Category: Nevin Manimala

Arch Suicide Res. 2022 Nov 25:1-11. doi: 10.1080/13811118.2022.2150104. Online ahead of print.

ABSTRACT

OBJECTIVES: To estimate effects of potentially modifiable risk factors for self-harm among adolescents in the Child Protective Services (CPS) system.

METHODS: Data came from the National Survey of Child and Adolescent Well-being, a nationally representative longitudinal survey. Candidate risk factors included child’s feelings of worthlessness, the presence of supportive adults in the child’s life, and parental psychological aggression. Propensity score weighting (PSW) was used to control for observed confounders, and the average effect of experiencing the risk factor among those who did was estimated using weighted logistic regression.

RESULTS: Odds ratios for self-harm comparing youth with low and high parental psychological aggression to none were 0.93 (0.35-2.45) and 1.25 (0.55-2.82), respectively. The OR for feelings of worthlessness was 1.73 (0.70-4.27), and for supportive adults 0.58 (0.28-1.19). The combination of survey and propensity score weights may have affected statistical power.

CONCLUSIONS: Preventing self-harm in adolescents requires a multifaceted approach given the existing evidence base and lack of strong associations with individual risk factors. Fostering supportive relationships with adults merits future research given the observed, non-significant 42% reduction in odds of self-harm among CPS involved youth who had a supportive relationship with an adult, compared to those who did not.

PMID:36426537 | DOI:10.1080/13811118.2022.2150104

Lancet. 2022 Nov;400 Suppl 1:S79. doi: 10.1016/S0140-6736(22)02289-9.

ABSTRACT

BACKGROUND: A social prescribing link worker is responsible for enabling and supporting individuals, by assessing their needs and co-producing solutions to make use of appropriate, local, non-clinical resources or interventions. Because the role is new, link workers might not have professional backgrounds in dealing with individuals with complex needs, which can affect their decision making for the referral of individuals to appropriate community assets to support their needs. The aim of this work was to explore link workers’ level of education, and past and current training needs, and to ascertain how much link workers were willing to pay to access and complete training to improve their skill set.

METHODS: A mixed-methods approach was used, including semi-structured interviews with key stakeholders who commission and deliver social prescribing interventions employing link workers, and a stated preference techniques questionnaire containing contingent valuation questions. A thematic analysis approach was used to identify concepts of interest to develop the survey, which contained stated preference techniques to estimate the value of access to training by link workers. Descriptive statistics were used to describe and summarise the data.

FINDINGS: 54 respondents took the survey. 23 (43%) held an undergraduate degree and 13 (24%) held a Masters’ degree as their highest level of education; the remainder 18 (33%) did not have a graduate qualification. Social prescribing coordinators (n=6) interviews and link worker surveys (n=54) reported personal skills as the most essential skills required by link workers in developing relationships for effective social prescribing interventions. Training is available for link workers; however, training varies depending on the type of intervention delivered, with 38 (70%) of 54 link workers previously completing training to facilitate their development as a link worker. Results from the stated preference techniques questionnaire (n=54) indicated that 100% of the respondents would consider benefitting from training. Link workers are willing to pay an average of £58 from their personal funds to access training and the associated benefits to enhance their skills and knowledge.

INTERPRETATION: Our findings suggest that training needs to be included in social innovation funding applications to ensure that link workers receive adequate training to carry out their role of effective future social prescribing interventions. For the community of practice in social prescribing, training for link workers should be made available in their own local areas. External funding for the salary of the link worker is an obstacle for link worker development through training. Willingness-to-pay findings suggest that link workers place value on their professional development and would be willing to spend their own money on training to improve their knowledge and skills.

FUNDING: AM is supported by a KESS 2 studentship.

PMID:36426499 | DOI:10.1016/S0140-6736(22)02289-9

Lancet. 2022 Nov;400 Suppl 1:S68. doi: 10.1016/S0140-6736(22)02278-4.

ABSTRACT

BACKGROUND: Cervical cancer is the fourth most common cancer in women worldwide. We aimed to assess the burden of cervical cancer risk factors among women in eight west African countries.

METHODS: Cross-sectional data from nationally representative samples of eight west African countries (Benin, Cameroon, Gambia, Guinea, Liberia, Mali, Nigeria, and Sierra Leone) as part of the demographic and health survey 2017-2020 were used. The interviewer-assisted survey assessed eight cervical cancer risk factors (smoking, early coitus, body-mass index, parity, early pregnancy, length of hormonal contraceptive use, multiple sexual partners, and sexually-transmitted infections). Data were analysed using descriptive statistics and Poisson regression. The Demographic and Health Service programme has ethical review documentation on the privacy and confidentiality of the respondents. We received authorisation to use the data from the Demographic and Health Service repository.

FINDINGS: A total of 128 173 women aged 15-49 years participated. Liberia had the highest number of risk factors (mean 3·05; SD 1·19), and Benin had the lowest (mean 2·20; SD 1·14). The mean age of first sexual intercourse was highest in Gambia at 18·15 years (95% CI 17·98-18·32) and lowest in Liberia at 15·72 years (15·62-15·81). Similarly, the highest mean age of first birth was 19·83 years (19·66-20·00) in Gambia, and the lowest is in Liberia at 18·69 years (18·54-18·83). Aside from Mali (45·9%), more than 50·0% of the women had at least two children. Age of first sexual intercourse, age of first birth, and parity were the most frequent risk factors across all the countries. Different age groups were significantly associated with the number of risk factors. Liberian women aged 30-34 years had the highest IRR of 30% (1·18-1·42; p<0·001) among all the countries. Women with the highest education level in Gambia and Nigeria had reduced risk. Limitations of the study included data collection from countries on different years and no human papillomavirus status data collection.

INTERPRETATION: Identification of age of first sexual intercourse, age of first birth, and parity as the most frequent risk factors of cervical cancer will support more focused public health interventions (such as human papillomavirus vaccination and cervical screening) in the countries that the data was collected from, as well as globally.

FUNDING: Federal Government of Nigeria.

PMID:36426487 | DOI:10.1016/S0140-6736(22)02278-4

Lancet. 2022 Nov;400 Suppl 1:S65. doi: 10.1016/S0140-6736(22)02275-9.

ABSTRACT

BACKGROUND: Adolescent dating and relationship violence (DRV) is widespread and associated with increased risk of subsequent poor mental health outcomes and partner violence in adulthood. Shifting social norms could be important for reducing DRV. We aimed to map and evaluate measures of social norms concerning DRV and gender reported in DRV research.

METHODS: We did a systematic review of global peer-reviewed and grey DRV literature in English, reporting on content and validity of measures used with individuals aged 10-18 years in four domains: descriptive DRV norms, injunctive DRV norms, descriptive gender norms, and injunctive gender norms. Searches included nine databases and Google Scholar (original search up to June, 2019; updated March, 2022), organisation websites (June, 2020), reference checking and known studies (June, 2019-May, 2022), and expert requests (September, 2019-April, 2022). Search terms included three concepts linked by “AND”: “social norms concerning DRV and/or gender”, “DRV”, and “adolescents”. Results were screened by title and abstract and then full text. After data extraction we summarised measure characteristics within each domain and assessed measures against seven quality criteria: participatory development, defined reference group, reliability (internal consistency, test-retest reliability, or split-half reliability), content validity, construct validity (association with DRV behaviour), other evidence of construct validity (association with theoretically related constructs) or convergent validity (factor analysis), and statistically desirable properties (responsiveness, absence of floor or ceiling effects, or data available on measures of central tendency and distribution of total score).

FINDINGS: 24 reports were included (14 North America, four Africa, four Europe, one Middle East, one Latin America) containing 40 measures assessing DRV (n=33) and gender (n=7) norms. No measure was shared across studies. 36 (90%) measures were significantly associated with DRV outcomes, 24 (60%) showed good reliability, and 38 (95%) had a defined reference group. Other evidence of quality was mixed. Several DRV norm measures specified heterosexual relationships, but measures rarely separated norms governing DRV by girls and boys. No measures specified same-sex relationships. Gender norm measures focused on violence, but missed broader gendered expectations underpinning DRV.

INTERPRETATION: Valid, reliable measures of social norms associated with DRV exist, but measurement methods are inconsistent. Researchers should report on development and quality of such measures, which should be gender-specific when norms exert gendered influence, consider sexual minority relationships, and assess gender norms beyond gendered violence. Evaluators should draw on such measures to assess whether changes to norms mediate effect on DRV.

FUNDING: US Agency for International Development (agreement number AID-OAA-A-15-00042).

PMID:36426484 | DOI:10.1016/S0140-6736(22)02275-9

Lancet. 2022 Nov;400 Suppl 1:S64. doi: 10.1016/S0140-6736(22)02274-7.

ABSTRACT

BACKGROUND: UK policy makers have called for urgent action to reduce prenatal alcohol exposure (PAE), but evidence on what is effective is scarce. We aimed to identify, evaluate, and synthesise evidence on content, process aspects, and effectiveness of UK PAE prevention initiatives.

METHODS: We conducted a systematic search of published and grey literature on UK PAE prevention (PROSPERO: CRD42020209460); consultations with 61 academic, practice, policy, third sector, and public stakeholders; and semi-structured 12 interviews with pregnant people (who were aged ≥18 years and ≥12 weeks’ gestation) and service providers to discuss experiences of PAE prevention. Participants were purposively sampled to cover each UK region and identified through maternity sites, social media and, for stakeholder consultees, researcher networks. Information from relevant PAE prevention initiatives from the literature was independently extracted by two reviewers. Ethical approval and informed consent were obtained for interviews, which were recorded and transcribed. Qualitative evidence was synthesised using thematic analysis. Quantitative data will be summarised using descriptive statistics and meta-analysis.

FINDINGS: We identified 14 PAE prevention initiatives through literature searches (22 of 4064 results were eligible), stakeholder consultation, and interviews. Initiatives included screening and intervention, campaigns, and education or training. Seven initiatives were identified in the north of England. Two initiatives were identified in Scotland and two in Wales. The East of England, West Midlands, and South East of England had one each. None were identified in Southwest of England or Northern Ireland. Barriers to prevention included absence of resources, excessive workload, concerns around blame, and COVID-19. Enablers included workforce training and trust between pregnant people and service providers. Effectiveness of evidence was scarce.

INTERPRETATION: Key strengths include extensive searches and multidisciplinary consultation. Data collection and analyses are ongoing and will be finalised before November, 2022. This research will provide a comprehensive analysis of current provision, providing crucial evidence to inform research and practice.

FUNDING: The National Institute for Health and Care Research.

PMID:36426483 | DOI:10.1016/S0140-6736(22)02274-7

Lancet. 2022 Nov;400 Suppl 1:S57. doi: 10.1016/S0140-6736(22)02267-X.

ABSTRACT

BACKGROUND: Preventing smoking uptake among adolescents is essential to achieve a smoke-free generation. The aim of this study was to assess risk factors for smoking in late adolescence and smoking uptake between early and late adolescence, using data from the Millennium Cohort Study. We also present estimates of numbers of smokers and smoking uptake.

METHODS: Adolescents aged 14-17 years were included in the analysis. In separate logistic regression models, we assessed associations between age, sex, ethnicity, household income, country of residence, current smoking of a caregiver, current smoking of peers and use of social media, and regular smoking (defined as smoking at least one cigarette per week) at the age of 17 years and smoking uptake between the ages of 14 and 17 years (defined as being a never-smoker at the age of 14 years and a regular smoker at the age of 17 years). We also estimated numbers of regular smoking and smoking uptake using the Office for National Statistics 2018-19 population estimates.

FINDINGS: Data from 8944 adolescents aged 14-17 years with smoking data available were included, 948 (10·6%) of which were regular tobacco smokers at the age of 17 years. 488 (51·5%) of these 948 started smoking between the ages of 14 years and 17 years. Smoking uptake was more common among adolescents reporting caregiver smoking (162 [13·6%] of 1188 vs 324 [5·0%] of 6538 with non-smoking caregivers; p<0·0001); peers smoking (223 [12·6%] of 1764 vs 229 [4·3%] of 5350 without smoking peers; p<0·0001), and those reporting higher (at least 5 h/weekday) social media use (115 [9·8%] of 1176 vs 120 [4·1%] of 2947 with lower [less than 1 h/weekday] social media use; p=0·0059), among 7786 adolescents who did not smoke at age 14. We estimated that 164 313 (95% CI 146 815-181 811) adolescents were regular smokers by the age of 17 years, of whom 101 715 (85 994-117 435) took up the habit between the age of 14 years and 17 years.

INTERPRETATION: Our findings are a reminder of the transmissibility of the smoking epidemic. Although we only assessed social media use, not actual exposure to online tobacco advertising, our findings strengthen calls for awareness of the changing landscape of tobacco advertising.

FUNDING: Cancer Research UK (grant reference PPRCTAGPJT100005) and the UK National Institute for Health and Care Research School for Public Health Research. The funders had no role in the writing of the manuscript or the decision to submit for publication.

PMID:36426475 | DOI:10.1016/S0140-6736(22)02267-X

Lancet. 2022 Nov;400 Suppl 1:S47. doi: 10.1016/S0140-6736(22)02257-7.

ABSTRACT

BACKGROUND: Maternal weight management increases risks for women and babies and is a public health priority. Interventions can substantially improve maternal diet and physical activity behaviours and pregnancy outcomes. Low self-efficacy is a core barrier to midwives’ implementation of guidelines. GLOWING used social cognitive theory to address evidence-based barriers to practice, aiming to support midwives’ guidelines implementation.

METHODS: This study was a pilot cluster randomised controlled trial in four UK National Health Service Trusts (clusters) in England. Clusters were randomised to intervention (midwives received intervention) or control (no intervention). Guideline recommendations for midwives’ practice were: first, communication-related behaviours (weight-communication and risk-communication); and second, support and intervention-related behaviours (diet and nutrition, physical activity, weight management, and referrals and signposting). Questionnaires were designed using social cognitive theory constructs (eg, self-efficacy, outcome expectancies, intentions, behaviours), higher scores being more positive. Following Consolidated Standards of Reporting Trials guidelines for pilot trials, descriptive statistics were used to compare arms, before and after the intervention.

FINDINGS: 100 midwives were randomised to complete questionnaires before and after the intervention. 74% consented, and 68% returned questionnaires. Pre-intervention, self-efficacy for support, and intervention-related behaviours scored lowest. In controls, the difference between pre-intervention and post-intervention scores were negligible. Post-intervention scores were consistently higher in midwives in the intervention group than the control group, particularly for support and intervention self-efficacy (mean 71·4 [SD 17·1] vs 58·4 [20·1]). Self-efficacy was higher after the intervention than before the intervention for all outcomes among intervention midwives: weight-communication (mean 76·3 [SD 16·7] vs 67·2 [21·1]), risk-communication (79·4 [16·4] vs 68·6 [14·9]), diet, nutrition, and physical activity (76·4 [16·0] vs 49·3 [16·5]), weight management (72·1 [18·3] vs 48·3 [19·8]), referrals and signposting (63·3 [26·0] vs 47·9 [17·3]), and consistently higher than controls.

INTERPRETATION: Results support the theoretical models used to develop GLOWING: low self-efficacy is a core implementation barrier. Results suggest GLOWING successfully targets self-efficacy, potentially with positive implications for guideline implementation. A strength of this work is the rigorous evidence-based theoretical approach to intervention development, largely absent in maternity-based research. A limitation is that this is a pilot trial. A definitive trial is required to determine effectiveness.

FUNDING: National Institute for Health Research Postdoctoral Fellowship (reference PDF-2011-04-034).

PMID:36426464 | DOI:10.1016/S0140-6736(22)02257-7

Injury. 2022 Dec;53(12):4104-4113. doi: 10.1016/j.injury.2022.10.019. Epub 2022 Oct 21.

ABSTRACT

BACKGROUND: High energy open tibial fractures are complex injuries with no consensus on the optimal method of fixation. Treatment outcomes are often reported with union and re-operation rates, often without specific definitions being provided. We sought to describe union, reoperation rates, and patient reported outcomes, using the validated EQ-VAS and Disability Rating Index (DRI) scores, following stabilisation with a Taylor Spatial Frame (TSF) and a combined orthoplastic approach for the management of soft tissues. A literature review is also provided.

METHOD: A prospective cross-sectional follow up of open tibial fractures, treated at a level 1 major trauma centre, managed with a TSF using a one ring per segment technique between January 2014 and December 2019 were identified. Demographic, injury and operative data were recorded, along with Patient Reported Outcome Measures (PROM) scores, specifically the EQ-VAS and Disability Rating Index (DRI). Union rates, defined by radiographic union scale in tibia (RUST) scores, and re-operation rates were recorded. Appropriate statistical analyses were performed, with a p<0.05 considered statistically significant.

RESULTS: Overall, 51 patients were included. Mean age was 51.2 ± 17.4 years, with a 4:1 male preponderance. Diaphyseal and distal fractures accounted for 76% of cases. Mean time in frame was 206.7 ± 149.4 days. Union was defined and was achieved in 41/51 (80.4%) patients. Deep infection occurred in 6/51 (11.8%) patients. Amputation was performed in 1 case (1.9%). Overall re-operation rate was 33%. Time to union were significantly longer if re-operation was required for any reason (uncomplicated 204±189 vs complicated 304±155 days; p = 0.0017) . EQ-VAS and DRI scores significantly deteriorated at 1 year follow-up (EQVAS 87.5 ± 11.7 vs 66.5 ± 20.4;p<0.0001 and DRI 11.9 ± 17.8 vs 39.3 ± 23.3;p<0.0001). At 1 year post op, 23/51(45.1%) required a walking aid, and 17/29 (58.6%) of those working pre-injury had returned to work.

CONCLUSION: Open tibial fracture have significant morbidity and long recovery periods as determined by EQVAS and DRI outcome measures. We report the largest series of open tibial feature treated primarily with a TSF construct, which has similar outcomes to other techniques, and should therefore be considered as a useful technique for managing these injuries.

PMID:36424690 | DOI:10.1016/j.injury.2022.10.019

Angiology. 2022 Nov 24:33197221141666. doi: 10.1177/00033197221141666. Online ahead of print.

ABSTRACT

Several studies have reported that the atherogenic index of plasma (AIP) is associated with serum uric acid (SUA) in healthy middle-aged men, kidney transplant patients, and diabetic patients. We assessed the relationship between AIP and SUA in patients with untreated essential hypertension (EH) in China. In the cross-sectional study, we evaluated 5003 patients with untreated EH in China; 1490 were assigned to the hyperuricemia (HUA) group and 3513 to the normouricemia (non-HUA) group according to the diagnostic criteria of HUA (SUA level≥6 mg/dL in females and ≥7 mg/dL in males). A higher AIP level was found in the HUA group (P < .001), and AIP was positively and independently correlated with SUA after adjusting for statistically significant variables (β = .204, P < .001). Moreover, multivariate logistic regression analysis showed that the AIP was closely and independently related to HUA after adjusting for confounders (odds ratio [OR]: 11.980, 95% confidence interval [CI]: 3.186-45.047, P < .001). Our findings suggested that the AIP was positively and independently associated with SUA, and elevated AIP might be a significant risk factor for HUA in patients with untreated EH in China.

PMID:36424679 | DOI:10.1177/00033197221141666

Genome Med. 2022 Nov 24;14(1):133. doi: 10.1186/s13073-022-01133-8.

ABSTRACT

BACKGROUND: Neuropsychiatric disorders afflict a large portion of the global population and constitute a significant source of disability worldwide. Although Genome-wide Association Studies (GWAS) have identified many disorder-associated variants, the underlying regulatory mechanisms linking them to disorders remain elusive, especially those involving distant genomic elements. Expression quantitative trait loci (eQTLs) constitute a powerful means of providing this missing link. However, most eQTL studies in human brains have focused exclusively on cis-eQTLs, which link variants to nearby genes (i.e., those within 1 Mb of a variant). A complete understanding of disease etiology requires a clearer understanding of trans-regulatory mechanisms, which, in turn, entails a detailed analysis of the relationships between variants and expression changes in distant genes.

METHODS: By leveraging large datasets from the PsychENCODE consortium, we conducted a genome-wide survey of trans-eQTLs in the human dorsolateral prefrontal cortex. We also performed colocalization and mediation analyses to identify mediators in trans-regulation and use trans-eQTLs to link GWAS loci to schizophrenia risk genes.

RESULTS: We identified ~80,000 candidate trans-eQTLs (at FDR<0.25) that influence the expression of ~10K target genes (i.e., “trans-eGenes”). We found that many variants associated with these candidate trans-eQTLs overlap with known cis-eQTLs. Moreover, for >60% of these variants (by colocalization), the cis-eQTL’s target gene acts as a mediator for the trans-eQTL SNP’s effect on the trans-eGene, highlighting examples of cis-mediation as essential for trans-regulation. Furthermore, many of these colocalized variants fall into a discernable pattern wherein cis-eQTL’s target is a transcription factor or RNA-binding protein, which, in turn, targets the gene associated with the candidate trans-eQTL. Finally, we show that trans-regulatory mechanisms provide valuable insights into psychiatric disorders: beyond what had been possible using only cis-eQTLs, we link an additional 23 GWAS loci and 90 risk genes (using colocalization between candidate trans-eQTLs and schizophrenia GWAS loci).

CONCLUSIONS: We demonstrate that the transcriptional architecture of the human brain is orchestrated by both cis- and trans-regulatory variants and found that trans-eQTLs provide insights into brain-disease biology.

PMID:36424644 | DOI:10.1186/s13073-022-01133-8