Nevin Manimala

J Nutr Educ Behav. 2021 Sep 21:S1499-4046(21)00762-4. doi: 10.1016/j.jneb.2021.08.005. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine the association between food insecurity and disordered eating behaviors (DEBs) in undergraduate college students.

METHODS: Cross-sectional data of college students (n = 533) were collected from February to April 2020. Food security was measured with the US Department of Agriculture’s Adult Food Security Survey Module. Disordered eating behaviors were measured with the Eating Disorder Examination Questionnaire. Associations were examined statistically with Pearson chi-square tests of independence and general linear regression models.

RESULTS: Across all food security ranges, linear trends detailed significant associations between food insecurity and global DEBs (β = 0.17; P < 0.001), eating concern (β = 0.27; P < 0.001), shape concern (β = 0.17; P = 0.001), and weight concern (β = 0.21; P < 0.001), but not restraint (β = 0.10; P = 0.08).

CONCLUSIONS AND IMPLICATIONS: Food insecurity was consistently related to DEBs. Future research may consider longitudinally examining this relationship, as food insecurity and DEBs may be associated worsen health outcomes among vulnerable college students.

PMID:34561153 | DOI:10.1016/j.jneb.2021.08.005

Patient Educ Couns. 2021 Sep 14:S0738-3991(21)00625-X. doi: 10.1016/j.pec.2021.09.016. Online ahead of print.

ABSTRACT

OBJECTIVES: To systematically synthesize the effectiveness of fatigue self-management education (SME) on fatigue and quality of life (QoL) in persons with disease-related fatigue, and to describe the intervention characteristics.

METHODS: We systematically reviewed the literature on SMEs in people with disease-related fatigue. We included randomized controlled trials (RCT), which aimed to improve self-management skills for fatigue in daily life. We synthesized the effectiveness and mapped the intervention characteristics.

RESULTS: We included 26 RCTs studying samples from eight disease groups. At follow-up, 46% studies reported statistically significant improvements on fatigue and 46% on QoL. For persons with cancer 6/8 and multiple sclerosis 8/10 RCTs showed positive evidence in favor of SME. The range of effect sizes was wide (d: 0.0 ->0.8). Delivery modalities (inpatient, outpatient, home), interactions (individual, group, remote), and duration [range (h): 1-17.5] varied.

CONCLUSIONS: The overall evidence on the effectiveness of SMEs on fatigue and QoL is limited and inconsistent. For persons with cancer and multiple sclerosis, the evidence provides a positive effect. The RCTs with medium to large effect on QoL indicate the potential benefit of SMEs.

PRACTICAL IMPLICATION: Duration and peer interaction should be considered when tailoring SMEs to populations and contexts.

PMID:34561143 | DOI:10.1016/j.pec.2021.09.016

Vaccine. 2021 Sep 21:S0264-410X(21)01226-3. doi: 10.1016/j.vaccine.2021.09.035. Online ahead of print.

ABSTRACT

IMPORTANCE: Passive surveillance systems are susceptible to the under-reporting of adverse events (AE) and a lack of information pertaining to vaccinated populations. Conventional active surveillance focuses on predefined AEs. Advanced data mining tools could be used to identify unusual clusters of potential AEs after vaccination.

OBJECTIVE: To assess the feasibility of a novel tree-based statistical approach to the identification of AE clustering following the implementation of a varicella vaccination program among one-year-olds.

SETTING AND PARTICIPANTS: This nationwide safety surveillance was based on data from the Taiwan National Health Insurance database and National Immunization Information System for the period 2004 through 2014. The study population was children aged 12-35 months who received the varicella vaccine.

EXPOSURE: First-dose varicella vaccine.

OUTCOMES AND MEASURES: All incident ICD-9-CM diagnoses (emergency or inpatient departments) occurring 1-56 days after the varicella vaccination were classified within a hierarchical system of diagnosis categories using Multi-Level Clinical Classifications Software. A self-controlled tree-temporal data mining tool was then used to explore the incidence of AE clustering with a variety of potential risk intervals. The comparison interval consisted of days in the 56-day follow-up period that fell outside the risk interval.

RESULTS: Among 1,194,189 varicella vaccinees with no other same-day vaccinations, nine diagnoses with clustering features were categorized into four safety signals: fever on days 1-6 (attributable risk [AR] 38.5 per 100,000, p < 0.001), gastritis and duodenitis on days 1-2 (AR 5.9 per 100,000, p < 0.001), acute upper respiratory infection on days 1-5 (AR 11.0 per 100,000, p = 0.006), and varicella infection on days 1-9 (AR 2.7 per 100,000, p < 0.001). These safety profiles and their corresponding risk intervals have been identified in previous safety surveillance studies.

CONCLUSIONS: Unexpected clusters of AEs were not detected after the mass administration of childhood varicella vaccines in Taiwan. The tree-temporal statistical method is a feasible approach to the safety surveillance of vaccines in populations of young children.

PMID:34561139 | DOI:10.1016/j.vaccine.2021.09.035

J Pediatr Nurs. 2021 Sep 21:S0882-5963(21)00274-8. doi: 10.1016/j.pedn.2021.09.006. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this study was to describe nurses perceptions of infants’ procedural pain assessment and alleviation with non-pharmacological methods including parental guidance in departments of neonatal and infant medicine and Neonatal Intensive Care (NICUs).

DESIGN AND METHODS: A descriptive cross-sectional survey was carried out among all nurses (n= 149) who were working in neonatal and infant departments or NICUs in Estonian hospitals. Altogether, 128 questionnaires were returned and 111 respondents were eligible (75% response rate). The data were analysed using statistical methods.

RESULTS: More than half of the nurses agreed that systematic documentation of the measurement of pain is necessary for nursing care and that it affects pain alleviation in infants. Half of the respondents (51%) confirmed that pain scales are important in the measurement of infants’ pain, but 58% claimed they were able to assess pain in a reliable way without using pain assessment scales. Nurses also reported that they were unfamiliar with most pain scales and they were not routinely used in everyday practice. Nurses said that the most useful non-pharmacological pain alleviation methods were touching (83%) and positioning infants (78%), the most rarely used were skin-to-skin care (12%) and encouraging mothers to breastfeed the infant (34%). The majority of respondents (79%) reported that they do not know or do not have written instructions on pain assessment in their workplace, and only a few (10%) reported that they have participated in pain management courses during the last year.

CONCLUSIONS: There is a need to increase the use of pain assessment scales and pain documentation in everyday practice in those hospitals in Estonia. The use of scales in pain assessment was valued by few nurses. It seems that there is a lack of knowledge on non-pharmacological methods, and nurses reported using only a few non-pharmacological pain alleviation methods and guided parents on using them.

PRACTICE IMPLICATIONS: Nurses need pain management guidelines for everyday work, and in addition to nurses, written guidelines for parents are needed.

PMID:34561132 | DOI:10.1016/j.pedn.2021.09.006

Am J Prev Med. 2021 Sep 21:S0749-3797(21)00404-9. doi: 10.1016/j.amepre.2021.06.010. Online ahead of print.

ABSTRACT

INTRODUCTION: The U.S. Affordable Care Act Medicaid expansion, which allowed states to expand Medicaid coverage to low-income adults beginning in 2014, has reduced the risk factors for child neglect and physical abuse, including parental financial insecurity, substance use, and untreated mental illness. This study examines the associations between Medicaid expansion and the rates of overall, first-time, and repeat reports of child neglect and physical abuse incidents per 100,000 children aged 0-5, 6-12, and 13-17 years.

METHODS: The 2008-2018 National Child Abuse and Neglect Data System was analyzed using an extension of the difference-in-differences approach that accounts for staggered policy implementation across time. Owing to evidence of nonparallel preperiod trends in the 6 states that expanded Medicaid from 2015 to 2017, the main analyses included 20 states that newly expanded Medicaid in 2014 and 18 states that did not expand Medicaid from 2008 to 2018. Analyses were conducted in 2020-2021.

RESULTS: Medicaid expansion states were associated with reductions of 13.4% (95% CI= -24.2, -9.6), 14.8% (95% CI= -26.4, -1.4), and 16.0% (-27.6, -2.6) in the average rate of child neglect reports per 100,000 children aged 0-5, 6-12, and 13-17 years, per state-year, relative to control states. Expansion was associated with a 17.3% (95% CI= -28.9, -3.8) reduction in the rate of first-time neglect reports among children aged 0-5 years and with 16.6% (95% CI= -29.3, -1.6) and 18.7% (95% CI= -32.5, -2.1) reductions in the rates of repeat neglect reports among children aged 6-12 and 13-17 years, respectively. There were no statistically significant associations between Medicaid expansion and the rates of physical abuse among children in any age group.

CONCLUSIONS: Insurance expansions for low-income adults may reduce child neglect.

PMID:34561125 | DOI:10.1016/j.amepre.2021.06.010

Immun Inflamm Dis. 2021 Sep 24. doi: 10.1002/iid3.537. Online ahead of print.

ABSTRACT

BACKGROUND: The narrow therapeutic window of tacrolimus (Tac) requires intense drug monitoring to achieve adequate efficacy while minimizing dose-related toxicities. Once-daily formulations of Tac (LCP-Tac and PR-Tac) have been recently designed for higher bioavailability and a more consistent exposure over time, as opposed to the twice-daily, administered immediate-release formulation of Tac (IR-Tac).

METHODS: This single-center, open-label, randomized cross-over pharmacokinetic (PK) study compares extended-release LCP-Tac with the prolonged-release formulation of tacrolimus (PR-Tac) in adult de novo liver transplant recipients. Eligible patients were screened and randomized 1:1 to the two treatment arms up to 30 days after liver transplantation. Patients were administered either LCP-Tac or PR-Tac for 14 days followed by another 14-day time interval of the other once-daily Tac medication. A 24hr-PK profile was obtained at the end of each time interval.

RESULTS: Nine patients (45%) completed the study resulting in a total of 18 Tac PK profiles. Overall, the profile of the mean concentrations indicated a flattened kinetic of LCP-Tac compared to PR-Tac, especially in the first 3 h after drug intake. The average cumulative dose per day to achieve equivalent trough levels was approximately 25% lower for LCP-Tac (8.7 mg) than for PR-Tac (11.7 mg). LCP-Tac resulted in a longer t_max and fewer peak-to-trough fluctuations compared to PR-Tac.

CONCLUSION: Despite methodological weaknesses that limit the conclusions, we have found a more consistent drug exposure for LCP-Tac in de novo LT recipients. LCP-Tac demonstrated a greater bioavailability compared to PR-Tac.

PMID:34559956 | DOI:10.1002/iid3.537

J Cosmet Dermatol. 2021 Sep 24. doi: 10.1111/jocd.14460. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this investigation was to assess the effectiveness of a non-cross-linked hyaluronic acid based soft-tissue filler in the correction of lateral canthal lines and periorbital lines.

MATERIAL AND METHODS: A total of 59 female Caucasian patients with a mean age of 52.6 ± 9.0 years were enrolled in this prospective open-label, multicentre study and received intradermal injections of a soft-tissue filler at baseline, after 3 and 6 weeks. Aesthetic improvement and patient satisfaction, skin hydration, skin firmness and skin elasticity, as well as adverse events were assessed at 3, 6, 8, 12 and 16 weeks.

RESULTS: At baseline, the lateral canthal skin firmness was 0.206 ± 0.07 mm and increased after 8 weeks to 0.087 ± 0.08 mm with p < 0.001, while the perioral skin firmness was 0.205 ± 0.09 mm and increased after 8 weeks to 0.116 ± 0.08 mm with p < 0.001. Increases in skin hydration were observed after 8 weeks in both areas, however, did not reach statistical significance at any point. At week 8, 12 and 16 a majority (93.1%, 91.1% and 73.7% respectively) of the patients stated that they were ‘satisfied’ or ‘very satisfied’ with the treatment.

CONCLUSION: Overall, the skin firmness and skin visco-elasticity showed significant increases in the lateral canthal and perioral region. Moreover, albeit not statistically significant, skin hydration increased in both areas after 8 weeks. The procedure has been shown to be safe and satisfactory for the treated patients; however, emergence of oral herpes should be added to the safety profile of intradermally applied hyaluronic acid treatments.

PMID:34559948 | DOI:10.1111/jocd.14460

J Cosmet Dermatol. 2021 Sep 24. doi: 10.1111/jocd.14394. Online ahead of print.

ABSTRACT

BACKGROUND: Various injectable autologous platelet aggregate preparations have been developed and used for facial rejuvenation. Limited evidence exists for the use of these for augmentation of the lip.

OBJECTIVES: This prospective, uncontrolled, single-center study evaluated the qualitative and quantitative effects of an injectable platelet-rich fibrin preparation (known as i-PRF+) for lip augmentation.

PATIENTS/METHODS: PRF^® PROCESS system technology was used to prepare i-PRF+ supernatant. Ten healthy females were included in the study and received a single intradermal injection of i-PRF+ in the upper and lower lips (5 ml in each quadrant, total ~2 ml). Participants were followed for 3 months post-procedure. The efficacy of the procedure was assessed qualitatively by a subjective patient-reported outcome (FACE-Q) assessment and quantitatively by objective 3D skin surface volume analysis (ProFace^® ) at baseline and after 3 months.

RESULTS: FACE-Q scales that measure satisfaction with skin and lip showed a statistically significant improvement from baseline (p = 0.04 and p = 0.02, respectively). Satisfaction with lip lines showed a numerical improvement with mean total scores for adverse effect scales related to the skin and lips reduced at 2 weeks post-procedure (p = 0.03 and p = 0.13, respectively). Overall lip volume at 3-month follow-up was unchanged (p = 0.11). The treatment was well tolerated with only minor adverse effects.

CONCLUSIONS: A single session of i-PRF+ injections resulted in significant lip rejuvenation at 3-month follow-up, shown by improved patient-reported outcome measure. No significant change in lip volume was observed.

PMID:34559947 | DOI:10.1111/jocd.14394

Neurourol Urodyn. 2021 Sep 24. doi: 10.1002/nau.24802. Online ahead of print.

ABSTRACT

AIM: To evaluate the quality of YouTube™ videos on bladder pain syndrome (BPS) and to investigate whether they can be used as a reliable source of information.

METHODS: The search term “bladder pain syndrome” was used on YouTube^TM platform. The first 100 videos were selected. Patient Education Materials Assessment Tool for audio-visual content (PEMAT A/V), Global Quality Score (GQS), Misinformation tool, and DISCERN score were used to assess videos’ quality content. Pearson’s test was used to assess potential correlations between variables.

RESULTS: Seventy-nine videos were suitable for the analyses. The median PEMAT A/V Understandability score and PEMAT A/V Actionability score were 66.7% (interquartile range [IQR]: 46.2-100.0) and 75.0% (IQR: 37.5-100.0), respectively. According to GQS, 26 (32.9%), 32 (40.5%), 3 (3.8%), 15 (19.0%), and 3 (3.8%) videos were excellent, good, moderate, generally poor, and poor, respectively. According to Misinformation tool, of all videos, 81% (n = 64), 6.3% (n = 5), 5.1% (n = 4), 5.1% (n = 4), 2.5% (n = 2) had respectively no, very little, moderate, high, and extreme misinformation. The overall median DISCERN score ranged from 5.0 (IQR: 2.0-5.0) to 5.0 (IQR: 5.0-5.0). A positive statistically significant correlation was found between video length and PEMAT A/V Understandability (r = 0.27, p = 0.01), video length and PEMAT A/V Actionability (r = .26, p = 0.02), and video length and DISCERN Question 16 (r = 0.28, p = 0.01).

CONCLUSIONS: Nowaday, the overall quality of YouTube^TM videos on BPS have been evaluated good according to PEMAT A/V, GQS, Misinformation tool, and DISCERN score. It is possible to assume that YouTube^TM may be considered as a reliable source of information on BPS.

PMID:34559920 | DOI:10.1002/nau.24802

J Rural Health. 2021 Sep 24. doi: 10.1111/jrh.12621. Online ahead of print.

ABSTRACT

PURPOSE: Rural public roads experience higher crash fatality rates than other roadways, with agricultural equipment adding greater risk of injury and fatality. This study set out to describe farmers’ experiences with farm equipment crashes and predictors of crashes at the farm level.

METHODS: A survey of farm operators was conducted in 9 Midwestern states (IL, IA, KS, MN, MO, NE, ND, SD, and WI) in collaboration with the US Department of Agriculture’s National Agricultural Statistical Service.

FINDINGS: From 1,282 farms operating equipment on public roads in 2013, 7.6% of farmers reported that equipment from their farm had ever been in a crash (n = 97). Crashes occurred most often in June-August (44.0%) and were most often reported as being during the daytime (71.3%), on dry roads (79.4%), or in clear weather (71.4%). While most farmers responded that they were driving the farm equipment at the time of the crash (52.0%), nearly half of crashes involved their employees as the driver (48.0%). Crashes often went unreported to law enforcement (28.6%).

CONCLUSION: To illustrate crash probabilities for farms with different profiles, we included farm acreage, crop farming, vehicle horsepower, annual miles driven, and the total number of farm vehicles driven on public roads in a predictive model. Large crop farms of 241+ acres, those who drove farm vehicles 1,430+ miles per year, and those with 20 or more farm vehicles had the highest probability of crash of 0.14.

PMID:34559912 | DOI:10.1111/jrh.12621