Tag: pubmed

Med J Aust. 2025 Sep 30. doi: 10.5694/mja2.70053. Online ahead of print.

ABSTRACT

OBJECTIVES: To quantify the cost of hospital separations attributable to environmental risk factors in the Northern Territory, including for Indigenous and remote subgroups.

STUDY DESIGN: A retrospective cross-sectional secondary data analysis of hospital separations data. Data collection, analysis and presentation were guided by our Indigenous Steering Committee.

SETTING AND PARTICIPANTS: All episodes of care from 1 July 2021 to 30 June 2022 with an inpatient separation (discharge, transfer, death) from NT public hospitals were included. Non-inpatient episodes of care (outpatient, emergency department and primary care presentations) were excluded.

MAJOR OUTCOME MEASURES: Individual hospital separations were classified as environmentally attributable if the International statistical classification of diseases and related health problems, 10th revision, Australian modification (ICD-10-AM) code for their primary diagnosis matched an included disease. Included diseases were based on environmental attributable fractions previously generated for the Kimberley region, contextualised to the NT. Costs were assigned to individual hospital separations based on activity-based funding allocations.

RESULTS: Environmental risk factors contributed more than $72 million to inpatient hospital costs in the NT over 1 year. Environmental risks disproportionately affected children aged 0-4 years ($10.9 million), Indigenous people ($47.2 million) and those in remote areas ($41.7 million). Skin disease made up the largest contribution by a single disease ($26.4 million). The two largest categories of environmental risk were “water quality, sanitation and hygiene” and “home condition”, together contributing $37.3 million in costs.

CONCLUSIONS: Quantifying the economic impact of preventable environmental risk in the NT bolsters the argument for strengthening environmental health initiatives. Health disparities between groups reflect the interconnectedness of environmental, social and cultural determinants of health. Targeted interventions to reduce inequities in housing, sanitation and water quality are needed. Delivering on existing environmental health commitments through meaningful partnerships and coordinated action across sectors such as housing and education is essential, particularly within the Northern Territory Implementation Plan on Closing the Gap.

PMID:41025242 | DOI:10.5694/mja2.70053

Stroke. 2025 Sep 30. doi: 10.1161/STROKEAHA.125.052545. Online ahead of print.

ABSTRACT

BACKGROUND: The take charge intervention-a conversation-based, community intervention to improve motivation, improved independence, and physical health 12 months after stroke in 2 randomized controlled trials with 572 participants. This article reports long-term outcomes for the 400 participants in the TaCAS study (Taking Charge After Stroke).

METHODS: Follow-up study of a New Zealand multicenter, randomized, controlled, parallel-group trial. Outcomes were collected by postal questionnaire or telephone call. The TaCAS study recruited 400 participants discharged after stroke, randomized within 16 weeks to one of 3 groups: 1 session of the take charge intervention, 2 sessions 6 weeks apart, or no sessions (control). This study is of participants still alive and willing to answer a questionnaire 5 to 6 years after their index stroke, undertaken in 2022. The primary outcome was the Physical Component Summary of the Short Form 36, comparing the take charge intervention and control. Secondary outcomes were: Frenchay Activities Index; modified Rankin Scale (mRS); survival; and stroke recurrence. These outcomes were compared with those 12 months after stroke. Analysis was by ANOVA or logistic regression.

RESULTS: Mortality data were available for all 400 participants, and functional data for 204/297 (69%) of survivors. The mean difference (95% CI) in Physical Component Summary between take charge and control groups was 2.8 (-0.8 to 6.5) units, P=0.12, and for independence (modified Rankin Scale score, 0-2) the odds ratio (95% CI) was 0.56 (0.28-1.16), P=0.11, both favoring take charge with similar point estimates to those after 12 months. Differences between take charge and control participants for Frenchay Activities Index scores, survival, and stroke recurrence were small and nonsignificant.

CONCLUSIONS: The clinically significant improvements in physical health and independence for take charge participants, observed at 12 months, were sustained 5 to 6 years after stroke, but no longer statistically significant.

REGISTRATION: URL: https://anzctr.org.au; Unique identifier: ACTRN12622000311752.

PMID:41025238 | DOI:10.1161/STROKEAHA.125.052545

Disaster Med Public Health Prep. 2025 Sep 30;19:e285. doi: 10.1017/dmp.2025.10213.

ABSTRACT

OBJECTIVE: Exertional heat stroke (EHS) occurs when core body temperature exceeds 40°C (104°F) with central nervous system dysfunction and has been identified as a leading cause of morbidity and mortality among endurance athletes. With rapid identification and treatment, survival approaches 100%. This study describes the clinical presentation and course of seven patients transported by emergency medical services from a half marathon with EHS.

METHODS: The 2022 Cambridge Half Marathon occurred during unusually warm weather, with a did not finish rate of 2%. Retrospective review was performed of seven patients transported during the race to an urban, level I trauma center with EHS.

RESULTS: Seven patients transported to the study site were included for analysis. All patients treated with cold water immersion at scene were discharged from the emergency department. Three patients without treatment on scene required admission to the intensive care unit. Descriptions of all patients are provided.

CONCLUSIONS: Lessons learned from this event include the importance of rapid cooling, the role of event-day communications, the varied impacts on emergency department operations, and the increasing need to anticipate such events outside of traditional warm weather seasons.

PMID:41025212 | DOI:10.1017/dmp.2025.10213

Reumatismo. 2025 Sep 25. doi: 10.4081/reumatismo.2025.1773. Online ahead of print.

ABSTRACT

OBJECTIVE: Systemic sclerosis (SSc) is a multisystem autoimmune disease of heterogeneous pathogenesis, including vascular, immunologic, genetic, epigenetic, and environmental factors. Progressive fibrosis is the hallmark of SSc. Intense research has been conducted to unveil new tools for early diagnosis and management, thus reducing morbidity and mortality. miR-21 has recently been considered to play an important role in the fibrosis of SSc. The objective of this study was to evaluate miR-21 levels in SSc patients and study its correlation to the extent of skin fibrosis and association with various clinical characteristics.

METHODS: A total of 25 patients with SSc who fulfilled the American College of Rheumatology/European Alliance of Associations for Rheumatology 2013 classification criteria, as well as 25 controls, were enrolled in a cross-sectional study. The extent of skin fibrosis was evaluated using the modified Rodnan skin score, and disease severity was assessed using the Medsger severity score. The levels of miR-21 were measured by quantitative real-time polymerase chain reaction. The 2-ΔΔCt method was used for analysis. SSc patients affected by diabetes mellitus, hypertension, renal impairment, heart disease, malignancy, other autoimmune diseases, or a history of serious acute infection within 6 weeks were excluded.

RESULTS: There was a high statistically significant difference in miR-21 levels between cases and controls (p<0.001). At a cut-off level of 2.55, miR21 could discriminate between SSc patients and controls with sensitivity and specificity. There was no significant correlation between miR-21 levels and the degree of skin fibrosis. There was a significant positive association between miR-21 levels and the presence of arthritis in SSc patients (p=0.007).

CONCLUSIONS: miR-21 was suggested as a robust diagnostic biomarker in SSc with exceptional superiority over the traditionally utilized antibodies. Additionally, due to its association with arthritis, it is supposed to play a proinflammatory role in addition to its pronounced profibrotic effects. Interestingly, the profibrotic miR-21 may not reflect the extent of skin fibrosis.

PMID:41025207 | DOI:10.4081/reumatismo.2025.1773

Disaster Med Public Health Prep. 2025 Sep 30;19:e283. doi: 10.1017/dmp.2025.10193.

ABSTRACT

The Flint water crisis was a lead-in-water disaster that occurred in Flint, Michigan. The Center for Children’s Integrated Services Assessment Center (CISAC) was established to provide neuropsychological assessments and recommendations for exposed children. Our objective was to describe the implementation of the CISAC and report the clinical diagnoses of the first cohort of children who received comprehensive assessments. The CISAC’s eligibility criteria were broad and allowed referrals from physicians, schools, community organizations, and parents. A cross-sectional, descriptive analysis was conducted for 376 children who received initial neurodevelopmental assessments. About 60% of assessed children (ages 3-18) were diagnosed with ADHD, and 70% were diagnosed with ≥2 conditions. Most (96.8%) children received recommendations for new or continued educational, medical, and mental health services. Recognizing the implications of lead exposure and community-wide trauma on neuropsychological trajectories, the CISAC provides longitudinal assessments, secondary prevention efforts to mitigate potential sequelae, and trauma-informed treatment.

PMID:41025206 | DOI:10.1017/dmp.2025.10193

Geospat Health. 2025 Jul 7;20(2). doi: 10.4081/gh.2025.1408. Epub 2025 Sep 29.

ABSTRACT

An important area of use of the geographic information systems in health is the organization of Emergency Medical Services (EMS). In this study, the EMS application offered in Turkey’s 81 provinces, in particular, Istanbul metropolis, which has the highest population in the country, was examined with a statistical approach. It was determined that the correlation level between the number of EMS stations and the population of the 39 districts of Istanbul was higher compared to the land area and population density; the number of EMS stations in the Fatih District was significantly greater than the median value of the number of EMS stations in all districts of Istanbul. It was determined that the number of EMS stations, ambulances, and hospitals in Istanbul is significantly greater than the median value of all provinces in Turkey; the population density per hospital and EMS station in Istanbul is significantly greater than the median value of all provinces, and the area value is smaller than the median value of all provinces. Ambulance response time, hospital transfer time and reasons for delays at these stages were questioned through a survey. The most common reasons for delay were traffic congestion, followed by the few and far distances of ambulance stations. Considering the problems arising from the geographical location of EMS stations and hospitals, it is expected that taking population density into account when planning EMS station distribution would contribute to increased efficiency in EMS and equality in access to services.

PMID:41025202 | DOI:10.4081/gh.2025.1408

Ann Agric Environ Med. 2025 Sep 18;32(3):411-417. doi: 10.26444/aaem/204854. Epub 2025 Jun 4.

ABSTRACT

INTRODUCTION AND OBJECTIVE: Health behaviour is a set of activities that affect an individual’s well-being and attitude toward health. These behaviours are shaped by socio-demographic characteristics, social circumstances, cultural background, personality traits, and the mass media. The health of an individual is largely determined, among other factors, by his/her actions, decisions, and the resulting outcomes. The health locus of control affects an individual’s adherence to health-related recommendations. The aim of the study is to examine the association between the health locus of control and declared health behaviours in Polish women in the setting of breast cancer prevention.

MATERIAL AND METHODS: The study included 407 women between the age of 45 and 69 years (mean: 54.86, SD: 6.718), selected using convenience sampling. The research was conducted at the Medical University of Warsaw between March 2021 – May 2022, using convenience sampling. The research tool was a survey consisting of an author-designed questionnaire, the Multidimensional Health Locus of Control Scale, and the Health Behaviour Inventory Correlation analysis between scales from HBI questionnaire and scales from MHLC-B questionnaire was conducted.

RESULTS: Correlation analysis showed that the internal health locus of control was positively correlated with healthy nutrition habits, preventive behaviours, and positive adjustment. Additionally, the external health locus of control was also positively correlated with preventive behaviours, positive adjustments, and health-promoting practices. In contrast, a higher belief in the influence of chance was inversely correlated with healthy nutrition habits and positive adjustment.

CONCLUSIONS: Psychological factors influencing women’s attitudes towards preventive behaviours can help in the planning of preventive measures. An increase in the internal health locus of control may translate into a higher participation rate in population-based screening programmes.

PMID:41025188 | DOI:10.26444/aaem/204854

Ann Agric Environ Med. 2025 Sep 18;32(3):398-44. doi: 10.26444/aaem/196268. Epub 2024 Dec 17.

ABSTRACT

INTRODUCTION AND OBJECTIVE: Hiking is becoming an increasingly popular leisure activity, practised due to its benefits, often regardless of people’s exercise capacity and Body Mass Index (BMI) values. The aim of the study was to investigate the relationship between the level of daily physical activity and BMI, as well as the incidence and severity of injuries experienced during hiking.

MATERIAL AND METHODS: A total of 230 individuals fulfilled completed questionnaire forms. Questionnaires were distributed via Google form between 15 January 2021 and 23 February 2021. A modified Global Physical Activity Questionnaire (GPAQ) and BMI values were used to check how the hikers’ health and physical condition influenced the incidence and severity of trauma while hiking. 162 mountain hikers were included in the final analysis.

RESULTS: Using independence tests, it was shown that in the cases there was no relation between the created BMI categories and the occurrence of injury (p-value=0.708), or between physical activity groups and the occurrence of injury (p-value=1). The results also showed no statistically significant correlation between the severity of the injury sustained during hiking, or both daily physical activity level (p-value=0.754) and BMI value (p-value=0.854).

CONCLUSIONS: The study might indicate that proper, adjusted hiking could be the correct way of spending free time, regardless of pre-existing levels of physical activity and/or BMI.

PMID:41025186 | DOI:10.26444/aaem/196268

Ann Agric Environ Med. 2025 Sep 18;32(3):383-390. doi: 10.26444/aaem/208382. Epub 2025 Aug 6.

ABSTRACT

INTRODUCTION AND OBJECTIVE: Menstrual poverty lies at the intersection of poverty, sustainability, reproductive rights, and gender inequality. The study investigates menstrual poverty among women affected by the 2023 earthquake in Turkey.

MATERIAL AND METHODS: A descriptive cross-sectional study was conducted between 24 April – 24 May 2023 with 400 women impacted by the earthquake. Data were collected via social media using a survey form. Chi-square tests, Bonferroni test, and binary logistic regression model were used for statistical analysis.

RESULTS: The mean age of participants was 27.27 ± 8.40 years; 69.5% had higher education, 57.0% lived in urban areas, and 90.5% had no chronic disease. A significant relationship was found between access to menstrual products and basic needs (clean water, toilet paper, soap, safe toilet access, and healthcare) during menstruation after the earthquake (p<0.05). A significant correlation was also observed between disruptions to the menstrual cycle and the following variables: lack of privacy, perception that lack of privacy affected menstruation, healthcare access, and difficulty obtaining menstrual products (p<0.05).

CONCLUSIONS: Most participants faced difficulties accessing menstrual products, water, hygiene supplies, privacy, and healthcare. Those living in tents or containers reported greater challenges. These barriers contributed to menstrual poverty and impacted women’s cycles. As menstrual health and hygiene are basic needs and human rights, menstrual poverty must be addressed globally.

PMID:41025184 | DOI:10.26444/aaem/208382

Ann Agric Environ Med. 2025 Sep 18;32(3):377-382. doi: 10.26444/aaem/207636. Epub 2025 Jul 8.

ABSTRACT

INTRODUCTION AND OBJECTIVE: Learning effectiveness is a key element in the educational process that determines how effectively students can assimilate, store, and apply the knowledge acquired. There are many approaches and theories in the research literature exploring the different aspects of this process. Factors influencing learning effectiveness include learning style, motivation, learning techniques, and learning environment. Learning effectiveness also depends on individual student characteristics, including socio-demographic characteristics. The aim of the study is to verify the influence of socio-demographic characteristics on the assessment of the effectiveness of medical simulation as a learning method, using the standardised EPQ tool.

MATERIAL AND METHODS: The study was conducted between 2023-2024 among 306 nursing students by means of a diagnostic survey, using the survey instrument EPQ.

RESULTS: The surveyed students rated the educational techniques best in terms of collaboration. Statistical analysis showed a weak negative correlation between age and the evaluation of active learning, expectations, and the overall evaluation of educational techniques. Statistically significant results were obtained in the correlation of place of residence with the evaluation of educational practices.

CONCLUSIONS: The study showed a general relationship of the influence of selected socio-demographic characteristics on the evaluation of educational practices in medical simulation. Despite the occurrence of a relationship, the age of the subjects did not determine the outcome of the simulation effectiveness evaluation. There is a lack of detailed research in the available literature on the influence of socio-demographic variables on the evaluation of medical simulation educational practices, which allowed the identification of a research gap (white gap).

PMID:41025183 | DOI:10.26444/aaem/207636