Journal of Health Sciences

Clinical outcome in a neonate born from a coexisting pregnancy with a molar pregnancy

Carlos Torres-Salinas — 2023-04-30

Introduction: The coexistence of a live fetus in a molar pregnancy is extremely rare and represents a challenge for the maternal-perinatal team. Obstetric aspects have been described previously, but it’s possible effects on the newborn have not been detailed. The case that we present to our knowledge is the first to describe such outcomes. Aim of this case report is to describe the clinical events that occur in a neonate born from the previous coexistence of a molar pregnancy with a live fetus.

Case Report: We present the case of a 35-week preterm neonate born by cesarean section due to loss of fetal well-being, who presented with severe intrauterine growth restriction and a high suspicion of intrauterine flow redistribution, with mild hyaline membrane disease. At 48 h after birth, enteral nutrition with infant formula was started in the absence of breast milk, reaching an oral volume of 75 cc/kg/day, after which he presented porraceous residues, abdominal distension, absence of hydroaerial noises, and deterioration. The diagnosis of necrotizing enterocolitis was considered, responding to medical management without the need for a surgical approach. The patient was discharged at 19 days of life with outpatient follow-up.

Conclusion: The outcome of complications in a newborn of this rare coexistence is similar to those associated with prematurity and intrauterine growth restriction, the latter being more severe. It is important to focus on the mother-child binomial from the antenatal stage, as well as family-centered care in such a way that modifiable factors such as the degree of acceptance support and availability of autologous milk turn out to be important allies in the context of places with limited resources.

Changes in stress intensity associated with gastrointestinal health in students population during the COVID-19 lockdown

Lejla Usanovic — 2023-04-30

Introduction: The COVID-19 pandemic and the restrictions from routine life habits had a tremendous impact on psychological and physical health of youth. It is known that stress, anxiety and depression can be associated with the development of gastrointestinal (GI) symptoms and known to exacerbate present GI symptoms. The pandemic has forced many changes in the behavior of student population such as the studying in an asocial environment. The aim of this study was to examine and quantify the influence of stress onto the quality of life and GI symptoms in the student population in Bosnia and Herzegovina (B&H), before and during the pandemic lockdown.

Methods: A total of 279 students from B&H were assessed for their GI and emotional status in pre-COVID period and during the COVID period using validated instruments: GI symptom rating scale (GSRS), Visceral Sensitivity Index, and the Patient Health Questionnaire 15-item Somatic Symptom Severity Scale.

Results: The results showed that moderate and severe GI symptoms were more frequently present among student population at the time of the pandemic than in period before pandemic. The most pronounced symptoms were bloating syndrome and abdominal pain syndrome according to the GSRS.

Conclusions: We concluded that concern for one’s health and changed way of life are directly related to a worsening of the symptoms of GI disorders in the student population. Further research should go in the direction of early prevention of GI disorders that take root in early youth and later develop into chronic forms.

Stigma and stigma-induced stress in filarial lymphoedema patients in Puducherry, India

Vijayalakshmi Gnanasekaran — 2023-04-30

Introduction: The morbidity management and disability prevention (MMDP) strategy for elimination of lymphatic filariasis (ELF) focuses on alleviating the sufferings of about 36 million filariasis patients living in 49 endemic countries. At present, available quality of life questionnaires are not adequate to address the stigma and stress of filarial lymphoedema (FLE) patients. Therefore, a comprehensive and a robust stigma and stress assessment tool needs to be developed.

Methods: We developed 49 item SARI-FLE-Version-2 questionnaire for stigma assessment and 20 item PSS-FLE-Version-2 questionnaire for stress assessment and tested it among different grades of FLE patients. We followed the Likert scale scoring system and conducted a statistical analysis using SPSS IBM version 25.0.

Results: Of the 80 lymphatic filariasis (LF) patients assessed, 35.0%, 42.5%, and 22.5% had grades 2, 3, and 4 LE of the lower extremity, respectively. The developed stigma tool had an excellent internal consistency, as indicated by high Cronbach alpha values for all six domains. There was a significant correlation (p < 0.05) between different stigma domains. In three domains (cognitive function, social stigma, and experienced stigma), the mean stigma scores were significantly higher for the grade 4 patients compared to grade 2 patients (p < 0.02).

Conclusion: Stigma and stress assessment tools in the form of 49 item SARI-FLE-Version-2 and 20 item PSS-FLE-Version-2 questionnaires are reliable in quantifying the stigma and stress of LF patients. There is a scope to incorporate these tools in the MMD

Midwives’ descriptions of strategies and requirements when following up pregnant women at risk of developing perinatal depression - a qualitative study

Bente Fuglestein — 2023-04-30

Introduction: According to the guidelines, health-care personnel should have routines to identify depression and anxiety, but no screening tool is required. The aim of the study is to describe how midwives in antenatal care describe strategies and requirements when following up pregnant women at risk of developing perinatal depression.

Methods: Study is designed as qualitative descriptive study. It includes authorized midwives who work in prenatal care in Western Norway (n = 11) were interviewed between October 21 and November 02, 2021. Verbatim transcribed interviews were analyzed using manifest qualitative content analysis. The study was performed in accordance with the Consolidated Criteria for Reporting Qualitative Research.

Results: The manifest content analysis revealed three categories: (1) Midwife as haven, (2) Growing into the professional role as a midwife and (3) Organizational challenges in antenatal care. The midwives also expressed that they felt they were saddled with a great responsibility that could be a lot to bear. Clinical experience was highlighted as essential sources of self-confidence in work.

Conclusion: Identified categories confirm some crucial issues in midwifery-led maternity care, such as the need for continuous professional training, clear local guidelines, and sufficient time for consultation with women at risk of developing perinatal depression. The findings also reflect the importance of early detection of these women to offer support and assistance throughout pregnancy and after delivery.

The association of metformin dose up-titration and treatment duration with adiposity, lipid profile indicators, and serum leptin levels in T2DM Iraqi patients

Zainab S. Abdulrahman — 2023-04-30

Introduction: Numerous factors, including age, gender, physical inactivity, insufficient dose, noncompliance, and drug-drug interactions, may contribute to significant intraindividual variation in metformin (MET) response. This study aims to determine the effect of Met dose and treatment duration on adiposity markers and serum leptin levels in Iraqi patients with type 2 diabetes.

Methods: Between October 2021 and March 2022, a cross-sectional study at the Diabetes and Endocrinology Center in Baghdad included 150 type 2 diabetes mellitus (T2DM) patients with a disease duration of more than 1 year. Clinical and physical examinations were conducted before enrollment. We measured anthropometric variables such as body mass index, waist-to-hip ratio, and visceral adiposity index. We evaluated glycated hemoglobin, leptin, C-reactive protein, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-c), and triglycerides (TGs) in the serum.

Results: Only the TC/HDL-c and TG/HDL-c ratios were significantly different after the data were arranged according to glycemic control level. Arrangement for MET doses and treatment duration, none of the evaluated parameters were significantly different (p > 0.05) between groups receiving different doses of MET for different durations, except visceral adiposity index (VAI), which shows a very slight decrease (p = 0.046) after more than 10 years of treatment. Pearson’s correlation analysis revealed a weak and significant association between waist circumference (WC) and hip circumference and MET doses, and a weak and significant association between WC, VAI, and TG levels and treatment duration. The other markers lacked a significant relationship with MET doses or duration of treatment.

Conclusion: MET dose and duration of treatment were not significantly correlated with adiposity and lipid profiles in Iraqi patients with T2DM.

Influence of length of use of the Information and Communication Technologies on the health of school-age children

Amra Mačak Hadžiomerović — 2023-04-30

Introduction: The use of the Internet is becoming increasingly important in enabling children and adults to fully participate in society, whether it is learning new skills or connecting with friends and family. Consequently, children's opportunities are increasingly dependent on the Internet. The advance of technological innovations has resulted in more and more ICT devices being available to children, contributing to the deterioration of children and adolescents' health.

Methods: The study was designed as an epidemiological, cross-sectional, descriptive-analytical, comparative study. The study was conducted from October 18, 2021, to January 16, 2022, using an online questionnaire accessible through the Microsoft Forms platform. Respondents were able to access the questionnaire via a link or QR code located on the child's consent form for participation in the study, which was previously signed by a parent/guardian.

Results: The results of the study showed that school-age children were the most frequent users of smartphones and watches TV, with male respondents spending more time using almost all ICT devices, with the exception of tablets, which were used more frequently by female respondents. The analysis of pain intensity in the use of information and communication technologies revealed that respondents most frequently experienced mild pain, especially in the neck/shoulders and lower extremities. The frequency of eye problems after using ICT devices was found to be occasional, with the most pronounced symptoms being fatigue, tearing, and eyestrain, as well as headaches in one in five respondents.

Conclusion: Increasing frequency of ICT device use was associated with higher pain intensity in all anatomic regions. A 1-hour increase in weekly ICT device use also increased the likelihood of pain intensity in all anatomic regions, including eye symptoms and headaches. High exposure to ICT is of concern because it leads to adverse health outcomes for children.

Association of the metabolic syndrome components with the chronotype, level of daytime sleepiness and dispositional optimism in patients with arterial hypertension

Khrystyna Novak-Mazepa — 2023-04-30

Introduction: Arterial hypertension (AH) coexists with such conditions as obesity, insulin resistance/hyperinsulinemia and dyslipidemia, that is, interrelated metabolic disorders that characterize the metabolic syndrome (MS). The aim of the study was to establish relationships between components of MS and chronotype, level of daytime sleepiness, and dispositional optimism in patients with AH.

Methods: The study included 42 patients diagnosed with stage 2 essential AH. To study the chronotype, we used the validated questionnaire “Composite Scale of Morningness” and scales from official available sources. Dispositional optimism (LOT-R) was assessed using a questionnaire adapted from O.A. Sychova. Epworth scale was used to assess the severity day sleepiness. Laboratory parameters were determined using commercially available kits.

Results: The main components of the MS are found in more than half of the patients with AH, of which 61.90% have abdominal obesity, 42.86% have hypertriacylglycerolemia, 26.19% have hyperglycemia, and 66.67% have a decrease in HDL-C levels. Patients with AH with diagnosed components of MS have an evening chronotype, daytime sleepiness, and low optimism is diagnosed to the same extent as patients without MS. At the same time, evening (53.85%) and intermediate (38.46%) chronotypes are found in patients with abdominal obesity, and the frequency of daytime sleepiness registration, and a low level of optimism does not depend on the presence of abdominal obesity; patients with dyslipidemia are characterized by low optimism, evening and intermediate chronotypes, and severe daytime sleepiness; and a glucose level ≥5.6 mmol/l is registered in most patients with an evening chronotype.

Conclusion: The research conducted showed significant relationships between abdominal obesity, dyslipidemia, hyperglycemia and evening chronotype, daytime sleepiness, and low optimism in patients with AH.

Exploring critical factors affecting sign language knowledge and motivation for sign language learning in nurses: A cross-sectional study

Ana Marija Hosnjak — 2023-04-30

Introduction: In times when the term inclusion, rights of patients, and the patient as a subject in health care are used more often, the limited availability of written material or sign language interpreters at health services is still a key barrier to health services for people who are hearing-impaired. The aim of this study is to examine nurses’ knowledge of communication skills with hearing-impaired patients, their preferred methods, and the possibility of using translation services.

Methods: The study was cross-sectional, and data were collected in September–October 2019. The study included 407 nursing students. A demographic data form and questions divided into three parts, namely, communication skills (six questions), communication methods (three questions), and interpretation services (five questions), were used to collect data. Data were analyzed with descriptive statistics.

Results: The questionnaire was administered among 424 students, and total of 407 students completed the questionnaire. Most of the respondents were female (320 [78.6%]) with 0–5 years of work experience (227 [55.8%]) in the tertiary level of healthcare (184 [45.3%]). The results showed that 326 (80.1%) of the respondents encountered a person with some form of hearing impairment during their work. Sign language was used by 56 (13.8%) of the respondents, but 74 (18.14%) nurses did not communicate when meeting with hearing-impaired patients. Two-thirds of the respondents never had the opportunity to learn sign language, and 43 (10.54%) respondents would choose an official interpreter as support. Male respondents were aware of the importance of communication with hearing-impaired patients and the use of an application for pain assessment (p < 0.05). No statistically significant difference was observed regarding the department in which the respondents work (p > 0.05).

Conclusion: The results of the study showed insufficient knowledge and skills of nurses to communicate with hearing-impaired people.

Activities of daily life of people of the third age

Amila Jaganjac — 2023-04-30

Introduction: Aging is a natural physiological process based on disturbances of homeostatic mechanisms and loss of adaptability that significantly affects life activities over time. The activities of daily living (ADL) in old age represent the relationship between the subjective characteristics of each individual, supplemented by previous life experiences, and objective socioeconomic factors that create a desirable living framework for people in the third age. The objectives of this research are to analyze the sociodemographic characteristics of third-age people, to study the daily activities of third-age people, and to compare the daily life activities of third-age people living in a rural setting with those of third-age people living in an urban setting.

Methods: The research was conducted in the area of urban and rural environment of Travnik municipality. One hundred elderly people (50 from urban and 50 from rural areas) were included in the research using the snowball method. The instrument used in our research is a standardized questionnaire on instrumental ADL (IADL) according to Lawton-Brody. The study was conducted during the period from the end of March to the end of May 2022.

Results: There is a statistically significant difference in ADL in all eight domains. The mean IADL score in the total sample (n = 100) was 6.36 ± 1.78 and ranged from 1 to 8. The largest number of respondents had the highest IADL score of 8 in 41% of cases, while only one respondent had an IADL score of 1.

Conclusion: The obtained results prove that the score of ADL is lower in people of third-age living in rural areas.

The risk of hidden “hot spots” with high levels of air pollution in Madrid (Spain)

Angel Lopez-Encuentra — 2023-04-30

All urban areas at risk of breathing polluted air should be identified. In the outskirts of Madrid (Spain), there are roads with high traffic (highway A5) that are <5 meters away from nearby residential homes and schools with children and adolescents. The objective of this study is to ascertain the levels of NO2 in these populated areas. Several NO2 diffusion tubes were installed at a height of 3-m to measure NO2 concentrations in various locations of the A5 during the month of May 2022 (30 days). The four tubes located near the A5 measured a NO2 concentration of 49.7; 88.2; 56.8; and 60 μg/m³. The standard deviation and variation coefficient of the measurements were 0.5 and 2.7%, respectively. According to the WHO (2021), the admissible average annual limit is 10 μg/m³ and the daily limit is 25 μg/m³. This study aimed at measuring the concentration of NO2 near homes and primary and secondary schools located in a “toxic microenvironment” (close to the A5 in Madrid) found high and dangerous levels of NO2 impacting the health of the population. This is an area with a population of low socioeconomic level, which increases the impact on health.