Tag: nevin manimala

BMJ Open. 2023 Jun 1;13(6):e070900. doi: 10.1136/bmjopen-2022-070900.

ABSTRACT

OBJECTIVES: We used the process mapping method and Three Delays framework, to identify and visually represent the relationship between critical actions, decisions and barriers to access to care following injury in the Karonga health system, Northern Malawi.

DESIGN: Facilitated group process mapping workshops with summary process mapping synthesis.

SETTING: Process mapping workshops took place in 11 identified health system facilities (one per facility) providing injury care for a population in Karonga, Northern Malawi.

PARTICIPANTS: Fifty-four healthcare workers from various cadres took part.

RESULTS: An overall injury health system summary map was created using those categories of action, decision and barrier that were sometimes or frequently reported. This provided a visual summary of the process following injury within the health system. For Delay 1 (seeking care) four barriers were most commonly described (by 8 of 11 facilities) these were ‘cultural norms’, ‘healthcare literacy’, ‘traditional healers’ and ‘police processes’. For Delay 2 (reaching care) the barrier most frequently described was ‘transport’-a lack of timely affordable emergency transport (formal or informal) described by all 11 facilities. For Delay 3 (receiving quality care) the most commonly reported barrier was that of ‘physical resources’ (9 of 11 facilities).

CONCLUSIONS: We found our novel approach combining several process mapping exercises to produce a summary map to be highly suited to rapid health system assessment identifying barriers to injury care, within a Three Delays framework. We commend the approach to others wishing to conduct rapid health system assessments in similar contexts.

PMID:37263691 | DOI:10.1136/bmjopen-2022-070900

BMJ Open. 2023 Jun 1;13(6):e073300. doi: 10.1136/bmjopen-2023-073300.

ABSTRACT

INTRODUCTION: Rheumatic heart disease (RHD) is responsible for a significant burden of cardiovascular morbidity and mortality, and remains the most common cause of acquired heart disease among children and young adults in low-income and middle-income countries. Additionally, the global COVID-19 pandemic has forced the emergency restructuring of many health systems, which has had a broad impact on health in general, including cardiovascular disease. Despite significant cost to the health system and estimates from 2015 indicating both high incidence and prevalence of RHD in South Africa, no cohesive national strategy exists. An updated review of national burden of disease estimates, as well as literature on barriers to care for patients with RHD, will provide crucial information to assist in the development of a national RHD programme.

METHODS AND ANALYSIS: Using predefined search terms that capture relevant disease processes from Group A Streptococcal (GAS) infection through to the sequelae of RHD, a search of PubMed, Scopus, ISI Web of Science, Sabinet African Journals, SA Heart and Current and Completed Research databases will be performed. All eligible studies on RHD, acute rheumatic fever and GAS infection published from April 2014 to December 2022 will be included. Vital registration data for the same period from Statistics South Africa will also be collected. A standardised data extraction form will be used to capture results for both quantitative and qualitative analyses. All studies included in burden of disease estimates will undergo quality assessment using standardised tools. Updated estimates on mortality and morbidity as well as a synthesis of work on primary, secondary and tertiary prevention of RHD will be reported.

ETHICS AND DISSEMINATION: No ethics clearance is required for this study. Findings will be disseminated in a peer-reviewed journal and submitted to national stakeholders in RHD.

PROSPERO REGISTRATION NUMBER: CRD42023392782.

PMID:37263687 | DOI:10.1136/bmjopen-2023-073300

BMJ Glob Health. 2023 Jun;8(6):e011591. doi: 10.1136/bmjgh-2022-011591.

ABSTRACT

BACKGROUND: Caesarean section (CS) rates in women experiencing stillbirth have not been studied with nationally representative data. Two Ghana Maternal Health Surveys (GMHS) have captured pregnancy and mode of birth data for all women including those with stillbirths. We compared CS rates between women with live births and stillbirths, and identified socio-economic and pregnancy-related factors associated with CS in stillbirths.

METHODS: A population-based cross-sectional study was conducted in a pooled sample of 17 138 women who had given birth within 5 years preceding the 2007 and 2017 GMHS. CS rates were compared between women with stillbirths and very early neonatal deaths (SBVENDs) and women with live births who survived the first day. Bivariate and multivariable logistic regressions explored variables associated with CS. Effect modification of household’s wealth and maternal educational level by birth outcome was assessed using multivariable logistic regression with interaction terms.

RESULTS: CS rate in women with SBVEND was 19.3% compared with 9.6% in women with live births who survived the first day (rate ratio 2.2; 95% CI 1.6 to 2.9). In multivariable analysis, attaining middle school compared with no formal education (adjusted OR, aOR 2.8; 95% CI 1.1 to 7.1), having had five or more births compared with nulliparity (aOR 3.7; 95% CI 1.3 to 10.7) and reporting prolonged or obstructed labour (aOR 3.3; 95% CI 1.3 to 8.3) were associated with CS in women with SBVEND. Higher household wealth and educational levels were associated with an increased risk of CS in both study groups, with no statistically significant difference in effect.

CONCLUSION: Disaggregating CS rates by birth outcome revealed a high rate among women with SBVEND, twice the overall rate compared with live births. Exclusion of these ‘hidden’ CSs from rate calculations may lead to underestimation of (inter)national CS rates and potentially conceals CS overuse or misuse.

PMID:37263671 | DOI:10.1136/bmjgh-2022-011591

South Med J. 2023 Jun;116(6):471-477. doi: 10.14423/SMJ.0000000000001569.

ABSTRACT

OBJECTIVES: We assessed the impact of obesity and racial disparities on preterm birth (PTB) in the United States and sought to determine whether obesity widens the racial-ethnic disparity gap in preterm birth with a focus on non-Hispanic Black and White women.

METHODS: Using birth data for the years 2014-2019 made publicly available by the Centers for Disease Control and Prevention and obtained from the National Vital Statistics System, we conducted a cross-sectional cohort study analyzing a total of 14,864,844 births from 2014 to 2019.

RESULTS: We observed dose-dependent changes in obesity and PTB by defining obesity in subgroups and PTB in a stratified method. PTB occurred more among non-Hispanic Black women than their non-Hispanic White and Hispanic counterparts. We observed a consistent trend of increased PTB among women with high body mass index. Racial disparity existed in PTB among pregnant obese women, with non-Hispanic Black women exhibiting the greatest risk for PTB.

CONCLUSIONS: Our work further contributes to the growing knowledge of the existence of health disparity among the Black population.

PMID:37263609 | DOI:10.14423/SMJ.0000000000001569

South Med J. 2023 Jun;116(6):464-470. doi: 10.14423/SMJ.0000000000001565.

ABSTRACT

OBJECTIVES: Stress among free clinic patients is an important issue to address in health care. Evaluating the differences between perceived stress and physiological stress will help healthcare professionals to better understand the stress and coping management skills that will improve health outcomes for underserved populations. The aim of this study was to accelerate research to better understand the biological and psychological aspect of stress in health disparities.

METHODS: This was a cross-sectional study using a convenience sample of free clinic patients aged 18 years and older who spoke English and/or Spanish. Multiple modals of data were collected from 178 participants during summer 2019, including a self-administered paper survey and a biomedical saliva sample. Descriptive statistics were used to present the characteristics of the participants, and a correlation heatmap was used to show a graphical representation of the main variables. Two models of multivariable regression were performed to understand factors associated with cortisol and perceived stress.

RESULTS: Higher levels of perceived stress were not significantly more prevalent than higher levels of salivary cortisol among free clinic patients; however, higher levels of social networking were significantly associated with lower levels of perceived stress. Our analysis revealed that having more friends in a social network was slightly more associated with lower levels of perceived stress than having more family members.

CONCLUSIONS: The result of this study provides awareness to healthcare promoters and educators concerning the health of uninsured patients. More specifically, this study provides a foundation to understand the salivary cortisol levels and the relation to perceived stress among this population. Further studies are needed to measure salivary cortisol repeatedly during a period of time among a larger population to better understand the reasons behind normal cortisol level manifesting along with chronic stress.

PMID:37263608 | DOI:10.14423/SMJ.0000000000001565

Eur J Public Health. 2023 Jun 1:ckad088. doi: 10.1093/eurpub/ckad088. Online ahead of print.

ABSTRACT

Researching mortality during the COVID-19 pandemic has been challenging due to methodological inconsistencies and the limited availability of vital statistics data. At the beginning of the pandemic, the World Health Organization recommended daily data publication to inform policy response, but these data were often poor. Final data on COVID-19 deaths in many countries are not yet available, especially for 2021. This report shows that many countries have significant inconsistencies between the preliminary number of deaths and what vital statistics and excess mortality indicate. The inconsistencies in the mortality data raise concerns about the reliability of analyses and public health recommendations.

PMID:37263603 | DOI:10.1093/eurpub/ckad088

Eur J Public Health. 2023 Jun 1:ckad075. doi: 10.1093/eurpub/ckad075. Online ahead of print.

ABSTRACT

BACKGROUND: Analyses of coronavirus disease 19 suggest specific risk factors make communities more or less vulnerable to pandemic-related deaths within countries. What is unclear is whether the characteristics affecting vulnerability of small communities within countries produce similar patterns of excess mortality across countries with different demographics and public health responses to the pandemic. Our aim is to quantify community-level variations in excess mortality within England, Italy and Sweden and identify how such spatial variability was driven by community-level characteristics.

METHODS: We applied a two-stage Bayesian model to quantify inequalities in excess mortality in people aged 40 years and older at the community level in England, Italy and Sweden during the first year of the pandemic (March 2020-February 2021). We used community characteristics measuring deprivation, air pollution, living conditions, population density and movement of people as covariates to quantify their associations with excess mortality.

RESULTS: We found just under half of communities in England (48.1%) and Italy (45.8%) had an excess mortality of over 300 per 100 000 males over the age of 40, while for Sweden that covered 23.1% of communities. We showed that deprivation is a strong predictor of excess mortality across the three countries, and communities with high levels of overcrowding were associated with higher excess mortality in England and Sweden.

CONCLUSION: These results highlight some international similarities in factors affecting mortality that will help policy makers target public health measures to increase resilience to the mortality impacts of this and future pandemics.

PMID:37263602 | DOI:10.1093/eurpub/ckad075

Orthop Traumatol Surg Res. 2023 May 30:103637. doi: 10.1016/j.otsr.2023.103637. Online ahead of print.

ABSTRACT

INTRODUCTION: The EFAS score is a new recently validated European quality of life score for foot and ankle surgery, comprising 6 questions on activities of daily living (ADL) and 4 on sport. The aim of the present study was to assess the kinetics of functional recovery on the EFAS and SF36 scores, and to assess correlations between the two at 0 to 6 months then 6 months to 1 year in a population of foot and ankle surgery patients, globally and per pathology.

HYPOTHESIS: Hindfoot and ankle surgery requires at least 1 year’s follow-up for assessment of recovery, whereas 6 months is sufficient to assess forefoot recovery.

MATERIAL AND METHODS: A multicenter prospective cohort study included all patients undergoing surgery for foot and ankle pathology between December 2015 and July 2016. Statistical analysis, global and per pathology, was performed preoperatively and at 6 months and 1 year.

RESULTS: 98 patients were assessed at 1 year. In the global population, EFAS ADL score improved by 17.1 ± 22.1 points (hindfoot, 16.9 ± 24.6; forefoot, 19.7 ± 21.4) and global SF36 score by 8.7 ± 17.1 points (hindfoot, 10.2 ± 19.1; forefoot, 9.6 ± 15.9). Both scores progressed between 6 months and 1 year for hindfoot pathologies, whereas they remained constant after 6 months for the forefoot. The EFAS score showed weak correlation with SF36.

CONCLUSION: Recovery kinetics differs according to type of foot and ankle pathology. The EFAS score is more suitable than the SF36.

LEVEL OF EVIDENCE: II.

PMID:37263580 | DOI:10.1016/j.otsr.2023.103637

Environ Pollut. 2023 May 30:121938. doi: 10.1016/j.envpol.2023.121938. Online ahead of print.

ABSTRACT

Per- and polyfluoroalkyl substances (PFAS) have extensively contaminated freshwater aquatic ecosystems where they can be transported in water and partition to sediment and biota. In this paper, three freshwater benthic macroinvertebrates with different foraging modes were exposed to environmentally relevant concentrations of eight perfluoroalkyl carboxylates (PFCA), three perfluoroalkyl sulfonates (PFSA), and three fluorotelomer sulfonates (FTS) at varying divalent cation concentrations of magnesium (Mg²⁺) and calcium (Ca²⁺). Divalent cations can impact PFAS partitioning to solids, especially to sediments, at higher concentrations. Sediment dwelling worms (Lumbriculus variegatus), epibenthic grazing snails (Physella acuta), and sediment-dwelling filter-feeding bivalves (Elliptio complanata) were selected due to their unique foraging modes. Microcosms were composed of synthetic sediment, culture water, macroinvertebrates, and PFAS and consisted of a 28-day exposure period. L. variegatus had significantly higher PFAS bioaccumulation than P. acuta and E. complanata, likely due to higher levels of interactions with and ingestion of the contaminated sediment. “High Mg²⁺” (7.5 mM Mg²⁺) and “High Ca²⁺” (7.5 mM Ca²⁺) conditions generally had statistically higher bioaccumulation factors (BAF) than the “Reference Condition” (0.2 mM Ca²⁺ and 0.2 mM Mg²⁺) for PFAS with perfluorinated chain lengths greater than eight carbons. Long-chain PFAS dominated the PFAS profiles of the macroinvertebrates for all groups of compounds studied (PFCA, PFSA, and FTS). These results indicate that the study organism has the greatest impact on bioaccumulation, although divalent cation concentration had observable impacts between organisms depending on the environmental conditions. Elevated cation concentrations in the microcosms led to significantly greater bioaccumulation in the test organisms compared to the experimental reference conditions for long-chain PFAS.

PMID:37263566 | DOI:10.1016/j.envpol.2023.121938

Contemp Clin Trials. 2023 May 30:107247. doi: 10.1016/j.cct.2023.107247. Online ahead of print.

ABSTRACT

BACKGROUND: Young adults experience high rates of cannabis use and consequences. Cross-sectional work has linked positive psychological constructs (e.g., savoring) to less cannabis use and consequences, and positive psychological interventions (PPIs) have shown promise in targeting other substance use behaviors. This pilot study sought to provide an initial test of PPIs to reduce young adult cannabis use and consequences.

METHODS: Adults (18-25 years old) who endorsed at least weekly past-month cannabis use (N = 59, 69.6% men, 41.1% White) reported their baseline cannabis use and consequences. Participants were randomized to complete one of three daily exercises (Savoring, Three Good Things, or a control) along with daily text message surveys for two weeks, then completed a follow-up survey at the end of the two weeks.

RESULTS: Paired samples t-tests indicated that participants in the Three Good Things group showed medium to large reductions in frequency of weekly cannabis use (p = .08, g_av = -0.57) and cannabis-associated consequences (p = .08, g_av = -0.57) from baseline to follow-up. In the Savoring and control groups, there were not significant changes in frequency of weekly cannabis use (Savoring: p = .39, g_av = 0.20; Control: p = .96, g_av = 0.01) nor cannabis-associated consequences (Savoring: p = .84, g_av = 0.05; Control: p = .45, g_av = -0.18). Participants in both positive psychology conditions reported the exercises were easy to complete, providing evidence for acceptability.

DISCUSSION: Results provide initial support for the feasibility and potential promise of a text-message based PPI as a harm reduction approach for cannabis users. A larger clinical trial is warranted to test the effects of such interventions with adequate statistical power.

PMID:37263491 | DOI:10.1016/j.cct.2023.107247