Nevin Manimala

Scand J Public Health. 2021 Jun 14:14034948211019798. doi: 10.1177/14034948211019798. Online ahead of print.

ABSTRACT

BACKGROUND: Health literacy (HL) is an important determinant for maintaining and improving health throughout the lifespan. This underlines the need to monitor HL, including among adolescents, and to understand the factors explaining HL, with a view to decreasing differences in HL. The aim of this study was to objectively measure HL, and the relationship between HL and socio-demographic factors (gender, language of instruction, pupils’ educational aspirations, parents’ educational background and pupils’ school achievement) among pupils (n = 3652) at the end of basic education in Finland.

METHODS: A nationally representative assessment, which included 55 items on HL, was conducted as a traditional paper-and-pencil test in schools. The data were analysed via descriptive statistics and a two-level hierarchical linear model to determine how the socio-demographic factors affected HL.

RESULTS: The pupils’ average score on the HL test items was 58.9%, indicating a satisfactory HL level. A two-level hierarchical linear model showed that the variables (gender, language of instruction, pupils’ educational aspirations, parents’ educational background and pupils’ school achievement) predicting the HL level had statistically significant effects.

CONCLUSIONS: Among ninth graders (15-16 years old), almost one third of the boys and 8% of the girls exhibited an unsatisfactory HL level. The study also confirmed the importance of school-related factors in explaining HL differences. Since low HL has been linked to several unfavourable health indicators and has been viewed as an underestimated problem in times of pandemic and other health crises, the findings suggest that the HL level of Finnish ninth graders is a clear public-health issue.

PMID:34120530 | DOI:10.1177/14034948211019798

J Prim Care Community Health. 2021 Jan-Dec;12:21501327211024390. doi: 10.1177/21501327211024390.

ABSTRACT

INTRODUCTION: In an effort to improve health outcomes and promote health equity, healthcare systems have increasingly begun to screen patients for unmet social needs and refer them to relevant social services and community-based organizations. This study aimed to identify factors associated with the successful connection (ie, services started) to social needs resources, as well as factors associated with an attempt to connect as a secondary, intermediate outcome.

METHODS: This retrospective cohort study included patients who had been screened, referred, and subsequently reached for follow-up navigation from March 2019 to December 2020, as part of a social needs intervention at a federally qualified health center (FQHC). Measures included demographic and social needs covariates collected during screening, as well as resource-related covariates that characterized the referred resources, including service domain (area of need addressed), service site (integration relative to the FQHC), and access modality (means of accessing services).

RESULTS: Of the 501 patients in the analytic sample, 32.7% had started services with 1 or more of their referred resources within 4 weeks of the initial referral, and 63.3% had at least attempted to contact 1 referred resource, whether or not they were able to start services. Receiving a referral to resources that patients could access via phone call or drop-in visit, as opposed to resources that required additional appointments or applications prior to accessing services, was associated with increased odds (aOR 1.95, 95% CI 1.05, 3.61) of connection success, after adjusting for age, sex, race, ethnicity, education, number of social needs, and resource-related characteristics. This study did not find statistically significant associations between connection attempt and any variable included in adjusted analyses.

CONCLUSION: These findings suggest that referral pathways may influence the success of patients’ connection to social needs resources, highlighting opportunities for more accessible solutions to addressing patients’ unmet social needs.

PMID:34120507 | DOI:10.1177/21501327211024390

Exp Biol Med (Maywood). 2021 Jun 12:15353702211024572. doi: 10.1177/15353702211024572. Online ahead of print.

ABSTRACT

Optical coherence tomography angiography (OCTA) is a functional extension of optical coherence tomography for non-invasive in vivo three-dimensional imaging of the microvasculature of biological tissues. Several algorithms have been developed to construct OCTA images from the measured optical coherence tomography signals. In this study, we compared the performance of three OCTA algorithms that are based on the variance of phase, amplitude, and the complex representations of the optical coherence tomography signals for rodent retinal imaging, namely the phase variance, improved speckle contrast, and optical microangiography. The performance of the different algorithms was evaluated by comparing the quality of the OCTA images regarding how well the vasculature network can be resolved. Quantities that are widely used in ophthalmic studies including blood vessel density, vessel diameter index, vessel perimeter index, vessel complexity index were also compared. Results showed that both the improved speckle contrast and optical microangiography algorithms are more robust than phase variance, and they can reveal similar vasculature features while there are statistical differences in the calculated quantities.

PMID:34120494 | DOI:10.1177/15353702211024572

Chronic Illn. 2021 Jun 12:17423953211023960. doi: 10.1177/17423953211023960. Online ahead of print.

ABSTRACT

OBJECTIVES: Stroke is a leading cause of disability and one of the most debilitating conditions especially in the developing world. Rehabilitation focuses on improving functional ability which may enhance quality of life (QoL). The aims of this study were to investigate the association between QoL and each of functional independence (FI), self-reported fatigue (SRF) and exercise self-efficacy (ESE) in stroke survivors.

METHODS: This is a descriptive cross-sectional survey, documenting QoL, FI, SRF and ESE of stroke survivors seen at the physiotherapy outpatient clinics of two health care facilities in Oyo state, Nigeria. Descriptive and inferential statistics were used to analyse the data with significance level set at 0.05.

RESULTS: Participants were 110 stroke survivors (64 males; 46 females) aged 60.9 ± 11.9 years. Significant associations were found between QoL and each of FI and ESE (p < 0.01) while no significant association was observed for SRF. FI strongly predicts good QoL in stroke survivors (OR = 16.34; p < 0.01) and high ESE is a determinant of QoL (OR = 6.46; p = 0.04). Stroke survivors with SRF were less likely to report good QoL.

DISCUSSION: Functional independence and exercise self-efficacy were directly associated with QoL and were also major predictors of good QoL in stroke survivors.

PMID:34120490 | DOI:10.1177/17423953211023960

Ann Clin Biochem. 2021 Jun 12:45632211026961. doi: 10.1177/00045632211026961. Online ahead of print.

ABSTRACT

OBJECTIVE: Carbohydrate antigen 72-4 (CA72-4) is widely used in the diagnosis and monitoring of many cancers. However, there are few studies on the differences of CA72-4 levels in terms of age and gender.

METHODS: 10957 healthy subjects were divided into two groups according to gender and three age groups. The serum CA72-4 were detected. Statistical analysis was performed by SPSS.

RESULTS: The CA72-4 level in female group was significantly higher than that in male group. The level of CA72-4 gradually decreased with age. Compared with the age >60 group, the CA72-4 levels were increased in the age 46-60 group and 16-45 group (P >0.05, respectively). To better observe the age difference, the age 16-45 and 46â60 group were combined into the age 16-60 group. In comparison to the age >60 group, the CA72-4 level of age 16-60 group was significantly increased (P =0.000). In the age >60 group, there was no difference between genders. Nevertheless, the difference between the sexes in the age 16-60 group was significant (P =0.023).

CONCLUSIONS: The reference interval of CA72-4 for local healthy population was established. CA72-4 levels gradually decreased with the increase of age, and CA72-4 level in females aged 16-60 years (0-18.0 U/mL) was higher than in males (0-14.5 U/mL), however there was no gender difference in the age group above 60 years old (0-14.5 U/mL). Moreover, male CA72-4 was no significant difference among all age groups, while the potential mechanism of female changes with age needed further study.

PMID:34120477 | DOI:10.1177/00045632211026961

J Wound Care. 2021 Jun 1;30(Sup6):S23-S32. doi: 10.12968/jowc.2021.30.Sup6.S23.

ABSTRACT

OBJECTIVE: To compare consultations carried out via video with those performed in person for patients with painful, hard-to-heal ulcers, with a focus on ulcer pain and pain treatment. A further aim was to investigate predictors for pain and pain treatment.

METHOD: This was a register-based, quasi-experimental study based on data from the Swedish Registry of Ulcer Treatment (RUT). A total of 100 patients with hard-to-heal ulcers diagnosed via video consultation were compared with 1888 patients diagnosed in person with regard to pain assessment, intensity and treatment. Ulcer pain intensity was assessed by the visual analogue scale (VAS). Normally distributed variables (age, VAS) were compared between consultation groups using Student’s t-test. Non-normally distributed variables (ulcer size, ulcer duration) were compared using the Mann-Whitney U-test, except for healing time, which was analysed with a log-rank test. Categorical variables (gender, ulcer aetiology and prescribed analgesics) were compared using Pearson’s chi-square test (χ²). A p value of less than 0.05 was considered to indicate statistical significance. Predictors for pain and pain treatment were analysed in multiple regression analyses.

RESULTS: The results showed a high presence of pain; 71% of patients with pain reported severe ulcer pain. There was no significant difference in ability to assess pain by VAS in the group diagnosed via video consultation (90%) compared with the group diagnosed in person (86%) (χ², p=0.233). A significantly higher amount of prescribed analgesics was found for patients diagnosed via video (84%) compared with patients diagnosed by in-person assessment (68%) (χ², p=0.044). Predictors for high-intensity pain were female gender or ulcers due to inflammatory vessel disease, while the predictors for receiving analgesics were older age, longer healing time and being diagnosed via video consultation.

CONCLUSION: To identify, assess and treat ulcer pain is equally possible via video as by in-person consultation. The results of this study confirm that patients with hard-to-heal ulcers suffer from high-intensity ulcer pain, with a discrepancy between pain and pain relief. Further well-designed randomised controlled studies are necessary to understand how best to deploy telemedicine in ulcer pain treatment.

PMID:34120467 | DOI:10.12968/jowc.2021.30.Sup6.S23

Hypertension. 2021 Jun 14:HYPERTENSIONAHA12117131. doi: 10.1161/HYPERTENSIONAHA.121.17131. Online ahead of print.

ABSTRACT

Whether the combination of different blood pressure and arterial stiffness (AS) status is independently associated with clinical outcomes in community dwellers has not been fully investigated so far. We measured AS by brachial-ankle pulse wave velocity and other cardiovascular risk factors in a community-based population. A total of 5797 participants were enrolled. The end point was a composite of stroke, unfatal myocardial infraction, and all-cause death. Using Cox proportional hazard model to calculate hazard ratios with 95% CIs, we compared the end point between individuals with ideal vascular function (defined as normotension with normal AS), normotension with elevated AS, hypertension with normal AS, and hypertension with elevated AS. After a median follow-up of 6.34 years, the end point was confirmed in 346 participants. Compared with ideal vascular function group, the individuals of normotension with elevated AS and hypertension with elevated AS exerted a higher risk independently (normotension with elevated AS: hazard ratio, 1.74 [95% CI, 1.09-2.79]; hypertension with elevated AS: hazard ratio, 2.10 [95% CI, 1.30-3.39]; P for trend, <0.001), but the association between ideal vascular function and hypertension with normal AS did not reach statistical significance (hazard ratio, 1.13 [95% CI, 0.58-2.17]). In subgroup analysis, our data showed similar results in individuals with isolated systolic, isolated diastolic, high systolic and diastolic hypertension, and uncontrolled hypertension, while for the individuals with controlled hypertension, although crude model showed a similar result, after adjusting for risk factors, the risk of hypertension with elevated AS was not significantly increased. In conclusion, the individuals with hypertension and elevated AS had a much higher risk than the other groups. Combined control of hypertension and AS may help reduce the risk of clinical events.

PMID:34120451 | DOI:10.1161/HYPERTENSIONAHA.121.17131

J Am Heart Assoc. 2021 Jun 14:e020180. doi: 10.1161/JAHA.120.020180. Online ahead of print.

ABSTRACT

Background Serum uric acid (SUA) has been demonstrated as a risk factor for myocardial infarction (MI) and all-cause mortality; however, the impact of cumulative SUA (cumSUA) remains unclear. We aimed to investigate the association of cumSUA with MI risk and all-cause mortality, and to further explore the effects of SUA accumulation time course. Methods and Results The study enrolled 53 463 participants without a history of MI, and these participants underwent 3 examinations during 2006 to 2010. cumSUA from baseline to the third examination was calculated, multiplying mean values between consecutive examinations by time intervals between visits. Cox models estimated hazard ratios (HRs) and 95% CIs of MI and all-cause mortality for cumSUA quartiles, hyperuricemia exposure duration, and SUA accumulation time course. During a median follow-up of 7.04 years, 476 incident MIs and 2692 deaths occurred. In the fully adjusted model, a higher MI risk was observed in the highest cumSUA quartile (HR, 1.48; 95% CI, 1.10-1.99), in participants with longer hyperuricemia exposure duration (HR, 1.71; 95% CI, 1.06-2.73), and in participants with cumSUA≥median and a negative slope (HR, 1.58; 95% CI, 1.18-2.11). Similar associations persisted for all-cause mortality. Conclusions The risk of MI and all-cause mortality increased with higher cumSUA and was affected by the SUA accumulation time course. Early SUA accumulation contributed more to MI risk and all-cause mortality than later SUA accumulation with the same overall cumulative exposure, emphasizing the importance of optimal SUA control early in life.

PMID:34120449 | DOI:10.1161/JAHA.120.020180

Zhongguo Fei Ai Za Zhi. 2021 Jun 14. doi: 10.3779/j.issn.1009-3419.2021.104.08. Online ahead of print.

ABSTRACT

BACKGROUND: Tumor markers (TM) in cerebrospinal fluid (CSF) are useful for diagnosing leptomeningeal metastasis (LM). It has not been fully exploited the diagnostic possibilities of the CSF levels since the basic fact that the TM concentration of CSF depends strongly upon the serum levels as well as upon the condition of the blood brain barrier (BBB). To analyze the intrathecal TM synthesis and evaluate the integrity of BBB can be helpful for the definitive diagnosis of LM. Therefore, the aim of this study was to further explore the clinical value of intrathecal TM synthesis and BBB in the diagnosis for the lung cancer patients with LM.

METHODS: Twenty-five lung cancer patients with LM and 57 patients with nonmalignant neurological diseases (NMNDs) admitted to Nanjing Drum Tower Hospital from December 2016 to March 2020 were included. We compared the integrity of BBB and intrathecal TM synthesis between two groups, analyzed the correlation of CSF TM between the detection and intrathecal synthesis, and evaluated serial CSF cytology, the integrity of BBB and intrathecal TM synthesis when intrathecal chemotherapy for one patient.

RESULTS: Ninety-four percent LM patients showed the dysfunction of BBB, and all LM patients showed at least one intrathecal synthesized TM in CSF. In one patient, the CSF cytology was negative for the first time, but LM was eventually diagnosed based on the the intrathecal TM synthesis and positive CSF cytology of repeated lumbar puncture. In LM group, no correlation was observed between the detection and intrathecal synthesized TM in CSF. In the control group, only 3.5% (2/57) NMNDs patients had the dysfunction of BBB and no patients had intrathecal TM synthesis, both the differences of which were statistically significant (P<0.05). Finally, evaluating the CSF cytology, integrity of BBB and intrathecal TM synthesis can be used to assess the intracranial treatment effect. Moreover, intrathecal TM synthesis changes earlier than cytology.

CONCLUSIONS: The evaluation of intrathecal TM synthesis and integrity of BBB are novel clinical diagnostic tools. In addition, serial measurement of intrathecal synthesized TM may play an important role in monitoring efficacy of lung cancer patients with LM, which is worthy of further promotion and clinical application.

PMID:34120432 | DOI:10.3779/j.issn.1009-3419.2021.104.08

Zhongguo Fei Ai Za Zhi. 2021 Jun 14. doi: 10.3779/j.issn.1009-3419.2021.102.17. Online ahead of print.

ABSTRACT

BACKGROUND: The mortality of lung cancer ranks first among all malignant tumors, but there are few studies on the effect of different segmentectomy on lung function in patients with early lung adenocarcinoma. The purpose of this study was to evaluate the degree of lung function preservation and short-term results of preoperative planning combined with fluorescence thoracoscopic precision segmentectomy and traditional segmentectomy in patients with early lung adenocarcinoma.

METHODS: From January 1, 2020 to October 31, 2020, 60 patients underwent thoracoscopic segmentectomy in the Department of Thoracic Surgery of the First Affiliated Hospital of University of Science and Technology of China: 30 patients in precision segmentectomy group and 30 patients in traditional segmentectomy group. The clinicopathological features, perioperative data and postoperative pulmonary function of the two groups were compared.

RESULTS: The operation time of the precision group was shorter than that of the traditional group, and the difference was statistically significant (P<0.05). The preoperative pulmonary function accuracy group and the traditional group in forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and carbon monoxide diffusing capacity (DLCO) were (3.65±0.63)L vs (3.54±0.64)L, (2.72±0.50)L vs (2.54±0.48)L and (20.36±3.02)mL/mmHg/min vs (19.16±3.18)mL/mmHg/min, respectively. One month after operation, the FVC, FEV1 and DLCO of pulmonary function accuracy group and traditional group were (3.35±0.63)L vs (2.89±0.57)L, (2.39±0.54)L vs (2.09±0.48)L and (17.43±3.10)mL/mmHg/min vs (15.78±2.865mL/mmHg/min, respectively. Three months after operation, the FVC and DLCO of pulmonary function accuracy group and traditional group were (3.47±0.63)L vs (3.20±0.56)L and (19.38±3.02)mL/mmHg/min vs (17.79±3.21)mL/mmHg/min, respectively.

CONCLUSIONS: Preoperative planning combined with fluorescence thoracoscopic precise segmentectomy provides advantages in intersegmental plane recognition, vascular anatomy and postoperative recovery, which significantly shortens the operation time and makes the treatment more accurate.

PMID:34120431 | DOI:10.3779/j.issn.1009-3419.2021.102.17