Category: Nevin Manimala

BMJ Open. 2024 Jun 4;14(6):e078842. doi: 10.1136/bmjopen-2023-078842.

ABSTRACT

OBJECTIVES: This study investigated changes in the length of stay (LoS) at a level III/IV neonatal intensive care unit (NICU) and level II neonatology departments until discharge home for very preterm infants and identified factors influencing these trends.

DESIGN: Retrospective cohort study based on data recorded in the Netherlands Perinatal Registry between 2008 and 2021.

SETTING: A single level III/IV NICU and multiple level II neonatology departments in the Netherlands.

PARTICIPANTS: NICU-admitted infants (n=2646) with a gestational age (GA) <32 weeks.

MAIN OUTCOME MEASURES: LoS at the NICU and overall LoS until discharge home.

RESULTS: The results showed an increase of 5.1 days (95% CI 2.2 to 8, p<0.001) in overall LoS in period 3 after accounting for confounding variables. This increase was primarily driven by extended LoS at level II hospitals, while LoS at the NICU remained stable. The study also indicated a strong association between severe complications of preterm birth and LoS. Treatment of infants with a lower GA and more (severe) complications (such as severe retinopathy of prematurity) during the more recent periods may have increased LoS.

CONCLUSION: The findings of this study highlight the increasing overall LoS for very preterm infants. LoS of very preterm infants is presumably influenced by the occurrence of complications of preterm birth, which are more frequent in infants at a lower gestational age.

PMID:38834326 | DOI:10.1136/bmjopen-2023-078842

BMJ Open. 2024 Jun 4;14(6):e076580. doi: 10.1136/bmjopen-2023-076580.

ABSTRACT

OBJECTIVES: The objective of this study is to estimate the overall pooled prevalence of depression and its associated factors among high school, college and university students in Ethiopia.

DESIGN: Systematic review and meta-analysis.

DATA SOURCES: PubMed/MEDLINE, EMBASE, Science Direct, African Journal Online and Google Scholar. The primary articles were searched from 2 April 2023 to 11 May 2023.

ELIGIBILITY CRITERIA: Observational studies such as cross-sectional, case-control and cohort studies that reported the prevalence and associated factors of depression among students in Ethiopia were included. Both published and unpublished primary studies were included in this review.

DATA EXTRACTION AND SYNTHESIS: Two authors independently extracted all the important data using a Microsoft Excel spreadsheet and exported it to Stata V.14 for analysis. The statistical heterogeneity among the included articles was assessed by the I² statistics test. Publication bias was checked using the funnel plot and Egger’s regression test.

RESULTS: A total of 17 primary studies with 8798 study participants were included in the current study to estimate the combined prevalence of depression. The pooled prevalence of depression among Ethiopian students was 35.52% with a 95% CI (30.54% to 40.51%). Subgroup analysis showed that the pooled prevalence of depression was higher in Addis Ababa, which was 40.43%, with a 95% CI (28.02% to 52.83%). Female sex, first-year educational level, family history of mental illness, alcohol drinking and parental neglect were significantly associated with depression in this study.

CONCLUSION: In this review, the overall pooled prevalence of depression among students in Ethiopia was high compared with the general population. Therefore, it is necessary to make more efforts to provide mental healthcare and psychosocial support to students to improve their mental health and decrease the overall burden of depression.

PROSPERO REGISTRATION NUMBER: CRD42023424301.

PMID:38834322 | DOI:10.1136/bmjopen-2023-076580

BMJ Open. 2024 Jun 4;14(6):e081837. doi: 10.1136/bmjopen-2023-081837.

ABSTRACT

OBJECTIVE: We aimed to evaluate the feasibility and utility of an unsupervised testing mechanism, in which participants pick up a swab kit, self-test (unsupervised) and return the kit to an on-campus drop box, as compared with supervised self-testing at staffed locations.

DESIGN: University SARS-CoV-2 testing cohort.

SETTING: Husky Coronavirus Testing provided voluntary SARS-CoV-2 testing at a university in Seattle, USA.

OUTCOME MEASURES: We computed descriptive statistics to describe the characteristics of the study sample. Adjusted logistic regression implemented via generalised estimating equations was used to estimate the odds of a self-swab being conducted through unsupervised versus supervised testing mechanisms by participant characteristics, including year of study enrolment, pre-Omicron versus post-Omicron time period, age, sex, race, ethnicity, affiliation and symptom status.

RESULTS: From September 2021 to July 2022, we received 92 499 supervised and 26 800 unsupervised self-swabs. Among swabs received by the laboratory, the overall error rate for supervised versus unsupervised swabs was 0.3% vs 4%, although this declined to 2% for unsupervised swabs by the spring of the academic year. Results were returned for 92 407 supervised (5% positive) and 25 836 unsupervised (4%) swabs from 26 359 participants. The majority were students (79%), 61% were female and most identified as white (49%) or Asian (34%). The use of unsupervised testing increased during the Omicron wave when testing demand was high and stayed constant in spring 2022 even when testing demand fell. We estimated the odds of using unsupervised versus supervised testing to be significantly greater among those <25 years of age (p<0.001), for Hispanic versus non-Hispanic individuals (OR 1.2, 95% CI 1.0 to 1.3, p=0.01) and lower among individuals symptomatic versus asymptomatic or presymptomatic (0.9, 95% CI 0.8 to 0.9, p<0.001).

CONCLUSIONS: Unsupervised swab collection permitted increased testing when demand was high, allowed for access to a broader proportion of the university community and was not associated with a substantial increase in testing errors.

PMID:38834321 | DOI:10.1136/bmjopen-2023-081837

BMJ Open. 2024 Jun 4;14(6):e080022. doi: 10.1136/bmjopen-2023-080022.

ABSTRACT

OBJECTIVE: Investigating attitudes accepting two categories of violence against women and girls (VAWG) (intimate partner violence-IPV-and other expressions of VAWG) and their association with seven demographic/social determinants and health-seeking behaviours in South Sudan.

DESIGN: Cross-sectional study using data from the South Sudan National Household Survey 2020.

SETTING: South Sudan.

PARTICIPANTS AND METHODS: 1741 South Sudanese women and 1739 men aged 15-49 years; data captured between November 2020 and February 2021 and analysed using binary logistic regression.

RESULTS: People with secondary or higher education displayed attitudes rejecting acceptance of IPV (OR 0.631, 95% CI 0.508 to 0.783). Women and men living in states with more numerous internally displaced people (IDP) or political/military violence had attitudes accepting IPV more than residents of less violence-affected regions (OR 1.853, 95% CI 1.587 to 2.164). Women had a higher odd of having attitudes accepting IPV than men (OR 1.195, 95% CI 1.014 to 1.409). People knowing where to receive gender-based violence healthcare and psychological support (OR 0.703, 95% CI 0.596 to 0.830) and with primary (OR 0.613, 95% CI 0.515 to 0.729), secondary or higher education (OR 0.596, 95% CI 0.481 to 0.740) displayed attitudes rejecting acceptance of other expressions of VAWG. People residing in states with proportionately more IDP and who accepted IPV were more likely to have attitudes accepting other expressions of VAWG (OR 1.699, 95% CI 1.459 to 1.978; OR 3.195, 95% CI 2.703 to 3.775, respectively).

CONCLUSION: Attitudes towards accepting VAWG in South Sudan are associated with women’s and men’s education, gender, residence and knowledge about health-seeking behaviour. Prioritising women’s empowerment and gender transformative programming in the most conflict-affected areas where rates of VAWG are higher should be prioritised along with increasing girls’ access to education. A less feasible strategy to decrease gender inequalities is reducing insecurity, military conflict, and displacement, and increasing economic stability.

PMID:38834318 | DOI:10.1136/bmjopen-2023-080022

Neurointervention. 2024 Jun 5. doi: 10.5469/neuroint.2024.00129. Online ahead of print.

ABSTRACT

PURPOSE: This multicenter prospective study aimed to evaluate the quality and diagnostic effectiveness of cerebral angiography images obtained using low-concentration iodinated contrast agents (iohexol 240 mgI/mL, iopamidol 250 mgI/mL, and iodixanol 270 mgI/mL) and to assess the safety thereof. The study addresses the need for safer contrast agent alternatives without compromising the diagnostic quality of identifying cerebrovascular disease.

MATERIALS AND METHODS: Conducted in 5 medical centers in South Korea, we enrolled patients aged 19 years or older who were referred for diagnostic cerebral angiography under non-emergency conditions, excluding those with specific health conditions and sensitivities. The study design included a prospective, observational approach with a 1-way analysis of variance (ANOVA) for sample size calculation, aiming for a total sample of 231 participants for adequate power. Image quality was evaluated using a 4-level scale by 2 independent, blinded radiologists, and adverse reactions were monitored both immediately and up to 7 days post-procedure. Statistical analysis involved 1-way ANOVA and Kruskal-Wallis tests to assess the image quality and safety profiles of the contrast agents.

RESULTS: Among 266 patients screened, 243 were included in the final analysis. The evaluation revealed no statistically significant differences in image quality among the 3 types of low-concentration contrast agents. Adverse events were observed in 28.8% of patients, with 27.2% experiencing acute reactions, primarily mild reactions, and 3.3% experiencing delayed reactions. The overall safety profile showed no significant changes in vital signs or electrocardiogram readings before and after contrast agent injection.

CONCLUSION: Using low-concentration iodinated contrast agents for cerebral angiography provides image quality comparable to that of conventional high-concentration agents, with no significant increase in adverse events, suggesting a safer alternative for patients.

PMID:38834304 | DOI:10.5469/neuroint.2024.00129

Med Humanit. 2024 Jun 4:medhum-2024-012892. doi: 10.1136/medhum-2024-012892. Online ahead of print.

ABSTRACT

OBJECTIVES: To explore how higher education institutions (HEIs) make transparent the data they collect on staff disability, and how this relates to existing equality, diversity and inclusion (EDI) charters.

DESIGN: Descriptive cross-sector quantitative study based on UK HEIs.

SETTING: Higher education sector in the UK.

PARTICIPANTS: 162 HEIs across the UK with information extracted from the Higher Education Statistics Agency (HESA), each institution’s website and Advance HE.

PRIMARY AND SECONDARY OUTCOME MEASURES: Availability of a publicly available EDI report. Type of information on staff disability identified within the EDI report and level of detail, the latter derived from the number of different types of information provided in the report. Athena SWAN and Disability Confident award level for each HEI were used as a proxy for the sector’s commitment to EDI.

RESULTS: Under a quarter of HEIs do not have an open EDI report online. The majority of Athena SWAN award holders make their EDI reports publicly available, which is similar by Disability Confident status. Russell Group universities are more likely to have a publicly available report. Regionally, EDI report availability is lowest in London. The level of detail with regards to staff disability varies, with more than half of institutions providing ‘little detail’ and just under a third ‘some detail’. Athena SWAN award holders and Disability Confident members are twice as likely to provide ‘some detail’ than those which do not hold an award.

CONCLUSIONS: Challenges remain to obtain a clear picture of staff with disabilities within higher education. The lack of both uniformity and transparency in EDI reporting with respect to disability hinders the ability to quantify staff with disabilities within higher education, develop meaningful interventions and address inequities more widely.

PMID:38834295 | DOI:10.1136/medhum-2024-012892

J Med Genet. 2024 Jun 4:jmg-2024-109943. doi: 10.1136/jmg-2024-109943. Online ahead of print.

ABSTRACT

BACKGROUND: No validation has been conducted for the BOADICEA multifactorial breast cancer risk prediction model specifically in BRCA1/2 pathogenic variant (PV) carriers to date. Here, we evaluated the performance of BOADICEA in predicting 5-year breast cancer risks in a prospective cohort of BRCA1/2 PV carriers ascertained through clinical genetic centres.

METHODS: We evaluated the model calibration and discriminatory ability in the prospective TRANsIBCCS cohort study comprising 1614 BRCA1 and 1365 BRCA2 PV carriers (209 incident cases). Study participants had lifestyle, reproductive, hormonal, anthropometric risk factor information, a polygenic risk score based on 313 SNPs and family history information.

RESULTS: The full multifactorial model considering family history together with all other risk factors was well calibrated overall (E/O=1.07, 95% CI: 0.92 to 1.24) and in quintiles of predicted risk. Discrimination was maximised when all risk factors were considered (Harrell’s C-index=0.70, 95% CI: 0.67 to 0.74; area under the curve=0.79, 95% CI: 0.76 to 0.82). The model performance was similar when evaluated separately in BRCA1 or BRCA2 PV carriers. The full model identified 5.8%, 12.9% and 24.0% of BRCA1/2 PV carriers with 5-year breast cancer risks of <1.65%, <3% and <5%, respectively, risk thresholds commonly used for different management and risk-reduction options.

CONCLUSION: BOADICEA may be used to aid personalised cancer risk management and decision-making for BRCA1 and BRCA2 PV carriers. It is implemented in the free-access CanRisk tool (https://www.canrisk.org/).

PMID:38834293 | DOI:10.1136/jmg-2024-109943

Emerg Med J. 2024 Jun 4:emermed-2023-213521. doi: 10.1136/emermed-2023-213521. Online ahead of print.

ABSTRACT

INTRODUCTION: Optimising emergency department (ED) patient experience is vital to ensure care quality. However, there are few validated instruments to measure the experiences of specific patient groups, including older adults. We previously developed a draft 82-item Patient Reported Experience Measure (PREM-ED 65) for adults ≥65 attending the ED. This study aimed to derive a final item list and provide initial validation of the PREM-ED 65 survey.

METHODS: A cross-sectional study involving patients in 18 EDs in England. Adults aged 65 years or over, deemed eligible for ED discharge, were recruited between May and August 2021 and asked to complete the 82-item PREM at the end of the ED visit and 7-10 days post discharge. Test-retest reliability was assessed 7-10 days following initial attendance. Analysis included descriptive statistics, including per-item proportions of responses, hierarchical item reduction, exploratory factor analysis (EFA), reliability testing and assessment of criterion validity.

RESULTS: Five hundred and ten initial surveys and 52 retest surveys were completed. The median respondent age was 76. A similar gender mix (men 47.5% vs women 50.7%) and reason for attendance (40.3% injury vs 49.0% illness) was observed. Most participants self-reported their ethnicity as white (88.6%).Hierarchical item reduction identified 53/82 (64.6%) items for exclusion, due to inadequate engagement (n=33), ceiling effects (n=5), excessive inter-item correlation (n=12) or significant differential validity (n=3). Twenty-nine items were retained.EFA revealed 25 out of the 29 items demonstrating high factor loadings (>0.4) across four scales with an Eigenvalue >1. These scales were interpreted as measuring ‘relational care’, ‘the ED environment’, ‘staying informed’ and ‘pain assessment’. Cronbach alpha for the scales ranged from 0.786 to 0.944, indicating good internal consistency. Test-retest reliability was adequate (intraclass correlation coefficient 0.67). Criterion validity was fair (r=0.397) when measured against the Friends and Families Test question.

CONCLUSIONS: Psychometric testing demonstrates that the 25-item PREM-ED 65 is suitable for administration to adults ≥65 years old up to 10 days following ED discharge.

PMID:38834289 | DOI:10.1136/emermed-2023-213521

Emerg Med J. 2024 Jun 4:emermed-2024-214097. doi: 10.1136/emermed-2024-214097. Online ahead of print.

ABSTRACT

Electronic patient records (EPRs) are potentially valuable sources of data for service development or research but often contain large amounts of missing data. Using complete case analysis or imputation of missing data seem like simple solutions, and are increasingly easy to perform in software packages, but can easily distort data and give misleading results if used without an understanding of missingness. So, knowing about patterns of missingness, and when to get expert data science (data engineering and analytics) help, will be a fundamental future skill for emergency physicians. This will maximise the good and minimise the harm of the easy availability of large patient datasets created by the introduction of EPRs.

PMID:38834288 | DOI:10.1136/emermed-2024-214097

Anal Chim Acta. 2024 Jul 11;1312:342758. doi: 10.1016/j.aca.2024.342758. Epub 2024 May 21.

ABSTRACT

BACKGROUND: The selection of the sample treatment strategy is a crucial step in the metabolomics workflow. Solid phase microextraction (SPME) is a sample processing methodology with great potential for use in untargeted metabolomics of tissue samples. However, its utilization is not as widespread as other standard protocols involving steps of tissue collection, metabolism quenching, homogenization, and extraction of metabolites by solvents. Since SPME allows us to perform all these steps in one action in tissue samples, in addition to other advantages, it is necessary to know whether this methodology produces similar or comparable metabolome and lipidome coverage and performance to classical methods.

RESULTS: SPME and homogenization with solid-liquid extraction (Homo-SLE) sample treatment methods were applied to healthy murine kidney tissue, followed by comprehensive metabolomics and lipidomics analyses. In addition, it has been tested whether freezing and storage of the tissue causes alterations in the renal metabolome and lipidome, so the analyses were performed on fresh and frozen tissue samples Lipidomics analysis revealed the exclusive presence of different structural membrane and intracellular lipids in the Homo-SLE group. Conversely, all annotated metabolites were detected in both groups. Notably, the freezing of the sample mainly causes a decrease in the levels of most lipid species and an increase in metabolites such as amino acids, purines, and pyrimidines. These alterations are principally detected in a statistically significant way by SPME methodology. Finally, the samples of both methodologies show a positive correlation in all the analyses.

SIGNIFICANCE: These results demonstrate that in SPME processing, as long as the fundamentals of non-exhaustive extraction in a pre-equilibrium kinetic regime, extraction in a tissue localized area, the chemistry of the fiber coating and non-homogenization of the tissue are taken into account, is an excellent method to use in kidney tissue metabolomics; since this methodology presents an easy-to-use, efficient, and less invasive approach that simplifies the different sample processing steps.

PMID:38834268 | DOI:10.1016/j.aca.2024.342758