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American Journal of Critical Care : An... Jul 2024Pain is a significant burden for children with neurodevelopmental disabilities but is difficult for clinicians to identify. No pain assessment tools for children with... (Observational Study)
Observational Study
BACKGROUND
Pain is a significant burden for children with neurodevelopmental disabilities but is difficult for clinicians to identify. No pain assessment tools for children with neurodevelopmental disabilities have been validated for use in pediatric intensive care units. The Individualized Numeric Rating Scale (INRS) is an adapted 0-to-10 rating that includes parents' input on their child's pain indicators.
OBJECTIVES
To evaluate the reliability, validity, and feasibility and acceptability of use of the INRS for assessing pain in critically ill children with neurodevelopmental disabilities.
METHODS
This observational study enrolled critically ill patients with neurodevelopmental disabilities aged 3 to 17 years in 2 pediatric intensive care units at a children's hospital using a prospective repeated-measures cohort design. Structured parent interviews were used to populate each patient's INRS. Bedside nurses assessed pain using the INRS throughout the study. The research team completed independent INRS ratings using video clips. Participating parents and nurses completed feasibility and acceptability surveys. Psychometric properties of the INRS and survey responses were evaluated with appropriate statistical methods.
RESULTS
For 481 paired INRS pain ratings in 34 patients, interrater reliability between nurse and research team ratings was moderate (weighted κ = 0.56). Parents said that creating the INRS was easy, made them feel more involved in care, and helped them communicate with nurses.
CONCLUSIONS
The INRS has adequate measurement properties for assessing pain in critically ill children with neurodevelopmental disabilities. It furthers goals of patient- and family-centered care but may have implementation barriers.
Topics: Humans; Child; Child, Preschool; Female; Adolescent; Male; Critical Illness; Pain Measurement; Reproducibility of Results; Prospective Studies; Psychometrics; Intensive Care Units, Pediatric; Neurodevelopmental Disorders; Parents; Feasibility Studies
PubMed: 38945815
DOI: 10.4037/ajcc2024343 -
American Journal of Critical Care : An... Jul 2024
Topics: Humans; Intensive Care Units, Pediatric; Child; Neurodevelopmental Disorders; Child, Preschool; Critical Care
PubMed: 38945809
DOI: 10.4037/ajcc2024366 -
Public Health Jun 2024To estimate the health and economic burden of non-communicable diseases (NCDs) attributed to alcohol consumption in 2019 for the Brazilian Unified Health System (SUS)...
OBJECTIVE
To estimate the health and economic burden of non-communicable diseases (NCDs) attributed to alcohol consumption in 2019 for the Brazilian Unified Health System (SUS) stratified by states.
STUDY DESIGN
Observational, descriptive, and ecological study.
METHODS
We used population attributable fractions (PAFs) of NCDs due to alcohol consumption from the Global Burden of Disease study. We applied the PAFs to the costs of hospitalizations and outpatient procedures of medium to high complexity paid by SUS for each outcome, obtained from official databases. We also calculated the disability-adjusted life years (DALYs) and mortality caused by alcohol-related NCDs. We converted the costs into international dollars (Int$) using the purchasing parity power in 2019.
RESULTS
Alcohol-related NCDs accounted for 8.48% of deaths and 7.0% of DALYs among men, and 1.33% of deaths and 1.6% of DALYs among women. The main diseases were substance use, digestive, and neoplastic diseases. The SUS spent Int$202.0 million on alcohol-related NCDs, mostly on hospitalizations. The highest health burden was observed in the states of the Northeast region, and the highest expenses in the states from the South. The burden and cost values varied by sex, age group, and state.
CONCLUSION
The study showed that alcohol consumption has a significant impact on Brazilian population morbidity and mortality and SUS expenditures, especially among men. These results can support policies for the prevention and control of alcohol consumption and health promotion at the subnational level, prioritizing strategies that are more appropriate to local realities.
PubMed: 38944900
DOI: 10.1016/j.puhe.2024.05.014 -
Inflammatory Bowel Diseases Jun 2024Inflammatory bowel diseases are chronic disabling conditions with a complex and multifactorial etiology, still incompletely understood. OCTN1, an organic cation...
BACKGROUND
Inflammatory bowel diseases are chronic disabling conditions with a complex and multifactorial etiology, still incompletely understood. OCTN1, an organic cation transporter, could have a role in modulating the inflammatory response, and some genetic polymorphisms of this molecule have been associated with increased risk of inflammatory bowel diseases. Until now, limited information exists on its potential in predicting/modulating patient's response to therapies. The aim of this study was to evaluate the role of OCTN1 in modifying gut microbiota and mucosal immunity in response to infliximab therapy in murine colitis.
METHODS
A dextran sodium sulphate model of colitis was used to assess the clinical efficacy of infliximab administered intravenously in ocnt1 gene knockout mice and their C57BL/6 controls. Stool, colon, and mesenteric lymph node samples were collected to evaluate differences in gut microbiota composition, histology, and T cell populations, respectively.
RESULTS
Octn1 -/- influences the microbiota profile and is associated with a worse dysbiosis in mice with colitis. Infliximab treatment attenuates colitis-associated dysbiosis, with an increase of bacterial richness and evenness in both strains. In comparison with wild type, octn1-/- mice have milder disease and a higher baseline percentage of Treg, Tmemory, Th2 and Th17 cells.
CONCLUSIONS
Our data support the murine model to study OCTN1 genetic contribution to inflammatory bowel diseases. This could be the first step towards the recognition of this membrane transporter as a biomarker in inflammatory conditions and a predictor of response to therapies.
PubMed: 38944815
DOI: 10.1093/ibd/izae135 -
Advances in Gerontology = Uspekhi... 2024A study was conducted to investigate the associations of the diseases of the organ of vision and its accessory apparatus with anxiety and depression in the elderly...
A study was conducted to investigate the associations of the diseases of the organ of vision and its accessory apparatus with anxiety and depression in the elderly people. The study included 678 participants of the ESSE-RF3 population study in the Arkhangelsk region in the age of 60-74 years. We used a questionnaire, including the hospital scale of anxiety and depression score (HADS), and the assessment of the ophthalmological status. It was found that all the study participants had diseases of the visual organ. Elevated depression scores were associated with sex, age, marital status (being single), and disability, elevated anxiety scores - with sex. The scores on the anxiety scale were on average 25% higher in participants whose visual acuity decreased to 0,5 units, and showed no independent associations with diagnosed ophthalmological diseases. The scores on the depression scale were on average 33% higher in participants with visual acuity 0,5 units, and 22% higher in the presence of retinopathy. In conclusion, anxiety and depression in the elderly people were more associated with visual deficits rather than with the presence of ophthalmological diseases underlying a decrease in functional status.
Topics: Humans; Male; Female; Aged; Middle Aged; Russia; Anxiety; Visual Acuity; Depression; Eye Diseases; Surveys and Questionnaires; Vision Disorders
PubMed: 38944776
DOI: No ID Found -
Advances in Gerontology = Uspekhi... 2024The foundation of healthy aging is the prevention of disability. In modern medical usage, a syndrome refers to a collection of symptoms and signs with a single... (Review)
Review
The foundation of healthy aging is the prevention of disability. In modern medical usage, a syndrome refers to a collection of symptoms and signs with a single underlying cause that may not yet be known. Geriatric syndromes, on the other hand, refer to multifactorial health conditions and occur when the accumulated effects of impairments in multiple systems make an older person vulnerable to situational changes. The use of the term "syndrome" in geriatrics emphasizes the multiple causes of a single manifestation involving an abundance of factors involving multiple organs and systems and is characterized by unique features of common health problems in older adults. It is the geriatric syndromes that can have a significant impact on quality of life and disability. Therefore, early detection of these medical conditions using targeted geriatric assessment is essential in geriatrics. Understanding the essence and feminology of geriatric syndromes, their correct positioning and interpretation is an extremely urgent problem. The main purpose of the presented review is precisely to try to answer these questions. In addition, it has not yet been determined whether geriatric syndromes should be included in the diagnosis (the only exception is sarcopenia syndrome, which was officially included in the 10th International Classification of Diseases in 2016).
Topics: Humans; Aged; Terminology as Topic; Geriatric Assessment; Syndrome; Quality of Life; Geriatrics; Sarcopenia; Aging
PubMed: 38944774
DOI: No ID Found -
Advances in Gerontology = Uspekhi... 2024The purpose of this review is to demonstrate the importance of using a comprehensive geriatric examination in cardiology, including geriatric aspects of the management... (Review)
Review
The purpose of this review is to demonstrate the importance of using a comprehensive geriatric examination in cardiology, including geriatric aspects of the management of this patient population. Until now, the Russian Federation has completely lacked a geriatric approach to the management of cardiological patients, which provides for consideration of international experience in this survey. The curation of elderly and elderly patients is complicated by the presence of geriatric syndromes and age-associated diseases leading to deterioration of quality of life, repeated hospitalizations, disability and risk of death. The leading geriatric syndrome in geriatric practice is senile asthenia and multiple comorbid polymorbid pathologies of the geriatric patient. A patient admitted to an acute care hospital with a history of cardiovascular comorbid pathology is primarily viewed as a patient at high risk for cardiovascular complications, omitting the risk of adverse outcomes, including loss of independence and impaired functional status. The following literature review demonstrates the importance of defining senile asthenia outside of the geriatrician's office, justifying the need for advanced training for cardiologists in geriatrics.
Topics: Humans; Geriatric Assessment; Aged; Cardiovascular Diseases; Quality of Life; Cardiology; Asthenia; Comorbidity
PubMed: 38944769
DOI: No ID Found -
Mymensingh Medical Journal : MMJ Jul 2024This was a multicenter cohort study to evaluate the relationship between radiological findings and disability in moderate and severe head injury patients. The study...
This was a multicenter cohort study to evaluate the relationship between radiological findings and disability in moderate and severe head injury patients. The study places were the Neurosurgery department of Sylhet M A G Osmani Medical College Hospital, Sylhet Women's Medical College Hospital (SWMCH) and King Faisal Hospital (KFH), Taif, KSA. Sample size was 104 and the study period was 36 months (July 2021 to December 2022). On the basis of radiological findings the participants were divided into three arms. The different arms were diffused traumatic brain injury (arm-1), focal traumatic brain injury (arm-2) and both (diffused and traumatic) types traumatic brain injury (arm-3). Outcome was assessed by modified Rankin Score (mRS). Mean age was significantly higher in female. Overall mean age was 40.28 year. Highest number was in the below 20-year age group followed by the 41-50-year age group. Lowest number of participants was in the above 60-year group. Improved group was significantly higher than 'not improved' and the 'died' group (p<0.00001). Improved participants were significantly higher in the arm-1 and arm-2. Mortality was significantly higher (p<0.00001) in the arm-3 group.
Topics: Humans; Female; Adult; Middle Aged; Male; Cohort Studies; Craniocerebral Trauma; Young Adult; Brain Injuries, Traumatic; Adolescent; Aged; Disability Evaluation
PubMed: 38944732
DOI: No ID Found -
Journal of the American Geriatrics... Jun 2024Sensory disability in older adults is associated with increased rates of depressive symptoms and loneliness. Here, we examined the impact of hearing, vision, and...
BACKGROUND
Sensory disability in older adults is associated with increased rates of depressive symptoms and loneliness. Here, we examined the impact of hearing, vision, and olfaction disability on mental health outcomes in older US adults.
METHODS
We studied respondents from the first three rounds (2005/6, 2010/11, and 2015/16) of the National Social Life, Health and Aging Project, a nationally representative, longitudinal study of older US adults. Sensory function was assessed by structured interviewer ratings (hearing and vision) and objective assessment (olfaction). Cox proportional hazards models and one degree of freedom tests for trend were utilized to analyze the relationships between sensory disability and self-rated mental health, frequent depressive symptoms, frequent perceived stress, frequent anxiety symptoms, and frequent loneliness symptoms over time, adjusting for demographics, health behaviors, comorbidities, and cognitive function.
RESULTS
We analyzed data from 3940 respondents over 10 years of follow-up. A greater number of sensory disabilities was associated with greater hazard of low self-rated mental health, frequent depressive symptoms, frequent perceived stress, and frequent loneliness symptoms over time (p ≤ 0.003, all). After adjusting for covariates, older adults with a greater number of sensory disabilities had greater hazard of low self-rated mental health (HR = 1.22, CI = [1.08, 1.38], p = 0.002) and loneliness symptoms (HR = 1.13, CI = [1.05, 1.22], p = 0.003) over time in our tests for trend. In our Cox proportional hazards model, older adults with vision disability had greater hazard of low self-rated mental health (HR = 1.34, 95% CI = [1.05, 1.72], p = 0.02) and loneliness symptoms (HR = 1.21, CI = [1.04, 1.41], p = 0.01).
CONCLUSIONS
Older US adults with greater numbers of sensory disabilities face worse subsequent mental health. Future longitudinal studies dissecting the relationship of all five classical senses will be helpful in further understanding how improving sensory function might improve mental health in older adults.
PubMed: 38944677
DOI: 10.1111/jgs.19056 -
BMC Pulmonary Medicine Jun 2024For patients with congenital heart disease-related pulmonary arterial hypertension (CHD-PAH), cardiopulmonary exercise testing (CPET) can reflect cardiopulmonary reserve...
BACKGROUND
For patients with congenital heart disease-related pulmonary arterial hypertension (CHD-PAH), cardiopulmonary exercise testing (CPET) can reflect cardiopulmonary reserve function. However, CPET may not be readily accessible for patients with high-risk conditions or limited mobility due to disability. Echocardiography, on the other hand, serves as a widely available diagnostic tool for all CHD-PAH patients. This study was aimed to identify the parameters of echocardiography that could serve as indicators of cardiopulmonary function and exercise capacity.
METHODS
A cohort of 70 patients contributed a total of 110 paired echocardiogram and CPET results to this study, with 1 year interval for repeated examinations. Echocardiography and exercise testing were conducted following standardized procedures, and the data were collected together with clinically relevant indicators for subsequent statistical analysis. Demographic comparisons were performed using t-tests and chi-square tests. Univariate and multivariate analyses were conducted to identify potential predictors of peak oxygen uptake (peak VO) and the carbon dioxide ventilation equivalent slope (VE/VCO slope). Receiver operating characteristic (ROC) analysis was used to assess the performance of the parameters.
RESULTS
The ratio of tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP) was found to be the only independent indicator significantly associated with both peak VO and VE/VCO slope (both p < 0.05). Additionally, left ventricular ejection fraction (LVEF) and right ventricular fractional area change (FAC) were independently correlated with the VE/VCO slope (both p < 0.05). TAPSE/PASP showed the highest area under the ROC curve (AUC) for predicting both a peak VO ≤ 15 mL/kg/min and a VE/VCO slope ≥ 36 (AUC = 0.91, AUC = 0.90, respectively). The sensitivity and specificity of TAPSE/PASP at the optimal threshold exceeded 0.85 for both parameters.
CONCLUSIONS
TAPSE/PASP may be a feasible echocardiographic indicator for evaluating exercise tolerance.
Topics: Humans; Female; Male; Exercise Test; Heart Defects, Congenital; Echocardiography; Adult; ROC Curve; Exercise Tolerance; Pulmonary Arterial Hypertension; Oxygen Consumption; Middle Aged; Young Adult; Hypertension, Pulmonary; Pulmonary Artery
PubMed: 38944669
DOI: 10.1186/s12890-024-03113-7