Category: Statistics

J Clin Psychiatry. 2024 May 1;85(2):23m15071. doi: 10.4088/JCP.23m15071.

ABSTRACT

Introduction: This study aimed to assess the association between long-acting injectable (LAI) antipsychotic prescription and the risk of psychiatric hospitalization in patients with treatment-resistant schizophrenia (TRS) receiving clozapine.

Methods: In this retrospective cohort study at a single tertiary psychiatric center, we analyzed rehospitalization hazard ratios (HRs) in refractory schizophrenia patients, classified by DSM-IV-TR and DSM-5 criteria. We examined various psychotropic regimens-clozapine with or without other oral antipsychotics (OAPs) or LAI antipsychotics. Subgroups were stratified by daily clozapine dosage and previous admissions.

Results: A total of 719 patients were included in the study. Analyses were conducted on all the patients over 3- month, 6-month, and 1-year periods. Patients treated with a combination of clozapine and LAI antipsychotics (CLO + LAI) had a significantly higher number of previous hospitalizations (P = .003), and a higher daily dose of clozapine (P < .001) was found in the CLO + OAP group than in the CLO (monotherapy) group and the CLO + LAI group. Patients treated with LAI antipsychotic comedication had significantly lower HRs for rehospitalization in 1 year among 3 studied groups. Moreover, the protective effects of LAI antipsychotics were observed in all the subgroups stratified by daily clozapine dosage and number of previous admissions to represent disease severity.

Conclusion: The combination of clozapine and LAI antipsychotics was associated with a significantly lower risk of rehospitalization compared to both the combination of clozapine and OAPs and clozapine monotherapy. The use of LAI antipsychotics should be considered to prevent rehospitalization in patients with TRS who are already being treated with clozapine.

PMID:38696112 | DOI:10.4088/JCP.23m15071

J Glob Health. 2024 May 3;14:04065. doi: 10.7189/jogh.14.04065.

ABSTRACT

BACKGROUND: Clinical research in sub-Saharan Africa (SSA) has often focussed on communicable diseases. However, with the increasing burden of non-communicable diseases (NCDs), there is a need for Africa-specific NCD research.

METHODS: GSK established the Africa NCD Open Lab in 2014. Three calls for proposals were advertised through various media channels. An external independent scientific advisory board, predominantly representing African scientists and NCD experts, reviewed and selected projects to receive funding. An additional programme in the Africa NCD Open Lab was designed to build statistical capability by supporting training initiatives. We assessed the impact of the Africa NCD Open Lab in three ways: scientific quality with impact; research training and professional development; and research environments. We captured metrics through regular reports/interactions with researchers; via a final report; and through exit interviews with principal investigators.

RESULTS: Twenty projects in 11 African countries were funded; reports from 18 completed projects are available (data capture is ongoing). Overall, 139 articles have been published in peer-reviewed journals and other data have been presented at conferences and other forums. Most completed projects led to positive outcomes, such as further research, informing policy, or positively impacting clinical care, including three projects that saw changes to regional or national practice guidelines: the CREOLE study in Nigeria; the African Severe Asthma Program in Uganda; and the African Prospective Study on the Early Detection and Identification of Cardiovascular Disease and Hypertension in South Africa. Participation in the Africa NCD Open Lab led to the award of 34 grants related to or influenced by increased research capacity or experience. Significant professional development related to the projects also occurred with higher-level degrees being awarded, including 30 MScs, 30 PhDs, and nine postdoctoral fellowships. Through these projects, research capacity was strengthened across the region by equipping core research facilities, training research staff, strengthening research support services, and supporting the expansion of investigator networks.

CONCLUSIONS: The completed Africa NCD Open Lab projects demonstrate high-quality research outcomes addressing important health challenges with potential benefits to African populations. Based on the success of the Africa NCD Open Lab, additional funding has been secured to extend the Open Lab initiative.

PMID:38695258 | DOI:10.7189/jogh.14.04065

Int J Mol Med. 2024 Jun;53(6):56. doi: 10.3892/ijmm.2024.5380. Epub 2024 May 2.

ABSTRACT

Numerous studies have attempted to develop biological markers for the response to radiation for broad and straightforward application in the field of radiation. Based on a public database, the present study selected several molecules involved in the DNA damage repair response, cell cycle regulation and cytokine signaling as promising candidates for low‑dose radiation‑sensitive markers. The HuT 78 and IM‑9 cell lines were irradiated in a concentration‑dependent manner, and the expression of these molecules was analyzed using western blot analysis. Notably, the activation of ataxia telangiectasia mutated (ATM), checkpoint kinase 2 (CHK2), p53 and H2A histone family member X (H2AX) significantly increased in a concentration‑dependent manner, which was also observed in human peripheral blood mononuclear cells. To determine the radioprotective effects of cinobufagin, as an ATM and CHK2 activator, an in vivo model was employed using sub‑lethal and lethal doses in irradiated mice. Treatment with cinobufagin increased the number of bone marrow cells in sub‑lethal irradiated mice, and slightly elongated the survival of lethally irradiated mice, although the difference was not statistically significant. Therefore, KU60019, BML‑277, pifithrin‑α, and nutlin‑3a were evaluated for their ability to modulate radiation‑induced cell death. The use of BML‑277 led to a decrease in radiation‑induced p‑CHK2 and γH2AX levels and mitigated radiation‑induced apoptosis. On the whole, the present study provides a novel approach for developing drug candidates based on the profiling of biological radiation‑sensitive markers. These markers hold promise for predicting radiation exposure and assessing the associated human risk.

PMID:38695243 | DOI:10.3892/ijmm.2024.5380

Vet Med Sci. 2024 May;10(3):e1427. doi: 10.1002/vms3.1427.

ABSTRACT

BACKGROUND: Canine babesiosis is a clinically significant tick-transmitted disease caused by several species of the intraerythrocytic protozoan parasite Babesia, which result in a wide range of clinical manifestations, from mild, transient infection to serious disease and even death.

OBJECTIVES: The current study aimed to estimate the global prevalence and associated risk factors of Babesia in dogs.

METHODS: Multiple databases (PubMed, Scopus, ProQuest, Web of Science and Google Scholar) were searched for relevant literature published from January 2000 up to December 2022. The statistical analyses were performed based on the R software (version 3.6) meta-package.

RESULTS: Out of 23,864 publications, 229 studies met the inclusion criteria. The pooled prevalence of canine babesiosis was 0.120 (95% CI; 0.097-0.146). The highest pooled prevalence was found in Europe (0.207, 95% CI; 0.097-0.344). Among several species, Babesia canis was the most prevalent parasite (0.216, 95% CI; 0.056-0.441). The highest pooled prevalence of Babesia in dogs was observed in the summer season (0.097, 95% CI; 0.040-0.174).

CONCLUSIONS: Regular screening and appropriate control strategies are recommended for the prevention of transmission of tick-borne disease transmission among dogs.

PMID:38695207 | DOI:10.1002/vms3.1427

Disaster Med Public Health Prep. 2024 May 2;18:e84. doi: 10.1017/dmp.2024.46.

ABSTRACT

OBJECTIVES: The co-occurring flood and coronavirus disease (COVID-19) increase the consequences for health and life. This study examined the strategies to manage the health consequences of the co-occurring flood and COVID-19, with a specific focus on these 2 challenges.

METHODS: This review included all the studies published in peer-reviewed journals between January 1980 and June 2021. Several electronic databases were searched, including Scopus, Web of Science, and PubMed. Mixed Methods Appraisal Tools (MMT), version 2018, assessed the articles retrieved through a comprehensive and systematic literature search. Descriptive and thematic analyses were carried out to derive strategies for managing the health consequences of the simultaneous flood and COVID-19.

RESULTS: Among 4271 identified articles, 10 were eligible for inclusion. In total, 199 strategies were identified in this review for managing the multi-hazard health consequences of flooding and COVID-19, which were classified into 9 categories and 25 subcategories. The categories included policy making and decision making, coordination, risk communication, logistics, planning, preparedness measures, response measures, social and humanitarian support, and actions of local communities and non-governmental organizations.

CONCLUSIONS: Managing a multi-hazard and reducing its health consequences requires various actions. Flood management must be needed, and flood-affected people and their health should be protected.

PMID:38695206 | DOI:10.1017/dmp.2024.46

Disaster Med Public Health Prep. 2024 May 2;18:e82. doi: 10.1017/dmp.2024.50.

ABSTRACT

BACKGROUND: Medical students hold significant importance, as they represent the future of healthcare provision. This study aimed to explore psychological antecedents towards the monkeypox (mpox) vaccines among postgraduate and undergraduate medical students across countries.

METHODS: A cross-sectional survey was conducted among medical students aged 18 years old and above in 7 countries; Egypt, Romania, Malaysia, and Yemen, Iraq, India, and Nigeria. We used social media platforms between September 27 and November 4, 2022. An anonymous online survey using the 5C scale was conducted using snowball and convenience Sampling methods to assess the 5 psychological antecedents of vaccination (i.e., confidence, constraints, complacency, and calculation, as well as collective responsibility).

RESULTS: A total of 2780 participants were recruited. Participants’ median age was 22 years and 52.1% of them were males. The 5C psychological antecedents of vaccination were as follows: 55% were confident about vaccination, 10% were complacent, 12% experienced constraints, and 41% calculated the risk and benefit. Lastly, 32% were willing to be vaccinated for the prevention of infection transmission to others. The Country was a significant predictor of confidence, complacency, having constraints, and calculation domains (P < 0.001). Having any idea about the mpox vaccine was linked to 1.6 times higher odds of being more confident [OR = 1.58 (95% CI, 1.26-1.98), P < 0.001] Additionally, living in a rural area significantly increased complacency [OR = 1.42 (95% CI, 1.05-1.95), P = 0.024] as well as having anyone die from mpox [OR = 3.3 (95% CI, 1.64-6.68), P < 0.001]. Education level was associated with increased calculation [OR = 2.74 (95% CI, 1.62-4.64), P < 0.001]. Moreover, being single and having no chronic diseases significantly increased the calculation domain [OR = 1.40 (95% CI, 1.06-1.98), P = 0.02] and [OR = 1.54 (95% CI, 1.10-2.16), P = 0.012] respectively. Predictors of collective responsibility were age 31-45 years [OR = 2.89 (95% CI, 1.29-6.48), P = 0.01], being single [OR = 2.76 (95% CI, 1.94 -3.92), P < 0.001], being a graduate [OR = 1.59 (95% CI (1.32-1.92), P < 0.001], having no chronic disease [OR = 2.14 (95% CI, 1.56-2.93), P < 0.001], and not knowing anyone who died from mpox [OR = 2.54 (95% CI, 1.39-4.64), P < 0.001), as well as living in a middle-income country [OR = 0.623, (95% CI, 0.51-0.73), P < 0.001].

CONCLUSIONS: This study underscores the multifaceted nature of psychological antecedents of vaccination, emphasizing the impact of socio-demographic factors, geographic location, and awareness, as well as previous experiences on individual attitudes and collective responsibility towards vaccination.

PMID:38695200 | DOI:10.1017/dmp.2024.50

Disaster Med Public Health Prep. 2024 May 2;18:e83. doi: 10.1017/dmp.2024.69.

ABSTRACT

OBJECTIVE: This study was conducted to reveal the relationship between nursing students’ disaster response self-efficacy and their disaster preparedness perceptions.

METHODS: This cross-sectional study was conducted on nursing students after a major earthquake that occurred in Turkey on February 6, 2023 (n = 302). Data collection took place from June 2023 to October 2023, using the Disaster Response Self-Efficacy Scale (DRSES) and Disaster Preparedness Perception Scale (DPPS). Descriptive statistics, independent samples t-test, correlation, and multiple linear regression analysis were used to analyze the data.

RESULTS: Nursing students’ DRSES mean score was 63.35 ± 10.83 (moderate level) and DPPS mean score was 3.41 ± 0.50 (high level). A positive and moderate correlation was found between nursing students’ DRSES and DPPS scores (r = 0.515; P = 0.000). Predictors affecting nursing students’ disaster preparedness are disaster response self-efficacy score, being male, and making a family disaster plan.

CONCLUSIONS: The results of this study highlight the importance of increasing the disaster response self-efficacy needed by nursing students to successfully assist patients in disaster situations.

PMID:38695197 | DOI:10.1017/dmp.2024.69

ACR Open Rheumatol. 2024 May 2. doi: 10.1002/acr2.11674. Online ahead of print.

ABSTRACT

OBJECTIVE: In 2019, the EULAR/American College of Rheumatology developed classification criteria for systemic lupus erythematosus (SLE). A positive correlation between summary score at diagnosis and SLE disease activity at five years has been noted in adult patients with lupus, but little is known among the pediatric population. We evaluated the prognostic value of higher summary scores and number of extrarenal domains at diagnosis (low/moderate number [1-5] vs high number [6-9]) to renal outcomes after one year of treatment in pediatric patients with lupus nephritis (LN).

METHODS: This retrospective, single-center cohort study included 74 pediatric patients with LN. Published pediatric renal response definitions were used for our outcome measure (no, partial, and complete response). Descriptive statistics were reported, and an ordinal logistic regression estimated adjusted odds ratios (ORs) for renal response including 95% confidence intervals (CIs).

RESULTS: Patients with high extrarenal domains had OR 1.47 (95% CI 0.55-2.91) of having a complete renal response compared to patients with low/moderate domains. Patients with a summary score <30 had OR 1.31 (95% CI 0.50-3.44) of having a complete renal response relative to a summary score ≥30, though a larger proportion of patients with a summary score of ≥30 had no renal response after one year of treatment.

CONCLUSION: More extrarenal domains at diagnosis did not have a statistically significant impact on renal response at one year, nor did a higher summary score. However, a larger portion of patients with a summary score <30 achieved complete renal response compared to patients with a score ≥30.

PMID:38695166 | DOI:10.1002/acr2.11674

Dig Endosc. 2024 May 2. doi: 10.1111/den.14806. Online ahead of print.

ABSTRACT

OBJECTIVES: Bleeding after endoscopic submucosal dissection (ESD) for gastric tumors in patients taking antithrombotic drugs, in particular direct oral anticoagulants (DOACs), remains unresolved; therefore, we evaluated the risk factors for post-ESD bleeding and drug differences in patients taking DOACs.

METHODS: We included 278 patients taking antithrombotic drugs who underwent gastric ESD between January 2017 and March 2022. Antithrombotic drugs were withdrawn following the 2017 guidelines (Appendix on anticoagulants including DOACs). To further clarify differences in antithrombotic agents’ effects, the peri-cancerous mucosa in the resected specimen was pathologically evaluated according to the Updated Sydney System. Multivariate analysis was performed to assess the risk of post-ESD bleeding.

RESULTS: The incidence of post-ESD bleeding in patients taking DOACs was 19.6% (10/51). Among patients taking antithrombotic drugs, DOACs were identified as a possible factor involved in post-ESD bleeding (odds ratio [OR] 4.92). Among patients taking DOACs, possible factors included resection length diameter ≥30 mm (OR 3.72), presence of neutrophil infiltration (OR 2.71), lesions occurring in the lower third of stomach (OR 2.34), and preoperative antiplatelet use (OR 2.22). Post-ESD bleeding by DOAC type was 25.0% of patients (4/16) receiving apixaban, in 20.0% (3/15) receiving edoxaban, in 21.4% (3/14) receiving rivaroxaban, and in none of those receiving dabigatran.

CONCLUSIONS: The administration of DOACs was shown to be a possible factor involved in post-ESD bleeding, and risk factors for patients taking DOACs included neutrophil infiltration. The pharmacological differences in the effects of DOACs contributing to bleeding in gastric ulcers suggest comparatively less bleeding with dabigatran after ESD.

PMID:38695106 | DOI:10.1111/den.14806

J Int AIDS Soc. 2024 May;27(5):e26249. doi: 10.1002/jia2.26249.

ABSTRACT

INTRODUCTION: South African men face a substantial burden of HIV and are less likely to test for HIV and initiate antiretroviral therapy if tested positive and more likely to die from AIDS-related causes than women. In addition to condoms and circumcision, guidelines provide for the use of daily oral pre-exposure prophylaxis (PrEP) as an HIV prevention intervention for any men who recognize their need and request PrEP. However, heterosexual men have not been a focus of PrEP programmes, and since its introduction, there is limited literature on PrEP use among men in South Africa. This study explores the experiences, motivators and barriers to oral PrEP use among heterosexual men accessing primary healthcare services in South Africa.

METHODS: This study forms part of a mixed-methods implementation science study aimed at generating evidence for oral PrEP introduction and conducted in primary healthcare clinics in South Africa since 2018. Men aged ≥15 years who initiated oral PrEP and enrolled in a parent cohort study were purposefully invited to participate in an in-depth interview (IDI). Between March 2020 and May 2022, 30 men participated in IDIs exploring their motivators for PrEP use, and experiences with accessing health services. Interviews were audio recorded, transcribed and analysed thematically.

RESULTS: The final analysis included 28 heterosexual men (18-56 years old). Motivations to initiate PrEP included fear of acquiring HIV, self-perceived vulnerability to HIV and mistrust in relationships; health systems factors which motivated PrEP use included the influence of healthcare providers, educational materials and mobile services. Perceived reduction in HIV vulnerability and changing proximity to partners were reasons for PrEP discontinuation. Side effects, daily-pill burden and stigma were noted as challenges to PrEP use. Health system barriers to PrEP use included limited PrEP availability, school and work demands, and inconsistent mobile clinic schedules.

CONCLUSIONS: Our study reports on the experiences of heterosexual men accessing oral PrEP in real-world settings and contributes to the limited literature among this population. We highlight multiple levels which could be strengthened to improve men’s PrEP use, including individual support, education among partners and communities, and addressing health system barriers to access.

PMID:38695102 | DOI:10.1002/jia2.26249