Nevin Manimala

Health Rep. 2024 Mar 20;35(3):18-32. doi: 10.25318/82-003-x202400300002-eng.

ABSTRACT

BACKGROUND: Canada is experiencing rapid population aging, which has a wide range of implications, including an increased need for health care services. However, very few studies have examined use of specialized health care services (e.g., visits to medical specialists, non-emergency tests, and surgeries) among older Canadians.

DATA AND METHODS: Data from the Canadian Health Survey on Seniors – 2019/2020 were used to examine specialized health care service use among older Canadians. Latent class analysis was calibrated using a nationally representative sample of 39,047 Canadians aged 65 years or older to identify distinct patterns of need factors related to health care service use. Multivariable logistic regression, stratified by gender, was used to examine the association of predisposing characteristics, enabling resources, and need factors with specialized health care service use.

RESULTS: In 2019/2020, an estimated 2.6 million older Canadians (43.4%) visited medical specialists, 1.4 million (23.2%) got non-emergency tests, and 0.6 million (10.4%) had non-emergency surgeries. Among those, 15.6% reported experiencing difficulties accessing services. Women were less likely than men to have visited medical specialists and have received non-emergency tests. Lower education was consistently associated with lower odds of specialized health care service use. Individuals in the multimorbidity, high stress-multimorbidity-disability, and poor physical and mental health classes were more likely than those in the comparatively healthy class to use specialized health care services and to experience difficulties accessing them.

INTERPRETATION: Findings of this study highlight gender differences and the importance of considering multidimensional need factors – ranging from physical health to mental health to psychosocial factors – in examining use of specialized health care services.

PMID:38527108 | DOI:10.25318/82-003-x202400300002-eng

Health Rep. 2024 Mar 20;35(3):3-17. doi: 10.25318/82-003-x202400300001-eng.

ABSTRACT

BACKGROUND: Small area estimation refers to statistical modelling procedures that leverage information or “borrow strength” from other sources or variables. This is done to enhance the reliability of estimates of characteristics or outcomes for areas that do not contain sufficient sample sizes to provide disaggregated estimates of adequate precision and reliability. There is growing interest in secondary research applications for small area estimates (SAEs). However, it is crucial to assess the analytic value of these estimates when used as proxies for individual-level characteristics or as distinct measures that offer insights at the area level. This study assessed novel area-level community belonging measures derived using small area estimation and examined associations with individual-level measures of community belonging and self-rated health.

DATA AND METHODS: SAEs of community belonging within census tracts produced from the 2016-2019 cycles of the Canadian Community Health Survey (CCHS) were merged with respondent data from the 2020 CCHS. Multinomial logistic regression models were run between area-level SAEs, individual-level sense of community belonging, and self-rated health on the study sample of people aged 18 years and older.

RESULTS: Area-level community belonging was associated with individual-level community belonging, even after adjusting for individual-level sociodemographic characteristics, despite limited agreement between individual- and area-level measures. Living in a neighbourhood with low community belonging was associated with higher odds of reporting being in fair or poor health, versus being in very good or excellent health (odds ratio: 1.53; 95% confidence interval: 1.22, 1.91), even after adjusting for other factors such as individual-level sense of community belonging, which was also associated with self-rated health.

INTERPRETATION: Area-level and individual-level sense of community belonging were independently associated with self-rated health. The novel SAEs of community belonging can be used as distinct measures of neighbourhood-level community belonging and should be understood as complementary to, rather than proxies for, individual-level measures of community belonging.

PMID:38527107 | DOI:10.25318/82-003-x202400300001-eng

Bull Menninger Clin. 2024 Winter;88(1):81-99. doi: 10.1521/bumc.2024.88.1.81.

ABSTRACT

Prior studies of behavior therapy for trichotillomania (TTM) have shown that response is variable, and relapse after treatment discontinuation is common. Little information is available concerning prognostic factors capable of predicting individual differences in response or maintenance of improvement. The present study is a secondary analysis of a randomized controlled trial (N = 36) of the Comprehensive Behavioral (ComB) model of treatment for TTM (Carlson et al., 2021). We investigated age, disorder history, pre-treatment symptom severity, longest prior period of abstinence from pulling, and Emotion and Intention hair pulling styles as predictors of initial response. We studied age, disorder history, pre-treatment symptom severity, longest prior period of abstinence from pulling, and post-treatment symptom severity or hair-pulling abstinence as predictors of relapse following treatment. Older age significantly predicted lower TTM severity following treatment. Lower pre-treatment severity significantly predicted lower severity of TTM at the 3-month follow-up.

PMID:38527102 | DOI:10.1521/bumc.2024.88.1.81

J Orthop Trauma. 2024 Mar 25. doi: 10.1097/BOT.0000000000002810. Online ahead of print.

ABSTRACT

OBJECTIVES: To compare radiographic and clinical outcomes in non-operative management of humeral shaft fractures treated initially with coaptation splinting (CS) followed by delayed functional bracing (FB) versus treatment with immediate FB.

METHODS: Design: Retrospective cohort study.

SETTING: Academic Level 1 Trauma Center.

PATIENT SELECTION CRITERIA: Patients with closed humeral shaft fractures managed non-operatively with initial CS followed by delayed FB or with immediate FB from 2016 to 2022. Patients younger than 18 years and/or with less than 3 months follow-up were excluded.Outcome Measures and Comparisons: The primary outcome was coronal and sagittal radiographic alignment assessed at final follow-up. Secondary outcomes included rate of failure of non-operative management (defined as surgical conversion and/or fracture nonunion), fracture union, and skin complications secondary to splint/brace wear.

RESULTS: Ninety-seven patients were managed non-operatively with delayed FB (n=58) or immediate FB (n=39). Overall, the mean age was 49.9 years (range 18-94), and 64 (66%) patients were female. The immediate FB group had less smokers (p=0.003) and lower incidence of radial nerve palsy (p=0.025), with more proximal third humeral shaft fractures (p=0.001). There were no other significant differences in demographic or clinical characteristics (p>0.05). There were no significant differences in coronal (p=0.144) or sagittal (p=0.763) radiographic alignment between groups. In total, 33 (34.0%) humeral shaft fractures failed non-operative management, with 11 (28.2%) in the immediate FB group, and 22 (37.9%) in the delayed FB group (p=0.322). There were no significant differences in fracture union (p=0.074) or skin complications (p=0.259) between groups.

CONCLUSIONS: This study demonstrated that non-operative treatment of humeral shaft fractures with immediate functional bracing did not result in significantly different radiographic or clinical outcomes compared to treatment with coaptation splinting followed by delayed functional bracing. Future prospective studies assessing patient reported outcomes (PROs) will further guide clinical decision making.

LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

PMID:38527088 | DOI:10.1097/BOT.0000000000002810

PLoS One. 2024 Mar 25;19(3):e0298670. doi: 10.1371/journal.pone.0298670. eCollection 2024.

ABSTRACT

Statistical Learning (SL) refers to human’s ability to detect regularities from environment Kirkham, N. Z. (2002) & Saffran, J. R. (1996). There has been a growing interest in understanding how sensitivity to statistical regularities influences learning to read. The current study systematically examined whether and how non-linguistic SL, Chinese SL, and English SL contribute to Chinese and English word reading among native Chinese-speaking 4th, 6th and 8th graders who learn English as a second language (L2). Children showed above-chance learning across all SL tasks and across all grades. In addition, developmental improvements were shown across at least two of the three grade ranges on all SL tasks. In terms of the contribution of SL to reading, non-linguistic auditory SL (ASL), English visual SL (VSL), and Chinese ASL accounted for a significant amount of variance in English L2 word reading. Non-linguistic ASL, Chinese VSL, English VSL, and English ASL accounted for a significant amount of variance in Chinese word reading. Our results provide clear and novel evidence for cross-linguistic contribution from Chinese SL to English reading, and from English SL to Chinese reading, highlighting a bi-directional relationship between SL in one language and reading in another language.

PMID:38527080 | DOI:10.1371/journal.pone.0298670

PLoS One. 2024 Mar 25;19(3):e0301106. doi: 10.1371/journal.pone.0301106. eCollection 2024.

ABSTRACT

BACKGROUND: Socioeconomic inequality in antenatal care visits is a great concern in developing countries including Bangladesh; however, there is a scarcity of investigation to assess the factors of inequality and these changes over time. In this study, we investigated the trend of socioeconomic inequalities (2004-2017) in 1+ANC and 4+ANC visits, and extracted determinants contributions to the observed inequalities and urban-rural disparities in Bangladesh over the period from 2011 to 2017.

METHODS: The data from the Bangladesh Demographic and Health Surveys (BDHS) conducted in 2004, 2007, 2011 and 2017 were analyzed in this study. The analysis began with exploratory and bivariate analysis, followed by the application of logistic regression models. To measure the inequalities, the Erreygers concentration index was used, and regression-based decomposition analyses were utilized to unravel the determinant’s contribution to the observed inequalities. The Blinder-Oaxaca type decomposition is also used to decompose the urban-rural disparity into the factors.

RESULTS: Our analysis results showed that the prevalence of 1+ANC and 4+ANC visits has increased across all the determinants, although the rate of 4+ANC visits remains notably low. The magnitudes of socioeconomic inequality in 4+ANC visits represented an irregular pattern at both the national and urban levels, whereas it increased gradually in rural Bangladesh. However, inequalities in 1+ANC visits declined substantially after 2011 across the national, rural and urban areas of Bangladesh. Decomposition analyses have suggested that wealth status, women’s education, place of residence (only for 4+ANC visits), caesarean delivery, husband education, and watching television (TV) are the main determinants to attribute and changes in the level of inequality and urban-rural disparity between the years 2011 and 2017.

CONCLUSIONS: According to the findings of our study, it is imperative for authorities to ensure antenatal care visits are more accessible for rural and underprivileged women. Additionally, should focus on delivering high-quality education, ensuring the completion of education, reducing income disparity as well as launching a program to enhance awareness about health facilities, and the impact of caesarean delivery.

PMID:38527067 | DOI:10.1371/journal.pone.0301106

PLoS One. 2024 Mar 25;19(3):e0300713. doi: 10.1371/journal.pone.0300713. eCollection 2024.

ABSTRACT

INTRODUCTION: Although extracorporeal membrane oxygenation (ECMO) is a well-established treatment for supporting severe cardiopulmonary failure, the morbidity and mortality of patients requiring ECMO support remain high. Evaluating and correcting potential risk factors associated with any ECMO-related complications may improve care and decrease mortality. This study aimed to assess the predictors of ECMO-related vascular and cerebrovascular complications among adult patients and to test the hypothesis that ECMO-related complications are associated with higher in-hospital mortality rates.

METHODS: This single-center, retrospective study included 856 ECMO runs administered via cannulation of the femoral vessels of 769 patients: venoarterial (VA) ECMO (n = 709, 82.8%) and venovenous (VV) ECMO (n = 147, 17.2%). The study outcomes included the occurrence of ECMO-related vascular and cerebrovascular complications and in-hospital death. The association of ECMO-related complications with the risk of in-hospital death was analyzed.

RESULTS: The incidences of ECMO-related vascular and cerebrovascular complications were 20.2% and 13.6%, respectively. The overall in-hospital mortality rate was 48.7%: 52.8% among VA ECMO runs and 29.3% among VV ECMO runs. Multivariable analysis indicated that age (P < 0.01), cardiopulmonary cerebral resuscitation (P < 0.01), continuous renal replacement therapy (P < 0.01), and initial platelet count [<50×103/μL (P = 0.02) and 50-100(×103)/μL (P < 0.01)] were associated with an increased risk of in-hospital death. ECMO-related vascular and cerebrovascular complications were not independently associated with higher in-hospital mortality rates for VA or VV ECMO runs.

CONCLUSION: ECMO-related vascular and cerebrovascular complications were not associated with an increased risk of in-hospital death among adult patients.

PMID:38527053 | DOI:10.1371/journal.pone.0300713

PLoS One. 2024 Mar 25;19(3):e0298403. doi: 10.1371/journal.pone.0298403. eCollection 2024.

ABSTRACT

The anatomy of the edentulous posterior maxilla and maxillary sinus possess unique challenges in implant dentistry. The purpose of this study was to assess maxillary sinus membrane thickness (MT) and lateral wall thickness (LWT) in different facial index profiles and to describe the clinical implications. A retrospective image analysis of 75 CBCT scans was done, which yielded a total of 150 sinus images. The facial index was calculated as per the formula given in the text and grouped as euryprosopic, mesoprosopic and leptoprosopic. The images obtained were of 36 women (48%) and 39 men (52%), with maximum subjects in 30-39 years age group. MT and LWT were measured at three different points on the radiograph at every 3mm from the base of the sinus floor in premolar and molar regions of each image. Results showed females had significant differences from males in LWT in both premolar and molar regions (p = 0.018 and 0.032 respectively). Subjects in 40-49 years of age had significant differences (p = 0.021) in MT in premolar region only. Also, difference in MT in premolar and molar regions were also statistically significant. Lastly, the present study did not find any statistically significant difference in MT and LWT in all three facial indices groups. It can be concluded that different facial indices have no positive correlation with maxillary sinus membrane thickness and lateral wall thickness. Hence, surgical complications are avoidable with proper detailed knowledge and appropriate identification of the anatomic structures characteristic to the maxillary sinus.

PMID:38527039 | DOI:10.1371/journal.pone.0298403

PLoS One. 2024 Mar 25;19(3):e0300532. doi: 10.1371/journal.pone.0300532. eCollection 2024.

ABSTRACT

INTRODUCTION: Firefighters, compared to other occupational groups, are exposed more frequently in their working environment not only to physical issues, such as musculoskeletal disease, respiratory disease, and burns but also to mental health issues, such as PTSD and depression. Specifically, Korean firefighters experience significantly higher rates of work-related injuries compared to those in other countries. Recent statistics from the Korea National Fire Agency indicate a steady increase in the number of firefighting work-related injuries. However, there is a shortage of measures in place to address these issues. This study aims to investigate the health needs, overall healthcare usage, and unmet needs of firefighters in Korea. We also aim to investigate, through in-depth interviews, perceptions and hindering factors for integrative medicine approaches to fulfilling unmet needs.

METHOD: This study was conducted in accordance with the consolidated criteria for reporting qualitative research. Convenience and snowball sampling methods will be used to recruit firefighters to participate in the study, and interviews will be conducted using a semi-structured interview guide. The data will be analyzed in four stages using the qualitative analysis method of Krippendorff.

DISCUSSION: In this study, we examine the state of health issues and healthcare usage among Korean firefighters and investigate their perceptions of and needs for integrative medicine. In this way, we aim to explore how integrative medicine and Korean medicine approaches could improve and assist healthcare services for firefighters. Furthermore, our findings will provide policymakers and healthcare providers with the necessary basic information to develop integrative medicine systems suited to firefighters.

PMID:38527034 | DOI:10.1371/journal.pone.0300532

PLoS One. 2024 Mar 25;19(3):e0298960. doi: 10.1371/journal.pone.0298960. eCollection 2024.

ABSTRACT

INTRODUCTION: The increasing prevalence of refractive error has become a serious health issue that needs serious attention. However, there are few studies regarding the prevalence and associated factors of refractive error at the community level in Ethiopia as well as in the study area. Therefore, providing updated data is crucial to reduce the burdens of refractive error in the community.

OBJECTIVE: To assess the prevalence and associated factors of refractive error among adults in Hawassa City, South Ethiopia, 2023.

METHOD: A community-based cross-sectional study was conducted on 951 adults using a multistage sampling technique from May 8 to June 8, 2023, in Hawassa City, South Ethiopia. A pretested, structured questionnaire combined with an ocular examination and a refraction procedure was used to collect data. The collected data from the Kobo Toolbox was exported to a statistical package for social sciences for analysis. Binary and multivariable logistic regression analyses were performed. A P-value of less than 0.05 was considered statistically significant in the multivariable analysis.

RESULT: A total of 894 study participants were involved in this study with a 94.1% response rate. The prevalence of refractive error was 12.3% (95% CI: 10.2, 14.5%). Regular use of electronic devices (adjusted odds ratio = 3.64, 95% CI: 2.25, 5.91), being diabetic (adjusted odds ratio = 4.02, 95% CI: 2.16, 7.48), positive family history of refractive error (adjusted odds ratio = 2.71, 95% CI 1.59, 4.61) and positive history of cataract surgery (adjusted odds ratio = 5.17, 95% CI 2.19, 12.4) were significantly associated with refractive error.

CONCLUSION AND RECOMMENDATION: The overall magnitude of refractive error in our study area was high. Regular use of electronic devices, being diabetic, positive family history of refractive error, and a positive history of cataract surgery were associated with refractive error.

PMID:38527026 | DOI:10.1371/journal.pone.0298960