Tag: nevin manimala

Birth. 2022 Apr 22. doi: 10.1111/birt.12633. Online ahead of print.

ABSTRACT

INTRODUCTION: Despite calls for increased vaginal birth after cesarean (VBAC), <14% of candidates have VBAC. Requirements for documentation of scar type, and prohibitions on induction or augmentation of labor are not supported by evidence but may be widespread. The purpose of this study was to document midwives’ perceptions of barriers to labor after cesarean (LAC) and their effects on midwives’ ability to accommodate patient desires for LAC.

METHODS: Midwives certified by the American Midwifery Certification Board (AMCB) were surveyed in 2019. Multiple option and open-ended text responses were analyzed using quantitative statistics and thematic content analysis. Select barriers to LAC, ability to accommodate LAC, and supportiveness of collaborators among midwives offering LAC were explored.

RESULTS: Responses from 1398 midwives were analyzed. Eighty-four percent felt able to accommodate LAC “most of the time,” and 39% reported one or more barriers to LAC. Barriers decreased ability to accommodate LAC by as much as 80%. Analysis of text responses revealed specific themes.

CONCLUSIONS: Thirty-nine percent of midwives reported their practice was limited by one or more barriers that were inconsistent with professional guidelines. Imposition of barriers was driven primarily by collaborating physicians, and superceded supportive practices of midwives, nurses, and system administrators. Affected midwives were significantly less able to accommodate patient requests for LAC than those not affected. Midwives also reported pride in providing VBAC care, restrictions specific to midwifery scope of practice, and variation in physician support for LAC within practices affecting their ability to provide care.

PMID:35460106 | DOI:10.1111/birt.12633

Risk Anal. 2022 Apr 22. doi: 10.1111/risa.13934. Online ahead of print.

ABSTRACT

During public emergencies, the level of public safety will be resilient and follow a process from decline to rise. Regarding the concept and influencing factors of public safety resilience, a three-level public safety resilience framework that includes personal, community, and government levels was proposed in this study. It provided the overall metrics that used the resistance and recovery ability to describe the dynamic characteristics of public safety resilience as well as the resilience assessment indexes on three levels. In the context of the Coronavirus Disease 2019 (COVID-19) pandemic, this study applied the proposed framework in a case study on public safety resilience at the Beihang community, Beijing, China through descriptive statistics, structural equation model, and principal component regression analysis of questionnaire data. The data analysis results showed that community resilience was the most important of the three levels of public safety resilience. In addition, community resilience could improve personal resilience, and government resilience had a positive effect on community and personal resilience. Compared with the resistance ability, the recovery ability was influenced more by the operation and improvement of the community. This study is conducive to understanding and improving public safety resilience on the personal, community, and government levels and can help relevant parties improve their ability to respond to the COVID-19 pandemic. Furthermore, the methods used in this study can be extended to other studies on public emergencies.

PMID:35460097 | DOI:10.1111/risa.13934

Risk Anal. 2022 Apr 22. doi: 10.1111/risa.13931. Online ahead of print.

ABSTRACT

A number of investigators have explored the use of value of information (VOI) analysis to evaluate alternative information collection procedures in diverse decision-making contexts. This paper presents an analytic framework for determining the value of toxicity information used in risk-based decision making. The framework is specifically designed to explore the trade-offs between cost, timeliness, and uncertainty reduction associated with different toxicity-testing methodologies. The use of the proposed framework is demonstrated by two illustrative applications which, although based on simplified assumptions, show the insights that can be obtained through the use of VOI analysis. Specifically, these results suggest that timeliness of information collection has a significant impact on estimates of the VOI of chemical toxicity tests, even in the presence of smaller reductions in uncertainty. The framework introduces the concept of the expected value of delayed sample information, as an extension to the usual expected value of sample information, to accommodate the reductions in value resulting from delayed decision making. Our analysis also suggests that lower cost and higher throughput testing also may be beneficial in terms of public health benefits by increasing the number of substances that can be evaluated within a given budget. When the relative value is expressed in terms of return-on-investment per testing strategy, the differences can be substantial.

PMID:35460101 | DOI:10.1111/risa.13931

Gerodontology. 2022 Apr 22. doi: 10.1111/ger.12632. Online ahead of print.

ABSTRACT

OBJECTIVES: The main objectives of the study were to review patient characteristics, recommendations made and treatment outcomes of frail/older patients referred to a specialist multidisciplinary geriatric assessment and optimisation-based preoperative clinic (PROKARE), prior to patients receiving dental treatment under general anaesthesia (GA) or conscious sedation (CS).

BACKGROUND: Although the use of preoperative comprehensive geriatric assessment to improve pre/peri and postoperative mortality has been reported for many surgical domains, its use prior to dental surgery has not been reported previously.

METHODS: The data were collected retrospectively from the dental notes of 52 patients referred from the Special Care Dental (SCD) Department to the PROKARE service for optimisation prior to dental treatment under GA/CS using a case note study approach. The data extracted included patient demographic characteristics, medical history, clinical management and the treatment outcomes for each patient. The data extracted was analysed with descriptive statistics.

RESULTS: Key reasons for referral were caries management, retained roots and poor co-operation. Multiple co-morbidities were noted among the patients referred, with 14 (27%) having four or more co-morbidities. The PROKARE assessment identified issues such as treatment could be carried out under CS instead of GA; consent; and the need for medication change and/or further medical investigations. As per recommendations from PROKARE, 39 patients (75%) received dental treatment while five (10%) did not receive treatment, and a further eight (15%) died prior to treatment.

CONCLUSION: Geriatric assessment and optimisation-based preoperative clinics in the dental management of frail, elderly patients having treatment under GA or CS techniques is valuable, but further research and assessment of current service provision are needed to increase the evidence base.

PMID:35460087 | DOI:10.1111/ger.12632

J Sci Food Agric. 2022 Apr 22. doi: 10.1002/jsfa.11955. Online ahead of print.

ABSTRACT

BACKGROUND AND AIM: To date, no study has investigated the effects of probiotic yogurt as a functional food in patients with chronic heart failure (CHF). So, the aim of this study was to compare the impact of probiotic yogurt versus ordinary yogurt on inflammatory, endothelial, lipid and renal indices in CHF patients.

MATERIAL AND METHODS: In this randomized, triple-blind clinical trial, 90 patients with CHF were randomly allocated into two groups to take either probiotic or ordinary yogurt for 10 weeks. Serum levels of Soluble Tumor Necrosis Factor-Like Weak Inducer of Apoptosis) sTWEAK(, Soluble Cluster of Differentiation 163 )sCD163(, Asymmetric dimethylarginine (ADMA) , lecithin cholesterol acyltransferase (LCAT) were measured by using ELISA kits, and Blood urea nitrogen (BUN) was measured by calorimetry method at baseline and at the end of trial. P-value < 0.05 was defined as statistically significant.

RESULTS: 78 patients completed the study. At the end of the intervention, the levels of sTWEAK in both groups increased significantly, and this increase was greater in the probiotic yogurt group (691.84 (335.60, 866.95)) compared to control group (581.96 (444.99, 929.40)), and the difference between the groups was statistically significant after adjusting for confounders (P-value: 0.257, adjusted P-value: 0.038). However, no significant differences were found between the groups in the cases of other study indices.

CONCLUSION: Probiotic yogurt may be useful for improving the inflammatory status in patients with CHF through increasing sTWEAK levels, however, further studies are needed in this area. This article is protected by copyright. All rights reserved.

PMID:35460085 | DOI:10.1002/jsfa.11955

Int J Cancer. 2022 Apr 22. doi: 10.1002/ijc.34043. Online ahead of print.

NO ABSTRACT

PMID:35460074 | DOI:10.1002/ijc.34043

Curr Top Behav Neurosci. 2022 Apr 23. doi: 10.1007/7854_2021_280. Online ahead of print.

ABSTRACT

Sensitive periods are times during development when life experiences can have a greater impact on outcomes than at other periods during the life course. However, a dearth of sophisticated methods for studying time-dependent exposure-outcome relationships means that sensitive periods are often overlooked in research studies in favor of more simplistic and easier-to-use hypotheses such as ever being exposed, or the effect of an exposure accumulated over time. The structured life course modeling approach (SLCMA; pronounced “slick-mah”) allows researchers to model complex life course hypotheses, such as sensitive periods, to determine which hypothesis best explains the amount of variation between a repeated exposure and an outcome. The SLCMA makes use of the least angle regression (LARS) variable selection technique, a type of least absolute shrinkage and selection operator (LASSO) estimation procedure, to yield a parsimonious model for the exposure-outcome relationship of interest. The results of the LARS procedure are complemented with a post-selection inference method, called selective inference, which provides unbiased effect estimates, confidence intervals, and p-values for the final explanatory model. In this chapter, we provide a brief overview of the genesis of this sensitive period modeling approach and provide a didactic step-by-step user’s guide to implement the SLCMA in sensitive- period research. R code to complete the SLCMA is available on our GitHub page at: https://github.com/thedunnlab/SLCMA-pipeline .

PMID:35460052 | DOI:10.1007/7854_2021_280

J Community Health. 2022 Apr 22. doi: 10.1007/s10900-021-01058-0. Online ahead of print.

ABSTRACT

COVID-19 is a novel coronavirus with data suggesting a more serious clinical course in pregnancy. We aimed to assess changes in knowledge, behaviors, and intentions of pregnant women regarding COVID-19. This was a cross-sectional survey study of 58 and 77 predominantly African-American and Afro-Caribbean pregnant patients presenting for prenatal care in Brooklyn, NY in 2020 (during the first surge of the pandemic) and 2021, respectively. Descriptive and inferential statistics were performed. Many beliefs and intentions were unchanged between 2020 and 2021 (e.g. believing pregnant women were at higher risk of COVID-19 infection and subsequent ICU admission due to pregnancy, having the desire to breastfeed, among others). Other beliefs and behaviors changed between 2020 and 2021 (fewer women believed they received information from their provider regarding COVID-19 and fewer would miss a prenatal visit for fear of COVID-19 contagion). Patients’ behaviors and intended behaviors in both 2020 and 2021 were directly influenced by their beliefs, many of which were based on unsupported data regarding COVID-19 and pregnancy (ie: babies were at increased risk of being born with congenital malformation following a mother’s COVID-19 infection). Patients who held these beliefs were more likely to say that they did not attend prenatal visits and did not receive information from their provider regarding COVID-19. Knowledge of patient beliefs is useful for structuring care as the pandemic evolves. This study demonstrates that pregnant patients make decisions regarding behaviors based on beliefs grounded in misinformation. Accordingly, it is the provider’s responsibility to ensure that beliefs regarding COVID-19 are based in fact, so patients can make informed decisions.

PMID:35460062 | DOI:10.1007/s10900-021-01058-0

Pediatr Radiol. 2022 Apr 22. doi: 10.1007/s00247-022-05372-0. Online ahead of print.

ABSTRACT

BACKGROUND: Fetal growth restriction caused by placental insufficiency is associated with increased risk of poor neurodevelopment, even in the absence of specific perinatal brain injury. Placental insufficiency leads to chronic hypoxaemia that may alter cerebral tissue organisation and maturation.

OBJECTIVE: The aim of this study was to assess the effects fetal growth restriction and fetal haemodynamic abnormalities have on brain volumes and white matter microstructure at early school age.

MATERIALS AND METHODS: This study examined 32 children born with fetal growth restriction at 24 to 40 gestational weeks, and 27 gestational age-matched children, who were appropriate for gestational age. All children underwent magnetic resonance imaging (MRI) at the age of 8-10 years. Cerebral volumes were analysed, and tract-based spatial statistics and atlas-based analysis of white matter were performed on 17 children born with fetal growth restriction and 14 children with birth weight appropriate for gestational age.

RESULTS: Children born with fetal growth restriction demonstrated smaller total intracranial volumes compared to children with normal fetal growth, whereas no significant differences in grey or white matter volumes were detected. On atlas-based analysis of white matter, children born with fetal growth restriction demonstrated higher mean and radial diffusivity values in large white matter tracts when compared to children with normal fetal growth.

CONCLUSION: Children ages 8-10 years old born with fetal growth restriction demonstrated significant changes in white matter microstructure compared to children who were appropriate for gestational age, even though no differences in grey and white matter volumes were detected. Poor fetal growth may impact white matter maturation and lead to neurodevelopmental impairment later in life.

PMID:35460034 | DOI:10.1007/s00247-022-05372-0

Environ Sci Pollut Res Int. 2022 Apr 23. doi: 10.1007/s11356-022-20112-5. Online ahead of print.

ABSTRACT

Industrial upgrading is the key to promoting green economic efficiency. Coordination between environmental regulations and industrial structure can lead to sustainable economic growth. However, insufficient attention has been paid to the mechanism by which environmental regulation (ER) promote green economic efficiency (GEE) under the mediating role of industrial structure optimization. Using robust and comprehensive measures of green economic efficiency, we assess how various environmental regulations affect green economic efficiency as well as the intermediate effect of industrial structure of a certain province with provincial panel data during the period 2003-2017. The results of dynamic panel two-step system generalized method of moments (GMM) confirm the heterogeneous effects of the three types of ER, namely control-and-command regulation, market-based regulation, and voluntary regulation on GEE in China. The spatial analysis demonstrates that control-and-command and voluntary regulations significantly accelerate GEE in inland provinces, while they have insignificant effect in coastal provinces. Based on the mediating analysis, we find that market-based regulation is conducive to GEE through both advanced and rationalized industrial structure, whereas control-and-command regulation improves GEE through advanced industrial structure only. The voluntary-based regulation on one hand stimulates GEE through advanced industrial structure, but on other hand impedes it through rationalized industrial structure. The results could provide critical insights and a theoretical basis for policy makers in reasonable optimization of industrial structure and guaranteeing green economic efficiency.

PMID:35460008 | DOI:10.1007/s11356-022-20112-5