Tag: nevin manimala

J Allied Health. 2024 Summer;53(2):155-160.

ABSTRACT

PURPOSE: The highest rates mTBI occurrence are seen among geriatric populations (ages ≥65), and these patients often have persistent and untreated symptoms. This study’s purpose was to explore mild traumatic brain injury initial onset (mTBI-IN) and mild traumatic brain injury subsequent (mTBI-S) emergency department (ED) visit population percentages and associations with geriatric (population ages ≥65), sex, and fall mechanism of injury.

METHODS: The design was a population-based cross-sectional study using data from the 2018 Nationwide Emergency Department Sample (NEDS). Study sample size was 261,349. An independent t-test was used to investigate mean age differences between mTBI-IN and mTBI-S. Pearson’s chi-squared correlational analyses were used to investigate associations of age, sex, and fall injury with mTBI-IN and mTBI-S.

RESULTS: The mean age of those in 2018 with ED visits suggested that age was older for those patients with mTBI-S (age mean, 50.4 yrs) than those with mTBI-IN (age mean, 41.4 yrs) (95% CI 9.77, 8.30; p=0.025). The number of visits for those aged ≥65 was significantly associated with mTBI-S (p<0.001). More males than females reported mTBI-S ED visits in all ages (p=0.022). Falls injury alone was not found to be significantly associated with visits (p<0.001).

CONCLUSIONS: Those returning to the ED for continued care after mTBI were associated with those aged ≥65. Monitoring after mTBI ED visits may need to target geriatric populations for medical management.

PMID:38834343

J Allied Health. 2024 Summer;53(2):116-121.

ABSTRACT

OBJECTIVE: Today’s healthcare system requires interprofessional collaborative practice (IPCP) to improve health outcomes. IPCP often begins with interprofessional education (IPE), which should stimulate meaningful idea exchange. This study’s purpose was to assess the impact of a photovoice-based IPE experience on the attitudes and beliefs of students in two health professions programs.

METHODS: Forty-two Doctor of Physical Therapy students and 13 Radiation Therapy students created photovoice slides representing the most significant “thing” in their professional education. Students discussed their slides in small groups followed by a large-group discussion. A pretest-posttest survey containing researcher-generated questions and the Student Perceptions of Interprofessional Clinical Education-Revised (SPICE-R2) and a post-activity evaluation were administered.

RESULTS: Forty-two students completed the pretest survey; 35 completed the posttest survey. A statistically significant difference was found between pretest (M=4.07, SD=0.91) and posttest (M=4.45, SD=0.70) SPICE-R2 total scores, t(928)=7.22, p<0.001. Statistically significant differences were found for all SPICE-R2 factor scores. Thematic analysis revealed three themes: 1) students learned about the other profession, 2) the IPE experience was meaningful, and 3) the IPE experience could be improved.

CONCLUSIONS: The photovoice IPE experience stimulated student reflection, interprofessional collaboration, and new perceptions about the other health profession. Future studies should focus on similar activities offered earlier in the education program.

PMID:38834337

J Allied Health. 2024 Summer;53(2):105-115.

ABSTRACT

Health professions educators can benefit from continuing education to more effectively facilitate interprofessional education (IPE) in clinical settings. Online learning formats enable broader participation and overcome barriers to in-person events, though few studies describe the most effective platforms and methods of online continuing education for this purpose. In the context of the COVID-19 pandemic, we developed a 6-week interactive online program implemented via an integrated online educational platform (OEP) to equip participants with knowledge and skills to better facilitate IPE in clinical settings. Program outcomes evaluation involved mixed-methods data analysis from OEP site usage statistics, pre/post-program surveys, pre/post program validated self-assessment surveys, and post-pro¬gram focus group. Twenty-four participants representing 5 professions from inpatient and outpatient clinical settings completed the program. Quantitative findings include statistically significant improvement in all of 11 measures of IPE knowledge and skills developed for this study, 4 of 9 socialization measures, and 7 of 18 facilitation measures. Qualitative findings include participants placing value on multiple modes of instruction, facilitated small group engagement, brief condensed asynchronous content, clear expectations of program time commitment, and detailed understanding of the OEP.

PMID:38834336

BMJ Open Diabetes Res Care. 2024 Jun 4;12(3):e004191. doi: 10.1136/bmjdrc-2024-004191.

ABSTRACT

INTRODUCTION: None of the studies of type 2 diabetes (T2D) subtyping to date have used linked population-level data for incident and prevalent T2D, incorporating a diverse set of variables, explainable methods for cluster characterization, or adhered to an established framework. We aimed to develop and validate machine learning (ML)-informed subtypes for type 2 diabetes mellitus (T2D) using nationally representative data.

RESEARCH DESIGN AND METHODS: In population-based electronic health records (2006-2020; Clinical Practice Research Datalink) in individuals ≥18 years with incident T2D (n=420 448), we included factors (n=3787), including demography, history, examination, biomarkers and medications. Using a published framework, we identified subtypes through nine unsupervised ML methods (K-means, K-means++, K-mode, K-prototype, mini-batch, agglomerative hierarchical clustering, Birch, Gaussian mixture models, and consensus clustering). We characterized clusters using intracluster distributions and explainable artificial intelligence (AI) techniques. We evaluated subtypes for (1) internal validity (within dataset; across methods); (2) prognostic validity (prediction for 5-year all-cause mortality, hospitalization and new chronic diseases); and (3) medication burden.

RESULTS: Development: We identified four T2D subtypes: metabolic, early onset, late onset and cardiometabolic. Internal validity: Subtypes were predicted with high accuracy (F1 score >0.98). Prognostic validity: 5-year all-cause mortality, hospitalization, new chronic disease incidence and medication burden differed across T2D subtypes. Compared with the metabolic subtype, 5-year risks of mortality and hospitalization in incident T2D were highest in late-onset subtype (HR 1.95, 1.85-2.05 and 1.66, 1.58-1.75) and lowest in early-onset subtype (1.18, 1.11-1.27 and 0.85, 0.80-0.90). Incidence of chronic diseases was highest in late-onset subtype and lowest in early-onset subtype. Medications: Compared with the metabolic subtype, after adjusting for age, sex, and pre-T2D medications, late-onset subtype (1.31, 1.28-1.35) and early-onset subtype (0.83, 0.81-0.85) were most and least likely, respectively, to be prescribed medications within 5 years following T2D onset.

CONCLUSIONS: In the largest study using ML to date in incident T2D, we identified four distinct subtypes, with potential future implications for etiology, therapeutics, and risk prediction.

PMID:38834334 | DOI:10.1136/bmjdrc-2024-004191

BMJ Open Respir Res. 2024 Jun 4;11(1):e002148. doi: 10.1136/bmjresp-2023-002148.

ABSTRACT

OBJECTIVE: This study aims to explore the common genetic basis between respiratory diseases and to identify shared molecular and biological mechanisms.

METHODS: This genome-wide pleiotropic association study uses multiple statistical methods to systematically analyse the shared genetic basis between five respiratory diseases (asthma, chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis, lung cancer and snoring) using the largest publicly available genome wide association studies summary statistics. The missions of this study are to evaluate global and local genetic correlations, to identify pleiotropic loci, to elucidate biological pathways at the multiomics level and to explore causal relationships between respiratory diseases. Data were collected from 27 November 2022 to 30 March 2023 and analysed from 14 April 2023 to 13 July 2023.

MAIN OUTCOMES AND MEASURES: The primary outcomes are shared genetic loci, pleiotropic genes, biological pathways and estimates of genetic correlations and causal effects.

RESULTS: Significant genetic correlations were found for 10 paired traits in 5 respiratory diseases. Cross-Phenotype Association identified 12 400 significant potential pleiotropic single-nucleotide polymorphism at 156 independent pleiotropic loci. In addition, multitrait colocalisation analysis identified 15 colocalised loci and a subset of colocalised traits. Gene-based analyses identified 432 potential pleiotropic genes and were further validated at the transcriptome and protein levels. Both pathway enrichment and single-cell enrichment analyses supported the role of the immune system in respiratory diseases. Additionally, five pairs of respiratory diseases have a causal relationship.

CONCLUSIONS AND RELEVANCE: This study reveals the common genetic basis and pleiotropic genes among respiratory diseases. It provides strong evidence for further therapeutic strategies and risk prediction for the phenomenon of respiratory disease comorbidity.

PMID:38834332 | DOI:10.1136/bmjresp-2023-002148

BMJ Open. 2024 Jun 4;14(6):e078085. doi: 10.1136/bmjopen-2023-078085.

ABSTRACT

OBJECTIVES: This study aims to investigate the incidence, associated factors and interventions to address teen pregnancy involvement (TPI) among African, Caribbean and Black (ACB) adolescents in North America.

DESIGN: We conducted a scoping review of the literature, guided by the social-ecological model.

DATA SOURCES: Studies were retrieved from databases such as Ovid Medline, Ovid Embase, CINAHL, CAB Direct and Google Scholar and imported into COVIDENCE for screening.

ELIGIBILITY CRITERIA: The Joanna Briggs Institute scoping reviews protocol guided the establishment of eligibility criteria. Included studies focused on rates, associated factors and interventions related to TPI among ACB boys and girls aged 10-19 in North America. The publication time frame was restricted to 2010-2023, encompassing both peer-reviewed and non-peer-reviewed studies with diverse settings.

DATA EXTRACTION AND SYNTHESIS: Data were extracted from 32 articles using a form developed by the principal author, focusing on variables aligned with the research question.

RESULTS: The scoping review revealed a dearth of knowledge in Canadian and other North American literature on TPI in ACB adolescents. Despite an overall decline in teen pregnancy rates, disparities persist, with interventions such as postpartum prescription of long-acting birth control and teen mentorship programmes proving effective.

CONCLUSION: The findings highlight the need for increased awareness, research and recognition of male involvement in adolescent pregnancies. Addressing gaps in housing, employment, healthcare, sexual health education and health systems policies for marginalised populations is crucial to mitigating TPI among ACB adolescents.

IMPACT: The review underscores the urgent need for more knowledge from other North American countries, particularly those with growing ACB migrant populations.

PMID:38834331 | DOI:10.1136/bmjopen-2023-078085

BMJ Open. 2024 Jun 4;14(6):e078842. doi: 10.1136/bmjopen-2023-078842.

ABSTRACT

OBJECTIVES: This study investigated changes in the length of stay (LoS) at a level III/IV neonatal intensive care unit (NICU) and level II neonatology departments until discharge home for very preterm infants and identified factors influencing these trends.

DESIGN: Retrospective cohort study based on data recorded in the Netherlands Perinatal Registry between 2008 and 2021.

SETTING: A single level III/IV NICU and multiple level II neonatology departments in the Netherlands.

PARTICIPANTS: NICU-admitted infants (n=2646) with a gestational age (GA) <32 weeks.

MAIN OUTCOME MEASURES: LoS at the NICU and overall LoS until discharge home.

RESULTS: The results showed an increase of 5.1 days (95% CI 2.2 to 8, p<0.001) in overall LoS in period 3 after accounting for confounding variables. This increase was primarily driven by extended LoS at level II hospitals, while LoS at the NICU remained stable. The study also indicated a strong association between severe complications of preterm birth and LoS. Treatment of infants with a lower GA and more (severe) complications (such as severe retinopathy of prematurity) during the more recent periods may have increased LoS.

CONCLUSION: The findings of this study highlight the increasing overall LoS for very preterm infants. LoS of very preterm infants is presumably influenced by the occurrence of complications of preterm birth, which are more frequent in infants at a lower gestational age.

PMID:38834326 | DOI:10.1136/bmjopen-2023-078842

BMJ Open. 2024 Jun 4;14(6):e076580. doi: 10.1136/bmjopen-2023-076580.

ABSTRACT

OBJECTIVES: The objective of this study is to estimate the overall pooled prevalence of depression and its associated factors among high school, college and university students in Ethiopia.

DESIGN: Systematic review and meta-analysis.

DATA SOURCES: PubMed/MEDLINE, EMBASE, Science Direct, African Journal Online and Google Scholar. The primary articles were searched from 2 April 2023 to 11 May 2023.

ELIGIBILITY CRITERIA: Observational studies such as cross-sectional, case-control and cohort studies that reported the prevalence and associated factors of depression among students in Ethiopia were included. Both published and unpublished primary studies were included in this review.

DATA EXTRACTION AND SYNTHESIS: Two authors independently extracted all the important data using a Microsoft Excel spreadsheet and exported it to Stata V.14 for analysis. The statistical heterogeneity among the included articles was assessed by the I² statistics test. Publication bias was checked using the funnel plot and Egger’s regression test.

RESULTS: A total of 17 primary studies with 8798 study participants were included in the current study to estimate the combined prevalence of depression. The pooled prevalence of depression among Ethiopian students was 35.52% with a 95% CI (30.54% to 40.51%). Subgroup analysis showed that the pooled prevalence of depression was higher in Addis Ababa, which was 40.43%, with a 95% CI (28.02% to 52.83%). Female sex, first-year educational level, family history of mental illness, alcohol drinking and parental neglect were significantly associated with depression in this study.

CONCLUSION: In this review, the overall pooled prevalence of depression among students in Ethiopia was high compared with the general population. Therefore, it is necessary to make more efforts to provide mental healthcare and psychosocial support to students to improve their mental health and decrease the overall burden of depression.

PROSPERO REGISTRATION NUMBER: CRD42023424301.

PMID:38834322 | DOI:10.1136/bmjopen-2023-076580

BMJ Open. 2024 Jun 4;14(6):e081837. doi: 10.1136/bmjopen-2023-081837.

ABSTRACT

OBJECTIVE: We aimed to evaluate the feasibility and utility of an unsupervised testing mechanism, in which participants pick up a swab kit, self-test (unsupervised) and return the kit to an on-campus drop box, as compared with supervised self-testing at staffed locations.

DESIGN: University SARS-CoV-2 testing cohort.

SETTING: Husky Coronavirus Testing provided voluntary SARS-CoV-2 testing at a university in Seattle, USA.

OUTCOME MEASURES: We computed descriptive statistics to describe the characteristics of the study sample. Adjusted logistic regression implemented via generalised estimating equations was used to estimate the odds of a self-swab being conducted through unsupervised versus supervised testing mechanisms by participant characteristics, including year of study enrolment, pre-Omicron versus post-Omicron time period, age, sex, race, ethnicity, affiliation and symptom status.

RESULTS: From September 2021 to July 2022, we received 92 499 supervised and 26 800 unsupervised self-swabs. Among swabs received by the laboratory, the overall error rate for supervised versus unsupervised swabs was 0.3% vs 4%, although this declined to 2% for unsupervised swabs by the spring of the academic year. Results were returned for 92 407 supervised (5% positive) and 25 836 unsupervised (4%) swabs from 26 359 participants. The majority were students (79%), 61% were female and most identified as white (49%) or Asian (34%). The use of unsupervised testing increased during the Omicron wave when testing demand was high and stayed constant in spring 2022 even when testing demand fell. We estimated the odds of using unsupervised versus supervised testing to be significantly greater among those <25 years of age (p<0.001), for Hispanic versus non-Hispanic individuals (OR 1.2, 95% CI 1.0 to 1.3, p=0.01) and lower among individuals symptomatic versus asymptomatic or presymptomatic (0.9, 95% CI 0.8 to 0.9, p<0.001).

CONCLUSIONS: Unsupervised swab collection permitted increased testing when demand was high, allowed for access to a broader proportion of the university community and was not associated with a substantial increase in testing errors.

PMID:38834321 | DOI:10.1136/bmjopen-2023-081837

BMJ Open. 2024 Jun 4;14(6):e080022. doi: 10.1136/bmjopen-2023-080022.

ABSTRACT

OBJECTIVE: Investigating attitudes accepting two categories of violence against women and girls (VAWG) (intimate partner violence-IPV-and other expressions of VAWG) and their association with seven demographic/social determinants and health-seeking behaviours in South Sudan.

DESIGN: Cross-sectional study using data from the South Sudan National Household Survey 2020.

SETTING: South Sudan.

PARTICIPANTS AND METHODS: 1741 South Sudanese women and 1739 men aged 15-49 years; data captured between November 2020 and February 2021 and analysed using binary logistic regression.

RESULTS: People with secondary or higher education displayed attitudes rejecting acceptance of IPV (OR 0.631, 95% CI 0.508 to 0.783). Women and men living in states with more numerous internally displaced people (IDP) or political/military violence had attitudes accepting IPV more than residents of less violence-affected regions (OR 1.853, 95% CI 1.587 to 2.164). Women had a higher odd of having attitudes accepting IPV than men (OR 1.195, 95% CI 1.014 to 1.409). People knowing where to receive gender-based violence healthcare and psychological support (OR 0.703, 95% CI 0.596 to 0.830) and with primary (OR 0.613, 95% CI 0.515 to 0.729), secondary or higher education (OR 0.596, 95% CI 0.481 to 0.740) displayed attitudes rejecting acceptance of other expressions of VAWG. People residing in states with proportionately more IDP and who accepted IPV were more likely to have attitudes accepting other expressions of VAWG (OR 1.699, 95% CI 1.459 to 1.978; OR 3.195, 95% CI 2.703 to 3.775, respectively).

CONCLUSION: Attitudes towards accepting VAWG in South Sudan are associated with women’s and men’s education, gender, residence and knowledge about health-seeking behaviour. Prioritising women’s empowerment and gender transformative programming in the most conflict-affected areas where rates of VAWG are higher should be prioritised along with increasing girls’ access to education. A less feasible strategy to decrease gender inequalities is reducing insecurity, military conflict, and displacement, and increasing economic stability.

PMID:38834318 | DOI:10.1136/bmjopen-2023-080022