Tag: nevin manimala

Lancet. 2022 Nov;400 Suppl 1:S64. doi: 10.1016/S0140-6736(22)02274-7.

ABSTRACT

BACKGROUND: UK policy makers have called for urgent action to reduce prenatal alcohol exposure (PAE), but evidence on what is effective is scarce. We aimed to identify, evaluate, and synthesise evidence on content, process aspects, and effectiveness of UK PAE prevention initiatives.

METHODS: We conducted a systematic search of published and grey literature on UK PAE prevention (PROSPERO: CRD42020209460); consultations with 61 academic, practice, policy, third sector, and public stakeholders; and semi-structured 12 interviews with pregnant people (who were aged ≥18 years and ≥12 weeks’ gestation) and service providers to discuss experiences of PAE prevention. Participants were purposively sampled to cover each UK region and identified through maternity sites, social media and, for stakeholder consultees, researcher networks. Information from relevant PAE prevention initiatives from the literature was independently extracted by two reviewers. Ethical approval and informed consent were obtained for interviews, which were recorded and transcribed. Qualitative evidence was synthesised using thematic analysis. Quantitative data will be summarised using descriptive statistics and meta-analysis.

FINDINGS: We identified 14 PAE prevention initiatives through literature searches (22 of 4064 results were eligible), stakeholder consultation, and interviews. Initiatives included screening and intervention, campaigns, and education or training. Seven initiatives were identified in the north of England. Two initiatives were identified in Scotland and two in Wales. The East of England, West Midlands, and South East of England had one each. None were identified in Southwest of England or Northern Ireland. Barriers to prevention included absence of resources, excessive workload, concerns around blame, and COVID-19. Enablers included workforce training and trust between pregnant people and service providers. Effectiveness of evidence was scarce.

INTERPRETATION: Key strengths include extensive searches and multidisciplinary consultation. Data collection and analyses are ongoing and will be finalised before November, 2022. This research will provide a comprehensive analysis of current provision, providing crucial evidence to inform research and practice.

FUNDING: The National Institute for Health and Care Research.

PMID:36426483 | DOI:10.1016/S0140-6736(22)02274-7

Lancet. 2022 Nov;400 Suppl 1:S57. doi: 10.1016/S0140-6736(22)02267-X.

ABSTRACT

BACKGROUND: Preventing smoking uptake among adolescents is essential to achieve a smoke-free generation. The aim of this study was to assess risk factors for smoking in late adolescence and smoking uptake between early and late adolescence, using data from the Millennium Cohort Study. We also present estimates of numbers of smokers and smoking uptake.

METHODS: Adolescents aged 14-17 years were included in the analysis. In separate logistic regression models, we assessed associations between age, sex, ethnicity, household income, country of residence, current smoking of a caregiver, current smoking of peers and use of social media, and regular smoking (defined as smoking at least one cigarette per week) at the age of 17 years and smoking uptake between the ages of 14 and 17 years (defined as being a never-smoker at the age of 14 years and a regular smoker at the age of 17 years). We also estimated numbers of regular smoking and smoking uptake using the Office for National Statistics 2018-19 population estimates.

FINDINGS: Data from 8944 adolescents aged 14-17 years with smoking data available were included, 948 (10·6%) of which were regular tobacco smokers at the age of 17 years. 488 (51·5%) of these 948 started smoking between the ages of 14 years and 17 years. Smoking uptake was more common among adolescents reporting caregiver smoking (162 [13·6%] of 1188 vs 324 [5·0%] of 6538 with non-smoking caregivers; p<0·0001); peers smoking (223 [12·6%] of 1764 vs 229 [4·3%] of 5350 without smoking peers; p<0·0001), and those reporting higher (at least 5 h/weekday) social media use (115 [9·8%] of 1176 vs 120 [4·1%] of 2947 with lower [less than 1 h/weekday] social media use; p=0·0059), among 7786 adolescents who did not smoke at age 14. We estimated that 164 313 (95% CI 146 815-181 811) adolescents were regular smokers by the age of 17 years, of whom 101 715 (85 994-117 435) took up the habit between the age of 14 years and 17 years.

INTERPRETATION: Our findings are a reminder of the transmissibility of the smoking epidemic. Although we only assessed social media use, not actual exposure to online tobacco advertising, our findings strengthen calls for awareness of the changing landscape of tobacco advertising.

FUNDING: Cancer Research UK (grant reference PPRCTAGPJT100005) and the UK National Institute for Health and Care Research School for Public Health Research. The funders had no role in the writing of the manuscript or the decision to submit for publication.

PMID:36426475 | DOI:10.1016/S0140-6736(22)02267-X

Lancet. 2022 Nov;400 Suppl 1:S47. doi: 10.1016/S0140-6736(22)02257-7.

ABSTRACT

BACKGROUND: Maternal weight management increases risks for women and babies and is a public health priority. Interventions can substantially improve maternal diet and physical activity behaviours and pregnancy outcomes. Low self-efficacy is a core barrier to midwives’ implementation of guidelines. GLOWING used social cognitive theory to address evidence-based barriers to practice, aiming to support midwives’ guidelines implementation.

METHODS: This study was a pilot cluster randomised controlled trial in four UK National Health Service Trusts (clusters) in England. Clusters were randomised to intervention (midwives received intervention) or control (no intervention). Guideline recommendations for midwives’ practice were: first, communication-related behaviours (weight-communication and risk-communication); and second, support and intervention-related behaviours (diet and nutrition, physical activity, weight management, and referrals and signposting). Questionnaires were designed using social cognitive theory constructs (eg, self-efficacy, outcome expectancies, intentions, behaviours), higher scores being more positive. Following Consolidated Standards of Reporting Trials guidelines for pilot trials, descriptive statistics were used to compare arms, before and after the intervention.

FINDINGS: 100 midwives were randomised to complete questionnaires before and after the intervention. 74% consented, and 68% returned questionnaires. Pre-intervention, self-efficacy for support, and intervention-related behaviours scored lowest. In controls, the difference between pre-intervention and post-intervention scores were negligible. Post-intervention scores were consistently higher in midwives in the intervention group than the control group, particularly for support and intervention self-efficacy (mean 71·4 [SD 17·1] vs 58·4 [20·1]). Self-efficacy was higher after the intervention than before the intervention for all outcomes among intervention midwives: weight-communication (mean 76·3 [SD 16·7] vs 67·2 [21·1]), risk-communication (79·4 [16·4] vs 68·6 [14·9]), diet, nutrition, and physical activity (76·4 [16·0] vs 49·3 [16·5]), weight management (72·1 [18·3] vs 48·3 [19·8]), referrals and signposting (63·3 [26·0] vs 47·9 [17·3]), and consistently higher than controls.

INTERPRETATION: Results support the theoretical models used to develop GLOWING: low self-efficacy is a core implementation barrier. Results suggest GLOWING successfully targets self-efficacy, potentially with positive implications for guideline implementation. A strength of this work is the rigorous evidence-based theoretical approach to intervention development, largely absent in maternity-based research. A limitation is that this is a pilot trial. A definitive trial is required to determine effectiveness.

FUNDING: National Institute for Health Research Postdoctoral Fellowship (reference PDF-2011-04-034).

PMID:36426464 | DOI:10.1016/S0140-6736(22)02257-7

Injury. 2022 Dec;53(12):4104-4113. doi: 10.1016/j.injury.2022.10.019. Epub 2022 Oct 21.

ABSTRACT

BACKGROUND: High energy open tibial fractures are complex injuries with no consensus on the optimal method of fixation. Treatment outcomes are often reported with union and re-operation rates, often without specific definitions being provided. We sought to describe union, reoperation rates, and patient reported outcomes, using the validated EQ-VAS and Disability Rating Index (DRI) scores, following stabilisation with a Taylor Spatial Frame (TSF) and a combined orthoplastic approach for the management of soft tissues. A literature review is also provided.

METHOD: A prospective cross-sectional follow up of open tibial fractures, treated at a level 1 major trauma centre, managed with a TSF using a one ring per segment technique between January 2014 and December 2019 were identified. Demographic, injury and operative data were recorded, along with Patient Reported Outcome Measures (PROM) scores, specifically the EQ-VAS and Disability Rating Index (DRI). Union rates, defined by radiographic union scale in tibia (RUST) scores, and re-operation rates were recorded. Appropriate statistical analyses were performed, with a p<0.05 considered statistically significant.

RESULTS: Overall, 51 patients were included. Mean age was 51.2 ± 17.4 years, with a 4:1 male preponderance. Diaphyseal and distal fractures accounted for 76% of cases. Mean time in frame was 206.7 ± 149.4 days. Union was defined and was achieved in 41/51 (80.4%) patients. Deep infection occurred in 6/51 (11.8%) patients. Amputation was performed in 1 case (1.9%). Overall re-operation rate was 33%. Time to union were significantly longer if re-operation was required for any reason (uncomplicated 204±189 vs complicated 304±155 days; p = 0.0017) . EQ-VAS and DRI scores significantly deteriorated at 1 year follow-up (EQVAS 87.5 ± 11.7 vs 66.5 ± 20.4;p<0.0001 and DRI 11.9 ± 17.8 vs 39.3 ± 23.3;p<0.0001). At 1 year post op, 23/51(45.1%) required a walking aid, and 17/29 (58.6%) of those working pre-injury had returned to work.

CONCLUSION: Open tibial fracture have significant morbidity and long recovery periods as determined by EQVAS and DRI outcome measures. We report the largest series of open tibial feature treated primarily with a TSF construct, which has similar outcomes to other techniques, and should therefore be considered as a useful technique for managing these injuries.

PMID:36424690 | DOI:10.1016/j.injury.2022.10.019

Angiology. 2022 Nov 24:33197221141666. doi: 10.1177/00033197221141666. Online ahead of print.

ABSTRACT

Several studies have reported that the atherogenic index of plasma (AIP) is associated with serum uric acid (SUA) in healthy middle-aged men, kidney transplant patients, and diabetic patients. We assessed the relationship between AIP and SUA in patients with untreated essential hypertension (EH) in China. In the cross-sectional study, we evaluated 5003 patients with untreated EH in China; 1490 were assigned to the hyperuricemia (HUA) group and 3513 to the normouricemia (non-HUA) group according to the diagnostic criteria of HUA (SUA level≥6 mg/dL in females and ≥7 mg/dL in males). A higher AIP level was found in the HUA group (P < .001), and AIP was positively and independently correlated with SUA after adjusting for statistically significant variables (β = .204, P < .001). Moreover, multivariate logistic regression analysis showed that the AIP was closely and independently related to HUA after adjusting for confounders (odds ratio [OR]: 11.980, 95% confidence interval [CI]: 3.186-45.047, P < .001). Our findings suggested that the AIP was positively and independently associated with SUA, and elevated AIP might be a significant risk factor for HUA in patients with untreated EH in China.

PMID:36424679 | DOI:10.1177/00033197221141666

Genome Med. 2022 Nov 24;14(1):133. doi: 10.1186/s13073-022-01133-8.

ABSTRACT

BACKGROUND: Neuropsychiatric disorders afflict a large portion of the global population and constitute a significant source of disability worldwide. Although Genome-wide Association Studies (GWAS) have identified many disorder-associated variants, the underlying regulatory mechanisms linking them to disorders remain elusive, especially those involving distant genomic elements. Expression quantitative trait loci (eQTLs) constitute a powerful means of providing this missing link. However, most eQTL studies in human brains have focused exclusively on cis-eQTLs, which link variants to nearby genes (i.e., those within 1 Mb of a variant). A complete understanding of disease etiology requires a clearer understanding of trans-regulatory mechanisms, which, in turn, entails a detailed analysis of the relationships between variants and expression changes in distant genes.

METHODS: By leveraging large datasets from the PsychENCODE consortium, we conducted a genome-wide survey of trans-eQTLs in the human dorsolateral prefrontal cortex. We also performed colocalization and mediation analyses to identify mediators in trans-regulation and use trans-eQTLs to link GWAS loci to schizophrenia risk genes.

RESULTS: We identified ~80,000 candidate trans-eQTLs (at FDR<0.25) that influence the expression of ~10K target genes (i.e., “trans-eGenes”). We found that many variants associated with these candidate trans-eQTLs overlap with known cis-eQTLs. Moreover, for >60% of these variants (by colocalization), the cis-eQTL’s target gene acts as a mediator for the trans-eQTL SNP’s effect on the trans-eGene, highlighting examples of cis-mediation as essential for trans-regulation. Furthermore, many of these colocalized variants fall into a discernable pattern wherein cis-eQTL’s target is a transcription factor or RNA-binding protein, which, in turn, targets the gene associated with the candidate trans-eQTL. Finally, we show that trans-regulatory mechanisms provide valuable insights into psychiatric disorders: beyond what had been possible using only cis-eQTLs, we link an additional 23 GWAS loci and 90 risk genes (using colocalization between candidate trans-eQTLs and schizophrenia GWAS loci).

CONCLUSIONS: We demonstrate that the transcriptional architecture of the human brain is orchestrated by both cis- and trans-regulatory variants and found that trans-eQTLs provide insights into brain-disease biology.

PMID:36424644 | DOI:10.1186/s13073-022-01133-8

Arthritis Res Ther. 2022 Nov 22;24(1):258. doi: 10.1186/s13075-022-02948-x.

ABSTRACT

BACKGROUND: Current recommendations on the management of systemic sclerosis (SSc) suggest that autologous hematopoietic stem cell therapy (HSCT) can be a rescue therapy for patients with rapidly progressive SSc.

OBJECTIVES: To assess the safety and efficacy of HSCT for patients with SSc and to compare these with non-HSCT patients in a control cohort with adjusted risk factors.

METHODS: A retrospective analysis of data from the multicentric German network for systemic scleroderma (DNSS) with 5000 patients with SSc. Control groups consisted of all patients with diffuse cutaneous (dc)-SSc (group A) and an adjusted high-risk cohort of male patients with Scl70-positive dc-SSc (group B).

RESULTS: Eighty SSc patients received an HSCT 4.1 ± 4.8 years after SSc diagnosis. Among them, 86.3% had dc-SSc, 43.5% were males, and 71.3% were positive for Scl70 antibodies. The control group A (n=1513) showed a significant underrepresentation of these risk factors for mortality. When the survival of the control group B (n=240) was compared with the HSCT group, a lower mortality of the latter was observed instead. Within 5 years after HSCT, we observed an improvement of the mRSS from 17.6 ± 11.5 to 11.0 ± 8.5 (p=0.001) and a stabilization of the DLCO. We did not see differences in transplant-related mortality between patients who received HSCT within 3 years after SSc diagnosis or later.

CONCLUSION: Our analysis of real-life data show that the distribution of risk factors for mortality is critical when HSCT cohorts are compared with non-HSCT control groups.

PMID:36424638 | DOI:10.1186/s13075-022-02948-x

BMC Oral Health. 2022 Nov 24;22(1):531. doi: 10.1186/s12903-022-02600-9.

ABSTRACT

BACKGROUND: To evaluate the clinical and radiographic assessment of customized fusion-sputtered one-piece zirconia implants.

METHODS: Twenty-eight patients received either fusion sputtered one-piece zirconia implants (n = 14) or one-piece titanium implants (n = 14). All implants were one-piece designs. After 4 months of immediate loading, all implants were restored with a monolithic zirconia crown. All implants were evaluated at baseline, 6 months, 1 year, 2 years, and 5 years. Implant mobility, plaque index, and gingival index evaluations were performed. The measurements of marginal bone level were calculated radiographically.

RESULTS: All implants were well maintained through the evaluation period with a 100% survival rate without any clinical complications. Regarding gingival index, there was no statistically significant difference (P = .364) between zirconia (3.3 ± 0.7 mm) and titanium (3.5 ± 0.6 mm) implants, after 5 years. There was no statistically significant difference (P = .470) between zirconia (1.77 ± 0.039 mm) and titanium (1.80 ± 0.28 mm) implants regarding marginal bone loss, after 5 years.

CONCLUSIONS: One-piece fusion-sputtered zirconia implant represents a reliable treatment modality in replacing a missing tooth in the esthetic zone.

PMID:36424624 | DOI:10.1186/s12903-022-02600-9

BMC Med. 2022 Nov 23;20(1):456. doi: 10.1186/s12916-022-02651-3.

ABSTRACT

BACKGROUND: Supporting decisions for patients who present to the emergency department (ED) with COVID-19 requires accurate prognostication. We aimed to evaluate prognostic models for predicting outcomes in hospitalized patients with COVID-19, in different locations and across time.

METHODS: We included patients who presented to the ED with suspected COVID-19 and were admitted to 12 hospitals in the New York City (NYC) area and 4 large Dutch hospitals. We used second-wave patients who presented between September and December 2020 (2137 and 3252 in NYC and the Netherlands, respectively) to evaluate models that were developed on first-wave patients who presented between March and August 2020 (12,163 and 5831). We evaluated two prognostic models for in-hospital death: The Northwell COVID-19 Survival (NOCOS) model was developed on NYC data and the COVID Outcome Prediction in the Emergency Department (COPE) model was developed on Dutch data. These models were validated on subsequent second-wave data at the same site (temporal validation) and at the other site (geographic validation). We assessed model performance by the Area Under the receiver operating characteristic Curve (AUC), by the E-statistic, and by net benefit.

RESULTS: Twenty-eight-day mortality was considerably higher in the NYC first-wave data (21.0%), compared to the second-wave (10.1%) and the Dutch data (first wave 10.8%; second wave 10.0%). COPE discriminated well at temporal validation (AUC 0.82), with excellent calibration (E-statistic 0.8%). At geographic validation, discrimination was satisfactory (AUC 0.78), but with moderate over-prediction of mortality risk, particularly in higher-risk patients (E-statistic 2.9%). While discrimination was adequate when NOCOS was tested on second-wave NYC data (AUC 0.77), NOCOS systematically overestimated the mortality risk (E-statistic 5.1%). Discrimination in the Dutch data was good (AUC 0.81), but with over-prediction of risk, particularly in lower-risk patients (E-statistic 4.0%). Recalibration of COPE and NOCOS led to limited net benefit improvement in Dutch data, but to substantial net benefit improvement in NYC data.

CONCLUSIONS: NOCOS performed moderately worse than COPE, probably reflecting unique aspects of the early pandemic in NYC. Frequent updating of prognostic models is likely to be required for transportability over time and space during a dynamic pandemic.

PMID:36424619 | DOI:10.1186/s12916-022-02651-3

BMC Chem. 2022 Nov 23;16(1):102. doi: 10.1186/s13065-022-00890-2.

ABSTRACT

A precise, sensitive eco-friendly, simple, rapid, and derivative spectrofluorimetric method was developed to quantify edoxaban tosylate monohydrate in pure form and pharmaceutical dosage form. Sudden death due to pulmonary embolism as a consequence of coronavirus infection (covid-19) is an emerging problem. As a result, the world health organization introduced new guidelines to treat patients with COVID-19 with oral anticoagulants. Edoxaban tosylate monohydrate is an oral anticoagulant that doesn’t require hospitalization after dose adjustment. This spectrofluorimetric method relies on the derivatization by 9-fluorenyl methyl chloroformate at room temperature in borate buffer pH 9.0. After excitation at 265 nm, the product is highly fluorescent at 309 nm. Many experimental factors influencing the reaction’s stability and development were thoroughly investigated and optimized. The method validation was evaluated by using ICH guidelines and showed high precision and accuracy with an average percent recovery of 101.46% ± 1.02. The linear range was 5.0-50.0 ng/mL with a correlation coefficient of 0.9999, the LOD was 1.5 ng/mL, and the LOQ was 4.5 ng/mL. The green assessment of the method was achieved utilizing the eco-scale and the Green Analytical Procedure Index. There was no significant difference between the results of the suggested method and those of the reported method according to Statistical analysis.

PMID:36424617 | DOI:10.1186/s13065-022-00890-2