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Analysing the association of BMI, physical activity and sociodemographics with osteoarthritis symptom severity: cross-sectional study in Southern Bosnia and Herzegovina

Por: Brkic · S. · Gilic · B. · Obradovic Salcin · L. · Ostojic · D. · Ostojic · L. · Miljanovic Damjanovic · V. · Geets Kesic · M. · Simic · J. · Sekulic · D.
Objectives

This study aimed to investigate the associations between body mass index (BMI), physical activity levels (PALs) and sociodemographic factors (gender, age, education and marital status) with different outcomes (symptoms) of osteoarthritis (OA) severity, in patients with knee OA.

Design

Cross-sectional study.

Participants

The sample included 200 participants from southern Bosnia and Herzegovina (61 males, 65.1±9.01 years of age) who had been diagnosed with primary knee OA.

Outcome measures

OA symptoms as evidenced by the Western Ontario and McMaster Universities OA Index (WOMAC) scale, including three subscores (WOMAC-pain, WOMAC-stiffness, WOMAC-functionality) and total WOMAC score. The predictors included age (in years), gender (male or female), BMI, PAL, education level, urban/rural living environment and marital status (partnership).

Results

Female gender was correlated with the WOMAC-pain, WOMAC-stiffness and WOMAC-total. Older age was correlated with the WOMAC-pain and WOMAC-total. Patients who were better educated and reported higher PAL had better WOMAC functionality. BMI was the most significant factor of influence, with higher WOMAC-pain (OR 1.44, 95% CI 1.27 to 1.65), WOMAC-stiffness (OR 1.20, 95% CI 1.1 to –1.33), WOMAC-functionality (OR 1.26, 95% CI 1.13 to 1.40) and WOMAC-total (OR 1.29, 95% CI 1.6 to –1.44) scores in patients with higher BMI.

Conclusions

Results indicate the necessity of controlling body weight in patients with diagnosed knee OA irrespective of gender. Further prospective studies are warranted in order to establish causality between variables.

Do patients and doctors perceptions about cardiovascular outcomes coincide? A one-to-one survey at in-hospital and outpatient level

Por: Spinucci · G. · Gili · A. · Mascelloni · M. · Fortuni · F. · Tritto · I. · Jacoangeli · F. · Manolis · A. · Carreras · G. · Carluccio · E. · Ambrosio · G.
Objectives

Cardiovascular (CV) diseases are associated with adverse outcomes. However, attention has typically focused on outcomes considered relevant by doctors, whereas the potential gap in perception and relative importance of outcomes that may exist between patients and doctors has been scarcely explored. Evidence available reports the views of either patients or doctors alone, and data are analysed in aggregate. We investigated this issue by surveying for the first time patients’ and doctors’ opinions simultaneously, on a one-to-one basis.

Design

Survey involving patients with different CV diseases. Each patient and their attending doctor were asked to simultaneously but independently gauge the importance each attached to a predetermined set of outcomes, filling out disease-specific questionnaires. Results were analysed by compositional analysis.

Setting

Inpatients and outpatients being seen by cardiologists and internal medicine specialists at hospitals affiliated with the National Health System in Umbria, Italy.

Participants

All-comer patients, presenting with one of the following conditions: atrial fibrillation (AF), myocardial infarction (MI), heart failure (HF) or considered at high CV risk.

Main outcome measures

Importance attached to outcomes relative to life path, quality of life, future clinical events.

Results

From 337 paired questionnaires returned, significant differences between patients’ and doctors’ perspectives emerged. Specifically: (1) patients with AF were significantly less concerned about the risk of stroke than doctors; (2) worsening of HF was a greater concern for doctors than patients, whereas patients weighed the risk of disability more; (3) patients with a previous MI, or at high CV risk, weighed the risk of hospitalisation less relevant than doctors, but were significantly more concerned about the risk of disability.

Conclusions

Simultaneous, one-to-one assessment of patients’ and doctors’ opinion shows remarkable differences between patients’ perception and physicians’ judgement concerning the relevance of major CV outcomes. Appreciation and sharing of these issues may inform better tailoring of cardiac care.

Insurance type and risk of dementia diagnosis after traumatic brain injury: a study of 267 473 US civilians from 2000 to 2022

Por: Deshmukh · M. · Ugiliweneza · B. · Gilsanz · P. · Whitmer · R. A. · Boakye · M. · Nuno · M.
Objectives

To evaluate how insurance influences the risk of a dementia diagnosis among a large, diverse cohort of US civilian adults with traumatic brain injury (TBI) over a 22-year period.

Design

This is a retrospective cohort study involving individuals diagnosed with TBI.

Setting

The study used the Merative MarketScan Research Database, specifically drawing from the Commercial Claims and Encounters, Medicare Supplemental and Medicaid databases, from 2000 to 2022 in the USA. These databases provide comprehensive insights into healthcare services received by enrollees, including inpatient and outpatient services, outpatient prescription claims, clinical utilisation records and healthcare expenditures.

Participants

267 473 adults aged 55 and older who were diagnosed with a TBI between 1 January 2000 and 31 December 2022. Individuals with unknown TBI severity and dementia claims 2 years preceding TBI were excluded. TBI and dementia diagnoses were identified using International Classification of Disease 9th and 10th editions codes from inpatient and outpatient admission records.

Interventions

None.

Primary and secondary outcome measures

We compared the incidence of all-cause dementia across different insurance types to assess potential disparities in diagnosis following TBI. Cox proportional hazards models, with age as the time scale, were used to study the association between insurance type and dementia diagnosis following a TBI. Models were adjusted for key demographic variables, medical comorbidities and psychiatric conditions to account for potential confounding.

Results

Of the 267 473 individuals with TBI, 12.7% were diagnosed with dementia over a mean follow-up period of 40 months (SD of 42 months). Dementia incidence differed significantly by insurance type, with 18.2% for Medicaid recipients, 17.3% for Medicare beneficiaries and only 2.3% among individuals with commercial insurance. The adjusted HR for dementia was notably higher among individuals enrolled on Medicaid (HR 2.9, 95% CI: 2.8 to 3.1) and Medicare (HR 2.1, 95% CI: 2.0 to 2.2), when compared with those with commercial insurance.

Conclusions

Individuals with TBI covered by Medicaid and Medicare are significantly more likely to be diagnosed with dementia, with a 2.9-fold and 2.1-fold increase risk, respectively, compared with those with commercial insurance. Addressing insurance-related disparities in dementia diagnosis is crucial for building a more equitable healthcare system. It is essential that individuals with TBI cases, regardless of their insurance type, have access to comprehensive care and preventive interventions to achieve the best possible long-term outcomes.

Immersive Simulation Training: Comparing the impact on midwifery and paramedic students’ confidence to perform basic life support skills

Simulated practice using high fidelity has been shown to have significant benefits in the medical and nursing field. However, the benefits among paramedical and midwifery students are not well known.
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