Tag: pubmed

Intern Med J. 2022 May 24. doi: 10.1111/imj.15827. Online ahead of print.

ABSTRACT

BACKGROUND: COVID-19 has caused a global shift in healthcare seeking behaviour, however, presentation rates with serious conditions such as stroke in low COVID-19 prevalence cities has received less attention.

AIMS: To determine if there was a significant reduction in stroke admissions, delivery of acute reperfusion therapies, or increased delays to presentation during the first wave of the COVID-19 pandemic.

METHODS: A multicentre, retrospective, observational cohort study was performed across three tertiary hospitals in Brisbane, Australia. Cases were identified using ICD-10 codes and then individually reviewed for eligibility using prespecified inclusion and exclusion criteria. All metrics were compared over three months from March 1 to May 31, 2020 with two corresponding 3-month periods in 2018 and 2019.

RESULTS: There was a mean of 2.15 (95% CI 1.87-2.48) stroke admissions per day in the examined pandemic months compared to 2.13 (95% CI 1.85-2.45) and 2.26 (95% CI 1.97-2.59) in March to May 2018 and 2019 respectively, with no significant difference found (p = 0.81). There was also no difference in rates of intravenous thrombolysis (p = 0.82), endovascular thrombectomy (p = 0.93) and time from last known well to presentation (p = 0.54). Conversely, daily emergency department presentations (including non-stroke presentations) significantly reduced (p < 0.0001).

CONCLUSIONS: During the early months of the COVID-19 pandemic there was no significant reduction in stroke presentations, use of acute reperfusion therapies or delays to presentation, despite a reduction in ED presentations for any cause. Our results differ from the global experience, with possible explanations including differences in public health messaging and healthcare infrastructure. This article is protected by copyright. All rights reserved.

PMID:35608890 | DOI:10.1111/imj.15827

JMIR Diabetes. 2022 May 24;7(2):e31832. doi: 10.2196/31832.

ABSTRACT

BACKGROUND: The use of digital technology to assess patients remotely can reduce clinical study costs. In the European Union, the 2D matrix code on prescription drug packaging serves as a unique identifier of a given package of medication, and thus, also of the patient receiving that medication. Scanning of the 2D matrix code may therefore allow remote patient authentication in clinical studies.

OBJECTIVE: The aim of the DePRO study was to assess the feasibility of a fully digital data-capture workflow, the authentication of participants via drug packaging 2D matrix codes, in patients with type 2 diabetes mellitus (T2DM) who use metformin. The primary objective was to describe the self-care activities of these patients. Secondary objectives were to evaluate (1) the self-reported health status of these patients, (2) the association of self-care activities with demographics and disease characteristics, and (3) the usability of the my ePRO app.

METHODS: DePRO was an observational, multicenter, cross-sectional, digital, and patient-driven study conducted in Germany from June to December 2020. Adult patients prescribed metformin were invited to participate via their pharmacist or a medication tracker app. Participants downloaded the my ePRO app onto their own mobile device, scanned the 2D matrix code on their metformin package for registration and authentication, and provided informed consent via an electronic form. They were then able to complete a study-specific questionnaire on demographics and clinical characteristics, the German version of the Summary of Diabetes Self-Care Activities measure (SDSCA-G), the Diabetes Treatment Satisfaction Questionnaire (DTSQ), and the EQ-5D-5L. The patients conducted the study without support from a health care professional. Statistical analyses were exploratory and descriptive.

RESULTS: In total, 3219 patients were invited to participate. The proportion of patients giving consent was greater among those invited by pharmacists (19/217, 8.8%) than among those invited via the medication tracker app (13/3002, 0.4%). Of the 29 patients eligible for analysis, 28 (97%) completed all study questionnaires. Most of the patients (23/29, 79%) were aged <60 years, and 59% (17/29) were male. The patients spent a mean total of 3.5 (SD 1.3) days out of 7 days on self-care activities (SDSCA-G). Most patients (24/29, 83%) were satisfied to extremely satisfied with their current treatment (DTSQ). Events of perceived hyperglycemia or hypoglycemia were reported by 20 of 29 (69%) patients. The best possible health status (EQ-5D-5L) was reported by 18 of 28 (64%) patients. Age was positively correlated with time spent on general and specific diet (Spearman coefficient 0.390 and 0.434, respectively).

CONCLUSIONS: The DePRO study demonstrates the feasibility of fully digital authentication (via 2D matrix codes on drug packaging) and data capture in patients with T2DM. Personal invitations yielded higher recruitment rates than remote invitations via the medication tracker app. A high questionnaire completion rate was realized, based on completion by 28 out of 29 patients.

TRIAL REGISTRATION: ClinicalTrials.gov NCT04383041; https://clinicaltrials.gov/ct2/show/NCT04383041.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/21727.

PMID:35608887 | DOI:10.2196/31832

Eur J Anaesthesiol. 2022 Jun 1;39(6):489-497. doi: 10.1097/EJA.0000000000001682.

ABSTRACT

BACKGROUND: Disparities in access to pain management have been identified in several care settings, such as emergency departments and intensive care units, but with regard to labour analgesia, it remains poorly explored.

OBJECTIVES: To determine the proportion of women without pain management during labour and its individual and organisational determinants.

DESIGN: Secondary analysis of a nationwide cross-sectional population-based study, the 2016 French National Perinatal Survey.

SETTINGS: All maternity units in France.

PARTICIPANTS: Ten thousand and eleven women who attempted vaginal delivery with a labour duration at least 15 min.

MAIN OUTCOME MEASURE: Absence of pain management, defined as absence of any pharmacological or nonpharmacological analgesic method during labour.

RESULTS: Among the 10 011 women included, 542 (5.4%) had no labour pain management: 318 (3.7%) of the 8526 women who initially preferred to use neuraxial analgesia and 222 (15.8%) of the 1402 who did not. Using generalised estimating equations stratified according to the maternal antenatal preference for neuraxial analgesia, the common determinants of no labour pain management in both groups were no attendance at childbirth education classes and admission to a delivery unit during the night. Among women who initially preferred to use neuraxial analgesia, those who delivered in units with <1500 annual deliveries compared with units with 2000 to 3499 annual deliveries, were more likely to do without pain management [adjusted odds ratio (OR) = 1.96; 95% confidence interval (CI), 1.39 to 2.78]; among those who did not prefer to use it, women born abroad were more likely to do without labour pain management (adjusted OR = 1.64; 95% CI, 1.12 to 2.40).

CONCLUSION: In France, 1 : 20 women had no labour pain management, and this proportion was three times higher among women who preferred not to use neuraxial analgesia. Enhancing maternal information on labour pain and its management, especially nonpharmacological methods, and rethinking care organisation, could improve access to analgesia of any kind.

PMID:35608876 | DOI:10.1097/EJA.0000000000001682

JAMA Netw Open. 2022 May 2;5(5):e2213643. doi: 10.1001/jamanetworkopen.2022.13643.

ABSTRACT

IMPORTANCE: The evidence base for the association between montelukast and adverse neuropsychiatric outcomes is mixed and inconclusive. Several methodological limitations have been identified in the evidence base on the safety of montelukast in observational studies.

OBJECTIVE: To investigate the association between new montelukast exposure and 1-year incident neuropsychiatric diagnoses with improved precision and control for baseline confounders.

DESIGN, SETTING, AND PARTICIPANTS: This propensity score-matched cohort study was conducted using electronic health records from 2015 to 2019 in the TriNetX Analytics Network patient repository of more than 51 million patients from 56 health care organizations, mainly in the US. Included patients were those aged 15 to 64 years at index prescription for montelukast or for control prescription who had a history of asthma or allergic rhinitis. After propensity score matching for various baseline confounders, including comorbidities and dispensed prescription medicines, we included 154 946 patients, of whom 77 473 individuals were exposed to montelukast. Patients were followed up for 12 months. Data were analyzed from June through November 2021.

EXPOSURES: New dispensed prescription for leukotriene receptor antagonist montelukast or control medication.

MAIN OUTCOMES AND MEASURES: Incident neuropsychiatric diagnoses at 12 months identified using International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes.

RESULTS: There were 72 490 patients with asthma (44 726 [61.7%] women; mean [SD] age at index prescription, 35 [15] years) and 82 456 patients with allergic rhinitis (54 172 [65.7%] women; mean [SD] age at index prescription, 40 [14] years). In patients exposed to montelukast, the odds ratio [OR] for any incident neuropsychiatric outcome was 1.11 (95% CI, 1.04-1.19) in patients with asthma and 1.07 (95% CI, 1.01-1.14) in patients with allergic rhinitis compared with patients who were unexposed. The highest OR was for anxiety disorders (OR, 1.21; 95% CI, 1.05-1.20) among patients with asthma exposed to montelukast and insomnia (OR, 1.15; 95% CI, 1.05-1.27) among patients with allergic rhinitis exposed to montelukast.

CONCLUSIONS AND RELEVANCE: This study found that patients with asthma or allergic rhinitis had increased odds of adverse neuropsychiatric outcomes after montelukast initiation. These findings suggest that clinicians should consider monitoring potential adverse mental health symptoms during montelukast treatment, particularly in individuals with a history of mental health or sleep problems.

PMID:35608857 | DOI:10.1001/jamanetworkopen.2022.13643

JAMA Netw Open. 2022 May 2;5(5):e2213540. doi: 10.1001/jamanetworkopen.2022.13540.

ABSTRACT

IMPORTANCE: Prior studies on the association between fine particulate matter with diameters 2.5 μm or smaller (PM2.5) and probability of death have not applied multilevel analysis disaggregating data for US census tract, states, and counties, nor tested its interaction by socioeconomic status (SES). Such an approach could provide a more refined identification and targeting of populations exposed to increased risk from PM2.5.

OBJECTIVE: To assess the association between PM2.5 and age-specific mortality risk (ASMR) using disaggregated data at the census tract level and evaluate such association according to census tract SES.

DESIGN, SETTING, AND PARTICIPANTS: This nationwide cross-sectional study used a linkage of 3 different data sets. ASMR for the period of 2010 to 2015 was obtained from the National Center for Health Statistic, SES data covering a period from 2006 to 2016 came from the American Community Survey, and mean PM2.5 exposure levels from 2010 to 2015 were derived from well-validated atmospheric chemistry and machine learning models. Data were analyzed in April 2021.

EXPOSURES: The main exploratory variable was mean census tract-level long-term exposure to PM2.5 from 2010 to 2015.

MAIN OUTCOMES AND MEASURES: The primary outcome was census tract-level ASMR. Multilevel models were used to quantify the geographic variation in ASMR at levels of census tract, county, and state. Additional analysis explored the interaction of SES in the association of ASMR with PM2.5 exposure.

RESULTS: Data from 67 148 census tracts nested in 3087 counties and 50 states were analyzed. The association between exposure to PM2.5 and ASMR varied substantially across census tracts. The magnitude of such association also varied across age groups, being higher among adults and older adults. Census tracts accounted for most of the total geographic variation in mortality risk (range, 77.0%-94.2%). ASMR was higher in deciles with greater PM2.5 concentration. For example, ASMR for age 75 to 84 years was 54.6 per 1000 population higher in the decile with the second-highest PM2.5 concentration than in the decile with the lowest PM2.5 concentration. The ASMR, PM2.5 concentrations, and magnitude of the association between both were higher in the census tracts with the lowest SES.

CONCLUSIONS AND RELEVANCE: This cross-sectional study found that census tracts with lower SES presented higher PM2.5 concentrations. ASMR and air pollution varied substantially across census tracts. There was an association between air pollution and ASMR across all age groups in the United States. These findings suggest that equitable public policies aimed at improving air quality are needed and important to increase life expectancy.

PMID:35608861 | DOI:10.1001/jamanetworkopen.2022.13540

Hum Vaccin Immunother. 2022 May 24:2069960. doi: 10.1080/21645515.2022.2069960. Online ahead of print.

ABSTRACT

BACKGROUND: Health professionals’ willingness to accept the COVID-19 vaccine is very important, and evidence suggests that only a limited proportion of health-care workers were ready to accept a COVID-19 vaccine, which is very low when compared with the risk of the disease. This study aimed to assess health professionals’ acceptability and associated factors in Wollega University referral hospital, Western Ethiopia.

METHODS: An institution-based cross-sectional study was conducted among health-care workers in Wollega University referral hospital from March 26-28, 2021. The data were collected by using a self-administered questionnaire. Epi-data version 3.2 was used for data entry, and STATA version 14 was used for data analysis. The binary logistic regression model was employed to determine factors associated with the acceptability of the COVID-19 vaccine. Adjusted Odds Ratio (AOR) with 95% confidence intervals was computed and statistical significance was declared at a 5% level (p-value <.05).

RESULTS: A total of 191 health professionals have participated in the study. The study indicates that 65.4% (95% CI: 58.6%, 72.2%) of health professionals had the willingness to receive the COVID-19 vaccine if available. Age of health professionals (AOR = 3.58, 95% CI: 1.38, 8.38), knowledge of the COVID-19 vaccine (AOR = 2.98, 95% CI: 1.22, 7.23), and perception of COVID 19 vaccine (AOR = 5.71, 95% CI: 2.50, 13.00) were significantly associated with vaccine acceptability.

CONCLUSIONS AND RECOMMENDATIONS: Nearly, two-thirds of health professionals were willing to accept the COVID-19 vaccine, which is low. In general, continuous communication and health education have to be provided to enhance overall awareness of the COVID-19 vaccine.

PMID:35608849 | DOI:10.1080/21645515.2022.2069960

Ann Bot. 2022 May 24:mcac065. doi: 10.1093/aob/mcac065. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Tree growth in plateau forests is critically limited by harsh climatic conditions. Many mathematical statistics have been used to identify the relationship between tree growth and climatic factors, but there is still uncertainty regarding the relative importance of these factors across different regions. We tested major climatic limits at 30 sites to provide insights into the main climatic limits for juniper trees (Juniperus tibetica Kom.) across the southern Tibetan Plateau.

METHODS: We analysed the linear and nonlinear relationships between tree growth and climatic factors using Pearson correlation statistics and a process-based forward Vaganov-Shashkin-Lite (VS-Lite) model, respectively. These relationships were used to identify the strength of the influence of different climatic factors throughout junipers’ growing season and to identify the main climatic factors limiting tree growth.

KEY RESULTS: The growth of juniper trees began in April and ended in October in the study area. The radial growth of juniper trees was limited by the soil moisture throughout the summer (June to August) of the current year at 24 sampling sites and limited by temperature at the six extra sites on the southern Tibetan Plateau.

CONCLUSIONS: Soil moisture limited juniper growth at the majority of sites. The temperature in the current summer limited the growth of juniper trees at a few sampling sites in the western part of the study area. Local climate conditions may contribute to different limiting factors in the growth response of trees on the southern Tibetan Plateau. These findings may contribute to the understanding of divergent forest dynamics and to sustainable forest management under future climate scenarios.

PMID:35608820 | DOI:10.1093/aob/mcac065

Int Urol Nephrol. 2022 May 24. doi: 10.1007/s11255-022-03200-w. Online ahead of print.

ABSTRACT

PURPOSE: To explore the gender differences in survival under different treatments in localized muscle-invasive bladder cancer (MIBC), and to find clinical strategies to improve the poor prognosis of female with bladder cancer (BC).

METHODS: Patients with localized MIBC were collected in the SEER database from 2010 to 2016 to analyze the gender differences in clinical characteristics. Propensity score matching was used to balance the effects of confounding factors. Kaplan-Meier method and Cox proportional hazards regression model were performed to compare the overall survival (OS) and cancer-specific survival (CSS) of patients between different treatment subgroups.

RESULTS: The entire cohort included 13,272 T2N0M0 MIBC patients, with a male-to-female incidence of 3:1. Compared with male patients, females had a higher age of onset and more blacks. There were more female patients undergoing bladder-sparing surgery (BSS) alone, and the OS and CSS were worse than those in males. The gender difference showed statistical significance in the BSS group, but not in the radical cystectomy (RC) group.

CONCLUSION: The survival of localized MIBC patients can be affected by treatments. Multi-modality treatment and RC may improve the survival prognosis of female patients.

PMID:35608804 | DOI:10.1007/s11255-022-03200-w

Drug Saf. 2022 May 24. doi: 10.1007/s40264-022-01180-5. Online ahead of print.

ABSTRACT

INTRODUCTION: The inclusion of herbal medicinal products and herbal supplements in pharmacovigilance systems is important because a systematic approach of collecting and analyzing adverse drug reactions related to these products will help practitioners, patients, and regulators to gain more knowledge and prevent harm.

OBJECTIVE: We aimed to categorize the adverse drug reaction reports on herbal medicinal products and herbal supplements submitted to the Pharmacovigilance Centre Lareb between 1991 and February 2021 on the basis of their regulatory status, herbs included, and adverse drug reactions involved.

METHODS: We categorized products on the basis of their registration status and herbal ingredients. The products were then categorized according to the Herbal Anatomical Therapeutic Chemical Classification System. We used descriptive statistics in Microsoft Excel 2019. Pivot tables were used for the analysis and presentation of the data.

RESULTS: Until February 2021, a total of 789 reports of herbal medicinal products and herbal supplements were received by Lareb. In these reports, a total of 823 herbal products were labeled as suspect. These products caused a total of 1727 adverse drug reactions. Of the 823 products, 229 were registered as a medicine, and 594 were on the market as a herbal supplement. Of the 823 herbal products, 522 reports concerned single-herb products, 256 reports concerned combination products, 27 reports concerned vitamin products containing herbal ingredients, and 18 reports concerned product issues. Approximately 15% of reports concerned serious adverse drug reactions, and adulterated products harbored a high risk of causing serious adverse drug reactions.

CONCLUSIONS: Analysis of the herbal medicinal products and herbal supplements in the Dutch pharmacovigilance database revealed a variety of suspected herbal ingredients. The reports provide insight into the variety of herbal products used in the Netherlands and the adverse reactions associated with their use. Pharmacovigilance of herbal products is essential to ensure their safe use.

PMID:35608783 | DOI:10.1007/s40264-022-01180-5

Ann Surg Oncol. 2022 May 24. doi: 10.1245/s10434-022-11839-z. Online ahead of print.

ABSTRACT

BACKGROUND: Patients with sentinel lymph node-positive (SLN+) melanoma are increasingly undergoing active nodal surveillance over completion lymph node dissection (CLND) since the Second Multicenter Selective Lymphadenectomy Trial (MSLT-II). Adherence to nodal surveillance in real-world practice remains unknown.

METHODS: In a retrospective cohort of SLN+ melanoma patients who underwent nodal surveillance at a single institution from July 2017 through April 2021, this study evaluated adherence to nodal surveillance ultrasound (US). Adherence to nodal US was compared with adherence to other surveillance methods based on receipt of adjuvant therapy. Early recurrence data were reported using descriptive statistics.

RESULTS: Among 109 SLN+ patients, 37 (34%) received US surveillance at recommended intervals. Of the 72 (66%) non-adherent patients, 16 were lost to follow-up, and 33 had planned follow-up at an outside institution without available records. More patients had a minimum of bi-annual clinic visits (83%) and cross-sectional imaging (53%) compared to those who were adherent with nodal US. The patients who received adjuvant therapy (60%) had fewer ultrasounds (p < 0.01) but more exams (p < 0.01) and a trend toward more cross-sectional imaging (p = 0.06). Of the overall cohort, 26 patients (24%) experienced recurrence at a median follow-up period of 15 months. Of these recurrences, 10 were limited to the SLN basin, and all of these isolated nodal recurrences were resectable.

CONCLUSIONS: Pragmatic challenges to real-world delivery of nodal surveillance remain after MSLT-II, and adjuvant therapy appears to be associated with a decreased likelihood of US adherence. Understanding US utility alongside cross-sectional imaging will be critical as increasingly more patients undergo nodal surveillance and adjuvant therapy.

PMID:35608800 | DOI:10.1245/s10434-022-11839-z