Nevin Manimala

J Perinat Med. 2021 Dec 13. doi: 10.1515/jpm-2021-0542. Online ahead of print.

ABSTRACT

OBJECTIVES: To compare the immunohistochemical expression of IL-6 in placental membranes of late preterm delivery in women with histologically proven chorioamnionitis with and without preterm premature rupture of membranes (PPROM).

METHODS: Fetal membranes were collected from 60 women who had late preterm delivery with histologic chorioamnionitis with and without PPROM (30 in each group). Immunohistochemistry for IL-6 was performed on formalin fixed and paraffin-embedded sections. The two groups were matched for age, body mass index and parity. SPSS Version 17.0 was used for statistical analysis.

RESULTS: There was no difference in immunohistochemical expression of IL-6 in placental membranes of women with histologic chorioamnionitis regardless of the membrane status.

CONCLUSIONS: Chorioamnionitis has no impact on immunohistochemical expression of IL-6 in placental membranes of women with late preterm delivery despite the clinical presentation.

PMID:34890500 | DOI:10.1515/jpm-2021-0542

J Nurs Manag. 2021 Dec 10. doi: 10.1111/jonm.13534. Online ahead of print.

ABSTRACT

AIM: To explore primary healthcare nurses’ mental health, concerns, and perceived safety and supports during COVID-19.

BACKGROUND: Respiratory pandemics have negative impacts on nurses’ wellbeing. While literature is replete with hospital nurses’ experiences, there is less exploration of COVID-19 impacts on primary healthcare nurses. Given the importance of primary healthcare nurses in the health system, understanding their experiences is vital.

METHODS: A cross-sectional survey of 359 primary healthcare nurses. The Depression Anxiety Stress Scales (DASS-21) was used to measure emotional state. Data were analysed using descriptive and inferential statistics.

RESULTS: DASS-21 scores indicated that 39.6% of participants were experiencing depressive, anxiety or stress symptoms. Of those, 41.8% were experiencing symptoms on one scale, 26.9% were experiencing symptoms on two scales and 31.2% were experiencing symptoms across all three scales. Most participants identified that their feelings were related to COVID-19.

CONCLUSIONS: COVID-19 is having a significant impact on primary healthcare nurses’ mental health. Nurse managers need to develop strategies to effectively address nurses’ concerns and support them to sustain the workforce during and after the pandemic.

IMPLICATIONS FOR NURSING MANAGEMENT: Findings from this study can inform the design of effective support programs to reduce mental health impacts and promote staff wellbeing.

PMID:34890472 | DOI:10.1111/jonm.13534

J Am Geriatr Soc. 2021 Dec 10. doi: 10.1111/jgs.17594. Online ahead of print.

ABSTRACT

BACKGROUND: Males have worse outcomes after hip fracture than female counterparts. Cognitive impairment (CI) also increases the risk of poor recovery from hip fracture; however, CI is under-recognized. Patient sex may contribute to this under-recognition through differential misclassification. The objective of this study was to measure under-recognition and differential misclassification of CI by patient sex.

METHODS: A cross-sectional analysis of baseline data from an observational cohort study of community-dwelling hip fracture patients aged 65 and older (n = 339; females = 171, males = 168) recruited from eight hospitals in the greater Baltimore, MD area within 15 days of hospitalization for surgical repair with cognitive testing within 22 days of admission. Indication of Alzheimer’s disease or related dementias and/or delirium as a postoperative complication in the medical record was considered evidence of documented CI. Observed CI was measured with the Modified Mini-Mental State Examination (3MS, ≤78). Source of cognitive impairment identification (SCI) was defined as: “3MS Only,” “Hospital Record Only,” “Both,” “No CI” was compared between males and females using logistic regression.

RESULTS: Males had more comorbidities and worse physical status upon admission, but otherwise had similar hospital experiences. SCI distribution was 12.7% “3MS Only” (n = 42), 11.5% “Hospital Record Only” (n = 38), 9.4% “Both” (n = 31), and “No CI” (n = 219). Males were more likely to be identified with CI using the “3MS Only” and “Both,” and females were more likely to have no indication of CI.

CONCLUSION: There were sex differences in the documentation of CI versus observed impairment. Males had more CI using direct testing. This may be contributing to sex differences in recovery outcomes after hip fracture. Results support the implementation of cognitive testing in hip fracture patients to reduce the impact of differential misclassification by patient sex.

PMID:34890469 | DOI:10.1111/jgs.17594

Hosp Pediatr. 2021 Dec 13:e2021006094. doi: 10.1542/hpeds.2021-006094. Online ahead of print.

ABSTRACT

CONTEXT: Artificial intelligence (AI) technologies are increasingly used in pediatrics and have the potential to help inpatient physicians provide high-quality care for critically ill children.

OBJECTIVE: We aimed to describe the use of AI to improve any health outcome(s) in neonatal and pediatric intensive care.

DATA SOURCE: PubMed, IEEE Xplore, Cochrane, and Web of Science databases.

STUDY SELECTION: We used peer-reviewed studies published between June 1, 2010, and May 31, 2020, in which researchers described (1) AI, (2) pediatrics, and (3) intensive care. Studies were included if researchers assessed AI use to improve at least 1 health outcome (eg, mortality).

DATA EXTRACTION: Data extraction was conducted independently by 2 researchers. Articles were categorized by direct or indirect impact of AI, defined by the European Institute of Innovation and Technology Health joint report.

RESULTS: Of the 287 publications screened, 32 met inclusion criteria. Approximately 22% ( n = 7) of studies revealed a direct impact and improvement in health outcomes after AI implementation. Majority were in prototype testing, and few were deployed into an ICU setting. Among the remaining 78% ( n = 25) AI models outperformed standard clinical modalities and may have indirectly influenced patient outcomes. Quantitative assessment of health outcomes using statistical measures, such as area under the receiver operating curve (56%; n = 18) and specificity (38%; n = 12), revealed marked heterogeneity in metrics and standardization.

CONCLUSIONS: Few studies have revealed that AI has directly improved health outcomes for pediatric critical care patients. Further prospective, experimental studies are needed to assess AI’s impact by using established implementation frameworks, standardized metrics, and validated outcome measures.

PMID:34890453 | DOI:10.1542/hpeds.2021-006094

PLoS One. 2021 Dec 10;16(12):e0261128. doi: 10.1371/journal.pone.0261128. eCollection 2021.

ABSTRACT

Bangladesh positioned as third rice producing country in the world. In Bangladesh, regional growth and trend in rice production determinants, disparities and similarities of rice production environments are highly desirable. In this study, the secondary time series data of area, production, and yield of rice from 1969-70 to 2019-20 were used to investigate the growth and trend by periodic, regional, seasonal and total basis. Quality checking, trend fitting, and classification analysis were performed by the Durbin-Watson test, Exponential growth model, Cochrane-Orcutt iteration method and clustering method. The production contribution to the national rice production of Boro rice is increasing at 0.97% per year, where Aus and Aman season production contribution significantly decreased by 0.48% and 0.49% per year. Among the regions, Mymensingh, Rangpur, Bogura, Jashore, Rajshahi, and Chattogram contributed the most i.e., 13.9%, 9.8%, 8.6%, 8.6%, 8.2%, and 8.0%, respectively. Nationally, the area of Aus and Aman had a decreasing trend with a -3.63% and -0.16% per year, respectively. But, in the recent period (Period III) increasing trend was observed in the most regions. The Boro cultivation area is increasing with a rate of 3.57% per year during 1984-85 to 2019-20. High yielding variety adoption rate has increased over the period and in recent years it has found 72% for Aus, 73.5% for Aman, and 98.4% for Boro season. As a result, the yield of the Aus, Aman, and Boro seasons has been found increasing growth for most of the regions. We have identified different cluster regions in different seasons, indicating high dissimilarities among the rice production regions in Bangladesh. The region-wise actionable plan should be taken to rapidly adopt new varieties, management technologies and extension activities in lower contributor regions to improve productivity. Cluster-wise, policy strategies should be implemented for top and less contributor regions to ensure rice security of Bangladesh.

PMID:34890444 | DOI:10.1371/journal.pone.0261128

PLoS One. 2021 Dec 10;16(12):e0261309. doi: 10.1371/journal.pone.0261309. eCollection 2021.

ABSTRACT

The aim of this study was to evaluate the content of periradicular surgery-related YouTube videos available for patients’ education. YouTube search was made for videos related to periradicular surgery using specific terms. After exclusions, 42 videos were selected, viewed and assessed by two independent observers. The videos were assessed in terms of duration, days since upload, country of upload, number of views, likes and dislikes, authorship source, viewing rate and interaction index. To grade the content of videos about periradicular surgery, a usefulness score was created with 10 elements based mainly on the American Association of Endodontists guidelines. Each element was given a score of 0 or 1. SPSS software (SPSS Inc, Chicago, IL, USA) was used to analyze data at a 95% confidence level. An inter-evaluator reliability analysis for the scoring system was performed using the Kappa statistic. The videos received an average of 35103.9 views (range: 9-652378) with an average duration of 338.71 seconds (range: 42-2081), respectively. Most videos were provided by individuals (57%). Half of the videos were posted by authors from the United States. The inter-evaluator reliability for usefulness scoring was 94.5%. No video covered the 10 scoring elements completely, presenting very low usefulness scores (mean: 3.2; range: 1-7). The most discussed elements were supporting media (100%) and steps of the procedure (90.5%) followed by indications and contraindications (45.2%) and symptoms (31%). None of the included videos discussed the procedure’s cost or prognosis. In terms of usefulness score, no significant difference was detected between different sources of upload (chi-square test, P > 0.05). Information on periradicular surgery in YouTube videos is not comprehensive and patients should not rely on YouTube as the only source of information. Dental professionals should enrich the content of YouTube with good quality videos by providing full and evidence-based information that will positively affect patients’ attitudes and satisfaction.

PMID:34890439 | DOI:10.1371/journal.pone.0261309

PLoS One. 2021 Dec 10;16(12):e0260885. doi: 10.1371/journal.pone.0260885. eCollection 2021.

ABSTRACT

BACKGROUND: New-onset heart failure (HF) is associated with poor prognosis and high healthcare utilization. Early identification of patients at increased risk incident-HF may allow for focused allocation of preventative care resources. Health information exchange (HIE) data span the entire spectrum of clinical care, but there are no HIE-based clinical decision support tools for diagnosis of incident-HF. We applied machine-learning methods to model the one-year risk of incident-HF from the Maine statewide-HIE.

METHODS AND RESULTS: We included subjects aged ≥ 40 years without prior HF ICD9/10 codes during a three-year period from 2015 to 2018, and incident-HF defined as assignment of two outpatient or one inpatient code in a year. A tree-boosting algorithm was used to model the probability of incident-HF in year two from data collected in year one, and then validated in year three. 5,668 of 521,347 patients (1.09%) developed incident-HF in the validation cohort. In the validation cohort, the model c-statistic was 0.824 and at a clinically predetermined risk threshold, 10% of patients identified by the model developed incident-HF and 29% of all incident-HF cases in the state of Maine were identified.

CONCLUSIONS: Utilizing machine learning modeling techniques on passively collected clinical HIE data, we developed and validated an incident-HF prediction tool that performs on par with other models that require proactively collected clinical data. Our algorithm could be integrated into other HIEs to leverage the EMR resources to provide individuals, systems, and payors with a risk stratification tool to allow for targeted resource allocation to reduce incident-HF disease burden on individuals and health care systems.

PMID:34890438 | DOI:10.1371/journal.pone.0260885

PLoS One. 2021 Dec 10;16(12):e0261211. doi: 10.1371/journal.pone.0261211. eCollection 2021.

ABSTRACT

The study aimed to assess disposal practices and quantify the microbial load present in SMW from ten sub-district level healthcare facilities and 385 households in Yilo Krobo municipality, Ghana. Disposal of solid medical waste (SMW) was assessed by questionnaire-based surveys, unstructured interviews and field observations. Microbiological analysis identified species and counts of bacteria present in SMW from both sources. Sociodemographic factors influencing the method of SMW disposal in households were evaluated using logistic regression analysis, with statistical significance set at p<0.05. Open burning (29%), burying (25%) and disposal at a dumpsite (49%) were common methods used by households to discard SMW. SMW disposal at a dumpsite was associated with age of respondents in households. Older people (50+ years) were three times more likely to place SMW in household waste later discarded at a dumpsite, compared to younger persons (20-30 years) [a0R, 95%CI = 3.37, 1.41-8.02]. In sub-district level healthcare facilities, open burning and burying were the most common methods used. Bacillus subtilis, Klebsiella pneumonia, Pseudomonas aeruginosa, Clostridium tetani, Enterococcus faecalis, Acinetobacter spp. Escherichia coli, Bacillus cereus and Enterococcus faecium) were bacteria identified in SMW recovered from both the healthcare facilities and the households. Klebsiella pneumoniae, Acinetobacter spp. and Clostridium tetani were found exclusively in untreated SMW generated in the healthcare facilities. Bacillus spp. and Pseudomonas spp. were found in one sample of treated SMW. The microbial load in SMW from healthcare facilities and households ranged from 0.036 x 103cfc/mg to 0.167 x 103 cfc/mg and from 0.118 x 103cfc/mg to 0.125 x 103cfc/mg respectively. This highlights the need for institutionalizing appropriate treatment methods in sub-district level facilities or strengthening the linkages with higher level facilities to ensure regular and adequate treatment of SMW. Public guidance on management of SMW generated in households which is context specific should also be provided.

PMID:34890437 | DOI:10.1371/journal.pone.0261211

PLoS One. 2021 Dec 10;16(12):e0260941. doi: 10.1371/journal.pone.0260941. eCollection 2021.

ABSTRACT

BACKGROUND: Mother-to-child transmission of HIV infection is a significant problem in Mozambique. This study aims to determine the risk factors associated with mother-to-child transmission of HIV in rural Mozambique.

METHODS: Retrospective case-control study in a rural area of Bilene District, on the coast of southern Mozambique, performed from January 2017 to June 2018. The analysis considered the clinical data of HIV exposed children with definitive HIV positive results and their respective infected mothers (cases), and the data of HIV exposed children with definitive HIV negative results and their respective infected mothers (controls) registered in At Risk Child Clinics from 1st January 2017 to 30th June 2018 at the Macia and Praia de Bilene health facilities in Bilene district, Gaza province-Mozambique.

RESULTS: Ninety pregnant women with HIV were involved in the study, including 30 who had transmitted the infection to their children and 60 who had not. Statistical analysis, adjusted for maternal age and gestational age at first antenatal care visit, showed that independent risk factors for transmission were gestational age at first visit (adjusted odds ratio [aOR] 1.19, 95% confidence interval [CI] 1.05-1.36), non-adherence to combination antiretroviral therapy (56.7% vs. 5%; aOR 14.12, 95% CI 3.15-63.41); a viral load of 1000 copies/mL or more (90% vs. 5%; aOR: 156, 95% CI 22.91-1,062) and female sex of the neonate (80% vs. 51.7%; aOR: 4.43, 95% CI 1.33-15.87).

CONCLUSION: A high viral load and non-adherence to antiretroviral therapy are important predictors of mother-to-child HIV transmission.

PMID:34890430 | DOI:10.1371/journal.pone.0260941

PLoS One. 2021 Dec 10;16(12):e0261186. doi: 10.1371/journal.pone.0261186. eCollection 2021.

ABSTRACT

INTRODUCTION: Coronavirus (Covid-19) is a respiratory disease mostly affecting old aged and those with comorbidities. Due to resource constraints in developing countries, control of Covid-19 was based on preventive measures. However, there is variation in adherence to these precautionary measures from place to place among communities. Therefore, this study assessed the practice of Covid-19 preventive measures and associated factors among residents of Southern, Ethiopia.

METHODS: A community-based cross-sectional study was employed on residents of Southern, Ethiopia. Interviewer administered questionnaire was used to collect data from households through systematic random sampling methods. Data was entered, coded, and analyzed using STATA version 16. Logistic regression analysis was used to explore the association between outcome variables and predictor variables. Finally, the interpretation of Adjusted Odds ratio (AOR) with 95% Confidence Interval (CI) and p-value was done for statistically significant factors of Covid-19 preventive measures practice.

RESULTS: The proportion of residents who had good practice of Covid-19 preventive measures was 31.3% (95% CI: 26.5, 36.1). Out of 364 residents, 264 (72.5%) used facemasks, 218 (59.9%) washed their hands frequently, 167 (45.9%) practiced social distancing, 135 (37.1%) stayed at home, 75 (18.1%) avoided handshaking and 228 (62.6%) used hand sanitizer. Following government directions (AOR = 225; 95% CI: 68.6, 738), good knowledge about Covid-19 (AOR = 3.47; 95% CI: 1.12, 10.73), having access to water supply (AOR = 2.92; 95% CI: 1.05, 8.18), belief towards protectiveness of preventive measure (AOR = 3.53; 95% CI: 1.08, 11.61) and chronic illness (AOR = 5.09; 95% CI: 1.44, 17.96) were significantly associated with practice of Covid-19 preventive measures.

CONCLUSION: In this study, the proportion of residents practicing Covid-19 preventive measures was low. Having comorbidity, following government directions, knowledge about Covid-19 and access to water supply were significantly associated with Covid-19 preventive measures practice. Therefore, government and all concerned stakeholders should increase the accessibility of infrastructure and provide continuous awareness creation campaigns regarding Covid-19 mode of transmission, sign and symptom, and protectiveness of Covid-19 preventive measures. Moreover, dissemination of teaching aids using local languages and close monitoring of community compliance to Covid-19 preventive measures is crucial.

PMID:34890428 | DOI:10.1371/journal.pone.0261186