Category: Nevin Manimala

BMJ Open. 2023 May 18;13(5):e071381. doi: 10.1136/bmjopen-2022-071381.

ABSTRACT

INTRODUCTION: Historic disruption in health infrastructure combined with data from a recent vaccine coverage survey suggests there are likely significant immunity gaps to vaccine preventable diseases and high risk of outbreaks in Timor-Leste. Community-based serological surveillance is an important tool to augment understanding of population-level immunity achieved through vaccine coverage and/or derived from prior infection.

METHODS AND ANALYSIS: This national population-representative serosurvey will take a three-stage cluster sample and aims to include 5600 individuals above 1 year of age. Serum samples will be collected by phlebotomy and analysed for measles IgG, rubella IgG, SARS-CoV-2 antispike protein IgG, hepatitis B surface antibody and hepatitis B core antigen using commercially available chemiluminescent immunoassays or ELISA. In addition to crude prevalence estimates and to account for differences in Timor-Leste’s age structure, stratified age-standardised prevalence estimates will be calculated, using Asia in 2013 as the standard population. Additionally, this survey will derive a national asset of serum and dried blood spot samples which can be used for further investigation of infectious disease seroepidemiology and/or validation of existing and novel serological assays for infectious diseases.

ETHICS AND DISSEMINATION: Ethical approval has been obtained from the Research Ethics and Technical Committee of the Instituto Nacional da Saúde, Timor-Leste and the Human Research Ethics Committee of the Northern Territory Department of Health and Menzies School of Health Research, Australia. Co-designing this study with Timor-Leste’s Ministry-of-Health and other relevant partner organisations will allow immediate translation of findings into public health policy, which may include changes to routine immunisation service delivery and/or plans for supplementary immunisation activities.

PMID:37202138 | DOI:10.1136/bmjopen-2022-071381

BMJ Open. 2023 May 18;13(5):e067343. doi: 10.1136/bmjopen-2022-067343.

ABSTRACT

INTRODUCTION: In Liberia, emergency care is still in its early development. In 2019, two emergency care and triage education sessions were done at J. J. Dossen Hospital in Southeastern Liberia. The observational study objectives evaluated key process outcomes before and after the educational interventions.

METHODS: Emergency department paper records from 1 February 2019 to 31 December 2019 were retrospectively reviewed. Simple descriptive statistics were used to describe patient demographics and χ² analyses were used to test for significance. ORs were calculated for key predetermined process measures.

RESULTS: There were 8222 patient visits recorded that were included in our analysis. Patients in the post-intervention 1 group had higher odds of having a documented full set of vital signs compared with the baseline group (16% vs 3.5%, OR: 5.4 (95% CI: 4.3 to 6.7)). After triage implementation, patients who were triaged were 16 times more likely to have a full set of vitals compared with those who were not triaged. Similarly, compared with the baseline group, patients in the post-intervention 1 group had higher odds of having a glucose documented if they presented with altered mental status or a neurologic complaint (37% vs 30%, OR: 1.7 (95% CI: 1.3 to 2.2)), documented antibiotic administration if they had a presumed bacterial infection (87% vs 35%, OR: 12.8 (95% CI: 8.8 to 17.1)), documented malaria test if presenting with fever (76% vs 61%, OR: 2.05 (95% CI: 1.37 to 3.08)) or documented repeat set of vitals if presenting with shock (25% vs 6.6%, OR: 8.85 (95% CI: 1.67 to 14.06)). There was no significant difference in the above process outcomes between the education interventions.

CONCLUSION: This study showed improvement in most process measures between the baseline and post-intervention 1 groups, benefits that persisted post-intervention 2, thus supporting the importance of short-course education interventions to durably improve facility-based care.

PMID:37202137 | DOI:10.1136/bmjopen-2022-067343

BMJ Open. 2023 May 18;13(5):e069683. doi: 10.1136/bmjopen-2022-069683.

ABSTRACT

OBJECTIVE: To assess the magnitude of suicidal ideation, attempts and associated factors among adults living with HIV attending antiretroviral therapy follow-ups at Tirunesh Beijing General Hospital, Addis Ababa.

DESIGN: Hospital-based observational, descriptive, cross-sectional study was conducted.

SETTING: A study was conducted in Tirunesh Beijing General Hospital, Addis Ababa from 8 February 2022 to 10 July 2022.

PARTICIPANTS: Two hundred and thirty-seven HIV-positive youth were recruited for interviews, using the systematic random sampling technique. The Composite International Diagnostic Interview was used to assess suicide. Patient Health Questionnaire-9, the Oslo social support and HIV perceived stigma scale instruments were used to assess the factors. Bivariate and multivariate logistic regressions were computed to assess factors associated with suicidal ideation and attempt. Statistical significance was declared at p value <0.05.

RESULTS: The finding of the study revealed magnitude of suicide ideation and suicide attempt was 22.8% and 13.5%, respectively. Disclosure status (adjusted odd ratio (AOR)=3.60, 95% CI 1.44 to 9.01), history of using substances (AOR)=2.86, 95% CI 1.07 to 7.61), living alone (AOR=6.47, 95% CI 2.31 to 18.10) and having comorbidity or other opportunistic infection (AOR=3.74, 95% CI 1.32 to 10.52) are factors associated with suicide ideation while disclosure status (AOR=5.02, 95% CI 1.95 to 12.94), living arrangement (AOR=3.82, 95% CI 1.29 to 11.31) and depression history is a factor associated with suicide attempts (AOR=3.37, 95% CI 1.09 to 10.40).

CONCLUSION: The finding of the study indicated the magnitude of suicide ideation and attempt is high among the subjects included in this study. Disclosure status, history of using substances, living alone and having comorbidity or other opportunistic infection are factors associated with suicide ideation while disclosure status, living arrangement and depression history are factors associated with a suicide attempt.

PMID:37202134 | DOI:10.1136/bmjopen-2022-069683

BMJ Open. 2023 May 18;13(5):e069355. doi: 10.1136/bmjopen-2022-069355.

ABSTRACT

INTRODUCTION: Data linkage systems have proven to be a powerful tool in support of combating and managing the COVID-19 pandemic. However, the interoperability and the reuse of different data sources may pose a number of technical, administrative and data security challenges.

METHODS AND ANALYSIS: This protocol aims to provide a case study for linking highly sensitive individual-level information. We describe the data linkages between health surveillance records and administrative data sources necessary to investigate social health inequalities and the long-term health impact of COVID-19 in Belgium. Data at the national institute for public health, Statistics Belgium and InterMutualistic Agency are used to develop a representative case-cohort study of 1.2 million randomly selected Belgians and 4.5 million Belgians with a confirmed COVID-19 diagnosis (PCR or antigen test), of which 108 211 are COVID-19 hospitalised patients (PCR or antigen test). Yearly updates are scheduled over a period of 4 years. The data set covers inpandemic and postpandemic health information between July 2020 and January 2026, as well as sociodemographic characteristics, socioeconomic indicators, healthcare use and related costs. Two main research questions will be addressed. First, can we identify socioeconomic and sociodemographic risk factors in COVID-19 testing, infection, hospitalisations and mortality? Second, what is the medium-term and long-term health impact of COVID-19 infections and hospitalisations? More specific objectives are (2a) To compare healthcare expenditure during and after a COVID-19 infection or hospitalisation; (2b) To investigate long-term health complications or premature mortality after a COVID-19 infection or hospitalisation; and (2c) To validate the administrative COVID-19 reimbursement nomenclature. The analysis plan includes the calculation of absolute and relative risks using survival analysis methods.

ETHICS AND DISSEMINATION: This study involves human participants and was approved by Ghent University hospital ethics committee: reference B.U.N. 1432020000371 and the Belgian Information Security Committee: reference Beraadslaging nr. 22/014 van 11 January 2022, available via https://www.ehealth.fgov.be/ehealthplatform/file/view/AX54CWc4Fbc33iE1rY5a?filename=22-014-n034-HELICON-project.pdf. Dissemination activities include peer-reviewed publications, a webinar series and a project website.The pseudonymised data are derived from administrative and health sources. Acquiring informed consent would require extra information on the subjects. The research team is prohibited from gaining additional knowledge on the study subjects by the Belgian Information Security Committee’s interpretation of the Belgian privacy framework.

PMID:37202131 | DOI:10.1136/bmjopen-2022-069355

BMJ Open. 2023 May 18;13(5):e071155. doi: 10.1136/bmjopen-2022-071155.

ABSTRACT

INTRODUCTION: Considering the increasing complexity of care and workload for home care nurses due to the ageing of the population, it is crucial to describe the work environment and the community care setting. The aim of this study protocol is to map the characteristics and identify gaps of home care in the community to design future interventions aimed at ensuring quality and safety.

METHODS AND ANALYSIS: This is a national cross-sectional descriptive observational study using the survey method. Nurses from all participating community care centres will be recruited through convenience sampling by the coordinators of each centre, who will act as facilitators for this study. All community care recipients and their informal carers during the study period will be invited to complete a survey.To map the characteristics and identify gaps of home care in the community, three sources of data will be collected: (1) organisational characteristics, professional satisfaction, intention to leave and burn-out; (2) experience of care recipients and their informal carers and (3) improper access to the emergency department, readmission to hospital, comorbidities, services offered and users’ level of autonomy, and main and secondary diagnoses.Considering the total Italian nursing population of approximately 450 000 registered nurses, a sample size of 1% of this population, equal to approximately 4600 nurses, was hypothesised.This study started in July 2022 and is planned to end in December 2023.Data will be analysed using descriptive and inferential statistics.

ETHICS AND DISSEMINATION: This study protocol was approved by the Liguria Regional Ethics Committee in November 2022. Informed consent will be obtained from participants and confidentiality will be ensured. Data collected for this study will be kept anonymised in a protected database.The results of the study will be disseminated mainly through conferences, publications and meetings with government representatives.

PMID:37202129 | DOI:10.1136/bmjopen-2022-071155

BMJ Open. 2023 May 18;13(5):e069851. doi: 10.1136/bmjopen-2022-069851.

ABSTRACT

OBJECTIVE: This study aimed to assess the prevalence and determinants of anaemia among lactating and non-lactating women in low-income and middle-income countries (LMICs).

DESIGN: Comparative cross-sectional study.

SETTING: LMICs.

PARTICIPANTS: Reproductive-age women.

PRIMARY OUTCOME: Anaemia.

METHODS: Data for the study were drawn from the recent 46 LMICs Demographic and Health Surveys (DHS). A total of 185 330 lactating and 827 501 non-lactating women (both are non-pregnant) who gave birth in the last 5 years preceding the survey were included. STATA V.16 was used to clean, code and analyse the data. Multilevel multivariable logistic regression was employed to identify factors associated with anaemia. In the adjusted model, the adjusted OR with 95% CI and a p value <0.05 was reported to indicate statistical association.

RESULT: The prevalence of anaemia among lactating and non-lactating women was found at 50.95% (95% CI 50.72, 51.17) and 49.33% (95% CI 49.23%, 49.44%), respectively. Maternal age, mother’s educational status, wealth index, family size, media exposure, residence, pregnancy termination, source of drinking water and contraceptive usage were significantly associated determinants of anaemia in both lactating and non-lactating women. Additionally, the type of toilet facility, antenatal care visit, postnatal care visit, iron supplementation and place of delivery were factors significantly associated with anaemia in lactating women. Besides, smoking was significantly associated with anaemia in non-lactating women.

CONCLUSIONS AND RECOMMENDATIONS: The prevalence of anaemia was higher in lactating women compared with non-lactating. Almost half of the lactating and non-lactating women were anaemic. Both individual-level and community-level factors were significantly associated with anaemia. Governments, non-governmental organisations, healthcare professionals and other stakeholders are recommended to primarily focus on disadvantageous communities where their knowledge, purchasing power, access to healthcare facilities, access to clean drinking water and clean toilet facilities are minimal.

PMID:37202128 | DOI:10.1136/bmjopen-2022-069851

BMJ Open. 2023 May 18;13(5):e072059. doi: 10.1136/bmjopen-2023-072059.

ABSTRACT

OBJECTIVES: This study set out to assess the knowledge, perception and practices of consumers regarding self-medication with over-the-counter (OTC) drugs, the prevalence of risky practices and their associated factors in pharmacy outlets in Ibadan, Southwestern Nigeria.

SETTING: A cross-sectional study was conducted using an interviewer administered questionnaire. Descriptive statistics and multivariate analysis were performed by using SPSS V.23 with statistical significance set at p<0.05.

PARTICIPANTS: 658 adult consumers aged 18 years and above.

PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was self-medication, measured using the following question: A positive answer indicates a self-medicated participant. Do you practise self-medication?

RESULTS: Respondents who had practised self-medication with OTC drugs were 562 (85.4%), of which over 95% were involved in risky practice. Consumers agreed (73.4%) that OTC drugs can be recommended by pharmacists and perceived (60.4%) that OTC drugs are harmless regardless of how they are used. Reasons for practising self-medication with OTC drugs include: if it is a minor condition, I can take the initiative (90.9%), visiting a hospital wastes my time (75.5%) and ease accessibility of the pharmacy (88.9%). Overall, (83.7%) respondents had good practices of handling and use of OTC drugs, while (56.1%) had good knowledge of OTC drugs and identification of OTC drugs. Factors associated with consumer handling and use of OTC drugs in self-medication were older participants (p=0.01), those with postsecondary education (p=0.02), and who possessed good knowledge (0.02), were more likely to practise self-medication with OTC drugs.

CONCLUSION: The study revealed a high prevalence of self-medication, good practices towards handling and use of OTC drugs, and moderate knowledge of OTC drugs by the consumers. This underscores the need for policy-makers to introduce measures to enforce consumer education by community pharmacists to minimise the risks of inappropriate self-medication with OTC drugs.

PMID:37202127 | DOI:10.1136/bmjopen-2023-072059

BMJ Open. 2023 May 18;13(5):e063026. doi: 10.1136/bmjopen-2022-063026.

ABSTRACT

OBJECTIVES: To systematically review and provide estimates of the minimal important change (MIC) and difference (MID) for outcome tools in people with knee osteoarthritis (OA) after non-surgical interventions. Design A systematic review.

DATA SOURCES: MEDLINE, CINAHL, Web of Science, Scopus and Cochrane databases were searched up to 21 September 2021.

ELIGIBILITY CRITERIA: We included studies that calculated MIC and MID using any calculation method including anchor, consensus and distribution methods, for any knee OA outcome tool after non-surgical interventions.

DATA EXTRACTION AND SYNTHESIS: We extracted reported MIC, MID and minimum detectable change (MDC) estimates. We used quality assessment tools appropriate to the studies’ methods to screen out low-quality studies. Values were combined to produce a median and range, for each method.

RESULTS: Forty-eight studies were eligible (anchor-k=12, consensus-k=1 and distribution-k=35). MIC values for 13 outcome tools including Knee injury and Osteoarthritis Outcome Score (KOOS)-pain, activities of daily living (ADL), quality of life (QOL) and Western Ontario and McMaster Universities Arthritis Index (WOMAC)-function were estimated using 5 high-quality anchor studies. MID values for 23 tools including KOOS-pain, ADL, QOL and WOMAC-function, stiffness and total were estimated using 6 high-quality anchor studies. One moderate quality consensus study reported MIC for pain, function and global assessment. MDC values from distribution method estimates for 126 tools including KOOS-QOL and WOMAC-total were estimated using 38 good-to-fair-quality studies.

CONCLUSION: Median MIC, MID and MDC estimates were reported for outcome tools in people with knee OA after non-surgical interventions. The results of this review clarify the current understanding of MIC, MID and MDC in the knee OA population. However, some estimates suggest considerable heterogeneity and require careful interpretation.

PROSPERO REGISTRATION NUMBER: CRD42020215952.

PMID:37202126 | DOI:10.1136/bmjopen-2022-063026

Zhejiang Da Xue Xue Bao Yi Xue Ban. 2022 Aug 1;51(4):480-490. doi: 10.3724/zdxbyxb-2022-0145.

ABSTRACT

OBJECTIVE: To evaluate the efficacy and safety of antidepressants in treatment of depression disorder in children and adolescents by network meta-analysis.

METHODS: Databases of PubMed, Cochrane Library, EMBASE, Web of Science, PsycINFO, CBM, CNKI and Wanfang Data were searched for randomized controlled trials (RCT) related to antidepressants in treatment of children and adolescents with depression from inception to December 2021. Quality assessment and data extraction from the included RCTs were performed. Statistical analyses of efficacy and tolerability were conducted with Stata 15.1 software. Surface under the cumulative ranking (SUCAR) was used to rank the value of the antidepressants.

RESULTS: A total of 33 RCTs were included in 32 articles, involving 6949 patients. There are 13 antidepressants used in total, including amitriptyline, vilazodone, fluoxetine, selegiline, paroxetine, imipramine, desipramine, sertraline, nortriptyline, escitalopram, citalopram, venlafaxine and duloxetine. The results of network meta-analysis showed that the efficacy of duloxetine ( OR=1.95, 95% CI: 1.41-2.69), fluoxetine ( OR=1.73, 95% CI: 1.40-2.14), venlafaxine ( OR=1.37, 95% CI: 1.04-1.80) and escitalopram ( OR=1.48, 95% CI: 1.12-1.95) were significantly higher than that of placebos (all P<0.05); the probability cumulative ranks were duloxetine (87.0%), amitriptyline (83.3%), fluoxetine (79.0%), escitalopram (62.7%), etc. The results showed that the intolerability of patients receiving imipramine ( OR=0.15, 95% CI: 0.08-0.27), sertraline ( OR=0.33, 95% CI: 0.16-0.71), venlafaxine ( OR=0.35, 95% CI: 0.17-0.72), duloxetine ( OR=0.35, 95% CI: 0.17-0.73) and paroxetine ( OR=0.52, 95% CI: 0.30-0.88) were significantly higher than that of placebos (all P<0.05), and the probability cumulative ranks were imipramine (95.7%), sertraline (69.6%), venlafaxine (68.6%), duloxetine (68.2%), etc. Conclusion: Among 13 antidepressants, duloxetine, fluoxetine, escitalopram and venlafaxine are significantly better than placebo in terms of efficacy, but duloxetine and venlafaxine are less well tolerated.

PMID:37202104 | DOI:10.3724/zdxbyxb-2022-0145

Zhejiang Da Xue Xue Bao Yi Xue Ban. 2022 Aug 1;51(4):438-453. doi: 10.3724/zdxbyxb-2022-0283.

ABSTRACT

OBJECTIVE: To explore the characteristics of intestinal microecology in hepatocellular carcinoma (HCC) model mice.

METHODS: C57BL/6 male mice aged 2 weeks were divided into normal control group and HCC model group. Mice in HCC model group were exposed to a single intraperitoneal injection of diethylnitrosamine (DEN) 2 weeks after birth; the surviving mice were intraperitoneally injected with 1,4-bis[2-(3,5-dichloropyridyloxy)]benzene (TCPOBOP), once every 2 weeks for 8 times starting from the 4 ^th week after birth. Mice in each group were randomly selected and sacrificed at 10 ^th, 18 ^th and 32 ^nd weeks after birth, respectively, the liver tissue samples were obtained for histopathological examination. At the 32 ^nd week, all mice in both groups were sacrificed and the feces samples were collected under sterile conditions right before the sacrifice. The feces samples were sequenced for the V3-V4 hypervariable regions of the 16S rRNA gene, and the species abundance, flora diversity and phenotype, as well as flora correlation and functional prediction were analyzed.

RESULTS: Alpha diversity analysis showed that all Good’s coverage reached the maximum value of 1.00, and the differences in the Observed features, Chao1 index, Shannon index and Simpson index of the intestinal flora of mice between normal control group and HCC model group were all statistically significant (all P<0.05). Beta diversity analysis showed that PCoA based on weighted or unweighted Unifrac distances all yielded R>0, confirming that the intra-group differences of the samples were less than the inter-group differences; the trend of separation between the two groups was significant ( P<0.05). Bacteroidetes, Firmicutes, Actinobacteria and Patescibacteria were the dominant taxa at the phylum level in both normal control group and HCC model group. However, compared with normal control group, the abundance of Bacteroidetes in HCC model group was significantly decreased ( P<0.01), while the abundance of Patescibacteria was significantly increased ( P<0.05). Moreover, the dominant taxa at the genus level in normal control group mainly included Muribaculaceae_unclassified, Paramuribaculum, Muribaculum, Lachnospiraceae_NK4A 136 group, Olsenella. The dominant taxa at the genus level in HCC model group mainly included Akkermansia, Dubosiella, Muribaculaceae_unclassified, Lachnospiraceae_NK4A 136 group, Coriobacteriaceae_UCG-002. There were 30 genera with statistically significant differences in relative abundance at the genus level between the two groups (all P<0.05). LEfSe analysis of the intestinal flora of mice in the two groups revealed a total of 14 multi-level differential taxa (all P<0.05, LDA score>4.0), which were mainly enriched in Bacteroidetes. The enrichment of 10 differential taxa including Bacteroidetes, Bacteroidia, Bacteroidales, Muribaculaceae, etc. were found in normal control group, and the enrichment of 4 differential taxa including Dubosiella, Peptostreptococus, etc. were found in HCC model group. There were both positive and negative correlations between the dominant intestinal genera in normal control group (|rho|>0.5, P<0.05), while the correlations of the dominant intestinal genera in HCC model group, being less complex than that in normal control group, were all positive. The relative abundance of gram positive and mobile element containing in the intestinal flora of mice in HCC model group was significantly up-regulated compared with normal control group (both P<0.05), while that of gram negative ( P<0.05) and pathogenic potential ( P<0.05) was significantly down-regulated. The metabolic pathways of the intestinal flora in the two groups were significantly different. For instance, 18 metabolic pathways were enriched in normal control group (all P<0.005), including those related to energy metabolism, cell division, nucleotide metabolism, etc., while 12 metabolic pathways were enriched in HCC model group (all P<0.005), including those related to energy metabolism, amino acid metabolism, carbohydrate metabolism, etc. Conclusions: The amount of intestinal flora in DEN-induced primary HCC model mice decreased, and the composition, correlation, phenotype and function of the intestinal flora in mice were significantly altered. Bacteroidetes at the phylum level, as well as several microbial taxa at the genus level such as Muribaculaceae_unclassified, Muribaculum, Peptostreptococus and Dubosiella could be closely associated with DEN-induced primary HCC in mice.

PMID:37202098 | DOI:10.3724/zdxbyxb-2022-0283