Tag: nevin manimala

Cien Saude Colet. 2025 Jun 2;30(suppl 1):e16642023. doi: 10.1590/1413-812320242911.16642023. eCollection 2025.

ABSTRACT

The aim is to verify the trend in infant mortality (IM) and preventable infant mortality (PIM) in municipalities in the metropolitan region of Porto Alegre from 1996 to 2021 and their associations with per capita public spending on health and population coverage of the Family Health Strategy (FHS). Ecological study with data from information systems: on mortality, live births, public budgets and primary health care. The deaths described in the Ministry of Health’s list were considered preventable. Statistical analysis used Prais-Winsten regression. A decrease in MIE was observed in the municipalities studied with the exception of Esteio. There was an association between per capita public spending on health and the study outcomes in Novo Hamburgo, Canoas and Porto Alegre. An association was found between the FHS coverage and IM in Novo Hamburgo, Sapucaia do Sul, Canoas and Porto Alegre. PIM was associated with FHS coverage in Novo Hamburgo, Canoas and Porto Alegre. Despite the decrease in the IM and PIM coefficients, the association of this indicator was more impacted by per capita public spending on health than by the FHS population coverage.

PMID:40471615 | DOI:10.1590/1413-812320242911.16642023

Cien Saude Colet. 2025 Jun 2;30(suppl 1):e16402023. doi: 10.1590/1413-812320242911.16402023. eCollection 2025.

ABSTRACT

Hospitalizations for ambulatory care sensitive conditions (ACSCs) are preventable with adequate primary care (PC). For the elderly population, they are important due to their greater vulnerability to chronic diseases and comorbidities. Objective: to carry out an integrative review of articles on ACSCs in the elderly and their correlation with indicators of access to primary care. The research was carried out on the BVS and PUBMED databases. Inclusion criteria: relationship between ICSAP and PA, publications from 2000 to 2022, analysis of the elderly age group, statistical methods, Portuguese, Spanish or English languages and indexing in peer-reviewed journals. We identified 315 publications and selected 15, 12 of which focused on the elderly population. The South and Southeast regions were the most analyzed, and the year most investigated was 2012. Coverage of the Family Health Strategy was the most commonly used indicator. A reduction in ACSC rates in the elderly was positively correlated with access to PHC. Monitoring ACSCs is an important tool for managing the health of the elderly, with PH playing a strategic role in reducing hospitalizations, minimizing risks and promoting healthy ageing.

PMID:40471614 | DOI:10.1590/1413-812320242911.16402023

Cien Saude Colet. 2025 Jun 2;30(suppl 1):e01402024. doi: 10.1590/1413-812320242911.01402024. eCollection 2025.

ABSTRACT

The International Statistical Classification of Diseases and Related Health Problems (ICD) allows the systematization of health statistics around the world. This study describes the origin, functionalities, forms of construction and updating of the CID, through a qualitative, exploratory and descriptive study focusing on document analysis, considering official documents and technological tools. Since its creation, the ICD has been revised and published, reflecting its connection to advances in health, science and society. Such reviews were accompanied by many studies, debates and consensus. The current version of the ICD, called ICD-11, in addition to traditional content revisions, has been transformed to better adapt to the digital world. This new version has been available in Portuguese since February 2024 and its implementation is in process in Brazil – a fact that requires preparation from all operators of the Unified Health System.

PMID:40471591 | DOI:10.1590/1413-812320242911.01402024

Cien Saude Colet. 2025 Jun 2;30(suppl 1):e01312023. doi: 10.1590/1413-812320242911.01312023. eCollection 2025.

ABSTRACT

This article analyzed the possible shifts in the senses and meanings of obesity for primary care health professionals in Bahia after a health education initiative. A qualitative study carried out with 37 participants, which used a semi-structured online questionnaire and method triangulation (Free Word Association Technique – prototypical analysis, open question – content analysis, and Obesity Development Factors – descriptive statistical analysis). The Concept and Etiological Approaches categories revealed significant inflections in the senses and meanings of obesity, beyond the biological and biomedical model, in dialogue with the ecological, syndemic, and multifactorial approaches, in addition to evocating anthropological perspectives and body diversity. They also revealed the assumption of concerns about the prevalence and resolution of care practices, the question of the uniqueness of obesity, and the limitation of the evaluation method by Body Mass Index, evidence that contributes to the reflection of health education in the structuring of curricula to the light of the multifactorial nature and complexity of this phenomenon.

PMID:40471590 | DOI:10.1590/1413-812320242911.01312023

Biochem J. 2025 May 14:BCJ20240621. doi: 10.1042/BCJ20240621. Online ahead of print.

ABSTRACT

Constipation is a forerunner to Parkinson’s disease (PD) diagnosis, worsening thereafter. We explore the relationship of intestinal barrier dysfunction to constipation, and whether intestinal fungal load is an aggravating factor. Fungal load was quantified by real-time PCR, using ITS1F-ITS2 primer-set, on microbial DNA-extract from stool in 68 participants with PD, 102 without. Fungal load was 60% higher per decade after age 60 years, with no PD-status interaction with age. After age adjustment, it was associated inversely with dietary renal acid load. It was unrelated to presence of constipation or barrier dysfunction. Neither consumption of antimicrobials nor of other targeted exogenous substances was associated. Enzyme-linked-immunosorbent assays measured barrier dysfunction markers, faecal alpha-1 antitrypsin and zonulin and serum intestinal-fatty-acid-binding-protein. Barrier dysfunction was associated with constipation and slower colonic transit. Functional constipation was 28% more frequent with a doubling of alpha-1 antitrypsin concentration. More colonic-transit-test markers were retained in transverse colon, the higher alpha-1 antitrypsin and zonulin concentrations, anatomically spotlighting abnormality for entire colon. In contrast, the concentration of the small intestinal barrier marker, fatty-acid-binding-protein, was associated with looser stool consistency, that is consistent with secondary microbial overgrowth. By showing the relationship of intestinal barrier dysfunction to constipation, this study supports the hypothesis that dysfunction may be consequential. Dysfunction may be a necessary, but not sufficient, precursor to PD, in allowing inflammaging. Since ageing is the clearest risk for PD, a gut pathogen escalating in abundance from the sixth decade, integral to fungal load, whose reproduction and virulence is favoured by alkalinity, tallies.

PMID:40471586 | DOI:10.1042/BCJ20240621

JAMA Netw Open. 2025 Jun 2;8(6):e2513807. doi: 10.1001/jamanetworkopen.2025.13807.

ABSTRACT

IMPORTANCE: Inequities in pediatric health care services persist in Bangladesh, with critical disparities between public and private hospitals, particularly for children younger than 5 years. These disparities hinder progress toward equitable health care access and quality outcomes.

OBJECTIVE: To evaluate the availability and quality of health care workforce and service coverage for children younger than 5 years in public and private hospitals in Bangladesh to identify gaps in infrastructure, workforce distribution, and adherence to pediatric care standards.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study was conducted from October 13, 2023, to May 24, 2024. Data collection included facility assessments, structured questionnaires, and direct observations using World Health Organization (WHO)-adapted tools. The study covered both private and public hospitals across 6 subdistricts in Bangladesh, representing a mix of urban and rural populations. Senior hospital staff and administrators were surveyed. Inclusion criteria were general inpatient and outpatient pediatric care delivered in hospitals. Diagnostic centers and specialized facilities were excluded.

EXPOSURES: Availability of pediatric infrastructure, workforce, essential medications, and adherence to clinical guidelines assessed against WHO standards.

MAIN OUTCOMES AND MEASURES: The primary outcomes included the presence of pediatric-specific departments, neonatal care facilities, and trained personnel and adherence to WHO care standards. Data were analyzed using descriptive statistics and χ2 tests to highlight disparities.

RESULTS: The study sample included 102 private and 7 public hospitals. A significantly higher proportion of public hospitals compared with private hospitals had pediatric inpatient departments (100% vs 39.2%), newborn wards (100% vs 12.8%), and trained nurses (100% vs 32.4%). Only private hospitals in the sample had neonatal intensive care units (6.9% vs 0%). Pediatricians were available for extended consultations at a greater proportion of public hospitals compared with private hospitals (71.4% vs 26.5%).

CONCLUSIONS AND RELEVANCE: These findings show substantial disparities in the availability of pediatric health care services between public and private hospitals in Bangladesh. Addressing these disparities through workforce investment and infrastructure improvements is crucial for equitable child health care and better health outcomes.

PMID:40471581 | DOI:10.1001/jamanetworkopen.2025.13807

JAMA Netw Open. 2025 Jun 2;8(6):e2513906. doi: 10.1001/jamanetworkopen.2025.13906.

ABSTRACT

IMPORTANCE: Patients with language barriers may experience difficulties accessing virtual care.

OBJECTIVES: To synthesize the literature on the association between language barriers and use of and satisfaction with virtual care among adult patients and among caregivers of pediatric patients in high-income countries.

DATA SOURCES: Four electronic databases, MEDLINE, Embase, PsycINFO, and Web of Science, were searched from inception to March 2023 using a combination of language and virtual care terms.

STUDY SELECTION: Eligible studies compared quantitative data on use of or satisfaction with virtual care among adult patients or caregivers of pediatric patients with or without language barriers in high-income countries.

DATA EXTRACTION AND SYNTHESIS: Data were extracted by 2 independent reviewers using a piloted data extraction form. Risk of bias assessments were performed using the ROBINS-E tool. Data were synthesized by outcome type using random-effects meta-analyses stratified by primary vs specialist care and narrative synthesis. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020 guideline.

MAIN OUTCOMES AND MEASURES: The primary outcomes were use of virtual care and satisfaction with virtual care among adult patients and among caregivers of pediatric patients with vs without language barriers.

RESULTS: In total, 41 studies were included, 35 with adult patients (N = 4 543 906) and 6 with caregivers of pediatric patients (N = 7921). Most studies (n = 38) were set in the US, and examined use of virtual care (n = 35). Adult patients facing language barriers had no significant difference in adjusted pooled odds of virtual vs in-person primary or specialist care use (adjusted OR [AOR], 0.91 [95% CI, 0.61-1.35]; n = 5; I2 = 95.0%) and significantly lower adjusted pooled odds of video vs telephone primary or specialist care use (AOR, 0.66 [95% CI, 0.52-0.85]; n = 5, I2 = 93.5%), with high heterogeneity. Restricting to specialist care, adult patients facing language barriers had significantly lower adjusted pooled odds of using virtual vs in-person (AOR, 0.78 [95% CI, 0.70-0.87]; n = 4; I2 = 0.0%) and video vs telephone (AOR, 0.62 [95% CI, 0.53-0.73]; n = 3; I2 = 0.0%) care, with low heterogeneity. Results for caregivers of pediatric patients were limited and showed no significant difference in odds of virtual vs in-person specialist care, with a wide confidence interval and high heterogeneity (OR, 0.62 [95% CI, 0.38-1.02]; n = 3; I2 = 91.2%). Results specific to primary care and results on other use of virtual care outcomes (eg, visit noncompletion) were inconclusive due to limited numbers of studies (eg, n = 2 studies reporting AOR of visit noncompletion for primary and specialist care, with I2 = 75.5% and 89.6%, respectively, for the corresponding meta-analyses). Results on satisfaction with virtual care, synthesized narratively, were limited and mixed. In studies of adult patients and caregivers of pediatric patients (n = 3 each), 2 of the 3 studies found no statistically significant difference in satisfaction, while 1 study found significantly lower satisfaction.

CONCLUSIONS AND RELEVANCE: In this systematic review and meta-analysis, adult patients facing language barriers had no significant difference in pooled odds of using virtual compared with in-person care overall, and significantly lower pooled odds of using video compared to telephone care overall. Restricting to specialist care, pooled odds of using virtual care and video care were significantly lower among adult patients facing language barriers, with low heterogeneity. Further research on virtual care among individuals facing language barriers is needed, focusing on virtual primary care, patient satisfaction, and caregivers of pediatric patients.

PMID:40471580 | DOI:10.1001/jamanetworkopen.2025.13906

JAMA Netw Open. 2025 Jun 2;8(6):e2513931. doi: 10.1001/jamanetworkopen.2025.13931.

ABSTRACT

IMPORTANCE: Alzheimer disease and related dementias (ADRD) have substantial clinical and public health consequences for individuals, families, employers, and government.

OBJECTIVE: To assess ADRD’s economic burden on non-Latino African American, Latino, and non-Latino White adults and their caregivers, employers, and the government between 2020 and 2060.

DESIGN, SETTING, AND PARTICIPANTS: Population-based cross-sectional study using nationally representative data on African American, Latino, and White adults aged 50 years and older with ADRD and their unpaid caregivers from the 2014 to 2020 Medical Expenditure Panel Survey (MEPS) alongside the 2011 to 2017 National Study of Caregiving (NSOC) and 2013 Panel Study of Income Dynamics. These data were augmented with information from the US Census Bureau, Bureau of Labor Statistics, Internal Revenue Service, and other sources to estimate current and future economic burden. Two-part regression models were used to estimate medical and work-related costs for older adults, and multivariate-distance matching was used to estimate the value of unpaid care, lost wages and productivity, loss of federal income tax revenue, and financial transfers for caregivers. Data were analyzed from March 2023 to February 2025.

EXPOSURE: Older adults with ADRD and their family caregivers.

MAIN OUTCOMES AND MEASURES: Projected medical costs and work-related losses for persons with ADRD, and unpaid care value, forgone earnings, and lost federal income tax payments and labor productivity for caregivers.

RESULTS: Of 31 028 older adults in MEPS, 5184 (10%) were African American; 146 (<1%) American Indian or Alaska Native; 1043 (3%) Asian (Indian, Chinese, or Filipino); 5346 (10%) Latino; 690 (2%) Other Asian, Native Hawaiian, and Pacific Islander; and 18 617 (75%) were White. In the NSOC sample of 1929 older adults, there were 644 (33%) African American, 169 (9%) Latino, and 1116 (58%) White adults. The total estimated economic burden of ADRD was close to $344 billion in 2020 and was projected to increase to over $3 trillion in 2060. African American and Latino adults bore one-third ($113 billion) of it in 2020, with projections rising to $1.7 trillion by 2060, surpassing the economic burden for White adults, which was projected to grow from $231 billion to $1.4 trillion.

CONCLUSIONS AND RELEVANCE: The findings of this study suggest that African American and Latino older adults with ADRD and their families are likely to face disproportionately high burdens, primarily associated with unpaid caregiving. Understanding ADRD prevalence, comorbidity, inadequate care, and support policies may attenuate economic burdens for all US residents.

PMID:40471578 | DOI:10.1001/jamanetworkopen.2025.13931

Prehosp Emerg Care. 2025 Jun 5:1-6. doi: 10.1080/10903127.2025.2504521. Online ahead of print.

ABSTRACT

OBJECTIVES: Adenosine is a common prehospital treatment for paroxysmal supraventricular tachycardia (PSVT); however initial dosing varies and the optimal first dose is unknown. To evaluate the association of the two common initial adenosine dosing regimens (6 mg and 12 mg) with prehospital patient improvement, hospital admission, complications, and death.

METHODS: This retrospective observational study included all 9-1-1 responses with prehospital adenosine administration between 1/1/2022 and 12/31/2022 from the ESO Data Collaborative. Outcomes included EMS clinician documented patient response (improved v. unchanged/worse) to the initial dose, emergency department (ED) dispositions, compressions/cardioversion/pacing after adenosine administration, and death. Descriptive statistics and adjusted odds ratios (OR) were used to compare outcomes for patients who received an initial adenosine dose of 6 mg versus 12 mg.

RESULTS: We analyzed 11,245 patients that received adenosine from 1,350 EMS agencies. Most received an initial dose of 6 mg (70%, n = 7,825), while 30% (n = 3,314) received an initial dose of 12 mg. Initial pulse rate and systolic blood pressure were similar between groups. Nearly half in the 6 mg group (48%, n = 3,746) received additional doses, compared to 25% (n = 815) in the 12 mg group. An initial dose of 12 mg was associated with 65% increased odds of prehospital improvement (OR: 1.65, 95%CI: 1.49-1.82). Complications including cardioversion (5%, n = 481), pacing (<1%, n = 2), and cardiopulmonary resuscitation (CPR) (<1%, n = 20) were rare. There was no difference in the need for cardioversion, pacing, or CPR between groups (p > 0.05). Amongst EMS transported patients, 25% (n = 2,732) had available ED dispositions. An initial dose of 12 mg was associated with a 28% reduction in odds of admission (OR: 0.72, 95%CI: 0.59-0.87). In total, 2% (n = 48) who received prehospital adenosine and had available outcome data died. Of those, 70% (n = 32) were in the 6 mg group and 30% (n = 14) were in the 12 mg group.

CONCLUSIONS: An initial prehospital adenosine dose of 12 mg was associated with less re-dosing, greater rates of patient improvement, and lower rates of hospital admission compared to an initial dose of 6 mg. Complications requiring interventions and death were rare and similar across dosing regimens.

PMID:40471550 | DOI:10.1080/10903127.2025.2504521

Oral Radiol. 2025 Jun 5. doi: 10.1007/s11282-025-00833-2. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to investigate the relationship between masseter muscle thickness and variables such as age, gender, dental occlusion, and parafunctional habits in adolescents aged 11-15 years using ultrasonographic measurements.

METHODS: A total of 168 adolescents aged 11-15 years who were referred to the Department of Oral and Maxillofacial Radiology at Van Yuzuncu Yil University for routine dental examinations participated in this cross-sectional study. Data on parafunctional habits, age, height, and weight were collected. Dental occlusion and tooth loss were documented during clinical examinations. Masseter muscle thickness was measured bilaterally at rest and during contraction using ultrasonography. Statistical analyses included Kolmogorov-Smirnov, Wilcoxon, and Mann-Whitney U tests, with a significance level of p < 0.05.

RESULTS: No significant differences in masseter muscle thickness were observed between genders, either at rest or during contraction (p > 0.05). Similarly, muscle thickness did not significantly differ according to dental occlusion or parafunctional habits such as mouth breathing and swallowing (p > 0.05). However, a positive correlation was found between the number of premolar and molar teeth and masseter muscle thickness on the left side during contraction (p = 0.006, r = 0.213).

CONCLUSION: Dental occlusion and parafunctional habits appear to have minimal impact on masseter muscle thickness in adolescents. Ultrasonography provides a reliable and non-invasive method for assessing masseter muscle thickness, supporting its utility in clinical practice.

PMID:40471539 | DOI:10.1007/s11282-025-00833-2