Tag: pubmed

BMJ Open. 2023 Aug 9;13(8):e071971. doi: 10.1136/bmjopen-2023-071971.

ABSTRACT

OBJECTIVE: The study assessed COVID-19 era-related e-learning cyberchondria, internet addiction and anxiety-related symptomatology among nursing students. The relationships, predictors and differences between the studied concepts were measured.

DESIGN: In 2021, a quantitative cross-sectional research design using a web survey with a sample size of 333 nursing students yielded a response rate of 70%.

RESULTS: Nursing students had a moderate level of cyberchondria, low to moderate internet addiction, a moderate to severe level of anxiety and depression, and a normal stress level. Demographic characteristics, cyberchondria, internet addiction and anxiety-related symptomatology were significantly correlated. Grade point average, age, type of organisation where the students were trained and level of education were significant predictors of the studied variables. Significant differences in the studied concepts were found based on the sample’s characteristics such as gender, type of organisations or universities where the students were trained or studied, and age.

CONCLUSION: Cyberchondria, internet addiction, depression, anxiety and stress symptomatology are troublesome. Higher education organisations might benefit from examining the variables of interest and investigating the relations between internet addiction and depression and anxiety symptomatology among nursing students. Such research will aid in tailoring treatments to assist vulnerable students by targeting counselling and educational efforts toward building a future generation of nurses with reduced cyberchondria, internet addiction and anxiety-related symptomatology.

PMID:37558438 | DOI:10.1136/bmjopen-2023-071971

BMJ Open. 2023 Aug 9;13(8):e074256. doi: 10.1136/bmjopen-2023-074256.

ABSTRACT

INTRODUCTION: Heart failure (HF) as a long-term clinical syndrome is associated with inadequate self-care behaviours, a feeling of uncertainty and frequent hospitalisation. In recent years, empowerment has evolved for improving chronic disease management. Nevertheless, there is a lack of studies investigating remote care interventions such as a tele-empowerment programme in patients with HF. Therefore, this protocol proposes a randomised controlled trial which aims to evaluate the effectiveness of a comprehensive tele-empowerment programme on self-care behaviours, uncertainty and readmission in patients with HF.

METHODS AND ANALYSIS: The study is a double-arm and parallel-group randomised controlled trial in which a 10-week intervention, including 6 weeks of a comprehensive tele-empowerment programme and 4 weeks of follow-up, will be compared with usual care. A total of 96 eligible patients with HF will be recruited and randomly assigned to the intervention or control group. The patients in the intervention group will join virtual groups and receive the five-step tele-empowerment programme through the internet. The primary outcomes include self-care behaviours and uncertainty which will be measured with valid instruments at baseline and 10th week. The secondary outcome is the number of patients’ hospital readmissions and will be assessed at the end of the study. Descriptive statistics will be used to describe variables. According to the types of variables, appropriate statistical tests including two-sample t-tests, Χ², analysis of covariance or linear regression will be performed. In addition, standardised intervention effect sizes will be calculated for each outcome.

ETHICS AND DISSEMINATION: The trial has been approved by the Research Ethics Committee of School of Nursing and Midwifery & Rehabilitation at Tehran University of Medical Sciences. In this study, written consent will be obtained from all participants. The results will be presented to representative groups and published in peer-reviewed journals.

TRIAL REGISTRATION NUMBER: Iranian Registry of Clinical Trials (IRCT20100725004443N30).

PMID:37558436 | DOI:10.1136/bmjopen-2023-074256

Heart. 2023 Aug 9:heartjnl-2023-322830. doi: 10.1136/heartjnl-2023-322830. Online ahead of print.

ABSTRACT

OBJECTIVE: The recommended duration of dual anti-platelet therapy (DAPT) following acute coronary syndrome (ACS) varies from 1 month to 1 year depending on the balance of risks of ischaemia and major bleeding. We designed paired ischaemic and major bleeding risk scores to inform this decision.

METHODS: New Zealand (NZ) patients with ACS investigated with coronary angiography are recorded in the All NZ ACS Quality Improvement registry and linked to national health datasets. Patients were aged 18-84 years (2012-2020), event free at 28 days postdischarge and without atrial fibrillation. Two 28-day to 1-year postdischarge multivariable risk prediction scores were developed: (1) cardiovascular mortality/rehospitalisation with myocardial infarction or ischaemic stroke (ischaemic score) and (2) bleeding mortality/rehospitalisation with bleeding (bleeding score).

FINDINGS: In 27 755 patients, there were 1200 (4.3%) ischaemic and 548 (2.0%) major bleeding events. Both scores were well calibrated with moderate discrimination performance (Harrell’s c-statistic 0.75 (95% CI, 0.74 to 0.77) and 0.69 (95% CI, 0.67 to 0 .71), respectively). Applying these scores to the 2020 European Society of Cardiology ACS antithrombotic treatment algorithm, the 31% of the cohort at elevated (>2%) bleeding and ischaemic risk would be considered for an abbreviated DAPT duration. For those at low bleeding risk, but elevated ischaemic risk (37% of the cohort), prolonged DAPT may be appropriate, and for those with low bleeding and ischaemic risk (29% of the cohort) short duration DAPT may be justified.

CONCLUSION: We present a pair of ischaemic and bleeding risk scores specifically to assist clinicians and their patients in deciding on DAPT duration beyond the first month post-ACS.

PMID:37558394 | DOI:10.1136/heartjnl-2023-322830

Lancet Planet Health. 2023 Aug;7(8):e694-e705. doi: 10.1016/S2542-5196(23)00143-2.

ABSTRACT

BACKGROUND: The global spatiotemporal pattern of mortality risk and burden attributable to tropical cyclones is unclear. We aimed to evaluate the global short-term mortality risk and burden associated with tropical cyclones from 1980 to 2019.

METHODS: The wind speed associated with cyclones from 1980 to 2019 was estimated globally through a parametric wind field model at a grid resolution of 0·5° × 0·5°. A total of 341 locations with daily mortality and temperature data from 14 countries that experienced at least one tropical cyclone day (a day with maximum sustained wind speed associated with cyclones ≥17·5 m/s) during the study period were included. A conditional quasi-Poisson regression with distributed lag non-linear model was applied to assess the tropical cyclone-mortality association. A meta-regression model was fitted to evaluate potential contributing factors and estimate grid cell-specific tropical cyclone effects.

FINDINGS: Tropical cyclone exposure was associated with an overall 6% (95% CI 4-8) increase in mortality in the first 2 weeks following exposure. Globally, an estimate of 97 430 excess deaths (95% empirical CI [eCI] 71 651-126 438) per decade were observed over the 2 weeks following exposure to tropical cyclones, accounting for 20·7 (95% eCI 15·2-26·9) excess deaths per 100 000 residents (excess death rate) and 3·3 (95% eCI 2·4-4·3) excess deaths per 1000 deaths (excess death ratio) over 1980-2019. The mortality burden exhibited substantial temporal and spatial variation. East Asia and south Asia had the highest number of excess deaths during 1980-2019: 28 744 (95% eCI 16 863-42 188) and 27 267 (21 157-34 058) excess deaths per decade, respectively. In contrast, the regions with the highest excess death ratios and rates were southeast Asia and Latin America and the Caribbean. From 1980-99 to 2000-19, marked increases in tropical cyclone-related excess death numbers were observed globally, especially for Latin America and the Caribbean and south Asia. Grid cell-level and country-level results revealed further heterogeneous spatiotemporal patterns such as the high and increasing tropical cyclone-related mortality burden in Caribbean countries or regions.

INTERPRETATION: Globally, short-term exposure to tropical cyclones was associated with a significant mortality burden, with highly heterogeneous spatiotemporal patterns. In-depth exploration of tropical cyclone epidemiology for those countries and regions estimated to have the highest and increasing tropical cyclone-related mortality burdens is urgently needed to help inform the development of targeted actions against the increasing adverse health impacts of tropical cyclones under a changing climate.

FUNDING: Australian Research Council and Australian National Health and Medical Research Council.

PMID:37558350 | DOI:10.1016/S2542-5196(23)00143-2

Lancet Planet Health. 2023 Aug;7(8):e684-e693. doi: 10.1016/S2542-5196(23)00138-9.

ABSTRACT

BACKGROUND: Climate change is increasing heat-associated mortality particularly in hotter parts of the world. The Northern Territory is a large and sparsely populated peri-equatorial state in Australia. The Northern Territory has the highest proportion of Aboriginal and Torres Strait Islander people in Australia (31%), most of whom live in remote communities of over 65 Aboriginal Nations defined by ancient social, cultural, and linguistic heritage. The remainder non-Indigenous population lives mostly within the two urban centres (Darwin in the Top End region and Alice Springs in the Centre region of the Northern Territory). Here we aim to compare non-Indigenous (eg, high income) and Indigenous societies in a tropical environment and explore the relative importance of physiological, sociocultural, and technological and infrastructural adaptations to heat.

METHODS: In this case time series, we matched temperature at the time of death using a modified distributed lag non-linear model for all deaths in the Northern Territory, Australia, from Jan 1, 1980, to Dec 31, 2019. Data on deaths came from the national registry of Births, Deaths and Marriages. Cases were excluded if location or date of death were not recorded or if the person was a non-resident. Daily maximum and minimum temperature were measured and recorded by the Bureau of Meteorology. Hot weather was defined as mean temperature greater than 35°C over a 3-day lag. Socioeconomic status as indicated by Index of Relative Socioeconomic Disadvantage was mapped from location at death.

FINDINGS: During the study period, 34 782 deaths were recorded; after exclusions 31 800 deaths were included in statistical analysis (15 801 Aboriginal and 15 999 non-Indigenous). There was no apparent reduction in heat susceptibility despite infrastructural and technological improvements for the majority non-Indigenous population over the study period with no heat-associated mortality in the first two decades (1980-99; relative risk 1·00 [95% CI 0·87-1·15]) compared with the second two decades (2000-19; 1·14 [1·01-1·29]). Despite marked socioeconomic inequity, Aboriginal people are not more susceptible to heat mortality (1·05, [0·95-1·18]) than non-Indigenous people (1·18 [1·06-1·29]).

INTERPRETATION: It is widely believed that technological and infrastructural adaptations are crucial in preparing for hotter climates; however, this study suggests that social and cultural adaptations to increasing hot weather are potentially powerful mechanisms for protecting human health. Although cool shelters are essential during extreme heat, research is required to determine whether excessive exposure to air-conditioned spaces might impair physiological acclimatisation to the prevailing environment. Understanding sociocultural practices from past and ancient societies provides insight into non-technological adaptation opportunities that are protective of health.

FUNDING: None.

PMID:37558349 | DOI:10.1016/S2542-5196(23)00138-9

J Nurs Meas. 2023 Aug 9:JNM-2021-0076.R1. doi: 10.1891/JNM-2021-0076. Online ahead of print.

ABSTRACT

Background and Purpose: Healthcare-seeking behavior is an issue affecting the promotion of sexual health among Filipino men. However, tools to measure healthcare-seeking behaviors among men, in general, are scarce. This study aimed to find evidence of validity and reliability of the Health Care-Seeking Behavior Questionnaire (HCSBQ). Methods: A cross-sectional online survey was conducted among N = 464 Filipino men. Linear Structural Relations (LISREL®) was used for statistical analysis. Results: The HCSBQ demonstrates validity and reliability after data analysis. The overall Cronbach’s α of 0.94 shows excellent internal consistency. The exploratory factor analysis revealed three latent variables, namely, interactional, intellectual, and active and decision-making. Cronbach’s α for each latent variable is 0.91, 0.84, and 0.88, respectively. A confirmatory factor analysis shows an excellent goodness-of-fit indices (Adjusted Goodness-of-fit Index [AGFI] = .95; Goodness-of-fit Index [GFI] = .97; Comparative Fit Index [CFI] = .99; Incremental Fit Index [IFI] = .99; Expected Cross Validation Index [ECVI] = .45; and Root Mean Square Error of Approximation [RMSEA] = .03). Conclusions: The HCSBQ is a valid and reliable tool to measure healthcare-seeking behaviors among Filipino men.

PMID:37558255 | DOI:10.1891/JNM-2021-0076

J Nurs Meas. 2023 Aug 9:JNM-2021-0068.R1. doi: 10.1891/JNM-2021-0068. Online ahead of print.

ABSTRACT

Background and Purpose: The prevention of aggressive behavior in child and adolescent inpatient settings is essential. However, it can be difficult to prompt a quick appropriate intervention without an early warning scale for the prevention and management of behavioral emergencies in a psychiatric inpatient adolescent unit. Behavioral emergencies often result in restraint/seclusion and/or administration of psychotropic medications. The objectives are to develop and evaluate the Pediatric Behavioral Early Warning Scale (Pedi-BEWS) as a screening tool to prompt quick appropriate interventions and to decrease incidents of restraint/seclusion and/or administration of psychotropic medications. Methods: A two-phase methodological design was applied. A total of 447 inpatients and 21 nurses were used to test internal consistency reliability and validity. Results: Receiver operating characteristic curve areas for the developed instrument were calculated to be 0.890 (Cognition), 0.959 (affect), and 0.951 (behavior). The overall Pedi-BEWS indicated high reliability (Cronbach’s alpha = .98). Conclusions: The Pedi-BEWS shows high internal consistency and validity. The use of the newly developed tool may reduce or eliminate episodes of seclusion and restraint for pediatric patients with a behavioral problem. In addition, the tool has the potential to enhance psychiatric nurses’ assessment skills and competencies. The use of the newly-developed Pedi-BEWS can promote an appropriate and timely nursing assessment and intervention before the deterioration in psychiatric nursing practice.

PMID:37558252 | DOI:10.1891/JNM-2021-0068

BMJ. 2023 Aug 9;382:e076222. doi: 10.1136/bmj-2023-076222.

ABSTRACT

OBJECTIVES: To characterize the long term risk of death and hospital readmission after an index admission with covid-19 among Medicare fee-for-service beneficiaries, and to compare these outcomes with historical control patients admitted to hospital with influenza.

DESIGN: Retrospective cohort study.

SETTING: United States.

PARTICIPANTS: 883 394 Medicare fee-for-service beneficiaries age ≥65 years discharged alive after an index hospital admission with covid-19 between 1 March 2020 and 31 August 2022, compared with 56 409 historical controls discharged alive after a hospital admission with influenza between 1 March 2018 and 31 August 2019. Weighting methods were used to account for differences in observed characteristics.

MAIN OUTCOME MEASURES: All cause death within 180 days of discharge. Secondary outcomes included first all cause readmission and a composite of death or readmission within 180 days.

RESULTS: The covid-19 cohort compared with the influenza cohort was younger (77.9 v 78.9 years, standardized mean difference -0.12) and had a lower proportion of women (51.7% v 57.3%, -0.11). Both groups had a similar proportion of black beneficiaries (10.3% v 8.1%, 0.07) and beneficiaries with dual Medicaid-Medicare eligibility status (20.1% v 19.2%; 0.02). The covid-19 cohort had a lower comorbidity burden, including atrial fibrillation (24.3% v 29.5%, -0.12), heart failure (43.4% v 49.9%, -0.13), and chronic obstructive pulmonary disease (39.2% v 52.9%, -0.27). After weighting, the covid-19 cohort had a higher risk (ie, cumulative incidence) of all cause death at 30 days (10.9% v 3.9%; standardized risk difference 7.0%, 95% confidence interval 6.8% to 7.2%), 90 days (15.5% v 7.1%; 8.4%, 8.2% to 8.7%), and 180 days (19.1% v 10.5%; 8.6%, 8.3% to 8.9%) compared with the influenza cohort. The covid-19 cohort also experienced a higher risk of hospital readmission at 30 days (16.0% v 11.2%; 4.9%, 4.6% to 5.1%) and 90 days (24.1% v 21.3%; 2.8%, 2.5% to 3.2%) but a similar risk at 180 days (30.6% v 30.6%;-0.1%, -0.5% to 0.3%). Over the study period, the 30 day risk of death for patients discharged after a covid-19 admission decreased from 17.9% to 7.2%.

CONCLUSIONS: Medicare beneficiaries who were discharged alive after a covid-19 hospital admission had a higher post-discharge risk of death compared with historical influenza controls; this difference, however, was concentrated in the early post-discharge period. The risk of death for patients discharged after a covid-19 related hospital admission substantially declined over the course of the pandemic.

PMID:37558240 | DOI:10.1136/bmj-2023-076222

J Dermatolog Treat. 2023 Dec;34(1):2245084. doi: 10.1080/09546634.2023.2245084.

ABSTRACT

Mesotherapy is a technique by which lower doses of therapeutic agents and bioactive substances are administered by intradermal injections to the skin. Through intradermal injections, mesotherapy can increase the residence time of therapeutic agents in the affected area, thus allowing for the use of lower doses and longer intervals between sessions which may in turn improve the treatment outcome and patient compliance. This systematic review aims to summarize the current literature that evaluates the efficacy of this technique for the treatment of hair loss and provides an overview of the results observed. Of the 416 records identified, 27 articles met the inclusion criteria. To date, mesotherapy using 6 classes of agents and their combinations have been studied; this includes dutasteride, minoxidil, growth factors or autologous suspension, botulinum toxin A, stem cells, and mesh solutions/multivitamins. While several studies report statistically significant improvements in hair growth after treatment, there is currently a lack of standardized regimens. The emergence of adverse effects after mesotherapy has been reported. Further large-scale and controlled clinical trials are warranted to evaluate the utility of mesotherapy for hair loss disorders.

PMID:37558233 | DOI:10.1080/09546634.2023.2245084

Int J Sports Physiol Perform. 2023 Aug 9:1-10. doi: 10.1123/ijspp.2023-0130. Online ahead of print.

ABSTRACT

PURPOSE: To determine the effects and transferability of a resisted-jump training program on strength, speed, power, and agility maintenance during the in-season phase of rugby training.

METHODS: Thirty high-level male rugby players (age: 21.78 [1.86] y; height: 1.83 [0.10] m; mass: 95.17 [10.45] kg) participated in a crossover, within-subject study design. Participants were randomly assigned to treatment groups (resistance band [VertiMax, VM] or control [Con]) and evaluated on jumping, sprinting, agility, and strength over a 4-week period. A 10-week wash-out period was initiated, followed by a crossover that incorporated randomization of the treatment sequence (ie, receiving VM during the first or second phase of the testing period). Within- and between-groups differences for each variable of interest were evaluated using a linear mixed-effects model.

RESULTS: No significant treatment (VM vs Con) or time (pre vs postintervention) effects were evident across all variables (all P > .197), although the order or treatment allocation may play a role for strength (P = .037) and jumping (P = .003). Power, agility, and countermovement-jump height were statistically equivalent for the intervention period. Following the VM treatment, changes in strength seem to transfer favorably to changes in agility (r = -.54, P < .05) but no other variables, and no significant associations were evident for the Con treatment.

CONCLUSION: Regardless of treatment, power, agility, and jump height were conserved throughout the treatment period. Although changes in mean sprint and strength were not significantly different from zero, it was not possible to conclude whether performance decrements could be eliminated.

PMID:37558219 | DOI:10.1123/ijspp.2023-0130