Nevin Manimala

JMIR Form Res. 2023 Aug 24;7:e49439. doi: 10.2196/49439.

ABSTRACT

BACKGROUND: The health information system (HIS) functions are getting wider with more diverse users. Information security in the health industry is crucial because it involves comprehensive and strategic information that might harm human life. The human factor is one of the biggest security threats to HIS.

OBJECTIVE: This study aims to investigate the information security behavior (ISB) of HIS users using a comprehensive assessment scale suited to the information security concerns in health care. Patients are increasingly being asked to submit their own data into HIS systems. As a result, this study examines the security behavior of health workers and patients, as well as their demographic variables.

METHODS: We used a quantitative approach using surveys of health workers and patients. We created a research instrument from 4 existing measurement scales to measure prosecurity and antisecurity behavior. We analyzed statistical differences to test the hypotheses, that is, the Kruskal-Wallis test and the Mann-Whitney test. The descriptive analysis was used to determine whether the group exhibited exemplary behavior when processing the survey results. A correlational test using the Spearman correlation coefficient was performed to establish the significance of the relationship between ISB and age as well as level of education.

RESULTS: We analyzed 421 responses from the survey. According to demographic factors, the hypotheses tested for full and partial security behavior reveal substantial differences. Education levels most significantly affect security behavior differences, followed by user type, gender, and age. The health workers’ ISB is higher than that of the patients. Women are more likely than men to engage in prosecurity actions while avoiding antisecurity behaviors. The older the HIS user, the more likely it is that they will participate in prosecurity behavior and the less probable it is that they will engage in antisecurity behavior. According to this study, differences in prosecurity behavior are mostly impacted by education level. Higher education, on the other hand, does not guarantee improved ISB for HIS users. All demographic characteristics, particularly concerning user type, show discrepancies that are caused mainly by antisecurity behavior rather than prosecurity behavior.

CONCLUSIONS: Since patients engage in antisecurity behavior more frequently than health workers and may pose security risks, health care facilities should start to consider information security education for patients. More comprehensive research on ISB in health care facilities is required to better understand the patient’s perspective, which is currently understudied.

PMID:37616025 | DOI:10.2196/49439

Eur J Public Health. 2023 Aug 23:ckad151. doi: 10.1093/eurpub/ckad151. Online ahead of print.

ABSTRACT

BACKGROUND: The aim of this study was to assess the associations between cannabis use and frequency of alcohol intoxication in adolescence with the risk of traumatic brain injury and craniofacial fractures in early adulthood. Hypothesis was that using alcohol and cannabis in adolescence could increase the risk for head traumas.

METHODS: Data from the Northern Finland Birth Cohort 1986 (n = 9432 individuals) were used to investigate the prospective association between the self-reported frequency of alcohol intoxication (n = 6472) and cannabis use (n = 6586) in mid-adolescence and register-based, head trauma diagnoses by ages 32-33 years. To test the robustness of these associations, the statistical models were adjusted for a range of other confounders such as illicit drug use, previous head trauma and self-reported mental health problems.

RESULTS: In multivariate analyses, cannabis use was statistically significantly associated with a greater risk of traumatic brain injury among females [hazard ratio (HR) 1.9, 95% confidence interval (CI) 1.1-3.2, P = 0.024). Frequent alcohol intoxication was a statistically significant independent risk factor for both traumatic brain injury (HR 2.6, 95% CI 1.7-3.9, P < 0.001) and craniofacial fractures (HR 2.7, 95% CI 1.6-4.8, P < 0.001) among males.

CONCLUSIONS: Cannabis use in adolescence appears to associate independently with elevated risk for traumatic brain injury among females, and frequent alcohol intoxication in adolescence seems to associate with elevated risk of both traumatic brain injury and craniofacial fractures among males.

PMID:37616019 | DOI:10.1093/eurpub/ckad151

JAMA Netw Open. 2023 Aug 1;6(8):e2330754. doi: 10.1001/jamanetworkopen.2023.30754.

ABSTRACT

IMPORTANCE: Emerging evidence has consistently demonstrated that sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce the risk of heart failure (HF) hospitalization and cardiovascular (CV) death among patients with HF. However, it remains unclear how long a patient needs to live to potentially benefit from SGLT2 inhibitors in this population.

OBJECTIVES: To estimate the time to benefit from SGLT2 inhibitors among patients with HF.

DESIGN, SETTING, AND PARTICIPANTS: This comparative effectiveness study systematically searched PubMed for completed randomized clinical trials about SGLT2 inhibitors and patients with HF published until September 5, 2022; 5 trials with the year of publication ranging from 2019 to 2022 were eventually included. Statistical analysis was performed from April to October 2022.

INTERVENTION: Addition of SGLT2 inhibitors or placebo to guideline-recommended therapy.

MAIN OUTCOMES AND MEASURES: The primary outcome was the time to first event of CV death or worsening HF, which was broadly comparable across the included trials.

RESULTS: Five trials consisting of 21 947 patients with HF (7837 [35.7%] were female; mean or median age older than 65 years within each trial) were included. SGLT2 inhibitors significantly reduced the risk of worsening HF or CV death (hazard ratio [HR], 0.77 [95% CI, 0.73-0.82]). Time to first nominal statistical significance (P < .05) was 26 days (0.86 months), and statistical significance was sustained from day 118 (3.93 months) onwards. A mean of 0.19 (95% CI, 0.12-0.35) months were needed to prevent 1 worsening HF or CV death per 500 patients with SGLT2 inhibitors (absolute risk reduction [ARR], 0.002). Likewise, 0.66 (95% CI, 0.43-1.13) months was estimated to avoid 1 event per 200 patients with SGLT2 inhibitors (ARR, 0.005), 1.74 (95% CI, 1.07-2.61) months to avoid 1 event per 100 patients (ARR, 0.010), and 4.96 (95% CI, 3.18-7.26) months to avoid 1 event per 50 patients (ARR, 0.020). Further analyses indicated a shorter time to benefit for HF hospitalization and among patients with diabetes or HF with reduced ejection fraction.

CONCLUSIONS AND RELEVANCE: In this comparative effectiveness research study of estimating the time to benefit from SGLT2 inhibitors among patients with HF, a rapid clinical benefit in reducing CV death or worsening HF was found, suggesting that their use may be beneficial for most individuals with HF.

PMID:37615988 | DOI:10.1001/jamanetworkopen.2023.30754

JAMA Netw Open. 2023 Aug 1;6(8):e2330856. doi: 10.1001/jamanetworkopen.2023.30856.

ABSTRACT

IMPORTANCE: Many pulse oximeters have been shown to overestimate oxygen saturation in persons of color, and this phenomenon has potential clinical implications. The relationship between overestimation of oxygen saturation with timing of COVID-19 medication delivery and clinical outcomes remains unknown.

OBJECTIVE: To investigate the association between overestimation of oxygen saturation by pulse oximetry and delay in administration of COVID-19 therapy, hospital length of stay, risk of hospital readmission, and in-hospital mortality.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study included patients hospitalized for COVID-19 at 186 acute care facilities in the US with at least 1 functional arterial oxygen saturation (SaO2) measurement between March 2020 and October 2021. A subset of patients were admitted after July 1, 2020, without immediate need for COVID-19 therapy based on pulse oximeter saturation (SpO2 levels of 94% or higher without supplemental oxygen).

EXPOSURES: Self-reported race and ethnicity, difference between concurrent SaO2 and pulse oximeter saturation (SpO2) within 10 minutes, and initially unrecognized need for COVID-19 therapy (first SaO2 reading below 94% despite SpO2 levels of 94% or above).

MAIN OUTCOME AND MEASURES: The association of race and ethnicity with degree of pulse oximeter measurement error (SpO2 – SaO2) and odds of unrecognized need for COVID-19 therapy were determined using linear mixed-effects models. Associations of initially unrecognized need for treatment with time to receipt of therapy (remdesivir or dexamethasone), in-hospital mortality, 30-day hospital readmission, and length of stay were evaluated using mixed-effects models. All models accounted for demographics, clinical characteristics, and hospital site. Effect modification by race and ethnicity was evaluated using interaction terms.

RESULTS: Among 24 504 patients with concurrent SpO2 and SaO2 measurements (mean [SD] age, 63.9 [15.8] years; 10 263 female [41.9%]; 3922 Black [16.0%], 7895 Hispanic [32.2%], 2554 Asian, Native American or Alaskan Native, Hawaiian or Pacific Islander, or another race or ethnicity [10.4%], and 10 133 White [41.4%]), pulse oximetry overestimated SaO2 for Black (adjusted mean difference, 0.93 [95% CI, 0.74-1.12] percentage points), Hispanic (0.49 [95% CI, 0.34-0.63] percentage points), and other (0.53 [95% CI, 0.35-0.72] percentage points) patients compared with White patients. In a subset of 8635 patients with a concurrent SpO2 – SaO2 pair without immediate need for COVID-19 therapy, Black patients were significantly more likely to have pulse oximetry values that masked an indication for COVID-19 therapy compared with White patients (adjusted odds ratio [aOR], 1.65; 95% CI, 1.33-2.03). Patients with an unrecognized need for COVID-19 therapy were 10% less likely to receive COVID-19 therapy (adjusted hazard ratio, 0.90; 95% CI, 0.83-0.97) and higher odds of readmission (aOR, 2.41; 95% CI, 1.39-4.18) regardless of race (P for interaction = .45 and P = .14, respectively). There was no association of unrecognized need for COVID-19 therapy with in-hospital mortality (aOR, 0.84; 95% CI, 0.71-1.01) or length of stay (mean difference, -1.4 days; 95% CI, -3.1 to 0.2 days).

CONCLUSIONS AND RELEVANCE: In this cohort study, overestimation of oxygen saturation by pulse oximetry led to delayed delivery of COVID-19 therapy and higher probability of readmission regardless of race. Black patients were more likely to have unrecognized need for therapy with potential implications for population-level health disparities.

PMID:37615985 | DOI:10.1001/jamanetworkopen.2023.30856

J Am Med Inform Assoc. 2023 Aug 23:ocad157. doi: 10.1093/jamia/ocad157. Online ahead of print.

ABSTRACT

OBJECTIVE: To pilot test an infographic-based health communication intervention that our team rigorously designed and explore whether its implementation leads to better health outcomes among Latino persons with HIV (PWH).

MATERIALS AND METHODS: Latino PWH (N = 30) living in New York City received the intervention during health education sessions at 3 study visits that occurred approximately 3 months apart. At each visit, participants completed baseline or follow-up assessments and laboratory data were extracted from patient charts. We assessed 6 outcomes (HIV-related knowledge, self-efficacy to manage HIV, adherence to antiretroviral therapy, CD4 count, viral load, and current and overall health status) selected according to a conceptual model that describes pathways through which communication influences health outcomes. We assessed changes in outcomes over time using quantile and generalized linear regression models controlling for the coronavirus disease 2019 (COVID-19) research pause and new patient status (new/established) at the time of enrollment.

RESULTS: Most participants were male (60%) and Spanish-speaking (60%); 40% of participants identified as Mixed Race/Mestizo, 13.3% as Black, 13.3% as White, and 33.3% as “other” race. Outcome measures generally improved after the second intervention exposure. Following the third intervention exposure (after the COVID-19 research pause), only the improvements in HIV-related knowledge and current health status were statistically significant.

DISCUSSION AND CONCLUSION: Our infographic-based health communication intervention may lead to better health outcomes among Latino PWH, but larger trials are needed to establish efficacy. From this work, we contribute suggestions for effective infographic use for patient-provider communication to enhance patient education in clinical settings.

PMID:37615971 | DOI:10.1093/jamia/ocad157

Int J Epidemiol. 2023 Aug 23:dyad116. doi: 10.1093/ije/dyad116. Online ahead of print.

NO ABSTRACT

PMID:37615969 | DOI:10.1093/ije/dyad116

Int Endod J. 2023 Aug 24. doi: 10.1111/iej.13965. Online ahead of print.

ABSTRACT

AIM: To determine the effect of a novel antimicrobial peptide (AMP; OP145) and cell-penetrating peptide (Octa-arginine/R8) conjugate on the killing of intracellular Enterococcus faecalis, compared to OP145 and an antibiotic combination recommended for regenerative endodontic procedures.

METHODOLOGY: The biocompatible concentrations of OP145 and OP145-R8 were determined by assessing their cytotoxicity against human macrophages and red blood cells. Spatiotemporal internalization of the peptides into macrophages was investigated qualitatively and quantitatively by confocal laser scanning microscopy and flow cytometry respectively. Killing of extracellular and intracellular E. faecalis OG1RF by the peptides was determined by counting the colony-forming units (CFU). Intracellular antibacterial activity of the peptides was compared to a double antibiotic combination. Confocal microscopy was used to confirm the intracellular bacterial eradication. Significant differences between the different test groups were analysed using one-way analysis of variance. p < .05 was considered to be statistically significant.

RESULTS: Peptides at a concentration of 7.5 μmol/L were chosen for subsequent experiments based on the results of the alamarBlue™ cell viability assay and haemolytic assay. OP145-R8 selectively internalized into lysosomal compartments and the cytosol of macrophages. Conjugation with R8 improved the internalization of OP145 into macrophages in a temporal manner (70.53% at 1 h to 77.13% at 2 h), while no temporal increase was observed for OP145 alone (60.53% at 1 h with no increase at 2 h). OP145-R8 demonstrated significantly greater extracellular and intracellular antibacterial activity compared to OP145 at all investigated time-points and concentrations (p < .05). OP145-R8 at 7.5 μmol/L eradicated intracellular E. faecalis after 2 h (3.5 log reduction compared to the control; p < .05), while the antibiotics could not reduce more than 0.5 log CFU compared to the control (p > .05). Confocal microscopy showed complete absence of E. faecalis within the OP145-R8 treated macrophages.

CONCLUSIONS: The results of this study demonstrated that the conjugation of an AMP OP145 to a cell-penetrating peptide R8 eradicated extracellular and intracellular E. faecalis OG1RF without toxic effects on the host cells.

PMID:37615967 | DOI:10.1111/iej.13965

Environ Sci Pollut Res Int. 2023 Aug 24. doi: 10.1007/s11356-023-29408-6. Online ahead of print.

ABSTRACT

Parkinson’s disease (PD) is the second most common human neurodegenerative disorder, and the pathogenesis of it remains poorly understood. Limited studies have shown that both long- and short-term exposure to air pollutants may be associated with increased risk of PD while lacking evidence on the effects of intermediate-term exposure. In this study, over-dispersed Poisson generalized additive models (GAMs) were applied to explore the association between intermediate-term sulfur dioxide (SO₂) exposure and outpatient visits for PD in Chongqing, China, and further stratified analyses were performed by age and gender. A total of 39,984 PD cases from January 1, 2014, to December 31, 2019 (2191 days) were included. The association of intermediate-term SO₂ exposure with outpatient visits for PD was statistically significant: per 1 μg/m³ increase of SO₂ corresponded to 2.34% (95% CI: 0.88%, 3.80%) elevation in monthly PD outpatient visits at lag 0 (the concurrent month). Stratified analyses showed that the associations between SO₂ and PD outpatient visits were stronger in younger (≤ 60 years) and female patients. In conclusion, intermediate-term SO₂ exposure can be associated with an increased risk of PD outpatient visits. Our results highlight the importance of recognizing the role of intermediate-term SO₂ exposure in the development of PD. In addition to focusing on the effects of long-term or short-term air pollutants, it is necessary to pay more attention to the health effects of intermediate-term exposure time windows of air pollutants, which will facilitate policy formulation and public health interventions for health risks.

PMID:37615914 | DOI:10.1007/s11356-023-29408-6

Environ Sci Pollut Res Int. 2023 Aug 24. doi: 10.1007/s11356-023-29254-6. Online ahead of print.

ABSTRACT

Fluoride pollution is a major issue worldwide, posing health risks such as dental and skeletal fluorosis. This study was conducted in fluoride enrichment hard rock regions of Vaniyambadi and Ambur talks in Tirupathur district, Tamil Nadu. Four hundred eighty groundwater samples were collected from May 2021 to April 2022 and grouped as summer, southwest monsoon (SWM), northeast monsoon (NEM), and winter. Maximum concentration of fluoride was found to be 4 mg/L in the summer season in Vellakuttai region of Vaniyambadi taluk. The study aims to investigate the hydrogeochemical process and mechanism influencing groundwater chemistry and it also provides the confirmation of exploratory data analysis in groundwater quality using structural equation modeling. The Piper and Gibbs diagrams illustrate the rock-water interaction and anthropogenic sources that contribute to the NaHCO₃ and NaCl-type waters, respectively. Multivariate statistical analysis such as hierarchical cluster analysis (HCA), principal component analysis (PCA), multiple linear regression (MLR), and structural equation modeling (SEM) has been carried out to determine the groundwater quality. HCA manifests the nature and sources of groundwater, whereas PCA divides all the physicochemical parameters into two PC loadings, accounting for 97.46%, 99.46%, 99.18%, and 98.93% of cumulative % of variance during the summer, SWM, NEM, and winter seasons, respectively. PC1 has a higher loading factor to Cl, Ca, and Mg, whereas PC2 has a higher loading factor to Na, HCO₃, SO₄, and NO₃. The results of the MLR model provide higher accuracy in detecting the contamination factors associated with the environment and natural rocks. SEM revealed the goodness-of-fit indices 0.993, 0.999, 1.000, and 0.999 in summer, SWM, NEM, and winter, respectively. Hence, this study provides insight view of variation of fluoride concentration in groundwater in different seasons and also mentions the factors that influence fluoride concentration in Vaniyambadi and Ambur taluk.

PMID:37615908 | DOI:10.1007/s11356-023-29254-6

Psychometrika. 2023 Aug 24. doi: 10.1007/s11336-023-09926-5. Online ahead of print.

ABSTRACT

In social, behavioral and economic sciences, researchers are interested in modeling a social network among a group of individuals, along with their attributes. The attributes can be responses to survey questionnaires and are often high dimensional. We propose a joint latent space model (JLSM) that summarizes information from the social network and the multivariate attributes in a person-attribute joint latent space. We develop a variational Bayesian expectation-maximization estimation algorithm to estimate the attribute and person locations in the joint latent space. This methodology allows for effective integration, informative visualization and prediction of social networks and attributes. Using JLSM, we explore the French financial elites based on their social networks and their career, political views and social status. We observe a division in the social circles of the French elites in accordance with the differences in their attributes. We analyze user networks and behaviors in multimodal social media systems like YouTube. A R package “jlsm” is developed to fit the models proposed in this paper and is publicly available from the CRAN repository https://cran.r-project.org/web/packages/jlsm/jlsm.pdf .

PMID:37615903 | DOI:10.1007/s11336-023-09926-5