Category: Nevin Manimala

J Med Internet Res. 2023 Jan 31;25:e39321. doi: 10.2196/39321.

ABSTRACT

BACKGROUND: Lifestyle behaviors during the periconception period contribute to achievement of a successful pregnancy. Assessment of attitudes and practices toward these modifiable behaviors can aid in identifying gaps in unhealthy lifestyle behaviors with impact on intervention effectiveness.

OBJECTIVE: This study investigates the effectiveness of coaching by the eHealth program Smarter Pregnancy during the periconception period on improvement of attitudes and practices toward fruit and vegetable intake and smoking in women attempting pregnancy through assisted reproductive technology (ART) or natural conception.

METHODS: Women attempting pregnancy through ART (n=1060) or natural conception (n=631) were selected during the periconception period. The intervention groups, conceived through ART or naturally, received Smarter Pregnancy coaching for 24 weeks, whereas the control group conceived through ART and did not receive coaching. Attitudes and practices at baseline and follow-up periods were obtained from self-administered online questionnaire provided by the program. Attitudes were assessed in women with unhealthy behaviors as their intention to increase their fruit and vegetable intake and to quit smoking using a yes/no question. Outcomes on practices, suggesting effectiveness, included daily fruit (pieces) and vegetable (grams) intake, and if women smoked (yes/no). Changes in attitudes and practices were compared at 12 and 24 weeks with baseline between the ART intervention and ART control groups, and within the intervention groups between ART and natural conception. Changes in practices at 12 and 24 weeks were also compared with baseline between women with negative attitude and positive attitude within the intervention groups: ART and natural conception. Analysis was performed using linear and logistic regression models adjusted for maternal confounders and baseline attitudes and practices.

RESULTS: The ART intervention group showed higher vegetable intake and lower odds for negative attitudes toward vegetable intake after 12 weeks (β_adj=25.72 g, P<.001; adjusted odds ratio [OR_adj] 0.24, P<.001) and 24 weeks of coaching (β_adj=23.84 g, P<.001; OR_adj 0.28, P<.001) compared with ART controls. No statistically significant effect was observed on attitudes and practices toward fruit intake (12 weeks: P=.16 and .08, respectively; 24 weeks: P=.16 and .08, respectively) and smoking behavior (12 weeks: P=.87; 24 weeks: P=.92). No difference was observed for the studied attitudes and practices between the ART intervention and natural conception intervention groups. Women with persistent negative attitude toward fruit and vegetable intake at week 12 showed lower fruit and vegetable intake at week 24 compared with women with positive attitude (β_adj=-.49, P<.001; β_adj=-30.07, P<.001, respectively).

CONCLUSIONS: The eHealth Smarter Pregnancy program may improve vegetable intake-related attitudes and practices in women undergoing ART treatment. Women with no intention to increase fruit and vegetable intake had less improvement in their intakes. Despite small changes, this study demonstrates again that Smarter Pregnancy can be used to improve vegetable intake, which can complemented by blended care that combines face-to-face and online care to also improve fruit intake and smoking behavior.

PMID:36719733 | DOI:10.2196/39321

Allergy Asthma Proc. 2023 Jan 1;44(1):51-58. doi: 10.2500/aap.2023.44.220088.

ABSTRACT

Background: Children with anaphylaxis often emergently present for treatment. Providers’ adherence to the principles of optimal management according to the most recent national guidelines is unknown. Objective: To assess the variation in management approaches for allergic reactions and anaphylaxis between allergy/immunology (AI) and emergency medicine (EM) providers. Methods: This was a cross-sectional survey study of AI and EM providers in the University of Colorado affiliated hospitals and Colorado Asthma and Allergy Society. The survey consisted of six cases of patients with allergic reactions, with four cases that represented patients with anaphylaxis that resolved by the time of discharge. For each vignette, the participants were asked about preferred initial therapy, adjunctive therapies, monitoring, outpatient prescription medications, and discharge instructions provided. Survey derivation and validation was accomplished by a multidisciplinary team of experts by using a modified Delphi process. Results: A total of 413 clinicians were contacted, of whom 194, (47%) responded, including 69 pediatric EM, 50 general EM, and 49 AI providers, and 26 did not identify a provider type. There were no statistically significant differences in correct recognition of anaphylaxis between the AI and EM providers. For each case, statistically significant differences were noted in the use of corticosteroids during and after resolution of anaphylaxis: AI providers reported giving fewer prescriptions than did the EM providers for corticosteroids in all cases of anaphylaxis (p < 0.001). The AI providers were less likely to prescribe scheduled antihistamines than were the EM providers in half of the cases (p < 0.02). Conclusion: Across the specialties, there were high rates of recognition of epinephrine as first-line treatment for anaphylaxis. The majority of the EM providers prescribed scheduled corticosteroids and antihistamines after resolution of anaphylaxis, whereas most of the AI providers did not prescribe scheduled corticosteroids. Analysis of the current data suggests against the routine use of corticosteroids in the management of anaphylaxis, particularly continued use after resolution of symptoms. AI involvement in the creation of EM and hospital protocols for allergic reactions could improve overall care.

PMID:36719699 | DOI:10.2500/aap.2023.44.220088

JAMA Netw Open. 2023 Jan 3;6(1):e2253820. doi: 10.1001/jamanetworkopen.2022.53820.

ABSTRACT

IMPORTANCE: Dual-energy chest radiography exhibits better sensitivity than single-energy chest radiography, partly due to its ability to remove overlying anatomical structures.

OBJECTIVES: To develop and validate a deep learning-based synthetic bone-suppressed (DLBS) nodule-detection algorithm for pulmonary nodule detection on chest radiographs.

DESIGN, SETTING, AND PARTICIPANTS: This decision analytical modeling study used data from 3 centers between November 2015 and July 2019 from 1449 patients. The DLBS nodule-detection algorithm was trained using single-center data (institute 1) of 998 chest radiographs. The DLBS algorithm was validated using 2 external data sets (institute 2, 246 patients; and institute 3, 205 patients). Statistical analysis was performed from March to December 2021.

EXPOSURES: DLBS nodule-detection algorithm.

MAIN OUTCOMES AND MEASURES: The nodule-detection performance of DLBS model was compared with the convolution neural network nodule-detection algorithm (original model). Reader performance testing was conducted by 3 thoracic radiologists assisted by the DLBS algorithm or not. Sensitivity and false-positive markings per image (FPPI) were compared.

RESULTS: Training data consisted of 998 patients (539 men [54.0%]; mean [SD] age, 54.2 [9.82] years), and 2 external validation data sets consisted of 246 patients (133 men [54.1%]; mean [SD] age, 55.3 [8.7] years) and 205 patients (105 men [51.2%]; mean [SD] age, 51.8 [9.1] years). Using the external validation data set of institute 2, the bone-suppressed model showed higher sensitivity compared with that of the original model for nodule detection (91.5% [109 of 119] vs 79.8% [95 of 119]; P < .001). The overall mean of FPPI with the bone-suppressed model was reduced compared with the original model (0.07 [17 of 246] vs 0.09 [23 of 246]; P < .001). For the observer performance testing with the data of institute 3, the mean sensitivity of 3 radiologists was 77.5% (95% [CI], 69.9%-85.2%), whereas that of radiologists assisted by DLBS modeling was 92.1% (95% CI, 86.3%-97.3%; P < .001). The 3 radiologists had a reduced number of FPPI when assisted by the DLBS model (0.071 [95% CI, 0.041-0.111] vs 0.151 [95% CI, 0.111-0.210]; P < .001).

CONCLUSIONS AND RELEVANCE: This decision analytical modeling study found that the DLBS model was more sensitive to detecting pulmonary nodules on chest radiographs compared with the original model. These findings suggest that the DLBS model could be beneficial to radiologists in the detection of lung nodules in chest radiographs without need of the specialized equipment or increase of radiation dose.

PMID:36719681 | DOI:10.1001/jamanetworkopen.2022.53820

JAMA Netw Open. 2023 Jan 3;6(1):e2253840. doi: 10.1001/jamanetworkopen.2022.53840.

ABSTRACT

IMPORTANCE: Time of day was associated with a decline in adenoma detection during colonoscopy. Artificial intelligence (AI) systems are effective in improving the adenoma detection rate (ADR), but the performance of AI during different times of the day remains unknown.

OBJECTIVE: To validate whether the assistance of an AI system could overcome the time-related decline in ADR during colonoscopy.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study is a secondary analysis of 2 prospective randomized controlled trials (RCT) from Renmin Hospital of Wuhan University. Consecutive patients undergoing colonoscopy were randomly assigned to either the AI-assisted group or unassisted group from June 18, 2019, to September 6, 2019, and July 1, 2020, to October 15, 2020. The ADR of early and late colonoscopy sessions per half day were compared before and after the intervention of the AI system. Data were analyzed from March to June 2022.

EXPOSURE: Conventional colonoscopy or AI-assisted colonoscopy.

MAIN OUTCOMES AND MEASURES: Adenoma detection rate.

RESULTS: A total of 1780 patients (mean [SD] age, 48.61 [13.35] years, 837 [47.02%] women) were enrolled. A total of 1041 procedures (58.48%) were performed in early sessions, with 357 randomized into the unassisted group (34.29%) and 684 into the AI group (65.71%). A total of 739 procedures (41.52%) were performed in late sessions, with 263 randomized into the unassisted group (35.59%) and 476 into the AI group (64.41%). In the unassisted group, the ADR in early sessions was significantly higher compared with that of late sessions (13.73% vs 5.70%; P = .005; OR, 2.42; 95% CI, 1.31-4.47). After the intervention of the AI system, as expected, no statistically significant difference was found (22.95% vs 22.06%, P = .78; OR, 0.96; 95% CI; 0.71-1.29). Furthermore, the AI systems showed better assistance ability on ADR in late sessions compared with early sessions (odds ratio, 3.81; 95% CI, 2.10-6.91 vs 1.60; 95% CI, 1.10-2.34).

CONCLUSIONS AND RELEVANCE: In this cohort study, AI systems showed higher assistance ability in late sessions per half day, which suggests the potential to maintain high quality and homogeneity of colonoscopies and further improve endoscopist performance in large screening programs and centers with high workloads.

PMID:36719680 | DOI:10.1001/jamanetworkopen.2022.53840

Rambam Maimonides Med J. 2023 Jan 29;14(1). doi: 10.5041/RMMJ.10490.

ABSTRACT

OBJECTIVE: In patients with acute hepatic porphyria (AHP), prolonged fasting is a known trigger of AHP attacks. Despite this, some Jewish AHP patients-mainly hereditary coproporphyria (HCP) and variegate porphyria (VP) patients-fast for 25 consecutive hours during the traditional Jewish holy day known as Yom Kippur. In this study, we evaluated the effect of the fast on these patients.

METHODS: A retrospective study and survey of AHP patients in Israel was carried out. Patients were asked whether they have fasted and whether any symptoms were induced by this fast. Patients’ medical records were reviewed for an emergency department (ED) visit following Yom Kippur between 2007 and 2019. Only 3 acute intermittent porphyria (AIP) patients reported fasting; they were excluded from analysis.

RESULTS: A total of 21 HCP patients and 40 VP patients completed the survey; 30 quiescent patients reported they fast, while 31 did not fast. The majority of fasting patients (96.67%) reported no symptoms following a fast. We found no statistically significant association between ED visits 1 week (0.26% in both fasting and non-fasting patients) or 1 month (2.1% visits in non-fasting versus 0.78% in fasting patients) following Yom Kippur. Of the symptomatic ED visits following a fast, none were defined as severe attacks.

CONCLUSION: A 25-hour fast in stable HCP and VP patients did not increase the risk of an acute attack and can probably be regarded as safe.

PMID:36719670 | DOI:10.5041/RMMJ.10490

Med Sci Sports Exerc. 2023 Jan 16. doi: 10.1249/MSS.0000000000003126. Online ahead of print.

ABSTRACT

PURPOSE: To assess the V̇O2 uptake obtained during a GXT and subsequent verification phase in untrained participants in a hot environment.

METHODS: Twelve sedentary males completed a GXT followed by a biphasic supramaximal-load verification phase in a hot environment (39 ° C, 32% relative humidity). Rest between tests occurred in a temperate chamber and lasted until gastrointestinal temperature returned to baseline.

RESULTS: Mean verification phase V̇O2max (37.8 ± 4.3 mL·kg-1·min-1) was lower than GXT (39.8 ± 4.1 mL·kg-1·min-1; p = 0.03) and not statistically equivalent. Using an individualized analysis approach, only 17% (2/12) of participants achieved a V̇O2 plateau during the GXT. Verification phase confirmed GXT V̇O2max in 100% of participants while the traditional and the new age dependent secondary V̇O2max criteria indicated GXT V̇O2max achievement at much lower rates (8/12 [67%] vs. 7/12 [58%], respectively). Correlational indices between GXT and verification phase V̇O2max were strong (ICC = 0.95; r = 0.86) and Bland-Altman analysis revealed a low mean bias of -2.1 ± 1.9 mL·kg-1·min-1 and 95% limits of agreement (-5.8 to 1.7 mL·kg-1·min-1).

CONCLUSIONS: Very few untrained males achieved a V̇O2 plateau during GXT in the heat. When conducting GXT in a hot condition, the verification phase remains a valuable addition to confirm V̇O2max in untrained males.

PMID:36719655 | DOI:10.1249/MSS.0000000000003126

Med Sci Sports Exerc. 2023 Jan 30. doi: 10.1249/MSS.0000000000003135. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this study is to determine the criterion validity of Activities Completed over Time (ACT24), an automated previous day recall tool designed for mobile devices for 1) estimating sedentary vs active time compared to an activPAL; and 2) estimating time spent in activity domains (e.g., work, household, leisure) compared to direct observation (DO).

METHODS: Over a 7-day study period, 53 participants were sent invitations to complete three automated ACT24 recalls and to wear an activPAL device. A subset (N = 24) consented to two, 3-hour video recorded DO sessions. activPAL and ACT24 data were matched by date, and agreement for sedentary versus active time was compared between methods using paired t-tests for mean differences and spearman correlations. We compared DO and ACT24 results by domain for overall time-use and separately for sedentary and active time using Kappa statistics and tested mean differences with linear mixed models.

RESULTS: Compared to the activPAL, the mean difference in ACT24 sedentary time was 1.9% (mean [95%CI] -0.17 [-0.75,0.40] hrs/day) and the mean difference for ACT24 active time was 2.2% (0.14 [-0.32,0.60] hrs/day). Correlations were R = 0.61 (95% CI: [0.39, 0.76]) and R = 0.65 (0.44, 0.78) for sedentary and active time, respectively. Domain-specific agreement was substantial for leisure-time, work, and shopping/errands (Kappa range: 0.63-0.79), moderate for transportation (Kappa = 0.49) and fair for personal care and household activities (Kappa: 0.24 and 0.33). ACT24 estimates of average time within each domain were not significantly different than DO.

CONCLUSIONS: The present study confirms that ACT24 is accurate for group-level estimation of active and sedentary time. Domain-specific agreement tended to be higher for more commonly reported activities and those that were of longer duration.

PMID:36719650 | DOI:10.1249/MSS.0000000000003135

J Perinat Neonatal Nurs. 2023 Jan 30. doi: 10.1097/JPN.0000000000000686. Online ahead of print.

ABSTRACT

OBJECTIVE: Under-5 mortality has declined globally; however, proportion of under-5 deaths occurring within the first 28 days after birth has increased significantly. This study aims to determine the impact of an educational intervention on neonatal care and survival rates in Nigeria.

METHODS: This was a sequential exploratory mixed-methods design involving 21 health workers in the preintervention phase, while 15 health workers and 30 mother-baby dyads participated in the postintervention phase. Data were collected using semistructured interviews and nonparticipatory observation. Qualitative data were analyzed using thematic analysis, while quantitative data were analyzed using descriptive and inferential statistics.

RESULTS: Healthy newborns were routinely separated from their mothers in the preintervention period. During this time, non-evidence-based practices, such as routine nasal and oral suctioning, were performed. Skin-to-skin contact and early initiation of breastfeeding were frequently interrupted. After the intervention, 80.6% were placed in skin-to-skin contact with their mothers, and 20 of these babies maintained contact with the mother until breastfeeding was established. There was decline in neonatal deaths post-intervention. Independent t-test analysis of the day of neonatal death demonstrates a significant difference in mean (P = .00, 95% confidence interval -5.629; -7.447 to -4.779).

CONCLUSION: Newborn survival can be improved through regular training of maternity health workers in evidence-based newborn care.

PMID:36719649 | DOI:10.1097/JPN.0000000000000686

J Relig Health. 2023 Jan 31. doi: 10.1007/s10943-023-01749-z. Online ahead of print.

ABSTRACT

This study was conducted to determine the compassion fatigue level of nurses and to review several variables believed to be associated with it; in addition, an assessment is made of empathy levels in the same group. This is a cross-sectional study conducted from December 2021 to May 2022 on nurses working at a city hospital linked to the Turkish Ministry of Health. The study group consisted of 616 nurses. A Personal Information Form, the Compassion Fatigue-Short Scale (CF-SS), and the Jefferson Scale of Empathy were used to collect data. Data were collected through face-to-face interviews. Student’s t-test, One-Way Analysis of Variance, and Multiple Linear Regression Analysis were used for data analysis. The statistical significance value was accepted as p < 0.05. The study group consisted of 499 (81.0%) females and 117 (19.0%) males, and their ages ranged from 20 to 51, with a mean age of 29.2 ± 6.9 years. The scores obtained from the CF-SS ranged from 16 to 130, with a mean score of 70.96 ± 25.04. The level of compassion fatigue was found to be higher in participants with a low family income, those who work more than 40 h a week, those who chose their profession unwillingly, those who are not satisfied with their profession, and those with a history of contact with a COVID-19 patient (p < 0.05 for each group). There was a significant association between levels of compassion fatigue and empathy (r = 0.92; p = 0.220). The level of compassion fatigue was found to be moderate in the nurses observed. The factors affecting the level of compassion fatigue included gender, family income, reasons for choosing nursing as a profession, the number of patients given daily care by the nurses, satisfaction with their profession, and history of contact with a COVID-19 patient. More extensive studies focusing on the association between compassion fatigue and empathy in nurses are needed.

PMID:36719601 | DOI:10.1007/s10943-023-01749-z

Environ Sci Pollut Res Int. 2023 Jan 31. doi: 10.1007/s11356-023-25344-7. Online ahead of print.

ABSTRACT

Statistical analysis of streamflow and sediment is very important for integrated watershed management and the design of water infrastructure, especially in silt-rich rivers. Here, we propose a bivariate joint distribution framework based on nonparametric kernel density estimation (KDE) and a hybrid copula function to describe the complex streamflow-sediment dependent structure. In this framework, the non-parametric KDE is used to fit the marginal distribution function of streamflow and sediment variables, and then the hybrid copula function is constructed by using the linear combination of Clayton, Frank, and Gumbel copulas, and compared with five commonly used single copulas (Clayton, Frank, Gumbel, Gaussian, and t). We use the Jinsha River Basin (JRB) in the Yangtze River’s (JR) upper reaches to verify the proposed method. The results show the following: (1) Compared with the gamma distribution (Gamma) and generalized extreme value (GEV) distribution of parameters, the marginal distribution function of streamflow and sediment variables can be effectively obtained based on nonparametric KDE. (2) Compared with the single copula, the hybrid copula function more fully reflects the complex dependent structure of streamflow and sediment variables. (3) Compared with the best single copula, the precision of return period based on hybrid copula can be increased by 7.41%. In addition, the synchronous probability of streamflow and sediment in JRB is 0.553, and the asynchronous probability of streamflow and sediment is 0.447. This study can not only improve the accuracy of streamflow and sediment statistical analysis in JRB, but also provide a useful framework for other bivariate joint probability analysis.

PMID:36719583 | DOI:10.1007/s11356-023-25344-7