Tag: nevin manimala

BMC Pregnancy Childbirth. 2024 Nov 13;24(1):747. doi: 10.1186/s12884-024-06971-5.

ABSTRACT

BACKGROUND: Education during pregnancy is important for the development of the pregnant woman’s ability to adapt to change and for a healthy birth. In this study, we aimed to examine the effects of education through a diabetes education program on maternal and newborn health in women diagnosed with gestational diabetes.

MATERIALS AND METHODS: In our study, we compared the maternal and neonatal health outcomes of pregnant women who participated in the diabetes education program and were diagnosed with gestational diabetes with the outcomes of pregnant women who did not participate in the diabetes education program and were diagnosed with gestational diabetes. The study included patients who were diagnosed with diabetes between 24and 26 weeks gestation at a tertiary education and research hospital and who underwent a 75-gram OGTT test. Age, BMI, parity, method of delivery, weight gain during pregnancy, newborn birth weight, gestational age and Apgar scores were compared.

RESULTS: The study included 119 patients and analyzed maternal-neonatal outcomes. There were no statistically significant differences in age (33 ± 5.7 versus 31 ± 5.2), body mass index (BMI) (32.2 vs. 31.2), gravidity, parity, number of miscarriages, mode of delivery, family history of diabetes, smoking, prenatal corticosteroid use, and gestational age at delivery. The HbA1c value (p: 0.013), the total weight gain during pregnancy (p: 0.015), the need for insulin treatment (p: 0.002), and the birth weight (0.005) were significantly higher in the group without diabetes education.

CONCLUSION: In our study, diabetic school education was associated with lower HbA1c levels, less weight gain and less need for insulin therapy. When the results were categorized by insulin use, it was found that in patients using insulin, those who received diabetic school education had fewer macrosomic fetuses, whereas in patients not using insulin, those who received diabetic school education had lower maternal weight gain during pregnancy.

PMID:39538195 | DOI:10.1186/s12884-024-06971-5

BMC Med Educ. 2024 Nov 13;24(1):1298. doi: 10.1186/s12909-024-06306-0.

ABSTRACT

BACKGROUND: Procrastination is characterized by the deliberate postponement of assigned educational tasks and is correlated with low academic achievement and depression. Concern about procrastination is particularly high among medical students, as it has a strong association with aspects such as low self-efficacy, lack of organization, low intrinsic motivation, inefficient effort regulation and time management problems. On the other hand, it was found that students’ use of study strategies is significantly related to better academic results. The relationship between students’ tendency to procrastinate and the adoption of effective study strategies remains little explored, leaving a critical space for investigation. This study aims to fill this gap by exploring how procrastination affects the selection and effectiveness of study strategies adopted by students.

METHODS: This cross-sectional study was conducted in Brazil and included medical students from the first to the seventh semester of the Unichrsitus Medical School. The validated procrastination scale and the Learning and Study Strategies Inventory were used. Generalized linear regression multivariate models with robust errors were used to verify the association between the study variables.

RESULTS: 447 students participated, 70.2% of whom were female, with an average age of 23 years. The domain of “study aids” scored higher among younger students, who self-referred as black and who studied in private schools prior to the Medical School. Higher procrastination scores were statistically associated with higher main idea selection, concentration, time organization and anxiety scores and with lower study aids and study preoccupation scores (p values < 0.05). In addition, active methodology was associated with higher scores in the domains of study aids and time organization.

CONCLUSIONS: Procrastination is associated with the study strategies used by medical students, which can be modified through training and ultimately improve their performance. Students in traditional models, who are older, white and from public schools may especially benefit from this training.

PMID:39538189 | DOI:10.1186/s12909-024-06306-0

BMC Public Health. 2024 Nov 13;24(1):3144. doi: 10.1186/s12889-024-20534-5.

ABSTRACT

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is closely linked to cardiovascular diseases. We aimed to investigate the association between Life’s Essential 8 (LE8), the newly established measurement to assess cardiovascular health (CVH), and COPD among U.S. general adults.

METHODS: This study extracted the National Health and Nutrition Examination Survey (2007-2018) data. Multivariate logistic regression models were used to examine the associations between LE8 and COPD. A restricted cubic spline regression model was used to explore the dose-response relationships between LE8 scores and COPD. In addition, subgroup and sensitivity analyses were performed to assess the robustness of our results.

RESULTS: Our study included 19,774 participants representing 145.2 million non-institutionalized U.S. population aged ≥ 20 years. The overall age-adjusted prevalence of COPD was 4.5%. After adjusting for the potential covariates, LE8 was inversely associated with COPD [adjusted odds ratio (AOR) = 0.169, 95% CI: 0.115, 0.249], exhibiting a nonlinear dose-response relationship (P for nonlinearity < 0.05). Similar trends in the associations of health behavior score (AOR = 0.300, 95% CI: 0.223, 0.404) and health factor score (AOR = 0.603, 95% CI: 0.426, 0.852) with COPD were also identified. Furthermore, higher LE8 metric scores of nicotine exposure and sleep health were associated with a lower prevalence of COPD.

CONCLUSION: LE8 was inversely associated with spirometric/self-reported COPD in a nonlinear trend, primarily driven by the nicotine exposure metric of LE8. Adhering to LE8 guidelines, especially smoking cessation, to sustain optimal CVH levels may be beneficial to alleviate the burden of COPD.

PMID:39538175 | DOI:10.1186/s12889-024-20534-5

BMC Med Educ. 2024 Nov 13;24(1):1300. doi: 10.1186/s12909-024-06311-3.

ABSTRACT

PURPOSE: This study explored the effectiveness of a Problem-based Learning (PBL) teaching model on the WeChat public platform for radiation oncology residency training programs.

MATERIALS AND METHODS: The WeChat PBL program was initiated in 2019. The study recruited student participants, on a voluntary basis, who were in their first and second years of standardized training in radiation oncology. We selected classic and trending issues in radiation oncology as the two main teaching topics. Students in the PBL group searched for relevant literature, summarizing PowerPoint presentations or academic speeches on specific issues published on the professional WeChat public platform after an in-depth review by teachers. The final national standardized training examination scores for resident physicians were used to evaluate teaching effectiveness. The graduation scores of the PBL and non-PBL groups were compared, and a stratified analysis was conducted based on the year of participation to assess the teaching effectiveness of this model. Moreover, questionnaires were administered to evaluate students’ experiences.

RESULTS: Among the 36 students who joined the study in 2019, 16 (44.0%) voluntarily joined the PBL teaching group. Nine students started teaching PBL in their first year of residency, accounting for 47.4% of that year, and seven started in their second year, accounting for 41.2%. The average graduation scores of the PBL group were superior to those of the non-PBL-focused group for the same grade. The rate of high scores among students in the PBL group (56.3%) was higher than that of students in the non-PBL group (25%). Specifically, first-year residents who joined the PBL group had an average score of 92.3 ± 2.2, significantly higher than their non-PBL counterparts, who scored an average of 88.6 ± 4.6, showing a statistically significant advantage (p = 0.042). All students were satisfied with the PBL WeChat teaching and would recommend the PBL WeChat course to others.

CONCLUSION: The PBL residency teaching model on the WeChat platform improved residency scores and garnered student satisfaction.

PMID:39538173 | DOI:10.1186/s12909-024-06311-3

Genetics. 2024 Nov 13:iyae187. doi: 10.1093/genetics/iyae187. Online ahead of print.

ABSTRACT

Gene co-expression networks typically comprise modules and their associated hub genes, which are regulating numerous downstream interactions within the network. Methods for hub screening, as well as data-driven estimation of hub co-expression networks using graphical models, can serve as useful tools for identifying these hubs. Graphical model-based penalization methods typically have one or multiple regularization terms, each of which encourages some favorable characteristics (e.g., sparsity, hubs, power-law) to the estimated complex gene network. It is common practice to find a single optimal graphical model corresponding to a specific value of the regularization parameter(s). However, instead of doing this, one could aggregate information across several graphical models, all of which depend on the same data set, along the solution path in the hub gene detection process. We propose a novel method for detecting hub genes that utilizes the information available in the solution path. Our procedure is related to stability selection, but we replace resampling with a simple statistic. This procedure amalgamates information from each node of the data-driven graphical models into a single influence statistic, similar to Cook’s distance. We call this statistic the Mean Degree Squared Distance (MDSD). Our simulation and empirical studies demonstrate that the MDSD statistic maintains a good balance between false positive and true positive hubs. An R package MDSD is publicly available on GitHub under the General Public License https://github.com/markkukuismin/MDSD.

PMID:39535861 | DOI:10.1093/genetics/iyae187

Pediatr Pulmonol. 2024 Nov 13:e27396. doi: 10.1002/ppul.27396. Online ahead of print.

ABSTRACT

STUDY OBJECTIVES: Rapid growth in childhood predisposes to obesity and cardiometabolic diseases in adulthood. While obstructive sleep apnea (OSA) is bidirectionally linked to obesity, its developmental origins are sparsely studied. We examined associations between postnatal growth and the risk of OSA in adulthood.

METHODS: We included adults whose childhood anthropometric data was collected in the New Delhi Birth Cohort study. The risk of OSA was defined by the Berlin Questionnaire (BQ) with and without the obesity criterion. Using logistic regression, we studied associations of OSA risk with conditional growth parameters, which are statistically independent measures of gain in height, weight, and body mass index (BMI), during infancy (0-2 years), early childhood (2-5 years), and late childhood (5-11 years).

RESULTS: Among 521 subjects (58.9% males) with a mean (SD) age of 40.9 (1.7) years, 30.9% had a high risk of OSA. On multivariate analysis, a high risk of OSA was associated with a higher conditional BMI in infancy (odds ratio: 1.25; 95% confidence interval: 1.00-1.57; p = 0.048) and early childhood (1.35; 1.07-1.69; p = 0.011). Higher risk of OSA was associated with greater conditional weight in early childhood (1.34; 1.06-1.68; p = 0.013). Using the modified BQ definition without obesity, adult risk of OSA was significantly associated with a higher adult BMI instead of childhood conditional BMIs.

CONCLUSIONS: Greater gain in conditional BMI or weight in early childhood is associated with a high risk of OSA in middle age, which is mediated by a higher attained adult BMI.

PMID:39535853 | DOI:10.1002/ppul.27396

West Afr J Med. 2024 Nov 10;41(11 Suppl 1):S21-S22.

ABSTRACT

BACKGROUND: Fetal malnutrition has been reported to result in developmental adaptations, which may lead to chronic diseases later on in life. Maternal body composition, nutritional stores, diet, and ability to deliver nutrients through the placenta determine nutrient availability for the fetus. Thus, this study aimed to determine and compare the dietary intake among pregnant women attending antenatal clinics in rural and urban primary health centres in the Uyo senatorial district of Akwa Ibom State.

METHODS: This cross-sectional study was carried out in 6 primary health care (3 urban and 3 rural) facilities in Uyo senatorial district, Akwa Ibom, selected by a multi-staged sampling technique. An interviewer-administered semistructured questionnaire was used to obtain information on weekly food frequency and 24-hour dietary recall. Descriptive statistics were used, and a chi-square test was performed to examine the relationship between outcome variables. Statistical significance was set at a p-value of 0.05.

RESULTS: The major findings from this study indicated that urban respondents had a significantly higher intake of highly processed carbohydrates, fruits, and vegetables compared to rural respondents (p=0.025 and 0.001, respectively). Overall, highly processed carbohydrates were the most consumed food group in both locations, with 42.2% consuming them over 5 times a week. The average iron and protein intakes were below the recommended nutrient intakes (RNI) in pregnancy at 72.4% and 69.1%, respectively, whereas carbohydrate and calcium intakes exceeded the RNI at 122.5% and 125.7%, respectively. Only protein intake was significantly different across the two locations, with urban respondents having higher intake (53.1g) compared to rural respondents (40.5g), p=0.013.

CONCLUSION: Based on the above findings, it is recommended that adequate nutrition education be taught during antenatal clinics. Micronutrition supplementation, especially iron supplementation, should also be emphasized during the antenatal period.

PMID:39535821

JAMA Pediatr. 2024 Nov 13. doi: 10.1001/jamapediatrics.2024.4727. Online ahead of print.

ABSTRACT

IMPORTANCE: Pediatric patients with cancer experience severely bothersome symptoms during treatment. It was hypothesized that symptom screening and provision of symptom reports to the health care team would reduce symptom burden in pediatric patients with cancer.

OBJECTIVE: To determine if daily symptom screening and provision of symptom reports to the health care team was associated with lower total symptom burden as measured by the Symptom Screening in Pediatrics Tool (SSPedi) compared to usual care among pediatric patients with cancer admitted to a hospital or seen in a clinic daily for at least 5 days.

DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial enrolled participants from July 2018 to September 2023 from 8 Canadian tertiary care centers that diagnose and treat pediatric patients with cancer. Patients aged 8 to 18 years with cancer expected to be in a hospital or clinic daily for at least 5 consecutive days were eligible for inclusion. Participants were randomized to intervention (n = 176) vs control (n = 169) groups. Data were analyzed from November 2023 to December 2023.

INTERVENTION: Intervention participants completed the SSPedi once daily for 5 days. Printed symptom reports were provided daily to the health care team, and email alerts were distributed for severely bothersome symptoms. Control participants received usual care.

MAIN OUTCOMES AND MEASURES: The primary outcome was self-reported total SSPedi score on day 5. Secondary outcomes were individual SSPedi symptoms, pain, quality of life, symptom documentation, and intervention provision. The primary analysis compared the day 5 total SSPedi scores between randomized groups using a multiple linear regression model. For the secondary analysis comparing individual SSPedi symptom scores, the odds ratio for the intervention was estimated using a proportional odds model. Pain and quality of life were analyzed using the same approach as the primary outcome. Fisher exact test was used to compare symptom documentation, any intervention, and symptom-specific intervention between groups.

RESULTS: A total of 345 participants were enrolled; median (range) participant age was 13.8 (8.0-18.8) years, and 150 participants (43.5%) were female. Day 5 SSPedi score was significantly better with symptom screening compared to usual care (adjusted mean difference, -2.5; 95% CI, -3.8 to -1.2). Symptom screening reduced the odds of higher individual symptom scores; 8 of 15 symptom reductions were statistically significant. There were no significant differences in pain or quality of life scores between groups. Five symptoms were documented or treated significantly more often with symptom screening than usual care.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, among pediatric patients with cancer admitted to a hospital or seen in a clinic daily for at least 5 days, symptom screening with SSPedi improved total symptom scores compared to usual care.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03593525.

PMID:39535812 | DOI:10.1001/jamapediatrics.2024.4727

JAMA Netw Open. 2024 Nov 4;7(11):e2443937. doi: 10.1001/jamanetworkopen.2024.43937.

ABSTRACT

IMPORTANCE: Few studies have explored the association between sexual and gender minority (SGM) status and occupational well-being among health care workers.

OBJECTIVES: To assess the prevalence of burnout, professional fulfillment, intent to leave, anxiety, and depression by self-reported SGM status.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional survey study collected data from October 2019 to July 2021, from 8 academic medical institutions participating in the Healthcare Professional Well-Being Academic Consortium. The survey, including questions on SGM status, was administered to attending physicians and trainees. Statistical analyses were performed from June 1, 2023, to February 29, 2024.

EXPOSURE: SGM status was determined via self-reported sexual orientation and gender identity.

MAIN OUTCOMES AND MEASURES: Primary outcomes measured were the Professional Fulfillment Index (burnout and professional fulfillment), intent to leave, and self-reported anxiety and depression using the Patient-Reported Outcomes Measurement Information System short-form 4-item measure.

RESULTS: Of 20 541 attendings and 6900 trainees, 8376 attendings and 2564 trainees responded and provided SGM status. Of these respondents, 386 attendings (4.6%) and 212 trainees (8.3%) identified as SGM. Compared with their non-SGM peers, SGM attendings had a lower prevalence of professional fulfillment (133 of 386 [34.5%] vs 3200 of 7922 [40.4%]) and a higher prevalence of burnout (181 of 382 [47.4%] vs 2791 of 7883 [35.4%]) and intent to leave (125 of 376 [33.2%] vs 2433 of 7873 [30.9%]) (all P < .001). Compared with their non-SGM peers, SGM trainees had a lower prevalence of professional fulfillment (63 of 211 [29.9%] vs 833 of 2333 [35.7%]) and a higher prevalence of burnout (108 of 211 [51.2%] vs 954 of 2332 [40.9%]) (both P < .001). After adjusting for age and race and ethnicity, SGM attendings had higher odds of burnout than their non-SGM peers (adjusted odds ratio, 1.57 [95% CI, 1.27-1.94]; P < .001). Results for burnout were similar among the SGM trainees compared with their non-SGM peers (adjusted odds ratio, 1.47 [1.10-1.96]; P = .01).

CONCLUSIONS AND RELEVANCE: In this cross-sectional survey study of academic physicians and trainees, SGM attendings and trainees had higher levels of burnout and lower levels of professional fulfillment. SGM attendings had greater intent to leave than their non-SGM peers, but trainees did not. These disparities represent an opportunity for further exploration to retain SGM health care workers.

PMID:39535798 | DOI:10.1001/jamanetworkopen.2024.43937

JAMA Netw Open. 2024 Nov 4;7(11):e2444593. doi: 10.1001/jamanetworkopen.2024.44593.

ABSTRACT

IMPORTANCE: The associations of exposure to fine particulate matter (PM2.5) and its constituents with spontaneous preterm birth (sPTB) remain understudied. Identifying subpopulations at increased risk characterized by socioeconomic status and other environmental factors is critical for targeted interventions.

OBJECTIVE: To examine associations of PM2.5 and its constituents with sPTB.

DESIGN, SETTING, AND PARTICIPANTS: This population-based retrospective cohort study was conducted from 2008 to 2018 within a large integrated health care system, Kaiser Permanente Southern California. Singleton live births with recorded residential information of pregnant individuals during pregnancy were included. Data were analyzed from December 2023 to March 2024.

EXPOSURES: Daily total PM2.5 concentrations and monthly data on 5 PM2.5 constituents (sulfate, nitrate, ammonium, organic matter, and black carbon) in California were assessed, and mean exposures to these pollutants during pregnancy and by trimester were calculated. Exposures to total green space, trees, low-lying vegetation, and grass were estimated using street view images. Wildfire-related exposure was measured by the mean concentration of wildfire-specific PM2.5 during pregnancy. Additionally, the mean exposure to daily maximum temperature during pregnancy was calculated.

MAIN OUTCOMES AND MEASURES: The primary outcome was sPTB identified through a natural language processing algorithm. Discrete-time survival models were used to estimate associations of total PM2.5 concentration and its 5 constituents with sPTB. Interaction terms were used to examine the effect modification by race and ethnicity, educational attainment, household income, and exposures to green space, wildfire smoke, and temperature.

RESULTS: Among 409 037 births (mean [SD] age of mothers at delivery, 30.3 [5.8] years), there were positive associations of PM2.5, black carbon, nitrate, and sulfate with sPTB. Adjusted odds ratios (aORs) per IQR increase were 1.15 (95% CI, 1.12-1.18; P < .001) for PM2.5 (IQR, 2.76 μg/m3), 1.15 (95% CI, 1.11-1.20; P < .001) for black carbon (IQR, 1.05 μg/m3), 1.09 (95% CI, 1.06-1.13; P < .001) for nitrate (IQR, 0.93 μg/m3), and 1.06 (95% CI, 1.03-1.09; P < .001) for sulfate (IQR, 0.40 μg/m3) over the entire pregnancy. The second trimester was the most susceptible window; for example, aORs for total PM2.5 concentration were 1.07 (95% CI, 1.05-1.09; P < .001) in the first, 1.10 (95% CI, 1.08-1.12; P < .001) in the second, and 1.09 (95% CI, 1.07-1.11; P < .001) in the third trimester. Significantly higher aORs were observed among individuals with lower educational attainment (eg, less than college: aOR, 1.16; 95% CI, 1.12-1.21 vs college [≥4 years]: aOR, 1.10; 95% CI, 1.06-1.14; P = .03) or income (<50th percentile: aOR, 1.17; 95% CI, 1.14-1.21 vs ≥50th percentile: aOR, 1.12; 95% CI, 1.09-1.16; P = .02) or who were exposed to limited green space (<50th percentile: aOR, 1.19; 95% CI, 1.15-1.23 vs ≥50th percentile: aOR, 1.12; 95% CI, 1.09-1.15; P = .003), more wildfire smoke (≥50th percentile: aOR, 1.19; 95% CI, 1.16-1.23 vs <50th percentile: aOR, 1.13; 95% CI, 1.09-1.16; P = .009), or extreme heat (aOR, 1.51; 95% CI, 1.42-1.59 vs mild temperature: aOR, 1.11; 95% CI, 1.09-1.14; P < .001).

CONCLUSIONS AND RELEVANCE: In this study, exposures to PM2.5 and specific PM2.5 constituents during pregnancy were associated with increased odds of sPTB. Socioeconomic status and other environmental exposures modified this association.

PMID:39535795 | DOI:10.1001/jamanetworkopen.2024.44593