Category: Nevin Manimala

Work. 2023 Mar 8. doi: 10.3233/WOR-220482. Online ahead of print.

ABSTRACT

BACKGROUND: Neck pain (NP) is associated with high disability rates among healthcare workers.

OBJECTIVE: To determine the potential risk factors associated with disability due to NP among healthcare staff working in primary care settings.

METHODS: This 30-day prospective cross-sectional study involved a survey of 63 healthcare personnel (55 women and 8 men aged 45.30±12.34 years) of two primary healthcare centers in Serbia, who completed a general questionnaire developed for this purpose along with the Neck Disability Index (NDI), whereby the potential predictors of NP-related disability were assessed using the statistical package SPSS ver. 24.

RESULTS: Female healthcare workers achieved a higher score on the NDI scale (Me = 8.00, p < 0.05), as did older respondents (r = 0.260, p < 0.05), those with longer work experience (r = 0.323, p < 0.05), and those that wear prescription glasses (Me = 9.00, p < 0.01). Higher NDI scores were also achieved by respondents that suffered from neck pain at the time of the study (Me = 12.50, p < 0.001), especially if they relied on pain medication (Me = 13.00, p < 0.05), and topical analgesic creams (Me = 12.50, p < 0.05) for treating neck pain.

CONCLUSION: Female sex, older age, greater work experience, current neck pain, use of pain-relieving medications and creams, and need for prescription glasses to correct vision increase the risk of disability due to pain in the cervical spine among healthcare workers.

PMID:36911959 | DOI:10.3233/WOR-220482

J Vestib Res. 2023 Mar 4. doi: 10.3233/VES-220107. Online ahead of print.

ABSTRACT

OBJECTIVE: The purpose of this study was to determine the extent to which sensory integration strategies via head sway, derived from a Head-Mounted Display (HMD), change in people with vestibular disorders following vestibular rehabilitation.

DESIGN: Randomized Controlled TrialSetting:Vestibular Rehabilitation ClinicParticipants:Thirty participants with vestibular dysfunction and 21 age-matched controls.

MAIN OUTCOME MEASURES: Participants experienced two levels of visual surround (static or moving ‘stars’, front to back at 0.2 Hz, 32 mm) and white noise (none or rhythmic) while their head sway was recorded via the HTC Vive. We quantified head sway via Directional Path (DP) and Root Mean Square Velocity (RMSV) in 5 directions: anterior-posterior, medio-lateral, pitch, yaw, and roll and Power Spectral Density in low (PSD 1), medium (PSD 2) and high (PSD 3) frequencies in the anterior-posterior direction.

INTERVENTIONS: Participants performed the assessment prior to being randomized into 8-weeks of contextual sensory integration training in virtual reality or traditional vestibular rehabilitation and once again following completion of the intervention. Controls performed the assessment once. Twelve participants dropped out, half due to covid lock-down. We applied an intention to treat analysis.

RESULTS: We observed significant increases in AP DP, RMSV and all PSDs with change in visual level. Both intervention groups significantly decreased medio-lateral, pitch and roll DP and RMSV and anterior-posterior PSD 2 with no group differences. Vestibular participants were significantly higher than controls on all outcomes pre rehabilitation. Post rehabilitation they were only significantly higher on PSD 2. Sound was not a significant predictor of head sway in this protocol.

CONCLUSIONS: Head sway decreased following vestibular rehabilitation regardless of visual load or type of intervention applied. This change was measured via head kinematics derived from a portable HMD which can serve as a sensitive in-clinic assessment for tracking improvement over time.

PMID:36911951 | DOI:10.3233/VES-220107

Clin Hemorheol Microcirc. 2023 Mar 8. doi: 10.3233/CH-221444. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the effects of hydrocortisone combined with vitamin C and vitamin B1 versus hydrocortisone on sublingual microcirculation in septic shock patients.

METHODS: This pilot study enrolled septic shock patients admitted to the ICU of a tertiary teaching hospital from February 2019 to January 2020. We randomly assigned the enrolled patients to the treatment group (hydrocortisone combined with vitamin C and vitamin B1 added to standard care) and the control group (hydrocortisone alone added to standard care) in a 1 : 1 ratio. The primary outcome was perfused small vascular density (sPVD) monitored by a sublingual microcirculation imaging system at 24 hours after treatment.

RESULTS: Twelve patients in the treatment group and ten in the control group completed the study. The baseline characteristics were comparable between the groups. No statistically significant difference was found in the sPVD between the groups at baseline. The sPVD in the treatment group was significantly higher than that in the control group at 4 hours after treatment (mean difference, 7.042; 95% CI, 2.227-11.857; P = 0.009) and 24 hours after treatment (mean difference, 7.075; 95% CI, 2.390-11.759; P = 0.008).

CONCLUSIONS: Compared with hydrocortisone, hydrocortisone combined with vitamin C and vitamin B1 significantly improves microcirculation in septic shock patients.

PMID:36911931 | DOI:10.3233/CH-221444

Breast Dis. 2023;42(1):45-58. doi: 10.3233/BD-220026.

ABSTRACT

BACKGROUND: Multiple lines of evidence suggest that single nucleotide polymorphisms (SNPs) in genes encoding components of the microRNA processing machinery may underlie susceptibility to various human diseases, including cancer.

OBJECTIVE: The present study aimed to investigate whether rs6877842, rs642321 and rs10719 SNPs of DROSHA, a key component of the miRNA biogenesis pathway, are associated with increased risk of breast cancer.

METHODS: A total of 100 patients diagnosed with breast cancer and 100 healthy women were included. Following extraction of DNA, genotyping was performed by tetra primer- amplification refractory mutation system-PCR (T-ARMS-PCR) technique. Under the co-dominant, dominant and recessive inheritance models, the association between DROSHA SNPs and breast cancer risk was determined by logistic regression analysis. The association of DROSHA SNPs with patients’ clinicopathological parameters was assessed. Also, haplotype analysis was performed to evaluate the combined effect of DROSHA SNPs on breast cancer risk.

RESULTS: We observed a statistically significant association between DROSHA rs642321 polymorphism and breast cancer susceptibility (P < 0.05). Under the dominant inheritance model, DROSHA rs642321 polymorphism was significantly associated with increased risk of breast cancer (OR: 6.091; 95% CI: 3.291-11.26; P = 0.0001). Our findings demonstrated that DROSHA rs642321 T allele can contribute to the development of breast cancer (OR: 3.125; 95% CI: 1.984-4.923; P = 0.0001). We also found that GTC and GTT haplotypes conferred significant risk for breast cancer (OR: 2.367; 95% CI: 1.453-3.856; P = 0.0001 and OR: 7.944; 95% CI: 2.073-30.43; P = 0.0001, respectively).

CONCLUSIONS: These results provide the first evidence that DROSHA rs642321 polymorphism is associated with increased risk of breast cancer. However, further studies are needed to firmly validate these findings.

PMID:36911928 | DOI:10.3233/BD-220026

Cardiol Young. 2023 Mar 13:1-7. doi: 10.1017/S1047951123000264. Online ahead of print.

ABSTRACT

Prolonged pleural effusion is a fairly common condition which has considerable impact on complicated and longer hospital stays after Fontan surgery. Identifying the patient population prone to have pleural effusions is still seeking for an answer. This study is to determine the variables that may predict prolonged pleural effusion according to the data of 69 patients who underwent Fontan operation between June 2018 and December 2020 and survived to date. Prolonged pleural effusion was defined as the need for a chest tube for more than 7 days. Two patient groups, with and without prolonged effusion, were compared in terms of pre-, peri-, and post-operative variables. The patients were subdivided into “high-risk” and “low-risk” groups based on the pre-operative catheterisation data. The most frequent main diagnosis was tricuspid atresia (n: 13, 19%). Among 69 patients, 28 (40%) had prolonged pleural effusion whereas 11 (16%) had effusions that lasted longer than 14 days. Ten patients among prolonged effusion group (35%) had pulmonary atresia coexistent with the main diagnosis. Fontan operation was performed in 6 patients (8.7%) over the age of 10, and 4 of these patients (67%) had prolonged pleural effusion. Among numerous variables, statistical significance between the two groups was achieved in pre-operative mean pulmonary artery pressure, post-operative albumin, C-reactive protein levels, length of hospital stay, duration of chest tube drainage, and amount of effusion per day. Early recognition and treatment strategies with routine medical protocol use remain to be the cornerstone for the management of post-operative prolonged pleural effusions after Fontan surgery.

PMID:36911913 | DOI:10.1017/S1047951123000264

Hosp Pediatr. 2023 Mar 13:e2021006471. doi: 10.1542/hpeds.2021-006471. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Inequities in pediatric illness include unequal treatment and outcomes for children of historically marginalized races/ethnicities. Length of stay (LOS) is used to assess health care quality and is associated with higher costs/complications. Studies show LOS disparities for Black and Hispanic children in specific diagnoses, but it is unclear how broadly they exist or how they change over time. We examined the association between race/ethnicity and LOS longitudinally for the most common pediatric inpatient diagnoses.

METHODS: We used the 2016 and 2019 Kids’ Inpatient Databases. The 10 most frequent diagnoses in 2016 were determined. For each diagnosis in each year, we assessed the association between race and LOS by fitting a generalized linear mixed effects model with a negative binomial distribution, accounting for clustering and confounding. Using descriptive statistics, we compared associations between the 2 years for trends over time.

RESULTS: Our analysis included >450 000 admissions and revealed significantly longer LOS for Black, Hispanic, and/or Asian American or Pacific Islander, Native American, and other children in 8 of the 10 diagnoses in 2016, with mixed changes over time. Three new disparities emerged in 2019. The largest disparities were for Black children in most diagnoses.

CONCLUSIONS: Kids’ Inpatient Database data showed longer LOS for children of historically marginalized race/ethnicity with common pediatric inpatient diagnoses, which largely persisted from 2016 to 2019. There is no plausible biological explanation for these findings, and inequities in social needs, access to care, and quality of care likely contribute. Future directions include further study to understand and address contributing factors.

PMID:36911912 | DOI:10.1542/hpeds.2021-006471

Scott Med J. 2023 Mar 13:369330231163375. doi: 10.1177/00369330231163375. Online ahead of print.

ABSTRACT

INTRODUCTION: Intraoperative feedback can be associated with improved surgical performance. Quality feedback can reduce the time required by trainees to achieve proficiency in psychomotor skills. Operative training time has become increasingly limited, and it has become imperative to use surgical training time effectively.

AIM: In this survey, we assessed trainees’ perspectives of intraoperative feedback. We included several aspects of feedback including its occurrence, quality, and potential barriers.

METHODS: All surgical trainees in a single centre were invited to complete an electronic questionnaire. Participants were anonymised. We summarised data using descriptive statistics.

RESULTS: Most trainees (85%) reported they had the opportunity to share their training goals with trainers. Just under three-quarters of trainees felt they always or sometimes got timely feedback. Only half of the trainees were signposted to feedback and 23% felt feedback was not part of their department’s culture. Half of the trainees did not always feel comfortable asking for feedback from their trainers stating their reasons as fear of criticism, lack of time and competing clinical commitments.

CONCLUSION: There is no denying the importance of feedback on operative performance, however, this survey shows that many of the pillars of quality feedback are poorly adhered to.

PMID:36911887 | DOI:10.1177/00369330231163375

Vascular. 2023 Mar 13:17085381231162160. doi: 10.1177/17085381231162160. Online ahead of print.

ABSTRACT

BACKGROUND: Intimal hyperplasia is the response to endothelial injury. Platelet-derived growth factor is released early and favors the formation of intimal hyperplasia. Although multiple treatments, from open surgery to endovascular techniques, have been used they remain controversial. There is currently interest in developing pharmacological strategies to address this pathology. Local vascular inflammation induced by vessel barotrauma generates intimal hyperplasia due to mechanical stress over the venous endothelium. Cilostazol is a selective phosphodiesterase type 3 (PDE3) selective inhibitor with a regulatory effect over intimal hyperplasia. The objective was to investigate cilostazol’s role in inhibiting smooth muscle cell proliferation due to changes in the expression and release of PDGF-BB isoform and the effect on developing IH using an experimental model of vascular barotrauma (balloon-induced injury model).

METHODS: We included 12 New Zealand rabbits. The balloon-induced injury model (BIIM) and experimental group cilostazol (20 mg/kg/day) included 6 rabbits each. Contralateral veins from 6 rabbits used in BIIM model has been taken as control group. We measured and compared the expression of PDGF-BB and the development of IH. A pathologist board chooses a PDGFRα antibody to localized its expression by immunohistochemistry analysis. Subsequently, using an automated immunohistochemical staining machine, the PDGFR expression was evaluated using a Zeiss Primo Star 4 light microscope.

RESULTS: The measurement obtained in the intimal layer was: 126.12 μm2 in the CG, 232 μm2 in the BIIM group, and 178 μm2 in the EG. A statistically significant difference was observed. Baseline serum concentrations of PDGF-BB in the BIIM group were 0.22 pg/mL. At 12 h 0.42 pg/mL, and 0.17 pg/mL at seven days. In the experimental group, the basal levels were 0.33 pg/mL. With the use of cilostazol, a lower peak was obtained at 12 h (0.08 pg/mL). This difference was statistically significant.

CONCLUSIONS: Cilostazol induced a significant reduction of IH caused by barotrauma in the venous endothelium, which correlates with decrease in the PDGF-BB in serum. This could be attributed to the pharmacologic effect on PDGFR expression.

PMID:36911886 | DOI:10.1177/17085381231162160

Campbell Syst Rev. 2023 Jan 13;19(1):e1296. doi: 10.1002/cl2.1296. eCollection 2023 Mar.

ABSTRACT

BACKGROUND: Involving men and boys as both users and supporters of Family Planning (FP) is now considered essential for optimising maternal and child health outcomes. Evidence on how to engage men and boys to meet FP needs is therefore important.

OBJECTIVES: The main objective of this review was to assess the strength of evidence in the area and uncover the effective components and critical process- and system-level characteristics of successful interventions.

SEARCH METHODS: We searched nine electronic databases, seven grey literature databases, organisational websites, and the reference lists of systematic reviews relating to FP. To identify process evaluations and qualitative papers associated with the included experimental studies, we used Connected Papers and hand searches of reference lists.

SELECTION CRITERIA: Experimental and quasi-experimental studies of behavioural and service-level interventions involving males aged 10 years or over in low- and middle-income countries to increase uptake of FP methods were included in this review.

DATA COLLECTION AND ANALYSIS: Methodology was a causal chain analysis involving the development and testing of a logic model of intervention components based on stakeholder consultation and prior research. Qualitative and quantitative data relating to the evaluation studies and interventions were extracted based on the principles of ‘effectiveness-plus’ reviews. Quantitative analysis was undertaken using r with robust variance estimation (RVE), meta-analysis and meta-regression. Qualitative analysis involved ‘best fit’ framework synthesis.

RESULTS: We identified 8885 potentially relevant records and included 127 in the review. Fifty-nine (46%) of these were randomised trials, the remainder were quasi-experimental studies with a comparison group. Fifty-four percent of the included studies were assessed as having a high risk of bias. A meta-analysis of 72 studies (k = 265) showed that the included group of interventions had statistically significantly higher odds of improving contraceptive use when compared to comparison groups (odds ratio = 1.38, confidence interval = 1.21 to 1.57, prediction interval = 0.36 to 5.31, p < 0.0001), but there were substantial variations in the effect sizes of the studies (Q = 40,647, df = 264, p < 0.0001; I ² = 98%) and 73% was within cluster/study. Multi-variate meta-regression revealed several significant intervention delivery characteristics that moderate contraceptive use. These included community-based educational FP interventions, interventions delivered to women as well as men and interventions delivered by trained facilitators, professionals, or peers in community, home and community, or school settings. None of the eight identified intervention components or 33 combinations of components were significant moderators of effects on contraceptive use. Qualitative analysis highlighted some of the barriers and facilitators of effective models of FP that should be considered in future practice and research.

AUTHORS’ CONCLUSIONS: FP interventions that involve men and boys alongside women and girls are effective in improving uptake and use of contraceptives. The evidence suggests that policy should continue to promote the involvement of men and boys in FP in ways that also promote gender equality. Recommendations for research include the need for evaluations during conflict and disease outbreaks, and evaluation of gender transformative interventions which engage men and boys as contraceptive users and supporters in helping to achieve desired family size, fertility promotion, safe conception, as well as promoting equitable family planning decision-making for women and girls.

PMID:36911859 | PMC:PMC9837728 | DOI:10.1002/cl2.1296

Campbell Syst Rev. 2023 Jan 10;19(1):e1302. doi: 10.1002/cl2.1302. eCollection 2023 Mar.

ABSTRACT

BACKGROUND: Police-initiated pedestrian stops have been one of the most widely used crime prevention tactics in modern policing. Proponents have long considered police stops to be an indispensable component of crime prevention efforts, with many holding them responsible for the significant reductions in violent crime observed across major US cities in recent decades. Critics, however, have taken issue with the overuse of pedestrian stops, linking them to worsening mental and physical health, attitudes toward the police, and elevated delinquent behavior for individuals directly subject to them. To date, there has been no systematic review or meta-analysis on the effects of these interventions on crime and individual-level outcomes.

OBJECTIVES: To synthesize the existing evaluation research regarding the impact of police-initiated pedestrian stops on crime and disorder, mental and physical health, individual attitudes toward the police, self-reported crime/delinquency, violence in police-citizen encounters, and police misbehavior.

SEARCH METHODS: We used the Global Policing Database, a repository of all experimental and quasi-experimental evaluations of policing interventions conducted since 1950, to search for published and unpublished evaluations of pedestrian stop interventions through December of 2019. This overarching search was supplemented by additional searches of academic databases, gray literature sources, and correspondence with subject-matter experts to capture eligible studies through December 2021.

SELECTION CRITERIA: Eligibility was limited to studies that included a treatment group of people or places experiencing pedestrian stops and a control group of people or places not experiencing pedestrian stops (or experiencing a lower dosage of pedestrian stops). Studies were required to use an experimental or quasi-experimental design and evaluate the intervention using an outcome of area-level crime and disorder, mental or physical health, individual or community-level attitudes toward the police, or self-reported crime/delinquency.

DATA COLLECTION AND ANALYSIS: We adopted standard methodological procedures expected by the Campbell Collaboration. Eligible studies were grouped by conceptually similar outcomes and then analyzed separately using random effects models with restricted maximum likelihood estimation. Treatment effects were represented using relative incident rate ratios, odds ratios, and Hedges’ g effect sizes, depending on the unit of analysis and outcome measure. We also conducted sensitivity analyses for several outcome measures using robust variance estimation, with standard errors clustered by each unique study/sample. Risk of bias was assessed using items adapted from the Cochrane randomized and non-randomized risk of bias tools.

RESULTS: Our systematic search strategies identified 40 eligible studies corresponding to 58 effect sizes across six outcome groupings, representing 90,904 people and 20,876 places. Police-initiated pedestrian stop interventions were associated with a statistically significant 13% (95% confidence interval [CI]: -16%, -9%, p < 0.001) reduction in crime for treatment areas relative to control areas. These interventions also led to a diffusion of crime control benefits, with a statistically significant 7% (95% CI: -9%, -4%, p < 0.001) reduction in crime for treatment displacement areas relative to control areas. However, pedestrian stops were also associated with a broad range of negative individual-level effects. Individuals experiencing police stops were associated with a statistically significant 46% (95% CI: 24%, 72%, p < 0.001) increase in the odds of a mental health issue and a 36% (95% CI: 14%, 62%, p < 0.001) increase in the odds of a physical health issue, relative to control. Individuals experiencing police stops also reported significantly more negative attitudes toward the police (g = -0.38, 95% CI: -0.59, -0.17, p < 0.001) and significantly higher levels of self-reported crime/delinquency (g = 0.30, 95% CI: 0.12, 0.48, p < 0.001), equating to changes of 18.6% and 15%, respectively. No eligible studies were identified measuring violence in police-citizen encounters or officer misbehavior. While eligible studies were often considered to be at moderate to high risk of bias toward control groups, no significant differences based on methodological rigor were observed. Moderator analyses also indicated that the negative individual-level effects of pedestrian stops may be more pronounced for youth, and that significant differences in effect sizes may exist between US and European studies. However, these moderator analyses were limited by a small number of studies in each comparison, and we were unable to compare the effects of police stops across racial groupings.

AUTHORS’ CONCLUSIONS: While our findings point to favorable effects of pedestrian stop interventions on place-based crime and displacement outcomes, evidence of negative individual-level effects makes it difficult to recommend the use of these tactics over alternative policing interventions. Recent systematic reviews of hot spots policing and problem-oriented policing approaches indicate a more robust evidence-base and generally larger crime reduction effects than those presented here, often without the associated backfire effects on individual health, attitudes, and behavior. Future research should examine whether police agencies can mitigate the negative effects of pedestrian stops through a focus on officer behavior during these encounters.

PMID:36911857 | PMC:PMC9831287 | DOI:10.1002/cl2.1302