Tag: nevin manimala

J Neuroeng Rehabil. 2022 Jul 21;19(1):76. doi: 10.1186/s12984-022-01058-8.

ABSTRACT

OBJECTIVE: To investigate the effect of robot-assisted therapy (RAT) on upper limb motor control and activity function in poststroke patients compared with that of non-robotic therapy.

METHODS: We searched PubMed, EMBASE, Cochrane Library, Google Scholar and Scopus. Randomized controlled trials published from 2010 to nowadays comparing the effect of RAT and control treatment on upper limb function of poststroke patients aged 18 or older were included. Researchers extracted all relevant data from the included studies, assessed the heterogeneity with inconsistency statistics (I² statistics), evaluated the risk of bias of individual studies and performed data analysis.

RESULT: Forty-six studies were included. Meta-analysis showed that the outcome of the Fugl-Meyer Upper Extremity assessment (FM-UE) (SMD = 0.20, P = 0.001) and activity function post intervention was significantly higher (SMD = 0.32, P < 0.001) in the RAT group than in the control group. Differences in outcomes of the FM-UE and activity function between the RAT group and control group were observed at the end of treatment and were not found at the follow-up. Additionally, the outcomes of the FM-UE (SMD = 0.15, P = 0.005) and activity function (SMD = 0.32, P = 0.002) were significantly different between the RAT and control groups only with a total training time of more than 15 h. Moreover, the differences in outcomes of FM-UE and activity post intervention were not significant when the arm robots were applied to patients with severe impairments (FM-UE: SMD = 0.14, P = 0.08; activity: SMD = 0.21, P = 0.06) or when patients were provided with patient-passive training (FM-UE: SMD = – 0.09, P = 0.85; activity: SMD = 0.70, P = 0.16).

CONCLUSION: RAT has the significant immediate benefits for motor control and activity function of hemiparetic upper limb in patients after stroke compared with controls, but there is no evidence to support its long-term additional benefits. The superiority of RAT in improving motor control and activity function is limited by the amount of training time and the patients’ active participation.

PMID:35864524 | DOI:10.1186/s12984-022-01058-8

J Adv Nurs. 2022 Jul 21. doi: 10.1111/jan.15386. Online ahead of print.

ABSTRACT

AIM: Explore how nurses and midwives use patient experience data collected from a mobile health app to influence the development of person-centred practice.

DESIGN: Participatory action research, underpinned by the Person-Centred Nursing Framework and Practice Development principles.

METHODS: Six clinical units in a large health district engaged in three action cycles from 2018 to 2020 using a mobile health app. Nursing/midwifery staff on the units (N = 177) utilized data collected via the app to evaluate and improve person-centred practice. A pre-post survey using the PCPI-S was conducted to evaluate staff perceptions of person-centredness. Data from the surveys (n = 101 in 2018 and n = 102 in 2020) and 17 semi-structured interviews were used to understand the influence working with these data had on person-centred practice. The Guidelines for Best Practices in the Reporting of Participatory Action Research have been used to report this study.

RESULTS: Improvements in person-centred practice were noted across both data sets. There was a statistically significant increase in two domains of the PCPI-S in the independent t-test and across all three domains in the paired t-test results. Thematic analysis resulted in the identification of six themes: Getting everyone on board, once we understood, keeping on track, there’s a person in the bed, knowing you’re doing a good job and improving over time.

CONCLUSION: Engaging with the data collected from the app in a facilitated and collaborative way results in increases in person-centredness.

IMPACT: This study provides insight into how nurses and midwives used data from a mHealth app to evaluate and improve person-centred practice. Utilizing the data generated by the app resulted in increased person-centredness amongst staff and changes to practice and culture. Nursing and midwifery teams who are supported to engage with patient experience data in an action-oriented way will see person-centred practice improvements, affecting patients and staff.

PMID:35864521 | DOI:10.1111/jan.15386

Inj Epidemiol. 2022 Jul 21;9(1):23. doi: 10.1186/s40621-022-00388-4.

ABSTRACT

BACKGROUND: Construction workers are 3-4 times more likely than other workers to die from accidents at work-however, in the developing world, the risks associated with construction work may be 6 times greater. India does not publish occupational injury statistics, and so little is known about construction workers injured. We aimed to use Indian police records to describe the epidemiology of construction site injuries in Delhi and to thus generate knowledge that may help to control the burden of injuries to construction workers in India and in other developing countries.

METHODS: This was a cross-sectional analysis of accident records maintained by the Delhi Police. We included all construction workers reported to have been killed or injured in construction site accidents in Delhi during the period 2016-2018. We used multivariable logistic regression models to investigate associations between injury severity (fatal vs. non-fatal injury) and exposure variables whilst adjusting for a priori risk factors. We also estimated the number of Delhi construction workers in total and by trade to generate estimates of worker injury rates per 100,000 workers per year.

RESULTS: There were 929 construction site accidents within the study period, in which 1,217 workers and children were reported to have sustained injuries: 356 (29%) were fatal and 861 (71%) were non-fatal. One-eighth of injuries were sustained by females. Most occurred in the Rainy season; most were sustained during the construction of buildings. The most frequent causes were the collapse of an old building, the collapse of a new building under construction, and electric shocks. Electricians were more likely than unskilled workers to suffer a fatal injury (adjOR 2.5; 95% CI: 0.87-6.97), and there were more electrical shocks than electricians injured. The odds of a fatal injury were statistically significantly lower in Central districts than in the less developed, peripheral districts.

CONCLUSIONS: Construction site injuries are an unintended health impact of urbanisation. Women undertake manual work alongside men on construction sites in Delhi, and many suffer injuries as a consequence: an eighth of the injuries were sustained by females. Children accompanying their working parents on construction sites are also at risk. Two main hazards to construction workers in Delhi were building collapses and electrical shocks. Electricians were over twice as likely as unskilled workers to suffer a fatal injury, and electrical work would appear to be undertaken by a multitude of occupations. As the global urban population increases over the coming decades, so too will the burden of injuries to construction workers. The introduction and enforcement of occupational safety, health, and working conditions laws in India and in other rapidly developing countries will be necessary to help to control this injury burden to construction workers.

PMID:35864514 | DOI:10.1186/s40621-022-00388-4

Inj Epidemiol. 2022 Jul 21;9(1):24. doi: 10.1186/s40621-022-00389-3.

ABSTRACT

BACKGROUND: Temporary, voluntary storage of firearms away from the home during times of risk is a recommended strategy for suicide prevention. Law enforcement agencies (LEAs) are often suggested as storage sites, and online maps in Colorado and Washington display LEAs willing to consider storage. Questions remain about the experiences and views of LEAs, including barriers to providing storage.

METHODS: LEAs in Colorado and Washington were invited to complete a survey via mail or online from June to July 2021; invitations were sent by email and mail, with telephone calls to non-responders. Survey data were analyzed using descriptive statistics, with testing between states and other subgroups using Fisher’s exact tests.

RESULTS: Overall, 168 LEAs in Colorado (n = 91) or Washington (n = 77) participated (40% participation rate). Of those, 53% provided temporary, voluntary storage upon request by community members at the time of the survey. More LEAs said they had ever provided storage when the requester was under a court order (74% overall). Over half (60%) of responding LEAs had received at least one storage request in the prior 12 months. Many (41%) said they had declined to return a firearm after temporary storage due to safety concerns. Most LEAs supported engagement in suicide prevention (89%) and provision of community services (77%), but they simultaneously preferred being a storage option of last resort (73%). Factors negatively influencing storage provision included liability and funding concerns.

CONCLUSIONS: In Colorado and Washington, half of LEAs currently offer temporary, voluntary firearm storage upon request. While LEAs support suicide prevention and community engagement, broader provision of storage and participation in online maps may be limited by logistic, liability, and financial concerns. Addressing these barriers may facilitate broader suicide prevention efforts.

PMID:35864502 | DOI:10.1186/s40621-022-00389-3

Lipids Health Dis. 2022 Jul 21;21(1):60. doi: 10.1186/s12944-022-01673-3.

ABSTRACT

BACKGROUND: Trimethylamine N-oxide (TMAO)-related metabolites are associated with the pathogenesis of atherosclerotic cardiovascular disease (ASCVD) and are known to disrupt lipid metabolism. The aims of this study were to evaluate the associations between TMAO-related metabolites and blood lipids and determine how lowering the lipid profile via rosuvastatin therapy influences TMAO-related metabolites.

METHODS: A total of 112 patients with suspected ASCVD were enrolled in this study. The levels of plasma TMAO-related metabolites, including TMAO, choline, carnitine, betaine, and γ-butyrobetaine (GBB), were analyzed by stable isotope dilution liquid chromatography-tandem mass spectrometry (LC/MS/MS) before and after rosuvastatin therapy in all patients. Statistical methods were used to detect the associations between TMAO-related metabolites and blood lipids and determine how rosuvastatin therapy alters the levels of these metabolites.

RESULTS: A significant positive correlation was found between TMAO and triglycerides (TG) (r = 0.303, P < 0.05). Furthermore, significant negative correlations were found between TMAO and high-density lipoprotein cholesterol (HDL-c) and between betaine and low-density lipoprotein cholesterol (LDL-c) (r = – 0.405 and – 0.308, respectively, both P < 0.01). Compared to baseline, significantly lower TMAO levels and higher carnitine, betaine and GBB levels were observed after rosuvastatin therapy, while the lipids decreased significantly (P < 0.05). The significant correlation between TMAO and TG or between betaine and LDL-c disappeared after rosuvastatin therapy (r = 0.050 and – 0.172, respectively, both P > 0.05). However, a significantly positive association between carnitine and TC and a negative association between carnitine and LDL-c or between betaine and TG were found after adjustment for sex, age, body mass index (BMI) and lipids (P < 0.05).

CONCLUSIONS: This study suggests that TMAO-related metabolites are significantly associated with blood lipids, although some of them are changed postrosuvastatin therapy. Lower TMAO and higher TMAO precursors were observed after rosuvastatin therapy compared to baseline. This study indicates that elevated TMAO precursors after rosuvastatin therapy and their potential impact on ASCVD should be considered in the clinic.

PMID:35864500 | DOI:10.1186/s12944-022-01673-3

BMC Endocr Disord. 2022 Jul 21;22(1):186. doi: 10.1186/s12902-022-01073-9.

ABSTRACT

BACKGROUND: Diabetes mellitus (DM) and its cardiovascular disease (CVD) complication are among the most frequent causes of death worldwide. However, the metabolites linking up diabetes and CVD are less understood. In this study, we aimed to evaluate serum acylcarnitines and amino acids in postmenopausal women suffering from diabetes with different severity of CVD and compared them with healthy controls.

METHODS: Through a cross-sectional study, samples were collected from postmenopausal women without diabetes and CVD as controls (n = 20), patients with diabetes and without CVD (n = 16), diabetes with low risk of CVD (n = 11), and diabetes with a high risk of CVD (n = 21) referred for CT angiography for any reason. Metabolites were detected by a targeted approach using LC-MS/MS and metabolic -alterations were assessed by applying multivariate statistical analysis. The diagnostic ability of discovered metabolites based on multivariate statistical analysis was evaluated by ROC curve analysis.

RESULTS: The study included women aged from 50-80 years with 5-30 years of menopause. The relative concentration of C14:1, C14:2, C16:1, C18:1, and C18:2OH acylcarnitines decreased and C18 acylcarnitine and serine increased in diabetic patients compared to control. Besides, C16:1 and C18:2OH acylcarnitines increased in high-risk CVD diabetic patients compared to no CVD risk diabetic patients.

CONCLUSION: Dysregulation of serum acylcarnitines and amino acids profile correlated with different CAC score ranges in diabetic postmenopausal women. (Ethic approval No: IR.TUMS.EMRI.REC.1399.062).

PMID:35864499 | DOI:10.1186/s12902-022-01073-9

BMC Health Serv Res. 2022 Jul 21;22(1):936. doi: 10.1186/s12913-022-08319-1.

ABSTRACT

BACKGROUND: There is limited understanding of the drivers of increasing infant accident and emergency (A&E) attendances and emergency hospital admissions across England. We examine variations in use of emergency hospital services among infants by local areas in England and investigate the extent to which infant and socio-economic factors explain these variations.

METHODS: Birth cohort study using linked administrative Hospital Episode Statistics data in England. Singleton live births between 1-April-2012 and 31-March-2019 were followed up for 1 year; from 1-April-2013 (from the discharge date of their birth admission) until their first birthday, death or 31-March-2019. Mixed effects negative binomial models were used to calculate incidence rate ratios for A&E attendances and emergency admissions and mixed effects logistic regression models estimated odds ratio of conversion (the proportion of infants subsequently admitted after attending A&E). Models were adjusted for individual-level factors and included a random effect for local authority (LA).

RESULTS: The cohort comprised 3,665,414 births in 150 English LAs. Rates of A&E attendances and emergency admissions were highest amongst: infants born < 32 weeks gestation; with presence of congenital anomaly; and to mothers < 20-years-old. Area-level deprivation was positively associated with A&E attendance rates, but not associated with conversion probability. A&E attendance rates were highest in the North East (916 per 1000 child-years, 95%CI: 911 to 921) and London (876 per 1000, 95%CI: 874 to 879), yet London had the lowest emergency admission rates (232 per 1000, 95%CI: 231 to 234) and conversion probability (25% vs 39% in South West). Adjusting for individual-level factors did not significantly affect variability in A&E attendance and emergency admission rates by local authority.

CONCLUSIONS: Drivers of A&E attendances and emergency admissions include individual-level factors such being born premature, with congenital anomaly and from socio-economically disadvantaged young parent families. Support for such vulnerable infants and families should be provided alongside preventative health care in primary and community care settings. The impact of these services requires further investigation. Substantial geographical variations in rates were not explained by individual-level factors. This suggests more detailed understanding of local and underlying service-level factors would provide targets for further research on mechanisms and policy priority.

PMID:35864495 | DOI:10.1186/s12913-022-08319-1

BMC Womens Health. 2022 Jul 21;22(1):302. doi: 10.1186/s12905-022-01886-9.

ABSTRACT

INTRODUCTION: Women heads of households (widows or divorcees) are vulnerable groups in society who face various psychological problems and have less resilience than other women. Therefore, the present study was conducted to determine the effectiveness of resilience educational intervention on the psychological capital of poor widows in Fasa city, south Iran.

MATERIALS AND METHODS: In this quasi-experimental study, 120 widows covered by Imam Khomeini Relief Foundation were selected by a simple random sampling method based on a random Efron algorithm (Efron coin) and randomly assigned into two interventions and control groups (60 people each) in the second half of 2021. About 8 training sessions on resilience and psychological capital were held for the experimental group through training clips, audio transmissions, and podcasts. Data were collected using demographic characteristics forms, widowers’ resilience assessment questionnaires, and Luten’s psychological capital scale for testing and control before and two months after the intervention. Data were analyzed with Chi-square test, independent and paired t-test using SPSS V. 26 software.

RESULTS: There were differences between the two groups at pretest in demographic variables and psychological capital and its subscales, and resilience and its subscales (P ≥ 0.05).. But two months after the educational intervention, a statistically significant increase was observed in the experimental group in these variables compared to the control group (p < 0.05). It indicates that there was an improvement in the outcomes from pretest to post-test within the intervention and no change in the outcomes over time within the control group.

DISCUSSION AND CONCLUSION: Using a resilience-based educational approach as a novelty of this research to promote psychological capital and resilience can increase resilience and psychological capital in widows. Then, considering the positive effect of this educational approach and the low cost of this intervention, it seems that the implementation of such interventions should be included in the plans related to widows.

PMID:35864493 | DOI:10.1186/s12905-022-01886-9

BMC Pediatr. 2022 Jul 22;22(1):439. doi: 10.1186/s12887-022-03499-5.

ABSTRACT

BACKGROUND: Vitamin A is a nutrient that is required in a small amount for normal visual system function, growth and development, epithelia’s cellular integrity, immune function, and reproduction. Vitamin A has a significant and clinically important effect since it has been associated with a reduction in all-cause and diarrhea mortality. The aim of this study was to determine factors associated with national vitamin A supplementation among children aged 6-35 months.

METHOD: The data for this study was extracted from the 2019 Ethiopian Mini Demographic and Health Survey. A total weighted sample of 2242 women with children aged 6-35 months was included in the study. The analysis was performed using Stata version 14.2 software. Applying sampling weight for descriptive statistics and complex sample design for inferential statistics, a manual backward stepwise elimination approach was applied. Finally, statistical significance declared at the level of p value < 0.05.

RESULT: The overall coverage of vitamin A supplementation among children aged 6-35 months for the survey included was 44.4 95% CI (40.15, 48.74). In the multivariable analysis, mothers who had four or more antenatal visits [AOR = 2.02 (95% CI: 1.34, 3.04)] were two times more likely to receive vitamin A capsules for their children than mothers who had no antenatal visits. Children from middle-wealth quintiles had higher odds of receiving vitamin A capsules in comparison to children from the poorest wealth quintile [AOR = 1.77 (95% CI: 1.14, 2.73)]. Older children had higher odds of receiving vitamin A capsules than the youngest ones. Other factors that were associated with vitamin A supplementation were mode of delivery and region.

CONCLUSION: The coverage of vitamin A supplementation in Ethiopia remains low and it is strongly associated with antenatal visit, household wealth index and age of child. Expanding maternal health services like antenatal care visits should be prioritized.

PMID:35864488 | DOI:10.1186/s12887-022-03499-5

BMC Pediatr. 2022 Jul 22;22(1):441. doi: 10.1186/s12887-022-03503-y.

ABSTRACT

BACKGROUND: Mortality among under-five children in Tanzania remains high. While early presentation for treatment increases likelihood of survival, delays to care are common and factors causing delay to presentation among critically ill children are unknown. In this study delay was defined as presentation to the emergency department of tertially hospital i.e. Muhimbili National Hospital, more than 48 h from the onset of the index illness.

METHODOLOGY: This was a prospective cohort study of critically ill children aged 28 days to 14 years attending emergency department at Muhimbili National Hospital in Tanzania from September 2019 to January 2020. We documented demographics, time to ED presentation, ED interventions and 30-day outcome. The primary outcome was the association of delay with mortality and secondary outcomes were predictors of delay among critically ill paediatric patients. Logistic regression and relative risk were calculated to measure the strength of the predictor and the relationship between delay and mortality respectively.

RESULTS: We enrolled 440 (59.1%) critically ill children, their median age was 12 [IQR = 9-60] months and 63.9% were males. The median time to Emergency Department arrival was 3 days [IQR = 1-5] and more than half (56.6%) of critically ill children presented to Emergency Department in > 48 h whereby being an infant, self-referral and belonging to poor family were independent predictors of delay. Infants and those referred from other facilities had 2.4(95% CI 1.4-4.0) and 1.8(95% CI 1.1-2.8) times increased odds of presenting late to the Emergency Department respectively. The overall 30-day in-hospital mortality was 26.5% in which those who presented late were 1.3 more likely to die than those who presented early (RR = 1.3, CI: 0.9-1.9). Majority died > 24 h of Emergency Department arrival (P-value = 0.021).

CONCLUSION: The risk of in-hospital mortality among children who presented to the ED later than 48 h after onset of illness was 1.3 times higher than for children who presented earlier than 48 h. It could be anywhere from 10% lower to 90% higher than the point estimate. However, the effect size was statistically not significant since the confidence interval included the null value Qualitative and time-motion studies are needed to evaluate the care pathway of critically ill pediatric patients to identify preventable delays in care.

PMID:35864482 | DOI:10.1186/s12887-022-03503-y