Tag: nevin manimala

Int J Environ Health Res. 2023 Apr 10:1-14. doi: 10.1080/09603123.2023.2199972. Online ahead of print.

ABSTRACT

We investigated the distribution of dengue cases, solid waste deposits (SWDs), forest fragments, water drainage, population income, and the possible association with dengue outbreaks in Presidente Prudente, São Paulo, Brazil. An urban setting with recent transmission. Data were obtained from public agencies. Kernel density maps of the variables were constructed. From 2015 to 2021, 33026 cases of dengue were reported; the incidence and mortality rate were highest in 2016. The number of cases decreased during the COVID-19 pandemic (2020 and 2021) compared with 2019, but alarming rates were registered in 2022. In 2015, 56 points of SWDs were identified, with an increase of 1.6-fold in 2020 and 2021. Multivariate analysis showed a positive correlation between the density of dengue cases and SWDs with the highest correlation (0.70) in 2020. Identifying these areas could guide public health authorities in surveillance measures and improvements in health care infrastructure.

PMID:37036947 | DOI:10.1080/09603123.2023.2199972

Chin Med J (Engl). 2023 Apr 11. doi: 10.1097/CM9.0000000000002580. Online ahead of print.

ABSTRACT

BACKGROUND: Human neutrophil lipocalin (HNL) has been used extensively to differentiate acute bacterial infection from febrile diseases as a biomarker to reflect the activation of the neutrophil. The serum HNL levels in the adult-onset Still’s disease (AOSD) patients with and without infection, as well as the healthy controls (HCs), were analyzed statistically in this study to evaluate the value of HNL for the diagnosis of AOSD.

METHODS: A total of 129 AOSD patients were enrolled, from whom blood samples were drawn and the AOSD diagnosis was confirmed through the review of the medical records, where the systemic score, demographic characteristics, clinical manifestations, and laboratory parameters were also collected for the patients; in addition, a total of 40 HCs were recruited among the blood donors from the healthcare center with the relevant information collected. The HNL test was done for the blood samples with the enzyme-linked immunosorbent assay and the analyses were done for the correlations of HNL with clinical manifestations and diagnostic effectiveness.

RESULTS: The serum HNL increased significantly in the patients with only AOSD as compared with that in the HCs (139.76 ± 8.99 ng/mL vs. 55.92 ± 6.12 ng/mL; P < 0.001). The serum HNL level was correlated with the white blood cell (WBC) count (r = 0.335, P < 0.001), neutrophil count (r = 0.334, P < 0.001), erythrocyte sedimentation rate (r = 0.241, P = 0.022), C-reactive protein (r = 0.442, P < 0.0001), and systemic score (r = 0.343, P < 0.0001) in the AOSD patients significantly. Patients with fever, leukocytosis ≥15,000/mm3, and myalgia in the HNL-positive group were observed relatively more than those in the HNL-negative group (P = 0.009, P = 0.023, and P = 0.007, respectively). HNL was a more sensitive indicator than ferritin and C-reactive protein (CRP) to differentiate the AOSD patients with a bacterial infection from AOSD-only patients, and the Youden index was 0.6 for HNL and 0.29 for CRP.

CONCLUSION: Serum HNL can be used as a biomarker for the diagnosis of the AOSD, and HNL is also observed to be associated with the disease activity.

PMID:37036898 | DOI:10.1097/CM9.0000000000002580

Oncologist. 2023 Apr 10:oyad037. doi: 10.1093/oncolo/oyad037. Online ahead of print.

ABSTRACT

BACKGROUND: Little is known about the impact of spiritual caregivers, psychologists, and social workers on desired end-of-life (EoL) medical outcomes, such as reduced use of aggressive care in the final 2 weeks of life, having more time between the last active oncological treatment and death, and increased hospice use.

PATIENTS AND METHODS: We conducted a prospective study of 180 patients with cancer and their families, their interactions with social work, psychology, and spiritual care, and the above three treatment outcomes.

RESULTS: We found that having one or more spiritual care visits (adjusted odds ratio (AOR) = 2.02; P = .04), having more quality visits with the psychologist (P = .01), and speaking with someone about one’s inner resources (AOR = 2.25; P = .03) all correlated with reduced EoL aggressive care. The key interventions correlating with increased time after final treatment were more visits with the spiritual caregiver or the social worker (AOR = 1.30; P < .001), and speaking about the medical treatment (AOR = 1.54; P < .001) and about interpersonal relationships (AOR = 2.28; P < .001). A subjectively good-quality connection with the spiritual caregiver correlated with increased hospice use (AOR = 10.00; P = .01).

CONCLUSIONS: Patients with cancer who availed themselves of the spiritual care, psychology, and social work services, each profession in distinct ways, had significantly different outcomes in their EoL medical treatment, including undergoing fewer futile aggressive measures, having more time after their last active treatment, and using hospice services more. These outcomes directly bear on improved quality of life and reduced costs.

PMID:37036873 | DOI:10.1093/oncolo/oyad037

PLoS One. 2023 Apr 10;18(4):e0283618. doi: 10.1371/journal.pone.0283618. eCollection 2023.

ABSTRACT

This paper provides a novel model that is more relevant than the well-known conventional distributions, which stand for the two-parameter distribution of the lifetime modified Kies Topp-Leone (MKTL) model. Compared to the current distributions, the most recent one gives an unusually varied collection of probability functions. The density and hazard rate functions exhibit features, demonstrating that the model is flexible to several kinds of data. Multiple statistical characteristics have been obtained. To estimate the parameters of the MKTL model, we employed various estimation techniques, including maximum likelihood estimators (MLEs) and the Bayesian estimation approach. We compared the traditional reliability function model to the fuzzy reliability function model within the reliability analysis framework. A complete Monte Carlo simulation analysis is conducted to determine the precision of these estimators. The suggested model outperforms competing models in real-world applications and may be chosen as an enhanced model for building a statistical model for the COVID-19 data and other data sets with similar features.

PMID:37036849 | DOI:10.1371/journal.pone.0283618

Ann Med. 2023 Dec;55(1):2197293. doi: 10.1080/07853890.2023.2197293.

ABSTRACT

INTRODUCTION: The study aims to determine whether body mass index (BMI), metabolic syndrome (MS) or its individual components (primary hypertension, type 2 diabetes mellitus and dyslipidemias) are risk factors for common urological diseases.

MATERIALS AND METHODS: Cross-sectional study with data collected on February 28, 2022 from the TriNetX Research Network. Patients were divided in cohorts according to their BMI, presence of MS (BMI > 30 kg/m², type 2 diabetes mellitus, primary hypertension and disorders of lipoprotein metabolism) and its individual components and its association with common urological conditions was determined. For each analysis, odds ratio (OR) with 95% confidence intervals were calculated. Statistical significance was assessed at p < .05.

RESULTS: BMI > 30 kg/m² was associated with increased risk of lithiasis, kidney cancer, overactive bladder, male hypogonadism, benign prostatic hyperplasia, and erectile dysfunction (p < .05). On the contrary, BMI was inversely associated with ureteral, bladder and prostate cancer (p < .05). In all urological diseases, MS was the strongest risk factor, with prostate cancer (OR = 2.53) showing the weakest and male hypogonadism the strongest (OR = 13.00) associations.

CONCLUSIONS: MS and its individual components were significant risk factors for common urological conditions. Hence holistic approaches with lifestyle modification might prevent common urological disease.Key messagesOverall, metabolic syndrome is the strongest risk factor for all the analysed urological diseases.Abnormally high body mass index can be a risk or protective factor depending on the threshold and urological disease that are being evaluated.Metabolic syndrome and increased BMI should be considered important factors associated to the prevalence of common urological diseases.

PMID:37036830 | DOI:10.1080/07853890.2023.2197293

Australas J Ageing. 2023 Apr 10. doi: 10.1111/ajag.13191. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine whether measures of neuromuscular control and proprioceptive acuity were predictive of falls in an older community-dwelling population and to develop a multivariate prediction model.

METHODS: Fifty-eight adults aged above 60 living independently in the community were recruited for a prospective falls study. On entry, they undertook a Sensory Organisation Test (SOT) and an Active Movement Extent Discrimination Assessment (AMEDA) and completed a short fall risk questionnaire. Participants were monitored for falls over the subsequent 12 months. Prior to analysis, falls were classified into three categories based on the difficulty of the activity being undertaken and the demands of the environment in which the fall occurred. Logistic regression was used to predict the probability of a fall.

RESULTS: For falls occurring under the least challenging circumstances, the model fitted using the AMEDA score and two of the questions from the fall risk questionnaire, related to balance and confidence, achieved a specificity of 87% and sensitivity of 83%. Falls occurring in more challenging circumstances could not be predicted with any accuracy based on the variables recorded at inception.

CONCLUSIONS: This study highlights the importance of considering the heterogeneous nature of falls. Poorer proprioceptive acuity appears to play a role in falls occurring where neither the environment nor the activity is challenging, but not in falls occurring in other circumstances. Falls in the least-challenging circumstances affected 15% of participants, but this group was considerably more likely to have multiple falls, increasing their vulnerability to adverse consequences.

PMID:37036826 | DOI:10.1111/ajag.13191

Australas J Ageing. 2023 Apr 10. doi: 10.1111/ajag.13186. Online ahead of print.

ABSTRACT

OBJECTIVES: To quantify physical activity in patients prior to and during an acute general medical hospital admission and explore relationships between mobility, pre- and in-hospital physical activity.

METHODS: This was a prospective, single-site secondary observational study conducted on general medical wards at a tertiary hospital. Prehospital physical activity was measured via the Physical Activity Scale for the Elderly (PASE; scored 0-400); in-hospital physical activity was measured via accelerometry (time at metabolic equivalents [METs] > 1.5), and mobility was measured via the de Morton Mobility Index (DEMMI). Associations were determined via Spearman’s correlations.

RESULTS: Forty-six participants were included: median age 81 [76-85] years, 59% female, DEMMI on admission 39 [30-49]. Prehospital physical activity was low (PASE median 27.1 [1.6-61.9]). In-hospital physical activity was also low (0.5 [0.2-1.5] hours per day being physically active and 54 [16-194] steps per day taken). No statistically significant relationships existed between pre- and in-hospital physical activity (Spearman’s rho (ρ) 0.24, 95% CI -0.08-0.53, p = 0.07). However, physical activity levels in the pre- and in-hospital settings were positively associated with patients’ mobility in-hospital (Spearman’s ρ 0.44, 95% CI 0.15-0.67, p = 0.002; Spearman’s ρ 0.40, 95% CI 0.08-0.645, p = 0.011 respectively).

CONCLUSIONS: Physical activity is low both before and during a general medical admission. Assessment of usual physical activity patterns should be part of the clinical assessment of patients in general medicine; however, the low activity levels observed indicate a need for valid and reliable tools suitable for an older, frail cohort. Findings will inform the development of physical activity guidelines during hospitalisation.

PMID:37036825 | DOI:10.1111/ajag.13186

Anesth Analg. 2023 Apr 10. doi: 10.1213/ANE.0000000000006479. Online ahead of print.

ABSTRACT

BACKGROUND: Red blood cell (RBC) transfusions are used frequently in pediatric patients admitted to the intensive care unit (ICU) after cardiac surgery. To improve data-driven transfusion decision-making in the ICU, we conducted a retrospective analysis to assess the effect of RBC transfusion on cerebral and somatic regional oxygenation (rSO2).

METHODS: We evaluated post- versus pre-RBC transfusion cerebral rSO2 and somatic rSO2 in all consecutive pediatric patients (age >28 days to <18 years) who underwent biventricular cardiac surgery at a single center between July 2016 and April 2020.

RESULTS: The final data set included 263 RBC postoperative transfusion events in 75 patients who underwent 83 surgeries. The median pretransfusion hemoglobin was 10.6 g/dL (25th-75th percentile, 9.3-11.6). The median pretransfusion cerebral and somatic rSO2 were 63% (54-71) and 69% (55-80), which increased by a median of 3 percentage points (-2 to 6) and 2 percentage points (-3 to 6), respectively, after transfusion. After adjusting for pretransfusion hemoglobin, change in hemoglobin posttransfusion versus pretransfusion, and potential confounders (age, sex, and STAT surgical mortality risk score), the posttransfusion versus pretransfusion change in cerebral or somatic rSO2 was not statistically significant. Pretransfusion cerebral rSO2 (crSO2) was ≤50%, a previously described threshold for increased risk for unfavorable neurological outcome, for 22 of 138 (16%) transfusion events with complete pre- and post-crSO2 data. Sixteen of these 22 (73%) transfusions resulted in a posttransfusion crSO2 >50%. When restricting analysis to the first (index) transfusion after arrival to the ICU from the operating room (administered at a median of 1.15 postoperative days [25th-75th percentile, 0.84-1.93]), between-patient pretransfusion hemoglobin was not associated with pretransfusion crSO2 but within-patient posttransfusion versus pretransfusion hemoglobin difference was significantly associated with posttransfusion versus pretransfusion crSO2 difference (mean posttransfusion versus pretransfusion crSO2 difference, 2.54; 95% confidence interval, 0.50-4.48).

CONCLUSIONS: In this study, neither cerebral nor somatic rSO2 increased significantly post- versus pre-RBC transfusion in pediatric cardiac surgery patients admitted to the ICU after biventricular repairs. However, almost three-quarters of transfusions administered when pretransfusion crSO2 was below the critical threshold of 50% resulted in a posttransfusion crSO2 >50%. In addition, the significant within-patient change in crSO2 in relation to the change in posttransfusion versus pretransfusion hemoglobin in the immediate postoperative period suggests that a personalized approach to transfusion following within-patient trends of crSO2 rather than absolute between-patient values may be an important focus for future research.

PMID:37036824 | DOI:10.1213/ANE.0000000000006479

Telemed J E Health. 2023 Apr 10. doi: 10.1089/tmj.2022.0445. Online ahead of print.

ABSTRACT

Background: Telehealth and in-person behavioral health services have previously shown equal effectiveness, but cost studies have largely been limited to travel savings for telehealth cohorts. The purpose of this analysis was to compare telehealth and in-person cohorts, who received behavioral health services in a large multisite study of usual care treatment approaches to examine relative value units (RVUs) and payment. Methods: We used current procedural terminology codes for each encounter to identify RVUs and Medicare payment rates. Mixed linear regression models compared telehealth and in-person cohorts on RVUs, per-encounter payment rates, and total-episode payment rates. Results: We found the behavioral health services provided by telehealth to have modest, but statistically significantly lower RVUs (i.e., less provider work in time spent and case complexity), per-encounter payments, and total episode payments than the in-person cohort. Despite Medicare rates discounting payments for nonphysician providers and the in-person cohort using clinical social workers more frequently, the services provided by the telehealth cohort still had lower payments. Thus, the differences observed are due to the in-person cohort receiving higher payment RVU services than the telehealth cohort, which was more likely to receive briefer therapy sessions and other less expensive services. Conclusions: Behavioral health services provided by telehealth used services with lower RVUs than behavioral health services provided in-person, on average, even after adjusting for patient demographics and diagnosis. Observed differences in Medicare payments resulted from the provider type and services used by the two cohorts; thus, costs and insurance reimbursements may vary for others.

PMID:37036816 | DOI:10.1089/tmj.2022.0445

Percept Mot Skills. 2023 Apr 10:315125231169868. doi: 10.1177/00315125231169868. Online ahead of print.

ABSTRACT

We assessed the accuracy of intraset repetitions in reserve (RIR) predictions on single-joint machine-based movements of trained and untrained men and women. Participants were 27 men (M age = 22, SE = 0.6 years; M weight = 90.8, SE = 4.0 kg; M height = 182.3, SE = 1.4 cm; M training experience = 66, SE = 9 months) and 31 women (M age = 20, SE = 0.4 years; M weight = 67.8, SE = 2.3 kg; M height = 167.6, SE = 1.1 cm; M training experience = 22, SE = 4 months). In one session, participants performed a five-repetition maximum (5RM) test on biceps curl, triceps pushdown, and seated row exercises; we then estimated one repetition maximum (1RM). Participants then performed four sets of each exercise, in a randomized order, to the point of momentary muscular failure at 72.5% of 1RM. During each set, participants indicated when they first perceived 5RIR and then predicted RIR on every repetition thereafter until failure. The difference between actual repetitions performed and predicted repetitions at each intraset prediction was determined to be the RIR difference (RIRDIFF). A 3-way repeated measures ANCOVA found that a 3-way interaction was not statistically significant (p = 0.435) and no covariates of sex (p = 0.917), training experience (p = 0.462) nor experience rating RIR significantly affected RIRDIFF (p = 0.462-0.917). There were significant main effects for the proximity to failure of the prediction and the set number (p < 0.01) but not for exercise (p = 0.688). Thus, intraset RIR predictions were more accurate when closer to failure and in later sets, but sex, training experience, and experience rating RIR did not significantly influence RIR prediction accuracy on machine-based single-joint exercises.

PMID:37036795 | DOI:10.1177/00315125231169868