Nevin Manimala

Fundam Clin Pharmacol. 2023 Jan 23. doi: 10.1111/fcp.12873. Online ahead of print.

ABSTRACT

BACKGROUND: Previous estimates to meta-analyze administration error rates were limited by the high statistical heterogeneity, restricting their use.

OBJECTIVES: To investigate sources of heterogeneity in pooled administration error rates in hospitalized adults.

METHODS: We systematically searched scientific databases up to November 2017 for studies presenting error rates/relevant numerical data in hospitalized adults. We conducted separate meta-analyses for the numerators: One Medication Error (OME) (each dose can be correct or incorrect) and Total Number of Errors (TNE) (more than one error per dose could be counted), using the generic inverse variance with a 95%-confidence interval. Heterogeneity was assessed using the I² and Cochran’s Q test.

RESULTS: We meta-analyzed 33 studies. The global pooled analyses based on the OME and TNE numerators showed very high heterogeneity (I² =100%;p<0.00001). For each meta-analysis, subgroup analyses based on study characteristics (countries, wards, population, routes of administration, error detection methods, and medications) yielded results with consistently elevated heterogeneity. Beyond these characteristics, we stratified the studies according to the mean error prevalence level as the threshold. Based on the OME numerator, we identified two subgroups of low (0.15[0.13-0.17];I² =0%;p=0.43) and high (0.26[0.24-0.27];I² =38%;p=0.17) pooled prevalence rates, with controlled heterogeneity. Similarly, for the TNE numerator, we identified two subgroups of low (0.10[0.09-0.10];I² =0%;p=0.76) and high (0.28[0.27-0.29];I² =0%; p=0.89) pooled prevalence rates, with controlled heterogeneity. These subgroups differed regarding the denominators used: Total opportunities for errors versus others (doses, observations, administrations).

CONCLUSION: Calculation methods, specifically the denominator, seem a primary factor in explaining heterogeneity in error rates. Standardizing numerators, denominators, and definitions is necessary.

PMID:36691676 | DOI:10.1111/fcp.12873

J Trop Med. 2023 Jan 14;2023:2831175. doi: 10.1155/2023/2831175. eCollection 2023.

ABSTRACT

BACKGROUND: Food handlers should be screened periodically for intestinal parasitic infections, and they should be treated to reduce intestinal parasite transmission to consumers through contaminated foods and drinks. Therefore, this study aimed to assess the prevalence and associated risk factors of intestinal parasitic infection among food handlers in Woldia town, North-East Ethiopia.

METHOD: A community-basedcross-sectional study was conducted among food handlers in Woldia town, North-East Ethiopia. A structured questionnaire was used to collect sociodemographic characteristics and intestinal parasite-associated risk factors. Microscopic examination of a stool sample was performed using wet-mount and formol-ether concentration techniques. Data were analyzed using SPSS version 20.0 statistical software packages. Bivariate and multivariate analyses were performed to investigate the association between intestinal parasitic infections and associated risk factors. In all comparisons, P value <0.05 was considered as statistically significant.

RESULT: The overall prevalence of intestinal parasitic infection among food handlers in Woldia town was 14.3%. Six different intestinal parasites were detected. The majority of the parasites identified were helminthic infections 37/52 (71%). Ascaris lumbricoides was the most dominant parasite (7.7%), followed by E. histolytica/dispar (2.7%) and G. lamblia (1.4%). Multivariate logistic regression analysis showed that intestinal parasitic infection had a statistically significant association with food handlers’ habits of hand washing without soap after latrine use (P < 0.01), swimming habit (P=0.03), and using a common knife (P < 0.01).

CONCLUSION: This study revealed a relatively high prevalence of intestinal parasites among food handlers in Woldia town. Strict and standard hygienic and sanitary practices should be implemented by food handlers. Moreover, food handlers should be screened for intestinal parasitic infection, and health education should be given periodically.

PMID:36691674 | PMC:PMC9867574 | DOI:10.1155/2023/2831175

Sci Afr. 2023 Mar;19:e01519. doi: 10.1016/j.sciaf.2022.e01519. Epub 2023 Jan 2.

ABSTRACT

A Bayesian joint modeling approach to dynamic prediction of HIV progression and mortality allows individualized predictions to be made for HIV patients, based on monitoring of their CD4 counts. This study aims to provide predictions of patient-specific trajectories of HIV disease progression and survival. Longitudinal data on 254 HIV/AIDS patients who received ART between 2009 and 2014, and who had at least one CD4 count observed, were employed in a Bayesian joint model of disease progression. Different forms of association structure that relate the longitudinal CD4 biomarker and time to death were assessed; and predictions were averaged over the different models using Bayesian model averaging. The individual follow-up times ranged from 1 to 120 months, with a median of 22 months and IQR 7-39 months. The estimates of the association structure parameters from two of the three models considered indicated that the HIV mortality hazard at any time point is associated with the rate of change in the underlying value of the CD4 count. Model averaging the dynamic predictions resulted in only one of the hypothesized association structures having non-zero weight in almost all time points for each individual, with the exception of twelve patients, for whom other association structures were preferred at a few time points. The predictions were found to be different when we averaged them over models than when we derived them from the highest posterior weight model alone. The model with highest posterior weight for almost all time points for each individual gave an estimate of the association parameter of -0.02 implying that for a unit increase in the CD4 count, the hazard of HIV mortality decreases by a factor (hazard ratio) of 0.98. Functional status and alcohol intake are important contributing factors that affect the mean square root of CD4 measurements.

PMID:36691645 | PMC:PMC7614071 | DOI:10.1016/j.sciaf.2022.e01519

Educ Inf Technol (Dordr). 2023 Jan 19:1-26. doi: 10.1007/s10639-023-11585-z. Online ahead of print.

ABSTRACT

Despite the growing attention towards gamification in learning context, challenge-based gamification application has rarely been subjected to testing in education. In recognition of this void, and grounded on gamification principles, we developed Educhall web-based program. Drawing on self-determination theory, and flow theory the present study aims to explore how the application of this challenge-based gamified program in to learning process of students can increase students’ motivation, flow, and academic success through the generated competition and challenge. The study applied a random experimental research design within distance learning context with 30 university students of control group and 30 students of experimental group who used the Educhall application for one academic semester. In line with self-determination theory, it was statistically evidenced that application of challenge-based gamified learning method increased level of academic performance and overall motivation. Of the motivational sub factors, experimental group reported significantly higher confidence level and satisfaction towards the course. Furthermore, grounded on flow theory, the study showed that challenge-based gamified learning increased flow level of learners but not significantly which warrants further data collection and experimental research in future studies. Implications for research and practice are discussed.

PMID:36691635 | PMC:PMC9850335 | DOI:10.1007/s10639-023-11585-z

Cereb Circ Cogn Behav. 2023 Jan 7;4:100157. doi: 10.1016/j.cccb.2023.100157. eCollection 2023.

ABSTRACT

INTRODUCTION: In this follow-up study, cerebral microvascular formations termed ‘raspberries’ were quantified according to cerebral atherosclerosis (C-ASCL) and acute circulatory failure (ACF). We also examined the regional distribution of raspberries throughout the brain.

MATERIALS AND METHODS: The study population consisted of adult individuals who had undergone a diagnostic neuropathological autopsy. Groups were formed to examine the association between raspberries, C-ASCL and ACF (control group, C-ASCL group, C-ASCL+ACF group [n = 47 per group] and a combined C-ASCL-tot group [n = 94]). To examine the regional distribution, additional groups were formed based on previously known raspberry densities of the frontal cortex (high-, medium- and low-density group [n = 6 per group]). Raspberries were quantified on scanned haematoxylin-eosin-stained sections.

RESULTS: Cortical raspberry density did not differ at a statistically significant level between the control group, the C-ASCL group and the C-ASCL+ACF group (P = 0.10) but did so between the control group and the C-ASCL-tot group (P = 0.033). The total raspberry density of the high-, medium- and low-density groups differed at a statistically significant level (P = 0.005), which remained in group-to-group comparisons of the high- and medium-density groups (P = 0.015) and the high- and low-density groups (P = 0.002). Raspberries were rare in cerebral white matter and in the cerebellum.

CONCLUSION: An association between raspberry density and C-ASCL is supported but is weaker than previously indicated. An association with ACF is not indicated. The raspberry density of the frontal cortex provides an approximation of the brain’s total raspberry density.

PMID:36691600 | PMC:PMC9860404 | DOI:10.1016/j.cccb.2023.100157

BMJ Open. 2022 Sep 8;12(9):e055581. doi: 10.1136/bmjopen-2021-055581.

ABSTRACT

OBJECTIVES: This study aims to explore the spatial and spatiotemporal distribution of pertussis in Hunan Province, and provide a scientific basis for targeting preventive measures in areas with a high incidence of pertussis.

DESIGN: In this retrospective spatial and spatiotemporal (ecological) study, the surveillance and population data of Hunan Province from 2009 to 2019 were analysed. The ArcGIS V.10.3 software was used for spatial autocorrelation analysis and visual display, and SaTScan V.9.6 software was used for statistical analysis of spatiotemporal scan data.

SETTINGS: Confirmed and suspected pertussis cases with current addresses in Hunan Province and onset dates between 1 January 2009 and 31 December 2019 were included in the study.

PARTICIPANTS: The study used aggregated data, including 6796 confirmed and suspected pertussis cases.

RESULTS: The seasonal peak occurred between March and September, and scattered children were at high risk. The global Moran’s I was between 0.107 and 0.341 (p<0.05), which indicated that the incidence of pertussis in Hunan had a positive spatial autocorrelation. The results of local indicators of spatial autocorrelation analysis showed that the hot spots were mainly distributed in the northeast region of Hunan Province. Moreover, both purely space and spatiotemporal scans showed that the central and northeastern parts were the most likely cluster areas with an epidemic period between March and October in 2018 and 2019.

CONCLUSION: The distribution of the pertussis epidemic in Hunan Province from 2009 to 2019 shows spatiotemporal clustering. The clustering areas of the pertussis epidemic were concentrated in the central and northeastern parts of Hunan Province between March and October 2018 and 2019. In areas with low pertussis incidence, the strengthening of the monitoring system may reduce under-reporting. In areas with high pertussis incidence where we could study whether the genes of endemic pertussis strains are mutated and differ from vaccine strains.

PMID:36691220 | DOI:10.1136/bmjopen-2021-055581

BMJ Open. 2022 Sep 8;12(9):e058491. doi: 10.1136/bmjopen-2021-058491.

ABSTRACT

OBJECTIVE: To examine the association between area-level education and the local growth trajectories in antibacterial dispensing rates in Norwegian municipalities among children under 3 years old.

DESIGN: Retrospective, longitudinal study using individual primary care prescription data from the Norwegian Prescription Database for the period 2006-2016. Data were collected on the date of dispensing, the type and amount of antibiotic, the patient’s age, sex and municipality of residence and linked to municipality-level statistics on education available from Statistics Norway. We used multilevel growth curve modelling, with a linear trend variable modelled as a random effect and a cross-level interaction between linear trends and the proportion of the population in the municipality having received a university or college education.

SETTING: The local government level in Norway. The sample includes all municipalities over the study period.

OUTCOME MEASURE: Number of dispensed antibacterial prescriptions per 100 children in individual primary care by municipality and year.

RESULTS: We identified a significant negative linear trend in the square root of the dispensing rate for children under 3 years old during the period. This trend varied between municipalities. A negative cross-level interaction term between population education levels and random trends showed that municipalities with an average level of population education saw a reduction in their square root dispensing rates of -0.053 (95% CI -0.066 to -0.039) prescriptions per 100 children. Each additional percentage point in population education contributed a further -0.0034 (95% CI -0.006 to -0.001) reduction to the square root dispensing rate.

CONCLUSIONS: Municipalities in which a larger proportion of the local population have high educational achievements have been more successful in reducing antibacterial dispensing rates in children under 3 years old. Adopting area-level strategies and addressing local community disadvantages may help to optimise practices and prescribing patterns across local communities.

PMID:36691217 | DOI:10.1136/bmjopen-2021-058491

BMJ Open. 2022 Sep 8;12(9):e060775. doi: 10.1136/bmjopen-2022-060775.

ABSTRACT

OBJECTIVE: To describe the chronological genomic evolution of SARS-CoV-2 and its impact on public health in the Middle East and North Africa (MENA) region.

METHODS: This study analysed all available SARS-CoV-2 genomic sequences, metadata and rates of COVID-19 infection from the MENA region retrieved from the Global Initiative on Sharing All Influenza Data database from January 2020 to August 2021. Inferential and ‎descriptive statistics were conducted to describe the epidemiology of SARS-CoV-2.

RESULTS: Genomic surveillance of SARS-CoV-2 in the MENA region indicated that the variants in January 2020 predominately belonged to the G, GR, GH or O clades and that the most common variant of concern was Alpha. By August 2021, however, the GK clade dominated (57.4% of all sequenced genomes), followed by the G clade (18.7%) and the GR clade (11.6%). In August, the most commonly sequenced variants of concern were Delta in the Middle East region (91%); Alpha (44.3%) followed by Delta (29.7%) and Beta (25.3%) in the North Africa region; and Alpha (88.9%), followed by Delta (10%) in the fragile and conflict-affected regions of MENA. The mean proportion of the variants of concern among the total sequenced samples differed significantly by country (F=1.93, P=0.0112) but not by major MENA region (F=0.14, P=0.27) or by vaccination coverage (F=1.84, P=0.176).

CONCLUSION: This analysis of the genomic surveillance of SARS-CoV-2 provides an essential description the virus evolution and its impact on public health safety in the MENA region. As of August 2021, the Delta variant showed a genomic advantage in the MENA region. The MENA region includes several fragile and conflict-affected countries with extremely low levels of vaccination coverage and little genomic surveillance, which may soon exacerbate the existing health crisis within those countries and globally.

PMID:36691215 | DOI:10.1136/bmjopen-2022-060775

BMJ Open. 2022 Sep 8;12(9):e064573. doi: 10.1136/bmjopen-2022-064573.

ABSTRACT

INTRODUCTION: The carcinogenic liver fluke Opisthorchis viverrini is a major public health problem in the Mekong basin region. The liver flukes can induce cholangiocarcinoma, a bile duct cancer that causes a significant burden of mortality and economic loss. Various public health interventions have been conducted to reduce opisthorchiasis but the prevalence of O. viverrini remains high in endemic regions. The aim is to quantify the effectiveness of public health interventions in reducing the prevalence of O. viverrini infection.

METHODS AND ANALYSIS: Seven databases (including PubMed, SCOPUS, Web of Science, EMBASE, ScienceDirect, Thai thesis database and TCI (Thai journals online)) will be searched from initiation through to 2022 to identify studies of interventions to reduce the prevalence of O. viverrini infection. The prevalence, incidence or number of O. viverrini-infected people will be used as the source of O. viverrini prevalence data. A conventional meta-analysis and a Bayesian network meta-analysis will be conducted to undertake direct and indirect comparisons of different interventions. Meta-regression will be used to determine the effect of each intervention. The risk of bias will be assessed using the Cochrane Collaboration’s risk of bias tool. Heterogeneity between studies will be determined by forest plots and I² and publication bias investigated with funnel plots and the Egger’s test.

ETHICS AND DISSEMINATION: Ethical approval will not be required because this study will only use published data. The final report of this review will be disseminated through publication in a peer-reviewed scientific journal and will also be presented at relevant conferences.

PROSPERO REGISTRATION NUMBER: CRD42022323066.

PMID:36691213 | DOI:10.1136/bmjopen-2022-064573

BMJ Open. 2022 Sep 8;12(9):e062351. doi: 10.1136/bmjopen-2022-062351.

ABSTRACT

INTRODUCTION: Therapeutic recommendations for hidradenitis suppurativa (HS) have recently shifted towards non-invasive pharmacological options. Recent evidence has shown promising efficacy for specific treatments. However, data regarding the comparative efficacy of these treatments in patients with HS are still limited. Therefore, we plan to conduct a systematic review and network meta-analysis (NMA) to summarise the benefits and harms of different pharmacological interventions for treating people living with HS.

METHODS AND ANALYSIS: We will search electronic databases, including Medline, Embase, PubMed, Web of Science, Scopus, CINAHL and Cochrane Library beginning from their inception dates with no language restrictions. A grey literature search will be performed to supplement the electronic databases. Both randomised trials and non-randomised studies using validated measurement tools that investigated the benefits and harms of pharmacological interventions among people living with HS will be included. The predefined primary outcomes will include treatment responses that reflect the patient’s perspective and all-cause discontinuation. Screening, selection, extraction, assessment of the risk of bias and analysis of the strength of the evidence will be performed independently by a pair of reviewers. A two-step approach of traditional pairwise and NMA will be performed. Based on a random-effects model, standardised weighted mean differences and ORs with corresponding 95% CIs will be pooled as effect estimates for the continuous and categorical endpoints, respectively. Statistical and methodological heterogeneities will be assessed. Preplanned subgroup analyses and univariate meta-regression will be conducted to quantify the potential sources of heterogeneity. Evidence-based synthesis will be based on the magnitudes of effect size, evidence certainty and the surface under the cumulative ranking curve values.

ETHICS AND DISSEMINATION: Ethical approval is not required because this study is based on existing published data. These findings will be disseminated through scientific meetings and publications in peer-reviewed journals.

PROSPERO REGISTRATION NUMBER: CRD42022302795.

PMID:36691211 | DOI:10.1136/bmjopen-2022-062351