Tag: pubmed

Menopause. 2024 Dec 17. doi: 10.1097/GME.0000000000002459. Online ahead of print.

ABSTRACT

OBJECTIVES: The aims of the study are to explore the range and variation in serum estradiol concentration, and to estimate the prevalence of “poor absorption” (women using licensed estradiol doses with subtherapeutic levels), in perimenopausal and postmenopausal women using transdermal estradiol in the real world.

METHODS: This is a cross-sectional analysis in a specialist menopause clinic in the UK.

RESULTS: Serum samples were obtained from 1,508 perimenopausal and postmenopausal women. A total of 61.87% were using licensed doses. The median estradiol concentration was 355.26 pmol/L (interquartile range 198.44-646.15 pmol/L). A reference interval for the whole cohort was defined as 54.62-2,050.55 pmol/L. There was substantial interindividual variation across the dose range. Variance was greater in younger women (P = 0.002) and gel users (P = 0.002). There was a trend toward greater variance in women using higher doses, but the association failed to reach statistical significance (P = 0.074). One in four women (24.84%) using the highest licensed dose had subtherapeutic levels (<200 pmol/L). Older women (≥50 y) and patch users were more likely to have low levels (odds ratio 1.77, 95% confidence interval 1.22-2.62, P = 0.003; and odds ratio 1.51, 95% confidence interval 1.18-1.95, P = 0.001, respectively).

CONCLUSIONS: The reference interval for perimenopausal and postmenopausal women using on-label and off-label doses of transdermal estradiol in the real world is wide, and there is considerable interindividual variation. The number of estradiol users with low estradiol levels (<200 pmol/L) is higher than previously recognized. Measurement of serum estradiol can be helpful to identify women who may benefit from an off-label dose. Dose customization is key to ensure that all women can reap the benefits of HT.

PMID:39689249 | DOI:10.1097/GME.0000000000002459

Menopause. 2024 Dec 17. doi: 10.1097/GME.0000000000002460. Online ahead of print.

ABSTRACT

OBJECTIVE: Metabolic dysfunction-associated steatotic liver disease (MASLD) and vasomotor symptoms (VMS) are associated with increased cardiovascular disease risk. Although visceral adiposity has been linked to MASLD and VMS independently, this study aimed to evaluate associations between the two in midlife women.

METHODS: A cross-sectional study of women aged 45-60 years receiving primary care at one of four sites was conducted from March 1 through June 30, 2021. MASLD diagnosis was obtained utilizing the International Classification of Diseases, Ninth Revision and Tenth Revision codes. VMS burden was evaluated with the Menopause Rating Scale and categorized as severe/very severe versus none/mild/moderate. Logistic regression models were used to assess the association between VMS and diagnosed MASLD both univariately and after individually adjusting for several risk factors.

RESULTS: A total of 4,599 women were included in the final analysis, 304 (7%) of whom had an MASLD diagnosis. On univariate analysis, women with an MASLD diagnosis were more likely to have severe/very severe VMS (odds ratio [OR], 1.50; 95% CI, 1.08-2.08; P = 0.015). However, the association between MASLD diagnosis and severe/very severe VMS was no longer statistically significant after individually adjusting for body mass index (adjusted OR, 1.36; 95% CI, 0.97-1.92) and hypertension (adjusted OR, 1.38; 95% CI, 0.99-1.93).

CONCLUSIONS: The relationship between MASLD and VMS appears to be best explained by other variables including BMI and hypertension. Although they do not appear to be directly linked, given the prevalence of bothersome VMS in midlife women, addressing VMS may enable greater adherence to lifestyle modifications as part of MASLD management.

PMID:39689247 | DOI:10.1097/GME.0000000000002460

Cancer Nurs. 2024 Dec 18. doi: 10.1097/NCC.0000000000001413. Online ahead of print.

ABSTRACT

BACKGROUND: Unmet supportive needs are directly correlated with more frequent psychological distress, reduced quality of life, and low patient satisfaction with healthcare and indirectly connected with low compliance with treatment and increased care-related costs.

OBJECTIVE: To assess the spectrum of unmet needs among patients with cancer in Oman and identify predictors of these needs and their relationship with psychological distress and symptom burden.

METHOD: A descriptive, correlational study design was used, involving 551 patients with cancer from 2 major healthcare facilities in Muscat, Oman. Data on patients’ unmet needs were collected between January and June 2023 using the Supportive Care Needs Survey Short-Form 34.

RESULTS: Participants had a mean age of 45.8 (SD, 15.6) years, with female patients comprising 65.5% of the sample. Breast cancer was the most prevalent type of cancer. The mean unmet need score was 31.0/100 (SD, 20.1). Statistical analysis revealed significant predictors of unmet needs, including marital status, treatment type, performance status, symptom interference, and psychological distress, with the regression model explaining 26% of the variance in unmet needs.

CONCLUSIONS: Healthcare providers must regularly assess supportive needs, recognizing that they may vary across populations and are influenced by cultural factors. Additionally, individuals identified as having characteristics that predict higher levels of need should receive focused and prioritized supportive care.

IMPLICATIONS FOR PRACTICE: By adopting regular tailored assessments that address the comprehensive supportive needs of patients with cancer, clinicians can significantly enhance patients’ quality of life and optimize treatment outcomes.

PMID:39689231 | DOI:10.1097/NCC.0000000000001413

Urogynecology (Phila). 2024 Dec 18. doi: 10.1097/SPV.0000000000001622. Online ahead of print.

ABSTRACT

IMPORTANCE: Restrictive physical activity after pelvic reconstructive surgery is recommended, although the optimal duration and intensity are not standardized.

OBJECTIVE: This systematic review and meta-analysis aimed to evaluate the existing literature comparing clinical outcomes for liberal postoperative physical activity versus standard of care, defined as restricted postoperative physical activity, after pelvic reconstructive surgery.

STUDY DESIGN: PubMed, CENTRAL, Scopus, Web of Science, and CINAHL databases were searched for observational and randomized studies comparing liberal postoperative physical activity and standard of care in women undergoing pelvic reconstructive surgery, reporting anatomic and functional outcomes. Statistical analysis was performed using RevMan software, presenting results as mean difference (MD) or odds ratio in a random-effects model, with 95% confidence intervals (CIs).

RESULTS: Five randomized trials, representing total n = 434, were included, with 2 studies on sling surgical procedures and 3 on prolapse surgical procedures. Data from 3 studies suggest no significant difference between liberal and standard postoperative instructions in surgical outcomes, measured by Point Ba from POP-Q assessment tool, up to 3 months follow-up (MD, -0.04; 95% CI, -0.16 to 0.07; P = 0.49). Disease-specific symptom distress, measured by Pelvic Floor Distress Inventory-20, favored the liberal approach (MD, -10.09; 95% CI, -18.33 to -1.86; P = 0.02). Other domains, including Urinary Distress Inventory-6, also showed significant improvements with liberal postoperative activities (MD, -4.29; 95% CI, -7.84 to -0.74; P = 0.02).

CONCLUSIONS: Patients with liberal postoperative physical activity recommendations in prolapse repair surgical procedures had similar short-term anatomic outcomes compared with standard restrictions, with more favorable outcomes in disease-specific symptom relief and quality of life.

PMID:39689229 | DOI:10.1097/SPV.0000000000001622

J Urol. 2024 Dec 17:101097JU0000000000004392. doi: 10.1097/JU.0000000000004392. Online ahead of print.

ABSTRACT

PURPOSE: Patients with refractory neurogenic bladder dysfunction may require urinary reconstruction due to severe incontinence, difficulty with catheterization, and to prevent upper urinary tract compromise. We evaluated long-term decisional regret and associated factors following urinary reconstruction in spinal cord injury patients.

MATERIALS AND METHODS: We interviewed patients with spinal cord injuries who underwent bladder reconstruction surgery at least ten years ago, administering validated surveys on bowel quality of life and dysfunction, urinary tract infections, and decisional regret. Daily bladder management and symptoms were assessed using the Neurogenic Bladder Symptom Score (NBSS), a validated questionnaire consisting of three domains that examine incontinence, storage and voiding, and other health and quality of life consequences of neurogenic lower urinary tract dysfunction. Demographics, injury characteristics, and surgical modality were collected through chart reviews. Decisional regret was compared among subgroups and correlated with patient-reported outcomes.

RESULTS: We evaluated 52 patients (41 men, 78.8%; mean age 54.9±10 years) with average follow-up of 30±8.6 years post-injury and 21.9±5.3 years post-surgery. Reconstruction procedures mostly included bladder augmentation (n=38, 73.1%) and augmentation with continent catheterizable stoma (n=9, 17.3%). The majority of patients were of Hispanic origin (n=41, 78.8%) with complete spinal cord injuries (n=39, 76%). The median decision regret score was 7.5 (interquartile range: 0-25), indicating low regret among most participants. Bladder irrigation frequency (p=0.002) was associated with decision regret, while other patient and surgical factors (e.g., demographics, urinary tract infection frequency, and surgery type) were not. Surgical regret was moderately correlated with diminished bowel-related quality of life (ρ=0.333, p=0.016) and increased NBSS score (ρ=0.328, p=0.018). The Incontinence (ρ=0.286, p=0.040) and Consequences (ρ=0.299, p=0.031) domains of this measure showed weak statistically significant correlations with regret, while the Storage and Voiding domain did not reach significance (ρ=0.245, p=0.080).

CONCLUSIONS: Long-term follow-up suggests that lower urinary tract reconstruction with bowel interposition is a well-accepted and durable approach for managing refractory neurogenic bladder. Factors associated with decision regret, such as need for irrigation, should be incorporated in patient-centered decision-making.

PMID:39689225 | DOI:10.1097/JU.0000000000004392

Pol Merkur Lekarski. 2024;52(5):604-609. doi: 10.36740/Merkur202405120.

ABSTRACT

OBJECTIVE: Aim: To assess the level of occupational safety, health and hygiene of healthcare workers in the terms of the COVID-19 pandemic..

PATIENTS AND METHODS: Materials and Methods: bibliosemantic, bibliographic, analytical, statistical methods as well as a systemic approach have been used in the research. The data of the Cabinet of Ministers of Ukraine, the Ministry of Health of Ukraine, the State Labour Service and the scientific research findings from open sources have been analyzed.

CONCLUSION: Conclusions: The safety of healthcare workers with regard to infection is essential for a secure hospital environment. From an infection prevention perspective, PPE and sanitary requirements are fundamental to ensuring a safe environment for healthcare workers. The analysis revealed inadequate provision of PPE for healthcare workers during the pandemic, with levels ranging from 61,25% to 63,63%. The risk of contracting the novel coronavirus among healthcare personel during the pandemic was 12 times higher than in the general population. The risk of developing an occupational disease among those who treated patients infected with SARS-CoV-2 was 58,1 times higher. The analysis revealed that the provision of personal protective equipment (PPE) to healthcare workers during the study period was only two-thirds of the required amount, which consequently elevated the risk and incidence of morbidity among healthcare workers.

PMID:39689211 | DOI:10.36740/Merkur202405120

Pol Merkur Lekarski. 2024;52(5):562-567. doi: 10.36740/Merkur202405113.

ABSTRACT

OBJECTIVE: Aim: The aim of the study was evaluation of the methionine-enkephalin in patients with severe COVID-19 with various activities of the renin-aldosterone system in comparison with COVID-19 patients with pre-existing comorbidities (renal cell cancer, critical limb ischemia) and adverse pregnancy outcomes..

PATIENTS AND METHODS: Materials and Methods: To test our hypothesis, this case-control study consisted of 20 healthy donors (control group); 49 patients with a positive diagnosis of COVID-19 according to PCR analysis; 15 patients with a positive diagnosis of COVID-19 in combination with renal cell cancer; 29 patients with a positive diagnosis of COVID-19 in combination with critical limb ischemia, 10 pregnant womens with COVID-19. Methionine-enkephalin, plasma renin activity, plasma aldosterone was measured by radioimmunoassay. Statistical and graphical analyses were done using Statistica 7.0 StatSoft software and using MedCalc.

RESULTS: Results: As our results have shown, hyperreninemia against the background of hypoaldosteronism and inhibition of enkephalinergic activity is fatal for COVID-19 patients. In COVID-19 patients with renal cell carcinoma, met-enkephalin, aldsterone, and plasma renin activity also showed a high predictive value for mortality. Whereas in patients with critical limb ischemia the strongest predictor biomarkers of mortality were only renin plasma activity. In conditions of physiological hyperreninemia during pregnancy, met-enkephalin acts as a biomarker for preterm birth, and in pregnant patients with COVID-19, plasma renin activity acts as such a biomarker.

CONCLUSION: Conclusions: We found that in different categories of patients with COVID-19, the severity and outcome depend on the different activity of the renin-angiotensinaldosterone and enkephalinergic systems.

PMID:39689204 | DOI:10.36740/Merkur202405113

Pol Merkur Lekarski. 2024;52(5):557-561. doi: 10.36740/Merkur202405112.

ABSTRACT

OBJECTIVE: Aim: To study the psychological peculiarities of the manifestation of leadership qualities by modern managers of police organizations..

PATIENTS AND METHODS: Materials and Methods: The research conducted in 2022-2024 involved 64 mid-level managers of police organizations and 462 officers from police units directly subordinated to these managers. Research methods: bibliosemantic, psychological and diagnostic, system analysis and generalization method, statistical.

RESULTS: Results: It has been found that a significant number of modern mid-level managers of police organizations are not inclined to show leadership in their units. It has been found that 15,6% of today’s mid-level managers demonstrate low leadership. The average level of leadership qualities was recorded in 50,0% of managers, and this result generally coincides with the opinion of officers (51,1%). A sufficient level of leadership qualities of managers, which ensures the effectiveness of their management activities, was identified in 34,4% of respondents. It has been determined that a third of the respondents in both groups (35,9% of managers; 33,3% of officers) believe that the efficiency of management activities is above average and can be improved through various measures and means.

CONCLUSION: Conclusions: The obtained results indicate the practicality of using an integrated approach to developing leadership qualities and skills of successful team management (at the subsequent stages of work with personnel). Also this indicates problems in the organization of professional selection and psychological support of police managers.

PMID:39689203 | DOI:10.36740/Merkur202405112

Pol Merkur Lekarski. 2024;52(5):547-556. doi: 10.36740/Merkur202405111.

ABSTRACT

OBJECTIVE: Aim: The purpose of this study is to comprehensively assess the workload of general practitioners using the time study and the WISN method..

PATIENTS AND METHODS: Materials and Methods: Time studies are used to assess the objective workload of physicians, by measuring the duration of physicians’ activities, and the WISN method, which is based on the workload of a health care professional and determines how many health care professionals of a certain type are needed to cope with the workload of a given health care facility.

RESULTS: Results: The results show that general practitioners spend short period of time for one patient visits, which may be conditioned by high patient attendance. In addition, general practitioners perform unusual functional duties. When calculated based on the Republican standard, the needs assessment by the WISN method showed that there is a shortage of general practitioners in outpatient clinics.

CONCLUSION: Conclusions: The needs assessment for the first and second scenarios shows that general practitioners cope with the workload of receiving patients, so the WISN assessment shows that there is a surplus of general practitioners.

PMID:39689202 | DOI:10.36740/Merkur202405111

Pol Merkur Lekarski. 2024;52(5):536-540. doi: 10.36740/Merkur202405109.

ABSTRACT

OBJECTIVE: . Aim: To find out the influence of melatonin on the enzyme activities of glucose-6-phosphate dehydrogenase, 6-phosphogluconate dehydrogenase and transketolase in the liver of rats with alloxan diabetes under conditions of variable photoperiod.

PATIENTS AND METHODS: Materials and Methods: Experiments were conducted on male outbred white rats weighing 180±10 mg. Photoperiodic changes: 1) equinox (light from 8:00 a.m. to 8:00 p.m., 500 lux); 2) light throughout the day and night (500 lux); 3) darkness. Alloxan diabetes was induced by administration of a 5% solution of alloxan monohydrate at a dose of 170 mg/kg once. Groups: 1) control; 2) rats with diabetes mellitus; 3) rats with diabetes mellitus and melatonin injections at the rate of 10 mg/kg of weight for a week daily. Rats were sacrificed on the 12th day in accordance with the ethical principles of experiments on animals. Enzyme activities were determined according to standard methods. Statistical processing was performed according to Statistica 10 StatSoft Inc.

RESULTS: Results: In the liver of rats with diabetes mellitus, under the conditions of equinox activities of investigated enzymes decreased by 42, 32 and 40%, while an administration of melatonin let to: 1) an increase in enzyme activities by 40, 31, and 25%, respectively; 2) normalization under conditions of darkness; 3) an increase of the activities by 87, 120, and 60%, respectively in light conditions, compared to the control of equinox.

CONCLUSION: Conclusions: Melatonin contributed to the restoration of the amphibolic and energetic function of the pentose phosphate pathway of glucose-6-phosphate oxidation in liver of rats with alloxan diabetes under condition of variable photoperiod.

PMID:39689200 | DOI:10.36740/Merkur202405109