Nevin Manimala

J Orthop Surg Res. 2023 Mar 18;18(1):213. doi: 10.1186/s13018-023-03702-y.

ABSTRACT

BACKGROUND: Distal first metatarsal osteotomy is used to correct mild or moderate hallux valgus (HV). We designed a cadaveric study to compare the resistance to axial load between two percutaneous distal first metatarsal osteotomies: Bösch osteotomy and percutaneous chevron. The first aim of this study was to develop a systematic technique for measuring the sagittal displacement on lateral foot X-rays. Our second objective was to measure the resistance to axial load for both of these osteotomies.

METHODS: Ten pairs of freshly frozen cadaveric feet were randomly assigned to one of the two techniques investigated. Pre- and post-operative lateral X-rays were obtained. After surgery, the feet were placed under progressive axial loads up to 60 kg. Metaphyseo-diaphyseal angle (MDA) and the distance between bone fragments were measured, and the differences between the two techniques were statistically assessed.

RESULTS: The MDA decreased in both surgical techniques. The mean plantar tilt was -6.90 degrees (SD = 10.251) for chevron osteotomy and -5.34 degrees (SD = 16.621) for Bösch osteotomy. There was no significant difference between the techniques (p = 0.41). Regarding the distance between the bone fragments, the Bösch osteotomy produced more plantar displacement than the chevron osteotomy, which was statistically significant for the 10 and 20 kg loads (p = 0.031 and 0.04, respectively). At loads ≥ 30 kg, the bone fragment distance did not differ significantly between the techniques (p = 0.114).

CONCLUSIONS: Although the chevron technique confers higher stability regarding fragment displacement during axial loading, both techniques increase the plantar angulation of the metatarsal head.

LEVEL OF EVIDENCE: Cadaveric study.

PMID:36934263 | DOI:10.1186/s13018-023-03702-y

BMC Health Serv Res. 2023 Mar 18;23(1):269. doi: 10.1186/s12913-023-09116-0.

ABSTRACT

BACKGROUND: Individuals experiencing multimorbidity have more complex healthcare needs, use more healthcare services, and access multiple service providers across the healthcare continuum. They also experience higher rates of functional decline. Rehabilitation therapists are well positioned to address these functional needs; however, little is known about the influence of rehabilitation therapy on patient outcomes, and subsequent unplanned healthcare utilization for people with multimorbidity. The aims of this study were to: 1) describe and compare the characteristics of people with multimorbidity receiving: home care rehabilitation therapy alone, other home care services without rehabilitation therapy, and the combination of home care rehabilitation therapy and other home care services, and 2) determine the association between home care rehabilitation therapy and subsequent healthcare utilization among those recently discharged from an acute care unit.

METHODS: This retrospective cohort study used linked health administrative data housed within ICES, Ontario, Canada. The cohort included long-stay home care clients experiencing multimorbidity who were discharged from acute care settings between 2007-2015 (N = 43,145). Descriptive statistics, ANOVA’s, t-tests, and chi-square analyses were used to describe and compare cohort characteristics. Multivariable logistic regression was used to understand the association between receipt of rehabilitation therapy and healthcare utilization.

RESULTS: Of those with multimorbidity receiving long-stay home care services, 45.5% had five or more chronic conditions and 46.3% required some assistance with ADLs. Compared to people receiving other home care services, those receiving home care rehabilitation therapy only were less likely to be readmitted to the hospital (OR = 0.78; 95% CI: 0.73-0.83) and use emergency department services (OR = 0.73; 95% CI: 0.69-0.78) within the first 3-months following hospital discharge.

CONCLUSIONS: Receipt of rehabilitation therapy was associated with less unplanned healthcare service use when transitioning from hospital to home among persons with multimorbidity. These findings suggest rehabilitation therapy may help to reduce the healthcare burden for individuals and health systems. Future research should evaluate the potential cost savings and health outcomes associated with providing rehabilitation therapy services for people with multimorbidity.

PMID:36934243 | DOI:10.1186/s12913-023-09116-0

BMC Pregnancy Childbirth. 2023 Mar 18;23(1):189. doi: 10.1186/s12884-023-05500-0.

ABSTRACT

BACKGROUND: Acute pancreatitis in pregnancy (APIP) with a high risk of death is extremely harmful to mother and fetus. There are few models specifically designed to assess the severity of APIP. Our study aimed to establish a clinical model for early prediction of severity of APIP.

METHODS: A retrospective study in a total of 188 patients with APIP was enrolled. The hematological indicators, IAP (intra-abdominal pressure) and clinical data were obtained for statistical analysis and prediction model construction.

RESULTS: According to univariate and multivariate logistic regression analysis, we found that red cell distribution width (RDW), neutrophil-lymphocyte ratio (NLR) and Intra-abdominal pressure (IAP) are prediction indexes of the severity in APIP (p-value < 0.05). Our novel clinical prediction model was created by based on the above three risk factors and showed superior predictive power in primary cohort (AUC = 0.895) and validation cohort (AUC = 0.863). A nomogram for severe acute pancreatitis in pregnancy (SAPIP) was created based on the three indicators. The nomogram was well-calibrated.

CONCLUSION: RDW, NLR and IAP were the independent risk factors of APIP. Our clinical prediction model of severity in APIP based on RDW, NLR and IAP with predictive evaluation is accurate and effective.

PMID:36934238 | DOI:10.1186/s12884-023-05500-0

BMC Oral Health. 2023 Mar 18;23(1):156. doi: 10.1186/s12903-023-02845-y.

ABSTRACT

BACKGROUND AND AIM: Lack of knowledge on COVID-19 among people and healthcare staff significantly impacts late management and its rapid transmission. Dental students must be aware of the exact preventive instructions due to their close contact with patients and clinical work in the dental setting during the pandemic. This interventional study aimed to investigate the effectiveness of designed educational content regarding COVID-19 on Iranian dental students’ knowledge, attitudes, and practices at Alborz University of medical sciences.

MATERIALS AND METHODS: A total of 88 dental students were investigated in this study. Educational content was designed based on the clinical guidelines regarding COVID-19 in dentistry. The content was presented to dental students as a three-hour webinar. In addition, the online, validated questionnaire was obtained from the students as pre, post, and follow-up surveys.

RESULTS: A statistically significant difference between students’ knowledge, attitudes, and practices were obtained before and after the intervention and the follow-up survey. 48.58% improvement in knowledge score, 6.37% in attitudes, and 17% in practice scores were observed.

CONCLUSION: Although this educational intervention significantly improved the knowledge, attitude, and practice of dental students, additional education and clinical training are mandatory for effective and safe dental practice management in future crises.

PMID:36934228 | DOI:10.1186/s12903-023-02845-y

BMC Geriatr. 2023 Mar 18;23(1):150. doi: 10.1186/s12877-023-03759-8.

ABSTRACT

BACKGROUND: Frailty is associated with mortality among older adults. We aimed to determine the appropriate time and frailty index (FI) threshold for frailty intervention in Chinese community-dwelling older adults.

METHODS: In this prospective cohort study, we used data from the 2011 wave of the Chinese Longitudinal Healthy Longevity Study. Follow-up was performed for seven years from baseline. Using the FI to evaluate frailty and define frailty status, we explored the best time point and FI score for frailty intervention, by comparing the relationships of FI and frailty status with mortality.

RESULTS: From 2011 to 2018, 8642 participants were included and followed-up. A total of 4458 participants died during the study period. After adjusting for variables such as age, sex, marital status, education level, and living conditions, the hazard ratio (HR) of mortality risk based on the FI at baseline was 37.484 (95% confidence interval [CI]: 30.217-46.498; P < 0.001); female sex, living in the city, being married, and living with spouse were found to be protective factors, whereas ageing was a risk factor for frailty. The mortality risk was higher in pre-frail than in frail participants (HR: 3.588, 95% CI: 3.212-4.009, P < 0.001). Piecewise linear regression analysis revealed an FI score threshold of 0.5. When the FI score was > 0.5, the HR of mortality based on the FI was 15.758 (95% CI: 3.656-67.924; P < 0.001); when the FI score was ≤ 0.5, the HR of mortality based on the FI was 48.944 (95% CI: 36.162-66.244; P < 0.001).

CONCLUSION: Using FI as a continuous variable to predict death is more accurate than frailty status. The advancement of early interventions for mortality risk reduction is more beneficial in pre-frail than in frail patients, and an FI score of 0.5 was found to be the threshold for mortality prediction using the FI.

PMID:36934220 | DOI:10.1186/s12877-023-03759-8

BMC Public Health. 2023 Mar 18;23(1):524. doi: 10.1186/s12889-023-14997-1.

ABSTRACT

BACKGROUND: In Nepal and across the globe, the COVID-19 pandemic has primed an environment for increased rates of violence against women (VAW). This paper explores pandemic-driven economic insecurity and increased alcohol use as instigators of VAW and Intimate Partner Violence (IPV) within newly married households in the rural, Nawalparasi region of Nepal.

METHODS: This study is a secondary analysis of data obtained from the Sumadhur Intervention pilot study that has been previously described and demonstrates successful implementation of group-based, household-level intervention for women’s empowerment and sexual and reproductive health education (1). Our three sets of data were collected before and during the COVID-19 pandemic. The first set is from a Longitudinal Cohort of 200 newly married women who were surveyed twice a year from February 2017 through July 2020. The second data set is a subset cohort of newly married women, their husbands, and their mothers-in-law (31 women, 31 husbands and 31 mothers-in-law) who participated in Sumadhur in January 2021. The third data set was obtained through in-depth interviews in July 2021 from 15 households following Sumadhur. The interviews were thematically coded, and subthemes were identified. A t-test of the January 2021 survey data set was run to look at correlations between income loss, alcohol consumption and experience of IPV among newly married women. All other survey data was analyzed for change over time.

RESULTS: At three months after the onset of the pandemic (July 2020), the Longitudinal Cohort survey data from newly married women reported increased rates of husbands’ alcohol use as well as personal experiences of IPV as compared to pre-pandemic averages. There was a statistically significant difference (p < 0.001) in the effects of income loss on increased alcohol use and experience of IPV. Qualitative results iterated the common theme of alcohol use and economic insecurity as upstream instigators of VAW in the community.

CONCLUSIONS: In the Nawalparasi district of Nepal, the pandemic has led to unstable economic situations that have instigated alcohol use among men, and increased rates of IPV among young, newly married women, and reports of VAW in the community. We have demonstrated a need for urgent programmatic and policy responses aimed at reducing VAW and IPV and protecting women during times of uncertainty and crisis.

PMID:36934217 | DOI:10.1186/s12889-023-14997-1

Breast Cancer. 2023 Mar 18. doi: 10.1007/s12282-023-01447-4. Online ahead of print.

ABSTRACT

INTRODUCTION: Surgical options for post-mastectomy breast reconstruction (PMBR) have increased and become more diverse. These options may cause difficulty and stress for patients in making the best choice, and this also increases the likelihood of postoperative regret over a particular decision. To solve this issue, implementation of shared decision-making (SDM) using a decision aid (DA) has become of increasing interest. We have created the first prototype DA in Japan. The aim of the current field study was to assess the usability of this DA in promoting effective SDM and avoiding regret over a decision to undergo reconstructive surgery.

METHODS: A total of 25 consecutive patients who underwent BR were enrolled in the study, including 13 with SDM using the decision aid (DA + group) and 12 who received standard information (DA- group) before their choice of surgery. The Decision Regret Scale (DRS) were completed after PMBR, whereas SDM Questionnaire (SDM-Q-9) was completed before PMBR. Descriptive and summary statistics were compared to identify differences between the two groups to assess the usability of the DA.

RESULTS: The DA + group had significantly higher mean total scores on the SDM-Q-9 (90.2 ± 5.3 vs. 84.1 ± 3.5, P = 0.0034) and DRS (90.3 ± 3.8 vs. 84.3 ± 6.7, P = 0.023), compared to those in the DA- group.

CONCLUSION: Use of the DA may cause patients to have a higher level of perceived SDM and less regret, which suggests that the DA helps to facilitate smooth and effective implementation of SDM. We conclude that this type of decision-making approach should be recommended for choice of surgery for PMBR.

PMID:36934211 | DOI:10.1007/s12282-023-01447-4

Environ Sci Pollut Res Int. 2023 Mar 18. doi: 10.1007/s11356-023-26346-1. Online ahead of print.

ABSTRACT

Environmental sustainability is an umbrella approach depending on various climatic and economic policies. In doing so, the current study empirically evaluates the role of green finance, eco-innovation, and environmental policy stringency on the ecological footprint in China. To meet the objectives, the novel quantile autoregressive distributed lag (QARDL) approach was employed from 2000 to 2017. The outcomes reveal heterogeneous associations between the proposed variables. Manifestly, the QARDL estimation results demonstrate a positive impact between eco-innovation, green finance, and environmental policy stringency with the ecological footprints of China; however, the extent of the relationship is quantile dependent. The outcomes are further validated through the Wald test of parameter constancy. The bi-direction causality is observed among all variables at several quantiles. The current study offers policymakers helpful suggestions on enhancing the positive effects of environmentally supported innovation, green finance, and stringent environmental policies on the ecosystem.

PMID:36934184 | DOI:10.1007/s11356-023-26346-1

Sci Rep. 2023 Mar 18;13(1):4480. doi: 10.1038/s41598-023-31628-2.

ABSTRACT

Our aim was to develop a tool to accurately predict the possibility of non-sentinel lymph node metastasis (NSLNM) during surgery so that a surgeon might decide the extent of further axillary lymph node dissection intraoperatively for patients with 1-3 positive sentinel lymph node(s) (SLN) after neoadjuvant chemotherapy. After retrospective analysis of Asan Medical Center (AMC) database, we included 558 patients’ records who were treated between 2005 and 2019. 13 factors were assessed for their utility to predict NSLNM with chi-square and logistic regression with a bootstrapped, backward elimination method. Based on the result of the univariate analysis for statistical significance, number of positive SLN(s), number of frozen nodes, Progesterone Receptor (PR) positivity, clinical N stage were selected for the multivariate analysis and were utilized to generate a nomogram for prediction of residual nodal disease. The resulting nomogram was tested for validation by using a patient group of more recent, different time window at AMC. We designed a nomogram to be predictive of the NSLNM which consisted of 4 components: number of SLN(s), number of frozen nodes, PR positivity, and clinical N stage before neoadjuvant chemotherapy. The Area under the receiver operating characteristics curve (AUC) value of this formula was 0.709 (95% CI, 0.658-0.761) for development set and 0.715 (95% CI, 0.634-0.796) for validation set, respectively. This newly created AMC nomogram may provide a useful information to a surgeon for intraoperative guidance to decide the extent of further axillary surgery.

PMID:36934173 | DOI:10.1038/s41598-023-31628-2

Sci Data. 2023 Mar 18;10(1):143. doi: 10.1038/s41597-023-02034-0.

ABSTRACT

The air in the Lombardy region, Italy, is one of the most polluted in Europe because of limited air circulation and high emission levels. There is a large scientific consensus that the agricultural sector has a significant impact on air quality. To support studies quantifying the role of the agricultural and livestock sectors on the Lombardy air quality, this paper presents a harmonised dataset containing daily values of air quality, weather, emissions, livestock, and land and soil use in the years 2016-2021, for the Lombardy region. The daily scale is obtained by averaging hourly data and interpolating other variables. In fact, the pollutant data come from the European Environmental Agency and the Lombardy Regional Environment Protection Agency, weather and emissions data from the European Copernicus programme, livestock data from the Italian zootechnical registry, and land and soil use data from the CORINE Land Cover project. The resulting dataset is designed to be used as is by those using air quality data for research.

PMID:36934159 | DOI:10.1038/s41597-023-02034-0