Tag: pubmed

Health Place. 2021 Apr 19;69:102571. doi: 10.1016/j.healthplace.2021.102571. Online ahead of print.

ABSTRACT

BACKGROUND: Population ageing and air pollution have become two major public health concerns in China. Longitudinal evidence on the body weight impacts of air pollution among older adults is rare. This study aims to investigate the impacts of ambient particulate matter with aerodynamic diameters ≤2.5 μm (PM_2.5) on weight status of older adults in China and the potential behavioral and metabolic pathways through which PM_2.5 influences weight status.

METHODS: The longitudinal data from the China Health and Retirement Longitudinal Study (body mass index-BMI, n = 9053; waist/height ratio-WHR, n = 9064) were linked to the air pollution data at the city-level with a rural-urban distinction. We used mixed-effects linear models to evaluate the impacts of PM_2.5 on individual weight status and multiple mediation analysis to examine potential pathways.

RESULTS: After adjusting for relevant socioeconomic and city-level risk factors, significant and robust positive impacts of PM_2.5 on BMI (0.025, 95%CI: 0.018, 0.031) and WHR*100 (0.058, 95%CI: 0.044, 0.072) were found among older adults in China. The PM_2.5-weight status relationship among older adults may be mediated through metabolic and inflammatory dysfunction pathways particularly HbA1c and C-reactive protein (CRP). As PM_2.5 deteriorates, the detrimental impacts tend to be more severe for rural-urban migrants and rural residents, compared to their urban counterparts. The worsening rural PM_2.5 profiles in some areas, such as the northern parts of the Central and the Eastern, may leave them particularly vulnerable to air pollution air .

CONCLUSIONS: PM_2.5 has an independent and significant detrimental impact on weight status including BMI and WHR of older adults in China, especially among rural adults and rural-urban migrants. PM_2.5 may affect weight status of older adults through biomarkers such as HbA1c and CRP. More research is needed to confirm our findings.

PMID:33887573 | DOI:10.1016/j.healthplace.2021.102571

Int J Med Inform. 2021 Apr 15;150:104465. doi: 10.1016/j.ijmedinf.2021.104465. Online ahead of print.

ABSTRACT

BACKGROUND: The plethora of information in the contemporary digital age is enormous and beyond the capability of the average person to process all the information received. During the COVID-19 pandemic outbreak, huge amount of information is increasingly available in digital information sources and overwhelms the average person. The purpose of this research was to investigate public’s information seeking behavior on COVID-19 in Greece.

METHOD: The study was conducted through a web-based survey, facilitated by the use of questionnaire posted on the Google Forms platform. The questionnaire consisted of closed-ended, 7-point Likert scale questions and multiple choice questions and was distributed to all over Greek Regions to almost 3.000 recipients, during the implementation of restrictive measures against the COVID-19 outbreak in Spring 2020. The data collected were subjected to a descriptive statistical analysis. The median was used to present the results. In order to perform analysis between genders, as well as age groups, the non-parametric criteria Mann-Whitney U and Kruskal-Wallis were applied to determine the existence of differences in participants’ beliefs.

RESULTS: Responses by 776 individuals were obtained. Individuals dedicated up to 2 h per day to be informed on COVID-19. Television, electronic press and news websites were reported by the participants as more reliable than social media, in obtaining information on COVID-19. Respondents paid attention to official sources of information (Ministry of Health, Civil Protection etc.). Family and friends played an additional role in the participants’ information on COVID-19, while the personal doctor, other health workers and pharmacists did not appear to be most preferred sources of information on COVID-19. Participants’ most common information seeking strategy in digital environment was keyword searching. Unreliable information, fake news and information overload were the most common difficulties that the participants encountered seeking information on COVID-19. The respondents’ views seemed to differ significantly among age groups. The older the participants, the more often they were informed by television (p < 0.001) and the less often by the internet (p < 0.001). Females appear to use more frequently internet (p < 0.001) and social media (p = 0.001) out of habit and visit more often the Ministry of Health (p < 0.001) and the Civil Protection (p=0.005) websites, compared to males. Most of the participants seemed to worry about the fake news phenomenon and agreed that fake news on COVID-19 is being spread in the media and especially social networks.

CONCLUSION: The study revealed that, during the COVID-19 pandemic in Greece, participants obtained information about the disease mainly by television, electronic press and news websites. On the contrary, the limited use of social media demonstrates the participants awareness of the spread of fake news on social media. This observed information seeking behavior might has contributed to individuals’ acceptance of the necessary behavioral changes that had led to the Greek success story in preventing spread of the disease.

PMID:33887589 | DOI:10.1016/j.ijmedinf.2021.104465

J Biomech. 2021 Apr 11;121:110432. doi: 10.1016/j.jbiomech.2021.110432. Online ahead of print.

ABSTRACT

The purpose of this study was to examine the association of breast cancer-related lymphedema on shoulder girdle kinematics and upper extremity function. The study included 67 breast cancer survivors with and without unilateral lymphedema. Individuals were divided into non-lymphedema, moderate and severe lymphedema groups according to the volumetric measurement difference between the affected and unaffected upper extremities. A three-dimensional motion monitor-electromagnetic system was used to analyze scapular movements during the elevation and depression phases of the upper extremity elevation in the scapular plane. Shoulder range of motion was assessed with a digital inclinometer. Upper extremity function was assessed with the ‘Disabilities of the Arm, Shoulder, and Hand Questionnaire-Short Form (Quick-DASH)’. The scapular upward rotation was lower for the severe lymphedema group than for the non-lymphedema group in the 90-60-30° depression phases of arm elevation (p < .05). The scapular anterior tilt was higher for the severe lymphedema group than for the non-lymphedema group in the 30° depression phase of arm elevation (p < .05). Shoulder abduction range of motion was the lowest in the severe lymphedema group (p < .05). The non-lymphedema group had the lowest quick-DASH score and the severe lymphedema group had the highest score (p < .05). There were statistically significant moderate associations between the quick-DASH scores and scapular movements in all groups (p < .05). The development, presence and/or severity of lymphedema were associated with impaired shoulder-girdle kinematics and decreased upper extremity function. However, a need exists for longitudinal studies comparing individuals with and without lymphedema and healthy controls.

PMID:33887538 | DOI:10.1016/j.jbiomech.2021.110432

Clin Res Hepatol Gastroenterol. 2021 Apr 19;45(3):101594. doi: 10.1016/j.clinre.2020.101594. Online ahead of print.

ABSTRACT

BACKGROUND: Appropriate nutritional support is critical for patients undergoing liver transplantation (LT). Early enteral nutrition (EEN) has been considered effective in critically ill patients. However, the clinical effect of EEN on liver-transplanted patients is unclear.

AIM: To evaluate the clinical effect of early enteral nutrition in patients receiving a liver transplant.

METHODS: A systematic search was performed on the Cochrane Library, PubMed, CINAHL, EMBASE, Web of Science, WanFang database, Chinese Biomedical Literature Database and China National Knowledge Infrastructure to collect relevant studies up to January, 2020. The results of these studies were pooled to calculate relative risk and mean differences with 95% confidence intervals for dichotomous data and continuous data. All statistical analysis was carried out by Review Manager 5.3.

RESULTS: 9 RCTs and 10 cohort studies with 1300 patients were included in this meta-analysis. Compared with TPN, EEN reduced postoperative infection rates, ICU hours, length of hospitalization, and the duration of bowel ventilation as well as strengthening the nutritional status and liver function of LT patients. There is no difference in mortality rates, blood glucose levels or gastrointestinal complications. Compared to TPN, the combined EN + PN method more effectively prevented infection.

CONCLUSION: For patients undergoing liver transplantation, early enteral nutrition with or without combination may considered as a better nutritional therapy than total parenteral nutrition.

PMID:33887541 | DOI:10.1016/j.clinre.2020.101594

Pathol Res Pract. 2021 Apr 15;221:153447. doi: 10.1016/j.prp.2021.153447. Online ahead of print.

ABSTRACT

BACKGROUND: anaplastic lymphoma kinase (ALK) overexpression and gene alterations have been detected in several malignancies, with prognostic and therapeutic implications. However, few studies investigated the correlation between ALK altered expression and prognosis in patients with glioblastoma (GBM).

METHODS: We performed an evaluation of ALK overexpression and structural/quantitative chromosome alterations through immune-histochemical assay (IHC with D5F3 antibody) and fluorescent in situ hybridization (FISH) in patients with isocitrate dehydrogenase (IDH) wild type (wt) GBM. Assuming an ALK overexpression in 20 % of patients we planned a sample of 44 patients to achieve a probability of 90 % to include from 10 % to 30 % of patients with ALK alterations.

RESULTS: We evaluated 44 patients with IDH wt GBM, treated in our institution and dead due to GBM progression in 2017. ALK overexpression obtained by a composed score (the product of IHC intensity staining and rate of positive cells) was observed in 19 (43 %) patients. FISH analysis showed that 11 patients (25 %) had gene deletion, 2 patients (4.5 %) had monosomy and one patient (2.3 %) presented polysomy. Only one patient (2.3 %) demonstrated ALK rearrangement. There was no statistical difference in median OS between patients with ALK-positive (mOS = 18.9 months) and ALK-negative IHC (mOS = 18.0 months).

CONCLUSION: We identified some rare previously unreported alterations of ALK gene in patients with IDH wt GBM. In these patients, the ALK overexpression does not influences survival.

PMID:33887544 | DOI:10.1016/j.prp.2021.153447

Pain Pract. 2021 Apr 22. doi: 10.1111/papr.13021. Online ahead of print.

ABSTRACT

PURPOSE: Various adjuvants for prolongation of intraoperative and postoperative analgesia have been clinically studied, but the safety and efficiency of nalbuphine as an adjuvant to local anesthetics in spinal anesthesia remains unconfirmed. Therefore, we conducted a meta-analysis about the effect of nalbuphine as an adjuvant to local anesthetics in spinal anesthesia in regard to time of onset of sensory blockade and motor blockade,duration of motor blockade, two-segment sensory regression time, the duration of analgesia, and incidence of side effects to provide a reliable basis for clinical application.

METHODS: Databases including PubMed, Cochrane, EMBASE, Web of Science, CNKI, CBM, WanFang database and Viper database were searched for eligible studies. Data was extracted according to the proposed inclusion and exclusion criteria, RevMan 5.3 and Stata16 were selected to perform meta-analysis.

RESULTS: Eighteen published studies including 1633 patients met the inclusion criteria. The results showed that adding nalbuphine to local anesthetics for spinal anesthesia can prolong two-segment sensory regression time [MD=24.31; 95% CI 19.61~29.00, P < 0.001] and the duration of analgesia [(MD =118.11;95%CI 71.34 ~ 164.89, P < 0.001]without significantly increasing the incidence of adverse reactions in comparison to normal saline group. What’s more, the analgesic effect of nalbuphine group was not statistically different from that of control group when compared with the potent opioid group, but the occurrence of hypotension(RR = 0.35, 95% CI: 0.18-0.68, P<0.01), the occurrence of shivering(RR = 0.19, 95% CI: 0.08-0.43, P<0.01)and the occurrence of pruritus (RR = 0.23, 95% CI: 0.10-0.53, P<0.01) was lower than the potent opioid group.

CONCLUSIONS: Nalbuphine as additives to local anesthetics can significantly prolong the two segments of sensory block and the average duration of analgesia without increasing the incidence of adverse reactions when compared with normal saline group. And the analgesic efficacy of nalbuphine served as an adjunct to local anaesthetics was clinically not different from that of the potent opioids, but the occurrence of hypotension, shivering and pruritus was lower than the potent opioids.

PMID:33887111 | DOI:10.1111/papr.13021

Fam Med. 2021 Apr;53(4):295-299. doi: 10.22454/FamMed.2021.399314.

ABSTRACT

BACKGROUND AND OBJECTIVES: Substance use disorders (SUD) remain a public health crisis and training has been insufficient to provide the skills necessary to combat this crisis. We aimed to create and study an interactive, destigmatizing, skills-based workshop for medical students to evaluate if this changes students’ self-reported knowledge, skills, and attitudes toward patients with SUD.

METHODS: We surveyed students on a required family medicine outpatient rotation at a Pacific Northwest medical school during clerkship orientation on their views regarding SUDs utilizing the validated Drug and Drug Problems Perceptions Questionnaire containing a 7-point Likert scale. After attending a substance use disorder workshop, they repeated the survey. We calculated differences between the paired pre- to postsurveys.

RESULTS: We collected the pre- and postdata for 118 students who attended the workshop and showed statistically significant positive differences on all items.

CONCLUSIONS: The positive change in the medical students’ reported attitudes suggests both necessity and feasibility in teaching SUD skills in a destigmatizing way in medical training. Positive changes also suggest a role of exposing students to family medicine and/or primary care as a strategy to learn competent care for patients with substance use disorders.

PMID:33887053 | DOI:10.22454/FamMed.2021.399314

Int J Clin Pract. 2021 Apr 22:e14256. doi: 10.1111/ijcp.14256. Online ahead of print.

ABSTRACT

AIM: This study aimed to investigate hemogram parameters and CRP that can be used in clinical practice to predict mortality in hospitalized patients with a diagnosis of COVID-19.

METHODS: This cohort study was conducted at University Hospital, which is a designated hospital for COVID-19 patients. Adult patients who were admitted to our hospital emergency department with suspected COVID-19 and who were hospitalized in our institution with a COVID-19 diagnosis were analysed.

RESULTS: There were 148 patients hospitalized with COVID-19. All-cause mortality of follow-up was 12.8%. There were statistically significant results between the 2 groups (survivors and non-survivors), which were classified based on hospital mortality rates, in terms of the lymphocyte to C-reactive protein ratio (LCRP), Systemic immune inflammation index (SII), , neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), CRP concentration and comorbid disease. In a Receiver operating characteristic (ROC)”. curve analysis, LCRP, NLR, PLR, and SII area under the curve (AUC) for in-hospital mortality were 0.817, 0.816, 0.733 and, 0,742 respectively. Based on an LCRP value of 1 for in-hospital mortality, the sensitivity, and specificity rates were 100%, 86.8% respectively. Based on the average SII of 2699 for in-hospital mortality, the sensitivity, specificity, and accuracy rates were 68,4%, 77,5%, and 76,3%, respectively A total of 19 patients died during hospitalization. All of these patients had an LCRP level ≤ 1; 14 had an NLR level ≤ 10.8; 13 had a SII ≥ 2699 (Fisher’s exact test, p = 0.000). Independent predictors of in-hospital mortality rates were LCRP < 1, PLR, SII ≥ 2699, white blood cell count, CRP, age, comorbidities, and ICU stay.

CONCLUSIONS: We concluded that inflammatory parameters, such as LRCP, SII and NLR, were associated with disease severity and could be used as potentially important risk factors for COVID-19 progression.

PMID:33887100 | DOI:10.1111/ijcp.14256

Rev Saude Publica. 2021 Apr 14;55:10. doi: 10.11606/s1518-8787.2021055002685. eCollection 2021.

ABSTRACT

OBJECTIVE: To analyze the effect of matrix support on health for older adults in primary care according to the dimensions of frailty measured with the Clinical-Functional Vulnerability Index-20 (IVCF-20).

METHODS: This is a randomized controlled community trial, developed in the Northern Minas Gerais state, Brazil, in 2018. Initially, the stratification of clinical and functional vulnerability of older adults supported by six Family Health Strategy teams occurred with the IVCF-20. Subsequently, three teams were drawn to receive matrix support for six months, and the others for control. In this intervention, face-to-face educational activities were developed for health teams. Descriptive statistics were performed, followed by bivariate analysis by Pearson’s chi-square test, to compare the variables of the IVCF-20 between the two moments (before and after the intervention), with a 5% significance level. Relative risks and respective 95% confidence intervals (95%CI) were estimated.

RESULTS: The groups were similar before intervention, and the effect of matrix actions was positive for most dimensions measured by IVCF-20 (instrumental daily living activity, cognition, mood, mobility, communication, and multiple comorbidities). At the end of the research, the percentage of frailty in the group assisted by professionals participating in matrix support was lower than that of the control group.

CONCLUSIONS: Matrix support actions, such as pedagogical attribution and horizontal care for health teams, have the potential to contribute to the articulation of models of care for older adults.

REBEC: registro BR-7b9xff.

PMID:33886949 | DOI:10.11606/s1518-8787.2021055002685

J Burn Care Res. 2021 Apr 22:irab070. doi: 10.1093/jbcr/irab070. Online ahead of print.

ABSTRACT

Electrical burn injuries can cause devastating and debilitating morbidities and impairments for patients. This cross-sectional descriptive study was performed on electrical burn patients hospitalized from 2014 to 2019 to evaluate electrical burn injuries’ epidemiology and characteristics. A total number of 726 patients with the mean age of 31.17 years were evaluated for electrical burn injuries. Mean total burn surface area (TBSA) was 16.61 ± 12.56. Most victims were male (696 cases, 95.7%); and most patients did not have a constant job (n = 458, 63%). Most affected burn sites were hands (28.6%) and upper limbs (27.8%). A total number of 89 (12.2%) patients suffered amputations with the hand fingers (64 cases) as the most common site. Low voltage injuries were more common (n = 649 , 89%). Most incidents happened at the workplace (n =459 , 63%). Comparison of patients with high voltage and low voltage injuries showed significant correlations and statistical difference between these 2 groups regarding TBSA, mean hospital stays, escharectomy, fasciotomy, amputations, debridement, fracture and mortality rate (P = 0.001). Our observation revealed that electrical burn injuries are still significant causes of morbidity and mortality among trauma patients. In contrast to previous studies, low voltage injuries were more common than high voltage ones. We propose improvements in the manufacturing of electrical appliances; paying attention to safety measures will reduce thenumber of incidents. Moreover, training and education play important roles in reducing the number of incidents and mortality rates.

PMID:33886962 | DOI:10.1093/jbcr/irab070