Category: Nevin Manimala

Environ Health. 2022 Jul 28;21(1):73. doi: 10.1186/s12940-022-00885-5.

ABSTRACT

BACKGROUND: Environmental exposures such as traffic may contribute to asthma morbidity including recurrent emergency department (ED) visits. However, these associations are often confounded by socioeconomic status and health care access.

OBJECTIVE: This study aims to assess the association between traffic density and recurrence of asthma ED visits in the primarily low income Medicaid population in New York State (NYS) between 2005 and 2015.

METHODS: The primary outcome of interest was a recurrent asthma ED visit within 1-year of index visit. Traffic densities (weighted for truck traffic) were spatially linked based on home addresses. Bivariate and multivariate logistic regression analyses were conducted to identify factors predicting recurrent asthma ED visits.

RESULTS: In a multivariate model, Medicaid recipients living within 300-m of a high traffic density area were at a statistically significant risk of a recurrent asthma ED visit compared to those in a low traffic density area (OR = 1.31; 95% CI:1.24,1.38). Additionally, we evaluated effect measure modification for risk of recurrent asthma visits associated with traffic exposure by socio-demographic factors. The highest risk was found for those exposed to high traffic and being male (OR = 1.87; 95% CI:1.46,2.39), receiving cash assistance (OR = 2.11; 95% CI:1.65,2.72), receiving supplemental security income (OR = 2.21; 95% CI:1.66,2.96) and being in the 18.44 age group (OR = 1.59;95% CI 1.48,1.70) was associated with the highest risk of recurrent asthma ED visit. Black non-Hispanics (OR = 2.35; 95% CI:1.70,3.24), Hispanics (OR = 2.13; 95% CI:1.49,3.04) and those with race listed as “Other” (OR = 1.89 95% CI:1.13,3.16) in high traffic areas had higher risk of recurrent asthma ED visits as compared to White non-Hispanics in low traffic areas.

CONCLUSION: We observed significant persistent disparities in asthma morbidity related to traffic exposure and race/ethnicity in a low-income population. Our findings suggest that even within a primarily low-income study population, socioeconomic differences persist. These differences in susceptibility in the extremely low-income group may not be apparent in health studies that use Medicaid enrollment as a proxy for low SES.

PMID:35896993 | DOI:10.1186/s12940-022-00885-5

BMC Pregnancy Childbirth. 2022 Jul 27;22(1):599. doi: 10.1186/s12884-022-04921-7.

ABSTRACT

BACKGROUND: The World Health Organization recommends a minimum of three doses of quality-assured sulfadoxine-pyrimethamine for intermittent preventive treatment of malaria during pregnancy (IPTp), in moderate to high malaria transmission areas in sub-Saharan Africa. Currently, coverage of IPTp lags behind coverage of antenatal care (ANC) visits; in Nigeria, 57% of women attended four or more ANC visits, whereas only 17% received the recommended three or more doses of IPTp. The innovative program aimed to close this gap by providing counseling on the benefits of comprehensive ANC, referral to ANC and community distribution of IPTp (C-IPTp), complementing IPTp at ANC. The study aimed to examine whether CHW referral to ANC improved the likelihood of receiving three or more doses of IPTp.

METHODS: The data for this study were extracted from the maternity record books of 1437 pregnant women seen at 25 public health facilities in Ebonyi State, Nigeria. The outcome of interest was defined as the receipt of three or more doses of IPTp (IPTp3) and the independent variable was referral to ANC by a community health worker for any visit. Descriptive statistics were reported and the results from the multi-level regressions are reported as adjusted odds and prevalence ratios with corresponding 95% confidence intervals.

RESULTS: Of the 936 women included in the analysis, 24.47% received the recommended three or more IPTp doses and 61.32% were referred by a community health worker (CHW) for at least one ANC visit. There was no difference in the mean number of ANC visits between women who received C-IPTp and those who received IPTp exclusively at a facility (2.40 vs 2.52; p = 0.374). There were no maternal characteristics associated with CHW referral. Women who were referred by a CHW had 60% greater odds (95% CI, 1.08-2.38) of receiving IPTp3 than those who were never referred.

CONCLUSION: The results indicate that CHW referrals conducted within a C-IPTp program are associated with higher IPTp uptake but not fewer ANC visits and that CHWs applied the referral process equally. This strengthens the evidence base for C-IPTp scale-up, which could have a large impact in sub-Saharan Africa in mitigating existing health systems issues.

PMID:35896992 | DOI:10.1186/s12884-022-04921-7

BMC Neurol. 2022 Jul 27;22(1):278. doi: 10.1186/s12883-022-02781-4.

ABSTRACT

BACKGROUND: Migraine is a neurological condition characterized by chronic inflammation. However, not much is known about the potential role of peripheral blood immune cells in the pathophysiology of migraine.

METHODS: We investigated the status of peripheral blood immune cells of 15 adults with frequent episodic or chronic migraine recruited chronologically from a randomized clinical trial (RCT) on Nutrition for Migraine (NCCIH 5R01AT007813-05) and 15 non-migraine, healthy volunteers (control) matched by age, gender, and Body Mass Index (BMI). Continuous variables were presented as means ± standard deviationas well as medians, and comparisons between patients and healthy volunteers were performed with non-parametric Wilcoxon signed rank tests. Statistical analysis was performed using Stata (StataCorp. 2019. Stata Statistical Software). Fluorescence-Activated Cell Sorting (FACS) data were processed using FlowJo software (Ashland, OR: Becton, Dickenson and Company; 2019).

RESULTS: We observed that migraineurs had a significantly lower percentage of non-classical monocytes (CD14⁺CD16⁺⁺) in blood circulation, compared to the control group. In addition, Migraineurs also showed a significantly lower percentage of blood CD3⁺CD4⁺ helper T cells and CD4⁺CD25⁺ regulatory T cells, compared to controls. Differences in leukocyte surface markers between chronic migraine patients and their matched controls were more prominent than those between episodic migraine patients and their matched controls.

CONCLUSIONS: Our results suggest that migraine is associated with dysregulated peripheral immune homeostasis and that inflammation and autoimmunity may play a role in its pathophysiology.

PMID:35896985 | DOI:10.1186/s12883-022-02781-4

Br J Clin Pharmacol. 2022 Jul 27. doi: 10.1111/bcp.15472. Online ahead of print.

ABSTRACT

AIM: Primary nonadherence (PNA) is defined as not filling the first prescription for a drug treatment. PNA can lead not only to poor patient outcomes but also to exposure misclassification in written prescription databases. This study aims to estimate PNA in primary care in the Netherlands and to investigate associated factors.

METHODS: Patients from the Nivel Primary Care Database who received a new prescription (>1 year not prescribed) from a general practitioner in 2012 were linked to pharmacy dispensing information of consenting pharmacies, based on sex, year of birth, 4-digit postal code and at least 50% matching ATC-codes. PNA was defined as not having a prescription dispensed within 30 days from the prescribing date. PNA was assessed overall and per drug class. The associations between PNA and several patient- and prescription-related characteristics were assessed using mixed effects logistic regression models.

RESULTS: After matching 86,361 of 396,251 subjects (21.8%) in the Nivel-PCD records to the pharmacy records, this study included 65,877 subjects who received 181,939 new drug prescriptions. Overall, PNA was 11.5%. PNA was lowest for thyroid hormones (5.5%) and highest for proton pump inhibitors (12.8%). Several factors were associated with PNA, such as having comorbidities (OR 1.46 95% CI [1.37-1.56] for >3 active diagnoses, compared to no active diagnoses) or reimbursement status (OR 2.78 [2.65-2.92] for not reimbursed drugs compared to fully reimbursed drugs.

CONCLUSIONS: 11.5% of newly prescribed drugs were not dispensed. This can lead to overestimation of the actual drug exposure status when using written prescription databases.

PMID:35896043 | DOI:10.1111/bcp.15472

JMIR Med Inform. 2022 Jul 26. doi: 10.2196/37578. Online ahead of print.

ABSTRACT

BACKGROUND: Healthcare costs have been continuously increasing in the past few years despite various efforts and policies by the government. The Centers for Medicare and Medicaid Services projects that healthcare costs will continue to grow over the next few years. Rising readmission costs have been a significant contributor to the increasing healthcare costs. Multiple areas of healthcare, including readmissions, have benefited from the application of various machine learning algorithms in several ways.

OBJECTIVE: We identify suitable models for predicting readmission charges billed by hospitals. Our literature review revealed that this application of machine learning is still underexplored. We used various predictive methods, ranging from glass-box models (such as regularization techniques) to black-box models (such as deep learning-based models).

METHODS: Readmission with the same major diagnostic category (RSDC) and all-cause readmission category (RADC) are the two ways we defined readmissions. 576,701 and 1,091,580 individuals were identified from the Nationwide Readmission Database (NRD), Healthcare Cost and Utilization Project (HCUP) by the Agency for Healthcare Research and Quality (AHRQ) for 2013 for the two identified readmission categories, i.e., RSDC and RADC, respectively. Linear regression, Lasso regression, Elastic Net, Ridge regression, XGBoost, and deep learning model based on multilayer perceptron (MLP) were the six machine learning algorithms we tested for both RSDC and RADC through 10-fold cross-validation.

RESULTS: Our preliminary analysis using a data-driven approach revealed that within an RADC, the subsequent readmission charge billed per patient was higher than the previous charge for 541,090 individuals, and this number is 319,233 for an RSDC. The top three Major Diagnostic Categories (MDCs) for such instances were the same for both RADC and RSDC. The average readmission charge billed was higher than the previous charge for 21 of the MDCs in the case of RSDC, whereas it was only 13 of the MDCs for RADC. We recommend XGBoost and a deep learning model based on MLP for predicting readmission charges. The performance obtained for XGBoost: (i) RADC (MAPE-3.121%; RMSE-0.414; MAE-0.317; RRSE-0.410; RAE-0.399; NRMSE-0.040; MAD-0.031) and (ii) RSDC (MAPE-3.171%; RMSE-0.421; MAE-0.321; RRSE-0.407; RAE-0.393; NRMSE-0.041; MAD-0.031). The performance obtained for deep neural networks based on MLP: (i) RADC (MAPE-3.103%; RMSE-0.413; MAE-0.316; RRSE-0.410; RAE-0.397; NRMSE-0.040; MAD-0.031) and (ii) RSDC (MAPE-3.202%; RMSE-0.427; MAE-0.326; RRSE-0.413; RAE-0.399; NRMSE-0.041; MAD-0.032). Based on repeated measures ANOVA, the mean RMSE was significantly different across models with P<.001. Post-hoc tests using the Bonferroni correction method indicated that the mean RMSE of deep learning/XGBoost models was statistically significantly (P<.001) lower than that of all other models i.e., linear regression/Elastic Net/Lasso/Ridge regression.

CONCLUSIONS: Models built using XGBoost and MLP deep neural networks are suitable for predicting readmission charges billed by hospitals. The MDCs can be used by models to accurately predict hospital readmission charges.

CLINICALTRIAL: Not applicable.

PMID:35896038 | DOI:10.2196/37578

Trans R Soc Trop Med Hyg. 2022 Jul 27:trac068. doi: 10.1093/trstmh/trac068. Online ahead of print.

ABSTRACT

BACKGROUND: Chagas disease (CD) is still an important public health issue in Latin America. This study aims to analyse the association between socio-epidemiological factors and comorbidities with clinical manifestations of CD.

METHODS: We performed a cross-sectional study of 985 adult patients (65±11 y; 59.5% women) with CD. Data collection was based on questionnaires and medical records review. CD clinical forms (indeterminate, digestive, cardiac and cardiodigestive) and the stages of the cardiac form were classified according to the II Brazilian Consensus on CD. Statistical analyses were based on univariate and multivariate logistic regression.

RESULTS: Older age and Brazilian birth state (Minas Gerais and Bahia) were associated with a greater likelihood of the cardiac form of CD. A greater likelihood of the digestive form was seen in men and those of older age. Patients with arterial hypertension and diabetes were less likely to have the digestive form. Men had a greater likelihood of having a more severe cardiac presentation. Those from Minas Gerais and Bahia states had a greater likelihood of having stage B1 or B2.

CONCLUSIONS: The results reinforce the aging of the CD population living in urban areas in Brazil, the high prevalence of comorbidities and that epidemiology, sex and the presence of comorbidities may be related to the clinical form of CD.

PMID:35896031 | DOI:10.1093/trstmh/trac068

J Med Internet Res. 2022 Jul 27;24(7):e31803. doi: 10.2196/31803.

ABSTRACT

BACKGROUND: Screen use is part of daily life worldwide and morbidity related to excess use of screens has been reported. Some use of screens in excess could indicate a screen use disorder (ScUD). An integrative approach to ScUD could better fit the polymodal reality of screens, and concurrent problems with screens, than a split approach, activity by activity. In that paradigm, a pragmatic and operationalized approach to study a potential ScUD requires the use of common criteria, for all screens and activities done on screens, in a single questionnaire.

OBJECTIVE: Our goals were (1) to describe screen uses in a general population sample and (2) to test the unidimensionality, local independence, and psychometric properties of the 9 Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) internet gaming disorder (IGD) criteria adapted to screen use in a community sample. We hypothesized that the 9 DSM-5 IGD criteria adapted to ScUD would show unidimensionality, local independence, and good discrimination, with criteria distributed on the severity continuum.

METHODS: This cross-sectional survey in a French suburban city targeted adults and adolescents. A self-administered questionnaire covered the main types of screens used and their use for various activities in the past month. Presence of ScUD diagnostic criteria in past 12 months was also self-evaluated in the questionnaire. Factor and 2-parameter Item Response Theory analysis were used to investigate the dimensionality, local independence, and psychometric properties of the ScUD criteria.

RESULTS: Among the 300 participants, 171 (57.0%) were female (mean age 27 years), 297 (99.0%) used screens, 134 (44.7%) reported at least one criterion (potential problem users), and 5 (1.7%) reported 5 or more criteria and endorsed an ScUD. The most endorsed criteria were loss of control (60/300, 20.0%) and preoccupation (52/300, 17.3%). Screen types used and screen activities differed between participants with no ScUD criteria and those with at least one ScUD criterion. The latter were more likely to have a computer as the most used screen type, and more video gaming, communication/social network, and watching news and research of information as activities. Unidimensionality was confirmed by all fit indices. Local independence was confirmed by the absence of residual correlation between the items. Criteria had relatively high factor loading, with loss of interest in other recreational activities having the highest. However, criteria with the lowest factor loading all remained above the cut-offs, sanctioning unidimensionality. Most discriminating criteria were loss of interests, preoccupation, deceive/cover up, and risk/lose relationship/opportunities, which also provided the most information on the measurement of the latent trait.

CONCLUSIONS: We described screen uses in a French community sample and have shown that the adaptation of the DSM-5 IGD to “ScUD” has good psychometric validity and is discriminating, confirming our hypothesis. We suggest to use those criteria to assess potential “ScUD.” Further studies should determine if all criteria are needed and whether others should be added.

PMID:35896018 | DOI:10.2196/31803

Traffic Inj Prev. 2022 Jul 27:1-6. doi: 10.1080/15389588.2022.2098280. Online ahead of print.

ABSTRACT

OBJECTIVES: Ergonomic design of child restraint systems (CRS) may facilitate optimal travel behavior and crash protection of child passengers during motor vehicle trips. However there have been few studies examining the relationship between CRS design and child passenger travel behavior. The aim of this study was to examine whether associations between CRS design features and child passenger behavior exist during real-world, everyday vehicle trips.

METHODS: Video from a naturalistic driving study (NDS) was analyzed in this study. Families drove an instrumented study vehicle for approximately two weeks with at least one child aged between one and eight years traveling in their own forward-facing (FF) CRS or belt positioning booster (BPB). Video for one child passenger was randomly selected from each trip for analysis. Video was coded for five-second epochs at nine time points (5%, 17%, 25%, 30%, 50%, 53%, 75%, 89% and 95% of trip length). Two types of child passenger travel behaviors were identified by manual review of the video and audio recordings: (i) optimal/suboptimal head position and (ii) correct/incorrect use of the internal harness/shoulder belt. Video screenshots were used to characterize CRS design features. Random effects logistic regression models were used to examine the associations between specific CRS design features and the travel behaviors of interest, whilst accounting for clustering of data by child and trip.

RESULTS: Suboptimal head position was associated with the absence of a height adjustable headrest and a narrow headrest wing width in FFCRS. Incorrect harness use in a FFCRS was associated with the absence of an adjustable headrest, in addition to headrest features such as wing width and depth. In BPBs, a reduction in suboptimal head position was associated with the absence of a sash belt guide, however no restraint design features were associated with incorrect shoulder belt use.

CONCLUSIONS: Some CRS design features may influence undesirable child passenger travel behavior. These early findings support enhanced and user-centric CRS design as a likely important mechanism to improve child passenger safety.

PMID:35896022 | DOI:10.1080/15389588.2022.2098280

J Med Internet Res. 2022 Jul 27;24(7):e36996. doi: 10.2196/36996.

ABSTRACT

BACKGROUND: Telemedicine can help mitigate important health care challenges, such as demographic changes and the current COVID-19 pandemic, in high-income countries such as Germany. It gives physicians and patients the opportunity to interact via video consultations, regardless of their location, thus offering cost and time savings for both sides.

OBJECTIVE: We aimed to investigate whether telemedicine can be implemented efficiently in the follow-up care for patients in orthopedic and trauma surgery, with respect to patient satisfaction, physician satisfaction, and quality of care.

METHODS: We conducted a prospective randomized controlled trial in a German university hospital and enrolled 60 patients with different knee and shoulder conditions. For follow-up appointments, patients received either an in-person consultation in the clinic (control group) or a video consultation with their physician (telemedicine group). Patients’ and physicians’ subsequent evaluations of these follow-up appointments were collected and assessed using separate questionnaires.

RESULTS: On the basis of data from 52 consultations after 8 withdrawals, it was found that patients were slightly more satisfied with video consultations (mean 1.58, SD 0.643) than with in-clinic consultations (mean 1.64, SD 0.569), although the difference was not statistically significant (P=.69). After excluding video consultations marred by technical problems, no significant difference was found in physician satisfaction between the groups (mean 1.47, SD 0.516 vs mean 1.32, SD 0.557; P=.31). Further analysis indicated that telemedicine can be applied to broader groups of patients and that patients who have prior experience with telemedicine are more willing to use telemedicine for follow-up care.

CONCLUSIONS: Telemedicine can be an alternative and efficient form of follow-up care for patients in orthopedic and trauma surgery in Germany, and it has no significant disadvantages compared with in-person consultations in the clinic.

TRIAL REGISTRATION: German Clinical Trials Register DRKS00023445; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00023445.

PMID:35896015 | DOI:10.2196/36996

JMIR Aging. 2022 Jul 27;5(3):e39335. doi: 10.2196/39335.

ABSTRACT

BACKGROUND: Monitoring technologies are used to collect a range of information, such as one’s location out of the home or movement within the home, and transmit that information to caregivers to support aging in place. Their surveilling nature, however, poses ethical dilemmas and can be experienced as intrusive to people living with Alzheimer disease (AD) and AD-related dementias. These challenges are compounded when older adults are not engaged in decision-making about how they are monitored. Dissemination of these technologies is outpacing our understanding of how to communicate their functions, risks, and benefits to families and older adults. To date, there are no tools to help families understand the functions of monitoring technologies or guide them in balancing their perceived need for ongoing surveillance and the older adult’s dignity and wishes.

OBJECTIVE: We designed, developed, and piloted a communication and education tool in the form of a web application called Let’s Talk Tech to support family decision-making about diverse technologies used in dementia home care. The knowledge base about how to design online interventions for people living with mild dementia is still in development, and dyadic interventions used in dementia care remain rare. We describe the intervention’s motivation and development process, and the feasibility of using this self-administered web application intervention in a pilot sample of people living with mild AD and their family care partners.

METHODS: We surveyed 29 mild AD dementia care dyads living together before and after they completed the web application intervention and interviewed each dyad about their experiences with it. We report postintervention measures of feasibility (recruitment, enrollment, and retention) and acceptability (satisfaction, quality, and usability). Descriptive statistics were calculated for survey items, and thematic analysis was used with interview transcripts to illuminate participants’ experiences and recommendations to improve the intervention.

RESULTS: The study enrolled 33 people living with AD and their care partners, and 29 (88%) dyads completed the study (all but one were spousal dyads). Participants were asked to complete 4 technology modules, and all completed them. The majority of participants rated the tool as having the right length (>90%), having the right amount of information (>84%), being very clearly worded (>74%), and presenting information in a balanced way (>90%). Most felt the tool was easy to use and helpful, and would likely recommend it to others.

CONCLUSIONS: This study demonstrated that our intervention to educate and facilitate conversation and documentation of preferences is preliminarily feasible and acceptable to mild AD care dyads. Effectively involving older adults in these decisions and informing care partners of their preferences could enable families to avoid conflicts or risks associated with uninformed or disempowered use and to personalize use so both members of the dyad can experience benefits.

PMID:35896014 | DOI:10.2196/39335