Tag: pubmed

Neurology. 2023 Jul 5:10.1212/WNL.0000000000207538. doi: 10.1212/WNL.0000000000207538. Online ahead of print.

ABSTRACT

BACKGROUND: and purpose: It is unclear whether intravenous thrombolysis (IVT) outperforms early dual antiplatelet therapy (DAPT) in the acute setting of mild ischemic stroke. The aim of this study was to compare early safety and efficacy of IVT to DAPT.

METHODS: Data of mild non-cardioembolic stroke patients with admission NIHSS <=3 who received IVT or early DAPT in the period 2018-2021 were extracted from a nationwide, prospective stroke unit registry. Study endpoints included symptomatic intracerebral hemorrhage (sICH), early neurological deterioration ≥4 NIHSS points (END), and 3-months functional outcome by modified Rankin Scale (mRS).

RESULTS: 1195 mild stroke patients treated with IVT and 2625 treated with DAPT were included. IVT patients were younger (68.1 versus 70.8 years), had less hypertension (72.8% versus 83.5%), diabetes (19% versus 28.8%) and history of myocardial infarction (7.6% versus 9.2%) and slightly higher admission NIHSS scores (median 2 versus median 1) as compared to DAPT patients. After propensity score matching and multivariable adjustment, IVT was associated with sICH (4 (1.2%) vs 0), END (aOR 2.8, CI 1.1-7.5), and there was no difference in mRS 0-1 at 3 months (aOR 1.3, CI 0.7-2.6).

CONCLUSIONS: This analysis from a prospective nationwide stroke unit network indicates that IVT is not superior to DAPT in the setting of mild non-cardioembolic stroke and may eventually be associated with harm. Further research focusing on acute therapy of mild stroke is highly warranted.

CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that IVT is not superior to dual antiplatelet therapy in patients with acute mild (NIHSS<=3) non-cardioembolic stroke. The study lacks the statistical precision to exclude clinically important superiority of either therapy.

PMID:37407270 | DOI:10.1212/WNL.0000000000207538

Infect Chemother. 2023 Jun;55(2):306-307. doi: 10.3947/ic.2023.0060.

NO ABSTRACT

PMID:37407245 | DOI:10.3947/ic.2023.0060

Infect Chemother. 2023 Jun;55(2):237-246. doi: 10.3947/ic.2023.0028.

ABSTRACT

BACKGROUND: This study aimed to identify the trends in pharmaceutical expenditure (PE), share of PE in health expenditure (HE), and trends in expenditure by pharmacological groups (ATC level 1 classification) in Korea for a 10-year period (2011 – 2020) and compare the data with those of other Organisation for Economic Co-operation and Development (OECD) countries. Using the findings, we determined the current status of pharmaceutical expenditure (PE) management in Korea and derived the implications for establishing future macroscopic policies on PE.

MATERIALS AND METHODS: We analyzed the OECD Health Statistics and the Korean national health insurance claims database from January 2011 through December 2020. The outcome measures were HE, PE, and pharmaceutical sales data for ATC level 1 medicines from OECD Health Statistics data during 2011 – 2020. As OECD collects limited ATC level 1 data, we used the HIRA health insurance claims data for PEs of ATC level-1 classification, including D, L, P, and S.

RESULTS: PE in Korea increased by 38.5% from 19.9 billion USD in 2011 to 27.6 billion USD in 2020, whereas the share of PE in HE decreased by 6.3%p from 26.4% in 2011 to 20.1% in 2020. In 2020, Korea ranked third in PE per capita (760.9 USD PPP) and had the highest share of PE (20.1%) among the 19 OECD countries studied. By ATC level 1 class, the highest PE was A (alimentary tract and metabolism) at 4.3 billion USD, and L (antineoplastic and immunomodulating agents) had the highest increase at 13.4%; in contrast, J (anti-infectives for systemic use) had the lowest increase in annual average PE at -0.2% in 2020 relative to 2011. Among the 17 OECD countries, Korea had the highest and the third-highest expenditures for ATC codes A and J, respectively.

CONCLUSION: PE in Korea has continued to increase between 2011 and 2020, indicating the need for macroscopic management of PE. Our results on PE by ATC code may help health authorities in establishing future policies on PE.

PMID:37407241 | DOI:10.3947/ic.2023.0028

BMJ Glob Health. 2023 Jul;8(7):e011837. doi: 10.1136/bmjgh-2023-011837.

ABSTRACT

BACKGROUND: The world will face a human resource gap of 10 million health workers in 2030. Community health workers (CHWs) can contribute to mitigating this workforce gap while improving equitable access to care and health outcomes. However, questions on how to best implement and optimise CHW programmes, especially across varied contexts, remain. As each context has its determinants for a successful CHW programme, this research identifies and assesses pertinent factors needed for optimal CHW programmes in conflict settings, specifically Northwest Syria.

METHODS: A mixed-methods study in Northwest Syria consisting of a literature and document review, semistructured interviews with CHWs’ team leaders and programme managers, key informant interviews with policymakers and a survey with CHWs was conducted across three research phases from 2018 to 2022. The three phases aimed to identify, refine and finalise a framework for CHW optimisation in humanitarian conflict contexts, respectively. Qualitative data were analysed thematically, and quantitative data were statistically analysed to identify critical trends.

RESULTS: 16 interviews and 288 surveys were conducted, supplemented by key reports and literature. The framework underwent two iterative rounds of refinement, reflecting varying stakeholders’ perceptions of CHW optimisation. The resulting framework presents important implementation factors with subthemes across identified topics of institutionalisation, integration and representation for CHW optimisation in Northwest Syria and other humanitarian conflict contexts. The presented factors are similar in various ways to other fragile low/middle-income country settings. However, in protracted conflict settings like Syria, careful consideration should be given to strategic dimensions such as integration and representation.

CONCLUSION: For CHW programmes to impact health outcomes in humanitarian conflict settings, they require a set of implementation and design factors relevant to the context. The dynamics of humanitarian funding restrictions, health system capacity and governance structures confront achieving these requirements. Nevertheless, pioneering projects which use available resources are possible. Evidence is needed to understand the impact of CHWs’ interventions and further support implementation across humanitarian contexts.

PMID:37407227 | DOI:10.1136/bmjgh-2023-011837

Fam Process. 2023 Jul 5:e12914. doi: 10.1111/famp.12914. Online ahead of print.

ABSTRACT

Relationship dissolution is a critical life event individuals have to cope with. Factors like relationship duration and relationship quality or having a new partner are likely to affect how people recover emotionally from a separation, which is linked to long-term adjustment. However, prospective evidence on the role of these factors is scarce. Hence, this study aims to investigate predictors of emotional recovery following relationship dissolution. Pooled data of the German Family Panel pairfam on 3734 separation events of 2709 individuals aged 18 to 48 were used, applying a statistical model called seemingly unrelated regressions to predict emotional outcomes (relief, anger, guilt, and sadness) and the general emotional state regarding separation. Sociodemographic and relationship characteristics, indicators of relationship quality, conditions of the separation, and features of the current situation were considered as potential predictors. Regression analyses evidence strong links of initiator status, having a new partner, time since separation, and satisfaction with the social network to less negative emotional outcomes following separation. Relationship quality or serious problems before the separation only affected some of the investigated emotional outcomes. Interestingly, the predictors investigated were less powerful in explaining respondents’ feelings of guilt compared to the other emotions. Overall, these findings provide deeper insight into short-term adjustment to separation. Understanding these processes may help to assess risk factors for negative coping mechanisms and improve tailored counseling strategies.

PMID:37407225 | DOI:10.1111/famp.12914

Clin Med Res. 2023 Jun;21(2):69-78. doi: 10.3121/cmr.2023.1821.

ABSTRACT

Objective: To investigate the pattern and prevalence of persistent symptoms of Post-COVID-19 Syndrome (PCS) at 3, 6, 9, and 18 months after discharge. Associated risk factors were further examined to potentially explain the persistence of these symptoms.Design and Setting: A cross-sectional cohort study was conducted at the primary health care facility of Aruba, Dr. Horacio E. Oduber Hospital (HOH).Participants: Inclusion criteria were adults hospitalized at HOH for at least one night between March and July 2021 and laboratory-confirmed COVID-19 diagnosis. Exclusion criteria were deceased before the follow-up, not able to mobilize before or after discharge, living outside of Aruba or in nursing homes, and patients with psychosis, dementia, or hospitalized due to unrelated diseases.Methods: Eligible and willing participants completed a 20-question survey: a self-reported symptoms questionnaire about symptoms during and after COVID-19 infection, level of dyspnea measurement (mMRC-scale), quality of life measurement (EQ-5D-5E with EuroQoL VAS), and mental well-being (WHO-5). Hospitalization related data were gathered via retrospective analysis of patient records. Chi-square test, logistic regression, and ANOVA analyses were conducted; P<0.05 was chosen as level of statistical significance for all analyses.Results: In total, 222 (34.5%) patients were eligible, consenting, and completed the survey. Most participants were interviewed a year or more after their initial COVID-19 infection. Fatigue (37.8%), new-onset dyspnea (38.7%), hair loss (20.3%), and muscle pain (18.0%) were the most frequently reported symptoms at any time post COVID-19 infection. Female participants were found more likely to experience fatigue (P<0.05, OR 2.135, 95% CI 1.154-3.949) and new-onset dyspnea (P<0.05, OR 2.026 95% CI 1.093-3.756) after initial infection. Participants with one or more respiratory comorbidity were more likely to experience new-onset dyspnea (P<0.05, OR 2.681, 95% CI 1.223-5.873). None of the predictor variables was associated with cognitive impairment.Conclusion: This study identified female sex and respiratory comorbidity as crucial risk factors for PCS. Females were also found to have significantly lower health scores. Female participants were more likely to experience fatigue and dyspnea after COVID-19 infection.

PMID:37407214 | DOI:10.3121/cmr.2023.1821

Taiwan J Obstet Gynecol. 2023 Jul;62(4):547-552. doi: 10.1016/j.tjog.2023.04.004.

ABSTRACT

OBJECTIVE: This study aimed to confirm the clinical significance of elastographic endometrium measurement in comparison with conventional ultrasonography for tamoxifen users with breast cancer.

MATERIALS AND METHODS: In this retrospective analysis, 98 women receiving tamoxifen as postoperative breast cancer treatment were included. Patient medical charts were reviewed, and related medical, obstetric, and gynecological information and histories relevant to breast cancer were evaluated. Patient clinical imaging data included endometrial thickness measurements using both conventional ultrasonography and elastography, and the differences between these two modalities in delta values were statistically analyzed along with possible influencing factors.

RESULTS: Endometrial thickness measured using 2-dimensional ultrasonography had a mean value of 5.81 mm (standard deviation [SD] = 3.09), and elastosonography showed a mean value of 3.07 mm (SD = 1.62). A paired t-test was conducted and a significant difference between them was confirmed (P-value <0.001). Logistic regression analysis revealed that age and duration of tamoxifen treatment significantly influenced the degree of difference between endometrial thickness measurements.

CONCLUSIONS: Elastosonography may be a more successful and useful tool for measuring actual endometrial thickness than generalized 2-dimensional ultrasonography. In clinical cases with limited use of elastosonography and consequent inability for thorough evaluation of endometrial thickness, practitioners should exercise caution in deciding whether or not to adopt invasive diagnostic procedures, such as endometrial curettage, especially for young patients of reproductive age or those with prolonged treatment of breast cancer with tamoxifen.

PMID:37407192 | DOI:10.1016/j.tjog.2023.04.004

Taiwan J Obstet Gynecol. 2023 Jul;62(4):537-542. doi: 10.1016/j.tjog.2022.12.012.

ABSTRACT

OBJECTIVE: This study aimed to assess the effect of atosiban on in vitro fertilization (IVF) pregnancy outcome among women with both endometriosis and adenomyosis, and compared it to that of patients with endometriosis but without adenomyosis and that of patients with tubal factor only.

MATERIALS AND METHODS: 106 infertile women (176 embryo transfers) from a medical center in Taiwan were included in the analysis, where 34 (54), 34 (66), and 38 (56) cases (embryo transfers) were endometriosis without adenomyosis, endometriosis with adenomyosis, and tubal infertility factor only, respectively. Adenomyosis morphologies were classified using an ultrasound-based classification system. The logistic generalized estimating equation model was used to analyze the association between atosiban use and pregnancy outcomes.

RESULTS: The crude pregnancy rates for the endometriosis-only group were significantly higher than those for the endometriosis + adenomyosis group (i.e., biochemical pregnancy: 50.0% versus 29.7%, p = 0.041; ongoing pregnancy: 35.2% versus 16.9%, p = 0.038). Significantly higher chances of biochemical pregnancy and ongoing pregnancy among endometriosis patients without adenomyosis versus those with both endometriosis and adenomyosis were found (odds ratios [95% confidence intervals]: 2.981 [1.307, 6.803]; p = 0.009, 2.694 [1.151, 6.304]; p = 0.022). A significant positive association between atosiban use and biochemical pregnancy existed among endometriosis cases without adenomyosis (a 2.43-fold [1.01, 5.89] increase in successful pregnancy; p<0.05), but not for the other groups.

CONCLUSIONS: Poor pregnancy outcomes among adenomyosis-affected women were confirmed. The use of atosiban significantly enhanced IVF pregnancy among endometriosis patients without adenomyosis.

PMID:37407190 | DOI:10.1016/j.tjog.2022.12.012

Taiwan J Obstet Gynecol. 2023 Jul;62(4):525-529. doi: 10.1016/j.tjog.2023.04.003.

ABSTRACT

OBJECTIVE: To evaluate the IVF outcomes of conventional insemination for less severe teratozoospermia (LST) patients (sperm morphology >2% and <4% normal forms and total motile sperm count ≥10 × 10⁶) and normal sperm patients defined by WHO criteria 2010 in the interest of reducing intracytoplasmic sperm injection (ICSI) rate in IVF.

MATERIALS AND METHODS: In this retrospective study, a total of 330 patients were recruited in the conventional IVF insemination. Among them, there were 76 patients in LST group and 254 patients in the normal sperm group. Fertilization rate, abnormal fertilization rate, embryo quality, implantation rate, chemical pregnancy rate, clinical pregnancy rate, abortion rate and live birth rate were assessed.

RESULTS: No statistical differences were achieved in the percentage of normally fertilized eggs (85.9% vs. 85.8%), abnormal fertilization rates of 1 PN (2.76% vs. 3.01%) or 3 PN (5.70% vs. 6.30%), good embryo rate (52.4% vs. 51.5%), implantation rate (20.9% vs 17.5%), chemical pregnancy rate (45.1% vs. 39.4%), clinical pregnancy rate (36.0% vs. 31.7%), live birth rate (28.9% vs. 26.7%) and abortion rate (9.6% vs. 10.2%) between LST group and normal sperm group regardless of the sperm morphology.

CONCLUSION: Patients with less severe teratozoospermia may not need ICSI in their IVF treatment since the outcomes particularly the fertilization rates were not affected by the less compromised sperm morphology at all when compared with the normal sperm patients.

PMID:37407188 | DOI:10.1016/j.tjog.2023.04.003

Taiwan J Obstet Gynecol. 2023 Jul;62(4):521-524. doi: 10.1016/j.tjog.2023.02.004.

ABSTRACT

OBJECTIVE: This comparative study aimed to evaluate the effect of postoperative dienogest treatment on serum anti-Mullerian hormone (AMH) levels in patients undergoing laparoscopic cystectomy of ovarian endometriomas.

MATERIALS AND METHODS: A total of 71 patients with ovarian endometriomas treated at our department were enrolled. After surgery, 54 patients received oral dienogest 2 mg daily continuously for 6 months (dienogest group). The other 17 patients did not receive postoperative medical treatment (control group). Serum AMH levels were measured before surgery, at 3-month period after surgery, and at the end of 6-month follow-up period. Serial changes of AMH levels were compared between the two groups.

RESULTS: The age, endometrioma size, and serum AMH level before surgery were comparable between the dienogest group and the control group. The AMH levels decreased significantly at 3-month period after surgery in the dienogest group (a decrease of 65.5%; p < 0.001) and the control group (a decrease of 64.8%; p = 0.018). The AMH levels increased gradually from the nadir at 3-month period after surgery and recovered partially at the end of 6-month follow-up period in both groups. There were no statistically significant differences in the rate of reduction of serum AMH levels between the two groups (p = 0.707).

CONCLUSION: Laparoscopic cystectomy of ovarian endometrioma causes a significant decrease in serum AMH levels. The rates of reduction of AMH levels are similar regardless of dienogest treatment. Postoperative dienogest treatment for 6 months has no rescue effect on serum AMH levels in these patients.

PMID:37407187 | DOI:10.1016/j.tjog.2023.02.004