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Polish Archives of Internal Medicine Jun 2024The role of iron homeostasis has become increasingly recognized as a key factor in determining the prognosis of patients with heart failure (HF). Disruptions in iron...
INTRODUCTION
The role of iron homeostasis has become increasingly recognized as a key factor in determining the prognosis of patients with heart failure (HF). Disruptions in iron balance, encompassing deficiency and overload, can affect patient prognosis, therefore, these indicators are considered of significant implications for treatment and management strategies.
OBJECTIVES
The current study intends to delve into the association between iron homeostasis-related indicators and long-term mortality as well as first-admission mortality in individuals with HF.
PATIENTS AND METHODS
Data on 3483 HF patients from the MIMIC IV database were retrospectively analyzed. The relationship between iron homeostasis-related indicators (ferritin, serum iron, transferrin, and total iron binding capacity [TIBC]) and the prognosis of HF patients was discerned utilizing the Cox proportional hazards model and Kaplan-Meier survival analysis. Additionally, the predictive capability of these indicators for patient prognosis was assessed using receiver operating characteristic curve (ROC).
RESULTS
Fourth quartile levels of ferritin and serum iron were obviously associated with poor long-term outcomes in HF patients. Conversely, fourth quartile levels of transferrin and TIBC served as protective factors and were associated with a better prognosis. Additionally, iron homeostasis indicators exhibited a certain predictive value for both long-term mortality and first-admission mortality in HF patients.
CONCLUSIONS
This study underscores the significant association between iron homeostasis indicators and the prognosis of HF patients, providing valuable insights for risk stratification and clinical decision-making for this population. Future studies should focus on the dynamic fluctuations in patients' iron homeostasis and explore intervention measures to improve the prognosis of HF patients.
PubMed: 38934851
DOI: 10.20452/pamw.16788 -
Indian Journal of Public Health Oct 2023The present study intends to examine whether there exists any gender gap in out-of-pocket spending on hospitalization between elderly men and elderly women. Data were...
The present study intends to examine whether there exists any gender gap in out-of-pocket spending on hospitalization between elderly men and elderly women. Data were drawn from the NSS 75th Round Health Care Survey (2017-2018) consisting of a total number of 45,299 elderly. Bivariate analysis and t-test were used to examine the disease burden and gender gap in health spending. The burden of noncommunicable diseases such as bone disease and anemia is considerably higher among elderly women than elderly men. There is a significant, positive gender gap in inpatient health spending, especially in the rural area across various diseases. Lower level of awareness, male dominance in health-related decision-making, and financial dependence are some possible factors for the gender gap. Generating awareness among households and particularly among women regarding health-care system, chronic diseases, and sources of health financing along with formulating disease-specific policy may reduce the gender gap in health spending.
Topics: Humans; Female; Male; Noncommunicable Diseases; India; Aged; Health Expenditures; Hospitalization; Sex Factors; Middle Aged; Socioeconomic Factors; Health Care Surveys; Aged, 80 and over
PubMed: 38934814
DOI: 10.4103/ijph.ijph_1551_22 -
Acute Medicine & Surgery 2024Owing to the miniaturization of diagnostic ultrasound scanners and their spread of their bedside use, ultrasonography has been actively utilized in emergency situations.... (Review)
Review
Owing to the miniaturization of diagnostic ultrasound scanners and their spread of their bedside use, ultrasonography has been actively utilized in emergency situations. Ultrasonography performed by medical personnel with focused approaches at the bedside for clinical decision-making and improving the quality of invasive procedures is now called point-of-care ultrasonography (POCUS). The concept of POCUS has spread worldwide; however, in Japan, formal clinical guidance concerning POCUS is lacking, except for the application of focused assessment with sonography for trauma (FAST) and ultrasound-guided central venous cannulation. The Committee for the Promotion of POCUS in the Japanese Association for Acute Medicine (JAAM) has often discussed improving the quality of acute care using POCUS, and the "Clinical Guidance for Emergency and Point-of-Care Ultrasonography" was finally established with the endorsement of JAAM. The background, targets for acute care physicians, rationale based on published articles, and integrated application were mentioned in this guidance. The core points include the fundamental principles of ultrasound, airway, chest, cardiac, abdominal, and deep venous ultrasound, ultrasound-guided procedures, and the usage of ultrasound based on symptoms. Additional points, which are currently being considered as potential core points in the future, have also been widely mentioned. This guidance describes the overview and future direction of ultrasonography for acute care physicians and can be utilized for emergency ultrasound education. We hope this guidance will contribute to the effective use of ultrasonography in acute care settings in Japan.
PubMed: 38933992
DOI: 10.1002/ams2.974 -
Heliyon Jun 2024This study examines the Voluntary Partnership Agreement (VPA) between Ghana and the European Union (EU) within the Forest Law Enforcement Governance and Trade Initiative...
This study examines the Voluntary Partnership Agreement (VPA) between Ghana and the European Union (EU) within the Forest Law Enforcement Governance and Trade Initiative (FLEGT). The VPA aims to enhance forest governance, reduce deforestation, combat illegal practices, and improve livelihoods of forest fringe communities. The research focuses on the implementation of social responsibility agreements (SRAs) under the VPA framework and identifies factors contributing to their success or presenting challenges. Data collection involved mixed methods, including literature review and a survey of individuals involved in SRAs. Descriptive and inferential statistical analyses, including exploratory factor analysis, were conducted. Principal component analysis revealed that accountability, monitoring of implementation and progress of SRAs, and documentation of SRA agreements were key factors contributing to the success of negotiated SRAs, explaining about 68.36 % of success variance. Challenges and constraints were categorized into two main factors: weak community capacity to negotiate SRAs and weak community capacity to enforce compliance, explaining about 71.4 % of challenge variance. The study found that the exclusion of the local SRA committee (LSRAC) from certain decision-making processes affected trust and transparency in calculating SRA benefits. Elite capture of benefits was identified as an issue, as the LSRAC did not conduct sufficient consultations with community members before negotiations. The findings emphasize the importance of including local communities in all forest management activities and call for increased awareness of SRAs, particularly for the LSRAC. The study highlights the need for proper representation of community interests during negotiations and their inclusion in forest management plans.
PubMed: 38933937
DOI: 10.1016/j.heliyon.2024.e32368 -
Heliyon Jun 2024Higher education is regarded as being of paramount importance in Vietnam and as being essential to raising the level of the country's labor force and promoting economic...
Higher education is regarded as being of paramount importance in Vietnam and as being essential to raising the level of the country's labor force and promoting economic progress. Evaluation of lecturers is one of the institution's activities and a crucial component of managing human resources in higher education institutions. How to evaluate faculty members' overall performance using a range of criteria is one of the key evaluation-related challenges. This study presents a method that uses fuzzy analytical hierarchy process (AHP) and fuzzy technique for order performance by similarity to ideal solution (TOPSIS) to assess and rank the performance of lecturers. Specifically, the evaluation framework is developed by identifying criteria and sub-criteria based on a comprehensive review of existing literature. Following that, the fuzzy AHP approach is used to determine the weights of the criteria and sub-criteria using the pairwise comparisons. The Fuzzy TOPSIS approach is employed to assess and prioritize lecturers identified through expert evaluation. When applied in group decision-making, utilizing fuzzy AHP and fuzzy TOPSIS promotes agreement among decision-makers and diminishes uncertainty in decision-making processes. The utilization of the multiple criterion measurement approach can then be used to carry out the evaluation. The suggested framework is also demonstrated via a case study. The use of this framework can improve the evaluation's objectivity, accuracy, and scientific methodology. It is believed that this work will assist managers of higher education institutions improve their standards for educational quality.
PubMed: 38933935
DOI: 10.1016/j.heliyon.2024.e30772 -
British Journal of Biomedical Science 2024The Biomedical Scientist (BMS) role is established in healthcare, working in laboratory environments to provide diagnostic testing and to monitor treatment effects on a...
INTRODUCTION
The Biomedical Scientist (BMS) role is established in healthcare, working in laboratory environments to provide diagnostic testing and to monitor treatment effects on a patients' health. The profession is subject to several professional standards which highlight the importance of working in the best interests of the patient and service user. However, Biomedical Scientists have little or no patient contact. This study aimed to determine how Biomedical Scientists evidence that they meet the professional standards and support the achievement of patient outcomes.
MATERIALS AND METHODS
This study utilised a Delphi method to explore the opinions of professional stakeholders to determine whether there was consensus for how this professional group contributes to patient outcomes and offers evidence that they are working in the best interests of the patient. The qualitative 1st round of the study consisted of focus groups and interviews with staff and students on the BSc Biomedical Science awards, Professional, Statutory and Regulatory body (PSRB) representatives and Biomedical Scientists from the National Health Service (NHS). The first-round responses were analysed using thematic analysis which then generated attitude statements which participants scored using a 5-point Likert scale in the 2nd round. Consensus or divergence of opinion was determined based upon a 70% consensus level within each participant group and overall.
RESULTS
Following analysis of the 2nd round data, there was divergence of opinion across all stakeholders, with consensus rates being highest in the Biomedical Scientist group (72.7% of statements reached 70% consensus), followed by the student group (54.5% of statements reached 70% consensus) and lowest in the academic group (40.9% of statements reached 70% consensus).
DISCUSSION
This demonstrates a theory-practice gap in both the academic and student groups, suggesting that graduates are insufficiently prepared for their post-graduate role. This gap was particularly evident when discussing topics such as how Biomedical Scientists contribute to patient care, professional registration and working as part of the multi-disciplinary team (MDT). The identification of a theory-practice gap in the education of Biomedical Scientists is a novel finding, indicating that students may graduate with insufficient understanding of the Biomedical Scientist role.
Topics: Humans; Biomedical Research; Delphi Technique; Focus Groups; Consensus; Research Personnel; Male; Female
PubMed: 38933755
DOI: 10.3389/bjbs.2024.12629 -
Asia-Pacific Journal of Oncology Nursing Jun 2024The delivery of bad news is an unpleasant but necessary medical procedure. However, few studies have addressed the experiences and preferences of the families of...
OBJECTIVE
The delivery of bad news is an unpleasant but necessary medical procedure. However, few studies have addressed the experiences and preferences of the families of school-aged children with cancer when they are informed of the children's condition. This study aimed to explore families of school-age children with cancer for their preferences and experiences of truth-telling.
METHODS
This descriptive phenomenological qualitative research was conducted using focus group interviews and semistructured interview guidelines were adopted for in-depth interviews. Fifteen families participated in the study. The data were analyzed using Colaizzi's analysis. Data were collected from August 2019 to May 2020.
RESULTS
The study identified two major themes: "caught in a dilemma" and "kind and comprehensive team support." The first major theme focused on families' experiences with cancer truth-telling. Three sub-themes emerged: (1) cultural aspects of cancer disclosure, (2) decision-making regarding informing pediatric patients about their illness, and (3) content of disclosure after weighing the pros and cons. The second major theme, which revealed families' preferences for delivering bad news, was classified into three sub-themes: (1) have integrity, (2) be realistic, and (3) be supportive.
CONCLUSIONS
This study underscores the dilemma encountered by the families of children with cancer after disclosure and their inclination toward receiving comprehensive information and continuous support. Health care personnel must improve their truth-telling ability in order to better address the needs of such families and to provide continuous support throughout the truth-telling process.
PubMed: 38933686
DOI: 10.1016/j.apjon.2024.100500 -
Frontiers in Reproductive Health 2024In 2016, UNAIDS set ambitious targets to reduce global HIV infections by 75% by 2020 and 90% by 2030, based on the 2.1 million new infections reported in 2010. However,...
INTRODUCTION
In 2016, UNAIDS set ambitious targets to reduce global HIV infections by 75% by 2020 and 90% by 2030, based on the 2.1 million new infections reported in 2010. However, by 2022, new HIV infections had only decreased by 38%, from 2.1 million in 2010 to 1.3 million in 2022, raising concerns about reaching the 2030 goal. Female sex workers (FSWs) in sub-Saharan Africa face a disproportionately high risk of HIV acquisition, contributing 5%-20% of all new infections in several countries in the region. This analysis investigates HIV seroconversion and associated factors among FSWs, offering insights into critical interventions for preventing HIV transmission in this population and advancing the goal of ending the HIV pandemic by 2030.
METHODS
We conducted a retrospective cohort study involving 17,977 FSWs who initially tested HIV negative upon enrollment in the Sauti project between October 2016 and September 2018. HIV incidence rates were calculated by dividing the number of new HIV cases by observed person-time within the cohort. Cox regression analysis identified factors associated with seroconversion.
RESULTS
The study revealed an HIV incidence rate of 8.6 per 100 person-years among FSWs [95% confidence interval (CI): 8.1-9.1]. Factors independently associated with HIV seroconversion included age 35 years or older [adjusted hazard ratio (aHR): 2.53; 95% CI: 2.03-3.14], unprotected sex (aHR: 1.27; 95% CI: 1.13-1.42), STI symptoms (aHR: 1.99; 95% CI: 1.67-2.38), and alcohol consumption before sex (aHR: 1.20; 95% CI: 1.07-1.34).
CONCLUSION
Targeted interventions are vital in curbing HIV transmission among FSWs, with a focus on expanding access to primary HIV prevention services, particularly for older FSWs who face heightened risk. Tailored sexual health education programs are imperative to encourage consistent condom use and enable informed decision-making. Accessible and timely STI screening and treatment services are crucial to mitigate HIV transmission risk. Collaborative partnerships between healthcare providers, community organizations, and government agencies are essential in implementing these interventions among FSWs.
PubMed: 38933455
DOI: 10.3389/frph.2024.1332236 -
BMJ Open Sport & Exercise Medicine 2024The purpose of this study was to review the current literature regarding the non-operative treatment of isolated medial collateral ligament (MCL) injuries.
OBJECTIVE
The purpose of this study was to review the current literature regarding the non-operative treatment of isolated medial collateral ligament (MCL) injuries.
DESIGN
Systematic review, registered in the Open Science Framework (https://doi.org/10.17605/OSF.IO/E9CP4).
DATA SOURCES
The Embase, MEDLINE and PEDro databases were searched; last search was performed on December 2023.
ELIGIBILITY CRITERIA
Peer-reviewed original reports from studies that included information about individuals who sustained an isolated MCL injury with non-surgical treatment as an intervention, or reports comparing surgical with non-surgical treatment were eligible for inclusion. Included reports were synthesised qualitatively. Risk of bias was assessed with the Risk of Bias Assessment tool for Non-randomized Studies. Certainty of evidence was determined using the Grading of Recommendations Assessment Development and Evaluation.
RESULTS
A total of 26 reports (1912 patients) were included, of which 18 were published before the year 2000 and 8 after. No differences in non-operative treatment were reported between grade I and II injuries, where immediate weight bearing and ambulation were tolerated, and rehabilitation comprised different types of strengthening exercises with poorly reported details. Some reports used immobilisation with a brace as a treatment method, while others did not use any equipment. The use of a brace and duration of use was inconsistently reported.
CONCLUSION
There is substantial heterogeneity and lack of detail regarding the non-operative treatment of isolated MCL injuries. This should prompt researchers and clinicians to produce high-quality evidence studies on the promising non-operative treatment of isolated MCL injuries to aid in decision-making and guide rehabilitation after MCL injury.
LEVEL OF EVIDENCE
Level I, systematic review.
PubMed: 38933372
DOI: 10.1136/bmjsem-2023-001750 -
Neurobiology of Stress Jul 2024Many everyday decisions, including those concerning our health, finances and the environment, involve choosing between a smaller but imminent reward (e.g., €20 now)... (Review)
Review
Many everyday decisions, including those concerning our health, finances and the environment, involve choosing between a smaller but imminent reward (e.g., €20 now) and a later but larger reward (e.g., €40 in a month). The extent to which an individual prefers smaller imminent rewards over larger delayed rewards can be measured using delay discounting tasks. Acute stress induces a cascade of biological and psychological responses with potential consequences for how individuals think about the future, process rewards, and make decisions, all of which can impact delay discounting. Several studies have shown that individuals focus more on imminent rewards under stress. These findings have been used to explain why individuals make detrimental choices under acute stress. Yet, the evidence linking acute stress to delay discounting is equivocal. To address this uncertainty, we conducted a meta-analysis of 11 studies (14 effects) to systematically quantify the effects of acute stress on monetary delay discounting. Overall, we find no effect of acute stress on delay discounting, compared to control conditions (SMD = -0.18, 95% CI [-0.57, 0.20], p = 0.32). We also find that neither the gender/sex of the participants, the type of stressor (e.g., physical vs. psychosocial) nor whether monetary decisions were hypothetical or incentivized (i.e. monetary decisions were actually paid out) moderated the impact of acute stress on monetary delay discounting. We argue that establishing the effects of acute stress on the separate processes involved in delay discounting, such as reward valuation and prospection, will help to resolve the inconsistencies in the field.
PubMed: 38933285
DOI: 10.1016/j.ynstr.2024.100653