Tag: nevin manimala

Eur J Pain. 2024 Nov 23. doi: 10.1002/ejp.4761. Online ahead of print.

ABSTRACT

BACKGROUND: Functional neuroimaging studies indicate that central transmission of trigeminal pain may commence up to 48 h prior to the onset of headache. Whether these cyclic changes are associated with somatosensory alteration remains incompletely understood.

METHODS: The present study aimed to investigate the temporal progression of somatosensory alterations preceding the onset of a migraine attack. Patients with menstrually related migraine (n = 10) and matched healthy controls (n = 13) underwent consecutive daily quantitative sensory tests, commencing 6 days prior to the expected onset of the migraine attack and menstruation. Each subject was investigated for 7-11 consecutive days, resulting in 85 and 91 days of experimentation for the respective cohorts.

RESULTS: Electrical/heat/cold pain thresholds showed a phase-dependent decline towards the spontaneous migraine attack, which had commenced 48 h prior to the onset of the headache. The pain thresholds further declined towards the ictal phase, with only the electrical pain threshold reaching statistical significance (ictal vs. preictal). In healthy controls, the pain thresholds remained stable and unaltered during the consecutive daily measurements. In an exploratory analysis, the pain thresholds at baseline (interictal phase) were comparable between both cohorts.

CONCLUSIONS: The data suggest the existence of a trigeminal somatosensory alteration in the preictal phase of migraine, occurring up to 48 h prior to the onset of the headache. This change occurred in a chronologically synchronous manner with the brain activation in the preictal phase in functional neuroimaging studies. It will be important to combine pain threshold measurement and functional neuroimaging in future studies.

SIGNIFICANCE: Our data suggest the existence of a somatosensory behavioural correlate of the functional neuroimaging changes starting 48 h before the onset of headache. Despite the concurrence of the behavioural and functional neuroimaging changes in a chronological sequence, the next step in elucidating the cause of migraine is to combine the behavioural and functional neuroimaging changes in a temporal sequence, i.e. to identify the generator behind the cyclic sensory fluctuation.

PMID:39578922 | DOI:10.1002/ejp.4761

Arch Public Health. 2024 Nov 22;82(1):222. doi: 10.1186/s13690-024-01449-4.

ABSTRACT

BACKGROUND: Healthy eating patterns from sustainable food systems are crucial for population and planetary health. Primary schools are opportune settings for teaching children about food, nutrition and sustainability (FNS) though little is known about the delivery of FNS education in this sector. This study aimed to analyse current approaches to FNS education in Australian primary schools.

METHODS: A cross-sectional online survey with closed- and open-ended questions collected data about (i) teacher perceptions and attributes regarding FNS education; (ii) FNS teaching practices; and (iii) factors influencing FNS education. Statistical analyses were conducted using STATA including descriptive statistics and chi-square analyses to test for associations between categorical variables. Qualitative content and thematic analyses of open-ended questions were conducted using NVivo 14.

RESULTS: Participants were 413 Australian primary school teachers. Teachers considered FNS education as equally important to most curriculum subjects, though frequency of FNS education was low. Less than a third of teachers were trained in FNS education, had access to funding for FNS-related activities or were from schools with policies about including FNS education in the curriculum. There was a significant association between frequency of FNS education and teacher training, access to funding and presence of FNS curriculum policies (all p < 0.001). Teachers who were trained to teach nutrition, food skills or food sustainability (all p < 0.05) were more likely to teach this as both stand-alone and cross-curricular subjects. Teachers described personal factors (workload, stress, scope of practice) that influenced their FNS teaching practices, as well as factors related to students’ families (family responsibility for FNS education, family food practices, family engagement in FNS activities), the curriculum (overcrowding, prioritisation, access to resources) and the broader school environment (time, facilities, funding, training).

CONCLUSIONS: Strengthening the position of FNS education in the primary school sector is an important next step for public health research, policy and practice. Researchers and policy makers should explore future opportunities for training, funding and policy approaches that prioritise FNS within the primary school curriculum and in everyday teaching practice.

PMID:39578915 | DOI:10.1186/s13690-024-01449-4

J Orthop Surg Res. 2024 Nov 22;19(1):785. doi: 10.1186/s13018-024-05288-5.

ABSTRACT

BACKGROUND: Traditional Chinese exercise (TCE) is used as a therapeutic method in patients with postmenopausal osteoporosis. A meta-analysis was performed to evaluate the efficacy of TCE and provide reliable clinical evidence.

METHODS: Eight databases, including the Cochrane Library, PubMed, Embase, Web of Science, Chinese Science Citation Database, Wanfang, China National Knowledge Infrastructure, and Chinese Medical Journal full-text databases, were searched for randomized controlled trials. Meta-analysis was performed using the RevMan (version 5.4) software.

RESULTS: Sixteen studies involving 1,288 patients were included. Compared with conventional treatment alone, TCE improved patients’ bone mineral density, decreased pain, improved balance, improved quality of life, and decreased deoxypyridinoline levels. However, the intervention effects on the biochemical indexes of bone metabolism, including blood calcium, blood phosphorus, osteocalcin, and alkaline phosphatase levels, were not statistically significant.

CONCLUSION: TCE has a significant effect on postmenopausal patients with osteoporosis and can be used as a non-pharmacological treatment. The results of this study should be interpreted with caution because of the large heterogeneity for some indicators.

PMID:39578911 | DOI:10.1186/s13018-024-05288-5

J Orthop Surg Res. 2024 Nov 22;19(1):784. doi: 10.1186/s13018-024-05254-1.

ABSTRACT

PURPOSE: Vertebral body tethering (VBT) is a new growth-modulating surgery for adolescent idiopathic scoliosis (AIS) requiring a distinct skillset and intraoperative setup. We compared perioperative details and outcomes of VBTs performed in a public pediatric orthopedic hospital and a general private hospital setting.

METHODS: We identified all patients receiving VBT for AIS from 1/2020 to 12/2023 with ≥ 6 months post-operative follow-up, with surgeries performed by the same senior surgeons. Clinical, radiological, and surgical details were retrieved.

RESULTS: 24 VBTs were performed in the private setting and 16 in the public setting. Average age at operation was 11.9 ± 1.1 at a Sanders staging of 3.8 ± 1.2 when the major curve Cobb angle was 50.5 ± 8.0°. Tethered curves were most often thoracic in location (23/40) followed by thoracolumbar/lumbar curves (10/40) and double curve tethers (7/40). Overall correction ratio of 68.0 ± 19.0% was achieved. Time from booking to operation (82.2 ± 39.2 vs 63.1 ± 34.4 days, p = 0.112) and operation time (310 ± 86.4 min vs. 289 ± 87.4 min, p = 0.054) were longer in the public and private setting respectively but failed to reach statistical significance. Time to chest drain removal (1.5 ± 0.8 vs. 3.5 ± 1.7 days, p < 0.001) and length of stay (4.3 ± 0.9 vs. 6.6 ± 1.8 days, p < 0.001) were significantly shorter in the private setting, whilst complication rates remained similar (7/24 vs. 3/16, p = 0.456).

CONCLUSION: Expertise, resource availability, and costs differ in the public and private healthcare setting. With regards to VBT, the conditions for referral and surgical outcomes remained similar. Earlier drain removal and discharge for patients managed in the private setting was not associated with an increase in complication rate.

PMID:39578901 | DOI:10.1186/s13018-024-05254-1

Crit Care. 2024 Nov 22;28(1):381. doi: 10.1186/s13054-024-05180-y.

ABSTRACT

BACKGROUND: Pneumonia remains a significant global health concern, particularly among those requiring admission to the intensive care unit (ICU). Despite the availability of international guidelines, there remains heterogeneity in clinical management. The D-PRISM study aimed to develop a global overview of how pneumonias (i.e., community-acquired (CAP), hospital-acquired (HAP), and Ventilator-associated pneumonia (VAP)) are diagnosed and treated in the ICU and compare differences in clinical practice worldwide.

METHODS: The D-PRISM study was a multinational, survey-based investigation to assess the diagnosis and treatment of pneumonia in the ICU. A self-administered online questionnaire was distributed to intensive care clinicians from 72 countries between September to November 2022. The questionnaire included sections on professional profiles, current clinical practice in diagnosing and managing CAP, HAP, and VAP, and the availability of microbiology diagnostic tests. Multivariable analysis using multiple regression analysis was used to assess the relationship between reported antibiotic duration and organisational variables collected in the study.

RESULTS: A total of 1296 valid responses were collected from ICU clinicians, spread between low-and-middle income (LMIC) and high-income countries (HIC), with LMIC respondents comprising 51% of respondents. There is heterogeneity across the diagnostic processes, including clinical assessment, where 30% (389) did not consider radiological evidence essential to diagnose pneumonia, variable collection of microbiological samples, and use and practice in bronchoscopy. Microbiological diagnostics were least frequently available in low and lower-middle-income nation settings. Modal intended antibiotic treatment duration was 5-7 days for all types of pneumonia. Shorter durations of antibiotic treatment were associated with antimicrobial stewardship (AMS) programs, high national income status, and formal intensive care training.

CONCLUSIONS: This study highlighted variations in clinical practice and diagnostic capabilities for pneumonia, particularly issues with access to diagnostic tools in LMICs were identified. There is a clear need for improved adherence to existing guidelines and standardized approaches to diagnosing and treating pneumonia in the ICU. Trial registration As a survey of current practice, this study was not registered. It was reviewed and endorsed by the European Society of Intensive Care Medicine.

PMID:39578900 | DOI:10.1186/s13054-024-05180-y

Int J Equity Health. 2024 Nov 22;23(1):246. doi: 10.1186/s12939-024-02324-y.

ABSTRACT

BACKGROUND: The prevalence of gender disparities in physical, mental, and cognitive disorders among elderly hypertensive individuals in rural areas remains unclear. This study evaluates these disparities and the factors contributing to multimorbidity in this demographic.

METHODS: A face-to-face survey was conducted from July 1 to August 31, 2023, involving the hypertensive population registered with the National Basic Public Health Service Program in Jia County. Physical disorder was defined as having one or more self-reported chronic conditions other than hypertension. Participants experiencing anxiety or depression were as having a psychological disorder. The 9-item Patient Health Questionnaire (PHQ-9) was used to assess depression symptomatology, and anxiety symptoms were evaluated using the 7-item Generalized Anxiety Disorder questionnaire (GAD-7). Cognitive disorders were assessed using the Brief Mental Status Examination Scale (MMSE). Multifactorial logistic regression models were used to analyze factors affecting different disorder combinations in both genders. The net difference in multimorbidity prevalence between genders was determined using the propensity score matching (PSM).

RESULTS: Out of 18,447 hypertensive individuals aged 65 years and above (42.28% men), the prevalence of multimorbidity was 30.64% in men and 38.67% in women. Outcomes included seven categories: physical disorders, psychological disorders, cognitive disorders, and four different combinations of these disorders. The primary outcome was the presence of two or more disorders. The prevalence of physical, psychological, and cognitive disorders and their four combinations were higher in women than in men; Key factors influencing multimorbidity risk included subjective health status, illness duration, medication history, blood pressure control, and lifestyle behaviors in both men and women. Post-PSM analysis revealed that women had a 6.74% higher multimorbidity prevalence than men.

CONCLUSIONS: Physical, psychological, and cognitive disorders, along with their various multimorbid combinations, significantly impact the elderly hypertensive population. Prioritizing a healthy lifestyle is essential to mitigate multimorbidity risks. Considering that the prevalence of multimorbidity is higher in women than in men with hypertension, sufficient sleep, maintaining a healthy waist circumference, and medication adherence are vital for managing blood pressure and reducing multimorbidity risks.

PMID:39578886 | DOI:10.1186/s12939-024-02324-y

Crit Care. 2024 Nov 22;28(1):382. doi: 10.1186/s13054-024-05158-w.

ABSTRACT

BACKGROUND: Traumatic rhabdomyolysis (RM) is common and associated with the development of acute kidney injury and potentially with other organ dysfunctions. Thus, RM may increase the risk of death. The primary objective was to assess the effect of severe RM (Creatine Kinase [CK] > 5000 U/L) on 30-day mortality in trauma patients using a causal inference approach.

METHODS: In this multicenter cohort study conducted in France using a national major trauma registry (Traumabase) between January 1, 2012, and July 1, 2023, all patients admitted to a participating major trauma center hospitalized in intensive care unit (ICU) and with CK measurement were included. Confounding variables for both 30-day mortality and exposure were used to establish a propensity score. A doubly robust approach with inverse treatment weighting enabled the calculation of the average treatment effect on the treated (ATT). Analyses were performed in the overall cohort as well as in two subgroups: hemorrhagic shock subgroup (HS) and traumatic brain injury subgroup (TBI). Sensitivity analyses were conducted.

RESULTS: Among the 8592 patients included, 1544 (18.0%) had severe RM. They were predominantly males (78.6%) with median [IQR] age of 41 [27-58] years and severely injured (ISS 20 [13 – 29]) mainly from blunt trauma (90.8%). In the entire cohort, the ATT, expressed as a risk difference, was 0.073 [-0.054 to 0.200]. Considering the 1311 patients in the HS subgroup, the ATT was 0.039 [0.014 to 0.063]. As in the overall cohort, there was no effect on mortality in the TBI subgroup. Severe RM was associated with greater severity of trauma and more complications (whether related to renal function or not) during the ICU stay. Mortality due to multiorgan failure (39.9% vs 12.4%) or septic shock (2.6% vs 0.8%) was more frequent among patients with severe RM.

CONCLUSIONS: Severe RM was not associated with 30-day mortality considering the overall cohort. However, it was associated with a 4.0% increase in 30-day mortality among patients with concurrent hemorrhagic shock. Severe RM plays a significant role in ICU morbidity.

PMID:39578880 | DOI:10.1186/s13054-024-05158-w

Semin Arthritis Rheum. 2024 Nov 16;70:152592. doi: 10.1016/j.semarthrit.2024.152592. Online ahead of print.

ABSTRACT

Chronic musculoskeletal pain (CMP) poses a widespread health and socioeconomic problem, being the most prevalent chronic pain condition. Interdisciplinary multimodal pain treatment (IMPT) is considered the gold standard, offering cost-effective long-term care. Unfortunately, only a subset of patients experiences clinically relevant improvements in pain, fatigue, and disability post-IMPT. Establishing a prediction model encompassing various outcome measures could enhance rehabilitation and personalized healthcare. Thus, the aim was to develop and validate a prediction model for IMPT success in patients with CMP. A prospective cohort study within routine care was performed, including patients with CMP undergoing a 10-week IMPT. Success across four outcome measures was determined: patients’ recovery perspective, quality of life (physical and mental), and disability. Sixty-five demographic and candidate predictors (mainly patient reported outcome measures) were examined. Finally, 2309 patients participated, with IMPT success rates ranging from 30% to 57%. Four models incorporating 33 predictors were developed, with treatment control being the sole consistent predictor across all models. Additionally, predictors effects varied in direction in the models. All models demonstrated strong calibration, fair to good discrimination, and were internally validated (optimism-corrected AUC range 0.69-0.80). Our findings show that treatment success can be predicted using standardized patient-reported measures, exhibiting strong discriminatory power. However, predictors vary depending on the outcome, underscoring the importance of selecting the appropriate measure upfront. Clinically, these results suggest potential for patient-centered care and may contribute to the development of a scientifically sound decision tool.

PMID:39577031 | DOI:10.1016/j.semarthrit.2024.152592

Forensic Sci Int. 2024 Nov 19;366:112304. doi: 10.1016/j.forsciint.2024.112304. Online ahead of print.

ABSTRACT

Skeletonized human remains from Second World War mass graves in Slovenia are a major challenge in genetic identification, and bones with a high DNA yield must be selected for successful identification. The goal of this study was to construct skeletal sampling strategy recommendations through comparison of the most appropriate groups of skeletal elements. Altogether, 566 bones and teeth from the same mass grave were compared, half analyzed in this study and half in previous studies performed by our group. After anthropological examination, mechanical and chemical cleaning was performed, followed by bone and tooth powdering. Total demineralization of 0.5 g of bone and tooth was followed by extraction and purification of DNA with a Biorobot EZ1 device (Qiagen). The qPCR PowerQuant kit (Promega) was used to measure the amount of DNA, and statistical analysis was performed. Skeletal elements were selected according to known better preservation of DNA in the human body, and they were arranged in seven groups: petrous bone, long bones (femur and tibia), torso bones (first rib and 12th vertebra), metacarpals, metatarsals, short and sesamoid bones (talus, navicular, medial cuneiform, cuboid, calcaneus, and patella), and teeth. Sampling strategy recommendations were constructed based on DNA quantity and quality results. The petrous bone group, metacarpal group, torso bone group, and short and sesamoid bone group produced the highest DNA yields. Accordingly, in addition to standard sampling of long bones (femurs and tibias) and teeth, those additional bone types should be collected for Slovenian Second World War victim identification.

PMID:39577023 | DOI:10.1016/j.forsciint.2024.112304

Res Dev Disabil. 2024 Nov 21;155:104881. doi: 10.1016/j.ridd.2024.104881. Online ahead of print.

ABSTRACT

BACKGROUND: Restrictive repetitive behaviors (RRBs) and sensory processing disorders are core symptoms of autism spectrum disorder (ASD). Their relationship is reported, but existing data are conflicting as to whether they are related but distinct, or different aspects of the same phenomenon.

AIMS: This study investigates this relationship using artificial neural networks (ANN) analysis and an innovative data mining analysis known as Auto Contractive Map (Auto-CM), which allows to discover hidden trends and associations among complex networks of variables (e.g. biological systems).

METHODS AND PROCEDURES: The Short Sensory Profile and the Repetitive Behavior Scale-Revised were administered to 45 ASD children’s caregivers (M 78 %; F 22 %; mean age 6 years). Questionnaires’ scores, clinical and demographic data were collected and analyzed applying Auto-CM, and a connectivity map was drawn.

OUTCOMES AND RESULTS: The main associations shown by the resulting maps confirm the known relationship between RBBs and sensory abnormalities, and support the existence of sensory phenotypes, and important links between RRBs and sleep disturbance in ASD.

CONCLUSIONS AND IMPLICATIONS: Our study demonstrates the usefulness of ANNs application and its easy handling to research RBBs and sensory abnormalities in ASD, with the aim to achieve better individualized rehabilitation technique and improve early diagnosis.

PAPER’S CONTRIBUTION: Restricted, repetitive patterns of behaviors and interests and alteration of sensory elaboration are core symptoms of ASD; their impact on patients’ quality of life is known. This study introduces two main novelties: 1) the simultaneous and comparative use of two parent questionnaires (SSP and RBS-R) utilized for RRBs and alteration of sensory profile; 2) the application of ANNs to this kind of research. ANNs are adaptive models particularly suited for solving non-linear problems. While they have been widely used in the medical field, they have not been applied yet to the analysis of RRBs and sensory abnormalities in general, much less in children with ASD. The application of Auto Contractive Map (Auto-CM), a fourth generation ANNs analysis, to a dataset previously explored using classical statistical models, confirmed and expanded the associations emerged between SSP and RBS-R subscales and demographic-clinical variables. In particular, the Low Energy subscale has proven to be the central hub of the system; interesting links have emerged between the subscale Self-Injurious Behaviors and the variable intellectual disability and between sleep disturbance and various RRBs. Expanding research in this area aims to guide and modulate an emerging targeted and personalized rehabilitation therapy.

PMID:39577022 | DOI:10.1016/j.ridd.2024.104881