Tag: pubmed

Lipids Health Dis. 2024 Nov 26;23(1):389. doi: 10.1186/s12944-024-02373-w.

ABSTRACT

BACKGROUND: The ZJU index is an innovative computational method which integrates BMI, FBG, TG, and ALT to AST ratio. It strongly correlates with measures of lipid metabolism and glucose intolerance. No researches have yet explored the relationship between the ZJU index and sarcopenia.

METHODS: We analyzed NHANES data from 2011 to 2018, dividing the ZJU index into quartiles. The association was investigated by adjusting for confounders using multivariable linear and logistic regression analysis. Results were visualized through RCS regression and threshold effect analyses. We conducted various subgroup and sensitivity analyses and plotted ROC curves to assess prediction efficacy, with the AUC as the measure of accuracy.

RESULTS: As the ZJU index increases, the prevalence of sarcopenia also rises. Following the control of potential confounders via logistic regression analysis, our research identified a distinct relationship between the ZJU index and sarcopenia, which was statistically significant (P < 0.001), with higher ZJU index values associated with increased risk (OR = 12.40, 95% CI: 8.46-18.17). Interaction analysis suggests that the relationship between the ZJU index and the risk of developing sarcopenia varies significantly between males and females across different ZJU index levels. ROC analysis for the ZJU index shows an AUC of 0.749.

CONCLUSIONS: The ZJU index significantly correlates with a heightened risk of sarcopenia in Americans, suggesting its potential as a predictive marker for sarcopenia.

PMID:39593075 | DOI:10.1186/s12944-024-02373-w

Arch Public Health. 2024 Nov 26;82(1):225. doi: 10.1186/s13690-024-01445-8.

ABSTRACT

BACKGROUND: Added sugars intake is common among individuals with Parkinson’s disease (PD), yet the link between added sugars intake and PD is not well understood. Our study aims to investigate the association between added sugars intake and PD.

METHODS: This study utilized data from the National Health and Nutrition Examination Survey (NHANES) from1990 to 2020. Added sugars intake was estimated based on a 24-hour dietary recall from participants. Multivariable logistic regression analysis was employed to explore the relationship between added sugars intake and the prevalence of PD. Restricted cubic spline (RCS) was used to explore the nonlinear association between added sugars intake and PD. To further observe whether the conclusions were consistent across different subgroups, we conducted subgroup analyses to investigate the association of added sugars intake with PD in different populations.

RESULTS: The study included 12,489 participants, of which 100 had PD. When weighted, the data represented 136,959,144 participants. The study revealed a positive association between added sugars intake and the prevalence of PD. In multivariable regression models adjusted for all confounding factors, compared with the lowest quartile of added sugars intake, the third quartile (OR = 2.99; 95% CI: 1.43-6.26) and those consuming more than 25% of their calories from added sugars (OR = 3.34; 95% CI: 1.03-10.86) had the highest risk of PD. The RCS curve showed an L-shaped nonlinear association between added sugars intake and PD. Two-segment linear regression by sex revealed that PD prevalence in women was linearly related to sugar intake (nonlinear P = 0.465), while men exhibited an L-shaped nonlinear relationship (nonlinear P = 0.03). Additionally, subgroup analysis showed that alcohol consumption and diabetes significantly influenced the association between added sugars intake and the prevalence of PD.

CONCLUSION: These results highlight a positive association between added sugars intake and the prevalence of PD, particularly among women, heavy drinkers, and individuals with diabetes.

PMID:39593073 | DOI:10.1186/s13690-024-01445-8

BMC Health Serv Res. 2024 Nov 26;24(1):1471. doi: 10.1186/s12913-024-11863-7.

ABSTRACT

BACKGROUND: Prior to the COVID-19 pandemic there were midwifery workforce deficits reported in Australia, but inadequate workforce data to identify retention and attrition in the profession. In the post-pandemic era, workforce deficits continue. This paper reports on midwives’ intentions to leave the profession and explores reasons for and factors associated with having high intention to leave, to inform strategies that can address retention and attrition of midwives.

METHODS: A cross-sectional survey with midwives was conducted in 2017 via an online survey in two maternity care sites in Victoria, Australia. Plans for remaining in or leaving the profession were explored along with reasons for leaving or intending to leave the profession. Other data collected included demographic and workforce characteristics and occupational stressors. Burnout was measured using the Copenhagen Burnout Inventory and job satisfaction using the Midwifery Process Questionnaire. Descriptive statistics, univariate, multivariate analyses, and content analysis were used for data analysis.

RESULTS: Of the 326 respondents (326/508, 64%), over half had considered leaving the midwifery profession in 12 months prior to the study, 20% had thought about leaving frequently and 12% were planning on leaving in the next five years. The main reasons for leaving were not wanting to do shift work, feeling worn out, and experiencing work-related stress. Factors associated with a high intention to leave the profession were work-related burnout, poor job satisfaction and a high intention to leave the workplace. Age did not impact intention to leave but was influential on the reasons for leaving.

CONCLUSIONS: Pre-pandemic, midwives in Victoria, Australia had a high intention to leave the profession regardless of age. Approaches that address midwifery stress, burnout, and fatigue need to be considered, including developing options that offer employment that does not require shift work. To provide safe quality care that supports positive outcomes for women and their families, an appropriate midwifery workforce must be achieved and maintained. Understanding midwives’ intentions to leave the profession is critical and requires ongoing attention given the workforce is likely to remain under significant stress until the major contributing factors are addressed.

PMID:39593052 | DOI:10.1186/s12913-024-11863-7

BMC Med Educ. 2024 Nov 26;24(1):1366. doi: 10.1186/s12909-024-06371-5.

ABSTRACT

BACKGROUND: Migrant and ethnic minority populations in Europe are growing, leading to a demand for health systems and health educations to accommodate the growing diversity. Research indicates that health professionals feel inadequately prepared to care for diverse populations, and medical education has gaps in addressing these issues. The aim of the study is to explore whether Danish medical students and newly graduated physicians feel prepared to meet the needs of the increasingly diverse populations.

METHODS: An online survey was emailed to students in the four medical Master’s programs in Denmark and to newly graduated physicians in clinical internships. Data was collected spring 2023. Descriptive statistics reported overall numbers, and multivariate logistic regression was used to model the association between survey answers and the background variables: semester, gender/sex, parent’s education, self-identified ethnicity.

RESULTS: Many medical students and newly graduated physicians feel unprepared to care for patients of backgrounds different from their own. For all items women reported feeling more unprepared than men. Among the medical students and newly graduated physicians with enough clinical experience to answer the question, 34.2% reported feeling helpless at times or often in the past year when treating culturally different patients. Men were less likely than women to report feeling helpless (OR = 0.42; 95% CI 0.28 to 0.64); and self-identified ethnic minorities were 2.59 times more likely than Danish/European medical students and newly graduated physicians to report feeling helpless (95% CI 1.32-5.07).

CONCLUSION: Our findings indicate shortcomings in medical students and newly graduated physicians feeling of preparedness to provide care to patients of backgrounds different from their own. These findings can assist medical education management with identifying curriculum gaps.

PMID:39593048 | DOI:10.1186/s12909-024-06371-5

Health Qual Life Outcomes. 2024 Nov 26;22(1):101. doi: 10.1186/s12955-024-02312-4.

ABSTRACT

BACKGROUND: Patient-reported outcome measures (PROMs) provide invaluable information on patients’ health outcomes and can be used to improve patient-related outcomes at the individual, organizational and policy levels. This systematic review aimed to a) identify contemporary applications and synthesize all evidence on the use of PROMs in these contexts and b) to determine characteristics of interventions associated with increased effectiveness.

METHODS: Five databases were searched for studies providing quantitative evidence of the impact of PROM interventions. Any study design was permitted. An overall benefit (worsening) in outcome was defined as a statistically significant improvement (deterioration) in either a PROM, patient-reported experience measure or clinical outcome. Study quality was assessed using the Effective Public Healthcare Panacea Project’s Quality Assessment Tool for Quantitative Studies. A narrative synthesis was conducted.

RESULTS: Seventy-six studies of the 11,121 articles identified met the inclusion criteria. At the individual level, 10 (43%) of 23 studies that fed back PROMs to the patient or healthcare provider showed an improvement in outcome. This percentage increased in studies which used PROMs to monitor disease symptoms and linked these to care-pathways: 17 (68%) of 25 studies using this mechanism showed an improvement. Ten (71%) of 14 studies using PROMs to screen for disease found a benefit. The monitoring and screening approach was most effective using PROMs covering cancer-related, depression and gastro-intestinal symptoms. Three studies found that the mere collection of PROMs resulted in improved outcomes. Another three studies used PROMs in decision aids and found improved decision quality. At the organizational/policy level, none of the 4 studies that used PROMs for benchmarking found a benefit. The three studies that used PROMs for in-depth performance analyses and 1 study in a plan-do-study-act (PDCA) cycle found an improvement in outcome. Studies employing disease-specific PROMs tended to observe improved outcomes more often. There are concerns regarding the validity of findings, as studies varied from weak to moderate quality.

CONCLUSIONS: The use of PROMs at the individual level has matured considerably. Monitoring/screening applications seem promising particularly for diseases for which treatment algorithms rely on the experienced symptom burden by patients. Organizational/policy-level application is in its infancy, and performance evaluation via in-depth analyses and PDCA-cycles may be useful. The findings of this review may aid stakeholders in the development and implementation of PROM-interventions which truly impact patient outcomes.

PMID:39593045 | DOI:10.1186/s12955-024-02312-4

Pediatr Rheumatol Online J. 2024 Nov 26;22(1):102. doi: 10.1186/s12969-024-01035-6.

ABSTRACT

BACKGROUND: To assess the psychosocial impact of moderate-severe juvenile idiopathic arthritis (JIA) on patients and their families, among those who had been treated with at least one anti-tumor necrosis factor (anti-TNF-α), according to routine clinical practice in Spain.

PATIENTS AND METHODS: A 24-month observational, multicentric, cross-sectional and retrospective study was performed. Children diagnosed with JIA were enrolled at three tertiary-care Spanish hospitals. The study included children treated with biologic disease-modifying antirheumatic drugs (bDMARD) who participated in a previous study, the ITACA, and who continued follow-up in these pediatric rheumatology units. Patient health-related quality of life (HRQoL) was assessed using the Pediatric Quality of Life Inventory (PedsQL™). Caregivers completed an interview to gather information about school attendance, their children’s participation in school and social activities, its impact on their jobs and social life and perceived psychosocial support. A descriptive statistical analysis of all the variables was performed. The Mann-Whitney-U test or Kruskall-Wallis H test were used to compare quantitative variables and Fisher’s exact tests was used for qualitative variables. Tests were two-tailed with a significance level of 5%. The data were analyzed using SPSS V18.0 statistical software.

RESULTS: One hundred and seven patients were included. Overall, patients were on inactive disease or low disease activity according to JADAS-71 score and had very low functional disability according to CHAQ score. Up to 94.4% of patients were receiving drug treatment, mainly with bDMARD in monotherapy (84.5%). Based on PedsQL, patients and parents referred a high HRQoL. School Functioning PedsQL domain achieved the lowest score. Work and social impact due to the child´s disease was greater for mothers than for fathers. The understanding of the disease was lower at school than in the with family and friends’ environments.

CONCLUSION: Most of the patients had a high HRQoL and had controlled disease activity, despite having a negative psychosocial impact on some of them and their families, mainly on school functioning. Children’s disease seems to involve greater work and psychosocial impacts for mothers than for fathers of children affected by JIA.

PMID:39593042 | DOI:10.1186/s12969-024-01035-6

BMC Musculoskelet Disord. 2024 Nov 26;25(1):965. doi: 10.1186/s12891-024-08108-3.

ABSTRACT

BACKGROUND: The anatomical structure of the elbow joint makes it vulnerable to contractures. While elbow arthroscopy minimizes soft tissue damage and enhances early rehabilitation, the optimal duration for postoperative Continuous Passive Motion (CPM) therapy is unclear. This retrospective study aims to establish the appropriate duration of CPM following arthroscopic elbow contracture release.

METHODS: We analyzed postoperative outcomes from patients undergoing CPM rehabilitation for 1, 3, or 5 months. Metrics such as ASES, VAS, DASH, MEPS scores, grip strength, and range of motion were assessed before surgery and at 1,3,6 and 12 months post-surgery.

RESULTS: Patients who received 3 or 5 months of CPM therapy showed statistically significant improvements in elbow flexion-extension, range of motion, and functional scores (ASES, VAS, DASH, MEPS) compared to the 1-month group (p < 0.05). However, no significant differences were observed between the 3- and 5-month groups.

CONCLUSIONS: A 3-month CPM period is effective for patients with higher functional demands, with no additional benefit from extending therapy to 5 months.

PMID:39593033 | DOI:10.1186/s12891-024-08108-3

BMC Public Health. 2024 Nov 26;24(1):3276. doi: 10.1186/s12889-024-20794-1.

ABSTRACT

BACKGROUND: The adverse selection theory speculates a high level of demand for health insurance by people with vulnerable health conditions. However, the COVID-19 pandemic changed the prevailing narratives and pattern of healthcare utilization in many African countries. This study estimated the effects of household member’s disability and presence of serious illness on the probability of National Hospital Insurance Fund (NHIF) subscription with the average treatment effect (ATE) and average treatment effect on the treated (ATET).

METHODS: The data were collected telephonically in 2020 using the sampling frame of the United Nations High Commission on Refugees (UNHCR). The respondents were refugees with active phone numbers who were registered by the UNHCR in Nairobi, Mombasa and Nakuru cities. A total of 2,438 completed the surveys. The data were analysed with Treatment Effects Probit regression model using the regression adjustment estimator.

RESULTS: The results showed that 24.89% of the respondents had health insurance. Also, 3.28%, 1.39% and 2.46%, respectively suffered from physical, cognitive and sensory disability, while 8.28% had some form of serious illness. The Probit regression results showed that probability of being health insured significantly increased (p < 0.05) with membership of community-based organizations (CBO), asset index, possession of bank savings account, residence in Nairobi and household size, while residence in Nakuru reduced it. The ATE for physical and cognitive disabilities were significant (p < 0.05) with 0.1100 and 0.1816, respectively, while that for serious illness was 0.1046 (p < 0.01). The ATET for physical disability and serious illness were also significant (p < 0.05) with 0.1251 and 0.0996, respectively.

CONCLUSION: It was concluded that efforts to facilitate NHIF subscriptions among the refugees should be channelled among people with disability and serious illness. In addition, there is the need to promote refugees’ welfare through employment that can induce formal savings and promote less reliance on informal borrowing. The operational mechanisms and differences in healthcare service distribution between the three cities should be considered along some salient interventions for health insurance subscription that are channelled through some CBOs.

PMID:39593027 | DOI:10.1186/s12889-024-20794-1

BMC Med Educ. 2024 Nov 26;24(1):1375. doi: 10.1186/s12909-024-06243-y.

ABSTRACT

BACKGROUND: Remedial teaching is a tailored educational approach dedicated to enhancing the academic performance of students facing challenges within the curriculum. By identifying and addressing specific learning difficulties, it provides essential support and guidance to bring students closer to expected standards while preventing future setbacks. We hypothesize that underperforming medical students who receive daily, tailored remediation will demonstrate significant improvement in their formative and summative assessment scores in biochemistry.

METHODS: A cross-sectional mixed-method study was conducted on 56 underperforming first-year medical undergraduates to assess the effect of targeted remediation on formative and summative assessments in Biochemistry. Training sessions included various remediation techniques over six months. Post-remediation feedback was collected to gather insights into students’ attitudes, perceptions, and the effectiveness of the methods in improving their understanding of the subject. Logistic regression analysis was employed to determine the most effective remediation for student performance. Benefits and weaknesses of remedial training approaches for future application as perceived by the students were derived through deductive thematic analysis of their feedback.

RESULTS: The mean marks, evaluated out of a maximum of 100, showed improvement from 29.86 ± 7.71 to 71.48 ± 10.19, with statistical significance (p < 0.001). From the students’ perspective, the most effective remediation method was grade incentives in formative assessments (odds ratio 6.19). Five major themes were identified: perceived barriers prior to remediation, positive outcomes and behavioral changes observed after remediation, and strengths and areas for improvement in remediation.

CONCLUSIONS: The study concludes that identifying underperformers in the early stages of the medical curriculum and providing them with tailored remediation can enhance their performance in exams. Grade incentives in formative assessments, mind maps, quizzes, quick revisions, and assignments were beneficial remedial tools. Targeted remediation proved advantageous for students in improving their academic skills, exam preparation, time management, and attitudes towards the subject.

PMID:39593026 | DOI:10.1186/s12909-024-06243-y

BMC Med Imaging. 2024 Nov 26;24(1):319. doi: 10.1186/s12880-024-01506-y.

ABSTRACT

BACKGROUND: This study aimed to perform a comprehensive morphometric analysis of the epiglottis using cone-beam computed tomography (CBCT) images, including the determination of epiglottis dimensions, the investigation of shape variations, and the assessment of their relationship with gender and age.

METHODS: A retrospective analysis was conducted on high-quality CBCT images from 100 patients, obtained using the NewTom 5G system. In CBCT images, epiglottis thicknesses (right, midline, left) and horizontal angle at three levels (suprahyoid, hyoid, infrahyoid) were measured in axial sections, while the length and vertical angle of epiglottis were measured in midsagittal view. Epiglottis shapes were identified through 3D visualization.

RESULTS: The midline epiglottis thicknesses were 4.68 mm at the suprahyoid level, 5.51 mm at the hyoid level, and 6.80 mm at the infrahyoid levels. Epiglottis thicknesses and length were statistically significantly greater in males. Of the 100 patients, 51 had a normal curvature, 41 had a flat epiglottis, and 8 had an omega epiglottis. The omega-shaped epiglottis was significantly longer compared to both the flat and normal curvature types (p = 0.011). There was a positive correlation between age and epiglottis thicknesses at the suprahyoid level and horizontal angles at three levels.

CONCLUSIONS: This study visualizes epiglottis morphology and uncovers significant morphometric differences. Males exhibit greater epiglottis thickness and length compared to females, while the omega-shaped epiglottis is notably longer than other types. These findings underscore the need for further investigation into the clinical relevance of these morphometric differences, particularly in improving airway management and refining approaches to swallowing function.

PMID:39593020 | DOI:10.1186/s12880-024-01506-y