Nevin Manimala

JAMA Netw Open. 2024 Aug 1;7(8):e2429137. doi: 10.1001/jamanetworkopen.2024.29137.

ABSTRACT

IMPORTANCE: Socioeconomically disadvantaged subpopulations are more vulnerable to fine particulate matter (PM2.5) exposure. However, as prior studies focused on individual-level socioeconomic characteristics, how contextual deprivation modifies the association of PM2.5 exposure with cardiovascular health remains unclear.

OBJECTIVE: To assess disparities in PM2.5 exposure association with cardiovascular disease among subpopulations defined by different socioeconomic characteristics.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used longitudinal data on participants with electronic health records (EHRs) from the All of Us Research Program between calendar years 2016 and 2022. Statistical analysis was performed from September 25, 2023, through February 23, 2024.

EXPOSURE: Satellite-derived 5-year mean PM2.5 exposure at the 3-digit zip code level according to participants’ residential address.

MAIN OUTCOME AND MEASURES: Incident myocardial infarction (MI) and stroke were obtained from the EHRs. Stratified Cox proportional hazards regression models were used to estimate the hazard ratio (HR) between PM2.5 exposure and incident MI or stroke. We evaluated subpopulations defined by 3 socioeconomic characteristics: contextual deprivation (less deprived, more deprived), annual household income (≥$50 000, <$50 000), and race and ethnicity (non-Hispanic Black, non-Hispanic White). We calculated the ratio of HRs (RHR) to quantify disparities between these subpopulations.

RESULTS: A total of 210 554 participants were analyzed (40% age >60 years; 59.4% female; 16.7% Hispanic, 19.4% Non-Hispanic Black, 56.1% Non-Hispanic White, 7.9% other [American Indian, Asian, more than 1 race and ethnicity]), among whom 954 MI and 1407 stroke cases were identified. Higher PM2.5 levels were associated with higher MI and stroke risks. However, disadvantaged groups (more deprived, income <$50 000 per year, Black race) were more vulnerable to high PM2.5 levels. The disparities were most pronounced between groups defined by contextual deprivation. For instance, increasing PM2.5 from 6 to 10 μg/m3, the HR for stroke was 1.13 (95% CI, 0.85-1.51) in the less-deprived vs 2.57 (95% CI, 2.06-3.21) in the more-deprived cohort; 1.46 (95% CI, 1.07-2.01) in the $50 000 or more per year vs 2.27 (95% CI, 1.73-2.97) in the under $50 000 per year cohort; and 1.70 (95% CI, 1.35-2.16) in White individuals vs 2.76 (95% CI, 1.89-4.02) in Black individuals. The RHR was highest for contextual deprivation (2.27; 95% CI, 1.59-3.24), compared with income (1.55; 95% CI, 1.05-2.29) and race and ethnicity (1.62; 95% CI, 1.02-2.58).

CONCLUSIONS AND RELEVANCE: In this cohort study, while individual race and ethnicity and income remained crucial in the adverse association of PM2.5 with cardiovascular risks, contextual deprivation was a more robust socioeconomic characteristic modifying the association of PM2.5 exposure.

PMID:39158908 | DOI:10.1001/jamanetworkopen.2024.29137

JAMA Netw Open. 2024 Aug 1;7(8):e2429229. doi: 10.1001/jamanetworkopen.2024.29229.

ABSTRACT

IMPORTANCE: Early identification of the likelihood of autism spectrum disorder (ASD) using minimal information is crucial for early diagnosis and intervention, which can affect developmental outcomes.

OBJECTIVE: To develop and validate a machine learning (ML) model for predicting ASD using a minimal set of features from background and medical information and to evaluate the predictors and the utility of the ML model.

DESIGN, SETTING, AND PARTICIPANTS: For this diagnostic study, a retrospective analysis of the Simons Foundation Powering Autism Research for Knowledge (SPARK) database, version 8 (released June 6, 2022), was conducted, including data from 30 660 participants after adjustments for missing values and class imbalances (15 330 with ASD and 15 330 without ASD). The SPARK database contains participants recruited from 31 university-affiliated research clinicals and online in 26 states in the US. All individuals with a professional ASD diagnosis and their families were eligible to participate. The model performance was validated on independent datasets from SPARK, version 10 (released July 21, 2023), and the Simons Simplex Collection (SSC), consisting of 14 790 participants, followed by phenotypic associations.

EXPOSURES: Twenty-eight basic medical screening and background history items present before 24 months of age.

MAIN OUTCOMES AND MEASURES: Generalizable ML prediction models were developed for detecting ASD using 4 algorithms (logistic regression, decision tree, random forest, and eXtreme Gradient Boosting [XGBoost]). Performance metrics included accuracy, area under the receiver operating characteristics curve (AUROC), sensitivity, specificity, positive predictive value (PPV), and F1 score, offering a comprehensive assessment of the predictive accuracy of the model. Explainable AI methods were applied to determine the effect of individual features in predicting ASD as secondary outcomes, enhancing the interpretability of the best-performing model. The secondary outcome analyses were further complemented by examining differences in various phenotypic measures using nonparametric statistical methods, providing insights into the ability of the model to differentiate between different presentations of ASD.

RESULTS: The study included 19 477 (63.5%) male and 11 183 (36.5%) female participants (mean [SD] age, 106 [62] months). The mean (SD) age was 113 (68) months for the ASD group and 100 (55) months for the non-ASD group. The XGBoost (termed AutMedAI) model demonstrated strong performance with an AUROC score of 0.895, sensitivity of 0.805, specificity of 0.829, and PPV of 0.897. Developmental milestones and eating behavior were the most important predictors. Validation on independent cohorts showed an AUROC of 0.790, indicating good generalizability.

CONCLUSIONS AND RELEVANCE: In this diagnostic study of ML prediction of ASD, robust model performance was observed to identify autistic individuals with more symptoms and lower cognitive levels. The robustness and ML model generalizability results are promising for further validation and use in clinical and population settings.

PMID:39158907 | DOI:10.1001/jamanetworkopen.2024.29229

JAMA Netw Open. 2024 Aug 1;7(8):e2429613. doi: 10.1001/jamanetworkopen.2024.29613.

ABSTRACT

IMPORTANCE: Current guidance to furlough health care staff with mild COVID-19 illness may prevent the spread of COVID-19 but may worsen nursing home staffing shortages as well as health outcomes that are unrelated to COVID-19.

OBJECTIVE: To compare COVID-19-related with non-COVID-19-related harms associated with allowing staff who are mildly ill with COVID-19 to work while masked.

DESIGN, SETTING, AND PARTICIPANTS: This modeling study, conducted from November 2023 to June 2024, used an agent-based model representing a 100-bed nursing home and its residents, staff, and their interactions; care tasks; and resident and staff health outcomes to simulate the impact of different COVID-19 furlough policies over 1 postpandemic year.

EXPOSURES: Simulating increasing proportions of staff who are mildly ill and are allowed to work while wearing N95 respirators under various vaccination coverage, SARS-CoV-2 transmissibility and severity, and masking adherence.

MAIN OUTCOMES AND MEASURES: The main outcomes were staff and resident COVID-19 cases, staff furlough days, missed care tasks, nursing home resident hospitalizations (related and unrelated to COVID-19), deaths, and costs.

RESULTS: In the absence of SARS-CoV-2 infection in the study’s 100-bed agent-based model, nursing home understaffing resulted in an annual mean (SD) 93.7 (0.7) missed care tasks daily (22.1%), 38.0 (7.6) resident hospitalizations (5.2%), 4.6 (2.2) deaths (0.6%), and 39.7 (19.8) quality-adjusted life years lost from non-COVID-19-related harms, costing $1 071 950 ($217 200) from the Centers for Medicare & Medicaid Services (CMS) perspective and $1 112 800 ($225 450) from the societal perspective. Under the SARS-CoV-2 Omicron variant conditions from 2023 to 2024, furloughing all staff who tested positive for SARS-CoV-2 was associated with a mean (SD) 326.5 (69.1) annual furlough days and 649.5 (95% CI, 593.4-705.6) additional missed care tasks, resulting in 4.3 (95% CI, 2.9-5.9) non-COVID-19-related resident hospitalizations and 0.7 (95% CI, 0.2-1.1) deaths, costing an additional $247 090 (95% CI, $203 160-$291 020) from the CMS perspective and $405 250 (95% CI, $358 550-$451 950) from the societal perspective. Allowing 75% of staff who were mildly ill to work while masked was associated with 5 additional staff and 5 additional resident COVID-19 cases without added COVID-19-related hospitalizations but mitigated staffing shortages, with 475.9 additional care tasks being performed annually, 3.5 fewer non-COVID-19-related hospitalizations, and 0.4 fewer non-COVID-19-related deaths. Allowing staff who were mildly ill to work ultimately saved an annual mean $85 470 (95% CI, $41 210-$129 730) from the CMS perspective and $134 450 (95% CI, $86 370-$182 540) from the societal perspective. These results were robust to increased vaccination coverage, increased nursing home transmission, increased importation of COVID-19 from the community, and failure to mask while working ill.

CONCLUSION AND RELEVANCE: In this modeling study of staff COVID-19 furlough policies, allowing nursing home staff to work with mild COVID-19 illness was associated with fewer resident harms from staffing shortages and missed care tasks than harms from increased COVID-19 transmission, ultimately saving substantial direct medical and societal costs.

PMID:39158906 | DOI:10.1001/jamanetworkopen.2024.29613

Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med. 2024 Jul;32(4):848-854. doi: 10.32687/0869-866X-2024-32-4-848-854.

ABSTRACT

The approaches to analysis of medical personnel of stomatological service continue to be based on principles formed in relation to state health care system that makes it difficult to objectively assess situation due to increasing proportion of specialists employed in its private sector. The study, targeted to comprehensive comparative analysis of stomatological medical personnel of state and private medical organizations in the Irkutsk Oblast, for the first time made it possible to assess provision of population of large region and its municipalities with stomatologists, considering specialists employed in private medical organizations, in dynamics and in context of separate specialties. The decrease in provision of population with stomatologists in state medical organizations by 12.3% in 2019-2023 against the background of its increase in private ones by 14.5% was revealed. In 2023, 50.5% of stomatologists were concentrated in private sector of stomatological service and 30.8% in state sector. Yet another 18.7% combined their work in medical organizations of both types. The stomatologists employed in private sector of stomatological service were mainly concentrated in metropolises, especially in regional center, where their provision exceeds average regional level by 2.6 times.

PMID:39158886 | DOI:10.32687/0869-866X-2024-32-4-848-854

Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med. 2024 Jul;32(4):815-821. doi: 10.32687/0869-866X-2024-32-4-815-821.

ABSTRACT

In Russia, increases morbidity of myocardial infarction. The statistics of recent years demonstrate failure in meeting target indicators of national programs on reducing number of deaths from this disease. At that, able-bodied population is in high risk zone and their professional activity is under influence of large combination of risk factors of myocardial infarction. This risk area covers profession of seafarer that is characterized by irregular work schedule, high levels of stress and mental tension, low physical activity or, contrariwise, increased working loads, unbalanced diet, isotherm stress and interaction with harmful substances. Besides that, situation is aggravated by limited set of first medical aid measures at exacerbation of disease in view of remoteness from hospitalization centers. Thus, considering high mortality rate from myocardial infarction, it is extremely important for ship crews to have full and timely information about diagnostic, symptomatic and prevention of this disease. The article examines statistics data of morbidity and mortality of myocardial infarction in population of the Russian Federation on the basis of Rosstat data and target indicators of the National project “Health Care”. The risk factors of myocardial infarction established by INTERHEART studies are analyzed. The specifics of work conditions of crew members of marine vessels are established. The collection of professional modifying risk factors was selected. The recommendations for their correction were developed to enhance efficiency of primary preventive measures and to decrease morbidity and mortality among seafarers.

PMID:39158881 | DOI:10.32687/0869-866X-2024-32-4-815-821

Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med. 2024 Jul;32(4):791-797. doi: 10.32687/0869-866X-2024-32-4-791-797.

ABSTRACT

The article considers social, demographic and professional factors determining choice by general practitioners and district therapists of place of employment and their professional motivation. The special questionnaire was developed to be applied in sociological survey. The sampling included general practitioners and district therapists of outpatient medical organizations of the Health Department and the private health care sector of Moscow. The final analysis included 399 questionnaires. It is established that possibility of job combining depends on number of children physician has. The significance of conditions for career growth increases with physician age and availability of adult children. The opportunities for research and education activities are of great value for physicians of private health sector who obtained higher education in Russia and having adult children. The preferred management style of line manager and model of communication with patient are affected by level of workload, working conditions and income level. The preferences regarding type of organizational culture are affected by place of birth. For physicians who graduated from Russian universities, significant factor of non-material incitement is possibility of additional rest. The physicians of older age working in private health sector more often consider career advancement as professional development goal. The factors influencing choice of place of employment and professional motivation in general practitioners and district therapists are summarized. The proposals for attracting, retaining and stimulating physicians are formulated.

PMID:39158877 | DOI:10.32687/0869-866X-2024-32-4-791-797

Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med. 2024 Jul;32(4):762-771. doi: 10.32687/0869-866X-2024-32-4-762-771.

ABSTRACT

The article presents updated information concerning satisfaction of patients with quality of medical care in public and private health care institutions in Russia. The purpose of the study is to explore satisfaction with medical services in different groups of Russian population using representative sampling and considering various aspects of medical care quality. The statistical analysis on the basis of data of telephone survey “The National Monitoring of Public Health” (2022) was applied. The respondents were asked about four aspects of medical care quality: explanation of health condition and treatment, involvement into desision making concerning treatment, trust to medical workers, readiness for another visit. The most patients of public and private medical institutions were satisfied with all aspects of medical care quality. The level of satisfaction varies in different groups: it was lower in less healthy patients and patients with unmet demands in medical care. No significant differences in satisfaction of patients were established in relation to socio-demographic characteristics (except place of residence). Most patients were satisfied with two aspects of medical care quality at once. However, 1-9% and 8-14% of patients of private and public clinics were satisfied with one aspect and dissatisfied with another. Despite dominance of patient satisfaction nation-wide, behaviors in some patient groups requires more detailed study to develop measures promoting their further involvement into health care system.

PMID:39158873 | DOI:10.32687/0869-866X-2024-32-4-762-771

Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med. 2024 Jul;32(4):755-761. doi: 10.32687/0869-866X-2024-32-4-755-761.

ABSTRACT

The article presents results of analysis of morbidity rates in children aged 15-17 years in the Russian Federation, the Volga Federal Okrug, the Udmurt Republic, the Kirov Oblast and the Republic of Bashkortostan in 2014-2022. According to research data, in the Russian Federation there is an increase of general and primarily detected (primary) morbidity by 24.0% (from 229,468.3 to 231,505.5) and by 22.3% (from 143,109.3 to 149,143.8), respectively. In the morbidity structure, the greatest increase was noted for such diseases as obesity (24.0 and 27.8%, respectively), diabetes mellitus (30.9 and 32.8%, respectively) and diabetes mellitus type I (31.9 and 30.8%, respectively). The data of statistical reports on general and primarily detected (primary) morbidity of the Central Research Institute for Health Organization and Informatics of Minzdrav of Russia were used. The study established general and primarily detected morbidity in the Russian Federation. However, forecast for 2027, as compared with 2014, is marked by decline of total morbidity by 8.3% and primarily detected (primary) morbidity by 5.2%. Due to the unfavorable forecast for morbidity in the Russian Federation for 2027, further scientific studies are needed concerning children aged 15-17 years in order to develop preventive measures at population, group and individual levels, considering regional characteristics.

PMID:39158872 | DOI:10.32687/0869-866X-2024-32-4-755-761

Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med. 2024 Jul;32(4):748-754. doi: 10.32687/0869-866X-2024-32-4-748-754.

ABSTRACT

The article presents results of sociological analysis of social health of modern student youth. The empirical basis of study was composed with results of monitoring study of student youth carried out by sociological laboratory of the Department of Sociology and Social Technologies. Within a framework of sociological monitoring, were evaluated such components of social health of student youth as relationships with friends and relatives, relationships in student community, inter-ethnic relations in University and region, participation in public life, social well-being, active life position and family practices and values. It is established that modern possibilities of living conditions allow each person to organize one’s life-style in such a way as to develop synergetic effect for social health, combining achieved standards of organization of everyday life and fashion for healthy lifestyle. It is namely such synergistic effect can be enhanced and induced in social environment. The main role at that is played by namely large multi-generational family.

PMID:39158871 | DOI:10.32687/0869-866X-2024-32-4-748-754

Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med. 2024 Jul;32(4):740-747. doi: 10.32687/0869-866X-2024-32-4-740-747.

ABSTRACT

The suicide is serious public health problem with far-reaching social, emotional and economic consequences. The world trend is significant input of both suicide itself and suicide-like attempts into external causes of mortality, tangible challenge to health life, especially in the youngest population. The WHO estimates that currently more than 700,000 suicides occur worldwide yearly, and each one deeply affect others persons. Russia takes one the first places in the world with its rate of teenage suicides. The suicide of adolescents aged 10-24 years is actual social demographic problem. The process of rapid physical, cognitive and psycho-social growth of this contingent affect feelings, thinking, decision-making and interaction with outside world, causing development of behavioral models corresponding to individual specific of responses to impacting environmental factors. Purpose of the study is, on basis of results of mental health monitoring from analytical materials on population suicidal behavior with emphasis on children and adolescent contingent, to present general conception of suicide as social phenomenon, to make brief historical excursus into becoming and development of problem; to discuss min terminology applied; to present corresponding statistics and to reveal difficulties in obtaining information.

PMID:39158870 | DOI:10.32687/0869-866X-2024-32-4-740-747