Nevin Manimala

SAGE Open Med. 2023 Aug 18;11:20503121231187735. doi: 10.1177/20503121231187735. eCollection 2023.

ABSTRACT

BACKGROUND: Postabortion contraception is the initiation and use of postabortion contraceptive methods immediately after an abortion. It is a critical approach for preventing unwanted pregnancy, alleviating its complications, and avoiding repeated abortions by promoting immediate postabortion contraceptives provision.

OBJECTIVE: To assess the level of postabortion contraceptives uptake and its associated factors among clients visiting abortion care services in public hospitals in West Shewa Zone, Oromia regional state, Ethiopia.

METHODS AND MATERIALS: An institutional-based cross-sectional study was conducted in public hospitals in the West Shewa Zone from 1 March 2021 to 30 May 2021, among 227 proportionally allocated clients based on the proportion of the client served in the previous 3 months of the study period. Data were collected through face-to-face interviews using semi-structured and pretested questionnaire from women who received the abortion services. Bivariable and multivariable logistic regression were used to assess the association of independent variables with postabortion contraceptive uptake. Findings with p-value of 0.05 at 95% confidence interval were considered as statistically significant.

RESULTS: The overall postabortion contraception uptake among abortion service clients in public hospitals was 164 (74%) while about 42% of them used long-term contraceptive methods. Postabortion contraceptive uptake was significantly associated with media exposure to postabortion family planning information (adjusted odds ratio: 3.4 (95% confidence interval: 1.03-11.27)) and counseling on postabortion family planning (adjusted odds ratio: 20.48 (95% confidence interval: 5.02-83.64)).

CONCLUSION: Level of postabortion contraceptive method uptake in West Shewa was low as compared to the national target. Greater attention should be given on providing postabortion contraceptive counseling to increase the postabortion contraceptive uptake.

PMID:37602273 | PMC:PMC10437695 | DOI:10.1177/20503121231187735

SAGE Open Med. 2023 Aug 17;11:20503121231190963. doi: 10.1177/20503121231190963. eCollection 2023.

ABSTRACT

Background: A 2019 study by Prucnal and colleagues found that the majority of patients treated with unfractionated heparin for pulmonary embolism did not maintain therapeutic activated partial thromboplastin time levels during the first 48 h of therapy. Objective: The purpose of this study was to evaluate the ability of an institution’s unfractionated heparin dosing protocol to achieve and maintain therapeutic anti-Xa levels within the first 48 h of therapy in patients with venous thromboembolism. Methods: This retrospective study included 205 patients from May 2016 through September 2020. Patients were divided into two cohorts: bolus plus infusion (N = 89) and infusion only (N = 116). The primary objective was to determine the number of patients who achieved at least one therapeutic level. Results: Overall, 200 patients (97.6%) had at least one therapeutic level with no statistically significant difference between cohorts (p = 0.65). No more than 60% of patients achieved a therapeutic level at any of the 6-h intervals throughout the timeframe. The median time to the first therapeutic level in the overall group was 12.8 h with no statistically significant difference between the bolus plus infusion and infusion-only cohorts (13.3 h versus 12.7 h, respectively, p = 0.48). Conclusions: Most patients were able to achieve at least one therapeutic level within the first 48 h, but fewer were able to maintain therapeutic levels. Further studies are warranted to determine whether alternative dosing strategies would yield consistent achievement of therapeutic levels and affect patient-oriented outcomes.

PMID:37602272 | PMC:PMC10438427 | DOI:10.1177/20503121231190963

Surv Methodol. 2021 Jun;47(1):215-222. Epub 2021 Jun 24.

ABSTRACT

Predictive mean matching is a commonly used imputation procedure for addressing the problem of item nonrespone in surveys. The customary approach relies upon the specification of a single outcome regression model. In this note, we propose a novel predictive mean matching procedure that allows the user to specify multiple outcome regression models. The resulting estimator is multiply robust in the sense that it remains consistent if one of the specified outcome regression models is correctly specified. The results from a simulation study suggest that the proposed method performs well in terms of bias and efficiency.

PMID:37602271 | PMC:PMC10438827

Stat Med. 2023 Aug 20. doi: 10.1002/sim.9871. Online ahead of print.

ABSTRACT

We consider the design of a two-arm superiority cluster randomized controlled trial (RCT) with a continuous outcome. We detail Bayesian inference for the analysis of the trial using a linear mixed-effects model. The treatment is compared to control using the posterior distribution for the treatment effect. We develop the form of the assurance to choose the sample size based on this analysis, and its evaluation using a two loop Monte Carlo sampling scheme. We assess the proposed approach, considering the effect of different forms of prior distribution, and the number of Monte Carlo samples needed in both loops for accurate determination of the assurance and sample size. Based on this assessment, we provide general advice on each of these choices. We apply the approach to the choice of sample size for a cluster RCT into poststroke incontinence, and compare the resulting sample size to that from assurance based on a Wald test for the treatment effect. The Bayesian approach to design and analysis developed in this article can offer advantages in terms of an increase in the robustness of the chosen sample size to parameter mis-specification and reduced sample sizes if prior information indicates the treatment effect is likely to be larger than the minimal clinically important difference.

PMID:37599065 | DOI:10.1002/sim.9871

Stat Med. 2023 Aug 20. doi: 10.1002/sim.9877. Online ahead of print.

ABSTRACT

The Glasgow outcome scale-extended (GOS-E), an ordinal scale measure, is often selected as the endpoint for clinical trials of traumatic brain injury (TBI). Traditionally, GOS-E is analyzed as a fixed dichotomy with favorable outcome defined as GOS-E ≥ 5 and unfavorable outcome as GOS-E < 5. More recent studies have defined favorable vs unfavorable outcome utilizing a sliding dichotomy of the GOS-E that defines a favorable outcome as better than a subject’s predicted prognosis at baseline. Both dichotomous approaches result in loss of statistical and clinical information. To improve on power, Yeatts et al proposed a sliding scoring of the GOS-E as the distance from the cutoff for favorable/unfavorable outcomes, and therefore used more information found in the original GOS-E to estimate the probability of favorable outcome. We used data from a published TBI trial to explore the ramifications to trial operating characteristics by analyzing the sliding scoring of the GOS-E as either dichotomous, continuous, or ordinal. We illustrated a connection between the ordinal data and time-to-event (TTE) data to allow use of Bayesian software that utilizes TTE-based modeling. The simulation results showed that the continuous method with continuity correction offers higher power and lower mean squared error for estimating the probability of favorable outcome compared to the dichotomous method, and similar power but higher precision compared to the ordinal method. Therefore, we recommended that future severe TBI clinical trials consider analyzing the sliding scoring of the GOS-E endpoint as continuous with continuity correction.

PMID:37599009 | DOI:10.1002/sim.9877

Health Promot J Austr. 2023 Aug 20. doi: 10.1002/hpja.795. Online ahead of print.

ABSTRACT

ISSUE ADDRESSED: The COVID-19 pandemic led to the closure of many physical activity programs, with many online programs being created in place to maintain physical activity engagement. This study explored the outcomes of an online physical program on its participants.

METHOD: A validated survey was used to explore Virtual Streetgames (VSG) participants’ perceptions about their physical, mental, and social health while participating in VGS. Descriptive and inferential statistics were used to evaluate the impact of the online format.

RESULTS: Many VSG participants were not achieving their daily physical activity recommendations, with a considerable portion of individuals feeling frustrated at not being able to socialise. A substantial difference was seen between adults and adolescents, with increased adult activity rates for those adults participating in VSG. Despite this influence on physical well-being, VSG did not seem to influence mental or social wellbeing.

CONCLUSIONS: The results give detail into how the COVID-19 pandemic has influenced adolescent and young adult physical, mental, and social health, noting that the reduction of in-person contact influenced motivation for exercise. Online physical activity programs may have some positive impact in improving adult physical activity rates, but they are not as effective as face-to-face programs in improving overall well-being. SO WHAT?: The findings of this study suggest that online physical activity programs may not be as effective as face-to-face programs in improving overall well-being. Future research should explore ways to improve the social and motivational aspects of online physical activity programs to maximise their benefits for participants.

PMID:37599006 | DOI:10.1002/hpja.795

Am J Obstet Gynecol. 2023 Aug 18:S0002-9378(23)00547-1. doi: 10.1016/j.ajog.2023.08.013. Online ahead of print.

ABSTRACT

BACKGROUND: Having a Caesarean section at full dilatation (CSfd) has been associated with an increased subsequent risk of spontaneous preterm birth (sPTB). The Aberdeen Maternity and Neonatal Databank (AMND) provides a rare opportunity to study subsequent pregnancy outcomes after a previous CSfd over 40 years with an ability to include a detailed evaluation of potential confounding factors.

OBJECTIVE(S): To investigate if having an initial CSfd is associated with sPTB or other adverse pregnancy outcomes in the subsequent pregnancy.

STUDY DESIGN: A retrospective cohort study was conducted including women with a first and second pregnancy recorded within the AMND between 1976 and 2017, where previous CSfd at term in the first birth was the exposure. The primary outcome was spontaneous preterm birth (defined as spontaneous birth <37 weeks). Multivariate logistic regression was used to investigate any association between CSfd and the odds of spontaneous preterm birth (sPTB). Women with a prior CSfd were compared to (a) women with any other mode of birth (b) individual modes of birth including planned CS, CS in first stage of labour (<10cm dilated), vaginal birth (including spontaneous vaginal birth (SVB), non-rotational forceps, Kielland’s forceps, vacuum-assisted birth, breech vaginal birth). Other outcomes such as antepartum haemorrhage and mode of second birth were also compared.

RESULTS: Of the 30253 women included, 900 women had a prior CSfd in the first pregnancy. Women with prior CSfd had a three-fold increased risk of spontaneous preterm birth in a second pregnancy (unadjusted OR 2.63; 95%CI 1.82 – 3.81); adjusted OR 3.31; 95%CI 2.17 – 5.05) compared to all other modes of first birth adjusted for maternal age, diabetes, BMI, smoking, pre-eclampsia, antepartum haemorrhage, socioeconomic deprivation (SIMD 2016), year of birth and interpregnancy interval (in second pregnancy). When compared to women with vaginal births only, women with CSfd had five-fold increased odds of sPTB (aOR 5.37 (95%CI 3.40 – 8.48)). Compared to first spontaneous vaginal birth (SVB), first instrumental births (non-rotational forceps, Kielland’s forceps and vacuum births) were not associated with an increased risk of sPTB in the second birth. After an initial CSfd, 3.7% of women had a repeat CSfd and 48% had a planned CS in the second birth.

CONCLUSION: This study is a substantial addition to the body of evidence on the risk of subsequent sPTB after CSfd and demonstrates a strong association with spontaneous preterm birth following a CSfd in the first birth though the absolute risk remains small. This is a large retrospective cohort and includes a comprehensive assessment of potential confounding factors, including pre-eclampsia, antepartum haemorrhage (APH) as well as length of first and second stage of labour Future research must focus on understanding possible causality and to develop primary and secondary preventative measures.

PMID:37598995 | DOI:10.1016/j.ajog.2023.08.013

Biochem Pharmacol. 2023 Aug 18:115757. doi: 10.1016/j.bcp.2023.115757. Online ahead of print.

ABSTRACT

AIM: Previous evidence suggest that a sexual dimorphism in exercise fat oxidation and adipokines levels may explain a lower risk of cardio-metabolic disorders in women. Therefore, we investigated the role of sex in the relationship between adipokines levels, maximal fat oxidation (MFO) during exercise and insulin resistance.

METHODS: Fifty young adults with excess adiposity (31 women; body fat: 38.7 ± 5.3%) were included in this study. The fasting levels of leptin, adiponectin, glucose and insulin were determined from blood samples and the homeostatic model assessment of insulin resistance index (HOMA-IR) subsequently calculated. Body fat percentage and visceral adipose tissue (VAT) were assessed through dual-energy X-ray absorptiometry whereas MFO was estimated during an incremental-load exercise test after an overnight fasting through indirect calorimetry.

RESULTS: Men had lower levels of body fat (d = 1.80), adiponectin (d = 1.35), leptin (d = 0.43) and MFO (d = 1.25) than women. Conversely, men showed higher VAT (d = 0.85) and fasting glucose levels (d = 0.89). No sex differences were observed in HOMA-IR (d = 0.34). Adipokines levels were not associated with MFO in both sexes (r < 0.30), whereas adiponectin levels were inversely related with HOMA-IR in both men (r = -0.58) and women (r = -0.50). Leptin concentration was associated to HOMA-IR only in men (r = 0.41), while no statistically significant relationships were observed between MFO and HOMA-IR in both sexes (r < 0.44).

CONCLUSION: Insulin resistance was similar between sexes regardless of superior levels of adipokines and MFO during exercise in women. Therefore, adiponectin and leptin may regulate glucose homeostasis without altering whole body fat oxidation rate during exercise.

PMID:37598975 | DOI:10.1016/j.bcp.2023.115757

Sci Total Environ. 2023 Aug 18:166352. doi: 10.1016/j.scitotenv.2023.166352. Online ahead of print.

ABSTRACT

The occurrence of 25 multi-class pollutants comprising phthalate esters (PAEs), polycyclic aromatic hydrocarbons (PAHs), and synthetic musks (SMs) were studied in PM_2.5 samples collected at an industrial/commercial/residential/traffic mixed area in Shanghai during four seasons. During the whole period, a slight exceedance of the PM_2.5 annual limit was observed, with an average of 36.8 μg/m³, and PAEs were the most predominant, accounting for >70 % of the studied organic pollutants in PM_2.5, followed by PAHs and SMs. Statistically significant differences were observed for the concentrations of PM_2.5, PAEs, PAHs, and SMs in winter and summer. This seasonal variation could be derived from anthropogenic activities and atmospheric dynamics. Principal component analysis (PCA) and PAHs ratios suggested a mixed source mainly derived from vehicle emissions and industrial processes. Moreover, gaseous pollutants were also accounted for, indicating the emission of PAHs might accompany the NO₂ emission process. Finally, inhalation of PM_2.5-bound organic pollutants for carcinogenic and non-carcinogenic risks were estimated as average values for each season, showing outside the safe levels in autumn and winter in some cases, suggesting that new policies should be to developed to reduce their emissions and protect human health in this area.

PMID:37598962 | DOI:10.1016/j.scitotenv.2023.166352

J Neurosci Methods. 2023 Aug 18:109950. doi: 10.1016/j.jneumeth.2023.109950. Online ahead of print.

ABSTRACT

BACKGROUND: Consistent noise variance across data points (i.e. homoscedasticity) is required to ensure the validity of statistical analyses of MRI data conducted using linear regression methods. However, head motion leads to degradation of image quality, introducing noise heteroscedasticity into ordinary-least square analyses.

NEW METHOD: The recently introduced QUIQI method restores noise homoscedasticity by means of weighted least square analyses in which the weights, specific for each dataset of an analysis, are computed from an index of motion-induced image quality degradation. QUIQI was first demonstrated in the context of brain maps of the MRI parameter R2*, which were computed from a single set of images with variable echo time. Here, we extend this framework to quantitative maps of the MRI parameters R1, R2*, and MTsat, computed from multiple sets of images.

RESULTS: QUIQI restores homoscedasticity in analyses of quantitative MRI data computed from multiple scans. QUIQI allows for optimization of the noise model by using metrics quantifying heteroscedasticity and free energy.

COMPARISON WITH EXISTING METHODS: QUIQI restores homoscedasticity more effectively than insertion of an image quality index in the analysis design and yields higher sensitivity than simply removing the datasets most corrupted by head motion from the analysis.

CONCLUSION: QUIQI provides an optimal approach to group-wise analyses of a range of quantitative MRI parameter maps that is robust to inherent homoscedasticity.

PMID:37598941 | DOI:10.1016/j.jneumeth.2023.109950