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Circulation Feb 2024Up to 50% of women report sleep problems in midlife, and cardiovascular disease (CVD) is the leading cause of death in women. How chronic poor sleep exposure over...
BACKGROUND
Up to 50% of women report sleep problems in midlife, and cardiovascular disease (CVD) is the leading cause of death in women. How chronic poor sleep exposure over decades of midlife is related to CVD risk in women is poorly understood. We tested whether trajectories of insomnia symptoms or sleep duration over midlife were related to subsequent CVD events among SWAN (Study of Women's Health Across the Nation) participants, whose sleep was assessed up to 16 times over 22 years.
METHODS
At baseline, SWAN participants (n=2964) were 42 to 52 years of age, premenopausal or early perimenopausal, not using hormone therapy, and free of CVD. They completed up to 16 visits, including questionnaires assessing insomnia symptoms (trouble falling asleep, waking up several times a night, or waking earlier than planned ≥3 times/week classified as insomnia), typical daily sleep duration, vasomotor symptoms, and depressive symptoms; anthropometric measurements; phlebotomy; and CVD event ascertainment (ie, fatal or nonfatal myocardial infarction, stroke, heart failure, revascularization). Sleep trajectories (ie, insomnia, sleep duration) were determined by means of group-based trajectory modeling. Sleep trajectories were tested in relation to CVD in Cox proportional hazards models (multivariable models: site, age, race and ethnicity, education, CVD risk factors averaged over visits; additional covariates: vasomotor symptoms, snoring, depression).
RESULTS
Four trajectories of insomnia symptoms emerged: low insomnia symptoms (n=1142 [39% of women]), moderate insomnia symptoms decreasing over time (n=564 [19%]), low insomnia symptoms increasing over time (n=590 [20%]), and high insomnia symptoms that persisted (n=668 [23%]). Women with persistently high insomnia symptoms had higher CVD risk (hazard ratio, 1.71 [95% CI, 1.19, 2.46], =0.004, versus low insomnia; multivariable). Three trajectories of sleep duration emerged: persistently short (~5 hours: n=363 [14%]), moderate (~6 hours: n=1394 [55%]), and moderate to long (~8 hours: n=760 [30%]). Women with persistent short sleep had marginally higher CVD risk (hazard ratio, 1.51 [95% CI, 0.98, 2.33], =0.06, versus moderate; multivariable). Women who had both persistent high insomnia and short sleep had significantly elevated CVD risk (hazard ratio, 1.75 [95% CI, 1.03, 2.98], =0.04, versus low insomnia and moderate or moderate to long sleep duration; multivariable). Relations of insomnia to CVD persisted when adjusting for vasomotor symptoms, snoring, or depression.
CONCLUSIONS
Insomnia symptoms, when persistent over midlife or occurring with short sleep, are associated with higher CVD risk among women.
Topics: Female; Humans; Sleep Initiation and Maintenance Disorders; Cardiovascular Diseases; Snoring; Sleep; Women's Health
PubMed: 38284249
DOI: 10.1161/CIRCULATIONAHA.123.066491 -
PharmacoEconomics - Open Mar 2024Hereditary hemochromatosis (HH) is an autosomal recessive disorder that leads to iron overload and multiorgan failure.
BACKGROUND
Hereditary hemochromatosis (HH) is an autosomal recessive disorder that leads to iron overload and multiorgan failure.
OBJECTIVES
The aim of this systematic review was to provide up-to-date evidence of all the current data on the costs and cost effectiveness of screening and treatment for HH.
METHODS
We searched PubMed, Cochrane Library, National Health Service Economic Evaluation Database (NHSEED), Cost-Effectiveness Analysis Registry (CEA Registry), Health Technology Assessment Database (HTAD), Centre for Reviews and Dissemination (CRD), and Econlit until April 2023 with no date restrictions. Articles that reported cost-utility, cost-description, cost-minimization, cost-effectiveness, or cost-benefit analyses for any kind of management (drugs, screening, etc.) were included in the study. Patients with HH, their siblings, or individuals suspected of having HH were included in the study. All screening and treatment strategies were included. Two authors assessed the quality of evidence related to screening (either phenotype or genotype screening) and treatment (phlebotomy and electrophoresis). Narrative synthesis was used to analyse the similarities and differences between the respective studies.
RESULTS
Thirty-nine papers were included in this study. The majority of the studies reported both the cost of phenotype screening, including transferrin saturation (TS), serum ferritin, and liver biopsy, and the cost of genotype screening (HFE screening, C282Y mutation). Few studies reported the cost for phlebotomy and erythrocytapheresis treatment. Data revealed that either phenotype or genotype screening were cost effective compared with no screening. Treatment studies concluded that erythrocytapheresis might be a cost-effective therapy compared with phlebotomy.
CONCLUSIONS
Economic studies on either the screening, or treatment strategy for HH patients should be performed in more countries. We suggest that cost-effectiveness studies on the role of deferasirox in HH should be carried out as an alternative therapy to phlebotomy.
PubMed: 38279979
DOI: 10.1007/s41669-023-00463-6 -
Pain Research & Management 2024Pain from injections is common in children of all ages, and more than 90% of hospitalized children experience invasive and painful procedures such as venipuncture. In... (Randomized Controlled Trial)
Randomized Controlled Trial
Pain from injections is common in children of all ages, and more than 90% of hospitalized children experience invasive and painful procedures such as venipuncture. In light of the complications associated with pain relief medications, nonpharmacological and complementary medicine approaches have gained attention. This study aims to compare the effects of acupressure and music on venipuncture pain intensity in children. This randomized controlled clinical trial involved 180 children aged 3-6 years who sought treatment at the Children's Medical Center Hospital Emergency Department at Tehran University of Medical Sciences, Iran. The children were randomly assigned to one of three groups: acupressure, music, or control. The interventions were given within 5 minutes, starting 3 minutes before the venipuncture and continuing until completion. The interventions included playing music through headphones and applying acupressure to the Hugo point. Venipuncture was carried out under identical conditions using an Angiocath 24G needle. Pain intensity was assessed using the Oucher scale. Data were analyzed using SPSS 24, employing the Kruskal-Wallis, chi-square, and Bonferroni pairwise comparison tests, with a significance level of 0.05. The mean pain intensity was 3.32 ± 1.44 in the music group, 4.82 ± 1.51 in the acupressure group, and 8.32 ± 1.10 in the control group. Pain intensity significantly differed among the three groups ( < 0.001). Specifically, pain intensity was lower in the music group compared to both the acupressure ( < 0.001) and control ( < 0.001) groups. Furthermore, pain intensity was lower in the acupressure group than in the control group ( < 0.001). Based on the results, music and acupressure methods effectively reduce pain intensity during venipuncture in children. Considering that music demonstrated a more pronounced effect in alleviating venipuncture pain than acupressure, the recommendation is to utilize music as a method of pain management during venipuncture in children. Iranian Registry of Clinical Trials, Trial No. IRCT20120109008665N15, was registered on 6 December 2021.
Topics: Child; Child, Preschool; Humans; Acupressure; Iran; Music; Pain; Pain Measurement; Phlebotomy
PubMed: 38274399
DOI: 10.1155/2024/2504732 -
Hospital Pediatrics Feb 2024Nonpharmacologic distraction (NPD) during medical procedures in children is known to be beneficial to patients; however, no reviews have assessed their benefits to... (Meta-Analysis)
Meta-Analysis Review
CONTEXT
Nonpharmacologic distraction (NPD) during medical procedures in children is known to be beneficial to patients; however, no reviews have assessed their benefits to medical providers.
OBJECTIVES
We aimed to assess the benefits of NPD to medical providers.
DATA SOURCES
We searched 5 databases for relevant articles.
STUDY SELECTION
Peer-reviewed published randomized controlled trials comparing NPD with standard care that included children who had undergone medical procedures were included.
DATA EXTRACTION
Primary outcomes were procedure time, number of medical staff involved, and initial success rate of venipuncture. Two reviewers assessed the risk of bias by using the Cochrane Collaboration (Oxford, United Kingdom)'s Randomized Controlled Trials Risk of Bias Tool, and we performed a meta-analysis to assess efficacy.
RESULTS
We included 22 trials with 1968 participants. The main NPD was audiovisual distraction, such as tablets. No significant difference was found in venipuncture procedure time (mean difference: -9.79; 95% confidence interval: -22.38 to 2.81; low certainty). We found no studies on the number of medical staff.
CONCLUSIONS
Our review did not find any clear NPD-associated benefit for the medical provider. The review included a small amount of literature, analyzed a small number of cases, and had a low certainty of evidence regarding procedure duration; therefore, further studies are needed to conclude the benefits to clinicians of NPD.
Topics: Child; Humans; United Kingdom; Phlebotomy; Attention
PubMed: 38273770
DOI: 10.1542/hpeds.2023-007322 -
BMJ Case Reports Jan 2024Crohn's disease patients often need regular home parenteral nutrition (HPN) for intestinal failure due to multiple intestinal resections. Trace elements are necessary...
Crohn's disease patients often need regular home parenteral nutrition (HPN) for intestinal failure due to multiple intestinal resections. Trace elements are necessary for long-term HPN but the requirement volume of iron is undetermined. We describe three patients with Crohn's disease with short bowel syndrome (SBS) who had iron overload as a result of long-term HPN including iron. Serum ferritin level was significantly decreased through depleting intravenous iron administration in all cases. One patient needed regular insulin injection and phlebotomy for diabetes mellitus due to hemochromatosis, and intravenous iron administration had a significant impact on the patient's health. Long-term routine intravenous iron administration should be cautious in SBS patients to avoid the overload.
Topics: Humans; Crohn Disease; Trace Elements; Short Bowel Syndrome; Parenteral Nutrition, Home; Iron; Iron Overload
PubMed: 38272521
DOI: 10.1136/bcr-2023-254612 -
British Journal of Nursing (Mark Allen... Jan 2024This article will provide clinical guidance on carrying out venepuncture on an adult. It will discuss site, equipment selection and aseptic non-touch technique. The aims...
This article will provide clinical guidance on carrying out venepuncture on an adult. It will discuss site, equipment selection and aseptic non-touch technique. The aims are to increase knowledge of the anatomical structures associated with venepuncture, demonstrate the clinical procedural technique of venepuncture, and provide an awareness of the dangers and complications of this invasive technique.
Topics: Humans; Phlebotomy
PubMed: 38271039
DOI: 10.12968/bjon.2024.33.2.60 -
International Journal of Clinical... Nov 2023The presence of extensive dental caries leads to pain, inflammation, and discomfort and hence interferes with their nutritional intake, which includes iron deficiency...
AIM
The presence of extensive dental caries leads to pain, inflammation, and discomfort and hence interferes with their nutritional intake, which includes iron deficiency anemia. This study was undertaken to determine whether any correlation exists between severe early childhood caries (S-ECC), serum iron, and serum ferritin levels in children.
MATERIALS AND METHODS
A total of 688 children were examined in the age-group of 2-6 years, and 82 children who fulfilled the selection criteria were equally divided into group I, that is, case group (carious group = 41) and group II, that is, control group (caries-free group = 41), on the basis of decayed, missing, and filled primary teeth (dmft) scores. All the selected children in both groups underwent blood investigations through phlebotomy for assessment of serum iron and serum ferritin levels.
RESULTS
The mean values of variables, that is, hemoglobin (Hb), serum iron, serum ferritin, total iron-binding capacity (TIBC), and unsaturated iron-binding capacity (UIBC), are lower in the case group when compared to control group. The differences observed were statistically significant in case of dmft and UIBC values at < 0.05 but not significant in cases of other variables like Hb, serum iron, serum ferritin, and TIBC values.
CONCLUSION
An inverse relationship was found between S-ECC, serum iron, and serum ferritin levels, but the evidence is still inconclusive.
HOW TO CITE THIS ARTICLE
Atri Y, Garg N, Pathivada L, Association between Serum Iron, Serum Ferritin Levels, and Severe Early Childhood Caries: A Case-Control Study. Int J Clin Pediatr Dent 2023;16(S-3):S288-S292.
PubMed: 38268632
DOI: 10.5005/jp-journals-10005-2704 -
Revue Medicale Suisse Jan 2024
Topics: Humans; Bloodletting; Immunotherapy
PubMed: 38268346
DOI: 10.53738/REVMED.2024.20.858.113 -
The Indian Journal of Medical Research Nov 2023Injuries occurring from contaminated sharps are a major occupational health hazard. It carries a risk of transmitting blood-borne diseases such as human immunodeficiency...
BACKGROUND OBJECTIVES
Injuries occurring from contaminated sharps are a major occupational health hazard. It carries a risk of transmitting blood-borne diseases such as human immunodeficiency virus (HIV), hepatitis B and hepatitis C. Healthcare workers (HCWs), including personnel handling biomedical waste, are at risk. The objective of this study was to determine the incidence and details of needlestick injury (NSI) among HCWs.
METHODS
We analyzed data of all HCWs who reported NSI over the past three years. Demographic details, type and source of injury, use of personal protective equipment (PPE), immediate post-exposure measures, hepatitis B vaccination status and HCWs and source's HIV, hepatitis B and hepatitis C serological status were studied.
RESULTS
Fifty-six cases of NSI were recorded over three years, accounting for an incidence of 10.4/100 occupied beds per year. Maximum cases (73.2%) occurred between the 20 and 40 yr age group. The distribution among the work category was doctors (37.5%), nursing staff (26.8%), phlebotomy technicians (12.5%), housekeeping/subordinate staff (12.5%) and others (10.7%). Appropriate PPE was donned by 66 per cent of the HCWs. The majority of cases (46.4%) occurred in wards and operating rooms (23.2%). Phlebotomy (35.7%), followed by procedures, such as hemoglucotest (HGT) measurement, intravenous cannula insertion and operative procedures (33.9%), were the most common situation during which HCWs suffered NSI. While 64.2 per cent HCWs were vaccinated for hepatitis B, only 5.4 per cent of the HCWs completed post-exposure anti-retroviral regimen.
INTERPRETATION CONCLUSIONS
We conclude that a relative lack of awareness towards preventive measures and inexperience among HCWs may be contributory to high occurrence of NSI events. This study emphasizes upon ensuring active hospital-wide hepatitis B vaccination of all HCWs and supportive therapy to improve compliance towards post-exposure prophylaxis.
Topics: Humans; Incidence; Needlestick Injuries; Health Personnel; Hepatitis B; Hepatitis C; India; HIV Infections
PubMed: 38265947
DOI: 10.4103/ijmr.ijmr_892_23 -
Frontiers in Oncology 2023This case report presents a 3-year-old female patient initially diagnosed with polycythemia vera (PV) in 2001. The patient exhibited elevated red blood cell (RBC)...
This case report presents a 3-year-old female patient initially diagnosed with polycythemia vera (PV) in 2001. The patient exhibited elevated red blood cell (RBC) counts, high hemoglobin (Hb) levels, hyperleukocytosis, and moderate thrombocytosis, with sporadic abdominal pain and significant splenomegaly. Despite various treatments, including phlebotomies, hydroxyurea, and alpha-interferon, the patient struggled to maintain optimal hematocrit levels and experienced persistent symptoms. Subsequent genomic analysis revealed a rare G301R mutation alongside the canonical V617F mutation, potentially contributing to disease severity. In 2023, the patient started Ropeginterferon alfa-2b, leading to improved hematological parameters and symptom relief. The case underscores the challenges in managing PV, particularly in young patients, and highlights the potential clinical significance of additional mutations/variants and the potential benefits of Ropeginterferon alfa-2b in achieving better disease control.
PubMed: 38264737
DOI: 10.3389/fonc.2023.1338417