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JACC. Advances Jun 2024Patients with heart failure (HF) are a medically complex population with frequent hospitalizations. Downstream health care utilization following primary care delivered...
BACKGROUND
Patients with heart failure (HF) are a medically complex population with frequent hospitalizations. Downstream health care utilization following primary care delivered by telemedicine compared to in-person is unknown.
OBJECTIVES
The purpose of this study was to understand differences in return in-person visits, emergency department (ED) encounters, and hospitalizations following a telemedicine vs an in-person primary care visit for patients with HF seen for a HF-related complaint.
METHODS
This was an observational study of all primary care visits for HF from January 1, 2022, to December 31, 2022, in an integrated health care delivery system. We compared 7-day in-person follow-up visits, ED visits, and hospitalizations (all-cause and HF-specific) by index visit type.
RESULTS
We included 3,902 primary care visits with a primary diagnosis of HF. Most visits utilized telephone or video visits (58.4% total; 44.9% telephone, 13.5% video). After adjustment, telephone visits were associated with more in-person follow-up visits (6.14% vs 4.20%; adjusted OR: 1.08-2.21; < 0.05) but fewer ED visits (6.12% vs 8.07%; adjusted OR: 0.55-0.97; < 0.05) compared to in-person visits. Most hospitalized patients (74%) had an admitting diagnosis of HF. There was no difference between 7-day all-cause hospitalization following telephone or video visits compared to in-person visits.
CONCLUSIONS
Most patients used telemedicine to address HF-specific primary care concerns. Telephone visits were associated with slightly higher short-term in-person primary care follow-up but lower ED utilization. Overall, downstream ED visits and hospitalizations were low. Telephone and video visits appear to offer safe alternatives to in-person care for HF-related primary care and are a promising health care delivery strategy.
PubMed: 38938856
DOI: 10.1016/j.jacadv.2024.100969 -
JACC. Advances Mar 2024Hypertensive disorders of pregnancy (HDP) complicate 13% to 15% of pregnancies in the United States. Historically marginalized communities are at increased risk, with... (Review)
Review
Hypertensive disorders of pregnancy (HDP) complicate 13% to 15% of pregnancies in the United States. Historically marginalized communities are at increased risk, with preeclampsia and eclampsia being the leading cause of death in this population. Pregnant individuals with HDP require more frequent and intensive monitoring throughout the antepartum period outside of routine standard of care prenatal visits. Additionally, acute rises in blood pressure often occur 3 to 6 days postpartum and are challenging to identify and treat, as most postpartum individuals are usually scheduled for their first visit 6 weeks after delivery. Thus, a multifaceted approach is necessary to improve recognition and treatment of HDP throughout the peripartum course. There are limited studies investigating interventions for the management of HDP, especially within the United States, where maternal mortality is rising, and in higher-risk groups. We review the state of current management of HDP and innovative strategies such as blood pressure self-monitoring, telemedicine, and community health worker intervention.
PubMed: 38938826
DOI: 10.1016/j.jacadv.2024.100864 -
Frontiers in Neurology 2024Migraine, a prevalent neurological disorder, affects approximately 14.1% of the global population and disproportionately impacts females. This debilitating condition... (Review)
Review
Migraine, a prevalent neurological disorder, affects approximately 14.1% of the global population and disproportionately impacts females. This debilitating condition significantly compromises quality of life, productivity, and incurs high healthcare costs, presenting a challenge not only to individuals but to societal structures as a whole. Despite advances in our understanding of migraine pathophysiology, treatment options remain limited, necessitating ongoing research into effective therapies. This review delves into the complexity of migraine management, examining the roles of genetic predisposition, environmental influences, personalized treatment approaches, comorbidities, efficacy and safety of existing acute and preventive treatments. It further explores the continuum between migraine and tension-type headaches and discusses the intricacies of treating various migraine subtypes, including those with and without aura. We emphasize the recent paradigm shift toward trigeminovascular activation and the release of vasoactive substances, such as calcitonin gene-related peptide (CGRP), which offer novel therapeutic targets. We assess groundbreaking clinical trials, pharmacokinetic and pharmacodynamic perspectives, safety, tolerability, and the real-world application of CGRP monoclonal antibodies and gepants. In the face of persisting treatment barriers such as misdiagnosis, medication overuse headaches, and limited access to specialist care, we discuss innovative CGRP-targeted strategies, the high cost and scarcity of long-term efficacy data, and suggest comprehensive solutions tailored to Turkiye and developing countries. The review offers strategic recommendations including the formulation of primary care guidelines, establishment of specialized outpatient clinics, updating physicians on novel treatments, enhancing global accessibility to advanced therapies, and fostering patient education. Emphasizing the importance of lifestyle modifications and holistic approaches, the review underscores the potential of mass media and patient groups in disseminating critical health information and shaping the future of migraine management.
PubMed: 38938785
DOI: 10.3389/fneur.2024.1402569 -
JACC. Advances Nov 2023The prevalence and degree of lower extremity artery disease in hemodialysis (HD) patients is higher than in the general population. However, the pathological features...
BACKGROUND
The prevalence and degree of lower extremity artery disease in hemodialysis (HD) patients is higher than in the general population. However, the pathological features have not yet been evaluated.
OBJECTIVES
The aim of the study was: 1) to compare lesion characteristics of lower extremity artery disease in HD vs non-HD patients; and 2) to determine factors associated with severe medial calcification.
METHODS
Seventy-seven lower limb arteries were assessed from 36 patients (median age 77 years; 23 men; 21 HD and 15 non-HD) who underwent autopsy or lower limb amputation. Arteries were serially cut at 3- to 4-mm intervals creating 2,319 histological sections. Morphometric analysis and calcification measurements were performed using ZEN software. Calcification with a circumferential angle (arc) ≥180° was defined as severe calcification. Multivariable logistic regression was used to identify risk factors for severe medial calcification.
RESULTS
The degree of the medial calcification arc was significantly higher in the HD group compared to the non-HD group ( < 0.0001). In the multivariable analysis, HD was associated with severe medial calcification in below-the-knee lesions (OR: 17.1; = 0.02). The degree of intimal calcification in above-the-knee lesions was also significantly higher in HD patients with a higher prevalence of advanced atherosclerotic plaque ( = 0.02). The prevalence of severe bone formation was more common in the HD patients ( = 0.01).
CONCLUSIONS
Hemodialysis patients demonstrated a higher degree of medial and intimal calcification compared with non-HD patients. The difference was more prominent in the medial calcification of below-the-knee lesions.
PubMed: 38938733
DOI: 10.1016/j.jacadv.2023.100656 -
JACC. Advances Nov 2023Prior studies of aortic valve replacement (AVR) in patients with normal-flow, low-gradient aortic stenosis (NF-LG AS) have demonstrated conflicting results regarding the...
BACKGROUND
Prior studies of aortic valve replacement (AVR) in patients with normal-flow, low-gradient aortic stenosis (NF-LG AS) have demonstrated conflicting results regarding the survival benefit of AVR. Changes in quality of life (QoL) after transcatheter AVR (TAVR) have not been reported in this population.
OBJECTIVES
The purpose of this study was to compare changes in QoL after TAVR for patients with NF-LG AS to patients with high-gradient aortic stenosis (HG-AS).
METHODS
Patients who underwent TAVR for severe aortic stenosis (AS) were divided into 4 hemodynamic profiles of AS, including NF-LG AS. Changes in Kansas City Cardiomyopathy Questionnaire-12 score from baseline to 1 year were compared between AS groups. The primary composite outcome indicating clinical improvement consisted of survival to 1 year and improved Kansas City Cardiomyopathy Questionnaire overall summary score of ≥5 points while adjusting for relevant baseline factors.
RESULTS
Out of 860 patients who underwent TAVR, high gradient AS was present in 368 (42.8%) patients and NF-LG AS in 245 (28.5%). HG-AS and NF-LG AS groups had a similar proportion of patients who met the primary unadjusted outcome of clinical improvement (70.4% vs 63.9%, respectively; = 0.189). One-year Kaplan-Meier mortality estimates were higher for NF-LG AS patients than HG-AS patients (12.9% vs 5.8%, < 0.001). In the primary adjusted analysis, there was no significant difference in the composite outcome between HG and NF-LG AS groups (adjusted OR: 0.72, 95% CI: 0.47-1.11).
CONCLUSIONS
Selected patients with NF-LG AS experienced similar improvement in QoL after TAVR compared with HG-AS. Further investigation of patients with NF-LG AS will help to inform optimal selection for treatment with TAVR.
PubMed: 38938726
DOI: 10.1016/j.jacadv.2023.100641 -
Polish Journal of Radiology 2024To assess the effectiveness of contrast-enhanced mammography (CEM) recombinant images in detecting malignant lesions in patients with extremely dense breasts compared to...
Comparison of the effectiveness of contrast-enhanced mammography in detecting malignant lesions in patients with extremely dense breasts compared to the all-densities population.
PURPOSE
To assess the effectiveness of contrast-enhanced mammography (CEM) recombinant images in detecting malignant lesions in patients with extremely dense breasts compared to the all-densities population.
MATERIAL AND METHODS
792 patients with 808 breast lesions, in whom the final decision on core-needle biopsy was made based on CEM, and who received the result of histopathological examination, were qualified for a single-centre, retrospective study. Patient electronic records and imaging examinations were reviewed to establish demographics, clinical and imaging findings, and histopathology results. The CEM images were reassessed and assigned to the appropriate American College of Radiology (ACR) density categories.
RESULTS
Extremely dense breasts were present in 86 (10.9%) patients. Histopathological examination confirmed the presence of malignant lesions in 52.6% of cases in the entire group of patients and 43% in the group of extremely dense breasts. CEM incorrectly classified the lesion as false negative in 16/425 (3.8%) cases for the whole group, and in 1/37 (2.7%) cases for extremely dense breasts. The sensitivity of CEM for the group of all patients was 96.2%, specificity - 60%, positive predictive values (PPV) - 72.8%, and negative predictive values (NPV) - 93.5%. In the group of patients with extremely dense breasts, the sensitivity of the method was 97.3%, specificity - 59.2%, PPV - 64.3%, and NPV - 96.7%.
CONCLUSIONS
CEM is characterised by high sensitivity and NPV in detecting malignant lesions regardless of the type of breast density. In patients with extremely dense breasts, CEM could serve as a complementary or additional examination in the absence or low availability of MRI.
PubMed: 38938658
DOI: 10.5114/pjr/186180 -
PeerJ 2024The associations of fundamental motor skills (FMS), health-related physical fitness (., cardiorespiratory fitness, CRF), and moderate-vigorous physical activity (MVPA)...
BACKGROUND AND PURPOSE
The associations of fundamental motor skills (FMS), health-related physical fitness (., cardiorespiratory fitness, CRF), and moderate-vigorous physical activity (MVPA) have been demonstrated in Western children, but these associations have not yet been validated in a sample of Chinese children. The aims of this study, therefore, were to examine the association between FMS subdomains and MVPA in a sample of Chinese children and to evaluate whether this association is mediated by CRF.
METHODS
A cross-sectional study consisting of 311 children aged 8-12 years (49.2% girls; mean age = 9.9 years) from Shanghai was conducted. FMS, CRF and MVPA were assessed using the Test of Gross Motor Development-3rd Edition, Progressive Aerobic Cardiovascular Endurance Run and ActiGraph GT3X accelerometers. Preacher & Hayes's bootstrap method was used to test the mediating effects of CRF on the association between FMS and MVPA.
RESULTS
CRF fully mediated the association between total FMS and MVPA in girls (indirect effects, = 0.21, 95% CI [0.07-0.37]), while the mediation was only partial in boys (indirect effects, = 0.12, 95% CI [0.01-0.26]). CRF fully mediated the association between locomotor skills and MVPA in girls (indirect effects, = 0.27, 95% CI [0.09- 0.51]), whereas CRF partially mediated the association between object control skills and MVPA in boys (indirect effects, = 0.15, 95% CI [0.18-0.35]).
CONCLUSION
In order to better design and implement sex-specific interventions aiming to increase MVPA, it is essential to consider FMS subdomains and CRF alongside the sex differences in the association between them.
Topics: Humans; Female; Male; Child; Cardiorespiratory Fitness; Cross-Sectional Studies; Exercise; China; Accelerometry; Motor Skills; Sex Factors; East Asian People
PubMed: 38938618
DOI: 10.7717/peerj.17564 -
PeerJ 2024is the only species distributed in the subtropical region within the spring ephemeral genus . Extensive human exploitation and habitat destruction have resulted in a...
BACKGROUND
is the only species distributed in the subtropical region within the spring ephemeral genus . Extensive human exploitation and habitat destruction have resulted in a rapid shrink of populations. This study utilizes microsatellite markers to analyze the genetic diversity and structure and to deduce historical population events of extant populations of .
METHODS
A total of 143 individuals from eight extant populations of , including two populations from Anhui Province and six populations from Zhejiang Province, were analyzed with using 21 pairs of microsatellite markers. Genetic diversity indices were calculated using Cervus, GENEPOP, GenALEX. Population structure was assessed using genetic distance (UPGMA), principal coordinate analysis (PCoA), Bayesian clustering method (STRUCTURE), and molecular variation analysis of variance (AMOVA). Population history events were inferred using DIYABC.
RESULTS
The studied populations of exhibited a low level of genetic diversity ( = 0.179, = 0.286), but a high degree of genetic differentiation ( = 0.521). The mean value of gene flow ( ) among populations was 1.082, indicating prevalent gene exchange pollen dispersal. Phylogeographic analyses suggested that the populations of were divided into two lineages, Zhejiang (ZJ) and Anhui (AH). These two lineages were separated by the Huangshan-Tianmu Mountain Range. AMOVA analysis revealed that 36.59% of total genetic variation occurred between the two groups. The ZJ lineage was further divided into the Hangzhou (ZJH) and Zhuji (ZJZ) lineages, separated by the Longmen Mountain and Fuchun River. DIYABC analyses suggested that the ZJ and AH lineages were separated at 5.592 ka, likely due to the impact of Holocene climate change and human activities. Subsequently, the ZJZ lineage diverged from the ZJH lineage around 2.112 ka. Given the limited distribution of and the significant genetic differentiation among its lineages, both and conservation strategies should be implemented to protect the germplasm resources of .
Topics: China; Microsatellite Repeats; Genetic Variation; Gene Flow; Cycadopsida; Bayes Theorem; Genetics, Population; Phylogeny
PubMed: 38938610
DOI: 10.7717/peerj.17554 -
Clinical Ophthalmology (Auckland, N.Z.) 2024This study investigates the association between self-reported birth weight (BW) and the prevalence of hypertensive retinopathy (HR) in a large population-based cohort in...
This study investigates the association between self-reported birth weight (BW) and the prevalence of hypertensive retinopathy (HR) in a large population-based cohort in Germany, as part of the Gutenberg Health Study (GHS). The study involved analyzing fundus photographs of 6855 participants, aged 35 to 74, to assess signs of HR, classified according to the Mitchell-Wong Classification. The research aimed to explore the correlation between fetal growth restriction indicated by BW and the frequency of HR. The results showed that the frequency of HR did not significantly differ among groups with different BW ranges. In the univariable analysis, HR was initially associated with high BW, but this association disappeared after adjusting for age, sex, and cardiovascular risk factors. No association was found between low BW and HR. The study reveals novel insights as there are no prior population-based studies specifically exploring this association.
PubMed: 38938591
DOI: 10.2147/OPTH.S461261 -
Scientifica 2024Arruda (Anacardiaceae), popularly known as umbuzeiro or imbuzeiro, is a fruit tree native to the semiarid region of Brazil. The extractive harvesting of its fruits...
Arruda (Anacardiaceae), popularly known as umbuzeiro or imbuzeiro, is a fruit tree native to the semiarid region of Brazil. The extractive harvesting of its fruits contributes significantly to the economy, generating an annual revenue of approximately $4,2 million. The present study aimed to assess the spatial pattern, allometric variations, fruit measurements, and genetic diversity of trees within a remaining forest of the Caatinga biome, with a focus on intrapopulation analysis. We used intersimple repeated sequence markers and the second-order function density of neighbours to determine the genetic and spatial structure. The density of neighbours was highest within a 10-meter radius. Biometric analyses revealed average fruit lengths of 31.12 mm (±0.22), diameters of 28.68 mm (±0.25), and fresh masses of 15.56 g (±0.33). Diaspores exhibited an average length, diameter, and thickness of 19.27 mm, 13.95 mm, and 11.14 mm, respectively, with a fresh mass of 2.28 g. Notably, the fresh mass demonstrated the highest coefficient of variation. Ten molecular markers were selected, generating 103 highly polymorphic loci (99.03%) with an average informative content of 0.45. Nei's diversity index (0.37) and Shannon's index (0.55) indicated moderate genetic diversity. Furthermore, Bayesian analysis revealed a population structure with two distinct genetic groups. The Infinite Allele and Mutation Step Models suggested a significant historical decline in population size, indicative of a genetic bottleneck. As a result, proactive in situ conservation strategies, including establishing protected natural areas, become essential, considering the socioeconomic significance of the species. Additionally, it is recommended to establish germplasm banks for ex situ conservation and the development of managed cultivation initiatives to reduce the pressure on native populations of caused by extraction.
PubMed: 38938543
DOI: 10.1155/2024/5023974