporting poor self-care, and able to use technology. All received a tablet device programmed with websites providing vetted information on heart failure and caregiving. Half were randomized to also receive 10 synchronous support sessions virtually with a health coach over 6 months. Data on self-care, stress, coping, and health status were collected at baseline and 3 and 6 months. Linear mixed-effects models were used to assess the interaction between time and treatment group.

RESULTS: The sample was majority female (85.2%), White (62.2%), spouses (59.8%), and aged 55±13.6 years. Many were employed full time (41.8%). They had been caring for the patient 8 hours/day for a median of 3.25 years. In the intention-to-treat analysis, caregivers who received the health coach intervention had statistically and clinically greater improvement across 6 months compared with the control group in the primary outcome of self-care maintenance (5.05±1.99; P=0.01) and stress (-4.50±1.00; P<0.0001). Self-care neglect declined significantly (-0.65±0.32; P=0.04), but the difference between the treatment arms disappeared when the results were adjusted for multiple comparisons. Mental health status improved statistically but not clinically (3.35±1.61; P=0.04). Active coping improved in both groups but not significantly more in the intervention group (P=0.10). Physical health status was unchanged (P=0.27).

CONCLUSIONS: This virtual health coaching intervention was effective in improving self-care and stress in heart failure caregivers.

PMID:38904103 | DOI:10.1161/CIRCHEARTFAILURE.123.011475

Ann Surg. 2024 Jun 21. doi: 10.1097/SLA.0000000000006413. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aims to examine the relationship between procedural volume and annual trauma volume (ATV) of ACS Level I trauma centers (TC).

SUMMARY BACKGROUND DATA: Although ATV is a hard criterion for TC verification, importance of procedural interventions as a potential quality indicator is understudied.

METHODS: Patients managed at ACS level I TCs were identified from ACS-TQIP 2017-2021. TCs were identified using facility keys and stratified into quartiles based on ATV into low, low-medium, medium-high, and high volume. TCs were also stratified into tertiles (low [LV], medium [MV], high [HV]) based on procedural volume by assessing annual number of laparotomies, thoracotomies, craniotomies/craniectomies, angioembolizations, vascular repairs, and long bone fixations performed at each center. Cohen’s κ statistic was used to assess concordance between ATV and procedural volume.

RESULTS: 182 Level I TCs were identified: 76 low, 47 low-medium, 35 high-medium, and 24 high volume. Long bone fixation, laparotomy, and craniotomy/craniectomy were the most performed procedures with a median of 65, 59, and 46 cases/center/year respectively. 31% of HV laparotomy centers, 31% of HV thoracotomy centers, 22% of HV craniotomy/craniectomy centers, 22% of HV vascular repair centers, 32% of HV long bone fixation centers, and 33% of HV angioembolization centers contributed to the overall number of low-medium and low volume TCs. Cohen’s κ statistic demonstrated poor concordance between ATV and procedural volumes for all procedures (Overall procedural volume-κ=0.378, laparotomy-κ=0.270, thoracotomy-κ=0.202, craniotomy/craniectomy- κ=0.394, vascular repair-κ=0.298, long bone fixation-κ=0.277, angioembolization-κ=0.286).

CONCLUSION: ATV does not reflect the procedural interventions performed. Combination of procedural and ATV may provide a more accurate picture of the clinical experience at any given TC.

LEVEL OF EVIDENCE: Level III.

PMID:38904101 | DOI:10.1097/SLA.0000000000006413

Pathog Glob Health. 2024 Jun 21:1-11. doi: 10.1080/20477724.2024.2367442. Online ahead of print.

ABSTRACT

Understanding the distribution of tegumentary leishmaniasis (TL) in different periods enables the adequate conduction of actions at the public health level. The present study analyzes the spatiotemporal evolution of TL incidence rates in the municipalities of Brazil and identifies priority areas from 2001 to 2020. Notifications of new cases were analyzed employing space-time scan statistics and Local Indicators of Spatial Association. As TL incidence rates presented a downward trend in most Brazilian municipalities, spatiotemporal clusters of high relative risks (RR) were more frequent in the first decade of the series. There was a concentration of those clusters in the North and Northeast regions, mainly in the Legal Amazon area. More recent high-RR areas were identified in municipalities of different regions. The number of priority municipalities showed a stable trend in Brazil. There was a great concentration of such municipalities in the states of Acre, Mato Grosso, Rondônia, Pará, and Amapá, as well as large areas in Roraima, Amazonas, Maranhão, and Tocantins, and smaller areas in the states of Goiás, Ceará, Bahia, Minas Gerais, São Paulo, and Paraná. The present study contributes to the understanding of the historical evolution of TL in Brazil and subsidizes actions to combat the disease.

PMID:38904099 | DOI:10.1080/20477724.2024.2367442

J Palliat Med. 2024 Jun 21. doi: 10.1089/jpm.2023.0610. Online ahead of print.

ABSTRACT

Objective: The objective of this study was to examine the association between portal use and end-of-life (EOL) outcomes in the last year of life. Methods: A retrospective cohort (n = 6,517) study at Kaiser Permanente Colorado among adults with serious illness deceased between January 1, 2016, and June 30, 2019. Portal use was categorized into engagement types: no use, nonactive, active without a provider, and active with a provider. EOL outcomes were hospitalizations in the month before death, last-year advance directive completion, and hospice use. Association between EOL outcomes and levels of portal use was assessed using χ² statistics and generalized linear models. Results: Higher portal engagement types were associated with higher rates of hospitalizations (p = 0.0492), advance directive completion (p = 0.0226), and hospice use (p = 0.0070). Conclusion: Portal use in the last year of life was associated with increases in a poor EOL outcome, hospitalizations, and beneficial EOL outcomes, advance directives, and hospice care.

PMID:38904086 | DOI:10.1089/jpm.2023.0610

Games Health J. 2024 Jun 21. doi: 10.1089/g4h.2024.0092. Online ahead of print.

ABSTRACT

The “red potion,” inspired by video games, emulates the health point replenishment mechanism for injured game characters. Conversely, red ginger, known for its potential tonic properties in enhancing cardiovascular endurance, poses challenges in acquisition within specific regions. Several previous studies have highlighted the existence of an inseparable link when gamers are engaged in real-world activities, even without actively playing the game in the virtual world. This suggests the potential for the “red potion” concept to enhance the well-being of gamers in reality. A statistical ANOVA experiment involved 90 participants, all avid gamers, categorized into three groups: basic, placebo, and experimental. The basic group (BG) received a red-colored beverage without red ginger infusion or the ‘red potion’ concept. In contrast, the placebo group (PG) received a similar beverage described as a “red potion” but without red ginger. Lastly, the experimental group (EG) received a red ginger-infused beverage without the “red potion” concept. Despite receiving different treatments, all beverages were presented in the same red color. Participants underwent the “beep test” to assess their baseline stamina. The results revealed that both PG and EG exhibited comparable cardiovascular endurance, affirming the potential of the “red potion” concept to positively influence gamers.

PMID:38904083 | DOI:10.1089/g4h.2024.0092

Med Pr. 2024 Jun 20:187809. doi: 10.13075/mp.5893.01453. Online ahead of print.

ABSTRACT

BACKGROUND: Students of medical universities, future employees, will have an impact on the shaping healthcare system. It is important to know and understand their opinions on the factors affecting working conditions and, consequently, changes necessary to improve effectiveness of health care. Students’ expectations can contribute to the changing working conditions for graduates and bring added value to health system redefinition.

MATERIAL AND METHODS: The study used factor analysis to check whether its use was justified. Reliability analysis was performed and structure indicators were determined for each question. The anonymous survey was conducted from September 2017 until March 2018; 1205 students were randomly selected for the sample.

RESULTS: Eighty percent of the students declared interest in healthcare changes, >50% reported that the main factors influencing the work were competencies, financing, medical equipment and organization. Over 90% of the respondents indicated too long wait times for an appointment with a specialist and admission to hospital as the reason for the low efficiency of healthcare, whereas >80% of the survey participants considered insufficient funding to be a barrier. The need for changing the financing scheme was underlined by >90% of the students, and of health priorities by about 80%. Approximately 71% of the respondents were in favour of limiting the role of government in decision-making processes and introducing changes into the education system.

CONCLUSIONS: Students’ views on organizational and financial factors of working conditions can contribute to improvement in systemic solutions at both micro and macro levels. Limiting the role of politicians in planning and implementing reforms can motivate employees to be more creative and decisive. Analysis of opinions can bring added value to health policy and systemic changes and should be extended by further research results after the COVID-19 pandemic. Students’ interest in healthcare reform encourages reflection on enriching education with managerial skills. Med Pr Work Health Saf. 2024;75(4).

PMID:38904078 | DOI:10.13075/mp.5893.01453

Gut Liver. 2024 Jun 21. doi: 10.5009/gnl230143. Online ahead of print.

ABSTRACT

BACKGROUND/AIMS: Liver transplantation is the most effective treatment for the sickest patients with acute-on-chronic liver failure (ACLF). However, the influence of donor age on liver transplantation, especially in ACLF patients, is still unclear.

METHODS: In this study, we used the data of the Scientific Registry of Transplant Recipients. We included patients with ACLF who received liver transplantation from January 1, 2007, to December 31, 2017, and the total number was 13,857. We allocated the ACLF recipients by age into group I (donor age ≤17 years, n=647); group II (donor age 18-59 years, n=11,423); and group III (donor age ≥60 years, n=1,787). Overall survival (OS), graft survival, and mortality were compared among the three age groups and the four ACLF grades. Cox regression was also analyzed.

RESULTS: The 1-, 3-, and 5-year OS rates were 89.6%, 85.5%, and 82.0% in group I; 89.4%, 83.4%, and 78.2% in group II; and 86.8%, 78.4%, and 71.4% in group III, respectively (p<0.001). When we analyzed the different effects of donor age on OS with different ACLF grades, in groups II and III, we observed statistical differences. Finally, the cubic spline curve told us that the relative death rate changed linearly with increasing donor age.

CONCLUSIONS: Donor age is related to OS and graft survival of ACLF patients after transplantation, and poorer results were associated with elderly donors. In addition, different donor ages have different effects on recipients with different ACLF grades.

PMID:38904075 | DOI:10.5009/gnl230143

iScience. 2024 May 27;27(6):110125. doi: 10.1016/j.isci.2024.110125. eCollection 2024 Jun 21.

ABSTRACT

The UN (United Nations) collects global data on the country-level Percentage of Population Residing in Urban Area (PPRUA). However, variations in urban definitions make these data incomparable across countries. This study assesses national defined PPRUA within UN statistics against estimates we derived using global comparable definitions. Refer to the UN’s Degree of Urbanization framework, we propose 90 global harmonized methods for estimating PPRUA by combining different configurations of three global population datasets, six urban total population thresholds, and five urban population density thresholds. This approach demonstrated significant variations in country-level PPRUA estimations, with wide 95% confidence intervals using the Z score method. Most national defined PPRUA fall between the upper 95% CI and the median of the estimations, underscoring the need for globally harmonious PPRUA estimates. This study advocates for a reassessment of datasets and thresholds in the future and for investigating urbanization on a scale beyond the country level.

PMID:38904069 | PMC:PMC11186970 | DOI:10.1016/j.isci.2024.110125

PCN Rep. 2024 Jun 18;3(2):e212. doi: 10.1002/pcn5.212. eCollection 2024 Jun.

ABSTRACT

AIM: Given the escalating prevalence of autism spectrum disorder (ASD), the persistent paucity of child psychiatrists in Japan, and the need to prepare for unforeseen situations, such as the COVID-19 pandemic, it is essential to establish a reliable screening tool. This study aims to validate the Infant Behavior Checklist (IBC) developed by Japanese experts and determine its appropriate cut-off score.

METHODS: A total of 354 clinic-referred children, along with their caregivers, participated in this research. Clinical records, including diagnoses established through the sub-structured diagnostic interviews, and the IBC assessments, were subjected to rigorous statistical analysis.

RESULTS: Among the 24 items, six failed to reach significance to differentiate ASD from non-ASD cases. The Cronbach’s alpha coefficient for the IBC was calculated at 0.77. The IBC total score for ASD cases was significantly higher than that of non-ASD cases. With the chosen cut-off score, the IBC demonstrated an area under the ROC curve of 0.803, along with sensitivity, specificity, positive predictive value, and negative predictive value of 8.03, 0.79, 0.69, 0.34, and 0.94, respectively.

CONCLUSION: The IBC exhibits satisfactory internal consistency and content and discriminant validity. The high sensitivity and other associated indices for the optimal cut-off score of the IBC affirm its validity as a screening instrument for ASD. Nevertheless, further investigations are warranted to ascertain the clinical utility of the IBC.

PMID:38904062 | PMC:PMC11187909 | DOI:10.1002/pcn5.212

Front Endocrinol (Lausanne). 2024 Jun 6;15:1322253. doi: 10.3389/fendo.2024.1322253. eCollection 2024.

ABSTRACT

OBJECTIVE: Evidence has been increasingly pointing towards a potential link between phenotypes related to obesity and the incidence of colorectal cancer. However, confirming this as a direct causal connection remains elusive. This investigation aims to elucidate the causative links between obesity-associated phenotypes and the incidence of colorectal cancer.

METHODS: Employing the Two Sample Mendelian Randomization (TwoSampleMR) R package, analyses were conducted using Mendelian randomization (MR) to discern potential causative links between obesity categories sourced from both the Institute for Education and University (IEU) Open GWAS Project and Zenodo, and colorectal tumors (data obtained from IEU Open GWAS and FinnGen). For primary evaluations, the study utilized the Wald ratio and the Inverse Variance Weighting (IVW) methods, while the MR-Egger approach was integrated for sensitivity assessment. Bidirectional Mendelian Randomization (Bidirectional MR), as well as Linkage Disequilibrium (LD) Score Regression with well-imputed HapMap3 single nucleotide polymorphisms (SNPs), were additionally executed. Sensitivity assessments entailed IVW, MR-Egger methodologies to assess heterogeneity and pleiotropy, along with a leave-one-out strategy. Instrumental variables were chosen judiciously based on predetermined P-value thresholds and F-statistics.

RESULTS: Results from MR evaluations did not identify a clear causative link between BMI and colorectal malignancy. Conversely, both measures of obesity, the Waist-Hip Ratio (WHR) and its adjusted form for BMI (WHRadjBMI), displayed a connection to increased risk of colorectal cancer, especially prominent among female subjects. Reverse MR analyses dismissed potential reverse causality between colorectal malignancies and obesity. A significant genetic interplay was observed between WHR, WHRadjBMI, and colorectal cancer instances. Ensuing MR probes spotlighted inflammatory bowel ailment as a protective factor, while salad intake was indicated as a potential risk concerning colorectal malignancies. Sensitivity reviews, which included tests for both pleiotropy and heterogeneity, validated the robustness of the MR findings.

CONCLUSION: Findings from this research indicate that specific obesity-related parameters, notably WHR and WHRadjBMI, carry a causal relationship with an elevated colorectal cancer risk. The impact is distinctly more evident among females. Such insights might be pivotal for public health deliberations, hinting that individuals boasting a high WHR might necessitate intensified colorectal cancer screenings.

PMID:38904048 | PMC:PMC11187001 | DOI:10.3389/fendo.2024.1322253