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Effect involving durability in college student emotional wellness in the course of COVID-19.
BACKGROUND The highest burden of hypertension is found in Sub-Saharan Africa (SSA) with a threefold greater mortality from stroke and other associated diseases. Ethnicity is known to influence the response to antihypertensives, especially in black populations living in North America and Europe. We sought to outline the impact of all commonly used pharmacological agents on both blood pressure reduction and cardiovascular morbidity and mortality in SSA. METHODS We used similar criteria to previous large meta-analyses of blood pressure agents but restricted results to populations in SSA. Quality of evidence was assessed using a risk of bias tool. Network meta-analysis with random effects was used to compare the effects across interventions and meta-regression to explore participant heterogeneity. RESULTS Thirty-two studies of 2860 participants were identified. Most were small studies from single, urban centres. Compared with placebo, any pharmacotherapy lowered SBP/DBP by 8.51/8.04 mmHg, and calcium channel blockers (CCBs) were the most efficacious first-line agent with 18.46/11.6 mmHg reduction. Fewer studies assessing combination therapy were available, but there was a trend towards superiority for CCBs plus ACE inhibitors or diuretics compared to other combinations. No studies examined the effect of antihypertensive therapy on morbidity or mortality outcomes. CONCLUSION Evidence broadly supports current guidelines and provides a clear rationale for promoting CCBs as first-line agents and early initiation of combination therapy. However, there is a clear requirement for more evidence to provide a nuanced understanding of stroke and other cardiovascular disease prevention amongst diverse populations on the continent. TRIAL REGISTRATION PROSPERO, CRD42019122490. This review was registered in January 2019.BACKGROUND The Well-being of Future Generations (Wales) Act, 2015 (WFG Act), aims to change the ways of working in Wales to be sustainable for the future. Goals within the WFG Act include 'a healthier Wales', 'a more equal Wales' and 'a more prosperous Wales'. Reviewing key factors that led to Wales enacting this ground-breaking legislation is worthwhile for other legislatures around the world that may wish to create policy for future generations. We suggest that the drive of individual politicians, events at the time and recent history were the most critical issues in developing a more nuanced piece of legislation - the WFG Act. METHODS Ten interviews were conducted with those involved in the development of the WFG Act. Relevant documents were identified through systematic literature reviews and discussion with interviewees. Initial outcomes were tested against policy analysis frameworks, and Kingdon's Multiple Stream Analysis was selected. RESULTS Key 'policy entrepreneurs' were found to be important, alonggnificant in the development of the WFG Act. Due to multiple factors, policy-makers in Wales have legislated for the long term, placing sustainability and the well-being of present and future generations at the heart of public services and government.BACKGROUND Interstitial lung disease (ILD) is a heterogeneous group of mainly chronic lung diseases differing in disease course and prognosis. For most subtypes, evidence on relevance and outcomes of hospitalisations is lacking. METHODS Using German claims data we investigated number of hospitalisations (zero-inflated-negative-binomial models providing rate ratios (RR)) and time to first hospitalisation (Cox proportional-hazard models providing hazard ratios (RR)) for nine ILD-subtypes. Models were stratified by ILD-related and non-ILD-related hospitalisations. We adjusted for age, gender, ILD-subtype, ILD-relevant comorbidities and ILD-medication (immunosuppressive drugs, steroids, anti-fibrotic drugs). RESULTS Among 36,816 ILD-patients (mean age 64.7 years, 56.2% male, mean observation period 9.3 quarters), 71.2% had non-ILD-related and 56.6% ILD-related hospitalisations. We observed more and earlier non-ILD-related hospitalisations in ILD patients other than sarcoidosis. Medical ILD-treatment was associated with increased frequency and in case of late initiation, earlier (non-)ILD-related hospitalisations. Comorbidities were associated with generally increased hospitalisation frequency except for COPD (RR = 0.90) and PH (RR = 0.94) in non-ILD-related and for lung cancer in ILD-related hospitalisations (RR = 0.89). Coronary heart disease was linked with earlier (ILD-related HR = 1.17, non-ILD-related HR = 1.19), but most other conditions with delayed hospitalisations. CONCLUSION Hospitalisations are frequent across all ILD-subtypes. The hospitalisation risk might be reduced independently of the subtype by improved management of comorbidities and improved pharmacological and non-pharmacological ILD therapy.BACKGROUND One in nine emergency department (ED) visits in Canada are caused by adverse drug events, the unintended and harmful effects of medication use. Medication reviews by clinical pharmacists are interventions designed to optimize medications and address adverse drug events to impact patient outcomes. However, the effect of medication reviews on long-term outpatient health services utilization is not well understood. This research studied the effect of medication review performed by clinical pharmacists on long-term outpatient health services utilization. METHODS Data included information from 10,783 patients who were part of a prospective, multi-centre quality improvement evaluation from 2011 to 2013. Outpatient health services utilization was defined as total ED visits and physician contacts, aggregated to four physician specialty groups general and family practitioners (GP); medical specialists; surgical specialists; and imaging and laboratory specialists. During triage, patients deemed high-risk bas This was the first study to measure long-term trends of physician visits following an ED-based medication review. The lack of differences in level and trend of GP and ED visits suggest that pharmacist recommendations may not have been adequately communicated to community-based providers, and/or recommendations may not have affected health care delivery. Future studies should evaluate physician acceptance of pharmacist recommendations and should encourage patient follow-up to community providers.BACKGROUND The ribonuclear protein TDP-43 has been implicated in the pathophysiology of amyotrophic lateral sclerosis (ALS), with genetic mutations being linked to the neurological symptoms of the disease. Though alterations in the intracellular distribution of TDP-43 have been observed in skeletal muscles of patients suffering from ALS, it is not clear whether such modifications play an active role in the disease or merely represent an expression of muscle homeostatic mechanisms. Also, the molecular and metabolic pathways regulated by TDP-43 in the skeletal muscle remain largely unknown. Here, we analyze the function of TBPH, the Drosophila melanogaster ortholog of TDP-43, in skeletal muscles. RESULTS We modulated the activity of TDP-43 in Drosophila muscles by means of RNA interference and observed that it is required to promote the formation and growth of neuromuscular synapses. TDP-43 regulated the expression levels of Disc-large (Dlg), and restoring Dlg expression either in skeletal muscles or in motoneurons was sufficient to suppress the locomotive and synaptic defects of TDP-43-null flies. These results were validated by the observation of a decrease in Dlg levels in human neuroblastoma cells and iPSC-differentiated motoneurons derived from ALS patients, suggesting similar mechanisms may potentially be involved in the pathophysiology of the disease. CONCLUSIONS Our results help to unveil the physiological role of TDP-43 in skeletal muscles as well as the mechanisms responsible for the autonomous and non-autonomous behavior of this protein concerning the organization of neuromuscular synapses.INTRODUCTION Many countries in sub-Saharan Africa have adopted task shifting of surgical responsibilities to non-physician clinicians (NPCs) as a solution to address workforce shortages. There is resistance to delegating surgical procedures to NPCs due to concerns about their surgical skills and lack of supervision systems to ensure safety and quality of care provided. This study aimed to explore the effects of a new supervision model implemented in Zambia to improve the delivery of health services by surgical NPCs working at district hospitals. METHODS Twenty-eight semi-structured interviews were conducted with NPCs and medical doctors at nine district hospitals and with the surgical specialists who provided in-person and remote supervision over an average period of 15 months. Data were analysed using 'top-down' and 'bottom-up' thematic coding. RESULTS Interviewees reported an improvement in the surgical skills and confidence of NPCs, as well as better teamwork. At the facility level, supervision led to an igical supervision to become part of sustainable national programmes.BACKGROUND Handgrip strength (HGS) is an important health biomarker whose low scores have been shown to be associated with the morbimortality. This study aimed to analyze the factors associated with low HGS in older people in Rio Branco, Acre, Brazil. METHODS The study was carried out with data from the Study of Chronic Diseases (EDOC-I) - Older People, a cross-sectional household PAPI probability sample survey performed with 1016 people aged over 60 residing in Rio Branco in 2014. The low HGS was defined by the 20th percentile of the maximum HGS by sex and age group. Associations between variables of health status (psychological and physical) and low HGS, by sex, were estimated using logistic regression, expressed by adjusted ORs (aOR). RESULTS Older individuals had lower median HGS than younger individuals (- 6.0 kg among men and - 2.6 kg among women). Women aged over 80 had, on average, the lower quintile of HGS compared to women of the previous age groups. Factors independently associated with low HGS in tegy for disease prevention and health promotion.BACKGROUND The prevalence of malnutrition remains high in hospitals but no "gold standard" has been established to identify nutritional risks adequately. The Nutrition Risk Screening-2002 (NRS-2002), Subjective Global Assessment (SGA), and Controlling Nutritional Status Index (CONUT) are widely used screening tools, but their efficacy has not yet been compared in Mexican patients. Here, we aimed to compare the efficacy of these tools in identifying nutritional risks within the first 48 h of admission in a group of patients with gastrointestinal diseases. METHODS This was a cross-sectional study of 196 patients. The results of the screening tools, length of hospital stay, serum albumin and cholesterol concentrations, lymphocyte counts, age, body mass index (BMI), complications, and mortality were analyzed. find more Kappa (κ) statistics were applied to determine the degree of agreement between tools. The performances of the screening tools in predicting complications and mortality were assessed using binary logistic regression. RESULTS The NRS-2002, SGA, and CONUT tools identified nutritional risk in 67, 74, and 51% of the patients, respectively. The observed agreements between tools were NRS2002/SGA, κ = 0.53; CONUT/NRS-2002, κ = 0.42; and SGA/CONUT, κ = 0.36. Within age groups, the best agreement was found in those aged 51-65 years (κ = 0.68). CONUT and length of stay were both predictive for the number of complications. The number of complications and serum cholesterol concentrations were predictive for mortality. CONCLUSIONS The proportion of patients identified as having nutritional risk was high using all three screening tools. SGA, NRS-2002, and CONUT had similar capacities for screening risk, but the best agreement was observed between NRS-2002 and SGA. Only CONUT predicted complications, but none of these tools performed well in predicting mortality.
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