Journal of Medical Research and Innovation (JMRI)
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113 research outputs found
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Feasibility study of smartphone application for self-monitoring dietary intake among cancer patients
Full text linkObjective: Evidence accumulates that optimal nutrition status positively influences cancer treatment outcomes. A "smartphone application" (intelligent dietitian support apps, iDSA) was developed to act as a tool to assist patients in terms of dietary monitoring. This study aimed to examine the feasibility of iDSA for self-monitoring dietary intake among cancer patients.
Method: This was a pilot study. Eligible patients were approached and recruited. Dietitian entered individual estimated energy protein requirement into iDSA after installation. Participants recorded and monitored own daily dietary intake. Dietitian arranged for a two-week follow up to monitor nutritional status (weight and dietary intake).
Results: This study enrolled 14 participants, six males and eight females, with a mean age of 36.4 ± 10.1 years. iDSA improved participants’ nutritional outcomes significantly; weight gained 1.2 ± 0.2 kg, increased energy intake 215 ± 100 kcal/day and protein intake 8 ± 5.1 g/day. There were 92.9% of participants agreed or totally agreed that they were able to monitor and increase dietary intake during using iDSA. However, about 57.1% reported that it was burdensome to record their diet daily and sometimes they forgot to record their food intake.
Conclusion: Self-monitoring dietary intake via intelligent dietitian support apps was feasible among cancer patients. With compliance to iDSA resulted in an increase in dietary intake and body weight after two-week. iDSA usability was rated good and can be used to study dietary intake among cancer patients
Integrate Partial Hydrolyzed Guar Gum in Postoperative Ileostomy Nutritional Management
Full text linkObjective: This case report aimed to share our clinical practice about the Partially Hydrolysed Guar Gum (PHGG) incorporation in conventional ileostomy management.
Case presentation: Patients A and B, who diagnosed with Diabetic Mellitus and Hypertension recto-sigmoid adenocarcinoma stage III, had high stoma output after anterior resection with covering ileostomy (more than 1200ml per day). PHGG was integrated into nutritional management and showed a positive effect in normalizing volume and the consistency of ileostomy stoma output.
Discussion: Postoperative ileostomy patients often faced a higher risk for malnutrition among cancer patients. Persistent high stoma output without proper management could cause dehydration, depletion of magnesium and sodium, acute renal injury and malnutrition. High protein and high calories normal diet would normally be prescribed to postoperative colorectal cancer patients with an ileostomy. The addition of PHGG showed a positive effect in improving ileostomy consistency and output.
Conclusion: The PHGG incorporation in the post-operative nutritional management for ileostomy revealed positive outcomes in consistency and volume of stoma output and nutritional intake
Predictors of physician comfort in using pharmacogenomics data in clinical practice: A cross-sectional study
Full text linkObjective: Utilization of pharmacogenomics data in clinical practice is a critical step towards individual and precision medicine. This is a cross-sectional study conducted by incorporating several variables as outlined in the survey report to assess and analyze the reasons or behaviors that could influence clinicians to use or not use pharmacogenomics.
Methods: In this study, we conducted a cross-sectional quantitative survey among primary physicians practicing in Kettering Health Network facilities. 1,201 invitations were sent out and 135 Physicians participated in the survey. Physicians were requested by email to participate in a survey containing 14 multiple choice questions regarding their understanding and beliefs regarding pharmacogenomics, as well as questions about specific professional details which were intended to explore how physician characteristics affected familiarity, and comfort and confidence in using pharmacogenomics data in patient care. Statistical Package for the Social Sciences (standard version 25) was used for statistical analysis and consent was obtained from all study participants through the survey link.
Results: The ratings of the familiarly, comfort, and confidence with pharmacogenetics were highly intercorrelated (r = 0.81-0.87). Accordingly, we summed the three ratings to form a composite score of the three items; hereafter referred to as “scale scores”. Possible scores ranged from 5 to 15, whereas actual scores ranged from 3 to 15 (Mean = 6.32, SD = 3.12). Scale scores were not statistically significantly correlated with age (r = 0.12, p < 0.17) or number of years in practice (r = 0.11, p < 0.22), and were only weakly (inversely) correlated with number of hours spent in patient care each week (r = -0.17, p < 0.05).
Conclusion: In our study, physicians who had some education in the field of pharmacogenomics were more likely to use pharmacogenomics data in clinical practice. We have further characterized that continuing medical education (CME), more than medical education or residency training significantly predicts familiarity, confidence, or comfort in using pharmacogenomics data. Therefore, pharmacogenomics should be integrated in the CME for practicing clinicians as well as graduate medical education
Covid-19: A pandemic here to stay!
No full textSince December 2019, SARS-CoV-2 has spread to more than 200 countries and has become a global pandemic. There have been more than 49 million confirmed cases of Covid-19 as of 1st of November, 2020 with over 1.2 million case fatalities all over the world. The current review paper gives an update on the epidemiology, investigations modalities and treatment options including the various current treatment protocols, vaccines in development and experimental drugs in research
Blacks’ Diminished Health Returns of Educational Attainment: Health and Retirement Study
Full text linkBackground: Education level reduces the risk of health problems such as poor self-rated health (SRH), high body mass index (BMI), and depressive symptoms (DS). Marginalization – related Diminished Returns (MDRs), however, refer to smaller health benefits of socioeconomic status (SES) indicators particularly educational attainment for the members of racial minority groups such as non-Hispanic Blacks compared to the majority group (non-Hispanic Whites). It is not known, however, if MDRs also hold for middle-age and older adults over a long period of time.
Aims: The current study used a nationally representative data set to explore racial variation in the predictive utility of baseline education level on protecting people against poor SRH, BMI, and DS.
Methods: Data for this analysis were borrowed from the Health and Retirement Study (HRS 1992-ongoing), a nationally representative longitudinal study that followed 10,023 middle-aged and older adults (50+ years old) for up to 26 years. From this number, 1877 (18.7%) were non-Hispanic Black Americans, and 8,146 (81.3%) were non-Hispanic White Americans. Education level was the independent variable. We used cluster analysis to categorize individuals to low and high-risk groups (outcome) based on SRH, BMI, and DS over 26 years. Age and gender were the covariates. Race was the moderator.
Results: Overall, high education level reduced the odds of poor SRH, BMI, and DS over the 26 years of follow up. Interactions were observed between race and education on all three health outcomes indicating smaller protective effects of baseline educational attainment on poor health over time, regardless of the outcome.
Conclusions: In line with the MDRs, highly educated non-Hispanic Black Americans remain at high risk for poor health across domains, a risk which is unexpected given their education. The risk of all health outcomes, however, is lowest for non-Hispanic White Americans with highest education. Policies that exclusively focus on equalizing racial gaps in SES (e.g., education) may fail to eliminate the racial and ethnic health inequalities because of the racial inequalities in the marginal health return of education. Public policies must equalize education quality and address structural and environmental barriers that are disproportionately more common in the lives of non-Hispanic Black Americans, even at high education levels. Future research should test how contextual factors, segregation, labor market practices, childhood poverty, and education quality reduces the health return of education for highly educated non-Hispanic Black Americans
Cognitive test score and 25-Year mortality risk; Does race matter?
Full text linkObjectives: Despite our knowledge on the effect of cognitive test score on subsequent risk of mortality, few studies have compared Blacks and Whites for this association. The current study was conducted on Black-White differences in the magnitude of the association between baseline cognitive test score and all-cause mortality in a nationally representative sample of adults in the United States over 25 years.
Methods: We used data of the Americans’ Changing Lives Study (ACL), 1986 – 2011, a national prospective cohort in U.S. The study followed 3,361 adults (2,205 White and 1,156 Blacks), age 25 and older, for up to 25 years. The independent variable was cognitive test score measured at baseline (1986) using the 4-item version of the Short Portable Mental Status Questionnaire, treated in two different ways (as a dichotomous and as a continuous variable). The dependent variable was time to death (due to all causes) during the follow up period. Covariates included baseline age, gender, education, income, number of chronic diseases, self-rated health, and depressive symptoms. Race (Black versus White) was the focal effect modifier. We used a series of Cox proportional hazards models in the total sample, and by race, in the absence and presence of health variables.
Results: Overall, cognitive test score predicted mortality risk. A significant interaction was found between race and baseline cognitive test score suggesting that baseline cognitive test score has a weaker protective effect against all-cause mortality for Blacks in comparison to Whites. In race-stratified models, cognitive test score at baseline predicted risk of all-cause mortality for Whites but not Blacks, in the absence and presence of baseline socio-economic and health variables. The results were similar regardless of how we treated baseline cognitive test score.
Conclusions: In the United States, baseline cognitive test score has a weaker protective effect against all-cause mortality over a long period of time for Blacks than Whites. The finding is in line with the Minorities Diminished Returns theory and is probably due to structural and interpersonal racism
Non-Spinal Causes of Back Pain: An ‘undiagnosed’ diagnosis
Full text linkLow back pain is a common ailment affecting individuals all around the globe. Majority of Disability Adjusted Life Years lost amongst working population is due to low back pain. Though majority of surgeons/physicians keep only spinal causes in mind while treating such an ailments, a number of other causes exist for such a pathology. This editorial aims to make the readers aware about such non spinal causes of low back pain
Epidemiological Burden of Lower Limb Spasticity in Adults: A Systematic Review
Full text linkObjective: The objective of this study was to investigate the burden of disease associated with lower limb spasticity (LLS) and its complications in adults.
Methods: A systematic search of MEDLINE and EMBASE identified 9 studies published between November 2012 and July 2019 that assessed the epidemiological burden associated with LLS.
Results: LLS was found to occur in one-third of adults after neuromyelitis optica spectrum disorder (NMOSD), one quarter to one third with multiple sclerosis, one quarter to half with Parkinson’s disease and roughly half with stroke. LLS reduces mobility and diminishes the quality of life. LLS complications, especially injuries following falls are a common occurrence.
Conclusion: Given the high prevalence among adults with common disorders, such as stroke; the evidence on the burden of LLS is somewhat finite. Further research is needed to explore the trends over time and across different geographical regions in the incidence and prevalence of LLS. The dearth of high-quality evidence for LLS suggests a lack of awareness of the problem and interest in it, and hence, the unmet need among patients and their carers
Can we change autoimmunity in Type 1 Diabetes via insulin injection or oral insulin?
No full textThis article reviews recent immunotherapy studies of Type 1 Diabetes (T1D) which is an autoimmune disease. Researchers show that injecting human proinsulin peptides can safely modulate the immune system and affect beta-cell function in Type 1 Diabetes, but oral insulin consumption does not reduce the onset of Type 1 Diabetes in individuals at the early stage of the disease
Unequal Effects of Educational Attainment on Workplace Exposure to Second-Hand Smoke by Race and Ethnicity; Minorities’ Diminished Returns in the National Health Interview Survey (NHIS)
Full text linkBackground: One of the mechanisms by which high educational attainment promotes populations’ health is through reducing exposure to environmental risk factors such as second-hand smoke. Minorities’ Diminished Returns theory, however, posits that the protective effect of educational attainment may be smaller for racial and ethnic minority individuals particularly Blacks and Hispanics compared to Whites.
Aims: To explore racial and ethnic differences in the association between educational attainment and second-hand smoke exposure at work in a national sample of American adults.
Methods: Data came from the National Health Interview Survey (NHIS 2015), a cross-sectional study that included 15,726 employed adults. The independent variable was educational attainment, the dependent variables were any and daily second-hand smoke exposure at workplace, age and gender were covariates, and race and ethnicity were the moderators.
Results: Overall, higher educational attainment was associated with lower odds of any and daily second-hand smoke exposure at work. Race and ethnicity both interacted with educational attainment suggesting that the protective effects of educational attainment on reducing the odds of any and daily second-hand smoke exposure at work are systemically smaller for Blacks and Hispanics than Whites.
Conclusions: In the United States, race and ethnicity bound the health gains that follow educational attainment. While educational attainment helps individuals avoid environmental risk factors such as second-hand smoke, this is more valid for Whites than Blacks and Hispanics. The result is additional risk of cancer and tobacco related disease in highly educated Blacks and Hispanics. The results are important given racial and ethnic minorities are the largest growing section of the US population. We should not assume that educational attainment is similarly protective across all racial and ethnic groups. In this context, educational attainment may increase, rather than reduce, health disparities