Nevin Manimala

J Neurotrauma. 2022 Oct 19. doi: 10.1089/neu.2022.0300. Online ahead of print.

ABSTRACT

Recent investigations have identified water polo athletes as at risk for concussions and repetitive subconcussive head impacts. However, head impact exposure in collegiate varsity women’s water polo has not yet been longitudinally quantified. We aimed to determine the relationship between cumulative and acute head impact exposure across preseason training and changes in serum biomarkers of brain injury. Twenty-two Division I collegiate women’s water polo players were included in this prospective observational study. They wore sensor-installed mouthguards during all practices and scrimmages during eight weeks of preseason training. Serum samples were collected at six time points (at baseline, before and after scrimmages during week 4 and 7, and after the eight-week preseason training period) and assayed for neurofilament light (NfL) and glial fibrillary acidic protein (GFAP) using Simoa® Human Neurology 2-Plex B assay kits. Serum GFAP increased over time (e.g., an increase of 0.6559 pg/mL per week; p = 0.0087). However, neither longitudinal nor acute pre-post scrimmage changes in GFAP were associated with head impact exposure. Contrarily, an increase in serum NfL across the study period was associated with cumulative head impact magnitude (sum of peak linear acceleration: B = 0.015, SE = 0.006, p = 0.016; sum of peak rotational acceleration: B = 0.148, SE = 0.048, p = 0.006). Acute changes in serum NfL were not associated with head impacts recorded during the two selected scrimmages. Hormonal contraceptive use was associated with lower serum NfL and GFAP levels over time, and elevated salivary levels of progesterone were also associated with lower serum NfL levels. These results suggest that detecting increases in serum NfL may be a useful way to monitor cumulative head impact burden in women’s contact sports and that female-specific factors, such as hormonal contraceptive use and circulating progesterone levels, may be neuroprotective, warranting further investigations.

PMID:36259456 | DOI:10.1089/neu.2022.0300

Int J Nurs Pract. 2022 Oct 19:e13109. doi: 10.1111/ijn.13109. Online ahead of print.

ABSTRACT

AIM: The aim of this study was to adapt the Nurse Turnover Intention Scale to Turkish and test its validity and reliability.

METHODS: This methodological study was conducted with 200 nurses. The Personal Information Form and the Nurse Turnover Intention Scale were used for data collection between November and December 2021. Language and content validity, explanatory and confirmatory factor analysis, criterion validity, Cronbach’s alpha coefficient, item-total score correlation and test-retest reliability methods were used for the validity and reliability analysis of the scale.

RESULTS: Exploratory factor analysis showed that the Nurse Turnover Intention Scale had a single factor. Its single factor structure was confirmed using confirmatory factor analysis. Cronbach’s alpha coefficient of the scale was 0.902, and factor loading was between 0.60 and 0.78. Statistical analyses indicated that each item in the Turkish version of the scale had a high internal consistency. The test-retest correlation value was found as p < 0.05.

CONCLUSION: The Nurse Turnover Intention Scale has been confirmed to be a suitable, valid and reliable measurement tool for Turkish society. Nurse turnover intention is the most powerful predictor of actual turnover within the nursing profession. This scale will help to easily attain valid and reliable outcomes.

PMID:36259444 | DOI:10.1111/ijn.13109

Oral Health Prev Dent. 2022 Oct 19;20(1):363-368. doi: 10.3290/j.ohpd.b3464893.

ABSTRACT

PURPOSE: The aim of this study was to investigate the possible association between periodontitis and preterm birth in Ivory Coast.

MATERIALS AND METHODS: A cohort study including 446 volunteers (pregnant women) aged 15-50 years was performed in the Gynecology-Obstetrics Department of the University Hospital Center of Cocody-Abidjan in Ivory Coast. Socioeconomic and periodontal status was obtained during pregnancy. After delivery, obstetric data was collected. Periodontitis was diagnosed according to the new 2018 EFP/AAP classification of Periodontal and Peri-Implant Diseases and Conditions, as follows: a subject presenting with interdental CAL at two non-adjacent teeth or buccal/oral CAL ≥ 3 mm with pocketing > 3 mm was diagnosed with periodontitis. Any birth before the 37th week was considered a preterm birth (PTB).

RESULTS: The prevalence of periodontitis and preterm birth were 59.47% and 18.34%, respectively. Periodontitis was mainly stage 1. PTB was statistically significantly higher in pregnant women with periodontitis compared to women without periodontitis (p = 0.0002). Multivariate analysis showed that periodontitis was associated with PTB (p = 0.0002). Logistic regression showed that periodontitis is a risk factor for preterm birth (OR = 3.62; 95% CI: 1.80-7.31; p = 0.0003).

CONCLUSION: The results of this study suggest that periodontitis is an additional risk factor for preterm birth in Ivory Coast.

PMID:36259439 | DOI:10.3290/j.ohpd.b3464893

Oral Health Prev Dent. 2022 Oct 19;20(1):349-353. doi: 10.3290/j.ohpd.b3464887.

ABSTRACT

PURPOSE: To determine the prevalence of COVID-19 infection among dental professionals at an Academic Center in Madrid (Spain) at the beginning of the pandemic’s de-escalation phase.

MATERIALS AND METHODS: A cross-sectional study was designed. COVID-19 infection was determined by membrane-based immunoassay qualitative detection of IgG and IgM antibodies in human whole blood. Age, sex, race and professional qualification were recorded, as were symptoms compatible with COVID-19 infection whenever present. Data collected were analysed by means of descriptive and qualitative (X2) statistical analyses.

RESULTS: A total of 195 individuals were included (40 administrative professionals and 155 dentists). Seroprevalence at the end of the de-escalation phase was 20.0% among all the participants. The highest prevalence was found among the orthodontists (34.8%), followed by the paediatric dentists (28.6%) and oral surgeons (14.7%). Most subjects were positive for IgG and negative for IgM (79.5%).

CONCLUSIONS: The seroprevalence of SARS-CoV-2 among dental professionals at the end of the de-escalation phase after the first wave of the pandemic was almost double the seroprevalence of the general population. Orthodontists had the highest rates of SARS-CoV-2 infection.

PMID:36259437 | DOI:10.3290/j.ohpd.b3464887

Ann Ital Chir. 2022 Sep 5;11:S0003469X22037721. Online ahead of print.

ABSTRACT

AIM: The aim of this study was to compare the increase in the number of complicated cases in patients who underwent surgery for acute appendicitis during the COVID-19 pandemic and the previous year.

MATERIAL AND METHODS: A retrospective examination was made of the files of patients who presented at the Emergency Department and were diagnosed with acute appendicitis and underwent surgery within 24 hours or were followed up between 11 March and 1 June 2020 during the COVID-19 pandemic, and in the same period in the previous year. The patients in the pandemic period were named the pandemic group (PG) and the patients from the previous year, the control group (CG). The definition of complicated appendicitis included peri-appendicular abscess and perforated appendix.

RESULTS: The number of patients in the PG was 38.33% lower than in the CG. The duration of symptoms was 2 days in the PG and 1 day in the CG, and the difference was statistically significant (p=0.001). The mean neutrophil count was determined to be higher in the PG than in the CG (p=0.018). The rate of perforated appendix was determined to be 10.9 higher in the PG than in the CG.

CONCLUSION: The number of patients presenting at the Emergency Department reduced during the pandemic, especially during periods of lockdown, and it was seen that fewer but more complicated patients presented at our centre.

KEY WORDS: Acute appendicitis, COVID-19, Perforation.

PMID:36259431

J Am Geriatr Soc. 2022 Oct 19. doi: 10.1111/jgs.18039. Online ahead of print.

ABSTRACT

BACKGROUND: Older patients with poor prognosis cancers have complex needs that can benefit from geriatrics and palliative care principles. Because they are not routinely assessed, the prevalence of preexisting geriatric and palliative conditions in this population is unknown.

METHODS: We used the nationally representative Health and Retirement Study (HRS) linked with Medicare claims (1998-2016) to identify adults aged ≥65 years diagnosed with poor prognosis cancers (cancers with a median survival ≤1 year). Using the HRS interview before the first Medicare cancer claim, we used survey-weighted descriptive statistics and modified Poisson regression analysis to examine the prevalence of the following clinically significant conditions: functional impairment, difficulty with mobility, falls and injurious falls, social support, cognition, advance care planning, use of pain or sleep medications, and presence of pain or breathlessness.

RESULTS: Of 2105 participants (mean age 76, 53% women, 34% lung cancer, 21% gastrointestinal cancer), the median survival was 9.6 months. Approximately 65% had difficulty climbing stairs (95% CI 63%-67%), 49% had no advance directive (95% CI 45%-54%), 35% lived alone (95% CI 33%-37%), 36% fell in the last 2 years (95% CI 34%-38%), and 32% rated their memory as poor (95% CI 29%-34%). After adjusting for gender, cancer type, and HRS survey time before the first Medicare claim for a poor prognosis cancer, functional impairment and falls were highest among adults aged 85+. Adults aged 65-74 years were less likely to have an advance directive. After adjusting for age, cancer type, and HRS survey time, women had a higher rate of pain and physical impairment. In exploratory analyses, race and socioeconomic status predicted difficulty with mobility and instrumental activities of daily living, living alone, and advance directive completion.

CONCLUSIONS: Due to a high prevalence across multiple domains, all older adults with poor prognosis cancers should be assessed for geriatric and palliative care conditions.

PMID:36259424 | DOI:10.1111/jgs.18039

Br J Radiol. 2022 Oct 19:20220634. doi: 10.1259/bjr.20220634. Online ahead of print.

ABSTRACT

OBJECTIVES: To provide ultrasound baselines for spleen length in homozygous sickle cell disease (HbSS) and in normal controls with a HbAA genotype.

METHODS: The Jamaican cohort study identified 311 babies with HbSS and 246 matched HbAA controls during the screening of 100,000 consecutive deliveries in Kingston, Jamaica from 1973 to 1981. Ultrasonography commenced in 1988 when the youngest patients were aged 6 years at which time deaths, emigrations and default had reduced the numbers to 206 HbSS and 89 controls. It continued annually until 2000.

RESULTS: The spleen was visualized in all HbAA controls but in only 1103/2138 (52%) scans in HbSS. Where available, mean splenic lengths were significantly lower in HbSS (77-103 mm in males, 70-83 mm in females) compared to normal controls (89-101 mm in males, 86-95 mm in females). Assessed by statistical modelling after adjusting for body height, the splenic ratio (splenic length/body height) declined over the age range 12-20 years in HbSS, consistent with progressive splenic fibrosis. Genetic factors known to inhibit sickling, α thalassaemia and fetal haemoglobin level (HbF) significantly reduced the decline in splenic ratio. Clinical splenomegaly was an insensitive measure of splenic enlargement as only 50% of patients aged 18 years and above with spleens measuring ≥150 mm on ultrasonography had palpable spleens.

CONCLUSIONS: An age-related decline in splenic length occurred in HbSS and occurred more slowly with genetic factors known to inhibit sickling. The standards provided may be of value in assessing minor degrees of subclinical acute splenic sequestration. (241 words).

ADVANCES IN KNOWLEDGE: These are the first standards available for splenic length in HbSS. They may be useful in detecting red cell sequestration, not apparent from clinical splenomegaly and also provide a model for identifying factors inhibiting vaso-occlusion.

PMID:36259419 | DOI:10.1259/bjr.20220634

Forum Health Econ Policy. 2022 Oct 19. doi: 10.1515/fhep-2021-0035. Online ahead of print.

ABSTRACT

This study aims to investigate the association between gross domestic product (GDP), mortality rate (MR) and current healthcare expenditure (CHE) in 31 high-income countries. We used panel data from 2000 to 2017 collected from WHO and OECD databases. The association between CHE, GDP and MR was investigated through a random-effects model. To control for reverse causality, we adopted a test of Granger causality. The model shows that the MR has a statistically significant and negative effect on CHE and that an increase in GDP is associated with an increase of CHE (p < 0.001). The Granger causality analysis shows that all the variables exhibit a bidirectional causality. We found a two-way relationship between GDP and CHE. Our analysis highlights the economic multiplier effect of CHE. In the debate on the optimal allocation of resources, this evidence should be taken into due consideration.

PMID:36259392 | DOI:10.1515/fhep-2021-0035

Vox Sang. 2022 Oct 19. doi: 10.1111/vox.13370. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Donor criteria for diabetes vary significantly. We describe our evolving policies for donors with diabetes, their contribution to the Canadian blood supply and their rate of syncopal reactions compared to other donors.

MATERIALS AND METHODS: All donors are asked if they have diabetes and have taken medications in the last 3 days. We assessed donors with diabetes on various medications, the number deferred over time, and syncopal reactions in donors with diabetes and other donors in our donor reaction database.

RESULTS: Policy changes allowing type 2 diabetic donors on oral hypoglycaemics alone, type 2 diabetic donors on oral medications and insulin and type 1 diabetic donors (all on insulin) to donate resulted in a decrease in deferrals from 450 to 22 donors annually. Of donors being treated with medication for diabetes, 11% are receiving insulin as part of their treatment. Syncopal reaction rates were low and not statistically different between diabetic and non-diabetic donors, although confidence intervals (CIs) are large.

CONCLUSION: Policies decreased deferrals while maintaining safety. A longer observation period would strengthen these observations.

PMID:36259374 | DOI:10.1111/vox.13370

Med Decis Making. 2022 Oct 19:272989X221132257. doi: 10.1177/0272989X221132257. Online ahead of print.

ABSTRACT

OBJECTIVES: Immuno-oncology (IO) therapies are often associated with delayed responses that are deep and durable, manifesting as long-term survival benefits in patients with metastatic cancer. Complex hazard functions arising from IO treatments may limit the accuracy of extrapolations from standard parametric models (SPMs). We evaluated the ability of flexible parametric models (FPMs) to improve survival extrapolations using data from 2 trials involving patients with non-small-cell lung cancer (NSCLC).

METHODS: Our analyses used consecutive database locks (DBLs) at 2-, 3-, and 5-y minimum follow-up from trials evaluating nivolumab versus docetaxel in patients with pretreated metastatic squamous (CheckMate-017) and nonsquamous (CheckMate-057) NSCLC. For each DBL, SPMs, as well as 3 FPMs-landmark response models (LRMs), mixture cure models (MCMs), and Bayesian multiparameter evidence synthesis (B-MPES)-were estimated on nivolumab overall survival (OS). The performance of each parametric model was assessed by comparing milestone restricted mean survival times (RMSTs) and survival probabilities with results obtained from externally validated SPMs.

RESULTS: For the 2- and 3-y DBLs of both trials, all models tended to underestimate 5-y OS. Predictions from nonvalidated SPMs fitted to the 2-y DBLs were highly unreliable, whereas extrapolations from FPMs were much more consistent between models fitted to successive DBLs. For CheckMate-017, in which an apparent survival plateau emerges in the 3-y DBL, MCMs fitted to this DBL estimated 5-y OS most accurately (11.6% v. 12.3% observed), and long-term predictions were similar to those from the 5-y validated SPM (20-y RMST: 30.2 v. 30.5 mo). For CheckMate-057, where there is no clear evidence of a survival plateau in the early DBLs, only B-MPES was able to accurately predict 5-y OS (14.1% v. 14.0% observed [3-y DBL]).

CONCLUSIONS: We demonstrate that the use of FPMs for modeling OS in NSCLC patients from early follow-up data can yield accurate estimates for RMST observed with longer follow-up and provide similar long-term extrapolations to externally validated SPMs based on later data cuts. B-MPES generated reasonable predictions even when fitted to the 2-y DBLs of the studies, whereas MCMs were more reliant on longer-term data to estimate a plateau and therefore performed better from 3 y. Generally, LRM extrapolations were less reliable than those from alternative FPMs and validated SPMs but remained superior to nonvalidated SPMs. Our work demonstrates the potential benefits of using advanced parametric models that incorporate external data sources, such as B-MPES and MCMs, to allow for accurate evaluation of treatment clinical and cost-effectiveness from trial data with limited follow-up.

HIGHLIGHTS: Flexible advanced parametric modeling methods can provide improved survival extrapolations for immuno-oncology cost-effectiveness in health technology assessments from early clinical trial data that better anticipate extended follow-up.Advantages include leveraging additional observable trial data, the systematic integration of external data, and more detailed modeling of underlying processes.Bayesian multiparameter evidence synthesis performed particularly well, with well-matched external data.Mixture cure models also performed well but may require relatively longer follow-up to identify an emergent plateau, depending on the specific setting.Landmark response models offered marginal benefits in this scenario and may require greater numbers in each response group and/or increased follow-up to support improved extrapolation within each subgroup.

PMID:36259353 | DOI:10.1177/0272989X221132257