Category: Nevin Manimala

Gac Med Mex. 2024;160(6):578-584. doi: 10.24875/GMM.M24000907.

ABSTRACT

BACKGROUND: Diabetic retinopathy (DR) being a leading cause of blindness. Identifying the risk factors for patients with a higher risk of vision loss is crucial.

OBJECTIVE: To identify the risk factors for urgent referrals in diabetic patients through an ophthalmic examination program.

MATERIAL AND METHODS: Specific criteria for urgent referral were established to facilitate attendance. Risk factors related to urgent referral were evaluated in a multiple logistic regression model.

RESULTS: A total of 1,265 patients were screened. 678 (54%) had DR, 245 (19.4%) had diabetic macular edema, and 124 (10%) had visually significant cataracts. 399 (31.4%) patients needed urgent referral. Significant risk factors for urgent referral were 10 to 20 years from diabetes diagnosis (OR = 5.71, p < 0.001), more than 20 years from diabetes diagnosis (OR = 15.36, p < 0.001), high systolic blood pressure (OR = 1.66 per mmHg, p = 0.003), and high HbA1c (OR = 1.15, p = 0.002), after adjusting for sex and age.

CONCLUSIONS: A third of the patients require urgent referral. Main causes of urgent referral were DME, severe or worse DR, cataract and high intraocular pressure. Principal risk factors were diabetes duration, systolic blood pressure and HbA1c.

PMID:40209252 | DOI:10.24875/GMM.M24000907

Gac Med Mex. 2024;160(6):627-638. doi: 10.24875/GMM.M24000956.

ABSTRACT

BACKGROUND: In higher education institutions, the analysis of academic trajectories is key to evaluating training, which can generate interventions to promote regularity and improve terminal efficiency.

OBJECTIVE: To analyze the differences in the academic trajectories of the student body of the 2001 to 2018 generations of the medical degree at the National Autonomous University of Mexico (UNAM).

MATERIAL AND METHODS: A longitudinal comparative study was conducted with 18,739 UNAM Faculty of Medicine students, integrated by real cohorts from 2001 to 2018. Survival functions were adjusted with the KaplanMeier method and a Cox proportional hazards model was adjusted to evaluate the effect of sex and high school of origin. Failure in first-year students was also analyzed.

RESULTS: The study demonstrated that sex and baccalaureate history are variables that impact failure and consequently regularity and terminal efficiency.

CONCLUSIONS: Due to a lower failure rate, there is a higher regularity and terminal efficiency in men compared to women, and in those that were admitted from external baccalaureates or the National Preparatory School, compared to those from the College of Sciences and Humanities.

PMID:40209250 | DOI:10.24875/GMM.M24000956

Gac Med Mex. 2024;160(6):619-626. doi: 10.24875/GMM.M24000960.

ABSTRACT

BACKGROUND: The standardized assessment of the hypoplastic nasal bone (NB) by ultrasonography between 11-14 weeks’ gestation has value in the detection of fetal aneuploidies. The frequency of hypoplastic NB varies between populations and is unknown in Mexico.

OBJECTIVE: To analyze the performance of hypoplastic NB for the early detection of fetal aneuploidies in a Mexican population.

MATERIAL AND METHODS: A nested case-control study in a cohort of Mexican pregnant women. The inclusion criteria were live fetus with crown-rump length (CRL) 45-84 mm and the result of perinatal karyotype or phenotype at birth. Ultrasonographic assessment of the NB was standardized. The statistical analyses were univariable, multiple logistic regression, Bayes’ theorem and performance.

RESULTS: A total of 65 cases and 1187 controls were studied, with maternal age of 1753 years. The frequency of hypoplastic NB was 1.6% (95% CI, 0.9-2.3) in euploid fetuses versus 44.6% (95% CI, 32.5-56.7) with aneuploidies (p < 0.001, X²). Sensitivity for trisomy 21 was 58.3% (PPV 52.5%, NPV 98.7%). The probability of the hypoplastic NB was conditioned by aneuploidy (type), CRL, and nuchal translucency. The C-statistic of the Bayesian model was 0.904 (95% CI, 0.842-0.965).

CONCLUSIONS: A Mexican model of the NB had added value in the early detection of fetal aneuploidies.

PMID:40209249 | DOI:10.24875/GMM.M24000960

Gac Med Mex. 2024;160(6):585-593. doi: 10.24875/GMM.M24000958.

ABSTRACT

BACKGROUND: The pandemic effects on the mental health of health care personnel is a public health problem.

OBJECTIVE: To determine factors associated with psychopathological symptomatology in undergraduate medical students.

MATERIAL AND METHODS: 2961 students from four generations answered the GHQ-28 online: n₁. Pre-pandemic (n = 758) n2. Initial phase (n = 581), n₃. Acute phase (n = 705), and n₄. Protected return phase (n = 917), between August 2019 and September 2022. Using multivariable logistic regression models, factors associated (sociodemographic and clinical) with psychopathological symptomatology were identified.

RESULTS: 51.9% of students presented symptomatology, with a higher prevalence of depressive symptoms (22.9%), and somatic and sleep disturbance (11.1%). The pandemic phase (n₂: OR, 12.69; n₃: OR, 8.45; n₄: OR, 5.62), having a personal history of major depression (OR, 4.35), family history of depression (OR, 1.96), limited (OR, 1.54) and insufficient economic resources (OR, 2.09) and being female (OR, 1.46) were significantly associated with symptomatology.

CONCLUSIONS: The pandemic influenced the mental health of undergraduate medical students. Actions aimed at promoting healthy educational environments, and strategies for prevention and care of psychopathological symptomatology are necessary.

PMID:40209244 | DOI:10.24875/GMM.M24000958

Gac Med Mex. 2024;160(6):602-612. doi: 10.24875/GMM.24000279.

ABSTRACT

BACKGROUND: Mexico is one of the countries with the highest case-fatality ratio due to COVID-19.

OBJECTIVE: Explore the reasons for not getting vaccinated against COVID-19.

MATERIAL AND METHODS: A nationwide telephone survey, comprising all 32 states of Mexico, was conducted to examine associations between inoculation against COVID-19 and other characteristics, the chi-square test and logistic regression analysis were applied.

RESULTS: Out of 3 126 adults, 68% reported complete vaccination, 21% the first dose, 11% remained unvaccinated. Using logistic regression models: place of residence -Other central state and State of Mexico-, being single, lower education level, younger age, lower BMI, not getting tested for COVID-19, and the perception of COVID-19 as unreal and not severe, were all significantly associated with non-vaccination, i.e. not receiving any dose of anti-COVID vaccine. The predominant reasons for not getting vaccinated were: 63% “external barriers” (e.g., not being able to attend an appointment), and 37% “internal motives” (e.g., considering that the vaccine does not work).

CONCLUSIONS: The causes of non-vaccination against COVID-19 are related to social and geographical determinants. Addressing external barriers is necessary to promote equity in vaccination. Reviewing the results in the context of earlier studies on the willingness to vaccinate, the gap between intention and vaccination is notable.

PMID:40209243 | DOI:10.24875/GMM.24000279

JMIR Aging. 2025 Apr 10;8:e64324. doi: 10.2196/64324.

ABSTRACT

BACKGROUND: Digital technology in dementia is an area of great development with varying experiences across countries. However, novel digital solutions often lack a patient-oriented perspective, and several relevant barriers prevent their use in clinics.

OBJECTIVE: In this study, we reviewed the existing literature on knowledge, familiarity, and competence in using digital technology and on attitude and experiences with digital tools in Alzheimer disease. The main research question is whether digital competence and attitudes of patients and caregivers may affect the adoption of digital technology.

METHODS: Following the PRISMA guidelines, a literature search was conducted by two researchers in the group. Inter-rater reliability was calculated with Cohen κ statistics. The risk of bias assessment was also recorded.

RESULTS: Of 597 initial records, only 18 papers were considered eligible. Analyses of inter-rater reliability showed good agreement levels. Significant heterogeneity in study design, sample features, and measurement tools emerged across studies. Quality assessment showed a middle-high overall quality of evidence. The main factors affecting the adoption of digital technology in patients and caregivers are severity of cognitive deficits, timing of adoption, and the availability of training and support. Additional factors are age, type of digital device, and ease of use of the digital solution.

CONCLUSIONS: Adoption of digital technology in dementia is hampered by many patient-related barriers. Improving digital competence in patient-caregiver dyads and implementing systematic, patient-oriented strategies for the development and use of digital tools are needed for a successful incorporation of digital technology in memory clinics.

PMID:40209218 | DOI:10.2196/64324

JMIR Infodemiology. 2025 Apr 10;5:e55065. doi: 10.2196/55065.

ABSTRACT

BACKGROUND: Social media holds an increasingly significant position in contemporary society, wherein evolving public perspectives are mirrored by changing information. However, there remains a lack of comprehensive analysis regarding the nature and evolution of dental health care information on Chinese social media platforms (SMPs) despite extensive user engagement and voluminous content.

OBJECTIVE: This study aimed to probe into the nature and evolution of dental health care information on Chinese SMPs from 2018 to 2022, providing valuable insights into the evolving digital public perception of dental health for dental practitioners, investigators, and educators.

METHODS: This study was conducted on 3 major Chinese SMPs: Weibo, WeChat, and Zhihu. Data from March 1 to 31 in 2018, 2020, and 2022 were sampled to construct a social media original database (ODB), from which the most popular long-text posts (N=180) were selected to create an analysis database (ADB). Natural language processing (NLP) tools were used to assist tracking topic trends, and word frequencies were analyzed. The DISCERN health information quality assessment questionnaire was used for information quality evaluation.

RESULTS: The number of Weibo posts in the ODB increased approximately fourfold during the observation period, with discussion of orthodontic topics showing the fastest growth, surpassing that of general dentistry after 2020. In the ADB, the engagement of content on Weibo and Zhihu also displayed an upward trend. The overall information quality of long-text posts on the 3 platforms was moderate or low. Of the long-text posts, 143 (79.4%) were written by nonprofessionals, and 105 (58.3%) shared personal medical experiences. On Weibo and WeChat, long-text posts authored by health care professionals had higher DISCERN scores (Weibo P=.04; WeChat P=.02), but there was a negative correlation between engagement and DISCERN scores (Weibo tau-b [τb]=-0.45, P=.01; WeChat τb=-0.30, P=.02).

CONCLUSIONS: There was a significant increase in the dissemination and evolution of public interest in dental health care information on Chinese social media during 2018-2022. However, the quality of the most popular long-text posts was rated as moderate or low, which may mislead patients and the public.

PMID:40209216 | DOI:10.2196/55065

J Med Internet Res. 2025 Apr 10;27:e68936. doi: 10.2196/68936.

ABSTRACT

BACKGROUND: Diabetes mellitus significantly increases the risk of severe complications from influenza, necessitating targeted vaccination efforts. Despite vaccination being the most effective preventive measure, coverage remains below the World Health Organization’s targets, partly due to limited awareness among patients. This study evaluated a digital health intervention aimed at improving influenza vaccination rates among adults with diabetes.

OBJECTIVE: This study aimed to demonstrate the effectiveness of digital health platforms in increasing vaccination rates among people with diabetes and to emphasize the impact of tailored messaging frequency on patient engagement and health behavior change. We hypothesized that digital tools providing empirical evidence of increased health risk awareness can effectively drive preventive actions.

METHODS: The study leveraged the Dario (Dario Health Corp) digital health platform to retrospectively analyze data from 64,904 users with diabetes assigned by the platform into three groups: (1) Group A received previously studied monthly flu nudge messages; (2) Group B received an adapted intervention with 2-3 monthly messages; (3) Group C served as the control with no intervention. Surveys were conducted at baseline, 3 months, and 6 months to assess vaccination status, awareness of influenza risks, and recollection of educational content. Statistical analyses, including logistic regression, chi-square tests, and t tests, were used to evaluate differences between groups.

RESULTS: Out of 64,904 users, 8431 completed the surveys. Vaccination rates were 71.0% in group A, 71.9% in group B, and 70.5% in group C. Group B showed significantly higher awareness of influenza risks compared with the control group odds ratio (OR; OR 1.35, 95% CI 1.12-1.63; P=.001), while group A did not (OR 1.10, 95% CI 0.92-1.32; P=.27). Recollection of educational content was also higher in groups A (OR 1.29, 95% CI 1.07-1.56; P=.008) and B (OR 1.92, 95% CI 1.59-2.33; P<.001) compared with the control. In addition, a significant correlation between awareness and vaccination rates was found only in group B (χ²(df=1)=6.12, P=.01).

CONCLUSIONS: The adapted digital intervention (group B) effectively increased awareness of influenza risks and recollection of educational content, which correlated with the higher trend in vaccination rates. This study demonstrates the potential of digital health tools to enhance influenza vaccination among people with diabetes by improving risk awareness and education. Further research should focus on optimizing these interventions to achieve significant improvements in vaccination uptake and overall public health outcomes.

TRIAL REGISTRATION: ClinicalTrials.gov NCT06840236; https://clinicaltrials.gov/study/NCT06840236.

PMID:40209214 | DOI:10.2196/68936

JMIR Res Protoc. 2025 Apr 10;14:e64886. doi: 10.2196/64886.

ABSTRACT

BACKGROUND: Every day, approximately 800 women die from pregnancy-related causes, alongside 2.6 million stillbirths and 2.8 million neonatal deaths annually. Inadequate referral by skilled birth attendants hinders timely access to necessary emergency obstetric care, challenging progress toward the maternal health Sustainable Development Goal (SDG) 3. The COVID-19 pandemic further disrupted care in low- and middle-income countries, forcing women to rely on traditional birth attendants, thereby affecting the referral system. It is crucial to understand the experiences of both skilled and traditional birth attendants regarding upward referrals in emergency obstetric care to identify barriers and facilitators within these systems in low- and middle-income countries.

OBJECTIVE: This study aims to map existing evidence on the experiences of skilled and traditional birth attendants regarding upward referral systems in emergency obstetric care within low- and middle-income countries.

METHODS: We will conduct a scoping review guided by the Joanna Briggs Institute’s methodological framework. Studies will be included if they report on experiences with upward referral in obstetrical emergencies. We will consider studies published in English and French from 2016 to July 2024. The literature search will be conducted in databases including PubMed, EBSCOhost (Academic Search Complete and CINAHL with full text), Scopus, Web of Science, and Google Scholar. Identified citations will be managed using EndNote version 21 (Clarivate Analytics) and Rayyan. Two independent reviewers will screen eligible studies and resolve disagreements through discussion with a third reviewer. Data will be extracted using a validated form and analyzed through content analysis, with findings presented narratively. This protocol aligns with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. The review will offer a comprehensive narrative of upward referral systems in obstetrical emergencies, focusing on transitions from traditional birth attendants to health care facilities and from lower to higher levels of health care.

RESULTS: The preliminary search was completed in August 2024, and the database search will be conducted within the next 6 months. Findings will be disseminated through medical education conferences and publications.

CONCLUSIONS: This review contributes a comprehensive narrative of upward referral systems in obstetrical emergencies, aiming to enhance understanding and improve transitions from traditional birth attendants to health care facilities and between different health care levels. It could significantly impact maternal and neonatal care by identifying the referral experiences of both skilled and traditional birth attendants. The insights may inform interventions that integrate traditional birth attendants into health care systems, potentially reducing maternal and neonatal mortality. The results will guide future research aimed at developing a model to improve upward referrals for obstetric emergencies in sub-Saharan Africa.

TRIAL REGISTRATION: Open Science Framework 4HAVZ; https://osf.io/4havz.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/64886.

PMID:40209211 | DOI:10.2196/64886

JMIR Mhealth Uhealth. 2025 Apr 10;13:e57018. doi: 10.2196/57018.

ABSTRACT

BACKGROUND: Ecological momentary assessment (EMA) offers an effective method to collect frequent, real-time data on an individual’s well-being. However, challenges exist in response consistency, completeness, and accuracy.

OBJECTIVE: This study examines EMA response patterns and their relationship with sensed behavior for data collected from diverse studies. We hypothesize that EMA response rate (RR) will vary with prompt time of day, number of questions, and behavior context. In addition, we postulate that response quality will decrease over the study duration and that relationships will exist between EMA responses, participant demographics, behavior context, and study purpose.

METHODS: Data from 454 participants in 9 clinical studies were analyzed, comprising 146,753 EMA mobile prompts over study durations ranging from 2 weeks to 16 months. Concurrently, sensor data were collected using smartwatch or smart home sensors. Digital markers, such as activity level, time spent at home, and proximity to activity transitions (change points), were extracted to provide context for the EMA responses. All studies used the same data collection software and EMA interface but varied in participant groups, study length, and the number of EMA questions and tasks. We analyzed RR, completeness, quality, alignment with sensor-observed behavior, impact of study design, and ability to model the series of responses.

RESULTS: The average RR was 79.95%. Of those prompts that received a response, the proportion of fully completed response and task sessions was 88.37%. Participants were most responsive in the evening (82.31%) and on weekdays (80.43%), although results varied by study demographics. While overall RRs were similar for weekday and weekend prompts, older adults were more responsive during the week (an increase of 0.27), whereas younger adults responded less during the week (a decrease of 3.25). RR was negatively correlated with the number of EMA questions (r=-0.433, P<.001). Additional correlations were observed between RR and sensor-detected activity level (r=0.045, P<.001), time spent at home (r=0.174, P<.001), and proximity to change points (r=0.124, P<.001). Response quality showed a decline over time, with careless responses increasing by 0.022 (P<.001) and response variance decreasing by 0.363 (P<.001). The within-study dynamic time warping distance between response sequences averaged 14.141 (SD 11.957), compared with the 33.246 (SD 4.971) between-study average distance. ARIMA (Autoregressive Integrated Moving Average) models fit the aggregated time series with high log-likelihood values, indicating strong model fit with low complexity.

CONCLUSIONS: EMA response patterns are significantly influenced by participant demographics and study parameters. Tailoring EMA prompt strategies to specific participant characteristics can improve RRs and quality. Findings from this analysis suggest that timing EMA prompts close to detected activity transitions and minimizing the duration of EMA interactions may improve RR. Similarly, strategies such as gamification may be introduced to maintain participant engagement and retain response variance.

PMID:40209210 | DOI:10.2196/57018