Tag: pubmed

J Prim Care Community Health. 2021 Jan-Dec;12:21501327211024417. doi: 10.1177/21501327211024417.

ABSTRACT

INTRODUCTION: The proportion of patients who are frequent attenders (FAs) varies from few percent to almost 30% of all patients. A small group of patients continued to visit GPs year after year. In previous studies, it has been reported that over 15% of all 1-year FAs were persistent frequent attenders (pFAs).

OBJECTIVES: This study aimed to identify typical features of pFAs from the textual content in their medical entries, which could help GPs to recognize pFAs easily and facilitated treatment.Methods: A retrospective register study was done, using 10 years of electronic patient records. The data were collected from Finnish primary health care centers and used to analyze chronic symptoms and diagnoses of pFAs and to calculate the inverse document frequency weight (IDF) of words used in the patient records. IDF was used to determine which words, if any, are typical for pFAs. The study group consisted of the 5-year pFAs and control group of 1-year FAs. The main background variables were age, gender, occupation, smoking habits, use of alcohol, and BMI.

RESULTS: Out of 4392 frequent attenders, 6.6% were pFAs for 3 years and 1.1% were pFAs for 5 years. Of the pFAs, 65% were female and 35% were male. The study group had significantly more depressive episodes (P = .004), heart failure (P = .019), asthma (P = .032), COPD (P = .036), epilepsy (P = .035), and lumbago (P = .046) compared to the control group. GPs described their 5-year pFAs by words related to lung and breathing issues, but there was no statistical difference to the 1-year FAs’ descriptions.

CONCLUSION: A typical pFA seems to be a woman, aged about 55 years with depressive episodes, asthma or COPD, and lower back pain. Physicians describe pFAs with ordinary words in patient records. It was not possible to differentiate pFAs from 1-year FAs in this way.

PMID:34109878 | DOI:10.1177/21501327211024417

Nat Commun. 2021 Jun 9;12(1):3505. doi: 10.1038/s41467-021-23556-4.

ABSTRACT

Hundreds of thousands of genetic variants have been reported to cause severe monogenic diseases, but the probability that a variant carrier develops the disease (termed penetrance) is unknown for virtually all of them. Additionally, the clinical utility of common polygenetic variation remains uncertain. Using exome sequencing from 77,184 adult individuals (38,618 multi-ancestral individuals from a type 2 diabetes case-control study and 38,566 participants from the UK Biobank, for whom genotype array data were also available), we apply clinical standard-of-care gene variant curation for eight monogenic metabolic conditions. Rare variants causing monogenic diabetes and dyslipidemias display effect sizes significantly larger than the top 1% of the corresponding polygenic scores. Nevertheless, penetrance estimates for monogenic variant carriers average 60% or lower for most conditions. We assess epidemiologic and genetic factors contributing to risk prediction in monogenic variant carriers, demonstrating that inclusion of polygenic variation significantly improves biomarker estimation for two monogenic dyslipidemias.

PMID:34108472 | DOI:10.1038/s41467-021-23556-4

Nat Commun. 2021 Jun 9;12(1):3506. doi: 10.1038/s41467-021-23655-2.

ABSTRACT

In modern Whole Genome Sequencing (WGS) epidemiological studies, participant-level data from multiple studies are often pooled and results are obtained from a single analysis. We consider the impact of differential phenotype variances by study, which we term ‘variance stratification’. Unaccounted for, variance stratification can lead to both decreased statistical power, and increased false positives rates, depending on how allele frequencies, sample sizes, and phenotypic variances vary across the studies that are pooled. We develop a procedure to compute variant-specific inflation factors, and show how it can be used for diagnosis of genetic association analyses on pooled individual level data from multiple studies. We describe a WGS-appropriate analysis approach, implemented in freely-available software, which allows study-specific variances and thereby improves performance in practice. We illustrate the variance stratification problem, its solutions, and the proposed diagnostic procedure, in simulations and in data from the Trans-Omics for Precision Medicine Whole Genome Sequencing Program (TOPMed), used in association tests for hemoglobin concentrations and BMI.

PMID:34108454 | DOI:10.1038/s41467-021-23655-2

Med Sci Monit. 2021 Jun 10;27:e930151. doi: 10.12659/MSM.930151.

ABSTRACT

BACKGROUND The aim of this study was to assess the influence of socio-demographic and clinical factors on personality trait expression and their relationship with more intense interdialytic disorders and changes in health behaviors of patients with chronic kidney disease (CKD). MATERIAL AND METHODS A total of 200 participants were recruited for the research (84 women and 116 men; aged 61±12 years): 160 patients had CKD stage G4-G5 and 40 healthy participants constituted a control group. A diagnostic poll method was used in the research employing the following questionnaires to collect socio-demographic and clinical data: Health Behavior Inventory (IZZ), Personality Inventory (NEO-FFI), Beck Depression Inventory (BDI), and Researcher’s Questionnaire Test. RESULTS Statistically significant differences were found in the intensity of personal traits at different stages of treatment. The influence of factors resulting from CKD on the expression of personality traits increased with subsequent stages of treatment. Depression intensity was not connected with the expression of personality traits. A higher frequency of reported interdialytic disorders was significantly related to a higher degree of openness and conscientiousness and a lower degree of agreeableness. Increased extraversion, conscientiousness, and openness were significantly correlated with more intense health behaviors. CONCLUSIONS Personalities of patients with CKD changed with subsequent stages of treatment and were influenced by socio-demographic and clinical factors. Personalities affected the frequency of reported interdialytic disorders and health behaviors.

PMID:34108439 | DOI:10.12659/MSM.930151

J Trauma Acute Care Surg. 2021 Apr 8. doi: 10.1097/TA.0000000000003192. Online ahead of print.

ABSTRACT

BACKGROUND: Studies comparing mortality following massive transfusion (MT) with fresher versus longer-stored red blood cells (RBCs) have focused on trauma patients. The Australian and New Zealand Massive Transfusion Registry (ANZMTR) collects data on all adult MT cases (≥5 RBCs within 4 hours, any bleeding context, ≥ 18 years) at participating hospitals.

METHODS: 2007-2018 data from 29 hospitals were analyzed to quantify the association between mortality and RBC storage time in adult MT cases. We ran three logistic regression models separately on each of seven bleeding contexts, with in-hospital mortality as the outcome and, in turn, (1) mean storage time (STmean) quartiles, (2) proportion of RBCs ≥30 days old (propOLD), and (3) scalar age of blood index (SBI) as predictors.

RESULTS: 8,685 adult MT cases involving transfusion of 126,622 RBCs were analyzed with Australian and New Zealand data analyzed separately. Mean storage times for these cases were (by quartile in ascending order) Australia: 12.5 days (range: 3.1-15.5 days), 17.7 (15.5-19.9), 22.3 (19.9-24.9), 29.8 (24.9-41.7); New Zealand: 11.3 (3.6-13.7), 15.3 (13.7-16.8), 18.7 (16.8-20.7), 24.5 (20.7-35.6). The odds ratios comparing in-hospital mortality for each quartile to that of the control first quartile (freshest blood), proportion of longer-stored (≥30 days) RBCs, and SBI were not statistically significant across all bleeding contexts.

CONCLUSIONS: We find no correlation between in-hospital mortality and storage time of transfused RBCs in a large cohort of adult MT patients representing all bleeding contexts. These results are consistent with those of recent large multi-center trials.

LEVEL OF EVIDENCE: Level III (retrospective study with one negative criterion [heterogeneous population]).

PMID:34108423 | DOI:10.1097/TA.0000000000003192

Pain. 2021 Apr 5. doi: 10.1097/j.pain.0000000000002296. Online ahead of print.

ABSTRACT

Recent randomized controlled trials comparing the efficacy between intraoperative methadone and other opioids on postoperative outcomes have been limited by their small sample sizes and conflicting results. We performed a meta-analysis on randomized controlled trials which investigated outcomes between methadone and an opioid control group. Primary outcome data included postoperative opioid consumption, number of patients who received postoperative opioids, time to first analgesic, and pain scores. Secondary outcomes included time to extubation and incidence of nausea, vomiting, and respiratory depression. Statistical analysis was performed using RevMan. A P < 0.05 was considered statistically significant. Nine studies comprising 632 patients were included. There was no statistically significant reduction in opioid consumption postoperatively between the groups. Forty-seven percentage of patients in the methadone group received a dose of opioid postoperatively compared with 55% in the other opioids control group, which was not statistically significant. (P = 0.25) There was no difference in average time to receiving first postoperative analgesic among the groups. Pain scores within 24 hours were significantly lower in the methadone group when compared with other opioids (8 studies, n = 622, -0.49 [-0.74, -0.23], P = 0.002). However, there was no difference between 24 and 72 hours. There was no difference among the groups with respect to extubation time, nausea, vomiting, or respiratory depression. This meta-analysis concludes that there is currently insufficient evidence for the use of intraoperative methadone, when compared with other opioids. Although there was a decrease in average pain scores with methadone when compared with controls at 24 hours, there was no difference between 24 and 72 hours.

PMID:34108437 | DOI:10.1097/j.pain.0000000000002296

Clin J Pain. 2021 Jun 9. doi: 10.1097/AJP.0000000000000953. Online ahead of print.

ABSTRACT

OBJECTIVES: We sought to investigate emotional reactivity by measuring HRV and pressure pain sensitivity during a passive visualization task in participants with chronic low back pain (CLBP).

METHODS: This case-control study was composed of 47 participants with CLBP and 47 asymptomatic participants. Both groups were submitted to a passive visualization task using 27 pictures from PHODA (Photograph Series of Daily Activities). HRV frequency domains were measured before, during, and after the task. Pressure pain threshold (PPT) and pain intensity were also measured before and after the task.

RESULTS: The adjusted mean difference was statistically significant for HRV frequency domains during the visualization task, including low frequency (-5.92; 95%CI=-9.60 to -2.23), high frequency (-0.71; 95%CI=-1.02 to -0.39), and low frequency/high frequency ratio (8.82; 95%CI=5.19 to 12.45). PPT decreased after the task in the low back pain group in all body sites, and pain intensity increased (-0.8; 95% CI=-1.16 to -0.39).

DISCUSSION: Aversive environmental stimuli, such as visual cues, may generate defensive physiological reactions. Heart rate variability (HRV) can provide an available measure that reflects the perceptions of threat and safety in the environment. Participants with chronic low back pain presented changes in sympathovagal balance during passive visualization of pictures of daily activities, higher pain sensitivity, and high pain intensity when they are exposed to a passive visualization task using pictures of daily living that may arouse fears of harm.

PMID:34108363 | DOI:10.1097/AJP.0000000000000953

J Contin Educ Health Prof. 2021 Jun 8. doi: 10.1097/CEH.0000000000000370. Online ahead of print.

ABSTRACT

INTRODUCTION: Dietitians are in an important position to work alongside Aboriginal and Torres Strait Islander peoples to improve their health and may play a role in reducing the burden of disease experienced by Aboriginal and Torres Strait Islander peoples. Many dietitians do not feel confident to practice effectively in these settings and require improved workforce development opportunities. Communities of Practice can improve dietitians’ confidence and practice in Aboriginal and Torres Strait Islander health; however, evidence for long-term impacts is limited. This study aims to determine if a Community of Practice can have long-term impacts on dietitians working in Aboriginal and Torres Strait Islander health.

METHODS: Data were collected through semistructured interviews and a cultural awareness self-assessment tool. Analysis was through a multimethod approach and combined qualitative inductive thematic analysis, social network analysis, and descriptive statistics.

RESULTS: Three main areas of long-term impact were identified including development of a social and professional network, career progression and retention, and a fundamental change in thinking and practice. All participants experienced feelings of support and increased confidence.

DISCUSSION: Communities of practice may be a feasible, low-cost workforce development strategy that can reduce dietitians’ feelings of professional isolation when working in Aboriginal and Torres Strait Islander health. Further research is required to identify the mechanisms underlying sustained impacts. Social network analysis, combined with realist evaluation may be an appropriate research design, to answer future and more in-depth questions about the effectiveness of communities of practice.

PMID:34108390 | DOI:10.1097/CEH.0000000000000370

Med Care. 2021 Jun 9. doi: 10.1097/MLR.0000000000001576. Online ahead of print.

ABSTRACT

BACKGROUND: Many ethnic minority women have low attendance at breast cancer screening.

OBJECTIVES: This brief report explores whether women’s screening histories impact mammography screening attendance after tailored education.

RESEARCH DESIGN: Systematic searches were conducted in 5 databases. Randomized controlled trials of educational interventions tailored to ethnic minority women that measured attendance at mammography screening were eligible for inclusion. Data extraction and risk of bias assessment were performed independently. Data were combined in a meta-analysis by using random effects models. Heterogeneity was estimated by using I2 statistics.

RESULTS: Six studies with 3521 women were eligible for inclusion. The D+L pooled risk ratio (RR) for mammography attendance for never screened participants was 1.54 (95% confidence interval, 1.24-1.91; P<0.001), with low heterogeneity (I2=27.1%, P=0.231). The D+L pooled risk ratio for attendance for ever screened participants was 1.26 (95% confidence interval, 1.11-1.43; P<0.001), with low heterogeneity (I2=35.5%, P=0.213).

CONCLUSIONS: Tailored education increased attendance at mammography by 54% among never screened women and 26% among ever screened women. Although these findings must be interpreted with caution, the findings suggest that women’s screening history is an important and ignored variable that affects how effective tailored education is on mammography screening attendance.

PMID:34108408 | DOI:10.1097/MLR.0000000000001576

J Prosthodont Res. 2021 Jun 10. doi: 10.2186/jpr.JPR_D_20_00082. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the effect of three different designs and two monolithic ceramic materials on the durability and fracture resistance of endocrowns on maxillary first premolars, in comparison to post-and-core crowns.

METHODS: Fifty-six maxillary premolars were endodontically treated and shortened to a level of 2 mm from the cervical line, and randomly categorized into six endocrown groups and post-and-core crown control group (n=8); E1; endocrowns with flat occlusal table (without ferrule), E2; endocrowns with 1.5 mm circumferential ferrule, E3; endocrowns with 1.5 mm buccal ferrule preparation. Two materials were used for endocrowns: zirconia (4YSZ; Z), and lithium disilicate (L). The control group was restored with zirconia posts, and lithium disilicate crowns. All restorations were bonded using Panavia V5 and its respective primers and underwent thermo-mechanical fatigue with a 10 kg dynamic load for 1,200,000 cycles and thermocycling between 5 and 55 °C. Thereafter all survived specimens were loaded to fracture. The results were statistically analyzed using ANOVA and T-Test.

RESULTS: None of the specimens showed any signs of debonding or fracture caused by the fatigue test. The PC control group showed no statistically significant difference in comparison to groups ZE1, ZE2 and LE2 ( p > 0.05 ). However, it was significantly different from groups LE1, LE3, and ZE3 ( p ≤ 0.05 ).

CONCLUSIONS: Preparation designs and materials affected the fracture resistance of endocrowns. The results showed a superiority of the post-and-core crowns,zirconia/lithium disilicate endocrowns with 1.5 mm circumferential ferrule, and zirconia endocrowns with the flat occlusal table.

PMID:34108294 | DOI:10.2186/jpr.JPR_D_20_00082