Category: Nevin Manimala

Afr J Reprod Health. 2022 Sep;26(9):31-47. doi: 10.29063/ajrh2022/v26i9.4.

ABSTRACT

A myriad of demand-side factors hamper childbearing women from utilizing needed skilled birth care in low and lower-middle-income countries. The objective of this scoping review is to explore the extent of evidence available on the subject matter and identify knowledge gaps in the reviewed literature. We used the Arksey and O’Malley scoping review framework as a guide for this review and conducted searches on four electronic databases: PubMed, Embase, PsycInfo and Google Scholar. Eligible studies were those published in English and French languages between 2013 and 2022 that discussed demand-side barriers to access and utilization of skilled birth care in low and lower-middle-income countries. Five themes emerged as major types of barriers influencing the utilization of skilled birth care in low and lower-middle-income countries. These were socio-economic and socio-demographic status of women; lack of access to healthcare facilities; cost of healthcare services; ineffective healthcare systems and socio-cultural/religious factors. The identified gap in the literature was the lack of studies on the influence of women’s behaviour and psychological traits as barriers to the use of skilled birth care among reviewed publications. To design effective interventions, it is important to consider all influential factors that determine the utilization of skilled birth care by women in low-resource settings.

PMID:37585068 | DOI:10.29063/ajrh2022/v26i9.4

Am J Med Genet C Semin Med Genet. 2023 Aug 16:e32061. doi: 10.1002/ajmg.c.32061. Online ahead of print.

ABSTRACT

With the advances in computer vision, computational facial analysis has become a powerful and effective tool for diagnosing rare disorders. This technology, also called next-generation phenotyping (NGP), has progressed significantly over the last decade. This review paper will introduce three key NGP approaches. In 2014, Ferry et al. first presented Clinical Face Phenotype Space (CFPS) trained on eight syndromes. After 5 years, Gurovich et al. proposed DeepGestalt, a deep convolutional neural network trained on more than 21,000 patient images with 216 disorders. It was considered a state-of-the-art disorder classification framework. In 2022, Hsieh et al. developed GestaltMatcher to support the ultra-rare and novel disorders not supported in DeepGestalt. It further enabled the analysis of facial similarity presented in a given cohort or multiple disorders. Moreover, this article will present the usage of NGP for variant prioritization and facial gestalt delineation. Although NGP approaches have proven their capability in assisting the diagnosis of many disorders, many limitations remain. This article will introduce two future directions to address two main limitations: enabling the global collaboration for a medical imaging database that fulfills the FAIR principles and synthesizing patient images to protect patient privacy. In the end, with more and more NGP approaches emerging, we envision that the NGP technology can assist clinicians and researchers in diagnosing patients and analyzing disorders in multiple directions in the near future.

PMID:37584245 | DOI:10.1002/ajmg.c.32061

J Gerontol B Psychol Sci Soc Sci. 2023 Aug 16:gbad111. doi: 10.1093/geronb/gbad111. Online ahead of print.

ABSTRACT

OBJECTIVES: Several U.S. health surveillance surveys contain items related to self and proxy reports of dementia and subjective memory complaints (SMC). Despite their similar content, these items differ in terminology, item specificity, and time frame. The goal of this study was to analyze whether item features might influence endorsement rates for dementia and SMC.

METHODS: We calculated design-appropriate estimates for the endorsement of dementia and SMC across U.S.-based national surveys and employed pairwise comparisons to evaluate endorsement rates across surveys. We also examined item characteristics to explore possible effects on endorsement rates.

RESULTS: Endorsement rates were wide ranging for dementia (ranging from 2.7% – 9.9%) and SMC (5.6% – 46.6%). Pairwise comparisons revealed statistically significant differences on most dementia-related items (76%), and all SMC comparisons (100%). Items varied substantially in the terminology used to assess dementia and SMC (e.g., “dementia” versus “Alzheimer’s disease”) and used different time frames (e.g., “past month” versus “five years”).

DISCUSSION: National survey data on reported dementia and SMC can have important research, training, and policy implications, yet endorsement rates vary widely across surveys. That variability could emerge from subtle but influential item characteristics, and our findings highlight the need for item harmonization, in even their most basic characteristics. Standardizing items across national surveillance surveys facilitates comparison across surveys so that we can better understand the true burden of these conditions to inform public health initiatives.

PMID:37584229 | DOI:10.1093/geronb/gbad111

Dtsch Arztebl Int. 2023 Oct 13;(Forthcoming):arztebl.m2023.0175. doi: 10.3238/arztebl.m2023.0175. Online ahead of print.

ABSTRACT

BACKGROUND: Mediation analysis addresses the question of the mechanisms by which an exposure causes an outcome. This article is intended to convey basic knowledge of statistical mediation analysis.

METHODS: Selected articles and examples are used to explain the principle of mediation analysis.

RESULTS: The goal of mediation analysis is to express an overall exposure effect as a combination of an indirect and a direct effect. For example, it might be of interest whether the increased risk of diabetes (outcome) due to obesity (exposure) is mediated by insulin resistance (indirect effect), and, if so, how much of a direct effect remains. In this example, insulin resistance is a potential mediator of the effect of obesity on the risk of diabetes. In general, for a mediation analysis to be valid, more confounders must be taken into account than in the estimation of the overall effect size. A regression-based approach can be used to ensure the consideration of all relevant confounders in a mediation analysis.

CONCLUSION: By decomposing the overall exposure effect into indirect and direct components, a mediation analysis can reveal not just whether an exposure causes an outcome, but also how. For a mediation analysis to be valid, however, multiple assumptions must be satisfied that cannot easily be checked, potentially compromising such analyses as compared to the estimation of an overall effect.

PMID:37584228 | DOI:10.3238/arztebl.m2023.0175

PM R. 2023 Aug 16. doi: 10.1002/pmrj.13056. Online ahead of print.

ABSTRACT

INTRODUCTION: Amputation is a major condition that requires inpatient rehabilitation. Some research has been conducted to explore the risk factors for readmission of patients from inpatient rehabilitation facilities to acute care hospitals. However, few studies have included patients with amputation in the study population.

OBJECTIVE: This study aimed to identify the risk factors for readmission of patients with amputation to acute care hospitals from an inpatient rehabilitation facility.

DESIGN: Retrospective cohort study.

SETTING: An acute rehabilitation hospital associated with a community-based tertiary medical center.

PATIENTS: A retrospective review of 156 independent admissions of 145 patients from June 2019 to July 2022.

MAIN OUTCOME MEASURE: The study outcome measure was readmission to acute care from an acute rehabilitation unit.

RESULTS: Of the 156 independent admissions, the readmission rate was 19%(29/156). The most common cause of transfer was incision-site complications (9/29, 31%) including wound infection and wound dehiscence. Patients with amputation readmitted to acute care are more likely to be on dialysis(p < 0.001), have a longer length of stay in acute care before admission to the rehabilitation facility(p = 0.039), and lower Section GG score on admission(p < 0.001). Age, sex, ethnicity, amputation level and history of diabetes mellitus were not associated with acute care hospital readmission. The logistic regression model revealed that patients being on dialysis was the only significant risk factor predictive of readmission to acute care (odds ration[OR] 4.82, p = 0.006).

CONCLUSIONS: This study showed that incision-site complications were the most common cause of disruption in inpatient rehabilitation via acute hospital readmission in patients with amputation. Being on dialysis was associated with a higher risk of readmission to acute care hospitals. Based on the results of this study, specific rehabilitation plans might be required for patients with amputation that carry certain risk factors to reduce rehospitalization to the acute care unit. This article is protected by copyright. All rights reserved.

PMID:37584174 | DOI:10.1002/pmrj.13056

Hosp Pediatr. 2023 Aug 16:e2023007226. doi: 10.1542/hpeds.2023-007226. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Children and Youth with Special Health Care Needs (CYSHCN) have differing risk factors and injury characteristics compared with peers without special health care needs (SHCN). We examined the association between SHCN status and complications, mortality, and length of stay (LOS) after trauma hospitalization.

METHODS: We conducted a cross-sectional study using 2018 data from the National Trauma Data Bank for patients aged 1 to 18 years (n = 108 062). We examined the following hospital outcomes: any complication reported, unplanned admission to the ICU, in-hospital mortality, and hospital and ICU LOS. Multivariate regression models estimated the effect of SHCN status on hospital outcomes after controlling for patient demographics, injury severity score, and Glasgow Coma Score. Subanalyses examined outcomes by age, SHCN, and injury severity score.

RESULTS: CYSHCN encounters had a greater adjusted relative risk (ARR) of any hospital complications (ARR = 2.980) and unplanned admission to the ICU (ARR = 1.996) than encounters that did not report a SHCN (P < .001). CYSHCN had longer hospital (incidence rate ratio = 1.119) and ICU LOS (incidence rate ratio = 1.319, both P < .001). There were no statistically significant in-hospital mortality differences between CYSHCN and those without. Lower severity trauma was associated with a greater ARR of hospital complications for CYSHCN encounters versus non-CYSHCN encounters.

CONCLUSIONS: CYSHCN, particularly those with lower-acuity injuries, are at greater risk for developing complications and requiring more care after trauma hospitalization. Future studies may examine mechanisms of hospital complications for traumatic injuries among CYSHCN to develop prevention and risk-minimization strategies.

PMID:37584151 | DOI:10.1542/hpeds.2023-007226

J Pediatric Infect Dis Soc. 2023 Aug 16:piad054. doi: 10.1093/jpids/piad054. Online ahead of print.

ABSTRACT

BACKGROUND: Unwarranted variation in disposition decisions exist among children with pneumonia. We validated three prognostic models for predicting pneumonia severity among children in the emergency department (ED) and hospital.

METHODS: We performed a two-center, prospective study of children 6 months to <18 years presenting to the ED with pneumonia from January 2014 to May 2019. We evaluated three previously developed disease-specific prognostic models which use demographic, clinical, and diagnostic predictor variables, with each model estimating risk for Very Severe (mechanical ventilation or shock), Severe (ICU without very severe features), and Moderate/Mild (Hospitalization without severe features or ED discharge) pneumonia. Predictive accuracy was measured using discrimination (concordance or c-statistic) and re-calibration.

RESULTS: There were 1088 children included in one or more of the three models. Median age was 3.6 years and the majority of children were male (53.7%) and identified as non-Hispanic White (63.7%). The distribution for the ordinal severity outcome was mild or moderate (79.1%), severe (15.9%), and very severe (4.9%). The three models each demonstrated excellent discrimination (C-statistic range across models (0.786-0.803) with no appreciable degradation in predictive accuracy from the derivation cohort.

CONCLUSION: All three prognostic models accurately identified risk for three clinically meaningful levels of pneumonia severity and demonstrated very good predictive performance. Physiologic variables contributed the most to model prediction. Application of these objective tools may help standardize and improve disposition and other management decisions for children with pneumonia.

PMID:37584111 | DOI:10.1093/jpids/piad054

Pediatrics. 2023 Aug 16:e2023061522. doi: 10.1542/peds.2023-061522. Online ahead of print.

ABSTRACT

BACKGROUND: Although significant research is devoted to transitions of care at discharge, few measures assess the quality of transitions into the hospital. Our objective was to develop a caregiver-reported quality measure to evaluate the pediatric hospital admission experience.

METHODS: Measure development included: (1) adapting items from existing instruments; (2) an expert-consensus process to prioritize survey items; (3) cognitive pretesting with caregivers (n = 16); and (4) pilot testing revised items (n = 27). Subsequently, the survey was administered to caregivers at 2 children’s hospitals and 1 general hospital from February 2020 through November 2021. Item reduction statistics and exploratory factor analysis were performed followed by confirmatory factor analysis. Domain scores were calculated using a top-box approach. Known-group validity and indices of model fit were evaluated.

RESULTS: The initial survey included 25 items completed by 910 caregivers. Following item reduction and the exploratory factor analysis, 14 items were mapped to 4 domains: (1) Patient and Family Engagement, (2) Information Sharing, (3) Effectiveness of Care Delivery, and (4) Timeliness of Care. The confirmatory factor analysis and validity testing supported the factor structure. Domain scores ranged from 49% (95% confidence interval, 46-53) for Timelines of Care to 81% (95% confidence interval, 65-84) for Patient and Family Engagement, with significant differences between general and children’s hospitals in Information Sharing and Effectiveness of Care Delivery.

CONCLUSIONS: A 4-domain caregiver-reported hospital admission experience measure demonstrated acceptable validity and psychometric properties across children’s and general hospitals. This measure can be used to evaluate the quality of transitions into the hospital and to focus quality improvement efforts.

PMID:37584105 | DOI:10.1542/peds.2023-061522

Exp Dermatol. 2023 Aug 16. doi: 10.1111/exd.14904. Online ahead of print.

ABSTRACT

The risk of diabetes mellitus (DM) in vitiligo patients is higher than that in non-vitiligo population. Our goal was to explore the influencing factors for DM in vitiligo patients. A matched-pair design of 107 cases with DM and 428 controls without DM was conducted among vitiligo patients in Xijing hospital from January 2010 to October 2021. The baseline characteristics of patients were analysed based on standard descriptive statistics. The vitiligo-associated characteristics were analysed by logistic regression to identify influencing factors of DM. Interaction analysis was performed to explore the additive interactions between vitiligo-associated characteristics and baseline characteristics. After adjustment for the baseline characteristics, the severity of vitiligo [odds ratio (OR) = 2.47, 95% confidence interval (CI): 1.47-4.14] and onset age of vitiligo (OR = 0.98, 95% CI: 0.97-0.99) had a significant correlation with occurrence of DM. The severity of vitiligo had additive interaction with family history of diabetes [relative excess risk due to interaction (RERI) = 132.51 (95% CI: 5.51-1100.20), attributable proportion (AP) = 0.91 (95% CI: 0.17-0.95), synergy index (S) = 11.53 (95% CI: 1.32-100.5)] and with smoking history [RERI = 6.54 (95% CI: 0.67-19.83), AP = 0.64 (95% CI: 0.04-0.80), S = 3.48 (95% CI: 1.17-10.36)]. Earlier onset age of vitiligo and greater BSA involvement might be two independent risk factors for DM in vitiligo patients. Interaction assessment identified the severity of vitiligo as additive interaction factors with diabetes family history and with smoking history for the DM occurrence.

PMID:37584091 | DOI:10.1111/exd.14904

Cancer Commun (Lond). 2023 Aug 16. doi: 10.1002/cac2.12478. Online ahead of print.

NO ABSTRACT

PMID:37584087 | DOI:10.1002/cac2.12478