Tag: nevin manimala

Med Phys. 2023 Jul 7. doi: 10.1002/mp.16578. Online ahead of print.

ABSTRACT

BACKGROUND: Accuracy of electrode placement for deep brain stimulation (DBS) is critical to achieving desired surgical outcomes and impacts the efficacy of treating neurodegenerative diseases. Intraoperative brain shift degrades the accuracy of surgical navigation based on preoperative images.

PURPOSE: We extended a model-based image updating scheme to address intraoperative brain shift in DBS surgery and improved its accuracy in deep brain.

METHODS: We evaluated 10 patients, retrospectively, who underwent bilateral DBS surgery and classified them into groups of large and small deformation based on a 2 mm subsurface movement threshold and brain shift index of 5%. In each case, sparse brain deformation data were used to estimate whole brain displacements and deform preoperative CT (preCT) to generate updated CT (uCT). Accuracy of uCT was assessed using target registration errors (TREs) at the Anterior Commissure (AC), Posterior Commissure (PC), and four calcification points in the sub-ventricular area by comparing their locations in uCT with their ground truth counterparts in postoperative CT (postCT).

RESULTS: In the large deformation group, TREs were reduced from 2.5 mm in preCT to 1.2 mm in uCT (53% compensation); in the small deformation group, errors were reduced from 1.25 to 0.74 mm (41%). Average reduction of TREs at AC, PC and pineal gland were significant, statistically (p ⩽ 0.01).

CONCLUSIONS: With more rigorous validation of model results, this study confirms the feasibility of improving the accuracy of model-based image updating in compensating for intraoperative brain shift during DBS procedures by assimilating deep brain sparse data.

PMID:37418478 | DOI:10.1002/mp.16578

PLoS One. 2023 Jul 7;18(7):e0288323. doi: 10.1371/journal.pone.0288323. eCollection 2023.

ABSTRACT

Concerns over food safety issues during the coronavirus pandemic (COVID-19) have sparked worldwide interest. Being part of a farm-to-fork food safety chain, food handlers at home are the final line of defense in reducing foodborne diseases. The present study used a cross-sectional survey to investigate the knowledge, attitudes, and practices (KAP) of women food handlers in Jordan. The survey investigated the effect of the COVID-19 pandemic on women who handle food at home in terms of food safety KAP. One thousand one hundred twenty-six respondents completed a food safety questionnaire during the COVID-19 pandemic. With a mean score of 22.1 points out of 42, the results showed that women who handle food in their houses had insufficient knowledge, negative attitudes, and incorrect practices concerning food safety. The respondents demonstrated high knowledge, attitudes, and practices in the personal hygiene, cleaning and sanitation areas (≥ 60.0%). On the other hand, participants’ knowledge, attitudes, and practices regarding contamination prevention, health issues that would affect food safety, symptoms of foodborne illnesses, safe storage, thawing, cooking, keeping, and reheating of foods, as well as COVID-19 were all low (< 60.0%). The correlations between participants’ total food safety KAP scores and education, age, experience, region, and the pandemic effect on food safety were statistically significant (P ≤ 0.05). To the best of our knowledge, this study is the first conducted in Jordan to investigate food safety knowledge, attitudes, and practices by women handling food at home during the COVID-19 pandemic.

PMID:37418464 | DOI:10.1371/journal.pone.0288323

PLoS One. 2023 Jul 7;18(7):e0288020. doi: 10.1371/journal.pone.0288020. eCollection 2023.

ABSTRACT

BACKGROUND: People with chronic diseases in their advanced phase require palliative care. This is essential to ensure their quality of life as it ends. However, a very low percentage of patients receive the necessary palliative care. The COVID-19 pandemic has adversely affected the planning and provision of palliative care. Despite this, in Chile, palliative care coverage was extended by law to cover nononcological chronic diseases. Implementation of this law is expected to be a significant challenge in terms of material resources, as well as the need for the formation of specialized palliative care teams. Therefore, it is essential to estimate the need for palliative care for all chronic diseases to generate useful input for planning and decision-making in public health.

OBJECTIVES: To indirectly estimate the need for palliative care among people with Chronic Oncological Diseases (COD) and Chronic Non-Oncological Diseases (CNOD) during the prepandemic and pandemic context due to COVID-19 in the Biobío Region in Chile.

METHODS: Cross-sectional study based on mortality data from chronic oncological and nononcological diseases during the prepandemic (2010-2018) and pandemic (2020-2021) contexts due to COVID-19 in a Region of Chile through indirect estimation using minimal estimate, standardized mortality rates and geographically weighted regression.

RESULTS: It was estimated that 76.25% of deaths from chronic diseases in the Biobío Region would have required palliative care, which represents 77,618 people who should have been included in these health benefits. The pandemic had a significant effect on the average number of deaths from CNOD. People belonging to this group were more likely to die from COVID-19 than from their baseline disease, unlike the deaths of people from COD, where no significant changes were observed.

CONCLUSION: These estimates highlight the potential size of the population requiring palliative care and emphasize the importance of recognizing the rights of individuals with COD and CNOD conditions. It is evident that there is a significant demand for palliative care services, as well as a pressing need for adequate resources, effective management, and strategic planning to cater to the needs of this population. This is particularly crucial in the heavily impacted areas and communes of the Biobío Region, Chile.

PMID:37418462 | DOI:10.1371/journal.pone.0288020

Eye Contact Lens. 2023 Jul 3. doi: 10.1097/ICL.0000000000001013. Online ahead of print.

ABSTRACT

PURPOSE: To analyze critically the clinical trials on presbyopia correction with contact lenses (CLs) to investigate the quality of the research performed.

METHODS: A search was performed in PubMed database on clinical trials evaluating the efficacy of the presbyopia correction with different CLs, including multifocal or simultaneous vision contact lenses (MCLs). After a comprehensive analysis of the relevant publications found, quality assessment of such publications was performed by means of Critical Appraisal Skills Programme checklist tool according to the five types of evaluations: MCL versus spectacles, MCL versus pinhole CLs, MCL versus monovision, comparison between MCL designs, and MCL versus extended depth of focus CLs.

RESULTS: A total of 16 clinical trials were selected for evaluation. All evaluated studies addressed a clearly focused research question and were randomized, with a crossover design in most of the cases. Blinding was not possible in all cases due to the physical appearance of some of the CLs evaluated (pinhole or hybrid designs). Most of studies analyzed reported outcomes with complete data, providing the statistical tests used and the P-values, but some of the authors did not provide the statistical power associated to the sample size evaluated. The small sample size in some trials as well as the scarce information about the effect of addition on visual performance was the main limitations found in the peer-reviewed literature revised.

CONCLUSIONS: There is a high-quality scientific evidence supporting the use of presbyopia-correcting CLs, with several randomized controlled clinical trials conducted to this date.

PMID:37418305 | DOI:10.1097/ICL.0000000000001013

Eye Contact Lens. 2023 Jul 4. doi: 10.1097/ICL.0000000000001011. Online ahead of print.

ABSTRACT

OBJECTIVES: In this study, we aimed to evaluate Schlemm canal parameters using anterior segment swept-source optical coherence tomography in eyes that underwent keratoplasty and compare them with keratoconus and healthy control groups.

METHODS: The study included 32 patients who underwent penetrating keratoplasty or deep anterior lamellar keratoplasty once due to keratoconus and age-matched and sex-matched 20 keratoconus patients and 30 healthy controls. In all the patients, a single horizontal image centered on the central cornea was obtained from the nasal and temporal quadrants with low-intensity scanning to visualize Schlemm canal.

RESULTS: There was no statistically significant difference between the groups for age and gender (P˃0.05). In the keratoplasty group, the area and diameter of Schlemm canal were 2.266±1.141μm2 and 160.77±65.08 μm, respectively, in the nasal quadrant and 2.623±1.277 μm2 and 158.81±68.05 μm, respectively in the temporal quadrant, which were statistically significantly lower compared with other groups (P<0.001 for all). There was no significant difference between the penetrating and deep anterior lamellar keratoplasty subgroups for Schlemm canal parameters.

CONCLUSION: This is the first study to report anterior segment optical coherence tomography after surgery shows SC parameters that are, on average, less than age-matched and keratoconus controls.

PMID:37418302 | DOI:10.1097/ICL.0000000000001011

JAMA Netw Open. 2023 Jul 3;6(7):e2322056. doi: 10.1001/jamanetworkopen.2023.22056.

ABSTRACT

IMPORTANCE: Among patients with bipolar disorder, discordant findings have been published on the nephrotoxic effects of lithium therapy.

OBJECTIVE: To quantify absolute and relative risks of chronic kidney disease (CKD) progression and acute kidney injury (AKI) in people who initiated lithium compared with valproate therapy and to investigate the association between cumulative use and elevated lithium levels and kidney outcomes.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study had a new-user active-comparator design and used inverse probability of treatment weights to minimize confounding. Included patients initiated therapy with lithium or valproate from January 1, 2007, to December 31, 2018, and had a median follow-up of 4.5 years (IQR, 1.9-8.0 years). Data analysis began in September 2021, using routine health care data from the period 2006 to 2019 from the Stockholm Creatinine Measurements project, a recurrent health care use cohort of all adult residents in Stockholm, Sweden.

EXPOSURES: New use of lithium vs new use of valproate and high (>1.0 mmol/L) vs low serum lithium levels.

MAIN OUTCOMES AND MEASURES: Progression of CKD (composite of >30% decrease relative to baseline estimated glomerular filtration rate [eGFR] and kidney failure), AKI (by diagnosis or transient creatinine elevations), new albuminuria, and annual eGFR decrease. Outcomes by attained lithium levels were also compared in lithium users.

RESULTS: The study included 10 946 people (median [IQR] age, 45 [32-59] years; 6227 female [56.9%]), of whom 5308 initiated lithium therapy and 5638 valproate therapy. During follow-up, 421 CKD progression events and 770 AKI events were identified. Compared with patients who received valproate, those who received lithium did not have increased risk of CKD (hazard ratio [HR], 1.11 [95% CI, 0.86-1.45]) or AKI (HR, 0.88 [95% CI, 0.70-1.10]). Absolute 10-year CKD risks were low and similar: 8.4% in the lithium group and 8.2% in the valproate group. No difference in the risk of developing albuminuria or the annual rate of eGFR decrease was found between groups. Among more than 35 000 routine lithium tests, only 3% of results were in the toxic range (>1.0 mmol/L). Lithium values greater than 1.0 mmol/L, compared with lithium values of 1.0 mmol/L or less, were associated with increased risk of CKD progression (HR, 2.86; 95% CI, 0.97-8.45) and AKI (HR, 3.51; 95% CI, 1.41-8.76).

CONCLUSIONS AND RELEVANCE: In this cohort study, compared with new use of valproate, new use of lithium was meaningfully associated with adverse kidney outcomes, with low absolute risks that did not differ between therapies. However, elevated serum lithium levels were associated with future kidney risks, particularly AKI, emphasizing the need for close monitoring and lithium dose adjustment.

PMID:37418264 | DOI:10.1001/jamanetworkopen.2023.22056

JAMA Netw Open. 2023 Jul 3;6(7):e2322310. doi: 10.1001/jamanetworkopen.2023.22310.

ABSTRACT

IMPORTANCE: Health care delivery faces a myriad of challenges globally with well-documented health inequities based on geographic location. Yet, researchers and policy makers have a limited understanding of the frequency of geographic health disparities.

OBJECTIVE: To describe geographic health disparities in 11 high-income countries.

DESIGN, SETTING, AND PARTICIPANTS: In this survey study, we analyzed results from the 2020 Commonwealth Fund International Health Policy (IHP) Survey-a nationally representative, self-reported, and cross-sectional survey of adults from Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the UK, and the US. Eligible adults older than age 18 years were included by random sampling. Survey data were compared for the association of area type (rural or urban) with 10 health indicators across 3 domains: health status and socioeconomic risk factors, affordability of care, and access to care. Logistic regression was used to determine the associations between countries with area type for each factor, controlling for individuals’ age and sex.

MAIN OUTCOMES AND MEASURES: The main outcomes were geographic health disparities as measured by differences in respondents living in urban and rural settings in 10 health indicators across 3 domains.

RESULTS: There were 22 402 survey respondents (12 804 female [57.2%]), with a 14% to 49% response rate depending on the country. Across the 11 countries and 10 health indicators and 3 domains (health status and socioeconomic risk factors, affordability of care, access to care), there were 21 occurrences of geographic health disparities; 13 of those in which rural residence was a protective factor and 8 of those where rural residence was a risk factor. The mean (SD) number of geographic health disparities in the countries was 1.9 (1.7). The US had statistically significant geographic health disparities in 5 of 10 indicators, the most of any country, while Canada, Norway, and the Netherlands had no statistically significant geographic health disparities. The indicators with the most occurrences of geographic health disparities were in the access to care domain.

CONCLUSIONS AND RELEVANCE: In this survey study of 11 high-income nations, health disparities across 10 indicators were identified. Differences in number of disparities reported by country suggest that health policy and decision makers in the US should look to Canada, Norway, and the Netherlands to improve geographic-based health equity.

PMID:37418259 | DOI:10.1001/jamanetworkopen.2023.22310

JAMA Netw Open. 2023 Jul 3;6(7):e2322341. doi: 10.1001/jamanetworkopen.2023.22341.

ABSTRACT

IMPORTANCE: Smoking causes considerable noncommunicable diseases, perinatal morbidity, and mortality.

OBJECTIVE: To investigate the associations of population-level tobacco-control policies with health outcomes.

DATA SOURCES: PubMed, EMBASE, Web of Science, Cumulated Index to Nursing and Allied Health Literature, and EconLit were searched from inception to March 2021 (updated on 1 March 2022). References were manually searched.

STUDY SELECTION: Studies reporting on associations of population-level tobacco control policies with health-related outcomes were included. Data were analyzed from May to July 2022.

DATA EXTRACTION AND SYNTHESIS: Data were extracted by 1 investigator and cross-checked by a second investigator. Analyses were conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline.

MAIN OUTCOMES AND MEASURES: The primary outcomes were respiratory system disease (RSD), cardiovascular disease (CVD), cancer, mortality, hospitalization, and health care utilization. The secondary outcomes were adverse birth outcomes, such as low birth weight and preterm birth. Random-effects meta-analysis was used to estimate pooled odds ratios (ORs) and 95% CIs.

RESULTS: Of 4952 records identified, 144 population-level studies were included in the final analysis; 126 studies (87.5%) were of high or moderate quality. The most frequently reported policies were smoke-free legislation (126 studies), followed by tax or price increases (14 studies), multicomponent tobacco control programs (12 studies), and a minimum cigarette purchase age law (1 study). Smoke-free legislation was associated with decreased risk of all CVD events (OR, 0.90; 95% CI, 0.86-0.94), RSD events (OR, 0.83; 95% CI, 0.72-0.96), hospitalization due to CVD or RSD (OR, 0.91; 95% CI, 0.87-0.95), and adverse birth outcomes (OR, 0.94; 95% CI, 0.92-0.96). These associations persisted in all sensitivity and subgroup analyses, except for the country income category, for which a significant reduction was only observed in high-income countries. In meta-analysis, there was no clear association of tax or price increases with adverse health outcomes. However, for the narrative synthesis, all 8 studies reported statistically significant associations between tax increases and decreases in adverse health events.

CONCLUSIONS AND RELEVANCE: In this systematic review and meta-analysis, smoke-free legislation was associated with significant reductions in morbidity and mortality related to CVD, RSD, and perinatal outcomes. These findings support the need to accelerate the implementation of smoke-free laws to protect populations against smoking-related harm.

PMID:37418258 | DOI:10.1001/jamanetworkopen.2023.22341

Qual Life Res. 2023 Jul 7. doi: 10.1007/s11136-023-03467-1. Online ahead of print.

ABSTRACT

PURPOSE: Patients with heart failure (HF) possess low self-care activation and motivation, leading to a deprived quality of life and adverse mental health conditions. To this end, self-determination theory emphasizes that autonomy-supportive interventions (ASI) can stimulate intrinsic motivation and improve behaviors and quality of life. Nevertheless, studies that focused on ASI for HF are inadequate. This study aims to evaluate the effects of an HF-ASIP on self-care, quality of life and mental health in HF patients.

METHODS: In a two-arm randomized controlled trial, the participants are randomly allocated to the intervention (n = 41) or control (n = 41) groups. The intervention group received routine care and participated in an 8-week HF-ASIP, including individual education and consultation sessions. In contrast, the control group received only routine care. The primary outcome includes self-care management, while the secondary outcomes include self-care maintenance, quality of life, mental health, and motivation. After measuring the outcomes at baseline (T₀), 4-week (T₁), 8-week (T₂), and 12-week (T₃) follow-up, the intervention effects are assessed using the generalized equation models.

RESULTS: The outcomes indicated that self-care management (T₂: P = 0.001; T₃: P = 0.016), self-care maintenance (T₂: P = 0.003; T₃: P = 0.001), depression (T₂: P = 0.007; T₃: P = 0.012), anxiety (T₂: P = 0.001; T₃: P = 0.012), MLHFQ total score (T₁: P = 0.004; T₂: P < 0.001; T₃: P = 0.001), autonomous motivation (T₂: P = .0.006; T₃: P = 0.002) showed statistically difference between the groups.

CONCLUSION: In summary, the 8-week HF-ASIP significantly improved the attributes of self-care, quality of life, mental health, and motivation in HF patients, suggesting the potential for practical intervention effect.

TRIAL REGISTRATION: ChiCTR2100053970.

PMID:37418228 | DOI:10.1007/s11136-023-03467-1

Environ Sci Pollut Res Int. 2023 Jul 7. doi: 10.1007/s11356-023-28438-4. Online ahead of print.

ABSTRACT

The average population in sub-Saharan Africa that has access to clean fuel for cooking and technology is 23.6%. This study examines the panel data for 29 sub-Saharan African (SSA) countries for the period 2000-2018 to estimate impacts of clean energy technologies on environmental sustainability measured by load capacity factor (LCF) to capture both nature’s supply and man’s demand for the environment. The study used generalized quantile regression, which is more robust to outliers and eliminates the endogeneity of variables in the model using lagged instruments. Results show that clean energy technologies (clean fuels for cooking and renewable energy) have positive and statistically significant impacts on environmental sustainability in SSA for almost all quantiles. For robustness checks, we used Bayesian panel regression estimates and the results remained unchanged. The overall results suggest that clean energy technologies improve environmental sustainability in SSA. The result shows a U-shaped relationship between environmental quality and income and confirms the Load Capacity Curve (LCC) hypothesis in SSA, which implies that income first worsens environmental sustainability and then, after exceeding certain quantiles, improves environmental sustainability. On the other hand, the results also confirm the environmental Kuznet curve (EKC) hypothesis in SSA. The findings show the importance of using clean fuels for cooking, trade, and renewable energy consumption in improving environmental sustainability in the region. The policy implication is that governments in SSA should reduce the cost of energy services (i.e., renewable energy and clean fuels for cooking) to achieve greater environmental sustainability in the region.

PMID:37418191 | DOI:10.1007/s11356-023-28438-4