Chin Med J (Engl). 2022 Dec 5;135(23):2878-2879. doi: 10.1097/CM9.0000000000002455.
NO ABSTRACT
PMID:36745768 | DOI:10.1097/CM9.0000000000002455
Category: Nevin Manimala
J Cardiovasc Nurs. 2023 Feb 3. doi: 10.1097/JCN.0000000000000975. Online ahead of print.
ABSTRACT
BACKGROUND: Most patients with heart failure find self-care difficult to perform and rely on family caregivers for support. Informal caregivers, however, often face insufficient psychological preparation and challenges in providing long-term care. Insufficient caregiver preparedness not only results in psychological burden for the informal caregivers but may also lead to a decline in caregiver contributions to patient self-care that affects patient outcomes.
OBJECTIVE: Our objective was to test (1) the association of baseline informal caregivers’ preparedness with psychological symptoms (anxiety and depression) and quality of life 3 months after baseline among patients with insufficient self-care and (2) the mediating effects of caregivers’ contributions to self-care of heart failure (CC-SCHF) on the relationship of caregivers’ preparedness with patients’ outcomes at 3 months.
METHODS: A longitudinal design was used to collect data between September 2020 and January 2022 in China. Data analyses were conducted using descriptive statistics, correlations, and linear mixed models. We used model 4 of the PROCESS program in SPSS with bootstrap testing to evaluate the mediating effect of CC-SCHF of informal caregivers’ preparedness at baseline with psychological symptoms or quality of life among patients with HF 3 months later.
RESULTS: Caregiver preparedness was positively associated with CC-SCHF maintenance (r = 0.685, P < .01), CC-SCHF management (r = 0.403, P < .01), and CC-SCHF confidence (r = 0.600, P < .01). Good caregiver preparedness directly predicted lower psychological symptoms (anxiety and depression) and higher quality of life for patients with insufficient self-care. The associations of caregiver preparedness with short-term quality of life and depression of patients with HF with insufficient self-care were mediated by CC-SCHF management.
CONCLUSIONS: Enhancing the preparedness of informal caregivers may improve psychological symptoms and quality of life of heart failure patients with insufficient self-care.
PMID:36745758 | DOI:10.1097/JCN.0000000000000975
Biometrics. 2023 Feb 6. doi: 10.1111/biom.13837. Online ahead of print.
ABSTRACT
We propose a doubly robust approach to characterizing treatment effect heterogeneity in observational studies. We develop a frequentist inferential procedure that utilizes posterior distributions for both the propensity score and outcome regression models to provide valid inference on the conditional average treatment effect even when high-dimensional or nonparametric models are used. We show that our approach leads to conservative inference in finite samples or under model misspecification, and provides a consistent variance estimator when both models are correctly specified. In simulations, we illustrate the utility of these results in difficult settings such as high-dimensional covariate spaces or highly flexible models for the propensity score and outcome regression. Lastly, we analyze environmental exposure data from NHANES to identify how the effects of these exposures vary by subject-level characteristics. This article is protected by copyright. All rights reserved.
PMID:36745745 | DOI:10.1111/biom.13837
Int J Environ Health Res. 2023 Feb 6:1-17. doi: 10.1080/09603123.2023.2173153. Online ahead of print.
ABSTRACT
Air pollution is a critical public health concern. The present study assessed the risk to human health of airborne Potentially Toxic Elements (PTE) arsenic, nickel and lead exposure in particulate matter (PM10-2.5) in Sao Paulo, Brazil. Statistical analysis was performed using R Software and the risk assessment for human health was carried out according to the methods of the United States Environmental Protection Agency. The results for mean annual concentration of PTE (ng m-3) were within the limits stipulated for air-quality by international agencies (arsenic <6, nickel <20 and lead <150). Airborne arsenic and lead showed higher mean concentrations during the winter than the other seasons (p < 0.05). However, the results showed a greater health risk for the adult population and during the winter season. These findings highlight the importance of air pollution as a risk factor for population health.
PMID:36745741 | DOI:10.1080/09603123.2023.2173153
Perspect Psychol Sci. 2023 Feb 6:17456916221141357. doi: 10.1177/17456916221141357. Online ahead of print.
ABSTRACT
There is growing evidence that the published psychological literature is marred by multiple errors and inaccuracies and often fails to reflect the changing nature of the knowledge base. At least four types of error are common-citation error, methodological error, statistical error, and interpretation error. In the face of the apparent inevitability of these inaccuracies, core scientific values such as openness and transparency require that correction mechanisms are readily available. In this article, I reviewed standard mechanisms in psychology journals and found them to have limitations. The effects of more widely enabling open postpublication critique in the same journal in addition to conventional peer review are considered. This mechanism is well established in medicine and the life sciences but rare in psychology and may assist psychological science to correct itself.
PMID:36745732 | DOI:10.1177/17456916221141357
Am J Epidemiol. 2023 Feb 3:kwad029. doi: 10.1093/aje/kwad029. Online ahead of print.
ABSTRACT
This paper describes a new method to present and interpret linear trends in health inequalities, and presents a proof-of-concept for inequalities in smoking among adolescents in Europe. We estimated the regression line of the assumed linear relationship between smoking prevalence in low and high socioeconomic status (SES) youth over time. Using simulation, we constructed a 95% confidence interval for the smoking prevalence in low SES youth for when this would be 0% in high SES youth, and calculated the likelihood of eradicating smoking inequality (<5% for both low and high SES). This method was applied to data of 15-16-year-olds (N=250,326) from 23 European countries, derived from the 2003-2015 ESPAD surveys. Smoking prevalence decreased more slowly in low than high SES adolescents. The estimated smoking prevalence was 9.4% (6.1;12.7) for boys and 5.4% (1.4;9.2) for girls in low SES when 0% in high SES. The likelihood of eradicating smoking inequality was <1% for boys and 37% for girls. We conclude that this novel methodological approach to trends in health inequalities is feasible in practice. Applying it to trends in smoking inequalities among adolescents in Europe, we found that Europe is currently not on track to eradicate youth smoking across SES groups.
PMID:36745706 | DOI:10.1093/aje/kwad029
J Am Acad Orthop Surg. 2023 Feb 3. doi: 10.5435/JAAOS-D-22-00554. Online ahead of print.
ABSTRACT
INTRODUCTION: The purpose of this study was to evaluate rates of rotator cuff tears (RCTs), repairs (RCRs), and revision RCR in patients who were prescribed testosterone replacement therapy (TRT) and compare these patients with a control group.
METHODS: The PearlDiver database was queried for patients who were prescribed testosterone for at least 90 days between 2011 and 2018 to evaluate the incidence of RCTs in this population. A second analysis evaluated patients who sustained RCTs using International Classification of Diseases, 9th/10th codes to evaluate these patients for rates of RCR and revision RCR. Chi square analysis and multivariate regression analyses were used to compare rates of RCTs, RCR, and subsequent or revision RCR between the testosterone and control groups, with a P-value of 0.05 representing statistical significance.
RESULTS: A total of 673,862 patients with RCT were included for analysis, and 9,168 of these patients were prescribed testosterone for at least 90 days before their RCT. The TRT group had a 3.6 times greater risk of sustaining an RCT (1.14% versus 0.19%; adjusted odds ratio (OR) 3.57; 95% confidence interval (CI) 3.57 to 3.96). A 1.6 times greater rate of RCR was observed in the TRT cohort (TRT, 46.4% RCR rate and control, 34.0% RCR rate; adjusted OR 1.60; 95% CI 1.54 to 1.67). The TRT cohort had a 26.7 times greater risk of undergoing a subsequent RCR, irrespective of laterality, within 1 year of undergoing a primary RCR when compared with the control group (TRT, 47.1% and control, 4.0%; adjusted OR 26.4; 95% CI 25.0 to 27.9, P < 0.001).
CONCLUSIONS: There is increased risk of RCTs, RCRs, and subsequent RCRs in patients prescribed testosterone. This finding may represent a musculoskeletal consequence of TRT and is important for patients and clinicians to understand. Additional research into the science of tendon injury in the setting of exogenous anabolic steroids remains of interest.
LEVEL OF EVIDENCE: Level Ⅲ, retrospective cohort study.
PMID:36745691 | DOI:10.5435/JAAOS-D-22-00554
PLoS Med. 2023 Feb 6;20(2):e1004186. doi: 10.1371/journal.pmed.1004186. Online ahead of print.
ABSTRACT
BACKGROUND: Optimal nutrition is crucial during the critical period of the first 1,000 days from conception to 2 years after birth. Prenatal and postnatal supplementation of mothers with multimicronutrient-fortified balanced energy-protein (BEP) supplements is a potential nutritional intervention. However, evidence on the long-term effects of BEP supplementation on child growth is inconsistent. We evaluated the efficacy of daily fortified BEP supplementation during pregnancy and lactation on infant growth in rural Burkina Faso.
METHODS AND FINDINGS: A 2 × 2 factorial individually randomized controlled trial (MISAME-III) was implemented in 6 health center catchment areas in Houndé district under the Hauts-Bassins region. From October 2019 to December 2020, 1,897 pregnant women aged 15 to 40 years with gestational age <21 completed weeks were enrolled. Women were randomly assigned to the prenatal intervention arms receiving either fortified BEP supplements and iron-folic acid (IFA) tablets (i.e., intervention) or IFA alone (i.e., control), which is the standard of care during pregnancy. The same women were concurrently randomized to receive either of the postnatal intervention, which comprised fortified BEP supplementation during the first 6 months postpartum in combination with IFA for the first 6 weeks (i.e., intervention), or the postnatal control, which comprised IFA alone for 6 weeks postpartum (i.e., control). Supplements were provided by trained village-based project workers under direct observation during daily home visits. We previously reported the effect of prenatal BEP supplementation on birth outcomes. The primary postnatal study outcome was length-for-age z-score (LAZ) at 6 months of age. Secondary outcomes were anthropometric indices of growth (weight-for length and weight-for-age z-scores, and arm and head circumferences) and nutritional status (prevalence rates of stunting, wasting, underweight, anemia, and hemoglobin concentration) at 6 months. Additionally, the longitudinal prevalence of common childhood morbidities, incidence of wasting, number of months of exclusive breastfeeding, and trajectories of anthropometric indices from birth to 12 months were evaluated. Prenatal BEP supplementation resulted in a significantly higher LAZ (0.11 standard deviation (SD), 95% confidence interval (CI) [0.01 to 0.21], p = 0.032) and lower stunting prevalence (-3.18 percentage points (pp), 95% CI [-5.86 to -0.51], p = 0.020) at 6 months of age, whereas the postnatal BEP supplementation did not have statistically significant effects on LAZ or stunting at 6 months. On the other hand, postnatal BEP supplementation did modestly improve the rate of monthly LAZ increment during the first 12 months postpartum (0.01 z-score/month, 95% CI [0.00 to 0.02], p = 0.030), whereas no differences in growth trajectories were detected between the prenatal study arms. Furthermore, except for the trend towards a lower prevalence of underweight found for the prenatal BEP intervention at 6 months (-2.74 pp, 95% CI [-5.65 to 1.17], p = 0.065), no other secondary outcome was significantly affected by the pre- or postnatal BEP supplementation.
CONCLUSIONS: This study provides evidence that the benefits obtained from prenatal BEP supplementation on size at birth are sustained during infancy in terms of linear growth. Maternal BEP supplementation during lactation may lead to a slightly better linear growth towards the second half of infancy. These findings suggest that BEP supplementation during pregnancy can contribute to the efforts to reduce the high burden of child growth faltering in low- and middle-income countries.
TRIAL REGISTRATION: ClinicalTrials.gov: NCT03533712.
PMID:36745684 | DOI:10.1371/journal.pmed.1004186
PLoS One. 2023 Feb 6;18(2):e0281280. doi: 10.1371/journal.pone.0281280. eCollection 2023.
ABSTRACT
INTRODUCTION: Access to innovative pharmaceuticals is thought to be associated with several exogenous factors related to the local legal or financial framework of pharmaceutical reimbursement. Our aim was to describe the association between the outcome of the reimbursement procedure on innovative pharmaceutical submissions in Hungary and several potential explanatory variables related to the legal or financial framework of reimbursement procedures, such as the submission implying a need for a legal act to conclude on a positive decision; having a risk-sharing agreement (RSA) in place at the time of submission; the aim of the submission and expenditure on individual funding requests.
METHODS: Publicly available administrative announcements of the Hungarian National Health Insurance Fund Manager were used to construct the analysis dataset including all concluded procedures between 1 January 2018 and 7 June 2021, complemented with information on the overall aim of the submission (new compound or new indication). Logistic regression models were used to estimate odds ratios while adjusting for potential confounding.
RESULTS: Needing a legislative change as a proxy of involving high-level decision makers to reimburse had a lower (OR = 0.05, CI95%:0.02-0.11), whereas having an RSA had a statistically significant higher chance of a positive decision (OR = 3.49, CI95%:1.56-7.82). In contrast, neither the overall purpose of the submission (OR = 1.32, CI95%:0.65-2.69), nor the average biennial expenditure on individual funding requests exceeding 200 million HUFs (OR = 1.04, CI95%:0.92-1.19) had a statistically significant association with the decision.
CONCLUSIONS: This study quantitatively demonstrated that the need for legal acts to conclude on a positive decision decreases, whereas having an RSA for the particular product increases the likelihood of a positive reimbursement decision in Hungary. The role of other factors remain unclear. Our findings suggest that the legal requirements and RSAs play key roles in the reimbursement of innovative pharmaceuticals and can be viewed as potential areas of policy interventions in expanding access to these products, although the feasibility of such interventions need strong commitment from decision-makers, as well as implying increased autonomy to the entities involved in reimbursement procedures. Further research is needed to assess the impact of endogenous and exogenous factors in a coherent framework.
PMID:36745671 | DOI:10.1371/journal.pone.0281280
PLoS One. 2023 Feb 6;18(2):e0280454. doi: 10.1371/journal.pone.0280454. eCollection 2023.
ABSTRACT
BACKGROUND: Frontline providers mostly outside specific emergency areas deliver emergency care around the world, yet often they do not receive dedicated training in managing emergency conditions. When designed for low-resource settings, emergency care training has been shown to improve provider skills, facilitate efficient use of available resources, and reduce death and disability by ensuring timely access to life-saving care.
METHODS: The WHO/ICRC Basic Emergency Care (BEC) Course with follow up longitudinal mentorship for 6 months was implemented in rural Neno District Malawi from September 2019-April 2020. We completed a mixed-methods analysis of the course and mentorship included mentor and participant surveys and feedback, mentorship quantification, and participant examination results. Simple descriptive statistics and boxplot visuals were used to describe participant demographics and mentorship quantification with a Wilcoxon signed-rank test to evaluate pre- and post-test scores. Qualitative feedback from participants and mentors were inductively analyzed using Dedoose.
RESULTS: The median difference of BEC course examination percentage score between participants before the BEC course and immediately following the course was 18.0 (95% CI 14.0-22.0; p<0.001). Examination scores from the one-year post-test was lower but sustained above the pre-course test score with a median difference of 11.9 (95% CI 4.0-16.0; p<0.009). There were 174 mentorship activities with results suggesting that a higher number of mentorship touches and hours of mentor-mentee interactions may assist in sustained knowledge test scores. Reported strengths included course delivery approach leading to improved knowledge with mentorship enhancing skills, learning and improved confidence. Suggestions for improvement included more contextualized training and increased mentorship.
CONCLUSION: The BEC course and subsequent longitudinal mentorship were feasible and acceptable to participants and mentors in the Malawian low resource context. Follow-up longitudinal mentorship was feasible and acceptable and is likely important to cementing the course concepts for long-term retention of knowledge and skills.
PMID:36745667 | DOI:10.1371/journal.pone.0280454