Nevin Manimala

Stud Health Technol Inform. 2024 Aug 22;316:1938-1942. doi: 10.3233/SHTI240812.

ABSTRACT

Burkina Faso has been facing a security crisis due to terrorism since 2015. This study aims to assess the impact of the attacks on the use of healthcare services. This is a secondary study on data from the country’s health data warehouse and the ACLED security data warehouse. After a description, generalized additive models were used to assess the impact of attacks on the use of health services. Between January 2015 and December 2022, 2449 kidnap/disappearance attacks, armed attacks, bombings and landmine explosions were perpetrated, causing 4965 deaths. The Sahel region was the most targeted (36.37% of attacks and 50.57% of deaths). Only population density had a significant impact on the use of health services (p<5%). The models were valid. Our study has shown that, despite the persistent insecurity in Burkina Faso, people are resilient and, above all, continue to seek out the most important healthcare services. It is therefore important to work to maintain the supply of these services.

PMID:39176871 | DOI:10.3233/SHTI240812

Stud Health Technol Inform. 2024 Aug 22;316:1891-1895. doi: 10.3233/SHTI240802.

ABSTRACT

INTRODUCTION: Autistic individuals, parents, organizations, and healthcare systems worldwide are actively sharing content aimed at increasing awareness about autism. This study aims at analyzing the type of contents presented in TikTok and YouTube Shorts videos under the hashtag #actuallyautistic and their potential to increase autism awareness.

METHODS: A sample of 60 videos were downloaded and analyzed (n=30 from TikTok and n=30 from YouTube Shorts). Video contents were analyzed using both thematic analysis and the AFINN sentiment analysis tool. The understandability and actionability of the videos were assessed with The Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT A/V).

RESULTS: The contents of these videos covered five main themes: Stigmatization; Sensory difficulties; Masking; Stimming; and Communication difficulties. No statistically significant differences were found on sentiment expressed on videos from both channels. TikTok videos received significantly more views, comments, and likes than videos on YouTube Shorts. The PEMAT A/V tool showed that there is a high level of understandability, but little reference to actionability.

DISCUSSION: Autistic people videos content spread valid and reliable information in hopes of normalizing difficulties and provide hope and comfort to others in similar situations.

CONCLUSIONS: Social media videos posted by autistic individuals provide accurate portrayals about autism but lack information on actionability. These shared personal stories can help increase public literacy about autism, dispel autism stigmas and emphasize individuality.

PMID:39176861 | DOI:10.3233/SHTI240802

Stud Health Technol Inform. 2024 Aug 22;316:1884-1888. doi: 10.3233/SHTI240800.

ABSTRACT

This research aimed to follow up a 14-year period (2010-2023) public and private healthcare service organizations’ and community pharmacies’ entries to and exits from the centralized, interoperable and shared electronic Prescription Services in Finland. Our material were the official Social Welfare and Healthcare Organization Registry and the official Pharmacy Registry; their data were extracted in January 2024. Outcomes were continuous registration of services or registered exist from the services. In addition, we used information from the Kanta Services for presenting monthly and annual number of electronic prescriptions and medicine dispensations on national level. In 2010-2023, totally 838 community pharmacies’ and their subsidiary pharmacies’ entries to and 24 exits from the nationwide Prescription Services took place, and in total 814 pharmacy outlets had the Prescription Services in production in 2023. Totally, 1980 public and private healthcare service organizations’ entries to and 494 exits from the Prescription Service took place, and 1486 organizations had the Prescription Services in production in 2023. Healthcare service organizations recorded totally 303.8 million electronic prescriptions into the Prescription Services. Recorded numbers were lower during the Covid-19 epidemic in Finland in 2020-2021. We also observed seasonal effects in the time series. Pharmacies recorded totally 660.4 million medicine dispensations (purchases) into the Prescription Services with an increasing trend year after year. We also observed seasonal effects in the dispensation time series.

PMID:39176859 | DOI:10.3233/SHTI240800

Stud Health Technol Inform. 2024 Aug 22;316:1827-1831. doi: 10.3233/SHTI240786.

ABSTRACT

Successful implementation of clinical decision support tools is rare, the key barrier being the lack of user involvement during development. Following the idea, development, exploration, assessment, long-term follow-up (IDEAL) framework, this study aims to provide early insights into the current challenges, clinical processes, and priorities when developing new decision support tools in cardiac surgery. Using a qualitative approach, semi-structured interviews were conducted with cardiac anesthetists and surgeons from three Scottish cardiac centers. Thematic analysis identified adverse postoperative outcomes, ageing cardiac patient population and changing surgical procedures to be the main challenges in cardiac surgery. Existing risk prediction tools were largely not used due to a perceived lack of utility and validation. This study underscores the need to shift focus towards predicting postoperative complications, instead of mortality. It emphasizes the importance of early collaboration with clinical experts and stakeholders in developing decision support systems that are fit for purpose. By identifying the priorities of cardiac clinicians, the study lays the groundwork for developing clinically meaningful prediction models.

PMID:39176846 | DOI:10.3233/SHTI240786

Stud Health Technol Inform. 2024 Aug 22;316:1800-1804. doi: 10.3233/SHTI240780.

ABSTRACT

Missing values (NA) often occur in cancer research, which may be due to reasons such as data protection, data loss, or missing follow-up data. Such incomplete patient information can have an impact on prediction models and other data analyses. Imputation methods are a tool for dealing with NA. Cancer data is often presented in an ordered categorical form, such as tumour grading and staging, which requires special methods. This work compares mode imputation, k nearest neighbour (knn) imputation, and, in the context of Multiple Imputation by Chained Equations (MICE), logistic regression model with proportional odds (mice_polr) and random forest (mice_rf) on a real-world prostate cancer dataset provided by the Cancer Registry of Rhineland-Palatinate in Germany. Our dataset contains relevant information for the risk classification of patients and the time between date of diagnosis and date of death. For the imputation comparison, we use Rubin’s (1974) Missing Completely At Random (MCAR) mechanism to remove 10%, 20%, 30%, and 50% observations. The results are evaluated and ranked based on the accuracy per patient. Mice_rf performs significantly best for each percentage of NA, followed by knn, and mice_polr performs significantly worst. Furthermore, our findings indicate that the accuracy of imputation methods increases with a lower number of categories, a relatively even proportion of patients in the categories, or a majority of patients in a particular category.

PMID:39176840 | DOI:10.3233/SHTI240780

Acta Chir Plast. 2024;66(2):60-66. doi: 10.48095/ccachp202460.

ABSTRACT

INTRODUCTION: Smoking poses a risk to flap viability, with nicotine being a major contributor to the formation of free radicals. Allopurinol, known for its antioxidant properties, has been shown to enhance tissue survival in ischemic conditions by reducing the production of reactive oxygen species (ROS). This study aims to assess the impact of allopurinol on the viability and success of skin flaps in Wistar rats exposed to nicotine.

METHODS: This study examined skin flap survival in nicotine-exposed rats treated with allopurinol. Twenty-eight rats were separated into two groups. During 1 month of nicotine exposure, the treatment group received systemic allopurinol 7 days before and 2 days after the flap procedure, while the control group received no allopurinol. Pro-angiogenic factors, proinflammatory factors, anti-inflammatory factors, and oxidative markers were assessed on the 7th day after the flap procedure using enzyme-linked immunosorbent assay method. Macroscopic flap viability was evaluated on the 7th day using Image J photos.

RESULTS: As an oxidative marker, malondialdehyde levels were significantly lower in rats given allopurinol than in controls (P &lt; 0.001). The levels of interleukin 6 and tumor necrosis factor α, as markers of inflammatory factors, were significantly lower in the group of rats given allopurinol compared to controls (P &lt; 0.001). The level of angiogenesis in rats given allopurinol, measured by vascular endothelial growth factor levels, was also higher in the treatment group compared to controls (P &lt; 0.001). Macroscopically, the percentage of distal flap necrosis in Wistar rats given allopurinol was lower and statistically significant compared to controls (P &lt; 0.001).

CONCLUSIONS: Xanthine oxidoreductase is part of a group of enzymes involved in reactions that produce ROS. Allopurinol, as an effective inhibitor of the xanthine oxidase enzyme, can reduce oxidative stress by decreasing the formation of ROS. This reduction in oxidative stress mitigates the risk of ischemic-reperfusion injury effects and significantly increases the viability of Wistar rat flaps exposed to nicotine.

PMID:39174340 | DOI:10.48095/ccachp202460

BMJ Qual Saf. 2024 Aug 22:bmjqs-2024-017081. doi: 10.1136/bmjqs-2024-017081. Online ahead of print.

ABSTRACT

BACKGROUND: Early mobilisation of intensive care unit (ICU) patients has been recommended in clinical practice guidelines. Therefore, the Japanese universal health insurance system introduced an additional fee for early mobilisation and/or rehabilitation, which can be claimed by hospitals when starting rehabilitation of ICU patients within 48 hours after their ICU admission. However, the effect of this fee is unknown.

OBJECTIVE: To measure the proportion of ICU patients who received early rehabilitation and the impact on length of ICU stay, the length of hospital stay and discharged to home after the introduction of the financial incentive (additional fee for early mobilisation and/or rehabilitation).

DESIGN/METHODS: We included patients who were admitted to ICU within 2 days of hospitalisation between April 2016 and January 2020. We conducted interrupted time series analyses to assess the effects of the introduction of the financial incentive.

RESULTS: The proportion of patients who received early rehabilitation immediately increased after the introduction of the financial incentive (rate ratio (RR) 1.293, 95% CI 1.240 to 1.349). The RR for proportion of patients received early rehabilitation was 1.008 (95% CI 1.005 to 1.011) in the period after the introduction of the financial incentive compared with period before its introduction. There was no statistically significant change in the mean length of ICU stay, the mean length of hospital stay and the proportion of patients who were discharged to home.

CONCLUSION: After the introduction of the financial incentive, the proportion of ICU patients who received early rehabilitation increased. However, the effects of the financial incentive on the length of ICU stay, the length of hospital stay and the proportion of patients who were discharged to home were limited.

PMID:39174335 | DOI:10.1136/bmjqs-2024-017081

Klin Onkol. 2024;38(4):259-269. doi: 10.48095/ccko2024259.

ABSTRACT

BACKGROUND: Positron emission tomography (PET) is a state-of-the-art diagnostic method of nuclear medicine, used for diagnostics of many pathological states in the organism, first and foremost in oncological issues. The first analysis of utilization and potential utilization of PET in the Czech Republic was published in 2013. In the following years, there was a sharp increase in a number of PET/CT and PET/MRI scanners in the country; in 2013-2021, it doubled. Simultaneously with the increase in scans performed, the range of available radiopharmaceuticals also broadened.

MATERIAL AND METHODS: The study analyses the numbers and structure of PET, PET/CT and PET/MRI scans in the 2013-2021 period, using the pseudonymized data acquired from the General Health Insurance Company of the Czech Republic. The data was evaluated through a series of qualitative and quantitative indicators (number of scans performed, structure of diagnoses, use of different tracers, and availability of a scan for a patient).

RESULTS: In the observed interval of time, the number of scans performed practically doubled, both thanks to more scanners installed and more radiopharmaceuticals available. The percentage of oncological and non-oncological scans remains more or less the same. Nevertheless, the regional differences in a number of scans performed persist, as does the availability of the scan for patients.

CONCLUSION: PET is still a dynamically developing molecular imaging method in the Czech Republic. The analysis of a number and structure of scans performed offers a priceless overview of the development of the method over the years, in regard to diagnoses, utilization of individual radiopharmaceuticals or geographic distribution of scans performed. The observed findings are a motivation for further analyses.

PMID:39174329 | DOI:10.48095/ccko2024259

Heart. 2024 Aug 22:heartjnl-2024-324038. doi: 10.1136/heartjnl-2024-324038. Online ahead of print.

ABSTRACT

BACKGROUND: The relationships between various obesity measures and hypertensive disorders of pregnancy (HDP) remain inadequately explored, and their causal links are not well understood. This study aims to clarify these associations and investigate the mediating role of triglycerides.

METHODS: We conducted a comprehensive meta-analysis of observational studies alongside Mendelian randomisation (MR) analysis to assess the impact of 10 obesity measures on HDP risk. Additionally, we evaluated the mediating effect of triglycerides.

RESULTS: Our meta-analysis revealed significant associations between maternal prepregnancy overweight/obesity and increased risks of gestational hypertension (GH) (overweight: OR=1.98, 95% CI 1.83 to 2.15; obesity: OR=3.77, 95% CI 3.45 to 4.13) and pre-eclampsia (overweight: OR=1.78, 95% CI 1.67 to 1.90; obesity: OR=3.46, 95% CI 3.16 to 3.79). Higher maternal waist circumference (WC) was also linked to increased pre-eclampsia risk (OR=1.45, 95% CI 1.14 to 1.83). MR analyses indicated that each 1-SD increase in genetically predicted obesity measures (whole body fat mass, body fat percentage, trunk fat mass, trunk fat percentage, body mass index, WC, hip circumference) was associated with higher risks of GH and pre-eclampsia. Triglycerides mediated 4.3%-14.1% of the total genetic effect of these obesity measures on GH and pre-eclampsia risks.

CONCLUSIONS: This study demonstrates that various obesity measures are causally linked to increased HDP risk and highlights the mediating role of triglycerides. These findings could inform clinical practices and public health strategies aimed at reducing HDP through targeted obesity and triglyceride management.

PMID:39174317 | DOI:10.1136/heartjnl-2024-324038

Behav Ther. 2024 Sep;55(5):990-1003. doi: 10.1016/j.beth.2024.02.003. Epub 2024 Feb 29.

ABSTRACT

Psychometric properties of the Insomnia Severity Index (ISI) were analyzed in U.S. college samples. ISI items and total score with sleep and psychosocial questionnaires were examined in Experiment I. ISI diagnostic accuracy in a clinical sample with and without insomnia was assessed in Experiment II. ISI test-retest validity, confirmatory factor analysis (CFA), and item response theory via graded response model (GRM) were assessed in Experiment III. Results indicated analogous ISI and sleep diary items showed moderate correlations (r₁ = .40; r₂ = .45). The ISI total had weak to strong correlations with other indicators of sleep-related disturbance (rs = .25-.62). The ISI had weak to moderate correlations with psychosocial measures commonly associated with insomnia (rs = .10-.57). The diagnostic accuracy of the ISI was very high (area under the curve [AUC] = .999). Sensitivity and specificity were maximized at a cutoff score ≥ 8. The ISI demonstrated good test-retest reliability (ICC = .87). CFA revealed a three-factor model for two study samples and GRM indicated better ability of the ISI to assess moderate (Sample III) and moderate to high (Sample I) levels of insomnia severity. The ISI demonstrated good psychometric properties and appears generally valid for screening insomnia disorder and assessing insomnia severity in college students. Overlap with psychological symptoms suggests caution while interpreting these constructs independently.

PMID:39174275 | DOI:10.1016/j.beth.2024.02.003