Tag: nevin manimala

J Am Acad Child Adolesc Psychiatry. 2021 Mar 22:S0890-8567(21)00155-6. doi: 10.1016/j.jaac.2021.02.022. Online ahead of print.

ABSTRACT

OBJECTIVE: Wraparound is a common method for coordinating care for children and adolescents with serious emotional disorders (SED), with nearly 100,000 youth served annually in the U.S. The current systematic review and meta-analysis estimated effects on youth outcomes (symptoms, functioning, school, juvenile justice, and residential placement) and costs.

METHOD: A literature search identified 17 peer-reviewed and grey literature studies meeting criteria, which were coded on characteristics of sample, design, implementation, and outcomes. Random effects modeling was conducted using Comprehensive Meta-Analysis Version 3.0. Effect sizes were calculated using Hedges’ g. Homogeneity of effects were assessed using Q statistics.

RESULTS: Medium-sized effects favored Wraparound-enrolled youth for costs (g =.391, CI = [.282, .500], p < .001), residential outcomes (g = .413, CI = [.176, .650], p = .001), and school functioning (g = .397, CI = [.106, .688], p = .007); small effects were found for mental health symptoms (g = .358, CI = [.030, .687], p = .033) and functioning (g = .315, CI = [.086, .545], p = .007). Larger effects were found for peer-reviewed studies, quasi-experimental designs, samples with a larger percentage of youth of color, and Wraparound conditions with higher fidelity.

CONCLUSION: Results indicate positive effects for Wraparound, especially for maintaining youth with SED in home and community. However, many studies showed methodological weaknesses and fidelity measurement was largely absent, suggesting a need for additional research. Nonetheless, the results should aid decisions around resource allocation, referral practices, and system partnerships among child psychiatrists and other behavioral health professionals.

PMID:33785404 | DOI:10.1016/j.jaac.2021.02.022

J Sep Sci. 2021 Mar 30. doi: 10.1002/jssc.202001190. Online ahead of print.

ABSTRACT

Fructus Aurantii is a traditional medicated diet in East Asia. To determine the underlying chemical markers responsible for the quality and efficacy of Fructus Aurantii, a sensitive metabolomic method was applied to distinguish Fructus Aurantii in Jiangxi Province from other two geographical locations (Hunan Province and Chongqi City) in China. In the present study, multivariate analyses were adopted to compare chemical compositions in 21 batches of Fructus Aurantii samples. Among three geographical origins, 23 differential compounds were structurally identified. Serum pharmacochemistry exhibited that 22 components could be detected in rat serum. Six differential and absorbed components were selected as six potential markers. Statistical analysis of the effects of six potential markers on the quality of Fructus Aurantii revealed that the content of markers varied widely in three origins. Six differential and absorbed components were evaluated further biological activity. Neohesperidin, naringin and meranzin showed inhibitory effect on acetylcholinesterase that regulates gastrointestinal motility in vitro and in silico, suggesting that these three components may be determined as the active biomarkers of Fructus Aurantii. These findings demonstrate the potential of biomarkers for identification and quality control of Fructus Aurantii. This article is protected by copyright. All rights reserved.

PMID:33784419 | DOI:10.1002/jssc.202001190

Head Neck. 2021 Mar 30. doi: 10.1002/hed.26683. Online ahead of print.

ABSTRACT

BACKGROUND: Although nonsurgical treatment strategy is increasingly adopted in patients with locoregionally advanced laryngeal squamous cell carcinoma (LSCC), survival disparities were reported between surgical treatment modality and organ preservation protocols, highlighting the great importance for accurate patients’ selection.

METHOD: This secondary analysis used data from the Surveillance, Epidemiology, and End Results database between 2010 and 2015 with follow-up data up to 2018. We developed and validated a dynamic prognostic nomogram for overall survival (OS) in 4237 patients with LSCC and subgroup of 2087 patients with locoregionally advanced laryngeal squamous cell carcinoma (LALSCC). Based on the total risk score derived from the dynamic nomogram, two well-matched risk groups (i.e., low- and high-risk) were created via X-tile software and 1-to-1 propensity score matching (PSM); surgical treatment modality was compared with nonsurgical one in each risk group.

RESULTS: A more accurate and convenient dynamic prognostic nomogram based on age, marital status, T category, N category, M category, tumor size, and tumor differentiation was developed and validated, of which the predictive performance was superior to that of TNM staging system. For high-risk LALSCC selected by the dynamic nomogram, after 1-to-1 PSM, significantly improved OS was observed in patients with receiving surgical treatment compared to those receipt of nonsurgical management (restricted mean survival time at 36-month: 26.6 vs 22.7, p < 0.001; restricted mean survival time at 60-month: 36.7 vs 31.0, p = 0.003).

CONCLUSION: We establish and validate a more accurate and convenient dynamic prognostic nomogram for patients with LSCC, which may predict the benefit from surgical treatment modality for patients with high-risk LALSCC.

PMID:33784432 | DOI:10.1002/hed.26683

PLoS One. 2021 Mar 30;16(3):e0249085. doi: 10.1371/journal.pone.0249085. eCollection 2021.

ABSTRACT

BACKGROUND: Ethiopia launched free access for antiretroviral therapy in 2005. The number of patients on second line antiretroviral treatment has increased with each passing year. The objectives of this study were to describe the clinical, immunological and virologic outcomes of children and adolescents receiving second line anti-retroviral therapy in two referral hospitals, Yekatit 12 and Zewditu Memorial Hospitals, in Addis Ababa, Ethiopia.

METHODS: This was a hospital based retrospective cohort study conducted among children and adolescents aged 18 years and less and receiving a second line antiretroviral drugs. Data was collected using structured questionnaires. Means and percentages were used for nominal variables. Statistical analysis was made using statistical software-SPSS 23.0. Kaplan Meier analysis, long rank test and multivariate Cox proportion model were used to identify factors affecting survival.

RESULTS: A total of 75 children and adolescents were studied with a mean age of 13.28 years (SD: 4) with a mean treatment period on second line regimens of 35.2 months (SD: 21.8 months). Forty-eight participants were experiencing successful measures (in all three parameters) for their second line anti-retroviral treatment. Ten had virologic treatment failure while seven had died. Both treatment failure and death rates were higher within the first two years of treatment. Poor treatment adherence (Adjusted hazard ratio: 5.1 (95% CI: 1.1-23.2; p-value = 0.02)) and advanced World Health Organization clinical stage at start of the second line antiretrovirals (Adjusted hazard ratio: 7.51 (95% CI: 1.35-18.02; p-value = 0.002)) correlated significantly with survival of children and adolescents receiving treatment.

CONCLUSIONS: The study describes clinical, immunological and virologic outcomes of second line antiretroviral treatment in a pediatric cohort under care in two hospitals in Addis Ababa, Ethiopia. Poor adherence and pre-treatment advanced clinical stages were predictors of survival.

PMID:33784335 | DOI:10.1371/journal.pone.0249085

PLoS One. 2021 Mar 30;16(3):e0249325. doi: 10.1371/journal.pone.0249325. eCollection 2021.

ABSTRACT

BACKGROUND: The association between prolong metformin usage and B12 deficiency has been documented. However, the prevalence estimates of metformin-induced vitamin B12 deficiency showed substantial disparity among studies due to varied study definitions of vitamin B12 deficiency. Metformin blocks the calcium dependent absorption of the vitamin B12-Intrinsic Factor complex at the terminal ileum. Lack of intrinsic factor due to the presence of auto-antibodies to parietal cells (IFA) could lead to vitamin B12 deficiency and subsequently cause peripheral neuropathy. We investigated the prevalence of vitamin B12 deficiency using more sensitive, combined markers of vitamin B12 status (4cB12) and the immuno-biochemical mediators of vitamin B12 deficiency.

METHODS: In this observational study, 200 consecutive consenting metformin-treated T2DM patients, aged 35 and above, attending the diabetic clinic at KATH were recruited. Vitamin B12 deficiency was classified based on the Fedosov age-normalized wellness quotient. Anthropometric measurement was taken as well as blood samples for immunological and biochemical mediators. Peripheral neuropathy was assessed using the Michigan Neuropathy Screening Instrument (MNSI). Statistical analysis was performed using the R Language for Statistical Computing.

RESULTS: Using the combined indicator (4cB12), the prevalence of metformin induced vitamin B12 deficiency was 40.5% whilst the prevalence of MNSI-Q and MNSI-PE diabetic neuropathy was 32.5% and 6.5% respectively. Participants with vitamin B12 deficiency had significantly higher levels of IFA, GPA, TNF-α, TC, LDL and albumin compared to those with normal vitamin B12 levels (p < 0.05). Correlation analysis revealed a statistically significant negative association between 4cB12 and the immunological markers [IFA (rs = -0.301, p<0.0001), GPA (rs = -0.244, p = 0.001), TNF-α (rs = -0.242, p = 0.001) and IL-6 (rs = -0.145, p = 0.041)]. Likewise, 4cB12 was negatively associated with TC (rs = -0.203, p = 0.004) and LDL (rs = -0.222, p = 0.002) but positively correlated with HDL (rs = 0.196, p = 0.005).

CONCLUSION: Vitamin B12 deficiency and diabetic neuropathy are very high among metformin-treated T2DM patients and it is associated with increased GPA, IFA, TNF-α and cardiometabolic risk factors (higher LDL and TC and lower HDL). Upon verification of these findings in a prospective case-control study, it may be beneficial to include periodic measurement of Vitamin B12 using the more sensitive combined indicators (4cB 12) in the management of patients with T2DM treated with metformin in Ghana.

PMID:33784336 | DOI:10.1371/journal.pone.0249325

PLoS One. 2021 Mar 30;16(3):e0249365. doi: 10.1371/journal.pone.0249365. eCollection 2021.

ABSTRACT

BACKGROUND: Hyaline membrane disease (HMD) is a leading cause of morbidity and mortality in preterm newborn babies. Though, there are studies related to Hyaline membrane disease inclusive of all neonates, studies related to the burden among preterm neonates were limited. In addition, increasing neonatal mortality in Ethiopia could be related to increase in the burden of hyaline membrane disease among preterm neonates. Therefore, this study was aimed to assess the burden of hyaline membrane disease, mortality and its associated factors among preterm neonate admitted at neonatal intensive care unit, North Central Ethiopia.

METHODOLOGY: An institution-based retrospective follow-up study was conducted among 535 preterm neonates admitted at neonatal intensive care unit from January 1, 2014-December 30, 2017. Data were entered into EPi-data 4.2.0.0 and transferred to STATA version 14 statistical software for statistical analysis. Binary logistic regression was used for the analysis. All variables with P-value < 0.25 during bi-variable analysis were considered for multivariable logistic regression. Level of statistical significance was declared at P value ≤0.05.

RESULTS: In the current study, proportion of hyaline membrane disease was 40% (95% CI; 35.8, 44.3) of which 49.5% died. Preterm neonate born with Gestational age of less than 34 weeks of age (Adjusted odd ratio (AOR = 2.64; 95 CI: 1.49, 4.66)), 5th minute Apgar score less than 7 (AOR = 2.2; 95% CI: 1.20, 4.07), and newborn with birth weight of less than 1500 gram (AOR = 2.4, 95% CI: 1.3, 4.3) were predictors of hyaline membrane disease.

CONCLUSIONS: The mean gestational age (±) was 33.46 (±2.55) weeks. The incidence of hyaline membrane disease among preterm admissions was high. Preterm neonate born with gestational age of less than 34 weeks of age, asphyxiated newborns and newborn with birth weight of less than 1500 gram were predictors of hyaline membrane disease. So, emphasis should be given on early screening, follow up and timely interventions for preterm neonate.

PMID:33784349 | DOI:10.1371/journal.pone.0249365

PLoS One. 2021 Mar 30;16(3):e0248437. doi: 10.1371/journal.pone.0248437. eCollection 2021.

ABSTRACT

Gun violence and mass shootings are high-profile epidemiological issues facing the United States with questions regarding their contagiousness gaining prevalence in news media. Through the use of nonparametric Hawkes processes, we examine the evidence for the existence of contagiousness within a catalog of mass shootings and highlight the broader benefits of using such nonparametric point process models in modeling the occurrence of such events.

PMID:33784326 | DOI:10.1371/journal.pone.0248437

PLoS One. 2021 Mar 30;16(3):e0246965. doi: 10.1371/journal.pone.0246965. eCollection 2021.

ABSTRACT

BACKGROUND: While motorcycles are essential for moving people and goods, they are also, a significant contributor to Road Traffic Accidents (RTAs), making it a public health issue of concern globally. The Hohoe Municipal Hospital records increasing RTAs due to commercial motorcycles. Determining motorcycle riders’ compliance with road safety regulations is critical in helping to curb this menace.

METHOD: A cross-sectional study was employed involving a multistage sample of 238 motorcycle riders. Data were collected using a pretested structured questionnaire and entered into Epi Data version 3.2 software and exported to STATA software version 12 for analysis. Descriptive and inferential analyses were done while statistical significance was determined at 95% reliability interval and p-value of 0.05.

FINDINGS: The level of compliance with road safety regulations among respondents was 59.2%. The mean age of respondents was 29.9 ± 7.9 years, and all respondents were males. Respondents who did not own their motorbikes were 0.39 times less likely to comply with road safety regulations compared to their counterparts who owned one, while those without alternate occupations were 0.51times less likely to comply with road safety regulations compared to those with an additional occupation. Those aged between 30-39 years and 40-49 years were 2.37 and 4.1 times more likely to comply with road safety regulations, respectively, compared to those aged ≤29 years, and those who did not smoke were 3.15 times more likely to comply with road safety regulations than those who smoked.

CONCLUSION: Compliance to safety regulations are fairly low and although motorcycle usage on a commercial basis is yet to be legalised in Ghana, routine education targeting riders who smoke, do not have alternate occupations, do not own motorbikes and younger riders will improve their compliance. Also, riders should be encouraged to obtain their license from the appropriate authorities.

PMID:33784328 | DOI:10.1371/journal.pone.0246965

PLoS One. 2021 Mar 30;16(3):e0248676. doi: 10.1371/journal.pone.0248676. eCollection 2021.

ABSTRACT

INTRODUCTION: Governmental measures aiming at social protection, with components of disease control, have potential positive impacts in the nutritional and health outcomes of the beneficiaries. The concomitant presence of these measures with environmental sanitation interventions may increase their positive effect. The context of simultaneous improvement of social protection and environmental sanitation is found in Brazil since 2007 and an assessment of the combined effects of both programs has not been performed so far.

OBJECTIVE: To evaluate whether interaction effects between improvement of access to water, sanitation and solid waste collection with the Bolsa Família Program [PBF] were related to better responses in the reduction of morbidity due to diarrhea and malnutrition in children less than five years of age, acknowledging the positive results of these improved conditions and the PBF separately in coping with these diseases.

METHODS: Descriptive and inferential analyses were performed through Generalized Linear Models of the Negative Binomial type of fixed effects, with and without addition of zeros. Interaction models were inserted in order to evaluate the outcomes when the two public policies of interest in the current study were present simultaneously in the municipalities.

RESULTS: Interaction with negative effect when a concomitantly high municipal coverage of the Bolsa Família Program and adequate access to sanitation and solid waste collection were present. In contrast, regardless of municipal coverage by the PBF, the simultaneous presence of water and sanitation (0.028% / 0.019%); water and solid waste collection (0.033% / 0.014%); sanitation and solid waste collection (0.018% / 0.021%), all resulted in a positive effect, with a decrease in the average morbidity rates for both diseases.

CONCLUSION: Investments aimed at universalizing water, sanitation and solid waste collection services should be priorities, aiming at reducing the incidence of morbidity due to malnutrition and diarrhea and preventing deaths from these poverty-related diseases.

PMID:33784331 | DOI:10.1371/journal.pone.0248676

Cir Cir. 2021;89(2):212-217. doi: 10.24875/CIRU.20000094.

ABSTRACT

ANTECEDENTES: Los pacientes geriátricos presentan dificultad progresiva para expresar el dolor. Es muy importante establecer un parámetro preciso para manejar el dolor posoperatorio.

OBJETIVO: Determinar la validez de la escala facial del dolor (EFD) en pacientes geriátricos posquirúrgicos.

MÉTODO: Estudio comparativo, observacional, prolectivo, en un hospital de segundo nivel de atención. Fase 1: se presentaron las caras de la escala desordenadas a personas ≥ 60 años, con Glasgow íntegro, previa firma de consentimiento, para ordenarlas ascendentemente. Fase 2: se incluyeron pacientes ≥ 60 años, de cualquier sexo, sometidos a cualquier procedimiento quirúrgico, con Glasgow íntegro, previa firma de consentimiento informado. Se eliminaron los que no cooperaron o no completaron ambas escalas. A cada paciente se aplicó, antes de recibir analgesia, la escala visual numérica (EVN), y 5 minutos después la EFD, y nuevamente 30 minutos tras la analgesia. Se utilizó estadística descriptiva, tamaño del efecto, t pareada y Spearman.

RESULTADOS: Fase 1: todas las caras fueron ubicadas correctamente (75-100%). Fase 2: participaron 142 pacientes, 76 (53.5%) hombres y 66 (46.5%) mujeres. Promedios preanalgesia: EFD 3.4, EVN 7.9; posanalgesia: EFD 1.8, EVN 4.8. Tamaño del efecto (EFD): 2.389; t pareada 17.231 (p < 0.002); Spearman 0.654 (p = 0.016) preanalgesia, 0.798 (p = 0.004) posanalgesia.

CONCLUSIÓN: La EFD es válida para evaluar la intensidad del dolor posoperatorio en pacientes geriátricos.

BACKGROUND: Geriatric patients present progressive difficult to assess pain. Getting a precise parameter to approach postsurgical pain is a very important issue.

OBJECTIVE: To explore Faces Pain Scale (EFD) validity in geriatric post-surgical patients.

METHOD: Comparative, observational, prolective study in patients from a second level attention unit. Phase 1: faces were disorderly presented to ≥ 60 years old persons, Glasgow scale scored 15, signed authorization, to place them in ascending order. Phase 2: ≥ 60 years old patients, any sex, who received any surgical procedure, Glasgow scale scored 15, signed authorization were recruited. Those who did not cooperate/complete scales application were eliminated. Numeral Visual Scale (EVN) and 5 minutes after EFD were applied to each patient, before analgesia, and again 30 minutes after analgesia. Descriptive statistical data, effect-size, Student paired-t and Spearman tests were used.

RESULTS: Phase 1: every face was correctly placed (75-100%). Phase 2: 142 patients participated, 76 (53.5%) male, 66 (46.5%) female. Pre-analgesia media scores: EFDA 3.4, EVN 7.9; post-analgesia media scores: EFD 1.8, EVN 4.8. EFD effect-size test scored 2.389, paired-t scored 17.231 (p < 0.002); Spearman scores: 0.654 (p = 0.016) pre-analgesia, 0.798 (p = 0.004) post-analgesia.

CONCLUSION: EFD is a valid scale to evaluate postoperative pain intensity in geriatric patients.

PMID:33784276 | DOI:10.24875/CIRU.20000094