Nevin Manimala

Int J Qual Health Care. 2021 Jul 30:mzab109. doi: 10.1093/intqhc/mzab109. Online ahead of print.

ABSTRACT

BACKGROUND: The Turkish healthcare system has seen broad population-based improvements in expanded health insurance coverage and access to healthcare services. Hospital performance in this national system is understudied. We aimed to identify trends in hospital performance over time following implementation of the Health Transformation Program and describe how regional outcomes correlate with regional vital statistics.

METHODS: We conducted a retrospective cohort study of 674 public hospitals in Turkey using baseline data from 2013 and follow-up data from 2014-15 collected by the Turkish Statistical Institution (TSI) and the Public Hospital Agency (PHA). We report demographic and socioeconomic data across 12 geographic regions and analyze 29 hospital-level performance measures across four domains: (1) health services; (2) administrative services; (3) financial services; and (4) quality measures. We examine temporal variation, and study correlation between performance measures and regional vital statistics. We fit mixed-effects linear regression models to estimate linear trend over time accounting for within-hospital residual correlation. We prepared our manuscript in accordance with guidelines set by the STROBE statement for cohort studies.

RESULTS: During the three years of study period, 21 of 29 measures improved, and 8 measures worsened. All but 3 measures demonstrated significant differences across regions of the country. Several measures, including inpatient efficiency, patient satisfaction, and audit score, are associated with regional infant mortality and life expectancy.

CONCLUSIONS: Evidence for temporal improvement in hospital-level performance may suggest some positive changes within the Turkish national healthcare system. Correlation of some measures with regional level health outcomes suggests a quality measurement strategy to monitor performance changes in the future. Although hospital-level functions have improved performance, the results of our study may help achieve further improvement for the health of the country’s citizens.

PMID:34329442 | DOI:10.1093/intqhc/mzab109

J Athl Train. 2021 Jul 30. doi: 10.4085/1062-6050-0158.21. Online ahead of print.

ABSTRACT

CONTEXT: Previously, the most common treatment for a concussion was prolonged physical and cognitive rest. Recent research suggests that earlier physical activity (PA) may be better at promoting recovery. Research has not evaluated the relationship between free-living PA (e.g., walking) and symptom reporting or recovery duration.

OBJECTIVE: To assess the relationship between free-living physical activity (PA) participation and two recovery outcomes in college-aged adults with a concussion.

DESIGN: Prospective Cohort Setting: Division 1 & 3 Universities Participants: Thirty-two college-aged adults (68.8% female, age: 19.8±1.4) with a concussion.

MAIN OUTCOME MEASURES: Participants completed a post-concussion symptom evaluation at visits 1 (<72 hours from concussion) and 2 (8 days later). Between visits, participants’ PA was monitored using an Actigraph GT9X Link PA monitor and expressed as total PA (counts per minute) and percent time of PA spent in moderate-to-vigorous intensity (%MVPA). Recovery time was the number of days from injury occurrence to medical clearance. Separate hierarchical multiple regressions evaluated the relationship between total PA and each recovery variable (visit 2 symptom severity, recovery time). Additionally, separate exploratory hierarchical multiple regressions evaluated the relationship between %MVPA and each recovery variable. Statistical significance was set a priori at p ≤ .05.

RESULTS: Participants averaged 2446±441 counts per minute and spent 12.1±4.2% of their PA performing MVPA. Participants yielded median symptom severities of 28[24] and 2[8] for visit 1 and 2, respectively. Average recovery time was 14.7±7.5 days. Total PA did not significantly contribute to the model for visit 2 symptom severity (p=.122) or recovery time (p=.301). Similarly, %MVPA had little contribution to the model for visit 2 symptom severity (p=.358) or recovery time (p=.276).

CONCLUSION: Results suggest that free-living PA may not be enough to reduce symptoms or shorten recovery. Thus, clinicians may need to provide patients with more structured PA protocols mimicking previous research.

PMID:34329439 | DOI:10.4085/1062-6050-0158.21

Eur J Cardiothorac Surg. 2021 Jul 30:ezab349. doi: 10.1093/ejcts/ezab349. Online ahead of print.

ABSTRACT

OBJECTIVES: Our goal was to investigate the correlation of clinical and computed tomography (CT) features of thymic epithelial tumours (TET) with the World Health Organization classification and the Masaoka-Koga staging system.

METHODS: Clinical and CT imaging data from 159 patients surgically and pathologically diagnosed with TET (82 men, 77 women; mean [± standard deviation] age, 52.08 ± 11.76 years) were retrospectively collected and reviewed. CT features were evaluated by radiologists. Tumour size, morphology, margin, density, calcification, cystic necrosis, density of the fat layer around the tumour, invasion of surrounding tissues, mediastinal lymph node enlargement, pleural/pericardial effusion, metastasis, plain CT scans and enhanced CT values were analysed.

RESULTS: Of the 159 patients with TET, 76 had low-risk thymoma, 55 had high-risk thymoma and 28 had thymic carcinomas. Age, maximum tumour diameter, myasthenia gravis, morphology, edges, density, fat around the lesion, mediastinal vascular, pericardial and lung tissue invasion, pleural/pericardial effusion, metastasis and arterial phase CT values were statistically different among the 3 groups (P < 0.05). Multivariate regression analysis revealed that edges, fat around the lesion, mediastinal vascular invasion and pericardial effusion were most relevant to TET classification. The 159 patients with TET were categorized into the non-invasion group (stage I; n = 58); the invasion of surrounding fat (stage II; n = 46); and the invasion of surrounding structures and metastasis group (stages III and IV; n = 55). Tumour diameter, morphology, margins, density, cystic degeneration and necrosis, invasion of surrounding fat and structure, pleural and pericardial effusion and lymph node enlargement were statistically different among the 3 groups (P < 0.05). Multivariate regression analysis revealed that edges, fat around the lesion, mediastinal vascular invasion and pleura invasion were the most relevant CT signs in relation to TET staging.

CONCLUSIONS: Analysis of clinical and CT features before surgery may facilitate the preliminary classification and stage diagnosis of TET.

PMID:34329409 | DOI:10.1093/ejcts/ezab349

Eur J Public Health. 2021 Jul 30:ckab128. doi: 10.1093/eurpub/ckab128. Online ahead of print.

ABSTRACT

BACKGROUND: The aim of this analysis was to examine the prospective association between household availability of lard, butter, margarine and vegetable oil with all-cause mortality and cardiovascular disease (CVD) incidence in a general population sample in Russia.

METHODS: Data from the Russian Longitudinal Monitoring Survey were used. 6618 adult individuals with no previous CVD who were recruited for the study in 1994 and followed-up in subsequent years were included in the analysis. Household availability of lard, butter, margarine and vegetable oil were assessed at baseline with questions on whether these food items were purchased by the participants’ family. Self-reported information on heart attack or stroke (CVD) and death reported by another household member were used as outcome.

RESULTS: Over the median follow-up of 11 years, 1787 participants died or reported incident CVD. In the multivariable adjusted survival models, household availability of lard was significantly associated with the combined outcome of CVD incidence and/or death (OR in the high vs. no availability categories: 1.31; 95% CI: 1.05-1.62). The associations with butter (1.06; 0.93-1.20), margarine (1.18; 0.94-1.47) and vegetable oil (0.92; 0.80-1.06) were not statistically significant. When self-reported CVD and mortality were examined separately, the association regarding lard was particularly strong for CVD (1.52; 1.11-2.09).

CONCLUSION: Our results suggest that lard, a dietary fat of animal origin traditionally used in Eastern European cooking, is of a particular concern regarding CVD risk. Replacing it with plant-based oils in cooking practices is strongly recommended.

PMID:34329405 | DOI:10.1093/eurpub/ckab128

PLoS One. 2021 Jul 30;16(7):e0255271. doi: 10.1371/journal.pone.0255271. eCollection 2021.

ABSTRACT

BACKGROUND: The identification of high-risk heart failure (HF) patients makes it possible to intensify their treatment. Our aim was to determine the prognostic value of a newly developed, high-sensitivity troponin I assay (Atellica®, Siemens Healthcare Diagnostics) for patients with HF with reduced ejection fraction (HFrEF; LVEF < 40%) and HF with mid-range EF (HFmrEF) (LVEF 40%-49%).

METHODS AND RESULTS: A total of 520 patients with HFrEF and HFmrEF were enrolled in this study. Two-year all-cause mortality, heart transplantation, and/or left ventricular assist device implantation were defined as the primary endpoints (EP). A logistic regression analysis was used for the identification of predictors and development of multivariable models. The EP occurred in 14% of the patients, and these patients had higher NT-proBNP (1,950 vs. 518 ng/l; p < 0.001) and hs-cTnI (34 vs. 17 ng/l, p < 0.001) levels. C-statistics demonstrated that the optimal cut-off value for the hs-cTnI level was 17 ng/l (AUC 0.658, p < 0.001). Described by the AUC, the discriminatory power of the multivariable model (NYHA > II, NT-proBNP, hs-cTnI and urea) was 0.823 (p < 0.001). Including heart failure hospitalization as the component of the combined secondary endpoint leads to a diminished predictive power of increased hs-cTnI.

CONCLUSION: hs-cTnI levels ≥ 17 ng/l represent an independent increased risk of an adverse prognosis for patients with HFrEF and HFmrEF. Determining a patient’s hs-cTnI level adds prognostic value to NT-proBNP and clinical parameters.

PMID:34329368 | DOI:10.1371/journal.pone.0255271

PLoS One. 2021 Jul 30;16(7):e0255301. doi: 10.1371/journal.pone.0255301. eCollection 2021.

ABSTRACT

In the context of the current global pandemic and the limitations of the RT-PCR test, we propose a novel deep learning architecture, DFCN (Denoising Fully Connected Network). Since medical facilities around the world differ enormously in what laboratory tests or chest imaging may be available, DFCN is designed to be robust to missing input data. An ablation study extensively evaluates the performance benefits of the DFCN as well as its robustness to missing inputs. Data from 1088 patients with confirmed RT-PCR results are obtained from two independent medical facilities. The data includes results from 27 laboratory tests and a chest x-ray scored by a deep learning model. Training and test datasets are taken from different medical facilities. Data is made publicly available. The performance of DFCN in predicting the RT-PCR result is compared with 3 related architectures as well as a Random Forest baseline. All models are trained with varying levels of masked input data to encourage robustness to missing inputs. Missing data is simulated at test time by masking inputs randomly. DFCN outperforms all other models with statistical significance using random subsets of input data with 2-27 available inputs. When all 28 inputs are available DFCN obtains an AUC of 0.924, higher than any other model. Furthermore, with clinically meaningful subsets of parameters consisting of just 6 and 7 inputs respectively, DFCN achieves higher AUCs than any other model, with values of 0.909 and 0.919.

PMID:34329354 | DOI:10.1371/journal.pone.0255301

PLoS One. 2021 Jul 30;16(7):e0255388. doi: 10.1371/journal.pone.0255388. eCollection 2021.

ABSTRACT

The objective of this study was to report post-operative complications and outcomes in canines undergoing elbow arthrodesis (EA) with fixation techniques including bone plate fixation with a non-locking dynamic compression plate (DCP), bone plate fixation with a locking plate (LCP), and external skeletal fixator (ESF). Medical records of twenty-two cases that underwent EA between January 2009-December 2019 from 8 referral hospitals including both private practice and academic institutions were reviewed. Post-operative complications were classified as either minor or major, surgical evaluations were performed 8 weeks post operatively, and a follow-up questionnaire was sent to owners. Of the total 22 cases that met inclusion criteria, a total of 19/22 cases had complications, 12 major and 7 minor. Complications reported in 8/9, 7/9, and 4/4, for the DCP, LCP, and ESF fixation groups, respectively. Mild to moderate mechanical lameness was identified at surgical evaluation in 16/22 cases. Complete radiographic bone healing was achieved after 9 weeks in 19/22 cases. Long term owner follow up was available in 14/22 cases. Owners reported a good to normal quality of life in 13/14 cases and poor in one case. The majority of owners (11/14) reported good to excellent satisfaction with the outcome irrespective of persistent lameness. This study demonstrates that successful EA can be achieved using a variety of fixation methods, but persistent lameness is expected and complication rate is high.

PMID:34329353 | DOI:10.1371/journal.pone.0255388

PLoS One. 2021 Jul 30;16(7):e0255426. doi: 10.1371/journal.pone.0255426. eCollection 2021.

ABSTRACT

INTRODUCTION: Social mobility is considered as an important indicator of the economic development of a country. However, it varies widely across geographical regions and social groups in developing countries like Bangladesh. This paper intends to evaluate the intergenerational mobility in Bangladesh across generations.

METHODS AND MATERIALS: This paper considers a nationally representative sample survey of 8,403 respondents (rural: 5,436 and urban: 2,967). The male and female respondents aged 23 years and above were included in the sample. The education attainment of a son or daughter as compared to their father’s education level was considered as the measure of intergenerational mobility. Transition probability matrix and different social mobility indices were used to find out the intergenerational education mobility in Bangladesh.

RESULTS: The findings reveal that approximately three-fourth (74.5%) of the respondents attained formal education, while more than half (58.3%) of the respondents’ father was illiterate. The educational status of the respondents and their father who lived in urban areas was relatively better than who lived in rural areas. It is also observed that 91.2% and 81.6% of the intergenerational class movement was upward among sons and daughters respectively. The probability of a higher educated father will have a higher educated child is higher in urban areas than in rural areas of Bangladesh. The intergenerational mobility is higher in the primary, secondary, and higher secondary educational levels, though the illiterate and higher education levels are the least mobile classes. In addition, the limiting probabilities reveal that the chance of sending sons to schools by an illiterate father is less as compared to their daughters. Such difference is more obvious in the urban areas, i.e., it is highly likely that sons of the illiterate father are also illiterate.

CONCLUSION: Bangladesh has been progressing remarkably in recent years. To keep the pace of the ongoing economic development in the country, it is necessary to give more attention to the illiterate people especially the girls who live in rural areas. The authors anticipate that the findings will be helpful for the policymakers as the relationship between inequality and intergenerational mobility is vital for several aspects of the economic development of a country.

PMID:34329343 | DOI:10.1371/journal.pone.0255426

PLoS One. 2021 Jul 30;16(7):e0255282. doi: 10.1371/journal.pone.0255282. eCollection 2021.

ABSTRACT

Microarray patches (MAPs) have the potential to be a safer, more acceptable, easier to use and more cost-effective method for administration of vaccines when compared to the needle and syringe. Since MAPs deliver vaccine to the dermis and epidermis, a degree of local immune response at the site of application is expected. In a phase 1 clinical trial (ACTRN 12618000112268), the Vaxxas high-density MAP (HD-MAP) was used to deliver a monovalent, split inactivated influenza virus vaccine into the skin. HD-MAP immunisation led to significantly enhanced humoral responses on day 8, 22 and 61 compared with IM injection of a quadrivalent commercial seasonal influenza vaccine (Afluria Quadrivalent®). Here, the aim was to analyse cellular responses to HD-MAPs in the skin of trial subjects, using flow cytometry and immunohistochemistry. HD-MAPs were coated with a split inactivated influenza virus vaccine (A/Singapore/GP1908/2015 [H1N1]), to deliver 5 μg haemagglutinin (HA) per HD-MAP. Three HD-MAPs were applied to the volar forearm (FA) of five healthy volunteers (to achieve the required 15 μg HA dose), whilst five control subjects received three uncoated HD-MAPs (placebo). Local skin response was recorded for over 61 days and haemagglutination inhibition antibody titres (HAI) were assessed on days 1, 4, 8, 22, and 61. Skin biopsies were taken before (day 1), and three days after HD-MAP application (day 4) and analysed by flow-cytometry and immunohistochemistry to compare local immune subset infiltration. HD-MAP vaccination with 15 μg HA resulted in significant HAI antibody titres compared to the placebo group. Application of uncoated placebo HD-MAPs resulted in mild erythema and oedema in most subjects, that resolved by day 4 in 80% of subjects. Active, HA-coated HD-MAP application resulted in stronger erythema responses on day 4, which resolved between days 22-61. Overall, these erythema responses were accompanied by an influx of immune cells in all subjects. Increased cell infiltration of CD3+, CD4+, CD8+ T cells as well as myeloid CD11b+ CD11c+ and non-myeloid CD11b- dendritic cells were observed in all subjects, but more pronounced in active HD-MAP groups. In contrast, CD19+/CD20+ B cell counts remained unchanged. Key limitations include the use of an influenza vaccine, to which the subjects may have had previous exposure. Different results might have been obtained with HD-MAPs inducing a primary immune response. In conclusion, influenza vaccine administered to the forearm (FA) using the HD-MAP was well-tolerated and induced a mild to moderate skin response with lymphocytic infiltrate at the site of application.

PMID:34329337 | DOI:10.1371/journal.pone.0255282

PLoS One. 2021 Jul 30;16(7):e0255124. doi: 10.1371/journal.pone.0255124. eCollection 2021.

ABSTRACT

OBJECTIVE: A screening centre in Soweto, South Africa (SA), investigated high-risk human papillomavirus (HR-HPV), HIV, cervical cancer risk amongst women.

METHODS: This cross-sectional study (June 2018-March 2019) describes screening results (Roche Linear Array HPV test and Pap smear liquid based cytology) and history of screening (known HIV status, antiretroviral therapy [ART] use, previous Pap smears). Data were stratified by age group (18-29, 30+ years), HIV status, Pap smear results and tested for statistical significance.

RESULTS: Of 280 women, 20.4% were HIV-positive, 18.2% had abnormal Pap smears, 41.8% had HR-HPV. Of older women, 48.2% (n = 78/162) had never had a Pap smear. Of younger women, 89.0% (n = 105/118) never had a Pap smear, but had significantly more low-grade squamous intraepithelial lesions (LSIL) and other HR-HPV infection than older women (12.7%[n = 15/118] vs 4.9%[n = 8/162], p = 0.0193; and 49.2%[n = 58/118] vs 29.0%[n = 47/162], p = 0.0006; respectively). HIV-positive women had more abnormal cytology results and infection with other HR-HPV types or co-infection with other HR-HPV type(s)/HPV-16 compared to HIV-negative women (35.1%[n = 20/57] vs 13.9%[n = 31/223], p = 0.0002; 56.1%[n = 32/57] vs 32.7%[n = 73/223], p = 0.001; and 12.3%[n = 7/57] vs 4.9%[n = 11/223], p = 0.044; respectively). Of 57 HIV-positive women, 45.6% (n = 26) already knew their HIV status; of which 69.2% were on ART and 34.6% never had a Pap smear.

CONCLUSION: South African women have high rates of HIV, Pap smear abnormalities and HR-HPV, with low cervical cancer screening coverage. SA cervical cancer screening policy excludes (undiagnosed) HIV-positive and HIV-negative women <30 years, both populations found to have high prevalence of HR-HPV. HPV-based primary screening from 25 years could improve outcomes.

PMID:34329334 | DOI:10.1371/journal.pone.0255124