Total Responders Research Articles

What activities do patients hope to perform following anatomic total shoulder arthroplasty but are unable to? Looking beyond patient-reported outcome measures

Patients undergoing anatomic total shoulder arthroplasty (aTSA) routinely achieve significant improvements in common patient-reported outcome measures (PROMs). While these structured PROMs produce reliable and standardized data for surgeons, individual patient desires and expectations related to postoperative activities may not be completely captured in standard PROMs. The purpose of the present study was to identify specific activities, sports, and/or hobbies that patients wish they could perform but are unable to following aTSA at a minimum of 2 years postoperatively. Patients who underwent primary aTSA, with a primary diagnosis of glenohumeral osteoarthritis between February 1, 2016 and January 1, 2021, were identified using an institutional clinical registry. A survey was sent to patients at a minimum of 2 years postoperatively, which included a free-text-response section in addition to 8 selection-based questions assessing patients' ability to perform various activities. The survey was sent to 601 patients and 395 responded (65.7% response rate). The mean age at the time of the surgery for responders was 65.75±8.8 years. There was no significant difference in age (P=.095), sex (P=.691), race (P=.090), or ethnicity (P=.054) between responders and nonresponders. The majority of patients had no difficulty managing toileting (93.7%), driving a car (92.4%), washing their hair (91.9%), and putting on a seatbelt (90.7%). Of the 395 total responders, 131 (33.2%) patients reported at least one desired activity that they could not perform. Of these 131 patients, weightlifting (14.5%), throwing a ball (12.9%), playing tennis (11.4%), carrying/holding groceries (11.4%), and performing pushups/planks (11.4%) were most commonly reported. Following aTSA, patients are able to perform the majority of activities of daily living without difficulty. A subset of patients desire but are unable to participate in several sports and hobbies following aTSA-most commonly, weightlifting, tennis, throwing a ball, and swimming. These limitations present opportunities for further improvements in postoperative outcomes.

The Acceptability and Impact of a Video on Compassion Focused Therapy as a Psycho-Educative Tool to Deepen Awareness around Voice-Hearing

In the compassion focused therapy (CFT) model of voice-hearing, a distressing relationship with voices is thought to be influenced by evolved threat-protection patterns, which are activated and attuned by socially threatening experiences, such as being harmed by others, as well being shamed, stigmatised, invalidated, and excluded. Therefore, the CFT approach is particularly interested in the role of voice-hearers’ relationships with others and self, as well as their social context of family/friends, professionals/services, and the wider community. This article reports on the impact of a 5-minute film, ‘Compassion for Voices’, which aimed to engage a general public audience with the compassionate approach to relating with voices, with potential as a therapeutic, educational, and de-stigmatising tool. One hundred and thirty-seven people responded to an anonymous online public feedback survey asking about their perceived impact of this film, amongst whom were 20 voice-hearers, 30 family/friends of voice-hearers, and 87 who work with voice-hearers. Quantitative data were gathered from responders’ perceived impact ratings (yes/no) in several different domains, and qualitative feedback data were analysed using content analysis by an independent research team. Over 98% of total responders thought the film has, or could potentially have, an impact on people’s health and welfare, and within the subsamples of both family/friends and the people who directly work with voice-hearers, this was 100%. The qualitative data revealed main impact themes around <em>knowledge and education</em>, <em>changes of attitudes or approaches to voice-hearing</em>, and <em>validation of people’s lived experience</em>. Although there are limitations to the online survey method, and therefore caution around what conclusions can be drawn, this study demonstrated a clear value and perceived impact among the sample who responded. This offers support for the use of video tools for social and community interventions, which is very much in keeping with the theoretically- and empirically- supported aims of CFT.

Internet use and difficulties in acquiring health resources among older adults with disabilities during the COVID-19 pandemic: a population-based cross-sectional study

BackgroundThe various restrictions caused by the COVID-19 pandemic may have worsened the digital divide and health inequality. However, research to ascertain the association between Internet use and difficulties in acquiring health resources among older adults with disabilities is scarce. This study aimed to explore the relationship between Internet use and difficulties in acquiring health resources among older adults with disabilities during the COVID-19 pandemic and explore the associated factors by disability severity.MethodsData from the 2020 survey of people with disabilities in South Korea were used. This secondary analysis study included 4,871 older adults aged 55 and above among 7,025 total responders. Complex sample logistic regression analyses were conducted to identify the association between Internet use and difficulties in acquiring health resources during the pandemic.ResultsOnly 23.66% of older adults with disabilities used the Internet. Internet non-users were more likely to experience difficulties in obtaining health resources than Internet users. The relationship between Internet non-use and difficulties in acquiring COVID-19-related information (OR 1.57, 95% CI 1.28–1.92) and buying and using personal protective equipment (OR 1.36, 95% CI 1.11–1.65) were statistically significant in the overall sample. Whereas, difficulties with using medical services were not statistically significantly associated with Internet use. Additionally, factors associated with difficulties in acquiring health resources differed by disability severity.ConclusionsConsidering that older adults with disabilities experience triple the burden amid COVID-19 due to old age, disabilities, and the digital divide, policymakers, healthcare professionals, and engineers should aim to narrow the gaps between Internet users and Internet non-users among this population. Narrowing the gaps will make decreasing health gaps and increasing well-being among older adults with disabilities more attainable.

Is there a relationship between the first-day results of anti-VEGF therapy for macular edema due to vascular diseases and longterm outcomes?

To evaluate early changes after the first antivascular endothelial growth factor injection for macular edema secondary to diabetic retinopathy and retinal vein occlusion and the relationship between longterm outcomes. The study enrolled patients who received anti-vascular endothelial growth factor injections for treatment-naive macular edema due to retinal vein occlusion and diabetic retinopathy. The central macular thickness was measured at baseline, post-injection day 1, week 2, and month 1, and at the last visit using spectral-domain optical coherence tomography. A good response was defined as a central macular thickness reduction of ≥10% on post-injection day 1. Patients were reassessed at the last visit with regard to treatment response on post-injection day 1 based on the favorable anatomic outcome defined as a central macular thickness <350 µm. In total, 26 (44.8%) patients had macular edema-retinal vein occlusion and 32 (55.2%) had macular edema-diabetic retinopathy. The mean follow-up time was 24.0 (SD 8.5) months. A statistically significant decrease in the central macular thickness was observed in both patients with macular edema-retinal vein occlusion and macular edema-diabetic retinopathy after antivascular endothelial growth factor injection therapy (p<0.001 for both). All patients with macular edema-retinal vein occlusion were good responders at post-injection day 1. All nongood responders at post-injection day 1 belong to the macular edema-diabetic retinopathy group (n=16.50%). The rate of hyperreflective spots was higher in nongood responders than in good responders of the macular edema-diabetic retinopathy group (p=0.03). Of 42 (2.4%) total good responders, one had a central macular thickness >350 µm, whereas 5 (31.2%) of 16 total nongood responders had a central macular thickness >350 µm at the last visit (p=0.003). The longterm anatomical outcomes of macular edema secondary to retinal vein occlusion and diabetic retinopathy may be predicted by treatment response 1 day after antivascular endothelial growth factor injection.

Online Survey to Investigate Asthma Medication Prescription and Adherence from the Perspective of Patients and Healthcare Practitioners in England.

High short-acting β2-agonist (SABA) use and/or inhaled corticosteroid (ICS) underuse are common and are associated with poor asthma outcomes. This study explored patients' and healthcare practitioners' (HCPs') perspectives to contextualize asthma treatment patterns observed in real-world studies. Data were collected using online surveys from HCPs and people with asthma (≥18 years old with a confirmed asthma diagnosis of any severity) who had consented to research participation through the Clinical Practice Research Datalink. Data were analysed using descriptive statistics. In total, 76 HCPs and 63 patients were invited to take part. Of 48 valid HCP responders, 54.2% (n=26) reported scheduling an annual asthma treatment review with their patients and 83.3% of general practitioners (n=40) had prescribed repeated inhalers at the patient's request. Of 47 valid patient responders, 57.4% (n=27) reported using their reliever (SABA) inhaler daily and 55.3% of patients (n=26) reported being prescribed a preventer inhaler. Of the total patient responders, 31.9% (n=15) reported that they never used their preventer inhaler. Consistent annual adherence with preventer inhalers was reported by 44.7% of all valid responders (n=21), while other patients admitted to using preventers intermittently. SABA and ICS prescription patterns are driven by a combination of HCP and patient factors. Opportunities exist to improve asthma control and behaviours around inhaler use.

How healthcare workers reacted to the different COVID-19 waves: An Italian survey

IntroductionThe COVID-19 pandemic had a huge impact on radiology departments all over the world, affecting both management and healthcare workers (HCWs). Therefore, it became challenging to guarantee high standards of diagnosis while keeping up with the workload. MethodsThe study was approved by the institutional review board. Its aim was to assess the impact of the COVID-19 pandemic over the radiology departments and HCWs through a survey. The questionnaire was available online from January to March 2022. Twelve areas of interest (sessions) were highlighted in the survey. ResultsThe number of total responders was 1376 and 73.7% of participants worked in public healthcare facilities. Comparisons between participants working in public versus private healthcare facilities were carried out using chi-square tests and Fisher tests. Within public healthcare workers, 82% affirmed having operating instruction protocols regarding confirmed or suspected COVID-19 patient CT management (p< 0.001). Private healthcare facilities had fewer CT scanners available in general (p< 0.001); in fact, only 18% of them affirmed having two or more CT scanners, and did not have CT scanners dedicated to confirmed or suspected COVID-19 patients (p< 0.001). Finally, public facilities strongly reduced (by 88%) the number of examinations booked during the first wave, compared to private healthcare facilities (p< 0.001). ConclusionThis survey showed that public facilities appeared to be better prepared from an organizational point of view than private facilities. Rescheduling the examinations booked during the first COVID-19 wave was challenging and not always possible.

DIGITAL DIVIDE AND DIFFICULTIES IN ACQUIRING HEALTH RESOURCES IN DISABLED OLDER ADULTS DURING THE PANDEMIC

Abstract The digital divide refers to the gap between those who are connected and those who are not connected to the internet and technologies. Although COVID-19 worsens the digital divide and health inequality, few studies have focused on the relationship between digital divide and difficulties in acquiring of health resources during the pandemic. This study aimed to identify the relationship between internet use and difficulties in acquiring health resources among older adults with disabilities during the COVID-19 pandemic. This secondary analysis study included 4,871 older adults aged 55 and older among 7,025 total responders of the 2020 survey of people with disabilities in South Korea. As the results, only 23.7% of older adults with disabilities used the internet. Non-internet users are more likely to have difficulties in acquiring COVID-19-related information (aOR 1.59) and buying and using personal protective equipment (aOR 1.36). However, difficulties in using medical services (aOR 1.21) was not statistically significant. Considering that older adults with disabilities have triple burdens from old age, disabilities, and the digital divide amid COVID-19, healthcare providers need to pay more attention to mitigate gaps between internet users and non-non users among this population. By narrowing the digital divide, decreasing health gaps and increasing well-being among older adults with disabilities will be guaranteed.

The impact of perception regarding therapeutic exercises and dietary changing adherence of subjects known with low back pain

Abstract: Debates regarding the role of therapeutic exercises and diet as modulators of an anti-inflammatory state occurred in the last years in the medical environment. The syner-gy between moderate-intensity exercise and a proper diet targeting decreasing IL-1 inhib-its the production of the pro-inflammatory cytokine TNF-α, the key regulator of local and systemic inflammation. One of the most important causes of short and long-term disabil-ity in all occupational groups is back pain, impacting the quality of life. Degeneration of the intervertebral disc (IVD) causes low back pain that intensifies with age. Assessment of the Oswestry Disability Index was applied on 23 subjects with low back pain to investigate the degree of disability. Nutrition of IVD, implying therapeutic exercises, and a customized diet may be crucial adjuvants for the rehabilitation process. The appropriate diet and therapeutic exercise approach are meant to evaluate the impact of awareness regarding the possibility of improving health outcomes. In this present study, women have a strong positive Pearson correlation (p&lt;0.05) with minimal (66-70 years) disability and moderate disability (r=1.000, CI =99%). Subjects with moderate disability conditions have “no” intention to implement diet changes and maintain therapeutic exercise adher-ence (r=0.902, CI = 95%). Men (71-75 years, r=0.995, CI =99%) registered a positive strong correlation with maximum deficiency (r=1.000, CI =99%) and “possible no” change in diet and exercise adherence will be applied (r=0.866, CI = 95%). Total disability responders an-swered with a “probable yes” option (r=0.884, CI=95%) but the dependence on their ca-reers is decisive. The education strategy is essential because diet change implementation can cause resistive behavior as well as adherence to exercise therapy. A key to effectively managing the inflammatory state due to different comorbidities is to use the cumulative effects of health professionals' prescriptions. The challenge is to ensure adherence to these actions for each patient. Keywords: anti-inflammatory, therapeutic exercises, rehabilitation, diet, Oswestry Disability In-dex (ODI), back pain, intervertebral disc, nutrition, perception, disability.

1059. The Experiences of Healthcare Workers during the Second Wave of COVID-19 Crisis in the South Indian State of Kerala

Abstract Background The COVID-19 pandemic has presented an unprecedented crisis and challenge for healthcare professionals globally. This study aims to explore the challenges faced by healthcare professionals during the second wave of COVID-19 in the south Indian state of Kerala. Methods An online cross-sectional survey was designed and disseminated through social media and professional organizations to collect the relevant information from the healthcare workers. The questionnaire composed of demographics, and of questions about the employment, work role, and access to personal protective equipment. Results Of the 423 responses received, 268 (63.3%) were nurses, followed by pharmacists (7.4%), doctors (14.6%), and allied healthcare professionals (4.4%). Nearly half i.e., 198 (46.8%) of the total responders, expressed concern about work-related risks to themselves and their families. The primary concerns expressed by the participants include higher workload, psychological distress, shortage of quality personal protective equipment (PPE), lack of incentives, and social stigmatization. Just over a third of respondents (35%) perceived that care provided in their workplace was significantly worse than before the pandemic. Conclusion The study offers lessons for hospitals in middle-income and low-income countries to ensure a safe working environment for front-line healthcare workers in their fight against COVID-19. This implies the need to support with adequate safety kits, protocols, and support for both physical and mental health of the healthcare professionals. Disclosures All Authors: No reported disclosures.

Sperm Banking in Post-Pubertal Males with Newly Diagnosed High-Risk ALL

Purpose: 10-15% of adolescent and young adults (AYA) with high-risk pre-B acute lymphoblastic leukemia (ALL) may need treatment for relapsed/refractory leukemia, leading to impaired fertility. While hospitalized, sperm banking may be difficult for a newly-diagnosed AYA with ALL. This study examined practices and specific barriers to offering sperm banking at initial ALL diagnosis prior to starting chemotherapy. Methods: This cross-sectional survey study was distributed by email to all Children's Oncology Group (COG) oncologists (n=2345) in the United States, Canada, Australia and New Zealand from January-April 2022. Data were collected regarding size of program and institutional practices for sperm banking. Program size was defined by the total numbers of new ALL diagnoses per year: small (<10 per year), medium (10-30) or large (>30 per year). Data were summarized with counts and percentages and compared between groups using chi-square tests or Fisher's exact tests. Results: 572 surveys were completed, representing a 25% participation rate. 78% of responders offer sperm banking to physically able males with newly-diagnosed ALL prior to starting chemotherapy. Commonly reported barriers were: insufficient time before chemotherapy (70%), patients being too sick (44%), and lack of perceived need since most will be fertile after initial treatment (41%). 57% of the total responders work at an institution with a dedicated oncofertility team. Of the 445 responders who offer sperm banking, 190 (43%) work at programs without a dedicated oncofertility team. Most (86%) responders who offer sperm banking work at medium/large-sized institutions. Conclusion: A majority of COG oncologists who responded to our survey offer sperm banking prior to starting chemotherapy. The most frequently-cited barriers included insufficient time before treatment and patients being too sick. It is encouraging that 43% of individuals who offer sperm banking work at institutions without a dedicated oncofertility team. Medium/large institutions may have more resources to facilitate sperm banking in this setting. A possible study limitation may be respondent-bias towards individuals passionate about fertility preservation who have already adopted the practice of sperm banking at diagnosis and are not representative of all pediatric oncologists. Future directions include obtaining additional insight into COG oncologists who did not respond in order to improve education and best practices around offering sperm banking to AYA with newly-diagnosed high-risk ALL regardless of institution size or dedicated fertility preservation team. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Fluticasone Furoate/Umeclidinium/Vilanterol (FF/UMEC/VI) Triple Therapy Compared with Other Therapies for the Treatment of COPD: A Network Meta-Analysis.

IntroductionRandomized controlled trials (RCTs) comparing triple therapies (inhaled corticosteroid [ICS], long-acting β2-agonist [LABA], and long-acting muscarinic antagonist [LAMA]) for the treatment of chronic obstructive pulmonary disease (COPD) are limited. This network meta-analysis (NMA) investigated the comparative efficacy of single-inhaler fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) versus any triple (ICS/LABA/LAMA) combinations and dual therapies in patients with COPD.MethodsThis NMA was conducted on the basis of a systematic literature review (SLR), which identified RCTs in adults aged at least 40 years with COPD. The RCTs compared different ICS/LABA/LAMA combinations or an ICS/LABA/LAMA combination with any dual therapy (ICS/LABA or LAMA/LABA). Outcomes of interest included forced expiratory volume in 1 s (FEV1), annualized rate of combined moderate and severe exacerbations, St George’s Respiratory Questionnaire (SGRQ) total score and SGRQ responders, transition dyspnea index focal score, and rescue medication use (RMU). Analyses were conducted at 24 weeks (primary endpoint), and 12 and 52 weeks (if feasible).ResultsThe NMA was informed by five trials reporting FEV1 at 24 weeks. FF/UMEC/VI was statistically significantly more effective at increasing trough FEV1 (based on change from baseline) than all triple comparators in the network apart from UMEC + FF/VI. The NMA was informed by 17 trials reporting moderate or severe exacerbation endpoints. FF/UMEC/VI demonstrated statistically significant improvements in annualized rate of combined moderate or severe exacerbations versus single-inhaler budesonide/glycopyrronium bromide/formoterol fumarate (BUD/GLY/FOR). At 24 weeks, the NMA was informed by five trials. FF/UMEC/VI showed statistically significant improvements in annualized rate of combined moderate or severe exacerbations versus UMEC + FF/VI and BUD/GLY/FOR. FF/UMEC/VI also demonstrated improvements in mean SGRQ score versus other triple therapy comparators at 24 weeks, and a significant reduction in RMU compared with BUD/GLY/FOR (160/18/9.6).ConclusionThe findings of this NMA suggest favorable efficacy with single-inhaler triple therapy comprising FF/UMEC/VI. Further analysis is required as additional evidence becomes available.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12325-022-02231-0.

Identification of proteomic markers for prediction of the response to 5-Fluorouracil based neoadjuvant chemoradiotherapy in locally advanced rectal cancer patients

BackgroundNeoadjuvant chemoradiotherapy (nCRT) prior to surgery is the standard treatment for patients with locally advanced rectal cancer (LARC), while parts of them show poor therapeutic response accompanied by therapy adverse effects. Predictive biomarkers for nCRT response could facilitate the guidance on treatment decisions but are still insufficient until now, which limits the clinical applications of nCRT in LARC patients.MethodsIn our study, 37 formalin-fixed paraffin-embedded tumor biopsies were obtained from patients with LARC before receiving 5-fluorouracil based nCRT. Proteomics analyses were conducted to identify the differentially expressed proteins (DEPs) between total responders (TR) and poor responders (PR). The DEPs were validated via ROC plotter web tool and their predictive performance was evaluated by receiver operating characteristic analysis. Functional enrichment analyses were performed to further explore the potential mechanisms underlying nCRT response.ResultsAmong 3,998 total proteins, 91 DEPs between TR and PR were screened out. HSPA4, NIPSNAP1, and SPTB all with areas under the curve (AUC) ~ 0.8 in the internal discovery cohort were independently validated by the external mRNA datasets (AUC ~ 0.7), and their protein levels were linearly correlated with the graded responses to nCRT in the internal cohort. The combination of HSPA4 and SPTB could distinctly discriminate the TR and PR groups (AUC = 0.980, p < 0.0001). Moreover, multiple combinations of the three proteins realized increased specificity and/or sensitivity, while achieving favorable predictive value when moderate responders were introduced into the ROC analysis. Pathways including DNA damage repair, cell cycle, and epithelial mesenchymal transition were involved in nCRT response according to the enrichment analysis results.ConclusionsHSPA4, SPTB and NIPSNAP1 in tumor biopsies and/or their optional combinations might be potential predictive markers for nCRT response in patients with LARC. The DEPs and their related functions have implications for the potential mechanisms of treatment response to nCRT in patients with LARC.

IMPACT OF COVID-19 PANDEMIC ON SOCIAL, PSYCHOLOGICAL AND MENTAL HEALTH AMONG UNIVERSITY STUDENTS IN INDIA: A CROSS SECTIONAL ELECTRONIC SURVEY

Background: The COVID -19 pandemic has resulted in an increased level of stress among university students particularly due to online education, lockdown, stay-at-home orders. This exerted an extensive impact on social, psychological, emotional and mental health among students. Objective: In this survey, we analysed the social behaviour, psychological reactions, mental and emotional implications on the students due to the covid-19 pandemic. Methods: An online survey was conducted among students studying in different universities &amp; diverse elds in India, using a series of questionnaires to understand the effects of the pandemic on their mental health and well-being. The data were analysed through quantitative and qualitative methods. Results: During our online survey, we analyzed 800 participants (400 males and 400 females) who completed the questionnaire. While analysing for perceived social stress, we observed females to be more affected than males whereas, for psychological and mental stress, the majority of the participants were affected to some extent. The mean global stress score was 14.96±5.09 for females and 11.16±4.60 for males which showed a signicant difference between the two groups (p value=0.009). 72.9% of the total participants felt that their mental well being has deteriorated by the imposition of lockdown and being in quarantine has made 36.7% people burdened with stress to a whole lot of extent. 31.4% of the total responders experienced agitation, anger and irritability being at home during quarantine and only 10.6% were unaffected by it. Majority of the participants suffered from symptoms of anxiety or depression in this 2 year period. Conclusion: The survey concludes with its observation of mental and psychosocial implications in form of anxiety, disturbed sleep pattern, economic burden and future academic plan etc on university students in the span of the COVID -19 pandemic. Institutions must address these effects and consider implementing some student wellness programme which is supported by mental health experts in order to mitigate related consequences.

Changes in colonic enteroendocrine cells of patients with irritable bowel syndrome following fecal microbiota transplantation

Objectives The aim was to investigate the effect of fecal microbiota transplantation (FMT) on colonic enteroendocrine cells densities in patients with irritable bowel syndrome (IBS). Materials and methods This study is connected to the REFIT study, a double-blinded placebo-controlled trial to investigate using FMT for IBS treatment. Eighty-three subjects received either donor-FMT or placebo FMT (own feces) by colonoscope to cecum. Biopsies were obtained from sigmoid colon. Ten responders and ten non-responders consented to new biopsy one-year after FMT. Sixteen patients received donor-FMT and four received placebo FMT. Biopsies were immunostained for all of the colonic enteroendocrine cells and were quantified using computerized image analysis. Allocation sequence was revealed after obtaining re-biopsies and cells quantification. Results Scores for IBS-SSS (mean ± SEM) of responders (eight of 10 patients who received donor FMT) and non-responders changed from baseline to one year after FMT (297 ± 11 and 81 ± 16, p < .0001, and 270 ± 17 and 291 ± 16, p = .15, respectively). Using paired t-test to compare enteroendocrine cells densities one-year after FMT to baseline showed significant increase only in somatostatin immunoreactive cells density in the total IBS responders group (p = .023) and who received donor-FMT (p = .038). The densities of peptide YY and enteroglucagon immunoreactive cells increased significantly (p = .04 and .035, respectively) in donor-FMT recipients. No significant changes were noted in placebo FMT or nonresponders subgroups. Conclusion This study shows that colonic enteroendocrine cells densities significantly change in responders group that received donor-FMT. The mechanisms for the cross talks between gut microbiota and colonic enteroendocrine cells remain to be investigated.

Awareness, Knowledge, and Interest about Prebiotics-A Study among Romanian Consumers.

The consumer awareness towards healthier diets and the impact of nutrition on health has triggered an increase in the production and commercialization of foods with health claims. The scientific literature classifies these food products as functional foods, with a role in promoting health and preventing diseases, and they had a market share of almost 200 million EUR in 2019. Prebiotics are considered functional foods, referring to substrates that are selectively utilized by host microorganisms conferring a health benefit, as defined by the International Scientific Association for Probiotics and Prebiotics. Several health benefits are associated with the consumption of prebiotics; however, specific requirements must demonstrate the causality between the specific ingredient and the claimed effect. Health claims associated with food products are assessed in the European Union and need to be supported by rigorous scientific evidence before being authorized and permitted on the market. Consumers’ perception of this topic is influenced by the various stakeholders involved. The current work aimed to study the consumers’ perception and interest and to assess the knowledge on the prebiotic concept in Romania. The consumer interest level was quantified by using the web-based data tool Google Trends, and a questionnaire-based investigation was designed. The collected data were analyzed with the help of the SPSS program, and crosstabulation was used to identify the influence of socio-demographic characteristics on diet choice and awareness of prebiotics. A total of 303 persons answered the online applied questionnaire, grouped as young consumers (15–24 years old) and adults (25–64 years old). Even if most responders were familiar with the term of prebiotics (74% of total responders), some results were contradictory regarding their knowledge. The work emphasized the need to carry out educational campaigns and inform consumers on the relationship between certain food ingredients and health outcomes in a clear way and based on a rigorous assessment of the scientific evidence.

Health Trends among 9/11 Responders from 2011-2021: A Review of World Trade Center Health Program Statistics.

In a single day, the September 11, 2001 US terrorist attacks (9/11) killed nearly 3,000 people, including 412 first responders. More than 91,000 responders were exposed to a range of hazards during the recovery and clean-up operation that followed. Various health programs track the on-going health effects of 9/11, including the World Trade Center (WTC) Health Program (WTCHP). The objective of this research was to review WTCHP statistics reported by the Centers for Disease Control and Prevention (CDC) to analyze health trends among enrolled responders as the 20-year anniversary of the terrorist attacks approaches. The WTCHP statistics reported by the CDC were analyzed to identify health trends among enrolled responders from 2011 through 2021. Statistics for non-responders were excluded. A total of 80,745 responders were enrolled in the WTCHP as of March 2021: 62,773 were classified as general responders; 17,023 were Fire Department of New York (FDNY) responders; and 989 were Pentagon and Shanksville responders. Of the total responders in the program, 3,439 are now deceased. Just under 40% of responders with certified health issues were aged 45-64 and 83% were male. The top three certified conditions among enrolled responders were: aerodigestive disorders; cancer; and mental ill health. The top ten certified cancers have remained the same over the last five years, however, leukemia has now overtaken colon and bladder cancer as the 20-year anniversary approaches. Compared to the general population, 9/11 first responders had a higher rate of all cancers combined, as well as higher rates of prostate cancer, thyroid cancer, and leukemia. Trends in these program statistics should be viewed with some caution. While certain illnesses have been linked with exposure to the WTC site, differences in age, sex, ethnicity, smoking status, and other factors between exposed and unexposed groups should also be considered. Increased rates of some illnesses among this cohort may be associated with heightened surveillance rather than an actual increase in disease. Still, cancer in general, as well as lung disease, heart disease, and posttraumatic stress disorder (PTSD), seem to be increasing among 9/11 responders, even now close to 20 years later. Responders should continue to avail themselves of the health care and monitoring offered through programs like the WTCHP.

COVID-19 Impact in Neurosurgery Residency: Grit During Pandemic

BackgroundThe coronavirus disease−19 (COVID) pandemic has presented a significant challenge to health care providers. Neurosurgical patients are often critically ill and at particularly high risk for COVID, and the pandemic has produced ever-shifting circumstances to allow their continued care. This study explores the psychologic impact of the pandemic on neurosurgical residents at a single institution.MethodsResidents completed the Perceived Stress Scale (PSS) and the Inventory of Depressive Symptomology 30 (IDS-30), two validated surveys, before and during the pandemic. PSS scores range from 0 to 40 with higher scores indicative of increased stress. IDS-30 ranges from 0 to 84 with higher scores indicating more severe levels of depression. Survey results were compared collectively among residents and statistically analyzed.ResultsThe surveys had 19 out of 28 total responders (68%). Mean score on the PSS was 16.1 prepandemic and 14.7 during the pandemic (P > 0.05). The mean score on the IDS-30 was 14.7 prepandemic and 12.0 during the pandemic (P > 0.05). Matching the survey questionnaire results by each resident revealed an average decrease of 2.3 and 2.4 for the PSS and IDS-30, respectively.ConclusionsThere were no significant changes in perceived stress or depressive symptoms among neurosurgical residents during the pandemic.

Evaluating the cerebrospinal fluid tap test with the Hellstr\xf6m iNPH scale for patients with idiopathic normal pressure hydrocephalus

BackgroundThe cerebrospinal fluid tap test (CSF TT) is used for selecting shunt surgery candidates among patients with idiopathic normal pressure hydrocephalus (iNPH). We aimed to evaluate the predictive value of the CSF TT, by using the Hellström iNPH scale for shunted iNPH patients with a standardized method.MethodsOne hundred and sixteen shunt-operated iNPH patients were retrospectively included in this study. The gait and balance domains in the iNPH scale were used as outcome measures for the CSF TT and the total iNPH scale score as the postoperative outcome. A positive response to CSF TT was defined as a change of ≥ 5 points in the gait domain and ≥ 16 points in the balance domain. Differences between CSF TT responders and non-responders, sensitivity, specificity, positive and negative predictive values, accuracy, and correlations between changes from baseline to post CSF TT and from baseline to the postoperative follow-up, were calculated.ResultsIn the CSF TT there were 63.8% responders in the gait domain and correspondingly 44.3% in the balance domain. CSF TT responders had a significantly better postoperative outcome in the total scale score (gait P ≤ 0.001, balance P ≤ 0.012) and gait CSF TT responders improved more in gait (P ≤ 0.001) and balance CSF TT responders in balance (P ≤ 0.001). No differences between CSF TT gait or balance responders could be found in neuropsychological or urinary continence assessments postoperatively. The sensitivity and specificity of the CSF TT and the outcome of the total iNPH scale score postoperatively were 68.1% and 52.0% for gait and 47.8% and 68.0% for balance, respectively.ConclusionsThe CSF TT, with the Hellström iNPH scale as the outcome measure, has clear limitations in predicting postoperative results. The gait domain may be used to predict outcomes for gait, but the balance domain is too insensitive.

Provider perceptions on steroid dosing in AECOPD: Laying the groundwork for steroid stewardship.

Steroid overprescribing is well documented in acute exacerbations of COPD (AECOPD). Given the myriad of unwanted side effects of corticosteroids, facilities should implement steroid stewardship efforts. The objective of this project was to evaluate the prescribing habits of steroids in AECOPD for needs assessment and to tailor interventions in a single centre. A questionnaire was developed to evaluate practices and beliefs around steroid dosing in a simplified case of uncomplicated AECOPD. There were 31 total responders: 12 inpatient clinicians, 9 medical residents and 10 emergency department (ED) clinicians. All steroid dosing was converted to prednisone equivalents for reporting. Subgroup analysis was conducted between provider groups. Initial dosing ranged from 40 to 625mg/day with only four responders (13%) selecting 40mg/day. Dosing was not significantly different in newer providers ≤4 years' experience: mean 215mg versus >4 years' experience: mean 312mg (P=0.23). Less experienced providers selected shorter treatment durations: median 5 days (IQR 5,6) versus 8.5 days (IQR 6,10.5) (P=0.015). ED providers selected higher doses than non-ED providers: 447mg versus 208mg (P=0.003). Most responders (81%) selected IV agents over oral steroids. The majority (65%) stated dosing choices were based on prescribing habits/clinical experience, while 36% felt their selections were based on current evidence. Five (16%) of responders correctly identified consensus treatment guidelines and the majority (77%) reported being "very likely" or "somewhat likely" to prescribe lower doses. Baseline knowledge was a significant barrier to guideline utilisation. Education will need to focus on the evidence behind using lower doses, oral agents and disease severity.

COVID-19 Pandemic: Impact of Quarantine on Medical Students' Mental Wellbeing and Learning Behaviors.

Background and Objectives:The novel coronavirus COVID-19 pandemic causes great public health and socioeconomic harms. Worldwide many countries implemented quarantine policies to minimize the spread of this highly contagious disease. The present study aim was to investigate the impact of quarantine on the medical students’ mental wellbeing and learning behaviors.Methods:In this descriptive study, we used a questionnaire with a Five-Point Likert Scale to collect the information. The questionnaire was distributed among 625 medical students through their emails with a response rate of 530 (84.8%), majority 294 (55.47%) being female. The survey questionnaire consisted of total 20 items; 12 items were related to psychological wellbeing and stress-allied queries and 08 items were about learning behaviors.Results:The findings encompass two important characteristics related to quarantine, psychological wellbeing, and learning behaviors. A combined cohort of 234 medical students, either female or male, (which was 44.1% of the total responders) showed a sense of being emotionally detached from family, friends and fellow students, 125/ 530 (23.5%) medical students felt disheartened. Both female and male medical students showed a marked decrease in their overall work performance. Moreover, 56.2% of the total students (61.5% of the females and 49.5% of the males) felt a decrease in the time they spent studying.Conclusions:Both female and male medical students have identified that quarantine has caused them to feel emotionally detached from family, fellows, and friends and decrease their overall work performance and study period. The findings also show that one fourth of the medical students who participated in this study felt disheartened during the quarantine period. The long-term quarantine due to COVID-19 pandemics may causes further worsening in the psychological and learning behaviors of these medical students.