Nevin Manimala

Int J Health Plann Manage. 2022 Jul 6. doi: 10.1002/hpm.3506. Online ahead of print.

ABSTRACT

INTRODUCTION: Recognition of the relevance of violence against health workers in their work place has been growing around the world. In Mozambique, workplace violence in the health sector needs better documentation. Therefore, this article is part of a study that describes the typology and the perceived impact of violence against health care workers in their workplace at the Lichinga Provincial Hospital and at the Health Centre of the City of Lichinga in 2019.

METHOD: This was an observational, descriptive, cross-sectional study. The study was carried out in a simple random sample of health workers victims of violence at the Provincial Hospital and the Health Centre of the City of Lichinga, in the Province of Niassa in northern Mozambique. The questionnaire applied was adapted from the original developed by the International Labour Organization, the International Council of Nurse, the World Health Organization and Public Services International and applied in Maputo, Mozambique during 2002. Statistical analysis was carried out with Statistical Package for the Social Sciences 20.0 and WinPepi 11.65.

RESULTS: Two hundred and 60 healthcare workers (HCW) were selected to participate, 180 agreed, 145 had inclusion criteria and five gave up participating in the study during the consent procedure. Thus, a total of 140 HCW answered the questionnaire. Predominant types of violence were: verbal threat/aggression 34% (n = 62/180); moral pressure/bullying/mobbing 30% (n = 54/180); ethnic discrimination 9% (n = 16/180); against personal property 6% (n = 10/180); physical 4% (n = 8/180); sexual harassment 4% (n = 8/180). One hundred and 37 victims reported 154 episodes of violence, where 7% (n = 13/180) reported more than one type of violence. Most victims reported no reaction (55%, n = 76/137) and few said that they confronted the offender (16%, n = 22/137, particularly victims of sexual harassment, 38%, n = 3/8). Most HCW reported non-existence (39%, n = 54/137) or unawareness (32%, n = 44/137) of procedures to report violence within the Institution. Most (80%, n = 33/41) of those knowing about the procedures, knew how to use them. More than half (55%; n = 76/137) of HCW said that they were discouraged to report acts of violence.

CONCLUSIONS: Like for previous studies in Mozambique and elsewhere in Africa, the study confirms: a relatively high prevalence, a reluctance to talk about the issue and unawareness about procedures on how to report incidents. The findings reconfirm the necessity for the development and implementation of procedures to address violence incidents towards HCW, to develop support services for victims of health workplace violence. Like elsewhere in Africa, successive health workforce plans in Mozambique have failed to address this issue.

PMID:35791672 | DOI:10.1002/hpm.3506

Vox Sang. 2022 Jul 6. doi: 10.1111/vox.13330. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: This sub-study of the FIBRES trial sought to examine the patterns of ABO-compatible cryoprecipitate administration and to identify adverse consequences of ABO-incompatible cryoprecipitate.

MATERIALS AND METHODS: This was a post hoc analysis of data collected from the FIBRES randomized clinical trial comparing fibrinogen concentrate with cryoprecipitate in the treatment of bleeding related to hypofibrinogenemia after cardiac surgery. The primary outcome was the percentage of administered cryoprecipitate that was ABO-compatible. Secondary outcomes were adverse events at 28 days. A follow-up survey was distributed to the FIBRES participating sites to examine the rationale behind the identified cryoprecipitate ABO-matching practice patterns.

RESULTS: A total of 363 patients were included: 53 (15%) received ABO-incompatible cryoprecipitate and 310 (85%) received ABO-compatible cryoprecipitate. There was an increased incidence of post-operative anaemia in the ABO-incompatible group (15; 28.3%) in comparison to the ABO-compatible (44; 14.2%) group (p = 0.01) at 28 days, which was unrelated to haemolysis, without a significant difference in transfusion requirement. In the multivariable logistic regression models accounting for clustering by site, there was no observed statistically significant association between the administration of ABO-incompatible cryoprecipitate and any other adverse outcomes. Nine out of 11 sites did not have a policy requiring ABO-matched cryoprecipitate.

CONCLUSION: This sub-study demonstrated that most cryoprecipitate administered in practice is ABO-compatible, despite the absence of guidelines or blood bank policies to support this practice. A signal towards increased risk of post-operative anaemia may be explained by higher rates of urgent surgery (vs. elective) in the ABO-incompatible group. Future studies should prospectively examine the impact of ABO-compatible versus incompatible cryoprecipitate to conclusively establish if there is a meaningful clinical impact associated with the administration of ABO-incompatible cryoprecipitate.

PMID:35791670 | DOI:10.1111/vox.13330

Aliment Pharmacol Ther. 2022 Jul 6. doi: 10.1111/apt.17125. Online ahead of print.

ABSTRACT

BACKGROUND: The global prevalence of inflammatory bowel disease (IBD) is increasing. However, population-level data are scarce for Asian populations.

AIMS: To outline and compare paediatric and adult IBD incidence and prevalence data in Korea, describe prescription patterns, and analyse outcomes of anti-tumour necrosis factor (anti-TNF) use in a nationally representative cohort.

METHODS: IBD was identified based on the presence of Rare and Intractable Disease diagnosis codes for Crohn’s disease (CD) and ulcerative colitis (UC). We calculated age-based prevalence and incidence, and examined prescription patterns. We used Cox proportional hazard model to calculate the hazard ratio (HR) for undergoing surgery.

RESULTS: The prevalence of CD increased between 2006 and 2015, particularly among teenagers aged 10-19 years (12.7-35.5 patients per 100,000 people). The use of anti-TNF agents increased from 3.2% to 22.9% in paediatric CD patients. Early use of an anti-TNF agent increased 25-fold in CD patients. Further, CD patients aged 0-14 years were most likely to undergo fistulectomy (HR, 2.63; 95% confidence interval [CI], 1.73-3.97). Children with UC had a higher risk of undergoing surgery (HR, 3.01; 95% CI, 1.33-6.83) than adults. Early use of an anti-TNF agent in CD patients was associated with lower odds of surgery than late-stage use.

CONCLUSION: These data demonstrate that the prevalence of IBD has increased over time, especially among paediatric patients. Given the magnitude of paediatric IBD disease burden, a multi-faceted approach is needed for early detection and vigilant monitoring to aim for better prognosis.

PMID:35791668 | DOI:10.1111/apt.17125

BMJ Open. 2022 Jul 4;12(7):e058546. doi: 10.1136/bmjopen-2021-058546.

ABSTRACT

OBJECTIVES: Physical activity (PA) plays a significant role in the treatment of type two diabetes (T2D). This study evaluated the effectiveness of PA counselling in primary healthcare (PHC) on clinical outcome measures in patients with T2D, comparing them with a registry-based controls.

SETTING: The study was carried out in North Karelia, Finland, among PHC clients who have been diagnosed with T2D in 2016-2018.

PARTICIPANTS: The study population consisted of patients aged 19-87 years diagnosed with T2D (n=1803). Altogether 546 patients were referred to the PA educator of whom 521 participated the counselling. In totally 1382 sex, age, time of diagnosis and intervention time-matched controls were used to see the effect of intervention.

INTERVENTIONS: Patients with T2D followed up in PHC were offered to participate in PA counselling provided by trained PA educators. The number of counselling sessions and their content were tailored according to patients needs and willingness to participate. To assess the effects of PA to management of T2D clinical outcome measures such as weight and Haemoglobin A1c (HbA1c) and lipid levels were assessed using data from electronic patient records. Each patient was followed up from records at least for a year.

RESULTS: Weight and body mass index (BMI) decreased in both groups and mean yearly changes did not differ between the groups. HbA1c levels declined in the intervention and increased in the control group with statistically significant difference in the mean yearly change between the groups (p=0.001). The low-density lipoprotein declined in both groups. The decline was bigger in the intervention group, but the difference did not quite reach the statistical significance (p=0.096).

CONCLUSIONS: This study shows that PA counselling in PHC offers significant benefits in the treatment outcomes of T2D although no significant declines were not observed in the weight or BMI.

PMID:35788078 | DOI:10.1136/bmjopen-2021-058546

BMJ Open. 2022 Jul 4;12(7):e052630. doi: 10.1136/bmjopen-2021-052630.

ABSTRACT

OBJECTIVES: This study aimed to examine the association of high-sensitivity C reactive protein (hsCRP) with mortality risk and the attenuated effect of non-communicable disease history (NCD _history ) on the association.

DESIGN: Prospective cohort study.

SETTING: Health Examinees cohort.

PARTICIPANTS: A total of 41 070 men and 81 011 women aged ≥40 years were involved (follow-up: 6.8 years).

OUTCOME MEASURES: Data and cause of death occurring until 31 December 2015 were confirmed by death statistics from the National Statistical Office. We conducted advanced analysis after stratification by NCD _history and sensitivity analysis after excluding death before 1 or 2 years from recruitment. Cox proportional hazard and restricted cubic spline models were used to assess the association.

RESULTS: The association between serum hsCRP and risk of all-cause mortality was observed with strong linearity in both genders and was not influenced by NCD _history . The association of serum hsCRP with risk of cancer mortality was not observed in women with NCD _history , but the association with risk of cardiovascular disease (CVD) mortality was predominantly observed in men with NCD _history .

CONCLUSIONS: This study suggests a dose-response association of hsCRP with mortality risk, including cancer and CVD mortality, in Koreans with low serum hsCRP, although the association with cancer and CVD mortality risk could be influenced by gender and NCD _history .

PMID:35788076 | DOI:10.1136/bmjopen-2021-052630

BMJ Open. 2022 Jul 4;12(7):e058770. doi: 10.1136/bmjopen-2021-058770.

ABSTRACT

OBJECTIVE: To explore the impact of the COVID-19 on the distribution, type and patterns of diseases in hospitalised children under local antiepidemic measures.

DESIGN: Retrospective chart review.

SETTING: Electronic medical records of patients hospitalised in the paediatric department of a tertiary hospital in South China from 21 January 2019 to 20 January 2021.

PARTICIPANTS: Records of 2139 patients.

OUTCOME MEASURES: Data were analysed before and during the COVID-19 pandemic. Disease characteristics were analysed based on the 10th revision of the International Statistical Classification of Diseases and Related Health Problems. Features of the length of hospital stay were investigated. Categorical variables involving more than three groups were analysed using an overall χ² test, followed by pairwise comparisons.

RESULTS: During the COVID-19 outbreak period, paediatric hospitalisation was reduced by 29.6%, from 1255 to 884. The proportions of infection-related diseases (36.3% (455 cases) vs 20.8% (184 cases)), respiratory system-related diseases (22.5% (283 cases) vs 9.4% (83 cases)); and endocrine, nutritional and metabolic diseases (17.1% (214 cases) vs 9.2% (81 cases)) decreased significantly, whereas that of musculoskeletal and connective tissue diseases increased from 11.0% (138 cases) to 20.1% (178 cases), thereby becoming the most common reason for hospitalisation. The proportions of diseases of the nervous system (12.4% (156 cases) to 18.8% (166 cases)) and mental and behavioural disorders (0.2% (3 cases) to 2.1% (19 cases)) increased significantly. The average length of hospital stay increased after the outbreak (7.57±6.53 vs 8.36±6.87).

CONCLUSION: The number of hospitalisation cases decreased during the COVID-19 period. The prominent decreases in hospitalisation associated with infections and respiratory system diseases were likely attributed to the improved epidemic prevention work, enhancement of people’s health awareness and fear of possible exposure to COVID-19. Describing the impact of COVID-19 on disease patterns may provide a reference for resource planning during the pandemic.

PMID:35788068 | DOI:10.1136/bmjopen-2021-058770

BMJ Open. 2022 Jul 4;12(7):e062572. doi: 10.1136/bmjopen-2022-062572.

ABSTRACT

INTRODUCTION: Time-varying exposure is an important issue that should be addressed in longitudinal observational studies using routinely collected data (RCD) for drug treatment effects. How well investigators designed, analysed and reported time-varying exposure, and to what extent the divergence that can be observed between different methods used for handling time-varying exposure in these studies remains uncertain. We will conduct a cross-sectional study to comprehensively address this question.

METHODS AND ANALYSIS: We have developed a comprehensive search strategy to identify all studies exploring drug treatment effects including both effectiveness and safety that used RCD and were published in core journals between 2018 and 2020. We will collect information regarding general study characteristics, data source profile, methods for handling time-varying exposure, results and the interpretation of findings from each eligibility. Paired reviewers will screen and extract data, resolving disagreements through discussion. We will describe the characteristics of included studies, and summarise the method used for handling time-varying exposure in primary analysis and sensitivity analysis. We will also compare the divergence between different approaches for handling time-varying exposure using ratio of risk ratios.

ETHICS AND DISSEMINATION: No ethical approval is required because the data we will use do not include individual patient data. Findings will be disseminated through peer-reviewed publications.

PMID:35788067 | DOI:10.1136/bmjopen-2022-062572

J Acad Nutr Diet. 2022 Mar 25:S2212-2672(22)00170-8. doi: 10.1016/j.jand.2022.03.014. Online ahead of print.

ABSTRACT

BACKGROUND: Obesity is associated with a multitude of comorbidities and considerable healthcare costs.

OBJECTIVE: The objective was to examine the efficacy of weight management interventions provided by a registered dietitian or international equivalent (referred to as “dietitian”).

METHODS: This systematic review and meta-analysis of randomized controlled trials (RCTs) compared weight management interventions provided by a dietitian to usual care or no intervention on several cardiometabolic outcomes and quality of life in adults with overweight or obesity. MEDLINE, Embase, PsycINFO, Cochrane CENTRAL, Cochrane Database of Systematic Reviews and CINAHL databases were searched for eligible RCTs published between January 2008 and January 2021 in the English language. Meta-analyses were conducted using a random-effects model, publication bias was assessed using funnel plots and Egger’s statistics and heterogeneity was assessed by interpreting I² values. Efficacy of intervention components, such as telehealth or group contacts, were explored in sub-group analyses. The revised risk of bias tool for RCTs (ROB 2.0) tool was used to assess risk of bias. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) method was used to determine certainty of evidence.

RESULTS: This systematic review included 62 RCTs. Compared to control conditions, weight management interventions provided by a dietitian resulted in improved body mass index [Mean Difference (95% CI): -1.5 kg/m² (-1.74, -1.26); moderate evidence certainty]; percent weight loss [-4.01% (-5.26, -2.75); high evidence certainty]; waist circumference [-3.45 cm (-4.39, -2.51); high evidence certainty]; blood pressure [-3.04 mmHg (-5.10, -0.98) and -1.99 mmHg (-3.02, -0.96) for systolic and diastolic, respectively; moderate and low evidence certainty] and quality of life using the SF-36 tool [5.84 (2.27, 9.41) and 2.39 (1.55, 3.23) for physical and mental quality of life, respectively; low and moderate evidence certainty].

CONCLUSION: For adults with overweight or obesity, weight management interventions provided by a dietitian are efficacious for improving several examined cardiometabolic outcomes and quality of life.

PMID:35788061 | DOI:10.1016/j.jand.2022.03.014

J Shoulder Elbow Surg. 2022 Jul 1:S1058-2746(22)00548-1. doi: 10.1016/j.jse.2022.05.024. Online ahead of print.

ABSTRACT

BACKGROUND: Women surgeons receive lower compensation, hold fewer academic positions, and hold fewer leadership positions than men, particularly in orthopedic surgery. Gender bias at the trainee level has been demonstrated in various surgical subspecialties, but there is a lack of information on gender bias within the orthopedic training environment. This study investigated whether implicit gender bias is present in the subjective evaluation of orthopedic trainee arthroscopic skills.

METHODS: After institutional review board (IRB) approval, a web-based survey was sent to American Shoulder and Elbow Surgeons (ASES) members via the society’s email listserv. Study participants were informed that the study was being done to develop a systematic evaluation method for trainees. The survey randomized participants to view and evaluate a pre-fellowship and a post-fellowship video of “Rachel” (she/her) or “Charles” (he/him) performing a 15-point diagnostic shoulder arthroscopy. The videos for Rachel and Charles were identical except for the pronouns used in the video. Participants evaluated the trainee’s skill level using questions from the Arthroscopic Surgical Skill Evaluation Tool (ASSET). Blinded and de-identified additional comments regarding the trainee’s skill were classified as positive, negative, or neutral. Statistical analyses were used to compare scores and comments between Rachel and Charles.

RESULTS: Of 1115 active ASES members, 181 ASES members started the survey and 106 watched both videos and were included in the analysis. Of the 106 participants completing the survey, 96 (91%) were men and 10 (9%) were women with median [IQR] age of 44 [38-51]. A teaching role was reported by 84 of 106 participants (79%). There was no significant difference between pre-fellowship scores (p = 0.87) or between post-fellowship scores (p = 0.84) for the woman and man fellow. The numbers of comments classified as positive, negative, or neutral were not significantly different between the man and woman fellow (p = 0.19). Participants in teaching roles gave significantly lower scores to both fellows at both timepoints (p=0.04), and participants who had fellow trainees were more likely to give negative comments to both fellows (p = 0.02).

DISCUSSION: Trainee gender did not influence the ratings and comments participants gave for trainee arthroscopic skills, suggesting that gender bias may not play a major role in the evaluation of arthroscopic skill during orthopedic training.

PMID:35788056 | DOI:10.1016/j.jse.2022.05.024

Clin Microbiol Infect. 2022 Jul 1:S1198-743X(22)00330-5. doi: 10.1016/j.cmi.2022.06.017. Online ahead of print.

ABSTRACT

BACKGROUND: Randomised controlled trials (RCTs) investigated analgesics, herbal formulations, delayed prescription of antibiotics and placebo to prevent overprescription of antibiotics in women with uncomplicated urinary tract infections (uUTI).

OBJECTIVES: To estimate the effect of these strategies and to identify symptoms, signs or other factors that indicate a benefit from these strategies.

DATA SOURCES: MEDLINE, EMBASE, Web of Science, LILACS, Cochrane Database of Systematic Reviews and of Controlled Trials, and ClinicalTrials.

STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTIONS: RCTs investigating any strategies to reduce antibiotics versus immediate antibiotics in adult women with uUTI in primary care.

DATA SYNTHESIS: We extracted individual participant data (IPD) if available, otherwise aggregate data (AD). Bayesian random-effects meta-analysis of the AD was used for pairwise comparisons. Candidate moderators and prognostic indicators of treatment effects were investigated using generalised linear mixed models based on IPD.

RESULTS: We analysed IPD of 3524 patients from eight RCTs and AD of 78 patients. Non-antibiotic strategies increased the rates of incomplete recovery (odds ratio [OR] 3.0; 95% credible interval [CI] 1.7-5.5; Bayesian p-value p_B=0.0017; τ=0.6), subsequent antibiotic treatment (OR 3.5 [95% CI 2.1, 5.8; p_B=0.0003) and pyelonephritis (OR 5.6; 95% CI 2.3, 13.9; p_B=0.0003). Conversely, they decreased overall antibiotic use by 63%. In patients positive for urinary erythrocytes and urine culture were at increased risk for incomplete recovery (OR 4.7; 95% CI 2.1-10.8; p_B =0.0010), but no difference was apparent where both were negative (OR 0.8; 95% CI 0.3-2.0; p_B =0.667). In patients treated with using non-antibiotic strategies, urinary erythrocytes and positive urine culture were independent prognostic indicators for subsequent antibiotic treatment and pyelonephritis.

CONCLUSIONS AND RELEVANCE: Compared to immediate antibiotics, non-antibiotic strategies reduce overall antibiotic use but result in poorer clinical outcomes. The presence of erythrocytes and tests to confirm bacteria in urine could be used to target antibiotic prescribing.

PMID:35788049 | DOI:10.1016/j.cmi.2022.06.017