Effective Interventions Research Articles

5128 Role of Plasmapharesis- A Tale of Two Thyroid Storms

Abstract Disclosure: Z. Zhang: None. S. Joseph: None. A.M. Kodali: None. D. Eagerton: None. Background: Thyroid storm is an acute life threatening endocrinological emergency. The standard treatment for a thyroid storm is antithyroid medication, iodine, beta blockers and corticosteroids. However, when patients are refractory to standard treatment, plasmapheresis may be an effective and safe intervention. Case 1: A 49-year-old male with typical symptoms of hyperthyroidism, presented with a Ventricular tachycardia arrest. After the return of spontaneous circulation, he was febrile, and developed new onset atrial fibrillation (AF) and Amiodarone drip was started. Physical exam showed a thin gentleman with an enlarged thyroid. ECHO showed LVEF 50% with moderate to severe dilatation of left atrium and mild mitral and tricuspid valve regurgitation. CT abdomen/pelvis and CTA chest did not show any pathology. Labs showed TSH of 0.02 (reference range: 0.465-4.68); Free T 4 >6.99 (reference range: 0.78- 2.19). He was started on Propylthiouracil (PTU), Hydrocortisone, Potassium Iodide, and Cholestyramine. His blood pressure was too low to tolerate a beta blocker. He developed increased liver enzymes thought to be due to shocked liver. PTU was switched to Methimazole due to less risk of hepatotoxicity. A Thyroid Stimulating immunoglobulin was 13.40 (reference range 0.00-0.55), confirming Graves’ disease. He developed multiorgan failure and plasmapheresis was initiated. His Free T4 level prior to his first apheresis was still >6.99 but improved to 6.20 after two days. After the second session, free T4 level drastically improved to 2.65. He sustained a level of 2.09 until his hospital discharge. Case 2: A 59-year-old male with untreated hyperthyroidism and AF, who presented with shortness of breath. He was tachycardic, febrile and developed AF with rapid ventricular response. A TSH and free T4 level showed <0.02 (reference range: 0.465-4.68); and >6.99 (reference range: 0.78- 2.19), respectively. Physical exam shows a cachectic man with an enlarged thyroid. ECHO showed reduced ejection fraction of 35% with biventricular failure. He was initially started on PTU, Potassium Iodide, hydrocortisone and esmolol drip and eventually Cholestyramine. Patient developed multisystem organ failure and PTU was switched to methimazole due to continued deterioration of his liver enzymes. Plasmapheresis started with a total of 3 sessions. His free T4 improved from 4.32 to 3.59 by the second session. Round three was performed when his Free T4 increased back to 4.56. Unfortunately, he had a sudden decline in mentation and CT head showed an acute/subacute left anterior parietal stroke and after family discussion, was palliatively extubated and expired. Discussion: This case series shows two cases of thyroid storm treated with plasmapheresis and had two stark contrasts. Further studies should be done to elucidate the usefulness of plasmapheresis for thyroid storm when refractory to standard of treatment. Presentation: 6/2/2024

From eradication to reemergence: the growing threat of malaria in Turkey.

According to WHO, between 2000 and 2021, there were approximately 247 million malaria cases and 627,000 deaths globally, with the majority of cases occurring in sub-Saharan Africa. In Turkey, indigenous P. vivax malaria was a major public health problem until its eradication was achieved in 2010. Although indigenous malaria transmission has been significantly reduced since 2010, the country is challenged with imported malaria due to increasing global travel and migration from endemic regions. In this study, all imported malaria cases admitted to Dr. Sadi Konuk Research and Training Hospital, Istanbul, between 2018 and 2023 were included. DNA extraction was performed using archived slides and EDTA blood samples. Real-time PCR was performed to identify samples at the species level using previously reported primers and probes. In addition, all available patient demographics are presented. During the six years between 2018 and 2023, 157 patients were diagnosed with imported malaria. According to the real-time PCR results, 149 cases were P. falciparum (94.9%), five cases were P. vivax (3.2%), two cases were P. ovale (1.3%), and one case was P. malariae (0.6%). The male/female ratio among diagnosed patients was 2.34 (110♂/47♀) among diagnosed patients. Plasmodium falciparum was detected in patients from all African regions, whereas P. vivax was detected only in patients from Liberia and Djibouti. Although malaria cases in Turkey have significantly decreased due to elimination efforts and effective public health interventions, the recent increase in both imported and indigenous cases, as well as the presence of suitable vector species in the country, indicates that malaria still remains a serious public health problem for Turkey.

7792 Efficacy of Retatrutide for Weight Reduction and Its Cardiometabolic Effects Among Adults: A Systematic Review and Meta-Analysis

Abstract Disclosure: D.C. Lopez: None. J.T. Pajimna: None. M.D. Milan: None. G.V. Jasul: None. G. Orpilla: None. I. Zapanta: None. B. Serquiña: None. G. Dychiao: None. Background: Obesity remains to be a global health challenge and it is associated with several complications such as diabetes, cardiovascular disease, fatty liver disease, and reduced life expectancy. Although lifestyle modifications are the mainstay for weight management, long term maintenance of weight loss can be a challenge for many affected adults. There have been proven safe and effective pharmacologic interventions but these remain limited to date. One of the novel anti-obesity drugs, retatrutide, is a single peptide with agonist activity at the GLP-1, glucose-dependent insulinotropic polypeptide (GIP), and glucagon receptors. The aim of this systematic review and meta-analysis is to evaluate the effectiveness of this triple-hormone receptor agonist, Retatrutide, in weight reduction and assess its cardiometabolic effects in adults. Methodology: An extensive electronic database search was done to identify studies published from inception until December 2023. All randomized controlled trials (RCT) that evaluated the use of retatrutide for adult patients were included. The Cochrane Risk of Bias 2.0 tool was used to assess the risk of bias of each study. Meta-analysis was conducted to determine weight reduction and glycemic control using random effects model which was reported at 95% confidence interval. Statistical heterogeneity was assessed using I2 statistics and random effects analysis and sensitivity analysis were done to control for the heterogeneity. Results: A total of 3 eligible RCTs were included in the study, all of which had risk of bias ranging from low to unclear. Of these articles, in 2 RCTs involving 353 participants with type 2 diabetes mellitus, retatrutide showed significant weight reduction by 11.89kg as compared to placebo (MD -11.89; 95% CI -13.53 to -10.25) and decreased glycosylated hemoglobin (HbA1C) by 1.64% as compared to placebo (MD: -1.64%, 95% CI [-2.38, -0.89]). Using direct comparison, retatrutide 12mg reduced body weight by 11.83kg as compared to dulaglutide 1.5mg with significant difference (MD -11.83; 95% CI -18.50 to -5.16), and retatrutide showed slight decrease in HbA1C by 0.61% as compared to dulaglutide (MD -0.66; 95% CI -0.66 to -0.56). In another 1 RCT involving 338 non-diabetic adult patients with obesity, retatrutide decreased least-squares mean percentage in body weight by 24.2% and 83% of participants who received retatrutide achieved weight reduction of 15% or more at 48 weeks. Conclusion: The use of retatrutide may result in substantial reductions in mean body weight and HbA1C as compared to controls in adult patients, with low to moderate certainty of evidence. In addition, retatrutide showed marked decrease in body weight but with modest glucose lowering effect when compared to a single GLP1 agonist drug. Presentation: 6/3/2024

Food loss analysis in Nigeria: A systematic literature review

The issue of food loss and waste is a complex one that must be addressed if sustainable food systems are to be achieved. In the Global South, as evidenced by Nigeria, two paradoxical trends can be observed. Firstly, substantial losses of arable crops occur during the production and distribution stages. Secondly, Nigeria is affected by food scarcity, which is in part a consequence of losses occurring at these stages. In terms of food availability, Nigeria ranks 26th among African countries. In light of this context and the government's expressed interest in identifying sustainable solutions to this problem, a systematic review was conducted with the objective of consolidating the fragmented studies on food loss in the region. This review provides a foundation for understanding the causes of food loss, the preventive and reduction strategies required, and for identifying promising areas for future research. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Checklist 2020. Following the application of inclusion and exclusion criteria, 23 studies were selected for review. A thematic synthesis was employed to integrate and examine the findings of the studies. The findings indicated that maize, rice, and cassava continued to be the most prevalent food crops in Nigeria, with cultivation occurring across the entire country. We differentiate the critical loss points for different crops, which arise between the production and distribution stages. In conclusion, this review reveals that food loss in Nigeria is a multifaceted issue requiring integrated solutions that address the natural, social, and material dimensions. Further empirical research, especially qualitative studies that focus on the perspectives and practices of food system actors, is essential for developing effective interventions and policies. This approach will help achieve sustainable development of food systems and advance global food security goals.

Occurrence of human infection with Salmonella Typhi in sub-Saharan Africa

Typhoid fever, caused by Salmonella enterica serovar Typhi, results in over 1.2 million cases and 29 thousand deaths annually from sub-Saharan Africa. Combating this disease requires various intervention approaches, such as typhoid conjugate vaccines and improving water, sanitation, and hygiene. Enhancing the effectiveness of these strategies necessitates a deeper understanding of the variation of the typhoid fever across the target region. Although the magnitude and variation of typhoid fever at the country level have been studied globally, sub-national variation remains underexplored. To address this gap, we collected data from 229 published reports on typhoid fever occurrences in sub-Saharan Africa between January 2000 and December 2020. The dataset includes information on the year and geographical location of observation, diagnostic tests used, and the type of studies in which typhoid fever was reported. By analyzing this dataset, we can gain insights into the sub-national heterogeneity of typhoid fever’s burden in the region. This knowledge will be instrumental in designing more effective intervention strategies to combat the disease.

Determinants of Participatory Intention in Autism Volunteer Work for Improving Quality of Life of Persons with Autism (PWA) and their Caregivers

Evidence-based psychosocial interventions can enhance communication and social abilities, leading to a favorable effect on the overall welfare and quality of life for individuals with autism and those who care for them. Despite the importance of volunteers in supporting individuals with autism and their families, there is limited research on the factors influencing individuals' decisions to participate in autism-related volunteer work. This study aims to bridge this gap by investigating the various factors that shape individuals' intentions to participate in volunteer activities related to autism. A cross-sectional study design with a purposive sampling technique was conducted. Data obtained from a survey questionnaire polled ninety-nine university students’ attitudes regarding the factors influencing their participatory intention in autism volunteer work. Descriptive statistics show that the participation intention level among university students was high (M=4.47, SD=0.52). There was a statistically significant strong and moderate relationship between attitude, subjective norms, perceived behavioral control, self-efficacy and religiosity toward participation intention. The regression analysis revealed that subjective norms, perceived behavior control and religiosity affected participatory intention. This study provided practical implications for designing and implementing effective interventions and programs to recruit and retain volunteers, as well as to promote positive social change and inclusion for people with autism.

9397 Shatter Proofing Bones: Revamping Osteoporosis Screening

Abstract Disclosure: R. Subramani: None. T. Gupta: None. M. Anwar: None. J. Pamula: None. Background: Osteoporosis is a common disease characterized by low bone mass, structural deterioration of bone tissue, and increased risk of fractures. The World Health Organization (WHO) has defined osteoporosis based on bone density measurements. According to their definition, osteoporosis is diagnosed when the bone density at the hip or spine is at least 2.5 standard deviations (SDs) below the mean bone density of a reference population of young, healthy women (T score ≤ -2.5). According to NHANES data from 2017-2018, the overall prevalence of osteoporosis among adults over 50 was found to be 12.6%. It was observed that the prevalence of osteoporosis was higher among women (19.6%) compared to men (4.4%). According to US Preventative Services Task Force (USPSTF), the guidelines for screening are as follows: BMD Testing (DEXA) for all women aged 65 and older, postmenopausal women younger than 65 with clinical risk factors for fracture including advancing age, previous fracture, glucocorticoid therapy, parental history of hip fracture, low body weight, current cigarette smoking, excessive alcohol consumption, rheumatoid arthritis, secondary osteoporosis. BMD Testing for Men is not recommended. The most used bone measurement test to screen for osteoporosis is central DXA which measures BMD at the hip and lumbar spine. Goal: To improve the osteoporosis screening using DXA scan in the outpatient internal medicine resident patient panel by 5% Study Design:Subjects were identified by an EPIC report and will include retrospective chart review of records from July 2022 and prospective screening until April 2024 for the outpatient IM clinic list of patients including both resident panel. Methods: Pre-intervention data analysis of current rates; Educating residents about appropriate screening; Utilization of osteoporosis screening as care-gap in EPIC ;Calling patients who are due for screening from IM residents patient panels; Post-interventional data analysis Results: The total number of patients on the residents panel was 196. Before interventions, screening rate for osteoporosis were 71.2% among residents' patients. After intervention, screening rates increased to 75.5%. There was a 4.3 % improvement in screening rate. Conclusion: Resident education, addressing Osteoporosis care gaps in EPIC and patient outreach are effective interventions to improve screening rates. Discussion: Osteoporosis screening remains an area of needed improvement in IM clinic. EPIC system should not only take age for prompting osteoporosis screening but also other factors such as family history, pre-mature fractures, steroid use, etc. Adding osteoporosis screening into the metric system are few steps to be considered for future directions. Presentation: 6/3/2024

Effective community-based interventions to prevent and control infectious diseases in urban informal settlements in low- and middle-income countries: a systematic review

BackgroundThe impact of rapid urbanization taking place across the world is posing variegated challenges. Especially in terms of communicable disease, the risk is more concentrated in urban poor areas where basic amenities are inadequate. This systematic review synthesizes evidence on the effective community-based interventions (CBIs) aimed at preventing and controlling infectious diseases among the urban poor in low- and middle-income countries (LMICs).MethodsThis systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. A comprehensive search across five major databases was conducted to capture literature on CBIs published between 2011 and 2021. Scientific articles of any design that reported any type of CBIs effective in preventing and controlling infectious diseases (tuberculosis, diarrhea, typhoid, dengue, hepatitis B and C, influenza, and COVID-19) were included. Screening and selection of studies were done by two pairs of independent researchers using the predefined eligibility criteria. The risk of bias in included studies was assessed using the modified checklist outlined in the Cochrane Handbook for Systematic Reviews of Interventions and Effective Public Health Practice Project (EPHPP). Analysis of effective CBIs was guided by the conceptual framework for integrated CBIs for neglected tropical diseases (NTDs), and narrative synthesis was carried out. Geographical restrictions were limited to LMICs and papers published in English.ResultsOut of 18,260 identified papers, 20 studies met the eligibility criteria and were included in this review. Community-based screening and socio-economic support, community-based vector control, behavior change communication, capacity building of the community health workers (CHWs), health education, and e- and m-health interventions were found as effective CBIs. Diversified CBIs were found to be effective for specific diseases, including tuberculosis (TB), diarrhea, dengue, influenza and ARI, and hepatitis B and C. Bundling of interventions were found to be effective against specific diseases. However, it was difficult to isolate the effectiveness of individual interventions within the bundle. The socio-cultural context was considered while designing and implementing these CBIs.ConclusionThe effectiveness of an intervention is inextricably linked to social context, stakeholder dimensions, and broader societal issues. System approach is recommended, emphasizing context-specific, multi-component interventions that address social determinants of health. Integrating these interventions with public health strategies and community involvement is crucial for sustainable outcomes. These findings can guide the design of future interventions for better prevention and control of communicable diseases in urban poor areas.Systematic review registrationPROSPERO CRD42021278689.

Construction and psychometric validation in Spanish schoolchildren of a knowledge questionnaire on basic life support and Automated External Defibrillator (ConocES-BLS/AED) in Spain

The 60 % of cardiac arrests happen in the out-of-hospital setting. In 2023, the International Liaison Committee on Resuscitation issued a statement entitled “Children save lives”, recommending the teaching of basic life support to children from the age of 12. However, we have not identified validated instruments that assess the level of knowledge of schoolchildren about BLS and AED. Objective: Construction and psychometric validation of a questionnaire to assess knowledge on Basic Life Support (BLS) and Automated External Defibrillator (AED) in primary to secondary school children. Method: Cross-sectional descriptive study of validation of the questionnaire consisting of several phases: construction of the questionnaire on knowledge on BLS and AED (ConocES-BLS/AED), content validation, pilot test and psychometric validation. Results: The ConocES-SVB/AED questionnaire was constructed, content validation was carried out by 14 experts, the pilot test carried out on 105 students reported good reliability (0.84), and finally with the psychometric validation a questionnaire composed of 12 items was obtained and psychometrically validated using the Item Response Theory in a final sample of 182 participants. Adequate fit values and acceptable reliability (0.65) were obtained, demonstrating its usefulness to accurately measure the level of knowledge about SVB/AED maneuvers in schoolchildren. Conclusions: The created and validated questionnaire provides educators with a fundamental resource to identify areas of lack of knowledge, improve and design effective educational interventions for schoolchildren on SVB/AED maneuvers.

Impact of metro vibrations on people: critical aspects of designing vibration mitigation interventions

A methodology for assessing and mitigating the impact of metro infrastructure generated vibration and ground-borne noise on people is described. This methodology combines techniques for analyzing vibration measurements and predictive modeling to identify effective mitigation interventions. These interventions require working on existing railway track systems and involve interruption of service, unlike noise mitigation interventions that can be implemented without interfering with rail and road infrastructure. For this reason, it is important to identify the most effective mitigation techniques to minimize the impact on the population and simplify on-site implementation. The methodology was applied in Milan metro lines where the vibration level was estimated, and a vibration mitigation system was designed. The vibration phenomenon was quantified through accelerometric measurements taken in several buildings affected by the disturbance from vibration. The measured vibration levels were compared with reference level established by standards. The maximum difference obtained from this comparison was used as input data for the design of the mitigation intervention. The vibration mitigation interventions involve increasing the total mass and elasticity of the existing system. Their effectiveness was verified through numerical calculation using parametric software confirming the required amount of mitigation.

Inflammation and Immunity in Liver Neoplasms: Implications for Future Therapeutic Strategies.

Over the past two decades, the "hallmarks of cancer" have revolutionized cancer research and highlighted the crucial roles of inflammation and immunity. Pro-tumorigenic inflammation promotes cancer development along with inhibition of anti-tumor immunity, shaping the tumor microenvironment (TME) towards a tumor-permissive state and further enhancing the malignant potential of cancer cells. This immunosuppressive TME allows tumors to evade immunosurveillance. Thus, understanding the complex interplay between tumors and the immune system within the TME has become pivotal, especially with the advent of immunotherapy. Although immunotherapy has achieved notable success in many malignancies, primary liver cancer, particularly hepatocellular carcinoma (HCC), presents unique challenges. The hepatic immunosuppressive environment poses obstacles to the effectiveness of immunotherapy, along with high mortality rates and limited treatment options for patients with liver cancer. In this review, we discuss current understanding of the complex immune-mediated mechanisms underlying liver neoplasms, focusing on HCC and liver metastases. We describe the molecular and cellular heterogeneity within the TME, highlighting how this presents unique challenges and opportunities for immunotherapy in liver cancers. By unraveling the immune landscape of liver neoplasms, this review aims to contribute to the development of more effective therapeutic interventions, ultimately improving clinical outcomes for patients with liver cancer.

Sacral neuromodulation for Organophosphate-induced delayed neuropathy neurogenic lower urinary tract dysfunction: a case report

BackgroundOrganophosphate-Induced Delayed Neuropathy (OPIDN) is a rare neurological disorder triggered by exposure to organophosphorus compounds. These compounds exert their neurotoxic effects by impacting the nervous system, leading to systemic manifestations. Urinary system symptoms are infrequently observed in clinical settings. Currently, effective therapeutic interventions for OPIDN-related urinary symptoms are lacking. Sacral nerve modulation therapy, an FDA-approved approach for managing lower urinary tract symptoms, presents as a promising option. Herein, we present a case of OPIDN-induced lower urinary tract obstruction successfully treated with sacral nerve modulation therapy, resulting in substantial symptom relief.Case reportA 27-year-old male patient presented with severe bilateral hydronephrosis, attributed to low bladder compliance and accompanied by a fever persisting for 6 days. The patient’s medical history revealed accidental ingestion of organophosphate pesticide (Dimethoate) with no concomitant underlying diseases. In consideration of the potential for OPIDN, surgical intervention in the form of sacral neuromodulation (phase I) was undertaken. Subsequent evaluation one month post-surgery revealed notable improvements in both bladder compliance and bilateral hydronephrosis, necessitating sacral neuromodulation (phase II). Presently, following a 5-month follow-up period, the patient remains asymptomatic and in favorable health.ConclusionThis patient achieved long-term relief using sacral neuromodulation.

Emotional competence self-help mobile phone app versus cognitive behavioural self-help app versus self-monitoring app to promote mental wellbeing in healthy young adults (ECoWeB PROMOTE): an international, multicentre, parallel, open-label, randomised controlled trial.

Based on evidence that mental health is more than an absence of mental disorders, there have been calls to find ways to promote flourishing at a population level, especially in young people, which requires effective and scalable interventions. Despite their potential for scalability, few mental wellbeing apps have been rigorously tested in high-powered trials, derived from models of healthy emotional functioning, or tailored to individual profiles. We aimed to test a personalised emotional competence self-help app versus a cognitive behavioural therapy (CBT) self-help app versus a self-monitoring app to promote mental wellbeing in healthy young people. This international, multicentre, parallel, open-label, randomised controlled trial within a cohort multiple randomised trial (including a parallel trial of depression prevention) was done at four university trial sites in four countries (the UK, Germany, Spain, and Belgium). Participants were recruited from schools and universities and via social media from the four respective countries. Eligible participants were aged 16-22 years with well adjusted emotional competence profiles and no current or past diagnosis of major depression. Participants were randomised (1:1:1) to usual practice plus either the emotional competence app, the CBT app or the self-monitoring app, by an independent computerised system, minimised by country, age, and self-reported gender, and followed up for 12 months post-randomisation. The primary outcome was mental wellbeing (indexed by the Warwick-Edinburgh Mental Well Being Scale [WEMWBS]) at 3-month follow-up, analysed in participants who completed the 3-month follow-up assessment. Outcome assessors were masked to group allocation. The study is registered with ClinicalTrials.gov, NCT04148508, and is closed. Between Oct 15, 2020, and Aug 3, 2021, 2532 participants were enrolled, and 847 were randomly assigned to the emotional competence app, 841 to the CBT app, and 844 to the self-monitoring app. Mean age was 19·2 years (SD 1·8). Of 2532 participants self-reporting gender, 1896 (74·9%) were female, 613 (24·2%) were male, 16 (0·6%) were neither, and seven (0·3%) were both. 425 participants in the emotional competence app group, 443 in the CT app group, and 447 in the self-monitoring app group completed the follow-up assessment at 3 months. There was no difference in mental wellbeing between the groups at 3 months (global p=0·47). The emotional competence app did not differ from the CBT app (mean difference in WEMWBS -0·21 [95% CI -1·08 to 0·66]) or the self-monitoring app (0·32 [-0·54 to 1·19]) and the CBT app did not differ from the self-monitoring app (0·53 [-0·33 to 1·39]). 14 of 1315 participants were admitted to or treated in hospital (or both) for mental health-related reasons, which were considered unrelated to the interventions (five participants in the emotional competence app group, eight in the CBT app group, and one in the self-monitoring app group). No deaths occurred. The emotional competence app and the CBT app provided limited benefit in promoting mental wellbeing in healthy young people. This finding might reflect the low intensity of these interventions and the difficulty improving mental wellbeing via universal digital interventions implemented in low-risk populations. European Commission.

Improving Amniotic Fluid Index with L-Arginine Supplementation

Background: Oligohydramnios, characterized by a low Amniotic Fluid Index (AFI), is associated with adverse pregnancy outcomes, including fetal growth restriction, preterm labor, and low birth weight. Effective interventions for improving AFI are critical, particularly in resource-limited settings. L-Arginine, a nitric oxide precursor, has shown promise in enhancing uteroplacental circulation and increasing AFI. This study aimed to evaluate the efficacy of L-Arginine supplementation in improving AFI and associated maternal and neonatal outcomes in pregnant women with oligohydramnios in Bangladesh. Methods: This study was conducted at Islami Bank Hospital over one year (July 2023 to June 2024), involving 90 pregnant women diagnosed with oligohydramnios. Participants received daily L-Arginine supplementation, and AFI was measured before and after the intervention. Maternal and neonatal outcomes, including gestational age at delivery, birth weight, and neonatal intensive care unit (NICU) admissions, were recorded. Statistical analysis was performed using paired t-tests, with p < 0.05 considered statistically significant. Results: The mean AFI increased significantly from 5.4 cm (SD ±1.7) before the intervention to 8.6 cm (SD ±2.1) after supplementation, with a mean difference of 3.2 cm (p < 0.001). Low birth weight was observed in 20% of the neonates, while 17.78% required NICU admission. There was a notable improvement in neonatal outcomes with L-Arginine supplementation. Conclusion: L-Arginine supplementation significantly improved AFI and neonatal outcomes, making it a viable intervention for managing oligohydramnios in pregnant women. Further research is recommended to confirm these findings in larger populations.

Development of a vocational rehabilitation intervention to support return-to-work and well-being following major trauma: a person-based approach

ObjectivesMajor trauma centres (MTCs) save lives but rehabilitation to support return-to-work (RTW) is lacking. This paper describes development of a vocational rehabilitation intervention (the ROWTATE intervention) to support RTW following...

Stereotactic radiosurgery for arteriovenous malformations in pediatric patients: an updated systematic review and meta-analysis.

Intracranial arteriovenous malformations are the most common cause of intracranial hemorrhages in pediatric patients. Stereotactic radiosurgery (SRS) has been used extensively to treat these lesions. The authors conducted a systematic review and meta-analysis to report treatment outcomes and long-term complications. This study follows the PRISMA and MOOSE guidelines, with the search spanning electronic databases up to February 6, 2024. The outcome measures included obliteration rate, hemorrhage in the latency period, symptomatic radiation-induced changes (RICs), cyst formation, and radiation-induced tumorigenesis. A total of 1493 patients across 24 studies were included. The pooled complete obliteration after single-fraction SRS was 64.7% (95% CI 58%-69%). The pooled post-SRS hemorrhage rate at the final follow-up was 6.2% (95% CI 5%-8%). The overall incidence rate of RIC was 31.3% (267/854 patients), and the incidence of symptomatic RIC was 8.8% (114/1289 patients). For permanent symptomatic RIC, the pooled incidence was 4.8% (62/1283 patients). At final follow-up, 17 cases of radiation-induced necrosis were documented among 654 patients (2.6%). Similarly, cyst formation was reported in 1.3% of cases (17/1265 patients) and radiation-induced tumors occurred in 0.15% of cases (2/1342 patients). SRS can be considered an effective intervention for appropriately selected pediatric patients with arteriovenous malformations. Long-term complication rates appear to be low but additional longitudinal studies are required to better define the long-term outcomes.

Exploring the association between consultation themes and suicidal ideation: a gender-stratified analysis of Hangzhou Mental Health Hotline (2014-2023)

BackgroundSuicide is a critical global public health issue that demands a better understanding of its complex causes and effective interventions. This study examines data from the Hangzhou Mental Health Hotline (2014-2023) to explore the relationship between consultation themes and suicidal ideation, with an emphasis on gender differences and how these associations changed during different phases of the COVID-19 pandemic.MethodsThis retrospective analysis covers 128,245 calls to the hotline over a decade. Chi-square tests identified differences in suicidal ideation across consultation themes and demographics. Multivariate logistic regression models were used to examine the relationship between specific themes and suicidal ideation, adjusting for confounders. The analysis was stratified by gender and pandemic phases to assess the interaction between gender and pandemic-related changes.ResultsThe incidence of suicidal ideation was highest during the mid-pandemic phase (11.95%), compared to the pre-pandemic (7.68%) and post-pandemic phases (10.66%). Additionally, the rate was slightly higher among female callers (9.8%) than male callers (9.4%). Physical illness (OR = 4.70, 95% CI: 3.71-5.91) had the strongest association with suicidal ideation, followed by mental health issues (OR = 3.35, 95% CI: 3.03-3.70). Compared to male callers, female callers were more significantly affected by physical illness (OR = 6.86 vs. OR = 3.71, p < 0.001) and mental health issues (OR = 6.81 vs. OR = 2.11, p < 0.001). In the context of romantic relationship problems, female callers had a higher likelihood of suicidal ideation (OR = 4.13 vs. OR = 1.88, p < 0.001). Similarly, marital and family issues were more strongly associated with suicidal ideation in female callers (OR = 4.58 vs. OR = 1.21, p < 0.001). During the global COVID-19 pandemic, the association between suicidal ideation and consultation themes among male callers showed a sharp upward trend, which eased after the pandemic. In contrast, the association among female callers gradually accumulated and continued to worsen in the later stages of the pandemic.ConclusionThis study highlights the necessity of implementing gender-sensitive mental health interventions tailored to different gender groups during and after global crises such as the COVID-19 pandemic, to safeguard public mental health effectively.

Relationship between eating attitudes, depression, and insight in schizophrenic patients with and without type 2 diabetes mellitus: a comparative study in Guangdong, China

BackgroundSchizophrenia, a severe mental disorder, is often complicated by Type 2 Diabetes Mellitus (T2DM), which can further impact patients’ psychological health. This study investigated the differences in eating attitudes, depression, and insight between schizophrenic patients with and without comorbid T2DM and explored the correlations among these factors to provide empirical support for clinical interventions.MethodsThis case-control study was conducted in Guangdong Province, China. From December 2022 to May 2023, a total of 300 hospitalized patients with schizophrenia (92 with comorbid T2DM and 208 without T2DM) were recruited. Data were collected using the Personal Information Form, Eating Attitudes Test (EAT-26), Hamilton Depression Scale (HAMD), and Insight and Treatment Attitudes Questionnaire (ITAQ). Statistical analyses, including t-tests, ANOVA, and multiple linear regression, were performed to examine differences and predictive factors of eating attitudes among patients. This study was approved by the Ethics Committee of the Affiliated Brain Hospital of Guangzhou Medical University (approval number: 2020028), and written informed consent was obtained from all participants.ResultsPatients with schizophrenia and comorbid T2DM exhibited significantly higher risks of eating disorders (EAT-26: 12.54 ± 9.77 vs. 9.07 ± 7.90, P=0.003), more severe depression (HAMD: 14.71 ± 7.36 vs. 11.80 ± 6.04, P=0.001), and poorer insight (ITAQ: 10.46 ± 6.01 vs. 12.16 ± 6.09, P=0.025) compared to those without T2DM. Regression analysis revealed that gender, weekly exercise frequency, depression, and insight were significant predictors of eating attitudes among patients with T2DM. For patients without T2DM, weekly exercise frequency, smoking status, and insight were significant predictors.ConclusionSchizophrenic patients with comorbid T2DM are facing increasing risks related to eating attitudes, depression, and insight which highlight the need for targeted interventions. Regular psychological assessment and tailored support strategies might improve their mental health and quality of life. Future research should focus on longitudinal studies to clarify causal relationships and develop more effective interventions.

The longitudinal association between sport participation and self-esteem in youth in the Netherlands: The role of sport type

ObjectivesTo investigate the longitudinal associations of sport participation with self-esteem in youth, and whether this relationship differs between team compared to individual, and non-esthetic compared to esthetic sports. DesignProspective data on sport participation at age 10 and self-esteem at age 13 years was used, collected from 2970 participants within Generation R, a population-based cohort study in the Netherlands. MethodsHours of sports per week were measured with a questionnaire, completed by the primary caregivers. Participation in sports was classified into team vs. individual and non-esthetic vs. esthetic sports. Self-esteem was assessed by the Harter's Self-Perception Profile. Linear regression analyses, adjusted for multiple testing were conducted to test the association between sports and self-esteem subdomains. Then, differences in self-esteem among youth participating in different types of sports were explored by two separate sets of linear regression with team and non-esthetic sports as the reference groups. ResultsMore hours of sports were associated with higher self-esteem (β = 0.081, pfdr < 0.001). This association was driven by the subdomains social acceptance (β = 0.057, pfdr = 0.004) and athletic competence (β = 0.242, pfdr < 0.001). Participation in individual or esthetic sports was associated with lower self-esteem compared to the team (β = −0.196, pfdr < 0.001) or non-esthetic (β = −0.172, pfdr = 0.002) sports. ConclusionsSport participation, particularly team and non-esthetic sports, may be beneficial for self-esteem among youth, driven by aspects like socializing and one's ability to do well at sports. The aspects of different types of sports could be considered for developing improved sport-related environments and effective physical activity interventions.

The Universal Neighborhood Effect Averaging in Mobility-Dependent Environmental Exposures.

The neighborhood effect averaging problem (NEAP) is a fundamental statistical phenomenon in mobility-dependent environmental exposures. It suggests that individual environmental exposures tend toward the average exposure in the study area when considering human mobility. However, the universality of the NEAP across various environmental exposures and the mechanisms underlying its occurrence remain unclear. Here, using a large human mobility data set of more than 27 000 individuals in the Chicago Metropolitan Area, we provide robust evidence of the existence of the NEAP in a range of individual environmental exposures, including green spaces, air pollution, healthy food environments, transit accessibility, and crime rates. We also unveil the social and spatial disparities in the NEAP's influence on individual environmental exposure estimates. To further reveal the mechanisms behind the NEAP, we perform multiscenario analyses based on environmental variation and human mobility simulations. The results reveal that the NEAP is a statistical phenomenon of regression to the mean (RTM) under the constraints of spatial autocorrelation in environmental data. Increasing travel distances and out-of-home durations can intensify and promote the NEAP's impact, particularly for highly dynamic environmental factors like air pollution. These findings illuminate the complex interplay between human mobility and environmental factors, guiding more effective public health interventions.