Risultati per: Otite media acuta

Circulation, Volume 150, Issue Suppl_1, Page A4116603-A4116603, November 12, 2024. Objective:Alarmins resulting from cell death or oxidative stress have been shown to be involved in the development of Kawasaki disease (KD) vasculitis. In our previous study, we demonstrated the potential role of (IL)-33 as an alarmin in the development of KD vasculitis. Although edematous dissociation (necrotic change) of the tunica media is thought to be a major source of IL-33 in KD vasculitis, it has not yet been elucidated.Methods:We investigated the impact of IL-33 released from necrotic human coronary artery smooth muscle cells (HCASMCs) on human coronary artery endothelial cells (HCAECs) by a co-culture assay using the Transwell®cell culture insert system. Subsequently, we evaluated the anti-inflammatory effects of anti-IL-33 and anti-ST2 antibodies compared to the conventional therapies of KD, such as high-dose IgG or anti-tumor necrosis factor (TNF)-α antibody.Results:Primary necrosis of HCASMCs induced significant release of IL-33. In co-cultures of necrotic HCASMCs with HCAECs, necrotic HCASMCs significantly induced the production of various proinflammatory cytokines in HCAECs. Anti-IL-33 and anti-ST2 antibodies exhibited unique inhibitory effects on the production of platelet-derived growth factor-BB or IL-12(p70) in HCAECs.Conclusion:The results of the present study suggest the potential involvement of edematous dissociation of the tunica media in the development of KD vasculitis. Furthermore, the distinctive anti-inflammatory effects of the anti-IL-33/ST2 axis drugs suggest novel therapeutic options for patients with refractory KD.

Circulation, Volume 150, Issue Suppl_1, Page ASa1203-ASa1203, November 12, 2024. Background:In the United States, enrollment in clinical trials that involve emergency care may require compliance with federal regulations for Exception from Informed Consent (EFIC), including Community Consultation and Public Disclosure (CCPD). The most effective methods for CCPD in studies of emergency care in children are not known.Aim:To describe the results of a centralized media-based CCPD outreach effort for the Pediatric Prehospital Airway Resuscitation Trial (Pedi-PART), a multicenter trial testing paramedic airway management strategies in critically ill and injured children.Methods:During a three-month window, across 10 participating US communities, we deployed social media (SM – Facebook and Instagram) advertisements of the study, targeting users within Emergency Medical Services service regions and zip codes with high anticipated need for pediatric airway management. The SM advertisements hyperlinked to study websites and surveys. We also solicited survey completion using a marketing research platform (Qualtrics Marketing Research Services), targeting the same communities. We determined the extent of SM exposure (impressions), interactions (shares, reactions, saves, comments, likes and clicks), and referrals to study website. For each site, we determined the number of completed surveys and the time required to achieve 200 surveys as required by the Institutional Review Board. We determined the demographics of survey respondents and the percentage with supportive responses.Results:The SM campaign resulted in 23.3M advertisement impressions (range 1.8-2.7M per site) reaching 3.4M unique users (range 239,494-439,360 per site), 13,873 engagements (range 828-1,656 per site) and 10,154 click-throughs to the study website (range 760-1,589 per site). There were 6,771 completed community surveys (range 531-914 per site). Across the sites, time to 200 completed surveys ranged from 5-28 days. Survey respondents were: 54.1%

Circulation, Volume 150, Issue Suppl_1, Page A4129223-A4129223, November 12, 2024. Purpose:We utilized large language modeling (LLM) and automated topic modeling techniques to describe public perceptions regarding AF on Reddit, a social media platform.Methods:In this qualitative study, we curated all AF-related discussions on Reddit from 2006 to 2023 by searching for all posts and comments containing AF-related terms (“atrial fibrillation”, “afib”, and “atrial flutter”). Discussions were embedded using a state-of-the-art embedding model (BAAI/bge-base-en-v1.5). Embeddings are reduced in dimensionality using Uniform Manifold Approximation and Project and clustered using K-Means Clustering to find topics and groups. Topic and group labels are enhanced using large language models (Llama2 and GPT4, respectively).Results:We identified a total of 86,323 discussions related to AF from 38,183 unique users between April 14, 2006 and November 20, 2023. Discussions around wearables and ablations increased over time, while discussions around anticoagulation had periodic spikes. The topic modeling pipeline automatically identified 64 topics and 9 groups (Figure 1). Groups emphasized the following themes: lifestyle factors and triggers associated with AF (groups 1, 5, 7); patient experiences with management strategies including anticoagulation, rate control, pharmacological rhythm control, and ablation (groups 2, 4, 5); experiences with wearable devices (group 8); psychological burden of living with AF (group 6); and online advertisements for AF-related medications (groups 3, 9).Conclusions:Our AI-enabled topic modeling analysis revealed public perceptions about AF including triggers, experiences with different management strategies, impact of wearables, and psychological burden of the diagnosis, which may help guide potential strategies for improving shared decision making around the AF patient journey.

Objectives
Carotid intima–media thickness (CIMT) is a measurement for subclinical atherosclerosis and has been associated with overall cardiovascular diseases, especially in type 2 diabetes mellitus (T2DM). We aimed to assess the status of carotid health and lipid profile in T2DM.

Design
This systematic review and meta-analysis synthesised data published from clinical studies.

Data sources
Google Scholar, PubMed and Scopus were searched from inception to 18 January 2024.

Eligibility criteria for selecting studies
Studies conducted in patients with T2DM and those without T2DM were included. Studies conducted in T2DM adults evaluating carotid status and lipid profile were considered.

Data extraction and synthesis
Two authors independently used standardised methods to comprehensively search, screen and extract data from all relevant studies. The risk of bias was assessed using the Newcastle-Ottawa checklist. Meta-analysis was conducted using Review Manager and metaHun through random effects models. The random effect model was used due to high heterogeneity.

Results
Evidence was analysed from 57 studies with a sample size of 29 502 (8254 T2DM and 21 248 people without T2DM). There was a significantly higher CIMT, with a standardised mean difference (SMD) of 1.01 (95% CI 0.75, 1.26, p

Introduction
The prevalence of mental health problems is increasing worldwide, particularly in the vulnerable group of older people. The limited availability of therapists, long wait periods and increasing shortage of healthcare resources limit adequate care. As a result, digital applications are becoming more commonplace as an alternative to human therapists. However, these tend to be used by younger people with higher education, digital health literacy and experience. In Germany, applications that are approved by the health authorities, so-called digital health applications (DiGAs), can be prescribed by physicians and psychotherapists. It remains unclear to the extent older people are experienced with, are willing and can use a DiGA. Therefore, this research aims to identify specific challenges of older people’s accessibility, user experience and engagement with DiGA for depressive disorders. The DiGA4Aged project consists of: (1) a pilot study on usability, (2) a screening study on potential participants for a randomised controlled trial (RCT) evaluating the digital experience of the target population and (3) an RCT to test the effectiveness of a digital nurse as individualised user support in the intervention group. This paper focuses on the pilot study and the screening study.

Methods and analysis
The instrumental components in preparing for the RCT are a mixed-method pilot and observational quantitative screening study, which are described in this manuscript. The pilot study includes questionnaires (covering sociodemographic data, user experience, health literacy, electronic health literacy, media affinity, severity of depression and perceived usability of DiGA), a concurrent think aloud method and a semistructured interview to evaluate two applications with regard to their usability for, acceptance by and needs of older people. The observational screening study collects data of older patients consecutively admitted to an acute care geriatric hospital ward using various questionnaires to identify which clinical and medical factors are associated with the access to, experience with and (non-)use of digital media. Data from the comprehensive geriatric assessment is collected as well as data on their digital media experience and digital health literacy.

Ethics and dissemination
The overall project DiGA4Aged received ethical approval on 17 November 2023 from the ethics committee of the Medical Faculty of Ruhr-University Bochum (registration number 23-7901). Results will be disseminated within the scientific community via publication in peer-reviewed journals as well as presentation at national conferences. The findings from the pilot study and the observational screening study will determine the selection of the DiGA and the recruitment strategy for the subsequent RCT.

Trial registration numbers
The pilot study has been prospectively registered in the German Clinical Trials Register (DRKS00033640, registered on 18 March 2024, available from https://drks.de/search/de/trial/DRKS00033640). Likewise, the observational screening study has been prospectively registered in the German Clinical Trials Register (DRKS00032931, registered on 29 November 2023, available from https://drks.de/search/de/trial/DRKS00032931).

New England Journal of Medicine, Volume 391, Issue 17, Page 1648-1650, October 31, 2024.

Introduction
Social media influencers (SMIs) are popular sources of online information on various topics, including many aspects of health. Recently, there has been an upsurge in SMIs creating content about pregnancy and parenting, including from midwives, pregnant women and parents. Despite its popularity, SMI content on pregnancy and parenting is not currently regulated, which allows for misinformation and potential harm to women and their children. Research has also found that most women do not discuss the information they access online with their healthcare providers.
This is the first scoping review to map the existing evidence on SMIs in the context of pregnancy and early parenting.

Methods and analysis
The scoping review will be conducted from May to December 2024 and reported using guidance from Arksey and O’Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. 10 academic databases will be searched for relevant studies, using keywords and subject headings for the concepts of “social media”, “influencers”, “pregnancy” and “parenting.” All primary and secondary research studies of pregnancy and early parenting SMIs will be included. Two authors will screen the identified studies for eligibility. The risk of bias of the included studies will not be assessed. Extracted data will be presented in tables and will be described narratively.

Ethics and dissemination
Ethical approval was not needed for this scoping review. Results will be published in a peer-reviewed journal, presented at conferences, posted on social media and presented to relevant groups.

Registration details
The review is registered with the Open Science Framework (https://osf.io/7v4qb https://osf.io/7v4qb)

Introduction
Migration of the health workforce from low- and middle-income countries (LMCIs) is increasingly becoming a phenomenon of interest within migration governance systems. The COVID-19 pandemic aggravated health workforce shortages that have created job opportunities in high-income countries such as the USA, UK, Canada and Germany among others. Conditions of service in LMCIs are unattractive, leading to the search for better opportunities. The digital environment is becoming one of the facilitators of migration intentions due to the activities of recruitment agencies and the search for job opportunities on the World Wide Web. The digital environment creates opportunities for migration but also poses a security threat, economic loss and a brain drain to departure countries. However, there is a paucity of evidence on how the proliferation of advertisements on health workforce recruitment within social media, unsolicited emails and activities of recruitment agencies in the digital environment influence the migration of the health workforce and the implications of migration governance.

Method and analysis
This scoping review protocol describes a comprehensive systematic extraction and examination of existing literature to map key concepts and identify previous literature, noting the gaps in how social media and the digital environment are influencing the migration of the health workforce. We lean on Arksey and O’Malley’s scoping framework in developing this protocol. This involves the following: identifying research questions, searching for the literature, selecting articles or studies, charting the data and organising and reporting the outcome of the review. The review question is informed by the population, concept and context framework, which details the population as the health workforce (doctors, nurses, midwives and pharmacists), the key concepts as migration, social media and digital environment, and the context as LMICs. The search strategy was developed with the assistance of an experienced librarian who will work with the team to conduct a Peer Review of Electronic Search Strategies to evaluate titles, abstracts and full-text articles for inclusion from databases such as Scopus, PubMed, MEDLINE and Google Scholar. Additionally, we will search grey literature sources including online news media, social media platforms (Facebook, Instagram and Twitter), web pages of WHO, UN and migration-related agencies, and interfaces like EBSCO host. Two members of the team will screen titles and abstracts, and all team members will screen full text for data extraction. Data from grey sources will be converted to transcripts, coded and grouped into themes and subthemes consistent with thematic analysis strategies. All authors will be involved in the synthesis of the data. We intend to follow Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines in reporting the outcome of peer-review sources.

Ethics and dissemination
This is a scoping review protocol that addresses a subject of interest that poses no risk to individuals or groups. All the information will be retrieved from open sources only. The protocol was registered with the Open Science Framework registry (osf.oi/zan3q) to serve as an audit trail. Reports from the review will be published in peer-reviewed journals and presented at conferences.

Introduction
Stroke is a common cause of death and disability in the older adult and increases the risk and severity of cognitive impairment, which is a factor for long-term death among stroke survivors. Some studies have focused on the effects of reminiscence therapy with different media on stroke survivors. It is currently unclear which is the best medium. This protocol aims to deal with this problem by using a network meta-analysis.

Methods and analysis
Published randomised controlled trials will be included if reminiscence therapy plus usual care was applied in older adult patients who had a stroke in the experimental group and usual care was applied in the control group. Six electronic databases will be searched from their inception to August 2023, including the Cochrane Library, CINAHL, PubMed, Web of Science, Medline and Embase. The media of reminiscence therapy may include (but not restricted to) old photos, music or movies. Outcomes will be cognitive function and negative moods. Study selection, data extraction and quality assessment will be performed independently by two reviewers. The risk of bias (RoB) of the included studies will be evaluated in accordance with the Cochrane Collaboration’s RoB tool. The evidence quality will be measured based on the Grading of Recommendations Assessment, Development and Evaluation. To compare the efficacy of reminiscence therapy with different media, standard pairwise meta-analysis and Bayesian network meta-analysis will be conducted. The probabilities of intervention for all outcomes will be ranked based on the surface under the cumulative ranking curve.

Ethics and dissemination
Ethical approval is not required for reviewing published studies. The findings will be submitted to a peer-reviewed journal for review and publication to provide important evidence for clinicians and guideline developers to determine interventions for older adult patients who had a stroke.

PROSPERO registration number
CRD42023447828.

Per la spesa pro capite il gap con Paesi europei è 47 miliardi

This Medical News article is an interview with US Surgeon General Vivek Murthy, MD, MBA, and JAMA Editor in Chief Kirsten Bibbins-Domingo, PhD, MD, MAS, about his call for a warning label on social media platforms.

Objectives
The COVID-19 pandemic has had devastating worldwide impact but most prominent was its effect on marginalised, underserved and equity-deserving populations. Social media arose as an important platform from which health organisations could rapidly disseminate information to equity-deserving populations about COVID-19 risks and events, provide instructions on how to mitigate those risks, motivate compliance with health directives, address false information, provide the opportunity for engagement and immediate feedback. The objective of this scoping review was to synthesise the academic and grey literature on equity-informed social media risk communication strategies developed during the pandemic.

Design
The review followed the Arksey and O’Malley framework and focused on the research question: What are the promising principles, processes, and practices for producing equity-informed social media risk communications?

Data sources
CINAHL Complete, MEDLINE (OVID), Business Source Complete, EMBASE database OVID, Scopus and PubMed’s curated COVID-19 literature hub: LitCovid, PsycINFO OVID were searched using terms related to access to health services, social media, risk communication, misinformation, community engagement, infectious disease, pandemics and marginalisation, supplemented by grey literature from relevant health organisations.

Eligibility criteria for selecting studies
Studies were eligible if the population of interest was an equity-deserving population, the concept discussed was COVID-19 risk communication and the article was published in English between January 2019 and December 2022.

Data extraction and synthesis
COVIDENCE facilitated screening and extraction. Charted data were thematically analysed following Braun and Clarke’s phased process. Preliminary findings were collaboratively discussed with representatives from health agencies and community organisations focused on serving equity-deserving groups.

Results
12 studies were included. In terms of principles and process, studies emphasised the need to collaboratively create plans for message construction and targeted dissemination using a risk communication framework, capitalise on access to community resources and pre-established communication mediums and be considerate of population-specific needs and concerns. Practice entails careful consideration of communication mediums, language usage, communication frequency and evaluation.

Conclusion
This scoping review provides valuable insights for health agencies and community organisations in developing principles, processes and practices to equitably communicate risk information through social media. Engagement with stakeholders further refined and confirmed the findings, offering insights for future crisis communication strategies.

Objectives
This study explored the views of young people from diverse backgrounds, with or without a history of self-harm, on the motivation and impacts of sharing self-harm imagery online and the use of their social media data for mental health research.

Design
Thematic analysis of 27 semi-structured one-to-one interviews.

Setting
Two workshops were conducted in 2021.

Participants
We recruited 27 study participants aged 16–24 (60% male). Sixteen (59%) participants were refugee and asylum seekers (RAS).

Results
Two main themes were generated: (1) Online imagery of self-harm captured perceived motivations for sharing such images, the potential impacts on others and possible need of censorship. This theme was characterised by mixed attitudes towards motivations for sharing, with some perceiving this as attention seeking, while others thought of it as help seeking or sharing of pain. Overall, participants agreed that images of self-harm can be triggering and should include trigger warnings. (2) Data sharing for mental health and self-harm research captured views on the use of social media posts and images for research purposes, and levels of trust in public and private organisations. It outlined positive views on their data being shared for research for public benefit, but highlighted issues of consent. The two most trusted organisations to hold and conduct research were the National Health Service and Universities. Participants from the RAS group were more inclined to agree to their data being used and had higher levels of trust in government.

Conclusion
Young people care about their privacy and use of their data even when it is publicly available. Coproduction with young people of resources to support understanding and develop innovative solutions to gaining informed consent for data sharing and research for public benefit is required. Young people from excluded communities, post-immigration RAS and males should be purposively involved in future social media research.