Tag: nevin manimala

J Prim Health Care. 2023 Mar;15(1):14-23. doi: 10.1071/HC22133.

ABSTRACT

Introduction There is considerable variation in the structure and resources of New Zealand (NZ) rural hospitals; however, these have not been recently quantified and their effects on healthcare outcomes are poorly understood. Importantly, there is no standardised description of each rural hospital’s catchment boundary and the characteristics of the population living within this area. Aim To define and describe a catchment population for each of New Zealand’s rural hospitals. Methods An exploratory approach to developing catchments was employed. Geographic Information Systems were used to develop drive-time-based geographic catchments, and administrative health data (National Minimum Data Set and Primary Health Organisation Data Set) informed service utilisation-based catchments. Catchments were defined at both the Statistical Area 2 (SA2) and domicile levels, and linked to census-based population data, the Geographic Classification for Health, and the area-level New Zealand Index of Socioeconomic Deprivation (NZDep2018). Results Our results highlight considerable heterogeneity in the size (max: 57 564, min: 5226) and characteristics of populations served by rural hospitals. Substantial differences in the age structure, ethnic composition, socio-economic profile, ‘remoteness’ and projected future populations, are noted. Discussion In providing a standardised description of each rural hospital’s catchment boundary and its population characteristics, the considerable heterogeneity of the communities served by rural hospitals, both in size, rurality and socio-demographic characteristics, is highlighted. The findings provide a platform on which to build further research regarding NZ’s rural hospitals and inform the delivery of high-quality, cost-effective and equitable health care for people living in rural NZ.

PMID:37000550 | DOI:10.1071/HC22133

J Am Coll Health. 2023 Mar 31:1-12. doi: 10.1080/07448481.2023.2191147. Online ahead of print.

ABSTRACT

Objective: This mixed methods study examined student and parent experiences with anxiety and preferences for campus-based programming to address anxiety. Participants: College students (n = 156) completed a survey, and 20 students participated in focus groups. Parents of college students (n = 85) completed a survey, and 12 parents completed a phone interview. Methods: Students and parents completed surveys about trait worry, mental health literacy, and preferences for proposed programming. Descriptive statistics were calculated. Students participated in focus groups, and parents completed interviews regarding their experiences and preferences. Thematic analysis was conducted with the coded focus group and interview transcripts. Results: Quantitative and qualitative findings revealed specific program preferences (eg scheduling). Qualitative findings highlighted mismatches between student and parent perspectives and opportunities for parental skill building. Conclusions: Students and their parents are open to and eager for campus programming that provides education, skills, and support for college students with anxiety.

PMID:37000529 | DOI:10.1080/07448481.2023.2191147

Analyst. 2023 Mar 31. doi: 10.1039/d3an00074e. Online ahead of print.

ABSTRACT

T cells are considered to be critical drivers of intestinal inflammation in mice and people. The so called intra-epithelial lymphocyte (IEL) compartment largely consist of T cells. Interestingly, the specific regulation and contribution of IELs in the context of inflammatory bowel disease remains poorly understood, in part due to the lack of appropriate analysis tools. Powerful, label-free methods could ultimately provide access to this cell population and hence give valuable insight into IEL biology and even more to their disease-related functionalities. Raman spectroscopy has demonstrated over the last few years its potential for reliable cell characterization and differentiation, but its utility in regard to IEL exploration remains unknown. To address this question experimentally, we utilized a murine, T cell-driven experimental model system which is accepted to model human gut inflammation. Here, we repopulated the small intestinal IEL compartment (SI IELs) of Rag1-deficient mice endogenously lacking T cells by transferring naïve CD4⁺ T helper cells intraperitoneally. Using multivariate statistical analysis, high-throughput Raman spectroscopy managed to define a cell subpopulation ex vivo within the SI IEL pool of mice previously receiving T cells in vivo that displayed characteristic spectral features of lymphocytes. Raman data sets matched flow cytometry analyses with the latter identifying T cell receptor (TCR)αβ⁺ CD4⁺ T cell population in SI IELs from T cell-transferred mice, but not from control mice, in an abundance comparable to the one detected by Raman spectroscopy. Hence, in this study, we provide experimental evidence for high-throughput Raman spectroscopy to be a novel, future tool to reliably identify and potentially further characterize the T cell pool of small intestinal IELs ex vivo.

PMID:37000525 | DOI:10.1039/d3an00074e

JMIR Res Protoc. 2023 Mar 31;12:e37673. doi: 10.2196/37673.

ABSTRACT

BACKGROUND: Clear dialogue-based (interactive) communication that ensures comprehension and recall becomes more important in patient-provider interactions, especially in relation to patients with chronic diseases, where self-management education and counseling are cornerstones in managing these diseases. If patients with chronic disease experience challenges in obtaining, understanding, and applying health-related information (necessary to make informed health decisions and sufficiently manage their health), clear communication and ensuring comprehension become even more critical in the patient-provider interactions. Furthermore, patient-provider communication has been proposed as a potential pathway through which health literacy might influence health outcomes, especially in individuals with chronic diseases. Hence, adjusting communication to the individual level of health literacy might have a positive influence on health outcomes. On this basis, the authors have developed a web-based interactive communication model that both seeks to accommodate health literacy by allowing tailored communication and ensure comprehension and recall between nurses and patients.

OBJECTIVE: This study seeks to examine the use of an IT solution that comprises an interactive communication model that seeks to accommodate health literacy in communication and ensure comprehension and recall between nurses and patients.

METHODS: A quasi-experimental control group study including full economic evaluation with 6-month follow-up. Based on power calculation, a total of 82 participants will be included. Participants are assigned either the interactive communication model (intervention) or usual nursing care. It will be assessed if the model influences the level of health literacy and participants experience a higher health-related quality of life. Further, cost-effectiveness will be evaluated. Overall, the statistical methods will follow an intention-to-treat principle. Results will be presented in accordance with the Transparent Reporting of Evaluations with Non-randomized Designs guidelines for nonrandomized designs as well as the Consolidated Health Economic Evaluation Reporting Standards.

RESULTS: This paper describes a protocol for a clustered quasi-experimental control study that seeks to evaluate the effectiveness of the interactive communicative model. Most studies in the field of health literacy are epidemiological studies that seek to address the effects of poor health literacy in populations and its potential impact on health inequity. A total of 82 participants, who receive community nursing will be included. The final trial day is May 1, 2022, with the first report of results in the final quarter of 2022.

CONCLUSIONS: The results of the trial can create the base for conducting a large-scale study and inspire the conduction of more studies that seeks to create and evaluate interventions aimed at enhancing the level of health literacy and reducing the usage of health resources.

TRIAL REGISTRATION: ClinicalTrials.gov NCT04929314; https://clinicaltrials.gov/ct2/show/NCT04929314.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/37673.

PMID:37000515 | DOI:10.2196/37673

JMIR Cancer. 2023 Mar 31;9:e37141. doi: 10.2196/37141.

ABSTRACT

BACKGROUND: Shopping data can be analyzed using machine learning techniques to study population health. It is unknown if the use of such methods can successfully investigate prediagnosis purchases linked to self-medication of symptoms of ovarian cancer.

OBJECTIVE: The aims of this study were to gain new domain knowledge from women’s experiences, understand how women’s shopping behavior relates to their pathway to the diagnosis of ovarian cancer, and inform research on computational analysis of shopping data for population health.

METHODS: A web-based survey on individuals’ shopping patterns prior to an ovarian cancer diagnosis was analyzed to identify key knowledge about health care purchases. Logistic regression and random forest models were employed to statistically examine how products linked to potential symptoms related to presentation to health care and timing of diagnosis.

RESULTS: Of the 101 women surveyed with ovarian cancer, 58.4% (59/101) bought nonprescription health care products for up to more than a year prior to diagnosis, including pain relief and abdominal products. General practitioner advice was the primary reason for the purchases (23/59, 39%), with 51% (30/59) occurring due to a participant’s doctor believing their health problems were due to a condition other than ovarian cancer. Associations were shown between purchases made because a participant’s doctor believing their health problems were due to a condition other than ovarian cancer and the following variables: health problems for longer than a year prior to diagnosis (odds ratio [OR] 7.33, 95% CI 1.58-33.97), buying health care products for more than 6 months to a year (OR 3.82, 95% CI 1.04-13.98) or for more than a year (OR 7.64, 95% CI 1.38-42.33), and the number of health care product types purchased (OR 1.54, 95% CI 1.13-2.11). Purchasing patterns are shown to be potentially predictive of a participant’s doctor thinking their health problems were due to some condition other than ovarian cancer, with nested cross-validation of random forest classification models achieving an overall in-sample accuracy score of 89.1% and an out-of-sample score of 70.1%.

CONCLUSIONS: Women in the survey were 7 times more likely to have had a duration of more than a year of health problems prior to a diagnosis of ovarian cancer if they were self-medicating based on advice from a doctor rather than having made the decision to self-medicate independently. Predictive modelling indicates that women in such situations, who are self-medicating because their doctor believes their health problems may be due to a condition other than ovarian cancer, exhibit distinct shopping behaviors that may be identifiable within purchasing data. Through exploratory research combining women sharing their behaviors prior to diagnosis and computational analysis of these data, this study demonstrates that women’s shopping data could potentially be useful for early ovarian cancer detection.

PMID:37000495 | DOI:10.2196/37141

JMIR Aging. 2023 Mar 31;6:e41187. doi: 10.2196/41187.

ABSTRACT

BACKGROUND: Due to the aging population, there is a need for monitoring well-being and safety while living independently. A low-intrusive monitoring system is based on a person’s use of energy or water.

OBJECTIVE: The study’s objective was to provide a systematic overview of studies that monitor the health and well-being of older people using energy (eg, electricity and gas) and water usage data and study the outcomes on health and well-being.

METHODS: CENTRAL, Embase, MEDLINE (Ovid), Scopus, Web of Science, and Google Scholar were searched systematically from inception until November 8, 2021. The inclusion criteria were that the study had to be published in English, have full-text availability, target independent-living people aged 60 years and older from the general population, have an observational design, and assess the outcomes of a monitoring system based on energy (ie, electricity, gas, or water) usage on well-being and safety. The quality of the studies was assessed by the QualSyst systematic review tool.

RESULTS: The search strategy identified 2920 articles. The majority of studies focused on the technical algorithms underlying energy usage data and related sensors. One study was included in this review. This study reported that the smart energy meter data monitoring system was considered unobtrusive and was well accepted by the older people and professionals involved. Energy usage in a household acted as a unique signature and therefore provided useful insight into well-being and safety. This study lacked statistical power due to the small number of participants and the low number of observed events. In addition, the quality of the study was rated as low.

CONCLUSIONS: This review identified only 1 study that evaluated the impact of an energy usage monitoring system on the well-being and safety of older people. The absence of reliable evidence impedes any definitive guidance or recommendations for practice. Because this emerging field has not yet been studied thoroughly, many questions remain open for further research. Future studies should focus on the further development of a monitoring system and the evaluation of the implementation and outcomes of these systems.

TRIAL REGISTRATION: PROSPERO CRD42022245713; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=245713.

PMID:37000477 | DOI:10.2196/41187

Br J Radiol. 2023 Mar 31:20220682. doi: 10.1259/bjr.20220682. Online ahead of print.

ABSTRACT

OBJECTIVES: The novel CT-TDV scoring system, identifying T3c + disease; presence/absence of tumour deposits and EMVI has been shown to be superior in predicting prognosis when compared to the CT-TNM staging system in the evaluation of colon cancer. Reproducibility of this scoring system between specialist GI radiologists has not been assessed previously. The aim of this study was to assess the inter rater agreement of gastrointestinal radiologists in assessing the novel pre-operative CT-TDV scoring of patients with potentially curable right-sided colon cancer.

METHODS: 93 right colon cancer pre-operative CT scans were graded as CT TDV ‘good’ versus TDV ‘poor’ by four radiologists. Inter rater agreement was assessed using the intraclass correlation coefficient (ICC) between all four readers and individual readers against the central radiologist using Cohen’s κ statistic.

RESULTS: The ICC comparing those graded as TDV ‘good’ versus TDV ‘poor’ for all 93 cases was 0.61 (0.51-0.70) indicating moderate reliability. Individual κ scores across the 93 cases were 0.76, 0.59 and 0.59 (p < 0.001) indicating moderate to substantial agreement.

CONCLUSION: The CT TDV scoring system is reproducible amongst trained gastrointestinal radiologists in the assessment of newly diagnosed right colon cancer.

ADVANCES IN KNOWLEDGE: This further validates the clinical utility of the CT TDV scoring system as a prognostic tool to guide the management of patients with potentially curable right colon cancer.

PMID:37000465 | DOI:10.1259/bjr.20220682

J Occup Environ Hyg. 2023 Mar 31:1-16. doi: 10.1080/15459624.2023.2197634. Online ahead of print.

ABSTRACT

This study provides an overview on the relationships between exposure to work-related, hand-arm vibration and the occurrence of pre-defined disorders of the hands. We searched Medline, Embase, Web of Science, Cochrane Central, and PsycINFO for cross-sectional and longitudinal studies on the association between work-related vibration exposure and the occurrence of hand-arm vibration syndrome (including vibration-induced white finger), Dupuytren’s contracture, or hypothenar hammer syndrome. We used a 16-item checklist for assessing risk of bias. We present results narratively, and we conducted random effects meta-analyses if possible. We included 10 studies with more than 24,381 participants. Our results showed statistically significant associations between the exposure to hand-arm vibrations and the occurrence of the selected disorders, with pooled odds ratios ranging between 1.35 (95% CI: 1.28 to 2.80) and 3.43 (95% CI: 2.10 to 5.59). Considerable between-study hetereogeneity was observed. Our analyses show that exposure to vibrating tools at work is associated with an increased risk for the occurrence of selected disorders of the hands. Due to the majority of studies being cross-sectional, no firm conclusion is possible regarding causal relationships between vibration exposure and disorder occurrence. Future research should specifically address whether reducing the exposure to hand-held vibrating tools at work reduces the incidence of the disorders of the hands investigated in this systematic review.

PMID:37000463 | DOI:10.1080/15459624.2023.2197634

JAMA Netw Open. 2023 Mar 1;6(3):e236185. doi: 10.1001/jamanetworkopen.2023.6185.

ABSTRACT

IMPORTANCE: A previous meta-analysis of the association between alcohol use and all-cause mortality found no statistically significant reductions in mortality risk at low levels of consumption compared with lifetime nondrinkers. However, the risk estimates may have been affected by the number and quality of studies then available, especially those for women and younger cohorts.

OBJECTIVE: To investigate the association between alcohol use and all-cause mortality, and how sources of bias may change results.

DATA SOURCES: A systematic search of PubMed and Web of Science was performed to identify studies published between January 1980 and July 2021.

STUDY SELECTION: Cohort studies were identified by systematic review to facilitate comparisons of studies with and without some degree of controls for biases affecting distinctions between abstainers and drinkers. The review identified 107 studies of alcohol use and all-cause mortality published from 1980 to July 2021.

DATA EXTRACTION AND SYNTHESIS: Mixed linear regression models were used to model relative risks, first pooled for all studies and then stratified by cohort median age (<56 vs ≥56 years) and sex (male vs female). Data were analyzed from September 2021 to August 2022.

MAIN OUTCOMES AND MEASURES: Relative risk estimates for the association between mean daily alcohol intake and all-cause mortality.

RESULTS: There were 724 risk estimates of all-cause mortality due to alcohol intake from the 107 cohort studies (4 838 825 participants and 425 564 deaths available) for the analysis. In models adjusting for potential confounding effects of sampling variation, former drinker bias, and other prespecified study-level quality criteria, the meta-analysis of all 107 included studies found no significantly reduced risk of all-cause mortality among occasional (>0 to <1.3 g of ethanol per day; relative risk [RR], 0.96; 95% CI, 0.86-1.06; P = .41) or low-volume drinkers (1.3-24.0 g per day; RR, 0.93; P = .07) compared with lifetime nondrinkers. In the fully adjusted model, there was a nonsignificantly increased risk of all-cause mortality among drinkers who drank 25 to 44 g per day (RR, 1.05; P = .28) and significantly increased risk for drinkers who drank 45 to 64 and 65 or more grams per day (RR, 1.19 and 1.35; P < .001). There were significantly larger risks of mortality among female drinkers compared with female lifetime nondrinkers (RR, 1.22; P = .03).

CONCLUSIONS AND RELEVANCE: In this updated systematic review and meta-analysis, daily low or moderate alcohol intake was not significantly associated with all-cause mortality risk, while increased risk was evident at higher consumption levels, starting at lower levels for women than men.

PMID:37000449 | DOI:10.1001/jamanetworkopen.2023.6185

J Spinal Cord Med. 2023 Mar 31:1-11. doi: 10.1080/10790268.2023.2183334. Online ahead of print.

ABSTRACT

CONTEXT: The Spinal Cord Independence Measure is a comprehensive functional rating scale for individuals with spinal cord lesion (SCL).

OBJECTIVE: To validate the scores of the three subscales of SCIM IV, the fourth version of SCIM, using advanced statistical methods.

STUDY DESIGN: Multi-center cohort study.

SETTING: Nineteen SCL units in 11 countries.

METHODS: SCIM developers created SCIM IV following comments by experts, included more accurate definitions of scoring criteria in the SCIM IV form, and adjusted it to assess specific conditions or situations that the third version, SCIM III, does not address. Professional staff members assessed 648 SCL inpatients, using SCIM IV and SCIM III, at admission to rehabilitation, and at discharge. The authors examined the validity and reliability of SCIM IV subscale scores using Rasch analysis.

RESULTS: The study included inpatients aged 16-87 years old. SCIM IV subscale scores fit the Rasch model. All item infit and most item outfit mean-square indices were below 1.4; statistically distinct strata of abilities were 2.6-6; most categories were properly ordered; item hierarchy was stable across most clinical subgroups and countries. In a few items, however, we found misfit or category threshold disordering. We found SCIM III and SCIM IV Rasch properties to be comparable.

CONCLUSIONS: Rasch analysis suggests that the scores of each SCIM IV subscale are reliable and valid. This reinforces the justification for using SCIM IV in clinical practice and research.

PMID:37000427 | DOI:10.1080/10790268.2023.2183334