Nevin Manimala

Acta Paediatr. 2023 Jun 4. doi: 10.1111/apa.16866. Online ahead of print.

ABSTRACT

AIM: To explore the perspectives of adults born prematurely on guidelines for management at extreme premature birth, and personalisation at the limit of viability.

METHODS: We conducted four two-hour online focus group interviews in the Netherlands.

RESULTS: Twenty-three participants born prematurely were included in this study, ranging in age from nineteen to fifty-six years, and representing a variety of health outcomes. Participants shared their perspectives on different types of guidelines for managing extremely premature birth. They agreed that a guideline was necessary to prevent arbitrary treatment decisions and to avoid physician bias. All participants favoured a guideline that is based upon multiple prognostic factors beyond gestational age. They emphasized the importance of discretion, regardless of the type of guideline used. Discussions centred mainly on the heterogeneity of value judgments about outcomes after extreme premature birth. Further, participants defined personalisation as ‘not just looking at numbers and statistics’. They associated personalisation mainly with information provision and decision-making. Participants stressed the importance of involving families in decision-making and taking their care needs seriously.

CONCLUSION: Adults born prematurely prefer a periviability guideline that considers multiple prognostic factors and allows for discretion.

PMID:37272253 | DOI:10.1111/apa.16866

Scand J Med Sci Sports. 2023 Jun 4. doi: 10.1111/sms.14424. Online ahead of print.

ABSTRACT

Spatiotemporal metrics such as step frequency have been associated with running injuries in some studies. Wearables can measure these metrics and provide real-time feedback in-field, but are often not validated. This study assessed the validity of commercially available wireless instrumented insoles (ARION) for quantifying spatiotemporal metrics during level running at different speeds (2.78-5.0 m s^-1 ,) and slopes (3° and 6° up/downhill) to an instrumented treadmill. Mean raw, percentage and absolute percentage error, and limits of agreement (LoA) were calculated. Agreement was statistically quantified using four thresholds: excellent, <5%; good, <10%; acceptable, <15%; and poor, >15% error. Excellent agreement (<5% error) was achieved for stride time across all conditions, and for step frequency across all but one condition with good agreement. Contact time and swing time generally showed at least good agreement. The mean difference across all conditions was -0.95% for contact time, 0.11% for stride time, 0.6% for swing time, -0.11% for step frequency, and -0.09% when averaged across all outcomes and conditions. The accuracy at an individual level was generally good to excellent, being <10% for all but two conditions, with these conditions being <15%. Additional experiments among four runners showed that step length could also be measured with an accuracy of 1.76% across different speeds with an updated version of the insoles. These findings suggests that the ARION wearable may not only be useful for large-scale in-field studies investigating group differences, but also to quantify spatiotemporal metrics with generally good to excellent accuracy for individual runners.

PMID:37272215 | DOI:10.1111/sms.14424

J Clin Nurs. 2023 Jun 4. doi: 10.1111/jocn.16776. Online ahead of print.

ABSTRACT

AIMS: To identify the barriers and enablers perceived by hospital-based clinicians to providing evidence-based continence care to inpatients.

DESIGN: This was a cross-sectional study of inpatient clinicians using a questionnaire.

METHODS: Acute care and rehabilitation clinicians from 15 wards that admit patients after stroke at 12 hospitals (NSW = 11, Queensland =1, metropolitan = 4, regional = 8) were invited to complete an online questionnaire. The 58 questions (answered on a 5-point Likert scale) were aligned to 13 of the 14 domains of the Theoretical Domains Framework. Results were dichotomized into ‘strongly agree/agree’ and ‘unsure/disagree/strongly disagree’ and proportions were calculated. Data collection occurred between January 2019 and March 2019.

RESULTS: The questionnaire was completed by 291 participants with 88% being nurses. Barriers were found in nine domains including knowledge; skills; memory attention and decision making; emotion; environmental context and resources; behavioural regulation; social professional role; intensions, social influences; and beliefs about capabilities. Enablers were found in seven domains including goals; social influences; knowledge; skills; social, professional role and identity; reinforcement and beliefs about consequences.

CONCLUSION: This multi-site, multi-professional study that included predominantly nurses highlights the barriers and enablers to inpatient continence care. Future implementation studies in inpatient continence management should address these identified barriers and enablers to improve effectiveness of implementation of evidence-based care.

IMPLICATIONS FOR THE PROFESSION: This study highlights that although there are many barriers to ward nurses providing evidence-based continence care, there are also several enablers. Both should be addressed to improve practice.

REPORTING METHOD: We adhered to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) (Supplementary File 1).

RELEVANCE TO CLINICAL PRACTICE: Establishing barriers to practice gives a broader understanding of why practice does not occur and establishes areas where researchers and clinicians need to address in order to change behaviour.

PMID:37272209 | DOI:10.1111/jocn.16776

Int J Gynaecol Obstet. 2023 Jun 4. doi: 10.1002/ijgo.14897. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine the differences in both maternal and neonatal outcomes between flexible and non-flexible sacrum positions at birth.

METHODS: A descriptive, cross-sectional, retrospective study was carried out on a sample of low-risk pregnant women. Univariate and multivariate logistic regressions and multivariate linear regressions were conducted to estimate the association between our discrete or continuous variables of interest. Maternal outcomes were perineal tear, maternal blood loss, second stage length; neonatal outcomes were Apgar scores and neonatal asphyxia. Results were adjusted for maternal age, neonatal birth weight, and epidural analgesia.

RESULTS: We considered for final analysis 2198 women. In primiparous women, women giving birth in the all-fours position were significantly more likely to have an intact perineum (P = 0.011) and a shorter length of the second stage of labor (P = 0.022). Maternal age (P = 0.005) and neonatal weight (P = 0.013) significantly increased perineal tearing; maternal age (P = 0.004) and neonatal birth weight (P < 0.001) were significantly associated with a higher amount of blood loss. Maternal age (P = 0.002) and neonatal weight (P < 0.001) significantly increased the length of the second stage of labor. For multiparous women, the side-lying position was significantly correlated with an intact perineum (P = 0.031); maternal age and intact perineum were statistically inversely associated. Epidural analgesia significantly increased the length of the second stage of labor in both nulliparous (P < 0.001) and pluriparous women (P < 0.001). No significant differences were found in neonatal outcomes.

CONCLUSION: Women with a low-risk labor should be free to choose their birth position as flexible sacrum positions are shown to increase maternal well-being and do not affect neonatal health.

PMID:37272201 | DOI:10.1002/ijgo.14897

Clin Anat. 2023 Jun 4. doi: 10.1002/ca.24061. Online ahead of print.

ABSTRACT

Our study aimed to evaluate the hip joints of healthy children aged 2-13 years morphometrically through radiographic images. Demographic characteristics of 300 healthy children in our study include an average age of 6.4 years old based on the 2-to-13-year-old bracket and sex classified to 133 girls and 167 boys. A total of 600 normal hips from these children were digitally measured based on Acetabular Index, ACM angle, MZ distance, Sharp angle, CE angle, Femoral Head Coverage Ratio, Cranial, and medial joint space (MJS). *p < 0.05; **p < 0.01 indicated a statistically significant difference. It was found that Acetabular Index, ACM angle, MZ distance, Sharp angle, Cranial, and MJSs decreased with age; Acetabular Depth value and CE angle increased with age; the CE angle differed between the sides (right-left) in the young teens period and in boys; and the cranial joint space (CJS) differed between the sides in girls. In addition, girls had higher values than boys in terms of Acetabular Index, ACM angle, Sharp angle, MZ distance, and Femoral Head Coverage Ratio; CE angle and MJS were higher in girls; and Acetabular Depth Value and CJS did not differ significantly between sexes. Obtaining the normal values will guide in the diagnosis and treatment of many clinical conditions including DDH and Legg-Calve-Perthes disease. It can also be used to compare the hips between healthy children and those diagnosed with Cerebral Palsy.

PMID:37272199 | DOI:10.1002/ca.24061

J Sci Food Agric. 2023 Jun 4. doi: 10.1002/jsfa.12762. Online ahead of print.

ABSTRACT

BACKGROUND: Climate changes associated to global warming are increasingly affecting the quality of cultivated crops. Cultivation at different altitudes and similar latitudes may offer an extraordinarily useful opportunity to trigger changes in climate variables and to further investigate their effect on crop quality. This study evaluated the effect of climatic indices, calculated using temperature, rainfall precipitation and solar radiation data, on commercial parameters and volatile organic compounds (VOCs) profile of wheat at harvest.

RESULTS: Three common and durum wheat varieties, including two heritage wheat, were sown in experimental fields sited at three altitudes for three consecutive years and analysed for their yield, grading parameters and VOCs profiles. The datasets were processed by partial least square regression (PLS-R) and the results indicate that summer days (SU25) and diurnal temperature range (ΔT) are the climatic indices mainly responsible for VOCs profile changes in both common and durum wheat. Accumulated growth degree days (GDD), consecutive dry days (CDD) and accumulated solar radiation (ASR) induced species-specific responses. Terpenes represented the chemical class of VOCs most affected by stresses followed by ketones, and alcohols, which were affected by CDD, GDD and ASR.

CONSLUSION: This study showed a selective response of wheat to abiotic stresses associated with climate variables in terms of VOCs synthesis. The findings reported may be of relevance in several fields, from plant ecology to agronomy and food quality with final implication in local economy strategies. This article is protected by copyright. All rights reserved.

PMID:37272187 | DOI:10.1002/jsfa.12762

Zhongguo Dang Dai Er Ke Za Zhi. 2023 May 15;25(5):508-515. doi: 10.7499/j.issn.1008-8830.2301015.

ABSTRACT

OBJECTIVES: To investigate the distribution characteristics and correlation of intestinal and pharyngeal microbiota in early neonates.

METHODS: Full-term healthy neonates who were born in Shanghai Pudong New Area Maternal and Child Health Hospital from September 2021 to January 2022 and were given mixed feeding were enrolled. The 16S rRNA sequencing technique was used to analyze the stool and pharyngeal swab samples collected on the day of birth and days 5-7 after birth, and the composition and function of intestinal and pharyngeal microbiota were analyzed and compared.

RESULTS: The diversity analysis showed that the diversity of pharyngeal microbiota was higher than that of intestinal microbiota in early neonates, but the difference was not statistically significant (P>0.05). On the day of birth, the relative abundance of Proteobacteria in the intestine was significantly higher than that in the pharynx (P<0.05). On days 5-7 after birth, the relative abundance of Actinobacteria and Proteobacteria in the intestine was significantly higher than that in the pharynx (P<0.05), and the relative abundance of Firmicutes in the intestine was significantly lower than that in the pharynx (P<0.05). At the genus level, there was no significant difference in the composition of dominant bacteria between the intestine and the pharynx on the day of birth (P>0.05), while on days 5-7 after birth, there were significant differences in the symbiotic bacteria of Streptococcus, Staphylococcus, Rothia, Bifidobacterium, and Escherichia–Shigella between the intestine and the pharynx (P<0.05). The analysis based on the database of Clusters of Orthologous Groups of proteins showed that pharyngeal microbiota was more concentrated on chromatin structure and dynamics and cytoskeleton, while intestinal microbiota was more abundant in RNA processing and modification, energy production and conversion, amino acid transport and metabolism, carbohydrate transport and metabolism, coenzyme transport and metabolism, and others (P<0.05). The Kyoto Encyclopedia of Genes and Genomes analysis showed that compared with pharyngeal microbiota, intestinal microbiota was more predictive of cell motility, cellular processes and signal transduction, endocrine system, excretory system, immune system, metabolic diseases, nervous system, and transcription parameters (P<0.05).

CONCLUSIONS: The composition and diversity of intestinal and pharyngeal microbiota of neonates are not significantly different at birth. The microbiota of these two ecological niches begin to differentiate and gradually exhibit distinct functions over time.

PMID:37272178 | DOI:10.7499/j.issn.1008-8830.2301015

Clin Chem Lab Med. 2023 Jun 5. doi: 10.1515/cclm-2023-0040. Online ahead of print.

ABSTRACT

OBJECTIVES: Upper reference limits of high-sensitivity cardiac troponin T (hs-cTnT) are derived from healthy, population-based cohorts, and are frequently exceeded in hospitalized patients. In this study we aim to systematically examine the differences between in-hospital patients with no diagnosed cardiac diseases and a population-based cohort.

METHODS: Retrospective analyses were performed in two independent cohorts. We included 5,652 participants of the prospective population-based LIFE cohort as well as 9,300 patients having been treated at our hospital between 2014 and 2021. In both cohorts, subjects with diagnosed or suspected cardiac diseases were excluded. We used Spearman’s rank correlation for correlation analyses of hs-cTnT serum concentrations and age. Sex- and age-adjusted 99th percentiles for hs-cTnT in subjects with preserved renal function were obtained in both cohorts.

RESULTS: In both cohorts, hs-cTnT serum concentrations positively correlated with age. Male sex was associated with higher hs-cTnT serum concentrations. Persons treated in hospital showed significantly higher hs-cTnT concentrations in females and males aged above 50. While in the population-based cohort only 99th percentile hs-cTnT results of females aged above 70 and males aged above 60 years exceeded the assay’s upper reference limit, the 99th percentiles of in-hospital females over 40 years and males of all age groups exceeded this threshold.

CONCLUSIONS: Besides age and sex, hospitalization per se is correlated with higher serum concentrations of hs-cTnT in most age groups. Our results indicate, that unconditionally applying current hs-cTnT cut-offs to inpatients might overestimate myocardial infarction and potentially lead to overdiagnosis.

PMID:37272166 | DOI:10.1515/cclm-2023-0040

Turk Kardiyol Dern Ars. 2023 Jun;51(4):241-249. doi: 10.5543/tkda.2023.62296.

ABSTRACT

OBJECTIVE: This study sought to assess the prevalence and identify factors associated with depression among patients with cardiovascular diseases and followed-up in a public teaching hospital.

METHODS: A cross-sectional study was conducted with a systematic random sample of 302 out-patients with cardiovascular diseases and followed-up in the cardiology outpatient department at Tripoli University Hospital. Stable adults (>18 years of age) were eligible to be included in this study. Face-to-face interviews were conducted to complete a questionnaire comprising questions on demographic, medical, and lifestyle issues besides the Patient Health Questionnaire-9 tool. Statistical Package for the Social Sciences, Version 22, was used to analyze the data.

RESULTS: Age ranged between 29 and 84 years with a mean age of 60.6 ± 10.4 years; 60.6% were females and 75.8% were married. The highest prevalent morbidity was hypertension (76.2%) followed by diabetes mellitus (48%), ischemic heart disease (39%), and different types of arrhythmias (22.8%). About 59.3% of screened patients had different degrees of depression from mild to severe. The participants with a positive history of psychological problems, those complicated with cardiomyopathy, those who were females, patients with a history of cerebrovascular accident, and patients who were living alone were more likely to be depressed.

CONCLUSION: Prevalence of depression is found to be higher among patients with cardiovascular diseases and a family history of psychological illnesses, and cardiomyopathy had the highest contribution as independent predictor for depression. Screening of all patients with cardiovas-cular diseases is essential to identify and treat the patients at greater risk of depression.

PMID:37272156 | DOI:10.5543/tkda.2023.62296

J Contemp Dent Pract. 2023 Feb 1;24(2):107-112. doi: 10.5005/jp-journals-10024-3431.

ABSTRACT

AIM: The aim of the present study was to evaluate labiopalatal angulation of maxillary anterior teeth using Custom-made jig, Profile projector, and ImageJ computer software methods.

MATERIALS AND METHODS: The subjects for this study were selected in the age-group of 20-30 years having permanent dentition, including 2nd molars and bilateral Angle’s class 1 molar and canine relationship. Recording the labiopalatal angulation in proximal view was carried out by using one manual method and two digital methods namely using Custom-made jig, Profile projector, and ImageJ computer software, respectively. Alginate impressions were made for the subjects, and the spatial relationship of the maxilla to the cranium was recorded using a facebow. The casts were mounted in a semi-adjustable articulator, and the articulated mounted casts with the mounting ring were transferred to the Custom-made jig, and angulations were measured in proximal view. Digital methods of measurement were recorded by using Profile projector and ImageJ computer software methods. Data were tabulated and statistically analyzed.

RESULTS: In males, the mean labiopalatal angulation of maxillary right and left maxillary canines of Custom-made jig was 91.94 ± 1.47 and 91.70 ± 1.68, in Profile projector method 87.41 ± 3.75 and 87.58 ± 3.79, and in ImageJ computer software 84.23 ± 5.72 and 83.29 ± 6.74, respectively. In females, Custom-made jig was 91.82 ± 1.55 and 92.17 ± 1.84, in Profile projector method 86.70 ± 5.58 and 86.94 ± 5.57, and in ImageJ computer software 82.76 ± 6.34 and 83.05 ± 6.12, respectively. There was a very high statistically significant difference found between different methods.

CONCLUSION: In conclusion, the values obtained in the digital methods (i.e., both the Profile projector and ImageJ computer software) were more accurate than the manual method. However, the ImageJ computer software was most reliable in comparison with the values obtained in Profile projector.

CLINICAL SIGNIFICANCE: The labiopalatal angulation of anterior teeth will act as a guideline in re-establishing the correct angulations and the anatomic contours of the maxillary arch to achieve the desired esthetics that provide adequate lip support and to restore the required functions.

PMID:37272142 | DOI:10.5005/jp-journals-10024-3431