Nevin Manimala

PLOS Glob Public Health. 2023 Aug 8;3(8):e0001411. doi: 10.1371/journal.pgph.0001411. eCollection 2023.

ABSTRACT

There is a growing focus on interventions at the health system level to promote healthy aging and provide age-friendly health services (AFHS) in low- and middle-income countries where populations are aging. This study aimed to determine the provider and facility readiness for AFHS. We developed and implemented surveys to collect PHC facility capacity and readiness to deliver AFHS and a KAP survey for facility healthcare workers based on guidelines from the WHO age-friendly tool kit and questionnaires from other studies. Direct observation and structured interviews of facility heads were conducted in a stratified random sample of 15 out of the 57 comprehensive PHC facilities in Lagos, Nigeria. One hundred and twenty providers were conveniently sampled for the KAP survey. Statistical analysis was conducted using STATA version 15 (StataCorp, College Station, Texas, USA). For facility readiness, only 13.3% of PHCs sometimes offered hearing assessment and none of the PHCs offered colorectal cancer assessment. Few (20.0%) facilities offered home services and only 1 (0.7%) had dedicated funding for care of older people. Ramps were at the entrance in 60.0% of facilities and almost half (43.3%) of the PHCs had wheelchair accessible entrances to the public toilets. The majority of HCWs (81.7%) had heard about healthy aging but only 5.0% about AFHS, only 10.8% reported formal training. Around a third knew about specific conditions which affect people as they age, including; depression (37.5%), urinary incontinence (35.0%), and falls/immobility (33.3%). Over half of the providers (54.2%) screened for malnutrition in older patients, 25.8% screened for suspected elder abuse and much less (19.2%) for delirium. This study found some areas of strength but also gaps in facility readiness as well as knowledge and training needed to support AFHS care. We recommend identifying interventions to improve the availability and delivery of care for older adults.

PMID:37552675 | DOI:10.1371/journal.pgph.0001411

Health Lit Res Pract. 2023 Aug;7(3):e144-e153. doi: 10.3928/24748307-20230717-01. Epub 2023 Aug 7.

ABSTRACT

BACKGROUND: Health literacy is a critical health determinant. To implement initiatives aiming at improving health literacy among children, adapted measurement tools are needed.

OBJECTIVE: This study aimed to translate, adapt, and test the Health Literacy Survey Child Questionnaire-15 (HLS-Child-Q15) to assess health literacy among French-speaking 8- to 11-year-old pupils.

METHODS: The HLS-Child-Q15 was translated and adapted to the French context to become the HLS-Child-Q15-FR. A cross-sectional survey was carried out using a written, self-reported questionnaire to assess the psychometric properties of the HLS-Child-Q15-FR.

KEY RESULTS: Translation and adaptation of the HLS-Child-Q15 German-French translated versions were cross-referenced. Back-translation led to minor refinements. Qualitative pre-test among children led to simplifications in wording and structure. Validation of the HLS-Child-Q15-FR. Four trained interviewers collected data among 3,107 pupils in 74 elementary schools of the Auvergne-Rhône-Alpes region. HLS-Child-Q15-FR showed good reliability (alpha = 0.83). Exploratory factor analysis showed a two-factor model related to health care and primary prevention. Construct validity analyses suggested removing 3 items. External validity analyses indicated a significant and moderate relationship with perceived self-efficacy.

CONCLUSION: This study aimed to address the issue of measuring health literacy among French-speaking 8- to 11-year-old pupils. The HLS-Child-Q15-FR showed a high internal consistency. Statistics suggested a two-dimensional thematic scale. These findings should be further investigated. [HLRP: Health Literacy Research and Practice. 2023;7(3):e144-e153.].

PMID:37552490 | DOI:10.3928/24748307-20230717-01

Health Lit Res Pract. 2023 Aug;7(3):e139-e143. doi: 10.3928/24748307-20230713-01. Epub 2023 Aug 7.

ABSTRACT

Effective communication with patients and between members of the health care team are important strategies to enhance health care outcomes. Despite the prevalence of low health literacy and associated risks in the population, health professionals are often not trained adequately in health literacy communication practices. The purpose of this pilot program is to determine if offering learners an opportunity to practice health literacy communication techniques in a simulated patient care team can increase skills, attitudes, and confidence in this important area of patient care. We implemented a novel, team-based interprofessional Objective Structured Clinical Examination (iOSCE) focused on health literacy. Evaluation took place on three levels: student self-assessment of health literacy communication skills and beliefs about interprofessional teamwork, standardized patient assessment of skills during the clinical encounter, and observer assessment of interprofessional teamwork. Statistically significant gains were seen in students’ health literacy communication confidence, as well as beliefs, attitudes and understanding of interprofessional teamwork. The aim of this article is to describe our pilot health literacy iOSCE findings. This pilot shows that an OSCE is an effective assessment tool for a mix of health professional learners at different levels to demonstrate health literacy practices in an interprofessional teamwork environment. [HLRP: Health Literacy Research and Practice. 2023;7(3):e139-e143.].

PMID:37552489 | DOI:10.3928/24748307-20230713-01

Ophthalmic Plast Reconstr Surg. 2023 Aug 8. doi: 10.1097/IOP.0000000000002480. Online ahead of print.

ABSTRACT

PURPOSE: The integrity of the orbit has a finite structural limit due to the compliance of its tissue. The authors investigate these limits to quantify them and inform the treatment of heightened ocular and orbital pressure.

METHODS: Cadaveric study with 12 orbits being volumized before randomization of treatment for pathologic levels of ocular and orbital pressure. First-line and second-line treatment was chosen randomly (lateral cantholysis, superior septolysis, inferior septolysis). Prior to treatment, IOP, orbital compartment pressure, and axial globe projection was measured after delivery of each 1cc aliquot and surgical treatment.

RESULTS: Orbital compartment pressure and IOP were well correlated (r = 0.99). The average reduction in IOP after treatment averaged a 56.2 mm Hg reduction in IOP. All treatments were statistically equivalent (p < 0.01). Loss of compliance (PLOC) was determined when the mean plus 1 standard deviation of change in IOP/ml volume was achieved with simultaneous change in exophthalmometry of <0.5 mm change/ml added volume, indicating an acceleration in pressure in the face of a steady volume. This criteria was met for 11 of 12 orbits. The 12th orbit missed this threshold by 1 mm Hg in IOP. PLOC occurred at an average IOP of 43.0 mm Hg (±5.8 mm Hg, 90% CI) and after an average injection of 13 ml (±1.4 mm, 90% CI). Additionally, lateral cantholysis, superior septolysis, and inferior septolysis were statistically equivalent in reducing IOP after PLOC.

CONCLUSIONS: IOP and orbital compartment pressure are excellent proxies for each other in the authors’ model. Orbital compliance is a mathematic phenomenon that can be quantified, as evident in this investigation. PLOC can inform timing for orbital decompressions in the presence of heightened IOP. Multiple procedures can be used to extinguish dangerously high orbital compartment pressure.

PMID:37552488 | DOI:10.1097/IOP.0000000000002480

JAMA Netw Open. 2023 Aug 1;6(8):e2327415. doi: 10.1001/jamanetworkopen.2023.27415.

ABSTRACT

IMPORTANCE: Reasons for elevated suicide risks among autistic people are unclear, with insufficient population-based research on sex-specific patterns to inform tailored prevention and intervention.

OBJECTIVES: To examine sex-stratified rates of self-harm events and suicide death among autistic individuals compared with nonautistic individuals, as well as the associated sociodemographic and clinical risk factors.

DESIGN, SETTING, AND PARTICIPANTS: This population-based matched-cohort study using linked health administrative databases in Ontario, Canada included all individuals with physician-recorded autism diagnoses from April 1, 1988, to March 31, 2018, each matched on age and sex to 4 nonautistic individuals from the general population. Self-harm events resulting in emergency health care from April 1, 2005, to December 31, 2020, were examined for one cohort, and death by suicide and other causes from April 1, 1993, to December 31, 2018, were examined for another cohort. Statistical analyses were conducted between October 2021 and June 2023.

EXPOSURE: Physician-recorded autism diagnoses from 1988 to 2018 from health administrative databases.

MAIN OUTCOMES AND MEASURES: Autistic and nonautistic individuals who were sex stratified a priori were compared using Andersen-Gill recurrent event models on self-harm events, and cause-specific competing risk models on death by suicide or other causes. Neighborhood-level income and rurality indices, and individual-level broad diagnostic categories of intellectual disabilities, mood and anxiety disorders, schizophrenia spectrum disorders, substance use disorders, and personality disorders were covariates.

RESULTS: For self-harm events (cohort, 379 630 individuals; median age at maximum follow-up, 20 years [IQR, 15-28 years]; median age of first autism diagnosis claim for autistic individuals, 9 years [IQR, 4-15 years]; 19 800 autistic females, 56 126 autistic males 79 200 nonautistic females, and 224 504 nonautistic males), among both sexes, autism diagnoses had independent associations with self-harm events (females: relative rate, 1.83; 95% CI, 1.61-2.08; males: relative rate, 1.47; 95% CI, 1.28-1.69) after accounting for income, rurality, intellectual disabilities, and psychiatric diagnoses. For suicide death (cohort, 334 690 individuals; median age at maximum follow-up, 19 years [IQR, 14-27 years]; median age of first autism diagnosis claim for autistic individuals, 10 years [IQR, 5-16 years]; 17 982 autistic females, 48 956 autistic males, 71 928 nonautistic females, 195 824 nonautistic males), there was a significantly higher crude hazard ratio among autistic females (1.98; 95% CI, 1.11-3.56) and a nonsignificantly higher crude hazard ratio among autistic males (1.34; 95% CI, 0.99-1.82); the increased risks were associated with psychiatric diagnoses.

CONCLUSIONS AND RELEVANCE: This cohort study suggests that autistic individuals experienced increased risks of self-harm events and suicide death. Psychiatric diagnoses were significantly associated with the increased risks among both sexes, especially for suicide death, and in partially sex-unique ways. Autism-tailored and autism-informed clinical and social support to reduce suicide risks should consider multifactorial mechanisms, with a particular focus on the prevention and timely treatment of psychiatric illnesses.

PMID:37552480 | DOI:10.1001/jamanetworkopen.2023.27415

JAMA Netw Open. 2023 Aug 1;6(8):e2328005. doi: 10.1001/jamanetworkopen.2023.28005.

ABSTRACT

IMPORTANCE: Advancements in technology, including mobile-based ecological momentary assessments (EMAs) and passive sensing, have immense potential to identify short-term suicide risk. However, the extent to which EMA and passive data, particularly in combination, have utility in detecting short-term risk in everyday life remains poorly understood.

OBJECTIVE: To examine whether and what combinations of self-reported EMA and sensor-based assessments identify next-day suicidal ideation.

DESIGN, SETTING, AND PARTICIPANTS: In this intensive longitudinal prognostic study, participants completed EMAs 4 times daily and wore a sensor wristband (Fitbit Charge 3) for 8 weeks. Multilevel machine learning methods, including penalized generalized estimating equations and classification and regression trees (CARTs) with repeated 5-fold cross-validation, were used to optimize prediction of next-day suicidal ideation based on time-varying features from EMAs (affective, cognitive, behavioral risk factors) and sensor data (sleep, activity, heart rate). Young adult patients who visited an emergency department with recent suicidal ideation and/or suicide attempt were recruited. Identified via electronic health record screening, eligible individuals were contacted remotely to complete enrollment procedures. Participants (aged 18 to 25 years) completed 14 708 EMA observations (64.4% adherence) and wore a sensor wristband approximately half the time (55.6% adherence). Data were collected between June 2020 and July 2021. Statistical analysis was performed from January to March 2023.

MAIN OUTCOMES AND MEASURES: The outcome was presence of next-day suicidal ideation.

RESULTS: Among 102 enrolled participants, 83 (81.4%) were female; 6 (5.9%) were Asian, 5 (4.9%) were Black or African American, 9 (8.8%) were more than 1 race, and 76 (74.5%) were White; mean (SD) age was 20.9 (2.1) years. The best-performing model incorporated features from EMAs and showed good predictive accuracy (mean [SE] cross-validated area under the receiver operating characteristic curve [AUC], 0.84 [0.02]), whereas the model that incorporated features from sensor data alone showed poor prediction (mean [SE] cross-validated AUC, 0.56 [0.02]). Sensor-based features did not improve prediction when combined with EMAs. Suicidal ideation-related features were the strongest predictors of next-day ideation. When suicidal ideation features were excluded, an alternative EMA model had acceptable predictive accuracy (mean [SE] cross-validated AUC, 0.76 [0.02]). Both EMA models included features at different timescales reflecting within-day, end-of-day, and time-varying cumulative effects.

CONCLUSIONS AND RELEVANCE: In this prognostic study, self-reported risk factors showed utility in identifying near-term suicidal thoughts. Best-performing models required self-reported information, derived from EMAs, whereas sensor-based data had negligible predictive accuracy. These results may have implications for developing decision algorithms identifying near-term suicidal thoughts to guide risk monitoring and intervention delivery in everyday life.

PMID:37552477 | DOI:10.1001/jamanetworkopen.2023.28005

Lasers Med Sci. 2023 Aug 8;38(1):178. doi: 10.1007/s10103-023-03845-8.

ABSTRACT

The purpose of this study is to study the role of retro-mode (RM) in early detection and to compare it with other preexisting available modalities on multimodal imaging system in dry AMD. A prospective observational cross-sectional study was done between November 2020 and October 2021 which included 409 eyes of 207 patients. For study purpose, eyes were divided into 3 groups according to the size and number of the drusen, viz, group 1: No AMD, group 2: early AMD and group 3: intermediate AMD which was further divided into 2 subgroups, viz, subgroup A: eyes with drusen size 63-125 μm and subgroup B: eyes with drusen size 125-250 μm. Patients with active or treated wet AMD, scarred choroidal neovascular membrane (CNVM), other maculopathies, other retinopathies, high myopia, trauma and glaucoma were excluded from the study. In cases of No AMD and early AMD, a number of drusens detected on RM were statistically not significant compared to fundus autofluorescence (FAF) and color photo (CF), but in intermediate AMD cases, it was statistically significant. While the area involved by drusens calculated by RM was statistically significant compared to both other modalities. When all modalities were compared with enhanced depth imaging-optical coherence tomography (EDI-OCT) at the choroid and chorio-capillary (CC) level and vessel density (VD) on optical coherence tomography angiography (OCTA) at the choroid, capillaries, deep retinal and superficial retinal plexus level; it was only RM which was found to be in sync with these proven modalities in terms of pattern and trend. In the present scenario, RM is found to be a better diagnostic modality in detecting early and a greater number of drusens with area of involvement than other existing modalities. Though superior, as found in this study, this mode cannot replace other modalities at present but only acts as a complementary investigation in early detection of this disease.

PMID:37552467 | DOI:10.1007/s10103-023-03845-8

Environ Sci Pollut Res Int. 2023 Aug 8. doi: 10.1007/s11356-023-29064-w. Online ahead of print.

ABSTRACT

The sustainability of the earth depends on renewable energy. Forecasting the output of renewable energy has a big impact on how we operate and manage our power networks. Accurate forecasting of renewable energy generation is crucial to ensuring grid dependability and permanence and reducing the risk and cost of the energy market and infrastructure. Although there are several approaches to forecasting solar radiation on a global scale, the two most common ones are machine learning algorithms and cloud pictures combined with physical models. The objective is to present a summary of machine learning-based techniques for solar irradiation forecasting in this context. Renewable energy is being used more and more in the world’s energy grid. Numerous strategies, including hybrids, physical models, statistical approaches, and artificial intelligence techniques, have been developed to anticipate the use of renewable energy. This paper examines methods for forecasting renewable energy based on deep learning and machine learning. Review and analysis of deep learning and machine learning forecasts for renewable energy come first. The second paragraph describes metaheuristic optimization techniques for renewable energy. The third topic was the open issue of projecting renewable energy. I will wrap up with a few potential future job objectives.

PMID:37552450 | DOI:10.1007/s11356-023-29064-w

Clin Exp Med. 2023 Aug 8. doi: 10.1007/s10238-023-01153-7. Online ahead of print.

ABSTRACT

To assess the effect of pharmacotherapeutic interventions commonly employed in the management of COVID-19 hospitalized patients on the development of post-COVID-19 syndrome. This study employed two distinct databases, the Medisch Spectrum Twente (MST) clinical database comprising electronic health records of COVID-19 patients hospitalized at MST, and the Post-COVID cohort database which contains follow-up information on the same patients. These databases were integrated to establish the potential relationship between the administration of corticosteroids, antibiotics, or anticoagulants during hospitalization and the occurrence of post-COVID-19 syndrome after a 6-month interval following discharge. A total of 123 patients who were hospitalized due to COVID-19 infection were included in this study. Among these patients, 33 (26.8%) developed post-COVID-19 syndrome which persisted even 6 months after hospital discharge. Multivariate analysis revealed that patients who received treatment with corticosteroids had a significantly lower likelihood (OR 0.32, 95% CI 0.11-0.90) of developing post-COVID-19 syndrome, while no significant association was observed for treatment with antibiotics (OR 1.26, 95% CI 0.47-3.39) or anticoagulants (OR 0.55, 95% CI 0.18-1.71). The findings of this study indicate that corticosteroids exert a significant protective effect against the development of post-COVID-19 syndrome in patients who were hospitalized due to COVID-19 infection. Although a trend towards a protective effect of anticoagulants was observed, it did not reach statistical significance. On the contrary, patients treated with antibiotics were shown to have increased chances of developing post-COVID-19 syndrome, although this effect was also not statistically significant.

PMID:37552413 | DOI:10.1007/s10238-023-01153-7