Category: Nevin Manimala

BMJ Open. 2024 Jul 11;14(7):e080313. doi: 10.1136/bmjopen-2023-080313.

ABSTRACT

OBJECTIVE: The objective of this study is to assess the effects of social determinants of health (SDOH) and race-ethnicity on readmission and to investigate the potential for geospatial clustering of patients with a greater burden of SDOH that could lead to a higher risk of readmission.

DESIGN: A retrospective study of inpatients at five hospitals within Henry Ford Health (HFH) in Detroit, Michigan from November 2015 to December 2018 was conducted.

SETTING: This study used an adult inpatient registry created based on HFH electronic health record data as the data source. A subset of the data elements in the registry was collected for data analyses that included readmission index, race-ethnicity, six SDOH variables and demographics and clinical-related variables.

PARTICIPANTS: The cohort was composed of 248 810 admission patient encounters with 156 353 unique adult patients between the study time period. Encounters were excluded if they did not qualify as an index admission for all payors based on the Centers for Medicare and Medicaid Service definition.

MAIN OUTCOME MEASURE: The primary outcome was 30-day all-cause readmission. This binary index was identified based on HFH internal data supplemented by external validated readmission data from the Michigan Health Information Network.

RESULTS: Race-ethnicity and all SDOH were significantly associated with readmission. The effect of depression on readmission was dependent on race-ethnicity, with Hispanic patients having the strongest effect in comparison to either African Americans or non-Hispanic whites. Spatial analysis identified ZIP codes in the City of Detroit, Michigan, as over-represented for individuals with multiple SDOH.

CONCLUSIONS: There is a complex relationship between SDOH and race-ethnicity that must be taken into consideration when providing healthcare services. Insights from this study, which pinpoint the most vulnerable patients, could be leveraged to further improve existing models to predict risk of 30-day readmission for individuals in future work.

PMID:38991688 | DOI:10.1136/bmjopen-2023-080313

BMJ Open. 2024 Jul 11;14(7):e084609. doi: 10.1136/bmjopen-2024-084609.

ABSTRACT

OBJECTIVE: The study aimed to explore the determinants of prenatal breastfeeding knowledge, attitudes and self-efficacy among Burmese migrant pregnant mothers in Samut Sakhon Province, Thailand.

DESIGN: The data were collected as part of a baseline survey of a randomised controlled trial.

SETTING AND PARTICIPANTS: A total of 198 Burmese migrant mothers between 28th and 34th weeks of gestation were recruited from the antenatal care clinic of Samut Sakhon Hospital.

PRIMARY OUTCOME MEASURES: Breastfeeding knowledge, attitudes and self-efficacy RESULTS: The prevalence of good breastfeeding knowledge was 65.7% (n=130), positive attitudes towards breast feeding were 55.1% (n=109) and high breastfeeding self-efficacy was 70.7% (n=140). Multivariate logistic regression models revealed that mothers aged above 25 years (adjusted OR, AOR 3.1, 95% CI 1.2 to 7.9), being Bamar (AOR 2.3, 95% CI 1.2 to 4.4), having support from husband (AOR 2.3, 95% CI 1.2 to 4.6) and having previous childbirth experience (AOR 2.5, 95% CI 1.3 to 4.8) were the main determinants of good breastfeeding knowledge. Similarly, being Bamar (AOR 2.8, 95% CI 1.5 to 5.3), having high school education (AOR 4.3, 95% CI 1.8 to 10.1) and having access to workplace breastfeeding support (AOR 5.3, 95% CI 1.4 to 20.1) were found to be significant predictors of positive attitudes towards breast feeding. Moreover, mothers aged above 25 years (AOR 2.9, 95% CI 1.1 to 7.8), being Bamar (AOR 2.4, 95% CI 1.2 to 5.1), being unemployed (AOR 7.8, 95% CI 1.9 to 31.9), having support of husband (AOR 3.2, 95% CI 1.5 to 7.0), having previous breastfeeding experience for 6 months or more (AOR 5.0, 95% CI 2.1 to 11.7) and having intention to exclusively breastfeed (AOR 2.7, 95% CI 1.3 to 5.8) had significant associations with high breastfeeding self-efficacy.

CONCLUSION: The prenatal breastfeeding knowledge, attitudes and self-efficacy among Burmese migrant mothers were influenced by many factors. A comprehensive understanding of these factors will enable policy-makers and healthcare providers to develop context-specific interventions for the promotion of exclusive breast feeding among Burmese migrant mothers in Thailand.

TRIAL REGISTRATION NUMBER: TCTR20230310004.

PMID:38991685 | DOI:10.1136/bmjopen-2024-084609

BMJ Open. 2024 Jul 11;14(7):e079760. doi: 10.1136/bmjopen-2023-079760.

ABSTRACT

OBJECTIVES: In the midst of the pandemic, face-to-face data collection for national censuses and surveys was suspended due to limitations on mobility and social distancing, limiting the collection of already scarce disability data. Responses to these constraints were met with a surge of high-frequency phone surveys (HFPSs) that aimed to provide timely data for understanding the socioeconomic impacts of and responses to the pandemic. This paper provides an assessment of HFPS datasets and their inclusion of disability questions to evaluate the visibility of persons with disabilities during the COVID-19 pandemic.

DESIGN: We collected HFPS questionnaires conducted globally from the onset of the pandemic emergency in March 2020 until December 2022 from various online survey repositories. Each HFPS questionnaire was searched using a set of keywords for inclusion of different types of disability questions. Results were recorded in an Excel review log, which was manually reviewed by two researchers.

METHODS: The review of HFPS datasets involved two stages: (1) a main review of 294 HFPS dataset-waves and (2) a semiautomated review of the same dataset-waves using a search engine-powered questionnaire review tool developed by our team. The results from the main review were compared with those of a sensitivity analysis using and testing the tool as an alternative to manual search.

RESULTS: Roughly half of HFPS datasets reviewed and 60% of the countries included in this study had some type of question on disability. While disability questions were not widely absent from HFPS datasets, only 3% of HFPS datasets included functional difficulty questions that meet international standards. The search engine-powered questionnaire review tool proved to be able to streamline the search process for future research on inclusive data.

CONCLUSIONS: The dearth of functional difficulty questions and the Washington-Group Short Set in particular in HFPS has contributed to the relative invisibility of persons with disabilities during the pandemic emergency, the lingering effects of which could impede policy-making, monitoring and advocacy on behalf of persons with disabilities.

PMID:38991678 | DOI:10.1136/bmjopen-2023-079760

BMJ Open. 2024 Jul 11;14(7):e085636. doi: 10.1136/bmjopen-2024-085636.

ABSTRACT

INTRODUCTION: The leishmaniases are among the group of neglected tropical diseases that cause significant morbidity and mortality each year. Currently, the East Africa region has the highest visceral leishmaniasis burden in the world. Ethiopia is one of the East African countries that reports both visceral and cutaneous forms of the disease. As part of the Nairobi Declaration, Ethiopia showed commitment to the elimination of visceral leishmaniasis by 2030. In this endeavour, it is important to understand the scope of research conducted on leishmaniases in the country and identify where the research gaps exist. Determining the research landscape is vital in the plan towards leishmaniases control and elimination. It will help to reference conducted research, determine if systematic reviews are warranted and help prioritise future research directions.

METHODS AND ANALYSIS: This protocol was developed with reference to the JBI Scoping Review Methodology Group’s guidance on conducting scoping reviews and the PRISMA-ScR reporting guidelines for scoping reviews. The following databases will be searched: PubMed, Embase via Embase.com, Web of Science Core Collection, Cochrane CENTRAL, Global Index Medicus, ClinicalTrials.gov, the Pan African Clinical Trials Registry and PROSPERO. Locally published literature that may not be indexed in the above-mentioned systems will be identified through team members familiar with the setting. Each record will be dually and blindly reviewed in an abstract-title screen and full-text screen using inclusion-exclusion criteria. Included articles must contain an in-depth discussion of leishmaniasis in Ethiopia. Data extracted will consist of study themes, study types, and categories and subcategories each defined in the developed codebook, in addition to type of leishmania, year of publication, funding source and the number of citations. Results will be reported with summary statistics.

ETHICS AND DISSEMINATION: Individual consenting and ethical approvals are not applicable. We plan to disseminate our findings to the appropriate stakeholders.

PMID:38991674 | DOI:10.1136/bmjopen-2024-085636

BMJ Open. 2024 Jul 11;14(7):e079623. doi: 10.1136/bmjopen-2023-079623.

ABSTRACT

OBJECTIVE: The objective of this study is to determine the pooled prevalence of active trachoma among 1-9 years old children in Ethiopia.

DESIGN: A systematic review and meta-analysis were employed in accordance with the Preferred Reporting Items for Systematic Reviews.

DATA SOURCES: Medline/PubMed, Scopus, Web of Science, African Journal of Online and Google scholar databases were systematically explored to find studies published in English until July 2023.

ELIGIBILITY CRITERIA: The following criteria apply: (1) condition (Co): studies examined the prevalence of trachoma among children (1-9) years old; (2) context (Co): studies conducted in Ethiopia; (3) population (Pop): studies that were done among children (1-9) years old; (4) study type: observational studies and (5) language: studies published in English.

DATA EXTRACTION AND SYNTHESIS: The data were extracted using a Microsoft Excel spreadsheet. DerSimonian-Laird random effect model was used to estimate the pooled prevalence of active trachoma among 1-9 years old children. Cochrane Q-tests and I² statistics were used across studies to assess heterogeneity. To identify possible publication bias, Egger’s test was performed.

PRIMARY OUTCOME: Prevalence of active trachoma among children aged (1-9 years old)”.

RESULTS: Overall, a total of 42 articles with 235 005 study participants were included in the final analysis. The estimated pooled prevalence of active trachoma using random effect model was 24% (95% CI 20% to 27%). The subgroup analysis by region revealed that the highest prevalence of trachoma was 36% (95% CI 13% to 58%) in the Tigray region, and publication year revealed the prevalence of trachoma was decreasing from 32% to 19% after 2015.

CONCLUSION: In this review, the pooled prevalence of active trachoma was found to be high in Ethiopia compared with WHO threshold level. This underscores the need for increased focus on high-risk age groups to decrease trachoma and to achieve the elimination of trachoma from the country by 2030.

PMID:38991673 | DOI:10.1136/bmjopen-2023-079623

BMJ Open. 2024 Jul 11;14(7):e079401. doi: 10.1136/bmjopen-2023-079401.

ABSTRACT

OBJECTIVES: The aim of this study was to a) explore barriers and facilitators associated with medication-taking habit formation, and b) elicit feedback on the components of an intervention designed to help form strong habits for long-term medication adherence.

DESIGN: The study design was qualitative; we conducted semistructured interviews between September 2021 and February 2022.

SETTING: The interviews were conducted online, with 27 participants recruited at the Cedars-Sinai Medical Center in Los Angeles, California.

PARTICIPANTS: A purposive sample of 20 patients who were over 18 years of age, had been diagnosed with hypertensive disorder (or reported high blood pressure; >140/90 mm Hg) and who were prescribed antihypertensive therapy at the time of recruitment, along with seven providers were interviewed.

RESULTS: Contextual factors included frequent changes to prescription for regimen adjustment, and polypharmacy. Forgetfulness, perceived need for medication, and routine disruptions were identified as possible barriers to habit formation. Facilitators of habit formation included identification of stable routines for anchoring, planning, use of external reminders (including visual reminders) and pillboxes for prescription management, and extrinsic motivation for forming habits. Interestingly, experiencing medication side effects was identified as a possible barrier and a possible facilitator of habit formation. Feedback on study components included increasing text size, and visual appeal of the habit leaflet; and imparting variation in text message content and adjusting their frequency to once a day. Patients generally favoured the use of conditional financial incentives to support habit formation.

CONCLUSION: The study sheds light on some key considerations concerning the contextual factors for habit formation among people with hypertension. As such, future studies may evaluate the generalisability of our findings, consider the role of visual reminders in habit formation and sustenance, and explore possible disruptions to habits.

TRIAL REGISTRATION NUMBER: NCT04029883.

PMID:38991671 | DOI:10.1136/bmjopen-2023-079401

BMJ Open. 2024 Jul 11;14(7):e081181. doi: 10.1136/bmjopen-2023-081181.

ABSTRACT

INTRODUCTION: Communicating complex information about haemodialysis (HD) and ensuring it is well understood remains a challenge for clinicians. Informed consent is a high-impact checkpoint in augmenting patients’ decision awareness and engagement prior to HD. The aims of this study are to (1) develop a digital information interface to better equip patients in the decision-making process to undergo HD; (2) evaluate the effectiveness of the co-designed digital information interface to improve patient outcomes; and (3) evaluate an implementation strategy.

METHODS AND ANALYSIS: First, a co-design process involving consumers and clinicians to develop audio-visual content for an innovative digital platform. Next a two-armed, open-label, multicentre, randomised controlled trial will compare the digital interface to the current informed consent practice among adult HD patients (n=244). Participants will be randomly assigned to either the intervention or control group. Intervention group: Participants will be coached to an online platform that delivers a simple-to-understand animation and knowledge test questions prior to signing an electronic consent form.

CONTROL GROUP: Participants will be consented conventionally by a clinician and sign a paper consent form. Primary outcome is decision regret, with secondary outcomes including patient-reported experience, comprehension, anxiety, satisfaction, adherence to renal care, dialysis withdrawal, consent time and qualitative feedback. Implementation of eConsent for HD will be evaluated concurrently using the Consolidation Framework for Implementation Research (CFIR) methodology.

ANALYSIS: For the randomised controlled trial, data will be analysed using intention-to-treat statistical methods. Descriptive statistics and CFIR-based analyses will inform implementation evaluation.

ETHICS AND DISSEMINATION: Human Research Ethics approval has been secured (Metro North Health Human Research Ethics Committee B, HREC/2022/MNHB/86890), and Dissemination will occur through partnerships with stakeholder and consumer groups, scientific meetings, publications and social media releases.

TRIAL REGISTRATION NUMBER: Australian and New Zealand Clinical Trials Registry (ACTRN12622001354774).

PMID:38991670 | DOI:10.1136/bmjopen-2023-081181

J Am Med Dir Assoc. 2024 Jul 8:105145. doi: 10.1016/j.jamda.2024.105145. Online ahead of print.

ABSTRACT

OBJECTIVES: Nursing home (NH) leaders remain challenged to deliver quality care, despite the COVID-19 transition to an endemic phase. This study describes NH leadership perspectives on preparing and maintaining quality care during times of diminishing resources as experienced through the COVID-19 pandemic to gain insight on how best to support NHs moving forward.

DESIGN: This was a cross-sectional, parallel convergent mixed methods study.

SETTING AND PARTICIPANTS: This study reports quantitative data from 5001 NHs across 12 states along with qualitative data from a subsample of NH leaders (N = 15).

METHODS: Publicly reported survey data were analyzed using descriptive statistics. Individual in-depth interviews with NH leaders conducted at 12-month follow-up were analyzed using inductive thematic coding organized by a guiding framework. Data were integrated using convergent analysis and a joint display.

RESULTS: NH leaders (licensed administrators, clinical directors, and managers) reported resident and staff infection rates, and access to resources (such as personal protective equipment and testing supplies) that aligned with national trends. Leaders described their NHs (N = 14; 43% rural; 71% not for profit) to be in varied states of operational readiness (standard, contingency, crisis) to support quality infection prevention and control (IPC) at the transition to the endemic COVID-19 phase. Leadership reported continued challenges in addressing resident and staff vaccinations, securing testing supplies, obtaining financial resources to maintain acceptable levels of personal protective equipment, continued staffing shortages, and issues in implementing isolation practices in current facilities.

CONCLUSION AND IMPLICATIONS: NH leaders continue to struggle delivering quality IPC care post-pandemic and require focused support in several areas. Clinical practice guidelines should include IPC practices to prevent the infection and spread of any COVID-19 variant in this endemic phase. Policies should support continued reporting of IPC-related metrics and adequate funding to account for the long-term financial burden NHs face.

PMID:38991652 | DOI:10.1016/j.jamda.2024.105145

J Hazard Mater. 2024 Jun 15;476:134929. doi: 10.1016/j.jhazmat.2024.134929. Online ahead of print.

ABSTRACT

This study focuses on assessing the hydrogeochemical processes influencing the mobility of dissolved metal and metalloid species during mine effluent mixing. Field samples were collected to characterize effluents at an active gold mine located in the Abitibi Greenstone belt in western Québec, Canada. Controlled laboratory mixing experiments were further performed with real effluents. In situ physicochemical parameters, concentrations of major dissolved ions and trace elements were analyzed. Mineralogical analyses were also performed on precipitates from the laboratory mixtures. The data were used for statistical analyses and for modeling the geochemical evolution of effluents using PHREEQC with the wateq4f.dat database (with modifications). The results suggest that the formation of secondary minerals such as schwertmannite, Fe(OH)₃, and jarosite could significantly affect the concentrations of trace elements in effluents. The precipitation of secondary minerals immobilized trace elements through coprecipitation and sorption processes. The main limitations of the modeling approach used here include the evaluation of the ion balance for low pH samples with high Fe and Al concentrations and the omission of biological processes. The approach provides insights into the geochemical evolution of mine effluents and could be adapted to several mining sites as a tool for improving water management.

PMID:38991645 | DOI:10.1016/j.jhazmat.2024.134929

Surg Oncol. 2024 Jun 28;55:102098. doi: 10.1016/j.suronc.2024.102098. Online ahead of print.

ABSTRACT

BACKGROUND: Minimally invasive techniques have demonstrated several advantages over the open approach. In the field of prostate cancer, the LAP-01 trial demonstrated the superiority of robotic-assisted radical prostatectomy (RARP) over laparoscopic radical prostatectomy (LRP) when comparing continence at 3-month after surgery, with no statistically significant differences at 6 and 12 months of follow-up.

OBJECTIVES: Externally validate the LAP-01 study and compare functional outcomes between the two minimally invasive approaches.

MATERIAL AND METHODS: This retrospective study, conducted by a single surgeon (MRB), utilized data from a prospectively collected database, which included patients who underwent both RARP or LRP. Data regarding baseline characteristics, continence (assessed through the 24-h Pad test and ICIQ questionnaire) and potency were collected at multiple time points: 1 and 6 weeks after catheter removal, 3-, 6-, and 12-months post-surgery.

RESULTS: The study encompasses 601 patients, 455 who underwent LRP and 146 RARP. The median age at diagnosis was 64 for LRP and 62 for RARP, while the median PSA levels at diagnosis were 6.7 ng/mL for LRP and 6.5 ng/mL for RARP. Bilateral nerve-sparing procedures were performed in 34.07 % of LRP cases and 51.37 % of RARP cases. RARP exhibited a significant advantage over LRP both in continence and potency. Continence rates at 3-, 6- and 9-month after radical prostatectomy (RP) were 36.43 %, 61.86 % and 79.87 % for LRP, compared to 50.98 %, 69.87 % and 91.69 % for RARP. Potency rates at the same intervals were 0.90 %, 3.16 % and 6.39 % for LRP, and 6.19 %, 9.16 % and 18.96 % for RARP. These rates were more pronounced in patients with bilateral nerve-sparing.

CONCLUSION: Our study demonstrates that RARP results in significantly better continence recovery and superior potency outcomes throughout the entire follow-up period compared to LRP, even at the beginning of the robotic approach learning curve.

PMID:38991627 | DOI:10.1016/j.suronc.2024.102098