Search Results for: Artrite psoriasica e altre comorbilità in pazienti con psoriasi nel setting della medicina generale

Background
Despite global improvements in antiretroviral therapy (ART) access for children and adolescents living with HIV (CALHIV), a significant proportion continue to experience unsuppressed viral load (USVL). Limited studies focus on the factors contributing to USVL among CALHIV in the Democratic Republic of the Congo (DRC), especially in the context of evolving treatment landscapes. Understanding these determinants is crucial for enhancing ART outcomes.

Objective
This study aimed to determine the prevalence of USVL and identify factors associated with USVL among CALHIV receiving ART in Lubumbashi, DRC.

Design
A multicentre retrospective cross-sectional study was conducted. Data were gathered using an observational checklist based on assessing patient file data and entered into Microsoft Excel. Analysis was performed using STATA V.16. Variables with a p value of 0.20 from the bivariable analysis were included in a multivariable logistic regression model, and significant variables (p

Objectives
Smoking is a well-established risk factor that exacerbates multiple sclerosis (MS) progression and increases disease activity. Smoking cessation promotion practices of MS clinicians are not meeting the needs of people with MS (pwMS). This study aimed to explore the current practices and barriers faced by MS clinicians in Germany.

Design
A qualitative study design, using semi-structured interviews and thematic analysis.

Setting
Interviews with participants were held online, via telephone or face-to-face at our institute in Hamburg, Germany.

Participants
We recruited eight neurologists and four MS nurses from hospitals, neurology practices and rehabilitation facilities in Germany via purposive and snowball sampling.

Results
We identified 27 codes across four themes: (1) knowledge: the 12 participants demonstrated a satisfactory general knowledge of the negative impacts of smoking on MS (2) current practice: significant variability was reported in the current practices, with some clinicians providing detailed advice while others merely assessing smoking status without further advice or assistance. (3) Barriers: key barriers identified included limited consultation time, perceived lack of patient motivation and insufficient availability of resources, like information material, for effective smoking cessation support. (4) Needs and wishes: participants wished for specific smoking cessation courses to which they could refer patients, as well as information material to use during patient counselling.

Conclusion
The study reveals considerable gaps in the consistency and comprehensiveness of smoking cessation support provided by MS clinicians in Germany. Addressing these gaps through targeted interventions, and improving the availability of information materials could enhance smoking cessation promotion for pwMS.

Objectives
To investigate the association between triglyceride-glucose (TyG) index levels at hospital admission and the risk of in-hospital adverse events, including all-cause mortality, in patients with acute myocardial infarction (AMI). The primary hypothesis was that higher TyG index levels are associated with greater risk of adverse in-hospital outcomes.

Design
Retrospective cohort study.

Setting
Tertiary hospital inpatient care in China. The study included consecutively hospitalised patients with AMI between 1 August 2011 and 10 January 2022.

Participants
A total of 3458 patients with AMI were included. The mean age was 60.8 years, and 78.4% were men. Patients were excluded if they had incomplete data for TyG index calculation or outcome ascertainment.

Interventions
No therapeutic intervention was assigned; the study was observational. TyG index was calculated using fasting triglycerides and fasting plasma glucose levels at admission.

Primary and secondary outcome measures
The primary outcome was all-cause in-hospital mortality. Secondary outcomes included cardiogenic shock and fatal rapid arrhythmia. Outcomes were identified through standardised clinical records.

Results
Among 3458 patients, 375 (10.84%) died during hospitalisation, 236 (6.84%) developed cardiogenic shock and 147 (4.25%) experienced fatal rapid arrhythmia. After multivariable adjustment, higher TyG index levels were significantly associated with increased odds of all-cause mortality (OR, 1.27; 95% CI, 1.02 to 1.57; p

Objectives
The Asian American, Native Hawaiian and Pacific Islander (AANHPI) community is the fastest-growing racial/ethnic population in the USA. Previous research identified that medical students perceived a lack of exposure to AANHPI patients and topics in medical school curricula; however, there remains a lack of potential interventions to address this need. The goal of our study is to present a case study for identifying interventions in medical school curricula that improve cultural humility-based training for providing medical care for AANHPI populations.

Design
In this qualitative study, authors conducted four virtual focus groups with 15 medical students at a single institution to identify curricular interventions. The authors then conducted virtual semistructured interviews with eight medical educators one-on-one to explore the feasibility of the proposed interventions. Data were analysed using qualitative thematic analysis, and analysis was performed with ATLAS.ti.

Setting
Medical students and medical educators based at medical institutions in the USA.

Participants
15 medical students and eight medical educators participated in the study.

Results
All medical students (n=15) and educators (n=8) noted that there is limited engagement of AANHPI communities in current medical curricula and limited curricular components that address the diversity within the AANHPI umbrella. Medical student focus groups identified three interventions to improve cultural humility-based training for treating AANHPI patients: reflection spaces, community engagement and clinical training on documenting cultural needs. Educators supported the feasibility and importance of these interventions to prepare students to work with not only AANHPI patients but also with patients of other diverse backgrounds.

Conclusion
AANHPIs represent a heterogeneous population consisting of unique cultural heritages. Our research demonstrates the importance of highlighting this community in cultural humility curricula to provide an example of how to consider and appreciate diversity in patient populations. In this paper, we present student and medical educator-supported curricular interventions that not only increase awareness of issues impacting AANHPI communities, but also emphasise building skills of self-reflection, lifelong learning and empathy that are applicable to patients of all backgrounds.

Objectives
This study conducted a comprehensive probabilistic cost-effectiveness analysis comparing robotic exoskeleton therapy to conventional physiotherapy for stroke rehabilitation in Singapore, focusing on three patient groups categorised by their Functional Ambulation Category (FAC) scores.

Design
A probabilistic cost-effectiveness analysis was conducted alongside a non-randomised controlled study. Costs and Quality-Adjusted Life Years (QALYs) for both interventions were calculated and compared over a 6 month period.

Setting
The study was carried out at Alexandra Hospital, Jurong Community Hospital and St Luke’s Hospital in Singapore.

Participants
Individuals requiring inpatient gait rehabilitation from acute to subacute stages of stroke recovery, with FAC scores of 0–1, were included in the analysis.

Primary outcome measure
The primary outcome measure was QALYs, a composite measure combining the length and quality of life into a single value.

Results
Robotic exoskeleton therapy was found to be cost-effective compared with conventional physiotherapy across all patient groups, with Group 2 (FAC 0) showing the most favourable cost-effectiveness profile (incremental cost-effectiveness ratio (ICER): US$ 28 259.62 per QALY gained). The probabilistic sensitivity analysis demonstrated the robustness of the results, with QALY gains and the cost of the robotic exoskeleton having the largest impact on the ICER.

Conclusion
The findings suggest that robotic exoskeleton therapy is likely to be cost-effective for stroke rehabilitation in Singapore, particularly for patients with severe mobility impairments (FAC 0). The results have important implications for clinical practice, resource allocation and future research in the field of stroke rehabilitation in Singapore.

Trial registeration number
NCT05659121.

Objective
The aim of this study was to construct a quality evaluation indicator system for extended care in patients with chronic obstructive pulmonary disease (COPD), provide beneficial references for quality evaluation and practice standardisation of extended care.

Design
This study was conducted from April to November 2023. Based on the three-dimensional quality structure model of ‘structure–process–result’, we used literature review and Delphi method to form the quality evaluation indicator system for extended care in patients with COPD and determined the weight of each indicator by analytic hierarchy process (AHP).

Setting
Zhengzhou Central Hospital Affiliated to Zhengzhou University and School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China.

Participants
20 experts from different universities and hospitals in China participated in the study. They all had profound attainments in clinical treatment, nursing and extended care of COPD.

Primary outcome measures
Effective questionnaire response rate, coefficient of expert authority, arithmetic mean, proportion of maximum score, Kendall harmony coefficient, scores of importance, variation coefficient and weight were used to evaluate the quality evaluation indicator system for extended care.

Results
In the two rounds of Delphi expert consultation, the effective questionnaire response rates were both 100%. The coefficients of expert authority were 0.83 and 0.89, respectively. Kendall harmony coefficients were 0.088 and 0.215, respectively. The final formed quality evaluation indicator system for extended care included 3 primary indicators, 10 secondary indicators and 40 tertiary indicators. For each indicator, the variation coefficient was 0.063–0.151 and the weight was 0.001–0.065.

Conclusion
The quality evaluation indicator system for extended care based on mature theoretical basis and scientific method is scientific and reliable. And the weight of each indicator is set reasonably and accurately, which could provide a basis for quality evaluation and continuous quality improvement of extended care.

Objectives
Infective endocarditis (IE) is a global public health challenge, and our understanding of its temporal evolution in China compared with the Group of Twenty (G20) countries remains limited. This study aims to analyse the disease burden of IE in China from 1990 to 2021, forecast trends for the next 15 years and compare the findings with those in G20 countries.

Design
Observational study.

Setting
The data of 20 countries and regions in G20 were obtained from the Global Burden of Disease (GBD) Study 2021.

Participants
Data were publicly available and individuals were not involved.

Main outcome measures
Using data from the GBD 2021, we collected incidence, disability-adjusted life-years (DALYs) and age-standardised rates for both China and G20 countries. Temporal trends were assessed using the estimated annual percentage change (EAPC) and a joinpoint regression analysis was conducted to pinpoint periods of significant change. Additionally, a decomposition analysis was performed to identify the factors driving changes. Finally, the Bayesian age-period-cohort model was used to forecast trends for the next 15 years.

Results
In 2021, there were 264 282 (95% UI: 216 083 to 315 405) incident cases of IE in China, resulting in 49 925 (95% UI: 38 779 to 69 119) DALYs. The age-standardised incidence rate (ASIR) and age-standardised DALY rate (ASDR) were 14.38 (95% UI: 12.03 to 16.92) and 3.46 (95% UI: 2.65 to 5.01) per 100 000 population, respectively, with both rates being higher in males than in females. Notably, both ASIR and ASDR showed a pattern of first decreasing and then increasing with age, with the highest values observed in the age group of 95 years and above. From 1990 to 2021, the ASIR of IE in China showed a slow upward trend (EAPC: 0.49, 95% CI: 0.44 to 0.55), which was lower than the average level among G20 countries. In contrast, the ASDR exhibited a significant downward trend (EAPC: –6.26, 95% CI: –6.8 to –5.71), representing the largest decline among the G20 countries. The most notable increase in ASIR occurred from 1995 to 2005 in both China and the G20. The greatest decrease in ASDR was observed in China between 2001 and 2004 and in the G20 between 2018 and 2021. Projections suggest that over the next 15 years, the ASIR for both males and females in China will continue to rise, while the ASDR will show a declining trend.

Conclusions
In China, the incidence of IE-related diseases has steadily increased across both genders, despite a declining trend in DALYs. Compared with G20 countries, China’s age-standardised burden of IE is relatively low, yet the large increasing number of cases should not be underestimated. Therefore, establishing effective prevention and treatment strategies is crucial to alleviating the future burden of IE.

Objectives
To study the prevalence of and interplay between common neuropsychiatric sequelae 3–4 years after onset of first-ever stroke—specifically post-stroke fatigue (PSF), post-stroke depression (PSD) and post-stroke cognitive impairment (PSCI).

Design
Population-based cohort study.

Setting
Catchment area of a Swedish University Hospital.

Participants
We recruited individuals with first-ever ischaemic stroke or intracerebral haemorrhage in the initial cohort; 151 of these died prior to follow-up and 47 (12%) were lost to detailed follow-up. We followed up 202 individuals with median age: 72 (IQR 65–79), 40% female, either in clinic, via home visits or via telephone.

Primary and secondary outcome measures
Primary outcome measures included PSF (Fatigue Assessment Scale), PSD (Patient Health Questionnaire-9) and PSCI (Montreal Cognitive Assessment). Secondary outcome measures included dependency in activities of daily living (ADL; Barthel Index), health-related quality of life (HRQoL; Short-Form Questionnaire-36, EuroQoL-5D and Stroke Impact Scale) and stroke severity (National Institutes of Health Stroke Scale (NIHSS)).

Results
Significant PSF was present in 46/195 (24%), PSD in 21/191 (11%), and PSCI in 93/173 (54%) respondents. Among 169 participants with available data for all three domains, 100 (59%) had impairment in at least one domain. Participants with PSCI were older than those without (median: 75 vs 67 years; p

Objective
To explore patients’ experiences and preferences of self-testing using white cell count point-of-care test (POCT) and C reactive protein POCT during antibiotic treatment at home.

Setting
A University Hospital in the Region of Zealand (DK).

Participants
10 inpatients treated with antibiotics who were discharged from hospital to continue antibiotic treatment at home. They were trained in the hospital supervised by research personnel before self-testing at home.

Design
An explorative qualitative study using thematic analysis.

Results
The participants considered the self-testing beneficial, mainly due to not having to travel to get a blood test drawn, the rapid test time and the ability to closely monitor their treatment. The participants perceived that self-testing at home would make them feel more in control of their disease and would give them the ability to live a more normal life. Moreover, self-testing at home showed to be feasible for some patients but with barriers to overcome, such as the ability to use technology and cognitive challenges.

Conclusions
Our study showed that self-testing at home was feasible for some patients, provided they received thorough training at the hospital ensuring that participants were able to conduct the self-testing and use the smartphone technology before transitioning to their home. This could help reduce barriers to home self-testing by highlighting its benefits and emphasising the need for adequate patient guidance and support.

Objective
This study aimed to assess high-risk human papillomavirus (HPV) infection (HPV 16/18) and its determinants among women in East Gojjam Zone, Northwest Ethiopia.

Design
An institutional-based cross-sectional study.

Setting and participants
The study was conducted among 337 women screened for cervical cancer in two hospitals in East Gojjam Zone from February to April 2021 gregoriean calander.

Results
The prevalence of HPV infection was 14.2% (95% CI: 10.7% to 18.1%). The mean age of the respondents was 36.7±9.1 years. Women in the age group of 55–65 years (adjusted OR (AOR)=7.91, 95% CI: 1.95 to 32.09), early initiation of sexual intercourse (AOR=5.36, 95% CI: 1.58 to 18.13), history of sexually transmitted infection (STI) (AOR=3.52, 95% CI: 1.27 to 9.72), HIV positive status (AOR=6.8, 95% CI: 1.99 to 23.54) and number of lifetime sexual partners (AOR=4.37, 95% CI: 1.15 to 17.3) were important independent factors associated with the presence of oncogenic HPV infection.

Conclusion and recommendation
We found a relatively low prevalence of high-risk HPV infection. Age, early initiation of sexual intercourse at less than 18 years, history of STI, being HIV seropositive and multiple sexual partners were important factors for high-risk HPV infection. Women aged >46 years, women with early initiation of sex, a history of STI, being HIV positive and a history of multiple sexual partners should be encouraged to be screened and vaccinated for HPV infection. Wider-ranging studies are also needed in HPV-infected women in association with the cervical lesion.

Objectives
COVID-19 in children is generally of short duration, but some may take longer to recover. This study investigated the time to symptom resolution following SARS-CoV-2 infection among children in a community setting on the outskirts of an urban centre in Brazil.

Design
Prospective cohort study.

Setting
This is a community-based cohort of children living in Manguinhos, a favela in Rio de Janeiro. The cohort was followed through home visits and telephone monitoring of symptoms. The analysis focused on symptomatic children from this cohort with confirmed SARS-CoV-2 infection. Recovery time was defined as the interval between the first date with symptoms and the first date without symptoms following a positive SARS-CoV-2 test.

Participants
A total of 1276 children (boys and girls aged 2–

Background
Patient-centred care (PCC) is one of the six key attributes of healthcare quality. However, despite its significant contribution to improving healthcare quality, PCC is often poorly implemented. This study aimed to explore the determinants of effective PCC implementation among healthcare providers at Kahama Municipal Hospital in Tanzania.

Objective
To explore the determinants influencing the effective implementation of PCC among healthcare providers at Kahama Municipal Hospital in Tanzania.

Design
A qualitative approach was used, with 21 healthcare providers recruited through purposive and convenience sampling methods. Data were collected through focus group discussions and key informant interviews, and content analysis was employed to analyse the data.

Setting
The study was conducted at Kahama Municipal Hospital, in the Kahama Municipal Council of the Shinyanga region, Tanzania, from February to June 2019. As a referral hospital, Kahama Municipal Hospital serves a vast catchment area, including rural and semiurban communities across more than eight regions in Tanzania’s Lake and Western zones.

Results
The study identified several factors related to healthcare professionals, including awareness of PCC, staff motivation, heavy workload, professional competencies and effective communication. Organisational-related determinants, such as the absence of ethical guidelines, a lack of a clear organisational culture and the absence of specific policies and guidelines on PCC, were also found to affect its effective implementation.

Conclusion
PCC is recognised at Kahama Municipal Hospital, but key barriers hinder its implementation, including unclear policies, lack of a PCC-focused vision, staff shortages, excessive workloads, low motivation, limited practical exposure and communication issues. To improve PCC implementation, healthcare policymakers and hospital administrators should: (1) establish clear PCC policies, (2) integrate a patient-centred vision into leadership, (3) address workforce shortages, (4) provide targeted training on PCC and (5) boost staff motivation through recognition and career development. Implementing these measures will improve care quality and health outcomes. Further large-scale research is needed to assess PCC implementation across Tanzania and guide national policy.

Objective
Marked gender differences have been observed in ‘deaths of despair’, with suicides, drug overdoses and alcohol-related diseases more common among men. The present study examines whether men use fewer mental healthcare services than women during the years before dying from diseases of despair.

Design
Retrospective cohort study: population-wide administrative register data, covering all registered inhabitants of Norway, are analysed using descriptive statistics, logistic regression and ordinary least squares linear probability models. The regression models are adjusted for age and sociodemographic covariates (marriage, immigrant background, education and employment status), measured at baseline (2008).

Setting
Norway 2008–2017.

Participants
Men (number of observations (n) = 1 593 044) and women (n=1 569 717) who fell within the 15–69 age range in 2008 and were still alive and residing in Norway in 2014.

Outcome measures
Mental healthcare utilisation during a 6-year period (2009–2014) is monitored in men and women who died prematurely (

Objective
This study aimed to evaluate the utility of optical sensor-based technology in mitigating the frequency and severity of peripheral intravenous infiltration and/or extravasation (PIVIE) in neonates.

Design
Single-centre, retrospective, observational cohort study.

Setting
Tertiary-level neonatal intensive care unit (NICU) (112 cots) at the Women’s Wellness and Research Centre (WWRC), Hamad Medical Corporation (HMC), Doha, Qatar, January 2019–December 2022.

Participants
All neonates admitted to the NICU requiring intravenous therapy via a neonatal short peripheral intravenous catheter (n-SPC) were included. Participants were excluded if the insertion was unsuccessful, if they had incomplete data, or if they received intravenous therapy exclusively through alternative vascular access devices.

Interventions
The study analysed two cohorts representing different clinical practices over two distinct periods. In the conventional cohort (Phase 1, 2019–2020), PIVIE detection relied solely on periodic ‘Touch Look Compare (TLC)’ assessments. In the ivWatch cohort (Phase 2, 2021–2022), continuous optical sensor-based monitoring using the ivWatch system was implemented alongside TLC assessments. This sequential design allowed for a comparison of outcomes between the two phases.

Outcome measurements
The primary outcomes were the occurrence and severity of PIVIE. Secondary outcomes included the influence of patient demographics, vascular access characteristics, and management details on PIVIE incidence and severity.

Results
Over the 4-year data collection period, 32 713 peripheral intravenous catheters were analysed across two cohorts. PIVIE was the most common reason for unplanned device removal. In the conventional cohort (Phase 1, 2019–2020), 4941 infiltration events were reported (29.9%), compared with 4872 events (30.1%) in the ivWatch cohort (Phase 2, 2021–2022). However, severity measures using the Intravenous Extravasation Grading Scale (IEGS) revealed a marked reduction in severe PIVIE cases, with severe events decreasing from 243 (4.9%) in the conventional cohort to 54 (1.1%) in the ivWatch cohort (p

Objective
This study investigates the effects of dexmedetomidine on short-term and long-term survival rates in intensive care unit (ICU) patients with ischaemic stroke.

Design
This is a retrospective study.

Setting
Data were sourced from the Medical Information Mart for Intensive Care IV database.

Participants
This study analysed 2816 patients with ischaemic stroke from the US Intensive Care database.

Interventions
Dexmedetomidine administration during the ICU stay was defined as the exposure.

Methods
Patients were categorised into the dexmedetomidine group and the control group. Cox regression analysis was used to identify factors that may influence the 28-day mortality rate of patients with ischaemic stroke. High-risk factors were incorporated as covariates, and a 1:1 propensity score matching using the logit model was constructed to compare the prognosis between the two groups.

Primary and secondary outcome measures
The primary outcome was 28-day mortality. The secondary outcomes included in-hospital mortality, ICU length of stay, hospital length of stay, mechanical ventilation duration and 180-day mortality in discharged patients.

Results
A total of 2816 patients were included. Cox regression analysis revealed that dexmedetomidine use was associated with a reduced risk of 28-day mortality. Following propensity score matching, each group comprised 407 patients. Dexmedetomidine was found to improve 28-day mortality (27.8% vs 36.6%, p=0.007). However, it was also associated with the prolonged length of hospital and ICU stay (p=0.002). Among discharged patients, dexmedetomidine use was also associated with an improved 180-day mortality rate (p=0.0019).

Conclusion
The use of dexmedetomidine is associated with improved short-term and long-term prognosis in patients with ischaemic stroke and could potentially confer benefits in those receiving mechanical ventilation.