Category: Nevin Manimala

Womens Health (Lond). 2023 Jan-Dec;19:17455057221147380. doi: 10.1177/17455057221147380.

ABSTRACT

BACKGROUND: There are persistent racial/ethnic disparities in the occurrence of severe maternal morbidity. Patient-centered medical home care has the potential to address disparities in maternal outcomes.

OBJECTIVES: To examine (1) the association between receiving patient-centered medical home care and severe maternal morbidity outcomes and (2) the interaction of race/ethnicity on patient-centered medical home status and severe maternal morbidity.

DESIGN/METHODS: Using 2007 to 2016 data from the Medical Expenditures Panel Survey, we conducted a cross-sectional study to estimate the association between receipt of care from a patient-centered medical home and the occurrence of severe maternal morbidity, and racial-specific (White, Black, Asian, Other) relative risks of severe maternal morbidity. Our study used race as a proxy measure for exposure racism. We identified mothers (⩾15 years) who gave birth during the study period. We identified patient-centered medical home qualities using 11 Medical Expenditures Panel Survey questions and severe maternal morbidities using medical claims, and calculated generalized estimating equation models to estimate odds ratios of severe maternal morbidity and 95% confidence intervals.

RESULTS: Among all mothers who gave birth (N = 2801; representing 5,362,782 US lives), only 25% received some exposure patient-centered medical home care. Two percent experienced severe maternal morbidity, and this did not differ statistically (p = 0.11) by patient-centered medical home status. However, our findings suggest a 85% decrease in the risk of severe maternal morbidity among mothers who were defined as always attending a patient-centered medical home (odds ratios: 0.15; 95% confidence interval:0.01-1.87; p = 0.14) and no difference in the risk of severe maternal morbidity among mothers who were defined as sometimes attending a patient-centered medical home (odds ratios: 1.00; 95% confidence interval:0.16-6.42; p = 1.00). There was no overall interaction effect in the model between race and patient-centered medical home groups (p = 0.82), or ethnicity and patient-centered medical home groups (p = 0.62) on the severe maternal morbidity outcome.

CONCLUSION: While the rate of severe maternal morbidity was similar to US rates, few mothers received care from a patient-centered medical home which may be due to underreporting. Future research should further investigate the potential for patient-centered medical home-based care to reduce odds of severe maternal morbidity across racial/ethnic groups.

PMID:36660909 | DOI:10.1177/17455057221147380

J Pak Med Assoc. 2022 Oct;72(10):2019-2024. doi: 10.47391/JPMA.4438.

ABSTRACT

OBJECTIVE: To compare the efficacy of only dietary recommendations, zinc, probiotics and combination therapies in children admitted with acute gastroenteritis.

METHODS: The comparative, prospective, double-blind, placebo-controlled study was conducted from October 2020 to April 2021 at the Paediatric Emergency Service after approval from the ethics review committee of Diyarbakir Gazi Yasargil Training and Research Hospital, Turkey, and comprised infants with a diagnosis of acute gastroenteritis who were divided into four groups. Only appropriate dietary recommendations were given to the control group 1, while group 2 was given a single probiotic containing bifidobacterium breve, bifidobacterium bifidum, bifidobacterium infantis and bifidobacterium longum strains. Group 3 was given zinc and group 4 was given probiotics and zinc. Demographic data of the patients, admission complaints, physical examination findings, dehydration degrees, and laboratory findings were recorded and analysed.

RESULTS: Of the 132 subjects, 79 (59.8%) were males. The overall mean age was 27.5±3.6 months. There were 22 (16.7%) patients in group 1, 34 (25.8%) in group 2, 28 (21.2%) in group 3, and 48 (36.4%) in group 4. The mean duration time to diarrhoea termination was 84.5±10.7 hours (range: 79-89 hours) in group 1, 73.05±6.8 hours (range: 70.5-75.4 hours) in group 2, 80.1±10.3 hours (range: 76-84 hours) in group 3, and 43.5±9.6 hours (range: 46-48 hours) in group 4. Group 4 outcome was statistically significant (p<0.001).

CONCLUSIONS: The efficiency of combined treatment with probiotics and zinc was found to be significantly better in the treatment of childhood acute gastroenteritis.

PMID:36660970 | DOI:10.47391/JPMA.4438

BJOG. 2023 Jan 20. doi: 10.1111/1471-0528.17394. Online ahead of print.

ABSTRACT

BACKGROUND: Prolonged second stage of labour is an important cause of maternal and perinatal morbidity and mortality. Vacuum extraction (VE) and second-stage caesarean section (SSCS) are the most common performed obstetric interventions, but which procedure is used varies widely globally.

OBJECTIVE: To compare maternal and perinatal morbidity, mortality and other adverse outcomes after VE versus SSCS.

SEARCH STRATEGY: A systematic search was conducted in Pubmed, Cochrane and Embase. Studies were critically appraised using the Newcastle-Ottawa Scale.

ANALYSIS: Chi-square test, Fisher exact test and binary logistic regression were used and various Adverse Outcome Scores were calculated to evaluate maternal and perinatal outcomes.

RESULTS: 15 articles were included providing the outcomes for a total of 20 051 births by SSCS and 32 823 births by VE. All five maternal deaths resulted from complications of anaesthesia during SSCS. In total 133 perinatal deaths occurred in all studies combined, 92/20051 (0.45%) in the SSCS group and 41/32823 (0.12%) in the VE group. In studies with more than one perinatal death, both conducted in low-resource settings, more perinatal deaths occurred during decision-to-birth interval (DBI) in the SSCS group than in the VE group (5.5% vs. 1.4%, OR 4.00 (95%CI 1.17-13.70 and 11% vs 8.4%, OR 1.39 (95%CI 0.85-2.26)). All other adverse maternal and perinatal outcomes showed no statistically significant differences.

CONCLUSION: VE should be the recommended mode of birth both in HIC as in LMIC to prevent unnecessary SSCS and decrease perinatal and maternal deaths when safe anaesthesia and surgery is not immediately available.

PMID:36660890 | DOI:10.1111/1471-0528.17394

Ophthalmic Physiol Opt. 2023 Jan 20. doi: 10.1111/opo.13092. Online ahead of print.

ABSTRACT

PURPOSE: Ultra-Orthodox Jewish men are known to have a high prevalence of myopia, which may be due to intense near-work from an early age. This study objectively assessed near-viewing behaviours in ultra-Orthodox and non-ultra-Orthodox men in Israel for different tasks.

METHODS: Ultra-Orthodox (n = 30) and non-ultra-Orthodox (n = 38) men aged 18-33 years participated. Autorefraction, visual acuity, height and Harmon distance were measured. An objective range-finding sensor was mounted on their spectacles while they performed four 10-min tasks in a randomised order: (1) reading printed material, (2) writing printed material, (3) passive electronic and (4) active electronic tasks. Near-viewing distance and the number of viewing breaks were calculated for each task. Statistical analyses included Student t-tests and the Mann-Whitney test between groups and repeated measures ANOVA or Friedman between tasks.

RESULTS: For all tasks combined, a significantly shorter viewing distance was observed for the ultra-Orthodox group (36.2 ± 7.0 cm) than for the non-ultra-Orthodox group (39.6 ± 6.7 cm, p < 0.05). Viewing distances for the passive reading and electronic tasks were shorter for the ultra-Orthodox group (36.9 ± 7.7 cm vs. 41.3 ± 8.1 cm, p < 0.03 and 39.0 ± 10.1 vs. 43.9 ± 9.3, p < 0.05, respectively). Viewing distances were significantly different between all four tasks, with writing having the closest distance. No correlation was found between working distance and spherical equivalent or Harmon distance. However, a significant correlation was found in the ultra-Orthodox group between working distance and height for each task (p < 0.04, R < 0.42 for all). There was no difference in the number of viewing breaks between the groups.

CONCLUSION: When reading a book and viewing an iPad, ultra-Orthodox men demonstrated a closer objective working distance than non-ultra-Orthodox men. This shorter viewing distance may contribute to the high prevalence and degree of myopia in this population.

PMID:36660882 | DOI:10.1111/opo.13092

BJOG. 2023 Jan 20. doi: 10.1111/1471-0528.17395. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate perinatal mortality, morbidity and obstetric intervention following the introduction of a universal late third-trimester ultrasound scan for growth restriction.

DESIGN: Prospective cohort study SETTING: Oxfordshire (OUH), UK POPULATION: Women with a non-anomalous singleton pregnancy undergoing pregnancy care and term delivery at OUH with an estimated date of birth between 01/Jan/2014 and 30/Sept/2019.

METHODS: Universal ultrasound for fetal growth restriction between 35⁺⁰ and 36⁺⁶ weeks was introduced in 2016. The outcomes of the next 18631 eligible term pregnancies were compared, adjusting for covariates and time, with the previous 18636 who had clinically-indicated ultrasounds only. ‘Screen positives’ for growth restriction were managed according to a pre-determined protocol which included non-intervention for some SGA babies.

MAIN OUTCOME MEASURES: Extended perinatal mortality, a composite of mortality or encephalopathy Grade II-III, and expedited birth. Other outcomes included composite adverse outcomes used elsewhere, detection of low birthweight and birth from 37⁺⁰ to 38⁺⁶ weeks.

RESULTS: Extended perinatal deaths decreased 27% and severe morbidity decreased 33% but neither change was statistically significant (aOR 0.53; 00.18-1.56 and aOR 0.71; 0.31-1.63). Expedited births changed from 35.2% to 37.7% (aOR: 0.99 (0.92 – 1.06). Birthweight (<10^th centile) detection using fetal biometry alone was 31.4% and rose to 40.5% if all abnormal scan parameters were used.

CONCLUSION: Improvements in mortality and severe morbidity subsequent to introducing a universal ultrasound for growth restriction are encouraging but remain unclear. Little change in intervention is possible. The antenatal detection of low birthweight remains poor but improves where markers of growth restriction are used.

PMID:36660877 | DOI:10.1111/1471-0528.17395

Health Expect. 2023 Jan 20. doi: 10.1111/hex.13702. Online ahead of print.

ABSTRACT

INTRODUCTION: Genetic testing for hereditary cancer syndromes (HCSs) can improve health outcomes through cancer risk mitigation strategies. Effective communication between tested individuals and their family members is key to reducing the hereditary cancer burden. Our objective was to develop a patient portal to improve familial communication for patients undergoing HCS genetic testing, followed by an early-phase evaluation.

METHODS: The portal was developed following the completion of 25 semistructured interviews with individuals having undergone HCS susceptibility testing at BC Cancer. Following initial development, we recruited patients and healthcare providers to provide critical feedback informing portal refinement. Quantitative feedback was summarized using descriptive statistics, and qualitative feedback was synthesized by two reviewers who engaged in iterative discussion within the research team to prioritize recommendations for integration.

RESULTS: The patient portal includes four key components consisting of (a) targeted educational information about hereditary cancer and HBOC syndrome associated risks and testing process overview, (b) a general frequently asked questions ‘FAQ’ page informed by the qualitative interviews, patient partner feedback, and consultation with the HCP, (c) guidance to support familial communication including a video developed with a patient partner describing their lived experience navigating the communication process and (d) a series of lay summaries of genetic test findings to support information transfer among family members. Thirteen healthcare providers and seven patients participated in user testing. Domains within which participant recommendations were provided included presentation, educational content and process clarification.

CONCLUSIONS: This investigation demonstrates the value of continual integration of patient and provider preferences through the development of tools endeavouring to assist with complex genomics-informed decision-making. Our work aims to broaden the population-wide impact of HCS testing programs by improving communication processes between probands and their potentially affected family members.

PATIENT OR PUBLIC CONTRIBUTION: This work involved a patient partner who was actively engaged in all aspects of the research investigation including protocol development, review and editing of all study documentation (including that of the previously published qualitative investigation), interpretation of results, as well as reviewing and editing the manuscript. Patient partners and healthcare professionals were recruited as research participants to provide critical feedback on the patient portal.

PMID:36660874 | DOI:10.1111/hex.13702

J Food Sci. 2023 Jan 19. doi: 10.1111/1750-3841.16469. Online ahead of print.

ABSTRACT

Edible insects are recognized as a potential alternative and sustainable source of high-quality protein for the human diet. Entomophagy is highly related to negative emotions that may cause reluctance to adopt insects as food in Western countries. During human interaction, a person’s facial emotional expression (FEE) may influence other people’s emotional responses. A person’s emotional state may affect his/her food preference and food choice. Understanding how other people’s FEE would affect consumers’ emotional profiles, liking, and subsequent willingness to try (WTT) and purchase intent (PI) toward insect-containing food products may help increase the acceptance of entomophagy. This study identified emotional responses toward chocolate chip cookies containing cricket protein using valence and arousal scales in order to explore the effects of other people’s FEE (positive, negative, and/or sensation seeking) and to find the correlation between consumers’ emotional and overall liking (OL) responses for cricket-containing chocolate chip cookies. Predicting PI for such cookies was also performed. For consumers who perceived positive emotion from other people’s FEE after watching a short video clip, their emotional feeling was raised on both valence and arousal dimensions, while negative FEE stimulus imparted the opposite effects. The OL scores and emotional intensities after watching the three FEE videos were highly related to consumers’ PI. Males compared to females rated the cricket-containing cookies higher on positive emotion intensity, OL, and PI. Among the three FEEs evaluated, the positive emotional stimulus would be beneficial in increasing acceptance, WTT, and PI of insect-containing foods. PRACTICAL APPLICATION: Edible insects are potentially alternative and sustainable sources of high-quality protein for the human diet. Entomophagy is highly related to negative emotions that cause reluctance to adopt insects as food in Western countries. Other people’s facial emotional expressions (FEEs) may affect consumer food-evoked emotional profiles, overall liking (OL), and purchase intent (PI). For consumers who perceived positive emotion from other people’s FEE, their emotional feeling was raised on both valence and arousal dimensions, and OL scores and emotion intensities were highly related to consumers’ PI. Exploiting positive emotional stimuli as demonstrated in this study would be beneficial in increasing acceptance of insect-containing food.

PMID:36658671 | DOI:10.1111/1750-3841.16469

Australas J Dermatol. 2023 Jan 19. doi: 10.1111/ajd.13979. Online ahead of print.

ABSTRACT

BACKGROUND: Investigation of tools used for candidate selection as predictors of future performance in medical education has been primarily undertaken within the undergraduate setting, but little is known about the selection to medical specialist programs. This retrospective longitudinal study aims to explore correlations between selection tools and the performance of trainees enrolled in the Australasian College of Dermatologists (ACD), the accredited specialist medical college for training in dermatology in Australia.

METHODS: Data were collected from consecutive cohorts of ACD trainees commencing from 2007 to 2015. Predictive variables were trainee demographics and selection tools (prior academic qualification; research experience; clinical experience; curriculum vitae [CV] rating; interview scores). The outcome variables were exam performance. First Year ([Pharmacology and Clinical Sciences] and Fellowship Exam [Written, Clinical, and Overall Score]). Statistical analyses included: descriptive statistics summaries; bivariate correlation of selection criteria and demographic data with exam performance; and linear regression analysis to identify predictors of exam performance.

RESULTS: Demographic analysis (N = 172) showed that 64% of trainees were female, the average age was 30.5 years (± 3.47) and trainees living in high socioeconomic status (SES) areas were over-represented. Using Pearson correlation analysis, interview scores were significantly positively correlated with First Year Pharmacology results (p = 0.018), Fellowship Written results (p = 0.002), and Fellowship Overall Scores (p = 0.006). First Year Pharmacology Exam performance was most highly correlated with Fellowship Exam performance (p = 0.000). No association was identified between exam performance and gender, SES, prior academic qualification, research experience or CV rating. Linear regression analysis showed that interview score (p = 0.012), entry age (p = 0.026) and First Year Pharmacology score (p = 0.002) were predictors of Fellowship exam performance.

CONCLUSION: These results suggest that the comprehensive selection tools used by ACD are effective, with interviews being a highly valid tool linked to exam performance. These findings have important practical implications for assessing the selection process in specialist dermatology training.

PMID:36658664 | DOI:10.1111/ajd.13979

BMC Res Notes. 2023 Jan 19;16(1):5. doi: 10.1186/s13104-022-06270-2.

ABSTRACT

OBJECTIVE: A small electrocardiograph and Holter electrocardiograph can record an electrocardiogram for 24 h or more. We examined whether gender could be verified from such an electrocardiogram and, if possible, how accurate it would be.

RESULTS: Ten dimensional statistics were extracted from the heart rate data of more than 420,000 people, and gender identification was performed by various major identification methods. Lasso, linear regression, SVM, random forest, logistic regression, k-means, Elastic Net were compared, for Age < 50 and Age ≥ 50. The best Accuracy was 0.681927 for Random Forest for Age < 50. There are no consistent difference between Age < 50 and Age ≥ 50. Although the discrimination results based on these statistics are statistically significant, it was confirmed that they are not accurate enough to determine the gender of an individual.

PMID:36658657 | DOI:10.1186/s13104-022-06270-2

J Pharm Policy Pract. 2023 Jan 19;16(1):10. doi: 10.1186/s40545-023-00520-9.

ABSTRACT

BACKGROUND: Since 2015, the National Health Service (NHS) has funded pharmacists to work in general practice (GP practice) to ease workload pressures. This requires pharmacists to work in new roles and be integrated effectively in GPs. Independent prescribing is a key part of the GP pharmacist role, but little is known about pharmacists’ integration into GP practice as well as patients’ perceptions and experiences of the care provided by GP pharmacists. This study aims to explore the perceptions of pharmacist independent prescribers (PIPs) about their integration into GP practice and gain insight into patients’ perceptions about the care provided to them by pharmacists.

METHODS: A mixed-methods study comprising semi-structured interviews with PIPs (n = 13) followed by questionnaire-based assessment of patients’ (n = 77) evaluation of pharmacists’ care was conducted between December 2019 and March 2020. Quantitative data were analysed using descriptive statistics. Interviews and open comments of the survey were thematically analysed.

RESULTS: Pharmacist independent prescribers reported undertaking a range of patient-facing and non-clinical roles. Lack of understanding about PIPs’ clinical role and working beyond their clinical area of competence were some of the barriers to their integration into GP practice. Most patients were satisfied with the consultations they received from pharmacists and reported confidence in the pharmacist’s recommendations about their health conditions. However, a few patients (14%) felt they would still need to consult a general practitioner after their appointment and 11% were not sure if a further consultation was needed.

CONCLUSIONS: Pharmacist independent prescribers provide a range of clinical services for the management of long-term conditions which appear to be recognised by patients. However, there is a need to address the barriers to PIPs’ integration into GP practice to optimise their skill-mix and patient-centred care.

PMID:36658624 | DOI:10.1186/s40545-023-00520-9