Nevin Manimala

Cad Saude Publica. 2021 Oct 15;37(9):e00178520. doi: 10.1590/0102-311X00178520. eCollection 2021.

ABSTRACT

The objective was to demonstrate the rate of detection of mental disorders in primary healthcare units as a marker of access and indicator of care in mental health. A comparative case study was performed in the electronic patient files of adults seen in two neighboring primary care units in the city of Rio de Janeiro, Brazil, in 2015-2016 and 2016-2017. Diagnoses of mental disorders were extracted, using the International Classification of Diseases, dividing them into three groups: common mental disorders (CMD: F32; F33 F40-45, except F42, and R45), severe mental disorders (SMD: F20-F29; F31-F39), and alcohol and drug use (AD: F10-F19 and Z72). The results were compared to the community prevalence of mental disorders reported in the literature. Statistical analysis was applied with the chi-square test, in addition to a qualitative analysis of each unit´s scenario. Unit A (2015-2016) showed a low detection rate for all disorders [SMD = 45 (0.8%); CMD = 148 (2.64%) and AD = 0]; unit B detected about 50% of the expected cases [SMD = 23 (0.98%); CMD = 140 (5.97%) and AD = 130 (5.54%)]. In 2016-2017 there was an increase in the overall detection of mental disorders at unit A [SMD = 89 (1.6%); CMD = 298 (5.24%) and AD = 7 (0.12%)], in unit B the detection rate remained similar [SMD = 25 (1.0%); CMD = 176 (7.14%) and AD = 121 (4.9%)]. Changes in the units were detected. Distinction in the detection rate was used as an indicator for analysis of mental health care, allowing the study of factors potentially associated with this variation, influencing access to care. Monitoring this indicator helps improve mental health care.

PMID:34669772 | DOI:10.1590/0102-311X00178520

PLoS One. 2021 Oct 20;16(10):e0258807. doi: 10.1371/journal.pone.0258807. eCollection 2021.

ABSTRACT

The outbreak of the COVID-19 pandemic has dramatically shaped higher education and seen the distinct rise of e-learning as a compulsory element of the modern educational landscape. Accordingly, this study highlights the factors which have influenced how students perceive their academic performance during this emergency changeover to e-learning. The empirical analysis is performed on a sample of 10,092 higher education students from 10 countries across 4 continents during the pandemic’s first wave through an online survey. A structural equation model revealed the quality of e-learning was mainly derived from service quality, the teacher’s active role in the process of online education, and the overall system quality, while the students’ digital competencies and online interactions with their colleagues and teachers were considered to be slightly less important factors. The impact of e-learning quality on the students’ performance was strongly mediated by their satisfaction with e-learning. In general, the model gave quite consistent results across countries, gender, study fields, and levels of study. The findings provide a basis for policy recommendations to support decision-makers incorporate e-learning issues in the current and any new similar circumstances.

PMID:34669757 | DOI:10.1371/journal.pone.0258807

PLoS One. 2021 Oct 20;16(10):e0258815. doi: 10.1371/journal.pone.0258815. eCollection 2021.

ABSTRACT

Rigorous healthcare design research is critical to inform design decisions that improve human experience. Current limitations in the field include a lack of consistent and valid measures that provide feedback about the role of the built environment in producing desirable outcomes. Research findings about nurses’ efficiency, quality of care, and satisfaction related to inpatient unit designs have been mixed, and there was previously no validated instrument available to quantitatively measure nurses’ ability to work efficiently and effectively in their environment. The objective of this study was to develop, refine, and validate a survey instrument to measure affordance of the care environment to nurse practice, based on various aspects of their work in inpatient units. The HDR Clinical Activities Related to the Environment (CARE) Scale Inpatient Version was developed using item design, refinement, and reliability and validity testing. Psychometric methods from classical test theory and item response theory, along with statistical analyses involving correlations and factor analysis, and thematic summaries of qualitative data were conducted. The four-phase process included (1) an initial pilot study, (2) a content validation survey, (3) cognitive interviews, and (4) a final pilot study. Results from the first three phases of analysis were combined to inform survey scale revisions before the second pilot survey, such as a reduction in the number and rewording of response options, and refinement of scale items. The updated 9-item scale showed excellent internal consistency and improved response distribution and discrimination. The factor analysis revealed a unidimensional measure of nurse practice, as well as potential subscales related to integration, efficiency, and patient care. Within the healthcare design industry, this scale is much needed to generate quantitative and standardized data and will facilitate greater understanding about the aspects of an inpatient healthcare facility that best support nurses’ ability to provide quality patient care.

PMID:34669741 | DOI:10.1371/journal.pone.0258815

PLoS One. 2021 Oct 20;16(10):e0258720. doi: 10.1371/journal.pone.0258720. eCollection 2021.

ABSTRACT

The assessment of the strength and muscle mass of the hand-finger segment are reliable indicators of health and predictors of cardiometabolic risk in the adult population. However, there are no valid and reliable tests to assess the muscle power of this segment in healthy adolescents. The objective of this study was to determine the validity and inter-day reliability of a grip power test (GripW test) in healthy adolescents. Twenty-one adolescents (15.61 ± 2.20 years old) were part of the study. All participants were instructed to perform a grip with incremental load sets from 1-10 kg as fast as possible. The validity of the GripW test was determined with the load-power curve and linear regression equation. Inter-day reliability considered the coefficient of variation (CV), intra-class correlation coefficient (ICC), and standard error of the mean (SEM). The significance level for all statistical analyses was p < 0.05. The parabola in the load-power curve for both hands showed normality for the GripW test. In addition, the analysis showed a CV = 4.63% and ICC = 1.00 for the right hand, while the left hand showed a CV = 3.23% and ICC = 1.00. The GripW test proved to be valid and reliable for assessing gripping muscle power functionally and unilaterally in healthy adolescents.

PMID:34669739 | DOI:10.1371/journal.pone.0258720

PLoS Genet. 2021 Oct 20;17(10):e1009853. doi: 10.1371/journal.pgen.1009853. Online ahead of print.

ABSTRACT

Genome-wide association studies (GWAS) have identified thousands of genetic variants that are associated with complex traits. However, a stringent significance threshold is required to identify robust genetic associations. Leveraging relevant auxiliary covariates has the potential to boost statistical power to exceed the significance threshold. Particularly, abundant pleiotropy and the non-random distribution of SNPs across various functional categories suggests that leveraging GWAS test statistics from related traits and/or functional genomic data may boost GWAS discovery. While type 1 error rate control has become standard in GWAS, control of the false discovery rate can be a more powerful approach. The conditional false discovery rate (cFDR) extends the standard FDR framework by conditioning on auxiliary data to call significant associations, but current implementations are restricted to auxiliary data satisfying specific parametric distributions, typically GWAS p-values for related traits. We relax these distributional assumptions, enabling an extension of the cFDR framework that supports auxiliary covariates from arbitrary continuous distributions (“Flexible cFDR”). Our method can be applied iteratively, thereby supporting multi-dimensional covariate data. Through simulations we show that Flexible cFDR increases sensitivity whilst controlling FDR after one or several iterations. We further demonstrate its practical potential through application to an asthma GWAS, leveraging various functional genomic data to find additional genetic associations for asthma, which we validate in the larger, independent, UK Biobank data resource.

PMID:34669738 | DOI:10.1371/journal.pgen.1009853

CJEM. 2021 Oct 20. doi: 10.1007/s43678-021-00204-w. Online ahead of print.

ABSTRACT

OBJECTIVES: Frequent emergency department (ED) use is a growing problem that is associated with poor patient outcomes and increased health care costs. Our objective was to analyze the association between mood disorders and the incidence of frequent ED use.

METHODS: We used the Canadian Community Health Survey conducted by Statistics Canada, 2015-2016. Mood disorder was defined as depression, bipolar disorder, mania, or dysthymia. Frequent ED use was defined as 4 or more visits in the year preceding the interview. Multivariable log-binomial regression models were used to determine the associations between mood disorders and frequent ED use.

RESULTS: Among the 99,009 participants, 8.4% had mood disorders, 80.3% were younger than 65, and 2.2% were frequent ED users. Mood disorders were significantly associated with the 1-year cumulative incidence of frequent ED use (RR = 2.5, 95% CI 2.2-2.7), after adjusting for several potential confounders.

CONCLUSIONS: This national survey showed that people with a mood disorder had a three-fold risk of frequent ED use, compared to people without mood disorder. These results can inform the development of policies and targeted interventions aimed at identifying and supporting ED patients with mood disorder.

PMID:34669174 | DOI:10.1007/s43678-021-00204-w

CJEM. 2021 Oct 20. doi: 10.1007/s43678-021-00203-x. Online ahead of print.

ABSTRACT

OBJECTIVE: Rib fractures represent a significant cause of morbidity and mortality in trauma patients. The erector spinae plane block has come to the forefront as a potential safe and effective option for analgesia in painful conditions of the thorax over multiple dermatomal levels. Given the high morbidity associated with rib fractures, the inadequacy of opioid analgesia and the strong safety profile of the erector spinae plane block, this pilot study sought to address whether this block can be used to safely and effectively provide analgesia in emergency department (ED) patients with acute rib fractures.

METHODS: A total of nine patients underwent the procedure successfully. Patients were found to have a significant reduction in their pain score pre- and post-block. The reduction in mean pre- and post-block pain scores was 9.89 vs 3.56 which was statistically significant (p < 0.0001).

CONCLUSION: In a pilot sampling of emergency department patients with acute fractures who failed traditional analgesic therapy, the erector spinae plane block performed by emergency physicians provided safe and effective pain control. Further research is needed to fully establish the clinical benefit and safety of this procedure.

PMID:34669173 | DOI:10.1007/s43678-021-00203-x

Spine Deform. 2021 Oct 20. doi: 10.1007/s43390-021-00428-x. Online ahead of print.

ABSTRACT

PURPOSE: To analyse the progression of disc degeneration in distal unfused lumbar segments in post-operative Adolescent Idiopathic Scoliosis (AIS) patients; and to evaluate pre-operative and post-operative radiological parameters associated with progressive disc degeneration.

METHODS: A retrospective study of patients, who underwent surgery for AIS between 2006 and 2013 at a tertiary-care spine hospital, was conducted. Only patients aged between 11 and 18 years, who underwent deformity correction surgery with pedicle screw-only constructs, minimum of 6.5 year follow-up, and complete radiological data, and were included. On plain radiographs, coronal cobb’s angle (CCA), apical translation, lower instrumented vertebra tilt (LIV tilt), LIV-Sacral angle, and sagittal spinal and pelvic parameters were measured. Disc degeneration was assessed on Magnetic Resonance Imaging (MRI) using Pfirrmann’s grading. Total endplate score (TEPS) and facet degeneration (by Fujiwara’s grading) were also measured. Based on the difference in progression of disc degeneration, patients were classified as Pfirrmann’s grade static (PGS) and Pfirrmann’s grade progressive (PGP) groups. Comparison of all pre- and post-operative parameters was made between PGS and PGP groups, and statistically analyzed. Functional evaluation was performed using SRS-22 score.

RESULTS: A total of 58 patients were finally included. The mean follow-up was 9.1 years. 43 (74.1%) and 15 (25.9%) patients were classified under PGS and PGP groups, respectively. Among the15 patients in PGP group, selected LIV was L4 in 8, L3 in 3, L1 in 3, and L2 in 1. Among them, 11 patients (73.3%) progressed from grade 1 to grade 2. In the remaining 4 (26.6%), Pfirrmann’s grade progressed to ≥ 3. The progression of disc degeneration did not correlate with age or sex distribution (p = 0.3), pre-operative and post-operative TEP scores (p = 032), pre-operative disc or facet degeneration (p = 0.52), number of unfused spinal segments (p = 0.56), pre-operative or post-operative coronal (p = 0.42), or sagittal spinal (p = 0.27) or pelvic parameters (p = 0.14). The final functional outcome (SRS-22) was not significantly different between PGS and PGP groups (p = 0.67).

CONCLUSION: 74% of AIS patients demonstrated no signs of progressive disc degeneration at an average follow-up of 9.1 years. 26% (15/58) of AIS patients demonstrated progressive disc degeneration, among whom, degeneration progressed by only 1 Pfirrmann’s grade in 74% (11/15). In the remaining four patients, disc degeneration progressed to Pfirrmann’s grades 3 or greater. There was no correlation between higher grades of disc degeneration and lower instrumented vertebra (LIV) or functional outcomes scores (SRS-22).

PMID:34669167 | DOI:10.1007/s43390-021-00428-x

Infection. 2021 Oct 20. doi: 10.1007/s15010-021-01716-4. Online ahead of print.

ABSTRACT

PURPOSE: Residents in nursing homes for the elderly (NH) are at high risk for death from COVID-19. We investigated whether repeated non-mandatory RT-PCR SARS-CoV-2 surveillance of NH staff and visitors reduces COVID-19 incidence rates in NH residents and allows to reduce visiting restrictions.

METHODS: This pilot study at the beginning of the COVID-19 pandemic compared a surveillance approach of regular, twice-weekly voluntary PCR testing of health-care workers (HCW) and visitors in interventional NH (INH) with a setting without regular testing in control NH (CNH). Residents were not tested routinely within this study. Testing was performed in a mobile testing site with same-day result reporting. SARS-CoV-2 incidence among residents in both INH and CNH was the primary endpoint; secondary endpoints being SARS-CoV-2 infection among visitors and HCW in INH.

RESULTS: Two INH and two CNH participated between October and December, 2020. At INH1, 787 tests of HCW and 350 tests of visitors were performed, accounting for 18.1% (n = 1930) of visits. At INH2, 78 tests of HCW and 372 tests of visitors were done, i.e., 30.5% (n = 1220) of visits. At the two INH 23 HCW and three visitors tested positive for SARS-CoV-2. COVID-19 outbreaks occurred among residents in INH1 (identified through study testing) and in CNH1. Utilization of voluntary testing was low.

CONCLUSION: In a real-world setting without available rapid testing, voluntary RT-PCR SARS-CoV-2 testing of HCW and visitors does not prevent COVID-19 outbreaks in NH. Complete, non-selective testing for these groups should be instituted before visiting restrictions can be reduced.

TRIAL REGISTRATION: The study has been registered at ClinicalTrials.gov with the identifier: NCT04933981.

PMID:34669164 | DOI:10.1007/s15010-021-01716-4

J Gen Intern Med. 2021 Oct 19. doi: 10.1007/s11606-021-07135-3. Online ahead of print.

ABSTRACT

BACKGROUND: Selective or non-reporting of study outcomes results in outcome reporting bias.

OBJECTIVE: We sought to develop and assess tools for detecting and adjusting for outcome reporting bias.

DESIGN: Using data from a previously published systematic review, we abstracted whether outcomes were reported as collected, whether outcomes were statistically significant, and whether statistically significant outcomes were more likely to be reported. We proposed and tested a model to adjust for unreported outcomes and compared our model to three other methods (Copas, Frosi, trim and fill). Our approach assumes that unreported outcomes had a null intervention effect with variance imputed based on the published outcomes. We further compared our approach to these models using simulation, and by varying levels of missing data and study sizes.

RESULTS: There were 286 outcomes reported as collected from 47 included trials: 142 (48%) had the data provided and 144 (52%) did not. Reported outcomes were more likely to be statistically significant than those collected but for which data were unreported and for which non-significance was reported (RR, 2.4; 95% CI, 1.9 to 3.0). Our model and the Copas model provided similar decreases in the pooled effect sizes in both the meta-analytic data and simulation studies. The Frosi and trim and fill methods performed poorly.

LIMITATIONS: Single intervention of a single disease with only randomized controlled trials; approach may overestimate outcome reporting bias impact.

CONCLUSION: There was evidence of selective outcome reporting. Statistically significant outcomes were more likely to be published than non-significant ones. Our simple approach provided a quick estimate of the impact of unreported outcomes on the estimated effect. This approach could be used as a quick assessment of the potential impact of unreported outcomes.

PMID:34669145 | DOI:10.1007/s11606-021-07135-3