Category: Nevin Manimala

BMJ Open. 2023 Jul 12;13(7):e073010. doi: 10.1136/bmjopen-2023-073010.

ABSTRACT

INTRODUCTION: The timely treatment of acute myocardial infarction (AMI) patients is of utmost importance, and yet, there remains a significant disparity between urban and rural areas in China due to the unequal distribution of medical resources. The manifestation of symptoms and psychosocial factors play a crucial role in shaping medical decisions for AMI patients. It is well established that minimising prehospital delay (PHD) is crucial for the successful implementation of recanalisation therapy and reducing mortality in out-of-hospital settings. However, there remains a paucity of studies investigating the correlation between illness perception, symptom response, social support, and PHD in AMI patients.

AIM: The aim of this study was to analyse the relationship pathways between symptom response, illness perception, social support and PHD time in patients with AMI in rural areas of China.

METHODS: A primary care-based cross-sectional study was designed to investigate the inpatients initially diagnosed with AMI in the emergency department of three tertiary care hospitals in three counties in northern Zhejiang Province by convenience sampling method from January 2023 to December 2023. A minimum of 286 patients will be enrolled (voluntary response sample). Each participant will complete a paper-based questionnaire to gather research outcomes. Statistical analyses will be performed using logistic regression and structural equation model with PHD as main outcome parameter.

DISCUSSION: This is the first study of the factors influencing PHD in AMI in rural China using structural equation model. Our study will address this gap in the available research. The implementation and findings of this study may provide a reliable basis for reducing PHD in AMI patients in rural areas and establish a relevant theoretical foundation for the implementation of targeted interventions and risk prevention measures in primary care hospitals.

PMID:37438062 | DOI:10.1136/bmjopen-2023-073010

BMJ Open. 2023 Jul 12;13(7):e068668. doi: 10.1136/bmjopen-2022-068668.

ABSTRACT

OBJECTIVES: Health workers are at particular risk of contracting the COVID-19. However, non-acceptance of COVID-19 vaccination has been a noticeable challenge the world over and in Nigeria where supply constraints have also been an issue. We evaluated COVID-19 vaccination acceptance (the uptake, hesitancy, intention to receive and timeliness of the intention to receive) and the determinants, and the predictive power of acceptance factor compared with availability/access factor, among health workers in Ebonyi state.

METHODS: We conducted an online-offline survey, between 12 March 2022 and 9 May 2022, among all consenting health workers (clinical/non-clinical, public/private) working/living in Ebonyi state and who were selected by convenience and snowballing techniques. Data were collected using structured self-administered questionnaire distributed via WhatsApp and interviewer-administered questionnaire in KoBoCollect installed in android devices. Data were analysed using descriptive statistics and generalised linear models.

RESULTS: 1276 health workers were surveyed. Uptake was 68.2% vaccinated, 47.4% fully vaccinated and 20.9% partially vaccinated. Hesitancy was 22.6% or 71.2% among the unvaccinated (76.3% of hesitancy due to refusal and 23.7% to delay). Intention to receive was 36.0% of which 55.1% gave the intended time (days) to receive with a median (IQR) of 30 days (7-133). The strongest and most important predictor of COVID-19 vaccination acceptance was COVID-19 vaccination expectations and perceptions. Other important predictors were COVID-19/COVID-19 vaccination process experiences and perceptions. Acceptance factor was a stronger predictor compared with availability/access factor.

CONCLUSION: The slow pace of COVID-19 vaccination coverage among the health workers in Ebonyi state/Nigeria may encounter a bottle-neck due to the high refusal rate among the unvaccinated. COVID-19 vaccination policy interventions in Nigeria and other similar settings should, in addition to sustaining availability and access, prioritise improvement of COVID-19 vaccination expectations and perceptions (regarding importance/safety/effectiveness) and COVID-19 risk communication among the health workers.

TRIAL REGISTRATION NUMBER: ISRCTN16735844.

PMID:37438061 | DOI:10.1136/bmjopen-2022-068668

BMJ Open. 2023 Jul 12;13(7):e074469. doi: 10.1136/bmjopen-2023-074469.

ABSTRACT

OBJECTIVE: This study explores the effectiveness of a comprehensive licensure review and adaptive quizzing assignments intervention in improving the performance of undergraduate senior nursing students on the end-of-programme exit exam.

DESIGN: A quasi-experimental single-group design was used to compare pretest and post-test scores through computerised adaptive tests.

SETTING: The setting was a nursing college in Saudi Arabia.

PARTICIPANTS: The study included 292 senior nursing students enrolled in the Bachelor of Science in Nursing programme.

INTERVENTION: A comprehensive licensure review bundled with adaptive quizzing assignments was delivered over 15 weeks in the academic year 2021-2022. The bundle was guided by the elaboration theory, and it included 3-hour synchronous lectures every week and 23 adaptive quizzing assignments that covered weekly content.

PRIMARY AND SECONDARY OUTCOME MEASURES: Students’ mastery scores and the percentage of correct answers were the primary and secondary measures, respectively. Both measures were collected in the pretest and post-test (exit examination). Additionally, demographic characteristics were collected in the pre-test using an online survey.

RESULTS: The overall mean of the mastery score was statistically significantly higher in the exit exam (M=2.51, SD=1.70) than in the pretest (M=1.45, SD=0.44; p<0.001). Although the overall mean of the mastery score in the exit exam did not reach the cut-off score, students who demonstrated the required knowledge and satisfactory performance in the pretest achieved a mastery score above the cut-off. The percentage of correct answers was statistically significantly higher in the exit exam (M=58.59%, SD=9.50) than in the pretest (M=49.32%, SD=9.78; p<0.001). A statistically significant difference in students’ performance based on gender, age and grade point average was observed.

CONCLUSIONS: A comprehensive licensure review and adaptive quizzing assignments intervention bundle fostered the performance of undergraduate nursing students in the end-of-programme exit exam.

PMID:37438057 | DOI:10.1136/bmjopen-2023-074469

JACC Cardiovasc Interv. 2023 Jul 10;16(13):1654-1664. doi: 10.1016/j.jcin.2023.04.037.

ABSTRACT

BACKGROUND: Hypoechoic peri-stent areas in duplex ultrasonography (DUS) (ie, “halo”) have been noted following femoropopliteal artery stenting.

OBJECTIVES: This study sought to investigate the prevalence, risk factors, and potential safety implications of hypoechoic halos identified with DUS following stent implantation in the IMPERIAL (ELUVIA Drug-Eluting Stent Versus Zilver PTX Stent) and EMINENT (Trial Comparing ELUVIA Versus Bare Metal Stent in Treatment of Superficial Femoral and/or Proximal Popliteal Artery) trials.

METHODS: The IMPERIAL and EMINENT studies of femoropopliteal artery stenting included polymer-based drug-eluting stent, nonpolymer drug-coated stent, and bare metal stent treatment arms. A dedicated DUS protocol was implemented for core laboratory assessment of halo presence at study follow-up visits. Logistic regressions were used to investigate risk factors for a halo sign and its impact on clinically driven target lesion revascularization and primary patency.

RESULTS: Diagnostic DUS imaging from 659 patients was obtained at time points ranging from 6 months to 5 years post-stent implantation. Halo prevalence ranged from 20% to 35% of patients with diagnostic DUS and was present at all time intervals. Halos were identified surrounding all stent types. In analyses of patients with diagnostic imaging from at least 2 visits, halo presence typically persisted, with occasional cases of regression and development at later times. No statistically significant association was found for halo status (ie, halo vs no halo) on 1-year clinically driven target lesion revascularization (OR: 1.27; 95% CI: 0.70-2.30; P = 0.4240) or primary patency (OR: 0.68; 95% CI: 0.43-1.07; P = 0.0927).

CONCLUSIONS: A hypoechoic halo following a femoropopliteal stent procedure is a common occurrence associated with all studied stent types. The presence of a halo appears to be benign with no associated clinical sequelae or effect on target vessel revascularization rates within 1 year of stent implantation.

PMID:37438033 | DOI:10.1016/j.jcin.2023.04.037

Lancet Planet Health. 2023 Jul;7(7):e580-e589. doi: 10.1016/S2542-5196(23)00104-3.

ABSTRACT

BACKGROUND: Increasing evidence indicates that ambient outdoor temperature could affect mental health, which is especially concerning in the context of climate change. We aimed to comprehensively analyse the current evidence regarding the associations between ambient temperature and mental health outcomes.

METHODS: We did a systematic review and meta-analysis of the evidence regarding associations between ambient outdoor temperature and changes in mental health outcomes. We searched WebOfScience, Embase, PsychINFO, and PubMed for articles published from database origin up to April 7, 2022. Eligible articles were epidemiological, observational studies in humans of all ages, which evaluated real-world responses to ambient outdoor temperature, and had mental health as a documented outcome; studies of manipulated or controlled temperature or those with only physical health outcomes were excluded. All eligible studies were synthesised qualitatively. If three or more studies reported the same or equivalent effect statistics and if they had equivalent exposure, outcome, and metrics, the studies were pooled in a random-effects meta-analysis. The risk of bias for individual studies was assessed using the Newcastle-Ottawa Scale. The quality of evidence across studies was assessed using the Office of Health Assessment and Translation (OHAT) approach.

FINDINGS: 114 studies were included in the systematic review, of which 19 were suitable for meta-analysis. Three meta-analyses were conducted for suicide outcomes: a 1°C increase in mean monthly temperature was associated with an increase in incidence of 1·5% (95% CI 0·8-2·2, p<0·001; n=1 563 109, seven effects pooled from three studies); a 1°C increase in mean daily temperature was associated with an increase in incidence of 1·7% (0·3-3·0, p=0·014; n=113 523, five effects pooled from five studies); and a 1°C increase in mean monthly temperature was associated with a risk ratio of 1·01 (95% CI 1·00-1·01, p<0·001; n=111 794, six effects pooled from three studies). Three meta-analyses were conducted for hospital attendance or admission for mental illness: heatwaves versus non-heatwave periods were associated with an increase in incidence of 9·7% (95% CI 7·6-11·9, p<0·001; n=362 086, three studies); the risk ratio at the 99th percentile of daily mean temperature compared with the 50th percentile was 1·02 (95% CI 1·01-1·03, p=0·006; n=532 296, three studies); and no significant association was found between a 10°C increase in daily mean temperature and hospital attendance. In a qualitative narrative synthesis, we found that ambient outdoor temperature (including absolute temperatures, temperature variability, and heatwaves) was positively associated with attempted and completed suicides (86 studies), hospital attendance or admission for mental illness (43 studies), and worse outcomes for community mental health and wellbeing (19 studies), but much of the evidence was of low certainty with high heterogeneity.

INTERPRETATION: Increased temperature and temperature variability could be associated with increased cases of suicide and suicidal behaviour, hospital attendance or admission for mental illness, and poor community health and wellbeing. Climate change is likely to increase temperature anomalies, variability, and heatwaves as well as average temperatures; as such, health system leaders and policy makers must be adequately prepared and should develop adaptation strategies. More high-quality, standardised research is required to improve our understanding of these effects.

FUNDING: None.

PMID:37437999 | DOI:10.1016/S2542-5196(23)00104-3

CMAJ Open. 2023 Jul 12;11(4):E630-E636. doi: 10.9778/cmajo.20220227. Print 2023 Jul-Aug.

ABSTRACT

BACKGROUND: Patients with scleroderma require a lifetime of treatment and frequent contacts with rheumatologists and other health care professionals. Although publicly funded health care systems in Canada cover many costs, patients may still face a substantial financial burden in accessing care. The purpose of this study was to quantify out-of-pocket costs borne by people with scleroderma in Canada and compare this burden for those living in large communities and smaller communities.

METHODS: We analyzed responses to a Web-based survey of people living in Canada with scleroderma. Respondents reported annual out-of-pocket medical, travel and accommodation and other nonmedical costs (2019 Canadian dollars). We used descriptive statistics to describe travel distance and out-of-pocket costs. We used a 2-part model to estimate the impact on out-of-pocket costs of living in a large urban centre (≥ 100 000 population), compared with smaller urban centres or rural areas (< 100 000 population). We generated combined mean estimates from the 2-part models using predictive margins.

RESULTS: The survey included 120 people in Canada with scleroderma. The mean, annual, total out-of-pocket costs were $3357 (standard deviation $5580). Respondents living in smaller urban centres and rural areas reported higher mean total costs ($4148, 95% confidence interval [CI] $3618-$4680) and travel or accommodation costs ($1084, 95% CI $804-$1364) than those in larger urban centres (total costs $2678, 95% CI $2252-$3104; travel or accommodation costs $332, 95% CI $207-$458).

INTERPRETATION: Many patients with scleroderma incur considerable out-of-pocket costs, and this burden is exacerbated for those living in smaller urban centres and rural areas. Health care systems and providers should consider ways to alleviate this burden and support equitable access to care.

PMID:37437955 | DOI:10.9778/cmajo.20220227

Nutr Rev. 2023 Jul 12:nuad083. doi: 10.1093/nutrit/nuad083. Online ahead of print.

ABSTRACT

CONTEXT: Rheumatoid arthritis is a chronic inflammatory disease that causes synovitis. Vitamin D deficiency is common in rheumatoid arthritis.

OBJECTIVE: This systematic review and meta-analysis investigated whether vitamin D supplementation affects the inflammatory and clinical outcomes in patients with rheumatoid arthritis on the basis of randomized clinical trials.

DATA SOURCES: A literature search was performed in the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, MEDLINE, Embase, and Google Scholar for articles published until May 2022.

DATA EXTRACTION: The studies were selected according to PRISMA guidelines, and the risk of bias was assessed for randomized controlled trials.

DATA ANALYSIS: A random effects model was used to conduct a meta-analysis, and heterogeneity was assessed using the I2 statistic. Of 464 records, 11 studies were included from 3049 patients. Conclusion: Vitamin D supplementation did not significantly reduce C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), disease activity score in 28 joints (DAS28), or the health assessment questionnaire score; however, the response to supplementation was highly heterogeneous. The pooled analysis showed that vitamin D significantly reduced the pain-visual analogue scale (VAS) weighted mean difference (WMD = -1.30, 95% confidence interval [CI] [-2.34, -27], P = .01), DAS28-CRP (WMD = -.58, 95% CI [-.86, -.31], P < .0001), and DAS28-ESR (WMD = -.58, 95% CI [-.86, -.31], P = .0001). Subgroup analysis for vitamin D doses (>100 µg per day versus <100 µg per day) showed that the higher doses had a more significant effect on CRP than the lower doses (P < .05).

CONCLUSIONS: There was no significant difference between the effect of 2 vitamin D doses on ESR and DAS28. To minimize the high heterogeneity among studies in this meta-analysis, other confounding factors such as baseline vitamin D, age, dietary vitamin D, time of year, sun exposure, drug interaction, effect dosage, and power of study should be examined.

PMID:37437898 | DOI:10.1093/nutrit/nuad083

F S Sci. 2023 Jul 10:S2666-335X(23)00037-X. doi: 10.1016/j.xfss.2023.06.003. Online ahead of print.

ABSTRACT

OBJECTIVE: Vilaprisan is a highly potent selective progesterone receptor modulator shown to reduce heavy menstrual bleeding, induce amenorrhea, and diminish uterine fibroid volume in phase 2 studies. The objective of ASTEROID 3 was to demonstrate the superiority of vilaprisan compared with placebo in the treatment of heavy menstrual bleeding in women with uterine fibroids.

DESIGN: Randomized, double-blind, placebo-controlled, multicenter phase 3 study.

SETTING: Hospitals and medical centers.

PATIENTS: Women with ≥1 uterine fibroid of ≥3 cm and heavy menstrual bleeding of >80 mL/cycle.

INTERVENTION: Women were randomly assigned to 1 of 4 treatment arms, which were planned to comprise 2 treatment periods of 12 weeks each with vilaprisan (2 mg/day) or placebo that were continuous or separated by a break of 1 bleed.

MAIN OUTCOME MEASURES: Amenorrhea (primary endpoint; <2 mL in the last 28 days of treatment) and heavy menstrual bleeding response (key secondary endpoint; <80 mL/cycle and >50% reduction in bleeding from baseline) were measured with the alkaline hematin method. Change in volume of the 3 largest fibroids from baseline to end of treatment was assessed by ultrasound. Safety was monitored throughout the study.

RESULTS: Overall, 75 women completed the first 12 weeks of treatment. Statistically significant and clinically meaningful differences were observed between the vilaprisan- and placebo-treated groups in both the full analysis and per-protocol sets. In the per-protocol set (n=36 and n=12 for the vilaprisan and placebo groups, respectively), amenorrhea was observed more frequently in women treated with vilaprisan than in those who received placebo (83.3% vs 0%, P<.0001), with a median time to onset of 3 days in the vilaprisan group. Similarly, more vilaprisan- than placebo-treated women achieved a response in heavy menstrual bleeding (91.7% vs 25.0%, P<.0001). Serious adverse events were reported for 22 of 79 women (27.8%) and were evenly distributed among the 4 groups receiving vilaprisan and/or placebo. None of these events led to study discontinuation or were related to the liver, and no new safety findings were identified compared with the earlier phase 2 ASTEROID studies.

CONCLUSIONS: Vilaprisan is efficacious and well tolerated over 12 weeks in the treatment of heavy menstrual bleeding associated with uterine fibroids. Further investigations of the long-term efficacy and safety of vilaprisan are warranted.

PMID:37437885 | DOI:10.1016/j.xfss.2023.06.003

Rev Esp Cardiol (Engl Ed). 2023 Jul 10:S1885-5857(23)00193-7. doi: 10.1016/j.rec.2023.04.008. Online ahead of print.

ABSTRACT

INTRODUCTION AND OBJECTIVES: Transcatheter aortic valve implantation (TAVI) using the cusp overlap technique (COT) has shown a lower pacemaker implantation rate at 30 days. The objective of this study was to compare electrocardiogram changes and clinical outcomes between COT and the traditional technique (TT) at 1 year of follow-up.

METHODS: Observational, retrospective, nonrandomized study of consecutive patients undergoing TAVI between January 2015 and January 2021. Patients were matched using a propensity score and the TT was compared with COT. The primary endpoints were electrocardiogram changes and a combined endpoint including pacemaker implantation, hospitalization, or cardiovascular death at 1 year.

RESULTS: We included 254 patients. After propensity score matching, 184 patients (92 per group) remained. There were no statistically significant differences in baseline characteristics. At 1 year, COT patients showed a significant reduction in new onset left bundle branch block (49% vs 27%, P = .002) and less P wave (13.1 ± 21.0 msec vs 5.47 ± 12.5 msec; P = .003) and QRS prolongation (29.77 ± 27.0 msec vs 16.38 ± 25.4 msec, P < .001). COT was associated with a significant reduction in the occurrence of the primary endpoint (SHR, 0.39 [IC95%, 0.21-0.76]; P = .005).

CONCLUSIONS: At 1 year of follow-up, COT reduced the incidence of new onset left bundle branch block and diminished QRS and P wave widening compared with the TT. COT was also associated with a statistically significant reduction in the occurrence of the combined primary cardiovascular endpoint. Full English text available from: www.revespcardiol.org/en.

PMID:37437882 | DOI:10.1016/j.rec.2023.04.008

Neurosci Lett. 2023 Jul 10:137394. doi: 10.1016/j.neulet.2023.137394. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to investigate the levels of serum neurofilament light chain (NFL) and glial fibrillary acidic protein (GFAP) in patients with Parkinson’s disease (PD) and PD patients with sleep disorders (PD-SD), as well as the relationship between these proteins and sleep disorders in PD patients.

METHODS: A total of 96 PD patients and 38 healthy controls (HC) were included in this study, of which 70 PD patients experienced sleep disorders. Both motor symptoms and sleep conditions were assessed in all PD patients. The ultrasensitive single molecule array (SIMOA) technique was used to quantify NFL and GFAP in the serum. All data were statistically analyzed using SPSS 23.0.

RESULTS: Serum NFL and GFAP levels were significantly higher in PD patients than in HC. Similarly, PD-SD patients exhibited higher levels of these two proteins than PD patients without sleep disorders (PD-NSD). In addition, both serum GFAP and NFL were significantly associated with sleep-related scales in PD patients. After covariate-adjusted binary logistic regression analysis, NFL remained statistically significant in PD patients with or without sleep disorders, unlike GFAP.

CONCLUSIONS: Our findings substantiate that serum NFL and GFAP levels are elevated in PD and PD-SD, suggesting neurological axon damage in PD patients, which may be more severe in PD-SD than in PD-NSD. These findings may affect disease diagnosis and provide the foothold for future studies on the underlying mechanisms.

PMID:37437874 | DOI:10.1016/j.neulet.2023.137394