Tag: nevin manimala

JAMA Netw Open. 2022 Sep 1;5(9):e2232556. doi: 10.1001/jamanetworkopen.2022.32556.

ABSTRACT

IMPORTANCE: Environmental disasters, such as the Flint, Michigan, water crisis, are potentially traumatic events (PTEs) that may precipitate long-term psychiatric disorders. The water crisis was associated with acute elevations in mental health problems in the Flint community, but long-term psychiatric sequelae have not yet been evaluated using standardized diagnostic measures.

OBJECTIVE: To investigate the prevalence of and factors associated with current presumptive diagnostic-level major depression and posttraumatic stress disorder (PTSD) among Flint residents 5 years after the onset of the crisis.

DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study, a household probability sample of 1970 adults living in Flint, Michigan, during the crisis were surveyed about their crisis experiences, their psychological symptoms 5 years later, and their access to and use of mental health services in the intervening years. Analyses were weighted to produce population-representative estimates.

MAIN OUTCOMES AND MEASURES: Presumptive Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) diagnostic-level past-year major depression and PTSD.

RESULTS: Among 1970 respondents, 1061 of 1946 reporting sex (54.5%) were women; 1043 of 1951 reporting race (53.5%) were Black or African American and 829 (42.5%) were White; and 1895 of 1946 reporting ethnicity (97.4%) were non-Hispanic. Overall, 435 (22.1%) met DSM-5 criteria for presumptive past-year depression, 480 (24.4%) for presumptive past-year PTSD, and 276 (14.0%) for both disorders. Residents who believed that their or their family’s health was harmed by contaminated water (eg, risk ratio [RR] for depression: 2.23; 95% CI, 1.80-2.76), who had low confidence in public-official information (eg, RR for PTSD, 1.44; 95% CI, 1.16-1.78), who had previous exposure to PTEs (eg, RR for both disorders: 5.06; 95% CI, 2.99-8.58), or who reported low social support (eg, RR for PTSD, 2.58; 95% CI, 1.94-3.43) had significantly higher risk for depression, PTSD, and comorbidity. PTEs involving prior physical or sexual assault were especially potent risk factors (eg, both disorders: RR, 7.30; 95% CI, 4.30-12.42). Only 685 respondents (34.8%) were ever offered mental health services to assist with water-crisis-related psychiatric symptoms; most (543 [79.3%]) who were offered services utilized them.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of psychiatric disorder in Flint, Michigan, presumptive depression and PTSD were highly prevalent 5 years after the onset of the water crisis. These findings suggest that public-works environmental disasters have large-scale, long-term psychological sequelae. The Flint community may require expanded mental health services to meet continued psychiatric need. National disaster preparedness and response programs should consider psychiatric outcomes.

PMID:36125808 | DOI:10.1001/jamanetworkopen.2022.32556

Dermatitis. 2022 Sep 21. doi: 10.1097/DER.0000000000000943. Online ahead of print.

ABSTRACT

BACKGROUND: Allergic contact dermatitis (ACD) remains a public health issue worldwide, despite regulations intended to minimize sensitization. With up-to-date knowledge about which chemicals continue to have high allergenicity, the government/industry can refocus their efforts to be most effective.

OBJECTIVE: We reviewed updated data showing common allergens that elicit ACD to determine the progress in reducing sensitization to inform public health policy, government regulation, and industry standards.

METHODS: We compiled data from the North American Contact Dermatitis Group showing patch test results from 1984 to 2016 for 153 compounds. Using these data, we analyzed the trends over time of positive test reactions to determine whether they are increasing or decreasing.

RESULTS: Of the 47 compounds with sufficient data to analyze, 23 had a decreasing proportion of positive patch test results over the whole period. An additional 5 had a decreasing proportion over a shorter period. Finally, 4 had an increasing proportion over any period: compositae mix, methylchloroisothiazolinone/methylisothiazolinone, nickel sulfate, and thimerosal mix.

CONCLUSIONS: The data strongly indicate decreasing and increasing frequency trends and challenge us to seek explanations, which are not yet clear. It is hoped that these data can be valuable in informing public health policy, government, and industry.

PMID:36125806 | DOI:10.1097/DER.0000000000000943

J Endocrinol Invest. 2022 Sep 20. doi: 10.1007/s40618-022-01925-0. Online ahead of print.

ABSTRACT

PURPOSE: To investigate whether the metabolic score for insulin resistance (METS-IR) is associated with an increased risk of cardiovascular disease (CVD).

METHODS: A total of 6489 participants aged 35-70 years without a history of CVD were included in this prospective cohort study. The median follow-up time was 10.6 years. The METS-IR was calculated as ln [2 × FPG (mg/dL) + fasting TG (mg/dL)] × BMI (kg/m²)/ln [HDL-C (mg/dL)]. The primary outcome was CVD, defined as the composite of coronary heart disease (CHD) and stroke.

RESULTS: During follow-up, 396 individuals developed CVD. Kaplan-Meier survival curves by quintiles of METS-IR showed statistically significant differences (log-rank test, P < 0.001). Multivariate Cox regression analysis showed that the hazard ratio [95% confidence interval (95% CI)] of CVD was 1.80 (1.24-2.61) in quintile 5 and 1.17 (1.05-1.31) for per standard deviation (SD) increase in METS-IR. In subgroup analysis, the significant association between METS-IR and CVD was mainly observed among females and subjects without diabetes mellitus. A significant interaction was found between gender and METS-IR (P-interaction = 0.001). Moreover, adding METS-IR to models with traditional risk factors yielded a significant improvement in discrimination and reclassification of incident CVD.

CONCLUSION: The elevated METS-IR was independently associated with incident CVD, suggesting that the METS-IR might be a valuable indicator for risk stratification and early intervention of CVD.

PMID:36125732 | DOI:10.1007/s40618-022-01925-0

J Pediatr Gastroenterol Nutr. 2022 Sep 20. doi: 10.1097/MPG.0000000000003620. Online ahead of print.

ABSTRACT

PATIENTS METHODS: clinical data from CD patients under 15 years old were collected from the participating centres in an on-line multicentre nationwide observational Spanish registry called REPAC-2 (2011-2017). Correlation between anti-tissue transglutaminase antibodies (t-TGA) levels and other variables, including mucosal damage and clinical findings (symptoms, age and gender), was assessed.

RESULTS: 2955 out of 4838 patients had t-TGA and a small bowel biopsy (SBB) performed for CD diagnosis. 1931 (66.2%) patients with normal IgA values had a Marsh 3b-c lesion and 1892 (64.9%) had t-TGA IgA ≥10 times ULN (upper limit of normal).There is a statistically significant association between t-TG IgA levels and the degree of mucosal damage (p value < 0.001), the higher the t-TGA IgA levels the more severe the mucosal damage. Those patients who reported symptoms had more severe mucosal damage (p value 0.001). On the contrary there was a negative association between age and changes of the intestinal mucosa (p< 0.001). No association was found with gender.Regarding the IgA deficient patients, 47.4% (18 cases) had t-TGA IgG ≥10 times ULN and a Marsh 3b-c lesion was observed in 68.4% (26 patients). No statistical relation was found between t-TGA IgG levels and the changes of the intestinal mucosa, neither a relation with age, gender or symptoms.

CONCLUSION: There is a positive correlation between t-TGA IgA levels and the severity of changes of the intestinal mucosa. Such correlation was not found in IgA deficient patients who had positive t-TGA IgG serology. The results in this group of patients support the ESPGHAN recommendations about the need of performing a SBB in IgA deficient individuals despite high t-TGA IgG levels.

PMID:36123770 | DOI:10.1097/MPG.0000000000003620

J Pediatr Gastroenterol Nutr. 2022 Sep 20. doi: 10.1097/MPG.0000000000003624. Online ahead of print.

ABSTRACT

INTRODUCTION: Endoscopic procedures are increasingly performed for children and adolescents and these interventions represent a central element of both pediatric gastroenterology (GI) care and revenues. It remains unclear, however, which scheduling paradigm maximizes efficiency of resource utilization and delivery of care in this arena. In this study, we evaluate the impact of shifting from shared endoscopy blocks to individual, provider-specific endoscopy blocks for scheduling endoscopic procedures in our tertiary care academic center.

METHODS: The implemented endoscopy block system involves a single endoscopist performing procedures in an allocated room for the entire ½ day period of time, with most providers having 1-3 ½ day blocks per month. We analyzed block fragmentation (multiple providers in a single block), block utilization and procedure volume, comparing the 8-month period prior to implementation of the block system (pre-implementation period) with the 8-month period following implementation of the block system (post-implementation period). Provider satisfaction and perceptions were assessed by survey pre- and post-implementation. Standard descriptive statistics were utilized for analysis.

RESULTS: In the pre- and post-implementation periods, 22 half-day blocks were allocated to pediatric GI. In the pre-implementation period, mean utilization of these blocks was 65.9% (range: 47%-77%). In the post-implementation period, mean % utilization was 79.8% (range: 64%-89%). Overall endoscopy procedure volume increased from 279 in the pre-implementation period to 419 in the post-implementation period. Provider perception of endoscopy efficiency was enhanced by the block system, with 68.4% of pediatric GI respondents rating endoscopy as ‘efficient’ post-implementation (vs. 19% pre-implementation) and 63.2% indicating that the block system directly enhanced efficiency. 63.2% reported increased personal procedure volume and 84.2% reported perceived increase in overall procedure volume with block system implementation.

CONCLUSIONS: Strategic approaches for scheduling endoscopic procedures carry the potential to enhance efficiency and experience for both providers and patients. Implementation of the endoscopy block system was associated with increased procedure volumes and block utilization as well as a more positive experience for the majority of providers. Schedule adjustments with analysis of associated efficiency and satisfaction metrics can optimize pediatric endoscopy practice.

PMID:36123768 | DOI:10.1097/MPG.0000000000003624

J Pediatr Gastroenterol Nutr. 2022 Sep 20. doi: 10.1097/MPG.0000000000003625. Online ahead of print.

ABSTRACT

BACKGROUND: Estimation of the dimensions of endoscopic findings such as stricture diameter is largely subjective. Accurate assessment of stricture dimensions has multiple benefits including facilitating the choice of appropriately sized endoscopic therapies for treating stricture, properly tracking response to endoscopic therapies between procedures, and potentially even predicting outcomes of endoscopic therapy.

METHODS: Endoscopies performed in children with repaired esophageal atresia between August 2019 through August 2021 for which both 1) an endoscopic estimate of esophageal stricture diameter obtained by visual comparison with the known dimensions of the biopsy forceps and 2) an intraoperative esophageal fluoroscopy study were performed were included for analysis. Fluoroscopic stricture diameter measurements were manually obtained using a software ruler tool calibrated to the known dimensions of the intraluminal endoscope. Statistical concordance was calculated between the visual diameter estimates and the standard fluoroscopic stricture measurements.

RESULTS: One-hundred ninety one endoscopies were included for analysis. Lin’s concordance correlation coefficient was 0.92 (95% confidence interval: 0.89, 0.94) between the visual diameter estimates and the fluoroscopic stricture measurements. Correlation was strongest for smaller to mid-sized stricture diameters.

CONCLUSIONS: Use of the biopsy forceps as a visual reference of known dimensions enables accurate visual estimation of esophageal stricture diameter during endoscopy using commonly available tools, with high concordance with standard fluoroscopic measurement techniques.

PMID:36123760 | DOI:10.1097/MPG.0000000000003625

Diabetol Metab Syndr. 2022 Sep 19;14(1):133. doi: 10.1186/s13098-022-00901-1.

ABSTRACT

BACKGROUND: Diabetic foot ulcer (DFU) is a common diabetes mellitus (DM) complication. Individuals with DM and a DFU achieved significantly lower scores in cognitive tests than those without a DFU. We investigated whether baseline cognitive function in individuals with a DFU is a determinant of mortality.

METHODS: A prospective study using data collected during a case-control study conducted in 2010-2012 whereby 90 participants with a DFU (mean age at baseline 58.28 ± 6.95 years, 75.6% male) took the paper and pencil and the NeuroTrax battery of cognitive tests. Depression was assessed, and the DFU status was evaluated. In 2020, information pertaining to participants’ vital status (dead/alive) was collected and the relationship between baseline cognitive status and vital status was assessed.

RESULTS: During a median follow-up of 6.8 years (range 0.2-9.5), 39 participants died (43.3%). Individuals alive vs. those who had died during follow-up had a higher global cognitive score at baseline (92.16 ± 10.95 vs. 87.18 ± 12.24, p = 0.045), but increased risk was not found. Individuals who were alive vs. those who had died during follow-up had statistically significantly higher baseline executive function, reaction time and digit symbol substitution test results. However, after adjustment for glycosylated hemoglobin (HbA1c), microvascular and macrovascular complications, no relationship between cognitive tests and mortality remained significant.

CONCLUSIONS: The higher mortality rate among people with type 2 DM and a DFU was not significant after adjustment for HbA1c, micro- and macrovascular complications. There may be common pathophysiological pathways to both DM complications and cognitive impairment, which may contribute to increased mortality. Further studies are warranted.

PMID:36123752 | DOI:10.1186/s13098-022-00901-1

BMC Nutr. 2022 Sep 19;8(1):104. doi: 10.1186/s40795-022-00603-x.

ABSTRACT

BACKGROUND: The consequences of undernutrition have serious implication for the health and future reproductive periods of adolescent girls and young women aged 15-24 years. Inspite of this, they are neglected age groups and there is limited information about the nutritional status of this age group in Ethiopia. Therefore, estimating the extent and associated factors of undernutrition among adolescent girls and young women in a national context using multilevel analysis is essential.

METHODS: Secondary data analysis was conducted from the Ethiopian Demographic and Health Survey 2016. A total sample weight of 5362 adolescent girls and young women was included in this study. A multilevel mixed-effect binary logistic regression model with cluster-level random effects was fitted to determine the associated factors of undernutrition among adolescent girls and young women in Ethiopia. Finally, the odds ratios along with the 95% confidence interval was generated to determine the individual and community level factors of undernutrition. A p-value less than 0.05 was declared as the level of statistical significance.

RESULTS: Overall, 25.6% (95%CI: 24.5-26.9) of adolescent girls and young women were undernourished. Statistically significant individual level factors includes adolescent girls and young women aged 15-19 years (AOR: 1.53, 95%CI: 1.32-1.77), individual media exposure (AOR: 0.82, 95%CI: 0.69-0.97), and unprotected drinking water source (AOR: 1.24, 95%CI: 1.04-1.48). Whereas, Southern Nations, Nationalities, and Peoples’ Region (AOR: 0.33, 95%CI: 0.13-0.83) and rural residence (AOR: 1.69, 95%CI: 1.24-2.32), were community level factors for adolescent girls and young women undernutrition.

CONCLUSION: One quarter of the Ethiopian adolescent girls and young women were undernourished. Therefore, the Ethiopian government should better engage this age group in different aspects of the food system. To improve nutritional status, public health interventions such as increased media exposure for rural residents and interventions that improve access to protected water sources will be critical.

PMID:36123733 | DOI:10.1186/s40795-022-00603-x

Respir Res. 2022 Sep 19;23(1):256. doi: 10.1186/s12931-022-02177-5.

ABSTRACT

BACKGROUND: During the COVID-19 pandemic in The Netherlands, critically ill ventilated COVID-19 patients were transferred not only between hospitals by ambulance but also by the Helicopter Emergency Medical Service (HEMS). To date, little is known about the physiological impact of helicopter transport on critically ill patients and COVID-19 patients in particular. This study was conducted to explore the impact of inter-hospital helicopter transfer on vital signs of mechanically ventilated patients with severe COVID-19, with special focus on take-off, midflight, and landing.

METHODS: All ventilated critically ill COVID-19 patients who were transported between April 2020 and June 2021 by the Dutch ‘Lifeliner 5’ HEMS team and who were fully monitored, including noninvasive cardiac output, were included in this study. Three 10-min timeframes (take-off, midflight and landing) were defined for analysis. Continuous data on the vital parameters heart rate, peripheral oxygen saturation, arterial blood pressure, end-tidal CO₂ and noninvasive cardiac output using electrical cardiometry were collected and stored at 1-min intervals. Data were analyzed for differences over time within the timeframes using one-way analysis of variance. Significant differences were checked for clinical relevance.

RESULTS: Ninety-eight patients were included in the analysis. During take-off, an increase was noticed in cardiac output (from 6.7 to 8.2 L min^-1; P < 0.0001), which was determined by a decrease in systemic vascular resistance (from 1071 to 739 dyne·s·cm^-5, P < 0.0001) accompanied by an increase in stroke volume (from 88.8 to 113.7 mL, P < 0.0001). Other parameters were unchanged during take-off and mid-flight. During landing, cardiac output and stroke volume slightly decreased (from 8.0 to 6.8 L min^-1, P < 0.0001 and from 110.1 to 84.4 mL, P < 0.0001, respectively), and total systemic vascular resistance increased (P < 0.0001). Though statistically significant, the found changes were small and not clinically relevant to the medical status of the patients as judged by the attending physicians.

CONCLUSIONS: Interhospital helicopter transfer of ventilated intensive care patients with COVID-19 can be performed safely and does not result in clinically relevant changes in vital signs.

PMID:36123727 | DOI:10.1186/s12931-022-02177-5

BMC Oral Health. 2022 Sep 19;22(1):408. doi: 10.1186/s12903-022-02452-3.

ABSTRACT

OBJECTIVE: Myofascial pain syndrome with trigger points is the most common cause of nonodontogenic pain. Although injection of the trigger points is the most effective pain reduction treatment, many patients exhibit recurrence after a short period. Therefore, the aim of the current study was to evaluate the clinical efficacy of magnesium sulfate injections in the treatment of the masseter muscle trigger points when compared to saline injections.

MATERIAL AND METHOD: This study randomly (1:1) assigned 180 patients to one of two treatment groups based on whether their trigger points were injected with 2 ml of saline or magnesium sulfate. Pain scores, maximum mouth opening (MMO), and quality of life were measured at the pre-injection and 1, 3, and 6 months post-injection.

RESULTS: The pain scores were significantly higher in the saline group during all follow-up assessments, whereas the MMO was significantly higher in the magnesium sulfate group up to 3 months of follow-up (p < 0.001). However, the difference in MMO ceased to be statistically significant after 6 months of follow-up (p = 0.121). Additionally, the patient’s quality of life score was significantly higher in the magnesium sulfate group compared to the saline group (p < 0.001).

CONCLUSION: Injection of magnesium sulfate is an effective treatment measure for myofascial trigger points. However, further studies with a proper design addressing the limitations of the current study are necessary.

CLINICALTRIALS: org (ID: NCT04742140) 5/2/2021.

PMID:36123724 | DOI:10.1186/s12903-022-02452-3