Category: Nevin Manimala

JMIR Res Protoc. 2022 Nov 21;11(11):e37663. doi: 10.2196/37663.

ABSTRACT

BACKGROUND: Antimicrobial resistance is a known global public health threat. In addition, it brings serious economic consequences to agriculture. Antibiotic resistance in humans, animals, and environment is interconnected, as proposed in the tricycle surveillance by the World Health Organization. In Malaysia, research and surveillance of antimicrobial resistance are mainly performed in clinical samples, agricultural settings, and surface waters, but no surveillance of the drinking water systems has been performed yet. Hence, this policy-driven study is a combined effort of microbiologists and engineers to provide baseline data on the magnitude of antimicrobial resistance in the drinking water systems of Malaysia.

OBJECTIVE: The aim of this study was to study the baseline level of antibiotic-resistant bacteria in the drinking water distribution systems of Malaysia by collecting samples from the pretreatment and posttreatment outlets of water treatment plants in a selected state of Malaysia. We aimed to determine the prevalence of antibiotic-resistant bacteria, the occurrence of antibiotic-resistant genes, and the level of antibiotics present in the drinking water systems.

METHODS: This is a laboratory-based, cross-sectional study in a selected state of Malaysia. Water samples from 6 drinking water treatment plants were collected. Samples were collected at 3 sampling points, that is, the intake sampling station, service reservoir outlet station, and the distribution system sampling station. These were tested against 7 types of antibiotics in triplicates. Samples were screened for antibiotic-resistant bacteria and antibiotic-resistant genes and quantified for the level of antibiotics present in the drinking water treatment plants.

RESULTS: We will show the descriptive statistics of the number of bacterial colonies harvested from water samples grown on Reasoner’s 2A agar with or without antibiotics, the occurrence of antibiotic-resistant genes, and the level of antibiotics detected in the water samples. The sampling frame was scheduled to start from November 2021 and continue until December 2022. Data analysis is expected to be completed by early 2023, and the results are expected to be published in mid-2023.

CONCLUSIONS: This study provides baseline information on the status of the antimicrobial-resistant bacteria, the presence of resistance genes as contaminants, and the level of antibiotics present in the drinking water systems of Malaysia, with the aim of demonstrating to policymakers the need to consider antimicrobial resistance as a parameter in drinking water surveillance.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/37663.

PMID:36409546 | DOI:10.2196/37663

Vital Health Stat 1. 2022 Nov;(196):1-20.

ABSTRACT

To evaluate the quality of web surveys, the National Center for Health Statistics’ Division of Research and Methodology has been conducting a series of studies with survey data from commercially recruited panels,referred to as the Research and Development Survey (RANDS). This report describes the propensity-score adjusted estimates from the second round of RANDS (RANDS 2) using the 2016 National Health Interview Survey (NHIS).

PMID:36409516

JAMA Netw Open. 2022 Nov 1;5(11):e2243127. doi: 10.1001/jamanetworkopen.2022.43127.

ABSTRACT

IMPORTANCE: New York City, an early epicenter of the pandemic, invested heavily in its COVID-19 vaccination campaign to mitigate the burden of disease outbreaks. Understanding the return on investment (ROI) of this campaign would provide insights into vaccination programs to curb future COVID-19 outbreaks.

OBJECTIVE: To estimate the ROI of the New York City COVID-19 vaccination campaign by estimating the tangible direct and indirect costs from a societal perspective.

DESIGN, SETTING, AND PARTICIPANTS: This decision analytical model of disease transmission was calibrated to confirmed and probable cases of COVID-19 in New York City between December 14, 2020, and January 31, 2022. This simulation model was validated with observed patterns of reported hospitalizations and deaths during the same period.

EXPOSURES: An agent-based counterfactual scenario without vaccination was simulated using the calibrated model.

MAIN OUTCOMES AND MEASURES: Costs of health care and deaths were estimated in the actual pandemic trajectory with vaccination and in the counterfactual scenario without vaccination. The savings achieved by vaccination, which were associated with fewer outpatient visits, emergency department visits, emergency medical services, hospitalizations, and intensive care unit admissions, were also estimated. The value of a statistical life (VSL) lost due to COVID-19 death and the productivity loss from illness were accounted for in calculating the ROI.

RESULTS: During the study period, the vaccination campaign averted an estimated $27.96 (95% credible interval [CrI], $26.19-$29.84) billion in health care expenditures and 315 724 (95% CrI, 292 143-340 420) potential years of life lost, averting VSL loss of $26.27 (95% CrI, $24.39-$28.21) billion. The estimated net savings attributable to vaccination were $51.77 (95% CrI, $48.50-$55.85) billion. Every $1 invested in vaccination yielded estimated savings of $10.19 (95% CrI, $9.39-$10.87) in direct and indirect costs of health outcomes that would have been incurred without vaccination.

CONCLUSIONS AND RELEVANCE: Results of this modeling study showed an association of the New York City COVID-19 vaccination campaign with reduction in severe outcomes and avoidance of substantial economic losses. This significant ROI supports continued investment in improving vaccine uptake during the ongoing pandemic.

PMID:36409495 | DOI:10.1001/jamanetworkopen.2022.43127

JAMA Netw Open. 2022 Nov 1;5(11):e2243134. doi: 10.1001/jamanetworkopen.2022.43134.

ABSTRACT

IMPORTANCE: Prior studies have revealed gender differences in the milestone and clinical competency committee assessment of emergency medicine (EM) residents.

OBJECTIVE: To explore gender disparities and the reasons for such disparities in the narrative comments from EM attending physicians to EM residents.

DESIGN, SETTING, AND PARTICIPANTS: This multicenter qualitative analysis examined 10 488 narrative comments among EM faculty and EM residents between 2015 to 2018 in 5 EM training programs in the US. Data were analyzed from 2019 to 2021.

MAIN OUTCOMES AND MEASURES: Differences in narrative comments by gender and study site. Qualitative analysis included deidentification and iterative coding of the data set using an axial coding approach, with double coding of 20% of the comments at random to assess intercoder reliability (κ, 0.84). The authors reviewed the unmasked coded data set to identify emerging themes. Summary statistics were calculated for the number of narrative comments and their coded themes by gender and study site. χ2 tests were used to determine differences in the proportion of narrative comments by gender of faculty and resident.

RESULTS: In this study of 283 EM residents, of whom 113 (40%) identified as women, and 277 EM attending physicians, of whom 95 (34%) identified as women, there were notable gender differences in the content of the narrative comments from faculty to residents. Men faculty, compared with women faculty, were more likely to provide either nonspecific comments (115 of 182 [63.2%] vs 40 of 95 [42.1%]), or no comments (3387 of 10 496 [32.3%] vs 1169 of 4548 [25.7%]; P < .001) to men and women residents. Compared with men residents, more women residents were told that they were performing below level by men and women faculty (36 of 113 [31.9%] vs 43 of 170 [25.3%]), with the most common theme including lack of confidence with procedural skills.

CONCLUSIONS AND RELEVANCE: In this qualitative study of narrative comments provided by EM attending physicians to residents, multiple modifiable contributors to gender disparities in assessment were identified, including the presence, content, and specificity of comments. Among women residents, procedural competency was associated with being conflated with procedural confidence. These findings can inform interventions to improve parity in assessment across graduate medical education.

PMID:36409494 | DOI:10.1001/jamanetworkopen.2022.43134

JAMA Netw Open. 2022 Nov 1;5(11):e2243201. doi: 10.1001/jamanetworkopen.2022.43201.

ABSTRACT

IMPORTANCE: In the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) trial, there was a significant reduction in the adjudicated primary outcome among patients with stable atherosclerotic vascular disease randomized to dual pathway inhibition (rivaroxaban 2.5 mg twice daily plus aspirin 100 mg daily) vs aspirin monotherapy, but not with rivaroxaban 5 mg twice daily vs aspirin monotherapy. Whether the results are similar without adjudication is unknown.

OBJECTIVE: To examine the impact of dual pathway inhibition (with rivaroxaban plus aspirin) or rivaroxaban monotherapy compared with aspirin monotherapy on investigator-reported CV events and to understand the extent of concordance between investigator-reported and centrally adjudicated clinical events.

DESIGN, SETTING, AND PARTICIPANTS: This is a secondary analysis of the COMPASS trial, an international, double-blind, double-dummy, randomized clinical trial with a 3-by-2 partial factorial design that evaluated participants with stable atherosclerotic vascular disease receiving rivaroxaban plus aspirin, rivaroxaban monotherapy, or aspirin monotherapy. End points were collected by blinded site investigators and adjudicated by a blinded clinical end point committee. Data were analyzed from March 2013 through February 2017.

INTERVENTIONS: Participants received dual inhibition pathway (2.5 mg rivaroxaban twice daily plus 100 mg aspirin once daily), rivaroxaban monotherapy (5 mg twice daily), or aspirin monotherapy (100 mg once daily).

MAIN OUTCOMES AND MEASURES: The primary efficacy outcome was a composite of cardiovascular (CV) death, stroke, or myocardial infarction (MI). Adjudicated and investigator-reported end points were compared.

RESULTS: A total of 27 395 patients (mean [SD] age, 68.2 [7.9] years; 78.0% men) were assessed, including 9152 patients randomized to dual pathway inhibition, 9117 patients randomized to rivaroxaban monotherapy, and 9126 patients randomized to aspirin monotherapy. Adjudication reduced the number of events by 10% to 15% for most end points. Among investigator-reported end points, dual pathway inhibition significantly reduced the rate of the primary efficacy outcome compared with aspirin alone (411 patients [4.5%] vs 542 patients [5.9%]; hazard ratio [HR], 0.75 [95% CI, 0.66-0.85]; P < .001), with similar reduction in adjudicated end points, (379 patients [4.1%] vs 496 patients [5.4%]; HR, 0.76 [95% CI, 0.66-0.86]; P < .001). Likewise, effects on ischemic end points were highly concordant (κ statistic = 0.94 [95% CI, 0.93-0.95] for the primary composite end point). Unlike with adjudicated outcomes, there was a significant reduction in the primary end point with rivaroxaban monotherapy vs aspirin monotherapy using investigator-reported events (477 patients [5.2%] vs 542 patients [5.9%]; HR, 0.88 [95% CI, 0.78-0.99]; P = .04) compared with adjudicated events (448 patients [4.9%] vs 496 patients [5.4%]; HR, 0.90 [95% CI, 0.79-1.03]; P = .12).

CONCLUSIONS AND RELEVANCE: This secondary analysis of the COMPASS trial found that whether assessed by blinded site investigators or adjudicators, dual pathway inhibition significantly reduced CV events among patients with stable atherosclerotic disease compared with aspirin plus placebo. These findings suggest that using investigator-reported events in blinded clinical trials may be a more efficient alternative to adjudication.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01776424.

PMID:36409491 | DOI:10.1001/jamanetworkopen.2022.43201

Diabetes Technol Ther. 2022 Nov 21. doi: 10.1089/dia.2022.0419. Online ahead of print.

ABSTRACT

BACKGROUND: The majority of individuals referred to diabetes self-management education and support (DSMES) programs do not access this resource. Of those who do, attrition is high, with anecdotal reports pointing to the didactic and impersonal nature of these programs contributing to low utilization and completion rates. In an effort to develop a more engaging form of DSMES for adults with type 2 diabetes (T2D), we constructed a non-didactic, “discovery learning”-based DSMES program centered on real-time flash glucose monitoring (FGM).

METHODS: In this single-arm pilot study, 35 adults with T2D duration 1 – 5 years, ages 21 – 75 years, not using insulin and HbA1c >8.0% were introduced to FGM and participated in five weekly group sessions. DSMES content was personalized, emerging from the concerns and questions arising from participants’ FGM discoveries. The primary outcome was glycemic change as assessed by blinded FGM at baseline and month 3. Secondary outcomes included psychosocial and behavioral measures.

RESULTS: There was a significant gain in % TIR 70 -180 mg/dL from baseline (55%) to month 3 (74%), and a parallel drop in TAR > 180 mg/dL from 44% to 25% (ps = 0.01). Overall well-being rose significantly (p = 0.04), while diabetes distress showed a non-significant drop. Participants reported improvements in healthy eating (p < 0.001) and physical activity, though the latter did not reach statistical significance.

CONCLUSIONS: These findings support a new approach to DSMES, a method that integrates FGM with a highly interactive and engaging, patient-driven, “discovery learning” approach to education.

PMID:36409486 | DOI:10.1089/dia.2022.0419

JAMA Intern Med. 2022 Nov 21. doi: 10.1001/jamainternmed.2022.5268. Online ahead of print.

NO ABSTRACT

PMID:36409473 | DOI:10.1001/jamainternmed.2022.5268

CJEM. 2022 Nov 21. doi: 10.1007/s43678-022-00411-z. Online ahead of print.

NO ABSTRACT

PMID:36409448 | DOI:10.1007/s43678-022-00411-z

Environ Sci Pollut Res Int. 2022 Nov 21. doi: 10.1007/s11356-022-24113-2. Online ahead of print.

ABSTRACT

The purpose of this paper is to quantify the level of new-type urbanization and unravel the spatial and nonlinear effects of new-type urbanization and technological innovation on industrial carbon emissions. Although the impact of traditional urbanization levels on carbon emissions has been widely studied, there is still a huge room for optimization, and the impact of new-type urbanization on carbon emissions has not yet been clarified. Selecting 37 cities in the Yangtze River Delta as a research sample, this paper measures the new-type urbanization based on an evaluation system we build. Consequently, we assess the spatial and nonlinear effects of new-type urbanization and technological innovation on carbon emissions by the spatial Durbin model and non-parameter addictive model, respectively. The results indicate that the new-type urbanization and low-carbon city pilot policy have significant spatial spillover effects on reducing carbon dioxide emissions, while the economic growth plays a positive role in increasing carbon emission. As for nonlinear effects, there is a significant inverted “N”-shaped relationship between the level of new-type urbanization and carbon dioxide emissions, while the nexus between technological innovation and carbon emissions is an inverted “U”-shaped relationship. This paper provides a new perspective for confirming the mechanism of the new-type urbanization on carbon emissions. Meanwhile, these findings are of significance for the relevant authorities in China to develop appropriate policy in carbon dioxide emission reduction.

PMID:36409416 | DOI:10.1007/s11356-022-24113-2

Environ Sci Pollut Res Int. 2022 Nov 21. doi: 10.1007/s11356-022-24222-y. Online ahead of print.

ABSTRACT

Recently, a growing number of epidemiological studies have examined the relationship between household air pollution (HAP) and all-cause and cause-specific mortality. While the results were not entirely consistent, the current study followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) protocol to conduct a comprehensive review and meta-analysis. Data sources were PubMed, Web of Science, Embase, and Cochrane Library for studies published up to 12 May 2022. The pooled relative risks (RRs) with 95% confidence intervals (CI) were used to estimate the effect of household air pollution on all-cause and cause-special mortality. Then I square value (I²) was used to assess heterogeneity, and random-effects model was used as the pooling method. Seventeen studies were included in the quantitative analysis. Our results showed a significant association between household air pollution and increased risks of all-cause mortality (RR = 1.12, 95% CI = 1.06-1.19) and cardiovascular disease mortality (RR = 1.13, 95% CI = 1.04-1.24). Similarly, the associations between household air pollution and mortality from other specific causes (respiratory, ischemic heart disease, stroke, and total cancer) were positive, although they were not statistically significant. The study suggests that exposure to household air pollution increases the risk of all-cause mortality and cardiovascular disease mortality. In addition, our results found a trend of increased mortality from the respiratory system, ischemic heart disease, stroke, and total cancer, with household air pollution.

PMID:36409413 | DOI:10.1007/s11356-022-24222-y