Nevin Manimala

Dtsch Arztebl Int. 2022 Sep 5;(Forthcoming):arztebl.m2022.0256. doi: 10.3238/arztebl.m2022.0256. Online ahead of print.

ABSTRACT

BACKGROUND: It has been observed that the Medical Service (Medizinischer Dienst, an auditing body of the German statutory health insurance system) is more likely to audit the bill for a hospitalization in a psychosomatic clinic if the patient carries a secondary diagnosis of obesity.

METHODS: In an exploratory study, we retrospectively analyzed 771 datasets collected in 2019 as part of the standard documentation of acute psychosomatic hospitalizations.

RESULTS: In 2019, the Medical Service audited bills for psychosomatic hospitalizations much more often in obese than in non-obese patients (odds ratio [OR] 2.499; 95% confidence interval [1.69; 3.69]). This was accounted for by a very high audit rate for patients with a secondary diagnosis of grade 3 obesity (OR = 3.972 [2.30; 6.86]). The audit categories “quality of coding” and “possible incorrect admission” were examined.

CONCLUSION: Treatments of markedly obese inpatients that incurred greater expenses presumably led to a higher hospitalization audit rate as an automatic consequence of the auditing algorithms used. An unintentional statistical discrimination arose from the unjustified linkage of the audit category “quality of coding” of the secondary diagnosis (obesity) with the audit category “possible incorrect admission” with regard to the main diagnosis. Similar effects may be occurring with economically relevant secondary diagnoses in other areas of medicine as well.

PMID:36073157 | DOI:10.3238/arztebl.m2022.0256

Afr J Prim Health Care Fam Med. 2022 Aug 26;14(1):e1-e3. doi: 10.4102/phcfm.v14i1.3397.

ABSTRACT

After four decades of the HIV epidemic, women from sub-Saharan Africa remain at a differentially high risk of acquisition. The Joint United Nations Programme on HIV and AIDS (UNAIDS) statistics show that the majority of HIV infections occur in this population and region. Evidence from previous humanitarian crises demonstrated adverse maternal consequences as a result of neglect for the provision of essential maternal, sexual and reproductive health services. The ongoing COVID-19 pandemic has had a similar effect, including an additional risk of HIV acquisition amongst women in sub-Saharan Africa. The COVID-19 pandemic has aggravated the risk of sub-Saharan Africa women to HIV infection because of a multitude of factors including child marriages, teenage pregnancies, dropping out of school, increase in incidence of sexual and gender-based violence and reduced access to preventive and treatment services for HIV and sexually transmitted infections. These include provision of care for rape and sexual and gender-based violence victims and provision of pre-exposure and postexposure prophylaxis for HIV and other STIs. Failure to urgently restore and maintain robust HIV prevention and treatment during the ongoing COVID-19 pandemic poses a risk of reversing the gains made over the years in reducing the incidence and morbidity from HIV amongst the population of sub-Saharan Africa women. There is need for an urgent and robust discourse to formulate effective interventions for protecting women and girls living in sub-Saharan Africa from an aggravated risk of HIV infection during the ongoing COVID-19 pandemic and other future humanitarian crises.

PMID:36073132 | DOI:10.4102/phcfm.v14i1.3397

Afr J Prim Health Care Fam Med. 2022 Aug 22;14(1):e1-e8. doi: 10.4102/phcfm.v14i1.3595.

ABSTRACT

AbstractBackground: Carers of people with dementia (PWD) face a myriad of challenges. As dementia prevalence surges in the sub-Saharan population, the provision of data on the met and unmet needs of caregivers has become paramount.

AIM: This study aimed to identify the needs of carers of older adults living with dementia in Ghana.

SETTING: This study was conducted in Kumasi, Ghana, among participants ≥ 18 years old, serving as carers for PWD.

METHODS: This was a multicentre cross-sectional study involving carers of patients (≥ 50 years) with dementia. The authors administered the Carer’s Needs Assessment for Dementia (CNA-D) questionnaire, containing 18 problem areas with interventions for each problem area. Pearson’s correlation analysis was performed to establish a relationship between demographic characteristics, problem areas and intervention score.

RESULTS: Fifty participants were recruited with a mean age of 48.8 (± 16.9) years, 72.0% were female participants and 98.0% were family members of PWD. The problem area most frequently identified as no/mild problem was ‘legal issues’ (92.0%, n = 46), and ‘lack of information about dementia’ was assessed as severe (48.0%, n = 24). The commonest unmet need was ‘printed information material’ (84.0%, n = 42), and the commonest met need was ‘diagnosis and treatment of carer by a general practitioner’ (42.0%, n = 21). There was a statistically negative correlation between age of carer and number of unmet needs (r = -0.308, p = 0.011) and a positive correlation between problem area score and number of unmet needs (r = 0.308, p = 0.030).

CONCLUSION: Effective public education and provision of information on dementia to carers are essential interventions needed to equip them in performing their roles.Contribution: Carers in this study revealed that they lacked information on dementia but their commonest met need was accessibility to their general practitioner. This highlights the importance of promoting knowledge and awareness of dementia among primary care practitioners.

PMID:36073124 | DOI:10.4102/phcfm.v14i1.3595

Onderstepoort J Vet Res. 2022 Aug 4;89(1):2007. doi: 10.4102/ojvr.v89i1.2007.

ABSTRACT

Vaccination is an important disease prevention and control measure; however, vaccine adoption by livestock farmers in Tanzania is still low. This cross-sectional study examined the challenges to vaccine use faced by livestock owners and animal health professionals (AHPs) in Tanzania. A questionnaire was administered to 216 households that kept small ruminants and poultry and 19 AHPs’ data were collected electronically via the survey platform Qualtrics, and descriptive statistics were performed. Households with poultry reported vaccinating mostly against Newcastle disease (91.7%), fowl pox (48.1%) and Gumboro disease (37.0%), whilst households with small ruminants reported contagious caprine pleuropneumonia (62.2%), sheep and goat pox (17.1%), foot-and-mouth disease (7.3%) and peste des petits ruminants (7.3%). The households’ decision to vaccinate was mostly influenced by knowledge of diseases (82.4%), disease history on the farm (69.4%) and vaccine price (63.4%). Most households (54.6%) experienced challenges when purchasing vaccines, including high vaccine cost (78.0%), long distance from vaccine source (61.0%) and vaccine unavailability (21.2%). The findings suggest that improving the knowledge of livestock owners regarding the priority diseases and the benefits of vaccination, establishing more vaccine suppliers, improving vaccine distribution and access and training AHPs and households on appropriate vaccine storage and handling are necessary to improve vaccine adoption and ensure vaccine quality and effectiveness.

PMID:36073111 | DOI:10.4102/ojvr.v89i1.2007

Leuk Lymphoma. 2022 Sep 7:1-4. doi: 10.1080/10428194.2022.2115842. Online ahead of print.

NO ABSTRACT

PMID:36070601 | DOI:10.1080/10428194.2022.2115842

J Integr Complement Med. 2022 Sep 7. doi: 10.1089/jicm.2022.0586. Online ahead of print.

ABSTRACT

Aims/Hypothesis: Only 51% of patients with type 2 diabetes achieve the hemoglobin A1c (HbA1c) <7% target. Mind and body practices have been increasingly used to improve glycemic control among patients with type 2 diabetes, but studies show inconsistent efficacy. The authors conducted a systematic review and meta-analysis to assess the association between mind and body practices, and mean change in HbA1c and fasting blood glucose (FBG) in patients with type 2 diabetes. Methods: The authors conducted a literature search of Ovid MEDLINE, Embase, and ClinicalTrials.gov seeking through June 10, 2022, published articles on mind and body practices and type 2 diabetes. Two reviewers independently appraised full text of articles. Only intervention studies were included. Reviewers extracted data for meta-analysis. Restricted maximum likelihood random-effects modeling was used to calculate the mean differences and summary effect sizes. The authors assessed heterogeneity using Cochran’s Q and I² statistics. Funnel plots were generated for each outcome to gauge publication bias. Weighted linear models were used to conduct study-level meta-regression analyses of practice frequency. Results: The authors identified 587 articles with 28 meeting the inclusion criteria. A statistically significant and clinically relevant mean reduction in HbA1c of -0.84% (95% confidence interval [CI]: -1.10% to -0.58%; p < 0.0001) was estimated. Reduction was observed in all intervention subgroups: mindfulness-based stress reduction: -0.48% (95% CI: -0.72% to -0.23%; p = 0.03), qigong: -0.66% (95% CI: -1.18% to -0.14%; p = 0.01), and yoga: -1.00% (95% CI: -1.38% to -0.63%; p < 0.0001). Meta-regression revealed that for every additional day of yoga practice per week, the raw mean HbA1c differed by -0.22% (95% CI: -0.44% to -0.003%; p = 0.046) over the study period. FBG significantly improved following mind and body practices, with overall mean difference of -22.81 mg/dL (95% CI: -33.07 to -12.55 mg/dL; p < 0.0001). However, no significant association was found between the frequency of weekly yoga practice and change in FBG over the study period. Conclusions/Interpretation: Mind and body practices are strongly associated with improvement in glycemic control in patients with type 2 diabetes. The overall mean reduction in HbA1c and FBG was clinically significant, suggesting that mind and body practices may be an effective, complementary nonpharmacological intervention for type 2 diabetes. Additional analyses revealed that the mean decrease in HbA1c was greater in studies requiring larger number of yoga practice sessions each week.

PMID:36070591 | DOI:10.1089/jicm.2022.0586

Photobiomodul Photomed Laser Surg. 2022 Sep 7. doi: 10.1089/photob.2021.0177. Online ahead of print.

ABSTRACT

Background: Due to the high morbidity and mortality rates of this century, the COVID-19 pandemic has had a devastating impact on the health of the global population. Objective: The aim was to evaluate the disturbing impact of in-hospital stay length and the appeal of severe problems for supplemental oxygen for our patients with COVID-19 in moderate stage who were undergoing transvascular blood irradiation onto sublingual vessels. The demand for supplemental oxygen and the serum oxygen levels were measured, and the impact on the length of hospital stay was assessed. Methods: This randomized, prospective, clinical pilot study evaluated the diagnosis of COVID-19 patients admitted to the ventilatory care unit and undergoing treatment protocol usage of light-emitting diode (LED) irradiation by transvascular application onto the sublingual vessels daily. Patients were selected and enrolled into two groups: the Placebo group (n = 7) that received conventional treatment by the device off (LED-off), and the photobiomodulation therapy (PBMT) group (n = 7) that also received the same therapy plus LED irradiation. Results: There was a statistically significant clinical improvement, such as a reduction in serum creatinine, and oxygen usage per few days less in the PBMT group compared with the Placebo group. All patients in the PBMT group had normalized SatO₂, while a quarter of patients in the Placebo group required longer O₂ supplementation until hospital discharge. Conclusions: The surveillance of clinical improvement in moderate stage indicated that the daily PBMT was able to diminish oxygen supplementation within a short time, besides reducing the hospital stay length in the PBMT group, particularly, when compared with the Placebo group. Clinical Trial Registration number: The study was reviewed by the Ethics Committee in UNINOVE research under number 42325020.6.0000.5511 and approved through number 5,090,119.

PMID:36070590 | DOI:10.1089/photob.2021.0177

J Public Health Manag Pract. 2022 Sep 5. doi: 10.1097/PHH.0000000000001622. Online ahead of print.

ABSTRACT

CONTEXT: Considerable research has examined impacts of case investigation and contact tracing (CI/CT) programs on the spread of infectious diseases such as COVID-19, but there are few reports on factors affecting the ability of these programs to obtain interviews and acquire key information.

OBJECTIVE: To investigate programmatic and case-specific factors associated with CI outcomes using data from the Public Health Institute’s Tracing Health CI/CT program. Analyses were designed to detect variability in predictors of whether interviews and key information were obtained rather than quantify specific relationships.

DESIGN: Logistic regression models examined variability in the predictive value of interview timeliness and respondent characteristics on outreach outcomes and interview results.

SETTING AND PARTICIPANTS: Participants were members of a large California health care network with a positive laboratory test for COVID-19 and outreach from January 1 to July 31, 2021.

MAIN OUTCOME MEASURES: The primary outcome was the result of outreach attempts: completed interview, refused interview, or failure to reach the infected person. Secondary outcomes considered whether respondents provided information on symptom onset, employment, and contact information or a reason for declining to provide information, and whether resource support was requested or accepted.

RESULTS: Of 9391 eligible records, 65.6% were for completed interviews, 6.0% were refusals, and 28.3% were failed outreach. One-third of respondents (36.7%) provided information on contacts (mean = 0.97 contacts per respondent, 2.6 for those naming at least 1). Privacy concerns were the most common reasons for not providing contact information. Among respondent characteristics and interview timeliness, only race and number of symptoms showed statistically significant effects in all adjusted analyses.

CONCLUSIONS: Significant variation existed in outreach outcomes by subject characteristics and interview timeliness. CI/CT programs carefully focused to characteristics and needs of specific communities will likely have the greatest impact on the spread of COVID-19 and other communicable diseases.

PMID:36070585 | DOI:10.1097/PHH.0000000000001622

Photobiomodul Photomed Laser Surg. 2022 Sep 7. doi: 10.1089/photob.2022.0035. Online ahead of print.

ABSTRACT

Background: Stage 3 grade C periodontitis (S3GCP) has always been a challenge for clinicians. However, it is proposed that the use of lasers in addition to periodontal therapy can result in a more efficient therapy outcome. Objective: The aim of this clinical study was to determine the effects of additional application of diode laser (DL, 810 nm ±5) on clinical and microbiological values during Modified Widman Flap (MWF) periodontal surgery in the S3GCP patients. Methods: A total of 18 patients were randomly assigned to the test site (MWF + activeDL) and the control site (MFW alone). Clinical parameters and microbial samples were taken preoperatively, and postoperatively at 6 weeks, 3 months, and 6 months. Visual analog scale (VAS), tissue edema (TE), tissue color (TC), and pain medication (PM) consumption, were evaluated postoperatively at 10th day. Results: All bacteria were significantly decreased at follow-up times compared with preoperative amounts in both therapy sites (p < 0.05). Bacterial amounts of Treponema denticola, Prevotella intermedia, Tannerella forsythia, and Aggregatibacter actinomycetemcomitans at 6 weeks, Porphyromonas gingivalis and T. denticola at 3 months, T. denticola and A. actinomycetemcomitans at 6 months were statistically lower in the test site than the control site. All clinical parameters significantly improved after MWF surgery at follow-up times compared with preoperative values in intragroup comparisons, but a significant difference was not detected in the intergroup comparison. No differences were found in terms of VAS, PM, TE, and only TC was statistically more pink in the test site than the control site. Conclusions: The present study findings suggest that the use of DL together with MWF may have positive effects in the therapy of S3GCP patients by reducing the microbial load. Clinical Trial.org: NCT05108727.

PMID:36070584 | DOI:10.1089/photob.2022.0035

Transplantation. 2022 Sep 2. doi: 10.1097/TP.0000000000004277. Online ahead of print.

ABSTRACT

BACKGROUND: Characterization of anti-HLA versus anti-severe acute respiratory syndrome coronavirus 2 (anti-SARS-CoV-2) immune globulin isotypes in organ transplant recipients after coronavirus disease 2019 (COVID-19) infection has not been reported. We aimed to determine changes in anti-HLA antibodies in renal transplant patients with COVID-19 and compare the immunoglobulin and epitope-binding pattern versus anti-SARS-CoV-2 antibodies.

METHODS: This is a cross-sectional study of 46 kidney transplant recipients including 21 with longitudinal sampling. Using a semi-quantitative multiplex assay, we determined immunoglobulin (Ig) M, IgA, IgG, and IgG1-2-3-4 antibodies against Class I and Class II HLA, and 5 SARS-CoV-2 epitopes including the nucleocapsid protein and multiple regions of the spike protein.

RESULTS: Fourteen of 46 (30%) patients had donor-specific anti-HLA antibodies (donor-specific antibody [DSA]), 12 (26%) had non-DSA anti-HLA antibodies and 45 (98%) had anti-SARS-CoV-2 antibodies. Most DSAs targeted HLA-DQ (71%), with a dominant IgG isotype and IgG1 subtype prevalence (93%), and/or IgG3 (64%), followed by IgG2 (36%). Comparatively, there was a higher prevalence of IgA (85% versus 14%, P = 0.0001) and IgM (87%, versus 36%, P = 0.001) in the anti-SARS-CoV-2 antibody profile, when compared to DSAs, respectively. Anti-SARS-CoV-2 antibody profile was characterized by increased prevalence of IgM and IgA, when compared to DSAs. The median calculated panel reactive antibody before COVID-19 diagnosis (24%) tended to decrease after COVID-19 diagnosis (10%) but it was not statistically significant (P = 0.1).

CONCLUSIONS: Anti-HLA antibody strength and calculated panel reactive antibody in kidney transplant recipients after COVID-19 do not significantly increase after infection. Although the IgG isotype was the dominant form in both HLA and SARS-CoV-2 antigens, the alloimmune response had a low IgA pattern, whereas anti-SARS-CoV-2 antibodies were high IgA/IgM.

PMID:36070571 | DOI:10.1097/TP.0000000000004277