Nevin Manimala

Dan Med J. 2021 Jun 11;68(7):A11200805.

ABSTRACT

INTRODUCTION: COVID-19 has disrupted normal life and resulted in an online transformation of teaching. Little is known about how these changes affected academic stress in students. This study examined the role of changes of teaching methods on academic stress among university students during the first lockdown in Denmark.

METHODS: The cross-sectional survey was part of the international “COVID-19 International Student Well-being Study” and included responses on socio-economic characteristics, infection worries, academic stress, work capacity and satisfaction with teaching from 1,541 Danish health and medical science university students in May-June 2020. Changes in academic stress were analysed using descriptive statistics and multi-variable analyses using stepwise logistic regression.

RESULTS: A considerable part (39%) of students reported academic stress due to COVID-19. One third reported that their study workload had increased significantly due to the COVID-19 outbreak and that they were concerned about their ability to complete the academic year. Factors associated with academic stress were female sex, young age, bachelor level, knowing a COVID-19 patient and being worried about becoming infected, whereas immigration background, sufficient financial resources and living arrangements were not.

CONCLUSIONS: Our findings suggest that the COVID-19 outbreak has influenced university students’ academic stress. It is important to set up structures to support students’ mental health and educational trajectory during the pandemic.

FUNDING: none.

TRIAL REGISTRATION: not relevant.

PMID:34169831

J Nutr Educ Behav. 2021 Jun 21:S1499-4046(21)00607-2. doi: 10.1016/j.jneb.2021.04.466. Online ahead of print.

ABSTRACT

OBJECTIVE(S): Assess the quality of water language in California school district wellness policies and examine how language quality relates to school drinking water access.

DESIGN: Cross-sectional study.

PARTICIPANTS: Random sample of 240 schools selected from all California public schools, stratified by geography and grades served.

VARIABLES MEASURED: Policies (2016-2018) were coded for quality (strength and comprehensiveness) using an adapted school wellness policy tool. School administrators completed phone interviews about drinking water access on their campus.

ANALYSIS: Descriptive statistics (eg, means, standard deviations) summarized school-level characteristics and main outcomes. Mixed-effects linear regression models were used to examine the relationship between the strength and comprehensiveness of water policy language and water access.

RESULTS: On a scale of 0-100, mean strength was 11.3 (SD, 5.7), and mean comprehensiveness was 28.8 (SD, 8.7). There was an inverse association between the quality of water language in policies and excellence in drinking water access in schools.

CONCLUSIONS AND IMPLICATIONS: The strength and comprehensiveness of water language in California school district wellness policies were low. Districts would benefit from improving the quality of water language in their wellness policies and examining challenges to implementing policies.

PMID:34167919 | DOI:10.1016/j.jneb.2021.04.466

J Perianesth Nurs. 2021 Jun 21:S1089-9472(20)30319-1. doi: 10.1016/j.jopan.2020.10.004. Online ahead of print.

ABSTRACT

PURPOSE: The present study aimed to determine the prevalence and coping strategies for postoperative nausea and vomiting (PONV) and postdischarge nausea and vomiting (PDNV) in patients undergoing outpatient surgery.

DESIGN: A descriptive research design was used.

METHODS: This descriptive study was carried out with 350 patients who were admitted within the scope of outpatient surgery of the ear, nose, and throat; orthopaedics, urology, and general surgery departments of a university hospital between July 3, 2017 and March 6, 2018. A patient diagnosis form consisting of 34 items developed by the researcher and nausea-vomiting diary were used to collect data.

FINDINGS: The results showed that 30.6% of the patients had PONV and 26.3% had PDNV. Of the 92 patients with postdischarge nausea, 26.1% experienced mild, 44.6% moderate, 20.7% high, and 8.7% severe nausea. Among the strategies for coping with PDNV, the patients preferred resting (49%), going outdoors (23.4%), eating something (17%), and drinking something (10.6%). A statistically significant difference was found between postdischarge nausea and risk factors for nausea-vomiting, such as female gender, history of nausea-vomiting, nausea in the postanesthesia care unit, and opioid use in the postanesthesia care unit (P < .05).

CONCLUSIONS: This study shows that approximately a quarter of patients who undergo outpatient surgery will experience nausea and vomiting immediately after surgery as well as at home after discharge. Assessment of risk factors for PONV/PDNV was discovered to be an important factor in the care of perioperative patients. Therefore, the risk scoring system is expected to contribute to reducing PONV/PDNV incidence and improving patient coping strategies and satisfaction.

PMID:34167895 | DOI:10.1016/j.jopan.2020.10.004

Aust Crit Care. 2021 Jun 21:S1036-7314(21)00070-9. doi: 10.1016/j.aucc.2021.05.004. Online ahead of print.

ABSTRACT

BACKGROUND: Hyperkalaemia is a complication in patients with chronic kidney disease or acute kidney injury and occurs frequently in the intensive care unit. One treatment approach includes intravenous (IV) insulin to shift potassium intracellularly.

OBJECTIVES: The primary outcome was hypoglycaemia (blood glucose <70 mg/dL) after insulin administration. Secondary outcomes included change in serum potassium levels and incidence of severe hypoglycaemia.

METHODS: This was a single-centre, retrospective study evaluating critically ill adult patients with chronic kidney disease stage III-V, end-stage renal disease, or acute kidney injury who received IV insulin for treatment of hyperkalaemia from March 2008 to September 2018. Patients were divided into two insulin-dosing regimen groups: 5 units or 10 units.

RESULTS: Of the 174 patients included, hypoglycaemia after insulin administration occurred in eight of 87 patients (9.2%) in the 5-unit group and 17 of 87 patients (19.5%) in the 10-unit group (p = 0.052). There was no difference in rates of severe hypoglycaemia or change in serum potassium levels.

CONCLUSIONS: In critically ill patients requiring treatment for hyperkalaemia, a lower dose of IV insulin does not result in lower statistically significant rates of hypoglycaemia. However, lower insulin doses provide a similar potassium-lowering effect and cause a meaningful decrease in hypoglycaemic episodes. Intensive care unit providers may consider 5 units of IV insulin over 10 units although further larger controlled studies are needed.

PMID:34167889 | DOI:10.1016/j.aucc.2021.05.004

Aust Crit Care. 2021 Jun 21:S1036-7314(21)00071-0. doi: 10.1016/j.aucc.2021.05.005. Online ahead of print.

ABSTRACT

BACKGROUND: People with burn injury experiencing hypothermia are at risk of serious complications such as shock, multisystem organ failure, and death. There is limited information available for health professionals with regard to factors that contribute to restoration of normothermia after hypothermia in people with a major burn injury.

OBJECTIVE: The aim of the study was to identify factors that contribute to normothermia restoration after hypothermia in people with 10% or more total body surface area (TBSA) burn in the first 24 h of admission to a burn care hospital.

METHODS: The study was guided by the Gearing Framework for retrospective chart audit. The sample comprised medical charts of all adult people (n = 113) with a burn injury more than 10% of their TBSA admitted to a single-site burn care hospital intensive care unit in Victoria, Australia, between May 31, 2013, and June 1, 2015. Descriptive statistics were used to describe the sample, and logistic regression was conducted to predict variables contributing to return to normothermia in people with burn injury. Charts with incomplete data were excluded.

FINDINGS: The sample (n = 50) recorded a median initial temperature on admission to the emergency department (ED) of 35.4°C (range = 31.9-37.2°C) and took on an average of 6.2 (standard deviation [SD] = 4.96) hours to return to normothermia (36.5°C). Women took around 6 h longer than men to return to normothermia (mean = 11.14 h, SD = 5.58; mean = 5.38 h, SD = 4.41). Positive correlations were noted between TBSA%, the length of time between admission to the ED and the intensive care unit, and the hours taken to reach normothermia. Regression analysis suggests the initial recorded temperature on admission to the ED was the main predictor of the time body temperature takes to return to normothermia (β = .513, p < .001).

CONCLUSION: This study provides information for practice changes by highlighting the need for guidelines and education programs for health professionals to ensure the delivery of optimum care to people with burn injury.

PMID:34167888 | DOI:10.1016/j.aucc.2021.05.005

J Adolesc Health. 2021 Jun 21:S1054-139X(21)00242-1. doi: 10.1016/j.jadohealth.2021.05.010. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this study was to characterize COVID-19 content posted by users and disseminated via TikTok, a social media platform that has become known largely as an entertainment platform for viral video-sharing. We sought to capture how TikTok videos posted during the initial months of the COVID pandemic changed over time as cases accelerated.

METHODS: This study is an observational analysis of sequential TikTok videos with #coronavirus from January to March 2020. Videos were independently coded to assess content (e.g., health relatedness, humor, fear, empathy), misinformation, and public sentiment. To assess engagement, we also codified how often videos were shared relative to their content.

RESULTS: We coded 750 videos and approximately one in four videos tagged with #coronavirus featured health-related content such as featuring objects such as face masks, hand sanitizer, and other cleaning products. Most videos evoked “humor/parody,” whereas 15% and 6% evoked “fear” and “empathy”, respectively. TikTok videos posted in March 2020 had the largest number of shares and comments compared with January and February 2020. The proportion of shares and comments for “misleading and incorrect information” featured in videos was lower in March than in January and February 2020. There was no statistical difference between the share and comment counts of videos coded as “incorrect/incomplete” and “correct” over the entire time period.

CONCLUSIONS: Analyzing readily available social media platforms, such as TikTok provides real-time insights into public views, frequency and types of misinformation, and norms toward COVID-19. Analyzing TikTok videos has the potential to be used to inform public health messaging and public health mitigation strategies.

PMID:34167883 | DOI:10.1016/j.jadohealth.2021.05.010

J Formos Med Assoc. 2021 Jun 21:S0929-6646(21)00248-5. doi: 10.1016/j.jfma.2021.06.002. Online ahead of print.

ABSTRACT

BACKGROUND: This study was conducted to identify risk factors for distant interval metastases (IM) in patients with esophageal squamous cell carcinoma (ESCC) who underwent chemoradiotherapy (CRT).

METHODS: We retrospectively reviewed the clinical records of 358 patients with ESCC treated with CRT between 2006 and 2017. Distant IM were defined as systemic metastases developing during or shortly after CRT and identified during the restaging work-up period. A risk prediction nomogram for distant IM was developed based on independent pretreatment risk factors identified using multivariable logistic regression analysis.

RESULTS: Distant IM occurred in 26 (7.3%) patients and had a significant adverse impact on survival (median survival: 8.7 months). The most common site of distant IM was the lung (n = 9), followed by non-regional lymph nodes (n = 8) and the bone (n = 8). Multivariable logistic regression analysis revealed that high baseline tumor SUVmax values were independently associated with an increased risk of distant IM (odds ratio [OR] = 1.059, p = 0.019), whereas older age was an independent protective factor (OR = 0.946, p = 0.032). A nomogram based on age, tumor SUVmax, tumor length, and the chemotherapy regimen showed a good predictive performance (c-statistic = 0.761), which was internally validated using 200 bias-corrected bootstrap replicates (c-statistic = 0.71).

CONCLUSION: Distant IM were identified in 7.3% of patients with ESCC undergoing CRT. The nomogram described in our study may prove useful to predict the risk of distant IM in this patient group.

PMID:34167877 | DOI:10.1016/j.jfma.2021.06.002

Eur J Intern Med. 2021 Jun 16:S0953-6205(21)00208-9. doi: 10.1016/j.ejim.2021.06.009. Online ahead of print.

ABSTRACT

BACKGROUND: Single studies support the presence of several post-COVID-19 symptoms; however, no meta-analysis differentiating hospitalized and non-hospitalized patients has been published to date. This meta-analysis analyses the prevalence of post-COVID-19 symptoms in hospitalized and non-hospitalized patients recovered from COVID-19 .

METHODS: MEDLINE, CINAHL, PubMed, EMBASE, and Web of Science databases, as well as medRxiv and bioRxiv preprint servers were searched up to March 15, 2021. Peer-reviewed studies or preprints reporting data on post-COVID-19 symptoms collected by personal, telephonic or electronic interview were included. Methodological quality of the studies was assessed using the Newcastle-Ottawa Scale. We used a random-effects models for meta-analytical pooled prevalence of each post-COVID-19 symptom, and I² statistics for heterogeneity. Data synthesis was categorized at 30, 60, and ≥90 days after .

RESULTS: From 15,577 studies identified, 29 peer-reviewed studies and 4 preprints met inclusion criteria. The sample included 15,244 hospitalized and 9011 non-hospitalized patients. The methodological quality of most studies was fair. The results showed that 63.2, 71.9 and 45.9% of the sample exhibited ≥one post-COVID-19 symptom at 30, 60, or ≥90days after onset/hospitalization. Fatigue and dyspnea were the most prevalent symptoms with a pooled prevalence ranging from 35 to 60% depending on the follow-up. Other post-COVID-19 symptoms included cough (20-25%), anosmia (10-20%), ageusia (15-20%) or joint pain (15-20%). Time trend analysis revealed a decreased prevalence 30days after with an increase after 60days .

CONCLUSION: This meta-analysis shows that post-COVID-19 symptoms are present in more than 60% of patients infected by SARS-CoV‑2. Fatigue and dyspnea were the most prevalent post-COVID-19 symptoms, particularly 60 and ≥90 days after.

PMID:34167876 | DOI:10.1016/j.ejim.2021.06.009

J Subst Abuse Treat. 2021 Jun 17:108541. doi: 10.1016/j.jsat.2021.108541. Online ahead of print.

ABSTRACT

BACKGROUND: Smoking is highly prevalent among individuals with substance use disorder (SUD). No specific treatment policy exists for nicotine dependence treatment (NDT) in patients with SUD in Portugal, such as in most countries.

METHODS: We used the Index of Treatment Quality (ITTQ) and Tobacco Treatment Commitment Scale (TTCS) to assess NDT quality and commitment before and after training professionals who work in the Portuguese SUD treatment network (n = 203). The study assessed learning and competence through pre- and postknowledge tests, competence self-report, and intention-to-change questionnaires. The study carried out descriptive and inferential statistics using STATA software. We based the current study on the Revised Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0).

RESULTS: Compared to psychologists, physicians/social workers had worse NDT perceptions (i.e., NDT should not be included in drug treatment programs; NDT could hinder client recovery; it is unfair to take tobacco away from these patients). The counseling offer level was low overall. However, the study found higher levels of smoking assessment in all regions. Knowledge of motivational interviewing, stages of motivation, and addressing return to use improved. Self-competency skills also increased following training.

CONCLUSION: Treatment providers should be encouraged to implement counseling within NDT. Physicians and social workers should be aware of the importance of NDT for individuals with SUD. Attitudes and commitment to NDT for this subpopulation were quite similar to those found in U.S.

STUDIES: Our educational intervention increased learning knowledge and competence.

PMID:34167857 | DOI:10.1016/j.jsat.2021.108541

Clin Ther. 2021 May 21:S0149-2918(21)00162-4. doi: 10.1016/j.clinthera.2021.04.002. Online ahead of print.

ABSTRACT

PURPOSE: Celecoxib-tramadol co-crystal (CTC) is a first-in-class co-crystal of celecoxib and racemic tramadol. This Phase 1 bioavailability study compared single-dose pharmacokinetic (PK) parameters of CTC with those of the individual reference products from the United States, immediate-release celecoxib and tramadol, taken alone and simultaneously to determine their systemic exposure.

METHODS: This was a single-center, randomized, single-dose, open-label, 4-period, 4-sequence, crossover study conducted in healthy subjects between October and December 2016. Study treatments included 200-mg CTC (equivalent to 112-mg celecoxib and 88-mg tramadol; Treatment-1); 100-mg tramadol (Treatment-2); 100-mg celecoxib (Treatment-3); and 100-mg celecoxib plus 100-mg tramadol (Treatment-4). The PK parameters of interest were C_max, AUC_0-T, and AUC_0-∞, which were also calculated normalized to the dose. T_max was only considered as supportive. The statistical analysis was based on a parametric analysis of variance model of the PK parameters; the two-sided 90% CI of the ratio of geometric mean values for the C_max, AUC_0-T, and AUC_0-∞ was based on ln-transformed data, and T_max was rank-transformed.

FINDINGS: Thirty-six subjects aged 18 to 55 years (21 male subjects, 15 female subjects; mean age, 35 years) participated in the study. Celecoxib from CTC presented a lower C_max, reduced AUCs, and a faster T_max. The interference in celecoxib absorption when celecoxib and tramadol are administered together was minimized with the CTC. For Treatment-1, -3, and -4, celecoxib PK parameters were 259, 318, and 165 ng/mL (C_max), respectively; 1930, 2348, and 1929 ng • h/mL (AUC_0-T); and 1.5, 3.0, and 2.5 hours (T_max). Tramadol and its active metabolite O-desmethyl tramadol from CTC presented lower C_max and AUCs as well as a longer T_max. Tramadol/O-desmethyl tramadol PK parameters for Treatment-1, -2, and -4 were 214/55, 305/78, and 312/78 ng/mL for C_max; 2507/846, 2709/965, and 2888/1010 ng • h/mL for AUC_0-T; and 3.0/4.0, 2.0/2.5, and 1.9/2.5 hours for T_max. Reported adverse events (none unexpected) occurred more frequently with Treatment-2 and Treatment-4.

IMPLICATIONS: The aim of this study was to compare the PK profile of the US-marketed tramadol and celecoxib products with CTC to determine their systemic exposure and to validate the dosing regimen for a subsequent pivotal factorial Phase 3study. PK parameters of each active component in CTC were favorably modified by co-crystallization and did not result in higher systemic exposure compared with US-marketed celecoxib, tramadol, and their concomitant administration. (Clin Ther. 2021;43:XXX-XXX) © 2021 Elsevier HS Journals, Inc.

PMID:34167827 | DOI:10.1016/j.clinthera.2021.04.002