Nevin Manimala

BMC Health Serv Res. 2022 May 14;22(1):645. doi: 10.1186/s12913-022-08051-w.

ABSTRACT

BACKGROUND: Substance use disorders are a major problem in Uasin Gishu County, Kenya. The objective of this study was to describe the existing resources within substance use treatment facilities in the County, with the aim of guiding policy and interventions.

METHODS: This was a cross-sectional study. We collected data from six substance use treatment facilities within Uasin Gishu County between August and November 2021. We used a researcher-designed questionnaire to collect information on: availability of in-patient and out-patient services; facility ownership (private-for-profit vs government-run); bed capacity; mode of payment for services; cost of services; availability of medicines for substance use treatment; and staffing characteristics. Descriptive statistics were used to summarize the data.

RESULTS: One facility was run by the National government and the rest were private-for-profit. Uasin Gishu County government had no substance use treatment facility of its own. The total number of beds available within the six facilities was 174 against a population of 1.1 million. All six facilities had stocked at least one medication for substance use disorder treatment. None of the facilities had buprenorphine, buprenorphine naloxone, or methadone. Out-of pocket was the most common mode of payment for services with patients paying using this mode in all the six facilities. Only one facility was accredited by the National Hospital Insurance Fund (NHIF). All facilities had at least one certified addiction counselor and at least one psychologist. Half of the facilities did not have a nurse and two did not have a doctor. The qualification held by most staff was addiction counseling with 41.3% of them having achieved this qualification.

CONCLUSION: The facilities were well staffed with psychologists and addiction counselors. Gaps were found as regards bed capacity, use of pharmacotherapy, insurance coverage and availability of nursing staff and doctors. We recommend that the County government in collaboration with key stakeholders invests in substance use treatment in order to address the high burden of substance use disorders in Uasin Gishu County.

PMID:35568902 | DOI:10.1186/s12913-022-08051-w

BMC Oral Health. 2022 May 14;22(1):181. doi: 10.1186/s12903-022-02217-y.

ABSTRACT

BACKGROUND: Dental Caries affect more than half of children and adolescents globally and more so in Africa. Most caries studies in Africa are based on DMFT index which does not assess early carious lesions making early prevention and minimal invasive treatment impossible. This study therefore aimed at determining pattern, socio-demographic and behavioral correlates of dental caries according to Caries Assessment and Treatment Spectrum (CAST).

METHODS: Cross-sectional study involving secondary school adolescents in Copperbelt province, Zambia. Socio-demographics and oral health related behaviors were assessed using a structured questionnaire while dental caries was assessed using CAST. Data were summarized as frequency distributions while cross-tabulation with Chi-squire test and adjusted multinomial logistic regression assessed strength and direction of relationship between socio-demographics, oral health behaviors and dental caries. Level of statistical significance was set at 5%.

RESULTS: A total of 1,794 participants were enrolled 54% being females. Total frequency of adolescents with healthy teeth (CAST0-2) was 51.1%, pre-morbidity stages (CAST 3-4) was 24.7%, severe morbidity CAST (6-7) was 6.4% and mortality was 2.7%. The odds of being found with teeth at pre-morbidity stage decreased among male OR (95%CI) = 0.55 (0.44, 0.70) and younger participants OR (95%CI) = 0.77 (0.61, 0.98). Participants in high socio-economic status had lower odds of morbidity OR (95%CI) = 0.69 (0.52, 0.92) while those taking sugary foods five times or more per day had higher odds of morbidity OR (95%CI = 1.52 (1.01, 2.34). The odds of being found at mortality clinical stage of caries was lower among males OR (95% CI) = 0.53 (0.29, 0.96) and those who did not attend to a dentist in the previous year OR (95%CI) = 0.42 (0.23, 0.75), while higher odds OR (95%CI = 2.01 (1.02, 3.97) were among the high socio-economic status.

CONCLUSIONS: The proportion of participants with teeth at pre-morbidity and morbidity were high. Socio-demographics and behavioral predictors of dental caries were sex, socio-economic status, frequency of sugary food intake per day and dental visit in the previous year.

PMID:35568900 | DOI:10.1186/s12903-022-02217-y

BMC Health Serv Res. 2022 May 14;22(1):649. doi: 10.1186/s12913-022-08027-w.

ABSTRACT

BACKGROUND: Collaborative practice between community pharmacists and physicians is becoming increasingly common. Although tools and models to explore collaborative practice between both health care professionals have been developed, very few have been validated for their use in clinical practice. The objective of this study was to develop and validate a tool for measuring collaborative practice between community pharmacists and physicians from the perspective of community pharmacists.

METHODS: The DeVellis method was used to develop and validate the Professional Collaborative Practice Tool. A pool of 40 items with Likert frequency scales was generated based on previous literature and expert opinion. This study was undertaken in Spain. A sample of community pharmacists providing medication reviews with follow-up and a random sample of pharmacists providing usual care were invited to participate. Exploratory and confirmatory factor analysis was used to assess the tool’s reliability and content validity.

RESULTS: Three hundred thirty-six pharmacists were invited with an overall response rate of 84.8%. The initial 40 items selected were reduced to 14 items. Exploratory Factor Analysis provided a 3-factor solution explaining 62% of the variance. Confirmatory Factor Analysis confirmed the three factors “Activation for collaborative professional practice,” the “Integration in collaborative professional practice,” and the “Professional acceptance in collaborative professional practice.” The tool demonstrated an adequate fit (X²/df = 1.657, GFI = 0.889 and RMSEA = 0.069) and good internal consistency (Cronbach’s alpha = 0.924).

CONCLUSIONS: The Professional Collaborative Practice Tool has shown good internal reliability and criterion validity. The tool could be used to measure the perceived level of collaborative practice between community pharmacists and physicians and monitor changes over time. Its applicability and transferability to other settings should be evaluated.

PMID:35568892 | DOI:10.1186/s12913-022-08027-w

BMC Musculoskelet Disord. 2022 May 14;23(1):455. doi: 10.1186/s12891-022-05401-x.

ABSTRACT

BACKGROUND: Based on the Digital Imaging and Communications in Medicine (DICOM) data of three-dimensional magnetic resonance imaging (3D-MRI), finite element models of the hip joints of children with developmental dysplasia of the hip were established. The primary objectives included simulation and analysis of the finite element model pre- and post-closed reduction under different stances and loads, and evaluation of the size and distribution of von Mises stress in the acetabulum and femoral head pre- and post-operation and the short-term effects.

METHODS: Acetabular index measurements of both the unaffected and affected sides were conducted, alongside International Hip Dysplasia Institute (IHDI) classification of the affected hip. Establishing the finite element model of both the affected and unaffected hips was based on the 3D-T1WI sequence DICOM data, using Mimics, 3-matic, and Ansys software, before and after closed reduction surgery. The size and distribution data of von Mises stress on the affected side of the acetabulum and femoral head were collected pre- and post-operation.

RESULTS: The study indicated that the increasing acetabular index of the affected hip was directly proportional to the increasing severity based on IHDI classification (P < 0.05). Preoperative IHDI classification significantly correlated with the von Mises stress (r = 0.560-0.569, 0.562-0.564, P < 0.05). Under different stances and load conditions, the von Mises stress on the affected side post-operation was lower than that noted pre-operation (P < 0.01), while that on the acetabulum increased proportionally to the load. Although the magnitude and distribution of von Mises stress on the affected side of the acetabulum were similar to those on the healthy side post-operation, there were statistical differences between the two (P < 0.01). The von Mises stress of the lateral column of the femoral head post-operation was significantly lower than that noted pre-operation (P < 0.01). While the high-stress points of the lateral column disappeared post-operation, the von Mises stress was evenly distributed in the femoral head.

CONCLUSIONS: The 3D-MRI finite element could provide the von Mises stress value and distribution characteristics of the acetabulum and femoral head pre- and post-operation. Closed reduction can, therefore, improve the size and distribution of von Mises stress on the affected acetabulum and femoral head.

PMID:35568888 | DOI:10.1186/s12891-022-05401-x

Respir Res. 2022 May 14;23(1):124. doi: 10.1186/s12931-022-02041-6.

ABSTRACT

BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is a chronic and progressive lung condition. Currently, care models predominantly focus on acute medical and pharmacological needs. As a step towards holistic care, the aim of this prospective study was to investigate the psychological and behavioural needs of IPF patients treated with pirfenidone from diagnosis until two years of follow-up.

METHODS: The following variables were selected from the literature on patients’ needs and the COM-B model, a theoretical model explaining behaviour: medication adherence, barriers to adherence, importance and intentions of medication adherence, anxiety, depression, health literacy, knowledge, reported side effects, adherence to sun protection recommendations, alcohol use, physical activity, quality of life and health status. Linear and generalised linear models for longitudinal data were used to evaluate the evolution since treatment initiation.

RESULTS: We included 66 outpatients: 72.7% men, mean age of 70.3 years (range 50-87), predicted mean forced vital capacity of 85.8% (SD 17.4) and predicted mean diffusing capacity for monoxide of 56.9% (SD 15.7). The participants placed considerable importance on following the treatment recommendations. We noticed difficulties regarding health literacy, alcohol use, pirfenidone adherence (decline over time) and adherence to sun protection recommendations (early in follow-up care). There were low levels of physical activity (no effect of time), high body mass indices (decline over time) and moderate levels of depression and anxiety.

CONCLUSION: When providing care to IPF patients, behavioural issues, health literacy and psychological well-being should be taken into consideration. There is a need to further explore interventions and care models to tackle these difficulties. Trial registration This study was registered in the ClinicalTrials.gov database (identifier NCT03567785) on May 9th, 2018.

PMID:35568881 | DOI:10.1186/s12931-022-02041-6

Int Breastfeed J. 2022 May 14;17(1):37. doi: 10.1186/s13006-022-00480-x.

ABSTRACT

BACKGROUND: Adequate breastfeeding and complementary feeding practices are paramount in fragile situations where access to food and healthcare is limited. The objectives of this study are to examine breastfeeding and complementary feeding practices among Syrian refugees and their Lebanese host communities and to investigate the correlates of exclusive breastfeeding (EBF) at four and 6 months in these communities.

METHODS: Using two-stage stratified sampling, a cross-sectional survey was conducted in Akkar, a region with a high density of Syrian refugees in Lebanon, between April and November 2019. In one-to-one interviews, mothers of children (6-24 months) completed a questionnaire including specific questions about breastfeeding and complementary feeding practices, a 24-h recall, and socio-demographic characteristics for 189 Syrian refugees and 182 Lebanese host community households. Descriptive statistics, simple and multiple logistic regression were used in data analysis.

RESULTS: Among breastfeeding practices, ever-breastfeeding was most prevalent (90%), followed by early initiation of breastfeeding (64.8%), EBF at four (49.6%), and six (36%) months. One in four children was introduced to solids before 6 months of age, and less than a third was given iron-fortified baby cereals as the first complementary foods. Only 24.4% and 9.2% of children met the minimum dietary diversity and minimum acceptable diet requirements, respectively. Compared to children of the Lebanese host communities, those of Syrian refugees had higher rates of EBF at four and 6 months as well as continued breastfeeding at 1 year, whereas only 17.9% of Syrian refugees’ children met minimum dietary diversity compared to 30.9% of Lebanese host community children (p < 0.05). Among refugees, education and spouse’s employment status were associated with higher odds of EBF at 4 months. As for Lebanese households, female children were less likely to be exclusively breastfed at 4 months and 6 months, while a natural delivery increased the odds of EBF at 6 months.

CONCLUSION: Breastfeeding and complementary feeding practices are suboptimal among children of Syrian refugees and their Lebanese host communities in North Lebanon. There is a need for intervention strategies to tackle gaps in services and assistance delivery programs to enhance infant and young child feeding practices among both communities.

PMID:35568877 | DOI:10.1186/s13006-022-00480-x

J Transl Med. 2022 May 14;20(1):227. doi: 10.1186/s12967-022-03435-2.

ABSTRACT

BACKGROUND: Previous studies demonstrated a positive relationship between birthweight and breast cancer; however, inconsistent, sometimes even controversial, observations also emerged, and the nature of such relationship remains unknown.

METHODS: Using summary statistics of birthweight and breast cancer, we assessed the fetal/maternal-specific genetic correlation between them via LDSC and prioritized fetal/maternal-specific pleiotropic genes through MAIUP. Relying on summary statistics we conducted Mendelian randomization (MR) to evaluate the fetal/maternal-specific origin of causal relationship between birthweight, age of menarche, age at menopause and breast cancer.

RESULTS: With summary statistics we identified a positive genetic correlation between fetal-specific birthweight and breast cancer (r_g = 0.123 and P = 0.013) as well as a negative but insignificant correlation between maternal-specific birthweight and breast cancer (r_g = – 0.068, P = 0.206); and detected 84 pleiotropic genes shared by fetal-specific birthweight and breast cancer, 49 shared by maternal-specific birthweight and breast cancer. We also revealed fetal-specific birthweight indirectly influenced breast cancer risk in adulthood via the path of age of menarche or age at menopause in terms of MR-based mediation analysis.

CONCLUSION: This study reveals that shared genetic foundation and causal mediation commonly drive the connection between the two traits, and that fetal/maternal-specific birthweight plays substantially distinct roles in such relationship. However, our work offers little supportive evidence for the fetal origins hypothesis of breast cancer originating in utero.

PMID:35568861 | DOI:10.1186/s12967-022-03435-2

BMC Surg. 2022 May 14;22(1):188. doi: 10.1186/s12893-022-01642-8.

ABSTRACT

OBJECTIVE: To compare outcomes in neuroendoscopic-assisted vs mini-open craniotomy for hypertensive intracerebral hemorrhage (HICH), so as to provide reasonable surgical treatment.

METHODS: Clinical data of 184 patients with HICH in the hospital from January 2019 to May 2021 were analyzed retrospectively. The patients were divided into mini-open craniotomy group and neuroendoscopic-assisted group. The operation time, hematoma clearance rate, intraoperative blood loss, neurological function recovery, and postoperative mortality of the two groups were compared by retrospective analysis.

RESULTS: The operation time and intraoperative blood loss in the mini-open craniotomy group were more than those in the neuroendoscopic-assisted group, but there was no significant difference between the two groups. There was no significant difference in hematoma clearance rate between the two groups, but for the rugby hematoma, the hematoma clearance rate in the neuroendoscopic-assisted group was higher than in the mini-open craniotomy group, the difference was statistically significant. Within 1 month after the operation, there was no significant difference in mortality between the two groups. 6 months after the operation, there was no significant difference in the recovery of neurological function between the two groups.

CONCLUSION: Neuroendoscopic-assisted and mini-open craniotomy for the treatment of HICH has the advantages of minimal trauma with good effects, and its main reason for short operation time, reduced bleeding, and high hematoma clearance rate. Although the two surgical methods can improve the survival rate of patients, they do not change the prognosis of patients. Therefore, the choice of surgical methods should be adopted based on the patient’s clinical manifestations, hematoma volume, hematoma type, and the experience of the surgeon.

PMID:35568858 | DOI:10.1186/s12893-022-01642-8

BMC Public Health. 2022 May 14;22(1):976. doi: 10.1186/s12889-022-13390-8.

ABSTRACT

BACKGROUND: Loss to follow-up (LTFU) from tuberculosis (TB) treatment and care is a major public health problem as patients can be infectious and also may develop a multi-drug resistant TB (MDR-TB). The study aimed to assess whether LTFU differs by the distance TB patients travelled to receive care from the nearest health facility.

METHODS: A total of 402 patient cards of TB patients who received care were reviewed from March 1-30, 2020. The Kaplan-Meir curve with the Log-rank test was used to compare differences in LTFU by the distance travelled to reach to the nearest health facility for TB care. The Cox proportional hazard regression model was used to identify predictors. All statistical tests are declared significant at a p-value< 0.05.

RESULTS: A total of 37 patients were LTFU with the incidence rate of 11.26 per 1000 person-months of observations (PMOs) (95% CI: 8.15-15.53). The incidence rate ratio was 12.19 (95% CI: 5.01-35.73) among the groups compared (those who travelled 10 km or more versus those who travelled less than 10 km). Age ≥ 45 years (aHR = 7.71, 95% CI: 1.72, 34.50), educational status (primary schooling, aHR = 3.54, 95% CI: 1.49, 8.40; secondary schooling, aHR = 2.75, 95% CI: 1.08, 7.03), lack of family support (aHR = 2.80, 95% CI: 1.27, 6.19), nutritional support (aHR = 3.40, 95% CI:1.68, 6.89), ≥ 10 km distance to travel to a health facility (aHR = 6.06, 95% CI: 2.33, 15.81) had significantly predicted LTFU from TB treatment and care.

CONCLUSIONS: LTFU from adult TB care and treatment was 12 times higher among those who travelled ≥10 km to reach a health facility compared to those who travelled less. To retain adult TB patients in care and ensure appropriate treatment, health professionals and other stakeholders should give due attention to the factors that drive LTFU. We suggest identifying concerns of older patients at admission and those who travel long distance and establish social support platforms that could help people to complete TB treatment.

PMID:35568853 | DOI:10.1186/s12889-022-13390-8

Environ Sci Pollut Res Int. 2022 May 14. doi: 10.1007/s11356-022-20667-3. Online ahead of print.

ABSTRACT

Water quality deterioration is a prominent issue threatening water security worldwide. As the largest river in China, the Yangtze River Basin is facing severe water pollution due to intense human activities. Analyzing water quality trends and identifying the corresponding driver factors are important components of sustainable water quality management. Thus, spatiotemporal characteristics of the water quality from 2008 to 2020 were analyzed by using a Mann-Kendall test and rescaled range analysis (R/S). In addition, multi-statistical analyses were used to determine the main driving factors of variation in the permanganate index (COD_Mn), ammonia nitrogen (NH₃-N) concentration, and total phosphorus (TP) concentration. The results showed that the mean concentrations of NH₃-N and TP decreased from 0.31 to 0.16 mg/L and 0.16 to 0.07 mg/L, respectively, from 2008 to 2020, indicating that the water quality improved during this period. However, the concentration of COD_Mn did not reduce remarkably. Based on R/S analysis, the NH₃-N concentration was predicted to continue to decrease from 2020 to 2033, whereas the COD_Mn concentration was forecast to increase, highlighting an issue of great concern. In terms of spatial distribution, water quality in the upstream was better than that of the mid-downstream. Multi-statistical analyses revealed that the temporal variation in water quality was predominantly influenced by tertiary industry (TI), the nitrogen fertilizer application rate (N-FAR), the phosphate fertilizer application rate (P-FAR), and the irrigation area of arable land (IAAL), with contribution rates of 15.92%, 14.65%, 3.46%, and 2.84%, respectively. The spatial distribution of COD_Mn was mainly influenced by TI, whereas that of TP was primarily determined by anthropogenic activity factors (e.g., N-FAR, P-FAR). This study provides deep insight into water quality evolution in the Yangtze River Basin that can guide water quality management in this region.

PMID:35568786 | DOI:10.1007/s11356-022-20667-3