Tag: nevin manimala

BMJ Glob Health. 2023 Jun;8(6):e011591. doi: 10.1136/bmjgh-2022-011591.

ABSTRACT

BACKGROUND: Caesarean section (CS) rates in women experiencing stillbirth have not been studied with nationally representative data. Two Ghana Maternal Health Surveys (GMHS) have captured pregnancy and mode of birth data for all women including those with stillbirths. We compared CS rates between women with live births and stillbirths, and identified socio-economic and pregnancy-related factors associated with CS in stillbirths.

METHODS: A population-based cross-sectional study was conducted in a pooled sample of 17 138 women who had given birth within 5 years preceding the 2007 and 2017 GMHS. CS rates were compared between women with stillbirths and very early neonatal deaths (SBVENDs) and women with live births who survived the first day. Bivariate and multivariable logistic regressions explored variables associated with CS. Effect modification of household’s wealth and maternal educational level by birth outcome was assessed using multivariable logistic regression with interaction terms.

RESULTS: CS rate in women with SBVEND was 19.3% compared with 9.6% in women with live births who survived the first day (rate ratio 2.2; 95% CI 1.6 to 2.9). In multivariable analysis, attaining middle school compared with no formal education (adjusted OR, aOR 2.8; 95% CI 1.1 to 7.1), having had five or more births compared with nulliparity (aOR 3.7; 95% CI 1.3 to 10.7) and reporting prolonged or obstructed labour (aOR 3.3; 95% CI 1.3 to 8.3) were associated with CS in women with SBVEND. Higher household wealth and educational levels were associated with an increased risk of CS in both study groups, with no statistically significant difference in effect.

CONCLUSION: Disaggregating CS rates by birth outcome revealed a high rate among women with SBVEND, twice the overall rate compared with live births. Exclusion of these ‘hidden’ CSs from rate calculations may lead to underestimation of (inter)national CS rates and potentially conceals CS overuse or misuse.

PMID:37263671 | DOI:10.1136/bmjgh-2022-011591

South Med J. 2023 Jun;116(6):471-477. doi: 10.14423/SMJ.0000000000001569.

ABSTRACT

OBJECTIVES: We assessed the impact of obesity and racial disparities on preterm birth (PTB) in the United States and sought to determine whether obesity widens the racial-ethnic disparity gap in preterm birth with a focus on non-Hispanic Black and White women.

METHODS: Using birth data for the years 2014-2019 made publicly available by the Centers for Disease Control and Prevention and obtained from the National Vital Statistics System, we conducted a cross-sectional cohort study analyzing a total of 14,864,844 births from 2014 to 2019.

RESULTS: We observed dose-dependent changes in obesity and PTB by defining obesity in subgroups and PTB in a stratified method. PTB occurred more among non-Hispanic Black women than their non-Hispanic White and Hispanic counterparts. We observed a consistent trend of increased PTB among women with high body mass index. Racial disparity existed in PTB among pregnant obese women, with non-Hispanic Black women exhibiting the greatest risk for PTB.

CONCLUSIONS: Our work further contributes to the growing knowledge of the existence of health disparity among the Black population.

PMID:37263609 | DOI:10.14423/SMJ.0000000000001569

South Med J. 2023 Jun;116(6):464-470. doi: 10.14423/SMJ.0000000000001565.

ABSTRACT

OBJECTIVES: Stress among free clinic patients is an important issue to address in health care. Evaluating the differences between perceived stress and physiological stress will help healthcare professionals to better understand the stress and coping management skills that will improve health outcomes for underserved populations. The aim of this study was to accelerate research to better understand the biological and psychological aspect of stress in health disparities.

METHODS: This was a cross-sectional study using a convenience sample of free clinic patients aged 18 years and older who spoke English and/or Spanish. Multiple modals of data were collected from 178 participants during summer 2019, including a self-administered paper survey and a biomedical saliva sample. Descriptive statistics were used to present the characteristics of the participants, and a correlation heatmap was used to show a graphical representation of the main variables. Two models of multivariable regression were performed to understand factors associated with cortisol and perceived stress.

RESULTS: Higher levels of perceived stress were not significantly more prevalent than higher levels of salivary cortisol among free clinic patients; however, higher levels of social networking were significantly associated with lower levels of perceived stress. Our analysis revealed that having more friends in a social network was slightly more associated with lower levels of perceived stress than having more family members.

CONCLUSIONS: The result of this study provides awareness to healthcare promoters and educators concerning the health of uninsured patients. More specifically, this study provides a foundation to understand the salivary cortisol levels and the relation to perceived stress among this population. Further studies are needed to measure salivary cortisol repeatedly during a period of time among a larger population to better understand the reasons behind normal cortisol level manifesting along with chronic stress.

PMID:37263608 | DOI:10.14423/SMJ.0000000000001565

Eur J Public Health. 2023 Jun 1:ckad088. doi: 10.1093/eurpub/ckad088. Online ahead of print.

ABSTRACT

Researching mortality during the COVID-19 pandemic has been challenging due to methodological inconsistencies and the limited availability of vital statistics data. At the beginning of the pandemic, the World Health Organization recommended daily data publication to inform policy response, but these data were often poor. Final data on COVID-19 deaths in many countries are not yet available, especially for 2021. This report shows that many countries have significant inconsistencies between the preliminary number of deaths and what vital statistics and excess mortality indicate. The inconsistencies in the mortality data raise concerns about the reliability of analyses and public health recommendations.

PMID:37263603 | DOI:10.1093/eurpub/ckad088

Eur J Public Health. 2023 Jun 1:ckad075. doi: 10.1093/eurpub/ckad075. Online ahead of print.

ABSTRACT

BACKGROUND: Analyses of coronavirus disease 19 suggest specific risk factors make communities more or less vulnerable to pandemic-related deaths within countries. What is unclear is whether the characteristics affecting vulnerability of small communities within countries produce similar patterns of excess mortality across countries with different demographics and public health responses to the pandemic. Our aim is to quantify community-level variations in excess mortality within England, Italy and Sweden and identify how such spatial variability was driven by community-level characteristics.

METHODS: We applied a two-stage Bayesian model to quantify inequalities in excess mortality in people aged 40 years and older at the community level in England, Italy and Sweden during the first year of the pandemic (March 2020-February 2021). We used community characteristics measuring deprivation, air pollution, living conditions, population density and movement of people as covariates to quantify their associations with excess mortality.

RESULTS: We found just under half of communities in England (48.1%) and Italy (45.8%) had an excess mortality of over 300 per 100 000 males over the age of 40, while for Sweden that covered 23.1% of communities. We showed that deprivation is a strong predictor of excess mortality across the three countries, and communities with high levels of overcrowding were associated with higher excess mortality in England and Sweden.

CONCLUSION: These results highlight some international similarities in factors affecting mortality that will help policy makers target public health measures to increase resilience to the mortality impacts of this and future pandemics.

PMID:37263602 | DOI:10.1093/eurpub/ckad075

Orthop Traumatol Surg Res. 2023 May 30:103637. doi: 10.1016/j.otsr.2023.103637. Online ahead of print.

ABSTRACT

INTRODUCTION: The EFAS score is a new recently validated European quality of life score for foot and ankle surgery, comprising 6 questions on activities of daily living (ADL) and 4 on sport. The aim of the present study was to assess the kinetics of functional recovery on the EFAS and SF36 scores, and to assess correlations between the two at 0 to 6 months then 6 months to 1 year in a population of foot and ankle surgery patients, globally and per pathology.

HYPOTHESIS: Hindfoot and ankle surgery requires at least 1 year’s follow-up for assessment of recovery, whereas 6 months is sufficient to assess forefoot recovery.

MATERIAL AND METHODS: A multicenter prospective cohort study included all patients undergoing surgery for foot and ankle pathology between December 2015 and July 2016. Statistical analysis, global and per pathology, was performed preoperatively and at 6 months and 1 year.

RESULTS: 98 patients were assessed at 1 year. In the global population, EFAS ADL score improved by 17.1 ± 22.1 points (hindfoot, 16.9 ± 24.6; forefoot, 19.7 ± 21.4) and global SF36 score by 8.7 ± 17.1 points (hindfoot, 10.2 ± 19.1; forefoot, 9.6 ± 15.9). Both scores progressed between 6 months and 1 year for hindfoot pathologies, whereas they remained constant after 6 months for the forefoot. The EFAS score showed weak correlation with SF36.

CONCLUSION: Recovery kinetics differs according to type of foot and ankle pathology. The EFAS score is more suitable than the SF36.

LEVEL OF EVIDENCE: II.

PMID:37263580 | DOI:10.1016/j.otsr.2023.103637

Environ Pollut. 2023 May 30:121938. doi: 10.1016/j.envpol.2023.121938. Online ahead of print.

ABSTRACT

Per- and polyfluoroalkyl substances (PFAS) have extensively contaminated freshwater aquatic ecosystems where they can be transported in water and partition to sediment and biota. In this paper, three freshwater benthic macroinvertebrates with different foraging modes were exposed to environmentally relevant concentrations of eight perfluoroalkyl carboxylates (PFCA), three perfluoroalkyl sulfonates (PFSA), and three fluorotelomer sulfonates (FTS) at varying divalent cation concentrations of magnesium (Mg²⁺) and calcium (Ca²⁺). Divalent cations can impact PFAS partitioning to solids, especially to sediments, at higher concentrations. Sediment dwelling worms (Lumbriculus variegatus), epibenthic grazing snails (Physella acuta), and sediment-dwelling filter-feeding bivalves (Elliptio complanata) were selected due to their unique foraging modes. Microcosms were composed of synthetic sediment, culture water, macroinvertebrates, and PFAS and consisted of a 28-day exposure period. L. variegatus had significantly higher PFAS bioaccumulation than P. acuta and E. complanata, likely due to higher levels of interactions with and ingestion of the contaminated sediment. “High Mg²⁺” (7.5 mM Mg²⁺) and “High Ca²⁺” (7.5 mM Ca²⁺) conditions generally had statistically higher bioaccumulation factors (BAF) than the “Reference Condition” (0.2 mM Ca²⁺ and 0.2 mM Mg²⁺) for PFAS with perfluorinated chain lengths greater than eight carbons. Long-chain PFAS dominated the PFAS profiles of the macroinvertebrates for all groups of compounds studied (PFCA, PFSA, and FTS). These results indicate that the study organism has the greatest impact on bioaccumulation, although divalent cation concentration had observable impacts between organisms depending on the environmental conditions. Elevated cation concentrations in the microcosms led to significantly greater bioaccumulation in the test organisms compared to the experimental reference conditions for long-chain PFAS.

PMID:37263566 | DOI:10.1016/j.envpol.2023.121938

Contemp Clin Trials. 2023 May 30:107247. doi: 10.1016/j.cct.2023.107247. Online ahead of print.

ABSTRACT

BACKGROUND: Young adults experience high rates of cannabis use and consequences. Cross-sectional work has linked positive psychological constructs (e.g., savoring) to less cannabis use and consequences, and positive psychological interventions (PPIs) have shown promise in targeting other substance use behaviors. This pilot study sought to provide an initial test of PPIs to reduce young adult cannabis use and consequences.

METHODS: Adults (18-25 years old) who endorsed at least weekly past-month cannabis use (N = 59, 69.6% men, 41.1% White) reported their baseline cannabis use and consequences. Participants were randomized to complete one of three daily exercises (Savoring, Three Good Things, or a control) along with daily text message surveys for two weeks, then completed a follow-up survey at the end of the two weeks.

RESULTS: Paired samples t-tests indicated that participants in the Three Good Things group showed medium to large reductions in frequency of weekly cannabis use (p = .08, g_av = -0.57) and cannabis-associated consequences (p = .08, g_av = -0.57) from baseline to follow-up. In the Savoring and control groups, there were not significant changes in frequency of weekly cannabis use (Savoring: p = .39, g_av = 0.20; Control: p = .96, g_av = 0.01) nor cannabis-associated consequences (Savoring: p = .84, g_av = 0.05; Control: p = .45, g_av = -0.18). Participants in both positive psychology conditions reported the exercises were easy to complete, providing evidence for acceptability.

DISCUSSION: Results provide initial support for the feasibility and potential promise of a text-message based PPI as a harm reduction approach for cannabis users. A larger clinical trial is warranted to test the effects of such interventions with adequate statistical power.

PMID:37263491 | DOI:10.1016/j.cct.2023.107247

J Shoulder Elbow Surg. 2023 May 30:S1058-2746(23)00425-1. doi: 10.1016/j.jse.2023.04.030. Online ahead of print.

ABSTRACT

BACKGROUND: Patients undergoing a total shoulder arthroplasty (TSA) through a deltopectoral approach will require repair of the subscapularis tendon. There are no universal postoperative guidelines for rehabilitation of the subscapularis specifically. We hypothesize that the addition of a subscapularis-specific regimen will result in improved subscapularis strength and function.

METHODS: Adult patients undergoing anatomic TSA for the treatment of primary glenohumeral osteoarthritis were included. Patients were randomized into either the traditional rehabilitation (TR) control group or the subscapularis rehabilitation (SR) group, which consisted of the traditional therapy along with early and additional subscapularis exercises. Baseline demographics, patient reported outcome measures(PROMs), range of motion (ROM), provocative tests, and subscapularis strength using a handheld dynamometer were measured preoperatively at the initial clinic visit (ICV) as well as 3-months, 6-months, and one-year postoperatively. The primary outcome of interest was a comparison of subscapularis strength between cohorts relative to preoperative baseline, while secondary outcomes were functional, ROM and PROMs.

RESULTS: Sixty-six patients were included in final analysis (32 TR vs 34 SR). There were no statistically significant differences between cohorts at the ICV with regards to demographics, baseline subscapularis strength, functional testing, or PROMs. All postoperative time points demonstrated similar subscapularis strength testing between TR and SR groups (p>0.05). Additionally, peak and average subscapularis strength testing at 3, 6, and 12 months postoperatively were similar to baseline ICV testing in both groups. Both groups demonstrated improvements across several provocative tests, ROM and PROM outcome metrics at every postoperative timepoint as compared to baseline ICV values (p<0.05).

CONCLUSIONS: Patients undergoing anatomic total shoulder arthroplasty return to baseline internal rotation strength by 3-months postoperatively and demonstrate significant improvements in function, range of motion, and several patient reported outcome measures. The addition of early and focused subscapularis strengthening exercises does not appear to significantly impact any outcomes when compared to traditional rehabilitation programs.

PMID:37263480 | DOI:10.1016/j.jse.2023.04.030

J Shoulder Elbow Surg. 2023 May 30:S1058-2746(23)00415-9. doi: 10.1016/j.jse.2023.04.020. Online ahead of print.

ABSTRACT

BACKGROUND: The purpose of this study is to report the clinical and radiological outcomes of patients undergoing primary or revision reverse total shoulder arthroplasty using custom 3D printed components to manage severe glenoid bone loss with a minimum of 2-year follow-up.

METHODS: Following ethical approval (ref: 17/YH/0318), patients were identified and invited to participate. Inclusion criteria were: 1) severe glenoid bone loss necessitating the need for custom implants; and 2) patients with definitive glenoid and humeral components implanted more than 2 years prior. Included patients underwent clinical assessment utilizing the Oxford Shoulder Score (OSS), Constant-Murley score, American Shoulder and Elbow Surgeons score (ASES), and quick Disabilities of the Arm, Shoulder, and Hand Score (QuickDASH). Radiographic assessment included AP and axial projections. Patients were invited to attend a CT scan to confirm osseointegration. Statistical analysis utilized descriptive statistics (mean and standard deviation) and paired t test for parametric data.

RESULTS: Eleven patients declined to participate. 5 patients were deceased prior to study commencement, leaving 42 remaining patients in this analysis. Three patients had revision surgery prior to the 2-year follow-up. Of these, 2/3 retained their custom glenoid components. Mean follow-up was 31.6 months from surgery (range 24-52 months). OSS improved from a mean 15 (SD±8.4) to 36 (SD±12) (p < 0.001). Constant-Murley score improved from mean 15 (SD± 11.2) to 52 (SD± 20.1) (p < 0.001). QuickDASH improved from mean 70 (SD ±21) to 31 (SD ±24.8) (p = 0.004). ASES improved from mean 22 (SD± 17.8) to 71 (SD ±23.3) (p = 0.007). Radiological evaluation demonstrated good osseointegration in all but one included patient.

CONCLUSION: The utility of custom 3D-printed components for managing severe glenoid bone loss in primary and revision reverse total shoulder arthroplasty yields significant clinical improvements in this complex cohort. Large complex glenoid bone defects can be managed successfully with custom 3D-printed glenoid components.

PMID:37263477 | DOI:10.1016/j.jse.2023.04.020