Nevin Manimala

BMC Health Serv Res. 2024 Apr 27;24(1):541. doi: 10.1186/s12913-024-11036-6.

ABSTRACT

BACKGROUND: Research on health resource allocation trends in ethnic minority and impoverished areas in China is limited since the 2009 Medical Reform. This study aimed to investigate the variations and inequalities in health resource distribution among ethnic minority, poverty-stricken, and non-minority regions in Sichuan Province, a multi-ethnic province in Southwest China, from 2009 to 2019.

METHODS: The numbers of beds, doctors and nurses were retrospectively sourced from the Sichuan Health Statistics Yearbook between 2009 and 2019. All the 181 counties in Sichuan Province were categorized into five groups: Yi, Zang, other ethnic minority, poverty-stricken, and non-minority county. The Theil index, adjusted for population size, was used to evaluate health resource allocation inequalities.

RESULTS: From 2009 to 2019, the number of beds (Bed_p1000), doctors (Doc_p1000), and nurses (Nur_p1000) per 1000 individuals in ethnic minority and poverty-stricken counties consistently remained lower than non-minority counties. The growth rates of Bed_p1000 in Yi (140%) and other ethnic minority counties (127%) were higher than in non-minority counties (121%), while the growth rates of Doc_p1000 in Yi (20%) and Zang (11%) counties were lower than non-minority counties (61%). Doc_p1000 in 33% and 50% of Yi and Zang ethnic counties decreased, respectively. Nur_p1000 in Yi (240%) and other ethnic minority (316%) counties increased faster than non-minority counties (198%). The Theil index for beds and nurses declined, while the index for doctors increased. Key factors driving increases in bed allocation include preferential policies and economic development levels, while health practitioner income, economic development levels and geographical environment significantly influence doctor and nurse allocation.

CONCLUSIONS: Preferential policies have been successful in increasing the number of beds in health facilities, but not healthcare workers, in ethnic minority regions. The ethnic disparities in doctor allocation increased in Sichuan Province. To increase the number of doctors and nurses in ethnic minority and poverty-stricken regions, particularly in Yi counties, more preferential policies and resources should be introduced.

PMID:38678273 | DOI:10.1186/s12913-024-11036-6

BMC Res Notes. 2024 Apr 27;17(1):119. doi: 10.1186/s13104-024-06780-1.

ABSTRACT

Drought and Pierce’s disease are common throughout many grapevine-growing regions such as Mexico and the United States. Yet, how ongoing water deficits affect infections of Xylella fastidiosa, the causal agent of Pierce’s disease, is poorly understood. Symptoms were observed to be significantly more severe in water-stressed plants one month after X. fastidiosa inoculation, and, in one experiment, titers were significantly lower in water-stressed than well-watered grapevines. Host chemistry examinations revealed overall amino acid and phenolic levels did not statistically differ due to water deficits, but sugar levels were significantly greater in water stressed than well-watered plants. Results highlight the need to especially manage Pierce’s disease spread in grapevines experiencing drought.

PMID:38678272 | DOI:10.1186/s13104-024-06780-1

BMC Med Genomics. 2024 Apr 27;17(1):111. doi: 10.1186/s12920-024-01884-w.

ABSTRACT

BACKGROUND: Statistical epistasis, or “gene-gene interaction” in genetic association studies, means the nonadditive effects between the polymorphic sites on two different genes affecting the same phenotype. In the genetic association analysis of complex traits, nevertheless, the researchers haven’t found enough clues of statistical epistasis so far.

METHODS: We developed a statistical model where the statistical epistasis was presented as an extra linkage disequilibrium between the polymorphic sites of different risk genes. The power of statistical test for identifying the gene-gene interaction was calculated and then compared in different hypothesis scenarios.

RESULTS: Our results show the statistical power increases with the increasing of interaction coefficient, relative risk, and linkage disequilibrium with genetic markers. However, the power of interaction discovery is much lower than that of regular single-site association test. When rigorous criteria were employed in statistical tests, the identification of gene-gene interaction became a very difficult task. Since the criterion of significance was given to be p-value ≤ 5.0 × 10^-8, the same as that of many genome-wide association studies, there is little chance to identify the gene-gene interaction in all kind of circumstances.

CONCLUSIONS: The lack of epistasis tends to be an inevitable result caused by the statistical principles of methods in the genetic association studies and therefore is the inherent characteristic of the research itself.

PMID:38678264 | DOI:10.1186/s12920-024-01884-w

Cardiovasc Diabetol. 2024 Apr 27;23(1):145. doi: 10.1186/s12933-024-02221-2.

ABSTRACT

BACKGROUND: Sodium-glucose co-transporter 2 inhibitors (SGLT2i) have been suggested to exert cardioprotective effects in patients with heart failure, possibly by improving the metabolism of ketone bodies in the myocardium.

METHODS: This post hoc analysis of the EMMY trial investigated the changes in serum β-hydroxybutyrate (3-βOHB) levels after acute myocardial infarction (AMI) in response to 26-week of Empagliflozin therapy compared to the usual post-MI treatment. In addition, the association of baseline and repeated measurements of 3-βOHB with cardiac parameters and the interaction effects of Empagliflozin were investigated. Cardiac parameters included N-terminal pro-B-type natriuretic peptide (NT-proBNP), left ventricular ejection fraction (LVEF), left ventricle end-systolic volume (LVESV), left ventricle end-diastolic volume (LVEDV), and left ventricular filling pressure (E/é ratio).

RESULTS: The mean 3-βOHB levels increased from baseline (46.2 ± 3.0 vs. 51.7 ± 2.7) to 6 weeks (48.8 ± 2.2 vs. 42.0 ± 2.3) and 26 weeks (49.3 ± 2.2 vs. 35.8 ± 1.9) in the Empagliflozin group compared to a consistent decline in placebo over 26 weeks (p_interaction < 0.001). Baseline and longitudinal measurements of 3-βOHB were not significantly associated with NT-proBNP and E/é ratio. Baseline 3-βOHB value was negatively associated with LVEF (coefficient: – 0.464, 95%CI – 0.863;- 0.065, p = 0.023), while an increase in its levels over time was positively associated with LVEF (0.595, 0.156;1.035, 0.008). The baseline 3-βOHB was positively associated with LVESV (1.409, 0.186;2.632, 0.024) and LVEDV (0.640, – 1.170;- 2.449, 0.488), while an increase in its levels over time was negatively associated with these cardiac parameters (LVESV: – 2.099, – 3.443;- 0.755, 0.002; LVEDV: – 2.406, – 4.341;- 0.472, 0.015). Empagliflozin therapy appears to modify the association between 3-βOHB, LVEF (p_interaction = 0.090), LVESV (p_interaction = 0.134), and LVEDV (p_interaction = 0.168), particularly at 26 weeks; however, the results were not statistically significant.

CONCLUSION: This post hoc analysis showed that SGLT2i increased 3-βOHB levels after AMI compared to placebo. Higher baseline 3-βOHB levels were inversely associated with cardiac function at follow-up, whereas a sustained increase in 3-βOHB levels over time improved these markers. This highlights the importance of investigating ketone body metabolism in different post-MI phases. Although more pronounced effect of 3-βOHB on cardiac markers was observed in the SGLT2i group, further research is required to explore this interaction effect.

PMID:38678253 | DOI:10.1186/s12933-024-02221-2

Respir Res. 2024 Apr 27;25(1):189. doi: 10.1186/s12931-024-02796-0.

ABSTRACT

BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is a debilitating and progressive lung disease of unknown aetiology, characterized by the relentless deposition of fibrotic tissue. Biomarkers may play a pivotal role as indicators of disease presence, progression, and treatment response. Sirtuins, a family of enzymes with ADP ribosyltransferase or deacetylase activity, have been implicated in several diseases, including pulmonary fibrosis.

METHODS: A cross-sectional, prospective, observational single-center study was conducted to investigate the potential role of serum SIRTs levels as biomarkers in patients with IPF. Demographic, clinical, and functional data and serological samples were collected from 34 patients with IPF followed at the Interstital Lung and Rare Diseases Outpatient Clinic of the Vanvitelli Pneumology Clinic, Monaldi Hospital, Naples, Italy and from 19 age-matched controls.

RESULTS: Serum SIRT-1 levels were significantly reduced in IPF patients compared to controls (median IPF 667 [435-858] pg/mL versus controls 925 [794-1173] pg/mL; p < 0.001 ). In contrast, serum SIRT-3 levels were significantly increased in IPF patients compared to controls (median IPF 338 [230-500] pg/mL versus controls 154 [99.8-246] pg/mL; p < 0.001). There were no statistically significant differences in serum SIRT-6 and SIRT-7 levels between IPF and controls. In addition, we found a significant positive correlation between SIRT-1 and lung function parameters such as FEV₁% (ϱ=0.417;p = 0.016), FVC% (ϱ=0.449;p = 0.009) and DL_CO% (ϱ=0.393;p = 0.024), while a significant negative correlation was demonstrated between SIR-1 and GAP score, demonstrating a significant reduction in SIRT-1 in advanced Gender-Age-Physiology (GAP) stages 2-3 compared to GAP stage 1 (p = 0.008).

CONCLUSIONS: This prospective, cross-sectional study showed that SIRT-1 was associated with lung function and IPF severity and that both SIRT-1 and SIRT-3 could be considered as potential biomarkers of IPF, whereas SIRT-6 and SIRT-7 were not associated with IPF.

PMID:38678247 | DOI:10.1186/s12931-024-02796-0

BMC Oral Health. 2024 Apr 27;24(1):498. doi: 10.1186/s12903-024-04166-0.

ABSTRACT

BACKGROUND: Orthodontic treatment presents challenges with plaque accumulation around brackets, archwires, and elastics, leading to retained plaque and gingival inflammation. Conventional toothbrushing may not be enough, requiring additional oral hygiene aids like interproximal brushes, dental flosses, and water flossers. Limited research exists on comparing water flossing and interdental flossing in orthodontic patients. Therefore, this study aims to assess their effectiveness in maintaining oral hygiene during active orthodontic treatment.

METHODS: A single-blind, randomized, parallel clinical study recruited orthodontic patients with full-mouth brackets and archwires. Thirty participants were randomly assigned to either water jet flossing or interdental flossing groups. All participants were instructed to brush twice daily with a provided toothbrush and toothpaste and use the assigned intervention once daily at night. Clinical measures, including the Gingival Bleeding Index (BI), Plaque Index (PI), and Gingival Index (GI), were recorded at baseline and day 14. Descriptive statistics and statistical tests were performed using SPSS software.

RESULTS: The water jet flossing group demonstrated a slightly higher, albeit non-significant, benefit in plaque removal (median difference of 6.79%%, P = 0.279) and bleeding reduction (median difference of 5.21%%, P = 0.172) compared to the interdental flossing group after two weeks. Both groups showed significant reductions in gingival bleeding index and plaque index from baseline to the 2-week follow-up. The interdental flossing group had median mean percentage differences of 16.13%% (plaque index) and 23.57% (gingival bleeding index), while the water jet flossing group had median percentage differences of 21.87% (plaque index) and 32.29% (gingival bleeding index). No significant changes in gingival index grades were observed in either group.

CONCLUSION: Both water jet flossing and interdental flossing were effective in reducing plaque accumulation and gingival bleeding among orthodontic patients. While no significant differences were found between the two methods, water jet flossing showed a potential advantage. Further research is needed to validate its effectiveness, assess long-term impact, and understand its benefits for orthodontic patients.

PMID:38678246 | DOI:10.1186/s12903-024-04166-0

Malar J. 2024 Apr 27;23(1):124. doi: 10.1186/s12936-024-04951-w.

ABSTRACT

BACKGROUND: Malaria contributes to excess child mortality in The Gambia. Children under five are at risk of severe malaria and death if not treated promptly and appropriately. It is crucial that a child with fever receive appropriate care from a trained provider. The aim was to identify influences on child fever care-seeking in The Gambia to inform malaria control strategies.

METHODS: This cross-sectional analysis of The Gambia 2019-20 Demographic and Health Survey used logistic regression analysis to identify associations between source of care for a child with fever (public or private healthcare provider, other, or no treatment) and mother, child, and household characteristics.

RESULTS: Only 52.0% of mothers sought care from a trained healthcare provider for a child with fever-45.1% from a public facility and 7.0% from the private sector. 35.2% of mothers did not seek treatment. Mothers in urban households were 2.67 times as likely (aOR, 95% CI 1.504-4.736) as mothers in rural households to seek care from an informal source (e.g., pharmacy) versus not seeking treatment, and 0.29 times as likely (aOR, 95% CI 0.165-0.515) as mothers in rural households to seek care from a public provider versus informal source. Mothers in wealthier households were 2.30 times as likely (aOR, 95% CI 1.274-4.164) as mothers in poorer households to seek care from an informal source versus no treatment and half as likely as mothers in poorer households to seek care from a public provider versus informal source (aOR 0.53, 95% CI 0.291-0.959).

CONCLUSIONS: Maintaining The Gambia’s malaria control achievements will require the active engagement and oversight of private pharmacies along with continued integrated community case management to reach mothers who do not seek care for a child with fever, and remove challenges to seeking appropriate care from trained providers. Whether influenced by convenience, costs, perceived urgency, or other factors, given the likelihood of urban mothers and mothers in wealthier households to seek care from private pharmacies, it will be necessary to incorporate private pharmacies into malaria control strategies while building public sector capacity and workforce, and initiating more effective attitude and behavioural change among mothers and households.

PMID:38678245 | DOI:10.1186/s12936-024-04951-w

BMC Womens Health. 2024 Apr 27;24(1):261. doi: 10.1186/s12905-024-03102-2.

ABSTRACT

BACKGROUND: Infertility continued to be a major stressor among women with infertility during COVID-19pandemic. This study aimed to evaluate the impact of primary care posttraumatic stress disorder (PC-PTSD) on fertility problem of Iranian women with infertility during COVID-19 pandemic.

METHOD: In this cross-sectional study, 386 women with infertility completed the questionnaires of PC-PTSD-5 and Fertility Problem Inventory (FPI) at an infertility center between 2020 and 2022.

RESULTS: The mean of fertility problems was 145.20 (± 32.31). In terms of FPI subscales, the means were as follows: Sexual concern 21.80 (± 7.58), social concern 26.53 (± 8.94), relationship concern 26.02 (± 9.18), need for parenthood concern 40.88 (± 8.98), and rejection of childfree lifestyle 29.96 (± 7.69). The highest mean of FPI subscales was related to the need for parenthood concern in women with infertility. The strongest correlation was found between the subscales of sexual concern and social concern followed by sexual concern and relationship concern. The variables of PC-PTSD were a predictor of fertility problems (β = 0.203, P < .0001). Additionally, the variables of PC-PTSDwere a predictor of sexual concern (β = 0.248, P < .0001), social concern (β = 0.237, P < .0001), relationship concern (β = 0.143, P < .020), and need for parenthood concern (β = 0.101, P < .010). After adjusting for demographic characteristics, there was a significant relationship between FPI with job (β=-0.118, P < .031), education (β=-0.130, P < .023), living place (β = 0.115, P < .035), smoking (β = 0.113, P < .036), relationship with husband (β = 0.118, P < .027), and PC-PTSD symptom (β = 0.158, P < .0001). In addition, the multivariate linear regression showed a significant association between sexual concern and education (β=-0.152, P < .008), smoking (β = 0.129, P < .018), PC-PTSD symptom (β = 0.207, P < .0001); social concern and job (β=-0.119, P < .033), PC-PTSD symptom (β = 0.205, P < .0001); relationship concern and education (β=-0.121, P < .033), living place (β = 0.183, P < .001), relationship with husband (β = 0.219, P < .0001); and rejection of childfree lifestyle and job (β=-0.154, P < .007).

CONCLUSION: Systematic PTSD screening during COVID-19 pandemic by healthcare providers can be uniquely used to identify, evaluate, and treat trauma-related health conditions in infertility settings, which can link women with infertility to mental health services. This can be novel and useful for future policymakers and practitioners in the infertility field.

PMID:38678220 | DOI:10.1186/s12905-024-03102-2

BMC Bioinformatics. 2024 Apr 27;25(1):168. doi: 10.1186/s12859-024-05791-w.

ABSTRACT

This study investigates the impact of spatio- temporal correlation using four spatio-temporal models: Spatio-Temporal Poisson Linear Trend Model (SPLTM), Poisson Temporal Model (TMS), Spatio-Temporal Poisson Anova Model (SPAM), and Spatio-Temporal Poisson Separable Model (STSM) concerning food security and nutrition in Africa. Evaluating model goodness of fit using the Watanabe Akaike Information Criterion (WAIC) and assessing bias through root mean square error and mean absolute error values revealed a consistent monotonic pattern. SPLTM consistently demonstrates a propensity for overestimating food security, while TMS exhibits a diverse bias profile, shifting between overestimation and underestimation based on varying correlation settings. SPAM emerges as a beacon of reliability, showcasing minimal bias and WAIC across diverse scenarios, while STSM consistently underestimates food security, particularly in regions marked by low to moderate spatio-temporal correlation. SPAM consistently outperforms other models, making it a top choice for modeling food security and nutrition dynamics in Africa. This research highlights the impact of spatial and temporal correlations on food security and nutrition patterns and provides guidance for model selection and refinement. Researchers are encouraged to meticulously evaluate the biases and goodness of fit characteristics of models, ensuring their alignment with the specific attributes of their data and research goals. This knowledge empowers researchers to select models that offer reliability and consistency, enhancing the applicability of their findings.

PMID:38678218 | DOI:10.1186/s12859-024-05791-w

Addict Sci Clin Pract. 2024 Apr 28;19(1):33. doi: 10.1186/s13722-024-00463-9.

ABSTRACT

BACKGROUND: Individuals with substance use disorders (SUDs) frequently use acute hospital services. The Navigation Services to Avoid Rehospitalization (NavSTAR) trial found that a patient navigation intervention for hospitalized patients with comorbid SUDs reduced subsequent inpatient admissions compared to treatment-as-usual (TAU).

METHODS: This secondary analysis extends previous findings from the NavSTAR trial by examining whether selected patient characteristics independently predicted hospital service utilization and moderated the effect of the NavSTAR intervention. Participants were 400 medical/surgical hospital patients with comorbid SUDs. We analyzed 30- and 90-day inpatient readmissions (one or more readmissions) and cumulative incidence of inpatient admissions through 12 months using multivariable logistic and negative binomial regression, respectively.

RESULTS: Consistent with primary findings and controlling for patient factors, NavSTAR participants were less likely than TAU participants to be readmitted within 30 (P = 0.001) and 90 (P = 0.03) days and had fewer total readmissions over 12 months (P = 0.008). Hospitalization in the previous year (P < 0.001) was associated with cumulative readmissions over 12 months, whereas Medicaid insurance (P = 0.03) and index diagnoses of infection (P = 0.001) and injuries, poisonings, or procedural complications (P = 0.004) were associated with fewer readmissions. None of the selected covariates moderated the effect of the NavSTAR intervention.

CONCLUSIONS: Previous findings showed that patient navigation could reduce repeat hospital admissions among patients with comorbid SUDs. Several patient factors were independently associated with readmission. Future research should investigate risk factors for hospital readmission among patients with comorbid SUDs to optimize interventions.

TRIAL REGISTRATION: NIH ClinicalTrials.gov NCT02599818, Registered November 9, 2015 https://classic.

CLINICALTRIALS: gov/ct2/show/NCT02599818 .

PMID:38678216 | DOI:10.1186/s13722-024-00463-9