Category: Nevin Manimala

J Infect Dev Ctries. 2024 Dec 31;18(12.1):S227-S238. doi: 10.3855/jidc.20325.

ABSTRACT

INTRODUCTION: Significant challenges to implementing international health regulations (IHR) at points of entry (PoEs) have been highlighted by the coronavirus disease 2019 (COVID-19) pandemic. Better assessment of the capacities of the PoEs may promote focused interventions. This study aimed to assess the capacities and practices at PoEs.

METHODOLOGY: A self-filled questionnaire based on the World Health Organization (WHO) Joint External Evaluation Tool was distributed to frontline workers at four major PoEs. A total of 368 questionnaires were distributed and 308 were completed. Online interviews were conducted with key informants (n = 16). The capacity of PoE was scored by referencing the WHO checklist for core capacity requirement, and categorized into limited, partial, or full capacity. Pearson’s Chi square test was used to compare differences among PoEs. Qualitative data was thematically analyzed.

RESULTS: The majority of the 308 participants in the survey were from Ngwenya (59.4%). Approximately 68% were government employees, and 81% had more than 2 years of experience. Participants reported shortage of resources, such as medical facility (30.5%), staff (37.7%), gloves (47.7%), masks (48.4%), and isolation room; and inconsistencies in practices such as record keeping, reporting cases, and quarantine measures. The overall capacity for IHR implementation was limited, with the airport PoE showing partial capacity and the three ground PoEs having limited capacity.

CONCLUSIONS: The capacity to implement the IHR at Eswatini PoEs was limited. The results suggest the need to allocate resources to PoEs and to enhance training on practices regarding case handling, reporting, and record keeping.

PMID:39863938 | DOI:10.3855/jidc.20325

Acta Oncol. 2025 Jan 25;64:105-113. doi: 10.2340/1651-226X.2025.42367.

ABSTRACT

INTRODUCTION: To target psychological support to cancer patients most in need of support, screening for psychological distress has been advocated and, in some settings, also implemented. Still, no prior studies have examined the appropriate ‘dosage’ and whether screening for distress before cancer treatment may be sufficient or if further screenings during treatment are necessary. We examined the development in symptom trajectories for breast cancer patients with low distress before surgery and explored potential risk factors for developing burdensome symptoms at a later point in time.

METHODS: In total, 299 patients newly diagnosed with breast cancer who scored < 7 on the distress thermometer were included between August 2017 and October 2019 at the Department of Breast Surgery, Rigshospitalet, Copenhagen. Patients were followed through electronic questionnaires at baseline before surgery and after 6, 12, and 18 months. We used latent class mixed models to identify sub-groups of patients with similar development in distress, anxiety, depression, breast cancer-specific health-related quality of life, self-efficacy, and fear of recurrence over time. Logistic and multinomial regression analyses were applied to examine clinical and sociodemographic factors associated with specific symptom trajectories.

RESULTS: We did not identify any sub-groups of women with low distress at diagnosis who developed disabling psychological symptoms up to 18 months after diagnosis. However, we did identify a sub-group of 52% of the women who experienced persistent mild anxiety (Generalised Anxiety Disorder [GAD]-7 score 5-9). Adjusted for baseline treatment modalities and sociodemographic characteristics, women having low social support (odds ratio [OR]: 2.90; 95% confidence interval [CI]: 1.07-7.87) or living with a partner (OR: 3.18; 95% CI: 1.38-7.34) were more likely to experience persistent mild anxiety.

INTERPRETATION: The results show that the majority of women with low distress at breast cancer diagnosis do not experience an increase in psychological symptoms over time. Screening for distress at cancer diagnosis may be an essential step to identify most breast cancer patients in need of professional support for psychological symptoms.

PMID:39863933 | DOI:10.2340/1651-226X.2025.42367

BMC Health Serv Res. 2025 Jan 25;25(1):145. doi: 10.1186/s12913-025-12304-9.

ABSTRACT

BACKGROUND: To address the health inequity caused by decentralized management, China has introduced a provincial pooling system for urban employees’ basic medical insurance. This paper proposes a research framework to evaluate similar policies in different contexts. This paper adopts a mixed-methods approach to more comprehensively and precisely capture the causal effects of the policy. Ultimately, this paper aims to assess the impact of the UPA policy on health inequity.

METHODS: This study takes the provincial unified reform of basic medical insurance for urban employees in China as an example, uses the China Family Panel Studies (CFPS) data and related policy documents, and adopts the DID-RIF hybrid method to test the impact of the equalization of the medical insurance system on health inequity, by using the interaction term in the DID (Difference-in-Differences) model as the independent variable in the RIF (Recentered Influence Function) to exclude the influence of other interfering variables. In addition, the DID method explores the effects of UPA on medical expenditures, which can guide the improvement of the policy.

RESULTS: The empirical results show that the UPA policy increases the likelihood of patients developing chronic diseases within six months. Although factors such as age, gender, and marital status influence the probability of chronic disease, health inequity between income groups after the policy’s implementation primarily stems from the rise in outpatient and reimbursement expenses.

CONCLUSIONS: Although the gap in medical reimbursement expenses between participants of different socioeconomic statuses narrowed after the provincial medical insurance pooling reform, health inequity among the insured population increased. The equalized health insurance reform failed to address health inequities based on socioeconomic status. Additionally, the reverse reallocation of medical resources and outpatient arbitrage driven by moral hazard warrant close attention. This paper recommends that, in advancing the provincial pooling of UEBMI, greater focus should be placed on strengthening digital oversight and improving the hierarchical diagnosis and treatment system to promote social equity.

PMID:39863904 | DOI:10.1186/s12913-025-12304-9

BMC Health Serv Res. 2025 Jan 25;25(1):141. doi: 10.1186/s12913-025-12252-4.

ABSTRACT

HIV self-sampling and -testing (HIVSS/ST) reduces testing barriers and potentially reaches populations who may not test otherwise. In the Netherlands, at-home HIV tests became commercially available around 2016, but data on user experiences are limited. This study aimed to explore characteristics of users and their experiences with HIVSS/ST. In 2022 and 2023, a survey was distributed among users of one online commercial provider and one community-based provider; either users ordered a commercial online HIVSS/ST or they sought a free-of-charge HIVST via the community-based provider. Questions included usability, preferences, and barriers of HIVSS/ST-testing. We compared characteristics and experiences of users between providers, risk groups and first-time and repeat testers. In total, 133 users completed the survey; 89 (67%) via the commercial provider and 44 (33%) via the community-based provider. Response rates per provider were 2% and 26%, respectively. Users who bought their test at the commercial provider were more often Gay and Bisexual Men (GBM) (42%), 35 + years (43%), and born in the Netherlands (89%), compared to those recruited through the community-provider (respectively 27%, 25%, 14%). GBM were more often repeat and recent HIVSS/ST-testers, and using pre-exposure prophylaxis (PrEP). Women and heterosexual men were more likely to buy an HIVSS/ST as part of a combination Sexually Transmitted Infections (STI) test package. Overall, main reasons for choosing HIVSS/ST were saving time (42%), anonymity (36%) and not having to talk to a GP (35%). Twenty-two percent of the study participants experienced some problems performing the HIVSS/ST, the most reported problem was obtaining sufficient blood through the finger prick (71%). Recommendations to improve accessibility of HIVSS/ST included more awareness (advertising by trustful providers), more access locations (pharmacies/supermarkets/schools) and lower costs. Our findings indicate that HIVSS/ST is a valuable additional HIV testing method for users, but more insight into the contribution of HIVSS/ST to HIV prevention policies is needed.

PMID:39863901 | DOI:10.1186/s12913-025-12252-4

Acta Psychol (Amst). 2025 Jan 24;253:104735. doi: 10.1016/j.actpsy.2025.104735. Online ahead of print.

ABSTRACT

This study delved into the complex interplay between self-efficacy, achievement goals, positive emotions, and affective engagement among university students in China. To achieve this, a stratified random sampling technique was employed, resulting in a sample of 391 students from four geographically distinct universities across China. The data collection relied on self-reported questionnaires that measured academic self-efficacy, goal orientation (specifically focusing on mastery versus performance goals), positive emotions, and various aspects of affective engagement, including enjoyment, satisfaction, and interest in learning. Structural equation modeling (SEM) served as the primary statistical tool to analyze the hypothesized relationships between these variables. The analysis revealed a network of positive associations, indicating that students with higher levels of self-efficacy and positive emotionality reported experiencing greater affective engagement in their academic pursuits. Furthermore, a stronger mastery goal orientation was associated with increased enjoyment, satisfaction, and interest in learning. Self-efficacy and positive emotionality also indirectly influenced affective engagement through goal orientation, suggesting that students with higher self-belief and positive emotions were more likely to adopt mastery goals, leading to more positive learning experiences. This study highlights the importance of self-efficacy, positive emotionality, and goal orientation in shaping students’ affective engagement. By fostering these factors, educators can create more positive and engaging learning environments for university students.

PMID:39862451 | DOI:10.1016/j.actpsy.2025.104735

Br J Nurs. 2025 Jan 23;34(2):S21-S26. doi: 10.12968/bjon.2025.0019.

ABSTRACT

INTRODUCTION: Peripheral intravenous cannulation (PIVC) is a common and complex procedure with low first-attempt success rates, causing patient suffering and increased healthcare costs. Quiet Eye (QE) training, a gaze-focused approach, has shown promise in improving procedural PIVC skills. We will examine the effectiveness of traditional technical training (TT) and QE training (QET) on student nurse PIVC performance.

METHODS: Forty-four participants will be randomly assigned to either the TT or QET groups using a blocked randomization method to ensure balanced group sizes. Blinded outcome assessments will minimize bias. Data will be collected using a structured questionnaire and a mobile eye tracker to simultaneously record gaze and hand movements. Participants will complete pre-intervention, post-intervention, and one-week retention tests using a light-skinned manikin arm. A transfer task, utilizing a dark-skinned manikin arm, will assess participants’ skills post-trials. The TT group will receive traditional instruction on hand movement improvement; the QET group will receive feedback on their gaze behaviours. The primary outcome measure will be PIVC first attempt success defined as being able to flush the inserted catheter with 10 mL (maximum) normal saline into the vessel. A trial will be considered unsuccessful if more than gentle pressure on the syringe plunger is needed to flush the catheter or if the participant abandoned the attempt before attempting the flush. Other dependent variables will be QE duration (%), number of fixations, total movement time(s), and movement phase time(s). We will analyze data with descriptive and inferential statistics, including mixed model ANOVA and Chi-Square tests.

DISCUSSION: This study examines the significance of improving PIVC first attempt success rates and highlights QET potential as an intervention. Emphasis is placed on critical implications for health care, particularly the importance of integrating QET into nursing education programs. Future research utilizing large-scale trials and longitudinal designs is recommended.

PMID:39862409 | DOI:10.12968/bjon.2025.0019

Rheumatology (Oxford). 2025 Jan 25:keaf050. doi: 10.1093/rheumatology/keaf050. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the efficacy and safety of first-line targeted synthetic disease-modifying anti-rheumatic drugs (tsDMARDs) in patients with rheumatoid arthritis (RA) and chronic kidney disease (CKD).

METHODS: This retrospective cohort study included 216 patients with RA prescribed their first tsDMARDs at two hospitals between 2013 and 2022. Dose reduction and contraindication guidelines for tsDMARDs according to kidney function were followed. The patients were categorised by kidney function and tsDMARD modality. The primary outcome was the 24-month drug retention rate, and the secondary outcomes were changes in the Disease Activity Score 28-C-reactive protein (DAS28-CRP) level, prednisolone dosage, and reasons for discontinuation.

RESULTS: The 24-month drug retention rates according to the estimated glomerular filtration rate (eGFR) (≥60, 30-60, or < 30 mL/min/1.73 m2) were as follows: all tsDMARDs (46.0, 44.1, 47.1%), tofacitinib (55.9, 53.3, 66.7%), baricitinib (64.2, 42.0%), and peficitinib (36.4, 44.1, 40.0%). Even in groups with lower kidney function, the drug retention rate was maintained (adjusted hazard ratio was 1.14 (95% confidence interval, 0.81-1.62), p= 0.45). Patients had a decreased DAS28-CRP (p< 0.01) and a reduced prednisolone dosage (p< 0.01) over the six-month period following tsDMARD initiation. The incidence of herpes zoster and deep vein thrombosis (DVT) was higher in the group with an eGFR <30 mL/min/1.73 m2, but not statistically significant.

CONCLUSIONS: tsDMARDs have demonstrated efficacy and safety in patients with RA and CKD; however, clinicians should consider the potential for herpes zoster and DVT in patients with eGFR <30 mL/min/1.73 m2.

PMID:39862405 | DOI:10.1093/rheumatology/keaf050

Br J Radiol. 2025 Jan 25:tqae251. doi: 10.1093/bjr/tqae251. Online ahead of print.

ABSTRACT

PURPOSE: To explore the effect of different reconstruction algorithms (ASIR-V and DLIR) on image quality and emphysema quantification in chronic obstructive pulmonary disease (COPD) patients under ultra-low-dose scanning conditions.

MATERIALS AND METHODS: This prospective study with patient consent included 62 COPD patients. Patients were examined by pulmonary function test (PFT), standard-dose CT (SDCT) and ultra-low-dose CT (ULDCT). SDCT images were reconstructed with filtered-back-projection (FBP), while ULDCT images were reconstructed using FBP, 30%ASIR-V, 60%ASIR-V, 90%ASIR-V, low-strength (DLIR-L), medium-strength (DLIR-M) and high-strength DLIR (DLIR-H) to form 8 image sets. Images were analyzed using a commercial computer aided diagnosis (CAD) software. Parameters such as image noise, lung volume (LV), emphysema index (EI), mean lung density (MLD), 15th percentile of lung density (PD15) were measured. Two radiologists evaluated tracheal and pulmonary artery image quality using a 5-point scale. Measurements were compared and the correlation between EI and PFT indices was analyzed.

RESULT: ULDCT used 0.46 ± 0.22mSv in radiation dose, 93.8% lower than SDCT (P < 0.001). There was no difference in LV and MLD among image groups (P > 0.05). ULDCT-ASIR-V90% and ULDCT-DLIR-M had similar image noise and EI and PD15 values to SDCT-FBP, and ULDCT-DLIR-M and ULDCT-DLIR-H had similar subjective scores to SDCT-FBP (all P > 0.05). ULDCT-DLIR-M provided the best correlation between EI and the FEV1/FVC and FEV1% indices in PFT, and the lowest deviations with SDCT-FBP in both EI and PD15.

CONCLUSION: DLIR-M provides the best image quality and emphysema quantification for COPD patients in ULDCT.

ADVANCES IN KNOWLEDGE: Ultra-low-dose CT scanning combined with DLIR-M reconstruction is comparable to standard dose images for quantitative analysis of emphysema and image quality.

PMID:39862404 | DOI:10.1093/bjr/tqae251

Eur J Cardiothorac Surg. 2025 Jan 25:ezaf022. doi: 10.1093/ejcts/ezaf022. Online ahead of print.

ABSTRACT

OBJECTIVES: Previous analyses of the volume-outcome relationship have focused on short-term outcomes such as early mortality. The current study aims to update a novel statistical methodology, facilitating the evaluation of the relation between procedural volume and time-to-event outcomes such as long-term survival, using surgery for acute type A aortic dissection as an illustrative example.

METHODS: This study employed an existing dataset of type A dissection outcomes, retrieved from literature. Studies were included when reporting on annual case load and long-term survival, which served as the primary outcome of interest. Individual patient data were reconstructed from the included studies, and a hazard ratio was determined per study in relation to overall survival, after which the calculated hazard ratios were incorporated in a restricted cubic spline model, facilitating the application of the elbow-method.

RESULTS: Fifty-two studies were included (n = 14878 patients), with a median follow-up of 5 years. One-, 3-, 5-, and 10-year survival of the overall cohort were 82% (95% CI 82-83%), 79% (95% CI 78-80%), 74% (95% CI 74-75%), and 60% (95% CI 59-62%) respectively. A significant non-linear volume-outcome relation for long-term survival was observed in both the unadjusted and adjusted analyses (p = 0.030 and p = 0.002), with an optimal annual case load of 32 cases/year (95% CI 31-33).

CONCLUSIONS: Based on the available data, these findings imply that the annual case volume to achieve optimal long-term survival is located near a procedural volume of 32 cases/year. After accrual of more annual procedures, long-term survival may no longer significantly improve any further.

PMID:39862398 | DOI:10.1093/ejcts/ezaf022

West Afr J Med. 2024 Sep 30;41(9):927-936.

ABSTRACT

BACKGROUND: Indirect pulp capping is the main treatment modality for reversible pulpitis.

OBJECTIVE: To evaluate the efficacy of Biodentine® and Calcium hydroxide in the formation of dentin bridge.

MATERIALS AND METHODS: A double blinded, randomized clinical control trial involving 50 consenting subjects, aged 16 to 55 years with deep carious vital teeth. It was a comparative study with intervention comparing Biodentine® (test) and Calcium hydroxide (control). Subjects’ teeth were assessed for normal response to pulp testing. Cavity preparation was done and the cavity was dressed with either Biodentine® or Calcium hydroxide (Ca(OH)2) then restored with Glass ionomer cement. A bitewing digital dental x-ray was taken at the end of the procedure to measure radiographically the dentin depth as base line using a digital meter. The subjects’ teeth were examined radiographically at three, six and nine months. The probability level of p<0.05 was considered significant.

RESULTS: There was a progressive increase in dentin formation at three months, six months and a significant increase at nine months: the subjects’ teeth in the Biodentine® group recorded an increase in dentin depth of mean 0.67±0.07mm in the mesial aspect and mean 0.66±0.07mm in both the middle and distal aspects. The Ca(OH)2 group recorded an increase in dentin depth of mean 0.55±0.07mm in the mesial aspect, mean 0.52±0.07mm in the middle aspect and mean 0.55±0.07mm in the distal aspect at nine months. (p value 0.001).

CONCLUSION: Biodentine® and Ca(OH)2 have proven to be efficacious in dentin bridge formation. The Biodentine® group showed a statistically significant increase in mean dentin depth relative to that of Ca(OH)2 group following indirect pulp capping of deeply carious teeth.

PMID:39862396