Physiological Research Articles

The influence of internet sources on the patient's trust in the doctor (based on a survey of doctors and patients in the Nizhny Novgorod region)

BACKGROUND: Modern society is characterized by a tendency of a sharp increase in the influence of Internet sources on the interaction of subjects of the social institute of medicine. AIM: to assess the degree of influence of Internet sources on the patient's trust in the doctor. METHODS: The study was conducted in medical organizations of the Nizhny Novgorod region by means of a questionnaire survey of patients and doctors using author's questionnaires. The study involved 521 patients and 240 doctors. RESULTS: 32.3±2.1% of respondents almost never search for and recheck a diagnosis and doctor's appointments in Internet sources, and 32.5±2.1% do this rarely, 25.9±1.9% search for a diagnosis on Internet sites and recheck doctor's appointments from time to time, and only 9.2±1.2% do it all the time. At the same time, 82.8 ± 1.6% of patients declared priority trust in the doctor, rather than recommendations received on Internet sites. 61.5±3.1% of doctors from time to time face the fact that patients have a clear opinion about their diagnosis obtained from Internet sources, 15.0±2.3% of doctors face this constantly, 17.5±2.5% of doctors rarely, and only 6.0±1.5% of doctors never face it. 51.7±3.2% of the surveyed doctors do not feel well about the fact that patients double-check the criteria for diagnosis and doctor's appointment on Internet sites, 24.9±2.3% support the activity of patients and the study of information about their disease, and 23.4±2.7% are indifferent to such a phenomenon. According to 87.8±2.1% of doctors, patients trust information received from a doctor more than online sources. CONCLUSION: According to the results of the study, 67.6±2.1% of patients access Internet sites in order to verify the correctness of medical opinions, but at the same time, according to 82.8± 1.6% of patients and 87.8±2.1% of doctors, information received from a doctor is of priority importance for patients, compared with the Internet sources.

Comparing the Quality of Direct-to-Consumer Telemedicine Dominated and Delivered by Public and Private Sector Platforms in China: Standardized Patient Study.

Telemedicine is expanding rapidly, with public direct-to-consumer (DTC) telemedicine representing 70% of the market. A key priority is establishing clear quality distinctions between the public and private sectors. No studies have directly compared the quality of DTC telemedicine in the public and private sectors using objective evaluation methods. Using a standardized patient (SP) approach, this study aimed to compare the quality of DTC telemedicine provided by China's public and private sectors. We recruited 10 SPs presenting fixed cases (urticaria and childhood diarrhea), with 594 interactions between them and physicians. The SPs evaluated various aspects of the quality of care, effectiveness, safety, patient-centeredness (PCC), efficiency, and timeliness using the Institute of Medicine (IOM) quality framework. Ordinary least-squares (OLS) regression models with fixed effects were used for continuous variables, while logistic regression models with fixed effects were used for categorical variables. Significant quality differences were observed between public and private DTC telemedicine. Physicians from private platforms were significantly more likely to adhere to clinical checklists (adjusted β 15.22, P<.001); provide an accurate diagnosis (adjusted odds ratio [OR] 3.85, P<.001), an appropriate prescription (adjusted OR 3.87, P<.001), and lifestyle modification advice (adjusted OR 6.82, P<.001); ensure more PCC (adjusted β 3.34, P<.001); and spend more time with SPs (adjusted β 839.70, P<.001), with more responses (adjusted β 1.33, P=.001) and more words (adjusted β 50.93, P=.009). However, SPs on private platforms waited longer for the first response (adjusted β 505.87, P=.001) and each response (adjusted β 168.33, P=.04) and paid more for the average visit (adjusted β 40.03, P<.001). There is significant quality inequality in different DTC telemedicine platforms. Private physicians might provide a higher quality of service regarding effectiveness and safety, PCC, and response times and words. However, private platforms have longer wait times for their first response, as well as higher costs. Refining online reviews, establishing standardized norms and pricing, enhancing the performance evaluation mechanism for public DTC telemedicine, and imposing stricter limitations on the first response time for private physicians should be considered practical approaches to optimizing the management of DTC telemedicine.

Assessing the knowledge, attitude and practice of electronic cigarettes and their associated factors among undergraduate students of Institute of Medicine, Nepal: a cross-sectional study.

Electronic cigarettes (e-cigarettes) are gaining popularity globally and becoming popular among young people, including in Nepal. Easy accessibility, appealing ads, and the misconception that e-cigarettes are safer than traditional cigarettes have fueled their rising popularity among university students in Nepal. The lack of comprehensive data on the prevalence and determinants of e-cigarette use among university students in Nepal underscores the urgent need for targeted research in this area. This study aimed to examine the knowledge, attitudes, and practices regarding e-cigarettes, as well as their influencing factors, among undergraduate students at the Institute of Medicine in Kathmandu, Nepal. We conducted a cross-sectional study with 302 undergraduate students. A self-administered questionnaire assessed their knowledge, attitudes, and practices related to e-cigarettes. Descriptive statistics were reported, and chi-square tests and multivariate logistic regression analyses were performed to determine the statistical association among variables using STATA 14. The mean age of participants was 21.4 ± 2.1 years. Of the 302 respondents, 214 (70.9%) had heard of e-cigarettes. Among them, 71.5% had good knowledge, 62.2% held supportive attitudes, and 79.0% had never used e-cigarettes. Males were more likely to smoke e-cigarettes than females (AOR: 2.27; 95% CI: 1.01-5.01; p = 0.046). Students with friends who smoke were nearly three times more likely to use e-cigarettes (AOR: 3.00; 95% CI: 1.12-7.99; p = 0.028). Supportive attitudes towards e-cigarettes also doubled the likelihood of smoking them (AOR: 2.10; 95% CI: 1.02-4.35; p = 0.045). The study highlights important implications for interventions, policy, and education within Nepal's medical system. With a notable percentage of students holding supportive attitudes toward e-cigarettes, there is a clear need for targeted behavior change campaigns that educate about the health risks associated with e-cigarettes.

Management of opioid use disorder: 2024 update to the national clinical practice guideline.

In an evolving landscape of practices and policies, reviewing and incorporating the latest scientific evidence is necessary to ensure optimal clinical management for people with opioid use disorder. We provide a synopsis of the 2024 update of the 2018 National Guideline for the Clinical Management of Opioid Use Disorder, from the Canadian Research Initiative in Substance Matters. For this update, we followed the United States Institute of Medicine's Standards for Developing Trustworthy Clinical Practice Guidelines and used the Appraisal of Guidelines Research and Evaluation-Recommendation Excellence tool to ensure guideline quality. We carried out a comprehensive systematic literature review, capturing the relevant literature from Jan. 1, 2017, to Sept. 14, 2023. We drafted and graded recommendations according to the Grading of Recommendations, Assessments, Development and Evaluation approach. A multidisciplinary external national committee, which included people with living or lived experience of opioid use disorder, provided input that was incorporated into the guideline. From the initial 11 recommendations in the 2018 guideline, 3 remained unchanged, and 8 were updated. Specifically, 4 recommendations were consolidated into a single revised recommendation; 1 recommendation was split into 2; another recommendation was moved to become a special consideration; and 2 recommendations were revised. Key changes have arisen from substantial evidence supporting that methadone and buprenorphine are similarly effective, particularly in reducing opioid use and adverse events, and both are now considered preferred first-line treatment options. Slow-release oral morphine is recommended as a second-line option. Psychosocial interventions can be offered as adjunctive treatment but should not be mandatory. The guideline reaffirms the importance of avoiding withdrawal management as a standalone intervention and of incorporating evidence-based harm reduction services along the continuum of care. This guideline update presents new recommendations based on the latest literature for standardized management of opioid use disorder. The aim is to establish a robust foundation upon which provincial and territorial bodies can develop guidance for optimal care.

Relationship between Myocardial Performance Index (Tei Index) and angiographic severity of coronary artery disease in patients with Acute ST Elevation Myocardial Infarction

Background: Tei index is a Doppler derived measure of combined systolic and diastolic myocardial function and a better predictor of global LV function and outcome in patients with acute STEMI. The objective of this study was to determine the relationship between the myocardial performance index of LV (Tei index) and angiographic severity of coronary artery disease as assessed by SYNTAX score in patients with acute STEMI. Methods: This was a prospective, observational single centered study conducted from March 2022 to November 2022 at Manmohan Cardiothoracic Vascular and Transplant Centre, Institute of Medicine. (MCVTC, IOM). 160 patients with acute STEMI were enrolled. LV Tei index was calculated with the help of 2D and Tissue Doppler imaging, and the lesion severity was categorized with the help of SYNTAX score after the patients underwent coronary angiography. Results: The mean age was 61.23±12.33 years with a male preponderance. 107 (67%) were male with male to female ratio of 2:1. Tei index was significantly higher among the hypertensive (0.74±0.17) and diabetic (0.78±0.18) patients. 64 (40%), 51(31.9%) and 45(28.1%) had Single vessel disease (SVD), Double vessel disease (DVD) and Triple vessel disease (TVD) respectively with the Mean Tei index values 0.57 ± 0.10, 0.76 ± 0.11, and 0.88±0.11 (p&lt;0.05). The Tei index increased when patients were divided into low, mid, and high SYNTAX score groups as 0.58±0.11, 0.61±0.73, 0.88±0.13 respectively, p-value &lt; 0.05). Moreover, the study showed a positive correlation between Tei index and SYNTAX score with increasing severity of coronary artery stenosis. (r=0.654, p-value&lt;0.001). Proximal LAD, LCx and RCA lesions had greater Tei index than the distal lesions. Conclusion: More proximally located LAD, LCx, RCA lesions had higher value of Tei index, as assessed with the SYNTAX score.

The early COVID-19 pandemic period and associated gestational weight gain.

The aim of this study was to investigate if gestational weight gain was altered during the early COVID-19 pandemic period. This a retrospective cohort study evaluating gestational weight gain among individuals delivering during the early COVID-19 pandemic epoch (March 10-December 31,2020) compared to temporally matched pre-pandemic (matched months in 2018 and 2019) controls using electronic medical record data from a large tertiary care hospital. The primary outcome was gestational weight gain defined as a categorical measure representing below, meeting, or above Institute of Medicine (IOM) criteria with further adjustment for gestational age at delivery. The early-pandemic exposure group was also categorized by gestational age at the start period (<14weeks' and 14-20weeks') to assess if duration of exposure affected gestational weight gain risks with the use of multinominal logistic regression. Among 5,377 individuals 3,619 (67.3 %) and 1,758 (32.7 %) were in the pre and early pandemic epochs respectively. Overall, 934 (17.4 %) individuals gained below recommended, 1,280 (23.8 %) met recommendations, and 3,163 (58.8 %) gained above IOM recommended gestational weight gain. Compared to the pre-pandemic epoch, the early pandemic period was not associated with weight gain below (OR 1.06, 95 % Cl 0.89-1.27) or above (OR 1.03, 95 % Cl 0.89-1.19) IOM recommendations. This was also true when the early pandemic group was stratified based on gestational age at the start of the early pandemic period (<14weeks' and 14-20weeks'). This study demonstrated no significant difference in maternal weight gain between pre and early COVID-19 pandemic periods.

The formation of the idea of patient agency at the institute of medicine

This article is devoted to the topic of patient agency. The aim of this work is to consider the process of formation of the idea of patient agency at the Institute of Medicine. The author of this article, starting the consideration with the concept of the «patient role», authored by the famous American sociologist T. Parsons, shows the trend observed since the second half of the 20th century to move away from the paternalistic model of the «doctor-patient» relationship that was dominant at that time. The article examines the works of such modern researchers as A. Bock. E. Deffos, P.S. Sorokin, A.V. Zykova et al. It is noted that interest in the issue of agency in general and in the agency of patients in particular has increased during the coronavirus pandemic. The emergence of patient agency in recent years has also been facilitated by digital technologies, which began to be used in medicine thanks to the so-called «digital revolution», which, according to researchers, the pandemic has only accelerated. For example, telemedicine and various websites where patients can find the necessary information have begun to actively develop. At the same time, the very concept of agency today does not have an established meaning in scientific circles; there are heated discussions around this concept; the topic of patient agency is promising for research and needs further study.

Vitamin C intake, psychological distress and health outcomes in patients with heart failure

Abstract Background Patients with heart failure (HF) have lower dietary vitamin C intake than healthy adults, which may increase oxidative stress and worsen important patient-reported health outcomes (functional status and quality of life [QOL]). Patients with HF are more likely to have higher levels of psychological distress (anxiety and depressive symptoms). However, it is not known whether psychological distress is a link in the association of dietary vitamin C with health outcomes. Objective To examine the inter-relationships among dietary vitamin C intake, psychological distress (anxiety and depressive symptoms), and health outcomes (functional status and QOL) in patients with HF. Method We performed a secondary analysis of baseline data from 206 adults with HF (female: 33%, age: 61±12, NYHA class III/IV: 44%) with complete data on dietary vitamin C intake, anxiety, depressive symptoms, functional status, and QOL. Dietary vitamin C intake was assessed using a 4-day food diary and analyzed using the Nutrition Data System for Research software program. Low dietary vitamin C intake was defined as averaged daily intake below the estimated average requirement (EAR) from the Institute of Medicine of 75 mg/day for men and 60 mg/day for women. Anxiety was assessed using the Brief Symptom Inventory Anxiety subscale. Depressive symptoms were assessed using the Beck Depression Inventory II. Functional status was measured using the Duke Activity Status Index. Quality of life was measured using the Minnesota Living with Heart Failure Questionnaire. Linear regression was conducted using the PROCESS macro in SPSS. Results Eighty-four patients (41%) had low dietary vitamin C intake based on the EAR standard. In bivariate analyses, patients with low dietary vitamin C intake had higher levels of anxiety, depressive symptoms, poorer functional status, and worse QOL (all p &amp;lt;.005). In the mediation regression model, low dietary vitamin C intake was directly associated with higher levels of anxiety, but not with depressive symptoms. Depressive symptoms were directly associated with functional status and QOL. Dietary vitamin C intake was not directly associated with functional status or QOL. Low dietary vitamin C intake was indirectly associated with poor functional status through higher levels of anxiety and depressive symptoms (Figure 1). Similarly, low dietary vitamin C intake was indirectly associated with worse QOL (Figure 2). Conclusion Anxiety and depressive symptoms link the relationship between dietary vitamin C intake and functional status and between dietary vitamin C intake and QOL. Our findings highlight the importance of including interventions to enhance diet quality and psychological well-being as part of HF treatment to improve health outcomes.Vitamin C and functional statusVitamin C and quality of life

AI-Enhanced Allergy Diagnostics: Streamlining Healthcare and Reducing Costs

Abstract Issue/Problem WHO projects a shortfall of 10 million health workers by 2030. One area particularly lacking technological support is allergy diagnostics. The World Allergy Organization recognizes skin tests as the gold standard for allergy diagnostics, yet these tests are still manually assessed. General practitioners lack the time and tools, leading them to focus on treating the symptoms without addressing the causes. Description of the problem Symptomatic treatment of allergy can lead to the development of asthma in 30-40% of patients, increasing healthcare costs and causing lost productivity. The shortage of allergists further exacerbates this issue in many countries. Results Research conducted by the Military Institute of Medicine in Warsaw, in collaboration with a company producing automated allergy testing systems, explored a solution for allergy diagnostics, analyzing the entire process from the patient’s initial visit to desensitization therapy. The solution uses AI algorithms to reusable existing patient data and analyze patient history, correlate symptoms, medications, and allergen exposure, streamlining diagnostics and treatment. Patients at high risk undergo a computer-assisted interview to determine allergen panels. The only manual step is applying allergens to the skin, after which AI performs the reading and diagnosis. Clinical trials involving around 300 patients demonstrated high sensitivity and specificity, along with significant time savings for allergists and other medical staff, averaging 40 minutes per patient. The HTA evidence base will be ready by the end of this year. Lessons The integration of this AI-supported diagnostic method can eliminate bottlenecks in allergy diagnostics, improving health outcomes and reducing healthcare costs. However, its effectiveness depends on having at least few years of patient treatment data available. Without access to patient data, the method can be used in part to objectify PRICK test readings. Key messages • AI-supported diagnostics streamline allergy testing, reducing time and costs in the healthcare system. • The most accurate technique currently available for the automated reading of test results is that which evaluates the response to an allergen in the dermis in two spectra.

Profile of Medico-legal Age Estimation Cases in a Tertiary Hospital in Kathmandu

Introduction: Medico-legal age estimation is the estimation of chronological age of an individual which is based upon analysis of physical development of the body, development of secondary sexual traits, tooth eruption, appearance of ossification centers of bones, and the degree of epiphyseal union. Chronological age of the subject whether a minor (less than 18 years) or an adult determines the fate of the case in the court of law. Objective: The present study revealed varied profiles of the perpetrator and the victim who came for medico-legal age estimation. Methods: This is a retrospective, descriptive cross-sectional study conducted in the Department of Forensic Medicine, Maharajgunj Medical Campus, Institute of Medicine (IoM). The data of medico-legal age estimation of 5 years period was analyzed using the statistical software SPSS 20. Results: Total of 313 individuals were studied. Majority of the individuals were within the age group of 16-17 years. Males (70.3 %) outnumbered females (29.7 %). Theft (31.9 %) was common among subjects, followed by sexual assault (18.2 %) and majority of subjects (59.7%) came from Province 3. Sixty percent of the subject’s alleged age, matched the estimated ages. Conclusion: This study shows the status of children in crime which demands attention of concerned authority. Males were significantly involved in theft and females were victims of sexual assault. Forty percent of the alleged age given by the subject differed from the estimated age, to change the fate of the case. These results could greatly benefit the judiciary system of Nepal.

Intestinal Parasites and Hematological Parameters in Children Living in Ambatoboeny District, Madagascar

Madagascar is one of the poorest countries in the world. The country’s extreme weather conditions, poor sanitation, and weak economy facilitate the spread of parasitic diseases. Infections with intestinal parasites are particularly dangerous for children because they can cause malnutrition and anemia, which, in turn, have a negative effect on children’s cognitive functions and physical development. The aim of the present study was to analyze the prevalence of intestinal parasites and to assess hematological parameters in a group of children living in northern Madagascar. The screening was conducted in May 2024 in the Clinique Medicale Beyzym in Manerinerina, the Ambatoboeny district. It involved a sample of 208 children aged 0–17 years. Single stool samples were collected from all study participants. The samples were fixed in SAF fixative and then transported from Africa to Europe for further diagnostics at the Department of Epidemiology and Tropical Medicine, the Military Institute of Medicine–the National Research Institute in Poland. First, the samples were analyzed by light microscopy methods using three different diagnostic techniques (direct smear, decantation with distilled water, and the Fülleborn method). Next, they were tested by molecular biology methods (real-time PCR). Blood samples for the assessment of hematological parameters were collected at the healthcare center in Madagascar. The prevalence of intestinal parasites in the study sample was 61.5%. Helminths were found in 15.2% of the investigated children, and Giardia intestinalis (20.5%) was found to be the most prevalent parasite in the study population. Most infections were caused by potentially pathogenic stramenopila Blastocystis spp. (32.0%). Mean Hb, HCT, MCV, MCH, and MCHC levels in the study participants were below normal values. However, no correlation was found between the presence of a parasitic infection and low hematological parameters, which are a clinical sign of anemia. High rates of infections with intestinal parasites in children living in northern Madagascar support the necessity to introduce long-term preventive measures, which would limit the spread of parasitic diseases in the Malagasy population. Low hematological parameters in non-infected children may be indicative of persistent malnutrition or infection with other parasites, e.g., malaria or schistosomiasis.

Racial biases in clinical practice and medical education: a scoping review

IntroductionHealth inequalities represent a major challenge in contemporary medicine, with some attributed to racial biases. Recently, in the United States, a call to combat discrimination in the field of health has resonated, particularly in the context of the COVID-19 crisis, in which minorities have been disproportionately affected. These calls echo recommendations from the Institute of Medicine dating back to 2001, urging the fight against inequalities in access to health care. In France, inequalities based on presumed origin persist, yet medical education on these issues is virtually nonexistent.Materials and MethodsWe conducted a scoping review literature review in accordance with the JBI recommendations for scoping review writing and applied the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist to explore existing conceptual and educational data on racial biases in medicine. The inclusion criteria were interventional studies or evaluations of existing educational programs in medical training addressing the fight against racial biases in clinical settings published in French or English between 2003 and 2023. Six databases were systematically consulted.ResultsOut of 748 initial studies, 28 were included in our study. The median number of participants in the studies was low, interventions were diverse, and participants were generally well received, most of whom were self-selected. No study has evaluated the clinical impact of these interventions. The highlighted concepts included levels of racism, cultural competence, cultural humility, and critical race theory.DiscussionThe authors most frequently referred to institutionalized racism, demonstrating the systemic nature of these issues. At an individual level, implicit and unconscious biases were most often emphasized. It appears that the concept of “race” is a sociopolitical construct without supporting biological determinants. Humility is central to this field of study, as it encourages questioning of individual or collective medical practices. In France, the context, including the prohibition of ethnic statistics, may hinder the objectification of discrimination. Immersion and virtual patient scenarios emerged as potential solutions for evaluating the clinical impact of interventions. A more horizontal medical pedagogy seems better suited to teach these sensitive issues.

Relationship between personal anxiety and genes associated with eating disorders in women aged 45-64

Aim. To study the possible relationship between personal anxiety and polymorphic variants of genes associated with eating disorders (rs17782313 MC4R, rs1800497 DRD2, rs9939609 FTO) in women aged 45-64 in Novosibirsk.Material and methods. A random representative sample of women aged 45-64 years (n=1074, mean age, 54,27±0,2 years) was examined in 2003-2005 at the Research Institute of Internal and Preventive Medicine, a branch of the Institute of Cytology and Genetics, within the Health, Alcohol and Psychosocial Factors In Eastern Europe (HAPIEE) project. Personal anxiety was assessed using the Spielberger self-assessment questionnaire included in the protocol of the Multinational Monitoring of Trends and Determinants of Cardiovascular Disease — Optional Psychosocial Study (MONICA-MOPSY), tested at screenings of the World Health Organization (WHO) MONICA program in 1983-1995. The sample for the HAPIEE program was formed at the program data processing center in Prague for each of the collaborating centers in such a way that each respondent was random. From the sample, every second woman (n=537) was selected for genotyping of the FTO rs9939609 variant (n=384); every third woman (n=358) — for genotyping the MC4R rs17782313 (n=279) and DRD2 rs1800497 variants (n=327). Genotyping was performed in the laboratory of molecular genetic studies by the polymerase chain reaction with the analysis of restriction fragment length polymorphism.Results. Among women aged 45-64, anxiety was detected in 58,3%, and in 15,9% of women the anxiety level was high. The homozygous genotype C/C rs17782313 of the MC4R gene was more common among women with high anxiety levels (17,5%) than among women with low and moderate anxiety levels (1,8 and 0,8%, respectively; p=0,001). There were no significant differences in the detection rate of the rs1800497 genotypes of the DRD2 gene among women with different levels of anxiety (p&gt;0,05). The frequency of the A/A rs9939609 genotype of the FTO gene was highest among women with high anxiety levels — 29,5%, compared to participants with low and moderate anxiety levels (15 and 15,3%, respectively; p=0,048). The probability of anxiety among carriers of the C/C+C/T genotypes of the MC4R gene was 1,29 times higher than among carriers of the T/T genotype (p=0,001). Among carriers of the A/A rs9939609 genotype of the FTO gene, the anxiety probability was 2,34 times higher than among carriers of the A/T+T/T genotypes (p=0,008).Conclusion. The association between anxiety and genes of eating disorders dictates the need for diagnosis and subsequent treatment of anxiety and its associated consequences.

Preeclampsia Risk in Bali, Indonesia: The Role of Maternal Body Mass Index (BMI) and Gestational Weight Gain (GWG)

Background: Preeclampsia, a hypertensive disorder of pregnancy, significantly contributes to maternal and infant mortality and morbidity globally, including in Indonesia. Pre-pregnancy obesity and excessive gestational weight gain (GWG) are established risk factors for preeclampsia. This study investigated the association between pre-pregnancy body mass index (BMI) and GWG with the incidence of preeclampsia in Bali, Indonesia. Methods: A case-control study was conducted at a Maternal Hospital in Bali, Indonesia, from May 2023 to May 2024. The study included 429 pregnant women: 143 with preeclampsia (cases) and 286 without (controls). Data were collected from medical records. BMI was categorized using Asia-Pacific criteria, and GWG was assessed based on the 2009 Institute of Medicine (IOM) guidelines. Logistic regression analysis was performed to determine the associations, adjusting for maternal age, education, and occupation. Results: Obesity class II (BMI ≥ 30 kg/m²) and obesity class I (BMI 25.0-29.9 kg/m²) were significantly associated with an increased risk of preeclampsia, with adjusted odds ratios (AOR) of 2.90 (95% CI: 1.19-7.08) and 2.78 (95% CI: 1.60-4.81), respectively, compared to women with normal weight. Excessive GWG was also significantly associated with preeclampsia (AOR 2.53; 95% CI: 1.48-4.33) compared to adequate GWG. Conclusion: Maternal obesity and excessive GWG are significant risk factors for preeclampsia in Bali, Indonesia. These findings underscore the importance of pre-pregnancy counseling and interventions to manage weight and promote healthy GWG to reduce the burden of preeclampsia.

Estimation of the Effective Radiation Dose in Nuclear Medicine Workers from Dhaka by Measuring Radioactivity in Urine Sample Resulting from Internal Exposure

This study estimates the effective doses and activity concentration from 151 urine samples which are collected from 15 (Fifteen) occupational workers at National Institute of Nuclear Medicine and Allied Science (NINMAS) in Dhaka, Bangladesh. The radioactivity concentration in urine sample is due to intake of I-131, Tc-99m and F-18. The samples have been analyzed using High Purity Germanium (HPGe) detector. The radioactivity of I-131 and Tc-99m was found 0.91 ± 0.26 BqL-1 to 504.49 ± 6.03 BqL-1 and 0.15 ± 0.21 BqL-1 to 191.19 ± 6.98 BqL-1 respectively. Radioactivity of F-18 was found from 0.031 ± 0.022 BqL-1 to 0.282 ± 0.065 BqL-1. The effective doses of occupational workers have been also calculated using the radioactivity concentration and the dose coefficient according to ICRP publication 78. Jagannath University Journal of Science, Volume 11, Number 1, June 2024, pp. 64−80

When end of treatment situations challenge patient-centered care: a discussion paper proposing new theoretical insights.

According to the Institute of Medicine patient-centered medicine is one of the six crucial dimensions of health care quality. Although the patient-centered care model is widely recognized for its ethical underpinnings and effectiveness, its practical implementation still raises challenges, especially in end-of-treatment situations. This discussion paper offers an overview of the challenges facing the physician-patient relationship in end-of-treatment situations. We developed three clinical vignettes and made some theoretical considerations about ethical issues related to the decision-making process leading to the end of treatment. We identified two main challenges that end-of-treatment situations pose to patient-centered care: (1) when the patient's autonomy challenges the best clinical treatment; and (2) when the proposed treatment (discontinuation of treatment) challenges the patient's preferences. Patient-centered care supports personalized decision-making, in which the physician's approach varies according to the patient's situation and individuality. The idea of beneficence may change during care, because of acceptance of the patient's principles or a change in the primary goal of care.

Identifying potential outcomes of patient engagement in primary care quality improvement: a modified Delphi study.

A barrier to dedicating resources towards patient engagement in primary care quality improvement is the lack of clearly identified outcomes that might result from these initiatives. We sought to identify these potential outcomes at three healthcare levels as defined by the Institute of Medicine: 1) Micro/Direct Care; 2) Meso/Microsystem; and 3) Macro/Clinic/System using a Modified Delphi technique. Two focus groups of patients and primary care clinician leaders generated a first set of outcomes. These outcomes were then vetted and expanded through three web-based surveys sent to twelve national experts. Experts indicated the level of agreement with prior elicited outcomes and generated potential new outcomes. Included outcomes achieved at least 80% agreement. The final list of 46 consensus-derived outcomes was categorized across levels. 22 were at the Micro-level, 9 were at the Meso-level, and 15 were at the Macro-level. Our findings suggest outcomes across all health system levels have the potential for progress when patients are engaged in primary care quality improvement initiatives. Future programs should consider validating and measuring these outcomes as part of their interventions.

Clinical course of atrial fibrillation in patients who experienced coronavirus disease (COVID-19): results of a 6-month follow-up

Atrial fibrillation (AF) is the most common extrapulmonary complication of the past SARS-CoV-2 infection. According to experts, almost 20% of patients with past COVID-19 have a history of atrial fibrillation and the incidence of new paroxysms of this arrhythmia ranges from 10 to 18%. Referring to the studied patients who experienced COVID-19 more than 6 months ago, the subjective perception of cardiac arrhythmia is the most frequent complaint, reported by approximately two-thirds of patients. The aim of our study was to determine the course of atrial fibrillation in patients after past 2019 coronavirus disease (COVID-19) during a dynamic 6-month follow-up after the initial hospitalization for atrial fibrillation in the specialized department of cardiac arrhythmias of the SI “National Scientific Center” “M.D. Strazhesko Institute of cardiology, clinical and regenerative medicine of the National Academy of Medical Sciences of Ukraine” depending on the clinical and anamnestic, demo­graphic, anthropometric factors, the results of laboratory research methods and the received treatment. 36 patients were included in the study, 27 of them formed the first group, which included patients in whom the course of atrial fibrillation improved against the background of recommended antiarrhythmic treatment after initial hospitalization for AF and past COVID-19, who at the time of hospitalization had a negative PCR test, of which 17 were women and 10 were men, aged 62.38±1.83 years. The second group consisted of 9 patients including 4 women and 5 men, aged 69.88±2.60 years in whom the course of atrial fibrillation neither changed nor worsened. We determined that the number of patients in whom the course of atrial fibrillation improved during the 6-month follow-up was three times greater than those in whom the course of this arrhythmia neither changed nor worsened (75% and 25%, respectively). Patients with a more favorable course of atrial fibrillation were younger (on average by 7.5 years), three times less likely to suffer from diabetes and not often had arterial hypertension of the III stage, than those examined, in whom the course of this arrhythmia did not change or worsen. Systemic inflammation and severity of heart failure significantly worsen the course of AF within 6 months after the hospital stage of treatment. However signs of deterioration of lipid metabolism are characteristic of patients with an unfavorable course of atrial fibrillation during 6 months after hospitalization, which is probably caused by the activation of systemic inflammation in them. The improvement of the prognosis of the examined patients was probably influenced by the appointment of antiarrhythmic drugs, such as: amiodarone, flecainide, beta-blockers, statins – from the "up-stream" therapy drugs.

Research Institute of Internal and Preventive Medicine, Branch of the Institute of Cytology and Genetics, Siberian Branch, Russian Academy of Sciences

The purpose of the study was to evaluate the clinical manifestations of osteoarthritis (OA) in combination with MS (OAMS) and their relationship with concentration of several circulating proinflammatory cytokines, the level of lipids in peripheral blood serum. Forty women patients with knee OA were examined: 19 patients from the experimental group in whom OA was combined with metabolic syndrome (MS), 21 patients with OA without MetS. All patients were elderly and overweight. In the first subgroup of patients, the absolute majority of people were obese, while in the second subgroup, overweight patients predominated. Patients in the experimental subgroup showed a statistically significant increase in waist circumference compared to patients without MS. The duration of OA did not differ in both subgroups. It has been established that the metabolic phenotype of gonarthrosis – OA in combination with metabolic syndrome – differs from patients with OA without MS in greater severity of pain, a decrease in the level of daily activity, an increase in the burden of the disease and other symptoms of OA. These core characteristics are associated with poor quality of life and clinically significant symptoms of depression. The metabolic type of gonarthrosis is characterized by more pronounced laboratory signs of systemic low-grade inflammation in comparison with patients without MS, as evidenced by a threefold increase in CRP content and an increase in the level of IL-6, IL-18 in PC serum. In addition, in patients with the metabolic phenotype of OA, a fivefold increase in the level of a specific humoral immune response to type 2 collagen (Col2Ab) and dyslipidemia – an increase in the content of LDL cholesterol and triglycerides, with a comparable reduced level of HDL cholesterol – were revealed. It is concluded that the phenotype of OA in combination with MS is probably due to the pathogenetic similarity of OA and MS (syntropy), which is based on low-grade inflammation. Studying the pathogenesis of the OAMS phenotype and developing new principles for the treatment of multimorbidity should be based on patient-oriented approaches.

Measuring Nurses' Knowledge and Awareness of Climate Change and Climate-Associated Diseases: Systematic Review of Existing Instruments.

As early as 1995, the Institute of Medicine suggested that nurses were inadequately prepared for and educated about climate change and its health consequences. The aim of this systematic review is to identify the most reliable, robust, and valid instruments for measuring nurses' knowledge and awareness of climate change and climate-associated diseases. Included studies were appraised using the Mixed-Methods Appraisal Tool and the Appraisal tool for Cross-Sectional Studies. The psychometrics and clinimetrics of the instruments were evaluated using the COSMIN Risk of Bias checklist and the COSMIN methodology for assessing content validity. Medline, PubMed, Embase, CINAHL Ebesco, Cochrane Library Wiley, Web of Science Core Collection, Trip Database, JBI OVID SP, GreenFILE EBSCO, Google Scholar, ProQuest Dissertations and Theses Global, and DART-EU were consulted. The 14 studies retained identified eight different instruments evaluating attitudes, perceptions, environmental awareness, environmental sensitivity, environmental attitudes, behaviours, motivation, concern, optimism, and experience. This review is reported according to the PRISMA guidelines. The New Ecological Paradigm Scale (NEPS) and the Climate, Health, and Nursing Tool (CHANT) are the most reliable, robust, and valid instruments for measuring nurses' knowledge and awareness of climate change and climate-associated diseases.