Category: Statistics

Rural Remote Health. 2024 Jun;24(2):8641. doi: 10.22605/RRH8641. Epub 2024 Jun 4.

ABSTRACT

INTRODUCTION: Despite universal health coverage and high life expectancy, Japan faces challenges in health care that include providing care for the world’s oldest population, increasing healthcare costs, physician maldistribution and an entrenched medical workforce and training system. Primary health care has typically been practised by specialists in other fields, and general medicine has only been certified as an accredited specialty since 2018. There are continued challenges to develop an awareness and acceptance of the primary health medical workforce in Japan. The impact of these challenges is highest in rural and island areas of Japan, with nearly 50% of rural and remote populations considered ‘elderly’. Concurrently, these areas are experiencing physician shortages as medical graduates gravitate to urban areas and choose medical specialties more commonly practised in cities. This study aimed to understand the views on the role of rural generalist medicine (RGM) in contributing to solutions for rural and island health care in Japan.

METHODS: This was a descriptive qualitative study. Data were collected via semi-structured interviews with 16 participants, including Rural Generalist Program Japan (RGPJ) registrars and supervisors, the RGPJ director, government officials, rural health experts and academics. Interviews were of 35-50 minutes duration and conducted between May and July 2019. Some interviews were conducted in person at the WONCA Asia-Pacific Conference in Kyoto, some onsite in hospital settings and some were videoconferenced. Interviews were recorded and transcribed. All transcripts were analysed through an inductive thematic process based on the grouping of codes.

RESULTS: From the interview analysis, six main themes were identified: (1) key issues facing rural and island health in Japan; (2) participant background; (3) local demography and population; (4) identity, perception and role of RGM; (5) RGPJ experience; and (6) suggested reforms and recommendations.

DISCUSSION: The RGPJ was generally considered to be a positive step toward reshaping the medical workforce to address the geographic inequities in Japan. While improvements to the program were suggested by participants, it was also generally agreed that a more systematic, national approach to RGM was needed in Japan. Key findings from this study are relevant to this goal. This includes considering the drivers to participating in the RGPJ for future recruitment strategies and the need for an idiosyncratic Japanese model of RGM, with agreed advanced skills and supervision models. Also important are the issues raised by participants on the need to improve community acceptance and branding of rural generalist doctors to support primary care in rural and island areas.

CONCLUSION: The RGPJ represents an effort to bolster the national rural medical workforce in Japan. Discussions from participants in this study indicate strong support to continue research, exploration and expansion of a national RGM model that is contextualised for Japanese conditions and that is branded and promoted to build community support for the role of the rural generalist.

PMID:38832438 | DOI:10.22605/RRH8641

Nucl Med Commun. 2024 Jun 3. doi: 10.1097/MNM.0000000000001867. Online ahead of print.

ABSTRACT

OBJECTIVE: This study compared the radiomic features and quantitative biomarkers of 18F-PSMA-1007 [prostate-specific membrane antigen (PSMA)] and 18F-fluorocholine (FCH) PET/computed tomography (CT) in prostate cancer patients with biochemical recurrence (BCR) enrolled in the phase 3, prospective, multicenter BIO-CT-001 trial.

METHODS: A total of 106 patients with BCR, who had undergone primary definitive treatment for prostate cancer, were recruited to this prospective study. All patients underwent one PSMA and one FCH PET/CT examination in randomized order within 10 days. They were followed up for a minimum of 6 months. Pathology, prostate-specific antigen (PSA), PSA doubling time, PSA velocity, and previous or ongoing treatment were analyzed. Using LifeX software, standardized uptake value (SUV) maximum, SUVmean, PSMA and choline total volume (PSMA-TV/FCH-TV), and total lesion PSMA and choline (TL-PSMA/TL-FCH) of all identified metastatic lesions in both tracers were calculated.

RESULTS: Of the 286 lesions identified, the majority 140 (49%) were lymph node metastases, 118 (41.2%) were bone metastases and 28 lesions (9.8%) were locoregional recurrences of prostate cancer. The median SUVmax value was significantly higher for 18F-PSMA compared with FCH for all 286 lesions (8.26 vs. 4.99, respectively, P < 0.001). There were statistically significant differences in median SUVmean, TL-PSMA/FCH, and PSMA/FCH-TV as per table 2 between the two radiotracers (4.29 vs. 2.92, 1.97 vs. 1.53, and 7.31 vs. 4.37, respectively, P < 0.001). The correlation between SUVmean/SUVmax and PSA level was moderate, both for 18F-PSMA (r = 0.44, P < 0.001; r = 0.44, P < 0.001) and FCH (r = 0.35, P < 0.001; r = 0.41, P < 0.001). TL-PSMA/FCH demonstrated statistically significant positive correlations with both PSA level and PSA velocity for both 18F-PSMA (r = 0.56, P < 0.001; r = 0.57, P < 0.001) and FCH (r = 0.49, P < 0.001; r = 0.51, P < 0.001). While patients who received hormone therapy showed higher median SUVmax values for both radiotracers compared with those who did not, the difference was statistically significant only for 18F-PSMA (P < 0.05).

CONCLUSION: Our analysis using both radiomic features and quantitative biomarkers demonstrated the improved performance of 18F-PSMA-1007 compared with FCH in identifying metastatic lesions in prostate cancer patients with BCR.

PMID:38832429 | DOI:10.1097/MNM.0000000000001867

J Econ Entomol. 2024 Jun 4:toae120. doi: 10.1093/jee/toae120. Online ahead of print.

ABSTRACT

Corn, Zea mays L. (Poales: Poaceae), growers in the US Cotton Belt are required to plant 20% of total corn acres to non-Bt hybrids for resistance management (non-Bt refuge). Most growers do not meet this requirement, in part, because they perceive non-Bt hybrids to yield less than Bt hybrids. We planted multiple non-Bt and Bt hybrids from a single company in small-plot replicated trials at a single location from 2019 to 2023, as well as in small-plot replicated trials at multiple locations during 2022 and 2023. In the single location, we measured kernel injury from corn earworm, Helicoverpa zea Boddie (Lepidoptera: Noctuidae), and we recorded yield at all locations. In the single location trial, yields only separated among hybrids in 3 out of 5 years. In the multiple location trial, yields were variable between both years. We found that Bt hybrids tended to yield higher than non-Bt hybrids overall, but this was influenced by the inclusion of non-Bt hybrids that had a lower overall genetic yield potential in the environments we tested them in. In both tests, when hybrids were analyzed during each year, both Bt and non-Bt hybrids were among the statistically highest yielders. Our study demonstrates the importance of comparing multiple Bt and non-Bt hybrids to draw yield comparisons. This highlights the need for corn seed company breeders to put effort into improving yield for non-Bt hybrids. Hopefully this effort will translate into increased planting of non-Bt refuge corn for growers in the US Cotton Belt.

PMID:38832396 | DOI:10.1093/jee/toae120

S Afr Fam Pract (2004). 2024 May 27;66(1):e1-e6. doi: 10.4102/safp.v66i1.5891.

ABSTRACT

BACKGROUND: Computed tomography (CT) has become an invaluable aid in medical diagnostic workup, and its global usage has been shown to be consistently increasing across all departments. While typically located in regional or central hospitals in South Africa, its recent introduction at the district level has many foreseeable benefits. We evaluated its utility at one of the first district hospitals in the Western Cape to obtain a CT suite.

OBJECTIVES: This study aimed to describe the type of CT scans ordered, the clinical indications, the prevalence of significant abnormal findings and the agreement between the clinical opinion and radiological diagnosis.

METHODS: A descriptive cross-sectional study was conducted over a 1-year period at Khayelitsha Hospital, an entry-level hospital just outside of Cape Town.

RESULTS: A total of 3242 CT scans were analysed. The mean age of patients was 46 years; 51.4% were males. A mean of 13 scans were performed per working day. The head and neck area were the most scanned region (n = 1841, 52.3%). Predominantly requested by the Emergency Centre (n = 1382, 42.6%), indications were mainly for general medical conditions workup (n = 2151, 66.4%). Most scans showed abnormalities (n = 2710, 83.6%), with 2115 (65.2%) considered relevant (‘positive yield’). Clinical and CT diagnoses agreed in 1610 (49.7%) cases.

CONCLUSION: Computed tomography usage at the district level demonstrated positive yield rates comparable to that of tertiary centres. This implies an appropriate utilisation of the service with a potential decrease in the burden on the referral centre.Contribution: Computed tomography scanners at district-level facilities are appropriately utilised and can provide greater access to care while potentially decreasing the burden on referral centres.

PMID:38832391 | DOI:10.4102/safp.v66i1.5891

S Afr Fam Pract (2004). 2024 May 14;66(1):e1-e9. doi: 10.4102/safp.v66i1.5943.

ABSTRACT

BACKGROUND: Despite the efforts of Namibia’s Ministry of Health and Social Services to build maternity waiting homes (MWHs), few pregnant women make use of them. Long distances among the general population in Namibia limit the utilisation of MWHs. Little research has investigated what factors are limiting the use of these facilities despite the urgent need for them. The aim of this study thus was to explore and describe the perspectives of pregnant women on the utilisation of the MWHs near Onandjokwe Lutheran Hospital in Oshikoto Region.

METHODS: A qualitative, exploratory, descriptive and contextual design was employed. The accessible population in this study comprised 18 participants who were selected for the study using a purposive sampling technique.

RESULTS: Participants reported numerous barriers to visiting MWHs in Namibia, including an inadequate number of rooms, theft, food scarcity and the effects of poverty on the living conditions of the MWH users. Enablers visiting MWHs included the safe delivery of babies by skilled staff, reduced transport costs, access to timely management of labour complications and affordable accommodation.

CONCLUSION: The study revealed that a number of barriers must be overcome before the desired number of women take advantage of MWHs. Multiple factors act as constraints to their use, including inadequate number of rooms, theft, food scarcity and the long distance between patients’ homes and MWH services.Contribution: The study’s findings can be used to develop targeted interventions and strategies that can be used by MWH providers to address the identified barriers.

PMID:38832389 | DOI:10.4102/safp.v66i1.5943

S Afr Fam Pract (2004). 2024 May 10;66(1):e1-e8. doi: 10.4102/safp.v66i1.5837.

ABSTRACT

BACKGROUND: In 2021, South Africa introduced a new 6-month internship in family medicine and primary care. This study aimed to assess the new rotation at district health facilities in the Western Cape.

METHODS: A descriptive survey of interns and supervisors, as phase-two of an exploratory sequential mixed methods study. Questionnaires were developed from a descriptive exploratory qualitative study. Data were analysed with the Statistical Package for Social Sciences.

RESULTS: Questionnaires were completed by 72 interns (response rate 21%) and 36 supervisors (response rate 90%), across 10 training programmes. Interns felt more independent (97.2%), confident (90.3%) and resilient (91.6%). They learnt to manage undifferentiated and chronic conditions (91.6%), to refer patients (94.3%) and conduct procedures (77.8%). Most interns were not exposed to community-based services (68.0%) and continuity of care (54.1%). Supervision was mostly adequate during the day (79.1%) and afterhours (80.6%). Many interns reported no structured teaching programme (41.7% – 55.6%). Most supervision was from medical officers and registrars. Supervisors saw interns as valuable members of the clinical team (100.0%), who required extra support and administration (42.5%). The majority of interns (75.0%) and supervisors (72.7%) thought the rotation was the right length and the best preparation for community service (67.6%).

CONCLUSION: The rotation met most expectations of the Health Professions Council of South Africa. Programmes need to improve exposure to community-orientated primary care, public health medicine, palliative and ongoing care. Supervision and orientation of interns needs improvement.Contribution: This is the first evaluation of the new family medicine internship programme in South Africa.

PMID:38832386 | DOI:10.4102/safp.v66i1.5837

Afr J Prim Health Care Fam Med. 2024 May 9;16(1):e1-e11. doi: 10.4102/phcfm.v16i1.4421.

ABSTRACT

BACKGROUND: South Africa’s health care system grapples with persistent challenges, including health care provider shortages and disparities in distribution. In response, the government introduced clinical associates (Clin-As) as a novel category of health care providers.

AIM: This study mapped Clin-As’ history and practice in South Africa, assessing their roles in the health workforce and offering recommendations.

METHODS: Following the framework outlined by Arksey and O’Malley, we conducted a comprehensive literature search from January 2001 to November 2021, utilising PubMed, Scopus and EBSCOhost databases. One thousand six hundred and seventy-two articles were identified and then refined to 36 through title, abstract and full-text screening.

RESULTS: Strengths of the Clin-A cadre included addressing rural workforce shortages and offering cost-effective health care in rural areas. Challenges to the success of the cadre included stakeholder resistance, rapid implementation, scope of practice ambiguity, inadequate supervision, unclear roles, limited Department of Health (NDoH) support, funding deficits, Clin-As’ perceived underpayment and overwork, degree recognition issues, inadequate medical student training on Clin-A roles, vague career paths and uneven provincial participation.

CONCLUSION: As a health care provider cadre, Clin-As have been welcomed by multiple stakeholders and could potentially be a valuable resource for South Africa’s health care system, but they face substantial challenges. Realising their full potential necessitates enhanced engagement, improved implementation strategies and precise scope definition.Contribution: This study acknowledges Clin-As in SA as a promising solution to health care workforce shortages but highlights challenges such as stakeholder resistance, insufficient NDoH support and unclear policies, emphasising the need for comprehensive efforts to maximise their potential.

PMID:38832380 | DOI:10.4102/phcfm.v16i1.4421

Afr J Prim Health Care Fam Med. 2024 May 15;16(1):e1-e9. doi: 10.4102/phcfm.v16i1.4436.

ABSTRACT

BACKGROUND: Burnout in doctors is an important issue with far-reaching consequences. Community service doctors may be particularly vulnerable because of their specific roles (rural settings, junior positions and reduced supervision).

AIM: This study aimed to determine the prevalence of burnout among community service doctors in South Africa (SA), the potential contributory and protective factors and the consequences thereof.

SETTING: This was a national study of community service doctors in SA.

METHODS: A quantitative, descriptive cross-sectional study was performed. The Maslach Burnout Inventory was used to measure burnout. The online questionnaire also included demographic data, workplace and individual characteristics.

RESULTS: Of the 208 community service doctors analysed, 89% and 94% had high emotional exhaustion and depersonalisation, respectively, while 97% had a low personal accomplishment. Mental illness, financial difficulties, unmanageable volume of patients and female gender were found to be potential contributory factors. Having manageable patient volumes, satisfaction with their decision to study medicine, talking to colleagues and feeling supported by healthcare facility management were among the significant potential protective factors. Significant potential consequences of burnout included: leaving the government sector, ever being diagnosed with a mental illness, using alcohol as a coping mechanism and possible current major depression.

CONCLUSION: Burnout among community service doctors in SA is highly prevalent with significant potential consequences. There are a number of modifiable possible contributory and protective factors identified that may be targets for mental health interventions.Contribution: Healthcare burnout research is lacking in the African and specifically SA context. This void includes community service doctors.

PMID:38832374 | DOI:10.4102/phcfm.v16i1.4436

J Neurosci. 2024 Jun 3:e1344232023. doi: 10.1523/JNEUROSCI.1344-23.2023. Online ahead of print.

ABSTRACT

It was proposed that a reorganization of the relationships between cognitive functions occurs in dementia, a vision that surpasses the idea of a mere decline of specific domains. The complexity of cognitive structure, as assessed by neuropsychological tests, can be captured by Exploratory Graph Analysis (EGA).EGA was applied to the neuropsychological assessment of people (humans) with Subjective Cognitive Decline (SCD), Mild Cognitive Impairment (MCI), and Alzheimer’s Disease (AD) (Total N=638). Both sexes were included.In AD, memory scores detach from the other cognitive functions and memory subdomains reduce their reciprocal relation. SCD showed a pattern of segregated neuropsychological domains, and MCI showed a noisy and less stable pattern.Results suggest that AD drives a reorganization of cognitive functions toward a less fractionated architecture compared to preclinical conditions. Cognitive functions show a reorganization that goes beyond the performance decline. Results also have clinical implications in test interpretations and usage.Significance Statement The manuscript proposes an innovative vision for the study of the complex reorganization of cognition in people with dementia.We applied a sophisticated, reliable, cutting-edge statistical method (i.e., Exploratory Graph Analysis – EGA) to the neuropsychological evaluations of 638 patients classified into Subjective Cognitive Decline (N=155), Mild Cognitive Impairment (N=242) and Alzheimer’s Disease (N=241).Patients with Alzheimer’s Disease showed a simplified architecture as compared to subjects with Subjective Cognitive Decline. The MCI group resulted in sharing specific aspects with the SCD and others with the AD.Recognizing the complexity of the cognitive organization is fundamental for properly understanding cognitive impairment and stimulate the discussion about the interpretation of neuropsychological profiles from a more systemic point of view.

PMID:38830757 | DOI:10.1523/JNEUROSCI.1344-23.2023