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Frontiers in Rehabilitation Sciences 2024Peer-based community interventions have shown promise in improving health management and fostering coping skills and psychosocial functioning among individuals with a...
Peer-based community interventions have shown promise in improving health management and fostering coping skills and psychosocial functioning among individuals with a disability. Active Rehabilitation camps are examples of peer-based community interventions that provide structured, time-limited peer mentorship in conjunction with sports and leisure activities. These camps hold potential benefits for individuals with acquired neurological injury. However, the specific impact of Active Rehabilitation camps on children or individuals with acquired brain injury remains unexplored. In this longitudinal, qualitative study, we explored children with an acquired brain injury and their caregivers' experiences with an Active Rehabilitation camp in Norway through observations and interviews with nine children and ten caregivers. Using an abductive thematic analysis, we identified an overarching theme: Active Rehabilitation peer mentorship camps enrich the lives of children with acquired brain injury and their caregivers. The theme contains three sub-themes: (1) Interacting with peers made me wiser, (2) Nudging from peer mentors made me feel better, and (3) A sense of companionship through meeting peers. Peer mentorship, sports and leisure activities, and the safe camp atmosphere benefitted children with acquired brain injury and their caregivers. The children gained knowledge, motivation, and self-worth, and their caregivers had greater impetus to prioritize their children's independence. Meeting peers and peer mentors led to friendships and sustained social connections. The Self-Determination Theory was of assistance in explaining the informants' experiences. Active Rehabilitation camps provide children with acquired brain injury and their caregivers with an opportunity to develop better coping skills, improve psychological functioning, and build more robust social networks.
PubMed: 38884006
DOI: 10.3389/fresc.2024.1285742 -
MedRxiv : the Preprint Server For... Jun 2024Immune-checkpoint inhibitors (ICI) are associated with life-threatening myocarditis but milder presentations are increasingly recognized. The same autoimmune process...
BACKGROUND
Immune-checkpoint inhibitors (ICI) are associated with life-threatening myocarditis but milder presentations are increasingly recognized. The same autoimmune process that causes ICI-myocarditis can manifest concurrent generalized myositis, myasthenia-like syndrome, and respiratory muscle failure. Prognostic factors for this "cardiomyotoxicity" are lacking.
METHODS
A multicenter registry collected data retrospectively from 17 countries between 2014-2023. A multivariable cox regression model (hazard-ratio(HR), [confidence-interval]) was used to determine risk factors for the primary composite outcome: severe arrhythmia, heart failure, respiratory muscle failure, and/or cardiomyotoxicity-related death. Covariates included demographics, comorbidities, cardio-muscular symptoms, diagnostics, and treatments. Time-dependent covariates were used and missing data were imputed. A point-based prognostic risk score was derived and externally validated.
RESULTS
In 748 patients (67% male, age 23-94), 30-days incidence of the primary composite outcome, cardiomyotoxic death, and overall death were 33%, 13%, and 17% respectively. By multivariable analysis, the primary composite outcome was associated with active thymoma (HR=3.60[1.93-6.72]), presence of cardio-muscular symptoms (HR=2.60 [1.58-4.28]), low QRS-voltage on presenting electrocardiogram (HR for ≤0.5mV versus >1mV=2.08[1.31-3.30]), left ventricular ejection fraction (LVEF) <50% (HR=1.78[1.22-2.60]), and incremental troponin elevation (HR=1.86 [1.44-2.39], 2.99[1.91-4.65], 4.80[2.54-9.08], for 20, 200 and 2000-fold above upper reference limit, respectively). A prognostic risk score developed using these parameters showed good performance; 30-days primary outcome incidence increased gradually from 3.9%(risk-score=0) to 81.3%(risk-score≥4). This risk-score was externally validated in two independent French and US cohorts. This risk score was used prospectively in the external French cohort to identify low risk patients who were managed with no immunosuppression resulting in no cardio-myotoxic events.
CONCLUSIONS
ICI-myocarditis can manifest with high morbidity and mortality. Myocarditis severity is associated with magnitude of troponin, thymoma, low-QRS voltage, depressed LVEF, and cardio-muscular symptoms. A risk-score incorporating these features performed well.
TRIAL REGISTRATION NUMBER
NCT04294771 and NCT05454527.
PubMed: 38883792
DOI: 10.1101/2024.06.02.24308336 -
Frontiers in Public Health 2024The lack of access to a diverse and nutritious diet has significant health consequences worldwide. Governments have employed various policy mechanisms to ensure access,...
INTRODUCTION
The lack of access to a diverse and nutritious diet has significant health consequences worldwide. Governments have employed various policy mechanisms to ensure access, but their success varies.
METHOD
In this study, the impact of changes in food assistance policy on food prices and nutrient security in different provinces of Iran, a sanctioned country, was investigated using statistical and econometric models.
RESULTS
Both the old and new policies were broad in scope, providing subsidized food or cash payments to the entire population. However, the implementation of these policies led to an increase in the market price of food items, resulting in a decline in the intake of essential nutrients. Particularly, the policy that shifted food assistance from commodity subsidies to direct cash payments reduced the price sensitivity of consumers. Consequently, the intake of key nutrients such as Vitamin C and Vitamin A, which are often constrained by their high prices, decreased. To improve the diets of marginalized populations, it is more effective to target subsidies towards specific nutrient groups and disadvantaged populations, with a particular focus on food groups that provide essential nutrients like Vitamin A and Vitamin C in rural areas of Iran.
DISCUSSION
More targeted food assistance policies, tailored to the specific context of each province and income level, are more likely to yield positive nutritional outcomes with minimal impact on food prices.
Topics: Iran; Humans; Food Assistance; Nutrition Policy; Financing, Government; Food Supply; Diet
PubMed: 38883201
DOI: 10.3389/fpubh.2024.1354099 -
Journal of Pharmacy & Bioallied Sciences Apr 2024Early childhood caries (ECC) is a major oral health problem, mainly in socially disadvantaged populations. ECC affects infants and preschool children worldwide.
BACKGROUND
Early childhood caries (ECC) is a major oral health problem, mainly in socially disadvantaged populations. ECC affects infants and preschool children worldwide.
AIM
A survey to identify the factors influencing the ECC among preschool children in Madipakkam, Chennai.
METHODOLOGY
A descriptive cross-sectional survey was conducted among 3-5-year-old preschool children in Madipakkam, Chennai. Three schoolchildren participated in the study. In total, 313 children aged three to five years took part in the study. A closed-ended questionnaire was used to collect general information to assess their feeding habits and oral hygiene practices.
RESULTS
Dental caries experience (dmft and deft) was high among children who were bottle-fed compared to children who were breastfed. The children who were breastfed for less than six months had more caries than other children who were breastfed for more than six months.
CONCLUSION
Factors such as age and BMI did not show any association with ECC. Other factors such as feeding habits, snacking, oral health behavior, parental assistance in brushing, and regular dental visits are found to be associated with the ECC. Most of the risk factors studied in this study are modifiable. Therefore parents and children should be educated about the risk factors of ECC and mechanisms to control it.
PubMed: 38882890
DOI: 10.4103/jpbs.jpbs_806_23 -
Heliyon Jun 2024To develop and evaluate a nomogram prediction model for recurrence of acute ischemic stroke (AIS) within one year.
OBJECTIVE
To develop and evaluate a nomogram prediction model for recurrence of acute ischemic stroke (AIS) within one year.
METHOD
Patients with AIS treated at the second affiliated hospital of Xuzhou Medical University from August 2017 to July 2019 were enrolled. Clinical data such as demographic data, risk factors, laboratory tests, TOAST etiological types, MRI features, and treatment methods were collected. Cox regression analysis was done to determine the parameters for entering the nomogram model. The performance of the model was estimated by receiver operating characteristic curves, decision curve analysis, calibration curves, and C-index.
RESULT
A total of 645 patients were enrolled in this study. Side of hemisphere (SOH, Bilateral, HR = 0.35, 95 % CI = 0.15-0.84, p = 0.018), homocysteine (HCY, HR = 1.38, 95 % CI = 1.29-1.47, p < 0.001), c-reactive protein (CRP, HR = 1.04, 95 % CI = 1.01-1.07, p = 0.013) and stroke severity (SS, HR = 3.66, 95 % CI = 2.04-6.57, p < 0.001) were independent risk factors. The C-index of the nomogram model was 0.872 (se = 0.016). The area under the receiver operating characteristic (ROC)curve at one-year recurrence was 0.900. Calibration curve, decision curve analysis showed good performance of the nomogram. The cutoff value for low or high risk of recurrence score was 1.73.
CONCLUSION
The nomogram model for stroke recurrence within one year developed in this study performed well. This useful tool can be used in clinical practice to provide important guidance to healthcare professionals.
PubMed: 38882377
DOI: 10.1016/j.heliyon.2024.e32176 -
Journal of Registry Management 2024Women with early-stage ovarian cancer may be asymptomatic or present with nonspecific symptoms. We examined health care utilization prior to ovarian cancer diagnosis to...
BACKGROUND
Women with early-stage ovarian cancer may be asymptomatic or present with nonspecific symptoms. We examined health care utilization prior to ovarian cancer diagnosis to assess whether women with higher utilization differed in their prognosis and outcomes compared to women with low utilization.
METHODS
Using Medicaid, Medicare, and New York State Cancer Registry data for ovarian cancer cases diagnosed in 2006-2015, we examined selected health care visits that occurred 1-6 months before ovarian cancer diagnosis. We used multivariable-adjusted logistic regression to estimate odds ratios (ORs) and 95% CIs for associations of sociodemographic factors with number of prediagnostic visits and number of visits with tumor characteristics, and Cox proportional hazards regression to examine differences in survival by number of visits.
RESULTS
Women with >5 vs 0 prediagnostic visits were statistically significantly less likely to be diagnosed with distant vs local stage disease (OR, 0.72; 95% CI, 0.54-0.96), and women with 3-5 or >5 vs 0 prediagnostic visits had better overall survival (hazard ratio [HR], 0.88; 95% CI, 0.80-0.96 and HR, 0.90; 95% CI, 0.83-0.98, respectively). In stratified analyses, the association with improved survival was observed only among cases with regional or distant stage disease.
CONCLUSIONS
Women with high health care utilization prior to ovarian cancer diagnosis may have better prognosis and survival, possibly because of earlier detection or better access to care throughout treatment. Women and their health care providers should not ignore symptoms potentially indicative of ovarian cancer and should be persistent in following up on symptoms that do not resolve.
Topics: Humans; Female; Ovarian Neoplasms; New York; Middle Aged; Aged; Patient Acceptance of Health Care; Registries; United States; Adult; Medicaid; Medicare; Prognosis; Aged, 80 and over
PubMed: 38881990
DOI: No ID Found -
International Journal of Cardiology Jun 2024Cardiac rehabilitation (CR) is recommended following acute coronary syndrome (ACS). Diabetes is a common long-term condition associated with ACS, and the inclusion of...
BACKGROUND
Cardiac rehabilitation (CR) is recommended following acute coronary syndrome (ACS). Diabetes is a common long-term condition associated with ACS, and the inclusion of these patients in CR has been less studied. This study examines the referral, uptake, and completion rates in the CR pathway for ACS patients with and without diabetes to identify potential barriers in the CR pathway.
METHODS
The study included patients aged 18 or above who were discharged after a diagnosis of ACS in the Central Denmark Region between 1 September 2017 and 31 August 2018. Diabetes information was obtained from three sources. Logistic regression models were used to examine the associations between having diabetes and the three outcomes: non-referral, non-uptake and non-completion. Results were reported as odds ratios (OR) with 95% confidence intervals (CI).
RESULTS
A total of 2447 patients were eligible for the study, of which 457 (18.7%) had diabetes. Only non-uptake was found to be significantly associated with diabetes after adjustment for prespecified variables (OR = 1.38, 95% CI 1.01-1.90). Associations for non-referral (OR = 1.11, 95% CI 0.87-1.41) and non-completion (OR = 1.06, 95 %CI 0.73-1.53) were not found to be statistically significant between ACS patients with diabetes and those without diabetes.
CONCLUSION
This study highlights a significant disparity in the uptake of CR between patients with and without diabetes following ACS, demonstrating that patients with diabetes require early promotion and increased assistance to enrol in CR.
PubMed: 38880427
DOI: 10.1016/j.ijcard.2024.132275 -
International Journal of Infectious... Jun 2024An anticipated decline in external funding in sub-Saharan Africa (SSA) necessitates a re-evaluation of HIV response sustainability strategies. While institutional...
An anticipated decline in external funding in sub-Saharan Africa (SSA) necessitates a re-evaluation of HIV response sustainability strategies. While institutional capacity building (ICB) has yielded positive outcomes, including strengthened technical expertise and institutional frameworks, it faces challenges. These include overemphasis on technical expertise neglecting resource mobilization, and a limited focus on policy advocacy. To achieve long-term sustainability, ICB efforts must equip local institutions with skills for tailored donor engagement, data-driven advocacy, and collaborative policy influence. This multi-pronged approach, coupled with efforts to diversify funding and integrate HIV responses, is crucial to empower local ownership and ensure the long-term viability of effective HIV responses in SSA.
PubMed: 38880122
DOI: 10.1016/j.ijid.2024.107135 -
Therapeutic Advances in Respiratory... 2024Chronic cough (CC) affects about 10% of adults, but opioid use in CC is not well understood.
BACKGROUND
Chronic cough (CC) affects about 10% of adults, but opioid use in CC is not well understood.
OBJECTIVES
To determine the use of opioid-containing cough suppressant (OCCS) prescriptions in patients with CC using electronic health records.
DESIGN
Retrospective cohort study.
METHODS
Through retrospective analysis of Midwestern U.S. electronic health records, diagnoses, prescriptions, and natural language processing identified CC - at least three medical encounters with cough, with 56-120 days between first and last encounter - and a 'non-chronic cohort'. Student's -test, Pearson's chi-square, and zero-inflated Poisson models were used.
RESULTS
About 20% of 23,210 patients with CC were prescribed OCCS; odds of an OCCS prescription were twice as great in CC. In CC, OCCS drugs were ordered in 38% with Medicaid insurance and 15% with commercial insurance.
CONCLUSION
Findings identify an important role for opioids in CC, and opportunity to learn more about the drugs' effectiveness.
Topics: Humans; Retrospective Studies; Analgesics, Opioid; Male; Cough; Female; Middle Aged; Adult; Chronic Disease; Electronic Health Records; Cohort Studies; Aged; Antitussive Agents; United States; Drug Prescriptions; Medicaid; Midwestern United States; Practice Patterns, Physicians'; Young Adult; Adolescent; Chronic Cough
PubMed: 38877686
DOI: 10.1177/17534666241259373 -
BMC Medical Ethics Jun 2024In 2021, Spain became the first Southern European country to grant and provide the right to euthanasia and medically assisted suicide. According to the law, the State...
BACKGROUND
In 2021, Spain became the first Southern European country to grant and provide the right to euthanasia and medically assisted suicide. According to the law, the State has the obligation to ensure its access through the health services, which means that healthcare professionals' participation is crucial. Nevertheless, its implementation has been uneven. Our research focuses on understanding possible ethical conflicts that shape different positions towards the practice of Medical Assistance in Dying, on identifying which core ideas may be underlying them, and on suggesting possible reasons for this disparity. The knowledge acquired contributes to understanding its complexity, shedding light into ambivalent profiles and creating strategies to increase their participation.
METHODS
We conducted an exploratory qualitative research study by means of semi-structured interviews (1 h) with 25 physicians and nurses from primary care (12), hospital care (7), and palliative care (6), 17 women and 8 men, recruited from Madrid, Catalonia, and Andalusia between March and May 2023. Interviews were recorded, transcribed, and coded in Atlas.ti software by means of thematic and interpretative methods to develop a conceptual model.
RESULTS
We identified four approaches to MAiD: Full Support (FS), Conditioned Support (CS), Conditioned Rejection (CR), and Full Rejection (FR). Full Support and Full Rejection fitted the traditional for and against positions on MAiD. Nevertheless, there was a gray area in between represented by conditioned profiles, whose participation cannot be predicted beforehand. The profiles were differentiated considering their different interpretations of four core ideas: end-of-life care, religion, professional duty/deontology, and patient autonomy. These ideas can intersect, which means that participants' positions are multicausal and complex. Divergences between profiles can be explained by different sources of moral authority used in their moral reasoning and their individualistic or relational approach to autonomy.
CONCLUSIONS
There is ultimately no agreement but rather a coexistence of plural moral perspectives regarding MAiD among healthcare professionals. Comprehending which cases are especially difficult to evaluate or which aspects of the law are not easy to interpret will help in developing new strategies, clarifying the legal framework, or guiding moral reasoning and education with the aim of reducing unpredictable non-participations in MAID.
Topics: Humans; Spain; Suicide, Assisted; Male; Female; Qualitative Research; Attitude of Health Personnel; Adult; Health Personnel; Middle Aged; Palliative Care
PubMed: 38877494
DOI: 10.1186/s12910-024-01069-1