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BMJ Open May 2024A significant proportion of individuals suffering from post COVID-19 condition (PCC, also known as long COVID) can present with persistent, disabling fatigue similar to...
INTRODUCTION
A significant proportion of individuals suffering from post COVID-19 condition (PCC, also known as long COVID) can present with persistent, disabling fatigue similar to myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and post-viral fatigue syndromes. There remains no clear pharmacological therapy for patients with this subtype of PCC, which can be referred to as post-COVID fatigue syndrome (PCFS). A low dose of the opioid antagonist naltrexone (ie, low-dose naltrexone (LDN)) has emerged as an off-label treatment for treating fatigue and other symptoms in PCC. However, only small, non-controlled studies have assessed LDN in PCC, so randomised trials are urgently required.
METHODS AND ANALYSIS
A prospective, randomised, double-blind, parallel arm, placebo-controlled phase II trial will be performed to assess the efficacy of LDN for improving fatigue in PCFS. The trial will be decentralised and open to eligible individuals throughout the Canadian province of British Columbia (BC). Participants will be recruited through the province-wide Post-COVID-19 Interdisciplinary Clinical Care Network (PC-ICCN) and research volunteer platform (REACH BC). Eligible participants will be 19-69 years old, have had a confirmed or physician-suspected SARS-CoV-2 infection at least 3 months prior and meet clinical criteria for PCFS adapted from the Institute of Medicine ME/CFS criteria. Individuals who are taking opioid medications, have a history of ME/CFS prior to COVID-19 or history of significant liver disease will be excluded. Participants will be randomised to an LDN intervention arm (n=80) or placebo arm (n=80). Participants in each arm will be prescribed identical capsules starting at 1 mg daily and follow a prespecified schedule for up-titration to 4.5 mg daily or the maximum tolerated dose. The trial will be conducted over 16 weeks, with assessments at baseline, 6, 12 and 16 weeks. The primary outcome will be fatigue severity at 16 weeks evaluated by the Fatigue Severity Scale. Secondary outcomes will include pain Visual Analogue Scale score, overall symptom severity as measured by the Patient Phenotyping Questionnaire Short Form, 7-day step count and health-related quality of life measured by the EuroQol 5-Dimension questionnaire.
ETHICS AND DISSEMINATION
The trial has been authorised by Health Canada and approved by The University of British Columbia/Children's and Women's Health Centre of British Columbia Research Ethics Board. On completion, findings will be disseminated to patients, caregivers and clinicians through engagement activities within existing PCC and ME/CFS networks. Results will be published in academic journals and presented at conferences.
TRIAL REGISTRATION NUMBER
NCT05430152.
Topics: Humans; Double-Blind Method; Naltrexone; British Columbia; Narcotic Antagonists; COVID-19; Fatigue Syndrome, Chronic; Prospective Studies; Randomized Controlled Trials as Topic; SARS-CoV-2; Post-Acute COVID-19 Syndrome; Adult; Male; Clinical Trials, Phase II as Topic; Female
PubMed: 38740499
DOI: 10.1136/bmjopen-2024-085272 -
Journal of the American Board of Family... 2024Providing abortion in primary care expands access and alleviates delays. The 2020 COVID-19 public health emergency (PHE) led to the expansion of telehealth, including... (Comparative Study)
Comparative Study
INTRODUCTION
Providing abortion in primary care expands access and alleviates delays. The 2020 COVID-19 public health emergency (PHE) led to the expansion of telehealth, including medication abortion (MAB). This study evaluates the accessibility of novel telehealth MAB (teleMAB) initiated during the PHE, with the lifting of mifepristone restrictions, compared with traditional in-clinic MAB offered before the PHE at a Massachusetts safety-net primary care organization.
METHODS
We conducted a retrospective electronic medical record review of 267 MABs. We describe sociodemographic, care access, and complete abortion characteristics and compare differences between teleMAB and in-clinic MABs using Chi-squared test, fisher's exact test, independent test, and Wilcoxon rank sum. We conducted logistic regression to examine differences in time to care (6 days or less vs 7 days or more).
RESULTS
184 MABs were eligible for analysis (137 in-clinic, 47 teleMAB). Patients were not significantly more likely to receive teleMAB versus in-clinic MAB based on race, ethnicity, language, or payment. Completed abortion did not significantly differ between groups (). Patients received care more quickly when accessing teleMAB compared with usual in-clinic MAB (median 3 days, range 0 to 20 vs median 6 days, range 0 to 32; < .001). TeleMAB patients had 2.29 times the odds of having their abortion appointment within 6 days compared with in-clinic (95% CI: 1.13, 4.86).
CONCLUSION
TeleMAB in primary care is as effective, timelier, and potentially more accessible than in-clinic MAB when in-person mifepristone regulations were enforced. TeleMAB is feasible and can promote patient-centered and timely access to abortion care.
Topics: Humans; Female; Telemedicine; Abortion, Induced; Retrospective Studies; Adult; Primary Health Care; Pregnancy; COVID-19; Massachusetts; Health Services Accessibility; SARS-CoV-2; Young Adult; Mifepristone; Abortifacient Agents
PubMed: 38740468
DOI: 10.3122/jabfm.2023.230178R1 -
CMAJ : Canadian Medical Association... May 2024
Topics: Humans; Female; Pregnancy; Canada; Reproductive Health; Pregnancy Outcome; Black People; Healthcare Disparities; Health Equity
PubMed: 38740413
DOI: 10.1503/cmaj.231105-f -
PloS One 2024Elastic band resistance training in elderly individuals can improve physical fitness and promote mental health in addition to other benefits. This systematic review...
OBJECTIVES
Elastic band resistance training in elderly individuals can improve physical fitness and promote mental health in addition to other benefits. This systematic review aimed to review, summarize, and evaluate quantitative, qualitative, and mixed methodological studies on the use of elastic band resistance training in elderly individuals, and to investigate the influence of elastic band resistance training on the physical and mental health of elderly individuals, as well as their preferences and obstacles in training.
METHODS
A convergent separation approach was used to synthesize and integrate the results, specifically the mixed systematic review approach recommended by the Joanna Briggs Institute. The extensive search strategy included electronic database searches in the Cochrane Library, PubMed, Embase, Web of Science, Google Scholar, MEDLINE, and CINAHL. The researchers rigorously screened the literature, extracted and analyzed the data, and evaluated the quality of the included studies using the Mixed Methods Appraisal Tool (MMAT).
RESULTS
Twenty-eight studies were included, of which 25 were quantitative studies, 2 were qualitative studies, and 1 was a mixed-methods study. A total of 1,697 subjects were investigated across all studies. Quantitative evidence supports the notion that elastic band resistance training can improve upper and lower limb flexibility, endurance, upper strength, physical balance, and cardiopulmonary function and enhance the mental health of elderly individuals. Participants in the qualitative study reported some preferences and obstacles with band resistance training, but most participants reported physical benefits.
CONCLUSIONS
Despite the heterogeneity between studies, this review is the first systematic review to comprehensively evaluate the effectiveness of elastic band resistance training in older adults. It not only shows the influence of elastic band resistance training on the physical and mental health of the elderly, but also emphasizes the preference and obstacles of elderly individuals face.
Topics: Humans; Resistance Training; Mental Health; Aged; Physical Fitness; Muscle Strength; Male
PubMed: 38739588
DOI: 10.1371/journal.pone.0303372 -
JAMA Network Open May 2024Individuals with congenital heart disease (CHD) are increasingly reaching childbearing age, are more prone to adverse pregnancy events, and uncommonly undergo...
IMPORTANCE
Individuals with congenital heart disease (CHD) are increasingly reaching childbearing age, are more prone to adverse pregnancy events, and uncommonly undergo recommended cardiac evaluations. Data to better understand resource allocation and financial planning are lacking.
OBJECTIVE
To examine health care use and costs for patients with CHD during pregnancy.
DESIGN, SETTING, AND PARTICIPANTS
This retrospective cohort study was performed from January 1, 2010, to December 31, 2016, using Merative MarketScan commercial insurance data. Participants included patients with CHD and those without CHD matched 1:1 by age, sex, and insurance enrollment year. Pregnancy claims were identified for all participants. Data were analyzed from September 2022 to March 2024.
EXPOSURES
Baseline characteristics (age, US region, delivery year, insurance type) and pregnancy-related events (obstetric, cardiac, and noncardiac conditions; birth outcomes; and cesarean delivery).
MAIN OUTCOMES AND MEASURES
Health service use (outpatient physician, nonphysician, emergency department, prescription drugs, and admissions) and costs (total and out-of-pocket costs adjusted for inflation to represent 2024 US dollars).
RESULTS
A total of 11 703 pregnancies (mean [SD] maternal age, 31.5 [5.4] years) were studied, with 2267 pregnancies in 1785 patients with CHD (492 pregnancies in patients with severe CHD and 1775 in patients with nonsevere CHD) and 9436 pregnancies in 7720 patients without CHD. Compared with patients without CHD, pregnancies in patients with CHD were associated with significantly higher health care use (standardized mean difference [SMD] range, 0.16-1.46) and cost (SMD range, 0.14-0.55) except for out-of-pocket inpatient and ED costs. After adjustment for covariates, having CHD was independently associated with higher total (adjusted cost ratio, 1.70; 95% CI, 1.57-1.84) and out-of-pocket (adjusted cost ratio, 1.40; 95% CI, 1.22-1.58) costs. The adjusted mean total costs per pregnancy were $15 971 (95% CI, $15 480-$16 461) for patients without CHD, $24 290 (95% CI, $22 773-$25 806) for patients with any CHD, $26 308 (95% CI, $22 788-$29 828) for patients with severe CHD, and $23 750 (95% CI, $22 110-$25 390) for patients with nonsevere CHD. Patients with vs without CHD incurred $8319 and $700 higher total and out-of-pocket costs per pregnancy, respectively.
CONCLUSIONS AND RELEVANCE
This study provides novel, clinically relevant estimates for the cardio-obstetric team, patients with CHD, payers, and policymakers regarding health care and financial planning. These estimates can be used to carefully plan for and advocate for the comprehensive resources needed to care for patients with CHD.
Topics: Humans; Female; Pregnancy; Heart Defects, Congenital; Adult; Retrospective Studies; Insurance, Health; United States; Health Care Costs; Health Expenditures; Patient Acceptance of Health Care; Young Adult; Pregnancy Complications, Cardiovascular
PubMed: 38739390
DOI: 10.1001/jamanetworkopen.2024.10763 -
European Stroke Journal May 2024Malnutrition is common in stroke patients and has been associated with poor functional outcomes and increased mortality after stroke. Previous research on nutrition...
INTRODUCTION
Malnutrition is common in stroke patients and has been associated with poor functional outcomes and increased mortality after stroke. Previous research on nutrition status and post-intracerebral hemorrhage (ICH) outcomes, however, is limited and conflicting.
PATIENTS AND METHODS
Monocenter study of patients with spontaneous deep or lobar ICH from a longitudinal cohort enrolling consecutive patients between 1994 and 2022. Nutrition status was assessed using admission body mass index BMI), albumin, total bilirubin, cholesterol, c-reactive protein, hemoglobin a1c, high-density lipoprotein, hemoglobin, low-density lipoprotein, mean corpuscular volume, alanine transaminase, and triglycerides. Main outcome was favorable discharge outcome (mRS 0-2). Multivariable logistic regression was conducted with adjustment for baseline differences.
RESULTS
Among 2170 patients, 1152 had deep and 1018 had lobar ICH. Overweight BMI was associated with higher odds of favorable discharge outcome in all (aOR = 3.01, 95% CI 1.59-5.69, = 0.001) and lobar (aOR = 3.26, 95% CI 1.32-8.08, = 0.011) ICH after adjustment for baseline differences. This association did not reach statistical significance in deep (aOR = 2.77, 95% CI 0.99-7.72, = 0.052) ICH. No lab values were associated with functional outcome in all, deep, or lobar ICH after adjustment.
DISCUSSION AND CONCLUSION
Overweight BMI was associated with favorable discharge status after ICH. These findings could inform future studies to determine whether overweight BMI has a protective effect in ICH patients.
PubMed: 38738882
DOI: 10.1177/23969873241253048 -
Acta Dermato-venereologica May 2024Atopic dermatitis (AD) is one of the most common inflammatory diseases, and has a higher prevalence among females in adulthood. The aim of this observational,... (Observational Study)
Observational Study
Atopic dermatitis (AD) is one of the most common inflammatory diseases, and has a higher prevalence among females in adulthood. The aim of this observational, cross-sectional, survey-based study was to evaluate the impact of AD on the daily lives of adult women patients. A scientific committee composed exclusively of women constructed a specific questionnaire in partnership with the French Eczema Association. Severity of AD was evaluated with the Patient-Oriented Eczema Measure (POEM). A sample of 1,009 adult women (mean age ± standard deviation: 41.8 ± 14.2 years) with AD was identified from a representative sample of the French population (82% response rate 1,230 women surveyed). According to the POEM, 50.64% (n = 511) of subjects were identified as having mild AD, 39.35% (n = 397) moderate AD, and 10.01% (n = 101) severe AD. Overall, 67.7% (n = 682) reported that their eczema involved a visible area (face, neck or hands), and 19.6% (n = 198) a sensual area (breasts/chest, genital area or buttocks). Of the 720 women with menstrual cycles, exacerbations of AD were reported to occur mostly before (50.6%) and during (48.3%) menstruation. A small proportion of women, 7.3% (n = 74), reported being afraid of becoming pregnant because of their eczema. If AD involvement was in a visible area it had a greater impact on romantic relationships, sexual relationships and occupation. If AD involvement was in a sensual area it had a greater influence on romantic relationships and sexuality. Particular attention should be given to patients with localization of AD on the face, neck or hands, as they have a higher risk of social exclusion. Moreover, these results should encourage health professionals to ask patients with AD about the possible involvement of sensual areas.
Topics: Humans; Female; Dermatitis, Atopic; Adult; Cross-Sectional Studies; France; Middle Aged; Severity of Illness Index; Quality of Life; Cost of Illness; Young Adult; Surveys and Questionnaires; Health Surveys; Pregnancy
PubMed: 38738770
DOI: 10.2340/actadv.v104.10321 -
Women's Health (London, England) 2024Almost 10% of women in reproductive age are diagnosed with ovarian endometriomas and can experience symptoms and infertility disorders. Ovarian endometriomas can be...
BACKGROUND
Almost 10% of women in reproductive age are diagnosed with ovarian endometriomas and can experience symptoms and infertility disorders. Ovarian endometriomas can be treated with medical or surgical therapy.
OBJECTIVE
To assess whether long-term therapy with dienogest or oral cyclic estrogen-progestogens is effective in reducing the size of ovarian endometriomas, alleviating associated symptoms, and reducing the requirement for surgery.
DESIGN
Prospective non-interventional cohort study.
METHODS
We enrolled childbearing women diagnosed with ovarian endometriomas. We collected demographic, clinical, and surgical data, including the evaluation of ovarian endometrioma-associated symptoms and pain using the visual analog scale. We grouped the women according to treatment regimen into dienogest, estrogen-progestogens, and no-treatment. Patient's assessment was performed at baseline and after 12 months evaluating the largest ovarian endometrioma diameter (in millimeters) and the associated symptoms. Furthermore, we analyzed the impact of hormonal treatment in a sub-group of women fulfilling at baseline the criteria for a first-line surgical approach (ovarian endometrioma > 30 mm with visual analog scale > 8 or ovarian endometrioma > 40 mm before assisted reproductive treatments or any ovarian endometrioma(s) > 60 mm).
RESULTS
We enrolled 142 patients: 62, 38, and 42 in dienogest, estrogen-progestogens, and no-treatment groups, respectively. No significant differences were found regarding baseline characteristics. After 12 months, the mean largest ovarian endometrioma diameter increased in the no-treatment group (31.1 versus 33.8; p < 0.01), while a significant reduction was registered in the dienogest (35.1 versus 25.8; p < 0.01) and estrogen-progestogens (28.4 versus 16.7; p < 0.01) groups; no significant difference in ovarian endometrioma diameter reduction between these two latter groups was noted (p = 0.18). Ovarian endometrioma-associated symptoms and pain improved in dienogest and estrogen-progestogens groups, with a significantly greater effect for dienogest than for estrogen-progestogens for dysmenorrhea (74% versus 59%; p < 0.01). In the sub-group of women eligible for first-line surgery at baseline, long-term treatment with dienogest and estrogen-progestogens reduced surgical eligibility by 30%.
CONCLUSIONS
Decreased mean largest ovarian endometriomas'diameter after 12 months and reduction of the need for surgical treatment by 30% were observed in dienogest and estrogen-progestogens groups. Long-term treatment with dienogest had a greater effect in alleviating dysmenorrhea and pain.
Topics: Humans; Female; Nandrolone; Endometriosis; Adult; Prospective Studies; Ovarian Diseases; Progestins; Estrogens; Treatment Outcome; Young Adult
PubMed: 38738634
DOI: 10.1177/17455057241252573 -
Women's Health (London, England) 2024While menstruation is a physiologic process, it remains highly stigmatized. Despite the sheer number of menstruators, menstruation is a highly individualized experience,...
BACKGROUND
While menstruation is a physiologic process, it remains highly stigmatized. Despite the sheer number of menstruators, menstruation is a highly individualized experience, with wide variation in duration, symptoms, and management. This wide variability lends itself to large disparities in access to menstruation management products and subsequently the lived experience of menstruators.
OBJECTIVES
The research team sought to understand lived menstrual experiences, symptoms, management tactics, and commonly used and desired resources among 20 cisgendered women aged 18-45 years in Philadelphia.
DESIGN
This project was a qualitative research study.
METHODS
We used a collaborative, community-based participatory research approach with No More Secrets, a Philadelphia-based grassroots sexuality awareness and menstrual health hub. Semi-structured telephone interviews were used to gain insight into general menstruation-related experiences, communication, worries, and concerns, with subsequent thematic analysis via Key Words in Context approach.
RESULTS
Four themes emerged following analysis: cycle characteristics, menstruation management, coping resources, and future resources. Participants largely spoke about their menses as a negative experience, asked for more comprehensive, verified sources of information and needed greater access to menstrual management supplies.
CONCLUSION
Menstruation is a highly individualized experience with a large variety in knowledge, menstrual product use, and individual needs. Despite the individuality of menstruation, our community-based research shows that there is a dire need for interventions that promotes knowledge and access to menstrual care.
Topics: Humans; Female; Adult; Menstruation; Qualitative Research; Philadelphia; Young Adult; Adolescent; Middle Aged; Community-Based Participatory Research; Menstrual Hygiene Products; Health Knowledge, Attitudes, Practice; Adaptation, Psychological; Interviews as Topic
PubMed: 38738597
DOI: 10.1177/17455057241251975 -
Cureus Apr 2024Introduction Women's health is significantly impacted by undesirable pregnancies and unsafe abortions, leading to the deaths of thousands of women and causing many...
Introduction Women's health is significantly impacted by undesirable pregnancies and unsafe abortions, leading to the deaths of thousands of women and causing many others to suffer from infertility and long-term reproductive health issues. To address this problem, the use of modern contraception methods is increasing, regardless of economic status and dwelling, allowing women to exercise their rights and access reproductive health services. Objective The objective of this study is to examine the knowledge and practice of family planning and the factors associated with it. Setting and design A cross-sectional study was conducted among Muslim women (n=461) using a two-stage stratified random sampling method with a semi-structured questionnaire in the five taluks of Dakshina Kannada district in Karnataka. Methods and materials The required study sample was drawn by adopting the two-stage stratified random sampling technique. The study population was divided into different strata consisting of panchayats and wards. The number of households was selected from these panchayats/wards. Statistical analysis The association between faith in family planning and the knowledge and practice of family planning is studied using a chi-squared test. The factors associated with the practice of family planning are identified using a univariable and multivariable logistic regression analysis. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) version 27 (IBM SPSS Statistics, Armonk, NY). Results There is a significant association between faith in family planning and its practice, with a p-value of less than 0.0001. Age was also found to be a significant factor associated with the practice of family planning. Specifically, women aged 31-40 were less likely to practice family planning compared to women aged 21-30, with a p-value of 0.012. The majority of individuals indicated the preferred child (23.9%) and going against the custom (16.5%) as their reasons for not using family planning. Conclusions Muslim women are reasonably well-informed about modern methods of contraception, but their usage remains relatively low. Outreach initiatives, health worker mobilization from within the community, and health education and information sharing are examples of program interventions that could help address this issue.
PubMed: 38738056
DOI: 10.7759/cureus.58088