Nevin Manimala

JMIR Public Health Surveill. 2024 Dec 19;10:e63557. doi: 10.2196/63557.

ABSTRACT

BACKGROUND: In-flight medical emergencies (IMEs) can have severe outcomes, including the deaths of passengers and aircraft diversions. Information is lacking regarding the incidence rate and characteristics of IMEs in most countries, especially in mainland China.

OBJECTIVE: The objective of this study was to investigate the incidence, patterns, and associated risk factors of IMEs in mainland China and to provide medical suggestions for the evaluation and management of IMEs.

METHODS: This population-based retrospective study examined electronic records for all IME reports between January 1, 2018, and December 31, 2022, from a major airline company in mainland China. Outcome variables included the medical category of the IMEs, the outcomes of first aid, and whether or not the IMEs led to a flight diversion. We calculated the incidence rate and death rate of IMEs based on the number of passengers and flights, respectively. A logistic regression model was used to investigate the factors associated with aircraft diversions.

RESULTS: A total of 199 IMEs and 24 deaths occurred among 447.2 million passengers, yielding an incidence rate of 0.44 (95% CI 0.39-0.51) events per million passengers and 66.56 (95% CI 50.55-86.04) events per million flights, and an all-cause mortality rate of 0.05 (95% CI 0.03-0.07) events per million passengers and 7.50 (95% CI 4.81-11.16) events per million flights. From 2018 to 2022, the highest incidence and mortality rates were observed in 2019 and 2020, respectively, while the lowest were in 2020 and 2021, respectively. Additionally, the highest incidence and mortality rates were observed between 6 PM to 6 AM and noon to 6 PM, respectively. There was a higher incidence rate of IMEs in the winter months. Moreover, the highest case-fatality rates were observed in 2019 (12/74, 16.2%), on flights traveling ≥4000 km (9/43, 20.9%), and on wide-body planes (10/52, 19.2%). Seizures (29/199, 14.6%), cardiac symptoms (25/199, 12.6%), and syncope or presyncope (19/199, 9.6%) were the most common medical problems and main reasons for aircraft diversion. The incidence of aircraft diversion was 42.50 (95% CI 37.02-48.12) events per million flights. Narrow-body planes (odds ratio [OR] 5.69, 95% CI 1.05-30.90), flights ≥4000 km (OR 16.40, 95% CI 1.78-151.29), and the months of December to February (OR 12.70, 95% CI 3.09-52.23), as well as the months of March to May (OR 23.21, 95% CI 3.75-143.43), were significantly associated with a higher risk of diversion.

CONCLUSIONS: The occurrence of and deaths associated with IMEs are rare in mainland China, but a temporal trend shows higher incidence rates at night and in winter. The leading IMEs are cardiac symptoms, seizures, and syncope. The establishment of a unified reporting system for IMEs and ground-to-air medical support are of great value for reducing IMEs and deaths in the global community.

PMID:39700443 | DOI:10.2196/63557

J Clin Oncol. 2024 Dec 19:JCO2401121. doi: 10.1200/JCO.24.01121. Online ahead of print.

ABSTRACT

This randomized phase III trial aimed to determine whether treatment with cisplatin and volume-directed radiation followed by carboplatin and paclitaxel for four cycles (chemoradiotherapy [C-RT]) increased recurrence-free survival (RFS) and overall survival (OS) when compared with carboplatin and paclitaxel for six cycles (chemotherapy [CT]) in locally advanced endometrial cancer (UC). Previously reported results showed that C-RT did not improve RFS compared with CT. Here we report the final OS analysis. Patients with International Federation of Gynecology and Obstetrics (FIGO) 2009 stage III-IVA UC or stage I/II serous or clear cell UC and positive cytology were enrolled. The primary objective was RFS. Secondary objectives were OS, toxicity, and quality of life. Cumulative probabilities of OS were estimated using the Kaplan-Meier method. Subgroup analyses of treatment effect for FIGO stage, age, race, gross residual disease, histology, lymph-vascular space invasion, and body mass index were performed. In total, 813 patients were randomly assigned (407 C-RT and 406 CT). The median follow-up was 112 months. Median OS was not achieved in either arm. The stratified hazard ratio for death comparing C-RT versus CT was 1.05 (95% CI, 0.82 to 1.34, log-rank two-sided P value = .72). None of the factors analyzed predicted OS benefit from C-RT. Although C-RT reduced the rate of local recurrence compared with CT, it did not increase OS or RFS in stage III/IVA UC.

PMID:39700442 | DOI:10.1200/JCO.24.01121

J Natl Cancer Inst. 2024 Dec 19:djae338. doi: 10.1093/jnci/djae338. Online ahead of print.

ABSTRACT

BACKGROUND: Racial and ethnic minorities remain underrepresented in gynecologic cancer clinical trials despite disproportionately worse oncologic outcomes. Research shows differential racial enrollment patterns due to comorbidity-based exclusion criteria (CEC). Our objective was to evaluate contemporary trends in CECs among NCI-sponsored gynecologic cancer clinical trials and protocol adherence to broadened eligibility criteria guidelines as an assessment of equitable enrollment access.

METHODS: The ClinicalTrials.gov registry was queried for NCI-sponsored gynecologic cancer clinical trials (1994-2021). Study characteristics and CECs were abstracted from protocols. Descriptive statistics and temporal trends were calculated using chi-square testing with STATA v17 software.

RESULTS: Among 279 clinical trials identified, 65% completed enrollment, 53% were Phase II, and 48% focused on ovarian cancer. Pharmaceutical agents (85%) were the primary therapeutic interventions.Several inequitably restrictive exclusion criteria increased over time such as hepatitis infection (17% in 1994-2000 vs 49% in 2015-2021, p < .001) and cardiovascular disease (47% in 1994-2000 vs 66% in 2015-2021, p = .002). A previously rare exclusion, “mental illness/social situations,” dramatically increased from 5% to 51% (p < .001) over three decades.Adherence to broadened eligibility criteria recommendations was mixed. Renal function, cardiovascular disease, and performance status criteria were not broadened but HIV, prior/concurrent malignancies, and brain metastasis criteria were.

CONCLUSIONS: Some, but not all, of the known restrictive CECs have increased in gynecologic cancer clinical trial design, despite calls for improving racial and ethnic minority representation. While exclusion criteria are critical for trial safety, they must be carefully considered given the differential racial impact on eligibility.

PMID:39700440 | DOI:10.1093/jnci/djae338

Rheumatology (Oxford). 2024 Dec 19:keae690. doi: 10.1093/rheumatology/keae690. Online ahead of print.

ABSTRACT

OBJECTIVES: Salivary gland ultrasound (SGUS) has an interest in primary Sjögren’s disease (pSD) for diagnosis, but the evolution of parenchymal lesions over time is unknown. The objective of this study was to assess the severity of ultrasound abnormalities in relation to pSD duration from the time of buccal dryness onset.

METHODS: In this cross-sectional international multicentre study, patients with pSD according to the 2002 or 2016 ACR/EULAR classification criteria were included. Parenchymal abnormalities were classified according to the semiquantitative score as defined by OMERACT. Patients were separated into 4 groups (Group A: < 5 years, Group B: 5-9 years, Group C: 10-20 years, and Group D: > 20 years from the onset of buccal dryness). The association between disease duration groups and SGUS lesions was quantified in terms of odds ratios and 95% confidence intervals.

RESULTS: A total of 247 patients were consecutively included between May 2019 and February 2022. Eighty-nine percent of patients had a focus score ≥1/4 mm2, and 85% had positive anti-Ro/SSA. pSD duration was associated with a pathological OMERACT score (score 2 or 3): OR for 5-year duration: 1.23 [95% CI 1.04; 1.47], p= 0.0383). Considering each US item, the only statistical association with pSD duration was found regarding the presence of hyperechoic bands (25% or more): OR for five-year duration 1.18 [95% CI 1.03; 1.36], p= 0.038), independent of an older age.

CONCLUSION: pSD duration was associated with the presence of hyperechoic bands, but not with hypoechoic areas, suggesting a progressive fibro-adipose evolution.

PMID:39700419 | DOI:10.1093/rheumatology/keae690

G3 (Bethesda). 2024 Dec 19:jkae280. doi: 10.1093/g3journal/jkae280. Online ahead of print.

ABSTRACT

Amplicon panels using genotyping by sequencing methods are now common, but have focused on characterizing SNP markers. We investigate how microhaplotype (MH) discovery within a recently developed Pacific oyster (Magallana gigas) amplicon panel could increase the statistical power for relationship assignment. Trios (offspring and two parents) from three populations in a newly established breeding program were genotyped on a 592 locus panel. After processing, 92% of retained amplicons contained polymorphic MH variants and 85% of monomorphic SNP markers contained MH variation. The increased allelic richness resulted in substantially improved power for relationship assignment with much lower estimated false positive rates. No substantive differences in assignment accuracy occurred between SNP and MH datasets, but using MHs increased the separation in log-likelihood values between true parents and highly related potential parents (aunts and uncles). A high number of Mendelian incompatibilities among trios were observed, likely due to null alleles. Further development of a MH panel, including removing loci with high rates of null alleles, would enable high-throughput genotyping by reducing panel size and therefore cost for Pacific oyster research and breeding programs.

PMID:39700397 | DOI:10.1093/g3journal/jkae280

J Glob Health. 2024 Dec 20;14:04246. doi: 10.7189/jogh.14.04246.

ABSTRACT

BACKGROUND: Postpartum family planning (PPFP) is an essential component of birth care that helps avert maternal and newborn health hazards by preventing short-spaced births. Many Asian and African studies found PPFP counselling during antenatal care (ANC) and postnatal care (PNC) effective in increasing PPFP uptake. Studies in Bangladesh, however, provided limited evidence of the feasibility and effectiveness of integrating PPFP in maternal health services. The national action plan integrated PPFP services (counseling and providing methods) in maternal health care and immunisation programmes. However, no study has examined the availability of PPFP counselling, an essential component of PPFP, in maternity care points and its effectiveness in increasing PPFP initiation. We explore the prevalence and correlates of PPFP counselling during ANC and PNC and investigate whether PPFP counselling during ANC and PNC increases PPFP initiation.

METHODS: We used nationally representative data from the 2017-18 Bangladesh Demographic and Health Survey to analyse whether women having the last live birth in the past three years received PPFP counselling during ANC or PNC visits. We included women’s other characteristics as covariates in a multivariable logistic regression. Finally, we analysed the 12-month PPFP initiation by PPFP counselling during ANC and PNC visits. The PPFP initiation analysis used self-reported contraceptive calendar data, a life table technique, and a proportional hazards model.

RESULTS: The prevalence of PPFP counselling was 12% during ANC and 22% during PNC. Women with higher education, higher birth order, upper household wealth quintiles, and living in the Khulna division compared to Chattogram (i.e. the division with the lowest PPFP counselling prevalence) were more likely to receive PPFP counselling during ANC and PNC. Three-fourths of the women initiated FP within 12 months postpartum. PPFP initiation was higher for women receiving PPFP counselling during PNC than those who did not receive it during PNC. We did not find evidence of increased PPFP initiation among women receiving PPFP counselling during ANC.

CONCLUSIONS: The higher PPFP initiation among women receiving PPFP counselling during PNC is encouraging. Although we did not find evidence supporting increased PPFP initiation among women receiving PPFP counselling during ANC, further investigation on the quality of PPFP counselling during ANC may guide this necessary intervention’s implementation and scale-up.

PMID:39700387 | DOI:10.7189/jogh.14.04246

J Glob Health. 2024 Dec 20;14:05037. doi: 10.7189/jogh.14.05037.

ABSTRACT

BACKGROUND: While countries’ coronavirus disease 2019 (COVID-19) emergency contingency and response plans aimed to prevent and control the spread of the virus, they also caused major disruptions to health services. We assessed the effects of COVID-19 on coverage and inequalities in select maternal, newborn, and child health services in Burkina Faso.

METHODS: We analysed data from two cross-sectional household surveys conducted in two provinces, one rural and one urban. The first survey of 3375 households was conducted immediately before the pandemic (February to March 2020) and the second survey in the same areas two years after the pandemic (May to June 2022) using a similar methodology. We compared the coverage of maternal, newborn, and child health interventions and care-seeking between the two surveys to assess the effects of the pandemic on maternal, newborn, and child health services.

RESULTS: Our findings did not show significant disruptions in coverage of antenatal service, postnatal care for mothers and babies, child routine vaccination, and care-seeking for sick children during the pandemic. However, there was a dramatic drop of the number of women (23 percentage points) accompanied by their partners for delivery as well as the number of caesarean-section deliveries in urban areas. The shortage of health staff, facility congestion, fear of getting COVID-19 after a caesarean-section admission, and prioritisation of critical health services such as emergency caesarean-section to the detriment of elective cases may explain the decline of caesarean-section rates.

CONCLUSIONS: COVID-19 did not cause major reversals in the coverage of maternal, newborn, and child health services in Burkina Faso, except for caesarean sections. We also saw no substantial increases in service coverage. In the absence of a counterfactual, we could not attribute the stagnation to the pandemic. However, the very low proportion of women reporting disruption in care-seeking suggests some resilience of the health systems to mitigate the negative impacts of the pandemic.

PMID:39700386 | DOI:10.7189/jogh.14.05037

J Glob Health. 2024 Dec 20;14:05034. doi: 10.7189/jogh.14.05034.

ABSTRACT

BACKGROUND: The World Health Organization declared that coronavirus disease 2019 (COVID-19) constitutes an international public health emergency, which has strained health resources. In this study, we aimed to understand medical students’ willingness to join the workforce fighting against the COVID-19 pandemic and identify factors associated with their decisions.

METHODS: We conducted a nationwide cross-sectional study using the Wen-Juan-Xing platform and a pre-designed questionnaire from 23 March to 19 April 2021. We conducted logistic regression analyses to identify the determinants associated with the willingness.

RESULTS: Among the 5022 medical students, the majority (n = 4289, 85.40%) expressed willingness to work on the COVID-19 frontline. Logistic regression indicated that medical students’ willingness to work on the COVID-19 frontline in China was associated with gender, region, reason for choosing medicine, having medical workers in the family, students whose family members, relatives or friends experienced COVID-19, and professional attitude. Females (odds ratio (OR) = 1.305; 95% confidence interval (CI) = 1.100-1.549; P = 0.0023), medical students from urban areas (OR = 1.295; 95% CI = 1.089-1.539; P = 0.0034), medical students whose choice of a medical career was their desire (OR = 1.579; 95% CI = 1.290-1.933; P < 0.0001), medical students whose parents or relatives are medical workers (OR = 1.266; 95% CI = 1.066-1.505; P = 0.0073), medical students whose family members, relatives, or friends have never been infected with COVID-19 (OR = 4.567; 95% CI = 3.002-6.947; P < 0.0001), and medical students with undisturbed of professional attitudes (OR = 4.280; 95% CI = 3.241-5.654; P < 0.0001) showed increased willingness to work on the COVID-19 frontline compared with their counterparts.

CONCLUSIONS: Medical students demonstrated a strong willingness to contribute to COVID-19 work during the pandemic in China. The findings may provide valuable information for emergency management so that policymakers can maintain sufficient health resources and provide quality health care in similar health emergencies in the future.

PMID:39700384 | DOI:10.7189/jogh.14.05034

J Med Internet Res. 2024 Dec 19;26:e57786. doi: 10.2196/57786.

ABSTRACT

BACKGROUND: The status of the digitalization of companies and institutions is usually measured using maturity models. However, the concept of maturity in general practice is currently unclear, and herewith we examine the question of how maturity can be measured. There is a lack of empirical work on the dimensions and subcategories of digital maturity that provide information on the assessment framework.

OBJECTIVE: The aim of the study was to answer the question of how many and which dimensions and subcategories describe digital maturity in general practice.

METHODS: An explorative, qualitative research design based on semistructured expert interviews was used to investigate the dimensions of digital maturity. Twenty experts from various areas of the health care sector (care providers, interest groups, health care industry, and patient organizations) were interviewed. The interviews were analyzed based on a content-structuring analysis according to Kuckartz and Rädiker using MAXQDA software (VERBI GmbH).

RESULTS: In total, 6 dimensions with a total of 26 subcategories were identified. Of these, 4 dimensions with a total of 16 subcategories (1) digitally supported processes, (2) practice staff, (3) organizational structures and rules, and (4) technical infrastructure and were deductively linked to digital maturity. In addition to the use of digital solutions, digital maturity included, for example, individual, organizational, and technical capabilities and resources of the medical practice. The 2 further dimensions, (5) benefits and outcomes and (6) external framework conditions of the medical practice, were identified inductively with a total of 10 subcategories. Digital maturity was associated with the beneficial use of digitalization, for example, with efficiency benefits for the practice, and external framework conditions were associated with influencing factors such as the local patient situation in the medical practice.

CONCLUSIONS: The results indicate that digital maturity is a multidimensional construct that is associated with many dimensions and variables. It is a holistic approach with human, organizational, and technical factors and concerns the way digitalization is used to shape patient care and processes. Furthermore, it is related to the maturity of the organizational environment as well as the benefits of a digitalized medical practice; however, this still needs to be confirmed. To measure the level of digital maturity in outpatient care as accurately as possible, maturity models should therefore be multilayered and take external influencing factors into account. Future research should statistically validate the identified dimensions. At the same time, correlations and dependencies between the measurement dimensions and their subcategories should be analyzed.

PMID:39699948 | DOI:10.2196/57786

J Surg Oncol. 2024 Dec 19. doi: 10.1002/jso.28046. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: The tumor-associated stroma is an essential compartment in breast cancer, and collagen fiber organization in the stroma has been reported to be correlated with prognosis. In this study, we sought to evaluate collagen fiber characteristics in relation to pathological complete response (pCR) after neoadjuvant chemotherapy (NAC) in breast cancer patients.

METHODS: A total of 388 breast cancer patients receiving NAC were enrolled. The stroma type was manually assessed on pretreatment hematoxylin and eosin (HE)-stained slides, and the collagen fiber features were quantified by a computer tool. The relationship between syndecan-1 expression and collagen fibers and its correlation with treatment efficacy were detected by immunohistochemistry.

RESULTS: The pCR rate of patients with collagen-dominant stroma was lower than that of patients with lymphocyte-dominant stroma (19.6% vs. 40.0%, p = 0.001). Patients who achieved pCR had straighter and less dense fibers in pretreatment biopsied tissue than non-pCR patients (p = 0.031, p = 0.044). Additionally, the pCR group had greater syndecans-1 expression on the tumor epithelium than the non-pCR group (p < 0.001), while there was no statistically significant difference in the stroma (p = 0.333). Collagen fiber density was the only factor associated with pCR after correction for other clinicopathological variables in triple-negative breast cancer (TNBC) patients (OR 0.466, 95% CI 0.227-0.956, p = 0.037); patients with lower fiber density had a greater pCR rate (37.5% vs. 12.5%, p = 0.021).

CONCLUSIONS: Collagen fiber density was associated with pCR in patients with breast cancer, and it could be a potential candidate for discriminating between responders and nonresponders for TNBC patients receiving NAC.

PMID:39699940 | DOI:10.1002/jso.28046