Tag: nevin manimala

Am J Hum Biol. 2022 Oct 11:e23817. doi: 10.1002/ajhb.23817. Online ahead of print.

ABSTRACT

OBJECTIVE: To address the relationship between socioeconomic factors and age of menarche among Polish women born and reared in periods that varied considerably in environmental stresses: the Great Depression of the 1930s, the interval of World War II, and the interval of communist rule following World War II through the 1950s.

METHODS: The data set included information on age at menarche and socioeconomic status (SES) of 718 women born during the Great Depression (n = 182), WWII (n = 189), and post-WWII through the 1950s (n = 347). A structured semi-parametric statistical model (generalized additive model [GAM] class) was used for analysis. An ANOVA-like linear model was used to test for marginal effects of SES-related factors and their interactions together with nonparametric seasonal effect.

RESULTS: The influence of period of birth, month of birth, region of early childhood, and father’s education, and the interaction between period of birth and father’s education on age at menarche were statistically significant. During the economic crisis and the interval of WWII, differences in ages at menarche between the extreme categories of father’s education were marked. The differences in ages at menarche between women from the lowest and highest social groups were markedly reduced among women born during the post-war interval. In addition, women born in February-March attained menarche earlier than women born in September-October.

CONCLUSIONS: Unpredictable conditions associated with the economic crisis and war conditions had a stronger impact on age at menarche among women from families of lower SES compared to women from better economic circumstances. Individuals born and reared in low SES conditions likely suffered more severe deterioration across the spectrum of the standard of living and quality of life compared to those with a higher SES.

PMID:36219696 | DOI:10.1002/ajhb.23817

J Pediatr Hematol Oncol. 2022 Oct 3. doi: 10.1097/MPH.0000000000002562. Online ahead of print.

ABSTRACT

We investigated social and logistic factors eg, distance from the medical center, language barriers, other children to care for, number of caregivers, etc.) for families to delay seeking immediate emergency care for neutropenic fever in a retrospective cohort study of all pediatric hematology-oncology patients who presented for fever in the setting of neutropenia to our emergency department or clinic from 2015 to 2020. Patients with a history of at least 2 prior admissions for neutropenic fever waited more often for a second fever before presenting versus those without such history (odds ratio 5.00, 95% CI 1.26 to 19.84, P=0.04). No other significant associations were found.

PMID:36219679 | DOI:10.1097/MPH.0000000000002562

Cutis. 2022 Aug;110(2):76-79. doi: 10.12788/cutis.0587.

ABSTRACT

Dermatology is one of the least diverse medical specialties. Although there have been studies addressing barriers faced by underrepresented in medicine (UIM) applicants to dermatology, there is little information about how UIM applicants approach and fare in the dermatology residency match process. This study aimed to assess differences between UIM and non-UIM applicants in the dermatology match process. A survey was administered to 2020-2021 dermatology applicants (N=232) to evaluate applicant characteristics, approaches, and outcomes in the match process. Survey responses were analyzed to determine if differences between variables were statistically significant. An additional survey was administered to dermatology residency program directors to evaluate their approach to the 2020-2021 application process. Our findings are important in identifying interventions to improve equity in the dermatology application process and to improve diversity in the dermatology workforce.

PMID:36219632 | DOI:10.12788/cutis.0587

Biometrics. 2022 Oct 11. doi: 10.1111/biom.13759. Online ahead of print.

ABSTRACT

Investigating and monitoring misdiagnosis-related harm is crucial for improving health care. However, this effort has traditionally focused on the chart review process, which is labor intensive, potentially unstable, and does not scale well. To monitor medical institutes’ diagnostic performance and identify areas for improvement in a timely fashion, researchers proposed to leverage the relationship between symptoms and diseases based on electronic health records or claim data. Specifically, the elevated disease risk following a false-negative diagnosis can be used to signal potential harm. However, off-the-shelf statistical methods do not fully accommodate the data structure of a well-hypothesized risk pattern and thus fail to address the unique challenges adequately. To fill these gaps, we proposed a mixture regression model and its associated goodness-of-fit testing. We further proposed harm measures and profiling analysis procedures to quantify, evaluate, and compare misdiagnosis-related harm across institutes with potentially different patient population compositions. We studied the performance of the proposed methods through simulation studies. We then illustrated the methods through data analyses on stroke occurrence data from the Taiwan Longitudinal Health Insurance Database. From the analyses, we quantitatively evaluated risk factors for being harmed due to misdiagnosis, which unveiled some insights for health care quality research. We also compared general and special care hospitals in Taiwan and observed better diagnostic performance in special care hospitals using various new evaluation measures.

PMID:36219626 | DOI:10.1111/biom.13759

PLoS Negl Trop Dis. 2022 Oct 11;16(10):e0010832. doi: 10.1371/journal.pntd.0010832. Online ahead of print.

ABSTRACT

BACKGROUND: Dengue is not included explicitly in the WHO Integrated Management of Childhood Illness (IMCI) algorithm. However, the assessment, classification and management of dengue has been incorporated into several IMCI country adaptations. We aimed to evaluate the dengue algorithms incorporated into IMCI guidelines and discuss the need for harmonization, including an extension of the age range for IMCI.

METHODS: This study included three steps. First, we investigated dengue algorithms incorporated into five Southeast-Asian (Myanmar, Philippines, Vietnam, Indonesia, Cambodia) country IMCI guidelines through a desk-based analysis. Second, we conducted an expert survey to elicit opinions regarding the integration of dengue and extension of the age range in IMCI. Third, we compared our findings with data from a large multicentric prospective study on acute febrile illness.

RESULTS: We found considerable heterogeneity between the country specific IMCI guidelines in the dengue algorithms as well as classification schemes. Most guidelines did not differentiate between diagnostic algorithms for the detection of dengue versus other febrile illness, and warning signs for progression to severe dengue. Our expert survey resulted in a consensus to further integrate dengue in IMCI and extend the age range for IMCI guidelines beyond 5 years of age. Most of the interviewees responded that their country had a stand-alone clinical guideline for dengue, which was not integrated into the IMCI approach and considered laboratory testing for dengue necessary on day three of consecutive fever. Using data from a large multicentric study of children 5-15 years of age, we could confirm that the likelihood of dengue increased with consecutive fever days. However, a significant proportion of children (36%) would be missed if laboratory testing was only offered on the third consecutive day of fever.

CONCLUSIONS: This study supports the extension of the IMCI age range beyond 5 years of age as well as the inclusion of dengue relevant content in the algorithm. Because of the challenge of distinguishing dengue from other febrile illnesses, simple laboratory testing (e.g., full blood count) should be offered at an early stage during the course of the illness. Testing only children with consecutive fever over 3 days may lead to an underdiagnosis of dengue among those with acute febrile illness in children 5-15 years of age. In addition, specific laboratory testing for dengue should be made available to peripheral health facilities.

PMID:36219610 | DOI:10.1371/journal.pntd.0010832

PLoS One. 2022 Oct 11;17(10):e0275344. doi: 10.1371/journal.pone.0275344. eCollection 2022.

ABSTRACT

OBJECTIVES: Tuberculosis (TB) is an infectious disease that causes thousands of deaths in Bangladesh. Bangladesh is one of the 30 high TB burden countries. In this study, we aimed to assess the knowledge, practices, and attitude toward TB, and to determine the factors associated with them among people who have internet access in Bangladesh. Design, Setting, and Participant: A web-based anonymous cross-sectional survey was conducted from May 20 to August 10, 2021, among people (age> = 18 years) who have internet access in Bangladesh. A comprehensive consent statement was included at the beginning of the survey and informed consent was taken.

OUTCOME MEASURES: This study’s outcomes of interest were respondents’ adequate knowledge, good practices, and positive attitudes toward TB and were coded binarily. The association between respondents’ socio-demographic factors and knowledge, attitude, and practices toward TB was inspected using the Chi-square test and Multivariable logistic regression model.

RESULTS: Among 1,180 respondents, 58.64% were males, and 62.37% were married. The majority of the participants (78.28%) were aged between 18 to 44 years. Overall adequate knowledge, favorable attitudes, and good practices about TB were found respectively in 47.8%, 44.75%, and 31.19% of the people with internet access in Bangladesh. Almost the same sets of associated factors were found to influence adequate knowledge, favorable attitudes, and good practices toward TB among social media users in Bangladesh. Males, young, unmarried, social media users with higher education, and urban social media users were more likely to have adequate knowledge, favorable attitudes, and good practices toward TB.

CONCLUSION: Policymakers need to design programs and interventions to improve knowledge, attitudes, and practices toward TB in Bangladesh with a particular focus on females, young and older people, people who live in rural areas, and illiterate/less educated people. Social media can be a powerful medium for disseminating scientific facts on TB and other diseases.

PMID:36219607 | DOI:10.1371/journal.pone.0275344

Stroke Vasc Neurol. 2022 Sep 2:svn-2022-001816. doi: 10.1136/svn-2022-001816. Online ahead of print.

ABSTRACT

BACKGROUND: Cerebral small vessel disease (SVD) causes lacunar strokes (25% of all ischaemic strokes), physical frailty and cognitive impairment and vascular and mixed dementia. There is no specific treatment to prevent progression of SVD.

METHODS: The LACunar Intervention Trial-2 is an investigator-initiated prospective randomised open-label blinded-endpoint phase II feasibility study assessing cilostazol and isosorbide mononitrate for preventing SVD progression. We aimed to recruit 400 patients with clinically evident lacunar ischaemic stroke and randomised to cilostazol, isosorbide mononitrate, both or neither, in addition to guideline secondary ischaemic stroke prevention, in a partial factorial design. The primary outcome is feasibility of recruitment and adherence to medication; key secondary outcomes include: drug tolerability; recurrent vascular events, cognition and function at 1 year after randomisation; and safety (bleeding, falls, death). Data are number (%) and median (IQR).

RESULTS: The trial commenced on 5 February 2018 and ceased recruitment on 31 May 2021 with 363 patients randomised, with the following baseline characteristics: average age 64 (56.0, 72.0) years, female 112 (30.9%), stroke onset to randomisation 79.0 (27.0, 244.0) days, hypertension 267 (73.6%), median blood pressures 143.0 (130.0, 157.0)/83.0 (75.0, 90.0) mm Hg, current smokers 67 (18.5%), educationally achieved end of school examinations (A-level) or higher 118 (32.5%), modified Rankin scale 1.0 (0.0, 1.0), National Institutes Health stroke scale 1.0 (1.4), Montreal Cognitive Assessment 26.0 (23.0, 28.0) and total SVD score on brain imaging 1.0 (0.0, 2.0). This publication summarises the baseline data and presents the statistical analysis plan.

SUMMARY: The trial is currently in follow-up which will complete on 31 May 2022 with results expected in October 2022.

TRIAL REGISTRATION NUMBER: ISRCTN14911850.

PMID:36219567 | DOI:10.1136/svn-2022-001816

J Crohns Colitis. 2022 Oct 11:jjac151. doi: 10.1093/ecco-jcc/jjac151. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Rectovaginal fistula occurs in up to 10-20% of women with Crohn’s disease, significantly affecting their quality of life. We sought to determine outcomes of single and repeat operative interventions.

METHODS: A retrospective review of all adult patients with a Crohn’s related rectovaginal fistula who underwent an operation between 1995 to 2021 was performed. Data collected included patient demographics, Crohn’s related medical treatment, surgical intervention, postoperative outcomes, and fistula outcomes.

RESULTS: A total of 166 patients underwent 360 operations; mean age was 42.8 (+/-13.2) years. Thirty-four (20.7%) patients were current and 58 (35.4%) former smokers. The most commonly performed procedure was a local approach (n=160, 44.5%) using fibrin glue, fistulotomy/fistulectomy or seton placement, followed by a transvaginal/transanal approach (n=113, 31.4%) with an advancement flap repair (including Martius advancement flap) and episoproctotomy, a transabdominal approach (n=98, 27.2%) including proctectomy or redo anastomosis and finally gracilis muscle interposition (n=8, 2.2%). The median number of operative interventions per patient was 2 (1.0-3.0) procedures. The overall fistula healing rate per patient was 71.7% (n=119) at a median follow-up of 5.5 (1.2-9.8) years. Factors that impaired healing included former smoking (OR 0.52 95%, CI 0.31 – 0.87, p=0.014) and seton insertion (OR 0.42 95%, CI 0.21-0.83, p=0.012).

CONCLUSION: Over two-thirds of Crohn’s related rectovaginal fistulas can achieve closure with multiple surgical interventions. Smoking and seton usage negatively impact healing rates and should be avoided.

PMID:36219575 | DOI:10.1093/ecco-jcc/jjac151

J Crohns Colitis. 2022 Oct 11:jjac150. doi: 10.1093/ecco-jcc/jjac150. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Most pharmaceutical clinical trials for inflammatory bowel disease (IBD) are placebo-controlled and require effect size estimation for a drug relative to placebo. We compared expected effect sizes in sample size calculations (SSCs) to actual effect sizes in IBD clinical trials.

METHODS: MEDLINE, EMBASE, CENTRAL, and the Cochrane library were searched from inception to March 26, 2021, to identify placebo-controlled induction studies for luminal Crohn’s disease (CD) and ulcerative colitis (UC) that reported an SSC and a primary endpoint of clinical remission/response. Expected effects were subtracted from actual effects, and interquartile ranges (IQRs) for each corresponding median difference were calculated. Linear regression was used to assess whether placebo or drug event rate misspecifications were responsible for these differences.

RESULTS: Of eligible studies, 36.9% (55/149) were excluded because of incomplete SSC reporting, yielding 94 studies (46 CD, 48 UC). Treatment effects were overestimated in CD for remission (-12.6% [IQR: -16.3% to -1.6%]), in UC for remission (-10.2% [IQR: -16.5% to -5.6%]), and in CD for response (-15.3% [IQR: -27.1% to -5.8%]). Differences observed were due to overestimated drug event rates, whereas expected and actual placebo event rates were similar. A meta-regression demonstrated associations between overestimated treatment effect sizes and several trial characteristics: isolated ileal disease, longer CD duration, extensive colitis (UC), single-centre, phase 2, no endoscopic endpoint component (UC).

CONCLUSION: Overestimation of IBD therapy efficacy rates resulted in smaller-than-expected treatment effects. These results should be used to inform SSCs and trial design for IBD drug development.

PMID:36219564 | DOI:10.1093/ecco-jcc/jjac150

J Nurs Manag. 2022 Oct 11. doi: 10.1111/jonm.13869. Online ahead of print.

ABSTRACT

AIM: This study aimed to investigate the Integrating Sustainability Development Education Program in Nursing to Challenge Practice Among Nursing Interns in Health Care.

BACKGROUND: The combination of sustainable development and climate change in health care delivery benefits from the apparent environmental changes.

SUBJECTS AND METHODS: The quasi-experimental, cross-sectional, comparative study included 160 nursing interns who completed the intervention. Both genders were assigned to Saudi (N=80) and Egyptian nursing interns (N=80). Data were collected through a self-administered questionnaire, including The Sustainability Consciousness Questionnaire and the Sustainability Attitudes in Nursing Survey.

RESULTS: A statistically significant difference was found between student nurses’ knowledge, attitude, and behavior during pre intervention and post intervention, as well as in student nurses’ sustainability development dimension effectiveness after than before program implementation.

CONCLUSION: The program had a significant effect on all sustainability development domains and a large effect on total sustainability development during post intervention. This study recommended that educational programs can upgrade sustainability development and challenge practice levels.

IMPLICATIONS FOR NURSING MANAGEMENT: Sustainable development is the future of management and is the next phase of management innovation. Sustainability, in the context of healthcare, is about progress in high-quality patient care delivery for all by promoting the three elements of sustainable development: environmental, social, and financial. Nurses play a significant leadership role in addressing environmental sustainability and climate change.

PMID:36219534 | DOI:10.1111/jonm.13869