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Introduction: Frailty is widely acknowledged as influencing health outcomes among critically ill old patients. Yet, the traditional understanding of its impact has predominantly been through frequentist statistics. We endeavored to explore this association using Bayesian statistics aiming to provide a more nuanced understanding of this multifaceted relationship. Methods: Our analysis incorporated a cohort of 10,363 older (median age 82 years) patients from three international prospective studies, with 30-day all-cause mortality as the primary outcome. We defined frailty as Clinical Frailty Scale ≥ 5. A hierarchical Bayesian logistic regression model was employed, adjusting for covariables, using a range of priors. An international steering committee of registry members reached a consensus on a minimal clinically important difference (MCID). Results: In our study, the 30-day mortality was 43%, with rates of 38% in non-frail and 51% in frail groups. Post-adjustment, the median odds ratio (OR) for frailty was 1.60 (95% CI 1.45–1.76). Frailty was invariably linked to adverse outcomes (OR > 1) with 100% probability and had a 90% chance of exceeding the minimal clinically important difference (MCID) (OR > 1.5). For the Clinical Frailty Scale (CFS) as a continuous variable, the median OR was 1.19 (1.16–1.22), with over 99% probability of the effect being more significant than 1.5 times the MCID. Frailty remained outside the region of practical equivalence (ROPE) in all analyses, underscoring its clinical importance regardless of how it is measured. Conclusions: This research demonstrates the significant impact of frailty on short-term mortality in critically ill elderly patients, particularly when the Clinical Frailty Scale (CFS) is used as a continuous measure. This approach, which views frailty as a spectrum, enables more effective, personalized care for this vulnerable group. Significantly, frailty was consistently outside the region of practical equivalence (ROPE) in our analysis, highlighting its clinical importance. [ABSTRACT FROM AUTHOR]

Sexual dysfunction (SD) is a common symptom for many with multiple sclerosis (MS). However, most studies researching this topic have predominantly White samples. While this matches epidemiological estimates, research has shown that those of other ethnic groups, such as African Americans/Blacks and Hispanics/Latinos, tend to exhibit more symptomology. This study aimed to determine if this greater symptomology in other ethnic groups with MS holds for SD. Study participants were recruited from the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry. Participants completed the MSISQ-19 and the PDDS and provided demographic information. Study participants were 5445 respondents (Mage = 51 years, SD = 9.56, 75% female, 93% White). White, African American/Black, and Hispanic/Latino groups were compared on sexual dysfunction. Linear mixed effects modeling revealed that the MSISQ-19 subscale scores were significantly different for the African American/Black group (t = − 2.48, p < 0.013) and all female participants (t = − 2.58, p < 0.010). African American/Black participants had the least amount of primary SD (M = 10.56, 95% CI [9.09, 12.03]). African American/Black participants had the highest amount of secondary SD (M = 18.62, 95% CI [17.15, 20.09]), though the result was not statistically significant. Additionally, African American/Black females scored higher in all subscale scores when compared to African American/Black males, with a 3-point and 2-point difference in primary and tertiary symptoms. Our study has highlighted the importance of clinicians assessing for SD within their patients and to consider potential differences in symptom presentations of racial groups. [ABSTRACT FROM AUTHOR]

The correlation of female sexual dysfunction (FSD) with the degree of glycemic control, the duration and complications of diabetic disease and cardiovascular risk factors are not so clear. The aim of this study was to assess the prevalence of FSD in a sample of females with type 2 diabetes mellitus (T2DM), and to identify factors involved in its pathogenesis. We enrolled 81 females who have T2DM. We administered the female sexual function index (FSFI), self-rating anxiety scale (SAS) and self-rating depression scale (SDS) questionnaires. We also estimated anthropometric parameters, glyco-metabolic control, comorbidities, autonomic nervous system assessment, some adipocytokines and ongoing therapy. 87% of participants were affected by FSD. There was evidence of an inverse correlation between the total score of the FSFI questionnaire and the mean of the values ​​of HbA1c in the previous years. There was an inverse correlation with the duration of diabetes and homeostasis model assessment of insulin resistance index in participants not affected by FSD. Participants with FSD have a higher prevalence of anxiety (p = 0.043) and participants with depression and ischemic heart disease scored less on the FSFI questionnaire (p = 0.005 and p = 0.010, respectively). Homocysteine ​​and E-selectin values ​were higher in participants with FSFI (p = 0.002, and p = 0.017, respectively). Most of the enrolled females with T2DM had FSD. Glycemic control, ischemic heart disease, endothelial dysfunction, autonomic neuropathy, and psychological conditions, such as anxiety and depression, seem to have a close correlation with FSD. An early diagnosis of FSD can help to improve not only participants' quality of life, but also to early identify and treat risk factors related not only to FSD, but also to cardiovascular risk. Therefore, we highly recommend that clinicians have a high index of suspicion for FSD in females with T2DM. [ABSTRACT FROM AUTHOR]

Introduction: Patients with diabetes have up to five times higher incidence of cataract, mainly at a younger age, and cataract in these patients progresses more rapidly than senile cataract, especially in eyes affected with sight-threatening diabetic retinopathy (DR). Aim: This study aimed to investigate the risk factors associated with cataract development in patients with type 2 diabetes (T2DM). Methods: This case-control cross-sectional study included 90 T2DM (56M/34F). Metabolic risk factors glycated hemoglobin (HbA1c), total cholesterol, HDL cholesterol, LDL cholesterol, and triglycerides were determined using routine laboratory methods. Blood pressure was measured with a mercury sphygmomanometer after a 10-min resting period. Lens opacity was graded according to the Lens Opacity Classification System version III (LOCS III). Results: According to the LOCS III, patients were divided into two groups: group 1—patients with clear crystalline lens, and group 2—patients with initial cataract. Compared to patients with a clear crystalline lens, those with initial cataract had longer diabetes duration (p = 0.002), higher HbA1c (p = 0.037), higher total cholesterol (p = 0.029), higher diastolic blood pressure (DBP) (p = 0.014), and lower creatinine clearance (p = 0.017). Cataract was positively associated with diabetes duration (p = 0.001), HbA1c (p = 0.035), LDL cholesterol (p = 0.042), and DBP (p = 0.009), while negatively with creatinine clearance (p = 0.005). Logistic regression analysis showed that the influence of DBP (AOR = 1.06, p = 0.014) and creatinine clearance (AOR = 2.93, p = 0.045) on cataract development remained significant even after adjustment for diabetes duration and HbA1c. Conclusions: Diabetes duration and various metabolic risk factors, particularly poor glycemic control, hypercholesterolemia, DBP, and diabetic nephropathy's coexistence, are associated with cataract development in T2DM. [ABSTRACT FROM AUTHOR]

In a previous effort we showed that compared with immigrants who are permanent residents, undocumented immigrants are more likely to binge drink, but less likely to drink while impaired (DWI) partly due to their limited amount of driving. This report examines a related risk: riding with an impaired driver (RWI). Data came from an ongoing longitudinal sample of Latino immigrants to Miami-Dade County, FL. Descriptive analyses and regression techniques were applied. While DWI rates among Latino immigrants is heavily limited by their access to a car, RWI rates were not restricted by driving limitations, nor related to participants' legal immigration status (LIS). RWI rates were linked only to heavy drinking. Because it is not affected by driving limitations, RWI for these Latino immigrants is perhaps a more immediate risk than DWI. Addressing RWI among Latino immigrants should be a priority for traffic safety to Miami/Dade country. [ABSTRACT FROM AUTHOR]

We aimed to evaluate the feasibility of an online self-sampling pilot intervention for HIV testing addressed to gay, bisexual, and other men who have sex with men (GBMSM) and trans women (TW) users of dating apps in Spain. The website https://www.testate.org/ was designed to offer self-sampling kits for HIV testing and online consultation of the results. It was advertised on gay dating apps. Participants requested the delivery of a saliva self-sampling kit by mail and a postage-paid envelope to send the sample to the reference laboratory. An anonymous acceptability survey was conducted. The cascade of care was estimated. From November 2018 to December 2021, 4623 individual users ordered self-sampling kits, 3097 returned an oral fluid sample to the reference laboratory (67.5% return rate). 87 reactive results were detected. 76 were confirmed to be HIV-positive, we estimated an HIV prevalence of 2.45% (95% CI 1.9–3.0%). 100% of those referred to specialized care are in treatment. 45.8% of participants took more than one test. 23 incident cases were detected among repeat testers, of which 20 were confirmed. The estimated incidence was 1.00 confirmed case per 100 individual-years of follow-up. 98.01% of participants would recommend it to a friend. The most identified advantages were convenience and privacy. We demonstrated that the online offer of oral self-sampling kits for HIV detection and reporting results online among GBMSM and TW users of dating apps is feasible. The intervention counted with a high acceptability and high efficacy (in terms of reactivity, confirmation and linkage to care rates). [ABSTRACT FROM AUTHOR]

Purpose: Vitamin A deficiency (VAD) remains a significant contributor to childhood morbidity and mortality in developing countries; therefore, the implementation of sustainable and cost-effective approaches to control VAD is of utmost pertinence. This study aims to investigate the efficacy of red palm olein (RPO)-enriched biscuit supplementation in improving vitamin A, haematological, iron, and inflammatory status among vitamin A-deficient schoolchildren. Methods: We conducted a double-blinded, randomised controlled trial involving 651 rural primary schoolchildren (8–12 years) with VAD in Malaysia. The schoolchildren were randomised to receive either RPO-enriched biscuits (experimental group, n = 334) or palm olein-enriched biscuits (control group, n = 317) for 6-month duration. Results: Significant improvements in retinol and retinol-binding protein 4 levels were observed in both groups after supplementation (P < 0.001). The improvement in retinol levels were similar across groups among subjects with confirmed VAD (P = 0.40). Among those with marginal VAD, greater improvement in retinol levels was recorded in the control group (P < 0.001) but lacked clinical significance. The levels of α- and β-carotenes, haematological parameters (haemoglobin, packed cell volume, mean corpuscular volume and mean corpuscular haemoglobin) and iron enhanced more significantly in the experimental group (P < 0.05). The significant reduction in the prevalence of microcytic anaemia (− 21.8%) and high inflammation (− 8.1%) was only observed in the experimental group. Conclusion: The supplementation of RPO-enriched biscuits enhanced levels of provitamin A carotenes, iron, and erythropoiesis, and exhibited anti-inflammatory effects. Therefore, the incorporation of RPO into National Nutritional Intervention Programs may be a potential measure to improve the health status of vitamin A-deficient children, among various other interventions. Clinical trial registration: ClinicalTrials.gov (NCT03256123). [ABSTRACT FROM AUTHOR]

The purpose is to investigate the natural course and long-term prognosis of postpartum depression (PPD). In this retrospective longitudinal cohort study, mothers diagnosed as either suffering from PPD or without PPD were reassessed 5–8 years thereafter by a semi-structured interview and their charts were reviewed for past psychiatric illness prior to the index (initial) episode and for new-onset episodes in the following years. Present psychiatric state was also evaluated by interview and questionnaires. Sixty-five mothers with and 35 without past PPD underwent the full assessment. A total of 66.2% of mothers with past PPD had any axis I psychopathology before their index PPD episode, compared with only 8.6% in the non-PPD group (p < 0.001, φ =.55). Furthermore, 37.2% of the females who had a history of PPD and experienced subsequent childbirths during the follow-up years, developed at least one new episode of PPD. Throughout the 5 years subsequent to the index PPD episode, 42.5% of the PPD group compared with only 3.7% for the non-PPD group developed a new episode of depression (p < 0.001). Lastly, reported psychopathology was higher and functional level was significantly worse in the PPD group at the time of reassessment. Females who develop an episode of PPD show a high degree of subsequent psychopathology and unfavorable prognosis. Clinicians treating females for PPD should consider a longer treatment continuation phase in an effort to prevent further psychopathology and a closer follow-up program. [ABSTRACT FROM AUTHOR]

Introduction: Breastfeeding has significant health benefits for infants and birthing persons, including reduced risk of chronic disease. The American Academy of Pediatrics recommends exclusively breastfeeding infants for 6 months and recently extended its recommendation for continuing to breastfeed with supplementation of solid foods from one to two years. Studies consistently identify lower breastfeeding rates among US infants, with regional and demographic variability. We examined breastfeeding in birthing person-infant pairs among healthy, term pregnancies enrolled in the New Hampshire Birth Cohort Study between 2010 and 2017 (n = 1176). Methods: Birthing persons 18–45 years old were enrolled during prenatal care visits at ~ 24–28 weeks gestation and have been followed since enrollment. Breastfeeding status was obtained from postpartum questionnaires. Birthing person and infant health and sociodemographic information was abstracted from medical records and prenatal and postpartum questionnaires. We evaluated the effects of birthing person age, education, relationship status, pre-pregnancy body mass index, gestational weight gain (GWG), smoking and parity, and infant sex, ponderal index, gestational age and delivery mode on breastfeeding initiation and duration using modified Poisson and multivariable linear regression. Results: Among healthy, term pregnancies, 96% of infants were breastfed at least once. Only 29% and 28% were exclusively breastfed at 6-months or received any breastmilk at 12-months, respectively. Higher birthing person age, education, and parity, being married, excessive GWG, and older gestational age at delivery were associated with better breastfeeding outcomes. Smoking, obesity, and cesarean delivery were negatively associated with breastfeeding outcomes. Conclusions: Given the public health importance of breastfeeding for infants and birthing persons, interventions are needed to support birthing persons to extend their breastfeeding duration. Significance: What is already known? The benefits of breastfeeding to child and birthing person health are well-documented, however, rates of breastfeeding initiation and duration continue to fall short of health-based guidelines. Regional differences exist and certain rural New England states tend to have amongst the highest breastfeeding rates in the US. What this study adds? This study of n = 1176 birthing persons-infant pairs enrolled in the New Hampshire Birth Cohort Study, a rural, general population pregnancy cohort, suggests that factors influencing breastfeeding outcomes align closely with studies conducted in urban settings and using nationally-representative surveys. [ABSTRACT FROM AUTHOR]

Introduction: The physiological changes in mother-infant pairs during pregnancy increase the susceptibility to a series of infections, including those of the oral cavity. Therefore, the oral and systemic health of pregnant women is related to adverse pregnancy outcomes. Objective: This cross-sectional study aimed to evaluate the systemic profile and periodontal status of women with a high-risk pregnancy. Methods: Eighty-nine pregnant women at risk of preterm labor admitted to a hospital in southern Brazil were interviewed and received a periodontal examination. Data related to obstetric complications during pregnancy (pre-eclampsia, infections, medication use, and gestational diabetes) and systemic diseases were collected from medical records. The periodontal parameters of probing pocket depth, bleeding on probing, and clinical attachment level were evaluated. The data were tabulated, and statistical analysis was performed (p < 0.05). Results: The mean age of participants was 24 years (SD = 5.62). Gingival bleeding was recorded in 91% of the participants. The prevalence of gingivitis was 31.46%, and periodontitis was 29.21%. No association between systemic conditions and periodontal disease was observed. Conclusions and Implications for Practice: Periodontal inflammation was not associated with the systemic profile during pregnancy. However, women with high-risk pregnancies showed higher levels of gingival inflammation, emphasizing the importance of dental care during pregnancy. Significance: The gestational period is marked by a series of physiological changes that can be influenced by local and systemic conditions. Thus, investigating the periodontal status of pregnant women considered at risk for premature birth and evaluating associations with the systemic health of these patients can present important risk indicators for maternal and fetal health. [ABSTRACT FROM AUTHOR]

Purpose: Purposes are (1) to measure main radiation parameters and (2) to propose a method to estimate the absorbed doses of internal organs starting from DAP values. Measuring the exposition of internal organs by repeated irradiations on an anthropomorphic phantom with the same settings used in vivo, we could establish correlations between (1) DAP and the dose recorded by a dosimeter placed along the X-ray beam entrance pathway; (2) the dose recorded by the same dosimeter and the absorbed dose in internal organs. Methods: Forty-four consecutive patients (16 males, 28 females) (mean age 35.4 months) treated at our institution with IAC (216 procedures: 196 via the ICA and 20 into branches of the ECA) were included in this prospective study. IAC was divided into 5 phases. Fluoroscopic time, DAP, and ESD were measured. Results: The mean DAP was 595 ± 445 cGy cm2 and the mean fluoroscopic time was 540 ± 403 s. ESD was on average 9.59 mGy (range 0.8–165 mGy). The absorbed dose was lower than 12.1 mGy in the left retina (the more exposed organ) in 75% of single treatments and lower than 25 mGy in 95% of treatments. In the cases of 3 and 6 sessions, the left retina of 75% of patients absorbed respectively less than 36.3 and 72.7 mGy, whereas the left retina of 95% of patients received less than 75.2 and 150.4 mGy. Other organs were less exposed. Conclusion: This paper describes a method of absorbed dose estimation providing ranges used clinically in a single practice and the basis for further prospective studies. [ABSTRACT FROM AUTHOR]

Introduction: The role of the emergency medical dispatch centre (EMDC) is essential to ensure coordinated and safe prehospital care. The aim of this study was to implement an incident report (IR) system in prehospital emergency care management with a view to detecting errors occurring in this setting and guiding the implementation of safety improvement initiatives. Methods: An ad hoc IR form for the prehospital setting was developed and implemented within the EMDC of Verona. The form included six phases (from the emergency call to hospital admission) with the relevant list of potential error modes (30 items). This descriptive observational study considered the results from 268 consecutive days between February and November 2010. Results: During the study period, 161 error modes were detected. The majority of these errors occurred in the resource allocation and timing phase (34.2%) and in the dispatch phase (31.0%). Most of the errors were due to human factors (77.6%), and almost half of them were classified as either moderate (27.9%) or severe (19.9%). These results guided the implementation of specific corrective actions, such as the adoption of a more efficient Medical Priority Dispatch System and the development of educational initiatives targeted at both EMDC staff and the population. Conclusions: Despite the intrinsic limits of IR methodology, results suggest how the implementation of an IR system dedicated to the emergency prehospital setting can act as a major driver for the development of a “learning organization” and improve both efficacy and safety of first aid care. [ABSTRACT FROM AUTHOR]

The present study aimed to determine the prevalence of dental pain during pregnancy and its association with sociodemographic factors and oral health conditions among 315 pregnant women in South Brazil. Participants were interviewed to obtain sociodemographic data, such as age, educational level, employment status, family income, and marital and parity status. Medical and dental histories were also collected, including the occurrence of dental pain and the use of dental services during pregnancy. Clinical examinations were performed to assess the presence of visible plaque and gingival bleeding and to calculate the decayed, missing, and filled teeth index. Means and standard deviations of continuous variables and frequencies and percentages of categorical variables were calculated. Independent variables were included in a multivariate logistic regression analysis. A total of 173 (54.9 %) pregnant women reported dental pain during pregnancy. After adjustment of the analysis, caries activity remained the main determinant of dental pain (odds ratio 3.33, 95 % CI 1.67-6.65). The prevalence of dental pain during pregnancy was high and the presence of caries activity was a determinant of dental pain. Moreover, access to oral health care was low, despite pregnant women's increased need for dental assistance. [ABSTRACT FROM AUTHOR]

We aimed to develop and validate an instrument to detect hospital medication prescribing errors using repurposed clinical decision support system data. Despite significant efforts to eliminate medication prescribing errors, these events remain common in hospitals. Data from clinical decision support systems have not been used to identify prescribing errors as an instrument for physician-level performance. We evaluated medication order alerts generated by a knowledge-based electronic prescribing system occurring in one large academic medical center's acute care facilities for patient encounters between 2009 and 2012. We developed and validated an instrument to detect medication prescribing errors through a clinical expert panel consensus process to assess physician quality of care. Six medication prescribing alert categories were evaluated for inclusion, one of which – dose – was included in the algorithm to detect prescribing errors. The instrument was 93% sensitive (recall), 51% specific, 40% precise, 62% accurate, with an F1 score of 55%, positive predictive value of 96%, and a negative predictive value of 32%. Using repurposed electronic prescribing system data, dose alert overrides can be used to systematically detect medication prescribing errors occurring in an inpatient setting with high sensitivity. [ABSTRACT FROM AUTHOR]