Adequate Treatment Research Articles

Mental health and employment outcomes in working-age US adults, 2010-2019.

Individuals with severe mental illness experience greater unemployment and barriers to workforce re-entry. However, less is known about additional indicators of employment stability for individuals across mental illness severity. This study aims to examine associations between mental illness severity, use and adequacy of mental health treatment, and indicators of employment stability. In this repeated cross-sectional study, 2010-2019 data from the U.S. National Survey of Drug Use and Health were used to construct multivariate logistic regression models predicting the odds of part-time employment, past-year work interruption, number of past-year employers, and past-month health-related work absence by mental illness severity and adequacy of mental health treatment. Compared to individuals with no mental illness, those with any and severe mental illness had significantly higher odds of part-time employment (adjusted odds ratios [AORs] = 1.51 and 2.16, 95% confidence intervals [CIs] 1.4-1.6 and 2.0-2.3), multiple past-year employers (AORs = 1.78 and 2.34, CIs 1.7-1.9 and 2.1-2.6), past-year work interruption (AORs = 1.69 and 2.20, CIs 1.6-1.8 and 2.1-2.4), and >7 days of past-month work absence (AORs = 2.51 and 3.82, CIs 2.3-2.8 and 3.3-4.5). Among respondents with mental illness, perceived inadequacy of mental treatment predicted higher odds of all adverse employment outcomes. Compared to those with no mental illness, individuals with mental illness of any severity have higher odds of employment instability. Policy and programmatic support aimed at addressing the needs of individuals with mental illness, including access to adequate mental health treatment, are needed to facilitate continued, competitive employment.

Severe Alcoholic Hepatitis-optimizing Medical Management: Whether we need a Liver Transplant

Severe alcoholic hepatitis is an ethical and clinical conundrum, wherein a liver transplant is often recommended. The adequacy of medical treatment versus the risk of recidivism after transplant is often debated. Complete recovery in 26 of 27 patients with severe alcoholic hepatitis was observed, and hence the data was retrospectively analysed. Methods: 27 patients, with severe alcoholic hepatitis, with Maddrey's discriminant function between 59.7 to 165.2 (mean 107.53), from June 2017 to May 2022, were followed up for between 11 months to 6 years. INR ranged from 1.99 to 3.7 (mean 2.709), and bilirubin was between 7.6 to 37.01, (mean 20.859). 8 patients had pre-existing liver cirrhosis. All patients received probiotics, nutritional support, physical rehabilitation, saturated fat (clarified butter/ desi ghee) supplementation, and anti-oxidant support. At 90 days, total bilirubin improved to between 1.0 to 6.8 (mean 2.625). ALT (Alanine Transaminase/ SGPT) ranged from 65 to 550 (mean ALT – 197); and AST (Aspartate Transaminase / SGOT) ranged from 58 to 810 (mean AST – 271.51). Both the AST and ALT were near normal after 90 days. One patient died due to bacterial pneumonia and sepsis; the remaining 26 patients made a complete recovery. All patients including those with diagnosed liver cirrhosis, had complete resolution of their ascites, and near-normal liver function. At the last outpatient visit, none had ascites, edema, or encephalopathy, and had normal albumin levels and INR values. Conclusion: Probiotics, nutrition, a saturated fat diet, and exercise; all have shown benefits in patients with severe alcoholic hepatitis when tested individually. Concomitant use of all the above has not been reported in the treatment of alcoholic hepatitis. The role of nutrition alone versus the contribution of nutritional deficiencies and the role of gut-derived endotoxemia need to be studied in detail. How to identify patients who need a transplant, if it is needed at all, remains a challenge.

The TECo Database: Ecological and Technological Concepts at the Interface Between Abstractness and Concreteness

Ecology and Technology are two keywords of the era we inhabit. Knowing how people represent these domains is essential to inform adequate interventions aimed at promoting conscious behaviors. Here we investigated this aspect by taking insights from the literature on conceptual organization. Specifically, we hypothesized Ecological and Technological concepts might have a “hybrid” nature, at the edge between Abstract and Concrete concepts. We asked a sample of Italian participants to rate 200 concepts pertaining to Ecological (e.g., deforestation), Technological (e.g., Internet), Natural (e.g., water), and Geographical/Geopolitical domains (e.g., mountain, city) on 39 semantic dimensions, some of which traditionally investigated (e.g., Context Availability), and others completely new (e.g., Political Relevance). Results indicate that Ecological and Technological concepts, despite having concrete referents, were more similar to Abstract than Concrete concepts in Concreteness~Abstractness and other semantic dimensions (e.g., Interoception, Social Valence). Interestingly, for some dimensions, they displayed a “more abstract” pattern than that of more typical Abstract concepts—e.g., later and more linguistic acquisition, higher need of others to be understood. Moreover, a Principal Component Analysis revealed three major components that explained overall the conceptual organization of our set of concepts. The first component complements the rating results, with the opposition between concreteness~abstractness, where Ecological and Technological concepts lie in the most abstract extreme. A further Hierarchical Cluster Analysis supported this distinction. Overall, our results have a twofold relevance. On a theoretical side, they contribute to enrich theories on concepts, suggesting Ecological and Technological concepts are special conceptual domains questioning the concrete-abstract dichotomy; on a more pragmatic side, they might inform societal politics on these timely themes.

Adequacy of Levothyroxine Treatment in Subclinical Hypothyroid Pregnant Women and Its Association with Maternal and Fetal Outcomes

Adequacy of Levothyroxine Treatment in Subclinical Hypothyroid Pregnant Women and Its Association with Maternal and Fetal Outcomes

Critical appraisal of the adequacy of surgical indications for non-functioning pancreatic neuroendocrine tumours.

The lack of preoperative prognostic factors to accurately predict tumour aggressiveness in non-functioning pancreatic neuroendocrine tumours may result in inappropriate management decisions. This study aimed to critically evaluate the adequacy of surgical treatment in patients with resectable non-functioning pancreatic neuroendocrine tumours and investigate preoperative features of surgical appropriateness. A retrospective study was conducted on patients who underwent curative surgery for non-functioning pancreatic neuroendocrine tumours at San Raffaele Hospital (2002-2022). The appropriateness of surgical treatment was categorized as appropriate, potential overtreatment and potential undertreatment based on histologic features of aggressiveness and disease relapse within 1 year from surgery (early relapse). A total of 384 patients were included. Among them, 230 (60%) received appropriate surgical treatment, whereas the remaining 154 (40%) underwent potentially inadequate treatment: 129 (34%) experienced potential overtreatment and 25 (6%) received potential undertreatment. The appropriateness of surgical treatment was significantly associated with radiological tumour size (P < 0.001), tumour site (P = 0.012), surgical technique (P < 0.001) and year of surgical resection (P < 0.001). Surgery performed before 2015 (OR 2.580, 95% c.i. 1.570 to 4.242; P < 0.001), radiological tumour diameter < 25.5 mm (OR 6.566, 95% c.i. 4.010 to 10.751; P < 0.001) and pancreatic body/tail localization (OR 1.908, 95% c.i. 1.119 to 3.253; P = 0.018) were identified as independent predictors of potential overtreatment. Radiological tumour size was the only independent determinant of potential undertreatment (OR 0.291, 95% c.i. 0.107 to 0.791; P = 0.016). Patients subjected to potential undertreatment exhibited significantly poorer disease-free survival (P < 0.001), overall survival (P < 0.001) and disease-specific survival (P < 0.001). Potential overtreatment occurs in nearly one-third of patients undergoing surgery for non-functioning pancreatic neuroendocrine tumours. Tumour diameter emerges as the sole variable capable of predicting the risk of both potential surgical overtreatment and undertreatment.

A rare case of Klippel-Trenaunay-Weber syndrome in a child

Klippel-Trenon-Weber syndrome is a rare congenital disorder characterized by polymorphism of clinical manifestations, including vascular malformations, skeletal deformities, facial asymmetry and other developmental anomalies. The study of this syndrome is driven by its rarity, complexity of diagnosis and treatment, and significant impact on the quality of life of patients. Early diagnosis and adequate surgical intervention can significantly improve the prognosis and reduce the risk of serious complications This is a rare congenital disease characterized by a triad of symptoms: angiodysplasia, congenital skeletal anomalies and muscle hypertrophy. This syndrome is caused by a defect in the keratin 13 gene (KRT13), which causes dysfunction of cells of ectodermal origin, including keratinocytes, endothelial cells and ectodermal cells. Clinical symptoms of the syndrome may include hydrocephalus, congenital kidney defects, limb abnormalities, and other pathological changes. Treatment usually depends on the specific symptoms and complications and may include surgery, drug therapy, physiotherapy and rehabilitation. Understanding the genetic mechanisms and factors that cause the syndrome will allow us to develop more effective diagnostic and treatment methods and improve the prognosis for patients. The aim of the study was to demonstrate a clinical case of this extremely rare paediatric pathology, to show the peculiarities of its diagnosis and treatment. The peculiarity of this patient was a deformity (severe thickening) of the right foot at birth. In the process of growth, the deformity of the right foot increased, making it impossible to use standard shoes. The subcutaneous venous network on the right lower limb became stronger. The course of this disease and the treatment performed are described. Keywords: syndactyly, hypertrophy, foot, surgery, limb asymmetry, congenital anomaly.

A mendelian randomization study revealing that metabolic syndrome is causally related to renal failure.

The onset and progression of chronic kidney disease (CKD) has been linked to metabolic syndrome (MetS), with the results of recent observational studies supporting a potential link between renal failure and MetS. The causal nature of this relationship, however, remains uncertain. This study thus leveraged a Mendelian Randomization (MR) approach to probe the causal link of MetS with renal failure. A genetic database was initially used to identify SNPs associated with MetS and components thereof, after which causality was evaluated through the inverse variance weighted (IVW), MR-Egger regression, and weighted media techniques. Results were subsequently validated through sensitivity analyses. IVW (OR = 1.48, 95% CI = 1.21-1.82, P =1.60E-04) and weighted median (OR = 1.58, 95% CI =1.15-2.17, P = 4.64E-03) analyses revealed that MetS was linked to an elevated risk of renal failure. When evaluating the specific components of MetS, waist circumference was found to be causally related to renal failure using the IVW (OR= 1.58, 95% CI = 1.39-1.81, P = 1.74e-11), MR-Egger (OR= 1.54, 95% CI = 1.03-2.29, P = 0.036), and weighted median (OR= 1.82, 95% CI = 1.48-2.24, P = 1.17e-8). The IVW method also revealed a causal association of hypertension with renal failure (OR= 1.95, 95% CI = 1.34-2.86, P = 5.42e-04), while renal failure was not causally related to fasting blood glucose, triglyceride levels, or HDL-C levels. These data offer further support for the existence of a causal association of MetS with kidney failure. It is thus vital that MetS be effectively managed in patients with CKD in clinical settings, particularly for patients with hypertension or a high waist circumference who are obese. Adequate interventions in these patient populations have the potential to prevent or delay the development of renal failure.

Review of clinical characteristics and mortality outcomes in patients on maintenance hemodialysis during the Omicron surge: a single center experience

BackgroundThis hemodialysis center experienced the pandemic from December 2022 to January 2023. Therefore, we sought to describe the clinical characteristics and mortality outcomes in hemodialysis patients during this Omicron surge.MethodsAccording to whether they are infected, they are divided into two groups: SARS-CoV-2-positive and SARS-CoV-2-negative. The SARS-CoV-2-positive group was divided into a survival group and a non-survival group for comparison.Results366 of 457 hemodialysis patients were infected with SARS-CoV-2. The most common symptoms observed were fever (43.2%) and cough (29.8%), Followed by diarrhea (1.4%). Hemodialysis patients with hypertension were more susceptible to SARS-CoV-2 infection. The lymphocyte count, serum creatinine, serum potassium, and serum phosphorus in the SARS-CoV-2-positive group were significantly lower than those in the SARS-CoV-2-negative group. The all-cause mortality rate for infection with SARS-CoV-2 was 5.2%. Only 7 of 366 SARS-CoV-2-positive patients were admitted to the intensive care unit, but 6 of them died. Intensive care unit hospitalization rates were significantly higher in the non-survival group compared with the survival group. White blood cells count, neutrophil count, C-reactive protein, AST, and D-dimer in the non-survival group were higher than those in the survival group. The lymphocyte count, hemoglobin concentration, serum creatinine, serum albumin, serum phosphorus and parathyroid hormone in the non-survival group were lower than those in the survival group. Age > 65 years, elevated C-reactive protein and AST are independent risk factors for death. Finally, no significant difference in vaccination status was found between the SARS-CoV-2-positive group and the negative group.ConclusionsHemodialysis patients are at high risk for SARS-CoV-2 infection. Ensuring the adequacy of hemodialysis treatment and maintaining good physical condition of patients are the top priorities.

Development and implementation of a geriatric oncology interprofessional case-based educational intervention for cancer care providers.

9020 Background: Geriatric assessment (GA) is recommended as part of the standard of care for older adults with cancer. However, the GA has not been fully adopted as part of routine practice in oncology in Mexico, mainly due to lack of qualified personnel and limited knowledge. We designed an interprofessional case-based educational intervention to address the main barriers for implementation of GA in oncology. Methods: We followed Kern’s six-step approach to design a continuing professional development (CPD) activity. Our targeted learners consisted of teams comprised of one oncologist and one geriatrician who practiced at the same site in Mexico. By the end of the intervention, participants would be able to perform GA in older adults with cancer, and to integrate information obtained through a GA in a cancer treatment plan through adequate interventions. We used Project ECHO’s model to create a CPD activity consisting of 12 weekly 75-minute online sessions via Zoom, with content selected from international geriatric oncology guidelines. At baseline, and at the end of the course, participants answered a 36-item multiple choice knowledge assessment (scale 0-100), a survey on self-perceived competence in GA skills (scale 0-10), and an adaptation of the Association for Community Cancer Centers Geriatric Oncology Gap Assessment Tool, which assesses subjective performance of the GA (scale 0-4). Participants also completed a satisfaction questionnaire. We compared baseline and post-intervention scores through paired t tests; results from the satisfaction questionnaire are reported descriptively. Results: We included 56 participants (28 geriatricians and 28 oncologists). Median participant attendance was 10 sessions (IQR 9-11). Thirty-eight participants completed the satisfaction questionnaire: median satisfaction was 10/10 (range 8-10). There was no difference in satisfaction scores between oncologists and geriatricians. Mean baseline knowledge score was 59.5±12.8 and mean post-intervention knowledge score was 74.4±9.7 (p&lt;0.001, effect size 1.14). Mean baseline competence score was 6.42±2.5 and mean post-intervention competence score was 9.02±0.78 (p&lt;0.001, effect size 1.03). Mean baseline performance score was 2.58±0.65 and mean post-intervention knowledge score was 3.29±0.5 (p&lt;0.001, effect size 1.64). Increases in knowledge, competence, and performance scores were observed both in oncologists and in geriatricians separately. Conclusions: This interprofessional curriculum on GA in oncology was feasible and acceptable, and led to significant increases in knowledge, competence, and performance among participants. Project ECHO’s case-based learning model is adequate to provide interprofessional education, which is crucial in multidisciplinary areas such as geriatric oncology.

Risk factors for Pseudomonas aeruginosa VIM colonization or infection in the ICU: Case-control study

Carbapenem-resistant strains of Pseudomonas aeruginosa (CRPA) have become a major health care concern in many countries, against which anti-infective strategies are limited and which require adequate infection control interventions. Knowing the different modes of transmission of CRPA in intensive care units (ICUs) would be helpful to adapt the means of prevention. The aim of this retrospective case-control study was conducted between January 1, 2017 and February 28, 2022 to identify the risk factors for the acquisition of CRPA in ICUs. During the study period, 147 patients were included (49 cases and 98 controls). Among the 49 patients, 31 (63%) acquired CRPA in clusters and 18 (37%) sporadically. Aunivariate analysis showed that 4 variables were associated with CRPA acquisition, including (1) prior antibiotic prescriptions, (2) admission to rooms 203 and 207, (3) severity of illness at admission, and (4) use of mechanical ventilation. Multivariate analysis identified 3 factors of CRPA acquisition, including admission to room 203 (odds ratio [OR]=29.5 [3.52-247.09]), previous antibiotic therapy (OR=3.44 [1.02-11.76]), and severity of condition at admission (OR=1.02 [1-1.04]). Our study suggests the role of a contaminated environment in the acquisition of CRPA in the ICU, along with antibiotic use.

Factors associated with surgical intervention in Native American patients with hepatocellular carcinoma.

e16279 Background: Hepatocellular carcinoma (HCC) is the prevailing type of primary liver cancer, exhibited at a higher frequency in individuals afflicted by chronic liver conditions. Past literature has demonstrated the impact certain socioeconomic factors have on the prognosis of HCC. Native American patients often face late-stage cancer diagnoses and have the lowest survival rates among racial and ethnic groups. While surgery offers potential for cure, factors related to surgical interventions in liver cancer for Native American patients remain largely unexplored. Through the NCDB, this study analyzed factors associated with surgical intervention and survival trends in Native American patients with HCC. Methods: The National Cancer Database (NCDB) was used to identify Native American patients diagnosed with Hepatocellular Carcinoma from 2004 to 2019 using the histology code 8170 and race code 03 as assigned by the Commission on Cancer Accreditation program. Kaplan-Meier, ANOVA Chi-Square, and Cox Proportional Hazards tests were performed. Data was analyzed using SPSS version 27, and statistical significance was set at α = 0.05. Results: Of 1193 Native American patients included in this sample, 172 (14.4%) patients received surgical treatment for HCC, while 1021 (85.6%) patients did not receive surgical treatment for HCC. Native American patients who received surgery for HCC experienced a greater mean overall survival (90 months) when compared to the mean overall survival (24 months) in HCC Native American patients who did not receive surgical treatments (p &lt; 0.001). When controlling for age, year of diagnosis, stage, grade, facility type and income status, receiving surgery showed an independent decrease in hazard (HR = 0.245; p &lt; 0.05). HCC Native American patients who received surgery were more likely to be treated an at academic facility, have stage I disease, and have less aggressive tumors (grade) (p &lt; 0.05). Native American patients who did not receive surgery were more likely to be older (62 vs 60 years old), have larger tumors, and have brain, bone, lung, and liver metastases (p &lt; 0.05). No associations of surgical versus non-surgical treatment were seen in Charlson-Deyo score, urban or rural residence, and primary payor at diagnosis. Conclusions: Native American patients with HCC who received surgical intervention experienced improved overall survival compared to non-surgical treatment groups. Native American patients undergoing surgical intervention more often received care at academic or private institutions and had lower stages of HCC. These results follow previous trends, where cancer patients receiving adequate surgical intervention generally survive longer. Further research is needed to examine other treatment differences among Native American patients and how these findings compare across other disadvantaged groups.

Brief intervention for chronic liver disease patients with alcohol use disorder in a hepatology outpatient unit: Effects and limitations.

It is not uncommon to encounter outpatients in the hepatology department with harmful alcohol habits. When treating such chronic liver disease (CLD) patients, an adequate intervention method for harm reduction of alcohol use, such as brief intervention (BI) or BI and nalmefene, should be considered. This study aimed to elucidate the clinical effectiveness of BI for CLD patients affected by harmful alcohol use. From June 2021 to 2023, 123 Japanese CLD outpatients (hepatitis B virus:hepatitis C virus:alcoholic liver disease:others=32:18:42:31) with an Alcohol Use Disorders Identification Test (AUDIT) score of ≥8 at the initial interview and a repeat interview with AUDIT 9months later were enrolled. Clinical features related to patient behavior following the initial AUDIT interview were retrospectively evaluated, and compared between patients without and with BI treatment. For the non-BI and BI groups, baseline AUDIT score (median 10 [interquartile range (IQR) 9-13] vs. 12 [IQR 10-17], p=0.016) and relative change in AUDIT score (median 0 [IQR -3 to 2] vs. -3 [IQR -7 to 0], p<0.01) showed significant differences, whereas there was no significant difference between the groups for AUDIT score at the time of the second interview (p=0.156). Following BI, significant improvements were observed for items 1, 2, 3, 4, 5, 8, and 10 of AUDIT (each p<0.05). Patients with an alcohol use disorder as well as those with alcohol dependency who received BI showed a significant decline in AUDIT score, although the score of the follow-up AUDIT indicated continued alcohol use disorder. In addition to BI, medication with nalmefene should be considered, based on individual factors.

Seasonal Variations in Food Insecurity Prevalence of Mother-Child Dyads in Seme Sub-County, Kisumu, Kenya

Food insecurity remains a major impediment to the attainment of adequate health outcomes among the population. This is attributable to the adverse implications that food insecurity poses on the nutritional status of the populations. Globally, in the year 2021, an estimated population of 3.1 billion people (42%) faced unprecedented food crisis evident by inability to afford a healthy meal. Meanwhile, global rates of stunting attributable to food insecurity among children under the age of sixty months was 22.3%. In Kenya, close to 32% of the populations are acutely food insecure and require urgent food insecurity interventions. Kisumu County is a food import county; hence, decline in food supplies in the counties depends on for food supply results in food crisis amongst its populace. Women and children are disproportionately affected by food insecurity due to gender and age-related factors. Rural populations are often worse affected by food insecurity as evident by high rates of stunting experienced in rural areas when compared to overweight rates that are more in urban areas. It is on this basis that we sought to assess the prevalence of food insecurity among mother-child dyads drawn from Seme Sub-County, a rural area in the County of Kisumu, Kenya. We used a longitudinal study design adopting repeated cross-sectional measures to assess food security status of a sample of 201 mother-child pairs during planting and harvesting seasons. Food security status of mothers was assessed quantitatively using Household Food Insecurity Access Scale. Children’s food security status was assessed using Prevalence of Undernourishment as indicated by the anthropometric measurements. Qualitative data were further synthesized using Key Informant Interviews and Focus Group Discussions to complement quantitative data on prevalence of food insecurity among mother-child dyads. Data was analysed descriptively to indicate proportions of mothers and children depicting various food insecurity classifications. The mean HFIAS score for season I; 11.22 (± 5.36 SD) was statistically significantly different (higher) than mean HFIAS score for season II; 9.63 (± 5.18 SD) at α ≤ 0.05 (t-test: p=0.003). During planting season, a majority of the mothers; 134 (70.9%) experienced severe food insecurity prevalence and during harvesting season, a majority of the mothers; 117 (61.9%) experienced severe food insecurity prevalence. In planting season, almost three-quarters of the children; 137 (72.5%) were food secure as they had normal weight-for-age Z score (were not underweight). On the other hand, slightly higher than average; 102 (54.0%) of the children were food secure during harvesting season. These findings demonstrate suboptimal variations in prevalence of food insecurity across the two seasons. Mothers were more likely to experience severe food insecurity prevalence than children. Thus, there is a need to develop adequate interventions aimed at optimizing intra-household food distribution dynamics as means of ensuring adequate food security for both mothers and children in the study area

Viral Transmission? A Longitudinal Study of Media Use and Its Relation to Mental Strain During the First 2 Years of the COVID-19 Pandemic.

In light of the dynamic COVID-19 pandemic, the exposure to pandemic-related media coverage may change over time and may be particularly relevant due to associations with psychopathological symptoms. The aims of the present study were to examine changes in media consumption over time and to analyze its prospective associations with psychological strain. The study uses a longitudinal observational design with ten periods of online data collection from March 2020 to April 2022 in an adult convenience sample (N = 8337) of the general population in Germany. Our data revealed that the frequency and duration of pandemic-related media exposure as well as their subjective critical evaluation showed the highest levels at the beginning of the pandemic and peaked again in autumn 2020 and spring 2021. The primarily used media formats changed only slightly over time. The amount of media exposure at baseline was associated with more impairing pandemic-related anxiety 1month, 1year, and 2years later. Our results hint to potentially problematical and long-lasting associations of pandemic-related media consumption with mental strain. Our findings could serve as an orientation for recommendations, further research, and adequate interventions for a responsible dealing with media coverage. The authors have pre-registered this research at clinicaltrials.gov without an analysis plan; retrievable at: https://clinicaltrials.gov/ct2/show/NCT04331106 .

Reliability and validity of the Swedish indicator ‘Drugs that should be avoided in older people’—an appraisal of a set of potentially inappropriate medications

PurposeTo analyse the reliability and validity of the Swedish indicator ‘Drugs that should be avoided in older people’.MethodsFrom a previous study that included consecutive primary care patients ≥ 65 years of age, all patients ≥ 75 years of age were analysed. Two physicians independently screened their medication lists and medical records, applying the Swedish indicator which includes potentially inappropriate medications (PIMs): long-acting benzodiazepines, drugs with anticholinergic action, tramadol, propiomazine, codeine, and glibenclamide. The clinical relevance of identified PIMs was independently assessed. Thereafter, the physicians determined in consensus whether some medical action related to the drug treatment was medically justified and prioritised before the next regular visit. If so, the drug treatment was considered inadequate, and if not, adequate.ResultsA total of 1,146 drugs were assessed in 149 patients (75‒99 years, 62% female, 0‒20 drugs per patient). In 29 (19%) patients, at least one physician identified ≥ 1 PIM according to the indicator at issue; 24 (16%) patients were concordantly identified with ≥ 1 such PIM (kappa: 0.89). Of 26 PIMs concordantly identified, the physicians concordantly assessed four as clinically relevant and 12 as not clinically relevant (kappa: 0.17). After the consensus discussion, six (4%) patients had ≥ 1 PIM according to the studied indicator that merited action. Using the area under the receiver operating characteristic (ROC) curve, the indicator did not outperform chance in identifying inadequate drug treatment: 0.56 (95% confidence interval: 0.46 to 0.66).ConclusionThe Swedish indicator has strong reliability regarding PIM detection but does not validly reflect the adequacy of drug treatment.

Beyond individual responsibility: Exploring lay understandings of the contribution of environments on personal trajectories of obesity.

Reversing the upward trajectory of obesity requires responding by including the multiple influences on weight control. Research has focused on individual behaviours, overlooking the environments where individuals spend their lives and shape lifestyles. Thus, there is a need for lay understandings of the impact of environments as a cause and solution to obesity. This research aimed to understand the influence of environments on the adoption of health practices in adults with obesity and to identify lay strategies with which to address environmental barriers to behaviour change. Nineteen adults with a history of obesity living in the United Kingdom were interviewed through video conferencing between May 2020 and March 2021. Semi-structured interviews and socio-demographic questionnaires were used, and data analysed through hermeneutic phenomenology informed reflexive thematic analysis. Three main themes were created: living with convenience and normalcy: the increased accessibility of unhealthy food, people interacting with digital media for positive practice change, and the need to prioritise prevention in schools, the National Health Service and the food industry. The food environment was the major barrier, while interactions with social media was the most important opportunity to adopt healthy practices. The National Health Service was considered an obesogenic environment, something relevant since it has been traditionally recognised as an obesity management system. The perceptions from individuals with a history of obesity provide new suggestions on the influence of previously overlooked environments to design more adequate and effective interventions and policies that consider, more than in the past, the environments where people spend their lives.

Outcome of Descemet membrane detachment repair using air descemetopexy and Descemet membrane suturing after cataract surgery

Outcome of Descemet membrane detachment repair using air descemetopexy and Descemet membrane suturing after cataract surgery

Serological profile of hepatitis B virus infection among traditional birth attendants and the attending pregnant women in Ibadan, Nigeria

ABSTRACT Although a sizable number of pregnant women patronize Traditional Birth Attendants (TBAs) for deliveries in Nigeria, efforts to prevent or reduce the risk of HBV transmission are not targeted at the TBAs and the pregnant women patronizing them. This may be linked to the dearth of information on the serological profiles of HBV among this cohort. We, therefore, show the serological profiles of HBV among the cohort. One hundred and seventy pregnant women and 91 TBAs participated in this study between May and July 2019. Serological markers of HBV infection were assayed using ELISA. A prevalence of, 8.0% (95% CI: 5.0% − 11.5%) for HBsAg, 0.8% (95% CI: 0.0% − 1.9%) for HBeAg, 2.7% (95% CI: 0.8% − 5.0%) for HBcIgM, 26.1% (95% CI: 20.7% − 31.4%) for anti-HBs, 21.5% (95% CI: 16.5% − 25.4%) for anti-HBe and 67.0% (95% CI: 60.9% – 72.8%) for anti-HBc was found indicating a high percentage of carriers. Although 32 (12.3%) of the entire participants claimed to be fully vaccinated, serological evidence was only detected in 4 (12.5%). The high percentage of carriers and low evidence of vaccination necessitate intensified efforts to ensure that adequate interventions are made available and accessible to the TBAs and the pregnant women patronizing them (including newborn babies).

Exploring predisposing factors of hearing loss in prematurely born children: A nationwide case-control study

BackgroundWe conducted a nationwide population-based case-control study to analyse potential predisposing factors for hearing loss (HL) that present during the fetal, perinatal, and postnatal periods in prematurely born children. DesignThis study enrolled 21,576 children born at < 37 weeks of gestation; 3,596 with HL and 17,980 with normal hearing born between 2002 and 2015, matched for sex, age at diagnosis, and enrollment time. Data were abstracted from the concatenation of three nationwide databases for overall risk factors till the diagnosis of HL. ResultsMaternal HL, maternal diabetes, particularly type 1 diabetes mellitus, and at or before 32 weeks of gestation were the major obstetric risk factors for HL. Prematurely born children who were born via cesarean section and received a combination of antenatal steroids and magnesium sulfate exhibited a significantly reduced risk of developing HL. Ear malformation was a critical predictor for HL. The major postnatal risk factors included seizure and ototoxic drugs use. Premature infants diagnosed with more than 1 diagnosis of bronchopulmonary dysplasia, necrotizing enterocolitis, and intracerebral hemorrhage were at an increased risk of developing HL. Congenital CMV infection and recurrent acute otitis were also independent postnatal factors for HL in prematurely born children. ConclusionsTo reduce the incidence of childhood HL in prematurely born children, aggressive management of premature birth-related consequences and treatable causes and longitudinal audiological follow-up with early detection and adequate intervention are crucial.

Malnutrition management and the application of medical nutrition therapy in hospitalized patients at the end of life

Objectives(1) To determine the prevalence of malnutrition risk in hospitalized patients at the end of life (EOL), (2) to evaluate which nutritional interventions are administered in hospitalized end-of-life patients with malnutrition risk and (3) to assess the association of end-of-life care and the administration of medical nutrition therapy in patients with malnutrition risk. DesignCross-sectional multi-center study SettingHospital ParticipantsHospitalized adult patients MeasurementsBased on the valid and reliable questionnaire of the Nursing Quality Measurement 2.0 (LPZ), the parameters of demographic data, medical diagnoses, end-of-life phase, care dependency, malnutrition risk according to the Malnutrition Universal Screening Tool (MUST) and nutritional interventions conducted in patients at risk of malnutrition were assessed. Descriptive statistics and statistical tests were conducted. Logistic regression models were established to identify odds ratios (OR) and confidence intervals (CI) for the association of end-of-life care and the provision of medical nutrition therapy. This was done separately for oral nutritional supplements (ONS), enteral nutrition and parenteral nutrition as the respective dependent variables. ResultsOf all 12,947 participants, 706 (5.5%) were in an end-of-life phase. The prevalence of malnutrition risk in end-of-life patients was 41.1% compared to 24.7% in other patients (p < 0.001). End-of-life patients with malnutrition risk received more nutritional interventions than other patients with malnutrition risk. The regression models showed that being at the end of life (CI 1.30, 2.63; p < 0.001), being treated by a dietitian (OR 6.02; CI 4.86, 7.45; p < 0.001), suffering from dementia (OR 1.85; CI 1.10, 3.12; p = 0.02) or cancer (OR 1.56; CI 1.25, 1.96; p < 0.001) increased the chance of receiving oral nutritional supplements. For receiving parenteral nutrition, being at the end of life (OR 1.68; CI 1.04, 2.71; p = 0.04), being treated by a dietitian (OR 5.80; CI 4.07, 8.25; p < 0.001), surgery within the previous two weeks (OR 1.58; CI 1.09, 2.30; p = 0.02), younger age (OR 0.99; CI 0.98, 1.00; p = 0.04), care dependency (OR 0.97; CI 0.96, 0.98; p < 0.001), suffering from a disease of the digestive system (OR 2.92; CI 2.07, 4.11; p < 0.001) or cancer (OR 2.44; CI 1.71, 3.49; p < 0.001) were independent predictors. Being at the end of life did not influence the application of enteral nutrition. ConclusionThis study showed that nutritional interventions are often applied in end-of-life patients admitted to general hospitals. Being at the end of life was positively associated with the application of oral nutritional supplementation and parenteral nutrition. This data does not allow a conclusion about the appropriateness of using medical nutrition therapy in this study sample. Judging the appropriateness of medical nutrition therapy at the end of life is challenging because of the high variability of prognostication as well as the wishes and needs of the specific patients and their relatives that influences the appraisal of adequate interventions. Every decision about nutrition and hydration in end-of-life patients should be a shared decision and be based on advanced care planning principles.