Nevin Manimala

Diagn Pathol. 2023 Jan 10;18(1):3. doi: 10.1186/s13000-022-01278-5.

ABSTRACT

BACKGROUND: Much is known about tumor infiltrating lymphocytes (Tils) in primary breast cancer, as this has been the focus of much research in recent years, but regarding recurrent breast cancer, only few studies have been done. Our aim was to compare the quantities of Tils in primary breast carcinomas and their corresponding recurrences and to analyze the differences in the tumor Tils compositions in correlations with recurrence-free times and the clinicopathology of the tumor.

METHODS: One hundred thirty-seven breast cancer patients self-paired for primary- tumor-recurrence were divided into three groups based on the length of the recurrence-free interval. H&E-staining and immunohistochemical staining with antiCD3, antiCD4, antiCD8 and antiCD56 were performed. Differences in Tils between primaries and recurrences, between the recurrence-free interval groups, and between different clinicopathologic parameters were statistically analyzed.

RESULTS: Fewer stromal CD3+, CD8+ and CD56+ lymphocytes were found at recurrences compared to the primaries. No significant change in the percentage of CD4+ stromal lymphocytes. ER-negative primaries, PR-negative or HER2-positive tumors had more Tils in some subgroups. Ductal primaries had more Tils than lobular primaries and G3 tumors had more Tils than lower-grade tumors. The corresponding differences at recurrences could either not be detected or they were reversed. The fastest recurring group had generally more Tils than the slower groups.

CONCLUSIONS: CD4+ cell numbers did not decline from primary to recurrence in contrast to all other subclasses of lymphocytes. The proportion of CD4+ cells was higher in recurrences than in primaries. Tumors with a higher grade and proliferation rate had higher percentages of Tils. HER2+ and hormone receptor negative tumors tended to have higher Tils scores. In recurrences these differences were not seen or they were reversed.

PMID:36627701 | DOI:10.1186/s13000-022-01278-5

BMC Endocr Disord. 2023 Jan 10;23(1):11. doi: 10.1186/s12902-022-01234-w.

ABSTRACT

We investigated the prevalence and clinical metabolic characteristics of lean nonalcoholic fatty liver disease (NAFLD) in an elderly Chinese population and assessed the relevance of lipid markers and genetic variation. All 5,338 community subjects underwent detailed clinical and laboratory examinations and were divided into three groups: lean (Body mass index (BMI) < 23 kg/m², n = 2,012), overweight (BMI = 23-24.9 kg/m², n = 1,354), and obese (BMI ≥ 25 kg/m², n = 1,972). Single nucleotide polymorphisms were selected based on those reported in previous NAFLD or obesity genome-wide association studies. The frequencies of alleles and genotypes were calculated and statistically analyzed with Pearson’s χ² tests. One-way ANCOVA was used to test the association between positive SNPs and metabolic parameters in lean NAFLD individuals. Our results showed that the C allele frequency of rs2279026, the G allele of rs2279028, the C allele of rs780093, and the C allele frequency of rs1260326 were higher in obese NAFLD than in lean NAFLD (P < 0.05). In addition, we observed an association between the CC of rs1421085, TT of rs3751812, AA of rs8050136, and AA of rs9939609 genotypes in the FTO gene and low-density lipoprotein levels (P < 0.05). In conclusion, our findings provide a unique perspective on the prevalence, genetic characteristics, and metabolic profile of NAFLD in older lean individuals in China. This is the first study to examine the association between genetic variants in the FTO, TFAP2B and GCKR genes and NAFLD in a cohort of lean individuals.

PMID:36627697 | DOI:10.1186/s12902-022-01234-w

BMC Nutr. 2023 Jan 10;9(1):7. doi: 10.1186/s40795-023-00672-6.

ABSTRACT

BACKGROUND: Breakfast is considered the day’s most important meal. Skipping breakfast consumption is detrimental to health and intellectual performance. University life has tight schedules and rigorous intellectual activities often very early in the morning. This study aimed at assessing breakfast intake and its associated factors among the students of Takoradi Technical University (TTU).

METHODS: This was a descriptive cross-sectional study. Data was collected from 347 students in TTU using pre-tested questionnaire. Data collected were analysed using STATA v17. It employed descriptive and inferential statistics such as logistic regression. P-value less than 0.05 was set as statistical significance at 95% confidence interval.

RESULTS: Regular breakfast was taken by 35.7% of the students. Higher odds of regular breakfast intake were found among respondents aged 25-29 years (AOR = 3.13, 95%CI = 1.57-6.24) and those who buy their breakfast (AOR = 5.13, 95%CI = 2.16-12.19). However, lower odds of regular breakfast consumption were found among respondents who were females (AOR = 0.40, 95%CI = 0.18-0.85). Barriers to regular breakfast intake included negative mood, insufficient funds, health condition, weight management, religious reasons such as fasting, limited time/unfavourable academic schedules, daily activities/workload, and cost of food on campus.

CONCLUSION: The study stressed on the need for external and personal factors such as sex, age, religion, limited time/unfavourable academic schedules among others that hinder habitual breakfast intake to be addressed adopting innovative approach such as peer education and campaigns. University management should implement favourable policies on academic schedules, canteens/cafeterias, less stringent regulation on cooking at halls of residence.

PMID:36627687 | DOI:10.1186/s40795-023-00672-6

BMC Nutr. 2023 Jan 10;9(1):8. doi: 10.1186/s40795-023-00670-8.

ABSTRACT

BACKGROUND: In infant and young child feeding practice parents are the primary agents for childcare activities, such as feeding. Mothers’ role in infant and young child feeding practice has been the focus of previous research. The involvement of fathers in child-feeding practice has rarely been studied. Thus, this study aimed to assess fathers’ involvement in the complementary feeding of children and identify factors associated with it in Southern Ethiopia.

METHODS: A community-based cross-sectional study was conducted which included a survey, in-depth interviews, and focus group discussions (FGDs). The survey was conducted with 593 fathers who have at least one child of age 6-23 months. Four FGDs were conducted with fathers, and 21 in-depth interviews were conducted with fathers, mothers, and community health workers. The survey data were entered into Epi data software version 1.4.4.0 and statistical analysis was performed using SPSS software version 20. Bivariate and multivariate logistic regression analyses were performed and statistical significance was considered at p < 0.05. All interviews and FGDs were transcribed, coded, categorized, and analyzed using open code software version 4.0.2.

RESULTS: Of the total sample of 593, 50.9% of the fathers in the study were involved in their children’s complementary feeding practices. Fathers with better household income (AOR = 1.56; 95% CI: 1.09, 2.22) and good perception of child complementary feeding practice (AOR = 1.79; 95% CI: 1.28, 2.52) were more likely to be involved in their children’s complementary feeding practice. The majority of the fathers had better knowledge about the recommended complementary feeding practices.

CONCLUSIONS: Income-generating activities and behavioral change communication for fathers should be encouraged to improve their involvement in child feeding. Community-based nutrition programs should also give due attention to increasing the involvement of fathers.

PMID:36627682 | DOI:10.1186/s40795-023-00670-8

J Cardiothorac Surg. 2023 Jan 10;18(1):14. doi: 10.1186/s13019-022-02080-6.

ABSTRACT

BACKGROUND: Stanford type A aortic dissection (T(A)AD) is one of the most dangerous cardiovascular diseases and morbid obesity is associated with the prognosis of many cardiovascular diseases. The aim of this study is to investigate the impact of morbid obesity on in-hospital mortality, total hospital costs and discover the prevalence of morbid obesity among inpatients with T(A)AD.

METHODS: Patients with a primary diagnosis of T(A)AD were identified from the National Inpatient Sample database (NIS) from 2008 to 2017. These patients were categorized into non-obesity, obesity and morbid obesity. Multivariable regression models were utilized to assess the association between obesity/morbid obesity and in-hospital mortality, total cost and other clinical factors. The temporal trend in prevalence of obesity/morbid obesity in T(A)ADs and the trend of in-hospital mortality among different weight categories were also explored.

RESULTS: From the NIS database 8489 T(A)AD inpatients were identified, of which 7230 (85.2%) patients were non-obese, 822 (9.7%) were obese and 437 (5.1%) were morbid obese. Morbid obesity was associated with increased risk of in-hospital mortality (odds ratio [OR] 1.39; 95% confidence interval [CI] 1.03-1.86), 8% higher total cost compared with the non-obese patients. From 2008 to 2017, the rate of obesity and morbid obesity in patients with T(A)AD have significantly increased from 7.36 to 11.33% (P < 0.001) and from 1.95 to 7.37% (P < 0.001). Factors associated with morbid obesity in T(A)ADs included age, female, elective admission, hospital region, dyslipidemia, smoking, rheumatoid arthritis/collagen vascular diseases, chronic pulmonary disease, diabetes and hypertension.

CONCLUSIONS: Morbid obesity are connected with worse clinical outcomes and more health resource utilization in T(A)AD patients. Appropriate medical resource orientation and weight management education for T(A)AD patients may be necessary.

PMID:36627663 | DOI:10.1186/s13019-022-02080-6

BMC Womens Health. 2023 Jan 11;23(1):14. doi: 10.1186/s12905-023-02158-w.

ABSTRACT

BACKGROUND: Breast cancer remains the most serious public health problem affecting millions of women worldwide. Despite various studies regarding breast self-examination practices conducted among health professionals and students in Ethiopia, limited information was found on women attending health care services in the pastoralist community. This study aimed to identify the determinants of breast self-examination practice (BSE) among women attending pastoralist health facilities in Southern Ethiopia.

METHODS: An institutional-based cross-sectional study was conducted among 421 women who were attending family planning services in pastoralist health facilities in South Omo Zone, Southern Ethiopia from January to February 2022 using systematic random sampling to select a woman from each health facility in Jinka town. Data were collected using structured, pretested, and interviewer-administered questionnaires. Descriptive statistics such as proportions, means, and standard deviations were used to describe each relevant variable. Bivariate and multivariate logistic regression analyses were used to identify the determinants of BSE practices among women.

RESULT: The mean age of the women was 25.43 ± 6.66 years. Fifty-four percent (n = 173) of the women had heard of BSE from health professionals. Eighty-nine (21.1%) women had undergone BSE. Women who resided in the urban areas (AOR = 6.79, CI: 3.40, 13.56), attained at least primary education and above (AOR = 8.96, CI: 4.14, 19.35), heard about BSE (AOR = 4.07, CI: 2.07, 7.98), and had a family history of breast cancer (AOR = 7.46, CI = 3.27, 17.00) were significantly associated with BSE practice.

CONCLUSION AND RECOMMENDATION: Our study showed that women’s practice of BSE was lower when compared with the local studies. We recommend health care professionals and others working in the area improve ways of increasing awareness about breast cancer, including its risk, and the need for BSE.

PMID:36627644 | DOI:10.1186/s12905-023-02158-w

BMC Med Educ. 2023 Jan 10;23(1):16. doi: 10.1186/s12909-022-03976-6.

ABSTRACT

BACKGROUND: Traumatic musculoskeletal injuries are a common presentation to emergency care, the first-line investigation often being plain radiography. The interpretation of this imaging frequently falls to less experienced clinicians despite well-established challenges in reporting. This study presents novel data of clinicians’ confidence in interpreting trauma radiographs, their perception of AI in healthcare, and their support for the development of systems applied to skeletal radiography.

METHODS: A novel questionnaire was distributed through a network of collaborators to clinicians across the Southeast of England. Over a three-month period, responses were compiled into a database before undergoing statistical review.

RESULTS: The responses of 297 participants were included. The mean self-assessed knowledge of AI in healthcare was 3.68 out of ten, with significantly higher knowledge reported by the most senior doctors (Specialty Trainee/Specialty Registrar or above = 4.88). 13.8% of participants reported an awareness of AI in their clinical practice. Overall, participants indicated substantial favourability towards AI in healthcare (7.87) and in AI applied to skeletal radiography (7.75). There was a preference for a hypothetical system indicating positive findings rather than ruling as negative (7.26 vs 6.20).

CONCLUSIONS: This study identifies clear support, amongst a cross section of student and qualified doctors, for both the general use of AI technology in healthcare and in its application to skeletal radiography for trauma. The development of systems to address this demand appear well founded and popular. The engagement of a small but reticent minority should be sought, along with improving the wider education of doctors on AI.

PMID:36627640 | DOI:10.1186/s12909-022-03976-6

Int J Equity Health. 2023 Jan 10;22(1):8. doi: 10.1186/s12939-023-01825-6.

ABSTRACT

BACKGROUND: With the gradual increase of residents’ income and the continuous improvement of medical security system, people’s demand for pursuing higher quality and better medical and health services has been released. However, so far little research has been published on China’s high quality medical resources (HQMR). This study aims to understand the spatiotemporal variation trend of HQMR from 2006 to 2020, analyze regional disparity of HQMR in 2020, and further explore the main factors influencing the distribution of HQMR in China.

METHODS: The study selected Class III level A hospitals (the highest level medical institutions in China) to represent HQMR. Descriptive statistical methods were used to address the changes in the distribution of HQMR from 2006 to 2020. Lorentz curve, Gini coefficient (G), Theil index (T) and High-quality health resource density index (HHRDI) were used to calculate the degree of inequity. The geographical detector method was used to reveal the key factors influencing the distribution of HQMR.

RESULTS: The total amount of HQMR in China had increased year by year, from 647 Class III level A hospitals in 2006 to 1580 in 2020. In 2020, G for HQMR by population was 0.166, while by geographic area was 0.614. T was consistent with the results for G, and intra-regional contribution rates were higher than inter-regional contribution rates. HHRDI showed that Beijing, Shanghai, and Tianjin had the highest allocated amounts of HQMR. The results of the geographical detector showed that total health costs, government health expenditure, size of resident populations, GDP, number of medical colleges had a significant impact on the spatial distribution of HQMR and the q values were 0.813, 0.781, 0.719, 0.661, 0.492 respectively. There was an interaction between the influencing factors.

CONCLUSIONS: China’s total HQMR is growing rapidly but is relatively inadequate. The distribution of HQMR by population is better than by geography, and the distribution by geography is less equitable. Population size and geographical area both need to be taken into account when formulating policies, rather than simply increasing the number of HQMR.

PMID:36627636 | DOI:10.1186/s12939-023-01825-6

BMC Health Serv Res. 2023 Jan 10;23(1):23. doi: 10.1186/s12913-022-08995-z.

ABSTRACT

BACKGROUND: Institutions or clinicians (units) are often compared according to a performance indicator such as in-hospital mortality. Several approaches have been proposed for the detection of outlying units, whose performance deviates from the overall performance.

METHODS: We provide an overview of three approaches commonly used to monitor institutional performances for outlier detection. These are the common-mean model, the ‘Normal-Poisson’ random effects model and the ‘Logistic’ random effects model. For the latter we also propose a visualisation technique. The common-mean model assumes that the underlying true performance of all units is equal and that any observed variation between units is due to chance. Even after applying case-mix adjustment, this assumption is often violated due to overdispersion and a post-hoc correction may need to be applied. The random effects models relax this assumption and explicitly allow the true performance to differ between units, thus offering a more flexible approach. We discuss the strengths and weaknesses of each approach and illustrate their application using audit data from England and Wales on Adult Cardiac Surgery (ACS) and Percutaneous Coronary Intervention (PCI).

RESULTS: In general, the overdispersion-corrected common-mean model and the random effects approaches produced similar p-values for the detection of outliers. For the ACS dataset (41 hospitals) three outliers were identified in total but only one was identified by all methods above. For the PCI dataset (88 hospitals), seven outliers were identified in total but only two were identified by all methods. The common-mean model uncorrected for overdispersion produced several more outliers. The reason for observing similar p-values for all three approaches could be attributed to the fact that the between-hospital variance was relatively small in both datasets, resulting only in a mild violation of the common-mean assumption; in this situation, the overdispersion correction worked well.

CONCLUSION: If the common-mean assumption is likely to hold, all three methods are appropriate to use for outlier detection and their results should be similar. Random effect methods may be the preferred approach when the common-mean assumption is likely to be violated.

PMID:36627627 | DOI:10.1186/s12913-022-08995-z

BMC Health Serv Res. 2023 Jan 11;23(1):25. doi: 10.1186/s12913-022-09014-x.

ABSTRACT

OBJECTIVES: This study determined the correlates of unwanted pregnancy and induced abortion among sexually active female street-involved adolescents (SIAs) aged 10-19 years in two urban cities in South-west, Nigeria.

METHODS: The data for this study were extracted from a larger mixed-method survey dataset on the sexual and reproductive health (SRH) of 1505 street-involved young people aged 10 to 24 years. For the quantitative data, the explanatory variables were age, history of school attendance, employment status, religion, living arrangement and city of residence. The study outcomes were a history of pregnancy and a history of induced abortion of last pregnancy. Binomial regression analysis was performed to determine the association between the explanatory and outcome variables. For the qualitative data generated through focus group discussions and in-depth-interviews, inductive and deductive approaches were used in conducting a thematic analysis to explore the perspectives and experiences of SIA on pregnancy and induced abortion.

RESULTS: Of the 424 female SIAs, 270 (63.7%) reported having had sex. Sixty-four (23.7%) respondents had a history of pregnancy, of which 38 (59.4%) gave a history of induced abortion of the last pregnancy. A history of school attendance significantly reduced the likelihood of being pregnant (AOR: 0.42, 95% C.I: 0.19-0.91), while 15-19-years-old SIAs who were pregnant were significantly less likely to abort (AOR: 0.13, 95% C.I: 0.02-0.77). Qualitative reports indicated that unintended pregnancy and induced abortion was a common experience among the sexually active SIAs. Many participants were aware of the methods of, and places to induce abortion.

CONCLUSION: A large proportion of SIAs are sexually active with a high incidence of unintended pregnancy and a high rate of unsafe abortion. Access of female SIAs to education can reduce the risk of unintended pregnancy. Attention needs to be paid to how SIAs can have access to contraception.

PMID:36627625 | DOI:10.1186/s12913-022-09014-x