Category: Nevin Manimala

Liver Transpl. 2023 Jul 17. doi: 10.1097/LVT.0000000000000219. Online ahead of print.

ABSTRACT

BACKGROUND: In Italy, 20 minutes of continuous, flat-line electrocardiogram are required for death declaration, which significantly increase the risks of DCD LT. Despite prolonged warm ischemia time, Italian centers reported good outcomes in controlled DCD (cDCD) LT by combining normothermic regional and end-ischemic machine perfusion. However, data on uncontrolled DCD (uDCD) LT performed by this approach are lacking.

PATIENTS AND METHODS: This was a multicenter, retrospective study performed at three large volume centers comparing clinical outcomes of uncontrolled versus controlled DCD LT. The aim of the study was to assess outcomes of sequential normothermic regional perfusion (NRP) and end-ischemic machine perfusion in uncontrolled DCD liver transplantation (LT) Results: Of 153 DCD donors evaluated during study period, 40 uDCD and 59 cDCD grafts were transplanted (utilization rate 52% vs. 78%, p = 0.004). Recipients of uDCD grafts had higher MEAF (4.9 vs. 3.5, p < 0.001) and CCI score at discharge (24.4 vs. 8.7, p = 0.026), longer ICU stay (5 vs. 4 d, p = 0.047) and a trend towards more severe AKI. At multivariate analysis, 90-days graft loss was associated with recipient BMI and lactate downtrend during NRP. One-year graft survival was lower in uDCD (75% vs. 90%, p = 0.007) but became comparable when non-liver-related graft losses were treated as censors (77% vs. 90%, p = 0.100). Incidence of ischemic cholangiopathy was 10% in uDCD versus 3% in cDCD, p = 0.356.

CONCLUSIONS: uDCD LT with prolonged warm ischemia is feasible by the sequential use of NRP and end-ischemic machine perfusion. Proper donor and recipient selection are key in achieving good outcomes in this setting.

PMID:37450659 | DOI:10.1097/LVT.0000000000000219

Hum Vaccin Immunother. 2023 Aug 1;19(2):2235963. doi: 10.1080/21645515.2023.2235963.

ABSTRACT

The intranasal spray COVID-19 vaccine was made available for the first time in China, it is necessary to understand receivers’ satisfaction and experience toward the vaccine to help optimize vaccination service. A self-administered multicenter cross-sectional questionnaire survey was conducted in Beijing, China, in December 2022. The vaccination experience was evaluated through three dimensions: immediate tolerance, smooth progress, and time-saving. Vaccine acceptability was measured by receivers’ preference for the intranasal spray over intramuscular injection after vaccination and their recommendation willingness. Stepwise multinomial and binary logistic regression models were applied to investigate factors associated with vaccine acceptability. Among 10,452 participants included in the analysis, 92.6% felt no discomfort during the inoculation, 99.8% thought the vaccination process went well, and 89.4% deemed it a time-saving option. For vaccine acceptability, 5566 (53.3%) participants were willing to recommend the vaccine to others, 534 (5.1%) refused, and 4352 (41.6%) had not decided yet; 6142 (58.8%) participants preferred the intranasal spray, 873 (8.4%) preferred the intramuscular injection, and 3437 (32.9%) had no preferences. The most concerned aspects of the intranasal spray vaccine were vaccine effectiveness and safety. Receivers who perceived higher vaccine effectiveness or safety were more likely to recommend it to others (OR, 95%CI: 4.41, 3.24-6.00; 6.11, 4.52-8.27) or prefer it over intramuscular injection after vaccination (OR, 95%CI: 5.94, 4.62-7.65; 8.50, 6.70-10.78). Receivers showed good acceptability and experience toward the intranasal spray COVID-19 vaccine. Vaccine effectiveness and safety were the most concerned aspects, and corresponding publicity and education efforts may help improve vaccine acceptability.

PMID:37450312 | DOI:10.1080/21645515.2023.2235963

JAMA Netw Open. 2023 Jul 3;6(7):e2323489. doi: 10.1001/jamanetworkopen.2023.23489.

ABSTRACT

IMPORTANCE: Latin America has implemented the world’s largest and most consolidated conditional cash transfer (CCT) programs during the last 2 decades. As a consequence of the COVID-19 pandemic, poverty rates have markedly increased, and a large number of newly low-income individuals, especially children, have been left unprotected.

OBJECTIVE: To evaluate the association of CCT programs with child health in Latin American countries during the last 2 decades and forecast child mortality trends up to 2030 according to CCT alternative implementation options.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used a multicountry, longitudinal, ecological design with multivariable negative binomial regression models, which were adjusted for all relevant demographic, socioeconomic, and health care variables, integrating the retrospective impact evaluations from January 1, 2000, to December 31, 2019, with dynamic microsimulation models to forecast potential child mortality scenarios up to 2030. The study cohort included 4882 municipalities from Brazil, Ecuador, and Mexico with adequate quality of civil registration and vital statistics according to a validated multidimensional criterion. Data analysis was performed from September 2022 to February 2023.

EXPOSURE: Conditional cash transfer coverage of the target (lowest-income) population categorized into 4 levels: low (0%-29.9%), intermediate (30.0%-69.9%), high (70.0%-99.9%), and consolidated (≥100%).

MAIN OUTCOMES AND MEASURES: The main outcomes were mortality rates for those younger than 5 years and hospitalization rates (per 1000 live births), overall and by poverty-related causes (diarrheal, malnutrition, tuberculosis, malaria, lower respiratory tract infections, and HIV/AIDS), and the mortality rates for those younger than 5 years by age groups, namely, neonatal (0-28 days), postneonatal (28 days to 1 year), infant (<1 year), and toddler (1-4 years).

RESULTS: The retrospective analysis included 4882 municipalities. During the study period of January 1, 2000, to December 31, 2019, mortality in Brazil, Ecuador, and Mexico decreased by 7.8% in children and 6.5% in infants, and an increase in coverage of CCT programs of 76.8% was observed in these Latin American countries. Conditional cash transfer programs were associated with significant reductions of mortality rates in those younger than 5 years (rate ratio [RR], 0.76; 95% CI, 0.75-0.76), having prevented 738 919 (95% CI, 695 641-782 104) child deaths during this period. The association of highest coverage of CCT programs was stronger with poverty-related diseases, such as malnutrition (RR, 0.33; 95% CI, 0.31-0.35), diarrhea (RR, 0.41; 95% CI, 0.40-0.43), lower respiratory tract infections (RR, 0.66, 95% CI, 0.65-0.68), malaria (RR, 0.76; 95% CI, 0.63-0.93), tuberculosis (RR, 0.62; 95% CI, 0.48-0.79), and HIV/AIDS (RR, 0.32; 95% CI, 0.28-0.37). Several sensitivity and triangulation analyses confirmed the robustness of the results. Considering a scenario of moderate economic crisis, a mitigation strategy that will increase the coverage of CCTs to protect those newly in poverty could reduce the mortality rate for those younger than 5 years by up to 17% (RR, 0.83; 95% CI, 0.80-0.85) and prevent 153 601 (95% CI, 127 441-180 600) child deaths by 2030 in Brazil, Ecuador, and Mexico.

CONCLUSIONS AND RELEVANCE: The results of this cohort study suggest that the expansion of CCT programs could strongly reduce childhood hospitalization and mortality in Latin America and should be considered an effective strategy to mitigate the health impact of the current global economic crisis in low- and middle-income countries.

PMID:37450301 | DOI:10.1001/jamanetworkopen.2023.23489

JAMA Netw Open. 2023 Jul 3;6(7):e2323690. doi: 10.1001/jamanetworkopen.2023.23690.

ABSTRACT

IMPORTANCE: Lifestyles enriched with socially and mentally stimulating activities in older age may help build cognitive reserve and reduce dementia risk.

OBJECTIVE: To investigate the association of leisure activities and social networks with dementia risk among older individuals.

DESIGN, SETTING, AND PARTICIPANTS: This longitudinal prospective cohort study used population-based data from the ASPREE Longitudinal Study of Older Persons (ALSOP) for March 1, 2010, to November 30, 2020. Community-dwelling individuals in Australia aged 70 years or older who were generally healthy and without major cognitive impairment at enrollment were recruited to the ALSOP study between March 1, 2010, and December 31, 2014. Data were analyzed from December 1, 2022, to March 31, 2023.

EXPOSURES: A total of 19 measures of leisure activities and social networks assessed at baseline were classified using exploratory factor analysis.

MAIN OUTCOMES AND MEASURES: Dementia was adjudicated by an international expert panel according to Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria. Cox proportional hazards regression examined dementia risk over 10 years, adjusting for education, socioeconomic status, and a range of health-related factors.

RESULTS: This study included 10 318 participants. Their median age was 73.8 (IQR, 71.6-77.2) years at baseline, more than half (52.6%) were women, and most self-identified as White (98.0%). In adusted analyses, more frequent engagement in adult literacy activities (eg, writing letters or journaling, using a computer, and taking education classes) and in active mental activities (eg, playing games, cards, or chess and doing crosswords or puzzles) was associated with an 11.0% (adjusted hazard ratio [AHR], 0.89 [95% CI, 0.85-0.93]) and a 9.0% (AHR, 0.91 [95% CI, 0.87-0.95]) lower risk of dementia, respectively. To a lesser extent, engagement in creative artistic activities (craftwork, woodwork, or metalwork and painting or drawing) (AHR, 0.93 [95% CI, 0.88-0.99]) and in passive mental activities (reading books, newspapers, or magazines; watching television; and listening to music or the radio) (AHR, 0.93 [95% CI, 0.86-0.99]) was also associated with reduced dementia risk. In contrast, interpersonal networks, social activities, and external outings were not associated with dementia risk in this sample.

CONCLUSIONS AND RELEVANCE: These results suggest that engagement in adult literacy, creative art, and active and passive mental activities may help reduce dementia risk in late life. In addition, these findings may guide policies for geriatric care and interventions targeting dementia prevention for older adults.

PMID:37450299 | DOI:10.1001/jamanetworkopen.2023.23690

Br Poult Sci. 2023 Jul 14. doi: 10.1080/00071668.2023.2236038. Online ahead of print.

ABSTRACT

1. A pool of 480 E. coli isolates of poultry (broilers and ducks) representing different time intervals (0, 10, 20 and 30 days) was selected for ribotyping and used to determine polymorphism of 16-23S ribosomal RNA intergenic space. All the isolates were multidrug-resistant (MDR).2. Out of these, 10 isolates were tested for MLST (MultiLocus Sequence Typing) among which novel allelic combinations and therefore new sequence types were identified in seven isolates.3. This work showed the changes in E. coli strains structure at farm level and individual bird level in host species raised on organised farms with similar parental lineage and environmental housing. The statistical results showed that the structure of variation is very different by farm, supporting a strong effect of location, which confirms the temporal clustering.4. There were significant differences between E. coli strains in chickens and ducks, indicating host specificity of the E. coli strains.5. Some of the pathogenic E. coli strains found using MLST belonged to ST735, ST2796 and a pandemic clone ST752 of ST10 clonal complex. The results strongly suggested the clonal expansion and establishment of specific MDR clones that have zoonotic relevance.

PMID:37450277 | DOI:10.1080/00071668.2023.2236038

Arch Gynecol Obstet. 2023 Jul 14. doi: 10.1007/s00404-023-07135-0. Online ahead of print.

ABSTRACT

PURPOSE: To study whether it is better to perform or not a myomectomy, in terms of surgical and reproductive outcomes in patients of advanced reproductive age, by an observational prospective study in university-affiliated and Community Hospitals.

MATERIALS AND METHODS: 40 years and older patients affected by non-submucous symptomatic uterine fibroids and desiring future fertility were enrolled and treated by laparoscopic intracapsular myomectomy by (LIM) or by open laparotomy (OIM), or by a non-surgical management as control group, while attempting to conceive. The primary outcome measures were fibroid characteristics, pre- and post-surgical parameters, pregnancy achievement; the secondary outcome measures were the spontaneous or ART pregnancy outcomes, eventual week of abortion and type of delivery. Propensity scores have been calculated with logistic regression for binary and continuous variables.

RESULTS: 202 patients completed the study: 112 operated by LIM, 40 by OIM and 50 patients as control group. Patients undergoing OIM have a worse surgical outcome than LIM. No difference was seen in pregnancy either after myomectomy or control group during follow-up. In the LIM group, there were 44 pregnancies (39.2%), and in the OIM group, there were 9 (22.5%) and 16 in the control group (32%). The weeks of delivery were statistically greater for the control group versus the surgical groups, with no difference in Apgar score between the 3 groups.

CONCLUSION: Patients aged over 40 years did not show substantial differences in reproductive outcome, whether operated or not. Myomectomy in over 40-year-old patients has no detrimental effect on future pregnancy rates and over when compared to expectant management.

PMID:37450263 | DOI:10.1007/s00404-023-07135-0

Ir J Med Sci. 2023 Jul 14. doi: 10.1007/s11845-023-03442-2. Online ahead of print.

ABSTRACT

BACKGROUND: The widespread use of intraoperative fluoroscopy in orthopaedic procedures has revolutionised surgical practice. However, there are risks associated with using ionising radiation. Efforts to reduce radiation exposure include low-dose imaging protocols and lead protective equipment. Current communication during fluoroscopic procedures can be inefficient and lead to excessive radiation exposure for patients and staff.

AIMS: This study aims to implement a communication tool with standardised commands to reduce radiation exposure in an Irish orthopaedic department.

METHODS: Radiation exposure was evaluated using dose-area product (DAP) measured in uGy/m2. A control group was recorded before implementing the communication tool. Training sessions were conducted and posters of the standardised commands were displayed. Feedback was collected from surgeons and radiographers via surveys. Statistical analysis was performed to compare pre- and post-intervention groups.

RESULTS: A total of 673 surgical cases were included over 6 months. The post-intervention group showed a mean reduction in radiation exposure from 59.8 to 36.4 uGy/m2 (p < 0.011). Subset analyses revealed reduced radiation exposure for ORIF of the distal radius, ankle, humerus, and phalanges. Surgeons and radiographers recognised the need for improved communication and expressed willingness to learn the new tool.

CONCLUSIONS: Implementation of a standardised communication tool effectively reduced patient and staff radiation exposure. It was also believed to have a positive effect on theatre staff morale. Incorporating a universal language tool into training programmes could be beneficial. Surgeons and radiographers provided several suggestions to improve the effectiveness and implementation of this tool into other units.

PMID:37450259 | DOI:10.1007/s11845-023-03442-2

Ir J Med Sci. 2023 Jul 14. doi: 10.1007/s11845-023-03446-y. Online ahead of print.

ABSTRACT

BACKGROUND: Comprehensive geriatric assessment (CGA) is recommended by international guidelines prior to initiation of systemic anti-cancer treatment (SACT). In practice, CGA is limited by time constraints, lack of resources and expert interpretation.

AIMS: The primary objective of this pilot study was to establish the prevalence of frailty (assessed by G8), cognitive impairment (assessed by Mini-Cog), and risk of chemotherapy toxicity (assessed by CARG Chemo-Toxicity Calculator) among patients (pts) ≥65 years commencing SACT. We selected these three screening tools due to the ease of conducting them in a busy outpatient setting. In addition, they have been validated to predict frailty and risk of toxicity from SACT among older adults with cancer.

METHODS: Eligible participants were identified from medical oncology clinics. Assessments were conducted in an outpatient setting by treating physicians. Pt records were reviewed to gather demographic and cancer details. Statistical analyses were conducted using SPSS statistical software.

RESULTS: Sixty-three participants were enrolled. The mean age of participants was 73yrs (range=65-88). Thirty-three (52.4%) were female and 30 (47.6%) were male. The majority (n=38, 60.3%) had metastatic cancer. The mean G8 score was 11.9 (range=6-19). Eighty-three percent had a G8 score ≤14. Mini-Cog was positive in 13 pts (21%). The mean CARG score was 7.5 (range=0-16), and 80% had a risk of at least 50% grade ≥3 toxicity. Of these, 48 (76.2%) received chemotherapy and 15 (23.8%) received non-cytotoxic SACT. In multi-variate analyses, age, cancer type, treatment type, and disease stage did not impact G8, Mini-Cog, or CARG scores.

CONCLUSIONS: Our study has several limitations but suggests that the majority of older adults with cancer would qualify for formal CGA assessment. The risk of high-grade toxicity from SACT is substantial in this cohort. Chronological age was not found to negatively impact pts’ frailty, cognition, or risk of toxicity.

PMID:37450258 | DOI:10.1007/s11845-023-03446-y

J Racial Ethn Health Disparities. 2023 Jul 14. doi: 10.1007/s40615-023-01717-z. Online ahead of print.

ABSTRACT

INTRODUCTION: Workplace experiences may place Black nurses at higher risk for poor sleep and adverse health outcomes. This study aimed to identify poor sleep prevalence and associations of workplace discrimination and workplace social capital with sleep.

METHODOLOGY: Descriptive statistics and multiple linear regression with exploratory analyses were conducted of cross sectional survey data from US Black nurses.

RESULTS: On average, 63 respondents reported sleeping 6.15 h, 45 min less daily than 6.9 h reported nationally for nurses. Ninety-percent of respondents reported poor sleep quality. While no direct significance was found, respondents reporting sleep quality changes had lower workplace social capital and higher workplace discrimination.

CONCLUSION: Black nurses may have higher prevalence of poor sleep than the larger nursing workforce. A potential relationship between decreased sleep quality and negative perceptions of the work environment may exist. Organizations should examine sleep and potential occupational health inequities among Black nurses when considering worker health.

PMID:37450253 | DOI:10.1007/s40615-023-01717-z

J Behav Med. 2023 Jul 14. doi: 10.1007/s10865-023-00435-5. Online ahead of print.

ABSTRACT

The premise of this study was to gain more insight into whether type 1 diabetes (T1D) can impact how youth perceive parents and peers. To address limitations of previous observational studies comparing youth with T1D to control youth, propensity weighting was used to mimic a randomized controlled trial. A total of 558 youth with T1D and 426 control youth (14-26y) completed questionnaires on parental responsiveness, psychological control, overprotection, friend support, extreme peer orientation, and a host of background and psychological functioning variables. The groups were statistically weighted to become as comparable as possible except for disease status. The analysis plan and hypotheses were preregistered on the open science framework. Youth with T1D perceived their mothers to be more overprotective, perceived fewer friend support, and were less extremely oriented toward peers than control youth. There were no group differences for paternal overprotection and paternal and maternal responsiveness and psychological control. Mothers of youth with T1D seem at risk to practice overprotective parenting and clinicians could play an important role in making mothers aware of this risk. However, the absence of group differences for the maladaptive parenting dimension of psychological control and adaptive dimension of responsiveness are reassuring and testify to the resilient nature of youth with T1D and their families. Additionally, there is accumulating evidence that T1D could interfere with engaging in supportive friendships.

PMID:37450207 | DOI:10.1007/s10865-023-00435-5