SAGE Open Medicine最新文献

Objectives: To explore the impact of obesity on clinical outcomes, health-related quality of life, emotional well-being, and work productivity in people/patients with obesity across six countries by body mass index and the presence of complications.

Methods: Adelphi Real World Obesity Disease Specific Programme™ captured data related to physicians and their consulting people/patients with obesity on a weight management program or anti-obesity medication in Brazil, Canada, China, Japan, Kingdom of Saudi Arabia, and the United Arab Emirates from April to December 2022. Physicians reported data for up to eight qualifying people/patients with obesity. People/patients with obesity voluntarily completed outcome measures: 36-Item Short Form Health Survey, emotional well-being, and Work Productivity and Activity Impairment.

Results: Of 1506 people/patients with obesity, 58% were female (mean ± standard deviation age: 41 ± 12.7 years; body mass index: 32.3 kg/m² ± 7.7 kg/m²). Overall, 82% had ⩾1 complication (median and interquartile range: 2.0 (1.0-3.0)). People/patients with obesity struggled with weight for a mean ± SD of 64.1 ± 86.6 months with a median (interquartile range) of 3.0 (2.0-5.0) weight-loss attempts. Mean ± standard deviation 36-Item Short Form Health Survey scores for people/patients with obesity above the obesity threshold showed impairment in general health (42.3 ± 11.5), social functioning (44.3 ± 9.2), role-emotional (46.0 ± 9.3), and mental health (45.7 ± 9.6). People/patients with obesity with complications showed similar impairment. People/patients with obesity reported bother/embarrassment about their weight, with 72% worried about future weight gain. Work productivity and activity impairment scores among people/patients with obesity above the obesity threshold showed impairment in activity (36%), overall work (34%), and presenteeism (31%). Findings were similar for people/patients with obesity with complications.

Conclusion: Results suggest that obesity alongside the presence of complications negatively impacts health-related quality of life, emotional well-being, and work productivity, reinforcing the need for comprehensive interventions for this complex health issue.

Objective: Bacterial extracts have been used for many years to prevent airway infections. Recent findings suggest that immunity can be trained by inducing an immunological memory in both the innate and acquired immune response. This real-life observational study investigated the potential of sublingual bacterial immunotherapy in the prevention of ear, nose, and throat infections.

Methods: Patients received sublingual bacterial immunotherapy for 12 months and were followed for 24 months. The number of ear, nose, and throat infection episodes from the previous year was recorded during the initial visit based on the patient's clinical history. Patients were then followed up with visits every 2 months, and the occurrence of ear, nose, and throat infection episodes was documented at 6, 12, 18, and 24 months after the start of the study.

Results: The results demonstrated a strong potential for preventing ear, nose, and throat infections, with a reduction in the number of episodes by 75.68%, 82.27%, 82.78%, and 89.88% at 6, 12, 18, and 24 months, respectively. No adverse effects related to sublingual bacterial immunotherapy administration were reported.

Conclusion: The results suggested that long-term sublingual bacterial immunotherapy is safe and effectively prevents ear, nose, and throat infections, even after treatment ends.

Objective: This study utilized a sample of trangender, nonbinary, and gender-diverse (TGD) patients to build on emerging literature that suggests that hypermobile Ehlers-Danlos syndrome may be overrepresented in TGD populations. The objective of this retrospective chart review was to determine the prevalence of hypermobile Ehlers-Danlos syndrome syndrome at a gender-affirming primary care clinic.

Methods: A retrospective chart review of medical records was conducted with records between May 2021 and June 2024. Eligible participants were active patients at the gender-affirming primary care clinic, who were over the age of 16, were TGD, and had a diagnosis of hypermobile Ehlers-Danlos syndrome. Of 2180 patients over the age of 16, 59 patients met the criteria. The primary outcome was the prevalence of hypermobile Ehlers-Danlos syndrome in the sample, summarized by frequency and percentage. Secondary outcomes were the prevalence of associated clinical features within the sample of TGD patients with hypermobile Ehlers-Danlos syndrome.

Results: The prevalence of hypermobile Ehlers-Danlos syndrome syndrome was 2.7%. Within the sample of patients with hypermobile Ehlers-Danlos syndrome, 81.4% were found to have diagnoses of anxiety, depression, or attention deficit hyperactivity disorder, 50.8% had a history of migraines or dysautonomia, 39.0% had a history of gastroesophageal reflux disease, irritable bowel syndrome, nausea, diarrhea, or gastroparesis, 16.9% had history of mast cell activation disorder, 32.2% had postural orthostatic tachycardia syndrome, 30.5% had dysmenorrhea, 83.1% reported chronic pain, and 44.1% reported chronic fatigue.

Conclusions: We found that 2.7% of the 2180 patients had a diagnosis of hypermobile Ehlers-Danlos syndrome syndrome. The sample had notably high rates of medical comorbidities as well as anxiety, depression, or attention deficit hyperactivity disorder, consistent with emerging research. The results support the intersecting psychological and healthcare vulnerabilities of TGD patients with hypermobile Ehlers-Danlos syndrome. Further research in this intersection could support mitigation of health care disparities that affect TGD patients with hypermobile Ehlers-Danlos syndrome syndrome.

Background: To investigate the trends in Burkitt lymphoma incidence, mortality, and disability-adjusted life-years, considering sex and age, from 1990 to 2021, with a 20-year forecast.

Method: Data regarding Burkitt lymphoma were extracted from the Global Burden of Disease study for the year 2021.

Results: Globally, there were 19,072 incident cases of Burkitt lymphoma in 2021. Cases of Burkitt lymphoma experienced a 207% increase from 1990 to 2021. Over three decades, Burkitt lymphoma-associated deaths rose from 3843 to 6525. The global incidence rate of Burkitt lymphoma increased from 0.127 in 1990 to 0.236 in 2021 per 100,000 population. High body-mass indexes contribution to Burkitt lymphoma is evident in the disability-adjusted life-years, with the United States and the United Kingdom recording 0.06 and 0.05, respectively. Conversely, China and India demonstrated substantially lower contributions, at 0.02 and 0.005, respectively. The groups aged 0-14 and 50-74 years surpassed other age groups in both Burkitt lymphoma-associated incidence and death numbers. Moreover, males consistently had higher Burkitt lymphoma-associated mortality rates and numbers than females in all age groups. Furthermore, the estimated annual percentage changes of incidence with Burkitt lymphoma were positively correlated with sociodemographic index (Pearson r = 0.606; p = 0.003). The Bayesian age-period-cohort model predicts a significant increase in the age-standardized incidence rates of Burkitt lymphoma over the next 20 years. Interestingly, the age-standardized rates of death did not change dramatically from 1990 to 2021; and the trend is expected to remain relatively stable in the future 20 years.

Conclusion: The burden of Burkitt lymphoma varies according to different regions and genders, and children of 0-14 years, adults of 50-74 years with Burkitt lymphoma disease as well as male patients need special attention. High body-mass index contributes significantly to Burkitt lymphoma burden in the United States and United Kingdom, but less so in China and India. Hopefully, this study will help optimize the prevention, diagnosis, treatment, and management of Burkitt lymphoma to reduce the disease burden.

Background: The coronavirus disease 2019 (COVID-19) pandemic has affected millions of people worldwide, and although it is primarily a respiratory illness, gastrointestinal symptoms have been reported in a significant proportion of patients.

Aim: Prevalence of gastrointestinal symptoms after recovery from COVID-19.

Methodology: A community-based cross-sectional study was conducted in the Aseer region of Saudi Arabia. The study population included individuals aged 18 years or older with COVID-19 and living in the Aseer region. The data were collected through a pretested, structured online questionnaire preceded by consent and were used to maintain the confidentiality of the data. The questionnaire covered participants' data, COVID-19 infection status, and gastrointestinal tract symptoms during and after recovery from the infection.

Results: A total of 409 participants in the Aseer region completed the study survey. The participants' ages ranged from 18 to more than 50 years, with a mean age of 34.5 ± 11.9 years. A total of 205 (50.1%) participants were females. A total of 263 (64.3%) of the study participants experienced gastrointestinal tract symptoms during COVID-19 infection. Additionally, 203 (49.6%) of the study participants had gastrointestinal tract symptoms after recovering from COVID-19 infection. The most commonly reported symptoms were diarrhea (13.2%), nausea (13.2%), anorexia (12.7%), abdominal pain (11%), and constipation. Male sex who suffered form severe COVID-19 infection, and gastrointestinal tract symptoms during acute infection were significantly associated with post-COVID-19 gastrointestinal tract symptoms (p < 0.05).

Conclusions: In conclusion, the current study showed that nearly two-thirds of active COVID-19 patients experienced gastrointestinal tract symptoms. Additionally, approximately half of the COVID-19 patients who recovered had gastrointestinal tract-related symptoms, but few of those patients had gastrointestinal tract-related symptoms within 1 week.

Introduction: Urinary tract infections are prevalent among pregnant women and can lead to serious maternal and neonatal complications. Hypertensive disorders of pregnancy, a leading cause of maternal morbidity, may be associated with urinary tract infections. This study investigates whether bacteriuria detected via routine urinalysis, a standard screening in Indonesia, contributes to hypertension risk during pregnancy, aiming to enhance clinical management and screening protocols.

Aim of study: To evaluate the association between bacteriuria detected through routine urinalysis and hypertension during pregnancy in women at Margono Hospital, Purwokerto.

Methods: This study was conducted at Margono Hospital, Indonesia; the study included all pregnant women who delivered in 2022-2023, applying specific exclusion criteria. Urine samples were analyzed for bacteriuria, and statistical analysis determined the prevalence ratio and odds ratio for the correlation of bacteriuria and risk of hypertension.

Results: Hypertension prevalence was 1.52 times higher in patients with bacteriuria. The odds ratio was 1.379 (confidence intervals: 0.751-2.532) with a statistically significant p-value of <0.003. These findings indicate a significant association (p < 0.05) between positive bacteriuria and increased risk of hypertension and preeclampsia.

Conclusion: This study highlights a significant association between bacteriuria and hypertension in pregnancy, including severe complications like impending eclampsia. Pregnant women with urinary tract infections should be closely monitored for preeclampsia. Further research is needed to explore the mechanisms linking urinary tract infections and hypertension during pregnancy.

Background: There is a limited data examining the practice of using the airway pressure release ventilation mode for patients with acute respiratory distress syndrome among respiratory therapists.

Objectives: To evaluate the current practice and barriers when using airway pressure release ventilation mode in the management of patients with acute respiratory distress syndrome.

Methods: A cross-sectional online survey was disseminated between November 2022 and April 2023 to respiratory therapists in Saudi Arabia. Descriptive statistics were used to analyze the respondents' characteristics.

Results: Overall, 802 respiratory therapists (male: 59.60%) completed the survey. Five hundred nineteen (64.71%) did not receive training on airway pressure release ventilation mode. Moreover, 325 (40.52%) and 391 (48.75%) did not know if airway pressure release ventilation was used at their hospitals and if the mode was managed via protocol with acute respiratory distress syndrome patients. Of the participants, 276 (34.41%) reported that plateau pressure should be used as a target when setting P-high initially, while 427 (53.24%) believed that the initial P-low should be equal to 0 cmH₂O. Moreover, 468 (58.36%) believed that the initial T-high should be between 4 and 6 s, while 548 (68.33%) believed the initial T-low should be a set time (between 0.4 and 0.8) seconds. The most appropriate intervention to improve ventilation and oxygenation was to increase the P-high, which was reported by 370 (46.14%) and 326 (40.65%) respiratory therapists, respectively. Inadequate training was the most common barrier (678, 84.54%) to airway pressure release ventilation implementation.

Conclusion: Airway pressure release ventilation management varies between respiratory therapists which may be due to inadequate training and the absence of protocols.

Objectives: This study investigated the implementation of the ABCDEF bundle and the factors associated with its implementation according to national income levels.

Methods: This study is cross-sectional research. We conducted a secondary analysis of an international 1-day point-prevalence study that investigated the implementation of the ABCDEF bundle in critically ill patients. All patients admitted to the ICU were eligible. This study was conducted across 135 ICUs in 54 countries, including data from 664 patients. Outcomes were categorized according to the income level of the country (high-income, middle-income, and low-income countries) in which each ICU was located. A multilevel generalized linear model was developed to identify the factors associated with ABCDEF bundle implementation for each income level.

Results: We identified 664 patients in 79 high-income countries, 278 in 26 middle-income countries, and 287 in 30 low-income countries ICUs. Implementation rates of the ABCDEF bundle were low for all income levels but varied. Few individuals completed the entire bundle on the survey date. Common factors associated with the implementation among all income levels were a multidisciplinary team approach for Element A (pain) and mechanical ventilation use for Element C (sedation), which were also associated with lower Element E (mobility). The existence of a protocol was frequently identified as a promoting factor associated with ABCDEF bundle implementation. The associated factors varied by income level; for example, dedicated intensivists were only identified in high-income countries, but not in middle-income countries or low-income countries.

Conclusions: The overall low ABCDEF bundle implementation rates necessitate action. As factors associated with its implementation vary according to national income level, tailored strategies are essential for improving ICU care quality.

Trial registration: NA.

Objective: This pilot study aims to assess how individuals with rhythm perception, particularly musicians, are able to maintain the predefined chest compression rate during cardiopulmonary resuscitation compared to people without rhythm perception.

Methods: The study was conducted at the Pilsen Emergency Medicine Conference (Czechia) using a simulation-based cohort design. Participants performed chest compressions on a manikin for 120 s, with the first 10 s guided by a metronome. Participants were grouped based on self-reported rhythmic perception, such as playing a musical instrument. The primary outcome was the average chest compression rate per minute.

Results: A total of 67 participants were included. Both groups provided chest compression rate within the recommended limits. Musicians maintained a better chest compression rate (mean 110.56 compressions per minute) compared to nonmusicians (mean 107.31; T-test, p = 0.00074). Those with any rhythmic perception experience also performed better (T-test, p = 0.036931). Secondary factors, including gender, clinical experience, and prior resuscitation training, did not significantly affect the results.

Conclusion: This study demonstrates that individuals with rhythm perception, especially musicians, follow the predefined frequency of chest compressions more effectively.

Background: Despite multiple studies, less recent literature and data regarding the mortality associated with hip fractures in the elderly population are available.

Objectives: To assess the mortality data and functional outcomes of patients who underwent cemented and uncemented hemiarthroplasty in femoral neck fractures. To evaluate if preoperative (minimum 2 months) calcium and vitamin D supplement intake in patients affects postoperative mobilization with or without walker support.

Methods: All patients aged 65 and above who underwent hemiarthroplasty for femoral neck fractures in our tertiary care center were included. Postoperative functional outcomes were determined using the Modified Harris Hip score and Oxford Hip score at 3, 6, and 12 months. The mortality of the procedures was assessed at 3, 6, and 12 months. Individuals who took both calcium and vitamin D supplements for at least 2 months before surgery were divided into two groups: those who did not take supplements and those who did.

Results: We studied 110 patients above the age of 65 years. The postoperative mortality rate at 3, 6 months and 1 year postoperatively was found to be 3.6%, 4.7%, and 15.5% respectively. Functional outcomes were assessed at 3, 6, and 12 months postoperatively using modified Harris Hip score and Oxford Hip score and were found to be identical in both cemented and uncemented hemiarthroplasty groups. Patients who took calcium and vitamin D supplements preoperatively (minimum 2 months) could walk without support at the end of 1-year post-surgery.

Conclusion: Early surgery and early mobilization should be the main aim of treatment for femoral neck fractures.