Nevin Manimala

BMC Public Health. 2022 Nov 15;22(1):2084. doi: 10.1186/s12889-022-14506-w.

ABSTRACT

BACKGROUND: Stimulant use has been rising among people with opioid use disorder in recent years in North America, alongside a parallel rise in illicit drug toxicity (overdose) deaths. This study aimed to examine the association between stimulant use and overdose mortality.

METHODS: Data from a universal health insurance client roster were used to identify a 20% random general population sample (aged ≥12) in British Columbia, Canada between January 1 2015 and December 31 2018 (N = 1,089,682). Provincial health records were used to identify people who used opioids and/or stimulants. Fatal overdose observed during follow-up (January 12,015- December 312,018) was retrieved from Vital Statistics Death Registry and BC Coroners Service Data. Potential confounders including age, sex, health region, comorbidities and prescribed medications were retrieved from the provincial client roster and health records.

RESULTS: We identified 7460 people who used stimulants and or opioids. During follow-up there were 272 fatal overdose events. People who used both opioids and stimulants had more than twice the hazard of fatal overdose (HR: 2.02, 95% CI: 1.47-2.78, p < 0.001) compared to people who used opioids only. The hazard of death increased over time among people who used both opioids and stimulants.

CONCLUSIONS: There is an urgent need to prioritize the service needs of people who use stimulants to reduce overdose mortality in British Columbia. Findings have relevance more broadly in other North American settings, where similar trends in opioid and stimulant polysubstance use have been observed.

PMID:36380298 | DOI:10.1186/s12889-022-14506-w

BMC Pregnancy Childbirth. 2022 Nov 15;22(1):840. doi: 10.1186/s12884-022-05181-1.

ABSTRACT

BACKGROUND: Husbands’ involvement strategies are employed to support their wives to access care, address the influence of gender inequality on maternal and newborn health, and promote husbands’ positive involvement as fathers. Yet, evidence of the husbands’ involvement in skilled birth attendant service utilization in Ethiopia is scarce, which limits the facility to improve institutional delivery services. Therefore, this study aimed to assess the magnitude of husbands’ involvement in skilled birth attendant service utilization among fathers of children of less than one year in Deder town, Oromiya, Ethiopia.

METHODS: A community-based cross-sectional study was conducted using a structured questionnaire among 399 fathers selected by a simple random sampling technique. Data were collected through face-to-face interview from March 24 to April 20, 2021. Data entry was done by Epi-data version-4.2 and analyzed with SPSS version-21. Descriptive statistics used frequency, mean and median and presented by tables and figures. The level of significance was set at p-value ≤0.05 for multivariable logistic regression and an adjusted odds ratio with a 95% confidence interval was used to measure the degree of statistical significance of dependent and independent variables.

RESULT: The prevalence of husbands’ involvement in skilled birth attendant service utilization was 84.2%. The age group of 25 to 29 years (AOR = 2.63, CI: 1.124-6.142), prior knowledge of skilled-delivery attendants (AOR = 2.75, CI: 1.456-5.205) and good attitude towards skilled birth attendants (AOR =2.46, CI: 1.227-4.948) were statistically significant determinants of husbands’ involvement in skilled birth attendants service utilization.

CONCLUSION AND RECOMMENDATION: This study revealed that the husbands’ involvement in skilled birth attendants was high. Age, level of knowledge and attitude were the significant determinants of husbands’ involvement in promoting skilled-delivery attendants. Therefore, improving husbands’ level of knowledge and attitude towards skilled birth attendants is needed.

PMID:36380281 | DOI:10.1186/s12884-022-05181-1

BMC Neurol. 2022 Nov 15;22(1):430. doi: 10.1186/s12883-022-02970-1.

ABSTRACT

BACKGROUND: The aim of the study was to determine whether the combination of Glasgow Coma Scale (GCS) and Pupil responses score (GCSP) with arterial lactate level would be an index to predict the short term prognosis in patients with traumatic brain injury (TBI).

METHODS: A retrospective study was performed enrolling all TBI patients admitted to intensive care unit (ICU) from 2019 to 2020. The demographics, clinical characteristics, and arterial lactate concentration were recorded. The GCSP and arterial blood analysis (ABG) with lactate was tested as soon as the patient was admitted to ICU. The Glasgow Outcome Scale (GOS) after discharge was regarded as the clinical outcome. A new index named GCSP-L was the combination of GCSP and lactate concentration. GCSP-L was the GCSP score (range 1-15) plus the lactate score (range 0-2). The lactate score was defined based on different lactate concentrations. If lactate was below 2 mmol/L, lactate score was 0, which above 5 mmol/L was 2 and between 2 and 5 mmol/L, the score was 1. As the range of GCSP was 1-15, the range of the GCSP-L was 1 to 17. The area under receiver operating characteristic curve (AUC) was calculated to evaluate the predictive ability of GCSP, lactate and GCSP-L. Statistical significance was set when p value < 0.05.

RESULTS: A total of 192 TBI patients were included in the study. Based on GCSP, mild, moderate, and severe TBI were 13.02, 14.06 and 72.92%, respectively. There were 103 (53.65%) patients with the lactate concentration below 2 mmol/L (1.23 ± 0.37 mmol/l), 63 (32.81%) of the range from 2 to 5 (3.04 ± 2.43 mmol/l) and 26 (13.54%) were above 5 mmol/l (7.70 ± 2.43 mmol/l). The AUC was 0.866 (95% CI 0.827-0.904) for GCSP-L, 0.812 (95% CI 0.765-0.858) for GCSP and 0.629 (95% CI 0.570-0.0.688) for lactate. The AUC of GCSP-L was higher than the other two, GCSP and lactate alone.

CONCLUSIONS: The combination of GCSP and lactate concentration can be used to predict the short term prognosis in TBI patients.

PMID:36380277 | DOI:10.1186/s12883-022-02970-1

BMC Geriatr. 2022 Nov 15;22(1):858. doi: 10.1186/s12877-022-03579-2.

ABSTRACT

BACKGROUND: Routinely collected health administrative data can be used to estimate the prevalence or incidence of dementia at a population level but can be inaccurate. This study aimed to examine the accuracy of hospital and death data for diagnosing dementia compared with a clinical diagnosis in community dwelling older men in Australia.

METHODS: We performed a retrospective analysis of the Concord Health and Ageing in Men Project (CHAMP) in Sydney, Australia. Of the 1705 men aged ≥70 years in the CHAMP study, 1400 had available linked administrative data records from 1 year prior to 1 year post the date of clinical dementia diagnosis. The primary outcome was the accuracy of dementia diagnosis using linked administrative data records compared to clinical dementia diagnosis. The linked data diagnosis was based on hospital and death records for the 1 year pre and post the clinical diagnosis. Clinical dementia diagnosis was a two-stage process with initial screening, followed by clinical assessment for those meeting a validated cut-off. A final clinical diagnosis of dementia based on the Diagnostic and Statistical Manual of Mental Disorders (4th edition) criteria was reached by a consensus panel.

RESULTS: Administrative data identified 28 participants as having dementia, compared to 88 identified through clinical assessment. Administrative data had a sensitivity of 20% (95% CI: 13-30%, 18/88), specificity of 99% (95% CI: 99-100%, 1301/1312), positive predictive value (PPV) of 62% (95% CI: 44-77%), negative predictive value of 95% (95% CI: 94-95%), positive likelihood ratio of 24.4 (95% CI: 11.9-50.0) and negative likelihood ratio of 0.80 (0.72-0.89).

CONCLUSIONS: Administrative hospital and death data has limited accuracy for dementia diagnosis with poor sensitivity and PPV. The prevalence of dementia is likely underestimated using hospital and deaths data.

PMID:36380274 | DOI:10.1186/s12877-022-03579-2

J Med Syst. 2022 Nov 16;46(12):96. doi: 10.1007/s10916-022-01880-6.

ABSTRACT

Petabytes of health data are collected annually across the globe in electronic health records (EHR), including significant information stored as unstructured free text. However, the lack of effective mechanisms to securely share clinical text has inhibited its full utilization. We propose a new method, DataSifterText, to generate partially synthetic clinical free-text that can be safely shared between stakeholders (e.g., clinicians, STEM researchers, engineers, analysts, and healthcare providers), limiting the re-identification risk while providing significantly better utility preservation than suppressing or generalizing sensitive tokens. The method creates partially synthetic free-text data, which inherits the joint population distribution of the original data, and disguises the location of true and obfuscated words. Under certain obfuscation levels, the resulting synthetic text was sufficiently altered with different choices, orders, and frequencies of words compared to the original records. The differences were comparable to machine-generated (fully synthetic) text reported in previous studies. We applied DataSifterText to two medical case studies. In the CDC work injury application, using privacy protection, 60.9-86.5% of the synthetic descriptions belong to the same cluster as the original descriptions, demonstrating better utility preservation than the naïve content suppressing method (45.8-85.7%). In the MIMIC III application, the generated synthetic data maintained over 80% of the original information regarding patients’ overall health conditions. The reported DataSifterText statistical obfuscation results indicate that the technique provides sufficient privacy protection (low identification risk) while preserving population-level information (high utility).

PMID:36380246 | DOI:10.1007/s10916-022-01880-6

Mol Psychiatry. 2022 Nov 16. doi: 10.1038/s41380-022-01844-9. Online ahead of print.

ABSTRACT

Despite advances in identifying rare and common genetic variants conferring risk for ADHD, the lack of a transcriptomic understanding of cortico-striatal brain circuitry has stymied a molecular mechanistic understanding of this disorder. To address this gap, we mapped the transcriptome of the caudate nucleus and anterior cingulate cortex in post-mortem tissue from 60 individuals with and without ADHD. Significant differential expression of genes was found in the anterior cingulate cortex and, to a lesser extent, the caudate. Significant downregulation emerged of neurotransmitter gene pathways, particularly glutamatergic, in keeping with models that implicate these neurotransmitters in ADHD. Consistent with the genetic overlap between mental disorders, correlations were found between the cortico-striatal transcriptomic changes seen in ADHD and those seen in other neurodevelopmental and mood disorders. This transcriptomic evidence points to cortico-striatal neurotransmitter anomalies in the pathogenesis of ADHD, consistent with current models of the disorder.

PMID:36380233 | DOI:10.1038/s41380-022-01844-9

Abdom Radiol (NY). 2022 Nov 15. doi: 10.1007/s00261-022-03727-7. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the performance of spleen to non-cancerous liver volume ratio (STnLR) for diagnosing liver cirrhosis in patients with hepatocellular carcinoma (HCC) during preoperative evaluation.

METHODS: Patients were randomly divided into experiment group and validation group. Patients were grouped into cirrhosis group and non-cirrhosis group according to Scheuer staging. Patients’ routine image data were reconstructed using a three-dimensional system. STnLR, spleen to liver volume ratio (STLR), spleen volume, aspartate aminotransferase to platelet ratio index (APRI), and fibrosis index based on the four factors (FIB-4) were calculated. Correlations between indices and cirrhosis were measured by Spearman correlation analysis. Diagnostic performance was assessed and compared using receiver operating characteristic analysis. Accuracies of the models were analyzed in validation group.

RESULTS: No statistical difference in demographic and clinical characteristics was observed between groups. In experiment group, STnLR had the strongest correlation (r = 0.5399, P < 0.0001), and STLR, spleen volume, APRI, and FIB-4 had moderate correlations (r = 0.4583, 0.4123, 0.3648, and 0.3405, P < 0.0001, < 0.0001, < 0.0001, and = 0.0002) with liver cirrhosis stage. AUROC of STnLR (0.8326) was not statistically higher than that for spleen volume (0.7542, P = 0.09832) and STLR (0.8046, P = 0.3034), but was significantly higher than that for APRI (0.7099, P = 0.02046) and FIB-4 (0.7294, P = 0.03987). In validation group, STnLR showed the highest AUROC value (0.8538) and highest Youden index (0.5869) among all models.

CONCLUSION: STnLR is an accurate and stable volumetric model to diagnose hepatic cirrhosis in the HCC population, which is superior to APRI and FIB-4.

PMID:36380210 | DOI:10.1007/s00261-022-03727-7

World J Urol. 2022 Nov 15. doi: 10.1007/s00345-022-04215-9. Online ahead of print.

ABSTRACT

AIM: The aim of this study is to evaluate the factors affecting treatment success in patients who underwent Shock wave lithotripsy (SWL) and to investigate the effect of the Storz Medical Lithotripsy Index (SMLI) on treatment effectiveness.

METHODS: Prospective data were collected on patients undergoing SWL treatment for kidney stones between January 2013 and May 2021. Stone location, number and size were determined with non-contrast CT (NCCT) for all patients. All patients underwent SWL with a Storz Modulith SLK lithotripsy machine without anaesthesia. The total amount of energy applied to the stone was calculated using the SMLI. All patients were evaluated for stone-free status by X-ray at least 2 weeks after treatment. The success of the procedure was defined as the patient being completely stone free or the detection of residual fragments < 4 mm that did not require further treatment.

RESULTS: A total of 1230 patients with kidney stones were included in the study. The mean age of the patients was 42.33 ± 11.78 (18-75), and the mean BMI was 28.47 ± 8.78 (19.25-38.52). During SWL, 75.6% of patients demonstrated excellent pain tolerance (930/1230). A total of 116 patients could not tolerate the pain during SWL (9.4%). Treatment success was associated with fewer treatment sessions (2.34 ± 1.75 vs. 2.90 ± 2.04; p < 0.001), smaller stone size (7.52 ± 3.29 vs 8.60 ± 3.93; p < 0.001) and higher SMLI/stone size (25.11 ± 13.63 vs. 22.27 ± 14.50; p < 0.001). In the univariate and multivariate regression analysis, the factors affecting the success of the treatment were the number of sessions (OR 1.170), stone size (OR 1.142), number of shocks (OR 1.005), SMLI/stone size (OR 1.024) and pain tolerance (OR 0.692).

CONCLUSION: In the treatment of kidney stones with SWL, stone site, stone size, SMLI/stone size, and pain tolerance are the factors affecting success. SMLI per stone size is a statistically significant factor for predicting SWL success.

PMID:36380209 | DOI:10.1007/s00345-022-04215-9

Hypertens Res. 2022 Nov 15. doi: 10.1038/s41440-022-01085-x. Online ahead of print.

ABSTRACT

Sodium-glucose cotransporter 2 inhibitors (SGLT2is) reduce the risk of heart failure progression and mortality rates. Moreover, osmotic diuresis induced by SGLT2 inhibition may result in an improved heart failure prognosis. Independent of conventional diuretics in patients with type 2 diabetes (T2D) and chronic heart failure, especially in patients with heart failure with preserved ejection fraction (HFpEF), it is unclear whether SGLT2i chronically reduces estimated plasma volume (ePV). As a subanalysis of the CANDLE trial, which assessed the effect of canagliflozin on N-terminal pro-brain natriuretic peptide (NT-proBNP), we examined the change (%) in ePV over 24 weeks of treatment based on the baseline level associated with diuretic usage. In the CANDLE trial, nearly all patients were clinically stable (NYHA class I-II), with approximately 70% of participants presenting a baseline phenotype of HFpEF. A total of 99 (42.5%) patients were taking diuretics (mostly furosemide) at baseline, while 134 (57.5%) were not. Relative to glimepiride, canagliflozin significantly reduced ePV without worsening renal function in patients in both groups: -4.00% vs. 1.46% (p = 0.020) for the diuretic group and -6.14% vs. 1.28% (p < 0.001) for the nondiuretic group. Furthermore, canagliflozin significantly reduced serum uric acid without causing major electrolyte abnormalities in patients in both subgroups. The long-term beneficial effect of SGLT2i on intravascular congestion could be independent of conventional diuretic therapy without worsening renal function in patients with T2D and HF (HFpEF predominantly). In addition, the beneficial effects of canagliflozin are accompanied by improved hyperuricemia without causing major electrolyte abnormalities.

PMID:36380202 | DOI:10.1038/s41440-022-01085-x

Osteoporos Int. 2022 Nov 16. doi: 10.1007/s00198-022-06586-6. Online ahead of print.

ABSTRACT

Prior non-vertebral fractures, except of the ankle, are associated with increased likelihood of vertebral fracture. As knowledge of vertebral fracture presence may alter care, vertebral fracture assessment (VFA) is indicated in patients with prior fracture.

INTRODUCTION: Vertebral fractures are often unappreciated. It was recently advocated that all Fracture Liaison Service (FLS) patients have densitometric VFA performed. We evaluated the likelihood of vertebral fracture identification with VFA in patients with prior fracture using the Manitoba Bone Density database. METHODS : VFA was performed in patients with T-scores below – 1.5 and age 70 + (or younger with height loss or glucocorticoid use) obtaining bone densitometry in Manitoba from 2010 to 2018. Those with prior clinical vertebral fracture, pathologic fracture, or uninterpretable VFA were excluded. Vertebral fractures were identified using the modified ABQ method. Health records were assessed for non-vertebral fracture (excluding head, neck, hand, foot) diagnosis codes unassociated with trauma prior to DXA. Multivariable odds ratios (ORs) for vertebral fracture were estimated without and with adjustment for age, sex, body mass index, ethnicity, area of residence, income level, comorbidity score, diabetes mellitus, falls in the last year, glucocorticoid use, and lowest BMD T-score.

RESULTS: The study cohort consisted of 12,756 patients (94.4% women) with mean (SD) age 75.9 (6.8) years. Vertebral fractures were identified in 1925 (15.1%) overall. Vertebral fractures were significantly more likely (descending order) in those with prior pelvis, hip, humerus, other sites, and forearm, but not ankle fracture. There was modest attenuation with covariate adjustment but statistical significance was maintained.

CONCLUSIONS: Prior hip, humerus, pelvis, forearm, and other fractures are associated with an increased likelihood of previously undiagnosed vertebral fracture, information useful for risk stratification and monitoring. These data support recommending VFA in FLS patients who are age 70 + with low BMD.

PMID:36380162 | DOI:10.1007/s00198-022-06586-6