Category: Nevin Manimala

Public Health Nurs. 2023 Mar 21. doi: 10.1111/phn.13190. Online ahead of print.

ABSTRACT

OBJECTIVES: In this study we aimed to describe and compare groups formed by a rules-based algorithm to prospectively identify clients at risk of poor outcomes in order to guide tailored public health nursing (PHN) intervention approaches.

DESIGN: Data-driven methods using standardized Omaha System PHN documentation.

SAMPLE: Clients ages 13-40 who received PHN home visiting services for both the Caretaking/parenting and Mental health problems (N = 4109).

MEASUREMENT: We applied a theory-based algorithm consisting of six rules using existing Omaha System data. We examined the groups formed by the algorithm using standard descriptive, inferential statistics, and Latent Class Analysis.

RESULTS: Clients (N = 4109) were 25.1 (SD = 5.9) years old and had an average of 7.3 (SD = 3.2) problems, 250 (SD = 319) total interventions, and 32 (SD = 44) Mental health interventions. Overall outcomes improved after PHN interventions (p < .001 for all) and having more Mental health signs/symptoms was negatively associated with outcome scores (p < .001 for all).

CONCLUSIONS: This algorithm may be helpful in identifying high-risk clients during a baseline assessment who may benefit from more intensive mental health interventions. Findings show there is value using the Omaha System for PHN documentation and algorithm clinical decision support development. Future research should focus on algorithm implementation in PHN clinical practice.

PMID:36943178 | DOI:10.1111/phn.13190

Twin Res Hum Genet. 2023 Mar 21:1-5. doi: 10.1017/thg.2023.9. Online ahead of print.

ABSTRACT

A model in the form of a Markov chain is constructed to mimic variations in the human sex ratio. It is illustrated by simulation. The equilibrium distribution is shown to be a simple modification of the binomial distribution. This enables an easy calculation of the variation in sex ratio which could be expected in small populations.

PMID:36943175 | DOI:10.1017/thg.2023.9

Biotechnol Genet Eng Rev. 2023 Mar 21:1-11. doi: 10.1080/02648725.2023.2191087. Online ahead of print.

ABSTRACT

To investigate the predictive value of acoustic radiation force impulse imaging for neoadjuvant chemotherapy in breast cancer. Seventy-eight breast cancer patients treated in our hospital from March 2019 to March 2022 were recruited. They received neoadjuvant chemotherapy and were examined by conventional ultrasound and acoustic radiation force impulse imaging before chemotherapy and after two cycles of chemotherapy. The lesion diameter, intralesional blood flow pulsatility index (PI), resistance index (RI), shear wave velocity (SWV), and change rate (Δlesion diameter, ΔPI, ΔRI, ΔSWV) were compared between the two groups before and after chemotherapy. The receiver operating characteristic curve was drawn to evaluate the predictive power of related parameters on the efficacy of neoadjuvant chemotherapy in breast cancer. After two cycles of neoadjuvant chemotherapy, according to the Miller-Payne grading, 57 cases (73.08%) with significant neoadjuvant chemotherapy response were classified as the response group, and 21 cases (26.92%) with non-significant response were classified as the non-response group. Before and after chemotherapy, the difference in lesion diameter, PI, RI, SWV, and change rate (Δlesion diameter, ΔPI, ΔRI, and ΔSWV) was statistically significant between the two groups (P < 0.05). The area under the curve of ΔSWV in predicting the efficacy of neoadjuvant chemotherapy 0.876 (95%CI 0.781 ~ 0.939) was significantly higher than that of Δlesion diameter 0.652 (95%CI 0.535 ~ 0.756), that of ΔPI 0.712 (95%CI 0.599 ~ 0.809), and that of ΔRI 0.678 (95%CI 0.563 ~ 0.780) (P < 0.05). The change rate of tissue stiffness has a relatively high predictive value for the effect of neoadjuvant chemotherapy in breast cancer.

PMID:36943110 | DOI:10.1080/02648725.2023.2191087

United European Gastroenterol J. 2023 Mar 21. doi: 10.1002/ueg2.12367. Online ahead of print.

ABSTRACT

BACKGROUND: The management of postoperative recurrence (POR) in Crohn’s disease (CD) after ileo-colonic resection is a highly debated topic. Prophylactic immunosuppression after surgery is currently recommended in the presence of at least one clinical risk factor.

OBJECTIVE: Our aim was to determine whether early immunosuppression can be avoided and guided by endoscopy in CD patients with only one risk factor.

METHODS: CD patients with only one risk factor for POR, including previous intestinal resection, extensive small intestine resection (>50 cm), fistulising phenotype, history of perianal disease, and active smoking, were retrospectively included. Two groups were formed based on whether immunosuppression was started immediately after surgery (“prophylaxis group”) or guided by endoscopy (“endoscopy-driven group”). Primary endpoints were rates of any endoscopic recurrence (Rutgeerts ≥ i2a) and severe endoscopic recurrence (i4) within 12 months after surgery. Secondary outcomes were clinical recurrence rates at 6, 12 and 24 months after surgery.

RESULTS: A total of 195 patients were enroled, of whom 61 (31.3%) received immunoprophylaxis. No differences between immunoprophylaxis and the endoscopy-driven approach were found regarding any endoscopic recurrence (36.1% vs. 45.5%, respectively, p = 0.10) and severe endoscopic recurrence (9.8% vs. 15.7%, respectively, p = 0.15) at the first endoscopic evaluation. Clinical recurrence rates were also not statistically different (p = 0.43, p = 0.09, and p = 0.63 at 6, 12, and 24 months, respectively).

CONCLUSIONS: In operated CD patients with only one risk factor for POR, immediate immunoprophylaxis does not decrease the rate of early clinical and endoscopic recurrence. Prospective studies are needed to confirm our results.

PMID:36942657 | DOI:10.1002/ueg2.12367

AIDS Care. 2023 Mar 21:1-8. doi: 10.1080/09540121.2023.2189224. Online ahead of print.

ABSTRACT

Characterizing spatial distribution of HIV outcomes is vital for targeting interventions to areas most at risk. We performed spatial analysis to identify geographic clusters and factors associated with mortality in KwaZulu-Natal, South Africa. We utilized Sizanani trial (NCT01188941) data, which enrolled participants August 2010-January 2013 and obtained vital status at 5.8 (IQR 5.0-6.4) years of follow-up. We mapped geocoded addresses to 2011 Census-defined small area layer (SAL) centroids, used Kulldorff’s spatial scan statistic to identify mortality clusters, and compared socio-demographic factors for SALs within and outside mortality clusters. We assigned 1,143 participants living with HIV (260 [23%] of whom died during follow-up) to 677 SALs. One lower mortality cluster (n = 90, RR = 0.23, p = 0.022) was identified near a hospital outside Durban. SALs in the cluster were younger (24y vs 25y, p < 0.001); had fewer bedrooms/household (3 vs 4, p < 0.001); had more females (52% vs 51%, p = 0.013) and residents with no schooling past age 20 (4% vs 3%, p < 0.001) or no education at all (4% vs 3%, p < 0.001); had fewer residents with income >3,200 ZAR/month (5% vs 9%, p < 0.001); and had reduced access to piped water (p < 0.001), refuse disposal (p < 0.001), and toilets (p < 0.001). Targeted interventions may improve outcomes in areas with similar characteristics.

PMID:36942651 | DOI:10.1080/09540121.2023.2189224

Adv Life Course Res. 2023 Mar;55:100527. doi: 10.1016/j.alcr.2023.100527. Epub 2023 Jan 18.

ABSTRACT

The increase in cohabitation and nonmarital childbearing across Europe has raised questions about who still marries either before or after having a child. Although prior studies have addressed the sequence of marriage and childbearing, few have examined the role of relationship quality in these transitions. Here we employ a cross-national perspective to study the association between relationship quality and marriage and/or first birth within cohabitation. Using the Generations and Gender Survey and UK Household Longitudinal Study, we study seven European countries (Austria, France, Hungary, Netherlands, Norway, Sweden, and UK). We employ competing risk hazard models to follow respondents as they 1) transition from cohabitation into marriage or conception (or separation); 2) transition to marriage (or separation) after having a birth within cohabitation. Results show that cohabitors with higher relationship quality are more marriage prone than those in lower quality relationships in Austria, France, Hungary, and the UK, but not in the Netherlands, Norway and Sweden. Instead, higher relationship quality is associated with higher conception risks in cohabitation in Sweden. After childbearing, we find a positive association between relationship quality and marriage among cohabiting parents in the Netherlands, Norway, Sweden, and the United Kingdom. These results suggest that marriage is still important for couples with higher quality relationships; however, in countries where cohabitation is widespread, the timing of marriage may have shifted to after childbearing.

PMID:36942640 | DOI:10.1016/j.alcr.2023.100527

Birth Defects Res. 2023 Mar 21. doi: 10.1002/bdr2.2171. Online ahead of print.

ABSTRACT

BACKGROUND: Caffeine consumption is common during pregnancy, but published associations with birth defects are mixed. We updated estimates of associations between prepregnancy caffeine consumption and 48 specific birth defects from the National Birth Defects Prevention Study (NBDPS) for deliveries from 1997 to 2011.

METHODS: NBDPS was a large population-based case-control study conducted in 10 U.S. states. We categorized self-reported total dietary caffeine consumption (mg/day) from coffee, tea, soda, and chocolate as: <10, 10 to <100, 100 to <200, 200 to <300, and ≥ 300. We used logistic regression to estimate adjusted odds ratios (aORs [95% confidence intervals]). Analyses for defects with ≥5 exposed case children were adjusted for maternal race/ethnicity, age at delivery, body mass index, early pregnancy cigarette smoking and alcohol use, and study site.

RESULTS: Our analysis included 30,285 case and 11,502 control children, with mothers of 52% and 54%, respectively, reporting consuming <100 mg caffeine, and 11% of mothers of both cases and controls reported consuming ≥300 mg per day. Low (10 to <100 mg/day) levels of prepregnancy caffeine consumption were associated with statistically significant increases in aORs (1.2-1.7) for 10 defects. Associations with high (≥300 mg/day) levels of caffeine were generally weaker, except for craniosynostosis and aortic stenosis (aORs = 1.3 [1.1-1.6], 1.6 [1.1-2.3]).

CONCLUSIONS: Given the large number of estimates generated, some of the statistically significant results may be due to chance and thus the weakly increased aORs should be interpreted cautiously. This study supports previous observations suggesting lack of evidence for meaningful associations between caffeine consumption and the studied birth defects.

PMID:36942611 | DOI:10.1002/bdr2.2171

Biomed Pharmacother. 2022 Oct;154:113661. doi: 10.1016/j.biopha.2022.113661. Epub 2022 Sep 7.

ABSTRACT

A causal relationship between ginsenoside Rb3 (G-Rb3) and improved inflammation and cardiac function has not been established. To determine which specific signaling pathways were involved in G-Rb3 improvement of inflammation and myocardial function. In vivo, we found that G-Rb3 decreased the levels of both nuclear factor κB (NF-κB p65) and CD45, an inflammatory marker. G-Rb3 also enhanced key proteins of the contraction unit (cardiac troponin protein I (cTnI) and α-actinin) to improve cardiac function. G-Rb3 inhibited NF-κB p65 nuclear translocation in vitro, as verified by western blot and IF. When NF-κB p65 was overexpressed, a decrease in cyclic nucleotide phosphodiesterase 3B (PDE3B) and SERCA2a expression, while no statistical significance was observed in the expressions of cAMP, PKA, and calcium/calmodulin-dependent protein kinase type II (CaMKⅡ) in each group. The NF-κB p65 plasmid blocked the SERCA2a promoter, as verified by the luciferase reporter system, and G-Rb3 truncated the NF-κB p65 block on the SERCA2a promoter. qPCR was also used to confirm that G-Rb3 increased the mRNA of SERCA2a. In conclusion, we confirmed that the mechanisms of G-Rb3 on ventricular systolic dysfunction causing inflammation are not via the cAMP/PKA pathway, but via suppressing the blockage of NF-κB p65 on the SERCA2a promoter and increasing the SERCA2a expression.

PMID:36942602 | DOI:10.1016/j.biopha.2022.113661

Transfus Med. 2023 Mar 21. doi: 10.1111/tme.12967. Online ahead of print.

ABSTRACT

INTRODUCTION: Platelet products are scarce and expensive resources to be used judiciously. However, inappropriate usage is common. Lack of physician awareness is an important issue. We implemented a physician education program (PEP) along with repeated WhatsApp reminders at our centre. We audited the platelet usage practise before and after the intervention.

METHODS: Charts of patients with acute myeloid leukaemia (AML) treated between January 2020 and August 2020 was reviewed, and the mean platelet usage per patient per day was calculated. Physician education was implemented between September 2020 and December 2020 (2 PowerPoint lectures of 20 min each and weekly WhatsApp messages containing the guidelines). Data of patients treated between Jan 2021 and August 2021 was prospectively audited to understand platelet usage and the indications for transfusions. The British Committee for the Standards in Haematology (BCSH) platelet transfusion guidelines were used as the adjudication tool to evaluate compliance. The mean platelet usage per day per kg body weight of a patient before and after the PEP was compared using the t-test.

RESULTS: Group A (before physician education) consisted of 22 patients, and group B (after physician education) consisted of 23 patients. The mean number of platelet transfusions for each patient in a day per kg body weight was 125.7 × 10⁸ in group A whereas, after the PEP, it had reduced to 73.9 × 10⁸ amounting to an absolute reduction of 51 × 10⁸ (58.8%) from the baseline with a statistical significance of P = 0.001. After implementing the PEP, the mean number of random donor platelets used reduced by 10.25 units (34% reduction), and the mean single donor platelets used reduced by 0.83 units (19% reduction). The 190 requests for platelet transfusion received during this period were classified as appropriate (157/190), which constituted 82.63% of the requests, or inappropriate (33/190), which accounted for 17.36%.

CONCLUSIONS: A short-duration education programme supplemented with weekly WhatsApp messages and an active feedback mechanism on the rationale of platelet transfusion by the treating physician and transfusion specialist could significantly reduce platelet consumption during the therapy of acute myeloid leukaemia patients. This is a measure that can be considered by all high-volume haematology centres, which can improve patient safety and reduce costs.

PMID:36942594 | DOI:10.1111/tme.12967

Stroke. 2023 Mar 21. doi: 10.1161/STROKEAHA.122.041026. Online ahead of print.

ABSTRACT

BACKGROUND: Mood disorders and strokes are often comorbid, and their health toll worldwide is huge. This study characterizes prognostic and causal roles of mood disorders in stroke.

METHODS: We tested if genetic susceptibilities for mood disorders were associated with all strokes, ischemic strokes in the Malmö Diet and Cancer cohort (24 631 individuals with a median follow-up of 21.3 (interquartile range: 16.6-23.2) years. We further examined the causal effects for mood disorders on all strokes and ischemic strokes using summary statistics from large genome-wide association studies of mood disorders (up to 609 424 individuals, Psychiatric Genomics Consortium), all strokes and ischemic strokes (up to 446 696 individuals, MEGASTROKE Consortium).

RESULTS: Among 24 366 stroke-free participants at baseline, 2632 individuals developed strokes, 2172 of them ischemic, during follow-up. After properly adjusting for well-known risk factors, participants in the highest quintile of polygenic risk scores for mood disorders had 1.45× (95% CI, 1.21-1.74) higher risk of strokes and 1.44× (95% CI, 1.18-1.76) higher risk of ischemic strokes compared with the lowest quintile in women. Mendelian randomization analyses suggested that mood disorders had a causal effect on strokes (odds ratio, 1.07 [95% CI, 1.03-1.11]) and ischemic strokes (odds ratio, 1.09 [95% CI, 1.04-1.13]).

CONCLUSIONS: Our results suggest a causal role of mood disorders in the risk of stroke. High-risk women could be identified early in life using polygenic risk scores to ultimately prevent mood disorders and strokes.

PMID:36942587 | DOI:10.1161/STROKEAHA.122.041026