Category: Nevin Manimala

BMJ Open. 2023 Oct 18;13(10):e073419. doi: 10.1136/bmjopen-2023-073419.

ABSTRACT

OBJECTIVE: This study examines trends, spatial distribution and determinants of age at death of under-5 children in Ethiopia.

DESIGN: This study used secondary data from the 2000, 2005, 2011 and 2016 Ethiopian Demographic and Health Surveys. A multilevel partial ordinal logistic regression model was used to assess the effects of variables on the age at death of children under 5 years.

SETTING: Ethiopia.

PARTICIPANTS: The final analysis included a sample of 3997 deaths of newborns, infants and toddlers.

RESULTS: A total of 1508, 1054, 830 and 605 deaths of under-5 children were recorded in the 2000, 2005, 2011 and 2016 survey years, respectively. The death of newborns, infants and toddlers showed a significant decrease from 2000 to 2016, with reductions of 33.3% to 17.4%, 42.4% to 12.6% and 45.2% to 11.6%, respectively. The analysis using Global Moran’s Index revealed significant spatial autocorrelation in mortality for each survey year (p<0.05). The intraclass correlation of age at death of under-5 children within regions was substantial. Furthermore, the odds of newborn deaths among under-5 children (OR: 0.638, 95% CI: 0.535, 0.759) were lower for those delivered in health institutions compared with those delivered at home.

CONCLUSIONS: Throughout the survey years from 2000 to 2016, newborn children had higher mortality rates compared with infants and toddlers, and significant spatial variations were observed across different zones in Ethiopia. Factors such as child’s sex, age of mother, religion, birth size, sex of household head, place of delivery, birth type, antenatal care, wealth index, spatial autocovariate, Demographic and Health Survey year, place of residence and region were found to be significant in influencing the death of under-5 children in Ethiopia. Overall, there has been a decreasing trend in the proportion of under-5 child mortality over the four survey years in Ethiopia.

PMID:37852770 | DOI:10.1136/bmjopen-2023-073419

BMJ Open. 2023 Oct 18;13(10):e076154. doi: 10.1136/bmjopen-2023-076154.

ABSTRACT

BACKGROUND: Based on 2021 data, Nigeria had the second largest number of zero-dose children globally estimated at over 2.25 million, concentrated in the northern part of the country due to factors some of which are sociocultural. This study analysed the impact of the COVID-19 pandemic and response on childhood vaccination in Northern Nigeria.

METHODS: Using a mixed methods sequential study design in the most populous northern states of Kaduna and Kano, quantitative routine immunisation data for the period 2018-2021 and qualitative data collected through 16 focus group discussions and 40 key informant interviews were used. An adaptation of the socioecological model was used as a conceptual framework. Mean vaccination coverages and test of statistical difference in childhood vaccination data were computed. Qualitative data were coded and analysed thematically.

RESULTS: Mean Penta 1 coverage declined in Kaduna from 69.88% (SD=21.02) in 2018 to 59.54% (SD=19.14%) by 2021, contrasting with Kano where mean Penta 1 coverage increased from 51.87% (SD=12.61) to 56.32% (SD=17.62%) over the same period. Outreaches and vaccination in urban areas declined for Kaduna state by 10% over the pandemic period in contrast to Kano state where it showed a marginal increase. The two states combined had an estimated 25% of the country’s zero-dose burden in 2021. Lockdowns, lack of transport and no outreaches which varied across the states were some of the factors mentioned by participants to have negatively impacted childhood vaccination. Special vaccination outreaches were among the recommendations for ensuring continued vaccination through a future pandemic.

CONCLUSION: While further interrogating the accuracy of denominator estimates for the urban population, incorporating findings into pandemic preparedness and response will ensure uninterrupted childhood vaccination during emergencies. Addressing the identified issues will be critical to achieving and sustaining universal childhood vaccination in Nigeria.

PMID:37852768 | DOI:10.1136/bmjopen-2023-076154

BMJ Open. 2023 Oct 18;13(10):e067684. doi: 10.1136/bmjopen-2022-067684.

ABSTRACT

OBJECTIVES: To estimate the economic costs, health-related quality-of-life outcomes and cost-effectiveness of subthreshold micropulse laser (SML) versus standard laser (SL) for the treatment of diabetic macular oedema (DMO) with central retinal thickness (CRT) of <400µ.

DESIGN: An economic evaluation was conducted within a pragmatic, multicentre, randomised clinical trial, DIAbetic Macular Oedema aNd Diode Subthreshold.

SETTING: 18 UK Hospital Eye Services.

PARTICIPANTS: Adults with diabetes and centre involving DMO with CRT<400µ.

INTERVENTIONS: Participants (n=266) were randomised 1:1 to receive SML or SL.

METHODS: The base-case used an intention-to-treat approach conducted from a UK National Health Service (NHS) and personal social services (PSS) perspective. Costs (2019-2020 prices) were collected prospectively over the 2-year follow-up period. A bivariate regression of costs and quality-adjusted life-years (QALYs), with multiple imputation of missing data, was conducted to estimate the incremental cost per QALY gained and the incremental net monetary benefit of SML in comparison to SL. Sensitivity analyses explored uncertainty and heterogeneity in cost-effectiveness estimates.

RESULTS: One participant in the SL arm withdrew consent for data to be used; data from the remaining 265 participants were included in analyses. Mean (SE) NHS and PSS costs over 24 months were £735.09 (£111.85) in the SML arm vs £1099.70 (£195.40) in the SL arm (p=0.107). Mean (SE) QALY estimates were 1.493 (0.024) vs 1.485 (0.020), respectively (p=0.780), giving an insignificant difference of 0.008 QALYs. The probability SML is cost-effective at a threshold of £20 000 per QALY was 76%.

CONCLUSIONS: There were no statistically significant differences in EQ-5D-5L scores or costs between SML and SL. Given these findings and the fact that SML does not burn the retina, unlike SL and has equivalent efficacy to SL, it may be preferred for the treatment of people with DMO with CRT<400µ.

TRIAL REGISTRATION NUMBERS: ISRCTN17742985; NCT03690050.

PMID:37852765 | DOI:10.1136/bmjopen-2022-067684

BMJ Open. 2023 Oct 18;13(10):e071104. doi: 10.1136/bmjopen-2022-071104.

ABSTRACT

OBJECTIVE: The study aimed to investigate the effects of education and age on the experience of youth violence in low-income and middle-income country settings.

DESIGN: Using a standardised questionnaire, our study collected two waves of longitudinal data on sociodemographics, health practices, health outcomes and risk factors. The panel fixed-effects ordinary least squares regression models were used for the analysis.

SETTINGS: The study was conducted in 59 villages and the town of Nouna with a population of about 100 000 individuals, 1 hospital and 13 primary health centres in Burkina Faso.

PARTICIPANTS: We interviewed 1644 adolescents in 2017 and 1291 respondents in 2018 who participated in both rounds.

OUTCOME AND EXPOSURE MEASURES: We examined the experience of physical attacks in the past 12 months and bullying in the past 30 days. Our exposures were completed years of age and educational attainment.

RESULTS: A substantial minority of respondents experienced violence in both waves (24.1% bullying and 12.2% physical attack), with males experiencing more violence. Bullying was positively associated with more education (β=0.12; 95% CI 0.02 to 0.22) and non-significantly with older age. Both effects were stronger in males than females, although the gender differences were not significant. Physical attacks fell with increasing age (β=-0.18; 95% CI -0.31 to -0.05) and this association was again stronger in males than females; education and physical attacks were not substantively associated.

CONCLUSIONS: Bullying and physical attacks are common for rural adolescent Burkinabe. The age patterns found suggest that, particularly for males, there is a need to target violence prevention at younger ages and bullying prevention at slightly older ones, particularly for those remaining in school. Nevertheless, a fuller understanding of the mechanisms behind our findings is needed to design effective interventions to protect youth in low-income settings from violence.

PMID:37852761 | DOI:10.1136/bmjopen-2022-071104

BMJ Open. 2023 Oct 18;13(10):e072678. doi: 10.1136/bmjopen-2023-072678.

ABSTRACT

OBJECTIVES: This study aimed to evaluate the diagnostic utility of haematological parameters as a predictive marker of the severity of HIV infection in southwestern Ethiopia.

DESIGN: Comparative cross-sectional study.

SETTING: This study was conducted in southwestern Ethiopia.

PARTICIPANTS: Venous blood samples were collected from 344 participants (172 HIV, 172 healthy controls (HC)) and haematological parameters were determined using the automated haematology analyser. The diagnostic utility of haematological parameters was determined by a receiver operating curve analysis. Data were analysed using SPSS V.21 and the p value was set at less than 0.05 for the statistical significance.

RESULTS: In this study, red cell count (RCC) distinguishes HIV-infected patients from HC at a threshold value of 4.05×10⁹/L with sensitivity, specificity and an area under the curves (AUC) of 73.8%, 78.5% and 0.87, respectively. At a cut-off value of 4.25×10⁹/L, RCC significantly distinguishes non-severe HIV-infected patients from HC with a sensitivity of 72.7%, specificity of 81.7% and an AUC of 0.86. Haemoglobin (Hgb) significantly differentiates severe HIV-infected patients from HC with sensitivity, specificity and an AUC of 95.9%, 86.7% and 0.96, respectively. Platelet count (PLT) significantly discriminates HC from non-severe and severe HIV-infected patients with an AUC of 0.74 and 0.963, respectively.

CONCLUSION: RCC, PLT and Hgb demonstrated better diagnostic performance in predicting the severity of HIV infection and have been identified as the best haematological markers in predicting the presence and severity of HIV infection. Thus, the haematological profiles (RCC, PLT and Hgb) should be used as an alternative marker to predict the severity of HIV infection and may provide supportive information for evidence-based interventions and early diagnosis of infections.

PMID:37852759 | DOI:10.1136/bmjopen-2023-072678

BMJ Sex Reprod Health. 2023 Oct 18:bmjsrh-2023-201856. doi: 10.1136/bmjsrh-2023-201856. Online ahead of print.

ABSTRACT

BACKGROUND: National lockdowns in England due to COVID-19 resulted in rapid shifts in healthcare provision, including in primary care where most contraceptive prescriptions are issued. This study aimed to investigate contraception prescribing trends in primary care during the pandemic and the impact of socioeconomic deprivation.

METHODS: Prescribing data were accessed from the English Prescribing Dataset for the first year of the COVID-19 pandemic (1 March 2020-28 February 2021) and the year prior (1 March 2019-29 February 2020). Data were analysed by geographical region (London, Midlands and East of England, North of England, South of England) and contraceptive type (progestogen-only pill (POP), combined oral contraception (COC), emergency hormonal contraception (EHC) and contraceptive injections). Differences in prescribing rates were calculated using Poisson regression. Pearson correlation coefficients were calculated for the Index of Multiple Deprivation (IMD) scores for each Clinical Commissioning Group (CCG) in the North East and North Cumbria (NENC).

RESULTS: Contraception prescribing rates decreased overall during the COVID-19 pandemic in England (Poisson regression coefficient (β)=-0.035), with a statistically significant (p<0.01) decrease in all four regions. Prescriptions decreased for COC (β=-0.978), contraceptive injections (β=-0.161) and EHC (β=-0.2005), while POP (β=0.050) prescribing rates increased. There was a weak positive correlation between IMD and prescribing rates in NENC (p>0.05).

CONCLUSIONS: Contraception provision was impacted by COVID-19 with an overall decrease in prescribing rates. The deprivation results suggest that this may not be a significant contributing factor to this decrease. Further research is recommended to better understand these changes, and to ensure that services respond appropriately to population needs.

PMID:37852734 | DOI:10.1136/bmjsrh-2023-201856

Adv Clin Chem. 2023;116:277-317. doi: 10.1016/bs.acc.2023.06.001. Epub 2023 Sep 27.

ABSTRACT

Over time, the metrological concept of uncertainty in measurement has been very successfully integrated into laboratory sciences. For proper implementation, an understanding of specific metrology terminology and additional concepts such as metrology traceability and commutability is necessary. Although the original thinking about measurement uncertainty in laboratory medicine suggests the complexity of the concept, it basically refers to the result as the end product of the entire laboratory process. Although the data on measurement uncertainty can be expressed quantitatively, the basis of this concept is the continuous evaluation of all phases of the laboratory process. This means that laboratory experts should keep in mind that the extra-analytical phases (on which the uncertainty of the measurement results may depend the most) must be continuously monitored. The analytical phase can be “held in check” by established internal and external quality control processes. It is the internal/external quality control data that is used to calculate the numerical value of the measurement uncertainty of the measurement results. Although over time the awareness of laboratory experts regarding the concept of measurement uncertainty has increased, there are still many challenges that need to be followed, and the last one is how to achieve a balance between understanding, evaluation process and application of measurement uncertainty data of measurement results for complete and ultimate practical use.

PMID:37852721 | DOI:10.1016/bs.acc.2023.06.001

Am J Pharm Educ. 2023 Oct;87(10):100121. doi: 10.1016/j.ajpe.2023.100121. Epub 2023 May 8.

ABSTRACT

OBJECTIVE: To (1) evaluate changes in student pharmacists’ professional identity during a curriculum prior to advanced pharmacy practice experiences (APPEs) and (2) describe the components of a pre-APPE curriculum that positively and negatively influenced students’ professional identity formation (PIF).

METHODS: The University of Washington School of Pharmacy launched a new curriculum in 2019 featuring components intentionally designed to support students’ PIF. The Macleod-Clark Professional Identity Scale (MCPIS) was administered to the class of 2023 before starting pharmacy school (pre) and upon completion of the pre-APPE curriculum (post). The postsurvey also contained 2 open-response questions asking students to identify the most positive and negative influences on their PIF. Mean pre- and post-responses were calculated for all MCPIS items and each MCPIS item and compared using paired t tests. Responses to the open-ended questions were sorted into categories using inductive thematic analysis and frequencies were calculated.

RESULTS: A total of 99 students (96%) completed both surveys. Mean MCPIS pre-scores and post-scores were both 3.3, indicating no statistically significant change in professional identity. The most frequently reported positive influences on PIF were didactic coursework (40%), experiential learning (30%), and student organizations (27%). The most frequently reported negative influences were didactic coursework (27%), none (25%), and perceptions of the pharmacy profession (22%).

CONCLUSION: Students’ overall professional identity, as measured by the MCPIS, did not change during the pre-APPE curriculum. Didactic coursework had the most common positive and negative influence on professional identity prior to APPEs.

PMID:37852689 | DOI:10.1016/j.ajpe.2023.100121

Am J Pharm Educ. 2023 Oct;87(10):100041. doi: 10.1016/j.ajpe.2022.10.009. Epub 2023 Mar 15.

ABSTRACT

OBJECTIVE: The primary objective of this study was to compare grit, subjective happiness, satisfaction with life, and academic resilience among pharmacy and occupational therapy/physical therapy (OT/PT) students at 2 distinct universities using the short grit scale, subjective happiness scale (SHS), satisfaction with life scale (SWLS), and the academic resilience scale (ARS-30).

METHODS: In January 2019, investigators administered an online survey to students at 2 universities using a cross-sectional, voluntary, anonymous survey design using grit scale, SHS, SWLS, and ARS-30. Descriptive statistics, t tests, a 2-way analysis of variance, Pearson correlation, and regression analyses were used to examine the relationship between these scores.

RESULTS: There were 227 respondents who consented to participate in the study and completed all 4 surveys. The overall response rate for pharmacy students was 44% and 43% for OT/PT students, with most pharmacy and OT/PT students in the 19-25-year range. Grit scores did not differ between pharmacy students and OT/PT students, while SHS scores were significantly higher in OT/PT students. Subjective happiness was higher in the private university, with young, female students at the private university reporting higher SHS scores. Although the grit score was not correlated with SWLS, SHS, or ARS-30 scores, the SWLS was correlated with SHS. The SHS was a strong predictor of academic resilience in both OT/PT and pharmacy students.

CONCLUSION: Subjective happiness and satisfaction with life were found to be strong predictors of academic resilience among pharmacy students. Colleges of pharmacy may consider administering the SHS and/or SWLS at baseline and annually to measure well-being.

PMID:37852680 | DOI:10.1016/j.ajpe.2022.10.009

Lupus Sci Med. 2023 Oct;10(2):e000977. doi: 10.1136/lupus-2023-000977.

ABSTRACT

OBJECTIVES: Patients with SLE have higher cardiovascular (CV) risk compared with healthy controls (HC) and are characterised by accelerated atherosclerosis; intima media thickness (IMT), marker of subclinical atherosclerosis, is higher in patients with SLE than in HCs. Retinal microvascular impairment detected through optical coherence tomography angiography (OCTA) was investigated as a marker of systemic vascular involvement in SLE.The aim of the study was to evaluate the relationship between retinal vascular impairment and IMT in SLE.

METHODS: Cross-sectional study recruiting patients with SLE and HCs. Data of the study population were collected. CV risk was evaluated through the American College of Cardiology/American Heart Association (ACC/AHA) guidelines, Framingham and QRESEARCH risk estimator V.3 (QRISK3) scores. Both groups underwent OCTA and carotid ultrasound with IMT assessment.Statistical analysis was accomplished using Pearson/Spearman, t-test/Mann-Whitney or χ² test. Variables statistically significant at univariate regression analysis were tested in an age-corrected and sex-corrected multivariate regression model.

RESULTS: 43 patients with SLE and 34 HCs were recruited. Patients with SLE showed higher triglycerides (p=0.019), Triglycerides-Glucose (TyG) Index (p=0.035), ACC/AHA guidelines (p=0.001), Framingham Risk Scores (p=0.008) and a reduced superficial (p<0.001) and deep (p=0.005) whole retinal vessel density (VD) compared with HCs.In SLE univariate analysis, deep whole VD showed a negative correlation with IMT (p=0.027), age (p=0.001), systolic blood pressure (p=0.011), QRISK3 Score (p<0.001), Systemic Lupus International Collaborating Clinics Damage Index (p=0.006) and apolipoprotein B (p=0.021), while a positive correlation was found with female sex (p=0.029). Age-adjusted and sex-adjusted multivariate analysis confirmed QRISK3 Score (p=0.049) and IMT (p=0.039) to be independent risk factors for reduced retinal VD.

CONCLUSIONS: Patients with SLE showed lower retinal VD and higher CV risk indicators compared with HCs. Among patients with SLE, QRISK3 Score and IMT were found to be independent risk factors for retinal vascular impairment, suggesting a role of OCTA in evaluating preclinical CV involvement in SLE. Moreover, TyG Index could represent a biomarker of CV risk in patients with SLE compared with HCs.

PMID:37852671 | DOI:10.1136/lupus-2023-000977