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Electroconvulsive Treatment Utilization for Inpatient Management of Catatonia in Adolescents With Schizophrenia Spectrum Disorders

J ECT. 2022 May 25. doi: 10.1097/YCT.0000000000000858. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study was to determine rates of electroconvulsive therapy (ECT) use for catatonia in schizophrenia spectrum disorders, stratified by patient demographics and hospital characteristics, and its impact on inpatient length of stay and cost.

METHODS: We found 155 adolescents (aged 12-18 years) with principal discharge diagnosis of schizophrenia spectrum disorders with catatonia from the National Inpatient Sample. They were subgrouped into ECT (n = 20) and non-ECT (n = 135) groups. We used descriptive statistics to evaluate the utilization of ECT for catatonia and independent-sample t test for continuous variables with statistical significance at P ≤ 0.05.

RESULTS: The overall utilization rate of ECT in adolescents for catatonia was 12.9%. A high rate of ECT use was evident for Whites (30.8%) compared with the other race/ethnicities and also was seen in private health insurance beneficiaries (20%). The rate of ECT use varied by the region, with highest for the Northeast (20%), followed by the South (18.2%), and the West (14.3%). Adolescent inpatients with catatonia in public and teaching type, and large bed-size hospitals were more likely to receive ECT than their counterparts. The mean number of ECT sessions required during the inpatient stay was 5.2 (range, 1-15), and the mean number of days from admission to initial ECT was 2.5 (range, 0-6).

CONCLUSIONS: Electroconvulsive therapy is used for approximately only 13% of adolescents with catatonia when comorbid schizophrenia spectrum disorders are present, suggesting that many patients may not get evidence-based treatment. Future studies in this area are needed.

PMID:35623014 | DOI:10.1097/YCT.0000000000000858

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DEVELOPMENT OF THE POSTURAL HABITS AND AWARENESS SCALE (PHAS): A RELIABILITY AND VALIDITY STUDY

Int J Occup Saf Ergon. 2022 May 27:1-24. doi: 10.1080/10803548.2022.2082694. Online ahead of print.

ABSTRACT

Objectives. The aim of this study was to develop a scale that assesses postural awareness and habits, as well as to establish the validity and reliability thereof. Methods. The 19-item Postural Habits and Awareness Scale was developed. The scale has a score range of 0-95, with a higher score indicating good posture and awareness. 278 healthy adults with an age range of 18-65 years were included in the study. The sociodemographic form, Short Form 36 Health Survey (SF-36), and Body Awareness Questionnaire (BAQ) were used to test the validity and reliability of this newly developed scale. Results. From factor analyses, it was observed that the items clustered in 4 factors, which explained 55.99% of the variance. The Cronbach’s α for each factor of the scale varied between 0.619 and 0.832. A high correlation was observed regarding test-retest reliability of the scale (r: 0.905). Conclusion. This newly developed self-reported scale allows for the comprehensive determination of both postural habits and awareness together. The PHAS is a valid and reliable scale that can be used by professionals who are interested in posture.

PMID:35622409 | DOI:10.1080/10803548.2022.2082694

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The efficacy of polycaprolactone filler injection on enlarged facial pores

Dermatol Ther. 2022 May 27:e15600. doi: 10.1111/dth.15600. Online ahead of print.

ABSTRACT

BACKGROUND: Facial pores, visible topographic change of skin representing enlarged openings of pilosebaceous follicles, are common aesthetic concern.

AIM: To examine the efficacy of polycaprolactone (PCL) filler on enlarged facial pores and skin texture improvement.

PATIENTS AND METHODS: A total of seven participants with enlarged facial pores were included in the study and underwent deep dermal injection of PCL based filler (Ellanse M, Sinclair Pharma; London, United Kingdom). Skin quality measurements including skin evenness, red areas, UV spots, wrinkles and pore numbers evaluated with an automated aesthetic camera (FotoFinder®, Teach Screen Systems software GmbH; Bad Birnbach, Germany) before and three months after the injection session. Adverse events during procedure were monitored and recorded. Subjects were asked to report any injection related side effects.

RESULTS: The average size of enlarged pores was 33.51 ± 41 before treatment and 20.51 ± 35 after treatment. The difference was statistically significant (P < 0.05). The skin evenness, red areas, UV spots, and wrinkles showed no significant improvement after filler injection. No serious adverse events were reported at follow-up visit.

CONCLUSION: The PCL based filler seems to be notably effective in improvement of enlarged facial pores especially in moderate to severe cases. However, further structured studies with larger sample size and control group could be more beneficial to elucidate the possible efficacy of PCL filler injection on the skin quality characteristics. This article is protected by copyright. All rights reserved.

PMID:35622404 | DOI:10.1111/dth.15600

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Early treatment with low-molecular-weight heparin reduces mortality rate in SARS-CoV-2 patients

Panminerva Med. 2022 May 27. doi: 10.23736/S0031-0808.22.04572-4. Online ahead of print.

ABSTRACT

BACKGROUND: Since the beginning of the SARS-CoV-2 pandemic, millions of people have been infected and died. Different therapeutic approaches have been recommended, but only a few have shown clinical advantages. Low-molecular-weight heparin (LMWH) has been recommended to prevent COVID-19-related thrombo-embolic events. We aim to evaluate the impact of early treatment with LMWH on hospital admission and death in patients with SARS-CoV-2 infection.

METHODS: We conducted an observational monocentric retrospective study to evaluate the preventive role of LMWH on the mortality rate of COVID-19 patients. SARS-CoV-2 infected patients were recruited from the beginning of the Italian epidemic to March 31st, 2021. We excluded patients with missing data and those chronically exposed to LMWH. Treatment prescription was based on international and national guidelines and modified depending on clinical presentation and drug-drug interactions.

RESULTS: of 734 SARS-CoV-2 infected patients were recruited, with 357 (48.6%) males and a median (IQR) age of 77.9 (65-85.7) years. 77.5% of people developed SARS-CoV-2-related symptoms and 62.8% were admitted to the hospital, and 20.2% died. Four hundred ninety-two (67%) started LMWH. In particular, 296 (40.3%) were treated within five days since symptoms onset. At logistic regression, early LMWH therapy was associated with lower mortality. Furthermore, remdesivir treatment showed a lower risk of death. On the contrary, age, BMI >30Kg/m2, neurological diseases, fever or dyspnea were associated with an increased risk of death.

CONCLUSIONS: In conclusion, early treatment with LMWH was associated with lower mortality in our cohort. Further studies are needed to better assess the role of wider LMWH administration in terms of timing and regimen dose.

PMID:35622392 | DOI:10.23736/S0031-0808.22.04572-4

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Drinking Water Disinfection Byproducts, Ingested Nitrate, and Risk of Endometrial Cancer in Postmenopausal Women

Environ Health Perspect. 2022 May;130(5):57012. doi: 10.1289/EHP10207. Epub 2022 May 27.

ABSTRACT

BACKGROUND: Disinfection byproducts (DBPs) and N-nitroso compounds (NOC), formed endogenously after nitrate ingestion, are suspected endometrial carcinogens, but epidemiological studies are limited.

OBJECTIVES: We investigated the relationship of these exposures with endometrial cancer risk in a large prospective cohort.

METHODS: Among postmenopausal women in the Iowa Women’s Health Study cohort, we evaluated two major classes of DBPs, total trihalomethanes (TTHM) and five haloacetic acids (HAA5), and nitrate-nitrogen (NO3-N) in public water supplies (PWS) in relation to incident primary endometrial cancer (1986-2014). For women using their PWS >10y at enrollment (n=10,501; cases=261), we computed historical averages of annual concentrations; exposures were categorized into quantiles and when possible ≥95th percentile. We also computed years of PWS use above one-half the U.S. maximum contaminant level (>½ MCL; 40μg/L TTHM; 30μg/L HAA5; 5mg/LNO3-N). Dietary nitrate/nitrite intakes were estimated from a food frequency questionnaire. We estimated hazard ratios (HR) and 95% confidence intervals (CI) via Cox models adjusted for age, endometrial cancer risk factors [e.g., body mass index, hormone replacement therapy (HRT)], and mutually adjusted for DBPs or NO3-N. We evaluated associations for low-grade (cases=99) vs. high-grade (cases=114) type I tumors. We assessed interactions between exposures and endometrial cancer risk factors and dietary factors influencing NOC formation.

RESULTS: Higher average concentrations of DBPs (95th percentile: TTHM ≥93μg/L, HAA5 ≥49μg/L) were associated with endometrial cancer risk (TTHM: HR95vsQ1=2.19, 95% CI: 1.41, 3.40; HAA5: HR95vsQ1=1.84, 95% CI: 1.19, 2.83; ptrend<0.01). Associations were similarly observed for women greater than median years of PWS use with levels >½ MCL, in comparison with zero years (TTHM: HR36+vs0y=1.61, 95% CI: 1.18, 2.21; HAA5: HR38+vs0y=1.85, 95% CI: 1.31, 2.62). Associations with DBPs appeared stronger for low-grade tumors (TTHM: HRQ4vsQ1=2.12, 95% CI: 1.17, 3.83; p-trend=0.008) than for high-grade tumors (TTHM: HRQ4vsQ1=1.40, 95% CI: 0.80, 2.44; p-trend=0.339), but differences were not statistically significant (p-heterogeneity=0.43). Associations with TTHM were stronger among ever HRT users than non-HRT users (p-interaction<0.01). We observed no associations with NO3-N in drinking water or diet.

DISCUSSION: We report novel associations between the highest DBP levels and endometrial cancer for our Iowa cohort that warrant future evaluation. https://doi.org/10.1289/EHP10207.

PMID:35622390 | DOI:10.1289/EHP10207

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Investigating the Effectiveness of Health and Safety Management Systems within Construction Organisations

Int J Occup Saf Ergon. 2022 May 27:1-48. doi: 10.1080/10803548.2022.2082137. Online ahead of print.

ABSTRACT

PURPOSE: Previous studies presented the advantages of implementing health and safety management systems (HSMS) in the construction industry. Few studies have investigated the effectiveness of HSMS in developing countries. This study adopts a strategic management and multilevel perspective to assess the three main construction health and safety management system types in South Africa in terms of their adequacy across 14 HSMS dimensions.

METHOD: A literature review identified 14 health and safety management dimensions as building blocks of the strategically developed component of a HSMS. Statistical methods analysed the feedback from a questionnaire survey amongst 59 construction companies on the adequacy of three HSMS types observed in these companies across 14 HSMS dimensions.

RESULTS AND CONCLUSIONS: Differences between the three health and safety management types were identified, with inadequacies in three of the 14 health and safety management dimensions across all three HSMS types. The three dimensions are accountability and incentives for employee participation, management of subcontractors, and employee competence and training. This could indicate less attention is paid to behavioural based safety control strategies. The study quantified the differences between the three health and safety management types and will help contractor organisations to improve their health and safety management systems.

PMID:35622374 | DOI:10.1080/10803548.2022.2082137

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Call for Papers on the Effects of War on Health and Health Care Delivery, Access, and Equity

JAMA Netw Open. 2022 May 2;5(5):e2217872. doi: 10.1001/jamanetworkopen.2022.17872.

NO ABSTRACT

PMID:35622371 | DOI:10.1001/jamanetworkopen.2022.17872

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Effect of Brief Produce Exposure and Unconstrained Grocery Gift Cards on Caregiver Influence on Diet of Elementary Age Children: A Randomized Clinical Trial

JAMA Netw Open. 2022 May 2;5(5):e2212973. doi: 10.1001/jamanetworkopen.2022.12973.

ABSTRACT

IMPORTANCE: Children’s diets affect health trajectories but are difficult to influence, especially for resource-constrained families.

OBJECTIVE: To assess the effectiveness of providing 4 weeks of grocery gift cards and small produce boxes to caregivers on their ability to support healthy shifts in children’s diets.

DESIGN, SETTING, AND PARTICIPANTS: This 2-group randomized clinical trial was conducted from May to July 2021, with 4 weeks of intervention and follow-up at 8 weeks. Resources were provided curbside at 3 schools, 3 housing sites, and 1 after-school site for use at home. Participants consisted of 1 index child ages 5 to 11 years with 1 index caregiver from 68 low-income families. Data were analyzed from July 2021 through March 2022.

INTERVENTIONS: During each week for 4 weeks, caregivers were offered 10-lb (4.5 kg) boxes of fruits and vegetables, $10.00 grocery gift cards, an additional $10.00 gift card over the last 3 weeks triggered by a task completion, and a 1-time choice of a $25.00 food preparation tool.

MAIN OUTCOMES AND MEASURES: Index child and caregiver diets were measured together over the phone at baseline, 4 weeks, and 8 weeks using the 2019 to 2020 Texas School Physical Activity and Nutrition (SPAN) tool, which measures the number of times food items were eaten over the prior day to report a SPAN Healthy Eating Index (SHEI) score and subscores for specific categories of foods (range, 0-57, with higher scores indicating a more healthful diet).

RESULTS: Among 68 children (mean [SD] age, 8.2 [1.7] years; 35 [51.5%] girls) and caregivers (mean [SD] age, 37.9 [7.9] years; 63 mothers [92.6%]) from primarily low-income families, 26 caregivers were Hispanic or Latino (38.2%), while 18 caregivers were Black (26.4%), 25 caregivers were White (36.7%), and 24 caregivers had more than 1 race (35.3%). Most families were below the federal poverty level (41 of 60 families that reported income [68.3%]). Per participating caregiver, a mean (SD) 2.7 [1.4] fruit and vegetable boxes and $42.35 ($25.46) worth of gift cards were picked up over 4 weeks. Mean (SE) child SPAN SHEI increased from 32.03 (0.62) times/d to 33.75 (0.69) times/d at 4 weeks (ie, postintervention) and 34.03 (0.69) times/d 4 weeks later (ie, at 8 weeks of follow-up). Mean (SE) child fruit and vegetable intake increased from 5.31 (0.47) times/d to 5.78 (0.51) times/d postintervention and 6.03 (0.51) times/d at follow-up. Children in the control group did not have improved diet (overall mean [SE] SHEI: 31.48 [0.58] times/d at baseline, 31.68 [0.54] times/d postintervention, and 31.81 [0.52] times/d at follow-up; mean [SE] fruit and vegetable intake: 5.21 [0.45] times/d at baseline, 4.77 [0.45] times/d postintervention, and 4.68 [0.41] times/d at follow-up). Compared with children in the control group, mean SHEI was increased for children in the intervention group by 2.07 times/d postintervention and 2.23 times/d at follow-up. Improvements as a function of program dose were statistically significant for child SHEI (P = .01) and fruit and vegetable intake (P = .03). No significant changes in caregiver diets were found.

CONCLUSIONS AND RELEVANCE: This study found that easily accessed fruits and vegetables and unconstrained grocery store cards provided directly to caregivers over 4 weeks resulted in improvements in child diet, which were sustained over 4 additional weeks. Future work may investigate whether diet improvement from a brief intervention optimized for caregiver flexibility reflects a natural maximum or potential for greater improvements on extension.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04827654.

PMID:35622367 | DOI:10.1001/jamanetworkopen.2022.12973

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Type 2 Diabetes, Fasting Glucose, Hemoglobin A1c Levels and Risk of Primary Open-Angle Glaucoma: A Mendelian Randomization Study

Invest Ophthalmol Vis Sci. 2022 May 2;63(5):37. doi: 10.1167/iovs.63.5.37.

ABSTRACT

PURPOSE: To evaluate the potential causal associations between type 2 diabetes and fasting glucose and HbA1c levels and the risk of primary open-angle glaucoma (POAG) in European and East Asian populations.

METHODS: We selected genetic variants (P < 5 × 10-8) for type 2 diabetes (898,130 Europeans; 433,540 East Asians), fasting glucose, and HbA1c (196,991 Europeans; 36,584 East Asians) from three meta-analyses of genome-wide association studies (GWAS). The GWAS for POAG provided summary statistics (192,702 Europeans; 46,523 East Asians). Mendelian randomization (MR) analysis was accomplished using the inverse variance-weighted method, weighted-median method, MR Egger method, and MR-Pleiotropy RESidual Sum and Outlier test.

RESULTS: Genetically predicted type 2 diabetes was potentially positively associated with POAG in the European ancestry (body mass index [BMI]-unadjusted: odds ratio [OR] = 1.07, 95% confidence interval [CI], 1.01-1.14, P = 0.028; BMI-adjusted: OR = 1.07, 95% CI, 1.01-1.15, P = 0.035), but not in the East Asian ancestry (BMI-unadjusted: OR = 1.01, 95% CI, 0.95-1.06, P = 0.866; BMI-adjusted: OR = 1.00, 95% CI, 0.94-1.05, P = 0.882). There was no evidence to support a causal association of fasting glucose (European: OR = 1.19, P = 0.157; East Asian: OR = 0.94, P = 0.715) and HbA1c (European: OR = 1.27, P = 0.178; East Asian: OR = 0.85, P = 0.508) levels with POAG.

CONCLUSIONS: The causal effect of type 2 diabetes on the risk of POAG is different in European and East Asian populations. The point estimates of fasting glucose and Hb1Ac with POAG are large but not statistically significant, which prompts the question of statistical power.

PMID:35622353 | DOI:10.1167/iovs.63.5.37

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Factors associated with HIV viral suppression among children and adults receiving antiretroviral therapy in Malawi in 2021: Evidence from the Laboratory Management Information System

Trop Med Int Health. 2022 May 27. doi: 10.1111/tmi.13782. Online ahead of print.

ABSTRACT

OBJECTIVE: To describe the prevalence of HIV viral suppression and assess the factors associated with HIV viral suppression among persons receiving ART in Malawi in 2021.

METHODS: Implementation study using routinely collected patient-level HIV RNA-PCR test result data extracted from the national Laboratory Management Information System (LIMS) database managed by the Department of HIV/AIDS in 2021. We calculated frequencies, proportions and odds ratios (OR) of HIV viral suppression with their associated 95% confidence intervals (95%CI). We performed a random-effects logistic regression to determine the risk factors associated with HIV viral suppression amongst ART patients, controlling for the spatial autocorrelation between districts and adjusting for other variables.

RESULTS: We evaluated 515,797 adults and children receiving ART and having a viral load test in 2021. Of these, 92.8% had HIV viral suppression. ART patients living in urban areas had lower likelihood of HIV viral suppression than those living in rural areas (adjusted OR [aOR]=0.95, 95%CI: 0.92-0.99, P=0.01). There was an increasing trend in HIV viral suppression with increasing ART duration. Routine VL monitoring samples were 39% more likely to have suppressed VL values than confirmatory HIV VL monitoring samples (aOR=1.39; 95%CI:1.34-1.43, P<0.001).

CONCLUSION: This is the first national analysis of Malawi HIV VL data from LIMS. Our findings show the need to particularly consider the urban residents, those below 20 years, males, those on ART for less than a year as well as those on specific ARV regimens in order to persistently suppress HIV VL and consequently achieve the goal of achieving HIV VL suppression by 2030.

PMID:35622358 | DOI:10.1111/tmi.13782