High Need Research Articles

Sex Differences among Overweight/Obese Kidney Transplant Recipients Requiring Oxygen Support Amid the COVID-19 Pandemic.

Background and Objectives: Overweight/obesity puts individuals at greater risk for COVID-19 progression and mortality. We aimed to evaluate the impact of overweight/obesity on oxygen (O2) requirement outcomes of male and female kidney transplant recipients (KTRs) during the COVID-19 pandemic. Materials and Methods: We conducted a retrospective analysis of a cohort of KTRs diagnosed with COVID-19. Participants were stratified based on BMI categories, and data on the need for O2 therapy outcome were collected and analyzed separately for male and female KTRs. Results: In total, 284 KTRs (97 males and 187 females) were included in the study. Overweight/obesity was observed in 60.6% of male KTRs and 71% of female KTRs. Strikingly, overweight/obese women had a significantly higher requirement for supplemental O2 (63.3% vs. 41.7%, OR = 2.45, p = 0.03), particularly among older individuals (OR = 1.05, p = 0.04), smokers (OR = 4.55, p = 0.03), those with elevated lactate dehydrogenase (LDH) levels (OR = 1.01, p = 0.006), and those with lower admission and basal estimated glomerular filtration rate (eGFR) levels. Within this cohort, the necessity for O2 supplementation was correlated with more unfavorable outcomes. These included heightened mortality rates, transfers to the intensive care unit, employment of invasive mechanical ventilation, and the emergence of acute kidney injury requiring hemodialysis. On the other hand, although overweight/obese male KTRs had a higher prevalence of hypertension and higher fasting blood glucose levels, no significant association was found with COVID-19-related outcomes when compared to lean male KTRs. Conclusions: Overweight/obesity is highly prevalent in KTRs, and overweight/obese women demonstrated a higher need for supplemental O2. Therefore, the early identification of factors that predict a worse outcome in overweight/obese female KTRs affected by COVID-19 contributes to risk stratification and guides therapeutic decisions.

Early preservice teachers' development of social studies inquiry projects

PurposePreservice teachers (PSTs) typically have few opportunities to observe social studies instruction in PSTs' elementary field placements. To practice effective integration as a pathway to include more social studies instruction, PSTs developed a unit plan based on inquiry during an undergraduate methods course. The purpose of this study was to explore what scaffolds were effective in PSTs' development of social studies inquiry projects.Design/methodology/approachThe author used a multiple case study approach, examining initial submissions, feedback and resubmissions as PSTs developed PSTs' inquiry projects. The data were analyzed with an eye on PSTs' ability to plan a unit according to the four dimensions of the C3 Framework's inquiry arc (National Council for the Social Studies [NCSS], 2013).FindingsThe author analyzed data related to PSTs’ area of highest need from PSTs' initial submissions: staging the task, formative tasks and resources. PSTs were able to develop inquiry projects after being supported in their (1) organization, (2) clarity, (3) alignment and (4) developmental appropriateness.Originality/valueThis study shows that novice teachers can create high-quality social studies learning experiences in elementary school when provided appropriate supports (in this case, feedback about organization, clarity, alignment and developmental appropriateness). With the tools to develop such projects, new teachers may be able to increase the amount of social studies taught in elementary classrooms.

Does framing climate change policies to fit with epistemic needs for predictability reduce conservatives’ opposition?

AbstractA short‐term obstacle to united political action to fight climate change in various countries is opposition to pro‐environmental policies among conservatives. Three preregistered studies test the hypothesis that because conservatives have a higher need for closure than liberals (Hypothesis 1), framing pro‐environmental policies in a way that appeals to the need for closure, reduces conservatives’ opposition to these policies (Hypothesis 2). Study 1 confirms Hypothesis 1. Next, two studies test Hypothesis 2 and find that conservatives are less opposed to pro‐environmental policies proposed by a politician (Study 2) or an NGO (Study 3) if these policies are framed in a way that appeals to the need for closure, while the opposite is the case for liberals. Across these two studies, we also test the underlying process but find no evidence for the idea that differences in need for closure mediate the effect (Hypothesis 3a). Instead, the effect is primarily driven by inferences about group membership and ingroup bias (Hypothesis 3b, non‐preregistered). That is, these data suggest that framing policies to appeal to closure needs reduces conservatives’ opposition because they infer that the policy is proposed by a fellow conservative.

Modelling energy demand under discontinuities from an energy economic point-of-view

The major motivation for this paper is the need for the identification of policies required in principle for heading toward sustainable energy systems in any region world-wide. In particular, this work emphasizes modelling the demand side of energy systems and identifies interactions with energy policy measures. The core objective of this paper is to carry out a review of econometric energy demand modelling approaches over time. In this context, special attention is paid to lessons learned from modelling historical discontinuities and structural breaks in order to better understand issues of disruption. Our analysis builds on econometric analyses using standard estimation approach for modelling energy demand by means of a production function, depending on price and income. We start with ordinary least-squares (OLS) and extend the approach to autoregressive distributed lag (ARDL)model. We identify long-term as well as short-term elasticities. Finally, we analyze whether elasticities are constant over time and whether structural breaks exist. The major conclusions of our analyses are that approaches assuming constant elasticities over time are no longer useful. The magnitude of the impact made by economic parameters such as prices and income elasticities over time has been decreasing due to our analyses. This has an impact on energy policies, namely taxes and standard. The effect of taxes in an energy system is that they increase prices and reduce energy demand depending on the price elasticities. Yet, the smaller price elasticities are, the lower the impact of new taxes is. This leads to the conclusion that there is still a higher need for increased standards and technological innovations. The major useful policy suggestion based on this research is that technical measures for increasing energy efficiency are very important as a measure accompanying energy taxes.

Minimizing blood loss in laparoscopic myomectomy with temporary occlusion of the hypogastric artery.

Uterine leiomyomas are common benign pelvic tumors. Currently, laparoscopic myomectomy (LM) is the preferred treatment option for women in the fertile age group with symptomatic myomas. The authors hypothesize that combining LM with a bilateral temporary occlusion of the hypogastric artery (TOHA) using vascular clips minimizes uterine blood flow during surgery and can significantly reduce surgery-associated blood loss. This single-center, prospective randomized study was conducted at the Department of Obstetrics and Gynecology, Municipal Emergency Clinical Hospital Timisoara, Romania. Patients aged between 18 and 49 who preferred laparoscopic myomectomy and wished to preserve fertility were included, provided they had intramural uterine leiomyomas larger than 4 cm in diameter that deformed the uterine cavity. The study analyzed data from 60 laparoscopic myomectomies performed by a single surgeon between January 2018 and December 2020. Patients were randomly assigned to either: "LM + TOHA" group (29 patients), and "LM" group (31 patients). The study's main objective was to evaluate the impact of TOHA on perioperative blood loss, expressed as mean differences in Hb (delta Hb). Delta Hb was statistically lower in the "LM + TOHA" group compared to "LM" group, with mean ± standard (min-max): 1.68 ± 0.67 (0.39-3.99) vs. 2.63 ± 1.06 (0.83-4.92) g/dL, respectively (p < 0.001). There was a statistically significant higher need for postoperative iron perfusion in the "LM" group, specifically 0 vs. 12 patients (p < 0.001), and lower postoperative anemia in "LM + TOHA" group (p < 0.001). Necessary artery clipping time was 10.62 ± 2.47 (7-15) minutes, with no significant impact on overall operative time: 110.2 ± 13.65 vs. 106.3 ± 16.48 (p = 0.21). There was no difference in the length of hospitalization or 12-month post-intervention fertility. Performing bilateral TOHA prior to laparoscopic myomectomy has proven to be a valuable technique in reducing surgery-associated blood loss, while minimizing complications during surgery, with no significant increase in the overall operative time. ISRCTN registry, (www.isrctn.com), identifier ISRCTN66897343.

Body mass is associated with hibernation length, body temperature, and heart rate in free-ranging brown bears

BackgroundDespite centuries of research, debate remains on the scaling of metabolic rate to mass especially for intraspecific cases. The high variation of body mass within brown bears presents a unique opportunity to study the intraspecific effects of body mass on physiological variables. The amplitude of metabolic rate reduction in hibernators is dependent on body mass of the species. Small hibernators have high metabolic rates when euthermic but experience a drastic decrease in body temperature during torpor, which is necessary to reach a very low metabolic rate. Conversely, large hibernators, such as the brown bear (Ursus arctos), show a moderate decrease in temperature during hibernation, thought to be related to the bear’s large size. We studied body mass, abdominal body temperature, heart rate, and accelerometer-derived activity from 63 free-ranging brown bears (1–15 years old, 15–233 kg). We tested for relationships between body mass and body temperature, heart rate, and hibernation duration.ResultsThe smallest individuals maintained lower body temperatures during hibernation, hibernated longer, and ended hibernation later than large bears. Unlike body temperature, winter heart rates were not associated with body mass. In summer, the opposite pattern was found, with smaller individuals having higher body temperature and daytime heart rates. Body mass was associated with body temperature in the winter hypometabolic state, even in a large hibernating mammal. Smaller bears, which are known to have higher thermal conductance, reached lower body temperatures during hibernation. During summer, smaller bears had higher body temperatures and daytime heart rates, a phenomenon not previously documented within a single mammalian species.ConclusionWe conclude that the smallest bears hibernated more deeply and longer than large bears, likely from a combined effect of basic thermodynamics, the higher need for energy savings, and a lower cost of warming up a smaller body.

Are the outcomes of single-stage open reduction and Dega osteotomy the same when treating DDH in patients younger than 8 years old? A prospective cohort study

BackgroundThe primary objective was to report our early results after a one-stage procedure [open reduction (OR), Dega pelvic osteotomy (DPO), and femoral osteotomy (FO) when needed] for surgical management of a cohort of patients with developmental dysplasia of the hip (DDH). The secondary objective was to compare the functional, radiological, and complications among patients younger and older than 30 months.Materials and methodsThis prospective cohort study included 71 hips with DDH in 61 patients with a mean age of 34.3 ± 19.5 months. All patients underwent one-stage surgical procedures, including OR + DPO and FO, if needed. Functional and radiographic assessment at the last follow-up was conducted using the modified Severin grading system and the Severin classification system, respectively, in addition to assessing the acetabular index (AI), osteotomies healing, and presence of complications. We divided patients into two groups, younger than 30 months (group I) and older than 30 months (group II).ResultsWe included 35 hips in group I and 36 in group II. All hips received OR + DPO, while 25 (69.4%) hips in group II had FO. The operative time was significantly longer in group II (103.19 ± 20.74 versus 72.43 ± 11.59 min, p < 0.001). After a mean follow up of 21.3 ± 2.3 months, the functional outcomes were satisfactory in 62 (87.3%) hips (94.3% in group I and 80.6% in group II, p = 0.35). There was a significant improvement in the AI in all patients compared with preoperative values (27.2° ± 2.9 versus 37° ± 4.2, p < 0.05). Furthermore, 63 (88.7%) hips had satisfactory radiographic outcomes (94.3% in group I and 83.3% in group II, p = 0.26), and all osteotomies showed radiographic healing. The overall complications incidence was significantly lower in group I compared with group II (5.7% versus 30.6%, p < 0.05), and avascular necrosis occurred in 4 (5.6%) hips, all in group II (p = 0.06).ConclusionOne-stage procedure entailing open reduction, Dega pelvic osteotomy, and femoral osteotomy when needed for managing DDH in patients younger than eight years old revealed acceptable clinical and radiological outcomes. However, there was a higher need for a concomitant femoral osteotomy in patients older than 2.5 years, and complications were more frequent.Level of evidence III

Comparison of Postoperative Outcomes Between Intra-aortic Balloon Pump and Levosimendan in Patients Undergoing Coronary Artery Bypass Graft: A Systematic Review and Meta-Analysis.

This study was conducted to compare the postoperative outcomes between intra-aortic balloon pump (IABP) and levosimendan in patients undergoing coronary artery bypass graft(CABG) surgery.This meta-analysis was conducted following the recommendations of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).For this meta-analysis, a literature search was performed on PubMed, Cochrane Central Register of Controlled Trials, and EMBASE from inception to July 15, 2023. Keywords used to search for relevant articles included "intra-aortic balloon," "levosimendan," and "cardiac surgery" along with their key terms and Medical Subject Headings (MeSH) terms. Outcomes assessed in this study included postoperative outcomeslike all-cause mortality, postoperative arrhythmias, need for inotropic support, length of intensive care unit stay (ICU) in days, and duration of mechanical ventilation in hours. Other outcomes included two-hour, six-hour, and 24-hourpostoperative central venous pressure (CVP), mean atrial pressure (MAP), and heart rate (HR). A total of eight studies were included in the pooled analysis.The pooled results found that the length of ICU stay and the duration of mechanical ventilation were significantly higher in patients receiving IABP. Additionally, the findings of this meta-analysis showed a higher need for inotropic support in patients receiving IABP compared to patients receiving levosimendan but the difference was statistically insignificant. However, no significant differences were found between the two groups in terms of mortality and arrhythmias. In conclusion, patients treated with levosimendan exhibited significant advantages, as they experienced shorter ICU stays and reduced duration of mechanical ventilation compared to the IABP group and less requirement for inotropic support.

Predicting failure of detection of peritonsillar abscess with ultrasound in pediatric populations

PurposeSome patients require additional imaging following ultrasound (US) to definitively diagnose a peritonsillar abscess (PTA), delaying intervention and disease resolution. We seek to evaluate patient characteristics which may predispose to a secondary imaging requirement to diagnose PTA, in order to better understand ultrasound limitations and predict who will require additional studies. Materials and methodsRetrospective chart review of patients with an US for suspected PTA between July 2017 and July 2020. Patient age, weight, and clinical characteristics, such as pain, trismus, and reduced neck range of motion (ROM) were collected. The need for additional imaging, subsequent surgical intervention, and hospital length of stay (LOS) were also recorded. ResultsOf 411 qualifying patients, 73 underwent additional imaging. Patients who required additional imaging were younger (9.8 vs 11.3 years, p = 0.026) and more likely to have decreased neck ROM (17.8 vs 5.3 %, p = 0.001). Surgical intervention was performed more commonly (27.4 vs 14.8 %, p = 0.015) and hospital LOS was longer (24.0 vs 5.0 h, p < 0.001) in those with secondary imaging. ConclusionsSpecific patient characteristics, such as younger age and decreased neck range of motion, are associated with a higher need for additional imaging. Additionally, the need for additional imaging is associated with a longer hospital LOS and increased likelihood of surgical intervention. Nearly 18 % of patients who underwent US evaluation of PTA required secondary imaging. Although transcervical US remains an excellent tool for diagnosing PTA, this data supports the utility of secondary imaging in certain instances.

Early Postoperative Neurologic Events Are Associated With Worse Outcome and Fatal Midterm Survival After Adult Heart Transplantation.

Background Neurologic events during primary stay in heart transplant (HTx) recipients may be associated with reduced outcome and survival, which we aim to explore with the current study. Methods and Results We screened and included all patients undergoing HTx in our center between September 2010 and December 2022 (n=268) and checked for the occurrence of neurologic events within their index stay. Neurologic events were defined as ischemic stroke, hemorrhage, hypoxic ischemic injury, or acute symptomatic neurologic dysfunction without central nervous system injury. The cohort was then divided into recipients with (n=33) and without (n=235) neurologic events after HTx. Using a multivariable Cox regression model, the association of neurologic events after HTx and survival was assessed. Recipients with neurologic events displayed a longer intensive care unit stay (30 versus 16 days; P=0.009), longer mechanical ventilation (192 versus 48 hours; P<0.001), and higher need for blood transfusion, and need for hemodialysis after HTx was substantially higher (81% versus 55%; P=0.01). Resternotomy (36% versus 26%; P=0.05) and mechanical life support (extracorporeal life support) after HTx (46% versus 24%; P=0.02) were also significantly higher in patients with neurologic events. Covariable-adjusted multivariable Cox regression analysis revealed a significant independent association of neurologic events and increased 30-day (hazard ratio [HR], 2.5 [95% CI, 1.0-6.0]; P=0.049), 1-year (HR, 2.2 [95% CI, 1.1-4.3]; P=0.019), and overall (HR, 2.5 [95% CI, 1.5-4.2]; P<0.001) mortality after HTx and reduced Kaplan-Meier survival up to 5 years after HTx (P<0.001). Conclusions Neurologic events after HTx were strongly and independently associated with worse postoperative outcome and reduced survival up to 5 years after HTx.

Outcomes of a newly established transitional urology outpatient clinic: a real-world experience.

To evaluate the demographic and clinical characteristics of patients who visited our transitional urology (TU) outpatient clinic formed by pediatric urologists with urology background within the first year upon its establishment. Files of 130 consecutive patients who visited our TU outpatient clinic, which was established in 01 March 2021, between 01 March 2021 and 01 March 2022 were retrospectively collected. Patients were divided into two groups: those with a previous follow-up in our pediatric urology department (Group I, n: 81, 62.3%) and those who were followed up in other clinics during childhood (Group II, n: 49, 37.7%) afterwards. Demographic characteristics, complaints at admission, previous medical history, and management plans at the recent clinical visit were noted. We defined a successful and smooth transition from childhood to adult care as not being without follow-up within the first year after the age of 18years and not requiring extraordinary medical assistance (e.g., emergency room visits, hospitalization, intensive care unit admissions) from the last urological control to the TU outpatient clinic visits. The most common diagnoses were vesicoureteral reflux (n: 32, 24.6%), neuropathic bladder accompanied by spina bifida (n: 31, 23.8%), obstructive uropathy (n: 25, 19.2%), hypospadias (n: 20, 15.3%), non-neurogenic lower urinary tract dysfunction (n: 19, 14.6%), and bladder exstrophy (n: 8, 6.1%). The distribution of primary diagnosis in the two patient groups was similar. The median time from the last pediatric urology visit to the current TU clinical visit was significantly longer in Group II (12 vs. 60months, p < 0.001),consequently, the median patient age at admission was significantly higher in Group II (21 vs. 23years, p = 0.020). The rate of a successful and smooth transition was 86.4% in Group I, whereas Group II had a completely unsuccessful transition period. Upon admission to TU outpatient clinic, the requirement of a surgical intervention was lower in Group I (21% vs. 38.8%, p = 0.028).Also,the need for medical treatment changes was higher in Group II (9.9% vs. 53.1%, p < 0.001). Our findings emphasize the importance of patient referral to a TU clinic that deal with lifelong problems of congenital genitourinary diseases. Delays in receiving medical or surgical treatments during transition from childhood to adulthood may be associated with higher need for subsequent surgical interventions in this vulnerable patient population.

Universal assessment and tiered intervention: A model of care to meet the pediatric oncology psychosocial standard of care for school support.

The feasibility and acceptability of a tiered intervention model of school intervention services was investigated in response to the publication of evidence-based Psychosocial Standards of Care for Children with Cancer and their Families. Children with newly diagnosed malignancy or transitioning to long-term survivorship care were eligible. Families received universal school needs assessment and intervention targeted at the level of risk identified. Academic risk and resource utilization data collected over 1year were used to evaluate model feasibility and surveys evaluated family and medical provider satisfaction with the model. One hundred and eight children were enrolled and had academic risk assessed at enrollment as high (25%), moderate (44.4%) or low (30.6%) risk. School liaison staff time spent providing intervention was related to the level of risk. 54.6% of patients reported a decrease in risk status at the end of 1year of intervention. Parents (94%) and medical providers (100%) chose responses of "agree" or "strongly agree" when asked if they were satisfied with the intervention received over the year. The tiered model of care identifies the students with the highest need for intervention, allows for more targeted use of resources, and successfully meets the Psychosocial Standard of Care for academic needs.

Parent Ratings of Health Insurance Adequacy for Children with Emotional, Behavioral, or Developmental Problems.

Parents of children with special health care needs (CSHCN) report that private insurance is less adequate than public health coverage. Parents of CSHCN with emotional, behavioral, or developmental problems (EBDPs) may perceive private insurance to be especially inadequate due to higher need for a wider array of non-medical services and supports. This study's objective is to assess differences in parent ratings of insurance adequacy for public versus private health coverage between non-CSHCN, CSHCN, and CSHCN with EBDPs. This study pooled publicly available data from the 2016 through 2019 National Survey of Children's Health. Multivariable fixed effects logistic regression models estimated the association between insurance type, CSCHN and EBDP status, and parent ratings of their child's insurance adequacy. Marginal effects were calculated for insurance type, CSHCN and EBDP status, and their interactions to estimate the size of the association. Among all subgroups, consistently more parents with publicly insured children rated their insurance as adequate compared to those with private insurance. Parents of privately insured CSHCN with EBDPs rated their insurance as adequate at significantly lower rates than any other group of parents (55%)-including those with privately insured children without EBDPs (non-CSHCN= 67%; CSHCN=63%) and all other parents with publicly insured children (non-CSHCN=87%; CSHCN=83%; CSHCN with EBDPs=84%). Future research should investigate if perceptions of insurance adequacy among families whose CSHCN has an EBDP aligns with reports of service access and unmet health care needs.

Matrix-based assessment of spatial correlations between marine uses and ecosystem service supply in German marine areas

Marine ecosystems are highly dynamic and complex and contribute immensely to human well-being. Spatiotemporal overlaps of marine uses and human activities are constantly pressuring ecosystems, and that in turn impacts the supply quantity and quality of various ecosystem services (ES). This study is the first attempt to use the ES matrix to link marine uses and the capacity to supply ES. Combining expert- and literature-based evaluations, we assessed the relationships of twelve marine uses and five selected ecosystem services in the German North and Baltic Sea and mapped their spatial distribution. Despite a limited data availability and a higher need for simplification, the matrix approach proved to be applicable for the marine realm. Areas used for tourism and those that provide coastal safeguarding show high values of ES supply in comparison to areas used for sediment extraction and areas previously used as ammunition dumping areas. Nature conservation areas tend to have the highest capacity to supply ES. Differences in the ES supply pattern between the North Sea and Baltic Sea were identified. The results show the influence of anthropogenic activities on the spatial distribution of ES supply and can support future marine planning.

Comparative Evaluation of the Clinical Severity of COVID-19 Produced by the Omicron Variant Versus the Wuhan Strain

Abstract Purpose: Starting from the observations of the in vitro studies that describe a lower pathogenicity of the Omicron variant, we proposed to comparatively analyze two groups of patients admitted to our clinic, one at the beginning of the COVID-19 pandemic, and the other one at the beginning of the Omicron wave of the pandemic, and to compare the severity of disease episodes. Patients and methods: 2 groups of patients with COVID-19, one group of 480 patients hospitalized in our clinic in March-August 2020 and one group of 320 patients admitted in January-June 2022, were selected. Demographic data, paraclinical profile at admission, comorbidities, the type and duration of treatment and the evolution of the patients in the two groups, were analyzed comparatively. Results: Our study showed statistically significant differences between group A compared to the group B, which support the aggressiveness of the Wuhan strain and the severity of its disease forms, such as: the predominance of pulmonary opacity on radiographies, a higher need for immunosuppressive therapies, a lower oxygen saturation, and a higher average values of inflammatory markers at admission, in the first group. Also, some factors with predictive potential for a severe clinical form, with predominance in group 2 (older age, a higher score of cumulative comorbidities, a higher value of D-dimers and aspartateaminotransferase, a lower value of concentration of prothrombin, and the higher average CURB-65 score, at admission) were observed. Conclusion: Our study identified predictive parameters of severity (D-dimers, aspartate-aminotransferase, prothrombin concentration, CURB-65 Score), statistically significant modified in the Omicron wave group compared to the Wuhan wave group, which draw attention to the possibility of severe and unfavorable evolution of the infection with Omicron in elderly population with multiple comorbidities.

Special Education Teachers’ Self–Efficacy in Implementing Social–Emotional Learning to Support Students with Learning Disabilities

This study was designed to determine how special education teachers (SETs) in Saudi Arabia perceive their self–efficacy in implementing social–emotional learning (SEL) practices to support students with learning disabilities (LD). The data were collected by surveying 109 SETs of students with LD who teach at elementary and middle schools in Riyadh. The findings demonstrate that SETs had low to moderate self–efficacy in putting SEL into practice, and the participants highlighted the importance of receiving support that can enhance their self–efficacy in SEL. Moreover, the study's findings show some statistically significant variations in the responses of the teachers, as those who attended more professional development programs reported higher levels of self–efficacy. Additionally, middle school teachers and teachers with fewer years of experience showed a higher need for receiving support to enhance their implementation of SEL. Recommendations for future studies and practices are provided.

Sex disparities in treatment patterns after metformin initiation among patients with type 2 diabetes mellitus.

To assess sex differences in treatment patterns after metformin initiation among type 2 diabetes mellitus (T2D) patients. A cohort study was conducted using the Groningen Initiative to ANalyze Type 2 diabetes Treatment (GIANTT) primary care database. Patients aged ≥18 years initiating metformin were followed 2-5 years. Markov modeling was conducted to estimate treatment transition rates and calculate adjusted hazard ratios (aHR) with 95% confidence intervals (CI) comparing men with women adjusted for age, HbA1c level at initiation, and cardiovascular disease history. Kaplan-Meier analyses and Cox proportional-hazards models were used to determine the time to and likelihood of getting treatment intensification. HbA1c levels at initiation and intensification were compared using Mann-Whitney U tests. In total, 11 508 metformin initiators were included (50.1% women). The most common transition after initiation was a dose increase (probability women 0.52, men 0.59, no significant difference). Women were more likely than men to switch to any other non-insulin hypoglycemic agent after initiation (aHR 1.66; 95% CI 1.31-2.12), after dose increase (aHR 1.48; 95% CI 1.10-1.98) and after dose decrease (aHR 2.64; 95% CI 1.28-5.46). Time to intensification was longer, time to switching was shorter, and HbA1c levels at initiation and intensification were lower for women than men. Sex disparities were observed in treatment transitions after metformin initiation. Women more often switched treatment than men, which suggest that prescribers acknowledge more tolerance or other problems for metformin in women. Men intensified treatment earlier and at higher HbA1c levels, indicative of a higher need for treatment intensification.

Prevalence and Risk Factors for Iron Deficiency Anemia among Children under Five and Women of Reproductive Age in Pakistan: Findings from the National Nutrition Survey 2018.

Anemia remains a global public health problem, especially in developing countries. It affects primarily children under five (CU5), women of reproductive age (WRA), and pregnant women due to their higher need for iron. The most common form of anemia is iron-deficiency anemia (IDA). IDA is estimated to cause half of all anemia cases and one million deaths per year worldwide. However, there remains a lack of well-documented and biochemically assessed prevalence of IDA based on the representative population-based samples globally and regionally. In this study, we aimed to assess the National Nutrition Survey (NNS) 2018 to identify the prevalence and risk factors of IDA in Pakistani CU5 and WRA. Secondary analysis was conducted on the NNS 2018, a cross-sectional survey, which collected data on dietary practices, malnutrition, and food insecurity. Anemia was defined as hemoglobin levels < 11.0 g/dL in children and 12.0 g/dL in women. IDA was defined as low hemoglobin and low ferritin (<12 ng/mL) levels, adjusted for inflammation using AGP and CRP biomarkers in CU5 and WRA. Univariate and multivariable logistic regressions were conducted using Stata statistical software (version 16). We also compared the IDA rates of NNS 2018 and 2011. A total of 17,814 CU5 and 22,114 WRA were included in the analysis. Of the CU5, 28.9% had IDA, while 18.4% of WRA reported to experience IDA. Among the CU5, IDA was most prevalent among male children aged 6-23 months living in rural areas and with the presence of diarrhea and fevers in the last 2 weeks. Children whose mothers had no education, were aged 20-34 years, and employed, had a higher prevalence of IDA. Married WRA, who are employed, living in rural areas, and with no education, had a higher prevalence of IDA. In the multivariable logistic regression, children aged 6-23 months (AOR = 1.19, 95% CI [1.08-1.33], p < 0.001) and with the presence of diarrhea in the last 2 weeks (AOR = 1.32, 95% CI [1.13-1.54], p < 0.001) or fever (AOR = 1.16, 95% CI [1.02-1.32], p = 0.02) had higher odds of IDA. At the household level, the odds of IDA among CU5 were higher in the poorest households (AOR = 1.27, 95% CI [1.08-1.50], p = 0.005), with ≥5 CU5 (AOR = 1.99, 95% CI [1.28-3.11], p = 0.002), and with no access to improved sanitation facilities (AOR = 1.17, 95% CI [1.02-1.34], p = 0.026). For WRA, the multivariable logistic regression found that the odds of IDA were higher among women with vitamin A deficiency (Severe: AOR = 1.26, 95% CI [1.05-1.52], p = 0.013; Mild: AOR = 1.36, 95% CI [1.23-1.51], p < 0.001), zinc deficiency (AOR = 1.42, 95% CI [1.28-1.57], p < 0.001), no education (AOR = 1.53, 95% CI [1.30-1.81], p < 0.001), and from severely food insecure households (AOR = 1.20, 95% CI [1.07-1.34], p = 0.001). The odds of IDA were lower among women whose body mass index was overweight (AOR = 0.77, 95% CI [0.69-0.86], p < 0.001) or obese (AOR = 0.71, 95% CI [0.62-0.81], p < 0.001). The child's age, presence of diarrhea or fever, place of residence, household size, wealth status, and access to sanitation facilities were significantly associated with IDA among CU5 in Pakistan. For WRA, education, body mass index, vitamin A and zinc status, household food security status, wealth status, and access to sanitation facilities were significantly associated with IDA. Large, well-established, government-funded programmes focused on micronutrient supplementation, food fortification, the diversification of food supplies, and the treatment and prevention of infectious and parasitic diseases are needed to prevent IDA and all forms of anemia among children and women in Pakistan.

Materialism predicts burnout through the basic needs: individual-level and within-person longitudinal evidence

ABSTRACT Workplace burnout has strong negative consequences for both workers and organisations. Following Self-determination theory (SDT), we hypothesised that workplace materialism – the relative importance given to extrinsic (fame, money, image) versus intrinsic (relationships, pro-sociality, self-development) work goals – is a key antecedent of burnout. The relationship between work goals and burnout is expected to be mediated by lower satisfaction and higher frustration of basic psychological needs for autonomy, competence and relatedness. Extending previous correlational evidence, we tested the prospective relationships among these constructs using a three-wave longitudinal design among a large sample of Chilean workers (N = 1841). Both individual-level (cross-lagged panel model) and within-person (trait-state-occasion model) longitudinal analyses supported that materialism predicted subsequent levels of burnout through higher need frustration. Need satisfaction did not predict subsequent burnout in either analysis. Additionally, we found that burnout predicted subsequent need frustration, suggesting a dangerous reciprocal relationship between both constructs. Our findings support SDT and highlight the potential risks of emphasising materialism in organisational settings. Indeed, contrary to common organisational practices, our findings suggest that burnout can be reduced by lowering the importance of extrinsic goals, fostering intrinsic goals, and building working environments to avoid frustrating basic psychological needs.

A pragmatic digital health informatics based approach for aiding clinical prioritisation and reducing backlog of care: A study in cohort of 4022 people with diabetes

Background and aimsThe backlog of care in resource stretched healthcare systems requires innovative approaches to aid clinical prioritisation. Our aim was to develop an informatics tool to identify and prioritise people with diabetes who are likely to deteriorate whilst awaiting an appointment to optimise clinical outcomes and resources. Materials and methodsUsing data from electronic health care records we identified 6 risk-factors that could be addressed in 4022 people (52% male, 30% non-Caucasian) with diabetes attending a large university hospital in London. The risk-factors were new clinical events/data occurring since their last routine clinic visit. To validate and compare data-led prioritisation tool to a traditional ‘clinical approach’ a sample of 450 patients were evaluated. ResultsOf the 4022 people, 549 (13.6%) were identified as having one or more risk events/factors. People with risk were more likely to be non-Caucasian and had greater socio-economic deprivation. Taking clinical prioritisation as the gold standard, informatics tool identified high risk patients with a sensitivity of 83% and lower risk patients with a specificity of 81%. An operational pilot pathway over 3 months using this approach demonstrated in 101 high risk people that 40% received interventions/care optimisation to prevent deterioration in health. ConclusionA pragmatic data-driven method identifies people with diabetes at highest need for clinical prioritisation within restricted resources. Health informatics systems such as our can enhance care and improve operational efficiency and better healthcare delivery for people with diabetes.