Tag: pubmed

JAMA Netw Open. 2024 Feb 5;7(2):e2356609. doi: 10.1001/jamanetworkopen.2023.56609.

ABSTRACT

IMPORTANCE: In resource-constrained settings where the neonatal mortality rate (NMR) is high due to preventable causes and health systems are underused, community-based interventions can increase newborn survival by improving health care practices.

OBJECTIVES: To develop and evaluate the effectiveness of a community-based maternal and newborn care services package to reduce perinatal and neonatal mortality in rural Pakistan.

DESIGN, SETTING, AND PARTICIPANTS: This cluster randomized clinical trial was conducted between November 1, 2012, and December 31, 2013, in district Rahim Yar Khan in the province of Punjab. A cluster was defined as an administrative union council. Any consenting pregnant resident of the study area, regardless of gestational age, was enrolled. An ongoing pregnancy surveillance system identified 12 529 and 12 333 pregnancies in the intervention and control clusters, respectively; 9410 pregnancies were excluded from analysis due to continuation of pregnancy at the end of the study, loss to follow-up, or miscarriage. Participants were followed up until the 40th postpartum day. Statistical analysis was performed from January to May 2014.

INTERVENTION: A maternal and newborn health pack, training for community- and facility-based health care professionals, and community mobilization through counseling and education sessions.

MAIN OUTCOMES AND MEASURES: The primary outcome was perinatal mortality, defined as stillbirths per 1000 births and neonatal death within 7 days per 1000 live births. The secondary outcome was neonatal mortality, defined as death within 28 days of life per 1000 live births. Systematic random sampling was used to allocate 10 clusters each to intervention and control groups. Analysis was conducted on a modified intention-to-treat basis.

RESULTS: For the control group vs the intervention group, the total number of households was 33 188 vs 34 315, the median number of households per cluster was 3092 (IQR, 3018-3467) vs 3469 (IQR, 3019-4075), the total population was 229 155 vs 234 674, the mean (SD) number of residents per household was 6.9 (9.5) vs 6.8 (9.6), the number of males per 100 females (ie, the sex ratio) was 104.2 vs 103.7, and the mean (SD) number of children younger than 5 years per household was 1.0 (4.2) vs 1.0 (4.3). Altogether, 7598 births from conrol clusters and 8017 births from intervention clusters were analyzed. There was no significant difference in perinatal mortality between the intervention and control clusters (rate ratio, 0.86; 95% CI, 0.69-1.08; P = .19). The NMR was lower among the intervention than the control clusters (39.2/1000 live births vs 52.2/1000 live births; rate ratio, 0.75; 95% CI, 0.58-0.95; P = .02). The frequencies of antenatal visits and facility births were similar between the 2 groups. However, clean delivery practices were higher among intervention clusters than control clusters (63.2% [2284 of 3616] vs 13.2% [455 of 3458]; P < .001). Chlorhexidine use was also more common among intervention clusters than control clusters (55.9% [4271 of 7642] vs 0.3% [19 of 7203]; P < .001).

CONCLUSIONS AND RELEVANCE: This pragmatic cluster randomized clinical trial demonstrated a reduction in NMR that occurred in the background of improved household intrapartum and newborn care practices. However, the effect of the intervention on antenatal visits, facility births, and perinatal mortality rates was inconclusive, highlighting areas requiring further research. Nevertheless, the improvement in NMR underscores the effectiveness of community-based programs in low-resource settings.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01751945.

PMID:38372998 | DOI:10.1001/jamanetworkopen.2023.56609

JAMA Netw Open. 2024 Feb 5;7(2):e2356787. doi: 10.1001/jamanetworkopen.2023.56787.

ABSTRACT

IMPORTANCE: Despite decades of neuroimaging studies reporting brain structural and functional alterations in depression, discrepancies in findings across studies and limited convergence across meta-analyses have raised questions about the consistency and robustness of the observed brain phenotypes.

OBJECTIVE: To investigate the associations between 6 operational criteria of lifetime exposure to depression and functional and structural neuroimaging measures.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study analyzed data from a UK Biobank cohort of individuals aged 45 to 80 years who were enrolled between January 1, 2014, and December 31, 2018. Participants included individuals with a lifetime exposure to depression and matched healthy controls without indications of psychosis, mental illness, behavior disorder, and disease of the nervous system. Six operational criteria of lifetime exposure to depression were evaluated: help seeking for depression; self-reported depression; antidepressant use; depression definition by Smith et al; hospital International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnosis codes F32 and F33; and Composite International Diagnostic Interview Short Form score. Six increasingly restrictive depression definitions and groups were defined based on the 6 depression criteria, ranging from meeting only 1 criterion to meeting all 6 criteria. Data were analyzed between January and October 2022.

MAIN OUTCOMES AND MEASURES: Functional measures were calculated using voxel-wise fractional amplitude of low-frequency fluctuation (fALFF), global correlation (GCOR), and local correlation (LCOR). Structural measures were calculated using gray matter volume (GMV).

RESULTS: The study included 20 484 individuals with lifetime depression (12 645 females [61.7%]; mean [SD] age, 63.91 [7.60] years) and 25 462 healthy controls (14 078 males [55.3%]; mean [SD] age, 65.05 [7.8] years). Across all depression criteria, individuals with lifetime depression displayed regionally consistent decreases in fALFF, LCOR, and GCOR (Cohen d range, -0.53 [95% CI, -0.88 to -0.15] to -0.04 [95% CI, -0.07 to -0.01]) but not in GMV (Cohen d range, -0.47 [95 % CI, -0.75 to -0.12] to 0.26 [95% CI, 0.15-0.37]). Hospital ICD-10 diagnosis codes F32 and F33 (median [IQR] difference in effect sizes, -0.14 [-0.17 to -0.11]) and antidepressant use (median [IQR] difference in effect sizes, -0.12 [-0.16 to -0.10]) were criteria associated with the most pronounced alterations.

CONCLUSIONS AND RELEVANCE: Results of this cross-sectional study indicate that lifetime exposure to depression was associated with robust functional changes, with a more restrictive depression definition revealing more pronounced alterations. Different inclusion criteria for depression may be associated with the substantial variation in imaging findings reported in the literature.

PMID:38372997 | DOI:10.1001/jamanetworkopen.2023.56787

JAMA Netw Open. 2024 Feb 5;7(2):e2356863. doi: 10.1001/jamanetworkopen.2023.56863.

ABSTRACT

IMPORTANCE: While epinephrine and advanced airway management (AAM) (supraglottic airway insertion and endotracheal intubation) are commonly used for out-of-hospital cardiac arrest (OHCA), the optimal sequence of these interventions remains unclear.

OBJECTIVE: To evaluate the association of the sequence of epinephrine administration and AAM with patient outcomes after OHCA.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study analyzed the nationwide, population-based OHCA registry in Japan and included adults (aged ≥18 years) with OHCA for whom emergency medical services personnel administered epinephrine and/or placed an advanced airway between January 1, 2014, and December 31, 2019. The data analysis was performed between October 1, 2022, and May 12, 2023.

EXPOSURE: The sequence of intravenous epinephrine administration and AAM.

MAIN OUTCOMES AND MEASURES: The primary outcome was 1-month survival. Secondary outcomes were 1-month survival with favorable functional status and prehospital return of spontaneous circulation. To control imbalances in measured patient demographics, cardiac arrest characteristics, and bystander and prehospital interventions, propensity scores and inverse probability of treatment weighting (IPTW) were performed for shockable and nonshockable initial rhythm subcohorts.

RESULTS: Of 259 237 eligible patients (median [IQR] age, 79 [69-86] years), 152 289 (58.7%) were male. A total of 21 592 patients (8.3%) had an initial shockable rhythm, and 237 645 (91.7%) had an initial nonshockable rhythm. Using IPTW, all covariates between the epinephrine-first and AAM-first groups were well balanced, with all standardized mean differences less than 0.100. After IPTW, the epinephrine-first group had a higher likelihood of 1-month survival for both shockable (odds ratio [OR], 1.19; 95% CI, 1.09-1.30) and nonshockable (OR, 1.28; 95% CI, 1.19-1.37) rhythms compared with the AAM-first group. For the secondary outcomes, the epinephrine-first group experienced an increased likelihood of favorable functional status and prehospital return of spontaneous circulation for both shockable and nonshockable rhythms compared with the AAM-first group.

CONCLUSIONS AND RELEVANCE: These findings suggest that for patients with OHCA, administration of epinephrine before placement of an advanced airway may be the optimal treatment sequence for improved patient outcomes.

PMID:38372996 | DOI:10.1001/jamanetworkopen.2023.56863

Isotopes Environ Health Stud. 2024 Feb 19:1-19. doi: 10.1080/10256016.2024.2316584. Online ahead of print.

ABSTRACT

We investigated the stable isotope hydrology of Sable Island, Nova Scotia, Canada over a five year period from September, 2017 to August, 2022. The δ²H and δ¹⁸O values of integrated monthly precipitation were weakly seasonal and ranged from -66 to -15 ‰ and from -9.7 to -1.9 ‰, respectively. Fitting these monthly precipitation data resulted in a local meteoric water line (LMWL) defined by: δ²H = 7.22 ± 0.21 · δ¹⁸O + 7.50 ± 1.22 ‰. Amount-weighted annual precipitation had δ²H and δ¹⁸O values of -36 ± 11 ‰ and -6.1 ± 1.4 ‰, respectively. Deep groundwater had more negative δ²H and δ¹⁸O values than mean annual precipitation, suggesting recharge occurs mainly in the winter, while shallow groundwater had δ²H and δ¹⁸O values more consistent with mean annual precipitation or mixing of freshwater with local seawater. Surface waters had more positive values and showed evidence of isolation from the groundwater system. The stable isotopic compositions of plant (leaf) water, on the other hand, indicate plants use groundwater as their source. Fog had δ²H and δ¹⁸O values that were significantly more positive than those of local precipitation, yet had similar ¹⁷O-excess values. δ²H values of horsehair from 4 individuals lacked seasonality, but had variations typical to those of precipitation on the island. Differences in mean δ²H values of horsehair were statistically significant and suggest variations in water use may exist between spatially disparate horse communities. Our results establish an important initial framework for ongoing isotope studies of feral horses and other wildlife on Sable Island.

PMID:38372972 | DOI:10.1080/10256016.2024.2316584

Psychooncology. 2024 Feb;33(2):e6306. doi: 10.1002/pon.6306.

ABSTRACT

OBJECTIVE: Hematopoietic stem cell transplantation (HSCT) is considered an integral part of therapy in many hematological and non-hematological malignancies. The procedure can be highly stressful for patients. The primary objective of this study was to compare stress assessments in HSCT patients, depending on their stress coping style (CS) and type of treatment (autologous vs. allogeneic HSCT).

METHODS: A short longitudinal study was conducted between May 2021 and June 2023 among patients with hematological cancers undergoing HSCT. The study involved four time points: the day of admission to hospital – T1, the day before HSCT – T2, 6 days after HSCT – T3, and the day of discharge – T4. Participants completed the Coping Inventory for Stressful Situations (CISS) on T1, and the Distress Thermometer (DT) on T1-T4. Descriptive statistics and a repeated measures ANOVA were conducted.

RESULTS: A total of 128 participants completed the study: 54.2% female, mean age 48.7 years. They were divided into: (1) five groups based on their CS: task-oriented, emotion-oriented, avoidance-oriented, mix-oriented, differential-oriented; (2) two groups based on treatment type. The analyses showed significant differences in stress between the CS study groups (p = 0.001). The emotion-oriented group had the highest stress levels during the hospitalization period. There was also a significant time effect (p < 0.001): stress levels increased during the hospitalization period, peaking 6 days after HSCT, and decreased at discharge.

CONCLUSIONS: Stress levels depend on coping styles and time points during the hospitalization period, which should be taken into account in planning psychological interventions for HSCT patients.

PMID:38372968 | DOI:10.1002/pon.6306

Updates Surg. 2024 Feb 19. doi: 10.1007/s13304-024-01755-0. Online ahead of print.

ABSTRACT

Ventral abdominal wall incisional hernia is defined as a defect in the musculo-fascial layers of the abdominal wall in the region of the postoperative scar. There is a slight increase in the incidence of incisional hernia in the female gender. The higher percentage of incisional hernia in females might be due to laxity of abdominal wall muscles after multiple pregnancies and also an increased incidence of obesity in females. To assess incisional hernia repair using two different techniques: on-lay mesh and sub-lay mesh, as regards operative time, postoperative recurrence, wound infection, seroma, hematoma, and flap necrosis. Pubmed, Web of Science, and Scopus were searched on 15 March 2022. The keywords incisional hernia, sub-lay mesh on-lay mesh, retromuscular mesh, and polypropylene. According to our results, there is a statistical difference between onlay and sublay regarding intra-operative time as sublay mesh is more time-consuming. Regarding postoperative complications, there is no statistical difference in recurrence, seroma, hematoma, flap necrosis, and infection but there is a statistical difference regarding in hospital stay as patients with sub-lay repair stays less than only.

PMID:38372955 | DOI:10.1007/s13304-024-01755-0

Ir J Med Sci. 2024 Feb 19. doi: 10.1007/s11845-024-03636-2. Online ahead of print.

ABSTRACT

BACKGROUND: Tracheostomy is a crucial procedure in the management of neurosurgical patients, and determining the appropriate timing for the intervention remains a contentious issue. While some experts advocate for early tracheostomy, others recommend a more conservative approach of closely monitoring the patient’s condition before performing the procedure.

METHODS: To shed light on this debate, a retrospective observational cohort study was conducted on 78 cases who underwent tracheostomy in the neurosurgical ICU of Yashosai Hospital, Nanded, Maharashtra, between January and December 2022. The study relied on hospital records, and descriptive statistics were used to represent the quantitative data.

RESULTS: The study’s findings showed that the majority of the study subjects were male, with an average age of 46.3 + / – 15.2 years. The results suggested that early tracheostomy was associated with improved outcomes in terms of shorter durations of tracheostomy, hospital stays, ICU stays, and mechanical ventilation. However, the incidence of complications did not differ significantly between the early and late tracheostomy groups.

CONCLUSION: Overall, this study provides valuable insights into the optimal management of neurosurgical patients, with implications for clinical practice and patient outcomes.

PMID:38372946 | DOI:10.1007/s11845-024-03636-2

Environ Sci Pollut Res Int. 2024 Feb 19. doi: 10.1007/s11356-024-32484-x. Online ahead of print.

ABSTRACT

Amid China’s economic shift to high-quality development, addressing environmental challenges like greenhouse gas emissions and manufacturing pollution, there is a crucial demand for sustainable and eco-friendly development strategies. This study aims to investigate the impact of innovation efficiency in the high-tech industry on carbon emissions. It seeks to explore regional differences, mechanisms, and the influence of energy consumption structures in achieving sustainable development goals. Utilizing data from 30 provinces spanning 2009 to 2020, the study employs the DEA-Malmquist index model, spatial and temporal classification evaluation, and a panel measurement model to assess the efficiency of innovation and development in high-tech industries and their relationship with carbon emissions. The results indicate several key findings: (1) The overall operational efficiency of high-tech industry innovation and development in China is steadily increasing. However, there are distinct characteristics observed among provinces and cities, reflecting diverse input and output types. (2) High-tech industry innovation efficiency significantly contributes to carbon emission reduction, and there is regional heterogeneity in this impact. The central and western regions exhibit greater effects compared to other provinces and cities. (3) The optimization of the energy structure is identified as a mechanism through which high-tech industry innovation efficiency reduces carbon emissions. Moreover, different intervals of high-tech industry innovation efficiency yield varying effects on carbon emissions. This research underscores the importance of fostering high-tech industry innovation efficiency as a means to reduce carbon emissions. It also identifies key areas for future policy development and resource allocation, emphasizing the support needed for low-carbon technology research and development.

PMID:38372928 | DOI:10.1007/s11356-024-32484-x

Environ Sci Pollut Res Int. 2024 Feb 19. doi: 10.1007/s11356-024-32338-6. Online ahead of print.

ABSTRACT

While several research studies considered the utilization of reclaimed asphalt pavement (RAP) aggregates for asphalt and concrete pavements, very few attempted its possible utilization for precast concrete applications like concrete paver blocks (CPBs). Moreover, few attempts made in the recent past to improve the strength properties of RAP inclusive concrete mixes by incorporating certain supplementary cementitious materials (SCMs) have reported an insignificant or marginal effect. The present study attempts to comprehensively investigate the utilization potential of some locally and abundantly available materials having suitable physicochemical properties to improve the performance of a zero-slump CPB mix containing 50% RAP aggregates. The studied filler materials, namely, wollastonite (naturally occurring calcium metasilicate mineral) and jarosite (hazardous zinc industry waste), were used to replace 5-15% and 10-20% by volume of Portland cement in the 50% RAP CPB mix. Apart from their individual effects, the efficacy of wollastonite-jarosite blends was also investigated. Considering the lack of indoor storage facilities and economic aspects of CPBs, the influence of water spray curing regime on the performance of the RAP CPB mixes was studied and compared to that of continuous water curing regime. Inclusion of the considered fillers was found to statistically and significantly enhance the flexural strength, tensile splitting strength, and abrasion resistance of the 50% RAP CPB mix; however, the compressive strength (in most cases), permeable voids, water absorption, and water permeability properties showed an insignificant improvement. Results of thermogravimetric analysis confirmed the occurrence of pozzolanic reactivity, and microstructure analysis revealed improvements in packing of concrete matrix and ITZ with filler inclusion qualitatively substantiating the improvements in strength and durability characteristics. The toxicity characteristics of heavy metals that may leach from the hazardous jarosite-based RAP CPB mixes were found to be within permissible limits. Based on the performance requirements specified by IS, IRC, and ASTM standards, all the RAP CPB mixes with filler inclusions fulfilled the acceptance criteria for heavy traffic applications, and water spray curing can enact as an alternate method for curing these mixes. However, to avail maximum performance benefits, it is recommended to use 5% wollastonite, 15% jarosite, and a combination of 10% wollastonite and 10% jarosite as a Portland cement substitute to produce sustainable eco-friendly RAP CPB mixes.

PMID:38372924 | DOI:10.1007/s11356-024-32338-6

J Neurooncol. 2024 Feb 19. doi: 10.1007/s11060-023-04551-9. Online ahead of print.

ABSTRACT

PURPOSE: Bevacizumab has evolved as an integral treatment option for patients with high-grade gliomas. Little is known about clinical risk factors that predispose patients with high-grade gliomas receiving bevacizumab to VTE or ICH. We sought to characterize the clinical risk factors associated with risk of either event.

METHODS: In this multi-institutional retrospective study, we first evaluated patients with high-grade gliomas who were treated with bevacizumab at University of Texas MD Anderson Cancer Center from 2015-2021. We compared clinical and treatment-related factors among three cohorts: those who developed VTE, ICH, or neither. We further compared survival outcomes of these patients from the time of bevacizumab initiation. Then to further confirm our results in a non-cancer center hospital setting we evaluated patients from two Ascension Seton Hospitals in Austin, Texas which are affiliated with Dell Medical School at the University of Texas at Austin from 2017-2022.

RESULTS: We found that the presence of cerebral macrobleeding, defined as a magnetic susceptibility of > 1 cm³ on magnetic resonance imaging, was highly associated with risk of developing ICH after initiation of bevacizumab. Development of ICH was significantly associated with poorer survival outcomes. We did not find a statistically significant effect of VTE on survival after bevacizumab initiation.

CONCLUSION: In order to stratify the risk for developing ICH before the initiation of bevacizumab, we recommend to assess for the presence of cerebral macrobleeding as it is associated with ICH development.

PMID:38372903 | DOI:10.1007/s11060-023-04551-9