Category: Nevin Manimala

Glob Health Action. 2021 Jan 1;14(1):1890929. doi: 10.1080/16549716.2021.1890929.

ABSTRACT

Background: The perception within literature and populace is that the private for-profit sector is for the rich only, and this characteristic results in behaviours that hinder advancement of Universal health coverage (UHC) goals. The context of Northern Uganda presents an opportunity for understanding how the private sector continues to thrive in settings with high poverty levels and history of conflict.Objective: The study aimed at understanding access mechanisms employed by the formal private for-profit providers (FPFPs) to enable pro-poor access to health services in post conflict Northern Uganda.Methods: Data collection was conducted in Gulu municipality in 2015 using Organisational survey of 45 registered formal private for-profit providers (FPFPs),10 life histories, and 13 key informant interviews. Descriptive statistics were generated for the quantitative findings whereas qualitative findings were analysed thematically.Results: FPFPs pragmatically employed various access mechanisms and these included fee exemptions and provision of free services, fee reductions, use of loan books, breaking down doses and partial payments. Most mechanisms were preceded by managers’ subjective identification of the poor, while operationalisation heavily depended on the managers’ availability and trust between the provider and the customer. For a few FPFPs, partnerships with Non-governmental organisations (NGOs) and government enabled provision of free, albeit mainly preventive services, including immunisation, consultations, screening for blood pressure and family planning. Challenges such as quality issues, information asymmetry and standardisation of charges arose during implementation of the mechanisms.Conclusion: The identification of the poor by the FPFPs was subjective and unsystematic. FPFPs implemented various innovations to ensure pro-poor access to health services. However, they face a continuous dilemma of balancing the profit maximization and altruism objectives. Implementation of some pro-poor mechanisms raises concerns included those related to quality and standardisation of pricing.

PMID:33983106 | DOI:10.1080/16549716.2021.1890929

JMIR Med Educ. 2021 May 13;7(2):e28805. doi: 10.2196/28805.

ABSTRACT

BACKGROUND: Health professions students use social media to communicate with other students and health professionals, discuss career plans or coursework, and share the results of research projects or new information. These platforms allow students to share thoughts and perceptions that are not disclosed in formal education settings. Twitter provides an excellent window through which health professions educators can observe students’ sociocultural and learning needs. However, despite its merits, cyberincivility on Twitter among health professions students has been reported. Cyber means using electronic technologies, and incivility is a general term for bad manners. As such, cyberincivility refers to any act of disrespectful, insensitive, or disruptive behavior in an electronic environment.

OBJECTIVE: This study aims to describe the characteristics and instances of cyberincivility posted on Twitter by self-identified health professions students. A further objective of the study is to analyze the prevalence of tweets perceived as inappropriate or potentially objectionable while describing patterns and differences in the instances of cyberincivility posted by those users.

METHODS: We used a cross-sectional descriptive Twitter data mining method to collect quantitative and qualitative data from August 2019 to February 2020. The sample was taken from users who self-identified as health professions students (eg, medicine, nursing, dental, pharmacy, physician assistant, and physical therapy) in their user description. Data management and analysis were performed with a combination of SAS 9.4 for descriptive and inferential statistics, including logistic regression, and NVivo 12 for descriptive patterns of textual data.

RESULTS: We analyzed 20 of the most recent tweets for each account (N=12,820). A total of 639 user accounts were analyzed for quantitative analysis, including 280 (43.8%) medicine students and 329 (51.5%) nursing students in 22 countries: the United States (287/639, 44.9%), the United Kingdom (197/639, 30.8%), unknown countries (104/639, 16.3%), and 19 other countries (51/639, 8.0%). Of the 639 accounts, 193 (30.2%) were coded as having instances of cyberincivility. Of these, 61.7% (119/193), 32.6% (63/193), and 5.7% (11/193) belonged to students in nursing, medicine, and other disciplines, respectively. Among 502 instances of cyberincivility identified from 641 qualitative analysis samples, the largest categories were profanity and product promotion. Several aggressive or biased comments toward other users, politicians, or certain groups of people were also found.

CONCLUSIONS: Cyberincivility is a multifaceted phenomenon that must be considered in its complexity if health professions students are to embrace a culture of mutual respect and collaboration. Students’ perceptions and reports of their Twitter experiences offer insights into behavior on the web and the evolving role of cyberspace, and potentially problematic posts provide opportunities for teaching digital professionalism. Our study indicates that there is a continued need to provide students with guidance and training regarding the importance of maintaining a professional persona on the web.

PMID:33983129 | DOI:10.2196/28805

J Urol. 2021 May 13:101097JU0000000000001844. doi: 10.1097/JU.0000000000001844. Online ahead of print.

ABSTRACT

PURPOSE: We investigated 2019 and 2020 US News and World Report (USNWR) methodologies of assessing pediatric urology surgical revision rates for distal hypospadias, pyeloplasty, and ureteral reimplantation to evaluate statistical power and misclassification risks.

METHODS: Median annual volumes of distal hypospadias, pyeloplasty, and ureteral reimplantation procedures by hospital from 2016-2018 were calculated using the Pediatric Health Information Systems database. USNWR 2019 and 2020 methodologies were assessed to calculate power required to detect differences between hospitals and risk of hospital misclassifications.

RESULTS: Median (IQR) annual hospital procedure volume was 72 (43-97) for distal hypospadias procedures, 19 (9-34) for pyeloplasties, and 35 (19-50) for ureteral reimplantations. Based on 2019 methodology, in order to achieve 80% power 764 cases/hospital are required to distinguish between a 1% vs. 3% surgical revision rate, 1,500 cases/hospital are required to distinguish between a 3% vs. 5% revision rate, and 282 cases/hospital are required to distinguish between a 1% vs. 5% revision rate. Based on 2020 methodology, 98.0% of hospitals do not have adequate ureteral reimplantation volume to achieve full points even when reporting no revisions; similarly, 66.0% do not have adequate pyeloplasty volume, and 10.9% do not have adequate distal hypospadias volume. Risks of misclassification exceed 50% in several instances among hospitals reporting distal hypospadias and pyeloplasty revisions using both 2019 and 2020 methodology.

CONCLUSIONS: Based on median-volume hospitals, current USNWR methods for classifying revision rates for distal hypospadias, pyeloplasty, and ureteral reimplantation have insufficient power and are at high risk for misclassification.

PMID:33983039 | DOI:10.1097/JU.0000000000001844

J Vasc Access. 2021 May 13:1129729820976260. doi: 10.1177/1129729820976260. Online ahead of print.

ABSTRACT

PURPOSE: To review the incidence and type of tunneled hemodialysis catheter (THC) complications in a large cohort of patients with end-stage renal disease. Additionally, the longevity of the THC and factors predicting high risk for catheter complications were assessed.

MATERIAL AND METHODS: Between August 2009 and December 2016, a cohort of 538 patients underwent primary THC insertion; in 119 patients, THC was inserted after failed arteriovenous fistula or graft. Patients without available clinical follow-up data (n = 67) were excluded for further analysis. The Charlson comorbidity index (CCI) was calculated for each patient. The cumulative incidence function (CIF) was used for THC overall longevity, while Cox proportional hazards models were used for risk factor analysis.

RESULTS: In 352 patients, THC was inserted in a virgin neck. THC-related complications were observed in n = 104 (29.55%) of the patients. Infection occurred in n = 38 (10.80%) and malfunction, related to thrombosis or mechanical damage, in n = 45 (12.78%). Removal of the THC for the purpose of switching to alternative dialysis methods was planned in n = 135 (38.4%). The remaining patients were still alive with a functioning THC (n = 18; 5.11%) or died (n = 95; 27%) with a functioning THC. The THC survival rate was 82.67%, 78.13%, 74.15%, 72.96%, 71.02%, and 70.63% on follow-up after 6 months, and after 1-5 years, respectively. Gender, CCI, age, and site of placement of the catheter were found not to affect the life of the catheter.

CONCLUSION: The overall complication rate in primary inserted THC was nearly 30% and mainly related to infection and malfunction. THC survival was more than 70% after 5 years, which supports its use for permanent dialysis access, irrespective of gender, CCI, age, and jugular side of THC placement.

PMID:33983083 | DOI:10.1177/1129729820976260

J Sex Res. 2021 May 13:1-12. doi: 10.1080/00224499.2021.1924606. Online ahead of print.

ABSTRACT

Accurate, reliable self-reports of sexual behavior are a crucial component of valid HIV risk-estimation and behavioral intervention evaluation, yet this data’s reliability remains understudied. The goal of this study was to describe interpartner agreement on recent receptive anal intercourse (AI) and condomless receptive AI frequencies, among a sample of male couples. We quantified interpartner agreement on self-reported receptive AI and condomless receptive AI (absolute and relative to AI frequency), and position and condom use during a couple’s most recent AI, using cross-sectional data from male partners (US, 2016-2017; N = 718 individuals). Proportional and statistical agreement (intraclass correlation coefficients (ICC), kappa (k)) were assessed. Observed agreement for receptive AI frequency was 49.44% (ICC (95% CI): 0.82(0.79, 0.84)) and for relative receptive frequency, 59.05% (ICC: 0.96 (0.85, 0.96). Agreement on condomless receptive AI was 90.21% (ICC: 0.78 (0.75, 0.82), and for relative condomless receptive AI, 91.15% (ICC: 0.80 (0.77, 0.83). Most recent AI position agreement was 89.42% (k (95% CI): 0.84 (0.80, 0.88)), and condom use, 98.89% (k: 0.82 (0.87, 0.98)). Observed agreement was higher among those who reported consistent positioning and condom use. Further research on self-reported sexual behavior data is needed to improve research validity and intervention effectiveness.

PMID:33983091 | DOI:10.1080/00224499.2021.1924606

Transbound Emerg Dis. 2021 May 13. doi: 10.1111/tbed.14133. Online ahead of print.

ABSTRACT

Surveillance data are key to informing decisions on the control and prevention of transboundary and emerging diseases. Here, we describe new methods for acquiring difficult to access, publicly available disease surveillance data. We use World Organisation for Animal Heath (OIE) data on African Swine Fever (ASF) outbreaks in European countries to showcase the importance of adequate disease surveillance data to inform decision-making. The data acquired using these methods allow for large scale, geospatial outbreak mapping and estimation of summary statistics for any listed terrestrial disease in the OIE World Animal Health Information System (WAHIS) database. These techniques will make valuable epidemiological data more accessible to the scientific community, aiding further insight into the occurrence and spread of transboundary and emerging diseases in a timely manner, fulfilling an important function of disease surveillance.

PMID:33982877 | DOI:10.1111/tbed.14133

Arthritis Rheumatol. 2021 May 13. doi: 10.1002/art.41799. Online ahead of print.

ABSTRACT

OBJECTIVE: A recent genome-wide association study (GWAS) reported a significant genetic association between rs34330 of cyclin-dependent kinase inhibitor 1B (CDKN1B) and risk of systemic lupus erythematosus (SLE) in Han Chinese. This study aims to validate the reported association and elucidate the biochemical mechanisms underlying the variant’s effect.

METHODS: We performed allelic association with SLE followed by meta-analysis across 11 independent cohorts (n=28,872). We applied in silico bioinformatics and experimental validation in SLE-relevant cell lines to determine the functional consequences of rs34330.

RESULTS: We replicated genetic association between SLE and rs34330 (P_meta =5.29×10^-22 , OR (95% CI)=0.84 (0.81-0.87)). Follow-up bioinformatics and eQTL analysis suggest that rs34330 is located in active chromatin and potentially regulates several target genes. Using luciferase and ChIP-qPCR, we demonstrated substantial allele-specific promoter and enhancer activity, and allele-specific binding of three histone marks (H3K27ac, H3K4me3, H3K4me1), RNA pol II, CTCF, and a critical immune transcription factor (IRF-1). Chromosome conformation capture (3C) detected long-range chromatin interactions between rs34330 and the promoters of neighboring genes APOLD1 and DDX47, and effects on CDKN1B and the other target genes were directly validated by CRISPR-based genome editing. Finally, CRISPR-dCas9-based epigenetic activation/silencing confirmed these results. Gene-edited cell lines also showed higher levels of proliferation and apoptosis.

CONCLUSION: Collectively, these findings suggest a mechanism whereby the rs34330 risk allele (C) influences the presence of histone marks, RNA pol II, and the IRF-1 transcription factor to regulate expression of several target genes linked to proliferation and apoptosis, which potentially underlie the association of rs34330 with SLE.

PMID:33982894 | DOI:10.1002/art.41799

ACS Nano. 2021 May 13. doi: 10.1021/acsnano.1c02907. Online ahead of print.

ABSTRACT

The surface of metal oxides is of technological importance and is extensively used as a substrate for various electronic and chemical applications. A real surface, however, is not a perfectly well-defined and clean surface, but rather contains a diverse class of atomistic defects. Here, we show the direct determination of the 3D surface atomic structure of SrTiO₃ (001) including termination layers and atomistic defects such as vacancies, adatoms, ledges, kinks, and their complex combinations, by using depth sectioning of atomic-resolution annular dark-field scanning transmission electron microscopy (ADF STEM). To overcome the poor depth resolution in STEM, we statistically analyze the column by column depth profiles of ADF STEM images with a Bayesian framework fitting algorithm, and we achieve depth resolution at the entrance surface of ±0.9 Å for 1518 individual atomic columns. The present atomic-resolution 3D electron microscopy at the surface will provide fertile ground especially in surface science.

PMID:33983030 | DOI:10.1021/acsnano.1c02907

BJOG. 2021 May 13. doi: 10.1111/1471-0528.16739. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess whether folic acid supplementation ameliorates hot flushes.

DESIGN: Double-blind, placebo-controlled randomised trial.

SETTING: Nine hospitals in England.

POPULATION: Postmenopausal women experiencing ≥50 hot flushes weekly.

METHODS: Women (n=164) were randomly assigned in a 1:1 ratio to receive folic acid 5mg tablet or placebo daily for 12 weeks. Participants recorded frequency and severity of hot flushes in Sloan Diary daily and completed Greene Climacteric and Utian Quality of Life (UQoL) Scales at 4-weekly intervals.

MAIN OUTCOME MEASURES: The change in daily Hot Flush Score at week-12 from randomisation based on Sloan Diary Composite Score B calculation.

RESULTS: Data of 143 (87%) women was available for the primary outcome. The mean change (SD) in Hot Flush Score at week-12 was -6.98 (10.30) and -4.57 (9.46) for folic acid and placebo group, respectively. The difference between groups in the mean change was -2.41 (95% CI: -5.68, 0.87), p=0.149 and in the adjusted mean change was -2.61 (95% CI: -5.72, 0.49), p=0.098. Analysis of secondary outcomes indicated an increased benefit in the folic acid group regarding changes in total and emotional UQoL scores at week-8 when compared with placebo. The difference in the mean change from baseline was 5.22 (95% CI: 1.16, 9.28) and 1.88 (95% CI: 0.23, 3.52) for total and emotional score, respectively.

CONCLUSIONS: The study was not able to demonstrate that folic acid had a statistically significant greater benefit in reducing Hot Flush Score over 12 weeks in postmenopausal women when compared with placebo.

PMID:33982872 | DOI:10.1111/1471-0528.16739

Transpl Infect Dis. 2021 May 13:e13634. doi: 10.1111/tid.13634. Online ahead of print.

ABSTRACT

BACKGROUND: Neutropenia is a serious complication following heart transplantation (OHT) however risk factors for its development and its association with outcomes is not well described. We sought to study the prevalence of neutropenia, risk factors associated with its development and its impact on infection, rejection and survival.

METHODS: A retrospective single center analysis of adult OHT recipients from July 2004 to December 2017 was performed. Demographic, laboratory, medication, infection, rejection and survival data were collected for 1 year post-OHT. Baseline lab measurements were collected within the 24 hours before OHT. Neutropenia was defined as absolute neutrophil count ≤1000 cells/mm3. Cox proportional hazards models explored associations with time to first neutropenia. Associations between neutropenia, analyzed as a time-dependent covariate, with secondary outcomes of time to infection, rejection or death were also examined.

RESULTS: Of 278 OHT recipients, 84 (30%) developed neutropenia at a median of 142 days (range 81-228) after transplant. Factors independently associated with increased risk of neutropenia included lower baseline WBC (HR 1.12; 95% CI 1.11 – 1.24), pre-OHT ventricular assist device (1.63; 1.00 – 2.66), high risk CMV serostatus [donor positive, recipient negative] (1.86; 1.19 – 2.88), and having a previous CMV infection (4.07; 3.92 – 13.7).

CONCLUSIONS: Neutropenia is a fairly common occurrence after adult OHT. CMV infection was associated with subsequent neutropenia, however no statistically significant differences in outcomes were found between neutropenic and non-neutropenic patients in this small study. It remains to be determined in future studies if medication changes in response to neutropenia would impact patient outcomes.

PMID:33982834 | DOI:10.1111/tid.13634