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Aug 2018 DOI 10.14302/issn.2575-1212.jvhc-18-2167
Buckley PetraCorresponding author
Charles Sturt University, Wagga Wagga, New South Wales 2650, Australia.
A cohort of Pony Club horses was observed for 13 months with data collected from owner-kept diaries and monthly property visits. All horses studied had access to pasture for all or part of the day. Whilst paddock size was seldom limiting, pasture degradation was evident and observed pasture mass and composition varied greatly. Horses’ body weight indices and body condition scores also varied greatly, closely matching seasonal variations in pasture mass. Increments in bodyweight varied in a non-linear fashion with body condition score. Most horses experienced additional year-round hand-fed supplementation and half of the study horses recorded body condition scores greater than 3.5 out of 5. This suggests that the owners of Pony Club horses did not rely on pasture as the sole source of nutrition, even though, based on estimated energy demands, well-managed pasture can meet the energy requirements of Pony Club horses. Furthermore, the fact that owners appeared not to make horse feeding decisions based on body condition score resulting in obesity, raises health and welfare concerns in this cohort of horses. The inappropriate feeding of supplements observed during times of high pasture growth was a concern. Whilst the ideal pasture for Pony Club horses has not been described, it is likely to differ to those considered ideal for broodmares and other livestock because of these unique health risks associated with high levels of non-structural carbohydrate content in improved pasture species. This study highlights the need to educate owners about recognising unhealthy body conditions of horses and better managing pastures and pasture access to reduce the risk of obesity related disorders, whilst at the same time reducing pasture degradation and supplemental feed costs
Apr 2020 DOI 10.14302/issn.2691-5014.jphn-20-3297
Bittmann StefanCorresponding author
Department of Pediatrics, Ped Mind Institute (PMI), Gronau, Germany
A concise overview synthesizes early knowledge on COVID‑19 in pediatrics, covering transmission, clinical spectrum, diagnostics, and prevention, and pointing to priorities for longitudinal study.
Mar 2020 DOI 10.14302/issn.2641-4538.jphi-19-2610
Seyoum Tegegne AwokeCorresponding author
Dept. of statistics, Bahir Dar University, Ethiopia
Background The relationship between predictors and the variable of interest was estimated using a structural equation model which is used to predict latent variables. The main advantage of the SEM is the ability to estimate the direct and indirect pathways of the effect of the primary independent variable on the outcome, given sufficient sample sizes. Despite not directly modeling the mediated pathways, GLMMs excluding mediating variables performed well with respect to power, bias and coverage probability in modeling the total effect of the primary independent variables on the outcome. In longitudinal studies, data are collected from subjects at several time points. The main purpose of longitudinal analysis is to detecting the trends or trajectories of the variables of interest. Methods A longitudinal study was conducted on 792 adults living with HIV/AIDS who commenced HAART. Structural equation modeling was used to construct a model to detecting predictors of CD4 cell count change. The procedure was illustrated by applying it to longitudinal health-related quality-of-life data on HIV/AIDS patients, collected from September 2008 to August 2012 monthly for the first six months and quarterly for remaining study period. Results The result of current investigation indicates that CD4 cell count change was highly influenced by certain socio-demographic and clinical variables. Out of all the participants, 141 (82%) have been considered 100% adherent to antiretroviral therapy. Structural equation modeling has confirmed the direct effect that personality (decision-making and tolerance of frustration) has on motives to behave, or act accordingly, which was in turn directly related to medication adherence behaviors. In addition, these behaviors have had a direct and significant effect on viral load, as well as an indirect effect on CD4 cell count. The final model demonstrates the congruence between theory and data (x2/df. = 1.480, goodness of fit index = 0.97, adjusted goodness of fit index = 0.94, comparative fit index = 0.98, root mean square error of approximation = 0.05), accounting for 55.7% of the variance. Conclusions The results of this study support our theoretical model as a conceptual framework for the prediction of medication adherence behaviors in persons living with HIV/AIDS. Implications for designing, implementing, and evaluating intervention programs based on the model are to be discussed.
Mar 2018 DOI 10.14302/issn.2642-9241.jrd-18-1958
Ba T TaCorresponding author
Military Hospital 103
Background Bronchoscopic lung volume reduction (BLVR) has been applied in COPD patients with heterogeneous emphysema. In this first clinical trial in Vietnam, we evaluated the safety and initial results of BLVR by one-way valve in COPD patients with severe emphysema. Methods We performed a prospective, nonrandomized, single center longitudinal study in 30 stable COPD patients with heterogeneous severe emphysema on CT-scanner, the average age of 65.17 years old, FEV1≤35 %pred., TLC ≥ 100 %pred., RV ≥ 150 %pred. and 6MWT < 450 meters. The Zephyr one-way bronchial valves (PulmonX, Redwood City, CA, USA) with the size of 5.5 mm and 4mm were placed in lobar or segmental bronchi via flexible bronchoscopy. 28 patients were placed only one valve, 1 patient with two and 1 patient with three valves. 23 valves with the size 5.5 mm diameters and 10 valves with the size 4.0mm used. All patients received optimal medical treatment at the time of procedure and during the study period. Outcomes will be assessed at 3 months after treatment include the changes of clinic, and lung function, the occurrence of complications. Results After 3 months, mean CAT scores decreased significantly compared with before procedure (17.73 ± 3.53 vs 20.10 ± 3.58) (p<0.05), with the median change of 2.73 points and the improvement more than 2 points in 76.67% of patients. 6 MWT increased at 3 months with mean 32.13 meters, 93.33% of the patients increased 6MWT, 46.67% of the patients increased 6MWT more than 26 meters. MRC decreased with the median change of 0.5 score. VC decreased by a mean 0.2 (L) (0.42 - 0.02), FEV1 increased by a mean 0.05 (L) (0.04 - 0.05) but not statistically significant (p>0.05); FVC increased by a mean 0.14 (L) (0.01 - 0.28), RV decreased by a mean 0.62 (L) (1.05 - 0.2), TLC decreased by a mean 0.52 (L) (0.77- 2.4) with statistically significant (P<0.05). The early complications were 13.33%, the later complications were 23.34% of the patients. Conclusions The unilateral bronchoscopic lung volume reduction with one-way valve (mainly one valve) in treatment of heterogeneous severe emphysema in stable COPD patients in Viet Nam have shown that this procedure is safe with encouraging initial results.
Feb 2018 DOI 10.14302/issn.2329-9487.jhc-18-1932
Erne PaulCorresponding author
Faculty of Biomedical Sciences, Universita della Svizzera Italiana, Lugano, Switzerland
The aim of this study was to assess the use of ambulatory acoustic cardiography during the initial data collection of the longitudinal study of a rural population in Switzerland (n=297, mean age 48.9 ±16.5 years, 57% female). Ambulatory acoustic cardiography non-invasively can assess sleep disordered breathing (SDB) and provides markers of left ventricular systolic and diastolic dysfunction. The percentage of the third heart sound detected during sleep decreased significantly across age groups (age < 40 years, 40-60 years, > 60 years) for both genders (males, p=0.04; females, p=0.02). The percentage of a fourth heart sound detected exhibited an increasing trend for both genders with age suggesting increased diastolic dysfunction with aging. Mean electromechanical activation time (EMAT) during sleep was within the normal range across age groups and both genders (male 93.7 ± 11.6 ms, female 94.6 ± 13.0 ms), and did not vary significantly with age. A large proportion of subjects had a high likelihood of sleep disordered breathing (17.6%). Baseline characteristics categorized by SDB severity indicate increasing age, male gender and being overweight (BMI ≥ 25) to be associated with greater SDB severity. Acoustic cardiography findings categorized by SDB severity reveal increased nocturnal non-dipping heart rate, presence of atrial fibrillation, prolonged QRS duration and QTc interval, increased percentage of fourth heart sound detected, and longer EMAT to be significantly associated with greater SDB severity. Overall, acoustic cardiography detected a very low prevalence of systolic dysfunction, age-related increases in diastolic dysfunction and a moderate prevalence of sleep disordered breathing.
Jun 2017 DOI 10.14302/issn.2474-7785.jarh-17-1489
NE PhilipCorresponding author
Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram 695011, Kerala, India
We aimed to find the population coverage, health service utilization and out-of-pocket spending among the elderly who are insured under Comprehensive Health Insurance Scheme (CHIS), Kerala through a longitudinal study of 600 non-rich households for nine months. The study found that only 57.7% the elderly were insured under CHIS which is lower than the population average of 80%. Single elderly from a socially backward caste, living alone in kutcha or semi-pucca houses were excluded from CHIS. Even though insured elderly had more episodes of hospitalization, only 38.4% of the elderly could make use of CHIS smart card for payment during hospitalization and 43.6% of the episodes were covered by CHIS. The mean indirect out-of-pocket expenses among insured elderly who had used smart cards for hospitalization (INR 7679.25) was higher than that for the un-insured (INR 4455.26), p = 0.027. The mean monthly drug expenditure (INR 1105.09) was also significantly higher among the insured as compared to the un-insured elderly (INR 650.03), p=.004. More than 80% of the hospitalized households had to use distress finance mechanisms to meet health- related expenses. We found that population coverage among elderly did not translate into service coverage and thus financial risk protection was not achieved even in a state like Kerala which is considered to be well-performing in terms of health insurance coverage. This study points out that elderly being a vulnerable group with special needs require a more comprehensive service package including chronic disease care, and a higher level of financial coverage.
Apr 2017 DOI 10.14302/issn.2474-7785.jarh-17-1483
Dorfman JonCorresponding author
Department of Surgery, University of Massachusetts Memorial Medical Center Worcester, MA
Background: Discharge disposition planning begins at admission and is frequently one of the first questions posed to healthcare providers by patients and families. We hypothesized that pre-injury functional status would predict discharge disposition. Methods: We linked prospective data from the Worcester, MA cohort of the Global Longitudinal Study of Osteoporosis (GLOW) study and the UMassMemorial Level 1 Trauma Center Registry to determine predictors of discharge disposition for female geriatric (over the age of 55) trauma patients using bivariate comparisons and multivariable modeling. Results: 154 women of 5,091 in the Worcester GLOW cohort were evaluated for traumatic injury at UMassMemorial and were discharged alive either to their home (n=30) or to rehabilitation, skilled nursing, or nursing home facilities (n=124). The mean age was 79 years and the majority (99%) was white. There were no statistically significant differences in comorbidities or injury severity score between the groups. All women with femur fractures were discharged to a facility. The most common injury among women discharged home was traumatic brain injury. While univariate analysis revealed differences in pre-injury activity status, only age remained statistically different in a logistic regression model predicting discharge to facility (OR 2.61 per additional 10 years of age, 95% CI 1.62 to 4.19, p<0.0001). Conclusions: The majority of elderly women are not discharged home after injury. Pre-injury activity status was not associated with discharge disposition when accounting for other factors. It appears that physical function, which deteriorates with age, is a proxy for aging in older women at risk for osteoporosis.
Feb 2017 DOI 10.14302/issn.2381-862X.jwrh-15-848
Wittkowski AnjaCorresponding author
University of Manchester, Division of Psychology and Mental Health
Postpartum depression is a common mood disorder following childbirth. Depression occurring at this crucial stage in a child’s life is known to have far reaching and potentially damaging consequences for the mother, the baby and her family. Whilst a number of risk factors have been identified in the literature as contributing to the development of postpartum depression, including a past psychiatric history and lack of social support, some of these are not easily modifiable through psychological interventions. The aim of this longitudinal study was to examine the contribution of specific psychological factors, including maternal beliefs about motherhood and perfectionism and perceived social support, in the development of postpartum depression. Seventy-three pregnant women consented to take part and returned questionnaires during the third trimester of their pregnancy. Of those women, 61 also completed questionnaires 4-6 weeks following the birth of their baby. Significant associations were identified for postpartum depression and the psychological variables of perfectionistic beliefs and social support, whereas many demographic factors were not significantly implicated in the development of depression. Using a multiple hierarchical regression analysis, the study examined whether maternal beliefs about motherhood and beliefs about perfectionism predicted more of the variance in postpartum depression scores than other demographic variables, including a past history of emotional difficulties. As predicted, beliefs about motherhood and perceptions of poor social support from friends and family were significant predictors of postpartum depression, when the influence of antenatal depression scores were accounted for. A past history of emotional difficulties was also retained in the final model, whereas beliefs about perfectionism were not. These findings have implications for clinical services, highlighting the need for refined assessments of expectant mothers’ beliefs about motherhood and their perceptions of their social support during pregnancy and the need for more refined psychological interventions that address these beliefs.