Category: Nevin Manimala

BMJ Open. 2023 Jun 26;13(6):e070482. doi: 10.1136/bmjopen-2022-070482.

ABSTRACT

OBJECTIVES: Maximising the impact of community-based programmes requires understanding how supply of, and demand for, the intervention interact at the point of delivery.

DESIGN: Post-hoc analysis from a large-scale community health worker (CHW) study designed to increase the uptake of malaria diagnostic testing.

SETTING: Respondents were identified during a household survey in western Kenya between July 2016 and April 2017.

PARTICIPANTS: Household members with fever in the last 4 weeks were interviewed at 12 and 18 months post-implementation. We collected monthly testing data from 244 participating CHWs and conducted semistructured interviews with a random sample of 70 CHWs.

PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was diagnostic testing before treatment for a recent fever. The secondary outcomes were receiving a test from a CHW and tests done per month by each CHW.

RESULTS: 55% (n=948 of 1738) reported having a malaria diagnostic test for their recent illness, of which 38.4% were tested by a CHW. Being aware of a local CHW (adjusted OR=1.50, 95% CI: 1.10 to 2.04) and belonging to the wealthiest households (vs least wealthy) were associated with higher testing (adjusted OR=1.53, 95% CI: 1.14 to 2.06). Wealthier households were less likely to receive their test from a CHW compared with poorer households (adjusted OR=0.32, 95% CI: 0.17 to 0.62). Confidence in artemether-lumefantrine to cure malaria (adjusted OR=2.75, 95% CI: 1.54 to 4.92) and perceived accuracy of a malaria rapid diagnostic test (adjusted OR=2.43, 95% CI: 1.12 to 5.27) were positively associated with testing by a CHW. Specific CHW attributes were associated with performing a higher monthly number of tests including formal employment, serving more than 50 households (vs <50) and serving areas with a higher test positivity. On demand side, confidence of the respondent in a test performed by a CHW was strongly associated with seeking a test from a CHW.

CONCLUSION: Scale-up of community-based malaria testing is feasible and effective in increasing uptake among the poorest households. To maximise impact, it is important to recognise factors that may restrict delivery and demand for such services.

TRIAL REGISTRATION NUMBER: NCT02461628; Post-results.

PMID:37369403 | DOI:10.1136/bmjopen-2022-070482

Int J Med Inform. 2023 Jun 23;177:105134. doi: 10.1016/j.ijmedinf.2023.105134. Online ahead of print.

ABSTRACT

BACKGROUND: The search for valid information was one of the main challenges encountered during the COVID-19 pandemic, which resulted in the development of several online alternatives.

OBJECTIVES: To describe the development of a computational solution to interact with users of different levels of digital literacy on topics related to COVID-19 and to map the correlations between user behavior and events and news that occurred throughout the pandemic.

METHOD: CoronaAI, a chatbot based on Google’s Dialogflow technology, was developed at a public university in Brazil and made available on WhatsApp. The dataset with users’ interactions with the chatbot comprises approximately 7,000 hits recorded throughout eleven months of CoronaAI usage.

RESULTS: CoronaAI was widely accessed by users in search of valuable and updated information on COVID-19, including checking the veracity of possible fake news about the spread of cases, deaths, symptoms, tests and protocols, among others. The mapping of users’ behavior revealed that as the number of cases and deaths increased and as COVID-19 became closer, users showed a greater need for information applicable to self-care compared to following the statistical data. In addition, they showed that the constant updating of this technology may contribute to public health by enhancing general information on the pandemic and at the individual level by clarifying specific doubts about COVID-19.

CONCLUSION: Our findings reinforce the potential usefulness of chatbot technology to resolve a wide spectrum of citizens’ doubts about COVID-19, acting as a cost-effective tool against the parallel pandemic of misinformation and fake news.

PMID:37369153 | DOI:10.1016/j.ijmedinf.2023.105134

Int J Nurs Stud. 2023 Jun 12;145:104545. doi: 10.1016/j.ijnurstu.2023.104545. Online ahead of print.

ABSTRACT

BACKGROUND: Pressure injury risk assessment tools have several well-known limitations. As a result, new methods of assessing risk are emerging, including the use of sub-epidermal moisture measurement to detect localized edema.

AIMS: To assess the daily variation in sacral sub-epidermal moisture measurement over five days and establish if age and prophylactic sacral dressing use influenced these measurements.

METHODS: As part of a larger randomized controlled trial of the use of prophylactic sacral dressings, a longitudinal observational substudy was undertaken in hospitalized medical and surgical adult patients at risk of pressure injury. The substudy was conducted in consecutively recruited patients from 20 May 2021 to 9 November 2022. Using the SEM 200 (Bruin Biometrics LLC), daily sacral sub-epidermal measurements for up to five days were completed. Two measurements were generated, the most recent sub-epidermal moisture measurement and, after at least three measurements, a delta value, the difference between the highest and lowest values. The delta measurement was the outcome, with a delta of ≥0.60 considered abnormal, increasing the risk of pressure injury development. A mixed analysis of covariance was undertaken to determine if there was any change in delta measurements over the five days and to determine if age and sacral prophylactic dressing use influenced sub-epidermal moisture delta measurement.

RESULTS: A total of 392 participants were included in this study; 160 (40.8%) patients had completed five consecutive days of sacral sub-epidermal moisture delta measurements. In total, 1324 delta measurements were undertaken across the five study days. In total, 325 of 392 patients (82.9%) had experienced one or more abnormal delta. Furthermore, 191 (48.7%) and 96 (24.5%) of patients experienced abnormal deltas for two or more and three or more consecutive days. There was no statistically significant variation in sacral sub-epidermal moisture delta measurements over time; increasing age and prophylactic dressing use did not influence sub-epidermal moisture deltas over the five days.

CONCLUSION: If only one abnormal delta was used as a trigger, about 83% of patients would have received additional pressure injury prevention strategies. But, if a more nuanced approach to responding to abnormal deltas is taken, between 25 and 50% of patients may receive additional pressure injury prevention, representing a more time and resource efficient approach.

TWEETABLE ABSTRACT: Sub-epidermal moisture delta measurements did not vary over 5 days; increasing age and prophylactic dressing use did not influence these measurements.

PMID:37369147 | DOI:10.1016/j.ijnurstu.2023.104545

Am J Respir Crit Care Med. 2023 Jun 27. doi: 10.1164/rccm.202302-0289OC. Online ahead of print.

ABSTRACT

RATIONALE: Chronic obstructive pulmonary disease (COPD) is a prevalent and burdensome condition in low- and middle-income countries (LMICs). Challenges to better care include more effective diagnosis, and access to affordable interventions. There are no previous reports describing therapeutic needs in LMIC populations with COPD identified through screening.

OBJECTIVE: To describe unmet therapeutic need in screening-detected COPD in LMIC settings.

METHODS: We compared interventions recommended by the international ‘GOLD’ COPD strategy document, with that received, in 1000 people with COPD identified by population screening at three LMIC sites in Nepal, Peru and Uganda. We calculated costs using data on the availability and affordability of medicines.

MEASUREMENT AND MAIN RESULTS: The greatest unmet need for non-pharmacological interventions was for education and vaccinations (applicable to all), pulmonary rehabilitation (49%), smoking cessation (30%) and advice on biomass smoke exposure (26%). 95% of cases were previously undiagnosed and few were receiving therapy (4.5% had short-acting beta-agonists). Only three of 47 people (6%) with a previous COPD diagnosis had access to drugs consistent with recommendations. None of those with more severe COPD were accessing appropriate maintenance inhalers. Even when available, maintenance treatments were unaffordable with 30 days of treatment more than a low-skilled workers’ daily average wage.

CONCLUSION: We found significant missed opportunity to reduce the burden of COPD in LMIC settings, with most cases undiagnosed. Whilst there is unmet need in developing novel therapies, in LMICs where the burden is greatest, better diagnosis together with access to affordable interventions could translate to immediate benefit. This article is open access and distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).

PMID:37369142 | DOI:10.1164/rccm.202302-0289OC

Aust Health Rev. 2023 Jun 28. doi: 10.1071/AH23060. Online ahead of print.

ABSTRACT

ObjectivesTo assess whether compliance with the nationally endorsed Optimal Care Pathways is evident in 75% of patients treated with curative intent treatment and if this compliance was impacted by the COVID-19 pandemic (hereinafter COVID-19).MethodsThis retrospective study included patients undergoing curative treatment with radiotherapy in head and neck (HN), breast, lung and gastrointestinal malignancies between January 2019 and June 2021 in a single NSW outer metropolitan cancer service. For care delivered within the remit of cancer services, the primary outcome measure was the proportion of patients whose treatment complied with the Optimal Care Pathways recommended time frame. Secondary outcome measures included evaluating the effect of COVID-19 on the proportion of patients being treated within the recommended time frame.ResultsThere were n = 733 eligible patients across the five tumour streams with the majority being breast cancer patients comprising 65% (n = 479) of the cohort, followed by HN cancer patients (n = 125, 17%). None of the tumour subsites abided by the 75% compliance rate. Oesophageal cancer patients had the lowest compliance rate of 4% (P < 0.001), with a similarly low compliance rate for rectal cancer patients at 33% (P = 0.002). None of the hypothesis tests to assess for detriment in treatment time during COVID-19 were statistically significant (P > 0.05).ConclusionDespite the availability of best practice guidelines, there is limited compliance throughout all cancer subtypes, which has not been negatively influenced by COVID-19. Improved awareness of the Optimal Care Pathways, and implementation of the associated infrastructure and systems, are required to support compliance.

PMID:37369140 | DOI:10.1071/AH23060

Res Q Exerc Sport. 2023 Jun 27:1-10. doi: 10.1080/02701367.2023.2198575. Online ahead of print.

ABSTRACT

Purpose: This study investigated acute workload (wAW), chronic workload (wCW), acute: chronic workload ratio (wACWR), training monotony (wTM), perceived load training strain indicators (wTS), and countermove- ment jump (CMJ) as indicators of wellness in one season and defined weekly variations. In addition, we analyzed the relationships between training load measurements and weekly reports. Methods: 16 elite young wrestlers were monitored daily with individual observations for 46 consecutive weeks throughout the season. Training load was obtained using the session rating of perceived effort. wSleep, wStress, wFatigue & wMuscle Soreness well-being were monitored daily using the Hooper index. Results: As a result of the analysis, it was found that there is a moderate relationship (r = 0.51, p = .003) between ACWR and w mean load (A.U.) and a high relationship (r = 0.81, p < .001) between monotony and strain. Conclusion: All variables other than ACWR, w mean load, strain, and monotony presented small and statistically insignificant relationships. These results provide coaches and practitioners with new insights into perceived loads and health changes during a season at the elite youth level.

PMID:37369136 | DOI:10.1080/02701367.2023.2198575

Res Q Exerc Sport. 2023 Jun 27:1-14. doi: 10.1080/02701367.2023.2197024. Online ahead of print.

ABSTRACT

Background and aims: Muscle strength (MS) has been associated with better cardiometabolic health prognosis. However, the result for the beneficial relationship seems to be dependent on the influence of body size in determining MS levels. We investigate the association between allometric MS indexes and its association with cardiometabolic risk factors in adolescents. Methods: It was a cross-sectional study comprising 351 adolescents (male: 44.4%; age range 14-19 years) from Southern Brazil. MS was assessed by handgrip strength and three different allometric approaches were adopted: 1) MS index based on theoretical allometric exponent; 2) MS index including body mass and height; 3) MS index including fat-free mass and height. Obesity, high blood pressure, dyslipidemia, glucose imbalance and high-sensitivity C-reactive protein were investigated as individual factors or as combinations (either as combinations of components – presence of two adverse conditions, or number of components present in an individual – 0, 1, 2, 3+ cardiometabolic risk factors). Logistic and multinomial logistic regression analyses adjusted for confounding factors were used. The statistical significance adopted was 5%. Results: MS index based on theoretical allometric exponent was associated with lower likelihood (OR: 0.54; 95% CI: 0.28 – 0.89) for the presence of three or more cardiometabolic risk factors in the same individual. Conclusion: This study suggests that MS index based on the theoretical allometric exponent can be superior to allometric MS indexes that included body mass and height, or fat-free mass and height in representing the presence of high number of cardiometabolic risk factors in adolescents.

PMID:37369134 | DOI:10.1080/02701367.2023.2197024

Biosci Rep. 2023 Jun 27:BSR20230612. doi: 10.1042/BSR20230612. Online ahead of print.

ABSTRACT

Studies examining the role of signal transducer and activator of transcription 5 (STAT5) in various cancers have produced controversial results. To address this controversy, we examined the prognostic role of STAT5a in cancer patients across multiple cancers. Transcription levels of STAT5a between tumors and normal tissues, obtained from public databases, were analyzed for statistical differences using Cox regression analysis with the outcome as overall survival and covariate of interest as high STAT5a expression. Meta-analysis was then conducted to summarize the hazard ratio estimate from the Cox regression analyses. We found that STAT5a was significantly under-expressed in breast, lung, and ovarian cancers, while STAT5a was significantly overexpressed in lymphoid neoplasm diffuse large B-cell lymphoma, glioblastoma, and glioma. High STAT5a expression was significantly associated with favorable survival in bladder cancer (lnHR = -0.8689 [-1.4087; -0.3292], p-value = 0.0016), breast cancer (lnHR = -0.7805 [-1.1394; -0.4215], p-value < 0.0001) and lung cancer (lnHR = -0.3255 [-0.6427; -0.0083], p-value = 0.0443). After adjusting for clinicopathological factors, high STAT5a expression remained significantly associated with favorable survival in breast cancer (lnHR = -0.6091 [-1.0810; -0.1372], p-value = 0.0114). These results suggest that higher STAT5a expression is associated with favorable overall survival in breast cancer, and therefore might have protective effects, and that STAT5a expression could be a potential prognostic biomarker, especially in breast cancer. However, the prognostic role of STAT5a is dependent on cancer type.

PMID:37369132 | DOI:10.1042/BSR20230612

Addict Biol. 2023 Jul;28(7):e13288. doi: 10.1111/adb.13288.

ABSTRACT

Preclinical and clinical work suggests that mifepristone may be a viable treatment for alcohol use disorder (AUD). This was a Phase 1/2, outpatient, cross-over, randomized, double-blind, placebo-controlled trial with non-treatment-seeking individuals with AUD (N = 32). We assessed safety, alcohol craving and consumption, after 1-week mifepristone 600 mg/day administration, in a human laboratory study comprised of a single oral yohimbine administration (32.4 mg), a cue-reactivity procedure and alcohol self-administration. Safety was monitored by adverse events and hemodynamic parameters, alcohol craving by alcohol craving questionnaire and cue-induced saliva output. During the alcohol self-administration, we assessed alcohol pharmacokinetics, subjective effects and consumption. Outcomes were assessed using Generalized Estimating Equations and mediation analysis. Mild-moderate adverse events were reported in both conditions. There was no statistically significant difference between mifepristone and placebo in alcohol pharmacokinetics and subjective effects. Furthermore, blood pressure increased only in the placebo condition after the stress-induced laboratory procedures. Mifepristone, compared to placebo, significantly reduced alcohol craving and increased cortisol levels. Mifepristone-induced cortisol increase was not a mediator of alcohol craving. Mifepristone, compared to placebo, did not reduce alcohol consumption in the laboratory or in a naturalistic setting. This study successfully translated a developed preclinical procedure to a human laboratory study, confirming the safety of mifepristone in people with AUD and providing evidence to its role in reducing alcohol craving under stress procedures. The lack of effects on alcohol drinking may be related to the selection of non-treatment seekers and suggests future treatment-oriented trials should investigate mifepristone in people with AUD.

PMID:37369125 | DOI:10.1111/adb.13288

Optom Vis Sci. 2023 Jun 26. doi: 10.1097/OPX.0000000000002037. Online ahead of print.

ABSTRACT

SIGNIFICANCE: New refractive technologies are consistently emerging in the optometry market, necessitating validation against current clinical standards.

PURPOSE: To compare the refractive measurements between standard digital phoropter refraction and the Chronos binocular refraction system.

METHODS: Standardized subjective refraction was conducted on 70 adult participants using two separate refraction systems. The final subjective values from both devices were compared for M, J0, and J45. The time taken to complete refraction and patient’s comfort were also evaluated.

RESULTS: Good agreement was found between the standard and Chronos refraction, with narrow mean differences (including 95% confidence intervals), and no significant bias for M (0.03, -0.05 to 0.11 D), J0 (-0.02, -0.05 to -0.01 D) and J45 (-0.01, -0.03 to 0.01 D). The bounds of the limits of agreement (LoA) of M (lower bound -0.62, -0.76 to -0.49, and upper bound 0.68, 0.54 to 0.81), J0 (lower bound -0.24, -0.29 to -0.19) and upper bound (0.19, 0.15 to 0.24), and J45 (lower bound -0.18, -0.21 to -0.14) and upper bound (0.16, 0.12 to 0.19). No significant differences were noted between the two techniques for any of the refraction components (M standard: -3.03 ± 2.42 D, novel: -3.06 ± 2.37 D, Z = 0.07, P = .47, J0 standard: 0.12 ± 0.40 D, novel: 0.15 ± 0.41 D, Z = 1.32, P = .09, J45 standard: -0.04 ± 0.19 D, novel: -0.03 ± 0.19 D, Z = 0.50, P = .31). The Chronos was significantly faster than the standard technique, with an average difference of 19 seconds (standard: 190 ± 44 seconds, novel: 171 ± 38 seconds, Z = 4.91, P < .001).

CONCLUSIONS: The final subjective refraction endpoints of the standard technique and the Chronos were well aligned in this group of adult participants, and no statistically or clinically significant differences were noted in M, J0 or J45 components. The Chronos offered improved efficiency, meeting the demands of eye care.

PMID:37369097 | DOI:10.1097/OPX.0000000000002037