Category: Nevin Manimala

Breastfeed Med. 2023 Apr;18(4):315-325. doi: 10.1089/bfm.2023.0036.

ABSTRACT

Introduction: Infants with single-ventricle (SV) congenital heart disease (CHD) undergo staged surgical and/or catheter-based palliation and commonly experience feeding challenges and poor growth. Little is known about human milk (HM) feeding or direct breastfeeding (BF) in this population. Aim: To determine (1) HM and BF prevalence for infants with SV CHD, and (2) whether BF at neonatal stage 1 palliation (S1P) discharge is associated with any HM at stage 2 palliation (S2P; ∼4-6 months old). Materials and Methods: Analysis of the National Pediatric Cardiology Quality Improvement Collaborative registry (2016-2021) using (1) descriptive statistics for prevalence, and (2) logistic regression adjusted for multiple variables (e.g., prematurity, insurance, length of stay) to examine early BF/later HM feeding. Results: Participants included 2,491 infants from 68 sites. HM prevalence ranged from 49.3% any/41.5% exclusive before S1P to 37.1% any/7.0% exclusive at S2P. Direct BF ranged from 16.1% any/7.9% exclusive before S1P to 9.2% any/3.2% exclusive at S2P discharge. Prevalence varied among sites; for example, 0-100% any HM before S1P. Infants BF at S1P discharge had greater odds of any HM (odds ratio = 4.11, 95% confidence interval [CI] = 2.79-6.07, p < 0.001) and exclusive HM (1.85, 95% CI 1.03-3.30, p = 0.039) at S2P. Conclusions: The prevalence of HM and BF for infants with SV CHD was low and declined over time. Direct BF at S1P discharge was associated with increased odds of any HM at S2P. Wide variation suggests that site-specific practices impact feeding outcomes. HM and BF prevalence are suboptimal in this population, and identification of supportive institutional practices is needed.

PMID:37071633 | DOI:10.1089/bfm.2023.0036

PLoS One. 2023 Apr 18;18(4):e0283328. doi: 10.1371/journal.pone.0283328. eCollection 2023.

ABSTRACT

BACKGROUND: Health care providers including pharmacists are often on the first line when dealing with COVID -19; they can be under threat of contracting and spreading the disease. We aimed to assess and compare their knowledge of hand sanitization during COVID-19 pandemic to improve quality of care.

METHODS: A cross-sectional study was conducted in Jordan, on healthcare providers in different settings from 27 October till 3 December 2020, using a pre-validated electronic questionnaire. Participants (n = 523) were healthcare providers practicing in different settings. Descriptive and association statistical analyses were produced on the data using SPSS 26. Chi square was used for the categorical variables, and One way ANOVA was used on the continuous and categorical variables.

RESULTS: A significant difference was recorded in total knowledge mean according to gender (59.78 vs 61.79 p = 0.030) in favor of men, and between pharmacists and other healthcare providers in favor of the latter (59.22 vs 61.45, p = 0.02). No significant difference was generally noticed between those who attended hand hygiene training and those who did not.

CONCLUSION: Healthcare providers’ knowledge of hand hygiene was generally good among participants, regardless of training and it was possibly increased because of fear of COVID-19 infection. Physicians were the most knowledgeable in regard of hand hygiene while pharmacists were the least among healthcare providers. Thus, structured, more frequent, and tailored training on hand sanitization in addition to new educational strategies are recommended for healthcare providers, in particular, pharmacists for better quality of care especially in pandemics.

PMID:37071629 | DOI:10.1371/journal.pone.0283328

PLoS One. 2023 Apr 18;18(4):e0282851. doi: 10.1371/journal.pone.0282851. eCollection 2023.

ABSTRACT

INTRODUCTION: There have been significant advancements in risk identification and treatment for ovarian cancer over the last decade. However, their impact on health services costs is unclear. This study estimated the direct health system costs (government perspective) for women diagnosed with ovarian cancer in Australia during 2006-2013, as a benchmark prior to opportunities for precision-medicine approaches to treatment, and for health care planning.

METHODS: Using cancer registry data, we identified 176 incident ovarian cancers (including fallopian tube and primary peritoneal cancer) in the Australian 45 and Up Study cohort. Each case was matched with four cancer-free controls on sex, age, geography, and smoking history. Costs were derived from linked health records on hospitalisations, subsidised prescription medicines and medical services to 2016. Excess costs for cancer cases were estimated for different phases of care relative to cancer diagnosis. Overall costs for prevalent ovarian cancers in Australia in 2013 were estimated based on 5-year prevalence statistics.

RESULTS: At diagnosis, 10% of women had localised disease, 15% regional spread and 70% distant metastasis (5% unknown). The mean excess cost per ovarian cancer case was $40,556 in the initial treatment phase (≤12 months post-diagnosis), $9,514 per annum in the continuing care phase and $49,208 in the terminal phase (up to 12 months before death). Hospital admissions accounted for the greatest proportion of costs during all phases (66%, 52% and 68% respectively). Excess costs were higher for patients diagnosed with distant metastatic disease, particularly during the continuing care phase ($13,814 versus $4,884 for localised/regional disease). The estimated overall direct health services cost of ovarian cancer in 2013 was AUD$99million (4,700 women nationally).

CONCLUSION: The excess health system costs of ovarian cancer are substantial. Continued investment in ovarian cancer research, particularly prevention, early detection and more effective personalised treatments is necessary to reduce the burden of disease.

PMID:37071628 | DOI:10.1371/journal.pone.0282851

PLoS One. 2023 Apr 18;18(4):e0284577. doi: 10.1371/journal.pone.0284577. eCollection 2023.

ABSTRACT

BACKGROUND: Implantable medical devices (IMDs) are medical instruments embedded inside the body. Well-informed and empowered patients living with IMDs are key players of improving IMD-related patient safety and health outcomes. However, little is known about IMD patients’ epidemiology, characteristics, and current awareness levels. Our primary aim was to investigate the point and lifetime prevalence of patients living with IMDs. Patients’ IMD-related knowledge and determinants of IMDs’ impact on their life were also explored.

METHODS: An online cross-sectional survey was conducted. Respondents’ IMD history, whether they received instructions for use and IMD’s overall impact on life were recorded by self-reports. Patients’ knowledge about living with IMDs was assessed on visual analogue scales (VAS, 0-10). Shared decision-making was analyzed by the 9-item Shared Decision Making Questionnaire (SDM-Q-9). Descriptive statistics and subgroup comparisons between IMD wearers were performed for statistical differences. Significant determinants of IMD’s overall impact on life were examined in linear regression analysis.

RESULTS: In the total sample (N = 1400, mean age 58.1 ±11.1; female 53.7%), nearly one third of respondents were living with IMD (30.9%; 433/1400). Among them, the most frequent IMDs were tooth implants (30.9%) and intraocular lens (26.8%). Mean knowledge VAS scores were similar (range: 5.5 ±3.8-6.5 ±3.2) but differences by IMD types were observed. Patients who received instructions for use or reported better impact on life indicated higher self-reported knowledge. Regression confirmed that patients’ knowledge was significant predictor of IMD’s impact on life, but this effect was overwritten by the SDM-Q-9.

CONCLUSIONS: This first comprehensive epidemiological study on IMDs provides basic data for public health strategy planning alongside the implementation of MDR. Improved self-perceived outcomes were associated with higher knowledge hence education of patients receiving IMD deserves consideration. We suggest to investigate further the role of shared decision-making on IMD’s overall impact on patients’ life in future prospective studies.

PMID:37071626 | DOI:10.1371/journal.pone.0284577

PLoS One. 2023 Apr 18;18(4):e0284425. doi: 10.1371/journal.pone.0284425. eCollection 2023.

ABSTRACT

BACKGROUND: Despite the fact that direct oral anticoagulants (DOACs) are favoured over warfarin for stroke prevention in patients with non-valvular atrial fibrillation (NVAF), physicians need to maintain competence in using and monitoring warfarin since many patients have contraindications or other barriers to using DOACs. Unlike DOACs, warfarin therapy requires regular blood testing to ensure that it is within a target range to ensure efficacy and safety. There is limited real-world data on the adequacy of warfarin control and the cost and burden of monitoring warfarin therapy in Canadian NVAF patients.

OBJECTIVES: In a large cohort of Canadian patients with NVAF on warfarin we assessed time in therapeutic range (TTR), determinants of TTR, process of care, direct costs, health related quality of life and loss of work time and productivity related to warfarin therapy.

METHODS: Five hundred and fifty one patients with NVAF, either newly initiated or stable on warfarin were prospectively enrolled across 9 Canadian provinces from primary care practices and anticoagulant clinics. Participating physicians provided baseline demographic and medical information. Patients completed diaries for 48 weeks, capturing information about International Normalized Ratio (INR) test results, test locations, process of INR monitoring, direct costs of travel, health-related quality of life and work productivity measures. TTR was estimated using linear interpolation of INR results and linear regression used to investigate associations between TTR and factors (defined a priori).

RESULTS: Four hundred and eighty (87.1%) patients had complete follow-up with an overall TTR of 74.4% based on 7,175 physician-reported INR values from 501 patients. 88% of this cohort were monitored through routine medical care (RMC). The average number of INRs per patient during the 48-week period was 14.1 (standard deviation (SD) = 8.3) tests with a mean duration of 23.8 (SD = 11.1) days between tests. We did not find a relationship between TTR and age, sex, presence of major comorbidities, patient’s province of residence or rural vs. urban residence. 12% of patients monitored through anticoagulant clinics had significantly better TTR than patients monitored through RMC (82% vs. 74%; 95% confidence interval: -13.8, -1.2; p = 0.02). Health related quality of life utility values were high and remained consistent throughout the study. The majority of patients reported no impact on either work productivity or impairment of regular activities due to being on long-term warfarin treatment.

CONCLUSIONS: We showed excellent overall TTR in an observed Canadian cohort, with monitoring through a dedicated anticoagulant clinic being associated with a statistically and clinically significant improvement in TTR. The burden of warfarin therapy on patients’ health related quality of life or daily work and activities was low.

PMID:37071625 | DOI:10.1371/journal.pone.0284425

PLoS One. 2023 Apr 18;18(4):e0284387. doi: 10.1371/journal.pone.0284387. eCollection 2023.

ABSTRACT

Several studies have addressed motor coordination in dance, but few have addressed the influence of musical context on micro-timing during sensorimotor synchronization (SMS) in classical ballet. In this study, we analyze the Promenade in Arabesque of the Odile variations, first as a dance-music fragment non-embedded in a musical context, then as a dance-music fragment embedded in a musical context at two different instances. Given the musical structure of the fragments, there are repeats of patterns between and within the fragments. Four dancers were invited to perform the three fragments in twelve successive performances. The beats of the music were extracted and compared with the timing of the dancers’ heel movements, using circular-linear smooth regression modelling, and circular statistics. The results reveal an effect of repeat within fragments, and an effect of musical context between fragments, on micro-timing anticipation in SMS. The methodology offers a framework for future work on dynamical aspects of SMS.

PMID:37071622 | DOI:10.1371/journal.pone.0284387

PLoS One. 2023 Apr 18;18(4):e0283719. doi: 10.1371/journal.pone.0283719. eCollection 2023.

ABSTRACT

BACKGROUND: Immune checkpoint inhibitors (ICIs) have changed the treatment pattern of advanced and metastatic NSCLC. A series of ICI based therapies have emerged in the first-line treatment field, but the comparative efficacy was unclear.

METHOD: We searched multiple databases and abstracts of major conference proceedings up to Apri1, 2022 for phase III randomised trials of advanced driver-gene wild type NSCLC patients receiving first-line therapy. Outcomes analyzed included progression free survival (PFS), overall survival (OS), and et al.

RESULTS: Thirty-two double-blind RCTs were included, involving 18,656 patients assigned to 22 ICI-based first-line regimens. A series of ICI regiments (including ICI plus chemotherapy), ICI monotherapy, doublet ICIs, doublet ICIs plus chemotherapy) emerged, and showed significant PFS and OS benefit than chemotherapy and chemotherapy + bevacizumab (BEV) for advanced wild-type NSCLC. In comprehensive terms of PFS, chemoimmunotherapy (CIT) were significantly more effective than ICI monotherapy and doublet ICIs. In terms of OS for patients with non-squamous NSCLC, pembrolizumab containing CIT was associated with a median rank of the best regimens, and followed by Atezolizumab+BEV based CIT; while for OS in patients with squamous NSCLC, Cemiplimab and sintilimab based CIT were the most effective regimens. For more than 2 years follow-up, the atezolizumab, pembrolizumab, nivolumab and durvalumab containing ICI therapy all provide a durable long-term OS benefit over chemotherapy and BEV + chemotherapy.

CONCLUSIONS: The findings of the present NMA represent the most comprehensive evidence, which might suggest or provide basis for first-line ICI therapy decision for advanced NSCLC patients without oncogenic driver mutations.

PMID:37071610 | DOI:10.1371/journal.pone.0283719

Sex Health. 2023 Apr;20(2):180. doi: 10.1071/SH22113_CO.

ABSTRACT

BACKGROUND: This study explores the potential for behavioural economics techniques called ‘nudges’ to encourage the use of HIV pre-exposure prophylaxis (PrEP) by overseas-born men who have sex with men (MSM) in Australia. We investigated the preferences of overseas-born MSM for different nudges and the effect of nudges on reported likelihood of seeking information about PrEP.

METHODS: We conducted an online survey of overseas-born MSM, in which they were asked: (1) how likely they and a relevant friend would be to click on PrEP advertisements that used behavioural economics strategies; and (2) what they most and least liked about each ad. We conducted ordered logistic regression of reported likelihood scores against participant age and sexual orientation, use of a model in an advertisement, use of statistics about PrEP, reference to the World Health Organization (WHO), rewards for seeking further information, and use of a call-to-action.

RESULTS: Participants (n =324) reported higher likelihoods of clicking on advertisements with images of people, statistics about PrEP, rewards for seeking further information, and calls-to-action. They reported lower likelihoods of clicking on advertisements referencing the WHO. They had negative emotional responses to sexualised humour, gambling metaphors, and the slogan ‘Live Fearlessly’.

CONCLUSIONS: Overseas-born MSM prefer public health messages that feature representative messengers and statistics about PrEP. These preferences are consistent with previous data on descriptive norms (i.e. statistics about the number of peers doing the desired behaviour) and gain-framed information (i.e. focusing on what can be gained from an intervention).

PMID:37071575 | DOI:10.1071/SH22113_CO

Nutr Neurosci. 2023 Apr 18:1-9. doi: 10.1080/1028415X.2023.2201026. Online ahead of print.

ABSTRACT

BACKGROUND: Multiple sclerosis (MS), one of the main neurological causes of disability seen at young ages, affects the quality of life of patients. Studies on which dietary pattern or consumption of food groups may have an impact on quality of life for MS patients are insufficient. The study was conducted to determine the relationship between adherence to Mediterranean diet and consumption levels of food groups on quality of life in multiple sclerosis patients.

METHODS: This study was conducted with 95 patients, 76 females and 19 males, aged 18-65 years, who had been diagnosed with MS for at least 2 years and did not have any other chronic disease. Food Frequency Questionnaire, Mediterranean Diet Adherence Screener (MEDAS), Expanded Disability Status Scale (EDSS) and Multiple Sclerosis Quality of Life-54 Instrument (MS-QoL-54) used as tools. Data were analyzed by SPSS 25.0.

RESULTS: Adherence to the Mediterranean diet was associated with EDSS and physical and mental quality of life parameters (CPH and CMH), independent of progression. It was associated with EDSS and CMH in progressive MS. A statistically significant negative weak correlation was found between daily milk and oilseed consumption and EDSS. Daily fruit consumption was associated with CMH, and vegetable consumption was associated with both CPH and CMH.

CONCLUSIONS: The Mediterranean diet may be an effective nutritional model in MS patients and may be related to the disability level and quality of life of the patients. Some food groups can be associated with the quality of life and disability level of MS patients.

PMID:37071567 | DOI:10.1080/1028415X.2023.2201026

Comput Methods Biomech Biomed Engin. 2023 Apr 18:1-17. doi: 10.1080/10255842.2023.2199900. Online ahead of print.

ABSTRACT

Considering the time delay originating from a certain incubation period or asymptomatic state, we propose a delayed epidemic system within the noisy environment of the hepatitis B virus to analyze the mechanism of disease transmission and elucidate how to control it by applying the strategy of vaccinating and treatment. Applying stochastic Lyapunov functional theory, we first construct an integral Lyapunov function coupling the time delay and stochastic fluctuation to investigate whether there exists a unique global solution to the model. Next, we yield the threshold condition for controlling disease extinction, and persistence, as well as its stationary distribution. Governed by these sufficient conditions, we study the existence of optimal control solutions in deterministic and stochastic scenarios to uncover how to accelerate disease extinction through vaccination and treatment. The results indicate that the time delay will prolong the duration of the disease for the original system but suppress the peak value of HBV in the controlled system. Finally, we verify the versatility of theoretical results by numerical simulations. These results will effectively decipher the importance of the time delay in the control of hepatitis B.

PMID:37071542 | DOI:10.1080/10255842.2023.2199900