Category: Nevin Manimala

Prim Health Care Res Dev. 2024 May 9;25:e28. doi: 10.1017/S1463423624000136.

ABSTRACT

AIM: To identify and quantify general practitioner (GP) preferences related to service attributes of clinical consultations, including telehealth consultations, in Australia.

BACKGROUND: GPs have been increasingly using telehealth to deliver patient care since the onset of the 2019 coronavirus disease (COVID-19) pandemic. GP preferences for telehealth service models will play an important role in the uptake and sustainability of telehealth services post-pandemic.

METHODS: An online survey was used to ask GPs general telehealth questions and have them complete a discrete choice experiment (DCE). The DCE elicited GP preferences for various service attributes of telehealth (telephone and videoconference) consultations. The DCE investigated five service attributes, including consultation mode, consultation purpose, consultation length, quality of care and rapport, and patient co-payment. Participants were presented with eight choice sets, each containing three options to choose from. Descriptive statistics was used, and mixed logit models were used to estimate and analyse the DCE data.

FINDINGS: A total of 60 GPs fully completed the survey. Previous telehealth experiences impacted direct preferences towards telehealth consultations across clinical presentations, although in-person modes were generally favoured (in approximately 70% of all scenarios). The DCE results lacked statistical significance which demonstrated undiscernible differences between GP preferences for some service attributes. However, it was found that GPs prefer to provide a consultation with good quality care and rapport (P < 002). GPs would also prefer to provide care to their patients rather than decline a consultation due to consultation mode, length or purpose (P < 0.0001). Based on the findings, GPs value the ability to provide high-quality care and develop rapport during a clinical consultation. This highlights the importance of recognising value-based care for future policy reforms, to ensure continued adoption and sustainability of GP telehealth services in Australia.

PMID:38721700 | DOI:10.1017/S1463423624000136

Dev Med Child Neurol. 2024 May 9. doi: 10.1111/dmcn.15948. Online ahead of print.

ABSTRACT

Observational studies have a critical role in disability research, providing the opportunity to address a range of research questions. Over the past decades, there have been substantial shifts and developments in statistical methods for observational studies, most notably for causal inference. In this review, we provide an overview of modern design and analysis concepts critical for observational studies, drawing examples from the field of disability research and highlighting the challenges in this field, to inform the readership on important statistical considerations for their studies.

PMID:38721699 | DOI:10.1111/dmcn.15948

Prim Health Care Res Dev. 2024 May 9;25:e27. doi: 10.1017/S146342362400015X.

ABSTRACT

AIM: The study assessed mothers, children and adolescents’ health (MCAH) outcomes in the context of a Primary Health Care (PHC) project and associated costs in two protracted long-term refugee camps, along the Thai-Myanmar border.

BACKGROUND: Myanmar refugees settled in Thailand nearly 40 years ago, in a string of camps along the border, where they fully depend on external support for health and social services. Between 2000 and 2018, a single international NGO has been implementing an integrated PHC project.

METHODS: This retrospective study looked at the trends of MCAH indicators of mortality and morbidity and compared them to the sustainable development goals (SDGs) indicators. A review of programme documents explored and triangulated the evolution and changing context of the PHC services, and associated project costs were analysed. To verify changes over time, interviews with 12 key informants were conducted.

FINDINGS: While maternal mortality (SDG3.1) remained high at 126.5/100,000 live births, child mortality (SDG 3.2) and infectious diseases in children under 5 (SDG 3.3) fell by 69% and by up to 92%, respectively. Maternal anaemia decreased by 30%; and more than 90% of pregnant women attended four or more antenatal care visits, whereas 80% delivered by a skilled birth attendant; caesarean section rates rose but remained low at an average of 3.7%; the adolescent (15-19 years) birth rate peaked at 188 per 1000 in 2015 but declined to 89/1000 in 2018 (SDG 3.7).

CONCLUSION: Comprehensive PHC delivery, with improved health provider competence in MCAH care, together with secured funding is an appropriate strategy to bring MCAH indicators to acceptable levels. However, inequities due to confinement in camps, fragmentation of specific health services, prevent fulfilment of the 2030 SDG Agenda to ‘Leave no one behind’. Costs per birth was 115 EURO in 2018; however, MCAH expenditure requires further exploration over a longer period.

PMID:38721695 | DOI:10.1017/S146342362400015X

J Sex Med. 2024 May 9:qdae052. doi: 10.1093/jsxmed/qdae052. Online ahead of print.

ABSTRACT

BACKGROUND: Intravesical instillation of hyaluronic acid (HA) has been associated with reduced sexual dysfunction in participants with recurrent urinary tract infections (rUTIs), but the efficacy of an oral treatment has never been investigated.

AIM: To investigate the efficacy of an oral preparation of HA, chondroitin sulfate, N-acetylglucosamine, and vitamin C in improving sexual and urinary symptoms in a cohort of reproductive-age participants with rUTI.

METHODS: In a monocentric randomized crossover pilot trial, participants with rUTI who were referred to our institute between March 2022 and April 2023 were randomized 1:1 in 2 groups: intervention vs control. All participants had an oral preparation of cranberry, D-mannose, propolis extract, turmeric, and Boswellia twice a day for 3 months. The intervention group also included an oral preparation of HA, chondroitin sulfate, N-acetylglucosamine, and vitamin C once a day for 3 months. Crossover of treatment occurred at 3 months for an additional 3 months. At baseline and 3 and 6 months, participants were evaluated clinically and with the International Prostate Symptom Score (IPSS) and Female Sexual Function Index (FSFI). Descriptive statistics and logistic regression models tested the impact of the intervention on urinary and sexual symptoms at each follow-up assessment.

OUTCOMES: Improvement in sexual and urinary symptoms as measured by the FSFI and IPSS.

RESULTS: Overall, 27 (54%) participants had an FSFI score <26.5 at enrollment. At 3 months, FSFI scores were higher in the intervention group vs control (P < .001), but IPSS scores were lower (P = .03). After crossover of treatment, FSFI and IPSS scores remained stable in the intervention group. However, after crossover, the control group showed a significant improvement in IPSS and FSFI scores (all P < .01) vs the 3-month assessment. At last follow-up, urinary and sexual symptoms were comparable between groups. In logistic regression analyses, the intervention group was associated with early improvement in sexual symptoms (odds ratio, 3.9; P = .04) and urinary symptoms (odds ratio, 5.1; P = .01) after accounting for clinical confounders.

CLINICAL IMPLICATIONS: Combination treatment with HA, chondroitin sulfate, N-acetylglucosamine, and vitamin C is effective if started immediately or even after a few months from symptoms in participants with rUTI.

STRENGTHS AND LIMITATIONS: The main limitation is the lack of long-term follow-up.

CONCLUSION: The oral formulation of HA, chondroitin sulfate, N-acetylglucosamine, and vitamin C could be an effective therapy against urinary and sexual distress in participants with rUTI (NCT06268483; ClinicalTrials.gov).

PMID:38721680 | DOI:10.1093/jsxmed/qdae052

Trans R Soc Trop Med Hyg. 2024 May 9:trae032. doi: 10.1093/trstmh/trae032. Online ahead of print.

ABSTRACT

BACKGROUND: Haemophagocytic lymphohistiocytosis (HLH) is a rare complication of dengue fever with potentially life-threatening consequences and high mortality. Therefore, this study aims to investigate the prevalence, management and outcome of HLH in dengue fever.

METHODS: The major electronic databases, including PubMed, ScienceDirect and Ovid SP, were searched from inception until 31 January 2024 to identify relevant studies. Pooled prevalence and mortality were calculated using the random-effects generic inverse variance model with a 95% CI. All the statistical analysis was conducted using R programming.

RESULTS: A total of nine studies with 157 patients with HLH, 576 patients with severe dengue and 5081 patients with dengue fever were included in this meta-analysis. The prevalence of HLH in severe dengue (22.1%, 95% CI 8.07 to 48.0%) was significantly higher than the prevalence in dengue fever (3.12%, 95% CI 0.37 to 21.9%). The prevalence of HLH in severe dengue was higher in the paediatric population (22.8%, 95% CI 3.9 to 68.4%) compared with the adult population (19.0%, 95% CI 3.0 to 63.9%). The overall mortality rate was 20.2% (95% CI 9.7 to 37.2%).

CONCLUSION: The prevalence of dengue-associated HLH was low in patients with dengue fever but is significantly higher in patients with severe dengue and a high mortality rate.

PMID:38721675 | DOI:10.1093/trstmh/trae032

J Glob Health. 2024 May 10;14:04085. doi: 10.7189/jogh.14.04085.

ABSTRACT

BACKGROUND: Postnatal care (PNC) utilisation within 24 hours of delivery is a critical component of health care services for mothers and newborns. While substantial geographic variations in various health outcomes have been documented in India, there remains a lack of understanding regarding PNC utilisation and underlying factors accounting for these geographic variations. In this study, we aimed to partition and explain the variation in PNC utilisation across multiple geographic levels in India.

METHODS: Using India’s 5th National Family Health Survey (2019-21), we conducted four-level logistic regression analyses to partition the total geographic variation in PNC utilisation by state, district, and cluster levels, and to quantify how much of theses variations are explained by a set of 12 demographic, socioeconomic, and pregnancy-related factors. We also conducted analyses stratified by selected states/union territories.

RESULTS: Among 149 622 mother-newborn pairs, 82.29% of mothers and 84.92% of newborns were reported to have received PNC within 24 hours of delivery. In the null model, more than half (56.64%) of the total geographic variation in mother’s PNC utilisation was attributed to clusters, followed by 26.06% to states/union territories, and 17.30% to districts. Almost 30% of the between-state variation in mother’s PNC utilisation was explained by the demographic, socioeconomic, and pregnancy-related factors (i.e. state level variance reduced from 0.486 (95% confidence interval (CI) = 0.238, 0.735) to 0.320 (95% CI = 0.152, 0.488)). We observed consistent results for newborn’s PNC utilisation. State-specific analyses showed substantial geographic variation attributed to clusters across all selected states/union territories.

CONCLUSIONS: Our findings highlight the consistently large cluster variation in PNC utilisation that remains unexplained by compositional effects. Future studies should explore contextual drivers of cluster variation in PNC utilisation to inform and design interventions aimed to improve maternal and child health.

PMID:38721673 | DOI:10.7189/jogh.14.04085

J Diabetes. 2024 May;16(5):e13555. doi: 10.1111/1753-0407.13555.

ABSTRACT

BACKGROUND: The association between macronutrient intake and diabetes is unclear. We used data from the China Health and Nutrition Survey to explore the association between macronutrient intake trajectories and diabetes risk in this study.

METHODS: We included 6755 participants who did not have diabetes at baseline and participated in at least three surveys. The energy supply ratio of carbohydrate, protein, and fat was further calculated from dietary data; different macronutrient trajectories were determined using multitrajectory models; and multiple Cox regression models were used to evaluate the association between these trajectories and diabetes.

RESULTS: We found three multitrajectories: decreased low carbohydrate-increased moderate protein-increased high fat (DLC-IMP-IHF), decreased high carbohydrate-moderate protein-increased low fat (DHC-MP-ILF), and balanced-macronutrients (BM). Compared to the BM trajectory, DHC-MP-ILF trajectories were significantly associated with increased risk of diabetes (hazard ratio [HR]: 3.228, 95% confidence interval [CI]: 1.571-6.632), whereas no association between DLC-IMP-IHF trajectories and diabetes was found in our study (HR: 0.699, 95% CI: 0.351-1.392).

CONCLUSIONS: The downward trend of high carbohydrate and the increasing trend of low fat increased the risk of diabetes in Chinese adults.

PMID:38721664 | DOI:10.1111/1753-0407.13555

Disaster Med Public Health Prep. 2024 May 9;18:e89. doi: 10.1017/dmp.2024.77.

ABSTRACT

OBJECTIVES: To quantify the burden of communicable diseases and characterize the most reported infections during public health emergency of floods in Pakistan.

METHODS: The study’s design is a descriptive trend analysis. The study utilized the disease data reported to District Health Information System (DHIS2) for the 12 most frequently reported priority diseases under the Integrated Disease Surveillance and Response (IDSR) system in Pakistan.

RESULTS: In total, there were 1,532,963 suspected cases during August to December 2022 in flood-affected districts (n = 75) across Pakistan; Sindh Province reported the highest number of cases (n = 692,673) from 23 districts, followed by Khyber Pakhtunkhwa (KP) (n = 568,682) from 17 districts, Balochistan (n = 167,215) from 32 districts, and Punjab (n = 104,393) from 3 districts. High positivity was reported for malaria (79,622/201,901; 39.4%), followed by acute diarrhea (non-cholera) (23/62; 37.1%), hepatitis A and E (47/252; 18.7%), and dengue (603/3245; 18.6%). The crude mortality rate was 11.9 per 10 000 population (1824/1,532,963 [deaths/cases]).

CONCLUSION: The study identified acute respiratory infection, acute diarrhea, malaria, and skin diseases as the most prevalent diseases. This suggests that preparedness efforts and interventions targeting these diseases should be prioritized in future flood response plans. The study highlights the importance of strengthening the IDSR as a Disease Early Warning System through the implementation of the DHIS2.

PMID:38721660 | DOI:10.1017/dmp.2024.77

Pol Przegl Chir. 2024 Mar 5;96(3):1-8. doi: 10.5604/01.3001.0054.2672.

ABSTRACT

&lt;b&gt;&lt;br&gt;Introduction:&lt;/b&gt; Colorectal cancer (CRC) is the second-leading cause of cancer-related deaths worldwide. Distant metastases are usually located in the liver and are present in 50% of patients.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Aim:&lt;/b&gt; The aim of this study is to evaluate changes in body composition and phase angle before and after surgical treatment of CRC liver metastases, as well as survival time and treatment costs.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Material and methods:&lt;/b&gt; The study included 134 patients who received 174 surgeries for CRC liver metastases. Bioelectrical impedance analysis (BIA) was performed using an AKERN BIA 101 analyzer.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Results:&lt;/b&gt; BIA was performed before and after surgery. The results of tests (total body water content [TBW], body cell mass [BCM], and phase angle) showed a reduction in BCM by 2.21 kg and a statistically significant decrease in phase angle values after surgery (from 5.06 to 4.25 in women and from 5.34 to 4.76 in men). These values are below the reference range for both sexes. There was a correlation between phase angle values and muscle mass, both before (R = 0.528, p&lt;0001) and after surgery (R = 0.634, p&lt;000.1). Preoperative levels of the tumor marker CEA were elevated in more than half of the patients. The median survival time after resection of liver metastases was 37.6 months.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Discussion:&lt;/b&gt; A significant factor that increases complications, mortality, and treatment costs of cancer patients is malnutrition, which could be the earliest symptom of malignant disease.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Conclusions:&lt;/b&gt; Successful treatment of CRC requires the patients to participate in follow-up examinations and to be aware of early signs associated with recurrence (e.g., blood in the stool or weight loss). The patients’ nutritional status should be monitored and recorded in a DILO card.&lt;/br&gt.

PMID:38721641 | DOI:10.5604/01.3001.0054.2672

Pol Przegl Chir. 2024 Jan 1;96(3):1-5. doi: 10.5604/01.3001.0053.9871.

ABSTRACT

&lt;b&gt;&lt;br&gt;Introduction:&lt;/b&gt; It is already known that bariatric surgery can improve the health and quality of life of morbidly obese patients of all ages. Our population is getting older. That is why the number of bariatric surgeries among obese people over 65 years of age is systematically increasing.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Aims:&lt;/b&gt; The study aims to analyze the management of patients over 65 years of age in Polish bariatric centers.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Material and methods:&lt;/b&gt; The study was conducted on representatives from the 30 largest bariatric departments in Poland. By collecting surveys, we aimed to analyze changes in qualifications for surgery and care for elderly patients.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Results:&lt;/b&gt; 13 of 30 (43.3%) representatives responded to the survey. The remaining centers did not qualify patients over 65 years old for the surgical treatment of obesity. The mean percentage of patients over 65 who underwent bariatric surgery was 2.75. Most representatives (69.2%) chose SG as the procedure of choice in patients over 65 years of age. According to 84.6% of surgeons, age did not matter when qualifying patients over 65 years of age for BS. The majority of surgeons (53.8%) believed that bariatric surgery in older patients was comparable to the one in younger patients. Nine (69.2%) surgeons believed that there should be no age limit for bariatric surgery.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Conclusions:&lt;/b&gt; Only almost half of the bariatric centers in Poland perform operations on patients over 65 years of age. Most Polish surgeons claim that operations on older and on younger patients have comparable benefits, and that there is no need for age limit.&lt;/br&gt.

PMID:38721640 | DOI:10.5604/01.3001.0053.9871