Nevin Manimala

BMC Endocr Disord. 2022 Aug 31;22(1):217. doi: 10.1186/s12902-022-01135-y.

ABSTRACT

BACKGROUND: The data on lipid profile differences between primary aldosteronism (PA) and essential hypertension (EH) patients are inconsistent and inconclusive. Most studies reported lower levels of lipid profiles in PA than in EH. This meta-analysis aimed to explore differences in serum lipid profiles including triglyceride (TG), total cholesterol (TC), LDL and HDL levels in PA patients and EH patients.

METHODS: A search of published studies was performed using PubMed, Embase and Scopus databases from their inception through August 2022. Thirty studies involving 11,175 patients were identified. Inclusion criteria included 1) observational studies which contained data on any of the lipid profiles of interest (TG, TC, LDL and HDL) which could be acquired from baseline data or the outcomes, 2) data which should be compared between adult PA and EH patients and 3) the use of appropriate methods to diagnose PA. Standardized mean difference (SMD) with a 95% confidence interval (95% CI) was calculated to assess effect size by using STATA program version 15.0. Risk of bias was assessed by Joanna Briggs Institute (JBI) Critical Appraisal Tools for cross-sectional, cohort and case-control studies.

RESULTS: Levels of the lipid parameters TG (SMD – 0.16 mmol/L; 95%CI (- 0.25, – 0.07)), TC (SMD – 0.30 mmol/L; 95%CI (- 0.41, – 0.19)) and LDL (SMD – 0.17 mmol/L; 95%CI (- 0.27, – 0.08)) were significantly lower in PA than in EH patients. There was no statistically significant difference in HDL between PA and EH patients (SMD – 0.08 mmol/L; 96%CI (- 0.23,0.07)). High levels of heterogeneity for TG, TC, HDL and LDL were observed in all studies. Risk of bias among the studies was low to moderate.

CONCLUSION: Lower levels of TG, TC and LDL were observed in PA than in EH patients. Further study should be conducted to address the underlying mechanisms of lipid alteration in PA.

PMID:36045354 | DOI:10.1186/s12902-022-01135-y

BMC Palliat Care. 2022 Aug 31;21(1):153. doi: 10.1186/s12904-022-01041-z.

ABSTRACT

BACKGROUND: The limited access to palliative care resources along with the social stigma around cancer largely explains the poor quality of life (QoL) of Indian advanced cancer patients. As advanced cancer patients with poor QoL often harbour a desire for hastened death (DHD), it is imperative to understand factors affecting DHD, or the desire to live (DTL) among advanced cancer patients in India. We aim to examine the relationship between DTL and physical, psychological, spiritual, and social factors measuring patients’ QoL alongside their awareness of their late cancer stage.

METHODS: We surveyed 200 patients from a tertiary cancer hospital in India to collect their DTL, awareness of cancer stage, demographic characteristics, and standardized measures for patients’ QoL. We used a linear probability regression model to quantify the association between these factors and patients’ DTL among the final sample of 192 patients with no missing information for the variables of interest.

RESULTS: Among the various domains affecting cancer patients’ QoL, we found that the pain severity score (ranging from 0 to 10) and psychological distress score (ranging from 0 to 42) are negatively associated with the DTL. One point increase in each score reduced the DTL by 2.2% (p < 0.05) and 0.7% (p < 0.05), respectively. Our results also showed that patients whose perceived socio-economic status (SES) is poor have a 16% (p < 0.05) lower probability of DTL, compared to those with higher SES (lower middle class, upper middle class, and wealthy). Controlling for caste, religion, gender, age, marital status and years of education, we found psychological distress is statistically higher among patients belonging to this bottom SES.

CONCLUSIONS: We found that pain severity, psychological distress and perceived low SES are negatively associated with the desire to live in advanced cancer patients. Future research should focus on developing interventions to improve physical pain and psychological distress, particularly for patients who are socially and economically disadvantaged.

PMID:36045352 | DOI:10.1186/s12904-022-01041-z

BMC Pregnancy Childbirth. 2022 Aug 31;22(1):672. doi: 10.1186/s12884-022-04998-0.

ABSTRACT

BACKGROUND: Geographic barriers to healthcare are associated with adverse maternal health outcomes. Modelling travel times using georeferenced data is becoming common in quantifying physical access. Multiple Demographic and Health Surveys ask women about distance-related problems accessing healthcare, but responses have not been evaluated against modelled travel times. This cross-sectional study aims to compare reported and modelled distance by socio-demographic characteristics and evaluate their relationship with skilled birth attendance. Also, we assess the socio-demographic factors associated with self-reported distance problems in accessing healthcare.

METHODS: Distance problems and socio-demographic characteristics reported by 2210 women via the 2017 Ghana Maternal Health Survey were included in analysis. Geospatial methods were used to model travel time to the nearest health facility using roads, rivers, land cover, travel speeds, cluster locations and health facility locations. Logistic regressions were used to predict skilled birth attendance and self-reported distance problems.

RESULTS: Women reporting distance challenges accessing healthcare had significantly longer travel times to the nearest health facility. Poverty significantly increased the odds of reporting challenges with distance. In contrast, living in urban areas and being registered with health insurance reduced the odds of reporting distance challenges. Women with a skilled attendant at birth, four or more skilled antenatal appointments and timely skilled postnatal care had shorter travel times to the nearest health facility. Generally, less educated, poor, rural women registered with health insurance had longer travel times to their nearest health facility. After adjusting for socio-demographic characteristics, the following factors increased the odds of skilled birth attendance: wealth, health insurance, higher education, living in urban areas, and completing four or more antenatal care appointments.

CONCLUSION: Studies relying on modelled travel times to nearest facility should recognise the differential impact of geographic access to healthcare on poor rural women. Physical access to maternal health care should be scaled up in rural areas and utilisation increased by improving livelihoods.

PMID:36045351 | DOI:10.1186/s12884-022-04998-0

BMC Med Res Methodol. 2022 Aug 31;22(1):236. doi: 10.1186/s12874-022-01711-9.

ABSTRACT

OBJECTIVE: Previous research has demonstrated that individual risk of mental illness is associated with individual, co-resident, and household risk factors. However, modelling the overall effect of these risk factors presents several methodological challenges. In this study we apply a multilevel structural equation model (MSEM) to address some of these challenges and the impact of the different determinants when measuring mental health risk.

STUDY DESIGN AND SETTING: Two thousand, one hundred forty-three individuals aged 16 and over from 888 households were analysed based on the Household Survey for England-2014 dataset. We applied MSEM to simultaneously measure and identify psychiatric morbidity determinants while accounting for the dependency among individuals within the same household and the measurement errors.

RESULTS: Younger age, female gender, non-working status, headship of the household, having no close relationship with other people, having history of mental illness and obesity were all significant (p < 0.01) individual risk factors for psychiatric morbidity. A previous history of mental illness in the co-residents, living in a deprived household, and a lack of closeness in relationships among residents were also significant predictors. Model fit indices showed a very good model specification (CFI = 0.987, TLI = 0.980, RMSEA = 0.023, GFI = 0.992).

CONCLUSION: Measuring and addressing mental health determinants should consider not only an individual’s characteristics but also the co-residents and the households in which they live.

PMID:36045347 | DOI:10.1186/s12874-022-01711-9

BMC Pregnancy Childbirth. 2022 Aug 31;22(1):671. doi: 10.1186/s12884-022-04994-4.

ABSTRACT

BACKGROUND: Pregnancy losses remain a neglected issue and it will be taking more than a century before a pregnant woman in Sub Sahara has the same chance of her baby being born alive as a woman in a high-income country. Pregnancy loss data are limited and not universal in Sub Saharan countries. This study was aimed to assess the magnitude and determinants of pregnancy loss in eastern Ethiopia.

METHODS: This study was conducted in, open continues and dynamic cohort of population, Kersa Health and Demographic Survillance site (HDSS) in Eastern Ethiopia in 2008-2019. All mothers who had known pregnancy outcomes during the period and reside in Kersa HDSS were considered. The prevalence proportions were calculated as the sum of all pregnancy loss divided by the number births in the specified year. Log-Binomial regression was used to determine factors associated with pregnancy loss. Prevalence Proportion Ratio (PPR) was used to report the magnitude and strength of association. A p-value of less than 0.05 was considered statistically significant.

RESULTS: From 39,153 included pregnancies, 810 (20.7; 95%CI:19.32, 22.15 per 1000 births) experienced pregnancy loss. Stillbirth was higher than abortion (11.14 Vs. 9.55 per 1000 births). Lacking own income (aPPR:1.26; 95%CI: 1.01, 1.58), being daily laborer (aPPR:1.44; 95%:1.08, 306) history of previous pregnancy loss (aPPR:2.26, 95%CI:1.69, 3.03), unwanted pregnancy (aPPR:1.26; 95%CI:1.01, 1.80), not receiving antenatal care (aPPR:1.59; 95%CI: 1.19, 2.13) and not receive the TT-vaccine during pregnancy (aPPR:1.33; 95%CI: 1.08, 1.80) were positively associated with pregnancy loss.

CONCLUSIONS: The overall rate pregnancy loss was ranged between 19.32, 22.15 per 1000 births with higher still births than miscarriage or abortion. Pregnancy loss was positively associated with social factors reproductive health factors, and maternal health service utilization.

PMID:36045340 | DOI:10.1186/s12884-022-04994-4

BMC Prim Care. 2022 Aug 31;23(1):220. doi: 10.1186/s12875-022-01827-3.

ABSTRACT

BACKGROUND: Type 2 diabetes (T2D) and coronary artery disease (CAD) are chronic illnesses where adherence to a healthy lifestyle is crucial. If organisational and cultural factors are well managed, Peer support programs (PSP) can improve self-management, quality of life, and health outcomes. In preparation for launching a PSP, we surveyed family doctors (FD) about their attitudes toward such a program and about potential barriers, and facilitators.

METHODS: In March 2020 we surveyed 896 FDs from five university teaching practice networks in North-Rhine Westphalia, Germany, via an anonymous web-based survey. The questionnaire addressed details of PSPs, including suitable patients and FDs’role. Data were analysed using descriptive and inferential statistics; qualitative material underwent content analysis by two researchers.

RESULTS: A total of 165 FDs responded (response rate: 18.4%), 97% were practice owners. Respondents viewed PSPs positively (T2D: 92.0%, CAD 89.9%), especially for patients with poor self-structuring (82.7%), low motivation (76.3%) and few social contacts (67.6%). On average, FDs were able to identify 4.0 ± 3.2 patients as potential group leaders. Major facilitators reported included motivation by peers (92.5%), exercise (79.1%), and social contacts (70.1%). Waning interest over time (73.1%) and poor motivation (70.9%) were considered barriers. The majority of FDs would recommend PSPs to their patients (89.5%). They considered such a program a valuable addition to current care (79.7%). The percentage of FDs’ who expected long-term benefits for their workload was relatively low (37.6%).

CONCLUSIONS: In an exploratory survey among German FDs on PSPs, respondents viewed PSPs as a valuable add-on for T2D and CAD patients, while not expecting a positive impact on their workload. Communication with FDs on PSPs may need to highlight anticipated implementation outcomes such as benefits of PSPs to the practice.

PMID:36045339 | DOI:10.1186/s12875-022-01827-3

J Neurosci Nurs. 2022 Aug 31. doi: 10.1097/JNN.0000000000000673. Online ahead of print.

ABSTRACT

BACKGROUND: Surgical frailty is a condition in which patients are weak with varied recovery of various organ functions after surgery resulting in unpleasant outcomes. Frailty studies have been conducted in several populations with a limited knowledge on postoperative brain tumor patients. This study aimed to examine factors predicting frailty in brain tumor patients after craniotomy. METHODS: This study was a cross-sectional predictive study. The sample included 85 patients who were 18 years or older and underwent craniotomy with tumor removal from 1 university hospital in Bangkok, Thailand, between February and October 2021. Data were analyzed using descriptive statistic, Pearson correlation, and multiple linear regression, which determined significance level at .05. RESULTS: The prevalence of frailty among participants was 50.6%. Postoperative symptom and mood state were positively associated with frailty (r = 0.410 and r = 0.448, respectively; P < .01). Postoperative symptom, mood state, age, tumor type, and income could explain the variance of frailty in brain tumor patients after craniotomy by 40.3% (R2 = 0.403, P < .01). CONCLUSION: Healthcare providers should plan for discharge planning including assessment and develop the intervention for managing postoperative symptoms and psychological symptoms to promote recovery from frailty that generally occurs after brain tumor surgery.

PMID:36044724 | DOI:10.1097/JNN.0000000000000673

Ann Am Thorac Soc. 2022 Aug 31. doi: 10.1513/AnnalsATS.202203-201OC. Online ahead of print.

ABSTRACT

RATIONALE: Pulmonary exacerbation (PEx) events contribute to lung function decline in people with cystic fibrosis (CF). CF Foundation PEx guidelines note a short course of systemic corticosteroids may offer benefit without contributing to long-term adverse effects. However, insufficient evidence exists to recommend systemic corticosteroids for PEx treatment.

OBJECTIVES: To determine if systemic corticosteroids for the treatment of in-hospital pediatric PEx is associated with improved clinical outcomes compared to treatment without systemic corticosteroids.

METHODS: Retrospective cohort study using the CF Foundation Patient Registry-Pediatric Health Information System linked database. People with CF were included if hospitalized for a PEx between 2006-2018 and were 6-21 years of age. Time to next PEx was assessed by Cox proportional hazards regression. Lung function outcomes were assessed by linear mixed effect modeling and generalized estimating equations. To address confounding by indication, inverse probability treatment weighing was used.

RESULTS: 3,471 people with CF contributed 9,787 PEx for analysis. Systemic corticosteroids were used in 15% of all PEx. In our primary analysis, systemic corticosteroids were not associated with better pre- to post-PEx percent predicted forced expiratory volume in 1 second responses (mean difference, -0.36, 95% CI: -1.14, 0.42; p=0.4) or a higher odds of returning to lung function baseline (odds ratio (OR), 0.97, 95% CI: 0.84-1.12; p=0.7), but were associated with a reduced chance of future PEx requiring intravenous antibiotics (hazard ratio (HR), 0.91 (95% CI: 0.85-0.96; p=0.002). When restricting the analysis to one PEx per person, lung function outcomes remained no different among PEx treated with or without systemic corticosteroids, but in contrast to our primary analysis, the use of systemic corticosteroids was no longer associated with a reduced chance of having a future PEx requiring intravenous antibiotics (HR 0.96 (95% CI: 0.86, 1.07; p=0.42).

CONCLUSIONS: Systemic corticosteroid treatment for in-hospital pediatric PEx was not associated with improved lung function outcomes. Prospective trials are needed to better evaluate the risks and benefits of systemic corticosteroid use for PEx treatment in children with CF.

PMID:36044723 | DOI:10.1513/AnnalsATS.202203-201OC

Ann Am Thorac Soc. 2022 Aug 31. doi: 10.1513/AnnalsATS.202202-154RL. Online ahead of print.

NO ABSTRACT

PMID:36044710 | DOI:10.1513/AnnalsATS.202202-154RL

Int J Periodontics Restorative Dent. 2022 Sep-Oct;42(5):683-689. doi: 10.11607/prd.5005.

ABSTRACT

The high biomechanical loads in molar region wounds challenge the indication for short implants to be used as a single-unit implant. This study reports on the outcomes of single-unit short implants (≤ 8.0 mm) in the maxillary and mandibular molar regions. Forty-nine short implants were placed in 48 patients to replace a missing molar tooth. Two-piece restorations with screw retention were fabricated. During the follow-up, implant survival and marginal bone loss (MBL) were assessed. The known implant length was used as a reference to calibrate the linear measurements on digital periapical radiographs, and descriptive statistical analysis was performed. The implants were followed over a period of 47 ± 12 months. No implant failure was recorded, and no prosthesis failure was observed. The average MBL was 0.15 ± 0.5 mm. The mean crown height space was 13 ± 3 mm. The overall crown-to-implant ratio was 1.7 ± 0.4. Two technical complications occurred due to the loosening of the unit abutment. After screw re-tightening, no more screw loosening was observed. This study supports the use of short implants as a single-unit implant in the maxillary and mandibular molar regions.

PMID:36044701 | DOI:10.11607/prd.5005