Category: Nevin Manimala

SSM Popul Health. 2022 May 9;18:101119. doi: 10.1016/j.ssmph.2022.101119. eCollection 2022 Jun.

ABSTRACT

Research has documented important differences in smoking rates across race/ethnicity, gender, and age. Much of the research has either focused on smoking initiation among adolescents or cessation among adults, but little is known about racial/ethnic patterns in intermittent and daily smoking across young and early middle adulthood. We therefore use the life course perspective to identify how racial/ethnic and gender differences in smoking unfold across adulthood. Analyses investigate whether racial/ethnic and gender differences exist in the likelihood of daily smoking in early middle adulthood and whether these disparities persist after the inclusion of adolescent and early midlife sociodemographic characteristics and young adult smoking patterns. Descriptive statistics and multivariate binary logistic regression analyses employ recent data from a nationally representative sample of adults using the National Longitudinal Study of Adolescent to Adult Health (Add Health; N = 8,506). We find evidence that life course patterns of smoking differ across race/ethnicity and gender subgroups. In early middle adulthood (ages 33-44), White women are more likely to smoke daily than Black or Hispanic women. In contrast, there are no significant differences between White and Black men, but White men are more likely to smoke daily than Hispanic men. These racial/ethnic differences are no longer significant for men when previous smoking is controlled, suggesting that early young adult smoking plays an important role in the development of smoking disparities across race/ethnicity. Further, we find that young adult intermittent smoking is associated with daily smoking in early midlife, and this relationship is stronger for Black, compared to White, men and women. Although Black women display lower odds of daily smoking in early midlife compared to White women, they exhibit a higher risk of transitioning from intermittent to daily smoking. These results highlight the importance of considering a greater diversity of life course patterns in smoking across race/ethnicity and gender in future research and policies.

PMID:35652089 | PMC:PMC9149197 | DOI:10.1016/j.ssmph.2022.101119

Front Pediatr. 2022 May 16;10:851033. doi: 10.3389/fped.2022.851033. eCollection 2022.

ABSTRACT

BACKGROUND: Children with medical complexity (CMC) are prone to medical errors and longer hospital stays, while residents do not feel prepared to provide adequate medical care for this vulnerable population. No educational guidance for the training of future pediatric tertiary care specialists outside their field of expertise involving the multidisciplinary care of CMC exists. We investigated pediatric residents past educational needs and challenges to identify key learning content for future training involving care for CMC.

METHODS: This was a prospective mixed-methods study at a single pediatric tertiary care center. Qualitative semi-structured interviews with residents were conducted, submitted to thematic content analysis, linked to the American Board of Pediatrics (ABP) general pediatrics content outline, and analyzed with importance performance analysis (IPA). Quantitative validation was focused on key themes of pediatric nephrology within the scope of an online survey among pediatric residents and specialists.

RESULTS: A total of 16 interviews, median duration 69 min [interquartile range IQR 35], were conducted. The 280 listed themes of the ABP general pediatrics content outline were reduced to 165 themes, with 86% (theoretical) knowledge, 12% practical skills, and 2% soft skills. IPA identified 23 knowledge themes to be of high importance where improvement is necessary and deemed fruitful. Quantitative validation among 84 residents and specialists (response rate 55%) of key themes in nephrology yielded high agreement among specialists in pediatric nephrology but low interrater agreement among trainees and “trained” non-nephrologists. The occurrence of themes in the qualitative interviews and their calculated importance in the quantitative survey were highly correlated (tau = 0.57, p = 0.001). Two clusters of high importance for other pediatric specialties emerged together with a contextual cluster of frequent encounters in both in- and outpatient care.

CONCLUSION: Regarding patient safety, this study revealed the heterogeneous aspects and the importance of training future pediatric tertiary care specialists outside their field of expertise involving the multidisciplinary care of CMC. Our results may lay the groundwork for future detailed analysis and development of training boot camps that might be able to aid the improvement of patient safety by decreasing preventable harm by medical errors, especially for vulnerable patient groups, such as CMC in tertiary care pediatrics.

PMID:35652058 | PMC:PMC9149215 | DOI:10.3389/fped.2022.851033

Front Med (Lausanne). 2022 May 16;9:856654. doi: 10.3389/fmed.2022.856654. eCollection 2022.

ABSTRACT

OBJECTIVES: The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) has been widely utilized to evaluate disease activity in patients with ankylosing spondylitis (AS) by an arbitrary cut-off of ≥4 to indicate high disease activity and initiate biological therapy. The Ankylosing Spondylitis Disease Activity Score (ASDAS) is a new composite index to assess AS disease activity states that have been defined and validated. ASDAS ≥2.1 was selected as a criterion to start biological therapy. The purpose of this study was to estimate the corresponding BASDAI and ASDAS cut-off in a Taiwanese AS cohort.

METHODS: From November 2016 to October 2018, we assessed the ASDAS and the BASDAI regularly and recorded demographic data for 489 AS patients in Taichung Veterans General hospital (TCVGH) using an electronic patient-reported data system linked to electronic medical records. We used receiver operating characteristic curves with Youden’s J statistic to determine the BASDAI values that correspond to ASDAS disease activity cut-offs (i.e., 1.3, 2.1, and 3.5).

RESULTS: In our population, the best trade-off BASDAI values corresponding to ASDAS -C-reactive protein (CRP) 1.3, 2.1, and 3.5 were 2.1, 3.1, and 3.7, respectively. The optimal BASDAI values corresponding to ASDAS-erythrocyte sedimentation rates 1.3, 2.1, and 3.5 were 2.0, 2.6, and 4.8, respectively.

CONCLUSION: We propose a revised BASDAI cut-off based on our data, as BASDAI scores are commonly used globally. A more reasonable, lower BASDAI cut-off to initiate or change biological therapy will bring us closer to better decisions to treat AS patients.

PMID:35652077 | PMC:PMC9149077 | DOI:10.3389/fmed.2022.856654

Contrast Media Mol Imaging. 2022 May 12;2022:3503095. doi: 10.1155/2022/3503095. eCollection 2022.

ABSTRACT

OBJECTIVE: The main objective is to investigate the effect of PDCA circulation management on nursing quality in the day operation room.

METHODS: A retrospective study was performed in 300 patients in the day surgery room. For the control group, 150 patients received routine nursing. For the observation group, 150 patients underwent PDCA circulation nursing management. The scores for nursing quality management, the hospital infection, the detection rate of pathogenic bacteria, the incidence rate of adverse events, the negative emotion of patients, and the satisfaction rate for the day surgery department were recorded and analyzed between two groups.

RESULTS: Compared with the control group, the scores for nursing quality management and the satisfaction rate for the day surgery department were significantly increased (all P < 0.05), while the hospital infection, the detection rate of pathogenic bacteria, HAMA scores, HAMD scores, and the incidence rate of adverse events were obviously decreased (all P < 0.05). Significantly statistical differences were observed between the two groups.

CONCLUSION: PDCA circulation nursing management in the day operating room could optimize the nursing quality management, improve the satisfaction rate of the operating room, reduce the negative emotions of patients, and prevent adverse events in time, with lower hospital infections.

PMID:35652037 | PMC:PMC9119782 | DOI:10.1155/2022/3503095

Contracept Reprod Med. 2022 Jun 2;7(1):9. doi: 10.1186/s40834-022-00175-y.

ABSTRACT

BACKGROUND: Family planning for HIV-positive women has numerous advantages. However, the need of family planning utilization is challenged by women’s nonautonomous decision-making power. Therefore, this study aimed to examine the level and associated factors of decision-making power to utilize family planning among HIV-positive married women.

METHODS: A facility-based cross-sectional study was conducted from March to June 2020 among 363 HIV-positive married women on ART, using systematic random sampling technique. Logistic regression analysis was used to identify variables that affect women’s decision-making power on family planning utilization. Statistical significance was declared at p-value < 0.05 with 95% confidence interval and strength of association was reported by adjusted odds ratio.

RESULTS: Overall 55.2% (95% CI: 49.9-60.5) of the women had decision-making power on family planning utilization. Women’s having good knowledge (AOR: 2.87, 95% CI: 1.52-5.40), favorable attitude (AOR: 1.96, 95% CI: 1.13-3.38), women’s getting family planning counseling in ART clinics (AOR: 2.04, 95% CI: 1.16-3.59), women who get integration service of FP and ART (AOR: 1.83, 95% CI:1.07-3.12) were factors independently associated with women decision-making power on family planning utilization.

CONCLUSION: Decision-making power to utilize family planning among married HIV-positive women was low. Factors like poor knowledge about family planning, dissatisfaction with family planning service, not getting counseling about family planning in ART clinics, and not receiving family planning service in ART clinics were independently associated with women’s decision-making power on family planning. Infrastructure linked with the health facility, knowledge, and attitudinal factors should all be combined in future family planning programs.

PMID:35650651 | DOI:10.1186/s40834-022-00175-y

Diagn Progn Res. 2022 Jun 2;6(1):10. doi: 10.1186/s41512-022-00124-y.

ABSTRACT

BACKGROUND: There is substantial interest in the adaptation and application of so-called machine learning approaches to prognostic modelling of censored time-to-event data. These methods must be compared and evaluated against existing methods in a variety of scenarios to determine their predictive performance. A scoping review of how machine learning methods have been compared to traditional survival models is important to identify the comparisons that have been made and issues where they are lacking, biased towards one approach or misleading.

METHODS: We conducted a scoping review of research articles published between 1 January 2000 and 2 December 2020 using PubMed. Eligible articles were those that used simulation studies to compare statistical and machine learning methods for risk prediction with a time-to-event outcome in a medical/healthcare setting. We focus on data-generating mechanisms (DGMs), the methods that have been compared, the estimands of the simulation studies, and the performance measures used to evaluate them.

RESULTS: A total of ten articles were identified as eligible for the review. Six of the articles evaluated a method that was developed by the authors, four of which were machine learning methods, and the results almost always stated that this developed method’s performance was equivalent to or better than the other methods compared. Comparisons were often biased towards the novel approach, with the majority only comparing against a basic Cox proportional hazards model, and in scenarios where it is clear it would not perform well. In many of the articles reviewed, key information was unclear, such as the number of simulation repetitions and how performance measures were calculated.

CONCLUSION: It is vital that method comparisons are unbiased and comprehensive, and this should be the goal even if realising it is difficult. Fully assessing how newly developed methods perform and how they compare to a variety of traditional statistical methods for prognostic modelling is imperative as these methods are already being applied in clinical contexts. Evaluations of the performance and usefulness of recently developed methods for risk prediction should be continued and reporting standards improved as these methods become increasingly popular.

PMID:35650647 | DOI:10.1186/s41512-022-00124-y

BMC Musculoskelet Disord. 2022 Jun 1;23(1):524. doi: 10.1186/s12891-022-05481-9.

ABSTRACT

BACKGROUND: To compare potential of ultrashort time-to-echo (UTE) T2* mapping and T2* values from T2*-weighted imaging for assessing lumbar intervertebral disc degeneration (IVDD),with Pfirrmann grading as a reference standard.

METHODS: UTE-T2* and T2* values of 366 lumbar discs (L1/2-L5/S1) in 76 subjects were measured in 3 segmented regions: anterior annulus fibrosus, nucleus pulposus (NP), and posterior annulus fibrosus. Lumbar intervertebral discs were divided into 3 categories based on 5-level Pfirrmann grading: normal (Pfirrmann grade I),early disc degeneration (Pfirrmann grades II-III), and advanced disc degeneration (Pfirrmann grades IV-V). Regional differences between UTE-T2* and T2* relaxometry and correlation with degeneration were statistically analyzed.

RESULTS: UTE-T2* and T2*value correlated negatively with Pfirrmann grades (P < 0.001). In NP, correlations with Pfirrmann grade were high with UTE-T2* values (r = – 0.733; P < 0.001) and moderate with T2* values (r = -0.654; P < 0.001). Diagnostic accuracy of detecting early IVDD was better with UTE-T2* mapping than T2* mapping (P < 0.05),with receiver operating characteristic analysis area under the curve of 0.715-0.876.

CONCLUSIONS: UTE-T2* relaxometry provides another promising magnetic resonance imaging sequence for quantitatively evaluate lumbar IVDD and was more accurate than T2*mapping in the earlier stage degenerative process.

PMID:35650645 | DOI:10.1186/s12891-022-05481-9

Arthritis Res Ther. 2022 Jun 1;24(1):130. doi: 10.1186/s13075-022-02818-6.

ABSTRACT

BACKGROUND: We report results from a phase II randomised placebo-controlled trial assessing zibotentan, a highly selective endothelin receptor antagonist (ERA), in chronic kidney disease (CKD) secondary to systemic sclerosis (SSc).

METHODS: This trial included three sub-studies: ZEBRA 1-a randomised placebo-controlled, double-blind trial of zibotentan in SSc patients with CKD2 or CKD3 (and glomerular filtration rate (GFR) >45 ml/min) over 26 weeks; ZEBRA 2A-a 26-week placebo-controlled, single-blind trial of zibotentan in scleroderma renal crisis patients not requiring dialysis; and ZEBRA 2B-an open label pharmacokinetic study of zibotentan in patients on haemodialysis.

RESULTS: Sixteen patients were screened for ZEBRA 1. Of these, 6 patients were randomised to zibotentan and 7 to placebo. In ZEBRA 1, there were 47 non-serious adverse events (AE) during the trial. Twenty-seven occurred in the placebo group and 20 in the zibotentan group. One serious adverse event (SAE) occurred during ZEBRA1, in the placebo arm. Descriptive statistics did not suggest an effect of study drug on serum sVCAM1. Estimated GFR numerically declined in patients treated with placebo at 26 weeks and 52 weeks. In contrast, average eGFR increased in zibotentan-treated cases. The 4 patients in ZEBRA 2A experienced 8 non-serious AEs, distributed equally between placebo and zibotentan. There was one SAE each in placebo and zibotentan groups, both unrelated to study medication. ZEBRA 2B recruited 8 patients, 6 completed first dosing, and 2 completed a second dosing visit. Pharmacokinetic analysis confirmed zibotentan levels within the therapeutic range. Three patients experienced 3 non-serious AEs. One SAE occurred and was unrelated to study drug.

CONCLUSIONS: Zibotentan was generally well-tolerated. ZEBRA 1 did not show any effect of zibotentan on serum sVCAM-1 but was associated with numerical improvement in eGFR at 26 weeks that was more marked at 52 weeks. ZEBRA 2B suggested a feasible dose regimen for haemodialysis patients.

TRIAL REGISTRATION: EudraCT no: 2013-003200-39 (first posted January 28, 2014) ClinicalTrials.gov Identifier: NCT02047708 Sponsor protocol number: 13/0077.

PMID:35650639 | DOI:10.1186/s13075-022-02818-6

BMC Public Health. 2022 Jun 1;22(1):1098. doi: 10.1186/s12889-022-13514-0.

ABSTRACT

BACKGROUND: Under the outbreak of Coronavirus disease 2019 (COVID-19), a structural equation model was established to determine the causality of important factors that affect Chinese citizens’ COVID-19 prevention behavior.

METHODS: The survey in Qingdao covered several communities in 10 districts and used the method of cluster random sampling. The research instrument used in this study is a self-compiled Chinese version of the questionnaire. Of the 1215 questionnaires, 1188 were included in our analysis. We use the rank sum test, which is a non-parametric test, to test the influence of citizens’basic sociodemographic variables on prevention behavior, and the rank correlation test to analyze the influencing factors of prevention behavior. IBM AMOS 24.0 was used for path analysis, including estimating regression coefficients and evaluating the statistical fits of the structural model, to further explore the causal relationships between variables.

RESULTS: The result showed that the score in the prevention behavior of all citizens is a median of 5 and a quartile spacing of 0.31. The final structural equation model showed that the external support for fighting the epidemic, the demand level of health information, the cognition of (COVID-19) and the negative emotions after the outbreak had direct effects on the COVID-19 prevention behavior, and that negative emotions and information needs served as mediating variables.

CONCLUSIONS: The study provided a basis for relevant departments to further adopt epidemic prevention and control strategies.

PMID:35650608 | DOI:10.1186/s12889-022-13514-0

BMC Rheumatol. 2022 Jun 2;6(1):33. doi: 10.1186/s41927-022-00262-2.

ABSTRACT

BACKGROUND: The gold standard for skin thickness assessment in systemic sclerosis (SSc) is the modified Rodnan skin score (mRSS); however, inter- and intra-rater variation can arise due to subjective methods and inexperience. The study aimed to determine the inter- and intra-rater variability of mRSS assessment using a skin model.

METHODS: A comparative study was conducted between January and December 2020 at Srinagarind Hospital, Khon Kaen University, Thailand. Thirty-six skin sites of 8 SSc patients underwent mRSS assessment: 4 times the first day and 1 time over the next 4 weeks by the same 10 raters. No skin model for mRSS assessment was used for the first two assessments, while one was used for the remaining three rounds of assessments. The Latin square design and Kappa statistic were used to determine inter- and intra-rater variability.

RESULTS: The kappa agreement for inter-rater variability improved when the skin model was used (from 0.4 to 0.5; 25%). The improvement in inter-rater variability was seen in the non-expert group, for which the kappa agreement rose from 0.3 to 0.5 (a change of 66.7%). Intra-rater variability did not change (kappa remained at 0.9), and the long-term effect of using a skin model slightly decreased by week 4 (Δkappa 0.9-0.7).

CONCLUSIONS: Using a skin model could be used to improve inter-rater variation in mRSS assessment, especially in the non-expert group. The model should be considered a reference for mRSS assessment in clinical practice and health education.

PMID:35650637 | DOI:10.1186/s41927-022-00262-2