METHODS: Children <16 years old with TBI and Glasgow Coma Scale (GCS) ≤13 in an Asian multi-center PICU TBI cohort from January 2014 to October 2017 were included in this study. We defined unfavorable outcome as PCPC ≥3-moderate disability, severe disability, vegetative state, and death. We performed logistic regression to investigate the association between metabolic changes with unfavorable outcome. We divided hyperglycemia (glucose >11.1 mmol/L) during PICU admission into early-onset (within 24 h), late-onset (beyond 48 h) and persistent (throughout first 72 h).
RESULTS: Among the 305 children analyzed, 136 (44.6%) had unfavorable outcome. Children with unfavorable outcome were more likely to have early hyperglycemia (75/136, 55.1% vs. 33/169, 19.5%; P<0.001), high lactate levels >2.0 mmol/L (74/136, 54.4% vs. 56/169, 32.5%; P<0.001) and initial acidosis (85/136, 62.5% vs. 78/169, 56.1%; P=0.003) compared to those with favorable outcome. After adjusting for gender, GCS ≤8 and presence of polytrauma, early hyperglycemia [adjusted odds ratio (aOR) =3.68, 95% CI: 2.12-6.39, P<0.001] and late hyperglycemia (aOR =13.30, 95% CI: 1.64-107.8, P=0.015] were independently associated with unfavorable outcome. All children with persistent hyperglycemia died.
CONCLUSIONS: We described unfavorable outcome in pediatric TBI especially with persistent hyperglycemia. Future trials should investigate the causal relationship between glycemic trends, early intervention and outcome in this cohort.
METHODS: We conducted a cost-utility analysis using a Markov model to simulate lifetime costs and quality-adjusted life years (QALYs) of Thai smokers aged ≥35 years receiving smoking cessation services offered from FAHSAI Clinic or usual care over a horizon of 50 years. The model used a 6-month continuous abstinence rate from a multicenter prospective study of 24 FAHSAI Clinics. A series of sensitivity analyses including probabilistic sensitivity analysis were conducted to assess robustness of study findings. Cost data are presented in US$ for 2020.
RESULTS: The FAHSAI Clinic was dominant as it was less costly ($9537.92 vs $10964.19) and more effective (6.06 vs 5.96 QALYs) compared with usual care over the 50-year time horizon. Changes in risks of stroke and coronary heart disease among males had the largest impact on the cost-effectiveness findings. The probability that FAHSAI Clinic was cost-effective was 99.8% at a willingness-to-pay threshold of $5120.
CONCLUSIONS: The FAHSAI Clinic smoking cessation program was clinically superior and cost-saving compared to usual care for Thai patients with CVD in all scenarios. A budget impact analysis is needed to estimate the financial impact of adopting this program within the Thai healthcare system.
METHOD: Soccer (football) players (N = 1639; 30 countries; age 22.5 [5.7] y; 81% ≤25 y; 56% male; 30% elite; 66% Muslim) answered a retrospective, cross-sectional questionnaire related to their behavioral habits before and during COVID-19 lockdown (survey period July to September 2020), including (1) Pittsburgh Sleep Quality Index PSQI, (2) Insomnia Severity Index (ISI), (3) bespoke questions about training behaviors, and (4) Muslim player focused sleep and training behavior questions.
RESULTS: During lockdown (compared to prelockdown), PSQI (P < .001; moderate effect size [ES]) and ISI (P < .001; moderate ES) scores were higher in the overall sample and in elite versus nonelite (PSQI: P < .05; small ES and ISI: P < .001; small ES), >25 years versus ≤25 years (PSQI: P < .01; small ES and ISI: P < .001; moderate ES), females versus males (PSQI: P < .001; small ES), <1 month versus >1 month lockdown (PSQI: P < .05; small ES and ISI: P < .05; small ES), and players maintaining versus reducing training intensity (PSQI: P < .001; moderate ES and ISI: P < .001; small ES). Muslim players (41%) reported unfavorable sleep and/or training behaviors during Ramadan in lockdown compared to lockdown outside of Ramadan.
CONCLUSIONS: Specific subgroups appear more vulnerable to lockdown effects, with training-intensity maintenance moderating negative effects relative to sleep. Policy and support (respectful of subgroup nuances) during lockdown-like challenges that facilitate training (including intensity) appear prudent, given their favorable relationship with sleep, mental health, and physical health, in the present data and elsewhere.
PURPOSE: This meta-analysis aimed to evaluate the effect of visual distraction on adults undergoing colonoscopy.
METHODS: We searched PubMed, EMBASE, Web of Science, and Cochrane Library Database from their inception to February 2022. Randomized controlled trials comparing visual distraction with non-visual distraction were considered for inclusion. The fixed-effects and random-effects models were used to pool the data from individual studies and the Cochrane risk of bias assessment tool was used to determine the methodology quality.
RESULTS: This meta-analysis included four studies (N = 301) for pain level and total procedure time, three studies (N = 181) for satisfaction score, three studies (N = 196) for anxiety level, and four studie (N = 402) for willingness to repeat the procedure. The pooled analysis shown that significantly lower pain levels (SMD, - 0.25; 95% CI - 0.47 to - 0.02; P = 0.03), higher satisfaction score with the procedure (SMD, 0.63; 95% CI, 0.33 to 0.93; P