Nevin Manimala

BMC Public Health. 2024 Nov 5;24(1):3055. doi: 10.1186/s12889-024-20545-2.

ABSTRACT

BACKGROUND: Dengue has emerged as a rapidly escalating health issue in low- and middle-income countries, with its burden and geographic spread increasing over the years. Malaysia, in particular, has witnessed a significant rise in dengue cases, accompanied by a spike in mortality rates. Several studies have identified various factors, primarily focusing on the 27 clinical aspects of severe dengue infection and the development of dengue-related fatalities. Expanding on this focus, this study aims to identify the demographic, clinical, and environmental factors contributing to dengue mortality, providing a more comprehensive understanding of the variables influencing dengue-related fatalities.

METHODS: This study utilized a 1:2 case-control design, analyzing data from the E-dengue system database and medical records from January 2015 to December 2022, involving 219 participants (73 dengue fatalities as cases and 146 recovered patients as controls). Dengue deaths were confirmed by the Penang State Mortality Review Committee, and controls were randomly selected from laboratory-confirmed dengue cases. Statistical analyses were performed using SPSS software, including descriptive statistics, chi-square tests, and multivariable logistic regression to identify predictors of dengue mortality, with variables included in the multivariable model if p < 0.05.

RESULTS: Several significant predictors of dengue-related mortality, including clinical and environmental factors were identified. Key predictors were a platelet count below 50,000/µL (OR 15.70; 95% CI: 5.65-43.53), presence of one comorbid condition (OR 2.90; 95% CI: 1.22-6.90), more than two comorbid conditions (OR 10.15; 95% CI: 3.53-29.23), bronchial asthma (OR 12.00; 95% CI: 1.08-132.13), and outbreak locality status (OR 2.3; 95% CI: 1.11-4.79). An interaction was also found between locality status and platelet levels.

CONCLUSION: The study emphasizes the need for developing risk profiles for dengue patients by integrating factors such as platelet levels, comorbidities, and locality status to improve clinical care. Nuanced protocols are needed to address the specific challenges of single-case and outbreak areas. In single-case localities, patients with low platelet counts (below 100,000/µL) should be prioritized for rapid intervention to mitigate severe outcomes. In outbreak areas, healthcare systems should bolster resources and apply comprehensive triage approaches considering platelet levels and other risk factors. Implementing predictive models that account for geographical factors can enhance resource allocation and preparedness for dengue outbreaks. These recommendations aim to empower public health personnel, healthcare providers, and communities to collectively reduce dengue-related mortality rates.

PMID:39501241 | DOI:10.1186/s12889-024-20545-2

BMC Womens Health. 2024 Nov 5;24(1):587. doi: 10.1186/s12905-024-03425-0.

ABSTRACT

BACKGROUND: Dignified care is an important priority for childbearing mothers. Threats to this deteriorate the therapeutic relationship between healthcare providers and clients, which leads to a negative effect on the quality of care. However, little evidence is identified about dignified care and associated factors in the Ethiopian context. Therefore, this study aimed to assess dignified care and associated factors among mothers who gave birth at public hospitals in Sidama Regional States, southern Ethiopia, 2023.

METHOD: An institution-based cross-sectional study was conducted among 418 mothers who gave birth at public hospitals in Sidama Regional States from July 30 to August 30, 2023. A systematic random sampling technique was employed to select study participants. An interviewer-administered structured questionnaire was used, and the data was collected by Kobotool and analyzed using SPSS Version 25. Bivariable and multivariable logistic regression analyses were conducted, and the crude and adjusted odds ratios, together with their corresponding 95% confidence, were computed. A P value < 0.05 was considered a level of statistical significance in this study.

RESULTS: In this study, the overall study participants’ magnitude of dignified care was found to be 44.1%. Secondary education (AOR: 3.91, 95% CI: 1.56, 9.82), spontaneous vaginal delivery (AOR: 2.68, 95% CI: 1.31, 5.46), the presence of a companion during labor and delivery (AOR: 12.35, 95% CI : 7.08, 21.53), and less than two days hospital stay (AOR: 3.26, 95% CI: 1.37, 7.75), and midwife attendance of labour and delivery (AOR = 4.47 (1.40-14.25) were significantly associated with dignified care.

CONCLUSIONS: The findings of this study showed that the dignified care of mothers who gave birth at public hospitals in Sidama Regional State was relatively low to the pooled prevalence of respectful maternity care in Ethiopia. In light of these results, it is recommended to prioritize midwife attendance during labor and delivery, promote the presence of companions, facilitate a shorter hospital stay, and enhance educational opportunities.

PMID:39501236 | DOI:10.1186/s12905-024-03425-0

BMC Public Health. 2024 Nov 5;24(1):3054. doi: 10.1186/s12889-024-20566-x.

ABSTRACT

BACKGROUND: This study investigated the prevalence of pain, depressive symptoms, and their co-occurrence in Norwegian adolescents. Additionally, we investigated if perceived achievement pressure and coping with pressure were associated with pain, depressive symptoms and co-occurrent pain and depressive symptoms.

METHODS: Cross-sectional data from the Norwegian Ungdata Survey (2017-2019) were analysed. Adolescents from across Norway completed an electronic questionnaire including questions on perceived achievement pressure, coping with pressure, pain, and depressive symptoms. Descriptive statistics presented prevalence rates, and multinominal regression reported in relative risk ratios (RR) was employed to estimate associations, adjusted for gender (boys/girls), school level, and socioeconomic status.

RESULTS: The analyses included 209,826 adolescents. The prevalence of pain was 33%, 3% for depressive symptoms, and 14% reported co-occurring pain and depressive symptoms. The prevalence of co-occurring symptoms was higher in girls (22%) than boys (6%). Significant associations were found between perceived achievement pressure and pain (RR 1.11, 95% CI 1.10-1.11), depressive symptoms (RR 1.27, 95% CI 1.27-1.28), and co-occurring symptoms (RR 1.34, 95% CI 1.33-1.34). Struggling to cope with pressure was associated with pain (RR 2.67 95% CI 2.53-2.81), depressive symptoms (RR 16.68, 95% CI 15.60-17.83), and co-occurring symptoms (RR 27.95, 95% CI 26.64-29.33).

CONCLUSION: The prevalence of co-occurring pain and depressive symptoms is high among Norwegian adolescents. Perceived achievement pressure and struggling to cope with pressure were associated with isolated and, more strongly, co-occurring pain and depressive symptoms. Enhancing adolescents’ ability to cope with pressure could be a crucial target in treating pain and depressive symptoms.

PMID:39501232 | DOI:10.1186/s12889-024-20566-x

BMC Urol. 2024 Nov 6;24(1):243. doi: 10.1186/s12894-024-01588-4.

ABSTRACT

OBJECTIVE: To discuss the differences in the effectiveness and security of kidney stones in overweight or obese patients by mini percutaneous nephrolithotomy (MiniPCNL) and retrograde intrarenal surgery (RIRS).

MATERIALS AND METHODS: We exhaustively searched numerous databases, including PubMed, Embase, Web of Science, Cochrane Library, and CNKI, covering all records from their initiation date until September 2023. This included controlled trials focusing on the use of MiniPCNL and RIRS in the treatment of kidney stones in overweight or obese patients. The gathered data was then analyzed using the Review Manager 5.4 software.

RESULTS: 9 studies including 1122 patients were included. Meta-analysis showed that: The MiniPCNL group had higher overall complications, grade I complications, length of hospital stay(LOS), first stone-free rate (SFR), and final SFR in obese patients, with no significant difference between the two groups in terms of operative time(OT), hemoglobin drop, and grade II complication rate. There were more overall complications, grade I complications, final SFR, and LOS with MiniPCNL in patients with stones > 2 cm compared to no significant difference in grade II complications. MiniPCNL performed in the prone position had higher final SFR, less OT, hemoglobin drop, and no statistically significant difference in overall complications or LOS. Sheaths using > 14 F had higher overall complication rates, final SFR, and LOS, and no statistical differences in OT and first SFR between the two modalities. In the MiniPCNL subgroup aged ≤ 50 years, there were higher first SFR, final SFR, and shorter OT, and in the MiniPCNL subgroup aged > 50 years, there were more OT, LOS, and hemoglobin drop, with no statistical difference in overall complications between the two groups.

CONCLUSION: Our study showed that MiniPCNL in obese patients had higher initial SFR and final SFR, fewer procedures, but more postoperative complications, LOS, and grade I complications compared with RIRS. Similar results were seen in patients in the prone position, with stones > 2 cm and age ≤ 50 years.

SYSTEMATIC REVIEW REGISTRATION: [ https://www.crd.york.ac.uk/PROSPERO/ ], identifier PROSPERO (CRD42023467284).

PMID:39501220 | DOI:10.1186/s12894-024-01588-4

BMC Med Educ. 2024 Nov 5;24(1):1260. doi: 10.1186/s12909-024-06236-x.

ABSTRACT

BACKGROUND: Healthcare simulation is critical for medical education, with traditional methods using simulated patients (SPs). Recent advances in artificial intelligence (AI) offer new possibilities with AI-based simulators, introducing limitless opportunities for simulation-based training. This study compares AI-based simulators and SPs in undergraduate medical education, particularly in history-taking skills development.

METHODS: A randomized controlled trial will be conducted to identify the effectiveness of delivering a simulation session around history-taking skills to 67 fifth-year medical students in their clinical years of study. Students will be assigned randomly to either an AI-simulator group (intervention) or a simulated patient group (control), both will undergo a history-taking simulation scenario. An Objective Structured Clinical Examination (OSCE) will measure the primary outcomes. In contrast, secondary outcomes including student satisfaction and engagement, will be evaluated following the validated Simulation Effectiveness Tool-Modified (SET-M). The statistical approach engaged in this study will include independent t-tests for group performance comparison and multiple imputations to handle missing data.

DISCUSSION: This study’s findings will provide valuable insights into the comparative advantages of artificial intelligence-based simulators and simulated patients. Results will guide decisions regarding integrating AI-based simulators into healthcare education and training programs. Hybrid models might be considered by institutions in the light of this study, providing diverse and effective simulation experiences to optimize learning outcomes. Furthermore, this work can prepare the ground for future research that addresses the readiness of AI-based simulators to become a core part of healthcare education.

PMID:39501219 | DOI:10.1186/s12909-024-06236-x

BMC Med Educ. 2024 Nov 5;24(1):1263. doi: 10.1186/s12909-024-06165-9.

ABSTRACT

INTRODUCTION: Since the early 2000’s, the appeal of certain operating room specialties has decreasedamong medical school graduate students. The recent reform of the second and third cycles of medical studies in France provides an opportunity to set up teaching programs around operating room specialties. We have organised a teaching unit which is part of the final year of medical studies. The main objectives are: (1) to examine whether a boot camp can modify students’ opinions and preconceived assumptions about a surgical and/or anaesthetist career (2) to determine whether these changes in perception, have an impact on students’ interest in pursuing a surgical/anaesthetic career compared with the current situation.

MATERIALS AND METHODS: The “working in the operating theatre” boot camp (UETB) took place after the written exams of the sixth year of medical school, before students choose their future specialty for residency. This program included practical workshops, readings and time for exchanges surgeons and anaesthetists. At the beginning and at the end of the UETB, feedback forms were collected.

RESULTS: The cohort included 59 students from the Toulouse medical school, academic year 2023-2024. After attending the UETB, there was a significant qualitative improvement in interest in a surgical and intensive care-anaesthesia career. Feedback on how the UETB influenced the choice of a future specialty was very positive, with statistically significant qualitive improvement., Additionally, the students’ perception of a work-life quality as a surgeon and/or anaesthetist improved significantly.

CONCLUSION: The outcome of this study makes a strong case for integrating additional exposure to the various surgical subspecialties into the graduate medical curriculum in France. By helping to dispel misperceptions of “a surgical/anaesthetist career” early on, opportunities such as the UETB program may enable addressing the attrition rate observed among surgical and anaesthetic residency applications.

PMID:39501215 | DOI:10.1186/s12909-024-06165-9

BMC Med Educ. 2024 Nov 5;24(1):1266. doi: 10.1186/s12909-024-06278-1.

ABSTRACT

BACKGROUND: The rapid growth of technology forced enormous changes in the provision of healthcare services. Different strategies are used to keep nurses up to date with rapid changes in health systems. Microlearning is one of the new methods of teaching professional skills to health workers. This method is effective in care settings that have many limitations in terms of time and place. However, it is very important to test the acceptability of this method among nurses before practical measures are taken for its widespread use. This study aimed to determine nurses’ acceptance rate of quick response code as a microlearning tool in workplace.

METHOD: This is a cross-sectional study was conducted in medical and surgical wards in hospitals affiliated to Guilan University of Medical Sciences. 185 nurses participated in the study. A number of selected medical devices were labeled with quick response codes containing educational content. The eligible nurses were instructed how to use the QR codes. After two months, they were asked to complete a questionnaire adapted from the technology acceptance model 3. SPSS 21 software was used to analyze the data.

RESULTS: 166 nurses and 19 head nurses with mean age of 34.26 ± 8.17 years and mean work experience of 10.46 ± 7.64 years completed the questionnaires. Most participants were female, married, with a bachelor’s degree, worked on rotating shifts, in medical wards. The findings showed that the acceptance of the quick response code as a learning tool was at a moderate level (M = 66.1, SD = 16.6). Statistically, there was no significant relationship between nurses’ demographic characteristics and the total acceptance rate (P > 0.05). However, the analyses at the multivariate level, using multiple linear regression, showed a significant superiority of the total acceptance score in head nurses compared to nurses (b = 7.97, P = 0.047) and in nurses who had previous experience of using quick response codes, compared to colleagues without such experience (b = 5.18, P = 0.036). Based on the coefficient of determination, only 6.1% of the changes in the total acceptance score of quick response codes of nurses are explained by their personal-occupational characteristics (R² = 0.061).

CONCLUSIONS: The provision of QR code requirements such as necessary infrastructure and training by the health authorities could increase the acceptance of this tool as a microlearning measure.

PMID:39501213 | DOI:10.1186/s12909-024-06278-1

BMC Endocr Disord. 2024 Nov 6;24(1):237. doi: 10.1186/s12902-024-01773-4.

ABSTRACT

BACKGROUND: Obesity is a serious health problem with increasing incidence. worldwide and remains one of the most important causes of preventable deaths. We aimed to examine the relationship between Vitamin B12 and Folic acid, which have an important role for human life, and homocysteine is widely recognized for its association with the development of cardiovascular disease, although its role as an independent risk factor remains a topic of ongoing debate.

MATERIALS AND METHODS: We evaluated 126 patients who underwent bariatric metabolic surgery between September 2019-September 2020. In addition to demographic characteristics of the patients, weight, Vitamin B12, folate, HbA1c, cholesterol, triglyceride, ferritin, serum iron, albumin levels at preoperative, postoperative 1st month, 6th month, 12th month follow-ups were analyzed.

RESULTS: Patients with the desired biochemical parameters at the determined follow-up points were identified and two groups were formed as RYGB(n = 43) and SG(n = 7) patients. When biochemical parameters were analyzed between the groups, homocysteine, HbA1c, HDL Cholesterol, VLDL Cholesterol, Total Cholesterol, Triglycerides, Ferritin, Serum Iron levels showed a statistical difference (p < 0.001). Folate (p = 0.064) and albumin (p = 0.257) did not show a significant difference over time. The change in vitamin B12 (p = 0.409) over time was not significant in the SG group, whereas a significant difference was observed in the RYGB group (p < 0.001). When we established a marginal model to determine the factors affecting the change in homocysteine over time, vitamin B12 and folate values.

CONCLUSIONS: The relationship between Vitamin B12, folate and homocysteine is important in order to better understand the complications that develop in bariatric metabolic surgery patients, to prevent possible complications and to better manage the process.

PMID:39501209 | DOI:10.1186/s12902-024-01773-4

Waste Manag. 2024 Nov 4;190:654-665. doi: 10.1016/j.wasman.2024.10.028. Online ahead of print.

ABSTRACT

Picking up dog faeces with single use plastic bags and disposing in landfill is a common practice which ultimately harms the environment. Compostable plastic dog waste bags may help to divert these wastes from landfill and recover dog faeces as a compost feedstock, though little is known about how certified home compostable plastics behave in real world home compost systems. This study investigated the disintegration of commercially available certified home compostable plastic bags in outdoor home composts containing dog faeces. Two pilot trials (25 L) and one household trial (160 L) were conducted over 7, 15, and 9.5 months, respectively. Thermophilic temperatures were reached in all trials while moisture and pH were within optimal ranges for well managed compost systems. Bags showed statistically significant differences in disintegration. Based on final mass, none of the tested bags met the Australian Standard AS5810 minimum disintegration requirements of 90 % mass loss of plastic fragments >2 mm, with average mass change of certified home compostable bags ranging from +1.51 to -81.28 %. All certified industrial compostable bags showed an average mass increase of 10.90-35.04 % during composting. However, time series images of plastic fragmentation indicated some bags fully disintegrated and revealed residual biofilm that may have affected mass change data. Microplastic fragments < 2mm and macroplastic fragments >5 mm were recovered in all composts. Due to the potential risks of using home compost contaminated with microplastics in household gardens, dog owners should avoid including compostable plastic bags in their home composts.

PMID:39499966 | DOI:10.1016/j.wasman.2024.10.028

Perfusion. 2024 Nov 5:2676591241297401. doi: 10.1177/02676591241297401. Online ahead of print.

ABSTRACT

BACKGROUND: Azithromycin and methylprednisolone are two medications that are commonly used in patients who require ECMO support. Unfortunately, ECMO support can decrease drug concentrations through adsorption to circuit components. Such interactions have not been well described for either azithromycin or methylprednisolone. This study determined the extraction of these medications by ECMO circuits in an ex-vivo system.

METHODS: Medications were administered to closed-loop, blood-primed ECMO circuits to attain target therapeutic concentrations. Drug concentration remaining in the circuit was measured over 6 h. The difference in medication recovery was compared between the ECMO circuits and controls using two-sample t-tests.

RESULTS: Concentrations of azithromycin and methylprednisolone remained constant in control experiments over time, indicating medication stability in blood. There was no statistical difference in percent recovery after 6 h between control experiments and the ECMO circuits for either azithromycin (p = .32) or methylprednisolone (p = .17).

DISCUSSION: Azithromycin and methylprednisolone did not significantly interact with ex-vivo ECMO circuits. While these studies do not account for all in-vivo pharmacokinetic changes that may occur as a result of ECMO and critical illness, they suggest that standard dosing may be adequate to achieve therapeutic concentrations of azithromycin and methylprednisolone.

PMID:39499963 | DOI:10.1177/02676591241297401