Tag: nevin manimala

Anat Rec (Hoboken). 2024 Apr 15. doi: 10.1002/ar.25453. Online ahead of print.

ABSTRACT

Recent studies have suggested a connection between disturbances of the apelin system and various cardiac pathologies, including hypertension, heart failure, and atherosclerosis. Vascular endothelial growth factor is crucial for cardiac homeostasis as a critical molecule in cardiac angiogenesis. Neuronal nitric oxide synthase is an essential enzyme producing nitric oxide, a key regulator of vascular tone. The present study aims to shed light upon the complex interactions between these three vital signaling molecules and examine their changes with the progression of hypertensive heart disease. We used two groups of spontaneously hypertensive rats and age-matched Wistar rats as controls. The expression of the apelin receptor, vascular endothelial growth factor, and neuronal nitric oxide synthase were assessed immunohistochemically. We used capillary density and cross-sectional area of the cardiomyocytes as quantitative parameters of cardiac hypertrophy. Immunoreactivity of the molecules was more potent in both ventricles of spontaneously hypertensive rats compared with age-matched controls. However, capillary density was lower in both ventricles of the two age groups of spontaneously hypertensive rats compared with controls, and the difference was statistically significant. In addition, the cross-sectional area of the cardiomyocytes was higher in both ventricles of the two age groups of spontaneously hypertensive rats compared with controls, and the difference was statistically significant. Our study suggests a potential link between the apelin receptor, vascular endothelial growth factor, and neuronal nitric oxide synthase in cardiac homeostasis and the hypertensive myocardium. Nevertheless, further research is required to better comprehend these interactions and their potential therapeutic implications.

PMID:38618880 | DOI:10.1002/ar.25453

Disaster Med Public Health Prep. 2024 Apr 15;18:e70. doi: 10.1017/dmp.2024.40.

ABSTRACT

OBJECTIVE: To evaluate the effect of the Disaster Medical Assistance Team (DMAT) in an inner-city emergency department during the coronavirus disease (COVID-19) pandemic.

METHODS: Data were abstracted from individual emergency department encounters over 6 weeks. The study compared left without being seen (LWBS) percentage, door-to-provider, and door-to-disposition times for 2 weeks before, during, and after the DMAT.

RESULTS: The LWBS percentages for the 2 weeks before and after the DMAT were 16.2% and 11.6%, respectively. The LWBS percentage during the DMAT was 8.1%. Door-to-disposition times for the 2 weeks before and after the DMAT were 7.36 hours and 8.53 hours, respectively. The door-to-disposition during the DMAT was 7.33 hours. Door-to-disposition was statistically significant during the 2 weeks of the DMAT compared to the 2 weeks after the DMAT (7.33 vs 8.53, P < 0.05) but not statistically significant when compared to the period before the DMAT (7.36 vs 7.33, P = 1.00). Door-to-provider time was the longest during the DMAT (122.5 minutes [2.04 hours]) when compared to the time frame before the DMAT (114.54 minutes [1.91 hours]) and after the DMAT (102.84 minutes [1.71 hours]).

CONCLUSION: The DMAT had the most positive impact on LWBS percentages. The DMAT showed no improvement in door-to-provider times in the study and only in door-to-disposition times when comparing the time the DMAT was present to after the DMAT departed.

PMID:38618877 | DOI:10.1017/dmp.2024.40

Nurs Open. 2024 Apr;11(4):e2147. doi: 10.1002/nop2.2147.

ABSTRACT

AIM: This study focuses on the fathers of children with chronic illnesses in an effort to clarify how the stressor and the father’s sense of coherence (SOC) influence their mental health and how the father’s SOC is associated with the social support.

DESIGN: Cross-sectional study.

METHODS: We conducted a self-reported questionnaire survey of 137 respondents (51 fathers of children with chronic illnesses, 86 fathers of healthy children) were statistically using ANOVA.

RESULTS: The fathers’ stressor was significantly related to their SOC. Furthermore, the SOC of the fathers majorly influenced their mental health, while having a buffering effect on the stressor with respect to depression. And their SOC was significantly positively associated with the social support. Our findings underscore that father’s SOC has a buffering effect on self-mental health and is important for maintaining mental health and enhancing SOC to reduce the stressors of these fathers with respect to depression.

PMID:38618873 | DOI:10.1002/nop2.2147

Int J Health Policy Manag. 2024 Feb 17. doi: 10.34172/ijhpm.2024.7919. Online ahead of print.

ABSTRACT

BACKGROUND: The health system performance assessment is a challenging process for decision-makers. In case of Kazakhstan’s healthcare system, the calculation of avoidable mortality, which has been underutilized to date, could serve as an additional tool to prioritize areas for improvement. Therefore, the aim of the study is to analyse avoidable mortality in Kazakhstan.

METHODS: The data was retrieved from the Bureau of National Statistics, Kazakhstan. It covers population data by age, mortality rates from disease groups based on the Joint OECD/Eurostat classification of preventable and treatable causes of mortality. The data spans from 2015 to 2021, categorized by gender and 5-year age groups (0, 1-4, 5-9, …, 70-74). Standardization was performed using the 2015 OECD standard population. We used joinpoint regression analysis to calculate the average annual percentage change.

RESULTS: From 2015 to 2019, the annual percentage change in avoidable mortality per 100000 population was -3.8 (-5.7 to -1.8), and from 2019 to 2021 it increased by 17.6 (11.3 to 24.3). Males exhibited higher avoidable mortality rates compared to females. The preventable mortality rate was consistently higher than the treatable mortality. Both preventable and treatable mortality decreased from 2015 to 2019, with preventable mortality reaching 272.17 before rising to 379.23 per 100000 population in 2021. Between 2015 and 2021, treatable mortality rates increased from 179.3 (176.93- 181.67) to 205.45 (203.08-207.81) per 100000 population.

CONCLUSION: In Kazakhstan, the leading causes of avoidable mortality were circulatory diseases, respiratory diseases, and cancer. To achieve the goals of Universal Health Coverage and improve the overall population health, there is an urgent need to amend the healthcare system and reduce avoidable mortality. While it is important to acknowledge the influence of COVID-19 on these trends, our study’s focus on avoidable mortality provides valuable insights that complement the understanding of pandemic-related effects.

PMID:38618853 | DOI:10.34172/ijhpm.2024.7919

Int J Health Policy Manag. 2024 Mar 13. doi: 10.34172/ijhpm.2024.8032. Online ahead of print.

ABSTRACT

BACKGROUND: Mortality rate in rural areas is a useful measure of the health of the population and the function of the health system, which varies over space and time. The objective of this research is to explore the spatial and temporal variations in the rural mortality rate in Iran at the county level in 2006, 2011 and 2016.

METHODS: data were gathered from the rural population and mortality statistics published by the Statistical Centre of Iran and the National Organization for Civil Registration. Global spatial patterns were assessed using the Global Moran’s I and local clusters through the Local Moran’ I.

RESULTS: Spatial distribution of rural mortality rate shows that during the years under study the number of counties with a lower rate has increased. The counties with rate of less form continuous areas in the southwest, central and east regions. The excess risk map reveals significant variations in both value and extent. Also, the values of Moran’s index increased from 0.1848 in 2006 to 0.4041 in 2016, which indicates the strengthening of the cluster spatial pattern of the overall rural mortality rate. Local patterns have undergone substantial changes over space and time.

CONCLUSION: The findings indicate significant spatial and temporal variations in rural mortality rates in Iran. Policymakers can use this information to plan and enhance healthcare infrastructure in specific counties. The findings serve for evaluating the effectiveness of health policies, enabling policymakers to make informed decisions, allocate resources efficiently and design targeted interventions for improved public health outcomes.

PMID:38618838 | DOI:10.34172/ijhpm.2024.8032

Int J Health Policy Manag. 2023;12:7391. doi: 10.34172/ijhpm.2023.7391. Epub 2023 Aug 15.

ABSTRACT

BACKGROUND: Globally, data on stillbirth is limited. A call to action has been issued to governments to address the data gap by strengthening national policies and strategies to drive urgent action on stillbirth reduction. This study aims to understand the policy environment for stillbirths to advance stillbirth recording and reporting in data systems.

METHODS: A systematic three-step process (survey tool examination, identifying relevant study questions, and reviewing country responses to the survey and national documents) was taken to review country responses to the global 2018-2019 World Health Organization (WHO) Reproductive, Maternal, Neonatal, Child and Adolescent Health (RMNCAH) Policy Survey. Policy Survey responses were reviewed to identify if and how stillbirths were included in national documents. This paper uses descriptive analyses to identify and describe the relationship between multiple variables.

RESULTS: Responses from 155 countries to the survey were analysed, and over 800 national policy documents submitted by countries in English reviewed. Fewer than one-fifth of countries have an established stillbirth rate (SBR) target, with higher percentages reported for under-5 (71.0%) and neonatal mortality (68.5%). Two-thirds (65.8%) of countries reported a national maternal death review panel. Less than half (43.9%) of countries have a national policy that requires stillbirths to be reviewed. Two-thirds of countries have a national policy requiring review of neonatal deaths. WHO websites and national health statistics reports are the common data sources for stillbirth estimates. Countries that are signatories to global initiatives on stillbirth reduction have established national targets. Globally, nearly all countries (94.8%) have a national policy that requires every death to be registered. However, 45.5% of reviewed national policy documents made mention of registering stillbirths. Only 5 countries had national policy documents recommending training of health workers in filling out death certificates using the International Classification of Diseases (ICD)-10 for stillbirths.

CONCLUSION: The current policy environment in countries is not supportive for identifying stillbirths and recording causes of death. This is likely to contribute to slow progress in stillbirth reduction. The paper proposes policy recommendations to make every baby count.

PMID:38618824 | DOI:10.34172/ijhpm.2023.7391

Ann Surg. 2024 Apr 15. doi: 10.1097/SLA.0000000000006296. Online ahead of print.

ABSTRACT

OBJECTIVE: To characterize the trends in and characteristics associated with the utilization and cost of gender-affirming surgery (GAS) in the United States from 2012-2019.

SUMMARY BACKGROUND DATA: GAS is one option among gender-diverse (GD) people to transition from their biologic anatomy to the anatomy congruent with their gender. Little is known about its utilization and cost trends and whether patient and hospital characteristics are associated with differences in utilization and cost.

METHODS: This serial cross-sectional study collected retrospective data from the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS), a representative pool of inpatient visits in the United States. Records from 2012-2019 that indicated ages 18 or older, GD diagnoses, and GAS procedures were identified using the International Classification of Diseases, Ninth and Tenth Revisions. Within this cohort, demographics, utilization, and cost were collected and analyzed using descriptive statistics and multivariable regression models.

RESULTS: 6,325 records with GD diagnoses and GAS procedures were identified. From 2012-2019, utilization increased by more than 5-fold (0.9 to 5.0 per 100,000 records among all records), and the mean, inflation-adjusted cost increased by 36% ($19,451 to $26,517). This cost trend was similar by type of surgery, and genital surgery had consistently higher costs than chest surgery from 2012 to 2019 (genital: $21,487 to $26,712, chest: $13,238 to $21,309). Lower odds of utilization were found in records with Medicaid (OR = 0.27, 95% CI [0.22-0.35], P<0.001) and Medicare (OR = 0.15, 95% CI [0.11-0.23], P<0.001) compared to private insurance, as well as those in the lowest income quartile (OR = 0.68, 95% CI [0.54-0.85], P<0.001) compared to the highest quartile. Lower costs were found in records that indicated hospital location in the Midwest (27% lower, 95% CI [0.61-0.87], P<0.001), Northeast (34% lower, 95% CI [0.55-0.80], P<0.001) and South (39% lower, 95% CI [0.53-0.71], P<0.001) compared to the West.

CONCLUSIONS: As demand for GAS increases with varying utilization and costs based on patient and hospital characteristics, there will likely be a need for more qualified surgeons, increased insurance coverage, and policies to ensure equitable access to GAS.

PMID:38618736 | DOI:10.1097/SLA.0000000000006296

Circ Res. 2024 Apr 15. doi: 10.1161/CIRCRESAHA.123.322767. Online ahead of print.

ABSTRACT

BACKGROUND: The resiliency of embryonic development to genetic and environmental perturbations has been long appreciated; however, little is known about the mechanisms underlying the robustness of developmental processes. Aberrations resulting in neonatal lethality are exemplified by congenital heart disease arising from defective morphogenesis of pharyngeal arch arteries (PAAs) and their derivatives.

OBJECTIVE: To uncover mechanisms underlying the robustness of PAA morphogenesis.

METHODS AND RESULTS: The second heart field (SHF) gives rise to the PAA endothelium. Here, we show that the number of SHF-derived endothelial cells (ECs) is regulated by VEGFR2 (vascular endothelial growth factor receptor 2) and Tbx1. Remarkably, when the SHF-derived EC number is decreased, PAA development can be rescued by the compensatory endothelium. Blocking such compensatory response leads to embryonic demise. To determine the source of compensating ECs and mechanisms regulating their recruitment, we investigated 3-dimensional EC connectivity, EC fate, and gene expression. Our studies demonstrate that the expression of VEGFR2 by the SHF is required for the differentiation of SHF-derived cells into PAA ECs. The deletion of 1 VEGFR2 allele (VEGFR2^SHF-HET) reduces SHF contribution to the PAA endothelium, while the deletion of both alleles (VEGFR2^SHF-KO) abolishes it. The decrease in SHF-derived ECs in VEGFR2^SHF-HET and VEGFR2^SHF-KO embryos is complemented by the recruitment of ECs from the nearby veins. Compensatory ECs contribute to PAA derivatives, giving rise to the endothelium of the aortic arch and the ductus in VEGFR2^SHF-KO mutants. Blocking the compensatory response in VEGFR2^SHF-KO mutants results in embryonic lethality shortly after mid-gestation. The compensatory ECs are absent in Tbx1^± embryos, a model for 22q11 deletion syndrome, leading to unpredictable arch artery morphogenesis and congenital heart disease. Tbx1 regulates the recruitment of the compensatory endothelium in an SHF-noncell-autonomous manner.

CONCLUSIONS: Our studies uncover a novel buffering mechanism underlying the resiliency of PAA development and remodeling.

PMID:38618720 | DOI:10.1161/CIRCRESAHA.123.322767

Phys Sportsmed. 2024 Apr 15. doi: 10.1080/00913847.2024.2341607. Online ahead of print.

ABSTRACT

BACKGROUND: Despite the numerous health benefits of distance running, it is also associated with the development of ‘gradual onset running-related injuries’ (GORRIs) one of which is Iliotibial Band Syndrome (ITBS). Novel risk factors associated with a history of ITBS (hITBS) have not been described in a large cohort of distance runners.

OBJECTIVE: To identify risk factors associated with hITBS in distance runners.

DESIGN: Descriptive cross-sectional study.

SETTING: 21.1 km and 56 km Two Oceans Marathon races (2012-2015).

PARTICIPANTS: 106 743 race entrants completed the online pre-race medical screening questionnaire. A total of 1 314 runners confirmed an accurate hITBS diagnosis.

METHODS: Selected risk factors associated with hITBS explored included: demographics (race distance, sex, age groups), training/running variables, history of existing chronic diseases (including a composite chronic disease score) and history of any allergy. Prevalence (%) and prevalence ratios (PR; 95% CI) are reported (uni- & multiple regression analyzes).

RESULTS: 1.63% entrants reported hITBS in a 12-month period. There was a higher (p < 0.0001) prevalence of hITBS in the longer race distance entrants (56 km), females, younger entrants, fewer years of recreational running (PR = 1.07; p = 0.0009) and faster average running speed (PR = 1.02; p = 0.0066). When adjusted for race distance, sex, age groups, a higher chronic disease composite score (PR = 2.38 times increased risk for every two additional chronic diseases; p < 0.0001) and a history of allergies (PR = 1.9; p < 0.0001) were independent risk factors associated with hITBS.

CONCLUSION: Apart from female sex, younger age, fewer years of running and slower running speed, two novel independent risk factors associated with hITBS in distance runners are an increased number of chronic diseases and a history of allergies. Identifying athletes at higher risk for ITBS can guide healthcare professionals in their prevention and rehabilitation efforts.

PMID:38618688 | DOI:10.1080/00913847.2024.2341607

Heliyon. 2024 Feb 28;10(6):e26928. doi: 10.1016/j.heliyon.2024.e26928. eCollection 2024 Mar 30.

ABSTRACT

CONTEXT: Medical devices fall under the broad topic encompass everything from basic hardware to integrated software systems. The integration of software into hardware devices is not simple due to requirements of regional regulatory bodies. Therefore, medical businesses need to oversee not only the creation of devices but also the observance of guidelines and standards established by regulatory bodies. While plan-driven methodologies prevented software from evolving or changing, agile methodologies have inherent characteristics of insufficient planning and documentation.

OBJECTIVES: The objective of our research is to propose a suitable process model for medical device development, keeping in mind the regulatory requirements.

METHODS: First, based on the detailed analysis of literature and McHughs proposed model, we suggested the Enhanced Agile V-Model (EAV), which combines plan-driven and agile approaches. Second, we mapped the proposed model to the MDEVSPICE framework to confirm that it adhered to the rules outlined in the standard IEC62304. Finally, the proposed model is evaluated through implication to case study of wave therapeutic medical device.

RESULTS: The support of both agile and waterfall approach in EAV model helps in accommodating new requirements in the medical devices and the proposed systems engineering approach helps in hardware and software integration. The mapping of the EAV model to the MDEVSPICE shows complete compliance. Moreover, the implication of the proposed model has been clearly shown statistically and successfully implemented in our case study. Further, device usability and efficiency metrics showed confidence of P < 0.05 and for device safety and efficiency, we conducted an experiment which shows significant improvement in selected parameters.

CONCLUSION: The proposed model shows conformance to regulatory standards, and successfully implemented in development of wave therapeutic device. However, its applicability to more compact and straightforward medical products is unknown and can be determined by using this model to analyze the performance of other medical products.

PMID:38618646 | PMC:PMC11009884 | DOI:10.1016/j.heliyon.2024.e26928