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JMIR Public Health and Surveillance Jun 2024Globally, over 39% of individuals are obese. Metabolic syndrome, usually accompanied by obesity, is regarded as a major contributor to noncommunicable diseases. Given...
BACKGROUND
Globally, over 39% of individuals are obese. Metabolic syndrome, usually accompanied by obesity, is regarded as a major contributor to noncommunicable diseases. Given this relationship, the concepts of metabolically healthy and unhealthy obesity, considering metabolic status, have been evolving. Attention is being directed to metabolically healthy people with obesity who have relatively low transition rates to noncommunicable diseases. As obesity rates continue to rise and unhealthy behaviors prevail among young adults, there is a growing need for obesity management that considers these metabolic statuses. A nomogram can be used as an effective tool to predict the risk of transitioning to metabolically unhealthy obesity from a metabolically healthy status.
OBJECTIVE
The study aimed to identify demographic factors, health behaviors, and 5 metabolic statuses related to the transition from metabolically healthy obesity to unhealthy obesity among people aged between 20 and 44 years and to develop a screening tool to predict this transition.
METHODS
This secondary analysis study used national health data from the National Health Insurance System in South Korea. We analyzed the customized data using SAS (SAS Institute Inc) and conducted logistic regression to identify factors related to the transition from metabolically healthy to unhealthy obesity. A nomogram was developed to predict the transition using the identified factors.
RESULTS
Among 3,351,989 people, there was a significant association between the transition from metabolically healthy to unhealthy obesity and general characteristics, health behaviors, and metabolic components. Male participants showed a 1.30 higher odds ratio for transitioning to metabolically unhealthy obesity than female participants, and people in the lowest economic status were also at risk for the transition (odds ratio 1.08, 95% CI 1.05-1.1). Smoking status, consuming >30 g of alcohol, and insufficient regular exercise were negatively associated with the transition. Each relevant variable was assigned a point value. When the nomogram total points reached 295, the shift from metabolically healthy to unhealthy obesity had a prediction rate of >50%.
CONCLUSIONS
This study identified key factors for young adults transitioning from healthy to unhealthy obesity, creating a predictive nomogram. This nomogram, including triglycerides, waist circumference, high-density lipoprotein-cholesterol, blood pressure, and fasting glucose, allows easy assessment of obesity risk even for the general population. This tool simplifies predictions amid rising obesity rates and interventions.
Topics: Humans; Republic of Korea; Male; Female; Adult; Young Adult; Obesity, Metabolically Benign; Metabolic Syndrome; Nomograms; Obesity; Health Behavior; Risk Factors
PubMed: 38941611
DOI: 10.2196/52103 -
JMIR Formative Research Jun 2024In recent years, a range of novel smartphone-derived data streams about human mobility have become available on a near-real-time basis. These data have been used, for...
BACKGROUND
In recent years, a range of novel smartphone-derived data streams about human mobility have become available on a near-real-time basis. These data have been used, for example, to perform traffic forecasting and epidemic modeling. During the COVID-19 pandemic in particular, human travel behavior has been considered a key component of epidemiological modeling to provide more reliable estimates about the volumes of the pandemic's importation and transmission routes, or to identify hot spots. However, nearly universally in the literature, the representativeness of these data, how they relate to the underlying real-world human mobility, has been overlooked. This disconnect between data and reality is especially relevant in the case of socially disadvantaged minorities.
OBJECTIVE
The objective of this study is to illustrate the nonrepresentativeness of data on human mobility and the impact of this nonrepresentativeness on modeling dynamics of the epidemic. This study systematically evaluates how real-world travel flows differ from census-based estimations, especially in the case of socially disadvantaged minorities, such as older adults and women, and further measures biases introduced by this difference in epidemiological studies.
METHODS
To understand the demographic composition of population movements, a nationwide mobility data set from 318 million mobile phone users in China from January 1 to February 29, 2020, was curated. Specifically, we quantified the disparity in the population composition between actual migrations and resident composition according to census data, and shows how this nonrepresentativeness impacts epidemiological modeling by constructing an age-structured SEIR (Susceptible-Exposed-Infected- Recovered) model of COVID-19 transmission.
RESULTS
We found a significant difference in the demographic composition between those who travel and the overall population. In the population flows, 59% (n=20,067,526) of travelers are young and 36% (n=12,210,565) of them are middle-aged (P<.001), which is completely different from the overall adult population composition of China (where 36% of individuals are young and 40% of them are middle-aged). This difference would introduce a striking bias in epidemiological studies: the estimation of maximum daily infections differs nearly 3 times, and the peak time has a large gap of 46 days.
CONCLUSIONS
The difference between actual migrations and resident composition strongly impacts outcomes of epidemiological forecasts, which typically assume that flows represent underlying demographics. Our findings imply that it is necessary to measure and quantify the inherent biases related to nonrepresentativeness for accurate epidemiological surveillance and forecasting.
PubMed: 38941609
DOI: 10.2196/55013 -
Quality Management in Health CareThe purpose of this research was to assess the effect of telehealth management via WeChat on improving the quality of life of patients after percutaneous coronary...
OBJECTIVES
The purpose of this research was to assess the effect of telehealth management via WeChat on improving the quality of life of patients after percutaneous coronary intervention (PCI).
METHODS
In this study, we retrospectively collected the clinical data of 118 patients who underwent PCI and received remote health management from our hospital via WeChat from June 2021 to September 2021 (WeChat group). The clinical data of 114 patients who underwent PCI but did not receive remote health management from our hospital from September 2020 to December 2020 were also collected (conventional group). Anxiety, depression, and quality of life scale scores were compared between the 2 groups at 6 months postdischarge.
RESULTS
Six months postdischarge, patients in the WeChat group had significantly lower Self-rating Anxiety Scale (SAS) (55.7 ± 7.2 vs 58.8 ± 6.4, P = .001) and Self-rating Depression Scale (SDS) (56.0 ± 5.9 vs 58.2 ± 6.2, P = .007) scores than did those in the conventional group. Compared to those in the conventional group, the patients in the WeChat group had significantly greater 6 months post-discharge The World Health Organization Quality of Life - BREF scores in the following domains: physical (14.3 ± 1.7 vs 13.1 ± 1.7, P < .001 psychological (15.2 ± 1.3 vs 13.5 ± 1.5, P < .001 social relationship (12.9 ± 1.7 vs 12.3 ± 1.8, P = .01) and environmental (12.7 ± 2.0 vs 12.0 ± 1.9, P = .006).
CONCLUSION
The use of WeChat to carry out remote health management for patients who underwent PCI can be an effective way to provide high-quality hospital medical services to patients' families and can effectively alleviate patients' anxiety and depression and enhance their quality of life.
Topics: Humans; Quality of Life; Percutaneous Coronary Intervention; Male; Female; Middle Aged; Retrospective Studies; Aged; Anxiety; Telemedicine; Depression
PubMed: 38941582
DOI: 10.1097/QMH.0000000000000487 -
Quality Management in Health CarePatient experience narratives (narratives) are an increasingly important element of both measurement approaches and improvement efforts in healthcare. Prior studies show...
BACKGROUND AND OBJECTIVES
Patient experience narratives (narratives) are an increasingly important element of both measurement approaches and improvement efforts in healthcare. Prior studies show that narratives are considered by both clinicians and staff to be an appealing, meaningful, and credible form of evidence on performance. They also suggest that making concrete use of narratives within organizational settings to improve care can be complex and challenging. Our qualitative study was designed to explore how middle managers working in a health system's outpatient clinics value and use written narratives in their day-to-day work.
METHODS
We conducted qualitative interviews with 20 middle managers working in 8 outpatient clinics. Interviews were fully transcribed, loaded into MAX-QDA software, and coded using thematic analysis techniques. Code reports were extracted and reanalyzed for subthemes related to the objectives of this paper.
RESULTS
Middle managers across sites described valuing narratives as a tool to: enable better patient experience assessment by augmenting data from patient experience scores; deepen understanding of and relationships with patients; provide insight about operational issues; identify areas for needed improvement and potential solutions; and facilitate strategic work. They reported using narratives for a range of activities related to their roles as supervisors, such as focusing attention on positive practices and needed improvements, promoting deeper group learning, motivating change, reinforcing sense of purpose for staff, recognizing staff strengths and training needs, and inspiring transformational thinking. Finally, interviewees reported numerous specific quality improvement projects (both short- and longer-term) that were informed by narratives-for example, by identifying an issue to be addressed or by suggesting a workable solution. Together, these interviews suggest a collective "narrative about narratives" woven by these organizational actors-a story which illustrates how narratives are highly relevant for how middle managers derive meaning from their work, put organizational values such as responsive service provision into practice, and enact their roles as supervisors.
CONCLUSIONS
Our results add to the nascent literature a detailed description of how narratives can be used both as a tool for middle managers in their leadership and supervisory roles, and as a blueprint for improvement work within outpatient settings. They also illuminate why patient experience scores may improve when narrative data are collected and used. Finally, our results suggest that for middle managers, perhaps "nothing is more powerful than words" because narratives function as both an insight provider and a compelling tool that adds direction and meaning to workplace endeavors.
Topics: Humans; Qualitative Research; Narration; Quality Improvement; Patient Satisfaction; Interviews as Topic; Ambulatory Care Facilities; Female; Male
PubMed: 38941581
DOI: 10.1097/QMH.0000000000000477 -
Rheumatology (Oxford, England) Jun 2024Recurrent monoarthritis (RM) is a major challenge of many rheumatic diseases. Ablation is a well-known technique in the treatment of benign or malign lesions of...
OBJECTIVES
Recurrent monoarthritis (RM) is a major challenge of many rheumatic diseases. Ablation is a well-known technique in the treatment of benign or malign lesions of different etiologies. We aimed to to investigate the success and safety of microwave ablation (MWA) as an adjunctive therapy in a cohort of medical treatment-resistant RM.
METHODS
Patients with RM associated with different inflammatory diseases were included. MWA was performed after measuring the size of synovial hypertrophy with 15 or 20-watt power and different durations until microbubbles were shown indicating necrosis. Both clinical and radiologic data were recorded.
RESULTS
We applied MWA in total of 24 knee joints of 10 female and 12 male patients aged between 22-71 years. Median intra-articular aspiration (IAA) need in the last 6 months before MWA was 5 (0-15). The median follow-up was 10 (3-16) months. Overall IAA count in the last 6 months before MWA in total of 144 months was 129 and decreased to 7 in post-MWA in total of 226 months (0.89 vs 0.03 per month, p< 0.001). The second MWA session was needed for 3 patients and a third session for 1. Functional disability and pain scores were improved significantly (median score from 9 to 1, p< 0.00001, in both). In magnetic resonance imaging, follow-up significant regression in synovial hypertrophy size was shown especially after 6th month. No complication was observed during the procedure or follow-up.
CONCLUSION
As a less invasive technique compared with the surgical approach, MWA of synovial hypertrophy showed significant clinical improvement in RM safely. MWA seems promising as a treatment option candidate in the management of RM.
PubMed: 38941501
DOI: 10.1093/rheumatology/keae348 -
Medicine Jun 2024To explore the effects of tracking linkage self-management mode on the compliance of prenatal examinations and delivery modes in primiparas. A total of 270 primiparas... (Observational Study)
Observational Study
To explore the effects of tracking linkage self-management mode on the compliance of prenatal examinations and delivery modes in primiparas. A total of 270 primiparas undergoing prenatal examinations in Shijiazhuang Obstetrics and Gynecology Hospital were enrolled for prospective study between January 2021 and January 2022. They were divided into control group and observation group, 135 cases in each group. The control group was given routine management mode, while observation group was given tracking linkage self-management mode. All were intervened till discharge. The compliance (time and frequency of prenatal examinations), cognition of prenatal examinations, score of exercise of self-care agency scale, self-rating anxiety scale and self-rating depression scale, delivery modes and the occurrence of neonatal adverse outcomes were compared between the 2 groups. After intervention, total compliance rate of prenatal examinations in observation group was higher than that in control group (84.44% vs 72.59%) (P < .05). The scores of pregnancy care, genetic diseases counseling, prevention of birth defects and reasonable nutrition during pregnancy in observation group were higher than those in control group (P < .05), scores of health cognition, self-care skills, self-care responsibility and self-concept were higher than those in control group (P < .05), scores of self-rating anxiety scale and self-rating depression scale were lower than those in control group (P < .05), natural delivery rate was higher than that in control group (85.93% vs 74.81%) (P < .05), and incidence of neonatal adverse outcomes was lower than that in control group (0.74% vs 5.93%) (Fisher exact probability = 0.036). The application of tracking linkage self-management mode can significantly improve cognition to prenatal examinations, improve compliance of prenatal examinations and self-care ability, relieve anxiety and depression, increase natural delivery rate and reduce the incidence of neonatal adverse outcomes in primiparas.
Topics: Humans; Female; Pregnancy; Adult; Self-Management; Prospective Studies; Patient Compliance; Prenatal Care; Delivery, Obstetric; Parity; Self Care
PubMed: 38941437
DOI: 10.1097/MD.0000000000038494 -
Medicine Jun 2024To investigate the effect of case management (CM) based on the Omaha system on clinical symptoms and quality of life (QOL) of coronary heart disease patients after... (Randomized Controlled Trial)
Randomized Controlled Trial
To investigate the effect of case management (CM) based on the Omaha system on clinical symptoms and quality of life (QOL) of coronary heart disease patients after percutaneous coronary intervention (PCI). Patients with coronary heart disease after their first PCI in the People's Hospital of Longhua in Shenzhen were randomly divided into a control group (received CM based on the Omaha system) and an observation group (received routine nursing) using a random number table. Nursing problems and the knowledge-behavior-status (KBS) score of patients were evaluated on the day after surgery, on the day before discharge, at 5 weeks after discharge, and at 12 weeks after discharge. The QOL of patients was evaluated using the coronary intervention coronary revascularization outcome questionnaire (CROQ-PTCA-Post, Chinese version) score on the day after surgery and at 12 weeks after discharge. A total of 104 patients completed the study (51 in the control group, 53 in the observation group). There were no significant differences in baseline data between the 2 groups (P gr.05). The main nursing problems were circulation, mental health, and pain in both groups on the day after surgery, whereas they were circulation, sleep and rest, and mental health after nursing. There were no significant differences in the KBS scores of the co-existing nursing problems on the day after surgery (P Th.05). The KBS scores of the co-existing nursing problems were significantly increased between the 2 groups (P < .01) on the day before discharge and at 5 weeks and 12 weeks after discharge. The KBS scores of the most co-existing nursing problems in the observation group were significantly higher at 12 weeks after discharge than at the day before discharge and at 5 weeks after discharge. Moreover, there were no significant differences in the CROQ-PTCA-Post scores on the first day after surgery between the 2 groups (P gr.05). These scores were significantly increased between the 2 groups at 12 weeks after discharge (P < .01). CM based on the Omaha system for patients after PCI can effectively improve the KBS scores and QOL of PCI patients with postoperative nursing problems, making this approach worthy of clinical promotion.
Topics: Humans; Quality of Life; Male; Percutaneous Coronary Intervention; Female; Middle Aged; Coronary Disease; Case Management; Aged; Surveys and Questionnaires; China
PubMed: 38941436
DOI: 10.1097/MD.0000000000038553 -
Medicine Jun 2024This study investigated recurrence rates and treatment efficacy based on tomographic findings during a long-term follow-up after primary spontaneous pneumothorax (PSP)...
Is there a change in the view of treatment for primary spontaneous pneumothorax?: The effect of thoracic CT and autologous blood pleurodesis: a retrospective cohort study.
This study investigated recurrence rates and treatment efficacy based on tomographic findings during a long-term follow-up after primary spontaneous pneumothorax (PSP) treatment. We retrospectively analyzed patients with PSP treated at our hospital between 2003 and 2020. Patients were categorized into 2 groups based on computed tomography (CT) findings: group 1 (no bulla/bleb) and group 2 (bullae-bleb <3 cm). Data on demographics, recurrence, treatment methods, and outcomes were also collected and compared. A total of 251 PSP cases were evaluated, predominantly male (93.6%) with a mean age of 29.23 ± 1.14 years. Most cases (57%) occurred on the right side. Recurrence rates were highest within the first year (77.8%), with the first and second recurrences occurring at rates of 26% and 27.3%, respectively. In group 1 (n = 117), conservative treatment was applied in 15 cases, tube thoracostomy in 81, autologous blood pleurodesis (ABP) in 19, and surgery in 12. Recurrence rates were 46.6%, 21%, 5.3%, and 8.3%, respectively. In group 2 (n = 134), the recurrence rates were 50%, 32.7%, 20%, and 3.1%, respectively (P < .001). No mortality was observed for any patient. The treatment groups included conservative (n = 19), thoracostomy (n = 179), ABP (n = 34), and surgical (n = 44) groups. Recurrence rates were 47.3%, 27.4%, 11.8% (group 1: 5.3%, group 2: 20%, P = .035), and 4.5% (0% vs 6.3%), respectively. ABP effectively reduced recurrence in group 1 PSP patients without bullae or blebs on CT, potentially avoiding surgery. Video-assisted thoracoscopic surgery should be preferred in group 2 cases with bullae or blebs to minimize recurrence. These results underscore the importance of tailoring treatment strategies based on CT findings to optimize PSP management outcomes.
Topics: Humans; Pneumothorax; Male; Pleurodesis; Female; Retrospective Studies; Adult; Tomography, X-Ray Computed; Recurrence; Treatment Outcome; Thoracostomy
PubMed: 38941434
DOI: 10.1097/MD.0000000000038639 -
Medicine Jun 2024This study investigates the correlation between thyroid hormone levels and metabolic dysfunction in patients with type 2 diabetes mellitus (T2DM) who exhibit normal...
BACKGROUND
This study investigates the correlation between thyroid hormone levels and metabolic dysfunction in patients with type 2 diabetes mellitus (T2DM) who exhibit normal thyroid function and metabolic dysfunction associated with steatotic liver disease (MASLD).
OBJECTIVE
The objective is to identify a scientific basis for the management of T2DM complicated by MASLD, aiming to refine clinical strategies and enhance patient well-being.
METHODS
Statistical analysis was conducted using SPSS 26.0, employing independent sample t-tests for normally distributed data and logarithmic transformations for non-normal data to meet analysis prerequisites. Multifactorial logistic regression analysis elucidated the impact of various factors on the risk of MASLD in T2DM patients.
RESULTS
Elevated levels of FT3 may be associated with an increased risk of nonalcoholic fatty liver disease. Additionally, the FT3/FT4 ratio has been validated as an effective serological marker for predicting the risk of MASLD. In patients with DM2 and normal thyroid function, changes in thyroid hormone levels are closely related to the occurrence of MASLD. Elevated levels of FT3, total triiodothyronine (TT3), and thyroid-stimulating hormone are associated with an increased risk of MASLD.
CONCLUSION
FT3, TT3, and thyroid-stimulating hormone have important clinical value in the diagnosis of patients with T2DM complicated with MASLD.
Topics: Humans; Diabetes Mellitus, Type 2; Male; Female; Middle Aged; Triiodothyronine; Thyroid Hormones; Aged; Non-alcoholic Fatty Liver Disease; Thyrotropin; Biomarkers; Risk Factors; Thyroid Function Tests; Adult
PubMed: 38941427
DOI: 10.1097/MD.0000000000038643 -
Medicine Jun 2024Old age is associated with a higher risk of dementia. Psychosocial characteristics frequently affect cognitive function; however, the exact mechanism underlying the...
Effects of psychosocial characteristics on cognitive function in middle-aged and older adults: Focusing on change by year using the Korean Longitudinal Study of Aging panel data (2014-2018).
Old age is associated with a higher risk of dementia. Psychosocial characteristics frequently affect cognitive function; however, the exact mechanism underlying the effect of psychosocial factors on cognitive function is unclear. Therefore, this study aimed to investigate the effects of psychosocial characteristics on cognitive function. The participants comprised 4809 middle-aged and older (years 50+) adults. The analysis used data from the Korean Longitudinal Study of Aging from 2014 to 2018. The effects of neighborhood interaction, depression, life satisfaction, and economic activity on cognitive function were examined, and a linear mixed model analysis was performed to assess the change in cognitive function by year. A statistically significant association was found between neighborhood interaction and time. Additionally, cognitive function decreased in the presence of depression and with time. In men, significant interactions were found between depression and time and between economic activity and time. In women, significant interactions were found between life satisfaction and time. The findings indicate that since active neighborhood interaction positively affects cognitive function, it is necessary to develop various community-wide social activity programs for middle-aged and older adults. As depression is a risk factor for cognitive impairment, it is crucial to prevent cognitive decline through continuous management of depression. Given the positive effects of economic activity on cognitive function in men, it is essential to expand infrastructure to sustain economic activity by developing educational programs and creating job opportunities for middle-aged and older men.
Topics: Humans; Male; Female; Longitudinal Studies; Middle Aged; Republic of Korea; Aged; Cognition; Depression; Personal Satisfaction; Cognitive Dysfunction; Residence Characteristics; Aging; Risk Factors; Sex Factors; Aged, 80 and over
PubMed: 38941412
DOI: 10.1097/MD.0000000000038637