Nevin Manimala

Nurs Open. 2021 May 1. doi: 10.1002/nop2.762. Online ahead of print.

ABSTRACT

AIM: To investigate nurses’ perceptions of their work environment and to investigate the relationships between variables measuring the work environment (WE) and nursing outcomes (NO_s ).

DESIGN: A 2-year prospective longitudinal survey (2013-2015).

METHOD(S): Descriptive statistics of nurse demographics, organizational WE and NOs were calculated by position. The associations between Practice Environment Scale of the Nursing Work Index (PES-NWI) and NOs were examined for each unit.

RESULTS: The participants were 2,992 staff nurses, 137 nurse managers (NMs), and 8 chief nursing officers in Phase 1 and 7,849, 371 and 23 in Phase 2, respectively. The higher the job position, the better the WE was rated. The higher the PES-NWI scores, the better the outcomes. Descriptive statistics about organizational WEs and NOs and the statistically significant associations between the two were identified.

PMID:33932266 | DOI:10.1002/nop2.762

Eur J Heart Fail. 2021 May 1. doi: 10.1002/ejhf.2210. Online ahead of print.

ABSTRACT

AIMS: Viral-induced cardiac inflammation can induce heart failure with preserved ejection fraction (HFpEF) like syndromes. COVID-19 can lead to myocardial damage and vascular injury. We hypothesised that COVID-19 patients frequently develop a HFpEF-like syndrome, and designed this study to explore this.

METHODS AND RESULTS: Cardiac function was assessed in 64 consecutive, hospitalized, and clinically stable COVID-19 patients from April – November 2020 with left ventricular ejection fraction (LVEF) ≥50% (age 56±19 years, females: 31%, severe COVID-19 disease: 69%). To investigate likelihood of HFpEF presence, we used the HFA-PEFF score. A low (0-1 points), intermediate (2-4 points), and high (5-6 points) HFA-PEFF score was observed in 42%, 33%, and 25% of patients, respectively. In comparison, 64 subjects of similar age, sex, and comorbidity status without COVID-19, showed these scores in 30%, 66%, and 4%, respectively (between groups: p=0.0002). High HFA-PEFF scores were more frequent in COVID-19 patients than controls (25% vs. 4%, p=0.001). In COVID-19 patients, HFA-PEFF score significantly correlated with age, estimated glomerular filtration rate, high sensitivity troponin T (hsTnT), haemoglobin, QTc interval, LVEF, mitral E/A ratio, and H₂ FPEF score (all p<0.05). In multivariate, ordinal regression analyses, higher age and hsTnT were significant predictors of increased HFA-PEFF scores. Patients with myocardial injury (hsTnT ≥14 ng/L: 31%) vs. patients without myocardial injury, showed higher HFA-PEFF scores (median 5 [IQR 3-6] vs. 1 [0-3], p<0.001) and more often showed LV diastolic dysfunction (75% vs. 27%, p<0.001).

CONCLUSION: Hospitalised COVID-19 patients frequently show high likelihood of presence of HFpEF that is associated with cardiac structural and functional alterations, and myocardial injury. Detailed cardiac assessments including echocardiographic determination of LV diastolic function and biomarkers should become routine in the care of hospitalised COVID-19 patients. This article is protected by copyright. All rights reserved.

PMID:33932255 | DOI:10.1002/ejhf.2210

Pharmacotherapy. 2021 May 1. doi: 10.1002/phar.2530. Online ahead of print.

ABSTRACT

BACKGROUND: Observational studies comparing ticagrelor and prasugrel in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) have yielded contradictory results, but these studies often did not consider differential censoring (e.g., for treatment switching or insurance disenrollment) or confounding by time-dependent factors.

OBJECTIVE: Our objective was to conduct a comparative effectiveness and safety analysis of ticagrelor and prasugrel in patients who underwent PCI after being hospitalized for an ACS.

METHODS: This study used the Optum’s de-identified Clinformatics® Data Mart Database and included patients aged 18 years or older with an index hospital admission between May 2012 and September 2015, a diagnosis of ACS managed with PCI, and treatment with either ticagrelor or prasugrel. The primary composite outcome was defined as the first occurrence of all-cause death, myocardial infarction (MI), or ischemic stroke. The secondary composite outcome included the first occurrence of gastrointestinal (GI) bleed, intracranial hemorrhage (ICH), or other major bleeds requiring hospitalization. Weighted Cox proportional hazard models and robust variance estimation were implemented to adjust for baseline comorbidities, time-varying exposure, time-dependent confounders, and differential censoring.

RESULTS: Included in the analysis were 2,559 patients initiated on ticagrelor and 4,456 patients initiated on prasugrel following PCI. Patients initiated on ticagrelor were 10% more likely to have eligibility disenrollment (Ticagrelor: 57%, Prasugrel: 47%, P<.01) and 7 percentage-points more likely to switch medication (Ticagrelor: 35%, Prasugrel: 28%, P<.01). After adjusting for multiple factors, including time-varying exposure and censoring imbalance, ticagrelor was associated with a higher risk of all-cause death, MI, or stroke when compared to prasugrel (Hazard ratio (HR): 1.33; 95% CI: 1.04-1.68). Similarly, ticagrelor was associated with a higher risk in bleeding events when compared with prasugrel (HR: 1.61; 95% CI: 1.19-2.17).

CONCLUSION: When compared with ticagrelor, prasugrel use following PCI for ACS was associated with a lower risk of death, MI, or stroke, as well as a reduced risk of major bleeding.

PMID:33932252 | DOI:10.1002/phar.2530

J Viral Hepat. 2021 May 1. doi: 10.1111/jvh.13529. Online ahead of print.

ABSTRACT

We compared the care cascades of Hepatitis C (HCV) mono-infected and HCV/HIV co-infected patients screened in a universal Emergency Department (ED) HCV screening program. This was a retrospective review of program data collected between June 6, 2018 and December 31, 2019. HIV and HCV status, linkage to care and treatment outcomes were abstracted from the program-screening database. Descriptive statistics were used to characterize the population. Group comparisons (HCV mono-infected vs. HIV/HCV co-infected) were compared using Chi-square. There were 116,596 adult (age 18 y and above) patient visits, representing 62,001 unique individuals. Of these, 17,676 (28.5%) received an HCV antibody test. We identified 418 evaluable patients (2.4%) with active HCV (HCV RNA positive). Of these, 337 (81%) were HCV mono-infected, 58 (14%) were HCV/HIV co-infected and 23 (5%) had unknown HIV status. Among the 418 evaluable patients 174 (41%) were linked to care and 94 (22.5%) achieved sustained virologic response (SVR).There were no significant differences between HCV mono-infected and HCV/HIV co-infected groups at any step of the care cascade (diagnosed and aware, linked to care, medications prescribed or SVR). Universal HCV screening in the ED identified a large number of patients with active HCV infection, of which 14% were co-infected with HIV. While there were no differences in the care cascades between mono and co-infected patients, linkage and treatment outcomes were low in both groups. Barriers to linkage to care and treatment after ED diagnosis should be further investigated and addressed to improve public health outcomes.

PMID:33932240 | DOI:10.1111/jvh.13529

Qual Life Res. 2021 May 1. doi: 10.1007/s11136-021-02853-x. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the associations between cardiovascular health (CVH) metrics and health-related quality of life (HRQL) among patients with ischemic stroke in China, and further explore the role of physical and cognitive function in their associations.

METHODS: This hospital-based study included 1714 patients with first-ever acute ischemic stroke (age ≥ 40 years; 36.7% women) who were admitted to two university hospitals in Shandong, China. We collected information on seven CVH metrics (smoking, body mass index, diet, physical activity, blood pressure, total cholesterol, and fasting blood glucose) through interviews, clinical examinations, and laboratory tests. EQ-5D-3L was used to assess HRQL. Cognitive and physical functioning was assessed by the Montreal Cognitive Assessment test and Barthel index, respectively. Data were analyzed using the general linear regression models.

RESULTS: The average score (SD) was 0.746 (0.23) for HRQL index and 72.7 (15.8) for self-rated health. Optimal levels of four individual CVH metric components (diet, physical activity, blood pressure, and blood glucose) and a higher composite CVH score were significantly associated with a greater HRQL index and better self-rated health (p < 0.05 for all). Physical dependence and cognitive impairment were associated with a lower HRQL index and poorer self-rated health status (p < 0.001). Furthermore, the relationships between CVH metrics and HRQL index varied by functional status, such that their associations were statistically significant only among people who had physical dependence or cognitive impairment.

CONCLUSION: Achieving a better cardiovascular health profile is associated with better quality of life among ischemic stroke survivors, primarily in those with physical or cognitive impairment.

PMID:33932220 | DOI:10.1007/s11136-021-02853-x

Environ Sci Pollut Res Int. 2021 May 1. doi: 10.1007/s11356-021-14160-6. Online ahead of print.

ABSTRACT

Louhajang River, Bangladesh, which crosses Tangail as a densely industrialized and urbanized city, supplies water for different purposes. This study reports the levels of pH, electrical conductivity (EC), and some toxic heavy metals in 40 water samples collected during the summer and winter seasons from Louhajang River. The winter season reported higher levels of the examined parameters than the summer season with significant variation (p < 0.05) for all parameters, with the exception of Cd. The metal contents were assessed against local and international standards for drinking, irrigation, and aquatic life purposes where different trends were observed. The heavy metal evaluation index and the ecological risk index reported low to moderate risks. The spatial distribution of metal contents assigned hot spots in some sites along the riverbed. The health risk assessment for three population categories, i.e., adult male, adult female, and children, was examined. Cr and Cd recorded hazard index > 1 in all cases, indicating possible non-cancer risk. The total carcinogenic risk values during both seasons were > 1.0 × 10^-6, indicating possible cancer risk. The adopted collection of different approaches (comparison against standard levels of toxicants, statistical analysis, spatial distribution, and health risk assessment) successfully demonstrates a whole picture of the environmental status of Louhajang River, Bangladesh.

PMID:33932212 | DOI:10.1007/s11356-021-14160-6

Environ Sci Pollut Res Int. 2021 May 1. doi: 10.1007/s11356-021-14140-w. Online ahead of print.

ABSTRACT

Bisphenol A (BPA) leads to ROS production that considered the core of different inflammatory and chronic obstructive pulmonary diseases. As a natural antioxidant, lycopene plays a significant role in the prevention of many chronic diseases. This study aimed to investigate the possible protective role of lycopene against BPA-induced lung alterations using morphometric, histological, immunohistochemical and biochemical methods. Forty rats aged 3 months were divided into four groups (n=10): control group, lycopene group comprising rats that received lycopene by gavage (10 mg/kg /day) for 30 days, BPA group comprising rats that received BPA by gavage (50 mg/kg/day) for 30 days and lycopene + BPA group. On the 30th day, blood and lung tissue samples were collected for biochemical, histological and immunohistochemical studies. Morphometrical and statistical analyses were performed. The BPA group revealed significantly elevated IL-1B, IL-6, MDA and NO, and it showed significantly reduced IL-10, SOD, CAT and GSH when compared to the control and lycopene + BPA groups. Upon histopathological and immunohistochemical examination, lycopene supplementation improved the BPA-induced alveolar collapse, lymphocytic infiltration, extravasated RBCs and fibrosis. The lycopene + BPA group showed significantly reduced mean percentage of 8-OHdG immunopositive and mean area percentages of Bax and caspase 3 immunopositive cells and significantly reduced mean area percentage of Bcl2 immunopositive cells as compared with the BPA group. Lycopene is a protective agent against BPA-induced lung injury because of its anti-apoptotic, anti-inflammatory and antioxidant effects, as confirmed by biochemical and histological studies.

PMID:33932206 | DOI:10.1007/s11356-021-14140-w

J Cancer Educ. 2021 May 1. doi: 10.1007/s13187-021-02012-3. Online ahead of print.

ABSTRACT

African American women are disproportionately impacted by breast cancer, including triple-negative disease, at a young age. Yet most public health research in breast cancer focuses on women of screening age. This study identified the specific breast cancer educational needs of African American women below the recommended screening age. Data were collected through 30 key informant interviews with young African American women breast cancer survivors (diagnosed between 18 and 45), family members of African American women diagnosed between 18-45 years, and community organization leaders and healthcare providers who work with young African American women impacted by breast cancer. Data were coded and analyzed by multiple team members using template analysis. The analysis identified four overarching themes reflecting breast cancer educational needs of young African American women. Although most Breast Cancer Knowledge and Perceived Risk educational needs were consistent with those of older women, there were specific needs involving Cultural Reluctance in Health Disclosures and Breast Cancer Risk Reduction. With regard to Healthcare Provider Relationships, participants stated a need for younger women to be particularly proactive in advocating for their health, as providers may be dismissive about cancer concerns due to young age. Though breast cancer in younger women is statistically improbable, there are educational needs specific to young African American women involving self-advocacy and family history. Findings have implications for developing interventions guiding young women to advocate for themselves in medical encounters and in their families, as well as for teaching medical providers how to counsel the young women regarding breast cancer.

PMID:33932194 | DOI:10.1007/s13187-021-02012-3

Egypt Heart J. 2021 May 1;73(1):40. doi: 10.1186/s43044-021-00163-8.

ABSTRACT

BACKGROUND: Conflicting data were found regarding the anemia’s effect on percutaneous coronary intervention (PCI) outcomes. We directed our study to investigate anemia’s effect on clinical in-stent restenosis (ISR) following PCI.

RESULTS: A prospective multi-center cohort study was performed on 470 consecutive participants undergoing elective PCI. We classified the participants into two groups: group 1 who were anemic and group 2 who were non-anemic as a control group. At 1, 3, 6, and 12 months by clinic visits, we followed up with the patients to assess anemia’s clinical ISR effect. We found that 20% of the patients undergoing PCI had anemia. Anemic patients showed a statistically significant higher rate of impaired renal function and diabetes and a higher percentage of the female gender. Multivariate regression analysis for major adverse cardiovascular events (MACEs) after adjusting for confounding factors revealed that anemia represents a more risk on MACE (adjusted hazard ratio (HR) was 4.13; 95% CI 2.35-7.94; p value < 0.001) and carries a higher risk upon clinical ISR (adjusted HR was 3.51; 95% CI 1.88-7.16; p value < 0.001) over 12 months of follow-up.

CONCLUSION: Anemic patients going through PCI are generally females, diabetics, and have renal impairment. Anemia might be considered another indicator for clinical ISR and is fundamentally associated with an increased MACE incidence.

PMID:33932182 | DOI:10.1186/s43044-021-00163-8

Eur Arch Otorhinolaryngol. 2021 May 1. doi: 10.1007/s00405-021-06836-z. Online ahead of print.

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a contagious disease whose symptoms and risk factors are newly described. Some allergic diseases, including asthma, have been defined as risk factors for a poor outcome in COVID-19. We aimed to investigate the role of another allergic disease-allergic rhinitis-in the severity of COVID-19.

METHODS: This case-control study was conducted at Sakarya Educational and Research Hospital, Toyota Hospital and Yenikent State Hospital between March 18, 2020 and August 30, 2020. The study included a case group of 125 randomly selected patients who had been diagnosed with allergic rhinitis in advance of having COVID-19 and a control group of 125 patients without allergic rhinitis who were diagnosed with COVID-19. We evaluated all participants’ statuses regarding smoking, symptoms, and hospitalization, as well as the length of their hospitalization and the number of their comorbidities.

RESULTS: There were no statistically significant differences between the two groups regarding percentage of asymptomatic patients (p = 0.27), presence of smoking (p = 0.068), hospitalization status (p = 0.79), and hospitalization length (p = 0.55). From each group, two patients needed care in an intensive care unit (ICU). One patient from the case group and two from the control group died due to COVID-19.

CONCLUSION: We found that allergic rhinitis did not affect the severity of COVID-19. However, we recommend that the literature be augmented with further studies on the COVID-19 prognosis of patients who have allergic rhinitis.

PMID:33932179 | DOI:10.1007/s00405-021-06836-z