Category: Nevin Manimala

Cancer Control. 2021 Jan-Dec;28:10732748211045275. doi: 10.1177/10732748211045275.

ABSTRACT

BACKGROUND: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has overwhelmed the capacity of healthcare systems worldwide. Cancer patients, in particular, are vulnerable and oncology departments drastically needed to modify their care systems and established new priorities. We evaluated the impact of SARS-CoV-2 on the activity of a single cancer center.

METHODS: We performed a retrospective analysis of (i) volumes of oncological activities (2020 vs 2019), (ii) patients’ perception rate of the preventive measures, (iii) patients’ SARS-CoV-2 infections, clinical signs thereof, and (iv) new diagnoses made during the SARS-CoV-2 pandemic.

RESULTS: As compared with a similar time frame in 2019, the overall activity in total numbers of outpatient chemotherapy administrations and specialist visits was not statistically different (P = .961 and P = .252), while inpatient admissions decreased for both medical oncology and thoracic oncology (18% (P = .0018) and 44% (P < .0001), respectively). Cancer diagnosis plummeted (-34%), but no stage shift could be demonstrated.Acceptance and adoption of hygienic measures was high, as measured by a targeted questionnaire (>85%). However, only 46.2% of responding patients regarded telemedicine, although widely deployed, as an efficient surrogate to a consultation.Thirty-three patients developed SARS-CoV-2, 27 were hospitalized, and 11 died within this time frame. These infected patients were younger, current smokers, and suffered more comorbidities.

CONCLUSIONS: This retrospective cohort analysis adds to the evidence that continuation of active cancer therapy and specialist visits is feasible and safe with the implementation of telemedicine. These data further confirm the impact of SARS-CoV-2 on cancer care management, cancer diagnosis, and impact of infection on cancer patients.

PMID:34623943 | DOI:10.1177/10732748211045275

Sci Total Environ. 2021 Sep 7;804:150151. doi: 10.1016/j.scitotenv.2021.150151. Online ahead of print.

ABSTRACT

We measured SARS-CoV-2 RNA load in raw wastewater in Attica, Greece, by RT-qPCR for the environmental surveillance of COVID-19 for 6 months. The lag between RNA load and pandemic indicators (COVID-19 hospital and intensive care unit (ICU) admissions) was calculated using a grid search. Our results showed that RNA load in raw wastewater is a leading indicator of positive COVID-19 cases, new hospitalization and admission into ICUs by 5, 8 and 9 days, respectively. Modelling techniques based on distributed/fixed lag modelling, linear regression and artificial neural networks were utilized to build relationships between SARS-CoV-2 RNA load in wastewater and pandemic health indicators. SARS-CoV-2 mutation analysis in wastewater during the third pandemic wave revealed that the alpha-variant was dominant. Our results demonstrate that clinical and environmental surveillance data can be combined to create robust models to study the on-going COVID-19 infection dynamics and provide an early warning for increased hospital admissions.

PMID:34623953 | DOI:10.1016/j.scitotenv.2021.150151

Cent Eur J Public Health. 2021 Sep;29(3):223-229. doi: 10.21101/cejph.a6697.

ABSTRACT

OBJECTIVES: Socioeconomic status (SES) and lifestyle have impact on recovery after ischaemic stroke (IS) and on risk of recurrent ischaemic stroke (RIS) in elderly patients. With regard to currently available limited data on young people, we aimed to assess SES and parameters of lifestyle and evaluate their relationship to stroke recovery and risk of RIS in young patients.

METHODS: We analysed consecutive young IS patients < 50 years enrolled in the prospective HISTORY (Heart and Ischaemic STrOke Relationship studY) study registered on ClinicalTrials.gov (NCT01541163). Data were acquired from structured a self-evaluating multiple-choice questionnaire. Clinical outcome was assessed using the Modified Rankin Scale (MRS) after 3 months with score 0-1 for excellent outcome.

RESULTS: Data were obtained from 297 (163 males, mean age 39.6 ± 7.8 years) young patients. Patients with MRS 0-1 (237, 79.8%) did not differ in SES except university education (21.1 vs. 3.3%; p = 0.001), less smoked (16.5 vs. 58.3%; p < 0.001), more of them did regular sport activities (79.1 vs. 51.6%; p = 0.02) and passed regular preventive medical checks (45.6 vs. 24.2%; p = 0.01). Twelve (4%) patients suffered from RIS during a follow-up with median of 25 months. They did not differ in SES but had higher body mass index (31.6 vs. 26.7; p = 0.007), reported less regular sport activities (16.7 vs. 73.0%; p < 0.001) and less regular medical checks (8.3 vs. 40.0%; p = 0.001).

CONCLUSION: In young patients, SES had no relationship to clinical outcome after IS and to risk of RIS except education level. Some parameters of health lifestyle were presented more in patients with excellent outcome and without RIS during the follow-up.

PMID:34623123 | DOI:10.21101/cejph.a6697

Cent Eur J Public Health. 2021 Sep;29(3):195-200. doi: 10.21101/cejph.a6692.

ABSTRACT

OBJECTIVES: Mental stress, low health literacy (HL) and nutrition literacy (NL) are associated with serious negative health outcomes. The aim of this study was to investigate HL and NL levels, in relation to levels of perceived stress, in adults.

METHODS: This cross-sectional study was conducted in the urban area of the Attica region, Greece. The sample consisted of 1,281 individuals, aged ≥ 18 years. The European Health Literacy Questionnaire 47, the Greek version of the Nutrition Literacy Scale and the Perceived Stress Scale 14 were used. Socio-demographic characteristics were also assessed. Nonparametric Mann-Whitney U and Kruskal-Wallis tests, Pearson chi-square and multiple linear regression models were used.

RESULTS: The sample’s perceived stress mean value (SD) was 26.47 (7.27) with women scoring statistically significantly higher than men. The mean HL and NL scores were 32.28 (8.28) and 22.11 (5.67), respectively. Linear regression analysis has shown that perceived stress was significantly negatively associated with HL (p < 0.001) but not with NL levels (p = 0.675) after adjusting for a series of confounding variables.

CONCLUSIONS: Low health literacy seems to be very significantly associated with high levels of perceived stress. The reasons behind this association require further investigation.

PMID:34623119 | DOI:10.21101/cejph.a6692

Cent Eur J Public Health. 2021 Sep;29(3):201-208. doi: 10.21101/cejph.a6813.

ABSTRACT

OBJECTIVES: Virtually no previous research assessed physical activity (PA) of university students in Finland, and their associations with depressive symptoms, whilst simultaneously controlling for potential confounders.

METHODS: Students at the University of Turku (1,177) completed an online health and wellbeing questionnaire that assessed depressive symptoms (22 items), as well as their achievement of the guidelines of four forms of low, moderate, vigorous, and muscle strengthening PA (LPA, MPA, VPA, MSPA, respectively). We explored the associations of depressive symptoms with these PA forms, accounting for socio-demographic and health confounders (age, gender, year of study, marital status, accommodation during semesters, self-rated health).

RESULTS: Achievement of PA guidelines was generally low for these young adult Finnish undergraduates. Bivariate relationships (no controlling for confounders) between depressive symptoms and four forms of PA guidelines achievement showed that in males, good/very good/excellent self-rated health, and achievement of the MSPA guidelines were significantly negatively associated with depressive symptoms. Conversely, low PA was significantly positively associated with depressive symptoms. Multiple regression (controlling for confounders) showed that achievement of the MSPA guidelines was independently significantly negatively associated with depressive symptoms; and whilst achievement of the MPA and VPA guidelines was negatively associated with depressive symptoms, the relationships did not reach statistical significance. Likewise, low PA was positively associated with depressive symptoms, but the relationships were again not statistically significant.

CONCLUSION: Universities would benefit from multipronged strategies and approaches employing effective interventions aimed at improving students’ general awareness of their health and promoting more physically active lifestyles among students.

PMID:34623120 | DOI:10.21101/cejph.a6813

Cent Eur J Public Health. 2021 Sep;29(3):177-182. doi: 10.21101/cejph.a6670.

ABSTRACT

OBJECTIVES: Influenza is a widespread respiratory disease with a potentially risky course. Vaccination is considered the most effective method of prevention. However, only a small portion of the population is vaccinated. Teachers work in a high-risk environment and they have a significant impact on the population through student education. Therefore, the aim of this study was to find out the knowledge and attitudes of pre-service teachers about influenza and vaccination.

METHODS: A questionnaire survey was conducted to find out what knowledge, attitudes and behaviour pre-service teachers (N = 373) show in relation to influenza and influenza vaccination. It was statistically tested whether there were differences between students with respect to their field of study.

RESULTS: The majority of pre-service teachers have a good knowledge of influenza symptoms, however, they often mistaken it for other respiratory diseases. The field of study plays only a partial role in the knowledge. The respondents perceive influenza as an easily spread disease, but they have negative attitudes towards vaccination, and most pre-service teachers think that its disadvantages outweigh the advantages. This was stated primarily by pre-services science teachers. These attitudes are also reflected in the low vaccination rate of the sample (6%).

CONCLUSIONS: Relatively good knowledge of teachers is not reflected in their attitudes and behaviour. Negative attitudes towards vaccination are most held by pre-service teachers, whose field primarily includes teaching this topic. It can have a significant effect on students’ attitudes not only toward influenza vaccines but also to other vaccinations.

PMID:34623115 | DOI:10.21101/cejph.a6670

Cent Eur J Public Health. 2021 Sep;29(3):183-186. doi: 10.21101/cejph.a6153.

ABSTRACT

OBJECTIVES: The modern rise of vaccine rejection in society can alter the current progress that has been made towards the control and prevention of certain diseases, possibly even resulting in epidemics involving these preventable diseases. The aim of this study is to analyse the knowledge, attitude and behaviours of parents in Malatya city who rejected childhood vaccines.

METHODS: This descriptive, cross-sectional study was conducted between September-November 2019. The study includes parents who rejected vaccines and are registered in the family medicine clinics of Malatya city – total of 453 participants. The objective was to include all parents and avoid a sampling procedure. However, only 151 (33%) parents agreed to participate. These parents who rejected vaccines were individually contacted by phone. Descriptive data was represented by number (n) and percentage (%). The chi-square test was utilized in the statistical analysis of data and p < 0.05 was considered significant in all evaluations.

RESULTS: Mothers in the study group had a mean age of 26.07 ± 3.64, while the fathers were on average 30.03 ± 4.59 years of age; 98% of parents were aware of the health risks that vaccine rejection presented; 93% of parents were not satisfied with the explanation, insight, and advice that the healthcare personnel provided regarding vaccines. All parents of the study group stated the following: vaccines should not be administered because other children in their close environment acquired a disease as a result of vaccination, vaccines can harm the immune system of children – not yet fully developed, vaccines are unsafe and endanger the health of children.

CONCLUSIONS: It can be said that parents who have obtained a lot of false information possess altered decisions and views on vaccinations, to the point where they accept the risks presented by preventable diseases. In addition, individuals lose trust following negative experiences with vaccination.

PMID:34623116 | DOI:10.21101/cejph.a6153

Obstet Gynecol. 2021 Oct 1;138(4):583-592. doi: 10.1097/AOG.0000000000004540.

ABSTRACT

OBJECTIVE: To assess the extent to which hospitals participating in the MDPQC (Maryland Perinatal-Neonatal Quality Care Collaborative) to reduce primary cesarean deliveries adopted policy and practice changes and the association of this adoption with state-level cesarean delivery rates.

METHODS: This prospective evaluation of the MDPQC includes 31 (97%) of the birthing hospitals in the state, which all voluntarily participated in the 30-month collaborative from June 2016 to December 2018. Hospital teams agreed to implement practices from the “Safe Reduction of Primary Cesarean Births” patient safety bundle, developed by the Council on Patient Safety in Women’s Health Care. Each hospital’s implementation of practices in the bundle was measured through surveys of team leaders at 12 months and 30 months. Half-yearly cesarean delivery rates were calculated from aggregate birth certificate data for each hospital, and differences in rates between the 6 months before the collaborative (baseline) and the 6 months afterward (endline) were tested for statistical significance.

RESULTS: Among the 26 bundle practices that were assessed, participating hospitals reported having a median of seven practices (range 0-23) already in place before the collaborative and implementing a median of four (range 0-17) new practices during the collaborative. Across the collaborative, the cesarean delivery rates decreased from 28.5% to 26.9% (P=.011) for all nulliparous term singleton vertex births and from 36.1% to 31.3% (P<.001) for nulliparous, term, singleton, vertex inductions. Five hospitals had a statistically significant decrease in nulliparous, term, singleton, vertex cesarean delivery rates and four had a significant increase. Nulliparous, term, singleton, vertex cesarean delivery rates were significantly lower across hospitals that implemented more practices in the “Response” domain of the bundle.

CONCLUSION: The MDPQC was associated with a statewide reduction in cesarean delivery rates for nulliparous, term, singleton, vertex births.

PMID:34623072 | DOI:10.1097/AOG.0000000000004540

Obstet Gynecol. 2021 Oct 1;138(4):627-632. doi: 10.1097/AOG.0000000000004544.

ABSTRACT

OBJECTIVE: To examine compliance with a guideline to reduce exposure to supplemental oxygen for category II fetal heart rate (FHR) tracings in normally oxygenated laboring patients.

METHODS: All patients in labor in an urban academic medical center from January 1 to July 31, 2020 were assessed. The preintervention group included those who delivered from January 1 to March 19, 2020. On March 20, 2020, a new guideline took effect that recommended no maternal supplemental oxygen for category II FHR tracings. The postintervention group delivered from March 20 to July 31, 2020. Exclusion criteria were planned cesarean delivery, multiple gestations, delivery at less than 24 weeks of gestation, intrauterine fetal death, and patients who received supplemental oxygen for an oxygen saturation lower than 95%. The primary outcome was the percentage of patients who received oxygen in labor analyzed by control charts and the rules of special cause variation. Chi-squared and t tests were used for secondary outcome assessment. P<.05 was considered significant.

RESULTS: A total of 1,333 patients were included, 474 patients in the preintervention group and 859 in the postintervention group. Oxygen was administered to 22.6% of patients before guideline implementation, compared with 0.6% after the guideline. Special cause variation was detected with an 8-point shift starting the month that the guideline was implemented, indicating statistical significance. There were no differences in any studied secondary maternal or fetal outcomes, although our statistical power to detect differences in infrequent outcomes was limited.

CONCLUSION: This quality-improvement study demonstrated significant adherence to the guideline that supplemental oxygen would no longer be given to patients with category II FHR tracings in the absence of maternal hypoxemia, with no significant change in maternal or perinatal outcomes.

PMID:34623075 | DOI:10.1097/AOG.0000000000004544

Indian J Dermatol Venereol Leprol. 2021 Sep 15:1. doi: 10.25259/IJDVL_1_2021. Online ahead of print.

NO ABSTRACT

PMID:34623054 | DOI:10.25259/IJDVL_1_2021