Short-term Benefits Research Articles

Effect of pulmonary rehabilitation on all-cause mortality in patients with chronic respiratory disease: a retrospective cohort study in an Australian teaching hospital

BackgroundPulmonary rehabilitation (PR) is widely recommended for short-term benefits in chronic respiratory diseases, yet long-term outcomes remain uncertain. This retrospective cohort study addresses this gap, comparing 20-year mortality rates between PR participants and matched controls, and hypothesizing that the short-term benefits of PR contribute to improved long-term survival.MethodsThe 20-year mortality of stable chronic respiratory patients who participated in an outpatient PR program was compared with a matched control group based on the type of lung disease. Demographic and clinical variables, and the dates of deaths, were extracted and compared between two groups with two sample t-test and chi-square tests. Kaplan-Meier plots and Cox regression analyses were employed to evaluate survival differences.ResultsBetween 2000 and 2002, 238 individuals enrolled in a pulmonary rehabilitation (PR) program (58% male, mean age ± SD: 69 ± 8 years, mean FEV1% predicted ± SD: 46 ± 21%). An equal number of people with comparable lung disease were selected as controls (88% COPD, 5% ILD). Controls had lower FEV1% predicted values (mean ± SD: 39 ± 17%, P < 0.001), smoked more (mean ± SD: 48 ± 35 pack-years, P = 0.032), and no differences in age, BMI, sex, and Index of Relative Socio-economic Advantage and Disadvantage (IRSAD). Median (IQR) follow-up time was 68 months (34–123), with 371 (78%) deaths. Univariable (HR = 1.71, p < 0.001) and multivariable (HR = 1.64, p < 0.001) Cox regression found higher mortality risk in controls. Subgroup analysis for COPD replicated these findings (HR = 1.70, P < 0.001).DiscussionDespite some methodological limitations, our study suggests that clinically stable patients with chronic respiratory disease who undertake PR may have lower mortality than matched controls.Trial registrationRetrospectively registered.

Cost-Effectiveness of GaitSmart and an Artificial Intelligence Solution for Rehabilitation of Patients Undergoing Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA) in Older Population in the United Kingdom.

GaitSmart (GS) is a sensor-based digital medical device that can be used with the integrated app vGym to provide a personalised rehabilitation programme for older people undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA). This study aimed to determine whether the GS intervention used in the rehabilitation of older people undergoing THA or TKA is potentially cost-effective compared to the current standard of care (SoC). Decision-analytic modelling was conducted to estimate the cost-effectiveness over a seventeen-week time horizon from an NHS perspective. UK clinical and cost data from the GaitSmart randomised clinical trial was used to obtain the input parameters, and a sensitivity analysis was performed to address uncertainties. Over a seventeen-week time horizon, GS incurred cost savings of GBP 450.56 and a 0.02 gain in quality-adjusted life years (QALYs) compared to the SoC. These results indicate that GS is the dominant intervention because the device demonstrated greater effectiveness and lower costs. Probabilistic sensitivity analyses confirm the robustness of our results. GS appears to offer short-term efficiency benefits and demonstrates cost-effectiveness for the improvement in gait in people undergoing THA or TKA, compared to the SoC.

7427 Cellular Senescence As A Pro-Tumorigenic Process And Therapeutic Target In Adrenocortical Carcinoma

Abstract Disclosure: L. Smith: None. K. Warde: None. S. Haston: None. J. Martinez-Barbera: None. K. Basham: None. Adrenocortical carcinoma (ACC) is a rare, yet highly aggressive malignancy that arises in the adrenal cortex. Advanced age is a major risk factor for ACC, with the peak age incidence between 50 and 60 years old. Older individuals above age 50 also have significantly worse survival outcomes. A better understanding of how aging contributes to the development and progression of ACC will uncover new treatment strategies. A major hallmark of aging is the systemic accumulation of senescent cells. While senescent cells have been implicated in various age-related diseases, including cancer, their role in ACC remains poorly understood. ACC tumors from older patients have an enrichment of senescence-associated gene signatures. Moreover, advanced ACC patients are treated with etoposide, doxorubicin, and cisplatin (EDP), which are chemotherapies that induce senescence. While EDP offers short-term benefit in some patients, more than half will progress within 6-months. We hypothesize that the accumulation of senescent cells that arise after EDP treatment are ultimately tumor-supportive long-term. As a result, we postulate that the use of senolytic compounds that clear away senescent cells after EDP treatment will lead to improved survival outcomes for ACC patients. We developed a new ACC mouse model that provides a window to study the role of senescence in ACC tumor progression and treatment. Our model is based on adrenal specific loss of ZNRF3, which is a Wnt inhibitor that is frequently inactivated in human ACC tumors. Despite early adrenal hyperplasia, we showed that Znrf3 conditional knockout (cKO) mice do not develop adrenal tumors until 18-months of age, which corresponds to the peak age incidence in humans. Additionally, the adrenals of Znrf3 cKO mice show a robust senescence activation phenotype that precedes adrenal tumorigenesis. We hypothesize that the accumulation of senescent cells is pro-tumorigenic long-term. To test our hypothesis, we combined Znrf3 cKO mice with a newly established mouse model that enables selective ablation of senescent cells (ZKO-FDR mice). Ongoing aging studies will determine whether the removal of early and late senescent cells in ZKO-FDR mice reduces adrenal tumorigenesis. Further, we established new primary tumor cell lines from aged ZKO-FDR mice. These cell lines will facilitate testing of the pro-tumor mechanisms of senescence. Additionally, they will permit the removal of senescent cells, both genetically and pharmacologically with senolytics, as a new treatment strategy in ACC. Overall, this project aims to investigate the pro-tumor biology of age- and therapy-induced senescence in ACC. Results from these studies will advance our understanding of senescence in cancer and aid in the development of new therapeutic strategies for ACC, including senolytics. Presentation: 6/2/2024

Oxytocin differentially modulates reward system responses to social and non-social incentives.

Oxytocin has been shown to modulate behavior related to processing of monetary incentives and to regulate social and reproductive behavior, yet little is known about how oxytocin differentially influences neural responses to social and non-social incentives. We aimed to evaluate the effects of oxytocin administration on behavioral and neural responses to social and monetary incentives. Twenty-eight healthy adults (age 18-45 years) performed both monetary and social incentive tasks during blood oxygenation level dependent (BOLD) imaging. Intranasal oxytocin or placebo was administered before each scan using a double blind, randomized, cross-over design. Task performance and self-reported motivation and mood states were collected. Time-series analysis was conducted to assess the influence of oxytocin on the hemodynamic response in the ventral tegmental area and substantia nigra (VTA/SN) and nucleus accumbens (NAc). Oxytocin demonstrated a multifaceted effect on VTA/SN and NAc when processing reward incentives, with it increasing BOLD response in VTA/SN and decreasing BOLD response in NAc during social incentive anticipation. A reversal of this was shown with decreased BOLD responses in the VTA/SN and increased BOLD response in the NAc during monetary incentive anticipation. Our findings suggest a more nuanced purpose of oxytocin when evaluating reward incentive decision making. It is possible that while oxytocin does increase salience to rewards, that it is more important for cognitive control when determining short-term versus long-term benefits in rewards. Future studies should more closely examine the relationship between oxytocin and delay discounting.

Impact of COVID-19 led transition of work culture and travel to work patterns on society and environment in Delhi

Globally, COVID-19 has led to changes in daily lifestyle and travel behavior. There was a shift from in-person physical jobs to work-from-home culture, even for those jobs that required in-person presence at the job location. However, this was not true for everyone, and a majority continued to travel to work. The limited capacity of public transport services and the fear of exposure to the virus restrained people from practicing their conventional mobility choices. We explore the impact of COVID-19 on the nature of jobs and related changes in work travel patterns by population groups for Delhi using in-person surveys conducted during 2021 in six localities of Delhi. We also estimated the short- and long-term impacts of altered behavior on expenditures and equivalent CO2 emissions.As per the analysis, lower income groups, having no vehicles, with lesser qualifications, and employed as daily wagers, had limited capacity to change to work-from-home during COVID-19. We observed an increased dependency on personal motorized vehicles, leading to increased expenditures and reduced affordability. Adopting work-from-home during COVID-19 helped reduce equivalent CO2 emissions per working member by 39%. However, as the work at the site resumes, the emissions are expected to increase. The study shows that COVID-19 led to short-term benefits, but in the long term, the externalities will likely increase. Working from home during the pandemic provides short-term benefits; the social benefits are not equally distributed, and the transport emissions shall increase in the long term.

Effects of doxycycline post-exposure prophylaxis for prevention of sexually transmitted infections on gonorrhoea prevalence and antimicrobial resistance among men who have sex with men in the USA: a modelling study

Doxycycline post-exposure prophylaxis (PEP) has been shown to be efficacious for the prevention of bacterial sexually transmitted infections, but resistance implications for Neisseria gonorrhoeae remain unknown. We aimed to use a mathematical model to investigate the anticipated impact of doxycycline PEP on the burden of gonorrhoea and antimicrobial resistance dynamics in men who have sex with men (MSM) in the USA. Using a deterministic compartmental model, characterising gonorrhoea transmission in a US MSM population comprising three sexual activity groups defined by annual partner turnover rates, we introduced doxycycline PEP at various uptake levels (10-90%) among those with high sexual activity. Infections were stratified by symptom status and resistance profile (ie, susceptible, ceftriaxone-resistant, tetracycline-resistant, or dual-resistant), with ceftriaxone the treatment for active infection. As resistance to tetracycline, not doxycycline, is monitored and reported nationally, we used this as a proxy for doxycycline PEP resistance. We compared the 20-year prevalence, incidence rates, and cumulative incidence of gonococcal infection, resistance dynamics (time to 5% prevalence of ceftriaxone resistance, 5% prevalence of dual resistance, and 84% prevalence of tetracycline resistance), and antibiotic consumption with baseline (ie, no doxycycline PEP). Uptake of doxycycline PEP resulted in substantial reductions in the prevalence and incidence of gonorrhoea, but accelerated the spread of tetracycline resistance. The maximum reduction in prevalence over 20years compared with no uptake ranged from 40·3% (IQR 15·3-83·4) with 10% doxycycline PEP uptake to 77·4% (68·4-84·9) with 90%uptake. Similarly, the maximum reduction in the incidence rate ranged from 38·6% (14·1-83·6) with 10% uptake to 77·6% (68·1-84·7) with 90% uptake. Cumulative gonococcal infections were reduced by a median of 14·5% (IQR8·4-21·6) with 10% uptake and up to 46·2% (26·5-59·9) with 90% uptake after 5years, and by 6·5% (3·4-13·0) with 10% uptake and 8·7% (4·3-36·2) with 90% uptake by 20years. In almost all scenarios explored, doxycycline PEP lost clinical effectiveness (defined as 84% prevalence of tetracycline resistance) within the 20-year period, but itslifespan ranged from a median of 12·1years (IQR 9·9-15·7) with 10% uptake to 1·6years (1·3-1·9) with 90%uptake. Doxycycline PEP implementation had minimal impact on extending the clinical lifespan of ceftriaxone monotherapy (5·0years [IQR 4·0-6·2]), with the median time to 5% prevalence of resistance ranging from 4·8years (3·9-6·0) for 90% uptake to 5·0years (4·1-6·2) for 10% uptake. Similarly, the median time to 5%prevalence of dual resistance to ceftriaxone and tetracycline ranged from 4·8years (3·9-6·0) for 90% uptake to 5·8years (4·8-7·4) for 10% uptake. Median decrease in ceftriaxone consumption for high doxycycline PEP uptake levels compared with baseline ranged from 41·7% (27·0-54·3) for 50% uptake to 50·2% (29·3-62·7) for 90% uptake at 5years, but dropped to 11·8% (6·9-32·0) for 50% uptake and 12·1% (7·0-41·6) for 90% uptake after 20years. Notwithstanding the clear benefits of doxycycline PEP for other sexually transmitted infections, for Ngonorrhoeae, model findings suggest that doxycycline PEP is an effective but impermanent solution for reducing infection burden, given eventual selection for resistant strains. This finding presents a challenge for policy makers considering strategies for doxycycline PEP implementation and oversight: the need to balance the clear, short-term clinical benefits with the risk of harm via antimicrobial resistance. US Centers for Disease Control and Prevention, National Institute of Allergy and Infectious Diseases.

Spatiotemporal conversion and mechanism between production-living-ecological space and ecosystem service in the canal area

Rapid industrialization and urbanization in canal areas have led to significant conversion in production-living-ecological space (PLES), yielding short-term social-economic benefits but causing serious ecological degradation. However, the complex and dynamic interactions between PLES and ecosystem function remain underexplored, despite their importance for guiding sustainable canal development. Therefore, we analyzed the dynamic changes in PLES and ecosystem service value (ESV) in the Jiangsu section of the Beijing-Hangzhou Grand Canal, along with their interrelationships. By optimizing the ESV evaluation model to incorporate natural, social, and economic factors, we examined the spatiotemporal evolution of PLES and ESV from 2000 to 2020. Finally, we quantified the dynamic response of ESV to PLES using contribution rate factors and identified trade-offs and synergies among ESV indicators. Over the past two decades, ecological space (ES) expanded by only 5.31 %, yet contributing 94.36 % of total ESV growth. Despite fluctuations during 2005–2010, synergies among various ESV types remained largely stable. The regulation service shows the most significant response to the conversion of PLES, with an increase in ES’s ESV of CNY 67.87 billion over 20 years, representing 75.34 % of total ESV growth. Notably, the hydrologic regulation contributes substantially, with an increase in ES’s ESV of CNY 60.87 billion, accounting for 67.57 % of total ESV growth. Our findings provide a scientific basis for the sustainable development and resource management in canal areas.

Surgical Treatment Of Haemorrhoids: Stapled Haemorrhoidopexy Versus Conventional Excisional Haemorrhoidectomy - A Clinical Outcome Analysis

Background: Hemorrhoids are a common anorectal condition that often requires surgical intervention for thirddegree cases when conservative treatments fail. Although both stapled haemorrhoidopexy and conventional excisional hemorrhoidectomy are widely used, uncertainty remains about which technique is superior. This study compares the short- and long-term outcomes of these procedures, focusing on recovery time, pain, and complications to clarify the optimal surgical approach. Materials and Methods: An open-label randomized controlled trial was conducted at Bangabandhu Sheikh Mujib Medical University (BSMMU) over 12 months. Eighty-two patients with third-degree hemorrhoids were randomly assigned to undergo either stapled haemorrhoidopexy or conventional excisional hemorrhoidectomy. Primary outcomes were operating time, postoperative pain, and recovery period, while secondary outcomes included symptom improvement and complications. Data analysis was performed using SPSS, with statistical significance set at p &lt; 0.05. Results: Group A had a significantly shorter operating time (16.5 vs. 25 minutes, p = 0.001) and less postoperative pain, with 42.9% reporting severe pain at 4 hours post-surgery compared to 95.2% in Group B (p = 0.001). By day 15, 95.2% of Group A experienced mild pain, while 64.3% of Group B still reported moderate pain (p = 0.001). Group A also had a faster recovery, with a median pain-free defecation time of 7 days versus 18.5 days for Group B (p = 0.001). Urinary retention was more common in Group B (50% vs. 19%, p = 0.003), while recurrence of mucosal prolapse was lower in Group A (21.4% at 6 months, p &lt; 0.01). Conclusion: Stapled haemorrhoidopexy provides faster recovery and less pain but has a lower recurrence of mucosal prolapse compared to conventional hemorrhoidectomy. Surgical decisions should balance short-term benefits with long-term risks.

Efficacy and Safety of Adding Empagliflozin to Liraglutide on Renal Function in Patients with Advanced-Stage Type 2 Diabetic Kidney Disease: A Randomized Controlled Trial.

The aim of this study was to investigate the additional effects of empagliflozin on liraglutide in patients with advanced-stage type 2 diabetic kidney disease. Forty-one patients were randomly assigned (1:1) to treatment with liraglutide alone during the first 6 months and subsequent treatment with liraglutide plus empagliflozin during the next 6 months (liraglutide plus empagliflozin group) (n = 20) or treatment with liraglutide alone for 12 months (liraglutide group) (n = 21). Liraglutide was administered subcutaneously once daily at a starting dose of 0.3 mg/day and up-titrated weekly by 0.3 mg to a maximum dose of 0.9 mg/day. Empagliflozin was administered orally at a dose of 10 mg once daily. The primary outcome was the change in renal function (estimated glomerular filtration rate) during the latter 6 months. Secondary outcomes were changes in body weight, systolic blood pressure, hemoglobin, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglyceride, uric acid, blood glucose, hemoglobin A1c, and urine protein creatinine ratio during the latter 6 months. Empagliflozin significantly increased the hemoglobin concentration (from 12.9 ± 1.9 to 13.7 ± 1.9 g/dL; p<0.05) and decreased body weight (from 66.1 ± 12.9 to 64.5 ± 12.6 kg; p<0.05). No significant differences were observed between the groups for estimated glomerular filtration rate, systolic blood pressure, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglyceride, uric acid, blood glucose, hemoglobin A1c, and urine protein creatinine ratio. Empagliflozin increased hemoglobin concentration and decreased body weight in patients with advanced-stage type 2 diabetic kidney disease who received liraglutide. However, empagliflozin did not provide short-term benefits with regard to renal function decline, urinary protein excretion, or glycemic control in these patients.

Surgical Treatment of Haemorrhoids: Stapled Haemorrhoidopexy versus Conventional Excisional Haemorrhoidectomy - A Clinical Outcome Analysis

Background: Hemorrhoids are a common anorectal condition that often requires surgical intervention for thirddegree cases when conservative treatments fail. Although stapled haemorrhoidopexy and conventional excisional hemorrhoidectomy are widely used, uncertainty remains about which technique is superior. This study compares the short- and long-term outcomes of these procedures, focusing on recovery time, pain, and complications to clarify the optimal surgical approach. Materials and Methods: An open-label randomized controlled trial was conducted at Bangabandhu Sheikh Mujib Medical University (BSMMU) over 12 months. Eighty-two patients with third-degree hemorrhoids were randomly assigned to undergo either stapled haemorrhoidopexy or conventional excisional hemorrhoidectomy. Primary outcomes were operating time, postoperative pain, and recovery period, while secondary outcomes included symptom improvement and complications. Data analysis was performed using SPSS, with statistical significance at p &lt; 0.05. Results: Group A had a significantly shorter operating time (16.5 vs. 25 minutes, p = 0.001) and less postoperative pain, with 42.9% reporting severe pain at 4 hours post-surgery compared to 95.2% in Group B (p = 0.001). By day 15, 95.2% of Group A experienced mild pain, while 64.3% of Group B reported moderate pain (p = 0.001). Group A also had a faster recovery, with a median pain-free defecation time of 7 days versus 18.5 days for Group B (p = 0.001). Urinary retention was more common in Group B (50% vs. 19%, p = 0.003), while recurrence of mucosal prolapse was lower in Group A (21.4% at 6 months, p &lt; 0.01). Conclusion: Stapled haemorrhoidopexy provides faster recovery and less pain but has a lower recurrence of mucosal prolapse compared to conventional hemorrhoidectomy. Surgical decisions should balance short-term benefits with long-term risks.

Extensive intraoperative peritoneal lavage with surgery, compared to surgery alone, for patients diagnosed with gastric cancer: A systematic review and meta-analysis of randomized controlled trials.

Gastric cancer ranks as the fifth most frequently diagnosed cancer and the seventh most prevalent overall. The lifetime risk of developing gastric cancer is 1.87% for males and 0.79% for females worldwide. This systematic review and meta-analysis aimed to determine whether Extensive Intraoperative Peritoneal Lavage (EIPL) provides short-term benefits or improved survival outcomes for patients undergoing gastrectomy. A comprehensive search spanned PubMed, Embase, Cochrane Library, clinicaltrials.gov, and Web of Science, from their inception up to October 2023, adhering to predefined inclusion and exclusion criteria. The quality of the studies was analyzed using the Cochrane Collaboration Risk of Bias Tool. Data analysis was done using Review Manager 5.3, utilizing a random-effects model. Our analysis incorporated seven randomized controlled trials with 2602 patients. The follow-up time for all outcomes varied from 30-60 months. For our primary outcomes, EIPL demonstrated a significant benefit over surgery alone in terms of recurrence (RR=0.73; 95% CI: 0.65 to 0.83, P<0.00001) and postoperative complications (RR=0.67; 95% CI: 0.51 to 0.87, P=0.003). For our secondary outcomes, postoperative hospital stay (MD=-0.35; 95% CI: -1.11 to 0.41; P-value=0.37), 3-year overall survival (OR=1.44; 95% CI 0.84 to 2.47; P-value=0.19), 3-year disease-free survival (HR=0.93; 95% CI: 0.78 to 1.13; P-value=0.48), and time to first flatus (MD=-0.17; 95% CI: -0.35 to 0.01; P-value=0.06), no statistically significant differences were observed between the EIPL and control groups. While there is a marginal difference in survival outcomes, EIPL holds promise in significantly reducing overall cancer recurrence and suggests an enhancement in postoperative recovery.

Complacency in the quantification and reporting of climate impacts as carbon dioxide equivalent emissions

PurposeThe choice of characterization model has the potential to profoundly influence LCA results and conclusions. It is therefore a requirement of ISO 14044:2006 that the selection of characterization model shall be both justified and consistent with goal and scope. The purpose of this article was to examine current practices regarding the characterization of GHG emissions and reporting as CO2 equivalent emissions.MethodsA survey of practice was conducted across articles recently published in the International Journal of Life Cycle Assessment. Each article was examined using seven predetermined questions covering reporting of CO2 equivalent emissions and justification of climate metric used, interpretation of results in relation to climate measures or goals, and the implications of choosing an alternative climate metric.Results and discussionOf the sample of 85 articles, more than half reported GHG emissions as CO2 equivalent emissions. Of these, 81% unambiguously reported the climate metric used. Most often, there was no justification for the choice of a characterization model. Where a justification was given, the most common reason was alignment with the requirements of a program or PCR document. In some cases, the choice of characterization model was determined by the choice of impact assessment method (e.g., CML, ReCiPe). In other cases, the choice of characterization model was based on the desire to compare results to other studies. It is noted that none of the abovementioned reasons is scientific justification related to a stated climate objective. Not surprisingly, most studies made no attempt to interpret results reported as CO2 equivalent emissions in relation to climate measures or goals, and most did not discuss the potential implications of alternative climate metrics. For almost half of the articles, the choice of climate metric was assessed as potentially having major implications for decision-making or comparison to alternative systems.ConclusionsBased on this survey, it is evident that key aspects of ISO 14044:2006 are routinely not being followed. When GHG emissions are aggregated into a single impact category indicator result, there is a loss of transparency about climate impacts over time and the potential to unknowingly trade short-term climate benefits against the exacerbation of the difficulties of achieving long-term climate stabilization. As such, whenever GHG emissions are reported as CO2 equivalent emissions, it is imperative that the choice of characterization model is unambiguously reported and justified, that results are interpreted in relation to environmental outcomes, and that the potential implications of selecting alternative models are discussed.Graphical

Tree Planting Activity to Nurture Impactful Mission (Tanim) at Select Barangay in San Jose, Batangas

This study aimed to evaluate the impact of Tree Planting Activity to Nurture Impactful Mission (TANIM) at select barangay in San Jose, Batangas. The study design is descriptive-qualitative in nature. Based on the qualitative data analysis, two themes have emerged such as simple yet useful and the short-term and long-term ecological benefits. The respondents felt contentment and fulfillment with themselves and felt a sense of accomplishment as described as a sense of success and service from the heart which implied a profound sense of achievement and a heartfelt commitment to making a positive impact on the environment. The short-term ecological benefits as described by the participants were local biodiversity, soil protection, soil health improvement, air quality improvement, and microclimate regulation while the potential long-term ecological benefits were enhanced biodiversity, carbon sequestration, water quality improvement, climate resilience, nursery operations, seed collection and processing, community engagement, aesthetic and recreational value of planting more trees, and educational opportunities which implied the immediate gains and envisioned the lasting advantages. The output of the study is the action to increase participation in the Tree Planting Activity to Nurture Impactful Mission (TANIM).

Are There Benefits to Breastfeeding for Long Durations That Continue after Breastfeeding Has Stopped? An Analysis of Acute Respiratory Illness in Nigerian Children.

Background: While an abundance of evidence exists regarding infectious outcomes in children as they relate to the short-term benefits of breastfeeding, there is limited evidence related to similar impacts beyond one year and after breastfeeding has stopped. Specifically, little is known about the long-term benefits of breastfeeding for acute health outcomes after infancy, particularly in Nigeria. Methods: The Nigeria Demographic and Health Survey data was used in this study. We utilized data (n = 5391) on children who had stopped breastfeeding for at least 12 months before the survey. Breastfeeding duration was categorized into 1-6 months, 7-12 months, 13-18 months, 18-24 months, and > 24 months. Any recent incident of acute respiratory illness in children was operationalized using the responses to related questions (recent incidents of fever, cough, running nose, and short, rapid, or difficulty breathing in children). Adjusted logistic regression was used to estimate odds ratios, and statistical significance was determined at p ≤ 0.05. Results: Post-infancy and after breastfeeding had stopped, the odds of recent acute respiratory illness were significantly less (AOR = 0.37, 95% CI [0.15-0.79], p = 0.04) in children breastfed for 19-24 months compared to those breastfed for 1-6 months. No significant association was found between the other durations and ARI post-infancy (p > 0.05). Conclusions: These findings indicate that breastfeeding for up to 24 months has a long-term protective effect from an acute health condition that contributes to the high under-five mortality rates recorded for decades in Nigeria specifically, and more broadly, in sub-Saharan Africa.

Enhancing patient-provider encounters when proposing SDF therapy by utilizing a qualitative analysis of parental feedback.

Silver Diamine Fluoride (SDF) is a minimally invasive option for caries arrest, part of a paradigm shift in the management of pediatric dental caries. The perspective of parents regarding the long-term pros and cons of this therapy should be understood in order to achieve optimal patient-centered care. This study used Constant comparative analysis as an analytic approach, applying the Precaution-Adoption Process Model (PAPM) as the Grounded Theory framework in the qualitative analysis of 30 parental unformatted, spontaneous comments collected at the end of a questionnaire to evaluate their satisfaction with treatment provided at a University Clinic. Our analysis provided important insights about the factors that influenced the parents' decision to act and have their child receive SDF therapy, their perception of the outcomes, the necessary follow-ups after the therapy, and what impacted on their overall satisfaction with the completed procedure. Both positive and negative themes were identified. The positive themes point to SDF treatment's ease of application and addressing the immediate treatment needs on children with limited cooperation. The negative themes identified the adverse consequences of SDF treatment, specifically, the duration and appearance of the cosmetic consequences, as well as the parents' misunderstandings and incorrect expectations of the long-term sustainability of the treatment, which in many instances requires further interventions. It was also evident from the parents' comments that they needed additional educational guidance on other aspects of the treatment, such as the necessity for clinical follow-ups, information that impacted parents' overall satisfaction with the treatment their child received. Our results highlight the need to discuss the short and long term benefits of the treatment, as well as, its short and long-term limitations. Specifically, while it is important to discuss immediate outcomes and consequences, such as the ease of treatment and the resultant staining, to ensure that parental consent for the treatment is truly well-informed, it is also important to prepare parents, when this procedure is initially proposed, of the likely need for additional oral care interventions in the future.

Long-Term Effects of Auricular Medicine – A Key to the Future of Preventive Medicine?

Auricular medicine, based on the concept that the ear reflects the entire body, has gained recognition for treating various conditions through targeted acupuncture. Despite documented short-term benefits, such as pain relief and nervous system regulation, research into its long-term effects is limited. This editorial discusses the need for further long-term studies to explore whether regular auricular acupuncture can offer sustained health benefits and serve a preventive role. It summarizes two studies: one on auricular therapy with magnetic pearls for elderly insomnia and another on frequency-controlled ear acupuncture for COVID-19-related olfactory dysfunction. Both studies suggest potential benefits, underscoring the importance of continued research to fully understand and harness auricular medicine’s preventive and therapeutic potential.

Haemodynamic effects of intra-aortic balloon pumps stratified by baseline pulmonary artery pulsatility index.

Intra-aortic balloon pump (IABP) devices are commonly used in patients with heart failure related cardiogenic shock (HF-CS), including those with out-of-proportion right ventricular (RV) dysfunction. Pulmonary artery pulsatility index (PAPi) is a haemodynamic surrogate for RV performance. We aimed to assess short-term haemodynamic changes in patients with HF-CS following IABP support stratified by baseline PAPi. This is a single-centre study of 67 consecutive patients with HF-CS who underwent IABP placement between 2020 and 2022. The primary aim was haemodynamic changes of specific variables on pulmonary artery catheter monitoring over 72h following IABP placement. Secondary aims were clinically significant changes in diuretic regimens, changes in inotropes or vasopressors at 72h following IABP, along with clinical outcomes. Prior to IABP placement, 57% of the total cohort (median age 59years [48, 69], 31% female) had Society of Cardiovascular Angiography and Interventions Stage C HF-CS. Thirty-eight (56%) patients had a PAPi <2.0. Following 72h of IABP support, the PAPi <2.0 group had an observed significant decrease in central venous pressure (CVP; 20 to 12mmHg, P<0.001) and mean pulmonary artery pressure (mPAP; 37.5 to 28.5mmHg, P=0.001), and an increase in PAPi (1 to 1.6, P=0.001). No significant change in cardiac index (CI; 2 to 2.1L/min/m2, P=0.31) was observed. The PAPi ≥2.0 group (N=29) had no observed significant change in CVP (10 to 8mmHg, P=0.47), or PAPi (2.6 to 2.8, P=0.92), but there was a significant improvement in CI (1.9 to 2.5L/min/m2, P=0.004) along with reduction in mPA (37 to 29mmHg, P=0.03). The PAPi <2.0 group had a significant increase in diuretic requirement (52.6% vs. 20.7%, P=0.01) and numerically greater addition of inotropes/vasopressors (47.3% vs. 34.4%, P=0.07) compared with the PAPi ≥2.0 group at 72h following IABP placement. Significantly more patients in the PAPi ≥2.0 group underwent left ventricular assist device (55.2% vs. 26.3%, P=0.02), with no overall significant differences observed in escalation to veno-arterial extracorporeal membrane oxygenation, 30-day mortality, renal replacement therapy post-IABP, or rates of heart transplantation. IABP devices in those with HF-CS and low or abnormal PAPi may provide modest short-term haemodynamic benefits without significant improvement in CI, along with greater need for adjustment in medical therapeutics to achieve haemodynamic optimization.

Short-term exercise training benefits pulmonary arterial hypertension patients.

Studies have shown exercise rehabilitation training improves exercise tolerance in pulmonary arterial hypertension (PAH) patients. However, implementing such programs in developing countries can be challenging. We investigated the benefits of short-term exercise rehabilitation training for PAH patients in a developing country. This study was a prospective study of adult PAH patients attending the cardiology outpatient unit of a tertiary referral hospital. The patients were equally divided into an intervention group and a control group. We measured hemodynamic characteristics and six-minute walking distance (6MWD) before and after four weeks of exercise rehabilitation training. The Shapiro-Wilk normality test was performed, followed by an independent t-test or Mann-Whitney test to statistically compare the data. We included 28 patients aged 29.1 ± 11 years. We found no significant differences in all hemodynamic characteristics between the groups before and after the rehabilitation (all p-values >0.05). The intervention group showed a significant increase in 6MWD (300.6 ± 90.8 (95% CI: 248.2, 352.9) vs 436.3 ± 58.8 (95% CI: 402.3, 470.2), p-value <0.001) and consequently, the Δ6MWD in the intervention group was remarkably higher (17.1 ± 48.3 (95% CI: -10.8, 44.9) vs 115.36 ± 54.69 m (95% CI: 83.8, 146.9), p-value <0.001). A short-term exercise rehabilitation training safely improved the exercise tolerance of patients with PAH. Our findings may lead to the improvement of rehabilitation strategies for this detrimental disease in countries with limited resources.

Financial Sustainability of Social Insurance: The Case of Korean Workers’ Compensation Insurance and Possibility of Triple Moral Hazard

Abstract This study examines the economic stability of Korean Workers’ Compensation Insurance (WCI), highlighting the system’s vulnerability to triple moral hazard. Korean WCI features more generous worker compensation, lower employer premiums, and more active government involvement in accident prevention in addition to a higher industrial accident rate, compared to the system in Germany and Japan. The negotiation process of the WCI among workers, employers, and insurance managers often prioritizes short-term benefits, undermining long-term financial health. Workers seek greater compensation, employers push for lower premiums, and insurance managers may prioritize collective interests, exacerbating the system’s economic instability. Over recent years, applications for occupational disease recognition have surged, and premium rates have decreased, indicating increasing strain. To mitigate these issues, the study proposes enhancing transparency and rationality, involving non-political experts in decision-making, and clearly defining the government’s role in managing WCI. These measures aim to balance stakeholder interests and ensure the WCI system’s sustainability for future generations.

Guiding Principles for Department of Defense Global Health Engagements.

Within the past decade, the U.S. DoD has increased spending on global health engagements (GHEs). Not only do these increased efforts strengthen national security but they also fortify the United States' diplomatic relations with foreign governments through medical stability operations and health diplomacy. Maximizing health care-related programs will bolster a partner government's ability to maintain secure borders and prevent conflict while depriving extremists of safe havens. Looking beyond the short-term benefits, the long-term effects of GHEs are not limited to a nation's borders; aid permeates into a society providing social and economic opportunities otherwise unobtainable to the community and effectively winning the hearts and minds of the population. Although the DoD does list policies and procedures in which to conduct GHEs, the proposed set of principles can further prevent conflicts, deliver better foreign humanitarian assistance, and develop a better health care partnership centered around the host nation.