Category: Nevin Manimala

Acad Med. 2024 Aug 23. doi: 10.1097/ACM.0000000000005855. Online ahead of print.

ABSTRACT

PURPOSE: Accelerated 3-year programs (A3YPs) at medical schools were developed to address student debt and mitigate workforce shortage issues. This study investigated whether medical school length (3 vs 4 years) was associated with early residency performance. The primary research question was as follows: Are the Accreditation Council for Graduate Medical Education Milestones (MS) attained by A3YP graduates comparable to graduates of traditional 4-year programs (T4YPs) at 6 and 12 months into internship?

METHOD: The MS data from students entering U.S. medical schools in 2021 and 2022 from the 6 largest specialties were used: emergency medicine, family medicine, internal medicine, general surgery, psychiatry, and pediatrics. Three-year and 4-year graduates were matched for analysis (2,899 matched learners: 182 in A3YPs and 2,717 in T4YPs). The study used a noninferiority study design to examine data trends between the study cohort (A3YP) and control cohort (T4YP). To account for medical school and residency program effects, the authors used cross-classified random-effects regression to account for clustering and estimate group differences.

RESULTS: The mean Harmonized MS ratings for the midyear and end-year reporting periods showed no significant differences between the A3YP and T4YP groups (mean [SE] cross-classified coefficient = 0.01 [0.02], P = .77). Mean MS ratings across internal medicine MS for the midyear and end-year reporting periods showed no significant differences between the A3YP and T4YP groups (mean [SE] cross-classified coefficient = -0.03 [0.03], P = .31). Similarly, for family medicine, there were no statistically significant differences between the A3YP and T4YP groups (mean [SE] cross-classified coefficient = 0.01 [0.02], P = .96).

CONCLUSIONS: For the specialties studied, there were no significant differences in MS performance between 3-year and 4-year graduates at 6 and 12 months into internship. These results support comparable efficacy of A3YPs in preparing medical students for residency.

PMID:39178363 | DOI:10.1097/ACM.0000000000005855

Hum Reprod Update. 2024 Aug 23:dmae026. doi: 10.1093/humupd/dmae026. Online ahead of print.

ABSTRACT

BACKGROUND: Intermittent fasting, such as during Ramadan, is prevalent among pregnant women. However, the association between Ramadan during pregnancy and offspring health along the life course has not been fully established.

OBJECTIVE AND RATIONALE: Fetal programming research indicates that prenatal exposures, particularly during early pregnancy, can cause long-term structural and physiological changes that adversely affect offspring health. Our objective was to systematically identify and assess the evidence regarding Ramadan during pregnancy.

SEARCH METHODS: A total of 31 studies were sourced from PubMed, EMBASE, Web of Science, and EconLit. Included studies evaluated outcomes in individuals with prenatal Ramadan exposure, compared to unexposed Muslim controls. Main outcomes were birth weight, gestational length, and sex ratio in newborns; height, mortality, and cognition in children; and disabilities, chronic diseases, and human capital accumulation in adults. Each study was evaluated for risk of bias. The overall quality of evidence was appraised using the GRADE system. Random-effects meta-analyses were conducted for outcomes analyzed in at least three primary studies.

OUTCOMES: The initial search identified 2933 articles, 1208 duplicates were deleted. There were 31 publications fulfilled the eligibility criteria for the qualitative synthesis; 22 studies were included in meta-analyses. The overall quality of the evidence was low to moderate and differed by study design and outcome. Among newborns, prenatal Ramadan exposure was not associated with birth weight (mean difference (MD) -3 g (95% CI -18 to 11; I2 = 70%) or the likelihood of prematurity (percentage point difference (PPD) 0.19 (95% CI -0.11 to 0.49; I2 = 0%)). The probability that the newborn is male was reduced (PPD -0.14 (95% CI -0.28 to -0.00; I2 = 0%)). This potentially reflects sex-specific mortality rates resulting from adverse in utero circumstances. In childhood, the exposed performed slightly poorer on cognitive tests (MD -3.10% of a standard deviation (95% CI -4.61 to -1.58; I2 = 51%)). Height among the exposed was reduced, and this pattern was already visible at ages below 5 years (height-for-age z-score MD -0.03 (95% CI -0.06 to -0.00; I2 = 76%)). A qualitative literature synthesis revealed that childhood mortality rates were increased in low-income contexts. In adulthood, the prenatally exposed had an increased likelihood of hearing disabilities (odds ratio 1.26 (95% CI 1.09 to 1.45; I2 = 32%)), while sight was not affected. Other impaired outcomes included chronic diseases or their symptoms, and indicators of human capital accumulation such as home ownership (qualitative literature synthesis). The first trimester emerged as a sensitive period for long-term impacts.

WIDER IMPLICATIONS: Despite the need for more high-quality studies to improve the certainty of the evidence, the synthesis of existing research demonstrates that Ramadan during pregnancy is associated with adverse offspring health effects in childhood and especially adulthood, despite an absence of observable effects at birth. Not all health effects may apply to all Muslim communities, which are diverse in backgrounds and behaviors. Notably, moderating factors like daytime activity levels and dietary habits outside fasting hours have hardly been considered. It is imperative for future research to address these aspects.

REGISTRATION NUMBER: PROSPERO (CRD42022325770).

PMID:39178355 | DOI:10.1093/humupd/dmae026

PLoS One. 2024 Aug 23;19(8):e0307381. doi: 10.1371/journal.pone.0307381. eCollection 2024.

ABSTRACT

Big data pertains to extensive and intricate compilations of information that necessitate the implementation of proficient and cost-effective evaluation and analysis tools to derive insights and support decision making. The Fermatean fuzzy set theory possesses remarkable capability in capturing imprecision due to its capacity to accommodate complex and ambiguous problem descriptions. This paper presents the study of the concepts of dynamic ordered weighted aggregation operators in the context of Fermatean fuzzy environment. In numerous practical decision making scenarios, the term “dynamic” frequently denotes the capability of obtaining decision-relevant data at various time intervals. In this study, we introduce two novel aggregation operators: Fermatean fuzzy dynamic ordered weighted averaging and geometric operators. We investigate the attributes of these operators in detail, offering a comprehensive description of their salient features. We present a step-by-step mathematical algorithm for decision making scenarios in the context of proposed methodologies. In addition, we highlight the significance of these approaches by presenting the solution to the decision making problem and determining the most effective big data analytics platform for YouTube data analysis. Finally, we perform a thorough comparative analysis to assess the effectiveness of the suggested approaches in comparison to a variety of existing techniques.

PMID:39178296 | DOI:10.1371/journal.pone.0307381

PLoS One. 2024 Aug 23;19(8):e0307117. doi: 10.1371/journal.pone.0307117. eCollection 2024.

ABSTRACT

BACKGROUND: We sought to conduct this comprehensive systematic review and meta-analysis to assess the prevalence of depression, anxiety, and sleep disturbance in Iranian medical students and resident physicians.

METHODS: A systematic search was conducted on 23 December 2023 in PubMed/MEDLINE, Web of Science, Scopus, and Iranian national databases. We pooled the prevalence of individual studies using the random effect model.

RESULTS: Our systematic search showed 36 articles that meet the eligibility criteria. Most included studies were cross-sectional. The most used questionnaire to assess depression, anxiety, and sleep disturbance were Beck Depression Inventory (BDI), The Depression, Anxiety and Stress Scale-21 Items (DASS-21), and The Pittsburgh Sleep Quality Index (PSQI), respectively. The overall prevalence of depression, anxiety, and sleep disturbance among Iranian medical students were 43% (95%CI: 33%-53%%, I2 = 98%), 44% (95%CI: 31%-58%%, I2 = 99%), 48% (95%CI: 39%-56%%, I2 = 97%), respectively. The results of subgroup and meta-regression analyses showed questionnaires used and the place of the medical school were significantly associated with the prevalence of aforementioned outcomes. Funnel plot and Begg’s regression test did not show a significant source of funnel plot asymmetry for depression, anxiety, and sleep disturbance.

CONCLUSION: In conclusion, our study showed that nearly half of the medical students had some type of depression, anxiety, and sleep disturbance problems. To address this serious national public health issue, efficient preventive measures, routine screenings, and prompt interventions are required.

PMID:39178292 | DOI:10.1371/journal.pone.0307117

PLoS One. 2024 Aug 23;19(8):e0309175. doi: 10.1371/journal.pone.0309175. eCollection 2024.

ABSTRACT

AIM: In this review, we investigated how Machine Learning (ML) was utilized to predict all-cause somatic hospital admissions and readmissions in adults.

METHODS: We searched eight databases (PubMed, Embase, Web of Science, CINAHL, ProQuest, OpenGrey, WorldCat, and MedNar) from their inception date to October 2023, and included records that predicted all-cause somatic hospital admissions and readmissions of adults using ML methodology. We used the CHARMS checklist for data extraction, PROBAST for bias and applicability assessment, and TRIPOD for reporting quality.

RESULTS: We screened 7,543 studies of which 163 full-text records were read and 116 met the review inclusion criteria. Among these, 45 predicted admission, 70 predicted readmission, and one study predicted both. There was a substantial variety in the types of datasets, algorithms, features, data preprocessing steps, evaluation, and validation methods. The most used types of features were demographics, diagnoses, vital signs, and laboratory tests. Area Under the ROC curve (AUC) was the most used evaluation metric. Models trained using boosting tree-based algorithms often performed better compared to others. ML algorithms commonly outperformed traditional regression techniques. Sixteen studies used Natural language processing (NLP) of clinical notes for prediction, all studies yielded good results. The overall adherence to reporting quality was poor in the review studies. Only five percent of models were implemented in clinical practice. The most frequently inadequately addressed methodological aspects were: providing model interpretations on the individual patient level, full code availability, performing external validation, calibrating models, and handling class imbalance.

CONCLUSION: This review has identified considerable concerns regarding methodological issues and reporting quality in studies investigating ML to predict hospitalizations. To ensure the acceptability of these models in clinical settings, it is crucial to improve the quality of future studies.

PMID:39178283 | DOI:10.1371/journal.pone.0309175

PLoS One. 2024 Aug 23;19(8):e0309442. doi: 10.1371/journal.pone.0309442. eCollection 2024.

ABSTRACT

The livestock sector contributes almost 11% of Pakistan’s GDP and is crucial to 35 million people’s livelihoods. Ticks are a major economic threat, as over 80% of livestock, such as bovines, are tick-infested with Hyalomma and Rhipicephalus tick species. Hyalomma anatolicum and Rhipicephalus microplus are the most common tick species collected from livestock, transmitting primarily anaplasmosis, babesiosis, and theileriosis. We aimed to identify the geographical distribution of these two tick species and hot spot areas where the risk of these diseases being transmitted by these ticks is high. Following the PRISMA guideline, two authors conducted an independent review of literature sourced from various databases. We screened 326 research articles published between January 1, 1990, and December 31, 2023, focused on identifying the tick species at the district level. Thirty studies from 75 districts, representing 49.3% of the country’s total area, detected at least one tick species through collection from animals. R. microplus was present in 81% (n = 61) and H. anatolicum in 82% (n = 62) of these sampled districts. We employed spatial and conventional statistical methods with Geographic Information Systems (GIS) after mapping the weighted distribution of both ticks (the number of ticks per standard unit of sampling effort). We identified northwestern and northcentral regions of the country as hotspots with the highest tick distribution, which aligned with the documented high prevalence of anaplasmosis, babesiosis, Crimean-Congo hemorrhagic fever (CCHF), and theileriosis in these regions. This underscores the urgent need for robust tick control measures in these districts to safeguard animal health and boost the livestock economy.

PMID:39178282 | DOI:10.1371/journal.pone.0309442

PLoS One. 2024 Aug 23;19(8):e0305978. doi: 10.1371/journal.pone.0305978. eCollection 2024.

ABSTRACT

Studies taking a person-centred statistical approach when examining young peoples` psychological experiences in sport is scarce. The main aim of the present study was to examine the relationships between young football players’ psychological health resources and the psychological quality of their football-specific experiences. Data for this cross-sectional study was collected as part of the [BLINDED] arm of the larger Promoting Adolescence Physical Activity (PAPA) multi-centre project [1]. The sample consisted of young [BLINDED] male (n = 814), female (n = 576), grassroots football players between the ages of 10 and 15 years (M = 12.5 years, SD = 1.1 years). We performed a latent profile analysis using Mplus 8.4 using a robust maximum likelihood estimator (MLR). Players with the most resourceful psychological health profile experienced more coach social support (mean = 4.38) than did those with a less well-off resourceful profile (mean = 3.79) and those with the least well-off profile (mean = 3.28). Players with the most resourceful profile also felt a stronger sense of unity among their teammates and they enjoyed football more than those least well off (mean = 4.43 vrs. mean = 3.12 and mean = 4.74 vrs 3.50. respectively). Parallel between-profile differences were also found for the players’ general health resources including perceived life satisfaction, general health and family affluence as covariates. Findings suggest that variations in young players’ psychological health profiles and their general health resources play a role in the quality of their football-specific psychological experiences.

PMID:39178278 | DOI:10.1371/journal.pone.0305978

Rev Esc Enferm USP. 2024 Aug 16;58:e20240078. doi: 10.1590/1980-220X-REEUSP-2024-0078en. eCollection 2024.

ABSTRACT

OBJECTIVE: To investigate the repercussions of COVID-19 on the length of breastfeeding and analyze the associated factors in Belo Horizonte, Minas Gerais, Brazil.

METHOD: This is an epidemiological, prospective cohort study. Data were collected from medical records and through telephone interviews. Women who weaned were estimated using Kaplan-Meier survival analysis. The log-rank test was used to verify differences between groups, analyzing weaning time, according to sociodemographic and clinical characteristics. The values of hazard ratio and 95% confidence intervals were estimated using Cox regression analysis.

RESULTS: A total of 1,729 women participated in the study. During the COVID-19 pandemic, brown women and women undergoing cesarean section were more likely to stop breastfeeding.

CONCLUSION: The birth route and mothers’ ethnic characteristics were associated with early weaning during the COVID-19 pandemic. Such findings are important to guide the assistance of the multidisciplinary team, especially nursing, during the post-pandemic period and in future epidemiological scenarios.

PMID:39178020 | DOI:10.1590/1980-220X-REEUSP-2024-0078en

Prim Care Companion CNS Disord. 2024 Aug 13;26(4):24m03724. doi: 10.4088/PCC.24m03724.

ABSTRACT

Objective: To analyze contemporary trends of dementia and dementia-related mortality in the United States between 1999 and 2020 categorized by demographic and regional attributes.

Methods: A retrospective cohort analysis was conducted using mortality data from individuals aged 35 years to ≥85 years, where dementia/Alzheimer disease was recorded as a contributing or underlying cause of death. Data were extracted from the US Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research database for the years 1999-2020. Mortality rates adjusted for age due to dementia (annual age-adjusted mortality rate [AAMR]) per 10,000 individuals in the United States were categorized by gender, racial and ethnic groups, and geographic regions.

Results: Results revealed 6,601,680 deaths related to dementia between 1999 and 2020. Among these, 85.5% were non-Hispanic (NH) white, 8% NH black, 4.34% Hispanic or Latino, 1.6% NH Asian or Pacific Islander, and 0.3% NH American Indian or Alaska Native adults. The overall AAMR was 17.49, with women experiencing a higher AAMR of 18.19 compared to men (16.05). Ethnic disparities were evident, with NH black adults having the highest AAMR (18.23), followed by NH white (18.09) and Hispanic adults (12.7). Over the study period, the overall AAMR increased from 10.86 in 1999 to 21.42 in 2020, with a notable 18.4% rise in the AAMR from 1999 to 2001. From 2001 to 2020, the average percent change of the AAMR was 1.0%. This upward trend in mortality was observed for both men and women and across all ethnicities.

Conclusions: The study spanning 1999-2020 revealed concerning trends in dementia-related mortality in the United States. There is a critical need for targeted health care policy initiatives aimed at mitigating the increasing dementia burden.

Prim Care Companion CNS Disord 2024;26(4):24m03724.

Author affiliations are listed at the end of this article.

PMID:39178013 | DOI:10.4088/PCC.24m03724

JAMA Netw Open. 2024 Aug 1;7(8):e2429792. doi: 10.1001/jamanetworkopen.2024.29792.

NO ABSTRACT

PMID:39178002 | DOI:10.1001/jamanetworkopen.2024.29792