Category: Nevin Manimala

Acta Derm Venereol. 2022 Nov 29;102:adv00825. doi: 10.2340/actadv.v102.3504.

ABSTRACT

Hidradenitis suppurativa (HS) is a chronic inflammatory disease of the hair follicles. The aim of this case-control study was to assess whether HS is associated with disturbances in trabecular bone score, bone mineral density, bone remodelling markers, and calciotropic hormones. A total of 81 patients and 79 controls of similar age and sex were included. Demographic, anthropometric, laboratory data, trabecular bone score, bone mineral density, serum 25-hydroxyvitamin D (25OHD), serum amino-terminal pro-peptide of type 1 collagen (PINP), and C-terminal telopeptide of type 1 collagen (CTX) concentrations were assessed in both groups. Patients with HS had lower serum 25OHD levels than controls, and approximately 62% of them had vitamin D deficiency. Serum PINP was increased and CTX was decreased in patients with HS. Fully adjusted trabecular bone score values were lower in patients with HS compared with controls. Adjusted lumbar bone mineral density was similar in HS and controls, whilst total hip bone mineral density was lower in patients with HS. There were no statistical differences regarding disease severity in terms of 25OHD, serum turnover markers, bone mineral density, or trabecular bone score values. This study shows that patients with HS have lower trabecular bone score and total hip bone mineral density values than population-based controls. In addition, the prevalence of vitamin D deficiency is high in subjects with HS.

PMID:36444563 | DOI:10.2340/actadv.v102.3504

Psychiatr Serv. 2022 Nov 29:appips20220345. doi: 10.1176/appi.ps.20220345. Online ahead of print.

ABSTRACT

OBJECTIVE: The authors aimed to evaluate changes in use of government-subsidized primary mental health services, through the Medicare Benefits Schedule (MBS), by young people during the first year of the COVID-19 pandemic in Australia and whether changes were associated with age, sex, socioeconomic status, and residence in particular geographical areas.

METHODS: Interrupted time-series analyses were conducted by using quarterly mental health MBS service data (all young people ages 12-25 years, 2015-2020) for individual Statistical Area Level 3 areas across Australia. The data captured >22.4 million service records. Meta-analysis and meta-regression models estimated the pandemic interruption effect at the national level and delineated factors influencing these estimates.

RESULTS: Compared with expected prepandemic trends, a 6.2% (95% CI=5.3%-7.2%) increase was noted for all young people in use of MBS mental health services in 2020. Substantial differences were found between age and sex subgroups, with a higher increase among females and young people ages 18-25. A decreasing trend was observed for males ages 18-25 (3.5% reduction, 95% CI=2.5%-4.5%). The interruption effect was strongly associated with socioeconomic status. Service uptake increased in areas of high socioeconomic status, with smaller or limited uptake in areas of low socioeconomic status.

CONCLUSIONS: During 2020, young people’s use of primary mental health services increased overall. However, increases were inequitably distributed and relatively low, compared with increases in population-level mental health burden. Policy makers should address barriers to primary care access for young people, particularly for young males and those from socioeconomically disadvantaged backgrounds.

PMID:36444529 | DOI:10.1176/appi.ps.20220345

Psychiatr Serv. 2022 Nov 29:appips20220378. doi: 10.1176/appi.ps.20220378. Online ahead of print.

ABSTRACT

OBJECTIVE: This study examined telepsychiatry use among children enrolled in Medicaid before and during the COVID-19 pandemic.

METHODS: A retrospective analysis was conducted of claims data from the Transformed Medicaid Statistical Information System for children (ages 3-17) with any mental health service use in 2019 (N=5,606,555) and 2020 (N=5,094,446).

RESULTS: The number of children using mental health services declined by 9.1% from 2019 to 2020. Mental health services in all care settings (inpatient, outpatient, residential, emergency department, intensive outpatient/partial hospitalization) declined except for telehealth, which increased by 829.6%. In 2020, 44.5% of children using telehealth were non-Hispanic White, 16.1% were non-Hispanic Black, and 19.7% were Hispanic. Attention-deficit hyperactivity disorder, trauma, anxiety, depression, and behavior/conduct disorder were the most prevalent psychiatric diagnoses among children using telehealth services.

CONCLUSIONS: Although telehealth use increased substantially in 2020, overall mental health service use declined among Medicaid-enrolled children. Telehealth may not fully address unmet mental health service needs.

PMID:36444530 | DOI:10.1176/appi.ps.20220378

Obstet Gynecol Sci. 2022 Nov 29. doi: 10.5468/ogs.22232. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study was to evaluate the changes in twin pregnancy outcomes between 2007 and 2016 in a Korean population.

METHODS: The data for this nationwide population-based study was obtained from the national birth registry of the Korean National Statistical Office and the Health Insurance Review & Assessment Service of Korea. Women with twin pregnancies who gave birth between 2007 and 2016 were included.

RESULTS: From 2007 to 2016, the rate of twin pregnancies increased (1.37% vs. 1.91%, respectively, P<0.0001). The risk of preterm birth (adjusted odds ratio [aOR], 1.77; 95% confidence interval [CI], 1.66-1.89) also increased; however, the risk of twin growth discordance (aOR, 0.90; 95% CI, 0.82-0.99) decreased. The risks of cesarean section (aOR, 1.16; 95% CI, 1.03-1.29), gestational diabetes mellitus (aOR, 2.10; 95% CI, 1.83-2.39), and postpartum hemorrhage (aOR, 1.27; 95% CI, 1.14-1.41) all increased from 2007 to 2016.

CONCLUSION: Twin pregnancy outcomes have changed significantly in Korea over a recent 10-year period.

PMID:36444516 | DOI:10.5468/ogs.22232

BMC Med Inform Decis Mak. 2022 Nov 28;22(1):311. doi: 10.1186/s12911-022-02067-2.

ABSTRACT

BACKGROUND: Drug closed-loop management reflects the level of hospital management and pharmacist service. It is a challenge for hospital pharmacists to realize the whole-process closed-loop management of drugs in hospital pharmacies. Therefore, this study aimed to evaluate the operational effect of using mobile technology to build a closed-loop drug management system.

METHODS: Using mobile technology, replacing the traditional paper dispensing model and constructing a multinode information collection system according to the Healthcare Information and Management Systems Society Standard, we reformed the hospital information system and inpatient pharmacy workflow and then evaluated the new approach using statistical methods.

RESULTS: After the transformation, the entire process of drug data can be traced. Closed-loop management, as well as real-time data verification and control, thereby improves the work efficiency and reduces the drug dispensing time. By reducing the work error rate, the number of dispensing errors decreased from 5 to 1 case/month. The comprehensive dispensing process can achieve the whole workflow of paperless operation and reduce the use of paper A4 by 180,000 pieces per year.

CONCLUSIONS: Mobile technology can improve the service level of pharmacies, enhance the level of drug management and hospital quality management, ensure the safety of medication for inpatients, and significantly reduce the amount of paper used.

PMID:36443815 | DOI:10.1186/s12911-022-02067-2

BMC Health Serv Res. 2022 Nov 28;22(1):1438. doi: 10.1186/s12913-022-08862-x.

ABSTRACT

BACKGROUND: More information about the impacts of comprehensive pharmaceutical care program (CPCP) on the identification and resolution of drug-related problems (DRPs) is needed. This study aimed at researching the characteristics of DRPs in osteoporosis patients and evaluating the effect of CPCP in identifying and addressing DRPs.

METHODS: We performed a prospective interventional study in a teaching hospital. CPCP was established and conducted to identify and resolve DRPs by a multidisciplinary team (MDT) based on the Pharmaceutical Care Network Europe (PCNE) classification V9.0. Six pharmacists and one doctor worked directly in the study. All data was obtained from electronic medical records, direct observation and visits. The statistical analyses were performed using the SPSS Statistics software version 26.0.

RESULTS: Two hundred nineteen patients with osteoporosis were included in the final analysis. A total of 343 DRPs were identified, with an average of 1.57 DRPs per patient. The most common DRPs identified were “treatment safety P2” (66.8%; 229/343), followed by “other P3” (21.0%; 72/343) and “treatment effectiveness, P1” (12.2%; 42/343). The primary causes of DRPs were “dose selection C3” (35.9%; 211/588), followed by “drug use process C6” (28.9%; 170/588) and “drug selection C1” (12.6%; 74/588). Seven hundred eleven interventions were proposed to address the 343 DRPs, with an average of 2.1 interventions per DRP. The acceptance rate reached 95.9, and 91.0% of these accepted interventions were fully implemented. As a result, only 30 DRPs were unsolved before discharge. Additionally, the number of drugs was found to be associated with the number of DRPs significantly (p = 0.023).

CONCLUSION: DRPs frequently occurred in hospitalized osteoporosis patients. CPCP could be an effect option to solve and reduce DRPs for osteoporosis patients and should be implemented widely to increase patient safety.

PMID:36443812 | DOI:10.1186/s12913-022-08862-x

BMC Public Health. 2022 Nov 28;22(1):2205. doi: 10.1186/s12889-022-14608-5.

ABSTRACT

BACKGROUND: Migrants have been disproportionally affected by COVID-19 in Australia. Vaccination against COVID-19 is a key pillar of Australia’s public health response, but little is known about the willingness to receive booster vaccinations among migrants. This study aimed to assess the factors associated with a willingness to receive a COVID-19 booster vaccine among migrants living in Australia born in the World Health Organization’s Eastern Mediterranean Region (EMRO).

METHODS: A cross-sectional survey was conducted from September to November 2021 (n = 300). Participants were questioned on booster vaccine willingness, sociodemographic characteristics, COVID-19 vaccine information needs and sources, and perceptions of COVID-19 vaccines. Univariate and multivariate logistic regression were used to assess factors associated with booster willingness.

RESULTS: Most respondents (87%) had received two doses of COVID-19 vaccine, of which 81% were willing to receive a booster dose. About half of the participants reported high or very high needs for receiving information about “COVID-19 vaccines’ safety monitoring in Australia”, “COVID-19 vaccines protection against illness”, “Safety of COVID-19 vaccines used in Australia”, and “The Australian COVID-19 vaccination program”. People who were willing to receive a boost dose had significantly higher self-estimated knowledge of COVID-19 vaccines, confidence in COVID-19 vaccines and trust in the Australian government’s vaccine recommendations, and perceived COVID-19 as a greater risk compared to those who were unsure/hesitant. Both groups reported similar perceptions of their personal risks from COVID-19 but diverged on their views of COVID-19 as a broader health problem. There were no statistically significant differences between the two groups in terms of channels used to find information about COVID-19 vaccines. Factors associated with willingness to receive a COVID-19 booster vaccine in the multivariate logistic regression were age (aOR 1.07 95% CI 1.02-1.12), and no exposure to concerning news about COVID-19 vaccines (aOR 3.71 95% CI 1.51-9.09).

CONCLUSION: Vaccine acceptance and reported booster willingness was high. The results suggest the news and information seen may impact willingness to receive booster doses, even among those who have already received doses of COVID-19 vaccine. Addressing vaccine concerns and transparent communication about uncertainty should be a priority in the current and in future pandemics.

PMID:36443806 | DOI:10.1186/s12889-022-14608-5

BMC Musculoskelet Disord. 2022 Nov 29;23(1):1022. doi: 10.1186/s12891-022-06002-4.

ABSTRACT

BACKGROUND: Many studies have shown that hypoplasia of knee bone morphology is related to the morphological features of the discoid lateral meniscus (DLM). However, few studies have focused on hypoplasia of tibial eminence morphology in juvenile patients with complete DLM. The purpose of this study was to determine the relationship between tibial eminence morphology characteristics and complete DLM in juvenile patients.

METHODS: The DLM group comprised 34 juvenile patients with complete DLM, and the control group comprised 34 juvenile individuals, each with a normal lateral meniscus based on magnetic resonance imaging (MRI) findings. All parameters, including tibial width (TW), tibial eminence width (TEW), the height of the lateral tibial spine (HLTS), the height of the medial tibial spine (HMTS), lateral slope angle of the lateral tibial eminence (LSALTE), lateral slope angle of the medial tibial eminence (LSAMTE), tibial eminence width ratio (TEWR), height of the lateral tibial spine ratio (HLTSR), and the height of the medial tibial spine ratio (HMTSR), were recorded using coronal MR images. Statistical analyses were used to determine the differences between the two groups and whether differences were significant.

RESULTS: The TEW and TEWR were significantly greater (P < 0.05), and LSALTE and LSAMTE were significantly smaller (P < 0.05) in patients in the DLM group than in participants in the control group. Receiver operating characteristic (ROC) analysis revealed that a larger TEW, above 13.4 mm, was associated with complete DLM, with a sensitivity of 77.0% and specificity of 88.2%, and a larger TEWR, above 19.7%, was associated with complete DLM, with a sensitivity of 76.5% and specificity of 91.2%.

CONCLUSIONS: MR imaging can be used to diagnose tibial eminence hypoplasia in juvenile patients with complete DLM. Additionally, TEW and TEWR could help clinicians screen for complete DLM in juvenile patients.

PMID:36443796 | DOI:10.1186/s12891-022-06002-4

Cardiovasc Diabetol. 2022 Nov 28;21(1):261. doi: 10.1186/s12933-022-01666-7.

ABSTRACT

BACKGROUND: Enhanced de-novo collagen type VI (COL VI) formation has been associated with kidney and cardiovascular fibrosis. We hypothesized that endotrophin (ETP), a product specifically generated during collagen type VI formation, may be prognostic for heart failure (HF), cardiovascular death (CVD), kidney endpoints, and all-cause mortality in patients with type 2 diabetes.

METHODS: We measured ETP in plasma (P-ETP) and urine (U-ETP) samples collected at baseline and follow-up (year 3) from the randomized controlled trial, CANagliflozin cardioVascular Assessment Study (CANVAS), by use of the PRO-C6 ELISA measuring COL VI formation and ETP. At baseline, plasma and urine samples were available for 3531 and 3423 patients, respectively. At year 3, plasma and urine samples were available for 2178 (61.7%) and 2070 (60.5%) patients, respectively Patients were followed for a median of 6.1 years, and endpoints included: incident HF, CVD, three kidney composite endpoints, and all-cause mortality. Backward selection was used to identify variables to be included in the analyses. Robustness of the association with outcome was assessed by bootstrap analyses.

RESULTS: In univariable analysis, P-ETP predicted all investigated outcomes (all p < 0.0001), remained independently associated with all outcomes after adjustment for conventional risk factors (all p < 0.004), and increased C-statistics of the models for the outcomes HF, CVD, HFCVD, all-cause mortality, and kidney composite 2 (ΔC ≥ 0.002). In bootstrap analysis, P-ETP was retained with a frequency ranging from 41.0 to 98.4% for all outcomes. Levels of U-ETP were associated with outcomes in univariable analysis, but associations with most outcomes were lost after adjustment for conventional risk factors. The increase in P-ETP over time was greater with increasing albuminuria stage (p < 0.0001) and was independently associated with the kidney endpoints (p < 0.03). In the placebo arm, the increase in P-ETP was prognostic for all-cause mortality (HR [95% CI]; 1.14 [1.05-1.23], p = 0.003). Whereas levels of P-ETP were not impacted by treatment, levels of U-ETP significantly increased with canagliflozin treatment.

CONCLUSIONS: P-ETP generated during COL VI formation predicts cardiovascular, kidney and mortality outcomes in patients with type 2 diabetes. As ETP identifies patients at increased risk of experiencing relevant outcomes, it may be used for patient enrichment in future clinical trials. Trial Registry Number (ClinicalTrials.gov Identifier): NCT01032629.

PMID:36443792 | DOI:10.1186/s12933-022-01666-7

Health Res Policy Syst. 2022 Nov 29;20(Suppl 1):127. doi: 10.1186/s12961-022-00915-1.

ABSTRACT

BACKGROUND: Hypertension is a major cause of morbidity and mortality worldwide. Although multiple studies have assessed the prevalence of hypertension among older people, no study has examined the unmet need for hypertension care among older people in Malaysia. This study uses the hypertension care cascade to identify the prevalence of unmet needs for hypertension care and their determinants among the older population in Selangor.

METHODS: This is a cross-sectional study involving a total of 1204 participants recruited from different areas in Selangor. A face-to-face interview was conducted using the Bahasa Malaysia version of the Japan Gerontological Evaluation Study questionnaire. The inclusion criteria were Malaysians aged ≥ 60 years who could converse in Bahasa Malaysia.

RESULTS: Among the 637 participants with hypertension, 18% (117) had not been previously screened but were found to have BP ≥ 140/90 mmHg, 21% (136) were undiagnosed, 3% (17) were untreated, 42% (267) were treated with antihypertensive medication but still had high blood pressure, and 16% (100) had hypertension that was controlled with medication. The hypertension care cascade demonstrates that 18% (117) of those with hypertension had never been screened for hypertension; 26% (136/520) of those who were screened never received a diagnosis; 4% (17/384) of those who were diagnosed did not receive treatment; and 73% (267/367) of those who were treated did not reach the threshold for control. The prevalence of total unmet needs was 84% (537/637). Statistically significant determinants of having any unmet need for hypertension care were smoking status and medical history, with adjusted odds ratios and 95% confidence intervals (CIs) in the multivariate analysis of 0.5 (95% CI: 0.3-0.9) for being a smoker, 2.8 (95% CI: 1.1-6.9) for having a history of stroke and 1.6 (95% CI: 1.0-2.5) for having a history of diabetes mellitus.

CONCLUSIONS: The prevalence of unmet need for hypertension care among the older population in Selangor is 84% (537/637), which is alarmingly high. This study highlights where and how much of the loss of care for hypertension happens in the care cascade and provides insight into the efforts required to improve effective service coverage to manage the increasing burden of hypertension associated with population ageing.

PMID:36443790 | DOI:10.1186/s12961-022-00915-1