Nevin Manimala

J Glob Health. 2024 May 24;14:04073. doi: 10.7189/jogh.14.04073.

ABSTRACT

BACKGROUND: Studies have shown that the disease burden of anaemia varies globally, yet they have not yet determined its exact extent in East Asian countries specifically. We thus aimed to investigate the prevalence and years lived with disability (YLDs) due to anaemia from 1990 to 2021 in China, Japan, and South Korea.

METHODS: We extracted the prevalence and YLDs with their age-standardised rates (ASRs) in China, Japan, and South Korea from the Global Burden of Disease Study 2021, stratified by sex, age, and causes. We then examined the temporal trend of anaemia burden from 1990 to 2021 using joinpoint analysis and the association of anaemia burden with the Human Development Index and Universal Health Index through Spearman’s correlation analysis.

RESULTS: In 2021, anaemia affected 136 million people in China (95% uncertainty interval (UI) = 131, 141), with ASRs of prevalence of 8.9% (95% UI = 8.6, 9.3), and accounted for 3.0 million YLDs (95% UI = 2.0, 4.4). It affected 13.6 million people in Japan (95% UI = 11.8, 16.0), with ASRs of prevalence of 7.4% (95% UI = 6.1, 9.0), and caused 181 thousand YLDs (95% UI = 108, 282). It also affected 2.7 million individuals in South Korea (95% UI = 2.4, 3.0), with ASRs of prevalence of 5.2% (95% UI = 4.6, 5.7), and led to 34 thousand YLDs (95% UI = 22, 55). We observed a significant gender discrepancy in the anaemia burden in these three countries, with the prevalence and YLD rates in women being almost twice as high as those in men. Moreover, the peak age of the anaemia burden shifted toward higher age groups in all three countries, particularly in Japan. Chronic kidney disease was responsible for a growing share of anaemia cases and YLDs, especially in adults aged more than 60 years in Japan and South Korea. Haemoglobinopathies were another noticeable cause of anaemia in China, though dietary iron deficiency remained the leading cause. Both socioeconomic development and essential health service coverage showed negative associations with the anaemia burden in the three countries in the past three decades, though with differential patterns.

CONCLUSIONS: Anaemia remains a major public health issue in China, Japan, and South Korea; targeted surveillance and interventions are recommended for high-risk populations and cause-specific anaemia.

PMID:38779874 | DOI:10.7189/jogh.14.04073

Acta Oncol. 2024 May 23;63:373-378. doi: 10.2340/1651-226X.2024.25053.

ABSTRACT

BACKGROUND: The US government considers veterans to have been exposed to Agent Orange if they served in Vietnam while the carcinogen was in use, and these veterans are often deemed at high risk of prostate cancer (PCa). Here, we assess whether presumed Agent Orange exposure is independently associated with increased risk of any metastatic or fatal PCa in a diverse Veteran cohort still alive in the modern era (at least 2011), when accounting for race/ethnicity, family history, and genetic risk.

PATIENTS AND METHODS: Participants in the Million Veteran Program (MVP; enrollment began in 2011) who were on active duty during the Vietnam War era (August 1964-April 1975) were included (n = 301,470). Agent Orange exposure was determined using the US government definition. Genetic risk was assessed via a validated polygenic hazard score. Associations with age at diagnosis of any PCa, metastatic PCa, and death from PCa were assessed via Cox proportional hazards models.

RESULTS AND INTERPRETATION: On univariable analysis, exposure to Agent Orange was not associated with increased PCa (hazard ratio [HR]: 1.02, 95% confidence interval [CI]: 1.00-1.04, p = 0.06), metastatic PCa (HR: 0.98, 95% CI: 0.91-1.05, p = 0.55), or fatal PCa (HR: 0.94, 95% CI: 0.79-1.09, p = 0.41). When accounting for race/ethnicity and family history, Agent Orange exposure was independently associated with slightly increased risk of PCa (HR: 1.06, 95% CI: 1.04-1.09, <10-6) but not with metastatic PCa (HR: 1.07, 95% CI: 0.98-1.15, p = 0.10) or PCa death (HR: 1.02, 95% CI: 0.83-1.23, p = 0.09). Similar results were found when accounting for genetic risk. Agent Orange exposure history may not improve modern PCa risk stratification.

PMID:38779869 | DOI:10.2340/1651-226X.2024.25053

Nurs Leadersh (Tor Ont). 2024 Apr;36(4):57-72. doi: 10.12927/cjnl.2024.27307.

ABSTRACT

This paper presents an international academic partnership in teaching and research with two case studies. The cases explore the integration of Strengths-Based Nursing and Healthcare (SBNH) and SBNH-Leadership (SBNH-L) in nursing science programs. SBNH values and foundations were integrated within an undergraduate-level community health course in Canada and SBNH-L was introduced into a graduate-level program in Brazil. Both cases comprise active learning activities promoting the uptake of the values and foundations of SBNH and the capacity to identify strengths and innate capacities. This paper synthesizes the issues and provides recommendations to enhance teaching-learning strategies to support SBNH adoption by students to support the humanization of healthcare. International partnerships in education and research and facilitating factors are discussed.

PMID:38779836 | DOI:10.12927/cjnl.2024.27307

Epidemiol Psychiatr Sci. 2024 May 23;33:e29. doi: 10.1017/S2045796024000313.

ABSTRACT

AIMS: By the end of 2022, an estimated 108.4 million individuals worldwide experienced forced displacement. Identifying modifiable factors associated with the mental illness of refugees is crucial for promoting successful integration and developing effective health policies. This study aims to examine the associations between the changes in the diversity of social participation and psychological distress among refugees throughout the resettlement process, specifically focusing on gender differences.

METHODS: Utilizing data from three waves of a longitudinal, nationally representative cohort study conducted in Australia, this study involved 2399 refugees interviewed during Wave 1, 1894 individuals interviewed during Wave 3 and 1881 respondents during Wave 5. At each wave, we assessed psychological distress and 10 types of social participation across 3 distinct dimensions, including social activities, employment and education. The primary analysis employed mixed linear models and time-varying Cox models. Gender-stratified analyses and sensitivity analyses were performed.

RESULTS: Refugees engaging in one type or two or more types of social participation, compared with those not engaging in any, consistently had lower psychological distress scores (β = -0.62 [95% confidence interval (CI), -1.07 to -0.17] for one type of social participation; β = -0.57 [95% CI, -1.04 to -0.10] for two or more types of social participation) and a reduced risk of experiencing psychological distress (hazard ratio [HR] = 0.81 [95% CI, 0.65-0.99] for one type of social participation; HR = 0.77 [95% CI, 0.61-0.97] for two or more types of social participation) during the resettlement period. When stratifying the results by gender, these associations in the adjusted models only remained significant in male refugees. Moreover, three specific types of social participation, namely sporting activities, leisure activities and current employment status, were most prominently associated with a reduced risk of psychological distress.

CONCLUSIONS: The findings of this cohort study suggest that social participation was consistently associated with reduced risks of psychological distress among male refugees during resettlement. These findings highlight the significance of promoting meaningful social participation and interaction may be an effective strategy to improve the mental health of refugees and facilitate their successful integration into society, especially among male refugees.

PMID:38779823 | DOI:10.1017/S2045796024000313

Epidemiol Psychiatr Sci. 2024 May 23;33:e30. doi: 10.1017/S2045796024000325.

ABSTRACT

AIMS: While past research suggested that living arrangements are associated with suicide death, no study has examined the impact of sustained living arrangements and the change in living arrangements. Also, previous survival analysis studies only reported a single hazard ratio (HR), whereas the actual HR may change over time. We aimed to address these limitations using causal inference approaches.

METHODS: Multi-point data from a general Japanese population sample were used. Participants reported their living arrangements twice within a 5-year time interval. After that, suicide death, non-suicide death and all-cause mortality were evaluated over 14 years. We used inverse probability weighted pooled logistic regression and cumulative incidence curve, evaluating the association of time-varying living arrangements with suicide death. We also studied non-suicide death and all-cause mortality to contextualize the association. Missing data for covariates were handled using random forest imputation.

RESULTS: A total of 86,749 participants were analysed, with a mean age (standard deviation) of 51.7 (7.90) at baseline. Of these, 306 died by suicide during the 14-year follow-up. Persistently living alone was associated with an increased risk of suicide death (risk difference [RD]: 1.1%, 95% confidence interval [CI]: 0.3-2.5%; risk ratio [RR]: 4.00, 95% CI: 1.83-7.41), non-suicide death (RD: 7.8%, 95% CI: 5.2-10.5%; RR: 1.56, 95% CI: 1.38-1.74) and all-cause mortality (RD: 8.7%, 95% CI: 6.2-11.3%; RR: 1.60, 95% CI: 1.42-1.79) at the end of the follow-up. The cumulative incidence curve showed that these associations were consistent throughout the follow-up. Across all types of mortality, the increased risk was smaller for those who started to live with someone and those who transitioned to living alone. The results remained robust in sensitivity analyses.

CONCLUSIONS: Individuals who persistently live alone have an increased risk of suicide death as well as non-suicide death and all-cause mortality, whereas this impact is weaker for those who change their living arrangements.

PMID:38779822 | DOI:10.1017/S2045796024000325

Epidemiol Infect. 2024 May 23;152:e79. doi: 10.1017/S0950268824000621.

NO ABSTRACT

PMID:38779811 | DOI:10.1017/S0950268824000621

Multivariate Behav Res. 2024 May 23:1-17. doi: 10.1080/00273171.2024.2350236. Online ahead of print.

ABSTRACT

Linear mixed-effects models have been increasingly used to analyze dependent data in psychological research. Despite their many advantages over ANOVA, critical issues in their analyses remain. Due to increasing random effects and model complexity, estimation computation is demanding, and convergence becomes challenging. Applied users need help choosing appropriate methods to estimate random effects. The present Monte Carlo simulation study investigated the impacts when the restricted maximum likelihood (REML) and Bayesian estimation models were misspecified in the estimation. We also compared the performance of Akaike information criterion (AIC) and deviance information criterion (DIC) in model selection. Results showed that models neglecting the existing random effects had inflated Type I errors, unacceptable coverage, and inaccurate R-squared measures of fixed and random effects variation. Furthermore, models with redundant random effects had convergence problems, lower statistical power, and inaccurate R-squared measures for Bayesian estimation. The convergence problem is more severe for REML, while reduced power and inaccurate R-squared measures were more severe for Bayesian estimation. Notably, DIC was better than AIC in identifying the true models (especially for models including person random intercept only), improving convergence rates, and providing more accurate effect size estimates, despite AIC having higher power than DIC with 10 items and the most complicated true model.

PMID:38779786 | DOI:10.1080/00273171.2024.2350236

Am J Physiol Renal Physiol. 2024 May 23. doi: 10.1152/ajprenal.00043.2024. Online ahead of print.

ABSTRACT

Sepsis-associated acute kidney injury (SA-AKI) is a key contributor to the life threatening sequalae of sepsis. Mechanistically, SA-AKI is a consequence of unabated myeloid cell activation and oxidative stress that induces tubular injury. Iron mediates inflammatory pathways directly and through regulating the expression of ferritin, an iron storage protein comprised of ferritin light (FtL) and heavy chain (FtH). Previous work revealed myeloid FtH deletion leads to a compensatory increase in intracellular and circulating FtL and is associated with amelioration of SA-AKI. We designed this study to test the hypothesis that loss of myeloid FtL will exacerbate the sepsis-induced inflammatory response and worsen SA-AKI. We generated a novel myeloid-specific FtL knockout mouse and induced sepsis via cecal ligation and puncture or lipopolysaccharide endotoxemia. As expected, myeloid FtL and serum ferritin levels were significantly lower in the knockout mice. Interestingly, while sepsis led to production of pro- and anti-inflammatory cytokines, there was no statistical difference between the genotypes. There was a similar loss of kidney function and injury, identified by expression of kidney injury molecule-1 and neutrophil gelatinase associated lipocalin. RNA sequencing revealed upregulation of pathways for cell cycle arrest and autophagy post-sepsis, but no significant differences were observed between genotypes, including in key genes associated with ferroptosis, an iron-mediated form of cell death. FtL deletion did not impact activation of NFkB or HIF-1a signaling, key inflammatory pathways associated with dysregulated host response. Taken together, while FtL overexpression was shown to be protective, loss of FtL did not influence sepsis pathogenesis.

PMID:38779751 | DOI:10.1152/ajprenal.00043.2024

GMS J Med Educ. 2024 Apr 15;41(2):Doc16. doi: 10.3205/zma001671. eCollection 2024.

ABSTRACT

OBJECTIVES: The aim of this paper is to present the development of a longitudinal curriculum for medical students that is rooted in the particularity of the medical sciences and that aims to build and strengthen medical students’ scientific skills and use thereof in clinical practice.

METHODS: The curriculum development was initiated based on students’ feedback on the initial curriculum. To improve and expand the curriculum appropriately, a needs assessment, a literature review to define science specific to the medical sciences and practice, and an analysis of national and international curricula were performed. The curriculum development followed the PDCA cycle (Plan-Do-Check-Act).

RESULTS: The curriculum extends across the entire medical study programme from semesters 1 to 10. It consists of the seminar series on basic conduct and the epistemological groundings of science, scientific methods in medical research and health sciences, statistics and the scientific internship. Up to the sixth semester, the focus is on the acquisition of skills and abilities to work on and carry out a concrete research project; starting in semester seven, the critical evaluation and application of research results in everyday clinical practice are introduced. The curriculum is taught by epidemiologists, anthropologists, statisticians and public health scholars. Starting in semester seven, seminars are generally taught together with clinicians as tandem teaching. The curriculum is regularly assessed and adjusted.

CONCLUSIONS: The Brandenburg Scientific Curriculum can be seen as a model of a longitudinal curriculum to teach scientific thinking and acting. One that is at the same time highly integrated in the medical curriculum overall. A central coordination point seems to be necessary to coordinate the teaching content and to ensure that teachers are interconnected. Furthermore, a complex curriculum in scientific methodology requires a set of teachers from a range of disciplinary backgrounds. To ensure equally high-quality education, the variability of research projects and faculty must be taken into account by establishing generally applicable evaluation criteria and fostering faculty development, and providing all students supporting courses throughout the research project.

PMID:38779698 | PMC:PMC11106572 | DOI:10.3205/zma001671

GMS J Med Educ. 2024 Apr 15;41(2):Doc15. doi: 10.3205/zma001670. eCollection 2024.

ABSTRACT

AIM: This systematic review aims to investigate the level of empathy among medical students in Arabic speaking countries and analyze its determinants.

METHODS: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2022 (PRISMA), the authors conducted a systematic research of studies investigating the level and determinants of empathy among medical students in Arabic speaking countries. The databases PubMed, Scopus, web of science and google scholar were searched.

RESULTS: Ten studies from six countries were included. Nine of which had a cross-sectional study design. Level of empathy was assessed using the Jefferson scale in seven studies and using the Interpersonal Reactivity Index in two studies. The mean of empathy scale ranges between 97.65±14.10 to 106.55±19.16 in studies used the Jefferson scale of empathy. The associated factors with empathy were gender; high levels of empathy were reported in female students. Other factors are explored in relation with empathy such as specialty preference (surgery or medicine, “people-orientated” specialties or ”technology-oriented specialties”), family factors (marital status of parents, satisfactory relationship with parents, parents level of education and household income) and factors related to medical education (academic performance, year of study and type of curriculum) but the results are heterogeneous.

CONCLUSION: This is the first systematic review, which illustrated the determinants of empathy in Arabic medical students. Our results revealed varied results on empathy determinants. Further studies may guarantee a full exploration of this ability in order to improve the doctor-patient relationship and patient management in the Arab world.

PMID:38779697 | PMC:PMC11106575 | DOI:10.3205/zma001670