Category: Nevin Manimala

JAMA Netw Open. 2024 Oct 1;7(10):e2441203. doi: 10.1001/jamanetworkopen.2024.41203.

ABSTRACT

IMPORTANCE: Rural adolescents are at high risk for firearm-related injury, yet most existing prevention efforts are informed by research conducted in urban areas. Despite the need to account for rural perspectives, few studies have investigated the unique social ecological context of firearms for rural adolescents or have directly engaged with rural adolescents to understand their views on firearm use.

OBJECTIVE: To describe rural adolescents’ firearm behaviors and perceptions of firearm-related social norms within their communities, peer groups, and families.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used a convergent mixed-methods design and involved a community-based participatory research approach. Participants comprised 93 adolescents residing in rural Washington state and enrolled in a county or tribal reservation 4-H youth development program as an intermediate or senior age-level grouping (ie, aged 12-19 years). Adolescents completed a survey and participated in a semistructured focus group or interview between September 1, 2021, and September 30, 2022. Data were analyzed using descriptive and thematic analysis.

MAIN OUTCOMES AND MEASURES: Individual handgun behavior and peer, family, and community perceptions of firearm-related social norms.

RESULTS: The sample included 93 adolescents (mean [SD] age, 15.7 [1.7] years; 49 female participants [52.7%]). Approximately half of participants (52 [55.9%]) had carried a handgun at some point in their lives, with a mean (SD) age at first carry of 10.9 (3.1) years. Primary themes across quantitative and qualitative data focused on social norms (specifically, acceptable and unacceptable ways to engage with firearms, reasons for carrying firearms, and places to carry a firearm).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, rural adolescents in 4-H programs generally understood acceptable and unacceptable firearm carrying behaviors, which aligned with state laws. Findings provide context for rural adolescent behaviors such as carrying a firearm predominantly for prosocial reasons (hunting, recreation, and sport) and adult behavior such as carrying for protection of person and personal property. Understanding firearm-related social norms in rural communities holds implications for firearm injury prevention efforts, especially related to enhancing training, developing norms-based prevention approaches, and tailoring efforts to rural settings.

PMID:39446319 | DOI:10.1001/jamanetworkopen.2024.41203

J Med Toxicol. 2024 Oct 24. doi: 10.1007/s13181-024-01040-x. Online ahead of print.

ABSTRACT

Digital health refers to the use of information and communication technologies in medicine (including smartphone apps, wearables, other non-invasive sensors, informatics and telehealth platforms) to prevent illness, deliver treatment, and promote wellness. This rapidly proliferating group of technologies has the potential to reduce harm for people with opioid use disorder (OUD) and facilitate the recovery process; however, development in this space for OUD has been slower compared to that for other medical conditions. Unique issues with OUD management surrounding patient provider relationships, interaction with the healthcare system, autonomy and trust sometimes hinder care approaches, including those in digital health. The trauma informed care framework (TIC), developed for use by organizations to support individuals who have experienced trauma, has particular applicability for digital health interventions in OUD care. This manuscript will serve as a review of TIC principles and how they can be applied to digital health interventions to increase access, equity, and empowerment for people with OUD. We will highlight representative current and pipeline digital technologies for OUD, challenges with these technologies, TIC models for OUD, and the integration of TIC principles into digital technology development to better serve people with OUD. Finally, we will posit strategies to incorporate the aforementioned principles into future research efforts. We ultimately aim to use TIC as a lens through which to develop digital technologies to help individuals with OUD while minimizing harm.

PMID:39446308 | DOI:10.1007/s13181-024-01040-x

Updates Surg. 2024 Oct 24. doi: 10.1007/s13304-024-02025-9. Online ahead of print.

ABSTRACT

There is a debate over whether to transect or completely reduce the hernia sac during laparoscopic tension-free repair of inguinal hernia. This study endeavors to systematically assess the efficacy and safety of two approaches, namely transected sac (TS) and completely reduced sac (RS), in laparoscopic tension-free repair of inguinal hernia. Utilizing a meta-analysis methodology, we aim to provide a comprehensive analysis of these techniques. A comprehensive search was conducted across PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov databases to identify comparative studies focusing on laparoscopic tension-free repair of inguinal hernia, specifically comparing TS and RS techniques. The selected studies were subjected to meta-analysis using RevMan 5.3 software. A total of 8 studies, involving 2995 patients with inguinal hernia, were included in the analysis. The meta-analysis results revealed that the TS group had a higher incidence of seroma compared to the RS group [OR = 1.74, 95% CI (1.35, 2.25), P < 0.0001], and a prolonged time to return to normal activity postoperatively [MD = 0.99, 95% CI (0.85, 1.14), P < 0.00001]. However, no statistically significant differences were observed between the two groups in terms of operation time [MD = -1.75, 95% CI (- 8.72, 5.22), P = 0.62], incidence of postoperative pain [OR = 1.00, 95% CI (0.41, 2.44), P = 1.00], overall postoperative complication rate [OR = 0.98, 95% CI (0.43, 2.20), P = 0.95], and recurrence rate fOR = 2.53, 95% CI (0.61, 10.39), P = 0.20]. Transected sac in laparoscopic inguinal hernia repair is associated with an increased incidence of seroma and a longer recovery time for patients to return to normal activity. Clinical trial registration Registration number is INPLASY20223110070.

PMID:39446302 | DOI:10.1007/s13304-024-02025-9

Acad Psychiatry. 2024 Oct 24. doi: 10.1007/s40596-024-02079-2. Online ahead of print.

ABSTRACT

OBJECTIVE: Journal clubs are a common element of many residency programs. However, there is little data showing that they improve residents’ ability to interpret and use the scientific literature. The authors developed a structured journal club curriculum intended to improve scientific literacy skills among residents and increase acceptability and participation in meaningful discussion of high-quality articles among both residents and facilitators. This study examined the impact of the curriculum on objective skills, subjective skills, and engagement.

METHODS: Psychiatry residents from three academic medical centers completed 10-12 virtual journal clubs during academic year 2022-2023. At the start and end of that year, residents completed a knowledge assessment and a self-rating of scientific literacy skills; at the end of the year, residents self-rated participation in, preparation for, and attitudes towards journal club sessions and assessment of scientific literacy skills.

RESULTS: Twenty-seven residents completed self-reports at both time points. Performance on the objective skills assessment did not improve over the course of the year. Subjectively, residents reported increased understanding of common statistical techniques, ability to determine if techniques used in an article are appropriate, and the extent to which information learned from articles informs clinical practice. In the sample of 62 resident engagement surveys at follow-up, the journal club curriculum was well-received.

CONCLUSIONS: Use of a structured journal club curriculum was associated with improvements in self-rated scientific literacy skills among residents and had high acceptability. More work is needed to understand the impact of teaching methodology on journal club success.

PMID:39446299 | DOI:10.1007/s40596-024-02079-2

Can J Public Health. 2024 Oct 24. doi: 10.17269/s41997-024-00933-2. Online ahead of print.

ABSTRACT

OBJECTIVES: Experiences of discrimination reported during pregnancy are common and are associated with poor mental health and adverse birth outcomes. No Canadian studies have investigated interpersonal discrimination during pregnancy. This study aimed to quantify and identify lived-experiences of discrimination in a Canadian cohort of pregnant individuals, and examine associations with concurrent prenatal anxiety and depression symptoms.

METHODS: Pregnant individuals from the pan-Canadian Pregnancy During the Pandemic (PdP) study (n = 1943) completed the Everyday Discrimination Scale (EDS), demographic measures and self-report measures of depression and anxiety symptoms. Descriptive statistics and ANCOVA were used to assess prevalence of discrimination and associated mental health outcomes. Open-text responses (n = 189) to a question investigating reasons for discrimination were analyzed using conventional content analysis.

RESULTS: Approximately three quarters (72%) of pregnant individuals experienced at least one instance of discrimination during their pregnancy or within the year prior. Pregnant individuals experiencing more frequent and/or more types of discrimination were more likely to identify as non-white, not be partnered, have lower socioeconomic status, and have a pre-pregnancy history of anxiety and depression. The most common attributions for interpersonal discrimination were gender, age, and education/income level. Pregnant individuals who experienced more frequent discrimination and/or more types of discrimination were more likely to report clinically significant symptoms of depression and anxiety (n = 623; 35.2% and 49.1%, respectively) compared to those who reported no discrimination (n = 539; 11.5% and 19.1%, respectively). Conventional content analysis of open-text responses generated the following main themes: (1) personal attributes and sociodemographic characteristics, (2) occupation, (3) the COVID-19 pandemic, (4) pregnancy and parenting, and (5) causes outside the self.

CONCLUSION: Frequent discrimination was associated with more adverse concurrent mental health symptoms. Understanding experiences of discrimination can inform interventions that better address the needs of pregnant individuals and their infants.

PMID:39446296 | DOI:10.17269/s41997-024-00933-2

Bull Exp Biol Med. 2024 Oct 24. doi: 10.1007/s10517-024-06262-1. Online ahead of print.

ABSTRACT

Bacterial nanocellulose (BNC) prepared by the methods of “green” bionanotechnological synthesis is considered a promising food additive and food ingredient. At the same time, the risk of reducing the bioavailability of minerals due to their adsorption on BNC fibers having a high specific surface area and high adsorption and ion exchange capacity cannot be excluded. We studied the effect of oral administration of BNC on the accumulation of macronutrients and trace elements included in the diet in the liver and kidneys of laboratory animals. Male Wistar rats received BNC at doses of 0 (control), 1, 10, and 100 mg/kg body weight as part of their diet for 8 weeks. The content of 30 macronutrients and trace elements in the liver and kidneys was determined by inductively coupled plasma mass spectrometry. It was found that BNC at all doses did not significantly change the content of the main essential macronutrients and trace elements in the organs (Ca, Cr, Cu, Fe, K, Mg, Mn, Na, P, Se, and Zn), which indicates the absence of a negative effect on their bioavailability. Among other elements, a statistically significant decrease in the content of As, B, Cd, Co, and Pb in the liver and an increase in Al, B, Ba, Ni, and Pb in the kidneys were revealed (more than 20% of the control). The revealed decrease in the bioaccumulation of cobalt can indicate inhibition of assimilation of certain chemical forms of this trace element under the action of BNC.

PMID:39446275 | DOI:10.1007/s10517-024-06262-1

Issues Law Med. 2024 Fall;39(2):100-116. doi: 10.70257/LZXP7816.

ABSTRACT

INTRODUCTION: While both induced abortion and natural pregnancy loss have been associated with subsequent mental health problems, population-based studies directly comparing these two pregnancy outcomes are rare. We sought to compare mental health morbidity after an induced abortion or natural loss.

METHODS: Continuously eligible Medicaid beneficiaries age 16 in 1999 were assigned to two cohorts based upon the first pregnancy outcome: abortion (n = 1,331) or natural loss (n = 605). Outcomes were mental health outpatient visits, inpatient hospital admissions and hospital days of stay per patient per year. Average exposure periods before and after the first pregnancy outcome for each cohort were used to adjust the mental health service rates.

RESULTS: Prior to the first pregnancy outcome, all three utilization rates were significantly higher for the natural loss cohort compared to the abortion cohort. For the abortion cohort, the per-patient per-year increase from the pre- to post-pregnancy periods was significant for all three rates: 2.04 times for outpatient visits (p < 0.0001), 3.04 times for inpatient admissions (p = 0.0003), and 3.01 times for hospital days of stay (p = 0.0112). None of the pre-to-post rate increases were significant for the natural loss cohort.

CONCLUSION: Higher pre-pregnancy use rates for women who experience a natural pregnancy loss indicate that increased mental health services use following abortion cannot be solely attributed to pre-existing mental illness. Only the abortion cohort, but not the natural loss cohort, experienced significant increases in mental health services use following the first pregnancy outcome.

PMID:39446259 | DOI:10.70257/LZXP7816

Braz J Microbiol. 2024 Oct 24. doi: 10.1007/s42770-024-01540-6. Online ahead of print.

ABSTRACT

Antimicrobial Stewardship Programs (ASPs) are associated with positive outcomes, but seem to be consolidated in few hospitals. This study aimed to evaluate ASPs in Brazilian hospitals and the barriers to their consolidation from the pharmacists’ perspective. This is a cross-sectional study. Data were collected through an online questionnaire applied to hospital pharmacists. Data analysis was performed by descriptive statistics and Spearman’s ordinal correlation test. A total of 83 pharmacists participated in the study and 45.8% stated that the hospital in which they worked had an ASP. The ASPs were predominantly implemented in public hospitals, with a greater number of beds in the intensive care unit and beds in general. The main barriers to the consolidation of ASPs were: reduced number of pharmacists, time allocated to other demands of the pharmacy, the ineffectiveness of the communication process with doctors, and lack of access to reliable information about antimicrobials in the hospital. Pharmacists that work in hospitals where ASPs were implemented were more confident (p = 0.000) and with a better perception of the barriers that prevent their consolidation (p = 0.003. The ASP was commonly adopted in public hospitals with a greater number of beds. The main obstacles to consolidation were infrastructure, economic, and educational resources.

PMID:39446257 | DOI:10.1007/s42770-024-01540-6

Mol Biol Rep. 2024 Oct 24;51(1):1091. doi: 10.1007/s11033-024-10014-9.

ABSTRACT

BACKGROUND: Mono-resistance to rifampicin/isoniazid increases poor treatment outcomes and the risk of multi-drug resistance (MDR) in tuberculosis (TB) patients. Limited information exists about mono-resistance status of TB patients in Uttar Pradesh, North India. This study aimed to estimate the burden of rifampicin and isoniazid mono-resistance in Western Uttar Pradesh.

METHODS AND RESULTS: 153 sputum samples of suspected pulmonary tuberculosis patients were processed to isolate Mycobacterium tuberculosis using the Lowenstein-Jensen (L-J) culture medium. The isolates were identified using an immuno-chromatographic test and IS6110 PCR. The confirmed Mycobacterium tuberculosis isolates were tested for drug susceptibility testing against rifampicin and isoniazid anti-tuberculosis drugs. The results of the drug susceptibility testing were compared with demographic information and analyzed statistically. Out of 153 sputum samples, 83 (54.24%) samples were positive for growth on L-J medium, including 82 (98.79%) Mycobacterium tuberculosis isolates. Of the 82 Mycobacterium tuberculosis isolates, 16 (19.51%), 7 (8.54%), and 5 (6.10%) isolates were MDR, mono-resistant to rifampicin and isoniazid, respectively. The occurrence of RIF/INH mono-resistant-TB was higher in patients of male gender, age above 45 years, living in rural conditions, history of weight loss, and previous anti-TB treatment, but the effect was not statistically significant.

CONCLUSIONS: The study reported the status of rifampicin and isoniazid mono-resistance among TB patients and highlighted the need for continuous monitoring and improved intervention for the initial detection of mono-drug-resistant cases. This will improve clinical treatment outcomes and decrease the rate of drug-resistant TB in Uttar Pradesh, North India.

PMID:39446249 | DOI:10.1007/s11033-024-10014-9

Sci Rep. 2024 Oct 23;14(1):24963. doi: 10.1038/s41598-024-75644-2.

ABSTRACT

This emerging infectious disease poses one of the most severe threats to public health in these locations, but there are not many reliable therapies yet. In this work, we developed the Ebola virus dynamics and control factors epidemic model with a piecewise hybrid fractional Operator in time scale measure insight of Mittag-Leffler kernel. Patterns and structures that repeat at various scales are the focus of fractal analysis, which has applications in complex systems such as biological ones. Both qualitatively and statistically, a proposed model with the Lipschitz criteria and linear growth is examined, considering positive solutions, boundedness, and uniqueness at equilibrium points with Leray-Schauder results under time scale ideas. The regulation for linear responses approach will be used by Chaos Control to stabilize the system after its equilibrium points. A fractional-order framework with a controlled design will be considered, where solutions are bounded in the feasible domain of relations of different compartments. Ulam-Hyers stability results in the solution are treated when function (constant or rising) for the component of qualitative inquiry in generalized form. The dynamical behaviors of the suggested model are discussed with the Newton polynomial approach used to implement on model in the sense of classical piecewise and Mittag-Leffler kernel at different fractional order values. The model shows that solutions are stable and confined within a feasible range, ensuring reliability. Through detailed simulations, it effectively captures how different interventions and infection rates influence Ebola spread. This fractional-order model enhances understanding of Ebola transmission, providing a strong basis for predicting outbreaks and planning effective control measures, with practical applications for analyzing real-world data.

PMID:39443508 | DOI:10.1038/s41598-024-75644-2