Tag: nevin manimala

Diabetes Res Clin Pract. 2023 Jun 3:110735. doi: 10.1016/j.diabres.2023.110735. Online ahead of print.

ABSTRACT

AIM: To evaluate real-life changes of glycemic parameters among flash glucose monitoring (FLASH) users who do not meet glycemic targets.

METHODS: De-identified data were obtained between 2014 and 2021 from patients using FLASH uninterrupted for a 24-week period. Glycemic parameters during first and last sensor use were examined in four identifiable groups: type 1 diabetes mellitus (T1DM), type 2 diabetes mellitus (T2DM) on basal-bolus insulin, T2DM on basal insulin, and T2DM without insulin treatment. Within each group, subgroup analyses were performed in persons with initial suboptimal glycemic regulation (time in range (TIR; 3.9-10 mmol/L) <70%, time above range (TAR; >10 mmol/L) >25%, or time below range (TBR; <3.9 mmol/L) >4%).

RESULTS: Data were obtained from 1,909 persons with T1DM and 1,813 persons with T2DM (1,499 basal-bolus insulin, 189 basal insulin, and 125 non-insulin users). In most of the performed analyses, both overall and in the various subgroups, significant improvements were observed in virtually all predefined primary (TIR) and secondary endpoints (eHbA1c, TAR, TBR and glucose variability).

CONCLUSIONS: 24-weeks FLASH use in real life by persons with T1DM and T2DM with suboptimal glycemic regulation is associated with improvement of glycemic parameters, irrespective of pre-use regulation or treatment modality.

PMID:37276981 | DOI:10.1016/j.diabres.2023.110735

J Acad Nutr Diet. 2023 Jun 3:S2212-2672(23)00288-5. doi: 10.1016/j.jand.2023.05.028. Online ahead of print.

ABSTRACT

BACKGROUND: Breastfeeding has been linked to a higher consumption of fruit and vegetables at 4 to 5 years of age. More recently, it has been suggested that it may also be associated with lower ultra-processed food (UPF) consumption in childhood.

OBJECTIVE: The aim of this study was to assess whether breastfeeding duration was associated with consumption of UPF in a sample of Mediterranean preschoolers.

DESIGN: This study involved a cross-sectional analysis of baseline information of children in the SENDO cohort. Children were enrolled at 4 to 5 years of age and information was gathered through an online questionnaire completed by parents. Dietary information was collected with a previously validated semi-quantitative food frequency questionnaire (FFQ) and foods were classified based on the degree of processing according to the NOVA classification.

PARTICIPANTS/SETTING: This study used baseline information for 806 participants enrolled in the SENDO cohort between January 2015 and June 2021 in Spain.

MAIN OUTCOMES MEASURES: Main study outcome measures were 1) Difference in g/day and in the percentage of total energy intake (TEI) from UPF consumption related to breastfeeding duration, and 2) Odds ratio (OR) that UPF represents a high percentage of TEI.

STATISTICAL ANALYSES: Crude and multivariable adjusted estimates were calculated with generalized estimating equations to account for intra-cluster correlation between siblings.

RESULTS: The prevalence of breastfeeding in the sample was 84%. After adjusting for potential confounders, children who were breastfed for some time reported significantly lower consumption of UPF than children who were not breastfed at all. The mean differences were -19.2 g. (95% CI: -44.2, 10.8) for children who were breastfed for <6 months, -42.5 g. (95% CI: -77.2, -7.80) for those who were breastfed for 6-12 months, and -43.6 g. (95% CI: -79.8, -7.48) for those who were breastfed for 12 months or more (p for trend=0.01). After adjusting for potential confounders, compared with children who were not breastfed, those who were breastfed for ≥12 months had consistently lower odds of UPF representing more than 25%, 30%, 35% and 40% of TEI.

CONCLUSION: Breastfeeding is associated with lower consumption of UPF in Spanish preschoolers.

PMID:37276962 | DOI:10.1016/j.jand.2023.05.028

Asian Nurs Res (Korean Soc Nurs Sci). 2023 Jun 3:S1976-1317(23)00031-2. doi: 10.1016/j.anr.2023.05.002. Online ahead of print.

ABSTRACT

PURPOSE: Evidence on factors influencing the variations of music effect on anxiety and pain in surgical patients is unclear. We aimed to elucidate the effects of music intervention on anxiety and pain by study characteristics.

METHODS: We conducted a search on the PubMed, CINAHL, Embase, Cochrane, and Web of Science databases from March 7 to April 21, 2022, for randomized controlled trials (RCTs) for the effect of music intervention on anxiety, pain, and physiological responses in surgical patients. We included studies published within the last 10 years. We assessed the risk of bias in study using the Cochrane risk of bias tool for randomized trials and performed meta-analyses using random-effects model for all outcomes. We used change-from-baseline scores as summary statistics and computed bias-corrected standardized mean difference (Hedges’g) for anxiety and pain outcomes and mean differences (MD) for blood pressure and heart rate.

RESULTS: Of the 454 records retrieved, 30 RCTs involving 2280 participants were found to be eligible. Music intervention was found to be superior to standard care in reducing anxiety (Hedges’g = -1.48, 95% confidence interval: -1.97 to -0.98), pain (Hedges’g = -0.67, -1.11 to -0.23), systolic blood pressure (MD = -4.62, -7.38 to -1.86), and heart rate (MD = -3.37, -6.65 to -0.10) in surgical patients. The impact of music on anxiety and pain relief varied significantly depending on the duration of the intervention. The largest effect was observed in interventions lasting between 30 to 60 minutes, with a decrease in anxiety and pain.

CONCLUSION: Music intervention is an effective way to reduce anxiety, pain, and physiological response in surgical patients. Future reviews examining the influence of different types of surgery on the effects of music would add to the body of knowledge in this field. This study has been registered on PROSPERO under the number CRD42022340203, with a registration date of July 4, 2022.

PMID:37276961 | DOI:10.1016/j.anr.2023.05.002

J Biomed Inform. 2023 Jun 3:104415. doi: 10.1016/j.jbi.2023.104415. Online ahead of print.

ABSTRACT

OBJECTIVE: Disease knowledge graphs have emerged as a powerful tool for AI, enabling the connection, organization, and access to diverse information about diseases. However, the relations between disease concepts are often distributed across multiple data formats, including plain language and incomplete disease knowledge graphs. As a result, extracting disease relations from multimodal data sources is crucial for constructing accurate and comprehensive disease knowledge graphs.

METHODS: We introduce REMAP, a multimodal approach for disease relation extraction. The REMAP machine learning approach jointly embeds a partial, incomplete knowledge graph and a medical language dataset into a compact latent vector space, aligning the multimodal embeddings for optimal disease relation extraction. Additionally, REMAP utilizes a decoupled model structure to enable inference in single-modal data, which can be applied under missing modality scenarios.

RESULTS: We apply the REMAP approach to a disease knowledge graph with 96,913 relations and a text dataset of 1.24 million sentences. On a dataset annotated by human experts, REMAP improves language-based disease relation extraction by 10.0% (accuracy) and 17.2% (F1-score) by fusing disease knowledge graphs with language information. Furthermore, REMAP leverages text information to recommend new relationships in the knowledge graph, outperforming graph-based methods by 8.4% (accuracy) and 10.4% (F1-score).

CONCLUSION: In summary, REMAP is a flexible multimodal approach for extracting disease relations by fusing structured knowledge and language information. This approach provides a powerful model to easily find, access, and evaluate relations between disease concepts.

PMID:37276949 | DOI:10.1016/j.jbi.2023.104415

Int J Radiat Oncol Biol Phys. 2023 Jun 3:S0360-3016(23)00535-7. doi: 10.1016/j.ijrobp.2023.05.045. Online ahead of print.

ABSTRACT

PURPOSE: When compared to conventional dose rate irradiation (CONV), ultra-high dose rate irradiation (UHDR) has shown superior normal tissue sparing. However, a clinically relevant widening of the therapeutic window by UHDR, termed “FLASH effect”, also depends on the tumour toxicity obtained by UHDR. Based on a combined analysis of published literature, the current study re-examines the hypothesis of tumour isoefficacy for UHDR versus CONV and aims to identify potential knowledge gaps to inspire future in vivo studies.

METHODS: A systematic literature search identified publications assessing in vivo tumour responses comparing UHDR and CONV. Qualitative and quantitative analyses were performed, including combined analyses of tumour growth and survival data.

RESULTS: We identified 66 data sets from 15 publications that compared UHDR and CONV for tumour efficacy. The median number of animals per group was 9 (range: 3-15) and the median follow-up period was 30.5 (range: 11-230) days after the first irradiation. Tumour growth assays were the predominant model used. Combined statistical analyses of tumour growth and survival data are consistent with UHDR isoefficacy compared to CONV. Only one study determined tumour-controlling dose (TCD₅₀) and reported statistically non-significant differences.

CONCLUSION: The combined quantitative analyses of tumour responses support the assumption of UHDR isoefficacy compared to CONV. However, the comparisons are primarily based on heterogeneous tumour growth assays with limited numbers of animals and short follow-up, and most studies do not assess long-term tumour control probability. Therefore, the assays may be insensitive in resolving smaller response differences, such as responses of radio-resistant tumour sub-clones. Hence, tumour cure experiments, including additional TCD₅₀ experiments, are needed to confirm the assumption of isoeffectiveness in curative settings.

PMID:37276928 | DOI:10.1016/j.ijrobp.2023.05.045

Eur J Dent. 2023 Jun 5. doi: 10.1055/s-0042-1760299. Online ahead of print.

ABSTRACT

OBJECTIVES: To investigate the impact of the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) pandemic on stress and anxiety of preclinical and clinical dental students.

MATERIALS AND METHODS: Dental students (participants) in their clinical course (CC; n = 64) or preclinical course (PCC; n = 53) were included in the study. The subjective perceived levels of stress and anxiety were evaluated using the Dental Environment Stress (DES) questionnaire and the Depression, Anxiety and Stress Scales (DASS) questionnaire. Cortisol levels were measured in saliva samples collected from participants. Knowledge of the pandemic was evaluated using a 100-mm visual analog scale. All data were collected twice: once during the university holidays and once during term time.

STATISTICAL ANALYSIS: Results from DES, DASS, and salivary cortisol tests were compared between baseline and follow-up using descriptive and bivariate statistics. Multivariate linear regression models were computed with DES, DASS, and cortisol values as dependent variables to analyze possible influencing factors.

RESULTS: Participants showed medium levels of stress and anxiety at baseline and follow-up. The DASS score in the “anxiety” subdomain was significantly higher in the PCC group than in the CC group at baseline (p < 0.001) and increased during term time. DASS scores in the “stress” subdomain also increased during term time. However, both subdomain scores were lower than the cutoff value for a psychological disorder. The mean total DES scores were 615.9 ± 97.7 in the CC group and 580.40 ± 98.9 in the PCC group. These scores indicated medium stress levels and were not significantly different between the groups, nor did they change during the study period. Mean saliva cortisol levels were higher in the CC group (9.2 ± 5.2) than in the PCC group (4.9 ± 2.2) at baseline (p < 0.001) but converged by follow-up. Multivariate regression models showed that intraindividual perception of stress at baseline was consistently the most important aspect for changes in stress and anxiety levels during term time. The SARS-CoV-2 pandemic affected stress and anxiety levels in some participants, but this was not ubiquitous.

CONCLUSION: Intraindividual differences in stress perception seem to be more relevant than course affiliation (preclinical or clinical) or the SARS-CoV-2 pandemic to stress and anxiety levels in dental students.

PMID:37276882 | DOI:10.1055/s-0042-1760299

Eur J Dent. 2023 Jun 5. doi: 10.1055/s-0042-1758792. Online ahead of print.

ABSTRACT

OBJECTIVES: Our aims were to evaluate the Vitapex pulpectomy (PE) success rate, Vitapex resorption rate, and their associated factors in primary teeth.

MATERIAL AND METHODS: This retrospective study evaluated the clinical records of Vitapex PE-treated patients at the Pediatric Dental Clinic, Mahidol University, from 2013 to 2019. The patient’s and pulpectomized tooth’s characteristics, procedure, materials used, and type of operator were recorded. A dentist evaluated and compared the periapical lesion, root status, obturation quality, and Vitapex resorption on preoperative, immediate, and follow-up digital radiographs. PE failure was defined as radiographic lesion progression.

STATISTICAL ANALYSIS: The Kaplan-Meier method was used to estimate the Vitapex PE success rate and Vitapex resorption rate. Multivariate Cox regression was used to determine the related factors.

RESULTS: In total, 647 Vitapex PE teeth from 448 patients (19-121-month-old) were analyzed. The follow-up periods ranged from 6 to 60 months. The success rate was 88.9 and 68.1% at the 12- and 24-month follow-up, respectively, and remained stable at 53.8% at the 36 to 60-month follow-ups. The factors related to Vitapex PE failure were age and a preoperative pathologic lesion. More than 50% of the pulpectomized teeth presented Vitapex resorption faster than physiologic root resorption at the 12-month follow-up. The patients’ age at treatment and the obturation quality were significantly related to the Vitapex resorption rate.

CONCLUSIONS: The success rate of Vitapex PE decreased time dependently and was related to the patient’s age at treatment and a preoperative lesion. The Vitapex resorption was faster than root resorption and was associated with the patient’s age at treatment and the root filling extravasation.

PMID:37276881 | DOI:10.1055/s-0042-1758792

Endocrinol Diabetes Metab. 2023 Jun 5:e433. doi: 10.1002/edm2.433. Online ahead of print.

ABSTRACT

INTRODUCTION: Body mass index (BMI) fails to identify up to one-third of normal weight individuals with metabolic dysfunction who may be at increased risk of obesity-related cancer (ORC). Metabolic obesity phenotypes, an alternate metric to assess metabolic dysfunction with or without obesity, were evaluated for association with ORC risk.

METHODS: National Health and Nutrition Examination Survey participants from 1999 to 2018 (N = 19,500) were categorized into phenotypes according to the metabolic syndrome (MetS) criteria and BMI: metabolically healthy normal weight (MHNW), metabolically unhealthy normal weight (MUNW), metabolically healthy overweight/obese (MHO) and metabolically unhealthy overweight/obese (MUO). Adjusted multivariable logistic regression models were used to evaluate associations with ORC.

RESULTS: With metabolic dysfunction defined as ≥1 MetS criteria, ORC cases (n = 528) had higher proportions of MUNW (28.2% vs. 17.4%) and MUO (62.6% vs. 60.9%) phenotypes than cancer-free individuals (n = 18,972). Compared with MHNW participants, MUNW participants had a 2.2-times higher ORC risk [OR (95%CI) = 2.21 (1.27-3.85)]. MHO and MUO participants demonstrated a 43% and 56% increased ORC risk, respectively, compared to MHNW, but these did not reach statistical significance [OR (95% CI) = 1.43 (0.46-4.42), 1.56 (0.91-2.67), respectively]. Hyperglycaemia, hypertension and central obesity were all independently associated with higher ORC risk compared to MHNW.

CONCLUSIONS: MUNW participants have a higher risk of ORC than other abnormal phenotypes, compared with MHNW participants. Incorporating metabolic health measures in addition to assessing BMI may improve ORC risk stratification. Further research on the relationship between metabolic dysfunction and ORC is warranted.

PMID:37277888 | DOI:10.1002/edm2.433

J Health Popul Nutr. 2023 Jun 5;42(1):52. doi: 10.1186/s41043-023-00396-0.

ABSTRACT

BACKGROUND: Different pharmaceutical characteristics of the dosage form (DF) have a direct effect on how easily oral solid medicine is swallowed. The practice of crushing tablets or opening the capsule occurs daily in the hospital, and most nurses are unknowledgeable regarding these issues. Coadministration of medications with food can cause changes in drug absorption and lead to an alteration in gastrointestinal motility, which can cause an unexpected effect on the dissolution and absorption of the drug. Therefore, this study aimed to investigate nurses’ knowledge and practices regarding the mixing of medications with food or drink in Palestine.

METHODS: From June 2019 to April 2020, a cross-sectional study was conducted, encompassing nurses working in government hospitals across various districts of Palestine. The data were collected through face-to-face interviews, using questionnaires that assessed nurses’ understanding and implementation of mixing medications with food. The sampling method employed was convenience sampling. To analyze the gathered information, the Statistical Package for the Social Sciences version 21 (IBM-SPSS) was utilized.

RESULTS: A total of 200 nurses participated in the study. The data show a significant difference between the median knowledge scores according to the department of work (p < 0.001). The highest median [interquartile] knowledge score of 15 [12-15] was found for nurses working in the neonatal intensive care unit. In addition, nurses in the pediatric ward and the men’s medical ward had high scores of 13 [11.5-15] and 13 [11-14], respectively. In general, the results show that 88% of nurses modified oral DF prior to administration to patients. Regarding the type of food used, mixing medicine into juice was the most common procedure performed by nurses (approximately 84%); 35% of nurses used orange juice to mix with medicine. The most common reason for crushing was to administer medications to patients with a nasogastric tube (41.5%). In regard to medications, aspirin was the most frequently used drug that was crushed by the nurses (44%); however, 35.5% of nurses did not feel sufficiently trained to carry out this practice. Concerning the sources of information, 58% of nurses usually asked pharmacists for information about medications.

CONCLUSIONS: The results of this study show that crushing and mixing medications with food is common among nurses, and most nurses are unaware of the dangerous effect of this practice on patient health. Pharmacists, as medication experts, should participate in sharing knowledge about unnecessary crushing situations or when crushing should be avoided and try to find an alternative, when available, to aid administration.

PMID:37277885 | DOI:10.1186/s41043-023-00396-0

Implement Sci Commun. 2023 Jun 5;4(1):59. doi: 10.1186/s43058-023-00429-z.

ABSTRACT

BACKGROUND: Although the cost of implementing evidence-based interventions (EBIs) is a key determinant of adoption, lack of cost information is widespread. We previously evaluated the cost of preparing to implement Family Check-Up 4 Health (FCU4Health), an individually tailored, evidence-based parenting program that takes a whole child approach, with effects on both behavioral health and health behavior outcomes, in primary care settings. This study estimates the cost of implementation, including preparation.

METHODS: We assessed the cost of FCU4Health across the preparation and implementation phases spanning 32 months and 1 week (October 1, 2016-June 13, 2019) in a type 2 hybrid effectiveness-implementation study. This family-level randomized controlled trial took place in Arizona with n = 113 predominantly low-income, Latino families with children ages > 5.5 to < 13 years. Using electronic cost capture and time-based activity-driven methods, budget impact analysis from the perspective of a future FCU4Health adopting entity-namely, ambulatory pediatric care clinicians-was used to estimate the cost of implementation. Labor costs were based on 2021 Bureau of Labor Statistics Occupational Employment Statistics, NIH-directed salary cap levels or known salaries, plus fringe benefits at a standard rate of 30%. Non-labor costs were based on actual amounts spent from receipts and invoices.

RESULTS: The cost of FCU4Health implementation to 113 families was $268,886 ($2380 per family). Actual per family cost varied widely, as individual tailoring resulted in families receiving a range of 1-15 sessions. The estimated cost of replicating implementation for future sites ranged from $37,636-$72,372 ($333-$641 per family). Using our previously reported preparation costs (i.e., $174,489; $1544 per family), with estimated replication costs of $18,524-$21,836 ($164-$193 per family), the total cost of delivering FCU4Health was $443,375 ($3924 per family), with total estimated replication costs of $56,160-$94,208 ($497-$834 per family).

CONCLUSIONS: This study provides a baseline for costs associated with implementation of an individually tailored parenting program. Results provide critical information for decision makers and a model for future economic analysis and can be used to inform optimization thresholds for implementation and, when necessary, benchmarks for program adaptation to promote scale-up.

TRIAL REGISTRATION: This trial was prospectively registered on January 6, 2017, at ClinicalTrials.gov (NCT03013309).

PMID:37277878 | DOI:10.1186/s43058-023-00429-z