Tag: nevin manimala

BMC Emerg Med. 2022 Jun 8;22(1):102. doi: 10.1186/s12873-022-00655-z.

ABSTRACT

BACKGROUND: The prehospital emergency system in Norway involves out-of-hours (OOH) services with on-call physicians. Helicopter emergency medical service (HEMS) are used in cases of severe illness or trauma that require rapid transport and/or an anesthesiologist’s services. In recent years, on-call primary care physicians have been less available for call-outs in Norway, and HEMS may be requested for missions that could be adequately handled by on-call physicians. Here, we investigated how different availability of an on-call physician to attend emergency patients at site (call-out) impacted requests and use of HEMS.

METHODS: Our analysis included all acute medical missions in an urban and nearby rural OOH district, which had different approach regarding physician call-outs from the OOH service. For this prospective observational study, we used data from both HEMS and the OOH service from November 1^st 2017 until November 30^th 2018. Standard descriptive statistical analyses were used.

RESULTS: The rates of acute medical missions in the urban and rural OOH districts were similar (30 and 29 per 1000 inhabitants per year, respectively). The rate of HEMS requests was significantly higher in the rural OOH district than in the urban district (2.4 vs. 1.7 per 1000 inhabitants per year, respectively). Cardiac arrest and trauma were the major symptom categories in more than one half of the HEMS-attended patients, in both districts. Chest pain was the most frequent reason for an OOH call-out in the rural OOH district (21.1%). An estimated NACA score of 5-7 was found in 47.7% of HEMS patients from the urban district, in 40.0% of HEMS patients from the rural OOH district (p = 0.44), and 12.8% of patients attended by an on-call physician in the rural OOH district (p < 0.001). Advanced interventions were provided by an anesthesiologist to one-third of the patients attended by HEMS, of whom a majority had an NACA score of ≥ 5.

CONCLUSIONS: HEMS use did not differ between the two compared areas, but the rate of HEMS requests was significantly higher in the rural OOH district. The threshold for HEMS use seems to be independent of on-call primary care physician involvement.

PMID:35676626 | DOI:10.1186/s12873-022-00655-z

Environ Monit Assess. 2022 Jun 8;194(7):489. doi: 10.1007/s10661-022-10169-7.

ABSTRACT

Water quality sampling is a key element in tracking water quality monitoring objectives. However, frequencies adapted by different agencies might not be sufficient to provide an accurate indication of water quality status. In this study, data from low- and high-resolution water quality datasets were analyzed to determine the extent to which monitoring objectives could be achieved with different sampling frequencies, with a view to providing recommendations and best practices for water quality monitoring frequency in places with limited resources with which to implement a high-frequency monitoring plan. Water quality data from two watersheds (Maumee River and Raisin River) located in the Western Lake Erie Basin (WLEB) were used since these watersheds have consistent records over substantial periods of time, and the water quality data available have a high resolution (at least daily). The water quality constituents analyzed included suspended solids (SS), total phosphorus (TP), soluble reactive phosphorus (SRP), and nitrate + nitrite (NO₂₊₃). Sources of pollutants for watersheds located in the WLEB include contributions from point sources like discharges from sewage treatment plants and non-point sources such as agricultural and urban storm runoff. Weekly, bi-weekly, monthly, and seasonal datasets were created from the original datasets, following different sampling rules based on the day of the week, week of the month, and month of the year. The resulting datasets were then compared to the original dataset to determine how the sampling frequency would affect the results obtained in a water quality assessment when different monitoring objectives are considered. Results indicated that constituents easily transported by water (such as sediments and nutrients) require more than 50 samples/year to provide a small error (< 10%) with a confidence interval of 95%. Monthly and seasonal sampling were found appropriate to report a stream’s prevailing water quality status and statistical properties. However, these resolutions might not be sufficient to capture long-term trends, in which case bi-weekly samples would be preferable. Limitations of low-resolution sampling frequency could be overcome by including rainfall events and random sampling during specific time windows as part of the monitoring plan.

PMID:35676599 | DOI:10.1007/s10661-022-10169-7

Health Justice. 2022 Jun 9;10(1):19. doi: 10.1186/s40352-022-00182-w.

ABSTRACT

BACKGROUND: Fidelity assessment tools can assess whether a program embraces a core set of principles and performs well. A quality fidelity tool with valid scales can be a feedback loop to identify areas that need further work to improve the program. Using data collected from 1816 correctional and reentry programs in the United States in the construction sample and 761 programs in the confirmation sample, this study examined the internal consistency of the Risk-Need-Responsivity (RNR) Program Tool, an online resource to capture information about structural features of a program.

RESULTS: The study reports on reliability statistics and factor analyses to highlight individual subscales. Six scales emerged and had acceptable to excellent levels of internal consistency. These scales are staffing, reward-and-sanction, clinical standards for programs, coaching, program duration, and risk-need assessment.

CONCLUSIONS: This article discusses fidelity scales from the RNR Program Tool and provides guidance on the importance of tool development processes to ensure accurate, valid, and reliable scales. The purpose of the RNR Program Tool is to create a modern, online tool integrating both the empirical (research) literature on effective practices and clinical standards on quality programming. This process minimizes the need for consultants by giving program administrators the ability to gather information on their programs, score them, and receive instant and targeted feedback with recommendations for improvement to assess their programs against empirical standards in the field. Furthermore, it provides a standardized tool that administrators can use to examine what type of individuals fare better in their programs. The provided targeted feedback can give the programs the ability to seek technical assistance or guidance in specific areas that can strategically strengthen their program.

PMID:35676601 | DOI:10.1186/s40352-022-00182-w

J Gen Intern Med. 2022 Jun 8. doi: 10.1007/s11606-022-07681-4. Online ahead of print.

ABSTRACT

OBJECTIVE: The triglyceride and glucose (TyG) index is a useful marker of insulin resistance and is a predictor of several metabolic diseases. The aim of this study was to evaluate the association between the TyG index and all-cause or cardiovascular mortality using a large population-based cohort study database.

METHODS: A total of 255,508 subjects in the Kangbuk Samsung Health Study cohort were enrolled. Cox proportional hazards models were used to analyze the risk of mortality.

RESULTS: During a median 5.7-year follow-up, the cumulative all-cause and cardiovascular mortality was 0.47% and 0.07%. There was a nonlinear relationship between the TyG index and death, and moving from moderate to high, the TyG index levels were associated with an increase in the risk of death. The hazard ratio (HR) for all-cause and cardiovascular mortality of the TyG index was 1.21 [95% confidence interval (CI) 1.14-1.28] and 1.45 (95% CI 1.26-1.66) in the unadjusted model, respectively. After adjustment for covariates, the association between the TyG index and all-cause and cardiovascular mortality was attenuated. In the multivariable-adjusted model, the TyG index was associated with an elevated risk of all-cause mortality in women (HR 1.13, 95% CI 1.02-1.26) and a decreased risk in men (HR 0.92, 95% CI 0.85-0.99). The association between cardiovascular mortality and the TyG index was not statistically significant among either men or women in the multivariable-adjusted model.

CONCLUSIONS: The TyG index in a young, relatively healthy, population is associated with an elevated risk of all-cause and cardiovascular mortality. This association between the TyG index and all-cause mortality persists in women after multivariable adjustment.

PMID:35676587 | DOI:10.1007/s11606-022-07681-4

Environ Sci Pollut Res Int. 2022 Jun 8. doi: 10.1007/s11356-022-20839-1. Online ahead of print.

ABSTRACT

As phthalate metabolites might cross the placenta, it is possible to find them in the amniotic fluid. This cross-sectional study aims to investigate the levels of phthalate metabolites in the amniotic fluid of a sample of Iranian women and its association with neonatal anthropometric measures. The other objective was to study the potential sources of maternal exposure to phthalates. This study was conducted from June 2019 to June 2021 in Isfahan, Iran. Pregnant women were recruited from their first trimester of pregnancy and followed up until their delivery. Amniotic fluid samples were collected from those who were assigned to have delivery by cesarean section. Overall, 158 samples of amniotic fluid were collected, of which 139 samples had sufficient volume and were free of blood. Data from 142 newborns were included in this study. Four phthalate metabolites were measured using gas chromatography-mass spectrometry (GC-MS). After extraction of phthalate metabolites, 4 phthalate metabolites including mono-butyl phthalate (MBP; normal: 0.08 ± 0.79; overweight: 0.20 ± 1.11; obese: 0.07 ± 1.07; p-value: 0.405), mono-benzyl phthalate (MBzP; normal: 7.54 ± 6.69; overweight: 7.48 ± 7.16; obese: 8.67 ± 12.75; p-value: 0.729), mono(2-ethyl-5-oxohexyl) phthalate (MEOHP; normal: 4.27 ± 6.36; overweight: 3.03 ± 8.44; obese: 3.53 ± 7.04; p-value: 0.245), and mono(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP; normal: 246.18 ± 189.80; overweight: 238.48 ± 200.23; obese: 287.65 ± 206.70; p-value: 0.723) were simultaneously detected in samples of maternal amniotic fluid. Our findings suggest that maternal exposure to phthalate metabolites is positively associated with in utero exposure of the developing fetus. The geometric means and medians of MBP, MBzP, MEOHP, and MEHHP of detected samples were 10.17 (9.52), 6.24 (3.47), 5.03 (11.72), and 174.79 (229.94) (μg/L), respectively. The median anthropometric measures of newborns were as follows: weight 3171.8 g, height 49.6 cm, head circumferences 34.9 cm, chest 33.3 cm, hip 31.5 cm, and arm circumferences 10.8 cm. There was no statistically significant association between phthalate metabolites concentration and newborn’s anthropometric measures (p > 0.05). Future studies should focus on the collection of amniotic fluid at different trimesters and the corresponding maternal samples to better characterize the association and health impacts of these endocrine-disrupting chemicals during fetal development.

PMID:35676571 | DOI:10.1007/s11356-022-20839-1

J Comput Assist Tomogr. 2022 Jun 4. doi: 10.1097/RCT.0000000000001340. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to evaluate the reliability of liver and spleen Hounsfield units (HU) measurements in reduced radiation computed tomography (RRCT) of the chest within the sub-millisievert range.

METHODS: We performed a prospective, institutional review board-approved study of accrued patients who underwent unenhanced normal-dose chest CT (NDCT) and with an average radiation dose of less than 5% of NDCT. In-house artificial intelligence-based denoising methods produced 2 denoised RRCT (dRRCT) series. Hepatic and splenic attenuations were measured on all 4 series: NDCT, RRCT, dRRCT1, and dRRCT2. Statistical analyses assessed the differences between the HU measurements of the liver and spleen in RRCTs and NDCT. As a test case, we assessed the performance of RRCTs for fatty liver detection, considering NDCT to be the reference standard.

RESULTS: Wilcoxon test compared liver and spleen attenuation in the 72 patients included in our cohort. The liver attenuation in NDCT (median, 59.38 HU; interquartile range, 55.00-66.06 HU) was significantly different from the attenuation in RRCT, dRRCT1, and dRRCT2 (median, 63.63, 42.00, and 33.67 HU; interquartile range, 56.19-67.19, 37.33-45.83, and 30.33-38.50 HU, respectively), all with a P value <0.01. Six patients (8.3%) were considered to have fatty liver on NDCT. The specificity, sensitivity, and accuracy of fatty liver detection by RRCT were greater than 98.5%, 50%, and 94.3%, respectively.

CONCLUSIONS: Attenuation measurements were significantly different between NDCT and RRCTs, but may still have diagnostic value in appreciating hepatosteastosis. Abdominal organ attenuation on RRCT protocols may differ from attenuation on NDCT and should be validated when new low-dose protocols are used.

PMID:35675689 | DOI:10.1097/RCT.0000000000001340

Sex Transm Dis. 2022 Jun 7. doi: 10.1097/OLQ.0000000000001654. Online ahead of print.

ABSTRACT

BACKGROUND: Trichomonas vaginalis (TV) is the most prevalent non-viral sexually transmitted infection globally but routine screening is not recommended in HIV negative individuals. There is a significant racial/ethnic health disparity in TV infection rates. Evidence regarding the association between TV and adverse perinatal outcomes is conflicting, but a recent large meta-analysis found a modest increased risk of preterm birth with TV infection (OR 1.27, 95%CI 1.08, 1.50). The current study was undertaken to evaluate whether TV infection increases risk of spontaneous preterm birth (sPTB) in a high-risk obstetric cohort in Atlanta, Georgia.

METHODS: We conducted a retrospective cohort study of women delivering at a safety-net hospital in Atlanta between July 2016 and June 2018. Women delivering a singleton live fetus at >20 weeks gestation were included. TV diagnosis was by nucleic acid amplification testing (NAAT). The outcome of interest was sPTB prior to 37 weeks gestation. Multivariable Cox proportional hazards modeling was used to estimate the effect of TV on sPTB controlling for confounding variables, including clinical and demographic characteristics. Several sensitivity analyses were undertaken.

RESULTS: There were 3,723 deliveries during the study period and approximately half (46%) were screened for TV with NAAT. After exclusions, the analytic cohort included 1,629 women. Median age was 26 years (interquartile range 22, 31) and 70% of participants were listed as non-Hispanic Black in the electronic medical record. TV prevalence was 16% (n = 257). The sPTB rate was 7% (n = 112). In multivariable Cox proportional hazards modeling, TV infection was not associated with a statistically significantly increased risk of sPTB (HR 1.34; 95%CI 0.84, 2.13, p = 0.22). Factors associated with sPTB included history of prior PTB, adequate plus or transfer of prenatal care (versus adequate/intermediate prenatal care utilization using the Kotelchuck index), recreational substance use and Chlamydia trachomatis diagnosed during the current pregnancy. Results were not substantively different in sensitivity analyses.

CONCLUSIONS: TV prevalence was high in this cohort. TV infection was not associated with a statistically significantly increased risk of sPTB. Nevertheless, the magnitude of effect is consistent with prior meta-analyses.

PMID:35675705 | DOI:10.1097/OLQ.0000000000001654

J Laparoendosc Adv Surg Tech A. 2022 Jun 8. doi: 10.1089/lap.2022.0123. Online ahead of print.

ABSTRACT

Background: Laparoscopic sleeve gastrectomy (LSG) is associated with the long-term development of gastroesophageal reflux disease (GERD). Recent studies on LSG with fundoplication showed a lower rate of postoperative GERD than LSG alone; however, there is a lack of objective instrumental data in the literature. This study aimed to evaluate whether and how fundoplication associated with Sleeve Gastrectomy affects the esophagogastric physiology. Materials and Methods: This prospective observational study included 20 patients with morbid obesity, GERD, and lower esophageal sphincter (LES) hypotonia. All the patients underwent LSG with Rossetti fundoplication. High-resolution manometry was performed pre- and postoperatively. All the patients completed the 6 months follow-up. Results: The fundoplication increased LES tone in all patients. The increase in the LES tone was statistically significant (330% increase). The integrated relaxation pressure and the distal contractile integral both increased accordingly, indicating an increased esophageal effort to pass through the modified esophagogastric junction. Conclusion: Rossetti fundoplication associated with LSG increased LES tone and decreased the chance of developing long-term GERD after LSG.

PMID:35675688 | DOI:10.1089/lap.2022.0123

Breastfeed Med. 2022 Jun 8. doi: 10.1089/bfm.2021.0307. Online ahead of print.

ABSTRACT

Background: There is limited evidence on the relationship between hookah use and breastfeeding. This study examines the association between a history of hookah use and breastfeeding duration among women in the United States. Materials and Methods: This cross-sectional study examined 96,392 women from the Pregnancy Risk Assessment and Monitoring System (PRAMS) 2016-2019 data. The main outcome of interest was any breastfeeding for at least 3 months. Descriptive statistics, chi-square test, and multivariable regression analyses were performed. Results: Overall, 68.3% of women breastfed for at least 3 months and 4.6% reported using hookah in the last 2 years. Women who reported using hookah in the last 2 years were significantly less likely to breastfeed for at least 3 months compared with women who did not report using hookah in the last 2 years (56.0% versus 68.9%; p < 0.001). In the multivariable model, the odds of breastfeeding for at least 3 months were significantly lower in women who used hookah in the last 2 years compared with those who did not use hookah; odds ratio (95% confidence interval) 0.82 (0.74-0.92; p < 0.001). Additionally, the odds of breastfeeding for at least 3 months were significantly lower for dual users of hookah and cigarettes 0.48 (0.33-0.68; p < 0.001). Conclusion: A history of hookah use is associated with early weaning, independent of potential confounders. This finding suggests the need for educating women about the negative consequences of hookah use on breastfeeding during preconception, prenatal, and postpartum care encounters.

PMID:35675681 | DOI:10.1089/bfm.2021.0307

Lymphat Res Biol. 2022 Jun 8. doi: 10.1089/lrb.2022.0010. Online ahead of print.

ABSTRACT

Background: Lipedema of lower limbs is characterized by bilateral accumulations of excess adipose tissue starting from the ankle to the hips and buttocks. The studies with lymphoscintigraphy (LSC) and magnetic resonance (MR) lymphography show altered transport index and enlarged lymphatic vessels (LVs). Our studies aimed to investigate the superficial lymph flow, water accumulation, skin and subcutaneous tissue elasticity, and the possibility of using this information to diagnose lipedema. Methods and Results: Fifty patients with lipedema and 50 control subjects (women) were included. The Indocyanine Green (ICG) lymphography, LSC, skin water measurement, skin durometry, and deep tissue tonometry were done in all participants. ICG lymphography revealed: (1) Slower lymph flow in lipedema patients; after 3 minutes of feet movement in a horizontal position, the ICG-dyed lymph reached the upper calf level in 8% of lipedema patients compared with 56% in the control group (p ˂ 0.0001). (2) More than three LVs were noticed more often in lipedema patients. (3) The higher number of abnormal LV images at all limb levels and during each observation stage with a statistically significant number of foggy and dilated. (4) Statistically significant higher fluorescent intensity in all limb levels. Skin water concentration was higher in the feet in lipedema (p = 0.000189). Conclusion: Our studies have shown the differences in superficial lymph flow and water concentration between lipedema and normal limbs. Data proove the usefulness of ICG lymphography, skin water concentration and skin and subcutaneous tissue elasticity measurements in diagnosing lipedema.

PMID:35675661 | DOI:10.1089/lrb.2022.0010