Nevin Manimala

Nurs Open. 2022 Sep 20. doi: 10.1002/nop2.1344. Online ahead of print.

ABSTRACT

AIM: This descriptive-analytical correlational study was carried out to examine moral awareness and its relationship with moral sensitivity among Iranian nursing students.

DESIGN: A descriptive-analytical correlational study.

METHODS: The present descriptive-analytical study was performed among 140 Iranian nursing students. The data collection tool was a three-part questionnaire including (1) Demographic Information Questionnaire, (2) Nurses’ Awareness about the Iranian Nursing Code of Ethics by Mohajjel Aghdam and (3) Moral Sensitivity Questionnaire (MSQ) by Kim Lutzen. The data collected from these questionnaires were analysed in SPSS-26 using descriptive and inferential statistics.

RESULTS: The mean moral awareness (29.42 ± 4.01) was good, and the mean moral sensitivity (135.05 ± 18.79) was moderate among the students. A significant positive correlation was observed between the total score of moral awareness and moral sensitivity (r = .22, p = .009) in the nursing students.

PMID:36125847 | DOI:10.1002/nop2.1344

Curr Rheumatol Rev. 2022 Sep 20. doi: 10.2174/1573397118666220920104900. Online ahead of print.

ABSTRACT

BACKGROUND: Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by joint inflammation and destruction.

OBJECTIVE: Establish the association between Porphyromonas gingivalis (P. gingivalis) infection, body mass index (BMI), joint involvement, and serum adipokines in first-degree relatives (FDR) of patients with rheumatoid arthritis (RA).

METHODS: The cross-sectional study evaluated 124 FDR and 124 healthy controls (HC). The clinical examination included joint and radiographic evaluation and calculation of BMI. Serum adipokine levels were measured (leptin, vaspin, adiponectin, resistin, and adipsin), as were the erythrocyte sedimentation rate, C-reactive protein, and anti-citrullinated protein antibodies. Investigations were performed to detect P. gingivalis, and anti-P. gingivalis antibodies. Statistical analyses were performed to confirm associations.

RESULTS: Leptin levels in FDR were associated with BMI >25 (OR, 2.64; 95%CI, 1.17-5.97; P=0.019), radiographic damage (Simple Erosion Narrowing Score [SENS])/hands, total SENS, and joint space narrowing in feet (P=0.037, 0.026, 0.020, respectively). FDR had more tender joints (P=0.018); this finding was associated with high levels of leptin and resistin and low levels of adipsin (P=0.040, 0.040, and 0.019, respectively). The presence of P. gingivalis was related to FDR, low levels of adipsin, resistin, adiponectin, and a trend toward higher levels of leptin (P=0.002, 0.001, 0.003, and 0.060, respectively), whereas anti-P. gingivalis antibodies were related to low levels of adipsin (P=0.001).

CONCLUSION: In FDR, serum adipokine levels were associated with overweight, presence of P. gingivalis. Adipokine levels were also associated with joint involvement. Hence, adipokines may be involved in the pathogenesis of RA in FDR and warrant further investigation.

PMID:36125832 | DOI:10.2174/1573397118666220920104900

Curr Rheumatol Rev. 2022 Aug 21. doi: 10.2174/1573397118666220821143041. Online ahead of print.

ABSTRACT

OBJECTIVE: Low Back Pain (LBP) is the most common musculoskeletal disorder, particularly among working adults It is one of the most prevalent complaints among students. Medical students, are among those who are most exposed to this condition; due to stress, numerous hours of studying , and the sedentary lifestyle. The aim of our study was to determine the prevalence and the associated factors of LBP among the students of Tunis Faculty of Medicine and to assess its impact on student life. Methods This was a cross-sectional study carried out on the students of Tunis Faculty of Medicine. Data were collected through an online self-administered questionnaire. Sociodemographic, personal, and lifestyle characteristics were collected. LBP was assessed using the Nordic Musculoskeletal Health Questionnaire and Its impact using the Oswestry Disability Index (ODI).

RESULTS: One hundred and forty-eight students were included. The mean age was 22.9 ± 2.3 years [19.64-38.21]. The sex ratio was 0.29. According to the Nordic questionnaire, the point, annual and lifetime prevalence of LBP were 37.8%, 80.4%, and 90.5% respectively. The mean ODI score was 10.32± 8.48 % [0-32]. The ODI score was minimal in 87.3% and moderate in 12.7% of cases. The associated factors with LBP were: young age (p = 0.015), spending more than 4 hours in a sitting position (p = 0.059), second cycle of medical studies (p= 0.006), low screen projection in the amphitheater (p= 0.029) and poor layout of the amphitheatres (p= 0.000). The feeling of depression was significantly higher among LBP students (p= 0.018). In the multivariate analysis, the factors that remained statistically significant were the second cycle of medical studies (OR= 3.41), feeling of depression (OR = 3.7) and the belief in the responsibility of the poor layout of the amphitheaters in the genesis or maintenance of LBP (OR = 7.66).

CONCLUSION: LBP in medical students is multifactorial across both personal and college-life domains.

PMID:36125829 | DOI:10.2174/1573397118666220821143041

Endocr Metab Immune Disord Drug Targets. 2022 Aug 23. doi: 10.2174/1871530322666220823155956. Online ahead of print.

ABSTRACT

AIMS: The pandemic of coronavirus disease 2019 (COVID-19), has emerged as a dire health problem, causing a massive crisis for global health.

BACKGROUND: Most commonly reported clinical manifestations are fever, fatigue and dry cough. Interestingly, a small percentage of patients experience GI symptoms with the most common being anorexia, diarrhea, nausea and vomiting. We aimed to investigate a comparable study of COVID-19 patients with or without gastrointestinal patients (GI).

METHODS: Collective data of clinical manifestations and laboratory reports of patients admitted in Razi Hospital, Ahvaz, Khuzestan, Iran, during two weeks were analyzed.

RESULTS: Our results showed that GI symptoms are not statistically significant criteria to be predictive or prognostic factors in the COVID-19 patients despite they are probably related to acute or non-acute phase of the disease. Moreover, non-specific GI symptoms seem to be as a result of cytokine storm occurred during the disease.

CONCLUSION: Therefore, our results did not support GI tract involvement as a common route of COVID-19 infection. Maybe future research will shed light on why and how the gastrointestinal system became infected by COVID-19.

PMID:36125828 | DOI:10.2174/1871530322666220823155956

JAMA Netw Open. 2022 Sep 1;5(9):e2232556. doi: 10.1001/jamanetworkopen.2022.32556.

ABSTRACT

IMPORTANCE: Environmental disasters, such as the Flint, Michigan, water crisis, are potentially traumatic events (PTEs) that may precipitate long-term psychiatric disorders. The water crisis was associated with acute elevations in mental health problems in the Flint community, but long-term psychiatric sequelae have not yet been evaluated using standardized diagnostic measures.

OBJECTIVE: To investigate the prevalence of and factors associated with current presumptive diagnostic-level major depression and posttraumatic stress disorder (PTSD) among Flint residents 5 years after the onset of the crisis.

DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study, a household probability sample of 1970 adults living in Flint, Michigan, during the crisis were surveyed about their crisis experiences, their psychological symptoms 5 years later, and their access to and use of mental health services in the intervening years. Analyses were weighted to produce population-representative estimates.

MAIN OUTCOMES AND MEASURES: Presumptive Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) diagnostic-level past-year major depression and PTSD.

RESULTS: Among 1970 respondents, 1061 of 1946 reporting sex (54.5%) were women; 1043 of 1951 reporting race (53.5%) were Black or African American and 829 (42.5%) were White; and 1895 of 1946 reporting ethnicity (97.4%) were non-Hispanic. Overall, 435 (22.1%) met DSM-5 criteria for presumptive past-year depression, 480 (24.4%) for presumptive past-year PTSD, and 276 (14.0%) for both disorders. Residents who believed that their or their family’s health was harmed by contaminated water (eg, risk ratio [RR] for depression: 2.23; 95% CI, 1.80-2.76), who had low confidence in public-official information (eg, RR for PTSD, 1.44; 95% CI, 1.16-1.78), who had previous exposure to PTEs (eg, RR for both disorders: 5.06; 95% CI, 2.99-8.58), or who reported low social support (eg, RR for PTSD, 2.58; 95% CI, 1.94-3.43) had significantly higher risk for depression, PTSD, and comorbidity. PTEs involving prior physical or sexual assault were especially potent risk factors (eg, both disorders: RR, 7.30; 95% CI, 4.30-12.42). Only 685 respondents (34.8%) were ever offered mental health services to assist with water-crisis-related psychiatric symptoms; most (543 [79.3%]) who were offered services utilized them.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of psychiatric disorder in Flint, Michigan, presumptive depression and PTSD were highly prevalent 5 years after the onset of the water crisis. These findings suggest that public-works environmental disasters have large-scale, long-term psychological sequelae. The Flint community may require expanded mental health services to meet continued psychiatric need. National disaster preparedness and response programs should consider psychiatric outcomes.

PMID:36125808 | DOI:10.1001/jamanetworkopen.2022.32556

Dermatitis. 2022 Sep 21. doi: 10.1097/DER.0000000000000943. Online ahead of print.

ABSTRACT

BACKGROUND: Allergic contact dermatitis (ACD) remains a public health issue worldwide, despite regulations intended to minimize sensitization. With up-to-date knowledge about which chemicals continue to have high allergenicity, the government/industry can refocus their efforts to be most effective.

OBJECTIVE: We reviewed updated data showing common allergens that elicit ACD to determine the progress in reducing sensitization to inform public health policy, government regulation, and industry standards.

METHODS: We compiled data from the North American Contact Dermatitis Group showing patch test results from 1984 to 2016 for 153 compounds. Using these data, we analyzed the trends over time of positive test reactions to determine whether they are increasing or decreasing.

RESULTS: Of the 47 compounds with sufficient data to analyze, 23 had a decreasing proportion of positive patch test results over the whole period. An additional 5 had a decreasing proportion over a shorter period. Finally, 4 had an increasing proportion over any period: compositae mix, methylchloroisothiazolinone/methylisothiazolinone, nickel sulfate, and thimerosal mix.

CONCLUSIONS: The data strongly indicate decreasing and increasing frequency trends and challenge us to seek explanations, which are not yet clear. It is hoped that these data can be valuable in informing public health policy, government, and industry.

PMID:36125806 | DOI:10.1097/DER.0000000000000943

J Endocrinol Invest. 2022 Sep 20. doi: 10.1007/s40618-022-01925-0. Online ahead of print.

ABSTRACT

PURPOSE: To investigate whether the metabolic score for insulin resistance (METS-IR) is associated with an increased risk of cardiovascular disease (CVD).

METHODS: A total of 6489 participants aged 35-70 years without a history of CVD were included in this prospective cohort study. The median follow-up time was 10.6 years. The METS-IR was calculated as ln [2 × FPG (mg/dL) + fasting TG (mg/dL)] × BMI (kg/m²)/ln [HDL-C (mg/dL)]. The primary outcome was CVD, defined as the composite of coronary heart disease (CHD) and stroke.

RESULTS: During follow-up, 396 individuals developed CVD. Kaplan-Meier survival curves by quintiles of METS-IR showed statistically significant differences (log-rank test, P < 0.001). Multivariate Cox regression analysis showed that the hazard ratio [95% confidence interval (95% CI)] of CVD was 1.80 (1.24-2.61) in quintile 5 and 1.17 (1.05-1.31) for per standard deviation (SD) increase in METS-IR. In subgroup analysis, the significant association between METS-IR and CVD was mainly observed among females and subjects without diabetes mellitus. A significant interaction was found between gender and METS-IR (P-interaction = 0.001). Moreover, adding METS-IR to models with traditional risk factors yielded a significant improvement in discrimination and reclassification of incident CVD.

CONCLUSION: The elevated METS-IR was independently associated with incident CVD, suggesting that the METS-IR might be a valuable indicator for risk stratification and early intervention of CVD.

PMID:36125732 | DOI:10.1007/s40618-022-01925-0

J Pediatr Gastroenterol Nutr. 2022 Sep 20. doi: 10.1097/MPG.0000000000003620. Online ahead of print.

ABSTRACT

PATIENTS METHODS: clinical data from CD patients under 15 years old were collected from the participating centres in an on-line multicentre nationwide observational Spanish registry called REPAC-2 (2011-2017). Correlation between anti-tissue transglutaminase antibodies (t-TGA) levels and other variables, including mucosal damage and clinical findings (symptoms, age and gender), was assessed.

RESULTS: 2955 out of 4838 patients had t-TGA and a small bowel biopsy (SBB) performed for CD diagnosis. 1931 (66.2%) patients with normal IgA values had a Marsh 3b-c lesion and 1892 (64.9%) had t-TGA IgA ≥10 times ULN (upper limit of normal).There is a statistically significant association between t-TG IgA levels and the degree of mucosal damage (p value < 0.001), the higher the t-TGA IgA levels the more severe the mucosal damage. Those patients who reported symptoms had more severe mucosal damage (p value 0.001). On the contrary there was a negative association between age and changes of the intestinal mucosa (p< 0.001). No association was found with gender.Regarding the IgA deficient patients, 47.4% (18 cases) had t-TGA IgG ≥10 times ULN and a Marsh 3b-c lesion was observed in 68.4% (26 patients). No statistical relation was found between t-TGA IgG levels and the changes of the intestinal mucosa, neither a relation with age, gender or symptoms.

CONCLUSION: There is a positive correlation between t-TGA IgA levels and the severity of changes of the intestinal mucosa. Such correlation was not found in IgA deficient patients who had positive t-TGA IgG serology. The results in this group of patients support the ESPGHAN recommendations about the need of performing a SBB in IgA deficient individuals despite high t-TGA IgG levels.

PMID:36123770 | DOI:10.1097/MPG.0000000000003620

J Pediatr Gastroenterol Nutr. 2022 Sep 20. doi: 10.1097/MPG.0000000000003624. Online ahead of print.

ABSTRACT

INTRODUCTION: Endoscopic procedures are increasingly performed for children and adolescents and these interventions represent a central element of both pediatric gastroenterology (GI) care and revenues. It remains unclear, however, which scheduling paradigm maximizes efficiency of resource utilization and delivery of care in this arena. In this study, we evaluate the impact of shifting from shared endoscopy blocks to individual, provider-specific endoscopy blocks for scheduling endoscopic procedures in our tertiary care academic center.

METHODS: The implemented endoscopy block system involves a single endoscopist performing procedures in an allocated room for the entire ½ day period of time, with most providers having 1-3 ½ day blocks per month. We analyzed block fragmentation (multiple providers in a single block), block utilization and procedure volume, comparing the 8-month period prior to implementation of the block system (pre-implementation period) with the 8-month period following implementation of the block system (post-implementation period). Provider satisfaction and perceptions were assessed by survey pre- and post-implementation. Standard descriptive statistics were utilized for analysis.

RESULTS: In the pre- and post-implementation periods, 22 half-day blocks were allocated to pediatric GI. In the pre-implementation period, mean utilization of these blocks was 65.9% (range: 47%-77%). In the post-implementation period, mean % utilization was 79.8% (range: 64%-89%). Overall endoscopy procedure volume increased from 279 in the pre-implementation period to 419 in the post-implementation period. Provider perception of endoscopy efficiency was enhanced by the block system, with 68.4% of pediatric GI respondents rating endoscopy as ‘efficient’ post-implementation (vs. 19% pre-implementation) and 63.2% indicating that the block system directly enhanced efficiency. 63.2% reported increased personal procedure volume and 84.2% reported perceived increase in overall procedure volume with block system implementation.

CONCLUSIONS: Strategic approaches for scheduling endoscopic procedures carry the potential to enhance efficiency and experience for both providers and patients. Implementation of the endoscopy block system was associated with increased procedure volumes and block utilization as well as a more positive experience for the majority of providers. Schedule adjustments with analysis of associated efficiency and satisfaction metrics can optimize pediatric endoscopy practice.

PMID:36123768 | DOI:10.1097/MPG.0000000000003624

J Pediatr Gastroenterol Nutr. 2022 Sep 20. doi: 10.1097/MPG.0000000000003625. Online ahead of print.

ABSTRACT

BACKGROUND: Estimation of the dimensions of endoscopic findings such as stricture diameter is largely subjective. Accurate assessment of stricture dimensions has multiple benefits including facilitating the choice of appropriately sized endoscopic therapies for treating stricture, properly tracking response to endoscopic therapies between procedures, and potentially even predicting outcomes of endoscopic therapy.

METHODS: Endoscopies performed in children with repaired esophageal atresia between August 2019 through August 2021 for which both 1) an endoscopic estimate of esophageal stricture diameter obtained by visual comparison with the known dimensions of the biopsy forceps and 2) an intraoperative esophageal fluoroscopy study were performed were included for analysis. Fluoroscopic stricture diameter measurements were manually obtained using a software ruler tool calibrated to the known dimensions of the intraluminal endoscope. Statistical concordance was calculated between the visual diameter estimates and the standard fluoroscopic stricture measurements.

RESULTS: One-hundred ninety one endoscopies were included for analysis. Lin’s concordance correlation coefficient was 0.92 (95% confidence interval: 0.89, 0.94) between the visual diameter estimates and the fluoroscopic stricture measurements. Correlation was strongest for smaller to mid-sized stricture diameters.

CONCLUSIONS: Use of the biopsy forceps as a visual reference of known dimensions enables accurate visual estimation of esophageal stricture diameter during endoscopy using commonly available tools, with high concordance with standard fluoroscopic measurement techniques.

PMID:36123760 | DOI:10.1097/MPG.0000000000003625