Nevin Manimala

Trials. 2024 Mar 4;25(1):164. doi: 10.1186/s13063-024-08014-y.

ABSTRACT

BACKGROUND: Mortality, cerebral injury, and necrotizing enterocolitis (NEC) are common complications of very preterm birth. An important risk factor for these complications is hemodynamic instability. Pre-clinical studies suggest that the timing of umbilical cord clamping affects hemodynamic stability during transition. Standard care is time-based cord clamping (TBCC), with clamping irrespective of lung aeration. It is unknown whether delaying cord clamping until lung aeration and ventilation have been established (physiological-based cord clamping, PBCC) is more beneficial. This document describes the statistical analyses for the ABC3 trial, which aims to assess the efficacy and safety of PBCC, compared to TBCC.

METHODS: The ABC3 trial is a multicenter, randomized trial investigating PBCC (intervention) versus TBCC (control) in very preterm infants. The trial is ethically approved. Preterm infants born before 30 weeks of gestation are randomized after parental informed consent. The primary outcome is intact survival, defined as the composite of survival without major cerebral injury and/or NEC. Secondary short-term outcomes are co-morbidities and adverse events assessed during NICU admission, parental reported outcomes, and long-term neurodevelopmental outcomes assessed at a corrected age of 2 years. To test the hypothesis that PBCC increases intact survival, a logistic regression model will be estimated using generalized estimating equations (accounting for correlation between siblings and observations in the same center) with treatment and gestational age as predictors. This plan is written and submitted without knowledge of the data.

DISCUSSION: The findings of this trial will provide evidence for future clinical guidelines on optimal cord clamping management at birth.

TRIAL REGISTRATION: ClinicalTrials.gov NCT03808051. Registered on 17 January 2019.

PMID:38439024 | DOI:10.1186/s13063-024-08014-y

BMC Public Health. 2024 Mar 4;24(1):696. doi: 10.1186/s12889-024-18191-9.

ABSTRACT

BACKGROUND: Multimorbidity is becoming an increasingly serious public health challenge in the aging population. The impact of nutrients on multimorbidity remains to be determined and was explored using data from a UK cohort study.

METHOD: Our research analysis is mainly based on the data collected by the United Kingdom Women’s Cohort Study (UKWCS), which recruited 35,372 women aged 35-69 years at baseline (1995 to 1998), aiming to explore potential associations between diet and chronic diseases. Daily intakes of energy and nutrients were estimated using a validated 217-item food frequency questionnaire at recruitment. Multimorbidity was assessed using the Charlson comorbidity index (CCI) through electronic linkages to Hospital Episode Statistics up to March 2019. Cox’s proportional hazards models were used to estimate associations between daily intakes of nutrients and risk of multimorbidity. Those associations were also analyzed in multinomial logistic regression as a sensitivity analysis. In addition, a stratified analysis was conducted with age 60 as the cutoff point.

RESULTS: Among the 25,389 participants, 7,799 subjects (30.7%) were confirmed with multimorbidity over a median follow-up of 22 years. Compared with the lowest quintile, the highest quintile of daily intakes of energy and protein were associated with 8% and 12% increased risk of multimorbidity respectively (HR 1.08 (95% CI 1.01, 1.16), p-linearity = 0.022 for energy; 1.12 (1.04, 1.21), p-linearity = 0.003 for protein). Higher quintiles of daily intakes of vitamin C and iron had a slightly lowered risk of multimorbidity, compared to the lowest quintile. A significantly higher risk of multimorbidity was found to be linearly associated with higher intake quintiles of vitamin B12 and vitamin D (p-linearity = 0.001 and 0.002, respectively) in Cox models, which became insignificant in multinomial logistic regression. There was some evidence of effect modification by age in intakes of iron and vitamin B1 associated with the risk of multimorbidity (p-interaction = 0.006 and 0.025, respectively).

CONCLUSIONS: Our findings highlight a link between nutrient intake and multimorbidity risk. However, there is uncertainty in our results, and more research is needed before definite conclusions can be reached.

PMID:38439008 | DOI:10.1186/s12889-024-18191-9

BMC Public Health. 2024 Mar 4;24(1):682. doi: 10.1186/s12889-024-18170-0.

ABSTRACT

BACKGROUND: Type 2 diabetes mellitus represents a multifaceted disorder characterized by intricate pathophysiological mechanisms, encompassing diminished insulin secretion, augmented hepatic glucose production, and heightened insulin resistance. This study aims to assess the sex (Male and Female only) and family history-based differences in the prevalence of T2DM and explore the determinants contributing to this disparity among clinical patients.

SUBJECTS AND METHODS: The study encompassed a diverse pool of clinical patients, encompassing both individuals with diabetes and those without the condition, who had previously sought medical attention for clinical checkups at healthcare centers. The collected data included essential parameters such as blood pressure, weight, height, smoking habits, educational background, and physical activity levels. To ensure methodological rigor and data accuracy, blood pressure measurements adhered to the stringent guidelines set forth by the World Health Organization.

RESULTS: Participants of the present study reported diabetes, among which notable findings emerged regarding health indicators. It was observed that the prevalence of high blood pressure, obesity, and high blood cholesterol exhibited a statistically significant increase among the female participants, underscoring the sex-based disparities in these health parameters. The male population aged 60 or older, the presence of a family history of DM accentuated this risk, resulting in a striking 3.1 times higher prevalence compared to females, who exhibited a 2.4 times higher risk (OR = 2.4, p = 0.0008). This intriguing relationship between diabetes and cholesterol levels was not limited to sex. Both male (OR = 2.47) and female (OR = 2.1) diabetes patients displayed highly significant associations with cholesterol levels. The risk of T2DM was significantly associated with triglycerides in both sexes (1.58 times higher in males, and 1.71 times higher in females).

CONCLUSIONS: The significance of hypertension as a comorbidity in T2DM, highlighting sex-specific associations and the potential impact of a family history of diabetes on blood pressure. Our findings emphasize the importance of considering lipid profiles, obesity, and their sex-specific associations when assessing and managing diabetes risk. Comprehensive diabetes care should include strategies for lipid control, weight management, and cardiovascular risk reduction, tailored to the individual’s sex and specific risk profile.

PMID:38438994 | DOI:10.1186/s12889-024-18170-0

BMC Public Health. 2024 Mar 4;24(1):687. doi: 10.1186/s12889-024-18196-4.

ABSTRACT

BACKGROUND: Partner Notification Service is among the strategies used to conduct targeted Human Immunodeficiency Virus Testing Service by obtaining information about sexual contacts of index clients to refer for testing. But most people living with Human Immunodeficiency Virus are still unaware of their status, including Ethiopia. Limited studies are available on the magnitude of partner notification service utilization and associated factors in Ethiopia.

OBJECTIVE: The aim of this study was to assess the magnitude of partner notification service utilization and associated factors among people living with Human Immunodeficiency Virus attending anti-retroviral therapy clinics of public health facilities in Gimbi town, West Ethiopia.

METHODS: A facility-based mixed-method cross-sectional study design was used. Total of 455 study participants were selected by systematic random sampling for quantitative data and health workers were purposively selected for qualitative data until saturation of ideas was reached. The study was conducted from December 1, 2022 to January 30, 2023. Structured questionnaires and key informant interview guides were used for data collection. Quantitative data were analyzed using Statistical Package for Social Science version 25. Open code 4.02 software was used for qualitative data analysis. Frequencies and proportions were used to summarize descriptive statistics. Bivariable and multivariable logistic regression was used to identify associated factors then variables with a p value < 0.05 were declared to have an association with the dependent variable.

RESULT: Exactly 298 (65.5%) of the study participants were notified their HIV status to their sexual partners. Factors associated with Partner Notification Service Utilization were depression AOR: 0.12 (95% CI: 0.07, 0.20), urban settlers AOR: 2.21 (95% CI: 1.2, 3.83), fear of support loss AOR: 0.24 (95% CI: 0.14, 0.40) and intimate partner violence AOR: 0.55 (95% CI: 0.31, 0.97). From qualitative part of this study, factors associated to Partner Notification service utilization were fear of stigma, discrimination and fear of divorce.

CONCLUSION: Two-third of the study participants were utilized partner notification service, and efforts are important to prevent depression and intimate partner violence. Local government bodies and stakeholders should implement economic strengthening and strategies to address the rural community for HIV/AIDS prevention. Promotion of supportive and inclusive environment for PLHIV should also considered as way to increase PNS utilization.

PMID:38438988 | DOI:10.1186/s12889-024-18196-4

BMC Anesthesiol. 2024 Mar 4;24(1):91. doi: 10.1186/s12871-024-02471-3.

ABSTRACT

BACKGROUND: Reducing blood loss during excisional surgery in burn patients remains a challenge. Tranexamic acid during surgery can potentially reduce blood loss. The use of tranexamic acid during excisional surgery in burn patients has recently been described in a review and meta-analysis. However, quality assessment on studies included was not performed and this review did not apply independent reviewers. Quality assessment of studies investigating the effectiveness of tranexamic acid in burn patients is crucial before concusions can be drawn. Therefore, we conducted a systematic review and meta-analysis of the literature investigating the effectiveness of tranexamic acid in burn patients undergoing surgery.

METHODS: A systematic review and meta-analysis of the literature was conducted. The study was pre-registered in PROSPERO database (CRD42023396183).

RESULTS: Five studies including two randomised controlled trials (RCTs) with a total of 303 patients were included. Risk of bias of the included studies was moderate to high. Individual results of the studies were heterogeneous. In three studies of moderate quality the administration of tranexamic acid resulted in a reduction of blood loss per unit excised area, accounting as moderate level of evidence. In two low-quality studies and one moderate quality study the administration of tranexamic acid resulted in a reduction of transfused packed Red Blood Cells (pRBC’s), accounting for moderate level of evidence. Postoperative haemoglobin levels were higher after tranexamic acid administration in one study, accounting for insufficient evidence. Meta-analysis pooling overall blood loss from two separate RCTs failed to detect a statistically significant reduction. Substantial heterogeneity was observed.

CONCLUSIONS: Moderate level of evidence indicates that tranexamic acid reduces blood loss per unit of excised area and transfusion of packed Red Blood Cells. Results indicate that tranexamic acid can be beneficial in burn patients undergoing surgery. More high-quality research is needed to confirm these results. Future studies should focus on the dosing of tranexamic acid, the administration approaches, and even consider combining these approaches.

TRIAL REGISTRATION: PROSPERO: CRD42023396183.

PMID:38438978 | DOI:10.1186/s12871-024-02471-3

BMC Public Health. 2024 Mar 4;24(1):684. doi: 10.1186/s12889-024-18037-4.

ABSTRACT

BACKGROUND: The human-animal bond has been recognized as having positive effects on the health and well-being of both humans and pets. The present study aims to explore the influence of attachment on physical activity (PA), lifestyle, and health outcomes of dog owners (DO), highlighting the mutual benefits resulting from the relationship between DO and dogs.

METHODS: Thirty-eight DO and their dogs participated in this study. Socio-demographic data, the Self-Rated Health (SRH), FANTASTICO Lifestyle Scale, and the Lexington Attachment Pet Scale (LAPS) were assessed. PA was measured in both the DO and the dogs, using an ActiGraph GT3X accelerometer in the context of daily routine. Descriptive statistics and Spearman rank correlation analyses were performed to examine the associations between LAPS, PA levels, socio-demographic variables, lifestyle behaviors, and SRH.

RESULTS: Significant correlations were found between the dog owners’ light-level PA and the pets’ vigorous level of PA (rho = 0.445, p = 0.01). Furthermore, the importance of the pets’ health (rho = -0.785, p = 0.02) and the LAPS subscales, namely proximity (rho = 0.358, p = 0.03), and attachment (rho = 0.392, p = 0.01), were related to taking the pet for a walk. Regarding lifestyle, DO with a healthier lifestyle had a better self-assessment of their health using the SRH (rho = 0.39, p = 0.02). Moreover, DO with better lifestyles also exhibited greater concern for their pet’s health (rho = 0.398, p = 0.01).

CONCLUSIONS: This study emphasizes that individuals who adopt healthier habits tend to perceive themselves as healthier and exhibit greater concern for their pets’ health. The attachment between DO and dogs is important in promoting healthy lifestyle behaviors and engagement in PA. Our results highlight that the presence of a dog is associated with a higher level of PA in DO, depending on the strength of the human-animal bond.

PMID:38438977 | DOI:10.1186/s12889-024-18037-4

Int J Emerg Med. 2024 Mar 4;17(1):34. doi: 10.1186/s12245-024-00610-8.

ABSTRACT

BACKGROUND: Type C pelvic fractures (AO/OTA) are severe injuries that frequently lead to bleeding and hemodynamic instability. Pelvic binders play a crucial role in their initial management. Placement at the correct level in the prehospital setting is challenging. The aim of this study was to compare two pelvic binders regarding their effectiveness in reducing intrapelvic volume and increasing intrapelvic pressure in patients with type C pelvic fractures (AO/OTA) when applied at three different levels.

METHODS: Rotationally and vertically unstable pelvic injuries (AO/OTA classification 61-C1.1) were produced in five fresh-frozen human cadaveric specimens. Intrapelvic volume, vesical pressure and compression pressure within the pubic symphysis and the sacroiliac joint were measured when applying a SAM Pelvic Sling II and a T-POD at the level of the greater trochanter as well as levels higher and lower than recommended.

RESULTS: Comparison of the two pelvic binders positioned at the recommended level (greater trochanter) showed no significant difference in volume reduction (13.85 ± 31.37 cm³, p = 0.442), however, increase in vesical pressure was significantly higher when using the T-POD (5.80 ± 3.27 cmH₂O, p = 0.017). When positioned at the level of the iliac crest, vesical pressure increase and intrapelvic volume reduction were significantly greater with the T-POD (14.00 ± 8.57 cmH₂O, p = 0.022 and 10.45 ± 5.45 cm³, p = 0.031 respectively). Application of the SAM Pelvic Sling II below the greater trochanter led to a significantly greater decrease in volume (-32.26 ± 7.52 cm³, p = 0.003) than the T-POD. Comparison of the recommended attachment level with incorrect positioning led to no significant differences for the T-POD, while the SAM Pelvic Sling II achieved a significantly lower volume reduction when placed at the iliac crest (40.15 ± 14.57 cm³, p = 0.012) and a significantly lower increase in vesical pressure when applied below the greater trochanter (3.40 ± 1.52 cmH₂O, p = 0.007).

CONCLUSION: Direct comparison of the two pelvic binders showed that the T-POD achieved significantly greater results when applied at the recommended level and was less susceptible to incorrect positioning. These outcomes support the preferred use of the T-POD for prehospital emergency pelvic stabilisation.

PMID:38438968 | DOI:10.1186/s12245-024-00610-8

Proc Natl Acad Sci U S A. 2024 Mar 12;121(11):e2321595121. doi: 10.1073/pnas.2321595121. Epub 2024 Mar 4.

ABSTRACT

Polynyas, areas of open water embedded within sea ice, are a key component of ocean-atmosphere interactions that act as hotspots of sea-ice production, bottom-water formation, and primary productivity. The specific drivers of polynya dynamics remain, however, elusive and coupled climate models struggle to replicate Antarctic polynya activity. Here, we leverage a 44-y time series of Antarctic sea ice to elucidate long-term trends. We identify Antarctic-wide linear increases and a hitherto undescribed cyclical pattern of polynya activity across the Ross Sea region that potentially arises from interactions between the Amundsen Sea Low and Southern Annular Mode. While their specific drivers remain unknown, identifying these emerging patterns augments our capacity to understand the processes that influence sea ice. As we enter a potentially new age of Antarctic sea ice, this advance in understanding will, in turn, lead to more accurate predictions of environmental change, and its implications for Antarctic ecosystems.

PMID:38437551 | DOI:10.1073/pnas.2321595121

Ann Work Expo Health. 2024 Mar 4:wxae010. doi: 10.1093/annweh/wxae010. Online ahead of print.

ABSTRACT

Determining the vapor pressure of a substance at the relevant process temperature is a key component in conducting an exposure assessment to ascertain worker exposure. However, vapor pressure data at various temperatures relevant to the work environment is not readily available for many chemicals. The Antoine equation is a mathematical expression that relates temperature and vapor pressure. The objective of this analysis was to compare Antoine parameter data from 3 independent data sources; Hansen, Yaws, and Custom data and identify the source that generates the most accurate vapor pressure values with the least bias, relative to the referent data set from the CRC Handbook of Chemistry and Physics. Temperatures predicted from 3 different Antoine sources across a range of vapor pressures for 59 chemicals are compared to the reference source. The results show that temperatures predicted using Antoine parameters from the 3 sources are not statistically significantly different, indicating that all 3 sources could be useful. However, the Yaws dataset will be used in the SDM 2.0 because the data is readily available and robust.

PMID:38437526 | DOI:10.1093/annweh/wxae010

Am J Hosp Palliat Care. 2024 Mar 4:10499091241236921. doi: 10.1177/10499091241236921. Online ahead of print.

ABSTRACT

BACKGROUND: Sufficient knowledge of end-of-life care, positive attitudes, and emotions regarding death and dying are essential criteria for showcasing favorable palliative care educational results to undergraduate nursing students. However, nursing students have negative attitudes toward end-of-life care and know little about it.

AIM: This study aimed to examine the effect of a repeated standardized patient-based training program (intervention) on nursing students’ knowledge, attitudes, and emotions about end-of-life patients.

METHOD: This study adopted a pretest-posttest quasi-experimental research design. The sample consisted of 50 fourth-year nursing students divided into intervention (n = 25) and control (n = 25) groups. All participants attended the intervention. The intervention group attended the intervention twice, while the control group attended it only once. Data were collected using a personal information form, the Frommelt Attitudes Toward Care of the Dying Scale, the Positive and Negative Affect Schedule, and the End-of-Life Care Nursing Questionnaire. The data were analyzed using descriptive statistics, Pearson’s Chi-square test, dependent groups t test, Pearson-Spearman, Mann-Whitney test, Wilcoxon test, and Friedman test.

RESULTS: The intervention helped participants learn more about end-of-life care (χ2 = 27.167, P = .000; F = 42.725, P = .000) and develop more positive attitudes toward end-of-life patients (F = 13.279, P = .000; F = 6.934, P = .000). The intervention also helped participants develop communication skills.

CONCLUSION: Universities should integrate repeated standardized patient-based into nursing curricula.

PMID:38437522 | DOI:10.1177/10499091241236921