Nevin Manimala

Ann Rehabil Med. 2023 Oct;47(5):393-402. doi: 10.5535/arm.23058. Epub 2023 Oct 12.

ABSTRACT

OBJECTIVE: : To assess the effectiveness of combining physiotherapy techniques with conservative medical treatment in chronic rhinosinusitis (CRS) patients.

METHODS: : Sixty-eight volunteers with CRS were randomly assigned. Group A received only traditional medical treatment, whereas group B received a physiotherapy program that included pulsed ultrasound therapy, sinus manual drainage techniques, and self-sinus massage technique in addition to traditional medical treatment. Interventions were applied 3 sessions a week for 4 weeks. The rhinosinusitis disability index (RSDI) served as the main outcome indicator for assessing the quality of life, and the secondary outcome measure was the pressure pain threshold (PPT) using a pressure algometer.

RESULTS: : Wilcoxon signed rank test revealed a significant reduction (p<0.001) in total RSDI values from 71.08±1.13 pretest to 47.14±1.15 posttest for group A, while it decreased from 70.64±1.20 pretreatment to 31.76±1.04 posttreatment for group B; furthermore, Mann-Whitney U-test revealed a significant difference (p<0.001) in total RSDI values between both groups when comparing the change of the pre-post data values, it was 23.94±0.95 for group A and 38.88±0.67 for group B. The independent t-test revealed a highly statistically significant increase (p<0.001) in the PPT values in the experimental group compared to the control group.

CONCLUSION: : The physiotherapy program which included pulsed ultrasound therapy, sinus manual drainage technique, and self-sinus massage technique in conjunction with conventional medical treatment was more beneficial for enhancing the quality of life and PPT than traditional medical treatment alone in CRS patients.

PMID:37907231 | DOI:10.5535/arm.23058

Ann Rehabil Med. 2023 Oct;47(5):377-384. doi: 10.5535/arm.23110. Epub 2023 Oct 4.

ABSTRACT

OBJECTIVE: : To demonstrate the association between the physical and functional characteristics of individuals with spinal cord injury (SCI) and suicidality, an area of research that is less understood than the association with demographic, social, and psychological characteristics.

METHODS: : A retrospective cross-sectional study was conducted with 259 patients with SCI admitted for rehabilitation at the National Rehabilitation Center, Seoul, between January 2019 and December 2021. Demographic, SCI-related, physical, and functional data were collected from their medical records. Suicide risk was assessed using the Mini International Neuropsychiatric Interview.

RESULTS: : The 259 participants had an average age of 49.1 years, and 75.7% were male. The analysis revealed a statistically significant negative correlation between age and suicidality. No significant differences were found for sex, education, occupation, or SCI-related factors. Lower upper extremity motor score (UEMS) was significantly associated with higher suicide risk. Regarding functional factors, the inability to perform independent rolling, come to sit, wheelchair propelling, and self-driving were associated with increased suicidality. In the multiple linear regression analysis, lower UEMS, limited shoulder joint motion, upper extremity spasticity, and dependent wheelchair propulsion were predictors of higher suicide risk.

CONCLUSION: : This study highlights the associations among physical status, functional dependency, and suicide risk in individuals with SCI. These findings emphasize the need to address psychological aspects and physical and functional factors in the management of individuals with SCI who are at a high risk of suicide.

PMID:37907229 | DOI:10.5535/arm.23110

Ann Rehabil Med. 2023 Oct;47(5):348-357. doi: 10.5535/arm.23090. Epub 2023 Oct 27.

ABSTRACT

OBJECTIVE: : To systematically review the efficacy of e-Health interventions on physical performance, activity and quality of life in older adults with sarcopenia or frailty.

METHODS: : A systematic review was conducted by searching the MEDLINE, Embase, Cochrane Library, CINHAL, Web of Science, and the Physiotherapy Evidence Database for experimental studies published in English from 1990 to 2021. E-Health studies investigating physical activity, physical performance, quality of life, and activity of daily living assessment in adults aged ≥65 years with sarcopenia or frailty were selected.

RESULTS: : Among the 3,164 identified articles screened, a total of 4 studies complied with the inclusion criteria. The studies were heterogeneous by participant characteristics, type of e-Health intervention, and outcome measurement. Age criteria for participant selection and sex distribution were different between studies. Each study used different criteria for frailty, and no study used sarcopenia as a selection criteria. E-Health interventions were various across studies. Two studies used frailty status as an outcome measure and showed conflicting results. Muscle strength was assessed in 2 studies, and meta-analysis showed statistically significant improvement after intervention (standardized mean difference, 0.51; 95% confidence interval, 0.07-0.94; p=0.80, I²=0%).

CONCLUSION: : This systematic review found insufficient evidence to support the efficacy of e-Health interventions. Nevertheless, the studies included in this review showed positive effects of e-Health interventions on improving muscle strength, physical activity, and quality of life in older adults with frailty.

PMID:37907226 | DOI:10.5535/arm.23090

Ann Rehabil Med. 2023 Oct;47(5):318-325. doi: 10.5535/arm.23050. Epub 2023 Oct 31.

ABSTRACT

Cardiovascular disease (CVD) poses a significant health challenge globally, including in Korea, due to its status as a leading cause of death and its impact on cardiopulmonary function. Cardiac rehabilitation (CR) is a well-established program that not only aids in restoring cardiopulmonary function, but also improves physical and social conditions. The benefits of CR are widely recognized, and it is implemented globally. While the effectiveness of CR has been proven in Korea, it is underutilized. This fact sheet summarizes the current status of CR in Korea, including the prevalence of CVD, the clinical practice guidelines for CR programs, and the challenges of implementing CR in Korea.

PMID:37907223 | DOI:10.5535/arm.23050

Rehabilitation (Stuttg). 2023 Oct 31. doi: 10.1055/a-2134-2142. Online ahead of print.

ABSTRACT

PURPOSE: If COVID-19 disease sequelae also (co-)affect the respiratory organs, national and international guidelines recommend pulmonary rehabilitation (PR). So far, however, no studies are available from Germany on the course after PR, nor on possible course differences between the two Long COVID subgroups “Ongoing symptomatic COVID-19” and “Post-COVID-19 syndrome” (PCS).

METHODS: In a prospective observational study, patient-reported outcomes (PROs) regarding exertional dyspnea, quality of life, pain, fatigue, depression, and anxiety were assessed at the beginning of PR (T1), end of PR (T2), and after 3 (T3) and 6 months (T4). Statistical analyses were performed using latent difference models.

RESULTS: There were 224 rehabilitation patients (M_Age=54.4; SD_Age=10.4; 42.0% female) included in the study. During PR, all PROs improved significantly. After PR, improvements either persisted with large pre-post effect sizes (exertional dyspnea, quality of life), decreased slightly to small pre-post effect sizes (depression, fatigue), or decreased to baseline levels (anxiety, pain). PCS patients had greater burdens in depression, fatigue, and pain at baseline, but did not differ in trajectories. Indicators of the severity of the preceding acute phase (oxygen therapy, ICU treatment, ventilation) were associated with higher burdens at T0 in depression, fatigue, and pain, but not with the courses during and after PR. In contrast, female patients showed higher burdens in both depression and fatigue at T1 and higher pre-post effects than male patients.

CONCLUSION: The fact that improvements in PROs occurred in both subgroups only during PR, but not during the follow-up period suggests that the changes are not due to the natural healing process but at least partly due to PR. Moreover, the results suggest that both patient groups may benefit from PR. Persisting improvements in exertional dyspnea and quality of life and, to a reduced extent, in depression and fatigue until 6 months after PR, but not in pain and anxiety warrant study of additional multimodal interventions that may be needed to maintain these effects.

PMID:37907217 | DOI:10.1055/a-2134-2142

Curr Probl Cardiol. 2023 Oct 29:102184. doi: 10.1016/j.cpcardiol.2023.102184. Online ahead of print.

ABSTRACT

Venous Thromboembolism (VTE) carries significant clinical implications, and with the rise in cannabis consumption, its potential influence on VTE outcomes warrants investigation. Using the National Inpatient Sample (NIS) database (2016-2019), we analyzed 2,217,184 hospitalized VTE patients. Among these, 1.8% (38,810) reported cannabis use. We compared demographics, comorbidities, in-hospital outcomes, and quality metrics between cannabis users and non-users with VTE. Cannabis users were chiefly younger males (average age 45 in cannabis users vs. 62 in non-cannabis users) from lower-income brackets. Notably, 5.4% discharged against medical advice. Although in-hospital mortality was initially lower for cannabis users (2.8% vs. 5.1%, OR 0.6, 95% CI 0.69-0.94, p=0.008), this difference became non-significant post-propensity-score matching (aOR 0.9, 95% CI 0.72-1.10, p=0.3). Non-users faced higher in-hospital complications, a trend that persisted post-PSM. Among cannabis users, key mortality predictors were peripheral vascular disease, acute kidney injury, vasopressor use, cardiogenic shock, myocardial infarction, invasive ventilation, and surgical embolectomy. Cannabis users also had a shorter hospital stay (4.2 vs. 5.4 days) and slightly reduced costs ($27,472.95 vs. $31,660.75). The significantly younger age of VTE patients who use cannabis, coupled with the considerable proportion discharging against medical advice, underscores the urgency for tailored care interventions. Additional research is vital to comprehensively understand the interplay between cannabis consumption and VTE outcomes.

PMID:37907189 | DOI:10.1016/j.cpcardiol.2023.102184

Am J Prev Med. 2023 Oct 29:S0749-3797(23)00434-8. doi: 10.1016/j.amepre.2023.10.018. Online ahead of print.

ABSTRACT

INTRODUCTION: This study evaluates the real-world impact of a lifestyle change program (LCP) on healthcare utilization in a large health system.

METHODS: Using electronic health record (EHR) data from a large health system in northern California, United States, LCP participant and propensity-score-matched non-participant outcomes were compared in the second year post-participation: (1) overall healthcare utilization, and (2) utilization and medications related to cardiometabolic conditions and obesity. Adult LCP participants between 2010-2017 were identified and matched 1:1 with replacement to comparable non-participants. Participants without EHR activity in the 12-36 months before baseline, or with conditions or procedures associated with substantial weight change, were excluded. Statistical analysis and modeling were performed in 2021-22.

RESULTS: Compared to matched non-participants, LCP participants in the 12-24 months post-baseline were more likely to have specialty-care visits (+4.7%, 95% CI +1.8%,+7.6%), electronic communications (8.6%, 95% CI +5.6%,+11.7%), and urgent-care visits (+6.5%, 95% CI +3.0%,10.0%). Participants also had more office visits for cardiometabolic conditions and obesity (+1.72 visits/patient, 95% CI +1.05,+2.39).

CONCLUSIONS: Compared with matched non-participants, LCP participation was associated with higher utilization of outpatient services post-participation. Additional research could assess whether this indicates an increase in preventive care that could lead to improved future outcomes.

PMID:37907133 | DOI:10.1016/j.amepre.2023.10.018

Acad Pediatr. 2023 Oct 29:S1876-2859(23)00399-6. doi: 10.1016/j.acap.2023.10.008. Online ahead of print.

ABSTRACT

OBJECTIVE: Fewer than 40% of U.S. children complete the human papilloma virus (HPV) vaccine series before their 13^th birthday. In our large pediatric primary care network, HPV vaccine completion rate by age 13 was 30%. We hypothesized that a phased quality improvement (QI) initiative would increase rates of HPV vaccine completion by age 13 across our network.

METHODS: This QI initiative was conducted in a network of 30 practices located across 2 states, in urban and suburban settings, consisting of teaching and non-teaching clinics, and ranging in size from 3 to 50 providers per office. We used a phased approach incorporating multicomponent network-wide and iterative practice-specific interventions. Key interventions included: updating clinical decision support to default order HPV vaccine due at preventive visits starting at age 9 instead of 11, data audit and feedback to providers and practices, encouraging use of a strong provider recommendation, and standing orders.

RESULTS: From April 2019 to October 2022, HPV vaccine completion by age 13 across our network increased from 30% to 55% and met criteria for special cause variation on statistical process control charts. A gap in median HPV vaccine completion by age 13 between patients with public insurance and patients with private or commercial insurance decreased from 9% to 1%.

CONCLUSION: A QI initiative was associated with a sustained increase in HPV vaccine series completion by age 13 and reduced variation in care across a large network of 30 primary care practices.

PMID:37907128 | DOI:10.1016/j.acap.2023.10.008

Sci Total Environ. 2023 Oct 29:168189. doi: 10.1016/j.scitotenv.2023.168189. Online ahead of print.

ABSTRACT

AIM: As an important toxic heavy metal, lead exposure can lead to the occurrence of chronic kidney disease (CKD). However, the analysis of its disease burden pattern on a global scale is lacking. This study aimed to analyze the CKD burden attributable to lead exposure globally, regionally and temporally, as well as to examine the role of socio-economic factors.

METHOD: This study used data from the Global Burden of Disease (GBD) study 2019. We obtained the global burden of CKD caused by lead exposure between 1990 and 2019, and stratified this burden according to factors such as gender, age, GBD regions, and countries. From 1990 to 2019, the changing trend of the disease burden of CKD attributed to lead exposure was estimated using Joinpoint regression model with the average annual percent change (AAPC) estimated. Finally, the relationship between country-level socio-economic factors and lead exposure related CKD burden was explored using a panel data model analysis.

RESULTS: In 2019, worldwide, there were 52.94 thousand deaths (95 % uncertainty interval (UI): 31.64, 76.23) and 1225.2 thousand disability-adjusted life years (DALYs) (95 % UI: 707.88, 1818) of CKD caused by lead exposure, accounting for 3.71 % of total CKD deaths and 2.95 % of total CKD DALYs. The age-standardized death and DALY rates per 100,000 population were 0.68 (95 % UI: 0.40, 0.98) and 15.02 (95 % UI: 8.68, 22.26) respectively, indicating an upward trend and stable trend between 1990 and 2019. However, the age-standardized rates attributed to lead exposure showed a wide variability across regions, with the highest rates in Central Latin America and the lowest in Eastern Europe. Moreover, the results of panel model analysis indicated that GDP growth was positively associated with lead exposure related CKD death rate and DALY rate. However, there were inverse associations between life expectancy at birth and hospital beds (per 1000 people) with lead exposure-related CKD DALY rate.

CONCLUSION: In summary, a significant burden of CKD can be attributed to lead exposure, with noticeable regional discrepancies. Findings here are valuable to deploy efficient measures at curbing lead exposure worldwide.

PMID:37907111 | DOI:10.1016/j.scitotenv.2023.168189

Sci Total Environ. 2023 Oct 29:168114. doi: 10.1016/j.scitotenv.2023.168114. Online ahead of print.

ABSTRACT

The evolution of insecticide resistance has been attributed to strong directional selection by lethal concentrations of insecticides, but there is growing evidence that sublethal doses may also modify resistance through the hormetic effects. Hormesis is a beneficial effect caused by exposure to low doses. However, the role of parental (transgenerational) effects on hormesis, and through that on insecticide resistance, is still unclear. We investigated the effects of several sublethal pyrethroid insecticide (Decis) doses on survival, body mass, and reproduction within four generations (F0, F1, F2, and F3) of the Colorado potato beetle (Leptinotarsa decemlineata). We found that insecticide exposure had mostly linear adverse within-generation effects: decreased larva-to-adult survival, adult body mass, and egg hatching. However, transgenerational exposure led to hormetic effects: increased larva-to-adult survival and pre-diapause adult body mass. Moreover, transgenerational effects were even more positive for offspring exposed to insecticides, leading to decreased larva-to-adult survival, increased body mass, and egg hatching. Our results show that despite mostly negative within-generation effects, transgenerational sublethal exposure to insecticide can cause unwanted positive hormetic effects in their offspring, making them to resist or tolerate the insecticides better, even though the underlying mechanisms are still unclear.

PMID:37907109 | DOI:10.1016/j.scitotenv.2023.168114