Tag: pubmed

J Paediatr Child Health. 2022 Feb 10. doi: 10.1111/jpc.15895. Online ahead of print.

ABSTRACT

AIM: To evaluate whether the health-related quality-of-life (HRQoL) scores would be different for adolescents with menstrual problems as compared to those with normal menstruation after taking into account clinical, socio-demographic and life-style factors.

METHODS: The Paediatric Quality of Life Inventory 4.0 scale was used to assess HRQoL in 126 schoolgirls of 16 ± 0.4 years old. The adolescents completed semi-structured questionnaires containing information on social and demographic characteristics, life-style features and menstrual questionnaires that included the following: age of menstruation, menstrual cycle length, duration of production, the number of pads used per day, menstrual pain and drug administration to relieve dysmenorrhea. The menstrual problems were classified into three main groups: dysmenorrhoea, oligomenorrhoea, and heavy menstrual bleeding. Anthropometric measurements were performed by a physician. Medical history was obtained from school medical charts.

RESULTS: Ninety-seven (77%) girls had menstrual problems. Dysmenorrhoea (n = 92, 73%) was the most frequent of these, followed by oligomenorrhoea (n = 13, 10.3%) and heavy menstrual bleeding (n = 6, 4.8%). Thirteen (10.3%) girls had combined disorders. A multivariate analysis adjusted for life-style factors found an independent association of any menstrual problems, oligomenorrhoea and dysmenorrhoea with low HRQoL scores in the emotional functioning domain. For adolescents with oligomenorrhoea, an association with low total scale scores was also shown but it did not reach statistical significance.

CONCLUSION: The prevalence of menstrual problems is high among schoolgirls. Medical professionals working with adolescents should know that girls with menstrual problems are highly likely to have a poor quality of life, especially those with oligomenorrhoea.

PMID:35141982 | DOI:10.1111/jpc.15895

Semin Dial. 2022 Feb 9. doi: 10.1111/sdi.13061. Online ahead of print.

ABSTRACT

INTRODUCTION: The aim of our study is to compare clotting of CRRT filters in patients with COVID-19-associated AKI versus septic shock-associated AKI.

METHODS: Retrospective study of adult ICU patients with COVID-19 compared to those with septic shock admitted to a tertiary hospital April-October 2020. Independent t test and chi-square test used to determine statistical significance of CRRT filter clotting between the two groups. Time-to-event data analyzed with Kaplan-Meier curves. Analyses performed on Microsoft Excel and MedCalc.

RESULTS: Twenty-seven ICU patients with AKI requiring CRRT were included, 13 with COVID-19 and 14 non-COVID-19 patients with septic shock. The mean half-life of CRRT hemofilter was similar in COVID-19 patients compared to non-COVID-19 patients (27.4 vs. 27.5 h, p = 0.79). The number of CRRT hemofilter changes per day was similar in both groups (0.6 filter changes per day, p = 0.84). However, significantly more patients with COVID-19 were on systemic heparin (69% vs. 13%, p = 0.02).

CONCLUSION: We found that COVID-19 patients with AKI requiring CRRT had similar CRRT hemofilter half-life compared with sepsis-associated AKI patients with use of regional citrate and systemic heparin. Further studies are needed to find which methods of anticoagulation are optimal in patients with COVID-19 infection with AKI requiring CRRT.

PMID:35141966 | DOI:10.1111/sdi.13061

J Clin Periodontol. 2022 Feb 10. doi: 10.1111/jcpe.13603. Online ahead of print.

ABSTRACT

AIM: This study evaluated the intervention effect of omega-3 fatty acids on changes in periodontal parameters.

MATERIALS AND METHODS: This meta-analysis included English-language studies published between 2010 and 2020, which were extracted from the Cochrane Library, EMBASE, and PubMed databases. The effects of omega-3 fatty acid intervention were investigated using the amount of omega-3 intake, periodontal pocket depth (PPD), clinical attachment loss (CAL), and bleeding on probing (BOP). The random-effects model was generated for data analysis. To obtain robustness of the model, sensitivity analysis was implemented. Subgroup analyses were performed based on the intervention period for each parameter.

RESULTS: All 13 studies included in the meta-analysis were interventional randomized controlled trials. Two studies implemented omega-3 fatty acid-rich diets, while eleven studies used supplements. Risk of bias was low and publication bias was not shown. Meta-analysis showed a statistically significant PPD reduction (standardized mean difference; SMD = -0.81 mm, absolute mean difference; MD = -0.44 mm), CAL gain (SMD = -0.77 mm, MD = -0.51 mm), and BOP reduction (SMD = -0.65%, MD = -9.45%) for the omega-3 fatty acids intervention overall.

CONCLUSION: This study suggests that supplemental or dietary intake of omega-3 fatty acids for the treatment of periodontitis may positively impact on periodontitis.

PMID:35141945 | DOI:10.1111/jcpe.13603

Echocardiography. 2022 Feb 9. doi: 10.1111/echo.15320. Online ahead of print.

ABSTRACT

OBJECTIVES: Obesity is a public health problem that needs to be treated and it occurs as a result of excessive fat accumulation in the body. The relationship between obesity and pulmonary hypertension is well known. The aim of this study is to evaluate the relationship between pulmonary artery stiffness, right ventricular functions and bioelectrical impedance parameters in obese, overweight, and healthy individuals.

METHODS: In this study, 41 obese (17 female and 24 male, mean age 43.5±10.3), 39 overweight (20 female and 19 male, mean age 38.6±10.4), 34 healthy control group (19 female and 15 male, mean age 40.5±8.6) were included. Anthropometric measurements and bioelectrical impedance parameters of all participants were performed. Right ventricular functions and pulmonary artery stiffness were evaluated by using conventional echocardiography.

RESULTS: Right ventricle myocardial performance index, pulmonary artery stiffness values were statistically different between groups. Positive correlation was observed between pulmonary artery stiffness and Body Mass Index, Waist and Hip circumferences. Significant negative correlation was observed between muscle to fat ratio and pulmonary artery stiffness. In the linear regression analysis, it was observed that the muscle to fat ratio was independent predictor of pulmonary artery stiffness (β = -1.835; 95%CI(-2.434 – – .784); p < 0.001).

CONCLUSIONS: This study showed that right ventricular function was impaired and pulmonary artery stiffness increased in obese individuals. These findings could be considered as early markers of pulmonary hypertension in obese patients who do not yet have clinical evidence of cardiovascular disease.

PMID:35141938 | DOI:10.1111/echo.15320

Biotechnol Bioeng. 2022 Feb 10. doi: 10.1002/bit.28057. Online ahead of print.

ABSTRACT

Escherichia coli O157:H7 have previously been associated with disease outbreaks associated with leafy green vegetables. However, the physical mechanisms that determine the spatial organization of bacteria onto leafy greens are still not clear. Microfluidics with embedded trichome-mimicking microposts were employed to investigate the role of shear flow and configuration of trichomes on E. coli O157:H7 microcolonization. We characterized the 3D microcolonization of green fluorescent protein (GFP)-tagged E. coli O157:H7 using multiphoton fluorescence microscopy and compared their differences under static (no flow; incubated for 36 h at 37°C) and fluid shear conditions (750 nL/min for 36 h at 37°C). For micropatterned trichome arrays, we demonstrated that natural wax-mixed polydimethylsiloxane (PDMS) retains similar topographies and contact angles to the surface of trichome-bearing leafy greens. Our results showed that E. coli O157:H7 under fluid shear stress aligned their colonization parallel to the direction of flow. In a static condition, their colonization had no preferential alignment, with statistically similar angular distributions in all directions. In addition, depending on dimensions of the trichome arrays and flow conditions, different bacterial microcolonization patterns grew radially from initial attachment; they formed into filamentous structures and developed into bridges by surface hydrophobicity and flow-induced shear with a nutrient-rich medium. Collectively, these results demonstrate how the consequences of bacterial colonization in response to shear flow can affect pathogenic bacterial contamination of leafy greens and biofilm architectures. This article is protected by copyright. All rights reserved.

PMID:35141878 | DOI:10.1002/bit.28057

Neurocrit Care. 2022 Feb 9. doi: 10.1007/s12028-021-01425-8. Online ahead of print.

ABSTRACT

BACKGROUND: Although coma is commonly encountered in critical care, worldwide variability exists in diagnosis and management practices. We aimed to assess variability in coma definitions, etiologies, treatment strategies, and attitudes toward prognosis.

METHODS: As part of the Neurocritical Care Society Curing Coma Campaign, between September 2020 and January 2021, we conducted an anonymous, international, cross-sectional global survey of health care professionals caring for patients with coma and disorders of consciousness in the acute, subacute, or chronic setting. Survey responses were solicited by sequential emails distributed by international neuroscience societies and social media. Fleiss κ values were calculated to assess agreement among respondents.

RESULTS: The survey was completed by 258 health care professionals from 41 countries. Respondents predominantly were physicians (n = 213, 83%), were from the United States (n = 141, 55%), and represented academic centers (n = 231, 90%). Among eight predefined items, respondents identified the following cardinal features, in various combinations, that must be present to define coma: absence of wakefulness (81%, κ = 0.764); Glasgow Coma Score (GCS) ≤ 8 (64%, κ = 0.588); failure to respond purposefully to visual, verbal, or tactile stimuli (60%, κ = 0.552); and inability to follow commands (58%, κ = 0.529). Reported etiologies of coma encountered included medically induced coma (24%), traumatic brain injury (24%), intracerebral hemorrhage (21%), and cardiac arrest/hypoxic-ischemic encephalopathy (11%). The most common clinical assessment tools used for coma included the GCS (94%) and neurological examination (78%). Sixty-six percent of respondents routinely performed sedation interruption, in the absence of contraindications, for clinical coma assessments in the intensive care unit. Advanced neurological assessment techniques in comatose patients included quantitative electroencephalography (EEG)/connectivity analysis (16%), functional magnetic resonance imaging (7%), single-photon emission computerized tomography (6%), positron emission tomography (4%), invasive EEG (4%), and cerebral microdialysis (4%). The most commonly used neurostimulants included amantadine (51%), modafinil (37%), and methylphenidate (28%). The leading determinants for prognostication included etiology of coma, neurological examination findings, and neuroimaging. Fewer than 20% of respondents reported routine follow-up of coma survivors after hospital discharge; however, 86% indicated interest in future research initiatives that include postdischarge outcomes at six (85%) and 12 months (65%).

CONCLUSIONS: There is wide heterogeneity among health care professionals regarding the clinical definition of coma and limited routine use of advanced coma assessment techniques in acute care settings. Coma management practices vary across sites, and mechanisms for coordinated and sustained follow-up after acute treatment are inconsistent. There is an urgent need for the development of evidence-based guidelines and a collaborative, coordinated approach to advance both the science and the practice of coma management globally.

PMID:35141860 | DOI:10.1007/s12028-021-01425-8

J Gen Intern Med. 2022 Feb 9. doi: 10.1007/s11606-021-07287-2. Online ahead of print.

ABSTRACT

BACKGROUND: Integrated care for comorbid depression and chronic medical disease improved physical and mental health outcomes in randomized controlled trials. The Veterans Health Administration (VA) implemented Primary Care-Mental Health Integration (PC-MHI) across all primary care clinics nationally to increase access to mental/behavioral health treatment, alongside physical health management.

OBJECTIVE: To examine whether widespread, pragmatic PC-MHI implementation was associated with improved care quality for chronic medical diseases.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included 828,050 primary care patients with at least one quality metric among 396 VA clinics providing PC-MHI services between October 2013 and September 2016.

MAIN MEASURE(S): For outcome measures, chart abstractors rated whether diabetes and cardiovascular quality metrics were met for patients at each clinic as part of VA’s established quality reporting program. The explanatory variable was the proportion of primary care patients seen by integrated mental health specialists in each clinic annually. Multilevel logistic regression models examined associations between clinic PC-MHI proportion and patient-level quality metrics, adjusting for regional, patient, and time-level effects and clinic and patient characteristics.

KEY RESULTS: Median proportion of patients seen in PC-MHI per clinic was 6.4% (IQR=4.7-8.7%). Nineteen percent of patients with diabetes had poor glycemic control (hemoglobin A1c >9%). Five percent had severely elevated blood pressure (>160/100 mmHg). Each two-fold increase in clinic PC-MHI proportion was associated with 2% lower adjusted odds of poor glycemic control (95% CI=0.96-0.99; p=0.046) in diabetes. While there was no association with quality for patients diagnosed with hypertension, patients without diagnosed hypertension had 5% (CI=0.92-0.99; p=0.046) lower adjusted odds of having elevated blood pressures.

CONCLUSIONS AND RELEVANCE: Primary care clinics where integrated mental health care reached a greater proportion of patients achieved modest albeit statistically significant gains in key chronic care quality metrics, providing optimism about the expected effects of large-scale PC-MHI implementation on physical health.

PMID:35141854 | DOI:10.1007/s11606-021-07287-2

Cardiovasc Interv Ther. 2022 Feb 9. doi: 10.1007/s12928-021-00833-z. Online ahead of print.

ABSTRACT

In this real-world, retrospective cohort study of 9753 patients in Japan prescribed dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI), we investigated DAPT duration and determined factors associated with early DAPT discontinuation and with event rates in patients who discontinued DAPT. The study period was April 1, 2012-March 31, 2018; endpoints comprised composite efficacy [death, myocardial infarction (MI), and stroke] and bleeding (intracranial, gastrointestinal, and requiring transfusion) endpoints. Overall, 68.8% of patients were continuing DAPT at 3 months post-PCI. Patients without major efficacy or safety events within 3 months after index PCI were included in a landmark analysis set (LAS; n = 7056), and categorized as DAPT ≥ 3 months (continuation) versus < 3 months (discontinuation). In the two LAS analysis groups, there was no difference in the composite bleeding endpoint (P = 0.067), although the incidence of the composite efficacy endpoint was higher in the discontinuation group (P < 0.001). In multivariate regression analysis, age ≥ 75 years, minor bleeding after PCI, history of cerebral infarction, history of cerebral or gastrointestinal bleeding, atrial fibrillation, dialysis, and anticoagulant use after PCI were associated with early DAPT discontinuation. Acute coronary syndrome, history of MI, kidney disorder, and anticoagulant use after PCI were associated with the composite efficacy endpoint in the discontinuation group. In conclusion, early DAPT discontinuation is more likely in patients at high bleeding risk, but may influence the occurrence of ischemic events in these patients. Determination of DAPT duration should take into account potential ischemic risk, even in patients at high bleeding risk.

PMID:35141843 | DOI:10.1007/s12928-021-00833-z

Appl Health Econ Health Policy. 2022 Feb 10. doi: 10.1007/s40258-022-00716-1. Online ahead of print.

ABSTRACT

BACKGROUND: The current healthcare system is challenged with a large and rising demand for obstructive sleep apnoea (OSA) services. A paradigm shift in OSA management is required to incorporate the preferences of diagnosed patients and individuals at high risk of OSA.

OBJECTIVES: This study aimed to provide empirical evidence of the values and preferences of individuals diagnosed with OSA and high-risk populations regarding distinct OSA care pathway features.

METHODS: A discrete choice experiment was undertaken in two groups: those with a formal diagnosis of OSA (n = 421) and those undiagnosed but at high risk of having OSA (n = 1033). Participants were recruited from a large cross-sectional survey in Australia. The discrete choice experiment approach used mixed-logit regression models to determine preferences relating to eight salient features of the OSA management pathway, i.e. initial assessment provider, sleep study setting, diagnosis costs, waiting times, results interpretation, treatment options, provider of ongoing care and frequency of follow-up visits.

RESULTS: The findings indicate that all eight attributes investigated were statistically significant factors for respondents. Generally, both groups preferred low diagnostic costs, fewer follow-up visits, minimum waiting time for sleep study results and sleep specialists to recommend treatment. Management of OSA in primary care was acceptable to both groups and was the most preferred option by the high-risk group for the initial assessment, sleep study testing and ongoing care provision.

CONCLUSIONS: The discrete choice experiment results offer a promising approach for systematic incorporation of patient and high-risk group preferences into the future design and delivery of care pathways for OSA management.

PMID:35141851 | DOI:10.1007/s40258-022-00716-1

J Gastrointest Surg. 2022 Feb 9. doi: 10.1007/s11605-022-05265-5. Online ahead of print.

ABSTRACT

BACKGROUND: Routine placement of a feeding jejunostomy tube (FJT) following esophagectomy remains controversial due to the risk of complications including small bowel obstruction (SBO). This study aimed to evaluate FJT placement following esophagectomy.

METHODS: This retrospective cohort study included consecutive 229 patients undergoing thoracoscopic esophagectomy between January 2010 and June 2020. Short-term outcomes, postoperative nutritional status, incidence of SBO, and long-term outcomes were compared between patients according to FJT placement.

RESULTS: The total operative duration was significantly longer in the FJT group compared to the no FJT group (P < 0.0001); however, no differences in overall or severe postoperative morbidity were observed. Body weight loss at discharge was significantly attenuated in patients with FJT (5% vs 7%, P = 0.001). Serum cholinesterase levels were significantly higher in patients with FJT (P = 0.002), while no difference was observed in serum albumin levels. At 6-month follow-up, no statistically significant differences were observed in serological markers or percentage body weight. The incidence of SBO was significantly higher in the FJT group (P = 0.006). The 5-year incidence of SBO was 12%. Patients in the FJT group had higher progression-free and overall survival compared to patients in the no FJT group (P = 0.041 and P = 0.033, respectively). A similar trend toward better survival in the FJT group was observed after propensity score matching.

CONCLUSIONS: Routine placement of FJT significantly improves postoperative nutritional status and may contribute to improved long-term survival but is associated with increased long-term risk of SBO.

PMID:35141836 | DOI:10.1007/s11605-022-05265-5