Nevin Manimala

J Breath Res. 2024 Nov 5. doi: 10.1088/1752-7163/ad8ee7. Online ahead of print.

ABSTRACT

To investigate the halitosis level in oral lichen planus (OLP) participants and OLP-free participants.&#xD;Methods: This cross-sectional study recruited 70 participants at the New Zealand’s National Centre for Dentistry. Halitosis was determined using the objective measurements (parts per billion [ppb] volatile sulphur compounds [VSCs] in the exhaled air) and subjective measurement (self-reported halitosis questionnaire).&#xD;Results: The VSCs values of OLP participants (mean ± SD: 144.64 ± 23.85 ppb) were significantly greater than that in the OLP-free participants (105.52 ± 22.31ppb) (mean difference: 39.12 ppb; p < 0.05; 95% CI: 27.95, 50.29). The VSCs value of hyperplastic (mean difference: 34.11; 95% CI: 20.07, 48.15; p<0.05) and erosive/ulcerative (mean difference: 57.47; 95% CI: 34.19, 80.76; p<0.05) OLP participants were statistically greater than that of OLP-free participants. No statistical significance was found between hyperplastic and erosive/ulcerative OLP (p>0.05). “Type (OLP-free/OLP)” has a significant effect on the dependent variable (VSCs). 78.6% of OLP and 90.5% of OLP-free brushed their teeth at least twice daily, with a statistically significant observation (Mean square: 1.61; F: 13.13; p<0.05).&#xD;Conclusions: The levels of VSCs were greater in participants with hyperplastic and erosive/ulcerative OLP than that in the OLP-free participants. &#xD.

PMID:39499961 | DOI:10.1088/1752-7163/ad8ee7

Am J Trop Med Hyg. 2024 Nov 5:tpmd240341. doi: 10.4269/ajtmh.24-0341. Online ahead of print.

ABSTRACT

Sub-Saharan Africa has a high burden of hepatitis B virus (HBV) and hepatocellular carcinoma (HCC). The lack of surveillance programs has led to low rates of diagnosis and treatment, particularly in rural areas. We conducted mobile HBV-HCC screening clinics in rural Tanzania between March 2021 and February 2023. After undergoing informed consent, patients completed a questionnaire about HBV. A rapid point-of-care (POC) assay measured HBV surface antigen (HBsAg), and HBsAg-positive patients underwent POC ultrasound to screen for HCC and POC hepatitis C (HCV) antibody testing. The primary outcome was number of HBV diagnoses, and the secondary outcome was prevalence of liver masses in HBsAg-positive individuals. Data were analyzed with descriptive statistics. Five hundred and one patients were screened for HBV; 63% (n = 303) were female with median (interquartile range [IQR]) age of 40 (28-55) years. Only 6% (n = 30) reported being vaccinated against HBV, 92% (n = 453) reported no vaccination, and 2% (n = 12) did not know their vaccination status. Seventy-six percent (n = 340) did not know they should get vaccinated, and 4% (n = 16) reported that vaccination was too expensive. Two percent (n = 11) of patients were positive for HBsAg, with 55% (n = 6) of those being female with median (IQR) age of 36 (34-43) years. None of the HBsAg-positive patients reported being vaccinated against HBV, and all were negative for HCV. On ultrasound, one patient had a liver mass, and another had ascites. We demonstrated that community-based HBV and HCC screening can be implemented in Africa with local partnerships, and this model could be used to promote awareness and improve early detection of disease.

PMID:39499951 | DOI:10.4269/ajtmh.24-0341

J Med Internet Res. 2024 Nov 5;26:e50343. doi: 10.2196/50343.

ABSTRACT

BACKGROUND: Despite the popularity of JUUL e-cigarettes, other brands (eg, Elf Bar) may be gaining digital attention.

OBJECTIVE: This study compared Google searches for Elf Bar and JUUL from 2022 to 2023 using Google Health Trends Application Programming Interface data.

METHODS: Using an infodemiology approach, we examined weekly trends in Google searches (per 10 million) for “Elf Bar” and “JUUL” at the US national and state levels from January 1, 2022, to December 31, 2023. Joinpoint regression was used to assess statistically significant trends in the search probabilities for “Elf Bar” and “JUUL” during the study period.

RESULTS: Elf Bar had less online interest than JUUL at the beginning of 2022. When the US Food and Drug Administration denied JUUL marketing authority on June 23, 2022, JUUL searches peaked at 2609.3 × 10⁷ and fell to 83.9 × 10⁷ on September 3, 2023. Elf Bar searches surpassed JUUL on July 10, 2022, and steadily increased, reaching 523.2 × 10⁷ on December 4, 2022. Overall, Elf Bar’s weekly search probability increased by 1.6% (95% CI 1.5%-1.7%; P=.05) from January 2022 to December 2023, with the greatest increase between May 29 and June 19, 2022 (87.7%, 95% CI 35.9%-123.9%; P=.001). Elf Bar searches increased after JUUL’s suspension in Pennsylvania (1010%), Minnesota (872.5%), Connecticut (803.5%), New York (738.1%), and New Jersey (702.9%).

CONCLUSIONS: Increasing trends in Google searches for Elf Bar indicate that there was a growing online interest in this brand in the United States in 2022.

PMID:39499924 | DOI:10.2196/50343

JMIR Mhealth Uhealth. 2024 Nov 5;12:e58127. doi: 10.2196/58127.

ABSTRACT

BACKGROUND: Personal safety is a widespread public health issue that affects people of all demographics. There is a growing interest in the use of mobile apps for enhancing personal safety, particularly for children and youth at risk, who are among the most vulnerable groups in society.

OBJECTIVE: This study aims to explore what is known about the use of mobile apps for personal safety among children and youth identified to be “at risk.”

METHODS: A scoping review following published methodological guidelines was conducted. In total, 5 databases (Scopus, SocINDEX, PsycINFO, Compendex, and Inspec Archive) were searched for relevant scholarly articles published between January 2005 and October 2023. The gray literature was searched using Google and Google Scholar search engines. The results were reported using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. For summarizing the features and users’ experiences of the apps, a published framework for evaluating the quality of mobile health apps for youth was used.

RESULTS: A total of 1986 articles were identified, and 41 (2.1%) were included in the review. Nine personal safety apps were captured and categorized into 4 groups based on the goals of the apps, as follows: dating and sexual violence prevention (n=4, 44% of apps), bullying and school violence prevention (n=2, 22% of apps), self-harm and suicide prevention (n=2, 22% of apps), and homeless youth support (n=1, 11% of apps). Of the 41 articles, 25 (61%) provided data solely on app descriptions and features, while the remaining 16 (39%) articles provided data on app evaluations and descriptions. Outcomes focused on app engagement, users’ experiences, and effectiveness. Four articles reported on app use, 3 (75%) of which reported relatively high app use. Data on users’ experience were obtained from 13 studies. In general, participants found the app features to be easy to use and useful as educational resources and personal safety tools. Most of the views were positive. Negative perceptions included redundancy of app features and a lack of usefulness. Five apps were evaluated for effectiveness (n=2, 40% dating and sexual violence prevention; n=2, 40% self-harm and suicide prevention; and n=1, 20% bullying and school violence prevention) and were all associated with a statistically significant reduction (P=.001 to .048) in harm or risk to participants at the 95% CI.

CONCLUSIONS: Although many personal safety apps are available, few studies have specifically evaluated those designed for youth. However, the evidence suggests that mobile safety apps generally appear to be beneficial for reducing harm to at-risk children and youth without any associated adverse events. Recommendations for future research have been made to strengthen the evidence and increase the availability of effective personal safety apps for children and youth.

PMID:39499918 | DOI:10.2196/58127

JMIR Res Protoc. 2024 Nov 5;13:e62877. doi: 10.2196/62877.

ABSTRACT

BACKGROUND: Prolonged systemic inflammation is recognized as a major contributor to the development of various chronic inflammatory diseases. Daily measurements of inflammatory biomarkers can significantly improve disease monitoring of systemic inflammation, thus contributing to reducing the burden on patients and the health care system. There exists, however, no scalable, cost-efficient, and noninvasive biomarker for remote assessment of systemic inflammation. To this end, we propose a novel, multimodal, and noninvasive approach for measuring inflammatory biomarkers.

OBJECTIVE: This study aimed to evaluate the relationship between the levels of inflammatory biomarkers in serum (gold standard) and those measured noninvasively in urine, sweat, saliva, exhaled breath, stool, and core body temperature in patients with systemic inflammation.

METHODS: This study is a single-center, cross-sectional study and includes a total of 20 participants (10 patients with systemic inflammation and 10 control patients). Eligible participants provide serum, urine, sweat, saliva, exhaled breath, and stool samples for biomarker analyses. Core body temperature is measured using a sensor. The primary end point is the level of C-reactive protein (CRP). The secondary end points are interleukin (IL)-1β, IL-6, IL-8, IL-10, and tumor necrosis factor-α levels. The tertiary end points are fractional exhaled nitric oxide, calprotectin, and core body temperature. Samples will be collected in 2 batches, enabling preliminary analysis of the first batch (patients 1-5 from each group). The full analysis will include both batches. CRP and cytokine levels will be measured using enzyme-linked immunosorbent assay and electrochemiluminescence immunoassay. For statistical analysis, the Shapiro-Wilk test will be used to evaluate the normality of the distribution in each variable. We will perform the 2-tailed t test or Wilcoxon rank sum test to compare the levels of inflammatory biomarkers between patients with systemic inflammations and control patients. Pearson and Spearman correlation coefficients will assess the relationship between inflammatory biomarkers from noninvasive methods and serum biomarkers. Using all-subset regression analysis, we will determine the combination of noninvasive methods yielding the highest predictive accuracy for serum CRP levels. Participants’ preferences for sampling methods will be assessed through a questionnaire.

RESULTS: The study received ethics approval from the independent research ethics committee of Canton Zurich on October 28, 2022. A total of 20 participants participated in the study measurements. Data collection started on February 22, 2023, and was completed on September 22, 2023. Participants were on average 52.8 (SD 14.4; range 24-82) years of age, and 70% (14/20) of them were women. The analysis results reporting findings are expected to be published in 2025.

CONCLUSIONS: This study aims to evaluate the feasibility of noninvasive, multimodal assessment of inflammatory biomarkers in patients with systemic inflammation. Promising results could lead to the creation of noninvasive and potentially digital biomarkers for systemic inflammation, enabling continuous monitoring and early diagnosis of inflammatory activity in a remote setting.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/62877.

PMID:39499914 | DOI:10.2196/62877

J Vet Med Educ. 2024 Oct;51(5):695-700. doi: 10.3138/jvme-2023-0075. Epub 2023 Aug 31.

ABSTRACT

The European Society for Clinical Microbiology and Infectious Diseases (ESCMID) developed consensus-based generic competencies in antimicrobial prescribing and stewardship. These may be useful in structuring and evaluating antimicrobial prescribing education to veterinary students, but their applicability has not been evaluated. We aimed to evaluate whether the ESCMID competencies are currently taught and how relevant they are to veterinary prescribing in veterinary schools globally. A multi-center, cross-sectional survey was performed by administering an online questionnaire to academics teaching antimicrobial prescribing to veterinary students. Targeted recruitment was undertaken to ensure the representation of diverse geographical locations. Responses (48) were received from veterinary schools in Europe (26), North America (7), Asia (6), Australia (3), Central and South America (3), and Africa (3). Of the 37 ESCMID prescribing competencies, only 6 were considered only “slightly” or “not at all” relevant by more than 10% of respondents. Of the 37 competencies, 25 of the competencies were taught in more than 90% of schools and another 6 were taught in 80%-89% of schools. Time spent teaching was “too little” or “far too little” for five competencies according to more than 50% of the respondents. Additional competencies to address extra-label drug use; the use of compounded antimicrobials; the use of antimicrobials for metaphylaxis, prophylaxis, and growth promotion; and the importance rating of antimicrobials were suggested. The ESCMID antimicrobial prescribing competencies had broad relevance and were widely covered in the veterinary curriculum globally.

PMID:39499880 | DOI:10.3138/jvme-2023-0075

Aust J Gen Pract. 2024 Nov;53(11):859-863. doi: 10.31128/AJGP-06-23-6881.

ABSTRACT

BACKGROUND AND OBJECTIVES: Management of skin cancer comprises a substantial proportion of general practitioner (GP) workload in Australia. Flap and graft procedures below the knee have an increased risk of infection. Antibiotic resistance is a threat to global health, and any decision about antibiotic prophylaxis must balance adverse outcomes of antibiotic use with patient morbidity. This study will investigate the effectiveness of two interventions to prevent surgical site infection (SSI) after below-knee surgery: (1) 450 mg of clindamycin preoperatively and postoperatively; and (2) preoperative chlorhexidine wash and nasal mupirocin.

METHOD: This prospective randomised controlled trial will be conducted across three skin cancer clinics over nine months, with 155 participants. Consecutive patients presenting for below-knee flap and graft procedures will be eligible to participate. The primary outcome is superficial SSI in the first 30 days following excision. Secondary outcomes include adverse effects (anaphylaxis, skin irritation and foreign body reaction) and patterns of antibiotic resistance.

RESULTS: As this is a study protocol paper, there are no results available to present.

DISCUSSION: As this is a study protocol paper, there are no results to be discussed.

PMID:39499845 | DOI:10.31128/AJGP-06-23-6881

Aust J Gen Pract. 2024 Nov;53(11):794-798. doi: 10.31128/AJGP-04-23-6799.

ABSTRACT

BACKGROUND AND OBJECTIVES: Little is known about the views of service providers currently working in telehealth early medical abortion (EMA) provision in Victoria, Australia. This study aims to contextualise the enablers and barriers to telehealth EMA provision, providing insight for healthcare policy and practice to improve the accessibility of this service.

METHOD: This was a qualitative descriptive study involving semi-structured interviews with 14 Victorian stakeholders with expertise and knowledge on telehealth EMA provision. Data were analysed using conventional content analysis.

RESULTS: This study presents perceived enablers and barriers across four different contexts of the Victorian abortion system: (1) perceived patient context; (2) perceived provider context; (3) health organisation-system context; and (4) sociopolitical context. The COVID-19 pandemic’s disruption of healthcare services led to greater patient and provider acceptance of telehealth EMA. However, barriers within the patient context included the inability to ensure safety and confidentiality, digital access and literacy issues, language barriers, and the importance of trusting provider-patient relationships. Providers encountered challenges in delivering holistic care via telehealth, including time and workload issues and working with interpreters. Shortcomings within the organisational context encompassed structural barriers for culturally and linguistically diverse population groups, the absence of standard telehealth guidelines and varying interpretations of telehealth. Although temporary Medicare item number changes improved access, they presented financial challenges for mixed and private billing practices.

DISCUSSION: The application of these findings by relevant health services and policymakers has the potential to improve the quality of, and increase accessibility to, telehealth EMA, better meeting the needs of individuals seeking this service.

PMID:39499832 | DOI:10.31128/AJGP-04-23-6799

J Am Assoc Nurse Pract. 2024 Nov 1;36(11):664-670. doi: 10.1097/JXX.0000000000001088.

ABSTRACT

BACKGROUND: Fragility fractures have significant sequelae, including pain, loss of mobility, and increased risk of mortality. Fracture liaison services (FLS) represent a coordinated, interdisciplinary approach to secondary prevention and reduce mortality.

PURPOSE: To investigate the effectiveness and patient outcomes regarding readmission and mortality of a newly developed, nurse practitioner (NP) coordinated FLS in Chile.

METHODOLOGY: Retrospective longitudinal analysis of 214 patients who agreed to participate in a FLS was conducted. Variables studied include patient age, gender, anatomical fracture site, dual x-ray absorptiometry scans, medication, readmission information, and mortality. Demographics and clinical data were collected and analyzed with bivariate and multivariate statistics. Kaplan-Meier curves and log-rank tests were performed to compare survival curves between those who did and did not participate in the FLS.

RESULTS: The study sample was predominantly female (85%) with a mean age of 76 (SD: 12; range 41-101) years. The most frequently noted fracture sites were hip (n = 167), wrist (n = 132), and spine (n = 72). At one-year follow-up, the FLS group had a significantly lower mortality (5%, 10 patients) than those who did not participate in the program (12% [N = 50], p = .005). The Kaplan-Meier analysis indicated that patients who participated in the FLS had significantly better survival rates than those who did not participate.

CONCLUSIONS: Significantly improved survival rates were observed in FLS patients. Chile’s first FLS demonstrated improved patient outcomes, specifically a reduced mortality in patients who were enrolled in the FLS.

IMPLICATIONS: The NP role was fundamental in the screening, diagnosis, and treatment of patients with osteoporosis.

PMID:39499786 | DOI:10.1097/JXX.0000000000001088

J Am Assoc Nurse Pract. 2024 Nov 1;36(11):619-626. doi: 10.1097/JXX.0000000000001055.

ABSTRACT

BACKGROUND: Guatemala, a country with high rates of pediatric malnutrition, has significant challenges including food and potable water insecurity and a lack of health care providers.

PURPOSE: This study examined the impact of telehealth clinic attendance on pediatric malnutrition scores.

METHODOLOGY: A sample of 42 Guatemalan children aged 6-59 months with malnutrition were recruited to participate in eight clinic events, including two in-person and six telehealth clinics. Six telehealth clinics were held at 4- to 6-week intervals, bookended by an initial and concluding in-person event. Nonparametric tests were used to analyze changes between baseline and last visit z-scores for height, weight for length, mid-upper arm circumference (MUAC), and body mass index (BMI) and to examine the relationship between the number of telehealth visits and z-score measurements at baseline and last visit.

RESULTS: The number of children with severe malnutrition at baseline by weight for length, BMI, and MUAC decreased by the last visit. A decrease occurred in the number of children with stunted height. Changes in z-scores for height, weight for length, BMI, and MUAC between study onset and last visit did not reach statistical significance. Statistically significant relationships existed between clinic attendance and baseline and last visit weight for height/length z-scores and baseline MUAC z-scores.

CONCLUSIONS: Positive improvements in nutritional status occurred, especially among children with severe malnutrition. Children with severe malnutrition had significantly better telehealth attendance.

IMPLICATIONS: Studies with larger sample sizes are needed. Study results indicate that telehealth may be a tool to battle global pediatric malnutrition.

PMID:39499784 | DOI:10.1097/JXX.0000000000001055